Loading...
HomeMy WebLinkAboutBuilding Permit 12. 1428 + 13.283 � F r >a .0 n., i u f ,, nl y o � y � , � u t ✓u �r� �1 l dpi ��M2��z "� v i..rr _. .r _. n.u_ i._ .. _. 33 . . wN, r r r , M. � r ti . � � t s,� r � I ..rd _. r M . ti .1Y ., it dY : 4Y . r rurf' . rru i _. Yru it � Y ul� q rI M � � rr mj i �' rr i � _. m , ❑ _. r�n _. r .n., Y.. _, J _, y�yy�� Olt rtifiratt of (fir p v v .- _ PRIOR LAKE ,r CITY OF !:trpartturtlf 1 f ui tbin ciJx tsprxtion ❑ Fi nal Permitted ❑ Conditional C.O. Expires d ursuant to the requ of Section 110 of the Residential /❑ Internat `� This Certifi ierue p Nance with the various ' Code certifying that at the time of issuance this structure was in comp Building i £ of Prior Lake regulating building construction or use. For the following: ordinances of the City f Bldg. Permit No.,_____ a ° F p1 l�l �, = Use Cl a s sification ,� ,l '' Zoning D i strict �� L Type Construction O ccupancy Type Y � Legal Description cR Site Address i - Owner of Building Contractor's Name & Address ,,;117C : a ' n� t n T 11 P! ri r t- I I N F) City Planner e 1 Building Official ' f i `7` , / Date: ] Date. / POST IN CONSPICUOUS PLACE , ./ r lpA I � u� t hU. �Tw � � Y.4� I a ih �/ 'Y':4.)4' � � � � � ;� ,' � 'y 11 1 Id r ,', � .. � S N „ r m,. ;' ;,' " 4 l iii 1 III j , ''", $ :'", w ",,''' MNr �{N i;' ,',i2 " y A � pG '''Y''. . s� R d11 A n U I ' � :JM "� ' ay N r ny�a ' qF. - '1''''W''' ' Y . / " ui i z zw _ J o"� t� oc > vS c � 00 Z + 3 55 J a o ❑ 0[700. oC v t J O N c u . W SL.-, z m C 0 ! a .d J 0 O ° W 5 tit 0 O a F' d a Z Y i W A N k 000 N Z °C 0 0 tu 0 0 W to r K re to = W W W W W 0 \ V . 2=111z 11/ 0 0 Z N cd a a3 N a Te LL 1- o a ❑00000 1 Z < 0 et 14 a o It < 0 4 4 I a Y V 0 • vj y v V J W oG ° cn Z o d ° u cn g N z � °Z ° ° ° r re N f- ZZ12W 0 OW Z 0 y, 0 135 < 0 a 000000 0 Z 1 ti> a w su \ a w w > u.i00 o .4 mt ° gggZ v Z J U � o as r TLL ti 0 m w4 o w co S (''� ❑a ❑ ❑ ❑❑ � 1 o z o f' 7t) m o w iu z v v t ` � z x acLL � k, j w N ° o 0 ) Sg Z a S p Z re w miw w W a 11.1 t r tyy N 0 a 2x ' V U u.1 oC a- 'g 3 Na � J a o x -- ❑ ❑C]❑❑' c v a z Q o c v z f,' ( N U ti a ill 11,1 g 0 o z W 1,... + p g S: p p < Z � W N o �' IL V W W N �' p W OG W x 0 LLu 0 U Z Q 0 p ❑ ❑ ❑ ❑�❑ 0 3 CITY OF PRIOR LAKE BUILDING F ZOrL G C _ `+CE k,..._./ k,..._./ ��. � TE�IPORARY CERTIFICATE z d " AND UTILITY CONNECTION PER_�II,. ; ,} :y \ \\ 1 , <V1vESO 1. White File PERMIT NO. / 3 . Peak Qry 3. Yellow Applicant • ZONING (office use) (Please E e or Tint and sip at bottom) ADDRESS t`1396 a" -S t n LT new LEGAL DESCRIPTION (office use only) PID 2S'��1 ° 0 0 .5-Z) � E �tLS W P.---T-E--12--r-7-0 rvJ --t LOT 32 BLOCK t ADDITION (Phone) OWNER l l a - T1 -- T A. M "1 . U t---1 S (Name) E=0 t t\1 4\ M 1 ' 1 S S `a• 3 9 (Address) 1� t w p S V4 l� 6 A v e, s S"t� 20 i (Phone) BUILDER M�- i t�r-ty - v t"' ES (Phone) (Company Name) (Contact Name) S u S ST-E- 7 <I t n--0 l Ni ' t t.� � 5 � 11-.4 �"�� POIS (Address) Fireplace New Construction Deck ❑Porch ❑ Re- Roofing ❑Re- Siding ❑Lower Level Finis ❑ P TYPE OF WORK Addition OAlteration ❑Utility Connection 0 Mist: I B.C. t U l O bd CODE: QI ❑ " I II III IV V A B PROJECT COST /VALUE S Type a Construction: A B E F HI NI R S U land) (excluding Occupancy Group: I 2 3 4 5 agent for the Division' I also certify that I am the owner or authorized ag knowledge true and correct I am aware that the building furnished information construction a this conform t o which is to the best of my ceed in accordance win Pub submitted plans. I am i a tu• I hereby certify that I have furnis ee may enter upon the prop and that all construction °"ill e, I hereby agree that the city official or a designee � above-mentioned property �� 2A3 S official can revoke this permit for Just cause. Furthermore, Date e� �—�re Contractor's License No. X� w � J Signature # Park Support Fee KIIIIIIININII Permit Valuation t '- O C��' $ t3 Co 1 $ 56). Water Meter Size "i $ 1116 11061 1 $ $ 2-0. - IrilljNIIIIIIIIIIII Pressure Reducer Sewer /Water Connection Fee # $ t po, - Plumbing Water Tower Fee # $ \ tlO�. Permit Fee $ ( ° Builder's Deposit $ t Soo 1 $ O $ o S t S� $ 56. co Ot Plitt 4 e 1k5 $ t :, 41.18 TOTAL DUE Gas Fireplace Permit Fee $ 5 " • S° � ved Paid '�r�d�� B �� MNININ 1 This App • • lion B I !' es Your Building Permit Whe App Date l l' I at Buildin Offici• 1 Date Ordinance and may proceed a C as reQu cate estOcced. This document ado vets • m accordance with the anti ertifi es upancy must be est in the above application and accompanying of Z oe, c flan an d allows construction City to co Zoning mmence. Before oco p This to e • ; ,, at the o Certificate of Zoning P th City ,•�; per onstitutes a temporary when signe/ 4 / issued. II / �2— 'L 1 Spec Conditions, if any Date 4�7 t�45 Planning. Director (952) 447 -9850, fax (952) ---"".11111111 notice for all inspections (95 -) 'Minnesota 55372 4646 Dakota Street S.E., Prior Lake, ( 1S;IA Date xec u o� r n 1 p� CITY OF PRIOR LAKE BUILDING F ZONLV COMP PERMIT, I �� CE 61-7 CA TEMPORARY CERTIFICATE ITY CONNECTION PERMIT �� � AND LTI �/ L� 0/ /1 (4 Z;.? v ,�rNNESpSe' 2. White C ity. P ERMIT NO. 3 �',0 3. Yellow Applicant ` ZONING (office use) (Please 4 e or Tint and si + at bottom) ADDRESS D E CD v (2---1— ADDRESS � 4 '> 9 Q LEGAL DESCRIPTION (office use only) PID LOT 32 -BLOCK k, ADDITION J' --v-S k/J P--" i (Phone) 9 S2' 9g8 - too (Name) � R T � ►� M `� -1-1 v t OWNER In ix 20 1 E=0 t h.1 �R N N SS 439 (Address) 12.c:.1 1./•-/ A S 14 l t4 6 ` " 4-1 A v E S 9S L _ �9g , V LS (Phone) BUILDER M �t 'r`i l�r�t tea ES (Company Name) (Phone) (Contact Name) S v t S'� -t) l M 1.-A SS�43� (Address) Fireplace New Construction .Deck [Porch ❑ Re- Roofing ❑Re- Siding �`I,ower Level Finish ❑ P TYPE OF WORK D Addition ❑Alteration ❑Utility Connection ❑ Misc: I B.C. V A l5 , 000 CODE: I.R.C. I II 111 IV B PROJECT COST /VALUE S Type a Construction: A B E F FI I M R S U land) Group: 4 5 (excluding Occupancy 1 2 3 Division: that I am the owner I or authorized aw agene but for the llCatlOn which is to best of my lmowledge true coaect. I lso certif7+ tans. am are chat thildin g hed information on this app ee may enter upon the property to 1s0 nee l� � cti°ns. I hereby anti v that I have fume the 1 ` t o and that all construction will conform t a � e that the city official or a design wtll proceed and in accordance a with subtrutte p above mentioned property ore, I hereby S E 2c)2-S1 S3a>� official can revoke this permit for just cause. Furthermore, Date �� Contractor's License No. R Signature Park Support Fee # Permit Valuation - Pressure Reducer - Sewer /Water Connection Fee # Water Tower Fee Plumbing Permit Fee Builder's Deposit Mechanical Permit Fee SS Other h - ' - � TOTAL DUE r V Gas Fireplace Permit Fee Recei � N • . •,Y `I 5 Z P aid / L " (nation Becomes Your Building Permit When Approved , , 1 C ,. I B ■ This Application Date I Bu Date Official Zoning Ordinance and may proceed as requested. This document that tity P an ne in the above application empor ry and accompanying Zoning g compliance is m and c with the City Zoning Certificate of Occupancy must be the City Planner constitutes a temporary Certificate of Zonmg compliance and allows construction to commence. Before occupancy. This is to certify when signed by issued. Special Conditions if any Date Planning Director 447 -9850, fax (952) 447-42 24 hour notice for all inspections (952) 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 ?■.'k rea ,- T-003 P000410004 F -t}a3 pry �7 -�3 - - ' 13 15:18 FRS[- (°_,./ ; CITY OF PRIOR LAKE Date 'Reed . Rr° , MATING/AIR CONDITIONING/FIREPLA TCIFYTtEPIAC PERMIT y -i . iik 1.4 A , (••• 1 t. ' . ya1 w R ant 0 : r 9 ,.0 „.c atut WWtta= TViii0 a reside. Cr -101.' Loki a 20NINo (05:„ 04 • LEGAL DEBCII TION office= only) P1 LOT BLOCK ADDITION War et 0 1 11 a -. _ (Phone) • (Address) �j • PLI 4; AP CANT i v c s r e 4 ( Phone ) Name 00 (Address) (Address) i (C; iZif — {Phone) (Context Person) �> s�. • bATB - A r , .._. s • APPi ICAN'P SIGNATURE 010' . 1d ® APPLICANT PLEASE COMPLETE BELOW >s CEME 0 ALTU ATit7NS . • �+' SW CONSTRUCTION © R FUEL I+t11tNAt� MARE AND MOa� INPUT OUTPUT' FLUE SSE RETURN OPSNIl+iOS VirPE OF SYSTEM IDWITNO 4RpO 11LANT ILEASEN(1TB: Mr Conditioner steam Units and Fireplaces Cannot Sucrose% ■ u o arm Air Plants Hat Water into Required Side '9f and Setbacks. II s vity Radiation Fireplaces 'with Box matting or °Vent. S i to Di' i p Cantilevers to the Outside or Buildings Air Cantliti�h+8 Require *Building Permit. Ythpt� FIREPLACE MAKE AND MODEL FEE SCHEDULE Residential, Gee F replace 9.SQ Industriel. t^,amrnaci de Mnki�Famtly I% Gr ID 1hliTH :a4.�o $ 4.5a minimum Residential, Additions & Aiteratl Retidrnti ,Kest O ft A/C n1 (Now o n ) $6 44 4.3 0 Residential, AC only BUILDING P E Residential, Beating Beating O5► New Consultation) tm) 1;64 Estimated Cast Building Permit # he Mi rwt nsa P%" hiss exStatute # 32611 to "SURCUARC btxn changed for urge FEE you ciTwxttic I�'rrNCa >�>wl� t3 Jane .so July ,, Ma, mail a� w , i. STATE SURCHARGE -Ile nJu I stM tam 3 0 � " permit TOTATAos 1V[Xi'� PEB k re ii srg Mils. , u lin f boi (Ocoee vu O1 br) Pahl lteceiptNQ. This Application Steams Your Budldittg Permit Y Approved ptile • • Oats dtexOttiaht 441.4246 34 heunoise krla streets Prier L peseta 55312 Date Recd CITY or PRIOR LAKE r R? ° , TI /AIR CONDITIONING/FIREPLACE PERMIT NO. 2 $ t o ct PERMIT .. 1� '6 2. Green Cit P 3. Yellow Appliee �r NNEs ZONING (office use) Please r e or . 'nt and si: n at bottom ?USJ ADDRESS L os P cw K-adt. - ,71- LK) LEGAL DESCRIPTION (office use only) f ,, �� PM p ? Jt. [�IS "�' ` • LO��' BLOCK/ ADDTTIONCS �'(/r41��`r'' OWNER • 1'! jir (Phone) (Name) (Address) , r( � A( (Phone) / /— � (Name) V v d _ ) 1 f i •^ (Zip Code / . (City) e (Address) ( Addy s) / n 11' ) 11 . ' a r (Phone) /3 (Contact Person) �' DA TE APPLICANT SIGNATURE ,APPLICANT PLEASE COMPLETE BELOW ALTERATIONS FURNACE MAKE AND MODEL �eR".. CON TRUCTION • REPLACE NT c ❑ FUEL B� - 53 3 +L► � / ' ` ' f ID5 INPUT S �� OUTPUT _ . RET ' � OPENINGS FLUE SIZE SATING .OR FOWPR PLANT PLEASE NOTE; Air Conditioner TYPE OF SYSTEM ❑ Steam Units and Fireplaces Cannot Encroach Air Plants ❑ HotWater into Required Side Yard Setbacks. Gravity 0 Radiation Fireplaces with Box Additions or �a +'it• hanical ❑ Special Devices Cantilevers to the Outside of Buildings ±!_, ent. System [] Other Devices Require a Building Permit. Went. System FIREPLACE MAKE AND MODEL FEE SCHEDULE $49.50 Residential, Gas Fireplace 1% of job cost $49.50 Industrial, Commercial &Multi - Family $49.50 minimum Residential, Additions & Alterations $49.50 New Construction) $149.50 Residential, AC Only Residential, Heating & Only Construction) $64.50 Residential, Heating Only (N ' L3qC1 r, _ U Building permit he Minnesota Statutes § 326B.148 :ost $ "SURCHARGE" has been extended until Yune 30, 2013, H EATR 4 G PERMIT FM ' ` The minimum surcharge for a STATE SURCHARGE s / $ r ' � "fixed fee' permit is $5.00 TOTAL PERMIT FEE No. This Application Becomes Your 'Building Permit When Approved Paid Receipt Date _la l Dtte PERMIT euttdtneof0�a P 24 hour 646 Dakota Street sE � Prior Lake, Minnesota (952) 447 -4245 BUILDING 55372 Date Rec'd 0 V � 0 � CITY OF PRIOR LAKE PLUMBING PERMIT 0 F t F ir PERMIT NO. � 2 - /2y , �p z G° c 1j� ). Ydew AppliC " ZONING (office use) cease j or t ■ and si: at bottom yy �V� P� S A - ADD • - C 'I�'" LEGAL DESCRIPTION (office use only) �° PID o� /V , (' – ° LOT LOCK 1 ADDTTION C' � eiS - 1-r0i+ ' b% A/ (Phone) OWNER (Name) V1� _ �L / ;� 1 - • - (Address) APPLICANT (�� • II le 4A (Phone) 3 ✓ / (Name) � / ��� 1 (Zip Code) (City) (Address) (Address) • + , � 1 (Phone) � ^ (Phone ' 7^ • 1. 1 ,, • (Contact Person) r, /1 .4 DATE J• _ APPLICANT SIGNATURE I A , . l'g 1 — L APPLICANT PLEASE COMPLETE BELOW • multi ,r a of Fixture . T . e o[ Fixture Rou.b -ins MM. Bath Tub with or without shower allgillill Dishwasher Water Softener IIIINIIIIMIIIIII Floor Drain Stand Pi • ashin Machine ®�� Lavato ath 1 o Sink Sewa_e Sector Laura i Tra 1 or 2 com • went sink Sewa: e w Assembl r'� Shower Stall BackfiOW Assembl Test Sinks 1111.11.111 Bar Sink Other �� Water Closet Toilet FEE SCHEDULE Industrial, Commercial & Multi-family ] % of job cost with a S49.50 minimum Residential, New One & Two-Family S 144.50 Residential, Additions & Alterations $49.50 1st $ A Building Permit # The Minnesota Statutes § 326B.148 � ��, "SURCHARGE" has been extended PLUIBG PERMIT FEE S __ until June 30, 2013, 5 STATE SURCHARG The "fixed sur is 5 5 for a TOTAL PERMIT FEE $ ( �� "Fixed fee" permit is $5.00 Receipt No. This Application Becomes Your Building Permit When Approved Paid Date By PAID WITH �,ee Date u \ • - Radian Official 447 - 4245 24 hour not 8 Dakota e for a t Street S .E. , r or Minnesota 55372 4b46 D Sreet SE- r+ 1 F `\r j 5, C, ` 1 ?053 - • S° OF PRIOR LAKE BL''ILD1'NC,' PERMIT. Date Ree 3 11 ii c��IPLI,�c:I l', l APR r: � ; ; , CITY OF ZONING C' I �L r�, �-�'�P()12.�R1, CER'�IE Ic.aTE � � 1'F.R�Ii'T A,ND UTILITY CONNECTION 1 a.___Ez.... 1 y _ , f I R�,ii� __ t' €case_ 1 S rsnx and st ea tx sxxumt_ . XDLI RI?. — 11.,. It f ° t > t t _ y '...__ — - -------------- ___ _ ___— LEGAL DESCRIPTION , ofta-e use or..1 - � LOT BLOCK C }CI OWNER v M3 v '.e;) .— — .7 ,t,. Cl pns..ne f Y x TYPE t)n u0 A , . , '0- .. �.+rmea,+r OF V4CfRK ; ,itc. CODE: I.R.C. OLB.c, 0 'Y "AL1 E S 3 I p 111 IV 1' i1 B PROJECT LU Type of Construction: F H I V ' (cx T CO tand) nc'r' Group: A B E 2 3) 4 5 _ 111__1— r Occup f rt a, t_ ri a ..- ��.___. -.- ,1111. � � AM w :e ....z. . _. � 4 t 54T 3 � t« 1? f1 ez., h r z , bn si - Y x � , e i:z ,t , stiF.'rm e ,, n :e , Alt,:.--h x , n 1. , ._, Signature C. �t i � w 3 dry t 3KM � 1 i �: tt g• •zr. 41•11 <+,y . k�r . _ , .e . . Palk Supp Fce - Ijertr' Fee t ': .Atertety. { . -- - l cc it S t �.:eck�..�.ca I'errxxst Fee Other 1, ^� Sewer. ;k.:t "ater Perrot Fee ; S 7 ther '1.. DUE .... nit Fee Gas Farr:ace ' ; E'at�i Alt f carton Becomes our Snifdin� Permit When AppTOS' 4 Pate s __ . ___ __-- ---- -- �� r -- ' /( $us.z +.t'i � 9tc.sS� + � . > - r and a iav , (h. •- w � �,ir � �r� ._. aze t G - '� a urtr ` .y Za, r.c.�, 4 is , ,3C J z1 e ++ [ te!,.r. x. � a Sit¢ tUte trIlW e ant a > ^ r ttyt t , ,,, __ -, +r v a , . a �.a. r �.a..a:t , ..a�; a.x.mp;,e xnd xt - +zws e r � czr` "^ that x�c 2C�:xC3t 21 F, r*: _ - z�r C;,;, t'E,wtscr :sms:etu ^e > ::�.,ae.`. _-_ _--- -- vim•.. •n• i. te J asa +tea. ct,x .. q A:¢ ._-------- -"'"_. a 45.1 d3' -.3: «4 hour notice for x inspections 0051) 44' "4!t -fY" fax i a4ws F;r.ai tg L) rcccrar 4b4b t >akots Street ki.I Prior 1..a1c, Minnesota fise *. • Contractor's Material & Test Certificate for Aboveground Piping PROCEDURE Upon tests shall be made by the contractor's representative and witnessed by an owners representative. All defects shall be corrected and nd system stem m left in se on s i and o and service before contractor's personnel finally leave t job. prepared for approving authorities, owners, and contractor. It is A claim against re recontractor for faulty mate o poor and contracto or failure to understood t h e shall w filled out and signed signature both representatives. wayvee. di Copies any im be again wne n r. understood the owner's representative's signature in no way prejudices any comply with approving authority's requirements or local ordinances. DATE 2T' 3 PROPERTY NAME: JEFFERS POND PROPERTY ADDRESS: 14390 PARKSIDE COURT C OY OF WOODBURY III ACCEPTED BY APPROVING AUTHORITIES: ADDRESS: ®YES ONO INSTALLATION CONFORMS TO ACCEPTED PLANS YES ONO IF NO, EXPLAIN DEVIATIONS APPROVED ❑NO HAS PERSON IN CHARGE OF TO LOCATION OF CONTROL VALVES AND CARE AND MAINTENANCE AS OYES OF THIS NEW EQUIPMENT? ®YES ONO EVES ONO IF NO, EXPLAIN INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: OYES ONO 1 . SYSTEM COMPONENTS INSTRUCTIONS ®YES ONO 2. CARE AND MAINTENANCE INSTRUCTIONS 3. NFPA 25 ENTIRE BOLDING TEMPERATURE SIZE OTY. RATING YEAR OF S QTY MODEL MANUFACTURE TI MAKE 1l2 12 RELIABLE 155 RELIABLE RES 49 2012 1/2 15 RES 44HSW 2012 SPRINKLERS 155 RELIABLE F3QR 2012 1/2 1 Type of Pipe BLAZEMASTER PIPE AND Type of Fitting CPVC MAXIMUM TIME TO OPERATE DEVICE FITTINGS THROUGH TEST CONNECTION ALARM ALARM VALVE OR MODEL �_- FLOW INDICATOR POTTER FLOW INDICATOR - Q.O.D. DRY VALVE .® MODEL SERIAL NO. MODEL SERIAL TIME- ALARM WATER REACHED OPERATED TIME G TRIP WATER AIR TRIP POINT TEST OUTLET* OPERATED DRY PIPE THROUGH TEST ® ®® NO OPERATING TEST CONNNECTION* PRESSURE PRESSURE AIR PRESSURE w/0 -_ Q.O.D. . ■-- W Q.O ITH .D ________________________ IF NO, EXPLAIN FLOW RATE FLOWING Nia LOCATION MODEL RESIDUAL PRESSURE FLOW (GPM) & FLOOR 111111111111111111111 INLET (PSI) OUTLET (PSI) PRESSURE INLET (PSI) OUTLET (PSI) REDUCING VALVE TEST N/A IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII OPERATION: O PNEUMATIC ❑ELECTRIC ❑HYDRAULIC PIPING SUPERVISED OYES ONO DETACHING MEDIA SUPERVISED DOES VALVE OPE CUIT RATE FROM THE MANUAL TRIP AND /OR REMOTE YES ONO CONTROL STATIONS DELUGE & IS THERE AN ACCESSIBLE FACILITY IN EACH CIR OYES ONO PREACTION FOR TESTING VALVES IF NO, EXPLAIN N/A IMI OYES ONO DOES EACH , CIRCUIT OPERATE • DOES EACH CIRCUIT MAXIMUM TIME TO _® MI NO IIIIIIIIIIIIIIIIIIIIIIIIMI MN NO HYDRO JI(i Hydrostatitest shall be made at not less than 200 ps m e xcess of 150 psi (10.2 bars) for twp hours. Differential d Aboveground piping leakage shall be stopped. ( cars) fa two hours of 50 psi (3.4 bars) above static Pressure TEST DESCRIPTION TI rY P pe valve clapars shall be left open durin test to prevent damage. All Establish 40 psi (2.7 bars) air pressure and measure drop, tanks at normal water level and air pressure and p which shall ict shll exceed not exceed psi 10 1 bars) 01 hours. Test measure air pressure drop, which shall not exceed 1 -1/2 psi (0.1 bars) in 24 hours. ALL PIPING H YDROSTATICALLY TESTED AT DRY PIPING PNEUMATICALLY TESTED PSI FON �H RS IF NO, STATE REASON EQUIPMENT OPERATES PROPERLY OYE O NO EVES ONO N/A DO YOU CERTIFY AS THE SPRINKLER CORSICALS, IM SILICATE OR DERIVATIVES OF SO DIUM CONTRACTOR SILICATE BRINE , OR OTHER ADDITIVES CORROAND SIVE CROHEMICALS IVE CHEM WERE NOT SOD US U ED FOR TESTING SYSTEMS OR STOPPING LEAKS? CI YES ■ NO DRAIN READING OF GAGE LOCATED ^ N c EAR WATER RESIDUAL PRESSURE WITH VALVE IN TEST CONNECTION TEST SUPPLY TEST CONNECTION V�.z PSI CONNECTION OPEN WIDE 5 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. 858 FLUSHED BY INSTALLER OF UNDERGROUND ®YES ONO OTHER EXPLAIN SPRINKLER PIPING RYES ONO IF POWDER DRIVEN FASTENERS ARE USED IN OYES ONO IF NO, EXPLAIN TEST NGE BEEN SATISFACTORILY ICOMPLETED? BLANK TESTING NUMBER USED GASKETS 0 LOCATIONS NUMBER REMOVED WELDED PIPING OYES ®NO DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS 010.9, LEVEL AR -3? WELDING DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN ®YES ONO COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL ARC DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A ®YES ONO QUALITY CONTROL PROCEDURE TO INSURE THAT ALL DISC ARE RETRIEVED, THAT OPENINGS IN PIPING ARE SMOOTH, DOCUMENTED REMOVED, AND THAT THE INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED? CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL ®YES ONO CUTOUTS (DISCS) ARE RETRIEVED? HYDRAULIC NAMEPLATE PROVIDED EMS ONO DATA IF NO, EXPLAIN NAMEPLATE OYES ONO DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: -7 NAME OF SPRINKLER CONTRACTOR: FIRE SUPPRESSION SERVICES LL TEST WITNESSED BY SIGNATURES FO ROE D ER SIGNED " TITLE D TE Gngyel-' 4/4-ele F. " TRACTO- Z7 ■ K (SIGNED) TITLE .�:_ DA E ADDITIONAL EXPLANATION AND NOTES Z7 -4? o (Q �{ o P{ Builders Deposit 7 v City of Prior Lake , s A $1,500.0 Builders Deposit is included in the Building s not an escrow account.) All exterior it ms inctud ng bu0t to insure compliance for a Final Occupancy Permit. shall be complted 18 not limited to grading, sodding, landscaping, tree planting, f the work is not complete t h paintin the180 day time period, the days after the date the building permit 1s lssu ed or the $1,500.00 City shall notify the applicant of the violation and the applicant shall have 10 days to comply builders deposit will be forfeited and the applicant will be billed for clean up or corrective work to rectify the situation. for a period of A $500.00 Tree Deposit may also be required and will e refunded if I am preserved trees are of the erosion control one year. By signing this I, the undersigned c requirements of the City of Prior Lake as outlined in the Erosion Control Measures for Building Contractors handout. DATE: SITE ADDRESS: \ 1 -k 2 '9 O R°-" -S 1 D C3 kJ VNI PERMIT # REFUND TO BE MAILED TO: II - 1---I-C ° ES - 12-o t 1,N/ ASl-} t1-.16Tot,r PO/ E_ S SU 1 ZO t t 1 I 1-t SS 43 9 AUTHORIZATION TO RELEASE PLEASE REM EMBE E A(, Sob. 60 _,ynda S. A L—* en, Building S Amount !G. ?. 13 Acct. 801.20204 1. KEEP STREETS CONTROL RNNPLACE CONSTRUCTION Date 2. KEEP EROSION 3. TEMPORARY OCCUPANCY PERMIT MUST NOT EXPIRE OR $500.00 WILL BE FORFEITED SIGNATURE: THE FACE OF THIS DOCUMENT HAS A COLORED BACKGROUND ON WHITE PAPER AND ORIGINAL DOCUMENT SECURITY SCREEN ON BACK WITH PADLOCK SECURITY ICON. Mattamy Minneapolis Partnership 1876 7201 Washington Ave S., Ste 201 Edina, MN 55439 DATE `)..e— 19/ ` 0 12 PAY TO THE //'- SB LW_ ORDER OF �/► ,'� OF ttz-1 otZ— � n s.wm, mewres Ie1 C---r-e-- �t 6t-1T - B-10 t1S�,NiD coop --- -�UN Two 9-3 /DO DOLLARS o o gt. Wells Fargo gi MEMO $ 11 11376 1:053000 :200004231 L02?" / C :\Documents and Settings\Sbare \Local SettingstTemporary Internet Files \Content .Outlook \BD80X19A1BUILDERS DEPOSIT FORM.DOC P R I R LAKE DEPARTMENT OF BUILDING AND INSPECTION INSPECTION RECORD SITE ADDRESS • r A t At ' 11) 6 a • NATURE OF WORK At. .tom rrJl�ACil/' fv � USE OF BUILDING S .r PERMIT NO. C • = DATE ISSUED CONTRACTOR 40/ ;71. •ic1 .L : it 0 PHONE . %irgi NOTE: THIS IS NOT A PERMI FOR OF THE NSPECTI • NS BELOW THE PERMIT IS BY SEPARA TE Install erosion control & maintain clean streetgis, Tall times, DATE I FOOTING 1 1 I 1 FOUNDATION (Prior to Backfill) 1 1 I PLAC Nff?? CONCRETE UNTIL ABOVE HAS BEEN SIGNED vt5 ete Radon system under co � ict slab mama H - I N S SEWER / WATER / SEPTIC FRAMING - g,-(1; INSULATION ELECTRICAL j p f, ) , PLUMBING Yr.-, (J r /0O r f ' #(7 HEATING (if required) - - i_3 FIREPLACE 04, '^ 7, GAS LINE AIR TEST ladon piping COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED ;ystem. I Housewrap Fire Sprinkler FINALS -6, „,.*,, 74 (3 fiA., . GRADING (Prior to Sodding) BUILDING 4. ELECTRICAL PLUMBING Pji, V l3 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 (9521 447 - 9850