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HomeMy WebLinkAboutBuilding Permit 12. 1283 + 13.423 C rrfi ttaf� of ®r pr tru , r \\ CITY OF PRIOR LAKE !prfnuxt1 of uU UMtxtj jixuspi fii u ❑ Final Permitted ❑ Conditional C.O. Expires ,,; ; This Certificate issued pursuant to the requirements of Sectio 110 of the ❑ Residential / ❑ International Building Code certifying that at the time of issuance this structure was in compliance with the various ' ordinances of the City of Prior Lake regulating building construction or use. For the following: ,r, \ r �/^ : F IB Use Classification S I GI F , A: I 1 Y Bldg. Permit No. 1 ) .� i � f � ., Occupancy Typ Type Construction Zoning District �� K K Legal Description 134, P 1, 1 F F F F R S WATERFRONT �+ / t�(r1 II Owner of Building Site Address 1439 1 PA PKS t T)C CO�.I RT , y Contractor's Name &Address MATTAMY HOMFS ` R r!, HUTCH I NS Y I2' r City Planner ilditig Official li, 2 Date: / L ; / Date: il -= POST IN CONSPICUOUS PLACE , 1U / r s t sz " nn O ■m§�m71 0 § 0 C n a o 0 0 . § 3 gz■�co z m x mo § r , s �r� ■� ■ (n -I m m 2 ► m § -o z ■ t -4 -4 \ -4 m k��� � �J CO eo © q ; 1 q z § r. r . % S 7 ° 0 0:11 o % o > > o » , mm PD § r- § ../ 1) M % m 2 \ \ ` OOOOOO Z xi o \ . 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AND UTILITY CONNECTION PER IIJ � f , 4 r,. ,..... NWES 1. White File PERMIT NO . 2. Fink City /Z /Ze3 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS 1143 3 LF P— S I 0 E. G -- ZONLNG (office use) A/D LEGAL DESCRIPTION (office use only) LOT BLOCK 1 ADDITION 3 Fuel, ti\Jf - -- c 24 " ' J-T PID OWNER 952— gj9a -Zt (Name) in A 7 P. M'' 44 U t 1�S (Phone) (Address)'12a1 1/./ ASt4 11 6ica 0. vE S S - r - l l - l MN SS 439 BUILDER (Company Name) M 4, i 'v M ES (Phone) 9 S b 9 8 - 6126 (Contact Name) S v 1= (Phone) (Address) 11) t I", h S E-} 1.4 (, P VV S ST- 2_) 1 -O t NJ h-t N.1 SS4 39 TYPE OF WORK ,_,Be New Construction Eq.Deck ['Porch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace ['Addition ['Alteration ❑Utility Connection CODE: R.C. ❑LB.C. ❑ Misc: Type of Construction: I 11 III IV V A B 1 3 d Occupancy Group: A B E F HI M R S U PROJECT COST /VALUE $ Division: 1. 2 3 4 5 (excluding land) I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the above - mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building official can revoke this permit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections. X(4.-.-.._---F c. z Be.-- 23 S32:6 Signature Contractor's License No. Date Permit Valuation t 3 6, o 00, - Park Support Fee # $ Permit Fee $ 12 (oct . 5jo SAC # $ . Plan Check Fee $ S' .2.5 , 1 5 Water Meter Size 68"'; 1 "; $ 400- State Surcharge $ (08.- P S . - Pressure Reducer $ 1 2_0, - Penalty $ Sewer /Water Connection Fee # $ 1 5C D, Plumbing Permit Fee $ ( ° Water Tower Fee # $ ( 0 00,' Mechanical Permit Fee $ l 5 4 . Sp Builder's Deposit $ t 5.00,. Sewer & Water Permit Fee $ 5 Co Other Et(ks S v 12 e-SS 100- $ l Std.. 50 Gas Fireplace Permit Fee $ t> 4. 5--O TOTAL DUE $(410Z a lb This 4, li ti n : ec . es Your Building Permit en A proved Paid '702 , ( Re 'pt No. (v l / ) Date //d- 41 — 1l `Z Building Official Date This is to c. 1 that th requ • in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document when signe. �- .l P • . . constitutes a temporary Certificate of Zoning c mp ' e and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued. ► ...Al i r 11 Z [Z — ate Special Conditions, if any 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, N[innesota 55372 61.SOC s �1� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd h �� 9 TEMPORARY CERTIFICATE OF ZONING COMPLIANCE 5 ta 13 AND UTILITY CONNECTION PERMIT ktsiEs 0/ / 1. White File lti>�IT NO . 2. Pink City PER / 23 � 4 3. Yellow Applicant / ""TT "��-�� k2lease type or print and s at bottom) ADDRESS ( - 2D 9 4 P INJ2 -!LS t O'= c o -T Nr-J ZONING (office use) LEGAL DESCRIPTION (office use only) / 1 LOT 13 4 BLOCK ADDITION C1 e-r - ki P' — ^4 "1" PID Z C • S , 6 3 4- - 0 OWNER (Name) Y R 7- T N M'r -4- U N-t (Phone) (Address) 12c) I W R S 14 l t-16 —, ca .1.-1 A V E S S`iE_ 2p i i =0 l t-1 4\ H 1...1 S S 4 3 9 BUILDER WHI. c L .Z , 3X 0 3 (Company Name) t T IVI t 4 + M ES' (Phone) (Contact Name) 5 v l= Z'\ (Phone) W Cfk' R C - 2 4 r0 . (Z4-4- (Address) 1Q l 1..-kS14 -4( "1 P'S.S T - ' r>t > - olt.1 N. N-, 1.4 SS43 TYPE OF WORK ,Ei New Construction .1.Deck ❑Porch ❑Re- Roofing ❑Re- Siding ower Level Finish ❑ Fireplace ❑Addition DAlteration ❑Utility Connection ++ `` r� r i f CODE: DLR.C. ❑I.B.C. ❑ Misc: a f P. Type of Construction: I II III IV V A B `ccupancy Group: A B E F H I M R S U PROJECT COST /VALUE $ l , 000 — __ ivis i n: 1 2 3 4 5 excludin_ 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 7:s 1 c (--tee_. la)L - 2e - 1 S3 3.h S k 9 113 Signature Contractor's License No. Date Permit Valuation • 2, Q a p_ (D Park Support Fee # $ Permit Fee $ (, Z. ;.2.,S- SAC # $ Plan Check Fee $ ' , . Water Meter Size 5/8 "; 1 "; $ State Surcharge $ / CO ' Pressure Reducer $ Penalty $ Sewer /Water Connection Fee # $ Plumbing Permit Fee $ 5 / � Water Tower Fee # $ Mechanical Permit Fee $ ( Builder's Deposit $ Sewer & Water Permit Fee $ Other $ Gas Fireplace Permit Fee $ TOTAL DUE $ I 1-1,1r- This Application Becomes Your Building Permit When Approved Paid 7. 47 Receipt N. ,�, /�[I 72.-- Date • Pt,, By ( r.,,./ i Building Official Date is 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 .en 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 I+Rl CITY OF PRIOR LAKE Date Recd � `� `r•' HEATING /AIR CONDITIONING/FIREPLACE PERMIT A.sr I PA Pile 6'�NnrS�� x. _ cnr PER NO. C )4 _- ►. Yellow ADO6emt ............. .- -- _.,_.: ...._ (Please type orprint an d sign at bottom) ADD ZONING (o�iec use) R ESS \ A t C A k PCU ,1 e a . ____ LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER (Name) (Phone) (Address) . APPLICANT ! pt� (Phone) G - 000 • (Name) (Address) '2-?O -ham•\ mS\11 t 1� Code) 7 Address (City) (Zip (Address) (Contact Person) C4'-U'i +1 (rl k.-Pr-: (Phone) �67Zr) (0 /- iCh C� ) DA TE ✓ 1 l APPLICANT SIGNATURE _ 'i - .A ___.:21_13 . APPLICANT PLEASE COMPLETE BELOW EW CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS FURNACE MAKE AND MODEL RY\.1 GI.YI 611 2 SM 2 0 S \--/ FUEL ! i I�GLS FLUE SIZE � RETURN OPENINGS 0 INPUT 66 000 00 D OUTPUT 5?) l 3 ( 0 TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE: Air Conditioner a Air Plants 0 Steam Units and Fireplaces Cannot Encroach Gra ity ❑ Hot water into Required Side 'Yard Setbacks. i echanical ❑ Radiation Fireplaces with Box Additions or ' ❑Air onditioning 0 Special Devices Cantilevers to the Outside of Buildings ❑Vent. System 0 O Device,s Require a Building Permit. FIREPLACE MAKE AND MODEL - -- FEE SCHEDULE 549.50 Industrial. Commercial & Multi - Family 1% of job cost Residential, Gas Fireplace 549.50 minimum Residential, Heating & A/C (New Construction) 5149.50 Residential, Additions & Alterations 549.50 Residential, Heating Only (New Construction) 564.50 Residential, AC Only 549.50 Estimated Cost 5 Building Permit # The Minnesota Statutes (t 32611.148 "St ;RCI1ARC i I Mor one HEATING PERMIT FEE $ STATE SURCHARGE S — 50 t Ii C e TOTAL PERMIT FEE S 1 he mi cf. beginning Jnly 1.2010 ((Office Use Only) k This Application Becomes Your Building Permit When Approved Paid Receipt No. Date By Balidina Official Dan 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.B., Prior Lake, Minnesota 55372 r R1 4 CITY OF PRIOR LAKE PLUMBING PERMIT Date Rec , d 4, , t so'�" . LateI � - -- : ta PERMIT NO. /� _SPiease type or print and sign at bottom) Ys — /� ADDRES ZONING (office (P i l CC N ∎ii L . LEGAL DESCRIPTION (office use only) LOT BLOCK _— ADDITION PID OWNER (Name) (Phone) (Address) APPLICANT / /' � Z ? LCu'\ am L � (Phone) Os ('-1 " (OOO (Address) v-0 0 4"11N (J V v - -- _ _ � rn S'�f 1 t, k� 3 � 3� (Address)1 (City) n Lou Zip Code) (Contact Person) l - nor) Lt- (Phone (2) 7(61 ` tQ - p { APPLICANT SIGNATURE 01...A. rL* • DATE / L-• 7 / i _ �/ I / 1 _ APPLICANT PLEASE COMPLETE BELOW Quantity Type of Fixture Quantity Type of Fixture 2- Bath Tub with or without shower q Rough -ins Dishwasher I Water Heater r _ __ Floor Drain ---V1 IL Water Softener f_._ -I Lavato Bathroom Sink Stand Pi . ashin: Machine Laundry Tray (1 or 2 compartment sink Sewage Ejector I Shower Stall Backflow Assembly I_1 _ Sinks Backflo Assembly w ss mbly Test Bar Sink ` Lawn Sprinkler t Water Closet (Toilet) Other FEE SCHEDULE Industrial, Commercial & Multi- family 1% of job cost with a $49.50 minimum Residential, New One & Two - Family $149.50 Residential. Additions & Alterations 549.50 The Minnesota Statutes § 32613.148 — 1st $ Building Permit # SURCHARGl;" ha been changed for one year elTective PLUMBING PERMIT FEE $ PAID WITH July 1, 2010. until .tune 30, 2011. STATE SURCHARGE $ .50 j� BUILDING minimum surcharge for a "fixed fee" permit �+��L1J1!��127 � Fx M T TOTAL PERM 1s 1;, beginning July 1, 2010 IT FEE $ This Application Becomes Your Building Permit When Approved Paid Receipt No. Date B _ - Buildina Official Date 24 hour notice for all inspections (952) 447.9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 i �; Date Recd CITY OF PRIOR LAKE BUILDING PERMIT. i'..... e. TEMPORARY CERTIFICATE OF ZONING COMPLIANCE AND UTILITY CONNECTION PERMIT A'ry E 5 PERMIT NO. ( li 221S3 .8•• • I :Please . or • -.. t and si.. at bottom ..--------• ZONING , otr,:t ADDRESS i Ai, _ , k 14 -1-11 4 4 c st I. C.T.. 1\4 u.) 1-N6..rt.A3.cot. _______ ____ LEGAL DESCRIP'FION office use 0711) 3 LOT BLOCK ADDMON PID OWNER K A (Phone) 6 6 2 - 237 - CZ MO (Name) I 1 A At 0 ast.-*; (Address) C - 7 o u.)141 - tNIL-. ' ' -.vir - 1.--4 IA 4 431.4E0ER C-c bj( 0 E-- ) (Company Name) ■ _.....41 — .. . _ -_ . _- (Phonc) '740 ; • /17 -.gcl , (Contact Name) all • g. <V-A IA R.. (Phone) (Address) III (0 TbJC)L,5-ce_tilt.... Citzt,„.L.G" t•-\.&. 4 S , .; ITC- I-\ 'i. 14 j?...jue,C. , t--it-.. 55—;C::. i , TYPE OF WORK )81.1siew Construction ODeck 0:Pc:eh 0Re-Roofing 0 Re-S:drig ElLnwer Level Finish 0 Ftreplatte E3Adtistinn 0Aiteration 01.:tsilty Connection i CODE: gil.R.C. CII.B.C. 0 Mc Type of onstruction: 1 Il III IV V A B i Occupancy Group: A B E F 11 1 M. () S U PROJECT COST/VALUE S .... 2.- • C- , Division: 1 2 (3) 4 (excluding land) . I hereby cert:Py that I have ft:unshed Informarion or, this app!-cattota avhsch rs to the best of my knowledge r.te and metre. i., ) certtfy that I am the owner ec authorized nem fat the abc properry and that all et:mammon ‘all: copforrt to all exi.stIng state and local !was an w ': 7exeied o accerdattee %nth submated ptans 1 aro aware that the hut!ding , oft Cr •CYCkt MS pe33Ir or JU3 CAM Flir.1313 1 ''etretro aFfe f.at :ttc ON official or % Jes.arntt. ""zi. c 4. t'^e 7 MT% ZC perform needed inspector* X qe 444-*A. C4/10Z4 C. - /45 7 -22-- 13 Signature Cc/sr:a:for s L.:, ettse No Date Permit Valuation Park Support Fee # S Perna Fee $ SAC $ , Flan Check Fee $ 1 Water Mete: Sue 5/8 ' 1 State Surcharge $ t Pressure Reducer $ Penalty $ Sewer Water Connect:en Fe # S Plumbing Permit Fee $ Water Tower Fee # S Mechanical Permit Fee S Builder s Deposit I PI WITH Sewer & Water Pernin Fee $ Other S Gas Fireplace Permit Fee TOTAL DUE BUILDI G PERMIT i I on .. es Your Building Pcnyit When Approved Pawl i Receipt No Date I By 1 ir vicir 3 i i i Bu. ..... Official D ,cr Tian 3 to CtraY that the request is the above applicant-as and acceetthetnimg docurnertta is in acceldince with the C Zotung Orthetanct and MO proceed u requested Thes dr.tteit when ttpeet fry the Ctr) Maher constitutes a temporary CeroFcate at` Zontna :renpitance art4 aLows con.str .' t^rr te Before o,cupancy. a Om:fa:ate of Occupancy must be Issued Mamas Director Date Spec Cohilittorm. if' itti7. 24 her notice for all inspections (9:52144'-9650, fit 1 44*-1245 4646 Dakota Street S.E., Prior Lake, Minnesota 551'2 From:Genz -Ryan 952 767 1900 02/15/2013 11 :58 #061 P.004 /0. g O P RIr, Date Ree'd CITY OF PRIOR LAKE PLUMBING PERMIT t-, z. cold City [IERMIT NO. 1L 1 Yellow Applicant (Please type or print and shin at bottom] ADDRESS ZONING office use) Vit '14 1 N■I LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER (Name) (Phone) (Address) APPLICANT," (Name) . ?o-\ (Phone) ( 2 }11Q`� — t i (Address) 2x-00 t \NI _ rnS\A1Ve. S J31 ('� (Address (City) (Zip Code) (Contact Person) CPA i Y\ � � -(�vl Sv'r (Phone) (2)7fl — «)S de t � APPLICANT SIGNATURE &.. DATE 2- G APPLICANT PLEASE COMPLETE BELOW uanti T A. a of Fixture • uanti 1 e of Fixture Bath Tub with or without shower 11111111M1111 Rou 1h-ins 111111111111 Dishwasher immals Water Heater Floor Drain Water Softener °`' Lavato Bathroom Sink Stand Pi .0 ashin : Machine 1111 1111111 Laund Tra 1 or 2 cum F artment sink _ Sawa le E'ector ME Shower Stall - Backflow Assembl Sinks IIIIIIIIIIIIIM Backflow Assembl Test Bar Sink IIIIIIEIIIIIIIII Lawn S a rinkler Water Closet (Toilet) Other FEE SCHEDULE Industrial, Commercial & Multi- family 11/4 of job cost with a 549.50 minimum Residential, New One & Two- Family S149.50 Residential, Additions & Alterations 549.50 The Minnesota Statutes f 3260.148 — Est S Building Permit # PAID WITH "SURCHARGE" has been changed fir one B IJIL�3iiV year effective PLUMBING PERMIT FEB $ PERMIT .icily 1, 2010, until June 30, 201 1, STATE SURCHARGE $ .50 The minimum surcharge fora "fixed fee" permit TOTAL PERMIT FEE $ is RA& beginning duty 1, 2010 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 -4245 4646 Dakota Street B.R., Prior Lake, Minnesota 55372 From:Genz -Ryan 952 767 1900 0211512013 11:58 #061 P.00310E I 4 ?Rio CITY OF PRIOR LAKE Date Rec'd ° °�f f HEATING /AIR CONDITIONING/FIREPLACE PERMIT -: wry 40Mveso'tr r. . a« A a ur fa, r I PERMIT NO. / z — /2 x 1. veo w Mpt ea d ease a or print and sign at bottom) ADDRESS ZONING (cake u se} \ 'ParN a \,N\ . LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER Mame) (Phone) (Address) APPLICANT /1 to • (Name) � t2.- - i ,� , • (Phone) 652.)--K0-1-1000 (Address) ( 2; 2- 00 Ilk_ V �1 r ni f'... � (A• . • rest) (City) (Zip Code) (Contact Person) ( `t I f ! g U (Phone) ('52) - 7 6 ' E e)f _ • / -1 APPLICANT SIGNATURE - •� liar/o'' DATE " j APPLICANT PLEASE COMPLETE BELOW )IEW CONSTRUCTION ❑ REPLACEMENT ❑ ALTERATIONS • C� FURNACE MAKE AND MODEL Ct.Jirt p i 1 2 St.2 -0(2 %0 FUEL NA-±- P FLUE SIZE RETURN OPENINGS Q INPUT 60 ODO OUTPUT 5.3_ TYPE OF SYSTEM HEATING OR POWER PLANT • PLEASE NOTE: Mr Conditioner anal Air Plants 0 Steam Units and Fireplaces Cannot Encroach Ora it ❑ Hot water into Required Side Yard Setbacks. / echanical ❑ Radiation Air nditioning Special Devices [] Fireplaces with Box Additions or Vent. System g Other Devices Cantilevers to the Outside of Buildings Require a Building Permit. FIREPLACE MAKE AND MODEL FEE SCHEDULE Industrial, Commercial & Multi- Family t% of job cost Residential, Gas Fireplace $49.50 $49.50 minimum Residential, Heating & A/C (New Construction) $149.50 Residential, Additions & Alterations // �� �QQ �Q ,' �� Residential, Heating Only (New Construction) $64.50 Residential, AC Only �A I�Y.. �UiLDf PERMIT Estimated Cost $ Building Permit # The Minnesota Statutes F 32613.148 HEATING PERMIT FEE $ "St llIC11AR(ili" has been changed for one year effective STATE SURCHARGE $ .50 July 1. , until .tune 30, 21111. TOTAL PERMIT FEE 5 The minimum surcharge ge for a "fired fee" permit (OMee Use Only) is aS beginning July 1,2x10 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 -4245 4646 Dakota Street S.'E., Prior Lake, Minnesota 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 9-12 yf t 3 PROPERTY ADDRESS: 14394 PARKSIDE COURT ACCEPTED BY APPROVING AUTHORITIES: CITY OF WOODBURY ADDRESS: PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS OYES ONO EQUIPMENT USED IS APPROVED YES ONO IF NO, EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS YES ❑NO TO LOCATION OF CONTROL VALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? IF NO, EXPLAIN INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: OYES ONO 1. SYSTEM COMPONENTS INSTRUCTIONS OYES ONO 2. CARE AND MAINTENANCE INSTRUCTIONS OYES ONO 3. NFPA25 - 1 YES ONO LOCATION ENTIRE BULDING YEAR OF TEMPERATURE MAKE MODEL MANUFACTURE SIZE QTY. RATING RELIABLE RES 49 2012 1/2 11 155 SPRINKLERS RELIABLE RES44HSW 2012 1/2 16 155 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 - LIS 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 CI ELECTRIC ❑HYDRAULIC PIPING SUPERVISED OYES ❑NO 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 NO N/A DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO MAKF MOf1FI St1PFRVIRICI I CARS Al ARM OPFRATF VAI VF RFI FARE OPFRATF PI FARE YES NO YES NO MIN SEC HYDROSTATIC; Hydrostatic test shall be made at not less than 200 psi (13.6 bars) for two hours of 50 psi (3.4 bars) above static pressure in excess 01 150 psi (10.2 bars) for two hours. Differential dry 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 IF NO, STATE REASON DRY PIPING PNEUMATICALLY TESTED OYES ®NO EQUIPMENT OPERATES PROPERLY EVES 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 IDNO DRAIN READING OF GAGE LOCATED NR WATER RESIDUAL PRESSURE WITH VALVE IN TEST CONNECTION TESTS TEST SUPPLY TEST CONNECTION SI CONNECTION OPEN WIDEQL PSI ti UNDERGROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO oO SPRINKLER PIPING. VERIFIED BY COPY OF THE U FORM NO. 85B YES ONO OTHER EXPLAIN FLUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING YES 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 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 QUALIFIED IN COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR-3 BYES 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? ®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 ❑NO NAMEPLATE REMARKS DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: NAME OF SPRINKLER CONTRACTOR: FIRE SUPPRESSION SERVICES. LLC. ESSED BY i • ' P • TYJ R (SIGNED) LE DATE SIGNATURES ' , 11.4111-4--4--e u/Z tl I ; r TRACTOR (SIGNED) TITLE DATE c14.44,/0.17)), y 12#1/..5 ADDITIONAL EXPLANATION AND NOTES L/46E7f.9 P Builders Deposit t'j4VVr o-0- 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: \ 1 9`tv SITE ADDRESS: LI')9'-i PA- 11-1(— G 'r PERMIT # 12 - X ) REFUND TO BE MAILED TO: M Y 41o -tE.S 'I 2 0 l 1,.1,A<S t-1- t1.1 G N ova S SU t 20 t�t� i-ti SS439 AUTHORIZATION TO RELEASE PLEASE REMEMBER 1 ofrt 506.00 ynda S. Allen , :tiding Services Amount 1. KEEP STREETS CLEAN DURING CONSTRUCTION Acct. 801.20204 2. KEEP EROSION CONTROL IN PLACE Date - • - -40 • • . - r toSli. • _■ " ,14I:\ Mel: .1 ! II:101 1:14#1113 SIGNATURE: c - J` --�-- 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 P artnership: 1 843 7201 Washington Ave S., Ste 201; �' Edina, MN 55439' DATE N bv z1 2 ot2 PAY . TO;THE r`C o ORDER OF P� o'2= 1 $ 39 l'8.42 ot 1Z'r`e - -NI r�1G rt -toU Sartre 9 2 ' •, "YIBBW •• O N (� lJi tD2 1) S�Va =rJ tt( t=► � �r � t I no DOLLARS o g °o,r ,xt Wells Fargo MEMO t�}392 tL -139B T- v._ Iue G-r . ®. — 11P' ►1'00 LB4 3 1P 1 :0530002L91 :20000423LLO2711' C :\Documents and SettingslsbarelLocal Settings1Temporary Internet Files\ Content .Outlook \BD80X19A \BUILDERS DEPOSIT FORM.DOC DEPARTMENT OF P R 10 R LA K E BUILDING AND INSPECTION INSPECTION REC8eVDD SITE ADDRESS ii.3�4 � toe CT. NATURE OF WORK t� F-A INS Dec, No P14 �. 5,,.1. L.L. USE OF BUILDING S 1,- 1 vLe FAci --tL 1 A - ll, PERMIT NO. 12- 1283 1 DATE ISSUED tl /z 1 ��z CONTRACTOR MAT rt o�ES PHONE 152..8'1g-642g NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW THE PERMIT IS BY SEPARATE D OCUM e ENT `r i -S (NI STALL .(z-c;,5 I p 1 I- 4 1 n 3r0 c It l CL °. k /%1 .114 SP bR r mac.. { M DATE 1 FOOTING 1 1 I 1 FOUNDATION (Prior to Backfill) 1 1 I PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 6 II0oi Qe 4) esg. Po P '41 ' , T OUGH - INS SEWER /WATER /SEPTIC FRAMING G '`4 3yi ca f - INSULATION Iv „;.. ELECTRICAL PLUMBING e/ 7i/i/.17 HEATING (if required) , ghr FIREPLACE GAS LINE AIR TEST m 411} A` 4 ° , I 511 /13 COVER NO WORK UNTIL ABOVE S BEEN SIGNED I (Ao�se (2A-p f e ;, 1 1 F I IzE 'e a-(,- t_c-P- T 15 £ zC1 I FINALS t GRADING (Prior to Sodding) , // BUILDING ok p �/�3 (7l au) /D (i)13 ELECTRICAL PLUMBING `ve,k, (100_, Lac 11 . ) HEATING ? 22 ,�' DO NOT OCCUPY UNTIL ABOVE HAS BE N 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 • ' , •