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Expires - 31 T his Certificate issued pursuant to the requirements of Section 110 of the ❑ R esidential / ❑ I nternational (� p R f f •a Building Code certifying that at the time of issuance this structure was in compliance with the various J ordinances of the City of Prior Lake regulating building construction or use. For the following:!' ∎ 114' -, " Use Classification SINGLE FAMILY � Bldg. Permit No. 13 -0168 N Occupancy Type R3 Type Construction V N Zoning District PUSD ::: l' I t :a ” L33, B1, HICKORY SHORES SECOND ADDITION Legal Desc ription �` 17055 KENNETT CURVE SW ' A Owner of Building Site Address , ,t Contractor's Name & Address D D. 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LL N U U a Ui < 0 a 0 000❑❑ 0 0 0 c S. /3 /W oC PkJa CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd a TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 5 - =4 S AN U ILI 'Y C + CTION PERMIT �i 3 1 ( M ,,,..01 Wdite tilt PERMIT NO. /,,�) Y fink City . `J 3 Yellow Applicant �.v C-� (Please type or print and sign at bottom) ADDRESS ZONING (orrice use) /70 SS ire E T • 7 - 60 6 LEGAL DESCRIPTION (office use only) LOT 3 J BLOCK / ADDITION M o is (Sibs 2412 i PID OWNER (Name) (Phone) (Address) BUILDER (Company N 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 0 New Construction DDeck ©Porch DRe- Roofing DRe- Siding DLower Level Finish 0 Fireplace / A DAddition DAlteration DUtility Connection J CODE: JI.R.C. DI.B.C. 0 Misc. _. " Type of Construction: I It III IY V A B COU PROJECT COST /VALUE $ 2/O • 15. Occupancy Group: A B E F III MR S U ./ Division: I 2 3 4 5 (excluding land) 3 r v I hereby certify that 1 have fumished information on this application which Is to the best of my knowledge true and COMM 1 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 ain aware that the building official can revoke this permit or lust cause Furt rmorc,1 hereby agree that theory official or a designee may enter upon the property to perform needed tnspecttnns x �.....�_ BC605657 2/2-6. / 3 Sigt' e Contractor's License No. < Date Permit Valuation /I ' .t ooc . — Park Support Fee # $ Permit Fee [C -- ' q SAC # $ 7— A . - Plan Check Fee $ ( '1 ` - ( B Water Meter Size $ "; I "; $ �} e* State Surcharge �� ( Q ` ' P ressure Reducer $ (1 c U Penalty $ d✓ Sewer /Water Connection Fee # 5 Plumbing Permit Fee $ (C ,5o Water Tower Fee # $ O � r Mechanical Permit Fee $ 1 Si-. } � Builder's Deposit S 2:;56)(9, l Sewer & Water Permit Fee 5 5c .9) Other _ .. SS C9/✓ $ , / � , 5 c, Gas Fireplace Permit Fee $ 54, 5,p TOTAL DUE $' I AO "i r This App alto Be .,' ierr Building Permit Whc Ap i oved Paid /1, S 9 1) R `pt NO. G .' /4 Date. Z 1 ', l 3 1.+1v. 1 3 / Building Official p ate' This is to certify thy( the rcque t the above application and accompanying doct erns is n accordance with the City Zoning Ordinance and may proceed as requested. This document when signed by the it , Plan r on notes a tempaiery Certificate of Zoning c pliant and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued ' - rZ (3 Planning Director ` _ 0 to Special Conditions, if any 24 liottir notice for all inspections (952) 447 - 9850, fax (952) 447 - 4245 4646 Dakota Street Prior Lake, MN 55372 J Age } y �' .4 • k � D at e R e cd �, � •• f ITY C} " PRIOR AK I� , PI�CTi�1 BIN G PERMIT �r $ 1 3n,� a lp : [PER NO / O/ r .. y 3 Ycflow APi —._.. (please type o r print and •ax ci at bottom) _ _ AUDRLSS ZONING (offi � l s i � ':::.:•:"•':.:-..:.::.:-....„-"....:. .. LEGAL DE SCRIPTION ( ffi o ce use o l n y) LOT BT.:;OCIC ICI?' iION. — I I� iwN i • ( Name): (PI)onc) '(Addre _ -- A]PPII At. , ` ! h � (P hone) �t ` _.. , _ �- • (A.ddre ss) E � 1.1' (Cif ) : (Zip O~ode) . . i t. ( Z`) . ( Cantaert a 'e,)so z ) ) u t � D .f R .. ; APP'L CAN S1GNA Tt)1tL .� ! _ • APPLICAN T PLIi A C OIV IP LE I'E BELO Fvi a Hof Ftxtuxe Q ' :. `T ype of F uxe O�ttartt>>� . • . . t - . Ito h Batla, s a .. TuUw)tktoi wlthout.slipiv , _ � _.-•- �,-.. D Hater h . ! I~ Ioor: Dra)n Wat Snit - • •� I La avato Iflzt ooin Sts1)C St6114 .: e.,(Washm Maet )n) z�� � �Sc.w4 �e I?,lecto utad Try'' (I of 2 aoi parthtneiit t ;)k Shouter Stall 'BauklloW A Y _ u) kfi � .. t3acktlQw.l .sa><7nUly T est Lawn : :S xtnk.ler Isar S ln k _ �` . Water Ciu & filet (Jthe FE SCI + ,UU1. /� ` indi) tiiAl o , (n1111Crelal & Mujta -fta» my 1 %o iof 1017 <usi •W t a $4 9 50 nm in n 1u 1A1 R s Ideptlal, • I�1 4 •aJ11 C I Wo I an111y � I49 50 1ts.sidential, A & A1terat $49 50 l Stunated Cost $ :3uildi &iimt #! __ __ PLUMBI pL FE. $ PAID WITH S TATI; StJItCI IAT�CrE $ • TU1 AI, P:ERMLT FEE , $ (0)"fice :U Only) • ` Thus A P ilea n ti, Be o cmes Yau r I3uiidtrt Il rnut etA y�rov Wh) ed `Prnd Recetpt P t pp B y .t•-k . .i-. a,� A "� <' ,- . `.:: r` 1 + ' i rr# xsx v \ " "'"s, i •x� 9 s. `I �4 r b� M r w 1- ss"r`'•'?. s••a';L %uxF ..'ok.�? ` _• . t� - - r .. w. ' z •. .:: :z. „.*, v..', ? ., .as:.� Y fESSk� � ti ,xx nu. . ta :? :. .a;.s.:��` >. >nsr- •a,`•z':F.z,.r .,..« -.:. Y + 1 t t r » -sr v,.,, ^,.s< s L .,•:�. ;f, Y + `-;.e b -:o-« a : k U a , .n ' � - .. : ' 1•r 1 x . 1 ., .3k' y Y 1 '•• . ,+ ' s ir 4 41u ur not'I2c. fo'r all lnspe 11on s (9 447 9850 a f ` } 8G46 Dakota S treet •S , Prior Lake, Mi c$ nnota 55372 t ., tJ PRir, CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd TEMPORARY CERTIFICATE OF ZONING COMPLIANCE AND UTILITY CONNECTION PERMIT .5-P1-1.3- v ' aiiNNESa:: I. white File PERMIT NO. 2. Pink City 3 Yellow Applicant (Please type or print and sign at bottom) ADDRESS 1 S 11 13 1'6 , ( -1 6 1 1 3 v / G I ZONING (office use) 9 7 d'`i 1 /7°5-6 170S-3 ( 7055 Koan4-6i , /✓� LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER � - 1 e.-(en Slicri -e 5 (Phone) (Address) BUILDER (Company Name) C1'" 10 ''1 F-- ef e ,Lcam (Phone) (Contact Name) Q -1.-c," S/11/1 / l'-') (Phone) 657-2..5 l 8 C) (Address) 7-- // 1 /' ' 1 G 4 a Kee (4) - SA P-LI ( ,4' 7 . 1 0 3 TYPE OF WORK E New Construction ['Deck ❑Porch ❑Re- Roofing ❑Re- Siding ['Lower Level Finish ❑ Fireplace Addition ❑ Alteration ❑Utility Connection _ CODE: DI.R.C. ❑LB.C. CI Misc. �1 re' 5pr' -s id a.. ) Type of Construction: I II III IV V A B e d Occupancy Group: A B E F H I M pSU PROJECT COST /VALUE $ �y Z � (excluding land) Division: 1 ® 3 4 l 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 pro. Try and that all constru 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 'r trthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections. X - 2 = /q l �`�a 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 _$�� Sewer & Water Permit Fee $ Other MAW" - g� ° Gas Fireplace Permit Fee $ TOTAL DUE Bth IV! This Applicatio t Becomes Your Building Permit When Approved Paid Receipt No. a ) / ' Date By Bu Iding fticial 67 1 / qate 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 • p RIp CITY OF PRIOR LAKE Date Ree'd f-■ °re HEATING /AIR IN CONDITIONG/FIREPLACE PERMIT intr ` 141 , iRnk Fiie PERMIT NO. j 3 . Yellow Applicant /� - l� (Please type or print and sign at bottom) ADDRESS ZONING (office use) i70 kv►vv,.?-V tGovvk. eD c • LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER A n i (Name) t'O �C ._. (Phone) �' -� ` " Zak (Address) APPLICANT HEARTH & HOME TECHNOLOGIES (Name) dba FIRESIDE HEARTH & HO(1Iltone) Lic 662656 (Address) 2700 FAIRVIEW AVENUE N PCX-44-1- (Add ress) ROSEVILLE, MN 55113 (City) (Zip Code) 651.633,2561 (Contact Person) (Phone) • APPLICANT SIGNATURE Paid h DATE - 7 ` i 3 APPLICANT PLEASE COMPLETE BELOW • ['NEW CONSTRUCTION ❑ REPLACEMENT fl ALTERATIONS FURNACE MAKE AND MODEL FUEL FLUE SIZE RETURN OPENINGS INPUT OUTPUT TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE: Air Conditioner ❑Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach ❑Gravit ❑ Hot Water grlechanical ❑ Radiation into Required Side Yard Setbacks. ❑Air Conditioning ❑ Special Devices Fireplaces with Box Additions or ❑Vent. System j„ ,O ❑ Other Devices Cantilevers to the Outside of Buildings """ Require a Building Permit. FIREPLACE MAKE AND MODEL II ' (nom - ra-5 - 32__000 - ,47-L4/ 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 & Alt �tron � 9.50 Residential, Heating Only (New Construction) $64.50 Residential, AC Only U IL NG pErtfiter Estimated Cost $ Z 5 Building Permit it The Minnesota Statutes * 32613.148 HEATING PERMIT FEE $ "SURC1IARGF" has been changed for one Year effective STATE SURCHARGE $ .50 July 1, 2010, until June 30, 2011. TOTAL PERMIT FEE $ The minimum surcharge fora "fixed fee" permit (Office Use only) is E5, 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 • V R t CITY OF PRIOR LAKE Date Rec'd run's HEATING /AIR CONDITIONING/FIREPLACE PERMIT jMvESO�� 1. Mnk �,e PERMIT NO. 3 pI - 0/6 t. Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING (office use) / 7 0 52 54/ LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PIED OWNER' (Name) _ 6E4 Ir ip crri (Phone) c?" 48 r — 7 27 (Address) • APPLICANT HEARTH & HOME TECHNOLOGIES (Name) _ dba FIRESIDE HEARTH & HOME(Phone) • Lid 662656 (Address) 2700 FAIRVIEW AVENUE N (Address) ROSEVILLE, MN 55113 (City) (Zip Code) (Contact Pelson) 651.633.2561 (Phone) CO / 1 3-2-417 • APPLICANT SIGNATURE / J 0 DATE 7" 1 3 APPLICANT PLEASE COMPLETE BELOW EW 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 ❑Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach ❑ - Grty ❑ Hot Water into Required Side Yard Setbacks. Mechanical ❑ Radiation ❑Air Conditioning ❑ Special Devices Fireplaces with Box Additions or ❑Vent. System - ; ther Devices Cantilevers to the Outside of Buildings Require a Building Permit. FIREPLACE MAKE AND MODEL • 000 C. P ' — 5 r 07 ' 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 & AlteratioRAID WIT 11$49.50 t 1 11$4499..50 Residential, Heating Only (New Construction) $64.50 Residential, AC Only BUILDING PERMIT Estimated Cost $ 2 -0O„ Deb Building Permit # The Minnesota Statutes 326[3.148 HEATING PERMIT FEE $ "Sl RC:I IARGF" has been changed for one year effective STATE SURCHARGE $ .50 .Ixih• 1, 2010, mid: June 30, 2011. TOTAL PERMIT FEE $ The minimum [� surcharge for a "Pied fee" permit (Office Use Only) is ?3, beginning July 1.2010 This Application Becomes Your Building Permit When Approved Paid Receipt No. Date 13y Buiidinr Official Date • 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 1 .0 ?RIG CITY OF PRIOR LAKE Date Reed O :4'7" ' IIEATING /A CONDITIONING/FIREPLACE PERMIT 3 c, )- . 1( "Ifnrrvgse t.';'' C PERMIT NO. (� j x. r<nr cur ,l. Yellow Applicant (Please type or print and sign at bottom) ADDRESS -, , ZONING (office use) 11055 v€flf (uvue SW ? z v ,, 6 LEGAL DESCRIPTION (office use only) LOT 33BLOCK 1 ADDITION C knee/ .5`Z0e&s 2'/A IsO/11 PID>7.. ' 7 'O "G ( OWNER •T1 fa �- [ U T l7� T 1 O � (Phone) 6 /5Z - 965 - 721Z • ( Address ) 20 )(1)0 Ken bridle, C • 1OD 1418,4 ie. t Il iM Jl l L'Y"tI APPLICANT pp r 1�p p �/� ti l� 05i- 1,053- ! J (Name) reside ► ( L �`7 t� / Ho me (Phone) 2 SLI7 ! • (Address) 2100 FcDirVievu if1 vc, Kt eose t }i lie / Mk! tv 155 ( t k ` ( L_L Addrresss) (City) / (Zip Code) k (Contact Person) Lea . i �l • er/� l ev- (Phone) t 061 i - (0 � . APPLICANT SIGNATURE P\ Q J Q/1 DATE C3/ - 1 / O______ APPLICANT PLEASE COMPLETE BELOW I ❑NEW 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 ❑Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach ❑Gravity ❑ Rot Water into Required Side Yard Setbacks. ❑ Mechanical ❑ Radiation ['Air Conditioning ❑ Special Devices Fireplaces with Box Additions or ❑Vent. System ❑ Other Devices Cantilevers to the Outside of Buildings ` Require a Building Permit. FIREPLACE MAKE AND MODEL �J �flOC S.i' 0 C.X) � -x'��t s I %/ lai 14 ( 1't--- t `S l7_,CiUY`n FEE SCHEDULE Industrial, Commercial & Multi Family I% of job cost Residential, as Fireplace $49.50 $49.50 minimum Residential, Heating & A/C (New Construction) $149.50 Residential, Additions & Alterations $49.50 Residential, Floating Only (New Construction) $64.50 Residential, AC Only $49.50 Estimated Cost $ Building Permit # The Minnesota Statutes § 326B. 148 HEATING PERMIT FEB $ "SURCHARGE" has been changed rot. one year effective STATE SURCHARGE $ .50 Joiy 1, 2010, until .lane 30, 201i. TOTAL PERMIT FEE $ The n'inimam surchnrgc for n "fixed fee" permit (Office Use Only) k U, beginning July 1.21110 This Application Becomes Your Building Permit When Approved Paid Receipt No. Date By PAID y4t q�1f + �g H RuildiniOfficial Date UILD NG P=RM f 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 1�� 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 contractor's representative and witnessed by an owner's representative. All defects shall be 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 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 7 OSSTS C ACCEPTED BY APPROVING AUTHORITIES ( NAMES) City of Prior Lake PLANS ADDRESS: INSTALLA CONFORMS TO ACCEPTED PLANS M YES ❑ NO EQUIPMENT USED IS APPROVED M 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 M YES ❑ NO IF NO, EXPLAIN INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: ME YES ❑ NO 1. SYSTEM COMPONENTS INSTRUCTIONS E YES ❑ NO 2. CARE AND MAINTENANCE INSTRUCTIONS IM YES ❑ NO 3. NFPA 25 E 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/ 3001b Class Threaded Fittings ALARM DEVICE MAXIMUM TIME TO OPERATE THROUGH TEST ALARM VALVE CONNED 1 ION OR FLOW TYPE MAKE MODEL MINUTES SECONDS INDICATOR Vane Potter VFS -R 3 7 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 I= PNEUMATIC 0 ELECTRIC 0 HYDRAULIC PIPING SUPERVISED I=1 YES 0 NO DETECTING MEDIA SUPERVISED El YES El NO DELUGE & PREATION DOES VALVE OPERATE FROM THE MANUAL TRIP AND /OR REMOTE CONTROL STATIONS El YES 0 NO VALVES IS THERE AN ACCESSIBLE FACILITY IN EACH CURCUIT FOR TESTING IF NO EXPLAIN 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 Ge PSI FOR Z ^ r"' HRS. IF NO, STATE REASON DRY PIPING PNEUMATICALLY TESTED 0 YES Q NO EQUIPMENT OPERATES PROPERLY 0 YES Q 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 PRESSU RE WITH VALVE IN TEST PIPE OPEN WIDE STATIC PRESSURE: 7 ( PSI 6 44 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 El NO OTHER EXPLAIN: FLUSHED BY INSTALLATER OF UNDERGROUND 1=1 YES 0 NO SPRINKLER PIPING BLANK TESTING NUMBER USED LOCATIONS NUMBER REMOVED GASKETS WELDED PIPING 0 YES Q 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: z Z��3 NAME OF SPRINKLER CONTRACTOR: SUMMIT FRE PROTECTION SIGNATURES TEST WITNESSED BY FO" " •' = ' • R ( SIGNED) TITLE DATE: w. ,_„rr.9 r 2 c 3 SUMMIT G FOR SPRINK d CONTRACTOR ( SIGNED) TITLE DATE: t 3 .1 t Voci Builders Deposi . . City of Prior Lake A 0/500.00 BbildeM Deposit is included in the pttikilitig- Permit • fee. The 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 pettillt It 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 builders deposit will be fOrfelted and the applicant will be billed for clean up or corrective work to rectifythathuation. A$500400 Tree Deposit-MAY aisaberequired and wilt be refunded if specified trees are preserved for 8 period of Otte year. DATE: 2 7/ 2 6 , 4 3 SITE ADDRESS: . 1 7 ° 53 ,/ Es - 1 -- r up. PERMIT # /3 /66 RE To so mama Tot D.R. Horton, Inc Attn: JADA 6.1ZeeldwA LOT ' - , ,...... 20860 Kenbridge Court Suite 100 Lakeville, MN 55044 - . AUTHORIZATION TO RELEASE 14 PLEASE REMENIBER. /IVA- /V2-, SO 0-06 Lynda S. jii Services Amount / • ` • 1. I Acct. 801.20204 1. KEEP STREETS CLEAN DURINGCONSTRUCT1ON Date 2. KEEP EROSION CONTROL IN PLACE a. TEMPORARY OCCUPANCY PERMIT MUST NOT EXPIRE Oft $10,1100 WILL SE FORFEITED SIMATUR El' 2--- . . .. . ACCOUNT NO. 301-2G20.4 RETAINAQE FORFEITURE ACCOUNT NO, 32211 AMOUNT: AUTHORIZETO RELEASE: DATE: JAFORMS \BUILDERS DEPOSIT FORM.DOC PRIOR LAKE DEPARTMENT OF BUILDING AND INSPECTION INSPECTION RECORD SITE ADDRESS /7055 getvAierr et,ll?..✓ g NATURE OF WORK USE OF BUILDING s' PERMIT NO. /3 O /GS DATE ISSUED CONTRACTOR fl /G. ,too / PHONE 9705 . 72-7•. INSTALL EROSION CONRTOL AND MAINTAIN CLEAN STREETS AT ALL TIMES INSPECTOR DATE FOOTING • FOUNDATION (Prior To Backfill) RADON RETARDER PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ROUGH - INS SEWER/WATER/SEPTIC FRAMING 4 1), INSULATION UP . 0N ELECTRICAL PLUMBIN '(Q /S HEATING FIREPLACE p 7'Z i £, ' ,.") • GAS LINE AIR TEST RADON ft&FXRDZR P1Pl r ` � , � -i3 COVER NO WORK UNTIL THE ABOVE HAS BL SIGNED HOUSEWRAP L A T H/ - I =-- �t � - � ((: �4 / `INALS ' 'V :0 GRADING ( PRIOR TO SODDING) BUILDING , -;t.x) 1 \ -11, to A7 '3 ELECTRICAL PLUMBING /' S� HEATING h-� � / / 3 DO NOT OCCUPY UNTIL ABO E AS 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