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HomeMy WebLinkAboutBuilding Permit 11.923 Crfixttft Oxx v ' CITY OF PRIOR LAKE Prpztrfittrttf d pititbirt c Trtspri ft.vn Q Final Permitted ❑ Conditional C.O. Expires This Certificate issued pursuant to the requirements of Section 110 of the ❑ Residential / ❑ 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 :' Use Classification `''`, '� 1 ' --- c<( t^ ,..) G Bldg. Permit No. Occupancy Type Type Construction Zoning District r,. K = Legal Description L,,? ' -- E 1 j ,) : A � e 1 . L' j r- I k i cr K Owner of Building c, I E /- lo' Site Address 1 ' t �-. S le ;', 70 -4 / Contractor's Name & Address • K 1 I » t \-' rc .. _ r City Planner Building Official 1i Date: Date: POST IN CONSPICUOUS PLACE ' - ' — --- .... , 0• QQ J)_ 2 � 1r.. re w la la o z00 Z W k. aaaJ W 02WuiW Z c ;U tiii < rg Z M O 00000 0 > U W — V 0 —' x v 0 ■ J W r C.1 O . � Z >> Z CO E 0 W 0 • d' F E O 0 0 0 4' O < 0 W t x N Z G' Z -xx2LL � 0 d N O N +� d z w z 2wa N uc Z n W I � 0 0 Z f' O a a � W W to W k i ,� 000 0 00 o o w ce z �.I' a a LL x p J Y W M 2 i O F 2 V O u. ty V _ 0 0 Y h oC 0 z 2 0 � w I 4 � ) ~ < n I T 4. N O 2p 2 CL Z W N W W k1 < O OW d' W Z OO�N FW_- 2 0 0 0 - 0 C-) a 0 0 aa� vi H t5Z < 0 x 0000 0 -Q❑ 0 c 0 J i J E F W E Es zU U < z W 1 M �555z > w N Z 4( i l N � w z CG- 0000❑❑ cow o w = v o N 0 J W i Z0 � , z Y Y Z z o F o; 0OIL y w a. j U G\ 0 Z r M=x2� — W fn O 1 CO co N 0 a xzlaz a CO Z AC 114111j a�3Wd w w w w� ❑ ❑ ❑ ❑❑ ` O O z o4 a a O CL a w X p J \ 0 a 0 O W U a Y � N z � � Z \,� 3 rg G z U CO ill N r` a o 0 0 z w I- < f- ).- .. 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LEGAL DESCRIPTION (office use only) LOTS 'BLOCK 1 ADDITION A E F-E_t2 s W A N rr PID 2S y 1 by S So (Name) OWNER ''t R T i Ac h®t 44 U N 1 l (Phone) 9S 8 9 S - 21 ( DO (Address) - 1 Z[) t kiNi A S 41 i4 i ca 1,1 A vie_ S STE 2c) t t° O t ■-,1-N H t.1 SS 439 BUILDER (Company Name) M T 1\ M i - 1`"1 ES (Phone) q 6 2 g b— 6 1r2-8 (Contact Name) S U tr $ (Phone) (Address) 1'2 t L^., r t S 4 t C. 4 v 1 = S S - 1 7 - - 2-0 t l-O 1 N A, H +,.. S S t - 1 '39 TYPE OF WORK gf New Construction (Deck ❑Porch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace ❑Addition ❑Alteration ❑Utility Connection CODE: M.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 $ l �j 0 ( U CO 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 inspeC°ons. 3 �1 c. e_ BL 2A3 5 3ab g 126 t 11 Signature Contractor's License No. Date Permit Valuation ' Park Support Fee # $ ( QOd. -- Permit Fee $ (Z 45 .5 SAC # $ z z , Plan Check Fee $ Sol 73 Water Meter Size $La''; 1 "; $ 6 t 0 - State Surcharge $ Pressure Reducer $ 10- Penalty $ Sewer /Water Connection Fee # $ (S pO Plumbing Permit Fee $ t 54 , 50 Water Tower Fee # $ t 0 00. Mechanical Permit Fee $ (C 4 .So Builder's Deposit $ ( c Sewer &Water Permit Fee $ 5 O ther FtQ - cUP fZC-S�SI a» $ ( 51.50 Gas Fireplace Permit Fee $ 54..5-e. TOTAL DUE $ Gj ZS, Sp) This : pli .:� : e es Your Building Permit Wh. A roved Paid / 6o Zir..4 Re 1pt No. /3 r ) . Date S�� / I By Li — . t Bill ding Official Da e This is to - • tha ■ e re - t in the above application and accompanying do ents is in accordance with the City Zoning Ordinance and may proceed as requested. This document when si a by . e 1 ' , er constitutes a'temporary Certificate of Zoning co p ' ce and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued. Plannrn 0. tor 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 F w (11:?, O. rRt0 Date Rec'd 0 H CITY OF PRIOR LAKE ( `, SEWER AND WATER PERMIT q �' " Grellow an F Ci PERMIT NO. l / Z I . Y 3. Gold Applicant (Please type or print and sign at bottom) ADDRESS ZON NTG L H3 -1 — 7.3 -45-In patio aD --q 23 LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER , (Name) (Phone) (Address) (Address) (City) (Zip Code) APPLICANT (Name) h -S .ile■ • .i/(• (Phone) st —Liga ' 13 s 5 (Address) .9i( tG /'l -._c (Address) (City) (Zip Code) (Contact Person) At-- (Phone) APPLICANT SIGNATURE Mr , DATE q / - / APPLICANT PLEASE COMPLETE BELOW Size of water service inches. Location of any couplings from structure feet. Type of sewer pipe. ❑ ABC El PVC ❑ Cast Iron Estimated length of sewer line feet. Clean out (if required) located at feet from structure. FEE SCHEDULE Residential sewer and water line connection $51.50 Industrial, Com'l & Multi- family 1% of job cost with a $51.50 minimum Sewer connection only $25.50 Water connection only $25.50 Estimated Cost $ Building Permit # The Minnesota Statutes § 326B.148 R AND WATER PERMIT FEE $ pktD B "SURCHARGE" has been extended E SURCHARGE $ .50 until June 30, 2013, ■L PERMIT FEE $ 1D The minimum surcharge for a 4J "fixed fee" permit is $5.00 This Application Becomes Your Building Permit When Approved Paid Receipt . I Date `( By // / --. Building Official Date 9. 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 i rRrQ CITY OF PRIOR LAKE Date Recd ' I) o ,,,;. OCT 0 6 2011 ,, „ . r:�,t ^ A, HEATING/AM CONDITIONING/FIREPLACE PERMIT `' 1 ' ' '/MrFSco'' I. hnk Fite — N i t ” j — rhi ' " avow :l. Yellow App/icwit I (Pica' c type or print and sign at bottom) ADDRESS ZONING (otaec use) I LEGAL DESCRIPTION (office use only) L LOT BLOCK ADDITION PID OWNER (Name) ______ (l (Phone) (Address) { k t APPLICANT „��'' (Name). a -K. (Phone) q of�.(©( rr�� "2,t (Address) 9 __. t p t1�,) �� �1 t9., , l■- S J . 1 (City) (Addre — - /- ((Zi p Code) (Contact Person r - (� e-i W.:Y4 k (Phone) . "l Jg- p-i I. APPLICANT SIGNATUR "iikllt i ? / '1A _ . \ _ f \ 2 ,, TE .....__. t) to t 1 APPLICANT PLEAS E COMPLETE BELOW t` EW CO TRUCTION ❑ REPLACEMENT 0 ALTERATIONS • FURNACE MAKE AND pp _.�1— � ff�� MODEL i t- i L () ) .t' — FUEL %t.,�`_ FLUE SIZE RETURN OPENINGS INPUT ,3 _) _ OUTPUT td) J l ) TYPE OF SYSTEM PLEATING OR POWER PLANT PLEASE NOTE: Air Conditioner ,p Warrn Air Plants ❑ Steam Units and Fireplaces Cannot Encroach ❑Gravity ❑Hot Water Into Required Side Yard Setbacks. $! Mechanical ❑ Radiation q f ir Conditioning ❑ Special Devices Fireplaces with Box Additions or '178 ent. 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 549.50 $49.50 minimum Residential, Heating & A/C (New Construction) St49.50 Residential, Additions & Alterations S49.50 Residential, Heating Only (New Construction) $64.50 } , Residential, AC Only $49.50 Estimated Cost $ 5t tQ ✓ Building Permit # The Minnesota Statutes *326(1.148 "SURCti,\RGfi” has hccn changed for one HEATING PERMIT FEE $ 1 Lt("j year effective STATE SURCHARGE $ .. O July 1, zit t0. mitt; Jtinc 30.21111. TOTAL PERMIT FEE $ 1st{ , The minimum surcharge fora "fixed fee" permit (Otflee Use Only) Is N$, beginning July 1.2010 This Application Becomes Your Building Permit When Approved Paid Receipt No, Date By f � 8 w � Banding Official Date r I TH 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 �� ,��j' P ERAA 4646 Dakota Street S.E., Prior. Lake, Minnesota 55372 'L JJ 7' ,�. � *� '�:. ti On li CITY OF PRIOR LAKE PLUMBING PERMIT ___) ,..„, 6 t %3g By .--- I. Blue Pole 2 Gold Cey [ PERIVIIT NO. • (143 1. Yellow Applicout (Please type or print and sign at bottoE) ADDRESS ' [ZONING (office use) — 1 L A ) ■ I.) 2..., Pc-i_e_y_.aA c ov ..\— LEGAL DESCRIPTION (office use only) L LOT BLOCK ADDITION PID OWNER C. r (Name) ` (Phone) . ... (Address) ' 4 ' ______] -,PLICANT ..;,3. ) (Phone) (Address) ,:9XfD ' Li Ai i D V\--- __ faiSTII,l, ) M() 9i33 rs APPLICANT SIONAT:P (Phone) 1 S E (Address) RP entY,A-4 (City) (Zip Code) (Contact Peon) CIS ... . , ) CI .( ''''),..4' ,(42- !_t'IU'■Y ADA1C fl I i .... APPLICANT PLEASE COMPLETE BELOW _ [..__ Qua 3. : -- .. 2- ‘ _TA e LEpottere Quantity 'rYPe of Fixture Bath Tub with or without shower 3 Rough Dishwasher Water Heater Water Softener Floor Drain Lavatory (Bathroom Sink) Stand Pipeashing Machine) Laundry Tray (1 or 2 compartment sink Shower Stall 1 ) 2tra Sinks Fiackflow Assembly Test _ Bar Sink Lawn S_prinkler L 3 Water Closet (Toilet) Sewge Ejector 13ackflow Assembly Other FEE SCHEDULE Industrial, Commercial & Multi-Family l% of job cost with a $49.50 minimum Residential, New One & Two-Family $149.50 Residential, Additions & Alterations $49.50 ' • — The Minnesota S 'tst $ CO — Building Permit # itatutes § 32613.14/1 SlIRCHAROF.,' has been changed for one year effective PLUMBING PERMIT FEE $ k 9 95 ---D July 1, 2010, until Jun Ar 30, 2011. STATE SURCHARGE S le minimum surcharge for A "fixed fee" permit TOTAL PERMIT FEE $ 1 , f, - - is 5,5., Intoning July I, 21110 This Application Becomes Your Building Permit When Approved 1 Receipt No, I I Date i By Bailding OffleW Mite I _................. 1 8 4 24 hour notice for all inspections (952) 447-98514 rex (952) 447-4245 /1Ve't 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 '11114/7- pi! v N t, .(., , !!!■0 CITY OF PRIOR LAKE BUILDING PERMIT, i ' i i . ti E . ,... ,t: c TEMPORARY CERTIFICATE OF ZONING COMPLIANCE r; ! I- ,J- ','-- , I u AND UTILITY CONNECTION PERMIT . 4 ; - ; 1 1 1 1 1 u p • K c v L i 0 2:o11 it'iv E sO P/diri,a/ I I PERM NO. ' ..10)P. _M__t_a a e t7 r or twist aod sign at botwea) ADDRESS ZONING (�2C e use) -1 ,,../' ( g.,,k1 PA tZ.V...$1, DE.- ' NU..) gs: 1 I _ LEGAL DESCRIPTION (office use ordY) LOT BLOCK ADDITION Pip OWNER a ct se 59P - (49 (Name) r tilitixt-o< 1442,-46.. (Phone) (Address) 7 '1 ',":. el 114 1 AO - S. _ . 7 BUILDER e_12471.:4 (Company Name) , fritl RO _ 54_4_ Pg.6Tr (Phone) C.6 i - 11 (Contact Name) -JAI Sot-4 ittsirECZ. (Phone) (Address) 'I, Ao .„.., .., L I) Li 1.410 LeA "-..-, ki TYPE OF WORK ?!.New Construction Oriecii °Porch ORe-Roofing ORe.Sidong DLowcr Level Finish 0 Fireplace Addition 0 Alteranon 0Litil:ty Conntonon CODE; F i.R.C. OI.B.C, CD sills,: Type of onstruction: 1 II rn IV 0 A (ID Occupancy Groip: A 8 E F li 1 NICPS1..! PROJECT COST/VALUE 5 332 3 - OD ° Division: 1 2 elp 4 5 (excludi I land) ' I hereby cense+ Mat I tam (wombed infuessanon an dam applicanon wench o to the best of MY knowled8e nue on. calctecl : aisc :r7•Elft! that 1 Mr the owner or autharieed agent for ate above pre Loa tha all coos:Enaction mit COarotta to Ai vatting scat anal local laws and Neal proceed u,) accordance wub subs:toned plans I ara aware that Ise earidose official CIO Moat Etta p e r for rase muse, Furthermore. I ticre' agree that tbe cc!. oftioal oc a designee may earer upor. gt psvp..th to perrorth needed mspecoons X ./ -,a. .f. _ /0 -31-/1 ,...., Contractor's License No Date • Permit Valuation 1 1 000.eN, ' I Park Support Fee rs 5 I- ) Permit Fee .....$ SAC # $ ■ .I I Plan Check Fee ' $ ., 6) ts • IS ,I Water Meter Size 5/S I -, $ State Surcharge 5 6 ! Pressure Reducer S Penalty 5 Sewer/Water Cormecttoc Fe v # 5 ; Plumbing Permit Fee $ Water Tower Fee rr $ __-- Mecharocal Permit Fee S ■ i Builder's Deposit $ --1 4 Sen(eT & WW1' Permit Fee $ I ,` Other 5 t h 02 1.Wilace Permit Fee $ I TOTAL DUE $ VcV . vf•S 0 *I j %MI , Paid %., 1 aa ..; .7. - Your Striidini it APPro"d i t i V _ ..- _ Date 1 Receipt No i BY 1 nu4kit. Office Date 1 - rho a co mob tut rite request la the above applicuszat and accompanying 4omments is m acomdance wish the Ca' loath' OtUttT and may proceed as secluesied This docuseient 1 . when aped bt Ow Orr Mona COMMA= t EettreatE± Caulker o f 1.' cow:ante and allows cOnStnalron tO cotosnefgor 13cGsre occupancy, a C.enificatt of Occupancy must be 1 ■ — .. Ploming Duccuie ' One Spet.al Cen,ittons, .1 aer I ..,._ , 21 boot notice for all inspections (952) 447-9850. fat (952)447-4245 4646 Dakota Street S.E. Pnor Lake. Minnesota $53T2 r PR/04. CITY OF PRIOR LAKE Date Rec'd U 1 HEATING /AIR CONDITIONING/FIREPLACE PERMIT Q" *■/'ESDfS , 1. Pink rile PERMIT NO . I / trA, 2. Green City 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING (office use) 14325 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 DWarm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach ❑Gravity ❑ Hot Water into Required Side Yard Setbacks. ❑ Mechanical ❑ Radiation ❑Air Conditioning ❑ Special Devices Fireplaces with Box Additions or DVent. System 0 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 WM"I STATE SURCHARGE $ 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 Coevi. r • $ Contractor's Material & Test Certificate for Aboveground Piping PROCEDURE Upon completion of work, inspection and tests shall be made by the contractors 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 shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners, and contractor. It is understood the owner's representative's signature in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to comply with approving authority's requirements or local ordinances. PROPERTY NAME: JEFFERS POND DATE 1-9 —/Z PROPERTY ADDRESS: 14325 PARKSIDE COURT ACCEPTED BY APPROVING AUTHORITIES: CITY OF WOODBURY ADDRESS: PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS ®YES ONO 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 OF THIS NEW EQUIPMENT? IF NO, EXPLAIN INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: OYES ONO 1 . SYSTEM COMPONENTS INSTRUCTIONS OYES ❑ NO 2. CARE AND MAINTENANCE INSTRUCTIONS OYES ONO 3. NFPA25 OYES 0 N 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 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 jX 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 WIO Q.O.D. WITH Q.O.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 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 MOIIFL SIIPFRVISION I OSS Al ARM OPFRATF VAI VF RFI FASF OPFRATF Fl FASF YES NO YES NO MIN SEC HYDROSTATIC: Hydrostatic test shall be made at not Tess 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 Aboveground 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 pressure 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 2 HRS IF NO, STATE REASON DRY PIPING PNEUMATICALLY TESTED OYES El NO EQUIPMENT OPERATES PROPERLY EVES NO 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? EWES ❑NO DRAIN READING OF GAGE LOCATED EAR WATER RESIDUAL PRESSURE WITH LVE IN TEST CONNECTION TESTS TEST SUPPLY TEST CONNECTION (y- PSI CONNECTION OPEN WIDE 1 '/ 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 YES ONO OTHER EXPLAIN FLUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING YES ❑N IF POWDER DRIVEN FASTENERS ARE USED IN [DYES 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 DO 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 DO 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 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 NO CUTOUTS DO 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 OYES ONO NAMEPLATE REMARKS DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: / — NAME OF SPRINKLER CONTRACTOR: METRO FIRE PROTECTION TEST WITNESSED BY FOR PROPERTY OWNER (SIGNED) TITLE DATE SIGNATURES PRINT TRACTOR (SIGNED) J TITLE DATE ADDITIONAL EXPLANATION AND NOTESAA 0 i9 p (24,41.. e iz.. PRIOR LAKE BUILDING AND INSPECTION INSPECTION REC R { SITE ADDRESS (432.5 f: Cov al- NATURE OF WORK SlN &c..E- r-40i.« krric. -14 I Ki C. . 06C No {' .cu` 4 FIN USE OF BUILDING 5F L. • L, PERMIT NO. 1. , C . 2 1 DATE ISSUED 1 ILo (t1 CONTRACTOR rro4 Io'4 PHONE 9Sz -Sqg -eo i zs NOTE: THIS IS NOT A PER FOR ANY OF THE INSPECTIONS BELOW THE PERMITS BY SEPARATE DOC�M �, .V� ` ,, e5 114 � E - v2_cf tow! (,. 0 z.. 14"1N INSPECTOR DATE I FOOTING I 1 I 1 FOUNDATION (Prior to Backfill) 1 1 I PLACE NO CONCRETE UNTIL BOVE HA BEEN SIGNED c1ST &i () -1z O UG ' H -INS SEWER / WATER / SEPTIC FRAMING 414 i 1 ,2- // INSULATION I/ JO /I ELECTRICAL PLUMBING t4g ti/ y,,- HEATING (if required) FIREPLACE GAS LINE AIR TEST /u,.. PD « c9 A �o ��PC R N K UNTIL ABOV i lly/ "H BEEN SIGNED I 4 - 6 , -)c,6 -- wp.,Ap Vl 9 ' 1 1 I 3R- N KL (4 FIN ALS RA) 2Air2 GRADING (Prior to Sodding) BUILDING f) iir /A2, ELECTRICAL PLUMBING /'fly'' / /az HEATING PQ / /2C, / 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