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Building Permit 13. 0971
s akx; C�rrf firafr of ®crujnntr "F CITY OF PRIOR LAKE ptilarftttruf of PuU� Mnj cltztsprtfiott KI 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: �oUse Classification SINGLE FAIIlY Bldg.Permit No. I3-0971 R1SD Occupancy Type Type Construction Zoning District Legal Descnption 115 & 16 ! AKESIDE PARK ' Owner of Building Site Address 16270 PARK AVENUE S.E. , Contractor's Name&Address JEFF AND JESSICA YOUNG !"-='; ROBERT D . HUTCHINS (- • ' City Planner Building Official i j Date: j t j Date: ti POST IN CONSPICUOUS PLACE i i l 1 1 i i cl i i i u lA � u1� Ot i II'1 i i i i i 1 i i i i i i i i i i i ui 0 11,a> JN iii . Z aaN Q J au- 2 Ore z W JF- 1W< 2VV W > ..4 \ Ce 0 0% . 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Yellow •pphcant /�� 91 / (Please .e or 'tint and si: at bottom) _. - ADDRESS ZONING/� (office use) I.:Z 70 � V- p j £1_50 LEGAL DESCRIPTION(office use only) API LOTS BLOCK ADDITION L A Itc s%DE B-12-V--- S( - tf-6) p D 2�15q�(�O� OWNER (Name) J r i r- A 3 IK-S 5‘C A "/OU 1.4 6- (Phone) 6 12 L. ' I - tS 3 L, 3 (Address) 8 -41 (A zrz I p.-6,c, It 1(I 4 . •LAV'lm e . vvi&-) S 3 7 if' BUILDER (Company Name) J EIIe-. (A)r4G (Phone) (.012-(of Q) - 0 3 43 (Contact Name) J Err y OU.-e. (Phone) 6ZI - (!J 1 - q...3 tOS _ (Address) 2)6-11 (/ ( E 44 i It Rd - cc Uc q ei vvI►J cc 378 TYPE OF WORK ,New Construction ❑Deck ['Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑Fireplace DAddition ❑Alteration DUtility Connection CODE: [tI.R.C. ❑I.B.C. ❑Misc. Type of Construction: I II III IV 0 A B PROJECT COST/VALUE $ 3 oo i 000— Occupancy Group: ABE F III M J S U Division: 1 2 d4 5 (excluding land) I hereby ce . have furnished information on this application which is to the best of my knowledge title and correct. I also certify that I am the owner in authorized agent for the above- ntioned pro erty and that all construction w conform to all existing state and local laws and will proceed in accordance with submitted plans I am aware that the building offic. can revoke th s perry It/cause urthei re,I heieby agree that the city official or a designee may enter upon the property to pei form needed spections ` !x �Lcos— 23so if St na Contractor's License No. Date P • aluation Park Support Fee # $ Permit Fee > G�'� Plan Check Fee $ Z �7 �� SAC ## $ ;5'$ C 4 54 Water Meter Si /8"• I"; $ 4 State Surcharge $ I _ , Pressure Reducer $ / oy --- Penalty Penalty $ Sewer/Water Connection Fee # $ s Plumbing Permit Fee $ !'c-4- 5 0 Water Tower Fee # $ /06 -- Mechanical Permit Fee $ (5 4-, 50 Builder's Deposit $ -2_,....7,;-- , ,, Sewer&Water Permit Fee _ $ C( r��, Other ^tree ReO)a•c eme►. $ 02 lS Gas Fireplace Permit Fee $ s-4 , TOTAL DUE $1,-, 5Z8 /b I This Appli ion ..Your BuilitingPermit Wh A..roved Paid /q- 5lb/ Re pt No. 69e9D "Be)f Date < .c- .43 B . Buildinu. /ii r to _ This is to certify that the request in the above application and accompanying documents is in accoidance with the City Zoning Ordinance and may pi arced as requested. This document when signed by the City Plannei const utes a temporary Certificate of Zoning compliance and allows construction to commence Befoie occupancy,a Ceitificate of Occupancy must be issued ./ - - „ /�- _ _g /3 S PrP / n �._ r/..,„....„,t_ /y A Planning I ector Date Special Conditions,if any 24 hour notice for all inspections(952)447-9850,fax(952)447-4245 yvts' '4 j' 4646 Dakota Street Prior Lake,MN 55372 r1`l`ti (4PR77\ 9 U tail White - Building y/NNEsooCanary -Engineering Pink -Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT JEFF yoo,Jcy APPLICATION RECEIVED l(,v The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: f' /Ivy. Accepted ' Accepted With Corrections Denied Reviewed By: Date: 6 /3 Comments: \ Cr- �- �+' .�- �;�-1 Gt fe►-r) / 1-c' 70, 65 � E�if�f tib- —' 4 rL=c 2. / O ( F C C—>I'' 7,-`7" 61 L.,5\BLA Fit ' k-3 V6(.1 Pc5G)(-1 12-46) p,,,, /,5P&412/ "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." _; •° ,waw«, _ Oi P11 White -Building INNES0 CanaryEngineering nning ing 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: /6a76 Accepted X Accepted With Corrections Denied Reviewed By: # "1"-- Date: k- Fj-/3 /yJ i��`re t r rev�se4f S7 *rlcrls'�' Comments: yo t /M prr -" `ree l'e/otcemert= � �o2��Sescrov✓ rettir J /1/1 ,4 report rerIrI j Veri Y -Q.�ev vn 4.ve 7 LJp/a r /n y w.-14 6elaw 9d I/ pw& rTdre ON IQ per r'4 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." of PR/Z14. `� White -Building Canary -Engineering rNNE50�P Pink -Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT �\t�- -.,-kr. `= `�9‘J APPLICATION RECEIVED 7 / ! ,L3 i ‘3 The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: �, . 1 0 -4---;/-4.2„4. A\./(- - . . Accepted Accepted With Corrections Denied /6-ii Reviewed By: Date: 1 3 e.. ��t.-•- �,r.-a Comments: - div sd-? S�-Ac s .. > 4n -V4 ,,,.A ,,,J.104--,... . — S L -.„ ",..,....A.----...:..--- t ..d s o.--►-,C.L. ,,,..A.— ..+ Twp w Ler?e,..„11.2, Q V c a.✓-..4 I 2....^41x-re-- C-4.0.-4 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." 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 is 30 Percent. Property Address .)(X)6(1( P' _ lc /�/ 6Y� Lot Area sq. ft. x 30% = ...�.�... LENGTH WIDTH SQ. FEET HOUSE x = x = ATTACHED GARAGE x = TOTAL PRINCIPAL STRUCTURE 2 (o DETACHED BUILDINGS x (Garage/Shed) x TOTAL DETACHED BUILDINGS DRIVEWAY/PAVED AREAS x = (Driveway-paved or not) _ x _ (Sidewalk/Parking Areas) x = TOTAL PAVED AREAS 12-0 PATIOS/PORCHES/DECKS x = (Open Decks 1/4"min.opening between x _ boards,with a pervious surface below,are not considered to be impervious) X TOTAL DECKS 0 OTHER x = x = TOTAL OTHER TOTAL IMPERVIOUS SURFACE 3 3 UNDE OVER Prepared By '.c' il Date 7 — 70/7 Company V A-tt e y Svl. e-�-�t - Phone # �s l I-74y S-76) • . 4 CITY OF PRIOR LAKE Date RdHATING/AIR CONDITIONING/FIREPLACE PERMIT ( O4 V %tvase 1 a, a PERMIT NO13 I.Yoaar ANapiza , • (Please type or print mad slim at lam) ADDRESS ZONING(we=use) : 16; 70 RA lAkt- 36 LEGAL DESCRIPTION(office use only) LOT BLOCK ADDITION PID OWNER • 3e 4-(�w� (Phone) E$D SS 18'-836.1 •• (Address) Lig Y7 LJ. 13 id st. / r .A') H APPLICANT (Name) /Ot i 7,44 COlvti t ;1.r•c (Phone) ag)- 6?"- R)a6 (Address) 8ta1 int ,. • • ,g164.1.0553_ 7? . (A ) J , («ry) Crst,Casae) (Contact Person) (1) t• -• i /% (Phone) 6i" ?- •• )6 • APPLICANT SIGNATURE DATE APPLICANT PLEASE COMPLETE BELOW • 'kEW CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS )) //__ • FURNACE MAKE AND MODEL 11 titAh.f ' 6-64.1 f$l t) V j FUEL Nc T'�ic FLUE SIZE 3" Stetier.2 RETURN OPENINGS /`[ INPUT /(5q OM OUTPUT 913 ocv . TYPE OF SYSTEM HEATING OR POWER PLANT •• PLEASE NOTE: Mr Conditioner OWarm Air Plants 0 Steam Units and Fireplaces Cannot Encroach ❑Gravity ❑Hot Water into Required Side Yard Setbacks. aMecbanical 0 Radiation Fireplaces with Box Additions or u Conditioning ❑Special Devices Dyed.System 0 Other Devices Cantilevers to the Outside of Buildings • Require a Building Permit. FIREPLACE MAKE AND MODEL FEE SCHEDULE Industrial,Commercial&Multi-Family I%of job cost Residential,Gas Fireplace 349.50 ' $49.50 minimum Residential,Heating&A/C(New Construction) $149.50 Residential,Additions&Alterations 349.50 Residential,Heating Only(New Construction) $64.50 Residential,AC Only $49.50 Estimated Cost$ Building Permit $ The Minnesota Statutes f 32613.148 HEATING PERMIT FEE $ "SURCHARGE"has eef en changed for one e STATE SURCHARGE $ ,p July I.2010.until June 30,2011. TOTAL PERMIT FEE $ The allotment surcharge for a"fixed fee"penal' (t)tnce Use nary) Ls ES beginning,fury t.211te This App, ti II•nes Your Building Permit When Approved Paid Receipt No. `'MO' Date By . ,. Date 24 hour notice for all inspections(952)4474850,fax(932)447.42 i PAID WITH 4644 Dakota Street S.E.,Prior Lake,Minnesota 55372 BU I D fi N R 4 't ,M rr eittt3Date Rec'd ° r-.? *P CITY OF PRIOR LAKE PLUMBING PERMIT ?. 2 14, /J U 4tiNNtsn p 1,Gold FilePERMIT NO. 2 Gadd J3, �f�I i App 3.Ycllow Applitvnl (Please type or print and sign at bottom) ADDRESS ZONING(office use) _ ! 1 LEGAL DESCRIPTION(office use only) ,- ) / ? I./C3`I lB CK - ADDITION (/-� ;j/'�r- /� .� ' ' PID (,J✓— 69' '%._ -,(/'?--Z) OWNER • 't (Name) — - ` : - (Phone) • i / ;,- 1 ' 'A (Address) APPLICANT (Name) ) 1 t t `, (Phone) ' / -, . t (Address) ' . a I\.: r,z -- i ', I t, t i ;‘. d t -- J; (Address) (City) - (Zip Code) (Contact Person) 1 ''\• , • I ) `= • 1 1 , ` (Phone) ,1 k ,t. _-.' I< APPLICANT SIGNATURE - / . , t '4 ' '. ' r` ,' i i d k '' DATE / ;'e- � '�/ - APPLICANT PLEASE COMPLETE BELOW Quantity Type of Fixture Quality Type of Fixture } Bath Tub with or without shower Rough-ins / Dishwasher - 4 Water Heater / _Floor Drain f Water Softener -_ Lavatory(Bathroom Sink) Stand Pipe(Washing Machine) ` Laundry Tray(1 or 2 compartment sink 6 Sewage Ejector ((/ Shower Stall 0 Backflow Assembly / Sinks 0 Backflow Assembly Test 0 Bar Sink f Lawn Sprinkler 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§32613.145 lst $ Building Permit# "St1RCIIARGE"has been changed for one ' year effective PLUMBING PERMIT FEE $ - Jat, 1.2014,until June 30,201 i. STATE SURCHARGE $ g :.. .50 t (the minimum surcharge 1'or a'fixed fee"permit i , r. ! 1 `' TOTAL PERMIT FEE $ 1 is beginning filly 1,2010 This Application Becomes Your Building Permit When Approved Paid �y ��iR�" i&WITH S Date UFtyDiNG P MiT 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 PRIp Date Rec'd � f � CITY OF PRIOR LAKE SEWER AND WATER PERMIT NlNiv.ESO 2 1 GreYelloenw FlClerty /3 PERMIT NO. g'7 3 Gold Applicant (Please type or print and sign at bottom) ADDRESS ZONING(office use) t l l a1 O \"c k- love- CC-- LEGAL DESCRIPTION(office use only) LOT BLOCK ADDITION PID '(2. 3c- 11(o ,\ (Name) V 1 d ;\.( Phone V> (Phone) u l a`15�'H O1O (Address) Code) (Address) (City) (Zip (Name) P APPLICANT V POI. % � €aQ O\J C)c en (Phone) q S—bCi LI'' `qv (Address) c o 0 ` �-+\./c.,q Y-)P VY ss-6-) b (Address) V (City) I (Zip Code) (Contact Person) =r_ -- \, :a_► (Phone) \Q`V a-9'7'7 b-33401 APPLICANT SIGNA t URE atitrAINI. _ ' ' ", i o-a S^' APPLICANT PLEASE COMPLETE BELOW Size of water service 1 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# The Minnesota Statutes§326B.148 17,R AND WATER PERMIT FEE $ Pt‘ ( -D Eq "SURCHARGE"has been extended 'E SURCHARGE $ S d�:i EL0 I� until June 30,2013, .L PERMIT FEE $ The minimum surcharge for a "fixed fee"permit is$5.00 This Applicat' -ecomes Your Building Permit When Approved Paid Receipt No. l6 ZS . Date By ><d ¢Official Date 24 hour notice for all inspections(952)447-9850,fax(952)447-4245 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372 Land Surveyors Planners • Valley Surveying Co., P.A. I AIM 11111111111111111111111K (952)447-2570 Suite 230 16670 Franklin Trail S.E. Prior Lake, Minnesota 55372 September 19th,2013 Lamont Steinwand do Avid Builders 23050 Pillsbury Avenue Lakeville,MN 55044 RE:Young Residence,Park Avenue,Prior Lake,MN CERTIFICATION: I hereby certify that on September 18th, 2013, my firm did, under my direct supervision, measure the top of the foundation at the walkout of the house under construction within Lots 15 & 16, LAKESIDE PARK, Scott County, Minnesota. I further certify that the elevation of said top of foundation is 911.8, NGVD'29 adj. /P Scott M. Swanson,PLS Minnesota License Number 42309 Our file No.10888 44b Ina/SWAL \-5' r l 1211rAMMIN SYSTEMS Engineering eJob , 10/31 /2013 This eJob is prepared exclusively for: Villaume Industries, Inc. (452) 2926 Lone Oak Cr St. Paul, MN 55121-1488 Work Order: 247816 Job Customer: DAKOTA COUNTY LUMBER Job Name: YOUNG RESIDENCE Job Address: XXXX PARK AVENUE PRIOR LAKE, MN Truswal ID: T428192.J454964 I hereby verify that this document was prepared by me or under my direct supervision and that I am a duly Licensed Professional Engineer. I am responsible for the design of each component detail only -- not for the proper manufacture of the components. This document is no longer valid if any modifications are made to it . Truswal Systems Corporation 2820 N. Great Southwest Pkwy. Grand Prairie, TX 75050 800-521-9790 II TRuswAL Engineering eJob 10/31 /2013 Table of Contents Page No. Truss Label Page No. Truss Label Page No. Truss Label 1 P Page 1 Truswal Systems Corporation 2820 N. Great Southwest Pkwy. Grand Prairie, TX 75050 800-521-9790 // = AL Engineering eJob 10/31 /2013 Truss Engineer Design Responsibilities The engineer's signature on this design certifies that the individual component depicted, if built with the materials and to the placements and tolerances specified, will bear the loads shown on the drawing. Users of the component are responsible for determining that any as-built component conforms to the design. The loading and dimensions specified have been provided by others and have not been verified by the signing engineer. The building designer is responsible for determining that the dimensions and loads for each component match those required by the plans and by the actual use of the individual component. The building designer is responsible for ascertaining that the loads shown on the designs meet or exceed applicable building code requirements and any additional factors required in the particular application. The engineer's seal on the attached component designs indicates acceptance of professional engineering responsibility solely for the design of the individual component assuming that the loading and dimension requirements are as represented to the engineer. The suitability and use of this component for any particular building is the responsibility of the building designer in accordance with ANSI/TPI 1 Chapter 2. The engineer certifying this component is not responsible for anything beyond the specific scope of work set forth above, including but not limited to, the loading factors used in the design of the component, the dimensions of the component, the transfer of lateral loads from the roof and/or forward to the shear walls down to the foundation, connection of the components to the bearing support, the design of the bearing supports, the design and connection to the shear walls, the design of temporary or permanent building bracing required in the roof and/or floor systems, transfer of vertical loads down to the foundation, the design of the foundation or analysis in connection with the roof and/or floor diaphragms of the building. This is a high quality facsimile of the original engineering document. A wet or embossed seal copy of this engineering document is available upon request. Truswal Systems Corporation 2820 N. Great Southwest Pkwy. Grand Prairie, TX 75050 800-521-9790 // TRUSINAL orANrAvo SYSTEM Engineering eJob 10/31 /2013 Required Details* Other Available Details* http://www.itwbcg.com/trussconnections.php *Sealed versions of these details are available upon request. Truswal Systems Corporation 2820 N. Great Southwest Pkwy. Grand Prairie, TX 75050 800-521-9790 // 0 i m p 00 r-I N vt vt N •• J x n o o a z Y a '.c C',,a. '-•1.--•1 I--I O .. 0000 -w 1- ¢ r{- „ WVY r T 1-i.--1\\ U N 00' w F s,1 _ r II x001 ~ o "' KH FH1Z-1 xOm < !7.-,.7 n" F- o 0 I 0 oN IId Om WKx ZH0 VI LU QH W •0 'P W W W / 3 vl V.'iN N U) II oll� ZOF OW VI�WLLS}W J 5 Q' �.. / .r•, r-. \J S Wr-I VI OW 1--II--IW oNm bac mOmm'•'�n '^o ZVO VI VI a'JZV ZHdy f+• '--IH Tr 2 trii as n�cv 8'888888E.'88 o0 o'.ifi F HWW FdOWFWO f.J, 'l.x I _ II II -00 CT ••• oU. 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Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Company NAIC Number: 16270 Park Avenue SE City Prior Lake State MN ZIP Code 55372 A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) Lots 15 and 16,LAKESIDE PARK,Scott County,Minnesota(PIN=250960099) A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.)Residential A5. Latitude/Longitude:Lat.44-4748.8" Long.93-2618.5"Horizontal Datum: 0 NAD 1927 ® 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) 1375 sq ft a) Square footage of attached garage 968 sq ft b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage or enclosure(s)within 1.0 foot above adjacent grade 1 within 1.0 foot above adjacent grade 3 c) Total net area of flood openings in A8.b 5760 sq in c) Total net area of flood openings in A9.b 39168 sq in d) Engineered flood openings? 0 Yes ® No d) Engineered flood openings? 0 Yes ® No SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION B1.NFIP Community Name&Community Number B2.County Name B3.State Prior Lake,Minnesota 270432 Scott Minnesota B4.Map/Panel Number B5.Suffix B6.FIRM Index Date B7.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone 0004 C 7/26/1974 Effective/Revised Date Zone(s) AO,use base flood depth) 11/19/1997 X 909.0 B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9. ❑ FIS Profile ® FIRM 0 Community Determined 0 Other/Source: B11. Indicate elevation datum used for BFE in Item B9: ® NGVD 1929 0 NAVD 1988 0 Other/Source: B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? 0 Yes ® No Designation Date: 0 CBRS 0 OPA SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) Cl. Building elevations are based on: 0 Construction Drawings* 0 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.In Puerto Rico only,enter meters. Benchmark Utilized: Vertical Datum: NGVD 1929 Indicate elevation datum used for the elevations in items a)through h)below. ®NGVD 1929 0 NAVD 1988 0 Other/Source: Datum used for building elevations must be the same as that used for the BFE. Check the measurement used. a)Top of bottom floor(including basement,crawlspace,or enclosure floor) 911.9 ®feet 0 meters b)Top of the next higher floor 921.8 0 feet 0 meters c) Bottom of the lowest horizontal structural member(V Zones only) ❑feet 0 meters d)Attached garage(top of slab) 920.2 0 feet 0 meters e) Lowest elevation of machinery or equipment servicing the building ❑feet 0 meters (Describe type of equipment and location in Comments) f) Lowest adjacent(finished)grade next to building(LAG) 910.9 0 feet 0 meters g)Highest adjacent(finished)grade next to building(HAG) 920.2 ®feet 0 meters h) Lowest adjacent grade at lowest elevation of deck or stairs,including structural support ❑feet 0 meters 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 information./certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. ® Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a ® Check here if attachments. licensed land surveyor? ® Yes 0 No Certifiers Name Scott M.Swanson License Number 42309 Title President Company Name Valley Surveying Co.,P.A. Address 16670 Franklin Trail SE City Prior Lake State MN ZIP Code 55372 Signature Date 02/12/14 Telephone 952-447-2570 CERTIFICATE, page 2 ,NT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE j Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Policy Number: J Park Avenue SE ,ity Prior Lake State MN ZIP Code 55372 Company NAIC Number. 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 The subject home is a walkout rambler and although all site grading may not be complete due to frost,etc.,the LAG and HAG as shown hereon should not fluctuate dramatically when finished.All elevations shown hereon are on NGVD 1929 datum. Agg ignature Date 02/12/14 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 E1-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. E1. 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 0 feet 0 meters 0 above or 0 below the HAG. b)Top of bottom floor(including basement,crawlspace,or enclosure)is 0 feet 0 meters 0 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 0 feet 0 meters 0 above or 0 below the HAG. E3. Attached garage(top of slab)is 0 feet 0 meters 0 above or 0 below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is 0 feet 0 meters 0 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? 0 Yes 0 No 0 Unknown.The local official must certify this information in Section G. SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION The property owner or owners 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 0 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-G10.In Puerto Rico only,enter meters. GI.0 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.) G2.0 A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO. G3.0 The following information(Items G4-G10)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: 0 New Construction 0 Substantial Improvement G8. Elevation of as-built lowest floor(including basement)of the building: 0 feet 0 meters Datum G9. BFE or(in Zone AO)depth of flooding at the building site: 0 feet 0 meters Datum G10.Community's design flood elevation: 0 feet 0 meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments 0 Check here if attachments. iN CERTIFICATE, page 3 Building Photographs See Instructions for Item A6. ,ORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE duilding Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Policy Number: 16270 Park Avenue SE City Prior Lake State MN ZIP Code 55372 Company NAIC Number, If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions for Item A6. Identify all photographs with date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. If submitting more photographs than will fit on this page,use the Continuation Page. �iQ-nr g 1 -.41;',v„ I to $f'Ail I !z;:e_i 7 ror.J a arew e l r ,! i j yLi�e�_.'R.ivi ,, fb, ,t � r4 is iyw 7r - '.1; i 0 'Ai.--V , , '40‘t, ___ 4 .- ' - isiN, i r+ �� ►- , • 07,pr,.. . ....i, i , \ • 1 h ev. : . ,.v.n_4*}.w']...4:.,is'%4✓+etr..fi .• f4as'.4l„w-bH•"1"Y"010..tiMfYiJi9nft ♦ -.a iriof j ..'• - ' W4 • View from Street 02/04/14 .N CERTIFICATE, page 4 Building Photographs Continuation Page ORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Policy Number: 16270 Park Avenue SE City Prior Lake State MN ZIP Code 55372 Company NAIC Number: If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents,as indicated in Section A8. 4144 e .:# , / , atpi a�‘ f f r, ewlitss„ -,, 6, k ' te. lib( . Its4k ,, i, '. ftp riVr 4 $ ' -.Zr 1 2t C. ', ,, __ *AR Iiiiii." - „.... , . ' 4 (r ...k, , di AO 54 -1----- -.....' f'-, Iv , , . _ .rt ..... rr ',. = 06 View from Lake 02/04/14 Jo INS EL 0003 em N ..:�a Z • ti WI m rv�iZ ` aAV N O NUEN (r) -94m m -X v - 0 1 41111111111 3 X z ~--- V 11. X .t331119ri 1S3M KoRrsCH 1111 lily g 0 g m iiip 1. ¢mp�� v • 2. . ,., ,,,,..„.-_____ ,_---- I i N 0 0 = 1 I 12 a 11111 �n y I aI m 111![ t IP '162 !ial r 51!.J1 ( g- N o °� ,gyp m fig: 0 Jeff Young .1G .. itc.,..,,, 4... , . .,.. „. ,,,-;5, - ,— - 4i ' •••''''''''''''''''':'''''`'''''.. s.\''., \,. '/il"."(*1.- fr.s _ '41 w. e //y •i fk � . � Ski �. y,• � Y �� - fib.:-� '�" .14 v - . 1;1ft t , let ti 's` i v.r' rr-'. -. +�11 • L t Jai , . if 7 ii , .r....*'I' . ' * 74)".*:".-.'—''..--- �x *,11 fieriillk 1:17:''''''''1,t1 4: 1 Mrd mss'• y j.rat" er, ^ 't` ` '':n,. '. I 9 rl_ y , _..as. Map created on 2/11/2014 , Aerial Photo:April 2011 Legend SCO ti IL,' r.a'M'hrtntimg ►;U'Pan' Disclaimer: This information is to be used for reference purposes only.Scott County does not - Flo od way guarantee accuracy of the material contained herein and is not responsible for misuse or sinterpretation. The preceding disclaimer is provided pursuant to Minnesota Statutes 466.03,Subd.21(2000),and the Flood plain er of this service acknowledges that the County shall not be liable for any damages,and expressly waives all claims, 'd agrees to defend,indemnify,and hold harmless the County from any and all claims brought by User,its employees or 'encs,or third parties which arise out of the user's access or use of data provided.