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MC-12-1744Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 178678 Permit Number: MC -9 -12 -1744 Scheduled Inspection Date: December 05, 2012 Inspector: Perez, JanPierre Owner: CHURCH, ST ROSE OF LIMA CATHOLIC Job Address: 415 NE 105 Street Miami Shores, FL Project <NONE> Contractor: EDD HELMS ELECTRIC & A/C INC Permit Type: Mechanical - Commercial Inspection Type: Final Work Classification: A/C Replacement Phone Number (305)758 -0539 Parcel Number 1122310430010 Phone: 305 -653 -2520 Building Department Comments REPLACE PACKAGE UNIT CLASSROOMS 10 -20 Infractfo Passed Comments INSPECTOR COMMENTS False 24' ) 2/') Inspector Comments Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. December 04, 2012 For Inspections please call: (305)762-4949 Page 8of37 Miami Shores Village RECD Building Department sEP 19 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 tkt INSPECTION'S PHONE NUMBER: (305) 762.4949 B DING PERMIT APPLICATION Master Permit No. FBC 20 (0 Permit Type: MECHANICAL Owner's Name (Fee Simple Titleholder) ,4rCI1 d IOC.Q Q1C Mlarn1 Phone # 35- 751- 402-4 I Owner's Address 9401 City /L lam I 'gtioa5 State Zip 3.3/a. BY: 012 Permit No. f Tenant/Lessee Name Phone # Email Job Address (where the work is being done) 4z5 � E-_ Jcs City Miami Shores Village County Miami -Dade Zip 33/ 3, FOLIO / PARCEL # 11-2231 C4 3-'O0/ 6 Is Building Historically Designated-- Y ,S NO PX3Vrtree., Phone # 7° Contractor's Company Name id 14e /ms 4-(c Contractor's Address (7 O� .e. 5 aUe_ City lVClalirY)) State k-1„. Zip 33/(V2. Qualifier Name /? , r* Rake (IS State Certificate or Registration No. Certificate of Competency No. We—, Contact Phone Phone # 4,05%;96 3 E -mail Architect/Engineer's Name (if applicable) Phone # 3y Value of Work For this Permit $ Type of Work: ❑Addition ❑Alteration . ❑New Repair/Replace Square / Linear Footage Of Work: Describe Work: j / /� • CQ- ❑ Demolition ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees * * * * * ** ***** * * * * * * * * * * * * * * * * * * * * * * * * * * *** ** Submittal Fee $ '(� . (3 Permit Fee $ ® • CCF $ CO /CC $ Notary $ Training/Education Fee $ Technology Fee $ Scanning $ Radon $ DPBR $ Bond $ Double Fee $ Violation date: 1 q � '� 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 will not be approved and a reinspection fee will be charged. Signature nom, a, Signature Owner or Agent Contractor The foregoing instrument was acknowledged before me this /� The foregoing instrument was acknowledged before me this Lq day of , 20 jot, by P-ilemU - Co.rt 1 day of 5 , 20 Ia , by gober4 Rtheris, , o is personally known to tp e�r who has produced who is personally known t e or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: ` Print: My Commission Expir NADINE AI b MY COMMISSION # DD 919633 EXPIRES: November 7, 2013 rk $ Bonded Thru Notary Public Underwriters * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY * * * * * * * * * * * * * * * ** Sign: IV Print: My Co NADINE AUS i �► $ ty* X t1SMMISSION 600 919633 EXPIRES: November 7, 2013 Bonded Thru Notary Public Underwriters ******************************* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** lans Examiner Zoning Engineer (Revised 07 /10 /07)(Revised 06/10/2009) Clerk checked I Helms. Air Conditioning &Electric Customer: Saint Rose Of Lima Catholic Church Location: Classroom 10 -20 Attn: Art Castle, Director of Engineering Address: 415 NE 105th Street Miami Shores, FL. 33138 Email: acastleOsrlschool.com RE: Replace Existing Package Unit (Emergency Repair Classroom Down) Phone: 305 - 758 -0539 Fax: 305 - 751 -8389 Edd Helms Air Conditioning is providing a proposal to perform air conditioning work in accordance with the following: We have INCLUDED the following in this proposal; • Removal and disposal of existing unit • Install Rudd 5 Ton R410A three phase Package Unit • Reconnect to existing electrical • Reconnect to existing duct work • Secure unit to existing stand • Start up and check unit operation • Crane cost included • Warranty 1 year parts and labor, 5 years on the compressor We have EXCLUDED the following from this proposal; • Permits and Heat Load Calculation Fees ALL WORK IS TO BE PERFORMED Monday through Friday 7AM TO 3:30PM EXCLUDING HOLIDAYS -73 gil lax Price for the work or service performed: Written Amount $7844.00 Tax Included Terms of Payment: 50% due upon acceptance and 50% due upon completion All payments shall be due in accordance with the terms described above. Customer agrees to pay all court costs and attorneys fees should legal means be necessary for collection. This proposal shall be valid for a period of _30_ days from the date submitted below. Submitted by, Edd Helms Air Conditioning Mitchell Screen Account Manger - 305 - 216 -6513 CMC1249674 Date: 8 -30 -12 Accepted by: Authorized Signature & Title Pit vt+ IA at er/Gi c �) - Spar lr% Date: 17850 NE 51h Avenue • Miami, FL 33162 • Tel: (305) 653 -2530 • Toll Free: (800) 329 -2530 • Fax (305) 653-7933 • www.eddhelms.com Sep 19 2012 2:09PM HP LASERJET FAX p.1 Miami Shores village Building Department 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795, 2204 Fax: (305) 758.8972 AIR CONDITIONING REPLACEMENT DATA PERMIT NUMBER: MC 12- -1x74 This form must accompany ALL air condhloning replacement permit applications. Each unit change -out must be on its own data sheet. Multiple units on single sheets are not acceptable. Job Address (where the work Is being done): 416 N.E. 105 Sire- City: Miami Shores Village County: Miami Dade Zip Code: 3/3B 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 ❑ NO ® ARHI Sheet Attached: YES ❑ NO ❑ Contract Attached: YES 1. Minimum CircuitAmpacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: IIryIS' 4 Ph one :.° 4i30 State Certificate or Registration N. atC12,4 1(Q 1 Certificate of Competency N Signature only) Date: UNIT BEING REPLACED DATA NEW UNIT MANUFACTURER AHU orPKQ. UNIT MODEL # Ple 0 to0 CoK0Qo COND. UNIT MODEL # KW HEAT ID ped NOM TONS 5 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 / I EER/SEER YES NO REPLACING DUCTS YES NO YES NO REPLACING THERMOSTAT YES NO YES NO NEW4 "CONCRETE BLAB YES NO YES NO NEW ROOF STAND YES NO YES NO NEW RETURN PLENUM BOX YES NO 1. Minimum CircuitAmpacity (Wire Size): 2. Maximum Overcurrent Protection (Fuse/Breaker Size): 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: IIryIS' 4 Ph one :.° 4i30 State Certificate or Registration N. atC12,4 1(Q 1 Certificate of Competency N Signature only) Date: