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PL-15-1773 f . Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-239163 Permit Number: PL-7-15-1773 Scheduled Inspection Date: September 01, 2015 Permit Type: Plumbing - Residential Inspector: Diaz, Osvaldo Inspection Type: Final Owner: LUIS M PEREZ DE LA CRUZ JTRS, Work Classification: Repair 11 1 A AI IIA A 071KI C7 ITCC Job Address:65 NE 107 Street Miami Shores, FL 33161-7029 Phone Number Parcel Number 1121360070380 Project: <NONE> Contractor: BATH CREST OF FLORIDA LLC Phone: (754)999-3030 Building Department Comments REPLACING EXISTING VALVE AND OVERLAYING Infractio Passed Comments ACRYLIC OVER EXISTING TILE INSPECTOR COMMENTS False nspector Comments PassedEV i Failed Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. August 31, 2015 For Inspections please call: (305)762-4949 Page 14 of 37 i. 773 1s °RE¢y� Miami Shores Village tftl!#t � t'k'1�F1 � ILBlffttis< y� 10050 N.E.2nd Avenue NE t Ill�t t".la Repair, ,4Slrft�rt: Miami Shores, FL 33138-0000IT 44FN= � Phone: (305)795-2204 ' '\- _ ., li'17tt';'I~�ftU$:APPRQVED Ex iration: 0211512016 u f�014 12 Q1 5 p Project Address Parcel Number Applicant 65 NE 107 Street � 1121360070380 JUAN MARTINEZ JTRS LUIS M f Miami Shores, FL 33161-7029 Block: Lot: Owner Information Address Phone Cell AN MARTINEZ JTRS LUIS M PEREZ 65 NE 107 Street -- -- — --- MIAMI SHORES FL 33161-7029 65 NE 107 Street MIAMI SHORES FL 33161-7029 Contractor(s) Phone Cell Phone Valuation: $ 9,100.00 BATH CREST OF FLORIDA LLC (754)999-3030 Total Sq Feet: 0 Type of Work:REPLACING EXISTING VALVE AND OVERLA Available Inspections: Type of Piping: Inspection Type: Additional Info: Final Bond Return: Review Plumbing Classification:Residential Scanning:2 Review Plumbing Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $6.00 Invoice# PL-7-15-56353 DBPR Fee $4.78 07/15/2015 Credit Card $50.00 $300.06 DCA Fee $4.78 Education Surcharge $2.00 08/19/2015 Check#: 1024 $300.06 $0.00 Permit Fee $318.50 Scanning Fee $6.00 Technology Fee $8.00 Total: $350.06 In consideration of the issuance to me of this permit, I agree to perform the work covered hereunder in compliance with all ordinances and regulations pertaining thereto and in strict conformity with the plans,drawings, statements or specifications submitted to the proper authorities of Miami Shores Village. In accepting this permit I assume responsibility for all work done by either myself, my agent, servants, or employes. I understand that separate permits are required for ELECTRICAL,PLUMBING,MECHANICAL,WINDOWS,DOORS,ROOFING and SWIMMING POOL work. OWNERS AFFIDAVIT: I certify that II the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. Futher e;la oriz he above-named contractor to do the work stated. f August 19, 2015 Authorized Signature:Owner 'Applicant / Contractor / Agent Date Building Department Copy August 19,2015 1 Miami Shores Village 'G JUL � 5 2015 Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 v Tel:(305)795-2204 Fax:(305)756-8972 \ INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20 t� BUILDING Master Permit No.-FL-IS — PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL PLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP ^' LL I f l I Q c �( CONTRACTOR DRAWINGS JOB ADDRESS: 65 5 I V t 1-}- _ i City: Miami Shores 2 County: Miami Dade Zip: Lp 1 Folio/Parcel#: 11213 �2 0b -1 ®325 C) Is the Building Historically Designated:Yes NO Occupancy Type: Load: 1 Construction Type: Flood Zone: BFE2: (�G�FF{E:Q a Q OWNER: Name(Fee Simple Titleholder): -V 1f� I ' 1" 1 Ul -h n L Phone#: 0'5 I J 1 Cl I 0 U Address: 111 N �l�� - /�� I 1 u 1 (� 2 ` City: "i a N Y 1 �C S State: P L Zip: �J 1 o Tenant/Le�sseeName: n 0. Phone#: f) ICA, Email: 1 ti 0 ' CONTRACT-O-R:Company Name: E U� ���_ J 0 T l I�� Vl0-- Phone#: ' JV3 0 Address: I I' City:r_�� �� CA C►+,,! State: Zip: Qualifier Name: �Q Y\ U p` u i Phone#: �g State Certification or Registration#: �, I ��AA � I Certificate of Competency#: V' i^ y DESIGNER:Architect/Engineer: n , Phone#: Address: rN I()\, ,^�//�� City: State: Zip: Value of Work for this Permit:$ CA , 1 00. yy Square/Linear Footage of Work: Type of Work: ❑ Addition` M Alteration ❑ New El Repair/Replace n ❑ Demolition Description of Work: I ,1 C n N'v C., " A W e I AlnQl i Specify color of color thru tile: y� Submittal Fee$S Q Permit Fee$ /8. s,_ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ TOTAL FEE NOW DUE$ (Revised02/24/2014) 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 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 ELECTRIC, PLUMBING, SIGNS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,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 AGENT CONTRACTSIR The foregoing instrument was acknowledged before me this The foregoing instrument was acknowledged before me this p qday of 20 by �� day of J� � 20 J by IV 1 I�GlY1 u r �n i,fin, "who is person Ily own to �C A f\(X Ir who is personally known to me or who has produced ' J as me or who has produced as identification and who did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC: • �" SHANNON Sign: Sign: N N NWRIGHT - '= m� ; n p Print: �" `E Print ` y C My Commission Expires OvOmber 24 Seal: .. ;,",;= Seal: 2 8 ;,o November 24, 2018 ************************************************************************************************************ APPROVED BY �� `f'r Plans Examiner Zoning Structural Review Clerk (Revised 02/24/2014) C.I p! loss Miami Shores Village Building Department RID 10050 N.E.2nd Avenue Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 CONTRACTORS' REGISTRATION IF CONTRACTOR IS A FLORIDA STATE CERTIFIED CONTRACTOR: A. ✓TCOPY OF QUALIFIER'S STATE LICENCES B. V7 COPY OF LOCAL BUSINESS TAX RECEIPT C. ✓ COPY OF LIABILITY INSURANCE* D. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) IF CONTRACTOR HAS A MIAMI DADE COUNTY CERTIFICATE OF COMPETENCY: A. COPY OF CERTIFICATE OF COMPETENCY OF QUALIFIER B. COPY OF LOCAL BUSINESS TAX RECEIPT C. COPY OF STATE REGISTERED CONTRACTOR LICENSE OR MIAMI DADE COUNTY MUNICIPAL CONTRACTOR'S TAX RECEIPT. D. COPY OF LIABILITY INSURACE* E. COPY OF WORKERS COMPENSATION INSURANCE* (Workers Compensation EXEMPTION must have NOTICE TO OWNER form and Contractor Affidavit) *YOUR INSURANCE COMPANY MUST ISSUE A CERTIFICATE AS FOLLOW: ' Certificate Holder: MIAMI SHORES VILLAGE BLDG DEPT 10050 NE 2ND AVE MIAMI SHORES, FL 33138 Certificate must specify the description of operations or contractor license number. BUSINESS NAME:�C -Grp S,� 0-� 1m S (5 BUSINESS ADDRESS: 1�S �,�� CJ�)y�(�j S CITY _ ,S TE S— ZIP S30-0H BUSINESS PHONE: ( � J"j )C�9q FAX NUMBER(�i�"1 ) �I 30-H-0 CELL PHONE(�a) 9,- 19 QUALIFIER'S NAME: 11A A QUALIFIER'S LIC NUMBER: CACI I M 0 � 0 •06/13/2014 11:47 FAX 1@001/001 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD (850) 487••1398 a°�a* 1940 NORTH MONROE STREET TALLAHASSEE FL 32399-0783 KARP,TED BATH CREST OF FLORIDA LLC 1069 NE 204 TERR MIAMI FL 33179 Congratulationsl With this Ilcense you become one of the nearly' --- one million Floridians licensed by the Department of Business and romarchitects to yacht brokerur s,from boxers to barbequerbstaurants, STATE OF FLORIDA and they keep Florida's economy strong. DEPARTMENT OF BUSINESS AND Every day we work to Improve the way we do business In order toy PROFESSIQNAL REGULATION serve you better. For information about our services,please log onto CFC1429010 ';-fftUED: • 06/02/2014 www,myfloridelicense.com. There you can find more Information about our divisions and the regulations that Impact you,subscribe CERTIFIED PL0h'WNa Q.QNTRACl•QR to department newsletters and learn more about the Department's KARP.TED " initiatives. BATH CREST OF'PLORIPXkL ;- Our mission at the Department Is:License Efficiently,Regulate Fairly, •''" •:""N""'r We constantly strive to serve you better so that you can serve your customers. Thank you for doing business In Florida, and congratulations on your new licensel IS 08RTIFIED under the provisions of Ch.489 FS. Pxph0on fte:AUG 31,2016 L1409020001090 DETACH HERE RICK SCOTT,GOVERNOR KEN LAWSON.SECRETARY STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION CONSTRUCTION INDUSTRY LICENSING BOARD �0�.FC1429010 The PLUMBING CONTRACTOR Named below IS CERTIFIED "� • Under the provisions of Chapter 489 FS, ° wx Expiration date: AUG 31, 2016 KARP,TED �;, �, ■ BATH CREST OF FLORI[7 1751 WEST COPANS 3E .:< „ "'�:.,.. '.,,, '"��.''� � �,'� • POMPANO BEACH 08� �� ' ■r� ♦ 4„ ,.._.tea:-r..n::.:s7�-•v-•�•-_•-��8 r v�--r 7(a��sl`�i �rr t .'•y 6�89����^�i� �Es�A�BH�®-...`.�'.a:�.=-�'.^_`w^w�� . • 1�K�.t" ...--._»«...— ��®CB��®•�®fid■Y tl� Co����—�� .».. »... .. i- a 115 S.Andrews Ave.,Rm.A-100. Ft.Lauderdale, FL 33301-1895-954-831-4000 a VALID OCTOBER 102014 THROUGH •SEPTEMBER.30,Z®15 1<I DBS{ Receig�� :Py.M3XG/LVK SPI2NICt+/CON. nn: s= BATH CREST OF FL LLC Business Type-,Business Name: (CER.TIFIED PLDM 3 NG CONT_ eTo a M. Owner Name:TED iCfRP (QM) Business Opened:11Jo6/2013 = Business Location:1751 W COPANS RD 6 Stage/CounfjdCerUReg:CFC1429010 POMPANO BEACH Exemption Code: 2! Business Phone:754-999-3030 Rooms Seats Employees Machines Professionats 7 �# For Vending Business Only Number of Machines: Vending Type., • ' TaxAmount TransferFee NSFFee Penalty PdorYears Collection Cost Total Paid j 27.00 0.00 0.00 0.00• 0.00 0.00 27.00 �i 1 • THIS RECEIPT MUST'BE POSTED CONSPICUOUSLY IN YOUR PLACE OF BUSINESS • THIS BECOMES A TAX RECEIPT This fait is levied for the privilege of doing business within Broward County and is 21 =1"r, non-regulatory in nature.You must meet all County andlor Municipality planning r> : • and zoning uirements.This Business Tax Recipt must be transferred when . WHEN VALIDATED ig re e = 9 r` the business is sold, business name has changed or you have moved the i business location.This receipt does not indicate that the business Is legal orthat j N is in compliance with State or local laws and regulations. - i. Mailing Address: BATH CREST OF FL LLC Receipt #10B-13-00003226 1 = 1751 W COPANS RD 6 Paid 07/21/2014 27.00 ' POMPANO BEACH, FL 33064 t t—.-- i?{.^L�%C••.»�.^"'`-�.^ifl%�-• t+•i•:,y':7•_.•^��4.�•-.'r•S� rN4ryr�ix. ^'T � Nx��,.'.r-s•-�+' r•.—.-e.• —. �;.++� .••�� �..'i.?=.« ..r«.1''4r.` c• e.r+•.i _ •-.�.+.Ls���..1.• `r�'�s r:....�-r.......�r'G.••.:+:�ti°�...+1•�•.:� :—�5'•.��c.�':..^.:.s��i���.. ow Uoa I ® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 8/13/2015 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 CONTACT Judy Suarez Commercial Lines—800-868-8834PHONE 704-556-2580 FAX 866-332-3051 A/ N A/C No Wells Fargo Insurance Services USA, Inc. E-MAIL u .suarez wellsfar ADDRESS: ditho.com G g 6100 Fairview Road INSURERS AFFORDING COVERAGE NAIC# Charlotte,NC 28210 INSURERA: Southern Owners Ins.Co. 10190 INSURED INSURER B: Auto-Owners Insurance CO. 189$$ FLaBelle, Inc.dba Bath Crest&Bath Crest of Florida,LLC INSURER c: Bridgefield Casualty Insurance Co 10335 1751 W.Unit 6,Copans Road INSURER D: INSURER E: Pompano Beach FL 33064 INSURER F: COVERAGES CERTIFICATE NUMBER: 9437974 REVISION NUMBER: See below 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 ADDLSUBRPTYPE OF INSURANCE IVSD WVD POLICY NUMBER OL MDY EFF MM/DDPOLICY EXP LTR LIMITS X COMMERCIAL GENERAL LIABILITY 1,000,000 A 132312-35626482-14 9/13/2014 9/13/2015 EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE FxI OCCUR PREMISES Ea 0.0 ence $ 300,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JERCOT- I LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY 49-603277-00 9/13/2014 9/13/2015 COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED Per aPROP. ident ERTY DAMAGE X HIRED AUTOS $ X AUTOS $1,000 Comp $1,000 Coll D $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ C WORKERS EMPLOY EMPLOYERS'COMPENSATION 196-35483-1 11/01/2014 11/01/2015 X STAFERTUTE ETH AND EMPLOYERS'LIABILITY 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y� N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) City of Miami Shores-License#CFC1429010-Bath Crest CSA CERTIFICATE HOLDER CANCELLATION Miami Shores Village Bldg.Dept. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 10050 NE 2nd Avenue THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) (This cenificate replaces cerfilladet 9273471 Issued on 625/2015) r �2oomSketcher®Home Designer Page 1 of 1 a $ S AV iT t PLUMBING PLANS Approved __Dated-rS Dis2pproveo; • . . . . . . . . TO 6 . . . . . . . . . . . . ... . . . . . . .. . . . . . . . . . . ... . . . . ... . . . . . . . . . . . . http://planner.roomsketcher.com/printephp'i*maget;A"ttpa/*IA//projectmedia.roomsketc... 7/28/2015 + l� Juan Martinez Luis Perez Property: 65 NE 107th St Miami Shores, FL 33161 A—Shower and Toilet(67"x 114") B—Sink(68"x 82") C—Master Room(146"x 161") D—Guest Bathroom(89'x 59") E—Guest Room(125"x 130") • . • • . . • •• • • • • • . •• . • • • ••• . •• ••• •• • • • •• • ••• • • • • • • • • • • • • • • • • ••• • • • • • • 00 0.• •• • • • • • • • ••• • • • • ••• • • • • ••• • i • • • • • • • • • • • • •• •• • • • :0 • •• ••• • • • ••• • • MOEN" Specifications DESCRIPTION • Brass construction • Pressure balancing, four port valve design with volume control and integral check stops, 1/2" CC or IPS connections igr OPERATION • Adjustable temperature limit stop to control maximum hot water temperature • Pressure balancing mechanism maintain selected discharge temperature to ± 2°F CARTRIDGE • 1225 cartridge design • Nonmetallic/nonferrous and stainless steel materials • Accommodates back to back installations STANDARDS MOENTROL° VALVE• Third party certified by CSA to meet CSA B-125, Pressure-Balancing Valve with ASME A112.18.1 M and all applicable requirements Volume Control referenced therein and complies with the applicable requirements of ANSI A117.1 WARRANTY Models: 3570 (CC ,3550 (IPS) - Single Pack • Lifetime limited warranty against leaks, drips and 63170 (CC), 63150 (IPS) - Bulk Packed finish defects to the original consumer purchaser (Bulk packed 12 per carton) • 5 year warranty if used in commercial installations NOTE: See reverse side for illustrated parts FINISHED WALL LINE �--- 2-1/16"(52mm) MAX. 1-7/16" (37mm) MIN. 5-1/2" 0 0 (140mm) rr --- WALL OPENING 7 (178mm) 45" (1143mm)/ MIN. 48"(1219mm) -SHOWER HOT COLD 32"(813mm) -TUB OR INLET INLET TUB SHOWER FLOOR TUB RIM __ % CRITICAL DIMENSIONS (DO NOT SCALE) MOEN SPECIFIER SERVICES 1-800-321-8809 Ext. 2158 Rev.6/02 Bath Crest Office: (754)999-3030 1751 W. Copans Road BATHToll Free: (800)241-0215 Suite 6 (5,1 Fascimile: (754)999-3040 Pompano Beach, FL 33064www.bathcrest.com C STOMEI�-�NFO MATION !1 Date �,,- �.�»- /'' EOI Number Name: + E-Mail Address: City: ry � State! ", zip Tel (H) Ji Tel (W). 6f ' 16 l Tel (C) Liner ❑ Free Standing EDWalk-inTub ❑ EMXLH Walk-Through Insert LH ElRH Skirt Type Color $ Notes 17MO E]Liner ' Free Standing ❑ Flat ❑Other F Color Drain ED l H ❑Center El RH Notes $ FE-1Smooth ❑Simulated Tile(stylet Color Include all wails in pricing Sizes Right Left. Back $ Size Color Notes $ - ❑ Bypass ❑ Pivot ❑ Custom(specify) Finish Glass Size $ b Drain Kit ❑Shower Drain Kit Finish Valve ❑ Fixtures ❑ Handheld w/Slidebar ❑ Handheld w/Wall Mount ❑ Handheld w/Goose Neck $ Model Finish Grab Bars Finish Model QTY Finish Model QTY Window Trim Style Color Model $ Accessory-1 Description Color Qty $ Accessory-2 Description Color Qty $ Accessory-3 Description Color Qty $ Seat Style Color Model $ Wall Returns ❑Removal Existing Tub/Walk ❑Removal&Dispose Doors ❑Wall Repair ❑Window Frame ❑Wall Extensions ❑ Other $ ❑Beadboard El Other(specify) #'of Sheets required Notes Color Model COMMENTS-Year home built/Conditions 1 RequestsCustoLJmer is responsi le for�ll r , r d permit costs.- Please initial Total$, 491'": Discount$ beposit Balance SIGNATURES Balance above due'upon completion f l - Balance is subject to change if Customer --~' >7(- ' +Zak',t ` r Date 2--7, job requires permits. Bath Crest Rep ' Date" ES This job will be financed — NO Subject to credit approval have read&inderstand the terms on the Scheduled Date Completed On Installer reverse side on this agreement ♦- Initials here: WHITE ORIGINAL CUSTOMER CANARY-OFFICE PINK-FILE GOLD-ESTIMATOR 7 (SST.?)27.4-�73r' `J 1726 Corrmicrce St Fitz,91:t 272-7750 -GaiLtnd,Texas 75040-6710 ID1101: O l-23.13 TE,3T RYP•CDRT TEST NO.:39565-El .1-'0.R.: :STI At'uR Y1 J(.",•LIC Page l of 6 5162 'Vi1. 1`vr�ry 34• Contact: Chris Griffirt Erut.is,TX 75119 Background: BTI Acrylic,LLC subrriltte:l one Acrylic/Fiberglass Showerbase,for 01aluation per CSA B0.5.11/IAPMq 5:124.1 I. 't a showarbase was rec,&Pd in good cnndirion on Visual inspection 0,03 perfomied with no defects noted. All testing.fmd sample preparation wa::performed by Universal Laboratory personnel luith no outside services required The following information is provided, Order entry Log Date: 04-4)2-2013 Log No.: 7351311 Selected by ULI inxpector,Lance Baker Product Description:. 35-5/8"X 35.518"X 6-1/4"Acrylic/Fiberglass Showerbase :scope&Purpose: Testing to assure the compliance of.the product to C3A 845.5.1111APMO Zl14.11 standard's nequiren'jents for acci:ptab'tlity as a showerbase plumbing fixture for the manufacturer, lister„ Installer,arca end user. Preparation: CSA 1345-11-11/1APMO2124-11 Ternparatures&Preparation: Ambient Lab.Temp. 5:t• t'..olor-Fastness'Pest 5.5.1 Stain ltn5istance Test Specimen :.6.1.1 Wear Test Speci.nien 5.10 Coiourlbstn= 5.11 Stain 5.12.1 Wear ;1.1.2'.2.CleanabSlily 5.15 Chemical resistance S.16 Thermal Shock 5.2.5.4 Water Absorption Test Procedures: CSA 1345.5.1111APM0 2124-11 4.4.1 Flangros 4,1.2/5.4 Surface Finishes 4.2 Waste fittings openings 5.3 Warpage.tolerance:; 5.5 Subsur thce test 5.6 Waste fitting Connection 5.7 Point Impact 5.E Structural Integrity 1"e9ts 5.9 R.ailli Load Test For Bathtubs 5.10 Colourfastness 5.11 Stain Resistance S.12 C itanability and Wcar $.13 Ignitabiliry 5.1'4 Cigarette S.IS C h-emical iesista,nee 5.16 Thermal Shock 5.25.4 Water Absorption Test'Results: The test results are provided in the attached data report. CONCLUSIGINI: The Acrylicll7-1175hovrerbase Tested, Meets The Requirements Per CSA B45.5-11/IAPM O.Z'124-1 1,Per Paragraphs Tested, Note: "We certify that all portions of each test performed were under continuous,direct suoervision of this laboratory." • Jam/,.)f'J''A. /�/J A ��/p_� ,'/J/� ,�,�w//���j.�. Charles Stanley, Director G;7� This report shall riot be reproduced,exce{lt its Rill,without the written altproNal of Universal Laboratory,tnc. BT.:e:asVeg rPb9.g1;*7PRIt:01 :mcaca+.o»C r i a ewoj j TZ rata �I,./fi.•l�ri�r{„r��r/4laA.'{r{rlfa.'anF.11ndSrl1��6.r� ly'hIL�'�Ite�'W� I .I���o (97:2)272-7337 �• 1726 Cvnlrnetcts St Prix (517:1)272-7.790 Garland,Texas 7504,D-6710 D,IVI-L--: 04-23-2013 T1 ST REPORT TEST NO.:3956541, i-mit.:it;: ffrI ACRYLI C,LLC Page 2 o1' 6 CSA B45.5-2011/1AP1b10 21 2.4-2011 PLASTIC PLUMBING FI'XTURES 4.4 Etathoibs and shower bases: Showerbas e •11.4.1 Flanges: N/A 4A.2. Slope to the waste outlet: COMPLIES Unit's slope is within the maximum slope of4%to the waste outlet. Unit's slope is within the minimum slope of 11K. 1.n.4. Minimum dimensions ForShowerbase: COMPLIES Thm-sholds shall be at least 2"above top of waste outlet. 6"A.boue No overfirny:. Not appliceib4s :i Test Requiromentn 5:2 Load test fbr.grab bars: Not applicable 5.3 Warpage wlerance test COMPLIES 5.3.1 Unit was placed on flat,level surface to daermine the amount of devirdion from the horizontal plane that exists at it's!piigts. Used a realar gauge to test pe;r 5.3.1 instructions.Would riot slide under the unit at any area. 5.3.i Performance, (a)There was no Warpage erreeding 5mm/m (0.06 inlft); (b)No Warpage exceeding 7.5 mnVm(0.09 ht/ft};and(a)Total Warpage did not exceed 16 mm(0.063 in). 5.4 Surface examination test: COMPLIES 5A,l Unit was washed with a solution of standard liquid detergent and water,rinsed and dried.Then rubbed with a sponge and a 30%solution of water aml water":soluble black Ink.Ink rinsed immediately from the surface with water and d6sd before o>:aminaticnn. Surface was exaaninrd For defects with the unaided eye fiona a distance of between 300 and 610 mm(1 and 2 fl)using a light source of partially diffused artificial light giving an illuminance on the Surfice of 1615:h 5.40 1 x(1$0 d:50 foot-candles). 5.4.2 The unit wa.,free fl'on'i cracks,chipped arm,and blister's and no other defects were found. The fixture,was also free from blemished and defects on the visible surface to the extent specified in Table 1. 5.5 Subsurface test COMPLIES 5.5:1 The subsurface test wa:s conducted on tivo different areas of the unit.Washed with a liquid detergent and water solation,rinsed and dried..The specimens were rubbed with oorntal hand pressure for 25 cycles with 600 grit wet silicon carbide,abrasive paper.Following the abrasion the test ureas w,w-t-rinsed with water and dried. Standard dirt(5g(0.1 S oz.)was rubbed into each area with a dampened dharnois with heavy thumb pressure in a circular motion for 25 cycles and allowed to dry for one hour. Then washed by rubbing areas with a clean,dampemeh c:hanaois and liquid detergibnt. The surface of the areas were then rxamined per 5.4.1. 5.5.2. There were nn visible voids larger than 1.6 mm(0.063 In)in diameter below the original finish surface,and the less thus 1110 Maxitnum allowed number of voidS Smaller ON 1.6 rmrr(0.01)3 in)in the two test areas. iNs repoltl:;ltllill Ilot be reproduCed,W.-Cl:pt kq frill,without the written 2I1lnlroval of Universal Laboratory,Inc. BT/2::aapd 08901792L6 118:Woj_4 ;32:t;R bLPa-rta_ttaa / )i l�t0/➢s//,►{/� t I/��►qy' ry(ry 1 / r�11SIt(7W6d, (517.1)272-7337 1726 Commi-o0c.St Fax(972)277.-7.750 Garland, Texas 75040-6710 -04-23-1 j T'as,:r REPoR r TEST NO.: 39565-13; :1701R.: BTI.ACRYLIC,LL.0 . Page 3 of 6 CSAL B45.5-201 I/IAPIVIO ANSI:7124..2011 PLASTIC PLUMBING FIXTURES ..6 Waste Fitting;Connection Tett ofShovv;:r 13:nse COMPLIES :5.6.1 Procedure for bethtubn and ohower bases Grain-Fitting Connection fest: The test load vias applied by means of it lever arm 600 mat long connected to the drain:and extending horizontitlly..The weight and lever arm test load was applied hn three radial positions, two of whIch were approximately 180°apart. 3.6.3 There were:no visible cracks in the fixture when:inspected with-the flriing in place after testing per 5.6.l using a load of 220:1!4 N(50 t I IV). ,7 Point Impact Load Test COMPLIES 5.7.1.2 A. 1.5"steel(hall with a.weight of 2.204.0514(0.50x0.01 N)sari dropped from a height of 900 mm(36 in)w strike six different locations,:as follows;(1)"a hpmtions on flat areas in bottom of fixture;(ii)3 locations on the rim,from a height of 600 mm(24 in)to strike 3 locations on radii in the bottom of fixture,and one of those was In a comer of tile, -fixture. .5.7.2 Performance:There were,no cracks or.(,}tips in t:he surface of the unit when examined per items(b)to(d)of Clause 5.4.1 5.8 Structural I rangrity Tests La9d test-For sects: Not applicable 5.8.2 Load test i'or rims and bottoms: COMPLIES 5.8.2.2.1 -A preload of'1335.+2•:N(300*5 IV) test load applied to ilia center bottom of unit and left-for 2 to 3 minutes.To aik.)%Y for seale:tment of unit,then rcn:oved for ten to fifteen ntiinutes and then reapplied to the same area and deflection under the:load meastfred with a defleotometer with a-reading accuracy of 0.025 mm(0,001-in). The load matt removed and alter the-removal oi'the load the,residual deflectitnt.was mebsured. 5.8.2.3 Performance: There were no cracks In the surface and the deflection under the test load did not exceed 3.81 min (0.150 in)tend the maximum residual deflection 10 minutes after removal of load diel not exceed 0.203 mm (0.008 in). Under Load:&7_211 Residual Deflection-. .004" :5.8.4V✓alt 5utroitnd Not applicable 3.9 Radii Lead Test For Shower, Not applicable 5.10 Colourfastness Test COMPLIES S.10.2 &a.10.3 Conditions and Procedum.: Test specirien was cut from-the unit.Wide one half shielded as a conm)l,the test specimen was exposed to ultraviolet radiation for 2.00 hours by using clear glass filters in an Xenon Are Weatherometer. The Black-pane.]tempe:ravare:was malwallfed at 1i3 f 5°C. The test stttriple was then stored away from light source at 73 t 9°F for 72 hours and then evaluated. 5:10:4 There was no appreciable,change in color of the-specimen when tested in accordance with 5.10.2 and 5.10.3. 'Mis report shall not be Teprodueed,except in fill,without the written nppl'ovttl of Universal Laboratory,Inc. E TAP:aapd 56b9SS6 t0f3'6:01 n n9S9b9aL6 I e:wo.t_q 2a i60 til ln2-�0-81H�1 ....C.Ir..+•9.�I�Lrc)pURrRsf ll-U , tJ (972) 2-72-73 3-7 1726 Cormnerce St Fay,(!r/2)272-7790 Garlancl,Texas 75040-6710 DATE: 04-23-13 TEST REPORT TEST NO:: 39565-1;1 FOR. B'11 ACk2.Y111c, LLC Page 4 of 6 08A B45.5-2011/IAPMO ANSI 2124-2011 PLASTIC PLUMBING FIXTURES 5.11 Stain Resistance/Clause.=.1 i.1 Stain Resistance Test COMPLICS 'The maximum stain resl:atance rating shall be the sum of the individual:,(Erin ratings.ofeach of the covered and InCoVered stain sreas and shall not exceed SO when tested in acC►rdtmc*with Clause$.1 1.1 through 5.11.2.3. 5.11.3 Performance. The maximum reduction in the ihicknesir allowable of the surface,material with a stain having a rating of 5 is 0.175mm. COVER 61) UN-COVERED I Blinck crayon 2 _ DIfick liquid shoe polish I _ I Blur,washable ink -__ 22 — Lipstick 3 _ .Hair dye 3.� 2 — Iodine solution(I%alcohol sol) t — Gentian violet solution(2%aqueous) Stain Rating: 19 _.. Stain Rating: Total Stain Rating Covered&Uncovered:_ _,15� Reduction of material;Nz,Mlicable 5.1.2 Clennlability:and Wear Test 5.12.1 WcarTr..s1 Procedure COMPLIES 5.12.1.1 through 5.12.1.2 Specimens preparation and lest equipment preparation 532.1.3 Procedure:Each specimen was subjet:t to 7,600 scrub cycles. 5.:2.1.3.3 Samples ra.moved fi-otn-test machine,rinsed in viater,dried,and measurod for c)eanability per 5.12.2 for redaction in surface:material. There was no wear-throuth of the surface lrtatei-10 in the middle third of the specimens. 5. 2.2 Cteanability Test Results: 'Phe white-lir;ht reflectance•af 3 specimens dict not lose snore.than 5440 v,hite»light reflectance after being cleaned and not more than 2%white.-light reilecrtnce a-her an additional cleaning with abrasive cleaner,when tested in sorordance with 5.12.2. Avera€ic of 3 specimens First CleaningL. . 50 "_o Second Cleanittg.„0Q aQ:/S;,_ 'This report shall not be reproduced,except in FIJI,without the written approval of Universal Laboratory,Inc. STAG:0e48 I:I0999b92LS Il8:wo-Jd 22:90 t-t:02-r-0413d Uv��l�/r(rr'fr�,r�r�d 9���r'��l�r'.nlll�l.n•11/lir���.�'CA1�r9rdld�IM� •�/ �,C� _ i(972..)272.-733 7 d. .1726 Commerce at Fax(972)272-7790 Garland,Texas 75040-6710 _�-DATE: 04-21.13 TEST IMPORT TEST NO.. 39565-13 .1,oft.. E7.1 fi.C1RYLIC, LiLC Page 5 of 6 CSA► $45.5-201 VIAPlYfO ANSI 2124-2011 PLASTIC PLUMBING FIXTURES •.13 Ignitabillty Test Ignitability of the Unexposed Surface: ignition Fest: COMPLIES 5 specianers were remov,rd from unit and placed in a.draft ftea labor imy hood. The-flame ftom a propane:torch was applied to the center of the backslde.of each specimen at a 45°angle for 30 seconds and removed and flame time recorded. After i minute the flame,was reaalaplied to same area for 30 seconds and removed and timed again fiDr bum rate. Ignition test rcriults: y�piniLo. V112 miLme 1 3 t1 2 5 13 3 2• 16 4 6 10 5 8 12 Requirements: All specimens shall cease.to balm,if ignited,within 30 seconds after removal of burner. 5.14 Cigarette Test COMPLIES 5.14.1 Three lighted cigarettes,diflcrent brands,were placed I"in from edge ofspecimens•and allowed to bum For 2 minuees. Cigarettes wore removed and specimens allowed to cool,then cleaned with cheesecloth. All visible sua-Ins were removed with household cleaning powder,no sandpaper needed to remove stains. S.14.'-Z There was no lgnition or progressive gltnv ot'the specimens during or after contact with the cigarettes, 5.15 Chemical Resistance Test COMPLIES 5.15.2 Two drops of each of the following reagents were applied to surface specimens on two sets of samples. One:set left wicovered and one set covtred.wilh watch glasses;reagenls used:Naphtha;Ethyl alcohol, Amyl accutte,Ammonium hydroxide, Citric-acid 10%mater,Una,6.0%water solution,Hydrogen peroxide 3141 water, Sodium hypochlorite 6%solutitm,'foluene,Ethyl acetate,Lye, 1%to 2%water solution, and Acetone,and allowed to remain for 16 hours. Watch glasses and excess reagent removed from specimens and then specimens were Icept for 24 hours st 2:3 t 2'C(74.3*3.6°F)and a relative humidity of 50 zi:5%. Then examined per 511.1. :.4.1 Lin i t was washed with a solusion of s'tandiard liquid detergent and venter,rinsed and dried.Then rubbed with a sponge and a 50%sc0urion of water sant!ulat*r-soluble blank ink.Ink rinser! Immedlately from thesurface with water and :l I-d bofore examination. :Surface was examined ror defecis with the unaided eye ii-om a distance of between 300 and 610 rem (I and 2-R)using a light source of partially diffused anIflcial light giving an illumirruace on the surflive of 1615:E 5.40 Ix(150 t 50 fool.-candles). S 11.a The unit wail free from cracks,chipped areas,and blisters and no other defects were found. The fixture was also flee:from blemished and defects on the visible surface to the extent specified in Table 1. 5.15.3 Performance: The surface,finish was unaffected by the reagents,ex xpt for superficial changes removable,by sanding with 400-exit sandpaper and water. Damsgle resulting from the testing did not impair the;serviceability ofibe fixture and can be easily a epairatile using abrashve fans polishing compounds to(approximate the original finish This repoil shell not be reproduced,except in full,without die written approval of Universal Laboratory,Inc. ST.-51:260.4 al I aq_g9b9ZZ6 rie:wojA 2.2:60 i�1:02-r0-FIS I I�.J�,.�fi6/d.i-Eia����no.�/1rl�irJ 8i16•Ldr►✓ 1� , .,m../� (972j 272-7337 1726 Corruverce St I-ax (972)2 72 7 75llG Garland,Texas 75040-6'710 13jk'rE-: 04-23.13 TEST REPORT TEST NO..3956541 1?011;: C T(AC:R.Yi1C., LLC Page 6 of 6 �ti;ft 1345-5-2011/IAPM0 ANSI ZI24-2011 PLASTIC PLUMBING FIXTURES 5.1.6 Thermnl'Shoek Resistoanse Test COMPLIES 5.16.2 Showerbase was set up when:water at 15001 a:4°17 would impinge on starrare where vrater would normally strike for 1.:1 minutes,drain for 30 seconds,foil owed by•water tit 50°-±4°E=fbr 1.5 minutesand drain for 3.0 stcands. Warar mate at'3.78*010 L/min(1.0it 0.2 gpin), This procedure constitutes one compleje,eycie.. This.test vans continued for 250 cycles.. " 5:16.3 There was no cracking.,crazing,blistering,de-loamination or spalling of unit. 5.17 Waterresistance Gest for bathtubs and showers: COMPLIES Three sipecimens oire imus lied in a boil test tank and bailed for 100 hours using distilled water. BATE CHANGE LOSS OF SURFACE TOTAL P 2+1M 1M f,U.1 Ji!lQQ!K,x J''zl(,^?UMSj 01--Q9 PRQF1LE RATING No. 0 0 0 0 0 0 T1a. 2 0 0 0 0 0 0 No.3 0 0 0 0 0 0 RATING 0 NO CHANGE REQUIREMENTS: MAXIMUM DATING 9 ON ALL 11411Ee)~SPECIMENS. MAXIMUM ON,ANY ONE SPECIMEN RATING 4. 5,25.4 Water Ab..oriarion Test COMPLIII& 5.25.4.1 Three specirnens r,Ut from unit,scaled edges,ctmditioned for 24 hours in oven at 50:k 3°C 0 22:h 5°F), then cooled to ambient laboratory temperature,and weighed and then immersed in distilled water 23* 1'C (73 x 2.0F)for 24 hours,;then remaved•one st a time and dried.Then ine0gohed within 30 seconds after removal 11'om water. 'The perce.ntage,increase was then calculnfed to the nearest 0A I%. 5.25.4.2 The three specimens vestt:d did not absorb any•ove-ter in excess of 0.9%by mass. This report shall n-ot be reproduced,e:acopt in h11,without the,wrilton 2(pproval dt)niversal Laboratory,Inc. E✓trL:�y�d 66b955i6'10E '6tol @09S%92L6 I18:w0Jxl £2:60 b1;02-£0-E19zl