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HomeMy WebLinkAboutPLBG2019-3977PLUMBING PERMIT (VALUE) 7 ,tf 11Yif� 7-*tl f Issue Date: October 4, 2019 +1 5 ,• 1 PROJECT DESCRIPTION: double check replacement PROJECT# (817)410.3010 www.mygov.us PLBG-19-3977 Inspections Permits City of Grapevine LOCATION LEGAL P.O. Box 95104 1909 Wood Meadow Dr. Parkwood Addition Bilk 4 Lot 4 Grapevine, TX 76099 Grapevine, TX 76051 *05841410* (817) 410-3165 Voice (8 17) 410-3012 Fax CONTRACTOR INFORMATION MLB Landscape County Tarrant State ID # 19256 Square Footage P O. Box 330744 VALUATION 500 Ft. Worth, TX 76163 ( 903) 654-9858 Phone FEES TOTAL = $ 37.00 ( PAYMENTS TOTAL = $ 37.00 OWNER Patricia A Shaw MLB Landscape (brian mitchell) ($37.00) 1909 Wood Meadow Dr Cc on 1010312019 Grapevine, TX 76051 NOTICES ALL work must be done in compliance with the 2006 INTERNATIONAL AVAILABLE INSPECTIONS PLUMBING CODE. � Backflow Device Inspection (required) Plumbing Final (required) 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. READ AND SIGN 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. Signature Date MYGOV US Cay 0 Grapevine I PLUMBING PERMIT {VALUE) I PLBG-19-3977 I Printed 10104119 at 804 a. Page 1 of 3 r Texas Commission on Environmental Quality BACKFLON%T PREVENTION ASSEMBLY TEST AND :MAINTENANCE REPORT I ne follm:me town must be completed For each .usemhis tcetcd. A sienrd and dated ouainal must be submitted to the public wUto supplier for recordkeepin¢'nurroses: NAME OF PWS: (j; e / e Ve'-% PWS ID#: PWS MAILING ADDRESS: j PWS CONTACT PERSON: ADDRESS OF SERVICE: 1R04 Wv0d/q-3977 j The backflow prevention assembly detailed below has been tested trod maintained as required by commission regulations and is certified to be operating within acceptable parameters. TYPE OF BACKFLOW PREVENTION ASSEMBLY (BPA): ❑ Reduced Pressure Principle (RPBA) i ❑ Reduced Pressure Principle -Detector (RPBA-D) Type II ❑ D� Double Check Valve (DCVA) ❑ - Double Check -Detector (DCVA-D) Type it ❑ ❑ i Pressure Vacuum Breaker iPVB) ❑ Spill -Resistant Pressure Vacuum Breaker (SVB) Manufacturer: Main: (1, I ktt~F Bypass: Size: Main: ?Jy Bypass: i Model Number: Main: 3-50 Bypass: }-- ls+�l l7j BPA Locution:—<— — _ �^ �-- Sciial Number: Main' B}'pas,: ', BPa Stts'ed: �b.��` rOr•i-..ZciG� 1 Reason for test: Nett ❑ Existing ❑ Replacement ❑ Old Model/Serial # Is the assembly installed in accordance with manufacturer recommendations and/or local codes?I — - [j-yCS ❑ No Is the assembly installed on a non -potable water supply (auxiliary)? ❑ yes ©-'5o TEST RESULT PASS C2-- FAIL ❑ !Initial Test Date: II-ihto Time: Rcpairs and Materials Used` Test After Repair Date: Time: Reduced Pressure Principle Assembly (RPBA) DCVA 1 `t Check 2'e Cheek*** Held at psid Held atpsid Closed Tight ❑ Closed Tight ❑ Leaked ❑ Leaked ❑ Main: Held at _ psid Held at _ psid Closed Tight ❑Closed Tight ❑ * Ind check: numeric readint ret Difterential pressure gauge used: - - � Make/Model I /IIxl�, I") t ,Fca S'_ _J SV:_ I Remarks: i Relief Valve Opened at not I ❑ Type 11 Assembly PVB & SVB Bypass Check Air Inlet Check Valve Held at _ psid Opened al _ psid Held at _ Closed Tight ❑ Did not open ❑ p,al Leaked ❑ Did it fullyopen Leaked ❑ (Yes ❑ /No ❑) Opened at _ H'a'— psid Opened at _ psid Held at _ psid Closelded psid Tight ❑ tired for DCVA only Potable: ❑ — — -- — -� Non -Potable: ❑ I-_ 4) 305'/ 3 tan Date tested for aceuracV _ -1 Company Name: Licensed Tester Name (PrinVTvpc): (% � Company Address: p� /mac } i zyY 7`t Licensed Tester Name (Signature): I Company Phone #: � iBPATLicense # ! J3r�,�TS' (�li ti �tSy Li„ - E. D. ,. t 'Cerise xpirauon ate: The above is certified to be true at the time of testing. * TEST RECORDS MUST BE KEPT FOR AT LEAST THREE YEARS 130 TAC' §290.46tB)) ** USE ONLY MANUFACTURER'S REPLACEMENT PARTS