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HomeMy WebLinkAbout11130 W 44th AvenueLAM. 16 1y0 -&it 33y-5701 L, 0, Assembly Serial # Test Date / Time ` /- 20 P C)" C) Tester Certification #_ 5 Assembly Test Results y - PaSS F� *Fall Under Suspension - Process Immediately Denver water Backfitow Assembly Test & Maintenance Report (please print with BLW.K t FTiFRIN[: ) Testing C patty: Submit by e-mail (preferred) to CrossConnectionControlOdenverwater-org, type "Backtiow Test Reports" in the subject line OR submit by Fax to (303) 794-8325. *FAILED test results must be reporter/ to Denver Water within 24 hours of failure at (303) 628-5969. Facility Name: _ Meter #: Facility Address: {l�.,1 �I City= ',A';i�.i'CKt� Y� Contact Person: Phone: Make: `R ( C Model: 7L UF Pf Type: ❑ RP SDC ❑PVB ❑Air Gap ype of Use Protection Orientation L Size_ r3 Date Installed: Domestic ❑ Containment Inlet Outlet New ❑ Existing ❑ Fire ❑ Glycol ❑ Containment by Isolation ❑ Horizontal ❑ Previous Assembly #: ❑ Irrigation ❑ Isolation ❑ Vertical Up ❑ Location: j;1 Ii4 i F Wit ❑ Recycled ❑ Vertical Down ❑ Approved: Y ❑ N ❑ = :PSL Line Initial Test Results Repairs Re -Test Results Tightness Differential Tightness Differential Check Valve #1 ❑ Leak (RP, DC, PVB).,Tight `" {'i o Leak Check Valve #2 DC) 11Leak Tight - 11 Tight ❑Leak (RP, ❑Tight Relief Valve (RP) Buffer (RP) Air Inlet PVB ` Shutoff Valve #1: Tight ❑Leaking ❑ Replaced IShutoff Valve tt2: Tight ❑Leaking ❑Replaced Backpressure: ❑ Yes NoTes# Procedure: 11ABPA: ❑ ASSE: Comments: o Alarm Company/Fire Department: s Person Notified:. Contacted By: z . Turn Off Date/Time:, Turn On Date/ Time: e Y Test Kit Rdake: • Model: Serial# Last Calibration Date: x Tester cerfffies Phishas t with the above listed procedure and verifies the isolation valves were returned to pre-test orientation. m' Testing Comp n m' ,-: Tester N 3 %U % = Phone: ;Signature: _ Certificate Expiration Date: e5 3 / 2a Testing C patty: Submit by e-mail (preferred) to CrossConnectionControlOdenverwater-org, type "Backtiow Test Reports" in the subject line OR submit by Fax to (303) 794-8325. *FAILED test results must be reporter/ to Denver Water within 24 hours of failure at (303) 628-5969. e A i CITY OF WHEAT RIDGE Building Inspection Division (303) 235-2855 Office INSPECTION NOTICE Inspection Type: Job Address: Permit Number: �� o \ C� O c _C �ei r11 s�� Ani�`i����S ❑ No one available for inspection: Time AM/PM Re -Inspection required: Yes No When corrections have been made, schedule for re -inspection online at: http.IA,vww.cLwheatridge.co.uslinspection Date: k.�> "�\ \ `-, Inspector: DO NOT REMOVE THIS NOTICE City of Wheat Ridge Commercial Plumbing PERMIT - 201902293 PERMIT NO: 201902293 ISSUED: 10/29/2019 JOB ADDRESS: 11130 W 44th Ave EXPIRES: 10/28/2020 JOB DESCRIPTION: Commercial plumbing installing a back flow device. *** CONTACTS *** OWNER (303)423-8960 OBIALERO JOHN T JR SUB (303)429-9492 RONALD YANKER 021900 TRI -R -SERVICES *** PARCEL INFO *** ZONE CODE: UA / Unassigned USE: UA / Unassigned SUBDIVISION CODE: 420 / Storage Warehouse; 0 BLOCK/LOT#: 0 / *** FEE SUMMARY *** ESTIMATED PROJECT VALUATION: 1,800.00 FEES Total Valuation 0.00 Use Tax 37.80 Permit Fee 70.70 ** TOTAL ** 108.50 *** COMMENTS *** *** CONDITIONS *** Approved per plans and red -line notes on plans. Must comply with 2012 IBC, 2017 NEC and all applicable City of Wheat Ridge Municipal Codes. Work is subject to field inspections. **Prior to final inspection approval - As-builts are required before approval of the Building Final Inspection and Certificate of Occupancy can be issued. I, by my signature, do hereby attest that the work to be performed shall comply with all accompanying approved plans and specifications, applicable building codes, and all applicable municipal codes, policies and procedures, and that I am the legal owner or have been authorized by the le-, owner of the property and am authorized to obtain this permit and perform the work described and approved in conjunction with this e it I further attest that I am le ally authorized to include all entities named within this document as parties to the work to be p med nd that rk a per rmed is disclosed in this d ent and/or its' accompanying approved plans and specifications. Signature of OWNER CONTRACTOR (Circle one) Date I. This permit was issuedLbased on the information provided in the permit application and accompanying plans and specifications and is subject to the compliance with those documents, and all applicable statutes, ordinances, regulations, policies and procedures. 2. This permit shall expire 365 days after the date of issuance regardless of activity. Requests for extension must be made in writing and received prior to the date of expiration. An extension of no more than 180 days made be granted at the discretion of the Chief Building Official and maybe subject to a fee equal to one-half of the originalpermit fee. 3. If this permit expires, a new permit may be required to be obtained. Issuance of a new permit shall be subject to the standard requirements, fees and_procedures for approval of any new permit. Re -issuance or extension of expired permits is at the sole discretion of the Chief Building Official and is not guaranteed. 4. No work of any manner shall be performed that shall results in a change of the natural flow of water without prior and specific approval. 5. The permit holder shall notify the Building and Inspection Services Division in accordance with established policy of all required inspections and shall not proceed or conceal work without written approval of such work from the Building and Inspection Services Division. 6. The issuance orgranti of a permit shall not be construed to be a permit for, or an approval of, any violation of any provision of any app a e code or an dinance or regulation of this jurisdiction. Approval of work is subject to Held inspection. Signature of Chief Building Official Date REQUESTS MUST BE MADE BY 11:59PM ANY BUSINESS DAY FOR INSPECTION THE FOLLOWING BUSINESS DAY. City of �W heat � MUNITY DrVF1OPMFNT ge Building & Inspection Services 7500 W. 29' Ave., Wheat Ridge, CO 80033 Office: 303-235-2855 * Fax: 303-237-8929 Inspection Line: 303-234-5933 Email: permits(@ci.wheatridge.co.us I FOR OFFICE USE ONLY Date: ic%,i/9 Plan/Permit # Plan Review Fee: Building Permit Application *** Complete all applicable highlighted areas on both sides of this form. Incomplete applications may not be processed. *** Property Address: 1 / 1 3 © W6-,+' A Property Owner (please print): J o 14 tl,� t A ,� 6-jZ_0 Phone: 305- 423-- '896C Property Owner Email: Tenant Name (Commercial Projects Only) Property Owner Mailing Address: (if different than property address) Address: City, State, Zip: Architect/Engineer E-mail: Phone: Contractor Name- -Z c2VtPGG(� 7—N c, City of Wheat Ridge License #: (.o' Phone:.2-- Contractor E-mail Address: R. a s e p,_��) For Plan Review Questions & Comments (please print): CONTACT NAME (please print): Phone: CONTACT EMAIL(p/ease print): Sub Contractors (Must provide Wheat Ridge License No & Signed Subcontractor Authorization form): Electrical: Plumbing: Mechanical: W.R. City License # W.R. City License # W.R. City License # Other City Licensed Sub: Other City Licensed Sub: City License # City License # Complete all highlighted fields, if applicable. COMMERCIAL ❑ RESIDENTIAL Provide description of work: For ALL projects, provide a detailed description of work to be performed, including current use of areas, proposed uses, square footage, existing condition and proposed new condition, appliance size and efficiency, type and amount of materials to be used, etc. ,14 -r2-),4 G Sq. FULF BTUs Gallons Amps Squares For Solar: KW # of Panels Requires structural For Commercial Projects Only: Occupancy Type: Construction Type: Occupancy Load: Square Footage: Project Value: (Contract value or the cost of all materials and labor included in the entire project) $ I, Poneo — OWNER/CONTRACTOR SIGNATURE OF UNDERSTANDING AND AGREEMENT I hereby certify that the setback distances proposed by this permit application are accurate and do not violate applicable ordinances, rules or regulations of the City of Wheat Ridge or covenants, easements or restrictions of record; that all measurements shown and allegations made are accurate; that I have read and agree to abide by all conditions printed on this application and that I assume full responsibility for compliance with applicable City of Wheat Ridge codes and ordinances for work under any permit issued based on this application; that I am the legal owner or have been authorized by the legal owner of the property to perform the described work and am also authorized by the legal owner of any entity included on this application to list that entity on this application. I, the applicant for this building permit application, warrant the truthfulness of the information provided on the application. CIRCLE ONE: (OWNER) CONTRACTOR or (AUTHORIZED R PRESENTATIVE) of OWNE (CONTRACTOR) Signature (first and last name): �/ DATE: � � ` Printed Name: 1 i i1 L, F) E • lA't (CL ✓�-- ZONING COMMMENTS: Reviewer: BUILDING DEPARTMENT COMMENTS: Reviewer: PUBLIC WORKS COMMENTS: Reviewer: DEPARTMENT USE ONLY OCCUPANCY CLASSIFICATION: CONSTRUCTION TYPE: Building Division Valuation: