20050797 2007 C of O Final~C~C nnnnnnrn7G~7 rn~ rr7rr~7rn7 rna. rr7- Ir7N Ir7~ r~lr7a rl7 rl7- rf7
CITY OF YELM -BUILDING DEPARTMENT
RESIDENTIAL CERTIFICATE OF OCCUPANCY
Building Address 14820 Terra View St. SE
Owner Name
Owner Address
Building Permit Number BLD-05-0797-YL Plan Number Plan 3121 A Lot 189
Areas
Special
Building O~cial: G. Carlson Date: Mav 1 2007
This structure is incompliance with the International Residential Cade (Chapter
51-51 WAC) as adopted by the Washington State Building Code Council pursuant
to Chapters 19.27 and 70.92 RCW, effective July 1, 2004
Lod ~~g
Woodland Gardens Construction, INC.
253-445-0888
BACKFLOW PREVENTION ASSEMBLY TEST REPORT
NAME ()F PREMISE ~(/~~~~; ~~~~~;
~- - ~---- _ Comn{crciHl ^ Rcsickntial
SERVICE AUDRE.SS /yCJ ~v %~~T.G u/e(,~/ ,S`~ S~ CITY _yCL/!
~ zlr _ 7f 7;
CON'I'AC'i' PERSON PHONE ( ) FAX ( ~
LOCATION OF ASSEMBLY ~~~~,~~: ?
PREMISE ISULATTION (or) IN-I'itEMISF, ISOLATION
UUWNSTRRANI PitOCF.SS ~ /~. ~~~ ~ ~ ~, DCVA RJ RPBA ^ PVBA ^ 01'HER _ _
NEW INSTALL ^ EXISTING ~ REPLACEMENT ^ OLD SER. ~ ___ PROPER INSTALLATION? YF4 eY NO ^
tiIAKE OF ASSCMBI,Y ~~=~'~''' MOUEL r S ' SERIAL NO. ~~~~~(s~ ~_
SIZE ~ n
UCVA /RPBA UCVA /RPBA RIBA PVBA/SVBA
INITIAL CHECK VALVE NO.1 Cl~ECK VALVE NO 2 AIR INLET
I ~~ OPENED AT PSI
OPENED A'F PSID
LEAKED ^ LEAKED ^ //I CHECK PSID
PASSED. DID NOT OPEN ^
FAILEll ^ ~-- ~ PSID ~ ~ ~ PSID AIR GAP OK'?
c•i.-;~r, urri.nci~, rnK~r C~.cnN tt~:ri.ncr: PART CLIiAN kiih.ncr rnki CHECK YALVG
NEW ^ ^ ^ ^ ^ ^ FIELD AT _ PSID
PARTS ^ ^ ^ ^ ^ ^ ---- LEAKED ^
ANU _
REPAIRS ^ ^ ^ ^ ^ ^ _
^ ^ _ _ ^ ^ ^ ^ CLEANED ^
REPAIRED ^
9'FS'F AF'T'ER
ItF,I'AIRS LEAKED ^ LEAKED ^ OPENED AT PSID AIR INLET PSID
PASSED ^ PSID PSID l/1 CHECK PSID CHK VA~.VE PSID
FAILED ^ ---- -- - --
AlR GAP INSPECTION: Ra~wred roinin-uni air C+~1~ x~rara~iun pnwitkcfT YeS ^ No ^ Uctector Meter Rcs{ding
RF,MAItKS: CONFINED SPACE ? /'.J~" LINI; PRE.SSURF, ~~~ PSI
TCSTEItS SIGNATURE: CE~ZT. NO. B33S4 DATE ,~~ N n~
TESTERS NA114C PRIN j): JASON ANDERSON _ TESTERS PHONE // ( 253 ) 445-0888
RF,PAIREU IIY: DATE
FINAL TEST BY:____ __- Cf;RT. NO. UA'TC
CALIBRATION DATE / ~ / Z->/'GAUGE 1/ ~ 1030051 MODEL 40200TK5 SERVICE. RESTORF,D? YES ^ NO~
I cerNJy /ha! Ihla repay/ /s accurnle. and !hart used {YAC 246-290-090 appmrM /es! wrefhodc and /esr equ//mmur.
OCT-08-2008 14:47 City of Yelm Public Works 360 458 8417 P.06
City of Yelm
Public Works Dcpartmcnt
~JOI Rhocon Road
P.o. Box a7~
'elm, WA J859 i
(3G0) -t58.8•!OG Fax: (3G0) 45S-8a i
DATE: ~2..I_~Ld CJ
DEVELOPMENT:
NEW HOME FINAL
BUILDER'S NAME;
LOT ~: ~. ADDRESS:
COMMENTS: m OC~-Q_~ h~~~
~°... ~( G
INSPECTED [3•~':
a John tvc)~
o Edward ;;mitlti
Tim Rari~~k
Data: _ (p __ ~ -~2j
TOTAL P.06