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HomeMy WebLinkAboutBuilding Permit 12. 1284 Il _: I ( „_I. hY.° I,._ 1 i,:_ fi�.i ,. �. _. I. .., I ., ..i .� _., _, . il _. 5Y . :.I , .. _. CITY OF PRIOR LAKE Priaarftttruf of ix i u 4 n pri itxt ' ' ❑ Final Permitted ❑ Conditional C.O. Expires This Certif issued pursuant to the requirements of Section 110 of the ❑ Re sidential / ❑ International Building Code certifying that at the time of issuance this structure was in compliance with the various i ordinances of the City of Prior Lake regulating building construction or use. For the following: ; rs :' "<< Use Classification SINGLE F A YI I L Y Bldg. Permit No. 1 7 — 17 2 4 , : R3 Vi \f, P► 'I? Occupancy Type Type Construction Zoning District p x, Legal Description L 35� B1r JEFFER '`LATFRFRfNT Owner of Building Site Address 1 PARKSIDE COURT Contractor's Name & Address MATTA iY Hl 1FS ROF,ERT D, HUTCHINS '." �- Cit Planner / r 3 Date: Bml ing Official Date: /(f 7 / ((( POST IN CONSPICUOUS PLACE p ..i li P.:;',,- ' i �, , i i u ni '' a ,1 i i. vi i, 11 i �.i n I. i i �� J x'6 "k,.: � ',__' � v� � �� �� � , � r ..�� 4� �i �� v H �r a � i J 2 J Z ! — H J Ix u. � _ W er W 0 _ 'Wa' Wa N , 0 Q 41 z �\ _ + N a0000 �� 0 o J re x i t • t LL N O W � �� z __ =Z I \/ Z 5 2 2 O 4 c2 C = OQu.J % O 0 V o. w I 0"‹ 0 i.. 43 W 4 P. P. a. 0 0 w m 1 a Li 5 z N V 0 W< O w W W? x O WW a 23vo a 2 N.,.4 W v re z aC ❑O ❑OD❑ p = a a a H a YV ` 0 a O g o Z O o U N V) < 3 oC W F- �z Oa(9� N Z I► 0 0 O J W a O H Z HZ W re M u Q A O W W W W O0 NZ O O O 0 V o z u.w�z ,�V, 0 3 0 0 1. C)= Q 0 a 000000 0 0 0 5 0 J N Z 1° a J a LL .. cc W o 5c 00� a u. 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U. 0 O h O Z F Y '� J Z I ( � 3 0 0 V t% o O u. u.u._u.V) p r N 0 0 c li 5. c)? a 0 a 0 ❑00❑❑ 0 Q -1 1... Z p e u; E 2MI �� 0 w . 4 c' 2WUJ0 0 Q 2 ❑000 > 11 U O w _ O N vj J `, Z 5 D Z co o 0 iC w F YY ... O U U 4 F_ � QQtLJ � T • / r z 4t Z zZ d Z N w v 0 w , a u. U O. = U W 3 U 0 ti) 1 O Ail a�3 .., w w oWC Z i`' 000000 \ 8 8 o Z • I a a LL CC J CC < < 0 w Y0 Z ' V p Y A O .. 11- U f''►. CO w Z U N n o O Z O a Z r v Ili Q F J W H Z -0Z z IA V Y �� J W u. Ei O W Z u! Z OO2 2 1 Q O O t5 U V a 0 0 LLLL4. 3 0 0 a N 5 4 O a 000000 0 "�J' 0 0 c C ' N E S " CITY OF PRIOR LAKE BCTILDING PERMIT, Date Rec'd TEMPORARY CERTIFICATE OF ZONLNG G COMPLIANCE c...) �' AND UTILITY CONNECTION PER:vI :' m ; I 1 �.w ` r y O 1. White File PERMIT NO s 3 Pink City /2 . /z V 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS l 43 9S- 1 —St D E. C �— ZON7 (office use) `UL LEGAL DESCRIPTION (office use only) LOT 7 ✓S BLOCK ADDITION J 1 1,1 PID OWNER q52- Q�9 b -Zt UQ (Name) I A T i 1:=.. t 1' -44 0 M ES (Phone) (Address) 'Mat WAS141tJt,ita $.4 AVE S STa I t= 01t-4 Ht4 5S439 BUILDER (Company Name) t't 1't'T ' I"t Y 4+0 t`' ES (Phone) 9Z 83 9 8 - ( 126 (Contact Name) S Li E $ fit (Phone) (Address) 120 t 1... Ar S l-} 11-,1C }'c vE.. $ STh. w t --O t u Ac t--t t�l S SL4 39 TYPE OF WORK 0 New Construction ESIDeck ❑Porch ❑Re- Roofing ❑Re- Siding ['Lower Level Finish ❑ Fireplace ['Addition ['Alteration ❑Utility Connection CODE: E.R.C. ❑I.B.C. ❑ Misc: Type of Construction: I II III IV V A B 130, 000.60 Occupancy Group: A B E F H I 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. XcS.„.--. '- =� ezL 231 53Sb to `t 9 it 2— Signature Contractor's License No. Date Permit Valuation (3 4 0e>0. , Park Support Fee # $ Permit Fee $ 1 z a p 5 c SAC # $ 7 3 6 5, Plan Check Fee $ Z � l S Water Meter Size 59'; 1' ; $ ±8 , State Surcharge $ 6 8 - - Pressure Reducer $ (Zp. - Penalty $ Sewer /Water Connection Fee # $ ( S CO. Plumbing Permit Fee $ (� 4-.‘;'0 Water Tower Fee # $ (000.- Mechanical Permit Fee $ ( 4. S . a Builder's Deposit $ (> C - Sewer & Water Permit Fee $ s12. 5p Other F 1 cv ?t't2.ESS to $ 4. sO Gas Fireplace Permit Fee $ s 4 - So TOTAL DUE t � • I J This A 'c ' o fit Your Building Permit en Ap roved Paid c/ 7 3---q. 1 Receip o . (, 77)-s- Date /(„aY- 0.-- By .,. � /_ / . � -� 24 f z ' Building Official Date This is to c ,t that •. uest in e above application and accompanying dots eats is in accordance with the City Zoning Ordinance and may proceed as requested. This document when sit •. e Ci . c titutes a temporary Certificate of Zoning co liance d allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued. r A A,L4 1 zb (z Planning Director Date Special Conditions. if any 24 hour notice for all inspections (952) 447 -9850, fax (952) 447-42-45 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 el .Qsrp AD From:Genz-Ryan 952 767 1900 02/15/2013 11:58 #061 P.00510 1 4 ?Rio CITY OF PRIOR LAKE Date Rec'd Etv t •c HEATING /AIR CONDITIONING/FIREPLACE PERMIT 4.41 ,,Esc` 1.' rile 1 PERMIT NO. f L — /L'9 I x o� ca 3_ Yellow Armen, Please a orprint and sign at bottgm) ADDRESS ZONING (otecc use) LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID • OWNER _. - -- (Name) (Phone) (Address) • APPLICAN tNamel e..7Z P--'�( - (Phone) (49z)7('7—( (Address) 2- ` v b ' r l \ BOri i 1l G53'37 (Address) (City) (Zip Code) (Contact Person) ( O _ UX a (Phone) (l 52_) 7 (Pi - 1 I - APPLICANT SIGNATURE . r_ _.A; O A* - �w..► DATE 15 / 1 APPLICANT PLEASE COMPLETE BELOW , EW CONSTRUCTION 0 REPLACEMENT OS 0 ALTERATION • FURNACE MAID; AND MODEL I. ♦ 1 5 ' a 2©i OS FUEL, . GQ., FLUE SIZE ^ RETURN OPENINGS INPUT G.a8 OUTPUT 6313(00 TYPE O1? SYSTEM BEATING OR POWER PLANT • ►` ■ arm Air Plants Steam PLEASE NOTE: Mr Conditioner III eravity I Hot Water Units and Fireplaces Cannot Encroach Special Devices echenical D Radiation Into Required Side Yard Setbacks. ' Conditioning [] Fireplaces with Box Additions or :Went. System 0 Other D 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 ' U9.50 imam D WITH Residential, Heating & A/C ('New Construction) $11499.,50 50 Residential, Additions & Alterations Residential. Heating Only (New Construction) $64.50 Residential, AC Only BU I M G PERMIT Estimated Cost $ Building Permit # L The Minnesota Statutes * 32611.14R HEATING PERMIT FEE $ "SURCHARGE" has been changed for one year effective STATE SURCHARGE $ .50 tat. 1, 2010. until June 30, 2t)t I. TOTAL PERMIT FEE 5 fhc minimum surcharge far n "fiscd fee" permit (Office Use Only) is M. beginning July 1.2010 This Application Becomes Your Building Permit When Approved Paid Receipt No. — Date By Bundine Official Date 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 02/15/2013 11:58 #061 P.006 /0. D 04 PEip Date Rec'd a, CITY OF PRIOR LAKE PLUMBING PERMIT Eso (.91ae Piit: 1. c�ta ca,, [PERMIT NO. /2__0_,e_ 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING (office ) (42( 'Nt c C LEGAL DESCRIPTION (office use only) • LOT BLOCK ADDITION PLD OWNER (Name) (Phone) (Address) APPLICANT t �� -t (Name) 5e417 (Phone) 5 2)1( ! -� k ^ (Address) .'B \N R)rfSv1 '33 - f (Address, (City) (Zip Code) (Contact Person) _ 0 . a 1! rc (Phone) (T7 (67' *) C I A APPLICANT SIGNATURE • 4�• • DATE APPLICANT PLEASE COMPLETE BELOW _ _____, Quantity Type of Fixture Suantity Type of Fixture 2 Bath Tub with or without shower Rou 1h-ins Dishwasher 1111111111111111 Water Heater L _- Floor Drain -- 111111 Water Softener Lavatory (Washing ry (BathroosnSink) Stand Pipe {Washing Machine) met Laund Tra 1 or 2 compartment sink Sewa ± e E'ector Shower Stall IMIIIIIIIIII Backflow Assembl [ Sinks Backflow Assembly Test Bar Sink 1 Lawn Sprinkler r Water Closet oilet Other FEE SCHEDULE Industrial, Commercial & Multi - family I% of job cost with a 549.50 minimum Residential, New One & Two - Family S149.50 Residential, Additions & Alterations 549.50 The Minnesota Statutes f 3261.148 Est $ Building Permit # "SURC:IIARGS" has been changed For one PAID WITH year effective PLUMBING PERMIT PEE $ BUILDING PERMIT July i, 2010. until June 30, 2011. STATE SURCHARGE $ .50 The minimum surcharge Cur a "fixed fee" permit TOTAL PERMIT FEE $ is,' , beginning ittly 1.2010 This Application Becomes Your Building Permit When Approved Paid Receipt No. Date By $aildina Onielat Data 24 hour notice for all inspections (952) 447 -9850, fax (952) 447-4245 4646 Dakota Street S.E. , Prior Lake, Minnesota 55372 Date Rec'd o ff � RI4� k-1 CITY OF PRIOR LAKE PLUMBING PERMIT r A Uk a" °�` PERMIT NO. z ode cap 3 Yellow Appacon L .. _ 1 , _ / (Please type or print and sign at bottom) _ ADDRESS ZONING (orrice u 14 (0 t ) r ...1 C CA M \NI LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER (Name) (Phone) (Address) APPLICANT w (Name) 17 �1 PICA.,n (Phone) 5 Z-) ( 1 . 3 (Address) -200 13 \N ��rnSv l(� � 3 l (Address (City) (Zip Code) (Contact Person) _ ! . • 11 re (Phone) 052Y7 (67 ?) APPLICANT SIGNATURE __CA , � A'' 0 - DATE . 3 APPLICANT PLEASE COMPLETE BELOW Quantity Type of Fixture Quantity Type of Fixture 2. Bath Tub with or without shower ,3 Rough -ins I _ Dishwasher 1 Water Heater ( _ Floor Drain :L l____ Water Softener Lavatory (Bathroom Sink) I Stand Pipe (Washing Machine) Laundry Tray (t or 2 compartment sink Sewage Ejector Shower Stall Backflow Assembly I Sinks Backflow Assembly Test Bar Sink Lawn 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 Residential, Additions & Alterations 249.50 The Minnesota Statutes 1 32613.148 .. $ _ Building Permit # _ PAID WITH "SIAM IARGye G beenchangedfirone B UILDIN PERMIT year ear effective PLUMBING PERMIT FEE $ July 1, 2010, until June 30, 2011. STATE SURCHARGE $ .50 The minimum surcharge fora "fixed fee" permit TOTAL PERMIT FEE $ is Vii, beginning duly 1, 2010 ThL4 Application Becomes Your Building Permit When Approved Paid Receipt No. _ Date By Buntline Official Date 24 hour notice for all inspections (952) 447.9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 VJo CITY OF PRIOR LAKE Date Rec'd ... 4-, igi '��.�y AEATING /AIR CONDITIONINCIFIREPLACE PERMIT U - rr 4 46Nrvsso'tr i n.+ ru .�_:. One. ce ur PERMIT NO. / 3. Yellow Applicant �;, -_.... ' t ' WI (Please type or print and sign at bottom) ADDRESS (J- ZONING (office ue) I A C 1. 1 ?t,r e N\N\i LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER (Name) (Phone) (Address) APPLICANT' �► (Name) I _ CI7 _ (Phone) (gi)77 (CO 0 (Address) ,2- •0 rl Ni ■ so ' e GS 7 L.,../ (Address) (City) (zip Code) (Contact Person) l ( / S U(C.. (Phone) CGi 5 L-) 7 1 - 19) 5 APPLICANT SIGNATURE DATE / 15 / 15 APPLICANT PLEASE COMPLETE BELOW EW CONSTRUCTION ❑ REPLACEMENT ❑ ALTERATIOTA -1 FURNACE MAKE AND MODEL ID *, CLJ .' i2S' J 20 s OS FUEL � l - 67ctS FLUE SIZE RETURN OPENINGS a/ INPUT 5B OOO OUTPUT 33, 3(0 0 TYPE OF SYSTEM HEATING OR POWER PLANT ' PLEASE NOTE: Mr Conditioner warm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach ravity 0 Hot Water into Required Side Yard Setbacks. \ 1cchanical ❑ Radiation � 4tr Conditioning ❑ Special Devices Fireplaces with Box Additions or ❑ 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 549.50 549.50 minimum Residential. Heating & A/C (New Construction) 5149.50 Residential. Additions & Alterations 549.50 Residential, Heating Only (New Constriction) S64.50 Residential, AC Only 549.50 Estimated Cost S Building Permit # The Minnesota Statutes r; 32611.148 HEATING PERMIT FEE $ "S(.RCI 'ARM" has been changed for one year effecti +c STATE SURCHARGE $ A Jul) I.2010. unfit June 30. 2011. TOTAL PERMIT FEE $ 1 he minimum unrchnrge for "fled ice" permit (0 Mee Use Only) 1% 51, hei:innino Jul) 1.2010 This Application Becomes Your Building Permit When Approved P aid Rec � p DINr± PERMIT Date By Bulldlne Official Date 24 hour notice for all inspections (952)447 -9850. fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd 1,.... , TEMPORARY CERTIFICATE OF ZONING COMPLIANCE AND UTILITY CONNECTION PERMIT _ . ... „ ...‹,.. PERMIT NO i 2. (Please . or . ' . t anti O.. at bottom . ZONING 1 4 4 ADDRESS t‘s 1 t CT. ZONING • , r,--------------. 1 LEGAL DESCRIPTION (office use only) . LOT BLOCK ADDITION PID 1 OWNER . A (Name) r I Ptlico.vi I-1006c (Phone) 1 52. - 2.7 - 42 too , (Address) ' Zo 1 tfr.)1A5t-1 i NI L-TuNi i c V o--)A . 4 i. -MAL-WA (Company Name) Vi C-ciji-Rmc--10_,F-,,,,,„ c r -.›..4-varbp 5C.-E.0 it...g2S U..t. . i (Phone) i( ., ' 117 - f39 tot) , (Contact Name) MP.' t<CA t-tEsz- (Phone) (Address) I i i ID TOuf..) e..1. • %..- .11... i''41.1 553:43t> TYPE OF WORK XNew Colisinicnoti 0 Deck ['Porch °Re-Roofing CRe-Stchr,g 0 Lower Level Finish 0 Fireplace 1:Addition ClAlteranon 0 Uttary Comiecuon CODE: gil.R.C. OLB.C. 0 misc Type of onstniction: 1 II ID IV V A B Occupancy Group: A B E F 1:1 1 M To S U PROJECT COST/VALUE $ Division: 1 2 (2) 4 (caduCting land) 1 limbs certif.. ehat I have furrashed information on thu lop:ecancr ach(ces is to she heat of my knowtedge nor an„i wyterl I also certify Mat t am the owner Est authortzed agent for the atxriedreentioned peppery and that all constraCtion vr:r1 cot to aN caranng state and local :pas a-.ril a, l : trocect, ,n scurrtartre serth sutsmmed plans 1 an aware !tad the budding ofncial Can !evoke tho per CA Inn cause Fr e 4 heret-y agree Mat the city official 01 4 dolgote —0 Cr'f" 4 . . T `t trot ,Cin to oVfOrM heeded tharecroos -14 7-22.- 1'' Signature Contractot i Lt,enst No Date Permit Valuation Park Suppor Fee Perma Fee $ SAC *$ $ 4 1 Pla.n Check Fee $ Water Meter Sore 5 , 'S I', $ i 4 State Surcharge $ Pressure Reducer . $ Penalty $ Sewer Water Connection Fee Plumbing Penult Fee S Watt! Tower Fee # ; 5 Mechanical Permit Sewer & Water Permit Fee 5 Other t PAID Gas Fireplace Permit Fee $ TOTAL DUE BUILDING PERMIT / .. .. I / • ti : • , ,, C1 Your Building P Approved "F al - Paid By Date .1 Receipt No 1 4„,,. ,orrictal Date This el to re:14y the the request in the above application aril aCCempariyitg 40Ciancrits is in accordance with the Ct. Zoning Ord.nattee atid ma v proceed as requested 1 document Olen sl by the C:tv rair.fier constitutes a teirit<iiitti Ceittfica c r'f 7t. ling Mir pliancr a.rti Li! , a , a ce.nrn. -. eretreri.e Be tore sreorteanev a Celt:alder of Ocrussamm rniar bc ,ssIt Piantunt Demon Date spec al C011411(.1011$ If any . 24 hour notice for all inspections (952) 44 fax i9521 44 4646 Dakota Street S.E., Prior Lake, Ntionesots 5572 08-05- 13 15:39 FRC01- T-036 P0001/0001 F-045 pAD ni TR70 WY OF PRIOR LAKE Data Reed A: 1 MATING/AIR CONDITIONING/FIREPLACE PERMIT 1., Z - 4 /tease k Pr Plt., I PERMIT NO. tig -. ggeid . mew memo Olken tree egoist Wales at bottom) - ADDEESS ZW ego . 3 1 3r 0 C k ecur Por 1.-cke._. • LEGAL DESCRIPTION Wien we erdy) , LOT BLOCK Aromas pm "NER le _ 440 re,br$ Awe) e f 5 985-12-7Z aine) 2. i • • - I ;Pet C+ . Woo • - ■ - I N A 4 1141' • APPLICANT T.. . ki 1,...k - .. r .44 1 + , oz. u CPItcom) • (Arkitessi 2/ CO Pal rkli Ave IQ P r%4Alikte f in c0 /q PIO MP z . (rOnktot Person) Leak) 1-bleierhe 1 er han) i• t 6 • APPLICANT SIGNATURE ...P., r. ..ilL /miliA46.1,1_zt. nA.TE 2- / • APPLICANT PIXASE COMPArrit HILSW : EgNic CONSTRUCTION 0 REPLACEMENT 10 ALTERATIONS FURNACE MAKE AND MODEL NEL . Pula 8Z 11 RETURN OPENINGS INPUT OU?PVT TYPE OP SYSTEM PI:EATING OR POWER PLANT . PLEASE NOTE: Air Coaditiener OWeere Mr Finns Stara Wits sad Pireplaces Cam* Raieread m r • , Rot Wider Into Required Side Yard Setbeeka • Meebsoleel Radiation II Air Conditioning Special Devices Fireplaces vdtli Box Addidarre or • Vent. System Other Devices Cantilevers to the Gobi& of Maier ... 1 . :LREPLACMAR ND MODEL -1-1 em-...n-ci I c) . Rell tfr rillidt FEE SCHEDULE intbeskial, Commacial & MIRI I% snob con Reeidentlel, Gas Fireplace • $4950 • $49.50 madonna Reekkeeiet, &aft k A/C (New Construction) $14930 Redd:Wel, Adelina is Aliondions $OSO Resdential, Mating Only (New Construction) $64.50 Reekkatial, AC Only S49.54 Estimated Colt S Building Permit 0 ' The Miasmata somas i 3268.1414 SURCHARGE' hoe boon visaged For one SUMO PROW PEe $ year Weedy* • . STATE SURCHARGE S .50 -idly 1. talk antis Jane * 1011. TOTAL PERMIT FEZ S Tat abirnent serrbarge kr a "liced ke" pm* WA* Is fli, beginning .1 eV 14Mb (Who the Oath This Appliestiea Semmes Your Imildirig Permit Wain Approved Paid 1 ReceiptNo. Date AID WITH whil...0fileiel Date BUILDING PERMIT 24 hour notice in eti lameethole OM 44741150, fer WA 447-4345 . 4646 NM* Street 83., Pciibr lAits, Miamoote S5372 — ---------------------- -------...—.• ................- ................- • • .. • •....•• ....... ............. ..................... -.......... ................ ,_... ........ ... .. . . . 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 5 -6 -t3 PROPERTY ADDRESS: 14396 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 OYES ONO TO LOCATION OF CONTROL VALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? IF NO, EXPLAIN INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: OYES ONO 1. SYSTEM COMPONENTS INSTRUCTIONS OYES ❑NO 2. CARE AND MAINTENANCE INSTRUCTIONS EVES ONO 3. NFPA25 ®YES ONO LOCATION ENTIRE BULDING YEAR OF TEMPERATURE MAKE MODEL MANUFACTURE SIZE QTY. RATING RELIABLE RES 49 2012 1/2 11 155 SPRINKLERS RELIABLE RES 44HSW 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 - 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 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 El NO N/A DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO MAKE MOIlFI St1PFRVI ION I ORS Al ARM OPERATE VAI VF RFI FARE OPFRATF Fl FARE YES NO YES NO MIN SEC HYDROSTATIC; Hydrostatic test shall be made at not less than 200 psi (110 bars) for two hours of 50 psi (3.4 bars) above static pressure in excess of 150 psi (10.2 bars) for Iwo hours. Differential dry-pipe valve clappers shall be left open during test to prevent damage. All Aboveground piping leakage shall 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 _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 SIUCATE, BRINE, OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TESTING SYSTEMS OR STOPPING LEAKS? ®YES NO DRAIN READING OF GAGE LOCATED NEAR WATER RESIDUAL PRESSURE WITH V LVE IN TEST CONNECTION TESTS TEST SUPPLY TEST CONNECTION 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 EMS ONO OTHER EXPLAIN FLUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING !EYES ONO IF POWDER DRIVEN FASTENERS ARE USED IN BYES ONO IF NO, EXPLAIN CONCRETE, HAS REPRESENTATIVE SAMPLE TESTING BEEN SATISFACTORILY COMPLETED? BLANK TESTING NUMBER USED LOCATIONS NUMBER REMOVED GASKETS 0 WELDED PIPING OYES Ca NO IF YFS DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR -3? ®YES NO WELDING DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED IN COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS 010.9, 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? BYES ONO CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL CUTOUTS (DISCS) ARE RETRIEVED? YES ONO HYDRAULIC NAMEPLATE PROVIDED IF NO, EXPLAIN DATA YES NO NAMEPLATE REMARKS DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: 5-6,--E ,-E 3 NAME OF SPRINKLER CONTRACTOR: FIRE SUPPRESSION SERVICES. LLC. TEST WITNESSED BY FA - - ' OW ■i: • _- - TITLE DAT SIGNATURES —a► _r - r R E FOR • :INKLE� TACTOR (SIGNED) TITLE D TE a_? :ego, 5 -6-13 ADDITIONAL EXPLANATION AND NOTES FRib Builders Deposit 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: y h 2 - SITE ADDRESS: 1 t-13 9 5 Pa- u -V-St o G T PERMIT # i2.•I Z REFUND TO BE MAILED TO: M �T� M`� 4-1-o t-- ES 'I t o t t./ ,Ik S t-I- 11.1 G t.r A E. S Sv 1 i e Zo t i It t SS439 AUTHORIZATION TO RELEASE PLEASE REMEMBER \ 1 1(/560.00 ynda S�lll fuilding Services Amount 1. KEEP STREETS CLEAN DURING CONSTRUCTION ( JJ - ff Acct. 801.20204 2. KEEP EROSION CONTROL IN PLACE Date 3. TEMPORARY OCCUPANCY PERMIT MUST NOT EXPIRE OR • • . • SIGNATURE:- J` --�-- THE.FACE OF THIS DOCUMENT HAS A COLORED BACKGROUND ON WHITE PAPER AND ORIGINAL DOCUMENT SECURITY SCREEN ON BACK WITH PADLOCK SECURITY ICON. 1843 Mattamy MmneapoIS Partnership 7201 Wash flgton S., Ste 201 _ ? 21 Zo t 2 Edina, MN 55439 p v DATE 39 L-19 .9 PAY TO THE G t r`! p� PrZt o.x. �►'—� 5.,m .w,.. ORDER OF 9 2- i DO DOLLARS o indwed �o e_t t. - - sit - ON 14 V Wells Fargo MENIQ „" p V:_ . 0 I:0 5 3000 2 19 :20000 2 3 L L0 2 ?le u OaL843 C:IDocuments and Settingslsbare\Local Settings1Temporary Internet Files1Content .Outlook1BD80XI9A1BUILDERS DEPOSIT FORM.DOC PRIOR LAKE BUILDING AND INSPECTION INSPECTION RE File SITE ADDRESS I'3° R 1a& C, NATURE OF WORK ,S FA luc. Decic Nke. Roac i=(,u. t-. L . USE OF BUILDING St CPLe FA V\ L.1 A M. CAA elD PERMIT NO. 12 . 1284 DATE ISSUED tl /z l�z CONTRACTOR HATTA F1M 1 o PHONE 951. • sq8 -c,t28 NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW THE PERMIT IS BY SEPARATE DOCUMENT INSTAL — ( o� � �� CL-6"∎ - r �t� ►MMES µ/4 (tJ ) INSP OR DATE I FOOTING 1 1 FOUNDATION (Prior to Backfill) PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED 6 /\0o^- 1 Z- n• OUGH - INS SEWER/WATER/SEPTIC FRAMING P ' INSULATION ELECTRICAL PLUMBING u , UrS / , � 4/1451 HEATING (if required) Pi/9th)), FIREPLACE GAS LINE AIR TEST mA n, , - 4, , p Pw»s W C� �yS --^1 ' ` ° * COVER NO WOR U ABOVE HAS BEEN SIGNED 1 t ZA-P 1 1 F tIZt SPsZ(�■ � - , ' /- I N A L S & .)is GRADING (Prior to Sodding) BUILDING PA) /0/7/13 P! ‘ r - I`' --/ 3 ELECTRICAL PLUMBING , , 61,113 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