MC-09-1680 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL \O o/0-
Phone: (305)795 -2204 Fax: (305)756 -8972
may
Inspection Number: I NSP- 126986 Permit Number: MG -40 -09 -1680
Scheduled Inspection Date: February 09, 2010 Permit Type Medical - 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 4-4ton c/u #26, 27, 28, 29
V (�
Inspector Comments
Passed ha
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 7 of 25
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Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 3313 &00003 (z ,
Phone: (305)795 -2204„ .
Expiration: 06/0412010
s
Project Address Parcel Number Applicant
415 105 Street 1122310430010
ST ROSE OF LIMA CATHOLIC CI t
Miami Shores, FL Block: Lot
Owner Information Address Phone Cell
ST ROSE OF LIMA CATHOLIC CHURCH 9401 BISC BLVD (305)758 -0539
MIAMI FL 33138 -2970
Contractor(s) Phone Cell Phone
ASSOCIATED BUILDING & AIR PRODI (954)217 -1080 Valuation: $ 10,800.00
Total Sq Feet: 0
Tons: For Inspections please call:
Additional Info:
(305)762 -4949
Classification: Commercial Available Inspections:
Approved: In Review
Inspection Type:
Comments: Date Approved:: In Review Final
Date Denied: Type of Work:
Fees Due Amount Invoice # Total Amt Paid Amt Due
CCF $6.60 MC -10-09 -36141 $ 399.25 $ 399.25
$ 0.00
Education Surcharge $2,20
Permit Fee - Additions/Alterations $378.00
Permit Technology Fee $9.45
Scanning Fee $3.00
Total: $399.25
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
CIF H 2009RO197220
NOTICE OF COMMENCEMENT OR It 26792 ft 0786; (Ias)
RECDRM 03/18/2009 14122213
A MECORM COPY MUST BE POSTED ON THE Job GrM At TWE OF pMr INSPE=ON jj_�{ MI� C F'I IDA OF CUT
PERMIT NO TAX FOLIO NO- LAST PAW
STATE (W FLORIDA
COUNW OF M1AM1- 0ALE:
THE UNDERSIGNED hereby 91M MUM that {mptoY Mrb wlll be made to Corte'
del
propeiW, and M accordantre Wfth Chapter 713. Florida StBtutM the fo iicW
lnfbrrre*M is provided In this Nodes of CoMnWrImr"
and atreetraddress: _ ST• �� � e � � -f 4o d4r c 4e4owc li
1. Legal d�crlr, of property .0
2. DAW4 of im2PvOMB Ls .rrt Lt 0 �—�-
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3.Owner(s) name and address: /
Interest in proMty:
Name and addms of fee slmpie titleholder AWA -
4. ConV;B name and address: APPAO&O
21// A ttrss lc1>>� e s
g. Surety: (payment bond required by owner from ton r, if any)
Name arul address:'
Amount of bond I-
a . l Wwees name and addn :
7. persons with the state of Rorids designated by Owner upon whom notices or other documents may be serval as
..
provided by Section 713.1 1)(a)7., Florida Statutes.
Name and 8ddress: �.
8. In addition to himself, Owners designstes the following p sons) to n:�aelve 8 +�Py the L�nor's Idptil:8 as provid'liid
in Salon 713.13(1)(b). Florida Statutes.
Name and address: -
0. Expinatlon date of Commencement: (the expiratlon date is 1 year from the date of recording unless a
different data ed)
r
Slr�n (�iNnOr .L
red by
ar Pant is Name'1 g , � c J
Sworn to and subscribed before Me this day of AAY �/t 5 3 13
Notary Pub11C n k 0 MfCmH0Wl4DD5W4
Print Nod's Name d �' }r EXI'iR 6.
g,�eenw,c+�
My commission expires:
(seal)
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Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING Permit No. ykc -10 -0 q -1 l
PERMIT APPLICATIO �@ Master Permit No.
FBC 2004
OCT 13 �Wi4
Permit Type Mechanical _ c c --m
Owner's Owner's Name (Fee Simple Titleholder) [ . /?z0&,0F,4jwy& k& Phone #
Owner's Address
City A'/� *X-S State Zip
Tenant/Lessee Name AV6* Phone #
E -MAIL:
Job Address (where the work is being done) 4f/,�f 0* /11 j' f 40 S 3
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL #
Is Building Historically Designated YES NO
Contractor's Company Name /7330 G, L D. suVIC46.9 1A0 a Phone # 9e$eR 227.S
Contractor's Address • o?W l�• �p �JQ _ �• PA V
City ��T ( V Sta /-2 . Zip 3 3 3 Z
Qualifier Name �oI'd If -1 94W eAdJ 4k '+ Phone # p11 1K
State Certificate or Registration No. Certificate of Competency No. G8 Z3s
E -MAIL:
Arch itect/Engineer's Name (if applicable) Phone #
Value of Work For this Per Square /Linear Footage Of Work:
Type of Work: ❑Addition ❑Alteration New a air /R lace
p ep ❑ Demolition
Describe Work: L IAIA t act @.t! a -OSI p
�AS
1
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Submittal Fee $ Permit Fee $ o �" CCF $ to w CO /CC
IV Notary $ Training /Education Fee 6 Technology Fee $ • `i S
Scanning $ t Radon $ DPBR $ Zoning $
Bond $ Code Enforcement $ Double Fee $
Structural Review: $ Total Fee Now Due s , $ qq �5
See Reverse side
�5
Bondin g Company's any's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State . � . Zip
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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 sepajafie-per-mit_musLbe.8ecure# for ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC.....
OWNER'S AFFIDAVIT: l 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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be Ap ed . a re' ection will be charged
Signature
Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged b ore me this The foregoing instrument was acknowledged before me this
day of , 20f 3, by ��� T I day of - L / , 20 L, by l lyG �lA���- _
who is p o nown to me or w as produced who is p ersonally know to me or who has produced
as identification and who did take an oath.
p �$�, Dell Marie Springer NOTARY PUBL ;. ;giY��t%,; BRENDA FAYQORDON
NOTARY PUBLIC: z o * Commission DD566868 �. ;,� MY COMMISSION 8 DD 524514
* gust 25, 20 EXPIRES: April 5.2D10
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My Commission Expires: g,_ Z ® My Commission Expires: t- 3 0 /
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APPLICATION APPROVED BY: Plans Examiner
Engineer
Zoning
(Revised- 02/08/06)