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D ~ ~~~~c C) :.--. Z 0 >ooz:;; ""l !TI _mm-l_ -i ~ ;:0"1'1;:0 r ., -f-- r i enz z m -I~ Q 1 OF PRIOR LAKE BUILDING Pi ,:lIT, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE AND UTILITY CONNECTION PERMIT Date Rec' d /-8-02- ADDRESS County Road 42 & Pike Lake Trail NE LEGAL DESCRIPTION (office use only) L White File 2. Pink City 3 Yellow Applicant CX2.-6/1Q I PERMIT NO. () I I'j' '0 I -l f {f 44(,0 r()(J{I/7;4l tV 11 /I-LS [) ZONING (office use) VI- PID 2.5- LOT 2 BLOCK 1 ADDITION Fountain Hills Addition OWNER (Name) Holiday Companies, Inc. (Phone) 952-830-8700 (Address) 4567 West 80th Street, Minneapolis, MN 55437 BUILDER (Name) (Contact Name) (Address) (Phone) (Phone) TYPE OF WORK ORe-Siding rn New Construction o Misc. o Lower Level Finish PROJECTCOST/VALUE (excluding land) $ 800,000.00 o Alteration OUtility Connection ODeck o Fireplace o Porch DAddition ORe-Roofing I hereby certifY that I have furnished information on this application which is to the best of my knowledge true and correct. I also certifY that I am the owner or authorized agent for the above-mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections. x Permit Valuation Permit Fee Plan Check Fee State Surcharge Penalty Plumbing Permit Fee Mechanical Permit Fee Sewer & Water Permit Fee Gas Fireplace Permit Fee $ $ $ $ $ $ $ $ 1-1S'-o 2 Date Contractor's License No. 1/7/02 Date 7(:)0 Park Support Fee 85'0 X IS" SAC 112-0' x.. \S" Water Meter Size 5/8"; I"; Pressure Reducer Sewer/Water Connection Fee Water Tower Fee # # Builder's Deposit Other TOTAL DUE $ (p 7 9(P/. ~tNo1J2D2.. B ~ Paid Date P--5-c::>2 This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued. ~- Special Conditions, if any 24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 16200 Eagle Creek Avenue Prior Lake, MN 55372 CITY OF PRIOR LAKE BUILDING PERMIT, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE AND UTILITY CONNECTION PERMIT Date Rec' d C(-I/-{J2- (lAI N FIL-~ oz..- 0110 1. White File I PERMIT NO 2 Pink City . O'? -1/7 I 3. Yellow Applicant V ZONING (office use) C4- ADDRESS ltoL-l~ STA< T'l~ L..J ~ (p 0 fOU)\)T ~ 1,0 H l\..lS DCL\\J t LEGAL DESCRIPTION (office use only) LOTL-- BLOCK / ADDITION f-:Ct//l/711//\./ /l({(_,-J-~ /tVo;J. PID Z'5 - 3&".>- 0 (J2 ~ t) OWNER (Name) NorZ--TI-\ At'"\G".1Z--1CA :[NU - ~ DE 1D('i Hw - P.D .eox. 4 FMN('\S (Phone) 7lD~ - '''f'l- qq,,, (Address) BUILDER , (Name) \Nesl5lD It. ~G\M.'f' Co. (Contact Name) -=fbt"'\ 'F L.:\..Cs:..t:. (Address) c::r 0'2.. HW'1. E? 5 - M et)l tJ ~ I Mf\J. l:5~14 0 4'~ (Phone) 7fb3 - ~- 15]'2,... (Phone) SA.. M. t:... TYPE OF WORK ~New Construction OLower Level Finish ODeck OPorch ORe-Roofing ORe-Siding o Fireplace OAddition o Alteration OUtility Connection Misc. ?1L TJ PROJECT COST IV ALUE (excluding land) $ lot 00 I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the above-mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the pr?frty to perform needed inspections. X ---d.. d1~ \\ ~ - 11- DZ- Signature Contractor's License No. Date Permit Valuation Park Support Fee # $ SAC # $ Water Meter Size 5/8"; 1"; $ Pressure Reducer $ City SAC and WAC # $ Water Tower Fee # $ Builder's Deposit $ Other $ TOTAL DUE $ r~w ..43 Permit Fee $ Plan Check Fee $ State Surcharge $ Penalty $ Plumbing Permit Fee $ Mechanical Permit Fee $ Sewer & Water Permit Fee $ Gas Fireplace Permit Fee $ .4-'7 ,; fll-- This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued. Ci . \(0 -0 fA Date Special Conditions. if any 24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 16200 Eagle Creek Avenue Prior Lake, MN 55372 CITY OF PRIOR LAKE HEATING/AIR CONDITIONING/FIRE~l~A....,.CE~ii>>J... T "l,~"~ '~ . ..... .', ...,....,....... .........,...::~. /0. I~-OJ- Y {,tJ rol.: ~ /-1 1/.> Date Rec'd 2. ~e:n ~:~. I PERMIT NO. /J - /3c-.3 3. Yellow ApplIcant V 2. (=--- .::>. ZONING (office use) ~( LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER (Name) C h l:.-r I- C~0.-J:J I (Address) (Phone) APPLICANT (Name) (tGL yvLLut,-~",-'l/ MI IV1Uu~ T--.... (Phone) //,3 '-7'?t/"c.()p,;, (Address) ~/i'( _), U /, C'><' / ~ c.'jL .4 v c. /\/ J::;' (Address) (Contact Person) /~~?A L,.. t, , . (City) (Phone) DATE / ti ~ ~-/,j 2. ~-S-,~O 1/ - , (Zip Code) APPLICANT PLEASE COMPLETE BELOW NEW CONSTRUCTION 0 REPLACEMENT 0 AL TERA TIONS FURNACE MAKE AND MODEL S' e_.' C? \ /1-:"\ " :'" FUEL FLUE SIZE RETURN OPENINGS INPUT OUTPUT TYPE OF SYSTEM OWarm Air Plants o Gravity o Mechanical OAir Conditioning OVent. System HEATING OR POWER PLANT o Steam o Hot Water o Radiation o Special Devices o Other Devices PLEASE NOTE: Air Conditioner Units Cannot Encroach into Required Side Yard Setbacks FEE SCHEDULE I % of job cost Residential, Gas Fireplace $39.50 minimum $99,50 Residential, Additions & Alterations $64.50 Residential, AC Only FIREPLACE MAKE AND MODEL Industrial, Commercial & Multi-Family Residential, Heating & AIC (New Construction) Residential, Heating Only (New Construction) $39,50 $ $ $ ::i 2.0 - .50 '3 z.o ,S-O $39,50 ._$_3,9_ if),50 ~J~V i:ff Building Permit # O'L- / (353 Estimated Cost $ -3;) \ 000 HEATING PERMIT FEE STATE SURCHARGE TOTAL PERMIT FEE (Office Use Only) 24 hour notice for all inspections (952) 447-9850, f (952) ~7-4245 16200 Eagle Creek Avenue, Prior Lake, MN 55372 Date Rec'd CITY OF PRIOR LAKE PLUMBING PERMIT C)-L/-02- I. Blue File I PERMIT NO i ~~:~w ~~~licant . ~2 -1/2 6 ;j/~ 0 r ZONING (office use) (! L/ LEGAL DESCRIPTION (office use only) LOT ~LOCK ( ADDITION t) /idti.-l/ I (Address) '/9' {, 0 - ~~4/Pj~. (..s) ~~ r:f O"z..~ ~ ~s) (C....On) ~ ~~ AP~'Jj.";8fG"NATURE O~ OWNER (Name) Quantity ~ PID;;) 5- 3t,3- 00 J .- 0 (Phone) ~~. "'e) b<S/- Y J"c;-f/o ~h AKfl~?--/. \.~0/1? ~y) ~) ~, ~/-</!'l/-Vo?6 8'fE Type of Fixture Bath Tub with or without shower Dishwasher Floor Drain Lavatory (Bathroom Sink) Laundry Tray (lor 2 compartment sink Shower Stall Sinks Bar Sink Water Closet (Toilet) Type of Fixture Rough-ins Water Heater Water Softner Stand Pipe (Washing Machine) Sewage Ejector Backflow Assembly Backflow Assembly Test Lawn Sprinkler Other ~ /- 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 00 Estimated Cost $ t/J.,OOO ~ Building Permit # (J Z- -//28 ~\ PLUMBINGPERMITFEE $ 420.. -- 't 0 v STATE SURCHARGE $ .50 / ~ TOTAL PERMIT FEE $ 42v. SO en Approved Paid 4Z{). 57) Date {.I / 1-/ -(,it.-- Receipt No. / 4-3{J3 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 Lf/f!oo LEGAL DESCRIPTION (office use only) LOT ~LOCK ADDITION (Phone) OWNER (Name) IIoJldcy (!.{)Jr/naliL/e'<:;' / (Address) ~- 1-00- I. Green File PERMIT NO 2 Yellow City 'tJz...//# J, Gold Applicant o ZONING (office use) ~ (Address) (Zip Code) I ~~~IA1~;t/tJva I-ro~ I J '"4Wmlll~~3 if? COh?~\.ej~ce ~ Z A)C: 00 .. '~,.,' : ~I 1L~ :'~'li' ~" 'i<'<l>t,"'t: ~, (City) ~ & _Ii) 6-LJI- I/o :~T7: ~,J (~,:;A CC"ff~ (Phone) Ild- DATE ~gO- 8,j~ 7.,j- . {',4-.c:; 3.3 ~:"'l 1II1..L /JlJ~ ;(11 I ~"~'N..(~~€t)MPLE'fE'BELOW' Size of water service ~ inches. Location of any couplings from structure _ feet. Type of sewer pipe. D ABC ~ PVC D Cast Iron Estimated length of sewer line .}frC) feet. Clean out (ifrequired) located at ~feet from structure. FEE SCHEDULE $35.50 Industrial, Com'l & Multi-family $17.50 Water connection only '3 .... .c>C' , .j ()fX) Building Permit # Residential sewer and water line connection Sewer connection only ~.l.Ll$ SEWER AND WATER PERMIT FEE STATE SURCHARGE TOTAL PERMIT FEE (Office Use Only) This APPlic3tio,n /) B, ecomes Your BUildin'lg~ Pjerm/it ~hen Approved !r---;:'~ , { _ L Z_ ~. ng Official I Date 1% of job cost with a $39.50 minimum $17.50 ()Z.-//~~ $ 300-- $ .50 $ 3S-~,' C;-O Paid ~") 350,5 u DaYi., c.r--l! "'f/ Z- 24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 CITY OF PRIOR LAKE HEATING/AIR CONDITIONINGIFIREPLACE PERMIT Date Rec'd /0-/-02- ~. ~~~w ~J~icanl I PERMIT NO. 0 Z - / 2-~~ I ZONING (office use) 4v e4- LEGAL DESCRIPTION (office use only) LOT 2BLOCK / ADDITION r~t/lt/JJ1lrV ;l1t.bS PID' -0 OWNER (Name) S7/9170 (Phone) (Address) ~;;~~ANT~/4~ ~. (Address) c.. s- ;: ~ deo.J2- W (Address) (Contact Person) ~ [)~ APPLICANT SIGNATURE 4-r D.--eer (Phone) c,0/-YtI']/- $/fJJ>6 0'S-//7 (Zip Code) c#.~~ ~ (City) (Phone) C:. I.S/- SIR y - Sf Q c?6 DATE 0.2.. APPLICANT PLEASE COMPLETE BELOW NEW CONSTRUCTION 0 REPLACEMENT 0 AL TERA TIONS FURNACE MAKE AND MODEL FUEL # ? FLUE SIZE f?...lZd . RETURN OPENINGS INPUT ...s {JOj CIllO .fT.~UTPUT TYPE OF SYSTEM HEATING OR POWER PLANT DWarm Air Plants DGravity o Mechanical DAir Conditioning DVent. System o Steam aHot Water o Radiation o Special Devices o Other Devices PLEASE NOTE: Air Conditioner Units Cannot Encroach into Required Side Yard Setbacks FIREPLACE MAKE AND MODEL FEE SCHEDULE Industrial, Commercial & Multi-Family 1% of job cost Residential, Gas Fireplace $39.50 minimum Residential, Heating & AIC (New Construction) $99.50 Residential, Additions & Alterations Residential, Heating Only (New Construction) $64.50 Residential, AC Only dI oe Estimated Cost $ I? () 0 C) - Building Permit # $39.50 $39.50 $39.50 HEA TING PERMIT FEE STATE SURCHARGE TOTAL PERMIT FEE $ 1q~ $ .50 $-'(1 D'oC' (Office lIse Only) ~. ~icati~.n Bec,omes Your Building Permit When Approved '1/!1;1~~?,~ to /7/f'Z- ~ BUildin~ Date Paid /7 ---7) ~/ () . 6 C/ Date /(). /,5 ,0 2.. Receipt No. --') ':J. L':5LC ~ By 24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 CITY OF PRIOR LAKE HEATING/AIR CONDITIONINGlFlREPLACE PERMI Date Rec:'d I Pink Z Oree" ] YoUvw ZONING (DIIi~ use) a'-L/ H IL~S bR.\ L LEGAL DESCRIPTION (office \l$f ollly) LOTd-BLOCK / ADDITION UU1U1&; ~ ~ -0 (Phone) ~ '15J-830-~%~Lf N SSt{s7 (Phone) ,f.t, 3~ S \5 -4000 I E~ao~u{,....J PAe.lL SS4~ s:- (City) (Zip Code) (Phone) to I d - g 10-10 ,t.Jg DATEJO-J8-02 PLETE BELOW LifNEW CONSTRUCTION o REPLACEMENT o AL TERA TIONS FURNACE MAKE AND MODEL FUEL FLUE SIZE RETURN OPENINGS INPUT OUTPUT lYPE OF SYSTEM HEATING OR POWER PLANT OWarm Air Plants B Steam PLEASE NOTE: OGravity Hot Water Air Conditioner Units o Mechanical , 0 Radiation Cannot Encroach into ~." ~ R.~I~<.),.J 0 Spctlal Devices Required Side Yard . iW' ! OV cnt. System o Othcr Devices Setbacks WBI 1 r - .. Iff J.. J YI tV'" _~ INS~ RutI~:J ht)(L IJAt-t: -IJ WOL'C:J2..- ~ ~z.~ FE~ SCHEDULE l%orjob eost Residential, Gas Fireplace 539.50 minimum $99.50 Residential, Additions &. Alterations 564.'0 Residential. AC Only 4-, 850 ~ Building Permit # . r"dllstrial. Commercial &. Multi-Family Residential, Heating & AtC (New Constl1lction) Residential. HEating Only (New Construction) Estimated Cost $ HEA TlNG PERMIT FEE STATE SURCHARGE TOTAL PERMIT FEE (omn lJK Only) This Appliution Becomes Your Building Permit When Approved ~ ~t- /ala-~2- Building Offidat Oatt $39.50 539.50 $39.50 $ $ $ t..jg.~D .50 49. nJ Paid L/ q,o-o Date; U - N- 0 d 7 14 hour notice for .11 inspettions (952) 447-9850. fu (952) 447-4245 CITY OF PRIOR LAKE BUILDING PERMIT, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 6~. ONNECTION PERMIT ;:/[ E,<- /N 4/(), Z - 0, /I{) \) I, While fill ~- ~ /\,,-./ '___ _ 2 PI.. Cily '----- 3. Vollo... Applioon, 10/07/02 MaN 11:55 FAX 6124474245 4460 Fountain Hills Drive crT -<<rOR LAKE @001 Date Rec'd /O_9-Ud-. I PERMIT NO. Ol-13751 I ZONING ("""'''''' j LEGAL DESCRIPTION (offiee use only) LOT BLOCK ADDITION PID z5 - 3<'...3 - Q 0 Z -0 I OWNER (Name) (Address) BUILDER (Name) (Contact Name) (Address) Sentry Fire Protection, Inc. John J. Weber (phone) (Phone) (Phone) I j 763-658-4481 7h1-65R-L..4R3 4439 Hwy 12 S.W., Box 69, Waverly, MN 55390 TYPE OF WORK fXI New Construction Fire Sprinkler SYste.m. DLowerLt:vel FinISh ORl:-Siding o Misc. DDedc DPorch OAddition OUlility Conn~on ORe-Roofing o I"ireplaCl: OAltc:ration PROJECT COST IV ALUE (l:xc:Iuding land) S 22. 830 . 00 ! I hereby Cl:rtify tlut I have furnished information on this application which i~ [0 cite best of my kn.owledge trUe an.d comct. I also certify that I am the own~ or 1 ' authorized agent for the above-mentioned propertY and that al1l:onstnJc1ion will conform to all existing state and loca.llaws and will proeel'ld in accordance with submitted plans. I am a.ware that the building official can revoke this pennit for just cawe. Furthermore, I hereby agree that the city official or a designee may enter upon the propeny to pctform needed inspections. X '- "t~ :f~ Signature Permit Valuation 2'3 Q:)O.OCl Permit Fee Plan CheckFl:e State Surcharge Penalty Plumbing Permit Fee Mechanical Permit Fee Sewer & Water Permit Fee Gas Fireplace Permit Fee s S $ S $ $ $ S .tV . 'Z.. b ::< 5"~ Ql I '2 . 00 ecomes Your Building Permit When Appro'led JO-(~-C52- Dare COOl Contractor', Li~e No. 10-8-02 Date Park Suppon Pee # S SAC # S Water Meter Size 5/8"; I"; $ Pressure Reducer $ Sewer/Water Connection Pee # S WarerTowerFee # S Builder's Deposit S Oth~ $ TOTALDUE , It)"l -Ol-- $ 34. I ~ajd~ ~tf~ f!~1 'B=ipt NOtji! 9 10 _~ , :gate __ _~-,;J.. _-O~ By __~ _._.~ , This is to cmify milol the request in the above appllClltulD and aCCOm):llllymg docuDJCnI'S ls in accordance with the City Zenina Ordinance and /tIay proem! as ICquestl!a. This documal! I when slgnl:d by the City PWuier conruNlCS a cemporlll)' Ccnilicate of Zoning compliance and allows constl'llction 10 commence. Jle~ OCCUplllcy, a .Ccnilicate or OCl:Upancy must be i5su~d. Pb!'lninl> nir,.f'lnr Dale Special Conditions, irany PRIOR LAKE INSPECTION RECORD DEPARTMENT OF BJILDING AND INSPECTION SITE ADDRESS 41./100 FC)oVt~~"b\. 1-1 ('!Is Or NATURE OF WORK Hol.'&O SteJ-tm/\ USE OF BUILDING 0"- PERMIT NO. ~- 0//0 DATE ISSUED J - 15'-0 '"'2- CONTRACTOR ---H.Q1,~.(1,. PHONE '1S;;? -9'5b-87oa NOTE: THIS IS NOT A RMIT FOR ANY OF THE INSPECTIONS BELOW THE PERMIT IS BY SEPARATE DOCUMENT INSPECTOR DATE I FOOTING E3 (/ {/- /2-/- 0 :J- FOUNDATION (Prior to Backfill) -; J- il. PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ROUGH - INS SEWER I WATER I SEPTIC FRAMING INSULATION ELECTRICAL PLUMBING HEATING (if required) FIREPLACE GAS LINE AIR TEST ~ lJ/ /.5-- c]---- COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED I I I J 1~. G~ () (p1'lJo(()3 FINALS GRADING (Prior to Sodding) BUILDING W ELECTRICAL ~~ PLUMBING HEATING DO NOT OCCUpy UNTIL ABOVE HAS NOTICE This card must be posted near an electrical service cabinet prior to rough-in inspections and maintained until all inspections t .AVe L~en approved. On buildings and additions where no service cabinet is available, card shall be placed near main entrance. Call between 8:00 and 9:00 A.M. for all inspections FOR' '_L INSPECTIONS (952) 447-9850 Plan review comments Holiday Station Store 4460 Fountain Hills Dr. Prior Lake MN The following comments are the results of the plan review of the proposed Holiday station store. Our review is based on the Minnesota State Building Code (MSBC) and adopted amendments the 1997 Uniform Building Code (UBC). The Handicap requirements of the Minnesota Accessibility Code Chapter 1341. The Minnesota State Fire Code (MSFC) with the adopted amendments the Uniform Fire Code (UFC) 1. Separate permits are required for plumbing, electrical, HV AC, fire suppression i s~rinkler, fire alarm, under ground fuel tanks, sewer and water hookup and trademark SIgn. 2. Provide building plans and signed structural plans for the canopy and trademark sign before construction of the sign and canopy.(UBC 106.3.2) 3. Provide roof truss specifications with suspended HV AC units considered, at the : framing inspection. (UBC 106.3.2) 4. Plan reviews for plumbing, HV AC, fire sprinkler, fire alarm, canopy, and trademark sign has not been completed. 5. Provide TTY hearing assisted telephone. (Chapter 1341.0478) . 6. Fire department Lock box is required at the front entry. (See the attached order form) 7. See the approved plan for additional Fire Extinguishers. (UFC Sec. 1002) 8. See the approve plan for additional exit sign and emergency lights. 9. Provide No Parking Fire Lane signs at the entrances, fire department connection and at the perimeter of the parking area. See the approved plan for locations. 10. See corrected detail on approved plans for required sheathing. (Page A3, detail 2&6) Feel free to contact Paul Baumgrtner with any questions you may have. (952) 447-9853 . 16200 Eagle Creek Ave. S.E., Prior Lake, Minnesota 55372-1714 / Ph. (952) 447-4230 / Fax (952) 447-4245 AN EQUAL OPPORTUNITY EMPLOYER fA Sagat Architects, P.A. January 25, 2002 Mr. Paul Baumgartner Plans Examiner City of Prior Lake 16200 Eagle Creek Avenue S.B. Prior Lake, MN 55372-1714 Re: Holiday Stationstore #324- Prior Lake, MN Project Number: 00042A Dear Mr. Baumgartner: In response to you memorandum to Joel Geil on January 24, I have reviewed your comments, discussed them with Joel and offer the following response. 1. Acknowledged. 2. A soils report is attached. 3. It is my understanding Jane Kansier advised Joel this would not be necessary until later. 4. The certificate of survey will be submitted by February 1, 2002. 5. Roof truss specifications with suspended HV AC units considered will be provided at the framing inspection. 6. The Special Structural Testing and Inspection Schedule is attached. 7. Attic ventilation calculation is as follows: Building Area: 5413 GSF Ventilation Requirement: 1/300 of building area due to presence of vapor barrier and the fact we have both ridge and soffit ventilation locations. Ventilation Area Required: Minimum of 9.02 SF of ventilation in the soffit and 9.02 SF of ventilation in the ridge vent. 8. Acknowledged. 9. Acknowledged. 10. Acknowledged. 11. Acknowledged. 12. Fire Department lock box will be obtained and installed on the building in an approved location.. 13. Fire extinguishers will be installed per the approved plans. 14. Additional exit signage and emergency lights will be provided per the approved plans. 15. No Parking Fire Lane signs will be provided in the locations noted on the approved plans. 16. The floor level on both sides of door # 1 08A is the same; the floor level steps down into the car wash bay adjacent to the upper left (southwest) corner of room 108. Note spot elevations in that location. 17. We understand a submeter for the irrigation system is not permitted; it will not be installed. I 4159 G'""'^:;;jj'" . Mi"'"p,Ii;, MN 55'09 . (612)82H20<l . FAX: (612) 822-0808 . E-Mail: sagatarchitects@uswest.net g;" HOLIDAY STATIONSTORES 4567 West 80th Street, Bloomington, MN 55437 (952) 830-8700 STATIONSTORES Mr. Paul Baumgartner City of Prior Lake 16200 Eagle Creek Ave. S.E. Prior Lake, Mn 55372 January 31, 2002 RE: Holiday Stationstore 4460 Fountain Hills Drive Prior Lake, MN Dear Mr. Baumgartner; I have included with this letter written comments to your plan review letter dated 1/24/02. also included are revised civil drawing per the letter from Nate Briese dated 1/22/02. The items noted on the letter from Jane Kansier dated 1/23/02, were hand deliver to Jane on 1/23/02 by myself. I believe that Holiday Companies has satisfied all of the requests and comments from the cities plan review and feel that with this submittal all issues pertaining to CUP should be completed. As we discussed earlier, that there will need to be additional permits applied for a later date such as the gasoline canopy, signage, gasoline tanks etc. Thank you for your special attention in this plan review, and I look forward to working with you and other City of Prior lake staff as this projects goes forward. If you should have any questions or comments, please feel free to contact me 952-830-8884 Respectfully, Holiday Companies " r' rp.,:JJ Joel D. Geil Project Manager/Construction Supervisor Mr. Paul Baumgartner January 25, 2002 Page 2 Regarding the memorandum prepared by Jane Kansier on January 23, 2002 and her two comments, Joel Geil did, on January 23, furnish the requested proof of recording of the resolution approving the conditional use permit and the Assent Form signed by the permit applicant (Holiday). I trust this addresses your needs. Please call me directly if you have questions or need additional information. Sincerely, ~~~ Enclosures: Soils Report Special Structural Testing and Inspection Schedule Memorandum Date: To: Joel Geil, Project Manager Holiday Station From: Paul Baumgartner Plans Examiner RE: Proposed Holiday Station, 4460 Fountain Hills Dr. The following comments are the results of the plan review of the proposed Holiday station store. Our review is based on the Minnesota State Building Code (MSBC) and adopted amendments the 1997 Uniform Building Code (UBC). The Handicap requirements of the Minnesota Accessibility Code Chapter 1341. The Minnesota State Fire Code (MSFC) with the adopted amendments the Uniform Fire Code (UFC) 1. Separate permits are required for plumbing, electrical, HV AC, fire suppression sprinkler, fire alarm, under ground fuel tanks, sewer and water hookup and trademark SIgn. 2. Provide a soils report. (UBC 106.3.2) 3. Provide building plans and signed structural plans for the canopy and trademark sign. (UBC 106.3.2) 4. Provide a certificate of survey. 5. Provide roof truss specifications with suspended HV AC units considered, at the framing inspection. (UBC 106.3.2) 6. Submit the Structural Engineer's requirements for special inspections. (UBC 1701.5) 7. Provide attic ventilation calculation. (UBC1505) 8. FDC shall be located per page SP3. (See sheet SP3 and sheet FP1) 9. Fire sprinkler shall be monitored off site. (MSFC 1003,3.1) 10. Plan reviews for plumbing, HV AC, fire sprinkler, fire alarm, canopy, and trademark sign has not been completed. 11. Provide TTY hearing assisted telephone (Chapter 1341.0478) . 12. Fire department Lock box required. (See the attached order form) 13. See the approved plan for additional Fire Extinguishers per UFC Sec. 1002 14. See the approve plan for additional exit sign and emergency lights 15. Provide No Parking Fire Lane signs at the entrances, fire department connection and at the perimeter of the parking area. See the approved plan for locations. 16. Door # 108A swings over a change of elevation. (UBC 1003.1.3.6) 17. Sub meter is not allowed. For separate irrigation water meter must be served with a separate service and curb box. Feel free to contact me with any questions you may have. (952) 447-9853 TO: Paul Baumgartner, Plans Inspector FROM: Jane Kansier, Planning Coordinator DATE: January 23,2002 RE: Holiday Station - Pike Lake Trail CC: Bob Hutchins, Building Official Steve Horsman, Zoning Administrator I have completed my review of the Holiday Station permit application. Before the Planning Department will sign off on this permit, the following information must be submitted: 1. Proof of recording of the resolution approving the conditional use permit. 2. An assent form signed by the applicant. The building permit for this use must be issued by February 5, 2002, or the conditional use permit will be null and void. Please let me know if you have any questions about this matter. c:\windows\temp\permit memo.doc DATE: January 22,2002 TO: Robert Hutchins, Building Official FROM: Nate Briese, Engineer Technician I RE: Holiday Station (Project #47-00) The Engineering Department has reviewed the preliminary plans for the subject project and we have the following comments: 1. Utility Plan - SP 3: Show a storm sewer pipe connection to the existing catch basin on Fountain Hills with type, length, size, and slope of pipe. 2. Utility Plan - SP 3: Add a note to the above sheet stating that the connection to the existing storm manhole needs to be made with a concrete saw and repaired with non-shrink grout. 3. Utility Plan - SP 4: Place a note on the page stating, "Slopes greater or equal to 3:1 shall have an erosion control blanket installed immediately after finished grading. 4. Site Plan - SP1: Note 4 should read 8" Depth Concrete Approach to R.O.W. line. 5. Put existing contours on SP4 G: \PROJECTS\2000\4 7holiday\REVIEW3 .DOC ~ Metropolitan Council Building communities that work Environmental Services January 8, 2002 ~ / Oa ~ i / ..6f\rJ 0 /CJ~' Bob Hutchins Building Official City of Prior Lake 16200 Eagle Creek Ave. Prior Lake, MN 55372-1787 Dear Mr. Hutchins: The Metropolitan Council Environmental Services Division has determined SAC for the Holiday Station to be located at County Road 42 and Pike Lake Road within the City of Prior Lake. This project should be charged 15 SAC Units, as determined below. SAC Units Charges: Retail 2240 sq. ft. @ 3000 sq. ft./SAC Unit Gas Pumping Car Wash 35.44 gallons/car x 100 cars/day @ 274 gallons/SAC Unit 0.75 1.00 12.93 Total Charge: 14.68 or 15 If you have any questions, call me at 602-1113. s~; J ~ J~~'Z;:wards . Staff Specialist Municipal Services Section JLE: (380) 020108S1 Cc: S. Selby, MCES Joel Geil, Holiday www.metrocouncil.org 230 East Fifth Street . S Metro Info Line 602- 1888 t. Paul. Minnesota 55101-1626 . (651) 602-1005 . Fax 602- I 138 . TIY 291-0904 An Equal Opportunity Employer MINNESOTA DEPARTMENT OF HEALTH Division of Environmental Health REPORT ON PLANS Plans and specifications on plumbing: Holiday Stationstore No. 324,4460 Fountain Hills Drive, Prior Lake, Scott County, Minnesota, Plan No. 030793 OWNERSHIP: SUBMITTER(S): Roseville Plumbing and Heating, Inc., 65 South Owasso Boulevard, St. Paul, Minnesota 55117 Plans Dated: Date Received: October 15,2002, September 3,2002 Date Reviewed: October 17, 2002 SCOPE: This review is limited to the design of this particular project only insofar as the provisions of the Minnesota Plumbing Code, as amended, apply, and does not cover the water supply or sewerage system to which this plumbing system is connected. The review is based upon the supposition that the data on which the design is based are correct, and that necessary legal authority has been obtained to construct the project. The responsibility for the design of structural features and the efficiency of equipment must be taken by the project designer. Approval is contingent upon satisfactory disposition of any requirements included in this report. Special care should be taken to insure that the material and installation of the plumbing system are in accordance with the provisions of the Minnesota Plumbing Code. A copy of the approved plans and specifications should be retained at the project location for future reference. A set of the identified plans and specifications is being returned to Roseville Plumbing and Heating, Inc. Enclosed is a copy of the report and transmittal letter to be forwarded to the project owner. INSPECTIONS: All plumbing installations must be tested and inspected in accordance with the requirements of the Minnesota Plumbing Code. As specified in Minnesota Rules, part 4715.2830, no plumbing work may be covered prior to completing the required tests and inspections. Provisions must be made for applying an air test at the time of the roughing-in inspection as outlined in Minnesota Rules, part 4715.2820, subpart 2, of the code. A manometer test, as specified in Minnesota Rules, part 4715.2820, subpart 3, is required at the time of the finished plumbing inspection. It is the responsibility of the contractor/installer to notify the Minnesota Department of Health when an installation for a state contract job, licensed facility, or project in an area where there is no local administrative authority is ready for an inspection and test. To schedule inspections, contact the state plumbing standards representative for your region, or call the metro office inspection hotline at 1-800-926- 6216 (7:30 a.ill. to 9 a.m.), or 651/215-0836 (8 a.ill. to 9 a.m.) on Monday, Wednesday or Friday. REQUIREMENT(S): 1. The wall hydrants labeled as P7 and PH should be taken from the potable water lines. 2. The installation of reduced pressure zone backflow preventers is permitted only when periodic testing is done by a trained backflow preventer tester acceptable to the administrative authority. Testing intervals shall not exceed one year, and records must be kept. All devices must be tested after initial installation to assure that debris from the piping installation has not interfered with the functioning of the device. The devices shall be overhauled at least once every five years. The installation of new backflow preventers must be at least 12 inches, but not more than 6 feet above the finished floor or ground level. 3. Verify that roof scuppers discharge to a place of disposal satisfactory to the administrative authority. In no case, shall water from the roofs be allowed to flow upon the public sidewalk. ::>t.~-1~-~2 13: 35 l.ESTS I DE EGlU I Pl'ENT P.02 'f-. t~ CITY OF PRIOR LAKE 16200 EAGLE CREEK AVENUE S.E. PRIOR LAKE, MN 55372 SPEC~ fI'RUCTURAL TESTING AND INSPECTION SCHEDULE ProjectNamc tkL..'~1' <;TA.lllO~ s::.ll:>f2.E. Location : C~ ~ .~'2.- *' Pl~ ~ ~ It.- rlEi e_Q~ - -- I ~ _ -E-UN JA-N. 'W-t\.1Ji j)P-. l'l.E.) SPECIAL STRUCTURAL TESTING AND INSPECTION J Spc:cific:uiOft Dcsgoiption Type ofInspeetcr (3) Report Frequency Assigned Sec:tiOD Anic:le Finn (4) - - l'lcDl. , I~T~. 1 ~:.... .'-u - - -- J~ 10-1 Ar r ;';.L.o ^- . ~J- .~ 7 ~ NOles: This schedule to be filled our and inclllded in lbe project specific.don. lIlfonrlaDOn una"'ilable at that time. to be filled our wben applying for a buildina permit (I) t:se descriptions per use Section )70], as adopted by Minnesota State Buildin.a Code. (2) Special Inspector. Tec:.hnical. Spec:ia1lnspcctor - Strucunl. (3) Firm contracted to pcrfonn scrvi'e5. ACKNOWLEDGMENTS ~h appropriaIC representative shall sign below: Owner: Finn: Contractor; Firm: WeSr.6/~~ ~, Architt Finn: Finn: imI: Ce?~ ~ ~ ~/..v",)" ~ .ep&te: D.w: Date: Da~: Firm: Date: .The individual names orall prospective special inspectors and the work they inund. to se1'Ve shin be idel'ltiflCd. (Use reverse side of form ifnec:asary,) Le;ead: SEll - StNccural Ulgirlocr of Jtc:c;ord SI- T - SpcciaJ Inspcc:lor - TecbniQ! SI.S - Special Inspector - Struetllra1 T A K Testing AIODq F · fabricator ... Accepted for the BllildlDl Dcpanment by na1e SSTtDOC TOTFL P. e2 20-d EE~9 L~E 612 ^dou~J .J-~-L 'dEI:21 20-2I-das OCT-25' 02(FRI) 09:28 ROSEVILLE PLBG/HTG. I """,II" L...I........ J QA .~~ -~.1J-t.JOJL II 6514817878 ILt "J';) LIJUL B:45 p, 002 P.Ol I :1 I MINNESOTA DEPAR~ OF HEALTH Di'Yision of Euvirohmental Health REPORT ONlpLANS II Plans and specifications on plumbing: Holiday Sratio~S[O# No. 324,4460 Fountain Hills Drive. Prior Lake, Seen County. Minnesota., Plan No_ 0307~3 I ' OWNBRSIDP: SUBMITTER(S): II Roseville Plumbini and Heating, Jnc_,~" ~uth O~~ Boulevard, St. Paul, Minnesota 55117 I II, I Post-it" Fax, Note 7871 Oelao I To Q Date ReceiVed: October 15. 2002, September 3, 2002 I 'l.~ Phane . Plans Dated: .. Date Reviewed; October 17. 2002 I; Faz;t " ~. SCOPE: Thineview is limited to the desipl of this Parti~"rL. r- -.. - .' ...-. . .' . "'.- ~ :...::" '::" '-::n~-';;"'.. " MiJme$ota PlumbiDg Code, as amended, .pply. 8IId doe:I D<<lcovcr the water supply or iCwmage S)'S~ tif"W'iu"ll. this plumbing system is connected. The review is hued up~ the 6uppo5ition that tbe data em which the design is based are correct, &ad that necessary l~ authority has tx:cR obtained tp construct the projecl. The respcmaibility far the design of strucrutal feature:3 and the efficiem:y of equiP.DDt must be taken by the project desigpet. Approval is contingent upon satisfaclOI)' clispo5it~~n of ~y requiIements #acluded in this report. Spec,ial care mould be tabn [0 inli~ that the material and ltJl5ba11ation of Ehe plumbing system are in ~ce with the provisions of the Minnesota Plumbing Cock. A c~y of thE approved pla:as aDd spedficatiou should be retaiDed lit the project localion for fDtore tefereDce. :! 1 A set of the identified plans and specifications is being re~ed to Rosevi.lle Plumbing and Heating. Inc. Enclosed is a copy of the report and aansmittalleaer to be fJrwarded to the prDject owner. II "INSPECTIONS: All plumbing insta1lati0D5 must be testcc;l ~d inspected in 8CCardanct: with the Rqu.Ue.ImDt.'l of the MiD.Daota Plumbing Code. As specified in Minnesota RhIes. put 471S.283O, DO pJW1bing work may be coveted prior to completing Ihe required t&Bu and inspectiorit ProYisicms muat be made for applying an air ~ at the time of Ehe roughing-in inspection as outlined in Mjnn'~ata Rules, part 4715.2820, subpart 2. of the code. A JIWlomcter test, I' specified in Minnesota Rules. part 4715.2&20, subpart 3. i5 reqWred al the tilnc of the . fu1ishDd plumbing inspection. II is the responsibility of the ~bnU'Kr.orJiustallcr to Dodfy the Minnc50tA Deputmcni at Health when In installation for a rstate cODtra~1 job, licea.sed facility, or project in an Ilea where mere is DO locll1 administnui\lCl authority is ready for an insition and teaL To schedule inspections, eonUlCt the atAte pb~mbiDg sQUjdard5 rcptClSlKlbltlvCl for your reslon. or c~n t~c metro office in8pccdcm hcnline lit 1-800-926- 6216 (7:30 a-IlL to 9 l.m_). or 6j1l21S..o836 (8 R_m to 9 a.m~~ on Monday, Wednesday orFriday_ " 'I REQUIREMENT(S): : 1. The wall hydrants labeled as P7 and PH should be take~ from the potable Water lines- 2. The installation of reduced prcslure z.ane bacJd10w Pt'e~lnEerS i. permitted only when periOdic:: testing is done by I trained back.flow prCvcDter tt8tcr iaCceptable ~ the administrative authority. Testing int~rvals shall not ~c:eed one year, and reconis must be bpt. AU!devices IIlUII be teSted after initial installation 10 assure that debris from the piping iDsta1laIion has not interfemd with the iimctioniDg of the de~ice. The devices lihall be overhauled at least once every five YeaJill~. The iDJtallatioD of new backflow preveDters must be aI Jeallt 12 inches, but hot more thlD 6 feet above the finished floor or ground level. I 3. Verify that roof scuppers discharge to a place of diSPosal\ satisfal=tol)' to the adnainistrative authority_ In no case, Ilhall water from the roofs be allowed to fiG"" upo~ the public sicmwalk. II UL!-':;) U':ltKl) U'j:':1S 1"101.11'" LJ jo.J KU~t V I LLt t'Ltlli/ Hili. r~ 'U:')1 - ~ ,l,:rIJI:.DL b;) 1 q IS 1 i IS i IS u:t L'j LUUL ::;:41:, r. UUJ I"'.Ul Holiday StaUoDslore No. 324 Plumbing Plan No. 030793 Page 2 October 17, 2002 ,I 4. PVC piping complying with ASTM D 1785 fot stonn ~wer piping may be used for sizes of 14 through 24 inches. ' : NOTE(S): ' , 1. The 'cope of Ibis project consisrs of a nc:lW building. 1~~taIJation ibc;;ludes a car wash. bathroom groups. a tb:ree-comparunent sink. caonlel' sink, floor dnrlns. \Na~ softener. water heater. and hose bibbs. II " 2. This facility is 6ervll:d by nl:...... municipal water and $cw~r service counecnons. , . 1 Authorization for construction in ac;c;ordllJ1Ce with the applO~ed plans may be withdmwn if construction is not undertaken within a period of two YC8I'll. The fact rhar. the plaD& bave been approved docs Dot nece&&arily mcaIl that recommendations or requin:mcnts for clumge will not bt:l made at SODIIS larer rime when changed conditions. addhicmal information, or advanced knowledge make improMel1Je:Qts necessary. ~ Public Health Engineer Environmental Health Services Section P.o. BD~ 64975 St. Paul, Minnesota S5164-Q975 651/21S..o840 " , CMT:lss Enc:lO$UR cc: Project Owner Rosev:iUe Plutnbing and He.a.tU"g, Inc. Mr. Robert HUlChins, Plumbing Inspector Department of Agric:ulture Food Inspection Division Plumbing Unir File I " , " II (.. OSEVILL& 'I PLUMBING & HEATING, IN~. 651484-4086 FAX: 651-481-7878 MECHANICAL CONTRACTORS lOCATED AT 65 S. Owasso Blvd. St. Paul, MN 55117 I, ,: " RosevillePlbg@aol.com FROM; ~~o.{/P~ TO: C. . .~:::. 9f ATTN: &ob :1 FAX TRANSMITT~L SHEET Q ff'" , .. I po;'_ tD /L e 'I ,i 'I I NUMBER OF PAGES (INCLUDING COVER SHEET) " 3 I I, ;! I :i II .' I SENDING DATE: /0' ~!>:"- O:L ADDITIONAL MESSAGES: :1 ::I. 0 WI ..(l;w eu.J, >.. q .fl... .("'I!ee/ PI t;n i iRe v.eCJ .tJ.~ .J~e- H<71. J""w s./..,.).,~^ '1 -' L(L..tt.D Pov"rl.....;r- )-/,'/~ [)(. c:;s flClr:['1I!:O)" (P'1,-,'n+.. w__ n ~/~ ~o/<. f"-/.r.,,,.rc.. r::J-r LJM Jpr8,o.J"eI us. ~f" '1"'AH tr;,.,ups.f. r- 0", .J..Je/ +~f1~ .:or&- pID~rl/"..j fH'I p'....r.~ r.c>"-~~ele. 0,", SeJ....,tt/:J, one! bnr;pJ 'I ufo" .U e- ,o/~", r p. v on w I ~ I-l.,.. I s e 4i! nO. pr'okl"W1 W : -1-" -/).0-';" .. P)'(!tI,-e.. Ie-I- WI&. JLftDfc) I-I! yov ~pe nnj iipl~/~'lr' UJ'-<l-J... f/......I-, ~ I .. / !~A(),,1<s 'i 0 " ,I at II IF YOU DO NOT RECEIVE ALL OF THE PAGES. PLEA!SE CALL 651-484-4086 " I, il SHOULD YOU NEED TO REPL V, OUR FAX NUMBER IS 651-481-7878 :1 il '1 il Steve Horsman From: Sent: To: Cc: Subject: Cynthia Kirchoff Monday, April 12, 200410:42 AM Steve Horsman Bob Hutchins; Jane Kansier RE: Holiday Station Store Final LjL//vJ ~ ~ Steve- I inspected Holiday this morning. The sod on the east still looks a little unhealthy. Moreover, so do two of the evergreens planted along Pike Lake Trail. I would recommend they be replaced. Cynthia Kirchoff, AICP Planner City of Prior Lake 16200 Eagle Creek Avenue SE Prior Lake, MN 55372-1714 (952) 447-9813 (952) 447-4245-fax ok fi ~ /~~ q -----Original Message-m- From: Steve Horsman Sent: Monday, April 05, 2004 2:01 PM To: Cynthia Kirchoff Cc: Bob Hutchins; Jane Kansier Subject: Holiday Station Store Final Cynthia: Please re-inspect the Holiday Station Store for Planning Depart. issues as noted on your final inspection ticket in permit file # 02-110. Thank You, Steve 1 Contractor's Material and Test Certificate for A. roce ure on orms to NFPA 13-1994 Upon completion of work, inspection and tests shall be made by the contractor's representative and witnessed by an Omler'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 authori- ties, Omlers and contractor. It is understood the omler'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. All "No" answers shall be explained in the Comments portion of this form. Property Name:Holiday Stationstore #324 PiopertyAddress: 4460 Fountain Hills Dr. Date:lZ-!2.."t:\ B. Plans Prior Lake, MN 1. Accepted by Approving Authorities (Names): 2. Address: 3. Installation conforms to accepted plans 4. Equipment used is approved C. Instructions. I. Has person in charge of fire equipment been instructed as to location of control valves and care and maintenance of this new equipment gg Yes 0 No 2. Have copies of the following been left on the premises: a. System components instructions gg Yes 0 No b. Care and maintenance instructions ~ Yes 0 No c. NFPA 25 ~ Yes 0 No D. Location of system - Supplies building: Main Floor E. S rinklers Make Model Year Made Central TYB Ce r ELOH C8I Yes 0 No Q!l Yes 0 No 2002 2002 o F. Pipe and Fittings I. Type of Pipe: Allied XL & Dyna Flow 2. Type of Fittings: Maliable G. Alarm Valve or Flow Indicator Type I Make I Model ~ax. Time to O~rate Thr?_~w)n~p.:....Iest I-I I H. Dry-Pipe Valve I. Make and Model: 2. Serial Number: I. Quick Opening Device (Q.O.D.) I. Make and Model: 2. Serial Number: J. Dry-Pipe System Operating Test Without Q.O.D. 1. Time to trip through test connection.: 2. Water pressure psi. Air pressure 3. Trip point air pressure psi. 4. Time water reached test outlet.: 5. Alarm operated properly 0 Yes 0 No K. Dry-Pipe System Operating Test With Q.O.D. I. Time to trip through test connection.: 2. Water pressure psi. Air pressure 3. Trip point air pressure psi. 4. Time water reached test outlet.: 5. Alarm operated properly L. Deluge and Preaction Valves I. Make and Model: 2. Operation: 0 Pneumatic 0 Electric 3. Piping and detecting media supervised 4. Does valve operate from manual trip and/or remote control stations 5. Is there an accessible facility in each circuit for testing 0 Yes 6. Does each circuit operate supervision loss alarm 0 Yes 7. Does each circuit operate valve release 0 Yes 8. Maximum time to operate release: M. Pressure Reducing Valve I. Location and Floor: 2. Make and Model: 3. Setting: 4. Static Pressure: Inlet _ psi, Outlet _ psi 5. Residual Pressure (Flowing): Inlet_ psi, Outlet_psi 6. Flow Rate: gpm .measured from time inspectors test connection is opened allona Ire. pnn er ssoclatlOn, . . ox psi. psi. DYes ONo o Hydraulic DYes 0 No DYes 0 No ONo ONo ONo Aboveground Piping N. Test Description Hydrostatic: Hydrostatic tests shall be made at not less than 200 psi (13.6 bars) for two hours or 50 psi (3.4 hars) above static pressure in excess of ISO psi (10.2 bars) for two hours. Differentia' dry-pipe valve clappers shall be left open during test to prevent damage. All aboveground piping leakage shall be stopped. Pneumatic: Establish 40 psi (2.7 bars) air pressure and measure drop, which shall not exceed 1.5 psi (0.1 bars) in 24 hrs. Test pressure tanks at normal water level and air pressure and measure air pressure drop, which shall not exceed 1.5 psi (0.1 bars) in 24 hrs. O. Tests I. All piping hydrostatically tested at 200 psi for ---1- hours 2. Dry piping pneumatically tested 0 Yes 0 No 3. Equipment operates properly fK) Yes 0 No 4. Do you ct.rtify as the sprinkler contractor that additives :md corrosive chemicals, sodium silicate or derivatives of sodium silicate, brine, or other corrosive chemicals were not used for testing systems or stopping leaks? 5. Drain Test: a. Static pressure reading r gage located near water supply connectiOl. / /0 psi. b. Residual pnssure with valve in test connection open wide _J () S- psi. 6. UndergrOlmd 1nains and lead in connections to risers flushed before connection made to sprinkler piping and veri lied by copy of form No. 13-U 0 Yes 0 No 7. Flushed by installer of underground piping ~ Yes 0 No 8. I f powder driwn fasteners are used in concrete, Ii as representat: ve sample testing been satisfactorily completed? P. Blunk Testing Caskets I. Number used:_ 2. ! .ocations: 3. Number removed: Q. Welded Piping.. If welded piping was used in the sy: tern, complete the follow ng: 1. Do you certify as the sprinkler contractor that welding procedures comply with the require- ments of at least A WS 010.9, Level AR-3 2. Do you certify that the welding was performed by welders qualified in compliance with the re- quirements oLlt least A W~. 010.9, Level AR-3 eg Y ~s 0 No 3. Do you certifY hat welding was carried out in compliance WiLl a documented quality control procedure to insure that all discs are retrieved, openings in the pipe are smooth. slag and other welding residue are removed, and the internal diameters of piping are not penetrated R. Cutouts (Disks) Do you certify th"t you have a control feature to ensure that all CULlUts (disks) are retrieved? ~ Yes 0 No S. Hydraulic Data "ameplate Provided (3 Yes 0 No T. Date left in scn cc (with all control valves open): V. Signatures I. Name of sprinkler contractor: 2. Tests witnessed by: For prop' Y <2\\ e (Signe ): Title: Date:,/ 2 '(2- Of.. For sprinkler contr ctor (Signea): /?tT~ w~. Title: 1t~ Date: I 'Z.. -I 'Z-"'~ V. Comments (This section is for additional explanation and notes. All "No" answers mllst be explained here.) _ (gI Yes 0 No DYes 0 No (gI Yes 0 No ~ Yes ONo ,.~+ o Check here if comments continue on reverse side ofthi$.fomi Form 13-A Page lofl ~ )', (914) R7R-4200 Contractor's Material and Test Certificate for A. roce ure on orms to NFP A 13-1994 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 authori- ties, owners and contractor. It is understood the owner's representative's signature in no way prejudices any claim against contractor for faulty malerial, poor workmanship, or failure to comply with approving authority's requirements or local ordinances. All "No" answers shall be explained in the Comments portion of this form. Property Name: Holiday Stationstore 11324 Property Address: 4460 Fountain Hills Dr. Date: B. Plans Prior Lake, MN 1. Accepted by Approving Authorities (Names): 2. Address: 3. Installation conforms to accepted plans 4. Equipment used is approved C. Instructions. I. Has person in charge of fire equipment been instructed as to location of control valves and care and maintenance of this new equipment 129 Yes D No 2. Have copies of the following been left on the premises: a. System components instructions Qg Yes D No b. Care and maintenance instructions Q9 Yes D No c. NFPA 25 129 Yes D No D. Location of system - Supplies building: At t ic E. Sprinklers Make Model Year Made Central GB 129 Yes D No 129 Yes DNo 2002 F. Pipe and Fittings 1. Type of Pipe: A l1ied XL & DynR Flow 2. Type of Fittings: MR 1 i R h 1 f< G. Alarm Valve or Flow Indicator T e Make Model Max. Time to 0 H. Dry-Pipe Valve II 1. Make and Model: {~ f4 >r F~ II F J 2. Serial Number: I. Quick Opening Devicc (Q.O.D.) 1. Make and Model: 2. Serial Number; J. Dry-Pipe System Opcrating Test Without Q.O.D. 1. Time to trip through test connection.; ;)(;) SEe. 2. Water pressure 110 psi. Air pressure l.{ ~ psi. 3. Trip point air pressure ~.s- psi. 4. Time water reached test outlet.; J. 0 5. Alarm operated properly ~es D No K. Dry-Pipe System Operating Test With Q.O.D. 1. Time to trip through test connection.: 2. Water pressure psi. Air pressure 3. Trip point air pressure psi. 4. Time water reached test outlet.; 5. Alarm operated properly L. Delugc and Preaction Valvcs 1. Make and Model: 2. Operation: D Pneumatic D Electric 3. Piping and detecting media supervised 4. Does valve operate from manual trip and/or remote control stations 5. Is there an accessible facility in each circuit for testing D Yes 6. Does each circuit operate supervision loss alarm D Yes 7. Does each circuit operate valve release DYes 8. Maximum time to operate release: M. Pressure Reducing Valve I. Location and Floor: 2. Make and Model: 3. Setting: 4. Static Pressure: Inlet _ psi, Outlet pSI 5. Residual Pressure (Flowing): Inlet_ psi, Outlet_psi 6. Flow Rate: gpm .measured from time inspectors test connection is opened atlOna Ire prm er ssoclatlon, . . ox pSI. DYes DNo D Hydraulic D Yes DNa DYes D No DNo DNo DNo Aboveground Piping N. Test Description Hydrostatic: Hydrostatic tests shall be made at not less than 200 psi (13.6 bars) for two hours or 50 psi (3.4 bars) above static pressure in excess of 150 psi (10.2 bars) for two hours. Differential dry-pipe valve clappers shall be left open during test to prevent damage. All aboveground piping leakage shall be stopped. Pneumatic: Establish 40 psi (2.7 bars) air pressure and measure drop, which shall not exceed 1.5 psi (0.1 bars) in 24 Ius. Test pressure tanks at nonnal water level and air pressure and measure air pressure drop, which shall not exceed 1.5 psi (0.1 bars) in 24 hrs. O. Tests ]. All piping hydrostatically tested al-2.Q.O psi for --2..- hours 2. Dry piping pneumatically tested 0 Yes 0 No 3. Equipment operates properly lEI Yes D No 4. Do you certify as the sprinkler contractor that additives and corrosive chemicals, sodium silicate or derivatives of sodium silicate, brine, or other corrosive chemicals were not used for testing systems or stopping leaks? ~ Yes D No 5. Drain Test: a. Static pressure reading of gage located near water supply connection i (0 psi. b. Residual pressure with valve in test connection open wide /0..) psi. 6. Underground mains and lead in connections to risers flushed before connection made to sprinkler piping and verified by copy of form No. 13-U D Yes D No 7. Flushed by installer of underground piping ~ Yes D No 8. If powder driven fasteners are used in concrete, has representative sample testing been satisfactorily completed? DYes D No P. Blank Testing Gaskets 1. Number used: 2. Locations: 3. Number removed: Q. Wclded Piping - If welded piping was used in the system, complete the following; 1. Do you certify as the sprinkler contractor that welding procedures comply with the require- ments of at least A WS 010.9, Level AR-3 Ia Yes D No 2. Do you certity that the welding was perfJrmed by welders qualified in compliance with the re- quirements of at least A WS 010.9, Level AR-3 W Yes D No 3. Do you certity that welding was carried out in compliance with a documented quality control procedure to insure that all discs are retrieved, openings in the pipe are smooth, slag and other welding residue are removed, and the internal diameters of piping are not penetrated Ql Yes 0 No R. Cutouts (Disks) Do you certify that you have a control feature to ensure that all cutouts (disks) are retrieved? ~ Yes D No S. Hydraulic Data Nameplate Providcd ~ Yes D No T. Date left in service (with all control valves open): U. Signatures I. Name of sprinkler contrador:S 2. Tests witnessed by: For prop y 0 r (Si Title: Date:/2"2.o,,:>- For sprinkler cont ctor (Signed); Title: Date: V. Comments (Tlds section is for additional explanation and notes. All "No" answers must be explained here.) ..--....... .,,.~: . D Check here if comments continue on revers" side of thill.form. 'orm 3-A Page ] of I