HomeMy WebLinkAboutPlumbing 99-695
CI"tY OF PJ?JOR LAKE
INSPECTION NOTICE
ADDREss l-flfo 7
OWNER
PHONE NO.
o FOOTING
o FRAMING
o INSULATION
o FINAL
o FOUNDA nON
o DEMOLITION 1
o FIRE PREVo
COMMENTS: ~
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DATE TIME
JD: f<:J
SCHEDULED / T-l.. -99
R~ar~ ~
cON/R.
Cjq - &, 9 ~
PERMIT NO.
A rw{.LUMBING RI
.li MECHANICAL
o WATER HOOKUP
o SEWER HOOKUP
o SEPTIC INSTALL
o PLUMBING FINAL
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i I.A.5,'(Ur f- I 'r:7JA
Rec...._
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O-c.lCe&. e-Ov--~~co-~Cl"" tor
o EXC/GRAD/FILLlNG
o LKSHOREnNETLAND
o COMPLAINT
o SEPTIC FINAL
o FIREPLACE
o
lay
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I've "3U J~
)!"wORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT n. CALL FOR REINSPECTION BEFORE COVERING
Inspector: G If? . Owner/Contr:
-1~'5\'u
CALL 447-4230 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
CII'f OF PRIOR LAKE
PLUMBING PERMIT
Applicant: L~ k c: ~ , "of e. f' J v rS-l b ("J
Address: I ~ ~ (,? 2L'" ,-~""l J\lIe S.,
Signature: C1 K:;~.-..-P ____
Legal Description: Lot 3 Block ~ Sub;/'1!l Adttf1 , &)/:? f?rt/c;e-
Site Address: -<JJIo-;~rfJu~ .tGdqe, /id AJ& 1
Building Permit # qt; ~UCts PID # r2)-(-Y5 </ -I);).lf-t>
NOTE: This permit will not be processed without complete information.
1. Blue
2. Gold
3. Yellow
File
City
Applicant
Thr ernl.. of thr Llkr Counlry
PPNo.9CJ-ft:;9S-
Phone: ~'l' 4 - 7100
~~""ct.,c, (_ v-1 A.J
758 - ~G; 08
FIXTURE UNITS
Quantity
Type of Fixture
Quantity
Type of Fixture
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (bathroom sink)
Laundry Tray (1 or 2 compartment sink)
Shower Stall
Sinks
Bar Sink
Water Closet (toilet)
/
Rough-ins
Water Heater
Water Softner
Stand Pipe (washing machine)
Sewage Ejector
Backflow Assembly ~Double Check, PVB)
Backflow Assembly Test
Lawn Sprinkler
Other
I
FEE SCHEDULE
Industrial, Commercial & Multi-Family
(1 % of job cost, $39.50 minimum)
Residential, New One & Two Family
Residential, Additions & Alterations
State Surcharge
$99.50
$39.50
$
$
$J9.SC)
$ .50
GRAND TOTAL
r..
$ ,40 .ctJ~
(~"
This permit is granted upon the express condition that said
contractor, shall comply in all respects with the ordinances
of the State Plumbing Code and~he a e!)d~.!1hereof.
RECE}PfNO. -{[ 11 DATE
"0 i!t A TrEST
Call for all inspections 24 hours in advance.
16200 Eagle Creek Av. S.E. Prior Lake, MN 55372/ Ph (612) 447-9850/ FAX (612) 447-4245
An Equal Opportunity Employer
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CUSTOMER
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LAKE SIDE PLUMBING & HEATING, INC.
12469 Zlnran Avenue Savage, Minnesota 55378
612 I 894.7600
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4 U 7 ~p bc"""'y
'.f;?e.;DR- "AI.'~ I AA V
~
(J ANAj.4
~,nEET ADDRESS
. MAlUNG ADDRESS
PROPERTY OWNER
K:d~ {' _
t;/'
R-'
~'ncc,ADDRESS
MAlUNG ADDRESS
LOCATION OF ASSEMBLY
Rc..,~r- e-fl sr,;)e s
(J ~(
RPZ ~ · pCV 0 PYB 0 SIZE: /
'/,.JA-ff..:3 MODEL:-.&07 ~.1"'7SERIAL#:ff~9"rJ6
/VI eeL
7(>,p tJ ~
TYPE OF ASSEMBLY:
MANUFACTURER:
CHECK VALVE f:2 CHECK VALVE f:2 PRESSURE
CHECK VALVE... REUEFVALVE . c..:>>. #1 I t:.:) I 12 VACUUM
BACKPRESSURE CONARMAllON BREAKER
.-., ,0 ::~" opened at .3,..1- [J1eaked 0 leaked air i1Iet opened at psi
6a .J_J tigtlt, psi fa-dosedtight El dosed tight did not open 0
~ Pr8SSlJ8 did not open O. Differential pressure Oiffe.",.kJ pressure, check vaiYa:
aaoss~ valve .a...~vaJve aaoss ~ valve leaked 0
--~ psi . psi J. psi held at psi
OQeanedonly , o Cleaned only OCleanedortj o Cleaned only o Cleaned only
Repaced: 0 Replaced: 0 Replaced: 0 Replaced: 0 Replaced: 0
niXler kit rubber kit rubber kit rubber kit rubber kit
CVassemblyD RVassembly 0 CV assembly 0 CVassembly 0 CVassembly 0
0( or or or
Osc 0 disc 0 disc 0 disc 0 disc. air in 0
o-IDJs 0 diaphragm(s) 0 . o-rings 0 o.fings 0 disc. CV 0
seat 0 seat O. seat 0 seat 0 spring. air 0
~ 0 sping 0 spring 0 spring 0 . spring, CV 0
stemI~ 0 guide 0 steml~ 0 steml~de 0 retainer 0
retainer , 0 o-rings 0 retainer 0 retainer 0 guide 0
lock JUs 0 olher 0 lock nuts 0 lock nuts 0 o-ring 0
olher 0 other 0 other 0 other 0
Differential pressure Opened at Differential pressure Differential pressure />Jr inlet psi
aaoss check valve aaoss check valve aaoss check valve Check
psi psi psi psi valve psi
NOTE: AU REPAIRS SHALL BE COMPLc: I cu WITHIN TEN (10) DAYS. cqAtq?
REMARKS:
I
.
I HEREBY CERTIFY THAT THIS DATE IS ACCURATE AND REFLECTS THE PROPER OPERATION AND
MAINTENANCE OF THE ASSEMBLY., ;
TGSTER'S NAME (PRINT) ~ s ~ ~ 0.5
TESTER'S SIGNATURE G)1 t7~_~
C~RT. #
,
6of!1'7/
'J ~ '19
DATE