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Home My WebLink AboutPLM-1997-0005 - PLUMBING AND ELECTRIC WATER PLUMBING PERMIT CITY OF ANACORTES PERMIT NO. : PLM97-0005 P.O. BOX 547 APPLIED: 01/29/97 ANACORTES, WA 98221 ISSUED: 01/29/97 (206) 293-1901 EXPIRES: 01/29/98 SITE ADDRESS: 1312 COMMERCIAL AVE ASSESSOR'S PARCEL NO. : 3772-042-015-0005 PROJECT DESCRIPTION: Fuel piping system OWNER CONTRACTOR 14TH STREET CORPORATION FUEL TANK 310 COMMERCIAL P.O. BOX 462 ANACORTES WA 98221 BURLINGTON WA 98233 293-2197 757-2402 FUELTS1110DU TYPE OF WORK. . . . :ADD KIT SINKS W/DISP: 0 WTR PIPING/TREAT: 0 TYPE OF USE. . . . . :COX WASHING MACHINES: 0 HOSE BIBBS. . . . . . : 0 ELEC WTR HEATERS: 0 GREASE TRAPS. . . . : 0 WATER CLOSETS. . . : 0 LAUNDRY TRAYS. . . : 0 ADD'L FIXTURES. . : 1 BATH TUBS. . . . . . . . 0 URINALS. . . . . . . . . . 0 SHOWERS. . . . . . . . . : 0 WASTE INTERCEPT. : 0 DISHWASHERS. . . . . : 0 DRINKING FOUNT. . : 0 LAVATORIES. . .. . . : 0 FLOOR DRAINS. . . . : 0 FEES NOTES Code Amount---- By- Date---- Receipt PRMT $ 27. 00 MD 01/29/97 6445 L TOTAL $ 27.00 I hereby acknowledge that I have read this permit and state the above information is correct, and agree to comply with all ordinances and laws regulating activities covered by this permit. IssuecT by Applicant o O ne 's ignature 24 Hour Notice Required For All Inspections plm_prmt, Rev: 06/11/92 � r A1oxA s ti n.- rrurwi 1ius llm� . r'.19C CM OR ANArONM RETURN TO: `t y WATER DEPAR7~MENT city of Amacortss 4 Water Depwomment s a BACKFLOW PREVENTION ASSEMBLY Ml "A°271h Street y'C D �W TEST REPORT AnacOYteS,WA 98221 �J RETURN NO LATER THAN NAME OF PREMISES t' r t vet NJ FILE NO. SERVICE ADDRESS LOCATION OF ASSEMBLY + } �( 17n ;�t ASSEMBLY: µWUFALo t- FI gwr' -- MODEL Cole eeaNu rra LINE PRESSURE AT TIME OF TEST �S O LBS. TYPE OF ASSEMBLY Aeducsd Pressurs Aaeemblies Preswre Vacuum Breaker t]ou Cheek bliss Aeg•f Air InhH Cheek Valve Iel Check 2nd Check Valve Opened at Feld Inkier DC-Closed light -'Oldsed light, 't7Pened et D10 n0i Tact RP —R Leaked... ..........0 paid open.......,,.,, 0 Leaked ..........., Leaked................ ......� Rcpoirs and Materials Used i r Closed tight.,. —� Opened at paid . pgid Psid Opened at paid Teat A}Ier DG-closed ...., ❑ �� — � pepeiY RP-.—paid ' AIR GAP INSPECTION. Required minimum air gap mosrstion provided , • Yee ❑ NO REMARKS; i THE ABOVE REPORT IS CERTIFIED 70 ,�/ CERT, NO_S� i ]2 2 PATE�7' INITIAL TEST PERFORMED BY DATE IKPAIRED BY j CERT. NO. AAA y eo►�®a TmAT Ppg6ARMED BY TOTAL 17.02 T 'd NOIloInalSNOo Wn1wno 14dTE:20 L6, titi aHW CITY OF ANACORTES OFFICE USE ONLY WATER DEPARTMENT ❑ PASS DATE BACKFLOW' PREVENTION ASSEMBLY ❑ FAIL INT. TEST REPORT RETURNAnaco y City of Anacortes 2 Water Department 9C p RS 2201 'A'37th Street Anacortes,WA 98221 ;-RETURN NO iLATER THAN NAME OF PREMISES B C'� A� llii� � I��C fL 14 'I�IfO� FILE NO. SERVICE ADDRESS 1 q=a-C LOCATION OF ASSEMBLY �• ��21yErt_ U'1'�3l-DI<' 1 ASSEMBLY: o LK�>Js ado_ MANUFACTURER MOD SIZE SERIAL NO. LINE PRESSURE AT TIME OF TEST LBS. TYPE OF ASSEMBLY C�� Reduced Pressure Assemblies Pressure Vacuum Breaker Double Check Assemblies Relief Air Inlet Check Valve I!i 1st Check 2nd Check Valve Opened at psid psid Initial DC-closed tight .____._ Closed tight..__.. Opened at Dio not Test RP- psid psid Leaked ____.__. ❑ open.__.___ ❑ Leaked ... ❑ Leaked-................... ❑ ` Repairs and Materials Used Test After DC-closed tight ........ Closed tight.______. Opened at Opened at Repair RP- psid psid psid psid AIR GAP INSPECTION: Required minimum air gap separation provided . . . . Yes ❑ No ❑ REMARKS: — THE ABOVE REPORT IS CERTIFIED TO BE TRUE: INITIAL TEST PERFORMED BY •, �" CERT. NO.✓ 6 DATE — 1 I REPAIRED BY DATE FINAL TEST PERFORMED BY CERT. NO. DATE CITY OF ANACORTES OFFICE USE ONLY WATER DEPARTMENT ❑ PASS DATE BACKFLOW PREVENTION ASSEMBLY ❑ FAIL INT. RETURN TO: TEST REPORT City of Anacortes yWater Department 9C O Ft 2201 'A'37th Street L. Anacortes,WA 98221 RETURN NO LATER THAN NAME OF PREMISES `✓` C i` �f1"t'--f-� FILE NO. SERVICE ADDRESS LOCATION OF ASSEMBLY W ST "iO G v(� Lo ASSEMBLY: MANUFACTURER MODEL SIZE SERIAL NO. LINE PRESSURE AT TIME OF TEST 3� LBS. TYPE OF ASSEMBLY i Reduced Pressure Assemblies Pressure Vacuum Breaker III Double Check Assemblies Relief Air Inlet Check Valve 1st Check 2nd Check Valve Opened at psid psid Initial DC-closed tight ....__ Closed tight.... Opened at Did not Test RP- osid Leaked._ psid .......__. ❑ open____._ ❑ Leaked ........ ❑ Leaked-_................ ...❑ Repairs I�! and Materials Used t After DC-closed tight _.__. Closed tight... Opened at Opened at Test g 9 Repair RP- psid psid psid psid AIR GAP INSPECTION: Required minimum air gap separation provided . . . . Yes ❑ No ❑ ECJ 10 -!5 rP LC-9)Tt7N REMARKS. THE ABOVE REPORT IS CERTIFIED TO BE TRUE: INITIAL TEST PERFORMED BY '�� CERT. NOP)a10'0 DATE REPAIRED BY DATEI, FINAL TEST PERFORMED BY CERT. NO. DATE CITY OF ANACORTES OFFICE USE ONLY WATER DEPARTMENT ❑ PASS DATE ' BACKFLOW PREVENTION ASSEMBLY ❑ FAIL INT. TEST REPORT RETURN aco r y City of Anacortes l Water Department 2201 'A'37th Street Anacortes,WA 98221 RETURN NO LATER THAN G NAME OF PREMISESL-�-% � c>t '�-/� � I""'° FILE NO. 2 l �� SERVICE ADDRESS k ILI { C w.V1.5A C° ZP L- 10 ) D 1 9� .. S c LOCATION OF ASSEMBLY � � [ ASSEMBLY: ��L�`�N S J o XL- ' y /l(/ MANUFACTURER MODEL SIZE //� SERIAL NO LINE PRESSURE AT TIME OF TEST '� f` �r, LBS. TYPE OF ASSEMBLY C �"i"� Reduced Pressure Assemblies Pressure Vacuum Breaker Double Check Assemblies Relief .Air Inlet Check Valve tst Check 2nd Check Valve Opened at psid psid Initial DC-closed tight ........ Closed tight_..... Opened at Did not Test Leaked__.__...... ❑ open._.____ ❑ Leaked ....._.__ ❑. RP _...psid psid Leaked. _......._❑ Repairs and Materials Used i. Test After DC-closed tight ......--, Closed tight......._. -. Opened at Opened at Repair RP- psid psid psid psid AIR GAP INSPECTION: Required minimum air gap separation provided . . . . Yes ❑ No ❑ I�� REMARKS: l�� Z O ra 1 P, L1Q I To1� THE ABOVE REPORT IS CERTIFIED TOBE1TRUE: INITIAL TEST PERFORMED BY �""" 'C'� CERT. NO.G aO I DATE- REPAIRED BY DATE FINAL TEST PERFORMED BY CERT. NO. DATE P' CITY OF ANACORTES RETURN TO: WATER DEPARTMENT City of Anacortes Water Department BACKFLOW PREVENTION ASSEMBLY 22o1 "A'37thStreet TEST REPORT Anacortes,WA 98221 is li N' i RETURN NO LATER THAN NAME OF PREMISES U y'c./1a It:!, FILE NO. !' SERVICE ADDRESS LOCATION OF ASSEMBLY [Y DQQe OLD 31I1J It ,^^HIV P ASSEMBLY: e MANUFACTURER .MODEL SIZE SERIAL NO. jf LINE PRESSURE AT TIME OF TEST= ) LBS. TYPE OF ASSEMBLY i is Reduced Pressure Assemblies Pressure Vacuum Breaker Ir Double Check Assemblies Relief Air Inlet Check Valve list Check 2nd Check Valve Opened at h - - psid psid ji ii Initial DC-Closed tight 161osed tight..... ❑ Op�enpe�d at Did not Test RP- q— psid Leaked--- -- ❑ t+ psid open,'.........❑ Leaked ...... ❑ Leaked--- --- ............. ❑ !. ly c: fr Repairs and Materials Used P I% t Test After DC-closed tight ..... ❑ Closed tight__ ❑ Opened at Opened at psid Repair RP- psid psid psid C AIR GAP INSPECTION: Required minimum air gap separation provided . . . . Yes ❑ No ❑ ±: REMARKS: La i; is THE ABOVE REPORT IS CERTIFIED TOVBEUE: INITIAL TEST PERFORMED BY CERT. NO. �. ��~�� DATE REPAIRED BY DATE FINAL TEST PERFORMED BY CERT. NO. DATE { CITY OF ANACORTES RETURN TO: 1 WATER DEPARTMENT City of Anacortes Water Department BACKFLOW PREVENTION ASSEMBLY 2201 "A'37th Street s�o RSA TEST REPORT Anacortes,WA 98221 �I RETURN NO LATER THAN -NAME OF PREMISES U F`c4 va ' b�& iu!4 FILE NO. 'J SERVICE ADDRESS CD E 0 ri GaS y4tg S LOCATION OF ASSEMBLY R,-) U,8 ASSEMBLY: LC )Ar S 00si MANUFACTURER MODEL SIZE {� SERIAL NO. LINE PRESSURE AT TIME OF TEST 0 LBS. TYPE OF ASSEMBLY i Y1 �y. Reduced Pressure Assemblies Pressure Vacuum Breaker Double Check Assemblies Relief Air Inlet Check Valve f1st Check - 2nd Check Valve Opened at ^•• psid psid Initial DC closed tight._._.. t[�' Closed tight.__. ❑. pen�d at Did not I� Test RP psid Leaked _..__-. psid open........ ❑ Leaked ._....... ❑ i4 Leaked..._....... IIC Repairs and Materials { Used Test After DC-closed tight ........❑ Closed tight........ ® Opened at Opened at psid Repair RP--psid psid psid j AIR GAP INSPECTION: Required minimum air gap separation provided . . . . Yes ❑ No ❑ . b 1a REMARKS: a I i THE ABOVE REPORT IS CERTIFIED TO BE TRUE: �•-t �� - ' DATE •-7}✓�l'�INITIAL TEST PERFORMED BY ! CERT. NO. REPAIRED BY v ^ DATE FINAL TEST PERFORMED BY ` CERT. NO. �� 2 DATE T ;;