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HomeMy WebLinkAboutBuilding Permit 12. 1023 A - r t t" {: ht b t �, h M � , fi ry? h ' a Y` ^ :f Y. Vr � t ' r i Y V ,,m i YYYY .� YI r VVUr� y lVyr. ' i7 Yru r ;i 44Vr _. I C Y FYI :, irr Yr r iI rr _ f , l 7Y � �� li I 1 jl rrf fitMMr of ®ttnpa ntg CITY O PRIOR LAKE pr of !n ibi t ztsp t iUf 4. E] Final Permi ❑ Conditional C.O. Expires Th Certificate issued pursuant to the ime o this struct0e was i n n Reside with the International �rq Building Code certifying that at the time of of Prior Lake regulating building construction or use. For the following: . ar ordinances of the City f �� _ l �� 3 z i iii Bldg. Permit No. U se Classification VN P UU y , Type Construction Zoning District Occupancy Type 10 Legal Description r 14365 P A t�KS l DE COURT Si Address ., Owner of Building Contractor's Name & Address �, ., Hl.1TOa 1I NS .. . ,` POSE RT D , cit Planner uild g Official , ; l POST IN CONSPICUOUS PLACE f Date: Date: / :. 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V c af O 0 a u. 2 LU m re a z N i 0 a � W d DU W W Z X k � �• a23v�a2 8 LU w w ❑❑0000 ` a a o w .t p )..n L(1 O= U 0 w a Y H 0 0 4 ZO in 5 F 0 ct : S MZ ZO Z W d 3 aC a O N M Z H = J Z 2 i a .1 c 0 Q C Ow Ce w Z .6o201� o O tS V V d p O LLLL U.? tiH ►,�� . 3 0 0 5 3 4 0 o 000000 0 ,1 0 0 ❑ -` � � r fc /� / / � 9 CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd _ TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 1 " AND PERMIT CONNECTION PERT K,-30.11. 7 ' NNEso * L White File z. Pnk City PERMIT NO. /z / 0 a3 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS t b S P is k S t D F C- 0 u c2_r ZONING (office use) POD LEGAL DESCRIPTION (office use only) LOT U 6 BLOCK ADDITION C--\ --1- P k-/0 m4 P--0 r,..1 V PID 254"1 ?)0 4 b o OWNER (Name) i T IN. M `t' 44 0 M ES (Phone) (Address)12.t W A S H- it-1 6 *-1 A V E S S"TE. 2p 1 t .O t rat 4 \ H N S S c13 9 BUILDER (Company Name) M°- -fit i 4+0 f`I ES (Phone) (Contact Name) S U E (Phone) (Address) 'l20 t t... lk- S 4 t1- c,ruti N v S ST- w t > .-O 1 >v .N. h t�.1 SSA 9 TYPE OF WORK $ New Construction t8Deck ['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 III IV V A B Occupancy Group: A B E F HI MR S U PROJECT COST /VALUE $ D ' 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. Xc. c.---"-.._< BL-- - 2.-C ,2 -S1 S b c> -1-9- l'2. Signature Contractor's License No. Date Permit Valuation /360, 60 O 0 Park Support Fee # $ Permit Fee $ /L G g -57D SAC # $ 23 C25", 0 V Plan Check Fee $ 015- ` i' Water Meter Size 5/8 "; 1 "; $ 4;6 Q r 0 Q. State Surcharge $ t'O 1 U O 0 Pressure Reducer $ 1l0 -0 Penalty $ Sewer /Water Connection Fee # $ /' [ O O .. 0 0 Plumbing Permit Fee $ J54 ,56) Water Tower Fee # $ /0 0 G .0 0 Mechanical Permit Fee $ 75 63 Builder's Deposit $ /560 , 0 0 Sewer & Water Permit Fee $ 510,57) Other �/ S/oA-et4 $ /54-, 53 ' Gas Fireplace Permit Fee $ 54 V 67) TOTAL DUE $ 910 Z . / TJ This Application Becomes Your Building Permit When Approved Paid 9 / V 2 - _ tel Receip o. ( 7 � ( 0 Date /o.. 6 f Z,- By ` Building Official Date 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 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 From:Genz -Ryan 952 767 1900 10/17/2012 15:38 #657 P.005 /07 i .0 r Rro, CITY OF PRIOR LAKE Date Rec'd • °. HEATING /AIR CONDITIONING/FIREPLACE PERMIT 4 otr is o PERMIT NO. l Z 1 Oi3 3. Yellow Applicant g (Please 7pe or print and sign at bottom) ADDRESS ZONING (ofSce use) 1 4 (c c AN( leldke. eic. Vv LEGAL DESCRIPTION (off+iceuse only) LOT BLOCK ADDITION PID OWNER (Name) - (Phone) • (Address) • APPLICANT (Name) C .l 1.► 0 hone) . (Address) AZZO© 1\r c3 . \&1 � YM1111t0, 5 37 . \( ,, (A .. ress) (C' )_ (Zip Code) (Contact Person) t 1 1' ) J IY V 1 � NN'' - ! r -0 ` (Ph one) 10Z ^fiW 7 " I --- • APPLICANT SIGNATURE t V t i' DATE 1 O) 17 ) Pr.... APPLICANT PLEASE COMPLETE BELOW • • >:■ EW CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS FURNACE MAKE AND ODEL i , k • * _,,, Am FUEL IJO - 070Q? • FLUE SIZE R • OPENINGS INPUT $ (DCR {) OUTPUT 53 I Boo TYPE OF SYSTEM HEATING OR POWER PLANT ClWarm Air Plains Steam PLEASE NOTE: Mr Conditioner Units and /fireplaces Cannot Encroach Z. cavit El Hot Water into Required Side Yard Setbacks. . cohesion! L3 Radiation q ei it Conditioning Q Special Devices Fireplaces with Box Additions or I eat. System [Q 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 • $49.50 • $49,50 minimum (d* 1�' G 'aC.,ali1i op)al349 i Residential, Additions & Alterations $49.50 Residential, Heating Only (New Construction) $64.50 Residential, AC Only $49.50 Estimated Coat $ Building Permit # The Minnesota Statutes * 326E-3.14it HEATING PERMIT FEE $ ILi-I'. ---6 " SLR C:iIARG reet4 changed lbrone year effective STATE SURCHARGE $ 40 July 1, 2010. until Jane 30, 2014. TOTAL PERMIT FEE $ t LW . e ej The minimum surcharge for a "fixed ree" permit (Ott - ice lire only) is $5, beginning July 1, 2010 • ts■ This Application Becomes Your Building Permit When Approved Paid Receipt T • Data Radler Date • 24 hour notice for ail inspections (952) 447 -9$50, fax (952) 447.4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 From:Genz -Ryan 952 767 1900 10/17/2012 15:39 #657 P.006/0.. g P Rtp Date Rec'd 4`,, CITY OF PRIOR LAKE PLUMBING PERMIT Cit r.3 ;1 ! ' ' ,,, :� T r. alp �� PERMIT NO O Z3 ' Y A + �. Yellow Applicmit • ]case ty pe orttrsnt an sIEn at bottom) ADDRESS ZONING (orrice me) E-1 2 Y 16e, CSC .. \id LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER (Name) (Phone) (Address) APPLICANT (dame) GENZ -RYAN (Phone) (Address) 2200 IGHWAY 13 W , BURNSVILLE, MN 55337 (Address) (City) (Zip Code) (Contact Person) A elk \ .O V V t (Phont ) 952 - 76 7 - 18ep . ff �� �� APPLICANT SIGNATURE J DATE 1 -`�M ff.1 T APPLICANT PLEASE COMPLETE BELOW Quantity Type of Fixture Quantity Type of Fixture 'Z Bath Tub with or without shower Rough -ins t Dishwasher Water Heater 1 Floor Drain 1 Water Softener Lavator ((Batlfrootrt Sink) Stand Pipe (Washing Machine) u / Laundry Tray (1 or 2 compartment sink Sewage Ejector 7 Shower Stall Backflow Assembly It Sinks Backflow Assembly Test --- Bar Sink Lawn Sprinkler Water Closet (Toilet) Other FEE SCHEDULE u ,. 0 esv Industrial. Commercial & Multi - family 1%o of job cost with a $49.50 minimum 1dei't`tia � ,81,p t (.4 T Residential, Additions & Alterations 549.50 The Minnesota Statutes § 32613.148 —1st ---- Building Permit "SURCHARGE" has been changed for one year July I, 2010. �until Jui _ ne 30.201 t, STATE SURCHARGE EE $ \.5 0 the minimum surcharge fora "fixed fee" permit TOTAL PERMIT FEE $ V Pr) , 0 a is Ss, beginning July t, 2010 This Application Becomes Your Banding Permit When Approved Paid R M- M4 Date BBILDING PFRAii7 Building Official bate 24 hour notice for all inspections (952) 447.9850, (ex (952) 4474245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 2 ((/ 2-CCk 4 I' Rio CITY OF PRIOR LAKE Date Rec'd , ; ` , HEATING /AIR CONDITIONINGIFIREPLACE PERMIT drl !. Pink rig PE RMIT NO. 1023 23 z. Green city It 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING (office use) l '/3 c /dz i aei LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER �� � _ � �� �! (Name) Tr�'n (Phone) 6 ✓ z— & 2-14 (Address) 72- (9 / 2ela 6� C) J G-r / ig cte 4 1 ' y yt. 5 --- 4 13 7 APPLICANT"ARTH & HOMt TECHNOLOGIE io1C,. (Name) dba FIRESIDE HEARTH & HOM (Phone) • L1c. BCO512060 (Address) 2700 FAIRVIEW AVENUE N ROSEVILLE, (MI T 113 (City) (Zip Code) 651.633.2561 • (Contact Person) (Phone) Q APPLICANT SIGNATURE / ZT ) 4 4 - DATE 1 IC - 13 APPLICANT PLEASE COMPLETE BELOW ❑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 ❑ Hot Water into Required Side Yard Setbacks. ❑ Mechanical ❑ Radiation Fireplaces with Box Additions or :Air Conditioning ❑ Special Devices ❑vent. System 0 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) $64.50 Residential, AC Only $49.50 . Estimated Cost $ l 0 9 5, 00 Building Permit It The Minnesota Statutes §326B.148 . HEATING PERMIT FEE $ "SURCHARGE" has been changed for one year effective STATE SURCHARGE $ .50 Jul). 1, 2010, until June 30, 2011. TOTAL PERMIT FEE $ The minimum surcharge fora "fixed fee" permit (Office Use Only) is lif, beginning July 1 • This Application Becomes Your Building Permit When Approved Paid Recceip(og Date BlIVLDI3G PERMIT 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 . ESol _ - - - • - - - - - __ _ _ CITY OF PRIOR LAKE BUILDING PERMIT. D al.e R(1 ..... 7„...-) TDIPORA1.1•Y CERTIFICATE OF ZONING CM IPLIANCE - ...,, AND um CONNECTION PERMIT 4-1111aPe's-/ 1 _ -- ----__L-- - : , • PERMIT NO. _-1. zo-rE;:1 A 11 DRE SS - Ii ''', 7.-. 4 .. -., _____' '" 1 ----_L.--------- --------- -- -------- ------- _-- ----.---_—_—__—_- ----___---_—_—_—_—__ LE GAL DESCRIPTION orrice use ue.hil , JOT _—_—_----•—_----_------ OWNER k 1 eNarlIp) ______ phone, In Pt t 1 4 6 ,., :.' , ___._._---__--- -_--______ Bt:ttiaaLli D (Cct7T,ray Name) ,t. ; . _.. - . .1. l'—e--:-* •- ' ' t—Lv_—- tPhon 1(ca.;_"' (Contact N A :r) '• Address 1th c, . 1 1" P 1 . t.2._.__-- .,ra - __I - 3.____L-i-g , " - R ',..41 5 S' •_ TYPE OF WORls, New Construction 0 De ei. 0 i' corn 33(..e. -Roc r, nig LIl„r-_ ,„,,i'...ower Lat Flnisli Li I- erla : e D Asisil::on (...j.A.;', I " CODE: I.R.C. DEUX. 0 m,..,„: .;- i,.., , ,_....-- __,..,_--- 1 ---,--i------- ------- Type of Construction: 1 11 111 IV V A 13 Oecdrancy Group: A 13 E F H 1 M a) S li PROJECT COST.' VALUT S ••-•:`' CC- Division: __I_ 2,L,__a) 4 5 (excluding land/ ---------_-_— ..----...—__ ----------_—.-_..---,---_--.-- — ----- ! "--e!.etty rei-ttfy that t have t..",JMIS.hed Information on this acrl r 'A ..■•,:V• :..: 01 '* i'00- 7• •:-1 ttr:t it,c •A e■r../W.p.nr :t _ 1: . , ",ht • a ,,,t,na ,,,,,•,• ,: :f,, , :, •• :-.: ,:,.., .•,,,! ,-,-, • ,-% .:-.,...: ,,,i! .7:.,...,:-.:,, : 3,:;:.:•:.: `, ."'l s r' .... : : am 3wa :1: '‘.'.:.• ''' , . ...' ...' -: • ' ' • . ' 7 , , ` , " ! ;..ernSt faSt CAUS-e FO:Ittily,;", V r` . ' ,•:- ' ' t• - .,' '.. - ' ' , ' .' .'', 7 :' 7":`,* '" ":7 11 '.:'.t.7 , ': .0 nete.c ! • '; t ' ', r 4 (, -- 45 -- __________ _ Cor. : . 1..-cr.ttle No --- ------- ,......_-- ... ........— . .. .... \ alnon ' I Park Sum: :' lr-e.•..: # 1 S ---_-- --- 1 _ 1 . ., ---„7-_--------_t-:-... -------- St;7C1 ''''' - .„--7---- ., . — -- * r-st'.111•Zt: ' f.'• -- ' ----- :.tn1.1-; ., .. Stn •'...',.*. '.. '7'.' -,..--.--, Fee 1.-: S __ ., ------- ----_—__ :1.....'-ytng Pertnn Fee $ _....--- — ..,..._---- -------- ---_—_—__ — l'•le.:1‘..anica1 Ferrnit Fee , $ 1 Fiudiet I i'..n. ; - S ----- . -- --- — S cx er & Water Pemit Fee 1 $ Other $ Gas Flrepiace 2ermit Fee i $ VO TA.I. DUE ---1--- .......— - • --- ins,_ ..„...... ..... . 1 - Thi Ap . ' rues our Bulletins Penni( When Approvrd , ' Plld ‘CYAB4411Virt .. : / , • _ ! ' 4,4 05/4 .3. 'r ,--.__.-----_— — , - n.-_,A te to ett—Ify that thr request sr; thc atx) arp'..t.ttattott and accum...-ttr; 1 . ...ttment's 2.5 ',n a..;. . .th i:',:. Z,t '...%1 '...' f.:" , r::::'," dnd Ms': ;' al t'r•Z•4e.;!t...1 r':f 40 I NI= SI ty the City Plarawr coruts a ittl'ary Cc:-.5.:.v.z c( Zov.0.1„; .:•. ami ., :;•04.7r-I. .:. ..',- ' ' ''''' a 'Crrl'iker ", - ` ,2 'z'". 7 - ` - n - "' melt' "t • ;!..t.t..r, ---__.------... —._-_--.......--. ...Itt,:t.: 4., 0i ' i 4..-.) ---_ -----7 2 hQUI warier for 33 titspe (952)4.37.9850. fax On t 447.4145 ,......, r ta.......t la:, \I ittni■tatit 4S1." 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 — 1 PROPERTY ADDRESS: 14365 PARKSIDE COURT ACCEPTED BY APPROVING AUTHORITIES: CITY OF WOODBURY ADDRESS: PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS YES ONO EQUIPMENT USED IS APPROVED ®YES ONO IF NO, EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS RIVES 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 EWES ONO 3. NFPA 25 EVES 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 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 NO DOES VALVE OPERATE FROM THE MANUAL TRIP AND /OR REMOTE OYES NO 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 Mflf1FL Sl1PFRVI ION I OSS Al ARM fPFRATF VAI VF RFT FASF fPFRATF Fl FASF YES NO YES NO MIN SEC HYDROSTATIC: Hydrostatic test shall be made at not less than 200 psi (13.8 bars) for two hours of 50 psi (3.4 bars) above static pressure in excess 01150 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 exoeed 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 .HRS IF NO, STATE REASON DRY PIPING PNEUMATICALLY TESTED OYES 181 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? ® YES NO DRAIN READING OF GAGE LOCATED E R WATER RESIDUAL PRESSURE WITH ALVE IN TEST CONNECTION TESTS TEST SUPPLY TEST CONNECTION PSI CONNECTION OPEN WIDE QPSI 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 'EYES ONO IF POWDER DRIVEN FASTENERS ARE USED IN YES ONO IF NO, EXPLAIN CONCRETE, HAS REPRESENTATIVE SAMPLE TESTING BEEN SATISFACTORILY COMPLETED? BLANK TESTING NUMBER USED LOCATIONS NUMBER REMOVED GASKETS 0 WELDED PIPING OYES El NO IF VFR DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR -3? EVES ONO WELDING DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUAUFIED 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? C 4 YES NO 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: '3,— g_ k NAME • ' • INKLER CONTRACTOR: FIRE SUPPRESSION SERVICES, LLC. TEST WITNESSED BY FO' /I; : / TY O R (SIGNED) TIT DA SIGNATURES ` �- .2*.s e 3 � FOR PRIN • = •NTRACTOR (SIGNED) LE DATE h �.- '�Itt•� J W \ w -- •� 3r b 13 ADDITIONAL EXPLANATION AND NOTES ©1 PR/0 Builders Deposit u x 411NNES01'' . 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: \` PNr -StuIT= C0vt -r- PERMIT # /2. /dz. REFUND TO BE MAILED TO: M 4 VITh 1 -N-o t-t ES 12 0 t 1,-./ ,NS t-} t KJ GTO N Pc✓ Es S S i tT Zo 1 Qtt 4J, / Mht SS PLEASE REMEMBER 1. KEEP STREETS CLEAN DURING CONSTRUCTION 2. KEEP EROSION CONTROL IN PLACE AUTHO ' / ATION TO RELEASE SIGNATURE: �`--e— i 560. U a L da S. Allen, Building Services (6 .U. (3 Acct. 801.20204 Date C:1Documents and SettingslsbarelLocal Settings1Temporary Internet Files\ Content .Outlook1BD80XI9A1BUILDERS DEPOSIT FORM.DOC P R I R LAK DEPARTMENT OF BUILDING AND SPE T N ee .� Main File INSPECTION R SITE ADDRESS A �( /LOX .# 6 NATURE OF WORK i- , ±,oily j /. fv -- USE OF BUILDIN Ala PERMIT NO. (4 DATE ISSUED CONTRACTOR Al/ i% at' a PHONE NOTE: THIS IS NOT A PERMI FOR ANY OF THE INSPECTI NS BELOW THE PERMIT IS BY SEPARATE DOCUMENT Install erosion control & maintain clean streetsispUroall times. DATE I FOOTING 1 I I I FOUNDATION (Prior to Backfill) 1 1 PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED Radon system under concrete slab rnitOrtirg H - INS SEWER / WATER / SEPTIC. FRAMING 'v 12. q. 7,5 113 INSULATION ELECTRICAL PLUMBING ( 4 25 ,3 HEATING (if required) �. ( ( zf 3 . FIREPLACE ¢ b GAS LINE AIR TEST ✓ )0/1 4611 ladon piping COVER NO WORK UNTIL ABOVE HAS B N 91 system, Housewrap 1 Fire Sprinkler FINALS -7 - hi_ GRADING (Prior to Sodding) BUILDINGET g/Jt, 6 O,) /0/7 /13 ELECTRICAL 'l. PLUMBING , IL4 / /1 HEATING 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