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HomeMy WebLinkAboutBuilding Permit 13. 0101 Z W'" J �;�� % , �yy � � r �. $�� + v NY �SY � hn� P M rY�. eYYrr_ , '' Y , N �Vth,'`s!,• II4 Y r iY � ,M ��'�'! W YV4Y"I V �, VVUj� .hY�I YYVU `,�.Yr1.iI. II.VYII .II 4 il. Il 2' / tr4 S Yl W_. a d YMW >v�ryy Y .. x61 W111. �V II Vrll� YYI ��rYYI Fy � 7 Yll�h � � 'b I -. 1�r'( �, „!.I r ” YA _.IV Y UYV1Yi��.VY1 _. "(V�IY _. ihM.. YI Vuru� YVVii�:., VVY iYIV „ °� W 7 \ w �' IY u i __ Y Vu4 snrun .; IYYu�i _. ���� �� . OF PRIOR LAKE -.4 CITY 3 --,,g--; Prpartntrof of cpuiibiq c ilnsprrtion ❑ Conditional C Expires �� ❑ Final Permitted .. Hance with the various e rti ticate issued pursuant to the requirements nce thiststruct� e was i Residential / � Internattiona This i f that at the time of issua Code certifying Building o Prior Lake regulating building construction or use. For the fol owing'n n 1 ordinances of the City f Bld Permit No. �� 1 — , VN Wti P USD Use Classification R3 Z oning District W I t� Type Construction f --- 4: ' Occupancy lype Legal Description 1 4393 R A RKS I D E C OURT WI II Site Address s IAN Owner of Building V , , u .' Contractor's Name & Address R OBERT D. HUTCH [ NS City Planner ill Bu lding Official Date: A P viA , ,/,,,,, r D ate: C O N SPICUOUS PLACE u u aY „„ 1 4,'; ti' N, u Y POST IN �' "f rY ri t u �fl tl Jv[u�r " l�v V. ii " �,� ua n� m " m Ip ,1 tM 4,1, i �„M' ti^ r r r � � no +w �'nU �X� p an" �4 nWwv� u>�l� . �' Y ti ;7 i � . �, 1 , I Y � 8.. [ 7,; 1Jd r _ l } ,per k -- -- _ r II I Y ) a I i 4 mj 'dir a '� K ^Na -' _- r X i-- tl �ar / rr' i lk try _ _ ti ti� 0 -0 �` @ _ Ire - \��S« z 2 ! 2c$ 2 ozww� ' $ « § E . z j 1) ......'p 00000 . hi ,.. 8 rt u 0 w b / Z Si u. 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LL =t%f/) 0 U? 0 0 a 0000❑❑ 0 0 1� w u -.ZWW 0 W Z a. > 02WWm O Q o � - woU.LL(9'.. 2 Z E. = 0000 *❑ 0 co r---- V 0 c/' W x cc v N J z »a m o 0 w F _ Fe 00ti� 0 0 0 4 ' W 000< 1- a� W a _ Z ix Z —xx_Z 0 c a i (1) ' , a m a 8 z I j 0 / - 0 0 o CO ► - p _ "� a w w w i (� \� 00000 0 0 o w Ct 0 a a LL x ° z 0 0 ft `t U LLO 0 z QUO o = 0 o W 1- - A a z a a a u a . 5 CO W �z � dw Ce 04 C A 1 0 < o o Q OW C W Z OO E O O O y 0 U 0 0 LL LL LL? 17. u O s U 0 N 5z a O a 0 ❑❑00❑ 0 sck o E -T CH' K Y OF PRIOR LAE BUILDLNG PERMIT, Date Rec'd TEMPORARY CERTIFICATE OF ZONL OMPL " E w • AND UTILITY CONNECTION P ie i °ain /3 r`vN E S O 2. White File PERMIT NO. City / j ®/ 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS t LE 3 9 3 PA (t.4/- I D £ �T ZONING (office use) ti Pos.]) LEGAL DESCRIPTION (office use only) LOT L- [ BLOCK 1 ADDITION ;= 2--S kri-x - -- ^'-1-- PID ZS u 1 9,D LL O OWNER (Name) t'1 P. 'T T P. M `' 44 U NI E.S (Phone) ( Address) '1261 IN R S 1-I t r-1 —, a +,l A x. S ST` 20 t t=D t t-..l M N SS Ll 3 9 BUILDER (Company Name) MN'T i t 4+(-' r1 E5 (Phone) (Contact Name) SU Bit (Phone) (Address) 120 l . k S L-} Ira ( O') A v S ST - E- r) l l=p t u e. r-t a`.1 S S 3� TYPE OF WORK ,g New Construction gDeck ❑Porch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace ❑Addition ['Alteration ❑Utility Connection CODE: ❑I.R.C. ❑I.B.C. ❑ Misc: Type of Construction: I II 111 IV V A B Occupancy Group: A B E F H I M R S U PROJECT COST /VALUE $ 1 3 b 0 00 _ 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�....---, 1 - -...---e__ EC- . 2-C) 2- S - 1 SSS b ,11 \ , 3 Signature Contractor's License No. Date Permit Valuation C G r - , Park Support Fee # $ PermitFee $ E Z&- C-0 SAC # $ 7435 Plan Check Fee $ Z 5. 1 g Water Meter Size "; 1 "; $ 480- " State Surcharge $ 8. - Pressure Reducer $ t Penalty $ Sewer /Water Connection Fee # $ 1 ` � CO. Plumbing Permit Fee $ l S k• S Water Tower Fee # $ 1 oOfl Mechanical Permit Fee $ ( 5-4 , CC-) Builder's Deposit $ z S Ca Sewer & Water Permit Fee $ - (c. SO Other E-` 0i'��(C) $ `ti 4 SD Gas Fireplace Permit Fee $ 5 < TOTAL DUE $ `O' ( This App . atio B ,,, , es Y. Building Permit When ;roved Paid / I . i b Rec No. (/ e /3 t I D ,.., ate . c ,2_ 7, /3 By �/ S Buildin Offic`i Dat This is to c ' that the request in the above application and accompanying docum nts is in accordance with the City Zoning Ordinance and may proceed as requested. This document when sign y - C' 'tanner onstitutes a temporary Certificate of Zo • g co .liance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued. / I Arid 4 AVIdraliallagii, S (3 Planning Director 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 o i A�D�� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �' 7 AND UTILITY CONNECTION PERMIT , I 4 .,1116,17) r (/& W / J /3 t ( 0 1. White File PERMIT N O. /3 . 4 2. Pink City � j ( J 3. Yellow Applicant (Please type or print and sign at bottom) ZONING (office use) ADDRESS 1 9 3 P P- - -S t D r- c- N '-.( LEGAL DESCRIPTION (office use only) LOT q'' BLOCK 1 ADDITION E.------Q -s 1/\//›.----1:2--42-0 ■J PID ( . 41 • 6 4 3 . OWNER `mil A T P M T . ' E_ r -I-1 0 1%--1 S (Phone) c' C 2 - ° c} 9 $ - 10 l (Name) (Address) 12..c. I WAS 14 I rJ 61 i 0.v E S Ste 2 p t t=O I 1--...1 4\ M N SS 3 9 BUILDER (Company Name) "N--1-1-1\-1-1i v ES (Phone) (Contact Name) S v E ./21'..c..-.* (Phone) (Address) 1'2 t Imo... k S 1-1 it...a c,��.1 N vE S 5Th_ 2_a t > -o I Ni .a — t-t t.....1 SS�13` TYPE OF WORK jS New Construction L.Deck ['Porch ❑Re- Roofing ❑Re -Si ' g %Lower Level Fini ■ ❑ Fireplace ❑Addition DAlteration ❑Utility Connection --- CODE: ❑I.R.C. ❑I.B.C. ❑ Misc: Type of Construction: I II III IV V A B IS 0 00 - OC/ Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $ i 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. r C.A.--.--e____, BL ?-•-•C;' 1 S s 19-_..L 1 1 3 X Signature Contractor's License No. Date Permit Valuation 2. d 00 , CJ 0 Park Support Fee # $ Permit Fee $ CO2. Z r SAC # $ Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $ State Surcharge $ Pressure Reducer $ Penalty $ Sewer /Water Connection Fee # $ Plumbing Permit Fee $ 5 9' 5a Water Tower Fee # $ Mechanical Permit Fee $ Builder's Deposit $ Sewer & Water Permit Fee $ Other $ Gas Fireplace Permit Fee $ U� ' 2 TOTAL DUE 5 $ // '�f I � This Application Becomes Your Building Permit When Approved Paid g / / / 7 Recei p t No f) y 5 � J � Date b7,24? BY ( ., ..��- Building Official Date This is to when signed certify the City Planner constitutes a temp Certificate of Zoningcmplian e and allows construction City o commence. Before occupancy, proceed requested. Certificate Occupancy must be issued. Planning Director 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 • C.) --- • •• • ,.• • 7 . 1`12 10 e 4 CITY OF PRIOR LAKE BUILDING a UILDING PERMIT, MAY A V 3 1 1 I 4: c. TENIPC)RAR1' CERTIFICATE OF ZONING COMPLIANCE 1 mm 1 [.., AND UTILITY CONNECTION PERMIT .. , 4,1111111.14,7 By I wbac Fa" PERMIT NO. /3 101-1 2 Poi City Appbann . (Pleasttrpe or print artilitsa at bottom), ! ADDRESS ---- ; ZONING lake UM 1ARI4Sit (I" N LA) 1 LEGAL DESCRIPTION tuftice use LOT BLOCK ADDITION PID _ (Phone) 96: - 2-71 7- 21 oc (Name) 1 _ Pi I I A tst4 14 0 s--t CS , _ (Address) 2.0 I ) ji I ,51 tiro N Ave kic . Coo,A, mki 554-5i 111::=ZWA C,01441 Company Name) Pi gg: Lig?i.76.=.(c..trsl..1 e _...,;;IABS. ...k.i...4__L-1„,C.. (Phone) 7(o3 - 27 "7 - e corD (Contact Name) Pi tki V CZ (Phone) (Address) II I I C) 114DVS11Z.i U\ L.- C...“21..L.C IVW fu re 14 '& Rive Z i Mts.i ' TYPE OF 1KORK ,New Constructsori 01).z °Patch ORe.Rooftng 0Re-SutI2 Lowe: Level Fuush 0 Fuep:ace , all Addition 0Alteratton 0Ladity Cunrptction ! CODE: N,1.R.C, DI.B.C. 0 mist- Ty-pe of Construction: 1 II III IV V A B Occupancy Group: A B E F H I M(pS U PROJECT COST/VALUE $ Division: 1 2 (3) 4 (excluding land) 1 heel army mat 1 luve tionahed infOrmarion on Mrs application which a to Ow best of my knowledge rrue and dorm: 1 a.a o certify lut i am the owner or euthorszea agent tc.• ini abioste..mentw:ed propery and the all construction will conform to all mann state and local law) and soli proceed m aca.irdance wuh submitted plans : Am aware that the bitvddini.: officul c voice A IS perms or st cause Furthermore, 1 hereby we that the oty °Irma ot a designee may enter upon the property to perform needed inspections X 4 04/1 e, - /45 5 —i3- / — Si C " C..1 'TT S License No Da ■C ---.. ... ....... ..-- ___ _ , .-....... — Perrillt Vallialien Park SuiTt - Fee tt ■ 3 _ __. Fe _ rny Fee I 5 -: SAC At 1 $ I Plan Che,:i. Fee t $ Water Mete: Sue 5. S " I '' 5 I - _ State Surcharge 5 Pressure Reduces $ • Penalty $ Sewer/Water Conni:c Fee n. , 5 _ Plumbing Permit Fee $ . Water Tower Fee n S "Mechanical Permit Fec 1 $ Buiider"s Deposit S Sewer & Water Permit Fee 5 - Other i 1 $ 1 i i Gas Fireplace Permit Fee 5 I TOTAL DLT 3 r A lic ion i.omes lout Building Permit her. Approved 1 * i p S/2//7 Pald _ Date PA ---- BUILDNG - PERMIT ng Official 1 This is to certify that the request al the above app:scaticn ant +cc mrPat }mg dirsournenu ii. in accordance with the Cr)) Zoning Orr-mance and may proceed as twat Tta document iun by Me City Planner constuures a temporary Cernfrate of Zoning compliance and alinws maw II, Curnmencr tiefore occupancy. a Cernficase of Occupant, mug he i 1 punning 2Lrectot - -- - t Flee — .pc,.,t1 ■ , ...ndA ons :I AM , — 24 hour notice for Ai inspections (952) 4 4 - - 9 850. fa: ( 4O Dakota Street S.F._ Prior fake. Minnesota 5532 0':‘,$4-0 pR10 CITY OF PRIOR LAKE Date Rec'd • 4. -k :A { H /AI t CONDITIONING/FXREPLACE PERMIT - 1 Pink F I PERMIT NO. t3:iO (Please type or print and signal bottom) 1. Yellow APDlKid1 ADDRESS ZONING (office use) ■ /Li 39 3 Prx ,e. Cam-- cu ) LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID (Name) L l t.o t onsbtx i<11 C A (Phone) (Address) (Name). (,r t t � R V�Y 1 Pl � )iu /'e(.�111 ( Phone) 6 / 1 Sc) - -? n � 1 KS G (Address) (sacs ()) - Ka i3 L.1r I 10c_ X3 (Address) (City)) (Zip Code) . (Contact Person) (1/V( il I (If f 1-2)u u �)/��( ty � ( Phone ) "1 SD- ` �} (0-) - /8) APPLICANT SIGNATURE ji 1 - ■ ` f , s 16- DATE q/a 7l r 3 APPLICANT PLEASE COMPLETE BELOW 541:ir_row._ b UC1'1ON El REPLACEMENT ❑ ALTERATIONS n FURNACE MAKE AND MODEL f n'{ 1 1 ( l1�S AC)(00 31 FUEL lW (c FLUE SIZE RETURN 6'ENINGS INPUT 5S 1 WO OUTPUT 'S )3 ) /� TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE: Air Conditioner L, Air Plants n Steam Units and Fireplaces Cannot Encroach • , -vtty - .jIot Water into Required Side Yard Setbacks. ,.r" il ❑Radiation Fireplaces with Boa Additions or E. it Conditioning ❑ Special Devices ❑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 $49.50 Residential, Heating Only (New Construction) $6 Residential, AC Only $49.50 Estimated Cost $ q { U V --- Building Permit # The Minnesota Statute., § 3261).148 "SI ;RCI1AR(il has been changed for one HEATING PERMIT FEE $ year el'icetke STATE SURCHARGE $ .50 .111 In 1, 20111, unl .tune 30, 2011. TOTAL PERMIT FEE $ The minitnnln North lege for a "fired fee" permit (Office Use Only) - Is 5 beginning .hih 1.2010 This Application Becomes Your Building Permit When Approved Paid Rectyan w' Date B iLD' 9 T __ saline Orrci>ti Dale ■ 24 hour notice for all inspections (952)447-9850, fax (952) 447 - 4245 4646 Dakota Street S.L. Prior Lake. Minnesota 55372 (:),,,.::'"-----.,,,-4) Date Rec'd L e CITY OF PRIOR LAKE PLUMBING PERNIIT 6 gi g ,NESO,,p p t. Pole file 2. Oold Cdy I PERMIT NO. 3 Ydlowv Applicnu ►_ (Please type or print and sign at bottom) ADDRESS ZONING (office use) 1 3 3bdc_a - , c luou LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID (Name) OWNER !U e op CC f l x9 b at (Phone) (Address) n � APPLICANT C _) - kV ( C p Uivo,9. . �y! (Phone) `1 S)- - 7 2 1 /(y.� (Address) d (x) (-k) • ft W f &)/(2 J'"` (Address) (City) (Zip Code) (Contact Person) r' I<-Y( f U5)6 /� (Phone) `/ S -765) - (f5 j ._. APPLICANT SIGNATURE //1 —/ '"C / / L i � DATE Y �� %f / APPLICANT PLEASE COMPLETE BELOW Quantity Type of Fixture Quantity Type of Fixture a Bath Tub with or without shower Rough -ins 1 T Dishwasher 1 Water Heater Floor Drain �1 Water Softener 3 Lavatory (Bathroom Sink) 1 Stand Pipe (Washing Machine) 1 „L Laundry Tray (1 or 2 compartment sink Sewage Ejector ? Shower Stall Backflow 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 549.50 minimum Residential, New One & Two - Family $149.50 Residential, Additions & Alterations 549.50 ist $ Building Permit # June `�,�„�.0 year Thc Minnesota Statutes § 32611,148 VY f�► "SURCIIAR( lye a effective P LUMBING PERMIT been changed for one ERMIT FEE $ PAD PERMIT June 1, 2010, until 30, 2011. STATE SURCHARGE S The minimum surcharge fora "fixed fee" pernut TOTAL PERMIT FEE $ is 55, beginning Jule I, 2010 .50 This Application Becomes Your Building Permit When Approved Paid BU „ Receipt — vRR No. MG' PE Date By Buildina Offkial Date 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.F.., Prior Lake, Minnesota 55372 Contractor's Material & Test Certificate for Aboveground Piping PROCEDU RE 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 7/2 9/13 PROPERTY ADDRESS: 14391 PARKSIDE COURT ACCEPTED BY APPROVING AUTHORITIES: CITY OF WOODBURY ADDRESS: PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS [OYES ONO EQUIPMENT USED IS APPROVED OYES ONO IF NO, EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS OYES NO 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 OYES 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 2013 1/2 12 155 SPRINKLERS RELIABLE RES 44HSW 2013 1/2 15 155 RELIABLE F3QR 2013 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 9-9 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/0 Q.O.D. WITH 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 l ?' 6 16/ OPERATION: ❑PNEUMATIC ❑ELECTRIC ❑HYDRAULIC PIPING SUPERVISED OYES ONO DETACHING MEDIA SUPERVISED OYES ONO DOES VALVE OPERATE FFOM 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 MODFJ St IPF$IISION 1 OSS Al ARM OPFRATF VAI VF RFI FASF OPFRATF RFJ 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) fcr two hours. Differential dry -pipe valve clappers shall be left open during test to prevent damage. All Aboveground piping leakage shall be stopped. TEST DESCRIPTION PNEUMATIC: Establish 40 psi (2.7 bars) air pressure and measure drop, which shall not exceed 1 -1/2 psi (0.1 bars) in 24 hours. Test pressure tanks at normal water level and air pressure and measure air pressure drop, which shall not exceed 1-1/2 psi (0.1 bars) in 24 hours. ALL PIPING HYDROSTATICALLY TESTED AT 200 PSI FOR 2 HRS IF NO. STATE REASON DRY PIPING PNEUMATICALLY TESTED OYES ® NO EQUIPMENT OPERATES PROPERLY DYES 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 STCPPING LEAKS? ® YES NO DRAIN READING OF GAGIE LOCATED/ EAR WATER RESIDUAL PRESSURE WITH,VALVE IN TEST CONNECTION TESTS TEST SUPPLY TEST CONNECTION le" PSI CONNECTION OPEN WIDE ) PSI UNDERGROUND MAINS ANC) LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING. VERIFIED BY COPY OF THE U FORM NO. 85B DYES ONO OTHER EXPLAIN FLUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING ®YES ONO IF POWDER DRIVEN FASTENERS ARE USED IN DYES ONO IF NO, EXPLAIN CONCRETE, HAS REPRESENTATIVE SAMPLE TESTING BEEN SATISFACTORILY COMPLETED? BLANK TESTING NUMBER USED LOCATIONS NUMBER REMOVED GASKETS 0 WELDED PIPING DYES NO IF YFS DO YOU CERTIFY AS THE SF'RINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR -3? DYES ONO WELDING DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN COMPLIANCE WITH THE RECIUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR -3 DYES 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? EYES I::1 NO CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL CUTOUTS (DISCS) ARE RETF IEVED? YES ONO HYDRAULIC NAMEPLATE PROVIDED IF NO, EXPLAIN DATA EIYES ONO NAMEPLATE REMARKS DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: -7 1 ZCj 0 OF SPRINKLER CONTRACTOR: FIRE SUPPRESSION SERVICES, LLC. TEST WITNESSED BY OR P P O -HIED) TI DA SIGNATURES j y "I q �� Fe: •:IN -' da y r'CT )/;1 (SIGNED) TITLE DATE - ; /0.17 712_9/,3 ADDITIONAL EXPLANATION AND NOTESd/9 (---- 0i rRro Builders Deposit ,-ii,v se , City of Prior Lake A $2,500.00 Builders Deposit is included in the Building 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 permit 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 $2,500.00 builders deposit will be forfeited and the applicant will be billed for clean up or corrective work to rectify the situation. A $500.00 Tree Deposit may also be required and will be refunded if specified trees are preserved for a period of one year. By signing this I, the undersigned contractor, acknowledge that I am aware of the erosion control requirements of the City of Prior Lake as outlined in the Erosion Control Measures for Building Contractors handout. DATE: SITE ADDRESS: 743 93 Piq GS1 ° E °-- PERMIT # / 3 . "'I REFUND TO BE MAILED TO: fl/-1 `"L / 0r '(%s 72_01 o/A-14-/AIG, Trl Ffif: (-� NA- AUTHORI ATION TO RELEASE PLEASE REMEMBER J tL Lynda S. Men, Building Services Amount 1. KEEP STREETS CLEAN DURING CONSTRUCTION /0 ,1i. / 7 Acct. 801.20204 Date 2. KFFP FROSIQN_CO_NTROI IN PI AGE 3. TEMRORAR OCCU PANe'1f-PERMIT MU$T EXPIRE _® INitL BE FORFEITED _ - -- SIGNATURE: J: \FORMS \BUILDERS DEPOSIT FORM.DOC P R I R LAKE BUILDING AND INSPECTION INSPECTI N RECORD 0 SITE ADDRESS l9 3A 3 c?(5-- NATURE OF WORK `ESA E l .cAA � j. L . USE OF BUILDING F-prti c,. PERMIT NO. k A DATE ISSUEb CONTRACTOR TIPer"TA S PHONE 1`; Z S1S- I ZS NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW THE PERMIT IS BY SEPARATE DOCUMENT I NS 2-as t &A-5 � _pt.. Y'� N Y SPECTORR N DATE I FOOTING I 1 FOUNDATION (Prior to Backfill) PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED >7 RROUGH - INS SEWER / WATER / SEPTIC FRAMING �� } INSULATION ELECTRICAL PLUMBING 14, 60- 5 4/ f vp — HEATING (if required) ra 4 FIREPLACE io ia- - GAS LINE AIR TEST • 2° c COVER E NO WORK UNTIL ABi'SV S BEEN SIGNED I <6 _uport 1 c� fle5CS C ©N FINALS 03 7 2a63 GRADING (Prior to Sodding) BUI- LDINGT, J 1i -4- fr 7fsof, 4t,.i Wile _ ELECTRICAL PLUMBING jQ Z( r ,3 HEATING �/J _ ,3 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