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MC-09-1476Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 //e nspection Number: INSP- 123589 Permit Number: MC -9 -09 -1476 Inspection Date: September 24, 2009 Inspector: Perez, JanPierre Owner: RUSHING, DERK Job Address: 1351 NE 102 Street Miami Shores, FL 33138- Project: <NONE> Contractor: ALL YEAR COOLING AND HEATING Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1132050230170 Phone: (954)566 -4644 Building Department Comments Replace central a /c. Trane CU- 4tt20060 ahu- 4tee3c10 18 seer. 10kw Inspector Comments `ti .1' -1q1/1. _ C,0___-r`-fr b / N. Passed Eri Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. September 29, 2009 For Inspections please call: (305)762 -4949 Page 1 of 1 Miami Shores Village BUILDIN PERMIT A ICATION FBC 2004 Building Department 0050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 Permit No. `C -q Oq ftt1 Master Permit No. Permit Type: Mechanical Owner's Name (Fee Simple Titleholder) bolt U5 E-1 I N Phone # ()5 — -759-6111 Owner's Address 1 ,3S l NC' / O g S TA i . City in-) 'a 1 61-1 State R.o JPA- Zip a3 1 3? Tenant/Lessee Name Phone # E -MAIL: Job Address (where the work is being done) / 3S / A.1 /cdal s City Miami Shores Village County Miami -Dade Zip 33/ 3S3 FOLIO / PARCEL # /1 - 3, ;()S— ' - 617 0 Is Building Historically Designated YES NO Contractor's Company Name /Q( L cit.-J/4 x,/,„„(o I /-/ 7 -110- . Phone # Q5 c/ .ao 4CW Contractor's Address /3 (1S /'J, City L4vtzer cE State Zip 3 5Sdci Qualifier Name (i /Zt Phone # q'Sq "'v%(o qb / State Certificate or Registration No. CJ Co SV' /C, 0 E -MAIL: Certificate of Competency No. Om G^6 (/ Architect/Engineer's Name (if applicable) Phone # 060 %al—CD Value of Work For this Permit $ Square / Linear Footage Of Work: Type of Work: ['Addition ['Alteration ['New a; Repair/Replace ❑Demolition Describe Work: AgpciE dovragy /4/i G'cow/TIVn02 • 724 4 v v 6 eC! - q %Z.0C c - T( c 1 o / 8 s z . /O/c -ceJ • 5'11) n .(_ uct3 ** *** ****** **** * * *u ***** *fir ****** ** * ** *�Y ************ *�4 * **** * * * *a,r * **** * * *�4 *.t* ** *fir*** l/bd?/ �1 �1r lJ Submittal Fee $ 504 ° Permit Fee $ ■ CCF $ (P CO CO /CC Notary $ _- Training/Education Fee $ 0' (1C ) Technology Fee $' Scanning $ ) 00 Radon $ Bond $ Code Enforcement $ Double Fee $ Structural Review. $ Total Fee Now Due $ �� 9 ' 7S DPBR $ Zoning $ See Reverse side -› c24 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 bsence of such posted notice, the inspection will a approved and a reinspection fee will be charged The for day of 1 who is person Signature Owner or Agent ing instrument was ac owledged beforo me this c1y The forego 200 g, by i0/rj /0U..s i /Kr , day of ly known to me or who has produced who is personally Contractor trument was acknowle ed before me this 20 © by Lw wn to me or who has produced dentification and who did take an oath. - I) /t. /,tea, NOT PUBL As identification and who did take an oath. C: NOTARY PUBLIC: Sign: Print: My Commission Expires: pP�Q N ELiZAB�: ** * * * * * * * * * * * * * * * * * * * * * * * APPLICATION APPROVED BY: (Revised 02/08/06) Sign: Print: My Commission MY COMM)SS)O 1 Rr DD804407 * * * * * * * * * * * * ** Al. (4.07)30n-r.) Plans Examiner Engineer Zoning }