HomeMy WebLinkAboutBuilding (Fire Sprinkler) 06-0140
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CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
at _bottom)
Date Rec' d
1. White File
2_ Pink City
) Yellow Applic.onl
F/L (; W Oft;,OOOh
PERMIT NO. O~ . 0/4-0
ADDRESS
53.10 wE~r lAIOo () 0" S E-
I ZONlNGI__l
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
prD
OWNER
(Name)
rsfJ #llq
1:0. f!:JJt.. g ~ q
(Address)
(Phone)
BUlLDffll coNrmf;:.<.. ;V
(Company Name) f) Rv,ff(':I<.S FIl-E ffO/~rL(l.
(Contact Name)
(Address)
~
(Phone)
(Phone)
7bJ -L/~II-dJ?O
TYPE OF WORK. O(New Construction o Deck o Porch ORe-Roofing ORe-Siding
,3Addiltion o Alteration OUtility Connection 0 Misc.
CODE: OI.R.C. ~I.B.C.
Type of Construction: t':""1
Occupancy Group: (lY B
Division:
OLower Level Finish
I
E
fiV
F
I
PROJECT COST /V ALUE
(excluding land)
o Fireplace
s iOd, <(00
ill IV V
~<h:r
AGi)
R S U
5
I hereby certify that I have furnished information on this application which is to the best of my lcnowledge true and COfn'ct. I also ttrtif'y that I am lhe owner or authorizro agcnt for tm,
above-mentioned property and that all constrtlction will conform to aU existing state and local laws and will proceed in accordance with submilled plans. I am awarc that the building
:ffi~e ~::,se Furthermore. I hereby agree that the city official C :sO~ Cf enter upon the property to perform ~c~ 7~On6
Signature Contractor's License No. Dale
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
$
$
$
S
$
$
$
$
Park Support Fee
jSAC
Water Meter Size 5/8"; I";
Pressure Reducer
Sewer/Water Connection Fee
Water Tower Fee
Builder's Deposit
Other
TOTAL DUE
es Your Buildins Permit When Approved
3/7 Lov
laIc
rPaid / fl q, /-8
I Date 4-);/Ov
I
#
#
#
#
L Receg,t No.
IlYd~-
$
$
$
$
$
$
$
$
$ /1 ~ I q, 4. ~
51; g ~.__._.J
ThIs is to certif'y t t the ~uest in th,: above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signro by t c City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Cl"11if1cate of Occupancy must be
issued
Planning Director
Datc Special Conditions, if any
24 hour notice! for .11 in5~ction. (9~2) 447-98~. fill (9~2) 447-424~
]6200 Eagle Creek Avenue Prior Lake. MN 55372
CONTRACTOR'S MATERIAL & TEST C~RTIRcA TE FOR A BOVEGROUND PIPING
PROCBXJRE:
Upon completion of work, inspectic.n and tests shall be made by the contractor's representative and witnessed by an owner's representative. AI
defec:ts shaI be corrected and system left in service befOl1l contractor's ~nnel finally leave the job. .
A certificate shall be fiDed out and lrigned by both representatives. Copies shaD be prepared for approving authorities, owners and COntractor.
. It is uncIerstood the owner's repres.,ntatives signatu'lt in no way prejudices any claim against the contractor for faulty material, poor worlcmanship,
or faiUe to comply with approving authority's requirements or local ordinances. .
NAME
HAS PERSON IN CHARGE OF FIRE EQUIPMENT SEEN INSTRUCTED AS TO LOCATION OF CONlROL
VALVES AND lliiE CARE AND MAINlCNANa: OF nlls NEW EQUIPMENT7
F NO. EXPLAIN:
'YES DNO
YES DNO
YES DNO
-..-...- "
YES DNo
HAVE COPIES OF APPROPRIATE IN51RUCTlONS AND CARE AND MAINTENANa: OiARTS BeN
l..EFr oN PREMISES?
F NO. EXPLAIN:
AfE~TO~7tf1fm
FITTlNGS CONFOFlM TO IV . ~ F/Y)
F NO, EXPLA"':
STANDAAD
~
DNO
DNO
.STANDARO
~WM#M*fMlmiH@1\lHlrlfmi;~ij!i.:PWi~tM1MMiIljm:ffinl:ttllfI11. f~t~MQMg'6ijgit9.)~~~!tl$QY.~3amt;~~~.
TYPE MAKE MODEL MIN. SEe.
MODEL
SERIAL NUMBER
MAKE
MODEL
SERIAL NUMBER
1111111':II'!1~1:lii;: ::';i;'~..'::i;.j';'i~~~i:::'l:l.i:.:i..'i':'i..':iiil:l..il~lfJi:j!:!i:i!'i.i:'!'!'.!':f.I.~.~li:::i'i:'l..ii:ii1"11.11111:(1 :::,
MIN. SEC. PSI I PSI MIN. SEe. MIN.
SEe.
..--/
----------
----
B5A (8/991 ENGINEERING PRINTED IN USA -
o ELECTRIC
o YES 0 NO DETE
TE FROM THE MANUAL lRlP AND/OR REMOTE CO
W EAat CIRCUIT FOR TESTING?
MEDIA SUPERVISED?
D_ ..ch circuit
operate valve ....._7
. YES -\ NO
Maximum 11_ to
operate .......
IlIIN. SEe.
MAKE
ii;:t HYDROSTATIC: Hydrostatic tem aMll be made at not lea thlIn 200 p8i 113.6 ban) for two hours or 50 ,.. (3.4 INn) lIbove stdc
,.~. pre_ in excna of 150 psi (10.3 ban) for two hours. DiffmIntieI dry-pipe VlIIw c:lappen IheIJ be 11Ift open during tIIat to prewnt
d..-ge. AI abol,..grvund piping Ielllcege shell be stopped.
PNEUMATIC: Es1~blish 40 psi (2.7 bare) air preaan and 11I8_ drop which ..... not exceed 1-1/2'" 10.1 b__1 in 24 hcM.n. Tat
pre_ tanks lilt norm" water Ie.... and air pressure and me........ air pressure drop which ahaIl not exceed '-1/2 psi (0.1 b.r.' in
24 houn. .
All P1PlNG HYOROSTA11CAllY TESTED AT
PSI FOR
Hn.
F NO. STAle REASON
DYES DNa
EQUIPMENT OPE:RA7ES PflOA:RlY7 DYES ONO
AEADINGOF GAGE lOCATED NEAR WATER SUPPlY TEST l"~
PSI
RESIDUAl PRESSURE wmt VALVE .., TEST PIPE
_O!'ENuwu ~C...
Underground JnBlna and Jeed..in connec1io.. to ayatem ..... .... be lIua1Md IMfON co.-don III8de to spdnIder piping.
BY COPV' OF THE FORM NUMBER ass? 0 YES 0 NO OTHER EXPlAW
USHED BY lNS1'AUER OF UNDERGROUND
PRWKLER P1P1N(;I?
NUMBER USED lOCATIONS
DYES
DNO
.... : ~
NUMBER REMOVED
DYES
DNO
DO YOU camF'l' AS THE SPRINKLER CONTRACTOR THAT WElDWG PROca>URES COMPI. Y WITH
THE REQUIREMENTS. OF AT LEAST AWS 010.9. LEVEl AR-3?
DO YOU carrF'I'lHATTHEWELDING WAS PERFORMED BY WElDERS QUAlFlED IN COMPI..IANa:
WITH THE REQUIREMENTS OF AT LEAST AWS 010.9, LEVElAR-3?
DO YOU a:RTlFY lHAT WELDING WAS CARRIED OUT 1\1 COMPUANa: Willi A DOCUMENTED QUAUN
CONTROL PROCEDURE TO INSURE lliAT All DISCS ARE RETRIEVED. THAT OPENWGS IN PIPING
ARE SMOOTH. niAT SLAG AND OTHER WELDWG RESIDUE ARE REMOVED. AND THAT INTERNAL
DIAMETERS Of PIPING ARE NOT PENETRATED?
DYES
DNO
DYES
DNO
DYES
DYES
DNO
DNO
DATE lEFT 1\1 SERVIa: WITH All CONlROl VALVES OPEN:
CTOR (Signed!
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