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MC-15-563Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-230304 Permit Number: MC -3-15-563 Scheduled Inspection Date: June 03, 2015 Inspector: Perez, JanPierre Owner: CONLEY, LETY & MICHAEL Job Address: 1290 NE 104 Street Miami Shores, FL 33138-2660 Project: <NONE> Contractor: C&R AIR CONDITIONING CO Building Department Comments Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1122320300090 Phone: 305-685-6394 EXACT REPLACEMENT IF 5 TON AC SYSTEM. Infractio Passed Comments INSPECTOR COMMENTS False J June 02, 2015 For Inspections please call: (305)762-4949 Page 5 of 28 Inspector Comments Passed 00 Failed Correction Needed ❑ Re -Inspection ❑ Fee No Additional Inspections can be scheduled until re -inspection fee is paid. June 02, 2015 For Inspections please call: (305)762-4949 Page 5 of 28 Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 Expiration: 09/12/2015 rrojecr Eaaaress Parcel Number Applicant 1290 NE 104 Street 1122320300090 LETY & MICHAEL CONLEY Miami Shores, FL 33138-2660 Block: Lot: Owner Information Address Phone Cell LETY & MICHAEL CONLEY 1290 NE 104 Street MIAMI SHORES FL 33138-2660 1290 NE 104 Street MIAMI SHORES FL 33138-2660 Contractor(s) Phone Cell Phone C&R AIR CONDITIONING CO 305-685-6394 (954)680-4494 5 Info: EXACT REPLACEMENT IF 5 TON AC SYSTE ion: Residential In Review Denied: nino: 3 Fees Due Amount CCF $3.00 DBPR Fee $2.40 DCA Fee $2.40 Education Surcharge $1.00 Permit Fee $160.12 Scanning Fee $9.00 Technology Fee $4.00 Total: $181.92 Date Approved:: In Review Type of Work: Valuation: $ 4,575.00 Total Sq Feet: 0 Pav Date Pav Tvi3e Amt Paid Amt Due I Invoice # MC -3-15-54801 03/16/2015 Credit Card 03/16/2015 Credit Card $ 131.92 $ 50.00 $ 50.00 $ 0.00 Available Inspections: Inspection Type: Final Review Mechanical 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 info on i a rat hat all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore, I authorize the above- a nt a rt o he work stated. March 16, 2015 Authorized Signature: Owner / Applicant / Contract r / Date Building Department Copy March 16, 2015 1 Miami Shores Village Building Department 6201510050 N.E.2nd Avenue, Miami Shores, Florida 33138Tel: (305) 795-2204 Fax: (305) 756-8972 LM4AR INSPECTION LINE PHONE NUMBER: (305) 762-4949 FBC 2010 BUILDING master Permit No.W , 115' S�3 PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION []RENEWAL ❑PLUMBING 0 MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF []CANCELLATION ❑SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 1290 NE 104th Street City: Miami Shores County: Miami Dade Zip: Folio/Parcel#:11-2232-030-0090 Is the Building Historically Designated: Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER: Name (Fee Simple;Titleholder): MICHAEL & LETY CONLEY Phone#:305-758-8760 Address: 1290 NE 104th ST City: MIAMI SHORES State: FL Zip: 33138 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: C&R AIR CONDITIONING COMPANY Phone#: 305-685-6394 Address: 6073 NW 167th ST SUITE C-4 City: MIAMI GARDENS State: FL Zip: 33015 Qualifier Name: ROBERT J CHRYST Phone#: State Certification or Registration #: CACO26414 Certificate of Competency #: DESIGNER: Architect/Engineer: Phone#: _ Address: City: State: Value of Work for this Permit: $ 4S- S- 7 .S— - Square/Linear Footage of Work: Zip: Type of Work: ❑ Addition ❑ Alteration ❑ New © Repair/Replace ❑ Demolition Description of work: EXACT REPLACEMENT OF 5 TON AC SYSTEM Specify color of color thru tile: - Submittal Fee $ Permit Fee $ Scanning Fee $ Radon Fee $ Technology Fee $ Training/Education Fee $ Structural Reviews $ (Revised02/24/2014) CCF $_ DBPR $ Notary $ Double Fee $ Bond $ TOTAL FEE NOW DUE $ � 3 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 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 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 X kf • S SQotM-� Signature M CA:x— OWNER or AGENT The foregoing instrument was acknowledged before me this — t b— day/sof [ I 1meQ P C� , 20 IT . by K `"� Z�►cF� COa�� Pt/ . who' personallyknown o me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: ® Abe 4itit'll C I1 PCI J` CONTRACTOR The foregoing instrum nt was acknowledged before me this 1(o day of In W�C k 20 11 by Rbb et-t'S C hi Vii , who i ersonally known o me or who has produced as Identification and who did take an oath. NOTARY PUBLIC: Sign: LA V,4'MZV Print sctnet. Ki^ 12 Structural Review Clerk (Revs --2/24/2014) 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)- 1290 NE 104th ST City: Miami Shores VillageCounty: Miami Dade Zip fie. 33138 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 AHRI DATA SHEET REQUIRED Change disconnecting means: YES ❑ NO ❑ ARHI Sheet Attached: YES Q NO ❑ Contract Attached: YES Q 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: C&R AIR CONDITIONING COMPANY Phone: 305-685-6394 State Signature (Revised02/24/2014) 14 Certificate of Competency No. —I' 1b ° 115- UNIT BEING REPLACED DATA NEW UNIT C' e.rv-% MANUFACTURER - Ot AHU or PKG. UNIT MODEL # • ibf,6 COND. UNIT MODEL # KW HEAT NOM TONS AHU CU PKG 1) M.C.A AHU CU PKG AHUL(CJCU () PKG 2)M.O.P AHU40CUA4Q PKG AHU CU PKG 3) VOLTS 3.40 AHU CU PKG PKG UNIT / / PKG UNIT EER/SEER YES NO REPLACING DUCTS Y YES NO REPLACING THERMOSTAT NO YES NO NEW 4" CONCRETE SLAB S NO YES NO NEW ROOF STAND S NO YES NO NEW RETURN PLENUM BOX 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: C&R AIR CONDITIONING COMPANY Phone: 305-685-6394 State Signature (Revised02/24/2014) 14 Certificate of Competency No. —I' 1b ° 115-