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Ar S t lt'l (,,..T13 t.../ AV vE 3 5T 2.0 t 1=0 t >v N. H 1t SSA 39 TYPE OF WORK New Construction ElDeck ❑Porch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace ❑Addition DAlteration ❑Utility Connection CODE: E.R.C. DLB.C. ❑ Misc: Type of Construction: I II III IV V A B Occupancy Group: A B E F H I M R S U PROJECT COST /VALUE $ 1 `} 0 t 00 0 . CU 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 pennit for just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections. Xc _ BC-- - 2-c ,7 3 - 1 S32,b s Signature Contractor's License No. Date Permit Valuation 1,/,__, , Park Support Fee # $ Permit Fee $ / 4 01. S- SAC /41 # $ T Plan Check Fee $ q? �• tl Water Meter Siz- /17" "; 1 "; $ ,/ 0 e) / State Surcharge $ ` q � Pressure Reducer $ / - O 0 L / Penalty $ ---- Sewer /Water Connection Fee # $ / Z ) 6 � y .Plumbin Permit Fee $ /5 / � -� Water Tower Fee # $ / do Mechanical Permit Fee $ / 74. j -- 0 Builder's Deposit $ J Sewer & Water Permit Fee $ B 9�SiDG� � DG , � e >�, S D Other 47.1 � ,P..t.tter) $ /5- - Gas Fireplace Permit Fee $ fi - I t S TOTAL DUE $ / , 0 11.3 A atio Becomes Your Building Permit When Approved Paid j/ 0 /4 i b Re pt No. 6 �/ �y Date �.�� B ilding Official Date This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document when signed by the City Planner constitutes a temporary Certificate of Zoning compliance and allows construction to commence. Before occupancy, a Certificate of Occupancy must be issued. Planning Director Date Special Conditions, if any 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 P col c" 3, ; awe IP. '1 . 4.1■. - I 41% Residential Building Permit Checklist New Construct n for Single or Two - family Dwellings i R•1 or -2 Districts 4 Reviewed by: Date: S 2Q ( Building Permit # �—P1II; __—r— Zoning: 1v 57 Address: (I69 lr 0, 50c, - 1 F L , B Subdivision: • • Existing Structure? YES! i . Existing Nonconforming Structure? YES 1 NO CONFORMS TO ZONING `,,• NO ORDINANCE • 1 Yard Setbacks: NA 1 FAILS/ COMP Standard Proposed • Front Yard (can be 20' if avg. IA 50') .-W Z ©1 .zz. 7 S • Side Yards X81 7,0' MP 1 25' if abutting a street • Sidewall exceeding 60' requires additional side 2" 10' setback + setback for every 1' over 60' in length. Not required 2'11' over 60' if building wall is 10' -0" or greater of being parallel to _ a side lot line. • Rear Yard '' • 'Z • • Patio Door: provide for minimum 10' deck or sign 10' side! statement indicating no deck will be built in the future 25' rear • From 100 year flood elevation of wetland /NURP 30' - pond. • Refer in- ground pools to the Planning Department • From OHW (Prior or Spring Lake) 75' or setback average of adjacent structures, but no less than 50' Floor Area Ratio: NA I FAILS 1 CrIOLIES 1 .30 Maximum 1 r - .--J ' Yard Encroachments: p FAILS /COMPLIES Standard Proposed Eaves and Gutters no more than 2 feet in width and no closer than 5 feet to a lot line (Easements). • NC and other equipment cannot encroach on interior side yards. • Tree Preservation :64 FAILS/COMPLIES Standard I Proposed • Total caliper inches • Permit 35% Removal • Caliper Inches Re o ved • • • Cali drin�ches Pr served Ri • lacers tf 1/2:1 L : \TIIMPLkTB\BLDGLIST.DOC • I Driveway: NA / FAILS / CO IES Standard Proposed • Maximum width at prop tine 24' / q • Required setback 5' from side lot line or 30' from r -o -w on comer lots • Maximum slope 10% -7_ 2 • All parking areas to be paved including R V or spaces adjacent to the garage • Location to match subdivision grading plan Building Height: NA / FAILS / COMP,JS I 35' Maximum ! /a 4.'D ' Shoreland District: NA / FAILS / C • 'T : LIES Standard Proposed Minimum lot area (square feet) 7,500 Rip, 7,999 Non -rip Minimum lot width • 50' Rip, 57.3' Non -rip Shoreland alterations Im • ervio.us surface d ` 30% Maximum Pv M k" fir ' Bluff in Shoreland$�A / FAILS / COMPLIES Standard 1 Proposed • Setback from top of bluff By planning dept. • Bluff impact zone 20' From Top of Bluff • Engineering certification submitted /approved • By City Engineer • Grading in bluff or bluff impact zone No importing /exporting Floodplain: 1 FAILS / COMPLIES Standard Proposed • 100 yea lood elevation 908.9' Prior Lake 914.4' Spring Lake • Lowest floor elevation 909.9' Prior Lake / 915.4' Spring Lake • • Proposed lowest floor elevation Must be 1' above flood elevation for new and existing structures. If existing structure was constructed 9119/90- 11/22197 then additional foot is not required. • Elevations 15 feet from structure Must be flood elevation or hi ' her • Road access must be no more than 2 feet below 907.9' for Prior Lake Regulatory Flood Protection Elevation 913.4' for Spring Lake Accessory Structure: gi FAILS / COMPLIES Standard Proposed • Size 1000 sq.ft. or 30% rear yard • Not located in front yard (Materials) • Side yard and rear yard setbacks 10' • • Maximum height 15' • Materials compatible with principle structure L :ITBMPLATE\BLD GLIST.DO C C 11111° 9 ttt White - Building NES��P Canary - Engineering Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT P ' /I / y f/c/" aS APPLICATION RECEIVED 5, 3 - /3 The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: H30/ 03 QS 07 P,I/i o� c7 . Accepted Accepted With Corrections Denied Reviewed By: Date: 7(//7 Comments: 1. PI a6 GI. fa,' vo5(`4AA -v dc))rJ a.SocA 4-71 "The issuance or granting of a permit or approval of plans, specifications computations shall not be construed to be a permit for, or an approval of, any ' any of the provisions of this code or of any other ordinance of the jurisd' presuming to give authority to violate or cancel the provisions of ordinances of the jurisdiction shall not be valid." oo PRIp� U ri White - Building Canary - Engineering "'INNESO`� Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT 9'`M77fi / J y 1/0/ -1615 APPLICATION RECEIVED 3 /3 The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: /` / r 03 0 07 � , Accepted X Accepted With Corrections ... Denied Reviewed By Date: S' /6-.1-3 Comments: See RRVerse Side for Additional Information! x, " N. F See Attachments: 1) Grading Plan, 2) Erosion Control Standards "The issuance or granting of a permit or approval of plans, specificatio computations shall not be construed to be a permit for, or an approval of, any v' any of the provisions of this code or of any other ordinance of the juri i '' presuming to give authority to violate or cancel the provisions o )00.0000000 .0e - t" ordinances of the jurisdiction shall not be valid." 1 O i ?Rio o h U trr White - Building MINNESO�P Pink Canary - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT " 'h /,-//' 1 y / ' , - APPLICATION RECEIVED -' = M.,„.,, ' The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: Accepted / Accepted With Corrections Tr* Denied Reviewed By: Date: S Z 7 /3 k Comments: , f "The issuance or granting of a permit or approval of plans, specifications and computations shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of this code or of any other ordinance of the jurisdiction. Permits presuming to give authority to violate or cancel the provisions of this code or other ordinances of the jurisdiction shall not be valid." Oi "12 Date Rec'd CITY OF PRIOR LAKE SEWER AND WATER PERMIT 4'NEso t '. Green F Ci il e ty PERMIT NO. /3 O Z7 2. Yellow 3. Gold Applicant (Please type or print and sign at bottom) ADDRESS ZONING (office use) 1 L i 3o1 - 03 -oS -o7 P LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER (Name) (Phone) (Address) (Address) (City) (Zip Code) APPLICANT '/� A : ,�' (Name) IJ ' S, / 1• — `— • ' (Phone) (Address) � 1 t-i t l is,Q liv4C (Address) (City) (Zip Code) (Contact Person) 1 i k.-e. At- (Phone) 4 1 Z 1 (1-1.13 11 0 APPLICANT SIGNATURE 114Adtki ( DATE L &'"3 APPLICANT PLEASE COMPLETE BELOW Size of water service inches. Location of any couplings from structure feet. Type of sewer pipe. ❑ ABC ❑ PVC ❑ Cast Iron Estimated length of sewer line feet. Clean out (if required) located at feet from structure. FEE SCHEDULE Residential sewer and water line connection $51.50 Industrial, Com'l & Multi- family 1% of job cost with a $51.50 minimum Sewer connection only $25.50 Water connection only $25.50 Estimated Cost $ Building Permit # The Minnesota Statutes § 326B.148 ER AND WATER PERMIT FEE $ "SURCHARGE" has been extended until June 30, 2013, CE SURCHARGE $ rD WITH The minimum surcharge for a AL PERMIT FEE $ BUL-DiNG PET "fixed fee" permit is $5.00 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 Oi P RIB+ Date Rec'd a 9 CITY OF PRIOR LAKE f z.-3 447 SEWER AND WATER PERMIT b �j�NESD�P /3-3 /3 — .-Z S 1. Green File PERMIT NO V / — QQ// 2. Gold Applicant L 3. Gold Applicant (Please type or print and sign at bottom) L/ _ 3 -7� ADDRESS ZO G ffiic use) • /V3 oi-o3 o 7 P o � W6, LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER (Name) (Phone) (Address) (Address) (City) (Zip Code) APPLICANT (Name) � 8 4 CAI , .)14 (Phone) (Address) a` 9 I C.c € Qn� -c jY . - p 5s 0 3 (Addres) (City) U (Zip Code) (Contact Person) ini4 O. (Phone) Co / Ct /%a ` q c/c) APPLICANT SIGNATURE 44.0 0A-AA-4) DATE 9 / o. / APPLICANT PLEASE COMPLETE BELOW Size of water service inches. Location of any couplings from structure feet. Type of sewer pipe. ❑ ABC ❑ PVC ❑ Cast Iron Estimated length of sewer line feet. Clean out (if required) located at feet from structure. FEE SCHEDULE Residential sewer and water line connection $51.50 Industrial, Com'l & Multi - family 1% of job cost with a $51.50 minimum Sewer connection only $25.50 Water connection only $25.50 Estimated Cost $ Building Permit # SEWER AND WATER PERMIT FEE $ STATE SURCHARGE $ .50 PAID WITh TOTAL PERMIT FEE $ BUILDING PERMIT (Office Use Only) This Application Becomes Your Building Permit When Approved Paid Receipt No. Date By Buildine Official Date 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 E eRlo� CITY OF PRIOR LAKE BUILDING PERMIT, Date Recd TEMPORARY CERTIFICATE OF ZONING COMPLIANCE L AND UTILITY CONNECTION PERMIT NE5 I. white Pile PERMIT NO. 13 . 52:7 2. Pink City 3. Yellow Applicant (Please type or print and sign at bottom) ZONING (office use) ADDRESS 14- ,,�4319 Chug 1■4) WI Lux)) 5Cco K., LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID ( O N E E , A IVIA. MY It b - (Phone) q5 - ZI c'o (Address) 7Zo Wil5(4 l06 iso) 17 (K A 1 MN 55 4.31 RbEhEMIt G v�TI?GTb2 • r 0�-27?- Q�!(0 (Company Name) ' 6 �av - • - - -C (Phone) 7 1 (Contact Name) --- 111SOtJ 67itt i1 R (Phone) (Address) /I / / 00S t 4 L at 2L1 h0W SU t l H �L • vE.Z t M lJ 5 C7 TYPE OF WORK r.lsiew Construction ['Deck ❑Porch ['Re-Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace '(]Addition ['Alteration ❑Utility Connection CODE: NLR.C. ❑I.B.C. ❑ Misc: Type of Construction: I II III IV V AB Occupancy Group: A B E F H I M 7 S U PROJECT COST /VALUE $ 2 0 0 Division: 1 2 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 evoke this permit r just cause. Furthermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections. X 4 4 o il 44.1. 0-145 B -21 - 13 Signature Contractor's License No. Date Permit Valuation Park Support Fee # $ 4x00 Permit Fee $ j ' 0t . a0 SAC # $ Plan Check Fee $ &t 9 f'S Water Meter Size 5/8 "; 1 "; $ State Surcharge $ 2.o0 Pressure Reducer $ - Penalty $ Sewer /Water Connection Fee # $ Plumbing Permit Fee $ Water Tower Fee # $ Mechanical Permit Fee $ Builder's Deposit s �,� n [� t Sewer & Water Permit Fee $ Other P ("1 P��" Gas Fireplace Permit Fee $ TOTAL DUE 2015°1141 Thi • Ap li 'o , Becom Your Building P 't When Approved Paid Receipt No. _ Date By is ce3 Building EF icial Date This en signed by the City Planner constitutes a application eporary Certificate of Zoning � compliance in and accordance llows construction to commence. Before occupancy, a a of Occupancy document 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 • From:Genz -Ryan 952 767 1900 09/10/2013 13:54 #596 P.007 /0YL' 4 vRIO Date Rec'd "` CITY OF PRIOR LAKE PLUMBING PERMIT L ill 16 . 75 ' i t' p "° PERMIT NO. Yea A l7 .5 3. Yelbw AppNram (Please type or print and sign at bottom) ADDRESS ZONING (office use) 1 I A3 0 ) Pak ) as . A . L/SA LEGAL DESCRIPTION (office we only) �, /r / `�� X 1 L01104 BLOCK l ADDITION re`�`, / l ' �'" r 7'1 L 4 p1D 2 - 1 1. O'Vf�NER (Name} l ete\t `eA�� (Phone) ( Address} APPLICANT .. (Name) GENZ RYAN (Ph 952-767-1000 (Address) 2200 W HIGHWAY 13 BURNSVILLE 55337 (Address) (City) (Zip Code) (Contact Person) LONI PE ASON (Phone) 952-767-1000 �1.� w,r�► APPLICANT SIGNA ��,,, �� ,- k � •-- • DATE cs ) —/ b "- APPLICANT PLEASE COMPLETE BELOW Quantity Type of Fixture Quantity Type of Fixture r, Bath Tub with. or without shower / Rough -ins f Dishwasher / Water Heater / Floor Drain Water Softener 3 Lavatory (Bathroom Sank) Stand Pipe (Washing Machine) Laundry Tray (1 or 2 compartment sink Sewage Ejector Shower Stall Backflow Assembly Sinks Backflow Assembly Test Bar Sink Lawn Sprinkler 3 Water Closet (Toilet) 1 Other t or- 1,42 r,- .ce - FEE SCHEDULE Industrial, Commercial & Multi - family I% of job cost with a $49,50 minimum Residential, New One & Two-Family $149.50 Residential, Additions & Alterations $49.50 The Minnesota Statutes 4 326B,145 �'st $ `" Building Permit # "SURCHARGE:" re a been changed for one year effective PERMIT FEB $ / gil57) year July 1, 2010. until June 30, 2011. STATE SURCHARGE $ 20 The minimum surcharge fora "fixed fee" permit TOTAL PERMIT FEE $ Is LS beginning July 1.201 0 This Application Becomes Your Building Permit When Approved Paid Receipt No. PAID }h i t M=1 Date Buiid B UILDING PCRMIT iaa a[tHC1al Date BUILDING 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 09/10/2013 13 :54 #596 P.008 /0Y‘7 • Q 1' CITY OF PRIOR LAKE RIp � o. %�. �P HEATING/AM 4 , „ .. 11 A' IR CON DITIONING/FIREPLACE NING /FIREPLACE PERMIT ” Date Recd ftrl /'MESO' Ct" q,m. /3 E. Pink Pik ('�""-`^'--- ---- -- Please a or . fiat arul ' a at b ottom 2 . ono city RIV1IT NO. / �i "—� Y. Yellow Applicant ADDRESS tt 1 [ , ,, - — - ' l " p �� �v,,' ,` ,., ZONING (office use) Ut. �- �4�C.. eit .\t,,.) Pi/5A LEGAL DESCRIPTION (office use only) LOT • i.LOCK i ADDITION Je i toillei4Aft AmAi PID z if DL, - f OWNER (Name) �'1erir, A -- ---- ----__ ____ -�M i :: Address) (Phone) • APPLICANT (Name} GEN2 RYAN (Phone) 952 - 7 67 -1000 (Address) 2 ? 0 W HWY 13 (Address) BURNSVILLE 553 . (Contact Person) LONI PE RSON r (City) (tip Cod - j APPLICANT SICrNA • AlgilP (Phone) 952 767 - 1000 • ♦► • • DATE -- APPLICANT PLEASE COMPLETE BELOW 6.1 EW CONSTRUCTION FURNACE MAKE AND MODEL Q REPLACEMENT 0 ALTERATIONS RA ON FLUE SIZE RETURN OPENINGS FUEL TYPE OF SYSTEM INPUT ��_ OUTAUT HEATING OR POWER PLANT [Warm Air Platits] Steam PLEASE NOTE: Mr Conditioner DWacJty Units and Fireplaces Cannot Encroach ►` Mechanical 0 Rot Water ±r. it Conditioning ❑ Special Devices ©Rad'ation into Required Side Yard Setbacks. }: ent. System Fireplaces with Box Additions or (] Other Devices Cantilevers to the Outside of Buildings FIREPLACE MAKE AND MODEL Require a Building permit. Industrial, Commercial & Multi Family I% "E' SCHEDULE of job coat Residential, Gas Fireplace Residential, Heating & A/C (New Construction) $49.50 minimum $49.50 • Residential, Heating Only (New Construction) $6 Residential, AC C nly Residential, A O & $49.50 Only 7 $49,50 Estimated Cost $ Building Permit # The Minnesota Statutes C 32613.148 HEATING PERMIT FEE $ bO "S(JRC:MARGE" has been changed for one STATE SURCHARGE car effective (Office Use Only) TOTAL PERMIT I"E $ July 1, 2010, until June 30. 2011. The minimum surcharge fora " 1ised fee" permit This Application Becomes Your Building Permit When Approved Paid July t, 2oto Receipt N Noo. . Building Official bake ■ r11. bate a' . • s .; 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 byte contractors 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 /0 a PROPERTY ADDRESS: 14301 PARKSIDE COURT "WILLOWBROOK" ACCEPTED BY APPROVING AUTHORITIES: CITY OF PRIOR LAKE ADDRESS: PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS YES ONO EQUIPMENT USED IS APPROVED BYES ONO IF NO, EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS .� YES ONO TO LOCATION OF CONTROL VALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? IF NO, EXPLAIN INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: OYES ONO 1. SYSTEM COMPONENTS INSTRUCTIONS YES ONO 2. CARE AND MAINTENANCE INSTRUCTIONS YES ONO 3. NFPA 25 YES ONO LOCATION ENTIRE BULDING YEAR OF TEMPERATURE MAKE MODEL MANUFACTURE SIZE QTY. RATING RELIABLE RES 49 2013 1/2 11 155 SPRINKLERS RELIABLE RES 44HSW 2013 1/2 15 155 RELIABLE F3QR 2013 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 0 S' 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 RED UCING _ INLET (PSI) OUTLET (PSI) INCET (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 ❑N0 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 MOt1Fl SIIPFRVISION I lqS Al ARM OPFRATF VAI VF RFI FARE OPFRATF F.FI 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 of 150 psi (10.2 bars) for two hours. Differential dry-pipe valve clappers shall be left open during test to prevent damage. M 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 goo PSI FOR _LiHRS IF NO, STATE REASON DRY PIPING PNEUMATICALLY TESTED OYES 'ENO EQUIPMENT OPERATES PROPERLY 'EYES O NO 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 VALVE IN TEST CONNECTION TESTS TEST SUPPLY TEST CONNECTION 1,0 PSI CONNECTION OPEN WIDE PSI UNDERGROUND MAINS AND LEAD IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE TO SPRINKLER PIPING. VERIFIED BY COPY OF THE U FORM NO. 85B EYES ONO OTHER EXPLAIN FLUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING PAVES ONO IF POWDER DRIVEN FASTENERS ARE USED IN EVES ONO 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 ONO 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? EVES ONO WELDING DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUAUFIED IN COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, 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? YES CI NO CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL CUTOUTS (DISCS) ARE RETRIEVED? NINES NO HYDRAULIC NAMEPLATE PROVIDED IF NO, EXPLAIN DATA YES ONO NAMEPLATE REMARKS DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: re)-24—f3 NAME OF SPRINKLER CONTRACTOR: FIRE SUPPRESSION SERVICES, LLC. TEST WITNESSED BY FOR PROPERTY OWNER (SIGNED) TITLE DATE SIGNATURES • ' - NKL T^ • : (SIGNED) TITLE DATE �,. �` t 0-7.4 ADDITIONAL EXPLANATION A, " S ZQ (9 C Builders Deposit City of Prior Lake A $2,500.00 Builders Deposit is included in the Building Permit fee. The Builders Deposit is issued as security to insure compliance for a Final Occupa icy 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 $2,500.00 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 Lak3 as outlined in the Erosion Control Measures for Building Contractors handout. DATE: S 2 1 SITE ADDRESS: 1 4 Pte-¢- v-S(O1= ' t- PERMIT # 13 .511 REFUND TO BE MAILED TO: NIA- T A n'{ -I or-1 e s 120( INA5Ftl Ave. 5, Su t i E 2p EO l rJ p t-i r� 5 5 4 5 PLEASE REMEMBER 1. KEEP STREETS CLEAN DURING ZONSTRUCTION 2. KEEP EROSION CONTROL IN PLACE 3. TEMPORARY OCCUPANCY PERMIT MUST NOT EXPIRE OR $500.00 WILL BE FORFEITED SIGNATURE: �S-� / .K 412,500..0D ( t.. S Allen, B ilding Services Amount /4 / j/3 Acct. 801.20204 Date Larr R p ler, City Engr, J:IFORMSIBUILDERS DEPOSIT FORM.DOC • • x'111 lr) 4i'l,e " DEPARTMENT OF BUILDING AND INSPECTION f C INSPECTION RECORD r } SITE ADDRESS /4 Amit � I �� NATURE OF WORK �, USE OF BUILDING�'s• • to) Ale f �P �� No med.) p PERMIT NO. 3 - C DAT ISSUED CONTRACTOR /2/ y PHONE INSTALL EROSION CONRTOL AND MAINTAIN CLEAN STREETS AT ALL TIMES r INSPECTOR DATE FOOTING (4k_ 6,,- 1 c--- FOUNDATION (Prior To Backfill) 12 qZ.0 7 / j RADON RETARDER `j .:� auk" 5. '',/ ?,r,� , F PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ROUGH - INS r' SEWER/WATER/SEPTIC ' � �'` FRAMING .y4 77,3 INSULATION A ? t 5 C ELECTRICAL PLUMBING u tw , 4thtEk, 0,111,1(3 ,44 5 HEATING 11* 4118., FIREPLACE GAS LINE AIR TEST Ai& A,..4n .<f�r 47,-1. /09-,// 3 RADON RETARDER COVER NO WORK UNTIL THE ABOVE HAS BEEN SIGNED I HOUSEWRAP q 86 , c LATH { / s /0/z.-65,.076 4 WiT INALS - t ,.,_ 7400ei, GRADING ( PRIOR TO SODDI t) , ( 1 /� BUILDING • in �� ELECTRICAL y PLUMBING 490 //9/ HEATING A lFjinikirilI` rct ` "� � /� � � � DO NOT OCCUPY UNTIL AS BEEN SIGNE 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