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PLC-14-520Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-209141 Permit Number: PLC -3-14-520 Inspection Date: August 28, 2014 Permit Type: Plumbing - Commercial Inspector: Diaz, Osvaldo Inspection Type: Final Owner: , BARRY UNIVERSITY Work Classification: Addition/Alteration Job Address: 11300 NE 2 Avenue Soccer Stadium Miami Shores, FL 33138-0000 Project: BARRY UNIVERSITY Contractor: MARLIN PLUMBING OF MIAMI INC Buildina Department Comments Phone Number Parcel Number 1121360010160-37 Phone: 305-652-6108 REPLACE 1' RPZ BACK FLOW AND CERTIFY UNIT AT Infractio Passed Comments INSPECTOR COMMENTS False SOCCER FIELD Passed Inspector Comments WI LK I cl 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 August 28, 2014 Page 1 of 1 of PL- ILI--5 3 20145 N.E 16th Place Miami, Florida 33179 ell! Phone: (305) 652-3031 Fax: (305) 652-3135 292 M 1 A M I I N Licensed & Insured CC# CFC048 BACKFLOW PREVENTION ASSEMBLY TEST REPORT FORM MR J I ADDRESS OF DEVICE:, vN�Uf OWN OF DEVICE: ` II * J 1 OWNER CONTACT PHONE: FAX: ? ADDRESS OF OWNER: ZIP CODE: N TESTER: �i Cr—ra—.! C FICATION M 6 —10-,2_2 PIRATION DATE' — r' PH NE: i o s — GJ'� 2 BUSINESS NAME BUSINESS ADDRESS: ZIP CODE. 113 3 TE4T KIT MAKE: l EL #: K SERIAL t. �l �l DATE LAST CAL. SITE TUBE: 'r �� 1 1 7 YES C I TEST PLEASE MARK: R.P. D.C. P.V.B. MAKE OF ASSEMBLY: MO NO: SERIAL* SIZE: I �I d I LOC TION OF ASSEMBLY: !. �Pr / tA� I P oc- HAZARDISERVICE. MEM O ���� -- DATE OF TEST: - — - _�- .,� �L — 4 INITIAL TEST: ANNUAL TEST: M REF�f_ / (J(J I SHUT OFF VALVE #1: SHUT OFF VALVE #2: CLOSED TIGHT: _ 'CLOSED TIGHT:_—__ LINE PRESSURE: _qQ__ PRESSURE STAB YES - NO 11 I LEAKED: , LEAKED: — D.C.U. R.P,Z.A. RVA — - _ CHECK VALVE NO, I CHECK VALVE NO.2 DIFFERENTIAL RELIEF VALVE AIR INLET CHECK VALVE Closed Tight: Closed Tight: FAILED TO OPEN: I FAILED TO OPEN: LEAKED: I i Leaked: Leaked: PRESSURE DIFFERENTIAL ACROSS CHECK PRESSURE DIFFERENTIAL ACROSS CHECK 1 OPENED AT. HELD AT f OPENED AT: PSI. PSI PSI PSI PSI IF THE ASSEMBLY FAILS FOR ANY REASON, COMPLETE THIS SECTION AND NOTE REPAIRS REMARKS i REASON FOR FAILURE (IF APPARENT): CHECK VALLE NO. 1 CHECK VAVLE NO.2 DIFFERENTIAL RELIEF VALVE P V.B. I � I N LCLEANED CLEANED: CLEANED: �_- � I CLEANED: Q REPLACED: ` REPLACED: REPLACED: ( REPLACED. p 0.LU II t D.C.VA. R.P.2A. P.V.B. CHECK VALVE NO. 1 CHECK VALVE N0.2 DIFFERENTIAL RELIEF VALVE E _ _ AIR INLET CHECK VALVE _ j i Closed Tight: Closed Tight: FAILED TO OPEN: FAILED TO OPEN LEAKED: _. Ii LU LU II ) I OPENED AT: HELD AT ---"y 4 Leaked: I Leaked: ,I �I I PRESSURE DIFFERENTIAL ACROSS CHECK PRESSURE DIFFERENTIAL ACROSS CHECK OPENED AT. PSI PSI j PSI I 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 9 9� ACCURATE TO THEM • MY AB 'STER: _ SIGNATURE OF F PATE; !y C 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 BUILDING PERMIT APPLICATION Permit Type: PLUMBING JOB ADDRESS: 11300 NE 2ND AVENUE SOCCER FIELD FBC 20 Permit No, Master Permit No.plr l 7 City: Miami Shores County: Miami Dade gip: 33161 Folio/Parcelt 11-2136-000-0050 Is the Building Historically Designated: Yes NO Flood Zone: OWNER: Name (Fee Simple Titleholder): BARRY COLLEGE Phonet 305-899-3995 Address: 11300 NE 2ND AVENUE City: MIAMI SHORES State: FL Zip: 33161 Tenant/Lessee Name: Phone#: Email: CONTRACTOR: Company Name: MARLIN PLUMBING OF MIAMI, INC Phonet 305-652-3031 Address: 20145 NE 16TH PLACE City: NORTH MIAMI BEACH State: FL Zip: 33179 Qualifier Name: EDWARD J WALKER Phone#: 305-652-3031 State Certification or Registration #: CFC048292 Certificate of Competency #: Contact Phone#: 305-652-3031 Email Address: MARLIN PLU MBI NG@AOL.COM DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $ 680.00 Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New Repair/Replace ❑Demolition Description of Work: REPLACE 1" RPZ BACKFLOW AND CERTIFY UNIT AT SOCCER FIELD Submittal Fee $�Permit Fee $>SO , f CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Mortgage Lender's Name (if applicable) Mortgage Lender's Address City Zip 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. The foregoing instrument was acknowledged before me this `� The foregoing instrument was acknowledged before me this -L - day of Ak) , 20 �, by SSI eta, 0NVA KA "0 day of �c , 20 , by JWt d �CQir wl�: Ily known to me or who has produced who is personally known to me or who has produced As identification and who did take an oath. as identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: Sign: Sign:. Print: Ta ® Print '�ei'X��i�! My Commission Expires: ( y1,1` b 1 Y 7. YAO MY COMMI33ION # EE3W9 ,`,, u �� lvtExpu s: Novi 12, 2014 o THERESA MCCREERY n xomryn 7 �. ' _i�oaixornsY _ A1. HOWY Public - IM d Floft COmtMi M r FF 0i OT APPROVED BY 18-1 Plans Examiner Zoning Structural Review (Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09) Clerk r aco CERTIFICATE OF LIABILITY INSURANCE 11/22/201DATE 3) THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terns and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen s . PRODUCER NAME 'Kristina Snellina FAX Ke es Coverage Insurance PHONE _ 2 -7(AIC' A/C No 5900 Hiatus Road EMAIL Tamarac FL 33321 ADDREssRsnelling0keyescover ge.com INSURERS AFFORDING COVERAGE NAIC 0 INSURERA: Insurance CO 41297 INSURED 5937 - INSURER 136ridgefield Employers Marlin Plumbing of Miami, Inc.. INSURER C: 20145 N.E. 16th Place INSURER D: Miami FL 33179 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 9AA917179caa REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDLISUBRI INR WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS A GENERAL LIABILITY MMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR N77 Y Y 2589416 /8/2013 /8/2014 EACH OCCURRENCE $1,000,000 DAMAGE RENTED PREMI Ea occurrence $100,000 MED EXP (Any one person) $5,000 PERSONALBADVINJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY )( PRO LOC JFCT PRODUCTS - COMP/OP AGG $2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS Ea eccitlent BODILY INJURY (Per person) $ BODILY INJURY (Per acddent) $ PROPERTY DAMAGE $ Per accident UMBRELLA UAB EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? FN (Mandatory in NH) It yea, describe under DESCRIPTION OF OPERATIONS below / A Y 30-25781 2/1/2013 121112014 X I WC STATU- I OTH- TORY LIMITS E E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE- EA EMPLOYEE $1,000,000 E.L DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) GtK 111-IGA 1 t MULUtK City of Miami Shores 10050 NE 2nd Avenue Miami Shores FL 33138 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZER REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 10/24/2013 11:34 3056523135 MARLIN PLUMBING PAGE 01/di AC~# 6 � 10 7 8 0 STATE OF FLORIDA D?1FARTME11T aF aL7SI1 �8TRYR� S Nc B4X LATION. eQNSTRQGTIo SEW L12082801972 08 2$ 20 i2 1-280.5*542-9• ' 1CFC04829,��«°�:; The PLUMBING CONTRACTOR Named below IS GIMTIFIED raider the provisiona of Chap `y ` ...0 ' ';•, fa y Expiration date: AUG 31, 2014--" SER EDWARD - MARLIN MARLIN PLUMING OF MIAMI 20145 NE 16TH PLACE NORTH MIAMI BEACH FL 3 33,7 9 k` RICK SCOTT REN LAWSON GOVERNOR SECRETARY 004354 TF, :i�fi;�s�i%�a+�Ci� ,$�`ai•lors �: :•„ °•.. . .. ,,1•ruses;.ate;>�:e�e.��i�ai�.���:':'": :, mu Yia�GP4',H1lV.YlaIW4M'�\�WN .. r. �iGiFir�.IIY,M. .�,•" `': i,. :, mmbuumm ii�mf INC AL 901-4 20.146 -AEU: •' 27` i:t a3f cess �: pirlimi�rvt.�•courKy;. ' . pW SEC. TYPE OF 9t,ISINESS ^' 4 MARLIN PLUMBING OF MIAMI INC 196 Pi.AO094G CONTRACTt�I• PAYnnF.Isc�i tatvtEO CFC048M.'- : BY TAX 0TOAt :Warstaeris) t •875.00 137/1 1/20T3 TXKS1--13423374 Tlsis I.4081 Business Tex Receipt WV coy fi ms ��.y�tk�Li cat Business ran. The P,@M- s is not plicanse, pahvA or a cor i$cidon of the holsiefe gaalifil:=— heiress. Ho pg� WiUi any pov43mmamal or Qo�oVernmont8l repalaro+y laws eimt regnirameltts whtclf'ti[t�ftg'to the baste: The RECEIi'T1Y0, a4DvenmSt bsdispiayedan all cur6lMrcial vehi�,�,�. (•Or'tnttRa.Idf4rMatlell:• •