562 77th St WAddress :562 77TH gTREET WEST Lot g Blk 2 Sec/Sub ? ?AK HILLS IST
These items were/were not complete at the time of the final inspection.
Date: 8 28 92 Yes No (,(f
Final grade (b" from siding)
Permanent steps - garage
Permanent steps - main entry
Permanent driveway ?
Permanent gas ?
Sod/seeded grass v
Trail/curb damage
Porch
Basement finish ?
Deck ?
Please verify with the builder the removal of :roof test caps from tha plumbing'
system and the shut-off of water supply to the outside lawn faucet before
freeze potential exists. m
vx-9
?tcracowu
White - City copy Yellow - Resident copy Pink:- Contractor copy
? INSI'`ECTIOI? ?? ? ?
? "'CI'rY OF EAGAN PERMIT TYPE: BuTILnTH'A
? 3830 Pilot Knob Road Permit lVumber: 000764
Eagan, Minnesota 55123 Date lssued:
(612) 681-4675
" SITE ADDRESS: LOT; 9 "t r,?CKh APPLICANT:
Irrw ST W PEDERSON HaMES twc
I.ST 423-3086
,.
? PERMIT:SUBTYPE: TYPE fJF WORK:
Sf Dw14
;
`
f 00 11 ra (:? ?? RANIHQ
r14"t tl tA r rON FtNAL
r r r R t. 11 o A C f
? CIN A R C S . R 1: ??: Ef P t ? SW P1, 0RA ? `
.? .
Permit No. PermYt Holder Date Telephone #
SI41V '
PLUMBING
HVAC
EtEcTRic
ELECTR#C
inspection Date lnap. Commer?ts
Foot" 1
a
Foundacio,
Framing aZ-
R60fin9
Rou9n Pt»9•
Rough Htg.
[S,l.
Fir?Jace
! f7? 41
''G
Final Htg. ?/ qZ
GG• d ? ?'u S'..z-
n-.?G $Tn • .?t csa ?
Oes&t Test '? "i r? r.= L rrorL- -7 .r pp
Fin?.ai Plbg. Pibg. inspedar - hbtify Piumber
C.onst. Meter 5-- 72
Engr./Plan
Bidg. Final c
Deck Ftg.
Dedc Finai
Well
Pc Disp.
?
?
r
?
r+F[ I
D?
/
0/157?' -/ 9 ?---
,
? . ?
5 5 4 12 W?:& ` ? °v
Request Date
? Fire No. Rough-in Inspection
ired?
? Ready Now di Notify Inspector
Wh
R
d
?
s ? No
75 en
ea
y
1 9 licensed contractor p owner hereby request inspection of above electrical work at:
Job Address (Street, Box or Route No.)
4??47 2 -r'4 ST City
,?? &'gA1
Section No. Township Name or No. Range Na County l& 111-4.
OccuNT? )
C?h ?`
??
vrrc.v'z? Ph
o?
?? ? ??? .
Power Supplier
r4 /16D752- ,F/,z o7`?e` Address
Electricat Contractor (Company Name)
CD Contractor's License. Na . ...
G t;7
Mailing dd ss (CoMractor or OwnerMaking Installation) Az
AuXed??nature :ICtra - Owne_Ma I
ns Ilation)
?s ?
Phon mber
?
4?
?
MINNESOTA STATE BOARD O4LECTRICITY . THIS.INSPECTION REQUEST WILI NOT
Griggs-Midway Bldg. - Room S-173 BE ACCEPTED BY THE STATE BOARD
1821 University Ave., St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS
Phone (612) 642-0800 ENCLOSED.
t-9/? REGIUEST FOR ELECTRICAL INSPECTION ?es-ooooi-os? See instructions for completing this form on back of yellow copy. ?
5`? 4 I x? "JC" Below Work Covered by This Request
ew Add Rep. TypeofBuilding AppliancesWired EquipmentWired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Other (Specify)
CommJlndustrial Furnace
Farm Air Conditioner
Other(specify) . Contractor's Remarks: Compqte Inspection Fee Below:
# Other Fee # Service Entrance Size Fee ' # Circuits/Feeders Fee
Swimming Pool 0 to 200 Amps .?? 0 to 100 Amps
Transformers Above 200 Amps Above 100 Amps
SignS Inspector's Use Only: - jQTAL
' Irrigation Booms
Special Inspection
Alarm/Communication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MON HS.
I, the Electrical Inspector, hereby
f Rough-in Date
certi
that the above ins ection has
Y p
been made.
Final
?
ate
OFFICE USE ONLV
7hi5 request void 18 months irom " . . . . .
I ....:,
crrY oF EAGAv
LB?2 ? MECHAhTICAL MOW RECEIPT # C b 1 G't (n ?2?j
: SUBD. A?r,? d- ??? ? (612) 6814675 DATE lE, • d?c, ,c??
RESIDENTIAL
PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMII.Y DWF.i I.ING5. AISO, COMPI.ElM FOR
TOWNHOMES/CONDOS WHEN SEPARATE PF.RI1VITfS ARE REQUIRED FUR EACH DW.ELLING UNTT.
OWNER: Fk,-FS
SITE ADDgWS: r?? ? ADD ON/REMODEL (ERISTING
CONSTRUCTION QNLY) $ 15.00
INSTALLER: HVAC: 4100 M BTtT 24.00
PHONE #: ,',? ADDTTIONAL SQ 1VI BTU 5.00
ADDRESS: GA5 OUTLFTS - MINIMUM 1@ $3 EA?.
CITY: ZIP? J 3q??) SURCHARGE $ .SO
SIGNATUREz ?
TOTAL: 1
$,,27,s-v
'
C
OMMERCIAL
PLEASE GOMPLE,CE THIS PORTION' FOIt ALL COMMERCIAI.,/INDUSTRiAL BUILDINGS. ALSO C4MPLETE FOR
APARTMEATT BUILDINGS OR OTHEIt MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQI7IRED FOR
EACB, DWELLING UNIT.
?
BL ?
1 CITY OF EAGAN GITY USE ONLY
,c-
3 ?
???? PLUMBING PERMIT
c ?I
Co
? SUBI
1u?c___, (612) 6$1-4675 RECEIPT #
DATE Co- aCQ --1a
RESIDENTIAL
PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY'DWELI.INGS. ALSO, FOR TOWNH4MES AND CQNDOS
WHEN PERMITS ARE REQUIRED FQR EACH UNIT.
-
-
-
-
-- .
.
-
-
-
-
-
.
-
-
-
---
------------
-------
WORK DESCRIPTION -_-
--..,..
--
.----
---
----
-
-------------
_----
---
-
--
COMPLETE THE FOLLOWING:
? N0. FIXTURES
. EA. TOTAL
NEW CONST REPAIRjADD ON 15.00
ADD ON SHOWER 3.00 ` ___Jta-6
ItEPAIR WATER CIASET 3.00
BATH TUB 3.00
LAVATORY
? 3.00 ??,?
OWNER NAME: ?-- _ KITCHEN SINK 3.00 3+e?9
"`j
STTE ADDRESS
7 ? LAUNDRY TRAY 3.00 r
:
/ HOT TUB/SPA 3.00
,L WATER HEATER 3:00 ?d
FLOOR 'DRAIN 3.00 -a"
,? ?? (
4a GAS PIPING 4UT.
INSTALLER: -???R'1'? ry 1 ? (MINIMUM - 1-) 3'.00
ROUGH OPENINGS 1.50 -??
ADDRESS : OTHER
. ? .? .-- WATER SOFTENER 5:00
CITY: ZIP: PRIVATE DISP. 15.00
NE
PH
? 3 U.G. SPRINKLER
' 3.00
O
#: TiTRNAROtTND
W. 15.00
STATE SURCHARGE .50
SIGNATURE OF PERMITTEE TOTAL: $ -
C4MISERCIAL
PLEASE COMPLETE THIS PORTION FOR ALL C OMMERCIAL/INDUSTRIAL BUTLDINGS. ALSO FOR MULTZ•FAMILY
BUILDINGS WHEN SEPARATE PERMITB ARE`NOT REQUIRED FOR EACH DWELLING UNIT.
WORK DESCRIPTION:
OWNER NAME:
CONTRACT PRICE:
SITE ADDRESS: 1% OF CflNTRACT FEE, .
STATE SURCHARGE - $.50 FOR
TENANT NAMEi EACH $1,000 OF PERMIT FEE.
SUTTE #: $25.00 MINIMIIM FEE.
INSTALLER: CONTRACT PRICE x 1% $
ADDRESS: STATE SURCHARGE
CITY: ZIP:
TOTAL: $
YHONE #:
FOR:; (SIGNATUkE)
CITY OF EAGAN
? :
CITY OF`EAGAN
? 3830 Pilot Knob Road
? Eagan, Minnesota 55123
(612) 681-4675
SITE ADDRESS:
PERMIT Control No. 5 9 ?
??
PERMITTYPE: e??te.crz?re , _.
Permit Number: 000754
Date lssued: , • 6/! 9/92
5S2 77TH ST W ;
LQ1'r 9 BLQCK t Z
8UR 0l1K HILLS 1ST
I DESCRIPTiON:
Permit Typ•
ork Typ?
? ?? . ae
5 F DMi6
NEW
R-3 M_1
vm
R-i
68
_ 28 .
coftV oF czagan
i REMARKS:
iaG4GIp 1 # C) I 1 2,c' ?i ?.. .. ?, w . . . . .
s&u PLsR.
?
? FEE SUMMARY:
8ase Fee
Plan Revisw
Surchsrg•
SAC
SAG %
SAC Units
lia. Search Fss
Subtotal
YALl1ATIQM $160.00•
$011.b• NISC FEES
=529.43 Totsl Fee
*76.i•
;7rl. 0e
2!•
1
$2,123.93
1.610.6Y
=3,T34.43
....... . . .r... . ... .. ? ?, ?, .. .. w.... .. - ? . . S. . ...... o.. ..
PEDERSOM HQMES INC 14233086 000146 PEDERSON NQMES IMG
3511 143RO ST W 3611 143RD ST W
RQSEMDUMT Mil 55068 ROSEMOUIMT MN 5506$
(612) 423-3086 (612)423-3086
-?--r-Yi--------------__.-.._____?,_
--
INSPECTI4N RECORD I C°ntr°' "°. 0596
CITY OF EAGAN PERMIT TYPE: avILoZXG
3830 Pilot Knob Road Permit Number: i**754
Eagan, Minnesota 55123 Date Issued: 06 /!9 / 92
(612) 681-4675
SITE ADDRESS: LqT: 9
562 77TH ST W
BUR OAK HILLS iST
? PERMIT SUBTYPE:
s F oaG
eLQCK: 2 APPLICANT:
REQERSOft HOMES IIlC
(612) 423-3086
TYPE OF WORK:
NEW
INSPECTION .. . ..
FOOTIN6 FRAMIN6
INSULATION FIitAL
FIREPI.ACE
.RECEIPT #
SiW RLBR. -
OfFiCE USE ONLY
?
BUILDfNG PERMIT TYPE
? 01 Foundation 0 06 Garage/Accessory- 0 11 Res. Add./Parch 0 16 Agricultural
? 02 Single Family ? 07 Fireplace ? 12 Comm./Ind. New O 17`Building Move
C3 03 Two-family O 08 Deck O 13 Con?r?./Ind. Add ? 18 Demolition
? 04 Mu1ti-fam. T.H. O 09 Basement Finish 0 14 Co?mn./Ind. Rem. O 20 Miscelianeous
0 05 Apt. B1dg. ? 10 Swim Pool ? 15 Public Fac.
WORK TYPE
E 90 New ? 93 Remodel ? 96 Move :
D 91 Addition 13 94 Repair D 97 Demolish
O 92 Alterations 0 95 Tenant Finish ? 99 Undefined
GfNERAL 1NFORMATION
Oecupancy R-3 M-I Basement sq. ft. MWCC System
Zoning R..l 1st F1. sq. ft. City Water ?
Const. Actual) Y 1y 2nd F1. sq. ft. PRV Required
(A1lowable) V- N Sq. Ft. total Booster Pump
# of Stories Footprint 5q. ft. Fire Sprinkler
Length -?r- On-site well Census Code
Depth z8 On-site sewage SAC Code oi
APPROVALS
Plannin9 Building Assessments
Engineerinq Yariance .
REQUIRED INSPECTIONS
0 Site ? Footing ? Framing O`Insulation
? Wallboard • O Final 0 Draintile ? fireplace
vatuetione $ 160, 000y
Permit Fee
Surchar9e ?)9.90
88.C>0
-?---"---
Plan Review 155% /8 a°x IZ= 2 1-10 f2x12-1q yX2s=
License ? x t2 ? qe..
M4lCC SAC
C i ty SAC
o
a ,
I
Water Conn.
Water Meter &YS, ou
LS, o o
Z?x 56, '/1'1S6
Road Un i t 3 8 0. v o 1Lt c,( ^ ?. ?S9
?6 3
Treatment
Pl. ??o . & ?
}
R?i 1r .S')b? Pafw1L? ,'? t7 . U , `
Paar-k-??? .s1w s/? .; a 1 S?l S X i s- Z 3 2 Z ?
TCai7?s-.Ded A_etD-T. 3d ,av ?
1s-
r ?'L
ies
M er )sws
Total; 21e$= l6
1 s6 ?X s3= Sz, 89Z
SAC 96 FL.X,-I-
sac units x.x? 3 x s3 ? yg j /9
IS??g?3
. , i•i '1 ,3 t'J ?
t tt f:.'• 1(1 .1
, t1 0
:?'a1 Y ;"l?:??t i?CfA 10 1q W 1F!1
N? 'Atitj FitJri
Dwr1 ir
i'"Ui 1 M J1
1A44i i H c)I f A.JU6!!
{.:1A )cl`1iiT j
AM 3 i?
? Please Reply No Reply Necessary
PRODUCT 3053 . Inc; Grotoq Mass. 01 71. To OMer PHONE TOLL PREE 1+800-2256380
Ron Pederson
/
D ? .. . . .. . .
rEnergy Coneervation Supplement to 8uilding Permit Application
?_ - BUII,UIXG AND SAFETI DEPARTM
? This auPAlevent i' provided to assist ` th aPPlidat ia?'?eapsting the QTFltIOt QlMM AYERAGE 't!' fACiOR
IAF081IATI01. This tnforsatioa is Mnired so the ApI1.DU6 WfitlAi. aw dettniae that the subsitted plsas cinplt
rith the EXERGl' CpI15ER9ATI0A DESIGiI AtITERIA of the StA"fE MMIIG CODE lSection b001). It is the ANl.ICUT'S
responsibilitr to acmrat
& and cospleW-, compate the dats: reilect the pcoper DESIGx CRiTERIA in the ptasa; ,
aubsit product specificatioa, as aeeded to-suppoct the 040 ad '0` fwtora used: aad to aseare tbat contrsctfon
ia accosplished per Ebe appcoved,plsns.
.roe ?oc,?tio? S? Z. -7 7? 37 ; ?
,
.
O+ncEt(s) utep eIM _te Co'fwfa -
CMMcroa PVM '?Z3 - 3O496
A. Deterai.ae the Totai Eupused Yall Area as follois:
1. Total rall rindor area Z5 3,
. . . _r . . ...
2.? Total door area ?
3. Total stiding qlass door area
4. Total fireplace rall area •""'-""
S. 7ota1 rall framing area (average lOt)
6. 7ota1 aet nli area above floor
7. ?otal ria joist area
-
Subtotal: Total txpoaed rall area abore floor -----••----------------- -3?'
8. total fouadation rindoi area
9. total aet foundatioa area above grade ?? A• ??
SubtotaL• Total ezpoeed fournia#ioa araa ••------------- ..?_:.»__?__._________?.
sRAxa MTAt. EzpOsm rAu. eREA --------- _..------------------- __.w------------ ---....... ; 2.3s ?o
1. Kultiply t6e GRARD TOTAL EXPOSED YALL AiiFJI X.11 = ITEH I
C. Detenine the Totil ExpeaEd Rccf/Ceilimg Are: as fallaia: .
r
10. Total skriigAt area
tl. iotal rovf/ceilinq friaing area tarera(le SS} /.? To
12, ?otal net inenlaErd caoflceiling area
GRAItD ZQtAt EXFflSED R0(tFlCEIi.IiiG AREA ----------------------------------- --------------_
0. 1lultiplr the GRAND 70TAl, EXPOSED R{10F/CEILItG AREA X.026 = ITEtt II 7-1
1 !
,
'
,
f
.' i+etenine the 'U• salue of each seqaeat 1I-91 and rnitiply by the m as follo.s.
i. _ 2 ?'",?. ?S? z •m , ? 2' = 1D ?.'3r
2.
. x•?' 2- ?
30, sl
3. ""'..-..?
?
!. ...---- x .?. _
74- _ .r . Cql
6. 2 4-4-5-1 7 I
1 nr laf3 I Lo
?
04'-
7. ? Sr t?+o z.?. 4 D?,L
e• - 3, 7 ? t •?r . •41
9• `CV,?"'? xsU• tLo 1 s /4 5v
ADD 1-9 FOR TO?AL YALL SEGREAtS = ItER III !e
DeferHne the 'U' value of eacb eegnat i10-0 aW witiplr by tht area as fcllose.
a
10. 11. 470
u. •ug
ADQ 10-12 FOR TffAL ROO'lCEILING SMNERTS = I3£N IT
G. If i tem No. III is the sane as, or .les3 than Item Na. I, you have met the .fatent ` of Stste
9uilding Code 6006fc12. ,
H. If ,f tem No. IV is the same as, or 1esa than I#em Xo. .II, you have aret the fnte»t c?f State
8u.tldfng Code 6005(c).t..
I. Add Ttem No. I 3*'7. 53 . Item Ho. II ?Z t? _ L.._4 30t
J. , Add Item Ho. IIT Z?! i+,i? a item No. IV _ L?rv ???
K. If the sum af ItemB III ancf FY are less than Items I and II, you have? met the intent.vf
the code for total-envelope system.
In addition to the abave items you way heve to edd for such ite
unheated spaces, euch-as cantilevered areas, etc. ms es flnors over
To arrive at •U' value divide the total ot the R valuea ior eech segment tae sbcvel
into 1.000. Ansrer you have is'the •U' velue for thet eegn?ent.
Exsmple: A totel •R• of 35.08 divided into 1.000 =.028 'U'
P
_... _ ?_ .... . . ?'=? _ _
CERTIFgCATE OF SUR'V?Y FOR:
. . .
PEbERSON HOMES INC.
DELMAR H. SCHWANZ
wao aunvEroaa. INC.
. MpiNand uM« uws a tn. ftft et MiUnMOt.
• 14756 30UTH ROBltRT TRAII. ftO315MOUNT, MINNE30tJ15SM A12/493-1Te9
SUpVEYOR'$ CERTIFIGATE
b3
SCALE ]." = 30'
rf ? iran Montment
a a Set Waod Hub
910 a: Bxistinq Elevation
(D =' Prvpased Elevation -
4` /3 $ d0 ,?y k3 ?q ;
? ?f°1'
?°
? ? ? `' -.?? f 2 • 9G ?? . !
X
Q .?„
A
_,5 Zb \ •? ??? v '?p 'Ok"
N
$gr
?\,?
d '? `?? ,4,Jy
\ ?
I ?.? NAGAN EN INE RING DEPT
b?` ? ?/ B 4?f, Z- PROP(?SED GMOM FI,OOR ELEYA7'ItN
'jA ? P1tOPOSLD TbP OF BLOGK 13LEVATiON
\ '?r
vA ?- ? 8013
?
PROPOSEU LOiEST LEVFL BLSfJATICO:
I.EGAt, 088CRIP'PION
????sunur??, 9, BLOCIC 2, SUit OAlC HILLS, accazding to
`?r(?;g?orded p1at, thereof, DAlCOTA CotJNT7t, HINNESOTA
p , ... ? .
? i hereby csrtify that thA turvey pian, or rbport wis ?a?? • '•;"? ???
properod by ma or under my dkect eupxvision and =*: . p ELMA R H. .? ?? s
thet 1 am a?luiy Repistersd Lind 8urveyor under .? { SCNWANZ ;F
the laws ot tM 3tato Ot Mihnstot?.
?
*- 8625_--- i
t??? ? 1aMt?at H. $Chwglft
, p? 6-4-92 ??; ? Minniois l411abtilbn No. Am
'i. . ????1?•• .1 ? ?
S u p
,
71
LOT ? BLOCK; J- SUBD. o(&T-
RECEIPT # ?'JrDO3 DATE
.
1995 CITY OF EAGAN
IRRIGATION PERMIT (FOR BACKFLOW P
REVENTER
_ )
COMMERCIA lNSTA LATIONS: FORM MUST BE-COMPLETED BY LICENSED PLUMBER
?
?
Date: ( Cornmerciat GPM
Residenfial (bou(evards) GPM
C Existing residential
area/address to be irri9ated:
(nsta(ler: Owner X Pfumber ?
Street addres •
City, state & zip code: ? ?A°I-,,?O#hone #:
Owner Name• `
Street address, J?vz • 77
City, state & zip code: Phone
,
le'll
lrri9ation contractor, if different than installer:
? Telephone 13`7" rAN 7
-- -
herebY acknowled9e that I have read #his aPPlication, state that the information is correct, and a9ree
.
to comply wi#h alt applicable-City of Eagan ordinances. It is the appticant's responsibitity to notify ;
? the property owner that the City of Eagan assumes no tiabitity for any damages `caused by the City '
during its normal operational and' maintenance activities to the facilities constructed under this
permi# withirt City property/right-of-way/easement.
,
I
? pPlica ' signature Title
Approved by: Date:
?
PRV ? Yes 0 No New, service ? Yes ? No 7- 7???
Meter Size & Cost
?
--------------- --??. -------- ----------- --------- -- ---- - ---- -------- --------- ------ -- - ---- -----
Fees due: C-Ao Calculated by:
?
PROCEDURE FOR IRRIGATION SYSTEMS - 1995
An irrigation permit is required - please contact Protective Inspections at 6814675, '
Fees Commercial project; $25.50 irrigation permit to cover installation of backflow preventer.
$50.50 water permit fee on(v if new service is installed.
$300.00 per tap if installed by City.
Residential project: $20.50 irrigation permit to cover installation of backflow preventer.
$50.50 water permit fee if new senrice is instaNed.
$750.00 per cqnnection - WAC.
$372.00 per cannection = water treatment facility.
Existing residence: $20.50 irrigation permit to cover installation of backflow preventer -(not
required if backflow preventer previously instailed):
I Meter charge: If gal{ons per minute are fess than 25, a 1" meter wilf be required at a cost of
$170.00. If gaflons per minute are more than 25, a 2° turbo'with strainer will
? be required at a cost of $800.00. This inforrnation is to be supplied by the
designer of the system. ,
--------- ------- -- -----
No me ? ter w'I1 w
be sol fore !
d be a 1 sewer artd water insPections are compiete on a new e srvice. 1fne
service lines are not reauired, one check may be written formeter and pecmit costs. Receipt will be coded
ta 20-3716 (meter portion only) with pink coQy forwarded to Uti(ity Billing Clerk.
The installer is to contact Protective Inspections a# 681-4675 for inspection of the inside water line and
backflow preventer. The Public Works Department may be reached at 681-4300 for water tum-on and set
and seal of the meter. Inspection hours are 8:30 a:m. to 3:30 p.m. Monday through Friday. Requests for
A.M. inspectians shoufd be made on the preceding work day. Requests for PM inspections wifi be accepted `
until 12:00 noon. ,
213 - 037 ? OFFICj'USE O LY This requesf void 18 mon}hs from validation date printed in fhis box n?
o/
PLEAS'E PRINT OR TYPE
Request DaTe Rough-in inspection required2 ? Yes o Inspection Other Than Rough-In: eady Now ? Wiil Call
r- / ?"? ?j (You must call The inspedor when ready) Date Ready:
I, T%icensed contractor ? owner hereby request inspection of the above electrical work at:
Job Address (Streei, Box, or Route yNa? /
16?' O`^ ? f ? (? ( Ci
a f`?Z Zi?p ^Code
Sechon No. Township Name or No. Range No. Fire No. Counfy pa ko
Occupant -' ' Phone
??
" ~
Power Supplier Address ?
Conhador Company Name) ?
' ?
? Conimdor Licens o.
)
Masier Lic. No. (PlanT Elecf. Onl
.
?
t
T
G?
ig dd (Contmctor or Owner Performing Install on) r
.i
nA
h ??
Xx
, /
Authorized Signature (Contra o r wner Perf ing Instnlinfion)
????. Phone No.
6 ffffa?-?
_ PW ___
EB- 1A-10 6/95 STATE BOARDCPY -SEEINSTRUCTIONSO ACKOFYELLOWCOPY
REGIUEST FOR ELECTRICAL INSPECTIQN 1?1 _
I IIII II III I? II? II (?i ?I f II ??) ?? i?.l? I? ?III??I 8121 Uni es ity AvearRrof S ectacS/t Paul, 55104 ,_,
? nnesota * 0 2 1 3 0` 3u7 5* Pn ??) 642-0aoo MN
n??1 },?:
Home Duplex Apt. Bldg. Oto'e^?_ New Addn
Commercial Industrial Frm Remod Re air
Air Cond. Htg. Equip. ater Htr. Load Mgmt. Other. y?
Dryer Range Heat Temp. Service
"X" above the work covered by this request. Enter remarks in this spoce and on the back of the whitE copy onfy.
Calculate Inspection Fee - 7his Inspection Request will not be accepted without the correct fee:
Olher Fee # Service Entrance Size Fee # Circuiis/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTALL?
Sign/Outline Ltg. Xfmr.
?
Alarm/Remote Control
Swimming Pool
I hereb celti ihat I ins ins ation described herein on The dates sfated
Irrigation Boom Rough-In Dare
$
ecial Ins
ecFion
p
p
Investigative Fee
Final ?
THIS INSTALLATION MAY BE OR THS
DERED S E D IF NO COMPLETED WITHI M .
Use BLUE or BLACK Ink
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I For Office Use j
I I
I
City of Ea aR Permit
R I I
3830 Pilot Knob Road I Permit Fee: ~ I
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Eagan MN 55122 Date Received: I
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff:
I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
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Date: ~lr /3 Site Address: 2 ry
Unit
Name: cs: ;5!R K Phone: / X15" Z
Resident/
Owner Address / City / Zip: -Imn ~c ,
Applicant is: Owner ~ntractor
Type of Work Description of work:& - f -
Construction Cost: Multi-Family Building: (Yes No
Company:RContact: ~.e,4~ST
Contractor Address: Z57 City:
Stater Zip: Phone: Z `f Z ye5.F
License -6C Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
-
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 moonths, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes k-lllo If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that they are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.gopherstateonecall org
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit i ance.
x x dy yy7T,
Applicant's Prin ame Applicants Signature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA123993
Date Issued:06/18/2014
Permit Category:ePermit
Site Address: 562 77th St W
Lot:9 Block: 2 Addition: Bur Oak Hills
PID:10-15500-02-090
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace & Air Conditioner
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Andrea Preusse
4145 Sibley Memorial Hwy
Fee Summary:ME - Permit Fee (Replacements)$55.00 0801.4088
Surcharge-Fixed $5.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Thomas Tste J Perry
562 77th St W
Eagan MN 55121
(651) 905-0123
Wenzel Heating & Air Conditioning
4145 Sibley Memorial Hwy
Eagan MN 55122
(651) 894-9898
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA125418
Date Issued:07/23/2014
Permit Category:ePermit
Site Address: 562 77th St W
Lot:9 Block: 2 Addition: Bur Oak Hills
PID:10-15500-02-090
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:Two or More Windows/Doors
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow
windows, call for framing inspection. Call for final inspection after installation.
Carbon monoxide detectors are required by law in ALL single family homes .
Valuation: 4,000.00
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Thomas Tste J Perry
562 77th St W
Eagan MN 55121
(651) 451-6835
Beissel Window & Siding Co
1635 Oakdale Ave
W St Paul MN 55118
(651) 451-6835
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA171563
Date Issued:08/23/2021
Permit Category:ePermit
Site Address: 562 77th St W
Lot:9 Block: 2 Addition: Bur Oak Hills
PID:10-15500-02-090
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:Two or More Windows/Doors
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow
windows, call for framing inspection. Call for final inspection after installation.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Valuation: 5,000.00
Fee Summary:BL - Base Fee $5K $118.00 0801.4085
Surcharge - Based on Valuation $5K $2.50 9001.2195
$120.50 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Thomas J Tste Perry
562 77th St W
Eagan MN 55121
(651) 895-6291
Pella Northland
15300 25th Ave N #100
Plymouth MN 55447
(763) 745-1400
Applicant/Permitee: Signature Issued By: Signature