MC-12-1834Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
Inspection Number: I NSP- 179401
Permit Number: MC -10 -12 -1834
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 & 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 4 TON CONDENSING UNIT CLASSROOM #109
AT 425 NE 105 ST
Infractio Passed Comments
INSPECTOR COMMENTS
vi/
False
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 19 of 41
BUILDING
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
c' -aa�
ECEOVE
OCT 0 3 2072
FBC►�200 110
WIC"' Permit No. 1 C"' "
PERMIT APPLICATION Master Permit No.
Permit Type: MECHANICAL N i T Ff oNCry 11)(°9 0 k1t.- S Alin_
JOB ADDRESS: 425 t V . E. /05 S red
City: Miami Shores County: Miami Dade .3.313B
Folio/Parcel #: 11' 31 —o41.3— 00/ 0
Ls the Building Historically Designated: Yes NO Flood Zone:
OWNER: AmA1F,ee Simple Titleholder): � - _Ai, ,�
Address: 1 /�.� . LQ V
City: Miami State: Zip: 33136
Phone #:
Tenant/Lessee Name: Phone #:
Email:
CONTRACTOR: Company Name: EC6 / kinIS /41-C, Phone #: 3 `6 0
Address: / . AJ. E • 5 e- 4.y
�7, , State: t `° Zip: 53/42-
Qualifier Name: Phone #:
State Certification or Registration #: (�- Q (Q 74i Certificate of Competency #:
Contact Phone#: Email Address: 4..5La W &id hems CoYr)
DESIGNER: Architect/Engineer: Phone #:
City: rn 41-r I
Value of Work for this Permit: $ v 3 Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteratiioon �,, q ❑ ^Neew, ,, udKepair/Replace ❑Demolition ° �q
Description of Work: R l c CQ 4 *n ! Co € Sf T u%� o(s� dos root, 4 � O
******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees * * * * ** * * ******* **** * * * ** *** * ** * ******** * * **
Submittal Fee $ Permit Fee $ 1331 OccF $ CO /CC $
Scanning Fee $ Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $ Technology Fee $
Double Fee $ Structural Review $ G�"�
TOTAL FEE NOW DUE $ l f
D 13
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.F,CTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FU MACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC
OWNER'S AN'F'IIAVIT: 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
JT
Signature
Owner or Agent Contractor
The foregoing instrument was acknowledged before me this / The foregoing instrument was acknowledged before me this Q
day of ) 0 , 20 1Q, by ) ri hu r &A0 )'Q., , day of 1 0 , 200_, by c 1Zobeeis,
who is personally known to me or who has produced who is personally known to me 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:
Bonded Tnas Notary Public Underwriters
My Commission Exp.z
Bonded Thus Notary Public Underwriters
* * ** * * **** ** *** * * ***** * * *** ***mix ** T '** **7'2-pians ************************************ ****** ******* ** ** * * * * **** **** **
%p
APPROVED BY w Examiner Zoning
Structural Review Clerk
Revised 3 /12/2012)(Revised 07 /10 /07)(Revised 06/10 /2009)(Revised 3/15/09)
£/ll'Ill'Edd Helms
it Conditioning & Electric
Customer: Saint Rose of Lima Church
Attn: Art Castle, Director of Engineering
Address: 415 NE 105th Street
Miami Shores, FL. 33138
Email: acastle(cr.srlschool.com
Location: Classroom 109
RE: Replace Existing Condensing 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 4Ton Condensing Unit
• Install Suction line drier and replace liquid line drier
• Tie down and secure Unit
• Reconnect to existing electrical
• Charge System
• Start up and check unit operation
• Warranty 1 year parts and labor, 5 years on the compressor
We have EXCLUDED the following from this proposal;
• Permits and Calculation Fees
ALL WORK IS TO BE PERFORMED Monday through Friday 7AM TO 3:30PM EXCLUDING
HOLIDAYS
Price for the work or service performed:
Written Amount
$3823.00 Tax Included
Terms of Payment: Total Due upon Completion
All payments shall be due in accordance with the terms described above. Customer agrees to pay all court costs and attorneys
fees should legal means be necessary for collection.
This proposal shall be valid for a period of 30_ days from the date submitted below.
Submitted by, Accepted by:
Edd Helms Air Conditioning
Mitchell Screen
Account Manger - 305 - 216 -6513
CMC1249674
Okaw B,C
>sl_
Authorized Signature & Tit e
?acs 1 et.1 V>n � J / /4441,144-, s' re r,
Date: 9 -24 -12 Date:
17850 NE 5th Avenue • Miami, FL 33162 • Tel: (305) 653 -2530 • Toll Free: (800) 329 -2530 • Fax: (305) 653 -7933 • www.eddhelms.com
Oct 03 2012 9:11AM HP LASERJET FAX
p.l
Miami Shores village
Building Department
10050 N.E 2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
AIR CONDITIONING REPLACEMENT DATA
PERMIT NUMBER: MCI2'"k )-3y
This form must accompany ALL air conditioning replacement permit applications. Each unit change -out must be on its own data
sheet. Multiple units on single sheets are not acceptable:
Job Address (where the work is being done): 425 l Y. c.
City: Miami Shores Village County: Miami Dade Zip Code: — 1.5/38
ALL CONDENSING UNITS MUST BE ON A 4 INCH SOLID CONCRETE SLAB
•ALL UNITS MUST COMPLY WITH F.E.M ..A MINIMUM FLOOD ELEVATION
A COPY OF THE CONTRACT IS REQUIRED WITH ALL SUBMITALS
ARI• (AHRI) DATA SHEET REQUIRED
Change Disconnecting means: YES E.• NO [ ARHI Sheaf' Attached: YES El NO ® Contract Attached: YES
UNIT BEING REPLACED .
DATA
NEW UNIT
.
MANUFACTURER
AHUor PKG. UNIT MODEL #
COND. UNIT MODEL# •
13/jj,7AI$Act / -757*
KW HEAT
NOM TONS
T.
AHU CU PKG
1) M.C.A
AHU AO 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
1. Minimum Circuit Ampacity (Wire Size):
2, Maximum.Overcurrent Protection (Fuse /Breaker Size):
3. Voltage of Circuit (208/240/480):
4. Size Disconnecting Mears:
Contractor's Company Name: `�
State Certificate or R�•'stration N. e/ .Y! iP �7 Certificate of Competency N.
Phone: t3 663-001,530
Signature
Q.uUMei s'sI. only)
Date: