PLC-13-2127Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795 -2204 Fax: (305)756 -8972
nspection Number: INS P- 199510 Permit Number: PLC -9 -13 -2127
Inspection Date: November 07, 2013 Permit Type: Plumbing - Commercial
Inspector: Diaz, Osvaldo
Inspection Type: Final
Owner: , BARRY UNIVERSITY Work Classification: Addition /Alteration
Job Address: 11300 NE 2 Avenue Powers Building
Miami Shores, FL 33138 -0000
Project: BARRY UNIVERSITY
Contractor: MARLIN PLUMBING OF MIAMI INC
Buildina Denartment Comments
Phone Number
Parcel Number 1121360010160 -20
Phone: 305 -652 -6108
REPLACE EXISTING DOMESTIC
4" BACKFLOW
Infractio Passed Comments
INSPECTOR COMMENTS False
Passed
Inspector Comments
Failed
Correction
Needed
Re- Inspection ❑
Fee
No Additional Inspections can be scheduled until
re- inspection fee is paid.
For Inspections please call: (305)762 -4949
November 06, 2013 Page 1 of 1
OF MIAMI, INC
20145 N.E 16th Place
Miami, Florida 33179
Phone: (305) 652 -3031
Fax: (305) 652 -3135
Licensed & Insured CC# CFC048292
BACKFLOW PREVENTION ASSEMBLY TEST REPORT FORM
ADnRFCc nc
Ow F
01 C NTACT:
FAX
1
ADDRESS OF OWNER:
ZIP CODE:
TESTER: /
NA OF/S
CATION #
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+P TE:
+ "
PHONE:
2
B ESS NAME
r —EXPIRATOND
BUSINESS ADDRESS:
1 4-
ZIP CO^ DDE ::
3
TEST KIT MAKE: _
Mj
SERIAL k.
DATE LAST CAL.
' ,S_— j+
SITE TUBE:
YES 0
TEST PLEASE MARK: R.P. Q.C. P.V.B.
p� / (
SERIAL t.
(AZARDISERVICE:
SIZE:
H
L ON Of LY: �� P` e -'n�� �� ` ^/�
(��
METER N0, C16' / ®(j
INITIAL TEST: �/'�` ANNUAL TEST: _ _
DA OF TEST ,. ��
40
METER READI G 6 J)® '7 'If L)
SHUT OFF VALVE #1:
CLOSED TIGHT:
SHUT OFF VALVE #2:
CLOSED TIGHT: _ �' —
—
LINE PRESSURE: �
PRESSURE STABLE• ES -)NO
LEAKED:
LEAKED:
D.C.U. .. R.P.B. , PS.B.
CHECK VALVE NO.1
CHECK VALVE NO.2
DIFFERENTIAL RELIEF VALVE
AIR INLET
CHECK VALVE
Closed Tight:
Closed Tight: /
FAILED TO OPEN:
FAILED TO OPEN:_,
LEAKED:_
H
Leaked:
Leaked:
OPENED AT:
PRESSURE DIFFERENTIAL ACROSS CHECK
PRESSURE DIFFERENTIAL ACROSS CHECK
HELD AT:
�j
PSI
PSI
AA�
OP ENEDAi,� . : PSI.
PSI
PSI
IF THE
ASSEMBLY FAILS FOR ANY REASON COMPLETE THIS
SECTION AND NOTE REPAIRS
REMARKS / REASON FOR FAILURE (IF APPARENT):
CHECK VAVLE NO.1
CHECK VAVLE NO.2
DIFFERENTIAL RELIEF VALVE
P.V.B.
N
CLEANED:
CLEANED:
CLEANED:
CLEANED:
Q
REPLACED:
REPLACED:
REPLACED:
REPLACED:
G.
W
OS
D.CN A. R.P.ZA, P.Y.B.
CHECK VALVE-NO,1
CHECK VALVE NO.2
DIFFERENTIAL RELIEF VALVE
AIR INLET
CHECK VALVE
y
Closed Tight:
Closed Tight:
FAILED TO OPEN:
FAILED TO OPEN:
LEAKED'
W
�
OPENED AT:
HELD AT
W
Leaked:
Leaked:
PSI
PSI
PRESSURE DIFFERENTIAL ACROSS CHECK
PRESSURE DIFFERENTIAL ACROSS CHECK
OPENED AT: PSI
PSI
PSI
I CERTIFY THAT I HAVE TESTED THE ABOVE ASSEMBLY IN ACCORDANCE WITH THE A.W,WA CROSS CONNECTION CONTROL MANUAL AND THAT ALL THE INFORMATION IS
ACCURATE TO THE BEST OF LMES.
SIGNATURE OF EDT R:
DATE: /0
_��5
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
PERMIT APPLICATION
Permit Type: PLUMBING
JOB ADDRESS: 11300 NE 2ND AVENUE POWERS HALL
FBC 20
SEP 19 2013
Permit No. /�
Master Permit NoT I l - 13 2124
City: Miami Shores County: Miami Dade gip; 33161
Folio/Parcel #: 11- 2136- 000 -0050
Is the Building Historically Designated: Yes NO Flood Zone:
OWNER: Name (Fee Simple Titleholder): BARRY COLLEGE Phone #: 305 - 899 -3795
A,,,,,.0...11300 NE 2ND AVE
City: MIAMI SHORES
State: FL
TenandUssee Name: Phone#:
Email:
CONTRACTOR: Company Name: MARLIN PLUMBING OF MIAMI, INC
Address: 20145 NE 16TH PLACE
City: NORTH MIAMI BEACH State: FL
Qualifier Name: EDWARD J WALKER
33161
305 - 652 -3031
Up: 33179
305 - 652 -3031
State Certification or Registration #: CFC048292 Certificate of Competency #: _
Contact Phone#: 305 - 652 -3031 Email Address: MARLINPLUMBING@AOL.COM
DESIGNER: Architect/Engineer: Phone #:
Value of Work for this Permit: $ 4,350.00 Square/Linear Footage of Work:
Type of Work: DAddress ❑Alteration ONew ❑Repair/Replace
Description of Work: REPLACE EXISTING DOMESTIC 4" BACKFLOW
Submittal Fee
Scanning Fee $
Permit Fee $
Radon Fee $
I Sc --
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CCF $ CO /CC $
DBPR $ Bond $
Technology Fee $
ODemolition
TOTAL FEE NOW DUE $ ru
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
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 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 and a reinspection fee will be charged.
Signature Signature
Owner or Agent IK Contractor
The foregoing instrument was acknowledged before me this `3 The foregoing instrument was acknowledged before me this.
day of VX20 13, by WNCre day of &,64 20 , by Z&3&rel X I
who is personally known to me or who has produced who is personally known to me or who has produced
NOT
As identification and who did take an oath.
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APPROVED BY —ZG "l) Plans Examiner
Structural Review
(Revised3 /12/2012)(Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09)
as identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
My
MY COMISSM 9 DD 943808
EXPIRES: December 6,201 a
r7TR 1
Clerk
W1
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PLUMBING PLANS
Approved --DaW
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http://www.barry.edu/includes/img/maps/miami-shores-campus-map-990-2.jpg 9/25/2013
Miami Shores Village
Building Department
10050 N.E.2nd Avenue
Miami Shores, Florida 33138
Tel: (305) 795.2204
Fax: (305) 756.8972
Date: q -1 1`1— l ---s
Permit No: P L C
FBc- IQ-74 .
Osvaldo "Ozzie" Diaz
Chief Plumbing Inspector
Plumbing Critique
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Plan review is not complete, when all items above are corrected, we will do a complete
plan review.
If any sheets are voided, remove them from the plans and replace with new revised
sheets and include one set of voided sheets in the re- submittal drawings.