HomeMy WebLinkAboutPLBG2024-001717ADDRESS
3729 Ira E Woods Ave.
Grapevine, TX 76051
LEGAL
Riverwoods Blk 1 Lot 1ra
S
The Lodge at Bear Creek
PERMIT HOLDER
Brian McCall
CMS Mechanical Service
s
(940) 383-4357
COLLABORATORS
•Brian McCall
CMS Mechanical
Services
(940) 383-4357
OWNERS
•Eip Healthcare
Property Grapev
TENANTS
•The Lodge at Bear
Creek
INSPECTIONS 3
1. TCEQ Backflow Certification Submit
2. Backflow Device Inspection
3. Plumbing Final
INFORMATION FIELDS
**APPLICANT NAME (Individual)Brian McCall
**APPLICANT PHONE NUMBER 9403834357
VALUATION 1500
TCEQ Backflow Exp License 2027.pdf
FEE TOTAL PAID DUE
Plumbing Permit Fee {VALUE}$ 45.00 $ 45.00 $ 45.00
TOTALS $ 45.00 $ 45.00 $ 0.00
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.
May 15, 2024
Signature Date
City of Grapevine
PO Box 95104
Grapevine, Texas 76099
817) 410-3166
Plumbing Permit {VALUE}
Project # 24-001717
Project Description: Replace backflow under dishwasher in
kitchen "The Lodge at Bear Creek"
Issued on: 05/15/2024 at 1:55 PM
MYGOV.US 24-001717, 05/15/2024 at 1:55 PM Issued by: Connie Cook
Page 1/2
Texas Commission on Environmental Quality .
RACIULOW PRIWENT ION ASSOUBLY TEST ANDIWAINTENAX.CE RE.EPORT
The fall o-wingform must be completed for each assembly lested, A signed and dated ofiginalmust be subrrtied to the public water supj)Eer for recordkeeping `It} uposes:
NAME OF PWS:
Pws mm iy!y
N PWS 1�4.AILWG' ADDRESS:
PWSI CONTACT PERSON:
I Zv� 69
ADDRESS OF SERVICE- U1006)5 V
The backflow prevention assembly dotafted below has been testedand maintained as required by corantission regulations
and is certified to be operating within acceptable parameters.
TITE OF BACIULOW PREXT, NTION ASSEMBIAT (BPA):
Reduced Pressure Principle (IUMA) Irl Ite(iiieedPressure Prig icil)le-Detector(R-PBA-D) Type 11 !Ell
Double Check Valve (DCVA) I[] Double Check -Detector (DCVA-D) Type 11 101
IIEI Pressure Vacuum Breiker (PIrB) 10 Spill -Resistant Pressure Vacuum I Break - er - SVB)
Manufacturer:
Model NUmber: Nfain:
�ypa ss:
Serial NumMai
ber, 11:1 Aypass'll
Size: Main: Bypass:
BPA Location. 1,<Ilelvel) 1I./Iode 4);,v
BPA Serves:
Reason fear test: I New Existing 'Ell' Replacement Old Model/Serial #
Is the assembly installed in accordance with manufacturer recommendations ind/or local codes? jmYc'�_, jEIINo
Is the assembly installed on a non -potable water supply (auxiliary)? I IMINo
PAS
�
FAKI Ell
Initial Test
D 1�,5
eate,
.Time:
-
Acpairs and
Materials
Used"
Type 11
Reduced Pressure Principle Assembly (RPB.--k) I Asselubly PVB & SVB,
DCVA
2Relief Valve Bypass Check Air Inlet Check Valve
I" Check "' Check-"**
Held at sicl Bold at )sid Opened t Held at!
L psid Opened at L J psid 'Held at
11(yes [01 /N,, jci� i
psidsid
Closed Tight Closed Tight !a Closed TiTi9l't Did not open 101 1 1 i
1"Paked -cd I Did not caked
Leak pI L alced Ej Did it fully open L
open JEIJ 0
A k
Main -I I
Bypass: I i
Test After Held at L__] psid 'Held at j I psid Opened atLJjjheld afl__Jpsid Opened at[ psid Held at J
BR osedTighEI t JI Closed"right 1111 psid Closed psid
Sn a Wir Cl
Date: I I , Tight
Time:,
211d check: numeric reading re I ired for DCVA only
7 used: Potable: 101 Non -Potable: JEI, on c,�
c tes
ted
c .cl
34;'j-s-com SN: 10 120 1250 Date tested on Potable;
accutacy: 11410(U2023
Remarks: y
Company Name:
Licensed Tester Name JF!od Koeroer
(Prird:/Type):
Company Address: '5 0 '110 E o y t S 1 d 1 Licensed Tester Nime (Signature):
Company Phone #: 0 -c 15 7 BPAT License 4
License Expiration Date:
The above is certified to be true at the time of testing.
* TEST RECORDS NfUST BE KEPT FOP, AT LEAST TI-IREE YEARS [30 TAC §29M6(B)]
4 USE ONLY MANUFACTURER'S REPLACENIENT PARTS