HomeMy WebLinkAbout2003-P06871 - sprinkler system ITY F ORONO PERMIT
�' � Permit Number:
2750 Kelley Parkway - PO Box 66 P06871
Crystal Bay,ialinnesota 55323 Permit Type: Fire sySte�Pe�t
(952) 249-4�00 Date Issued: io�22�2003
SITE ADDRESS: 2765 Kelley Pkwy
Long Lake,MN 55356
PID: 33-118-23-12-0002
DESCRIPTION:
Proposed Use: Residential
Pernut Class: General
Pernut Type: Fire Systems Permit Pernut Sub-type(s): Sprinkler System
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
Bill Meyer-Fire Marshall to Inspect
FEE SUMMARY: Pernut Fee: $ 60338 Valuation: $ 48,270.00
State Surcharge Fee: $ 24.14
Misc. Fee: $ 1.50
TOTAL FEE: $ 629.02
APPLICANT: National Automatic Sprinkler Co. OWNER: City of Orono(Vacant Land)
1612 94th Lane NE P.O.Box 66
Blaine,MN 55449 Crystal Bay, MN 55323
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
/ i �. � .'\. �l� � /�����i��
APPLICANT PERMITEE SIGNATURE ISSUED BY SIG ATURE
Copies: 1-File(Si�nitures Required), 1-Anplicant, 1-Monthlv Renorts. 1-Assessin�, 1-Finance Page 1
Oct-D6-2003 02:46pm From-CITY OF ORONO +9522494616 T-238 P.002/003 F-329
�06�7 l
, l0/8/03
CITY OF ORONU APPT.ICATX4N FO'R
Sox 66 (275Q Kelley Parkway) FIRE S�RINI�.�-ER SYSTEM PEXtMIT
Cz-ystal Bay, MN 5532�
[TFNERAL �1FOT�MATIO�
1_ Permits are n�quired for alt fire sprinklcr inst�lia�ion and repair. All work shall be doue by a licensed fire
sprinkler cont:ractor_ 2 sets af plans, sp�cifieation and hydraulic caiculation sheecs shall be submitted u�che
Orono Pire Niarshal a mini um of da s before stiart of work.
2. You may apply for permits by mail or in person a[the Cicy offices.
3. All systems skiall be designed,installed and maintained to N.F.P.A.-13, N.P.P.A.-25, and Minnesota Sta�e
Building Code, Niinnesota Uniform Fire Cocle and Standards. All attic systems are to be spaced ac a
maximurn of 130 square fooc coverage. Plastic pipe will not be allowed at aay iime in attic spaces.
4. All equigmer�t iAs[alled shall be U.L. or F.M. approved for fire procectiQn service.
S, Yard or wall post indicator valves are required. A11 iadicting and control valves installed shail be provided
with tamper protection. On dry systems, th� eonuol valve w service the Qressure switch (aic) shall be
supervised.
(,_ Inspectozs test valves shall be installed ot�each floor level or c,oae of sys�em. Main drain and inspectors Fest
valves shall be piped to ihe autside.
7. No water is to be introduced into ihe sprinkler syscem until main had been chorou�hly flushed. Air test and
flushing ehall be wi[nessad by City of Orona Water Department.
g. A,n approved audible/visual device wired to main flow swiuh shall be installed above the Fire T7epar�nznt
eonneetion and in areas normally occupied by cenancs.
9. EXISTING SYSTEMS: If any changes in the hydraulically most demanding area, change in occupancy
elassificacior►or addition of 20 or more heads,hydraulie ealculatians and tlow tes�will be required.
10. All final flow or irip tests shall be witnessed by the Orvno Fire Marshal. Appointmeucs can be made by
calling Orono Ciry offices, (612)249-4b00. 24-hour notice required.
11. ALC������IT AND OB-SITE CARD. Ca 1(6��49 46 0 2 Shours in�advanc d�o sch d�le y�aur
R�
inspections.
Instruc ions Complete all items on this application. Compure the permit fee. Sign and date the
certification. INCOMPLETE AT�PLICATIONS WILL NOT BE PROCESSED. If you have
questions, call 2�9-4600. You will be notified by phone wh�� the permit review is completed_
permit will be issued Ca contractors at the City offices (2750 Kell�y Parkway)•
Please cheek one: �NeW Addition Remodel Replace
JdB SITE: �JCr S L �- C��r�r�v zip:_��J�-�
Owner's Name• i�-�-c�F- �pt,,�h � . r Telephone Nurr�ber: roZ 73�____I Y5"'I
Mailing Address_�7f,� l�<„�ls5c.. kw'� City: � o ��F�� �5..3�--
IVQ:�i.ono� ��.,..,k-ovnc�.�-i c� �i:.3!
Spri�xilcler Contractor: �p�-i n iL1f v v � Telephane Nu�nrxber= ��c..�—�C( �_
Cantractor's A�d�ess: �u lZ q'K`rn La-n� I�1E C�ti�'' e��— Zip: ��'�''f' S5 yyg
Contact Person- h Phone Number• i� - L2 _
(Circle one: Celi,�ager, ffic
��� /y�/�/�f(ff�t � /�C��"' oit,�'.-'� Ce�O y �r� �h ��„tp G�,�,i
I
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r6ct-D6-2003 02:46pm From-CITY OF ORONO +9522494616 T-23B P.003/003 F-329
,
PFRMIT FEE �L ULAT N
1. 1.25% of�ant a�" or N['ni�x�num �ee ($35.� X .0125 �
�j �-7Ci
(contract price)
2. St te�h%�r e. *� Add the State $uilding Code �1�1 �005 �a ��
Surcharge to each permiC. _��-o�d� rice
or $_Sd, whichever is greatez ( P �
$ .5� 01
3_ P sta e a 1 .and i (Only mail-in applications) � Q�� �_
4. TOTAL Pk?RMIT FEE (Add lines 1-3 above)
* C�NTRA�CT P�C�or JOS C4ST means the actual or a ta o�er fixed casts.n It hs �ed
for the permitted work in�cluding materials, labor, profit, n
amount to be charged to the custame{ fe owner, t n n�or anyf other party athe r a onable
la bor, ar i�t s t a l l a t i o n a r e f u r n�s h e d b y h
n�.arket value of such items must be added to the estimated cost or contract brcostothe C y
fee purposes. In the event that there is a dispute on the amount of the j
inay request the submission of a signed copy of the actual contract.
�* The STA'CE SURCHARC�E is .0005 of�e�QoL�O all the rieparcm�enot�000 spec ional
whichever�s greater. �or valuations over$1, ,
Services for the price.
Th�undersigned h�reby applies to the City for issuance of a Spzinkler System Permit, agrees to
do all work in st�'ict accordance with the ortlinances li ati n e o p1eLe�tYuae and correct� A
13, and certifies that all statements made on th�s app
�
Applicant's Signature:
~ Date:
Approved By: _
"Gc��-�-�,.�.., Date: � ���o �0 3
OCT-06-20a3 14�40 +9522494616 9B`/. P•0.s
/
� Cf:NF:RAI. INFORA�inT1UN 13-c
CONTRACT�R'S MATERIAL&7EST CERTIFICATE FOR �BOVEQROUND PIPING
PROCEOURE
Upon complstion ol work,In�p�ctian�nd ttrt��h�ll b�m�d�bY th�contf�ctor'�nPnwntatlw�nd witntiwd by�n own�r'�npnNnt�tlw, All
de(�etr�h�ll b�cpmctsd�nd�y�tsm I�ft in Nrv{a b�(orr eontnetor'�p�rsonnN fln�lly bw�tA�Job.
A drtlflpU�h�li bA tlll�d Out�nd�Ipn�d by both nprtqnLdvti.'CopFq q�all D�php�ryd fpr�pp�pvinp wtAorltlM,own�n�nd contnctor. �
It I�und�ntood th�own�r'�npn��nuciw'�t{p��tur�In no r�y pn�udipi�ny ddm pNrot oontnetor fa Iwiry mn�rld,poor workm�nthlP.
or f�ilun to eomply with�pprovinp wthorlly'�rpulnrrMnU or loeal ordinanpt,
PROPEqTV NqME
C��ar�; , �� „�;%_ -� : .� - ��' v `/
PROPERTY ADORESS
. �7Co � �
ACCEPTEO BY qPPqOVINa AUTHORITY( N ES �
%
ADORE55
PIANS
INSTALWTION CONFORMS i�ACCEPTEO PU1NS YES �NO
EqU1PMENT USEO IS AVPROVED �
�F NO,EXPLAIN DEVIATIONS �YES �NO
HAS PERSON IN CHAqGE OF FIRE EQVIPMENT BEEN INSTRUCTEO AS TO LOCATION
OF CONTROL VALVES ANO CARE AND MAINTENANGE OF THIS NEW EQUIPMENT �YES �NO
IF NO,EXPLAIN '
INSTRUCTIONS
HAVE COPIES OF APPROPq1qTE INSTRVCTIONS ANO CARE ANO MAINTEN/�NCE CMARTS YES �NO
AND NFPA�3A BEEN LEFT ON PqEMISES
IF NO,EXP(.AIN -
LOCATION SUPPLIES BLOGS.
OF SYSTEM �� � •
�' _ C{;��C
MAKE M�pE� YEA F ORIfICE pUANTITY TEMPERATURE
M<WUFA�TUqE SIZE RATING
SPRIIVK�EflS d /� �..7
/
/62.
� (.�� �
/ '? �'-
PIPE COtVFOHMS TO - STANDARD YES �NO
PIPE ANO F�TTINGS CONFORM TO /�1�PfF"� �3 STANOARO �YES �NO
FITTINGS �F NO,EXPLAIN ,
AIARM OE V ICE M/1XIMUM TiME Tp OPERATE 7NRp(X',H 7ESf p�pE
AI.ARM TVPE MAh;:
VALVG MOOEL MIN, SEC.
OR FLOW
INOICATOR � F _ ) "
Y V I.VE p
MAKE MODEL SERIALNO. MAKE MOOEI SERIALNO.
k�
I TIME TO TRIP ' WATEH AIR TRIP POINT TIME WA EH A ARM
THRU TEST PIPE� PRESSURE PRESSURE AlR PRESSUHE REACHED OPERATED
7ESTOUTLET� PFiOPERLY
DRYPIVE MIN, SEC. P51 v5� P5� M�N. SEG VES NO
OPERATING
TEST Witho�t
O.O.D.
w���
a.O.D. �
s �'�� > �� .� -3� �C
IF NO.EXPLqIN . �`��'+`.f�,^ ���`/
, I 'MEASURED FROM TIME INSPECTOH'S TEST PIPE IS OPENED.
esq ppep� PRINTEO IN VSA (OVER)
Conlraclo�'�Material 6� Tcs� Ccrtificaie for Abovcaround Piping
FORM li-4
3_�� 1PRINKLFR SYtiTEM�
OVEHATION �pNEUMATIC ❑ELECTRIC ❑HYORAULIC
v�PINGS� RVIS`EO OYES QNO OETECTIN6MEOIASUGERVISED QYES ONO
OOES vAIVE OPERATE i NUAL TRIP At�O/OR REMOTE CONTAO � YE
DELUGE d�, �S THERE AN ACCESSIBLE FACIUTY IN EACH CI O IF NO,E%PLAIN
PREACT�ON Q YES '°�<
VAL V ES ppEs EqU/pRQ11T OPERA7E OOES EAG�UR 7'^�,E. �MXIMUf.1 TME TO .
SI�PERV WON IO�SS AIAWd OPERATE VALVE R LEAS�`�e..,.. OfEi3ATE RFi FntF
M MOOEL VES NO VES NO MIN, SEC.
HYORQ�TATIC: Hydroiu[ic uw�h�ll ba mW��t not I�u tA�n 400 psi(13.6 b�nl tor two Aoun or 50 pu(1.4 b�n)�H�utic
p�euur�m exceit of 150 pu(10,2 banl for two hours, Differ�nti�l dry�ip�wlw clrppu��hdl W I�h op�n durinp�nt to pr�vent d�tnp�.
All eboveground pipiny le�kape�h�ll b�stopp�d.
P HIN : flow tha requirad nta until watu it N��r u indiut�d by no coll�ttion of fm�ipn mu�rld in burl�p bp��t outl�ts iuch q
DESCRIPTION hy rants a blowoll�. Flu�h st Ilow��ot less th�n 400 GPM(1614 Umin►for�•inch O�a.�GPM 122)t llmin)tor 5-inch pip�,
750 GPM(2839 L1min)�or 6�nch pip�,1000 GPM(3785 L/min)for Btinch pi�,1500 GPM I5678 L/m�nl for t0inch pip��nd 2000
GPM(�570 l/min)lor 12•incA piPa. Wh�n�upply un�ot Produt�uipu4ud low r�t�f,obuln maRimum w�il�bl�.
p►����q��� E�t�blish 40 p�i 12.7 bsn)�ir prown�nd m�aur�drop wAiG+Mall not�xu�d 1•1ti pu(0.1 b�n{in 24 noun. T��t
preuura t�n���t�o�mN w�tar levet and�ir pr�uur�u�d m�nur�sir Pn�wr�drop wAich Ma�l not�xc��d t-1l p�I 10.1 b�nl in 24�ow�.
AlL PIPING HYOROSTATICAILY TESTEO AT � PSI fOfl 'Z MRS. �F NO,STATE REASON .
ORV PIPIN6 PNEVMATICAILV TESTEO YES QNO
EqVtPMENT OPERATES PFlOPERLY YES Q NO ,
�� REAOING OF aAGE LDC/�TE�NEAR WATER SUPPI.V TEST PIPEi RES�OIWL.Pf�ESSUfi WRH VALVE IN TEST P�PE OPEN W I OE
TEST STATIC PRESSURE: PSI -�� P51
TESTS �
, Und�ryround m�in��nd lead in oonn�ction�to iy�t�m riNn fluih�d b�for�conn�ction m�d�to�prinkl�r pipinp.
VERIFtEO BY COPY OF THE U FORM NO.SSB ❑YES ❑NO OTHER EXPLAIN
FLUSHED BY INSTALI.ER Of UNOER• � /f°����S
OROUNO SPRINKLER PIPING ❑VES ❑NO �J J
NUMBER USED LOCATIONS � NUMBER HEMOVEO
BLA11M(TESTItJ� ,
GASKETS
WELDED PIPING YE$ ❑NO
IF YES...
DO YOU CERTIFV AS THE SPfi1NICLER CONTRAC70R THAT WELD��va PROCEDUHES COMPLY �YES ❑NO
WITH THE REQUIREMENTS OF AT LEAST AWS 010.9,LEVEL A{i•�
� 00 YOU CERTIFY THAT THE WELDINC WAS PENFORMEO 8Y wE�0ER5�UAl.IF1ED Ir� IG�YE$ ❑NO
WELDING COMPI.IANCE wITH THE ttEDU1REMENTS OF AT LEAST AWS 010.9,IEVE�AR•J y�
DO VOU CERTIFY TMAT WELOING WAS CARRIED OUT IN�OMPLIANCE WITH A
DOCUMENTED QUALITY CONTROL PROCEOUHE TO INSVRE T►�nT ALL DISCS AfiE
RETRIEVEU�TMAT OPENINGS IN PIPING ARE SMOOTH,THAT SLAG ANO OTHEQ
. WELOING RESIDUE ARE REMOVED,ANO THAT THE INTERNAL OIAMETERS OF ES ❑NO
� PIPING ARE NOT PENETRATEO
HYDRAUIIC NAMEPLATE PROVIDED IF NO,EXPLAIN
DA7A �.ES ❑NO
NAMEPIATE
DATE�EFT IN SERVICE WITH A�l COwTROI.vAl,VES OPEN� • - �
_ ..>F._�j
REMARKS
NAME OF SPRINKLER CONTRACTOR �
.y �' �
V 'f �"J;e'
' TES WITNEtSED 9Y
SIGNATUfiES FOR PROPE fiTV OWNER(51GNED) TI tLE OATE , ,f�'
�'-..�-� �s- l`: �'�IQI/' -' �at.� � -,s- �' (
FOR SPRItVKLER CONTRACTOR(51GNE0) TITLE � OATE
. n. �-�1ri � - �.,U � .
AOOITIONAL EXPLANA O NOTES
... . !
I
OSA BACK
Contnctor's Ma�crial&Tcat Certific�te for Abovearound Pipi�g
FORM H-4
_� BAN-KOE SYSTEMS
❑ Minneapolis ❑ Grand Rapids ❑ Peoria SERVICE WORK SHEET
'� -�L ❑ La Crescent ❑ Quad Cities ❑ Des Moines
❑ Sioux Falls
Date: P�#� Approved by:
Equipment Location Address: Invoice Address:
Contact: Attention:
Phone: Phone:
Type of Service: Maintenance Agreement: Billable: Non-Billable:
Preventive Maintenance None Labor Covered by PMA
Phone Support D-Hardware Parts Prepaid Prof Serv./Install
On Site O-Hardware Mileage Warranty
Shop D-Software Shipping Other�
Training Other* Adtl Prof Service
Other* Ex.Date Other•
•Explain Other:
General Description of Problem:
Equipment/Software Involved: Unit Serial #:
Services Rendered:
Parts Used:
Qty Inventory Number Description Seria�# Price Each
Labor: Mileage:
Hours @ $ Per Hr = Miles @ $ Per Mile =
DO NOT PAY FROM THIS COPY – AN INVOICE WILL FOLLOW
Customer acknowledges the above work and/or services were performed and,if applicable,the equipment and supplies were delivered.
Ban-Koe Representative Emp# Customer Representative Date
White-Ban-Koe AccYg Yellow-Ban-Koe Service Pink-Customer
DATE TIME �
CITY OF ORONO CALLED IN �I�IO Y
INSPECTION OTICE SCHEDULED �-/S IaW !!%�l��
PERMIT NO. �� 6��� COMPLETED
ADDRESS �� �� k���
OWNER ��� ��a� B� CONTR. ��'�I ��i�C ��
TELEPHONE NO. 6/2 —7�Z-�9 O Z
� DESCRIPTION ����- f� S '�' � SP �`� K �l �-� S y s{��.-
� 01 FOOTING '�MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETIANDS
y 03 INSULATIGN 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q OS FINAL 14 SEWER HOOK-UP O6 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
? 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVEfi REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATIOWREMOVAL
� OWNER/CONTRACTOR TO MEET YOU:�YES_NO
h COMMENTS:
�
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o �i� ��3 �- C34e�Q � 7,a o s�
� !.J �-� �- �v�y ��� �'�-�.l.� !�.r� s ys t�e�.
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� �WORK SATISFACTORY:PROCEED ❑PROJECT COMPLETE
W O CORRECT WORK 8 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING
PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. ppHOTOTAKEN
INSPECTOR W{LL REfURN
❑STOP ORDER POSTED.CALL INSPECTOR
❑CITATION ISSUED
❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS.
Call for the next inspection 24 hour�in advance. (952) 249-460�
OwnedContractor on site: '�`�' '"—""'`'�
Inspector. �� ....t.�:.-..
White Copyllnspector's File Canary Copy/Site Notics
DATE TIME �
CITY OF ORONO CALLED IN
INSPECTION NOTICE SCHEDULED � � °y t��!
PERMIT NO. �°6��� COMPLETED
ADDRESS �76 S ��^��y PY'��u
OWNER b u�e�o /�ao"� ��. CONTR. NQ,��'m�a/ Sfor��i,..4'��er.
TELEPHONENO. � /z ' ? 8 2 ` � 9 O 2
� DESCRIPTION
ly 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING j�MECHANICAL FINAL 19 LAKESHORE/WETIANDS
H
03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 72 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
4Qi 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
= 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
v
Q OWNERICONTRACTOR TO MEET YOU:_YES_NO
O �
c� COMMENTS: �n Q.� �tdw 7'��s� �p V`'
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y S P V`r �t.c, LC e.v� S �S�z�w
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� � 4.� ev' '��oc.r� �� sec D �y �
W
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� �WORK SATISFACTORY:PROCEED �`PROJECT COMPLETE
W ❑CORRECT WORK 8�PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
0 BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR C'CITATION ISSUED
❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS.
Cail for the next inspection 24 hours in advance. 249-460�
OwnerlContractor on site:
Inspector. �.�c�....� r �•
White Copyllnspector's File Canary CopylSite Notice