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MC-12-363Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756 -8972 Inspection Number: INSP - 171881 Permit Number: MC -3 -12 -363 Scheduled Inspection Date: April 04, 2012 Inspector: Perez, JanPierre Owner: MEHTA, SAILESH Job Address: 10480 NE 5 Avenue Miami Shores, FL 33138- Project: <NONE> Contractor: HOME OWNER Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: Addition /Alteration Phone Number (305)491 -5729 Parcel Number 1122310150010 Building Department Comments GAS VENT FOR TANKLESS WATER HEATER 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- 170646. need outside air for heater April 03, 2012 For Inspections please call: (305)762 -4949 Page 21 of 22 TANKLESS GAS WATER HEATER 0531S 31 S -OD, N -05 1 S -OL (Outdoor Installation) IV Potential dangers from accidents during installation and use are divided into the following three categories. Closely observe these warnings, they are critical to your safety. A DANGER indicates an imminently hazardous situation which, DANGER indicate if not avoided, will result in death or serious injury. WARNING AWARNING WARNING indicates a potentially hazardous situation which, if not avoided, could result in death or serious injury. A CAUTION CAUTION indicates a potentially hazardous situation which, if not avoided, may result in minor or moderate injury.. • • WARNING: If the information in this manual is not followed exactly, a fire or explosion may result causing property damage, personal injury or death. 1 Requests to Installers Prohibited Disconnect Power Ground CAUTION 0 Be sure to do .. ® MN III 1 • In order to use the water heater safely, read this installation manual carefully, and follow the I installation instructions. • Failures and damage caused by erroneous work or work not as instructed in this manual are not covered by the warranty. 1 •. Check that the installation was done properly in accordance with this Installation Manual upon I completion. I • After completing installation, please either place this Installation Manual in a plastic pouch and attach it to the side of the water heater (or the inside of the pipe cover or recess box if applicable), or hand it to the customer to retain for future reference. Also, be sure to fill in all of the required I items on the warranty and to hand the warranty to the customer along with the Owner's Guide. III. ENERGY STAR PHCC PUNIONHIMEGOOUNG IMMUNE MOWN SAR8584 -8 Rev. 08/08 Low NOx Approved by SCAQMD Accepted For Use City of New York Department of Buildings MEA 19 -03-E .1 FOR USE IN RESIDENTIAL, COMMERCIAL, OR MANUFACTURED HOME APPLICATIONS. (N-0631S-OD, N-0531S-OD only) Installation must conform with local codes, or in the absence of local codes, the National Fuel Gas Code, ANSI Z223.1/NFPA 54- latest edition and/or CSA 8149.1, Natural Gas and Propane Installation Code (NSCNGPIC). When applicable, installation must conform with the Manufactured Home Construc- tion and Safety Standard, Title 24 CFR, Part 3280 or the Canadian Standard CAN/ CSA -Z240 MH Mobile Homes, Series M86. (N-0631S-OD, N- 0531S -OD only) Noritz America regerves the right to discontinue, or change at any time, the designs and/or specifications of its products without notice. u Clearance Requirements from Vent Terminations to Building Openings * All clearance requirements are in accordance with ANSI 221.10.3 and the National Fuel Gas Code, ANSI Z223.1 and in Canada, in accordance with NSCNGPIC. [ For N -0631 S, N -0531 S ] . Maintain the following clearances to any opening in any building: Illustration • 4' below, 4' horizontally from, or 1' above any door, operable window, or gravity air inlet into any building. 3' above any forced air inlet within 10'. 4' nn 4' • 1' below, 1' horizontally from, or 1' above any door, operable window, or gravity air inlet into any building. 3' above any forced air inlet within 10'. • • Noritz vent cap VC4 -1 (for N-0631 S) VC3 (for N -0531 S) * For Installations in Canada, clearances are as follows: To windows, doors, & gravity air inlets: 36 °. To forced air inlets: 6'. These clearance requireMents hold true for all of the above situations: Indoor, Outdoor w /vent cap. 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: MECHANICAL OWNER: Name (Fee Simple Titleholder): O - N"� � me-. Permit No. nAG12 3D3 Master Permit No. R c 0 6- 10 SPr k l- t 1-1 A- Phone #: 3o S -f 1 S-12... C� Address: City: t t eArArt..% State: Zip: 3'j 1 1 Tenant/Lessee Name: Phone #: Email: r c ��� e �+ �l a� �i �� ��� �. cct ^� JOB ADDRESS: 04_ g e E City: Miami Shores County: Miami Dade Zip: 3 3t ikt t0 1SbO O Folio/Parcel #: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: $a X16- 4'r7!N Phone #: a 5 1( 1 2. 1 Address: City: State: Zip: Qualifier Name: Phone #: State Certification or Registration #: Certificate of Competency #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ Square/Linear Footage of Work: 9 Type of Work: Address alteration UNew ORepair/Replace ODemolition Description of Work: a:G �c.a F. cod –cb ao 9 1m0 11S4.2.6 **** �x**** �xx�x�m �xsxx�x�x�x�x��xx��xa�x��xx� wx�x�x�x�*** * a �x��xx�a��x****+>< �xs: x�x�x�a�x�x� +x�x�xx�a��x�xx��x�xx� **** ***may ***** Submittal Fee $ Permit Fee $ G CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ —0644(7— TOTAL FEE NOW DUE $ °)4 4 �, 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 fait at a copy of the notice of commencement ' and construction lien law brochure will be delivered to the person whose property is s ct to attachment. Also, a certified copy of the recorded notice of ?mmencement must be posted at the job site for the first inspecti: , which occurs seven (7) days after the building permit is issued. In the u% ce of such posted notice, the inspection will not be app . , _ and a reinspection fee will be charged. Signature Signature The forego day of who i before me ho has produced entification and who did take an oath. NOT Sign: Print: The foregoing instru edged before me this r, l`°d,yof'a b e ,20 iZ ell ,by� ij /ga /We. ii who is personally known to me or who has produced T' r> L. as identification and who did take an oath. NOTARY PUBLIC: My Commission Expires: Cl APu �� Sate of f1o2�15 My Commission Expire APPROVED BY `oPw� vuQ��,,�, tyy Gomm. Mites Sep 28, 20 •: + . q MY Gomnntssion a stool mtaty 2881',Assn • ************ *********** y'. �+xa 4' '�@ 1 ' ::: _ a�skskskskskm m+x�k�x�k+x�kN��b�k*N�N�x•N'.k �I�r _.�I' Plans Examiner Structural Review Sign: Print: ®P facrs4c C040fvA (Revised 07 /10 /07)(Revised 06 /1012009)(Revised 3/15/09) 4%1111111110` "7-46* Rotary Pi50 - of Rorkla SoaNtAtylialloa at. X15 Combas • if SOW Clerk Afig31,10 WOAD 0,00 * stit8 - recili ttlS .12 rtig, etnkti3 .mmo M t t 33 1 raissifwoo3 Miami Shores Village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 OWNER BUILDER DISCLOSURE STATEMENT NAME: 54/1-6--4. if t t—'14- ADDRESS: OA s.o `= ' A-' 6 DATE: 3 / i //2- Do hereby petition the Village of Miami Shores to act as my own contractor pursuant to the laws of the State of Florida, F.S 489.103(7). And I have read and understood the following disclosure statement, which entitles me to work as my own contractor; I further understand that I as the owner must appear in person to complete all applications. State Law requires construction to be done by a licensed contractbr. You have applied for a permit under an exception to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a ohe- family or two- family residence. You may also build or improve a commercial building at a cost of $25,000.00 or less (The new form states 75,000). The building must be for your own use and occupancy. It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will presume that you built for sa e or lease, which is a violation of this exemption. You may not hire an unlicensed person as a contractor. It is your responsibility to make sure the people employed by you have licenses required by state law and by county or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervision and must be employed by you, which means that you must deduct F.I.C.A and with - holdings tax and provide workers' compensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, buildings codes and zoning regulations. Please read and initial each paragraph. 1. I understand that state law requires construction to be done by a licensed contractor and have applied for an owner - builder permit under an exemption from the law. The exemption specifies that I, as the owner of the property listed, may act as my own contractor with certain restrictions even though I do not have a license. Initial CA "1 2. I understand that building permits are not required td be signed by a property owner unless he or she is responsible for the construction and is not hiring a licensed contractor to assume responsibility. 3. I understand that, as an owner builder, I am the responsible party of record on a permit. I understand that I may protect myself from potential financial risk by hiring a licensed contractor and having the permit filed in his or her name instead of my own name. I also understand that the contractor is required by law to be licensed in Florida and to list his or license numbers on permits and contracts. Initial 4. I understand that I may build or improve a one family br two- family residence or a farm outbuilding. I may also build or improve a commercial building if the costs do not exceed $75,000. The building or residence must be for my use or occupancy. It may not be built or substantially improved for sale or lease. If a building or residence that I have built or substantially improved myself is sold or leased within 1 year after the construction is complete, the law will presume that I buil�dr substantially improved it for sale or lease, which violates the exemption. 5. I understand that, as the owner- builder, I must provide direct, onsite supervision of the construction. Initial °J Initial 6. I understand that I may not hire an unlicensed person to act as my contractor or to supervise persons working on my building or residence. It is my responsibility to ensure that the persons whom I employ have the license required by law by county or municipal erdina Initial 7. I understand that it is frequent practices of unlicensed persons to have the property owner obtain an owner- builder permit that erroneously implies that the property owner is providing his or her own labor and materials. I, as an owner - builder, may be held liable and subjected to serious financial risk for any injuries sustained by an unlicensed person or his or employees while working on my property. My homeowner's insurance may not provide coverage for those injuries. I am willfully acting as an owner - builder and am aware of the limits of my insurance coverage for injuries to workers on my property. Initial 8. I understand that I may not delegate the responsibility for supervising work to be a licensed contractor who is not licenses to perform the work being done. Any person working on my building who is not licensed must work under my direct supervision and must be employed by me, which means that I must comply with laws requiring the withholding of federal income tax and social security contributions under the Federal Insurance Contributions Act (FICA) and must provide workers coil • -nation for the employee. I understand that my failure to follow these may subject to serious financial risk. Initial 9. I agree that, as the party legally and financially responsible for this proposed Construction activity, I will abide by all applicable laws and requirement that govern owner - builders as well as employers. I also understand that the Construction must comply with all applicable laws, ordinances, building codes, and zoning regulations. Initial 10. I understand that I may obtain more information regarding my obligations as an employer from the Internal Revenue Service, the United States Small Business Administration, and the Florida Department of Revenues. I also understand that I may contact the Florida Construction Industry Licensing Board at 850.487.1395 or htto://www.nnvfioridalicense.com/dbor/pro/cilbfind titml Initial 11. I am aware of, and consent to; an owner- builder building permit applied for in my name and understands that I am the party legally and financially responsible for the proposed construction activity at the following address: Initial 12. I agree to notify Miami Shores Village immediately of any additions, deletions, or changes to any of The informatioq that I have provided on this disclosure. Initial Licensed contractors are regulated by laws designed to protect the public. If you contract with a person who does not have a license, the Constr4uction Industry Licensing Board and Department of Business and Professional Regulation may be unable to assist you with any financial loss that you sustain as a result of contractor may be in civil court. It is also important for you to understand that, if an unlicensed contractor or employee of an individual or firm is injured while working on your property, you may be held liable for damages. If you obtain an owner - builder permit and wish to hire a licensed contractor, you will be responsible for verifying whether the contractor is properly licensed and the status of the contractor's workers compensation coverage. Before a building permit can be issued, this disclosure statement must be completed and signed by the property owner and returned to the local permitting agency responsible for issuing the permit. A copy of the property owner's driver license, the notarized signature of the property owner, or other type of verification acceptable to the local permitting agency is required when the permit is issued. Was acknowledged before me this 15— day of h' ACId , 20 t By1 Produced there License or who OWNER me or who has as identification. 1 CLA • IA V. CUBILLOS Public - State of Florida :ter °tLw1►�. • Notary omm. Expires Sep 23. 2015 sssyo'' Commission # EE 128810 Bonded Through National Notary Assn.