HomeMy WebLinkAboutCO2018-1030 I
NN rn
v=.-5 . .,.
coE � o irh
..OJUC !p}
Vao W
m U ai p
N j C J O p I
J �
0w 3 C Too
rnm O O mr-- `O
�y -- 00 t = N I- N
nm (D J P
m N C C ~ CCY)
�t } moo Z N L O
: V Corn d 0 L n m
r - rnC
Z
C'O U N=
Q O O T
CL C
+y ^} Q„ rn a y
t o a
U N C M c
\ N q).2
0 O o
tJry c
a
CL 0 O
n o� N�._-
M
ryry� y, L O 1 C OO *�• H D
O W Y a) EOO H F�
C
Q _ , m+
4 V V Na0 V a
U 0, i
LL M
G
' o d
0-_c C a) E
F- a O O U E
�y O
LU N rn p�N N U
°NNN Cl) C 3
r r (D C m E
N.N C @ C = a n
ct c Q C- U) d m U
= E �w N N 2 W c L)
U ofn W N C � I .
0U Oo = w >
O� UN •m m F- C n N
U O'0— m O (7 C O T
w � mn c a) ,� C7 o
m N T O y
()o- C E "T m N C U Q
y O N m m
N ( U O. CM
FU 3a N U C
O U N
f i
1
`'s
tj 11
UNDER CONSTRUCTION
CORRECTION LETTER
PIN OR LID NEEDED_
TD NO LETTER_
WAITING FIRE _
HOLD_
C/O CHECK LIST
C/O PERMIT # P1$- ICS 30
ADDRESS:
BUSINESS NAME: /N7�2�u/Yrt� _i� �JG1�pniin
USINES CROP ft
✓ CHANGE NAME / � � _ NEW CONST/ADDITION PERMIT#
NEW TENANT/ OCCUPANT REMODEL /ALTERATION T ION PERMIT#
ISSUE DATE
FINAL DATE
1. APPLICATION FORM COMPLETED
2. ZONING MAP COPIED &WORKORDER FORM COMPLETED
3. ZONING CHECKED &COMPLETED ON APPLICATION
4. BUILDING INSPECTION SCHEDULED DATE AU TIME ! 6 gjrA�
7 5. FIRE DEPT. INSPECTION SCHEDULED DATE -5P TIME —
FIRE INSPECTOR: r
0
6. CITY SECRETARY(ALCOHOL) NOTIFICATION DATE:
HEALTH INSPECTION NOTIFICATION DATE:
8. PUBLIC WORKS INSPECTION E-MAILDATE
9. LOT DRAINAGE INSPECTION E-MAIL DATE
V"� 10. CORRECTION LETTER SENT DATE
•11. BUILDING INSPECTORS SIGN OFF LETTER: YES / NO
✓/ 12. FIRE DEPARTMENTS SIGN OFF LETTER: YES / NO
✓�13. HEALTH DEPARTMENT SIGN OFF e irUd j,Zul IU F,rr
— 14. a'CITY SECRETARY(Alcohol License Sign Off)L?�� 3I_(Q)I6 V.0'
15. PUBLIC WORKS SIGN OFF
16. LOT DRAINAGE SIGN OFF
7. LANDSCAPING SIGN OFF
18. BUILDING OFFICIALS SIGNATURE
19. C/O ISSUED ELECTRIC RELEASED:
SCANNED:
CONDITIONS TO BE TYPED ON C/O? YES/ NO MAILED:
O:IFORMSIDSCOINFORMATIOMCRLIST
12130/06l Rev 1 Ill 1,1 Ill 5
MAR 14 2018 S ootR
,,ryry��yy DATE OF ISSUANCE:A P R 2 4 2018
•�lalllt� q'�1Vllv !! 77 TT
(.J
T e e s PERMIT#: / -/0,7
CERTIFICATE OF OCCUPANCY REQUEST
FEE: $50.00
NO FEE REQUIRED IF CERTIFICATE OF OCCUPANCY IS ASSOCIATED WITH AN ACTIVE CURRENT BUILDING PERMIT
ADDRESS OF OCCUPANCY: X,>At • W• SUITE#
LOT: BLOCK: 6 SUBDIVISION.
""CERTIFICATE OF OCCUPANCY WILL NOT BE ISSUIM WITHOUT LEGAL DESCWTION**x*
NAME OF BUSINESS: HAowky,-43pd Crap ovt ✓ e0 105 e9(,-rn5
NEW OCCUPANT: YES ( NO NEW BUILDING/PROPERTYOWNER: YES--Y _NO
NEW BUILDING: YES NO�— NEW BUSINESS NAME CHANGE: YES NO
NUMBER OF EMPLOYEES: 82 FREIGHT FORWARDING: YES NO
NEW BUSINESS OWNER: YES NO
TYPE OF BUSINESS: lno-t'e,l SQUARE FOOTAGE: SGi, to lQ
(Example:Retail Clatbing/Attorney's Office/Office-Wareliouse/Restaurant)
NAME OF TENANT (PERSON'S NAMED: C" -t r1L- Q?S,LAmg,
CURRENT MAILING ADDRESS: LAG( LR.fh3Cln C irG�2 �U CFA `�Ott
CITY/STATE/ZIP: Tka•VkO, PHONENUMBER: all-Otr3l-oTaa
PROPERTY OWNER: 0,tJZ Ct{L oPS L1.C,
MAILING ADDRESS: �L YCA �ti1'�•2.
CITY/STATE PHONENUMBER°t}Z-0its2-0200
♦ IS YOUR BUSINESS SUBJECT TO SALES TAX LAW?(if yes,provide copy of Sales Tax Certificate)---- YES NO_
♦ WILL THERE BE ALCOHOLIC BEVERAGE SALES?(if yes,provide copy of Alcoholic Beverage Permit)-YES_NO
♦ PERMITS ARE REQUIRE D FOR SIGNS. WILL ANYSIGNSBEINSTALLED?-------------------YES_ NO
♦ WILL BUSINESS GENERATE ANY INDUSTRIAL WASTE DISCHARGE TO SEWER SYSTEM?----- YES_NO X
♦ WILL OUTSIDE REFUSE/RECYCLING/COMPACTING CONTAINERS BE NECESSARY?
(if yes,screening is required)-----------------------------------------------------------YES_ NO X
♦ WILL THERE BE ANY OUTSIDE STORAGE,DISPLAY,USE ORDUUNG----------------------- YES_ NO
* WILL ANY ALTERATIONS BE MADE TO THE SITE OR BUILDING?------------------------ YES NO A
♦ IS BUILDING SPRINKLERED?------------------------------------------------------- YES:5�:NO_
♦ WILL BUSINESS STORE OR HANDLE HAZARDOUS MATERIALS OR LIQUIDS?
(if yes,provide list of types&quantities,along with material safety data sheets)----------------------YES_NO X_
I HEREBY CERTIFY THAT THE FOREGOING IS CORRECT TO THE BEST OF MY KNOWLEDGE AND THE SAID
OCCUPANCY IS IN CONFORMANCE WITH THE INFORMATION HEREIN SET FORTH.
(If access to the building�/s ace is not provided at the time of the scheduled inspection,a 542.00 re4nspection fee will be charged)
FOR QUESTJQN L IfaXSE CALL(817)_#0-3165.
SIGNATURE. PRINT NAME: K�f��1 KOV3C�1
PHONE#: EMAIL: -
(OVER)
Development Services Department
The City of Grapevine*P.O.Box 95104*Grapevine,Texas 76099*(817)410-3165
Fax(817)410-3012*www.grapevinetexas.gov
O:FORMSIMAPPLICATIONSIC/
3122126011aev:5106,210],4MS,2fl3,11115,10116
TEXASSALESTAX
Texas Sales Tax is charged and collected on sales within the State and City of Grapevine, Texas of"taxable items."Taxable
items include both tangible personal property,specified services. If you are in a business that will be selling"taxable items"
within the City of Grapevine,Texas you will be required to collect State and Local Sales Tax in the amount of 8.25%.
A"Seller or Retailer"means a person engaged in the business of making sales of"taxable items",the receipts from which are
included in the measure of sales or use tax.
The term,"place of business"includes any location at which three or more orders are received by the"Seller or Retailer
in a calendar year.If an order is received at the place of business of a retailer in Texas,but delivery or shipment is made
from a location within the state other than the retailer's place of business. State and local sales tax is due and is allocated to
the city where the order was received.
I have read the above and I understand that I will be required to provide a copy of the Sales Tax Permit to the City of
Grapevine,Texas if the circumstance applies to my business.
Texas Sales T x Numb! / ZOlo ' I
Signatu e /Y
WHERE YOU WANT YOUR COMPLETED CERTIFICATE OF OCCUPANCY MAILED?
ADDRESS: 5$ 51 l,4e.�pCv CIP ,Su��� y00
CITY, STATE, ZIP: P�rdln,p , -4v�UtiL-�
OFFICE USE ONLY************* x *
TYPE OF CONSTRUCTION: — N� Jn s OCCUPANCY: / 3 DIVISION:
ZONING DISTRICT: (:�7G• CONDITIONAL USE: Gj
PERMITTED USE: Yes
BUILDING DEPARTMENT. DATE:
BUILDING INSPECTOR: G/ DATE:T�8
ZONING APPROVAL: Q DATE:
L1
FIRE DEPARTMENT: A kQA DATE:
LOT DRAINAGE INSPECTION: DATE:
PUBLIC WORKS DEPARTMENT: f� 1! DATE: 1
HEALTH DEPARTMENT: �� �� 1�11'(�•lQ� DATE: �la
CITY SECRETARY: ``tte��e���������"```` lQ�ir� DATE:
LANDSCAPING APPROVAL: DATE:
APPROVAL FOR ISSUANCE: C 7, DATE:
O:FORMS:OSAPPLIOATIONSIOI
3122/2001/Rev:5106.2/07,4109,2113,11/15,10116
Connie Cook
From: Renee L. Minnfee <
Sent: Tuesday, March 27, 2018 8:04 AM
To: Connie Cook
Subject: Re: sign off 18-1030
Connie,
Yes ma'am. They are good.
Sent using OWA for Whone
From: Connie Cook <ccook @grapevinetexas.gov>
Sent: Monday, March 26, 2018 1:16:05 PM
To: Renee L. Minnfee
Subject: sign off 18-1030
Need to know ifyou are good on health inspection for Homewood Suites Change of
Business/Property Owner
2214 W. Grapevine Mills Cr.
Best Regards,
Connie Cook
Development Services Assistant
817-410-3158
***External email communication - Please use caution before clicking links and/or opening
attachments ***
t
Connie Cook
From: Brenda Queen
Sent: Monday, March 26, 2018 1:24 PM
To: Connie Cook
Subject: RE: alcohol sign off
All good!
From:Connie Cook
Sent: Monday, March 26, 2018 1:15 PM
To: Brenda Queen <bqueen @grapevinetexas.gov>
Subject: alcohol sign off
Need to know if CSO is good on Alcohol license for
Homewood Suites
Change of Business/Property Owner
2214 W. Grapevine Mills Cr.
Best Regards,
Connie Cook
Development Services Assistant
817-410-3158
1
GRAPEVINE,
1' G R A S
March 27, 2018
CNI THL OPS, LLC
5851 Legacy Circle #400
Plano, TX 75024
SUBJECT: CERTIFICATE OF OCCUPANCY REQUEST P18-1030
Dear Owner/Contractor:
On March 23, 2018, this office reviewed a Certificate of Occupancy request for property
located at 2214 W. Grapevine Mills Circle, and found the following violations. These
violations must be corrected and re-inspected before a Certificate of Occupancy can be
issued.
1. Provide back flow protection at the water supply to the coffee maker and juice
dispenser.
2. Provide a current testing report for the RPZ (reduced pressure zone) in the pool
equipment room.
For questions regarding this request, please call this office at(817)410-3165 and ask for a
Plans Examiner or Inspector. To request a re-inspection, please ask for a Building Permit
Clerk.
Thank you,
on Dixson
Plans Examiner i nt Building Official
Development Services Department
The City of Grapevine * P.O.Box 95104 *Grapevine,Texas 76099 +(817)410-3165
Fax(817)410-3012 Ala www.grapevinetexas.gov
O\Correction Letters12018118-1030
• Data aNTAS 0x T018
Invoice Irroi !, 762
READY FOR THE WORKDAY
4310 Metro Parkway
Due Date o !2018
State 300
FOn Myers.FL 33916
Bill To: _�... Service Location: -
Homewood Suites Grapevine-Pillar Homewood Suites Grapevine-Pillar 5760
2214 W.Grapevine Mills Cirde 2214 W.Grapevine Mills Cirde
Grapevine,TX 76051 Grapevine,TX 76051
Phone#(972)691-2427 Fax# Phone#(972)691-2427 Fax#
l
P70 Veriilof tOt 1�Service:Date, Seryt` ;Oilier,
i Net 30 457308 12/21/2017 51706 300673
Description Qty Unit Price Ext.Price Tax
.Domestic or Irrigation Back6ow Inspection 2.00 $115.00 5230.00 $18.96
Fire Baddlow Inspection 1.00 5115.00 $115.00 $9.49
Service Total 345.00 26.47
Description * Unit Prate FxL Price Tax `
BaddlowLabor-Regular _ 2. 00 589.00 $1711.00 $14.69
I Labor Total 178 00 14.89
Description Gty UMt Prlee Ext.Price Tax
lRebulld Kits for Three Bacidlows 2.00 $23.14 $46.28 $3.87
Material Total F 4628 3821,
r Description -~ Qty UnR Price Ext.Price Tax
Ta`,Rounding $0-00
Page 1 o12
Date 0 018
Ci1NrS. Invoice lnvoica# -N 11812220762
READY FOR THE WORKDAY DueYDatra' 12016
4310 MerrO Parkway
SuRe 3DO
Fort Myers.R.33916
Bill To: Service Location:
Homewood Suites Grapevine-Pillar Homewood Suites Grapevine-Pillar 57
2214 W,Grapevine Mills Circle 2214 W.Grapevine Mills Circle
Grapevine,TX 76051 Grapevine,TX 76051
Phone#(972)691-2427 Fax# Phone#(972)691-2427 Fax#
Ti P.d' w. ',.,VenGorlD `i $eMc`e'Date {Ortle7#
Net 30 457306 12/2112017 51706 300673
Comments:
Per quoted scope of work our technician disassembled,cleaned,flushed,rebuilt,and retested the internal c eck valves on
the 6'Are line baddbw assembly and disassembled,cleaned,flushed,rebuilt,and retested the internal VW a valves and
the relief valves on(2)314"domestic reduced pressure backilows for the pod equipment. 1 of the 2 dornes :reduced
pressure baddlows(314 inch FESCO#HD7306)will need to be replaced by a licensed plumber due to being VSW and
Remit To:
Cintas Corporation No.2 Subtotal $569.28
4310 Metro Parkway Tax 546.97
Suite 300 1 _
Fort Myers,FL 33916 Grand Total $616.25
868-246-8273
Page 2 of 2
From:Neth, Stephen rmuilto:
Sent: Tuesday. December 05,2017 12:09 PM
To:Jervis, Angela <
Subject:FW: HWS Grapevine Customer Proposal S1706130067?****30 DAY NOTIC i***
Good morning Angela.
This cork is approsed. Please rs ork with Theron to get scheduled.
Also please remove Dan Williams from your comaet list and add myselr for this property Dan is
no longer with the company.
Thanks,
Steve Neth 1 DUrworof Ooerationsl Aimtatdge HosOtalty 1 5851 L"acyardc 5uite4W,PIaw,TX 75024
C-972567W301 wymaknIstmbduggitatty SmM l
ciNrSs 17ate, for non
�UOte#: �. � S1 6130067-2
WN FOR WWOekonr Quotation Valid for 30 1-ays
4310 Metro Parkway
Suite 300
Fort Myers,FL 33916
Service Location: Bill To;
Homewood Suites Grapevine-Pillar Homewood Suites Grapevine- Pillar
2214 W.Grapevine Mills Circle 2214 W. Grapevine Mills Circle
Grapevine TX 76051 Grapevine TX 76051
Phone#(972)691-2427 Fax# Phone#(972)691-2427 Fax#
ticope OfiWork periptbnr u .: 1 `._
We recently performed the annual backf ow testing at this location.As a result vre found the folowing dew es:
There are two 314"domestic reduced pressure back0ows for the pool equipment that failed annual testing of he internal
check valves and the relief valve.These devices need to have the internal check valves and the relief valves disassembled.
cleaned, flushed,rebuilt,and retested.
The 6"fire line backflow assembly has failed annual testing of the Internal check valves.This device needs t have the
Internal Check valves disassembled,cleaned,flushed,rebuilt and retested.This work is to assure that no a
contamination of water from your facilities piping network drains back into the city water supply.
The following proposal has been put together using the guidelines set forth In the manufacturers'guidelines, W WA
standards,and local plumbing codes.All work to be done during normal business hours.
The labor portion of this proposal is an estimate;you will only be charged for the actual time that the technicii n Is on site.
This will be documented by a contractor verification form that is signed by a location representative upon cW mencement
of the work and again when the work is completed.
Labor and material pricing on following pages
• tai 10! 017
CIWASe )6130067-2
NAnr FOR TIE tYORi(oAr Quotation
Vaik!for 30 ays
4310 Metro Parkway
Suite 300
Fort Myers,FL 33916
Service Location: Bill To:
Homewood Suites Grapevine•Pillar Homewood Suites Grapevine-Pillar
2214 W.Grapevine Mills Circe 2214 W. Grapevine Mik Circle
Grapevine TX 76051 Grapevine TX 76061
Plane#(972)691-2427 Fadr Phone#(972)691-2427 Fax#
Labor,Material, Service and Fees
....�_ _ DOScrli only y, _"u; _ " s -) s UnitPaae' ; :TbtARdie."
Domestic or Irrigation Backtbw Inspection 2 $115.001 6230.00 $18.9
Fire Beckllow Inspection 1 5116.00 $115.00 $9.4
BackilowLabor-Regular 8 589. 5712.00 558.74
Rebuild Kits for Three Backflows 1 5841.76 5641.75 $5294
Subtotal $1,698,76 5140.1
r� Grand Total $1,838.90
GIeW�/tPPI'OVa1L�.t"s�T"'� �"'`j.,.�...�,.I.- ,���.;•,; � .. .jJ'e'.`:'-,. 'aYS'�r_.;-..i._._ o:c'�.�".�°Pt ArPC`d�*.T:H_.
Castomefs P Auth » n
(when ap dicable)
Customer Signature Title Date:
Labor hours proposed am"part to porC unless indicated oetenvise.NOTE Al electrical,gas and or alarm disconnections,moon ns,and/or
modifications am the responsibilities of me customer and not the required responsibility of Cmfas unless otherwise requested in rig and quoted
separately.Any work performed under this Quote shell be done pursuant to the Codes Inspection and/or Preventative Maintenan Agreernenrs
terms,conditions,parts,and tabor pricing.Safe operation of your equipment is the responsibilk of the fx1hy owner or their a .You are
responsible for ensuring gist any corrections and repairs to your life safety systems are completed.Cintas does not assume any bGity for the
condition d your life safely systems and is acting as an advisor on the working condition,performance potential and code compf, of your its
safety systems.NFPA17A Chapter 7 paragraph 7 3.3.4 states the following Where the maintenance of the systems)reveals a pans that
could cause impairmentor failure of the proper operation of the system(s),the affected parts shall be replaced or repaired in acc dance with the
monufaclurek recommendations.Until swh repairs are accomplished the systems shall be logged as noncompliant and the or owner's
representative responsible for the system and the authority having justification shall be notified.Unless you specifically authorize 10,193 to perform too
necessary repairs.arty deficiencies,impairments or required repairs discovered as a result of our Inspections are not the respons ity or Cimss.
Service Order
Repair-Backflow Service
tIQift811
ToCAC/xklNN(lTrVR&14-947.4Ie7 NR9255051
Service Location: Service Order No: Vendor I
Homewood Suites Grapevine-Pillar S1706130067 -3 _ Icintas-fl
2214 W.Grapevine Mile Circle
Grapevine,TX 76051 Customer PO: Schedule Data: omplete ft
Phone#(872)6131-2427 Fax# i 12!22/2017 1211512017
Requested by:
Scope Of Work:
Conduct Annual Fue Line Irickflow,prevention device test as required by applicable codes and standards,M let Nave a
complete and signed copy of your company's inspection report onsribe,and submit a copy with your invoke in 6 days of
compleow
APPROVED QUOTE
We recently performed the annual bacidlow testing at this location.As a result we found the following degci Miss:
There are two 3144 domestic reduced pressure backflows for the pool equipment that faded annual testing of he internal check
valves and the relief valve.These devices need to have the intamel check rdk,es and the relief valves dr"si wWK cleaned,
flushed,rebuitt,end retested. (1) 3/40 AD 10e T60 C-d 1019 (P1uramf(
The 6'fire floe backilow assembly has failed annual testing of the internal check valves.This device reeds t have Cie Intemal
check valves valves disassembled,cleaned,gushed,rebuilt and retested.This work is�tto�naassure that no cross mingtion of water
'17nb'fo bvrl beP dwasla {�water J WY8 9 Mi" is we
I ng proposal e t nOpYtttogether using The gutaelares set forth in the manufactureW guidelines, W WA
standards,
and local plumbing codes.All work to be done during normal business hours.
The labor portion of this proposal is an estimate;you will only be charged for the actual time that the technka n is on aria. This
will be documented by a contractor verification form that Is signed by a location representative upon comm ant of the
work and again when the work is completed.
Tech must call 866-24"273 to check in and out and for approval of additional time.Pictures of all deficient s must be sent
to.- FPG-PapervvorkkQCb»ae.com.
All paperwork must be signed by a GM,AGM,or MOD prior to Invoicing.
AddJtloriall{nfoema�on. i7oqulred�
G,,,F...,.,'.
Fov Equ4mwnr:
Cintas 666.246.6273
Service Order
dk* Repair-l3acktlow Service
fd>p�41)�Sit
Tech Clock lMNt/T IVR 844-3074087 NRk 2550$1
SeNICe Location: Service OMer No: Fccintas-1`77 ndor I
Homewood Suites Grapevine-Pillar + S1706130067-3
i 2214 W.Grapevine Mills Circe
Grapevine,TX 76051 Customer Po: Schedule Data: ornplate By:
Phone#(972)Sgt-2427 Fax# 12/22!2017 12115!2017
Requested by:
' t [s Serves lees Iisr
Technician Work Petformed: Check ali that apply - N
Data Time In Time out #Of Tachs Repair SuccessfrAly Completed? 0
? • 7we [rir Defldendes Found? E
System Tagged Compliant (�
System Red Tagged
Additional Work Authod=tion Call 868-2484275 - --- `i
Cintes Avftdzlng Agent Name
Comments:
" s st Tech niet n Acknowledgem_enYt juired z a '
I-NTY&*Stm�4�ffwe' l t .oie fa pemmoW wmderedMe inspection,uwfiad the pans omtcand above NO notified the cushxm of d0tieneeJ
_ - C1lstomer4Atsknowiedgem`e'nt,n.q;;:.+ed -
tore Stamp
ereby"knowledge,the satisfactory completion of the above stated work
r wyt rr> 2 S K 21 17
Aut(urhedS P"Rtllsme jog Date
My sgnanae irMkofes(hat thaw reve"d andaAwwd as work done by Iles WhfmciOnaod)amsal4f4d4siMfttwkdbnoao me final ca dhm or
mylocady wit the respect to the soope of wvk
Clnta6 866-246-8273
CITY OF GRAPEVINE
BMKFLOW PRMN110N AMMILY CE RE ORT
NAME OFPwB: GRAPEVINE ANNUAL TEST
IRRIGATION
PWS LD.O 2200013 OTHER
NAME OF BUSINESS INHERE DEVICE Ri LOCATED: Aftho
ADDRESS OF 8TIE SERVICED:
PLUMBING PERMIT IF APPLICABLE: 0
TESLERUCENSENUMBEl : SA fta EICNRSBs
DATE OF LAST TEST GAUGE CALIBRATION:
THE BACKMM PREVOMONA6SEM8LYDETAI LEDB .0WNW BEENTEWW AND MAWTAWDA6 BY
=29MMAT10Nb AND IS COMFIED TO BE OPERAT01OWTHM ACCOTABLE PARAMEMRB.
TYPE OF A&SEMBLY
_REDOCEDPREBBUREPRINCIPLE _PRESSURE VACUUM BREAKER
✓DOABLE CHECK —ATMOSPHERE VACUUM
MANUFACTURER: wx. �
MODEL; BN;S SERIALNUMBEJt:, ,�/�
.. PHYSICAL LOCATION OF METER:
REDUCED PREMRE PRINCIPLE A88EMBLY PRESSURE VACUUM B
DOUBLE CH VAL AIR RNLET CNECK VAL
ASSEMBLY
1a/CHECK a CHECK RELIEF VALVE
f. 8 Opal at—wid _..._Psid
DGCI 4Tight ClosodTight Openodat
Initlat _RP paid Vidnotopen Ladd
Test paid
Leaked Leaked _,
epdr
LAW
rLAW
To" arl4waad Tlgld Opamd at Oparod at
Alter CloarJd Tlol _pdd
Repay _RP—paid —pold _paid
The above Is cwVffod to be&W.
TESTERS FIRM NAME- 'F
ADDRESS: W &uar A&a CRYISTATEWN. /1 _ 7z"
DATE /- 5•/ PHONENUBBER:
pjtlNtNAME: r�r- h"M SIGNATURE:
DOUBLE CHECK VAL VE INSPECTION MUST HE CALLED FOkWECWON AT(811)00 90
aoonwe.�w�.u-�.vor,r+�++amvoma.,enwWa�wm.k
CITY OF GRAPEVINE
VACKIFLOW PR E MY r M C R
NAME OFPWS: ORAPEVNE ANNUAL TEST
PWS LOA 221)M3 IRRIGATION
OTHER
NAMe of Bustlers untERe I>£VIeE Is LOCATEW.
ADDRESS OF SITE SERVM:ED: .?a e
PLUMSMPERMTTB=AppLMAKL. y
TES'i-eR LIC�N3E NUMBER: E)WIRE,gt�z D
DATE OF LAST TEST GAUGE CALMRATION: •18 _
THE SACKFLOW PREVENTION ABM BLYDETNLF.D BELOW FtAS S�1 TESTED ANDtAA1NLiy:,t¢p AS
?GEQ RI:DIAAT101q AND IL D'IU SS OPERATtMD MefftllH AOCEPfABLE PARAMETER g, RED BY
TV OF A93EROBLY
_REDUCED PRESSURE PRWCIPLE _PRESSURE VACUUM RREAKER
✓'BOUBLS CHECK —ATMOSPHERE VACUUM
MANUFACTURER: Sc�
MODEL:—"7JC1L0- 74y BeRULL,NUMgERc ao 0
PHYSICAL LOCATION OF MBTER: a
ODUC *R6 Mj8W PRE38URE VACUUM DREAK
AIR IMLET C HECK VAL DOpen at—Psld __psld Inrda _Teat Old not open Loak6d Le
tqh
uamr6e.
twa
LeltDC-closed Tlght Opened st Opened at Closed Tight ��ysid—RP—petd paid ��WId
7Apa alava 7s oe+Nlfed ab be Irate.
TESTERS FIRM NAME r
ADDRESS: ?SO '&rI&q.ciTy/vTArErzP.-j3Pr4mx 2w
DATE, -S/d PHONE NWOEtER: L
PRINT N4�� SIGNATURE-
DOUBLECHECKVA'VE/NSPEC"ON MUST 13ECALLED )NSPECTTONAT(m?)d10 no
i muwtee.a+m�oc;�*wtwmvrttoewAUrnIDwamaro,o�4„
Z
Z y0
Ol
�a F ¢
N
Z'Z
\
y J a•N
¢ m
ei WO6D 101 a
2Nn s
s O EE`wW6MPWPY Q m¢ V'
\ N
W
W� a
n
6£W fx j QZc
`3 i — J
� AtlM031NtlNDN3 _ _ / \\'/\ sJ•� ` \
4
o°�
Md�N ��ss`O� ri W�u°°°v
tdlNr TN '�' _Nfrydf.rN -
"I 3NIfi3dtltl9/6602
p�FNTfa\:O MYf lIX3'6N LZ['XS
yP°tC^��PKWr my U nI xn�x sivss \• \\ `/\
10yv i U LZFNsN
\f9. \.
- ' •� � IH'635kBEN1EA B�s'PA9
\U) C " \0 /✓\
p NOyyO�/91) b
� z
a,
I 3 z
i 3 N P�
WA W
LU
QQ �
` war
CERTIFICATE OF OCCUPANCY
WORKORDER
PERMIT # 18 -/C73C�
ADDRESS OF INSPECTION:
DATE OF INSPECTION:, TIME OF INSPECTION: ��.3
NAME OF BUSINESS: as °zz
TYPE OF BUSINESS:
USE OF BUILDING AND/OR PREMISES:
REASON FOR APPLYING: (J r�/eA�ca�rJr-e
CONTACT PERSON:
TELEPHONE NUMBER:
COMMENTS/VIOLATIONS:A)61- APEPWeg) 9EE- ,tXNrgc IN
� 1t4y(AV
Sc)sm r-r cye2-ur �esr).va mpoKT F
NQ
VIOL.4i10,lj n&S Erc
**TO BE FILLED OUT BY BUILDING OFFICIAL**
ZONING DISTRICT OF INSPECTION LOCATION: G�
TYPE OF BUILDING: _I SPA l��Kf) GROUP AND DIVISION:
ZONING RESTRICTIONS:
O.PORMS D'COINFORMATION\VORKORO5R
12 90116 Rw,11'2006