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HomeMy WebLinkAboutBuilding Permit 12.605 , A �/ r r �/ V �/ �/ �/ k �/ � `� r r `� r � �/ �/ � �/ / A AA, AAA \ A f f K AA r� A, A ?C„ 7 _.Yr. i ,. r _: r..i ,, i c. ,, i . n _. .:i _, r ,, u:.n __ ,.v ,. � i _ u. n ,. aV..i1 _ ,. i ..niV i ._ ro.n c. w,u ., uVu ° ,. f n _. �rti1Vr ,. il.� ,. 1Y': i ,. r➢, i , lr.n _. ,., .. i _. �i i _, i._ Crrfifirafr of ®r p znr CITY OF PRIOR LAKE .: _ �xrt�xt � ����1 xt�xtorxr j ' ,!Final Permitted ❑ Conditional C.O. Expires T his Certificate issued pursuant to the requirements of Section 110 of the ❑ R esi d ential / ❑ Internationa Building Code certifying that at the time of issuance this structure was in compliance with the various o rdinances of the City of Prior Lake regulating building construction or use. For the following: Use Classification S/� ( - Li /`i1 / L-1 Bldg. Permit No /2 . G O Occupancy Type Type Construction Zoning District POI— Legal Description Owner of Building Site Address 4.._:' / 3 ;ter /<5 /0 £ (L Contractor's Name & Address /1-1/ T---71 /1'1 ! t& / � �-^' l� � L% / i/ r .mil / > , City Planner Building Official V t :� , /1" Date: � ` � _ . ...•• Date: , POST IN CONSPICUOUS PLACE V V V , V � E 0 cies,, 0 000000 "a 0 a ■n n n © 0 0 . 0 ( z - z m k �/ »c ■ m n to > *Ail x 3 . &>R 0 0 § .0 t 4.111e, q m 0 z- 0 6 Z z - § xl S � 0 n ; Fri n - z m m % 0 r 0 - . r ° -- ■ � -n -0 "0 % Z § 0 0 000000 rrl 41 X W m m C11 * 2 = 0Q o nc 1 2 t f � § ■ §$ m 0 n C m q I0 0 _ § r m NI 0 - o r m§ 0 73 rw • � c k 0 § co ��� - m / X X � _ k m oo❑000 | Li z > 0 irnmE - o E "0 - 0 � hi 0 > m m ■ ■ § § k r 0 5 O d n 00000 1 o> E i o0 0 _ ■ � � ��� 0 $ § §4 §/ o X X q @ r , - r a § % 0 -@ m m z >E oz a ■ % r q q > § ®§Q P �k KZ § & -C r , § / 0 k m & % tn 0 > ° ■ r Z 7 § -n '0 "0 CP Z 73 0 0 OoOO �a xi o \ - m LI mr • , . \ z §2 ��� 0 0 / 7 ƒ § >0 0 3 m § 0 § 0 �z Z r k z § m r §§ P § A 0 I m o n — G § Oc '_cD i o xi xi R. > 0 ' K mm� Q ® � & $ § \\ � 4 r xi, E k i l l r Ci: °p CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd N c c TEMPORARY CERTIFICATE OF ZONING COMPLIANCE j (( ( ND UTILITY CONNECTION PERMIT tt? ES ° `C See Main File I. White File 2. Pink City PERMIT NO. � (005 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS I. Li. 3 S 3 t21N- t2-1t S i OE- C 0(..)1 ZONI�i !G (office use) LEGAL DESCRIPTION (office use only) LOTS( BLOCK ( ADDITION .J F Wh 1 - 12 -F -12 -o^kr PID 25`1 - 1 SO S to OWNER (Name) 17 A T lN. M `t' -44 U NI -_..S (Phone) (Address) `I 2- 1 V A S F-I i t-1 6 i t, A v E S S"Ta 2p 1 a.O t t\t 4\ 1 N S S 4 3 9 BUILDER (Company Name) M t'r• r? ++v I"t ES (Phone) C ) - ' - u 9 8 - ' 2 - 1 c l a (Contact Name) SUE- (Phone) "5 2 , 9-) 9 a - (1 28 (Address) l2-o t 1... r S 4 It-...4 r, vE S T - w t t -O I >v l~ 1...1 SCI-4 TYPE OF WORK ig New Construction ElDeck ['Porch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace ['Addition ['Alteration ['Utility Connection CODE: EI.R.C. ❑I.B.C. ❑ Misc: Type of Construction: I II III W V AB Occupancy Group: A B E F HI M R S U PROJECT COST /VALUE $ 12-6, 0 30 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__ Be.-- 3 532, b k... 1 1 1 2 — Signature Contractor's License No. Date Permit Valuation k.Z 000-- Park Support Fee # $ Permit Fee $ • C 2-Z-1 - s __ SAC # $ Z Plan Check Fee $ -14k1 $ t$ Water Meter Size to; 1 "; $ ♦ State Surcharge $ 6'4‘c4> Pressure Reducer $ 1 Z1,, Penalty $ Sewer /Water Connection Fee # $ Plumbing Permit Fee $ ( I-- Water Tower Fee # $ C (5-00, ' Mechanical Permit Fee $ Builder's Deposit $ Sewer & Water Permit Fee $ S'Q:. . co Other $ / Gas Fireplace Permit Fee $ c74-.150 TOTAL DUE $ 1 ∎ / This Ap o "ecomes Yo Building Permit en A roved Paid '7 r` / 1/ R e ipt No. 66 ''I 2 - �� Date - 7, "L -/Z : uild' . • Official Date This is to . • . the request in the above application and accompanying I ocum; is is in accordance with the City Zoning Ordinance and may proceed as requested. This document when sir . i ity Plarltier constitutes a temporary Certificate of Zo • g comp 'ance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued. 4i k I '.. Planning Directo 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 A.*:• SEP -0? -2012 06:48 FIRESIDE - RSV 651 633 1749 P.002 04 . a i,1140 $ CPT OF PRIOR LAKE Doke `d ,s„ I REATMG/AIR. CONDITIONEICSIREPLACE PERMIT kRiszsoo o PERMIT NO. (Feareee type crp�4rt a>,dtiis• ati $. a.atim . . 1 • ISGAL »E$ PT QN watt •se oa6? LOTOCIC ADDITION PIE) • Name) ) `2..- j 2-.W - OW». .. i HFARTIi ii HOME TECHNOLOGIES, INC. APPLICANT dba FIRESIDE HEARTH & HOME Name) Li4 DCO512060 ) : 2700 FAIRVIEW AVENUE N ' t ) . ROS£1�I , - tear? - - -- 651 .633. 5 APPLICANT SIGNATURE t '" -- DATE ''I . (2-,- .... „e__,,./... Arn JC 1 PLEASE COMPI2TE BELOW ; EW CONSTRUCTION RUCTION 0 REPLACEliTENT ❑ ALTERATIONS PURNACE MAKE AND MODRI. lL : . Pam sly It TUM+ + OPENINGS LNPUT ett5e0 OUTPUT , : - OP SYSTEM BEATING OR POWER PLANT PLEASE NOTE. Air Condemner sY ' anoa /t r Planes © Steam Calla and Piirepla m Caw sok Encroach Of c ' El lice Water 'Oda Required Side Yard Setbacks. eel:ordeal g RaStrion Special »crime OWN. SP= 0 othcrDevioce Fireplaces * to t o: Additions FIREPLACE MARE AND MODEL `7L. a "i FEE SCHEDULE Industrial, Cipmmen id & Ildalti-Fam`ty 1%d job coat Resided. Gas V place :$49.50 • 449.50 ma Residential. Heaths & A/C Olov QO Goon) *14430 Residential, Mad= & Mentions 44950 at.g s Wi ) $64.50 Residential, AC Ouly *49.50 . Estimated Cost S Pd _ BaikEng Pazmit P 'The Mites Statutes 1 3268.145 . BEATING rsnar Fos t . .W . "St.RC IARG[ w> beei eha d lbrHire yers STATE SURCHARGE $ .S0 ,#alt i. 2010. eptil Julie Ati. wi I. ToTAL PERMI JIE $ Tat alali. ='maim tat of RC woo piece V= Oa* to a bodging Jar 1.20 * Thb Application Beeames YourB%i Permit Wbea Approved `Paid Receipt No. vi..4 [ Voltaw.eQU aete . - i�i1Ca � �R� . 24 hoar notice kir I* i 441440. fez{ ? 4474245 4646Dalaot *StreetSR., trier lake, illeeta 55372 _ • *„ 10 4 O� p Rio Date Rec'd H CITY OF PRIOR LAKE o hy SEWER AND WATER PERMIT INNESDc 1. Green File PERMIT NO. 2. Yellow City n 3. Gold Applicant (Please type or print and sign at bottom) ADDRESS ZONING (office use) 1 y3 S 3 polkivilt4Afh a LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER (, ,, (Name) H► e0 (Phone) (Address) (Address) (City) (Zip Code) APPLICANT (Name) U • S . ilei, E (Phone) cc cS 1 — S/9'O — i3—s.T (Address) r 1 r 4,..4.4 H J /LL... SS"03 (Address) (City) (Zip Code) (Contact Person) M 1 CI(P 1 ta (Phone) 6 1) "mil 1 9 -L/ 3 V 0 APPLICANT SIGNATURE (/w 0 DATE 7-1-12-- 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 # SEWER AND WATER PERMIT FEE $ Stf�C �'1� KIN STATE SURCHARGE $ .50 ONG . TOTAL PERMIT FEE $ �� ( Office Use Only) This Application Becomes Your Building Permit When Approved Paid Receipt No. Date By Building Official Date The Minnesota Statutes § 326B.148 "SURCHARGE" has been extended ur notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 until June 30, 2013, The minimum surcharge for a "fixed fee" permit is $5.00 - . PR1Q� CITY OF PRIOR LAKE Date Rec'd HEATING /AIR CONDITIONING /FIREPLACE PERMIT ''MvESO� r. k Fa` PERMIT NO. /2 D 4Q'5 3. Yellow Appfimar (Pl ease type or print and sign at bnftom) ADDRESS ZONING (office use) LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID 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 HERNANDEZ( `/ . hone 952 - 767 -1847 APPLICANT SIGNATURE 7.16 ' fl t ; / ) DATE 7/I _/W APPLICANT PLEASE COMM E BELOW ANEW CO STRUCTION 1 ' I? 170T • �r7. .r r p ALTERATIONS /} - FURNACE MAKE AND MODEL at, ` q 14J 0-6 L&IS I1 V FUEL N'`+ V kS FLUE SIZE RET ' • OPENINGS INPUT 5g, , O b0 OUTPUT J -3 ((� TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE: Air Conditioner []Warm Air Planes 0 Steam ❑Gravity Units and Fireplaces Cannot Encroach ❑ Hot Water into Required Side Yard Setbacks. Mechanical ❑ Radiation Fireplaces with Box Additions or e Conditioning ❑ Oth er Devices C antilevers to the Outside of Buildings [Went. System El Other Devices g 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) 5149.50 Residential, Additions & Alterations 0 Residential, Heating Only (Ncw Construction) $64.50 Residential, AC Only ���® �� 0 BUILDING PERMIT Estimated Cost $'0 Building Permit # The Minnesota Statutes § 32613.148 "S1 :RCIIARGEi" hes been changed kw one HEATING PERMIT FEE $ year effceti%e STATE SURCHARGE $ .50 July 1, 21110, until June 30.2011. TOTAL PERMIT FEE $ The minimum surcharge far n "filed fee" permit (Office Use Only) Is 55, beginning July 1.2010 This Application Becomes Your Building Permit When Approved Paid Receipt No. Date By Building Official Data 24 hour notice for nil inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 o f P Rto Date Rec'd ,� .:', CITY OF PRIOR LAKE PLUMBING PERMIT V „ 1/ 481 SO ,. Vol: l ile PERMIT NO . n 2. Yel City /� tJ / /) 3. Yellow AFpltean (Please type or print and sign at bottom) ADDRESS • ZONING (office me) 12- 5.3 Pat N fri LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER (Name) (Phone) (Address) APPLICANT (Name) GENZ -RYAN (Phone) 952- 767 -1847 (Address) 2200 HIGHWAY 13 W, BURNS V I LLE , MN 55337 (Address) (City) (Zip Code) (Contact Person) LISA HERNAID E Z (Phone) 952-767-1847 DA APPLICANT SIGNATURE FA il/j VI r 1 . � /I l(;k (, J r 1� 11.0 1 APPLICANT PLEASE C) PLETE BELOW Quantity Type of Fixture Quantity Type of Fixture , Bath Tub with or without shower ` j Rough -ins Dishwasher l Water Heater I . , Floor Drain Water Softener Lavatory (Bathroom Sink) Stand Pipe (Washing Machin:) i Laundry Tray (1 or 2 compartment sink Sewage Ejector 1 Shower Stall Backflow Assembly Sinks Backflow Assembly Test Bar Sink Lawn Sprinkler ' Water Closet (Toilet) Other FEE SCHEDULE Industrial, Commercial & Multi - family l % of job cost with a $49.50 minimum Residential, New One & Two- Family $149.50 Residential, Additions & Alterations 549.50 • The Minnesota Statutes § 32613.14R ^ $ Ce 75( Building Permit # "SURCHARGE" has been changed for one year effective PLUMBING PERMIT FEE $ PAID July 1, 2010. until June 30, 201 1. STATE SURCHARGE $ .50 The minimum surcharge fora "fixed fee" permit TOTAL PERMIT FEE s BUILDINIS PERMIT kg. beginning July 1, 2010 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 . uTgDTT CITY OF PRIOR LAKE BUILDING PERMIT. Date Reed 4.... ,,-. TEMPORARY CERTIFICATE OF ZONING COMPLIANCE SEP 2 1 2012 NNEso AND UTILITY CONNECTION PERMIT By PERMIT NO. t#0 i " (Please type or mint and signal bottom) ADDRESS ' 1 ZONING (c<15,-c1:4e, I 4 1 2 1 :).— , / _ "1 LEGAL DESCRIPTION totter use only) LOT BLOCK ADDITION P ID ,. t . OWNER i ,/' (Name) 1 1 47 evi y do iNs (Phone) 952 Eflel - Z (Address) 320 L)A4 1 ' ra, ' A __ i Otift0ER C.N.sret-JAC-__ 'T i',2e,.... LIZ Phor.e1 7(.473 - 271-PAG0 (Company Narne) I g4. N PYO r.a.,420, 1 , (Contac, Name) -JA50t kik . 1,1117F - Z ...--- (Address)it‘ to .1.3.4.0i,yairRifv..._ Cow) r., V ski." \ 4.."Qi i ,.., ,(...1- , i ; TYPE OF WORK 11New Construction ODeeit OFeh ORe-Roofing OEteSg 7,110% et Level Palish 0 Fireplace 0Adtimon 0Ancration a:tile:, Connecton . CODE: p.a.C. OI.B.C. 0 Mir:. Type of *mum-tied: 1 li III TV 6') A G.) Occupancy Group: A B E F H I M cip S. U PROTECT COST / V MATE $ ..Dt.....- -“,— C 'C Division: I 2 (...11'.,. 4 (excluding land) i retry =try 7.111: 1 taVI fur:called sndormanorl on rotss app"..tobts wrocts ss to the best of my knOV. ledge In:474 eceseet : ant ,restb eat I am the owner or aushornsed aced nor the i b o li, 144 property and that 41 construction will column to ar. trerang stare and local laws an sthll rey.te-1 h. anteesdanze Atte sclyntstet: plans 1 arn aware tr it/ triuthil i alfreis,:sit revoke tins peamo fee tureause Furtnentote, 1 herehy acre thas the ohy &Yea; or a oewer ma..: ever ober the r.zevrey to berform beetled tbspectsons a- 14C 6 1-11-io. Souture Contractor t 1nse NP Date ..3 Ferran VaItLanon $ . ' Park Support Fee = i 4 , Femur Fee S SAC e t $ I , Flan Check Fee $ AVater Meter Sze 5 S , i s Sate Surcharge $ Pressure Rce: 1 $ Penalty 1 $ Sewer/ Water Cor,r.emon Fee t...- I 5 Flurdmng Permit Fee $ Water Tower Fet ii 1 $ Meehan:cal Penritt Fee $ Builder's L'Iet RAID WITH Sewer & Water Perrin Fee $ Other dUll..1314 1 .3 H17111\111 Gas Fmlace Permit Fee S. TOTAL DUE 1 $ 411 A , ill . Your Building P - When Approved Paid i Receipt No < Date By . , .., . offi, , "ma ...v to oeely thet the ,equest to the above OPPIS And aentompartsola coesarrwots a as aateordaree tbalt thr .C.ss Lectata ■,,.......114.1.1 and may proceed ass reccesoct This comment : I when upped by the Ca'y rAZZa commutes a temporary Cesetheate et Zert.np eersocisanse and allows coate-oecten ".e commenter Bee:hr ecenpassey, a cC111: 'Z'f. CA.1:54 ' :IC : I 7:13:1C4 ____,.... rd Detector Date Snet-d Conchhons. t; Eh ' 24 hour notice (or sal Inspections (52) 44TY9SS4. fax 4,95114;4'4245 464 tt Dakota Street S•F.., Prior Lake, Minnesota !..3-2 " V s • * ``, • -A. 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 daim against contractor for faulty material, poor workmanship, or failure to comply with approving authority's requirements or local ordinances. PROPERTY NAME: JEFFERS POND DATE / /— ,i3--/2. PROPERTY ADDRESS: 14353 PARKSIDE COURT ACCEPTED BY APPROVING AUTHORITIES: CITY OFANZW5FtY PizioR Litilk 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 YES ONO 2. CARE AND MAINTENANCE INSTRUCTIONS EWES ONO 3. NFPA 25 BYES ONO LOCATION ENTIRE BULDING YEAR OF TEMPERATURE MAKE MODEL MANUFACTURE SIZE QTY. RATING RELIABLE RES 49 2011 1/2 10 155 SPRINKLERS RELIABLE RES 44HSW 2011 1/2 13 155 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 - 0 5l 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 MQDFI SI IPFRVISION I ORS AI ARM t VAJ VF RR FASF (PFRATF 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 _a_HRS IF NO, STATE REASON DRY PIPING PNEUMATICALLY TESTED OYES ®NO EQUIPMENT OPERATES PROPERLY 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? OYES NO DRAIN READING OF GAGE LOCATED N €AR WATER RESIDUAL PRESSURE WITH y9LVE IN TEST CONNECTION TESTS TEST SUPPLY TEST CONNECTION q / PSI CONNECTION OPEN WIDE (7(O 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. 858 (81 YES ONO OTHER EXPLAIN FLUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING OYES ONO IF POWDER DRIVEN FASTENERS ARE USED IN 0.1 YES 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 YFS DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR -3? ERNES 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 _AYES 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 NO 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 OYES NO NAMEPLATE REMARKS DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: /> —/3 jZ NAME OF SPRINKLER CONTRACTOR: FIRE SUPPRESSION SERVICES, LLC. TEST WITNESSED BY FOR PROPERTY OWNER (SIGNED) TITLE DATE SIGNATURES • : R Cs TRACTOR (SIGNED) TITLE DATE ra►! /I% �ou 11 - 12 ADDITIONAL EXPLANATI• 1 AND N• ❑S ~ c, / 1.1 1 -t � L [ CO(C P450- LAY-6 ( 1[ 43 41_7 PRIOR LAKE DEPARTMENT OF BUILDING ND INIRFCTION . :7o see ivii,--- .IN PE T C I RECORD- SITEADDRESS N t435 ei4-t2. KS. ia° -- ecctme-s NATURE OF WORK /- 04c-, Dc- - -- j■10 - , --/ L. L. L. F0.1 USE OF BUILDING 'i = "--,4-\ t (.. - Ar PERMIT NO. '' DATE ISSUE A' - rz... CONTRACTOR tlAcrp t46S PHONE 152 ° - fol?b NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS B LOW THE PERMIT IS BY SEPARATE DOCUMENT k ' `� k �1 �7 4 A-1 J"' -ins t 4 - 1 - DA I FOOTING I I I FOUNDATION (Prior to Backfill) 1 1 PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED Nibs ROUGH - INS )V14-\ SEWER /WATER /SEPTIC /g 7424- FRAMING 4'/) /W/7 c INSULATION ELECTRICAL PLUMBING p/ ,o/17 HEATING (if required) FIREPLACE oko64 ,:,, S LINE Al - TEST 11 , UPt CO E �O WORK UNTIL ABOVE HAS BEEN SIGNED ) .ot4 k' Lard 1 1 4N J c5 Q ,01,., 7 FINALS Pl + '- F1.bac- R r-4. li Ls LI GRADING (Prior to Sodding) BUILDING , , 4 (/ ELECTRICAL PLUMBING f24. „2 >3 >, 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