2020-00888CITY OF MONTICELLO
505 WALNUT STREET
MONTICELLO, MN 55362-
763) 295-3060 FAX (763) 295-4404
2020-00888*
DATE ISSUED: 12/07/2020
ADDRESS 9872 HART BLVD
PIN 155117002010
LEGAL DESC RIVER VIEW SQUARE
LOT 001 BLOCK 002
PERMIT TYPE FIRE SAFETY
PROPERTY TYPE MULTI FAMILY
CONSTRUCTION TYPE FIRE SUPPRESSION
VALUATION 750.00
NOTE: HOOK UP OF ONE PRE -PIPED ANSUL R-102 SYSTEM INTO ONE PRE -PIPED KITCHEN HOOD.
APPLICANT
LVC COMPANIES
4200 WEST 7TH STREET
EDINA, MN 55424-
952) 835-4600
OWNER
MONTICELLO SR HOUSING OWNER LLC
17550 HAMLOCK AVENUE
LAKEVILLE, MN 55044-
AGREEMENT AND SWORN STATEMENT
I agree that the work will be conducted in conformance with
the ordinances of the City of Monticello and with the
Minnesota State Building Code. I understand that the work
will be in accordance with the plan that has been approved by
the Building Official. I agree that any damage caused to
public property including but not limited to curb, sidewalk,
public utilities and signs will be repaired at my expense.
Applicant
Date
Bldg Official Date
Permit #: 2020-00888
FIRE SUPPRESSION FEE 100.00
PLAN REVIEW - FIRE 65.00
STATE SURCHARGE, OTHER VAL 0.37
TOTAL 165.37
Payment(s)
CHECK 080035 165.37
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
FIRE PROTECTION PERMIT APPLICATIONaO
103 CHELSEA ROAD MONTICELLO, MN 55362 PHONE: 763-271-7463
J_ E DE
ProjectAddress:.. ......................_.. _....._ ....,..... ___......._.__.... _... . ... ...... . . _.. .
9872 Hart Blvd, Monticello, MN 55362
ILegal
Lot
I
Block
I Development
Owner
Monticello Senior Living
Telephone E-Mall Address
Contractor LlaenseNumber E-MaliAddreae
LVC Companies TS00375 rcallee@lvcinc.com
Malling Address
4200 West 76th Street, Edina, MN 55435
Conud person Telephone Mobile Telephone
Randy Mee 1952-835-4600 ( 952-292-2174
Property SinglengFaamily Two -Family ^milly Multifamily Townhome Agricultural Type
C)
E= ONE) Commercial Industrial ® Institutional Public I Gov't OTHER Fire
Protection Permit Type Project Valuation Fire
Wet Sprinklers # of Heads Suppression
D
S rinklers—Pressurized SystemrYp # of Heads ( $ 750.00 Chemical,
Ansul / Comm Kitchen - OTHER # of Heads 8 Fire
Alarm Fire
Suppression Monitoring System I $ System
Building Fire Alarm System $ Number
and Tank Volumes . ISpecifyFuels, N es Installation
Above
Ground Removal
I I $ Tanks
Specify Fuels, Number and Tank Volumes: Installation
Below
Ground Removal
iuiecl
descnnllon... _ . _ ... ........ ..___.... ._. _............. Hook
up of one pre -piped Ansul R-102 system into one pre -piped kitchen hood. $ Fire
Protection Con .---.._-_-_.___ ........ Data 10/
13l2020 SignFZ
Owner (M Owner is Buildef) Date I
hereby apply for a Fire Protection permit and acknowledge: the f *rmodon above Is aQmplete and accurate,, the work w91 be In conformance with the ordinances and codes of the City
of Aftnticei/o and Affnnesoto Side Sullding and We Coda; I understand this Is not a permit but only on application forpermft• work is not tostart withoutpermih work willbe in accordance
with the Approved Plan when City plan approval required. This appifmttan and any issued permit may became muff and void il'permit is not issued or work Is not commenced within
280 days, or if work Is suspended orabadavned for a period of 280 days. I hereby certify that haw read and examined this application. The granting of a permit dam not
presume to give authority to violate or cancel the provislons of anyoMer Rate or local low regulating construction or the performance of construction. BELOW - FOR
CITY USE ONLY PLAN CHECK
REQUIRED Plans Checked By 650/a
of Permit Fee Approved for
issue I Date i
18.0 27.0 25.0 24.0
f2.75 b,9 CL=20 CL=18 CL=17
I-- r
PL=14.7
PL=14.3 PL=23.0 PL=10.7
ANSUL R102 PL=2.5
PIPE & CONDUIT
BY ANSUL DISTRIBUTOR
180.0
MARK: 42 EXHAUST HOOD - SECTION 1
PLAN VIEW
18.3 27.8 11.9
F36.
1
oI rt Wl o
11FN'P a a a a
I
41.0 45.0
CL=34 -2.75
PL=14.7
PL=39.9 PL=41.0
16.0
2W
I
1
1IN,P 2 FP 11FNP 8.0
P
6.0- -1 1-4.0 4.0-1 - ---4.0
g 3
x
IxU
p.gg..'n mM ii33 n
x u xFjf
LN
J
99 QQYS rJr. iL {aN ii 1LN uu' Wll i
MARK 42 EXHAUST HOOD - SECTION 1
ELEVATION VIEW
A°"
T194,
w"a MONTICELLO FIRE MARSHAL
Their Ftevlewed for
IR Code Compliance & Approved
FILE COPY
a=
x
amJ
91h
3.313
PL"
0
4.38I2.0
170-1 QL=
1
CL=1.5125
11
18.0
24.0 Ja
1 i
6.0
66.0
F--
REVLSmr1
ANSUL R-102 FIRE SYSTEM PARTS LIST
PNDS NMANsIA DESCRIPRON M RTOPARTOPATO
1FSS1 18OALLW I1NSlsEX
WTl SERIESERANSUIPIt e
@ss18 SEN@SDETECTOR 4lflw] 8
F119BLE LOD®fBO1 zm,
e TesruNr 1
wslo eaeci6mncnL mtuTaPPVALve.r alasn 41'
818, tot-10c101-10REBeTRELAYJODE t1iBW ONDIOCARr. wT3 LT3pR
NIIRWOOEN CARl1UDOE 1w81 101SD
CACART. 4T36Ai DWISLE TAM
W(WllInR OGENCART. easToE1eflEOULAT®Ri?
LEASE assr 41awz am DEN PEeAA
ACTKTQ4 iB:Iwt 1 amw REO
RELEASE ASSEMBLY -ARCH 4s2o18 aesew REL4ACTUATORfSSEAWLY- 4B,
10B 9.8 OMLIX4
TAW( ASSEMBLY 481]BB azeesa 18OaLLW TAN%
ASSEAwLr 4B1aBB TAW(Mo,WnNO
SRafAari[i[FL7, ]24000 @SS]S TAW(
MOUMIMSRMAQr 1487>g/ 41011 HOSE N11Cs1
iEJ1FW1a -7 t 418811 NOSEMmfi120N1ETai¢40] t 434818 REMOTEPULLSTATW
daft]] @T@B PULIEY TEE
4]Begl wwBRDPeJg4r14m4mlgmmm 1 @3818
DPD]
ELEctt uTcti aw Pmst1M IIORFIS,ROBE 4Tstrea ON4B aaasm 11041- WOHT
PULLEY ELSOWfs_eN48TI88 aZ1]BI WON I -
PULLEY ELHONI,(---; i 48T1S8 4 WE IN. OteKSEMSLFR4de
LWSHEP 45/167 2 Sre w.TjWK-
8PJLL18MALL 4Ts484 z mae as w.
CCAmRe&aiaN sEAL asieTa TStw 721W DDNDUR SEAL
4s/188 4T@w to w.CaePNesWawNOW
SEnL asrma 4 18 IF NOZZF1'
FL 4-3 4 1 im WDmerVt
now 4]BBm 1 4 4 w
1N NOffiE ft FLO V{ 4T 44I{]3 1W NOZZLE
P FLOAT 4]Bw6 aazsxs swN PFLMP 4]
BwB 1 1 4451]] MNoz&
ka FL01/81 4]8w1 adxfm 2W NOZZLE R
FLq,V&A 41BwB 1 z" NDTbE P.
iLSVl3) 414w8 1 4@31s zw NozzLE (
i FLays1 4]w,o1 443338 zm NozzLEPFiOAS)
4TBBf1 1 d4ST4] 2120--E91COW ,
4TSBB8 1 4 418s9 SMAVELAOAPTOt
dwW] 1 S4T BLACK OtON
Pa'E S 4n 188BTB N. CIwWCeLEEVe1[i
@'AID] 0.'?8@ K-0h
HANo!@1DP NIiWSIRP 4] 7 4174w BILBItAlAL EMERGENCY lASP1
4n 1 t @BA11 ALMID
ATINGBIMTCH 48 WNCWT tD PIECE 1]
KPl2 Hootl Mgr @EKHIWB NOW-
SECIIWI e :p11uE0 K020 a§
TlS
TGR e Nooa EnlEnoN WiWT m iDai4J-OOOF
INATON .K68STALLAH.OB
WNIMCfOR
13 AASVALVEHOOKUPTOREIEASEMECH m AMIOTGaBVSTAEOEANDTYPEVYI SEMSIT¢
WM'ACf Fi "
E'"O.ALST"O.AND ca" IOAT EIFCNAWSM. FiDN POwrB gPMNDTEST FROM STUBOUTSTEAI. 13 .RPNK1
APID IFY UANOEOFROMFACTORY8TlA0UBTHEAPPUANEINTERFERERFEREIFSIR4ESNOZZLEOM.ALIAFIDERB Wwv 4 NPO . THEAPP FEEEEINIERFEf@WIIfumoOISCfiAROEFLOWPOwISSOORDIPATESHHOODINSTUZ-Hoops. 22Ome"
JpmyA ATE OFwjLTmEHooLENFORPROPERLoiSENranaloFM1ATIREHW08. Job Name: Mon (Cello Senior
Living Sales Order Number. 8331277-20
nj- I., Lsav I ACCUREX
PROPRIETARY INFORMATION NOTICE, THIS
DOCUMENT
IS AND CONTAINS
CONFIDENTIAL nrac TRADE SECRET INFORMATION OF THE
COMPANY AND REMArNS THE PROPERTY OF
THE COMPANY AND IS TO HE RETURNED
UPON REQUEST. UL 300 FIRE NEITHER IT NOR THE INFORMATION
IT CONTAINS MAY HE REPRODUCED OR DISCLOSED
TO PERSONS PROTECTION SYSTEM MDT HAVING A NEED -TO -KNOW CONSISTENT WITH THE PURPOSE OF LOAN OF
THE DOCUMENT WITHOUT WRITTEN PERMISSMN. m a
11 Em R
m v. 8 10/
2020
ow sw
All 1000716107
y 8 084.9 CL=
0 2=
18 CL .
0741.0
2.75--
L 4.9 CL=20 CL=18 CL=17 CL=34
PL=14.7 f0L=14.7
PL=14.3 PL=23.0 PL=10.7 PL=39.9 PL=41.0
ANSUL R102
PL=2.5
PIPE & CONDUIT
BY ANSUL DISTRIBUTOR
180.0
MARK 42 EXHAUST HOOD - SECTION 1
PLAN VIEW
18.3 27.8 - 11.9 36.1 86.0
2FP 2FP
L O In U o
11FP a- d d d
I
1IN 2FOP 11FNP 8.0--
3FP
FP
6.0 ---
I [-
4.0 4.0 - 1 --4.0
IS x A } B X x
raX
lid; qq
ro
v X m ;X S XF
pUq~
J~J
V M
001• LLpp F%X j}QEQY mJKILNOILN
MARK 42 EXHAUST HOOD - SECTION 1
ELEVATION VIEW
a°"TI°e`a- MONTICELLO FIRE MARSHAL
fte Reviewed for
dagift
Wait Code Compliance & Approved)
pate JOB COPY
45.0 -
2.75
46b
1 }.o
IONNNP 24I+.0
I
Fes-- 6.0
3.313
PL-1.5 2.
38
PL1.5 `, .0
L=1.5CL-125
N
a
36.0
PROPRIETARY INFORMATION NOTICE,
THIS DOCUMENT IS AND CONTAINS CONFIDENTIAL
TRADE SECRET INFORMATION OF THE COMPANY
AND REMAINS THE PROPERTY OF THE COMPANY
AND IS TO DE RETURNED UPON REQUEST.
NEITHER IT NOR THE INFORMATION IT CONTAINS
MAY BE REPRODUCED OR DISCLOSED TO PERSONS
NOT HAVING A NEED -TO -KNOW CONSISTENT WITH
THE PURPOSE OF LOAN OF THE DOCUMENT
WITHOUT WRITTEN PERMISSION.
REVISD7i
A 48a R-102 FIRE SYSTEM PARTS LIST
OY® F =
ANSUL DESCROrRdV 4PARTOPARRPARTO
6884 t$OALLWIAN816ID(
2 ]mrz 3A(iALLON AN6lhEx
8 938848 BENPA QEnR:TON 48I®]
8 FUBBLE LRll®ll®1
1 20te TEBT uwc
1 - MEO1Ar6TOPE VALVE.r 48881] 42618,
MANIAC F,HSET Re6EfRELAY I
180® tw•10CARBON OIwODECART. 66r4
IGI0 CIISWNOCAM CARE 11lt881fLIMLE1R8Q4D1010DECART. N:1463 OIX1 E CART. OEM
REQIAATeD ReLFJ1BE ABSY 9eo6o2 41-
16681OEM RE(AIIAT®ACNATOR 4slBw I
1 429833 REO RELFA8E pS8ElIBLT-1d+161 4820G6 asBe66
REO ACTUATOR aBseMBLr•Meo a61m6 2
428882 3AQALL 4TANKABBEO Y 4M'AR 42B884 ,
ANALLON TAwCABBFA481288 TAwcMouNnrvo PBRAQOKET '_
T(OFC1, rz4oao 4m6]6
TANK MOVNS eRAQO?i fAN3U•14M26] 1 41TANKeNCLOSUReAN9UL96240EI141018811
HOSE AND (WOlET 4824M 1 afi4ele REeeole
ETTFP PE 6TAnaN4042]816
WIRE
9R883 1 W ELEEH(
ad Hmlth@tll I 1 423B16DPDTELECIRICPLBYATfOt3H1T30434R0AUD®Ipm6uALxIXOu
QIRP 4]B®
a
1 to nmro
wox ]osP FIILLEY Ermwl") -LSE a26i8, 318
N.=K4LLEYRGZVf4MM-167 2 3I6 w.="
EALfIAROE
VS5FffA 46t18] 2 2rs w.
1RxKSEIiLI6MALLNWBNER n 141 2 ve w. caeaPneA6iaw aFAL 462814 1 ]e1® 1rs
w. Wt4ourt 6EAL 481188 a2626s trs w.
c lsesawnoao BFAL 4S 44331E 1F NO$
E 11 FIAIM 4]8803 44332, 1rsN NOmE)
1rs ROM 479888 4 44331] 1N
NOffiCHRfM6, 4]6601 4a3:u3 44TBB08
NoNomemeI?FLM 2aaxc62wpFLns,:s TBB08 t -7 3N NOMJE
ra Ftw/al 4 fi 7 aaxQ6 230N=EL2 ii "
478808 a4x4aT 2®N.ZaE
rq nNs 4]B610 4433l9 2BD NOmE Q
FLQYeI 4-11 94321] 211 NOmE,Tl
FLOW31 4]8868 4 4161168 BVAVEL ADAPIIIM
48S441 3AT BLACK wON PPEe
4]B938 EBAnN. CIOtOLL+8LEE116W 4R627
432B0.T K-q"
H/JmHELD EKTINONB 4]8B8] 417468 ®LwE O@ROENCY LABEL
4]BeBB 1 428911 AlAF0/ SWIATINO
SWATCH 41P8888 IITICFSWE tie@2 q :42EKNAUBT
Imo: IION1
E]M1mnt C40er: 10x20
mwHo94 M9afit %YEN 1B03
s
t&sffP=jt amEs
o0o"'mmNo"D8INSTAl1ARON"'"" =f"ACTOR
13 i VALVE NOOIQMSM IPTO
RELEASE IMC VERIPY OAS VALVESIZEANDTYPE
WITHJOBSnE CONTACT rotF ublfl 4tMTE PIAL P STATION
HOOM RELFASE MECWXW. LONPOPiB 4WROINS,TEsTING.Aw mm"'
CAnON OF SYSTEM. 13 4nPM AND NOZZLES FROM 44
FACTORYSRIDOUIS IXFY APPLIANCE DROPS IF
SF¢
VES
OR SALAMANDERS ON M APPLIANCE INTERFERE WITH NOZZLE DISCIM
E. ArFUM'Pli9 .sumY PIPm EEIWFEN wATOLEHOODS. 22 ATE WITHH IWTALLER MR PROPER
ORIENFARON OF WATIPLE HOODS, Job Name:
Mont caIlo Senior Living
Sales Order Number. 8331277-20 EADJTI
PART k->ACCUREX nru. UL
300 FIRE
PROTECTION SYSTEM
MR
1rt FR Id
d. 8
1012020 M
11W1N1B
m 1000716107