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HomeMy WebLinkAboutWTR2702066 W-2066 Valley Medical Center MRI Phase 2 8" Waterline BEGINNING I� OF FILE FILE TITLE w .ao66 114 Pf L J ec ( ir r 4 Shon Plat (SFfpL 1) REQUEST FOR PROIEf.Tx Prelim Plal (Ppx ) a CAGN _ To Technical Services Date � /99!�j WON 95;fp 3/ _ Groenll �17�_ From Plan RMew/Pro)ect Manager A Project Name ZA1 C' 1VX 1>b drrrwrr w) Descrl tion of Project, P Circle Sin of Waterline: 10" 12" Circle One New or Extesnion Circle Sim of Sewrylim g" 10" Q. Circle Onc New or Extension ,t Circle Sin of Stormlim- 12" IS" IV 24" Cicle One New or Extemion Address or Street Name(s) DvlpdConincloNOwner/Crult — i — (lOdvrrwnwl Chock each discipline involved in Project Ltr Drwg N of sheets per discipline O Trans-Storm (RmJweY/1Minege) IUQriv„Mouruu+`ira`rclude Fum n.mel� — — -a' (aquae TFSC rbrab) { O Tiansponatioi. (s;wivaian awauln onM1 LSM,np — ' � 4 Waslcwatcr _ (aa��wy6ewr Mein)lu�luh bu�niwie) � — — ��� 4'?z �WeIC! IMeuet VMvw.Nybenu) lid �"� ' (Irclu4 sane.na a IloneunMl C41 si..M) t TS um Only ;s..LAp�pmv"edby7SMca oaa Dare. r : rF. �Yy I u / 4"RETURN TO / ///���Itl� � r BACKFLOW PREVENTION ASSEMBLY ♦1 TEST REPORT I' ./ RETURN No LATER THAN NAME OF PREMISES-J//I Cl6,1 y/y Q 1L C�Jr�jR " P EN y . SERVICE ADDRESS LOCATION OF ASSEMBLY JV�N. eAwle O+ AID& ASSEMBLY: WA7Ti /I e L 46.�rA/` ( / NAMVaC1LL'IFA - SER4/ND ONE PRESSURE AT TIME OF TEST Las TYPE OF ASSEMBLY_ l sKL Reduced PraaatKa DDuDIa Check Awn104aAr~ ' 7P-d _ akertal CM t A"w k VataaIna ChatVaNa psidInrkal DC ctoaeqkghlCIMaa kphtn.aat Test RP-_paq L:.j 3__LeekeaPSM L RePalrs and Materub Used T�NRM Rgbaa0 (J ose Cld u--Paidpene ght [_� Od at ---DSW Opened at AIR GAP INSPECTION Required minimum yr ya0 Walabon Wov.ded yea No REMARK$ i� C10rI1 ,2I *ml UI! 3 THE ABOVE REPORT IS CERTIFIED TO BE TRUE INITIAL TEST PERFORMED BY /(1/i(�/ . CERT No _�iAog DATE /- 9- 7� � REPAIRED By i —_ DATE FINAL TEST PERFORMED BY CERT No. DATE L� 3 N a RETU��Yyy TO BACKFLOW PREVENTION ASSEMBLY TEST REPORT RETURN NO LATER TRAN NAME OF PREMISES 1414EY ����\ F,7-&R. FILE NO. SERVICE ADDRESS 31 (S l T�ooy--C T��- S V I ��- 0c`) LOCATION OF ASSEMBLY Lr,✓R op ,S! (, :�t & ,cS_ Pfg, 2971 i,I 41,11d 4 fY S ASSEMBLY. ! �'4rfe I", .HUsaC1WR Uppft WF/T /�,SF9Yl//NO UNE PRESSURE AT TIME OF TEST -72 _LBS. TYPE OF ASSEMBLY 4r dA A `14CCK - 1/4L✓6 Reduced Preserve Assemblies Pressure Vacu mn Breaker Double Check Ase b§n Reael Air INM Cheek Valve tat Check 2nd Check Val" Opened at j I. psid _psW Inlbal OC Closed ngn! U Closed bgrlr Opened at D-d of Tesl RP._psW Leaked _psW open C Leaked Leaked Reparn and Materials / Used /lode/' 2S tL Teel Aber DC-closed tight ❑ closed Oghl [G Opened al Opened at _.psW Repan RP-_pyd Pw _psW AIR GAP INSPEECCTIO/Nn';, Rebaned mm r,,,,as gapseparation provxW Yes No❑ k REMARKS — !' 1lK� e zlicl //!SS✓/2G THE ABCVE REPORT IS CERTIFIED TO BE TRUE- INITIAL TEST PERFORMED BY CERT.NO - A� DATE REPAIRED BY -_ DATE FINAL TEST PERFORMED BY _ CERT NO DATE J ,4 AUTHORIZATION OF SPECIAL IMLING DATL PROJECT NAME �af!1/ �' PROJECT NUMBER - WORK ORDER NO. /--3 2 It is the intent of this letter to antis riu the City of Renton to bill the undersigned for all costs incurred relative to the above-referenced project,by the City of Renton for the following work • o G TJp BILLING O: To BE SENT T /1 'r F 147 Nam- YOU WILL BE BILLED TIME AND MATERIAL Address 0 40 S. 43w Sl FOR ANY WORK DONF BY CITY STAFF TO City,L_i tTOw> REPAIR DAMAGES Attu- Phone No_ -b L4 iitho=paqgent SOt.Caotg4et;dJ PUBLIC WORKS DEPARTMENT .2 ENGINEERING DIVISION CrrY Or RENTON, WASHINGTON PEERI'I �7 APPLICATION ONLY-UNTIL VALIDATED NUI�ER Pg�D dinar Location of Work oo 0 Address U INSPECTIONS FEES Sanitary Sewer/Storm Water Permits 00 CONSTRUCTION Right-of-Way Construction PERMIT Rs wodo u Inspection Fe (Public Right-of-Way) Water Inspection/Approval Fee Special Utility Connection Fee, Water Water Latecomer Fee e7 Special Assessment District, Water Date aimed Sewer inspection/Approval Fees Special Utility Connection Fee, Sewer -� EWpirat n Date Sewer Latecomer Fee Special Assessor at District,Sewer Reference Data Special Deposit, Private Latecomer Special Deposit, Cash Bond TOTAL FEE Description of Work and Number of Feet !/Q ' D 72 A Businaas /�A Contractor '�~ Licones s� Address 2 Bond IT IS UNDERSTOOD THAT THE CITY OF RENTON SHALT. PE HELD HARMLESS OF ANY AND ALL LIABILITY, DAMAGE OR INJURY ARISING FROM THE PERFORMANCE OF SAID WORK, ANY WORK PERFORMED WITHIN THE RIGHT-OF-WAY OR ON SEWER ML T BE DONE BY A LICENSED, BONDED CONTRACTOR. LOCATE UTILITIE ORE CA TI 7,LL 2I5-2631 FOR INSPECTION. APPLICANT. �11 between 8 AM and 9 AM for :nspection in afternoons call Afore 12 Noon the day before PUBLIC WORKS DIRECTOR Cor inspection in morning. ;PECIFY TIME FOR INSPECTION. CALL BEFORE YOU Oil By 7L•'rJ/a.- :ALL 235-2620 for street signs 48-HOUR LOCATORS J Y v d 1} t�'Fgp�, ••��s�w,^Sr�„�$Y WY...7 y} :ir, _ ,.. v i t v. LI IFpr T.' 'Y+MaY.e�. em .yia' Mal ( Y T �1j 1 l 5 �. . 'YAIiIA.�Wi 14Y'L�HN\r• �ulY�1MH M i�. 11 1L�s,a . I �r _ neon I t 3N 4. 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