PLC-14-523Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-209174 Permit Number: PLC -3-14-523
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 Kolasa Hall
Miami Shores, FL 33138-0000 Phone Number
Parcel Number 1121360010160-33
Project: BARRY UNIVERSITY
Contractor: MARLIN PLUMBING OF MIAMI INC Phone: 305-652-6108
Buildina Department Comments
REPLACE 4' RPC BACK FLOW AND CERTIFY UNIT AT
KOLASA HALL
infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed
EY'4«
0L)1Q)K S 3
L
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
AN
ple / �® .S�;L/
20145 N.E 16th Place
Miami, Florida 33179
Phone: (305) 652-3031
Fax: (305) 652-3135
92
M IAM I, - I IV C Licensed & Insured CC# CFC0482
BACKFLOW PREVENTION ASSEMBLY TEST REPORT FORM
ADDRESS OF DEVICE:
OWN F E:
OWNER C05`
PH E: FAX
RES OF OWNER:
ZIP CODE:
L-1
—
STER:
/vC
CERT ATION #:
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EXPIRATI N DATE:
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ONE.
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IN B SINESS ADDRESS:
ZIP CODE,
BUS S NAME
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,
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TEST KIT MAKE: MDQ EL #:,
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SERIAL#: DATE LAST CAL.
.. "_ /57-/-3
SITE TUBE:
C�
YES /N0
TEST PLEASE MARK:
R.P. D.C. P.V.B.
MAKE OF ASSEMBLY:
i J I -c Icm zuapq375
MODEL NO
SER AL #:
" 7,S Ss
SIZE:
OCATI N OF ASSE�
'C�djc_ Z'a
HAZARDISERVICE:
METdER
4
D W TFRT - --- - .-�
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INITIAL TEST: ANNUAL TEST:
METERREADI G: 09 Zf
,.Q'
SHUT OFF VALVE #1:
CLOSED TIGHT:
SHUT OFF VALVE #2:
CLOSED TIGHT:
PRESSURE STABL . Y S - NO
LINE PRESSURE: 'LJ
LEAKED:
BEAKED:
D.C.U.
.P.Z.A. P.V.B.
CHECK VALVE NO.1
_ _ CHECK VALVE NO.2 _
DIFFERENTIAL RELIEF VALVE
AIR INLET
CHECK VALVE
Closed Tight: �
Closed Tight.
FAILED TO OPEN:
FAILED roOPEN: --
LEAKED:`
Leaked:
Leaked:
`
OPENED AT:
HELD Ar
PRESSURE DIFFERENTIAL ACROSS CHECK
PRESSURE DIFFERENTIAL ACROSS CHECK
�'
�'
OPENED AL �' PSI.
PSI !
PSI
t
PSI
PSI
_
ii
IF THE ASSEMBLY FAILS FOR ANY REASON COMPLETE THIS SECTION AND NOTE REPAIRS
REMARKS ! REASON FOR FAILURE (IF APPARENT):
dq
i
CHECK VAVLE NO.1 CHECK VAVLE NO.2
CLEANED: CLEANED:
DIFFERENTIAL RELIEF VALVE P.V.B.
CLEANED:
_ –
IhI
CLEANED:
d ;REPLACED:
REPLACED: REPLACE
D.
I+
W
+REPLACED:
D.0 SLA. R.PZA. P.V.B.
CHECK VALVE•NO 1 CHECK VALVE NO.
DIFFERENTIAL RELIEF VALVE AIR INLET CHECK VALVE
Closed Tight: Closed Tight:
FAILEDToPPEN: FAILED TO OPEN LEAKED.
OPENED AT:
LU '! i
Leaked. Leaked:
HELD AT
r
PRESSURE DIFFERENTIAL ACROSS CHECK PRESSURE DIFFERENTIAL ACROSS CHECK
OPENED AT PSI PSI PSI
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 I
I ACCURATE TO THE BEST OF MY LITIES.
SIGNATURE OF CE RTI
—
DATE:
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 KOLASAE
City: Miami Shores County:
Folio/Parcel#: 11-2136-000-0050
Is the Building Historically Designated: Yes NO
OWNER: Name (Fee Simple Titleholder): BARRY COLLEGE
Add,-- 11300 NE 2ND AVENUE
City: MIAMI SHORES
Tenant/Lessee Name:
Email:
State: FL
FBC 20
Permit No.
Master Permit No.
CONTRACTOR: Company Name: MARLIN PLUMBING OF MIAMI, INC
Address: 20145 NE 16TH PLACE
City: NORTH MIAMI BEACH State: FL
Qualifier Name: EDWARD J WALKER
AIAR18 2014
I
gip: 33161
Zone:
P: 305-899-3995
gip. 33161
k:
k: 305-652-3031
gip: 33179
P: 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: $ 4,200.00 Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ❑New X1Repair/Replace
Description of Work: REPLACE 4" RPC BACKFLOW AND CERTIFY UNIT AT KOLASA-HOd3E
Submittal Fee $ �p 0
Scanning Fee $
Permit Fee $ */sem. CCF
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CO/CC $ .
DBPR $ Bond
Technology Fee $
TOTAL FEE NOW DUE $ /5 •_977�T
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.
Signator ,
Ownerer-Agent
The foregoing instrument was acknowledged before me this 1L_
day of ANt , 20 14, byCdit UWA. WILriMl014
Who is Mrsonally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
Sign:�^/�,
Print: - I `/ %�01-�i�+`►(1
My Commission Expires: t 1.
MY CONK IISSION # EE36929
W111: November 12.2014
Signature
Contractor
The foregoing instrument was acknowledged before me this /-Z-
day
'Zday ofI �% , 20 a, by CA00 I(d M %Ak I ke r
who is personally known to me or who has produced
as identification and who did take an oath.
APPROVED BY E� I Y Plans Examiner
NOTARY PUBLIC:
Sign:
Print: �Qa- kelt )(P_¢ rw
My Commission Expires:
Tt1EMA MCCREERY
Notuy Pdit • Stm 01 Raft
kVftW; Oeo 8, 2017
Commisda" I "070"7
Structural Review Clerk
(Revised3/1212012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)