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HomeMy WebLinkAboutBuilding Permit 14. 0077 K (�i iuur tfr of (On upunr r ' K CITY OF PRIOR LAKE Prparfmtuf of !nitMxt n%pirfi.n r inal Permitted ❑ Conditional C.O. Expires This Certificate issued pursuant to the requirements of Section 110 of the❑Residential/❑International K = 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 --7 Sl� CF� I-i9�I4 y Bldg.Permit No. /4.r 7.Classification ifej Occupancy Type (/// �anc Type;Construction V Zoning District /-I5 n/fir' �} /! /y�/ /� Legal Description L C3 V�(/�/V�J 1 1!l��� /vim D!//`1 /45/0 £ tE-' /�AGEH-i/E Owner of Building Site Address , '',< T. 8. iv ,, l Ery' r s-- 0G Contractor's/Name&Address ,�q /cO U�i . /-/vi(�1//// Lrty Planner �;��^^ Building Official �h Date: 0 tO 1A Date: POST IN CONSPICUOUS PLACE 0 J I W Z 1' � IL �' i J mtix iz t I- P t• WW < Q 4„ Z V V W > Zg '� duw. 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Bufd�g Str`etA e Address ir•.ciud ng Apt.,jJna,Suite.and/or Bldg.No.)Cr P.O.Route and Box No. Ccr^piii NAIL NL1IiiUur v`d ate Aveinae S 6. City der i or- Gtike State M.A ZIP Cede .A3. Property Description(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) 1. 5 L OV.D(N`S r 0JOIL EC©ND In 1O rioN Sc' COV,.... HAAS Building Use(e.g.,Residential,Non-Residential,Addition,Accessory.etc.) Res i' ,ztrt i a AS. Latitude/Longitude:Let. q-#. 73941) Long.-g 3. 3616,9 Horizontal Datum: ❑NAC 1927 p(NAD 1933 AS. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number I a A3. 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) sq ft a) Square footage of attached garage 704 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 within 1.0 foot above adjacent grade O c) Total net area of flood openings in A8.b sq in cj Total net area of flood openings in A9.b C, sq in d) Engineered flood openings? ❑Yes 0 No d) Engineered flood openings? ❑Yes Ago SECTION B-FLOOD INSURANCE RATE MAP(FIRM) INFORMATION ___. B1. NFIP Comnt,untty Name&Community Number B2.County Name B3.State Pr I oil- 1-ak- N1 ) 2.7o 432- Sc.e44 Cuwti tM1J _ 84. Map/Panel Number 85.Suffix 06. FIRM Index Date 07.FIRM Panel Effective/ 88.Flood Zone(s) 89. Base Flood Elevation(s)(Zone Revised Date A0,use base flood depth) 000 2 C. 'Rik Z. 1974t.)ov 14) Mil l , A909.0 _ 810.Indicate the sour,>;�ej'f the Base Flood Elevation(B E)datj or base flood depth entered in Item B9: ❑FIS Profile f7Q FIRM 0 Community Determined 0 Other/Source: _ 611.Indicate elevationdatumused for BFE in Item B9: p<NGVD 1929 0 NAVD 1988 0 Other/Source: _ 312.1s the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(CPA)? ❑Yes No Designation Date: / / DCBRS DOPA SECTION C-BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: 0 Construction Drawings* 0 Building Under Construction* XFinished Construction *A new Elevation Certificate will he required when construction of the building is complete. C2. Elevations-Zones A1-A30,AE,AH,A(with BFE).VE,V1-1130,V(with BEE),AR,AR/A,AR/AE,AR/A1-A30,AR/AH,AR/AO.Complete Items C2.a-h below according lo the building diagram specified in Ito A7.In Puerto Rico only.enter meters. Benchmark Utilized:CC 1 of P-iov L-dde D w.- Vertical Datum: N C,Vb 117-1 Indicate elevation datum used for the elevations in items a)through h)below. 'NGVD 1929 0 NAVD 1988 ❑Other/Source: Datum used for building elevations roust be the same as that used for the BFE. Check the measurement used. al Top of bottom floor(including basement,cr'awispace,or enclosure floor) 911 . I Kfeet 0 meters b) Top of the next higher floor 5i Cale t eve( 0 feet 0 meters c) Bottom of the lowest horizontal structural member(V Zones only) 0 feet ID meters d) Attached garage(top of slab) C((0 Kfeet ❑meters e) Lowest elevation of machinery or equipment servicing the building . 0 feet 0 meters (Describe type of equipment and location in Comments) �y f) Lowest adjacent(finished)grade next to building(LAG) t , Z K`eet 0 meters gj Highest adjacent(finished)grade next to building(HAG) _W.,-5_- feet D meters ti) Lowest adjacent grade at lowest elevation of deck or stairs,including 0 feet 0 meters structural support NoNe SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION This certification is to he signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information.I 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? X-Yes 0 No Corti r:s Name c.. license Number >=:z.:r.. Title u SS ell 1..)a w..lt> t9 013& SEAL. Companv Name HEREReg , Lei,v.d StAir v eyor Probe G+� �eetr�► �j, Address 0tiL [kb .54-k-eef Clt�aXtver%5 Otte State ZIPP Code Signature DO,.r ��•__ Date Telehone B-Z5- !`F pets-e--432_- 3000 • _ FEMA Form 0\86-0-33(Revised 7/12) See reverse side for continuation. Replaces all previous editions. l ELEVATION CERTIFICATE,page 2 IMPORTANT:In these spaces,copy the corresponding Information from Section A. f OR:IVSLRftNi E COItiPAEdY USC . Building Street Address(including Apt.,[pit,Suite,and/or Bldg.No.)or PO.Route end Box No. Pcltcyttuntoer l4ilfl C�let ate Ave SE City 'r�7a. State ZIP Ce-eode / 7 (omoanv f�P( Nu np 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. Continents Signature Date SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AD and A(without BEE),complete Items E1-E5.If the Certificate is intended to support a LOMA or LOA-MR-F request,complete Sections A,Band C. For Items E1-Ed,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 adjacen: 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 ❑below the HAG. b)Top of bottom floor(including basement,crawispace,or enclosure)is 0 feet 0 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 0 meters 0 above or 0 below the HAG. E3.Attached garage(top of slab)is ❑feet ❑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 0 below the HAG. E5.Zone A0 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 BEE)or Zone AD must sign here.The statements in Sections A,B,and E are correct to the best of my knowledge. Property Owner or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑Check here if attachmen s. SECTION G-COMMUNITY INFORMATION(OPTIONAL) -fhe local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A,8,C(or E),and G of this Elevation Certificate.Complete the applicable itends)arid sign below.Check the measurement used in Items G8-•G10.In Puerto Rico only,enter meters. G1. ❑ 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 A0. G3. 0 The following information(Items 64-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: D New Construction ❑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 GID.Community's design flood elevation: 0 feet 0 meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments ❑Check here If attachments. FEMA Form 086-0.33(Revised 7/12) Replaces all previous editions. ELEVATION CERTIFICATE,page 3 BUILDING PHOTOGRAPHS See Instructions for Item A6. IMPORTANT:In these spaces,copy the corresponding Information from Section A. FOR INSUP NCE COMPANY USE Building Sheat Address(including Apt.,Unit,Suite,and/or Bldg.No.)cr E0.Route and lox Na7;.u^ber. , Cin' State ZIP Code Ccn•pany.NXIC,hunrbe If using the Elevation Certificate to obtain NFIP flood insurance,affix at least 2 building photographs below according to the instructions for Item AG. Identily 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. FEMA Form 086-0-33(Revised 7/12) Replaces all previous editicns. ELEVATION CERTIFICATE,page 4 BUILDING PHOTOGRAPHS Continuation Page IMPORTANT:In these spaces,copy the corresponding Information from Section A. FOR i SURANCf>^0.'SiPANY USC Building Street Address(including Rpt,Unit,Suite,and/or Bldg.No or P0.Flouts and Box f'c �oliry t •t • .r Cay State ZIP Code LomFany NA 1'umber 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"Lett Side View."When applicable,photographs must show the foundation with representative examples of the flood openings or vents,as indicated in Section A8. FEMA Form 086.0-33(Revised 7/12) Replaces all previous editions. •i � Jj { i 4 Ort ' _. ¢ s } � fs . ^:'`i`yje•'$){ 1 ; h,,,. 4 e} r rix t+d t, r i ; I { h % h � � � �� So b < i• � � �. M..tv,tue• x�{4KfGl g rtf � Z4-0• II . :h,, �n:{:{.•tit. w:34T^ Tht, x4..•„..,,,i n' >:;°y;a Si.z c} :b:}t:.,,•.>ia:'£"�•'''>%}"''. . ! ; :g.2:;:4s i . 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'. .'x xi�4 .,•!7,•,.it: kY 3.:t'•�?;.)ti^? cz - .. • ':' .•�/'- :ti3•"t»};:J:c Y#:4'$5. i z t £t4. -�� • t i :. N _ f f .,i{•4 :, .. : :,.,tri 4k 4 \ . � -i'YY i ttt4"'�x•:t=iii�•�;i?ya.k:..'fi����a.i \ �': . . \:. X 7.'•••''' `'kat. <t {,viv`..,f::::01,..6.-.,, ,,•cw,i. N ... \ At'. Y 4 } }'7:. •,,y4-Y Y• td 4.7) O LO•/•\\ . Y{•'Fe^} 4`' < 4Y'' .. .-I`-"•rr .. P09 - s;: °ia� �:3iv,;r`Y�' t< . x to s ir;>:r.• .. 4/rj,/i \ i T >{y)•s tY£i }Y,<c -.9 • • ... . \- ?'z {ft.tf 1. `��..tic .. +.f eN r) %32 Im �. ' •.•".• O ' '' . • . . . ' • .......... . '' ••.•....... ' .• • .. „,, ., . .. ' ' :T. . ' ',./ .-. .. •• . i:fl I iiII • • \\..., �i ... E n drop {3�' � a j} .: ; • • • ` Ka m. „ ay p •cs • ! A • • .e, ,g p.. _ '�� wr. ' .M �:z P .:: ^ �, ”" z _: an E . ia1§3 y. -.- .�E 3 : In J” $ wR iu rn dram_ • • . ....... .. 1.n d.. \, ., .. .. ,..+•,•.� O - . _.� ... fit,• .. .. 4 PR/0, CITY OF PRIOR LAKE BUILDING PERMIT, Date]Rec'd o. ..y. TEMPORARY CERTIFICATE OF ZONING COMPLIANCE TEm -- / „ /.....,-., , /4, AND UTILITY CONNECTION PERMIT ill /1- 4, .„ p g 4 If / /`/ 1 "(4 rite PERIVIIT NO 4.1 ..NESO 2 Flo rity i Al 3 %now niolitorit 4 (Please type or 1irint and sign at bottom) , ,..„, ADDRESS' ' ,, i ZO 1 -5 10 ( Gcsii hi/1r_ LEGAL DES ClUPTION(office use only) LOT 5 BLOCK ADDITION Boudin's Manor 2nd Addition ND 2:5 ‘ 1 2_I. 6 0,5 0 ., ., OWNER (Name) Brian and Susan Haas (Phone) _____ (Acidro3s) 15165 Wood Duck Trail NW, Prior Lake, MN 55372 DIJILDER (company Name) JB Woodfitter&Associates, LLC. Phone) 952-447-0850 ., 363-5.6290e Tupy(6127919025) (Contact Name), Cr----ake TuPYS612- - - (PbOtte) _ (Address) P.O. BOX 1028, Prior Lake, MN 55372 TYPE OF WORK OINew construction °Dad DPorch ORnizortring °Re-Siding °towel'Level Finish a Fireplace °Addition ljAlteration OUtgity connection CODE: .R.C. 0131.C. Type of Consmictioin I n Ill IV V A II PROJECT COST/VALUE $ 850,000.00 Occupancy Group: ABB F ill NIR su (excluding iiind) Division: 1 2 3 4 5 I hereby cretin,that I have himinwd information on this application which is,to the best of nay knowledge hue and()erica I also 00"that i aui the owner or authtlfacd ASA*,For,the abovoinennoned property and that all etuolnictiOn will conform to all state and keel laws,and will ntacced mit accordance with submitted ill,,Itn5. I 4,4'0E6 that the building atiCial can IC 14 this permit for Just cause flush i,,,.I hereby agree that*feint-Official or a designee may enter upon theproneity to perform litetted inspections. alk _------ BC032109 12/18/2013 / ,,cnature Contractors License No. Date Permit Valuation g c5-49 — Park Support Pee # $ Permit Fee $ 6-17-7,75 SAC # $ Plan Check Check Fee $ 33&45°,. Water Meter Size , , 54: W ' - et"'I"'v $ 4-So 00 State Surcharge $ 45., - Pressure Reducer S i i () 00 Penalty "."$"" ' Sewer/Water connection Pee # $ / Plumbing Permit Fee $ t o- 4 --c> Water Tower Fee # .$ ‘ — ) Mechanical Permit Fee $ I 54 50 Builder's Deposit $ 2-500•` Sewer&Water Permit Fee $ c" , —0 Other $ _ Gas Fireplace Permit Fee $ 5".4-,50 luKAL , 2/-1/ /4 This i Appli,,,,I ion Be ,, )our Building Permit ••• Apse, ed Paid /2 171 7,c. f Receot . / 7 f i'41-- ,, Buildtint Orkin' —""oillw Dole This is to certify that the/equal in the above application and accompanying doormat 13 in accordance with the City Zoning Ordinance and may proceed as requested.This document when signed hv the City Planne tesa ten soraty Certificate of Zoning remisisere and allows eonsttortion to commence. Benue OCCOPARViiA CeotritAle 40004;404Y MOM he issued fee e'oomow4ip, -5-keitt'PT . aiming Dircct& Date --------7----"Ipeolal cavidaltins,if any -- 24 hour notice for all iiispeethins(952)44149850.fav(961)441.4245 4646 Dakota Street Prior Lake,MN 55372 , . • A,;.Alkit) Builders Deposit „ City of Prior Lake ii* opoomo eundoromoositis togadA10 11*Milelitritnilt lot ',ThkrAirlIfIrirtOeyrtell IOW*resew*folfroufkoomplIgocutoT Freer Occupancy-pow no PAP.101f.'49S-9.14K..)SIVilen0r 141M1f.•.Incliteirn%but not limited to gradIn ,SoddIng laridioaPhio;toe plenting,driveways,siding and' :painting berteitadeted itadayelaketlIWidetelha yoildt.ajjEgotot te 49:40.; pklicoik brotWoreN wire the 180.00401*pOgIr,#0.9.11v4441,o oggitore opLiortiltof Die vloIt1oi ihd.1404p141orriii etrariMve 10*yogi eempty or the • $100.9.-0orrimere'400eirrogvklorfriireormill6eApplioaritlalllika::bure410.r.clean up or correadvir werittoteiditytheittdatiorr. A Woo Tree De p.oelt 4fiey Aso helequiredand wi 11 teleta ri dettlispeellIed treevare.peeervedieta:.petiosIigooeiforap, D-ATer 01/06/2014 SITE .77 A . $. : - - REFUND TO.BE MAILED. JB Woodfitter&Associates, LLC . . . P.O. BOX 1028 Prior Lake, MN 55372 - 1111" S.2.500 00 Lynda S. • on;Building Services Amount • ptutsn REMEMBER. 14- Acct.80110204 Date Li [. H.T 14, KEEP STREETS OLEAN.OURINOOONMOOTION 2, KEEP EROSION CONTROL CONTROLINPLACE •lipje ; Lar Poppler, City Engineer 3.. TEMPORARY OCCAIPANOY PERMIT MUST Nor EXPIRE OR$60.0.1):0' - a•plei Ir 1,1 I • 'MN AVMS:. •• •14' J.B.INOODFITTER&ASSOCIATES, LLC REMITTANCE ADVICE 75-905/gig ACCOUNT A2• 2 TO 2 BRANCH.' 16817 DULUTH AVENUE SE . PRIOR LAKE,MN 55372 HtIDEs UNT ideAve, +koLAJ4A/1. _ 1,1 5r4v1.4.), way ki kTE DOLLARS TO THE ORDER OF 134 gab or,back. DESCRIPTION CHECK 14 I 6,i Pnar zedee, NUMBER 14") Fe• 2702, $ PRIOR LAKE STATE BANK PRIOR LAKE,MN 55372 •RIZED SIGNATURE 4111111111111.11111.111.111111111111111111 U.S.DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE TIFI AT ONB No. 1660-0008FEDERAL EMERGENCY MANAGEMENT AGENCY Native]Ficud Insur:ncc Prague IMPORTANT:Follow the instructions on pages 1-9. Expiration Date:July 39-, 2015 SECTION A-PROPERTY INFORMATIONFOR-ft 8LIRANCE.COII:PANY USE >i A1. Building Owner's Nanta PNlcf Num A2. Pu dog]tr t A dress including Apt.,pna,Suite,and/or Bldg.`Jo.)Cr PD-Route and Box No. torpor NplC'I t:ibiki oval a 'e e ikvvwLe S E. City Pv'i or- l�w;t r-e Stale A A ZIP Code r�5 3.72» A3. Property Description(Lot and Block Numbers,Tax Parcel Number.Legal Description,etc.)lc. 5 ISOW:HMIS MP )oRS SECOND ATMTiot. S-o4+ coy Pv�ilnvtestA-0- Ad. Building Use(e.g.,Residential,Non-Residential,Addition.,Accessory.etc.) Res i fttlfi al AS. Latitude/Longitude:Lat. 4.4_ 739°11 Long.-9$. 38,9%9 Horizontal Datum: 0 NAC 1927 NAD 1983 AS. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Building Diagram Number I a 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) sq it a) Square footage of attached garage 704 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 within 1.0 foot above adjacent grade O c) Total net area of flood openings in A8.b sq in cj Total net area of flood openings in Al-lb O sl in d) Engineered flood openings? 0 Yes 0 No d) Engineered flood openings? 0 Yes AJo SECTION B-FLOOD INSURANCE RATE MAP(FIRM) INFORMATION B1. NFIP Comn}un ty Name&Community Number 82.County Name f 83.State Pr i ov. Lair-e1 IAN 2.7o 432- co 44 Cm w'61 (mil h1 _ 84. Map/Panel Number 85.Suffix. B6. FIRM Index Date 67.FIRM Panel Effective/ 68.Flood Zone(s) 89. Base Flood Elevation(s)(Zone Revised Date AO,use base flood depth) 0002. c . 'SvIv 26,t97kMov 19, ViT7 A E 909.0 �. 610.Indicate the sourccej f the Base Flood Elevation(B )data or base flood depth entered in Item 69: 0 FIS Profile IRM 0 Community Determined 0 Other/Source: - 611.Indicate elevation datum used for BFE in Item B9: p<NGVD 1929 0 NAVD 1988 0 Other/Source: _ 812.Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? 0 YesNo 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* XFinished Construction 'A new Elevation Certificate will he 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 accordingo the building diagram specified in Ire A7.In Puerto Rico only,enter meters. Benchmark Utiiized:Ct�1 of Pr iov" t-oic.e Oa4uwe- Vertical Datum: N Ci,V Di "Z-41 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) 9 I I , I feet 0 meters b) Top of the next higher floor $j^9t'e (.eve1 0 feet 0 meters c) Bottom of the lowest horizontal structural member(V Zones only) 0 feet 0 meters d) Attached garage(top of slab) q 10.-7-- tgrfeet 0 meters e) Lowest elevation of machinery or equipment servicing the building 0 feet 0 meters (Describe type of equipment and location in Comments) �y 1 f) Lowest adjacent(finished)grade next to building(LAG) '1(0. Z [feet 0 meters g) Highest adjacent(finished)grade nest to building(HAG) 41c2._• 5 Kreet 0 meters h) Lowest adjacent grade at lowest elevation of deck or stairs,including `" . 0 feet 0 meters structural support NoNe r SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION This certification is to he signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation information.I certir,'that the information on this Certificate represents my best efforts to interpret the data available. l understand that any false statement may be punishable by fine or imprisonment under 18 U.S.Code,Section MOT.. 0 Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a 0 Check here if attachments. licensed land surveyor? XYes 0 No Cert' is Name ;",.. Kv 55 ell b a rh+�.tn License Number AL Title Comp�nv Name 2eg� Lad Su.Y V tyvtr- Nratee ?�eelrirt--n� Co. HERE Address oa City State V ZIP Code t Dvro s�'e ref 44..,..t.,.,41„i tie Signature ( jV Date Telephone B-E)-6-- I et 15 e-4132_- 3000 FEMA Form 086-0-33(Revised 7/12) See reverse side for continuation. Replaces all previous editions. ELEVATION CERTIFICATE,page 2 IMPORTANT:In these spaces,copy the corresponding Information from Section A. f OR,I VSLRANt L:;COM°ANY.LSE Building Street AAdress(including A•t., nit,Suite,and/or Bldg.No.)or PO.Route and Box No. Pdfcy Nunioer (410 Cte a.te AA/e. S� City Slate ZIP Code �t omoanv.f�P( NuTb tr-i or .a L-€ /V Ptj SS37 Z. 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 Dale SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BFE) For Zones AU and A(without BFE),complete Items El-E5.if the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A,Barna 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,crawispace,or enclosure)is - ❑feet 0 meters ❑above or 0 below the HAG. b)Top of bottom floor(including basement,crawispace,or enclosure)is 0 feet 0 meters 0 above or 0 below the LAG. E2.For Building Diagrams 8-9 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 0 meters 0 above or 0 below the HAG. E3.Attached garage(top of slab)is 0 feet ❑meters ❑above or 0 below the HAG. E4.Top of platform of machinery and/or equipment servicing the building is 0 feet ❑meters 0 above or 0 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 rnanagemer t 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 hest of my knowledge. _ Property Owner or Owner's Authorized Representative's Name Address City State ZIP Cade Signature Date Telephone Comments 0 Check here if attachmen's. 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 items)arid sign below.Check the measurement used in Items 88--G10.In Puerto Rico only,enter meters. G1. ❑ 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 A0. G3. ❑ The following information(Items G4-G10)is provided for community floodplain management purposes. G4. Permit Number G5.Date Permit Issued Gni.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: 0 feet 0 meters Datum — G9. BFE or(in Zone AO)depth of flooding at the building site: 0 feet 0 meters Datum GlO.Community's design flood elevation: 0 feet 0 meters Datum — Local Official's Nanie Title Community Name Telephone Signature Date Comments ❑Check here If attachments. FEMA Form 086-0-33(Revised 7/12) Replaces all previous editions. ELEVATION CERTIFICATE,page 3 BUILDING PHOTOGRAPHS See Instructions for Item A6. IMPORTANT:In these spaces,copy the corresponding Information from Section A. FOR'JNSUP NCECOMPAPb'USE Building Street Address(including Apt.,Unit,Suite.and/or Bidg.No.)cr P0.Route and Box No. roti 7:�ir^t er City State ZIP Code CompanyN\ICI'wither If using the Elevation Certificate to obtain NFIP flood insurance,affix at least 2 building photographs below according to the instructions for Item A6. Identity 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 AS. If submitting more photographs than will fit on this page,use the Continuation Page. • • FEMA Form 086-0-33(Revised 7/12) Replaces all previous editions. ELEVATION CERTIFICATE,page 4 BUILDING PHOTOGRAPHS Continuation Page IMPORTANT:In these spaces,copy the corresponding Information from Section A. FOR If SURAt`CE'CoMPANY USC Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P0.Route and Box No. )oDq'girt r, City State ZIP f;ode Lompany r4AI& t'umber 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 cif the flood openings or vents,as indicated in Section AS. FEMA Form 086-0.33(Revised 7/12) Replaces all previous editions. / } 1 \ s t - = � s . t 5h w/ 3. K ✓ s, f}yr i I .. vi )�sr`t`:zti: <rY♦.w}t.h+.3ns h:tit.:h.;;,✓-:,a:>�:S is}'<`tY^%':r -4. {Yrtt tl. Sa 4'f . m ktt . .> r2 - s ,v2E \U \ � < � 1 R. 2 tS M !£, 4•.tdo .., } vh/ r\} Qarvri..fd.t:-;•5=:d-u;v1?t} > . . =F-21LVV ♦ k^ nFr:4`:J'.'S:S.} .:t: n}; -`-.0v,,:: -... ro �tV„• F \ 4 r`a. x.! 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V . .. k "cs1� ,r, n& r,— W m ''....E .may .. L lg • • lett .. 1611 D•: ... g.•. .. .. ..-- . . . :: .. O4 PRIpP 0 White -Building Canary -Engineering '‘*/HrBso`o' Pink -Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT J B 11000 F --(7---)C-- APPLICATION `APPLICATION RECEIVED 1 /3 /4— The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: / .1-5-/ O 6(., P\105' . Accepted ✓ Accepted With Corrections Denied i / Reviewed By: r _____ Date: l Comments: ' - e- .A... i` 65 f0N F141A/A)TrA-1A, C-1,, � 1 ,_. T'‘,/v‘,..-e-r-s- \7.-, F v` ©R.. la -dv t 4, A vkcr'j21 t"..re_a", L c51-tr-kcp. - -- T P S 5 O c-s-c- Fz - t-LG JA--r— . 1141 f�1 Oce ClOC AI— naD oAi- (,u5 Afc rz oma/, v/. - c -c 0--a-c71/4-qtt-esP Ac-rsz Fe-A44-c___ As - u( L-A '2 VLS1 Rect.-)0--=40 R-4-Floa-/d-- FkAAArc--- M4 .1.--5T-si.w. �- - * ' tviAuibe, ©N 4ciii_v. "The issuance or granting of a permit or a proval 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." O4 YWp�, N White Building 'hHxsso��' Canary -Engineering Pink -Planning • 3UILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT B K000 00 0 (/ , r&J APPLICATION RECEIVED ! • /- , 71--- The -The-Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: / *3/ C 6 f'1Dr9 Accepted Accepted With Corrections Denied „Aairiewed By: M4 Date: 2-/S14- Comments: a SI&lar M 'tt • see MachnienW 1)qinkceia Plana)EIOSIO GC. "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." PIUn- c7 White -Building Canary -Engineering Pink -Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT . APPLICATION RECEIVED if. �- . J The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: / 4 / 6 n Accepted Accepted With Corrections Denied Reviewed By Date: Comment/s• fro,- re uri Fo f wt /n5Arrec_forie "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." ...,..;,.................... .......,ostErw" Pftruw:21--\ Ile. `"aa . -- w.Mw "Ma erre.era Ri.aw.er a a�a ar 0,,,*#' CITY OF PRIOR LAKE Impervious Surface Calculations (To he Submitted wtla Mats Peaa t For All Properties Located in the Sba eland District(SD). The Maximum Impervious Surface Coverage Permitted in 30 Parent. Property Address Pis-10 41 Q r'tcic,_i p A v e S t Lot Area 11 '7 39 Sq.Feet x30 6 g.......-...... 3e S- 3 *********** *******r**ss•ts•*r••asssa+ ••**saty**********ssss•ss•••••••s•. LENGTH WIDTH SQ.FEET HOUSE x - x - ATTACHED GARAGE x = TOTAL PRINCIPLE STRUCTURE Z.0 12 DETACHED BLDGS x (ate/Shcd) x TOTAL DETACHED BUILDINGS. .... DRIVEWAY/PAVED AREAS x - (Driveway.pay.d or awe) x r (Sidewalk/Partiatn Mem) x - TOTAL PAVED AREAL..... .......... 13 31 PATIOS/PORCHES/DECKS x - (Opal Decks W min.open*batmen x = boson.*rids*penis**saalbos babes. aro oat oaaid.mmd to be empaviaws) x - TOTAL D ....,... 9 c OTHER x = x TOTAL OTHER............. TOTAL IMPERVIOUS SURFACE I 3 q 3$ ( VER l GIS I Prepared By C'_hn',4 p er Ca .): 3 Duce 1- 1y•-• !y �*v Wq+P Date Reedc A. CITY OF PRIOR LAKE PLUMBING PERMIT c Orr of '. .) t A `''` �.skid Cary ra. I PERMIT NO. 4.1.1l ame 3 Y. iyglkmt (Please type or print and sign at bottom) ZONING ague sot)ADDRESS ‘ \ \0 6 1 z ct OLS LEGAL DESCRIPTION(office use only) ,' LOT BLOCK ADDITION FID OWNER (Name) (Phone) (Address) APPLIC(Name)ANT ,.)C`,I"1{ :k t; u t l,ti til t��l ^...�iU t°--( phone) ; ll !-2Ev ? L (Address) -' `j t C ti � s c y L- Lc i_ '553 5 ?)- (Address) } (City) (Zip Code) 1 C 1 C..t A.L,,`.i`"eY (Phone) t,/v��' t--)- `- 3 3 {Contact Person) .... (= APPLICANT SIGNATURE G- DATE t �)1 _ APPLICANT PLEASE COMPLETE BELOW Quantity Type of Fixture Quantity Type of Fixture 1 Bath Tub with or without shower Rough-ins I Dishwasher ( Water Heater, i Floor Drain Water Softener tp Lavatory(Bathroom Sink) j Stand Pipe(Washi g Machine) T 1 Laundry Tray(1 or 2 compartment sink _ Sewage Ejector ), Shower StallBackflow Assembly Sinks Backflow Assembly Test Bar SinkLawn Sprinkler t‘ Water Closet(Toilet) Other FEE SCHEDULE The Minnesota Statutes§328-B.148 (inti cost with a$49.50 minimum Rest, New One&Two-Family $149.50 SURCHARGE"has been extended idential,Additions&Alterations $49.50 The minimum surcharge fora i adding Permit# "fixed fee"permit 3s$5M0 $ PLUMB s s ERMIT FEE $ ST SURCHARGE $ XIM 5 00 TA.L PERMIT FEE $ (Office the Only) , ' This Application Becomes Your Building Permit When Approved Paid Re .I * 1111 Date By FIX gill Buntline Official llate 24 hour notice for all inspections(952)447-9850,fax(952)447.4245 u I 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372 r , �41'RtO� CITY OF PRIOR LAKE '' Date Rec'd HEATING/AIR CONDITIONING/FIREPLACE PERMIT h t.-30 gi 44Anfisdo' i c PERMIT NO I I ri 3.Yellow ityptiatitt (Please type or print and sign at bottom) ADDRESS ZONING(office use) 1 15([) 6 k n6tCJc AT-6- LEGAL DESCRIPTION(office use only) LOT BLOCK ADDITION PID OWNER (Name) --r, ) ' 1 -�'i*et (Phone) l s"2— 14`f-025L) . (Address) (0 a-g APPLICANT ' j //,, J GJ (Name) 3llf a ill, `fit '1 a `'".th (Phone) V—q;?-1— P �1 � p�C l,F (Address) 15185. � +'i.�`�t" , I �D .,t%GYi D7 fG2l".. 5rJ04 1 ,'(Address) Li (C ity) (Zip Code) (Contact Person) LTi " `� ` (Phone) C. r —J 7 APPLICANT SIGNATURE �s.-C /1e.-- 7 '2 DATE 14"--%"`j4 APPLICANT PLEASE COMPLETE BELOW NEW CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS FURNACE MAKE AND MODEL L tMY)oY 6114C V H i J O(N C. FUEL FLUE SIZE 3i' RETURN OPENINGS (y INPUT 1I D,00Jb.-hit y OUTPUT O ),30 o TYPE OF SYSTEM . HEATING OR POWER PLANT PLEASE NOTE: Air Conditioner __.. DWarm Air Plants ❑Steam Units and Fireplaces Cannot Encroach OGravity affot Water into Required.Side Yard Setbacks. echanical ❑Radiation Fireplaces with Box Additions or 9.'Air Conditioning ❑Special Devices VentSystem 0 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 $49.50, Estimated Cost$ Building Permit # HEATING PERMIT FEE $ PAID WITH H STATE SURCHARGE $ .50 TOTAL PERMIT FEE $ . BUILDING PERMIIT tome Use Only) This Application Becomes Your Building Permit When Approved Paid Receipt No. Date~ By 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 PRIORDEPARTMENT OF LAKE BUILDING AND INSPECTION INSPECTION RECORD SITE ADDRESS ! ' cn L60.4-L - AVE;:._ NATURE OF WORK w USE OF BUILDING 5 f'c_-., r-: I c e'-'-- VJ PERMIT NO. I4 i DATE ISSUED ' f El- CONTRACTOR , U30013F I PHONE 4-4-v -00 INSTALL EROSION CONRTOL AND MAINTAIN CLEAN STREETS AT ALL TIMES INSPECTOR DATE FOOTING 3)/01 1i PO FOUNDATION (Prior To Backfill) (.�;;i.„ F, al Fc. 4vtetra2-- RADON RETARDER PI yO PLACE NO CONCRETE UNTIL AB E HAS BEEN SIGNED ROUGH - INS SEWER/WATER/SEPTIC 3/244 FRAMING INSULATION WJc P V ELECTRICAL PLUMBING(%S L/G iaiij7 M HEATING FIREPLACE0:b GAS LINE MR TEST Ina ! RADON -Pi et/ COVER NO WORK UNTIL THE ABOVE HAS BEEN SIGNED HOUSEWRAP a 7(),;', Yj ' LATH FINALS 'GRADING ( PRIOR TO SODDING) t 1 — BUILDING � = /� .-0O t'�`� �,,.,,.�p i l /,H t, rile/ _ LiLECTRICAL _ PLUMBING c�,� �� HEATING * ill/ DO NOT OCCUPY UNTIL ABOVE HAS BEEN SIGD 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