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Ivtn 11 n1t11 nlin +rypl _ 111 t _, �I, �, it 1 �I :. _ IIL ._, Ctrfifirafr of ®xrupanr1r CITY OF PRIOR LAKE Prpartntruf o n i kt u tg (3nsprrfiatt :iii; �,". '- Condit C.O. Ex ires ❑ Final Permitted ❑ P This Certificate issued pursuant to the requirements of Section 110 of the ❑ Re s i dent i al / ❑ International „j Building Code certifying that at the time of issuance this structure was in compliance with the various 1 '� 0 . ordinances of the City of Prior Lake regulating building construction or use. For the following i' S I NG1 F FAMILY Bldg. Permit No. ) 2 -0979 Use Class ification PUD . Occupancy Type R3 Type Construction V iv Zoning District 1 3A, R1 , JEFFERS WATFR.FRONT ) it . - 1 Legal Description K I DE COURT ` :;.;. 14402 PARS ' =_ Owner of Building Site Address 111 " :, < Contractor's Name & Address MATTAMY HOMFS . ,') �� ROBERT D. 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A< S P 1 c,"1 J f vE_ S S 7 e t 1=-D t NJ t, t--11-.-1 SSA -13) TYPE OF WORK New Construction giDeck ['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 HE IV V A B Occupancy Group: A B E F HI M R S U PROJECT COST /VALUE $ 13U 0 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: E3i✓ .31 532, b 2 - 9 — 1' Signature Contractor's License No. Date Permit Valuation (- 9D ©00,-_ Park Support Fee # $ Permit Fee $ � , 2!v q Co SAC # $ 2 3(0 5 ,, Plan Check Fee $ 62.S. 1 ( 7 5 Water Meter Size t'8"; 1 "; $ State Surcharge $ (g...- Pressure Reducer $ t Z 6)- Penalty $ Sewer /Water Connection Fee # $ (SpQ ._ Plumbing Permit Fee $ (S 30 Water Tower Fee # $ (0O Mechanical Permit Fee $ f 5 , 5"D Builder's Deposit $ ( o� Sewer & Water Permit Fee $ . ,� Other ` �, L �, $ Gas Fireplace Permit Fee $ �¢ s� TOTAL DUE $ 44;; 9 Th ' . lic . ,n Becomes Your Building Permit n Appr ved Paid l 70 4 .-' ' `) c eipt No. (- {f �� it .A....... �� I e ZZ (z_ Date � . �. 0_-- 0_-- / B • i1. ng Official ate This is to c that • - reques . . - a.ove application and accompanying .ocumen is in accordance with the City Zoning Ordinance and may proceed as requested. This document when sign ,e C Planner constitutes temporary Certificate of Zo g comp ' ce and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued. ■. 1a': 3 zZ (z Plante . Date Special Conditions, if any `4 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 • , )1 t 46' irp4, 10 !Ilix 142 • • 41 `I, i r i'p CITY OF PRIOR LAKE Date Rec'd A.,_,::::„.., 4J ; : o BEATING /AIR CONDITIONING/FIREPLACE PERMIT H- �'�MvssoA I, Auk File PERMIT NO.' 2 AZ/ z. o em cu 3. Yelbw App lic t (Please type or print and sign at bottom) ADDRESS A ZONING (office use) fl 2 Po-)r --S t c) C÷ VQ LEGAL DESCRIPTION (office use only) LOTZR) BLOCK \ ADDITION `) e 1--- 'S PID OWNER `1',\ 3 �'11L� l (Name) ! r (Phone) (Address) APPLICANT (N ame) r� � 7 .)1 3 ,, l 13 (Phone) 7 (Address) 2 -00 l ! Ai IS Y N1 J ( ACV ��' jJ 3 3 (Address) (City) (Zip Code) (Contact Person) C Ck-4 . 0" - \ W U r e (Phone) (77 ` \ 9.55 (P APPLICANT SIGNATURE C 42 ; .1(-- DATE --/ ( 2 APPLICANT PLEASE COMPLETE BELOW VlEW CONSTRUCTION ❑ REPLACEMENT ❑ ALTERATIONS FURNACE MAKE AND MODEL ∎' p.Xt I S A' ZU • OS I FUEL NO* • C"lGLS FLUE SIZE RETURN OPENINGS l e INPUT S81 00 O OUTPUT 531 ,C.,( TYPE OF SYSTEM HEATING OR POWER. PLANT PLEASE NOTE: Air Conditioner Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach r avi ty ❑ Hot Water into Required Side Yard Setbacks. ❑ Mechanical ❑ Radiation Ir Conditioning ❑Special Devices Fireplaces with Box Additions or UYent. System ❑ Other Devices . Cantilevers to the Outside of Buildings Require a Building Permit. FIREPLACE MAKE AND MODEL FEE SCHEDULE Industrial, Commercial & Multi - Family I% of job cost Residential, Gas Fireplace S49.50 $49.50 minimum Residential, Heating & A/C (New Construction) S149.50 Residential, Additions & Alterations S49.50 Residential, Heating Only (New Construction) S6450 !� Residential, AC Only $49.50 Estimated Cost $ J R O G 00 Building Permit # The Minnesota Statutes § 32613.148 HEATING PERMIT FEE $ "SURCI !ARM" has been changed for one Year effective STATE SURCHARGE $ .50 July J. 2010, until June 30, 2011. TOTAL PERMIT FEE $ The minimum surcharge fora "lived fee" permit (Office Use Only) Is af beginning .July 1, 2010 This Application Becomes Your Building Permit When Approved Paid Receipt No. `. T%„y PAID * 11V I f � Ratldlna Official Date Date 13y ) LD1�G FIJI 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 v Rro Date Rec'd ,, CITY OF PRIOR LAKE PLUMBING PERMIT IT t; a di livrvEso t- ( tT �'` PERMIT NO I. QdA C55 3. Yellow Amlic.ni • (Please type or print and alga at bottom) ADDRESS ZONING (orrice use) M 0 2_ `:),01, V__Wfz_ CA- M\I LEGAL DESCRIPTION (office use only) r LOTEP) BLOCK i ADDITION Je.� pb',... PID (N ame ) 1K\ 3 Ok \ ?( ( (Phone) (Address) APP ' Z 1(210.-4/\ (Name) � � � { (Phone) (Address) 2 1 0 ° `1 v " \ ? n �tL i GG S (Addre s) (City) (Zip Code) (Contact Person) XTCU 11 ( ''� L LAS U (Phone) 0 -7 - --- ) 1 �7 ( P 7 ✓ (Q APPLICANT SIGNATURE _ / DATE f / �� ( 12- APPLICANT PLEASE COMPLETE BELOW Quantity Type of Fixture Quantity Type of Fixture 2- Bath Tub with or without shower ,�j Rough -ins Dishwasher Water Heater i Floor Drain ` S l Water Softener 4 Lavatory (Bathroom Sink) l Stand Pipe (Washing Machine) t Laundry Tray (1 or 2 compartment sink Sewage Ejector 1 Shower Stall Backflow Assembly t Sinks Backflow Assembly Test Bar Sink 1 Lawn Sprinkler Water Closet (Toilet) Other FEE SCHEDULE Industrial, Commercial & Multi - family I% of job cost with a $4930 minimum Residential, New One & Two - Family $149,50 q Residential, Additions & Alterations $49.50 )st $ (p 0. 00 Bu Permit # The Minnesota Statutes § 32611.14R j "� ( "SURCHARGE' has been changed for one year effective P LUMBING PERMIT FEE $O * - \� w �C T � July 1, 2010. until ,tune 30, 2011. STATE SURCHARGE $ .50 ` ` 0t1G `'' The minimum surcharge fora "fixed fee" permit TOTAL PERMIT FEE $ 'OA Is , 5. beginning July 1, 2010 This Application Becomes Your Building Permit When Approved Paid Receipt No. _ Date T 13y Balidine Official Date 24 hour notice for all inspections (952) 447 -9850, Fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 Date Rec.' d CITY OF PRIOR LAKE BUILDING PERMIT, .... , r- TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 7 AND UTILITY CONNECTION PERMIT Le. 10 dek ( 2 — i (5 2 43 5 i *Am Fir : Pai• Cm 1 PERMIT NO. / 2 A .q 2,47 ) tcoc. mway Please ry • or ' awl si,.. at bottom ADDRESS ----7--- 'ZONING (office use) % ! a .1 ...... L ...:4: - 1 4-40 - e PPR.. '-r, • ' LEGAL DESCRIPTION (office use orli,i'l LOT BLOCK ADDITION PID OWNER , i ..el. a -, (Phone) C l S 2 — , I. c, - c— I OD (Address) 724::' 1 l...t..)FASel II•A(.71 k1.)C ',, E- 1■1 il . ik-t I'S -554 39 1 awitirmil 11,AC-T-C>i: (Company Name) V 6L20 0 C,L‘J C. e :Pel - Z‘i LC-C I—LC- . (Phone) , t. 5 - Z — (Contact Name) t* K. AMC R. (Phone) (Address) Uk 0 , TYPE OF WORK L.'slew Construction ODeck LiPorch 0Re-Rooting 0Ftc-S:ding 0Lowc Lod Faust) 0 Fireplace Addition 0M:cram:in 01:111.1y Connection CODE: i4I.R.C. OI.B.C. 0 Misc Type of Construction: I II III IV 62) A a -7 , , 2 CO Occupancy Group: A B E F H I M (Its S U PROJECT COST/VALLT., S Division: 1 2 :12) 4 5 (excluding land) f beery cer mai I ban fnirni.thed informanor. on Mu acat,no ..ttxt. is to Me mit ot my knowledge nue cr.! iontot .. a-so xruN mat : arn the owner or gothic-need agent fee the ' 'boy I:. Inert t Met; ‘veperv, and th at all CertftniaXion. WI.. conform r all eusung SLIM and :ocal laws and w3:: rOcced in accordance voth ssAmtineel piifts 1 inn amine the :he budealg i Offi c.A1 can resort Mn penra for poi cause Earthierrocac, I hereby agree that the city officas: or a dentnee may enter tiern the posperry to perform needed =peen= X (764,-, ›,:±Jcvm-ti C - /45 /0 -zz -1 2. signatuic Conrractor's Lirense '',:: Dee Permit Valuation g 000 Park Support Fee g $ • , DO Permit Fee $ 1 03. CO , SAC $ Plan Check Fee S 44.qS i , Water Meter Size 5/8" : , $ State Su:charge S 2 . DO ' Pressure Reducer S Penalty S Sewer/Water Connection Fee # 5 Plumbing Permit Fee S Water Tower Fee st $ 1 1 Mechanical Permit Fee S Builder's Deposit 5 Sewer St. Water Permit Fee 5 Other $ Gas Fireplace Permit Fee ' 5 TOTAL DUE P AO 1 aUILD Win../- , T - i - A p • 1 o i ern Bcc . s Your Building Permit NVhen Approved A i .ALII. oiso),__ Paid Recept No Date NO a. , i i. - 1 By Rn4ir' I Badding , ifie / 71.13 el to :ends Mai the requou to the above applicatm and accompanying dOcIMICOIS if in accordance n, :, the ...:.. ...m.r.g , .. - >rd. mace arid [nay proceed aS requested This rsocussenz when s,F, z t -. i..7, - .:2.ri r:atotei cortninites • temeemrs Certzficate ..,s z,,, corcTI.ance 4113 allow' ete"tr ,,, .:,=, rle'-'.:e before Dor-of:Amy. a Cernficare of Occupancy mini as ssa.:el I' AarsAtt Dtici, WI' 1:.ic Spincial Corahimmii. if any 23 hour notice for all Inspectionsi952J 447•9890, Us toS2i44-1245 464 0 Dakota Street S.E. Prior Lake, Wanness 5537 Contractor's Material & Test Certificate for Aboveground Piping PROCEDURE Upon completion of work, inspection and tests shall be made by the contractor's representative and witnessed by an owner's representative. All defects shall be corrected and system left in service before contractor's personnel finally leave the job. A certificate shall be filled out and signed by both representatives. Copies shall be prepared for approving authorities, owners, and contractor. It is understood the owner's representative's signature in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to comply with approving authority's requirements or local ordinances. PROPERTY NAME: JEFFERS POND DATE / ,;� J „. PROPERTY ADDRESS: 14402 PARKSIDE COURT ACCEPTED BY APPROVING AUTHORITIES: CITY OF PRIOR LAKE ADDRESS: PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS EYES ONO EQUIPMENT USED IS APPROVED ® YES NO IF NO, EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS EYES ❑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: ® YES ONO 1 . SYSTEM COMPONENTS INSTRUCTIONS ® YES ONO 2. CARE AND MAINTENANCE INSTRUCTIONS EYES ONO 3. NFPA25 YES ONO LOCATION ENTIRE BULDING YEAR OF TEMPERATURE MAKE MODEL MANUFACTURE SIZE QTY. RATING RELIABLE RES 49 2011 1/2 11 155 SPRINKLERS RELIABLE RES 44HSW 2011 1/2 16 155 RELIABLE F3QR 2011 1/2 1 155 PIPE AND Type of Pipe BLAZEMASTER FITTINGS Type of Fitting CPVC MAXIMUM TIME TO OPERATE ALARM DEVICE THROUGH TEST CONNECTION ALARM VALVE OR FLOW INDICATOR TYPE MAKE MODEL MIN SEC FLOW INDICATOR POTTER VSR -F (wy `fi 1 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 (FLOWING) 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 MAKE MC)IIFI SI IPFJPVISION 1 C)SS Al ARM OPFRATF VAI VF RFI FASF OPFRATF E.FI FASE YES NO _ YES NO _ MIN SEC HYDROSTATIC: Hydrostatic test shall be made at not less than 200 psi (13.6 bars) tor 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 evel 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 _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? 'EYES NO DRAIN READING OF GAGE LOCATED NEAR WATER RESIDUAL PRESSURE WIT VE IN TEST CONNECTION TESTS TEST SUPPLY TEST CONNECTION /111051 CONNECTION OPEN WIDE PSI UNDERGROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING. VERIFIED BY COPY OF THE U FORM NO. 85B (OYES ONO OTHER EXPLAIN FLUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING [RYES ONO IF POWDER DRIVEN FASTENERS ARE USED IN OYES ONO IF NO, EXPLAIN CONCRETE, HAS REPRESENTATIVE SAMPLE TESTING BEEN SATISFACTORILY COMPLETED? BLANK TESTING NUMBER USED LOCATIONS NUMBER REMOVED GASKETS 0 WELDED PIPING OYES 181 NO IF VFC DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR -3? ®YES ONO WELDING DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR -3 YES ONO DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMENTED QUALITY CONTROL PROCEDURE TO INSURE THAT ALL DISC ARE RETRIEVED, THAT OPENINGS IN PIPING ARE SMOOTH, THAT SLAG AND OTHER WELDING RESIDUE ARE REMOVED, AND THAT THE INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED? OYES ONO 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 ONO NAMEPLATE _ REMARKS DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: i. 1 — / y NAME OF SPRINKLER CONTRACTOR: FIRE SUPPRESSION SERVICES. LLC. TEST WITNESSED BY FOR R / " R (SIGNED) TITLE DAIS/ ' SIGNATURES �� 2 F SPRIN 3' !•NT's 43F1 (SIGNED) TITLE DATE / _ ■ � v/ 1 z-2' 1'? ADDITIONAL EXPLANATION AND NOTES - 2-0/9 P RI© Builders Deposit U t� 41IN:vEsa. City of Prior Lake A $1,500.00 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 $1,500.00 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 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: 144 o v R+` 12- 1 E [_put —m PERMIT # REFUND TO BE MAILED TO: n ` �� o F S 120 1 If,/ ,Pc 5 t-1- t 1.l 6TO t.r Pit/ G S Su t i E: Za 1 tit rL / l--tN SS439 AUTHO' ATION TO RELEASE PLEASE REMEMBER I go 0.06 ynda S. All; , Building Services Amount 1 . KEEP STREETS CLEAN DURING CONSTRUCTION /a - (I . 13 Acct. 801.20204 Date Z 3. -TEMP e ' • e I" v ► I - - 1 - _ - • ,I . I S- a •- • SIGNATURE: C:\Documents and Settings\sbare\Local Settings \Temporary Internet Files \Content.Outlook \BD80XI9A \BUILDERS DEPOSIT FORM.DOC P RI R LAKE DEPARTMENT OF BUILDING AND INSPECTION a-� S le i `a INSPECTION RE 5 SITE ADDRESS ( 440 2- Pi - k&K.S', O C (h) l /2 . r - NATUREOFWORK S F fN C-- c,= K- re,FG- N c 1 r►\. Lt.- USE OF BUILDING I t � E- FAII4 i Li 4=r- c -i -4 PERMIT NO. IZ 12 -1 { DATE ISSUED 1 g /z2- z- CONTRACTOR tAkrt-A-41 u frfv E5 PHONE ct S -89 e - (c.:) 1Za NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW THE PERMIT IS ,By SEPARATE DC,MM„EAT INSPECTOR DATE I FOOTING 1 I 1 FOUNDATION (Prior to Backfill) 1 1 I PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED v>.1 v in ROUGH - INS SEWER / WATER / SEPTIC FRAMING c'ik(2- r uA1-1.- &IP A L.I4, t� 1 z I INSULATION c ,,,3 / ELECTRICAL ) z- HEATING PLUMBING A h (if required) FIREPLACE GAS LINE ik.[R TEST 4_,n,, pill F4 , z l, q/,2 e■-. A t R N COVO W ORK UNTIL ABOVE HAS BEEN SIGNS IN S Ja AP(. -- 1 S Pc-1N �. (_.e- 12— . ti, IA. FINALS a/ aB/ - ) GRADING (Prior to Sodding) BUILDING r. c. o. 7D 43 fli fir//3 0/' I P/Z /L3 ELECTRICAL PLUMBING l2. , I 13 HEATING f _ I' 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