HomeMy WebLinkAboutBuilding Permit 05-0023
0... TE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
)J -) R .ct
PHONE NO.
5670 JIll (' /7Y1~~ ~ /.
CONTR. He, VI /c, ~ ~
PERMIT NO. CJ 5...... -.23
ADDRESS
OWNER
o FOOTING
o FOUNDA liON
o FRAMING
o INSULA liON
~FINAL
v ~E INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
~EXIGRAD/FILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
/ /-
/71'''1t1t<: -
oK-
C../lb 8o~ - U(
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ ~ Owner/Contr:
...
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &; SAFETY!
INSNOTI
...-............
'\
)
/
/
/
~
.-------
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
-.S~07c> ~c0A ~-r
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
<; /' -,--
-(
/ I
( / {rJ(p
~.\.-...
.--.......
(j/
hLP
.
........."""'----
OATE TIME
12-2-~'a
.I)'-L-~
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
Y WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT W,OifiCA OR REINSPECTION BEFORE COVERING
!/
Inspector: L . Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTI
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &; SAFETY!
0... TE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
7-~-~
ADDRESS
~07 () LM-1fW\ <;;7t-CG r-
OWNER
CONTR.
PHONE NO.
PERMIT NO.
s-}., J
COMMENTS:
o PLUMBING RI 0 EXIGRADIFILLlNG
o MECH RI 0 COMPLAINT
o WATER HOOKUP 0 FIREPLACE RI
o SEWER HOO~UP FIREPLACE FINAL
,li!!"'PLUMBING FINA 0 GASLlNE AIR TST
~ MECH FINAL 0
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
s4INAL
o SITE INSPECTION
f-/lIlq( Irr'fJ~ a/lJ?"1JV'p I
SA d .f- 'T rr-r- 5
~/1f'WA 1- d j"'1&<..1A/~
I
o WORK SATISFACTORY, PROCEED
o ~RECT ACTION AND PROCEED
~ CORRECT,WJ5tK,.C#OR REINSPECTION BEFORE COVERING
Inspector: 1/ Iff Owner/Contr:
v
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &; SAFETY!
INSNOTI
[)0'10
(Please type or print and si~ at bottom)
ADDRESS
5070
CITY OF PRIOR LAKE BUILDING PERMIT,
TEMPORARY CERTIFICATE OF ZONING COMPLIANCE
AND UTILITY CONNECTION PERMIT
Date Rec' d
/1. ~ 04-
:# ()~ /031
I. White
2 Pink
3 Yellow
File
City
Applicant
I PERMIT NO'06. 007~ I
~ttlOt)N sT.
5.6" .
ZONING (office use)
12/.5" LJ
LOT 8 BLOCK
LEGAL DESCRIPTION (office use only)
ADDITION
~ItIO()/V'.f j1/d() OFh6
PID zs: ()z. 9. 00". 0
OWNER
(Name)
(Address)
(Phone)
J-Iaf,;/'st, /-IorYt!' > , ~
, ;V14+.J- ~; 1. ~ h .
BUILDER
(Company Name)
(Contact Name)
(Address) 10&..7":';' t'l;;F.1/::J./\ -r/-':i,
(Phone) (~I'~-Z;) i/qU -7C'{o)
(Phone)
~--'L:-- ~-/~. /11,..,/ 5-:,'7"7 L.
I S,E S.J, k ZvA.}
TYPE OF WORK ~ew Construction ODeck OPorch ORe-Roofing ORe-Siding OLower Level Finish 0 Fireplace
'lfiAddition OAlteration OUtility Connection 0 Mise,
CODE: ~I.R.C. DI.B.c.
Type ofk~nstruction:
Occupancy Group: A B
Division:
I
E
II
F
1
III IV V A
HIM R
2 3 4 5
B
S U
PROJECT COST /V ALUE $
(excluding land)
I hereby certify that I have furnished mfmmatlon on this application which IS to the best of my knowledge true and correct. I also certify that I am the owner or authoflzcd agent for the
above-mentlOned proper an t all construction will conform to all existmg state and local laws and will proceed in accordance with submitted plans I am aware that the build 109
official can revoke t ~~r ~'st cause F ermore, I hereby agree that the CIty officialm a designee may enter upon the property to perform n~:,~: ;n/s.p~c:;),~{s
X ~ A("~ ,?oL"DtE/qq' ~.v_
r / Signature Contractor's License No, Date
Permit Valuation
Permit Fee
Plan Check Fee
State Surcharge
Penalty
Plumbing Permit Fee
Mechanical Permit Fee
Sewer & Water Permit Fee
Gas Fireplace Permit Fee
4(z-so,OOO,QO
$ 19'53.50
$ I Z(o a" 7 ~
$ 'ZS".oo
$
$
$
$
$
This Application Becomes Your Building Pennit When Approved
~~.~
Build1l1g Otlicial
/ /S-~S-
/
$
$
$
$
$
$
$ \~OrDO
I $
1$ Sii 3@. z.f)
Paid , T7- '-~?r Ol?f" I Receipt No, Lf'?f00
Date i - -/- I? "'J I By q
\ ,I ecppen..... b~. ~~S't"?JP ~ H-or.tJ'E
FnfL- ~\t:rL SEXU//CC ~
Park Support Fee
#
#
SAC
-- ---
Water Meter "Size 5t.iP. 1";
~T:rt....,
60,.00
Pressure Reducer
Sewer/Water Connection Fee
#
Water Tower Fee
#
lOt}, 0 ()
Ida,. Of)
Builder's Deposit
Other
TOTAL DUE tJltud!J
I, J.':',r
1~,()o
Date
ThIS IS tll cewry that the request 10 the above application and accompanymg documents is in accordance with the City Zoning Ordinance and may proceed as requested, ThiS document
Wh~cn" 'd bY, t, he City Planner Cllnstlllltes a temporary Certificate of Zonmg co pliancynd allows construction to commence. Before occupancy, a ccru,ficate 'If OCfupancy must be
ISS d I 5/ I (15 rEJ..\~ ~\~v~.;.....C~V'.... n~4t~., "
> V'h. \~ '.., OI~.Jvl"'\{#~ ~ .J/.'(~IJ(J 1'-1'1
Planning Director Date a Special Conditions if any -L
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 &:u-~l,~ ~
16200 Eagle Creek Avenue Prior Lake, MN 55372 aI!O 1.. 0A04. ~~
..g.,.., '"" 1
c:::W;.ite - Buildin9::::>
Canary -""Engineering
Pink - Planning
lhr ("t'ntrT of th(' l.akE' Counlr)-
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
f!/}/JIsH H()HES
/ /. 4-. 04--
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
5070 ~OAJOo;t/ 51, 5.6.
Accepted
Accepted With Corrections /
Denied
~ 9dp . Date: (lhAy
I I ( ,..
Comments: ~,..; ~ ~ f-o ~--=.a ~
/7 /7 ~ ~ // ~- """'J '
~ a.d ~,; I" T..~ tf'):: 1", t"'~1'\O""n.""
(J' -tl-v
on ~ ~_ ~ (I~r.i:tip -In ~
~ ~ ~~-~l'~~ ~
~.,h:n ~C7.,FJ~ ~~
.. . () _ ~ /1/ ,(J ~ // . II
tAr- ~ ...r:2-fL-{ ~ /~'. -tL ~ ~1'I111N.
I
Wzt~~.~~~c;'~
~ 10~9 / A.p_", ~~ I}LJ~' ~, ~ 11. ~
~ '~~'" t/ J' ~
1t~ /)-r-J Lcal6S'r ~tnrl ~ ~ ~
,;;yo-U! ?L 7: {'. 0, t.d ~~,.~ t
Reviewed By:
"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."
~~
"'-
The ('",nlfOr of Ihf' I..kf' ('ount,..,.
White - Buildin~
("" l,;~narv - I::ngineerin1fJ
Pink - Planning
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
NAME OF APPLICANT
APPLICATION RECEIVED
I
,/i--,1 j.~-/!/"~ IL/ /.~. .~-~
, .I I " I , C-,,~--
/
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
.({..I'~'"":- /,0' -/ (~')
"",' '~,.,. '--"
-- ,
;/~l
(-,'
',,_.......
,i.--/
/' I
,/ \,,.i
--
~:....; I' .
Accepted
x
Accepted With Corrections
Denied
Reviewed By:
1YJ4~
Date:
/2. -/-01
Comments: See Reverse Side for Additional Information!
/~~~~~.
.J v
~ee Attachments: 1) Grading Plan. 2) Erosion Control Measures
"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."
.~
lhf ('f'nll'r (If lht' I ,ake Counlr~
White - Building
Canary - Engineering
~k - Plan!:!.lMP
BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST
I
J
NAME OF APPLICANT
APPLICATION RECEIVED
The Building, Engineering, and Planning Departments have reviewed the building permit
application for construction activity which is proposed at:
Accepted
Accepted With Corrections
Denied
Reviewed By:
Date:
Comments: -E~/~/~ C4.-~ ~~;-:t; ~J.
~ ~ ~ VlAM.~'
U
~~~~
,No' ~ ~,
~~~. ~
~.
"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."
Hz" \) ~S~()
CITY OF PRIOR LAKE
, Impervious Surfa(:e Calculations
(To be Submitted with Building Permit Application)
For All Properties Located in the Shoreland Distric',J.~D).
The Maximum Impervious Surface Coverage Permitted itf1o-Percent.
~[E
JAN 0 5 2005
[~ [J' IIr/ lcl i
i, lI, ,~.
I
_J
Property Address ~67 (:) CorldDN5 .5Tie€., .s E.
3' % pu.." V'M.,',...,.,t.-tt
Lot Area 5'; D €>"2... ~ t-Itv 'f~'-/ Sq. Feet x ~ = .............. '8z 9 I ~
************************************************************************
LENGTH
WIDTH
SQ. FEET
HOUSE
AND
ATTACHED GARAGE
x
x
x
=
=
=
TOTAL PRINCIPLE STRUCTURE...................... /; ~8 B
DETACHED BLDGS
(Garage/Shed)
x
x
TOTAL DETACHED ]~IUILDINGS.......................
DRIVEW A YIP A VED AREAS
(Driveway-paved or not)
(Sidewalk/ParkingAreas)
x
x
x
=
=
=
TOTAL PAVED AREi\.S......................................... Z t! 0
PATIOS/PORCHES/DECKS
(Open Decks'!." min. opening between
boards, with a pervious surface below,
are not considered to be impervious)
x
x
=
=
x
=
TOT A~ D ~CKS........... .............................................
OTHER
x
X
=
=
\0
TOTAL OTHER........... t...........................................
TOTAL IMPERVIOUS SURFACE
(UNnEj>OVER
Prepared By S Of) rl-S "";*",,StJ,.J
I
Date I I~ )05
I. fI "Z. f)
J. ~
Company V",l 1 Py ~11",,,pying, ("n 'P A.
Phone # (Q'i?) 447-2'570
Residential Building Permit Checklist
New Construction for Single or Two-family Dwellings in R-1 or R.2 Distrlcts
Reviewed by: ~"""'.~
Date: "/1_/0'1
Building Permit #
Address: Sc>10 ~
PID:
~. Sl,.
Zoning: R'. SD
FI ..J ~~~"-
L"'9c:.l. L
. 0
Subdivision: ~ ~ tA)~"'.JL...
Existing Structure? ~ NO
Existing Nonconforming Structure:.9 NQ .
CONFORMS TO ZONING
ORDINANCE
YES
NO
.-.;;:-.
Yard Setbacks: NA /~AILS[);OMPLlES
.~... Front Yard (can be 20' if avg. w/in ISO')
!,iF ~
!...~)'.
'<-'-.". .
\I ARt ~tJc.e~ ...
10' setback +
2"!1' over 50'
25'
1 0' side!
25' rear
30'
Proposed
\lACI A..C! - c)"-
. Sidewall exceeding 50' requires additional side 2"
setback for every l' over 50' in length
I. Rear Yard
. Patio Door: provide for minimum 10' deck or sign
statement indicating no deck will be built in the future
. From 100 year flood elevation ofwetland/NURP
pond
. From OHW (Prior or Spring Lake)
75' or setback average of
adjacent structures, but no
less than 50'
NA
'\I ~IZ.I~ C. ('.;'!,:'C '
( A1rAt.tIe"(:f'
"Pt~lJtSc.f:.s: '
(~o)
~.,
r.
'ill
Yard Encroachments: NAq FAILS)COMPUES 1 Standard t Proposedi>~:"~'"
'~i::::~,:~~~=:;;~=}~-,\I;.;,,,.,.,.,..~.~~~~t1~'~"J..'
A{(".&ld'Qtb~riqlJi~J;1eRt~4ARQti&lC'J:Qid:r~l'Tif1rerior ,~"'~.L...QV.r.A ~ ..~. J'-~,!~i,:':~;,.._.
:~:'5'. NItr- " w+"" 3. CO, t~., !".'\'~4~;jt'i't~~..;:s:},"1:'
~
t Tree Preservatiort. NA /rAIl.S I COMPLIES
.. Totaf caliper'inches
.. Permit25% Removal
. Calipeclnches Removed
. Caliper Inches Preserved
I.. Replacement
Standard'
~.
..',~:":~, ~
i..-
YzJ
L: \TEvIPLA TE\BLDGLlST.DOC
FEMA
FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CICRTIFICA'l'E
AND
INSTRUCTIONS
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
PAPERWORK BURDEN DISCLOSURE NOTICE
FEMA Form 81-:i1
The public reporting burden for this form is estimated to be 3.0 hours per response. The burden estimate includes the time
for reviewing instructions, searching existing data sources, gathering and maintaining the needed data, and completing,
reviewhig, and submitting the form. You are not required to respond to this collection ofinfonnation unless a valid OMB
control number appears in the upper right corner of this form. Send comments regarding the accuracy of the burden
estimate and any suggestions for reducing this burden to: lnfornlation Collections Managemcnt, Federal Emergency
Management Agency, 500 C Street. SW. Washington, DC 20472, Paperwork Reduction Project (3067-0077). NOTE:
Plcasc do not send your completed form to the above addrcss.
PURPOSE OF THE ELEVATION CERTIFICATE
The Elevation Certificate is an important administrative tool of the National Flood Insurance Program (NFIP). It is to be
used to providc elevation infonnation necessary to ensure compliance with community floodplain management
ordinances, to detennine the proper insurance premium ratc, and to :;upport a request for a Lctter of Map Amcndmcnt or
Revision (LOMA or LOMR-F).
The Elevation Certificate is required in order to properly rate post-F [RM buildings, which are buildings constructed afler
publication of the Flood Insurance Rate Map (FIRM), for flood insJrance Zones AI-A30, AE, AH, A (with BFE), VE,
VI-V30, V (with BFE), AR, ARIA, ARlAE. ARIA I-A30, ARlAH, alld ARlAO. The Elcvation Certificate is not required
for pre-FIRM buildings unless the building is being rated under the optional post.;pJRM flood insurance rules.
As part ohhe agreement for making flood insl.lranCe available in a community, the NFIP requires the community to adopt
a floodplain management ordinancc that specifics minimum requirements for reducing flood losses. One such requiremcnt
is for the community to obtain the elevation of the lowest t100r (including basement) of all new and substantially
improved buildings and maintain a record of such infonnation. The :3levation Certificate provides a way for a community
to comply with this requirement.
Use of this certificatc docs not provide a waiver ofthe flood insurancc purchase requiremcnt. Only a LOMA or LOMR-F
from the Federal Emergency Management Agency (FEMA) can alTIt~nd the FIRM and remove the Federal mandate for a
lending institution to require the purchase of flood insurance. Howe\'er, the lending institution has the option of requiring
flood insurance even if a LOMA/LOMR-F has been issued by FEW.. The Elevation Certificate may be used to support a
LOMA or LOMR-F request. Lowest floor and lowest adjacent grade elevations certified by a surveyor or engineer \vill be
required if the certificate is used LO support a LOMA or LOMR-F request.
This certificate is used only to certify building elevations. A separate certificate is required for floodproofing. Under the
NFIP. non-residential buildings can be floodproofed up to or abov~ thc Base Flood Elevation (BFE). A t1oodproofed
building is a building that has been designed and constructed to be watertight (substantially impermeable to floodwaters)
below the BFE. Floodproofing of residential buildings is not peTInitted under the NFlP unless FEMA has granted the
community an exception for residential floodproofed basemcnts. Thc community must adopt standards for design and
construction of floodproofed basements before FEMA will grant :1 basement exception. For both floodproofed non-
residential 'buildings and residential floodprootcd basemcnts in communitics that havc been granted an exception by
FEMA' a floodproofmg certificate is required.
~, FEOERAL EMERGENCY MANAGEMENT AGENCY
~ / e, \ f1 0 NATIONAL FLOOD INSURANCE PROGRAM
roe. \\-"\ 0 \- tf'\alt- ELEVATION CEIRTIFICATE
L...~~ \J~e.. o~ ''i Important: Read the Instructions on pages 1 . 7.
SECTION A. PROPERTY OWNER INFORMATION
BUILDING OWNER'S ~f... ,\ IH A (' "-
~ n II ,^,~i....p U V \ t'~_1:~:~.p Q..p
BUILDING STREET ADDRESS (In~~~~:., Unit, Su~,\and/or ~Idg. No.) c:.R P,O. ROUTE AND BOX NO,
~n () "'~ ~or~A- ""=>E
CITY \ ' , .,$.TATE
~\Q~ ~ \<-e... '" ~ .
PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) , ' ~ _ .\
'_ ~+ ~\ . r O~bl"~: '\}....\(:)~'O~~ -..A::n"tt-
BUILDING USE (e,g.,CResidentia\lNon-residential, I>\ddition, Accessory, etc. Use a Comments area, if necelsary.)
a.M.B. No. 3067-0077
Expires December 31, 2005
..fpf'H~llf.;iM~:cQmpMy':Q$~;):):...".'.:..'
ZIP CODE
~~17
c..o.} ~~
LATITUDE/LONGITUDE (OPTIONAL)
( ##0 _ ##' _ ##,##" or ##.#####0)
HORIZONTAL DATUM:
I_I NAD 1927 L....J NAD 1983
SOURCE: I_I GPS (Type):
LI USGS Quad Map 1--' Other
SECTION B. FLOOD INSURANCE RArE MAP (FIRM) INFORMATION
I Bll NFIP COMMUNITY NAME & COMMUNITY NUMBER I B2, COUNTY NAME c:::::." _\\ I B3. STATE M ,
~~\l)~ LA~ ""2-"D4~'"2.- ....J'-oO\\ I'\N
B4. MAP AND PANEL B5. SUFFIX 86, FIRM INDEX 87, FIRM PANEL B8. FLOOD B9. BASE FLOOD ELEVATION(S)
NUMBER ~ DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO, use depth offloodin,,) . ..
o 00 '-\ \ \ - \ '\ ...q, \ \ - \ ct - ~ I 'X '\ o~ ,C\ e. ow..~,,:, ~
B10. Indicate the source of the Base Flood Elev~ (BFE) data or base flood depth entered in 89. B Fe.
I_I FIS Profile I_I FIRM L.~Community D~ined I_I Other (Describe):
B 11. Indicate the elevation datum used for the BFE in 89: !2::fNGVD 1929 I_I NA VD 1988 I_I Other (Describe): /
B12. Is the building located in a Coastal Barrier Resources System (CBRS) urea or Otherwise Protected Area (OPA)? I_I Yes L\.j1Jo
Designation Date:
SECTION C . BUILDING ELEVATION JNFClR~ON (SURVEY REQUIRED)
C1, Building elevations are based on: '_IConstruction Drawings. 1Jd1~uilding Under Construction" I_I Finished Construction
.A new Elevation Certificate will be required when construction of the building is complete.
C2. Building Diagram Number \ (Select the building diagram most similar to the building for which this certificate is being completed. see
pages 6 and 7. If no diagram accurately represents the building, providEI a sketch or photograph.)
C3, Elevations - Zones A1.A30, AE, AH, A (with BFE), VE, V1-V30, V (with I3FE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/AO
Complete Items C3.a-i below according to the building diagram speeifiecl in Item C2. State the datum used. If the datum is different from
the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion
calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion. /'
Datum Conversion/Comments r
Elevation reference mark used Does the ele~t,ion re,f,erence mark used a~!lr, on t, h,e FIRM? I_I Yes L~, 0 ~
U a) Top of bottom floor (including basement or enclosure) ~~~l) C\ \ I) ,~ft.(m) -' '...,' I: Y ~\ :l~{~ =~lO ,,", 7l\'
U b) Top of next higher floor ''t~~) ~ \ ~ ,"2.. ft.(m) ~ ,'II'" \ t." ,,/
U c) Bottom of lowest horizontal structural member (V zones 'only). , _ ft.(m) ~ ~ l. \ \) \.U-t> ~ t"")
o d) Attached garage (top of slab) Otb~c&eLU ~'Z...(p .l ft.(m) ~ -g r' . '" ~ f)\\ot:,.>::. qZ.1.0
o e) Lowest elevation of machinery and/or equipment , u:: T' \\\ \~ . \ G f .
servicing the building (Describe in a Comments area,) , _ ft.(m) ~ i (i "\S,,", C:s~f". s\4b '-:; ~2..<-'1
;,J f) Lowest adjacent (finished) grade (LAG) . _ ft,(m) ~~.
r,J g) Highest adjacent (finished) grade (HAG) . _ ft.(m) ~ ,/~. .. ~
u h) No, of permanent openings (flood vents) within 1 ft, above adjacent grade ~ [) 1 oj \0 ~~I.) ~ \ n \ ~ '"
o i) Total area of all permanent openings (flood vents) in C3,h sq. in, (sq. cm) ~t\e" ,~()Z; e..~'1ct~ \1) ~5(-,.E\.
SECTION D - SURVEYOR,ENGINEER, OR ARCHITECT CERTIFICATION T
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information.
I certify that the information in SeGtions A, B, and C 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.
CERTIFIER'S NAME S(!.If..5 vJ PYl S(J~ LICENSE NUMBER L/z.3a 7
TITLE Lf\~p ~\)f2.,.,,~ot<...- COMPANYNAME\\~\eLi '~tu~e4\V'~ J(~.\ fJ.~
ADDRf~\o,\> h..~~\c..\'~~~\~\\ <:::E \i.\~~ U ,,(;), - \ S~~ \ CPCO~6312-
SIGNATURE Sri ~ DATE _ / _ ~- TELEPHONE I \ -7 ... ....,
.~_ lVJ IU r 1'"\ _ .'" - .t.~ - - GI .' G\~ 4. "'11 - r-';;> D
FEMA Form 81-31, January 2003 "--"'" See reverse side for continuation. Replaces all previous editions
.-ORTANT: In these spaces, copy the corresponding Information from !\ection A.
BUILDJNG STREET ADDRESS (InclUdin~pt., Unit, Suite, an~\ Bldg, Nfl,) OR P .0, RC~UTE AND BOX NO,
t6c..,' 0 b N t'1"I~ ~ -:::ft..~~.
CITY n \ \, STATE ZIP CODE
~\"r.> ~ \'J\N _ 15"6312-
SECTIO~ D _ SURVEYOR, ENGINEER, OR ARCHITE:CT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner.
COMMENTSt\.\__' ~'!:S n~) () rJ (-II .
'\~ ,\~ "t'l....\e.. I"\..lr-.e ~r,,~J o~ ~\\"\\~,^-€"M ~ ~
./ ND -P~oo ~ 'ocw.... ~ ~. ~~~ ..l.,^. .. ~ It 4 \.puCt\..xh~ :t'~
~~_ ~~ ~~ ~\~>t ~ ~k~\I~~ ~ dj\J*,Q ~D~
-t\ Dfl't"' \r..-e..t4 \\.; 4 I I Check here if attachments .
SECTION E..:..B)JILDING ELEVATION INFORMATION (SURVEY NOT REC:lUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zone AO and Zone A (without BFE), complete Items E1, through ES, If the Elevation Certificate is intended for use as supporting
information for a LOMA or LOMR~F, Section C must be completed,
E1, Building Diagram Number (Select the building diagram most similar tel the building for which this certificate is being completed -
see pages 6 and 7. If no diagram accurately represents the building, providl9 a sketch or photograph.)
E2. The top of the bottom floor (including basement or enclosure) of the building is LI_I ft. (m) I I I in. (em) I_I above or I_I below
(check one) the highest adjacent grade. (Use natural grade, if available.)
E3. For Building Diagrams &-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is
I_LI ft. (m) 1_1_lin. (cm) above the highest adjacent grade. Complete Items C3.h and C3.i on front of form.
E4. The top of the platform of machinery and/or equipment servicing the buildin" is 1_1_1 ft. (m) 1_1_1 in. (cm) I_I above or I_I below
(check one) the highest adjacent grade, (Use natural grade, if available,)
ES, For 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 manaQement ordinance? I I Yes "1 I No ' I 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, C (Items C3.h and C3.i only), and E for Zone A
(without a FEMA-issued or community-issued BFE) or Zone AO must sign here. The statements in Sections A, 8, C, and E are correct to
the best of mv knowledae.
PROPERTY OWNER'S OR OWNER'S-AUTHORIZED REPRESENTATIVE'S NAME
...,F6r.16~l)tanC$.6~mpar&U$~i~,n(
ADDRESS
CITY
STATE
ZIP CODE
SIGNATURE
DATE
TELEPHONE
COMMENTS
I I Check here if attachments
. "
SECTION G - COMMUNITY INFORMATION (OPTIONAL)
The local official who js authorized by law or ordinance to administer the commu nity's floodplain management ordinance can complete
Sections A, B, C (or E}:atId G of this Elevation Certificate. Complete the applicable item(s) and sign below.
G1. I_I The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor,
engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the
elevation data in the Comments area below.)
G2. I_I Acommunity official completed Section E for a building located in Zone A (without a FEMA-issued or community-issued BFE) or
Zone AO.
G3. LI The following information (Items G4-G9) is provided for community floodplain management purposes.
I G4, PERMIT NUMBER I G5, DATE PERMIT ISSUED I G6, DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY
ISSUED
G7. This permit has been issued for: I_I New Construction I_I Substantillllmprovement
G8. Elevation of as-built lowest floor (including basement) of the building is:
G9. BFE or (in Zone AO) depth of flooding at the building site is:
. _ ft. (m) Datum:
. _ ft. (m) Datum:
LOCAL OFFICIAL'S NAME
COMMUNITY NAME
TITLE
TE!_EPHONE
SIGNATURE
DATE
COMMENTS
I Check here if attachments
Replaces all previous editions
FEMA Form 81-31, January 2003
f[
il '
: I i
(Pleu. ~Unr.l U\d~t bottom \
>.DDRESS };' 07 (J C o/v b 0 tV).:
~'W-III,
, LEGAL DESCRIPTIO'!" (olrie~ ~,e only) r i I
I '
,~OT BLOCK A~~10t-l_ ~ - :
I'
~!I
03/14/2005 03:30
5073344811
/, ~ \l'1l1,.
7"
\~
.,. ~.
~.~;l\
I'...
rv1moRs
PAGE 01
3,( +,. oS'
I '~"~
.~\;' ; I ~ ",' ...
"
0.....
'(flnl8-
el,. 'H".,./AH '1,0: 05. ooz~
"H,),,,,nl \ _ .
~
ZON[NG (orTia: we)
PID
- '
(Phone) fs:1. J. 9:1 78 15'\
OWN'ER-"
I
: (N~mc) _
./ffi--n ~J
,) jl . ,I
fJnl ;t, W- -' #J
/II I I ,
I I ,: !
~ __w..
: (Add:tm)
,APPLICANT
I (NameL
...
: I
,
I (Address)
f "f' ':~"
,
I (Contact PClson)
I
, APPLICANT S1GNATURE
TYPE or SYSTEM
OWIIITI\ Air PI:!.l\tS
OGravi~)
, fv1CChI11ICl\ ,
I, ir CMditi(lnlnl ',' j'-
V~nl. ~y,t"." :
: FlREPLA.CE MAKE AND MODEL ~ 'JJ
',d"",,1 C'm~"'" & ~,,,..,""'" - 11-
R ~ Sldentl:\1. Heating &. Ale \.'Jew COnW1Jctton)
ResldcMtlaL Healing Only r'Ncw Construction)
I
rh~)
(City)
.J
(Zip Codoc)
~./
,
,
N\'NO: I tf
- liEA TIN
J SteNTI
:J HOI WI
J Radilli
J Special
:J Ocher C
TE BELOW
T OALTERATlONS ,I
fUEL N~
PUT"/!J. J 11J OUTPUT .};.5' If) l'
,. I
1 POWER PLANT
l I
I
PLEASE NOTE:
Air Conditioner Units
Cannol Encroe.ch mto
Re:quirod Side Yard
Setbac.k$
lIl. a., Fireplac{
S39,~
, .1 Addition, & AltcraLloo$
bl. AC Only
S39 ~O
S39.50
Buill I
~ermil 1/ 05. 0 0 z3
., PAID WITH
, ~LDING PERMIT
./
ESI,mp.ted Cosll,~ ,I ,
HE': ~ NG PERlI'tIT FEE
STA t SURCHI,RGl
TOi 1\ PERM~fr fEE
II
ThiS Appllc3[lon Becomes Your Sulldln I ctrmit "Vh.. Approved
'I
II
D~l. "il
]A houT ", II II ror al~ ltuptdlonl ('52) 1
I
lome! u., O"l}o\
Bulldlr.1! Omc:l.1
ate.,J./tf. oS"
if.. (~m) 447-4245/
~~I
I'Y~~P0:
i,11
(Please lVDe or ~ri.nt and sia;n at bottom)
ADDRESS
'~lO~)roOY\ &rrecl
CITY OF'PIDUk 'LARE . Date Rec'd
HEATING/AIR CONDITIONING/l'U<EPLACE PERMIT OC. J'
~: ~ ~l~ I rEKl'1IT NO.~
J. V.II_ AI'PIiCIIII ~
ZONING (otIiee IJ~)
.IJ
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
=~R ~)illl.O 1(- ~ LeeK
. (Phone)
(Address)
~~;~~ r<.JCClA--r
(Address) lD K1 Si-fA t\o Y\ P k (AJV
(Ad.dte.!S)
(Cont.lct Person) -FM n~LoH,' ~- n. . __' (phon<)
APPLICANT SIGNATURE ~~ ~ DATE 3l f I rzY-
,I APPLICANT PLEASE COMPLETE BELOW
~EW CONSTRUCTION 0 REPLACEMENT 0 ALTERATIONS
FURNACE MAKE AND MOPEL B~ I'<kt~A~t~ FUEL ~.f...~'
FLUE SIZE ~V(' / RET"JRN OPENINGS Cf lNPUTlc;:.DDO OUTPUT 'f.o;r)()Q
TYPE OF SYSTeM HEATING OR POWER PLANT
.. OWann Air Plant~ 0 Steam
o Gravity 0 Hel Water
J;CChlUlical 0 Radiation
Air Conditioning ~ Special Devices ~
ent. System 0 Other Dcvices
, (Phone) "Jl;~-lSLJ.-LtCX'O
~y h~~
(City) (Zip Cede)
PLEASE NOTE:
Air Conditioner Units
Cannot Encroach into
Required Side Yard
Setbacks
FIREPLACE MAKE AND MODEL
R.esidential, Heating & AIC (New Constroction)
Residential. Heating Only (New Construction)
.I' J!.,I!. SCHEDULE
I % of job cost Residential, Gas Fireplace
$39.50 minimum
$99.50 Residential, Additions &. Alterations
$64..50 Residential, AC Only
$39.50
$39.50
$39.50
Industrial. Commercial & Multi-Family
Estimated Cost $
Building Pennie #
HEATING PElU'v1IT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
'r:AID ~:.~":".~
.50j,~ t':~',,,:<.r.:!.. ......t'.t,;.
"'~.~~~ '\ '--. ,. ,
(Office Un Only)
r::-::--~"-"--~""-'--~-'--
Tbis Application Becomes Your Building Permit Wben Approved i }3aid
Receipt No.
Buildln~ Official
DlI.tf
~t1v 1 5 2004
By
24 hour notice (or all inspeetions (952) 44'7~9gS0, (n (952) 447-4245
04/22/2005 08:38
9522245092
LLO'lD EXCA V A T n,jG me
PAGE 01
--i -.
~ , P/l.: D~""
f(/'\' '~~\
l..,) \ ~ v
~i~~
<"NN..i Y
~~,
-/ -
~. '/?'I/U~
... , ...,
TIIUoOW . .....ICAIf\"
dOlO. err.
II'
J ,., "''''''''''''''''''", "',' ""','1'" """": "~3
s.w.No,_5
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
~{OTE :
Sewer and Water
contractorsmU$t
be reqisterad
with thQ city.
APPJ:.: CANT: t/oYd t:tc:;, ~c.....
.. - -'"
ADOn:! 38; ffi /lJ duff (,,;.. , \, JtIVAA,,,,.
SIGtfi! rURE:~ ~
SITE: \DDRESS; ,707 (J Und on fr
PHONE: cr.o,oJ.)y,-,j'"U'10
m,J5UJ~ DA'l'E: 0~d-{)_r
BuOG. PERl'HT #
.--.-
, _PI01/:
F! LL IN THE BLANKS
1." I! ;timated length of water service LtD
feet.
2. 8 ~ze of water service
l"
inch(es) .
~~..,.s:L
line
frol1\ structure
PVC_ j Cast Iron
rJL~feet .
'~
~
feet.
J.
4.
I. lcation Of any couplings
5.
'1' 'PQ of sewer pipe.
~ :timat~d longth ef
ABS
E..
c: ean out
S ,ructure.
(if
required) ,
located
at
feet
from
:"._~=;;t: '=:::=~=:;;:''IlJI!I'''E!!==~':!!=::::.=..nl:QII__e=---:::l8_lII!'=='===D:''''''_=.:::2i:::D:::.a..::-::!:!!=::::::=='Z'~::BP=~-"
Thi~ " pplication b~comes your PQrmit when approved.
ax
DATE:
~.'1,'_~:.o:::'!e: ~ ..~'=:D==::~::::.::::IDI!..t::::=~:::t~:.'!':::Ia=_...,.:::.=::::;==~=_.IZIZ=~ =Z:"UC::%___'J:= ==-c== !:!::c: =..,etr =
,"'C::;ES:
$
$
$
::35.00
.50
35.50
Sawer and water line cono&ction pF.rmit.
Surcharge
TOTAL
."
r'i ~ for either sewer or \.later individually is ~..6liJ phIS
!) - 50 surcharge..
i.,! "rer and 111&, tar perm I,. ts, - i~,5ued tor new construction must be
rl; :::?:tde.d on th&Puildinf/p,erJ\lit card at th,e tiJl1lil of ~s5uance
t~( J.nsure that no dupllCZl. te SQwer and water pernll. ts c.1l;e.
i:, 3ued. APR 2 8 2005 I
."
DATE I; U,D
l<ECEH r ~
AMOUNT PAID
R~C/D ~y
PAIO-wmi
BUILDING PERMIT
16200 Eaglr: Creek. Av. S.E., Pri<lr I...alc.e, Minnesota SS312/ Ph. (612) 447-42'30 I FAX (612) 447-4245
An Equal Opp<lt'Ul\1ity Employer
PRIOR LAKE
INSPECTION RECORD
SITE ADDRESS .ft'?tJ ~~()~/4J Srz.r .s-:6....
NATURE OF WORK HE ~Alsrl&U:c';~
USE OF BUILDING S:!=': I) . A
PERMIT NO. OS. 00.23 DATE ISSUED 11/ ';I-; "I .
CONTRACTOR HANlrlLHutl'r dAle, POONE -W4- ~d,,1
NOTE: THIS IS NOT A PERMIT FOR ANY OF THE INSPECl'ONS BELOW
. THE P~RMIT IS B.Y ~EPARATE DO:~::~~ ~ ~~ om
FOOTING t.d. ;liJ 111// () 11'1/ \ ).4 iI:) 1 \ I
FOUNDATION (Prior to Backfill) I I
PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
ROUGH - INS
SEWER I WATER I SEPTIC
FRAMING iLl f~ t: ,I.(-{,"
INSULATION
ELECTRICAL
PLUMBING Ou.A~l,\ I 1/'If/1.--'S'v,; f."IL~
HEATING (if required) tv,t? t.-,f" l.15-~'
FIREPLACE
GAS LINE AIR TEST
DEPJ'.RTMENT OF
BUILDING AND INSPECTION
I~
//1$
()lK+ rV(/ WI
v)./f ~
1'-' j ~-VJ
?r"' j.., S 't/5
I
I
I
I
I
f1-tt)vlJ{,
5-1.-r-I')'
.cOVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
LA'l1f6/--11olArE /I)(lAI' I i/\/1;/ I i\. 1Lif5
FINALS rV'
, GRADING (Prior to Sodding) \J V
BUILDING 1'...w.(7,)Af,~ lO.-(--qj
ELECTRICAL I
PLUMBING
HEATING
DO NOT
\~.~ .ul,
/7
vVV/
f/VJ/7
OCCUpy UNTIL ABOVE HAS
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.
7--7-rJs
7--?-c.l('
BEEN SIGNED
FOR ALL INSPECTIONS (952) 447-9850