HomeMy WebLinkAboutBuilding 06-0006 (Edgewood), S/W 06-0008, FDN 05-1101, PL 06-0007, HTG 06-0154, Fire 06-0140, Hydronic 06-0181, Fuel Tank 06-0296, Alarm 06-0515
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I
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
/0. ZOo 05
60~B wa 00 51't It:A--Y C!-ttl L-O H tJo D
A~ ~ ~I A? I White
~rvf e,:...',,,- Pink
;vJ ;::; / IV /3 LrD Yellow
WESTtVtJOO .DfCll/b S.t;.....
I PERMIT NO. 0(0. OOO~ I
ZONING (office use)
C-I
LEGAL DESCRIPTION (office use only)
1101
LOT BLOCK
ADDITION
PID26. '13&.00/.0
7/9
OWNER
(Name) /5.0
(Address) /58 (p 0
(Phone)
QSZ, Z2~- 005/
I
DI9 IV 1'-16H/,6/S
P. L-. 5537 2-
FisH PT. eo.
BUILDER
(Company Name) J3~H/bOT CL;NSTJL.
(Contact Name) sn;ve- /0 v/'7 6 e, C,oNST7e-.
I
(Address) 5 5" tv. 7. TN sr. #/00
n9/2-.
"j?Lt)(}n I Ai
(Phone)
(Phone)
rotJ
ew Construction ODeck OPorch ORe-Roofing ORe-Siding OLower Level Finish 0 Fireplace
Addition OAlteration OUtility ConnectIOn
TYPE OF WORK
CODE: DI.R.C. .u;,T B.C.
Type of Constmction'r" ~, II
Oc cy Group: A B CY F
Div sio I
III IV V
HIM
2 3 4
A
R
5
x
Permit Valuatio
Permit Fee 5'14 - z.5...4 .,.l\/'?1-
Plan Check Fee
State Surcharge
I Penalty
I Plumbing Permit Fee
~lechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
o Misc.
B
S U
5, f 52.. 000 A
- , \
PROJECT COST IV ALUE $
(excluding land)
-
Pressure Reducer
Sewer/Water Connection Fee-
Water Tower Fee
Builder's Deposit
Other
$
$
$ 36 "1.'U>. 4'=>
!ThIS IS to celtlty that the lequest m the above apphcatlOn and aceompanymg documents IS m accOldance wIth the CIty Zonmg Ordmance and may ploceed as lequested TillS document
I when SIgned by the CIty Plannel Clln tltutes a tempOlary Celtlticate ot ZOl1lng comph,mcc and allows constluetlOn to eommcnce BefOlc occupancy, a Celtlticate ot Occupancy must be
\;:Ul'd . ,/IZ/O/"
l ~ SpeCial Conditions, If any
24 hOllr notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
CITY OF PRIOR LAKE BUILDING PER\1IT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
(Please type or print and sign at bottom)
~ADD~SS \
L. 5~ l\ We.. ?;\-1J\)COcA
LEGAL DESCRIPTION (otlice USe only)
LOT
BLOCK
ADDITION
Date Rec' d
White
Pink
Yellow
r/t.,,(5 tv' 0 (,. 01)0 ("
jPERMITNO. OG - 5/J
File
City
Appliollt
l
--.J
r----~
I ZONING (office U'~J
PID
I
~
OWNER
(Name)
(Phone)
=1
i
(Address)
~
,-
BUILDER C - \ 41' \/> \": \- \ -
(Company Name) DMu~r AA\ '-J1~--M. eu\W fX)\~CS
(Contact Name) ~ lo. (Y\ee... _
(Address) 110 L(O-+hAv. AltEr Ct>\O<lV\blcA. ~~h+5
(Phone) 7 i;3 ~o.-.~ l=O ~~___
(Phone) ~_~707 -~~
.65l-f21
,
I
I
I
_---1
DLower Le':e1 Film:,
I" TYPE OF WORK ~ew Construction ODeck OPorch ORe-Roofing
!UAddition OAlter<won DUtIliry CcJnnectlon
CODE: DI.R.C. ,!&fr.B.C. I jJ UI IV V A B
Type of Construction:
Occupancy Group: A B E F II I .\1 R S U
Division: I 2 3 4 5
-----,
ORe-Siding
o Fireplace
o Mise ~) I (5!!_"!3j11'6'o.V__f..'- ~'!_'--!!~___
PROJECT COST/VALUE $_E.1J}_{)~______
(excluding land)
r-l hen.:by certify that I have rurnlshcci mformal1on un thiS ,lpphCJ!1O:11vh:ch IS to the best of my knowledge true and correct. I also cl..':tify tl1ar I am the u\vnl..'r \~I au:jlllflzcd ~lgcnr ~or the
Jbovc<11t:ntto pro~L'rry ,1nc1 that ,1ll ":;Jnqrac~icn will (\}r:fi)rrn te, al! eXIstmg stare and tocallaws and will proceed in accordance with stlomHtcd plans [am d\X~;rl' lint the buddmg
lcf':C:.ll ;::10 'V T thiS pt'rmH r>" 'ust C..1liSl' Fl .rht:rmorc. ~ .1cret1y ,lgrt'c th,:H the CIty i)ffietal or J deSignee may enter upon the ;Jfopenv to pt'rfc.rrn l1ec(h:~1l!L<'ccttl'>llS
x
PermIt Valuation
i / 6- ~t:J&J. cA1 !
1 S --1::xJ -1
__----L___~-'~---~
: S I ~.1. "-.)... !
S / ClI'~
(p. '
~
Permit Fee
Plan Check Fee
State Surcharge
Pe!1aity
~
Plumbing Permit Fee
\1echamcal Permit Fee
s
S,:wcr & Water Permit Fee
s
s
Gas Fireplace PermH fee
s
I
----------------'
------------,
Thj~ ,.~,i'plit:ation Becolnes Your Building Pennit ',Vla:::n /\.:PPToved :
N~~~----
811ildll1~ U;'tiCI;!i
_~ ~../t: ",& ____ '
r-~~ !
7S 00 I~r
Contractor's License No.
__ ____.k~cJ2__:P,h __
Date
___-.J
l!.:rk Support Fee
1 SAC
# I ~
I
._--~~~----_.. -.-..,--
;; i $
-------_.----_._._-_.._~--~--------,
! Water Meter Size 5/8'" i ", ! :> !
Pressure Reducer
Sewer/Water ConnectIon Feo::
#
: s
~
!
S
! I
-------.--:-S... "-----.-- ~--.----l
..________i--______________.J
! Other ,0
. TOTAL DUE U--\~---~O~cj-
L .----9------------
~~&------: ReceiDt N~~'-tc-;q-Js-----:
. . /+____~____u _________________
_pate (Z-, ~. __~ra : B~/ ____~---------J
: Vv'ater Tower Fee
h-:- .
I BuIlder's Deposit
.,-,
~
-_._---_._-~~-_.~--_.._----_.... - --.------ -...........,
;h;:; l; H' Cf.'nl!~' rtlJ.: the :':lll~l':;t' in me ;.,bUV(.'rpl,C;:rJUfl ~;:li Jc..~()tnp(.;.n:!jng ,joCUrr:e:HS is :11 .1Ccordance WIth the City ZllnJ:1g ~>.dinance Jnd :,~av ~n;.~t'vd ;~:; rt:quc.,;tc~ T:,L; ,~:~ "',lrX'nt
'~i~,~:1 ;~nl''-: by ;;,c \...x., ":.:i.jl~~r .:U;':;l;rl:~C; ,1 :,,';-1]'.;; In' ..:ruflc:t,C ,~~':Tlli';P. ;~".)r:1rl:dn::~' ::.n(; :::In'.';s c~JnstrUCtlCn to i.f'iT1m":iL",: ~."':;lih: ,,;c,~':,:Pl";;' -.,'::iiIC',li ~.li:C\!G,;;',;'
~,sued
.-.---- .------------.-- ------.---.-----.---.-.----------------.---
.____._..____~~~ng ?~I::_:2~__._..___._________._ l)ate ______ .__~)~~~_~~.:::{ (:,_~~I.i,(.r~~"il_~~;:~._ ._______.____.________
2-4 h01ir nOlil'f' flH :lIi ;llSptnjoll~;, ~":':!) ~J7.9S5n. f:i\ ;1)5'2'; .. .,.,
16200 l~"'-'~~; ~,'. - ;ur L<lK'~. :it:"~ ::j:J~.<:
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT FIl-f/WL
fI'lAt tV /I - /J (') t..
PERMIT NO. 00.02..90
~"L
Ji<~ .-J _c- "'r.-/ ,or...
0,.,-
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
Date Rec l d
I. White file
2 Pink City
] Y dlow AppliClnl
..../
I ZONING ''''''~) I
PIDZS, 3~. 00 1,0
I OWNER
(Name)
(Address)
-::c J D
?19
(Phone)
BUILDER
(Company Name)
(Contact Name)
(Address) s- ..1 0
f;~:!'/ ~ !i: f"~ -;;4/)'
A .v .... <.. v /<-.. .....J -- - / R
(, 51'" '" S Z. . 0"1 J1f "1
,<:.. W
4,,J ..F[ rz...
TYPE OF WORK. ~ew Construction ODed o Porch ORe-Roofing ORe-Siding OLower Level Fimsh 0 Fireplace
OAddition OAlteration OUtility Connection 0 Misc.
CODE: DI.R.C. DLB.c. PROJECT COST IV ALUE S ...,7 'Y' """cc:J
I> ."
Type of Construction: I IT ill IV V A B (excluding land) ,
Occupancy Group: A B E F H I M R S U --'Je_ f c). / -~,.rl.
Division: I 2 3 4 S
I ht,.eby certify that I have furnished mformation on this applicalion which is 10 the best of my Icnowkdge true and correct. I also ify that I am the owner Ilr authonzed agent for thc
above-mentIOned properlY and tbal aU constrUction will conform to aU existin& state and local laws and will proceed in accordance with submilled plans. I am aware that the buddmg
official can revoke this permll fo~st cause. Furthermore. I hereby agree tMtme CIty officia1 or a desisnee may enter upon the property to perform needed mS'J?Cctlon.%
X ~ ~ <Y1fJC:...A OO/!S ~7 oc.
.. Signature Contractor's License No. o(re
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
'Z.s
S
S
S
S
S
S
S
S
Park Support Fee # $
SAC # S
Water Meter Size 5/8"; 1"; S
Pressure Reducer S
Sewer/Water Connection Fee # S
Water Tower Fee # S
Builder's Deposit S
Other S
TOTAL DUE ~/;veD +. '2- f (J(, S l, "f 3-~
/
I ReCfljrftNo. 5/25~
..J1 '
(J
\ Paid
Date
~ 0/3. r~
~ .. ~1 (,. ,-
ThIS IS to certify thatthc request in lhe above application and accompanying documents is in accordance with me City Zoning Ordinance and may proceed as requl'Sll'<l ThIs documenl
when siglll.'<l by the City Planner constltutcs a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Cl'rtlflCate of Occupancy musrbe
issued
Planning Director
Dale Special Conditions, if any
24 hour notice for an inspections (~2) 447-98~, fax (~2) 447-424!1
16200 Eagle Creek Avenue Prior Lake, MN 55372
IMAGE VIEW
,PLAN1[1] - 1
,
]
4 UP 4"w UP
TO FCO T?FD-4 I
4"W UP 4''W UP
TO FD-6 TO FD-1
I
2"w UP
TO JS-2 ;
2~V UP
2"W UP
TO FD- \
iot:t"
~4"W UP
TO FCO
-4
NEW 2000 GAL FUEL OIL
STORAGE TANK. SEE DETAILS
ON SHT M6.1? SPEC. SECTION
15????? FOR FABRICATION
AND INSTALLATION. 2"W UP
TO LAV-2
2"W UP
TO FD-2
2N~ FUEL OIL VENT UP
BE EXTENDED 10'-0" ABV.
I PAVEMENT LEVEL. TERMINATE
\ WITH RAIN~ROOF ~CREE~. _ _ _
-r---
\
I
I
"
I
~
2NW UP TO WATER
COOLER PROVIDED BY
OWNER - VERIFY
LOC. wi OWNER.
3" SO UP
2"W UP
TO SK-1
-4"
2"W UP
TO SK-2
4''W UP
~ TO WC-2
(,0;- - - - -- - -2:W UP -
~ TO FD-2 "
2"W UP II \
TO LAV-2 , !
October 07,200509:40:49 AM
4 NW UP
Not to scale, Page 1 of 1
09: 42 CITY OF PRIOR LAKE MAINT
CITY OF PRIOR LAKE
HEA TING/AIR CONDITIONING/FIREPLACE PERMIT
rlt...6 IN *~(P. OOOb
~ ~:n ~~ \ I PERMIT NO. Ci &; - ! 7/i /
3. yef1u,r ^tlliH~ ~lol~--",,"____".____.:::y:
P.02/02
Date Rct'd
t::17L
ZONING (ome., usc)
(,/
1".10) ^- (.....,,l ~
LEGAL DESCRIPTION (offi~ use only)
LOT BLOCK
.-
\/ --f-'--;7'
7jic/{ , '} .'
PID 25. 93(,. 001, 0
OWNER
(Name)
Address)
-:L~ ~ TI 1 t ~i
-.) '7 C=--.:... ) s-D 1:::. &i.
(Phone)
~l
..--
W t..-t I
APPLICANT 1 ~ -
(Name)~ p..~....,. 4 '-- ~., Mf. t"'t L-
2- ~ '30 L 0 ~. '\ ~ A-..-.a.... Av.4.-
(Add~)
} ~tt.,.J~~
(Contact Person)
(Phone) I~ J .- s-4- ~ - 8141
fJ\ 9 ' (~ty) ~~.1.~:!e)
(phone) , ~ 3 - s-4 4- -8,4"
DATE ~ 3 - 2- - 0<.,..
~PPLJCANT PLEASE COMPLETE BELOW
NEW CONSTRUCTtON 0 REPLACEMENT L:fALTERATIONS
FURNACE MAKE AND MODEL ___",._. _"_,'._..__ FUEL
FLUE SIZE RETURN OPENINGS INPUT OUTPUT
TYPE OF SYSTEM HEATING OR POWER. PLANT
~
(Address)
DWlIrm Air t>lftuts
DGravily
o Mecbllnical
DAir Conditioning
;aVent. Sy~em
FIREPLACE MAKE AND MODEL
DStt:llm
o Hol Wa~r
o R.diation
o Special Devices
o Other bevlcet;
PLEASE NOTE: Air Conditioner
Units and Fireplaces Cannot E"tro,,~,h
into Requircd Side Y ard Setback.~.
FireplacM with 80* AdcUtlons or
- Cantlkvers to the Outside of BulJdlnls
_......~. ----- Require a Building Permit..
".".~.. -
Residential. HeaLinlt & AlC (New COlllltruction)
Re.,idential, Healing Only (New Construction)
FEE SCHEDULE
1 % of Job cost Rel;itlential, GAS f'ircplli.cQ
$39.S0 minimum
$99.50 RelSidcnlilll, Additioos & AItCl1ltions
IM,SO RC6idcnlial. AC Only
$39.50
Industrial, Commercial &: Multi-FlImily
$39.50
$39.50
Estimated Cost $
Lj~0JOOO Buildingpennit #_______
. .
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$ L/~106
$ .50
$" Lf8hO I~O
Paid II? ~l} 5 ()
Date __ b F 0 C:::,
Receipt'~. r / <&'
uJ(::)
By C,'
---~
(om!:\: OSI: Only)
Thi. Applicatiou Becomes Your Building Permit When Approved
~~ ~ff(;,
24 bour notke for all inlpedlOD~ (951) 4017-9850, fall (951) 4.7-4245
TOTAL P.02
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
"./'"
'\ ('J_
I}-c.y, - / .)
" "
€O~6f1.1OV !)
;:~ ~~~ I PERMIT NO ()G, . 00 07,1
3 Yellow Applicant _ '
j
ZONING (office use)
(Address)
/~D
jJ
ADDITION
PID
$" 3CJ4--
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
OWNER
(Name)
(Phone)
.J L
(Address)
Ie 5"/- L-f5")-/s-G-
55/'~1
APPLICANT
(Name)
(Contact Person)
(Phone)
(Zip Code)
0')J- L/Jd--/:>6S*' 3/
1d-/tJ(f/~~
APPLICANT SIGNATURE
DATE
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
Floor Drain Water Softner
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (lor 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet (Toilet) Other
APPLICANT PLEASE COMPLETE BELOW
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum Residential. New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $ a 8a J 8tO . ......-/
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOT AL PERMIT FEE $
32:9.8.
;1 f.3 ~~}
.50
sL'
.... rJ
L- \
\tU /
& 't '. 0"
c) '(
Building Permit #
./
(Office Use Only)
This Application Becomes Your Building Permit When Approved
~~ J4~
paid~ca~ gl <:;0
Date 9./ II::,'"
Rece~~~&, C(
By'
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
Date Rec'd
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
/.;{ _ {),.~ ~ (^ ...r:;
~: ~~~:w ~ii~. I PERMIT NO. ei/ ('I(). /)0 I
3. Gold Apphcant lC - - l_ (..,
ZONING (office use)
ev~ v.}o(jj
s~
LEGAL DESCRIPTION (office use only)
LOT BLOCK
ADDITION
:1G
-1 L>- c( J
~~~~SD ~'1,q
(Address) y. 0 . ~O '/.- 'Jjq
(Address)
PR,tfl Li'- -St\vAc;t 5(HDCi5(PhOne)
ffl iC~. LAI(b- ,N/)\J
(City) )
~S"3 7 ?-
(Zip Code)
(Contact Person)
(Phone)
GAtAA/
(City)
(Phone)
DATE
~~J- 'I<{J - IS-'h<s"
5.)/ ~ I
(Zip Code)
APPLICANT
(Name)~ t 1J"Zr:. ~ 1\-1 eLl Hi tv' ) (. f1 L
17 ) 0 A L ~l!Itlv(J 6fL t2 d
(Address)
v.;bi-J7 ~
(Address)
leAN OMPLETE BELOW
Size of water service~' Inches.
Location of any couplings from structure _ feet.
Type of sewer pipe. 0 ABC ~ PVC 0 Cast Iron
Estimated length of sewer line &d.
Clean out (if required) located at feet from structure.
FEE SCHEDULE
Residential sewer and water line connection $35.50 Industrial, Com'l & Multi-family 1% of job cost with a $39.50 minimum
Sewer connection only $17.50 Water connection only $17.50
Estimated Cost $ -:;'J-.0i) ~=) Building Permit #
~- - J
SEWER AND WATER PERMIT FEE $ 2:lj~O
STATE SURCHARGE $ .50 \( \1
TOTAL PERMIT FEE $ kfO'oc'L t"""U \t) '\
(Office Use Only)
r Building ~~it
L.
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
CITY OF PRIOR LAKE
HEATING/AIR CONDITIONINGIFIREPLACE PERMIT
Date Rec'd
.:3. z.3. 6(,
&1JGE fJ/OO.D
rl06 (IV' Orb,0000
~. ~ ~:~ PERMIT NO.O / . 0 18/
J. Yellow ^l'Plieont lP
ZONING (ofllceu..)
(,
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID ZS-. '/3'.001. D
~=R:r Sf) -it 1--lC1
(Address) ':f:j 1'0 ,-
(Contact Person)
,-/' .,
APPLICANT SIGNATURE ,,-~.,/-~
(Phone)
APPLIC T PLEASE COMPLETE BELOW
NEW CONSTRUCTION 0 REPLACEMENT 0 AL TERA TIONS
FURNACE MAKE AND MODEL FUEL
FLUE SIZE
RElURN OPENINGS
TYPE OF SYSTEM
OWarm Air Plants
OGravity
o Mechanical
OAir Conditioning
OVent. System
INPUT OUTPUT
HEATINGORPO~RPLANT
o Steam PLEASE NOTE:
lot Water Air Conditioner Units
Radiation Cannot Encroach into
o pedal Devices Required Side Yard
lll""h<< nc.;=A~~ ~I",~~ ~elb'C"
FIREPLACE MAKE AND MODEL
FEE SCHEDULE
Industrial, Commercial & Multi-Family I % of job cost Residential, Gas Fireplace
$39.50 minimum
Residential, Heating & AlC (New Construction) $99.50 Residential, Additions & Alterations
Residential, Heating Only (New Construction) $64_50 Residential, AC Only
Estimated Cost $ (:;215D, ODD Building Pennit # 0(" 0 / 8 /
,
$39.50
$39.50
$39,50
HEATING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$ c2i5Do
$ .50
S ~~rp,/-:;O
(Omce Use Only)
This Application Becomes Your Building Permit When Approved
~~ ~~
uilding Official Dlte
24 hour notice for aD Inspections (952) 447.9850, fax (952) 447-4245
16200 Eagle Creek Avenue, Prior Lake, MN 55372
Pai 21500.50
Date..:::;: 23. 0 t..,
ReceIpt No.5/ I
By
DEDARTMENT OF
BUILDING AND INSPECTION
INSPECTOR DATE
~ d,..~-,r ~-//~I'
I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUG - INS
SEWER I WATER I SEPTIC~<!"r
FRAMING.?:' L ~ ~o"
INSULATION
ELECTRICAL
PLUMBING I ~ ~.
HEATING (if required) LL. ~ r. ~
FIR PLACE
GA LINE AIR TEST cY. 7. ~~
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
SITE ADDRESS
FINALS
G~ADING (Prior to Sodding)
. BljJLDING
ELEiC.TRICAL
PLUMBING
HEATING
DO NOT OCCUpy UNTIL ABOVE HAS BEEN
NOTICE
....
This card must be posted near an electrical service cabinet prior to rough-in inspections
and maintained until all inspections have been approved. On buildings and additions
where no service cabinet is available, card shall be placed near main entrance.
FOR ALL INS~'::CTIONS (952) 447-9850
--
THE DAMA CO.
FIRE DEPARTMENT
KEY LOCK BOX
AUTHORIZATION AND ORDER FORM
I PL:ASE READ
ORDERING INFORMATION:
1) This order must be signed with the signature of the
authorized Fire Department official on file with the DAMA CO.
2) The key box will be shipped to you without any keys and will
be locked in the open position. Contact your local Fire
Department for specific mounting requirements.
3) Please include 6.5% Minnesota sales tax and shipping charge.
4) Full payment must accompany order. Make check payable to THE DAMA CO.
5) Allow 1-2 weeks for delivery.
CUSTOMER INFORMATION
SHIP TO:
(DO NOT USE A P.O. BOX)
Company
Address
City/St/Zip
~ttentionOf~_______~__
ORDERED BY: DATE:' 12- D(.:.
Company _1b~sAk>1 .
Address €JsB5" W. 1~~T. d:.1~
City/St/Zip fVt .....t;,; 3e
Name & Ph # PVAlrf::- ~&J 1t;1'B?.l.S1re>
FIRE DEPARTMENT INFORMATION
NAME:
PRIOR LAKE FIRE DEPT.
INSTALLATION ADDRESS ED GW~
- REQUIRED BY FIRE DEPT. b
- ATTACH LIST IF MORE ROOM IS NEEDED
5~O\~T~ Gt. ~.C.
J'{l-\o(L ~ wt,v
ORDER FORM - Payment must be submitted with order
S2-SURFACE MOUNT (NO MTG KIT OPTION AVAilABLE) $107.00
S3-SURFACE MOUNT $131.00
S3-SURFACE MOUNT W{TAMPER SWITCHES $168.00
R3-RECESSED MOUNT $160.00
R3-RECESSED MOUNT W{T AMPER SWITCH $186.00
MOUNTING KIT (OPTIONAL FOR S-3 & R-3 MODELS ONLY) $ 59.00
SUB TOTAL
SHIPPING & PROCESSING CHG. $9.00
SUB TOTAL WITH SHIPPING CHG.
MINNESOTA SALES TAX, 6.5%
TOT AL AMOUNT ENCLOSED
ITEM
QTY
PRICE
TOTAL
White & Yellow Copy - f" . (~O.
Pink Copy - Customer
MAIL TO:
DAMA-MP INC.
P.O. BOX 47824
PLYMOUTH, MINN.
55447
DARRYL SUNDBERG
763-559-3660
Contractor's Material & Test Certificate for Aboveground Piping
PROCEDURE
Upon completion of work, inspection and tests shall be made by the contractor's representative and witnessed by an owner's representative. All defects shall
be corrected and system left in service before contractor's personnel finally leave the job.
A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners, and contractor It is
understood the owner's representative's signature in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to
comply with approving authority's requirements or local ordinances.
PROPERTY NAME EDGEWOOD SCHOOL (LOWER LEVEL) DATE
PROPERTY ADDRESS
ACCEPTED BY APPROVING AUTHORITIES CITY OF PRIOR LAKE MN
ADDRESS
PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS ~YES DNO
EQUIPMENT USED IS APPROVED ~YES DNO
IF NO, EXPLAIN DEVIATIONS
HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS ~YES DNO
TO LOCATION OF CONTROL VALVES AND CARE AND MAINTENANCE
OF THIS NEW EQUIPMENT?
IF NO, EXPLAIN
INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: ~YES DNO
1. SYSTEM COMPONENTS INSTRUCTIONS ~YES DNO
2. CARE AND MAINTENANCE INSTRUCTIONS ~YES DNO
3: NFPA 25 ~YES DNO
LOCATION ENTIRE BULDING
YEAR OF TEMPERATURE
MAKE MODEL MANUFACTURE SIZE QTY. RATING
TYCO TY-FRB UP 2005 1/2 11 155
SPRINKLERS TYCO RFII CONC 2005 1/2 39 155
TYCO TY-FRB PEND 2005 1/2 137 155
TYCO DS-1 DRY PD 2005 1/2 0 155
PIPE AND Type of Pipe SCHD. 10
FITTINGS Type of Fitting STEEL
MAXIMUM TIME TO OPERATE
ALARM DEVICE THROUGH TEST CONNECTION
ALARM VALVE OR
FLOW INDICATOR TYPE MAKE MODEL MIN SEe
FLOW POTTER VSR-F <7)
DRY VALVE Q.O.D.
MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO.
DRY PIPE TIME TO TRIP TIME WATER ALARM
OPERATING TEST THROUGH TEST WATER AIR TRIP POINT REACHED OPERATED
CONNNECTION' PRESSURE PRESSURE AIR PRESSURE TEST OUTLET' PRO PERL Y
MIN SEC PSI PSI PSI MIN SEe YES NO
WIO
Q.O.D.
WITH
Q.O.o.
IF NO, EXPLAIN
LOCATION MAKE & SETTING STATIC PRESSURE RESIDUAL PRESSURE FLOW RATE
& FLOOR MODEL (FLOWING)
PRESSURE
REDUCING INLET (PSI) OUTLET (PSI) INLET (PSI) OUTLET (PSI) FLOW (GPM)
VALVE TEST
NIA
,
(I4N J COfY)
Contractor's Material & Test Certificate for Aboveground Piping
PROCEDURE
Upon completion of work, inspection and tests shall be made by the contractor's representative and witnessed by an owner's representative. All defects shall
be corrected and system left in service before contractor's personnel finally leave the job.
A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners, and contractor. It is
understood the owner's representative's signature in no way prejudices any claim against contractor for faulty matenal, poor workmanship, or failure to
comply with approving authonty's requirements or local ordinances
PROPERTY NAME WESTWOOD GYM ADDITON DATE
PROPERTY ADDRESS:
ACCEPTED BY APPROVING AUTHORITIES CITY OF PRIOR LAKE MN
ADDRESS:
PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS I2'JYES DNO
EQUIPMENT USED IS APPROVED I2'JYES DNO
IF NO, EXPLAIN DEVIATIONS
HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS I2'JYES DNO
TO LOCATION OF CONTROL VALVES AND CARE AND MAINTENANCE
OF THIS NEW EQUIPMENT?
IF NO, EXPLAIN
INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: I2'JYES DNO
1. SYSTEM COMPONENTS INSTRUCTIONS I2'JYES DNO
2. CARE AND MAINTENANCE INSTRUCTIONS I2'JYES DNO
3. NFPA 25 I2'JYES DNO
LOCATION ENTIRE BULDING
YEAR OF TEMPERATURE
MAKE MODEL MANUFACTURE SIZE QTY. RATING
TYCO TY-FRB UP 2005 1/2 74 155
SPRINKLERS TYCO RFII CONC 2005 1/2 0 155
TYCO TY-FRB PEND 2005 1/2 11 155
TYCO DS-1 DRY PD 2005 1/2 0 155
PIPE AND Type of Pipe SCHD.10
FITTINGS Type of Fitting STEEL
MAXIMUM TIME TO OPERATE
ALARM DEVICE THROUGH TEST CONNECTION
ALARM VALVE OR
FLOW INDICATOR TYPE MAKE MODEL MIN SEC
EXISTING
DRY VALVE QOD.
MAKE I MODEL I SERIAL NO. MAKE MODEL SERIAL NO.
I I
DRY PIPE TIME TO TRIP TIME WATER ALARM
OPERATING TEST THROUGH TEST WATER AIR TRIP POINT REACHED OPERATED
CONNNECTION* PRESSURE PRESSURE AIR PRESSURE TEST OUTLET* PROPERL Y
MIN SEC PSI PSI PSI MIN SEC YES NO
WIO
Q.O.D.
WITH
Q.OD
IF NO, EXPLAIN
LOCATION MAKE & SETTING STATIC PRESSURE RESIDUAL PRESSURE FLOW RATE
& FLOOR MODEL (FLOWING)
PRESSURE
REDUCING INLET (PSI) OUTLET (PSI) INLET (PSI) OUTLET (PSI) FLOW (GPM)
VALVE TEST
N/A I I
!
Contractor's Material & Test Certificate for Aboveground Piping
PROCEDURE
Upon completion of work, inspection and tests shall be made by the contractor's representative and witnessed by an owner's representative. All defects shall
be corrected and system left in service before contractor's personnel finally leave the job.
A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners, and contractor. It is
understood the owner's representative's signature in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to
comply with approving authority's requirements or local ordinances.
PROPERTY NAME: EDGEWOOD SCHOOL (UPPER LEVEL) DATE
PROPERTY ADDRESS:
ACCEPTED BY APPROVING AUTHORITIES: CITY OF PRIOR LAKE MN
ADDRESS
PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS C8]YES DNO
EQUIPMENT USED IS APPROVED C8]YES DNO
IF NO, EXPLAIN DEVIATIONS
HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS C8]YES DNO
TO LOCATION OF CONTROL VALVES AND CARE AND MAINTENANCE
OF THIS NEW EQUIPMENT?
IF NO, EXPLAIN
INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES C8]YES DNO
1. SYSTEM COMPONENTS INSTRUCTIONS C8]YES DNO
2. CARE AND MAINTENANCE INSTRUCTIONS C8]YES DNO
3. NFPA 25 C8]YES DNO
LOCATION ENTIRE BULDING
YEAR OF TEMPERATURE
MAKE MODEL MANUFACTURE SIZE QTY. RATING
TYCO TY-FRB UP 2005 1/2 0 155
SPRINKLERS TYCO RFII CONC 2005 1/2 39 155
TYCO TY-FRB PEND 2005 1/2 158 155
TYCO DS-1 DRY PD 2005 1/2 0 155
PIPE AND Type of Pipe SCHD. 10
FITTINGS Type of Fitting STEEL
MAXIMUM TIME TO OPERATE
ALARM DEVICE THROUGH TEST CONNECTION
ALARM VALVE OR
FLOW INDICATOR TYPE MAKE MODEL MIN SEC
FLOW POTTER VSR-F
DRY VALVE Q.O.D.
MAKE MODEL I SERIAL NO. MAKE MODEL SERIAL NO.
I
DRY PIPE TIME TO TRIP TIME WATER ALARM
OPERATING TEST THROUGH TEST WATER AIR TRIP POINT REACHED OPERATED
CONNNECTION* PRESSURE PRESSURE AIR PRESSURE TEST OUTLET- PROPERLY
MIN SEC PSI PSI PSI MIN SEC YES NO
WIO
Q.O.D.
WITH
O.O.D.
IF NO, EXPLAIN
LOCATION MAKE & SETTING STATIC PRESSURE RESIDUAL PRESSURE FLOW RATE
& FLOOR MODEL (FLOWING)
PRESSURE
REDUCING INLET (PSI) OUTLET (PSI) INLET (PSI) OUTLET (PSI) FLOW (GPM)
VALVE TEST
NIA
welD
AND.ERSON-JOHNSON~
_ ASSOCIA TES,
INC.
WOLD ARCHllECTS AND ENGINEERS
6 I\(ST F1flH STREET
ST. PAUL, t.lN 55102
FAX: 651.223.5646 lEL: 651.227.7773
LANDSCAPE ARCHfTECTURE . SITE PLANNING . ClI1L ENGINEERING
7575 GOLDE}I.' V.ILLEY Ro..1D SUITE 100 MNl\"E.iPOUS. MN 55427
F.H (76.1) 544-05.1/ PI! (16.'1544-1119
715 TOLLGAlE ROAD. SUllE H
ELGIN. IL 60123.
FAX: 847.608.2654 TEl: 847.608.2600
.
.
.
.......
- - '"';;'s:rr.7-
"-
"-
"-
"-
SCALE: 1 "=30'
SUBJECT: GRADING REVISION
DATE: 1/12/06
REVISIONS &
COMMISSION NO: 052055
REV . DATE 3/15/06
~
\2Y
weLD
AND.ERSON-JOHNSON~
_ ASSOCIATES,
INC
LANDSCAPE ARCHlTEC7VRE . SITE PUNNING . cn7L ENGINEERlNG
757$ GOLDEN V,JLLEY IIOAD . SUITE 100 . }.fNA'E.~us..1N 55427
FAX (761) J4<I-'lJJ/ PlI (76JjJ44-7/29
WOlD ARCHllECTS AND ENGINEERS
6 ~ST FIFlH STREET
ST. PAUl. lIN 55102
FAX: 651.223.5646 la: 651.227.7773
715 TOllGA lE ROAD. SUITE H
ElGIN. Il 60123
FAX: 847.608.2654 lEL: 847.606.2600
.
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SUBJECT: STORM SEV'tER REVISION
DATE: 1/12/06 COMMISSION
REVISIONS & REV. IlATF
'~l
SCALE: 1"=40'
NO: 052055
3/22/06
~
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ANDERSON-JOHNSON~
~ ASSOCIA TES,
lNe
UNDSCAPE ARCHITECTURE . SITE PUNNING . CII'lL ENGINEERING
7S7S GOLDEN V./LLEY ROolD SlJTTE 1fI/I MNNEAPOUS. AIN SU27
FAX(76J)J<4.IIJJI PI/(76J)S44-7J29
WOLD ARCHllECTS AND ENGINEERS
6 WEST F1F1Ii STREET
ST. PAUl, MN 55102
FAX: 651.22l5646 ffi: 651.227.m3
715 TOllGA lE ROAD. SUllE H
ELGIN. II. 60123
FAX: 847.608.2654 lEL: 847.608.2600
.
.
.
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eNJ,IN' LINK FENce
it} i"r WCST OF
"i "PER;',( i.JNE: HERE
FES 1
t...
EMERGENCY
OVERFLOW · 942.00
TOP OF BERM = 943.0 (MIN)
CONSTRUCT EARTH 6ERM WITH
CLAY. GRANULAR SOILS SHALL
NOT BE USED ABOVE ELEVATION
936. CAP BERM WITH MIN.
6" TOPSOIL.
.......... /)46
"'---- fJ~
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SCALE: 1"=30'
Sl'SJECT: oes LOGA TION REVISION
DATE: 1/12/06
REVISIONS &
COMMISSIOl\ 1\0: 052055
REV. DATE 3/22/06
LED
\237
weLD
ANDERSON-JOHNSON~
c ASSOCIA TES,
INC
LANDSCAPE ARCHITECTURE . SITE PLANNING . Clf'lL ENGlNEERlNG
7575 GOLDEN V.Il.LEY ROAD . SUITE 100 . MlNNE..,POUs.. AIN 5j417
FAX(76J) 544.nSJI PIJ(76J)S4UI19
WlUl ARCHllECTS AND ENGINEERS
6 YlEST fiFTH STREET
ST. PAUL. lIN 55102
FAX: 651.223.5646 TEL: 651.227.7773
715 TCUGATE ROAD. SUllE H
ELGIN. IL 60123
FAX: 847.6OB.2654 TEl: 847.608.2600
.
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ON LAKE MINN.-
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SCALE: 1"=30'
SUBJECT: SILT FENCE REVISION
DATE: 1/12/06
REVISIONS &
COMMISSION !\o: 052055
REV. DATE 3/22/06
LEU
\@7
03/20/06 11:43 FAX 763 843 0421
,,_ 1 nNGINEERS
@003/003
(
-
B VBM 5930 BROOKLYN BOULEVARD
nJ -~ MINNEAPOLIS, MN 55429-2518
ENGINEERS -
. _ PH: (763) 643-0420 FAX: (763) 843-0421
DESIG~ OFl'-;elofL t...P.<te.~ _/U~ /€C-
SHEET NO.
PROJECT NO.
~Jl!'~ "2...'l-IS'2..\.\
CD '51:c1a .0'\)
>1"t.~JCIo
KS (2...
J DATE
DESIGNER
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I . .
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Geov.\ C-AD'j2..r;S
C (Q x ~:L Cohl'f
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I
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(
443 Lafayette Road North
St. Paul, Minnesota 55155
www.doILstate.mn.us
651-284-5000
TTY: 651-297-4198
1-800-DIAL-DLI
Minnesota Department
of Labor and Industry
August 29, 2006
APPROVED FOR USE
ISO #719
15860 Fish Point Rd. S.E.
Prior Lake MN 55372
RE: Hydraulic Passenger - Elevator 10# -12981 PT06-01
Site: Edgewood Early Childhood Ctr.
5304 Westwood Dr. S.E.
Prior Lake 55372
Dear Sir/Madam:
Minnesota Statutes Chapter 16B provides that the Department of Labor and Industry, Building
Codes and Standards Unit, Elevator Safety Section, inspect and approve elevators and
manlifts (endless belt lifts) before they can be legally used in Minnesota. An Inspector from
the Elevator Safety Section recently inspected your facility and determined it meets
requirements of the Minnesota Elevator Safety Code.
NOTE: Compliance with Minnesota Rules and the ANSI/ASME A 17.1, Safety Code for
Elevators and Escalators does not necessarily assure compliance with the
Americans With Disabilities Act of 1990.
Sincerely,
BUILDING CODES AND STANDARDS
,.~~'~\~'-'-
(~.::a
\.......~ -
. ....-.-........... '..c~_.:t._"._.-,..
Bill J. Reinke
State Elevator Inspector
bir/rsQ (CE-2)
c: Hutchins, Robert Dana, BO, City of Prior Lake
Minnesota Elevator, Inc.
Bossardt Corporation
EIFormCE2
This information can be provided to you in alternative formats (Braille, large print or audio tape).
An Equal Opportunity Employer
~,I,.eR.
"'~MECHANICAL SERVICES
Office: (651) 224-3100
Fax: (651) 224-5390
~.~_.
BURNER INSPECTION REPORT
A Full Service HVAC Contractor
200 West Plato Boulevard St. Paul, MN 55107
Job Number :s 0 d- q S
Date 'S -.;t"3.' 0 I.,
Job Name and Address
[\j(.,z..'\,...)OO~ SCJ-\O()}
S~()4 h.\L~lwoo[) OQ
.t~ "\ng 1.A1( 4- ;\N'J
Boiler Model Number J( tv ) ()
Burner Model Number -
Serial Number Kr-J ~()05'" Ie) L/ 7
U.L. Number /V/A
SO Number tJL1 A
I
.- '-':'~"
~LOl PR~'i.S - \\ S') we.,
l:t-R \ita w 5W1_"\(.I-\- v
I-u<. 'S \.J "t:\L\~ 5;--0 ~
S (1'<foV N<..R Pv..tt">? - V-
OW ~l\,-Jt CV-\ov::(- V'
i:;:.. L-:f:-M:1:-T - ~ 10' V
OW GAS - liS rl /'
N PIT. GAS ~
LOW MED HIGH LOW MED HIGH
02 ~It, S.lt, I 5.~
C02 ~ 8,~ ~,1 .'
"
CO f tfl\. Lf ;2.8 -
Net Stack Temp. {If /10 -~ f-3D~
Combustion Eft % '?>'1,E: '67,5
xI{ ~ I~
Fuel Pressure () 11-1 . -il; - ,8
I
Input ct=H 340 /000
\
1. Flame signal
2. Open burner and check fire box
3. Check condition of gas ring4."~'
4. Check and clean pilot g,ssembfy
'1;.'1M
5. Clean air strain~f/~(
6. Change oil filt~'(
7. Replace nozzlE3'
8. Clean permanet,nozzles
9. Check combustion air fan
10. Clean and adjust electrodes
11. Check high voltage wire
12. Check electrodes for cracks
TEST AND CHECKS
~V
--.
13. Lubricate motor
14. Check all linkage for wear
15. Tighten all linkage
16. Replace vacuum tubes (if Applicable)
17. Clean control cabinet
18. Tighten all wires
19. Check starter contacts
20. Check and prove all operating
and limit controls
21. Check and record gas pressure
22. Discuss findings with operating
engineer
~
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Customer Signature
Service Technician (~c\-\o;Q::s.-.) ~"\~G\-\4J(
::.,
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Minnesota Department
of labot" and lndl!stry
i::LL\',\TOR L'\SPECTJO\ HE.PORI
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FROM WENZEL PLUMBING & HEATING 651-452-0367
(MON) 8. 21' 06 15: 101ST. 15: 05/NO. 4860053501 P 2
In:)trumental Research, Inc.
7800 Main St. Fridley, MN 55432 763-571-3698
August 18, 2006
Wenzel Plumbing & Healing
1710 Alexander Road
Eagan., MN 55121
LABORATORY RESULTS - WELL WATER SAMPLE 553-06W
A water sample from ~jgewood Efementary School 5304 Westwood~ Prior Lale, MN was
submitted to Instrumental Research laboratory and tested under my supervision.
EPA & MDH IRI Analysis
PararneterIMethod Results Drinking Reporting Date
Water Limits Limit
(Total) Coliform Baeteri a Absent Absent Absent 8/16/2006
9223 B. (P-A) Method
These results meet Em ironmental Protection Agency (EP A) and Minnesota Department of
Health (MDH) standards :f; If a safe drinking waler source.
All analyses were perlOl moo using Standard Methods for the Examination of Water and
Wastev.rater, 19th edition E:) A approved methodologies.
Report submitted by.
~~~~
SUZANNE MELCmOR, 1.ABORA TORY SUPERVISOR
SM/eh
Minnesota Department of 1 iea1th Certified Laboratory No. 027-003-130
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