HomeMy WebLinkAboutPLIRR2025-001019ADDRESS
803 Portamerica Pl.,
Shell
Grapevine, TX 76051
LEGAL
D F W Ind Park Phase I
Addition Blk N/A Lot C
S
PERMIT HOLDER
Cameron Kirby
Prestonwood Landscape
Services
(214) 357-4668
COLLABORATORS
•Cameron Kirby
Prestonwood
Landscape Services
(214) 357-4668
OWNERS
•B9 Sequoia Port
America Owner
TENANTS
•Shell Building
INSPECTIONS 3
1. TCEQ Backflow Certification Submit
2. Backflow Device Inspection
3. Plumbing Final
INFORMATION FIELDS
**APPLICANT NAME (Individual)Colby Grob
**APPLICANT PHONE NUMBER 210-797-1331
FEE TOTAL PAID DUE
Plumbing Miscellaneous Fee $ 37.00 $ 37.00 $ 37.00
TOTALS $ 37.00 $ 37.00 $ 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.
March 18, 2025
Signature Date
City of Grapevine
PO Box 95104
Grapevine, Texas 76099
817) 410-3166
Plumbing - Irrigation
Permit
Project # 25-001019
Project Description: Replace Backflow Device
Issued on: 03/18/2025 at 8:41 AM
MYGOV.US 25-001019, 03/18/2025 at 8:41 AM Issued by: Courtney Cogburn
Page 1/2
Fexas Conimission on Environmental Quality
RACKFLOW rREvENrI0.N ASSEMBLYTEST AND MAINTENANCE REPORT
'nu� foi;awm, form ra u�ovcw,'t,,ted usfed- mu-Abesubfnkw" Utbe pbblic wa(ersu",,Ak� for Loo ocrlKL��'
NAME OF FWS: Gracevine
PVVS LD#:
_TW_� NiAILING ADDRESS, 501.9hady Brook
PWS �,6N'FACT PERSOM Sackftow Coordinator
ADDRESS OF SERVICE: Commercial/ 803 Port America Place {Cormacior) Presionwood L&469-953-34'39
the Isaac kfloar prevention assembly detailed below has been tested and maintained as required by commission regulations
and is certified to bu otvradng witbin acceprable parameters�
TYPE OFBACK14'LOW PREVENTION ASSEMBLY (BPA):
C1 Reduced blc ChecPressure Principle (RPBA) Reduced Pressure Principle -Detector (RPBA
(DCVA-D) Type If �CJ
Double Check -Defecor t(DCV A-D)
Douk Valve `) Type 1111
Pressure Vacu urn. Breaker (PVB) 0 Spill -Resistant Pressure Vacuum, Breaker (SVB)
. . ... . ......
�Jn-, tfypass�
Manufacturer. Sai
Model Number: Main,
RPA Location:
B pass' BPA Serves:
'-Scrial Number: Mahn:y
PERMIT NUMBER: 25-001019
Reason for test: New X Existing 0 �1 Replacement Old Modol/Scrial 4�
ales') r
Is the assembly installcd in accordarce with manufacturer recornmendaticurs andlor local cL des No
he assembly instal -led on a notr-potable water supply tauxiljary�?
tl 'Yes No
TEST SiREJLT I
PASS,
FAIL 0
Initial Test
Date.
Tiaie_
Repairs and
Materials
Used--'
0
Type I
Reduced pressure Principle Assembly (RPBA) Assembly PVB & SVB
Held psi4 I Hold ate,,, psid,,:
1�10,,,ed Tight Clo,, se 'Light
Leakcd 0 Uakcd '0
Relief Valve !I Bypass Check Air olet Check Valve
Opened at__ i Ifeld at; psid Opened at psid Held at
PW Closed Tight 13 Did not open 1[:]! psid
Did am Leaked 0 Did it fully open Leaked 0,
open 13 1(yes 1 13 /No i0'�
at __ I Held at � — 1 psid 0pened at
Closed
Tight 0
psid 11 Ifeld at
I psid
211 check: numeric readi ;, rea tured for .VA -nil,
Differential pressure gauge used, Potat e. Non -Potable: 0
M
-0 -202 aka /Mockd:
_J'AN, 09241240 Date tested for,,nracL.�_ 12 6�4__�
Remarks.
Comp,my Name, 0Licensed'Fester Name 1 Accuracy Backfiow f, t4oberl MacCloskey
rn pany Address: 6832 Licensed Tester Name (Signature):
Po Box
McKinney, TX 75071
Company Phone If: BPAT License # BPOO�1622
972-699-7156
Lioense Expiration lac: 1 11-22-2025
The above is certified to be true at the time of testing.
*TEST RECORDS MUSTBE KEFyr FOR AT LEAST THREE YEARS [30 TAC k29046(B).1
-t* USE ONLY NIANUFACTURER'S Rt-*,PI,A(.,F4)vlf'-,N'I'PA.PTS
TCEQ-20700 (Revision 04-04-2019) Page I of I