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PW-11-1799Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 164990 Scheduled Inspection Date: November 18, 2011 Inspector: Hernandez, Rafael Owner: SHORES VILLAGE, MIAMI Job Address: 8850 BISCAYNE Boulevard Miami Shores, FL 33138 -0000 Permit Number: PW -9 -11 -1799 Project: <NONE> Contractor: LASSETER PLUMBING CO INC Permit Type: Public Works Inspection Type: Final Work Classification: Public Works Phone Number 305/751 -1271 Parcel Number PUBLIC WORK Phone: (305)525 -5075 Building Department Comments INSTALL 3/4" PRESSURE VACUME BREAKER ON SPLINKLER SYSTEM Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comments November 17, 2011 For Inspections please call: (305)762 -4949 Page 3 of 7 NOV-15-2011 14:44 FROM: TO: 3058937852 P.2'3 MIAMIDADE WATER & SEWER DEPARTMENT METER OPERTATIONS & MAINTENANCE CROSSCONNICTION CONTROL UNIT COUNTY 1001 N.W. 11* STREET, MIAMI, PI. 33130.2209 Phone , 5474046 7 Fen ')545.9555 ■■•■* C LOW PREVENT! N ASS - , LY EST RE ORT FORM •` 1 • OF . ILEVICS: . OM. ER 5 11 ' .a4 ' ifI_= f • t7, ' T Iti ' - r , n • rmilaLt , STEA a I ,. 0 a ...70 RUMNESS NM: / Puim a IMAM MAWS EP VILIk :!..:-.'f::•:::.-:,.- now mu_ I. 4 SWAM Jac 4 ,y,-,7 44377,-,malan"Qm.-1;0010 . , 7::g...et•-44.-A,.-, 1,.::•:::: - ,ir-lic. ,.-..... • :11,;,,, 4; wai OF ASSEMBLY' NAL NO lou14-T7-5 X4o Si _ 4 LOCATION OF ASSEMBLY: MATARDSERViCS: lariarAPAIIIIIIIMIM LINE PRESSURE.: 6 ei /0 pRESSURE STABLE: COP 0 INMAL TEST: ANNUAL TEST: oaser.vaLmet NW INA WAWA CLOSED TICK!' A CLOSED TIGHT: A , LEAKED: LF.AKED: — IIEM'RZ.TaaaTAfrNira We= , twimst avel CHECK vAi.vg No, 1 CHECK VALVE NO. 2 i,,,:..:6itiC17,,, ;1',:,;;I'.,v2H•,; „Ve,,,:- ,4,`,',.:_rilialg DIFFERINTIAL RELIEF VALVE 11111111P,' CRACK VALVE W Closed Tight Leaked; ___________ ........ Closed Tight FAILED TO OPEN: FAILED TOCIPEtt--,- LEAKED:_ OPENED AT: Pa °MED AT: IF WOO a PRESSURE CAPFERENTIAL ACROSS CHECK PSI FRESNO OFFERENRAL ACROSS OLEO( PSI / • Kg • 1F7HE: REMARKS I REASON FOR FAILURE (IF APPARENT): :... g 4K a. UJ ac * ' .• ilgiii&A-1.>,..,'.7.1'z' CLEANED: REPLACED: It ..... .•:'..;r. - i.").7,-:447;t2V; '''''' ''' ' '-, ' '' T,` _or , ,',7,,: ; i', tirit'Lla-Zirl'ffgKAANNI CLEANED: - . CLemek L/EAIVED: REPLACED. REPLACED: REPLACED: • Mat vaLvE CHECK VALVE NO. 1 • CHECK VALVE ND. 2 cormala ge wp yawl! AM OUT ro- Closed Tight • Closed Tight FAILED TO OPEN cam To ma _ LEAKED: UJ I-- LU ; CC Leaked: Leaked: . °PENEDO: PSI OPENED AT: PSI HEIDAt PSI PRESSURE OFTERISMAL CROSSCREOL PSI ParissuKs aoseNrtaL ACROSS CHECK PSI ff._"-116.T-e: , ;i1>'-.. -',''... ' ) ''''....W1:417V-Iti . FOR OF ' , ONLY: DATE vaiww.m emIdade.govlwaedibeckflow.esp 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) 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit Type: PLUMBING OWNER: Name (Fee Sim le itleholder): \ C I V p C Addr ss. City: Tenant/Lessee Name: Phone #: Email: Permit No. PLO 1) I TiC)1 Master Permit No. JOB ADDRESS: City: Folio/Parcel #: J'J �� s, c. 8 ///4) Miami Shores County: Miami Dade Zip: Is the Building Historically Designated: Yes NO Flood Zone: CONTRACTOR: Company Name: ‘A."1"1- p(4444 b 5' Phone #: -.3473 -7/8 Address: '' /3© s- City: ,V 44c.4- t State: zip: Z.3f'( Qualifier Name: 14 el e Phone #: State Certification or Registration #: e 4 491/6 9' (' p Certificate of Competency #: Contact Phone #: Email Address: 4, A -a ei42 p4/446,0697 C r W N DESIGNER: Architect/Engineer: Phone #: © SP Y Value of Work for this Permit: $ D ®• Square/Linear Footage of Work: Type of Work: ❑Address OAlteration ONew ' ORepair/Replac ODemolition s 7,4 -(/ 5/4 �` Gv,'t4 E Description o'Work: -. ;�!?7 ' (�o'u°�St�l�� ****************** ** **+ x+ x+ x******* x:****** Fees**** *x: ********* ***** *x: ****** **************** Submittal Fee $ Permit Fee $ /41")'''' CCF $ CO/CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural 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 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 reinspection fee will be charged. Signature 1 Signature Owner or Agent Contractor The f. yin " <i nstrument was ackn wled ed ? o e this The fo ; o` g i .trument w ackno'+ ed;, ed befo �e m-�this iir day o " li , 20 - 11 , by t--- wled / P" , day of a e , 20 11 , by Ia I �AV d% r who is personally known to ipe or who has produced ho is .-�so all known t. me or who has produced I As identification and who did take an oa NOTARY PUBLIC: Sign: Print: My Commission Expires: cation and who did take an oath. N Sign: Print: My Commission Ex ** *** ** ** *** * *** ***** * **** �u : ;.,.2,. ***** ******u: *x: +x**** * *+xx:******* * * * * * ** **: *** APPROVED BY Plans Examiner Structural Review (Revised 07 /10 /07)(Revised 06 /10/2009)(Revised 3/15/09) .State of F�i015 My Comm Expires Sep Commission # EE 12$3810 * * * * * * * * * * * * * * * * * * * * * * ** Zoning Clerk