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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 1 WWI;; �I�f i l' • ry. M'. r . tr,� r t 1• -�° �•� a • v. ..• : t, _ s 1334 v 83 S? NTALEAH FL 33014 Ion MVI-0 ow •) 1 0 It I - 143�- fn.c?N� 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,