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PLC-15-2026 i Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795-2204 Fax: (305)756-8972 Inspection Number: INSP-241183 Permit Number: PLC-8-15-2026 Scheduled Inspection Date: September 09, 2015 Permit Type: Plumbing - Commercial Inspector: Diaz, Osvaldo Inspection Type: Final Owner: MILITANA,JOHN AND ADRIENNE Work Classification: Addition/Alteration Job Address:8900 BISCAYNE Boulevard Miami Shores, FL Phone Number Parcel Number 1132060110160 Project: <NONE> Contractor: HURRICANE PLUMBING CONTRACTORS LLC Building Department Comments INSTALL BACK FLOW DEVICE Infractio Passed Comments INSPECTOR COMMENTS False Inspector Comments Passed �j Failed S Correction ❑ Needed Re-Inspection ❑ Fee No Additional Inspections can be scheduled until re-inspection fee is paid. September 08,2015 For Inspections please call: (305)762-4949 Page 18 of 44 MIAMI-DADE WATER&SEWER DEPARTMENT METER OPERTATIONS&MAINTENANCE MIAMM ZDF, CROSS-CONNECTION CONTROL UNIT 1001 N.W. 11th STREET,MIAMI,FL 33136.2209 Phone(305)547-3046?Fax(305)545.9555 BACKFLOW PREVEN ION ASSEMBLY TEST REPQRT FORM ADDRESS OF DEVICE: J"I ,�.` 1 ; t! f OWNER OF DEVICE: �r N � ' V t xc OWNER CONTACT: e e A+ PHONE:: �' FAX: ADDRESS OF OWNER: ZIP CODE:: NAME OFTESTE + CERTIFICAT : EXPIEI I :: PHONE:: 2 BUSINESS NAME:• I�At BUSINESS ADDRESS: 3 TEST KIT MAK MODEL#: SERIAL#: 1) 1-) DATE LA CAL. SITE TUBE: ' �f/� ' 1'" �11 YES /NO rN, s .£ MAKE OF ASSEMBLY: MODEL N SERIAL#: SIZE: n �� Axe d'�� 1414 655)� -� LOCATION OF ASSEMBLY: 'OfjHAZARD/SERVICE: METER NO. % 4 INITIAL TEST: ANNUAL TE T: DATE OF TEST 2 j ( METER READING: SHUT OFF VALVE#1: SHUT OFF VALVE#2: r CLOSED TIGHT: D� CLOSED TIGHT: LINE PRESSURE: PRESSURE STABLE:YES- NO LEAKED: LEAKED: r - d CHECK VALVE NO.1 CHECK VALVE NO.2 DIFFERENTIAL RELIEF VALVE AIRINLET CHECK VALVE N Closed Tight: Closed Tight: FAILED TO OPEN: FAILED TO OPEN: LEAKED:_ H Leaked' — Leaked' OPENED AT: PRESSURE DIFFERENTIAL ACROSS CHECK PRESSURE DIFFERENTIAL ACROSS CHECK HELD AT: PSI PSI OPENED AT: PSI. PSI PSI Avr. REMAR KS/REASON FOR FAILURE(IF APPARENT): L ffi P !I k C" G m/ - i N CLEANED: CLEANED: CLEANED: CLEANED: w Q REPLACED: REPLACED: REPLACED: REPLACED: a W GC i Y CHECK VALVE NO.1 CHECK VALVE NO.2 DIFFERENTIAL RELIEF VALVE AIR INLET CHECK VALVE Closed Tight: Closed Tight: FAILED TO OPEN: FAILED TO OPEN:_ LEAKED:ui _ OPENED AT: HELDAT: W Leaked: Leaked: PRESSURE DIFFERENTIAL ACROSS CHECK PRESSURE DIFFERENTIAL ACROSS CHECK OPENED AT: PSI PSI PSI PSI P I `� T AGC{ � � ' ��AT .. nI SIGNATURE OF CERTIFIED TESTER: r DATE /. J FOR OFFICE USE ONLY: DATE: Revised: 01/10/2005 www.miamidade.gov/wasd/backfiow.asp Permit/vo. PLIC-8-1 5-21 `58oRFs y�� Miami Shores Village ftrinit Typ Plumbing-Comr rclal.rE, . � 10050 N.E.2nd Avenue Wo�� 1a ocati6h.Addition/Aitei�at%�n., Miami Shores, FL 33138-0000 Ferait Status,APPROVED PN_ o� Phone: (305)795-2204 Is$ue4at 8131120 15 Expiration: 2/27/2016 Project Address Parcel Number Applicant 8900 BISCAYNE Boulevard 1132060110160 .._.._._ JOHN AND ADRIENNE MILITAN/ Miami Shores, FL Block Lot: Owner Information Address Phone Cell JOHN AND ADRIENNE MILITANA 8801 BISCAYNE Boulevard MIAMI SHORES FL 33138-3381 8801 BISCAYNE Boulevard MIAMI SHORES FL 33138-3381 Contractor(s) Phone Cell Phone $ 1,200.00 Valuation: HURRICANE PLUMBING CONTRACTC _ Total Sq Feet: 00 Type of Work: INSTALL BACK FLOW DEVICE Available Inspections: Type of Piping: Inspection Type: Additional Info: Top Out Classification:Commercial Re Pipe Scanning:3 Main Drain Heater Water Service Final Water Main Lavatory Review Plumbing Review Plumbing Underground Fees Due Amount Pay Date Pay Type Amt Paid Amt Due CCF $1.20 Invoice# PLC-8-15-56681 DBPR Fee $2.25 DCA Fee $2.25 08/11/2015 Credit Card $50.00 $ 116.70 Education Surcharge $0.40 08/31/2015 Credit Card $ 116.70 $0.00 Permit Fee $150.00 Scanning Fee $9.00 Technology Fee $1.60 Total: $166.70 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 pros er authorities of Miami Shores Village. In accepting this permit I assume respo sibility for all work done by either myself, my agent, servants, or employes I understand that separate permits are required for ELECTRICAL, PLUMBIN ,MECHANICAL,WINDOWS,DOORS, ROOFING and SWIMMING POOL wo;k. OWNERS AFFIDAVIT: I hat II the fore oing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning r , I nze ttie above-named contractor to do the work stated. August 31, 2015 Authorized Signa ure:Own r / Applicant / Contractor / Agent Date Building Departm nt Copy August 31, 2015 1 Miami Shores Village A 11:2015 Building Department BY: 10050 N.E.2nd Avenue, Miami Shores,Florida 33138 Tel:(305)795-2204 Fax:(305)756-8972 V INSPECTION LINE PHONE NUMBER:(305)762-4949 FBC 20/y BUILDING Master Permit No. — PERMIT APPLICATION Sub Permit No. ❑BUILDING ❑ ELECTRIC ❑ ROOFING ❑ REVISION ❑ EXTENSION ❑RENEWAL QPLUMBING ❑ MECHANICAL ❑PUBLIC WORKS ❑ CHANGE OF ❑ CANCELLATION ❑ SHOP CONTRACTOR DRAWINGS JOB ADDRESS: 8900 Biscayne Blvd City: Miami Shores County: Miami Dade zip: Folio/Parcel#: 1132060110160 Is the Building Historically Designated:Yes NO Occupancy Type: Load: Construction Type: Flood Zone: BFE: FFE: OWNER:Name(Fee Simple Titleholder): John Mllltana Phone#: Address: 8801 Biscyane Blvd City: Miami Shores State: FL _ Zip: 33138 Tenant/Lessee Name: Koning Restaurant International Phone#: 305-430-1200 Email: etunis@aol.com CONTRACTOR:Company Name: Hurricane Plumbing � rad-a(< Phone#: 305-525-2107 Address: 104 Crandon Blvd City: Key Biscyane _state: FL Zip: 33149 Qualifier Name: Lawrence C. Lanza Phone#.. 305-525-2107 State Certification or Registration#: CFC1427078 Certificate of Competency#: DESIGNER:Architect/Engineer. _ Phone#: Address: City: State: Zip: Value of Work for this Permit:$ 1200.00 Square/Linear Footage of Work: Type of Work: ❑ Addition ❑ Alteration Q New ❑ Repair/Replace ❑ Demolition Description of Work: ) 157 ALt- (1jA IA FCc,-,> ')LvI Specify color of color thru tile: Submittal Fee$ Permit Fee$ !> a "j`CCF$ _ CO/CC$ Scanning Fee$ Radon Fee$ DBPR$ Notary$ Technology Fee$ Training/Education Fee$ Double Fee$ Structural Reviews$ Bond$ �` � Bonding Company's Name(if applicable) NIA Bonding Company's Address City State Zip Mortgage Lender's Name(if applicable) N/A 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 no . 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 ust be posted at the job site for the first inspection which occurs seven J days after the building permit is issued. In the absen of such posted notice, the inspection will not be approved and a rein ection fee will-bre charged. Signature Signature 0 R or AGENT CONTRA/TOR The foregoing instrum7'ijfi was acknowledged before me this The foregoing instrument was acnowledged before me this i% day of _ 20 i by ��day of / - 20 l t _, by J iY? L f ho is personally known to C.G�i��X'� /!2a ,who is personally known to me or who has produced as me or who has produced EZX= as identification anho did take an oath. identification and who did take an oath. NOTARY PUBLIC: NOTARY PUBLIC. Sin: �.'lt.�t `--=c ✓ Sign: _. . P t 'rt rint: : Notary Public•Stat o1 Florida °' Notary Pupfk State of Fforlda S zN •'-'My Comm.Expires Mar 21,2018 Seal: 4,v Joanna M Feliciand►Pa Commission#FF 097586 My Commission FF 082753 1°;;;a` Expires 01/12/2018 Bmft Through Wtio w luotary assn. APPROVED BY Plans Examiner Zoning Structural Review Clerk �.___.._ ._..._.._ _ �_ _...._......._ _............ ACORv® CERTIFICATE OF LIABILITY INSURANCE °A'E`""MID°"'"'r' 5/8/2015 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 NAME:CT Yamile Corral Gil, Garden, Avetrani Insurance Group PHONEYVG (305)630-4777 No:(305)279-3022 10689 N. Kendall DriveA No- a MSS:YCorral@ggaig.com Suite 208 INSURER(S)AFFORDING COVERAGE NAICN Miami FL 33176 INSURERA White Pine Insurance Co. INSURED INSURERS Normandy Harbor Insurance Company Hurricane Plumbing Contractors, LLC INSURER C: 104 Crandon Blvd. INSURER D: Suite 420 INSURER E: Key Biscayne FL 33149 1 INSURER F: COVERAGES CERTIFICATE NUMBER:15/16 Master Cert REVISION NUMBER: 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 LTR TYPE OF INSURANCEADDLSUBR U R POLICY EFF POLICY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE ❑X OCCUR PREMISES Ea occurrence $ 100,000 QCP0066007 5/10/2015 5/10/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY 7 JPERQ 7 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINEDL 1 a accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N STATLITE X ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑N/A E.L.EACH ACCIDENT $ 500,000 B OFFICER/MEMBER EXCLUDED? 1rH]rL143055 11/14/2014 11/14/2015 E.L DISEASE-EA EMPLOYE $ 500,000 (Mandatory In NMI K yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Scherbrle,may be attached H moreapace la required) Certified Plumbing Contractor License number: CFC1427078 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Miami Shores Village THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 10050 NE 2nd Avenue Miami Shores, FL 33138 AUTHORIZED REPRESENTATIVE Joe Avetrani/YC '� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 rgmann .. . . . .. ... . . ... . . . . .. . • Fia DUa ((77 �Vic_Felt t 470Li�11I 1 13,kc x FcCw 1/ ('Rcv;.N�it 3�C ALI' f',Rt�Nttti U A.0 g t xl srINw LX�53't,vb w,�>YL ---------- 1� 1 .226 BY T "4 15 CITY Arm IR in AW RR '�I .� i AUG 2 5 2015 BY: