MC-13-169 Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL C,
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-184908 Permit Number: MC-1-13-169
Scheduled Inspection Date: September 04,2013 Permit Type: Mechanical - Residential
Inspector: Perez,JanPierre
Inspection Type: Final
Owner: MICHELS,SAMUEL Work Classification: Addition/Alteration
Job Address:1070 NE 92 Street
Miami Shores FL
Phone Number
Parcel Number 1132050130040
Project: <NONE>
Contractor: C&R AIR CONDITIONING CO Phone: 305-685-6394
Building Department Comments
REPLACE A FEW DUCT WORKS IN ATTIC Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed
Failed
Correction ❑
Needed
Re-Inspection ❑
Fee
No Additional Inspections can be scheduled until
re-inspection fee is paid.
September 03,2013 For Inspections please call: (305)762-4949 Page 3 of 26
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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
INSPECTION'S PHONE NUMBER:(305)762.4949
BUILDING Permit No.,MCZ
PERMIT APPLICATION Master Permit No.
FBC 20
Permit Type: MECHANICAL
a
OWNER:Name(Fee Simple Titleholder): A4-1� Phone#:�05 7 17° !U 7 9
Address: 10'70 tv E 4 � V T
Ci ty: State: Zi .
Tenant/Lessee Name: Phone#:
Email:
JOB ADDRESS: I ® 17 ® N r q L a ST
City: Miami Shores County: Miami Dade Zip: l
Folio/Parcelt
Is the Building Historically Designated:Yes NO Flood Zone:
CONTRACTOR:Company Name: C_ -1 R At,c: Co vA C-0 . Phone#: S'(a S_ �4
Address: A® 7,3 0 W e '
c t
City: ' ct M State: ! Zip: ® Q
Qualifier Name: ®6,e rt V c-k ir l d- Phone#:
State Certification or Registration t C A C ® ��ti l `'c Certificate eof'Competency#: e
Contact Phone#: Email Address: C Ot d►el C C 8 vv,Pq h Pq fT 0 1- Q®/V l
DESIGNER:Architect/Engineer: Phone#:
Value.of Work for this Permit:$>; t 000. ?"Sdu ft/Linear Foo "of Work:
Type of Work: OAddress DAlteration .��ONew , r epa�r/Re dace ❑Demolition
Description of Work• Cx
Submittal Fee$ Permit Fee$ r/ CCF$ CO/CC$
Scanning Fee$ Radon Fee$ DBPR$ Bond$
Notary$ Tmining/Education Fee$ Technology Fee$
Double Fee$ Structural Review$
TOTAL FEE NOW DUE$
ll 3
S
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 na be approved and a reinspection fee will be charged.
Signature Signature
Owner or Agent ntractor
The foregoing instrument was acknowledged before me this 3 0 The foregoing instrument was acknowledged before me this,
day of A r% a, 20 t�,by day of ,20 I.1,by
who i personally known o me or who has produced who is<EEKknown me or who has produced
As identi as i a ngH^-fIa t.1—
NOTARY PUBLIC: '�'CF6ZYST NOTARY PUB ���� A JANET ItRAWZ
• Cater t#W 865419 VI Comn is t#EE 0919:37
BOW hkV
B e6 d1}� �k"W=W 8*MWW n T mT yFFaYt9kMM0S
Sign: Sign:
Print: r X J`� Print: J h C- K r o h
My Commission Expires: My Commission Expires:*Mk APPROVED BY 2ns Examiner
Zoning
Structural Review Clerk
(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)