4016 Camberwell Dr N7- 11
INS
?. ' CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesata 55122-1897
(612) 681-4675
SITE ADDRESS:
i ! ", 1'4 14 t 1,1 t,I (' I, 1 ? &P N
I I' I 3 1; ', 11?,.? ? 11?4FFtV I ItfaE, i?tiI.l
P,ERAAIT SUBTYPE:
,. , ?
I If 1>!f f I I4IC,
' {: E'1Ir1a?h
PERMIT TYPE:
Permit Number:
Date Issued:
lati ? i i? I M??
APPLICANT:
fl1 I?? i? , , *
• ? ? ? , .? , . ? ". ?
TYPE OF WORK:
II f ',f I? 1I'1 f ('rPf
f I t4 i1 1.
II i{. tI
Pfi F f i
{ F Ii I 1?',;! 1'ti?;+ Z1 Y
I rl ' iYi i.3' i IMfi 11 N li"• ', k iI 1 ? I1k / if'I k44. ! f'I 1f'I:11 !.:',. ", (I?` ? 1 1
ft(ah1i) i idPlri l i? t:;?S { P f: , i i It 19 ! I. h! I? 1' '.1 E)tFl F3t Jipl )
J
Permft No. Permlt Holder Dete Telephone #
ELECTRIC
PLUMBING
HVAC
Inspecdon Date Insp. Comments
FOOTINGS
FOUNO
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYPBOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
BSMT R.I.
BSMT FINAL
DECK FTG
DECIS FINAL
!b ? G'Dmp
i?!Ur" I
?W, I
INSPECTIQN RECORD
?CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued:
(612) 681-4675
? ¦. e 1'! ,. ; J ra -" ,:T A'... '7':i
SITE ADDRESS:
t) I% F3 C. p WE L l_ t_t R Id
!i F???, ?r l ? i??ldE ftf? F C?t,F ;i(ii?
v9i:7, ? APPLICANT:
„ . . ;•„ ,:i.;
?`WI li
PERMIT SUBTYPE:
TYPE OF WORK:
;if t.l
INSPECTION „
h . D•
;?:;% , ;, P e A N rat: V r-W Ft? FsY MrN F' a;?A R
;':;l ?tl t`'1 'fi?t3 ?11 ; .1 [: 1 t:li:
Permit Holder Date Telephone #
PLUMBING
HVAC
Inspection Date Insp. Comments
FOOTINGS
C
?J
FOUNQ
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
dRSAT
TEST
BLDG FINAL
DOMESTIC
METER
IRRIGATION
METER
FLUSH MAINS
coNaucTivirr
TEST
HYDROSTATIC
TEST
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
. _ , .
`'. iNSPECTIUN RECORD .
CiTY`O F EAGAN PF-RMIT TYPE:
3830 Pilot Knob Road Permit IVurrrber:
Eagan, Minnesota 55123 Date issued:
(612) 681-4675
SITE ADDRESS: APPLICANT:
PERMIT SUBTYPE: TYPE OF WORK:
INSPECTION DA . D,
?
Permit No. Permi[ Holder Date Telephone #
SflN
PLUMBING ?'r.2'?41/
HVAC
ELECTRIC
ELECTRIC ;49
Inspection Uate Insp. Comments
Foa[ingsl ?-2(?
9i'4 @_i'O 0 k ?ee
-7') ?,l
Foundation
Framing 6
Rvofing
Rough Plbg. r ?
Rough Htg. Y 3? ?? el1l. 1
JW%
Isul.
Fireplace
Final Htg.
arsat Test
Final Pibg. Plbg. Inspector- Notity Plumber
Const. Meter
EngclPlan
Bidg. Final g??? 3 ps
Deck Ftg.
Deck Final
Well
Pr. Disp.
42"
0f CCC"Q1iCV
uaaing zn#Pectaan
T7tis Certificate issreed pursuant to the
certifying that at the tirne of issuance thi,
. ordinances of the City regulating buildin,
SE' L?1G
.??..
?quirements of the Uniform Building Code
fruclure was in compZiance with the various
onstructian or use. For the following:
21017
$Idg. Permit No. ,
w.,u .,?. ,., E...,... ,. _..??.?....
Address
Locality L, B3, HII
+ ? ? XT Date:
P05T IN A CONSPICUOUS PLACE
(")afo /_':I.t?i
Address 4016 c.94BE[daErb DkIVE Zip 5512 3
L.oC - i? Blk 3 Sub xn.r.s cF srrNIxurmM sun
TfIESE IT'EMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECI'ION.
Date: g7 ?? Yes No Inspector: ?
Final grade (6" from siding) ?
Permanent steps (gazage)
Permanent steps (main entry)
Permanentdriveway
Permanent gas
Sod/Seeded grass ?
TraiUcurb damage ?
Porch
Basement finish ?
Deck
Please verify with the builder the removal of roof test caps from the plumbing system and the shut•off of warer supply to
the outside lawn faucet before freeze potential exists.
ContaM engineering division at 681-4645 before working in rightof-way or installing underground sprinkler system. ?
Whice - City Copy Yellow - Resident Copy Pink - Contractor Copy
e"
5
Request Date Fire No h-in Inspecnon
epmretl?
? Ready Now ? Will NoLy Inspedor
R
d
?
Wh
- a- 9 Yes ENo ea
y
e^
I)? licensed contractor !] owner hereby request inspection of above elactrical work at:
Job ACO
ss (Sireet Box Or RaNe No )
re ary
7
?
U O .
• 4..?
S«tion No lownship Name or Na RenBe No, Co
Occu am (PPINT) Phona No
Power SupP??er AOdress
Eiecv¢al Confrac?orlGOmpany Name) Connector§ L¢ense'No
• 0?
Matlmg Atltlress (COnVacror or Owner Meking Installatron)
Awhmrzetl na re(COnvetlou0wner aking Inslallation) Phone Nu be?
w O
-!
MINNESOTA STATE BOARD OF ELECTPICITY THIS INSPECTION REQUEST WILL NOT
Grlgga-MlEway Bltlq. - Roam 3-fl3 ?LL ?, BE AGCEPTED BV THE STATE BOARD
1BR1 Unrverclty Ave., St. Poul. MN 55104 UNLESS PFOPER INSPECTION FEE IS
PhOne (612) 642-0800 S V ENCLOSED
REQL,}e._ST F9R ELECTRICAL INSPECTION ee-ooooi.oa
? See Instmctions lor completing Wa lorm on back W yellow cnpy.
271 9-7 / "X" Below Work Covered by This Aequesi ??•?' ` C?? ?
ew Add Rap, TypeoBuiltlinq ApphancesWired EquipmentWired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt Budding Dryer OMer-(Specify)
Comm./Industrial Furnece
Farm Air Conditioner
Omer (speay) Contraclor§ Remarks
Compute Inspection Fee 6elow:
# Other Fee # ServiceEniranceSize Fee # Circuits/Feeders Fee
Swimming Pool 0 to 200 Amps 0 to 10o Amps
Transformers Above 200 _ Amps Above 100 _ Amps
SIgnS Inspenor6 Use Only: TOTAL p
Irrigation Booms /J?O
Special Inspection ?
Alarm/Communicauon THIS MSTALLATION MAY 6E 0 ED DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONTHS.
I, the Electrical Inspector, hereby Rough-m oa?e
certdy that the above inspection has
been made. F,nei oe?e
OFFICE USE ONW
This reqoest voitl 18 months trom
L L r?wq--?
R puest Dete
_ -?j
'? Fue N0. ?
- R I-in InspBCtiOn
R nretl?
VBS ? No ///
? ReaGy Now ?i WAI NObty InepBCtw
/ When Reatly7
1 licensed contractor ? owner hereby request inspection of above electrical work at:
Ja0 Adtlrees ISVeet. Box or ROUte No )
0 X^\
W? Cfly
Sernon No Township Name or Na. Range No, Couqq
A \ /I ?--
!
Occu I (PRIN ? Phone Na.
Power S ier? ? Atltlress
Elecinc =eny NL ConVactor's Lbense No.
C o0 3f/
Maibng Cress (Connactor ar Owner aking Instellalion)
Authanietl Signelure IGonVactor ner i Instellation)
.. Phona Number
- e,16
MINNESOTA STATE BOARO OF ELECTPICITV A THIS INSPECTION REOUEST WILL NOT
GrIB9c-Mltlway BIEg. - ppom S-173 BE ACCEPTED BV THE STATE BOARO
1B]1 Univpralty qve., St. Paul. MN 55104 UNLESS PROPER INSPECTION FEE IS
Phona1el2)6/2-0800 ENCLOSED
HEQUEST FOR ELECTRICAL INSPECTION
? See Insimcuons for romplevng fiis lorm on back of yellow copy
L 4 6 9 2 9 "X" Be/ow Work Covered by This Request
??y(M?? EB-00001-08
Y
pf?
?,,.??c?2oo8?r?
ew Aild Rep TypeofBUilding AppliancesWiretl EquipmentWired
Home Range Temporary Servlce
Duplex Water Heater Electric Heating
Apt 8uilding Dryer Othec(Specify)
Comm.llndustrial Furnace
Farm Air Conditioner
OMar (speafy) Comractor§ Remarks.
Compute Inspection Fee Below:
# Other Fee X SerwceEntrance5ae Fee # Circuits/Feeders Fee
Swimming Pool 0 to 200 Amps 0 to i0o Amps
Trensformers Above 200 _ Amps _ Amps
Signs inspectar§ use onry. / TpTAL
Irrigation Booms • , ?j
SpeCial InspeClion
AlarmiCommunicauon THIS INSTALLATION MAY BE ORD ED CONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 HS.
I, the Electrical Inspector, hereby
certify that the above inspection has
been made. Rough-in
F,,,ai P
f Dele
oe
OFFICE USE ONLY ???? , , ??ThW requesl voitl 18 mOnihe lrom U?
PERMIT
"1CI7Y OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
PERMITTYPE: suzLoxNG
Permit Number: 0 3 2 2 4 3
Date Issued: 0 6/ 2 4/ 9 6
SITE ADDRESS:
P.I.N.: 10-32992-120-03
4016 CAMBERWELL
LOT: 12 BLOCK: 3
HILLS OF STONEBRIDGE
DR N
3RD
DESCRIPTION:
SCREEN
B•Uil?ing_Permit Type
?
?RuLlding W?rk Type
r{`Census Code
? ,.
? ? ? - e?•'?^????
i
PORCH
SF PORCH
NEW
434 ALT. RESIDENTIAL
im.
REMAM REVEWED BY MTKE BARCK
NO HEATJNO ELECTRICAL - PER APPLICANT.
FEE SUMMARY:
VALUATION $6,000
Base Fee $112.25
Surcharge $3.00
Total Fee $115.25
CONTRACTOR: OWNER: - Applicant -
, GUSTAFSON GREG
4016 CAMBERWELL DR N
EAGAN MN 55123
' (612)596-2160
T heraby acknowledge that °I ?haue Pead thisa'pp'1iCatfon and state that 'the
intormat.kon is correct and agree to compl.y.with all appIicable State of M-n.
Statutes'`and City oP Eagan" Ordfinances.
? APPLICANT/PERMITEE SIGN9?- ISS D BY SIGNATURE
i ?
s 98 BUILDING PERMIT APPLICATION (RESIDENTIAL)????, ?
? CITY OF ElIQAN
? 3830 PII.OT KNOS RD - 65122 h
? ` I '?,
i
v 681-4678 ??i
t
New Conshudion Reauirements RemodeVRenair Reoufrements . 11
? 3 registered site surveys
? 2 copies of pians (include Deam 8 window sizea; poured fid. desipn; etc.)
? 7 energy calculations
? 3 copies of hee preaervation plan if tot platted eRer 711193
required: _ Yes _ No
DATE: (i '
DESCRIPTION OF WORK:
STREET ADDRESS:
Phone #:
BLOCK: 3 SUBD./P.I.D. #: rlu'S Or- JJbt:?Eg2,S L,&F
PROPER'CY
OWNER
CONTRACTOR
ARCHIT'ECT/
ENGINEER
Street
Ciry pj? P? Stete: Zip:
Company: ? ? M ? Phone #:
Street
Ciry
? 2 coPies oT plan ' ?(,! GIMS
? 2 ske aurveys(exterior addklona & decks) `?? ?
? t energy caleuletions for heated additions? j. 00
av?s
ONSTRUCTION COST; ??:OOV;= ??p
License #
State:
Company: ?? E Phone #:
Name: Registratian #:
Street
City
Sewer 8 water licensed plumber (new constructlon only):
and lot change is requested once pertnit is issued.
Zip:
Zip:
Penalty applies when address chang
i hereby acknowledge that I have read this application and sfate that the information is correct and agree to compy with all applicabl
State of MinnesoW Statutes and Gity of Eagan Ordinances. I/ A J o. ,
SignaW re of Applicant:
OFFICE USE ONLY R1k ?6 R OvY
CeRificates of Survey received Yes No ?1Q?
Tree Preservation Plan Received _ Yes _ No _ Not Required XAII:?
State:
OFFiCE USE ONLY
BUILDING PERMIT TYPE
? '01 Foundation ? 06 Duplex
? 02 SF Dwelling ? 07 4-plex
? 03 SF Addition ? 08 8-plex
X 04 SF Porch ? 09 12-plex
? 05 SF Misc. ? 10 _-plex
WORK TYPE "SCQ EON
? 31 New ? 33 Afterations
0 32 Addition ? 34 Repair
GENERAL INFORMATION
Const. (Actual) _
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
Planning
? 36
? 37
Basement sq. ,ft.
Main level sq. ft.
sq. ft.
sq. ft.
sq. ft.
sq. ft.
Footprint sq. ft.
Building
Permit Fee
Surcharge
Plan Review
License
MCM/S SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
? 11
? 12
Ei 13
? 14
? 15
Fvctc.r4
.
i
I
i
Apt./Lodging ? 16 Basement Finish
Multi RepaidRem. ? 17 Swim Pool
Garage/Accessory O 20 Public Facility
Fireplace ? 21 jMiscellaneous
Deck '
i
Move
Demolition
?1 Engineering
MClWS Systertl
City Water
Fire Sprinklereo
PRV f
Booster Pump '
Census Code. SAC Code ?
Census Bidg
Census Unit
VarianFe
Valuation: $ 61
?, - 'i
?
?
Copies .5? (L)
N3
ol
-+
? % SAC „
i'! iSAC%Units ? ??
, • ?L * ?' • 2422 Entcrpri3g Dfive
Mendota Hciqhts, MN 55120
* PIONEEp L,,,,0 SUNVEYOr+sqNL er+CMEEAS _ (612) 681 _1910.•Fox 881=9485
* ? ??'+?n - UNO PLMINEfl9 • uND9CME AR[HIT[C73
en9 9 szs Hi9nWay io Notthcast
* * Bloine, MN 55434
* a? 11512) 783-1880•Fox 783-1893
Certificate of survey for: The ROttlUrld CompC1ny, Inc.
House Address: Statgs Avenue. Eyan, MN
Model Na(ne: - olo ial ?
13
?
?
fTl -? (V
T7 ° N
°
,
o Lri
o?
c ?. N
? 905
n°
s e77s'a7" w
79.15
yo4•4 A @ 05•12'23"
R ? 637.98
`?- - --?.
"`--?---
R
STAT?.S ?
NOTE: CONlRACTOR ML]ST VERIFY ALL DIMENSIONS
. 900.o Denotes Existing Elevation
x ? Denotes Proposed Eievation --- Denotas Drainage ac Utility Easement
-- Denotes Drainage Fiow Dlrectlon
, ---?- Denotes Monument
--$- qenotes Offset Hub Bearings sho
LO?T 12 , BLOCK 3
a 30 ,
?a•8g , ?
N ? ?-
, NI ? ,
o
? ,
30 ?
?
, -)3
1C)W?
O Lr. CD
?- ,
?
?
-?---? , I
?
28.05
`02•3
? I
46.46
89•10'15" w I `
I
E „Q4t''
s
PROPt7-$EQ hI0U5E ELEVATION
Lowesf Floo? Elevation:899.05
Top of Block Elevation, 907.16
Garage Slab Elevation; 906.83
wn are assumed T?
HILLS OF ST4NEBRIDGE
N
? DAKOU -CpUNT'Y, lAINNE?OTA R A D D T10
I hanhy nrtify ihet thp Survty, OlaA or roport WOi Dr arW Ey me W undet my dinct wpuvyion and tha[ 1am duly Rplateued Land Survcvor
uotlar the laws of [he Stati of Miannoto. Da(ed thiiday of ? A.D. 19?+L. ?
?
SC?t?• 11 C=30?9 4?t 2nanR9n.1RKK1;rHI S RFG.IVn 1 AV1
AVENUE
PERMIT GP
J2 z 1
CITY OF EAGAN
? ,
°
3830 Filot Knob Road
PERMIT TYPE: IG
8 ?! I
J
Eagan, Minnesota 55122-1897 Permit Number: 025981
(612) 681-4675 Date Issued: 0 7/ 0 7/ 9 5
SITE ADDRESS:
4016 CAMBERWELL DR N
LOT: 12 BLOCK: 3
HILLS OF STONEBRIDGE 3RD
P.I.N.: 10-32992-120-03
DESCRIPTION:
-(FUTURE PORCH)
9"uilding-..Permit Type DECK
J?uil,dinge Waq?, k T y p e NEW
l7
t ?
. ?'. . -
? N
0'??- d r":; g
'???-.3 ? t ?`? ?? ??iJ?',?'?? (?.J?` { ?':' ?,t*?'?a"f,?{ /'i?.?t ? ?r-.,`K {?k _--? i?,,.?•.r?
.._ ? .. `?•._ ,-,= 7 L::? i *?..i ?.?.7.? ? ?_.
REMARKS:
14'x 14' DECK FOOTTNGS SI2E0 FOR FUTURE PORCH (22" BELL)
FOOTINGS SIZED FOR CLEAR SPAN TRUSSES OR CA7HEDRAL CEILING
(y, o NGNfI-FRAA9F11 RAFTFRC LiTTH CFNTFR RTOf,F RFAM)
FEE SUMMARY:
Base Fee $39.00
Surcharge $.50
Total Fee $30.50
CONTRACTOR: OWNER: - Applicant -
GUSTAFSON GREG
4016 CAMBERWELL DR N
EAGAN MN 55123
(612)896-4416
-
I hereby acknowledge that Z have read th3s applicdtian and sCate that the
, infprmation is corrett and agre,e;, to eompY;y'? wi`th; aI11' a?aplic?able 9tate o'f Mci'. Statutes and City o'F Eagan 0`rdinances.
L
? ?4??n ;?,ll Yh.?
APPLICANT/PE MITEE SIGNATURE 3`S IED B SIG TURE
N
9ti
cinr oF eaGaN *30•M
3830 PILOT KNOB RD - 55122
1995 BUILDING PERMIT APPLICATION (RESIDENTIAL)
681-4675
? 3 rogisterod sito surveys ? 2 capks of plan
? 2 wpies W plans (hidude beam 8 window sius; poured fi0. tlesign; emJ ? 2 site surveys (e)darbr a0tlitiorro 8 decks)
? 1 enerpy cekulations ?1 enerey caicuMoris ror nwaW aaaftrons
? 3 uples W tree pissenation plen if lot platted after 711/93
tequlred: _ Yos _ No
DATE: CONSTRUCTION COST: ~ D90
lytel'1
DESCRIPTION OF WORK: E6614- r1lA Lhln?l
STREETADDRESS: ???6z-4-
LOT -1L BLOCK A_ SUBD./P.I.D. #: rCL-S 6F ? ?JEAP-146r-
PROPERTY Name: Phone #:
OWNER A . . .
Street Address• :Ji1? V L"--
City: State: -? . Zip:
CoNTRACTOR Company: 4rMA if, Phone #:
Street Address: License #:
ciry: state: 6 zip:
ARCHITECT! Company: <Yw? ' Phone #,
ENGINEER
Name: Registration #Street Address,
Ciry:
Sewer & water licensed piumber:
change are requested once permft is issued.
I hereby acknowledge that I have read this application and state that the
apptlcable State of Minnesota Statutes and Ciry of Eagan Ordinances.
Signature of Appiicant:
OFFICE USE ONLY
Certificates of Survey Received
_ Yes _ No
State:
Zip:
Penafty applies when address change and lot
is corcect and agree to comply with all
,1 U L 0 3 1995
Tree Preservation Plan Received - Yes - No
OFFICE USE ONLY
BUILDiNG PERMIT TYPE
0 01 Foundation ? 06 Duplex ? 11 Apt./Lodging o 16
0 02 SF Dwelling a 07 4-piex o 12 Mufti RepaiNRem. 0 17
0 03 SF Addition o 08 8-plex ? 13 Garage/Accessory o 20
0 04 SF Porch o 09 12-plex a 14 Fireplace a 21
0 05 SF Misc. a 10 = plex ?15 Deck
? ?
WORK TYPE
,dL31 New o 33 Alterations ? 36
0 32 Addition o 34 Repair o 37
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
Planning
Basement sq. ft.
Main level sq. ft.
sq. ft.
sq. ft.
sq. ft.
sq. ft.
Footprint sq. ft.
?
B sement Finish
S?nrim Pool
Public Facility
v' , ? i Gx fiYsS
c? rd+ac
PAr?/d?,eac L°i.vy.
ca eAFf rx f w/ cgN?
(Ir9! C l?tNn'??
'ab ly X ,
Move S?2LtJ? 14"p/e
Demolition
?T4t. l ZFD
7jZuSSiJ ?
A/
41 N44059
MCMfS System
City Water
Fire Sprinklered
PRV
Booster Pump
Census Code.
SAC Code
Census Bldg
Census Unk
Building
Engineering
Permit Fee
Surcharge
Plan Review
License
MCNVS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
SNV Pertnft
S/W Surcharge
Treatment PI.
Road Unit
Park Ded.
Trails Ded.
Other
Copies
Total:
Valuation: $ /Zoo
y3 y
?
_0
% SAC
SAC Units
r?onaar nna?nearins .o?+??? ----
1` .L
----,
, , .
?' ,? * ?? L • ? . 2422 EntCrpri3@ Oriv4
Mendota Hciqhts, MN 55120
u _ i
* PiOPiIEEp
do surrvera+s • aeu eucwEp+s (612) 681--1914•Fox 681-9a88
* engmeer ng uNO awFrieR§ • U.ND9GME ARd+dTCC1S ? 625 Hfghway 10 No,-- rtT hc? ost
* ,? ,tf * (612) 783-1880 Fax 783-1883
Certificate of Survey for. ThG Rottlund Comgany. InC.
House Address: States Avenue. Eggan, MN
Model Narne: - ol iai 1
?
T ?
?
l?
R
S 87'19'47" W
79.15
STATE?-S I
NOiE: CONIRACTOR MUS7' VERIFY AlL DIMENSIONS
. 9ao.0 Denotes Exlsting Elevatian
x<gglD Denotes Proposed Flevation Denotes Drainage dc Utility Easement
- Denotes Drainage Flow Dtrectlon
-a= Denotes Monument
-e Denotes Offset Hub ggarinas sho
? 30 1
?eo•8$ , ? .
? lic,
,
LP
?
30
l
1 , ? 1
,
1 ? e°a w
a ?
?
r ?
' xaae 3 ? 1
46.46
.?
ss7o'i5" w I
wn ore assumed
F.% I
- -- - -? . . to I
? ( 1
PROPOSfO HOiJSE EIEVAMQN
Lowest Floo? Elevation:899.05
Top of Block Mevotlon:907.16
Garage Stab Elevatlon.906.93 •
LOT 12 , B-LOCK 3 HILLS 4F STONEBRIDGE
• DAKOTA -CWN9'Y, MlNNE?OrA , 3RD D D TI ON
I hYraEy cartlfy thst th15 4urvey, Olan w roport vaf D rod EY ma a under mY dinet supo+v4ion snd that I am duly Rplitaad Land Surwvw
wnWr the iawo ot the Stan al Minnnota. WW thtsaY of _111? A.D. 79+L.
%i
; •: %
SCale' 11m?-30144 I ' RORRIIYR.6IKI.Nf.S.PFf..Nn/1 1101
AVENUE
qo4•9 A ? 05'12'23" S
R m 637.98
ACITy OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
SITE ADDRESS:
DESCRIPTION:
PERMIT ?
PERMIT TYPE:
Pertnit Number:
Date Issued:
4016 CAMBERWELL DR
LOT: 12 BLOCK: 3
HILLS OF 5TONEBRIDGE 3RD
r- • _.
eu'ilding_Permit Type
8uii,ding Wprk Type
r'UBC Occupa?c°y?
? Construction Type
? Zoning
? Building Length
Building Width
i .?. . , .. _:/
SF DWO
NEW
R-3 M-1
VN
R-1
74
34
oc)? ?a n
S&W CONTRACTOR - VALLEY PLUMBING
REMARKS:
FEE SUMMARY:
Base Fee
Plan Review
Surcharye
5AC
SAC %
SAC Units
SubtoCal
i
;
?
VALUATION
$856.50
$656.73
$81.00
$750.00
100
1
$2.244.23
$162,000
MISC FEE3 $1,744.50
Total Fee $3,988.73
•. CONTRACTOR: - APPlicant - sT. LIc OWNER:
•'ROTTLUND CO INC, THE 15710304 0001335 ROTTLUND CO INC THE
5201 E RIVER RD 5201 E RIVER RD
FRIDLEY MN 55421 FRIDLEY MN 55421
(612) 571-0304 (612)571-0304
I
301
I hereby acknowledge that Z have read Chis applicatipn and state that the
information is correct and agree to camply with;all applicable 9tate of Mn.
Statutes and City of Eagan Ordinances,
APPLIGAN PERMI E SIGNATURE ISSU Y. SIGNATURE
0/?°c
-7 Y0 7
BUILDIN6
021017
05/26/93
REACiI'M£ • F?CEQ`U/[?D CITY OF EAGAN
PxRMIT'?' ' 1993 BUIl.'JING PERMIT APPUCATION,,,, ?--,?
, .
MAY 12 1993 681-4675
----- ?3 5,?? 73
C?/o - -- -----
.??_. ?..:?, : ...?. r?--
SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, I copy af energy
calcs.
COMMERCIAL 2 sets of architectural & structural plans, 1 set of
specifications, 1 copy of energy calcs.
Penalty applies: 1) when permit is typed, but not picked up by last working day of month
in which request is made, 2) address is changed or 3) lot change is requested once permit
is issued.
Date S /&_ Valuation of work ?fto,,,_'C10v
Site Address: i-lol a?Mkmrr,mLl D!`. _
STREET SU17E #
Tenant Name: (commercial only) o -t--?,vncQ (!f?. X16c-.
IAT I Z BIACK ? BD. Y.I.D. ??
G
Descri tion of work: s A e- 0Ac4
The applicant is: V4wner Contractor O Other coescrtbe>
Phone 571-030¢
h CFJ Dr
4L
GA-N
.
u
4
Name =a_
Property LAST ?IRST
Owner pddress S201 E 2ikfU' ?P -
STREET STE !f
City ?'r???? State M _ Zip 554ZI
Company S aw-e- Phone
COl1tf8CtOP Address License # (33 ,S_ Exp.3-3?-
City State ZiP
Company Phone
Archftect/
Engineer Name Registration #
Address '
City State ZjP
,
Processing time for
Sewer & water licensed plumber e pi
sewer & water permits is two days nce a ea has been proved.
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. ?
Signature of Applicant:
. ?
OFFICE USE ONLY
. ,
BUILDING PERMIT TYPE
? 01 Foundation 13 06 Duplex O 11 Apt./Lodging ? 16 Basement Finish
12?42 SF Dwg. ? 07 4-Plex O 12 Multi. Misc. D 17 Swim Poal
? 03 SF Addition ? 08 8-Plex ? 13 Garage/Accessory ? 18 Comm./Ind.
? 04 SF Porch ? 09 12-Plex p 14 Fireplace ? 19 Comm./Ind. Misc.
? 05 5F Misc. ? 10 Multi. Add'1. O 15 Deck ? 20 Public Facility
? 21 Miscellaneous
WORK TYPE
New
O 32 Addition
? 33 Alterations ? 35 Tenant Finish
? 34 Repair ? 36 Move
GENERAL INFORMATION
? 37 Demolish
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
#` of Stories
Length Y- N Basement sq. ft.
lst F1. sq. ft.
2nd F1. sq, ft.
Sq. Ft. total
Footprint Sq. ft.
On-site well MWCC System
City Water
PRY Required
Booster PumP
Fire Sprinkler
Census Code yG5.
yES
01
Depth
APPROVALS 3y On-site sewage SAC Code ?
?-
Planning
Engineering Building
Variance Assessments
REDUIRED IN SPECTION S
O Site ? Footing ? Framing O Insulation
? Wallboard _ ? Final ? Oraintile O Fireplace
Permit Fee
Surcharge
Plan Review
License
MWCC SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Trails Ded.
Capies
Other
Total:
SAC % 14,7
SAC Units I_
Yaluatim: $ I6T00
GA?2.46E; 20 X 1p= ZOO
?X 2Z^-- Yo
.?S rt'1 T- 6`{U Jc / 6=
uG Z,? = 12a
Ilyv
/a z.o.440
1 30o x ?? ?
Isr FLoo2;
EtsmT,= 13ao X55' :::
lo2No
i
/ q/ S'D u
17012oo
Z•Jb R-.aori
3% 19 ^3 o% 11Ke xS`( _
G? 560
,
I
16 (, svo
P.02
! 1
* PIONEER
* ?ng n?er
*
,?
? 4 3
Certificote of Survey for: The Rottlu U C p_C7' X ric•
co' N
N
?-
N^
n S ?99-?7?? W
13
5?
House Address: e n ° N
Mode1 Name: Colonial 1
1427 Enterprlee DrWe
Mende4a He3gbte, !AH 56120
oas • QNL [NtlINFFR9 (612) 681-1914•Fax 681-9488
• UuoxAPE AaaU? 625 Hlghway 10 Northeast
8laine, MN 65434
(e12) 783-18e0•Fax 783-11e83
I
<0?)
1
a
?
A x
r-T --== ~ -T
1 {? ^ '
si ? \,4?
n ?
a?30 ?-'
, 4b ? ,0.33
w? ? N ? 11
? 2s.n an
??.
I g 4.0
V
I a Sw ? BOt
I al ?o ?'L? ? s? - -~ yo
I iL ?
24;
` } LeIF
L=57.97
A = 05'12'23"
R ? 837.98
.9
STATES
S 89'14'15" W
E Wj E
AVENUE
aY -714&
Data 1'
NotE: CONTRACTOR MU57 VERIFY ALL DIMENSiONS
¦ eoo.u Denotes Exlsting Elavatlon
¦(aO Denotes Propoeed Elevation
Denotes Drainage & Utfllty Easement
--= Denotea Drainage Flow Direction
---o- Qenotes Monument
--43- Denotcs Offaet Hub Bearings ahown
' I
PROP05ED HOUSE ELEVAl10N
Lowest Floor Elevation:899.05
Top of Block Elevation:907.16
Garage Slab Elevation:9Q6.83
pre assumed
LOT 12 , BLOCK 3 HILL 3R F Spp NEBRIDGE
DAKOTA COUNTY. MINNESOTA
I hareyy eani}y [ha[ thlt aurvay, plan O/ +aport wAq?ry?q/y ered hv m?r. M. vndn my direee cupervhlan end that 1 emdWV acslvterad LoM 5urwvor
und0? thB bwa W tlie SptO of Mlnnawh. Oatod thi6 4e?6? d9Y of A•?• 19?..
51, (e. 1?-30e? RO TB.5lHICH .5. Ea• 0.14891
?.
o ?
W
I? l
1
1
?
?
} ? 1
& ?° 1
M ?
d
l
0
° ?o ? x
1
?
? I
N ?
? O
is,
?
ITWBI 13030.08
R=96% 05-21-93 12:01PM P002 #50
U .. LOT BIIRVEY CHECRLIST FOR RESIDENTIAL
w
¢
? y` - BUILDING PERMIT APPLICAT N
m m
J ?
m
PROPERTY LEGAL:
a
W a W
Date of Survey: S ?
o j
< Z 2 DOCUMENT STANDARDS
E 0 0 • Registered Land Surveyor signature and company
? ? ? • Building Permit Applicant
? • Legal description
? ? ? • Address
? ? ? • North arrow and bar scale
? ? ? • House type (ramb e, walkout, split w/o, split
lookout, etc.)
9f ? ? • Directional drainage arrows with slope/gradient ?.
? ? 0 • Proposed/existing sewer and water services
? ? 13 • Street name
pK ? ? • Driveway
Existina
? ? ? • Sewer service
p? ? ? • Lot corners
L9? ? 0 • Top of curb at the driveway
? 0 0 • Elevations of any existinq adjacent homes
Provosed
W/ ? ? • Garage floor
Le ? ? • First floor
? &"? • Lowest exposed elevation (walkout/window)
C9? ? ? • Property corners
Gi+? ? 0 • Front and rear of home at the foundation
PONDING AREAS (if appl_icable
? ? ? • Easement line
? ? ? • NWL
? ? ? • HWL
? Nl? ? • Pond # designation
? ? 0 • Emergency Overflow Elevation
entry,
? 0 ? • Lot lines
[? ?? • Right-of-way and street width (to back o£ curb)
[3oo' ?? • Proposed home dimensions including any proposed decks,
overhangs greater than 21, porches, etc. (i.e. all
/ structures requiring permanent Pootings)
p0•? ? • Show all easements of record and any City utilities within
those easements
? p? • Setbacks of proposed structure and setback of adjacent
existing homes
??? • Retaining wall requirements, if any
/,? 4 ! +?7?-. 3
Reviewed:_???(?"G( /? ~ ??
Name / Date
October 1992
.?
. . . cc?.or? IcL
, F?c7'F.r:iort F:rrvet.rn•t: nvici;nr,i: "u" currr u•Pn•I•inN
. ot+rtER
SITE ADDRE$S 1-0T 121 {'?I Lc.S o z' ?7?NE SRiD[?c 3RD.CJQ p M
CONTRP.CTOR ?'J j i LUh.}'?
Go DATF. .
PHONE
' Determin vorkinr; squnre footai,.c o1' ench.
1. Total exposed vall area sq. ft. x 0'll = G9G, /?
• 2. Total roof/ceiling a-ea
? .. 1300 • sq. ft. x e.,026
- ,
Total exposed vail arcz nbovc floc,r = 2,4e 37,6/ ?
a. Total czil vindov area ............................ Z;?,
b. Totel daor area ................ Z.
................... (
c. Total sliding glase door area .....................
d. Total fireplece va11 area .............
......... -
e. Total vail framing a:ea (everage 10%) .... .. .......... Za O,?
f. Total net vell area nbove floor ...................
. 6• Total rim Joist s-ee ................ ........... 2 Z>. L
Total exoosed foundotion arca
h. Total foundetion vindcv a:ee .....•.. ?t
i. Total net foundation a -ea tLbove grade ... ..........
. • Deter.nine "U" va lue o; each wall :,FF;ment.
' . 8. ,.u„ p,¢2
b. X .,,,?, 0,?34? = 5Sq
.' . C. 3 9, 97 X „U„
d. - X "u., . __ _ _, •
e.. X. 1.u,l 18,77
f. X ,.U,. . o, o? 3 =79. I-?
, g. 22? l. X ..tr, O ac? ' = 9- 24-
h. G X "t,l, 014(-2-
_ z.sz
; l/0. °p X "U„
3. .................
..... .... .... •cof.a7 = L?7=rJ, 7`r
.,
:
If 3tem p3 is the same as, or
or ssc 6oo6(c)2. lesc. :.kian .iteta al, yoii nave met the intent
?,
H, .G.
-?1H1 -?Glh?------ -
O
?
O
?
G
0
O
O
CC
? ,-
-
?':Fi{- ?IM a0!?.
SH5R jrliN(d
?
?-•I.^v ? ?.. .
? -?
- o ?-
-- - ?-: :-"
i?==
r
!?•.?i?
- .... ? ,
? -
t-
??L!lyi-??
.at
,i?eq??
-
? ? . .
--
-
1 I
6AV6ULATIoW-,7 (GcNT?.
r-f AMr-- WAu. G IH,?2aL.ATlcH
, LOMPON?N?
?
u
?
-FFAM5' wAu.
C
C
C
L
C
(?(J:
LoMPVNrN j5
ouT??M ai? F9Lht
-h,° ?a?IF4c?. - -
- .??ATHiN6,
- 5%L lNSUGA?l?4
&i(i Irv,
t?51r? Pd(L riLNI,
o_uT-4;10E Pif? PLA.
hH'E?A?I-i I N!, ,
h'P.1C7 (FRAM Kp)
fq.c '
.
- - ---G::.• o -
- F--vA'Uu5
_... ._c.li._..._? _
2.GJ _
?•?b_-- -
,
-- ?-? G,4'? ---_ -
-0:(>G:--
???,=._Il, Ic?-
u
?L
-G?M f?).''U+= (0.)2 X 0.0,a9? t(o,s,,L- x 0.043?
?VAC_tt?G??GUI?7?o??-- _ O
G
G
?
C
IA PG-?? K I
2?:? --? GKGt?t?•
?=?- ?1f? i?f?M•
-5- _ _
- ?" 5/%z L? '
-r,?,-i - -
J
027
"'F"?? r _ .
._i
0
C
?
?
Fi L:ti1.
_Ea =
- G 'I i
,:?; ¢.---A,
o. cS
?-- :
i
0, oZ2
?,? ?
' Total exposed roof/ceilinG aren = 3 DOf
'? . ? .
.. , Total gross roof/ceilini-, area _
J. Total skylight area .................. ........
k. Total roaf/ceiling frzlnin3 area ....... ........
1. Total net insulated roaf/ceilinF area ......... // % p _
Determine "U" value for cnch rocif/cei l inj; se6ment.
J - X l2Ulf I
.
x: !3o X lU„ O,p2?
//70
i
X
.
4 . ...............................:. Tatal ?-
?'i ?i
If total oP A'4 is the same as, or less than N 2, you have met tlte intent of
s$c 6oo6(c)i.
, To utilize the total envelope syste= nethod, the values establi:hed by the
stmm of itens N3 and 14 shall not be sreater.thKn the sum of iten:s 11 and 12.
1. + 2, -
' 3•. + L . _ •
0
` ' -
_ .._ O •
N O Y- 1 b-?J 2 1`7 O N 1 0 - 0 B F L Fi 12 E H T G - U. R/ l: r . e s
.. _..-V!
0.4
T)E7ATLED r<EPORT E=Ott ENrI+,K HOUr.r:
Pr-f?parecl For: h'r•ept7r-ed By:
RfJTTL.UND i:OMPANY INC 'fTM t..laUlalVEF:
FLHRE HEn-rrniG
, ,7ub Name: THE GDL(JNIAL
i 7V??C%??*1k%?7k$1k*?t*#?NC1k?7k?kMW?#AY??k kW$?%K?ffi?'k??7Y?1k?k*M?C:k?C?C?C**7kk*?C??*??*?7k*?tf'U?aL?t?C?
rcXF'f:1SURr-
Gl..A5S NL]RT"H £aOtJT'H E:61;=T WE,aI' NE:/MW SE/5W HfJkl. TL]TAL
- --------°-
l1fti?F', A ---_____._-
i ?. ?.? i __°-----
`Ji i --
Y 11?t ? ...____..._..._
._.??.... 1l:6i ..-- --__._..___ _ _
0 i
3881
coaLxNG 1 isi; i,Zoo: S,926, 5,6ev o; ot oi 15,967;
HEA"fTNG f 4921 2,134; E3,l261 5,171l
.._.._.......... Q:
_._... 4i
,.____ b: 15,9241
_?. .----.---_ BEL.QW
Wf:l_t.:3 NOF'TH uCIUTW F'AST WC:f.i'T Nl:/IVW
.
-
--- aF.:/SW
...__-._____ GRHDE
..__... ?'OTRI.
-...., ,_..__...,.._
AREfa __.__---_ _..__,.
i E7tiif3l _.._..___.___
8741 _..___----....
941 i .._
-_._.._.__._...__.
977 I (:) 1 0; Z.bSq;
t:,t)ol_tNCi 1 8061 79:3I 954; 2871 O; 0 1 0: 3.340 f
HF:F4'I'iMG i .S„J+S,i I 3.4651 3,7:51 I 3.'r374t
_.___.._.....---..... oi
__.._ G:
..___ 7,491 t 229081 !
,._.,._,..,.__.__.._
CUl'7RS __._...._.__,.___.
NQk'T'M ._._.__...._.__
S(:lIJ7N .------ __...._
E.ASI' __..,_
a1c:S1' NF::/NW
............_ ' _'.
.
-
..
... :iE/EiW
....?.......?-.?.?..
. .... 7U7'Al.
..'r-...-....._. '_"
' ""'
_'_
'
""'...._..`....?
01
?.
?....?....?...
.
4C11
f.
JS
4i
;
?1
7?
fyCJ0LIIVf? 1 a:t"?1 +?1 24:=1 4861 01 GI i 9481
NFiATIh!(i 1 9567 61 1,0621
.
__...__ 2}124:
. __...._.......,.,.,... S)i pt 1 4}I421
..---.__...__._._
F'I,.,CJCIF( .__....-.._-.--._.__. _..._.__....__
f3REA ..-___
.
. Cl7Dl_IIVCa
.__....__.
...
._--..__
_ HCATIIVG
- ---_..__.__ __.._____._- '_
1;7;=1 ?._._
._
.1 _.____
f
_
:> p32b
--._.__..... _,.
CG:TLING .____________ ___-•-..___
AREA __-------
_ -._,___._.___,__...
C:f30LXNG
---._...._........_..._ .
NEA'7'TNC,
. ....-•-----..»
-------- ..____..., __.___
----------- ._..._------._
s?li i
-------- --__._-_,.
_
f
-------- 10196 I
-------------
--- 21626
--------
--------
--------
People Sene.ible Load
L.9yl'it5 & Appl. l.nac1
Vpntilatiqn Load
UOc.t Hr?aY. Gain
Infil•trat.ion f_nad
n;.xrtsib).c± EiKety Stah
'i'1.1Ti1L SENSIL'yLE L_f.lAD
summer ACIi
MISCELLAU@UtJE CqL1L'INC; L..C1AD'a"
i,?:;??_.__---_? __{.atent LoAd
k,195 Lat.ent S;afe-•t.y Htuh
955
{
.)
62H
857
26 T1:3TA1. t, f1'S"F N f LqAD
I
0.06 _fE:>mp. Swiriy Mitlt.
7,410
171
**2 7ota1 Cqoliny l.aad 34.646 BTUM Or 2.09 Tons *2*
MiSCELLAIV50L1S HFF;TIMr LOl1D5
uu
:n+alt.r?-?txan t..nad f,p64£3 ?`+????^VentS.lal;.ion 4oad
Uuct Hedt LoS% 0 Safety &tuh
W,i.nter ACH 0.1:
7 ,7c'39
1.titj
4,950
1.98"'i
*** 1'crt2i2 Hr;.z6tinca Lorad 62,692 BT[JH ***
SIJMMARY REF'OFT
PN-?pared Fal": FrF?p,xred F?y:
fil'377'LL1ND GpMPANY INC: 'I'1I1I 4,At.1T)IWCFi
1=LAkk: MEA7IIVL=,
Jc:,b ad.aines: 'THE L"Ol_G3NIh1L
r _ v c
I1-1Z?°91
3.1
&?A?c?Nc?K?c?C??Mcffi?k*???k#?'?f%k??*?t?k:k?kt??k#???#?k???X?#??#?#X???R#Mc1k??k*??**#**#*??*?*??:k*
llF:SiTUN f::C1N1")I'fTGfdS fc,r
ouI'nOcsR
aUMMER WII'JIEH
Dr-y Eu1b 92 --20
WC?t BU 1 t1 7`3
r NDracar-:
SUMNfEFi WTNTER
75 70
f,"'1
U:iil'y Rarige 22
L<atitude 44
C?aily Swing :=.t:I
k:levat,ian 8:t2
F.3afehy f'•,-ac•t.nr• ("/.) :5
t,.atGrr'k F„c 1:err (%) ?9
?#*??k#M?7K?K?k**??k?%??k???C??C???k*'?:K?YF:k#???k%c???k?#???k??CYI*:k+k?k??*M??Ctk*?A?*%kAc?#M#**?%*%R?*
:7E:h?-?`1b1E'
Ruom 14tzotin9 Hea'k..iny Gcaling Coo1inq
`
B 7UW CFM
,. F'fllH
------- L
FM
.,...
`c?eJFIt1E?f1't
,7i A
£
yQ
FUYar :5134 .3 47 1, 9:36 98
Dirting Ropnt : ?9tX5 41
:55 2„094
560
2 lOb
129
L.z.vin9 Raom 3,916
4
459 62 ,
4p604 2.72
Pa+mi A y Huom
Dinette .
4,001 .sb 1.126 57
t'ikchen f3.Gby 4:; 3,213 162
Lwauridry/F'owder :',806 4() 9943 50
107
$edretom 1 :S;,b72 7
6 2,120
1
458 74
Sathraorn 2,u94)
9=7
1 ?
27 0
1,487 55
EiedrOntn 2
3 .
t
94s^. 27 1l081. 55
Pi.drnc>m r
468 %' 1 4'r 7
k?ath
E,ec1ronm 4 2 ,ai< 37 11856 93
?ittirtiyHrpa 1,1y0 17
---81"!
-
____4?
_
_._
bE?2
6:' 277 =6 v£357 1 .:i..r6
..
HI:eATING DELTR T 65.0 f:pL"1L.IIVG AEi_TA ? 18.0
.in•r'r^_ wmw f`.ti•. , 'la}en?a 0 wr'F'Inw iC: t'«S-if<, Ci t.liiCllt }.t:n'al"J Y'kQ6lIY"E°.fCl(a^f1t 5.
PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOIvfES AND
CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNTf.
? NEW CONSTRUCTION
ADD-ON A/C
ADD-ON FURNACE
DAT'E ks? - \ \ -01`?
FEES
HVAC: 0-100 M BTU $ 24.00
ADDITIONAL 50 M BTU 6.00
GAS OUTLETS (MINIMUM I @ $3.00 EACH)
ADD-ON/REMODEL (EXISTtNG CONSTRUCI1oN) $ 15.00
STATE SURCHARGE .50
TOTAL ?
SITE ADDRESS: ?-ia\lo
OWNER NAME: TELEPHONE
INSTALLER:\?S?l ?' ??Cr
?s_?-e N
STATE: Z?? ZIP CODE: '?_%_N
TELEPHONE #:
1993 MECHANICAL PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN MN 55122
(612) 681-4675
PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMES AND
CONDOS WHEN PERMITS ARE REQUIItED FOR EACH LINTT.
NO. FIXTURES
t SHOWER
3 WATER CLOSET
a BATH TUB
LAVATORY
i KITCHEN SINK
1 LAUNDRY TRAY
, HOT TUBlSPA
WATER HEATER
FLOOR DRAIN
GAS PIPING OLTTLET • ?? -
? ROUGH OPENINGS
WA'T`ER SOFI'FNER
PRIVATE DISP. • Dgx.ay. rc.
U.G. SPRINKLER • eome unaff mmt.
ALTERATIONS ' to austing
WATER TURN AROUND
STATE SURCHARGE
TOTAL:
FACH TOTAL
3.00 5 -
3.00 q -
3.00 4 °
3.00 s;• _
3.00
3.00 3-
3.00
3.00 1l.
3.00 0 ?
3.00 3 -
1.50 4• r,.
5.00 ? -
15.00
3.00
15.06
15.(JO
.50
SITE ADDRESS:
OWNER NAME:
WST
)P,-??ku Pt-L S ('n L? . .
ADDRESS: D! j) C i2-t?- IC._ Li -
CITY: 121 6 a -) STATE: ZIP CODE: >> 3?
PHONE #: ( ) a I a,
( 1) fl-A--
SIGN URE OF PERMITTEE
? 1993 PLUMBING PERMIT (RESIDEIVTIAL)
CITY OF EAGAN
3830 PIIAT KNOB RD
EAGAN MN 55122
(612) 6814675
. . . 1999 BUILDING PERMIT APPLICA1710N (RESIDENTIAL)
cirr oF eacaw
? rO9 0? 3830 PILOT KNOB RD - 55122
` 651-681-4675 c?- ---??
+
New Conshucflon ReaulremeMs Remodel/ReeaU ReauIremeMs
-l-a-I-?i
? 3 registered aHe suneya showing aq. H. of bi, aq. R. of house 2 copies of plan and al rooled areas (20% maximum lof coveraae allowetn
? 2 copies of plans (show beam i window shes; poured fnd. dealgn; Mc.)
D i seT W energy calcutaHons
? 3 copies of hee presenatton plan N IW plaMed affar 7/1/93
DATE: ' '
DESCRIPTION l7F WOAK: ' e?
STREET ADDRESS:
LOT: I I BLOCK ? SUBD./P.I.D. #:
11. ?,S I t{s z as7 ?
Name:Phone?k? D
taat Firsl n
S}fAOf AfIfIIP55' . O i Y/ ?liW
PROPERTY
OWNER
CONTRACTOR
ARCHITECT/
ENGINEER
Cffy Gri Stafe: ? Zip:
Company: Phone #:
(area code)
Sheet Address: license # Exp.
City
1 set of energy calculaffons for heoTed addfflons
1sBe survey lor exlerior addBlons i decks
4-'-J?8-0
CONSTRUCTION COST:
Stafe:
Company: Name:
Telephone #: area code ( )
Shee't Address: RegishaHon M:
Cffy
Sewer i water Ilcensed plumber lreauired for new consfrucHon onN):
State:
Zip:
Zip:
PenalFy applies when address change and bf change Is requested onee permH is luued.
1 htreby acknowledge thaf I hcve read this appifcation, sfafe that the Information is coneet, and agree fo comply wRh all applicabl
Sta1e oi Minnesofa Statufes and City of Eagan Ordinances. '
? Signature of Applicanh
OFFICE USE ONLY 00
Certificates of Survey Received _ Yes _ No
Tree Preservation Plan Received _ Yes _ No ^ Not Required
OFFICE USE ONLY
BUILDING PERMIT TYPE
.
? 01 Foundation ? 06 4-plex ? 11 10-plex O 16 Fireplace ? 21 Porch (3-sea.)
? 02 SF Dwelling ? 07 5-plex ? 12 12-plex ? 17 Garage 22 Porch/Addn. (4sea.
? 03 1 of _ plex ? 08 6-plex ? 13 16-plex 18 Deck ? 23 Porch (screened)
0 04 2-plex ? 09 7-plex 0 14 Apartments ? 19 Lower Level ? 24 Storm Damage
? 05 3-plex ? 10 8-plex ? 15 Lodging ? 20 Pool 25 Miscellaneous
WORK TYPE i
? 31 New ? 35 Tenant Impr ? 39 Gas Line Only ? 43 S?? ding/Soffits/Fascia
' 32 Addition 0 36 Move Bldg. O 40 Gas Insert O 44 W indows/Doors
? 33 Alteration ? 37 Demolish Bldg.* O 41 Wood Stove ? 45 Fi? e Repair
? 34 Repair ? 38 Demolish (Interior) ? 42 Reroof j?
`
Give PCA handout to applicant for demolition
ermit
GENERAL INFORMATION p
?
Const. (Actuaq
? Basement sq. ft. Census Code j
(Allowable)
? Main level sq. ft. SAC Code i o
UBC Occupancy sq. ft. l
No. of Units
Zonin
9
P, 9
sq, ft. '
No. of Bldgs
# of Stories sq. ft. MC/ES System
Length sq. ft. City Water ,
Width Footprint sq. ft. Booster Pump ;
PRV il
Fire Sprinklereii
APPROVALS
i
Planning Buiiding Engineering Variance
,i
Permit Fee
Valuation: e..eJ i
$ ?iOG
Surcharge ?
Pian Review
License
MC/ES SAC ;
City SAC ?
Water Conn. ?
Water Meter
Acct. Deposit j
S!W Permit
S/W Surcharge
Treatment PI.
Park Ded ?I
Trails Ded.
Other i ?
Copies ( ,00
Total: ?
i
SAC Units '
% SAC
I
..,:. k
4
* •
* PI~NNER I-liNO SUNVCYOFS - _GNL
* o n 9il n a er?n9 "- uND PUNNEfl3 • IAND9CAl
* -jK * ?
2422 Entcrpri3p Orive
Mendota HclghiS, MN 55120
612) 681-1914•Fax 681-9485
625 Highway 10 Northcast
Bloine, MN 55434 '
612) 783-1880•Fax 783-1883
Certificate of Survey far: Tr1G Rottlund Compan,. IC1C.
House Address: States Avenue. Eayan, MN
Model Narne: olonial ?
_ ?.
?
v?
?'.
°-1
Z `
?
R
s az-1s'a7" w
79.15
9o¢•p a. = 0512'23" g
R = 637.98
?__?---
STATE?.S ?
NOTE: CONiRACTOR MUST VERIFY ALL DlMENSIONS
x voo.u Qenotea Existing Elevotian
x(!!? Denotes Proposed Elevation --- Denotes Drainage k Utility Easement
Denotes Drainage Flow Dtrectlon
-a- Denotes Monument
-? Denotes Offset Hub Bearinas sho
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1ea?8g, n
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a
1 .
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1
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3 ? I
28.06
46.46 °2,
89'10'15?? W I ?
6 @ PIQ'?'C? C„?
_ .? _ ?? . ?A f? ?
wn ? ore
PROPOSED HOUSE_ELEVATION
Lowest FIaoF Elevatian:899.05
Top of Block Elevation:907_16
Garage Slub Elevatton; 906.83
assumed Y
LOT 12 , BLOCK 3- HILLS OF STONEBRIDGE
DAKOTA 'COUNlY, IAINNE?OTA R A D D TI 0 N
I hYreGy nrtify lhat thb iYlvOy, pl9n or raport w0? pr ond by me of undee tn4 direct ?upervyion snd tha[ t am duly RplaNracl Land Surwvor
une.r the Iaws of che 5[ais ol Minnnot.. O•led chis?tlay of ? A.D. 19
?f
a
: ?Y
p. 1?fIL?1_3OjOg rsnwcn-?w SIKI.MI S Pif.N(1.I nal
ylL!
SlJ/"l! 1
AVENUE
RESIDENTIAL
BUILDINC PERMIT APPLICATION
CITY OP EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651•681-4675
New Construction Reouirementa
. 7 ra.gisteretl sde surveys showing sq. 3. of lol, sq. ft. of house; and all raofed areas
(20°6 maximum lol coverage allcwed)
• ?:ocies of plan showing beam 3 wmdow srzes, poured found tlesign, etc.)
• 7 set of Eneyy Calculations
• 3 co0ies of Tree Preservation Poan d lot Platted after 717197
• Rim Jo?t De[ad Opuons selection sheet (blags vnth 3 or less units)
DATE 3 11 Z, n Z
Water SoRener
_ Water Heater
v o. oF Baths
¢5ao.'°
SITEADDRE55 4-D I la Caw.?er..x?-Q G?• ? MULTI-FAMILYBLDG _ Y N
TYPE OF WORK R O o-P FIREPLACE(S) _ 0 _ t_ 2
APPLICANT fz`F- T l.J . (t " a w,-.a--
STREETADDRESS 131 OO ?Q51` t3& 00, 5 fi- CITY 5Nr`nsu;YIe-- STATEn?Zlp 55337
TELEPHONE # P I Z 2 2 G zo i 1 CELL PHONE #' FAX #bl2q5'z 2)7S
? 2
PROPERiY OWNER G ??ej Cn " 5'` °` TELEPHONE #4125 ( 2-1-3 39
-----------------------------------------------------------------------------------------------
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ M[NN(.;Sl)'f:\ RGLLS 7670 C.1"fE(;0Rt' l MI\\I:SO"1'A RI'LI:S 7674
(-1 submission rype) • Residential Ventilation Category 7 Worksheet Submitted • New Energy Cotle Worksheet SubmiC.eC
• Energy Envelope Calculatlons Submitted
Plumbing Contractor:
Plumbing system includes:
Mechanical Contractor:
N(cch.mic.a,cstcm includrs:
Sewer/Water Conhactor:
-- Air Condiuoning
_ He1t Rccoccr}• S}'stcm
Phone #
Phone #
Pee: 590.00
Fcr. 570.00
-------°-----.. _.. - ° --°-----° ------------° ------ °-------°-------------° --°--------------- °----------------------
I hereby acknowledge ihat I have read ihis application, state that the information is correct, and agree to comply
with all applicable STate of Minnesota Statutes and City of Eagan Ordinances.
Signafure of Applicanf
OFFICE USE ONLY
?S
113 ? ?"
RemadaUReDair Racuiraments
• 2 copies o( aan
• 1 set of Eneryy Calculaticns (or heated additions
• I sde survey'or extenor additwns 8 decks
• Intlicate if home served by septic system foraddrtions
VALUATION
Phone #
_ Iawn Sprinkler
Vo. of R.I. Baths
Certificates of Survey Received - Tree Preservation Plan Recerved - Not Required _
Updatetl 3102
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA132219
Date Issued:07/30/2015
Permit Category:ePermit
Site Address: 4016 Camberwell Dr N
Lot:12 Block: 3 Addition: Hills Of Stonebridge 3rd
PID:10-32992-03-120
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Air Conditioner
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
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 -
Gregory A Gustafson
4016 Camberwell Dr N
Eagan MN 55123
(651) 308-8847
Haley Comfort Systems
122 3rd St W
Hastings MN 55033
(651) 437-0338
Applicant/Permitee: Signature Issued By: Signature
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