HomeMy WebLinkAboutBuilding Permit 7-0914
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C~TY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
o".~- <.;\ x
Date Rec' d
...,
/4- . Cl
I White
Pink
Yellow
I PERMIT NO. / -".7 '.
'. I. '
j/4-1
File
City
Applicant
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
~~e~RJ\:; , ! 'I {.\",(!.--. r IV'.. -"_
(Address) 1.....1 q ':2.'1 C>,,!~ ~. ~
(Phone) ()"")- '-/'-f7-;::'. ~ "'1 <I(
BUILDER
(Company Name) L t (..;. ./J, ~_""\l ",.,-j _.y s.,r ~u. S', :;:." c
.,.-."
(Contact Name) ~~ 6 \....... L \ " 'I ~
(Address) 1;.1(;"\ tv I ~ ~....;: ~ 'S':s'v'" p" ^-J
(Phone) C')<,; '-"-;'/~. ~'ii ?:2
(Phone)
<'("17
TYPE OF WORK 0 New Construction ODeck OPorch ORe-Roofing ORe-Siding OLower Level Finish 0 Fireplace
OAddition OAlteration OUtility Connection
CODE: DI.R.C. DI.B.c. ~'MiSC. j ;:>'l-. L / t. ,'~j / ILL.
Type of Construction: I II III IV V A B PROJECT COST IV ALUE $
Occupancy Group: A B E F H I M R S U (excluding land)
Division: I 2 3 4 5
/> i I . K..
x
I hereby certifY that I have furnished mfmmation on this applicatIOn which IS III the best of my knowll'dge true and correc!. I also certifY thai I am the owner or authorized agent for the
dbove-menuoned propl'1'ty and that all Cllnstruction Will conform to all eXlstmg state and local laws and will proceed m accordance with submitted plans. I am aware that the buildmg
offiCial can revoke tl rmIt for Just cause F Irthermore, I hereby agree that the City official or a designee may enter upon the property to perform needed mspectlOns
~" ? :? -1- 07
I ReG~ipt No.
Bt .
. I
f
I
/
ThIS IS III certifY that the request m the above application and accompanymg documents is m accordance with the City Zoning Ordinance and may proceed as requested TllIs document
when Signed by the City Planner Cllnstltutes a temporary Certificate of Zonmg compliance and allows constructIOn to commence Before occupancy, a Cl'1'l1ficate of Occupancy must be
issued
Permit Valuation
Permit Fee $
Plan Check Fee $
State Surcharge $
I Penalty $
Plumbing Permit Fee $
Mechanical Permit Fee $
Sewer & Water Permit Fee $
Gas Fireplace Permit Fee $
This Applieation Becomes Your Building Permit When Approved
Buildll1!l Official
Date
Contractor's License No.
Date
Park Support Fee # $
SAC # $
Water Meter Size 5/8"; I"; $
Pressure Reducer $
Sewer/Water Connection Fee # $
Water Tower Fee # $
Builder's Deposit $
Other $
TOTAL DUE $ - / ( {C'
/./.~j/
Paid
Date
! .'
.
<.
~..- .r
I~
( r
, _' v
2:1 {-"7
Planning Director
Special Conditions. if any
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372
&eAna/yticaJ.
- www.paroJabs.com
Pace Analytical Services, Inc.
1700 Elm Street
Minneapolis, MN 55414
(612)607-1700
October 02, 2007
Aaron Berger
Liesch Associates, Inc.
13400 15th Ave. N.
Minneapolis, MN 55441
RE: Project: HAFFERMANN BUS
Pace Project No.: 1059589
Dear Aaron Berger:
Enclosed are the analytical results for sample(s) received by the laboratory on September 25,2007.
The results relate only to the samples included in this report. Results reported herein conform to the
most current NELAC standards, where applicable, unless otherwise narrated in the body of the
report.
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
~"'<~
Paul Kirchberg
paul.kirchberg@pacelabs.com
Project Manager
Florida (Nelap) Certification #: E87605
Illinois Certification #: 200011
Iowa Certification #: 368
Minnesota Certification #: 027.053.137
Wisconsin Certification #: 999407970
Enclosures
REPORT OF LABORATORY ANALYSIS
Page 1 of6
This report shall not be reproduced. except in full,
without the written consent of Pace Analytical Services, IncH
~OHe<;:~'~"raO{~,:co.~.c,..
<:>' '-
~i 'I~
. ~
'ace AnalytIcal
www.paceJabs.com
Project:
Pace Project No.:
HAFFERMANN BUS
1059589
SAMPLE SUMMARY
Pace Analytical Services, Inc.
1700 Elm Street
Minneapolis, MN 55414
(612)607-1700
LablD
1059589001
Sample ID
Matrix
Date Collected Date Received
Solid
09/25/07 09:10 09/25/07 10:30
T-1 (9')
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc..
'.fieIOC"'.4"~'~:~""C..
5" ( '" ~~
~i _ _ 'i~
Page 2 of6
aAnalyticai'
. -" www.plJceJabs.com
Pace Analytical Services, Inc.
1700 Elm Street
Minneapolis, MN 55414
(612)607-1700
SAMPLE ANALYTE COUNT
Project:
Pace Project No.:
HAFFERMANN BUS
1059589
Lab 10
Sample 10
Method
Analytes
Reported
1059589001
T-1 (9')
TPH WI GRO/PVOC 8021
2
REPORT OF LABORATORY ANALYSIS
Page 3 of6
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc..
ffr&1ii6'~
'ace Analytical ~
www.pacelabs.com
Project:
Pace Project No.:
Sample: T-1 (9')
HAFFERMANN BUS
1059589
Parameters
WIGRO GCV
Gasoline Range Organics
a,a,a-Trifluorotoluene (S)
Date: 10/02/200703:09 PM
Pace Analytical Services, Inc.
1700 Elm Street
Minneapolis, MN 55414
ANALYTICAL RESULTS
LablD: 1059589001
Collected: 09/25/0709:10 Received: 09/25/07 10:30 Matrix: Solid
Results
Units
Analyzed
CAS No.
Report Limit
DF
Prepared
Analytical Method: TPH WI GRO/PVOC 8021 Preparation Method: TPH GRO/PVOC WI ext
ND mg/kg
98 %
5.0
80-150
09/27/0700:00 09/30/0706:54
09/27/0700:00 09/30/07 06:54 98-08-8
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, IncH
'.<.h'.."..'<'''"''.'." '.j$'.;~'.
ff( Ino:iIC1C1,
(612)607-1700
Qual
Page 4 of 6
'ace Analytical ~
www.paceJabs.com
Project:
Pace Project No.:
HAFFERMANN BUS
1059589
Pace Analytical Services, Inc.
1700 Elm Street
Minneapolis, MN 55414
(612)607-1700
QUALITY CONTROL DATA
QC Batch: GCV/4451
QC Batch Method: TPH GRO/PVOC WI ext.
Associated Lab Samples: 1059589001
Analysis Method:
Analysis Description:
TPH WI GRO/PVOC 8021
WIGRO Solid GCV
Associated Lab Samples:
1059589001
METHOD BLANK: 393109
Parameter
Gasoline Range Organics
a,a,a-Trifluorotoluene (S)
mg/kg
%
Units
Blank Reporting
Result Limit Qualifiers
ND 5.0
98 80-150
393111
Spike LCS LCSD LCS LCSD % Rec Max
Cone. Result Result % Rec % Rec Limits RPD RPD Qualifiers
-- -
50 55.0 53.9 110 108 80-120 2 20
101 99 80-150
LABORATORY CONTROL SAMPLE & LCSD: 393110
Parameter Units
Gasoline Range Organics
a,a,a-Trifluorotoluene (S)
mg/kg
%
Date: 10/02/2007 03:09 PM
REPORT OF LABORATORY ANALYSIS
Page 5 of6
This report shall not be reproduced, except in full,
without the written consent of Pace Analytical Services, Inc..
,j;~;~'i.i:"~,
f/neIC:lC'~
,aAnalyticat'
www.p8Gl1labs.com
Pace Analytical Services, Inc.
1700 Elm Street
Minneapolis, MN 55414
(612)607-1700
QUALIFIERS
Project:
Pace Project No.:
HAFFERMANN BUS
1059589
DEFINITIONS
DF - Dilution Factor, if reported, represents the factor applied to the reported data due to changes in sample preparation, dilution of
the sample aliquot, or moisture content.
ND - Not Detected at or above adjusted reporting limit.
J - Estimated concentration above the adjusted method detection limit and below the adjusted reporting limit
MDL - Adjusted Method Detection Limit.
S - Surrogate
1 ,2-Diphenylhydrazine (8270 listed analyte) decomposes to Azobenzene.
Consistent with EPA guidelines, unrounded data are displayed and have been used to calculate % recovery and RPD values.
LCS(D) - Laboratory Control Sample (Duplicate)
MS(D) - Matrix Spike (Duplicate)
DUP - Sample Duplicate
RPD - Relative Percent Difference
NC - Not Calculable.
Pace Analytical is NELAP accredited. Contact your Pace PM for the current list of accredited analytes.
BATCH QUALIFIERS
Batch: GCV/4452
[1] A matrix spike/matrix spike duplicate was not performed for this batch due to insufficient sample volume.
Date: 10/02/2007 03:09 PM
REPORT OF LABORATORY ANALYSIS
Page 6 of 6
This report shall not be reproduced, except in full.
without the written consent of Pace Analytical Services, Inc..
lne<;~r^j::;~~.,
.. t____ ~1C:l'- i '"
.' ~.'~eAna/ytical"
Sample Condition Upon Receipt
Client Name: L\esu~ ~((,~C{,tcs
Project # (o)'Cz >& C;
Courier: 0 Fed Ex D UPS 0 USPS KJclient
Tracking #:
OCommercial
D Pace Other
\W;~5$t:t
Custody Seal on Cooler/Box Present: Dyes ~no Seals intact:
Packing Material: 0 Bubble Wrap ~ubble Bags 0 None 0 Other
Thermometer Used 230194010 Type of Ice: B Blue None
Dyes
o no
Cooler Temperature ~ Biological Tissue Is Frozen: v's No Oate and 'n~f~'01~~57'~g
content.:
Temp should be above freezing 10 S'C Comments:
Chain of Custody Present: ..z1vas oNo ON/A 1.
Chain of Custody Filled Out: ~,s oNo oN/A 2.
Chain of Custody Relinauished: ..0"VIS DNo DN/A 3.
Sampler Name & Signature on COC: ~e. oNo ON/A .4.
Samples Arrived within Hold Time: Ave. DNo DN/A 5.
Short Hold Time Analvsl. (<72hr): ov.. ;1NO DN/A 6.
Rush Turn Around Time ReQuested: Dv,. ~o ON/A 7.
Sufficient Volume: J1(v.. DNo DN/A 8. .
Correct Containers Used: ;1Y.. oNo oN/A 9.
.Pace Containers Used: ;dYe. DNo DN/A
Containers Intact: AY.. DNo DN/A 10.
Filtered volume received for Dissolved tests Dyes oNo tfN/A 11.
Sample Labels match COC: ;z5Ye. oNo DN/A 12.
-Includes date/time/lD/Analvsis Matrix; Sv
All containers needing preservation have been checked. ov.. DNo PN/A 13.
All containers needing preservation are found to be in DYas ONo ~A
compliance with EPA recommendation. -
exceptiOn.: Wllform, TOC. 0&0. WI.ORO (weter) ftll DNo Initial when ~ot # of added
completed preservalive
Samples c ~ked for dechlorination; OY.. DNo ~/A 14.
Headspace in VOA Vials ( >6mm): DYe. DNo ~A 15.
Trip Blank Present: DYe. po ON/A 16.
Trip Blank Custody Seals Present ov,. oNo ~
Pace Trio Blank Lot #I lif Durchased):
o Samples on ice. cooling process has begun
Client Notification! Resolution:
Person COI1tacted:
Comments! Resolution:
Field Data Required?
Y I N
Datemme:
Project Manager Review:
~;;?
Date:
c; /25/c::/
Note: Whenever there is a discrepancy affecllng North Carolina compliance samples, a copy 01 this form will be senlto the North Carolina DEHNR
Certification Office (I.e out of hold, incorrect preservative, oUl of lemp, Incorrect containers)
F.ALLC003rev.3, 11 September2006
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