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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 ("T ox CERTIFICATE OF SURVEY 93-6 / Q 94 6 /0 ~ 93.9 5 0 / / Z ~ p ..p -0 cry / ~ . / p~ O Q / 96.3 h p /o 8 9 96 3 1 97 9 7 ic~ 4, oti ? r c: ~x i ` i"=i S2 2s9 9 4~ Oe y, z'le rs n ' . x cwr y w h\ /S' 10 7 Lot I,-^K ~1GG02';jl17t:: to the 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. r aa4r6~~- 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 ~ t~ . i ` r A Dunn chi Curry Community r N ~rlt fi DEVELOPER'S CERTIFICATION .r} Lot: f rti-; Block: & Subdivision:*x 1./s w ~ (~CC~1 . This is to certify that has complied with the Seller's requirements necessary to obtain r 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 9a 93.6 AA~ 94 6 / ~or_ ~O \5 j 93-9 95 O \ ti 0% `COQ \ph /~~30- ' D \ c9 2 ` 2 O~i \O2 '1• Q. y 96.3 Q p h, S 100, (0 96 3 \ / f h 97 1 97 A \ A, a Fleve.+ions shOun are existing 2 0 ,99, 9 1\ 1,1 ,rades and are assumed datum. 10r, o / 2 10 7 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 1 F'tnv~-~. 93 tpao1- iS IC-Prom L! ,-rr D m S P r...,S Q m &AJ f -s h) tu ct 94 s tai &+P-r^ "0 f 95 O > 93.9 ~ rQ~ -p q,'' - Poe 2 W~ f C-3 040Q\O 96-3 96 3 A;, 97 97 ! A, O ! sK /`3,T : / ~O a2 lc nns d-o n are Iristing 00 sV. 9 11~ s jr y~ r7 IR *q F- ,rr,0Rq and are asst?,pod datum. -z' 10 7 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 x L I Crc"m ~r v g s 93-6 y. 94 6 c a p +k 93-9 ,9 5 t) r t ti 0-6 P 1 l ` V f 95. 2 4 \ p 004` oQ _ rj L r /0 All ~ e o ` y ~ ova es _ _ O r ~R ~~S& ti. Q 9 97 r` 1k ~C- iTr lar':•and affi assoyriod diatu?"ct. (9~~ 7 d 7 104 7 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 y ✓L t f AUG3' 02017 1 Ale, 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 ' t ' F +, h'� �T�P93•B �/. Y` ��J �#kQ 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: t : 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