MC-06-2406Inspection Worksheet
Miami Shores Village l/
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972 -� /� —
Inspection Number: INSP -27786 Permit Number: MC -9 -06 -2406
Scheduled Inspection Date: November 16, 2011 Permit Type: Mechanical - Residential
Inspector: Perez, JanPierre
Inspection Type: Final
Owner: RESPONDEK, CAROL Work Classification: Addition /Alteration
Job Address: 1162 NE 105 Street
Miami Shores, FL Phone Number
Parcel Number 1122320280150
Project: <NONE>
Contractor: RIB AIR CONDITIONING INC Phone: (305)216 -7766
Building Department comments
CENTRAL A/C 2.5 TON. HEATERWATER 10 KW.1
BATHROOM L
November 15, 2011 For Inspections please call: (305)762 -4949 Page 43 of 43
Inspector Comments
Passed
Failed
Correction
Needed ❑
Re- inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
November 15, 2011 For Inspections please call: (305)762 -4949 Page 43 of 43
Owner Information Address Phone Cell
CAROL RESPONDEK 1162 NE 105 ST
MIAMI SHORES FL 33138 -2108
RIB AIR CONDITIONING INC
Tons: 2.5
\dditional Info: 10 KW
:lassification: Residential
\pproved:
:omments:
)ate Denied:
Phone Cell Phone Valuation: $ 3,900.00
(305)216 -7766 u
Total Sq Feet: p
Fees Due
Amount
CCF
$2.40
Education Surcharge
$0.80
Permit Fee - Additions/Alterations
$225.00
Permit Technology Fee
$5.62
Scanning Fee
$3.00
Total: $236.82
Date Approved:
Type of Work:
Pay Date Pay Type Amt Paid Amt Due
Invoice # MC-10 -06 -26308
04/06/2010 Check #: 5510 $236.8 2 $ 0.00
Avaname
Hood
Duct
Test
In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations
pertaining thereto and in strict conformity with the plans, drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In
accepting this permit I assume responsihility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS 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. Futhermore, I authorize the above -named contractor to do the work stated
April 06, 2010
Authorized Signature: Owner / Applicant / Contractor / Agent Date
Building Department Copy
April 06, 2010
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10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit
Permit Status: APPROVED
Issue Date: 2/8/2007 Expires: 08/07/2007 Permit Number: MC -9 -06 -2406
Owner's Name: CAROL RESPONDEK one:
Permit Type: Mechanical - Residential
Work Classification: Addition /Alteration
Parcel #: 1122320280150
Block:
Job Address: 1162 105 Street NE Section:
Miami Shores Village, FL
Contractor(s) Phone Primary Contractor
RB A/C INC (305)216 -7766 Yes
Additional Information
Tons: 2.5 Additional Info: 10 KW
Classification: Residential
In consideration of the issuance to me of this permit, I agree to perform the work
covered hereunder in compliance with all ordinances and regulations pertaining
thereto and in strict conformity with the plans, drawings, statements or specifications
submitted to the proper authorities of Miami Shores Village. In accepting this permit I
assume responsibility for all work done by either myself, my agent, servants, or
employes. I understand that separate permits are required for ELECTRICAL,
PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING
POOL work.
OWNERS 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. Futhermore, I authorize the above -named contractor to do the work
stated.
Fees Due
Amount
CCF
$2.40
Education Surcharge
$0.80
Permit Fee - Additions /Alterations
$225.00
Scanning Fee
$3.00
Technology Fee
$5.62
Total:
$236.82
Building Department File Copy
Applicant Signature
Lot:
PB:
Total Square Feet: 0
Total Valuation: $ 3,900.00
Invoice Number Amt Due Amt Paid
MC -10 -06 -26308 $236.82
Total:
NOTICE: In addition to the requirements of this permit, there may be
additional restrictions applicable to this property that may be found in the
public records of this county.
AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT
DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES.
Permit Status: APPROVED
Issue Date: 2/8/2007 Expires: 08/07/2007 Permit Number: MC -9 -06 -2406
Phone:
Owner's Name: CAROL RESPONDEK
Permit Type:
Mechanical - Residential
Work Classification: Addition /Alteration
Parcel #: 1122320280150
Block:
Section:
Job Address: 1162 105 Street NE
Miami Shores Village, FL
Contractor(s) Phone Primary Contractor
RB A/C INC (305)216 -7766 Yes
Additional Information
Tons: 2.5 Additional Info: 10 KW
Classification: Residential
In consideration of the issuance to me of this permit, I agree to perform the work
covered hereunder in compliance with all ordinances and regulations pertaining
thereto and in strict conformity with the plans, drawings, statements or specifications
submitted to the proper authorities of Miami Shores Village. In accepting this permit I
assume responsibility for all work done by either myself, my agent, servants, or
employes. I understand that separate permits are required for ELECTRICAL,
PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING
POOL work.
OWNERS 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. Futhermore, I authorize the above -named contractor to do the work
stated.
Fees Due
Amount
CCF
$2.40
Education Surcharge
$0.80
Permit Fee - Additions /Alterations
$225.00
Scanning Fee
$3.00
Technology Fee
$5.62
Total:
$236.82
Lot:
PB:
Total Square Feet:
Total Valuation: $ 3,900.00
Rough
Rough Duct
Ventilation
Smoke Test
Hood
Smoke Det Test
Final
Invoice Number Amt Due Amt Paid
MC -10 -06 -26308 $236.82
Total:
NOTICE: In addition to the requirements of this permit, there may be
additional restrictions applicable to this property that may be found in the
Applicant Copy public records of this county.
AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT
DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES.
For Inspections, Call (305) 795 -2204 exts 431 & 442. Requests must be received by 3 pm for following day inspections. Obtain Certificate of
Ocupancy /Completion Before Using the Building
Miami Shores Village
10050 N.E. 2nd Avenue
Miami Shores, FL 33138 -0000
Phone: (305)795 -2204 Fax: (305)756 -8972
Permit
Permit Status: APPROVED
Issue Date: 2/8/2007 Expires: 08107/2007 Permit Number: MC -9 -06 -2406
Owner's Name: CAROL RESPONDEK one:
Permit Type: Mechanical - Residential
Work Classification: Addition /Alteration
Parcel #:
Block:
Job Address: 1162 105 Street NE Section:
Miami Shores Village, FL
Contractor(s) Phone Primary Contractor
RB A/C INC (305)216 -7766 Yes
Additional Information
Tons: 2.5 Additional Info: 10 KW
Classification: Residential
In consideration of the issuance to me of this permit, I agree to perform the work
covered hereunder in compliance with all ordinances and regulations pertaining
thereto and in strict conformity with the plans, drawings, statements or specifications
submitted to the proper authorities of Miami Shores Village. In accepting this permit I
assume responsibility for all work done by either myself, my agent, servants, or
employes. I understand that separate permits are required for ELECTRICAL,
PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING
POOL work.
OWNERS 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. Futhermore, I authorize the above -named contractor to do the work
stated.
Fees Due
Amount
CCF
$2.40
Education Surcharge
$0.80
Permit Fee - Additions /Alterations
$225.00
Scanning Fee
$3.00
Technology Fee
$5.62
Total:
$236.82
County Copy
1122320280150
Lot:
PB:
Total Square Feet: 0
Total Valuation: $ 3,900.00
Invoice Number Amt Due Amt Paid
MC -10 -06 -26308 $236.82
Total:
NOTICE: In addition to the requirements of this permit, there may be
additional restrictions applicable to this property that may be found in the
public records of this county.
AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT
DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES.
Permit Status: APPROVED
Issue Date: 2/8/2007 Expires: 08/0712007 Permit Number: MC -9 -06 -2406
Owner's Name: CAROL RESPONDEK one:
Permit Type: Mechanical - Residential
Work Classification: Addition /Alteration
Parcel #:
Block:
Job Address: 1162 105 Street NE Section:
Miami Shores Village, FL
Contractor(s) Phone Primary Contractor
RB A/C INC (305)216 -7766 Yes
Additional Information
Tons: 2.5 Additional Info: 10 KW
Classification: Residential
In consideration of the issuance to me of this permit, I agree to perform the work
covered hereunder in compliance with all ordinances and regulations pertaining
thereto and in strict conformity with the plans, drawings, statements or specifications
submitted to the proper authorities of Miami Shores Village. In accepting this permit I
assume responsibility for all work done by either myself, my agent, servants, or
employes. I understand that separate permits are required for ELECTRICAL,
PLUMBING, MECHANICAL, WINDOWS, DOORS, ROOFING and SWIMMING
POOL work.
OWNERS 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. Futhermore, I authorize the above -named contractor to do the work
stated.
Finance Copy
1122320280150
Lot:
PB:
Total Square Feet: 0
Total Valuation: $ 3,900.00
Invoice Number Amt Due Amt Paid
MC -10 -06 -26308 $236.82
Total:
NOTICE: In addition to the requirements of this permit, there may be
additional restrictions applicable to this property that may be touna in the
public records of this county.
AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT
DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES.
Fees Due
Amount
CCF
$2.40
Education Surcharge
$0.80
Permit Fee - Additions /Alterations
$225.00
Scanning Fee
$3.00
Technology Fee
$5.62
Total:
$236.82
Finance Copy
1122320280150
Lot:
PB:
Total Square Feet: 0
Total Valuation: $ 3,900.00
Invoice Number Amt Due Amt Paid
MC -10 -06 -26308 $236.82
Total:
NOTICE: In addition to the requirements of this permit, there may be
additional restrictions applicable to this property that may be touna in the
public records of this county.
AND THERE MAY BE ADDITIONAL PERMITS REQUIRED FROM OTHER
GOVERNMENTAL ENTITIES SUCH AS WATER MANAGEMENT
DISTRICTS, STATE AGENCIES, OR FEDERAL AGENCIES.
Miami Shores Villagea
Building Department L11 SEP 2 5 2006
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
d Tel: (305) 795.2204 Fax: (305) 756.8972 BY: __.!_1t----------
BUILDING Permit No. J�(�-24%
PERMIT APPLICATI s,,! j ; faster Permit No.
�,
FBC 2001
Permit Type (circle): Building Electrical Plumbing Mechanical Roofing
Owner's Name (Fee Simple Titleholder) 1C�.� ' i Pf cQ N,, C,G Phone #
Owner's Address ; / AF-
City (�tc:�w�- ktt'' State 1 Zip , :: > _3 F-
Tenant/Lessee Name Phone ,q t -- Z2 j
Job Address (where the work is being done);,, s
City Miami Shores Village County Miami -Dade Zip
Is Building Historically Designated YES NO
Contractor's Company Name
Contractor's Address q 0
C 6
City is , hZA, -" .
Qualifier
' _W�
G. r AM
Phone # Q �.- -%7 66
Zip
State Certificate or Registration No. CAO iq��f - Certificate of Competency No.
Architect/Engineer's Name (if applicable) � , �� Phone # `30:5 � En -44 ``-
,8
$ Value of Work For this Permp
Type of Work: WfAddition ElAlteration
Describe Work: ,
Submittal Fee $
Notary $
QNew
Square Footage Of Work:
❑ Repan
❑ Demolition
Permit Fee $_ "`? CCF $Z.40
C0 /CC
Training/Education Fee $ ..nn Technology Fee S 5. ro Z
Scanning $
Code Enforcement $
Radon $ Zoning
Total Fee Now Due $ Z.VO . S 2
(Continued on opposite side)
Structural Plan Review. $
Bond $
i
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City
State
Zip
Zip
a
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
The foregoing instrument was acknowledged before me this
day of , 20 _, by
who is personally known to me or who has produced
As identification and who did take an oath.
Signature
°C Jf,,,,(kontractor
The foregoing instrument was acknowledged before me this
day of ,20& ,by_ � irWi�
_ who is personally known to me or who has produced
as ntification and who did take an oath.
NOTARY PUBLIC: NOTARY PUBLIC: J
Sign: Sign:
Print: Print: /yq
My Commission Expires: My Commission Expires: NOURY FUUC.5 ATE OF noR%DA
Yadira On=
Comtn�ssi��`�'b'113�}2357
Explres: nB. 19, 2009
Donded7hru Atlantic Nonding C*" 'At-
APPLICATION APPROVED BY: U Plans Examiner
Engineer
chc 05/13/03
Zoning
ADDENDUM TO BUILDING PERMIT APPLICATION
(AN A£PLICATION FOR BUILDING PERMIT MUST ACCOMPANY THIS ADDENDUM. IF A MASTER PERMIT HAS B.
OBTAINED, THE OWNER'S NOTARIZED SIGNATURE NEED NOT BE PRESENT ON SUBSEQUENT APPLICATIONS.)
PLUMBING ELECTRICAL MECHANICAL
ITEM
BATH TUB
BIDET
UNIT
FEE
ITEM
SWITCH OUTLETS
LIGHT OUTLETS
UNIT
FEE
ITEM
SPACE HEATERS
CENTRAL HEATING
UNIT
FEE
DISHWAHR
DIAL
RECEPTACLES
SERVICE TEMPORARY
A/C (WIND)
A/C (CENTRAL)
DRINKIN3 FOUNTAIN
FLOOR DRAIN
GREASE TRAP
INTERCEPTOR
LAVATORY
LAUNDRY TRAY
CLOTHES WASHER
SHOWER
SINK, POT /3 CDMP.
SINK, RESIDENCE
SINK, SLOP
TEMPORARY WATER CLOSET
SERVICE SIZE IN AMPS
SERVICE REPAIR/METER CHANGE
APPLIANCE OUTLETS
RANGE TOP
OVEN
WATER HEATER
MOTORS D- 1 HP
MOTORS OVER 1- 3 HP
MOTORS OVER 3- 5 HP
MOTORS OVER 5- 8 If
MOTORS OVER 8- 10 HP
MOTORS OVER 10- 25 HP
DUCT WORK
REFRIGERATID
PROCESS AND PRESS PIPING
UNOERGROIX TANKS
ABOVE MM TANKS
U.F. PRESSURE VESSELS
STEAM BOILERS
HOT WATER BOILERS
MECHANICAL VENT ILATIO .,
TRANSPORTING ASSEMBL!
ELEVATORS/ESCALATORS
RINKLER SYSTEMS
URINAL
MOTORS OVER 25-100 w
TOWERS
WATER CLOSET
MOTORS OVER 100 hE'
=RE
ON
I
INDIRECT WASTES
A/C WINDOW
CTION
WATER SUPPLY TO:
AIR CONDITIONERS
A/C UNIT
STRIP HEATER
FIRE SPRINKLER
GENERATORS TRANSFORMERS
HEATER -NEW INST.
GENERATORS * TRANSFORMERS
HEATER- REPLACE
GENERATORS TRANSFORM&RS
LAWN SPRINKLER -WELL
SPECIAL PIPPOSE
SWIMMING POOL
OUTLETS CO KRCIAL
WATER SERVICE
SIGN TUBES
SEWER CONNECTIONS
'SIGN TRANSFOMRS
UTILITY -SEWER
SIGN TIME CLOCK
UT IL ITY -WATER
F IXTLRES
.SEPTIC TANK
ANTENNA
-RELAY
TELEVISION OUTLETS
# MINFIELD, 4` TILE/RES.
VIOLATION
i, W 8 ABANDON SEPTIC TANK
REINSPECTION
SOAKAGE PIT CU. FT.
CATCH BASIN
DISCHARGE WELL
DOMESTIC WELL
AREA DRAIN
i
ROOF INLET
E
I
SOLAR WATER HEATER
I
I
I
FIRE STAMP I PE
POOL PIPING
{
f
LAWN SPRINKLER SYSTEM:
E
I
GAS, RAKE
METER SET (GAS)
k
I
GAS Rlplk^
E
i
U
*kn - OOMO,