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PL-14-510 I � 0C L (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-239100 Permit Number: PL-3-14-510 Scheduled Inspection Date:July 23,2015 Permit Type: Plumbing - Residential Inspector: Diaz,Osvaldo Inspection Type: Final Owner: MARTINELLO(PRESIDENT),CHRISTEL Work Classification: Addition/Alteration Job Address:1329 NE 105 Street Miami Shores, FL 33138-2136 Phone Number Parcel Number 1122320270060 Project: <NONE> Contractor: UNIVERSAL PLUMBING CORP Phone:(305)887-3131 Building Department Comments BATHROOM RENOVATION,WATER HEATER Infractio Passed Comments REPLACEMANT AND WASHING MACHINE. INSPECTOR COMMENTS False Inspector Comments Passed CREATED AS REINSPECTION FOR INSP-209086. recertify backflow E�r vacuum breaker washing machine trim hose bib Failed condensate disposal well as per plan Correction 6k Needed ❑ Fla Re-Inspection Fee No Additional Inspections can be scheduled until re-inspection fee is paid July 22,2015 For Inspections please call:(305)762-4949 Page 16 of 39 MIAMI-RADE WATER&SEWER DEPARTMENT METER OPERTATIONS&MAINTENANCE CROSS-CONNECTION CONTROL UNIT 1001 N.W.11+h STREET,MIAMI,FL 33136-2209 Phone(305)547.3046?Fax(305)5459555 BACKFLOW PREVENTION ASSEMBLY TEST REPORT FORM ADDRESS OF DEVICE: �� 7 /o� s OWNER OF DEYK E: ? ep 1 OWNER CONTACT: p( �r PHONE::� A�J� FAX ADDRESS OF OWNER ZIP CODE: NAME OF TESTER ?v 11v 4� CERTIFICA 3 1 EXPIR%j PH 4 2 BUSINESS NAME: A J, BUSINESS ADDRESS: (® (y ZIP CODE 3 TEST Kffl MA -� MODEL# SERIAL#//1,3 DATE j SITETUBE: ��v,,�•J (�' YES /NO MAKE OF LY: n MODEL NO: SERIALS: SIZE:: LOCATION OF ASSEMBLY: E: METER NO. 4 INITIAL TEST: ANNUAL TEST: DATE OF TEST: , METER READING: SHUT OFF VALVE#1: p ® SHUT OFF VALVE 02: CLOSED TIGHT: l/ CLOSED TIGHT: LINE PRESSURE: PRESSURE STABLE:1/ES-N O LEAKED: LEAKED: CHECK VALVE NO.1 CHECK VALVE NO.2 DIFFERENTIAL RELIEF VALVE ARIAM CHECKVALVE Closed Tight: Closed Tight: L000 FAILED TO OPEN: FAILED TO OPEN: LEAKED._ ,u,_j Leaked: Leaked: OPENED AT: HELDAT. PRESSURE DIFFE�RENTIAL ACROSS CHECK PRESSURE DI NTIAL ACROSS CHECK -7,� IPSI PSI OPENED AT: PSI. PSI PSI REMARKS!REASON FOR FAILURE(IF APPARENT): CLEANED: CLEANED: CLEANED: CLEANED: aREPLACED: REPLACED: REPLACED: REPLACED: 7 CHECK VALVE NO.1 CHECK VALVE NO.2 DIS RELIEF VALVE AIR INLET CHECKVALVE ;� Closed Tight: Closed Tight: FAILED TO OPEN: FAILED TO OPEN:_ LEAKED:Lu — T: HELDAT: Leaked: Leaked: OPENED A PRESSURE DIFFERENTIAL ACROSS CHECK PRESSURE DIFFERENTIAL ACROSS CHECK OPENED AT: PSI PSI PSI PSI PSI Tak SIGNATURE OF CERTIFIED TESTER: A7 Avn-to, 'A " DATE: y FOR OFFICE USE ONLY: v DATE: Revised: 01/10/2005 www.miamidade.gov/wasdlbackflow.asp 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)762A949 FBC 2(P, - 1 BUILDING Permit No. PERMIT APPLICATION Master Permit No Permit Tyo;--PI.LLM_RI JOBADDRESS: /OTO #46 /OS a4f" City: Miami shores County: Miami Dade Zip: 3-3141 Folio/ParceW "- 2.'Z3 t—O 27- 006 O Is the Building Historically Designated:Yes NO K Flood Zone: OWNER:Name(Fee Simple Titleholder): G 1TD r R K ee l L C Phone#: 789•V 9 3 Address: /0 70 HE /19 V- city: w e a cs y rue. P&rt< state: FA Zip: '37141 Tenant/Lessee Name: Phone#: Email: CONTRACTOR:Company Name: x (/e/LS4e %1 'D(1 Phone#: r(/�t�yeXS weaCcwr Address: �,iZ_4ki Y55r7 City: xl/, ,p l,evf_ e_1 state: 114?" Zip: �la Qualifier Name: )°_ lfz4f,,�� Phone# V 5 ,O q E State Certification or Registration#: ''°c c 6 ,? eya,l Cert'if'icate of Competency#: Contact Phone#: 9V_S j?0 CI-SV7V Email Address: ��•ve/t$�fL �t.'G �jr� DESIGNER:Archiwct/Engineer. GftJXr A. C.1.C%A Phone#: 30 V-'ref 4.19 t9 400—V Value of Work for this Permit:$ "!.� ® SgnardLinear Footage of Work: Type of Work: OAddress OAlteration , iew PfRepair/Replace DDemolition Description of Work: Submittal Fee,, �� Permit Fee$ CCF$ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Boud$ Notary$ Training/E lucation Fee$ Techology Fee$ Double Fee$ Strnctaral Review$ TOTAL FEE NOW DUE$� { , �► Bonding Company's Name(if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) Mortgage Lender's Address 6 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$2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued In the absence of such posted notice, the inspection will not be approved and a reins tion fee will be charged Signature Signatur rd i R or Agent Contractor The foregoing insMnl5ent was acknowledged before me this_f�LV The foregoing instrument was acknowledged before me this, day of �=�$ ,20 L,by �; e O /�z S- GQ Day of ,20fe,by , who is Uercnnatty known to me or who has p490111140- who is personally known to me or who has produced �— As identificationrJNft ``• ��th. _ �� pno clia MARIN th. NOTARY P C: a�G Old' :* NOTARY PUBLIC• de COMMISSION#FFoMa7 Sip: Iwo Si `"' EXPIRES Apro 17,2017 . i m EIB OQ` FlorideWOt�YSenh�eoD»! Print: ` Gl y# � � Print: ., My Commission Expires: fit.�''�ra'UB � `°� My Commission Expires: ****************************************** ***************************************************************** APPLICATION APPROVED BY: Plans Examiner Engineer Zoning Chc 05/13/03 Miami Shores Village Building Department 10050 N.E.2nd Avenue,Miami Shores,Florida 33138 Tel:(305)795.2204 Fax:(305)756.8972 BUI LDING Permit No. PERMIT APPLICATION Master Permit No: FBC 2001 Permit Type(circle): Building Electrical Plumbing Mechanical Roofing Owner's Name(Fee Simple Titleholder) Phone# Owner's Address City State Zip Tenant/Lessee Name Phone# Job Address(where the work is being done) City Miami Shores Village County Miami-Dade Zip Is Building Historically Designated YES NO / / Contractor's Company Name 64<f P/e K S/kC Z"�ll�"`�� ;wone# Contractor's Address axSS / City �e�GG4 State�� Zip .3 o/vZ Qualifier. State Certificate or Registration No. ��2 Certificate of Competency Na Architect/Engineer's Name(if applicable) Phone# $Value of Work For this Permit Square Footage Of Work: Type of Work: ElAddition FlAlteration RINew Repair/Replace []Demolition Describe Work: Submittal Fee$ Permit Fee$ CCF$ CO/CC Notary$ Training/Education Fee$ Technology Fee$ Scanning$ Radon$ Zoning Bond$ Code Enforcement$ Structural Plan Review.$ Total Fee Now Due$ (Continued on opposite side)