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HomeMy WebLinkAboutBuilding Permit 11. 1258 1 f. ��� � �� �1 N , I I l .. ' �i � fi r � { , ) ti ., � �� Y lY..11 _. If..11 ,. i __I. I _. I. ,:II..II_: I :;I I.,, I II,_., I.. fY:. i _. � I I I..y .. f,Ii C�it � ,. �l ,. r.El I f_. l li:.l _. I,_IY..iI� II. II __I I.: i '„ CITY OF PRIOR LAKE !ptrfmi iif tit ?trtg 1xtsprrfiou y Final Permitted ❑ Conditional C.O. Expires ,, ` This Certificate issued pursuant to the requirements of Section 110 of the ❑ Residential / ❑ International 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 L 6( At`/ / /Z-7 Bldg. Permit No // / 2 -%?) 7 i s Occupancy Type r \-- Type Construction V/J Zonin District /` 1....11., i Legal Description G ,_?5, Al t' /��--/I V (- C'L) Owner of Building Site Address 1 j 62 Z 1 j `/ i A, U l L1 • Contractor's Name & Address C`- . / f ' i��:G , L C O/J l IC./.) (❑ ( ;A f ()I f"{(..7 / t c, % tie - / /A/5 City Planner uili Official ■'K _ Date: .///.- ' /// -- e(:-./' y -' 7. 1 2 Date: / /// 1 POST IN CONSPICUOUS PLACE n i R a A 7A l l I i IA " n i r 0 J I- li „ Z Z I - _ , C = Z C W ic W i a z w ki z > � gSg7 o O UJ Wu Z ,_ < ul C)LLL 0 W [�. ~ �� 0000❑❑ o 0 0 .. r�\ cc x � 1 0 N O W r:-.. 0 aaQ O� m L Z 1.J z Y Y Z � � z o F= ',. F- c7 O0 1i J 0 0 W t !\ F 2 0 0 0 0 a 0 c d S. ° z x z�xxzLL a 6 z �” 3 m x xm N M 0 O O F U '�! 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C ; Z o W w 1- li p OSOa ' �\ ' , L a� W t c.) 0 W =_=SZ W C W C x (1) 0 Q. O° xw �m x 1 a 8 Z 2. IL W W 3 tb �/ S W W Z X O 0 0 a �3w a � l W W rt W t h y ' ❑ ❑ ❑❑ _ ,. re re O w 1 l v` a a a• 1- V �: , - p Q C O w W W N j ,, ,„ �, p -. 1 - Z p Y V O L i `� (: V O Y Z p L 42.) a Ore � O Z M p w IN- A 0 W CC a co z z Z _ W - _ � �_ Y w J w a W w p �Z <� < W � , 1 ■ • 0 , cg re Ix 0 a C OW CZ W = ooRez 2 B 4.w I \J Li U t3 v C) Pa- ° 0 u. U. u.? vi 0 d 3 O O O 0 0 v= � 0 a ❑ ❑ ❑ ❑�❑ V .-:' cif M ' 1.6 N• . 1. ❑ ❑ o f PRi CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd F ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE /o./3 . II .. x AND UTILITY CONNECTION PERMIT erl 4 iNNESol f. 2 Pinke C Y PERMIT NO / I _ /2,6 3 Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING (office use) 3 I (.02 riSv-T-r � -s- CreLLE (-(SD LEGAL DESCRIPTION (office use only) b'�.'r{-�-/ LOTTSBLOCK ADDITION IVWOOD PID LS 4-1 , 017 , 0 OWNER..., 1 41Q – a (Name)jY\CA`fl 1-40■-(Lvv\otdoer f CAAMNi1S. , )kA.' (Phone) 6i1-' -c efeiA (Address) BUILDER 6 / z , -130, eb7Z ,evQ CiVC L (Company Name) ( � � i A G t h p & // i i / r u c hog i a / L ke (Phone) (Contact Name) C2 rid h-e f/ , CC-- /r (Phone) 9, 3 6 - y /cer _ ��11 �� r (Address) / y2'✓E ( j et, „ L (O� L°,, /ol , _G4, `� - , ��f TYPE OF WORK New Construction ['Deck ['Porch ❑Re- Roofing ❑Re- Siding ❑Lower Level Finish ❑ Fireplace Addition ['Alteration ['Utility Connection CODE: R.C. ❑I.B.C. ❑ Misc Type of Construction: I II III IV B PROJECT COST /VALUE $ ? J t000 Occupancy Group: A B E F H I M S U (excluding land) Division: 2 3 4 5 1 I hereby certify that f have furnished information • this application which is to the best of my knowledge true and correct 1 also certify that 1 am the owner (i authouzed agent for the ,..} above -me .ned .roperty and tha consn ti will conf' m to , I existing state and local laws and will proceed in accordance with submitted plans 1 am aware that the building official .:n revo this permit forli cause hermore, I ereby ..ree that the city official or a designee may enter upon the property to peiform needed inspections Sign Contractor's License No Date Permit Valuation c-) af?EJO- Park Support Fee # $ Permit Fee $ ."2-SS 3 --0 SAC # $ EY j.-` Plan Check Fee $ ‘051 - Water Meter Size 5 /8 " (e $ 4.1 i State Surcharge $ 1 5 Pressure Reducer $ 12— - .- Penalty $ Sewer /Water Connection Fee # $ L xT. Plumbing Permit Fee $ t S 4 50 Water Tower Fee # $ . Xt , Mechanical Permit Fee $ 1 54- '3® Builder's Deposit $ l5 Sewer & Water Permit Fee $ 5 (,,, .50 Other - $ Gas Fireplace Permit Fee $ 5 d. S p TOTAL DUE $ t/ ,C} C j� / This Application Beco es sir Building Permit When Approved Paid y© 7 / ptNo. ( t(p lo �iC/ � � Date /j - /*, // ` Building fti • I Date This is to certify that the request in the above application and accompanying documents is in accoidance with the City Zoning Ordinance and may proceed as iequested This document when signed by the City Plannei constitutes a temporary Certificate of Zoning compliance and allows construction to commence Before occupancy, a Certificate of Occupancy must be issued / /l /S /l �- / e,...��t Carr. re9idj ing Director Date SpeciarConditions, if any 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 - 4245 4646 Dakota Street Prior Lake, MN 55372 OF PRI0 Ft Z CI") n White - Building Canary - Engineering �''^NES °�� Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT £-/ 1 PPEL. -1 _ 0,0I (/CT CA/ APPLICATION RECEIVED /0. /3. /1 The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: 31(2 L& IE Jl v i 0 ec. . Accepted ✓ Accepted With Corrections Denied Reviewed By: Date: 11 104( Comments: t • 6=6Hru x- Lam/ ,,,,,J o #4_,, j , e c- A u. , 7 . 1-0 L Evec-. /'a-opc oo Fc - n.6-041-a-t ' G.c it #.V1 Suh 1< — /7 0c-c tor.v u /iv rz 3 _ F A C62. r7F(CAT - 6 - A- 4 FAA- /N s/)-► ,1- S ��t, F,..).1.-4 `N C c, i9c 4 . Alai r-lx.)e., .,4. AI .414%. 0 f S 463b te,,. A C M 1 r 6(46,0 ip4(4, 1 ,i7Vo 41 0166r- . ligi tl iA.i, frs ( 9 f Q i "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 PRI0 9 h U rr1 411 AINEso' S ,...) White E Buil Enginering ES� Pink Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT ' % ` , ° ,a . c- t_ C - .... w_.,_ p, ; / : '' APPLICATION RECEIVED • f ., -- / I The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: Accepted 7 Accepted With Corrections Denied Reviewed By: Date: /J 71 =1/ Comments: Q / — / ,.W/4 i %Vevt,or �ert`, ew,-fc l ono'r �v 40 Jtire ver y owes t ILr jR.,e,. ei-- Zen.. 9 /0..(J 444.wb,,, 4 ° 'tip , - 7 •k`l `,/'`f , - _ r\X„ ir . ' LPL .i. . , ,i. : „P 5.....: ;'7 '- "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 o Fill ti 7 U t White - Building y �� Canary - Engineering N NESO Pink - Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT f -t4 1`',1 PL E L C_. 1 C ,' J 77:f / C. i7 C' A APPLICATION RECEIVED /0. /3. /1 The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: i u t 1,e , 11; 2. f•.1 i... I , d h.. " C (...-L_ . Accepted x Accepted With Corrections Denied Reviewed By: �i¢ Date: /////// Comments: 'See Attachments: 1) Grading Plan, 2) Erosion Control Measures { 4. See Reverse Side for Additional lnformation! "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." 952 445 7487 Line 1 - ^ ~ ~ _ _ _ 02:45:42 p.m. 12 -22 -2011 1 / 1 D U 4 �' HEATING• /AIR CONDITIONING/FIREPLACE PERMIT Z.5 . d oionsoo 1 L Zeo cs n� �r ■ r PERMIT N • I ii L� 3. Ydlow Applicant • (Please type or print and sign at bottom) ADDRESS • • ZONING (office nee) 3/ COO' ELL 7TNn e1i N(,) (,) • LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER • (Name) (Phone) (Address) • APPLICANT e { • (Name) C., I &Ala Nerd neI re 1 .fix t'. (Phone) Q f:a- 'y Sr' Y6 P (Address) ( . C d, L., Zr1 ti-Q rch iere2 553 (Address) 1l � i/ (City) WC:" Code) (Contact Person) D * /� !/ (Phone) a' 7 r6 7. • APPLICANT SIGNATURE i if DATE 1,2 — .23 .. 2.c' /1 . • APPLICANT PLEASE COMPLETE BELOW ,®NEW CONSTRUCTION ❑ REPLACEMENT 0 ALTERATIONS FURNACE MAKE AND MODEL Le.,.•o IL tInI 93LWW()'b FUEL � sdru,r A FLUE SIZE 3' S1/-- RETURN OPENINGS 1/ INPUT St; CAA OUTPUT ; i9 Ate TYPE OF SYSTEM HEATING OR POWER PLANT PLEASE NOTE: Mr Conditioner ' WWann Air Plants ❑ Steam Units and Fireplaces Cannot Encroach (]Gravity 0 Hot Water into Required Side Yard Setbacks. • ❑ Mechanical Radiation Fireplaces with Box Additions or ' Air Conditicalj g Special Devices Went. System k f ta , c , e „( " ❑ 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, Heating Only (New Construction) $64.50 Residential, AC Only $49.50 Estimated Cost $ 7S'• . do Building Permit # • The Minnesota Statutes f 326B. 148 HEATING PERMIT FEE $ "SURCHARGE." has been changed for one year elTective STATE SURCHARGE $ ,50 Judy 1, 2010. until Julie 30, 2011• TOTAL PERMIT FEE $ The minimum surcharge for n "fixed fee" permit • (Office Use Only) Is ,�% beginning July 1.2010 • This Application Becomes Your Building Permit When Approved Paid Receipt No. • Date i 11 B f ' '4it) 1/14 rt./ Rutldtar Official Date 11 —D tk f (3 24 hour notice for all inspections (952) 447-9850, fax (952) 447 -4245 i•-.. tl it•'o' 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 DEC -23 -2011 10:34 From:DBD t'ECHANICAL 9527588098 To:9524474245 P.1 DAD pitrp Date Rcc'd C I' CITY OF PRIOR LAKE PLUMBING PERMIT -' L. f7Y C7 , .. 4'w , n w my PFR.M,].T NO W_ AMMO -sat , - or .0 sd Rail d • at bottom ADAR.ESS w Wien n aause) 1 - 5u4-4 - 4 1 4sur u r _i g _....... .,, ... • L E G A L DESCRIPTION (t ie us oaly) LOT BLOCK ADDITION PTO &num) VNBR in nuAt Pf n' 1 kMiS (Phone) ,. i __...'(, WO") 5 I CO r4 r4 (14)14 s C*,. S. -(r-� 1 a r- _) k c� A 3 APPLI � .M . , /� x, 2- ; Q Walne . r !� t t �P•1..�„ (Phone) .. �..� .— (Address) j 12 .0 i'C' ` t ' - 1 r f 'A • 5 . • ) (Address) "" { (City) S (Zip Code) (Contact Person) l . c 7\ - b• _ ' 4. " \ i" (Phone) .q 5 2--1 SS -R °95- _ . A CANT STC3NATUIt� --� =� _ • _. _ .: DATE Nor ... APPLICANT PLEASE COM:PLETI: i SLOW nt Tjie of Fi re -- - - Qu!t ty , ______Upe _ ! rIe of Fixture Bath Tab wit or without shower 0 Roush -ins Dishwasher / water Heater Floor Drain ' Water Softener LavatorrQBathroom Sinks [ Stead Pi pcSWtwhing Machines Laundry Tray,(I or 2 cornpatttnent sink 0 SowaRo Ejector . i Shower Stall 6 ' - Back iow Assembly , Sinks v Baekfiow Assembly Tort . Bur Sink T Lawn Sprinkler 1/ . water Glaser Toilet 6 Other FEE SCHEDULE Industrial, Commercial & Multi- family 1% of job mat with s $49,50 minimum Residential, New One & Two- Family S149,50 Residential, Additions & Altcrstione $49 50 A- � The Minnesota Statutes i3 3260,14* —' binding Permit #/ "SUItCk1ARCi hod been changed liar one PLUMBING PERMIT FEE $ 1 1 /' , ._ year effective J' July 1. 2010. oath dune" 24111, STATE SURCHARGE $ .50 _Y" 1 he minlrhum snrchsrgs firs "iheil Ibe" i ynia TOTAL PE MIT FEE S 415 1021 beginning' duly 1, 2410 [ 11 1i Application Became $ War Binding Permit When Approved Paid rtetaoipt No. Dili T' 8y ...P $uUdha Otlklsl A#fe 24 hear eatiee ror all Inspections (952) 447.0650, fs; (952) 447•14LIILD IN(3 pCRA�f� -�. 4644 Dakoti *oft $i., Prior Lae, Mlnrtoa*ts 55372 •, .._...� ... _ .��._.. . . ... .........n+ —r — . ..• o x....,.. o CITY OF '1'1tY0llt LAY{E Date Recd 0.0),R-r_ ' , i MATING /AIR CONDITIONINGIFIREPLACE FE Ai kN,va$ ; r „ P "• i i N s 1 n t ~� 9. 'Mew App wnt ' an i' ' '' ' ;�. d s _ az at bottom ADDRESS ZONING cotticti user) 0 or.. 4 •I -' '_ Al S+ , LEGAL DESCIOPTION (office uses anly) 14. '. LOT BLOCK AD1aI`'i'ION PID -- OWNER .. l �" • 1 .. _ Al a t. (Phone) ( r ) $ - --? 0 q1 : -.. (Name} — • Address) ` M • A 4:ar — P I a; r 11 7 �-- APPLY • • (N is _ ' 1 r. 'It ` O. al kr • • 4rdlh a - . (,Phone) "T -- c� 0 (Address) SAM . td.� • �► o 1.■ a 1 • _ ( YY 1 �] 5 (Address) f f ail _ , ( I - � � r 1•- (Contact Person) _, ! ""'— APPLICANT SIGNATURE , .! DATE - • 1-.C �. APB' /ANT PLEASE COMPLETE BELOW _� EW CONSTRUCTION Q REPI..AC]3l�tE"NT �TERATi NS FURNACE MAKE AND MODEL -,_ FUEL FLUE SIZE RETURN OPENINGS INPUT _ 0 . TPUi , TYPE OF SYSTEM HEATING Olt. POWER PLANT PLEASE N'O . Asir Conditioner QWann Air plants Steam Units and Firep' ces Cannot Encroach Citrvity 8 Hot Water into Required e Yard Setbacks. Mechanical ❑ Radiation Fireplaces with ux Additions or DAir Conditioning ❑ Special Devices Cantilevers to . Outside of Buildings :Neat. System a Otter Devices Require a But 1 g Permit. FIREPLACE MAKE AND MODEL V° - N 1 ` - 1;,4*. ! • - - - - t — PE scan t ,— Industrial, Ctnnmercial & Multi - Family 1% of job cost ?Rersidiiitial, Firs places $49.50 $49.50 minimum Residential, Heating & A/C (New Construction) $14 0 ai t, AC Only Additions & Actions $4 50 Residential, heating Only (New Construction) 55 Residential, PAID Wit t - - - -- -• • "bst S Building Permit # BI.A DU The Minnesota Statutes § 3268.148 — "SURCHARGE" has been extended H EATYN( PERMIT FEE $___VJA j..,. \v mid June 30. Z01<3, The minimum surcharge for a STATE SURCHARGE $ i "Fixed fee" permit is $5000 TOTAL PERMIT FEE S, 5 -. te — • ° -1lJ This Application Becomes Your Funding Permit When Approved Paid Receipt No. _ Date . Y na l)ttiebd - Dater 24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 8646 Dakota Street S.E., Prior Lab, MInnesnta 553 U 9009Z6tiZ56 E5 '60 T TOZ /6ZlZ T W / TO 39 H9IH/ : HIdV3-I 9NIi+'1079 O !RIO Date Rec'd L; CITY OF PRIOR LAKE Z5 g SEWER AND WATER PERMIT 411 n'NESO 6P G reen ellow Fil Cit y � / • /�Jr) File PERMIT NO. /� Y 3 Gold Applicant CC.• // (Please type or print and sign at bottom) ADDRESS / C Z e� ��/ // d, 4.... ZONING (office use) LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER phi JZ'�— (Name) /" "� (Phone) (Address) (Address) (City) (Zip Code) 41/14 1 B S yl c€ 9 L 1 (Phone) A s9.R (Q 9 5 (Address) 0 67 6 84,1 7' k - 7 (Addre (City) (Zip Code) (Contact ' - • • .. ___..1_ i. • % ( Phone) 1 G mir I. • ' 4, . l:M _,if DATE APPLICANT PLEASE COMPLETE BELOW Size of water service inches. Location of any couplings from structure feet. Type of sewer pipe. LI 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 # / The Minnesota Statutes § 326B.148 ;R AND WATER PERMIT FEE $ P<I D V "SURCHARGE" has been extended E SURCHARGE $ .50 I until June 30, 2013, IL PERMIT FEE $ l ae-- The minimum surcharge for a l "fixed fee" permit is $5.00 This Application Becomes Your Building Permit When Approved Paid Recei e 5� Date '� - Z .(3 1 fi, Building Official Date ( i �� f 24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 CITY OF PRIOR LAKE Impervious Surface Calculations (To be Submitted with Building Permit Application) For All Properties Located in the Shoreland District (SD). The Maximum Impervious Surface Coverage Permitted in 30 Percent. Property Address 316z L it ec' s fc/ //a) L2' 33- /(/a27 / /6/01OJ/ L ot t'y yyArea yy yT�..yy * 7t'y/yy� /TJy.1.PT.yL ,y** y yy .yy yy yy T ,,yy yy yy .y yy * F yy eet **yy yy 3yy0% = yy yy534 7 C ************* /' ******* ** T * * TTTT * TT'1I'T'F****TT ***********i` TTTTTT* ** LENGTH WIDTH SQ. FEET HOUSE x = x = ATTACHED GARAGE x = 4 TOTAL PRINCIPLE STRUCTURE - ZOZG DETACHED BLDGS x (Garage /Shed) x TOTAL DETACHED BUILDINGS DRIVEWAY/PAVED AREAS x Uvie / tip/ Sf (Driveway -paved or not) x o weft 37 SF (Sidewalk/ParkingAreas) x a g = fZ $1 TOTAL PAVED AREAS adcsp PATIOS/PORCHES/DECKS x = (Open Decks''' /" min. opening between x = boards, with a pervious surface below, are not considered to be impervious) Sftei /zo SF x 'Odra, = 117 $F TOTAL DECKS fi Z 3751 OTHER x = x = TOTAL OTHER TOTAL, IMPERVIOUS SURFACE 5114 SF L : OVER 23W Prepared By Date /l - // Company • ®rwei &9 eeri:41 / v4 Phone # ((BSI) ff /9'L✓ dIENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660 -0008 .nergency Management Agency Expires March 31, 2012 ..al Flood Insurance Program Important: Read the instructions on pages 1 -9. SECTION A - PROPERTY INFORMATION :For Insurance Company Use :, ' Al. Building Owner's Name Cece Just "- Policy Number,:__ . -- _ ? A2. Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No. Com pany,NAIC Number _< - -7-'1 ._,: 3162 Butternut Circle NW - ` -' - --,gi City Prior Lake State MN ZIP Code 55372 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 35 NORTHWOOD OON PRIOR LAKE and part of Government Lot 5, Section 3, Township 114, Range 22, Scott County MN A4. Building Use (e.g., Residential, Non - Residential, Addition, Accessory, etc.) Residential A5. Latitude /Longitude: Lat. 44.708968 Long. - 93.456056 Horizontal Datum: ❑ NAD 1927 El NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number 7 A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) N.A. . sq ft a) Square footage of attached garage 740 sq ft b) No. of permanent flood openings in the crawlspace or b) No. of permanent flood openings in the attached garage enclosure(s) within 1.0 foot above adjacent grade N. within 1.0 foot above adjacent grade N.A. c) Total net area of flood openings in A8.b N.A. . sq in c) Total net area of flood openings in A9.b N.A. . sq in d) Engineered flood openings? ❑ Yes El No d) Engineered flood openings? ❑ Yes ® No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number B2. County Name B3. State PRIOR LAKE SCOTT MN B4. Map /Panel Number B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone 2704320003 C Date Effective /Revised Date Zone(s) AO, use base flood depth) 7 -26 -1974 11 -19 -1997 X, AE 909.0 B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other (Describe) B11. Indicate elevation datum used for BFE in Item B9: ® NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe) B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ® No Designation Date ❑ CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* ® Finished Construction *A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations - Zones A1-A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, AR/AE, AR/A1 -A30, AR/AH, AR/AO. Complete Items C2.a -h below according to the building diagram specified in Item A7. Use the same datum as the BFE. Benchmark Utilized LAKE GAGEVertical Datum 1929 Conversion /Comments Check the measurement used. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 914.3 E I feet ❑ meters (Puerto Rico only) b) Top of the next higher floor 924.7 ® feet ❑ meters (Puerto Rico only) c) Bottom of the lowest horizontal structural member (V Zones only) NA. ❑ feet ❑ meters (Puerto Rico only) d) Attached garage (top of slab) 922.6 ® feet ❑ meters (Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building NA. ❑ feet ❑ meters (Puerto Rico only) (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 914.3 IZI feet ❑ meters (Puerto Rico only) g) Highest adjacent (finished) grade next to building (HAG) 922.2 ❑ feet ❑ meters (Puerto Rico only) h) Lowest adjacent grade at lowest elevation of deck or stairs, including NA. ❑ feet ❑ meters (Puerto Rico only) structural support SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation tl Ith information. / certify that the information on this Certificate represents my best efforts to interpret the data available.) W understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. ❑ J • > . �N(/ �� Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a �(/ ' y� licensed land surveyor? ® Yes ❑ No �(/ ` 1 A , ` sa1 4 REGISTERED Certifier's Name Peter J. Hawkinson License Number 42299 H Fi'.=,AND Title Sr. Surveyor Company Name Pioneer Engineering P.A. x N SURVEYOR Address 2422 Enterprise Drive City Mendota Heights State MN ZIP Code 55120 -s / 2 ,�� j, f ) Signatur Date 4-24 -2012 Telephone (651) 681 -1914 It% � � r =r=RAA I'r,rm $11- 2I Mcir no Rap ravarcP Ririe fnr rnntiniiatinn Renlaces all nravinus editinns . In these spaces, copy the corresponding information from Section A. For Insurance Company .,eet Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and Box No. Policy Number, .' ,dtternut Circle NW .y Prior LakeState MN ZIP Code 55372 Company NAIC Numbera'_; SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments // / Signature Date ❑ Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items El -E5. If the Certificate is intended to support a LOMA or LOMR -F request, complete Sections A, B, and C. For Items E1 -E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. El. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or 0 below the LAG. E2. For Building Diagrams 6 -9 with permanent flood openings provided in Section A Items 8 and /or 9 (see pages 8 -9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E3. Attached garage (top of slab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery and /or equipment servicing the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA- issued or community- issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑ Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8 and G9. 01. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA- issued or community- issued BFE) or Zone AO. G3. ❑ The following information (Items G4 -G9) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building: ❑ feet ❑ meters (PR) Datum G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters (PR) Datum G10. Community's design flood elevation ❑ feet ❑ meters (PR) Datum Local Official's Name Title Community Name Telephone Signature Date Comments ❑ Check here if attachments FEMA Form 81 -31. Mar 09 Replaces all previous editions Build P hotogr See Instructions for Item A6. For Insurance Company Use: Building Street Address (including Apt, Unit, Suit and/or Bldg. No.) or P.O. Route aphs and Box N o. Number 3162 Butternut Circle NW City Prior Lake State MN ZIP Code 55372 lid!' Com If using the Elevation Certificate to obtain NFIP flood insurance, affix a le tw b uding ar View photographs below according Policy to the instructions for Item A6. Identify all photographs with: date taken; "Front View an d "Re"; and, if required, "Right Side Vie and "L Side View." If submitting more photographs than will fit on this page, use the Continuation Page, following. 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T � w s E y ¢{ y .E _ Bu ilding Photographs Cont Page For Insurance Company Use: Bu ilding Street Address (including Apt, Unit, Suite, an d/or Bldg. No.) or P.O. Route and Box No. Policy Number 3162 Butternut C NW City Prior Lake State MN ZIP Code 55372 Company If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all p hotographs with: date taken; " View" and "Rear View "; and, if required, "R Side View" and "Left Side View." • '� `� 3 ... -- K`* z------'-q- a4 - :- ..E,,, < '� 1#, i,� •,.J 's�"y f ' r ev „r" c ,., �" - - - - ` + + , y �, .. .� te r-_ -. w . P y,� o- s iff < ` � ;., „ �., I'd. ,t °r., r- *�e:_ ;' �.' - _ } .. s ; i7 , -� {7 . ;, „ fi r,,, ° ^' °s.. - o � 7 , r : � . 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( 25 DATE ISSUED t� rlo �� CONTRACTOR P� C At- L 4 k I,ix•, PHONE t5 z�- 3 S '- A 124 NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECTIONS BELOW THE PERMIT IS BY SEPARATE DOCUME - j- t tas.rr4a,. v j & Al - Fr f t 1l4' ' 6 c-INSPECTOR DATE FOOTING vrRtFitArusi op L 4- 1 a I lotizzlh FOUNDATION (Prior to Backfill) L4 9/ (l?� /1 I PLACE NO CONCRET UNTIL A I S BEEN SIGNED SEWER / WATER / SEPTIC FRAMING - �'` { INSULATION k ELECTRICAL 14\-:\c' PLUMBING ft‘,..14.c,radk. Uktaii n t HEATING (if required) t l ,, 1 1�i t ( 4 ) `Ll FIREPLACE -'!'' GAS LINE AIR TEST itko e/3 (c ° � NO WW ORK UNTIL ABOVE HAS L N SI 1 A PI" / /r LAN I .0 / 1 ' `r > C I paik FINALS GRADING (Prior to Sodding) BUILDING Per-4A C.cc - t2kfQ ©_ iu... c / / z 7atrz.- ELECTRICAL ` PLUMBING P q/.20/(z �j 4/12511,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 afl 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