Mechanical Tests MAR/30/2023/THU 09:45 FAX No, P. 002
AINaNUAL RPZ TE5T REPORT Alecha
SMI Job# 2302-0340P
JOB ADDRESS: CITY: STATE. ZIP CODE:
4100 Shoreline Dr. S ring Park MN 55384
OWNERIOCCUPANT BUILDING NAME: DESCRIPTION OF WORK: ANNUAL X
The Mist on Lake Minnetonka INSTALL ALTER I REPAIR REPLACE OVERHAUL
Apartments The Mist E-1 El Fl El
CONTACT PERSON: TELEPHONE NUMBER:
Barbie 952-471-Z428
SYSTEM SERVED: DEVICE LOCATION: FLOOR#: ROOM#:
Boiler Fill Garage Lobby P1 Water Service
MAKE: MODEL; SIZE: SERIAL#:
WATTS 009 M3 3 4" 24ZO60
TEST DATE : OVERHAUL DATE : INSTALL DATE : PREVIOUS OVERHAUL DATE:
3 23 2023 7 15 2011
CHECK VALVE CHECK VALVE PRES. RIFF. ACROSS PRES. DIFF, WHEN STRAINER
NUMBER 1 NUMBER 2 NUMBER 1 CHECK RELIEF OPENS
INITIAL LEAKED LEAKED X NONE
TEST X CLOSED Hx CLOSED 9.0 PSI 2.8 PSI I CLND
1XI INITIAL TEST PASSED, SUBMIT AS FINIAL INITIAL TEST FAILED, REPAIR NEEDED
DESCRIBE REPAIR :
CHECK VALVE CHECK VALVE PRES. DIFF, ACROSS PRES. RIFF. WHEN
NUMBER 1 NUMBER 2 NUMBER 1 CHECK RELIEF OPENS
INITIAL LEAKED LEAKED
TEST CLOSED= CLOSED PSI PSI
TESI PERFORMED BY: CERTIFICATION NUMBER :
John Jarosiewicz BF020215
COMPANY NAME ,. COMP NY ADD ESS : CITY: STATE : ZIP CODE :
St�naturle 8260 Arthar Street NIF Spring Lake
MECHANICAL Suite A Park MN 55432
SIGNATURE MECHANICAL, INC.
8260 Arthur Street NE
SPRING LAKE PARK, MINNESOTA 65418
PHONE : 763-788-9844 FAX: 763-788-0868
MAR/30/2023/THU 09: 45 FAX No, P, 003
ANNUAL RPZ TEST REPORT
SMI Job# Z302-0340P
JOB ADDRESS: CITY: STATE: ZIP CODE:
4100 Shoreline Air. S ring Park MN 55384
OWNER/OCCUPANT BUILDING 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 Trash Room. 1st I Trash.
MAKE: MODEL: SIZE : SERIAL#:
WATTS 009 M3 3 4" 249076
TEST DATE : OVERHAUL DATE • INSTALL DATE : PREVIOUS OVERHAUL DATE :
3 23 2023 7/15 2011
CHECK VALVE CHECK VALVE PRES. RIFF.ACROSS PRES. DIFF. WHEN STRAINER
NUMBER 1 NUMBER 2 NUMBER 1 CHECK RELIEF OPENS
INITIAL LEAKED LEAKED X NONE
TEST CLOSED CLOSED 9.0 PSI 3.0 PSI CLND
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 larosiewicz BF020215
COMPANY NAME : COMPANY ADDRESS : CITY: STATE: ZIP CODE :
Signature 8260 Arthur Street NE Spring Lake
MECHANICAL Suite A Park MN 55432
S(GNATURE MECHANICAL, INC.
8260 Arthur Street NE
SPRING LAKE PARK, MINNESOTA 55418
PHONE., 763-788-9844 FAX : 763-788-9868