PLC-14-521I
Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
inspection Number: INSP-209151 Permit Number: PLC -3-14-521
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 Broad Auditoriu
Miami Shores, FL 33138-0000
Project: BARRY UNIVERSITY
Contractor: MARLIN PLUMBING OF MIAMI INC
Building Department Comments
Phone Number
Parcel Number 1121360010160-04
Phone: 305-652-6108
REPLACE 1/1/2" RPZ BACK FLOE AND CERTIFY UNIT
Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed
E9____
[I-� ��.► s ®1 :S
Failed E]
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
atIC, -14s m6f
/Z-/. 5-L/
20145 N.E 16t6 Placa-
Miami, Florida 33179 '
Phone: (305) 652-3031
Fax: (305) 652-3135
M I A M 1, 1 IV C Licensed & Insured CC# CFC048292
BACKFLOW PREVENTION ASSEMBLY TEST REPORT FORM
I
�
ADDRESS OF DEVICE:
OWNER OF DEVICE:
OWNER CONTACT:
PHONE:
FAX:
ADDRESS OF OWNER:
I
ZIP CODE:
NAME OF TESTER �' �
C ' ICATION ®
EXPIRATION DATE:
PHONE:
� 3 d-3/
-3
'
2
_
BUSINESS NAME: � ;B SI� S ADDRESS: �� �
ZIP CODE.
e
_
3
TESTI KITT MAKE: � MODEL #: SERIAL #: DATE LAST CAL.
en
1 _
SITE TUBE:
i `l w17
— S- 43
YES 0
i TEST PLEASE MARK: R.P. D.C. P.V.B.
MAKE OF ASSEMBLY:
MODEL NO:
SERIAL #:
SIZE:
HAZARDISERVICE.
- --- --
METER NO.
Z
�LOCATION FO ASSLY:
,
esf Si
4
DA OF TEST - - - — - -
_.
INITIAL TEST: ANNUAL TEST:
METER READING:
SHUT OFF VALVE #1;
CLOSED TIGHT:
UT OFF VALVE #2:
CLOSED TIGHT:
PRESSURE STABLE
LEAKED:
LEAKED:
LINE PRESSURE:
E _ NO
D.C.V.A.
- R.P.Z.A.
DIFFERENTIAL RELIEF VALVE
P.V.B.
CHECK VALVE NO. 1
CHECK VALVE NO.2
AIR INLET
CHECK VALVE
Closed Tight:
FAILED TO OPEN:
LEAKED:_
Closed Tight:
FAILED TO OPEN:
y
i
Leaked:
Leaked:
OPENED AT:
PRESSURE DIFFERENTIAL ACROSS CHECK
PRESSURE DIFFERENTIAL ACROSS CHECK
HELD AT
OPENED AT: ® PSI
PSI
PSI
o 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 1
CLEANED:
CLEANED.
CLEANED:
CLEANED:
REPLACED: REPLACED: REPLACED: REPLACED:
EL
J W
D.C.V.A. R.PZ.A. r P.V.B.
CHECK VALVE -NO. 1 CHECK VALVE NO.2 OIFFERENTIAL RELIEF VALVE AIR INLET CHECK VALVE
I) Closed Tight:
'Jiosed Tight:
FAILED TO OPEN:
FAILED TO OPEN . _
LEAKED:
Wj
OPENED AT:
HELD AT
Leaked:
Leaked: r
AT: PSI
PSI
PSI
lPRESSURE DIFFERENTIAL ACROSS CHECK
PRESSURE DIFFERENTIAL ACROSS CHECKOPENED
u PSI
PSI
I CERTIFY THAT I HAVE TESTED THE ABOVE ASSEMBLY
IN ACCORDANCE WITH THE A.WW.A.
CROSS CONNECTION CONTROL MANUAL
AND THAT ALL THE INFORMATION
IS
U ACCURATE TO THE BEST OF MY ABILITIES.
H SIGNATOR RTIFIED TESTER:
DTE:
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
FBC 20
MAR 1 s 2®14
Permit No.
Master Permit Noa
JOB ADDRESS: 11300 NE 2ND AVENUE MANAGEMENT BUILDING rb
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#: 305-899-3995
Address: 11300 NE 2ND AVENUE
City: MIAMI SHORES State: FL Zip: 33161
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: _
Address: 20145 NE 16TH PLACE
MARLIN PLUMBING OF MIAMI, INC
City: NORTH MIAMI BEACH
Qualifier Name: EDWARD J WALKER
State Certification or Registration #: CFC048292
Contact Phone#: 305-652-3031
FL
305-652-3031
33179
305-652-3031
Certificate of Competency #:
Address: MARLINPLUMBING@AOL.COM
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $ 980.00 Square/Linear Footage of Work:
Type of Work: UAddress UAlteration UNew �Repair/Replace
Description of Work: REPLACE 1 1/2" RPZ BACKFLOW AND CERTIFY UNIT
MANAGEMENT BUILDING
Submittal Fee $ Permit Fee $ /SC1 CCF $ CO/CC $
Scanning Fee $
Radon Fee $ DBPR $ Bond $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
Technology Fee $
UDemolition
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
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."
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 '
-Ow"ePoi° Agent
The foregoing instrument was acknowledged before me this
day of % eft , 20 0q, byV2rQ U4QA MVILAC," ,
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
:7
r�'R'i &4 Z(l
My Commission Expires: ti •`"JJEFFRY J. YAO
C0MAMI0N#EE36829
J* EXPIRES: Novwgw 12.2014
14MCa NOTARY N. Nowy Di==Asm Co.
Signature V4,,cl "hot"
Contractor
The foregoing instrument was acknowledged before me this / 2
day of re b , 20 , by _EJae)p,nJ S WA1 kg -
who is perso 11 kll + kn+ known to me or who has produced
APPROVED BY `®c6 Plans Examiner
Structural Review
(Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
identification and who did take an oath.
NOTARY PUBLIC:
Sign:
Print:
THERESA MCCREERY
Notary Public - State of FlorWa
Commission # FF 070897
Zoning
Clerk