4236 Braddock TrParcel Files Cover Sheet
Unique ID: 2029
4236 Braddock Tr
105210007002
,
??,` EAGA4
??
P. SQ?C " ' ?
't
i,
?AGAl11, lVI1NN?SL?'F'd 55't29 . h ? ?r?
AMotINT
e -?- ? ?r" .•r , ? ?a,__?9___„???li????' { ;
MM? . '. 1 ''I I ?u
??•? d „l ? ????
e?,,• ?.=..••?, ???? '??,, ,.
?-
?
y 1
I
I'
I
?
i ?
i .k
?
1
r„
?"-?"?-•?-• i ? I
Is v ,??`? t'' ? ???? ' '? ' i I? '? i ; , .??.'? ? ?,?? , ,. , ? F ?" ? ??d ?? 1 ' I :,, i ?,! , ?,?,
?
,
r-.r r..-,- -,r.?-,.•-..am...?.-_,m . -3,?TWM.?.,.s.. p."7'fR
? .: ; .. . . . ... . ... . . . . .
, .. VII Ti Of GAQAN .. .., .. .
3830 Mot Knob Road, P.O. Box 21-1 99, Eagan. NM1 65129 91!78
PHDNE: 454-8100 v ? _
SWILDlN+G PERINIT Receipt
Te be med foR SP DWC/GAR Est. vaiue $56,000 tbre JtJNE 18` 1o$4 ..
SiteAdd ss
? "' ,0 ?.?'ae.airua.? a.a?[emsae ? ??? R3
l:ot Block? Sec/Sub. NOR`'?'IVIET? Iv1EA7S A? q Zoning RJL
P??l No. io-sZ1o0-o7o-ma
Re
pir
Fi
Z
p (3 re
or?
E
f
n
? ?7 Type of Car?.
Neme ?O?EPH K1?t?iE move
p
,# StoNes
I Aadress ?710 IC?T:P?GO
City Phone ?5?-8 ?
? Nwno GRAND OAICS
23 P
C???'aVrI E Phone 326561
-
Neme _
Address
Gity Phone
1 hereby acknowledge tFat I have read this nppiicotion arui state that
the lnformotion !s correct ond agree to tanpty with oll cpplicable
Stute a4 Minnesotc 5totutes ond Gty af Ecori. Clydirwnces.
Siguofure of Pem?ittee
Derrrottah p Length 4 6
Grade p Depth AO Sq. Ft.
Annmals - Fees
Assessment
Woter & Sew.
Police
Fire
Eng.
Planeer
Councii
Bldg. Off.
APC
Permit ° 00
28?
l?0
SurcFarge •y?
Ricn check Q
?C .Water Conn. 0 • ? 0
Water Mster ?9' 0 0
Rood Unit ' 00
Tota_ ;
A Building Pennit is issued UIUILNU on fhe e
xpress emredititm thot
oll vro?k sholt be dmm in withAll a icabl !91& of Mtnnesota Statutes and pty of Eagn Ofdinances.
Building Offkiol
Permit Ww Pertnit Htiider IN" Permit Na Hofder
Pluwmbing C? '4 _t
??.c. y y (o d, ?fi ? ?I?s?g?
El?trto
?
InspeatiOn Oate Insp.: Other ?
?
i
footinga {
?'l? 5
Foundation p? t.f1 ?
I Rough Plbq.
7= ctty -- state ztp
?- _
i
t.:- -
Apsrovei CFTY flF fAGlOW 464-8980 No. Fixtures . No. Fixtures
T 12. I heceby certify that the above i fwmataon is true and correct, and ?__agree to-- -- -
? cnmply wixk ordirta n codes goveming th[s tYi'e o# wor
- Signed ' ?? #or
w a
? Rough _ Finat - - -
- laspections: Date InsP• Date Insp.
?- This is yaurpermit when numbered and epproYed.
- _ - - --,
Water Closet Cesspool/Drainfisid
Bath tubs Septia Tank
.? Lavaiory Softner
Shovwer ' Vttell
.°Kitchen Sink '
Urinal/Bidet ott-m
Laundry Tray °
Ffsmr Drains =
Drinking Ftn.
? Slop Sink
Gas Piping Outlets.
,? u4
;
arr + ?` : . .. .. ?,, ...?...?.,?."K? ?
sc
7low or A^A*Wwlt Ta?. -?? G?
f. Daee Coat
y9 33. ???'f?i##:?-T?-- Eot ? 8!!c. ??- TiBCtrtf'..1
?-^--^- --?*-^------•
4. Ow;w
y?
S. Contracw \/ ?' /..? -?'si"'. ;y? • /p 1 P4me
?. Addres .??C.?? ?/L< ??--Yj'?I?...r ...??I-?c-.
?
7. (?ty StBte Zip
8. Building Type: ResideMtai Eg}~ Comrmrciai Ci irstitutional C]
9. Work Descriptfon: New 93' Add ? Almer C! Repair ?
10. Describe Fctei Type
91.
?
? EmdaffLtlt BTti - M. Ea.
Fa?cod Atr 7"f,
O1 No. Ea+iomni CFM
Ai
H
{li
. i-
6fi.ai,..
?.. r
ant
ng:
Boifers
Mf9• Meeh. Exhaust
Unit Heater
Mfg• Other
Air Cond.
Mt9•
Gas, Piping Outiets
92 1 hereby certNY that the above infortnetion is true and oorrect. and tswee to
compiy with a!f ordinances and codes goveming this type of work.
Ogned' for
Rough Firai
inspections: Date lnsp. Date insp.
This is your permit when numbered and approved.
Appoved CITY OF EAMM 45"900
cirY oF eaGaN WATER SERVICE PERMIT
3830 Piloi Knob Road
P. O. Bc?x 28 i99
PERMIT NO.: 5551
Eagan, MN 55127 DATE: 626-84
-
zonin9: Rl No. of unitr.
Owner. Gs'atid 08ks
Add?ess:
stte Adar?ss: BrAddoc'k Tr. ai i, B Nort??vi.ew ea ca?re
Piumber. MCDOA&Y F3.bg
Meter No.: Connection Chorget 470 . 0 pc1
Size: ' Account Deposit: ` p
Reader No.: Permit Fee: 10.00 pd
1 a ree to wm
8 Phr with the City of Ecgon
Surchorge: ' f1 pd
Ordinonees.
Misc. Chorges: mCte'x'
TotaL•
BY Date Paid:
Date of Insp.: Insp
:
.
CITY OF EAGAN
3830 Pilot Knob Road
P. O. Box 21199,
Eagan, MN 55127
Zoning: R1
Owner: GYaAd
Address:
Site Address• 4236 :
SEWER SERVICE PERMIT
` PERMIT NO.: 6741
DATE:
No. of Units: I
Qaks
r $2
Plumber: MGDqIIlIZCl P1tDg
b-18--84 44136 -
1 egno to eom* with the City of Eagan Connection Charye: 425.00 pd -
Ordinences. Accounf Deposit: '?' p
Pern,n Fee: 1(}.00 gd
Surdharge: .50 pd
BY Misc
Ciwrges:
.
Dote of Insp.: TotoL•
Insp.: Date Pald•
? ??? ?l1M ?1?
b? 'I? I
i?? 0
P??
.
? 4`N I? ??. I •: DAMi _ I • (.'. ' ? ?
? t??
'` ??a
' ?
?
?
:r•, ?
?, ? ??,
???? ,?? ?'????"?? ?' ? F.• ?? .- I ?'.{ ?I f .'': I .1'.'I ?I
I
? .
?i ????N???
? ??, ?. ,6•? ;?
i
4 ? ?.
?gC, Cfq ?
? r
?
? ' -
r ? ' ° ? ?? ' ' , , , ? '? • F;?x
CITY OF EAGAN ?
Remarks II R
Additton ? NOR iVIEW MEADOWS ? 'Loti'7 2 Parcei 40-521_00-070-02
owner strees 4''236-I$RADDOCK TRA ? ? 3tate 'I EAGAIV =MN 55123
Improvement : Date Amount ' Annual o r Payment Receipt Dhte
sTReeT suRF. ? .1984 ? 76.'??75 7.68 ?? ? !?'I'69 .'O8- A014375 8-7-84
STREET RESTOR.
GRADING '
EWER T
1981
15,189
.79
J2.73 '
AOl1+375
8-7- 4
SANSEINTRUNK 57-15 1981 138.48 6.92 2? ' 110.80 ' A014375 8-7-84
SEWER LATERAL ?'b 1984 27$ .'22 ' 18.35 456.88 A01i4375 8-7-$4
SE R LAT 1981 22.128 , I 1.11 ;''16.3fa ' A014375 ' 8-7- 4
WATERMAIN y 1984 70.,67 ' 4.71 ;1!65.96 ' l A014375 ' 8-7-$4
wATeR LAreRaL 1981 .93 :13.69 A014375 8-7- 4
wa-reR ARea 1981 138.°,48 I 6.92 i`10.80 AO '''I+375 8-7-$4
WATER LAT _3 1982 29:'S2 1.48 2 01 1 j123.64 ' A014375 ' 8-7- 4
sToRnn sEw rRK 1984 392.'32 39. 23 ! 13..86 ' A014375 ; 8-7-$4
STORM SEW LAT
,
1
RAINAGE 11 1984 33.?97 3.40 1 1 '30.58 A01;4375 8-7-
4
CURB & GUT7ER I ? I
SIDEWALK
STREET LIGHT
1
ROAD UNIT ?' ' " ? . I I, 260.OQ ' J4
'+136 6-1 -84
WATER CONN. 70.00' J I i!.
IgUILDING PER. 91?H i
sac 525.00
PARK
.
? ,. I
.
,.
i
?
? ,
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55 127 N? 9178
PHONE:454-8100
BUILDING PERMIT Receipt #
To be used for SF DWG/GAR Est. Volue $56,000 Date JUNE 18 ,1 9 8 4
4236 BRADDOCK TRAIL
y R3
Site Address Erect
[] Occupancy
Lot 7 Block 2 Sec/Sub. NORTIiVIEW MEADSAIter ? Zoning R1
Parcel No. 10-52100-070-02 Repoir ? 'Fire Zone N A
E
l v
st
T
f C
n
arge ? on
.
ype o
W Name JOSEPH KANE Move p # Stories
Z Address $710 CHICAGO Demolish p Length 46
? City PMone $ 5 4-$ 14 5 Grade ? Depth 4 0Sq. Ft.
? GRAND OAKS Approvals Fees
,O
oU Name
Address 7623 UPPER 167TH
Assessment
Permit $ 301 . 00
u? City LAKEVILLE phone 432-6561 Water&Sew. Surcharge 28-00
Police Pian check 150 .?
?Z Name Fire
'
SAC 525.00
?U Address Eng. Water Conn. 470.00
<W City Phone Plonner Woter Meter 63_ 00
Council Road Unit` 260 _ 00
I hereby acknowledge that I hove read this upplicotion and stote that gldg. Off.
the informotion is correct ond ogree to tomply with oll opplicabie
APC -?
,
Totol
Stote of Minnesoto Statutes and City of Eagon Ordirwnces.
Signature o f Permittee
/1 Building Permit is issued t• GRAND OAKS on the expreu condition thert
oli work shali be done in a cord with QII op licable t e of Minnesoto Statutes ond City of Eagan Ordinances.
9uilding Officiol
?
reqw.st void ? ? ? ?l .
ts '-ft.ns ? v ...
A - , .Q-S 7 8 18 .?-
pe,uess ? F,? ?.
°"
??,?;?,
[sjx?dy Now I Nous?, l+sc?=
?Mo When ReadY
" . . i ricai Cartracior. .. . . . t Aere6y raqusat iwsPectiuw ut abora . . ..
Owoer eidetrecsl vwrk Snsbtled st_
Street Address. Box or 1?e Mo. ... Cit1t
v
Section . TownshiP Name or No.
9/ nge Count?p
?
L..d ' ? '?{It/ ?,,
Ri?
Oc? nt tPR! J
?
? Phox+e 1?10_
? ?? ??
_
1! I
KF /'L' •
t'bwMer SuoPl'er Add?ess
a 4'
E1e C t
nY N 1
r-
Z
'?
Cantractor's License Na.
E
-.-
- -
Mailing /lddress (Cd?tract w Ovo?er MaInsiatWtion{
Auihor" Sig?r?aw?e ctor A"a 'n9 tnstaitateoni Plwne Nunnber
-3
1tL(`t Y,
,-5u
YlNNESOTA STATE sa?iMD OF ELECTAICITY TN? IMISPE-C710N BEQUEST wlLl NOT
Griggs•Midwway Bidg. - Room N-191 BE ACCEP'TED 8Y THE STA1E BOARD
1821 Uaivmaity Aw.. St Paul. M SS1Q4 UNlE5S PROPER INSPECTiQIIi FEE IS
Pinne 16121 297-2111 ENCIQSED. -
/?...
5
V waa Reo. REnuEST FOR ELEcMca. IMPEcnoN ER-OOM -04
? See itffitrueiians for comRtetiM this tarw ow betk. at 1MIMrr coPY. `
.1XBe%w Work .'werg& Ly This ReQuest
78T8 -
zym at suiwing wvaliances wir.a £auiwionreife,a
Nome Range Temparary Service
Duplex Water Heater Lighring:Fixtures
Apt Buiiding Dryer Electric Heatin
Carrriercial Bidg. Furnace Silo llnNaader
Industriai Bldg. Air Ccanditioner Bulk Milk Tank
F'dflTl Other? Pect. V .. hev &SDeciiYb . .
.
Other SoCC? ? . ? ? . ? .. Other?. ? ? .. ?
_O/nD/AP_ iASDBClI/M FPP RBInW ? . ? ? . . . ? ?
# r Fee $arviceEnts nce8izs # Feq Feeders/$ubfeadsrs ? Fee p Circuits
0 to200 AnWs 0 ta30 2 0to3o Aaws
Above 200-q 31 to 70Q Amps /D 31 to 100 Arnlys
Swimmi Pool Abovre tOQ Above 1(]0_A fnPs
Tra?formers ligation Booms , Partial<`Other Fee
brgns apeceai i nsPec[wn $ ?
Remarks TO ?/ ?F/EE
rf.tiF • ?? '
Rough-in Date Cal .!
InsPectar, hmeM
certity that Me above
Final tion Ins been
iiisroquatVold 76nwnlnsirom
Date Iq / i Lq / (-)
SiteAddress
Description of Work
MuIti-Fatnily Bldg
_ Y ?N
Property Owner
Construction Cost
,.,
--rci 1, 0
Unit/Ste #
Fireplace(s) 0 ]. 2 ? Telephone # ((gr'j? fQ5?
Coniractor _ RMA HOME SERVICES INC.
Address THE HOME DEPOT INSTALLED SALES
- 660 MENDELSSOHN AVE. NORTH
State GOLDEN VALLEY, MN 55427
City
Telephone # ( )
COMPLETE THIS AREA ONLY IF CONSTRUC'i`ING A NEW BUICDING
Energy Code Cafegory "- M?esota. Rules 7670 Cate?ory 1 _ Minnesota. Rules 7672
(qsubmission type) ,• Residentiai Ventilation Category 1 Worksheet
Submifted . • New Energy Gode Worksheet
.
Energy Envelope Calculations Submitted Submitted
Have you previously constructed a buiiding in Eagan with a similar pian? _, Y N If so, 25% plan review I
fee applies.
Licensed Plumber Telephone # ( ) _
Mechanical Contractor Telephone # ( )_
Sewer/Water Contractor ? a Telephone # ( )=
I hereby apply, for a Residential Build
that the work will be in confortnance
Statutes; I understan.d this is not a pen
permit; that the work will be in accord,
approval of plans.
(Ckc C?. ??
?. v? So
Applicant's Printed Name .
mit and acknow dge that the information is complete and accuxate;
t.th Per
the and d codes of the City of Eagan and the Stafe of MN
, only an application for a perinit, and work is not to start without a
uice with the approved plan i the case of work which requires a review and
? 4571-V
ApPlicant's Signature
i
OMCE USE ONLY
Sub Types
_ ? 01 Foundation---- 0- 07 - 05=pfex- --0--13--16=plex--:?_----- p--=20-Poo(------ ---- 0- 34 -Accry Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ?: .31 Ext. Ait - Multi
0..- 03 • 01 of _ plex' 0 09 07-pfex ? 17 Garage ? 22 PorctilAddn. (4-sea.)` 0 33 Ezt. Ait = SF
E7 04. 02-plex , ? 10 08-plex ? 18 Deck ? 23 Porch'(screen/gazebo) ? 36 Mulfi Misc;
0 05. 03-pfex 0 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex ' Pfbg Y or _ N ? 25 Miscellaneous
Work Types
? 31. New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 32'Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33. Alteration ? 37 Demolish Building* ? 43 Reroof ? 46 Windows/Doors
0 34 Replacement *Demolition (Entire Btdg) - Give PCA handout to applicant
Valuation Occupancy MCES System
Census Code Zoning City Water
SAC Units
,
Stories Booster Pump
# of Units Sq. Ft. PRV
# af Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED 1NSPECTIONS
Footings (new bldg) _ FinaUC.O.
_ Footings (deck) _ FinaUNo C.O.
Footings (addition) Plumbmg
Foundation
Drain Tile Other
Roof Ic8 8i Water
_ ,
Pool Ftgs _ Air/Gas Tests
Final Final
:
--
Framing _ _
`
Sidirig _ Stucco Stone _ Brick`
_
Fireplace R I. '-
. "Air'Test _
Final Wmdows
_
Insulation Retainirig Wall"
Approved By: Building Inspector ?
-------------------- - ---- - ------------ - -- - ---------- - ---------------- - - -- - ------ - -----------------------------------
Base Fee
Surcharge Plan Review
MC/ES SAC
City SAC
Utility Connection Charge ,
S&W Permit & Surcharge ` . .
Treatment Plant .
License Search
Copies
Other .
Total -
?
Instal(ed
Siding and Windows
LIlVIITED POWER OF ATTORNEY.
c.;uuN i Y ur c;uBB
STATE OF GEORGIA
KNOW ALL PEOPLE BY THESE PRESENTS:
THAT I, David N. Katz, a resident of Montgomery County, Pennsylvania
("Principal"), and a licensed contractor of RMA Home Services, Inc., DBA Home
Depot Install_ed Sales loca±ed at 5E0 Mendelssohn Avent.e North, Czo?c'.e? Vu??e;?, Ml?.?
55427, having a license number of BC- 20268257, do hereby appoint, name and
constitute Elder-Jones Building Permit Service, Inc. ("Agent") as my true and lawful
attorney-in-fact and do authorize and grant said attorney-in-fact for me and in my
name, place and stead the power to execute, acknowledge, sign and deliver (in such
form as may be required by the municipality) a permit application, or any other
instrument(s) which may be necessary and appropriate, in order to obtain the proper
permit(s) from the City of Eagan, Minnesota for the installation, maintenance and
repair of windows and siding (the "Work").
The powers conveyed to the Agent by this Limited Power of Attorrey are
limited salely to the express powers delineated herein ancl appl_y solely to the Work.
This Limi*ed Power of Attomey shall expire arid automatically be revoked on the 21 st
day of Muy, 2004, which date is one year from the execution hereof. Further, the
powers conveyed by this Limited Power of Attorney may be revoked by Principal at
any time by express revocation and shall also be revoked by the Principal's death,
disability, incapacity or incompetence.
I?,? Ws1"NF_SS WHEREOF this Limited Poiver of Attorney is e.;etii_rtcd this
21st day of May, 2003
David N. Katz
Ilj
SWORN TO AND SUBSCRIBED BEFORE ME by David N. ILatz on this
21st day of May, 2003.
G ?
Notary P?iilic in for the State of eorgia
My Commission EYpires: January 21, 2006
396816.v3
Proudly sold, furnished and installed by RMA Home Services, Inc., a Home Depot authorized contractor.
3200 Cobb Galleria Parkway, Suite 200 • Atlanta, GA 30339 • Phone (770) 779-1300 • Fax (770) 984-0709 • Toll free (800) 79-DEPOT
i
/7 ?off RESIDENTIAL BUILDING
Permit Appiication
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651=675-5694
New Construction Reauirements RemodellRepair Reauirements Office Use ONv
3 registered site surveys showing sq. ft of lot, sq. it. of house; and allroofed areas 2 copies of plan Cert of Survey Recd
(20% maximum lot coverage allowed) 1 set of Energy Calculations for heated additions Tree Pres Plan Recd
2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey for additions & decks Tree Pres Not Reqd
1 set of Energy Calculations Add'rt'ron - indicate if on-site septic system _ On-site Septic System
3 copies of Tree Preservation Plan if lot platted after 7l1/93
Rim Joist Detail Options selection sheet (bldgs with 3 or less units
Date Cons ruction Cost
Site Address /
l Q 'Ib C a('?,? ?
Unit/Ste #
Description of Work ..
• • 1
Multi-Family Bldg _ Y _ N Fireplace(s) _ 0 _ 1 _ 2 V'T
Property Owner Telephone #(?)
Contractor RMA Home Depot Installed Sales
3200 Cobb Galleria Parlcway Ste. #200
Address Atlanta; GA 30339 City
State 763-542-8826
License #BG20268257 Telephone # ( )
?
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Categorv 1 Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Woricsheet
(q submission type) Submitted Submitted
• Energy Envelope Calculations Submitted
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone # (
Telephone # (
?-? r ? ? ?I
Telephone # ( ? [})? '
?
I hereby apply for a Residential Building Permit and acknowledge that the informati i?cor??°??rate;
that the work will be in conformance with the ordinances and codes of the City of agan and the State of MN
Statutes; 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
approv/al of plans. % / /1-N -
I Applicant's Printed Name (9fplica?'l?s Signature
?
'bFFICE USE ONLY
Sub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace 0 21 Porch (3-sea.)
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.)
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo)
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Pibg_Y or _ N ? 25 Miscellaneous
Work Types
0 31 New ?
? 32 Addition ?
? 33 Alteration ?
? ,34 Replacement
315; Int Improvemept
36 Move P1d,g.
37 Demolish (Bidg)*
*Demolition (Entire
Occupancy _
Zoning _
? 38 Demolish (Interior) 43 9 44
; Q `42 Demolish (Foundation) ? 45
? 43 Reroof ? 46
Bidg) - Give PCA handout to applicant
MC/ES System _
City Water _
? 30 Accessory Bidg
? 31 Ext. Alt - Multi
? 33 Ext. Alt - SF
? 36 Multi Misc.
Siding
Fire Repair
W indows(Doors
Valuation _
Census Code
SAC Units Nbr. of Units ? Nbr. of Bldgs
Type of Const
Stories Booster Pump
-F--
_ ? .
Sq. Ft. PRV
Length Fire Sprinklered
W idth
REQUIRED INSPECTIONS
_ Footings (new bldg) _ FinaUC.O.
_ Footings (deck) _ FinaUNo C.O.
_ Footings (addition) _ Plumbing
Foundation HVAC
Drain Tile Other
Roof _ Ice & Water Final _ Pool _ Ftgs _ Air/Gas Tests _ Final
_ Framing _ Siding Stucco Stone
_ Fireplace _ R.I. _ Air Test _ Final _ Windows (new/replacement)
_ Insulation _ Retaining Wall
Approved By , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
Installed
Siding and Windows
LIMITED POWER OF ATTORNEY
C:UUNI'Y UF COBB
STATE OF GEORGIA
KNOW ALL PEOPLE BY THESE PRESENTS:
THAT I, David N. Katz, a resident of Montgomery County, Pennsylvania
("Principal"), and a licensed contractor of RMA Home Services, Inc., DBA Home
Depot Installed Sales located at 660 Mendelssohn Avenue North, Golden Valley, MN
55427, having a license number of BC- 20268257, do hereby appoint, name and
constitute Elder-Jones Building Permit Service, Inc. ("Agent") as my true and lawful
attorney-in-fact and do authorize and grant said attorney-in-fact for me and in my
name, place and stead the power to execute, acknowledge, sign and deliver (in such
form as may be required by the municipality) a permit application, or any other
instrument(s) which may be necessary and appropriate, in order to obtain the proper
permit(s) from the City of Eagan, Minnesota for the installation, maintenance and
repair of windows and siding (the "Work").
The powers conveyed to the Agent by this Limited Power of Attorney ar-
limited solely to the express powers delineated herein anci appl_y solely tu the Work,
This Limi*.ed Power of Attoi-ney shall expire and automatically be revoked on the 21 st
day of May, 2004, which date is one year from the executian hereof. Further, the
powers conveyed by this Limited Power of Attorney may be revoked by Principal at
any time by express revocation and shall also be revoked by the Principal's death,
disability, incapacity or incompetence.
IN WT?NFSS WHEREOF this Limited Power of Attorney is e?ie;.ur,ed this
21st day of May, 2003
.
?
David . Katz
SWORN TO AND SUBSCRIBED BEFORE ME by llavid N. Katz on this
21 st day of May, 2003.
Notary P ic in for the State o eorgia
NZy Commission Expires: January 21, 2006
396816.v3
Proudly sold, furnished and installed by RMA Home Services, inc., a Home Depot authorized contractor.
3200 Cobb Galleria Parkway, Suite 200 • Atlanta, GA 30339 • Phone (770) 779-1300 • Fax (770) 984-0709 • Toll free (800) 79-DEPO,'T
? _ .
ISA RESIDENTIAL BUII.DING
F ? Permit Application
Cfty Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5674
New Construcdon Reauirements
3 registered site surveys showing sq, ft of lot, sq. ft. of house; and ail roofed areas
(20% maximum lot coverage allowed)
2 copies of plan showing beam 8 wirnMw sizes; poured found design, etc.
1 set of Energy CalCUlations
3 copies of Tree Pre"ation Phan if bt platted after 7/1/93
Rim Joist Detail Options selection sheet (bldjs with 3 or less un'rfs
RemodeVReoair Reauirernents
2 copies of plan
1 set of Energy Calculatiais forheated additrons
1 site survey for addiflons & dedcs
Addidon - indicate if on-site septic system
4 qq' 2-5
Otfice Use Oniv
_ Cert of Suney Recd
_ Tree Pre.s PPan Recd
_ Tree Pres Not Reqd
_ On-site Septic Sysbem
Date 1? / ? t" C) I Construction Cost 3,93 aco
Site Address 1
?.CIOCK f Ai I
25410 t'
Unit/Ste #
Description of Work Q,
Multi-Family Bldg ` Y _ N Fireplace(s) _ 0 _ 1• ? A j I? ?
?
Property Owner 'Z' '_Y-Y-N Telephone # ((a5l Zy 6s-
?RMA HOME SERVICES INC.
Contractor ? Home Depot Installed Sales
Address 3200 Cobb Galleria Pkwy., Ste. #200 City
Atlanta, GA 30339 -
State 763-542-8826 hone # ( }
BG20268257
COMPLETE THiS AREA ONLY IF CONSTRUCTING A NEW BUtLDING
Energy Code Category - M?esota Rules 7670 Categorv l _ Minnesota Rules 7672
• Residentiai VenUlation Ca#egory i Worksheet • New Energy Code Worksheet
(4 submission type) Submitted Sulxnitted
• Energy Enveiope Ca4culations Submitted
i
I Licensed Plumber telephone # r, ) -?
?
Mechanical Contractor Telephone # ;
Sewer/Water Contractor Telephone #$( )
I hereby apply for a Residential Building Permit and acknawiedge that the information is comptete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; 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.
Applicant's Printed Name Applicant's Signature
OI'FICV, USE ONLY
Sub Types
O 01 Foundation ? 07 05-plex ? 13 16-piex ? 20 Pooi
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.)
? 03 01 of, p{ex 0 09 07-ptex O 17 Garage 0 22 Porch/Addn. (4-sea.)
? 04 02-plex O 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo)
0 05 03-plex ? 11 10-piex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-ptex Ptbg_Y ar _ N 0 25 MisceNaneous
Work Types
? 31 New . (ti7 35
? 32 Addition ? 36
? 33 Alteration O 37
O 34 Repiacement
Vatuativn , .
Census Code
SAC Units
Nbr. of Units `
Nbr. of Bldgs
Type of Const
.w
?
? 30 Accessory Bldg
[3 31 Ext. Alt - Muiti
? 33 Ext. Alt - SF
E3 36 Multi Misc.
Int Improvement ? 38 Demolish (Interior) 0 44 Siding
Move Bldg. ? 42 Demalish (Fdundation) ? 45 : Fire Repair
Demolish (Bidg)* ? 43 Reroof ? 46 WindowsJDoors
'Dsmolition (Entire Bldg) - Give PCA handout to applicant
Occupancy MC/ES System
Zoning City Water
Stories Booster Pump
Sq. Ft. . PRV I
Length Fire Sprinkiered
W idth
REQUIRED INSPECTIONS
_ Footings (new bldg) FinaUC.0.
_ Footings (deck) Final/1*To C.O.
_ Footings (addirion) _ Plumbing
_ Foundation HVAC
_ Drain Tile Other
Roof Ice & Water _ Final _ Pool T Ftgs Air/Gas Tests _ Final
_ Framing Siding Stucco^ Stone
Fireplace _ R.I. _ Air Test _ Final Windows (new/replacemettt)
_ Insularion _ Retaining Wall
_ Approved By , Building Inspector
--
??-?- - •_--------_ -___ _? ?_??-_
"--__ -__?---__- ___------
Base Fee
SurcMarge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
.
Installed
Siding andl*M&RsPOWER OF ATTORNE)(
UNTY OF COBB
STATE OF GEORGIA
KNOW ALL PEOPLE BY THESE PRESENTS:
THAT I, David N. Katz, a resident of Montgomery County, Pennsylvania
("Principal"), and a licensed contractor of RMA Home Services, Inc., DBA Home
Depot Installed Sales located at 660 Mendelssohn Avenue North, Golden Vailey, MN
55427, having a license number of BC- 20268257, do hereby appoint, name and
constitute Elder-Jones Building Permit Service, Inc. ("Agent") as my true and lawful
attorney-in-fact and do authorize and grant said attorney-in-fact for me and in my
name, place and stead the power to execute, acknowtedge, sign and deliver (in such
form as may be required by the municipality) a permit application, or any other
instrument(s) which may be necessary and appropriate, in order to obtain the proper
permit(s) from the City of Eagan, Minnesota for the installation, maintenance and
repair of windows and siding (the "Work").
The powers conveyed to the Agent by this Limited Power of Attorney are
limited solely to the express powers delineated herein and apply solely to the Work.
This Limited Power of Attorney shall expire and automatically be revoked on the 300'
day of May, 2003, which date is one year from the execution hereof. Further, the
powers conveyed by this Limited Power of Attorney may be revoked by Principal at
any time by express revocation and shall also be revoked by the Principal's death,
disability, incapacity or incompetenee.
IN WITNESS WHEREOF this Limited Power of Attorney is executed this
30? day of M /h-f , 2002.
,,? ML-,
David . z
SWORN TO AND SUBSCRIBED BEFORE ME by David N. Katz on this
30th day of May,
?
Notary blic in for the Stat of eorgia
My Commission Expires: January 21, 2006
396816.v3
Proudly sold, furnished and instalied by RMA Home Services, Inc., a Home Depot authorized contractor.
3200 Cobb Gaiteria Parkway, Suite 200 • Atlanta, GA 30339 • Phone (770) 779-1300 9 Fax (770) 984-0709 • Toll free (800) 79-DEPOT
i
. .
v i '? •? ?" I . 2/H4
CITY OF EAGAN
APPLICATION FOR PERiMIT
- SEWER AND/OR WATER CONNECTIODI
(PLEASE PRINi)
1) PROPER'I'Y ADDRESS : y? 3?p Jet -'4 d Q G/- ,?rl
LEraz, DESCRItirzcv : f3 . <? e Q A/
?
r fh
a
v ,
?v
(Lot/Block/Subcttvision or Tax Parcel I.D. NtAnber)
LzSTRLCTL12E, DaTE G=' ORIG.i :AL :uIL^u=G FEF_-zT.'?' Ic^ ?AC.:
?? ??
` ,,'-?:=_-•,-- ,
R-1 S,--L\i= r?MII,Y
D R-2 DUPI= ('1ti`0 LT?tITS )
O R-3 TC;%-NHCY?SE ('I??E" + iJVITS ) ( Ui,TI'rS )
O R-d_ Ap.?R'1?`'''`:m/C^viZC'A?iNIL'?i ( LNITS i
? Ca4VERCIALi'RETAIL,/OFFICE
p IML'STRIAL
p INSTIT[.PI'IONN-'1L/GG??,7=
2) AppI,I= (PLEASE PRINi)
C-7
aDDREss: _`7 tv a3 t J (o -7
CITY, STATE, ZIP:
PHOiNE: 4132 - .-
3) pj?,rmm PLEASE PRINT)
NAI"IE : i'CLA
?
W
D n /
4
4 Pit ? /?
1 FOR CITY USE ONLY
i
(
-
-
?^
,??? , , - - 5
ADDRESS:
,r?a
d
PLUM?3ERS LICENSE:
?
Active
CITY, STATE, ZIP: L V;Ile- Mi-7, Expired
MASTER
PHOiVE: ?({? -r'j- 3,??j p? PLUMBER LICENSE # N ?e? d
arr nitia
4) OCC'lJp.z?'?]'j'/a,zim NANIE (PLEASE PRINi)
:
ADDRESS: ,
CITY, STATE, ZIP:
PHO:VE :
5) INDICATE WHICH PEP,MIT IS BEINIG REQUESZ'ID:
? MMNECrION TO CITY SE.TrIER
? CCINDIECTIGN TO CITY 6JATER
? (7I'EER (PLEASE DESCRIBE)
6) LN'DICA=.:. C:Z:
? PLFaSE F?OLD APPR0VID PERtilIT FOR PICK-UP BY OD1E OF ABOVE
? PLEC'1SE ?tAIL APPRO= PER?IIT TO 1, a? 3, 4ABaJE
. (Circle one)
? 7) SI=TL-1E:
=
MUA DATE:
,
6
F 0 R C I T Y U S E O N L Y
PERti1IT " ISSUED
F7--
FEES: $ O ? •vC?d s?'T.?? T?L`A\TT'y ???iC?..:t.?i? ?iJl?.?F!r'_2!(,;?}
$ ? a -s- ? WATER PEI2MIT ( INCLUDE SURCHARGE )
$ WATER METER/COPPERHORN/OUTSIDE REaDER
$ WATER TaP (INCLQDE CORPORAT7 CN STOP)
$ SE:IER `:'T,D
$ /-?-?---? ACCOUNT DEPOSIT - SEWER
$ ACCOUNT DEPOS IT - WATER
$ WAC
SAC
$ TRUiNK WATiR P,SSESSME:IT
S TRliNK SETNER ASSESSMENT
$ LATERAL BENEFIT/TRUNK SEIqER
S LATERAL BENEFIT/TRUNK WATER
$ OTHER
$ TOTAL
$ AMOUNT PAID/RECEIPT #
DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
C? YES IF YES, THEN A"PERMIT FOR WORK 6JITHIN
? PUBLIC ROADWAY" MUST BE ISSUED BY THE
NO ENGINEERING DIVISION. LIST AS A CONDI-
TION.
SUBJECT TO TfiE FOLLO:IING CONDITIONS:
APPROVED BY:
TITLE:
DATE :
.eas" alum s? ? ? ? ?m am wF?lw w?M now
?
?? ,
-? 9??? . __.__._. _
_ :.
??
? .
?? ? ? ?
_ ? ?? ?. CITY OF F11GAN
? Inclzade 2 sets c5f ?plans,
1 site plan w/elevations &
G
? ?`Y? '
? / BUZLDINC? PrRMiT I?PI LICl1TION
?, ?. l? W ? ? /G??lz ?_ 1 set of enerc?y calculations.
Zb Be Used For aluation ? ??, ?C?. ? Date ? - ? - ? y
Site Ar]dress ?v? 3 /1. ,? ?f'E? ICG USE OI?JLY
Lot _? Block ? Sec . /Sub. i ??'
? E.rect x
t?c:cupar3cy ? - ?
Parcel # : ? Q _ ?;?f ? -?- ? ?7? - C) ? Alter Zc?ninc? ? ?- I ?
I2epair ? rire Zon? N /A
Owner: ?rr?? Enlarc?e 'I`y?e of Const. T,?.
Address: ? • f`9ove ~ # Stories
-?.? D?rolish Front 4 (? ft.
Ci ty/Zip Code : Gradc ^ ?cpth 4 p f t.
P?? #: ???y-??y5
Contractor: ???2??? ?Xe.?
Address: `7Gz 13 c, lfl 7?'
City/Zip Code: S SO`?y
Phone # : ?3 d- (9 ?-'(? C
Arch . ,/F?Ig . .
Address •
City/Zip Code:
Phone #:
i
11PPf:C)VllTS . I?TT.S .
11.?sessilx?nts Perntit 3C:,? I. °-°
W?ter/S??aer
_ Sizrcharc?e
? Z,.,?3. °-"
Pol.ice ^?. Plan Check 1 SC?, 5°
Fir? 511C 525 . °=
`?
1?? . wa ter Conn . 410. ?°
Plannc?r Water Meter ?, 3 °°
Cotinr.il .?ad Unit ? ?(?. °'?
.??r
Bldg?. Off ?/!?/S "? ' ?C?,°=
AI'C:
?,I;? -? -?
i i o ??-?
T
? ? ? ?,?? s ?
- r ??
?` ? +7?.. ?`'r?., i O ? `,.??? ?. I ? ?? ..... I i ! 1 ?`i
52-
g x ?I = ?g??
?-
? x
0 a *
? p ? • ? C ¢
? $ • 0 ? ?'
525
4
1 6 0
? ?9'1 • 5?;*
or
?
[OURVEYORPS'dEATIFICATE
PROPOSED GRADES WERE TAKEN
FROM THE DEVELOPMENT PLAN
FOR NORTHVIEW MEADOWS BY
SUBURBAN ENGINEERING, LAST
DATED 9-29-83.
GRAND OAKS bEVELOPMENT C0. (202)
APPROVED FOR SIENNA
CORPORATION
BY:
ROBERTS ARCHITECTS
DATED THIS DAY QF,
19
--?--- DENOTES PROPOSED SURFACE DRAINAGE
O DENOTES IRQN MONUMENT SET -SCALE: 2 INCH = 30 FEET
• DEPJOTES IRON MONUPIENT FOUND. PROPOSED GARAGE FLOOR =c) Lo9, g FEET
X000.0 DEPIOTES EXISTING ELEVATION PROPOSED LOl4EST FLOOR = 9(o(o -9 FEE7
(000.0) DEtJOTE5 PROPQSED ELEVATION PROPOSED TOP OF BLOCK = 910 - ( FEE7
I HEREBY CERTIFY TO GRRND OAKS DEVELOPMENT C0. THAT THIS IS A TRt1E AND CORRECT
REPRESENTATION OF A SURVEY OF TNE BOUNDARIES OF:
Lot 7, Block 2, NORTHVIE41 MEAD041S, according to the recorded plat thereof,
Dakota County, Minnesota.
AND OF 7HE LOCATION QF A PROPOSED BUILDING. IT DOES NOT PURPORT TO SHOW IMPROVEMENTS
OR ENCROACHMENTS, IF ANY, THEREON. AS SURVEYED 8Y ME, OR UNDER MY DIRECT SUPERVISIQN,
THIS 3RD pAY OF 'APRIt,. 1984.
SIGNED: JA7jvi ILL, INC.
C
BY:
SHEET ? OF 2 SHEETS NAROID C. PETERSON, LAND SURVEYOR
MIN??ESOTA LICENSE N0. 12294
PROJEC7 NO. BOOK / PAGE JAMES R. HILL, INC.
194614
- Planners / Engineers / Surveyors
FILE NO. 6200 Humboldt Avenu• South
FOLDER . Bbomington, Mn. 55431 812-8e4-3029
5 RVEYOR'S CERTIFICATE "' GRANt7 OAKS DEVEL. C0.
(202)
COUNT Y STATE A/D H/GHWAY
NO. 30
.? . h
b
,.. N89°52'11"W 716.49 _
,
J
,
.
. i v--? • p T ?y?s•w
,s ?DRAlNAGE & UTIUTY EASEMENT PER PLAT?
s
I
? LOT 7
`? . ?e?
.
Al ,y
? o hy9
0
i ?
? ? 2? ( ``! .,??
? V
?o •0 96
?. ? ? ryo 9 SJ ?0
lb
0
, ? ao N
' `?3o.?R?? O? •? ?
f969?OJ?6o :ry' r`+' ? /?\ '
,
,
.?
,:?''
O ;
p
4j6
\ •O 6'
c% ?,.J.
0
,yo
Fr
?
i
lof = 301
SHEET 2 OF 2 SHEETS
PROJECT NO. BooK / PAGE . JAMES R. HILL9 INC.
84614 Ptanners / Engineers / Surveyors
FILE NO. 8200 Humboldt Avenu• 8outh:
FO L D ER eioornlngton, Mn, 55431 e i Z-ae4-soz9
, . . . ..
. .. _ ?., ,.. .. . . • . .. . . 4 ? .
Use BLUE or BLACK Ink
For Office Use I
; Permit
Dty ofEap
6'1`
Permit Fee:!.
3830 Pilot Knob Road
Eagan MN 55122 ; Date Received:
Phone: (651) 675-5675 1 I
Fax: (651) 675-5694 1 staff:
----------------J /
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: `t xs ' t2 1 r~`d (>Z v > Unit #
Name. _ ---)lrL:LiI tP~ _Phone:. ct~ Z' CuL~
Resident!
Owner Address / City / Zip: t• a d A-)
Applicant is: Z Owner Contractor
Description of work:
Type of Work
Construction Cost: Q Multi-Family Building: (Yes / No
Company: Contact:
Contractor Address: City:
State: Zip: Phone:
License Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
TD J~flz___
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
Yes ____No 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 the are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 4540002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.gooherstateonecail.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 160
days of per-merit issuance.
X
Applicant's Printed Name
J Applican s S gnatu
Page 1 of 3
+ !)0 N T WRITE BE W THIS LINE bO"19
SUB TYPES
- Foundation _ Fireplace Porch (3-Season) _ Storm Damage
_ Single Family _ Garage _ Porch (4-Season) _ Exterior Alteration (Single Family)
- Multi Deck _ Porch (Screen/Gazebo/Pergola) _ Exterior Alteration (Multi)
_ 01 of Plex _ Lower Level _ Pool Miscellaneous
Accessory Building
WORK TYPES
_ New _ Interior Improvement Siding _ Demolish Building*
Addition - Move Building ^ Reroof _ Demolish Interior
_ Alteration _ Fire Repair _ Windows _ Demolish Foundation
- Replace _ Repair Egress Window _ Water Damage
_ Retaining Wail *Demolition of entire building - give PCA handout to applicant
DESCRIPTION
Valuation Occupancy !J/ MCES System
Plan Review Code Edition SAC Units
(25% 100% ) Zoning - City Water
Census Code Stories Booster Pump
# of Units Square Feet PRV
# of Buildings Length Fire Sprinklers
Type of Construction- Width
REQUIRED INSPECTIONS
Footings (New Building) Meter Site:
1( Footings (Deck) Final / C.O. Required
~i~ Footings (Addition) 4- Final / No C.O. Required
Foundation HVAC _ Gas Service Test Gas Line Air Test
Drain Tile Other:
Roof: -Ice & Water -Final Pool: ,Footings Air/Gas Tests -Final
Framing Siding: _,Stucco Lath !Stone Lath -Brick
Fireplace: -Rough In Air Test iFinal Windows
Insulation Retaining Wall: _ Footings - Backfill _ Final
Sheathing Radon Control
Sheetrock Erosion Control
Reviewed By: , Building Inspector
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC c-,q
Utility Connection Charge
SSW Permit $ Surcharge
Treatment Plant
Copies
TOTAL
Page 2 of 3
j~.41Nrn1W1v1)1S]1v1Z V n I JWW"- nECps://ulX -i v-~v-uv~~viGwci.g~vy~cu~ci~vii~cii~.~v++uuhvicwvx» a uivuv .
1 i;J d
CER TIFICA TE OF SUR VEY FOR
J0147V 13-ER C-jr
PR OPER T Y A DDR ESS DESCRIPTION- FROM TAX RECORDS
4236 Braddock Trail Lot 7, Block 2,
Eagan, MN 55123 NORTHMEW MEADOWS
Dakota County, Minnesota
CSA H NO. 30
CDI FLEY R~OA p~ D~
S8A'5Z11'E from FOUM
116.49 0.6 1W of Moot
-R" f~mCE k , CN,IRI~ E'
0 50 a'
SCALE IN FEET
4
%
, 5 try
y ~ S Sr
4.9
o '
,
I hereby certify that this survey, plan A LEGEND:
%
or report was prepared by me or under Denotes Iron monument found
my direct supervision and that I am a 0 Denotes 1/2 inch Iron Pipe set
duly Licensed Land Surveyor under the and marked with RLS #47223
laws of the state of Minnesota.
144Dk adeStM250
Saint Pei, MN 55106
Theresa K. Foster ~i ftKO51.7"12
MN 47223 L j Fen 651-776-0 M
GATE UC. NO. "''.~rr..,I'd+r,r." E~na~:H~mpasaa.0om
~i DRAWN BY-A&- PROJECT NUMBER X31-041 r
1 of 1 4/10/2013 9:27 PIb
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA141813
Date Issued:03/31/2017
Permit Category:ePermit
Site Address: 4236 Braddock Tr
Lot:7 Block: 2 Addition: Northview Meadows
PID:10-52100-02-070
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
Surcharge-Fixed $1.00 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 -
John R Berg
4236 Braddock Tr
Eagan MN 55123
(320) 290-2600
Benjamin Franklin Plumbing
5718 International Parkway
New Hope MN 55428
(612) 238-9709
Applicant/Permitee: Signature Issued By: Signature