HomeMy WebLinkAbout2017-10-16 RPZ Test Reports - Voss Utility an Plumbing - Aspen DentalP.O. Box 240
885 Katydid Lane
ty Hanover, NN 55341
VOSS UTILITY & PLUMBING
763-497-4577
763-497-3994 Fax
BACKFLOW PREVENTOR (RPZ) TEST REPORT
JOB ADDRESS:
OWNERIOCCUPANTICONTACT PERSON: CONTACT PHONE:
DEVIGE LOCATION: ^,
FLOOR #:
RELIEF
PSI/DIFF
ROOM #:
SERVES WHAT SYSTEM:"
FINAL TEST
MAKE:
MODEL #:
SIZE-
SERIAL #
INSTALL DATE (MONTH/DAY/YEAR):
OVERHAUL DATE (MONTH/DAY/YEAR):
TEST DATE (MONTH/DAY/YEAR):
(DO NOT PUT A FUTURE DATE IN THIS BOX)
DESCRIBE REPAIR IF ANY (IF THIS IS A NEW INSTALLATION AND REPLACES AN EXISTING DEVICE, INDICATE THE SERIAL NUMBER
OF THE DEVICE REMOVED):
TEST DONE BY (PLEASE PRINT FIRST 8, LAST NAME):
COMPANY NAME: V
COMPANY ADDRESS:
CITY:
1, (-T'P i ,u i% -,A �) L
Im
CERTIFICATION
ER:
CONTRACTOR LICENSE #: r
COMPANY PHONE #:
CONTACT PERSONIPHONE#:
0
#1 CHECK VALVE
PSI/DIFF
RELIEF
PSI/DIFF
#2 CHECK VALVE
TEST BEFORE REPAIRS'2
FINAL TEST
DESCRIBE REPAIR IF ANY (IF THIS IS A NEW INSTALLATION AND REPLACES AN EXISTING DEVICE, INDICATE THE SERIAL NUMBER
OF THE DEVICE REMOVED):
TEST DONE BY (PLEASE PRINT FIRST 8, LAST NAME):
COMPANY NAME: V
COMPANY ADDRESS:
CITY:
1, (-T'P i ,u i% -,A �) L
Im
CERTIFICATION
ER:
CONTRACTOR LICENSE #: r
COMPANY PHONE #:
CONTACT PERSONIPHONE#:
0
P.O. Box 240
885 Katydid Lane
Hanover, NfNT 55341
763-497-4577
763-497-3994 Fax
Awl
JOB ADDRESS: r fp
DWNER)OCCUPANTICONTACT PERSON: CONTACT PHONE:
I
DEVICE LOCATION:
FLOOR #:
ROOM #:
SERVES WHAT SYSTEM
TEST BEFORE REPAIRS
cL
za r�
MAKE:
MODEL #: Z/-7
SIZE: A, r
SERIAL #:
INSTALL DATE (MONTH/DAY/YEAR):
OVERHAUL DATE (MONTH/DAY/YEAR):
TEST DATE (MONTH/DAY/YEAR):
(DO NOT PUT A FUTURE DATE IN THIS BOX)
DESCRIBE REPAIR IF ANY (IF THIS IS A NEW INSTALLATION AND REPLACES AN EXISTING DEVICE, INDICATE THE SERIAL NUMBER
OF THE DEVICE REMOVED):
TEST DONE BY (PLEASE PRINT FIRST & LAST NAME):
CERTIFICATION NUMBER:
ey
COMPANY NAME: "(h(4 (Z^
CONTRACTOR LICENSE #:
COMPANY ADDRESS: COMPANY PHONE #:
-CITY: STATE: ZIP: CONTACT PERSONIPHONE#:
#1 CHECK VALVE
PSI/DIFF
RELIEF
PSI/DIFF
#2 CHECK VALVE
TEST BEFORE REPAIRS
FINAL TEST
DESCRIBE REPAIR IF ANY (IF THIS IS A NEW INSTALLATION AND REPLACES AN EXISTING DEVICE, INDICATE THE SERIAL NUMBER
OF THE DEVICE REMOVED):
TEST DONE BY (PLEASE PRINT FIRST & LAST NAME):
CERTIFICATION NUMBER:
ey
COMPANY NAME: "(h(4 (Z^
CONTRACTOR LICENSE #:
COMPANY ADDRESS: COMPANY PHONE #:
-CITY: STATE: ZIP: CONTACT PERSONIPHONE#:
CITY OF OAK PARK HEIGHTS
14168 OAK PARK ILMI N. 92007
OAK PARK HEIGHTS, MN iSO82-2007
(651) 351-1661 FAX. (651) 439-0574
ADDRE�ss 1817, 60TH STN
PIN 05.029.20 22,0020
LEGAL DESC BRACKI.Y 44 1'l1 ADDI I ]ON
LOT 2 B!"OCK I
PERNTITTYPE� PLUMBINO
PROPERTY TYPE COMNIFRCIAL
CONSTRUCTION TYPE NL'\k` CONSTRLICTION
ISSUED: 08'22/201'7
Permit #: 2017-00252
A
TEN UC11 V ITY 'AN I '�,IIACF PLUMBING BUILD OUT
VALUATION S 3-1930.00
_10171 &,A1JiU'ST3,20l'7. WORK SHALL FUIZI'HHI CO"Mill"i" MTH ;%LLNIN 11L1,'MI31NG ASf'FN, DI NTAL
ITNAX I'SPACI- "
VIUAIT" OF PLU"NIBINO 3'930
APPLICANT
VOSS t ITILITY& PLUMBING
P.(Y BOX 240
HANOVER, MN 553=11-
(763) 497-4577
Minnesota State License =4: 007658109
LANE LLC
4999 FRANCE AVE
MINNEAPOLIS, NIN 55410-
AGREE11ENT AND SWiORN STATEMENT
The work for which this permit is issued shall be performed
according to: (1) the conditions of this pci-mit. (2) the
approval plans and specifications: (3) the applicable city
approvals, Ordinances. and Codes: and. (4) the State Building
Code. This permit is for only the work described, and does
not (rant permission for additional or related work which
requires separate permit.,;. This permit will expire and become
nult and void it'work is not started within 180 days, or il'worl,
is suspended or abandoned for a period of 180 days any time
after work, has commenced. The applicant is responsible i()I-
aS,SUring all required inspections are requested in conforinancC
with the Minnesota State lluildinL, Code.
PLU'MBING-COMNMERCIAL 32 9.3 0
PLI)MBING ST,,�,TE SURCIIARGF COMMERCIAl 16.46
f ()T,1\ 1, 345.776
PavMent(s)
CHECK 033744 345.76
SERARAIT" P[RMITS REQUIRFID FOR WORK OTHER THAN DESCRIBED ABOVE.