HomeMy WebLinkAbout2001-03-26 Horwitz Rebuild Report for Boiler Feed Device ' the following described' work, .
up the express candition the alb perso firm ''
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corporation, and agents, employ d workmen, in all the following described, and
any part thereof, shall conform in spects to the ordinances of the City of M. `oolis,
regarding the Installation maintel. ce, repair, alterations, replacement or col. •ction
within the city limits, and t permit may be revoked at any time upon the violation o► any of
the provisions of said ordinances.
.2t 4. 1 0.0 * \. 2s2A1.2..er‘.. o
REOUi • A OVA lr
O ELEVATOR 0 _____._...r. VACANT BLDG. 0 ....... . PLAN REVIEW 0 . .e _ HERITAGE
O HEATING 0 HOUSING RIG. 0 ,_ . SAC INSP. 0 NOLO
•
❑ - HOMEOWNER 0 BOARDED REG. 0 DOUBLE FEE 0 OTHER
• .'T^- . EA 3:
O BU4DINo 0 STREET 0 ELECTRIC 0 n.UMQING 0 WARM AUN 0 on. BURNER '
0 WIICKIMOVP ❑ SIGN C] ELEVATOR 0 FIRS SUPPRESSION 0 STEAWNOT WATER ❑ REFRIGERATION •
O PLASTERA.AT'H 0 0 tILEC HEATING 0 _ ENEET METAL 0 GAS BURNER ❑ AIR CONDITIONING •
'•' '' -•• APPLICATION FOR BACKFLOW PREVENTOR TEST REPORT
JOB ADORES : (ILO -in (STREET NAM) AV • 3T - BLVD • PKWY • ETC) IDIRECTTON N.E.S.w. N.E S.E) (SLOG ANTE) ' •
• LINER OCCU ANT _ _ _- : OESCfIPTION OF WORK: --
�^ tt] INSTALL 0 ALTER REPAIR 0 REPLACE ''
CONTACT PERSON: SERV • HA BY - EM: I !' —
4
DEY LOCATION: P ,
LOONS NUMB QOM NUMBER.
•
�MAK MOOEI: •--- - - -___ SIZE: SE - IAl NUMBER: •
IN LL DA (M N 11, OAY a YEAR): �Y(T�HAUL 0 5 1 N, AY a V r): TEST DATE NT • • • Y a v. A �'
CHECK VALVE CHECK VALVE RES. DIF. ACROSS PRES. DIP. E
NUMBER 5 NUMBER_.,_.._ NUMBER 1 CHECK RELIEF OPENS DRAINER
• TEST BEFORE ❑ LEAKED 0 LEAKED PSI PSI []
REPAIRS 0 CLO ED v CLOSED i CLNO
FINAL TEST CLOSED CLOSED PSI PSI —
• 8
• DESCRIBE REPAIR: _ 4 L �:-, i X .0Y.B.4 !
11 ° 0,0 I , 0 4 A ,
Aft I
. TEST VA C T CERTIFICATION NUMBER:
Alt
/ .... ./..e/ ■ArAilli •
_,,,._.
°r� T
{MA • C . MPL /•N: • TAL V OF •-".• It FEE: CCI SURCHARGE: PERMIT FEE: t
•
E t $ t
• A NAM I wt.. • Y WI M ALL REQUIREMENTS ON THIS APPLICATION.
RUTH. SIGNATURE:
••
PANY STREET ADORI<SS: ADDRESS: -- _ ,
• .
CITY; stet: LIPS YELEPHONE NUMBER UCENSE NUMBER
MAKE CHECK PAYABLE TO MINNEAPOLIS FNWtNCE DEPARTMENT RETURN TO: DEPARTMENT OF warn room
VALPDITY OF PERMIT SUBJECT TO COLLECTION PAYMENT Kt !•'UBL(C HEALTH BUILDING. MINNEAPOLIS. MN EPPS
USE TYPEWRITER OR BALLPOINT PEN AND PRESS FIRMLY
OUTS RW. 6At PLEASE RETURN ALL COPIES INTACT
' twour _ . .... .. . WACO a.•h.•. f.■.. -