Loading...
HomeMy WebLinkAboutBLD-2012-0352 - YARD IRRIGATION SPRINKLERS •r Qom Cityof Anacortes Permit#: BLD-2012-0352 904 6th Street Issue date: 09/07/2012 .75. P.O.Box 547 :` Anacortes, WA 98221-0547 Expire date: 03/06/2014 Job Address: 1000 SHIP HARBOR BLVD Permit Type: Irrigation Permit ANACORTES WA 98221 Project: APN: Remarks: Irrigation system for entrance to San Juan Passage and Overlook Parks Owner: GP ANACORTES LLC Contractor: Address: 7 JACKSON WALKWAY Address: PROVIDENCE RI 02903-3638 Phone: (401)824-6324 Phone: License#: General Information: Fees: #of Backflow Devices 1 Plumbing Permit Fee 27.00 Total Calculated: 27.00 Deposits/Receipts: 0.00 Total Due: 27.00 t1) r•.) rw to :' h•:! tX If sue} Ca Cs CD CO %C. C. t•O t C.•t --! N. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 180 DAYS, OR k ;t CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS AT ANY TIME AFTER WORK IS COMMENCED. t" 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 ,J NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. SIGNATURE OF OWNER OR AUTHORIZED AGENT ISSUED BY kb& ( V\-WX5 'Ni )),(1+tik;u1A1 ilTzstC3U 3 Return to: G{i Y O4 kIUVEGYLEAS- r CITY OF ANACORTES V� c2C)t City of Anacortes cr i tr SSt.�u.WATER DEPARTMENT 2281 "A 37`"Street 7. d„ Anacortes,WA 98221 4.gC w BACKFLOW PREVENTION ASSEMp46BLY TEST REPORT ph: 360.293.1921 Fax: 360.293.1931 ACCOUNT# q AusoJ P Sp DeMci 1.1,c) -Nri- NAME OF PREMISE 44 *VI'Rctf't1. eo i� '-11^03 I` 1 Commercial❑ Rcsiden a1X C SERVICE ADDRESS 6tAip} StIODY btvei/ F -i i CITY Aviaccot4es ZIP CONTACT PERSON-- 'HONt ) FAX t } i,(014.r i✓Vk �• '' :..j , st .-4 L04.N! C Otr�yU LOCATION OF ASSEMBLY - -- __ 20 ,C ti (ot.�.4'11E 4 _ Pu rk. -1. — LOv Cvurn 5r`dCtue4 k DOWNSTREAM PROCESS L&r d SCE trri 5 0-1.0.1.-DCVA )1( RPBA O PVBA 0 DCDA NEW INSTALL)4 EXISTING 0 REPLACEMENT 0 OLD SER.# PROPER INSTALLATION?YES ill NO 0 MAKE OF ASSEMBLY MODEL 3 0 SERIAL NO. 8 27344 SIZE a" DCYA/RPBA (6CV3/RPBA RPBA PVBA/SVBA INITIAL ! CHECK VALVE NO I , CHECK VALVE NO.2 AIR INLET TEST I OPENED AT PSID OPENED AT PSID LEAKED 0 LEAKED 0 #I CHECK PSID y�`� DID NOT OPEN 0 BAILED PSID �-/ PSID AIR GAP OK? CLEAN REPLACE P. T CLEAN REPLACE PART CLEAN REPLACE PART CHECK VALVE NEW 0 6,,,,i n I ❑ © ❑ ❑ HELD AT PSID PARTS ❑ �10 n ❑ ❑ iN �` , ❑ ❑ LEAKED 0 AND REPAIRS ❑ ❑ -- & ❑ aj`� Q CLEANED 0 ?Cp t-t! t4 0 pc Si-t 6 Ovn bvt ieti►r' )Its. REPAIRED 0 TEST AFTER inci d� ci x,Ci�Al, REPAIRS LEAKED 0 LEAKED 0 OPENED ATdd[ PSID AIR ET PSID PASSED ❑ LAYDSCAPIta._ 51REF y�ID 14E---a),. FAILED ❑ ei 12i, AIR GAP.INSPE_CTTI�ON:Required minimum air gap separation provided_? Yes}es❑} No 0 Detector Meter Reading REMARKS: .Pen ar, %tt " �t� A } r)L�� .C , LINE P;;;: /3 PSI i-eectS : 2`t cX t S pv,ncs w- V IA Co r7T`v — CONFINED SPACE? ---- TESTERS SIGNATURE: SAM CERT.NO. 3�J0 � DATE t 'tJ 'I`.�. TESTERS NAME PRINTED: Shy t{74 iiitirliathd TESTERS PHONE I (4n .g'1O 9r192. REPAIRED BY: • DATE FINAL TEST BY: 2 ( CERT.NO. DATE (� CALIBRATION DATE i /t31 t GAUGE*�� Oz ODEL. C-C SERVICE RESTORED Ill NO Ei L.0 t AS FDu `=' I cernfr that this report is accurate.and I have used I) le 2-1 b-2904911 approved test methods and test equipment. * ( P RV, PcrD .ctt yci/ewe