The URL can be used to link to this page

Home My WebLink AboutPLIRR2012-23411 1 t o MECHANICA _ JUL 5 2012 c CITY OF GRAPEVINE ELECTRICAL PLUMBING_ C FUEL GAS C5 PERMIT APPLICATION PLEASE PRINT JUL I I no S PERMIT # 1 ), -�� BLDG. PERMIT # DATE: I -- JOB ADDRESS: SUITE # DESCRIPTION OF WORK: ' dr PROPERTY OWNER: � i � C CONTRACTING COMPANY: (`t S iA,nm kn ` - ADDRESS: oll D DDRESS: CITY /STATE /ZIP: I CITY /STATE /ZIP: Iry 1 1 C PHONE NUMBER: I PHONE NUMBER: 0a G G TYPE OF OCCUPANCY B BUILDING AREA P PERMIT FEES A AMOUNT DUE EACH TRADE I. R -3 1— 749 $ $ 33.25 O: \FORMS \DS APPLICATIONS - FEES \MEP APPLICATION 4- 11.doc U� PLAN SUBMITTAL: WHEN PLANS ARE REQUIRED BY CODES, ORDINANCES, OR AS DETERMINED BY THE BUILDING OFFICIAL, THREE (3) SETS OF PLANS SHALL BE SUBMITTED IN HARD COPY FORMAT. ENGINEER SEALED PLANS AND CALCULATIONS SHALL BE SUBMITTED AS REQUIRED BY CODES, ORDINANCES OR WHERE OTHERWISE REQUIRED BY STATE LAW. OTHER INSPECTIONS AND FEES: • INSPECTIONS OUTSIDE NORMAL BUSINESS HOURS (2HR MINIMUM ) ............................ ...................$42.00 /HOUR* • REINSPECTION FEES ................................................................................... ............................... $42.00 • PERMITS FOR WHICH NO FEE IS SPECIFICALLY INDICATED ............................ ............................... $37.00 • INSPECTIONS FOR WHICH NO FEE IS SPECIFICALLY INDICATED (1/2 HOUR MINIMUM) .. ....................$42.00 /HOUR • ADDITIONAL PLAN REVIEW REQUIRED BY CHANGES, ADDITIONS, OR REVISIONS TO APPROVEDPLANS .................................................................... ............................... ....................$42.00 /HOUR • BUILDING PERMIT FEES FOR THE GRAPEVINE - COLLEYVILLE INDEPENDENT SCHOOL DISTRICT SHALL BE 25% OF THE FEES ESTABLISHED IN THIS TABLE • FOR USE OF OUTSIDE CONSULTANTS FOR PLAN CHECKING AND INSPECTIONS, OR BOTH......... ACTUAL COSTS ** I HEREBY CERTIFY THAT THE FOREGOING IS CORRECT TO THE BEST OF MY KNOWLEDGE AND ALL WORK WILL BE PERFORMED ACCORDING TO THE DOCUMENTS APPROVED BY THE BUILDING DEPARTMENT AND IN COMPLIANCE WITH THE CITY OF GRAPEVINE CODES REGULATING CONSTRUCTION. IT IS UNDERSTOOD THAT THE ISSUANCE OF THIS PERMIT DOES NOT GRANT OR AUTHORIZE ANY VIOLATION OF ANY CODE OR ORDINANCE OF THE CITY OF GRAPEVINE. I FURTHER CERTIFY THAT ALL WORK THAT IS REQUIRED TO COMPLY WITH ANY FEDERAL, STATE, AND / OR LOCAL LAW REGARDING ENERGY CONSERVATION WILL BE PERFORMED IN ACCORDANCE WITH THOSE LAWS, AND THAT VERIFICATION OF ENERGY CODE COMPLIANCE SHALL BE SUBMITTED TO THE CITY UPON REQUEST. SIGN4ftkRE OF CONT CTOR OR AUTHORIZED AGENT (OR M OWNER FOR HOMEOWNERS PERMITS) PRINTED NAME PHONE #: �� J 111 EMAIL: & *OR THE TOTAL HOURLY COST TO THE JURISDICTION WHICHEVER IS GREATER. * *ACTUAL COSTS INCLUDE ADMINISTRATIVE AND OVERHEAD COSTS. CITY OF GRAPEVINE, BUILDING INSPECTIONS, P. O. BOX 95104, GRAPEVINE, TX 76099 (817) 410 -3165 6/21/01 REVISED: 10/01, 5/06, 2/07, 7/07, 6/09, 11/09, 4/11 0: \FORMS \DS APPLICATIONS - FEES \MEP APPLICATION 4- 11.doc JUN I 1 2012 CITY OF GRAPEVINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: GRAPEVINE ANNUAL TEST IRRIGATION PWS I.D.# 2200013 OTHER NAME OF BUSINESS WHERE DEVICE IS LOCATED: ADDRESS OF SITE SERVICED: 4r PLUMBING PERMIT IF APPLICABLE: # TESTER LICENSE NUMBER: P .132 -Z-e EXPIRES: 1 DATE OF LAST TEST GAUGE CALIBRATION: THE BACKFLOW PREVENTION ASSEMBLY DETAILED BELOW HAS BEEN TESTED AND MAINTAINED AS REQUIRED BY TCEQ REGULATIONS AND IS CERTIFIED TO BE OPERATING WITHIN ACCEPTABLE PARAMETERS. TYPE OF ASSEMBLY REDUCED PRESSURE PRINCIPLE PRESSURE VACUUM BREAKER DOUBLE CHECK ATMOSPHERE VACUUM BREAKER MANUFACTURER: / '� SIZE: MODEL: S SERIAL NUMBER: 14 3,f/ Z/S PHYSICAL LOCATION OF METER: J& ,-Pt - -c -- ;31!�I The above is certified to be true. TESTERS FIRM NAME: kt1 ,�C %Lase ADDRESS: &- Agx- % CITY /STATE/ZI�P�:° e'i DATE: �'&I`Z PHONE NUMBER: �Z`/5p- Z-5& PRINT NAME: LYN "D,41-L °T.✓�� _ SIGNATURE: DOUBLE CHECK VALVE INSPECTION MUST BE CALLS OR INSPECTION AT (817) 410 -3010 C, 'DC)CUME—l\sbafte\LOCALS-1%TempVPgrpWse\TCEO BACKFLOW TESTER REGISTRATION.doc 11 /3100IRe, Gros, 1 06, 2110 REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER DOUBLE CHECK VALVE ASSEMBLY RELIEF VALVE AIR INLET CHECK VALVE 1sT CHECK 2ND CHECK Open at psid psid DC -Close g t -` Closed figs Initial _RP L psid t,�[ Psy,v Opened at p Did not open Leaked Test 1 /i t ,Repair Leaked Leaked psid Materials Used Test DC- Closed Tight Opened at Opened at After Closed Tight psid Repair _ RP psid psid psid The above is certified to be true. TESTERS FIRM NAME: kt1 ,�C %Lase ADDRESS: &- Agx- % CITY /STATE/ZI�P�:° e'i DATE: �'&I`Z PHONE NUMBER: �Z`/5p- Z-5& PRINT NAME: LYN "D,41-L °T.✓�� _ SIGNATURE: DOUBLE CHECK VALVE INSPECTION MUST BE CALLS OR INSPECTION AT (817) 410 -3010 C, 'DC)CUME—l\sbafte\LOCALS-1%TempVPgrpWse\TCEO BACKFLOW TESTER REGISTRATION.doc 11 /3100IRe, Gros, 1 06, 2110 JUN 1 I ZOV CITY OF GRAPEVINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: GRAPEVINE PWS I.D.# 2200013 ANNUAL TEST IRRIGATION OTHER NAME OF BUSINESS WHERE DEVICE IS LOCATED: 7z?6+,.y x0-5. ADDRESS OF SITE SERVICED: _ �' / /9-YD s"f, PLUMBING PERMIT IF APPLICABLE: # TESTER LICENSE NUMBER: DATE OF LAST TEST GAUGE CALIBRATION: EXPIRES: $ 13 THE BACKFLOW PREVENTION ASSEMBLY DETAILED BELOW HAS BEEN TESTED AND MAINTAINED AS REQUIRED BY TCEQ REGULATIONS AND IS CERTIFIED TO BE OPERATING WITHIN ACCEPTABLE PARAMETERS. TYPE OF ASSEMBLY REDUCED PRESSURE PRINCIPLE DOUBLE CHECK PRESSURE VACUUM BREAKER ATMOSPHERE VACUUM BREAKER MANUFACTURER: f-e c v SIZE: vt ti MODEL: g S O SERIAL NUMBER: 14 9 12,9 PHYSICAL LOCATION OF METER: t-- The above is certified to be true. TESTERS FIRM NAME: A-+- 6Ac&,, t --, ADDRESS: PV-3 °X' ss13X7�1 CITY /STATE/ZIP: C,ON3, P? DATE: ��« %rZ PHONE NUMBER:�/� PRINT NAME: L- YAoAzr- T :v:zrs _ SIGNATURE: DOUBLE CHECK VALVE INSPECTION MUST BE CALLED FOR INSPECTION AT (817) 410 -3010 C \DOCUME— l\sbatle \LOCALS- 1 \Temp\XPgrpwise \TCEO BACKFLOW TESTER REGISTRATION.doc 11/3/00 /Rev. 4/05, 1/06, 2110 REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER DOUBLE CHECK VALVE AIR INLET CHECK VALVE ASSEMBLY RELIEF VALVE 1sT CHECK 2ND CHECK Open at psid psid DC-Closed Closedfi�f Initial _RP j.4 psid �3 A,'P Opened at Did not open Leaked Test Leaked Leaked psid Repair Materials Used Test DC- Closed Tight Opened at Opened at After Closed Tight psid Repair RP psid psid psid The above is certified to be true. TESTERS FIRM NAME: A-+- 6Ac&,, t --, ADDRESS: PV-3 °X' ss13X7�1 CITY /STATE/ZIP: C,ON3, P? DATE: ��« %rZ PHONE NUMBER:�/� PRINT NAME: L- YAoAzr- T :v:zrs _ SIGNATURE: DOUBLE CHECK VALVE INSPECTION MUST BE CALLED FOR INSPECTION AT (817) 410 -3010 C \DOCUME— l\sbatle \LOCALS- 1 \Temp\XPgrpwise \TCEO BACKFLOW TESTER REGISTRATION.doc 11/3/00 /Rev. 4/05, 1/06, 2110 JUN 11 2012 CITY OF GRAPEVINE BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT NAME OF PWS: GRAPEVINE PWS I.D.# 2200013 ANNUAL TEST IRRIGATION OTHER NAME OF BUSINESS WHERE DEVICE IS LOCATED:'1= L'tT�L'L� ADDRESS OF SITE SERVICED: *;0 l T. YD PLUMBING PERMIT IF APPLICABLE: # TESTER LICENSE NUMBER: Z J3Z2- a DATE OF LAST TEST GAUGE CALIBRATION: EXPIRES: �f31J3 THE BACKFLOW PREVENTION ASSEMBLY DETAILED BELOW HAS BEEN TESTED AND MAINTAINED AS REQUIRED BY TCEQ REGULATIONS AND IS CERTIFIED TO BE OPERATING WITHIN ACCEPTABLE PARAMETERS. TYPE OF ASSEMBLY REDUCED PRESSURE PRINCIPLE DOUBLE CHECK PRESSURE VACUUM BREAKER ATMOSPHERE VACUUM BREAKER MANUFACTURER: SIZE: � 11 MODEL: ms's PHYSICAL LOCATION OF METER: The above is certified to be true. TESTERS FIRM NAME: /+ " 13 i�Cfc e ADDRESS: f0,3,, - CITY /STATE/ZIP: CeI ^,,-) 64141'e, DATE: PHONE NUMBER: Z17j!��7' Z30 ` V Z Z R PRINT NAME: �ivd/'sGL %�°�� SIGNATURE: •_� !� DOUBLE CHECK VALVE INSPECTION MUST BE CALLED FOR INSPECTION AT (817) 410 -3010 C.\D000ME- 1\sbatte \LOCALS- 1 \Temp\XPgrpwise \TCEO BACKFLOW TESTER REGIST RAT ION.doc 11 /3100 /Re ✓. 4/05, 1/06, 2/10 REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER DOUBLE CHECK VALVE AIR INLET CHECK VALVE ASSEMBLY RELIEF VALVE 1sT CHECK 2ND CHECK Open at _psid psis DC- Closed;Ti- ' Closed- Ti.ghi Initial RP ',(� psid p i. �5�'� Opened at Did not open Leaked Test Leaked Leaked psid Repair Materials Used Test DC- Closed Tight Opened at Opened at After Closed Tight psid Repair _ RP psid psid psid The above is certified to be true. TESTERS FIRM NAME: /+ " 13 i�Cfc e ADDRESS: f0,3,, - CITY /STATE/ZIP: CeI ^,,-) 64141'e, DATE: PHONE NUMBER: Z17j!��7' Z30 ` V Z Z R PRINT NAME: �ivd/'sGL %�°�� SIGNATURE: •_� !� DOUBLE CHECK VALVE INSPECTION MUST BE CALLED FOR INSPECTION AT (817) 410 -3010 C.\D000ME- 1\sbatte \LOCALS- 1 \Temp\XPgrpwise \TCEO BACKFLOW TESTER REGIST RAT ION.doc 11 /3100 /Re ✓. 4/05, 1/06, 2/10