MC-09-1442 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972<
Inspection Number: INSP - 123252 Permit Number: MC -$` =09 -1442
Scheduled Inspection Date: February 09, 2010 Permit Type: Mechanical- Commercial
Inspector: Perez, JanPierre Inspection Type: Final
Owner: CHURCH, ST ROSE OF LIMA CATHOLIC Work Classification: A/C Replacement
Job Address: 415 NE 105 Street
Miami Shores, FL Phone Number (305)758 -0539
Parcel Number 112231043001
Project: <NONE>
Contractor: ASSOCIATED BUILDING & AIR PROD UCTS Phone: (954)217 -1080
Building Department Comments
REPLACE 3 1/2 TON #38,5 Ton #37, 10 TON #36 C/U
W
Inspector Comments
Passed
Failed
Correction ❑
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
February 08, 2010 For Inspections please call: (305)762 -4949 Page 4 of 25
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s Miami Shores Village' - T �.
10050 N.E. 2nd Avenue T.,,
Miami Shores, FL 33138-00003 y�y�..rr�
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" Phone: (305)795 -2204 �f
Expiration. .» 1
Project Address Parcel Number Applicant
415 105 Street 1122310430010
ST ROSE OF LIMA CATHOLIC Cl
Miami Shores, FL Block: Lot:
Owner Information Address Phone Cell
ST ROSE OF LIMA CATHOLIC CHURCH 9401 BISC BLVD (305)758 -0539
MIAMI FL 331.38 -2970
Contractor(s) Phone Cell Phone Valuation: $ 14,250.00
ASSOCIATED BUILDING & AIR PRODI (954)217 -1080
Total Sq Feet: 0
Tons: 31/2 &5 & 10 TONS For Inspections please call:
Additional Info: A/C SYSTEM (305)762.4949
Classification: Commercial Available Inspections:
Approved: In Review Inspection Type:
Comments: Date Approved:: In Review Final
Date Denied: Type of Work: MECHANICAL
Fees Due Amount Invoice # Total Amt Paid Amt Due
CCF $9.00 MC -11 -09 -36317 $ 513.00 $ 513.00 $ 0.00
Education Surcharge $3.00
Permit Fee - Additions/Alterations $498.00
Scanning Fee $3.00
Total: $513.00
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.
November 10, 2009
Authorized Signature: Owner / Applicant / Contractor / Agent Date
Building Department Copy
November 10, 2009 1
NOTICE OF COMMENCEMENT R Sk a6� Ps 0786F i�9 220
itECQROE!>< 03/18/2+004 14122
A 111MROM COPY' NOT BE POOTED ON THE JOB SrM Ar TIME O F FMT INSPECTION HARVEY RIMNr CLE K OF CiltOtT
ItIA"t -WE WRITY, Fl.OftIDA
PERMIT NO, � TAX FOLIO NO LAST PAGE
STATE OF FLORIDA
COUNW OF MIAMI - DAVE.
THE UNDERSIGNED hereby gives Woce that improvements vAl be mods to canal
reai property, and in socordsr= wfth Chapter 713. Florida Statutes. the fot
iribma dw is provided in # ft Notice of Comrmnoemerk
i . L2g01 desoripiiKan of PI'ol y and etreetMaddrsss. Sr. Amo D F A A
_ 2• Dow0ft of 6nw ,ems L(r+� - - -
a. Ownwr(s) name and address:
�!
Interest In pnOperty:
Name and address of file simple titleholder. /� •
4. Contractor's name and address:
5. Surety; (payment bond required by owner from con r, If any)
Name and address: A
Amount of bond ffi
a. Landees r wrrm. and rddrms!
.7, persons with the state of Florida designated by Owner upon wham notices or other documents may be serer as
provided by Section 713.9 1 )(a)7., Florida Statutes.
Name and addn: ��
a. In addIUon to himself, Owners deslgnetes the foilowir>g persons) to recalve a OW of the Llenor's Notice as providsd
in Section 713.13(1 )(b ). Florida Statutes.
Neme and address: 13 ' _
O. Expiration date of f Commencement: (the ex tudon date is 1 y ear from the dgAa of recording unkm a
dtffenett date 1 ecified}
S owner
Pltnt Ownefs Name �s ` 1�.. Q� red by
U1,t�Y' . ao fG /it/ o r
Swom to and s�ubs�ibed before me this Z dt► of _ lAn1> >
Notary Public FAi►flOiIflON
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Print Notary's Name VWj $.2Mo
a >
My commission expires.
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Miami Shores Village �����
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g AUG 2 7 2004
,p Building Department
By .. .......
10050 �• 10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING Permit No. GO r R - 142
PERMIT APPLICATION Master Permit No.
FBC 2004
Permit Type Mechanical
Owner's Name (Fee Simple Titleholder) 'Tl• >l ?oS'E'07- A�"W06a&A p hone # ,3 0 3 ',7
Owner's Address 11 o w i
City State * • Zip
Tenant/Lessee Name Phone #
E- MAIL: /✓Jf�
Job Address (where the work is being done)
City Miami Shores Villase County Miami -Dade Zip
FOLIO J PARCEL #
Fs*Building Historically Designated 'YES NO
Contractor's Company Name , sdoc,04 Ages / �J 4 sl/r . phone # $-7 f�'�� 77-5
Contractor's Address 0 A x'01~ Adt�[-C JA
City &J,6S7Od/ State / Zip .433
Qualifier Name 4 �42 A) C. )1WAW tAAJ Phone
State Certificate or Registration No. ew co 16WT Certificate of Competency No.
E -MAIL:
Architect/Engineer's Name (if applicable) _. Phone # N�/q
Value of Work For this Permit ' 0 • ®d Square / Linear Footage Of Work:
Type of Work: EjAddition ❑Alteration
ONew Repair /Replace El Demolition
Describe Work:
l C R T
xoYxxatr de ztx4e oY x� a: aexaY :xde Y x.rxxnY,exxotxde do xY 4e •x 4ex Feesat de ieo: e4 di•oexaY &xxxae a4 aEusex•x aYsL•xaYx oY 4ck.4�4ee'r�s4 sa 9e 8zee,estxxec aY
Submittal Fee $ Permit Fee $ ti� CCF $ CO /CC '
Notary $ Training /Education Fee $ 12) - a Technology Fee $ -US
Scanning $ 3. bib Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review. $ Total Feg IYow Due $
See Reverse side -
Bonding Compan y's Name (if applicable) /vl
M P
Bonding Company's Address
City State ZIp
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State Z
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
Signature nature ( / A Signatur
wn r Agent Contractor
The foregoing instrument was acknowledged before me this c2& The foregoing instrument was acknowledged before me this
� �o
day of ; 200), by D I'1Y�/ �I G , day of . S , 20 9J, by �' . '1 1A �co1 ,
who ' personally known jn e or who has produced who is pe rsonally known to me or who has produced
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC:
Sign- P Sign: p
Print: N Print: O `�
o i � �� D Marie Springer My Commis eMt COMMISSION #DD524514
My Commission Expires: x �; plpl�g;ppri15,2010
*
Commission # D D
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OF t°I 8w.&dTmy Fey+ -1MUM 8,1 &W- M.7059 ,
APPLICATION APPROVED BY: Plans Examiner
Engineer
Zoning
(Revised:02/08 /06)