MC-05-76Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Date: 04/10/2007
Inspector: Perez, JanPierre
Owner: DOLL, ANN
Job Address: 100 95 Street NE
Miami Shores Village, FL
Project: <NONE>
Block:
Contractor: A -1 AIR & HEAT INC.
Permit Type: Imported Permit
Inspection Type: Final
Work Classification: <NONE>
Phone Number
Parcel Number 1132060132860
Lot:
Building Department Comments
CHANGE OUT FOR AIR CONDITIONING
APR 1 0 2001
Passed(
Inspector Comments
C.\Al
A \ \11.----)
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid.
until
Monday, April 9, 2007
Page 2 of 2
Miami Shores Village
10050 NE 2nd Avenue
Phone: 305 - 795 -2204
Printed: 6/7/2005
Mechanical Permit
Permit Number: MC2005 -76
Applicant: ANN DOLL
Owner: DOLL ANN
JOB ADDRESS: 100 NE 95 ST
Contractor A -1 AIR & HEAT INC.
Local Phone:
Parcel # 1132060132860
Page 1 of 1
Contractor's Address: 19511 SW 21ST STREET
Legal Description: 1 53 41 6 53 42 MIAMI SHORES SEC 1 AMD PB 10 -70 LOTS 13 & 14 BLK 21
Fees: Description Amount
FEE2005 -7440 Building Fee $150.36
FEE2005 -7441 CCF $3.00
FEE2005 -7443 Training and Education Fee $1.00
FEE2005 -7444 Technology Fee $3.80
FEE2005 -7445 Scanning Fee $3.00
Total Fees: $161.16
Total Fees: $161.16
Total Receipts: $0.00
Permit Status: APPROVED Permit Expiration: 11/28/2005 Construction Value: $4,296.00
Work: CHANGE OUT FOR AIR CONDITIONING
44\0,5
Signed: (INSPECTOR)
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 responisibility for all work
done by either myself, my agent, servants or employes.
Signed: (Contractor or Builder) BY:
BUILDING
PERMIT AP
FBC 2001
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
5) 756.8972
LICATIO
Permit Type (circle): Building
Owner's Nalme (Fee Simple Titleholder)
Electrical
c®l t
Owner's Address /0 i/ e fir v,
Permit No. CC? 5 7�
Master Permit No.
Plumbing
Roofing
City I. If 5 State Zip 33/ 3r
Tenant/Lessee Name Phone # � 76.1'. fig/
Job Address (where the work is being done)
City Miami Shores Villa County Miami -Dade Zip
Is Building Historically esignated YES NO___OL_
Contractor's Company N me A- / 4-% 'lt ►jn 11 // Phone # 3®S" 01 311— D Fo
Contractor's Address / 737/ is w 2 6(9 s JJ
City nn, tkinni State _pt. Zip '63 1 70
Qualifier `Cola c Ces of.A4
State Certificate or Registration No. C469143/024 Certificate of Competency No.
Architect/Engineer's Name (if applicable) Phone #
$ Value of Work For this
Permit _l) 76.00
.a0
Type of Work: ['Addition" "
Describe Work:
AlterajtiYln EINew
®vl in 014 CA/101
Square Footage Of Work:
epair/Reiilace
El Demolition
****************************Fees******************************
j 50 56
Submittal Fee $ 1 Permit Fee $
Notary $ Training/Education Fee $
CCF $ CO /CC
Technology Fee $ -'
Scanning $ Radon $ Zoning Bond $
Code Enforcement $ Structural Plan Review. $
Total Fee Now Due $
(Continued on opposite slide)
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
Signature e4
Owner or Agent
The foregoing instrument was acknowledged before me this
day of Z)I ,20�';j ,by 4/S, all
The foregoing instrument was acknowledged before me this
day of JUK(., , 20 OTby 1 2 Zee-
e�dfr
C
who i .erso - % known to me or who has produced who is known to me or who has produced
NOTARY PUBLI
As identification and who did take an oath. as identification and who did take an oath.
NOTARY PUBLIC:
Sign: is—
Print:
My Commission Expires : Bonded through
(8004324254) Florida Notary Assn., Inc
Sign:
Print:
My Co
�^*+ .414.1.741.c.
IMO*
. Bonded pica Notaryn
Ass. Inc. a
******************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * * * * * * ** * * * * ** ****** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
APPLICATION APPROVED BY: Plans Examiner
Engineer
Zoning
chc 05/13/03