HomeMy WebLinkAbout2001-03-26 Horwitz Rebuild Report for Outside Irrigation Device ' the following described work, um° the expr ss condition said pirson "firm or
corporation, and agents, employ d workmen, in all the following describe and
any part thereof, shall conform )n ►spects to the ordinances of the City of M `polls,
regarding the installation mainte., .ce, repair, alterations, replacement or co( 'lion
within the city limits, and this permit may be revoked at any time upon the violation or airy of '
the provisions of *aid ordinances.
• SI . f , r . .:
i
O ELEVATOR ❑ VACANT SLOG. ❑ -,_ _,� __ PLAN REVIEW 0 —...._ HERITAGE
❑ HEATING 0 moutons nee. ❑ SAC INSP. 0 HOLD •
❑ . - HOMEOWNER 0 t _ SoARuso REG. ❑ DOUBLE FEE ❑ ._ , OTHER
ER S:
0 BUILDING 0 STREET 0 ELECTRIC ❑ PLUMBING 0 WARM AMR O on. BURNER ,
❑ WIIEOK/I,Ion 0 SKIN 0 ELEVATOR 0 FIRE SUPPRESSION 0 STEAM/HOT WATER ❑ REFRIGERATION
O Pt.ASTEWLATM 0 ❑ Ric. HEATING O NO SHEET METAL ❑ GAS BURNER ❑ AIR CONDITIONING
• APPLICATION FOR BACKFLOW PREVENTOR TEST REPORT
( JON ADORES : ( L • • In (STREET N AM) AV • ET - BLVD. PKWY • • ETC) (DIRECTION N.E.S.W. we S.E) (BLDG NAME) - . • .
• WNEIVOCCUPANT• PTKS
! DESCrUN or WORK: .. • ' ' • ... ..
__ �_1� INSTALL ❑ALTER ❑REPAIR (] REPLACE .
T CMN iACT P$N SON: S V s WMATBY1TEIA:' -"
•
l / � f C) I i � O IV
' D � - LOOTT NU. - - IV :, i • JABBER:
•
MAK .• / MODEL: .'- .
_nt1[: I , E IAL NUMBER '
• , I' ' ♦' ^ I a = • • ' . •
N 11 DA ( • TH. OA f YEAR): OATS • (MON H, 4 AYE Iv ): TEST TS IM 'NTH. • A V
... 6::).. Al .. _ .01 _ .
CHICK VALVE CHECK VALVE PRES. CIF. AC - •SS PRES. DIF. EN STRAINER
NUMBER 1 NUMBER -- NUMBER I CHECK RELIEF OPENS
TEST BEFORE ❑ LEAKEO O LEAKED
REPAIRS (] CLOSED _ 0 CLoSE0 _- PSI PSI CI NO O •
^ FINAL TEST 0 - ••SEO CLOSE() s S PSI 5 Ps' . .. .
DESCRIBE REPAIR. S � Ia �% v A •u1 , • 't7���! 1� %t/
i . Din 0A--12.0
P 1
• TEST ST: tilr.
aPtilk _ CERTIFICATION NUMBER:
at /if iri..44..= 9.3g T .
ESTIMATED COMP ETON: TOTAL VALUE OF WORK: FEE: CC1 SUM/MACE: ( PERMIT PEE: 1
: 1) 11 1... J S
1- ••••••10, .•},LOIN• S IS � : ,
• M A NAM : I iNtU f ALL NEWT ON THIS ALICATICN. •
ATTN. .
TN. SIGNATURE:
• ANY ES •AO • -T ADDRESS:
CITY; S A ZIP cope: TE .EPHONF NUM -
H OrWilline.
_ _ mechanical contractors
MAKE CHECK PAYABLE TO' MINNEAPOLIS FINANCE DEPNMTMSHT RETURN TO: DEI • PLUMBING • HEATING
VALIDITY OF PERMIT SUfJECT TO COLLECTION PAYMENT 000 PUBLIC HEALTH B
IGH PURITY PIPING
USE TYPEWRITER OR BALLPOINT PEN AND PR Joseph P. ('Shaughnessy • HAIR CONDITIONING
10.061E R.r. Bit PLEASE RETURN ALL COPIES INTAC
cz ...... , , _ _ _- wove ...v.,.... r ..,.., , e-mail: joshaughneSSy@horWitzinC.COm • PROCESS PIPING
8825 Xylon Avenue North Phone: (763) 425 -7566
Brooklyn Park, MN 55445 FAX: (763) 425 -4436