HomeMy WebLinkAboutBuilding Permit 12. 1019 �a a..�a.r.»II'arrOlrVl yiiliM'�rrrir,!. �W rr .a r Q1A1t .,rP0 .. ,, rr ... r. . .. ��•. .,, ... -...r_..-.. _. r.-.-..-.. ._ -_ _.._�_._� .._
.- _I /IN1 111111 11 1 � 1111Y' 1N/14:' 11111{ r.r1Y.,. :,1 r. ..1 - -
�... r..111r 1 + rnl.. r. .,r „r. I. �rrpp,rrl..,rr, ♦.� ...., .....:.
e � I '111111 .1 � :.:11111 {. I , 1. ul• L. w, rt i•a ,,,, ♦•. J„r +iye:n f;M'V::4•orp•...; M1•.p.:
__� r ( „1 IIN4 11111. � 1111Y ,1111 1 n 1„r. ,Ire Ia rrr ♦ ♦ rr ♦ ♦ ♦ . r...v .sr.,. --
.... r, 1 1 ,.11114 1 � 1. , 11M1 r II rI,.. I.• I♦ r 1 r••, r„..:. - '.. -. +s
Jll 11 1111h,. 111 .,111 I lF +,1 �.,, , Ia .11r, ♦•. ,h h;•b -,YS �i �;r8 i,i �.•'�• -• ••••.q:•'•s
._.f 111 t:.. 1 1 ...sill IIIIIVI., -1 .111 1, =rll,rl ;+, ,1r, rllr la. ♦ ,Irrr♦.r,rr♦♦ • -•
1 11 (. �. llf 111 i 11111 ,. 11 II ! �. r ,r. 11r l.,r, I♦. 1rn r . r,rr i:J•,•r •'•; •••- ,y +•'••v:••Ca�:••'� •v.. :r.. -
,.._ -..� ll' t N � Hf N1) 1 n „ .111 Y 11111 ;;:111111 111 I 1 1.. 1.H,rP: 11,111: NUS ,I!I I r,. .rlr,.I ,. r, I!. ... .......... .•. ,••• ••
. ___> Illdllll tl' �) � ll I) iN N . tl. fl 111 \ (111 + ,., (, 1 11 .,1111111 1111111,_. 111111 11 ' � 1. 1111' Ir111k ir11 :. rr, ! 1 1,111 11111 I♦ ,r,lr 1a ,11, Ia..••r'rj�•'Mi':r0:•:'ilj�
-N 1S/lllllll 111tio 111111 11411111 11111 i y� ( 11 1 f lllllf 11 11 11 111 Nlllf 1H111f 111 1 1 t r Y, rrl„ lnrl, �r,.r. rr,l„ .r., r . , a „rr• iigt!,
Ill" INI � � 11 N 1 11 � iNlll roll) }ItNI (11111. •. 111111.:1111) 11 (,,. 111111. IIIINY -. 1111N4.�1111N(�r11r11r,,, 1111111 ;1111111 � ilrrlii .ir/1111111 ♦ttr1111f_ ♦ %i�'ilj)
IIPIIII ul�huu4rluuu111 N1111111 4111111 ura111u1W1u1u�lluu��It11111I1i111�Itlt�l�hi11�11ItfIiS' t1Iti1Mi1111YVi1Pl1d111��11111�M11i111114R11i141f111i1 Il ��� llr� :�
(I11 t
1), .r Lerfifii fr of (�rrix )
4. CITY OF PRIOR LAKE 4µ-
.� P r ft-urn v ui� i ns 1 - ,>
♦
F
i%)
( 4 1 F [11 Final Permitted ❑ Conditional C.O. Expires - si
This Certificate issued pursuant to the requirements of Section 110 of the III Residential / Ill International _AO
Building Code certifying that at the time of issuance this structure was in compliance with the various '"
(0.i
ordinances o the City o
f f Prior 1 g�eZaxan,¢i�di�tg construction or use. For the olio %)
L t - f� i f iz 1019 �
Use Classification
Bldg. Permit No. 1 +?;)
Occupancy Type R3 Type Construction PIJD ','r
�1 Zoning District a�
Legal Description 1 91, Bi , JFFFERS WATERFRONT
Owner of Building site A 14366 PARKSIDE COURT' ')
Address
�.
Contractor's Name & Address
MATTAMY HOMES _ ---- ;:;,);.4)
ROBERT D. HUTCHINS 41
�' I City Planner
Building 0 icial ,
S • Date: 4• .Al r
Date:
POST IN CONSPICUOUS PLACE i.0
,IN IIIpA 111111 11141+ ;,��Irdlllli IIIIN NIIN NNN N 1
1 1111 %:1 P:.
1 1111 1
(I', . r,rl ,1 ll . .: lllIIIF , 11: A alllilN. ,1111111 111111 1111111 111111 I •_
,1 ellll,elii � H1111 1111N1 I H ) Ir1 1 1 1 1 .•` 1 N 1 1N,1, .: IIIIN IIIIII' 11111) ,1411N ^ (NIII. 11111 �, � -•. - •- -• -- '•:�; I
�.: � . Ilrr aI .ttt .. Irllr �� .rr�l � .rlr, 1, 1 aul .111 r 1 N I 11 11 ,:
- •.o... .., •• O.•l ., ...Irr.....,,, .. III, a�i 111 a�. .1111 � Irrrr � 1.,111 1, r., ANlll ?N11, dill fur.. ..111 /11111p,,;. 1111N1 .NIIN1.. 11 �. II .,111111 ,MINI �;: IIIIN ,:.. 11 1:.. . � ,. ..
..♦ „rl ... uu a ,
,,,, a. �s rr, � Irr,. � llr„ 1 1 4u11 ful 1 N111 r1NNN. 1N11 1 -. �.. .,, III 111111 111111 11 1 r... .. . _ .
e . :: a. -..• e;.•:{ .-r. . "- gN•q:J.,,-a,o•.. ... .... I . , l , ;, r.,. P.. ,Ir, of ,. a♦ a . „rr 1,111 .� Ir I / o- llu l. 1! ,111111 A11111�r ,A1 : , ... N) MINI 1 N.., {
..,...,......I,.a.,,y p,rp p.. rr, ,........ ,I ... I,,, .. Ilrr a i .-` rrr 1 1,111 ♦ 1'' , 111111• 11111 AI r ,,.11111. 4 1 „ ,. AIN111 ;! 1 1 ,, II .. IINI rv� INr +e a
_.._- _. :.- __.r t -. •.••r - - -vv: -v• ..•.:-.:.. v :... • ..r....•y...•.f.:.r..o....rr... ..,. 0;♦ a.. ..,l a !G ,.rrvlrrry rrr, a� ♦.rrlr�allr�. OA :10A II �.flHl 1 ,1111�r�111111 ,;IIIIIN� 111111 i.
;_._ .__ =v . -_ c1 - {_ _s te r. s.vrr__vv. r. e.•..• :...:.Yr.:v,.y..:..,.....a'�a,: pr•p,A: J... ,1. 0:. ♦i„ ...I 1111 a .. rill �I 111..1 111 .., •1111 �Ir }I/ Ir 11 1Allllf' 'A lllf' al ll�A1111 IINI:' �Illi{• sM,�
_ -� . ^ _ _ _ _ - .. 1 ,, Av ♦4V10.J, tal y 1 1 .. II.L . a ttrl i . t l 1 Iti,r1 +i a III � ( �llul.:'a!
��i -' -_— __ ___ - - - - . t. . �. l A . M1 a�i A AF I 1 . r 7 re.,1
_
� \� '� �..;/�:v, ��` � : � v da L,. .l i . �'.ti'i ,!a 3 3' � 1 r'�r l �}•,f$o �. kf} a.�. { +ri
J
0
H
W z�
S t- 4,
d' li p
LL 0 La tu 0 Z W
W
� gga= '1 >
IL A c ?) W W cn 0
o w liu. 0 F Z pz ,,t
I ❑❑D❑ w `o ce
N o
x
0 , „
LL
N
w 1 � O a aJ w z o
p I a H 2 O Q LL --I I O U O - x z ?_xxzz 0
0 �� 0 a g xw a g x I n. 0 z
JWQ JW ■ fa 0 Z F' p
cn
a� w w w w CC
0000❑❑ 1 0 0 z
a a LL f-
ww \ 0 z U.
< i .
5 o MN 0 1 a o o �
Z 0 Z w Cl� Q 3 OI
O W
w F- E-
M a.
LL W a W t = z ic � Q - ce ce cc 0 a
0 A
p Q
p ti 0
0 0 OO O > 0 o a
Ui 4 0 a ❑00000 0❑ ❑ c
0 Q E-
W Z Z 1--
Q' 4 ix Llit E
�y =WwQ Z( w U U
z
0 UJ W u 0 Q
w __a o W U titi0 0' W N E"
000000 > cc
U w
U. N O
w L_ z
0 � I (
z OE OOLLJ 0 U 0 t ` �U
w Z � Z -22 Z? W c � O 2
,,
0 0 w =W N 8 z b
W Q W W W Z X O
� 1 vi v re z
%U. ❑ ❑ ❑ � z z o w `,
CI. d LL
lit ix z Q 0 w
�J 0 < 0 � LL t
Y U ZO \\ < 0 O Y___.� . m
� z z • — N Q ` d
OZ , Z O O w F- U < 0 0 4. 44
Q O- n. Z N 0 U J
J
a � co _ ca ..4 m �� re re " a o
0 w r4 w z p &wz 2 + 0 0 o 0 a U C"
0 0 LL LL LL LL N O
5 ? a O a 0 000❑❑ 0 L. ❑ �❑
_ c ..„) r.
J
0 w Z _ 2 p
p J 4' 6 LL cc W
LL Z U U< z 44 4 Z
w OMW WN 0 Q `M
r O ? _ < Z
o W U LL LL W _....
❑ ❑ ❑ ❑ 0 ,,,,),
re x
` N
W Z O Col
O. Q. m
J Z _ Y Y Z Z o 0 g
C c e H 2 O O LL -1 O U 0 o�
Q 1- `N W ti 0 _ — Z et Z ,= S Z LL W c 0 1.' U 0 w
co U CL 2 U U o O Z O
1 J W Q J W ••-9 W W W x LL,
( \ \ T`-j a2 3coa2 U 111 U IX Z IL
00000 0
w CC Ct O = C
CA in O. d LL I- F.
o Q U 0 w
5P z \ a o
6 Z J O Z U I- P< a CO °
w F—
W o O O a Z O q N Z N w w -J
L
a_ r= co , Z ?o_ NB \A Y re r ° Q q
° Z O O <a E , O o a V, 0 o
LL U W W 0.1 F- v Z H 0 0
a 0 0 LL LL LL= LL N 5. U U n
o a 0000❑❑ 0 ❑ 0 c
U? < O
w j z a
g I -
u � w
Vi ti 0 §
2 5 \ \z < 4. 4 « M
r) CL CI_ a� >
o■ww� o «
0 O woMM0 2 z 2
000000 > 0
o R
§ I \
§ $ §\< \ m ® Z k
0 ■ ce e E o O z 0*,
o � Q
1, z B 7_IIz . � 0 c a -`
0 w � 12 o 0 2
- �� 4.
j w w w j
OOEOEO ® o 0 w re
Z
I a E / k
• • 0 k :Iii 2 d
o . w
« �
$ z 0 z LU 1 • k
■ o A 2 u IQ IQ
� — Cl) z y w w . w
o� w Ce w 1_z
--R _12 � \ ct re re k 4 ( ®
/\ 0 0 §§� 0 _ k \\ k E
a? « o a 00000 0 — N 0 E .E
)k
k - 2 � re u §
@ � L� 0
_� 4. )) ))§ > A
w o■WWu) 0 0
§ E o■cea
Q =moo 2 ? \
0000❑K III
u 0 --
§ m /
-I 0 aaa § { Z k
0• 1- 2 \kƒ� 0 0 o
w 1- § o 000 § § W
3 0 w § § a j co 2 (
® 0 73/670 c o w e\
' a &
� � a � w S b w
a O=OEOO o o 0 w®
a a 1
• 0 -„Cl 0 § \ rCg
ili i 0 0 0
w 2 u. §
0 2 z 0 W 1- §< ~ /
■ § 0 < 2� B z co w w , /
�� 2 te z §2ACjaw & & ) q
k 0 0 R
w w o Q
w
0 § z o 2�k
§2 2 o 1 000000 0 �o o -
° i r xr0
CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
9 TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
r2:1 AND UTILITY CONNECTION PERMIT C. 30. 1
lN�v E 5° �� See Main File 7 ��
1. white File PERMIT 1\O ® (_„/
2. Perak City / _ [l/
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS '04 3l0 , pis, T2-Y.--- t t) F �-r ZONING (office use)
PL2
LEGAL DESCRIPTION (office use only) + ,� v /
LOT - 2-1 BLOCK ADDITION . �� P-- V - -R t rRaPJT PID z Li ` $ 021 0
OWNER
(Name) 1' R T i IN- t-- 44 U N1 ES (Phone)
(Address) 12-(1.1 1N A S 141 1-1 t , r u A v E S , Ta 2O I a..0 t -J -P Hr-1 S S 4 3 9
BUILDER
(Company Name) MST Th U I >=S (Phone) 95 e.9 $ - Zt oa
(Contact Name) S $1/4. (Phone) 9S 2 _ S 9 8 — 4-12S
(Address) 12c.) ( 1... tt S 14 It,/ c N vl= S s 7 '.) t t -D ► u A t-1 1-..1 SSA 3�
TYPE OF WORK $ New Construction Deck ❑Porch DRe-Roofing ❑ Re- Siding DLower Level Finish ❑ Fireplace
DAddition DAlteration DUtility Connection
CODE: EII.R.C. ❑I.B.C. ❑ Misc:
Type of Construction: I II III IV V A B
Occupancy Group: A B E F III M R S U PROJECT COST /VALUE $ 30, °°C.)
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 L. � c4.--0.-___e___ E16.-- Zo31 53.E. o -2 9 - ■ 2
Signature Contractor's License No. Date
Permit Valuation P 00f,./ Park Support Fee # $
Permit Fee $ 2,— 1 , Cc) SAC # $ Z s- —
Plan Check Fee $ Water Meter Size V "; 1 "; $
State Surcharge $ e - Pressure Reducer $ / L _
Penalty $ Sewer /Water Connection Fee # $ C SY-0., _
Plumbing Permit Fee $ t S-4- ,,, Water Tower Fee # $ t 000.
Mechanical Permit Fee $ 1('S-4- Builder's Deposit $ ` S-00.
Sewer & Water Permit Fee $ ~` Other e l
Gas Fireplace Permit Fee $ S-4- V TOTAL DUE $9j ,O
This • it plic •': o 1 • eco .• Your Building Permit When prov d Paid '�! C V e - ( L ' '
Date c (y, CL - Re t No. 7c /.S
/ L /� By
Buildin i Dat ce'
This is to ce tha - e r est ' - the above application and accompanying documents ' • in acce .ance with the City Zoning Ordinance and may proceed as requested. This document
when signe. or the ity / er onstitutes a temporary Certificate of Zoning complian. and . .ws construction to commence. Before occupancy, a Certificate of Occupancy must be
issued. ,
1 o A 42 f 1 4 Z.
a . 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, Nlinnesota 55372
,
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 _Z — I 'L- t3
PROPERTY ADDRESS: 14366 PARKSIDE COURT
ACCEPTED BY APPROVING AUTHORITIES: CITY OF WOODBURY
ADDRESS:
PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS YES El NO
EQUIPMENT USED IS APPROVED ® YES ONO
IF NO, EXPLAIN DEVIATIONS
HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS OYES 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: ® YES ❑NO
1 . SYSTEM COMPONENTS INSTRUCTIONS OYES ONO
2. CARE AND MAINTENANCE INSTRUCTIONS OYES 0 N
3. NFPA 25 OYES 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 0 Li
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
OPERATION: ❑ PNEUMATIC 0 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 MOnFI SI IPEB /ISION I ORS Al ARM OPFRATF VAI VF RFI FASF OPFRATF FFI FASF
YES NO YES NO MIN SEC
HYDROSTATIC: Hydrostatic lest 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 Iwo hours. Differential dry -pipe valve clappers shall be left open during test to prevent damage. All
Aboveground piping leakage shall ba 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 ONO
EQUIPMENT OPERATES PROPERLY YES NO 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 ONO
DRAIN READING OF GAGE LOCATED N AR WATER RESIDUAL PRESSURE WITH VALVE IN TEST CONNECTION
TESTS TEST SUPPLY TEST CC NNECTION 1 75 PSI CONNECTION OPEN WIDE i,: PSI
UNDERGROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO
SPRINKLER PIPING.
VERIFIED BY COPY OF THE J FORM NO. 85B EYES ONO OTHER EXPLAIN
FLUSHED BY INSTALLER OF 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 REQL IPEMENTS OF AT LEAST AWS 010.9, 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 EYES 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? DYES 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 DYES ONO
NAMEPLATE
REMARKS DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: 2, ^ +,3
NAME OF SPRINKLER CONTRACTOR: FIRE SUPPRESSION SERVICES, LLC.
TEST WITNESSED BY
F• ' - y '': , NERk .AIELt) TITLE �' ATE �
/
SIGNATURES / 1������� 2//
FOR SP - R C r R ACTOR (SIGNED) TITLE DATE
- /Cr r
ADDITIONAL EXPLANATION ATI AND NOT! -- " ` L /9
i
pRi0 CITY OF PRIOR LAKE
O ; >- 'P Date Rec d
E , , HEATING /AIR CONDITIONING/FIREPLACE PLACE PERMIT
-
U`, d g.
i
1. rink Fi
} Yellow Appli<m PERMIT NO. • f 1f • 2. O men City
(Please type or print and sign at bottom)
-
L AD
1 4 69 (0 1 ‘-1 a '(- CA N\ \)
DRESS ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PM
OWNER
(Name) ' -Q M t a (Phone)
(Address)
APPLICAN
(Name) 7____ (, t-'r)
� 1 (Phone)
(Address) `- N V U rI \( l t' GT63 7
(Address) (City) Zi —
r (Zip Code)
(Contact Person) • J ) (� S7-) 7(7_ 1 C6
(Phone) ` 1 7
APPLICANT SIGNATURE 'i - DATE (
APPLICANT PLEASE COMPLETE BELOW
►! EW CON TRUCT!ON ❑ REPLACEMENT [f ALTERATIONS
FURNACE MAKE AND MODEL A i . �i'" 1 1 FUEL N .
FLUE SIZE RETURN OPENINGS R INPUT ge OUTPUT 53, 3 62 U
TYPE OF SYSTEM HEATING OR POWER PLANT
PLEASE NOTE: Air Conditioner
It arm Air Plants ❑Steam
• avity ❑Hot Water Units and Fireplaces Cannot Encroach
h [11 Mechanical into Requited Side Yard Setbacks.
rrConditioning ❑ Radiation
❑ Special Devices Fireplaces with Box Additions or
❑Vent. System 0 Other Devices Cantilevers to the Outside of Buildings
FIREPLACE MAKE AND MODEL Require a Building Permit.
FEE SCHEDULE
Industrial, Commercial & Multi- Family I% of job cost Residential, Gas Fireplace 549.50
$49.50 minimum
Residential, Heating & A/C (New Construction) $149.50 Residential, Additions & Alterations $49.50
Residential, Heating Only (New Construction) $64.50 y� Residential, AC Only $49.50
Estimated Cost $ c /J1 0. 00 Building Permit #
"fhe Minnesota Statutes § 32611.141{
HEATING PERMIT FEE $ "S1%RCl IARGti" has been changed for one
STATE SURCHARGE $ year effective
50 July 1, 211111, until .tune 30. 201 I.
TOTAL PERMIT FEE $ The minimum curchnrgc for "lived fee" permit
(Office Use Only) 15 �
beginning July 1.2010
This Application Becomes Your Building Permit When Approved Paid Receipt No. n
Date PAID WI y T
BulldinaOfficial Date PAID
� �J �t_I�11 Ir "
24 hour notice for all Inspections (952) 447-9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
i'Rlp Date Rec'd
.� CITY OF PRIOR LAKE PLUMBING PERMIT
` ..
n ata c„,
'" rt I PERMIT NO.1
3 Yellow Apptcnnt it
(Please type or print and sign at bottom)
ADDBESS ZONING (office use)
H (0(0 ( 4 ) (A-1' c i 'e- CA \f\\
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
C c _
(Name) N3 co NA k 1(_ (Phone)
(Address)
APPLICANT 7
ell '1 0---r-1
(Name) el !� (Phone)
(Address) r • gt • . 1 v `l)OOrvlS \l I k 2 2
�� c�7 — 7
(Address (City) (Zip Code)
Q- (Contact Person) 1 ✓1 Lacure_ (Phone) 0 ! -7 co 7 - l 5'co
APPLICANT SIGNATURE DATE 2 —
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
...? Bath Tub with or without shower 3 Rough-ins ,f
Dishwasher W ater Heater
Floor Drain l Water Softener
Lavatory (Bathroom Sink) 1 Stand Pipe (Washing Machine)
Laundry Tray (1 or 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
2_ Sinks Backflow Assembly Test
Bar Sink - - I Lawn Sprinkler
ii Water Closet (Toilet) Other
FEE SCHEDULE
Industrial, Commercial & Multi - family I% of job cost with a $49.50 minimum Residential, New One & Two-Fannily $149.50
" ' V
/� / j Residential, Additions & Alterations $49.50
The Minnesota Statutes § 326B.14K .'1st S / V Building Permit #
"SURCHARGE" has been changed for one
year effective PLUMBING PERMIT FEE $
.rely 1, 2010. until June 30, 2011. STATE SURCHARGE $ .50
The minimum surcharge for a "fixed fee" permit TOTAL PERMIT FEE $
is S beginning July 1, 2010
This Application Becomes Your Building Permit When Approved Paid Receipt No 410 ` ca A
Bolhiln>ZOtridal Date Date By A, wiq •• A �7 C G P R 'Ir T
24 hour notice for all inspections (952) 447-9850, fax (952) 447 -4245 � i
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
CITY OF PRIOR LAKE BUILDING PERMIT, Date Re:: d
7:--
TEMPORARY CERTIFICATE OF ZONING CO■IPLIANCE
AND UTILITY CONNECTION PERMIT
" 4 ',IIIIIIIP":•` - 1
1 %luta Far '
' PERMIT NO12 • 1 oil
2 Pea C./
7- Yew:. AdsaWara , ,
Please type or prim and sign at bottom) — --
ZONrsZG , -,ff
ADDRESS
! , \ Y • I i
I
i
LEGAL DESCRIPTION (office use onl)t
LOT BLOCK ADDITION PID
C i I 41 kADt-ta-- (Phone)
(Name)
,
(Add '7 2 0 i u.) t\s1/4-k t 1.1(.7 LE- 3,
mserant. C ..0 1.-n A 4-1
(Companv Name) V IZE P P'R.c...51f--,),...1 SC1 7 -0 '4C-_-'-, i L-L-C-. (Phone) 1 L)3 " - L.C.)
(Contact Narne) f't fVg.'l k CRP--1. (Phone)
1 0
(Address) 1 t I i 0 _71:1,10‘.:,1 c.\ ,_ L. f_;1/4., cre ,C ZIVC.CZ. frt rNi
TYPE OF WORK ,New Construction Eineck OPorch ORe-Roofing ORe-Stdrog OLower Level Finish 0 Fireplace
CAddition OAlteranon 01:tility. Connect:co
CODE: 5C I.R.C. 01.8.C. 0 Misr
Type of I n ra IV ,S) A 2
Group: A B E F H I M (5,) S U PROJECT COST/11AL L'E S ;: 23. cc) 1
Division: 1 2 T 4 5 (excluding land)
1 Nit certify that I have &mined mfonstatton on this apyficanon which is to the best of my kne :: and :ones:: : 1_3.: certify that I 3m the w. ce aurhonzei agent f or she
aboYe.rnentioned property and that all constructroo voll conform re all existing state and local laws and ie proceed in a.cordarce % MI submitted rani I arn &Wirt t...112 tne bw.ding
ofFiera: re‘oee this esseenn for Ns: cause Forbes-more 1 hereby agrer Mat the cry official or a dessitner may ever u he pers t r, operry to perform needed irtsper
X ilaitrt -
c s k an
i i - Z7- /2
signature Contractor's License No Date
Perrntt Valuate 7', Park Support Fee
Permit Fee 5 SAC ii; 5
.
Plan Check Fee $ Water Meter Sae 5
State Surcharge $ Pressure Reducer ' S
i
Pend!:y 5 Sewer/ Water Connec .., tion Fer
i... ; s
i
Plumbing Permit Fee 5 Water Tower Fee m t 5
i -
Mechanical Permit Fee $
-I Builder's Deposit 1 s
i
Sewer d: Water Permit Fee 5 Other I 5
Gas Fireplace Permit Fee 5
i TOTAL DUE
1 $
Fcati..f :sc.:a es Your Building Permit NN hen Approved
lo p
Pd
/ 2 / 2._ ai
, Date i , itilaiirtri.
1 Reliakvit , , ...:
! BvYr‘
tO ---4
__
.
B ., u
...
:nu is to ;cern mar Me ,,est.sest sn the abos.e appl.s. and aCtOtTIW> Ins do...‘scnenti os sn 1. oordance waft Me ,. ',Fun3 Ordinance and may proceed as m.luek-eci This domment ,....-
j la ler, 'sped by the Co Planner consunites a rernoorarli Cern5i. of Insing zompliarive itn allows commxorm to comme.ore Before oco.triancy a Ger-16,11x of Occopancy mu '
iss.•.sed.
s F'!ar.nsng Dtrector - Dior 'special Condritors.sf any i
24 hour notice for afl inspections 1952) 44%9850. fas t952) 4474245
4446 Dakota Street S.E., Prior Lake, Minnesota 55372
., p RI� CITY OF PRIOR LAKE Date Recd
HEATING /AIR CONDITIONING/FIREPLACE PERMIT
41tMvESOc' 1. Sink File PERMIT NO . 9
2. Gwen City • /Z - � O
3. Yellow Applicant
Please ty .e or ' nt and si : n at bottom
ADDRESS y3 6c, 14144.12.140 Cow ill W ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER 6 �� `/
(Name) / -� _ (Phone) -ZI,
(Address) 7 2. 0 1 2 .{, 1 ,,� Z C`VL - j #' i f
APPLICANT &MME ECHNOLOGIES, INC. f
(Name)_ dba FIRESIDE HEARTH Re HOME (Phone) •
---tic. BCO512060
(Address) 2700 FAIRVIEW AVFNUE N
ROSEVILL43,4*4)55113 (City) (Zip Code)
651 .633.2561
(Contact Person) (Phone)
APPLICANT SIGNATURE Pail l' a'►vv-- DATE / Li --/ 3
APPLICANT PLEASE COMPLETE BELOW
1/_ ',W CONSTRUCTION ❑ REPLACEMENT ❑ ALTE RATIONS
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 ❑ Hot Water
into Required Side Yard Setbacks.
M echanical
❑ ❑Radiation .
❑Air Conditioning ❑ Special Devices Fireplaces with Box Additions or
❑Vent. System ❑Other Devices Cantilevers to the Outside of Buildings
Require a Building Permit.
r
FIREPLACE MAKE AND MODEL g /_ Illy s — TIZ." tr '2276, i
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 $ / o O. & Building Permit #
The Minnesota Statutes § 32613.148
HEATING PERMIT FEE $ "Sl RCF!ARGE" has been changed for one
y ear e ffeetive
STATE SURCHARGE $ .50 July i, :010, until .ni ne 30.2011.
TOTAL PERMIT FEE 5 The minimum surcharge for a "fixed fee" permit
(Office Use Only) is , E „ 5, beginning July 1.2010
This Application Becomes Your Building Permit When Approved Paid Receipt No.
Date PAID
BuildinE Official Date i
BUILDING PERMIT -
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372 .
PRr
o O x Builders Deposit
tri
27 <'v, so 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: S - 2 -5 - �� SITE ADDRESS: t`A b b PA, [ S ID Co U t 21- 1 — PERMIT #(i. 10(
REFUND TO BE MAILED TO: 1'1 1 1 1'" r-1`C -4-1 -o t-1 E S
12o 1 1.-. ASt-1-t► l rots NV F._ S SW 20 1
'__-r> l hl t-11 SS L4 9
PLEASE REMEMBER
1. KEEP STREETS CLEAN DURING CONSTRUCTION
2. KEEP EROSION CONTROL IN PLACE
3. TEMPORARY OCCUPANCY PERMIT MUST NOT EXPIRE OR $500.00 WILL BE FORFEITED
AUTH 0 RIZATION TO RELEASE
SIGNATURE c %-i^---- c� �` � I
Il / ADD.
Lynda • 1e Bi' Services J ng Se rvic ' Amount CZ
4 V .. 1 Acct. 801.20204
Date
C:\Documents and Settings\sbare\Local Settings\Temporary Internet Files\Content.Outlook1BD8OXI9A \BUILDERS DEPOSIT
FORM.DOC
PRIOR DEPARTMENT A BUILDING OF
E ING AND
INSPECTION
r
INSPECTION RECOFD
SITE ADDRESS 4346P ' " 051 ,
NATURE OF WORK LIWI lii∎
USE OF BUILDING s�
• DATE ISSUED
PERMIT NO. El z
CONTRACTOR I/ ; nL' Aft PHONE :W; 111M
NOTE: THIS IS NOT A PERMI FOR ANY OF THE INSPECTI • NS BELOW
THE PERMIT IS BY SEPARATE DOCUMENT
Install erosion control & maintain clean streets4spUToall times. DATE
I FOOTING
1 1
I FOUNDATION (Prior to Backfill) I 1
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
radon system under concrete slab m tbrurG H _ I N S
SEWER / WATER / SEPTIC
FRAMING Z/! (
r--
INSULATION
ELECTRICAL
PLUMBING ,L ;v/ii lt
HEATING (if required)
FIREPLACE 1
GAS LINE AIR TEST M JtM /' 2/4J,
R.14. «lul v
tadon piping/ NO WORK UNTIL ABOVE HAS BEEN SIGNED
system, I I
Housewrap
Fire Sprinkler ' R.= � 2z//t
GRADING (Prior to Sodding)
BUILDING
ELECTRICAL
PLUMBING 4 i5 //3�/(3
HEATING // y)
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