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MECHANICALBUILDING PERMIT APPLICATION FBC 2001 Permit Type (circle): Building Electrical Plumbing (Mechanical Roofing Owner's Name (Fee Simple T' leholde 71144.141.v. Lib._ ,� "7f" Phone # 30S' 7 S8 • D Owner's Address r..(tAk,tt_Q. City P1.COvws., �Q Tenant/Lessee Name Contractor's Company Name Contractor's Address e 0 City PI l Q (/► � ( Qualifier k 0 �Je rT $ Value of Work For this Permit Type of Work: El Addition Describe Work: Submittal Fee $ Notary $ Scanning $ State Permit Fee $ Training/Education Fee $ Radon $ Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 E Job Address (where the work is being done) 4 aS N ST City Miami Shores Village County Miami Hade Zip Is Building Historically Designated YES NO C+R C� State T. C k e y ,fi bc3(6A"1Z336 Architect/Engineer's Name (if applicable) Phone # c_. ❑Alteration ['New 2 5 OO Zoning Code Enforcement $ Structural Plan Review. $ Total Fee Now Due $ (Continued on opposite side) Square Footage Of Work: Aflu' Permit No. MO 1152- Master Permit No. Phone# 0S 6 - 6 0 9 Lr Zi 3 ]6 (C' (�Repair/Replace * * * * * * * * * * * * * * * * * * * * * * * * * * ** F ees * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** CCF $ Technology Fee $ Bond $ CO /CC ❑ Demolition Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Sign The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this .0 day of J utk 20 (:), by day of 3 ( , 20 6 by who is ersonally known o me or who has produced who i As identification and who did take an oath. NOTARY Sign: Print: '� Commissicr X524602 My 7anet Kranz My Commission Expires: -.• M Commission E +� t �� = .: � • :: MYCOMMISSION# OD113 EXPIIES * * * * * * * * * * * * * * * * * * * * ** * � � �' i , `il" BondeQ !roy c�.. i e *24:11Q * *** *' tit ** *** * ** ** * *** *�k,d * WI y fi,,y* #,a * — tce�rtrnL r zompetency Holder) "RU" ` BONDED THRU TROY FAIN INSURANCE INC State Certificate or Registration No. C qC D a 6 (-114 *********************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** ******************* * * *- * * * * * * * * * * * * * * * * * * * * * * * * * ** APPLICATION APPROVED BY: Chc 12/15/03 Owner or Agent Signature to me or who has produced as identification and who did take an oath. NOTARY PUBLIC. Sign: Print: Z K rc4dz Certificate of Competency No. 0 Plans Examiner Engineer Zoning I i 1.8 UNIT FEE ITEM SWITCH OUTLETS UNIT FEE ITEM SPACE HEATERS UNIT FEE :T L I GNiT OUTLETS CENTRAL HEATING I= 10\ :WASHER RECEPTACLES A/C (WIND) .0 AL SERVICE TEMPORARY A/C (CENTRAL) I = J AXING FOUNTAIN SERVICE SIZE IN A},PS DUCT WORK A / H t Cow . It DRAIN SERVICE REPAIR/1kTER CHA4EE REFRIGERATION SE TRAP APPLIANCE OUTLETS PROCESS AND PRESS PIPING XiPTOR RANGE TOP UNDERGROUND TANKS :TORY OVEN ABOVE GROUND TANKS AY TRAY WATER HEATER ' U.F. PRESSURE VESSELS KS WASHER 1AJTORS 0- 1 HP STEAM BOILERS nER MOTORS OVER 1- 3 FP HOT WATER BOILERS K, POT /3 COMP. MOTORS OVER 3. 5 FP MECHANICAL VENTILATION :K, RESIDENCE MOTORS OVER 5- 8 FP TRANSPORTING ASSEMBLIES K, SLOP MOTORS OVER 8- 10 FP ELEVATORS/ESCALATORS FCRARY WATER CLOSET MOTORS OVER 10- 25 FP FIRE SPRINKLER SYSTEMS NAL .. MOTORS OVER 25-100 FP COOLING TOWERS ER CLOSET MOTORS OVER 100 FP VIOLATION 'IRECT WASTES A/C WINDOW REINSPECTION ER SUPPLY TO: AIR CONDITIONERS • JC UNIT STRIP HEATER ' 'IRE SPRINKLER GENERATORS TRANSFORM€RS • EATER -NEW INST. GENERATORS TRANSFORM€RS EATER- REPLACE GENERATORS TRANSFORMERS .AWN SPRINKLER -WELL SPECIAL PURPOSE • ;WIRAING POOL CUTLETS COM}ERCIAL LATER SERVICE SIGN TUBES (ER CONNECTIONS SIGN TRANSFOR}ERS l I TY -SEWER SIGN T I M E CLOCK LITY -WATER FIXTURES 'TIC TANK ANTENNA .AY TELEVISION OUTLETS U NFIELD, 4' TILE/RES. • VIOLATION 4 & ABANDON SEPTIC TANK REINSPECTION OWE PIT CU. FT. 'CH BASIN AURGE WELL - 4ESTIC WELL '.A DRAIN ~ )F INLET _AR WATER HEATER ', 3E STANDPIPE A. PIPING • iN SPRINKLER SYSTEM + TRAIL ' - rER SET (GAS) , ; PIPING APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B. TAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.) PLUMBING ADDENDUM TO BUILDING PERMIT APPLICATION ELECTRICAL MECHANICAL Inspection Number: INSP -22818 Permit Number: MC -7 -06 -1952 Inspection Date: 09/06/2006 Inspector: Perez, JanPierre Owner: CHURCH, MIAMI SHORES BAPTIST Job Address: 425 95 Street NE Miami Shores Village, FL 33138- Project: <NONE> Contractor: C&R AIR CONDITIONING CO Building Department Comments Tuesday, September 5, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 SEP 1 3 REC'D Block: Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: New Phone Number (305)758 -0559 Parcel Number 1132060140610 Lot: Phone: 305 -685 -6394 Page 2 of 2 Passed Inspector Comments L,16 N Failed Correction Needed Re- Inspection Fee ($75) No Additional Inspections can be scheduled re- inspection fee is paid. until Inspection Number: INSP -22818 Permit Number: MC -7 -06 -1952 Inspection Date: 09/06/2006 Inspector: Perez, JanPierre Owner: CHURCH, MIAMI SHORES BAPTIST Job Address: 425 95 Street NE Miami Shores Village, FL 33138- Project: <NONE> Contractor: C&R AIR CONDITIONING CO Building Department Comments Tuesday, September 5, 2006 Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 SEP 1 3 REC'D Block: Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: New Phone Number (305)758 -0559 Parcel Number 1132060140610 Lot: Phone: 305 -685 -6394 Page 2 of 2 Issue Date: 7/24/2006 Owner's Name: MIAMI SHORES BAPTIST CHURCH Permit Type: Mechanical - Residential Work Classification: New Job Address: 425 95 Street NE Contractor(s) Phone C &R AIR CONDITIONING CO 305 - 685 -6394 Primary Contractor Yes Comments: EXACT REPLACEMENT OF 3 1/2 TON A/C SPLIT SYSTEM Additional Information Miami Shores Village, FL 33138- Tons: 3 1/2 Classification: Residential Additional Info: In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated. Fees Due Amount CCF $2.40 Education Surcharge $0.80 Permit Fee - New Construction $125.00 Scanning Fee $3.00 Technology Fee $3.13 Total: $134.33 Building Department File Copy Applicant Signature Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Expires: 01/20/2007 Invoice Number MC - 7 - 06 - 25673 Total: Permit Status: APPROVED Permit Number: MC - - - 1952 Parcel #: 1132060140610 Block: Lot: Section: PB: Total Square Feet: 0 Total Valuation: $ 4,000.00 Re • uired Ins • ections Rough Rough Duct Ventilation Smoke Test Hood Smoke Det Test Final Amt Due $134.33 Phone: (305)758 -0559 Amt Paid 1 NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. Issue Date: 7/24/2006 Owner's Name: MIAMI SHORES BAPTIST CHURCH Permit Type: Mechanical - Residential Work Classification: New Job Address: 425 95 Street NE Miami Shores Village, FL 33138- Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Expires: 01/20/2007 Contractor(s) Phone C &R AIR CONDITIONING CO 305 - 685 -6394 Primary Contractor Yes Comments: EXACT REPLACEMENT OF 3 1/2 TON A/C SPLIT SYSTEM Additional Information Tons: 3 1/2 Classification: Residential Additional Info: In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated. Fees Due Amount CCF $2.40 Education Surcharge $0.80 Permit Fee - New Construction $125.00 Scanning Fee $3.00 Technology Fee $3.13 Total: $134.33 Applicant Copy Parcel #: Block: Section: Permit Status: APPROVED Permit Number: MC - - - 1952 Total Square Feet: Total Valuation: Re • uired Ins • ections Rough Rough Duct Ventilation Smoke Test Hood Smoke Det Test Final Phone: (305)758 -0559 1132060140610 Lot: PB: 0 $ 4,000.00 THIS UST aE ON JOB AT TIME OF INSPECfiON Invoice Number MC - 7 - 06 - 25673 Total: Amt Due $134.33 Amt Paid NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. For Inspections, Call (305) 795 -2204 exts 431 & 442. Requests must be received by 3 pm for following day inspections. Obtain Certificate of Ocupancy /Completion Before Using the Building Issue Date: 7/24/2006 Owner's Name: MIAMI SHORES BAPTIST CHURCH Permit Type: Mechanical - Residential Work Classification: New Job Address: 425 95 Street NE Additional Information County Copy Miami Shores Village, FL 33138- Comments: EXACT REPLACEMENT OF 3 1/2 TON A/C SPLIT SYSTEM Fees Due CCF Education Surcharge Permit Fee - New Construction Scanning Fee Technology Fee Total: Amount $2.40 $0.80 $125.00 $3.00 $3.13 $134.33 Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Expires: 01/20/2007 Contractor(s) C &R AIR CONDITIONING CO Phone 305 - 685 -6394 Primary Contractor Yes Tons: 3 1 /2 Classification: Residential Additional Info: In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated. Re Invoice Number MC - 7 - 06 - 25673 Total: Parcel #: Block: Section: Rough Rough Duct Ventilation Smoke Test Hood Smoke Det Test Final Permit Status: APPROVED Permit Number: MC - - - 1952 Lot: PB: Total Square Feet: Total Valuation: Amt Due $134.33 Phone: 0305)758 -0559 1132060140610 0 $ 4,000.00 uired Ins • ections Amt Paid i NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES. Issue Date: 7/24/2006 Owner's Name: MIAMI SHORES BAPTIST CHURCH Permit Type: Mechanical - Residential Work Classification: New Job Address: 425 95 Street NE Additional Information Miami Shores Village, FL 33138- Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL 33138 -0000 Phone: (305)795 -2204 Fax: (305)756 -8972 Permit Expires: 01/20/2007 Contractor(s) Phone C &R AIR CONDITIONING CO 305 - 685 -6394 Primary Contractor Yes Comments: EXACT REPLACEMENT OF 3 1/2 TON A/C SPLIT SYSTEM Tons: 3 1/2 Classification: Residential Additional Info: In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above -named contractor to do the work stated. Fees Due CCF Education Surcharge Permit Fee - New Construction Scanning Fee Technology Fee Total: Amount $2.40 $0.80 $125.00 $3.00 $3.13 $134.33 Finance Copy Parcel #: Block: Section: Re.uired Ins Rough Rough Duct Ventilation Smoke Test Hood Smoke Det Test Final Permit Status: APPROVED Permit Number: MC -7 -06 -1952 Total Square Feet: Total Valuation: ections Phone: (305)758 -0559 1132060140610 Lot: PB: 0 $ 4,000.00 Invoice Number MC - 7 - 06 - 25673 Total: Amt Due $134.33 Amt Paid NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county. AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES.