The URL can be used to link to this page

PL-13-2572Inspedlon Worksheet Miami Shores Village 10050 .N.E. 2nd Av"ue Miami Shores, FL Phone. f305)795-2204 Fax: (306)7664972 Contractor DESIMAR PLUMBING INJC Phone: (305)594-4930 LAWN SPRINKLERS False Oecember D2, 2013 For Inspections please call: {306}762-4049 Page 34 of 40 MIAMI -DADE WATER & SEWER DEPARTMENT METER OPERTATIONS & MAINTENANCE CROSS- CONNECTION CONTROL UNIT 1001 N.W.11th STREET, MIAMI, FL 33136 -2209 Phone (305) 5473046 ? Fax (305) 545.9555 BACKFLOW PREVENTION ASSEMBLY TEST REPORT FO ADDRESS OF DEVICE: ®� , f y� 0 ® / OWNER OF DEVICE: i C [G OWNER CONTACT: �'�� PHON� FAX: 1 ADDRESS OF OWNER: ZIP CODE:: NAME OF TESTE uq CERTIFICAT I J EXPI DATE:: 2 BUSINESSNAMErn 1 1 Idq + BUSIN�SAqD� 0L� g�-y C_/° a r ( (�� r' 3 TEST KIT MAKE:: MODEL # SERIAL # DATE LAS AL. SITE TUBE: r YES /NO MAKE OF � � � BLY�: � W/JJ s� MODEL NO: � � � � SERIAL* p � / � SIZE: � r LOCATION OF ASSEMBLY: 19 L HAZARDISE ICE: / METER NO. 4 INITIAL TEST: 61-41 ANNUALTEST: DATE OF TEW METER READING: SHUT OFF VALVE #1: CLOSED TIGHT: — SHUT OFF VALVE 92: CLOSED TIGHT: - Leoo� PRESSURE STABLE: YES - NO LEAKED: LEAKED: LINE PRESSURE: CHECK VALVE NO.1 CHECK VALVE NO.2 Closed Tight: Closed Tight: 1H Leaked: Leaked: PRESSURE DIFFERENTIAL ACROSS CHECK PRESSURE DIFFERENTIAL ACROSS CHECK PSI PSI REMARKS I REASON FOR FAILURE (IF APPARENT): N CLEANED: CLEANED:_ OC Q REPLACED: REPLACED: D. W Ix CHECK VALVE NO.1 CHECK VALVE NO.2 y Closed Tight: Closed Tight: W F— W It Leaked: Leaked: PRESSURE DIFFERENTIAL ACROSS CHECK PRESSURE DIFFERENTIAL ACROSS CHECK PSI PSI DIFFERENTIAL RELIEF VALVE FAILED TO OPEN: OPENED AT: PSI. CLEANED: REPLACED: DIFFERENTIAL RELIEF VALVE FAILED TO OPEN: OPENED AT: PSI AIRINLET CHECKVALVE FAILED TO OPEN:_ LEAKED:_ OPENED AT: HELD AT: any PSI �&� PSI CLEANED: REPLACED: AIR INLET CHECKVALVE FAILED TO OPEN: _ LEAKED: — OPENED AT: HELD AT: PSI PSI SIGNATURE OF CERTIFIED TESTER: DATE'� FOR OFFICE USE ONLY: DATE: Revised: 01/10/2005 www .miamidade.govtwasd/backflow.asp I " Inspection Worksheet Miami Shores Village 1066*0 N.E. 2nd Avenue Miami Shores, #L Phone (306)796.2204 Fax (306)7564072 inspection Number: INSP-203866 Permit Number: PL-11-1372-5,72 Scheduled Inspection. Date., December 03, 2013 Permit Type: Plumbing - Residential Insioector Diaz. Osvaldo Owner. ROIDIEk 40(00RE & EMILIE Job Address: 1009 NE 104-Street Miami Shores, R 31138-2655 . Project, <NONE> Inspection Type: Rough Phone Number ftrcel Number 1122320290140 Contractor: DESMAR PLUMBING INC Phone- (306)6944930 LAWN SPRINKLERS Failed Correction Needed Re-Inspection Fee No Additional InWctions can be scheduled until re-Inspection fee it pafd Inspector Comments. CREATED AS REINSPECTION FOR INSP-203039, ROUGH IRRIGATION OK WILL REQUIRE BACK-FLOW CERTIFICATION FOR FINAL ALL. SPRINKLER HEADS SHALL BE A MINjMUM**O**F ON FOOT AWAY FROM BUILDING WALL December O2,2013 For .inspections please.call: (305).76 49 Page 35 of 40 Miami Shores Village Building Department 90050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fag: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 BUILDING PERMIT APPLICATION Permit Type: PLUMBING JOB ADDRESS: I P ! &A. / o 4 s-r NGV 13 260 BY. -1c eA--- FBC 20 C C:> Permit No. ? L 1 3= Master Permit No.-I C A a 5 City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: Is the Building Historically Designated: Yes OWNER: Name (Fee Simple Titleholder): Addre�cc IO • (b 1 C NO Flood Zone: 2 Phone0 J q ZS* °"b City: 017 / 4en i State: 41— Zip: 3324/ Tenant/LesseegN�amee: Email: M Ali-. Wm CONTRACTOR: Company Name: s 1 ,r ;;, AV_ P( , fit ® Phone#: �5�� , ®79 Address a5i A Ord Cs3 A145 City: P � State: Zip. Qualifier Name: Equk &aeL Phone #: State Certification or Registration #: cis.. ice/ N Certificate of Come petency, #: Contact Phone #: Email Address: DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ ( ® Square/Linear Footage of Work: Type of Work: ❑Address a DAlteration � e�3� — ORepair/Replace Description``of Work: Submittal Fee $ O' Permit Fee $ CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ Technology Fee $ TOTAL FEE NOW DUE $ ODemolition 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 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." . n 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 gbsgnce of such posted notice, the inspection will not be approved and a reins' eee will be charged. Owner or Agent oregoing instrument was acknowledged before me this L day of , 20 � by �'iL90k, "OZ- who is personally known tome or who has produced I PJ , �✓(Q As NOTARY PUBLIC: Sign: �C g Print: My Commission Expires: WUdlicNFiic lj& an oath. by '''% �o= Signature Contractor The foregoi ms meent was acknowl ed before me this day of C, 20 , 20 , by V vl N aI who is personally known to me or who has produced as identification and wh ' take an oath. NOTARY P LIC: Sign: !rJ9KEL e OT Y Print: U IC My Commissi Comm# EE161218 Et�� l- xpires 1/18/2016 APPROVED BY Plans Examiner Zoning Structural Review Clerk (Revised3 /12 /2012)(Revised 07 /10 107)(Revised 06 /10 /2009)(Revised 3/15/09) ACORD,. CERTIFICATE OF LIABILITY INSURANCE 08/16/2013 08 /1M/DD013 PRODUCER (305) 270 -1424 Pan Am Assurance Agency, Inc 9100 Sunset Drive Miami FL 33173 -3433 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED DESMAR PC, INC. 6405 NW 36 Street Suite #123 MIAMI FL 33166- INSURER A: NORTH POINTE CASUALTY INS LIMITS INSURER B: BUSINESS FIRST INS CO 10 050 N.E. 2 Ave. INSURER C: Miami Shores FL 33138- INSURER D: % / INSURER E: $ 1,000,000 IKeP/ =1: vAci ZI.9 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD'L INSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD POLICY EXPIRATION DATE MM/DD/YY) LIMITS A 10 050 N.E. 2 Ave. GENERAL LIABILITY Miami Shores FL 33138- / / % / EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE X❑ OCCUR 3094120082 01/07/2013 01/07/2014 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MEDEXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 7X POLICY F1 JECT F1 LOC PRODUCTS - COMP /OP AGG $ 2,000,000 AUTOMOBILE LIABILITY ANY AUTO / / f / COMBINED SINGLE LIMIT (Ea accident) $ ALL OWNED AUTOS SCHEDULED AUTOS / / / / BODILY INJURY (Per person) $ HIREDAUTOS NON -OWNED AUTOS / / / / BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO / / / / OTHER THAN EA ACC $ $ AUTO ONLY: AGG EXCESS/UMBRELLA LIABILITY % / % / EACH OCCURRENCE $ AGGREGATE $ OCCUR F-1 CLAIMS MADE DEDUCTIBLE / / / f $ $ RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABIUTY 52103296 08/16/2013 08/16/2014 WCSTATU- TR TORY LIMITS X ER E.L. EACH ACCIDENT $ 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? If yes, describe under E.L. DISEASE - EA EMPLOYEE J$ 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS /LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS CERTIFICATE HOLDER rANrFI I AT7nN ( ) - (305) 756 -8972 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 030 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT Miami Shores Village FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE Building Department INSURER, ITS AGENTS OR REPRESENTATIVES. 10 050 N.E. 2 Ave. AUTHORIZED REPRESENTATIVE Miami Shores FL 33138- ACORD 25 (2001/08) © ACORD CORPORATION 1988 q , INS025 (0108).05 ELECTRONIC LASER FORMS, INC. - (600)327 -0645 Page 1 of 2 . . p� RS Miami, t-I ssloo To( /`�V�Ic�� From: 0 Urgent Cl. For Review 0 Please Comment O Please Reply 0 Please Recycle 'I�IvN�s iN al�vd�l .. de• n BY I DATE ZONING TR CTURAL ELI CTRICAL r Mir I MEC IAN BLI IG. SU 1ECT T(! LIANCE WITH ALL STA E AND COON b _&E( Ur D T - j0-0 `Do � (A oza �r D z N 8 � fi F- w 0 a 43.78'C. 43.15•P 0 -Y P1 G pi 1 11 mg H 11 g�f3 ° 1X -M' P.L ° 5.89'5715 "E 134.87' BISCAYNE CANAL $ — WIAiN.TWOQDTf�R Txmrwwsaeertmewa< $ /� HAVEBBa ZrTo0mMmPrl rPSRODIER RESIDENCE EWARMLOMPEP M Tonm 1 + IRRIGATION PLAN 1009 N.E. 104TH STREET ��y, P1 eaanannau wr mmasHom MIAMI SHORES, FLORIDA VaLwe umanx of . .� BB?3NW iT1IAtE 1M1YFl2R18 ®OAR O&ANZ,P£CQVOATAMEKiHJ@� { OOzJ)�oGd d•DO i I ®®© a � c� 43.78'C. 43.15•P 0 -Y P1 G pi 1 11 mg H 11 g�f3 ° 1X -M' P.L ° 5.89'5715 "E 134.87' BISCAYNE CANAL $ — WIAiN.TWOQDTf�R Txmrwwsaeertmewa< $ /� HAVEBBa ZrTo0mMmPrl rPSRODIER RESIDENCE EWARMLOMPEP M Tonm 1 + IRRIGATION PLAN 1009 N.E. 104TH STREET ��y, P1 eaanannau wr mmasHom MIAMI SHORES, FLORIDA VaLwe umanx of . .� BB?3NW iT1IAtE 1M1YFl2R18 ®OAR O&ANZ,P£CQVOATAMEKiHJ@� {