MC-14-2282Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-234021 Permit Number: MC -10-14-2282
Scheduled Inspection Date: May 06, 2015 Permit Type: Mechanical - Residential
Inspector: Perez, JanPierre
Owner: HANSEN, DENNIS
Job Address: 10642 NE 10 Place
Miami Shores, FL 33138 -
Project: <NONE>
Contractor: RUIZ CONSTRUCTION INCORPORATION
Building Department Comments
Inspection Type: Final
Work Classification: Addition/Alteration
Phone Number
Parcel Number 1122320280860
Phone: (305)688-9770
2 ABTHROOM EXHAUST VENTS, CLEANIN A/C UNIT Infractio Passed comments
AND CLEANING DUCT INSPECTOR COMMENTS False
Inspector Comments
Passed CREATED AS REINSPECTION FOR INSP-232924. CREATED AS
10 REINSPECTION FOR INSP-221743. 1. NEED TO VENT EXHAUST FANS
TO OUTSIDE.
2. CLOSET NEED TO BE SEAL ALL HOLE IN WALL & DUCTWORK.
Failed ❑ 3. NEED TO SECURE C/U
4. NEED PERMIT FOR A/C CHANGE OUT need permit for a/c change out
jpp
Correction ❑
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
May 05, 2015 For Inspections please call: (305)762-4949 Page 39 of 50
L.�
I I J -2o 12-o14
BUILDING
PERMIT APPLICATION
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949
❑BUILDING M ELECTRIC ❑ ROOFING
RE C
OCT 16 2014
FBC 20 rO
Master Permit No.
Sub Permit No.�
❑ REVISION ❑ EXTENSION ❑ RENEWAL
❑PLUMBING MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: I 0� 4 a, t� e 6- e 10 P L A C.L-c-- 2
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 1I ® L /'3 2.- 07 ' a 16 ® Is the Building Historically Designated: Yes NO X_
Occupancy Type: Load: Construction Type: a , , Flood Zone: BFE: FFE:
OWNER: Name (Feer Simple Titleholder):.) �A 5 AA � S G j Phone#:
Address: q4 9—jz0 1VQ T)jR 1
City: 0 6 A t l \)A L�-8 �4 i' State: � f Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: 9"12— CorxskTu4(L�lO�TINtr
Address: 2-NLJJ 12,S e�, S+Te-�
ryry�—�°
City: 1,/tom ( DG State: FL Zip:
Qualifier Name: QtA Phone
State Certification or Registration #CACl S iS I y Certificate of Competency #:
DESIGNER: Architect/Engineer: Phone#:
Address: City: State: Zip:
Value of Work for this Permit. $_ Square/Linear Footage of Work:
Type of Work: ❑ Addition ❑ Alteration ❑ New
Description of Work: ) LVY LO VY) -?-X
Specify color o color thru We.-
Submittal
ile:Submittal Fee $ Permtt Fee $
Scanning Fee $ Radon Fee $
Technology Fee $ Training/Education Fee $
❑ Repair/Replace ❑ Demolition
\1-R, o d�I-
CCF $ CO/CC $
DBPR $ Notary $
Double Fee $
Structural Reviews $ Bond $
TOTAL FEE NOW DUE $
(Revised02/24/2014)
Bonding Company's Name (if applicable)
Bonding Company's Address
City
State
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
Zip
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 ELECTRIC, PLUMBING, SIGNS, POOLS,
FURNACES, BOILERS, HEATERS, TANKS, 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 Men (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be approved and a in ection fee will be charged.
or AGENT
Thl foregoing instrument was acknowledged before me this
day of t e 2014 , by
'Go swho 1s personally known to
me or who has produced 7-1) as
identification and who did take an oath.
Signature
CTOR
The foregoing instrument was acknowledged before me this
(� day oof66� � ��� 20 14 , by
b�' �l t2,, , who is personally known to
me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
NOTARY PUBLIC:
& zas
Sign:
'; Sign:
Print:
2T o f • Print:
r
Seal:
=rico• � �, �
Z Seal:
;� • �--
o• rp�%, Janet More]on
,���iii '° •
''-.coMMISSIQN#FF000743
v EXPIRES: MAP. 25,2017
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APPROVED BY
Plans Examiner
Zoning
Structural Review Clerk
(Revised02/24/2014)
Miami Shores Village
10050 N.E. 2nd Avenue NE
Miami Shores, FL 33138-0000
4' Phone: (305)795-2204
Project Address Parcel Number Applicant
10642 NE 10 Place 1122320280860 DENNIS HANSEN
Miami Shores, FL 33138- Block: Lot:
Owner Information Address Phone Cell
DENNIS HANSEN 7430 BEACHVIEW Drive
NORTH BAY VILLAGE FL 33141-
7430 BEACHVIEW Drive
NORTH BAY VILLAGE FL 33141-
Contractor(s) Phone Cell Phone
RUIZ CONSTRUCTION INCORPORATI (305)688-9770
Tons:
Additional Info: 2 ABTHROOM EXHAUST VENTS, CLEANIN A
Classification: Residential
Approved: In Review
Comments: Date Approved:: In Review
Date Denied: Type of Work:
Scanning: 3
Fees Due
Amount
CCF
$0.60
DBPR Fee
$2.25
DCA Fee
$2.25
Education Surcharge
$0.20
Notary Fee
$5.00
Permit Fee
$150.00
Scanning Fee
$3.00
Technology Fee
$0.80
Total:
$164.10
Valuation: $ 400.00
Total Sq Feet: p
Pay Date Pay Type Amt Paid Amt Due
Invoice # MC -10-14-53303
10/16/2014 Credit Card $ 50.00 $ 114.10
04/14/2015 Credit Card $ 114.10 $ 0.00
Available Inspections:
Inspection Type:
Final
Rough Duct
Underground
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 wd* done by either myself, my agent, servants, or employes. I understand that separate permits are
required for ELECTRICAL, PLUMBING, MECHANICAL, V*DOWS, DOORS, ROOFING and SWIMMING POOL work.
OWNERS AFFIDAVIT: I certify �hjat;rr the foregoing info ation is accurate and that all work will be done in compliance with all applicable laws regulating
construction and zoning. Futhe , r uthorize the bov amed contractor to do the work stated.
April 14, 2015
Authorized Sign ure:� s�{e / Applicant / Contractor / Agent
Building Department Copy
April 14, 2015
STATE OF FLORIDA
1'BISIIB[fFL AXWXy V
Cfmptar 8A —Art J & 10
cn"En - BEn. TYPE OF BUSINESS : PAYMOMMCEN6D
RUIZ CONSTRUCTION INCORPORATED 196 SPEC MECHANICAL CONTRACTOR- By TAX COLLECTOR
Wo*eKs) 1 CACl817314 W.00 OW06/2014
FRW5-14-014755.
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DISPLAY AS REQUIRED BY LAW
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AwJ CERTIFICATE OF LIABILITY INSURAINCEQat
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Apr 131512:35p RCI Group Inc.
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THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED 13Y THE POiJCIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORMED
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IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pONCY(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
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55 Royal Palm Pointe, Suite B O1ONE 407-569-5490 F r 407-3gg-3rgQ
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3eneral Construction, Roofing and Mechanical
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Miami Shores Village
BUlid[ Department
10050 CVE 2nd Avenue
Miami Shores FL 33138
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVMON&
AUTHORIZED
ACORD 25 (2014/01) The ACORD name and logo are registered arks o ACORD
ORD CORPORATION. All rights reserved