731 Camberwell Dr
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
It 1 1 1 '. (11INSPECTION REC4RD
SITE ADDRESS:
i
PERMIT TYPE:
Permit Number:
Date Issued: t?:1 : .• ? •' °? t
1'Rhltif li4JL E-?'`;1lI
r Orlr tsii I iti;l s?11
I i•rINA1if.';: hFtFll?l If
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PERMIT SUBTYPE: TYPE OF WORK: ?
; ?r:w
Permft No. PermR Holder Data Telephona N
S/W
PLUMBING IQ 3 d ? ?'
HVAC
ELECTRIC S 11$ 1q ?
ELECTRIC ??rj-1
Inspwtfon Date Insp. Comments
Footings 1 ? . j G1?L]
FoundaUon
Framing
Roofi9
Rough Plb9• ?
Roug'' "'g- ? S 9 3 ,8l?/
?s,l. ?
Fireplace
Flnal Hcg. 'I Z'3
Orsat Test
Final Pbg. _ 4 Plbg. Inspedor - Noti(Y Plum6er
Const. Meter
Ergr-/Pl-
sidq. Final '7. Z6 ? 3
Deck Ftg.
Deck Final
Well
Pr. Disp.
.
L-
Wertificate of Cccupanc?
KU4 of c???
??ftimt $f lox{" 3860"dm
This Certif cate issued pursuant tn the reqwirements of the Unifarm Building Code
certiJying that at the time of issuanee this stnrcture was rn complianee with rhe various
orrlinances of the Ciry regulating building construction or use_ For t/ie following:
SF DWG 20737
ux c??ification: Bwg. ramit Mm
0-pa-rType z? n;5vi?
_ ,
Owner of Buildin Address
T
B LA)cali f s
? -? Dam, /Building Official /
POST IN A CONSPICUOUS PLACE
Address 731 CAru3ERWELL Dluve Zip 5512 3
Lot 4 Bik 2 Sub HIi.iS oF siilNEB= 31D
THGSE? MS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECT'ION.
Dat / ?' ? ? ? Yes No Inspector: .
Final g de (6 om siding) ?
Petmanent steps (garage)
Permanent steps (main entry)
Permanent driveway
Permanent gas
Sod/Seeded grass
Trail/curb damage
Porch
Basement finish
Deck
Please verify with the builder the removal of roof test caps from the plumbing system and the shu6off of water supply W.
the outside lawn faucet before freeze potential exists. Contact engineering division a[ 681-4645 before working in tight-of-way or ins[alling underground sprinkler system.
Whire - City Copy Yellow - Resident Copy Pink - Contractor Copy E)
d 7 8 8 //??P?
R Quesc Ble Fire Na. ough-in Inspaction
e Ired?
J Reatly Now f2,' W ill Nolify Ins?
W °'
3 ? Vas u N.
Ixlicensed coMractor p owner hereby request inspection of above elect al work at:
Job Atltlress (Sireet. x or Rome No.? Giry
7 3 f
Section No. Township Name or No. Ranga No. Co? b
OI PM1One No. -
Power 5 lier Atltlress
^
ElecVm ontracbr?COm Name] ConVaclor5 Lioense No.
? do 3?I
Mailin AtlOress IGOn?rector or Owner Makinq Ins1a11a0on)
Authoriietl Siqnature ICoro tlor,0 r aiing Installatio Phone Number .
(. 3•38(0
MINNESOTA STATE BOAPD OF ELECTRICITV , U TNIS INSPECTION REQLlEST W ILL NOT
Grlggs-Mltlway BIEg. - Hoom S-173 BE ACCEPTED BY THE STATE BOARO
1821 Univeraity Ave.. St. Vaul. MN 55106 UNLESS PflOPEfi INSPECTION FEE IS
Vhone(611) 6<Y-OB00 ENCLOSED.
1,1 '?iEQUEST FOR ELECTRICAL INSPECTION 94?, G??o,qoo ae
p ? Sae inshuctions lar completing tnis lorm on beck al yellow cropy.
Z1 G
Lt 271 H? ~ X" Below Work Covered by This Request ?y??,
ew Aatl Rep: , Typeof8uilding AppiiancesWired ipmemWired`
Home Range Temporery Service
Dupiex Water Heater Electric Heating
Apt. Builtlinq Dryer Other (Specify)
CommAndustrial Furnace
Farm Air Conditioner
Omer (syecilyl Contractor's fiemarks'.
Compute lnspection Fee Below:
# Other Fea # ServiceEniranceSize Fee # Cimuits/Feetlers Fee
Swimming Pool 0 to 200 Amps 1 io 100 Amps
Transtormers A6ove 200 _ Amps A6ove 100 _ Amps
Signs inspecmrs use omy:
?
?? TOTAL ?
' Irrigation Booms ?n
??
[^, y.
Special Inspection ?
q
TAv ?f
Alarm/Communication p
?_
?
THIS INSTALLATION MAY? ORDERED?ISCONN?TEd iF NOT
Other Fee COMPLETED WITHIN 18,MONTHS,/f ?
I, the Electrical Inspector, heieby
i
h Rough-in
?
ry that t
cert
e above inspection has
been made. - Final ( D ?
OFFICE USE'JNLY ?
Tnis request voia 18 montns trom '
? 1 o 0 ?'/'/?/9??. . ?
d llp>
Request Date
5 - ? ? - ? ? Fire No, ougninlnspecti0n
uiretl?
Ves u No
? Ready Now ?Will Notiy mspeGOr
When Reedy?
I"t'licensetl contractor D owner hereby request inspection of a6ove electrical work at.
Jo0 AOdress f5veet. Box or Rome No.l Gity
Section No. Townstrp Name or No. Range No. Co nt
Occupant(PRINT) _ Phone No.
Power SuOPlier
? Adaress
Elechi Conlrec?orlGOmpany Name)
? Gontractor's License No.
C? 6 O
Mailing Atlaress ICOr,vactor or Ownar Making Installalion)
Aumonze S?gna re IConuacior.Owner aMing Installalioni Phone NumDer
,-?e,:?_ 4-(. 3- 3 S U
MINNESOT4 STATE BOqqD OF ELECTRICITY
Griggs-Mltlwey Bldg. - Room S473
1821 Unlvarsity Ave., SL Paul. MN 55104
Ptwne (612) 6J2-0800
THIS INSPEGTION FEOUEST WILL NOT
BE ACCEPTED BV THE STATE BOAPD
UNLESS PROPER INSPECTION PEE IS
ENClOSED.
,4:0b''' 9,v REQUEST FOR 5L'iGTRICAL INSPECTION ?,°?` ?? ee ooooi ae
lo See Instmclions lor completing Ihis lortn on Dack of yeliow copy. 11227
1 92 x" Be/ow Work Covered by This Reques?/
ew Add Rep. TypeoBUilding AppliancesWiretl EquipmentWired
Hm
oe
Range
Temporary Service
Duplex Water Heater Eleciric Heating
pt. Building Dryer Other.(Specity)
omm./Industrial Furnace
4 Farm Air Conditioner
Ot
her(syecify) Cpnvactor's Remarks'.
Compute Inspecfion Fee Belaw:
# Other Fee # ServiceEnlranceSize Fee # Circuits/Feeders Fee
Swimming Pool 0 to 200 Amps 0 to 100 Amps
Transformers Above 200 _ Amps Ahove 100 _ Amps
Signs Inspecmr's Use Onry: -' 7OTAL 5 4
' Irrigation Booms 61 po- CJ '-
Special Inspection
AlarmlCOmmunication THIS INSTALLATIDN MAY BE ORDRED SCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONTHS.
I, the Electrical Inspector, hereby
tif
h
h
b Aougm" r oaie
cer
y t
at t
e a
ove inspection has
been made.
OFFICE USE'JNLY
This repoest voi0 18 monihs Irom
` RESIDENTIAL BUILDING
?J Li Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX 4 651-675-5694
?`7U?oa
New Consdvc6on Reauirements RemodeVReoair ReauiremenGS Office Use Onlv
3 regislered site surveys showing sq. ft. of lot, sq. R. of house; and all roofed areas 2 copies of plan Cerl of Survey Rectl
(200% maximum lot coverage allowed) 1 set of Energy Calculations for heated additbns Tree Pres Plan Recd
2 copies of plan showing heam 8 window sizes; poured found design, etG 1 site survey for additions & decks Tree Pres Nat Reqtl
1 set of Eriergp Calcalations Add'Non - indicete if on-stte septic system _ On-site Septic System
3 copies of Tree Preservation Plan i( lot platled atter 717/93
Rim Joist Detail Op6ons selecdon sheet (bldgs wAh 3 or less units
Date OJ Construction Cost
SiteAddress UniUSte #
DescriptionotWork /???? ?«/c
Mu1ti-Family Bldg _ Y,KN Fireplace(s) , 0 2
Property Owner - Telephone #( G!l ) 6??- d G Z/
??G/! 'f' ?c' ? i t?
/2'r? p?r+Gdi
Contractor r/ !/qlOwHCr ?,61
Address City ?---
State Zip Telephone # ( ) -'
COMPLE7E THIS AREA ONLY IF CONSTRUCTING A NENf BUILDtNG
- Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code woricsheet
(+1 submission type) Submitted Submit[ed
• Energy Envelope Calculations Submitted
Licensed Plumber IU ?? P LS i_ Telephone #(
Mechanical Contractor IIAY 19 200?3 Telephone #(
Sewer/Water Contractor Telephone # (
I hereby apply for a Residential Building Permit and aclaiowledge that the information is complete 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
pernrit; that the work will be in accordance with the approved plan in the case of work which requires a review and
approval of plans. ,
c".--
Applicant's Printed Name Applicant's Signature
OFFICE USE ONLY
Sub Types
? 01 Foundatlon ? 07 05-plex ? 13 16-plex ? 20 Pool
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 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 ip-plex 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex pibg_v or _ N ? 25 Miscellaneous
Work Types
? 31 New ?
? 32 Addition ?
33 Alteration ?
? 34 Repiacement
Valuation
Census Code
?
SAC Units
Nbr. of Units
Nbr. of Bldgs
Type of Const
Footings (new bldg)
? Footings (deck)
Footings(addition)
Foundation
Drain Tile
Roof Ice & Water Final
_ Frauuug
_ Fireplace _ R.I. _ Air Test _ Final
Insularion
Width
REQUIRED INSPECTIONS
FinaUC.O.
? Final/No C.O.
_ Plumbing
HVAC
Other
_ Pool _ Ftgs _ Air/Gas Tests _ Final
_ Siding Stucco Stone
_ Windows (new/replacement)
_ 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
t,.
? 30 Accessory Bldg
? 31 6ct. Alt - MWti
? 33 Ext. Alt - SF
? 36 Multi Misc.
35 Int Improvement ? 38 Demalish (Interior) ? 44 Siding
36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
37 Demolish (Bldg)* ? 43 Reroof ? 46 Windows/Doors
`Demolition (Entire Bldg) - Give PCA handout to applicant
Occupancy MC/ES System
Zoning City Water
Stories Booster Pump
Sq. Ft. PRV
Length Fire Sprinklered
? ??
?? o cao
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EACAN
3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675
NewConrtruetion Reauirements
. 3 registered site surveys showing sq. ft. of lof, sq. ft. of house; and all roo(ed areas
(20°h mazimum lol coverage allowed)
• 2 copies of plan showing beam & window s¢es; poured found design, etc.)
• 1 set of Emrgy Calculations
. 3 capies of Tree Preservation Plan'rf lot platted after 711/93
• Rim Joist Detail Oplions selection sheet (bldgs with 3 or less units)
DATE S / (? IOa
t-) 5& --I .-C.J
RemodeVReoair Reauiremente
. 2 copies of plan
• 1 set of Ener9y Calculalions for heated additions
. 1 site survey for exterior additions & decks
• IMxate if home urved 6y septic system (or addiUons
VALUATION ?. ,? S?I • ?
SITEADDRESS 13) L'Q??c°rr,.? P1, CJr• ?• MULTI-FAMILYBLDG _Y _h
TYPE OF WORK 2r ?12e FIREPLACE(S) _ 0_ 1 _ 2
APPLICANT Ur1AA C? r c??-kL7C?'c.n
STREETADDRESS ?70S (_c.ke CIiYLhc,4?ssr-\ STATE MI'\4IP 55312
TELEPHONE # GSd -?6Y 9q?Ss CELL PHONE # FAX # asa
PROPERTYOWNER ???+' \Cl'fi?n \ e,II TELEPHONE# 651- 6B1 (}qW
------°---------'-----------'------°------°°-°---------'---'-----'-----'----------'-------
COMPLETE THIS SECTION fOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNrSO'CA RULI' 7670 CA1'CGORY 1 A
(J su6mission type) . Residential Ventllation Category t Worksheet Submitted •
• Energy Envelope Calculations Submitted
Plumbing Conhactor: ___
Plumbing system includes:
Mechanical Contracfor:
Mech:uucal system includes:
Sewer/Water Conhactor:
_ Air Conclitioning
Heat Recovery System
Phone #
Phone #
o s Zooz
Fee:
Fee: $70.00
-°------------------°°°------------------------°°--------------------------------------------°--°-----------------
I hereby acknowiedge that I have read this application, state that the informa?'on is correct, and 7tocomply
with all applicable State of Minnesota Statutes and City of Eagan Ord4inoc,V /?
SlgnntureofApplicant / / l/?J
OFFICE USE ONLY
Water Softencr
_ Water Hcater
_ No. of Baths
_ Phonc #
Lawn Sprinklcr
No. of R.I. Baths
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4102
?
LAND SURVEYORS • CML
LAND PLANNERS. IANUSCAf
*
s
?
;
'oo
.
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> N. \?20? ?
;;ertificate of survey for: The Rottlund Companv, ItiC.
House Address:
Model Name:
S 83•25'30" W
72.04
$3
Camberwell Drive. Eagan, MN
Hampton , Customer:01son
. /
- ?------ ?
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S\ ?
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Al?
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g-1y.o7
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SS ?m ?
> >O•? GM•?
i
E'(.5 Highwoy 16 Norii,cast
eloine, MN 5543+
672) 783-1880•Fax 783-1883
899.8
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?,? 899./7 ?
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899.9 ? Q ?1•
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o
NOTE: GONIRACTOR MUST VERIPY ALL DIMENSIONS ?
i i'S.J.:AAal
. 900.0 Denotes Existing Elevation pROPOSED HOUSE ELEVATION
• eoo. Denotes Proposed Elevation Lowest Floor Elevation:894.45
Denotes Drainage & Utility Easement
Denotes Drainage Flow Direction Top of Biock Elevation:902.56
--o-- Denotes Monument Garage Slab Elevation:9a2.23
a- Denotes Offset Hub Bearings shown are assumed
LOT 4, BLOCK 2 HILLS OF STONEBRIDGE
DAKOTA COUNTY, MINNESOTA 3 R D A D D I TI 0 N
I herebVi certfly [het tAi: survey, plen orravort wa?s?p?r/e/pared by me r unde my direct suparv?ision end ehat I am duly Re9istered Land Surveyor
,der the laws of the State ot Minnpota. Dated this_L'L^?'., day of A.D. 19?/?L. _---?
SC.aIC. 1inch=30f88i R 3ERT?.SIKICHL.S.K0.M1O.I4B91
?
...,
? 2422 Fnterprise Drive
Mendota Heights, MN 55120
(612) 681-1914•Fax 681=0488
3
?
?
1303D.0?
REACTIYATE _
?`? `??? CITY OF EAGAN
PEi2MIT .,& 71?5j
1993 BUILDING PERMIT
681-4675
I(%-AT1QN I ..: ?`:? LL. , L_')
APN 19 t"3
SiNGLE & MULTI-FAMILY 2 sets of plans, 3 registered site su vsws?-?-eopy-e€-en rgy
calcs.
COMMERCIAI 2 sets of architectural & structural plans, 1 set of
specifications, 1 copy of energy calcs.
nalty applies: 1) when permit is typed, but not picked up by last working day of month
which request is made, 2) address is changed or 3) lot change is requested once permit
issued.
/ ti te / G'? Valuation of work
[Date
te Address: ?73 t C?v??erwell D?1'S t?
STREET SUITE M
Tenant Name: (commercial only) ? f-?+'?JQh(? C0•?- C.
LOT BLt1CK 2 S B
D. P.I.D, M
I
I 5 ne /'
Descri tion of work: Sr ? l-c- -?c"v-'4
The applicant is: wner Contractor ? Other (Deseribe)
NameC\ (2_?? Phone 5'7f ^d o
Property us, FIRST
Owner Address S 20 k?• ?? ? 120? _ ^3 0?
STREET STE #
City State /--t ZiP SS?T
Company 5;',l?_ _ Phone
Contractor Address License S1X_5_' Exp..X3
City State ZiP
Company Phone
Architect/
Engineer Name Registration #
Address
City State Zip
Sewer & water licensed plumber 6/ . Processin9 time for
sewer & water permits is two days once ar ha een approv .
I hereby acknowledge that I have read this application and state that the information is
correct and agree to comply with all applicable St e of Minnesota Statutes and City of
Eagan Ordinances.
Signature of Applicant:
OFFICE USE ONLY
BUILDING PERMIT TYPE '
13 01 Foundation ? 06 Duplex ? 11 Apt./Lodging ? 16 Basement Finish
JA 02 SF Dwg. ? 07 4-Plex ? 12 Mu1ti. Misc. ? 17 Swim Pool
0 03 SF Addition ? 08 8-Plex ? 13 Garage/Accessory ? 18 Comm./Ind.
? 04 SF Porch ? 09 12-Plex ? 14 Fireplace ? 19 Comm./Ind. Misc.
O 05 Sf Misc. ? 10 Multi. Add'1. ? 15 Oeck 0 20 Public Facility
? 21 Miscellaneous
WORK TYPE
3K 31 New ? 33 Alterations ? 35 Tenant Finish ? 37 Demotish
O 32 Addition ? 34 Repair ? 36 Move
GENERAL INFORMATION
Const. (Actual) V-N Basement sq. ft. MWCC System YES
(Allowable) lst Ft. sq. ft. City Water y&S
UBC Occupancy ?j 2nd F1. sq. ft. PRV Required
Zoning Pp'Q_i Sq. Ft. total Booster Pump
# of Stories Footprint Sq. ft. Fire Sprinkler
Length ? On-site well Census Code ini
Depth 3 y' On-site sewage SAC Code ar
Wd"o
?
i -
APPROVALS ??
cur?f -_-----
Planning Building Assessments
Engineering Variance
REQUIRED INSPECTIONS
? Site
? Wallboard
0 Footing
? Final
O Framing
? Draintile
? Insulation
? Fireplace
Permi t fee ! veiuac;a,_ g IL{ 3 f ODO
Surcharge
Plan Review GA 2AC.cr
32 X 20 ,- Gyo
License z X Iv=
(2p
)
MWCC SAC
City SAC ._.-,-- Z?xza.:- ?By GZo x/6=9rlZo
Water Conn.
?
a.o ?e 144
Water Meter
Acct. Deposit
{srF?o?,a; l?Nx1S- l5?96Q
S/W Permit
S/W Surcharge BsmTF l06?1
Treatment Pl. I Y. 9 -z r?
Road Unit
Park Ded.
Trails Ded. l081 X i?f = 5839 `4
Copies
Other
ZNU F???xe %
Total:
SAC % IDa
SAC Units
/yZ,?yZ
k1 CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
PERMIT
PERMIT TYPE:
Permit Number:
Date Issued:
BUILDING
020737
04/27/93
SITE ADDRESS:
P.I.N.: 10-32992-040-02
731 CAMBERWELL OR
LOT: 4 BLOCK: 2
HILLS OF STONEBRIDGE 3RD
DESCRIPTION:
Building Permit Type
8uilding Work Type
UBC Occupancy-_,
Construction Type
Zoning
Building Length
Building Width '
SF DWG
NEW
R-3 M-1
VN
PD R-1
59
34
REMARKS:
RECEIPT #
S&W CONTRACTOR - VALLEY PLBG.
FEE SUMMARY:
VALUATION
Base Fee
Plan Review
Surcharge
SAC
SAC %
SAC Units
Subtotal
$790.00
$513.50
$71.50
$750.00
100
$2,125.00
$143,000
MISC FEES $1,744.50
7ota1 Fee $3,869.50
CONTRACTOR: - Applicant - S7. LIC. OWNER:
ROTTLUND CO INC, THE 15710304 0001335 ROTTLUNp CO INC THE
5201 E RIVER RD 5201 E RIVER RD 301
FRIDLEY MN 55421 FRIDLEY MN 55421
(612) 571-0304 (612)571-0304
I hereby acknowledge thet I have read this application and state that the
information is carrect and agree to comply with all applicable State of Mn.
Statut s and City of Eagan prdinancas.
L -
APPLICANT/PEFMIT S16NATURE ISSUED B: SI NATUR-E I
INSPECTION RECORD
CITYOFEAGAN PERMITTYPE: BuzLoiNG
3830 Pilot Knob Road Permit Number: 020737
Eagan, Minnesota 55123 Date Issued: 0 4/2 7/9 3
(612) 681-4675
SITE ADDRESS: Lo T: o B L 0 C K: 2 APPLICANT:
731 CAM9ERWELL DR ROTTLUNO CO INC, THE
WILLS OF 570NEBRIDGE 3RD (612) 571-0304
PERMIT SUBTYPE: TYPE OF WORK:
SF DW6 NEW
INSPECTION
FOOTING .. .
FRAMING DA
INSULATION FINAL
FIREPLACE
REMARKS: RECEZPT #
F-
S&W CON1"RACTOR - VALLEY PIBG.
L
* PIONEER
* engineeri
* * * *
LANO SURVEYORS •
LANO PLANNERS • LAN
2422 Enterprise Drive
Mendoto Heights, MN 55120
612) 681-1914•Fox 681-9488
625 Highway 10 Northeast
8laine, MN 55434
;612) 783-1880•Fax 783-1883
Certificate of Survey for: The ROttIUI'iCl Companv, If1C.
House Address:
Model Name:
S 83•25'30" W
3 72.04
Camberwell Drive Eagan. MN
Hampton i Customer:01son
/
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899.4 /
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hr 47\Z??Zla?1?Eti1i`t
NOTE: CONTRACTOR MUST VERIFY ALL DIMENSIONS /
/
1?14C2#G?Sa?
x 900.0 Denotes Existing Elevation PROPOSED HOUSE ELEVATION
x 900.o Denotes Proposed Elevation Lowest Floor Elevation:894.45
Denotes Drainage & Utility Easement
Denotes Drainage Flow Direction Top of Block Elevation:902.56
-o- Denotes Monument Garage Slab Elevation:902.23
--9- Denotes Offset Hub Bearings shown are assumed
LOT 4, BLOCK 2 HILLS OF STONEBRIDGE
DAKOTA COUNTY, MINNESOTA 3 R D A D D I TI 0 N
1 hereby certify that this survey, plan or report was?prVared by me r unde my tlirect supe?rv?ision and that I am duly Registered Land Surveyar
under the laws of the Staie of Minnesota. Dated this 14?'l day of A.D. 191L ---?
S C aI e. 1Lnch = 30 feet
ROBERT B. SIKICH Z.5. G. O. 11891
178 13030.07
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0---0 D
tror soAVSY eatru=1s scA axssazxrsu
lRODTRTY .9e+_t.!
Date OZ SOt7SYi
• Rsqistered 7,ana surveyor aiqrrsture and empany
• Suildiaq Permit 1lpplicant
• Lgal desesiptioa '
• 1lddress
• North arrow and bar seale •
• ifous• type (zambies, valkout, sp11L t?/o, split aritry.
Iookout, ato.) '
• Dizeetional draiaaqe asrovs vith siope/qradianL 0.
• Fzoposed/axisLinq sevar and vater servicss
• Str*et tsame
• Dsiveuay
, Sevez service
D' D D Lot eorners
8' D D
D?D D • Top ot eurb at the drivevay
• Eievations of any sxisiinq aCjaeeni bomes
.
?D 0 • ?SODOflQ
?arage floor
? n n • fs:st rioo=
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? D • pzoperty eorners
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pONDiVG lRLaB [i! aenlie b?.?
Fnsement line
0 0? D .
t7WL :
'
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D
? •
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Por,d 1 desiqnation
!
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? D D
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Lot lines
?' 0 L
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• Pzoposed bome dimeasions incluCinq tny proposee doelu,
overhnngs qzeatsr tlsaa 21, poreAes, ete. (3.e. all
PJ? D siructures seqnisinq pezmaaent lootinqs)
0 • Shov all ensemer,ts of secard and any City utilities vithin
? D D those ensemente
k
f
• betbac
s o
proposad strueture and •aLback of adjaesnt
sxisiing homes
? Reieininq v zeqyisaments, it any
• ? / /Z4r 5?1
Rev i.ye3: ( C
• • THE {??}M?oN
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Detenin vorkini; sqiinre footai?c of ench.
1. iotal er.pcsed vall area .. 2tL??. 2 sq. ft. x 0.11 - 2q4,2
2. Total reof/ceiling a-ea .. /? D+ c;", ft. X 0N0.'.b
•
iotel exposed wall ¢rea nbove floc+r = 26 7 S • Z+
a. Total vzll window area .................... :....... v7•7
b. Totel door erea .._...... ? ?
..........................
c. Tota1 slidine 61ags Zoor area :........
d. Total fire?lece vall area ........... .-
.............
e. Total vall framing a:ea (average lOP) ............. 2 ,
f. Total net vall area above floor ................... z Z,d
g. Total rim Joist area ..............................
Total exposed founclation arca
h. Total foundet+_on vindov a:ce ....... ?
................
i. ^total net foundation a-ea above gr.ade
....... 7
? . C:te^ine "U" valce o: each vall .es;ment.
? . g. 2 r 7, 7 X ".u° 0, 42 = q l. 43
b. 3p7,7I; _ x,.U„
C. 39. ? l X„?„
a. X
--?
e. 713. S?o xA,ul,
r. Zz,D(p X„U„ D,D¢?j _ . sp.2,?,¢
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h. X ,Iu„ _ • _??
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3 . .................................. .r??.?., Z?F Z.l
If iter.. k3 is the same as, or lesa :.h:?n ilcm 11, yoti n.?vc met the intent
or sac 6006(c)2..
f,
Total exposed rooC/ceilinG nren
' '? ? . .. .
Total gross roof/ceilinr, arc:t
,j. Total skylieht erza .......................... _?s--
k. Total roof/ceiling frzming area...............
/? ?•
1. Total net insulated roof/ceilinti area ........
Dete-mine "U" vnluc for cnch rnof/cci 1 int; scFgment.
, X nUn
k: X 'lUll ?• G? ?7 = ?i?'J ? • ?
x„u„ p.U2Z = zl,o? .
a . ...............................:. TotaI Z 3 .`T
- • e,?
If to:al of N4 is the same as, or less than N2, you have met ttie intent of
ssc 6006(c)1. .
To utilize the total envelope systec method, the values establi<hed by the
sua of items N3 and BL ehall not be 6reater.thxn the sum of iten:s A1 and 92.
1. + 2. '
? • 9•, ' ?+ 4. =
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k 46?-g
PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. AISO, FOR TOWNHOMFS AND
CONDOS WHEN PERMITS ARE REQUIl2ED FOR EACH UNTT.
NEW CONSTRUCTION
ADD-ON A/C
ADD-ON FURNACE
FIREPLACE INSERT
DATE _ (1 /?
HVAC: 0-100 M BTU
ADDTTIONAL 50 M BTU
GAS OUTLETS (MINIMUM 1 @ $3.00 EACH)
ADD-ON/REMODEL (ExisTIlVG CoNSTRUCrtoN)
STATESURCHARGE
TOTAL
SITE
OWNER
n^n ??
CITY:,nQ 1- STATE:
TELEPHONE #: V?(D Cp o 1
??s9Y
FEES
$ 24.00
6.00
$ 20.00
.50
a?-5o
TELEPHONE #: 23CG_2J?J?2
ZIP CODE:
SIGNATURE OF PERMITTEE
1994 MECHANICAL PERMIT (RESIDENTIAL)
CITY OF EAGAN
, 3830 PII,OT KNOB RD
EAGAN MN 55122
(612) 681-4675
PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. AISO, FOR TOWNHOMES AND
CONDOS WHEN PERMTTS ARE REQUIRED FOR EACH UNTT.
NO. FIXTURES EACH TOTAL
1 SHOWER 3,00 3 -
-'-? WA'T't;k i,ivJET 3 ;,,n
a BATH T'UB 3.00
3 LAVATORY 3.00 9-
t KITCHEN SINK 3.00 ? -
LAUNDRY TRAY 3.00
HOT TUB/SPA 3.00
WATER HEATER 3•00 ?-
? FLOOR DRAIN 3•00 3 `
GAS PIPING OLTTLET • minimum - 1 3.00 3-
3 ROUGH OPENINGS 1.50
WATER SOFTENER 5.00
PRIVATE DISP. • ueiLcry. i+c. 15.00
U.G. SPRINKLER • eome uneer consi. 3.00
ALTERATIONS • to austing 15.00
WATER TURN AROUND 15.00
STATE SURCHARGE .50
TOTAL:
SITE ADDRE3S: 131 C a?b«.... <l% 4c-
OWNER NAME: R6w ,J
INSTALLER: Vd?l ?c ? Q1t,.
ADDRESS: L? ( v C 2"tc c n?
CTTY: ?f3 A? STATE: ZIP CODE: S-? PHONE #: ( ) 4?0-
SIGNATURE OF PERMITTEE
1993 PLUMBING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PII.OT KNOB RD
EAGAN MN 55122
(612) 6814675
PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMES AND
CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNTT.
X NEW CONSTRUCTION
ADD-ON A/C
ADD-ON FURNACE
DATE
FEES
HVAC: 0-100 M BTU $ 24.00
ADDITIONAL 50 M BTU 6.00
GA5 OUTLETS (MINIMUM 1@ 53.00 EACH)
ADD-ON/REMODEL (ExISTiNG CONSTRUCTION) $ 15.00
STATE SURCHARGE .50
TOTAL a-1 SO
SITE ADDRESS:
OWNER NAME: TELEPHONE #:
INSTALLER:?\c.\e \\"y?
ADDRESS:
.
CITY: C-_\c'?Q? STATE: ZIP CODE: ?
TELEPHOIv'E #:
1993 MECHANICAL PERMTf (RESIDEIVTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
FAGAN MN 55122
(612) 6814675
RESIDENTIAL BUILDING
Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5674
S ?1 O.So
LQj?
l-1'3'p3
NewConsWclionReaui2ments RercrodeVReoairReauirements Ofice UseOnN
3 registered site surveys showing sq. R. of lot, sq. ft. of house; and all roofed areas 2 copies of plan Cert of Suney Reoi
(20% maacimum lot coverage allaved) 1 set of Energy Cakulations for heated addillons Tree Pres Plan Reoi
2 copies of plan showirg 6eam & window sizes; poured found design, etc. 7 site survey for additlons & decks Tree Pres Not Reqd
lsetofEneyyCalculations Addifion - indicateilan-sNesepticsystem _ On-siteSepGcSystem
3 copies of Tree Pmsenatlon Plan if lot platled aRer 71153
Rim Joist Detail Options selection shcet (bldgs with 3 or less units
Date 4-/_{? Construction Cost /0, OV U
Site Address 73 / UniUSte #
Description of Work /?• ''"5 ???r? v,/hJ?i"'?K ?
-T
Multi-Family Bldg _ YN Fireplace(s)
_ 0 _ 1?Z_ 2
PropertyOwner 1'9 114n ?rri?/cn5s?? Telephone#( 61_1
Contractor
Address
S[ate Zip City
Telephone # ( )
COMPLETE THIS AREA ONLY IF
Energy Code Category - Minnesota Rules 7670 Cateeorv 1
. . Residential Ven6lation Category 1 Worksheet
(Jsubmissiontype) Submitted
• Energy Envelope Calculations Submitted
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
A NEW BUILDING
Minnesota Rules 7672
. New Energy Code Worksheet
Submitted
Telephone #(
Telephone #(
Telephone #(
I hereby apply for a Residential Building Permit and acknowledge that the information is complete 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 pemut, 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.
ApplicanYs Printed Name
??-- o
Applicant's Signature
` L
?-??
OFFICE USE ONLY
Sub Types
? 01 Foundation ? 07 OS-plex ? 13 16-plex ? 20 Pool ? 30 AccessoryBldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt- SF
? 04 02-plex ? 10 OS-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex U' 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg}rY or _ N ? 25 Miscellaneous
Work Types
? 31 New
? 32 Addition
W' 33 Alteration
? 34 Replacement
Valuation ? O O U
Census Code `F 3
SAC Units ?
Nbr. of Units 0
Nbr. of Bldgs /
Type of Const ----
- Footings(new bldg)
_ Footings (deck)
_ Footings (addition)
_ Foundation
Drain Tile
Roof Ice & Water Final
? Framing
? Fireplace _4/ R.L ?Air Test ? Final
?Insularion
Occupancy
Zoning R- !
Stories
Sq. Ft.
Length
Width
MC/ES System
City Water
Booster Pump
PRV
Fire Sprinklered
REQUIRED INSPECTIONS
FinaUC.O.
FinaUNo C.O.
? Plumbing
HVAC
Other
_ Pool _ Ftgs _ Air/Gas Tests _ Final
_ Siding Stucco Stone
_ Windows (new/replacement)
_ Retaining Wall
Approved By 3 03, 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
? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 37 Demolish (Bldg)* ? 43 Reroof ? 46 Windows/Doors
•Demolition (Entire Bldg) - Give PCA handout to applicant
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN C} , C) C?
3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675
New Construction Reouirements RemodeUReoair Reauiremenb
. 3 registered site surveys showing sq. 8. of lol, sq. ft. of house; and all roofed areas . 2 copies W plan
(20% mazimum lot coverege allowed) . 1 set of Ereigy Calculations for heated additions
• 2 copies of plan showing beam & window s¢es; poured faund design, etc.) . t sile survey for exlenar addNons & decks
• 7 set W Energy Calculations . Indicate if fwme served by septic system for additiom
• 3 copies M Tree Preservation Plan if lol platted atiar 711193
• Rim Joist Detail Optians selection sheel (bldgs with 3 or less units) '
DATE M 14, -3VALUATION ?10?0a (?i
SITE ADDRESS ?3 f (;ix bn ?N_r il/p,I ? A/?^ ((/ f?, MULTI-FAMILY BLDG _? Y/ N
TYPE OF WORK ?'uj??rA I( OIGtS d`Y-PrTUuW ri?It1rp FIREPLACE(S) _ OT?1 _ 2
ah. . {"d.?h 0. r? L+i)7e ? . (!/t l/)
APPLICANT f-jJ' P S 1LE' Q LfIrvi er.1 I
STREET ADDRESS .9 S r
TELEPHONE #042- Yqa-19 `.65 CELL PH E #
PROPERTY OWNER / I I (('/ (/1 /J
Energy Code Category
(J submission type)
Plumbing Contractor:
FAX #
TELEPHONE# Of' I^L29? I
COMPLETE FOR KNEW° RESIDENTIAL BUILDINGS ONLY
_ MINNESOTA RULES 7670 CA1'LGORY 1
• Residential Ventilation Category 1 Worksheet 5ubmitted
• Energy Envelo¢e Calculations SubmiHed
Plumbing system includes: Water Softener
_ Water Heater
_ No. of Baths
Phone #
f'n rn
MINNESqTA RULES 769_2
• 'New,EqergyCodeWOrksBeeGSubmitted
U
Igy ?
Lawn Sprinkler Fee: $90.00
_ No. of R.I. Baths
Mechanical Contarctor. ?`l? P C f(X Ft'C7VL4eD°`
Mechanical system includes: Air CondiLioning
Heat Recovery System
Sewer/Water Contwctor:
Phone # ?6k ;?7 )?o/?(7
Pee: $70.00
Phone #
I hereby acknowledge that I have read this application, state that the information is correct, ond agree to comply
with all applicable State of Minnesota Statuies and City of Eagan O inance?
?
Signature of Applicanf ,
OFFICE USE ONLY
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Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4/02
PLUMBING (RESIDENTIAL)
Permit Application
t? City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5674
Please complete for: Single Family Dwellings
Townhomes and Condos when permits are required for each unit
Date i / / O j
Site Address e,?k, Unit #
Property Owner ?/41a ??7?G??a y at ?.. Telephone #( lI/)
Contracmr ???•'?'?/?C?
Address City.
State Zip Telephone # ( )
The AppGcant is ? Owner _ Contractor _ Other
Septic System New Refurbished Submit 2 sets of plans and MPC license $ 100.00
InGudes County fee. Additional consultant fees may apply.
Altera?ions To Existing Dwelling Unit, Including $ 50
00
?? Adding fiutures to lower levels or room additions, excluding water softener and water heater .
_ Abandonment of septic system
_ Water turnaround (+ 518" meter if needed -$121.00)
Other.
_ RPZ _ new installation _ repair _ rebuild $ 30.00
_ Lawn irrigation system
_ Water softener _ Water heater $ 15.00
_ replacement _ additional
State Surcharge $ .50
Total $ `j? oG
I bereby apply for a Residential Plumbing Permit and acknowledge that the information is complete and accurate; that the work will
be in conformauce with the ordinances and codes of the City of Eagan and with the Plumbing Codes; that I understand this is not a
pemtit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance wiW the
approved plan in the case Qf work which requires a review and approval of plans.
Applicant's Printed Name
??- ??-
ApplicanYs Signature
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PERMIT
City of Eagan Permit Type:Building
Permit Number:EA108388
Date Issued:12/05/2012
Permit Category:ePermit
Site Address: 731 Camberwell Dr
Lot:4 Block: 2 Addition: Hills of Stonebridge 3rd
PID:10-32992-02-040
Use:
Description:
Sub Type:e-Windows/Doors
Work Type:Windows/Doors
Description:House
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, 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 -
Dag A Hugdahl
731 Camberwell Dr
Eagan MN 55123
Sandau Construction
9925 Lyndale Avenue South
Bloomington MN 55420
(952) 403-9100
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA116950
Date Issued:10/14/2013
Permit Category:ePermit
Site Address: 731 Camberwell Dr
Lot:4 Block: 2 Addition: Hills Of Stonebridge 3rd
PID:10-32992-02-040
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and leave on site.
Carbon monoxide detectors are required by law in ALL single family homes .
Viktar Skirukha
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 -
Dag A Hugdahl
731 Camberwell Dr
Eagan MN 55123
Smart Builders Inc
7001 Garland Ln N
Maple Grove MN 55311
(763) 691-5021
Applicant/Permitee: Signature Issued By: Signature
CZI13I For Office Use
SEP ®4 2O B Permit#: /Y/ 73 v e; a
Permit Fee: '/
Date Received: Lf'(r /vfL
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 O
(651)675-5675 I TDD:(651)454-8535 I FAX:(651)675-5694 Staff:
buildinginspections(&citvofeagan.com L
r 2018/ RESIDENTIAL BUILDING PERMIT APPLICATION
Date: i'�- !X Site Address: 73/ «aAC�1 /91'. Unit#:
r • Name: f /¢.6 r e1, , f klutp,t-�I Phone:
Resident! ,J /�
Owner '• ,h Address/City/Zip: 73/ 61wr r Gt'/f !Jr•
Applicant is: Owner X Contractor
x
Type f Work
Description of work: /t i hL.r�, Re c I
w
Construction Cost: 3 3 " Multi-Family Building:(Yes /No
Company: C6D/f2 57?/dtL. .':e..-445,74. 14C, Contact: --a RX/iv �A/WGd#ft
Contractor Address: /Lo 4/ City: keo,��c
>UyNLa
State: 101A'Zip: S GL/`/ Phone: 6957-11-7r Email: jay ,1 Leshrs/e.kee rGv�—L
• License#: Lead Certificate#: /U/4
If the project is exempt from lead certification, please explain why:
0 J -l-kvs—C
VV
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:
Fire Suppression Contractor: Phone:
r .r, n
NOTE: lans and supporting docum+rnn that you submit a. " i nsidered to be public information.„moo as f i/ mon may be'
classified as on-public if you provide specific eas s that would permit the;City to;conclude that they erre{trade e @ ” 0,4
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's
website at www.cityofeauan.com/subscribe.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
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.orq
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 that I
uplan
in the case of work which requires a review and approval of plans.
x t4
Applicant's Printed Name App' ant's Si C`ttire
DO NOT WRITE BELOW THIS LINE t`YY`70
SUB TYPES
_ Foundation Fireplace _ Porch(3-Season) _ Exterior Alteration(Single Family)
Single Family _ Garage _ Porch (4-Season) Exterior Alteration(Multi)
Multi _ Deck _ Porch (Screen/Gazebo/Pergola) _ Miscellaneous
01 of_Plex Lower Level Pool Accessory Building
WORK TYPES
New _ Interior Improvement _ Siding _ Demolish Building*
Addition _ Move Building _ Reroof _ Demolish Interior
y,, Alteration Fire Repair _ Windows _ Demolish Foundation
Replace _ Repair Egress Window Water Damage
Retaining Wall *Demolition of entire building-give PCA handout to applicant
DESCRIPTION
Valuation ' c2-1_0 Occupancy lis-t./1--• MCES System
Plan Review Code Edition 1,01) SAC Units
(25%_100% X) Zoning City Water
Census Code Stories Booster Pump
#of Units Square Feet PRV
#of Buildings Length Fire Suppression Required
Type of Construction
V6 Width
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
Footings (Deck) Final/C.O. Required
Footings (Addition) Final/No C.O. Required
Foundation Foundation Before Backfill HVAC Service Test Gas Line Air Test Hood
Roof: Ice &Water Final Pool: _Footings Air/Gas Tests Final
Framing 30 Minutes 1 Hour Drain Tile
Fireplace: Rough In _Air Test _Final Siding: _Stucco Lath Stone Lath Brick_EFIS
x Insulation Windows
Sheathing Retaining Wall: _Footings_Backfill Final
Sheetrock Radon Control
Fire Walls Fire Suppression: _Rough In_Final
Braced Walls Erosion Control
Shower Pan Other:
Reviewed By: 1-4/- , Building Inspector
RESIDENTIAL FEES
Base Fee
1 .(1/jivilli4jadi,,,i,
-I"
Surcharge
Plan Review,
MCES SAC 1 1
City SAC
Utility Connection ChargeC/ 0 S&W Permit&Surcharge 5(
— 2'YD
Treatment Plant
Copies
TOTAL
Page 2 of 3
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA158943
Date Issued:11/12/2019
Permit Category:ePermit
Site Address: 731 Camberwell Dr
Lot:4 Block: 2 Addition: Hills Of Stonebridge 3rd
PID:10-32992-02-040
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:One Window/Door
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: 1,500.00
Fee Summary:BL - Base Fee $1500 $62.50 0801.4085
Surcharge - Based on Valuation $1500 $0.75 9001.2195
$63.25 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 -
Dag A Hugdahl
731 Camberwell Dr
Eagan MN 55123
(952) 373-1432
Sandau Construction
9025 Hwy 101 W
Savage MN 55378
(952) 403-9100
Applicant/Permitee: Signature Issued By: Signature