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HomeMy WebLinkAboutBuilding Permit 12. 1285 + 13.150 .. , ,,r vci _MY,,.n & ,_.r,.„r r_ , .:Si .r _. , :ri_. i,:, r_.r h r :,u, r rc.i,.i.. i.. 1,. 1..k.:i,_, i i CITY OF PRIOR LAKE Prjatrfittrttf f il o ! n c !n pi t i n C] Final Permitted ❑ Conditional C.O. Exp _ This Certificate issued pursuant to the requirements of Section 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: Use Classification S I N G L F FAMILY B ld g' Permit No. 1 9 —1 S R 1/N1 PU1) ■ Occu Type Type Construct Zoning District Legal Description _ 1 14398 PARKS IDE COURT ' Site Address Owner of Building . Contractor's Name & Address M A T T A M i HOMES ROBERT Pi . HUTCH I NS 4.9 / City Planner Bu' ding Official / Date: = `, c ; Date: / 7 / POST IN CONSPICUOUS PLACE ` . 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Pink City PERMIT NO /Z /20s 3. Yellow Applicant (Please type or print and sign at bottom) ADDRESS l 1.4 3 , t3 Vis.,V S t 0 G C 1 ZONING (office use) t` 0 0 LEGAL DESCRIPTION (office use only) LOT 3k' BLOCK ADDITION k.lf1/4-T-I z- :2-0 r..1T PID OWNER 952- p>9 - Zt UQ (Name) `i't A T M - *T i - 4 0 NI eS (Phone) (Address) 12 - I IN A S1 I rJ t, +-1 A v E S ,s"i 2.D t .O t tit H N SS 439 BUILDER (Company Name) M R'T i A, 4+o t `" t ES (Phone) 95-2--- i3 9 S " GI 26 (Contact Name) S L) t= . 224 \1 (Phone) (Address) '1'2 1 U.-, Ar 5 14 tt,i r O J Ac vE S ST - 2_cO t t -O 1 NJ e c-t tit SSt4'39 TYPE OF WORK jg New Construction ElDeck ['Porch ❑Re- Roofing ❑Re- Siding ['Lower Level Finish ❑ Fireplace ['Addition ['Alteration ['Utility Connection CODE: ❑I.R.C. ❑LB.C. ❑ Misc: Type of Construction: I H HI IV V A B Q Occupancy Group: A B E F H I M R S U PROJECT COST /VALUE $ 1.4 r 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 . -'-- -- — BL 2 3'1 538b t o l t 9 1 t Signature Contractor's License No. Date Permit Valuation (Co, 000, - Park Support Fee # $ Permit Fee $ (35-3 , S SAC # $ 2.3 Plan Check Fee $ g -19 • 1$ Water Meter Size 01"; 1 "; $ Aeo. State Surcharge $ 1 S. - Pressure Reducer $ t 2 p - Penalty $ Sewer /Water Connection Fee # $ 1 S 00 . Plumbing Permit Fee $ t 5 4 • 5° Water Tower Fee # $ 1 D - Mechanical Permit Fee $ t S 4 , So Builder's Deposit $ (%;-°°- Sewer & Water Permit Fee $ 5 Cr?. So Other fl (?- Ct't'9-6 ©"t $ Gas Fireplace Permit Fee $ S 4 • y° TOTAL DUE $ 5 4. This . , 1i . ti �� : ec . es Your Building Permit en Approved Paid G ? 7 . - Z ReOpipt No. 6 - 77 L D ate i ) f� / -i- - By - Building Official Date This is to c. , that the 1 q lest in the above application and accompanying docu eats is • . accordance with the City Zoning Ordinance and may proceed as requested. This document when signer ' the City ( er o : tutes a temporary Certificate of Zoning co pliance • d allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued. / ) A i AaraavAIL — Planning Direc er Da - 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 i r.v+et• o� I ittD� CITY OF PRIOR LAKE BUILDING PERMIT, Date Reed _ti TEMPORARY CERTIFICATE OF ZONING COMPLIANCE - g / t, AND UTILITY CONNECTION PERMIT 4j �� fn.4//L!zJ3 `�'NESO 1. White city Flt i. fink PERMIT N . /3 /50 3. Yellow Applicant f (Please type or print and sign at bottom) ADDRESS 439$ Ph,1 CO Uulz - ti' ZONING (office use) LEGAL DESCRIPTION (office use only) LOT . b b BLOCK 1. ADDITION EFFEP -s l (N46 ' u--l 6 '�t' PID SS, 41$. 034.6 (Name) OWNER N ;'1 A'T i 1 -14 U NI E...S (Phone) (4S '2" -$ 9 u- v b 6 (Address) `12a 1 W A S l-E t r l 1; u Q v E S STE. 20 a.O l t-1 H N S S L13 9 BUILDER 952- 9 S- 1 2$ (Company Name) M N-T � t-ls i 4 v t ES (Phone) (Contact Name) S V E- $rat (Phone) (Address) 1 t 1^.1t S I-} (I-4 6YO'-J Pv vE S ST- 2-o t .-O t N Ac. i-t tit SS14 39 TYPE OF WORK jg New Construction ci.Deck ['Porch ❑Re- Roofing ❑Re- Siding ower Level Finish ❑ Fireplace ['Addition ['Alteration ❑Utility Connection 3 gots. CODE: ❑I.R.C. DI.B.C. lqMisc: -117-'4 1 ✓ -0- #PnDG- >D - re) r-% 5 Bvr:13R4m — 1 Type of Construction: I II III IV V AB I S D d 0 . 6 0 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. Be- 2 3 53Sb , 2-11s I 13 Signature Contractor's License No. Date Permit Valuation 3 000.00 Park Support Fee # $ A Permit Fee $ 77" . 75 SAC # $ Plan Check Fee $ Water Meter Size 5/8 "; 1 "; $ State Surcharge $ /- 5) Pressure Reducer $ Penalty $ Sewer /Water Connection Fee # $ Plumbing Permit Fee $ ..5-41" 50 Water Tower Fee # $ Mechanical Permit Fee $ Builder's Deposit $ Sewer & Water Permit Fee $ Other $ Gas Fireplace Permit Fee $ TOTAL DUE $ /3n.7.5- This Applrca • n comes Your Building Permit When Approved Paid /c3 d , S Rpt No. (9 6/(97 Date � 2 , ( D B, Z, Zf, /3 B tiding Official Date I 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 t (4l) . . •- . • • ..i P R /0 CITY OF PRIOR LAKE BUILDING PERMIT. Date Recd TEMPORARY CERTIFICATE OF ZONING COMPLIANCE , ) AND UTILITY CONNECTION PER%IIT (Please 4 or .4 ' 4t and rsk b at bottom ADDRESS , ZONING 'cfrrre i 1/..-r LEGAL DESCRIPTION office use ortiy) i LOT BLOCK ADDITION PID I OWNER K A A , (Name) 1 1 K. I I AM`i IA 00.64; (Phone) 15 - 21 - '2_ 100 , , (Address) - 7 7.0 I v...AA5t-1 i hi (,-Tot..1 j-k■IC 4. .•01 t--) A , Pt t4 • -suit-Ewa. c•nsi 0...,.,i2- (Company Narne) ctzE- ....x4-112 56-e.0 it.4521; i t IL . (phone) - 7(.); - 2-17 -,g9 (e) (Contact Name) t t<CA Nt.E.-R- (Phone) (Address) i 1 i i C.> Tv-300fire. 44- CAW-LC t•I's ;..; rrc- N 6'1_14 R,lue.c. 1 i--tt:) S53;t> TYPE OF WORK tiLtiew Construction precis OPotch ORe-RooEng ORe-Sod rig pLosx er Level Finish 0 Fireplace Addition OAltetation 01:ttlitv Connection CODE: ?LAX. OLB.C. D Type of ust:mei:ion: I. II III TV V A 13 Occupancy G NT ( roup: A B E F II 1 S U PROJECT COST/VALUE $ - 2...,.. or) Division: 1 2 (T) 4 (excluding land) I hereM certify that liners furnished Information on this /pp:meson saheb Is to Mt best of ern, knowtedge rue and htnrect 1 aho onstify. that I atn the owner ce authorized at for the alyn.e-rdennotted peeve:1y and that all construction ix-,;41 conform to al existing state and local 13.*1 and wr: rotted n aatordande with submitted plans I am aware enat the boasting officio! cat revoke th3 pernm or pat Cause Fottlictrnom I rs4oe'ov wee :'u f the crn official or a doignee rnsr, erre- zpeet rhe reonern, to petrforrn needed inspetrons a-145 -2.-22-- i Signature Perrmt Valuation I Park Support Fee Permit Fee 1 $ SAC # $ Plan Check Fee S Water Meter Size 5 8' I ', S State Surcharge S Pressure Reducer S. Penalty $ s Water Conr.ectton Fee # S Plumbing Pernut Fee S Water Tower Fee # S Mechanical Fermin Fee 5 Builder's DeposIt 5 BUIL g WIT11 PERMIT Sewer & Water Permit Fee S Other Gas Fireplace Permit Fee $ TOTAL DUE • Ap4ii - An Be - 4 .es Your Building P t ' lien Appeased Paid 1 Receipt No 1 A■ Date i By " kraal AlMini t7 in ( , v Bud 4 Official vote , This a to certify the the request in the above appladaticri and 4= rtpanytng docsments s In andance win't the t.1. Zoning 0:dirtince and may pror:ved at tend Thns dire.mr- when taped en Me City Flarshw commutes a remporarn Cerhf :are or Zontis oomphance and a:ows tordernnnem -, , zmnter :4- Bctore occurarto A Crrlf..--tre (Med I 1 PtdinnUlg Dtrectet Dec Spe.tal Condemns , f ary 4490 fax J 24 hoot notice for all inspections (9.52} 7-1t5. 4'W2) 44'..4245 4646 Dakota Street &E., Prior lake. Minnesota 5.9'72 • . Date Rec'd O ; ? �, A '2',c CITY OF PRIOR LAKE PLUMBING PERMIT 15- 4' rnrrES O'›J 1 alp F a PERMIT NO . j0••• 1 Gold City riv k Yellow Applseem GG�� (Please type or print and sign at bottom) ADDRESS LONING (of5ce use) LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER (Name) (Phone) (Address) APPLICANT ''[ -7 J /� (Name), r C ()12- l' � 1 (Phone) 1 ( c 9 ` 5 2) / (6 - 1 tl �i - (Address) 2-L-C C 1 1 l3 V\ ll 1� (�ISV 1 l„ e GC73 J1 (Address) (City) (Zip Code) 1i (Contact Person) fa-cni 1 c l'1 Los �J t� (Phone) (Id) 76 -7 - ( g I li ' If ;� APPLICANT SIGNATURE A DATE �7 APPLICANT PLEASE COMPLETE BELOW Quantity Type of Fixture Quantity Type of Fixture `2. Bath Tub with or without shower '3 Rough -ins i Dishwasher Water Heater -- Floor _ Drain i — _ P-- Water Softener 5 Lavatory (Bathroom Sink) t Stand Pipe (Washing Machine) k Laundry Tray (1 or 2 compartment sink _ Sewaje Ejector Shower Stall - Backflow Assembly I } _ Sinks Backflow Assembly Test Bar Sink 1 Lawn Sprinkler [ 4 Water Closet (Toilet) Other FEE SCHEDULE Industrial, Commercial & Multi - family I% of job cost with a 549.50 minimum Residential, New One & Two - Family 2149.50 Residential, Additions & Alterations 549.50 . " )st $ Building Permit # The Minnesota Statutes § 72613.148 "SURCHARGE* has been changed for one year effective PLUMBING PERMIT FEE $ July 1, 2010, until June 30, 2011. STATE SURCHARGE $ .50 7'he minimum surcharge for a "fixed lie" permit TOTAL PERMIT FEE $ is s, beginning Jul} 1, 20]0 {� 'pI This Application Becomes Your Building Permit When Approved Paid Rec6i t rY �� BUILDING (PERMIT Date By Bnildin OtOclal Date 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S,E., Prior Lake, Minnesota 55312 j l 1 e rR) CITY OF PRIOR LAKE Date Rec'd A ' v i HEATING /AIR CONDITIONING/FIREPLACE PERMIT 't' : - .-.A=i , V i 4.,..SO`t9• l vn MIT NO. / / J 2 . Yellow Applicant ! PER , lApplicant „�,< -- -_- (Please typo or print and sign at bottom)_ _ ZONING o f I ADDRESS ` 9 J ? de Ci i V t( (us= me) J LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER (Name) (Phone) (Address) APPLICANT / h (Name) ('7 enii - _ ` 1 (Phone) ( ) . 1 {o7 - 1 OOO (Address) 2-'m ; o '4 Y x.1'1 ta v.,1 Bu (YL S 1 1 �”, � -'"3 (Address) (City) (Zip Code) (Contact Person) CL- ti 1 n WS (Phone) Z1 7 ` t,S 3 APPLICANT SIGNATURE DATE 21 I S / l 3 APPLICANT PLEASE COMPLETE BELOW VEW CONSTRUCTION ❑ REPLACEMENT �7 ❑ ALTERATIO1.14011K.1— NS ,,, FURNACE MAKE AND MODEL ar1C.L li - (� ] 1 2- p '2O1QO C 01 ! FUEL 6:iri p FLUE SIZE RETURN OPENINGS (O INPUT 54 tW OUTPUT 53/ 3(.0 0 TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE: Air Conditioner ►; 4 arm Air Plants ❑ Steam Units and Fireplaces Cannot Encroach ■ G avity ❑ trot Water into Required Side Yard Setbacks. echanical 0 Radiation Fireplaces with Box Additions or At Conditioning ❑ Special Devices ❑Vent. System [] Other Devices Cantilevers to the Outside of Buildings Require a Building Permit. FIREPLACE MAKE AND MODEL _ _ FEE SCHEDULE Industrial, Commercial & Multi- Family I% of job cost Residential, Gas Fireplace $49.50 S49.50 minimum Residential, Heating & A/C (New Construction) 5149.50 Residential, Additions & Alterations 549.50 Residential, Heating Only (New Construction) 564.50 Residential, AC Only $49.50 Estimated Cost 5 Building Permit d the Minnesota Statutes § 12613.148 HEATING PERMIT FEE S "SI RCI IARGE" has hem changed fnr one year ci'beli%c STATE SURCHARGE S .50 Iiih 1.20111. until .lone 30. 2011. TOTAL PERMIT FEE 5 1'hc minimum surcharge for a "tired fee" permit (Office Use Only) Is v beginning July 1.20111 This Application Becomes Your Building Permit When Approved Paid Receipt No. Date By Bundles Mail Date PAID WITH ® 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 BUILDING PERMIT M IT 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 . From:Genz -Ryan 952 767 1900 02/15/2013 11:59 #061 P.008 /0 Or p RI'p Date Rec'd � CITY OF PRIOR LAKE PLUMBING PERMIT Z3 J r0YtvEsoo I. Blue Pile � 2. akld City [ERMIT NO. /y / 1 S. Yellow Appliemo L� (Please type or print and sign at bottom) ADDRESS ZONING (orrice me) t P' C NW LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER (Name) (Phone) (Address) APPLICANT CL�� (Phone) (2Y7(67tO (Name), 2-200 i t°i 11 ` (Address) RN} UY lrlS\) ! 1 �ee, G ? 7 (Address) (City) (Zip Code) (Contact Person) -Ht rl LoS v ye e. (Phone) (acs) - 7(6 - 1 - I 2: APPLICANT SIGNATURE r. t DATE 2--/ l 6 J , APPLICANT PLEASE COMPLETE BELOW Quantity Type of Fixture Quantity Type of Fixture ''Z Bath Tub with or without shower Rough - ins Dishwasher Water Heater 1111M_ Floor Drain Iejir Water Softener �'� Leveto Bathroom Sink Stand Pi.e ashin:Machine 1111INEIN Laund Tra 1 or 2 cam, artment sink ®111 Sewa_ e B'ector mfrr - Shower Stall Backflow Assembl iii Sinks Backflow Assembl Test Bar Sink IIIIIIIIIIIIIIIIII =m' Water Closet Toilet 1111111111.11 Other FEE SCHEDULE Industrial, Commercial & Multi -family I% of jab cost with a 549.50 minimum Residential, New One & Two- Family 5149.50 Residential, Additions & Attentions 549.50 The Minnesota Statutes f 32613.148 — 1st $ Building Permit # PAID " "SURCHARGE" has been changed for one BUILDING Pig year effective PLUMBING PERMIT FEB $ PERMIT July I, 2010, until June 30, 2011. . STATE SURCHARGE $ .50 The minimum surcharge fora "fixed fee" permit TOTAL PERMIT FEE $ is SS, beginning July i, 2010 i• t 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) 441-4245 i 4646 Dakota Street S.E., Prior Lake, Minnesota 55312 • , From:Genz -Ryan 952 767 1900 02/15/2013 11:59 #061 P.007 / i PRto CITY OF PRIOR LAKE Date Rec'd ° = ,-, HEATING /AIR CONDITIONING/FIREPLACE PERMIT 4 :/ sdo . Mr, C i;: PERMIT NO. 1 3. Yellow Applicant _ I a �� �� 1 (Please type or print end sign at bottom) � ADDRESS ZONING (of�iccuse) ___�_� lode" _ LEGAL DESCRIPTION (office use only) LOT BLACK ADDITION PID OWNER -- - (Name) _ (Phone) (Address) APPLICANT • (Marne) APPLICANT"-, t o-Jr1 _ (Phone) ) ^ 1 000 (Address) 2-' 1+1\11 ta 3 awnsvi 14�. G5.-)5 7 (Address) (City) ( Code) (Contact Person) CCU 1.....05) (Phone) i5R7 (q c • APPLICANT SIGNATURE DATE S APPLICANT PLEASE COMPLETE BELOW • 8W CONSTRUCTION ❑ REPLACEMENT -^� 0 ALTERATION �,�, p FURNACE MAKE AND MODEL 1 - t l G I 1 Z 'L-o(Q0S1 1 FUEL l.�' FLUE SIZE RETURN OPENINGS (0 INPUT 9c3 ( JO OUTPUT r `a 3 j SG 0 TYPE OF SYSTEM HEATING OR POWER PLANT • PLEASE NOTE: Air Conditioner a Air Plants ❑ Steam Units and Fireplaces Cannot Encroach / v rm ery ❑ Hot water into Required Side Yard Setbacks. chani ❑ Radiadoa Fireplaces with Box Additions or At Conditioning ❑ Special Devices -- -- [Went. System 0 Other Devices Cantilevers to the Outside of Buildings Require a Building Permit. FIREPLACE MAKE AND MODEL FEE SCHEDULE Industrial, Commercial & Multi - Family 1% of job cost Residential, Gas Fireplace $49.50 • S49.50 minimum \ A Y /� Residential. Heating & A/C (New Construction) $149,50 Residential, Additions & Alterations RAID Y Residential, Heating Only (New Construction) $64.50 Residential, AC Only BUILIIING PERMIT Estimated Cost $ Building Permit It The Minnesota Statutes § 3260.148 "St :RCHARGIr has hem changed for one HEATING PERMIT FEE $ year effective STATE SURCHARGE $ .50 duly 1. Min. until June JO. 21111. TOTAL PERMIT FEE $ The minimum surcharge fore "1lwd fee" permit (Office Use Only) Is ,C,,:, btginaing duly 1.2010 This Application Becomes Your Building Permit When Approved ` Paid Receipt No. Date By Baitdlne 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. Ad 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_4 - -/ PROPERTY ADDRESS: 14398 PARKSIDE COURT ACCEPTED BY APPROVING AUTHORITIES: CITY OF WOODBURY ADDRESS: PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS YES ONO EQUIPMENT USED IS APPROVED YES ONO IF NO, EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS YES 0 N 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 0 N 1. SYSTEM COMPONENTS INSTRUCTIONS 'EYES 0 N 2. CARE AND MAINTENANCE INSTRUCTIONS EWES ONO 3. NFPA 25 ®YES ONO LOCATION ENTIRE BULDING YEAR OF TEMPERATURE MAKE MODEL MANUFACTURE SIZE QTY. RATING RELIABLE RES 49 2012 1/2 12 155 SPRINKLERS RELIABLE RES 44HSW 2012 1/2 15 155 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 O 53 • y 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 (FLOW ING) 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 ONO N/A DOES EACH CIRCUIT OPERATE DOES EACH CIRCUIT MAXIMUM TIME TO MAKF MOf1FL AI IPFRVI.SION 1 CAS Al ARM OPFRATF VAI VF RFI FASF f F,FI FASF 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 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 bare) 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 PSI FOR.HRS IF NO, STATE REASON DRY PIPING PNEUMATICALLY TESTED OYES ®NO EQUIPMENT OPERATES PROPERLY YES ONO NIA 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 VALVE IN TEST CONNECTION TESTS TEST SUPPLY TEST CONNECTIONS 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 YES ONO OTHER EXPLAIN FLUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING YES CI NO IF POWDER DRIVEN FASTENERS ARE USED IN OYES ❑NO IF NO, EXPLAIN CONCRETE, HAS REPRESENTATIVE SAMPLE TESTING BEEN SATISFACTORILY COMPLETED? BLANK TESTING NUMBER USED I LOCATIONS I NUMBER REMOVED GASKETS 0 WELDED PIPING OYES El NO IF VFR DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR -3? RYES 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 CI NO 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 00 YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL CUTOUTS (DISCS) ARE RETRIEVED? BYES ONO HYDRAULIC NAMEPLATE PROVIDED IF NO, EXPLAIN DATA ®YES ONO NAMEPLATE REMARKS DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: 5 -6 -{3 NAME OF SPRINKLER CONTRACTOR: FIRE SUPPRESSION SERVICES, LLC. TEST WITNESSED BY e l SIGNATURES ER / - NED) ^ TITLE E - - - •NTRACTOR (SIGNED) TITLE DATE !e _ ' o, r wt. 5-6-13 ADDITIONAL EXPLANATION AND NOTES 445 10 i9 o PR tA Builders Deposit r 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 1, 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. I I DATE: I b It 4 lt'v SITE ADDRESS: L439% PQ-1 V sto GT PERMIT # • V REFUND TO BE MAILED TO: M Y 4-1 -o tit ES '12 o t 1. AS44-11.1 rots /1. 1/E S SU t Zo I 1� t ‘41s, � I-1 SS I4 9 AUTHORIZATION TO RELEASE PLEASE REMEMBER 11/ Soo. po ynda S. Alle , Building Services Amount 1. KEEP STREETS CLEAN DURING CONSTRUCTION 10 . t (- (3 Acct. 801.20204 2. KEEP EROSION CONTROL IN PLACE Date - - „ - , el�atJl: - 4C1'DJfX'I'i • SIGNATURE: —�-- _.. THE FACE OF THIS DOCUMENT HAS A COLORED BACKGROUND ON WHITE PAPER AND DOCUMENT ORIGINAL DOCUME SECURITY SCREEN ON BACK WITH PADLOCK SECURITY ICON - - 1843 M Minneapol Partnership 7201 washingfon-Ave,S.,Ste 201 Edina, MN 55439 DATE N ov Z `' i 1-°1-2- 39 t - 18.32 PAY TO THE G , - o f Ptzi D ORDER OF °' tires DOL LARS n Ue�eOSon bad �iki12�fl' - Ntat= - &4bUSatyr) pNe l4-Ur�c,a ) SE-V *xJ e-1 1 n0 Wells Fargo MEMO "` t�w6 Y '• u•00 L84r 11■ I :0530002191 :20000423LL02W C :\Documents and Settingslsbare1Local Settings\Temporary Internet Files\Content.Outlook1BD80XI9A \BUILDERS DEPOSIT FORM.DOC P R'OR DEPARTMENT OF . B BUILDING AND INSPECTION - INSPE S e :k) i � _. � RE F� SITE ADDRESS (IBc0 PAR-KS ►nE C . NATURE OF WORK ,S FA li.ic OEcic tJo P � 02 ,,.3. t_.1, . USE OF BUILDING St, - F A,v tL1 ,t\-.n-,A%G6k.eV PERMIT NO. 12- 12.£3B- 1 DATE ISSUED tl /z l bz. CONTRACTOR MATTA rt`C (`towkes PHONE 952.. s- ►s -‘rz8 NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW THE PERMIT IS BY SEPARATE D OCUMENT ( rte srAt -.t._ t: iv ,,, C o� ; L. Gc-a S-ra EE �4r A L� �i M 5 ►��' (t'`I INSP OR DATE I FOOTING 1 1 I FOUNDATION (Prior to Backfill) 1 1 NO CONCRETE UNTIL I PLACE C A430"-1 L AB OVE HAS BEEN SIGNED Qe ' ; ' a,ROUGH - INS SEWER / WATER / SEPTIC FRAMING c 3- ' ,, ,,- INSULATION / P ELECTRICAL PLUMBING (`J. 6 I/CS ..2 41.2 - / ei ., 41 HEATING (if required) /9, fdl:'-'%?/:FIREPLACEGAS LINE AIR TEST gr,,gi,v i f!p . e d, 4' 3 a4' COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED F t izE. SF Iz -Ir.1 K L , - ; 7 5 ,1 ! FINALS ,',.6,,,n" . GRADING (Prior to Sodding) BUILDING 'a - --15- '3 ELECTRICAL / FLUMBING teC g WO 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 • f