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MC-16-3434Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-273544 Permit Number: MC -12-16-3434 Scheduled Inspection Date: December 28, 2016 Inspector: Perez, JanPierre Owner: MURSULI, JORGE Job Address: 600 NE 97 Street Miami Shores, FL 33138-2471 Project: <NONE> Contractor: TEST AND BALANCE AIR CONDITIONING CORP Permit Type: Mechanical - Residential Inspection Type: Final Work Classification: A/C Replacement Phone Number Parcel Number 1132060171680 Phone: (305)218-1798 Building Department Comments REPLACE EXACT CHANGE OUT 4 TON REPLACE PERMIT MC 14-1127 Infractio Passed Comments INSPECTOR COMMENTS False V6) 17* Passed Failed Correction Needed Re -Inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid. Inspector Comments December 27, 2016 For Inspections please call: (305)762-4949 Page 13 of 32 Project Address Miami Shores Village 10050 N.E. 2nd Avenue NE Miami Shores, FL 33138-0000 Phone: (305)795-2204 600 NE 97 Street Miami Shores, FL 33138-2471 Owner Information Permit Permit NO. MC -12-16-3434 Permit Type: Mechanical - Residential Work Classification: AIC Replacement Permit Status: APPROVED Issue Date: 12122/2016 Expiration: 06/20/2017 Address Parcel Number 1132060171680 Block: Lot: 600 NE 97 Street MIAMI SHORES FL 33138-2471 Applicant JORGE MURSULI Phone CeII Contractor(s) Phone TEST AND BALANCE AIR CONDITION (305)218-1798 CeII Phone Valuation: Total Sq Feet: $ 5,000.00 0 Tons: 4 Additional Info: CHANGE OUT Classification: Residential Approved: In Review Comments: Date Denied: Scanning: 3 Date Approved: : In Review Type of Work: Fees Due CCF DBPR Fee DCA Fee Education Surcharge Permit Fee Scanning Fee Technology Fee Total: Amount $3.00 $2.63 $2.63 $1.00 $175.00 $9.00 $4.00 $197.26 Pay Date Pay Type Invoice # MC -12-16-62430 12/22/2016 Check #: 80377 $ 147.26 $ 50.00 12/21/2016 Check #: 80375 $ 50.00 $ 0.00 Amt Paid Amt Due 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 a foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating constru and .ping. Futhprmo I authoriz the above-named contractor to do the work stated. December 22, 2016 Authorized Sign ryfuredwner / Applicant -/ Contractor / Agent Date Building Department Copy December 22, 2016 1 • \b Miami Shores Village Building Department BUILDING PERMIT APPLICATION ❑BUILDING ❑ PLUMBING 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795-2204 Fax: (305) 756-8972 INSPECTION LINE PHONE NUMBER: (305) 762-4949 ELECTRIC ❑ ROOFING Master Permit No. Sub Permit No. 'RECEIVED DEC�2 1 2018 BY_'� w l kl+ Fsc zoiy Mc 10- u3y REVISION EXTENSION ECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION CONTRACTOR JOB ADDRESS: boo Ne 'T `�T ❑ RENEWAL SHOP DRAWINGS City: Miami Shores Folio/Parcel#: Is the Building Historically Designated: Yes NO Occupancy Type: Load: 1 Constructionru/Type: Flood Zone: BFE: FFE: :./ OWNER: Name (Fee Simple Titleholder)tVW 7 �O/c/I y f.4. a( C -57)04.e b rrdlQrhone#: 0S- - 60 6-.2 0Z--() 0 Address: /2.41:5—kr &Yee-yhe. ae{L" # 8? -2- City: /V SY,4m/' State: F. Tenant/Lessee Name: Phone#: County: Miami Dade Zip: 3 3/ 38 Email: S'hce, (graerrea/fy. 67,7 Zip: 33/69/ CONTRACTOR: Company Name: rf - r/ Address: 3.05L/ Phone#: 8/ 77 City: /!// l . 1'7/ State: /1%' ' Qualifier Name: !ry �Zagz�iz— Zip:/ -I Phone#:, a V /bl l n State Certification or Registration #: /_,-41-C71 / S 71 Certificate of Competency #: DESIGNER: Architect/Engineer: Address: Value of Work for this Permit: $ . ,0 j-; Square/Linear Footag Work: Type of Work: ❑ Addition ❑ Alterd'tion _ ❑ New Repair/Replace ❑ Demolition ! J - l 7l /VC -- .7__3 \L �_-r ("t-fr Re- c -/y_ //27 Phone#: City: State: Zip: Description of Work: �GJ ' 4. , Specify color di color thr"u}tile: ` ` , } • 5441:571:7---6...- Y:, ,✓� c+: : ,.: Pm -v s -w,..... .. t j 1. i : Submittal Fee $ 5�" . ..Permit Fee $ �. �O CCF $ �.... O' ,4 ,CO/CC $:' ' x� Scanning Fee $(9, Radon Fee $ a • 3 DBPR $- a -63 Notary $ Technology Fee $ 4 . 4Z Training/Education Fee $ l - Q Double Fee $ Structural Reviews $ p Bond $ TOTAL FEE NOW DUE $ • 2_G/ (Revised02/24/2014) 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 a d a reinspection fee will be charged. Signature OWNER or AGENT The foregoing instrument was acknowledged before me this /9 day of he gem , 20 / 6 by Ctnt /'1 Get/ ,who is personally known to me r who has produced as identification and who did take an oath. NOTARY PUBLIC: Seal: • BRYAN JOSE AMAYA GARCIA MY COMMISSION # FF987789 EXPIRES May 01.2020 Kwicon ***************** APPROVED BY (Revised02/24/2014) N•. q:.i,.. Signature CONTRACTOR The foregoing instrument was acknowledged before me this c:ZO day of d , 20 // , by �kvsin 4lv , who ispersonally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: Seal: ************************************************************* Plans Examiner Zoning Structural Review 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 acce •ta • 1, Job Address (where the work is being done): O kJt 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 1S REQUIRED WITH ALL SUBMITALS AHRI DATA SHEET REQUIRED Change disconnecting means: YES 0 NO ARHI Sheet Attached: YES 0 NO [ Contract Attached: YES 0 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 AI -IU CU PKG PKG UNIT / / PKG UNIT / / EER/SEER 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): I74(P// 3. Voltage of Circuit (208/240/480): 4. Size Disconnecting Means: Contractor's Company Name: i `) J tcrC State Certificate or Registration No. Signature (Revised02/24/2014) Iifier's signature) Phone: ,2iy/Ile Certificate of Competency No. Date: / Z/-41/4 CID . Detail by Entity Name Page 1 of 2 Florida pep men of State I<irf i i r` r.? ry \T1 cifr bbl U fried .` ate oi 1,brida Department of State / Division of. Corporations / Search Records / Deta/ By Document Number / D VISION or Ccy=; rorzr-:c,ra3 Detail by Entity Name Florida Limited Liability Company JAVA HOLDINGS LLC Filing Information Document Number L04000003310 FEI/EIN Number 20-0597202 Date Filed 01/13/2004 Effective Date 01/13/2004 State FL Status ACTIVE Principal Address 12555 BISCAYNE BOULEVARD 877 NORTH MIAMI, FL 33181 Changed: 03/20/2009 Mailing Address 12555 BISCAYNE BOULEVARD 877 NORTH MIAMI, FL 33181 Changed: 03/20/2009 , ecis�d Agent Name & drreess ''Graber, Shane M 12555 BISCAYNE BOULEVARD X877 _ NORTH MIAMI7FL-33181 Name Changed: 04/04/2015 Address Changed: 04/04/2015 Authorized Person(s) Detail Name & Address Title MGRM GRABER, SHANE M http://search. sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entit... 12/21/2016 Detail by Entity Name Page 2 of 2 12555 BISCAYNE BOULEVARD 877 NORTH MIAMI, FL 33181 Annual Reports Report Year Filed Date 2014 01/08/2014 2015 04/04/2015 2016 04/17/2016 Document Images 04/17/2016 -- ANNUAL REPORT 04/04/2015 -- ANNUAL REPORT 01/08/2014 -- ANNUAL REPORT 01/15/2013 --ANNUAL REPORT 09/01/2012 -- ANNUAL REPORT 01/18/2011 --ANNUAL REPORT 01/25/2010 -- ANNUAL REPORT 03/20/2009 --ANNUAL REPORT 05105/2008 -- ANNUAL REPORT" 04/30/2007 -- ANNUAL REPORT 04/28/2006 ANNUAL REPORT 06/29/2005 -- ANNUAL REPORT 01/13/2004 -- Florida Limited Liabilites View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF forrnat View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format View image in PDF format http://search. sunbiz.org/Inquiry/CorporationSearch/SearchResultDetail?inquirytype=Entit... 12/21/2016