PLC-18-3622 (2)DERM PROCESS NO.: % ���� Z'l o 1O l DATE: TIME: `% = 3c') �'
MUNICIPAL PROCESS/PERMIT NO.: /mil L - /') - / Y " •-7'5�- J� ---)- •
ADDRESS: G� 'SG / �v /� Ila rn 1
COMMENTS: 1' e
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INSPECTOR NAME: e PHONE NO.: J'G�-> 3 V
INSPECTOR E-MAIL:
APP��VEtj
SIGNATURE:
HYDROMECHANICAL FOG CONTROL DEVICE (H-FCD) INSTALLATION INSPECTION'
MIAMI-DADE COUNTY RER-DERM
FOG CONTROL PROGRAM
TO BE FILLED OUT BY THE APPLICANT
Building Permit No.:.
DERM Process No.:
Site Address: �
City:
Folio: /%— � �0 '�w _ QQ/0
Zip Code:
Contact Person: C
✓!I r.� S�•.e �/-Cn -s
Title:
�ZJ-�—jn7-�rrGr" �>77`
Ph: s
Email: �• � QGl/� ��-v�7'�.1�.� • GG'�
FOR RER-DERM USE ONLY
Date: Q/� /�
Time: � .. 3v
GDO:
DERM Inspector: Mayde Izquierdo
Ph: (305)372-6640
Email: Mayde.lzquierdo2@miamidade.gov
DERM Supervisor: Ashton Younquist
Ph: (305)372-6957
Email: Ashton.Youngquist@miamidade.gov
INFORMATION FROM APPROVED PLANS
Number of FCDs :
#1
#2
#3
#4
#5
Manufacturer:
�&ker
Third Party Certifier:
Model #:
Capacity (gpm):
a)d
Lbs. of Grease
Retention 99% removal
efficiency:
Monitoring Alarm
System:/
Solids Separator:
1 MDC Code, Section 24-42.6(7)(ii)
ON -SITE INSPECTION CHECK LIST
GDO-
#
ITEM
Yes
No
No
Applicable
1
Are plans available on site with DERM approved stamp
❑
ARE THE FOLLOWING PER APPROVED PLANS?
2
FCD location
❑
3
Identification of the FCD visible
G'
❑
4
Installation of the FCD (inlet/outlet)
❑
5
FCD type
U
El6
FCD size (gpm)
D/
❑
7
FCD lbs. of grease retention
❑
8
FCD accessibility
❑
9
Sampling point installation
E,-;r'
❑
10
Sampling point accessibility
❑
11
Monitoring alarm system
❑
❑
12
Solids separator installation
❑
❑
._
I�
13
Inspection outcome'
PASS:
FAIL.-
** Payment of re -inspection fee required prior to requesting the second re -inspection and thereafter. The total amount to be
paid is eighty dollars and sixty-three cents ($80.63). To make the payment contact the DERM Cashier at 305-372-6755.
The confirmation number obtained from the DERM Cashier shall be provided to schedule the re -inspection.
Note for the DERM Cashier: Fee: $75.00, Surcharge(7.5%): $5.63, Total Fee: $80.63
INSPECTION NOTES
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Updated: 5/30/2018
2 If the inspection results show that the FOG Control Device (FCD) is not what was approved on plans, the applicant would have two options: a) Revise
the plans to show alternative FCD, which would need to be approved by DERM and Plumbing, or b) Replace the FCD to match the one on the approved
plans, and schedule a re -inspection.