1270 Berry Ridge Rd7qqd-Le
2007 RESIDENTIAL MECHANICAL PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please complete for: single family dwellings & townhomes/condos when permits are required for each unit
I hereby apply for a Residential Mechanical 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 with the Mechanical Codes;
permit, but only an application for a permit, and work is not to start without a permit; that the work
ap roved plan in the case of work which requires a review and approval of pla s.
i ly� AWii
Applicant's Printed Name
Applicant's Signature
#
Date —7 / 1 / / 0 )
Site Address 1 /0 Bpi j R,Lci,-C Unit
Property Owner PJ Ian `f 1,i 8 .Sh6V) Telephone #(&2 / ) 2(-/0— /DLO
Contractor
BURNSVILLE HEATING & NC, INC.
Street Address 3451 W. Burnsville Parkway City
State Suite 120 Zip Telephone # 9,-..-
)`f —
nn'' $ultisvilie,
l2MN 55337
Bond #: L/ 5j3f % Expires: '7 4).6 /6
The Applicant is Owner X Contractor Other
Fire repair (replace burned out appliances, ductwork, etc.)
This fee applies when extensive mechanical repairs are made to a building.
$ 90.00
Add-on or alteration to existing dwelling unit
)( furnace Additional x Replacement New
$ 50.00
air exchanger
X air conditioner
heat pump
other
State Surcharge
$ .50
Total
$,
I hereby apply for a Residential Mechanical 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 with the Mechanical Codes;
permit, but only an application for a permit, and work is not to start without a permit; that the work
ap roved plan in the case of work which requires a review and approval of pla s.
i ly� AWii
Applicant's Printed Name
Applicant's Signature
CAW# R lR
CfTY Of EAGAN
3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
ATE 19
RECEIVED"
F"Ot
AMOUNT
& -DOLLARS
+oo
❑ CASH CHECK
FOR IL .~l t l~
FUND CODE AMOUNT
Thank You
White-Payers Copy
Yellow-Posting Copy
Pink.-File Copy
tr '
Receipt MECHANICAL PERMIT Permit No.
CITY OF EAGAN
Fee
fill in numbered spaces S/C
Type or Print legibly Tot.
1. Date 2. Installation Cost ' . r. r
3, Job Address Lot Blk. Tract
4. Owner.
5. Contractor Phone
6. Address S
a i
7. City State { Zip
8. Building Type: Residential Commercial ❑ Institutional ❑
9. Work Description: New ❑ Add ❑ Alter ❑ Repair ❑
10. Describe ?(j J f
full- Fuel Type i
11. No. Equipment BTU - M. Ea. No. Equipment CFM
Forced Air Air Handling:
Mfg.
Boilers
Mech. Exhaust
Mfg.
Unit Heater
Mfg. Other it i 4
Air Cond. -4
Mfg.
Gas, Piping Outlets
`r 12. 1 hereby certify that the above information is true and correct, and I agree to
comply w)to all ordinances Td codes,governing this type of work.
Signed: -.a
for v<';-_,.` l( 4
Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
ApP+oved = - ? CITY OF EAGAN 46"100
CITY Of EAGAN
i • 4 y 37" Pilot Knob Road Eagan, MN 55122 N2 6268
PHONE: 454-8100
BUILDING PERMIT Receipt #
To be used for nri" /l' Afi h5 qtr}
Est. Value Date 19
Site Address 1271 ferry ' ~l d~_ e P,d • Erect ® Occupancy
Lot Block 6 Sec/Sub.llilltOP 1'sta.tes Alter ❑ Zoning
Parcel # 10 33^~O 000 Repair C1 Fire Zone %
r, Enlarge ❑ Type of Cons#. v
-u.T1s}pine Corstruction "o.
W Name ~1 Move ❑ # Stories ,
3 Address 1"17 E. 157th St. Demolish ❑ Front 42 ft.
F ° city Burnsville 55~~+dne 435-653r' Grade ❑ Depth ft.
Approvals Peus
o Name
Assess ei~ Permit • rn
oi Address same
U~ Water & Sew. Surcharge 3,-
city Phone rtj • (;1
Police Plan cheek
Name Phillips Plan -SYC. Fire SAC 5 215 •n`l
HZ
x,, Address Eng. Water Conn.
4 W City - `n e . a- @ Phone 432-"144 .
Planner Water Meter
Council Road Unit ri l
I hereby acknowledge that 1 have read this application and state that Bldg. Off.
the information is correct and agree to comply with all applicable APC Total 35~• 5n
State of Minnesota Statutes and City of Eagan 'Ordinances.
Signature of Permittee
A Building Permit is issued to: 0-re ConstructioY? C-o_ on the express condition that
all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building Official
L-
Perudt # Deft Issued Pout""
Plumbing Q Q Q
M a icol a Ao a -~O
i
/0-
j
INSPECTIONS DATE INSP.
Rough-In Final
Footings fr!n Date Insp. Dote Insp.
00,
Foundation _ Plumbing
Frame/ins. Mechanical
-V 74
Final
Remarks:
l l (.c S~
i
r
CITY OF EAGAN
3745 Pilot Knob Rood
2ncrr Eagan, Minnesota 55122 INSPECTOR NOTIFICATION
No. Phone: 454-8100 REQUIRED BY LAW
Plurbinr PERMIT _ FOR ALL INSPECTIONS
Date: 10-24-CO Receipt No.: 21542
Single
Site Address: 1270 Berry ddge F.d. Residential
Lot 2 Block Sub/Sec. Hilltop Est. Multi Res., Comm./Ind.
Name Sunshine Construe. New/Alter./Repair new
Address 1017 E. 157th St. Cost of installation
City Eurnsville. '.fn. Phone X435-6535 Permit Fee 20.00
k
'f Name Lakeville P & I. Surcharge "5
E
1 Address Rt • 2
*~keville X41-3325 20.50
City Phone: Total
This Permit is issued on the express condition that all work shall be done in accordance with all applicable State of
Minnesota Statutes and City of Eagan Ordinances.
Building Official -4
CITY OF EA"H
3795 Pilot Knob Rood
No 4'117 Eagan, Minnesota 55122 INSPECTOR NOTIFICATION
Phone: 454.8100 REQUIRED BY LAW
ti.nf PERMIT FOR ALL INSPECTIONS
Date: 10-21- 21502
Receipt No.:
Single
,y ~'.f cl~?4 t' v
Site Address: Residential
6 Hilltop ~;st.
Lot Block Sub/Sec. Mufti Res., Comm:/Ind.
Name 23w,,31hine Construe. Co. new
New/Alter./Repoir. Address 1'117 E. 157th St. Cost of Installation
-"Urnsv-llle, '~T:. 435-6535 20.(ri
City Phone: Permit Fee
The Heating Co.
Name ^
Surcharge
2016 200th St. "l.
Address
City Faz'rdr4°tC72jh. 55024 Phone: ,.63-•'7213 2('-). r
Total
t This Permit is issued on the express condition that all work shall be done in accordance with all applicable State of
Minnesota Statutes and City of Eagan Ordinances.
Building Official
l
q (prrtif tratr of (Orru our
iy
Its of eagan
~epttrfm~nf of +~uitdingJtc,s.prrti~m ~
,j This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building
XV k.I Code certifying that at the time of issuance this structure was in compliance with the various
~j ordinances of the City regulating building construction or use. For the following: '
va<clamtiution SF DWG/GAR 4 efdg.PerautNo: 6265
n Occupancy Type R3 Type caorituctionV Fin zone zoning District R'1 .
Sunshine Construe.C1017 E. 157th St,Burnsville!
Budding Address 1270 Berry Ridge Rdt ity L2 , B6 , Hilltop ESt.
By: f.
Budding OfTkw Date:
►OW7 !N A CA "ICUOUf K Cg
~'.L~~.:liS' j~.ss3~_aZ`x~..'cda;..::aa~.i:-..a..`aL'~.--~'3S.-i-.:.~..a.: ~.:;:s.~vsa.`•".A.:aa'°~'~a.-..~-~:.:_. s.~.9._an. ......,7..°:~::-a. -r
- O(iJF3 ♦91 _ ~ LlTNOIN y.$.P.
CITY OF EAGAN Remarks
Addition HILLTOP ESTATES Lot 2 BIk 6 Parcel
ownert'a Street 1270 Berry Ridge Road state Eajzan> MN 55123
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. 1069.38 0006920 1/12/81 1336,72 113. 67 10 STREET RESTOR.
GRADING
SAN SEW TRUNK 1973 172.14 8.61 94.74 A009667 11-18-80
* SEWER LATERAL 3183.86 -,;19 - 19 11) 2547.10 0006920 1/12/81
WATERMAIN
* WATER LATERAL 1980
* WATER AREA iggn
• Services 1980
• STORM SEW TRK 1980
* STORM SEW LAT 1980
CURB & GUTTER
SIDEWALK
STREET LIGHT
Rd. NIT 185.00 21247 8/7/80
WATER CONN. 305.00 21247 8/7/80
BUILDING PER.
SAC 525.00 2.1247 8/7 80
PARK
L .21
s request void
18 months from ~
Date of this Request 6_26-81 Fire No. T 4 2 5 8 3
I, as IR Licensed Electrical Contractor ❑ Owner, do hereby request inspection of the above electri-
cal wiring installed at:
treet Address or Route No, Donald Lerehe 454-8593 City Ea sa.n
ition ' Township Range County /Dka a
ch is occupied by 1270 Berryridge Road
(Name of Occupant)
Is a roughin inspection required on this job? No 0 Yes Fl Ready Now W Will Call El
Power Supplier Address
28
Electrical Contractor Rossow, Inc. Contractor's License No. JW0
(Company Name)
Mailing Address P.O. Box 254 Lake Elmo, Mn. 550942
(Electrical Contractor or Owner Making This Installation)
Authorized Signature Phone N677075046
(E ctrica ntractor or Owner Making This installation)
v F r This inspection request will not be accepted by the
4L- I
STATE
C
State Board unless proper inspection fee is enclosed.
Minnesota State Board of Electricity
Griggs Midway Bldg. - Room N191 EB-00001-02
'l University Ave., St. Paul, Minn. 55104 - Phone 297-2111$
REQUEST FOR ELECTRICAL INSPECTION 42583
CHECK BELOW WORK COVERED BY THIS REQUEST Type of Building New Add. Rep. Check Appliances Wired For Check Equipment Wired For
Home ❑ ❑ Range ❑ Temporary Wiring ❑
Duplex ❑ ❑ ❑ Water Heater ❑ Lighting Fixtures ❑
Apt. Bldg. ❑ ❑ ❑ Dryer ❑ Electric Heating ❑
Commercial Bldg. ❑ ❑ ❑ Furnace ❑ Silo Unloader ❑
Industrial Bldg. ❑ ❑ ❑ Air Conditioner ® Bulk Milk Tank ❑
Farm , ❑ ❑ ❑ List List
Others ethers
Other ❑ ❑ ❑ Here Here
COMPUTE INSPECTION FEE BELOW
Service Entrance Size: # Fee Feeders&Subfeeders: # Fee Circuits: # Fee
0 to 100 Amps. 0 to 30 Am eyes 0 to 30 Amperes
101 to 200 Amps. 31 to 100 Amperes 31 to 100 Amperes
Above 200 Amps. Above 100 Amps. Above 100 Amps.
Transformers Remote Control Circ. Partial or other fee
Signs Special Inspection Minimum fee $5.00
Remarks
TOTAL FE
I, the >?*Caj' e~ { hey y certify that the above inspection has been ma
(Rough , t , I Date
(Final) Date
This request void
18 months from
T * void /`c_GLf r~ r _
s
1-8 m rom r
S~
Date of this Request / Fire No.
I, as ETLicensed Electrical Contractor ❑Owner, do hereby request inspection of the above electri-
cal wiring installed at:
Street Address or Route No- /Cite
Section Township' " ange County
!:n ",r' . -~t'-'~ ~i , '-ter
Which is occupied by
(Name of Occupant)
Is a rot,ghin inspection required this job? No El Yes 11
Ready Now ❑ Will Call ❑
z 4~ -
Power Supplier ! 1 /~~~c 219
Electrical Contract
an e) Contractor's License No.
Mailing Address PLE A~'{ r .,r+ `ate
R ( , a N 6* e ing T Installation)
Authorized Signature G 1~ Phone No.
(Ele tric r t r r" t )
This inspection request will not be accepted by the
v b - z State Board unless proper inspection fee is enclosed.
Minnesota State Board of Electricity
Griggs Midway Bldg. - Room N191 EB-00001-02
**I-.sity Ave., St. Paul, Minn. 55104 - Phone 297-2111 EST FOR ELECTRICAL INSPECTION S 9 69 6 9
CHE -0W WORK COVERED BY THIS REQUEST r
Type of Building New Add. Rep. Check Appliances Wired For Check Equipment Wired For "
Home ❑ ❑ ❑ Range ❑ Temporary Wiring
Duplex ❑ ❑ ❑ Water Heater ❑ Lighting Fixtures ❑
Apt. Bldg. ❑ ❑ ❑ Dryer ❑ Electric Heating ❑
Commercial Bldg. ❑ ❑ ❑ Furnace ❑ Silo Unloader ❑
Industrial Bldg. ❑ ❑ ❑ Air Conditioner ❑ Bulk Milk Tank ❑
List List
Farm ❑ ❑ ❑ p
Other ❑ ❑ ❑ Herers Here
COMPUTE INSPECTION FEE BELOW
Service Entrance Size: # Fee Feeders&Subfeeder . Circuits: # Fee
0 to 100 Amps. 0 to 30 A res t 0 to 30 Amperes-
101 to 200 Amps. 31 to 1%A 7'ti 31 to 100 Amperes
Above 200 Amps. Above Above 100 Amps.
Transformers Remote 01 Clip. Partial or other fee
Signs Special Inspection Minimum fee $5.00
Remarks TOTAL FEE
I, the Electrical Inspector, hereby certify tl"th above inspection has been ma e-
(Rough-in) Date
(Final) Date_ _ f
This request void
18 months from
This request void 0
18 Months from
Date of his Request Fire No. S 9 " 9 9
I, as Licensed Electrical Contractor O Owner, do hereby request inspection of the above electri-
cal wiring installed at: /
Street Address or Route No. City aw~
Section Township Range County
Which is occupied by - 1
(Name of Occupan
Is a roughin inspectio r~puired on is job? No ❑ Yes Ready Now 0 Will Call 0--^
Power Supplier Address
Electrical Contractor KMRICK ELECTRIC 34%7 tor's Li~.
1443 ' ' .t r : LAINE
Mailing Address -<<
c r r In tallation)
Authorized Signature T on No.
(Elec ri r i n tion
This inspe ti equest will not be accepted by the
State Board unless proper inspection fee is enclosed. -
Minnesota State Board of Electricity -
Griggs Midway Bldg. - Room N191 1 ( EB-00001-02
iversity Ave., St. Paul, Minn. 55104 - Phone 297-2111 / 1
QUEST FOR ELECTRICAL INSPECTION S g g 9 4
CHECK BELOW WORK COVERED BY THIS REQUEST
Type of Building New Add. Rep, Check Appliances Wired For Check Equipment Wired For
Home ❑ ❑ Range ❑ Temporary Wiring ❑
Duplex ❑ ❑ ❑ Water Heater ❑ Lighting Fixtures 3-~
Apt. Bldg. ❑ ❑ ❑ Dryer ❑ Electric Heating ❑
Commercial Bldg. ❑ ❑ ❑ Furnace M'-' Silo Unloader ❑
Inaustrial Bldg. ❑ ❑ ❑ Air Conditioner ❑ Bulk Milk Tank ❑
Farm ❑ E] ❑ List List
R
Other ❑ ❑ ❑ Here rs Rtehers
COMPUTE INSPECTION FEE BELOW _
Service Entrance Size: # Fee Feeders& Subfeeders: # Fee `Circuits: # Fee
0 to 100 Amps. 0 to 30 Amperes 0 to 30 m eres
101 to 200 Amps. 31 to 100 Amperes 3t to,10WAm eres
Above 200 Amps. Above 100 Amps. Above 100 Amps.
Transformers Remote Control Circ. Partial or other fee
Signs Special Inspection Minimum fee $5.00
Remarks f r TOTAL FEE Q
I, the Electrical Inspector, h eby certi / h th has been ade, Gf -cam
(Rough-in) 91 Date
(Final) • Date %
This request void
18 months from
{ CITY OF EAGAN
3795 Pilot Knob Road Eagan, MN 55122 N-0 6268
PHO142: 454-8100 l41
BUILDING PERMIT APPLICATION Receipt #
To be used for SF DWG/GAR. Est. Value 65,000 Date 1980
Site Address 1270 Berry Ridge Rd. Erect ® Occupancy R3
Lot 2 Block 6 Sec/Sub. Hilltop Estates Alter ❑ Zoning Rl
Parcel # 10 33000 020 06 Repair ❑ Fire Zone 3___.
Enlarge ❑ Type of Const. V
W Name Sunshine Construction Co. Move ❑ # Stories
z Address 1017 E. 157th St. Demolish ❑ Front 42 ft.
0
City Ri rnSyi l l e 55 Wne 435-(,5 Grade ❑ Depth 49 ft.
Approvals Fees
o Name 10--6-$0 Permit 162.00
oU Address same Assessn ~~ht
u~ City Phone Water & Sew. Surcharge 32.50
u~ Phillips Plan Svc. Police Plan check $1.00
UZ Name Fire SAC 525.00
Address Eng. Water Conn.305.00
aW city Apple V3-ley Phone 1+32-201+1+ Planner Water Meter 60.00
Council Road Unit 185.00
I hereby acknowledge that I have read this application and state that Bldg. Off.
the information is correct and agree to comply with all applicable APC Total la 350.50
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Permittee
A Building Permit is issued to: Sumbi nP Constrileti nn _Go on the express condition that
all work shall be done in accordonc with all a livable State of Minnesota Statutes and City of Eagan Ordinances.
x
Building Official
CITY OF EAGAN Include 2 sets of plans,
1 site plan w/elevations &
BUILDING PERMIT APPLICATION 1 set of energy calculations.
To Be Used For
`Yl A,.w Valuation 6% ' a L~,• Date 3
Site Address : 1 7 o OFF,
~ ICE USE ONLY
Lot Block Sec. /Sub. /I Erect Occupancy
Parcel 416 Alter Zoning Repair
Fire
Z
one
Owner: Enlarge Type of Const.
Move # Stories
Address: (U11 1 s"7z Demolish Front ft.
City/Zip Code: 55"3 3.7 Grade Depth ft.
Phone 1 3 5~--6 5 3
APPROVAL FEES
Contractor: Assessments Permit x`
Address: Water/Sewer Surcharge
Police Plan Check
City/Zip Code : "
Fire SAC
Phone Eng• Water Conn.
Planner Water Meter (ACT
Arch./Eng.: ~ u Council Road Unit
Bldg. Off.
Address :
_ APC
City/Zip Code:
Phone ~3'~ - 2 z y y TOTAL
7 ~
2
//0 f
II
city of Cagan
PATRICIA E. AWADA
Mayor
PAUL BAKKEN
PEGGY CARISON December 13, 2002
CYNDEE FIELDS
MEG TILLEY
Council Members CEDAR VALLEY EXTERIORS INC
9920 ZILLA ST #500
COON RAPIDS MN 55433
THOMAS HEDGES
City Administrator RE: REFUND OF BUILDING PERMIT #52220
TO WHOM IT MAY CONCERN:
Municipal Center: As requested in your letter of December 11, 2002, building permit #52220 to reroof 1270 Berry
Ridge Road is being cancelled and refunded. You will receive a refund check in the amount of
3830 Pilot Knob Road $229.25 under separate cover. A $50.00 processing fee applies to this refund and the State
Eagan, MN 55122-1897 Surcharge of $8.50 is non-refundable.
Phone: 651.681.4600
If you have any questions, please feel free to give me a call at 651-675-5695.
Fax: 651.681.4612
TDD:651,454.8535 Sincerely,
Maintenance Facility: anice D. Severson
3501 Coachman Point Office Supervisor
Eagan, MN 55122
cc: Dale Schoeppner, Chief Building Official
Phone: 651.681.4300
Fax: 651.681.4360 On 12/10/02, City of Eagan telephone numbers changed. For your information, listed below are
TDD: 651.454.8535 our main department numbers:
Municipal Center 651-675-6050 Parks & Recreation 651-675-5500
wwwcityofeagan.com Administration 651-675-5001 Planning 651-675-5685
Engineering 651-675-5646 Police 651-675-5700
Fire Department 651-675-5900 Protective Inspections 651-675-5675
Maintenance 651-675-5300 Utility Billing 651-675-5030
THE LONE OAKTREE
The symbol of strength
and growth in our
community
CLAIM VOUCHER -REFUND REQUEST
CITY OF EAGAN
MAKE CHECK PAYABLE TO: CEDAR VALLEY EXTERIORS INC
9920 ZILLA ST #500
COON RAPIDS MN 55433
LOCATION: 1270 BERRY RIDGE RD
RECEIPT #/DATE: 29414 6/25/02
REASON FOR REFUND: CONTRACTOR REQUEST PERMIT 52220
VALUATION: $17,000
TYPE OF REFUND:
Plumbing Permit 9001.4087 $
Mechanical Permit 9001.4088 $
Building Permit Fee 9001.4085 $ 229.25
Plan Review Fee 9001.4222 $
SAC (MCJWS) 9220.2275 $
SAC (City) 9379.4681 $
SAC (Admire) 9001.4246 $
Water Connection 9220.3865 $
Sewer Permit 9220.4532 $
Water Permit 9220.4507 $
Account Deposit 9220.2252 $
Water Meter 9220.4509 $
Water Treatment 9220.4685 $
Surcharge 9001.2195 $
Overpayment 9001.2250 $
Curb Box Deposit Refund 9220.2253 $
Construction Meter Dep Refund 9220.2254 $
Other $
TOTAL $ 229.25
I declare under the penalties of law that this account, claim, or demand is just and that no part of it has been paid.
C , 12/13/02
SIGNATURE DATE
t
Cedar Valley
INSURANCE CONTRACTING SPECIALISTS
MN License #20177285
(763) 755-2221 - Fax (763) 755-5390
"From Storm to Finish"TM
December 11, 2002
City of Eagan
Building Division
3830 Pilot Knob Road
Eagan, MN 55122
Re: Permit Number- EA052220
Dear Sir or Madam:
The job for Alan Blanshan at 1270 Berry Ridge Road has been cancelled. Cedar Valley Exteriors has
not done any repairs to this property.
Per this letter, please reimburse Cedar Valley for the amount of the permit.
Sincerely,
Amy Berglund
Office Manager
Cedar Valley Exteriors, Inc.
Encl:
i
RESIDENTIAL 3m
BUILDING PERMIT APPLICATION
CITY OF EAGAN ZST-75
5 2n 0 3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675
New construction ui en RemodelfRepair Requirements
• 3 registered site surveys ng sq, ft. of lot, sq. ft of house; and all roofed areas • 2 copies of plan
(20% maximum lot cove Mowed) . 1 set of Energy Calculati r heated additions
• 2 copies of plan showing b & window sizes; poured found design, etc.) • 1 site survey for exterior ditions & decks
• 1 set of Energy Calculations Indicate rf home serv y septic system for additions
• 3 copies of Tree Preservation Plan platted after 711/93
• Rim Joist Detail Options selection s bldgs with 3 or less units)
DATE ~ g a VALUATION I
SITE ADDRESS tot-^10 '~tOl e. (200. MULTI-FAMILY BLDG Y N
TYPE OF WORK T-f ~'F CZ2 t'Dt~ FIREPLACE(S) ^ 0 1 2
APPLICANT Cedar Val!ff C3r IWO
UUZU e
STREET ADDRESS CITY STATE ZIP
TELEPHONE CELL PHONE # FAX #
PROPERTY OWNER 1 a-n TELEPHONE # 5 `
COMPLETE THIS SECTION OR "NEW RESIDENTIAL BUILDINGS ONLY
Energy Code Category MINNESOT RULES 7670 CATEGOR 1 MINNESOTA RULES 7672
(4 submission type) . Residentia entilation Category 1 Worksheet bmitted New Energy Code Worksheet Submitted
• Energy velope Calculations Submitted
Plumbing Contractor: one #
Plumbing system includes: Water Softener Lawn rinkler Fee: $90.00
_ Water Heater No. of R.. Baths
No. of Baths
Mechanical Contracto , Phan #
Mechanical system' cludes: M :fir Conditioning 0.00
Heat Recovery System D T a
i77 P ,I!
Sewer/Water Co tractor: Pho # j 4 206Z ~
L
I hereby ack owledge that I have read this application, state that t nformat bi ' o comply
with all ap icable State of Minnesota Statutes and City of Eagan CrIne, 1 66
Signature of Applicant
OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received Not Required _
Updated 4/02
OFFICE USE ONLY
❑ 01 Foundation ❑ 07 05-plex ❑ 13 16-plex ❑ 20 Pool ❑ 30 Accessory Bldg
❑ 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 08-plex ❑ 18 Deck ❑ 23 Porch (screened) ❑ 36 Multi
❑ 05 03-plex ❑ 11 10-plex ❑ 19 Lower Level ❑ 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_,
Nbr. of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
- Footings (new bldg) - Final/C.O.
Footings (deck) - Final/No C.O.
Footings (addition) - Plumbing
Foundation HVAC
- -
Drain Tile Other
Roof Ice & Water _ Final - Pool - Ftgs , Air/Gas Tests _ Final
Framing - Siding _ Stucco _ Stone
Fireplace R.I. Air Test Final Windows (new/replacement)
Insulation - Retaining Wall
Approved By , Building Inspector
- - - - - - - - - - -
Base Fee
Surcharge
Plan Review
MC/ES SAC..
City SAC
Water Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
S 55 DS RESIDENTIAL
BUILDING PERMIT APPLICATION a `
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675
New Construction Requirements Remodel/Repair Requirements
• 3 registered site surveys showing sq. ft. of'ot, sq. ft. of house; and a roofed areas 2 copies of plan
(20% maximum lot coverage allowed) . 1 set of Energy Calculations for heated additions
• 2 copies of plan showing beam & window sizes; poured found design, etc.) . 1 site survey for exterior additions & decks
1 set of Energy Calculations • Indicate if home served by septic system for additions
• 3 copies of Tree Preservation Plan if lot platted after 711193
• Rim Joist Detail Options selection sheet ibidgs with 3 or less units)
DATE 4? A VALUATION 'j 7
SITE ADDRESS 70 &t?~L2 _ 1~ MULTI-FAMILY BLDG -Y _N
TYPE OF WORK ~f FIREPLACE(S) - 0 _ 1 _ 2
APPLICANT dnib
STREET ADDRESS ~~S S QU t CITY ~STAT ZIP5p!~.,5
TELEPHONE # CELL PHONE # FAX # _901,2--l
PROPERTY OWNER ja~ TELEPHONE # (a
COMPLETE FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNESOTA RULE 7670 CA'T'EGORY I _ MINNESOTA RULES 7672
(•J submission type) • Residential Ventilation Category 1 Worksheet Submitted • New Energy Code Worksheet Submitted
• Energy Envelope Calculations Submitted
Plumbing Contractor: Phone #
Plumbing system includes: Water Softener Lawn Sprinkler Q 17 Ile : -
Water Heater No. of R.I. Baths S EP 1 6 2002
No. of Baths
Mechanical Contractor: Phone # .
`Icclianical system includes: Air Conditioning Fee: V0.00
HcaL Recovery System
Sewer/Water Contractor: Phone #
I hereby acknowledge that I have read this application, state that the information is corre and ee to comply
with all applicable State of Minnesota Statutes and City of Eagan Ordina es.
Signature of Applicant
OFFICE USE NLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4102
OFFICE USE ONLY
❑ 01 Foundation ❑ 07 05-piex ❑ 13 16-plex ❑ 20 Pool ❑ 30 Accessory Bldg
❑ 02 SF Dwelling ❑ 08 06-piex ❑ 16 Fireplace ❑ 21 Porch (3-sea.) ❑ 31 Ext. Alt - Multi
❑ 03 01 of _ plex ❑ 09 07-piex ❑ 17 Garage ❑ 22 Porch/Addn. (4-sea.) ❑ 33 Ext. Aft - SF
❑ 04 02-piex ❑ 10 08-plex ❑ 18 Deck ❑ 23 Porch (screened) ❑ 36 Multi
❑ 05 03-plex ❑ 11 10-piex ❑ 19 Lower Level ❑ 24 Storm Damage
❑ 06 04-piex ❑ 12 12-piex Plbg_Y or - N ❑ 25 Miscellaneous
❑ 31 New ❑ 35 Int Improvement ❑ 38 Demolish (Interior) V-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
Nbr. of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
Footings (new bldg) Final/C.O.
Footings (deck) _ Final/No C.O.
Footings (addition) _ Plumbing
_ Foundation HVAC
Drain Tile Other
Roof _ Ice & Water _ Final Pool _ Ftgs _ Air/Gas Tests -Final
_ Framing Siding _ Stucco _ Stone
- Fireplace _ R.I. -Air Test -Final Windows (new/replacement)
Insulation Retaining Wall
Approved By , Building Inspector
Base Fee
Surcharge O
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Sdarch
Copies
Other
Total
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CERTIFICATE OF SURVEY
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And t.iai wn F 411, .y T_., fi~~'~"'e?.'. a1;.:. "•rl;-~:...r~r,r z:,(3t--r t. if) laws rX the State of W.in1esota.
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D&t t,K 1: k•^>1 :.k,' 7t' . Rev. No. 7734
DR. BY GLJ SCALE - 1"= 40' o DENOTES IRON MON. BEARINGS ARE ASSUMED DATUM
Pre;ared for
JACOBSON SURVEYORS
'sr -ne '"snsk-~a~t..'}r LAKEVILLE, MINN. 55044
1 "1" U,7t:!- iii' .
lRunns-7111r., Minn. ; .;x?? PHONE 469 -4328
Weatherstrips A Guide . Construction No. Insulation
Windows Doors Reference Out. Wall Int. Wa$ Ceiling Roof 4=11-00-1 ( hind How Applied
Yes-No I Yes-No 19_
F1.1 Room Length `(3T Width Height F1.1 + Room Length \-f Width l a` C" Height` C~
Windows and Doors-Crackage and Ana Windows and Door"rackage and Area
Width Height Nu. of Lineal ft. Area Width Height No. of Ltoeai ft. Area
No. ~o ff pano of pans ii!hta of/ ack -7W .pt~t,. No. of pane of pane lights of crack sq. ft.
Jt,1 It i LV z1o" t~N ! V
1 ' 16' 1q -b 7, LAO
X, 0, 14
Cocf. Btu Coef, Btu
Infiltration y1 - 0 \Vbo Infiltration Wobo
Glass S 5O "so Glass Sci 2 -I'm Exp. wall Exp. wall
Net exp. wall to le L Net exp. wall \Q~.2
Int. wall Int. wall
Floor \2~
Floor 1.
Cell. L4 3 t'.1 \
Total Btu. Total Btu. ~j
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Fl.~ L Room ( Length 11e p" Width IT lo" Height F1.1 4-1 fl Room (Length Ly'Qa Width tQ Height
Windows and Doors-Crackage and Area Windows and Doors-Crackage and Area
No. of Width e Ho[eighpant e No. lights Ltofneat ftcreek. q. Area R Width Height No. of Lineal ft. Area
1 \V h~ ' No. of pja~ce of pane lights of crack eq. ft.
v zV ! 1
Coef. Btu Coef. Btu
Infiltration ~g - 1AO 1Sb0 Infiltration ILAO 10 Cj
Glass 343, 510 V500 Glass Q-
Exp. wall Exp, wall
Net exp. wall 2A, (4 1) 1 Net exp. wall 100 -7 1
OO
Int. wall f~ Int. wall
Floor Zl t 3 Floor
Ced. 2a 4 $bts. Cell. O 4 "1 (100
Total Btu. Total Btu. 2.,
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
\ F1. DR e 1I RtLR-om (Length ] f p't Width 14 ~0He:ght O Fl.~ 1e Room l Length \A O Width 1Q'O"Height '0 ZTT
Windows and Doors-Crackage and A. Windows and Doors-Crackage and Area
Width Height No. of Llnsal M Area Width Height No. of Lineal [t. Area
o. of pane of pans lights of crack sp. ft. - No, of pane of.pans lights of crack SQ. ft.
'o `o \
Coef. Btu Coef. Btu
Infiltration 40 qS 6(3 Infiltration 14 1b (~l,
Glass b Glass 1 Z. ko d O = ?100
Exp. wall ~ Exp. wall ~ y
Net exp. wall Net exp. wall 4
Int. wall Int. wall
Floor Floor 1
Ceil. L- 4 Q Cell: C~
Total Btu. ~p2 Q Total Btu.
Required s q. ft. E.D.R. or sq. ins. WA Leader area Required sq. ft. E.D.R., or sq. ins. W.A. Leader area
f .
'Weatherstrips A Construction No. Insulation
Guide
\kindows _ Doors Reference Out. Wall Int. Wall Ceiling Roof Floor kind How Applied
Yes-No ( Yes-No 19___._ _
F1.1 \ Room , Length Width A-Room length ~41,C)" Width ° :3' Height ~~t^
Windows and Doors-Craclcage and Area Windows and Doors---Crackage and Area
Width Height Nu. of Lineal ft. Ana Width Height No. of Lineal ft. Area
No. of rano of pane 11.111@ of crack M. (t. No, of pane of pane lights of crack sq. ft.
1 1~." C)
✓ i' a 1 3 b
Coef. Btu Coef. Btu
Infiltration 1 \.40 Infiltration
Glass O "'JO Glau \ob o
Exp. wall Exp. wall
Net exp. wall 22 (7 col-ko Net eip. wall f_ ry
%A\ V y
x c
Int. wall
NZA
Floor Floor
110141 Cell. L>r $ C. •1.
Total Btu. Total Btu. S OQ
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Requited sq. fL E.D.R. or sq. ins. W.A. Leader area
F1.1 &('N Room I Length b a`t Width V b" Height V 0 FI.I Room ( Length Width Height
Windows and Doors-Crackage and Area Windows and Doors-Crackage and Area
Width Height No. of Lineal it. Area Width }f eight No. of Lineal tt. Area
No. of pane of pane lights of crack aq. R No. of pane of pane lights of crack sq. ft.
Coef. Btu Coef. Btu
Infiltration Infiltration
Glau Glass
Exp. wall Exp. wall
Net exp. wall Net exp. wall
Int. wall Int. wall
Floor 3 1 VJ Floor
Cell. W 1 Q Cell.
Total Btu. Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
FI. Z , 9 Room Length Q" Width S 0 Height ' F1.1 Room I Length Width Height
Windows and Doors-Crackage and Area Windows and Doors-Crackage and Area
Width Height No. of Lineal fL Area Width Height No. of Lineal ft. Area -
No4 of pane of pane lights of crack sq. it. No. of pane of,p►ne ll`hts of crack eq. ft.-
Coef Btu Coef. Btu
Infiltration Infiltration
Glass Glass
Exp. wall Exp. w;Al:
Net exp. wall Net exp. wall
Int. wall Int. wall
Floor Floor
Ceil. Q Q CA.
Total Btu. Q _Total Btu.
Required sq. ft. E.D.R. or sq. ins. WA Leader area Required sq. ft. E.D.R.,or sq. ins. WA. Leader area
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A Dunn chi Curry Community
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DEVELOPER'S CERTIFICATION
.r} Lot:
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Block: &
Subdivision:*x 1./s w
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(~CC~1 .
This is to certify that
has complied with the Seller's requirements necessary to obtain
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Seller's approval for a building permit.
This Approval is by Seller only. Builder must comply with all
city requirements and must secure his own building permit.
Approved by Seller, Dunn Curry Real Estate Management, Inc.:
By ft AMA,
ut or ze gent ate
Accepted by Buyer:
By
ate
4940 Viking Drive
Pentagon Office Park
Minneapolis
`t MN 55435
(612) 835-2808
CERTIFICATE OF SURVEY
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Fleve.+ions shOun are existing 2 0 ,99, 9 1\ 1,1
,rades and are assumed datum. 10r, o / 2
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I hereby certify that flits is a rnrrn^t representation of a survey of:
Lot Plock iii Ilt;p E,tet+~s, Dakcta ^cunty, ~°.ir.ne rote, accordinr- to the
plat thereof on file and of record .
And that I ears a duly r-gl eitered land murveyor under the laws of the State of Virmesota.
12
Dated this lmt day of October, 1980 Gene L. G'acohson, M . . Red;. No. 7734
DR. BY GLJ SCALE - Iof =,40 ~ o DENOTES IRON MON. BEARINGS ARE ASSUMED DATUM
Pre~;ared for:
JACOBSON SURVEYORS
SuztshinR ^anstrcactinn
10,17 157th St LQKEVlI.LE, MINN. 55044
.
Purnavi 11e, Minn. Ei.5337 PHONE 469 --4328
.;ITY EA6AN SEWER SERVICE PERMIT
2.795 Pitt Knob Road f ,
Eagan, MN 55122 PERMIT NO.:
DATE:
Zoning:
No. of Units:
Owner:
Address:
Site Address:
Plumber: - -
1 agree to comply with the City of Eagan Connection Charge:
Ordinances. -
Account Deposit:
Permit Fee:
By Surcharge:
Misc. Charges:
Dote of Insp.:
Total:
Insp.: Date Paid:
CITY OF EAGAN
WATO
3795 Pilot Knob Road
PERMIT NO.:
Eagan, MN 55122
Zoning: DATE: F
No. of Units:
Owner:
Address:
Site Address:
Plumber: s- -
Meter No.:
Size: Connection Charge: 3
Account Deposit:
Reader No.:
1 Permit to eom Fee:
ply with the City of Eagan Surcharge:
Ordinances.
Misc. Charges:
By Total
Date of Ins Date Paid:
Insp.:
I
Use BLUE or BLACK Ink
r
For Office Use
Permit#:
Ron
City of EaV I z
I Permit Fee:
3830 Pilot Knob Road ° I I
Eagan MN 55122R" I Date Received:
Phone: (651) 675-5675
Fax: (651) 675-5694 , I Staff: ►~1`~ I
I I v
2012 RESIDENTIAL BUILDING PERMIT APPLICATION \ rs
Date: Site Address: n 9/ °e- Unit M --I'~
Name: A/ a /V SX r, Al Phone: ~~~'ZO IJ /~•/p~
RESIDENT /
OWNER Address / City / Zip: 0 n PIA C q ti N S~/01-
/
Applicant is: )L Owner Contractor
TYPE OF WORK Description of work: x3
Construction Cost: 9~ • ®y Multi-Family Building: A es / No )
Company: C S / Bev cz-
Address: ( ,
CONTRACTOR City: ~~~G~~Z/C%(l~
State: A14 Zip: S~ Phone:
License Lead Certificate
Ael-
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
III
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that they are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Buildin C de ust be completed within 180
days fof permit issuance.
x I®T/~/ &.aC /4/it/ x Applicant's Printed Name Appl an 's nature
Page 1 of 3
DO NOT WRITE BELOW THIS LINE
SUB TYPES (Z 7( r, /ej
Foundation _ Fireplace _ Porch (3-Season) _ Storm Damage
Single Family Garage Porch (4-Season) _ Exterior Alteration (Single Family)
Multi Deck Porch (Screen/Gazebo/Pergola) _ Exterior Alteration (Multi)
01 of Plex Lower Level Pool Miscellaneous
Accessory Building
WORK TYPES
_ New _ Interior Improvement _ Siding _ Demolish Building*
Addition _ Move Building _ Reroof _ Demolish Interior
Alteration _ Fire Repair Windows _ Demolish Foundation
Replace _ Repair _ Egress Window _ Water Damage
Retaining Wall *Demolition of entire building - give PCA handout to applicant
DESCRIPTION
Valuation , Occupancy MCES System
Plan Review Code Edition . 4 SAC Units
(25%_ 100%-~-) Zoning City Water
Census Code Stories Booster Pump
# of Units Square Feet PRV
# of Buildings Length Fire Sprinklers
Type of Construction Width
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
Footings (Deck) Final / C.O. Required
Footings (Addition) Final / No C.O. Required
Foundation HVAC Gas Service Test Gas Line Air Test
Drain Tile Other:
Roof: -Ice & Water Final Pool: Footings Air/Gas Tests Final
Framing Siding:-Stucco Lath -Stone Lath -Brick
Fireplace: -Rough In -Air Test -Final Windows
Insulation Retaining Wall: _ Footings _ Backfill _ Final
Sheathing Radon Control
Sheetrock Erosion Control
Reviewed By: , Building Inspector
RESIDENTIAL FEES
Base Fee
Surcharge a xr
Plan Review Y
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant,.
Copies
TOTAL ;
Page 2 of 3
~
CERTIFICATE F SURVEY
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,rr,0Rq and are asst?,pod datum. -z'
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EAGAN ENGINBW~j-NG DEPT',
1 Fsel-by c ort:ify tha? UtIs IF, a ftnrrrv^r. rmpres(int.atfnn of it survey czf :
Lot I, Pluck I!i11t.!r Fstat-s, Dakota C.iunty, mI.-mesota, accoriinf: to the
r.lat thereof on f'i le ft nil r, f reanrel.
Ami that I an s duly r-gl etc^red lard w3rveyor wider tho lawts of the State of Vinne gote.
Dat-k-d thia tat day ref' October, 1990 {scene L. ,'acobson, M061 Rer;. No. 773A
I BY GLJ SCALE _ I"= 40' o DEMOTES IRON MON. BEARINGS ARE ASSUMED DATUM
Irn,ared fort
JACOBSON SURVEYORS
Sunnhinn '.;~rnr;t!-°~r.ti~sn
j(',17 l,i7tt~ `3t. LAKEVILLE, MINN. 55044
Purrisvi llo, !Inn. :?53:7 PHONE 469 -4328
CERTIFICATE OF SURVEY
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LAGAN ENGINEERING L)Lff
1 F ~tzy cent ff'y tl:a}: ~.}its f a Cntrr'.^P. rog~reW.4n+r~tfon of t-1 survey of Y
T,at l., Pioclr P111t;-~r Fs totr~s Dak~t^n °:iunty Y ir_nle:cntR, raccor-11nV to the
r.lst thereof cm file anti nf' rennrd.
An-1 t')lkt 18m a duly r-sgl qtnred lsnd rrvt•vnyor wider tho laws of the State of Mimienot&,
:?a '_ct? this 1nt clay of October, 19PO Gene L. . ~cobscn, M . a Reg;. No. 77 4
BY GL.J Sf:t11<E iii= 40 o DENOTES IRON MON. BEARINGS ARE ASSUMED DATUM
't"nr"Y`C9 for: - fl
JACOBSON SURVEYORS
5tartest!i~~afi ';°~netr~~c°ti~srr
LAKEVILLE, M INN. 55044
f'l7 1;7 tl
Burusvi tb-, Minn. k5337 PHONE 469-4328
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Nov 20 2012 10:14PM BRUCKMUELLER PLUMBING INC 6516882160 page 1
4 qty of Eaall 11111111'
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
e -
Use BLUE or BLACK Ink
For Office Use
Permit #:
Permit Fee:
Date Received:
Staff:
INFLOW & INFILTRATION PERMIT APPLICATION
V Plumbing / Sewer & Water
Date: %/G%%aZ Site Address: 1x70 /3-ejcy Avas
Tenant: V Suite #:
ifl
�trjrl�t
Name: 4 /CLn glaosixte) Phone: 66/ 716 aqaz/
Address / City / Zip: / g7 6 Piny /`S idqeR
o zd, I'aye:tn Into 55-7 a3
4 t�h '
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h'� �T�P93•B �/.
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Name: 131,1.,.r "im.,(• -/1ec / h.4m 6, 19, c".'. License #: (9D/ `3"-1 /- pal
2Q en /a � is
Address: Pf3Sc�/! /7vL%iii.( c.- City: i..-4.GfCIr'1
State: it .) Zip: 557 , Phone: 6' - 60'5 ie - Ce Coq C(D
-
Contact: Email:
1J3iy1
y �� , yxrb
4 lid i'
PLUMBING (Within the building envelope)
.. Sump Pump Repair
SEWER & WATER (Outside the building envelope)
Repair
Other.
Other:
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y } i ° "� h 4�
-----
Description of work: Pr it %1 r� up M rode_
luny :I G.�ufn/c) �rprJ .
puny)
y
``
FEES
360.00 I Each (includes $5.00 State Surcharge) TOTAL FEE $ 60' 00
*
*Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submit II/l repair costs for
reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors
can be found by visiting www.cittrofeagan.com/inflow, or City Hall at 3830 Pilot Knob Rd.
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.000herstateonecall.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 approved plan in the case of work which requires a review and approval of plans.
x JlibtarCiCkrhtlefier
Applicant's Printed Name
cant's Signature
Use BLUE or BLACK Ink
r-----------------
For Office Use /
Permit
City of Ea~a~ I as1 -~c--
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
2013 RESIDENT`I~AL) BUILDING PERMIT APPLICATION
Date: nSite Address: Unit _0_'~ 4-ig" V -7
Name: ( B ~ctry 1 Phone: 6711 l S
Resident/
Owner Address / City / Zip: t 02 44
Applicant is: ~wner Contractor
Type of Work Description of work: SCp_ d~
Construction Cost: Multi-Family Building: (Yes / N
Company: C6 ~ Contact:
11[~ r U C'
I Contractor Address: 1 ~1 < ( 1,_ Q C+ City:
State: A y " Zip:SS I Phone: (Q
License Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 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:
if ysubmit are considered to be public information. Portions ou provide specifr"crea reasons that would permit the of
NOTE: Plans and supporting the information may be classified as non-public you
City to
conclude that they are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuanc
C'
A.6
x so-L x
A licant's Printed Name plica t' g ture
Page 1 of 3
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA119258
Date Issued:11/20/2013
Permit Category:ePermit
Site Address: 1270 Berry Ridge Rd
Lot:2 Block: 6 Addition: Hilltop Estates
PID:10-33000-06-020
Use:
Description:
Sub Type:Fireplace
Work Type:Gas Insert
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home may require smoke detectors in all bedrooms. Chimney / flue must be inspected prior to
concealing.
Carbon monoxide detectors are required by law in ALL single family homes .
Valuation: 3,000.00
Fee Summary:BL - Base Fee $3K $88.50 0801.4085
Surcharge - Based on Valuation $3K $1.50 9001.2195
$90.00 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 -
Alan C Blanshan
1270 Berry Ridge Rd
Eagan MN 55123
Hearth And Home Technologies
2700 N. Fairview Ave
Roseville MN 55113
(651) 638-3309
Applicant/Permitee: Signature Issued By: Signature