HomeMy WebLinkAboutBuilding Permit 11.723 ta i r 6v ` ss i , i d � .
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CITY OF PRIOR LAKE
Ptparftuntf of e: cJnsprtftut
`t Permitted ❑ Conditional C.O. Expires
This Certificate issued pursuant to the requirements of Section 110 of the ❑ Residential l ❑ International ,.
Building Code certifying that at the time of issuance this structure was in compliance with the various
ordinances of the City of Prior Lake regulating building construction or use. For the following:
7 -y '�
Use Classificati J AI6 7 fi -iikI f L Bldg. Permit No. � 1 _ J 1
Occupancy Type I Type Construction 1/2'1 Zoning District i (i1
Legal Description
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Owner of Building Site Address Y , �Z p fe
Contractor's Name & Address / /' / / T/ I ", 0/ g
y /� �_
rL 1 U1 �%ti / City Planner
Building Official 7
Date: l '/ `�i J Date:
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CITY OF PRIOR LAKE BUILDING PERMIT, C (� 0'1' -
TEMPORARY CERTIFICATE OF ZONING COMPLIAN I 15
AND UTILITY CONNECTION PERMIT
+ _ JUL 19 2011
j *NES O as � � w
2. Wrot City PERM �: t I Mr `Y�
3. Yellow Applicant • t r 41
(Please type or print and sign at bottom)
ADDRESS Ili ?)'2.-1--1 p/ y v S t 0 E COURT ZONING (office use)
PUD
LEGAL DESCRIPTION (office use only)
LOT 9 BLOCK 1 ADDITION 3 EF - tZs w A-- . PID ZS `4 1 b o 090
OWNER
(Name) 1' P. - 1 - 1 - A i "' 4-4- 0 t"► ES (Phone)
(Address)1 2:31 W A S t- . t ht 6 i t, +,l A V E S ST E_ 2c i O t t - Ak M N S S 4 3 9
BUILDER
(Company Name) 1.-1 1 i A- l" i 4+0 P 1 ES (Phone)
(Contact Name) S u E g' (Phone)
(Address) 1'2-01 IA" Ar S 14 lt---A c,Ttoti N vE- S STS 2_0 t > -O t Ni J Hi.-.1 SS 3 9
TYPE OF WORK 0 New Construction SDeck ['Porch ❑Re- Roofing ❑Re- Siding ['Lower Level Finish ❑ Fireplace
['Addition ❑Alteration ['Utility Connection
CODE: I.R.C. DI.B.C. ❑ Misc:
Type of Construction: I II III IV V A B
Occupancy Group: A B E F H I M R S U PROJECT COST /VALUE $ t' Cb / 000
Division: 1 2 3 4 5 (excluding land)
I hereby certify that I have furnished information on this application which is to the best of my knowledge nue 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 needecrmspections.
Xc ---.. ) --1 BC--- -2 -b 2 J - 1 538.E — 1 6 9 l‘1
Signature Contractor's License No. Date
Permit Valuation ‘3 Z _ Park Support Fee # $
Permit Fee $ 1 SAC # $ 2-2-30,
Plan Check Fee $ b c) c t Water Meter Size"; 1 "; $ 1 E�
a. State Surcharge $ Vo _ Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $ ( C D co .,
Plumbing Permit Fee $ e S� 5r-> Water Tower Fee # $ /ow, -
Mechanical Permit Fee $ `F O Builder's Deposit $ /5-1,6),
Sewer & Water Permit Fee $ Other $
S�-�c� F -cam w Pt' l2' S S
Gas Fireplace Permit Fee $ 5 Sb TOTAL DUE $ i&Z•59
This Application Becomes Your Bw q lding Permit When Approved Paid 1 Co 2-5 — . 5 Receip o. (p,3 8
Date . / I . (1 By .
Building Official Date
This is to certify at • e requ- in the above application and accompanying documents is a ordance with the City Zoning Ordinance and may proceed as requested. This document
when signed /,� e P P. . constitutes a temporary Certificate of Zoning compliant an allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued. �'
■
Z._ . Ad. e r 9(
fanning 1' ctor ate Special Conditions, if any
24 hour notice for all inspections (952) 447 - 9850, fax (952) 447 - 4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
car.i;
CITY OF PRIOR LAKE BUILDING PERMIT, — t d
ti TEMPORARY CERTIFICATE OF ZONING COMPLIANC OCT 2 4 2 01
`3 AND UTILITY CONNECTION PERMIT _
1 hNEsd c By_____ / 7i
1. White File PERMIT NO .
2. Pink City / / „ r 1 /
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3. Yellow Applicant //
(Please type or print and sign at bottom)
ADDRESS t t 32 -( P S I D E C D v [L-rf ZONING (office use)
LEGAL DESCRIPTION (office use only) 1
LOT c ) BLOCK 1 ADDITION v �E-- w le-11--12-01---11- PID 2s'-[ 1 go a 9 0
OWNER
(Name) l. A 'T i P* M'i' -I4 U t`-1 -S (Phone) 9 52 - P 9 Pte at oU
(Address) 1 1N A S N t tJ 6 A v E S Si 20 1 E O t t..l 4\ 1-1 N S S L1 9
BUILDER
(Company Name) r'lh ---1- 7. 40--1 Y 4+0 ES (Phone) 9s2 - e9 s1 - 60 12.6
(Contact Name) S ° E .2 =-°\. 12-c -- . (Phone)
(Address) 120 t 1... At S 1-4 t (, 1, va S S"►— ' e) t t -0 t u ac h-I 1-‘ SS
TYPE OF WORK 0 New Construction Deck ❑Porch ❑Re- Roofing ❑Re- Siding glower Level Finish ❑ Fireplace
DAddition DAlteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc:
Type of Construction: I 11 III IV V A B
Occupancy Group: A B E F I I I MR S U PROJECT COST /VALUE $ 9' D 00 • O 0
Division: 1 2 3 4 5 (excluding land)
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 inspfctions. I
X� _, P .. PSG,- - 2._c>3 .- 1 53x 6 l c. '2--0 l !r l
Signature Contractor's License No. Date
Permit Valuation 2../ O o o . 00 Park Support Fee # $
Permit Fee $ 6, Z, 25 SAC # $
Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $
State Surcharge $ J. Q 0 Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ 5¢, 5V Water Tower Fee # $
Mechanical Permit Fee $ - --- Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ 34- TOTAL DUE $ / 7 2 ' ZS
This Application Becomes Your Building Permit When Approved Paid / 7 23 I Receipt N G 4/ 3 ,5
Date J( /Z.J, /,i BY C ,p� --i
Building Official Date
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.
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
CITY OF PRIOR LAKE BUILDING PERMIT, Date Reed
TETSIPORARN' CERTIFICATE OF ZONING COMPLIANCE t_ 1 7 2011 lj
AND UTILITY CONNECTION PERMIT _ •
4 ,-,11111.10'..507
, PERMIT NO I [ 01
_,Tterastaatti ian at bottom) ____-------- ,
' ADDRESS ' 1 ZONING 101F10t .t.W1 i
I I
...-__________________--
LEGrAL DESCRIPTION trATicc u.s.t only1 ,
1
i 1
LOT BLOCK ADDITION PID ..,.
....-,,
OWNER I
('s: arte 11P11' MY H •ii - (Phone) c 152 - .8.92)-- 6 tS.
t_. 1
( Add.re$s) 720 I LiAsk i NI L-,- kJ '',
BUILDER PTLIV.:-.
(Company Narne) l'ACTF,..t. 'ri g.. 4-10./J Thonel (.# 51 --7
(Contact Narne) , _ha spt4.1 17 PiNTC12... iPhone ) ,.
----.
1.-4 VgiV6 i 1 WO I.-44Jc-e
........___ ,
TYPE OF WO( )25 New Ceristrtterson 12,Deek °Porch DteaR °gating DR GLowet 1 - ava a d Fmrsh 0 Frre'rb‘ce ■
Ofssadaton OAlteranora OCiasaissy Connectors ■
a
CODE: ZLIL.C. DI.B.C. 1:1 Mil,:
i Type of Construction: 1 El ill rw e> A 6)
Occupancy Group: A B E F 11 I N1XSU '.7) 3 C t.
PROJECT COST/VALUE $ - 4 - t
, Division: 1 2 N) 4 5 (excluding land)
,
1 1 beitta sandhi that r.. hate furnished mformahon ortt T1115 100:1010011 .111+:11 0 10 die hest of nd 11110 100 000000 : r1:40 certify dui I am the owntt or authorized agent for the ;
at:dittaertiontd pr and that ail constructan sta cdridetr tt 4,1 t111.100g 1120 and local laws and wt.:1 :trocen.` tri accordance wail iiiiintitted plans 1 arn aware Ma; the traded:le i
; crlid.al can orrithe thd remit for Jose Mit Frif10‹30010., I "serer 4g:tr. tat thr e'r't catotal or a , =r041r 101 I , TII enW .0X rOe ProPerrY re Perform orreee traervtlets I
11 ....e.‘,... /0 "'• /I
' "Ill elt
X -1 *ea 41110.
• at* . --- — .....—Y.-
..
Stgattrit____ , ,,,......... S. Dece No Date
,---------a ---
! Pennant 'Valuation — ' 0 i r34: lasurstsia's Fee #
1 $
---4--------q+—;
t Perraai Fee ; $ j5.3.0o i sAt.
- ti 1 $
i 1
Thaa Chrck Fte 1 t
1 - 1
44/A5 ', Water Meet St :e 5; S' I", i 5
1
5
State Surcharge i ; rressur e Recli:cer I $
2.60
--,
; Penalty 5 1 Sewer i's ate!' Connection Feta # I $
Paumbing Ft Fee I 5 Water Tower Fee 0 i $
j I .,, „
; Me.rhanIcal PEITtlit Fee I 5 , 1 riul,Ger s C;crsos,";
---:
1 :
Sewer & Water Prrtnit Fre I 5 , , Other 1
i =
Gas Fireplace Penult Fee i 5 i 1 TOTAL DUE
t ID W1T1-1
T
met Your Building Permit When Approved 1 1 Pald Receipt No. ' • ' ,
1
Date i By
t :
--
* forftwon.14
TM/ rt 10 00Stly 1hr the request m the abase sprq_taace. a:4 a:comptinsszig ddl...frietts ts m aci.:orran did the Clta Zoning Orsimance and may proceed 11 pr.:anted This document
conArmtrs a t cern$iare rd lorada zotcnitaner and at-cro cza.dructi:n td ct...minence Doter occupancy, A Cat.icav of Occupaw mast de
' diaei
RA& U.e.r4 4
, riannal DoNler Doc tai CPrtslattomlif atv=
_
24 hOUr notice fn all inspections -0)51 _ ; ir-48,50. tat i952'!4-r4245
4646 Dakota Street S.E.,Prtor 1 atat, Minnesota $53-2
• a
Jpt * • °
• • 41
I
F r PA CITY OF PRIOR LAKE Date Rec'd
6u ,,t" HEATING /AIR CONDITIONING /FIREPLACE PERMIT
" c o xx
s /,
r �l�'NESO� a. peak rile x. Grcite• PERMIT NO. I ple
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
1 1 1 /71 111 y_acte- COL( •i ----
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) `/ 1 AI I11 A A 4 (Phone)
(Address) .
APPLICANT
(Name) , . (Phone) 6 r5) \ L 61
(Address) /alter P _ _ � ' a , ∎►1�� . 's
4 . ddress) (City) ii (Zip Code)
(Contact Person) • ` ,, _ ti (P one) °i5 1 L • 1 0
APPLICANT SIGNATU' i`f! 1 DATE C6
IV
APPLICANT PLEASE COMPLETE BELOW
NEW CON STRUCTION
El REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL _CS E t t�� '� '` `� FUEL NtX.J
FLUE SIZE RETURN OPENINGS 1NPUT 0 OUTPUT
TYPE OF SYSTEM HEATING OR POWER PLANT
l�]rm Air Plants PLEASE NOTE: Air Conditioner
Wa
❑ Steam Units and Fireplaces Cannot Encroach
['Gravity ❑ Hot Water
'. 2 Mechanical ❑ Radiation into Required Side Yard Setbacks.
`V Air Conditioning ❑ Special Devices Fireplaces with Box Additions or
nt. System ❑ Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODEL
FEE SCHEDULE
Industrial, Commercial & Multi- Family 1 % of job cost Residential, Gas Fireplace $49.50
$49.50 minimum
Residential, Heating & A/C (New Construction) $149.50 Residential, Additions & Alterations $49.50
Residential, Heating Only (New Construction) $64.50 Residential, AC Only $49.50
Estimated Cost $ Ssc ' - Building Permit #
MM The Minnesota Statutes § 32613.148
HEATING PERMIT FEE $ f _I L , "SURCIIARGE" has been chanced for one
year effective
STATE SURCHARGE $ b.0\) -5( July 1, 2010, until .hle 30, 2011.
TOTAL PERMIT FEE $ )54,s7) The minimum surcharge for a "fixed fee" permit
(Office Use Only) Is; , beginning July 1.2010
This Application Becomes Your Building Permit When Approved Paid Recei',t No.
PAID WITH
Building Official Date Date EitilLDING PEWIT
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
4 4,411 *
4 h.*
4 MRI Date Rec'd
,, M,, =,. C CITY OF PRIOR LAKE PLUMBING PERMIT
- ` ,: x •,,,.....,,,,t,
4,INNESO,,, 1. Blue File PERMIT NO .
2. Gold City 1 1 1.1 723
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
li '. PlifLs\cke, eau
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER �(�� j� �,,
(Name) 1" \U�JG�(). ���V( (Phone)
(Address)
APPLICANT (I 1 Q h ^ ]� ! ) qa:1-(p--k‘uu,., (Name) C, 1 L� , A, � -� l (P ��
(Address) 'L4.2./.." 1 ! (s�.J t l� w� .. r T7
(Addres•1� (City) ' (Zip Code)
_ (Phone) q ,. t
(Contact Person) � 1 S� (Phone
♦
APPLICANT SIGNATURE g x
_a- C L � � V `� �� I �rJ
APPLIC • N 1' PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
r Q Bath Tub with or without shower Rough -ins
Dishwasher Water Heater
` Floor Drain Water Softener
,3 Lavatory (Bathroom Sink) _ Stand Pipe (Washing Machine)
Laundry Tray (1 or 2 compartment sink _ Sewage Ejector
J9 Shower Stall Backflow Assembly
Sinks _ Backflow Assembly Test
Bar Sink Lawn Sprinkler
c� Water Closet (Toilet) Other
FEE SCHEDULE
Industrial, Commercial & Multi- family 1% of job cost with a $49.50 minimum Residential, New One & Two - Family $149.50
Residential, Additions & Alterations $49.50
The Minnesota Statutes § 326B.148 ,t $ `vim Building Permit #
"SURCHARGE" has been changed for one '' LL
year effective PLUMBING PERMIT FEE $ i -1 Cl -
July 1, 2010, until June 30, 2011. STATE SURCHARGE $ S,6v
The minimum surcharge fora "fixed fee" permit TOTAL PERMIT FEE $ LS4 . s PAID WITH
is IS beginning July 1, 2010
BLHLDING PERMIT
This Application Becomes Your Building Permit When Approved Paid Receipt No.
Date By
Buildine Official Date
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
4 4 v- i
w
Contractor's Material & Test Certificate for Aboveground Piping
PROCEDURE
Upon completion of wcr K. +aspect on and tests shall be made by the contractor's representative and witnessed by an owner's representative. All defects shall
be corrected and system :eft in service before contractor's personnel finally leave the job.
A certificate shat! .,e fed out and signed by both representatives. Copies shall be prepared for approving authorities, owners, and contractor. It is
understood the eaw:er's re: =eseatative's signature in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to
comply with app <rv;rag :authority's requirements or local ordinances.
PROPERTY NAME: JEFFERS POND DATE 12-53.-11
PROPERTY ADDRESS: 14324 PARKSIDE COURT
ACCEPTED BY APPROVING AUTHORITIES: CITY OF WOODBURY
ADDRESS:
PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS OYES ONO
EOthPMENT USED IS APPROVED YES ONO
IE NO, EXPLAIN DEVIATIONS
HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS ®YES ONO
TO LOCATION OF CONTROL VALVES AND CARE AND MAINTENANCE
OF THS NEW EQUIPMENT?
NO. EXPLAIN
INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: ®YES ONO
1. SYSTEM COMPONENTS INSTRUCTIONS (OYES ONO
2. CARE AND MAINTENANCE INSTRUCTIONS ®YES ONO
3. NFPA 25 OYES ONO
LOCATION ENTIRE BULDING
YEAR OF TEMPERATURE
MAKE MODEL MANUFACTURE SIZE QTY. RATING
RELIABLE RES49 2011 1/2 11 155
SPRINKLERS RELIABLE RES 44HSW 2011 1/2 16 155
RELIABLE F3QR 2011 1/2 1 155
PIPE AND `Type o' Pipe BLAZEMASTER
FITTINGS Type of Fitting CPVC
MAXIMUM TIME TO OPERATE
ALARM DEVICE THROUGH TEST CONNECTION
ALARM VALVE OR
FLOW INDICATOR TYPE MAKE MODEL MIN SEC
:FLOW INDICATOR POTTER VSR - F ( 55
DRY VALVE Q.O.D.
MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO.
DRY PIPE TIME TO TRIP TIME WATER ALARM
OPERATING TEST THROUGH TEST WATER AIR TRIP POINT REACHED OPERATED
CONNNECTION* PRESSURE PRESSURE AIR PRESSURE TEST OUTLET' PROPERLY
MIN SEC PSI PSI PSI MIN SEC YES NO
O.O.D
WITH
c.Q.D.
IF NO. EXPLAIN
LOCATION MAKE & SETTING STATIC PRESSURE RESIDUAL PRESSURE FLOW RATE
& FLOOR MODEL (FLOWING)
PRESSURE
REDUCING INLET (PSI) OUTLET (PSI) INLET (PSI) OUTLET (PSI) FLOW (GPM)
VALVE TEST
N/A
OPERATION: ❑PNEUMATIC ❑ELECTRIC ❑HYDRAULIC
P SUPERVISED OYES ONO DETACHING MEDIA SUPERVISED OYES ONO
DOES VALVE OPERATE FROM THE MANUAL TRIP AND /OR REMOTE OYES ONO
CONTROL STATIONS
DELUGE & iS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT IF NO, EXPLAIN
PREACTION FOR TESTING
VALVES OYES ONO
N/A - -
DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO
MAKF Mnl)FI SI IPFRVISW)N I ORS Al ARM OPFRATF VAI VF RFI FASF OPFRATF PFI FASF
YES NO YES NO MIN SEC
HYDROSTATIC: Hydrostatic test shall be made at not less than 200 psi (13.6 bars) for two hours of 50 psi (3.4 bars) above static pressure
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
Aaveground piping leakage shall be stopped.
TEST
DESCRIPTION PNEUMATIC: Establish 40 psi (2.7 bars) air pressure and measure drop, which shall not exceed 1 -112 psi (0.1 bars) in 24 hours. Test
, essure tanks at normal water level and air pressure and measure air pressure drop, which shall not exceed 1 -1/2 psi (0.1 bars) in 24 hours.
ALL PIPING HYDROSTATICALLY TESTED AT 200 PSI FOR j_HRS IF NO, STATE REASON
DRY PIPING PNEUMATICALLY TESTED OYES ID NO
EQUIPMENT OPERATES PROPERLY OYES ONO
DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS, SODIUM
SLICATE OR DERIVATIVES OF SODIUM SILICATE, BRINE, OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR
TESTING SYSTEMS OR STOPPING LEAKS?
OYES NO
DRAIN READING OF GAGE LOCATE4 NEAR WATER RESIDUAL PRESSURE WITH VALVE IN TEST CONNECTION
TESTS TEST SUPPLY TEST CONNECTION (AN PSI CONNECTION OPEN WIDE 4 r{- PSI
UNDERGROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO
SPRINKLER PIPING.
VERIFIED BY COPY OF THE U FORM NO. 85B OYES ONO OTHER EXPLAIN
FLUSHED BY INSTALLER OF UNDERGROUND
SPRINKLER PIPING YES ONO
IF POWDER DRIVEN FASTENERS ARE USED IN YES ONO IF NO, EXPLAIN
CONCRETE, HAS REPRESENTATIVE SAMPLE
TESTING BEEN SATISFACTORILY COMPLETED?
BLANK TESTING NUMBER USED LOCATIONS NUMBER REMOVED
GASKETS 0
WELDED PIPING OYES ONO
IF YFS
00 YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES
COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR -3? OYES ONO
WELDING 00 YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN
COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR -3 OYES ONO
00 YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMENTED
QUALITY CONTROL PROCEDURE TO INSURE THAT ALL DISC ARE RETRIEVED, THAT
OPENINGS IN PIPING ARE SMOOTH, THAT SLAG AND OTHER WELDING RESIDUE ARE
REMOVED, AND THAT THE INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED? (DYES ONO
CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL
CUTOUTS (DISCS) ARE RETRIEVED? YES ONO
HYDRAULIC NAMEPLATE PROVIDED IF NO, EXPLAIN
DATA (OYES ONO
NAMEPLATE
REMARKS DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN:
NAME RINKLER CONTRACTOR: METRO FIRE PROTECTION
l TEST WITNESSED BY
- (SIGNED) �� IT A
SIGNATURES /� r - 1 \ ._44S i�f1 /41/
-OR SPRI CONTRACTOR (SIGNED) TITLE DATE
�tst� r►udtn i -ll
ADDITIONAL. EXPLANATION AND NOTES ���
DEPARTMENT OF
P RIOR LAKE BUILDING AND INSPECTION
INSPECTION REC
'villain i
SITE ADDRESS (4 - PAlei4sio. e
NATURE OF WORK 'tr.1�ce-- 1 Ly - Rx2.44- it
USE OF BUILDING 5 A.
PERMIT NO. ( - Z. DATE ISSUED 8f 1
CONTRACTOR FTC -A t1 [ t t-s PHONE "ca- ems - c
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTI NS BELOW
THE PERMIT IS BY . NT A T. S
W e-Az"- 6.4±2a...1 (�� �° INSPECTOR DATE
FOOTING 1 1
FOUNDATION (Prior to Backfill) 1 1
PLACE NO C nCRE UN I ABOVE HAS BEEN SIGN AD
Cr-A-W■ O I SEWER /WATER / SEPTIC
FRAMING t>v v L
INSULATION � �
ELECTRICAL
PLUMBINGM uc 4 t4(/ f b r
HEATING (if required) P 101771 ,
FIREPLACE b r6A2 (
0403 GAS LINE AIR TEST /2 /7
R p ►.� to �l s tti� -rte ,6 v z.c� v
OVER NO WORK UNTIL ABOVE HA BEEN SIGNED
I rt05.61-4AP 1 1
° 3 1 ,1 z? FINALS e 12f f v
GIUDING (Prior to Sodding) j
BUILDING 1` (2/16 (/f
ELECTRICAL
PLUMBING '/' I Z fr
HEATING
DO NOT OCCUPY UNTIL ABOVE HAS BEEN SIGNED
NOTICE
This card must be posted near an electrical service cabinet prior to rough -in inspections
and maintained until all inspections have been approved. On buildings and additions
where no service cabinet is available, card shall be placed near main entrance.
FOR ALL INSPECTIONS (952) 447 -9850