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Building Permit 13. 0483
.x7 ., r.•�' s �d' '..,.fi e y+.'"'_ ',a.�,s',+ '.�,..:r cw': ,rra ..�x.:. y•.1Y3.0 _ ''�,t�s'x+i'*7, CITY OF PRIOR LAKE !iinirfminf of puiIktMng nspi tth xt K jK >< inal Permitted ❑ Conditional C.O. Expires y K This Certificate issued pursuant to the requirements of Section 110 •of the 0 Residential/❑International ,. K _ 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 SING I F FAMI LYBldg. 13-0483 Permit No. p �+ Occupancy Type R3 Type'Consttuction VN Zoning District r�'J� D K L14, Bl , HIrKORY SHORFS SFCOND ADDITION Legal Description < Owner of Building site Address 3891 TURNER DRIVE SW Contractor's Name&AddressD'. R R. HORTON, I NC ROBERT D . HUTCH NS- - • City Planner Building Official Date: - (a -- i Lk Date: POST IN CONSPICUOUS PLACE � �3 5 O n 000000 ° 0 a 20 n 0 a 0 0 o � � K� kk k m/ § © � � � s � Ac ■ s � § 0m hi r 0 0 ■ m § _•-•G-) g ■ �� t -1 _1 > Z m oQ � ) �k .. ro0 a n ■ . w n z z z■ \ 0 k m \ o » > § k � II r 0 s § xi R R O ❑ OO ❑ O -] X q2 m ® -0cn ■ ® - E § o0 �c2 � � 2 $ zC mzE -0 n ' ■ )4 ct M / d kkkk � k 73 z F k q 0 ¢ 0V 2 c c 0 73 z r Z # mr � � P v / A. ilb A.0 M k c n 2 A . } 0O ❑ O0K : CI d ■ " -nn§ , - $ % § \ § � 'V -0§ Z " t21 0 z & & � � 9 m -212 ■fit 2 —Ir 0 y5 ❑ O N - c) ❑ ❑ ❑ ❑ ❑ v 0 a Z0 AO 0 3 N z- -rt z m � b c� 0 73 73 73 0 ` 3 rc3zg m N �O rn far ; n n N ;_ , Ri z 5z• yz CO �11 -4 -ai ( ' m Opp z— C ,0�` p D -n U! = z M 0 „ O ' . 0 :7.1 Da 0 % mm z 0 73 r p : m z O o / ❑ ❑ ❑ ❑ ❑ ❑ 0 -xi z v o a 13, icy"� > a 11 co � c * t -cp n N r. " 0 ( ` ZZXX Zi 3 z m b -i o z rzco xx - ' C O P to �. 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PR/ ---- CITY OF PRIOR LAKE BUILDING PERMIT, TEMPORARY CERTIFICATE OF ZONING COMPLIANCE Date Reed . , .., AND UTILITY CONNECTION PERMIT 4N-NEfix)*°' i WAtte file 2 pit* city PERMIT NO. /3 4-0 `7 a 'know Applicant (Please type or print and sign at bottom) ADDRESS ZONING(office use) 33C1/ 47-1),Ai'L-7-- Avg- SA/ PUD< LEGAL DESCRIPTION(office use only) LOTp/ELOCK / ADDITION ih'e-iy," pr-- 5.1.01- .2.-- PID 2.6, 4$70 . Cli te.0 OWNER ' (Name) (Phone) (Address) BUILDER (Company Name) D.R.HORTON, INC (PhMO 952-985-7272 (Contact Name) Brooke Hareid bmhareid@drhorton.com (phone) 952-985-7806 (Address) 20860 Kenbridge Court, Lakeville, MN 55044 ... TYPE OF WORK 0 New Construction ()Deck Croat °Re-Roofing Me-Siding OLOgartevel Finish 0 Firepittee ()Addition ()Alteration OUtility Connection CODE: 1i.R.C. D.B.C. U?vibe. Type of Construction: I II III IV V A B PROJECT COST/VALUE $ 2'03) O.3..Z. Occupancy Group: A B E F II I M R S U (excludhlaud) Division: 1 2 3 4 5 tg rai hereby certify that 1 have ftimisttedinfinintenon on this application which is to the best of My knowledge true and Collett. 1 also certify that I am the owner or authorized agent for the hrave-loCtillOaled proPftly and that all Conaltitetion wall conform to all eXisting OW andiocal taws and wilt proceed in accordance with submitted plans. I am aware that the building offidal cannVeke this Permit for oat cause Putthentime.I hereby agree that the env official ma designee may enter upon thepropeny to perform needed Inspectums BC605657 Signa aff Contractors LiceffstNo, Date , .. Permit Valuation 0 006.i3e Park Support Fee # $ ---, Permit Fee . - C, $ 1 O‘, . $-40 j SAC 4 S 24 3 ‘.--)--- - s Q Plan Check Pee $ 5,, , ie Water Meter Size 5/11";10; $ 4-bo, co _ State Surcharge S / 1 6-0 Pressure Reducer $ i ( 0 . 0 0 Penalty $ Sewer/Water Connection Fee # $ 75-6 Cl ..00 Plumbing Permit Fee S /5.4/ 3-(-) Water Tower Fee 4 $ /0 0 0_ 0 0 Mechanical Permit Fee ---0 $ 1S-2/ 5 Builder's Deposit S 2,5-0 o 0 C Sewer&Water Permit Fee ,..--..;-7) Other $ 42)/i2, . is-4i. Gas Fireplace P-rinit Fee $ 6-2.7__-„,5 7) TOTAL DUE $ /(, (#5 , a I f III . Thl A t y on 13writs Your Building Pent. When Approved Paid Receipt No. /1 / .--- Date By la 4/1 iv 1 d official f,att. 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 SpeoMiConditions,if any 24 hour notice for all inspections(952)447-9850,fax(952)447.4245 4646 Dakota Street Prior Lake,MN 55372 • •', ' pitto, . . , •• . :Itr:-; ,,,,•••:,i, ;:. . .. . . � rDeposit . . . .. .... , _ , . . , ,_ ". . .: . ,. . --- ,. .,6itt : t... ...:., 7. ...• :, . cityof , !` " �; ,lit1Q' etxtCcteira o tkatti 1 t att# tt +r the 8titltttt .l a4txtfilt fatY rt a .l ttltd r f l it(a sued a estjaxl tt4 htAngt:Cat pitance film a 146.4 # gC14°t t :'id411: A'is- rov eermt ` 1�.A t eXta tits tteal tacluddrta but•l::iIi' i[ald too�td`ttt r:: tidal Iarrrla a 60.a, trait et#in r3 lls�st ttq 1 t` ACL#, sttitp'e d t# ay4 tort ga a.I 111 p i t r—•.t ti. of t fit c ctr the' •v1tlt -iiia- -- 4011_11.1_1t a d". City= It titin th X110 1 t V0.411a attd ttik#fit{�sit ll e' Ys�t ecl ly ctr the' �i,> . ( #et1`dens: sp IEwltt"t ea anvit.s'atptie talitb bili .rcteatrue.p. coal dIv xicttt irda tt,*tom A ! '_tee ReptxsCt treat atbrgairard�rrixt:tetltllxt"r:fttrxtl lit40. a pribtt t' �ata ; . Ol;i`S:... ._.. ...,__ Z:- .. 7... : .... ... . . . • • T :,MA`s. D.R. Horton, Inc Attn: ftp AUTHO'�I ZATION TO RELEASE N BE 20860 Kenbridge Court Suite 10021 GO,CO :� ` " ` . . Lynda S Allen, ildingServices Amount Lakeville,MN 55044~ Acct.801.20204 bate +++ - ..,...avi. J.v 1WL'JLL`t11J.EI it 4. '1 E La ' oppler, City Engineer — • 1, KEEP�RE -�$A OPA1 AUTITOPIZ,ATmic TO PVT 'A cu' .: !KEEP Ett11 _: l ? a`.R R 0 * PAISIOTPERIVITT MUSA'NIT` V-1.. =0` . . 0.M E f ,,.. Ce 7 ,S PRiy' .;77-71,1"4:'''' N •# prr- cs ��1 1�ply �N''JI rj��ll III , ,. 4C C .� .,D B C m R ,0:vE,AP .YID H tN SIB E: '.i:" § . sr .,Y; i^, ,-sr,; - I I� �I `` .�, �l� I I ,1 . III ��af.. s _�� � �-.. �. al pI. a"•IihIx:i -�d ' II Ip.': .r, y _— -yE o `. I'I ��, *< ln !UGt A-, IIl1 � �' ,; II 0:, ..K.:.', x i9e .. 4,.y :3 r ala i �<� ;l r, 1 s r i t ' e_ I�_v'��7�7��T__—��. «� I ,111!drrI�'- I IQi IP i "i, i lc. Y ;���� `���� 1 �. ll�..�x� • I , e � �. ->�� y,,�.j 1 ���Y' - —,� � �� _�. d I' IG';Iflx! J 1 F.-I�1� ! � � ��; � � _<.. �; x �, ,z � � � $--:—=�°i. i' 1I ISI I � 11-11 u 199 1 11 r'. , _' .>f -ms`s- _ A I I.s_ 1i 1,7,_.1 1�n., k7 ,-:.�+�`: �--�-� _� tom,-' � 4 'K3 �.I I�.�1 I I4;l,q d'lll:E'�II i".'1'jII I ��'�: —�: _ y�,.z �Yx�c�y 10 ��' In: I� m.71?�.o i�.^Yu�^1 u�� �. t_-� r I gt _ .: �VI!�ill�itli 1,l1 11 * IIII"' I II I — x p j I•i I I ° I II11,(J dir:$7,4:'4.•_,- .:,--. ..1,.-7.----,_-=:-,5=E a ' `= �II 1�►11I �I�u�i1, IlIS i ( — _ II ,, �t�, I a ldga t = , Sou. I.Ildul ,- N,IIII 1�ry1111I 11111u ����tliq�ll...:.,h , - , THIRTY FIVE THOUSAND SIX AND 54/100 *********************************************;* * - 1 I'.pl I1\t191511 . Ve G I. III, Oi•ker,,,4, „II Ilin pp l llllryII II.III� 1,IIIIdN,J`{ 4 „-�E III ,I 411 N IJ I,� d n ` '„b S I g��I. I -I 114IIt.! ®F CITY OF PRIOR LAKE(PERMITS II° _lls'ilC � � 21,0 .1 i tI u 4646 DAKOTA STREET SE 0 , ` ` `. 4I„ PRIOR LAKE MN 55372I � µ ; ,r t '� '� n; } ', •4+nilig . 4 t z 4 ylI'ur E i91@ I!1 g1111d '10 alltl a': s• �I5 /4. -i k -t_ . x ,A 4r r i i . .�+=�p W t 1'N'',ill E.s`d'�.', ,e G ' ..9”*` 'T«si4 ` t . sof+; t .fit gest:d:'Fs syn,` ,,,,PtLaj.y ' x; 9 , , s,tF 4,g ,a -I fit AtiVi '�``» .�..isa'r.J°.''z`:c�;,,.,til*, r,,_',; x..�.`. .' -+°ak :��-.4�''. (ci . rif op LII xyr rtbiw L,Aii r, a;$kJHal)Inks rtt61Vt.UI s bate Kec'd TEMPORARY CERTIFICATE OF ZONING COMPLIANCE �,,, AND UTILITY CONNECTION PERMIT �y 7� R�77 41- i li'NESo�P I. White File PERMIT NO. I 2. Pink City ' q�I rawI 3 Yellow Applicant • (Please type or print and sign at bottom) ADDRESS ,. Ortve_ ZONING(office use) LEGAL DESCRIPTION(office use only) LOT BLOCK ADDITION PID OWNER4 . _ (Name) I i C- k OrL) 5 illor -J (Phone) (Address) BUILDERA 1 , `j (Company Name) ! .• a (Phone) i S7 - Z57 /gko (Contact Name) 3 4.),47 F,.l,% _I-,r C PPo)-e.r -(uv-, (Phone) 5'7S reit 4netut Ila Ave W (Address) Si, O€ () A..) S4-I 03 TYPE OF WORK ❑New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑Fireplace ❑Addition EAlteration DUtility Connection CODE: EI.R.C. ❑I.B.c. ❑Misc. Type of Construction: I II III IV V B PROJECT COST/VALUE $ 3 3 OO two ! Occupancy Group: ABE F HI M SU • Division: 1 2 (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 pro• rty 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 permit for just I use. Furthermor, hereby agree that the city official or a designee may enter upon the property to perform needed inspections. X � (G 5 O{ - a7- / 3 Signature Contractor's License No. Date • Permit Valuation //// Park Support Fee # $ q 0m0a ac, Permit Fee $ /03. ob SAC # $ Plan Check Fee _ $ /-/ . °M ..—. � Water Meter Size 5/8"; 1"; $ State Surcharge $ W t2P•0 U Pressure Reducer $ Penalty $ Sewer/Water Connection Fee # $ Plumbing Permit Fee $ Water Tower Fee # $ Mechanical Permit Fee $ Builder's Deposit $ Sewer&Water Permit Fee $ Other $ Gas Fireplace Permit Fee $ TOTAL DUE $ PAID WITH This - .p1• I t eeo '•s Your Building Permit When Approved Paid 'i (tP +1f Date By v. 21/0 Buil. <z Oftici ii /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 16200 Eagle Creek Avenue Prior Lake,MN 55372 rRIo CITY OF PRIOR LAKE Date Recd t.- HEATING/AIR CONDITIONING/FIREPLACE PERMIT U g 4,-/NIVEsco. t.Pink File / ■ 2.Green Cllr PERMIT NO. ' �. 3.Yellow Applicant IL (Please type or print and sign at bottom) ADDRESSZONING(office use) SCI 1 1MrrAi v fl\f 5W LEGAL DESCRIPTION(office use only) LOT BLOCK ADDITION PID OWNER (Name) (Phone) (Address) APPLICANT-- (Name) MOODYL W I QJ (Phone) '1t0 3 "41-1,- -22..V7 (Address) 5'— /A Q..ktM,.d.• r/..:1, P1 1/ , 44'1 (Address) ( ` ) (Zip Code) (Contact Person) (Phone) I(p O 1.`J 5'411 Y APPLICANT SIGNATURE VDATE 11-10-LOS APPLICANT PLEASE COMPLETE BELOW ❑NEW CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS FURNACE MAKE AND MODEL FUEL FLUE SIZE RETURN OPENINGS INPUT OUTPUT TYPE OF SYSTEM HEATING OR POWER PLANT ['Warm Air Planks Steam PLEASE NOTE: Air Conditioner ❑Gravity 0 Hot Water Units and Fireplaces Cannot Encroach ❑Mechanical fl Radiation into Required Side Yard Setbacks. DAir Conditioning D Special Devices Fireplaces with Box Additions or ❑Vent.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 $49.50 minimum Residential,Heating&A/C(New Construction) $149.50 Residential,Additions&Alterations $49.50 Residential,Beating Only(New Construction) $64.50 Residential,AC Only $4930 Estimated Cost$ Building Permit # HEATING PERMIT FEE $ I PAID WITH . STATE SURCHARGE $ .50?u g i r. i 1,0, '_ F'M r T TOTAL PERMIT FEE $ (Office Use Only) // r This Applic tit ;!; naes Your Building Permit When Approved — Paid Receipt No. 14 Date By Bulldia t fficial Date 24 hour notice for all inspections(952)447-9850,fax(952)447-4245 4646 Dakota Street S.E„Prior Lake,Minnesota 55372 1 t CITY OF PRIOR LAKE Date Rec'd ° ° HEATING/AIR CONDITIONING/FIREPLACE PERMIT Iv?i!I ► M \:......47 .0 ..Pink Pile — nnvss 2.Caen city PERMIT NO.13 ' 3.Yellow Applicant •(Please type or print and sign at bottom) ADDRESS . ZONING Office use) - 313CA Iwrner bre S1\ Thor L LEGAL DESCRIPTION(office use only) LOT BLOCK ADDITION PID (Na -D c b �} "�� e.5 (Phone) 952--965-7272. • (Address) .ZUbCp0 i'• 1a' tQMO C-1--..4-f00 [mat/01e, kI S,/0A • APPLICANT /� /� /� I, CI _ ) (Name) i v s de T frc l/ q Tl o M• (Phone) (o /r lL 53-Z SIL I (Address) 7100 mai Ir V i e(' ) R- e. K] T o' e 0 I l IoN1 ( 13 (Address) (City) (Zip Code) (Contact Person) Lppcg k L &e ^^�I /I (Phone) t9617 to3Br2J1 . APPLICANT SIGNA'T'URE e'' he r1(21-4 dhASI10-4.. DATE _ D , , • APPLICANT PLEASE COMPLETE BELOW DNEW CONSTRUCTION ❑REPLACEMENT ❑ALTERATIONS • FURNACE MAKE AND MODEL FUEL FLUE SIZE RETURN OPENINGS INPUT OUTPUT TYPE OF SYSTEM HEATING OR POWER PLANT • PLEASE NOTE: Air Conditioner ❑Wavy Air Plants ❑Steam Units and Fireplaces Cannot Encroach ❑Gway 0 Rot Water into Required Side Yard Setbacks. ®dviochanical ❑Air Conditioning ❑Radiation 0 Special Devices Fireplaces with Box Additions or ❑Vent System 0 Other Devices Cantilevers to the Outside of Buildings 7 c-- (Dr`) Require a Building Permit. L FIREPLACE MAKE AND MODEL S -1-104---r\-1.0 FEE SCHEDULE Industrial,Commercial&Multi-Family 1%of)ab cost Residential,Gas Fireplace •$49.50 $49.50 minimum Residential,Heating&A/C(New Construction) $149.50 Residential,Additions&Alterations $49.50 Residential,Heating Only(New Construction) $64.50 Residential,AC Only $49.50 Estimated Cost$ Building Permit # . The Minnesota Statutes$3260,148 t— "SURCHARGI,"has been changed for one HEATING PERMIT FEE $ year effective STATE SURCHARGE $ .50 July 1,2010,un61 June 30.2011. TOTAL PERMIT FEE $ The minimum surcharge for a"filed fee"permit (Office Use Only) i Is$,5.beginning July I.2010 This Appli 'tion?, es Your Building Permit When Approved Paid Receipt No. iiif �.J Date By _ a �tD� ,5 � i.--- Building i'ficial Date f''1) 1 24 hour notice for all inspections(952)447-9850,fax(952)447.4245 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372 o. P Rips Date Rec'd CITY OF PRIOR LAKE SEWER AND WATER PERMIT 4iINNEsoo 1. Green FilePERMIT NO. 13_N4t ?3 Z. Yellow City 3. Gold Applicant (Please type or print and sign at bottom) ADDRESS , ZONING(office use) � f / Zv A - k- LEGAL DESCRIPTION(office use only) LOT BLOCK ADDITION PID OWNER A A- 14X (Name) (Phone) (Address) (Address) (City) (Zip Code) APPLICANT l (Name) f.5.jy1 ii4 %C., (Phone) e7 �8a ./3'r (Address) i9/4, /1e--e iV jje/SYA/tt c513,3 (Addres (City) (Zip Code) (Contact Person) ______*& '2/N ' (Phone) /2 &r y34/s' APPLICANT SIGNATURE / _. AL sdarf DATE 3 .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# SEWER AND WATER PERMIT FEE $ PAID WITH STATE SURCHARGE $ BIJfi. MNG PERMIT TOTAL PERMIT FEE $ (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 Date Rec'd 01PRlp CITY OF PRIOR LAKE PLUMBING PERMIT `.7 l/3 tit.,,4::fig itte, INNES_..dit- ,,g,,n File PERMIT NO. / 3.YelCity / _04/8',5 L 3.Yellow Applicam (Please type or print and sign at bottom) ADDRESS ZONING(office use) 3V11 ' vor-vvar Yt. s w Pu.s_A LEGALDESCRIPTION(office use only) 1 LOT 1 BLOCK / ADDITION , ' 'G 5-7a1)2--87,-S- O'S 2 I ALI PID =I 5--" 18 — £2/4 d OWNER (Name) (Phone) (Address) APPLIC(Name)ANT, L 1A0 9 tt 1,1-4- (Phone) 1413Z2 ,1 _.._ (Address) 155'36 qukiivoL... %eA_ Pi 4�/1�1ffi'lA.i'i1 554414' dress) (may) (Zip Code) (Contact Person) 5iitit&k_,''9 (Phone) 11 -Z53-4411V _ APPLICANT SIGNATURE c V%4.J4' DATE —zo 1 _ 6 3 APPLICANT PLEASE COMPLETE BELOW Quantity Type of Fixture Quantity Type of Fixture Bath Tub with or without shower Rough-ins Dishwasher Water Heater Floor Drain Water Softener Lavatory(Bathroom Sink) 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 I 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 $49.50 The Minnesota Statutes*326B.148 . st $ Building Permit# PAID WITH "SURCHARGE"has been changed for one •�►"�7 year effective PLUMBING PERMIT FEE $ BUILDING PFPIMIT July 1,2010.until June 30,2011. STATE SURCHARGE $ .50 The minimum surcharge for a"fixed fee"permit TOTAL PERMIT FEE $ is 5.5,beginning July 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 S.E.,Prior Lake,Minnesota 55372 CONTRACTORS MATERIAL&TEST CERTIFICATE FOR ABOVEGROUND PIPING PROCEDURE: Upon completion or work,inspection and tests shall be made by the contractor's representative and witnessed by an owner's representative. All defects shall be 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 for faulty material,poor workmanship,or failure to comply with approving authority's requirements or local ordinances. PROPERTY NAME:Hickory Shores (()) DATE: 9-30-13 PROPERTY ADDRESS: `�31/ �V Arke-v-. A«� ,,t ACCEPTED BY APPROVING AUTHORITIES(NAMES) City of Gerry ipv4091.- PLANS ADDRESS: INSTALLATION CONFORMS TO ACCEPTED PLANS • YES 0 NO EQUIPMENT USED IS APPROVED al YES El NO IF NO,EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION OF CONTROL VALVES AND CARE AND MAINTENANCE OF THIS NEW EQUIPMENT • YES 0 NO IF NO,EXPLAIN INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THE PREMISES: MI YES 0 NO 1.SYSTEM COMPONENTS INSTRUCTIONS • YES El NO 2.CARE AND MAINTENANCE INSTRUCTIONS ■ YES El NO 3.NFPA 25 • YES CI NO LOCATION OF SUPPLIES BUILDINGS SYSTEM ENTIRE BUILDING DESCRIPTION MODEL YEAR ORIFICE SIZE TEMPERATURE QUANTITY Reliable F1FR 2013 1/2" 155 31 Reliable F3QR(Dry) 2013 1/2" 155 1 SPRINKLERS CPVC with CPVC Slip fittings PIPE&FITTINGS ALARM DEVICE MAXIMUM TIME TO OPERATE THROUGH TEST ALARM VALVE CONNECTION OR FLOW TYPE MAKE MODEL MINUTES SECONDS INDICATOR Vane Potter VFS-R "T a DRY VALVE Q.O.D. MAKE MODEL SERIAL NO. MAKE MODEL SERIAL NO. TIME TO TRIP* WATER AIR TRIP POINT TIME WATER REACHED ALARM OPERATED THROUGH TEST CONNECTION PRESSURE PRESSURE AIR PRESSURE TEST OUTLET" PROPERLY MINUTES SECONDS PSI PSI PSI MINUTES SECONDS YES NO DRY PIPE WITHOUT OPERATING Q.O.D. TEST WITH Q.O.D. IF NO,EXPLAIN "MEASURED FROM THE TIME THE INSPECTOR'S TEST CONNECTION IS OPENED. OPERATION CJ PNEUMATIC EJ ELECTRIC CJ HYDRAULIC ,22 ha;lnPRIOR `DEPARTMENT OF BUILDING AND INSPECTION INSPECTION RECp SITE ADDRESS 3991 V*i 'E� S T �/� NATURE OF WORK Sf2 `7Ave' ; 4cJ- I 4�` r 1 USE OF BUILDI _ si.vwce-F4,,tit y ,g .2) PERMIT NO. DATE ISSUED CONTRALTOPHO . INSTALL EROSION CONRTOL A D MAINTAIN CLEAN STREETS AT ALL TIMES INSPECTOR DATE FOOTING FOUNDATION (Prior To Backfill) jp RADON RETARDER - - PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ROUGH - INS SEWER/WATER/SEPTIC FRAMING INSULATION ELECTRICAL PLUMBING vis L)('o f2/3 ? t�Y1 /g3 >/: �- gr-,613i P1)°,HEATING FIREPLACE ' 7/ C GAS LINE AIR TEST 8-52,6 RADON f,._ k 'y8- COVER NO WORK UNTIL THE ABOVE HAS BEEN SIGNED ----irldVSEWRAP f�/,LATH EP4 fetecb aw 4M1 FINALS fi1-e 7e" 54,7, GRADING ( PRIOR TO SO ING) BUILDING-- 6/ /0b ,,ELECTRICAL PLUMBING iV /� .HEATING Atese,•tt1 r � /' �, /® / j/3 DO NOT OCCUPY UNTIL A,_ 'V HAS BEEN SIGNE NOTICE This card must be posted near an electrical service cabinet prior to rough-in inspections Bind maintained until all inspections have been approved. On buildings and additions where rio service cabinet is available, card shall be placed near main entrance. FOR ALL INSPECTIONS (952) 447-9850