PLC-11-66Inspection Number: INSP - 154899 Permit Number: PLC- 1 -11 -66
Scheduled Inspection Date: January 21, 2011
Inspector: Hernandez, Rafael
Owner: EDELMAN, ALEX
Job Address: 9999 NE 2 Avenue
Project <NONE>
Miami Shores, FL 33138-
Contractor: USA PLUMBING & SEPTIC, INC.
Building Department Comments
January 20, 2011
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
For Inspections please call: (305)762 -4949
Permit Type: Plumbing - Commercial
Inspection Type: Final
Work Classification: New
Phone Number -
Parcel Parcel Number 1132060134490
Phone: 305 -856 -1696
INSTALL 2" BACKFLOW PREVENTER IN FRONT OF
WATER METER IN FRONT OF BLGD.
Passed
Failed
Correction
Needed
Re- Inspection
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
Inspector Comments
Page 9 of 15
CHECK VALVE #
1
RELIEF VALVE
CHECK VALVE # 2
PRES VACUUM BREAKER
[ ] leaked
[ 4closed tight
diff.pressure
across check
valve 6 . e l psi
opened at:
9 psi
[
]
[ peaked
[ v�olosed tight
dill pressure
across check
valve D •
psi
air inlet opened
at psi
[ ]
[ 1
psi
did not open
did not open
check valve: leaked
held at
[ ] cleaned only
replaced:
rubber kit [
CV assembly [
Repair. Explain [
]
]
]
[ ] cleaned only
replaced:
rubber kit
RV assembly
Repair: Explain
[
[
[
]
]
]
[ ] cleaned only
replaced:
ribber kit
CV assembly
[ ]
[ _
[ ] cleaned only
replaced:
rubber kit
CV assembly
[ ]
[ ]
dim pressure
across check
valve psi
opened at:
psi
diR pressure
across check
valve
psi
air inlet
psi
chk valve
psi
U.S.A. PLUMBING AND SEPTIC, INC.
STATE CERTIFIED PLUMBING CONTRACTOR CFC 056905
415 S.W. 19 Rd, MIAMI, FLORIDA 33129 OFFICE: (305) -856 -1696 - FAX: (305) 859 -8879
E -MAIL: usaplumbinginc @aol.com
CERTIFICATE No. 1102576
BACKFLOW PREVENTOR CERTIFICATION
CUSTOMER: 514 o fQ' V + e I.: Ce v-1 i DATE OF TEST:
CONTACT PERSON: lot: c rit, ✓ ill z.
STREET ADDRESS: qcaq‘j N 2- a TEL #
LOCATION OF ASSEMBLY: t, ,4 c: CX e., i v-,50- *ran - oc- irx,, k A : ✓-, c
TYPE OF ASSEMBLY:' RP [VI PVB [ ] DC [ ] OTHER [ ] SIZE
MANUFACTURER 1. 1 l a a , MODEL: q 5 SERIAL No. 1 q' 9 C
WATER METER No. t L Li .3 i 9 INLET LINE PRESS: e J PSI
INITIAL TEST: ANNUAL TEST: REPAIR CLEANED: REPLACED:
BUSINESS NAME: U.S.A. PLUMBING AND SEPTIC, INC. PHONE: 305 - 856 -1696 FAX: 305- 859-8879
Test Equip. Used: MIDWEST Calibration date : Feb 21, 2010
I HEREBY CERTIFY THAT THIS DATA IS ACCURATE AND REFLECTS THE PROPER OPERATION AND
MAINTENANCE OF THE ASSEMBLY.
Testing Co. I.S.I. MODEL: 830
CERTIFIED TESTER SIGNATURE PRINT NAME: ANTONIO L.GARCIA
EXPIRATION DATE: 6 -05 -2012
BUILDING
PERMIT APPLICATION
FBC 20
Permit Type: PLUMBING C, /
Owner's Name (Fee Simple Tiitl eholder) —= 70/ / Phone #
Owner's Address ��' , /'� c' -�/ �'
City/ V / °�/ j 5 State Zip 3
Tenant/Lessee Name d � r Phone #
Email 7,/,7/044 ( � i �'G /a/J&'Z'(k• 'J 4 L��f
Job Address (where the work is being done)
City Miami Shores Village County _ Miami -Dade
y
FOLIO / PARCEL # /�°��,�s'
Is Building Historically Designated YES NO
Contractor's Company Name V g_ P P LV M Ij l Ill L 5 6 p776 6 /)1/f Phone # 305 - 83 " / b 9
Contractor's Address Lt 1 S S Lk) O J 2 b
City PIT 1 A 7M L State L°. 4
Qualifier Name A T% J TC ki L L) L 6- i g C l 4 Phone# 5 /14
Z
State Certificate or Registration No.0 65"h TO 5
Contact Phone3 D 5'7 7 g / LI 2_ ?
Architect/Engineer's Name (if applicable) Phone #
Value of Work For this Permit $ q ,S ( Square / Linear Footage Of Work:
Type of Work:
Describe Work:
1 10
Addition DAlteration :New
/VgT4 L ®JAI ( 2l/
(Ai re :72 E -re 2-
Submittal Fee $
******** * * * * * * * * * * *** * * * * * * * * * * * * * * * * * Fees**** * * * * * * * * * * *** * * * * * * * * * * *** * * * **
Notary $
Scanning $ Radon $
Double Fee $
Miami Shores Village
Building Department
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
ggqc 1 U E 2/qv-
Training/Education Fee $
DPBR $
Permit No. fl,C, 1 1 V
Master Permit No.
Zip 3 E ' z q
Certificate of Competency No. C. rC ® 5 - 6 965
E -mail US)9eiv ,e Py06 / fl; C RaL
Zip
Repair/Replace ❑ Demolition
Flood Zone
Permit Fee $ /4 CCF $ CO /CC $
Technology Fee $
Bond $
NIE@MMI'
.uw i 1 200 J ql �
8Y:m
Violation date:
Structural Review. $ Total Fee Now Due $ L (C
See Reverse side -
Bonding Company's Name (if applicable)
Bonding CompankAddress
City
Sign:
Print:
My Commission Expires:
(Revised 07 /10 /07)(Revised 06/10/2009)
wner or Agent
The foregoing instrum:' t was acknowledged before me this !
day of �, 20 i lk, by ;Silt I (At ,
who is personally known to me or who has produced C '..L
As identification and who did take an oath.
NOTARY PUBLIC:
State Zip
/ A-
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State
Engineer
Signature
My Commission Expires:
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 ELECTRICAL WORK, PLUMBING, SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and 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 t "at a copy of the notice of commencement and construction lien law brochure will be delivered to the person
whose property is subj 'et to atta hment. Also, a certified copy of the recorded notice of commencement must be posted at the job site
for the first inspectio tiyhicfh occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the
inspection will not be i 1 ove Od a reinspection fee will be charged.
Cf eh tractor
The foregoing instrument was acknowledged before me this
day of , 20 AL, by n O A
who is personally known to me or who has produced l 1
as identification and who did take an oath.
NOTARY PUBLIC:
Sign: \enis
Print: `\ M
3ede4r,Y #oYFr****9e4 * ** *9r *a4o *** *9e9e*4341p re vri nlr *qtr `vWc** *dr***** *�Y:Ld *** *oY,�3eat4r *4eeY�Ydr�SroY4e ****fie *oY9coY�4oYoYdedeV �Y, fio3'.9 \tk • * �
` 7,10/1.21q) / A 0 /,,�� FL O R O, ����`
APPROVED BY Plans Examiner �
ExpJ G co
®,
cp C0 4, U®!/
%mil• 5g .�
Clerk checked