MC-09-2014Inspection Worksheet
Mianii Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 131002
Scheduled Inspection Date: December 22, 2009
Inspector: Rodriguez, Jorge
Owner: BLOCK, DAVID
Job Address: 1040 NE 96 Street
Miami Shores, FL
Permit Number: MC -12 -09 -2014
Project: <NONE>
Contractor: C&R AIR CONDITIONING CO
Permit Type: Mechanical - Residential
Inspection Type: Final
Work Classification: A/C Replacement
Phone Number (305)757 -8408
Parcel Number 1132060143540
Phone: 305 - 685 -6394
Building Department Comments
EXACT REPLACEMENT ON 3 TON SPLIT SYSTEM
Inspector Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
December 21, 2009
For inspections please call: (305)762 -4949
Page 13 of 27
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
BUILDING
PERMIT APPLICATION
FBC 2004
GEC 0 7 2UU
®o- omen ®a ®.0® -® ®_®
Permit No. VC/ Clq an+
Master Permit No.
Permit Type: Mechanical �,
Owner's Name (Fee Simple Titleholder) DOJ\ `LJ ,'l, / ,! Phone # 0 Q J 7 S 7
Owner's Address 1040 !J E 945
City State . Zip 33 13 8.
Tenant/Lessee Name Phone #
E -MAIL:
Job Address (where the work is being done) . 0 40 . N e 90 r
City Miami Shores Village County Miami -Dade Zip
FOLIO / PARCEL #
Is Building Historically Designated YES NO
Contractor's Company Name CtR Pt ‘ r Co r C(. Co. Phone # 3 O n 6 Q 4— 60 9 `t'
Contractor's Address 60' 3 N u%0 le -7 4r G-
City IQ VVt in State FI . Zip 0101 r
Qualifier Name K O O e Art . Cie) r y f s N Phone # ;05' � 8C6 3 9 (4
State Certificate or Registration No. Certificate of Competency No. C. A c- 0 h h g l y
E -MAIL:
Architect/Engineer's Name (if applicable)
Value of Work For this Permit $
49Io
Phone #
Square / Linear Footage Of W orkt
Type of Work: ['Addition ['Alteration ['New
Describe Work: '� , /� ate.
Repair /Replace ❑ Demolition
********** * ** * ** * ** * *** * * * * *** * * ** * * * **F„ �** tic * ** * **k * * *** *****tie* *tie * *** *tie* ****** ** **
Submittal Fee $ Permit Fee $ ➢ CCF $ 300 CO /CC
Notary $ Training /Education Fee $
Scanning $ 5.00 Radon $ DPBR $ Zoning $
Technology Fee $ 4'00
Bond $ Code Enforcement$ Double Fee $
Structural Review. $ Total Fee Now _Due .$
See Reverse side -->
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 w t be :'rove and reinspection fee will be charged.
Signature
wner or Agent
The foregoing instrument was acknowledged before me this `7
day of Dee em' 20O , by
who i( personally kno
o me or who has produced
As identificati . n a d
NOTARY PUBLIC:
Sign:
Print:
Robert J. Chryst
Commission it DD524602
,. Expires May 24, 2010
N rK 8004 1834019
�1t
My Commission Expires:
************* *********
C;orr+Fz i.SIler 00524602 •
Fx1}1res May 24, 2010
�icxx 6 F, i3Re8
Signature
The foregoing instrument was acknowledged before me this 7
day of Dec ber, 20 01, by
who i personally known o me or who has produced
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
Tome " Kr
My Commis jrANETKRAW
.__ Commission DD 621880
4xpi fftt tt6' D x*xX *xx
, ,,,,,, Bonded TNu Troy Fakt kwitance 800086 .7019
APPLICATION APPROVED BY:
(Revised 02 /08/06)
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
BATH TUB
DISHWASHER
DISPOSAL
SWITCH OUTLETS
LIGHT OUTLETS
FLOOR DRAIN
RECEPTACLES
GREASE TRAP
INTERCEPTOR
LAVATORY
SERVICE TEMPORARY
SERVICE SIZE IN AMPS
SERVICE REPAIR/METER CHANGE
LAUNDRY TRAY
APPLIANCE OUTLETS
CLOTHES WASHER
SHOWER
RANGE TOP
OVEN
SINK. POT /3 COMP.
SINK, RESIDENCE.
SINK, SLOP.
WATER HEATER
MOTORS 0 -1 HP
MOTORS OVER 1 -3 HP
TEMPORARY WATER CLOSET
URINAL
MOTORS OVER 3 -5 HP
MOTORS OVER 5 -8 HP
WATER CLOSET
MOTORS OVER 8 -10 HP
INDIRECT WASTES
MOTORS OVER 10.25 HP
WATER SUPPLY TO:
A/C UNIT
MOTORS OVER 25 -100 HP
MOTORS OVER 100 HP
FIRE SPRINKLER
A/C WINDOW
HEATER -NEW INST.
HEATER - REPLACE
AIR CONDITIONERS
SPACE HEATERS
UNIT
FEE
CENTRAL HEATING
A/C (WIND)
A/C (CENTRAL) 1; Xtvvt
DUCT WORK ¢C,
REFRIGERATION
PROCESS AND PRESS PIPING
UNDERGROUND TANKS
ABOVE GROUND TANKS
U.F. PRESSURE VESSELS
STEAM BOILERS
HOT WATER BOILERS
MECHANICAL VENTILATION
TRANSPORTING ASSEMBLIES
ELEVATORS/ESCALATORS
FIRE SPRINKLER SYSTEMS
COOLING TOWERS
VIOLATION
REINSPECTION
STRIP HEATER
LAWN SPRINKLER -WELL
SWIMMING POOL
WATER SERVICE
GENERATORS TRANSFORMERS
GENERATORS TRANSFORMERS
GENERATORS TRANSFORMERS
SEWER CONNECTIONS
UTILITY -SEWER
UTILITY -WATER
SEPTIC TANK
RELAY
SPECIAL PURPOSE
OUTLETS COMMERCIAL
SIGN TUBES
SIGN TRANSFORMERS
SIGN TIME CLOCK
FAINFIELD, 4" TILE /RES.
FIXTURES
PUMP & ABANDON SEPTIC TANK
SOAKAGE PIT CU. FT.
CATCH BASIN
ANTENNA
TELEVISION OUTLETS
VIOLATION
DISCHARGE WELL
DOMESTIC WELL
AREA DRAIN
ROOF INLET
REINSPECTION
SOLAR WATER HEATER
FIRE STANDPIPE
POOL PIPING
a
LAWN SPRINKLER SYSTEM
GAS RANGE
METER SET (GAS)
GAS PIPING
Andrea C. Clarke
Ann -Marie Luciano
aclarke @kslaw.com
lucianoa @dsmo.com
Avi Benayoun benayouna @gtlaw.com,
FTLLitDock @gtlaw.com, santiniv @gtlaw.com, steffesj@gtlaw.com
Benedict P. Kuehne
Benjamin D. Singer
Benjamin F. Johns
Boyd Cloern
Bruce E. Gerstein
Bruce Harris Fleisher
victoria @brucefleisherlaw.com
Bryan Robert Cleveland
Carmen Guerricagoitia McLean
cgmclean @jonesday.com
ben.kuehne @kuehnelaw.com
ben.singer @linklaters.com
bfj @chimicles.com
boyd.cloern @cliffordchance.com
bgerstein@garwingerstein.com
bruce @brucefleisherlaw.com,
BRC @WNFlaw.com
Catherine J. Maclvor
dospina@mflegal.com, jschwartz @mflegal.com, rkeith@mflegal.com
Christopher Fitzgerald Branch
branchc @dicksteinshapiro.com
Christopher Rebel Jude Pace
christopher.pace @weil.com, amorita.gaucin@weil.com
Christopher T. Casamassima
cmacivor@mflegal.com,
ccasamassima @kirkland.com
Dan Litvin dlitvin @garwingerstein.com
Daniel A. Goldschmidt
Daniel Allan Lurvey
Danielle Randazzo
David Ian Horowitz
David John Zack
lmaclaren @coffeyburlington.com, service @coffeyburlington.com
Donald C. Klawiter
2
goldschmidtd @sullcrom.com
dlurvey @llpalaw.com
danielle.randazzo@linklaters.com
dhorowitz@kirkland.com
dzack @coffeyburlington.com,
dklawiter@mayerbrown.com