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HomeMy WebLinkAboutBuilding Permit 13.0165 N t i s rr i 0 t o � x O - 4 = C: r o^. ro•�pr . „ / f .�. t ` ; • r .." .f✓: y c. �' ` .. \ y: rr rr� r r++ VI' ,ryO. t ar r �.r > r ',5 r ` R i RR �r.i et t '. ?r- r �"f r fit *0,. .+$4. Wi , / R rM1r4 �� R'P41 WW ' AK 'f P i r r r 'r .:. ° �' '° ti.i .� 1 Y'r � r , „ , ,... 1 .'..{� !. �y � d t�, '� +Ptir � r r . I V :; r rr b ; r rr ✓ rr �r r irrrr , <, "AA , rrrOn , WOW � rrY dr rrr'r rr' rOr„ 1ii0P R?irSrr VAT !`r'iirO If ��t�� �1fl ��Y ,�yy • r a 1 pp f f p S r rr r Jr ,, rrS: rr v r , trf r ; iS f N S�ir�': Vrrrrrr rrurrr rrflrr rurrrr rrrrrrr <r h rrrrr r'rrSr4 '•t ,iN �__:r .. ,/.,h t ai : ..a�V,YYI .u„Wikccki'IYY',,:cM if t # .a�VV411�:'r ,,g1 f t ��� �I'Os ff� i f it �A - 1 1 IN rMHI ffllif _ Ilr!N ^� IIrNf Null q •, ,. � _. _. _. �i ..:��� �_� 4�n �f�ord�i� _ � � uuwl�lwiudaw�t�i i \ C� rrfffir tfr of ®rrupaux r CITY OF PRIOR LAKE of ci s rrfio iri Final Permitted Li Conditional C.O. Expires 0 This Certificate issued pursuant to the requirements of Section 110 of the ❑ Residential / ❑ International s „ Building Code certifying that at the time of issuance this structure was in compliance with the various St'_' ordinances of the City of Prior Lake regulating building construction or use For the following: .+) , `_ ' Use Classification SINGLE FAMILY Bldg. Permit No 13-0165 Y°'-' R3 VN PUSD yi O ccupancy Type Type Construction Zoning District Legal Description L30, B1, HICKORY SHORES SECOND ADDITION 0," 17049 KENNETT CURVE S. W. f Owner of Building Site Address �(, Contractor's Name & Address D.R. HORTON , INC. ROBERT D. HUTCHINS it (i' ,� p ity Planner _ ui 'ng Official�;;��� . (r . ; Date: lD 3•/ Date: r �, �, POST IN CONSPICUOUS PL ACE _�111 III r �'' I;?, i. ';; n r �r . 4 P P h� � q• ,. .� 'e4 111111,., rg k '.11' r: tit ;, N M) 1 �N 111 �N 1, II�0 C r IO .., 1��If 11�II r? 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(Phone) (Address) I BUILDER (Company Name) D.R.HORTON, INC (Phone) 952- 985 -7272 (Contact Name) Brooke Hareid bmhareid @drhorton.com (Phone) 952- 985 -7806 (Address) 20860 Kenbridge Court, Lakeville, MN 55044 TYPE OF WORK VI New Construction DDeck ❑Porch ❑Re•Roofing DRe- Siding DLower Level Finish D Fireplace DAddition DAlteration D Utility Connection CODE: 67]I.R.C. DI.B.C. El Misc. _ _ _ Type of Construction: 1 II III IV V A B PROJECT COST/ VALUE $ 2-10 , 2- 5 Occupancy Group: A B E F III MR S U (excluding land) Division: 1 2 3 4 5 • 1 hereby certify that 1 have furnished Information on this application which is to the beat of my knowledge true and correct. 1 atso certify that 1 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. 1 am aware that the building official can revoke this perm t for lust cause 'urthermore, I hereby agree that the coy official or a designee may enter upon the property to perform needed Inspections x BC605657 1 /2.&, / 3 Signature Contractor's License No. Date Permit Valuation - l (o ` D aD, I Park Support Fee If $ Permit Fee $ 1141 SAC # S 2. 4 3c Plan Check Fee $ 1 1$-1 • (0 Water Meter Size Scs' °; 1 "; $ , , • State Surcharge $ t O 8 . ' Pressure Reducer $ ( ( Penalty $ Sewer /Water Connection Fee # $ l S 05. Plumbing Permit Fee . $ ( 5 4 , so Water Tower Fee # $ ( o Mechanical Permit Fee $ lS 4. c-47 Builder's Deposit $ 25 Sewer & Water Permit Fee $ Other $ Gas Fireplace Permit Fee $ 54 • S TOTAL DUE S I I t 4- S _ IS This AppXltation B e . Your Building Pennit Wien Ap roved Paid /7 5 % / y ceipt No. & y , 1' Date 3. Z- ,( .44/ r 3 /L t3 Bui1dn Official Date Thus n to cent y that the rem 'st to the above application and accompanym • . ocu ents is in accordance with the City Zoning Ordnance and may proceed as requested. This document when signed y the Ci Plat r constitutes a temporary Certificate of Zorn g co p and allows conshvction to commence. Before occupancy, a Certificate of Occupancy must be issued _ ,, 3 i Z i 3 `r , itng y a Date Special Conditions, if any 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street Prior Lake, MN 55372 M Residential Building Permit Checklist New Construction for Single or Two-family Dwellings in R-1 or R -2 Districts Reviewed by: Date: 3 r3 Building Permit # i PID: Zoning: ,,, u5 - ,r) Address: 1 e Sy r S3 5 11 Legal: L , B Subdivision: • Existing Structure? YES Sit . Existing Nonconforming Structure? YES / NO CONFORMS TO ZONING NO ORDINANCE Yard Setbacks: NA 1 FAILS/ COMP 1ES Standard ' Proposed I • Front Yard (can be 20' if avg. Alin 150') , le Reive 't • Side Yards 10'! "11.644 /aka. t 25' if abutting a street fJ 'f . ,tee ,. . 2 f • Sidewall exceeding 60' requires additional side 2" 10' setback -1- 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 25' V t'ut' • 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' f Floor Area Ratio: NA 1 FAILS 1 COI' 419.IES I .30 Maximum 1 1 n 1 . Yard Encroachments: MI FAILS 1COMPLIES I Standard Proposed Eaves and Gutters no more than 2 feet in width and no closer than 5 feet to a lot line (Easements). NC and other equipment cannot encroach on interior side yards. Tree Preservation: 01 FAILS 1 COMPLIES Standard Proposed • Total caliper inches • Permit 35% Removal • Caliper Inches Rer>a'oved • - Calipelrpches P,r6served • Replaceme V Y2:1 L: \TEM BLATE\�LD GLI ST.D O C / I Driveway: NA / FAILS / COOLIES Standard Proposed • Maximum width at property line _ 24' Jb • Required setback 5' from side lot line or 30' from r -o -w on corner lots • Maximum slope — � • All parking areas to be paved including R -V or spaces adjacent to the garage • Location to match subdivision grading plan l v , i Building Height: NA/ FAILS / CO ( p .IES 1 35' Maximum PL-"0 Shoreland District: NA/ FAILS / CUPLIES Standard I 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 pup Bluff in Shoreland: A / FAILS / COMPLIES Standard Proposed • Setback from to 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 Floodplain0 / 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 I Accessory Structure: ► / FAILS / COMPLIES 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\BLD GLIST.D O C (PR / CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd TEMPORARY CERTIFICATE OF ZONING COMPLIANCE / s x AND UTILITY CONNECTION PERMIT M/A'NESD*O" I. White City i 2 Pink C PERMIT NO. . 3 Yellow Applicant (Please type or print and sign at bottom) ADDRESS IS -(( (3 ✓ (b t: , ( - 1 tr 1 (3 - / C. I ZONING (office use) I 7 eq, , i7dsi, 17DSr r 7e2 Kin �„v__ LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER tTlc/e 5A ^per (Phone) (Name) (Address) BUILDER F7r rr r (Company Name) C2 �'"t ;4 /- ( /6 i- e cci1 (Phone) (Contact Name) 1 4 -.r� SP11 / 1 �l (Phone) G 57 l (Address) 4C // M -71 c. 4 a ke ( - g A e ( ASt i / 03 TYPE OF WORK C New Construction ['Deck ❑Porch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace Addition EAlteration DUtility Connection CODE: ❑LR.C. ❑I.B.C. ❑ Misc. frir` 5pr. -. /4-� -4.,f, Type of Construction: I II III IV V A B ...,,— is al PROJECT COST /VALUE $ f 4 z. t Occupancy Group: A B E F H I M/ S U (excluding land) Division: 1 © 3 4 1 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 pro.'rty and that all consul' tion 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 revok ' permit for just cause.% irthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections. -`tea re Contractor's License No. Date Permit Valuation Park Support Fee # $ Permit Fee $ SAC # $ Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $ State Surcharge $ Pressure Reducer $ Penalty $ Sewer /Water Connection Fee # $ Plumbing Permit Fee $ Water Tower Fee # $ Mechanical Permit Fee $ Builder's Deposit W Sewer & Water Permit Fee $ Other PAID$ ■I Gas Fireplace Permit Fee $ TOTAL DUE BU %LD'� ��� 'T This Applicatio t Becomes Your Building Permit When Approved Paid Receipt No. / Date By "_ 3 4 Bu Iding ' fficial Date This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued Planning Director Date Special Conditions, if any 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 16200 Eagle Creek Avenue Prior Lake, MN 55372 0 K) x PRIO White - Building Canary - Engineering MNNES °�� Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT APPLICATION RECEIVED The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: Accepted Accepted With Corrections Denied Reviewed By: /1/146 Date: 3 e '13 Comments: 1.. See Reverse Side for Additional Information! Dpoe..e- / fit( oCr -1 . 2 - • A, if O rt ►— See Attachments: 1) Grading Plan, 2) Erosion Control Standards "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� e U 'Y� White - Building Canary - Engineering MNN�s Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT !.>. 7L- - HOlL -- 4 APPLICATION RECEIVED ' ' ' The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: /70 °— / 70. 5 1667 CUE- VC Accepted ` Accepted With Corrections Denied t/) /4 Reviewed By: Date: 1 • meg Comments: e 6 ° ` 6 1 ‘ / -- mi "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." PR, IG e. O , z of) U m 4 k '7 White - Building P Canary - Engineering "�INNES °, Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT APPLICATION RECEIVED The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: Accepted Accepted With Corrections Denied 1 g W Reviewed By: Date: /! it j Comments: "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." Date Reed CITY OF PRIOR LAKE PLUMBING PERMIT 4( 419Esd Ct ' 2 ' G 1 0; 1 ( ' 7 i i ly 1 PERmrr NO. /3 3 Yellow Applicont —•••-----o.1 pease type or print and tkel at bottom) ADDRESS . ........._____ ) C 't ( 1 tilntA\ U fsi It'd! , ,—)1,4 ibNING (o ose — -- LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER (Name) _ (Phone) (Address) — .----------- _________ APPLICAFT. , 1 , (Name) - v::".)0 1 4Y.L.2 _('.1..) I'' 1ii I.) (Phon) ]..te 2 ) "_11._..1 ' 2- Z I (Address) Y":"3 AA.t...4,6.1.LL_, le.1_ 01 ui vvirukr 5 E,N ill (Address) (GAY) (Zip Code) ‹-.--.- . (Contact Person) ...-,_:)0ylk.k.U\ .., _. .. .........._ ... j (Phone) Lt g•f.) - 2.! 41 C:( APPLICANT SIGNATURE ( ) tA 4.. ./ lik. TAW , t-Yltli.td-• DATE 7 4 - I - •2.,(;) • .. • _ APPLICANT PLEASE COMPLETE BELOW Quantity_ Type of Fixture uantit Type of Fixture _ Bath Tub with or without shower Rou:h-ins ---- Dishwasher Water Heater _ Floor Drain Water Softener Lavatory (Bathroom Sink) Stand Pipe (Washing Machine) --- Laundry Trayll or 2 corlipartmeni sink Sewa e Ejector Shower Stall Baekflow Assembly, Sinks _ Backflow Assembly Test ------__ _______ Bar Sink Lawn _S Water Closet (Toilet) ter .._ __ ___ Oh _ ... FEE SCHEDULE industrial, Commercial & Multi 1% of job cost with a $49.50 minimum Residential, New One& Two-Family $149.50 Residential, Additions & Alterations $49.50 ' • • g $ Building Permit ft The Minnesota Statutes 32613.148 • — "SURCHARGE" has been changed fin one year effective PLUMBING PERMIT FEE $ _______ ___ July 1, 2010, until June 30, 2011. STATE SURCHARGE $ .50 PAID WITH l'he minimum surcharge for a "fixed fee" permit TOTAL PERMIT FEE $ is S.5, beginning July 1, 2010 BUILDING PERMIT ________ This Application Becomes Your Building Permit When Approved Receipt No. r Paid— Building °Metal Bate z:4 ,,,:tt.,,.1-.:,;, -.:, rr ,-,-,....,. , ek.r.::: : ,,,t, v e :: :, : , : ,...... , :,,, ,:.-,,: :::1::::::. ,.i•:::.,: ,::: ,:,,:.;, i= -- . r 9,,,,, wawa anon a.14., rrior bane, ivorinesora 3N1 p RI CITY OF PRIOR LAKE Date Reed °O HEATING /AIR CONDITIONING/FIREPLACE PERMIT - �� t, Pink F t o `t'llvrrrss `t 2 . o<rea c; PERMIT NO. j! � 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING (office use) rJ4 g AZO/) _ LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PHA • (Name) /9, R. f �C r'/UIJ�'� (Phone) A - 1- ." ft'— 7 (Address) -O O 6c) , fl (f t APPLICANT HEARTH & HOME TECHNOLOGIES (Name) dba FIRESIDE HEARTH & H tfl5ne) • Lid 662656 . (Address) 2700 FAIRVIEW AVENUE N (Address) ROSEVILLE, MN 55113 (City) (Zip Code) 651.633.2561 (Contact Person) (Phone) /_ APPLICANT SIGNATURE 6 _ DATE -v2.--d_3 APPLICANT PLEASE COMPLETE BELOW • CONSTRUCTION ❑ REPLACEMENT ❑ ALTERATIONS FURNACE MAKE AND MODEL FUEL FLUE SIZE RETURN OPENINGS INPUT OUTPUT TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE: Air Conditioner DWarm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach ❑Gravity 0 Hot Water into Required Side Yard Setbacks. ❑ Mechanical 0 Radiation Fireplaces with Box Additions or DAir Conditioning ❑ Special Devices ❑Vent. System [] Other Devices Cantilevers to the Outside of Buildings Require a Building Permit. FIREPLACE MAKE AND MODEL ffr'i?J SL- 7 o7'7 -r et lomogriz.7 • 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 $ l le, O6, $ 0O Building Permit # The Minnesota Statutes § 326B.148 HEATING PERMIT FEE $ "Sl`RC1IARGI:" has hecn changed l'or one year effective STATE SURCHARGE $ .50 July 1, 2010, until June 30.2011. TOTAL PERMIT FEE $ The minimum surcharge for a "fixed fee" permit (Office Use Only) is Es, beginning July 1.2010 This Application Becomes Your Building Permit When Approved Paid Receipt No. Date PA`©BYVI , n Bulldin'uOffiicial Date RUILnING PERMIT 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 yRI„ CITY OF PRIOR LAKE Date Rec'd HEATING /AIR CONDITIONING/FIREPLACE PERMIT d iiivivEso* 1 . Din1 rip` PERMIT NO 2. OEM City 3. Yellow Applicant (Please type or print and sign at � bo ) ` ttom j 'n p r J ADDRESS I - 7 0 6' V e ! l 1' e+ C V l e cr lokt ZONING (offitc �5e) V • LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID ( Name) {� �. .Alvin t7YY1eS (Phone) 6 15z - 985 - 72V (Address) 2 Ob (PO ei k d a t � Lave le mkt SSL'`t APPLICANT - p �/,, / f`� g� /, J 2 Z 5L / (Name) �[ StG�e� �`7 l' I I7lJ Y r a� (Phone) l!/5 [ (J ✓, (Address) 2 .t o/ F V V t e V3 PT V c, K J OS U `` L/ M '5 t t73 Lea L v i / l (Address) (City) f , {Zip Code) (Contact Person) Lea k e (e v (Phone) l 061 t i3 E - 3"; { 2 APPLICANT SIGNATURE \ DATE APPLICANT PLEASE COMPLETE BELOW ONEW CONSTRUCTION ❑ REPLACEMENT ❑ ALTERATIONS FURNACE MAKE AND MODEL FUEL FLUE SIZE RETURN OPENINGS INPUT OUTPUT TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE: Mr Conditioner :Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach ❑Gravity ❑ Hot Water into Required Side Yard Setbacks. ❑ Mechanical ❑ Radiation Fireplaces with Box Additions or :Air Conditioning ❑ Special Devices ❑Vent. System ❑ Other Devices Cantilevers to the Outside of Buildings 1 _ + ] Require a Building Permit. FIREPLACE MAKE AND MODEL 5 u !? V 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 # The Minne_ota Statutes § 326B. l48 HEATING PERMIT FEE $ "SURCHARGE" has been changed 1b one year effective STATE SURCHARGE $ .50 .piny 1, 2010, until .3it ne 30. 20 I. TOTAL PERMIT FEE $ '11c minimum surcharge for o "rise(' fee" permit (Office Use Only) is S beginning July 1, 211111 This Application Becomes Your Building Permit When Approved Paid Receipt No. Date By Buildiun Official Date 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 CONTRACTORS MATERIAL & TEST CERTIFICATE FOR ABOVEGROUND PIPING PROCEDURE: Upon completion or work, inspection and tests shall be made by the contractors representative and witnessed by an owners representative. All defects shall be left in service before contractors 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 for faulty material, poor workmanship, or failure to comply with approving authority's requirements or local ordinances. PROPERTY NAME: Hickory Shores IDATE: 08 -08 -13 PROPERTY ADDRESS: 1 701 �-�,, , . c4.4",.c_ ACCEPTED BY APPROVING AUTHORITIES ( NAMES) City of Prior Lake PLANS ADDRESS: INSTALLATION CONFORMS TO ACCEPTED PLANS IM YES ❑ NO EQUIPMENT USED IS APPROVED IN YES ❑ NO IF NO, EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION OF CONTROL VALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT 1M YES ❑ NO IF NO, EXPLAIN INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: M YES ❑ NO 1. SYSTEM COMPONENTS INSTRUCTIONS M YES ❑ NO 2. CARE AND MAINTENANCE INSTRUCTIONS M YES ❑ NO 3. NFPA 25 M YES ❑ NO LOCATION OF SUPPLIES BUILDINGS SYSTEM ENTIRE BUILDING DESCRIPTION MODEL YEAR ORIFICE SIZE TEMPERATURE QUANTITY Reliable F1 44 2012 1/2" 155° 44 Reliable F1 49 2012 1/2" 155° 29 Reliable Dry F3QR 2012 1/2" 155° 3 SPRINKLERS • Blazemaster CPVC w/ CPVC Slip Fittings PIPE & FITTINGS 1" Allied XL w/ 300lb Class Threaded Fittings ALARM DEVICE MAXIMUM TIME TO OPERATE THROUGH TEST ALARM VALVE GUNNEL I ION OR FLOW TYPE MAKE MODEL MINUTES SECONDS INDICATOR Vane Potter VFS - 4f f DRY VALVE Q.O.D. MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO. TIME TO TRIP * WATER AIR TRIP POINT TIME WATER REACHED ALARM OPERATED THROUGH TEST CONNECTION PRESSURE PRESSURE AIR PRESSURE TEST OUTLET ` PROPERLY MINUTES SECONDS PSI PSI PSI MINUTES SECONDS YES NO DRY PIPE WITHOUT OPERATING Q.O.D. TEST WITH Q.O.D. IF NO, EXPLAIN * MEASURED FROM THE TIME THE INSPECTOR'S TEST CONNECTION IS OPENED. OPERATION 0 PNEUMATIC 0 ELECTRIC 0 HYDRAULIC PIPING SUPERVISED 0 YES 0 NO DETECTING MEDIA SUPERVISED 0 YES 0 NO DELUGE & PREATION DOES VALVE OPERATE FROM THE MANUAL TRIP AND /OR REMOTE CONTROL STATIONS OYES 0 NO VALVES IS THERE AN ACCESSIBLE FACILITY IN EACH CURCUIT FOR TESTING . IF NO EXPLAIN 0 YES 0 NO MAKE MODEL DOES EACH CURCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO OPERATE SUPERVISION LOSS ALARM OPERATE VALVE RELEASE RELEASE YES NO YES NO MINUTES SECONDS HYDROSTATIC: HYDROSTATIC TEST SHALL BE MADE AT NOT LESS THAN 200 PSI (13.6 BAR) FOR TWO HOURS OR 50 PSI (3.4 BAR) ABOVE STATIC PRESSURE IN EXCESS OF 150 PSI (10.2 BAR) FOR TWO HOURS. DIFFERENTIAL DRY -PIPE VALVE CLAPPERS SHALL BE LEFT OPEN DURING TEST TO TEST PREVENT DAMAGE. All ABOVEGROUND PIPING LEAKAGE SHALL BE STOPPED. DESCRIPTION PNEUMATIC: ESTABLISH 40 PSI (2.7BAR) AIR PRESSURE AND MEASURE DROP WHICH SHALL NOT EXCEED 1 -1/2 PSI (0.1 BAR) 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 BAR) IN 24 HOURS. ALL PIPING HYDROSTATICALLY TESTED AT C44) PSI FOR HRS. IF NO, STATE REASON DRY PIPING PNEUMATICALLY TESTED 0 YES 0 NO EQUIPMENT OPERATES PROPERLY 0 YES 0 NO TESTS DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS, SODIUM SILICATE OR DERIVATIVES OR SODIUM SILICATES, BRINE, OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TESTING SYSTEMS OR STOPPING LEAKS? 0 YES 0 NO DRAIN TEST READING OF GAUGE LOCATED NEAR WATER SUPPLY TEST PIPE: RESIDUAL PRESSURE WITH VALVE IN TEST PIPE OPEN WIDE 7 STATIC PRESSURE: S PSI 7o PSI UNDERGROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFOR CONNECTION MADE TO SPRINKLER PIPING. VERIFIED BY COPY OF THE U FORM NO. 85B 0 YES 0 NO OTHER EXPLAIN: FLUSHED BY INSTALLATER OF UNDERGROUND 0 YES 0 NO SPRINKLER PIPING BLANK TESTING NUMBER USED LOCATIONS NUMBER REMOVED GASKETS WELDED PIPING 0 YES 0 NO IF YES........ DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY 0 YES 0 NO WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR -3 WELDING DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED 0 YES 0 NO IN COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR -3 DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A 0 YES 0 NO DOCUMENTED QUALITY CONTROL PROCEDURE TO INSURE THAT ALL DISCS 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. CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL CUTOUTS 0 YES 0 NO (DISKS) (DISKS) ARE RETRIEVED HYDRAULIC NAMEPLATE PROVIDED IF NO, EXPLAIN DATA NAMEPLATES 0 YES 0 NO REMARKS DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: - ( 2- 1DCi NAME OF SPRINKLER CONTRACTOR: SUMMIT FIRE PROTESTER ` SIGNATURES TEST WITNESSED BY F0 -: d - r - • f P ER ( SIGNED) TITLE DATE: SUMMI "'�- 1kS�er t-' FOR SPRIN !' R CON RACTOR (SIGNED) TITLE DATE: ✓ ��-` tS / 2.- z ( 3 vitr A CITY OF PRIOR LAKE Date Rec'd • R HEATING /AIR CONDITIONING/FIREPLACE PERMIT / / / j C i5- l . Nrv>sso t' i. I �;te PERMIT NO. / "3 / , . Green Lily 3. Yallmv Applicant - (Please type or print and sign at battom) ADDRESS 1 c eel) ne+ C l vve S 0/ fir-vola Z / �ffice use) V L' LEGAL DESCRIPTION (office use only) /J LOT BLOCK ADDITION aekney %a� Ai -6 //Y z AM PID ,RIj - v z - o3e ° 0 ( Name) � � �� ���� (Phone) 951 gb} ✓ 7Z7Z (Address) 2 C) PO Kell bridle, C+. 1 a 61 le (Y + SS NU APPLICANT - �, ,� j �1 ,, , ` g� (051— Z C) _ ) (Name) �� S te l� 1`► � 'T / V Pic is (Phone) 0 �l , st o J • (Address) 7100 Fa 1 v VAe e Ave, IV eta. L` Ike., lV 1 5 i t (Address) Code) (Contact Person) L c\ t U e v e(e v (Phone) l 061 ` (Q3 Y Y 3'312. APPLICANT SIGNATURE 666f `9�( ,ftt0D /! DATE 2 1!) APPLICANT PLEASE COMPLETE BELOW ONEW CONSTRUCTION ❑ REPLACEMENT 0 ALTERATIONS • FURNACE MAKE AND MODEL FUEL FLUE SIZE RETURN OPENINGS INPUT OUTPUT TYPE OF SYSTEM HEATING OR POWER PLANT []Warm Air Plants PLEASE NOTE: Air Conditioner ❑ Steam Units and Fireplaces Cannot Encroach ['Gravity ❑ Hot Water ❑ Mechanical ❑Radiation into Required Side Yard Setbacks. :Air Conditioning 0 Special Devices Fireplaces with Box Additions or [Went. System ❑ Other Devices Cantilevers to the Outside of Buildings _ Require a Building Permit. FIREPLACE MAKE AND MODEL _ `)L7 C l am — 1 1— E FEE SCHEDULE Industrial, Commercial & Multi Family I% of job cost Residential, Gas Fireplace • $49.50 $49.50 minimum Residential, Heating & AJC (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 # The Minnesota Statutes § 32613.148 HEATING PERMIT FEE $ "SURCHARGE has been changed I'or one yew effective STATE SURCHARGE $ .50 duly 1, 2010, until June 30. 2011. TOTAL PERMIT FEE $ 11n tniuinunn surclinrge fora "hied fee" permit (Office Use Only) Is ,E,•,� beginning. July 1, 2010 I This Application Becomes Your Building Permit When Approved Paid Receipt No. irD WITH Date By DWG PFR IT • Building Official Date 29 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 ( :i 11 t I, Xir'' ^t. ..„_ NivEso a Builders Deposit ___........ City of Prior Lake A 4600.00 Builders Deposit is included in the Building Permit fee. Tile Builders Deposit is Issued as security to insure compliance for a Final Occupancy Permit, (it is not an escrow account.) All exterior items including but not limited to grading, sodding, landscaping, tree planting, driveways, siding and painting shall be completed 180 days after the date the building perm* is issued. If the Work is not complete within the 180 day time period, the City shall notify the applicant of the violation and the applicant shall have 10 days to comply or the $1,500.00 bultders deposit will be forfeited and the applicant will be billed for clean up or corrective work to rectify the situation. A$500.00 Tree Deposit may also be required and will be refunded if specified trees are preserved for a period of one year. DATE: SITE ADDRESS: /70 4 / 7 Ife7IAIE C,og v6 PERMIT # / REFUND TO BE MAILED TO: D.R. Horton, Inc Attn: jADA &tzemAJA LOT 20860 Kenbridge Court Suite 100 Lakeville, MN 55044 AUTHORIZATION TO RELEASE PLEASE REMEMBER ‘4/ - Ott Lynda S I len, Building Services Amount . 1. KEEP STREETS CLEAN DUR 1. 1— /3 Acct. 801.20204 ING CONSTRUCTION Date 2. KEEP EROSION CONTROL IN PLACE 3. TEMPORARY OCCUPANCY PERMIT MUST NOT EXPIRE OR $500.00 WILL BE FORFEITED SIGNATURE: (--- ( 1-------- ACCOUNT NO. 801-20204 RETAINAGE FORFEITURE ACCOUNT NO, 32211 AMOUNT: AUTHORIZE' TO RELEASE: DATE: JAFORMRBUILDERS DEPOSIT FORM.DOC PRIOR LAKE oF D E�'ARTMENT BUILDING AND I INSPECTION RECORD SITE ADDRESS / 70 ieeithverr Wi4/,,. NATURE OF WORK „s USE OF BUILDING PERMIT NO. ,(3 0 /(t DATE ISSUED CONTRACTOR 3. t. HO 42-6"/ PHONE 9 $5: 7272.. INSTALL EROSION CONRTOL AND MAINTAIN CLEAN STREETS AT ALL TIMES INSPECT R DATE FOOTING �A) L FOUNDATION (Prior To Backfill) 4 � • RADON RETARDER �, ` PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ROUGH - INS SEWER/WATER/SEPTIC 5� �..� " %' 4 "G ftt., FRAMING (,)L P Lo/, / INSULATION �) ELECTRICAL l ,� PLUMBING i),< d,tc-P,,j �1....' 1'48 bh )/ HEATING /94 FIREPLACE GAS LINE AIR TEST RADON RE-WAGER ?tp1IJC A) `- • 3 COVER NO WORK UNTIL THE ABOVE HAS BEEN SIGNED HOUSEWRAP ` L TH 1 INALS o R; 4 GRADING ( PRIOR TO SOD i I G) ' a r BUILDING L fyf l l3 d 4�lr/ +'e-F; 10 s r 3 ELECTRICAL PLUMBING HEATING 4 , LQ: DO NOT OCCUPY UNTIL ABOVE HAS BEEN SI N ED 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