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MC-09-1604Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 125853 Permit Number: MC -9 -09 -1604 Scheduled Inspection Date: October 15, 2009 Inspector: Peres, JanPierre Owner: DECKER, VIVIAN Job Address: 1138 NE 99 Street Miami Shores, FL Project: <NONE> Contractor: C&R AIR CONDITIONING CO Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number (305)751 -5594 Parcel Number 1132050180140 Phone: 305 -685 -6394 Building Department Comments eXACT rEPLACEMENT OF 4 TON SPLIT SYATEM r) Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. October 14, 2009 For Inspections please call: (305)762-4949 Page 14 of 20 vo1oc21 oni J\C,Ck. Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 BUILDING PERMIT APPLICATIO FBC 2004 Permit Type: Mechanical SEP 0 2 Permit No. NAC`Ci—VCI— I(c l Master Permit No. Owner's Name (Fee Simple Titleholder) /.(„J 1L.4. 9w L) i 1 Owner's Address 1 g N 9 City to lewL4 4euttli, ')- State y Tenant/Lessee Name E -MAIL: Phone # :ZC\ 7- • .I A Zip Phone # Job Address (where the work is being done) (i 3 U C C1 4 City Miami Shores Village FOLIO / PARCEL # ti County Miami -Dade Zip ,3 3 I :j ' Is Building Historically Designated YES T n A Contractor's Company Name Contractor's Address 60.73 City f 1r i VIA1 Qualifier Name K e a' State Certificate or Registration No. E -MAIL: NO uw C- State F r . �t, ti Co Phone # Zip Phone # .1 f ,37t, g t✓3 9 Certificate of Competency No. 0'1! 3O 2 Architect/Engineer's Name (if applicable) Phone # Value of Work For this Permit $ Type of Work: ❑Additioia Describe Work: A4Let, Square / Linear Footage Of Work: ['Alteration ['New Repair /Replace ❑ Demolition x x xx x xx*iwW * xxxxx xx a:xx x x* ***'%'* Submittal Fee $ I DVS Permit Fee $ Notary $ Training /Education Fee $ Scanning $3400 F�esx% *****ww wxxxww, w, x* ** ** ************** ***** 0 Radon $ Bond $ Code Enforcement $ Structural Review. $ Total Fee Now Due $ IQ . DPBR $ CCF $ 3'6c0 CO /CC Technology Fee $ 4(.4 Zoning $ Double Fee $ See Reverse side - �d� 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. 1 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. W 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 Luc/2;n 04-ecit.). Owner or Agent The foregoing instrument was acknowledged before me this 30 day of 20 Oct, by who i personally knows to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: ••� J. Ch st My Commission Expir:: Q1PU�� Robert IY My Commission, s: JANETKRANZ Qmmi DD524602 CA s o qt) 1 x�nxx�xwWW ,x_ xx�rxrr�xYrx�xxxxx " �"Exz 'b 26 010 Signature The fore day of who is ntractor oing instrument was acknowledged before me this3O 20 ®C, by ersonally known o me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: scion # -...— .._ - ��x�xKx • '�z�x�x ►�� , x�>r# �xxx�xx>r>: ��--: Aires ecem er plres lf`a ,3 •.„;; ; . Bonded Tlw Troy Fain Insurance S00- J�r7019 Bonded Troy Fain -NUawnea.leo. 50031 Plans Examiner Engineer Zoning APPLICATION APPROVED BY: (Revised-02 /08/06) 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 ' °� u DISHWASHER LIGHT OUTLETS CENTRAL HEATING 9 4 DISPOSAL RECEPTACLES A/C (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 LAWN SPRINKLER -WELL GENERATORS TRANSFORMERS SWIMMING POOL GENERATORS TRANSFORMERS WATER SERVICE SPECIAL PURPOSE. SEWER CONNECTIONS OUTLETS COMMERCIAL UTILITY -SEWER SIGN TUBES 1 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 CATCH BASIN REINSPECTION 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