2006, 05-16 Permit: 06001853 Plumbing Fixtures*Wane
jvaliey
BUILDING DIVISION
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Site Information
Project Information
1
Site Address: 10401 E VALLEYWAY AVE
Parcel Number: 45174.2316
Subdivision:
Block: Lot:
Zoning: UR -3 Urban Residential 3.5
Owner: RAPP, DAVID
Address: BOX 363
OROFINO, ID 83544
Building Inspector: DOUG POWELL
Water Dist:
Project Number: 06001853 Inv: 1 Issue Date: 05/16/2006
Permit Use: 1 CROSS CONNECTION DEVICE
Applicant: GOLD SEAL MECHANICAL
5524 E BOONE AVE
SPOKANE WA 99212
Contact: GOLD SEAL MECHANICAL
5524 E BOONE AVE
SPOKANE WA 99212
Setbacks - Front: Left: Right:
Group Name:
Project Name:
Phone: (509) 535-5944
Phone: (509) 535-5944
Rear:
Permits
�jg pg tt Contractor. GOLD SEAt-Iv1ECHA3<I CAL -DVC
License-#:—GOLDSM*290C4
CROSS CONNECTION DEVICE 1
FOR PLUMBING INSPECTIONS CALL (509) 688-0054.
$6.00 PROCESSING FEE
Total Permit Fee:
$35.00
$41.00
Payment Summary
Total Fees AmountPaid AmountOwing
$41.00 $41.00 $0.00
Tran Date Receipt # Payment Amt
05/16/2006 5413 $41.00
Processed By: Main, Jodi L
Printed By: Blake, Anita M Page 1 of 1
PERMIT
NOTICE
The ownership of a Spokane Valley Development Permit will inure to the property owner. The permit applicant, by
definition, is the property owner or an authorized agent of the property owner. It is the responsibility of the
applicant/permittee that the use described on the front of this permit complies with applicable codes and that required
inspections are requested. Failure to request inspections as listed below and obtain the necessary approvals before
progressing beyond the point where inspections are required may necessitate removal of certain parts of the
construction at the applicant's/permittee's or property owner's expense. At a minimum, the following inspections ARE
REQUIRED by City Code:
FOOTING — when forms and reinforcement are in place and prior to placement of concrete -all structures, including manufactured homes.
NOTE: This inspection includes review of the structure's setback from property lines. Minimum setbacks are established by City of Spokane
Valley Ordinance. Curb lines and fence lines are not necessarily indicative of property lines. The responsibility to comply with applicable
setback provisions lies solely with the permittee -neither the City of Spokane Valley nor its authorized representatives assume any
responsibility for the verification or location of your property lines. Please verify their location prior to locating your structure. Failure to
properly locate the structure may require its relocation at the owner's/permittee's expense.
FOUNDATION — when forms and reinforcement are in place and prior to placement of concrete.
PLUMBING — after rough -in, before covering, and final.
MECHANICAL — rough -in of piping, before covering, metal chimneys before concealment, and final.
FRAMING — after all framing, bracing and blocking is in place, rough electrical, plumbing and mechanical systems are complete, and prior to
concealing.
FINAL — when complete and prior to occupancy and/or use. All permits require final inspection.
NOTE: In addition to inspection of the structure, this inspection includes review of site improvements (typically depicted on the approved site
plan) required by ordinance or as a condition of approval of this permit. Items such as the installation of fire hydrants, fire department access,
on-site drainage ('208' swales), road improvements, parking and landscaping are common requirements of a permit/site plan which must be
completed prior to final approval of a building or issuance of a Certificate of Occupancy.
MANUFACTURED HOMES — Final inspection required when complete, stairs, handrails, skirting, etc. installed, and prior to occupancy;
completed inspection record card must be available on site.
PLUMBING REVERSALS FOR SEWER CONNECTIONS — prior to cover.
RIGHT-OF-WAY/APPROACH — prior to placement of concrete/asphalt or, if gravel approach, after completion.
In addition to the above, any plumbing or mechanical systems or material which would be concealed by framing, drywall, concrete, etc. must
be inspected prior to cover. Check with the Building department for "special inspections" in conjunction with commercial projects.
FOR INSPECTIONS
Please give one working day/24 hour notice. Different parts of your project may require permits and inspections from more than one agency.
Building, plumbing (includes interior reversals for sewer) and
mechanical, City of Spokane Valley Building Division 688-0054
Road cuts for utilities or driveways, City of Spokane Valley
Public Works 688-0195 or State Dept of Transportation
324-6000
Permits and inspections for electrical wiring, State Department of Labor Permits and inspections for Sewer Connection, Spokane County Utilities Division
And Industries 324-2640 477-3604
Permits and inspections for on-site septic systems, Spokane Regional Fire sprinkler and alarm systems and private access road inspections, Spokane Valley
Health Distnct 324-1560 Fire Department 892-4122
State law RCW 19.122 requires that prior to any excavation the "CALL BEFORE YOU DIG" center must be notified. Call before you dig at least 2 working days in advance, 456-8000.
PERMIT EXPIRATION AND REFUNDS
All pen -nits shall expire by limitation and be declared void if a) work is not started within 180 days of obtaining a permit, or b) work is
abandoned for 180 days or more after beginning work, or c) after two years from the date of permit issuance, regardless of whether the work is
finished. If a permit is expired for time, a new permit may be obtained for half the permit fee based on the value of the remainder of the work to
finish the original permit.
All refund requests must be made in writing by the original permittee to the Building Official no later than 180 days after the date of fee
payment. 100% refunds will be granted for any fee erroneously paid or collected. Refunds of not more than 80% of a permit fee may be
authorized when no work has been done under the permit issued. Refunds of not more than 80% of a plan review fee paid may be authorized
when an application is withdrawn or cancelled prior to the plan review being completed.
Owner / Agent Date
Staff Approval Date
05/17/2006 08:42 FAX 509 535 1382 GOLD SEAL MECH.
Gold Seal Mechanical Inc.
5524 East Boone Ave, Spokane Valley WA 99212 ' 509-535-5946 ' Fax 509-535-9359
Fax
To: D Pude) From: Glynnis Luu �� kai, 1
Fax: g2 - oc 7
Phone_ ZS rO Date: 5 -(1-0
Re: 9�%�- ' 'P( r 7 S ✓^ Io �0 ! lleZ� ��
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MAY 17 2006 09:56
509 535 1382 PAGE.01
05/17/2006 08:42 FAX 509 535 1382 GOLD SEAL MECH.
BACKFLOW PREVENTION ASSEMBLY
TEST REPORT
Name: -jug ggep yz °! - 6s5-9
Service Address: /0 0/ f iJAu' )A-',' 5Po,( £ Vi ti.cr L.l 94406
Location: 5, �_ 4-,cdo.= / zarrjt bite Gdrec.c P. r -
Assembly Type: v �9
Manufacturer: lJtL /zy g,s
Model: 95-D
Size: / Serial No: A3aO 6o3
IS THIS A PROPER INSTALLATION?
WA STATE APPROVED ASSEMBLY
REMARKS: S/.6' j41)C-4 G ,i -Ar o •4
Yes }( No
Yes X No
v' GFyF: oG
Test Equipment: Make: MIDWEST Model: 830 Serial #: 240789 Type: DIFFERENTIAL
I CERTIFY TIDE ABOVE REPORT TO BE TRUE:
,V 3. l''t i /
Certified Tester's Typed or Printed Name
Initial Test By: ' h/L,l Cert. No. g 4/7 4/0 Date S- /6 06
Signature
Repaired By: Cert No. Date
Signature
Repair Test By:
Cert No.
Signature
Date
GOLD SEAL MECHANICAL INC.
5524 E. BOONE - SPOKANE, WA 99212 - 509-535-5946 (FAX) 535-9359
MAY 17 2006 09:56
Backflow Report Form -8117/01
509 535 1382 PAGE.02
I.. I L� ,�1.i gramssloug
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. �{
!.'}.�1a:'"Y1Vi, Lia 15.'�,��Jp�nf
Line Pressure
Pressure Drop Across
No. 1 Check Valve psid •
i r �r�i?ia`
P.' 'els=r
��t° 1'"
�I
af°
Pressure Drop Across
No. 1 Check Valve psid
Relief Valve Opened psid
'' ,' r h
1;}.
-Jr.,
Relief Opened psid
No 1 Check Valve: Closed tight ❑
Leaked ❑
No 2 Check Valve: Closed tight ❑
Leaked
Minimum A/G present Yes No
;.''s
dF
,�;+;
,.•:iv
M: Y
-v fin
fir, >i',il
�'sN •_ • r4. ',
Y. ,
r .
No 1 Check Valve: Closed tight ❑
Leaked ❑
No 2 Check Valve: Closed tight ❑
Leaked ❑
Minimum A/G present Yes No
Passed Test Yes No
.:J
Passed Test Yes No
44k1
t ill
Line Pressure 60 Psr (P.ti> vNvs[F
No_ 1 Check Valve: Differential psid
a ; 'VI
No_ 1 Check Valve: Differential Z,N psid
No. 2 Check Valve: Differential psid
';'
No. 2 Check Valve: Differential A,f psid
Passed Test: Yes No
•' a:a,. •\1µ•M
°° ` -�' ""
3iCir�.jy��+r �' 74 i�
Passed Test: Yes k No
'N "��"t-• ""4'-'•`-,
'1.,
Line Pressure
Line Pressure
Air Inlet: _ _ _ . Opened psid
- �a,a
j, , i sik
nr
Air Inlet: Opened psid .
Failed to Open ❑
P
psid
Check Valve: •
•"
,r., '1,r, e
=`
"r • .'41;Iiiw'
rd
i,4.
1 � ,
1I
Failed to Open ❑
Check Valve: psid
Leaked
Passed Test: Yes No
�v. mK��c ��:�.�,',";
. ' a`$F ',
Leaked ❑
Passed Test: Yes No
PLL.1SL RECORD REP.ATI iNSPECt1Oi\
CLEANING INFORMATION IN SECTION' IRI?I.OW
' ►,' r . Vii«
Minimum Separation: Yes No
I� ':r, M",,
IS THIS A PROPER INSTALLATION?
WA STATE APPROVED ASSEMBLY
REMARKS: S/.6' j41)C-4 G ,i -Ar o •4
Yes }( No
Yes X No
v' GFyF: oG
Test Equipment: Make: MIDWEST Model: 830 Serial #: 240789 Type: DIFFERENTIAL
I CERTIFY TIDE ABOVE REPORT TO BE TRUE:
,V 3. l''t i /
Certified Tester's Typed or Printed Name
Initial Test By: ' h/L,l Cert. No. g 4/7 4/0 Date S- /6 06
Signature
Repaired By: Cert No. Date
Signature
Repair Test By:
Cert No.
Signature
Date
GOLD SEAL MECHANICAL INC.
5524 E. BOONE - SPOKANE, WA 99212 - 509-535-5946 (FAX) 535-9359
MAY 17 2006 09:56
Backflow Report Form -8117/01
509 535 1382 PAGE.02
05/17/2006 08:42 FAX 509 535 1382 GOLD SEAL MECH.
MODERN ELECTRIC & WATER
BACKPLOW PREVENTION ASSEMBLY TEST REPORT PLEASE R.STURN NO LATER THAIS;
9 szo6
Name: swot- /t.¢•P,
Premise Address: to/ 6 1/41 ' Ad,/ d6 vrlclFr,��
Contact Person: J-140 Y
Phone #: � r(_ 6 57,-1
Location of Assembly: •�, e,ptemFrc of (1Do 44174'
Type of Hazard: 4 6(4 - XIZ rt: `n 77,o t/
Manufacturer. WZL /40Ycr5
• ec-n w , Size: 0.000
Folder::
Service:
6Y FOAff— -r i�I vtuAY
Assembly #
Date Installed 'S /� G /a 6
type: 0 G L/4 -
Serial #; �3 ov,9o3
TEST EQUIPMENT k, -,t /�
MAKE V11014)4./ MODEL �7i J SERIAL # 2 (07 �` 9 TYPE �;..F16.'" - VERIFICATION OF CCURACY DATE A'� "' 0l0
! CERTIFY T 1IE ABOVE REPORT TO SE TRUE:
L° RAS4- %S•
CERTIFIED CERTIFIED TESTER'S TYPED OR PRINTED NAME
/{:;t
INITIAL TEST BY SIGNATURE t'/ 1/a
REPAIRED BY:
REAPIR TEST RYSIGNATURE
Water Service Restored? (Y) N
REMARKS MAY BE CONTINUED ON THE BACK IF REQUIRED.
OwnerlAgent Signatures:
MAY 17 2006 09:56
PHONE*
5'P/it
9/
CERT. NO j3 17 W O DATE: 5---76-0
CERT. NO DATE:
CERT. NO DATE:
RETURN TO:
MODERN ELECTRIC & WATER
PO BOX 14006
Spokane, WA 99214
Phone; 928-4540
Fax: 7595000
509 535 1392 PAGE.03
INITIAL TEST RESULTS
TEST AFTER REPAIR OR CLEANING
RPBA
RPDA
UNE PRESSURE AIR GAP YES NO
UNE PRESSURE AIR GAP YES NO_
PRESSURE DROP ACROSS
NO, 1 CHECK VALVE PSID
PRESSURE DROP ACROSS
NO. 1 CHECK VALVE PSID
RELIEF VALVE OPENED PSID
RELIEF VALVE OPENED PSID
NO. 1 CHECK PASS ■ FAILD
NO.2 CHECK PASS 0 FAIL •
PASSED TEST: YESNO^
NO. 1 CHECK PASS ■ FAIR ■
N0.2 CHECK PASS ■ FAIL
PASSED TEST: NO
41M tl
• ••i''
/YES_
\
UNE PRESSURE I,CP (roc! Dg• vi /
UNE PRESSURE
NO. i CHECK VALVE PSID i.`1 PASSEDd
NO. 1 CHECK VALVE P5ID PASSED
PSID FAILED 0
PSID FAILED 0
NO. 2 CHECK VALVE PSID J PASSEOZ'
NO. 2 CHECK VALVE PSID PASSED❑
P810 FAILED 0
PSID FAILED 0
PASSED TEST: YES NO!
PASSED TEST: YES_ No
PVB
UNE PRESSURE
LINE PRESSURE -
AIR INLET: OPENED PSID
AIR INLET: OPENED PSID
FAILED TO OPEN 0
CHECK VALVE PSID
FAILED TO OPEN III
CHECK VALVE PSID
PASS • FAIL 0
PASSED TEST: YESNO^
PASS ■ PAL ❑
PASSED TEST! YES NO
AG
MINIMUM SEPARATION: YES NO
MINIMUM SEPARATION: YES NO
REMARKS:
TEST EQUIPMENT k, -,t /�
MAKE V11014)4./ MODEL �7i J SERIAL # 2 (07 �` 9 TYPE �;..F16.'" - VERIFICATION OF CCURACY DATE A'� "' 0l0
! CERTIFY T 1IE ABOVE REPORT TO SE TRUE:
L° RAS4- %S•
CERTIFIED CERTIFIED TESTER'S TYPED OR PRINTED NAME
/{:;t
INITIAL TEST BY SIGNATURE t'/ 1/a
REPAIRED BY:
REAPIR TEST RYSIGNATURE
Water Service Restored? (Y) N
REMARKS MAY BE CONTINUED ON THE BACK IF REQUIRED.
OwnerlAgent Signatures:
MAY 17 2006 09:56
PHONE*
5'P/it
9/
CERT. NO j3 17 W O DATE: 5---76-0
CERT. NO DATE:
CERT. NO DATE:
RETURN TO:
MODERN ELECTRIC & WATER
PO BOX 14006
Spokane, WA 99214
Phone; 928-4540
Fax: 7595000
509 535 1392 PAGE.03