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HomeMy WebLinkAboutBuilding Permit 13. 1339 J W Z I � F J E LL ' W Z W W < ` Z W `l 2 W < 02W 111 in " Z 0 ViZ < • Z i ` co � orz M o W III et 0 ,_ _N O » < m c O 0 J Z Y Y Z Z G U w -I I- 2 0 OOt9 < O d a t S , Z ce Z — = = Z — W fn C U % O w mZZW�!�JmW ,1 a A Z C. co U d n0I3M0 0 0 Z F- C JW < JW W WW X Lt. a23wa2 .1. v v i 000000 ■1 i o o w "" J J a a LL In0 0 1:( I%k.. 1/.64 1 I- leU M Z . V • Y a 11 g0 ° al . uco � � � Sy 0Z0 O z W H - < �n oC � Z 0 < z 'Q uai Z y 0 o a° N z ZpZJJZ W Y W Ill `o < q I w W w 0012gire re CC 1- w D O uUu0 �Z�` N v C� b 5Z 4 0 a 0000 ®,❑ C) V, ❑ 0 -` ,y C�rrftfttaf of ®r prnx r CITY OF PRIOR LAKE K Prjaaritttrtif of pttilbitt cIn prtfiti K ! 'n--Final Permitted ❑ Conditional C.O. Expires , , This Certificate issued pursuant to the requirements of Section 110 of the❑Residential l❑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: 's� S/lv Ci L& Pie/Pi/LA/ Bldg.Permit No. i' - 133 7 Use Classification 7 '/ �r - .› Occupancy Type f - Type Construction Y� Zoning District E /SO Legal Description L/ 4-f tj 6 LIL) VS// /c'�tIA/0 / 354 W'/6. S /„r Owner of Building .1 / Site Address /1 �� ��y (moi a�rdress -13, Y► 0 U0 Pi ?/tJ.�C... J^ tZ2C—. -/F-! J 1-- ;4 1.) 0 g=1 ,_ _ ,,,...,. :•(''' g t'l la R r 113 -2, E 'ki . 1,4, ti Ik-1 -4 4 ; pj 3 j 19._s^� ` = idQ kn rn Ea ❑ ❑ ❑❑ ❑❑ J rev mo I 1 Q2.d .-1-,e_44?-... 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Pink city PERMIT NO./2 3.Yellow Applicant I ilimil (Please type or print an sign at bottom) ADDRESS / / ZONING(office use) XXXXX Waters Edge Trail, Prior Lake, MN 55372 1.5h LEGAL DESCRIPTION(office use only) LOT 14 BLOCK ADDITION Boudin's Manor PID a5 -//g- ©ft - b OWNER (Name) Jason Miskowic (Phone) (Address) BUILDER (Company Name) JB Woodfitter&Associates, LLC (Phone) 952-447-0850 (Contact Name) Joe Tupy- 612-791-9025/ Jake Tupy - (Phone) 612-363-560 (Address) P.O. Box 1028 Prior Lake, MN 55372 TYPE OF WORK [ANew Construction ['Deck ['Porch ORe-Roofing ❑Re-Siding ['Lower Level Finish 0 Fireplace ['Addition ['Alteration ❑Utility Connection CODE: A.R.C. ❑I.B.C. 0 Misc: Type of Construction: I II III IV V AB Occupancy Group: A B E F H I M R S U PROJECT COST/VALUE $ 315,000.00 Division: 1 2 3 4 5 (excluding land) I hereby certify that I have furnished information on this application which is to the best of my knowledge true and correct. I also certify that I am the owner or authorized agent for the above-mentioned property and that all construction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the building official cane e .... .- -: v st cause. Furthermore,I hereby agree that the city official or a designee may enter upon the property to perform needed inspections. x Jr" - 1.13 N BC032109 9/4/2013 Signature Contractor's License No. Date Permit Valuation F/5-e p ! Park Support Fee # $ ____—, Permit Fee $ a.'343, 5--c SAC # $ i[3 S o o Plan Check Fee $ / 5-23. 23 Water Meter Size 5/8" 1"; $ ,5-,,,,7, 0 0 State Surcharge $ /57-50 Pressure Reducer $ /50. 00 Penalty $ - Sewer/Water Connection Fee # $ Plumbing Permit Fee $ /5/{ S-0 Water Tower Fee # $ /OOP)•i 0 Mechanical Permit Fee $ /5-zi, ,s---e), Builder's Deposit $ 572 0 Sewer&Water Permit Fee $ 5 • s--0 Other $ - Gas Fireplace Permit Fee $ 534 S C) TOTAL D13,4 e /Z.3(?PtNo. $ , /_/meq. (?4 Thus Ap•F cation •/ o,, s Your Building Permit Whe Ap ved Paid /2 G/%- 2-/ OI ., _.iiiLeagAdaraw,_ 12 3 /� Date /Z� s' 3 ddd Building Official Date This is to certify that the request in the above application and accompanying documents is'n accordance with the City Zoning Ordinance and may proceed as requested. This document when signed by the City Planne constitutes a temporary Certificate of Zoning co,•lian• and allows construction to commence. Before occupancy,a Certificate of Occupancy must be issued. t?�� (Z 3 P ing Director Sate Special Conditions,a any 24 hour notice for all inspections(952)447-9850,fax(952)447-4245 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372 ,.. . r410.# . . Builders Dept. : , r 44.4zontso , City of Prior Lake A$1,500.00 Builders Monett is included in the Building Permit fee. The Builders Deposit is issued as security to Insure compliance for a Final,Occupancy permit (it is not an escrow Account.)All exterior items including but not hauled to grading,sodding,landscaping,tree planting,driveways,siding and painting shall be completed 180 days after the date the building permit is issued. if the work Is not complete within the 180-day time period, the City shall notify:the apt:leant of the.violation and thivappikant shall have 10 days to comply or the $1,500 00 builders deposit will be forfeited and the applicant will billet:tier clean up Or corrective Work to rectify the situation. A$500;00 Tree Deposit may also be required and wilt be refunded if specified trees are preserved for a period of one year. DATE- .. \ BITE:ADDRESS: . al--ep(5 ' ----(3-e.- -4\--yot 1 PERMIT# /3• /3 , ..wooDfmr..... REFUND TO BE MAILED TO: B or 1D`/Act. .? ‘ : , r i or- 1...otilre. vtN) I 1 •A2I5-0 O,(k) ' 41c.... Lynda S.Allen, r:uilding Services Amount 6th 30 ALI' Acct 801.20204 Date PLEASE ItEMEIVIRER E 1. KEEP STREETS CLEAN DURING CONSTRUCTION 2. KEEPEROSION CONTROL IN PLACE Larry Poppler,City Engineer 3. TEMPORARY OCCUPANCY PERMIT MUST NOT EXPIRE OR$500.00 WILL BE FORFEITED SIGNATURE: ACCOUNT iiiir — d 8\IV ,- --- . , . , 1 1 I NO.801-20204 , , , , RETAINAGE FORFEITURE ACCOUNT NO.32211 AMOUNT:, I AUTHORIZE TO RELEASE: DATE: JAFORMMBUILDEFIS-bEPOtit FORM,Dbe • i .,.. _ Doc. No. A 939907 OFFICE OF THE COUNTY RECORDER SCOTT COUNTY, MINNESOTA Certified Filed and/or Recorded on 07-01-2013 at 03:00 Recpt: 631644 James L. Hentges, County Recorder o� STATE OF MINNESOTA) Fee: $ 46.00 )ss. COUNTY OF SCOTT ) The undersigned, duly qualified and Planner for the City of Prior Lake,hereby certifies the attached hereto is the original true and correct copies of RESOLUTION 13-074 APPROVAL OF VARIANCES FROM THE MINIMUM LAKESHORE STRUCTURE SETBACK, MINIMUM FRONT YARD, MINIMUM SUM OF THE SIDE YARD SEBTACKS, MINIMUM BUILDING SEPARATION, MAXIMUM IMPERVIOUS SURFACE, AND MINIMUM LOT AREA FOR A PROPERTY IN THE R-1 (LOW DENSITY RESIDENTIAL) ZONING DISTRICT • fes/• AGLier ' Jef zke City of Prior Lake Dated thisJO 1.0t'day of June, 2013. 14354 Watersedge Trail NE PID 25-119-010-0 Please return document to: City of Prior Lake Community and Economic Development Department - 4646 Dakota Street SE ' 4' spa> � ,; Prior Lake,MN 55372 • '?'1t1tf!lit: ,'\' 1 06/04/2013 Dear City Council Members: In response to the meeting on 5/28/13 my wife and I have met with the city and are proposing the following changes as requested by the council. • t ' 1. Raise the elevation to a 912.3 where the driveway meets the garage thus allowing the water to from that point to run towards the street. 2. Put a high end maintenance free gutter system on the entire home and control where rain water goes off the house. Run all rain water through the gutters to either the front of the home facing the lake or to the back of the home facing the road thus keeping all runoff from the house off of the side yards. 3. Put a drain tiles in the swales to further control and maintain where the water goes. 4. Put a 100 square foot rain garden in the front right side of the lot along the street. The rain garden could effectively handle all runoff from all impervious house square footage. This will be professionally designed and will look like many other rain gardens in the area. This would comply with water management requirements of 34"of runoff per all impervious surface. 5. Split the house in half and run the runoff from the right side of the home towards the road and rain garden and run the left side of the house towards the lake. Thanks for your time and consideration, Jason and Amanda Miskowic • 4. The variance are hereby approved subject to the following to the following conditions: a) This resolution must be recorded at Scott County within 60 days of adoption. Proof of recording, along with the acknowledged City Assent Form,shall be submitted to the Community&Economic Development Department prior tc the issuance of a building permit b) All mitigation techniques to address the 39% impervious surface approval identified by the applicant in his 6/5/13 letter including raising of the garage elevation,gutter systems, drain tiles, and a rain garden are to be completed prior to issuance of a final certificate of occupancy and maintained to assure operability by the property owner in perpetuity. c) Any trees on adjacent properties that are lost or damaged as a result of the initial house construction (within one year)shall be replaced with at least a three inch(3")diameter tree. d) A shoreline buffer shall be installed near the shore of Prior Lake. The buffer shall be a minimum 20 feel: across the width of the lot and 15 feet deep. A maintenance agreement shall be completed between the property owner and the City of Prior Lake for future maintenance of this buffer feature. 5. The variances are hereby approved on property legally described as follows: Lot 14 BOUDIN'S MANOR,SCOTT COUNTY,MINNESOTA (PID 25-119-010-0). PASSED AND ADOPTED THIS 10th DAY OF JUNE,2013. YS No Hedberg X Hedberg Keeney X Keeney McGuire X McGuire Morton Morton X Soukup X Soukup 9Jf Frank .6,C Manager 3 - :, ,.t.,. - ., .. �. &• +`- ;. a 'yN.at-ter, 01 "(1).0; {„ r U 01White -Building Canary -Engineering �rNNEso�� Pink -Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT %4 ' IJ • /4--)670 j 47 1/4".:- -k..-- APPLICATION RECEIVED /. ( , ,11„x`' The Building, Engineering, and Planning Departments have reviewed the building permit , application for construction activity which is proposed at: // 3-'/ , i / 6 6 7-A--;Ale L. Accepted X Accepted With Corrections Denied Reviewed By: /0 /"T Date: //-.2-‘-/3 Comments: ----_7":;,s 61A oL Cr} v 45 per- o 'or- 1~c G Tnstiu.it _dc,-.o he hr./ ;r r acc orde e, v., i r'eS%rt /3 -09- "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." c• PRIp4 (gf[%\ White -Building yf �� Canary -Engineering "NEso Pink -Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT -' 13 : 40000/47 -/---&-k__, v4s-Oc APPLICATION RECEIVED 67 (a. , I� The Building, Engineering, and Planning Departments have reviewed the building permil: application for construction activity which is proposed at: /11354' r.� rhe 774i L , • Accepted Accepted With Corrections Denied t. Reviewed By: Date: ?/.2.04 Comments: (- frill-r 4(--)/•--) � �© ( ..4*egr C --"i Ac- Al ;nes, II '1 ad, 4/ a" tri PAP/96'5-45aLac- �lL. �V/ (vn/ GtiiV0A-re /# cr /, k A F.'off ..� , ) ' O �ar SC' (11, / ..-.....,,__,,I 4 1 Ar `... " V,g,, v 0_40,4.- - 444- / V7T4V "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." Y / O White -Building Canary -Engineering 41INNESO Pink -Planning BUILDING PERMIT APPLICATION DEPARTMENT CHECKLIST NAME OF APPLICANT U; itz)©cl `- ��' `-�-' v ACYO C APPLICATION RECEIVED C/. (©, is The Building, Engineering, and Planning Departments have reviewed the building permit application for construction activity which is proposed at: /I/35 VQkir-C "--0/ye Accepted Accepted With Corrections Denied Reviewed By: "46 Date: / /3 Comments: See Reverse Side for Additional Information! �ervi c a I A di,In y /eevfr{ f rrJ ,4$ C See Attachments: 1) Grading Plan, 2) Erosion Control Standards "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." DEPARTMENT OF HOMELAND SECURITY-FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B.ND,1660-0015 PROPERTY INFORMATION FORM Expires February 28,2014 mew PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden for this data collection is estimated to average 1,63 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data sources,gathering and maintaining the needed data,and completing and submitting the form.This collection is required to obtain or retain • benefits. You are not required to respond to this collection of information unless a valid OMB control number is displayed on this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing this burden to:Information Collections Management,Department of Homeland Security,Federal Emergency Management Agency,1800 South Bell Street,Arlington,VA 20598-3005,Paperwork Reduction Project(1660-0015). NOTE:Do not send your completed form to this address. This form may be completed by the property owner,property owner's agent,licensed land surveyor,or registered professional engineer to support a request for a Letter of Map Amendment(LOMA),Conditional Letter of Map Amendment(CLOMA),Letter of Map Revision Based on Fill(LOMR-F),or Conditional Letter of Map Revision Based on Fill(CLOMR-F)for existing or proposed,single or multiple lots/structures. In order to process your request,all information on this form must be completed In its entirety,unless stated as optional. Incomplete submissions will result In processing delays. Please check the item below that describes your request: ❑ LOMA A letter from DHS-FEMA stating that anexisting structure or parcel of land that has not been elevated by fill(natural grade)would not be inundated by the base flood. ❑ CLOMA A letter from DHS-FEMA stating that a proposed structure that is not to be elevated by fill(natural grade)would not be inundated by the base flood if built as proposed, LOMR-F A letter from DHS-FEMA stating that an existing structure or parcel of land that has been elevated by fill would not be inundated by the base flood. A letter from DHS-FEMA stating that a parcel of land or proposed structure that will be elevated by Iill ❑ CLOMR-F would not be inundated by the base flood if fill is placed on the parcel as proposed or the structure is built as proposed. Fill is defined as material from any source(including the subject property)placed that raises the ground to or above the Base Flood Elevation(BFE).The common construction practice of removing unsuitable existing material(topsoil)and backfilling with select structural material Is not considered the placement of fill if the practice does not alter the existing(natural grade)elevation,which is at or above the BFE.Fill that Is placed before the date of the first National Flood Insurance Program(NFIP)map showing the area in a Special Flood Hazard Area(SFHA)is considered natural grade. Has fill been placed on your property to raise ground that was previously below the BFE? JZ Yes ❑ No If yes,when was fill placed? ay.„. / ti- month/year Will fill be placed on your property to raise ground that is below the BFE? ❑ Yes* ❑ No If yes,when will fill be placed? / month/year If yes,Endangered Species Act(ESA)compliance must be documented to FEMA prior to issuance of the CLOMR-F determination(please refer page 4 to the MT-1 instructions). 1. Street Address of the Property(if request is for multiple structures or units,please attach additional sheet referencing each address and enter street names below): 14354 L a4. VS Edge Tra P Ni.NJ Ss;72- 2. Legal description of Property(Lot,Block,Subdivision or abbreviated description�I �from the Deed): l-o'�• l4 ) 6OVOtnits n.t�.pNlOR. 5c.o--1- Couw}y, .r1/41 3. Are you requesting that a flood zone determination be completed for(check one): Structures on the property? What are the dates of construction? 07/2.0 14 (MM/YYYY) ❑ A portion of land within the bounds of the property?(A certified metes and bounds description and map of the area to be removed,certified by a licensed land surveyor or registered professional engineer,are required.For the preferred format of metes and bounds descriptions,please refer to the,MT-1 Form 1 Instructions.) ❑ The entire legally recorded property? 4. Is this reqiat for a(check one): Single structure ❑ Single lot ❑ Multiple structures(How many structures are involved in your request?List the number: ) ❑ Multiple lots(How many lots are involved in your request?List the number DHS•FEMA Form 086.0.26,FEB 11 Property Information Form MT..1 Form 1 Papa 1 of 2 In addition to this form(MT-1 Form 1),please complete the checklist below, ALL requests must include one copy of the following: ❑ Copy of the effective FIRM panel on which the structure and/or property location has been accurately plotted(property inadvertently located in the NFIP regulatory floodway will require Section B of MT-i Form 3) ❑ Copy of the Subdivision Plat Map for the property(with recordation data and stamp of the Recorder's Office) OR Copy of the Property Deed(with recordation data and stamp of the Recorder's Office),accompanied by a tax assessor's map or other certified map showing the surveyed location of the property relative to local streets and watercourses. The map should include at least one street intersection that is shown on the FIRM panel. Form 2—Elevation Form, If the request is to remove the structure,and an Elevation Certificate has already been completed for this property,it may be submitted in lieu of Form 2. If the request is to remove the entire legally recorded property,or a portion thereof,the lowest lot elevation must be provided on Form 2. et Id k.Please include a map scale and North arrow on all maps submitted, See Fv.ua e 4 col-- Ara Ws 515 l(_ co •e For LOMR-Fs and CLOMR-Fs,the following must be submitted in addition to the items listed above: Ig Form 3 Community Acknowledgment Form For CLOMR-Fs,the following must be submitted in addition to the items listed above: ❑Documented ESA compliance,which may include a copy of an Incidental Take Permit,an Incidental Take Statement,a"not likely to adversely affect" determination from the National Marine Fisheries Service(NMFS)or the U.S.Fish and Wildlife Service(USFWS),or an official letter from NMFS or USFWS concurring that the project has"No Effect"on proposed or listed species or designated critical habitat,Please refer to the MT-1 instructions for additional information, Please do not submit original documents. Please retain a copy of all submitted documents for your records. DHS-FEMA encourages the submission of all required data in a digital format(mg.scanned documents and images on Compact Disc(CD)). Digital submissions help to further DHS-FEMA's Digital Vision and also may facilitate the processing of your request. Incomplete submissions will result In processing delays.For additional information regarding this form,including where to obtain the supporting documents listed above,please refer to the MTh Form Instructions located at http://www,fema.gov/pian/prevent/fhrn/dl mt-1,shtrn, Processing Fee(see instructions for appropriate mailing address;or visit http://www.fema,gov/fhm/frrn fees.shtm for the most current fee schedule) Revised fee schedules are published periodically,but no more than once annually,as noted in the Federal Register. Please note: single/multiple lot(s)/structure(s)LOMAs are fee exempt. The current review and processing fees are listed below: Check the fee that applies to your request: ❑$325(single lot/structure LOMR-F following s CLOMR-F) $425(single lot/structure LOMR-F) ❑$500(single lot/structure CLOMA or CLOMR-F) ❑$700(multiple lot/structure LOMR-F following a CLOMR-F,or multiple lot/structure CLOMA) $800(multiple lot/structure LOMR-F or CLOMR-F) Please submit the Payment Information Form for remittance of applicable fees, Please make your check or money order payable to: National Flood Insurance Program. All documents submitted In support of this request are correct to the best of my knowledge, I understand that any false statement may be punishable by fine or imprisonment under Title 18 of the United States Code,Section 1001. Applicant's Name(required): Company(if applicable): Mailing Address(required): Daytime Telephone No.(required): E-Mail Address(optional):❑By checking here you may receive Fax No,(optional): correspondence electronically at the email address provided): Date(required) Signature of Applicant(required) DHS-FEMA Form 086-0.28,FEB 11 Property Information Form MT"1 Form 1 Page 2 of 2 DEPARTMENT OF HOMELAND SECURITY-FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B.NO.1660-0015 ELEVATION FORM Expires February 28,2014I PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden for this data collection is estimated to average 1.25 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data sources,gathering and maintaining the needed data,and completing and submitting the form. This collection is required to obtain or retain benefits. You are not required to respond to this collection of Information unless a valid OMB control number is displayed on this form. Send comments regarding rhe accuracy of the burden estimate and any suggestions for reducing this burden to:Information Collections Management,Department of Homeland Security,Federal Emergency Management Agency,1800 South Bell Street,Arlington,VA 20598-3005,Paperwork Reduction Project(1660-0015). NOTE:Do not send your completed form to this address. This form must be completed for requests and must be completed and signed by a registered professional engineer or licensed land surveyor. A DHS-FEMA National Flood Insurance Program(NFIP)Elevation Certificate may be submitted In lieu of this form for single structure requests. For requests to remove a structure on natural grade OR on engineered fill from the Special Flood Hazard Area(SFHA),submit the lowest adjacent grade(the lowest ground touching the structure),including an attached deck or garage.For requests to remove an entire parcel of land from the SFHA,provide the lowest lot elevation; or,if the request involves an area described by metes and bounds,provide the lowest elevation within the metes and bounds description.All measurements are to to rounded to nearest tenth of a foot. In order to process your request,all information on this form must be completed in its entirety. Incomplete submissions will result in processing delays. 1. NFIP Community Number: Property Name or Address: 14-35.4 u..)ct...2.vs Ec{EEj t Tra I 1 Z70432. Qatnei 0002 2. Are the elevations listed below based on gexistin g or 0 proposedPy i or- La�-t 1 I1/4.) SSS 3 7 Z conditions? (Check one) 3. For the existing or propose structures listed below,what are the types of construction? (check all that apply) 0 crawl space slab on grade 0 basement/enclosure 0 other(explain) 4. Has OHS-FEMA identified this area as subject to land subsidence or uplift?(see instructions) 0 Yes ,No If yes,what is the date of the current re-leveling? / (month/year) 5. What is the elevation datum/ NGVD 29 0 NAVD 88 0 Other(explain) If any of the elevations listed elow were computed using a datum different than the datum used for the effective Flood Insurance Rate Map (FIRM)(e.g.,NGVD 29 or NAVD 88),what was the conversion factor? Local Elevation+/-ft.=FIRM Datum 6. Please provide the Latitude and Longitude of the most upstream edge of the structure(in decimal degrees to the nearest fifth decimal place): Indicate Datum: WGS84 0 NAD83 0 NAD27 Lat.44.74l44Long. -93.3'758 Please provide the Latitude and Longitud o the most upstream edge of the property(in decimal degrees to the nearest fifth decimal place): Indicate Datum: WGS84 0 NAD83 0 NAD27 Lat.44 *74.237Long.—93, 3€'777 - Lowest Address Lot Number Block Lowest Lot Adjacent Base Flood Number Elevation* Grade To Elevation BEE Source Structure t 354 uJn{,etrs cd�eTr. t4 -- , 90z*(a 909.6 90'1 t•1GVD9Z°1 M) (FI R This certification is to be signed and sealed by a licensed land surveyor,registered professional engineer,or architect authorized by law to certify elevation information,All documents submitted in support of this request are correct to the best of my knowledge. I understand that any false statement may be punishable by fine or imprisonment under Title 18 of the United States Code,Section 1001. Ctrtifier s Name: License No.: ��ss ell P. cli w.o l9 D 6� expiration Dare: Sutn e_ 3o 20140 Company Name:Proelephone No.: / �Oe .I int�elr:uta3 CoCtip.*y .- 432-3loo Email• Fax No. YUsid Q__roklee einc�i v.eetr„ , CCM., qSL-432- 3723 l . Signature: Date: 7 10 - lt *For requests involving a portion of property,Include the lowest ground elevation within the metes and bounds description, Seal(optional) Please note:If the Lowest Adjacent Grade to Structure is the only elevation provided,a determination will be issued for the structure only. / DHS-FEMA Form 088-0.2BA,FEB 11 Elevation Form MT-1 Form 2 Pape 1 of 2 Pale 2. - 1,3A DEPARTMENT OF HOMELAND SECURITY-FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B.NO.1660-0015 COMMUNITY ACKNOWLEDGMENT FORM Expires February 24 2014 ow PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden for this data collection is estimated to average 1.38 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data sources,gathering and maintaining the needed data,and completing and submitting the form,This collection is required to obtain or retain benefits. You are not required to respond to this collection of information unless a valid OMB control number is displayed on this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing this burden to:Information Collections Management,Department of Homeland Security, Federal Emergency Management Agency,1800 South Bell Street,Arlington,VA 20598-3005,Paperwork Reduction Project(1660.0015). NOTE:Do not send your completed form to this address. This form must be completed for requests involving the existing or proposed placement of fill(complete Section A)OR to provide acknowledgment of this request to remove a property from the SFHA which was previously located within the regulatory floodway(complete Section B). This form must be completed and signed by the official responsible for floodplain management in the community. The six digit NFIP community number and the subject property address must appear in the spaces provided below. Incomplete submissions will result in processing delays.Please refer to the MT-1 instructions for additional information about this form, Community Number: V TD 43 Z. Property Name or Address: 14354 W a.�QV S rG f "bra!I A. REQUESTS INVOLVING THE PLACEMENT OF FILL As the community official responsible for floodplain management,I hereby acknowledge that we have received andreviewed this Letter of Map Revision Based on Fill(LOMR-F)or Conditional LOMR-F request. Based upon the community's review,we find the completed or proposed project meets or is designed to meet all of the community floodplain management requirements,including the requirement that no fill be placed in the regulatory floodway,and that all necessary Federal,State,and local permits have been,or in the case of a Conditional LOMR-F,will be obtained. For Conditional LOMR-F requests,the applicant has or will document Endangered Species Act(ESA)compliance to FEMA prior to issuance of the Conditional LOMR-F determination.For LOMR-F requests,I acknowledge that compliance with Sections 9 and 10 of the ESA has been achieved independently of FEMA's process.Section 9 of the ESA prohibits anyone from"taking"or harming an endangered species. If an action might harm an endangered species,a permit is required from U.S.Fish and Wildlife Service or National.Marine Fisheries Service under Section 10 of the ESA. For actions authorized,funded,or being carried out by Federal or State agencies,documentation from the agency showing its compliance with Section 7(a)(2)of the ESA will be submitted.In addition,we have determined that the land and any existing or proposed structures to be removed from the SFHA are or will be reasonably safe from flooding as defined In 44CFR 65.2(c),and that we have available upon request by DHS-FEMA,all analyses and documentation used to make this determination. For LOMR-F requests,we understand that this request is being forwarded to DHS- FEMA for a possible map revision. Community Comments: Community Official's Name and Title: (Please Print or Type) telephone No.: Community.Name: Community Official's Signature: (required) Date: B. PROPERTY LOCATED WITHIN THE REGULATORY FLOODWAY As the community official responsible for floodplain management,I hereby acknowledge that we have received and reviewed this request for a LOMA. We understand that this request is being forwarded to DHS-FEMA to determine if this property has been inadvertently included in the regulatory floodway. We acknowledge that no fill on this property has been or will be placed within the designated regulatory floodway. We find that the completed or proposed project meets or is designed to meet all of the community floodplain management requirements. Community Comments: Community Official's Name and Title: (Please Print or Type) Telephone No.: Community Name: Community Official's Signature(required): Date: DH8-FEMA Form 086-0.268,FEB 11 Community Acknowledgment Form MT-1 Form 3 Page 1 of 1 CITY OF PRIOR LAKE Impervious Surface Calculations (To be Submitted with Building Permit Application) For All Properties Located in the Shoreland District (SD). The Maximum Impervious Surface Coverage Permitted in 30 Percent. Property Address ghirM 6 t' ��%G �Co?/¢ haah 'S%doh Lot Area 4 12- Sq. Feet x 30% _ ************************************************************************ LENGTH WIDTH SQ. FEET HOUSE x = x = ATTACHED GARAGE x = TOTAL PRINCIPLE STRUCTURE ipe 6 DETACHED BLDGS x (Garage/Shed) X TOTAL DETACHED BUILDINGS /6/X1 DRIVEWAY/PAVED AREAS x = (Driveway-paved or not) x = (Sidewalk/Parking Areas) X = TOTAL PAVED AREAS 0/2/E' qbiz'-R PATIOS/PORCHES/DECKS x = (Open Decks''/4"min.opening between X = boards,with a pervious surface below, are not considered to be impervious) X = TOTAL DECKS /24/(-E// OTHER x = X = TOTAL OTHER /0) TOTAL IMPERVIOUS SURFACE ZZS UNDE OV Prepared By Date // -/? Company ,4/1)6.e..__ Phone # ¢32-3e oc_D I i . CITY OF PRIOR LAKE Date Rec'd • ;= ?Rio _ HEATING/AIR CONDITIONING/FIREPLACE PERMIT LLL .`'9 `3`.1 %i►t1 .fir. 1 dr ptt` I.Pink Ph PERMIT NO jNNES 2.Qua cuy • d.Yellow Applicant (Please type or print an 'gn at bottom) ADDRESS • ZONING(office use) 1 I ako1 Ece f, L J LEGAL DESCRIPTION(office use only) LOT BLOCK ADDITION PID {Nam .-.5-, (Phone) L ` Z 3103 >4c0 (Address) r-P0'0 b <C4-11110 p at-A .t ) SC-3—?2' APPLICANT (Name) . . ., . .et u . t •LI ES(Phone) . dba FIRESIDE HEARTH &HOME (Address) LIC IACA6?656 (Add"2900 FAIRVIEW AVENUE N (City) (Zip Code) (Contact Person) ROSEVILLE; MN 55113 (Phone) • 651.633.2561 Q APPLICANT SIGNATURE DATE J Z APPLICANT PLEASE COMPLETE BELOW EW CONSTRUCTION 0 REPLACEMENT ❑ALTERATIONS • FURNACE MAKE AND-M` DEL FUEL FLUE SIZE RETURN OPENINGS INPUT OUTPUT TYPE OF SYSTEM HEATING OR POWER PLANT • PLEASE NOTE: Air Conditioner ❑Warm Air Plants 0 Steam Units and Fireplaces Cannot Encroach ■Gravity ❑Hot Water into Required Side Yard Setbacks. .----iii ical ❑Radiation Fireplaces with Box Additions or i Air Conditioning 0 Special Devices ❑Vent.System ❑Other Devices Cantilevers to the Outside of Buildings �S�7i6_ ,�,/ Require a Building Permit. FIREPLACE MAKE AND MODEL / FEE SCHEDULE Industrial,Commercial&Multi-Family I%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,Healing Only(New Construction) $64,50 Residential,AC Only $49.50 • Estimated Cost$ A L ` Building Permit # • lie Mims totes**'32611.148 HEATING PERMIT FEB $ "5 C1 l G een changed for one fictive STATE SURCHARGE $ .5 p v I til June 30, I. ) TOTAL PERMIT FEE $ h It u so •urge f r"f. c"perm it is&it hegImlin• 6 , J (Office Use Only) This Application Becomes Your Building Permit When Approved Paid ii vi Faiill Date 7ciiilkaIIIIIIII Buntline Official Date l 24 hour notice for all inspections(952)447-9850,fax(952)447-4245 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372 04 r Rr04 Date Recd 47 CITY OF PRIOR LAKE PLUMBING PERMIT v Ifilvkasd ' t> -il-k 1r z:a a °, 4(PERMIT NO. 3.Yonas ApplinI (Please type or paint and Apt at bottom)t ADDRESS �1 1 `1 ev.-. i s r --Ty. ZONING(naw.wel { LEGAL DESCRIPTION Niue use only) LOT BLOCK ADDITION PID OWNER (Name) (Phone) JAd ) APPLICANT (Name) C xc r P1t a `c) c WRQ (Phone) CI -a-k--441-034 (Address) \ 51-1$ ks c et. cos S Pr`or Lt 5 5 3 112, (Address) _._ (City) (Zip Code) (Contact Person) .-cc 5c-\l,ef?c` (Phone) (G 12..- 141-3Cll3 APPLICANT SIGNATURE e -/t,t, --*o DATE17-'113\13 APPLICANT PLEASE COMPLETE BELOW Quantic Type of Fixture Quantity Type of Fixture 3 Bath Tub with or without shower Rough-ins kDishwasher 1 Water Heater t Floor Drain Water Softener Co Lavatory(Bathroom Sink) I Stand Pipe(Washing Machine) 1 Laundry Tray(I or 2 compartment sink Sewage Ejector 1.-' Shower Stall Backflow Assembly t Sinks Backflow Assembly Test Bar Sink Lawn Sprinkler 4 Water Closet(Toilet) F Other FEE SCEIEDULE 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 326F1.148tst $ Building Permit#_ __ Tho Minnesota Statutes g 320le "SURCHARGE"has been changed for one FA i D 5 l/l/1 T year effective PL I :ING PERMIT FEE $ "_ a�. July l,2010,nntilJune 30,2011. : ATE SURCHARGE $ ; „C'Y� :�- ei a to l+'4 ;"_ The minimum!combine rare"fized fee"permi TOTAL PERMIT FEE -- h&j.beginning July 1,2010 This Application Becomes Your Building Permit When Approved Paid Receipt No. Date By Readiest OfficialDate 24 hour notice for all inspections(952)447-9550,fax(952)447-4245 4646 Dakota Street ST.,Prior Lake,Minnesota 55372 Date Rec'd /lo(. CITY OF PRIOR LAKE t.,,, A ik et SEWER AND WATER PERMIT U `21l , ., y' NNE. . Gree . 2. Yellon File PERMIT NOw City 1 • l r' 3. Gold Applicant 1 (Please type or print and sign at bottom) ADDRESS ZONING(office we) €uf 35 L-- U3 caus i-Ay- . [ vim•-;- , Kl LEGAL DESCRIPTION(office use only) LOT t 4 BLOCK ADDITION RO(A i l'i 1.< Fl cU't °" PID OWNER -e, ; , .,r• - it (Name) "-i (,t Dth c.-+- i i, l C. H i. .i.:LaL...'tt• (Phone) (Address) (Address) (City) (Zip Code) APPLICANT ll j T7 (Name) `t U.J� , 1 Pitt l l i>7 RCo(Phone) _3) ' T . j� ' I t (Address) l C U . /_ _ ^ . c�?v2.- S•t-0_ la, ' L3.Yl. 5535a. �t _ (Addx s C) (City) C 1 (Zip Code) (Contact Person) ax I•�.-- l i i,1 (Phone) (i?1 a - f I q 64a, APPLICANT SIGNATURE DATE APPLICANT PLEASE COMPLETE BELOW . Size of water service t inches. Location of any couplings from structurefeet. Type of sewer pipe. ❑ABC Q PVC ❑ Cast Iron Estimated length of sewer line 50 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# SEWER AND WATER PERMIT FEE $ STATE SURCHARGE $ .50 TOTAL PERMIT FEE $ - (Office Use Only) This Application Becomes Your Building Permit When Approved Paid PiT BUILDING PERMIT 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 4rRrp� • CITY OF PRIOR LAKE Date Rec'd HEATING/AII2 CONDITIONING/FIREPLACE PERMIT Z` 1% .11- . 00 h' ' lvas) 'z' PERMIT NO.1 13,:j 3.Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING(office use) 10354 tk)cui-e t' -1-v- 1 LEGAL DESCRIPTION(office use only) LOT BLOCK ADDITION PID OWNER(Nam0 71.x.` CSC }` '-tic-etr (Phone) -441-H'-'D 0 4 r� (Address) ?C) 'y( i,©L APPLICANT-r; ' (Name) cit 14� i (Phone) Le51_L Z_ Yt� — (Address) 19,35 Ca s I t h Hn (X fl , nit-- 55D0g (Address) (City) (Zip Code) 7 (Contact Person) -1 r Lv f 1 (Phone) t--1-0-3- 5 os I iltilk�41 . It 0,..d ._4 DATE APPLICANT SIGNATURE ,..r_______._... __�.__ A APPLICANT PLEASE COMPLETE BELOW C EW CONSTRUCTION ❑REPLACEMENT ❑ALTERATIONS p� FURNACE MAKE AND MODEL v1 O[ ill LI qt-N)1- brI(�}' (i6FUEL 1 id 6 FLUE SIZE .9ff RETURN OPENINGS INPUT `W.,DOC) OUTPUT bar il)v _ . TYPE OF SYSTEM . • BEATING•OR POWER PLANT PLEASE NOTE: Air Conditioner ❑Warm Air Plants 0 Steam Units and Fireplaces Cannot Encroach ❑Gravity ' • 0 Hot Water into Required Side Yard Setbacks. 72 echanicai ❑Radiation Fireplaces with Box Additions or ■Air Conditioning 0 Other Devices Special Devices Cantilevers to the Outside of BBuildings[]Vent.System Require a Building Permit. FIREPLACE MAKE AND MODEL FEE SCHEDULE Industrial,Commercial&Multi-Family 1%ofjob 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) $64.50 Residential,AC Only Estimated Cost$ Building Permit # 0 y t D Telo HEATING PERMIT FEE $ STATE SURCHARGE $ .50 TOTAL PERMIT FEE $ • (Office Use On N This Appl ;! I Becomes Your Building Permit When Approved Paid -"'"ik. i i•tNo. Date By • d „ ae f 24 hour notice for all inspections(952)447-9850,fax(952)447-4245 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372 DEPARTMENT OF PRIOR LAKE BUILDING AND INSPECTION INSPECTION RECORD •SITE ADDRESS à4 /ey Epee ?*A I L NATURE OF WORK USE OF BUILDIN/49a-. �/ e e-,e/c/1/ '''Ke h, ,C)61 ; / /'.� W/) 47v) PERMIT NO. DATE ISSUED _ CONTRACTOR Ltr i *ASSOC PHONE ?oz. 414•7 Nob INSTALL EROSION CONRTOL AND MAINTAIN CLEAN STREETS AT ALL TIMES INSPECTOR DATE FOOTING i'}C. (t_24 , FOUNDATION (Prior To Backfill) (1,�,v i-- z- �{al c-, 2-�� ,i/ RADON RETARDER 94 2/rte/f PLACE NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED ROUGH - INS SEWER/WATER/SEPTIC _ 4- /2 "7�3 — FRAMING ,3- FL Fc-A.,.-k- 1I xis N ib 4 ./A,jf — INSULATION — ELECTRICAL — PLUMBING a \ ",\-7 .P1191)4 p. 4 rte' ,r.. ` _ HEATING - '- 7d4' FIREPLACE — GAS LINE AIR TEST 0191-1,t1 15-c<__, 2511lLk _ RADON'S prvr%v16 — COVER NO WORK UNTIL THE ABOVE HAS BEEN SIGNED HOUSEWRAP 4 ({itc( (r( LATH . : C`-`7 1 FINALS GRADING ( PRIOR TO SODDING) - -BUILDING FL MA v ; 6. TZ, e/16 � ELECTRIC AL Af4 — PLUMBING ?II: JHI — — HEATING a IP & DO NOT OCCUPY UNTIL ABOVE HAS BEEN SIGNED NOTICE This card must be posted near an electrical service cabinet prior to rough-in inspections and maintained until 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