HomeMy WebLinkAboutPLBG2018-3197CityofGrapevine
P.O.Box95104
Grapevine,TX76099
(817)410-3165Voice
(817)410-3012Fax
PLUMBINGPERMIT{VALUE}
IssueDate:August20,2018
PROJECTDESCRIPTION:Replace1/2"RPZbetweenovens
PROJECT#
PLBG-18-3197
(817)410-3010
Inspections
www.mygov.us
Permits
LOCATIONTENANTLEGAL
1701WState114Hwy.
Grapevine,TX76051
Sam'sClubWal-MartAdditionGpvBlk1
Lot1a
PlatA8059
CONTRACTOR
EmergencyPlumbingServices
StateID#18274
212W.Sycamore
Denton,TX76201
(817)329-0223Phone
(817)682-6912Mobile
OWNER
Sam'sRealEstateBusinessTR
POBox8050
Bentonville,AR72712-8055
AVAILABLEINSPECTIONS
BackflowDeviceInspection(required)
TCEQBackflowCertificationSubmit
(required)
PlumbingFinal(required)
INFORMATION
County Tarrant
SquareFootage
VALUATION 500
Zoning CC-CommunityCommercial
FEESTOTAL=$37.00
PlumbingPermitFee{VALUE}$37.00
PAYMENTSTOTAL=$37.00
EmergencyPlumbingServices(TerryWatts)
Ccon08/20/2018 ($37.00)
NOTICES
ALLworkmustbedoneincompliancewiththe2006INTERNATIONAL
PLUMBINGCODE.
PLANSUBMITTAL:WHENPLANSAREREQUIREDBYCODES,
ORDINANCES,ORASDETERMINEDBYTHEBUILDINGOFFICIAL,THREE
(3)SETSOFPLANSSHALLBESUBMITTEDINHARDCOPYFORMAT.
ENGINEERSEALEDPLANSANDCALCULATIONSSHALLBESUBMITTED
ASREQUIREDBYCODES,ORDINANCESORWHEREOTHERWISE
REQUIREDBYSTATELAW.
READANDSIGN
IHEREBYCERTIFYTHATTHEFOREGOINGISCORRECTTOTHEBEST
OFMYKNOWLEDGEANDALLWORKWILLBEPERFORMEDACCORDING
TOTHEDOCUMENTSAPPROVEDBYTHEBUILDINGDEPARTMENTAND
INCOMPLIANCEWITHTHECITYOFGRAPEVINECODESREGULATING
CONSTRUCTION.ITISUNDERSTOODTHATTHEISSUANCEOFTHIS
PERMITDOESNOTGRANTORAUTHORIZEANYVIOLATIONOFANY
CODEORORDINANCEOFTHECITYOFGRAPEVINE.
IFURTHERCERTIFYTHATALLWORKTHATISREQUIREDTOCOMPLY
WITHANYFEDERAL,STATE,AND/ORLOCALLAWREGARDINGENERGY
CONSERVATIONWILLBEPERFORMEDINACCORDANCEWITHTHOSE
LAWS,ANDTHATVERIFICATIONOFENERGYCODECOMPLIANCESHALL
BESUBMITTEDTOTHECITYUPONREQUEST.
MYGOV.USCityofGrapevine|PLUMBINGPERMIT{VALUE}|PLBG-18-3197|Printed10/26/18at1:03p.m.Page1of3
CITY OF GRAPEVINE
BACKFLOW PREVENTION ASSEMBLY TEST AND MAINTENANCE
REPORT
f,
NAME OF PWS: GRAPEVINE ANNUAL TEST ✓
IRRIGATION
PWS I.D.# 2200013 OTHER ✓
NAME OF BUSINESS WHERE DEVICE IS LOCATED: Sam's Club#4795
ADDRESS OF SITE SERVICED: 1701 W State HWY 114,Grapevine,TX 76051
PLUMBING PERMIT IF APPLICABLE:
TESTER LICENSE NUMBER: B130006162 EXPIRES: 4/4/2020
DATE OF LAST TEST GAUGE CALIBRATION: 10/9/2017
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: Watts SIZE: 1/2"
MODEL: LF009QT SERIAL NUMBER: 179865
PHYSICAL LOCATION OF METER: In deli, under rotesserie
Reduced Pressure Principle Assembly Pressure Vacuum Breaker
Double Check Valve Assembly Air Inlet Check Valve
tat Check 2nd Check Relief Valve rDId paid paid
Initial DC-Closed Tight Closed Tight � Opened at 2 8 open Leaked
Teat -RP-_7_,k paid 7.6 paid
Leaked Leaked
w IIVy
T••+ DC-Closed Tight Closed Tight Opened at Opaned at Paid
Afur RP id
aswk _ _pa paid Paid
The above Is certif led to be true.
TESTERS FIRM NAME: A& A Active Backflow
ADDRESS: 1611 N. IH 35 E,Suite 410 CITY/STATE/ZIP: Carrollton,TX 75006
DATE: 8/28/2018 PHONE NUMBER: 972-242,22129
PRINT NAME: John AnSIE SIGNATURE:
DOUBLE CHECK Vi! LV SPECTION MUST BE C! LLED FOR INSPECTION AT
(8 1 71 4 10-30 10
0:1FORMIBACKFLOW 1/9/98
Revised:01/11/00