4343 Andromeda WayI CITY OF EAGQN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
StTE ADDRESS:
t
:tt 1 1,; ;,hli Idli
i PERMIT SUBTYPE:
[oN REcoRn
PERNIIT TYPE: • ' ? ; ' ? ? ? : ? ?
Permit Number:
Date Issued:
i
APPLICANT:
TYPE OF WORK:
INSPECTION
.. ,, DA . ..
?? y 9
540
?
Permft No. PermR Holder Date Telephone #
S/W
PLUMBING
HVAC
ELECTRIC
ELECTRIC
Inspection Date Inap. Comments
Footings I
Foundation
Framing
Rooting
Rough Plbg.
Rough Htg.
Isul.
Fireplace
Final Htg.
Orsat Test
Final Pibg. Plbg. InspeCtor -Notify Plumber
Const. Meter
Engr./Plan
Bidg. Final
Deck Ftg.
Deck Final 14 /7 ?
weu
Pr. Disp.
? __
lim
.
RECEfVEP
AMOUNT
CASH RECEIPT
CITY OF EAGAN
3795 PILOT KNOB ROAD
EAGAN. MINNESOTA 55122
•
DATE 19
? I
? CASH ? CHECK
FOA
FIJND CODE AMOUNT
G.! ? v
T ank You
BY
? L
?Y
White-Payers Copy
Yellow-Posting Copy
Pink-File Copy
CITY OF EAGAN Remarks
Addition WILDERNESS PARK 2ND ADDITION, LQt 13 Rtk 2 Parcel 10 84251 130 02
Owner?'???t???'"-"'.? ??•?QL streex 4343 Andrameda Way State Eagan, NIN 55123
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK 94L/ 1973 154.4 7.11 20 100.24 A008318 9/20/79
SEWER LATERAL
WATERMAIN
WATER LATERAL
-1F WATER AREA 1979 638.96 63.90 10 • r
* STORM SEW TRK 1979
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
Road Unit Char e 75.00 12593 12-5-78
WATERCONN. 250.00 12593 12-5-?8
BUILDING PER. SOHO
s,ac 500.00 12593 12-5-78
PARK
CITY OF EAGAN
3795 Pilot Knob Road
Eogan, Minnesota 55122
Phone: 454-8100
7=''V PERMIT
Dote:
3-24-71
-?34 3 Andrsnacia Way
Site Address:
! .,,ildet7rtesb Par}c 2rx3
Lot Block ` Sub/Sec. _
Ncme AbCarthy ?,'?. mw'
°e Address 1472 Rr7d7[tiw
3
4,f7.a7; ;"73
City _ Phone:
Nome °•Rj11 aty :leat11:cT
-
.
dd p.,T,. .,kn.
ress
V •'i '. . , . . -,. . . City Phone:
This Permit is issued on the express condition thet all work sholl be
Minnesoto Statutes and City of Eagon Ordinonces.
a7w" IQ`I AIIt RflQIJIRM
No. 1,117
Receipt No.: 13674
Single
Residential ?C
Multi Res., Comm./Ind. I
New/Alter./Repoir
Cost of Installation
Permit Fee
rr)
SurcFarge ' Tota I ' done in accordance with all opplicable Stote of
Officiol
CITY OF EAGAN
3795 Pilot Knob Road
Eagan, Minnesoto 55122
Phone: 454-8100
TT-L,rIn-T1.417- pERMiT
Date:
1-4-79
Site Address; -1343 `rtlrM1BM 4W
Lot ' ' Block - Sub/Sec, r,Yilrl--rrJE-MS r,al* TI
Nome 'r'CC?3?hY (?0?93?+ Iri"• •
e Address 14'! ? 'Brido--"%id
?
City Phone:
Name ?"'•""t?'?
?
.? ti/A'ddress TW*)flt '-T'.Cnjl
s , .
City Phone:
This Permit is issued on the express condition that ail work shall be
Minnesota Statutes ond City of Eagan Ordinances.
No. ? 295
Receipt No.:
Singfe
Residentiol
12!933
X
New/Alter./Repair
Cost of Installation
Permit Fee ?
Surcharge
roto I
done in accordance with all appliwble State of
Building Officicl
WATER SERVICE PERMIT
CITY t1F EAGAN
3795 Pilot Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning: No. of Units:
Owner: • ? t?:.?° {?.,;- -
Address:
Site Address: ''•" ? ?..., - , ' i
Plumber:
Meter No.: Cannection Charge:
Size: Actount Deposit: -
Reade? No.: Permit Fee:
1 ugroe to eompFr with tl+e Gty of Eagon Surcharge:
Ordinanees. Misc. Charges:
Total:
By Dote Paid:
? Oate of Insp.: Msp.:
CITY fOF EAGAN
3795 Pilot Knob Rood
Ecgon, MN 55122
Zoning:
Owner: _
Address:
SiYe Address: ? Plumber:
1 ugree Fo eomply wifh fhe Cify of Eogon
Ordinonces.
By
Dote of Insp.:
SEWER SERVICE PERMIT
PERMIT NO.:
DATE:
No. of Units:
Connedion Charge:
Account Deposit: _
Permit Fee:
$urcharge: --
Misc. Chorges: -
Total:
Date Paid:
10).00 pc
Ann_ nr? rw
. cirY oF EAGn?N
8745 Mlae Knob Road Eegen, MN S5122 N! 5O8 0
' PHONE:4S4-8100
SUILDING PERMIT Receipt .?#
To M used for Est. Value ' Dote 19
Site Address Erect p Occuponcy
Lot Block $ec/Sub. T. Alter ? Zohing
Parcel Repair ? Fire Zone
,,•? .?1"-? _; :`, { y?'" Enlarge ? TyPe of Const.
?
•
oc Nome
,
" ;',
-,-' ' .r,? _.
Move ? # Stories
•i ?
Z Addreas Demolish ? Front ft.
? Ci Phone Grade p Depth h.
o Nome Approvols Fees
,
?Q Address Assessment Permit
F
Ci Water & Sew. Surthorge
Phone
? Polioe Plan check ?
Name Fire 5AC
?? Add?ess
`W Ci Eng. Water Conn.
Plonner Water Meter
C
ounci I
I hereby acknowledge thot I have read this application and state that gldg, pff. '
the informotion is correct and agree to comply with ull applicuble APC Totol '
State of Minnesoto Statutes and City of Eagpn Ordinantes.
Signatum of Permittee •
A Building Permit is issued to: ; . _r ,-,-y ,
on the axpress condition thot
all work shall be done in accordance with oll appliaoble Stcte of Minnesota 5tatutes and City of Eogan Ordinances.
Buildin9 Official
?N+nk # paM lawd Pomtttw
Plumbin9 rV /- y- 7? =?
Mechaniwl
si457a33 ? 2`-7
INSPECTIONS DATE IP6P. Rouph-In find
Footings Oote ? _.?ufe Insp.
Foundation Plumbing
c
?.?-
Frome/fns. -21,..:)q Mechonical
Finol
?
v.-•
RemQrks: ?-
j
?' ?'r?ehd o fa ??
? SPP y ,? , ?
? ? ?UrJA! t y ?y -
This request void 18 months Gom
1\ 5 7 0 3 3
Date of tla's Request 3-! 1- '/ 7
I, as g9. Licensed Electrical Contractor OOwner, do hereby re ues mspection of the above electri-
cal wiring installed at: U3 I? L ?
Street Address or Route No. 4343 fi'AJ D 0 /'vi F-b A' ?;ty ? AG? nJ
SecUon Township Range County 4XO 7Y4
Which is occupied by ?? 1C (, A P-
Is a roughin inspection required on this job? No ? Yes ? Ready Now ? Will Call,e51
Power Supplier _ I,JF} KOT M (?T?, Address
ElectncalContractor StAl2 ?L@LT2?C_ Contractor'sLicenseNo.n-31D?y
I (COmpany Name)
Mailing Address
Authorized
or
xo. 3 G, - 400
SUAi1L5 BOWRD QOPV
inspecUon request will not be accepted by the
i Board unless proper inspection fee is endosed.
,nnesota State Board of Electricity
1954 ty Ave., St. Paul, Minn. 55104-Phone 645-7703
R EST FOR ELECTRICAL INSPECTION
CHECKAEL W WORK COVERED BY THIS REpUEST
R 57033
Type otBuilding New dd. Rep. Check Appliances Wired For Check Equipment W"ved For
Home ? ? Range ? Temporary Wtring ?
Duplex ? ? Walet Heater ? Lighting Fixtutes x
Apt. Bldg. ? ? ? Dryer ? Electric Heanng ?
Commercial Bldg. ? ? ? Fumace ? Silo Unloade, ?
Industrial Bldg. ? ? ? A'v Condriio er ? Bulk Milk Tank ?
Faim ? ? ? L151 15
12 P o,5 p L Lis[ 1
Other
?
?
? p[hets
Hete Others}
Here I
COMPUTE INSPECTION FEE B
Serice Entrance Size:
0 ro 100 Am s # Fee er [
0 t Fee Cvcuits:
0 to 30 Am etes # Fee
]Ol to 200 Amps. / O.OD 31 to 00 ATMelm 31 to 100 Am eres
Above 200_Amps. Above 100 Amps. Above 100 Amps.
Transformers 11 RemoteControlCim. Pa[tulorotherfee
Signs S ecial [nspection Minimum fee E5.00
Remarks Dd
a. TOTAL FEE
P..
4a;-S0
I, the Electrical Inspector, hereby certif t the o u'?spection has been made.
(Rough•in) Date y?a(Final) ? Date '?-
This request void 18 months from '
BUILDING PERMIT APPLICATION
Te be ume f,. SF Dwlg & Garage E
Site Address
Lot 13
Parcel # -
c Ncme
o AddrE
p Name
z?
8? Addra.
r ?:...
Block Z Sec/Sub.
Value 50,000.
Name _
Address
I hereby ocknowiedge that I h
the infomwtion is correct an
State of Minneaoto Statut?]
X/
Signoture of Permittee?2L
A Building Permit is Issued to:
oll work shall be done in ac
Building Officiul
CITY OP EAGAN
3795 Pi1W Knob Road Eagan, MN 55I22
PHONEt 4548100
ReceiDt #
N° 5080
?-d ?z
12-5 , .78
Erect Occupancy I
ii Alter ? Zoning
Repair ? Fire Zone 3
? Eniorge ? Type of Const. V
Move ? # Stories
Demolish ? Front 52 ft.
_
Grade ? Depth 48 ft.
Aeerevelf F88f
Assessment _
Water & Sew.
Ptrona
Police -
Fire
Eng.
PFrone Planner -
Council -
read this application and state that
3ree ro comply with oll applicable
City , E gnn r an gldg. Off. _
APC
IriC. on the express condition that
Minnesoto Statutes ond City of Eogan Ordinancea
Permit 1YVJV_
Surcharge 25.00
Plan check
snc 500.00
Water Conr2LO . 00
Woter Meter 60.00
mad Unit 75.00
Total 1,050.50
i/ -
a
naTE 'v- - z v --
BUILDING PERMIT APPLICATION
Include 2 sets of plans, 1 site plan w/elevations and 1 set of energy calcuations.
/
To be used for /1o? 5 i[lfn G& Valuation
Site Address:
Lot Block Sec./Sub. Parcel Number
/S 12-- w,'/c1arness Vc,/?.?nOf
Owner /L/c
Address /y
.
Telephone /j s-?- - S 3 7 3
Contractor Telephone
Address
Arch/Eng. Telephone
Address
Erect
Alter _
Repair _
Enlarge
Move
Demolish
Grade
Date of A roval and Initial
Assessment ?7
Water/Sewer
Police
Fire
Engineer
Planner
Council
Bldg. Off.
A.P.C.
OFFICE USE ONLY
Occupancy
Zoning e /
Fire Zone 3
Type of Const. l?
# of Stories
Front ll a ?
Dep th
Fees
Permit SIX2
Surcharge a? 5-
Plan Check
SAC
Water Connection od
•?O ?
Water Meter
?? j'.?.mzy ) Gi"
??-
TOTAL ci)
(
.?'? ? ?
?
?THE AUSTIN
COlV1PANY
DESIGNERS • ENGI NEERS . BUILDERS
LISTED BY OWNEH
CHECKED BV LOCATION
CONTRACT NO
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FORM N0.48
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cOMPUrATioiM
saaEET
EST. NO.
SHEET OF
DATE
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. EXTERIOR ENVELOPE AVERAGE "U" COMPUTATION
One or two fami ly dwei I i ng ? Owner /`/e 6?;, ZZi ( ir,4 ,cZ-
AIl other Site A'ddress
Contractor e-en s / Ji, c D a t e / / - 2- O - 7 ? Phone 5-37 ?
?
LINEAL FT. OF
EXPOSED WALL Ng + 26 + U 8+ RG + _ + + + _ + _ X /3,Cft above grade s
TOTAL EXPOSED ALL AREA SQ. FT. ? 0 2 2-5-4
OPAQUE WALL CONSTRUCTION: "U" value x area
/Z"iZ ? "U" 0667X sq. ft. yf. J'•7i= 8-J 09i4,? (U) (A)
riit 2 nUli .o» x sq. ft. _1v.9184_ (U) (A)
r-??Z y "U" .oso x sq. ft. 9.0132 (U) (A)
Detai I reference a,irt "U" .1oa3x sq. ft. 48,f4 = a9'? (U) (A)
from "U" , /Z x sq. ft. lS9
-75- = /9
(U)
(A)
attached sheets "U" x sq. ft. _ (W (A)
liull - -x sq. ft. _ (U) (A)
WINDOWS: "U" value x area
Make 8 Type "U" ,S.rx sq. ft. /o/, 31 =SS.723 (U) (A)
"lJ" x sq. ft. _ (U) (A)
"U" x sq. ft. _ (U) (A)
"U" x sq. ft. _ (U) (A)
DOORS: "U" value x area
Make $ Type o "U" S?x sq. ft. yp = ?1•?v (U) (A)
"U" ,Ssx sq. ft. 37. /7 = 90• wH?/ (U) (A)
"U" x sq. ft. _ (U) (A)
TOTALS 'a %Z2•SG Sq. Ft. ?S;f , 5 6/.? (U) (A)
TOTAL (U) (A) VALUES
DIVIDED BY TOTAL WALL AREA aS,3•961.3 AVG. "U"
ao.2 2 .f(-
AVERAGE "U" .17 or less for I& 2 family dwelling
ROOF/CEILING:
TOTAL AREA: 1.2 V ? sq. ft .
Detai I reference o3iJ' "U" x sq. ft.
from ' "U" x sq. ft.
attached sheets, "U" x sq. ft.
describe openings "U" x sq. ft.
in Poof "U" x sq. ft.
,2vB = 39.G8?y (U) (A)
_ (U) (A)
_ (U) (A)
_ (U) (A)
_ (U) (A)
TOTALS / 2 y S'
TOTAL (U) (A) VALUES
D I V I DED BY TOTAL ROOF/ 3g• ? 8` y?
CEILING AREA
AVERAGE "U" .05 for ventilated roofs
sq. Ft. 39.684G (u) (n)
M dC.qRr yy
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BEA BLOMqUIST
MAYOR
THOMASEGAN
JAMES A. SMITM
JERRY THOMAS
THEODORE WnCHTER
COONCIL MEM8EF5
Febnaary 23, 1952
Mr. Robert Mr-Ibnald
4343 Anciromeda T,JaY.
Fagan, MN 55123
Re: Fireplace
Ipar Mr. :°1clbnald:
.A
CI:TY; OF E
f tkj°PA. 80%41199 .
'?'2-? "'EAGAN,'MINNESOTA'-,, ?
'?,a ss°iiz} ,.•u?.: r- : ?... .? . .
? vMONE 4SO-B1O0 "'y?i.p7
,? .
.??
?
THOMASHEOGES
C17Y PUMiNiSiflRfOR
EUGENE VAN OVERBEKE
LIiY CLENK
At yots reRuest we inspected the above mentione(i heater for proper install-
atian on 'Iliesday, February 9, 1992. lhis particular brand of manafactured
fireplace is imlisted, and in this case we must follow manufact+-wer's install-
ation instnmtian. 1he origi.nal installation clid not conform with the marnr
factw^er's instructians wu Pmvideci, but I tmderstand that the instructions
have been upgraded neri.odi.cally, 'the rn-esent re-instaZlation which I inspected
on February lI, 1981 meets the present instructions which I have enclosed.
Sincerely,
at,?- kf'/
mu? Rp-ia
ass c. Pui.laing aFficial
Fhc.
CC : Parcel File -?.1Q 84251 130-D21 - W, T_ p K ;?^ a
THE LONE OAK TREE ... THE SYMBOL OF STRENGTM AND GROWTH IN OUR COMMUNITY.
ITEMS CIRCLED ARE CRITICAL.
Note: 2 bolts in bottom of fire box, remove
these, drill holes in lower fouvers to fasten
fire box.
UALF PNRICK FCR
SINGLE WALL
GON STRUCTION
:?/4" PLY'D.1?
TEMPORARY `
SUPPoR"r5-
Remove these when
concrete is properly
cured. i
?==--- -?
FORM F OR SLAB
SINGLE WALL CONSTRUGTION
For SAFE EFFICIENT Operation
Follow Installation lnsfructions
This unit must be double walled, with insulation between, use 31h inch fiber glass with- '
out vapor barrier, compress to 2 inches. ?
1. 5-8" .
4'-0..
9"CONC. SlA
REINF. RODS
?.a_ ? ? a • .
? . ..
?
0
OVEN SUPPORT-,.
SILL SEALER
AROUND TuE FRONT
0F FIRE BOX--?
NSUL.
6"' AIR SPACE__.
OUT SIpE A1R INTAKE
CoNC. 5LA15-
2"x8" J015,T@l6'0.C:-
BOLT HOLES
?
I
-? ; ,---- - - ----------- ---; . ?
i °
? ? o o? d a i
1 . "
•n ? ' / U21
• i 'X i
'i
a
0
c
?- o
0
=
0
?
FRONT VIEW POR INSTALLING INSIDE
A BUILDING, USE
`?DOUOLE WALL GoNSTRUGTION INSIDE WALL.
I 10"x10" ID or I
12"x12" Modular FLUE
Use this for bifold
fireplace.
CEIL
NEAT OUTLET VENT
?
?
?
?
No MoRTAR 30NT
AIR INTAKE ?
CoNC.F TG, oN
FOUNDATON WALL?
2wX V„ JOIST-?-,
WALLS SHOWN ARE 4 INCHES THICK.
i
-o- 4" CONC. SLAB
,RE1NF. RODS
OVE N SUPEflRT
IN SUL.
3' QIR SPACE -*-N
-OUT SIDE AIR INTAKE
4" CoNC. SLAB
L?
b o
p . a ? .
O
° REINF. RUDS
b
a
•
SIDE VIEW
010U51LE WAIL CONSTRUCTION
?
,
3z-
; .
,
;--!-
, ?
?
?
i o
D
? , '`•
DRAWN BY
LES DAGI:E
FEB. 12 1 1975
4' CONC
RCWF
OVEN
INSuL.
(o" AIR
OUT 51
4° CON
2"x8" ?
L-J aI
RE?N7 ?oDS I T
. . . . .
REAR VIEW
DeubLE wai-L coNSTRUcTioN
? CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
Base Fee $30.00
Surcharge $.50
Total Fee $30.50
SITE ADDRESS:
4343 ANDROMEDA WAY
LOT: 13 BLOCK: 2
WILDERNESS PARK 2ND
p.I.N.: 10-84251-130-02
DESCRIPTION:
Building-Permit Type DECK
Building Wor.k Type NEW
?.. ,1
``.
\ f '
. _,
? CI 1
. . ??.x..- .? -
REMARKS:
FEE SUMMARY:
CONTRACTOR:
I
PERMITTYPE: euzLorNG
Permit Number: 0 2 3 8 2 3
Date Issued: 0 6/ 0 9/ 9 4
OWNER: - Applicant -
ZUBICK DOUGLAS
4343 ANDROMEOA WAY
EAGAN MN 55123
(612)454-4343
I hereby acknowledge that X have read this application and state that the
infarmation is correct and agree to comply with all applicable Stete of Mn.
Statutes and City of Eaqan Ordinances.
APPLICANT/PERMITEE SIGNATURE
PERMIT cK a-IqD3 6-9 _ ,?q
? ISSUE BY:S ATURE
I
INSPECTION RECORD
CITYOFEAGAN PERMITTYPE: BuzLozNG
3830 Pilot Knob Road Permit Number: 0 2 3 8 2 3
Eagan, Minnesota 55123 Date Issued: 06 /09 J94
(612) 681-4675
SITE ADDRESS: APPLICANT:
L07: 13 BLOCK: 2
4343 ANDROMEDA WAY ZUBICK DOUGLAS
WILDERNESS PARK 2N0 (612) 454-4343
PERMIT SUBTYPE: TYPE OF WORK:
DECK NEW
INSPECTION D. . ..
FOOTINGS FINAL
F ?
L ?
CITY OF EAGAN
1994 BUILDING PERMIT APPLICATION
681-4675
?
tA
SINGLE & MULTI-FAMILY 2 sets of plans, 3 regis ere si e s 41 s, 1 copy of energy
calcs. .1' J::
COMMERCIAL 2 sets of architectural structural plans 1 set of
specifications, 1 copy --? - -
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 Valuation of work
Site Address: -e13 q3 Arvdromeda W3
STREET SUiTE #
Tenant Name: (commercial only)
LOT 13 BLOCK SUBD.??L ey?Q'SS /?'?r/?' P 2 D. #
.S'eCONoI Aold:T?aN
Descri tion of work: a?ep
The applicant is: Jil Owner ? Contractor ? Other (Destribe)
Name ??Jli ir-k ,0 oK ? ?as Phone --
'
Property 00
LAST FIRST a.G.?tn, •
Owner
Address ?3 q3 Ruali"oYM a% I,Va
STREET STE M
City ? a 9 aN State Zip M023
Company Phone
Co ntractor Address License # Exp.
City 5tate Zip
Company Phone
Architect/
Engineer Name Registration #
Address
City State Zip
Sewer & water licensed plumber Processing time for
sewer & water permits is two days once area has been approved.
I hereby acknowledge that I have read this application and state that the information is
correct and agree to compl with all applicable State of Minnesota Statutes and City of
Eagan Ordinances.
?
Signature of AppTicant: ?
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundatian ? 06 Duplex ? 11 Apt./Lodging
? 02 SF Dwg. ? 07 4-Plex ? 12 Multi. Misc.
? 03 SF Addition ? 08 8-Plex ? 13 Garage/Accessary
11 04 SF Porch ? 09 12-Plex ? 14 Fireplace
? 05 SF Misc. O 10 Multi. Add'1. 0" '15 Deck
WORK TYPE
P?31 New ? 33 Alterations ? 35 Tenant Finish
? 32 Addition ? 34 Repair ? 36 Move
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of 5tories
Length
Depth
APPROVALS
Planning
Fngineering
REG1UlRED INSPECTIONS
? Site
? Wallboard
Basement sq. ft.
lst F1. sq. ft.
2nd F1, sq. ft.
Sq. Ft. total
Footprint Sq. ft.
On-site well
On-site sewage
Building
Variance
ED Footing
,15 Final
? Framing
? Draintile
?
?
? Insulation
? Fireplace
Permit Fee
Surcharge
Plan Review
License
MWCC SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
5/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total:
vatuec;one $
4 "'
? 16 Basement Finish
? 17 Swim Pool
? 18 Comm./Ind.
? 19 Comm.JInd. Misc.
? 20 Public Facility
? 21 Miscellaneous
? 37 Demolish
MWCC System
City Water
PRU Required
Booster Pump
Fire Sprinkler
Census Code
SAC Code
Census Bldg
Census Unit
Assessments
SAC %
5AC Units
,,• 7-
• .??/"e e ? rT ? ??O h'f ?. ?? Lf/ c?
• ?
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• ?m
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130 c/s Lo%
, ,.RESIDENTIAL
BUILDING PERMIT APPLICATION
5 } CITY OF EAGAN
? 3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675
New Conatruction Reauirements
• 3 registered site surveys showiig sq. ft. of lat, sq. k. of house; and all roofed areas
(20% maxunum lot coverage allowed)
• 2 copies o( plan showing beam & window s¢es; poured found design, etc.)
• lsetotEnergyCalculations
• 3 capies of Tree Preservation Plan H bl platled after 711193
. Rim Jaist DeUJ OpUons selectian sheef (bldgs with 3 or less unib)
DATE 6,1916) -?
SITE ADDRESS '-/3113 MULTI-FAMILY BLDG _ Y x N
TYPE OF WORK Remf R[p/?ce.yCn-i- ? ParY%s/ S"?+?9 FIREPLACE(S) _ O _ 1 X 2
APPLICANT
STREETADDRESS ??p? «?''? y`• ? CITY ??/%, WL'?STATE A(ti ZIP 5??2Y
TELEPHONE # 9Sa-y3i-97VCELL PHONE # 6?2-5?8- 36 rz FAX # ^
4 1z-S78-36?L
PROPERTYOWNER_???5''?/?? TELEPHONE# 6S7 -238-3a Yz
n?'jGS?Cty?
..---......'------'------------------.-..----------..----------.--..-----..--.---.----.m .......
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNES01'A RiJLES 7670 CA1'EGORY 1 MINNESO't'A RULES 7672
(J submission lype) • Residential Ventilation Category 7 Worksheet Submitted • New Energy Code Worksheet Submitted
• Energy Envelope Calculations Submitted
Plumbing Contractor: __
Plumhing system includcs:
Mechanical Contractor:
Mechanical syslem incfudes:
Sewer/Water Contractor:
Phone #
Phone #
Fcc: $90.00
Pcc: $70.00
---------°----°-------°-°------------°-------° °----------------------------------°--------°---------°-----------
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply
with all applicable State of Minnesota Statutes and City of Eagan OrdinancIps.
Signature of Appllcant
OFFICE USE ONLY
WaLer Softener
Waler Hcatcr
No. of Baths
_ Phone #
Lawn Sprinklcr
No. of R.I. Badis
_ Air Condilionuig
_ Heat Recovery Systein
RemodeVReoair ReauiremeMs
• 2 copies of plan
• 1 sel of Energy Calculatiom for heated additbrs
• 1 site survey for erierior additions & decks
• Indicate H home served 6y septlc system for additions
VALUATION -? Sa&o
JUN 1 1 2002
Certificates of Survey Received - Tree Preservation Plan Received - Not Re?uired -
OFFICE USE ONLY
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? OS 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 6ct. Alt - Multi
? 03 01 of _ plex ? 09 07-plex O 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screened) ? 36 Multi
? OS 03-plex ? 11 10-plex ? 19 LowerLevel ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)• ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement 'Demolition (Entire Bldg only) - Give PCA handout to applicant
Valuation Occupancy MC/ES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
N6r. of Bldgs Length Fire Sprinklered
Type of Const W idth
REQUIRED INSPECTIONS
_ Footings (new bldg) _ FinallC.O.
_ Footings (deck) _ Final/No C.O.
_ Footings (addition) _ Plumbing
Foundation HVAC
Drain Tile Other
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tes[s _ Final
_ Framing _ Siding Stucco Stone
_ Fireplace _ R.I. _ Au Tes[ _ Final _ Windows (new/replacement)
_ Insulation _ Retaining Wall
Approved By
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
Building Inspector
Use BLUE or BLACK Ink
r
For Office Use J ^ I
U~
City of Ea in
J I Permit Fee:
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff:
I I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit
Name: ~`~,J+~41 Phone:
Resident/
Owner Address / City / Zip: Lf33 JneC~~ k.Jc"
Applicant is: Owner -19 Contractor
Type of Work Description of work: oof l
Construction Cost: Multi-Family Building: (Yes /No X
i
Company: Cc>jW:cLxAM0 e_ 5 3 15 LLC- Contact: 1'-j,--Q If
I
Contractor Address: i~tSg9ut'h s'~' City:
State: 1't1 N1 Zip: b a 14 Phone: {O zap
License iACi G377G3 '~v Lead Certificate
F FIf the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
i
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:
I 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) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
x
Applicant's Printed Name Applican 's Signature
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