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HomeMy WebLinkAboutBuilding Permit 12.604 ii ,_ :, _. ,env _ :.I,_ .., ._ _ ;. _. r _ ir. _. ir, .:,ir..0 rr. r._ rr. �. m r r. _ r.. _ m..❑ _ o.` �ru,. ., n'�, .. .� n. . :: _ (itrrfifiraft of M rxix atitr CITY OF PRIOR LAKE F rpartnitxtf of 1ufl ixtg nsptt h -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 / Bldg. Permit No Occupancy Type Type Construction Zoning District Pe/1.0 Legal Description K = Owner of Building Site Address / 4 ..%,- / / /Lic s / & e--7. ' Contractor's Name & Address /" ll —TT r/r�n Y f 7 6 /A / , ✓'� �; 6�'�_ � 1 /�/f'l `1� City Planner � ��;. 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Yellow Applicant lf/ (Please type or print and sign at bottom) ADDRESS l 4 2 _)51 P V V I D E C O V l2 t ZONING (office use) LEGAL DESCRIPTION (office use only) LOT S2 BLOCK ( ADDITION J t= nS L\.l.t ri- tz_PCIaor./ -r PID 2S - 7 SO S 20 OWNER (Name) ;'l A 'T i 1\- M `e -14 0 l`-1 E S (Phone) (Address)12a 1 W A S 1-E t iJ (j v *-1 A v'E S S 2p t t=.O t r t -I H N SS 43 9 BUILDER (Company Name) M k'T Arl i' v t ES (Phone) 952 - $ 9 8 ' 21 (5 G (Contact Name) S U E 12 (Phone) qG - e 6 t 28 (Address) `12c) 1-I It-,.I - r - oti A vE S T - zo t -o t >v 4 t-, t`t SSA D5 TYPE OF WORK New Construction Elpeck ❑Porch DRe-Roofing DRe-Siding ❑Lower Level Finish ❑ Fireplace DAddition DAlteration ❑Utilit Connection CODE: R.C. ❑I.B.C. El Misc: Type of C nstruction: I II III IV V A B Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $ 1 `} 0, 000 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(. ...,.`—e •_ BC..- 2031 53S (o 1 (t 2 — Signature Contractor's License No. Date Permit Valuation � ,r � Park Support F # $ Permit Fee $ t s SAC # $ Z Plan Check Fee $ 511 • 1 6 Water Meter Size$' ; 1 "; $ ik j _ State Surcharge $ '5 • - Pressure Reducer $ (Za s Penalty $ Sewer /Water Connection Fee # $ C S at Plumbing Permit Fee $ t 5 450 Water Tower Fee # $ bap, Mechanical Permit Fee $ ( c 4 Builder's Deposit $ c-460., Sewer & Water Permit Fee $ ce D Other $ Gas Fire place Permit Fee $ �� TOTAL DUE 960.2e il This . J , 1 n Becomes • . :wilding Permit 7 - n Ap ,roved Paid '/ 14 j 2 V Re pt No. 6 ( 32- 7/ l I Z Date 7 ! t B r J t Build (g Official Date This is to certify 77 11111, a above application and accompanying locum• is is in accordance with the City Zoning Ordinance and may proceed as requested. This document when signed by - : ex constitutes a tem.orary Certificate of Zo ' , g comp ance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued. P IMA ( lam ' anning Dire • .. 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 ■ 44„.9 04 PRIp ti U t White - Building yf �� Canary - Engineering NNESO Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT ATM � APPLICATION RECEIVED ,( The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: 14351 14-353 14-355 (4357 P5De CT i / Accepted Accepted With Corrections Denied Reviewed By: u Date: //// /Z Comments: See Attachments: 1) Grading Plan, 2) Erosion ControLStandards 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 ibackf-illing of the foundation. 6: \Admin \dept info \ADDITIONAL COMMENT5 FOR BUILDING PERMIT APPLICATIONS.doc N x White - Building Canary - Engineering 4,I Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT MATTINM\( ( M GS APPLICATION RECEIVED 6 ( 1 A 2___ The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: 1 4351 I+353, 1x-355 14-35 PNair---s(Db C A. Accepted v Accepted With Corrections Denied / " Reviewed By: A 1 /f Date: r Comments: 4 '% �� C174r,-` CC.u3*-} 4&- / ( 1 - 7 --- 4c-c-- /74A "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." ,., -.... , e•wa, , ,6E* ,, . , ._ ., y�,rt+,n. ,, .,n,..pymw -x- •fie^. .+h"w ran *rad .z..,f. x.., FJ"«.. .: •y - ry - w« *n. ,R.. „.,. rev }ta ^._.,, i?yia'BCMh; PRIO U tr1 White - Building �� Canary - Engineering NNES° Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT t ' 4. ' " 1� E k APPLICATION RECEIVED �.,� . �(.f The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: = r, k - _ Accepted V Accepted With Corrections _. Denied / — 1 Reviewed By: 1 /I��. Date: Comments: 11445 vt u -© e c rr 615 N CB e.3O 2Z� z S t 4 - T Ta-L- KLL -t,EO LWP6iL" to.)- - 1-0 trik Ft: "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.” • Residential Building Permit Checklist New Construc on for Single or Two - family Dwellings 1 -1 or -2 Districts 4 Reviewed by: Date: 4 4, fz Building Permit # Zoning: Pc.-v Address: 1+3 5 I, 1+ l g - 3 s S` , t 4 57 � tc s h C.-,.r- Legal: L , B Subdivision: Existing Structure? YES 1 NO . Existing Nonconforming Structure? YES/NO CONFORMS TO ZONING ilk NO ORDINANCE Yard Setbacks: NA 1 FAILS/ CONItaES Standard Proposed • Front Yard (can be 20' if avg. w /in 150') 1. r v , `(3 • Side Yards ng7� 91 `3 ( � � ' ", t rA0 25' if abutting a street `u . Ate FAc444 tot Zo21 • 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. • Rear Yard 1u 4 1 2 ' 5 7 • 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 wetlandlNURP 30' pond. 400 • Refer in- ground pools to the Planning Department • From OHW (Prior or Spring Lake) 75' or setback average of adjacent structures, but no Tess than 50' Floor Area Ratio: NA I FAILS 1 COMPS I .30 Maximum 1 FOP I . Yard Encroachments: NA 1 FAILS 1CODLIES 1 Standard Proposed Eaves and Gutters no more than 2 feet in width and no closer than 5 feet to a lot line (Easements). ANC and other equipment cannot encroach on interior 6 ���� A side yards. Tree Preservation: , rb 1 FAILS 1 COMPLIES Standard Proposed ' • Total caliper inches • Permit 35% Removal • Caliper Inches Reni'oved • • CalipeInches P,4served • R placem ntf Y2:1 L : \TTMPIATE\BLDGLIST.DOC Driveway: NA I FAILS / C0OLIES Standard Proposed • Maximum width at property line 24' pv • Required setback 5' from side lot line or 30' from r -o -w on corner lots P • Maximum slope • 10% 5. o • All parking areas to be paved including R -V or spaces adjacent to the garage • Location to match subdivision grading plan 1 v` Building Height: NA/ FAILS / COMIS 35' Maximum 1 25 F.. Shoreland District: NA/ FAILS / COMPLIES 1 , Standard 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 tin,o Tiaga Bluff in Shoreland: NA/ FAILS / COMPLIES Standard 1 Proposed I • Setback from top of bluff By planning dept, • Bluff impact zone 20' From Top of Bluff • Ens ineerin• certification submitted /a. .roved By City Engineer • Grading in bluff or bluff impact zone No importing /exporting Floodplain: NA/ FAILS / COMPLIES Standard Proposed • 100 year flood 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: NA / FAILS / COMPLIES Standard Proposed • Size 1000 sq.ft. or 30% rear yard • Not located in front and Materials • Side and and rear and setbacks 10' • Maximum height 15' • Materials com • atible with • rinci • le structure L : \TEMPLATE\BLDGLIST.DOC SEP -0? -2012 06:48 FIRESIDE - RSV 651 633 1749 P . 001 o,.Q g lino CITY OFP 4ttLAKE Date Reed • HEATING/AIR CONDITIONDIGNIREPLACE PERMIT 4444 Ir. rto 1 ERMfl Na [2 ve lad a . LEGA, Des Oft in WO LOT BLOCYC ADDITION V • OWNER .. HEARTH & HOME TECHNOLOGIES INC. !1 PLIC.AN'1` db8 FIRESIDE HEARTH & HOME. • 4Pi�oao) -- . 2700 AIRVIEW AVENUE N (Ades). - ROSEVILLE. MN 55113. ... (Addra0 651 639 2561 Caoh Ivocode? • APPLICANT SIGNATUIU1 44120'34YA---- DATE cr- -6i "lam. - . APPLICANT PLEASE COMPLETE : SW CONSTRUCTION 0 REPLACIIMPHr 13 ALTERATIONS • FURNACE MAKE MODEL _ _ . FUEL FLUE SIZE SYSTEM OPENINGS /�1� POW R � PLANT PLANT INPUT __' ,,� G -- OUTpur i TYPE OF SiS D+�7 T OR EI G r - - - — -- -- - puma Nom Aft Cosierisser fly sad Fireplaces Oaf* aw& xot water �i 9 i• Requited Mile Yard Sstbsd i l , Cencra oaiss Spesdat Devices,_ _ ' e Boa Add or ewers re 1bC4 de of System 0 o D Ragofre a Beilillog Per - litillthags FlR c MA AND MODEL - SL - .7Z /1 7 , - .1 - FEE ScH WYl . Industrial. ilk Med ity I% on* oast Re ideda1, Gay Fireplace . 44450 • SOSO minimum Resident*, Haft $4 MC (New t3osatietice) 5149.50 Rdtidd+titd. Maim a Altaatieee • 149.50 RocidendaI, Only (New Ca haat on) $64.50 Residagiat AC Only l49.50 . Wilma(' Cost $ /O ea Build ran* * P The Mineesats Mayes * 32613. MI . HEATING PERMIT FEE $ "SURCHARGE* hasis� clam d liar one year kt11'tedve STATE SURCHARGE S .50 July 1.3010 $n iii Jaae40.2011. Tow, pea= nag $ - tut $alma$$$ sartitir p for*Nino to." *emit >Ae it SS bechalwility 1.2014 nit Apprication BecOatts Your Building Penult Wks Apps ed ! i - Reocipt1o. Deft By maim waist - Dot 14 bear sages for ell lesperriess CM) 4474150, res # 445.4245 Wli 4646 WoetdtmetI E,?der lake, Olbaavwwti 55372 PAID 1T i a a *4 lito • CITY OF PRIOR LAKE BUILDING PERMIT, Ir 11 , • n ell.,U 11 Ti .„.. .,-- .4.. .7 TEMPORARY CERTIFICATE OF ZONING COMPLIANCE AND UTILITY CONNECTION PERMIT SEP 2 1 2012 4,sibre,.,„T A T PERMIT NO L7M __,Mw 6.- —W. Er..." : ,.. ..:-„.. , Please ripe r print and sign at bottom) _ . ADDRESS ZONING (cekt .....se: t 4' - 1'; t 1 ARK5it CI: LEGAL DESCRIPTION (office use aniy) LOT BLOCK ADDMON PIO OWNER (Name) NIA 1- oNgg (phone) 952- ffi E, - z I 4 : 1 4) (Address) - 72o1 tx)+1941A&rAV ALL C. C-Pri■ , JA, 1•Atv : BtflEt0E (...: NQTC-Aci c e_ (Company Name) C 17.F 'S, q)P0 ..:,-. 1 Lk....e. . ; Phone) 71.3- 27/ M(cc) (Contact Name) , -JP P- tors t...•tri:?. ( Phone) ( Address) 1 i tb -1-1- (-IL_ C C.- 14.1.- 4 - 7 Q kl6 4 C-1-)4- K 0 1 i 'v t-- 5L53.;D . TYPE OF WORK 6New Cense OCr,:`4 C ORt-Riaofing El,Re-S,:i.r.g :=LcAcr :_cvel Finch Fireplace Addrtien 0AI:entice Ot::lity Cm CODE: ?I-LC. OI.B.C. _ 0 mac Type of onstruction: I II 111 IV & A (B) Occupancy Group: A B E F H I M & S 1.. PROJECT COST/VALUE 5 :,),..., ,._ , , ,... L Division: 1 2 (3:). 4 5 (etcludtng land) 1 .e.r.et..y Cary that : have , ortsbcd miasmam on ails apn.1 a tla 3 t Ch: t.:31 Of rny kntneetr tr..L aZi ::' : L..IC cer tnat 1 am the owner v.: au:troll= arr..t kl. Me anose-mannoned ;Topers and '1141 all assurrarrier via: conterrn to sL extanng rate snd local laws arK: s■ti. ;ttoceri ..r., accrtsance 'A-rt. rtts . pans I am ass re r•sat te P-.Pdassi aa,:..1; aLs 7c.".xce Pan theratar (Peps? cause Furthermore, : AcTrtv igm ±u te .7,7 efficill -Jr a cirsrper ma), rrtipe7r to prrforrn neelcd Lcsr■e.mcns .-- 1 X 414.4.-7L .21004...t..4 C. - 14C cY-il-I4?_ Signature Contrarer s Lee S.: Dee I remit Valuation Park Supper, Fee 1 $ Fennst Fee $ SAC , $ Plan Check Fee 5 Water eter Size , 5 State 5u:charge $ Pressure Reducer $ Penalty 5 Sewer/ Wa:er Connect:on Fee u s Plurntring Patna Fee 5 Water Tower Fee # 5 Mechanical Permit Fee $ -1 Builder's Pcpcslt PAID WITI-1 Sewer te Water Permit Fee 5 Other RUILnING PFYIMIT Gas F Perm n Fec ! 5 TOTAL DUE 5 , . ..,,, Y owe Building P 'I Wke Approved ' `, Paid Receipt No. ;„ -...ciimmo. Date BY i •17 qr ,fficia; Oat: This to =II:SI that the request tn ars above app'..c4- Ana oc,.. ma 4ossanerno so Ln acctsaance wtth .t.e L. locmg OcrLnance and may proceed as requesend Thin am/ram: ...hen rained bs the s.:" MAI= alRallUttS a rersspcs-ar. Cerr.t of 7on-ni .srsuplostute and allows cons=ucuor lo ccatmence before occupant's, a Certskate ce Occupanzs nu= tsr Issued lei Veer- 4,11 lle4.4 Imt,41,t4 : Kanamte Duector Dale $bec: :kJ Cenclittort).. t f any 24 boar notice for all laspertioas (9'2)447-9850, as 1,932) 44 4646 Dakota Street S.E., Prior Lake, Mtanesols 5$3": t lo * p4t O � RIO Date Rec'd f C CITY OF PRIOR LAKE SEWER AND WATER PERMIT kIi'NES�� 1. G reelloen w Fil Ci PERMIT NO. 11- 3. Gold Applicant (Please type or print and sign at bottom) ADDRESS ZONING (office use) 1 L i 3 s ! ' a • LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID O (Na .1(v _V — L,+�^ 1+6 (Phone) (Address) • `� J (Address) (City) (Zip Code) APPLICANT ^ (Name) b � • • n (Phone) - � 6 S t " Ll. Q 13 X, ' (Address) al (Address) (City) (Zip Code) (Contact Person) L I 1 LQ h (Phone) 6 / - 'l 1 9 -V3 rO APPLICANT SIGNATURE / d DATE 7— q— / a-- APPLICANT PLEASE COMPLETE BELOW Size of water service inches. Location of any couplings from structure feet. Type of sewer pipe. ❑ ABC n 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 # SEWER AND WATER PERMIT FEE $ STATE SURCHARGE $ 0l 0 TOTAL PERMIT FEE $ (j (Office Use Only) This Application Becomes Your Building Permit When Approved Paid Receipt No. Date By Buildine Official Date The Minnesota Statutes § 326B.148 it notice for all inspections (952) 447 -9850, fax (952) 447 -4245 "SURCHARGE" has been extended 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 until June 30, 2013, The minimum surcharge for a "fixed fee" permit is $5.00 ; ' O '..RS �, Date Rec'd .�,: i9.;-,,,c\ CITY OF PRIOR LAKE PLUMBING PERMIT IN i2 , � M , a'"` F''` PERM NO. / _ 0 -- 6 2. odd Aro L.1T a. Yellow A�plka" (Please type or print and sIRn at bottom) ADDRESS . (Orrice use) 1 3st P (161 CA. N WT LEGAL DESCRIPTION (office nse only) LOT BLOCK ADDITION PID OWNER (Name) (Phone) (Address) A PPLICANT GENZ -RYAN (Name) (Phone) 952 - 767 -1847 (Address) 2200 HIGHWAY 13 W , BURNSVILLE, MN 55337 (Address) (City) (Zip Code) (Contact Person) LISA HERNANDEZ 952- 767 -1847 - (Phone) y; APPLICANT SIGNATURE oa f Nt, f Gl `7 / f DATE l'�-'~ _110 APPLICANT PLEASE e PLETE BELOW Quantity Type of Fixture Qu . tity Type of Fixture �`' Bath Tub with or without shower J Rough - ins — Dishwasher J Water Heater 1 . .. Floor Drain Water Softener _ Tj Lavatory (Bathroom Sink) Stand Pipe (Washing Machine — Laundry Tray (1 or 2 compartment sink Sewage Ejector Shower Stall -__ Baclrflow Assembly 1 Sinks Backflow Assembly Test Bar Sink Lawn Sprinkler .3 { 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 Residential, Additions & Alterations $49.50 The Minnesota Statutes §32611.148 ~ $1515 Building Permit 11 "SURCHARGE" has been changed for one year effective PLUMBING PERMIT FEE $ PAID WITH July 1, 2010, until June 30, 2011. STATE SURCHARGE $ .50 The minimum surcharge fora "fixed fee" permit TOTAL PERMIT FEE $ BUILDING PERMIT is g. beginning duly 1, 2010 - This Appllcatlon Becomes Your Building Permit When Approved Paid Receipt No. Date By Buntline official Date 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 PRIp CITY OF PRIOR LAKE Date Rec'd ° y HEATING /AIR CONDITIONING/FIREPLACE PERMIT i . . 4 , . ip ` v. �N' P . fr'lc 6--t-)1 . P Pg _, PERMIT NO. /Z-.. 0 1. Yellow Applion Please l or print and sign at bottom) ADDRESS ! 11 ?�, , fir} ! A `n J ZONING (office use) de/ LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PM OWNER (Name) (Phone) (Address) . APPLICANT (Name) GENZ -RYAN (Phone) 952-767-1847 (Address) 2200 HIGHWAY 13 W, BURNSVILLE, MN 55337 (Address) (City) (Zip Code) (Contact Person) LISA HERNAND Z } }' t/ (Phone) 952-767-1847 . APPLICANT SIGNATURE a' 1, E� 'K�L" DATE 1 I APPLICANT PLEASE C MPLETE BELOW , ANEW CONSTRUCTION ( ❑ ['REPLACEMENT ❑ ALT s • FURNACE MAKE AND MODEL frt 6 , #• q ia.,Jb `7p1O(i dS i 1 FUEL i r1 f e3 r\ FLUE SIZE _ RETUR14 OPENINGS ID INPUT ST) 000 OUTPUT 53 TYPE OF SYSTEM HEATING OR POWER PLANT ❑Warm Air Plants PLEASE NOTE: Air Conditioner ❑ Steam Units and Fireplaces Cannot Encroach ❑Gravity ❑ Hot Water N. Mechanical ❑Radiation into Required Side Yard Setbacks. Air Conditioning ❑Special Devices Fireplaces with Sox Additions or Vent. 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 $49.50 $49.50 minimum Residential, Heating & A/C (New Construction) $149.50 Residential, Additions & Alterations PAID wag 0 Residential, Heating Only (New Construction) $64.50 Residential, AC Only r y �1 �D � BUtLDINC PFPNIIT Estimated Cost $ ) . Building Permit # The ivlinncsola Statutes § 32(8.148 HEATING PERMIT FEE $ "SURCHARGE" has been changed Ibr one v car effective STATE SURCHARGE $ .50 July 1, 2010. until June 30, 2011. TOTAL PERMIT FEE $ The minimum surchnrgc for a " fl ec1 fee" permit (Office Use Only) Is 55, beginning .July 1.2010 This Application Becomes Your Building Permit When Approved Paid Receipt No. Date By Budding Official Date 24 hour notice for all inspections (952) 447 -9050, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 (L- 6 `f" 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 PROPERTY ADDRESS: ADDRESS: 14351 PARKSIDE COURT ACCEPTED BY APPROVING AUTHORITIES: CITY OF WIRY PRt$2 L#E{ 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 :AYES ONO 2. CARE AND MAINTENANCE INSTRUCTIONS YES ONO 3. NFPA 25 OYES ONO 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 15 155 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 56 DRY VALVE Q.O.O. 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. WfTH 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 DELECTRIC ❑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 DYES ONO N/A DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO MAKF MODFI SUPFRVI.SInN I nSS AI ARM OPFRATF VA I VF RFI FASF fPFRATF PFI 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 2HRS IF NO, STATE REASON DRY PIPING PNEUMATICALLY TESTED OYES NO EQUIPMENT OPERATES PROPERLY ■n 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 NEAR WATER RESIDUAL PRESSURE WITH VALVE IN TEST CONNECTION TESTS TEST SUPPLY TEST CONNECTION /O/ PSI CONNECTION OPEN WIDE 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 YES ONO IF POWDER DRIVEN FASTENERS ARE USED IN YES ONO IF NO, EXPLAIN CONCRETE, HAS REPRESENTATIVE SAMPLE TESTING BEEN SATISFACTORILY COMPLETED? BLANK TESTING NUMBER USED I LOCATIONS I NUMBER REMOVED GASKETS 0 WELDED PIPING OYES ONO 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? RYES 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 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? BYES 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: I )- NAME OF SPRINKLER CONTRACTOR: FIRE SUPPRESSION SERVICES, LLC. TEST WITNESSED BY FOR PROPERTY OWNER (SIGNED) TITLE DATE SIGNATURES S" 4: ONT' ACTOR (SIGNED) TITLE DATE 416,' I/I►�rl� ■1 3 Z •v v l ADDITIONAL EXPLANATION A- r • •l9 i7,���,, ► � t r e hf2 r3k-- y PRIOR LA K E DEPARTMENT OF BUILDING AND INSPECTIQN ..in File .. INSPECTION - 113 SITE ADDRESS ( 351 Ks itt-- &�,�.,= -4-- NATURE OF WORK /4 (t4c, Dt X- - c . 1 L. L _ F-rf.P USE OF BUILDING 'c c. r-- t(.. - 'A � PERMIT NO. ' - c DATE ISSUED iz-.. CONTRACTOR 'IAcr 1 t4E S PHONE 15'2 -i -G12,6 NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTION1 B LOW ,yy THE PERMIT IS BY SEPARATE DOCUMENT lL1-6( FOOTING * ` s r 1A 1 FOUNDATION (Prior to Backfill) 1 --M, gh - //Y 1 I O P PLACE NO C TE UNTIL l -9/ ABOVE HAS BEEN SIGNED kv O C - a � zROUGH INS SEWER / WATER / SEPTIC �e 741//i, P FRAMING ,d /,/,._, j INSULATION /a z .), z 1 " -- / ELECTRICAL PLUMBING -c /'z._ L „i,hL HEATING (if required) `"///k- FIREPLACE d"6 /0/Vic- Q_AD o\s S LINE Al - TEST P )//9j,.. rot CO O �O WORK UNTIL ABOVE HAS BEEN SIGNED 1 t i 65 ,dq r 1-kt 1 I 1 D N Y 1 -464- / 1 FINALS S PR /N /G , /y )/ GRADING (Prior to Sodding) BUILDING , A-. G .D , _-,, 1/ ELECTRICAL PLUMBING vc e() / o I / ice HEATING l F 11 14 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 h e been approved. On buildings and additions where no service cabinet is available, caQI be placed near main entrance. FOR ALL INSPECTIONS (952) 447 -9850 • e •,