Loading...
PL-14-2629Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number. INSP-224331 Permit Number: PL -12-14-2629 Scheduled Inspection Date: April 07, 2015 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo .' Inspection Type: Final Owner: BUTLER, JACQUELINE Work Classification: Sprinkler System Job Address: 1461 NE 102 Street Miami Shores, FL 33138-2621 Project: <NONE> Phone Number Parcel Number 1132050240140 Contractor: AFFORDABLE IRRIGATION, INC Phone: 305-681-6322 comments install sprinkler system INSPECTOR COMMENTS False April 06, 2016 For Inspections please call: (305)762-4949 Page 9 of 63 Inspector Comments Passed Failed Correction Needed ❑ Re -inspection Fee No Additional Inspections can be scheduled until re -inspection fee is paid April 06, 2016 For Inspections please call: (305)762-4949 Page 9 of 63 Miami Shores village b 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 FSC 20 Permit Type: PLUMBING Permit No. :R L d Y- ?-9 Master Permit No. OWNER: Name (Fee Simple Titleholder):T#j4dUXG•r!e .9 &l 7,444-__ Phone#: Address: 1�eotry /iJ• /0 2 S? J -- City: „; 1'0.04 • soa I• e,f State: Zip: 3 3 TenanVUssee Email: —A , 0Zc Z JOB ADDRESS: ! r/G / /l/• !O Z S7 City: Miami Shores County: Miami Dade Zip: Folio/Parcel#: & 3 2 PC- D a y^ b/ yo Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: 11 4.fA&'Q Address: Z 3 9 S ms* 2tc Phone#:G3 • fl 6&-6 SZ Z City: �l? i %3 •' State: 0• L Zip: 3 3 00 Qualifier Name: ,,dill! 4L Com .1 cif �! Phone#: State Certification or Registration #: Certificate of Competency #: 0.21 �%d� G .21 f Contact Phone#: bf14t/-63 Z' - Email Address: rl��j2�e?hG d- A-r-G1'r.ee?w uG7• DESIGNER: Architect/Engineer: Phone#: Value of Work for this Permit: $�Z, �V� • Square/Linear Footage of Work: Type of Work: ❑Address ❑Alteration ❑New ❑Repair/Replace ❑Demolition Description of Work: —;�e -r;o;r // wl4 , yd S'L10, Submittal Fee $ Permit Fee $ . /50' CCF $ CO/CC $ of Scanning Fee $ Radon Fee $ Notary $ Training/Education Fee $ Double Fee $ Structural Review $ DBPR $ Bond $ Technology Fee $ 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 , e C 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 feeawill be charged. Signature Signature caAneror ent Contractor The foregoing instrument was acknowledged before me this , �?w The foregoing instrument was acknowledged before me thi day of , 20 , by �� G t!• yt[ U ��lGtv day of O V , 20fif, by W o 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: Sign: Print: My Y JORGETOLEDO RAY COMMISSION # EE 714679 EXPIRES: August 22, 2016 Bonded ThN Notary Public Uffilw N6 APPROVED BY ®1- -1 I - ,f "-i, Plans Examiner Structural Review (Revised 07/10/07)(Revised 06/ 1 OJ2009)(Revised 3/15/09) NOTARY PUBLIC: Sign: Print: My a-14 0tejlcC1� - JORGETOLEDO MY COMMISSION # EE 224678 EXPIRES: August 22, 2016 Zoning Clerk L; I wts Construction Trades Qualifying Board BUSINESS CERTIFICATE OF COMPETENC 96P000219 IRRIGATION D. B.A.: RrSSM�-- ROSAS MARCO Is certified under the provisions of Chapter 10 of Miami -Dade Court. � 4, , MT — #q__ � Cq�ro�t �od� OWNt; - SEC. TYA�P BUSINESS PAYMENT,"CEN� p �lRl piBLE IRRIGATION; INC 196 $ ECIALTY PLUIUI@ I BY TAX cOLLECTO� CONTRACTOR 7.00 119/30/2014 98P0002t9 0228-14-09451 Local � Tax Recongt Anly wMttms peymenEof ffie Local Business Tex Tbs Receipt is ', it, or a t tion chit thcider's quMeations, to do business.,Noldet mustcomply with aay ehAongo reguleterylstivs and requirenumts which apply tdt(te bus►hess ._ The REGI -WNO. above Mahe dispiayg40 4oimemial refitcfah lk ar-wile Code Sic& -276 BID w =-FBrmore informadop�3t ABLE IRRIGxrk \cSP TYP E#�Nn MIAMM BY TA*,WLLECW 175.0 09/361 ƒ0 14 0228-4 4 _,00945� I 4 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) 9/11/2014 THIS CERTIFICATE IS ISSUED AS A 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 endorsement(s). PRODUCER CONTACT NAME: Nancy Munoz Brown & Brown of Florida, Inc. PHONE (305)247-5121 FAX (305)248-6543 (AIC. No. FxthA/C N.I. dba T.R. Jones & Co. E-MAIL ADDRESS: nmunoz@bbinsfl . com 1780 N Krome Ave 9/12/2014 Homestead F1 33030 INSURER(S) AFFORDING COVERAGE NAIC g DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 INSURERA:SCOttBdale Insurance Company 41297 INSURED Affordable Irrigation, Inc. INSURER B: P.O. BOX 601743 INSURERC: GENERAL AGGREGATE $ 2,000,00 INSURER D: INSURER E: No Miami Beach FL 33160-1743 INSURER F: -- - -- - - - - - - --- 9A"v wwry rwrrror=rn. 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 ADDL SU BR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM D/YYYY LIMITS GENERAL LIABILITY A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ® OCCUR CPS2028748 9/12/2014 /12/2015 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X1 POLICY PRO -_CT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 AUTOMOBILE LIABILITY COMBINEDINGL UMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO ALLOWNED AUTOSS SCHEDULED AUTOS BODILY $ ) HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAR _FTENTION CLAIMS -MADE AGGREGATE $ DED $ $ WORKERS COMPENSATIONWC AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ N / A STATU- OTH- T I ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Installation/Repairs Sprinkler System 96P000219 ua Village of Miami Shores Zoning Dept 10050 N.E. 2 Ave Miami, 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. AUTHORIZED REPRESENTATIVE T Jones Jr./NANMUN ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS026 (201005).01 The ACORD name and logo are registered marks of ACORD conn® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/03/2014 THIS CERTIFICATE IS ISSUED AS A 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 terms 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 endorsement(s). PRODUCER Automatic Data Processing Insurance Agency, Inc. 1 Adp Boulevard CONTACT NAME: A N E.: FN No): A E -MIL DARESS: Roseland, N.1 07068 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Technology Insurance Company, Inc. 42376 EACH OCCURRENCE $ INSURED AFFORDABLE IRRIGATION INC INSURER B: INSURERC: DBA: Affordable Irrigation Inc INSURER D: 198 NW 139TH ST Miami, FL 33168 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 287224 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 INSURANCEADDLSUBR INSD WVD POLICYNUMBER POLICY EFF MM/DD POLICY EXP MMIDD/YYYY LIMITS Miami Shores, FL 33138- COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 171 OCCUR EACH OCCURRENCE $ PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICYR T F—] LOC OTHER: GENERAL AGGREGATE $ PRODUCTS-COMP/OPAGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTYDAMAGE $ Per accident UMBRELLA LIAB EXCESS LIAR HOCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATIONX AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑N (Mandatory in NH) If es, describe under DESCRIPTION OF OPERATIONS below N I A N TWC3396567 01/17/2014 01/17/2015 PER OT - STATUTE I ER 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 (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Instal lation/Prepares Sprinkler sytems License # 96P000219 CERTIFICATE HOLDER CANCELLATION A©1988-2014 ACORD CORPORATION. All rlgnts reserveo. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Village of Miami Shores Bldg & Zoning Dept ACCORDANCE WITH THE POLICY PROVISIONS. 10050 No 2nd Ave AUTHORIZED REPRESENTATIVE Miami Shores, FL 33138- A©1988-2014 ACORD CORPORATION. All rlgnts reserveo. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD NOTE: TEST FORM MUST BE COMPLETED IN ITS ENTIRETY. INCOMPLETE TEST FORMS WILL BE RETURNED. MIAMI-DADE WATER & SEWER DEPARTMENT METER OPERTATIONS & MAINTENANCE MIAMI-RADE `° CROSS-CONNECTION CONTROL UNIT 1001 N.W. 11th STREET, MIAMI, FL 33136.2209 Phone(305)547-3046 Fax(786)268-5485 BACKFLOW PREVENTION ASSEMBLY TEST REPORT FORM ADDRESS OF DEVICE 1461 NE 102nd St, Miami Shores, FL. OWNER OF DEVICE: ,Jaqueline Butler- New Installation OWNER CONTACT: Affordable Irrigation - Marco PHONE:: 305 6816322 FAX: 305 6816321 1 ADDRESS OF OWNER: SAME ZIP CODE:: 33138 NAME OF TESTER ROBERTO COLLAZO CERTIFICATION #: H 02387 EXPIRATION DATE:: 09-30.15 PHONE:: 305 273 6100 2 BUSINESS NAME: MRC PLUMBING S BACKFLOW, INC. BUSINESS ADDRESS: P.O. BOX 833323 MIAMI, FL ZIP CODE: 33283 3 TEST KIT MAKE:: MIDWEST MODEL P. 835 SERIAL#: 09091454 DATE LAST CAL. SITE TUBE: 01-24-2014 YES /NO "?PLEASE 1IiIK: R.P, , D C I'M .t .. X. _ MAKE OF ASSEMBLY: WILKINS MODEL N0: 720A SERIAL #. T179246 SIZE: 1 LOCATION OF ASSEMBLY HAZARD/SERVICE: METER NO Not Visible 4 INITIAL TEST: X ANNUAL TEST: _ DATE OF TEST: 0110712015 METER READING: SHUT OFF VALVE #1: SHUT OFF VALVE #2: CLOSED TIGHT: CLOSED TIGHT: LINEPRESSURE: 70 PRESSURE STABLE: YES - NO LEAKED: LEAKED: 1� CHECK VALVE NO.1 CHECK VALVE NO.2 DIFFERENTIAL RELIEF VALVE AIR INLET CHECK VALVE � Closed Tight: Closed Tight: FAILED TO OPEN: FAILEDTOOPEN:_ LEAKED:_ Leaked: Leaked: OPENEb AT: PRESSURE DIFFERENTIAL ACROSS CHECK PRESSURE DIFFERENTIAL ACROSS CHECK HELD AT: PSI PSI OPENED AT: PSI. 4.6 PSI 2.8 _PSI THE ASS Y f�►IL$ EQ N, P04 THIS S T N"AND NOT RS REMARKS / REASON FOR FAILURE (IF APPARENT): :GHKVIA1NOr1DIFt?EM1ITIALE LIEPI� y CLEANED: _ CLEANED: CLEANED: CLEANED: OC Q REPLACED: REPLACED: REPLACED: REPLACED: a w nc ... CHECK VALVE NO.1 CHECK VALVE NO.2 DIFFERENTIAL RELIEF VALVE AIR INLET CHECK VALVE � Closed Tight: Closed Tight: FAILED TO OPEN: FAILED TO OPEN: _ LEAKED' — WOPENED AT: HELD AT: � Leaked: Leaked: PRESSURE DIFFERENTIAL ACROSS CHECK PRESSURE DIFFERENTIAL ACROSS CHECK OPENED AT: PSI -PSI PSI PSI PSI #CERTIFY THAT J I �3`E$TeD THE �4BQV - S LY IN ACCORI3ANCE 1lUfTH THE R.W.W.A. G€2{$SS QNNECTIC3N C{ SAL AND THAT Elt+f1✓(;Rt ACCLiRATETOT#ST�}FiulYA6lLi1'iE;� .t _. "" _ . ' Roberto C o l l a z o DATE: 01/07/2015 SIGNATURE OF CERTIFIED TESTER: NOTE: TEST FORM MUST BE COMPLETED IN ITS ENTIRETY. INCOMPLETE TEST FORMS WILL BE RETURNED. f9m mvw./w 1V I." RANT NAIEOX PYO LATOW PIPE W40%. PYO wx 40 TEE NM IALLATION DETAIL USC DMI ymm *a a."M -------- Or UAW" OOM OD WEN ANWOWL RAIN BIRD 1806 SERIES SPRINKLER PAIN RIRf) CnMTY?n1 C'D 4IC8# 96P000219 Affordable Irrigation, 198 NW 139 Street Miami, FL 33168 Kei""ll'®rs- ,ORGETMYCOMMISSION # EE 224678 EXPIRES' August Bonded Thru Notarv_Pablic Underwiters pAy S cG 7 RAIN BIRD PGA Q ?..e, 0.4111` S (s - 027 6 jJ'''tij Inc. O o umm oc (Der, jp7cowavow ®TO 4wagmpomm O3 VALVE = wM comb 12-•Ity1 So I6 F*M amwyOP OR WiwiT PVC SCH 8D NPPLE (CLOSE) 8 PVC SCH 40 ELL 9 PY4} 5011 BO Nanu (�p19j11 AS ,0 ED,N2t (, OF 4) PYO MADAM PPD T SCH DO HPPIS (2 -UM W AYID 11314143166MI PVC SCH 40 TEE OR ELL PVC 5011 40 MALE AW= PYc L470ML PPE ", VALVE FOLIO: 11-3206-024-0140 SUB -DIVISION: MIAMI SHORES BAY PARK ESTS AMD OWNER: JACQUELINE C BUTLER 1461 NE 102 ST MIAMI SHORES ............ •• ••• •• • • • •• • ••• • • ••• ..• • • • • • • • • • • • •• • • • • • •• .... ....... . .......... ............ .... ...... . 0000 0000.. 0000.. .. .. ,. .6 0006.6 . 0 . . .00000 . . ....• 6... 0000 0000. 0000 0000 . . 0000.. 0000.. 000000 . 6• ..66.6 .. . ..as . . . 000000 0000..