Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Building Permit 11.1040
C rrfiftraft of (Cxrix am CITY OF PRIOR LAKE K,', ,== gitpurfturnf of .guiltritt c iittsyttflott i -...x ›`Final Permitted ❑ Conditional C.O.Expires rt This Certificate issued pursuant to the req of Section 110 of the CJ Residential 1 ❑ International • i Building Code certifying that at the time of issuance this structure was in compliance with the various �K ordinances of the City of Prior Lake regulating building construction or use. For the following :' ( Use Classification . \' Z 1- c ( f L.,,, < Bldg. PermitNo. / i I ( if Occupancy Type Type Construction Zoning District • - Legal Description 1 . t E- Li I, 1 1< l Owner of Building Site Address / I -' / 1 ' , ' I,t Contractor's Name & Address ,) 71t1 J =(. City Planner f Building Official Date: / I l l - 1 - __ r Date POST IN CONSPICUOUS PLACE i ' " \ V / h h V V o 4§ k j ■ u E � §vv« C.) ■ « 2 5 5 5 z > A til (1 a. 0. 0 2 § � — SQ� ft § / ❑00000 > 2 . 0 M w = 2 0 0 � § §Z z k p k re p o 0 0 0 0 I 0 u, care $ ■ 0 a x s= ■ — r4 § n 0 o o z e o a : §■ a2 0 0 § z cOOC ❑O % �f � �� ttCC 1- NMI k a § % In w i ■ 0 z © I NI% �k z �� u. § re z 0 z 0- e a -Z I- CD Q a Z 4C 4 n.ce 2 2 z -5 z W � U1 % b� LU § w k § ,f 0«■ ■■■ .9 u o �� 0§ 0 �� 0 0 0 0 E o 2 0 a 0000 0 0 0 0 / 0 Ja F J cc u. W 1 8 6 < 0 l� ��g Id W !� (7 Z.v_r 0 Q O 1 w o u. u. 0 re N b 000000 > oc 1 0 o '\ W = re U N J � » < CO c 0 w Z z 0 .... ~ re oou.J 0 0 V 4.. O aC _ z a' z -ZSZ z < 1- y W W t w O y 0 a m=Wlmx ., a 0 Z aW< ): W W z W O (7)- a �3v� _ U ` W �j r UU 8 re z ty ❑ ❑ ❑0 ❑ O re reO W a a a F G W W -..1 >: = V LL W Y V R 0 < I 5 1= 0 z J o 0 w F- 1 P \ P- W en C40 C O N Z h F h1 1 w CW W z O Og a � l_- O V d 0 E o u. W u. 3 IT to 3 0 0 E. z, 0 0 a 0 000❑❑ 0 — ❑ c 0 J W H o= ti,tu, a 0 W a `` M\ 5 552 > Ili 4 (92 /a N a 0 F- O u W z 1 0 O re a W x Z x N p a 4. J W L Z CA J Z »_ z 0 0 W 2 Y Y rE J o U 0., 8 a i= d W V ` z 2 z -=x 0 Z 0 mZxxm N 4 0 0. m W � y 6 n 0 u u Z K C !\ aZ v1a're W W z W k' 00000 0 o 0 W W • IS. a u. p J Y W O z Z p ° a 5 Z 0 < Z 0 Z — ° 0 W - g w Z ~01- a Z a 0 V u.V W py W H Z2 �JW Y R' . a O DW re W Z OOrt t E 0 O O y 0 V H 0 § 0 u. u. 0 '� t1 0 y E3 a 0 a 0 000❑❑ 0 ❑ c lii x J e i H W � ggSJ c V tLIL � w Z F ILI N • A ' ❑DOOO� o � � W O / , N o W U °z »� m o Z 00 - 0 Y Z U fr. 4. O H E2 O pciJ 0 0 0 m 0 00 04 °� a O P. S Z ce Z —x=ZZ c.) N O o 0 0 a °°xw a Z � . j 0 .... I- 3 O G Z I' O a , a� UJ W W cc ❑00000 a 0, O 0 re z _ ,. D J 1— I 0 Z a u. re re a YV Z V O ° a 0 g o a o- a 5 0 o Z w H P a ; , W Ce 0 O CO < e ° y z y 0 _. w a p H Z Zp J W Y U.I al p Q A LL 0 004C1 0 0 0 ti — V OW Z W Z OOW rai 0 0 u.u.u. Zu p _ 3 1 0 0 E. Es a 0 = a 000000 0 --H 0 —` o � rxl �' CITY OF PRIOR LAKE BUILDING PERMIT, ���53W e = t TEMPORARY CERTIFICATE OF ZONING COMPLIANC AND UTILITY CONNECTION PERMIT SEP 2 2011 l *NES ° � See M ai n File 2. hit City /11110A. % 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS L 3 4z (D 4 12.-v-s t O t: r o ) P---q ZONING (office use) Pi LEGAL DESCRIPTION (office use only) LOTS Li BLOCK 1 ADDITION t= t=ell 5 �A ' -P -i— ti -oN- PID - 2._S4 °� S 4D OWNER (Name) 1 R T Pl M - c' 44 U M E -S (Phone) 9 G Z' v c ) b' Zt OO (Address)12 c. l V.J A S N i t-i 6 t A V e S St Zc l GO t tit - P H i SS 4 3 9 BUILDER (Company Name) H i\ i U E S (Phone) Q S Z- `8' 9 8- b t Z8 (Contact Name) S 1 -' a- Z.? (Phone) (Address) 1'2-0 z t tAd k 5 l-} ti--,t ��ru VE S 5Th-? C? 1 t =O I u r-, t~. S S t--1.35 TYPE OF WORK Jg New Construction Speck ['Porch ❑Re- Roofing [Me- Siding ['Lower Level Finish ❑ Fireplace ['Addition ['Alteration ['Utility Connection CODE: E1I.R.C. ❑I.B.C. ❑ Misc: _ . Type of Construction: I II III IV V A B SO OvG Occupancy Group: A B E F H I MR S U PROJECT COST /VALUE $ f 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 the 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 ..,..___" 1 A --`_ BC-- 2c' 3 S b Signature Contractor's License No. Date Permit Valuation t 5 q oo o- - Park Support Fee # $ Permit Fee $ i 3 53 . c® SAC # $ 22 Cj_ - Plan Check Fee $ B1 1 $ Water Meter Size "; 1 " $ 0 (©. State Surcharge $ 1 s. - Pressure Reducer $ el o_ - Penalty $ Sewer /Water Connection Fee # $ t 5-00, Plumbing Permit Fee $ 1 54 ca Water Tower Fee # $ t ooB_ - Mechanical Permit Fee $ ( 54. r0 Builder's Deposit $ t 5 60, Sewer & Water Permit Fee $ 5G. 50 Other S' P/24 Ql XiL $ / 54 17 Gas Fireplace Permit Fee $ �- 4 5-o TOTAL DUE $ fS/& ' a C--- This &a.' n! a me� our Building Permit A roved Paid 9� /Z, 7( Re• ' •t No. 1 -7ilj/ !/ (/ / Date /b J y // - Building • fici. ate / This is t o that th t, in documen is in n danc with thince an and a G eed as sted. This doen when s' ; . d by the +' P requ • consti tu above te a temporary application Certificate of Zoning accompanying Iliacn, ts ' ce and allo construction e to City commence. Zoning Ord Before occup m y cy, o a Certificate reque of Occupancy must be t issued/ 7 A i k∎_.► (s 3 Planning Director Date Special Conditions, ifany 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 \ ft* "si, „„ tr .34st CITY OF PRIOR LAKE , „1101te Reed BEATING/AIR CONDITIONING/FIREPLACE PERMIT II uLl 17 i° i By InNew 11.- IN.. ay 411 AN ESCICt.' 1: Y r P A PERMIT NO. 1 I tlI If 1 3. Yeilow Applgterd (Please type or print and sign at bo(tom) ADDRESS ZONING coiticv .,,e i 5 1 L ? Petcv.skAe- i 1 LEGAL DESCRIPTION (office use only) [ LOT BLOCK ADDITION » PID ___ OWNER r\ LiCtIkrA—TY\ (Phone) (Address) APPLICANT r 'N . • -- - (Phone) C) k.,) . & -- - .4- La. V6 (Name) ,... (Address) L9K vtvol (A) --- fumv\,tui_ (A k) (City) (Zip Code) (Contact Person) QiAi,,0(k_i2_,Rek.INA..4.CLI (Phone) 1r Kql) APPLICANT SIGN/VT - ....ilata ' ' to ! tAJ . DATE 1 . _ APPLICANT PLEASE COMPLETE BELOW -.... ;to EW CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS - ) FURNACE MAKE AND MODEL L a.CA .,..Q-1 Sc6EV.2,(,?g.)(00-{()-- FUEL l'i at . CIA5 FLUE SIZE RETURN OPENINGS INPUT UP PDA) OUTPUT 55,151.) I TYPE OF SYSTEM HEATING OR. POWER PLANT PLEASE NOTE: Mr Conditioner jWann Air Plants D Steam Units and Fireplaces Cannot Encroach -- Elqsavity 0 Hot Water into Required Side Yard Setbacks. iill Mechanical 0 Radiation Fireplaces with Box Additions or 1 Air Conditioning 0 Special Devices i--. ent, System Other Cantilevers to the Outside of Buildings 0 Devices Require a Building Permit FIREPLACE MAKE AND MODEL .....___ FEE SCHEDULE Industrial. Commercial & Multi-Fatnily I% ofjob cost Residential, Gas Fireplace 549.50 $49.50 minimum Residential, Heating & A/C (New Construction) $149.50 Residential, Additions & Alterations 549.50 Residential, lieating Only (New Construction) $64.50 Residential, AC Only $49.50 , ----- Estimated Cost $ E-;? Building Permit II The Minnesota Statutes § 3266.148 HEATING PERMIT FEE / -- "SUR CI IARG lor one $ .. STATE SURCHARGE $ c--; — 7-60 — Jai ly 1. 2010, iiii tit Jo ne 30, 2011. TOTAL PERMIT FEE $ 1 9...i , rhe minimum xureharge for a "lixed fee" permh (Mike Use Only) .. is !..i:it beginning July 1.2010 This Application Becomes Your Building Permit When Approved Paid ; Receipt No. P ADwT++ Date — •■•""Mi A fl g4c , ,,...,, _ sondine Official Date b UILLA P. 24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 . .. . , ._._ ._ „. _..._ ........ .... ._. .. _____ .. _ .... ______ _ .._. _. .. . __ . . _.... ... ..... ...... . .. . . .. ......___ _ _..„... A14: 1 if • ,NO 1 1 P 1110 Date Rec'd CITY OF PRIOR LAKE PLUMBING PERMIT OCT 1 7 2011 i-,..t - •5•Z';`' 4, ' B y INNEsd F c l e y [pERMIT NO. 11 c0 • 3. Yellow APPlicsn, - ---- Please type or print and sign at bottom) ADDRESS — 1 ZONING (office use) II l — 1 LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID — OWNER (Name) ..C*2__U_ Nct-it (Phone) (Address) Phone) q S1-1 Of) APPLICANT p 0 ,,,, , l_k 6) irx (Narne).___ _____... tl, \, •- ) ( , (Address) _ .....',„bUk. ( ki)'. n Address) (City) (Zip Code) (Contact Person) W,elYk.e VCCV\W (. ..0 (Phone) o L' I - , t APPLICANT SIGNATURE , 1 ' vii ) _ , ' , - DATE 1. - 1 APPLICANT PLEASE COMPLETE BELOW 7 Quantity Type of Fixture Quantity Type of Fixture ,P Bath Tub with or without shower i3 Rough-ins il Dishwasher 1 Water Heater - 1 Floor Drain Water Softener ,.. Lavatory (Bathroom Sink) Stand Pipeffashing Machine) _ Laundry Tray (1 or 2 compartment sink Sewage Ejector Shower Stall Back:flow Assembly \ Sinks Backflow Assembly Test Bar Sink Lawn Sprinkler Water Closet (Toilet) L„... 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 _ . . . - Thc Minnesota Statute 1st $ t9 . 1C-514 ---- Building Permit it s § 32611.1 „ SURCHARGE" has been changed for one year effective PLUMBING PERMIT FEE $ t C I 9 .1uly 1, 2010, until june 30, 2011. STATE SURCHARGE $ — lc minimum surcharge for s "fixed fie" permit TOTAL PERMIT FEE $ is sii, hegirminiz July 1, 2010 This Application Becomes Your Building Permit When Approved Paid Receipt Ns PAID WTH_ Date BEzuiinio. PHF; ' i r Buildhut Official Date 24 hour notice for alt inspections (952) 447-98511, fax (952) 447-4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 34 isoplii. ( 01 PRI04, CITY OF PRIOR LAKE Date Recd HEATING /AIR CONDITIONING/FIREPLACE PERMIT N, 21 . Pink File y PERMIT NO I C I ' . G 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING (office use) 14345 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 ❑ 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 # 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(vii CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd #.. ... - ' TEMPORARY CERTIFICATE OF ZONING COMPLIANCE / / Z • 12- AND UTILITY CONNECTION PERMIT 4 ; 1 111111We e ,,, .vN : ,., : pERMIT NO. M*0 , ,.,...„„. . • 'Please j - or • , . ,. at bottom ; ADDRESS 1 1 ZONING urfSce tile . li 3 4 C PA4KICE CT Mt) (f lee - 0 , )oc ., 0 ` 1 LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID --------- fl A TT 41 PAY 140,..4E.S _ (Phone) t- - c-• i P "Lit 32. (Name) (Address) 12.0 1 Ltigkca-1 i t.i.iirctj Ati 5, BAR Cci.yreacr (Company Name) 4Ffilt VI eC a.00!2-1 tON1 (Phone) bet-794 -C44 7 (Contact Name) -40 inIVJTLR- . (Phone) (Adress) e ti ter 1 -- x tuc ux" ottieLs, ii..46i .9 TYPE OF WORK '.New ConstructIon ODeck OPordi ,nRe-Roctfing ORe-Shitng OLower Level Funsb 0 Fueplace DAddttion Ortiterabon 01:til try Connection CODE: vL C. 01.B.C. 0 Mix Type of Counseling: 1 II ID IV 65 A & Occupancy Group: A J1 E F H 1 31 (1) $ U PROJECT COST/VALUE $ 33z Division; 1 2 4) 4 5 (exd . ' , ' land) 1 bentry Mid?: that I haw (unstilted infornunon on this applicanort which n to the best of my knowledge nue and correct I also certify that I am the owner or tuthoneed agent for the abowenennoned property astd that all eunooKnon oral conform to all ousting state and toad Was and wrii proceed in accordance with Tabulated plans I am awue du! the holding o can Mu; roma for ouse _ letinhornote, I horbe aver that the or ofrKlai of a delhee mar flue' t+P-'n !he PloPeeer et> retiOfen needed =Pechora X Mork 0 eke C -074 / -4 Sitnature Contractor's License No Date Permit Valuanon . 1 , Park Support Fee # i S . . Permit Fee 5 .., SAC # 1 $ Plan Check Fee $ Water Meter Size 5 . 1", $ State Surcharge S 1 Pressure Reducer $ Penalty $ Sewer/Water Connecnon Fee att 5 Plumbing Permit Fee $ Water Tower Fee tt $ ,. Mechanical Permit Fee . S Butlder's Deposit $ Sewer & Water Permit Fee -, S ()the: PAID WITH Gas Fireplace Permit Fet I 5 TOTAL DUE BULINNOPM4rf — Y par Building Permit When Approved Ali i 2-- Paid Date Receipt No. lz By 8n g Official . ate This is to mob, that Me request m the shove arlAKa410 trid accompanymi documents is u acoudanct with the Coy Zoning Ord:name and may proceed as requested Thu document obeli owed by the Cry Planner commutes a temporary Cestthute or Zoning comphartot and allows conununon In comments Before accopancy. a CertiSmte of Gm-wanes muse be I issued I Re(cA. LieriC../. ce.0.-Q Planning Dottier Date Spool Conditions, if any i I ---------,..— 24 our notice tor aU taspectsons (952) 447-4450. las (452t 447-4245 4446 Dakota Street S.,.E., Prior Lake, Minnesota 55.172 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 2_2:7-12. PROPERTY ADDRESS: 14345 PARKSIDE COURT ACCEPTED BY APPROVING AUTHORITIES: CITY OF WOODBURY ADDRESS: PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS (OYES ONO EQUIPMENT USED IS APPROVED OYES ONO IF NO, EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS 'EYES 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: ®YES ONO 1. SYSTEM COMPONENTS INSTRUCTIONS ®YES ONO 2. CARE AND MAINTENANCE INSTRUCTIONS OYES ONO 3. NFPA 25 [OYES 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 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 L i 0 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 (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 FOR TESTING VALVES OYES ONO N/A DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO MAKF MOflFl 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 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 slopped. 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 ONO 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,NEAR WATER RESIDUAL PRESSURE WITH LVE IN TEST CONNECTION TESTS TEST SUPPLY TEST CONNECTION 4:x:! 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 (DYES El NO 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 121 NO IF VFS DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR -3? ®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 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 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 EVES ONO NAMEPLATE ) j REMARKS DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: NAME OF SPRINKLER CONTRACTOR: METRO FIRE PROTECTION TEST WITNESSED BY ERTY O ' ' -(SIGNED) T LE AT SIGNATURES //'� ��S / 2 2 �/�2 VVV � FOR SPRINK L NTRAC OR (SIGNED) TITLE DATE ..fir ADDITIONAL EXPLANATION AND NOTES PRIOR DE PARTMENT OF LAK BUILDING AN N SP O See Main. File INSPECTION RECORD SITE ADDRESS 1k345 FAQ.v-s hod- Cr NATURE OF WORK sIN6L6- ►!,-1 Arrievc,itegb 1146. Deck No P At oa. . L. USE OF BUILDING S F- PERMIT NO. DATE ISSUED le4s CONTRACTOR +'K, ---a e s PHONE asa -acts - 6 /is NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW THE PERMIT �� � , IS y BY SEPARA DOC ME T iL` ,, -S r � i krc �'� Q 5I 3 CeugI 0 49,-- 5c MAIN r �INSPECTO DATE I FOOTING I I I I FOUNDATION (Prior to Backfill) 1 1 PLACE NO CONCRETEUNTI ABOVE HAS BEEN SIGNED P cl�-U S� s vv �` 612- ROUG .a 6 P{ � PA1" {NS SEWER / WATER / SEPTIC FRAMING //s/2 INSULATION ,. ` / (i, ELECTRICAL PLUMBING Cs. .ie IV? HEATING (if required) FIREPLACE GAS LINE AIR TEST /LI COVER NO WORK UNTIL ABOVE HAS BEEN SIG ED I Awe-J.6- L- 1 1 ,s P114 kJ ( /f/i - FINALS OD 2 /Z ?I - GRADING (Prior to Sodding) BUILDING (4. I. e 11. ELECTRICAL PLUMBING •27'' 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