Pool Spa Renovation Worksheet by amd51223

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									                               Pool & Spa Renovation Worksheet
                         Please fill out one form for each pool/spa and submit three copies of each.
                                                                                        FOR OFFICE USE ONLY
Name of Facility: ____________________________________________
Address:____________________________________________
City: ______________________________________________
Name of Contractor completing the work: ____________________
Contractor License #_________________License Type:_____________
Phone number of Contractor:______________________________

    Scope of work: (Check all that apply)
       Re-surfacing with white plaster (alternate materials must be
       reviewed and approved, samples required)
       Splitting of the main drain, jet suction lines, equalizer lines
       (single skimmer system)
         Changing suction outlet covers
         Adding an SVRS system
         Make:                         Model:
         Other. Please explain:
         Variable speed pumps
         Suction Pipe size:               Return Pipe Size:
         Filter Make:                     Model:
    Circle One:            POOL                 SPA
    Surface Area:________________________ Volume:_____________________ Depth(s):_______________

1. Recirculation Pump: Make________________________ Model___________________________________
                       Hp:_______________________ GPM @ 60 ft. Head:___________________________

2. Jet System Pump:        Make:________________________ Model:___________________________________
                           Hp:________________________GPM @ 60 ft. Head:___________________________

3. Jet System Pump:        Make:________________________ Model:____________________________________
                           Hp:_________________________GPM @ 60 ft. Head:___________________________

4. Anti Entrapment Covers:
   Note: All main drain/suction outlet covers must comply with ASME/ANSI A112.19.8 performance standards.
   The flow rating of each cover shall be equal to or greater than the flow rating of the pump it is connected to.
             Main Drain
  Make:_________________________Model:________________________Max. Flow Rate____________gpm

           Jet Suction Outlets
  Make:_________________________Model:________________________Max. Flow Rate____________gpm

              OFFICES IN: RIVERSIDE, BLYTHE, CORONA, HEMET, INDIO, MURRIETA AND PALM SPRINGS
                                      For more information call (888) 722-4234
Page 1 of 2                           Department Web Site – www.rivcoeh.org               Rev. Date 2-1-10
          Equalizer Lines
Make:________________________Model:_________________________Max. Flow Rate____________gpm


Sump:
Circle One:              Manufactured                                Field Built (circle one)




General Notes:
    (a) D = inside diameter of pipe
    (b) All dimensions shown are minimums
    (c) A broken line (____) indicates suggested
         sump configurations




Describe any additional changes (plumbing, electrical, structural, etc.):
 __________________________________________________________________________________________
 __________________________________________________________________________________________

Scaled drawing of the pool or spa:
   Include the following:
   1. Locations of all suction outlets (main drains, skimmers, equalizers, and jet suction outlets)
   2. Main drain split- At least 3 feet apart with the “T” on center
   3. Pool or spa depths




            OFFICES IN: RIVERSIDE, BLYTHE, CORONA, HEMET, INDIO, MURRIETA AND PALM SPRINGS
                                    For more information call (888) 722-4234
Page 2 of 2                         Department Web Site – www.rivcoeh.org                Rev. Date 2-1-10

								
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