HomeMy WebLinkAboutPLBG2019-1636 PLUMBING PERMIT {VALUE}
Issue Date:April 26,2019
PROJECT DESCRIPTION:Install double check valve
PROJECT# (817)410-3010 www.mygov.us
PLBG-19-1636 Inspections Permits
City of Grapevine
LOCATION LEGAL
P.O.Box 1210 Woodmoor Ct. Forest Lake Addn Blk 1 Lot 35
TX
Grapevine,,TX 76099
Grapevine,TX 76051 No.1220 Tr 35
(817)410-3165 Voice *05162653*
(817)410-3012 Fax
CONTRACTOR INFORMATION
The Plumber County Tarrant
State ID#17841 Square Footage
3407 Lookout Ct. VALUATION
Grapevine,TX 76051 200
(817)267-6542 Phone FEES TOTAL=$37.00
(817)442-9618 Fax
(817)909-1845 Mobile
Plumbing Permit Fee(VALUE) $37.00
PAYMENTS TOTAL=$37.00
OWNER The Plumber(Curtis B. Hollyfleld)
Douglas Arnold Hines Cc on 0412512019 ($37.00)
1210 Wood moor Ct NOTICES
Grapevine,TX 76051-5073 ALL work must be done in compliance with the 2006 INTERNATIONAL
PLUMBING CODE.
AVAILABLE INSPECTIONS
� Backfiow Device Inspection(required)
TCEQ
* TCEQ Backflow Certification Submit PLAN SUBMITTAL:WHEN PLANS ARE REQUIRED BY CODES,
(required) ORDINANCES,OR AS DETERMINED BY THE BUILDING OFFICIAL,THREE
i, Plumbing Final(required) (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 City of Grapevine I PLUMBING PERMIT(VALUE)I PLBG-19-1636 1 Printed 04/26/19 at 6.30 a.m. Page 1 of 3
CITY OF GRAPEVINE
BACKROW PREVENTION ASSEMBLY TEST AND MAINTENANCE REPORT
NAME OF PWS: GRAPEVINE ANNUAL TEST
IRRIGATION
PWS I.D.# 2200013 ! ' OTHER
NAME OF BUSINESS WHERE DEVICE IS LOCATED:
ADDRESS OF SITE SERVICED: 12 /D Svc A4 z-
PLUMBING PERMIT IF APPLICABLE: #
TESTER LICENSE NUMBER:� 00P.?31--;� EXPIRES:-7 _ 3z% -ZI
DATE OF LAST TEST GAUGE CALIBRATION: / - 2 -t
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: U SIZE: f'
MODEL: L r SERIAL NUMBER:
PHYSICAL LOCATION OF METER: I&I toDifc, ,VN p7t2t2£
REDUCED PRESSURE PRINCIPLE ASSEMBLY PRESSURE VACUUM BREAKER
DOUBLE CHECK VALVE AIR INLET CHECK VALVE
ASSEMBLY
1sT CHECK 2ND CHECK RELIEF VALVE
' ✓ Open at_paid _paid
DC-Closed Tight Closed Tight Opened at
Initial _RP _paid Did not open Leaked
Test _psid
Leaked Leaked
Repair
Materials
Used
Test DC-Closed Tight Opened at Opened at
After Closed Tight _paid
Repair RP_ paid —paid _psid
The above is certified to be true.
�_�,rc� A11-�
TESTERS FIRM NAME:
ADDRESS: ft-a, D� CITY/STATE/ZIP: "'/
DATE: Z tom' t PHONE NUMBER: J� Y g tq
PRINT NAME.T' 6+V-- t-- 'f—L L--T- SIGNATURE: y
DOUBLE CHECK VALVE INSPECTION MUST BE CALLED�AOR INSPECT/ IGI`AT(817)410-3010
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