MC-12-688Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL �
Phone: (305)795 -2204 Fax: (305)756 -8972 — j 01
Inspection Number: INSP- 172505 Permit Number: MC -4 -12 -688
Scheduled Inspection Date: January 09, 2013 Permit Type: Mechanical - Residential
Inspector: Perez, JanPlerre Inspection Type: Final
Owner: MORALES, RUTH & ALFREDO Work Classification: Addition /Alteration
Job Address: 169 NW 110 Street
Miami Shores, FL 33161-
Project: <NONE>
Contractor: AMP A/C AND REFRIGERATION INC
Building Department Comments
INSTALL BATHROOM FAN AND KITCHEN HOOD.
Phone Number
Parcel Number
1121360030510
Phone: (954)733 -3083
January 08, 2013 For Inspections please call: (305)762 -4949 Page 1 of 40
Inspector Comments
Passed 1 01
Failed
Correction
Needed ❑
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
January 08, 2013 For Inspections please call: (305)762 -4949 Page 1 of 40
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
PE PLICATION
FBC V
Permit ype: MECHANICAL
V
APR 17 201 �1
2
8 Yo - ---(2 &/ o
Permit No.� —�
Master Permit No. 8(--3—)2-- 16 1
OWNER: Name (Fee Simple Titleholder): C_ �S � � (_ q% Phone#: —7 Qo " 35 ® - (9 Ll W
Address: )&q AIIA% go _S
city: b ilk { �SAC)!!.Ls State: IF L Zip: 3,:r
Tenant/Ussee Name: Phone#: -7 8-6 3SZ —0 L/D
Email:
JOB ADDRESS: I I vU )(on S7
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel #:
Is the Building Historically Designated: Yes
CONTRACTOR: Company Name:
NO ✓ Flood Zone:
AU 1`Q1,11tC-jA+Im !KC Phone#: '? 7t/ 7 33 30 5
Addres s: 5-09q ft4v q% S-V' C14
City: L A L Q yw4 w(k L 1/ State 1t Zip: 3 3�
Qualifier Name: A t A -2 A tM I t 413 1 'E Phone#: Ct s"y 7 `53 � 0 9 S
State Certification or Registration #: Certificate of Competency #: C A` eo 5-62—f A
Contact Phone#: Email Address:
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ 0 SquarelLinear Footage of Work:
Type of Work: OAddress ❑t Alteration •JNew ORepair/Replace ODemolition
Description of Work: ,,1/i � °+ A u �. -7Yk, 1��,/ OV Vx�� y��y�� w/� �Yl nI
Submittal Fee $ Permit Fee $_ N Ca 6 1 0 D
Scanning Fee $ Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
TOTAL FEE NOW DUE $ '
5 A
Bond>>3g 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
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
Signature
Contractor
The foregoin ins went was ackn wledged before //me this The foregoing instrument was acknowledged before me this a %�
day of to�yla 20 �, by _ 0,�.4� �U &W 6 410 day of '' , 20`;,.by �`lbwho is nown to me or who has produced —!I—&— who is personally known tAe or who has produced
Structural Review
(Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09)
Clerk
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
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):
City: Miami Shores Village County: Miami Dade Zip Code:
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 ❑
1. Minimum Circuit Ampacity (Wire Size):
2. Maximum Overcurrent Protection (Fuse/Breaker Size):
3. Voltage of Circuit (208/240/480):
4. Size Disconnecting Means:
Contractor's Company Name:
State Certificate or Registration N. Certificate of Competency
Phone:
Signature Date:
(Qualifier's signature only)
UNIT BEING REPLACED
DATA
NEW UNIT
MANUFACTURER
AHU or PKG. UNIT MODEL #
COND. UNIT MODEL #
KW HEAT
NOM TONS
AHU
CU
PKG
1 M.C.A
AHU
CU
PKG
AHU
CU
PKG
2 M.O.P
AHU
CU
PKG
AHU
CU
PKG
3 VOLTS
AHU
CU
PKG
PKG UNIT I
I
PKG UNIT
/
EERISEER
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 Means:
Contractor's Company Name:
State Certificate or Registration N. Certificate of Competency
Phone:
Signature Date:
(Qualifier's signature only)
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IMPACT INSJRANCE LLC
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Tt qS TO CERTIFY THAT THN POLICIES OP d ANW USTED aft ow MAV BBBN ISSUED TO 1 M CURED p ggpyQN � PO PER
INDMA7W. NOT.tTHSTANDb�K1 ANY Rfi�1UiREMENT. TERM OR COJVOITtON AMY
CERT�iCATE MAY BE OR MAY PERTAIN. THE DURANCE AFFORWD BY Tea poWT S OTHER pQCUM� WITH SECT TO M MCH TJi44
EXCW6IONSANO 9U)NO IONSOF SUCH POUCIES LIMMISHOWN MAY HAW. g�ROUC � PAA AIM IS SUBJECT TO ALL THE TV=.
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This certifies tW the indiViduel listed below has elected to be exempt from Roride mss' CMWls MW law
EFFECTIVE DATM 11/01!2011 EXPIRATION DATP- 10/3112013
PERSON: NAME
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BUSINESS NAME AND ADDREM
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SCOPES OF SUSINESS OR TRADE:
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Busf e" Phone: 954 - 733 -3085
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