HomeMy WebLinkAboutBuilding 06-0938 (Well House)
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
q, Z5~Ob
White
Pink
J Yellow
File
City
Applicant
I PERMIT NO. a, .01361
ZONING (offlcc usc)
(\AUrYlIliV,\ ~~ ~
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PIDZo.<315.00/.0
OWNER
(Name)
(Phone) cr;2 '-14=1- q8Q 1
(Address)
I' BmLbER ~ ~
(Company Name) ~+ A ()
I (Contact Name) ~~ ~;-
(Address)
llt~(J
(Phone)
(Phone)
TYPE OF WORK 0 New Construction ODeck OPorch ORe.Roofing ORe.Siding OLower Level FinIsh 0 Fireplace
DAddition DAlteration DUtility Connection
CODE: OLR.C. OLB.C. o Misc. W
Type of Construction: I II III IV V A B PROJECT COST /V ALUE
Occupancy Group: A B E F H I M R S U (excluding land)
Division: I 2 3 4 5
I hereby 'rtify that I have furnished mformation on this application which IS to the best of my knowledge true and correct. I also certify that I am the owner or authollzed agent fel< the
above-m nt ned property and that all construction WIll conform to all eXlstmg state and local laws and will proceed m accordance with submllted plans, I am aware that the buildmg
official ca re ,ke Ihlslermlt for JU t cau I1"lhermore, I hereby agree that the Clty official or a desIgnee may enter upon the propeny to perform neede mspecl10ns
q
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Contractor's License No,
x
Sewer/Water Connection Fee
#
#
$
$
$
$
$
$
I $
$
$
.......,
Permit Valuation
Permit Fee
$
$
$
$
$
$
$
$
Park Support Fee
SAC
#
#
Water Meter Size 5/8"; I";
Pressure Reducer
Water Tower Fee
Builder's Deposit
Other
This
TOTAL DUE
ThIS IS to certify that the request m the abov lOn and accompanymg documents is m accordance with the City Zoning Ordmance and may proceed as requested, TIllS document
when signed by the City Planner conS'l1tutes a temporary Certificate of Zonmg compliance and allows constructlOn to commence, Before occupancy. a Certificate of Occupancy must be
issued
/cJ -;}3 -o{'
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Avenue Prior Lake, MN 55372
Special Conditions, if any
White - Building
Canary - Engineering
cPink - p!!!lnlnv
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
9~
,
"",~,
The Building, Engineering, and Planning Departments have reviewed the building permit
apPlicatio~~str~~~ion activity which is proposed at:
Accepted
Denied
)(!
Accepted With Corrections
Reviewed By:
y#~
Date:
/0-:2.3 - at ,.'
-<
Comments:
"The issuance or granting of a permit or approval of plans, specifications and
computations shall not be construed to be a permit for, or an approval of, any violation of
any of the provisions of this code or of any other ordinance of the jurisdiction. Permits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."
7~'
/
White - Building .
~rv - t::ngm~eri~
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
Pr/or i4kp (;?t3 tf/c/rd
9- ?~--h
NAME OF APPLICANT
APPLICATION RECEIVED
1
The Building, Engineering, and Planning Departments have reviewed the building permit
appiication for construction activity which i~ at: _
/?tJ~'j .' ~/y;J}a /J/U .
Accepted
x
Accepted With Corrections
Denied
Reviewed By:
~
Date: It?- 2' '06
Comments: See Reverse Side for Additional Informationl
See Attachments: 1) Grading Pla.I42) Erosion Control Measures
"The issuance or granting of a permit or approval of plans, specifications and
computations shall not be construed to be a permit for, or an approval of, any violation of
any of the provisions of this code or of any other ordinance of the jurisdiction. Permits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."
White - Building
Canary - Engineering
Pink - Planning
NAME OF APPLICANT
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
pr/or hke a~ /;11nd
9- ?5--~
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is propose at:
d/J/V
Accepted
Accepted With Corrections
/
Denied
Reviewed By: (Z, D ~~ Date:
Comments: --l. M~~ + ELC~ ~~ t>r'> ~.
II 115/~
I
"The issuance or granting of a permit or approval of plans, specifications and
computations shall not be construed to be a permit for, or an approval of, any violation of
any of the provisions of this code or of any other ordinance of the jurisdiction. Permits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."
:iir_-:-~
PRIOR LAKE DEPARTMENT OF
. BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS 11. c..t 3> AC>~~~N . >-- C;, E-:
NATURE OF WORK \ 1L:- N~
,
USE OF BUILDING \UW'? t-\-OV)6-
PERMIT NO. DATE ISSUED
CONTRACTOR C\T'1 c:J(c- Yr-\ot1-~($" PHONE 4~,-q~\,
,
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELO~
THE PERMIT IS BY SEPARATE DOCUMENT
INSPECTOR
DATE
I FOOTING [
I FOUNDATION (Prior to Backfill) I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING
INSULATION
ELECTRICAL
PLUMBING
HEATING (if required)
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
," I I
FINALS
GRADING (Prior to Sodding)
BUILDING
ELECTRICAL
PLU~JqING
F
.~~
I,_~
, ~
Man
,,,.(
:)i'lliaHon of Vuloan MeUlMl. c~nv
P 0 Bmc 530390
B1rm1nQ~. AL 35153-0380
MATERIAL SAFETY DATA SHEET
24 Hour Emergency Phone 316/524-5751
SECTlON 1 PRODUCT IDENTlF1CA TlON
CHEMICAL NAME
Chlorine
CHEMICAL FORMULA
Cl:z
MOLECULAR WEIGHT
70.90
PRODUCT NAME
Chlorine
SYNONYMS
Uquid 'Chlorine
DOT IOENnFICA nON NO.
UN 1017
SECTION -t' COMPONENT DATA
C;HEMICAL NAME
CAS NUIlAB~
~ Iwt.1 ApDrox
OSHA Pet
· Chlorine
7782-50..5
100
1.0 ppm Ceiling
. C.not.. chemic:~ ,ubioet to reponing requirements of Section 313 of Tide III ot the 1986 SUp"',fund Amendments Bnd RBBUd.,ori~lItion
Act (SARA) and 40 CfR Psn 372 .
SECTION 3 PHYSICAL DATA
APPEARANCE AND ODOR
Greenish-yellow gas. amber liquid;
pungent odor
SPEaFlC GRAVm
Liquid -- 1.467 @ aoe
BOUN<: POINT
-29.JoF (-34.QoC)
VAPOR DENSITY IN AIR (Air = 11
2.5
VAPOR PRESSURE
71 psia @ 60QF
'}l, VOlA TILE BY VOlUME
100
~APORA TION RAn:
Not Applicable
SOLUBJUTY IN WATER
Slight
SECTION 4 REACTlVITY INfORMATION
STABIlITY
Stable
CONomoNS TO AVao
Dry chlorine is highly reactive with titanium and tin. Reacts with most metals at high temperatures;.RI13cts
with water to produce hydrochloric and hydrochlo(oos acids. which are corrosive to most metals (See ~iection
8)
INCOMPATIBLE MATERIALS
Ammonia. elemental metals. certain metal hydrides, carbides. nitrides. oxides. phosphides and sUlfic!e'" easily
oxidized materials, organic materials (e.g. petrochemicals. oils. greases) and unstabltt and reaclive- -
compounds. .
1
(0 O~
HAZAJa)'QUa DECOMPOSmCN PROCUCT8
Wiil not decompose.
HAZARDOUS POL YMERIZA TION
Will not occur.
SECTION 5 F1RE AND EXPLOSION HAZARD INFORMATION
R.ASH PO&NT
None
R.AMMABLE UMITS IN AIR
Non-flammable but does support combustion.
EXTlNGUISHINQ MEDeA
None
NFPA RATINGS
Health 3; Rammabili'tY 0; ReactivitY 0; 0 X
UNUSUAL RAE AND EXPLOSION HAZARDS
Apply water to ke6p containers cool. 00 not apcly water to leaking containers. refer to ReactivitY Data,
Section 4. Remove chlorine containers from fire zone if pO$3ible. Firefighters $hould wear self-contained.
positive-pressure breathing apparatus,. and a one piece, total-encapsulating suit of Butyl coated nylon or
equivalent.
SECT10N 6 TOXICITY AND FIRST AID
EXPOSUAESTANDARDS
ACGIH: 0.5 ppm (8 hrl TWA, 1 ppm STEL
OSHA: 1.0 ppm Ceiling
IMMEDIATELY OAJ\lGEROUS TO UFE OR HEALTH:
IOLH: 30 ppm
IOdor threshold apPTo)(imately 0.3 ppm - highly variable especially with individuals routinely exposed)
Whdn oxpoluro to tN. product and other chemicals is concurrent. th~ dxposure limit: must bo dcfinlld in the workplace. Effects d_ucrit:l~d
In thl. aection .r. a.M'."'" .....1: to occur if ~o.ur.. ora maincDinad oC or bGlow tko approprioto TLV.,. nowevor boo.use of t.... ""ide
"ari.OOR in indi..;auallluscaptibility, thoso oxposure limits mev not be applicable to all pereons and those with the medical conditions
listed below.
UEDICAL CONDmONS A.GGAAVA TED BV EXPOSURE
Asthma, bronchitis. emphysema and other lung diseases, and chronic nose. sinus or throat conditions.
ACUTE TOXICITY
~IMARV ROUTES OF EXPOSURE
Inhalation
1NHAl.A noN
MaioI' po~ential route of exposure. Chlorine is a respiratory irritant. Concentrations of 3-6 ppm can cause
irritation of the nose and mucous membrane of the upper respiratory tract followed by headache and
coughing. 10 ppm can cause severe irritation of respiratory tract with 15-20 ppm causing intense cough.
Other symptoms of overexposure can include nausea. vomiting. dizziness, shortness of breath and chest pain.
Pulmonary edema and chemical pneumonia can develop and may occur hours after exposure. EXDosures to
concentrations above 2S ppm can cause unconsciousness and death. E.xposures to humans to .5 ppm for a
hours and 1 ppm for 4 hours have caused transient decreased pulmonary capaci~. as measured by pulmonary
function tests. In persons exposed to acute. non-lethal levels. decreased pulmonary capacitY is followed by a
gradual return to normal. In some cases long lasting effects have been observed.
SKIN
Liquid contact can cause local irritation and burns. Chlorine vapors can cause irritation. burning and blisters.
EYE
Liquid contact can cause irritation and burns. Vapor concentrations of 1 ppm can cause redness. teari"lg and
irritation of eyes.
;
INGE5nON
Chlonne is gas at room temperature. Ingested liquid chlorine can cause severe bums of mouth, esoph.lgus
and stomach. Nausea and' vomiting :are likely to occur.
2
RRST AID
INHALATION
If person eJqJ6riences nausea. headache, dizziness, difficulty breathing or ather symDtoms. remove to fresh air
unol Iymotams disappear. If breathing remains difficujt. administer oxygen and contact a Dhysici.an
..~ " immediately. tf breathing stops, start artificial respiration and call for emergency assistance. Keep patient
--.,.. 'I warm and at rest.
Note to Physician: Monitor closely for delayed onset of pulmonary edema and chemical pneumonia. Provide
treatment as is medically indicated.
SKIN
Remove contaminated c:fothing and shoes. Wash exposed area thoroughly with large Quantities at Water for
at least 1 5 minutes. Wa:sn contaminated clothing before reuse.
EVES
Flush eyes immediately with water for at least 15 minutes, periodically lifting the upper and lower eyelidS.
Call .a physician at once if irritation of the eyes, skin or other body surfaces p8rsists.
lNaeanOH
Do not induce vomiting. If person is conscious, give water or milk and contact physician immediately. 00
not give anything by mouth jf unconscious.
CHRONIC TOXICJTY
Numerous studies nave been conducted 1:0 determine the potential chlorine has to cause chronic effects. In
rat3 exgosed tD conCBntraOons up to 9 ppm for 6 hours a day, 5 days a week for 6 weeles. decreases in tiody
weight and inflammation of the respiratory uact were observed. At exposures of 3 and 9 "pm, changes in
the liver and kidneys were 3Jso noted. Rabbits and guinea pigs exposed to 1.7 ppm for 9 months showed
weight IOS3 and a decreased resistance to disease.
No adverse effects were observed in rabbits and guinea pigs at levels of .7 ppm. Guinea pigs exposed to ,1 .6
ppm for 5 hours a day~ for 47 days and injected with tuberculosis (bacterial displayed shorter life cycles, than
, those eJeposed to just one at the agents. Aats with pUlmonary disease ~howed an increased response to
'chlorine. Rhesus monkeys e:xposed to concentrations up to 2.3 ppm for 6 hours a day, 5 days a week Tor
one year did not exhibit any signs of chronic toxicity, except for eye irritation.
A study of SOO diaphragm cell workers from 25 plants with an average duration of exposure at 11 years
exposed to .006 to 1.42 ppm, showed no statistically significant increase in <Ibnormal chest lNays. EKGs or
pulmonary function tests.
CARClNOGENICJTY
One STudy has been conducted to e"3Juate chlorine's ability to cause cancer in experimental animals. Seven
generations of rats were exposed by ingestion to highly chlorinated water daily (100 mglliter). No increased
incidences of tumors were observed.
Chlorine is nOt listed on the !ARC, NTP or OSHA carcinogen lists.
AEPRQOUCTNE TOXJaTY
Two studies have been conducted to a~sess the ability of chlorine to cause reproductive effects. Rabbits
exposed by inhaJation to concentrations up to 1.5 ppnt and rats exposed by ingestion to highly chlorinated
drinking water daily for seven generations did not display any adverse reoroductive effects.
SECTION 7 PERSONAL PROTECTION AND C()NTROl~
RES~RATORYPAOTEcnON
Where vapor concentration exceeds or is likely to exceed 0.5 porn, a NIOSH/MSHA approved full face
chlorine type respirator is acceptable. A NIOSH/MSHA. approved self-contained breathing ape;l3ratus, with full
facepiece, is required for vapor concentrations above 30 pprn and for leaks and/or 8mergencies. Follow any
~. applicable respirator use standards and regulations.
3
~nQN
As necessary to maintain vapor concen1:rations below 1 ppm, at aU times.
SKIN PROTECTION
Wear cotton or lother gloves during normal operations to avoid freeze bums.
'\
:vi: PROTECTION
Waar safetY gfas3es. Contact lenses should not be worn. Chemical goqglEls should be worn when operating
valves and connecting or disconnecting chlorine lines.
HYGIENE
Avoid conaC1; with skin and avoid breathing vapors. Do noe eat. drink, or smoke in work area. Wash hands
prior to eating. drinkino. or using restroom. Anv clothing or shoes which become contaminated with chlorine
should be removed immediately and thoroughly laundered before wearing again.
OTHER CONTROl. MEASUReS
To detormine the exposure leveHs). monitoring should be performed regularly. Wear respirator while operating
valves and connecting or disconnecting lines. SafetY shower and eys wash fountain should be available.
NOTE: Protective equipment and clothing should be selected. used, and maintained according to applicable
standards and regulations. For further information, contact the clothing or equipment manufacturer or me
Vulcan Chemicals Technical Service Department.
SECTION 8 HANDLING AND STORAGE
Follow protective controls set forth in Section 7 when handling this product.
Do not attempt to handle, store. or use chlorine without: complere review of The Chlorine InstItute's Chlorine
Manual. Any use ~ OJ pesticide must be in a manner consistent wit" the labeling.
Store progerly labeled containers in <I cool. dry, well-ventilated area and away from basements. pits. etc.
Room vents should be located at floor level. Vapors are heavier than air and will collect in low areas. Do not
enter confined :spaces such 83 tanu or pic without following proper entry procedures as required b~ 29 CFR
1910.146. Do not 30ply heat to a chlorine container. Do not remove or deface label or tags.
Chlorine piping and equipment must be thoroughly cldaned of organics and moisture before use. Keep
chlorine piping and handling equipment clean and dry. Liquid chlorine lines must have suitable expansion
chambers between block valves due to the high coefficient of expansion.
SARA Title UI Hazard Categories: Immediate Health. Fire. Sudden Release of Pressure.
SECTION S SPilL LEAK AND DISPOSAL PROCEDURES
STEPS TO BE TAJCEN IN CASE MATERIAL Ie AELEASED OR SPlL1..EO
Move unprotected personnel uDwind or crosswind out of danger area. Wear one-piece. total encapsulating
suit of Butyl coated nylon or equivalent with self-contained br~athing apparatus. Isolate leak to whatever
extent possible. If a chlorine container is leaking. trY to position it so that gas rather than liquid leaks; apply
emergency kit device if possible. For other than minor leaks. immediately implement predetermined
emergency plan. Call CHEMTREC or supplier when help is needed. Aep-onable Quan-tity (RO) is 10 Ibs.
Notify National Response Canter (800/424.aa02) of uncontained releases to the environment in excess of the
RO.
WASTE DISPOSAL. METHOD
Chlorine gas will disperse to the atmosphere leavinQ no residue. Chlorine may be neutralized by intrOducing it
in to caustic 3oda. soda ash. or hydrated lime. UqUid <lnd/ar SOlid residues from neutralization must be
disposed of in :II ptitrmitted waste management facility. Consult federal. state, or local disposal authorities for
approved procedures.
4
~EcnON 10 TRANSPORTATION INFORMATION
DOT SHIPPING DUClUPTlCN 149 C:FA 172.. 10 11
Chlorine, 2.3, Pensen Gas, UN 101 7. RQ
Poison-Inhalation Hanrd. Hazard Zone a, Marine Pollutant
· ..,~'uu.a. REQUIRED
..,. Poiaon Gas. CJasa 2, Cotrosiw
Label as required by OSHA Hazard Communication Standard, and any applicable state and local regulations.
PLACARO ReQUIRED
Poison Gas, , 017, Cla.s~ 2
:,i:~?::::::~;~~{'?::;~:;~~?13:I;;~E:i~~~~~~;:.~:;::::;;(:r::,:.~'.'/,~:.:::: " "'J~: '~;':'~:':::'::':'::.:.:::.\:.:::<" .' .~.. .~:.: . ;..:......:: ...... .... :'. :'-:::'.;."
:::.'~ Medrc3f'. i:merOl!l1C:les;:~'7;;:;;:;.'...:='"':";;,~",,~:~;~:;;::;:-:,::,;;.;,:...;. ,;:^::. ::~>;.. .. ";. :":.:;'..~. For.: anv' offier: iiTformatfon contact:. . .. .. . . '.:' ..... . :.:
_.~lI~:~IE!lf}::;~is.~~.~~J~-::
.:.:Z'::.:;.cajf::31~I5.Z4;.i..~:sst:f;2~:;Hour.st.;;;.:;.:.....::...:.:.;:. :~.::..;.:..,:..,' ~.~-:"~':::. : .. ,. ~ '.:: 8"AM:-'5.: PM~' Cantral Time. .. ._:'. :". '.
~~~~;;~~~;~i/;~~fKS'",;::t~~,,_~~~;~,gh Friday- .. .. ..':,/
.:::i~.~.NdTi~~~k8ri;'ci1d;t~iiri:' oVu:'ifi.t:il'i':i"to'mu.t;a~~CO':J(ain'cid'gn:.t"is: rn~t8n8i:.uf.;tY. dllt8' shIMf ia'acetJrato.. The $uggastlt,l .:..........
;::~~::-'proci~u;~~.: .~:b~<idtOn.:~.riiiRc~~i....o-=n:;lt~d8fa ;, '~i:i;ic'.tian~ ..Th~>,l' a~1t nQ'r;'~e..arihf. 1I1r';ncIUlSive. nor. fully adequlIto lIT tI"e'~.: ,::'.;."
1li1llti.li~l~tf~i'f#j~!~'~>lj
date of Preparation: January " 1995 (A..\IIslId. Reformatted and RdQrinted: January 15. 1996)
FORM 3239-310
..., ~
'. ,
5
c-s
'-,
\
)
~J)~(:=>~
P.O. Box 1346
Pittsburgh, PA 15230-1346
Phone-(412)494-8000
CHEMTREC. 1-800-424-9300
MATERIAL SAFETY DATA SHEET
Section 1. PRODUCT IDENTIFICATION
PRODUCT NAME: c-s
CHEMICAL DESCRIPTION: tmitf@l.Isptwspha1Q sollJtion
PRODUCT CLASS: Corrosion and deposit Inhibitor
MSDS CODE: OK26
Section 2. INFORMATION ON INGREDIENTS
CMmlca\ Name
CAS
Number
%by
Wel~ht OSHA PEL
ACG1H n..V
"No ingredients listed in this section.
This product Is not considered to be hazardous according to the criteria of the U.S. Federal OSHA Hazard
Communication Standard'(29 CFR 1910.1200) and is not a controlled product under WHMIS in Canada
Section 3. HAZARDS IDENTIFICATION
**** ******** **** *** * * EMERGENCY OVERVIEW
*********************
Clear. slightly viscous liquid.
This product poses little or no immediate hazard.
************~***************************************************
PRIMARY ROUTES OF ENTRY: None
T ARGEr ORGANS: None
MEDICAL CONDITIONS AGGRAVATED BY EXPOSURE: None known
POTENTIAL HEALTH EFFECTS:
EYE CONTACT: This product would be classified as practically non-irritating!o the eye.
SKIN CONTACT: The product is not expected to cause skin irritation upon contact. No data is available to
suggest that this product may produce an allergic skin reaction or be absorbed through the skin in
harmful amounts.
MSDS Code: 0K26
Issue Date: 8120/97
Page 1
Continued on Page 2
)OOCp
C-5
-")
INGESTION: This product would be considered practically non-toxic by ingestion. If ingested in large
amounts. nausea. vomiting, and diarrhea are probable. Since phosphates are slowly and incompletely
absorbed, systemic reactions are unlikely when these salts are swallowed. Polyphosphates are thought
to be hydrolyzed to orthophosphates before absorption. which may Induce a metabolic acidosis. If
appreciable amounts of the intact polymer are absorbed from the alimentary tract, hypocalcemic tetany
(muscular contractions, pains, tingling, etc. caused by a deficiency of calcium salts) may be a danger
due to the binding of ionized calcium.
INHALATION: This product Is not expected to present an inhalation hazard.
SU8CHRONIC, CHRONIC:
No applicable lnfonnatlon was found concerning any potential health effects resulting from subchronic or chronic
exposure to the product.
CARCINOGENICITY:
NT?:
.No ingredients listed In this section"
fARC:
.No ingredients listed in this section.
OSHA:
.No Ingredients listed In this section.
Section 4. FIRST AID MEASURES
EYE CONTACT: Not expected to require first aid measures. However, follow good industrial hygiene practices and.
In case of co~ntact, flush eyes with plenty of water.
SKIN CONTACT: Not expected to require first aid measures. However, follow good Industrial hygiene practices and,
in case of contact. wash affected skin areas thoroughly with soap and water.
INGESTION: Not an expected route of overexposure. If swallowed, do not induce vomiting. Call a physician. This
product would be expected to be practically non-toxic by Ingestion.
INHALATION: Not an expected route of overexposure. However. if exposure by Inhalation Is suspected, move
individual to fresh air. Aid In breathing if necessary and seek medical aid if symptoms occur.
Section 5. FIRE-FIGHTING MEASURES
FLASH POINT: None
LOWER FlAMMABLE UMIT: Not available
UPPER FLAMMABLE LIMIT: Not available
AUTO-IGNITION TEMPERATURE: Not available
EXTINGUISHING MEDIA:
Use extinguishing media appropriate for the surrounding fire.
FlRE-AGHTING INSTRUCTIONS:
Exercise caution when fighting any chemical fire. A self-contained breathing
apparatus and protective clothing are essential.
F\Rl: &. E."X?LOS\O~ \-\~f\DS: No \1\iusua\ na1.aros.
MSDS Code: 0K26
Issue Date: 8/20/97
Page 2
Continued on Page 3
C-5
p) DECOMPOSITION PRODUCTS: Thermal decomposition or combustion may produce dlsodium oxide and phosphorus
oxides.
NFPA RATINGS:
'ealth = 0 F1ammabill~ 0 Reactivity ~ ~
Hazard rating scale: O..M"llimal1..sllght 2..Moderaf8 3=Serious 4=Severe
Special Hazard = None
Section 6. ACCIDENTAL RELEASE MEASURES
STEPS TO BE TAKEN IF MATERIAL IS RELEASED OR SPILLED: Wearing appropriate personal protective
equipment, contain spill, collect onto inert absorbent and place Into suitable container.
Section 1. HANDLING AND STORAGE
HANDLING: As part of good industrial and personal hygiene and safety procedure, avoid all unnecessary
exposure to the product and ensure prompt removal from eyes, skin and clothing.
Wash thoroughly after handling. Keep container closed when not in use.
STORAGE: Froduct must be maintained at 3S"F or higher. Protect from low temperatures.
Section 8. EXPOSURE CONTROLS I PERSONAL PROTECTION
PERSONAL PROTECTIVE EQUIPMENT:
EYElFACE PROTECTION: Chemical splash goggles recommended as a good Industrial hygiene practice.
SKIN PROTECTION: No special requirement.
RESPIRATORY PROTECTION: None required.
ENGINEERING CONTROLS: No specific recommendations.
Section 9. PHYSICAL AND CHEMICAL PROPERTIES
BOILING POINT: > 212.F
SOLUB1LliY IN WATER: Complete
VAPOR PRESSURE: Similar to water
SPECIFIC GRAVITY: 1.37 - 1.42 @ 25.C
VAPOR DENSITY (alr=1): Similar to water
pH: 6.0 -7.0 @ 25.C
%VOLAllLE BY WEIGHT:
- 62 (water)
FREEZING POINT: Not available
APPEARANCE AND ODOR: Clear, slightly viscous liquid.
MSDS Code: 0K26 Page 3
Issue Date: 8/20/97 Continued on Page 4
C-5
.~ Section 10. STABILITY AND REACTIVITY
CHEMICAL STABILITY: Stable
HAZARDOUS POLYMERIZATION: Will not occur
CONDITIONS TO AVOID:
No specilic Information.
INCOMPATIBILITY: Carbon steel
DECOMPOSITION PRODUCTS: Thennal decomposition or combustion may produce dlsodium oxide and
phosphorus oxides.
Section 11. TOXICOLOGICAL INFORMATION
ON PRODUCT:
Product Oral LDso (rat): > 5 g1kg
Eye Irritation: Instillation ot 0.1 ml of the product In rabbit eyes produced slight conjunctival irritation but showed no
iritis or corneal opacity. All eyes cleared by day 2. The eye scores on day 1 ranged from 0 - 4/110.
Skin Irritation: The primary skin Irritation index (rabbits) Is 0.21/8.
Section 12.. ECOLOGICAL INFORMATION
ON PRODUCT:
Aquatic toxl~lty data:
96 hr LCso (fathead minnow): 1,162 ppm
Environmental data:
Although the principal problem of phosphates In the environment Is not directly related to human health, there Is
considerable concern about the effects of phosphorus from various sources on water quality. Phosphate Is a major
cause of the eutrophication process in lakes and ponds.
Section 13. DISPOSAL CONSIDERATIONS
RCM STATUS: Discarded product, as sold, would not be considered a RCRA Hazardous Waste.
DISPOSAL: Dispose of In accordance with local, state and federal regulations. Keep from entering streams or lakes.
Section 14. TRANSPORT INFORMATION
DOT CLASSIFICATION:
Class/Division: Not restricted unless shipped In a quantity> 13,251 Ib, then: 9
Proper Shipping Name: environmentally hazardous substance, liquid, n.o.s. (contains Sodium phosphate,
tribasic), AQ
Label: CLASS 9
Packing Group: III
10 Number: UN 3082
MSDS Code: OK26
Issue Date: 8/20/97
Page 4
Continued on Page 5
C-5
"
) Section 15. REGULATORY INFORMATION
OSHA Hazard Communication Status: Nonhazardous
TSCA: The ingredients at this product are listed on the Toxic Substances Control Act (TSCA) Chemical Substances
Inventory.
CERCLA reportable quantity of EP A hazardous substances in product:
Chemical Name
Sodium polyphosphate
Sodium tripolyphosphate
.8Q..
5000lb
5000lb
Product RQ:
13,251 lb
(Notify EPA of product spills exceeding this amount.)
SARA TITLE III:
Section 302 Extremely Hazardous Substances:
Chemical Name CAS # .BQ..
There are no SARA 302 Extremely Hazardous Substances in this product.
IeQ...
Section 311 and 312 Health and Physical Hazards:
, Immediate Delayed Fire
[no] [no] [no]
Pressure
[no]
Reactivity
[no]
Section ~13 Toxic Chemicals:
Chemical Name CAS #
There are no reportable SARA 313 Toxic Chemicals in this product.
% by Weicht
FDA: This product Is FDA approved under 21 CFR Section(s):
173.310 (Boiler water additives)
176.170 (Components of paper and paperboard in contact with aqueous and fatty foods)
176.180 (Components of paper and paperboard in contact with dry food)
Consult your sales representative for any use limitations.
Section 16. OTHER INFORMATION
HMIS RATINGS: Health = 0 Flammability = 0
Personal Protective Equipment = A
Reactivity ::: 0
Hazard rating scale: o--Mlnlmal1::Sfight 2=Moderate 3=Sertous 4..severe
MSDS REVISION SUMMARY: Supersedes MSDS issued on 2110/97. Only the MSDS Code has changed.
MSDS Code: 0K26
Issue Date: 8120/97
Page 5
Continued on Page 6
C-5
"
\
While this informacion and reco~endacloas set f~rCb herein are believed to be accuraCe aa of the data hereof. CALGON
CORPORATION HAKES NO WARRANTY tilTH RESP!:CT HERETO AND DISCLAIMS ALl. l.IABII.ITY FROM RBLIAlICE 'nIBRBON.
PREPARED BY:
P.J. Maloney
MSDS Code: 0K26
Issue Date: 8/20/97
Page 6
Last Page
..
MATERIAL SAFETY DATA SHEET
.~
This Information
is provided for
your protection
by:
LeI LTD
THE fLUORIDE SPECIALlST
1-904-241..1200
I~'" . ....__" . __--..
SPECIAL NOTICE
OX = Oxidizer
ACID ~ Add
ALK = Alkaline
COR . Corrosive
= Usa No Water
Af" .. Radiation Hazard
REACTIVITY
4 = May Detonate
_ 3 = Shock & Heat May Delonate
~ 2 = Hazardous
1 '" Slighlly Hazardous
o = NormaJ Material
For 24 Hour
Emergency
Assistance
Call:
CHEMT1REC
1-800-424..9300
\~
Responsible C~re
A Public Cummitment
,
FLUOROSILICIC ACID
. "
SECTION I
SECTION II
SECTION III
SECTION IV
SECTION V
SECTION VI
SECTION VII
SECTION VIn
SECTION IX
SECTION X
SECTION XI
flu' ~ /'Z./t,4l-.!?
,. !/'(
Product Name And Description
Personal Protection Information
Health Information
Emergency And First Aid Procedul'es
Ingredients
Physical Data
Reacti vi ty
Fire And Explosion Hazards
Storage And Special Precautions
Transportation Requirements'
Emergency Action - (Spill or Leak)
/or(P@
"
MATERIAL SAFETY
5 H E E.T
DATA
Supplier: LeI Ltd_
24 Hour Emergency Assistance:
Chemtrec 1 - 800 - 424 . 9300
Address: P. O. Box 49000
Ja'cksonvilfe Beach, FL 32240-9000
1 - 904 - 241 - 1200
Section I
PRODUCT NAME AND DESCRIPTION
DOT Chemical Name: . Fluorosilrcic Acid
Synonyms:
Hydroffuosilicic Acid, Fluosilicic Acid, HexafJuosilicic Acid
. .
Chemical Family: . Inorganic Acid
CAS Number: 16961;-83-4
Note: N/A indicates Not Applicabl"e where shown.
Fonnula: H2SiF6
NIOSH Registry Number: V V B:~25000
Section II
PERSONAL PROTECTION .INFORMATION
Respiratory Protection: A NIOSH approved cartridge respirator with fuJI-face shield. Chemical
cartridge should provide protection against acid fumes, (Hydrogen Fluoride). For concentrations
greater than 20ppm, a NIOSH approved self-contained breathing apparatus with full-f,l( e shield
should be used.
Eye and Face Protection: Use tight-fitting Chemical splash goggles and a full-face shid j, 8 inch
minimum. Contact lenses should not be worn.
Hand, Arm and Body Protection: Prevent contact with skin by use of acid-proof c10thir r~ I, gloves
and shoes. Use a NIOSH approved acid proof suit and boots where liquid or hi~}h vapor
concentration is possible.
Other Protective Clothing and Equipment: Eye wash and emergency shower facilitie'5 should
be available in handling area.
Engineering Controls: General or local exhaust systems sufficient to maintain vapors below
2.5mg/m3 (as F).
Fluorosilicic Acid .. MA TERtAL SAFETY DATA SHEET
Page 3 of 6
Section III
HEALTH INFORMATION
OSHA Permissible Exposure Limit (PEL): 2.5mg/m3 (as F)
ACGTH Threshold limit Value (TLV): 2.5mg/mJ (as F)
Listed in the following -
Department of Transportation Hazardous Materials Regulations (49CFR)
Massachusetts Hazardous Substance list
Toxic Substances Control Act Inventory of Toxic Substances (TSCA)
OSHA Health Hazard Classification: Corrosive
-
Primary Route(s) of Entry: Eye and skin contact, inhalation.
Symptoms of Exposure:
Acute: Liquid or vapors can cause severe irritation and burns which may not be apparent
for hours_ Can cause severe irritation to the lungs, nose and throat. If swallowed, can cause severe
damage to throat and stomach.
Chronic: Prolonged exposure could result in bone changes, corrosive effect on mucous
membranes including ulceration. of nose, ttlroat and bronchial tubes, cough, shock, pulmonary
edema. Fluorosis, coma and death.
Aggravated Medical Condition: Any skin condition and/or pre-existing respiratcr'l disease
including asthma and emphysema.
Toxic Data: LDso 200 mglkg (Oral - Guinea Pig)
Section IV
EMERGENCY AND FIRST AJD PROCEDURES
Inhalation: Remove exposed person to c=.n uncontaminated area immediately. If breathing has
stopped, start artificial respiration at once. Oxygen should be provided for an exposed person
having difficulty breathing (but only by an authorized person) until exposed person ; S able to
breathe easily by themselves. Exposed person should be examined by a physician.
Eye Contact: Flush eyes for at least 15 minutes with large amounts of water. i::yelids should be
held apart during the flushing to insure contact of water with all accessible tissue of the eyes and
lids. Medical attention should be given as soan as possible.
Skin Contact: Exposed person should be removed to an uncontaminated area and subjected
immediately to a drenching shower of water for a minimum of 15 to 20 minutes. h~~move all
contaminated clothing while under shower. Medical attention should be given as soon as possible
for all bums, regardless of how minor they s~em.
L.
1. .'
Fluorosilicic Acid - MATERIAL SAFETY DATA SHEET
Page 4 of 6
Ingestion: tf conscious, give the exposed person large quantities of water immediately to dilute
the acid. Do NOT induce vomiting. Milk may be given for its soothing effect A physician shoutd be
contacted immediately.
Note to Physician: Beware of late onset of pulmonary edema for up to 48 hours. Treat severe
bums similar to Hydrofluoric Acid exposure.
Section V
INGREDIENTS
Composition
H2SiF6
H20
Percentage
25.0 :!: 2%
75.0 :: 2%
Section VI
PHYSICAL DATA
I
Boiling Point:: 2220 F or 1500 C Melting Point: -40 F
Specific Gravity (H20 = 1): 1.234 @ 25% Vapor Pressure (mm Hg): 24 @
nOF
Percent Volatile by Volume: N/A Vapor Density (Air = 1): N/A
Solubility in Water: Complete Evaporation Rate: N/A
Physical State: Fuming Liquid Molecular Weight: 144.06
Bulk Density: 10.291bs/gal @ 25% pH (1% Solution): 1.2
Appearance and OdC?r: Water white to straw yellow, burning liquid, with pungent odor.
Section VII
REACTIVITY
Stability: Stable.
Hazardous Polymerization: Will not occur.
Conditions and Materials to Avoid: Metal, glass, stoneware, alkali and strong concentrated
adds.
Hazardous Decomposition Products: When heated to decomposition (22rF), it emits highly
toxic and corrosive fumes of Hydrogen Fluoride, Silica Tetrafluoride and Hydrogen Gas_
Fluorosificic Acid . MATERIAL SAFETY DATA SHEET
Page 5 of 6
Section VIII
FIRE AND EXPLOSION HAZARDS
Flash Point and Method Used: N/A
Flammable limits. % Volume in Air: Lower N/A Upper N/A
Extinguishing Media: Use agent which is appropriate for surrounding fire.
Special Fire Fighting Procedures and Precautions: Wear NIOSH approved self-contained
acid suits.
Auto Ignition Temperature: NJA
Unusual Fire and Explosion Hazards: Reacts with many metals to produce flammable and
explosive hydrogen gas. Keep container cool with water, using fog nozzles, as decomposition will
occur above 2210F and produce toxic and corrosive fumes of fluorides.
Section IX
, STORAGE AND SPECIAL PRECAUTIONS
Handling and Storing Precautions: Store in containers in cool, dry, well ventilated area away
from sources of heat or ignition. Do NOT sture in glass or stoneware. Use non-sparktng tools.
Keep separate from alkali metals, oxidizing agents, combustible solids and organic peroxid 3S.
Ventilation: Provide adequate general and/or local exhaust to maintain vapors below 2.Smg/m3
(as F).
Other Precautions: Do not inhale fumes and prevent skin contact. rf pungent, irritating odor can
be detected, workers are being over-exposed. Eye wash and safety shower should be available in
aU acid handling areas.
Section X
TRANSPORTATION REQUIREMENTS
DOT Proper Shipping Name: Fluorosilicic Acid
DOT Hazard Class: 8 (Corrosive)
Identification Number: UN 1778
Packing Group: 1/
Subsidiary Hazard Crass: NJ A
EPA Hazardous Substance:
No
Placarding Requirement: Corrosive
Reportable Quantity: NJA
Fluorosilicic Acid - MATERIAL SAFETY DATA SHEET
Page 6 of 6
RCRA Status of Unused Material if Discarded: Not listed.
Hazardous Waste Number: Not listed.
Waste Disposal Method: Disposer must comply with federal, state, and local disposal or
discharge laws.
Additional Comments: For international transportation, Fluorosilicic Acid is regulated by the
International Maritime Organization (fMO) and the International Air Transport Association (lATA)
for vessel and air movement as a Class 8. Packaging, marking, labeling and shipping paper
descriptions must precisely reflect the regulation for export movement.
Section XI
EMERGENCY ACllON - SPILL OR LEAK
Emergency Action: Keep unnecessary people away. Stay upwind, keep out of low areas.
Isolate hazard area and deny. entry. We recommend that the user establish a spill prevention,
control and countermeasure pl~n. This plan should include procedures for proper storage as well
. ) as containment and clean-up of spills and leaks. The procedures should conform to safe practices
and provide for proper recovery and disposal in accordance with federal, state and local
regulation. Contact Chemtrec at 1-800-424-9300 for 24-hour emergency assistance.
Small Spills: Any personnel in area should wear a NIOSH approved air supplied acid suit. Dike
area to contain material. Do not allow solution to enter sewers or surface water. Take up With sand
or non-combustible absorbent material and place in containers for later disposal. I'rovide
ventilation and be wary of hydrogen generation upon reaction with some metals. Contact ('1' emtrec
at 1-800-424-9300 for 24-hour emergency assistance.
large Spills: Contact Chemtrec at 1-800-424-9300 for 24-hour emergency assistance. Any
personnel in area should wear a NIOSH approved air supplied acid suit. Dike area ahead of spill to
contain material. Do not allow solution to enter sewers or surface water. Provide ventilation and be
wary of hydrogen generation upon reaction with some metals. Notify the National Re:,ponse
Centerl if required.
DISCLArMER
The infonnatiol1 presented herein is based on data considered to be accurate and that reflects the requirements of the
OSHA Hazard Communication Standards in effect as of the date of preparation of this Material Safety DatCl Sheet.
However, no warranty 01' representation, express or implied, is made as to the accuracy or completeness of the
foregoing data and safety infonnation. In addition, no l'flSponsibility can be assumed by vendor for any dar1age or
injury resulting from abnormal use; from any failure to adhere to recommended practices, or from any ha~ards inherent
in the nature of the product.
Revised September 1997 by J. Micha~1 Coates
Regulatory Compliance Officer
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Canary - Engineering
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
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The Building, Engineering, and Planning Departments have reviewed the building permit
application for con~ru;;; :;v;, which i;~~Z ;~'77 ,-1 /'/j
Accepted
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Accepted With Corrections
Denied
Reviewed By:
tmfS
Date:
/0' '::I'I-ot;
Comments:: See Reverse Side for Additional Information!
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See Attachments: I) Grading Plan. 2) Erosion Control Measures
"The issuance or granting of a permit or approval of plans, specifications and
computations shall not be construed to be a permit for, or an approval of, any violation of
any of the provisions of this code or of any other ordinance of the jurisdiction. Permits
presuming to give authority to violate or cancel the provisions of this code or other
ordinances of the jurisdiction shall not be valid."
ADDmONAl COMMENTS FOR BUILDING PERMIT APPUCATIONS
. Surface storm water drainage flowing to the perimeter of this lot to
and from adjoining properties must be conveyed to the roadway
and/or to the rear of the lot in drainage swales wjthin the drainage
easement.
. All bare soil areas must be protected from eroding into neighboring
properties through the properly installed and maintained silt fence or
bales.
. The silt fence required by the erosion control plan must be installed
prior to any earthwork being started.
. The builder is responsible for maintaining the erosion control
measures until the turf is established.
~- . The rock construction entrance must be installed at the time of
backfilling of the foundation.
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6:'Admin'dcpt Irrfo'ADDITIONAL cOMMl:NTS FOR BUILD1:N6 PERMIT APPUCA nONS.dec
Address: /'/);; 1~3
Application Received: tf1J / () 'i ( ~
'T!
PERMIT TRACKING FORM
(1 J dh1 Cl~~---
Description:
{j/~
cfV-r
Permit Number:
Building
Date
Days Elapsed
Initial Review Conducted
Applicant Called with Corrections
Corrections Received
Corrections Reviewed
Final Review
Applicant Called
Date
Days Elapsed
Date Received
Initial Review Completed
Corrections Received
Corrections Reviewed
Final Review
Applicant Called
Engi
Date
Days Elapsed
Date Received
Initial Review Completed
Corrections Received
Corrections Reviewed
Final Review
Applicant Called
Initial Review Time
Correction Review Time
Initial Application Date
Final Corrections Received:
Applicant Called W/Corrections:
Final Applicant Call Date:
Total Days Elapsed: .
Total Days Elapsed:
J:\FORMS\Permit Tracking Form for Individual Permit.doc
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
q, ZS,Ob
While
Pink
Yclhnv
File
City
^pplicrllll
rRMIT NO.
n at bottom)
ZONING (omce lIse)
{\\
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l~EGAL OE, SCRIPTION (office lIse Onl,Y,'
LOT BLOCK ADDITrON
(Phone)
(Phone) ____.
rlo Z5.ZJQ, 001.6 J
~L ~'t qe: 1_:1
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OWNER
(Name)
(Phone)
(Addrcss)
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t~,c~I,;,.~,a~ Name) C\h, ~" L,ili Dr l (~______
(COr1t:c~pal11c) '~<:J..L~-- _____
(Address)
TYPE OF WORK 0 New Construction ODeck OPorch ORe.Roofing
OAddition OAlleralion OUtilily Connection
I
E
II
F
I
III IV V A
II I M R
Z 3 4 5
B
S U
ORe-Siding OLower Level Finish 0 Fircplacc I
,
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CODE: DLR.c. DLB.c.
Type of Constmction:
Occupancy Group: A B
Division:
o Mise
PROJECT COST /V ALUE
(excluding land)
$ ----~J~~' .- .---~,n03-
,_CWI ---.----
"-'
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II hClcby I lily that [ have furlllshed mInt matum on thIS application which IS to tile best or my kno\\lrctgc tlllC ~~Ild COl~cct I also CClt;fy tl1;H 1-;~~-(~\~~~(;;~;;-lh(ll1zcd ag~-t r{~;~~tl-(,
I ,lbnv('-rn nl !led plOp('1ty and that all COn\;\l\lcl1on will conform 10 all tXI~tll1g state and lor(lllaws and will pl(1(crc! 111 ilccoldancc with ~ubnllftcd plilllS I ,1m aWaIt that thc hulldmg
olflClal ca rc lkc tlllslCIn1ll rOt JlI~atl~thelmOlC. I hClchy ag!(~c that the city ofrill,ll (\l .1 dC~lgllee may f'nlcl UPPIl the plopt'11y 10 pcdOlm necdnl'n~PCC(lllO"
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- \ .1 .-~-~--.___~_.=-__
PermitVallla'tion
Park Support Fee
#
$
--._--~---
$
$
SAC
#
$
-~---------------
$
----~~_._------_.----
$
-------~-~
$
Permit Fce
Plan Check Fcc
Water Metcr
Sizc 5/8"; I",
Slale Surcharge
Pressure Reducer
Penalty
\-----------------,-
Plumbing Permit Fcc
Mechanical Permit Fee
Sewer & Water Permit Fce
$
$
$
----------------
$
$
Sewer/Warer ConnectIon Fce # $
--_._--_._-~-~--,-_.._--~--~.... ------ ---------~-.-.._-
Water Towcr Fee # $
_._--~---~- --.-----.- ------~_._----_...._.-
Builder's Deposif $
--.- --.--------..----
Othel $
Gas Fireplace Permit Fee
TOTAL DUE
$
I ~Tlri' Appli"';on "''Om'' y"", il;,;,,;~,r;m;iiw.;'n A""~'J
l_= !luildlllg Of II Cia! flak
[r)~~ -- ~_~-______ --~----_TI;ceiPt ~ __ -___~~--_ ~
l:hlS IS to ~t'lllfy thar the ICqUlst III the above apphctltlOn <Ind ac(ompanYlIlg documents IS 111 aC(otdance wllh rhe City ZOlllng Ol{i!nallcc anct may plocecd a... ICqlH.:...tcd 'rhl~ doC"ument
~Vhen stgned by the City Plannel constItutes a tempO! ary Celllficate of Zonlllg compham,' ~'~d allnws constln(:';lIl tn commence ~f(~,e occnl'.lIlcy. a Cn tl~,~~~~~ccnl'ancy mnst hr--
IsslIed
PI,nHllng Dlrec!or !:."-~ _____.__. s.r)cc''''--S=~)flditl'.'_'':~''.':'y____ ______
24 hOllr notice for all inspcctions (')~2) H7.<)R~n, fax (<)~2) 447.424~
16200 Eagle CrC'('k Avenue Prior Lake. MN 55372
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