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Home My WebLink About2130 W 7th St - Building Backflow Assembly Test Report City of Port Angeles Public Works and Utilities Department WaterIWastewater Collection Division Otlicial Use Only A I~ Cd a; ssell1.# :;; T T Received NAME OF PREMISES: .A'llj BtJ{ 7 )../}O LOCA nON OF DEVICE: 'J.. I IN e 5 (' j-::::E tiC? SERVICE ADDRESS: !tV G I? V 0/ E 1<- .A;L.. 7 Of WAfC~ if""v PJe7cj( J/~ / I I-lt;)/tfJJ ASSEMBL Y: Manufacturer Model Size Serial No. IS THIS AN APPROVED ASSEMBLY? YEs-.e:r NO 0 IS ASSEMBL Y INSTALLED CORRECTL Y') YES l1J--No 0 DATE OF INSTALLATION if - / -of UNKNOWN 0 REDUCED PRESSURE PRINCIPLE ASSEMBLY RP 0 RPDA 0 DC ID.... DCDA 0 DOUBLE CHECK VALVE ASSEMBLY PVB 0 Air Gap 0 SVB 0 AVB 0 CHECK VALVE #1 CHECK VALVE #2 RELIEF VALVE PVB/SVB Initial Leaked 0 Leaked 0 Did Not Open 0 AIR INLET Held at ? ~ & pSI Closed Tight 0 Did Not Open 0 Test Held at J. t'rsi Opened at _ pSI Opened at _ pSI Repairs Cleaned 0 Clean ed 0 Cleaned 0 / CHECK VALVE Leaked 0 Held at _pSI Replaced 0 Replaced 0 Replaced 0 REPAIRS Cleaned 0 Details Replaced 0 3 psi Buffer YES 0 NO 0 Final Closed Tight 0 AIR INLET Opened at _ psi Held at ;;J... t psi Held at ;;.. . t psi CHECK VALVE Held at _pSI Test Opened at _ psi BACK PRESSURE NO 0 YES 0 AIR GAP INSPECTION: L A W>(1 REQUIRED MINIMUM SEPARATION YES 0 NO 0 TYPE OF HAZARD COMMENTS Line Pressure I 'J- ?~si , J,I( )/e(-re.~ TeSTE;;; q. ;;?r9S'St /J Held Backpressure YES [!]/"NO 0 #2 Shutoff Held YES I!Y"NO 0 . Relief Valve Exercised YESO NO 0 Date/Time Tester Signature Cert.# Test Kit Passed Failed Initial r-.i{;~f8 1f.IJE(~t:;e /VA 6YrA /3;'-Yllt tVl! j)jtVt["1' ~ Test 0 - Repairs 0 0 Final 5' - 31~. f:l fl. veC.etR ~ ~ ;J '). Iff L( M I /J JI1ti:J'" ~ 0 Test ;' ~ 0J o ~ 1 ~ f :5' WHITE - CUSTOMER COPY YELLOW - PURVEYOR COPY PINK - TESTER COpy CITY OF PORT ANGELES DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION 321 EAST 5TH STREET, PORT ANGELES, W A 98362 Application Number Application pin number Property Address ASSESSOR PARCEL NUMBER:. Tenant nbr, name Application type description Subdivision Name Property Use Property Zoning . . . Application valuation 08-00000486 Date 709410 2130 W 7TH ST 06-30-00-9-8-0100-0000- ROBERT GROWER PLUMBING REPAIR 4/24/08 RS7 RESDNTL SINGLE FAMILY 500 Application desc DOUBLE-CHECK BACKFLOW FOR IRRIGATION SYSTEM Owner Contractor ROBERT G. GROWER 2130 W 7TH ST PORT ANGELES (360) 417-0381 WA 983631620 SANFORD IRRIGATION PO BOX 2246 SEQUIM WA 98382 (360) 683-9807 Permit . . , . . Additional desc . Permit pin number Permit Fee Issue Date Expiration'Date PLUMBING PERMIT IRRIGATION D/C BACKFLOW 125237 57.00 Plan Check Fee 4/24/08 Valuation 10/21/08 .00 500 Qty Unit Charge Per Extension 50.00 7.00 BASE FEE 1.00 7.0000 ECH PL- EA LAWN BACKFLOW Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 57.00 57.00 .00 .00 Plan Check Total .00 .00 .00 .00 Grand Total 57.00 57.00 .00 .00 /): /;q / S- /~~.../ 'd ~ o -o~ Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements, This permit becomes null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned for a period of 180 days after the work has commenced, or if required inspections have not been requested within 180 days from the last inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of construction, 1/-!2'f/f;t Date ' f}a.v;d GOf)/al1 Print Name J~~ Signature of Contractor or Authorized Agent Signature of Owner (if owner is builder) T:Forms/Building Division/Building Permit (I % 1/07).wpd BUILDING PERMIT INSPECTION RECORD CALL 417-4815 FOR BUILDING INSPECTIONS. CALL 4 I 7-4735 FOR ELECTRICAL INSPECTIONS. CALL 4 I 7-4807 FOR PUBLIC WORKS UTILITIES PLEASE PROVrDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER, INSULA TE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION. KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE. o 09 ( -C \1Y <S- INSPECTION TYPE DATE ACCEPTED COMMENTS YES NO FOUNDATION: FOOTINGS SHEAR WALLS / WALLS FOUNDA TION DRAINAGE / DOWN SPOUTS PIERS POST HOLES (POLE BLOGS.) PLUMBING UNDER FLOOR / SLAB ROUGH-IN WATER LINE (METER TO BLDG) GAS LINE FINAL DATE ACCEPTED BY: BACK FLOW / WATER I:)-~tl..^g K~ AIR SEAL WALLS CEILING FRAMING JOISTS / GIRDERS SHEAR WALL/HOLD DOWNS WALLS / ROOF / CEILING DRYWALL (INTERIOR BRACED PANEL ONLY) T-BAR INSULATION SLAB WALL / FLOOR / CEILING MECHANICAL HEA T PUMP / FURNACE / DUCTS GAS LINE WOOD STOVE / PELLET / CHIMNEY fiNAL DATE ACCEPTED BY COMMERCIAL HOOD / DUCTS MANUFACTURED HOMES FOOTING / SLAB BLOCKING & HOLD DOWNS SKIRTING PLANNING DEPT SEPARATE PERMIT #'s SEPA. PARKING/LIGHTING ESA: LANDSCAPING SHORELINE: FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/uSE RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED YES NO ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL LIGHT DEPT CONSTRUCTION R.W. / PW/ CONSTRUCTION - R.W. ENGINEERING 417-4807 PW / ENGINEERING F1RE 417-4653 FIRE DEPT PLANNING DEPT. 417-4750 PLANNING DEPT. BUILDING 417-4815 BUILDING N \)\J o L: ~ ~ H J -U:"' c ~ 3 <r' (J~ -~--t ~;;- E T:Forms/Building Division/Building Permit (10/0 1I07).wpd , CITY OF PORT ANGELES Attn: Building Permit Technician 321 E. Fifth St., Port Angeles, WA 98362 (360)417-4815 fax (360)417-4711 Applicant or Agent jJ a. II i J {'() w c.t VI Property Owner 1( 0 b.e y + r;.. y ~ fA} -e r Property Owner's Address 2. / J 0 .W I 7 I- It Contractor/Engineer S tl-Vl. fo rtlf Lv Y ; Contractor/Engineer's Address , (} t (J 2. 2 License # SAN" For:r q cr I L-.. F BUILDING PERMIT APPLICA TION Print in ink For City Use Only: Date Receiv~~tz.. L{ -6g Permit # U - (0 Date Approved Phone Phone 6' 6" 3 - q go ? l.fl7- ()3cf/ CJ3-Qg07 WA- 1 j 2. .c/ 12/ 200g I Phone 2/30 W,7fh PROJECT ADDRESS Parcel Number Lot Zoning Project Tvpe & Brief Description: 0 Commercial 0 Multi-family 0 Industrial Check all that apply o New Construction o Addition .p 0 y- o Remodel o Repair oRe-roof o Demolition o Heat System 0 Heat pump 0 wood-burning stove 0 gas fireplace 0 pellet stove 0 other Other Floor Areas Existinq (sq, ft.) Proposed (sq, ft.) Basement @$ per sq. ft. = $ 151 Floor 2nd Floor 3rd Floor Garage Carport Covered Porch Deck Shed Other TOTAL VALUATION $500, Or} Total footprint of structures sq. ft. Lot size sq. ft. = Lot coverage % Max. height of proposed structures ft. Occupancy group # of bedrooms Will a lawn sprinkler system be installed? -X- Occupant load # of full baths Will a fire sprinkler system be installed? Construction type # of half baths I have read and completed this application and know it to be true and correct. I am authorized to apply for this permit and understand that it is my responsibility to determine what permits are required, and to obtain permits prior to working on projects. Date i/2. f /08' Print Name f} tt II ; d . Cowan Signature ~a4~ T:Forms/Building Division/Bldg Permit Appl."2006 Code.doc . Site Address: Installed By: Owner/Business: Owner/Business Address: ~DENTIAL o COMMERCIAL o BASEBOARD KW _ o FURNACE KW ~ o FAN/WALL KW _ o HEAT PUMP KW ~ o SIGN Detai Is/ Descri ption: CITY OF PORT ANGELES LIGHT DEPARTMENT 321 E. Fifth Street Port Angeles, WA 98362 (206) 457-0411 ELECTRICAL PERMIT PERMIT NO. .::l s .3 '/ ~ /If h~ I DATE o READY FOR INSPECTION License Number: o TEMPORARY SERVICE III PERMANENT SERVICE 'l5CNEW CONSTRUCTION I[j" REMODEL o ADD/ALTER CIRCUITS o SERVICE UPGRADE/REPAIR o SPECIAL EQUIPMENT (LIST BELOW) /4/~u- ~ o WILL CALL FOR INSPECTION Phone: Phone: Sq. Ft. o OVERHEAD SERVICE ~ UNDERGROU~VICE VOLTAGE: /i:.61 12' SINGLE PHASE o THREE PHASE SERVICE SIZE e::;yJ.i) AMPS . W.S. No. SERVICE SIZE CAPACITY: o O.K. NOT O.K. ACTION REQUIRED: 0 CHANGE TRANSFORMER o INSTALL SERVICE POLE DATE ENGR. o CHANGE SERVICE WIRE o OTHER o Ditch Inspection O.K. ~ ~ Rough-in/cover O.K. ;(f'\~ O.K. to connect service ~Final O.K. Site Address: ;2.1'30 W. Installer: ?-f4 Efi Permit/Receipt No. cJ New Meters --- Notify Port Angeles City Light by Street Address and Permit Number when ready for inspection. Work must not be covered before inspection and O.K. for covering has been given by the electrical inspector in writing on either the Wiring Report or on the Building Permit. PHONE 457-0411, EXT. 224. ~ NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT $ Electrical Inspector WHITE - File by address YELLOW - file by number PINK - Top: Eng, Bottom, Customer OLYMPIC PAINTERS INC f9() t~ :.:- GREEN - Top: Meter Dept., Bottom: City Hall . Site Add ress: Installed By: CITY OF PORT ANGELES LIGHT DEPARTMENT 321 E. Fifth Street Port Angeles, WA 98362 (206) 457-0411 DATE $~.f( 7 /- ~ 7-Cf-'Y - PERMIT NO. ELECTRICAL PERMIT 7 -/lI o WILL CALL FOR INSPECTION Phone: READY FOR INSPECTION License Number: Owner/Business: Phone: ..,!;'OOS Sq. Ft. Owner/Business Address: ~RESIDENTIAL o COMMERCIAL o BASEBOARD KW _ o FURNACE KW _ o FAN/WALL KW _ o HEAT PUMP KW_ o SIGN Details/Description: M TEMPORARY SERVICE j. PERMANENT SERVICE NEW CONSTRUCTION o REMODEL o ADD/ALTER CIRCUITS o SERVICE UPGRADE/REPAIR o SPECIAL EQUIPMENT (LIST BELOW) o OVERHEAD SERVICE o UNDERGROUND SERVICE VOLTAGE: o SINGLE PHASE o THREE PHASE SERVICE SIZE AMPS . W.S. No. SERVICE SIZE CAPACITY: o O.K. NOT O.K. ACTION REQUIRED: 0 CHANGE TRANSFORMER o INSTALL SERVICE POLE DATE ENGR. o CHANGE SERVICE WIRE o OTHER o Ditch Inspection O.K. o Rough-in/cover O.K. #- "!6:oK to connect service b Final O.K. Site Address: Installer: New Meters I . Notify Port Angeles City Light by Street Address and Permit Number when ready for inspection. Work must not be covered before inspection and O.K. for covering has been given by the electrical inspector in writing on either the Wiring Report or on the Building P . PHONE 457-0411, EXT. 224. 'p WHITE - File by address NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT $ ,,;(0, 00 Permit Fee YELLOW - file by number GREEN - Top: Meter Dept., Bottom: City Hall OLYMPIC PAINTERS INC PINK - Top: Eng, Bottom, Customer