HomeMy WebLinkAboutBuilding Permit 11.924 CITY OF PRIOR LAKE
ptpurfmi of f !nitMn c littscittfirrn
K Final Permitted ❑ Conditional C.O. Expires
, ,; This Certificate issued pursuant to the requirements of Section 110 of the El 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 � ■ , a � L, I 6r'(- Bldg. Permit No. 1 C cI 2
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K Occupancy Type Type Construction Zoning District
Legal Description L ' 1 ? r IL . f J 0 1
K Owner of Building Site Address ` 1f
Contractor's Name &Address' 1.
� � e : �t � " ��` � � : City:Planner �
Building Official 1j
Date: Date:
POST IN CONSPICUOUS PLACE
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rxlp� CITY OF PRIOR LAKE BUILDING PERMIT, 1 [ ( That d
ti ilk1 TEMPORARY CERTIFICATE OF ZONING COMPLIAN ti ; AUG 2 6 2011
AND UTILITY CONNECTION PERMIT
N By
k. x,,44'. `';1 ' '' 44.° 4: t i , .. pi nte File PERMIT NO IL 7 ,
• .,P;n1c City
3. Yellow Applicant / m II
(Please type or print and sign at bottom)
ADDRESS t 4 2- 9 b.,(Zk.s t D E Co u P=C ZONING (office use)
POD
LEGAL DESCRIPTION (office use only)
LOTS BLOCK 1 ADDITION v — t S teN) A: t - 112—F2-0 " 'JT PID 4 - 1 8U S p
OWNER
(Name) '1 A 'T P, M't' • 0 li t =S (Phone) C 2 g 9 8 - - 2 - 1 UCH
(Address) - 12cA V A S l-I t t-t 6 i4 A 4 E s s 2p t t =O t t-,l -I\ H t-► SS 439
BUILDER
(Company Name) r'l i \ --1- M -7--1 i 4+o c -t E5 (Phone) gS2- 9 e - fo tom,
(Contact Name) S L' E- (Phone)
(Address) 120 1 l..... Ac S 14 Is�i (."t if,, vg. S s . ? e) t t -0 t NJ Ac r-, t,‘ Ss
TYPE OF WORK 0 New Construction (Deck ❑Porch ['Re-Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ['Alteration ['Utility Connection
CODE: CI.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 $ 14 0 l OC1 J
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 i 2io 1 `1 i3 I X� �^ _ BL 2. 3 Sag k::
Signature Contractor's License No. Date
Permit Valuation t Park Support Fee # $
Permit Fee $ (35 So SAC # $ Z Z-3o
Plan Check Fee $ 8 $ 3, (OS Water Meter Size 49"; 1 "; $ (o k o.
State Surcharge $ "1 , sue Pressure Reducer $ V_ -
Penalty $ Sewer /Water Connection Fee # $
Plumbing Permit Fee $ (S4 5 Water Tower Fee # $ ( v
Mechanical Permit Fee $ (5 4 w5o Builder's Deposit $ 1 5c.D-
Sewer & Water Permit Fee $ 5(0.50 Other r (46- c t eY1ue-S5tz+-i $ t 54.50
Gas Fireplace Permit Fee $ 54.50 TOTAL DUE $ cl e Z3 1 $
This App • tion : co .. Your Building Permit en Approved Paid /1.13, eipt No. 4'/ i,..3 Date
rf '+ it \(
Building Offci A i lk Date
This is to certify ; at the req - in above application and accompanying docum is is in accordance with the City Zoning Ordinance and may proceed as requested. This document
when signed by ( ■ e 'ty ' • . • er . . . tes a temporary Certificate of Zoning comp c and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued. , ' ( E I
t
Plann 1 , a e 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
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O) PRIO�� Date Recd
CITY OF PRIOR LAKE � /(e G
SEWER AND WATER PERMIT `T
�INNESD� �
2.
1. G Yello reen w City File PERMIT NO. l / 0/ Z
3. Gold Applicant
(Please type or print and sign at bottom)
O ADDRESS ZONH'TG oti
HN31l ." 2.3 - a5-171 pa .c ct -R 23
LEGAL DESCRIPTION (office use only) — q Z 1—
LOT BLOCK ADDITION PID
OWNER ,
(Name) (Phone)
(Address)
(Address) (City) (Zip Code)
APPLICANT
(Name) h ,s . ✓1't • AA• (Phone) eo 51-'190— J3 5 5
(Address) ef?`� l� �
(Address) (City) (Zip Code)
'/�,�
(Contact Person) r ~ ` 1 tCe '!v1"-- (Phone)
APPLICANT SIGNATURE • , DATE q ` - //
APPLICANT PLEASE COMPLETE BELOW
Size of water service inches.
Location of any couplings from structure feet.
Type of sewer pipe. ❑ ABC ❑ 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 $ i. ( SURCHARGE has been extended E SURCHARGE $ .50 J
until June 30, 2013, LL PERMIT FEE $
The minimum surcharge for a I
"fixed fee" permit is $5.00
This Application Becomes Your Building Permit When Approved Paid Receipt ..
/IA I
Datey / `( By f/ J4 4/
Building Official Date / 6 i l
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
r RIO CITY OF PRIOR LAKE a te Reec'
0 ,--. ` - .' HEAT ING /AIR CONDIT.IONINGIFIREPLACE PERMIT
...,2- , OCT 0 6 2011
i j
, ArNFS(ot- t, r4nk ri PERMIT s . ` � r ` . ■
x. 4rcm City
3. Yetiww Appriem
(Please type or print and sign at bottom)
ADDRESS ZONING oanct use)
1 L A 3 41 D ar LSYLe 0.0 u f j
LEGAL. DESCRIPTION (office use only)
LOT BLOCK ADDITION PM
OWNER C n, -
(Name).. (Phone)
(Address)
1
il
APPLICANT
(Name)_ if _4c �tl (Phone) �` � ;1
(Address) > Y) 1/1 _. PD . L 3 AC 0 ,r t"t R 3f
r' ( y (City) (Zip Code)
(Contact Person) ' i t ° c }
U W (Phone) ` ! S C3 ' t % .._.._...
' APPLICANT SIGNATURE t♦.. ) 4+► � 't A- DATE U !
APPLICANT PLEASE COMPLETE BELOW
NEW CONS UCTION ❑ REPLACEMENT ❑ALTERATIONS
FURNACE MA.KE AND MODEL _ _r. _.. x >L�/�.� ,.� FUEL C £'�Q �
FLUE SIZE
R ETURN OPENINGS INPUT 55/36D OUTPUT �D�
TYPE OF SYS'T'EM HEATING OR POWER PLANT
'Watin Air Plants PLEASE NOTE: Air Conditioner
[] Steam
Units and Fireplaces Cannot Encroach
LiOravity ❑Hot water into Required Side Yard Setbacks.
.�'i Mechanical ❑ Radiation
v: CI Air Conditioning ❑Special Devices Fireplaces with Box Additions or
ent. System ❑Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
FIREPLACE MAKE AND MODE
FEE SCHEDULE
Industrial, Commercial & Multi - Family I% of job cost Residential, Gas Fireplace $49.50
$49.50 minimum
Residential, Heating & A/C (New Construction) 5149.50 Residential, Additions & Alterations $49.50
Residential, Heating Only (New Construction) $64.50 Residential, AC Only $4930
Estimated Cost $ 1 54 a Building Permit #
The Minncscota Statutes §3261).148
HEATING PERMIT FEE $ '51 "su ci 1nRGf " hus been changed for One
._. -. • ---- year effective
STATE SURCHARGE $ (,). e--- .l) 1, 2010. until June 30. 2011.
TOTAL PERMIT FEE $ .-- the minimum cureharge tor a "rise(' fee" permit
(Mee Use Only)
Is ,U. het;lnnlneJuly 1.2DIo
This Application Becomes Your Building Permit When Approved Paici 1 Receipt No.
Date BY r WI
a+rtldlne Official uate a`" `"w+ ffi�j f III
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 'U r r
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
+
1
r e,,,„m•
CITY OF PRIOR LAKE PLUMBING PERMIT
ti
OCT 06 2011
NVNESO B °
I. Moe File f
PERMIT NO.
2. Gold CiG
3. YtIlow Applicont •
"
(Please type or print and s:Ign at hottom) _
ADDRESS (Doke Ise)
_:2)b' -
... . —
LEGAL DESCRIPTION (orrice use only)
LOT BLOCK ADDITION PLD
OWNER —
(Name) y
(Phone)
(Address) \: A. 1 IIMPK
....
APPLICANT ( , --z- , .... ) , ___, _,\., ji i _Ak ,
(NameL (Phone) .
(Address) . - D,_. 1
").. .
r.....) (Add= (City) I (Zip Code)
/2f.r ,. fl 1 ,,,
(Contact Person) . V N.-%-t- - kf.,.,,y ra,k1A
...,....z......... (Phone)
, ..----
APPLICANT SIGNATURE, ?La, ,,,,_ L ... _,„ ert -- -- PI t.6i
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
c;.. Bath Tub with or without shower "2
i_...> Rough-ins
--,-1 Dishwasher 1 Water Heater
Floor Drain Water Softener
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundty Tray (1 or 2 compartment sink Sewage Ejector
a Shower Stall Backflow Assembly
i Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
. 7 - ) Water Closet (Toilet) Other
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% ofjob cost with a $49.50 minimum Residential, New One & Two $149.50
Residential, Additions & Alterations 549.50
,
The Minnesota Statutes § 32613.14. Building Permit # 8 —1st $
'S1JRCHARGI' has been changed for one
year efTectiye PLUMBING PERMIT FEE $ I 1.-(C1 5
ility 1, 2010, until June 30, 2011. STATE SURCHARGE $
c minimum surchnrge for a "fixed f C
ec" permit TOTAL PERMIT FEE $ - 3 1- i
is 53,', hegintling July 1.2010
This Application Becomes Your Building Permit When Approved Paid
, Date
Receipt No.
By PAO )7
stow,
%Aldine Official Dote 1 NG ERI14
, _
' IT
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
4* , I a tt
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'
o ' I:Pop CITY OF PRIOR LAKE BUILDING PERMIT, LI
,,,, ati Ree
TEMPORARY II,
, :
— , MPORARY CERTIFICATE OF ZONING C ;
N n '. 02 2011
AND UTILITY CONNECTION PERMIT
ie$1111.04 i
IL ', _g____Ild
i 1
2 tall cot : PERMI 1 SO. f .
1 ..rttlot. Arrvon 1, ,
„Oen tve or print *24,in:a tot bon .
, ADDRESS I ZONING toagrust)
i 14 ,,....7. PA t'Llee,St DC. -
LEGAL DESCRIPTION office use only)
LOT BLOCK ADDITION PID
OWNER , I
(Name) r i Air 0,frort 1•616416:5 (Phone) 'i5 -- &9R
(Address) 1201 IJP6i4 04 (A A. .5.
BUILDEit Czi
(Company Name), t R 0 - ft ex. Pezre.x.r tug (phone) (4 — 6 4 - 04 ti
(Contact Name) -J * 914 (..Z'kOlr..---e, (Phone)
(Address) ,i, 4 _I .. . 1) Li MO L4 ' 3
TYPE OF WORK siNew etostruction Ontck Opotch 0Re.Roofing Ofte 0Lower Lev& Finish 0 Fireptoce
01111Ad4itton 0Alterattort 01:tiliry Cohhectu7s
CODE: yaI.R.C. C31.1),,C. 0
Type of Distraction: 1 II III IV 0 A
Occupancy Group; A B E E HI M PROJECT COST/VALUE 5
Division: —
1 2 a 4 5 (ticludi . land) t.- 1 4,0. Ct
rr ivreeby rem* ow i aave forsobed inforessatami oo thss appnearion whet els the hes of rev, knowledge out anti comet I aho cemey that I sm the 0Witerthonreei arts for the
abosensentstaseti. pespetts and that oh constrocnon mil comforre to ail =nog owe an4 local taws and will proceed to accoolar.,:x wIth tutttruttest Nam I ant aware that the butatag
("mai ow revrie dus matt tat put cum. Autbantor c I balt VW OW the ,..sey altos% or a designee may enter upon the propert+ to petfortzt needed Inspections
..
x tito‘kevi .4471"41 __C---C.,________.-----_____ /0 -3/ —it
, _4factitt Contractor's License No Date
t---
1 Permit Valuation i • Park Support Fee at 5
*MD • • rie
Permit Fee $ i 8 • 00 i ' SAC .g $
.0----
1 .- "PCIteck Fee $ 4,(v.gi ,, Water Meter Sat 5:5 I' $
State Surcharge $ 2 • o Ci 1 Pressure Reducer $
PetAlty $ ,L -- - ---- -
Seweri Water Conneztton Fee str $
. ...
Plumbing Pertilit Pet $ , I Water Tower Fee # $
Mechanical Permit Pee , $ t I Builder's Deposit $
Sewer & Water Permit Fee 5 — I :
Other
l - $
Oas Fireplace Permit Pee 5 ,
i I TOTAL DUE
I $ P1 014,10°411\411
to • v
4 ,r . , , - Your SollsVing Permit Olsen Approved 7 Paid [ Rece .,
f1, ik 1
r °
Bi 1/Vii
uld Mol l Date I
F rEn i that the mono* us the above apphosnor and accoatopantram tloctonents t to accordance with the Ctry Zoning Oedema= and may proceed as requested Thu document
otos gaped by the Csty Monet conattoges 4 importer Conneaut of Zonstss complance and allows coottntettoo to escomerter beim occupancy a Cernfirate o( OccupancY rant be
tossed
— *--..........
DOC Scarctal Cookhouse, If sny
24 hour nonce for all inspections I9S2) 44/-9850, fits t3S2S 44/-1245
444 4 Dakota Street S,E Prior Lake, Minnesota SW%
( PR /0
CITY OF PRIOR LAKE Date Recd
B HEATING /AIR CONDITIONING /FIREPLACE PERMIT
r hN ES O
1. P Gree ink n City Fiit PERMIT NO.'' 24
2.
3. Yellow Applicant •
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
14327 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
DAir Conditioning 0 Special Devices Fireplaces with Box Additions or
❑ Vent. 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 #
PA
HEATING PERMIT FEE $ D 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
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4
Contractor's Material & Test Certificate for Aboveground Piping
PROCEDURE
Upon completion of work, inspection 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 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 /.- 9-12
PROPERTY ADDRESS: 14327 PARKSIDE COURT
ACCEPTED BY APPROVING AUTHORITIES: CITY OF WOODBURY
ADDRESS:
PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS YES ONO
EQUIPMENT USED IS APPROVED OYES 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 ONO
2. CARE AND MAINTENANCE INSTRUCTIONS OYES ONO
3. NFPA 25 OYES ONO
-c -
LOCATION ENTIRE BULDING
YEAR OF TEMPERATURE
MAKE MODEL MANUFACTURE SIZE QTY. RATING
RELIABLE RES49 2011 1/2 12 155
SPRINKLERS RELIABLE RES 44HSW 2011 1/2 12 155
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
Q 2_
. 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
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 ❑NO
N/A - -
DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO
MAKF MODFL SIIPFRVI.SIC)N I ORS AI ARM OPFRATF VAI VF RFI FASF OPFRATF FFI 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
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 NO
EQUIPMENT OPERATES PROPERLY OYES 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?
OYES NO
DRAIN READING OF GAGE LOCATED SEAR WATER RESIDUAL PRESSURE WIT A VE IN TEST CONNECTION
TESTS TEST SUPPLY TEST CONNECTION ( PSI CONNECTION OPEN WIDE
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 1:0 YES ONO OTHER EXPLAIN
FLUSHED BY INSTALLER OF UNDERGROUND
SPRINKLER PIPING OYES ONO
IF POWDER DRIVEN FASTENERS ARE USED IN OYES 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? 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? OYES ONO
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: / 9 / 2
NAME OF SPRINKLER CONTRACTOR: METRO FIRE PROTECTION .
TEST WITNESSED BY
FOR PROPERTY OWNER (SIGNED) TITLE DATE
SIGNATURES
FOR SPRINK NTRA OR (SIGNED) TITLE DATE
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ADDITIONAL EXPLANATION AND NOTES ZJJQ'
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P R'OR DEPA
LAKE B. UILDIN DEPARTMENT OF
G AND INSPECTION
INSPE
RE CO D "'
SITE ADDRESS tits z
� PA P-14.91 �vrL -r
NATURE OF WORK sr r- +&c.g- K4, t I J c. DEC I� n {? cl Ph./
USE OF BUILDING 5FA
PERMIT NO. H. Zq- DATE ISSUED IL' f tl
CONTRACTOR KATTr4 Nt 6 - S PHONE 952.848 - 0 I zs
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW
THE PERMITT''IS BY SEPARATE DOCUMENT At- �5
DATE
FOOTING
1 I I
1 FOUNDATION (Prior to Backfill) 1 1
PLACE NO CONCRETE U IIL ABOVE H�ASBEEN SIGNED
1441 M isr l 0 O UGH - Wit �.
SEWER / WATER / SEPTIC
FRAMING / / /tc
INSULATION ? /2/5 /))
ELECTRICAL
PLUMBING ) / 1 /k,
HEATING (if required)
FIREPLACE 11123)A
GAS LINE AIR TEST 1:tp R.H. Vice ikz
0 PIP COV R • W • RK UNTIL ABOVE HAS BEEN SIG
t -wAP : gypI 1
N��..
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3 � FINALS ki
GRADING (Prior to Sodding)
BUILDING rl2 r2.
ELECTRICAL
PLUMBING l7- ,' z
HEATING J� � 1/76/1L
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