PLC-14-524Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-209185 Permit Number: PLC -3-14-524
Inspection Date: August 28, 2014
Inspector: Diaz, Osvaldo
Owner: , BARRY UNIVERSITY
Job Address: 11300 NE 2 Avenue 11603 Building
Miami Shores, FL 33138-0000
Project: BARRY UNIVERSITY
Contractor: MARLIN PLUMBING OF MIAMI INC
Building Department Comments
Permit Type: Plumbing - Commercial
Inspection Type: Final
Work Classification: Addition/Alteration
Phone Number
Parcel Number 1121360010160-27
Phone: 305-6524108
REPLACE 2" RPZ BACKFLOW AND CERTIFY UNIT 11603
BLDG
Infractio Passed Comments
INSPECTOR COMMENTS False
Inspector Comments
Passed
ff
di
Failed
El
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
20145 N.E 16th Place
Miami, Florida 33179
Phone: (305) 652-3031
Fax: (305) 652-3135
MIAMI, I N C � Licensed & Insured CC# CFC048292
BACKFLOW PREVENTION ASSEMBLY TEST REPORT FORM
ADDRES F DEVICE:
OWNE OF DEVICE: 1
i I
L1AJ)' d -e t
OWNER CONTACT:
PHONE:
FAX:
1
ADDRESS OF OWNER:
ZIP CODE:
NAMg TESTER:
A
CERICATIO;
EXPIRATION DATE:
PHONE-
-,30-71
` '
2
BUSINESS NAME P
B INESS ADDRESSe vc--
Q CODE:
f 79
SITE
3
TEST KIT MAKE: MODEL M
SERX *
DATE LAST CAL,
TUBE'
Tic
4q t 91 119
42
YES 160-1
TEST PLEASE MARK: R.P. D.C. P.Y.B.
I
MAKE/ OF ASSEMBLY: M NOf/��
SERIAL M
��5 (/�_ZJA
SIZE:
L /
LOCATION OF ASSEMBLY:
HAZARDISERVICE.
M 0.
, `
4
- - - - -
IN
INITIAL ANNUAL TEST:
E OF SL
SHUT OFF YAW At:SHUT
CLOSED TIGHT: X,
OFF VALVE #2:
CLOSED TIGHT:
— —
LINE PRESSURE:
- --
PRESSURE STABL • YE - NO
LEAKED:
LEAKED:
_
D.C.V.A. R.P.Z.A. P.V.B.
CHECK VALVE NO.1
CHECK VALVE NO.2
DIFFERENTIAL RELIEF VALVE
AIR INLET CHECK VALVE
Closed Tight:_
FAILED TO OPEN_ LEAKED:
Closed Tight:_
FAILED TO OPEN:
it
W
Leaked:
Leaked.
OPENED AT:
I
HELD AT
PRESSURE DIFFERENTIAL ACROSS CHECK
PRESSURE DIFFERENTIAL ACROSS CHECK
PSI
PSI
OPENED AT: PSI
i:,?— PSI
PSI
IF THE ASSEMBLY FAILS FOR ANY REASON, COMPLETE THIS SECTION AND NOTE REPAIRS
REMARKS / REASON FOR FAILURE (IF APPAREN T):
CHECK VAVLE NO.1
CHECK VAVLE NO.2
DIFFERENTIAL RELIEF VALVE
P.V.B.
CLEANED: -`_____
CLEANED.
CLEANED: _
CLEANED.
Q REPLACED: REPLACED: REPLACED: REPLACED:
CL
LLJ
D.CM.A. R.P.Z.A. P.V.B.
CHECK VALVE -NO. 1
CHECK VALVE NO.2
DIFFERENTIAL RELIEF VALVE
INLET
FAILED TO OPEN -.
CHECK VALVE
LEAKED:
I
Closed Tight:
i
Closed Tight:
— -AIR
FAILED TO OPEN:
Lu
OPENED AT: HELD AT
Leaked:
Leaked:
OPENED AT: PSI
i
PSI PSI I�
PRESSURE DIFFERENTIAL ACROSS CHECK
PRESSURE DIFFERENTIAL ACROSS CHECK
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 BES ABILITIES.
_
SIGNATURE OF FIED
DTE:
L
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
Permit No.
MAR 18 2014
Master Permit No.,P / C ) � —.�� y.
JOB ADDRESS: 11300 NE 2ND AVENUE PODIATRIC MED BUILDING
I/
City: Miami Shores County: Miami Dade Zip:
Folio/Parcel#: 11-2136-000-0050
Is the Building Historically Designated: Yes NO Flood Zone:
61
OWNER: Name (Fee Simple Titleholder): BARRY COLLEGE Phone#: 305-899-3995
Add-- 11300 NE 2ND AVENUE
City: MIAMI SHORES
Tenant/Lessee Name:
Email:
State: FL
CONTRACTOR: Company Name: MARLIN PLUMBING OF MIAMI, INC
Address: 20145 NE 16TH PLACE
City: NORTH MIAMI BEACH State: FL
Qualifier Name: EDWARD J WALKER
Up: 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:
Value of Work for this Permit: $1,280.00 Square/Linear Footage of Work:
Type of Work: ❑Address DAlteration ONew �Repair/Replace
Description of Work: REPLACE 2" RPZ BACKFLOW AND CERTIFY UNIT
DI -j ( A (�) r-,-- 1 rnk r7 _
Submittal Fee $ Permit Fee i CCF $ CO/CC $
Scanning Fee $
Radon Fee $
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
DBPR $ Bond $
Technology Fee $
❑Demolition
TOTAL FEE NOW DUE $ L 6 -
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.
Signatur
8w�Agent
The foregoing instrument was acknowledged before me this'�7
day offiNkht , 20, by SiE� LlVII,
who is personally known to me or who has produced
As identification and who did take an oath.
NOTARY PUBLIC:
A /I
Print:
My Commission
I:\1iQ;Zi) L,VA: 3P1 V4
MY COMMISSION # EE36829
EXPIRES: November 12.2014
Signature
Contractor
The foregoing instrument was acknowledged before me this
day of �b , 20 j �, by _EAL )p.,4 TVA �r
who is personally known to me or who has produced
as identification and who did take an oath.
Plans Examiner
Structural Review
(Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)
NOTARY PUBLIC:
Sign-:4-"Ae�
Print:
My Commission Expires: 12- & - Q 1
"Olffry F"ft - St"S N (loft
"Y Comal. bo" oft b 2017,
Clerk