Mechanical Permit MAR/30/2023/THU 09: 46 FAX No, P. 006
ANNUAL RPZ TE5T REPORT mil r0farlm
SMI Job# Z302-0340P
JOB ADDRESS: CITY: STATE: ZIP CODE:
4201 Sunset Dr. 5 ri g Park MN 55384
OWNER/OCCUPANT BUjLa NAME: DESCRIPTION OF WORK: ANNUAL 1xi
The Mist on Lake Minnetonka INSTALL I ALTER I REPAIR REPLACE OVERHAUL
Apartments The Mist
CONTACT PERSON; TELEPHONE NUMBER:
Barbie 952-471-2428
SYSTEM SERVED: DEVICE LOCATION: FLOOR#: ROOM#:
Humidifier Mechanical Room 5th Mechanical
MAKE: MODEL: SIZE : SERIAL#:
WATTS 009 M3 1 3 4" 247033
TEST DATE : OVERHAUL DATE : INSTALL DATE: PREVIOUS OVERHAUL DATE :
3 23 2023 7 15 2011
CHECK VALVE CHECK VALVE PRES. DIFF.ACROSS PRES, DIFF. WHEN STRAINER
NUMBER 1 NUMBER 2 NUMBER 1 CHECK RELIEF OPENS
INITIAL LEAKED LEAKED X NONE,
TEST X CLOSEDAil: CLOSED 8.0 PSI 3.0 PSI I CLND
13( l INITIAL TEST PASSED, SUBMIT AS FINIAL INITIAL TEST FAILED, REPAIR NEEDED
DESCRIBE REPAIR :
CHECK VALVE CHECK VALVE PRES. DIFF.ACROSS PRES, DIFF. WHEN
NUMBER 1 NUMBER 2 NUMBER 1 CHECK RELIEF OPENS
INITIAL LEAKED LEAKED
TEST CLOSED CLOSED PSI PSI
TEST PERFORMED BY: CERTIFICATION NUMBER
John lalrosi:ewicz BF020215
COMPANY NAME:. COMPANY ADDRESS : CITY; STATE: ZIP CODE:
Szgtwt re 8Z60 Arthur Street NE Spring Cake
MECHANICAL Suite A bark MN 55432
SIGNATURE MECHANICAL, INC.
8260 Arthur Street NE
SPRING LAKE PARK, MINNESOTA 55418
PHONE : 763-788-9844 FAX : 763-788-9868
MAR/30/2023/THU 09: 46 FAX Nc. P, 004
Signature.. i ANNUAL RPZ TEST REPORT
SMI Job# 2302-0340P
JOB ADDRESS: CITY: STATE: ZIP CODE:
4201 Sunset Dr. S rin Park MN 55384
OWNER/OCCUPANT BUILDING NAME: DESCRIPTION OF WORK: ANNUAL. X
The Mist on Lake Minnetonka INSTALL I ALTER I REPAIR REPLACE OVERHAUL
Apartments The Mist
CONTACT PERSON: TELEPHONE NUMBER:
Barbie 952-471-2428
SYSTEM SERVED: DEVICE LOCATION: FLOOR#: ROOM#:
Irrigation Mechanical Room Parking Garage Mechanical
MAKE: MODEL : SIZE : SERIAL#:
WATTS 009 M2 2" 266628
TEST DATE: OVERHAUL DATE : INSTALL DATE : PREVIOUS OVERHAUL DATE :
3 23 2023 7 15 2011
CHECK VALVE CHECK VALVE PRES. DIFF.ACROSS PRES. DIFF. WHEN STRAINER
NUMBER 1 NUMBER 2 NUMBER 1 CHECK RELIEF OPENS
INITIAL LEAKED LEAKED X NONE
TEST I P CLOSED AZ CLOSED 8.0 PSI 3.0 PSI CLND
X INITIAL TEST PASSED, SUBMIT AS FINIAL I INITIAL TEST FAILED, REPAIR NEEDED
DESCRIBE REPAIR :
CHECK VALVE CHECK VALVE PRES. um ACROSS PRES. DIFF,WHEN
NUMBER 1 NUMBER 2 NUMBER 1 CHECK RELIEF OPENS
INITIAL LEAKED LEAKED
TEST CLOSED CLOSED PSI PSI
TEST PERKORMEQ BY: CERTIFICATION NUMBER :
John jarosieuricz BF020215
COMPANY NAME : [COMPANY ADDRESS : CITY: STATE: ZIP CODE :
signature 8260 Arthur Street!71
Spring Lake
MECHANICAL Suite A Park MN 55432
SIGNATURE MECHANICAL, INC.
8260 Arthur Street NE
SPRING LAKE PARK, WNNESOTA 55418
PHONE : 763-788-98" FAX: 763-788-9868
MAR/30/2023/THU 09:46 FAX No. PAH
ANNUAL RPZ TEST REPORT Fm
SMI Job# Z30Z-0340P
JOB ADDRESS: CITY: STATE: ZIP CODE:
4201 Sunset Di'. S ring Park MN 55384
OWNER/OCCUPANT BUILDING NAME: DESCRIPTION OF WORK: ANNUAL 1XI
The Mist on Lake Minnetonka INSTALL ALTER I REPAIR REPLACE OVERHAUL
Apartments The Mist
CONTACT PERSON: TELEPHONE NUMBER:
Barbie 952-471-2428
SYSTEM SERVED: DEVICE LOCATION: FLOOR#: ROOM#:
Humidifier Roof Penthouse Penthouse
MAKE: MODEL : SIZE: SERIAL#:
WATTS 009 M3 3 4" 247029
TEST D TE : OVERHAUL DATE : INSTALL DATE : PREVIOUS OVERHAUL DATE :
3 23 2023 2 11 2020
CHECKVALVE CHECK VALVE PRES. DIFF_ACROSS PRE$, RIFF,WHEN STRAINER
NUMBER '[ NUMBER 2 NUMBER 1 CHECK RELIEF OPENS
INITIAL LEAKEEF LEAKED 2�j NONE
TEST CLOSED X CLOSED 9.8 PSI 4.0 PSI I CLND
INITIAL TEST PASSED, SUBMIT AS FINIAL I INITIAL TEST FAILED, REPAIR NEEDED
DESCRIBE REPAIR :
CHECK VALVE CHECK VALVE PRES. DIFF. ACROSS PRES. DIFF, WHEN
NUMBER 1 NUMBER 2 NUMBER 1 CHECK RELIEF OPENS
INITIAL LEAKED LEAKED
TEST CLOSED CLOSED PSI PSI
TEST PERFORMED BY: CERTIFICATION NUMBER
John larosiewicz BF020215
COMPANY NAME : COMPANY ADDRESS : CITY: STATE : ZIP CODE :
,nature 8260 Arthur Street NE Spring Lake
MECHANICAL Suite A Park MN 55432
SIGNATURE MECHANICAL, INC.
8260 Arthur Street NE
SPRING LAKE PARK, MINNESOTA 55418
PHONE : 763-788-9844 FAX : 763-788-9868