MC-12-898Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP - 173800
Permit Number: MC -5 -12 -898
Scheduled Inspection Date: August 20, 2012
Inspector: Perez, JanPierre
Owner: DINAR, SHOLMI & REBECCA
Job Address: 10110 NE 4 Avenue
Miami Shores, FL 33138-
Project: <NONE>
Contractor: ARCO TEMP AIR CORP
Permit Type: Mechanical - Residential
Inspection Type: Final
Work Classification: Addition /Alteration
Phone Number
Parcel Number 1132060135250
Phone: (786)470 -7857
Building Department Comments
RELOCATE AIR SUPPLY DUCTWORK
g tz
Inspector Comments
Passed
217
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
August 17, 2012
For Inspections please call: (305)762 -4949
Page 6 of 33
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 ID
Permit Type: MECHANICAL
OWNER: Name (Fee Simple Titleholder): ?c,6 q Q /khtft. Phone#: dos' 7/0 6
Address: /0/10 iUc qn Are
City: /114114 i £/ i eJ State: 7'L
Tenant/Lessee Name:
Email:
Zip: &a/3
Phone#:
JOB ADDRESS:
City: Miami Shores
Folio/Parcel #:
/01/0 'V fie.
County:
Miami Dade
Zip: .33 I'd
Is the Building Historically Designated: Yes
NO Flood Zone:
CONTRACTOR: Company Name:ArrCre R1't/1T• Q�P/ Phone #:V 720
Address: (- 3 Cs` N`-V -"
city: q ��
Qualifier Name: , JY'n,rc1 L\
State: AZA
Zip: sy-?)-N p
Phone#: +70 -73'3-
State Certification or Registration #: Certificate of Competency #:
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone#:
Valve of Work for this Permit: $ 50 Square/Linear Footage of Work: t. Ca v
Type of Work: )Address )Alteration _ )New )Repair eplace )Demolition
Description of Work: v nnV‘..M5
* * * * * * * * * * * * **
Submittal Fee $
Scanning Fee $
Notary $
Double Fee $
* * *** * * * * * * * * * * * ** * * *p * ** ******* * * * ** * * ** * * ** * * * ***** * *** * * **
Permit Fee $ it % t CCF $
Radon Fee $
Training/Education Fee $
Structural Review $
CO /CC $
DBPR $ Bond $
Technology Fee $
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
Owner or Agent
Signature
The foregoing in ' Tent was acknowledged before me this The foregoing ipos
da «% `_ day of
who is pe
��Yii >. (�3hf 6'ploduced
iiae u 'aia w did take an oath.
NOTARY PUBLIE: 0210712016
NOT
Prin
My Commission Expires:
aLonContractor
m t was acknowledgeed� "be frre�me
120 /d- by Ai"s '�.c�C
to me or who has produced
ntification and who did take an o
11 }
NOT ' .'PUBLIC:
Sian: ,
My Commission E
F iv°
EXPIRES: January 15, 2015
Bonded Thru Budget Notary Services
$ d�+ k[ �S $� &Abr3�b�N�TW�i�&�P$�3:N�a': *&* ***** * *** ** an sB +k �R+ hd��b w§d3�++B *9��R+1�8��T**** **** b+ k +k #d��h�bd�9�ls********A��h #***
APPROVED BY 1. ens Examiner Zoning
Structural Review Clerk
(Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09)