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HomeMy WebLinkAboutBuilding Permit 11.1098 - rrf f trafr of ®x am K CITY OF PRIOR LAKE K .. prparftttrxtf of . U UM M xtg nsprtfi n 'Final Permitted ❑ Conditional C.O.Expires This Certificate issued pursuant to the requirements of Section 110 of the ❑ Residential l ❑ 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 ' l N ,L � �! 141 k 1 19( j I �' Bldg. Permit No. !I — /0/4 Occupancy Type Type Construction Zoning District 17 V C - ` Legal Description L 1 1 t \e re' i . " N l �+►`--".1 1 ""' _ - rik 1 S ca �,� s% &r C,q / Owner of Building �j AX� Site Address � 1 K Contractdr's Name & Address _ .,; .: . s. . r . . . ::. 7 _ - .� r ► , t { { K I, E a a t k ` . /n .f' , - ` C Planner Building Official / r Date ' ' / J / 7 Date: K POST IN CONSPICUOUS PLACE Z < V Y �� ;� V V V _V V V . a V 5 000 0 0 D000 'a 0 a 2n 2 0 0 4 . 0 q■§§ z m k m O r $ 73 �■ 3 mIc■§§ m x§ ©m % r m m m$ z ® § 17 10 - > § m 0 ,- z � • n z o §§ 0 z 0 CA § k % o 6 m 73 • m 0 R O \� OOO O 41 x m I T F c 71 ■5EV lib 0 -I z o o nc �� e n -n §■ m 0 0 § 2 M ƒ \ > BQ§ � B § -I m § -1 o - X zAA - z c 2 .7 m I- -a - P m / I 0 I m 2 n gi 2 000000 _ z 0 n§ £ § R. • o a .0 -a�© _ . .— m m � 22� z m -4 r 0 I 0 0 cc❑❑OO 0 > §7 § A k k � m >c 8 co m m cn o � � � § § ■ Z § -40>0 0 » t 2 w § z §2 / \ • - im■ % T a 0 0 CA 0x m n 0 Cr 8 mm \ MI r 71 13 0 - % m zO O 000000 41 m §m mr � E ., § °° 0C mx ■ -u 0 Ca ? m M§■P3■§ m o 0 § 2 m G 0 >000 0 2§ m � - . r @oo xi rf * 0 / co z z r 2 } co mm P m r 0 / x x X m - c 0 I 2000Oo � _ m o 2 § O C 1 2 < �� /� j \ >mm \� m �Z■ .r=" 2 - r § 9 s° 1 CITY OF PRIOR LAKE BUILDING PERMIT, ' 1 C IP Re �t TEMPORARY CERTIFICATE OF ZONING COMPLIANC AND UTILITY C t ' A . ' " OCT 0 5 2 011 1. File White ' — ��� Jr r� i PERM I 1Z• �-- J — 3. . Yellow w A C p y plicant /RI L 0 I! 0 3ellop (Please type or print and sign at bottom) ADDRESS 1.4'2 9 - - O t= C Ov tL t ZONING (office use) ► u, LEGAL DESCRIPTION (office use only) LOT t9, BLOCK t ADDITION - t w-A' 0 --E)'v�t PID 15'-1 - 1 0 o 13o OWNER (Name) 1' P T IN.- l'-'t -t4 0 M E.S (Phone) (Address) 12..c2)1 1NASt4►t4 -J 0.\,E S St 2z, t GOttit4\ 1-1 1 SS439 BUILDER (Company Name) 1 - Mt -1 i - 4 - U M ES (Phone) (Contact Name) S U E - E (Phone) (Address) l '2-o t Ls... t4 S 14 Ii �T1 J i v� S ,s 7 <) t t-O t t.1 A H 1�1 GS4 39 TYPE OF WORK 0 New Construction IgDeck ['Porch ❑Re- Roofing ❑Re- Siding ['Lower Level Finish ❑ Fireplace ❑Addition ['Alteration ['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 HI M R S U PROJECT COST /VALUE $ IGA) , b U2 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......—........._ 86- Zo 3'1 538 t o `-5I. t Signature Contractor's License No. Date Permit Valuation (U')0t r - Park Support Fee # $ Permit Fee $ SAC # $ Z Z 3 ' Plan Check Fee $ 116. Water Meter Size'; 1 "; $ t p State Surcharge $ t - Pressure Reducer $ 10, - Penalty $ Sewer /Water Connection Fee # $ (sue, Plumbing Permit Fee $ , ¢ �� Water Towe F # $ (cx. _ Mechanical Permit Fee $ I 1-- 5-- Builder's Deposit $ ( 500 -- Sewer & Water Permit Fee $ 5 , d Other r «2 v s i $ (54.50 Gas Fireplace Permit Fee $ j TOTAL DUE $ ?IX 78 This A 1 'cation e • , • , .. es Your Building Permit Wile ' App • , ve Paid 7 y/ , ' e) Rec t No. 6 � ff Date By - . .. (0 ( :ui g •fl'r79` (i ate This is to c - : • that the req est in the above a .lication and accompanying docum. is is • accordance with the City Zoning Ordinance and may proceed as requested. This document when signe. i. the C P P. i -4 constitutes a te , .rary Certificate of Zoning com.... ce , d allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued. ..;. . �� 6 (' (/ • la . ' . _ Director D. e Special Conditions, if any our notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 `' • 4 it • 4 • 15 *ft Residential Building Permit Checklist New Construction for Single or Two - family Dwellings in R -1 or R -2 Districts (4, Reviewed by: Date: C b / Building Permit # PID: Zoning: Address: W5 52 s - Scot 5-b., Ccv Legal: L R-\% B 1, Subdivision: -,...it...- t---0.) Tito- Existing Structure? YES 10 Existing Nonconforming Structure? YES i1 CONFORMS TO ZONING X§8 NO ORDINANCE Yard Setbacks: NA 1 FAILS! COM I Standard_ Proposed • Front Yard (can be 20' if avg. ' 150') 1 'Z +.1' • Side Yards --F . l 25' if a a stet 1 ` `, , -p, '—.J6, 6 0r Vi rt„ , aa..t...4_,, \o t 1n , `s • Sidewall exceeding 60' requires additional side 2" 10' setback + setback for every 1' over 60' in length. Not required 2"/1' over 60' if building wall is 10' -0" or greater of being parallel to a side lot line. �y • Rear Yard ,c (! 2/2/ • Patio Door: provide for minimum 10' deck or sign 10' side/ statement indicating no deck will be built in the future 25' rear — • From 100 year flood elevation of wetland /NURP 30' pond. • Refer in- ground pools to the Planning Department • From OHW (Prior or Spring Lake) 75' or setback average of adjacent structures, but no less than 50' I Floor Area Ratio: NA / FAILS / CO L S .30 Maximum r I Yard Encroachments: NA / FAILS /C PLIES I Standard Proposed Eaves and Gutters no more than 2 feetwidth and no closer than 5 feet to a lot line (Easements). NC and other equipment cannot encroach on interior side yards. 04/4-1,1,412.0> Tree Preservation: 1 FAILS 1 COMPLIES Standard Proposed • Total caliper inc s • Permit 35% Removal • Caliper Inches Removed • Caliper Inches Preserved • Replacement %:1 L: \TEMPLATE\BLDGLIST.DOC Driveway: NA / FAILS / CO Standard Proposed • Maximum width at prop: • • - 24' • Required setback 5' from side lot line or 30' from r -o -w on corner lots Pc AD • Maximum slope 10% .3 6 k • All parking areas to be paved including R -V or spaces adjacent to the garage • Location to match subdivision grading plan 1ic:;, 1 Building Height: NA / FAILS 1 C P ES 1 35' Maximum Shoreland District: NA / FAILS / C • ' IES I Standard 1 Proposed Minimum lot area (square feet) 7,500 Rip, 7,999 Non -rip Minimum lot width 50' Rip, 57.3' Non -rip Shoreland alterations Impervious surface 30% Maximum tom ( n A• ,;- Bluff in Shoreland. ' FAILS / COMPLIES Standard Proposed • Setback from o. of bluff By planning dept. • Bluff impact zone 20' From Top of Bluff • Engineering certification submitted /approved By City Engineer • Grading in bluff or bluff impact zone No importing /exporting Floodplain A FAILS / COMPLIES Standard Proposed • 100 ye ood elevation 908.9' Prior Lake 914.4' Spring Lake • Lowest floor elevation 909.9' Prior Lake / 915.4' Spring Lake • Proposed lowest floor elevation Must be 1' above flood • elevation for new and existing structures. If existing structure was constructed 9/19/90 - 11/22/97 then additional foot is not required. • Elevations 15 feet from structure Must be flood elevation or higher • Road access must be no more than 2 feet below 907.9' for Prior Lake Regulatory Flood Protection Elevation 913.4' for Spring Lake Accessory Structure: N / FAILS / COMPLIES 1 Standard Proposed • Size 1000 sq.ft. or 30% rear yard • Not located in front yard (Materials) • Side yard and rear yard setbacks 10' • Maximum height 15' • Materials compatible with principle structure L : \TEMPLATE\BLDGLIST.DOC • PRIp U t� White - Building "'rN;vESO Canary - Engineering Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT N 1 A( { A M koha5 APPLICATION RECEIVED 1 I The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: 5 - 0 A - 7 fi ,„ Lam C R .. ?' LE.. --• ' _ 14 - 5 G (4 .te r- , l 3 S 6 i • _., ter C _. ? � �^ Accepted IK Accepted With Corrections Denied Reviewed By Date: Via/, // Comments: See Attachments: 1) Grading Plan, 2) Erosion Control Measures ' See Reverse Side for Additional Information! "The issuance or granting of a permit or approval of plans, specifications and computations shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of this code or of any other ordinance of the jurisdiction. Permits presuming to give authority to violate or cancel the provisions of this code or other ordinances of the jurisdiction shall not be valid." • ADDITIONAL COMMENTS FOR BUILDING PERMIT APPLICATIONS • Surface storm water drainage flowing to the perimeter of this lot to and from adjoining properties must be conveyed to the roadway and /or to the rear of the lot in drainage swales within the drainage easement. • All bare soil areas must be protected from eroding into neighboring properties through the properly installed and maintained silt fence or bales. • The silt fence required by the erosion control plan must be installed prior to any earthwork being started, • The builder is responsible for maintaining the erosion control measures until the turf is established. • The rock construction entrance must be installed at the time of backfilling of the foundation. • 6: \Admin \dept info \ADDITIONAL COMMENTS FOR BUILDING PERMIT APPLICATIONS,doc 0 1)11194 h U tr1 White - Building Canary - Engineering vNeso Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT M n I I A M 0 M l 5 APPLICATION RECEIVED t 0 • ( I The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: M-350--f43(oO PPKS(DECJL . I43 O (4 -352, f 4- r 3s4-, (43s(0 4-1'3 sE5 1 4-360 Accepted Accepted With Corrections Denied Reviewed By: r Date: ( 7 t Comments: t. 'Pz-z %AT 4• "h►-` A ( /,‘■ 5 K l4 „ A,L e Ac-- 4 "The issuance or granting of a permit or approval of plans, specifications and computations shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of this code or of any other ordinance of the jurisdiction. Permits presuming to give authority to violate or cancel the provisions of this code or other ordinances of the jurisdiction shall not be valid." O� PRIp� U tr1 White - Building • ,� �� Canary - Engineering "'NES° Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT i l T \ I �✓ APPLICATION RECEIVED The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: f / i f( j y„. '[yam,,,,/./ t: p / •,. Accepted Accepted With Corrections denied / 1 ( Reviewed By: + Date: to Comments: 1. 'C'z.. � �tJ t3t PPS ( A.x n� 5f a „ Itte (4.51r/ "The issuance or granting of a permit or approval of plans, specifications and computations shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of this code or of any other ordinance of the jurisdiction. Permits presuming to give authority to violate or cancel the provisions of this code or other ordinances of the jurisdiction shall not be valid." rizi CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd TEMPORARY CERTIFICATE OF ZONING COMPLIANCE L 0 41, 4 1 1 I III I I I I 0 I I . 11. 7 (\\\ ......„, AND UTILITY CONNECTION PERMIT . ■ PERMIT NO. Mew type or prim and sign at bottom) i ADDRESS 1 ZONDIG , ,otnne use C , C MA) ., .., LEGAL DESCRIPTION {office use old); LOT BLOCK ADDMON PID , I i OWNER , A r ( Arril JAY 1 40 FIE5 (Phone) ?..5-2- —B& - 21o0 j (Name) (Address) 1. i - 01 1,0 RS.44 tAl&ioNi AZ .5 Er)/NA iq hj :44FEbeeR e_tore4Ncrc (Company Name) 112.E ...k.)PeC 0" ....'- 2-ViCe•C‘ L . (Phone) 714, & - 277 - f31(0 a I (Contact Narne) _1 ASt.7 tpliNZrE.,s, (Phone) (Address) I 1 I %c) L. I, ,.., _. T . -, I ' %) 1 - 110 ,r OF WORK t i r N e w Construcoot 0 Deck OForit DRe Roofing DRetSiding D e r Level finish 0 Fireplace UAddmon DAiteratIon D'Uy Conr.eMon CODE: F IA,C. 01.8.C. 0 Ms Type c ype of nstruction: I .D. En IV & A a . Occupancy Group: A B E F 14 1 M. a) S Li PROJECT COST/VALUE 5 Division: 1 2 (3) 4 5 (excluding land) ., i i henry cent LeUtt 1 have famished toronTnahon Oft nos aprItirariao wiiiiiii ii io the best of my knowledge true and ..:07e:1 I a:S ..,:t.rttf* that 1 am the rwner or authmrced ag re. for abovedTtentemed remelty and that all renstamot wtlt zmfonn to 111 CAISAIL7.g sire ana local taws aria witt VICKttil M 16.::,:DIViariZt A . ,th sl*prnnsed plans 1 am aware I efru a,t1 revoke , ba ;virtu for not caws rtirthtfr.1Wr 1 here,v agree , ,.. , ,l' ''^:r col': dfricd,i; at a &meet' maY ente .at‘ "hf' b"ee ''.,,, berferrn needed mtpecno-4 - Signature Contractor s License N ,:i Date r Permit Valuation t Park Support Fee # $ Permit Fee $ I, SAC # $ , t Plat Check Fee S , Water Meter Size. ! - . $ . State Surcharge 5 i Pressure Reducer $ I Penalty 5 i Sewer Water Connection Fee P 5 , 1 Plumbing Peanut Fee $ i Water Tower Fee ti 5 - 1 Nlechania Permit Fee 5 ; Builder's Deposit $ Sewer & Water Permit Fee $ , I , Other $ - i Gas Fireplace Pemut Fee 5 : TOTAL DUE $ BuiliBag Permit lik' . . - i ved ' Paid 1 Recejpt No .....4.....6,.,, --f. 4147 ....... ; Date -- i i BY Bodibria a ... . Date Tus a to ante, that the requesiTathe above appheatIon and aeoeneanYrtg dv is 41 ac.:Ordanct with the Ciry Zonma Once and may proceed , reemened Thn dr'eument when tqated tb Me C.I.:y 'Planner ConStIOnts a terITMAri Ca r of 7,-,-"Ing zzImp!lance and a11tbs eonem,eter ...c. ;. Tie±re ,, ec ., .: ..1 a C .azate f (lc par: +run be : tsitlea / 1/0 1 Nannift$ Threztar DWG' pi COnthilitni, If Any 24 hour notice for all inspections (952) 447-9450, fax (9521447-424S 4646 Dakota Wert S.E., Prior Lake, Minnesota 553'2 NG PERMIT, : DatreR - -'..1 fu MPORARY CERTIFICATE OF ZONIN . COMPLIANCE AND UTILITY CONNECTION P 3 ' MIT 4113 I ,4%010";;,7 Aw IF iL gi, IAA tit; ... ,,, : PERMIT NO. o t .. . ii../of (Please . or . zit , , - m bottom ADDRESS ----■•••■■•■••■-- ' ZONING forfiot iisti: /43'c f/Ari:_.. i r) Li 1 LEGAL DESCRIPTION office use LOT BLOCK ADDITION PIP --- /00 Phone) ; OWNER A (Name) fri A riti 11/441 c 14 - (ne) ( 16 - 2. - b '0 ., (Address) ,C,i.`... L WATS4 tAi&76.sj toit ...<..) Er.,/".44 4 l 55439 ..84514LE1 it e__cf-J-rcikcrc (Company Name) cC. ", u Gi (Phone) X^ - 277 - 1 (Contact Name) JO z: ,1--.. C, ).=- R., (Phone) (Address) W '> 37.:v...o v A t,.: et: eel., C.. l'"t.:#:,; 4 " . .;,:.: CIL, F ,. CLI-", :1).; L. :1Z. t TYPE OF WORK E New Construction DD zi....k Crorch CRe Citt-Si..tinit CLowet L in eiel Fish C Fireplace Addition CA iter3rion 0 Lti::; C, ii, iioct ion CODE: p.R.C. DI.B.C. 0 Type of onsnuction: I El 111 IV d„: A Occupancy Group: A 13 E F ti I Mel,‘ S U PROJECT COST/VALUE $ :32-1‘c, cx) Division: 1 2 (3) 4 5 (excluding land) ':- 1 herilty centfi: Mat 1 havu furnished niformistme on tidit Arp114 Wilthil 3 th lit !nth Vein knnw:edge true and cored: 1 aLso ,:eftify Mat I am the mime: or authimzeUi awl:: fni rite , aberitimendioned nmeem and Mat 4 constroCinn will dioninnn tid a:: existing, ittate and ixai law, and wi:1 rinuett! if 1 with suhrntned plans : urn 2waze Mat Mt hui:dmit t:ffical cle , rfo'kid d':; Mratt for u1 cause Furhe 7 hfrem agnni +41 'ht ht" OffihttO Of a Mnignidc rum' cntiii tiri ddi: i.--;.otidrdi to 7edfaim nonicj Msrech,,n$ 4 t N- s co:v.,, N Date Permit Valuation ; ; ! Park Support Fee # $ , i Permit Fee $ ; SAC # $ Plan Check Fee $ . ' Water Meter Size 5./8": 3 -, s State Surcharge $ : Pressure Reducer $ _ . , Penalty S. , ! Sewer !Water Connection Fee 4. $ ; i Plumbing Permit Fee S i 1 , Water TOW Fee Mechanica: Perrrat Fee $ : Builder's Deposit , PAID %PH , .... , Sewer 4'z Water Permit Fee S . i Other t3tAit14146 "piker , G as ; S'a Fireplace Penn Fee S ; TOTAL DUE This . • lie h. ;co es Yourpuilding Permit W n A trhird : Paid : Receipt No. Date 1 B Buticting Official r),A, mi.,- , , ,,,,,....6, rhat the munest in the ilb(WC anplicamin and audutrdiaming Jt.,-4711,-nts ts tr.. ILii%i'hiattiitt With thr. C"3. I ii:drimance And may proceed m tehditested This ili when inept,: iii. tilt Citir Part chnstituto a temtiorard Cert.:ifs:air did Zon:r ig. dmmilartim and stows immtdradmiti n u,trritenue Fiefore tsompancy, a tritfi,^ate Of ttpandii. mutt 1 v Mlle,' r-ra,› V62 41,- 11...- irovLs — Manning ihrufiui Itate Sfefia: ("Midi; um. if ant, :4 hour miner for all inweetions (952i 44'74850. ful t9S21. 4-r-4245 4446 Dakom Street S.,E„ Prior Lake. Minnesota 55111 s1 c,. PRIO4. Date Rec'd t CITY OF PRIOR LAKE SEWER AND WATER PERMIT 4 jNNEso 1. Green Fifty PERMIT NO . /f „. (01 i 2. Yellow Ci lc l 3. Gold Applicant (Please type or print and sign at bottom) ADDRESS ZONING (office use) 1435o~ G 0 {) ovul C6 LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWN (Name) ER r t 4 (Phone) (Address) (Address) (City) (Zip Code) APPLICANT t, n _ (Name) 1J S. Y e` . _ i • (Phone) 6 S t y$0 J 3 aS (Address) A., CA LC. f y) J y tit"- 5 S4 3-3 (Address) (City) (Zip Code) (Contact Person) V % 2 ' tY. I (Phone) 6 1'1 q 1 Q- Lf3 i? d APPLICANT SIGNATURE A ►► 4 DATE 0 - . 7 8- Lf 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 iR AND WATER PERMIT FEE $ "SURCHARGE" has been extended E SURCHARGE $ 0 PAID WITH until June 30, 2013, ■L PERMIT FEE $ I�DING Pr�R�I�L�. The minimum surcharge for a "fixed fee" permit is $5.00 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 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 S -2 : 12, PROPERTY ADDRESS: 14350 PARKSIDE COURT ACCEPTED BY APPROVING AUTHORITIES: CITY OF WOODBURY ADDRESS: PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS OYES ONO EQUIPMENT USED IS APPROVED EYES 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: '2YES ONO 1. SYSTEM COMPONENTS INSTRUCTIONS EVES ONO 2. CARE AND MAINTENANCE INSTRUCTIONS YES ONO 3. NFPA25 EYES ENO LOCATION ENTIRE BULDING YEAR OF TEMPERATURE MAKE MODEL MANUFACTURE SIZE QTY. RATING RELIABLE RES 49 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 0 z 7 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 VIIN 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 (FLO VING) PRESSURE REDUCING INLET (PSI) OUTLET (PSI) INLET (PSI) OUTLET (PSI) FLOW (GPM) VALVE TEST N/A OPERATION: ❑PNEUMATIC ❑ELECTRIC DI 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 MOOFI Sl1PFRVISION I OSS AI ARM f)PFRATF VA VF RFI FASF f)PFRATF RFI 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? YES ONO DRAIN READING OF GAGE LOCATED NEAR WATER RESIDUAL PRESSURE WITH VALVE IN TEST CONNECTION TESTS TEST SUPPLY TEST CONNECTION 9 PSI CONNECTION OPEN WIDE 60 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 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 ®N0 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 ® YES ONO NAMEPLATE REMARKS DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: NAME OF SPRINKLER CONTRACTOR: FIRE SUPPRESSION SERVICES, LLC W TEST WITNESSED BY SIGNATURES F D) , TITLI DATE • : SPRR O = CTOR (SIGNED) TITLE DAPE R ADDITIONAL EXPLANATION AND NOTES � —4-26c 9 PRIOR LAKE BUILDING AND amer . File IN PE TI N RECORD S O SITE ADDRESS 'te -St NATURE OF WORK S' /AiW.. DSGC, NO # 1 V NO �••.`• USE OF BUILDING S AO* PERMIT NO. / . !01$ DATE ISSUED CONTRACTOR f/q'jTA 1401466 PHONE 9:52.198. 40 NOTE: THIS IS NOT A PERMIT OR ANY OF THE INSPEtTIONS BELOW /�y'� L THE � P � E �/d RM ` IT IS M � Mn SEPARATE DOCUMENT �', ( ---} /Y�7 I! L 6EAsi �r!/u L ` � i /�/ a 1 l" 'Y�` ". IM� FOOTING ¢ UNT ! �De2!# � $;1 J INSPECT I 67 bvw• J 1 FOUNDATION (Prior to Backfill) 1.1,14.45 1 PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED le-el 00 6 ..57 4 dove,e.e7E S retleaNw� ROUGH - INS . SEWER / WATER / SEPTIC t' oh, ( PI 111.1/ FRAMING �,Z INSULATION ELECTRICAL -- PLUMBING � F Cof? z HEATING (if required) �l 7,f 1 FIREPLACE ( j4 GAS LINE ♦♦ AIR TEST KA -00 F.? R _ c /3 1 1 . wo•vev NO WORK UNTIL ABOVE HAS BEEN SIGNED 510/24 c )- FINALS ? ��`"` Fj- GRADING (Prior to Sodding) (� UM`C? e" BUILDING ELECTRICAL PLUMBING Ste` wAtvt,116 125 /Z. HEATING 9/34 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 ma n entrance. FOR ALL INSPECTIONS (952) 447 -9850