HomeMy WebLinkAboutBuilding Permit 12. 0930 ��i -s �Jrl li( --,-- n�nv�'r'rrrrr, � +'r��rrir I'ar tNol �, rr 4. �. rrAI r -- a 'z \/ -�� iu - -
.__,1 llfll:; >,..1111HV 1111111 �'1 1� rr r;>�r,rrr.. a,rrr¢Fy,lrr �,.u0rr errrr..I�.,rrr IR r,I \.'rrr.I�rrrr. tr0l. ro •:••:•• .�
..,..�_J111 .. Y 1111,,,�111111('/,Ir111 fi'..r{ �11ri 1r1 �. Ir.1♦•Ir.rl�.r"'r �rrrrr •r.. ..o..
_._._ 1111 11 (, 11111 � t Io...al11,V. 11114„ ,, ;.v rrf ➢,11rr .Wrrr •.rr•I� �..., .•,•.',Y, %.:p••vt.� .....
,... ___� �� 1 f 11111 11 �. � i it p11t11/,�Y1 , • . ,� ,, rr ,rrrro- rr .rr.r I� .�..r.I� y. rrr. , vrt :,• :v5 - ,.,: ....._ . -..:,, _
1,, „1 f If flll/f 11111 1 AtiI V. `11r111V 1111114.11 rl,f �.. »rv�'r »rr. +r.nr:. n. r Is :;
=_ 11111 lu���w�w�rlurx 'YUlu11Y'i'7uo��111uIPfu�1 � l Q���y �llfL�, a��u .111(/���.���1f11N/��'��'f1,l foa�ll/ 6,c�� rtl'�.�1rIr111r,,., 11fIf1,,., 111111f�1r1,11,1 1rOrr � ^•rir- �r,.r,f..i "rr rr� •• •• •• � ... ''''i ° ?tti i•�:•: ,;«,.
' IIIIfIV#�IStiill'll `1YaT1Y 'YItitiI'IIINIIIt' IInI11fI11r�Y1f11f111111tIW 'kYlliilljf lll��lll �) 1 f11, } Ir l l l r l f l lr rrllllr 1r/iNr�.iil'ViWr iii/6iri 11(1,1 Iii ii' 1„ n I,ir•nrI •rrr I`. , .r.rr4:::ii
'� ll p. 111 } ,�� (1111} 111111 � r rr.
t f - a u I: �w�uld "€Iwwuiwl�Gwl�tL�fuiii�u�luur lull# �r1�ti�ildi4Y�lif111�iliVfi4liiiitifi�iiiilili� ?iiiililitililil ���i�fiifi�lii�illiliiiL ��Illtil�iil.(�il�lr�rir• .�.;,?+e
■*fi
CITY OF PRIOR LAKE - =• >
prpartntruf of Puithirt 4 ....,
~ :L)
❑ Final Permitted Li Conditional C.O. Expires
(f i r _:; :l
This Certificate issued pursuant to the requirements of Section 110 of the ❑ Residential / ❑ International
Building Code certifying that at the time of issuance this structure was in compliance with the various'
ordinances of the City of Prior Lake regulating building construction or use For the following: ;,
" Use Classification SINGLE FAMILY
1��,, Bldg. Permit No. 1 z— Q 9 3 0 f ."
Occupancy Type R 3 Type Construction VN
Zoning District PUD
Legal Description L39, B1, JEFFERS WATERFRONT
Owner of Building Site Address 14404 PARK S I D E COURT I ' `�
MATTAMY HOMES
Contractor's Name & Address
ROBERT D HUTCHINS
B Official 1 City Planner
Date: /D. / / ! , .;l
Date:
POST IN CONSPICUOUS PLACE :
1111 1
.�fyllrl I,�f l i l i t 1 1 1 1 1 1 1 1 1f111�11111 . If llll t l1111 A r 1 1 1 1 / 1 1 11 1 1 ' 1i 1 1 i� n 1 1 1 , NIII 1 ° NIIR ,, 111111 111111 .r 111111
081::V,* „4 vp:,• . •, � � � , ��i 0� y pp y ��' :iii,c�� 111 � -:pII ar ..1 11111111111 WO tIN111 r1111M i r ll �ll �.. {{MO �' 411.1{ 411.1{ i• IH,11'3 l0110i # 1 1 � R1fl Iii, .. III _ --
� _--< is : .' 4•.. rr.. I , r l � I .r lr 4 l� I 111. +a +Nllr a 1/!1111 "1 1,111 ,, ll ll 111 T. llrl l” r
.. , +. . �.. � . � . ,i..�r IUI, ,r1,1 u1,111 rHr11Y ,r II IH�IHII� � � � '
r � , IrHr- 1r f 1111 l s . l �
H �'-:
- r � , ur, , r 1, -
- - • 1 r 111 11
r it 1�,
_.n ti- - ll 1 ( 1
- - , 1 . 1.111 1 , 1 1
' ,1 1 Ir1
t ... .; v � �'. 1111 r 1 - • :
1 rr 11 '* ,
rH111 1 N 11f
- .' r1. 1.1„ 1 „ 1
\�- 11 rr
' - IrHr 1 r
- 1 r,
rIs 11
- ..� , 1 . 111 r
-- ;1. 11 „r�
- - tls
� �� .....:,...::.•.........;.::'.;.•....c x:+•••.::. �• yrrrc•;! g'' X<.. �: a,;.',•••:•. rr;, r.}: ay;' ?. e,? . {:�:r...;..,ypr,•.,•,¢;;•e..rs
IL Z = ►
- 4
LL Z W W �yj
U U = r.
w t 0 M IL% Esj
p W U ti tL U Q ' z z
❑ ❑ ❑ ❑ ❑�yq \: W Er
. N
` � , ■ 1 i - 0
i NI
U x
J ' 0 rt
N
w z » a \ w
L �C
Z m E 0 N
w N \ t- x 0 000<
I 1 0 (� U g
— x x z z
F- W
N 0 0 a. w mxxxmu' 1 � W N O i
xW
• n �3Na� _I W W W x
Q 000000 U U z W
a a O :.'
1
li
w cr z
ww z i p Q ::,` LL � o U 1 O ° LY Z I" Q } ti 0z O O w H N U OI
a Q ar- N z z 0 -..1_,_ ~ z W • a F-
LL N I.-Z2 ` W 0 J W
o ce w z OOwNZi re ce CC o Q p
N 0 LL LL lY ? lL N O o U
0 p 0 V
tn
U Z < 0 d 000000 0 ❑ ❑ C
c J I
iii 2 Z _ Z 1-
LL Z U Ili a w w
° — w U
p cr' WUIL Z Q
W z
_ � 1 00000 0 > co
LU
CC S
° J 0 N
w J Z Ci Z m
al L_ Z
W • H ~ S o LLJ �� Z p 0
--- O U U 4
U � z �' Z — SSZ? H ai w o� ti 1
ti 1 0 a 2=w
0 z o y
= U F- U h Z 1
..1 11.1 w w w X k.
�. 00000 0 o 0 M z ui
w
S
'-1 a o LL I -
}
ww z a O
re
W
Q Y U J Z O= U LL cwy
"� J 0 U O Y c in AC
tz Z z z U to < �" . m j
-Z o c� °— N z N U �- w
►- N Z ZpZ Z w N `�
LL CO ►► =zfgJ w �. -� W
LU LU o
ict ce w z O O2N Z i- 2 % 0 0 0 J A
Q 0 LLLLLLitLm O 3 0 0 p, U
6 ? a 0 a 0 000❑❑ U ❑ ❑ co
w Z _ Z y
LL Z 0 U a i W W
T‘ W q U
^ 0 . j-3 a N
N O0 rere y .. o
o N — w o iZ ( CA Z
1 ❑❑❑❑❑X y
0
W O
re _
00
0
0 o_ s -1 LLO N O
W
-I z » 2
w z
Y Y ._ CO c O
W
0 O 000.
a
C7 (9 O U 0 g
a' z -22zz 0 d W t y ..1 0 w m i w g m x a ? Z L
a 2 3 vo a2 W W? s X a
0
00000 0 0 0 z w ct % a a LL =
H
W �1 re Z J Ce
Q Y0 • Z Z U U.
5 P O NJ 0 o
z • ° Y o
Z O z U !/ U � 0 W y
2 0 O 1- - a Z a � n p a
LL~ CO Z H 2 5 J-� W j y J fx
a 0 W z OO 2 ���JJJ111 0 • 0 0 ° a 0
V (95 0 0 LLLLLLZILy O
0 0 0 y U V
Q 0 a 0000❑❑ 0
v v a
aZ
❑ ❑
o i rxr0� CITY OF PRIOR LAKE BUILDING PERMIT, = - ' ' 'd
TEMPORARY CERTIFICATE OF ZONING COMPLI.�NC : � 1 ( 1 V E (`
c., g AND UTILITY CONNECTION PERMIT
f 'c'' AUG 10:2012
kNES° m �®
See ii Lam Fie 1. White File PERMI �iO �. ��
2. rink city
3. Yellow Applicant - - w ai
wr r a _ I
-
(Please type or print and sign at bottom)
ADDRESS 14 t-}/04{ pA -L`DI lO a- G ov ( ZONING (office use)
i
LEGAL DESCRIPTION (office use only)
LOT 9 BLOCK l ADDITION c>c e-Fe.F....s 11\1 irs."re _FRotJ i PID 25`x 80 3.50
OWNER
(Name) 1.' A T i R M'e - 14 U t` E.S (Phone)
(Address) - 12X1.1 L'■./ A S1-1- 11-1 t, i ca i-1 A v E S ST 2_,c) 1 t=O I t l 4\ M N SS 43 9
BUILDER
(Company Name) Mk I °+U I ES (Phone)
(Contact Name) S U 1= SCR (Phone)
(Address) 120 1 Ii..1E S14 lt--..i (,, P vE 5 5 z._a t 1 - O 1 Ni tN. F t--.L SSLI 35
TYPE OF WORK New New Construction (.Deck ❑Porch ❑Re- Roofmg ❑Re- Siding ['Lower Level Finish ❑ Fireplace
Addition DAlteration ❑Utility Connection
CODE: E.R.C. ►}I I.B.C. ❑ ❑ Misc:
Type of Construction: I II III IV V A B `,2-3 , 0 CC/
Occupancy Group: A B E F K I M R S U PROJECT COST /VALUE $
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.
Xcn G ----e__ El C.-- - 7--c: , 31 53ab - 9 - l2
Signature Contractor's License No. Date
Permit Valuation 0 0 oO' — Park Support Fee # $
Permit Fee $ (2 - 21_ 50 SAC # $ 7 -- Ca S
Plan Check Fee $ 111 Ob Water Meter Size 03"; 1 "; $ 4B6.
State Surcharge $ c04.50 Pressure Reducer $
Penalty $ Sewer /Water Connection Fee # $ (500, ,
Plumbing Permit Fee $ I S ,S Water Tower Fee # $ ( OW..
Mechanical Permit Fee $ ( 4-- j0 Builder's Deposit $ t S -
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ .) et` TOTAL DUE
$ 7.38
This A - cati� B ecomes Your Building Permit Wh Appr ved Paid /4 S R No. ��r
Date (� /� B, .
„., 2rz
ui 'in.:: _ ate
>.l
This is to c 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 sign .y City Planner constitutes a temporary Certificate of Zo . g comp ce and allows construction to commence. Before occupancy, a Certificate of Occupancy must be
issued. 4 y'
I 5 z iz_
P as "r Date Special Conditions, if any
24 hour notice for all inspections (952) 447 -9850, fax (932) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
jo —
• spA, Ib
E . 44+
!
F rRto CITY OF PRIOR LAKE Date Rec'd
° , 4' AEATING /AIR CONDITIONING /FIREPLACE PERMIT
FY ,,.
v'>
6,
`�! a I.1'wh Fik
3 Y A p p liicmt PERMIT NO. 2 •
(Please type or print and sign at bottom)
AD SS ;CONING (oHicx „se)
LEGAL DESCRIPTION (otTice use only)
1.0'I I BLOCK I ADDITION J 5 715---y PID
OWNER h n
(Name) l y I,C 1 rmag.„ (Phone)
(Address)
APPLICANT--
(Name) -P-4'1-- \ (Phone)
(Address)22-00 y I S `t ' ` 3 U l�S� i t k. GG 33 s. i (Addrc�) (} (City) (Zip C Code)
(Contact Person)
7—). � T( (YlcS u re (Phone) 06 7 Co - 1 `� 125
APPLICANT SIGNATURE C-
. 29 DATE e
APPLICANT PLEASE COMPLETE BELOW
EW CONSTRUCTION ❑ REPLACEMENT ❑ ALTERATIONS
FURNACE MAKE AND MODEL f ' I Cj ) '2 SA42_O O S \—] FUEL 4 V 1 �`} • GO-S
FLUE SIZE RETURN ( OPENINGS e INPUT 5 $ i 00 OUTPUT 5 313 (Q 0
TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE: Air Conditioner
Warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach
❑Gravity ❑ Hot Water into Required Side Yard Setbacks.
cchanical
El Radiation
it 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
FEE SCHEDULE
Industrial, Commercial & Multi- Family l% of job cost Residential, Gas Fireplace $49.50
$49.50 minimum
Residential, Heating & A/C (New Construction) $ [49.50 Residential, Additions & Alterations $49.50
Residential, Heating Only (New Construction) $64.50 / Residential, AC Only $49.50
Estimated Cost $ 5, 30(O , CO Building Permit #
'Ilse Minnesota Statutes *32613.1.18
HEATING PERMIT FEE $ "St RCIIARGE" has been changed thr one
year effective
STATE SURCHARGE $ .50 Jai) I, 2010, until June 30, 2011.
TOTAL PERMIT FEE $ The minimum surcharge fora "fired fee" permit
(Office Use Only) lc Nia, beginning duly 1.2010
This Application Becomes Your Building Permit When Approved Paid Receipt No.
V
Buntline Official Date Date B140 p - � IkI tF
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 v 141 0
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
Date Rec'd
rAro� CITY OF PRIOR LAKE PLUMBING PERMIT
4 'fn'rr :so'v
is T:, Z PERM
ERMIT NO. 611!
9. Yam ApplinmI
Mean type or print and sign at bottom)
ADD ZONING (office use)
1� ' i R. CA N \
LEGAL DESCRIPTION (office use only)
LOB9 BLOCK 1 I ADDI'T'ION S f C PID
OWNER r
(Name) t (Phone)
(Address)
APPLICANT
(Name G `-'�� (Phone)
(Address) V �1 S`l. v AS V t 1 3 �J
(Address) (City) (Zip Code)
(Contact Person) C \ A - ' t /l O V r (Phone) (q2—) 70 7- 1856
APPLICANT SIGNATURE (, DATE 4 2 --
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
2.. Bath Tub with or without shower 3 Rough -ins
Dishwasher Water Heater
1 Floor Drain 1 Water Softener
4 Lavatory (13athroom Sink) ( Stand Pipe (Washing Machine) •
Laundry Tray (1 or 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
I Sinks Backflow Assembly Test
Bar Sink --1 ~ Lawn Sprinkler
A Water Closet (Toilet) Other —
FEE SCHEDULE
Industrial, Commercial & Multi -family I% of job cost with a $49.50 minimum Residential, New One & Two - Family $149.50
/ �] �j /�7� Residential, Additions & Alterations $49.50
The Minnesota Statutes § 32613.145 — *1st $ CO / 54 V
, u Buildin Permit #
"SURCHARGE" has been changed for one rilA
year effective PLUMBING PERMIT FEE $ '0 Vr r jr
July 1, 2010, until ,tune 30, 2011. STATE SURCHARGE $ .50 0^ S:)".
The minimum surcharge for "fixed fee" permit TOTAL PERMIT FEE $ �`�� !`i
Is, beginning July 1, 2010
This Application Becomes Your Building Permit When Approved Paid Receipt No.
Date By
Building( Official Date
24 hour notice for ail inspections (952) 447 -9550, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
% t
At.
pl ... ,.....
- 1,,,,,,, -
-- ,..., % ae“) 4
CITY OF PRIOR LAKE BL1LDIN. G PEELNIIT, Date Recd
.f.... .;,,,, TEMPORARY CERTIFICATE OF ZONING COMPLLOCE
AND UTILITY CONNECTION PERMIT
471111mme",:' f•(-e tt) ,..1,1.1..
'NNEs- kokkg Ir k
0
■ gIlv. k4,04k,
(Please . ot . ,t And i .n at bottom)
ADDRESS '---Z---------77----ONLNG __ ...
I
! li PtSPC-r 1 " i
LEGAL DESCRIPTION c,offiee use ordy)
I 1
LOT BLOCK ADDITION PID
OWNER ---------1
( f-ii A-rr kik" 1()Is-k (phone)
---------
iiiin;PfiR 4..-a■-ritzAc.-roi.:.
(Company Name) t - - 1 ' t- ' - (Phone)
(Contact Narne) vs • -N. A l'A .C. -7 _ (PhOne) -----------------.■—
t . lAds 5) It l tO 1---.4);.■ A C. s7\ l.:„ ac._ 1■IL.L..) _, .1 1-‘ _ -.).- k0C-2. .. r:5 — 2 ,c)
111 OF WORK 1 New Constructton ODsck. :::Forea CRe-Roofing 0Re.S1d:rg 0Lcivie: Leve Flrath 0 Fm-pli.c
Addition 0/1/41:crtuor. 0,..114:!# Connectlun
CODE: CI.R.C. 01.B.C. 0 Misc
Type of Consuucrion: i rt m ry 6': A 0
Occupang Group: A B E F H I M a> S U PROJECT COST/VALUE $ --—'• )`_-----=----.
DivIston: 1 2 4 5 (excluding land)
------_
1 hcrete crre d•41 I Save f.4.-rashe4 tatorntauon an tha appl=:ton vrozos a tv tnc vo; .A tra ti:nowiceige , tr:e S1Z4 7C1v.m;ila-S:n;c7rw.--h.,...;:btrn: :1;11;1:7 ,un Or asU:Orartian. the lljer ehe owidrait 1(1 IIC
1 ; abCfft-Inen ' C2Medr..r9e7"th'.5 Pr=04f411^Jthrlexultalcal ccg ust F tierrr,*-'01-11:71nrericnnt:sg.112e:Ngutimat4fhl:cli:; oli.c:al or a * .4 . 3", cote:upon - the •ronerrir, ::o perform meth"! inspect>ons
' X . •
Signatu:c COntra)..t.m $ Lt.trac tio Daze
''--------------'--Permit Valuation • 7 -------, , Park Support Fee
_ ocCLLP C__a__
liggig
S t 13 SAC # s
$
NgiEEIZIIIIIIIIIIII ,9..0 \
, ...._•_35 H IUINIIIIIIIII
State Surcharge S 2 • 00 Pressure Reducer 5
. Penairy 1
$ Se... er, Water Connection Fee :-.. UIIIIIIIIIIIII
.- ,
Flumtnrig Permit Fee Sr 1126111111111111111111
------
Mechanical Pernut Fee S Builder's Deposit UIINIIII
Sewer iSc Water Permit Fce $ ' Other S
11. _
Gas Fueplace Permit Fee S TOTAL DUE 9 1 y
, .
---
i:c , ii es Your Bsuldusg Permit NN hco April.? N C I ° Pd t Recet.t No -
, .7 ill Ili
e l
'''' • • _ nef C .,- , , •
12a15___—____________
L40 _ 1
--_.
This 13. to cesufi mat toe request in the abo‘t arpittalloo and aocorarianrmj di.,..,:=7,u is in ai.cosnan.x ini:o use C .IN Ziar..o4; Jrduna.noe &M..1 :Illy plt)CCe4 as mi./5mm Thu 4octeneur
1 s , net d tn. tc,c L.,ry Flac constitutes a tcarporan Ccraficatc of Zcaung c-ornplsuut and allows cansauctori to (,)=ICVILT Bc et! occupancy, a Cemfazate of Ocr.r.:cascr rx-g be
I Is . 4
■
1 P1actur2 accoor ----------------------------
U------717----4 ------ Spectal L'orssomnit, or an'r
4 hour ounce for sllinspectsous (952) 447 tin t912) 4 4245
464* Dakota Street SL Pilot 11-ake, VIInwesota 5537 :
Contractor's Material & Test Certificate for Aboveground Piping
PROCEDURE
Upon completion of work, inspection and tests shall be made by the contractors representative and witnessed by an owner's representative. All defects shall
be corrected and system 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 against contractor for faulty material, poor workmanship, or failure to
comply with approving authority's requirements or local ordinances.
PROPERTY NAME: JEFFERS POND DATE /Z --2_g /2
PROPERTY ADDRESS: 14400 PARKSIDE COURT
ACCEPTED BY APPROVING AUTHORITIES: CITY OF PRIOR LAKE
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 YES ONO
TO LOCATION OF CONTROL VALVES AND CARE AND MAINTENANCE
OF THIS NEW EQUIPMENT?
IF NO, EXPLAIN
INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: OYES ONO
1. SYSTEM COMPONENTS INSTRUCTIONS OYES ONO
2. CARE AND MAINTENANCE INSTRUCTIONS OYES ONO
3. NFPA 25 YES ONO
LOCATION ENTIRE BULDING
YEAR OF TEMPERATURE
MAKE MODEL MANUFACTURE SIZE QTY. RATING
RELIABLE RES 49 2011 1/2 12 155
SPRINKLERS RELIABLE RES 44HSW 2011 1/2 12 155
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 5 S
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
MAKF MOE)FL StIPFRVISION 1 ORS Al ARM . OPFRATF VAI VF RFI FASF OPERATE FFI RASE
YES NO YES NO MIN SEC
HYDROSTATIC: Hydrostatic test shall be made at not less than 200 psi (13.6 bars) for two hours of 50 psi (3.4 bars) above static pressure
in excess of 150 psi (10.2 bars) for two hours. Differential dry-pipe valve clappers shall be left open during test to prevent damage. All
Aboveground piping leakage shall be stopped.
TEST
DESCRIPTION PNEUMATIC: Establish 40 psi 12.7 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 ONO
EQUIPMENT OPERATES PROPERLY OYES ONO N/A
DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS, SODIUM
SILICATE OR DERIVATIVES OF SODIUM SILICATE, BRINE, OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR
TESTING SYSTEMS OR STOPPING LEAKS?
OYES UN()
DRAIN READING OF GAGE LOCATEDfI_EAR WATER RESIDUAL PRESSURE WITH V� IN TEST CONNECTION
TESTS TEST SUPPLY TEST CONNECTION (0 'PSI 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 01= UNDERGROUND
SPRINKLER PIPING !DYES 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 ONO
IF YFS
DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES
COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR -3? OYES 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 OYES 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 YES ONO
NAMEPLATE
REMARKS DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: /
NAME OF SPRINKLER CONTRACTOR: FIRE SUPPRESSION SERVICES. LLC.
/ TEST WITNESSED BY
O' P TTY . SIGNED) „ TITL DAT
SIGNATURES 1441gie_ /2fr J�
FOR SPRINK NTRACTOR (SIGNED) TITLE DATE
c i /
ADDITIONAL EXPLANATION AND NOTES 2049
PR./
Builders Deposit
IN,rESO�? 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 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: MLA O'-1. 1 A�1� lLS 1CDt= Gov L2-I PERMIT # / - 836
REFUND TO BE MAILED TO: 1 -4-+ t-i F S
12- t, A 11 1J( P / S SV VI ZU
tE.l t�K SS43
AUTHORIZATION TO RELEASE
PLEASE REMEMBER 11
.ynda S. A en, Building Services Amount
1. KEEP STREETS CLEAN DURING CONSTRUCTION /0, ( , 13 Acct. 801.20204
Date
2. KEEP EROSION CONTROL IN PLACE
l -�. �.� l �... a ...y �.• -R w - : -.- _. -.
SIGNATURE: £ —
C: \Documents and Settings \sbare \Local Settings \Temporary Internet Files \Content.Outlook\BD8OXI9A \BUILDERS DEPOSIT
FORM.DOC
PRIOR LAKE DEPARTMENT
BUILDING A IINSP TIQN
S ee Main :4 il
INPECTION RECORD
SITE ADDRESS i 44694 PA-en- et)o
NATURE OF WORK S = - 4 tiQ Cr- r o p - c - 1 - + vP F/ J L L.
USE OF BUILDING !G i_` FAevt 1 4
PERMIT NO. IZ -`i DATE ISSUED 8/z
CONTRACTOR -A t u ( - bt - s PHONE ct Z -89 - G 4Z
NOTE: THIS IS NOT A PERI& FOR ANY OF THE INSPECTIONS BELOW
THE PpRMIT IS SEPARATE / D C: V NT
�' IN SPECT ` DATE
FOOTING 1
1 FOUNDATION (Prior to Backfill)
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
v �L-
ROUGH - INS
SEWER / WATER / SEPTIC
FRAMING pAaa - '1 i- 67r Po ,.,. (2.4- 13 I L
INSULATION �, /4 /0 � 2
ELECTRICAL
PLUMBING _ O, It( /1
HEATING (if required)
FIREPLACE
GAS LINEAR TEST 6q5 /ic-)
0 04-4‘ F -- COVEA WORK UNTIL ABOVE HAS BOEN SIGNED
I � � , � 1
PCLUv _ FINALS= ''/z -Ae)).
GRADING (Prior to Sodding) _
BUILDING !n n g
l,t3 6 o .1, JEf) /a�/3
, ELECTRICA L
PLUMBING �.� - i A/3
HEATING O'U I R4
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