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HomeMy WebLinkAboutBuilding Permit 11.724 Y „ rr, Y' , i _ yy Y I” v ;, i a� ( Y t S_i , � � . i 5Y _ o -.. r.rf..i,., .. _.1 ..i .,rr .n ., i .. „ i _. _. .: r __ i. ._ i i.,�i _. �ii _. rV�.rr .,ii1.iV_. i �: nVV�f..,i Yf,' _lln,. 1Y1 _ :.. r., :: _. E, , 1, c 1. 1, c: . CITY OF PRIOR LAKE �, prparfturtlf of thintg 1nsprtfiaxt K �t ` Final Permitted ❑ Conditional C.O. Expires This Certificate issued pursuant to the requirements of Section 110 of the ❑ Residential / ❑ International r. 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: If . 7 24 Use Classification y` � 51 � C.2 r�'��� / Bld Perm No. Occupancy Type _ / 3 Type Construction VA,/ Zoning District /9 ijt� f Legal Description K Owner of Building Site Address / 32 tO I �/ Iel......J D 6, l , err I 1 ..,. Contractor's Name & Address t/ , 4i Al y izv t-i .�. !8&/?_, Hui . u/ ///'. 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Yellow Applicant 1 ^ 1 (Please type or print and sign at bottom) ADDRESS 1 c} 32 , P *. 12- -S I D E L D u L:r ZONING (office use) POD LEGAL DESCRIPTION (office use only) LOT l o BLOCK 1 ADDITION E r' p- __. rz rL P c �1 T PID 25 4 12,0 1 0 U OWNER (Name) i'l R T M `t -N 0 M eS (Phone) (Address) 12-c 1 W A S t--1 11-1 t ca A V E s 5`Ta 2.p t O t NJ H N B43 BUILDER (Company Name) t't 4 r - T \ i' 4 +0 f i E 5 (Phone) (Contact Name) S v - (Phone) (Address) l2L' l V.. k S 4 it-4 (, ,p vE_ S s'i— 7 t) 1 >=O I t.1 t.. M tit SCI-4 TYPE OF WORK New Construction Speck ['Porch DRe- Roofing ❑Re- Siding []Lower Level Finish 0 Fireplace DAddition DAlteration ❑Utility Connection CODE: [ I.R.C. I.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 $ 13 C- ) i 0 0 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 nee`Fd inspections. X��...._ - - Bt✓ ?-31 538b l 1 l 9 1 li Signature Contractor's License No. Date Permit Valuation Park Support Fee # $ V32_ cam_ Permit Fee $ SAC # $ ('Z45 , So Z ,. - Plan Check Fee $ , C 5 Water Meter Size r,";1"; $ pia lo: _ State Surcharge $ C, &. _ Pressure Reducer $ '1,0- — Penalty $ Sewer /Water Connection Fee # $ . S Plumbing Permit Fee $ 154 co Water Tower Fee # $ C->E, _ Mechanical Permit Fee $ ( _ Builder's Deposit $ 500. Sewer & Water Permit Fee $ 5 0 Other F(2- < e i2A S5 (- $ (5 , 5a Gas Fireplace Permit Fee $ 5 4.5c, TOTAL DUE •r . • ' I • • • ir This Application Becomes Your Building Permit When Approved Paid /4- 7/ 68 Rec.• No. e — 3,.S / / Date fj , 1r, (( B Building Official Date , This is to certify that „ request in the above application and accompanying documents is • ac .rdance with the City Zoning Ordinance and may proceed as requested. This document when signed ∎ ■ e ' Planner constitutes a temporary Certificate of Zoning complian • and . ows construction to commence. Before occupancy, a Certificate of Occupancy must be issued. •' 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 46, I * 46t 1r+11.$ • 464616elkitS 4610,pc I JL,s'1 CITY OF PRIOR LAKE BUILDING PERMIT, Date Re , i TEMPORARY CERTIFICATE OF ZONING COMPLIANC OCT 2 4 2 G I AND UTILITY CONNECTION PERMIT i j hN l"a S B y • , III a MIN■ Or 1. white File P ERMIT NO. 1 / . 1 /Z z. rank city / 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS l 43 2.6 P 1 s _ _ 2 - tLS 1 OE CO t Z v ZONING (office use) LEGAL DESCRIPTION (office use only) LOT l 0 BLOCK 1 ADDITION J E.P-P E 2S t. A T1= 2 F ri' o f li PID ZS LI 1 yj p t 0 b OWNER (Name) '1 p1/4-1- P. M 'T 44 U tom1 ES (Phone) 95 - 2 9 S r- 2 1 (z (Address) - 12,a1 1N A S 1-1- t t-t T u t-.t N vE S .sTt=- 2-o t t =D t tit H N C55 BUILDER (Company Name) .-14.-1----1- t i ++0 r-1 ES (Phone) 9S2 - 2) 9 2) - 6 v22, (Contact Name) S t- ' E- .1 (Phone) (Address) 120 t LA., It S 1 4 tt LTU Pc vE S S'1— ' ") t > =t7 t tv .4, M 1-.3 SSt-4. - DJ TYPE OF WORK 0 New Construction ' Deck ❑Porch DRe-Roofing DRe-Siding flower Level Finish ❑ Fireplace DAddition DAlteration ❑Utility Connection CODE: DI.R.C. ❑I.B.C. ❑ Misc: Type of Construction: I II III IV V A B Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $ `1 1 0 d U I 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 inspections. x�µ-- =t— E,L _l1 S c� t o l20 l Signature Contractor's License No. Date Permit Valuation 2. 006 , 00 Park Support Fee # $ Permit Fee $ G Z . Z-.5".. SAC # $ Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $ State Surcharge $ / • U O Pressure Reducer $ Penalty $ — Sewer /Water Connection Fee # $ Plumbing Permit Fee $ 54 ` 50 Water Tower Fee # $ Mechanical Permit Fee $ Builder's Deposit $ Sewer & Water Permit Fee $ Other $ Gas Fireplace Permit Fee $ 5¢ CD TOTAL DUE $ /7z. a5 This Application Becomes Your Building Permit When Approved Paid Receipt No. Date By 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 : - -E e ' T F1H1 CITY PRIOR LAKE BUILDING PERMIT, CERTIFICATE OF ZONING COMPLIANCE OCT 17 2011 • L,1 AND UTILITY CONNECTION PERMIT 4,stiore B y 4%v Es° ' 41....D: • :I, PERMIT NO.1 I ni 24' tirDS -v c' - s I Please I . or .rtat and si .. at bottom ZONING ADDRESS 1,' (0e5ce we) 1 i I II 32 7 -4J2 PA V' SibE-: . J. ■■'. 3r-----LEGAL DESCRIPTION (office use Pray; I, I PI LOT BLOCK ADDITIOPit) 1, ---- -_-------_ --------r ' OWNER 1/ , _... .. t-1 mh , (Name) ""TI ' M Y ' .4 - - .--- .- one i (Address) • t. riSi4 ■ .r * %) surLDER c3z Prtike-1 1 (Company Name) , :. . rl f.._ . ,. ,.. I - (Phone) (Contact Name) .. 1 -- r1/4 IP P. , R- (Phone) i (Address) 1 . i.-04 • giti6 I- 1 WO TYPE OF WORK •,.; New Ceestriscuou °Deck CPoreh aRe.11ooFrng EiEe-Sidir.s °Lower Lcvei Finish Q Fireplace i EjAddititin ElAllerarion OUtillry Connection CODE: 0111.C. OI.B.C. Type of Construction: 1 0 m ) IV (S) A 6C Occupancy Group: A li E F H 1 M&SU PROJECT COST/VALUE $ . , c, i Diyisia.: 1 2 t) 4 5 (excluding land) , flame" ernfy that ; have furnished ustormasion on chas app" Natt■Ch 17 tO The heft a [et kr.vw)e4fe zrue WIC train I CIO eemey thm I am the owoet or ludo:eased 'sent for the ' above•toe" Pit'PolY Ind dU in ctmstrUCKM s.:1". s 'OSIJW/T. TO 41! CuguIS gate and local ;pal saJ wi:..' pecceed In atecadance aVlth WhfrilFtrd plans I sm ramie thin &,e tvddthg .adkuil =I revoke this permit for luss cause Figtht,rittnr, ! het' aotrct that thr :ay ofr 0 . des tra' -'n the 7; to Perform needed Inspect X Signature Contractor's License tio -1 r- Permit 1/ablation , ParV S'..ippon Fec ts 5 I, ..... • ..) ee = ; Permit Fee 5 103, OCI I ,' SAC 1 4 _ S , Plan Check Fe 1 $ 449 . 1 1 Wale: Meter Size S.'S", 1", 1 $ r State Surcharg Z i , e S i Pressure Reduces S .00 ! L i Periaity 5 1 Sewer /Water Connection Fee # $ r I' Plumbtrig Permit Fee 5 1 „ Water Iccver Fee 5 4 Mechanical Permit Fee S i I 1 Buddr's Dr.po$1: $ , , , Sevier St Water Permit Fee 5 Other $ Gas F' -. . Permit Fee $ ifi TOTAL D $ UE 1 i , r1 ',Becom our Building Percent ' . n Approved / 1 i i , ....4. ; —, Date 7 Lim: 0 7 1 Etc I Tild o Warm& chat the request in the ibu,e appl■carior and sccornpaevyIng documents ts m acenzdan ozTh the Cln,' Zon Ordinance and may proceed as requested, Thu CSOCUIneet WS= PgrAnd 1 the Ca" PIIIIIIK c‘institutea a reer.perar Cernrkate of Zorng comptiance and alums cnrutractuin to ;um-menet Wore amicuincy. a Certificate of Occupancy must De 1 Lamed I e (4 tkri • 1 4 . 1 11 ‘ S 41.45CY 1 Marmot Mtectot Date • • 11 CO ■ I Mill, Ir 40 24 bout notke for sa inspections 052144 far (952)44 4646 Dakota Street S.F.., Prior Lake, Minnesota 55372 '■'+'• • . lk # • 5 ' , � PRIp � CITY OF PRIOR LAKE Date Rec'd HEATING /AIR CONDITIONING /FIREPLACE PERMIT � tz1 \ NE SO I. Pink File PERMIT NO. 2. Green City 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING (office use) 14326 PARKSIDE CT. NW LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER (Name) MATTAMY HOMES (Phone) 952- 898 -2100 (Address) APPLICANT (Name) FIRESIDE HEARTH & HOME (Phone) 651- 638 -3318 (Address) 2700 NORTH FAIRVIEW AVE. ROSEVILLE 55113 (Address) (City) (Zip Code) (Contact Person) (Phone) APPLICANT SIGNATURE _WENDY SCHROEDER DATE 651.638.3318_ APPLICANT PLEASE COMPLETE BELOW ❑NEW CONSTRUCTION FURNACE MAKE AND MODEL FUEL FLUE SIZE RETURN OPENINGS INPUT OUTPUT TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE: Air Conditioner ❑Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach ['Gravity ❑ Hot Water into Required Side Yard Setbacks. ❑ Mechanical ❑ Radiation ❑ Air Conditioning E] Special Devices Fireplaces with Box Additions or ['Vent. System ❑ Other Devices Cantilevers to the Outside of Buildings Require a Building Permit. FIREPLACE MAKE AND MODEL HEAT & GLO SL550TR -IPI -E 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 $ Building Permit # HEATING PERMIT FEE $ PAID WITH STATE SURCHARGE $ .50 BUILDING PERMIT TOTAL PERMIT FEE $ (Office Use Only) This Application Becomes Your Building Permit When Approved Paid Receipt No. Date By Building Official Date 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 0 '- it ' F rRio CITY OF PRIOR LAKE Date Rec'd • ` `& A.° , • HEATING /AIR CONDITIONING /FIREPLACE PERMIT H , (ja U. . 4 t p'n'` File PERMIT NO . 2. Green City 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING (office use) (-t3- Posy ode- c kr LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER . (Name) / 1 _. _ I. All ..41 4' . (Phone) (Address) II APPLICANT i � ^ (Name) 4 f _.... /t tn (Phone) Cif U1 6 ! 1) } , t` , (Address) AM/kW" 0 _ ( ,, ��`�L. 'I• 41 . ddress) (City) ) (Zip Code) (Contact Person) ° • Al a (P one) "1 `� � i • 1� • APPLICANT SIGNATU.• I .!Llta � �� V� DATE��� W APPLICANT PLEASE COMPLETE BELOW NEW CONSTRUCTION ❑ REPLACEMENT ❑ ALTERATIONS • FURNACE MAKE AND MODEL CM X 32n 1; -{ \QC - (a..— FUEL N FLUE SIZE RETURN OPENINGS INPUT ) 0� OUTPUT TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE: Air Conditioner -DWarm Air Plants 0 Steam ['Gravity ❑ Hot Water Units and Fireplaces Cannot Encroach ,rl Mechanical ❑Radiation into Required Side Yard Setbacks. IV Air Conditioning 0 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 I% 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 $ 5\,e , _ Building Permit # The Minnesota Statutes § 326E.I4 t HEATING PERMIT FEE $ ( L ,� "SURCI IARCiy" has been changed for one year effective STATE SURCHARGE $ 3.D\ -50 July 1, 2010, nntii June 330, 2011. TOTAL PERMIT FEE $ ,S—D '1'hc minimum surcharge for a "fixed fcc" permit (Office Use Only) is , beginning July 1.2010 This Application Becomes Your Building Permit When Approved Paid Receipt No. Date RAW, WITH BaildineOfficial Date , ..;. A P hi! (T 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 $4 ' tik 4. it • ■# 4 ?Rio Date Rec'd 'N CITY OF PRIOR LAKE PLUMBING PERMIT f-,t ,,,,,,,.., siJivNESoP 1. Blue File PERMIT NO. 2. Gold City 7 2 4 3. Yellow Applicant a (Please type or print and sign at bottom) ADDRESS ZONING (office use) I ParLSide -. LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER �(� t ' ,, (Name) € , � " - 1 " l � t'1��Vt (Phone) (Address) APPLICANT 6e t ..„. , , (Name) (Phone) R5a,To-,itoo (Address) sL�1,1 , d 1( 1 v\� W "z -� _ t'� i TJ (Addres • 1 1 (City) (Zip Code) (Contact Person) Rein , • 4 (Phone) CiD ' 0' APPLICANT SIGNATURE ��� � ��� �' aa 1 APPLIC, • N 1' PLEASE COMPLETE BELOW Quantity Type of Fixture Quantity Type of Fixture Bath Tub with or without shower _ Rough -ins 1 Dishwasher Water Heater l Floor Drain _ Water Softener 3 Lavatory (Bathroom Sink) Stand Pipe (Washing Machine) Laundry Tray (1 or 2 compartment sink Sewage Ejector a Shower Stall Backflow Assembly 1 Sinks _ Backflow Assembly Test Bar Sink Lawn Sprinkler ` 3 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 $ Building Permit # "SURCHARGE" has been changed for one year effective PLUMBING PERMIT FEE $ 1495 PAID WITH 1, 2010, until June 30, 2011. STATE SURCHARGE $�.� ,6� The minimum surcharge for a "fixed fee" permit TOTAL PERMIT FEE $ PERMOT is I5, beginning July 1, 2010 s-Ll This Application Becomes Your Building Permit When Approved Paid Receipt No. Date By Building 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 Contractor's Material & Test Certificate for Aboveground Piping PROCEDURE Upon completion of fNork, irnspect: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 left in service before contractor's personnel finally leave the job. A certificate shaf f t e tit €ed our aed signed by both representatives. Copies shall be prepared for approving authorities, owners, and contractor. It is understood the :owner's re,.fresentative's signature in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to comply with approv >rfg auttlorily's requirements or local ordinances. PROPERTY NAME: JEFFERS POND DATE / PROPERTY ADDRESS 14326 PARKSIDE COURT ACCEPTED BY APPROVING AUTHORITIES: CITY OF WOODBURY ADDRESS: PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS OYES ONO EQUIPMENT USED IS APPROVED OYES ONO NO, EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS OYES ONO TO LOCATION OF CONTROL VALVES AND CARE AND MAINTENANCE OF TH S NEW EQUIPMENT? iF NO. EXPLAIN INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: [DYES ONO 1 . SYSTEM COMPONENTS INSTRUCTIONS OYES ONO 2. CARE AND MAINTENANCE INSTRUCTIONS YES ONO 3. NFPA 25 ®YES ONO LOCATION ENTIRE BULDING YEAR OF TEMPERATURE MAKE MODEL MANUFACTURE SIZE QTY. RATING RELIABLE RES 49 2011 1/2 11 155 SPRINKLERS # RELIABLE RES 44HSW 2011 1/2 16 155 RELIABLE F3QR 2011 1/2 1 155 PIPE AND Type of Pipe BLAZEMASTER FITTINGS Type c:f Fitting CPVC MAXIMUM TIME TO OPERATE ALARM DEVICE THROUGH TEST CONNECTION ALARM VALVE OP FLOW INDICATOR TYPE MAKE MODEL MIN SEC FLOW INDICATOR POTTER VSR - F © 3 g" 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 w , O '0.0.D WITH C.O.D. iF NO. EXPLAIN LOCATION MAKE & SETTING STATIC PRESSURE RESIDUAL PRESSURE FLOW RATE 3 FLOOR MODEL (FLOW ING) PRESSURE REDUCING INLET (PSI) OUTLET (PSI) INLET (PSI) OUTLET (PSI) FLOW (GPM) VALVE TEST N/A OPERATION: ['PNEUMATIC ❑ELECTRIC ❑HYDRAULIC PIPING 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 EOR TESTING VALVES OYES ONO N/A DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO , MAKF MODFI RIIPFRVISIOIyLOSS Al ARM OPFRATF VAI VF RFI FASF OPFRATF Fl 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 it 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 At•oveground piping leakage shall be stopped. TEST DESCRIPTICt< PNEUMATIC: Establish 40 psi (2.7 bars) air pressure and measure drop, which shall not exceed 1 -1/2 psi (0.1 bars) in 24 hours. Test o•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 PSI FOR _HRS IF STATE REASON DRY PIPING PNEUMATICALLY TESTED OYES NO EQUIPMENT OPERATES PROPERLY ®YES ❑ NO 00 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? OYES NO DRAIN READING OF GAGE LOCATE NE AR WATER RESIDUAL PRESSURE WITH VALVE IN TEST CONNECTION TESTS TEST SUPPLY TEST CONNECTION PSI CONNECTION OPEN WIDE 4 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 (DYES ONO IF POWDER DRIVEN FASTENERS ARE USED IN ® YES ONO IF NO, EXPLAIN CONCRETE, HAS REPRESENTATIVE SAMPLE TESTING BEEN SATISFACTORILY COMPLETED? BLANK TES TlNC NUMBER USED LOCATIONS NUMBER REMOVED GASKETS 0 WELDED PIPING OYES ONO IF VFS DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY W1TH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR -3? 'DYES ONO WELDING 00 YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN C=OMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR -3 ®YES ONO DO 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? YES ONO CUTOUTS 00 YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL CUTOUTS (DISCS) ARE RETRIEVED? OYES ONO HYDRAULIC NAMEPLATE PROVIDED IF NO, EXPLAIN DATA YES ONO NAMEPLATE _ REMARKS DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: J 2 1 NAME OF SPRINKLER CONTRACTOR: METRO FIRE PROTECTION / TEST WITNESSED BY 1 / SIGNATURES *pop - P' K •� TRACTO' SIGNED) TITLE DAT — ADDITIONAL EXPLANATiCN AND NOTES J70‘9 DEPARTMENT OF PRIOR LAKE BUILDING AND INSPECTION INSPECTION RECQfl:. ,e FOC SITE ADDRESS (4 2G0 Ra.e145,oG G NATURE OF WORK Ly Amt.-hi-fro D&-+c. N P i r ir1 USE OF BUILDING PERMIT NO. l _ 2 DATE ISSUED 8# CONTRACTOR A -y -A- y 14'4 e-s PHONE Gt cz— Mgt (2c3 NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTI NS BELOW THE PERMIT IS BY SEPARATE NT S 1 /04471,-c- gr IF` ll ,,IVAITIVA INSPE DATE FOOTING 1 1 1 FOUNDATION (Prior to Backfill) 1 1 PLACE NO CnRE UN 1 ABOVE - HAS BEEN SIGNED talki Cr-A-eV&. O ' I II I�I S SEWER / WATER / SEPTIC FRAMING ,,d sm1 -i INSULATION /4 ELECTRICAL PLUMBING U &_ cd f, 4. 1of2r l HEATING (if required) Pt 14 r 1+ FIREPLACE e� ee �`r GAS LINE AIR TEST 1 - 1 '? g/j cop stti c O VER NO WORK UNTIL ABOVE HAS BEEN SIGNED 114 1 1 k5PRt1JKt..-6� < < P �a 11 0 e1 FINALS 6 12 1+ .GRADING (Prior to Sodding) BUILDING � 0 70/ ELECTRICAL PLUMBING Q6 ) J 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