PL-20-1114Miami Shores Village RECEIVED
Building Department JUN 0 3 2020
10050 N.E.2nd Avenue, Miami Shores, Florida 3313E BY:
Tel: (305) 795-2204 Fax: (305) 756-8972
INSPECTION LINE PHONE NUMBER: (305) 762-4949 L
FBC 201-
Master Permit No.FL-O(o-20- II +
❑BUILDING ❑ ELECTRIC ❑ ROOFING
Sub Permit No.
❑ REVISION ❑ EXTENSION RENEWAL
[?'PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP
CONTRACTOR DRAWINGS
JOB ADDRESS: 7' �_ /f/ C/ 9 2 --Fz".1 '?
City: Miami Shores Count:_ Miami Dade Zip:
Folio/Parcel#:_ / - 03 2 Ow/ -013— �0 Z LO Is the Building Historically Designated: Yes NO
Occupancy Type: Load
OWNER: Name (Fee Simple Titleholder):_
Aridrp, 7_ V0 'O!/- c 97
Construction Type: Flood Zone: BFE: FFE:
one#:_1i(6 . L0 S IF / ke;
City: & r /1 P�z" State: 74(_ Zip:
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: Phone#: r) iv 9f — 46 ,72 �-
Address: / 7 ri Ate- cry z _X > '_;-
City: State: _� C_ Zip: 3 r ;5,e
Qualifier Name:, %.� �'.� G p.�� -� Phone#: ,3c .3/a --
State Certification or Registration #: Certificate of Competency #: 9��n
DESIGNER: Architect/Engineer: Phone#:
Address: r City: State: Zip:
r
Value of Work for this Permit: $ 6 o 0 f _ Square/Linear Footage of Work:
Type of Work: ❑ Addition Alteration ❑ New ❑ Repair/Replace ❑ Demolition
Description of Work:-
X
Specify color of color thru tile:
Submittal Fee $ Permit Fee $ CCF $ CO/CC $
Scanning Fee $ Radon Fee $ DBPR $ Notary $
Technology Fee $ Train Ing/Education Fee $ 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
City
State
Zip
®7
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 estimatedvalue 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 offer 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 Signature
44
O ER or AGEN ?ONTRACTOR
The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this
G day of er-4-w C _ 20 2 by q A q0day of C- 20 2-0 by
+� who is personally known to .1.-� a� who is personally known to
me or who has produced as me or who has produced as
identification and who did take an oath.
NOTARY PUBLIC:
�, ,5. E ER
tOt:2iiSSt6tG97
Sign: �., i3oidTi,ro�EtNet�(srlEikl
Print:
Seal:
identification and who did take an oat,,,,,
NOTARY PUBLIC: soxoe TOLtoo
My tl"iCX A CG 020807
ExpiRUS August 22.2026
n� w
o Bonded ThN t:0t83 r ub c Utateh161e15
Sign:
Print:
Seal:
APPROVED BY � �a Plans Examiner Zoning
Structural Review Clerk
(RevisedO2J2412014)
PL -O(10 7n -1 11 y
MIAMI-DADE WATER & SEWER DEPARTMENT
METER OPERTATIONS & MAINTENANCE
MIAMI-DADE CROSS -CONNECTION CONTROL UNIT
1001 N.W.11th STREET, MIAMI, FL 33136-2209
Phone (305)547.3046 Fax(786)268-5485
BACKFLOW PREVENTION ASSEMBLY TEST REPORT FORM
ADDRESS OF DEVICE 240 NE 97thSt Miami Shores FI ,
OWNER OF DEVICE: New Installation
OWNER CONTACT: Affordable Irrigation —Marco
PHONE:: 305 6816322
FAX: 305 6816321
1
ADDRESS OF OWNER: SAME
ZIP CODE:: 33160
NAME OFT STER
CERTIFICATION #:
EXPIRATION DATE:
PHONE:: 305 273 6100
2
ROBERTO COLLAZO
H02384
12/17/21
BUSINESS NAME:
BUSINESS ADDRESS: P.O. BOX 833323 M IAM 1, FL
ZIP CODE:
MRC PLUMBING & BACKFLOW, INC.
33283
3
TEST KIT MAKE:: M I DWEST
MODEL #: 835
SERIAL M 09091454
DATE LAST CAL.
SITE TUBE:
02/03/20
YES / NO
TEST PLEASE MARK: R.P. D.C. P.V.B. X
MAKE OF ASSEMBLY:
MODEL NO:
SERIAL #:
SIZE:
Wilkins
720A
CB699567
1"
LOCATION OF ASSEMBLY: SE Of the Property
HAZARD/SERVICE:
METER NO 18309988
4
INITIAL TEST: X ANNUAL TEST:
DATE OF TEST: 1610112020
METER READING:
SHUT OFF VALVE #1:
SHUT OFF VALVE #2:
CLOSED TIGHT:
CLOSED TIGHT:
LINE PRESSURE: 7O
PRESSURE STABLE: YES
LEAKED:
LEAKED:
D.C.V.A. RP.Z.A. P.V.B.
CHECK VALVE NO.1
CHECK VALVE NO.2
DIFFERENTIAL RELIEF VALVE
AIR INLET
CHECK VALVE
Closed Tight:
Closed Tight:
FAILED TO OPEN:
FAILED rooPEN:_
LEAKED:_
co
u'
Leaked:
Leaked:
�
OPENED AT:
PRESSURE DIFFERENTIAL ACROSS CHECK
PRESSURE DIFFERENTIAL ACROSS CHECK
HELD AT:
PSI
PSI _
OPENED AT: PSI.
3.8
1.6 PSI
PSI
IF THE ASSEMBLY FAILS FOR ANY REASON, COMPLETE THIS SECTION AND NOTE REPAIRS
REMARKS I REASON FOR FAILURE (IF APPARENT):
CHECK VAVLE NO. 1
CHECK VAVLE NO.2
DIFFERENTIAL RELIEF VALVE
P.V.B.
N
CLEANED:
CLEANED:
CLEANED:
CLEANED:
w
Q
REPLACED:
REPLACED:
REPLACED:
REPLACED:
a
w
D.C.V.A. R.P.Z.A. P.V.B.
CHECK VALVE NO. 1
CHECK VALVE NO.2
DIFFERENTIAL RELIEF VALVE
AIR INLET
CHECK VALVE
I j
Closed Tight:
Closed Tight:
FAILED TO OPEN:
FAILED TO OPEN:_
LEAKED:_
WOPENED
AT:
HELD AT:
Leaked:
Leaked:
OPENED AT: PSI
PSI
PSI
PRESSURE DIFFERENTIAL ACROSS CHECK
PRESSURE DIFFERENTIAL ACROSS CHECK
PSI
PSI
I CERTIFY THAT I HAVE TESTED THE ABOVE ASSEMBLY IN ACCORDANCE WITH THE A.W.W.A. CROSS CONNECTION CONTROL MANUAL AND THAT ALL THE INFORMATION IS
ACCURATE TO THE BEST OF MY ABILITIES.
p�
arr "'m Va//n'
DATE: 06/09/2020
SIGNATURE OF CERTIFIED TESTER: Device Passed X Device Failed
NOTE: TEST FORM MUST BE COMPLETED IN ITS ENTIRETY. INCOMPLETE TEST FORMS WILL BE RETURNED.
•.r.
IRRIGATION DETAILS
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IVC.W 091
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RAIN BIRD PGA VALVE
OPY
BIRD CONTROLLER DETAI
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u�i� rew,uew.fwew.�e
' a< noxou.,.aoxww.wuws
PRESSURE VACUUM BREAKER RAIN BIRD 1800 SERIES SPRINKLER
Irrigation Legend
—► (1)
1" P.B.V backflow preventer
0
1" PGA rainbird valve
& ®
Rainbird 1804 spray heads
9�LAIQ-*
Rainbird 5400-4 rotor heads
A
Rain sensor
FC]
Rainbird Controller
�-
1" p.v.c sch. 40 main line
Existing Y. water meter
9
Alley
gEcEIVED
JUN 0 3 2020
1
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�.00camro�u�smcrmww�
RAIN BIRD MINI-CLIK RAIN SENSOR
.Affordable irrigation inc.
198 n.w 139 street
Miam florida
305 681 6322
96P000219
97t" Street
pLU'MBING PLANS
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SHEET
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