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MC-15-3200 Inspection Worksheet Miami Shores Village a 10050 N.E.2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-250142 Permit Number: MC-12-15-3200 Scheduled Inspection Date: May 04,2016 Permit Type: Mechanical- Residential Inspector: Perez,JanPierre Inspection Type: Final Owner: PERAGALLO, DINO&IRENE Work Classification: Pool Heater Job Address:55 NE 97 Street Miami Shores, FL 33138- Phone Number (305)995-5224 Parcel Number 1132060130990 Project: <NONE> Contractor: HAVANA AIR CONDITIONING, INC Phone: (305)558-9136 Building Department Comments POOL HEATER Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid May 03,2016 For Inspections please call: (305)762-4949 Page 4 of 34 i, Miami Shores Village ■ s 10050 N.E.2nd Avenue NE ••• Miami Shores,FL 33138-0000 Phone: (305)795-2204 F60RIDA _ ... Expiration: 08/01/2016 Project Address Parcel Number Applicant 55 NE 97 Street 1132060130990 Miami Shores, FL 33138- Block: Lot: DINO 8 IRENE PERAGALLO Owner Information Address Phone Cell DINO&IRENE PERAGALLO 55 NE 97 Street (305)995-5224 MIAMI SHORES FL 33138- 55 NE 97 Street MIAMI SHORES FL 33138- Contractor(s) Phone Cell Phone Valuation: $ 500.00 HAVANA AIR CONDITIONING, INC (305)558-9136 Total Sq Feet: 00 Tons: Available Inspections: Additional Info: Inspection Type: Classification:Residential Final Approved:In Review Review Mechanical Comments: Date Approved::In Review Date Denied: Type of Work: Scanning:3 Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $o.80 DBPR Fee $2.00 Invoke# MC-12-15-58182 DCA Fee $2.00 12/29/2015 Check*13229 $50.00 $64.60 Education Surcharge $0.20 02/03/2016 Check#:13299 $64.60 $0.00 Permit Fee $100.00 Scanning Fee $9.00 Technology Fee $0.80 Total: $114.60 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 inform ion is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futhermore,I authorize the above n mad contra or to do the work stated. �;` February 03, 2016 Authorized Signature:Owner / Applicant / Itontractor / Agent Date Building Department Copy February 03,2016 1 Miami Shores Village 7DEC uilding epartment 292015 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 BY Tei:(305)795-2204 Fax:(305)756-8972 INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20/y BUILDING gaster Permit No. PERMIT APPLICATION Sub Permit No.��oCz BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION F-� EXTENSION []RENEWAL [-]PLUMBING K MECHANICAL PUBLIC WORKS [] CHANGE OF [] CANCELLATION SHOP CONTRACTOR DRAWINGS JOB ADDRESS:_ �S a1-1 S�City: Miami Shores County: Miami Dade Zi 3 Folio/Parcel#: 1'�' �(r ol? C>919 U is the Building Historically Designated:Yes -NO Occupancy Type: Load: Construction TYPO: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): �,)►mooa-�r�) CD Phone#: Address: 55 wu c t 1 sic City: State: tel_ Zip: Tenant/Lessee Name: Phone#: Email' �J CONTRACTOR:Company Name: �f��Da�,J!/e® �� -<ti'�-- Phone# S rf Address' GL°�S`I 3/ City: State: f-c- Zip: Qualifier Name: U )S VA-Lc1b )04c,11,e e I Phone State Certification or Registration M (f/� cc-5-41 Certificate of Competency#: DESIGNER:Architect/Engineer: + �,+��.T� Cjr c) =It C®tc3 4 I phone#: '-! CSSS— Address: SL,1-D 1 a e City: "i®,.v,ni State: R�.Zip.. 3 M Value of Work for this Permit:$ " Square/Linear Footage of Work: Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition Description of Work: I n 5i&,I Spec*color of color thru tete: Submittal Fee$ Permit Fee$ ay) CCF$ c0/Cc$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ G � (Revised02/24/2014) �\�� Banding Company's Name(if applicable) , Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address iii d$r 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 ail 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also,a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued, to the absence of such posted notice, the inspection will not be approved and a reinspection fee will be charged. Signature 0 !►.•�— Signature OWNER or AGENT CONTRACTOR The foregoing instrument was acknowledged before me this. The foregoing instrument was acknowledged before me this - cQn day of by -3L 0 day of1� e II s2171 ��r ,wh(ispersonallykno nto 05%acAAO -tpnf-1�wh is ersonailyknown me or who has produucced as me or who has produced as Identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: C7 Sign: 4116 A124a Print: Vt PPrint• &A CA V e-C) v �eZ Seal: Seal: PPY ...�. <. U MARCOS A.MMTINEZ ppY Pti'i 0. 9. ,,,�i...Bc-i= MARCOSA.MARTINEZ Y COMMISSION =M: MY COMMISSiI)N#FF OO8A89 *_ M #FF 008985 a€ �rp�ta7cksk�ot$gc;e�ka3cho� p:edh°?.: EXPIEXPIRES: XPIRES:May 5,2017RES:MaY (- BondelihruNWBond� dW .# sR+ktn�kakax�kakk�akx tkiAek�Pk#!k�rkekak#csleakk+flsA'�k � APPROVED BY ns Examiner Zoning Structural Review Clerk (RevisedO2/24/2014)