MC-07-2254Miami Shores Village
Building Department
iZeCtIVOci
4(1V 0 6 off
Cam.
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING 1110(06/ d Permit No. M o�c.•r5
PERMIT ��
'
RMIT APPLICATION Master Permit No.
FBC 2004
Permit Type: Mechanical
Owner's Name (Fee Simple Titleholder) - t idle V�
Owner's Address -100 e,t o b4
City nrik 'D4 NhfySState Ff!m-
Phone # 3` q - 5 .-Nto
Tenant/Lessee Name
E -MAIL:
Job Address (where the work is being done)
Zip 7jJ L
Phone #
-7 Co f '
City Miami Shores Village County Miami -Dade
FOLIO /PARCEL# t t - 7 OLia l e ) IAD
Is Building Historically Designated YES NO L.
Zip �l
Contractor's Company Name '"F-11:„."" A- or Lpna tt-C one #
Contractor's Address 7 ( f ut, -7 6k- 11'u
atotocote
City State et.— Zip c�ic3L
Qualifier Name ______T„AcIrtavri Phone # �.106p
State Certificate or Registration No. LDa C Certificate of Competency No. f q 4 16 56 -7
E -MAIL:
Architect /Engineer's Name (if . :plic bl"O Phone #,
Value of Work For this Permit $ f `7 712 Square / Linear Footage Of Work:
Type of Work: ❑Addition ['Alteration
ElNewepair/Replace ❑ Demolition
Describe Work ( T �'��L� � lJ e QC7� �?� ®1 44fi 'D Mtn M
xxxxxxxxxxxxxxxxxxxxxxd : xxxxxxxxxxxxx xxx F xxxxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxxxxxxxx
f
Submittal Fee $ Permit Fee $ L ®° CCF $ g" ' 40 CO /CC
Notary $ '.."---- Training /Education Fee $ 0•80 Technology Fee $ 0 '
Scanning $ b-CO Radon $
Bond $ Code Enforcement $ Double Fee $
Total Fee Now Due $ Ogil . 40
See Reverse side -
DPBR $
Zoning $
Structural Review. $
Q�
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged.
Owner or Agent
The foregoing instrument was acknowledged before m this
day of$I/ , 2017, by G�i� �t°S. /ems''"
Contractor
The foregoing instrument was acknowledged before me this `S
day of no\Y , 200-7, by
who is personally known to me or who has produced
as identification and who did take an oath.
who .10TriallWilerWIWtr who has produced
As identification and who did take an oath.
My Commission Expires:
APPLICATION APPROVED BY:
(Revised 02/08/06)
NOTARY PUBLIC:
Sign:
Print:
.gab . #Z* ,
., =
" 1w i
Commission .~ DD308955
My Commission ExpiresS.., �f' Expires: APR. 30, 2008
sox$D **11,4 T;c*N *
x,t,Bx' xxxxx�Yx9r &x,txx3cxx xi:xxx
r
Plans Examiner
Engineer
Zoning
ADDENDUM TO BUILDING PERMIT APPLICATION
AN APPLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS BEEN OBTAINED, THE
OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.
PLEASE CIRCLE 0 DISCIPLINE APPLIED FOR:
PLUMBING
ELECTRICAL
PERMIT #
MECHANICAL
ITEM
UNIT
FEE
ITEM
UNIT
FEE
ITEM
UNIT
FEE
BATH TUB
SWITCH OUTLETS
SPACE HEATERS
DISHWASHER
LIGHT OUTLETS
CENTRAL HEATING
DISPOSAL
RECEPTACLES
NC (WIND)
FLOOR DRAIN
SERVICE TEMPORARY
A/C (CENTRAL)
GREASE TRAP
SERVICE SIZE IN AMPS
DUCT WORK
INTERCEPTOR
SERVICE REPAIR/METER CHANGE
REFRIGERATION
LAVATORY
APPLIANCE OUTLETS
PROCESS AND PRESS PIPING
LAUNDRY TRAY
RANGE TOP
UNDERGROUND TANKS
CLOTHES WASHER
OVEN
ABOVE GROUND TANKS
SHOWER
WATER HEATER
U.F. PRESSURE VESSELS
SINK. POT /3 COMP.
MOTORS 0 -1 HP
STEAM BOILERS
SINK, RESIDENCE.
MOTORS OVER 1 -3 HP
HOT WATER BOILERS
SINK, SLOP.
MOTORS OVER 3 -5 HP •
MECHANICAL VENTILATION
TEMPORARY WATER CLOSET
MOTORS OVER 5 -8 HP
TRANSPORTING ASSEMBLIES
URINAL
MOTORS OVER 8 -10 HP
ELEVATORS /ESCALATORS
WATER CLOSET
MOTORS OVER 10 -25 HP
FIRE SPRINKLER SYSTEMS
INDIRECT WASTES
MOTORS OVER 25 -100 HP
COOLING TOWERS
WATER SUPPLY TO:
MOTORS OVER 100 HP
VIOLATION
A/C UNIT
A/C WINDOW
REINSPECTION
FIRE SPRINKLER
AIR CONDITIONERS
HEATER -NEW INST.
STRIP HEATER
HEATER-REPLACE
GENERATORS TRANSFORMERS
I
LAWN SPRINKLER -WELL
GENERATORS TRANSFORMERS
®�
SWIMMING POOL
GENERATORS TRANSFORMERS
WATER SERVICE
SPECIAL PURPOSE.
SEWER CONNECTIONS
OUTLETS COMMERCIAL
UTILITY -SEWER
SIGN TUBES •
UTILITY -WATER
SIGN TRANSFORMERS
SEPTIC TANK
SIGN TIME CLOCK
RELAY
FIXTURES
FAINFIELD, 4" TILE/RES.
ANTENNA
PUMP & ABANDON SEPTIC TANK
TELEVISION OUTLETS
SOAKAGE PIT CU. FT.
VIOLATION
I
r_
CATCH BASIN
REINSPECTION
• I
DISCHARGE WELL
'
DOMESTIC WELL
AREA DRAIN
ROOF INLET
•
SOLAR WATER HEATER
FIRE STANDPIPE
POOL PIPING
LAWN SPRINKLER SYSTEM
GAS RANGE
METER SET (GAS)
GAS PIPING
AIR CONDITIONING
EIN 59-1680183 CAC #022414
7351 N.W. 7th STREET, "R" • MIAMI, FL 33126 • PHONE: (305) 266-6627 • FAX: (305) 261-6451
NAME/ ;Ls ,,, L-7--/e 4,---
DATE
0,0=-
ADDRESS.-.-
JOB NAME
"3 IPL,Z=.-
CITY,/, • __, STA '' '' ", ZIP
, A71'2,7 / .'°••*;e7'' C ,
ENGINEER
LI UNDER CONSTRUCTION (PERMIT NO.)
PHONE (H) - ..1 /
PHONE (0) 3 0 s . ?
El EXISTING STRUCTURE
ITEMS CHECKED APPLY:
EQUIPMENT
U s. cool Model # , `' Al A PAM -
El Package Unit tons • rev, cycle
.),( '74-0
( Condenser 5 tons III rev. cycle • S. cool Model # As ) 6 0
/g _
Air Handler i tons 1:1 vert.
t _.,_,_
, i
'4V r----
• horiz. Model # 7411 `--- 1,492.6
/ Heating k.w. ,,,,b Cooling
I Btuh S.E.E.R., ie C)
MISCELLANEOUS
Ilt hermostat 0 Ref. lines ft.
6/.1 Permit/X. El Fire Dampers
El Ref. line cover
El For Air Handler
Concrete Slab El Condensate line
CI Metal Stand El For Condensing Unit
El
El
DUCT SYSTEM
ELECTRIC SYSTEM
El Package Unit Changeout
4, -econnect to existing system
0
12 ' 'sting Reconnection
New Electric
5 9 q 2
LIMITED WARRANTY
'KManufacturers / 01 year warranty on compressor
for replacement parts installed by R.E.A. A/C Inc.
/ year warranty on any. efective parts and labor
,, 0
We agree to furnish and install the above described labor and
TOTAL
materials on the terms indicated below for the
dgc.„
CONTRACT PRICE OF $
% upon signing contract $ / 7 5
% on completion $ /
Jl{
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Date: 12/17/2007
Inspector: Perez, JanPierre
Owner: BUTLER, LOIS
Job Address: 700 96 Street NE
Miami Shores Village, FL
Project: <NONE>
Contractor: REA AIR CONDITIONING INC
Permit Type: Mechanical - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Block:
Phone Number (305)905 -5236
Parcel Number 1132060142110
Lot:
Phone: 305 - 266 -6627
Building Department Comments
exact change out of 5 ton a/c
WVZ-J1 / 7 I --)
Passed
Inspector Comments
CREATED AS REINSPECTION FOR INSP 66491. CC
SEAL HOLES JP 11/28/07
MI
Failed
Correction
Needed
Re- Inspection
Fee
($75)
No Additional Inspections can be scheduled
re- inspection fee is paid .
until
Thursday, December 13, 2007
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