MC-11-1690Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Rc-1 t - I lo$1
Inspection Number: INSP - 173807
Permit Number: MC -9 -11 -1690
Scheduled Inspection Date: May 21, 2012
Inspector: Perez, JanPierre
Owner: RHODES, LISA
Job Address: 1341 NE 103 Street
Miami Shores, FL 33138-
Project: <NONE>
Contractor: FREEZE AIR CORP
Permit Type: Mechanical - Residential
Inspection Type: Anal
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132050300140
Phone: 786- 4124308
Building Department Comments
DUCT WORK ONLY
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
CREATED AS REINSPECTION FOR INSP - 164449.
May 18, 2012
For Inspections please call: (305)762 -4949
Page 33 of 38
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: ,44 ll CA L
OWNER: Name (Fee Simple Titleholder): [...-0 SODS Phone#: 719 532:755e)
Permit No.
Master Permit No. -- !
SEP 1 g 2011
Address: 1 ? 1 NE 1 O' ST
City: M, l WW1-- S 1—CS
Tenant/Lessee Name:
State:
Phone #:
Zip: 33
Email:
JOB ADDRESS: 13141 N E ICY.
�T
City: Miami Shores County: Miami Dade
Folio/Parcel #: 11 —3205-0'30-01q0
Is the Building Historically Designated: Yes NO Flood Zone:
Zip: -2)3138
CONTRACTOR: Company Name: -, Freeze Air Corp Phone #: 786346088 j
Address: 7001 ..V . *1472,
City: f' a /eal1 1. State: FL- Zip: '529 /8
Qualifier Name:: `Ifea/LP�i O 406a /eS Phone #:
State Certification or Registration #: CAC 05731.E Certificate of Competency #:
Contact Phone #: 7g 6 34 60881 Email Address: Trvanc2 i0L • GOM .
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ 5/00 Square/Linear Footage of Work:
Type of Work: ErAddress °Alteration UNew ORepair/Replace °Demolition
Description of Work: Duck work On 1(1 •
**** �x: xx:: x*: x�:: x* �x�x�x :xx:�:a�u�:xx:�x ****�x ***** * * Fee ********** * ** ** *** * ** ** ***** **** ** ***** **
Submittal Fee $ Permit Fee $ 11 CCF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $
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 • t
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 $2500, the applicant must
promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a reinspection fee will be charged. a
Signature
Owner or Agent
The forego) )g instrument was a o ledged
day of (� , 20, by
who is nerc allylknown to me or who has produced
As identification and whgi \.an oath.
NOTAR PUBLIC: ' �,$`'N ' � , ,
Sign:
Print:
My Commission Expires:
The foregoing instrument was ac
day of ;20
who is personally known to me or who has p
as identification and who di
NOTARY PUI3LIC:
Print:
My Commission Expires:
zz
** * *** * * * * ** * * * * * **** ** * * * * * * * * ** ****r************************************** * * * * * * * * * * ** * * * * * * * * * * * * * * * * * **
4 APPROVED BY - % 14 Plans Examiner Zoning
(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
Structural Review Clerk
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305,) 795.2204
Fax: (305) 756.8972
AIR CONDITIONING REPLACEMENT DATA
PERMIT NUMBER: MC
This form must accompany ALL air conditioning replacement permit applications. Each unit change-out must he on its own data
sheet. Multiple units on single sheets are not acceptable.
Job Address (where the work is being done):
City: Miami Shores Village County: Miami Dade Zip Code:
ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB
ALL UNITS MUST COMPLY WITH F.E.M.A MINIMUM FLOOD ELEVATION
A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS
ARI (AHRI) DATA SHEET REQUIRED
Change Disconnecting means; YES 1 NO ARHI Sheet Attached: VESI NO Contract Attached: YES
UNIT BEING REPLACED
DATA
NEW UNIT
MANUFACTURER
• . ,
AHU or PKG. UNIT MODEL #
COND. UNIT MODEL #
KW HEAT
NOM TONS
AHU
CU
PKG
1) M.C.A
AHU CU
PKG
AHU
CU
PKG
2) M.O.P
AHU CU
PKG
AHU
CU
PKG
3) VOLTS
AHU CU
PKG
PKG UNIT
/
/
PKG UNIT
/
EER/SEER
YES
NO
REPLACING DUCTS
YES
NO
YES
NO
REPLACING THERMOSTAT
YES
NO
YES
NO
NEW 4"CONCRETE SLAB
YES
NO
YES
NO
NEW ROOF STAND
YES
NO
YES
NO
NEW RETURN PLENUM BOX
YES
NO
Minimum Circuit Ampacity (Wire Size):
2. Maximum Overcurrent Protection (Fuse/Breaker Size):
3. Voltage of Circuit (208/240/480):
4. Size Disconnecting Means:
Contractor's Company Name: 0-1/ v**/ Phone: ? 4f 154 0 !s/ -
State Certificate or Registration N. t.4CO 6-73/Z- Certificate of Competency N.
Signature
(Qualifier's signature rily)
Date: