HomeMy WebLinkAboutPL PB-P2407-0107 - RPZ Assembly Minor Remodel DEPARTMENT 8F 443 Lafayette Road N.,St. Paul, MN 55155
LD1
R AND INC►USTRY
(651) 284-5063 www.dli.mn.gov
PLUMBING PERMIT
PB-P2407-0107
Permit Date: 07/26/2024
Project Name
Presbyterian Homes The Gables RPZ Assembly Minor Remodel
Site Address
13575 58th St N, Oak Park Heights, Washington County
Applicant Name TWIN CITY PIPEWORKS INC
Address 5230 JAMACA BLVD N
Phone (651) 646-5675
Owner Name
Project Contact
Address
Phone
Contractor Name TWIN CITY PIPEWORKS INC
Phone (651) 646-5675
Inspector Kara Topper
Phone (651) 279-3418
Description of Work
(13575 58th St N)
Fees
Total Fees $126.00
Total Fees Paid $126.00
Total Fees Due $0.00
NOTICE
This permit is valid only for the work described and does not grant permission for additional or
related work.A separate permit may be required for work not included in the scope of this permit.
Permits become null and void if the work is not started within 180 days from the issue date and will
expire if the work is suspended or abandoned for a period of 180 days any time after the work has
commenced (see Minnesota Rule 1300.0120)
TWIN CITY
PIPWRKS
Residential Plumbing Repair Service
5230 Jamaca Blvd. N.
Lake Elmo, MN 55042
Reduced Pressure Zone Backflow Pressure Valve & Double Check (DC)Assembly Valve
Rebuild & Test Report
s.us,ness 1Con:act 'Data
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Locator of Device iSys•.e,r•Ser..ec
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)--16'7- 5'16 rt
15-..a. Year iReouild:'ate
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! ,
Test Year Check Valve#1 Check Valve#2 -fropeek-yelVe-#3
1 2 3 4y',
Leaked:: .;, Closed ()(:. Leaked 1 ;: Closed i, )I Leaked ( ) Closed
Overhauls ‘dt ) ,
Pressure: -7 , s( Pressure. i ' 1 Pressure --;
Cleaned Cleaned Cleaned
R Replaced Replaced Replaced
E Poppet Poppet Poppet
P Spring Spring Spring
A 0 Ring 0 Ring 0 Ring
I Rubber Seat Rubber Seat 1 Rubber Seat
R Other Repairs Other Repairs I Other Repairs:
,
S
I '
! , _
#2 Shutoff Valve:
Certification
• Pass [XV
I hereby certify the oregoin d a to be correct and that the device tested
is functioning within the limit the standards.
74 . Fail [ I
Assembly Final Test
Signature: / ' ..._ , Performance:
Date: --7 - 2c - 2 - / ' Pass
Fail [ ]
This report is for the purposes of recording only Ovmer is responsible for safe operation and upkeep of scheduled maintenance