MC-10-1395Inspection Worksheet
Miami Shores Village LL
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 149656 Permit Number: MC -8 -10 -1395
Scheduled Inspection Date: September 14, 2010
Inspector: Perez, JanPierre
Owner: HABERSIN, HELEN
Job Address: 950 NE 96 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: EDD HELMS ELECTRIC & A/C INC
Building Department Comments
September 13, 2010
For Inspections please call: (305)762 -4949
Permit Type: Mechanical - Residential
Inspection Type: Final
Work Classification: A/C Replacement
Phone Number
Parcel Number 1132060142960
Phone: 305 -653 -2520
replace existing 5 ton ac unit with 10kw heat
war ka4 Ler atAy
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
Page 8 of 28
Project Address
950 NE 96 Street
Miami Shores, FL 33138-
Owner Information
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204
Address
Parcel Number
1132060142960
Block: Lot:
Contractor(s)
Phone
EDD HELMS ELECTRIC & A/C INC 305 - 653 -2520
CeII Phone
Phone
HELEN HABERSIN
950 NE 96 ST
MIAMI SHORES FL 33138 -2524
1
Tons: 5
Additional Info: A/C SYSTEM REPLACEMENT
Classification: Residential
Approved: In Review
Comments:
Date Denied:
Scanning: 1
Date Approved: : In Review
Type of Work: MECHANICAL
Fees Due
CCF
Education Surcharge
Permit Fee
Scanning Fee
Technology Fee
Total:
Amount
$1.80
$0.60
$100.00
$3.00
$2.40
$107.80
Pay Date Pay Type Amt Paid Amt Due
Invoice # MC -8 -10 -38571
08/03/2010 Check #: 4844 $ 50.00 $ 57.80
08/09/2010 Check #: 4850 $ 57.80 $ 0.00
Valuation:
Total Sq Feet:
$ 2,776.00
0
1
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.
Authorized Signature: Owner / Applicant / Contractor / Agent
Building Department Copy
August 09, 2010
Date
Expiration: 02105/2011
Applicant
HELEN HABERSIN
Cell
Available Inspections:
August 09, 2010 1
Inspection Type:
Final
1
BUILDING
PERMIT APPLICATION
FBC 2004
Miami Shores Village
Wru:So IId B uilding Department 2 ° �� °
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 _ '
Tel: (305) 795.2204 Fax: (305) 756.8972 BY.... _
Master Permit No.
Permit Type: Mechanical r /�
Owner's Name (Fee Simple Titleholder) fe rat ei /T �/ a/IerS'rg Phone # 3i2 75-q-- /9 7/7
Owner's Address 9S4 Air 9; $% e S
/Worn, e� G
Cit /W 1 540).
- State T G Zip 33 13?
Tenant/Lessee Name
E -MAIL:
Job Address (where the work is being done) F5
Phone #
•/e 96 s
City Miami Sh ores Vi llage County Miami -Dade Zip 3/ 3 8'
FOLIO / PARCEL # // 32.06 d /4/ 29 4 U
Is Building Historically Designated YES NO
Contractor's Company Name I1 #e7/44...S 4 - hi hone # 3'Q — es 3 ^ 2 S3 d
Contractor's Address / 72.5 - -e -t r
City ' IV lan4 State / Zip 3
Qualifier Name A s oe T lees heA_,`S 36 5- S
Ph one # � 2 " 2 -6
State Certificate or Registration N3 ' 99 7 y
E- MAIL: ,li1Ac%sMexQ ept ca
Architect/Engineer's Name (if applicable) Phone #
Certificate of Competency No.
Permit No. t42) IOrbq
Value of Work For this Permit $ 77(x,. 6° Square / Linear Footage Of Work:
Type of Work: ❑Addition ❑Alteration ['New [I— Repair /Replace Q Demolition
Describe Work: /ct ce. 2.K&c -Ar"J lQ 4// G kw Al ea f
**** * * *xxxx *,r * *xx** ****** ** *** *** * F **x* **** *** *** **** **** ****** *** **** *** * ***
Submittal Fee $ Permit Fee $ e CCF $ CO /CC
Notary $ Training /Education Fee $
Scanning $ Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ Total Fee Now Due $
See Reverse side
Technology Fee $
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. 1 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. 1 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: 1 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 issu In th ' bse of s � posted notice, the
inspection will not be approved and a reinspection fee will be charged `\
Signatu
NOTARY PUBLIC:
Al
; SSION # DD 817400
Pik; /� -'t fib :* MY COMMI
1 b°.°' Ponded'rhtu Notary Pubno Underwriters
Sign:
rrtt:
My Commission Expires
xxx' xxxxxx****de *xxat*x*xxic *xxxx
APPLICATION APPROVED BY:
(Revised 02/08/06)
As identification and who did take an oath.
Signature
Print:
My Commissio
xxx a 4 xa: x x ** * * xx x x* x
UBLIC•
Contractor
Owner or Agent
The foregoing instrument was acknowledged before me this 2 — ^ f -
Ir/�
day of 1- 16 1V , by te- (Q_✓i. L -�a
- 4evS/4 , day of GA_ , 2Q , by r'TJUa v ,
who is personally known to me or who has produced. w
The foregoing instrument was acknowledged before me this 3d
to me or who has produced
as identification and who did take an oath.
' ' �, �! ISSION # DD 8174 +0
17!t!1-2!!!!!!712M2 h MY
ndenvrtew •
Plans Examiner
Engineer
Zoning
Edd Helms
Air Conditioning & Electric
AIR CONDITIONING REPLACEMENT DATA
CONTRACTOR: &lc/ , ' /e /n ( v aoiritatmi DATE:
Slit ADDRESS: 96 ti 5)4,
5 I APT:
LOT: ?Q Z BLOCK: 7 SUBDIVISION: in 41 r
Istassik
16.
LADDER REQUIRE
4) CHANGE DI
SIGNATURE:
FOR INSP ` CTION
S
YES ____
YES
A Name You Can Trust Since 1975
UNIT BEING REPLACED
VJ41 5"'Ti20otin4
AHU /COIL MODEL
KW HEAT
DATA
MANUFACTURER
PKG. UNIT MODEL
COND. UNIT MODEL
NOM TONS
2 M.O.P
3) VOLTS
EER/SEER
AHU S CU PKG
AHU (0O CU PKG
AHU CU PKG
PKG UNIT/ /
DUCTS
THERMOSTAT
SMOKE DETECTOR
YES NO
YES NO
YES NO
YES NO
YES NO
HEAT RECOVERY UNIT
STAND
NEW UNIT
/du
U /tic 2.(1S//
/0
.5
AHU . --O CU PKG
ABU ‘O CU PKG
AHU CU PKG
PKG UNIT /
YES NO �(
d� NO
YES NO
YES NO k
YES I NO _
NO _
NO
Robert Roberts
CMC1249674
FLORIDA STATE CER'1 ICATION/REGISTRATION NO.
BROWARD CTY /CER'TIF'ICATE OF COMPETENCY NO.
APPROVED BY: DATE:
1) MINIMUM CIRCUIT AMPACITY (WIRE SIZE)
2) MAXIMUM OVERCURRENT PROTECTION (F SE!BREA' 'R SIZE
3) VOLTAGE OF CIRCUIT (208/240/4801
4) SIZE DISCONNECTING MEANS
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