4682 Bristol Blvd0 " ? ?w
is !!-?..
w Wertificate vf rccu.panc?
WitTg of Wagan ?
zonrtmeat vf eui[biag 3n60ection
c
This Certificate issued pursuant to the nequirements of the Uniform Building Code
cerfifying that at the time of issuance this structure was in compliance wrth the various
orrfiriartces of the City regulating building constructiors ar use. For the fallowing:
useci ruadow SP Txat: siag. N.itNo. 22145
Oceup-y Type Zoning Uistrict R1 "i'ype Const. ?VN
Owner of Building r-04AR FiMM 00 namm3585 N LEKDUPON AVE, APM tIILLS
Building Addtcss 14682 ??OL BLVD [,ocaliry TB. B3 WESPON HHJZ
DaIC
BUII(hIIg OffiC18l
POST IN A CONSPICUOUS PIACE ?
?
?
' C1Tif 0F EAGAN
? 3830 Pilot Knob Road
Eaqan, Minnesota 55123
SITE ADDRESS: I
REVR:?
' , I i: l1 : Ml';
f PERMIT,SUBTYPE:
I '
TYPE OF WORK:
H 1 14
ftA t; ,-
?
h Wi•i {thitt !'I
G?,, : p.?ty,
t<if6ii-,/?t
PERMIT TYPE:
Permit Number:
Date Issued:
APPLICANT:
V-i '40i);i
I
iw?
Permit No. Permit Holder Date Telephone #
S/W
PLUMBING
HVAC
A-Li
ELECT64,
ELECTRIC
Inspection Date Insp. Comments
Fvotings I
U /
Foundation
Framing
Roofing
Rough Plbg.
o?
Rough Htg.
f
IsuL
(7
Fireplace 7 [t -3 t? S
Fnal Htg.
Orsat Test
Fnal Plbg.
,Z s37
/GJ z- -
Plbg. Inspector- Notify Plumber
Const. Meter
Engr./Pian
Bldg. Final
Deck Ftg.
Oedc Final
Nlell
Pr. Disp.
?
I CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS: `
?
,, : ?;?; 1:,??'?! i;{'W0
PERMIT SUBTYPE:
11
PERMIT TYPE•
Permit Number: .
Date Issued:
TYPE QF UVORK:
o ? NA 1.
I?
fi [;? ri rh:
Permit No. Permit Holder Date Tetephone #
ELECTRIC
PLUMBING
HVAC
Inspectlon Date Insp. Comments
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYPBOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
BSMT R.I.
BSMT FIMAL
DECK FfG f C
DECK FINAL -?4
.7
G
ABdress 4682 BRIsrCL ffi.vn Zip 5512 3
Lbt • s Blk 3 Sub WESTOrt xats
THESE I7'EMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECI'ION.
_ i
Date: ?,? ) 3 3 Yes No Inspector:
Final grade (6" from siding) ?
Permanent steps (garage) V
Permanent steps (main entry) V
Permanent driveway
Permanent gas J?
Sod/Seeded grass v
TraiUcurb damage ?
Porch V
Basement finish
Deck
Please verify with the builder the removal of roof test caps from the plumbing system and the shut-off of water supply W
the outside lawn faucet before freeze potential exists.
ContaM engineering division at 6814645 before working in righbof-way or installing underground sprinkler system. ?
White - City Copy Yellow - Resident Copy Pink - Contractor Copy
SEDGWICK HEATING & AIR CONDITIONING CO. HEATING
8910 WENTWOFiTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) 881-9000 TEST RECORD
JOB NO.s v 11
ADDRESS Z466Z PJ1?ISTOI Vk CITV 1.?4(????
OCCUPANT OWNER
SOLO BY
MAKE (- 'ew we k
SERIAL NO. -!;? I M????
THERMOSTAT v )o
VALVE 1 `w
LIMIT C'c f e..?
LIMI7 SETTING
FAN SETTING
PILOTTVPE t+ S 1
IGNITION MODEL C-
PILOT TIMING L\?'
PRESSURE PERCENTCOz
INPUTCFH a?+ PERCENTOi L-' ?
O
S7ACK TEMP. aa 7 PERCENT CO 0
FOBM 235 (PEV.11/89)
INSTALLED BY
MODEL 6 6Uix" ` ` 3(08c)
INPUT
VENT SIZE
TVPE OF LINER
LINER SIZE ?
FILTERS: SRE NUMBEH
wiaiNG ?? "T I?JI i ' i ?IS'
TES7TAG
LIGHTING INSL
DATE TESTED U ? - -
COMPANYTESTING ? ?tc??
NAME OF TESTER
FORMDISTRIBUTIONPY - J fAPVCITY
a? 5`ff7
M 36991
Request Date Fire No ougM1-in Inspecbon
Req iretlP NOTICE: You Must Cell Elettrical Inspedor
If A Raugh In Inspection
e3 ? No Is Feqwretl
I,?licensed contractor ? owner hereby request inspection of above electrical work at: ?.
,bb Atldresa Sveet, Boz or RoWe No.)
6 City
2
Secbon No. Township Name or No Rarge No Counry
?
Occupant (PRIN? Ptw?re N
?
Power Supplier
? AOG,?re}ss7? p
, ?
,
l ?6Y1 Vu-C.. L
C? ,
Electtlcal Conver (COmpeny Name)
' Connecior5 Licen e No
l aa6a,r
Mailing Adtlress (Caniraciw or Owner Meking Installatlon)
9;2-9o
AuHrorizetl SignaWre ( mreclw/Owner akin InstellaM1On) Phone Number
? -/
??l -7
MINNESOTA STATE BOARD OF ELECTPICITY THIS INSPECTION REOUEST WILL NOT
Grlggo-Mltlway BIEg. - Room S-173 BE ACCEPTED 8V THE STATE BOARD
1821 Universiry Ave., St. Vaul, MN 55100 UNLESS PROPER INSPECTION FEE IS
Phana (812) 6920800 ENClO$E0.
re/(? REQUEST FOR ELECTRICAL INSPECTION
, , See instrucGOna for complebng this form on back oi yellow o?py.
M 3 6991 "X" Below Work Covered by This Request
0 4w is3a?
ew /tld Rep Typeof8mlding AppliancesWired EqwpmeniWrtetl
Home Range .. Temporary Service
Duplex 14
Water Heater Efechic HeaH
Apt. Building Dryer Load Management
Comm./lndustrial Furnace Other (Specdy)
Farm Air Conditioner
Other (apeaty) ConVador$ Remarks:
Compute Inspection Fee Below:
# Other Fee # ServiceEnlranCeSrze Fee # Crccurts/Feeders Fee
Swimming Pool 0 to 200 Amps o to 10o Amps
Transformers Above 200 _ Amps A ve 100 _ Amps
SignS Inspeaao's Use Only ` r TOTAL
Irrigation 6ooms ? s ? s ??
Special Inspection
Alarm/Communication TNIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT
Ofher Fee
f
COMPLETED WITHIN ISN"THS.,ep
I, the Electrical Inspector, hereby Rough-in
certfy that the above inspechon has
6een matle F,nai
? oate
OFFICE USE ONLY ?
This requas[ vob 18 manihs ham
CITY OF EAGAN
? 38'0 Pllot-3<nob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
PERMIT
PERMIT TYPE:
Perm'rt Number:
Date Issued:
ckif3445
w I4145
BUILDING
@25787
06{12/95
SITE ADDRESS:
4682 BRISTOL BIVD
LOT: 8 BLOCK: 3
WE5TON HILLS
p.I.N.: 10-83750-080-03
DESCRIPTION:
Btifudi='&,Permit Type DECK
LdiYtg ,?"k,RX?k Type NEW
-. ?
. ? • -- ? ' :? .
REMARKS:
FEE SUMMARY:
,??? 0?`"?,s '? ?m?° ?' ?'' - ?
? ?
? .t
???? re? ?„?
??+
ease Fee $30.00
Surcharge $.50
Subtotal $30.50
COPY $.50
Total Fee ? $31.00
CONTRACTOR: - applicant - sr. Lzc. OWNER:
ALL-WRYS QUALITY CONST 17356337 2001308 HOFFEIT BRAD
1919 CATALINA 4682 BRIST6L BLVD
WOODBURY MN 55125 EAGAN MN 55129
(612) 735-6337 (612)688-3087
? . .?° • ? ? • ? F " rc I . .' 5 R•
1 h6rsby edg?e tE?a'?;,I hd+?s" r?ad? ???s.?? ap??-??c?`??uz?€
n{sfye,..mayy?t{?,o.M ??+n co-rr_e?ju e?rcqd>at-grJ.ejea? qptoyrycaq??s?}?? cabi? Stqt,e
R
tq ?y l''1Rb.??Y?? P??E?S3? SU`Yl!"1?SYM'}•'M"'Y?y'S t} ''tf ? N} ? o-.m: .. a`.sn..+. ?*'t? ?...2 x
_...,..._. ,..._.. ,. ,_t . p U ae a..;.,. ... _ ...,_..,.,..,._.._ ?._.,..?,.;,. e„m , e e.. .. ?
INSPECTIO
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITEADDRESS: P•z•N.: 1e-8375e-08e-e3
1p7: 8 BLOCK:
4682 BRISTOL BLVp
WESTON HILLS
PERMIT SUBTYPE:
DECK
(1 ,.?Jrr.rl,
-
ISSU SIG Ui?
?
N RECORD
PERMITTYPE: surLprNe
PermitNumber I 925787
Date Issued: 0 6/ 12 / 9 5
APPLICANT:
3
ALL-WAYS QUALITY CONST
(612) 735W6337
TYPE OF WORK:
NEW
z
a ?
F,_.
n .t v F? i ai ns ¢ n i?
i A, p . ? e?i
. m . a ..ar,._. n a . .. .. .w , e.2 , _ . ...-. .._. ,?t6 : F-LA ? ...w`i-
? CITY OF EAGAN ??
? 3830 PILOT KNOB RD - 65122 J
1995 BUILDING PERMIT APPLICATION (RESIDENTIAL) r?Q 0? (?_(?,
681-4675 ?"""
New CanaWelion Reouirements
? 3 regiarored aite surveYg ? 2 copin of plen •
? 2 wpies of plans (inGutle beam 8 window saes; poured fid. design; etc.) ?/2 site surveye (exterior Wditbna 8 dedcs)
? 1 mrergy celculations ?? 1 errergy celcu4tiona for heated addkions
? 3 copies of 6ee preservation Dlan if lot plaaed after 7/1/93
requiied: _ Yes _ No DATE: 6-1 CONSTRUCTION COST: -? ?
DESCRIPTION OF WORf
STREET ADDRESS:
LOT I BLOCK ?
SUBD./P.I.D. #:
PROPERTY Name: Phone #:
OWNER w* ,Q
Street Address---?? 'Jl/10
City: Lc4641 State: ww Zip: s`5-or 2-5
coNTancTOR Company: 4aA/?9C15 &CA44Z'-0rsAhone #: '??5 v?33 y
? pm 16--
Street Address: ' License #• ZOOf90&&
City: urr37JY>t???-l State: AOU Zip•?7ZZ--?
ARCHRECTI Company: Phone #ENGINEER
Name: Registration #Street Address-
City: State: ' Zip:
Sewer 8 water licensed plumber:
change are requested once permit is issued.
Penalty applies when address change and lot
I hereby acknowledge that I have read this application and state that the information is correct and agre to omply with all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant: ,'
OFFICE USE ONLY
Certificates of Survey Received = Yes = No
Tree Preservation Plan Received Yes No
x..4.....-
? r??Nrzia4 LAND SVRWVOfl$ - Crnl CNCMECRS
?4ingoneer ng UJlD PWlNO15 - IANDSCAPS Mpu1E
?
2422 Enterprlee Dri-o
' Mendota Ns)qhts, MN 55120
(612) 681^1914•rox 681-9468
625 Niqhwoy 10 Northeos???
6lolne, MN 55434
?(612) 783-1880•Fax 783-1883
Certificate of Survey for: Romor Homes
House Address: 4682 Bristol Boulevard. Eagan. MN
Modei Name: BOV-1ew ll
Customer:
Zr?
0?;5 00
y OJ? •
•?? •? ^•??
?
$n ?:
?
30.42
aa"• ?;? '? { ,,.
[?r
??
e• °4 cp 'q
37. `{? \ 4tiV00
?a? Vv \911-\
? j
F?
s
?l
qa°'3I?
1 140 IN
\ \
i 4, 1
??
1 0t ,p
2
s 42
? .
e 9 yo.23 .?
\
? fq4ot1 V
_.?
/
r
0
.M??7NM'a YI.{?"x4.l?nA+? tTS
a 4 ? .°1
? P
•Y Y¦S¦
.
Y r
?sii ?
s
?
?
NOTE: CONTRAC70R MUST VERIFY ALI. OIM,ENSIONS AND DRIVEWAY DESIGN
„ 900.0 Denotes Existing Elevotlon pROPOSED NOUSE ELEVATIQN .? Denotes Proposed Elevntfon Lowest Ftoor Efevation:938,95
Denotes Drainoge & Utfiity Easement
- Danotes Droinaga Flow Direction Top of Block Elevetton:942.16
- Oenotes Monurnent Garage S{ab Elevation:941.83
---a- Denotes Offset Hub Bearings shown are ossumed
LOT 8, BLOCK 3 WESTON HILLS
DAKO7A COUNIY. MINNESOTA
1 h¢roby <erUfy that tAb suevoy. Dl+n or rspon wes prored by m or under y dfract ?upervlslon and Iu1 I am duly Foyinnad land Survayw
undir the laws of th. Stite ai Mlnm.ob. Datad thla 2 f? d?y ol ?g,Q A.D, 19 3
Inch e feet
Scale; 1- 3?-
?P
Z_C?? y 3
4i
?
pOBERT B, SIKICH 1.3. REG. NO, 1ae91
,.
PERMIT
-,-?CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
PERMIT TYPE:
Permit Number:
Date Issued:
/W - /?///(
suiLorNe
022145
10/06/93
SITE ADDRESS:
P.I.N.: 10-83750-080-03
4682 BRISTOL BLVD
LOT: 8 BLOCK: 3
WESTpN HILLS
DESCRIPTION:
B
y-i1d3Ag;
Permit Type SF DWG
f
`
Building Work Type NEW
E16C Occuparf y. R-3 M-1
Construotioh Type V-N
Zoning ? R-1
Building Length ? 52
Building Width ? 48
I
REMARKS:
PRV
S& W PLBR - BJORLAND PLBG
FEE SUMMARY::
Base Fee
Plan Review
Surcharge
SAC
SAC %
SAC Units
Subtotal
VALUATION
$585.50
$380.58
$44.00
$750.00
100
$1,760.08
$88,000
MISCELLANEOUS $1,744.50
Total Fee $3,504.56
T2QMRR'"WMES"CO PP 14844044 0001281
3585 N LEXINGTON AVE 330
ARDEN HILLS MN 55126
(612) 454-4044 RUM'AFr'NOMES GO
3585 N LEXINGTON
ARDEN HILLS MN
(612)484-4044
AVE
55426
I hereby acknowle•dge that I
S h,ave read this appl9.cation and sta
te that the
information is corrsct and agree to comply with all applicable State ofi Mn.
. Statutes and City of Eagan Ordinances.
L.
-
; C
? /2
r?
APPLICAN E SIGNA U x
? c
ISSUED B: SIG
RE
INSPECTION RECORD
CITYOFEAGAN PERMITTYPE: BuzLaiNG
3830 Pilot Knob Road Permit Number: 022145
10 / 0 6/ 9 3
Eagan, Minnesota 55123 Date Issued:
(612) 681-4675
SITEADDRESS: Lor: s BLOCK: 3 APPLICANT:
4682 BRISTOL BLVD ROMAR HOMES CO
WESTON HILLS (612) 454-4044
PEgOIIAUBTYPE: TYPE OF WORK: ? NEw
INSPECTION
FOOTIN6 .• .
FRAMING .•
INSULATION PINAL
FIREPLACE
REMARKS: PRV
S& W PLBR - BJQRLAND PLBG
N
REACTINATE _ ??'?E?MI?[? CIIY OF EAGAN
pe?ip # S 2 9 1993 1993 BUILDING PERMIT
? ,-' ----- --- 681-4675
APPLICATION
SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy
ca7cs.
COMMERCIAL 2 sets of architectural & structural plans, 1 set of
specifications, 1 capy of energy calcs.
Penalty applies: 1) when permit is typed, but not picked up by last working day of month
in which request is made, 2) address is changed or 3) lot change is requested once permit
is issued.
Date ?°? / 3,1-k_ /? Valuation of work
Site Address:yb?Z?
STREET SUITE M
Tenant Name: (commercial only)
IAT
? BIACR P.I.D. *
_
_
Descri tion of work: Co
The applicant is: ? Owner XContractor ? Other coe.«;be)
Name Sacc`F O\r- c r?w'1m GLAe-c c,Q? Phone
Property LAST FIRST
Owner
pddress
STREET STE #
City State ZiP
Company Phone y? -\k0aa
w
Contractor Address Z>%? !?j ?bA,y ?'Cr??•License #??A\Z?,\ Exp
4?
Ci ty State Zi p
Company Phone
Architect/
Engineer Name Registration #
Address
City State ZiP
Sewer & water licensed plumber . Processing time for
sewer & water permits is two days onc ea ha een approved.
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. I
Signature of Appiicant:
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation
W02 SF Dwg.
? 03 Sf Addition
? 04 SF Porch
? 05 SF Misc.
? 06 Duplex
O 07 4-Plex
? 08 8-P1ex
? 09 12-Plex
? 10 Multi. Add'1
WORK TYPE
A 31 New
? 32 Addition
? 33 Alterations
0 34 Repair
? 11 Apt./Lodging
0 12 Multi. Misc.
? 13 Garage/Accessory
? 14 Fireplace
? 15 Deck
O 35 Tenant Finish
O 36 Move
??,•• .??? ;
? 1"asement Fifilsh
0 1?-Swim 46-I
? 18 Comm./Ind.
? 19 Comm./Ind. Misc.
? 20 Public Facility
? 21 Miscellaneous
? 37 Demolish
GENERAL INFORMATION
Const. (Actual) V-N Basement sq. ft. MWCC System yc3
(Allowable) v-K lst F1. sq. ft. City Water y?
UBC Occupancy R-3 M-1 2nd F1. sq. ft. PRV Required Y&S
Zoning R.I Sq. Ft. total Boaster Pump
i of Stories
- Footprint Sq. ft. Fire Sprinkler
Length z On-site well Census Code ivu
Depth 148, On-site sewage SAC Code
APPROVALS ?
Planning Building
Engineering Variance
REQUIRED INSPECTIONS
Assessments
? Site ? Footing ? Framing . ? , _ ? Insulation
F-I Wallboard ? Final ? Draintile ?'Fireplace
Permit Fee v.iusc;q,: g S8, 000 ?
Surcharge
Plan Review 6ARA6Ej ZZxeZ= 4jByX!(0- r nc}y
Lise
MWCCnSAC
aSMT:
22 x 30 =
66ox iS =
99 L)o
City SAC ?
Water Conn. 3ev30 : Iou
Water Meter I K 1z ^ 12
Acct. Deposit F?
?,n 8
S/W Permit ?Z ??
S/W Surcharge ?2B?K54% G9 552
Treatment P1.
Road Unit g7 I R fo
Park Ded. ?
Trails Ded.
Copies
Other
Total:
SAC % / 00
SAC Units -F
C
* * * ,
* aionieEa uWD SURVEYORS - CIVIL lNpNEERY
*ftng neer ng wro oLN+Hms - uwoscAa¢ Ana+nccrs ..
* * * ?
P. 01
2422 Enlerpriee Drive
Mendota Helqh19. MN 55120
612) 681^1914•Kax 881-9488
625 Hiqhway 10 Northeasl
6lolne, MN 55434
612) 783-1880-Fax 783-1883
Certificate of Survey for: Romor Homes
House Address: _ 4682 Bristnl Boulevard. Eagan. MN
Model Name: Bayview II
Customer:
?P
.
„?? h ,y?• _, /
ti?' 00 ?,
g a 90, 93?.-15b
/
? 4 ? G?? J0.19
?a° \•y \
/ 37.
. ?
O M1M1Sp '4
?
?\ qa?
\
\ \ ?
<190 /
'°° E1lG1Aai ENC?IId???t Y? D'
Qy?..R
` {{'??'I?J {\?{///]
/ ??m W , J ?^? `??111^.ILTJ??
NOTE: CONTRACTOR MUST VERIFY ALI. DIMENSIONS ANO DRIVEWAY DESIGN
. $00.0 Denotes Existing Elevatton pROPOSEO HOUSE FILEVATIQN .(? Denotes Proposed Elevation Lowest Fioor Elevation:938.95
-- Denotes Drafnoge & Uttlity Eosement Top of Block Elevatton:942.18
Denotes Drainaga Flew Direction
-- Denofea Monumcnt Garage Slob Elevotion:941.83
-a- Denotes Offset Hub Bearings shown are os9umed
LOT 8, BLOCK 3 WESTON HILLS
DAKOTq COUNiY. AiINNESOTA
I hereby eerUry ibaa tAla suway, plan or repon wai pr red by m or under yy dlta<S tupervi? n end hat 1 am duly Roplstwd Land Surwyor
undar Ihe lavusof the Slece o} Mlnnasote. Dated th6vy pl q,D, 1g
1 ineh= ee - ?
Se; t 3O qOBEi -'a x
RTB,SIKICHl.S.REG.NO,1aB91
41.
?
??. qa0' 36
?
?ry
y
"'s
?J iS .A
•? Qy
? 9?e 'f 9o.z3 ?
V
VjqQ#1 \
<t4D)
?t4o.u'?? fq4"1 ?
\ \
// \ y
/ ?40'4
\
A .,by
?
/ ?
?•
• u? `' ?
i
¢
?
?
fl 0 .
0 •
0" 0 0 •
o
.
?
.
0? 0 ? •
? .
•
??
C ?
?
O? ? ? •
LOT BURVEY CHECKLIBT FOR RESIDENTIAL
BIIILDING
BROPERTY LEGAL•
D9CIIMENT BTANDARDS
of Survey:
Registered Land Surveyor signature and company
Suilding Permit Applicant
Legal description
Address
North arrow and bar scale
House type (rambler, walkout, split w/o, split
lookout, etc.)
Directional drainage arrows with slope/gradient $.
Proposedjexistinq sewer and water services
Street name
Driveway
entry,
Existinc
Q 0" ? • Sewer service
0
91 • Lot corners
?
03 • Top of curb at the driveway
D L? 0 • Elevations of any existing adjacent homes
Prooosed
E1? ? ? • Garage floor
?I ? ?
? ? ? •
• First floor
Lowest exposed elevation (walkout/window)
F? 0 • Property corners
? • Front and rear of home at the foundation
pONDIN6 AREAS (if applicable)
0 0? ? • Easement line .
? p? ? • NWL
D ? • xwL
? 1,0 • Pond # designation
p p? • Emergency Overflow Elevation
DIMENSIONS
? ? p • Lot lines
?? ? • Right-of-way and street width (to back of curb)
12"13 ? , proposed home dimensions including any proposed decks,
overhangs greater than 21, porches, etc. (i.e. all
-/ structures requiring permanent footings)
ithin
i
i
i
D' D 0 • Show all easements of record and any City es w
t
ut
l
those easements
p?-'p ? • Setbacks of proposed structure and setback of adjacent
'
' existing home
a W/
6 • Retaini 're nts, if any
?
Rev iewed:
Name / ate
October 1992
it
EXTERIOR ENVELOPE ENERGY CODE COMPUTATION WORKSHEET
7b Determine Campliance with the Minnesota ESiergy Code
(Section 502,of the State Rmended 1983 Model Energy Code)
Project Title R01WI)47 Site Address ? ????) \-, Qz`? p
1. EXPOSED WALL CALCULATIONS
A. Opaque Wall
1. Masonry/Concrete
a.
B.
C.
D.
E.
b.
c.
2. Foundatirn WaL1. (ve Grade)
a.
b.
3. Niood Frame Wall
a. InsuZated Area
b. Frami.ng Area (Ave. 158 at 16" oc)
c. Framing Area (Ave. 108 at 29" oc)
4. Pezipheral Floor Edge/Rim Joist
Glazing
1. Windaas
a.
b.
2. Doors
Doors
1. ti?od
a. Solid
b. With storm dcor
2. Metal
3. Overhead
4. Other
ARFA "U" VALi7E AREF1 X "Uu
C_'? X = C_ 3
? x = c'?
x = -[l^
x ?e?S-
=' x = ?'7
X , ",;"f = 57.&v
2??f x ??.Sz
? x = C?
_/(:?,G x
p x
;?7 x
c? x
13.Hq
G? g = i--- ,
? x
x
x
? x = -7-
'POTAL WAM 7+RFA, sq. ft ..................... 2?
TOI`AL of AREA x "U..................................................... 2;? 2
1. ROQF/CEILING CALCULATIONS
A. Rmf/Ceiling Insulated Area
B. Roof/Ceiling Framing (Ave. 158 at 16" oc)
C. Roof/Ceiling Framing (Ave. 10% at 24" oc)
D. Skylight
1170 x , 02 z = Z.S7?f
? x = U
x 3./2
C? x = G?
E. 3'OTAL ROOF/CEILING ARFA sq. ft .............. ?,/ 3 eVl'>
F. ?,L C&' HREA x "U" .................................................. ?R.•?i't?
it
t%)Y!?/?. ?.o ( ? • ? /
III. BUILDING ENVELOPE REQUIREMENTS
4'OTAL ARFA RDQUIRID "U" ,ALLOWABLE
(Fnan I.D & II.E) (From V.) (Area x "U")
A. EScposed Wall: 2 17-7 x 2 S/. 5 ?
B. Roof/Ceiling: I 3?? x .t--)2 (? = 3 3. 75O
C. `POML ALwNTABLE BUII.DING EPIVELAPE (TOtal of A& B above)... 2$5-- 37
IV, ACTUAL BUILDING ENVELOPE
ACTUAL
(Area x "U")
A. Exposed Wall (From I.E) 211. C?'j
B. Rnof/Ceiling (From II.F) 1
C. TOTAL AG'tUAL BUILDING INVE[APE (Total of A& B) ............ ?.? /•?1(?
*(Meets code requirements if less than III.C)
V. REAUIRED "U" VALUES
WALLS " PDOF/CEILING
Detached ore and two family dwellings .11 .026
* Multi-Family Residential Buildings .238 .033
(3 stories or less in height)
* All Other Construction Zypes (3 stories or less) .238 .06
* All Other Constructirn 'Iypes (MOre than 3 stories) .28 .06
* 8ased on 8007 heating degree days (Mpls/St. Paul)
Adjust "U" values accordingly for other locations
CERTIFICATION
I hereby certify that I have catpleted the above information and that it oortiplies with the
Minnesota Stat,e Energy Code.
S/
-111 s vYa
BCSD 3-89
CC/SA1/6574
? ' , . ?2o?s U?, 6 7?
' HEAT 105S CALCUTATfON9 '?A?
~ WeathenlriDs _II Cuidt II. Can?truction No.
Wiadowi ( poors ? Referonce but, Wall Int_ W.II C.tlt... 17_.
?
1nFltration
C1ass
E.xp. wsll
Net exp. well
lot. wall
Ce.Lng
Fl rov
ot ?q. Ini. ?V.A. Leader are• ,?
LenBth Widih /d Height`
-CntksQe and Area
Btu
Clui
Exp.
Nat a
IN. w
Crihn
Floor
OP
.,a s._
.lient ? Inpl l?.ofCr?CM .0
???
M l5
I °J
^^-?
_Glau •) 7? 20
Exp. wall
?
Mat eap, wall
Int. wiil
........._?_
._ ?.
?
_.._
17e.1mg
h!ocr l?U• ?
I vu1 alu. ?. 5Y5
Rrqoired l1. h. E.D.R. ar i.q in?, W?A. (,?ader are?
-_..M•{1(,ni,.,/?oom?Lenplh5'?-? Widih /1 14.Ie6k •k I
W mdow% i nd Donn -Crackn ge jind A ru
.^Na WIEIn
Of Din, 11.11qt
c! penl Ne.e!
11 1111 blM?lf?.
0( CneY Ap?
p!.
? r?
? • +
?
? Coef. QW
in6ltretion 6' j 74-3-y""
CJa?t ? ?
Fap. wall
Net esp. wall
Int. wall
----•-?^"
?
•.•
_....
Ctdin ?? - ? `?j•?
?
Floor .
?
+o161 ow.
?Requirtd iq, ft. E.D.R, or mq, ins. W.A. L.nder aresi
-7,A e
In?ulAtioe
o nw vwlv ?rscqa QC EDa Nf e¦
W?QIA
a
f O.n. Nllt?!
0f Oan? NO.Of
11/Ifu InUlll.
ot cra[N ?wn,
M fi.
^
d? V
COCI. BtY
1n61?ietion ? W 50?
Glau
r._._. 0 97 W7
Exp. wall
?? ._
Net exp. wall I$
-onll
Chung
Finor
! O[A1 Ctu. ( 7-V
? Rtyui«d ,q. ft, E.o,R, or gq. ins. W,q, (,cader nrtp
-= FI.I ?j ---- Room I.angth 1 , Wi t ag?it ?
v? nuvwa o nv uuorr- -a.ncaA ge o0G ql ca
Ne Wlalh
e(?Ln. gelfh t
O
/
Mn? No.o
Ilf?t? lnU fl,
Ot<qpM Aro
p It
_ r )
?
w
InfiAruiion 9)0
F.up. wAII - $p
Nct cxp. wall
?
'
Int. waU
CeilinB
?
Flnor `
II 10161 tllW I l5"??]
?
Required eq, ft. L.D.R. or sq, im. W.A. [.ender ara ?
.t.??
? F]-I Room I Lenolh I Width a Ncight
I Windows and Doorw.Crse6ep AnA A.•
NO t?ou: o1tl?M Ilr?t? a1VUk Q '1i.
Coef. Btu
Ll
Ca?eef ?? ?? ?
ExP. well ? ..
Na! exp. wa11 I
!ot wail
Coling
?
?T `?
Fioor
IOltll GIU,
-- ?R-c?qvy-ir-e-d?sq. ft?
ri,l
Windowa and
!a?ins. W,A, Leader aita
I Length- Width
:ne4age and Arce
Exp, wall Nct ezp. wall
Int. waf!
CeiLng
F!uor
? Tcta1 6tu.
_ Required sq. (t. E.D.R, or ?q. ins. WA. Leader aM
r
PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOIvF-S AND
CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNTT• , 11 ? NEW CONSTRUCI'ION
ADD-ON A/C
ADD-ON FURNACE
DATE
FEES
? 3 ?-??
HvAC: 0-100 M BTU 26.?
ADDITIONAL 50 M BTU
GAS UTLETS (MINIMUM 1@ $3.00 EACH) '00
( Y1 ?l.?f? ? YY 21'?
ADD-ON/REMODEL (Ex1STING CoNSTRUCTION) $ 15.00
STATE SURCHARGE
TOTAL
.50
,5U
SITE ADDRESS: w (o
OWNER NAME: 4() ??r Pbn''-n TELEpHONE #:
INSTALLER: VOGT HEATING 8 kIN CONOITIONINB
ST LOUIS PARK, MN 55428
ADDRESS: SALES 92H7e7 sERVICEeze'aott
CITY
STATE: ZIP CODE:
TELEPHONE #:
?.?ra ??'LGVYI ?sfI I
SIGNATURE OF PERMITTEE
1993 MECHANICAL PERMIT (RESmENT7AL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN MN 55122
(612) 6814675
1993 PLUMBING PERMIT (RESIDEIVTIAL)
C1TY OF EAGAN
3830 PILOT KNOB RD
EAGAN MN 55122
(612) 681-4675
PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. AISO,
CONDOS WHEN PERMITS ARE REQUIl2ED FOR EA.CH UNTT•
NO. FIXTURES
SHOWER
? WATER CLOSET
? BATH TUB
_a LAVATORY
KITCHEN SINK
1 LAUNDRY TRAY
HOT TUB/SPA
WATER HEATER
? FLOOR DRAIN
GAS PIPING OUTLET • minimum -
? ROUGH OPENINGS
WATER SOFTENER
PRIVATE DISP. • DeI.cty. sc.
U.G. SPRINKLER • nome uneer const.
ALTERATIONS • w adscing
WATER TURN AROUND
STTE
OWNER
WST.
STATESURCHARGE
TOTAL:
LA lo'? a (J r lS? I
12 orrvo_& t-6 rr
u vV) r,i 144-"
ADDRESS: (Oq 6l 4ti
CITY: &O G IC?k-in PiL STATE:_
PHONE #: ( (p I Z) _ "J?33' `'1 3 S -I
EAC:
3.00
3.00
3.00
3.(10
3.00
3.00
3.00
3.00
3.00
3.00
1.50
5.00
15.00
3.00
15.00
15.00
TOWNHOMES AND
TOTAL
°,. 00
.3. OD
4 DO
D
.50
_ ?IOo
ZIP CODE: SSq 29
2000 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
? C? 3830 PILOT KNOB RD - 54142
? 851-881-4875
Remodel/Reoatr RaaulremeMs
> 3 reylslered sNe wrvays Yw'MrW tQ. H. of lol, sQ. ft. OI houle 2 coplat ot plan
mtl a{ roo/ed areas CIA76 maximum bf oovemae allowem 1 set of enerpy cdeWallons /or heoAetl addlMOna
D 4 copka of Plau (slww beam 8 wlndow daes: poured hid detlpn; etc.) 1 dte wrvey lor wdedor addHons A decka
D 1 $et o/ enerpy cdcLdallorq
D 3 eapks ol hee proservaMon plan N Id plaRed alfer 7/t/93
DATE: CONSiRUCTION C05f: l Z? y,,SrO
DESCRIPTION OF WORK:
STREET ADDRESS: _17LO ? Z- RA/ ST'o L- /S t 0 t7 E _
LOT: I BLOCK: ? SUBD./P.I.D. #: `,L?? t???-C7 vt l-?
Name: d09),) ///)4T7- pnone#: 488
PROPERTY wq FlRr
OWNER ?/ /?
Sh66f Addf6S8: 74SZ i8/STOL Nt? D
Clly ?i¢4AAJ Stafe: Y!'1 ? Zip; 5S/ 2 3
(05 ?
A
Company:_X?PELH ?•IISPDJW 004ofeli X?G, pr?one#: -14? ?i8J* 7L7/
(area code)
COMRACTOR l
street Address: ro LO ZAML
eR r
ucense # 3 2 L Ep, _AJ-46
CHy ArA 4N1 r/ SMte: `?!? Zip:
ARCHRECT/
ENGINEER Company: Name:
Telephone A: ( )
SMeef Address: Regishaflon 0:
Gty State: Zip:
SeweNwater Iicensed plumber (if Iristslliro sewerMraterl: Phone #: C?
1 heroby ackrawledpe fhaf I have read Mis applicalbn. atate fhat the Infortratbn is coRect, and ayree b comPN with a0 apP6cable Sfate
W MfnnesoM Stalufes and Cily of EaQan Ordirwnces.
? Slynclure of APPUCant
OFFICE USE ONLY
CeRificates of Survey Received _ Yes x No FEg _ 7
Tree Preservatlon Plan Received _ Yes _ No x_ Not Required VJ?
/?
BUILDING PERMIT SUBTYPES
0 01 Foundation O 07 Orplex
0 02 SF Dwelling O 08 06-plex
O 03 Ot of _ plex ? 09 07-plex
0 04 02-plex O 10 OB-plex
O 05 03-plex O 11 10-plex
? 06 04-plex O 12 12-plex
WORK TYPE
O 31 New
O 32 AddiGon
AR,-'33 Alteration
? 34 Repair
OFFlCE USE ONLY
O 13 16-plex ? 21 Poroh (3-sea.)
O 17 Garage ? 22 Porch/Addn.(4-sea.)
13 18 Deck 0 23 Porch (screened)
9 Lower Levei O 24 Stortn Damage
Plbp Y or_ N O 25 MiSCellaneoUB
? so Pooi o so nccessory aa9.
? 36 Move Bldg. O 43 Reroof
? 37 Demolish (Bldg)' ? 44 Siding
0 38 Demolish (Interior) E3 45 Fire Repair f
0 42 Demolish (Foundation) 0 46 Windows/Doors
' Give PCA handout to applicant for demolition permit
GENERAL INFORMATION
SAC Code 0 I
No. of Units i
No. of Buildings 0
Const. (Actuai)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
W idth
Basement sq. ft.
Main level sq. ft.
sq.ft.
sq.ft.
MISCELLANEOUS INSPECTIONS
O Stucco/Stone
APPROVALS
Planning _
Permit Fee
Suroharge
Plan Review
License
MC/ES SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Suroharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
Building
60.90
I 6G S 0
sq.ft.
sq.ft.
Footprint sq. ft.
Census Code
MC/ES System
City Water
Booster Pump
PRV
Fire Sprinklered
Q G Engineering Variance
r
Valuation: $ S,OU U
O 31 Ext Alt - Multi
? 33 ExL Aft - SF
O 36 Muftf
Lf34
SAC Units
96 SAC
? ? BL ? CITY USE ONLY RECEIPT#:" Ia 37a.5 .
sUBO. 1n)P,STC7V1 tTlk aeceIPT onTE: a-a5-aa
PERMIT# ? I
2000 PLUMBING PERMIT (RE3IDENTIAL)
cixx os Eacnx
3830_PILOT PINOB RD
EP.GAN, hIIi 55122
651-681-4675
Please complete for: ? single famiiy dwellings
? townhomes and condos when pertnits are required for each unR
? backflow preventer for underground sprinkler system
FIXTURES
EACH . #
TOTAL
Alteretions to existing dwelling - minimum fee
Describe: FtT.??? $ 30.00
Bath tub $ 3.00 x = S
Floor drain 3.00 x = . $
GaS pi ing ouUet ' minimum - t 3.00 x = $,
Hat tub/spa 3.00 ic = " . $
Kitchen sink 3.00 x S
Laundry tra 3.00 x = $ , .
Lavatory 3.00 x = :$
Septic System nawlreturmsned ' requires MPC Iit. 75.00 X
Septic S stem abandonment 30.00 x = $
RPZ new installatian/repairlrebuild 30.00 x = $
Rough openin 1.50 x = $
Shower 3.00 x =•., $-.a=sas;-
Under round sprinkler Hdwalling is underconstrudion 3.00 x = $'
Under round sprinkler if exisGng dwelling 30.00 tx $
Water closet 3.00 x = . :$
Water heater 3.00 x = $
Water softener if dwelling under construcUon 5.00 x = $
Water softener if exiating dwelflng 30.00 x,' $
Water tumaround 30.00 x ',$ '
State Surcharge .50 $ .50
Total
Reminder. Call for inspections of alteretions, i.e. water heaters, water softeners, efc:.
-----••-°---••-•------------------••-----...--------•---- -•• -
?1 Aereby adcnowledge Mat I have read this application, stste that the iMormation is correct, end sgiee to comply xridi all spplic@ble Gity?of Esgen ordinances.
It is the applicanYs responsibility to notify the property owner that the City of Eagan assumes no liability=for any damagescaused;by the City dudng i1s
nortnal operational and meintenance adivities to the facillties construGed under this pertnit wkhln Ciry propertylright-of-way/easement.
?
SITEADDRESS: yfSd (b-+1?6I bluj '
OWNERNAME:: M6d+ TELEPHONE#:
(AREA CADE)
INSTALLER NAME: ,m w?? v TELEPHONE #: it :I40- 1 ^qS.:I , I33?
. ?? ! i I (AREA CODE) . ' ' '
STREET ADDRESS:
ciTV: .t STATE:. ?JnN-IIi?' i FEB ZZIp?!:
OF
IZ?•Z'
z a? ?3 RESIDENTIAL
J BUILDING PERMIT APPLICATION
CITY OF EAGAN
3$30 PILOT KNOB RD, EAGAN MN 55122
831-881-4875
Naw CorAftuctbn Neauirementa
• 3 registered stte surveys slwwing aq. R W bt, sq. tt. W house; and litII roofetl arees
(201/o maximum IM coveraqe albwed)
. 2 copies ot plen slwwhg beam & window sizes; poured found tlesign, eic.)
• lsetofEnergyCakulatans
. 9 coples N Tree Preservatbn Plen H lot platted aRer 7l1/93
. Rim,bM Detall Optbns seledbn sheet (bWgs witli 3 or less unks)
DATE' I/ IoZ
SITE ADC
NPE OF
APPLICANT
STREET ADDRESS
TELEPHONE # G5f- 43`T- '02.o CELL PHONE #
AULTI-FAMILY BLDG _ Y _ N
FIREPLACE(S) _ 0 _ i _ 2
?STATE/JW-21P 25SaE2--
FAX# G,< I - Sf?:5I- 20`7'/
PROPERN OWNER &4 Su 11;-5n TELEPHONE # 6 S! Ag?' ? Lkf
COMPLEiE iHIS SECiION FOR °NE " RESIDENiIAL BUILDINGS ONLY
Energy Code Category _ MINNFSOTA RLJLFS 7670 CA1'EGORY 1 MINNESOTA RLTI,FS 76i
(d submiasion type) • ResideMial Ventilation Category 1 Worksheet Submitted • 7UL (gy Cm qW ?1?
. Energy Envelope Calculations Submittetl F ? 1? Ir ?? 0 9 2002
Plumbing Conhactor. __
Plumbing system includes:
Mechaniccl Contracfor:
Mechanical system includes:
Sewer/Water Contractor:
_ Air Conditioning
_ Heat Recovery System
Phone #
Phone M
Fee: $70.00
-------°------------------------------------°----------------°------------°-----------
I hereby acknowledge that I have read this application, state that the Informatlon is correct and agree to comply
with all applicable State of Minnesota Statutes and Clty of Eagan Ordinances.
Signalure o(Applicant ? ?/?/fly
_ Water Softener
Water Heater
No. of Baths
? zsy9
pemodaVNepalr ReauhameMe
. 2 copies of plan
• 1 set M Energy Cabuletions for heeted addilbns
. 7 sAe survey tor e#erior additions & tlecks
. Indlcate H Iwme served by saptk system tor atltlabns
VAWATION 5"q7 ? . OO
_ Phone #
I,awn Sprinkler
No. of R.I. Baths
.?.?._..........._...r........_..._
................................................
OFFICE USE ONLY
Certiflcates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4/02
RESIDENTIAL
S`I ilt c?;o BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651•681•4675
New Construction Reauirements
• 3 registerea site surveys showvg sq. ft. of lot, sq. ft, ol house; and all roofed areas
(20°h maximum lot coverage allowed)
• 2 copies of plan showing 6eam 3 window sam poured found design, elc )
. 1 setofEnergy Calculauons
• 3 coDies of Trea Preservahon Plan if lot platted after 711193
. Rim Joisl DeWtl Options sNecUon sheet (61Cgs wM 3 ar less unils)
DATE JlO( I0Z
_ Water SoFtener
Water Hcater
No. of Baths
SITEADDRESS ill l3r-sA'u 1 6I vd MULTI-FAMILYBLDG _Y _N
TYPE OF WORK Qill FIREPLACE(S) _ 0_ 1 _ 2
APPLICANT
STREET ADDRESS el Me.«nyl pil A.). CITY S+h1.y.k STATEAAl_ZIP5'%..RZz
TELEPHONE #(jl- ll y320 CELL PHONE # FAX #(e51-35l- 20?(0
PROPERTYOWNERol Su164jwn TELEPHONE#(o5/-(eQQ-2165
-------------- -..........................................................................
'-----
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ M[VNE:SO'I':\ RCLES 7670 G\TEGORY I NfINNL•S01AJUj_L'7072
(J submission type) • Residen[ial Ventilation Category 1 Worksheet Submittedheet SubmitteC
p . Energy Envelope Calculatlons Submitted
UG 0 &g2002
Plumbing Contractor: ___
Plumbing system includes:
Mechanical Contractor:
Mcch:uuc.il svstcm includcs:
SewerlWater Contractor:
Phone #
ree: s7o.oo
----------------------°°--------------------...-°---------------...._...---°------------^---...-------...----..._..°
I hereby acknowledge that I have read fhis application, state that the information is correct, and ogree to comply
with all applicable State of Minnesota Statutes and City of Eagan Ordinances. ^
Signature af Applfcanf 419i1?
OFF[CE USE ONLY
_2??
1-?- a'
RemodeUReoair Reauiremenb
• 2 copies ol plan
. 1 sel of Energy Calculatians for heated adAitbns
• 1 sile survey tar extenor additions & decks
• IiMicate i( home served by septic rystem for adddians
VALUATION 7:32`l
_ Phone?-
_ Lawrt Spri ?ei_
No. of R.I.?Kaths
Phone #
Air Condiuoning
-- Hcat Rccovcp' Systcm
CertiFicates of Survey Received - Tree Preservation Plan Received - Not Required _
Updated 4I02
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 4682 Bristol Blvd
Lot: 8 Block: 3 Addition: Weston Hills
PID:10- 83750- 080 -03
Use:
Description:
Sub Type: e - Fumace
Work Type: Replacement
Description: Furnace
Comments: Quesetions regarding electrical permit requirements should be directed to Ma rk Anderson, State Electrical Inspector,
952- 445- 2840Crystal Gemuenden 8910 Wentworth Ave S Bloomington, MN 55420 952- 881 -9000 Crystal.Gemuenden @Se
viceExperts.com
Fee Summary:
Contractor:
Sedgwick Heating & Air
8910 Wentworth Ave S
Minneapolis MN 55420
(952) 881 -7739
ME - Permit Fee (Replacements)
Surcharge -Fixed
Total:
Applicant/Permitee: Signature
PERMIT
City of Eaan
- Applicant -
Owner:
James G Gray
4682 Bristol Blvd
Eagan MN 55123
Permit Type:
Permit Number:
Date Issued:
Permit Category:
$30.00 0801.4088
$0.50 9001.2195
$30.50
I hereby acknowledge that I have read this application and state that the informa
of Minnesota Statutes and City of Eagan Ordinances.
on is correct and agree to comply
h all applicable State
Issued By: Signature
Mechanical
EA074893
08/25/2006
ePermit
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PERMIT
City of Eagan Permit Type:Building
Permit Number:EA112740
Date Issued:08/22/2013
Permit Category:ePermit
Site Address: 4682 Bristol Blvd
Lot:008 Block: 003 Addition: Weston Hills
PID:10-83750-03-080
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:One Window/Door
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings, call for framing
inspection. Call for final inspection after installation.
Window or Door:1 BOW WINDOW
Jay Deems
Fee Summary:BL - Base Fee $500 $40.00 0801.4085
Surcharge - Based on Valuation $500 $0.50 9001.2195
$40.50 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 -
James G Gray
4682 Bristol Blvd
Eagan MN 55123
(612) 386-7005
Minnesota Rusco
5558 Smetana Dr
Minnetonka MN 55343
(952) 935-9669
Applicant/Permitee: Signature Issued By: Signature
Use BLUE or BLACK Ink
r
I For Office Use
Permit#: ( I W V 0 j
InGH
City of EaEd I I Permit Fee: 0~5 a5
I
3830 Pilot Knob Road I 0'^ I
Eagan MN 55122 Date Received: V !
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 1 Staff: I
I I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit M
Name: 'S Phone:
Resident/
Owner Address/ City/Zip: 9 Z 414-z_` /v
Applicant is: Owner Contractor
Type of Work Description of work: /v27
Construction Cost: f> COD Multi-Family Building: (Yes / No )
Company: I,D e-yoo Qp Cans 7 2`A i C;4 Contact:
Contractor Address: ~~3 City: ~IAGf~
State: 06Z Zip: 1 2 3 Phone: (O/ Z-
License 7&_ 13a Z" J 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:
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 Building Code m e completed within 180
daysmppit issu/anceI ~
x 1C f ~.~vr~z ~'1 x
Applicant's Printed Name Applica
Page 1 of 3
Use BLUE or BLACK Ink
For Office Use /
Permit#: / 41(1 �t
City of Eaaau
Permit Fee: /42
3830 Pilot Knob Road
Eagan MN 55122 Date Received:
Phone:(651)675-5675
Fax:(651)675-5694 Staff:
2017 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: CZ-I -Z., 20 V Site Address:
H(0 vs-N, \\_.IF ( Unit#:
Name: YAC .L V Phone:
-Resident/ -
O t Address/City/Zip: � Y� '� ' \� �.c �°1 (�n ��a
s
Applicant is: Owner ..."--Contractor
Description of work: `w--c)�-
Type of Work t
Construction Cost: 1r2- _ 3 \ . Lein S° Multi-Family Building:(Yes /No )
Company: \N,If i Ll`,>G C 1,tc1-� Contact:
Address: Lk dr. 5k( ,�r..)c_J City: 2--c:: -5
Contractor JJ
State: 'YW\Zip: t J 3 Phone:
License#: t5C ( 3110 I Lead Certificate#:
If the project is exempt from lead certification, please explain why:
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 ll', No If yes,date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer&Water Contractor: Phone:
Fire Suppression Contractor: Phone:
NOTE:Plans and-supportingdocuments that you submit are considered to be public Information. Portions of
the information maybe 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.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.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be comple d within 180
days of permit issuance.
Applicant's Printed Naive Applicant' ignature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA146257
Date Issued:10/17/2017
Permit Category:ePermit
Site Address: 4682 Bristol Blvd
Lot:008 Block: 003 Addition: Weston Hills
PID:10-83750-03-080
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener).
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
James G Gray
4682 Bristol Blvd
Eagan MN 55123
(612) 386-7005
Bruckmueller Plumbing Inc
3992 Pennsylvania Ave
Eagan MN 55123
(651) 686-6696
Applicant/Permitee: Signature Issued By: Signature