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HomeMy WebLinkAboutBuilding Permit 11.725 i ' Yu ' , ,,, ' ' . w i cVYr : Vr i:, ' i t , Ca rr iftr ifr of ®cxttpanrg CITY OF PRIOR LAKE � Peparfntruf of Nuilbing 4" ttsyeriiaxt Fi nal Permitted ❑ Con ditional C.O. Expires This Certificate issued pursuant to the requirements of Section 110 of the ❑ Residential / 111 International <;. Building Code certifying that at the time of issuance this structure was in compliance with the various ordinances of the City of Prior t Lake � reeg g ulatiing � building construction or use. For the following: / ! V L" v Ci' , / Bldg. Permit No � 1 _ 7 Z-5 — Use Cassification /rte 3 j ( y K Classification Ty pe / _ Type Construction / Y Zoning Dis trict � (10/ Legal Description Owner of Building Site Address / 4 3Z-5 I /&/'..L � / D 0 /I /V Contractor's Name & Address / � J •/ � `) I / l Q C / ��J f 1--/,, // f (i/ / /y City Planner Building Official Date: 1 ; ( 5 Date: r { POST IN CONSPICUOUS PLACE + -_ k , , h a �! ' ," ‘ , s ki '! ' , ,. � :. '. 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I �F O n Z n D tti I P u e �, • Z 0 0 000000 lz7 m m m m 3�yS3 -In • X m m mr r 1 p N 2 r 71 XI XI 0_ z _ k, m -. _t >02p0 0 3 m n n 0 r - n 0 0 m =I 0 NI _ o Z Z X X _ O Z 71 m r 1:1 -0 p p m A x m O 0 m m .00000 � L,v N 11 R. > 0 O m m3�. m '� z mAO=� O > _ mm , 1 _ -I m -4 r m 11 -4 r 0 NC O. rat0� CITY OF PRIOR LAKE BUILDING PERMIT, a �c'd ti 9 TEMPORARY CERTIFICATE OF ZONING COMPLIANC 9 ! -.AND U TY.. T. ON PERMIT 1 TILT CONl� � ri l. JUL 1 2011 L *NES . 4' 'C �,. ') n,. ^ 4 a 4. I. White File PERMI '=1 • 11 R L+7 "'7 2. Pink City ��- - -r a r∎ 7 ■ 3. Yellow Applicant t r (Please type or print and sign at bottom) ADDRESS 14'2 p , p l..CZ Ir: S 1 D 1= cD v R-v ZONING (office use) Putt LEGAL DESCRIPTION (office use only) LOT 11 BLOCK 1 ADDITION J P - 1-7 - 5 /VT . . - 1 2- --P N pID 2 S U - 1 80 1 1 O OWNER (Name) "1. A T 1 R. M `t' 44 U ti ES (Phone) (Address) -- 12cs l IN A S 14 1 t-1 b U *--I. R 1/E S ...S 2_c) i l=O t t-.1 -A% 1-1 IQ S S 4 3 BUILDER. (Company Name) M 4 % --1— 1 `" t i 4+0 i`' ES (Phone) (Contact Name) S v E RJR (Phone) (Address) 12-0 1 Lti. k S 14 it C"rut� P v1= S S 7 e> t 1=0 l N e, P-, 1�1 SSL13' TYPE OF WORK 231 New Construction Speck ['Porch ❑Re- Roofing ['Re- Siding ['Lower Level Finish ❑ Fireplace ['Addition ['Alteration ['Utility Connection CODE: EI.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 St Z CI i OOU 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 inspections. E36.-- 2.c531 53 c::, 1 1) l lk Signature Contractor's License No. Date Permit Valuation Park Support Fee # $ M-5 °CA_ " Permit Fee $ 12 © 5 SAC # $ 2-Z._30,_ Plan Check Fee $ - Z 5 ZB Water Meter Size('; 1"; $ G ( State Surcharge $ 3 _ Pressure Reducer $ © _ Penalty $ Sewer /Water Connection Fee # $ (S Plumbing Permit Fee $ W Tower Fee # $ �j 4 -Sv CO.- Mechanical Permit Fee $ ( 5 -4 SO Builder's Deposit $ ( ), - Sewer & Water Permit Fee $ 5 - 0 Other 1=i f2 S a ics11 $ t 5 i SU Gas Fireplace Permit Fee $ 5 :4 -- 5C, TOTAL DUE $ 1 55 • It This Application Becomes Your Building Permit When Approved I . Paid q5_,7,3, Receip No. fj 1 / Date ,II,i) , By . Building Official Date This is to certify . , t the .. nest in the above application and accompanying documen is . accordance with the City Zoning Ordinance and may proceed as requested. This document when signed byy City :, . ■ er constitutes a temporary Certificate of Zoning comp ' ce d allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued. i�, L, A / i/ T F .: rISs!ifffita■ to 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 Zis •1 o ?Rioi CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd TEMPORARY CERTIFICATE OF ZONING COMPLIANCE i 0. ('3. I 1 AND UTILITY CONNECTION PERMIT FJ I. White File z. Pink city PERMIT NO. f OSS 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS 1 , 4 2 D 2 -8 pp, e_ lam -,l D 1 CCV 12--1 ZONING (office use) LEGAL DESCRIPTION (office use only) LOT t BLOCK ( ADDITION i E E - - liN A 1Zr ft_ °'J't PID 'ZS LI "l SD l I o OWNER (Name) ;1 R "T t P.- M `c 44 U M IES (Phone) (Address) `12451 tN R S 4 t t--t 6 i u t..1 h, vie. S S t t_. 20 t t - Ott-...1 4\ t-1 is S S t 4 3 9 BUILDER (Company Name) M `T ' y c 1 ES (Phone) (Contact Name) S L' E 81 ". 1 (Phone) (Address) 1'2 o f t... , Pr S E-} ti-,J (. l v1= 5 S lh- 7 n t t-0 1 NJ .t.- M m>> SSL4 7 TYPE OF WORK 0 New Construction fafltrek ['Porch ❑Re- Roofing ❑Re- Siding Lower Level Finish ❑ Fireplace ❑Addition ❑Alteration ❑Utility Connection CODE: ❑LR.C. ❑I.B.C. ❑ Misc: Type of Construction: I II III IV V A B Occupancy Group: A B E F III MR S U PROJECT COST /VALUE $ g, 0 oO . oo 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- %^ -�-_ c--- . PAL 2�3�1 5g 1 A 1 1t \ tl Signature Contractor's License No. Date Permit Valuation Z! cob O 0 Park Support Fee # $ Permit Fee $ (D 1. 255" SAC # $ Plan Check Fee $ _ Water Meter Size 5/8 "; 1 "; $ State Surcharge $ t - 0 0 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 $ 54-.51) TOTAL DUE Erma. lb . (4,,.11 $ 171. Th Application Becomes Your Building Permit When Approved Paid Recei. , N.e - 1 , Date 'ii B - 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 . a • • j • • • • 4 • ;',", * * • 10. • 4. A 0. arzawi • mp4_, - C.4 • ' • • a • • --Th M',G 1 1 . pRi Date Reed ii 1 CITY OF PRIOR LAKE BUILDING PERMIT, 0 C 1 1 7 2011 , 1 441101 TEMPORAR1' CERTIFICATE OF ZONING COMPLIANCE .., AND UTILITY CONNECTION PERMIT Bv_r_ PERMIT N( Q7_15 . 1 Melife e= or - ' .t and al ZONING (*set ttter 1 ADDRESS 143....;rnis) vo. lg SiO"&:. . 4, A ,-es , e t ie ' el-l'Sitiistsi , _ L_--i 1 . a I LEGAL DESCRIPTION (office use only) PID 7, LOT BLOCK ADDITION OWNER ,.. 1 (Name) ntill * ivvr IA* ...i - (Phone) q52. - (49(3a i ■ LOP(61.4 ..."1 i VC 6- 1 BUILDER CAPTLX-1 t,Phane __(e_;:_1 --/ .jk:, i (Compasty Name) ., ri — . . I (Contact Name . 11 :. IQ i7P‘Pj . ka ______ (Phone) •_____A________E___(Ao pess) L.-1444..C. IIIP g1 Liwo 1,46. - ‘, 1 4.4NI 1 TYPE OF WORK ANevi Construction °Deck OForth °Re-Roofing 0RetSideig [pLowei Level Finish 0 Fireplace l 0Addaton 0Alrerawn OUrillry Connection CODE: 141./LC, D.R.C. 0 vhsc ',. Type of Con TI struction: 1 in Pi C,) A 6) 1 Occupancy Group: ABE F III 154 &S 1.1 PROJECT COST/VALUE $ 342- Division: 1 2 t) 4 5 (excluding land) ---.....---- ii, I knell certify *co I have famished inforneatten on toss apetionstion whist ts to the hest ad no teninteledge troe and estmost also goofy the I arn the °waver aishatteed ages for the 1 4 at444 property and that ail emnistresdorut terel, =foam to seil =sang awe and local 1.2W7 and will proceed In accordance with submitted plans Lam aware that the holding i attain can treoks this perms fot )usi cause t1tberrlUrt,! Meets wee that the sus' official a: a deogreee :Etta cum espoo the property to Fel-form !waded inspections i , 543 , Contracter's Ltcenst No Date ....- perralt valuanon t 1 Park Support Fee # 1 5 $ . i ... . Permit Fee $) 1 $ - . • CA .....1 ; SAC il • 4. z 1 I Plan Check Fee 5 le i = Water Me:et Slzr 5 ‘S'', I". l 5 I State Surcharge 5 2 . 0c , , Pressure Reducer $ 1 Penalty 5 -i . r- Sewer,' WaTft Connect ton Fre # t I 5 = Plumbuig Permit Fee $ 1 Water Tower Fee # 1 5 1 1 , •i 191echanical Permit Fee 5 i I. Builder's D 5 eposit t I 4 , SeVk & Water Pelmit Fee 5 Other S J 03-5 Fireplace Permit Fee 1 S 1 1 TOTAL DUE FitID WITH ifirmilisai ,, . .4r ., . ii ; .....- Building Pete a Approved , Patti 7 1 By , 1, " ' Date . fhb I 1 3 II 1 1 . 1 - Building 0 ' cisi ate 1 The a to ottury that the repeat in OW aka3ve manor and accomparrong &unrest:to es ete asest,rdlact wo. th, cff, Zoning Ordinance and may piogeed as requested Thu doostmed i 1 whoa signed by the Ccy Planner Mare-Wes a tempc,rar,^ Legiefissete U.' Luting muthlosese arts allows constroctiose to outunence Before occupancy, a Crotficate of Occupattey gouts oe I Issued i 1 RAklert ag Z it‘544kAGIOV‘s 1 —,—,---.,----- i. Mamma taesegeos Nee Vled Condemns ef am 24 haw notice for so inspections 9S21 44 In (952) 4 r -1245 4646 Dakota Street ST —Preset Lake, Minnesota flir2 .4" r. '4 s- • t 4 . it • 4t "4 a ie It CITY OF PRIOR LAKE Date Rec'd l HEATING /AIR CONDITIONING /FIREPLACE PERMIT ' 2 r t NN ESO � 2. I . PiG'nk een File PERMIT NO.1 1 , 7Z. City 3 Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING (office use) 14328 PARKSIDE COURT N.W. 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 ❑Gravit ❑ Hot Water into Required Side Yard Setbacks. ❑ Mechanical ❑ Radiation DAir Conditioning ❑ 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 # PAID WITH HEATING PERMIT FEE $ �,��� PERMIT STATE SURCHARGE $ .50 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 txr,)1 I rRio CITY OF PRIOR LAKE Date Rec'd ° ` e r � « e HEATING /AIR CONDITIONING /FIREPLACE PERMIT V j3 M/NNESO`CP 2. Green ' ` t ' p '" Fit Ci` ty PERMIT NO. el l 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING (office use) 1 Pos s vk/ Couo- LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID c \ OWNER ame) b /y (� (N�L -- I v�� (Phone) (Address) APPLICANT (Name) 41 f _ .u.I n (Phone) Lam , 7) �1 1 . 1 61- (Address) /ika ( _ ( , i (1, \US o . 46 41 • ddress) `,� - /' (City) (Zip Code) (Contact Person) (.. 1�/\--\C I / (P one) � _3 • 1 1 APPLICANT SIGNATU _dis►� ' 1 dah $ • DATE , -1- I 1 If APPL ICANT PLEASE COMPLETE BELOW 2 NEW CONSTRUC ❑ REPLACEMENT ❑ ALTERATIONS FURNACE MAKE AND MODEL � L 5 _ ' l � 2_ FUEL 13a..4--. FLUE SIZE RETURN OPENINGS INPUT _11J1,_ OUTPUT TYPE OF SYSTEM HEATING OR POWER PLANT � ]Warm Air Plants PLEASE NOTE: Air Conditioner ❑ Steam Units and Fireplaces Cannot Encroach ❑Gravity ❑ Hot Water ' , rl Mechanical ❑Radiation into Required Side Yard Setbacks. %MI Air Conditioning El Special Devices Fireplaces with Box Additions or �lnt. System 0 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 $ 553O ((,. Building Permit # G MM The Minnesota Statutes �S 326(3.148 HEATING PERMIT FEE $ I 1 I L ,J" "SURCIIARGE" has been changed for one year effective STATE SURCHARGE $ 3.D - r .July 1, 2010, until June ;0.2011. TOTAL PERMIT FEE $ )5 51) The minimum surcharge for a "fixed fee" permit (Office Use Only) Is !SS beginning July 1.2010 This Application Becomes Your Building Permit When Approved Paid Receipt No. Date By PAID WITH Building Official Date BU ILDING 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 PERMIT 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 .(!, p RI0 Date Rec'd °, t o CITY OF PRIOR LAKE PLUMBING PERMIT 41 ji'NEsoo I. Blue File PERMIT NO. 2. Gold City 11:22: 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING (office use) I *'W ?Of V--SACk. C( LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER `�(� /�' VA �M (Name) 3Pe, — 1" �WV \l.(� 6( t (Phone) (Address) ( N ame ) NT h'] R (Phone) q 0o • (Name) � 1 L� j --� _ l DARSVAQ- � (Address) IL ' A . 1 �✓ Z- (Addres'11 (City) � V (Zip Code) 1 / • / 1 f� (, ' fp ' (Phone) v (Contact Person) APPLICANT SIGNATURE ATII.'� I It° A Alt . , (gum, i APPLIC ' N 1' PLEASE COMPLETE BELOW Quantity Type of Fixture Quantity Type of Fixture d Bath Tub with or without shower Rough -ins Dishwasher ( Water Heater 1 Floor Drain Water Softener Lavatory (Bathroom Sink) Stand Pipe (Washing Machine) Laundry Tray (1 or 2 compartment sink Sewage Ejector ( Shower Stall Backflow Assembly 1 Sinks Backflow Assembly Test Bar Sink Lawn Sprinkler 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 n Residential, Additions & Alterations $49.50 The Minnesota Statutes § 326B.148 't $ i Building Permit # "SURCHARGE" has been changed for one year effective PLUMBING PERMIT FEE $ I L I 9 July 1, 2010, until June 30, 2011. STATE SURCHARGE $S ,0) PAID WITH The minimum surcharge fora "fixed fee" permit TOTAL PERMIT FEE $ I • S �UI -" f L[31�V' -� . P �4'n is is beginning July 1, 2010 (� 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 lie Contractor Material & Test Certificate for Aboveground Piping PROCEDURE Upon completion of r• irk. inspect 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 sh0 he fi fed out and signed by both representatives. Copies shall be prepared for approving authorities, owners, and contractor. It is understood the ow representative signature in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to comply with apptoving authority's requirements or local ordinances. PROPERTY NAME: JEFFERS POND DATE 1' – 2.1-i 1 PROPERTY ADDRESS: 14328 PARKSIDE COURT ACCEPTED BY APPROVING AUTHORITIES: CITY OF WOODBURY ADDRESS: PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS OYES ONO j EQUIPMENT USED IS APPROVED YES ONO iF NO EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS OYES ONO TO LOCATION OF CONTROL VALVES AND CARE AND MAINTENANCE ,; fir OF THS NEW EQUIPMENT? IF NO, EXPLAIN INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: OYES ONO 1. SYSTEM COMPONENTS INSTRUCTIONS ■i YES ONO 2. CARE AND MAINTENANCE INSTRUCTIONS OYES ONO 3. NFPA 25 OYES ONO LOCATION ENTIRE BULDING YEAR OF TEMPERATURE I MAKE MODEL MANUFACTURE SIZE QTY. RATING RELIABLE RES 49 2011 1/2 10 155 SPRINKLERS RELIABLE RES 44HSW 2011 1/2 13 155 RELIABLE F3QR 2011 1/2 1 155 PIPE AND Type of 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 0 4-/V DRY VALVE Q.O.D. MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO. DRY PIPE TIME TO TRIP TIME TER 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 t 'O / WITH O.O.L. IF NO, EXPLAIN LOCATION MAKE & SETTING STATIC PRESSURE RESIDUAL PRESSURE FLOW RATE 3, FLOOR MODEL (FLOWING) 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 FOR TESTING VALVES OYES ONO N/A - DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO MAKF Mf71lFI SI IPFRVI.4ION I OSR Al ARM OPFRATF VAI VF RFI FARF 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 in 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 Atoveground piping leakage shall be stopped. TEST DESCRIPTION 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 c' assure 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 _HRS IF NO, STATE REASON DRY PIPING PNEUMATICALLY TESTED OYES ONO EQUIPMENT OPERATES PROPERLY ®YES ONO N/A DO 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? ❑YES NO DRAIN READING OF GAGE LOCATED AR WATER RESIDUAL PRESSURE WITH VALVE IN TEST CONNECTION TESTS TEST SUPPLY TEST CONNECTION PSI CONNECTION OPEN WIDE tp 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 OYES ONO IF POWDER DRIVEN FASTENERS ARE USED IN 0 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 NO IF YFS DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR -3? 181 YES ONO WELDING DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS 010.9, LEVEL AR -3 OYES 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? OYES ONO CUTOUTS DC) 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: I 7 1 _-1 1 NAME OF SPRINKLER CONTRACTOR: METRO FIRE PROTECTION 1 A TEST WITNESSED BY F ' NED) j4E DATE I / SIGNATURES � � JC �Q. / FOR SPRINK • , RACT•.' (SIGNED) TITLE "'`� ^ j 2/ DATE !!! ADDITIONAL EXPLANATION AND NOTES 1✓ DEPARTMENT OF PRIOR LAKE BUILDING AND INSPECTION I NSPECTION D. SITE ADDRESS 114,414510 . G-r-; NATURE OF WORK t►.1t'c.� Gui � LY A A 1 'NC. II F. L t USE OF BUILDING St�A PERMIT NO. l k - 72-5 DATE ISSUED 84/1 CONTRACTOR 1-14 -r --A%-k (4 PHONE e 5z_ — G. ( NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTI NS BELOW THE PERMIT IS BY ,SEPARATE NT A � - rS { rA1A1 INSPECTOR DATE I FOOTING 1 I I I FOUNDATION (Prior to Backfill) 1 1 PLACE NO CQ CRE UN I ABOVE HAS BpjN SIGI cWilkt- L:Auc. SEWER / WATER / SEPTIC FRAMING t✓� `/c1 to /,q /, INSULATION ,E'y /c`' ELECTRICAL PLUMBING l%'..& 9k/'( g ) o /K4jl HEATING (if required) ILA 16/4 FIREPLACE d GAS LINE AIR TEST giVi1/43 p � ` COVER O WORK UNTIL ABOV HA EEN SIG D 114 1 1 id-z e9e ,c1156, F INALS OpR�K�- - �� GRADING (Prior to Sodding) 1 BUILDING � )7A/4 ELECTRICAL PLUMBING ($ tl HEATING DO NOT OCCUPY UNTIL ABO E 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