CC-14--2119Inspection Worksheet
Miami Shores Village
10050 N.E. 2nd Avenue Miami Shores, FL
Phone: (305)795-2204 Fax: (305)756-8972
Inspection Number: INSP-228527 Permit Number: CC -9-14-2119
Scheduled Inspection Date: February 23, 2015 Permit Type: Commercial Construction
Inspector: Rodriguez, Jorge Inspection Type: Final
Owner: PROPERTIES LLC, SHORE SQUARE Work Classification: Alteration
Job Address: 9007-9029 BISCAYNE Boulevard 9007
Miami Shores, FL 33138- Phone Number (305)779-8040
Parcel Number 1132060110070
Project: <NONE>
Contractor: DAMICO BUILDING GROUP LLC Phone: (248)458-1122
sunamg uepartment comments
INTERIOR BUILD OUT OF WHITE BOX. TENANT SPACE TLfractio Passed Comments
PREVIOUSLY BLOCKBUSTER VIDEO I
INSPECTOR COMMENTS False
Passed °
i
Failed
Correction ❑
Needed
Re -Inspection ❑
Fee
No Additional Inspections can be scheduled until
re -inspection fee is paid.
Inspector Comments
CREATED AS REINSPECTION FOR INSP-228457. Missingfire final
February 20, 2015 For Inspections please call: (305)7624949 Page 17 of 28
BACKFLOW PREVENTION ASSEMBLY FIELD TEST REPORT /
DATE OF TEST:
NAME OF PREMISE: ICO CONTACT PERSON:�-
STREET ADDRESS:/ 0jD %la4A y)(�&D 411#�11. SWOWS TEL It
LOCATION OF DEVICE:dXiQ,_,jJ
TYPE OF DEVICE: RP X D.C. C) CPVB 11 OTHER SIZE: I Py PERMIT NUMBER
MANUFACTURER: _ _ _ C.ciILICt�LS METER NUMBER: !?7QQ �? / // tcS
MODEL NUMBER: 97S' X �- SERIAL NUMBER: -3 vp 3 %2yol --
LINE PRESSURE: 7D
NOTE: ALL REPAIRS/REPLACEMENT SHALL BE COMPLETED WITHIN TEN {10) DAYS.
REMARKS.
I HEREBY CERTIFY THAT THIS DATA IS ACCURATE Apu),;ix
E PROPER OPERATION AND MAINTENANCE OF THE UNIT.
CERTIFIED TESTi�Nr,COMPANY TEST EQUIPT, USED fil i (Lies�� ZO
PASSED
INITIAL TEST BY ; . ( _
REPAIRED BY
FINAL TEST BY
CERTIFIED TESTER SIGNATURE
FAILED - REPAIR NEEDED
CERTIFIED TESTER NO.. DI�
PRESSURE DROP ACROSS FIRST CHECK VALVE �_,._
EXP.
BATE
PSI
.
EXPMO
DOUBLE CHECK I r REDUCED PRESSURE
DATE
i
I
PRESSURE VACUUM
CHECK VALVE 1 CHECK :ALVE � a DIFFERENTIAL
PRESSURE RELIEF VALVE
BREAKER
IN[-
TIAL I
I. LEAKED
❑ t. LEAKED
^_
AIR INLET
TEST
2. CLOSED TIGHT
9 D
,��
OPENED AT
LBS.
OPENED AT
LBS.
_
2. CLOSED TIGHT
DID NOT OPEN
0
DID NOT OPEN
CLEANED
l
.,
CLEANED
._
CLEANED
O
CHECK VALVE:
REPLACED:
, REPLACED:
REPLACED:
LEAKED
C
RUBBER PARTS KIT
]
i RUBBER PARTS KIT
n
HELD AT
PSID
C.V. ASSEMBLY
n
4 C.V. ASSEMBLY
I
0
RUBBER PARTS KIT
r
CLEANED
0
OR
OR R V. ASSEMBOe ❑
DISC
C
DISC
t7
OR
REPLACED:
O -RINGS
i_;
O -RINGS
L
DISC
i
C.V. ASSEMBLY
RSPRING
SEAT
;'
SEAT
[' !!!
DIAPHRAGM
L7
DISC, AIR ASSEMBLY
#
c
SPRING
❑ f
SEAT
0
DISC. C.V.
v �
P
STEWGUIDE
J
STEM:GUIDE
Cl I
SPRING
—
SPRING
O
A
RETAINER
RETAINER
�
C-
GUIDE
=
RETAINER
C
LOCK NUTS
LOCK NUTS
0
O -RINGS
O
GUIDE
G
A
OTHER
c
OTHER
n
OTHER
]
O-RING
C
S
i
OTHER
G
i
i
b
i
I
' FINAL
I—OPEN
AT LBS.
TEST
CLOSED TIGHT
O 1
CLOSED TIGHT
n
REDUCED PRESSURE
SATISFACTORY
t
LINE PRESSURE: 7D
NOTE: ALL REPAIRS/REPLACEMENT SHALL BE COMPLETED WITHIN TEN {10) DAYS.
REMARKS.
I HEREBY CERTIFY THAT THIS DATA IS ACCURATE Apu),;ix
E PROPER OPERATION AND MAINTENANCE OF THE UNIT.
CERTIFIED TESTi�Nr,COMPANY TEST EQUIPT, USED fil i (Lies�� ZO
PASSED
INITIAL TEST BY ; . ( _
REPAIRED BY
FINAL TEST BY
CERTIFIED TESTER SIGNATURE
FAILED - REPAIR NEEDED
CERTIFIED TESTER NO.. DI�
MO DAYYR
EXP.
BATE
/D 1/51 /kp
DAY A.
EXPMO
DATE
1 _