HomeMy WebLinkAboutOT 2012-00069 RPZ Installation CITY OF OAK PARK HEIGHTS PERMIT NO.: 2012 -00069
14168 OAK PARK BLVD. N. #2007
OAK PARK HEIGHTS, MN 55082 -2007 DATE ISSUED: 04/27/2012
(651) 351 -1661 FAX: (651) 439 -0574
ADDRESS : 14949 62ND ST N
PIN : 33- 030 -20-44 -0001
LEGAL DESC : N/A
: LOT 0 BLOCK 0 PARCEL -
PERMIT TYPE : OTHER
PROPERTY TYPE : INSTITUTIONAL
CONSTRUCTION TYPE : OUTSIDE SPRINKLER SYSTEM
NOTE: PERMIT ISSUED FOR INSTALLATION OF NEW RPZ VALVE MAINTENANCE GUAGE, LOCATED AT LOWER LEVEL TO
SERVICE ORBIO SYSTEM. RPZ IS AN 1/2" APOLLO, MODEL RP -HO (SERIAL NO. 388823) AND WAS INSTALLED AND TESTED ON
04 -04-12 BY NAC MECHANICAL SERVICES. NAC PLUMBING LICENSE PC642594
APPLICANT OTHER PERMIT FEE 75.00
OTHER PERMIT SURCHARGE, FLAT 5.00
NAC MECHANICAL & ELECTRICAL SERVICE TOTAL 80.00
1001 LABORE INDUSTRIAL CT.
STE. B PAID WITH CHECK # 71093
VADNAIS HEIGHTS, MN 55701 -0000
(651) 490 -9868
OWNER
WASHINGTON COUNTY - ATTN PW DIRECTO
11660 MYERON RD N
STILLWATER, MN 55082 -
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed
according to: (1) the conditions of this permit; (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 grant permission for additional or related work which
requires separate permits. This permit will expire and become
null and void if work is not started within 180 days, or if work
is suspended or abandoned for a period of 180 days any time
after work has commenced. The applicant is responsible for
assuring all required inspections are requested in conformance
with the Minnesota State Building Code.
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
1\11 Ark
24 Hour WA Oe
Mechanical & Electrical Services www.neahrec.00m
1001 Lab ore Industrial Call, Suite 8, VW** Heights, Mnnesote 55110 tai: 851- 490-9888 In 851 490 - 1898
11-1 9 q (0Zr.ct St . N
RPZ Report
BACKFLOW PREVENTOR (RPZ) TEST REPORT
Jag A , ir „ `-1p_ �/
OWN UPANT/CONT'AC PERSON: ` 4_ - f l - 3 (r 3 --.1 Van
COMPACT PHONE N: (il 5
to
DEVICE rvt4id► t►r:n.K 1riOORir: L L. ROOM
MAKE d e , i s MODEL: j ` , - IMMO SERIAL U: Sir IN
INSTALL DATE: L - d. OVERHAUL DATE: TEST DATE: "
111 CHECK VALUE RELIEF N2 CHECK
P$UDIFF BPSI(D111 VALUE
TEST B EFORE REPAIRS ., Gam+ .3 ,, qq
- l OK
FINAL �EST g � ok
DESCRIER REPAIR IF ANY(IP 11115 IS A NEW INSTALLATION AND REPLACES AN EXISTING DEVICE,
INDICATE THE SERIAI. NUMBER OP THE DEVICE REMOVED):
2PZ
TEST DONE DY (P (PLEASE PRINT FIRST & LAST NAM
CERTIFICATION ]Yt)MaER: I j) 3 - f
COMPANY NAME: NAC Mechanic al & Elec CONTRACTOR LICENSE r0-
COMPANY ADDRESS: 1001 Labors Ieduettigi Ct ,COMPANV PHONE IA 651. 490 -9863
CITY: Vadnuis Height - STATE: MN ZIP: 55110 !CONTACT PERSON: Charlie Kistler
ATTACH COMPLETED TEST REPORT TO P'LUMBINGKA$F17TINC/RPZ PERMIT
APPLICATION AND SUBMIT WITH FEZ
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