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�� 04, CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd .
:-, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ,a &d.14
AND UTILITY CONNECTION PERMIT
drl R�
�'NESC1
1,white File PERMIT NO./ 4.'
2. Pink City
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
1000 O .1,ut‘,7 M ,i.„....,,/(. 5,Er
LEGAL DESCRIPTION� (office us/e only)
LOT BLO K DITIO PID�✓ / 77-009-f
I�1V
OWNER
(Name) Nd71.ID2 y S7 t- /04/STon7S 1l"C , (Phone) 9'S'? '030 ^888y
(Address) VS-6 7 kHE77/C/6/ S t 0.A i '.` /771.5%/-11-/_.57rV3 7
BUILDER
(Company Name) NCI.1 til--y STL-T/ON.57V P45 X1'4 I' (Phone) 957-830 4117
(Contact Name) ?GIL D. !„f/[ (Phone) •
(Address)
TYPE OF WORK ❑New Construction ['Deck ❑Porch 12112e-Roofing ❑Re-Siding ❑Lower Level Finish • ❑Fireplace
['Addition OrAlteration ['Utility Connection
CODE: ❑I.R.C. ❑I.B.C. 0 Misc:
Type of Construction: I II III IV V AB
Occupancy Group: ABE F HI MR SU PROJECT COST/VALUE $ Y0/ OattO
Division: 1 2 3 4 5 (excluding land) •
(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 far 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 r yoke 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 13...A8w✓ -- .,572 931/
" V
Signature Contractor's License No. ate
•
Permit Valuation /JO c't� Park Support Fee # $
Permit Fee $ �� 77 00 SAC # $
Plan Check Fee $ 33 15. O5 Water Meter Size 5/8"; 1"; $
State Surcharge $ 20 UU Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer&Water Permit Fee $ Other ,�yy $
•
Gas Fireplace Permit Fee $ TOTAL D j471-eirj 4J 4'• f# $ Q?Z. as-
This ,ppli o. + com our Building Permit When Approved Paid Ci 7.Q,CDS—
Date Receipt No. t l 1S br
(o . y l By 51.4(.3
ma., 01/1'l�
Building 0 i icial to
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
)(4HOLIDAY STATIONSTORES
4567 American Boulevard West, Minneapolis, MN 55437-1123• 952-830-8700 •www.holidaystationstores.com
Holiday
City of Prior Lake May 29, 2014
Building and Inspection Department
4646 Dakota Street S.E.
Prior Lake, MN 55372
Re: Holiday Stationstore#198
16800 Duluth Ave. S. E.
Prior Lake, MN
Dear Building and Inspections Department;
I have enclosed for your review existing and proposed floor plans as well as a building permit
application for the above mentioned location. Holiday Stationstores, Inc. is proposing an interior
remodel of the facility to include but not limited to the following:
1. Closed up current entrance door and relocate 3'-4' to the right.
2. Remove current checkout cabinets and replace with new in the same general location.
3. Remove the current food counter wall and 3-4' back into the current storage rooms
which will entail relocating the in ceiling furnaces
4. New refrigerator island case.
5. New food service cabinets along wall which will be ADA.
6. Interior wall decor such as paint oak trim, wall tile etc..
7. Misc. adding food equipment such as the island case, a pop and malt machine.
If you should have any questions during your review,please feel free to contact me at 952-830-
8884, via fax at 952-830-1678 or email at:joel.geil@holidaycompanies.com
Sincerely,
Holiday Stationstores, Inc.
Joel D. Geil
Construction Supervisor/Project Manager
443 Lafayette Road N. 651
MINNESOTA DEPARTMENT�3 F ( )284-5005
St.Paul, Minnesota 55155 1-800-342-5354
www.dli.rrin.gov LABOR 84 INDUSTRY
Ask
Division of Construction Codes and Licensing
REPORT ON PLANS
Plans and specifications on plumbing:Holiday Stationstore No. 198, 16800 Duluth Avenue SE,Prior Lake, Scott
County,Minnesota,Plan No.PLB 1406-00177
OWNERSHIP: Holiday Companies,P.O.Box 1224,Minneapolis,MN 55440
SUBMITTER: Mid City Mechanical Corporation,9103 Davenport Street NE,Blaine,MN 55449
Date Received: June 27,2014,June 20,2014
Date Approved: June 27,2014
SCOPE: This review is limited to the provisions of the Minnesota Plumbing Code,as amended.The review is
based upon the supposition that the data on which the design is based are correct. Approval is contingent upon
requirements included in this report. A copy of the approved plans,specifications,and this Report on Plans
must be retained at the project location for future reference.
INSPECTIONS: All plumbing installations must be tested and inspected in accordance with the requirements of
the Minnesota Plumbing Code. No plumbing work may be covered prior to completing the required tests and
inspections. The contractor/installer must obtain an inspection permit from the Minnesota Department of Labor
and Industry when an installation is for a state owned facility,Minnesota Department of Health licensed
healthcare facility,or a project in an area where there is no local administrative authority. To schedule
inspections,contact the state plumbing standards representative for your region. For your regional inspector's
contact information,visit our website at http://www.dli.mn.gov/COLD/CCLDContactus.asp
REQUIREMENT(S):
1. A separate backflow preventer is required at each potable water connection to an individual piece of
beverage equipment. The backflow preventers must meet the requirements of Minnesota Rules,part
4715.2100 and part 4715.2110.
2. Floor drain used as receptors for substantial amounts of liquid waste must be individually vented in
accordance with Minnesota Rules,part 4715.2620 and part 4715.1300,subpart 4.
3. The relocated island vent must be constructed in accordance with the following(see Minnesota Rules,part
4715.2655):
a. The horizontal vent must be pitched at 1/4-inch per foot minimum to drain.
b. Drainage fittings must be used for all portions of the vent located below the floor.
4: Materials used for water distribution systems must comply with Minnesota Rules,part 4715.0520. Cross-
link polyethylene(PEX)tubing must meet Minnesota Rules,part 4715.0520:
a. The tubing system must comply with ASTM F877 and F876.
b. When installed as a system in accordance with ASTM F877,the tubing and fittings must be of the same
manufacturer and be marked as required by the manufacturer,
c. When not installed as a system,the fittings must be marked with ASTM F1807,F3960,F2080,
F2098-01,or F2159. The tubing must list the fitting and tubing standard.
d. Installers must possess a card documenting completion of factory training.
This information can be provided to you in alternative formats(Braille,large print or audio).
An Equal Opportunity Employer
Holiday Stationstore No, 198
Plumbing
Plan No.P1.81406-00177
Page 2
June 27,2014
5. Materials used for drain.waste,and vent systems must comply with Minnesota Rules,part 4715.0570
through pan 4715,0600, if plastic pipe is used for the drain,waste and vent system:
a, ABS plastic'pipe shall comply with ASTM D2661 or F628,
b, PVC plastic pipe shall comply with ASTM D2665,D2949,or F891.
c, PVC solvent weld joints must include a primer of contrasting color to the pipe and cement,
6. The plumbing system shall be tested in accordance with Minnesota Rules,part 4715,2820.
7. The water distribution system shall be disinfected per Minnesota Rules,part 4715/250.
8, Complete plans and specifications must be submitted to and approved by the Minnesota Department of
Agriculture. Contact the Dairy,Food,Feed&Meat Inspection Division at 651/201-6027 regarding
information necessary for their plan review and licensing requirements.
NOTE(S):
1, The scope of this project consists of the remodelling of an existing building. The plumbing installation
includes relocating three floor drains and a hand sink,
2. This facility will he served by existing municipal water and sewer services.
Authorization for construction in accordance with the approved plans may be withdrawn if the plumbing
installation is not undertaken within a period of two years. Plan approval does not necessarily mean that
recommendations or requirements for change will not be made at some later time when changed conditions,
additional information,or advanced knowledge make improvements necessary,
Approved:
€ -
Bradley C.Erickson
Public Health Engineer
Plumbing Plan Review and Inspections Unit
651/284-5880
cc: Mid City Mechanical Corporation
Holiday Companies
City of Prior Lake Building Official
MDA Food Inspection Division
File
PRIOR LAKE DEPARTMENT OF
BUILDING AND INSPECTION
INSPECTION RECORD
SITE ADDRESS j(0ea) D U t,0 -k"- /4e
NATURE OF WORK A,tma,kav►
USE OF BUILDING
PERMIT NO. I *75. DATE ISSUED ' _ .f
CONTRACTOR �o1,�A, --�' `�`
PHONE 4Sa,-&30, 8say
INSTALL EROSION CO&RTOL AND MAINTAIN CLEAN STREETS AT ALL TIMES
INSPECTOR DATE
I)
h�1% riI 'iIjpER
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
FRAMING - 71 Zki 1 i
INSULATION f
ELECTRICAL
PLUMBING U� ( 1t Til f(2-1
HEATING
E
GAS LINE AIR TEST
giiiiii"la
COVER-NO WORK UNTIL THE ABOVE HAS BEEN
SIGNED
i L .
FINALS
BUILDING it jR 7/2r/)
ELECTRICAL
�"'
PLUMBING `t-k i
HEATING 6L 7)25-/,c4
DO NOT OCCUPY UNTIL ABOVE HAS BEEN SIGND
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