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Home My WebLink AboutBuilding Permit 10-1010 TE TIME CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED � 2 [' /D : .�0�, ADDRESS '4 S 1 I � �L�j c,,cJ O� OWNER CONTR. PHONE NO. PERMIT NO. /O — �Q/D O FOOTING ❑ PLUMBING RI ❑ EX/GRAD/FILLING ❑ FOUNDATION ❑ MECH RI ❑ COMPLAINT � FRAMING � WATER HOOKUP ❑ FIREPLACE RI ❑ INSULATION ❑ SEWER HOOKUP O FIREPLACE FINAL �EINAL ❑ PLUMBING FINAL ❑ GASLINE AIR TST ❑ SITE INSPECTION ❑ MECH FINAL ❑ COMMENTS: C, �,� � �/L� �11VORK SATISFACTORY, PROCEED ❑ CORRECT ACTION AND PROCEED ❑ CORRECT K, LL FOR REINSPECTION BEFORE COVERING Inspector: nedContr: CALL 447-9850 F NEXT SPECTION 24 HOURS IN ADVANCE. CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY! /NSNOTI V „ ' _ DAT TIME �l�� CITY OF PRIOR LAKE scN�pVLED INSPECTION NOTICE SCHEDULED I � �{ � � C1T`� � PR,�N� CE ADDRESS �� L � � L� w p� +NSpE �Z�ON � OWNER CONTR. � � C � Nt � � AO� PE RNI�T N� � PHONE NO. PERMIT NO. Q— O � O WNER 1 C Mg1NG R ( O FOOTING ❑ PLUMBING RI ❑ EX/GRAD/FILLING NE NO• p P�� N R� � ❑ FOUNDATION ❑ MECH RI ❑ COMPLAINT PND ME pOKU ❑ FRAMING ❑ WATER HOOKUP ❑ FIREPLACE RI �t�NG � � W ❑ INSULATION ❑ SEWER HOOKUP O FIREPLACE FINAL O F� u NpAT�� p S� F�NA �FINAL ❑ PLUMBING FINAL ❑ GASLINE AIR TST O F� M�NG � p PL H F�NA� �❑ SITE INSPECTION ❑ MECH FINAL ❑ O,� u �,T►O p ME� �. COMMENTS 0 gtE�N I� o� � cOMM � o � �/ � 1, �r� N S �' M�l� E ✓►� �� B�tF� c�'�1 D�l PR � C EE� ❑ WORK SATISFACTORY, PROCEED FAC�� CEE� �CORRECT ACTI AN ROCEED K Sp' Np PR F /❑ CORRECT WO K L OR REINSP ORE COVERING � ORRE CT`pCT,oN CAL� F � RE,NSp 0 � ORK� � Inspector: Owned ntr: O �� \nSP �R � NEXt CALL 447-9850 R THE NEXT INSPEC N 24 HOURS IN ADVANCE. 0 F CODE REQUIREMENTSARE FOR YOUR PERSONAL HEALTH & SAFETY.� Cp�.1- 9 U jgEMENTS ARE Fa CODE RE4. lNSNOTI , DATE TIME CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED G (i (� ADDRESS � � � 4 V�J t'�OCA�D� OWNER CONTR. PHONE NO. PERMIT NO. �j��0 � U ❑ FOOTING ❑ PLUMBING RI ❑ EX/GRAD/FILLING ❑ FOUNDATION ❑ MECH RI ❑ COMPLAINT O FRAMING ❑ WATER HOOKUP ❑ FIREPLACE RI ❑ INSULATION ❑ SEWER HOOKUP ❑ FIREPLACE FINAL � EINAL ❑ PLUMBING FINAL � GASLINE AIR TST O SITE INSPECTION ❑ MECH FINAL ❑ COMMENTS: / . () w� ' � cF- i 1�2. �. ,? , i � � � �� ❑ WORK SATISFACTORY, PROCEED ❑ CORRE CTION AND PROCEED �CORR CT RK, CALL FOR REINSPECTION BEFORE COVERING Inspecto Owner/Contr: CA L 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. CODE REQUIREMENTSARE FOR YOUR PERSONAL HEALTH & SAFETY.� rNSnon DATE TIME CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED �l � � ADDRESS � `�I, � � �'�� iQ OWNER CONTR. PHONE N0. PERMIT NO. I� '�a�[� ❑ FOOTING �PLUMBING RI ❑ EX/GRAD/FILLING � ❑ OUNDATION � MECH RI ❑ COMPLAINT RAMING ❑ WATER HOOKUP ❑ FIREPLACE RI ❑ INSULATION ❑ SEWER HOOKUP ❑ FIREPLACE FINAL ❑ FINAL � PLUMBING FINAL ❑ GASLINE AIR TST ❑ SITE INSPECTION ❑ MECH FINAL � COMMENTS: � — , � - Z. M � �c�-� 3. P��w,�: �_ �-��; F ra �n k,�-e c�-. a.,,� �rw. �� S ok c�.�u,�.� rnc� �-� Q�� r.� c4.� ___ �h < < �1IORK SATISFACTORY, PROCEED ❑ CORRECT ACTION AND PROCEED �CORREC ORK, CALL FOR REINSPECTION BEFORE COVERING Inspector: Owner/Contr: CALL -9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. CODE REQUIREMENTSARE FOR YOUR PERSONAL HEALTH & SAFETY! lNSMOTI DATE TIME CITY OF PRIOR LAKE INSPECTION NOTICE SCHEDULED / 2 � ADDRESS G�) � (,�J��,�,n,? wao,� OWNER CONTR. PHONE NO. PERMIT NO. �O I�16 ❑ FOOTING ❑ PLUMBING RI ❑ EX/GRADIFILLING ❑ FOUNDATION � MECH RI ❑ COMPLAINT � FRAMING � L�WATER HOOKUP ❑ FIREPLACE RI ❑ INSULATION ❑ SEWER HOOKUP O FIREPLACE FINAL ❑ FINAL � PLUMBING FINAL �GASLINE AIR TST O SITE INSPECTION ❑ MECH FINAL COMMENTS: �. ` 2. � r �� ❑ WORK SATISFACTORY, PROCEED �CORRECT ACTION AND PROCEED ❑ CORRECT CALL FOR REINSPECTION BEFORE COVERING Inspector: ' OwnedContr: CAL OR THE NEXT INSPECTION 24 HOURS IN ADVANCE. CODE REQUIREMENTSARE FOR YOUR PERSONAL HEALTH & SAFETY! fNSNOTI F PRIO � � '� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec d � �9 TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ' � ', x "� .�� _�� `� AND UTILITY CONNECTION PERMIT � `� � �`� ` � � ��' �'NE$� 1. Whlie Pite PERMIT NO . � �,� �,ry �a - �o/o 3. Yellow Applicant (Please or 'm and si at bottom .�D�SS �� w, � �� d �� -� � . � . �� Zo � ( �o�ce �� LEGAL DESCRiPT`ION (ofPice use only) LOT BLOCK ADDITION PID Z S. 3 o U S O OWNER `_ ,�DGE VA� C��✓� c� (Name) Tl�fz�� (Phone) �� Z. ZZ� ' Z6Ct� (Address) �� BUII,DER �Zc�I (�U. �'1�� C_�t G'1� `��j Z � �� • 2 `7 2' `� (Company Name) (Phone) (Contact Name) � 2 -i �� (Phone}� � � Z- � � �'s � S 7 s (Address) /`� Z- j �t C XC �� UYL— �t/L. ° � / ��✓lVl� l� � � �1 ��J �j - ��j Z� TYPE OF WORK ❑ New Consuuction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace �Addition �Alteration ❑Utility Connection CODE: �I.RC. �.B.C. ❑ Misc: Type of Constnution: I� III IV V A� �� Occapancy Gronp: A� E F H I M R S U PROJECT COST/VALUE $ � Division: 1 2 3 4 5 (exclnding land) I hereby certify that I h ve tumished information on this applicadon which is to the best of my lmowledge true and mrrect. I aLso certify that I am the owner or authorized agent for the above-menaoned yerty and that nstruction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am awaze that the building official can revok this it for j cause. Furt ermore, I hereby agree that the city official or a designee may enter upon the property to perform needed inspections. X �2 u c.��, - Sigiature Contracror's License No. Date Permit Valuation • 7� �� , Park Support Fee # $ Permit Fee $ � Z,� J SAC # $ Plan Check Fee $ 5 � 0 �� Water Meter Size 5/8"; 1"; $ State Surcharge $ �� _ Pressure Reducer $ Penalty $ Sewer/Water Connection Fee # $ Plumbing Permit Fee $ Water Tower Fee # $ Mechanical Perrnit Fee $ Builder's Deposit $ Sewer & Water Permit Fee $ Other $ Gas Fireplace Permit Fee $ TOTAL DITE �� S � �� $ ��c �� , This Appl' ion Becom Yo Building Permit When Ap oved Paid / � $e@4�ei t No. (o /� � Date i/, S . /J � �/ Z /D Buildin Official te / l�' This is to certify that the request in the above application and accompanying documents is in accordance with the City Zoning Ordinance and may proceed as requested. This document when signed by the Ciry Planner consritutes a temporary Certificate of Zoning mmpliance and allows construcdon to mmmence. Before occupancy, a Certificate of Oocupancy must be issued. �U � S�'�° \ P mg Director Date Special Conditions, if any 24 hour notice for all inspections (9S2) 447-9850, fax (952) 447-4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 - , PriorLake > City of Prior Lake > Forms, Applications 8 Handouts > Building Permtt Applications > Heating / AC / Fireplace Permit e * R!p r ..� Z � � ,�° �'� CI7'Y OI2' PRIOR LAI{� D�te Rec'd � � HLATING/AIR GO�IDITIOrtING/FIREPLACL PERMIT : ; : ��MMN� f /(/� ✓`i ` V � [ V l C/ 1. !ak Pik 7. Otwn Cdf � / � . � v � 7, Y�Ilrw Ap�llws� le6�t of aod d aC AI3DRBSS /7 / ZC?NII�C} (ollAae uee� L ��` C�/, /� �v � E� cv �l �; ,�.C'f �- L$GAL D$SCRYP'I`TON (oAix u�e onty) LOT BIACK ADDITlQI�I pID OWl�IBR ri�! /r^ vi f G✓ ��i �ti ,/ {Name) (Phone} (A44r�) APPLICANT � //��✓ �l G-G, ', � (Namt} (Phnne) �f Z J y � Jl �/ (Addt+esg) '�� /� �' r �s� r'� � C C � /�sf , :^. L /�i�✓ ,�J � _ (Addreet} ({:ltY (Zip Cadt) (Conuact PesBOn) �� ` � �' �'' �.� (Pbone) �� APPIIICANT SIQNATURS � DATS �� /a APPLICANT PL�AS� COMPLEI'� BELOW ❑NBW CQN�TRUCCtaH RBPI,ACEMBNT TERATIQN$ . FUt�2AC3� MAKB ANU MODHL l� � I��~ ! FUPI.. FLUE SiZE �xN aPSrrn�ras trrPV�r ov�v�r TYPB OF SYS�'F.I� f�iBA`I�G QR PdWEA FLANT QWum Air Plants Q 36oem PI,EAS�B NOTR: OC�rsviry � xot waoer A11' CazMittonet' UniL� � Mechenicai � It�liit�On Gutnot E�iGroaCh 1Ma �Air Car,�itionfng p 9pedJ Devicra Required Side Ysrd pvent, sy,tan Cj ocher Devicea secbacyce R�RBPLACE MAKE AND MODBL F�� b�CH&DULB Indusulel, Commet�ei�l dc Mult1•Fnmihy i'i� vf jvb cosG Raaidanti¢l, Gs� Rireplaee 539.30 $39.50 minimum ReHdemial, Heatina 8t A!C (AIevr Conatruction) S99_50 Resid�Ual, Addtflan� dc A)tuatioe� x39,30 Rasidentlel, Hating On�y (New Cansttucxifln) S64.S0 Ro�identisl, AC Oniy $39.30 E�timatad Cvn $�� U Buifding Pettnit # . HEATING PBRMZT FBE $ �I' .� ..7 U �TATS SURCHARGfi 0(� TOTAL PERMIT REE S� � •� (OlNu U�c Oaly) 'Thb Apti�c A Bee�m�Yoar Suuding Pe It n Approved ,/ eceipt o. ,�-� — , -, , I 1 '` --"'- � , � `� ,5 c�- � � �.: r .---�_. 1-, ( �ulldhp 019c1a1 —�� Aah U DAtC t , / £ - 7 / / � , . 1d hour nodw [or rl] l�upe¢dant (951) 4d7.9890, fax (!S1) 447�4�45 ` 16Z00 $�le Cr+eek Avenae, Ptlo� I�ke, MN SS3T2 "'"�^ w ��'"r� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd ti ;'�, � "� \� �;' ,' ;�i `� �� TEMPORARY CERTIFICATE OF ZONING COMPLIANCE ,, � �r ' I: ��,�� "'��.. �.�_... ...>, `� AND UTILITY CONNECTION PERMIT � �INNES°�� I�' I �E W I C� ,( O I C� I. Whire File pERMIT NO . � O C/ �� 2. Piok City ' / 3. Yellow Applicant �./ (Please e or rint and si at bottom) ADDRESS ,� ZONING (ot�'ice use) �l/J l GJ� t.c,or.�: T2 t�" T�l_ i 1 i�� (�� ( �(� LEGAL DESCR.IPTION (oflFice use only) LOT BLOCK ADDITION PID O WNER (Name) �� R-V l C.�-J G� r.� � c.. (Phone) (Address) BUII,DER '�tR-t � ��wT"�-'z T°1 v� Jr�?i�-rA-c tp ✓L (Company Name) ,�Jr¢' v�4 i�/ I Uwt �4 c_�� I c L t� (Phone) �7� 3��`'t �� v Z (Contact Name) ��-�� ,.J �t � � ' (Phone) ? (, � ? Y> �( s� � 7 (Address) s �,,,,,, c•� � w a 4 N L �J a `J� t t TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fueplace ❑Addition �Alteration ❑Utility Connection CODE: ❑I.R.C. ❑I.B.C. ❑ Misc: �f"�IZ� �i�WTtZ 7Zdn.> 5� 2�,�Ic-��.'Y�-5 Type of Construction: I II III N V A B Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ �S�v o � 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 existin s nd local laws and will proceed in accordance with submitted plans. I am aware that the building official can revol orjust cause. Furthermore, I hereby agr e ciry o ia] or a designee may enter upon the properry to perform needed inspections. ,� -,°''�"°.'�''�..`_.'`_ .. CU � �-- //— �j — ! c7 Signature /O/, � L Contractor's License No. Date Permit Valuation �� a� Park Support Fee # $ Peirnit Fee $ � rf� SAC # $ Plan Check Fee $ 3 Q //� Water Meter Size 5/8"; 1"; $ ! `T 7 State Surcharge $ � g� Pressure Reducer $ Penalty $ Sewer/Water Connection Fee # $ Plumbing Permit FQe $ Water Tower Fee # $ Mechanical Permit Fee $ Builder's Deposit $ Sewer & Water Permit Fee $ Other $ Gas Fireplace Permit Fee $ TOTAL DiJE $ ( O I . C� ¢-- Tlus Application Becomes Your Building Permit When Approved Paid Rec ' No. (�¢ Date � l•� , l O B Buildin 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 constirutes a temporary Certi6cate 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 �� ,uz0� llate Rec'd � :: `` � � C�TY (?F PRIt_?R LA.��!1 PLUMBIIVG P�ItMI'�` l/ / � , � � �' � ,� �.. . ,. //1 � �fF'YNESa�� i Y V [ V l V�� i. BF+x Fita �� 2. Cn,'i+� Ci�p lr /' /� � 3. Yeltox� AppHcuil r l/ ,� (,,L] J ._�._�.+.---- — ease t e ur pxtut at id sign a bateoe _ _ _ _ . . -.- -... _ ._ . -_____ __ _ -. _ . _. ADI3RESS ZONING {u�tice we) � � � � �/li ^ � �C;w w :�.; � S't S � _ (—�c � .-v �'�e,,.� " � �__ � �� U�. I (ey L I ;�t � 2 -- __ ___ _� � — - ___. _ . - __ --- — -- ---....__ LECrAL DESCRIPTIl7N {ot?ice use only) ' LOT �3LOCK ADDiTION p --___ --------- — .__ .___ •---- OWIV�K �- . . (NamG) . .i ��vi ew P� � �c I"� �rv� c � � _ ____.. — p'hone} L-. + Z _ �` 2. (Adciress) v`( 5� l�<v�.-5,`� �vz .._ '� s� ; n,�; _7� �-j �tj - - -- -- � - - __ ______ __. __.. _. APFLICAI�FT , � (Namc}----� `��y_�� f �'` �___ �..N� C..;T�r.�,_ � Iv , I� 5�+�__ h�__ (Phone) -� ��= 5_3 �-� c v c {Address) -- �'_.�� I w � i C `i �U _— ------ — I d y �.� �, 5� ti I �_ _ ___--- Ac2dress � } (City} (`Lip Code} (Contact Ycison} ._. •�i%� � �-!�G - -S -T � � - --- (Pt�oi�c) L � � q � `i - � il '�i �S' - --... ___---- Al'PLICANT SI UNA`i' UF � _ DATE __ ��1 c7 - _ - - - ��.�! _-. ^ - -� APPLICA�'V'1 PI,I C'nMP I3ELOW _ - _ ---------_ . _------ -- _ ---- — --- _... .. -- ---- -- Qu ant�ty __ ' T ]� C O I i1811fi� T�+}3C �� J� �ixture �_. - — --- -- _ Bath Tub wit(z or «ji thout s3�o �ver_ R ot�gh-ins - .. - -- -- - ------ __ __ ___ ___ i)ist�w� VJater Hcat _ - - - _ _ - -- _� --------_--- -- - -- - ---__.. 2 �toor Dr�zin Water So __ _�._� _ ---- - _. _ _ e_ --- �. Z _ I,avatc,r Batlzroom Si��l.� �x� ,-� �.��-.+�a Stand Pi c. f Was hi�� Macl2�ne __ . __ `�'_. ... _ __ - _. ____—!.�' � __.� -_�._ .._.._ __� Lau_ ��cl.Ey_ �I`r��t or 2 cc�rn�artmcnt s�nk _ --- Se�va 7e l� ect�a• ---- _ _- ------- . Sho:��e€• St�li F3ack£lc� Asscml�ly - — -- ------- -- ---- ___ 3 5i�lcs � � k , s h� - ,,� � � a l ._ .. - --_�----= �.-- Backtlow As sernbly 7'e st ___ _ _. __ _.-_- --- --- Ae{r• Si La�vn S rp inkie _ - -- --- -- � _.. __. ___�-- Z Wate3• Gioset "Toiiet)( �x',snn -,�i�<.:4-za) - -- , --- Qlher �,,..��, �� r�� scxl;�r�L� In�ustrial, C".omsnercial & Mttiti-f�mily 1°1a oPjo1� cosf witlt a�49.50 mini�tnun Kesidential, I�ew O�ie .�C Two-Fr.iuily �aI49.50 ktcsidentiat, Additiats �: A3teraticns �4A50 . • Esiu�ated Cost �� Z Building Permit# PIIUMBIT�1(T PERMI`�' FEE $ l U�. Sa S'1'ATE SURCHt11ZCrE $ S:Bf} ��t��cA�l, rLii�v�il� �x:E � 10 �.5� (t7fiice Use Only� --- — � _ _ _ -- pp i n e ies Your Ruileiing Permit'�V eu �provetl ( Paid ��-�� Recei�t No. �(� z 1't�is A hCat . ,� . ..._ . �� _ . �`,,;t/ i J ` '� " � Z �. � ��% � I)ate I3 - _- - -- -�--�--� � / i . / U / U y Ruitctio? fCitict! � � Aate � . .. �._. _ --- ---- 24 ltour uotice for 911 inspectfnns (452) 447-9R5(F, fnz (952) 447-4245 A5�6 Dakota 5treet S.P:., k►•1or i,Rke., i1?i►�nesoka 55372 443 Lafayette Road N. � N'�(.�NE�C}TA D�PARTMENT` OF (651) 284-5005 St. Paul, Minnesota 55155 1-800-DIAL-DLI www.dli.mn.gov , LABC�►R & II�IDUSTRY TTY: (651) 297-4198 � Division of Construction Codes and Licensing REPORT ON PLANS Plans and specifications on plumbing: Fairview Ridge Valley Clinic Remodel, 4151 Willowwood Street SE, Prior Lake, Scott County, Minnesota, Plan No. PLB 1011-00169 OWNERSHIP: Fairview Health Services, 2450 Riverside Avenue, Minneapolis, MN 55454 SUBMITTER(S): Budget Plumbing Corporation, 855 Highway 169 North, Plymouth, MN 55441 Date Received: November 30, 2010 Uate Reviewed: llecember 10, 2010 SCOPE: This review is limited to the design of this particular project only insofar as the provisions of the Minnesota Plumbing Code, as amended, apply, and does not cover the water supply or sewerage system to which this plumbing system is connected. The review is based upon the supposition that the data on which the design is based are correct, and that necessary legal authority has been obtained to construct the project. The responsibility for the design of structural features and the efficiency of equipment must be taken by the project designer. Approval is contingent upon satisfactory disposition of any requirements included in this report. Special care should be taken to insure that the material and installation of the plumbing system are in accordance with the provisions of the Minnesota Plumbing Code. 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. As specified in Minnesota Rules, part 4715.2830, no plumbing work may be covered prior to completing the required tests and inspections. Provisions must be made for applying an air test at the time of the roughing-in inspection as outlined in Minnesota Rules, part 4715.2820, subpart 2, of the code. A manometer test, as specified in Minnesota Rules, part 4715.2820, subpart 3, is required at the time of the finished plumbing inspection. It is the responsibility of the contractor/installer to notify the Minnesota Department of Labor and Industry when an installation for a state contract job, Minnesota Department of Health licensed healthcare facility, or project in an area where there is no local administrative authority is ready for an inspection and test. To scneduie 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/CCLD/CCLDContactus.asp REQUIREMENT(S): 1. The installation of cross-link polyethylene (PEX) tubing was specified for the water distribution system. If all of the following requirements cannot be met, a different material that complies with Minnesota Rules, part 4715.0520 must be used: a. The tubing system must comply with ASTM Standard F877 and F876. b. When installed as a system in accordance with ASTM Standard F877, the system tubing and fittings must be of the same manufacturer. c. When other fittings are used with ASTM Standard F877 and F876 tubing, the fittings must comply and be marked with ASTM Standard F 1807, F 1960, F2080, F2098-01, or F2159. In addition, the tubing must be marked to indicate the fitting standard and the corresponding tubing standard (e.g. ASTM F877/F876/F1960, F877/F876/F1807, etc.). d. The system must be installed by a factory trained installer of the particular PEX system to be installed. This information can be provided to you in alternative formats (Braille, large print or audio). An Equal Opportunity Employer Fairview Ridge Valley Clinic Remodel Plumbing Plan No. PLB 101 1-00169 Page 2 December 10, 2010 Certain manufacturers require installation by licensed plumbers who have been trained to install their material. e. All persons installing PEX materials shall have a card on their possession documenting completion of training by the manufacturer or his agent for the material to be installed. £ The tubing and fittings must be marked as required by the applicable standard specification and with the appropriate ASTM designations by the manufacturer. g. The installation must be in accordance with the manufacturer's installation instructions. 2. The installation of chlorinated polyvinyl chloride (CPVC) pipe for water distribution systems must meet the following requirements (see Minnesota Rules, part 4715.0520): a. Pipes iess thari 2iz-ir�cli in size criust compiy witii ASTiI�T Siandarct �2846. b. Pipes 2'/-inch to 6-inch in size must be schedule 80 and must comply with ASTM Standard F441. c. Solvent weld joints must either include the use of a primer which is of contrasting color to the pipe and cement or a one-step solvent cement complying with ASTM Standard F493 and ASTM Standard D2846 (see Minnesota Rules, part 4715.0810, subpart 2). d. The installation must be in accordance with International Association of Plumbing and Mechanical Officials (IAPMO) Installation Standards 20-98. 3. Black iron pipe is not an approved material for water distribution (see Minnesota Rules, part 4715.0520). 4. Plastic pipe must be installed in accordance with Minnesota Rules, part 4715.0580(F) and part 4715.0600. Above-grade horizontal runs of plastic waste and vent pipe cannot exceed 35 feet in total length. Above- grade vertical stacks constructed of plastic pipe may exceed 35 feet in total height only if an approved expansion joint is used. Solvent weld joints in PVC and CPVC pipe must include use of a primer which is of contrasting color to the pipe and cement. A one-step solvent cement complying with ASTM Standard F493 or D2846 may be used for CPVC joints (see Minnesota Rules, part 4715.0810, subpart 2). 5. Assuming a maximum developed length of 165 feet and a building water pressure at the meter greater than 60 psi, and using Minnesota Rules, part 4715.3800: a. The cold water distribution branch serving the water closets and the lavatories must be at least 1-inch in size. b. The hot and cold water distribution branches serving two counter sinks must be at least 3/4-inch in size. c. The hot water branch serving the new fixtures must be at least 1-inch in size up to the branch serving the lavataries. 6. The water closets must have open-front seats (see Minnesota Rules, part 4715.1420). 7. The plumbing system shall be tested in accordance with Minnesota Rules, part 4715.2820. 8. The water distribution system shall be disinfected in accordance with Minnesota Rules, part 4715.2250. NOTE(S): � L The scope of this project consists of the remodelling of an existing building. The plumbing installation includes two water closets, two lavatories, three counter sinks, an eyewash, and two floor drains. 2. This facility will be served by existing municipal water and sewer service connections. Fairview Ridge Valley Clinic Remodel Plumbing Plan No. PLB1011-00169 Page 3 December 10, 2010 Authorization for construction in accordance with the approved plans may be withdrawn if construction is not undertaken within a period of two years. The fact that the plans have been approved 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: Budget Plumbing Corporation Fairview Health Services City of Prior Lake Building Official File ; p;, . --- ;, ....,'i�„�a;r��d'��►.,r7.,. . . O � PRIp� � � ti �� '� U r;� trl White - Building , ,� Canary - Engineering ^'"ES° Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT -- � � �' � APPLICATION RECEIVED The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: ,� . Accepted Accepted With Corrections Denied , Reviewed By: � � Date: � � �g `O Comments /��v�/ /1ew 2�c Sigr�tu�r. vv�'�l �'e � si�TrM, "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." O � PRIp� � �e� � � �; U ; °� r�rf White - Buildin , ,� anary - ngmeering ""ESO Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT �� Y v� �� ° APPLICATION RECEIVED ��• Z� � �� The Building, Engineering, and Planning Departments have reviewed t e building permit application for construction activity which is proposed at: �� `�� `��c�t��/ V �� w � ffLLC G�i�c/iC Accepted Accepted With Corrections Denied Reviewed By: Date: Comments: l, ��'f:i_, �` f7�,��.-� i i S �>� fi,- ,,.� �.,;✓i� i r�/'� ��c=,�'F'i �� i::rN ,J'r,'� CL.� .�T-�^_ � r:.>4L ��' L� ��J�� ' �� / j � � ! '; ,� -,�� / �— ✓,�*�, [7�.',iV:.i ��',"V } �:Ji'!— �� n�il� % `� '� � .:7 r� � L — �'�' ✓ �'� / l� � '✓ -' /' / - � '� �/. J 1'.i� � i:. j} /�— � "The issuance or granting of a permit or approval of plans, specificatians 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." P I R LA KE BUP D�ING AND INSPECTION RO RE RD INS PEcT�o N CO SITE ADDRESS 4 � 51 �-�1��ow �..�odo �r. NATURE OF WORK �'`�-TCRAcT��) USE OF BUILDING � �- A PERMIT NO. �o- �� o DATE ISSUED �� z i d CONTRACTOR c�.v�o u�,� C�Nsr. PHONE (p�2•�S• S?�s NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW THE PERMIT IS BY SEPARATE DOCUMENT INSPECTOR DATE �� '� (Prior to Backfill) PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ROUGH - INS �e FRAMING �,JG- �� z. lit:�ATlC� ELECTRICAL PLUMBING �� 1' t! � �� HEATING (if required) , r 2 c, f�EPLAt� COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED �+RL Su �a�2�Ss io� ) 2 2 �[� � FINALS i� (Prior to Sodding) BUILDING 3 Z 3 � i ELECTRICAL PLUMBING • 1 �t I HEATING �z < 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 443 Lafayette Road N . MINNESOTA DEPARTMENT OF (651 ) 284=5005 St. Paul , Minnesota 551551 -800-DIAL-DLI www, dli. mn . gov INDUSTRY TTY : (651 ) 2974198 AAAffikkk t": Division of Construction Codes and Licensing REPORT ON PLANS Plans and specifications on plumbing: Fairview Ridge Valley Clinic Remodel, 4151 Willowwood Street SE, Prior Lake, Scott County, Minnesota, Plan No . PLB 1011 .00169 OWNERSHIP : Fairview Health Services, 2450 Riverside Avenue, Minneapolis, NIN 55454 SUBMITTER(S) : Budget Plumbing Corporation, 855 Highway 169 North, Plymouth, MN 55441 Date Received : November 30, 2010 Date Reviewed : December 10 , 2010 SCOPE : This review is limited to the design of this particular project only insofar as the provisions of the Minnesota Plumbing Code, as amended, apply, and does not cover the water supply or sewerage system to which this plumbing system is connected . The review is based upon the supposition that the data on which the design is based are correct, and that necessary legal authority has been obtained to construct the project. The responsibility for the design of structural features and the efficiency of equipment must be taken by the project designer. Approval is contingent upon satisfactory disposition of any requirements included in this report. Special care should be taken to insure that the material and installation of the plumbing system are in accordance with the provisions of the Minnesota Plumbing Code. 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. As specified in Minnesota Rules, part 4715 .2830, no plumbing work may be covered prior to completing the required tests and inspections . Provisions must be made for applying an air test at the time of the roughing- in inspection as outlined in Minnesota Rules, part 4715 .2820, subpart 2, of the code . A manometer test, as specified in Minnesota Rules, part 4715 .2820, subpart 3 , is required at the time of the finished plumbing inspection. It is the responsibility of the contractor/installer to notify the Minnesota Department of Labor and Industry when an installation for a state contract job, Minnesota Department of Health licensed healthcare facility, or project in an area where there is no local administrative authority is ready for an inspection and test. 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/CCLD/CCLDContactus . asp REQUIl2EMENT(S) 0 1 . The installation of cross-link polyethylene (PEX) tubing was specified for the water distribution system. If all of the following requirements cannot be met, a different material that complies with Minnesota Rules, part 4715 . 0520 must be used : a. The tubing system must comply with ASTM Standard F877 and F876 . b . When installed as a system in accordance with ASTM Standard F877, the system tubing and fittings must be of the same manufacturer. c . When other fittings are used with ASTM Standard F877 and F876 tubing, the fittings must comply and be marked with ASTM Standard F1807, F1960, F2080, F209 &01 , or F2159 . In addition, the tubing must be marked to indicate the fitting standard and the corresponding tubing standard (e. g. ASTM F877/F876/F1960 , F877/F876/F1807, etc.) . d. The system must be installed by a factory trained installer of the particular PEX system to be installed. This information can be provided to you in alternative formats (Braille, large print or audio) . An Equal Opportunity Employer Fairview Ridge Valley Clinic Remodel Plumbing Plan No . PLB 1011 -00169 Page 2 December 10, 2010 Certain manufacturers require installation by licensed plumbers who have been trained to install their material . e. All persons installing PEX materials shall have a card on their possession documenting completion of training by the manufacturer or his agent for the material to be installed . f. The tubing and fittings must be marked as required by the applicable standard specification and with the appropriate ASTM designations by the manufacturer. g. The installation must be in accordance with the manufacturer' s installation instructions . 2 . The installation of chlorinated polyvinyl chloride (CPVC) pipe for water distribution systems must meet the following requirements (see Minnesota Rules, part 4715 . 0520) : a. Pipes less than 2 '/24nch in size must comply with ASTM Standard D2846 . b . Pipes 2 '/2-inch to &inch in size must be schedule 80 and must comply with ASTM Standard F441 . c. Solvent weld joints must either include the use of a primer which is of contrasting color to the pipe and cement or a one-step solvent cement complying with ASTM Standard F493 and ASTM Standard D2846 (see Minnesota Rules, part 4715 . 0810, subpart 2) . d . The installation must be in accordance with International Association of Plumbing and Mechanical Officials (IAPMO) Installation Standards 20-98 , 3 . Black iron pipe is not an approved material for water distribution (see Minnesota Rules, part 4715 . 0520) . 4 . Plastic pipe must be installed in accordance with Minnesota Rules, part 4715 . 0580(F) and part 4715 . 0600 . Above-grade horizontal runs of plastic waste and vent pipe cannot exceed 35 feet in total length. Above- grade vertical stacks constructed of plastic pipe may exceed 35 feet in total height only if an approved expansion joint is used. Solvent weld joints in PVC and CPVC pipe must include use of a primer which is of contrasting color to the pipe and cement. A one-step solvent cement complying with ASTM Standard F493 or D2846 may be used for CPVC joints (see Minnesota Rules, part 4715 . 08 10, subpart 2) . 5 . Assuming a maximum developed length of 165 feet and a building water pressure at the meter greater than 60 psi, and using Minnesota Rules, part 4715 .3800 : a. The cold water distribution branch serving the water closets and the lavatories must be at least l4nch in size. b . The hot and cold water distribution branches serving two counter sinks must be at least 3 /44nch in size. c. The hot water branch serving the new fixtures must be at least 1 -inch in size up to the branch serving the lavatories . 6 . The water closets must have open-front seats (see Minnesota Rules, part 4715 . 1420). 7 . The plumbing system shall be tested in accordance with Minnesota Rules, part 4715 .2820 . 8 . The water distribution system shall be disinfected in accordance with Minnesota Rules, part 4715 .2250 . NOTE(S) . 1 . The scope of this project consists of the remodelling of an existing building. The plumbing installation includes two water closets, two lavatories, three counter sinks, an eyewash, and two floor drains . 2 . This facility will be served by existing municipal water and '4 sewer service connections. Fairview Ridge Valley Clinic Remodel Plumbing Plan No . PLB 1011 -00169 Page 3 December 10 , 2010 Authorization for construction in accordance with the approved plans may be withdrawn if construction is not undertaken within a period of two years . The fact that the plans have been approved 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: Budget Plumbing Corporation Fairview Health Services City of Prior Lake Building Official File