PLC-14-525Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-209195 Permit Number: PLC -3-14-525
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 11603 Building
Miami Shores, FL 33138-0000 Phone Number
Parcel Number 1121360010160-27
Project: BARRY UNIVERSITY
Contractor: MARLIN PLUMBING OF MIAMI INC Phone: 305-652-6108
Buildina Department Comments
REPLACE 2' RPZ BACK FLOW AND CERTIFY UNIT ON
Infractio Passed Comments
INSPECTOR COMMENTS False
NORTH SIDE OF THE 11603 BLDG
Passed ET
Inspector Comments
W) S "i �_5 kc
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
20145 N.E 16th Place
Miami, Florida 33179
Phone: (305) 652-3031
P L U R 11r � � � 6 16 � Fax: (305) 652-3135
' o /� B
OF MIAMI, (ISI (� T ' Licensed &Insured CC# CFC048292
BACKFLOW PREVENTION ASSEMBLY TEST REPORT FORM
REMARKS / REASON FUR FAILURE (IF APPAREN 1):
CHECK VAVLE NO. 1
Cn I I.LCHIVCU.
Q REPLACED:
a'
w
�i
REPLACED:
CHECK VAVLE NO.2 DIFFERENTIAL RELIEF VALVE
CLEANED:
REPLACED:
REPLACED:
P.V.B.
D.C.U. R.PZA. P.V.B.
i
DIFFERENTIAL RELIEF VALVE AIR INLET j CHECK VALVE i CHECK VALVE -NO. CHECK VALVE N0.2 _
Closed Tight: Closed Tight: FAILED TOOPEN: FAILED TO OPEN LEAKED:- �
W OPENED AT: HELDAT
F-
I Leaked: Leaked:
PSI
PRESSURE I PRESSURE DIFFERENTIAL ACROSS CHECK PRESSURE DIFFERENTIAL ACROSS CHECK OPENED AT: PSI 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
H ACCURATE TO THE BEST OF MY ABILITIES.
i SIGNATURES IFIED TESTER: DATE:
ADDRESS OF DEVICE:
OWN F EVICE:
e/eSI�
1
OWNER CONTACT,
PHONE:
FAX:
ADDRESS OF OWNER:
ZIP CODE:
1�opAE� ^ t e f
/
C FICAT
134S
ATE
PIRATION DATE -
-)-
PONE: 4S -
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BUUSIIN'EESSS NAME -R
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BUSINESS ADDRESS
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07
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3
TEST KIT MAKE:
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�
MODEL #:
^IC
SERIAL n
DATE LAST CAL.
-�
SITE TUBE'
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%$-
®
YES NO
TEST PLEASE MARK: R.P. Q.C. P.V.B.
MAKE OF ASSEMBLY:
�'U rIv
MODEL NNjO: { q
3� I z 1 — 9 /�� �
SERIAL #:
� Q � z
SIZE:
? f�
----
LOCATION OF ASSEMBLY: `
F— -- °rte^
HAZARDISERVICE:M
0•
0 - 6 00
4
DATE OF TEST.
INITIAL TEST: ANNUAL TEST:
MEER RI
(J (J
—
SHUT OFF VALVE #7:SHUTI OFF VALVE 02:
- - — --
CLOSED TIGHT. 0<.._ CLOSED TIGHT:
LINE PRESSU - ®
PRESSURE STABLE:ONO
LEAKED:-EAKED: -
D.C.V.A.
R.P.Z.A.
P.V.B.
i
CHECK VALVE N0.1
CHECK VALVE NO.2
Closed Tight:
DIFFERENTIAL RELIEF VALVE
FAILED TO OPEN:
AIR INLET
CHECK VALVE
Closed Tight:
! FAILED TO OPEN
LEAKED:
H Leaked:
Leaked:
6 I PRESSURE DIFFERENTIAL ACROSS CHECK
PRESSURE DIFFERENTIAL ACROSS CHECK
I
OPENED AT.
HELD AT
OPENED AT'• �. PSI.
PSI
PSI
{ PSI
• PSI
IF THE ASSEMBLY FAILS FOR ANY REASON, COMPLETE THIS SECTION AND NOTE REPAIRS
REMARKS / REASON FUR FAILURE (IF APPAREN 1):
CHECK VAVLE NO. 1
Cn I I.LCHIVCU.
Q REPLACED:
a'
w
�i
REPLACED:
CHECK VAVLE NO.2 DIFFERENTIAL RELIEF VALVE
CLEANED:
REPLACED:
REPLACED:
P.V.B.
D.C.U. R.PZA. P.V.B.
i
DIFFERENTIAL RELIEF VALVE AIR INLET j CHECK VALVE i CHECK VALVE -NO. CHECK VALVE N0.2 _
Closed Tight: Closed Tight: FAILED TOOPEN: FAILED TO OPEN LEAKED:- �
W OPENED AT: HELDAT
F-
I Leaked: Leaked:
PSI
PRESSURE I PRESSURE DIFFERENTIAL ACROSS CHECK PRESSURE DIFFERENTIAL ACROSS CHECK OPENED AT: PSI 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
H ACCURATE TO THE BEST OF MY ABILITIES.
i SIGNATURES IFIED TESTER: DATE:
Miami Shores Village /71
;
Building Department i VAR
10050 N.E.2nd Avenue, Miami Shores, Florida 33138 P,�2®
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.
Master Permit No. F_l� Z =fi�Y_
JOB ADDRESS: 11300 NE 2ND AVENUE PODIATRIC. MED NORTH SIDE OF BUILDING
City: Miami Shores County: Miami Dade Zip: 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
e",.o 11300 NE 2ND AVENUE
City: MIAMI SHORES
State: FL Zip: 33161
Tenant/Lessee Name: Phone#:
Email:
CONTRACTOR: Company Name: MARLIN PLUMBING OF MIAMI, INC Phone#: 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: MARLINPLUMBING@AOL.COM
DESIGNER: Architect/Engineer: Phone#:
Value of Work for this Permit: $1,280.00 Square/Linear Footage of Work:
Type of Work: ❑Address ❑Alteration ❑New epair/Replace
Description of Work: REPLACE 2" RPZ BACKFLOW AND CERTIFY dNIT
PODIATRIC MED NORTHSIDE OF BUILDING f I b C� a o�� s
Submittal Fee $ Permit Fee
Scanning Fee $
Radon Fee $
®—"CA / CCF
Notary $ Training/Education Fee $
Double Fee $ Structural Review $
CO/CC $
DBPR $ Bond
Technology Fee $
TOTAL FEE NOW DUE $
❑Demolition
Bonding Company's Name (if applicable)
Bonding Company's Address
City State Zip
Mortgage Lender's Name (if applicable)
Mortgage Lender's Address
City State
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 Agentll ll ontractor
The foregoing instrument was acknowledged before me this li� The foregoing instrument was acknowledged before me this.
day of `+ , 2014 , by <L1UJ UNU gVJJAVIIIA,, day of re—k3 , 20 L�L, by ciiw ,rJ i walke .Y
who is personally 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:mLda.
Print: Print: e
My Commission Expires: ( My Com
IW J. YAO ,,..•••.u,,.
MY CO?aff SION # EE36929 r?p �'v AWN, THERESA MCCREEar
EXPIRES: Novanba' 12. 2014 = Notary Public - StMe of FIa W
��'%%�; ;� to;:•'' Commf W n M FF 070807
APPROVED BY _� '/ Plans Examiner g
Structural Review Clerk
(Revised3/12/2012)(Revised 07/10/07)(Revised 06/10/2009)(Revised 3/15/09)