MC-12-1612Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: INSP- 177878
Permit Number: MC -8 -12 -1612
Scheduled Inspection Date: December 12, 2012
Inspector: Perez, JanPierre
Owner: CHURCH, ST ROSE OF LIMA CATHOLIC
Job Address: 10690 NE 5 Avenue
Miami Shores, FL
Project <NONE>
Contractor: EDD HELMS ELECTRIC & NC 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 CONDENSING UNIT CLASSROOM 208 -209 7.5
TON AT 425 NE 105 ST
x-61 Li/ vl ►v
Inspector Comments
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
December 11, 2012
For Inspections please call: (305)762 -4949
Page 15 of 41
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
B DING
PERMIT APPLICATION
AUG282012
FBC 20
Permit No.
Master Permit No. Ync (0 1 2
Permit Type: MECHANICAL 1U(Gc 1\14:—
5 A4
JOB ADDRESS: '425 NE E j Si -e C t»* 2 0 iI2. O1
City: Miami Shores County: Miami Dade Zip: 33138
Folio/Parcel #: 11 ~ 2 2 3 4 '4 3 .- t0 o to
Is the Building Historically Designated: Yes Flood Zone:
�c_,, -TH11
OWNER: Name (Fee Simple Titleholder): Arc A tb teSe. 8$ M 1 `Q 144 h Phone#:Js• 757. 4. 2q1
Address: -{ LIdj $eSCA.tyht. aIveg,
City: M t Q1ni 5IUhPCS State: er l o 1'1' 71 a Zip: •`3713 d=
Tenant/Lessee Name: Phone #:
Email:
CONTRACTOR: Company Name: C') C.) ) tGbnS 1);!` Cnnd Phone #:305- 6S3` 0530
Address: -4 2 St, NE }lot
City: )1h ;Cxrr. State: S=L
Qualifier Name: P.o her 4 k e..e t'
Zip: 3-S 1 C. 2�
Phone #:
State Certification or Registration #: CONC. 1 ALI cic, '7, LI Certificate of Competency #:
Contact Phone#: SCA - a3q
DESIGNER: Architect/Engineer
Value of Work for this Pe
Type of Work: CI Address
Description of Work:
1.5 `i` Di
ddress:
Phone #:
quare/Linear F i tage of Work:
New ' 'Repair/Replace ❑Demolition
UYL�- Gd2Ss
** * ******* ** * ** * ** ** **********
***** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
Submittal Fee $ . ,A'ermit Fee $ Q E/ a i 6 t/ CCF $ CO /CC $
Scanning Fee $ Radon Fee $ I Cl Y.Lo DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $
TOTAL FEE NOW DUE $ 1 1 I `, `7
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 FT FCTRICAL 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
CIAXA 6r late
Owner or Agent
The foregoing instrument was acknowledged before me this 2 t
day of Au9116", 20 I Z , by Ar 4 )Nuc CCAS fi k
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commission Expires:
* * * * * * * * * * * * * * * * * * **
APPROVED BY
`' MY COMmissnrl y
EXBonded f Ii?E -N N Nom' Pew. ndem,ite'
• c Thsu M: +t`l
* **
Signature
Contractor
The foregoing instrument was acknowledged before me this
by 1Q0 t 4464 GPfS,
or who has produced
day of
is ' ersonall known to
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My Commissi
MY COMBS EXPIRES: Nover ider r 2
o =` Bonded Thus Notety Nub
sky * * * * * * * *: FAR************ * ** * ** **** * * * * * * * * * * * * * * * * ** * **
lans Examiner Zoning
Structural Review
Revised 3 /12/2012)(Revised 07 /10/07)(Revised 06/10/2009)(Revised 3/15/09)
Clerk
Aug 28 2012 10:52AM HP LASERJET FAx
• •
P. 1
;;FiCitel
Customer: Seltit Gr:./1001 athcijc CIitit iassroto 20872C0
Attn: Art cinitte pitre.6t*.4. igfneeritig
Address: *t ve Street
MierA shorek-FL
scii4VittalsOttelittel ep1& tti Est tbodserisli-ta Unit
Moir Repetir Do410i,
Phone: 345-766itt$39,,
f.agt. 305-71”--8389'
Edd tme Air CondinIt1g le praing go: spitipittalito. perform aft* 4nu W065:411!-accordiinize..Witil
*plallovvirtgc. •
• **have :INCLUDED Mitt tilittPCX6*
Removal end dr** atttng • Olt
• Flush System VU11- 090 CAZ. • Install Rudd 7.5 Torr - ..katiktensitio:;:uttit
• 1111(812411. new expansion: vaivezn 016( AHU • • 4iYA -01#166eakit
• Ft.fkrittfrIzOi..1eak:theds.4n0 evacuate:
• Car ga syjOetp riMix rig*. fefitOtiatit 410A
gegcOno* lc existing eifttip
• Staft0 ond oineacprit.
• .W*t4r.rtyfygk,ikrtwIg gperliibdt 3 ears IIANSIOATTIP1.74sW
W6 have EXCELICED1Wftibtgatill,VMshtS .01350-ted1; i
ON: 00101*Iiiitivfiii*
Alla-.1111C4WATpi BE PERFORIVItt likttditlyor.gty tWay7t07114:30PIVI EXCLUDING.
HOLMAN*
.1)4r• ftig.walit.ortdekilb6:Fiettormiatit • •
.
$00$40:46-TittxsAttcluttiati.
term yrogrit duo upon atoppiOtipe3.1004.4%••dile,11P.Pri ...404.70011tin
Alt,Pagine* *Of Oxit*Itt 000041;0.4h thalami's .thait*Ottitiam.sgt***tt:OgrP911. iopqr411Vcesart.saatst-anif talvlo
itrOdAl _r:rtleguiate 11"ea'slarY for,6011.0009.% . •
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Apqount Mn9er w3M-2113;561-
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t4E T***.Aiiiiiritia4tOrarni; FL .331.02'* Talv Q54� Tj * p,. o Fax ON 664.7913.!1:4*.kataVrne.c9fra:
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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 12'1 `Q\ t_
This form must accompany ALL air conditioning 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): i0 G9 D S
City: Miami Shores Village County: Miami Dade Zip Code: 3
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
LI
UNIT BEING REPLACED
DATA
NEW UNIT
MANUFACTURER
AHU or PKG. UNIT MODEL #
COND. UNIT MODEL #
FI R 0 kJ L O9 Oe49 2.
KW HEAT
NOM TONS
AHU CU PKG
1) M.C.A
AHU CU PKG
AHU PKG
2) M.O.P
AHU PKG
AHU PKG
3) VOLTS
AHU U PKG
PKG UNIT / /
PKG UNIT / /
EER/SEER
�
YES C•
REPLACING DUCTS
YES NO
YES
REPLACING THERMOSTAT
YES NO
YES tro
NEW 4"CONCRETE SLAB
YES NO
YES �. ,'
NEW ROOF STAND
YES NO
YES /�
NEW RETURN PLENUM BOX
YES NO
1. Minimum Circuit Ampacity (Wire Size): P) /
2. Maximum Overcurrent Protection (Fuse /Breaker Size): /) /iC
3. Voltage of Circuit (208/240/4800i fig
4. Size Disconnecting Means:
Contractor's Company Name: yr; l�i)(FR en poi di 01) i99 Phone: 3D5 5 - S�C�
State Certificate or Registration N.C11)01 r l 4-1 Certificate of Competer y N.
Signature (R/? I ` Date: Vag /j
(Qualifier's signature only)