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HomeMy WebLinkAboutBuilding Permit 12. 1426 + 13.488 y r .,r X _., ^c. __X c / ,_ I, i�_. r v _. � _, r _. . i ..n ., i '� ' 3OVld Sf1Of1OIdSNOO NI 1SOd . l er a r O Satp iauun ica ?D i SNIHJIHN 'CI l S wOH AWV.1.14i ssaippv 7 8 aureN s, olaequoj 1 ssaippy al ?s Sutpimg jo Jaum0 MN C``11 _ rr�� 1 ' 1dyO Abd1VPM SdAdd :r ' Id `O 1 uopduasauivSa7 aoujsiu Sutuoz uopongsuoD ado odi(i, XauudnaoO i l id in o tuna t issni as �;C — �t N ;. d • pi g - I1iN� iJNIS u0,0,. : su ap dog •asn Jo uo!pon.usuoo su?pi!nq 8uijvjn8ai aaw7 .loud fo ddz,7 ay" /o saauvuipdo snow n auk Mina aouvI/diuoo ui svna &inland's szgJ aounnss2 fo au1i' alp ;v ivy" Bu!eff! Sao apo,7 Su!pfzng t 1vuopyvuJazul ❑ / in!'uapisaX azp fo pIj uoilaas fo szuaivaiinbai azp of luvnsind pans? aivaiji ».ia3 spjj saiidxg •0 ji uoiiitpuoj ❑ p oilituzad quid ❑ ��; utillaa.dsuji gut ppu4 Jo luautlantiad �x�Z2IOI2Id30A113 5 _ ' W Z z H aI 61 id c..) w ° 5 55z a `` tu O O � a z Q 4/ I-4 l U LL LL a Z t . N 0o❑0o . > 0 =O N LL 0 o J W . i . 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Yellow Applicant 0 (Please type or print and sign at bottom) ADDRESS 14 3 b L 1 �4 , 12-e-S %1 C r kv ZONTi I G (office use) LEGAL DESCRIPTION (office use only) I ^ LOT 3 t) BLOCK 1 ADDITION J E-� F `� tz-.1?-0 ^lam PID 2 541 S O 30 O OWNER (Name) tit A T T r - 1 - c' 44 0 N1 l=S (Phone) (Address)12a 1 W A S t - 1 t 1 T t , + - I ' I S STE 20 t t =O t hl I-1 N S S 4 3 9 BUILDER (Company Name) Mk IN -7-1 i t"1 ES (Phone) (Contact Name) S V t= (Phone) (Address) 11 -0 t t,... h C E-} tit (..rU N Ay VE S SM- z c) t 1= t 'J e, 1--1 Lt S S4 39 TYPE OF WORK %NewConstruction IgDeck ['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 AB Occupancy Group: A B E F H I M R S U PROJECT COST /VALUE $ (2 x 0 0 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+ •11:: u-�- . gL 24) 31 532>b L t k l iA 12 Signature Contractor's License No. Date Permit Valuation (Z‘` 000 - Park Support Fee # $ Permit Fee $ (2.0421.4-0 SAC # $ 2 -365- - Plan Check Fee $ - 8to 18 Water Meter Size 1a"; 1 $ 42.9-- State Surcharge $ 0S- ' Pressure Reducer $ t L O, Penalty $ Sewer /Water Connection Fee # $ (SCOr Plumbing Permit Fee $ r 54-. co Water Tower Fee # $ 1 0 Mechanical Permit Fee $ i 'S 4- s---;0 Builder's Deposit $ ( Soo Sewer & Water Permit Fee $ /5-&-5-0 Other (� (76 c j eettess (0/% $ I r Gas Fireplace Permit Fee $ 54 TOTAL DUE $ 75g . ' 41 This Appli ,l,•on ec ! es a Building Permit Whe , Appro • ed Paid 7 i eip ( Rec . ‘70-1) 1 / 4 A t Date I 2 D /L BY y - .:rM►11111e. ( 2 1 Z- a Builds _Official' f. ate . ___IIIIIMN.11► , This is to certify that the - 4 est in the a. e . •plication and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document when signed by the City ' . er c/- ti d e a -mporary Certificate of Zoning comp '. e and . ows construction to commence. Before occupancy, a Certificate of Occupancy must be issued. / 14 4, ' ■ (Z /Z Planning Director Date Special Conditions. if any 24 hour no "-"7 ` inspections (952) 447 -9850, fax (952) 4474245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 e n/0 e CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 5.23.13 AND UTILITY CONNECTION PERMIT / I,� A / / � E S O ` / t/V l 2 . /4-1(4; 1. White File PERMIT NO( 2. Pink City / 3 4A alA 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS 1,4- Ptt.s.P- K-S 1 D F c N w ZONING (office use) LEGAL DESCRIPTION (office use only) LOT 3 ° BLOCK ADDITION `i �E`' IA) A ` � � f 1 PID '7,7. 4-I .030.0 OWNER `f'1 P. T P.M`t - > t ES 452- 896 — 6l28 (Name) (Phone) (Address) 12-CA WAS l-1- t t,l 6Ttl t---1 A vE S S"TI= 20 f t_.o l t l H N 43 9 BUILDER (Company Name) M k --1--- F 110-1 s r 4 0 t'' ES (Phone) (Contact Name) S U E E'1/4. (Phone) (Address) 1 l L S H l*J C i Ac v S STh 2 t --o t tv A, H 1`1 SSA 3 9 TYPE OF WORK 0 New Construction ' iDeck ['Porch ❑Re- Roofing ❑Re- Siding Lower Level Finish )ireplace ❑Addition ['Alteration ['Utility Connection CODE: ❑I.R.C. I.B.C. ❑ Miser Type of Construction: I II III IV V A B Occupancy Group: A B E F H I M R. S U PROJECT COST /VALUE $ ta i U Division: 1 2 3 4 S (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`-.. 1 _ E- 23-1 538b 5 121 l t 3 Signature Contractor's License No. Date Permit Valuation Z c b O , d Park Support Fee # $ Permit Fee $ ( 1. 2-5- SAC # $ Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $ State Surcharge $ A 0 d Pressure Reducer $ Penalty $ Sewer /Water Connection Fee # $ Plumbing Permit Fee $ 5344 S I Water Tower Fee # $ Mechanical Permit Fee $ Builder's Deposit $ Sewer & Water Permit Fee $ Other $ Gas Fireplace Permit Fee $ TOTAL DUE 3/ X.3 $ /(7. 75 This Application Becomes Your Building Permit When Approved Paid lar 1 Recei : ' . Skirg Date FAM B wo. 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 • • .1 . qs• • 1.1 . • • 07-03- 13 15:18 FROM- T-003 P0002/0004 F-003 DAD CITY OF PRIOR LAKE Date Rec'd a t 1P BEATING/AIR CONDITIONING/FIREPLACE PERMIT (../ 1 1, . t 4 iio L., i ,..,,„ ,,,, 1 PERMIT No. X Yellow Applicant MO 0,...n.,.....2 ittatatt„..._...,....., . ADDRE$S, , ' ZONING totiatut40 / 1 l' 5U(.9 vi. kide frior a hi . . • — • LEGAL DESCRIPTION corgis only) LOT BLOCK ADDFfION pm • _ - cs (ir NER amo___,Aatl / ((P1) _ (Addruss) . . ■•■•■•■■■•■■■•■•■•IIWw■■■■■■■■•••■•••.ny...a., APPLICANT I rig - /10 li 11,.. a _ _ i I,,, -------- 7 ---- 1::: (Nerrtel,_f ' ricf ' i - imm (Phone) _ViZU • (Address) 2 7 ..F V V ieW A tie N fowl /it / _AV 55113 (Mums* (Cith (alli:0S (Contact Person) )-- ea 1 /1 (Phone) / /— / 0 ' 7cr 1 di AN— APPLICANT SIGNATURE /4 AVafP ' ' DATE --- APPLICANT PLEASE COMPLETE BELOW ikf ';;IN CONSTRUCTION 1 REPLACEMENT OM-MATIONS . • FURNACE MAKE AND MODEL FUEL FLUE size RETURN OPENINGS INPUT OUTPUT TYPE OE SYSTEM HEATING OR POWER PIANT PLEASE NOTE: Mr Conditioner Wann Air Plants Steen Units and Fireplaces Cannot Incroiteh ' Gravity Hot Water info Required Side Yard Setbacks, Mechanical Radiation Condit Fireplaces with Box Additions or Air ioning [Went System H " ir: Cantilevers to the Outside of Buildings — Require a Bonding Permit. PiREPLACE MAKE AND MODEL SL5) FLE SCIUMULB industrial, Commercial & Multi-Family i% OA cost Residential, Oat Fireplace . $49.50 54930 raindrnum Residential, Meths/ & A/C (New Coneracilon) $149.50 Residential. Additions & Alterations PAID tAn11150 Residential, Beetkag Only (Now Construction) $64,50 ReSideutiat. AC Only v v I 50 eitALIDING PERMIT Bottmated coots Building Peach # The Minnesota SINN* f 314(t 148 "SURCHARGE" bus been dianiteil ror one ilEATING PERMIT PEE $ year affective STATE STIRCHARGB $ .50 July L $I& liblit June )11. :OIL TOTAL PERMIT pitz $ The minimum larch* fors 'lima l'eto• permit (Ontea the Only) ls 12, kW mil* July L 20 irlik Appliestflos Becomes Year Building Permit When Approved Paid - llectiptIgn. Date By • • Rastas Ottkiel Ws , • .. _ . . ....- . .0.••■• • 24 hour mike Inv an inspetilotta (952) 447455* fax (912) 4414245 4646 Daiwa Street SA, Prior Leke, Minneseta MI - ................-..............u-a ...0.—wan.ove, At • •-••••■ . ..........v-r.-••-•-•••■•••■..1.41,•,..... u .. f.....4 44.... •••••••••••• •• . • 9..... • • •• • • • wo..... %V ...no A . 0.0 tr. • •••••••.• •••••• .....A ••••• ••• ..• • •••■••• ••••••• • ••• ••••••••••• • ....• ••• ••• ..... • • •• O� PRf Date Rec'd H CITY OF PRIOR LAKE PLUMBING PERMIT 4 s 1 5` t . Gc i Cft PERMIT NO /) 2. Y e l l A pp I , `!y z 6 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING (office use) I LE Poki f .Ctt Coro -emu rpvS LEGAL DESCRIPTION (office use only) — T ' / LOT 3 BLOCK / ADDITION z S 14 - 44 4Y-60,176 74 PiD45- 7"79" -Q OWNER f i\ C C) CAI (Phone) (Address) ' APPLICANT • in r�. A. � � (( �- i ) J� (Name) ` LD A ' AA 4.LL - 1 1 A' (Phone) `"i � - `Q (Address) U ?OE (jJ • a ) 3 k ' n,, 1 I le 5s 33 (Address) (City) (Zip Code) (Contact Person) Me---Y t d C )U air() LI (Phone) -1 .0 7- 1 bs ! APPLICANT SIGNATURE i l . ll ' . ! L 111 4 DATE A APPLICANT PLEASE COMPLETE BELOW Quantity Type of Fixture Quantity Type of Fixture Bath Tub with or without shower 3 Rough -ins 1 Dishwasher j Water Heater 1 Floor Drain Water Softener 3 Lavatory (Bathroom Smnk) Stand Pipe (Washing Machine) Laundry Tray (1 or 2 compartment sink Sewage Ejector r-,) Shower Stall Backflow Assembly ! Sinks Backflow Assembly Test Bar Sink _ Sprinkler Water Closet (Toilet) Other FEE SCHEDULE industrial, Commercial & Multi- family 1% of job cost with a S49.50 minimum Residential, New One & Two - Family S149.50 (� II ii Residential, Additions & Alterations S49.50 The Minnesota Statutes § 326B.148 'st $ `='`- g�� Building Permit # "SURCHARGE" til l e has 3 0, 20 , been 20 13 extended 1 �f tended until June 3 PLUMBING PERMIT FEE $ -1 . SO a The minimum surcharge for a STATE:SURCHARGE $ ` On "Fixed fee" permit is $5.00 TOTAL PERMIT FEE $ 1 �q ST) This Application Becomes Your Building Permit When Approved Paid Receipt No Date By Botldlna Official Date PAID WITH 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -40U 1LD N t' PERMIT 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 CITY OF PRIOR LAKE BUILDING PERMIT. 1 1 1 11 I APR 1 1 203 I TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 'i:.... - AND UTILITY CONNECTION PERMIT Li i J .1~ ';. : ^. PERMIT N "Please • or • ' t and si at bottom ADDRESS zorsiNG !,:.frIce use, 1 4 LEGAL DESCRIPTION (office use 00.1 LOT BLOCK ADDITION MD --- OWNER (Phone) 952 - -2 toe ■ (Address) - 72.0 t WA, . TO NI A \JC . ,N1A '414.111jEic-ft ex vsreAt- (Company Name). 'FEE -.. u . r-peP__..4.-Ir:v.■ Se.z.vv...e.s, 1 C. (Phone) - 7( : Z. - 2- 7 h Ce - Po (Contact N'arne) I-1Am Keweg ,Phone) (Address) 11 1 10 1 STiz i AL_ alC(le NI° Surrg. TYPE OF WORK New ConstnIcnor. 0Dtcli 01 ORe-Roofing °Re-Siding 0Lowcr Level Finish 0 Flreace Addition °Alteration 0i:itv C CODE: MI.R.C. OLB.C. 0 Ninsc _____ Type of Construction: 1 II 111 1Y V A 11 Occupancy Group: A B E F II 1 M a) S U PROJECT COST/N'ALUE S 3 2- Division: 1 2 a) 4 5 (excluding land) i herehy certif that I have ft.rnithcd tnforthanon on :Ills ax wn. s te tht hed of n. knoa ledge true and :, 1 alss -citify mat 1 aro the owner or author:red agent tee the abmse•rnenturxd property and that ail construction wii ! conform to a's: rxisting state and lOa woks aftd .0 rrsxred ti a,:cldance w!h suttnitted plans ; Am ZW11.: dee the tn.: !ding 0 fr'.:4 c revoke ',Ito teems 'or just cause Fonnertriorr I netthv aret -AA: v c cr, wliva I or a de ma*, 'r .sin..7r 0 .1 prorer to ti.erMrre. needed insreettons zi X 6- wi S t ilkil .- 145 i 1S , iimature C a): I_Icrese Nr, Date Permit Valuation 1 Park Support Fee n : S Permit Fee 5 SAC 5 Plan Check Fee 1 5 Vv'ater Meter Se 5IS' I ', 5 , State Surcharge 5 Pressure Reduce S Penalty $ Sewer Water Conneci:Qn Fee u I $ 1 c Plumbing Permit Fee S Water -, Mechanical Permit Fee S Builder s Deposit 1 5 Sewer & Water Pit Fee $ Other $ Gas Fireplace Permit Fee 5 TOTAL DUE 1 . r-- 1 P 1 / 41° NINI‘ 1 This/ "ea • Be es Your Bruidiug Penni Witen Approved , Paid , ocOrS , ''''' -I, ' Date BO -- kOfrtethl. Date This u to centy thas the request in the above 0.71:canon and ACCellpamymg documents ri In accordance wttth tux CIN Zing OnIMAM and may proceed aS requeged This dOCUMent when signed by il,-e Cry Planner constitutes a temparar) Cernficate of lotung compliance and artow$ orte_st.r.t fe commence Before occupancy. a Certificate of Checupamy must he i issued Planning Direc - tor Date Special Coruintons. dairy ' 24 hour notice for all inspections t9S2) 44, (as 4952144 4646 Dakota Street S.E., Prior Lake. Minnesota 55:4"2 4 • ••• q° • 4 • • Y R1 o CITY OF PRIOR LAKE Date Recd A. ° r l Ve. HEATING /AIR CONDITIONING/FIREPLACE PERMIT I Pink 'frjNNE50o 2. Green City PERMIT NO . `,2 `7 - / i / r 3 Yellow Applicant ""I (PIease type or print and sign at bottom) ADDRESS ZONING (ofceuse) N3%0 Par ic-Ldt CcXY LuQ Pvs_Ato LEGAL DESCRIPTION (office use only) / / l ' 7 LOT 3 � BLOCK / A.DDITIONN .l iVei E 0> C 4bz J PIDO I J ' 030-o (Name) '`-�` r e ` f 1 ( C)Y l Y UC) CM (Phone) , (Address) APPLICANT U j� q).--)(0)--/?5,5 (Name) 4 W t ` U v f eci l l (Phone) (Address) d? _ )0,4 ,1 "e ) 3 (Addy s) (City) (Zip Code (Contact Person) 4 I' 1 $ - 0 I (Phone) 9? . r e APPLICANT SIGNATURE ® . 1 I .41A11..1 ( o .1 • DATE y / / 3 ( APPLICANT PLEASE COMPLETE BELOW ft.EIW CONSTRUCTION pill ( R � EPLACEM � ( ENT El ALTERATIONS FURNACE MAKE AND MODEL CIa1- I � 't st �� 1 FUEL FLUE SIZE RET OPENINGS _ INPUT c gic ,(..(XT OUTPUT 5 L t ) TYPE OF SYSTEM BEATING OR POWER PLANT PLEASE NOTE: Air Conditioner 1'••,kt. Air Plants ❑ Steam Units and Fireplaces Cannot Encroach '■ Gravity ❑ Hot Water into Required Side Yard Setbacks. hantcal L c Conditioning ❑ Radiati4ti ❑ 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, 1% of job cost Residential, Gas Fireplace 549.50 $49.50 minimum Residential, Heating & A/C (New Construction) $14950 Residential, Additions & Alterations 549.50 Residential, Heating Only (New Construction) $64.50 Residential, AC Only 349.50 Me Minnesota Statutes § 326B.148 :ost $ `k QC) Building Permit # "SURCHARGE" has been extended /"� until lune 30, 2013, HEATINr r PERMIT FEE $ (Li `1 , 5 The minimum surcharge for a STATE SURCHARGE $ 5 "fixed fee" permit is $5.00 TOTAL PERMIT FEE $ / S lI , SD This Application Becomes Your Building Permit When Approved Paid Receipt No. Date By Building Official Date 24 hour notice for all inspections (952) 447 -9850, fax (952) 447-4 F' i4 ND y �' 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 P�R��-�- 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 6-z7-0 PROPERTY ADDRESS: 14386 PARKSIDE COURT ACCEPTED BY APPROVING AUTHORITIES: CITY OF WOODBURY ADDRESS: PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS YES 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: YES LINO 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 2012 1/2 10 155 SPRINKLERS RELIABLE RES 44HSW 2012 1/2 13 155 RELIABLE F3QR 2012 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 (, 147 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: ❑PNEU MAT IC ❑ELECTRIC ❑HYDRAULIC PIPING SUPERVISED OYES ONO DETACHING MEDIA SUPERVISED OYES NO 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 IPFRVISION I OSS Al ARM OPFRATF VAI VF RFI FASF OPFRATF 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 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 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 _g_HRS IF NO, STATE REASON DRY PIPING PNEUMATICALLY TESTED OYES ONO 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? OYES NO DRAIN READING OF GAGE LOCATED NEAR WATER RESIDUAL PRESSURE WITH V VE IN TEST CONNECTION TESTS TEST SUPPLY TEST CONNECTION 4. .. 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 'EYES ONO OTHER EXPLAIN FLUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING OYES 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 ONO IF VFS DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR-3? SPIES 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? :I YES ONO CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL CUTOUTS (DISCS) ARE RETRIEVED? OYES ONO HYDRAULIC NAMEPLATE PROVIDED IF NO, EXPLAIN DATA YES ONO NAMEPLATE REMARKS DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: t - �7_J3 NAME OF SPRINKLER CONTRACTOR: FIRE SUPPRESSION SERVICES, LLC. TEST WITNESSED BY FOR P r P" Y 0 • ER (SIGNED) 0,117 D E SIGNATURES �( ' ' C ® ,I � �4i�� 1� 'GA �� _ / /� ' R S - y s ED) 6'� TITLE DAT - _ 6 ■ ADDITIONAL EXPLANATION AND NOTES I PRI ° � Builders Deposit 4fZeNTArEs0 y 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 $500.00 Tree Deposit may also be required and will be refunded if specified trees are preserved for a period of one year. By signing this I, the undersigned contractor, acknowledge that I am aware of the erosion control requirements of the City of Prior Lake as outlined in the Erosion Control Measures for Building Contractors handout. DATE: SITE ADDRESS: 1 49 -3bk °�� -u-s' o z fJ w PERMIT* REFUND TO BE MAILED TO: M im M`r 4-1-o r—t E$ 12 t ICI SN NV E.. S SU rrE Zo I t i�l t t u SS Li3 9 AUTHORIZATION TO RELEASE PLEASE REMEMBER / 1 1 560. d0 , S. 1/1 -n, Building Services Amount 1. KEEP STREETS CLEAN DURING CONSTRUCTION Acct. 801.20204 2. KEEP EROSION CONTROL IN PLACE date 3. TEMPORARY OCCUPANCY PERMIT MUST NOT EXPIRE OR $500.00 WILL BE FORFEITED SIG NATU RE ECURITY ICON. THE FACE OF THIS DOCUMENT HAS A COLORED BACKGROUND ON WHITE PAPER AND ORIGINAL DOCUMENT SECURITY SCREEN ON BACK WITH PADLOCK S 1876 Mattamy Minneapolis Partnership 7201 Washington Ave S., Ste 201 Edina, MN 55439 19 2D 12- 58 402 -.Za PAY TO THE G � R:2 1a2— i r a ed iestures ORDER OF 28 1 o p DOLLARS o =L b.& let � - 11-10 � k-10 OS-AND Po U CZ- ! }UnIO T rinlO Wells Fargo . 1111 P MEMO 1100 i8 ? 611' 1:0530002191:200004231.102?" :0 5 3000 2 Ir 9I:20 4 2 3 ' L L0 2 ?" C:IDocuments and SettingslsbarelLocal SettingstTemporary Internet Files\ Content .Outlook1BD80XI9AIBUILDERS DEPOSIT FORM.DOC PRIOR LAK DEPARTMENT OF BUILDING AND INSPECTION INSPECTION RECORD SITE ADDRESS /#30& /d4aco moo e`. NATURE OF WORK +• , ..�' USE OF BUILDING PERMIT NO. P • .2� DATE ISSUED CONTRACTOR As/ . LLL1J Sea rl •+ PHONE .11,111rTio' NOTE: THIS IS NOT A PERMI FOR ANY OF THE INSPECTI • NS BELO% THE PERMIT IS BY SEPARATE DOCUMENT Install erosion control & maintain clean streets times. DATE FOOTING 1 I FOUNDATION (Prior to Backfill) � I PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED Radon system under concrete slab rrRlOUrG H - INS SEWER / WATER / SEPTIC L r FRAMING ; INSULATION ELECTRICAL PLUMBING, < . t! }t (L 4 t HEATING (if required) s7fe� FIREPLACE ' GAS LINE AIR TEST /,')),,„ =r / /1 , / Zadon piping COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED >ystem. Housewrap 1 Fire Sprinkler ti PO ,� /;FINALS , :( -r I , GRADING (Prior to Sodding) BUILDING c7� - . 7)- (., ELECTRICAL PLUMBING �l 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