4661 Bristol BlvdCity of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 4661 Bristol Blvd
Lot: 26 Block: 1 Addition: Weston Hills
PID:10- 83750- 260 -01
Use:
Description:
Sub Type:
Work Type:
Description:
Census Code:
Zoning:
Square Feet: 0
Comments:
Fee Summary:
Valuation: 3,000.00
Contractor:
Renewal Andersen
1920 County Road C West
Roseville MN 55113
(651) 264 -4777
e- Windows/Doors
Windows/Doors-New/Replacement
House
434-
Applicant/Permitee: Signature
PERMIT
City of Eaan
BL - Base Fee $3K
Surcharge - Based on Valuation $3K
- Applicant -
Construction Type:
Occupancy:
Permit Type:
Permit Number:
Date Issued:
Permit Category:
If altering the opening size, a framing inspection is required. Smoke detec tors are required in all sleeping rooms prior to
final inspection. When wall studs or ceiling joists are exposed, hard -wired detectors are required Bat tery operated types
are acceptable if the wall/ceiling finish (i.e. sheetroc k) has to be removed to install a smoke detector. Kara Benson 9533 -
67th Street North Branch, MN 55113 651- 674 -1766 wsandd @peoplepc.com
Total: $89.50
Owner:
Jamie C Wolf
4661 Bristol Blvd
Eagan MN 55123
$88.00 0801.4085
$1.50 9001.2195
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 with all applicable State
Issued By: Signature
Building
EA076330
01/02/2007
ePermit
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS:
, i z;; ??s?r?l F:1b.JO .
PERMIT SUBTYPE:
?
PERMIT TYPE: ?. ? i;? r? .? ?a= ?
Permit Number:
Date Issued:
?
??.
TYPE 4F WORK:
r I HAf
Permk No. Permit Holder Date Tetephone #
ELECTRIC
PLUMBING
HVAC
Inspection Date Insp. Cammants
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GVPBQAHD
FIREPLACE
FIFEPLACE
AIR TEST
FINAL PLBG
FINAL HTG
QRSAT
TEST
6L6G FINAL
BSMT R.I.
BSMT FINAL
dECK FfG .? ?
OECI( FINAL J ?. f / l
V i
..
_ .,, ?c:
. _
? --CI TY QF EAGAN PERMIT TYPE: "' W'
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55123 Date Issued:
(612) 681-4675
SITE ADDRESS: APPLICANT:
PERMIT SUBTYPE: TYPE OF WORK:.
I
INSPEC ?
k • „ . ..
?
.+sf I I "s., . ,..9171 ?
7: 6'? ??A R E ESIk) . i,. i ? ? t R A F. ! (), h- f' N ??Z V (y Iq p I
?
?
?
Permit No. Permit Hvlder Date Telephone #
S/W
PLUMBING
H VAC
ELECTRIC
ELECTRIC
Inspection Date Insp. Comments
Footings I bs
Foundation
Framing
l 7
t1
Roafing '
Rough Pibg. 3
Rough Htg. 9 ? ??y?3 E7?.. .
Isul.
t.1
Fireplace
Final Htg.
U1
drsat Test
Final Plbg. Plbg. Inspector- Notify Plumber
Const_ Meter
Engr./Plan
Bldg. Final 3 I
Deck Ftg.
Deck Final
Weil
Pr. Disp.
ff, I?
IJV
s
,? ? ?r, :..i. . ? ' ? ,. , . . . . . . .. . ? ? ? . _._ . ..
,w
This Cern'ficate issued pursuant to the nequirements of the Uniform Building Cade
certifying th,at at the trme of issuance thrs sinrcdim was in compliance wuh t)re vurivus
ondirrancea af the City regulating building canatrrrctiaqn or use: For the fnllowing:
on. SE I][Rr, gW r?mit Ho. 21504
,c P3IM 1 zo,ang Disu;a LR1 [?w CWL _ VN
? im HiLm E84FS AM.3459 h1ARLN= ll?2, EAGAN
? 4661 "MSTqd., AVL} L.MaYW6, B I, WE5'
/lJ??,%/ 1 •= POST IN A WNSPICUOU3 PLACE
Address 4661 BFUSmL s[,vD Zip 5512 3
I.ot .96 Blk i Sub wESrCN [mLs
THESE ITEMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECTION.
Date: f0 s 9Jr- Yes No Inspector:
Final grade (6" from siding)
Permanent steps (garage)
Permanent steps (main entry)
Permanent driveway
Permanent gas
Sod/Seeded gass ?
TraiUcurb damage
Porcb
Basement finish
Deck
Please verify with the builder the temoval of roof test caps from the plumbing system and the shuboff of water supply W
the oufside lawn faucet before freeze potential exisis.
Contad engineering division at 681-4645 before working in rightof-way or installing underground sprinkler system.
White - City Copy Yellow - Resident Copy Pink - Contracror Copy 0
laco i--)
? ?
Req est D te
ll g ll S t 24, 19 93 Frte No Rough-in Inspection
Reqm P '
? Fleatly Now II Noiity Inspeclw
j0irles G No When fleatly7
licensed cont
a
t
n
r D
h
b ti
f
bov
t i e electrical work at:
•
r
ow
er
on o
c
o
ere
y reques
nspec
a
Job Atltlres4 ISlreat. Box or RoNe No ) City
4661 Bristol Blvd. Ea an
$eclion No Township Neme or N. Rarge No. Coun
?atOta
`o "PPiller Homes
a WrV- 4663
.
PowerSupPber ??ress 4300 220th St. ' S.W.
Dakota Electric Farmin ton MN 55024
Eleclncal ConVactor (COmpany Name) Comractor§ ?cense No
Midland Electric CA 01236
""2"2ff"s".W&@°`TW9f'""]YR9:"s'fiag'keville,MN 550 44
AuID tl SignaWre ICOnVactor/ wn¢r Making Installation, Pho4pe,Ny1mbe1 444
0
MINNESOTA STATE BOAPU OF ELECTRIQTY THIS INSPEGTIDN REOUEST WILL NOT
Gtlgga-MlOwey Bltlg. - Room 5-113 9E AGCEPTED BYTHE STATE BOARO
1821 Unlvenlty Ave., St. Paul. MN 55100 UNLESS PROPER INSPECTION FEE IS
Phone (612) 6412-0800 ENCLOSED 1
REQUEST FOR ELECTRICAL INSPECTION
? S " nsimctimi5.for comple9ng this lorm on Dack ol yellOw copy
"X" 8e/ow Work Covered by This Request
.n?.°"•`t+?. e?I- o00 ?
??..
70?% I-A
a dd Rep 7ypeotBuilding ApphancesWiretl EquipmantWired
Home Range Temporary Service
ex Water Heater Ele ctnc Hea[ing
Butlding Dryer (Specify)
I m /Industrial Furnace
Air Gonditioner
(specity) Contrador5 Femerks
Other
Compute Inspechon Fee Below:
# Other Fee # ServiceEnlranceSrze Pea # Cimuds/Feeders Fee
Swimming Pool 0 to 200 Amps g O to 100 Amps
Transformers Above 200 _ Amps Above 100 _ Amps
SignS Inspecmr's Use Ony. TOTAL
Irrigalion Booms • ????„?j?
Special Inspection
Alarm/COmmunication THIS INSTALLATION MAY 8 ERE I ONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 M S.
I, the Electrical Inspector, hereby
certify that the above inspection has
been made. R°u9n-in
T
Fin81
si
Date
(-
OFFICE USE ONLY ?
Tpi6 reQUest vOltl 1B TOnihS lIOm ?
i7 s? I
2007 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
/f 0.1?1
New Construction ReauiremenGs RemodeVReoair Reuuirements OEftm UseOnlv
3 re3istered si[e surveys showing sq. ft of lot, sq. ft. of house; and all roofed areas 2 copies of plan showing footings, beams, joists Cert of 3urvey Recd _ Y _ N
(20°hmenimumlotcoverageallowed) lsetofEnergyCalculationsforheatedaddi6ons SoilsReport _Y _N
1 Sals Report if propased building is to be placed on disWrped soil 1 site survey for additions & dedcs Trce Pros Plan Recd _ Y _ N.
2 copies of pian showing beam & window saes; poured found design, etc. Addi6'on - indicate ifon-sde sep6c system Trea Pres R9quired _ Y _ N
1 set of Energy Calcula4ans Onsite Septic System _ Y, T N
3 copies of Tree Preservation Plan if lot platted atter 711193
Rim Jast Detail Opfions seledon sheet (butldingswith 3 or less unAS) ??
Minnegasw mechanical ventila6on fortn
Date -Y-_
Site Address !.S f Construc[ion Cost ?J-0 G
o UnidSte #
Description of Work F°n f?'"h ¢r Y C?4 ?1 9
9 P7-
Multi-Family Bldg _ Y 2-'N z
Fireplace(s) _ 0 , 1 _ 2
Property Owner iG N ec (It_! a Telep6one i# a?.2
Contractor ? /C 5?r7i't???Afl lj
Address :2/.2c)
State /at,(oo)
Zip-;!rU7Z City
Telephooe#(65'/ ) .2 0?-C
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy Code CBtegory . Residential Ventilahon Category 1 Worksheet • New Energy Code Worksheet
(J submission rype) Submitted Submitted
• Energy Envelope Calculations Submitted
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_ Y _ N If yes, date and address of master plan:
Licensed Plumber
Mechanical Contractor
Sewer)Water Contractor
I hereby apply for a Residential Building Permit and
Telephone # (
Telephone #(
Telephone # ( )
the information is complete and accural
e?,
e;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; 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 rey_iApw and
approval of plans.
( V'ai. P (11,/qr.uL(arcG"?
Appli t's Pri ted Name N70picant's Signature
DO NOT WRITE BELOW THIS LINE
r
Sub Tvpes
? 01 Foundation ? 07 05-plex ? 13 16-plex
x 02 SF Dwelling ? 08 06-plex ? 16 Fireplace
O 03 01 of_plex ? 09 07-plex ? 17 Garage
? 04 02-plex ? 10 OS-plex ? 18 Dedc
? OS 03-plex ? 11 10-plex ? 19 Lower Level
? 06 04-plex ? 12 12-plex
Work Tvpes
? 31 New
X 32 Addi6on
? 33 Alteration
? 34 Replacement
? 20 Pool ? 30 Accessory Bldg
? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 22 PorchlAddn.(4-sea.) ? 33 Ext.Alt-SF
? 23 Porch (screenlgazebo/pergola) ? 36 Muiti Misc.
? 24 Storm Damage
? 25 Miscellaneous
i
? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 37 Demolish Building` ? 43 Reroof ? 46 WindowslDoors
'Demolition (Entira Bldg) - Give PCA hantlout to applicant
DeSCrlptlOfl: Water Uamage _ Yes
Valuation -
Plan Review 100% or 25%
Census Code
SAC Units
# of Units -
?-
# of Bldgs
Type of Const ?
Occupancy MCES System
Zoning City Water -
Stories Booster Pump -
Sq. Ft. PRV -
Length Fire Sprirtklered ?
Width 0 ?
_ Footings (new bldg)
Footings (deck)
? Footings (addi[ion)
Foundation
Drain Tile
Roof _ Ice & Water * Final
? Framing
_ Fireplace R.I. _ Air Test _ Final
_ Insulation
Approved By:
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
REQUIltED INSPECTIONS
_ Sheetrock
Final/C.O.
? FanaUNo C.O.
HVAC
Other
_ Pool Ftgs Air/Gas Tests Final
_ Siding _ Stucco Lath _XStone Lath _Brick
_ Windows
_ Retaining Wall
Building Inspector
ya to C ijzrt--
?5//?
i .:
i
.4:43 TQ Flc E91 40E1 FR01I PRORE ENGINEEP,ING: T-189 F.02
O?O(?6 C??nNiiens° a? °inNe s3unvEVOns
ENGINEERING
? 'COMPANY, INC.
? 1000 EABT 1?61h OtqEfiT,
Legal Description:
?
scnLe i r d ao•
79°
qq;06
1
CERT61F1CATE OF SUFiVEY
BU1INSVII,LE. MIkNE80TA 615357 PN 432-3000
;/Zz.s
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C947,o )
94-?----
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147,66
?? 1
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.`
DCNOTES EXIS7INQ EIEVATION
DENOTES PROPOSED ELEVATION
INDICATES DIRECTIpN OF SURFACE DRAINAGE
= FINISHED GAFiAGE F1.00A EIEVATION
= HASEMEN7' FLOOR ELEVATION
= TOp OF FOUNDA7ION ELEVA710N
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6'E7944e L/NE ---.?_
X-N0767: 97MEE j/.5 NOT CON57-IQuC79D.
PROOv9155v 97,('EE7' EcEr/qT/arv$
SNow,v A,009 74KErv /.--Ro/?/
C-aRAD/N6 pLAnJ.
Z hereby certify that this is
land as ahown and described
?vcy , 19_ 93 .
?oe- NJicLCz HomEg
' # 58?/. O/
P6, 39
O.?AIN'JdE *t/O
D,
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? 110oo k.y4
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,
6 ??''b? h V''o
a true
Sierevn.
. 3,
?eR.
and correct representation of atraat oE
As preparad by me this /gr day o4
Afinn. Reg. No. /GoBS
q?40
9
? CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
PERMIT
PERMIT TYPE:
Permit Number:
Date Issued:
coOZL'1
surLorNc
025535
05/05/95
SITE ADDRESS:
P.I.N.: 10-83750-260-81
4661 BRISTOL BLVD
LOT: 26 BLtlCK: 1
WESTON HILLS
DESCRIPTION:
8 0 11 d?3ngrmit Type DECK
?mildiqg, Wol Type NEW
,.. .. ,_ - „ r na.. .. • ?• ??s ?•p? ?•? ?
}" *' d• ?y .'44 t
?r'sa
", %1?,`r?."- •° `, ?,?``r
?:, C? ?
(0, (9,
REMARKS:
FEE SUMMARY:
Base Fee $30.00 COPY
Surcharge $.50 Total Fee
Subtotal $30.50
$.sm
$31.08
CONTRACTOR:
OWNER: - Applicant -
KHAIIL RANDY
4661 BRISTOI BLVD
EAGAN MN 55123
(612)454-9094
y u d , a. rt . T` 9T4, 2 H.. • .'C. a.l' _ 1 . F?1?3.. ._ ? f? ? x Y ?j. ..a
' Z here-by ,ackhawledgb -Cliat t"'h94 e;?rj6b tfii'??iappii'ca tion `nclV4 state tf?at -?h?e
in??a?-r?ati.an :?s cbr?r6?u?t "ai??d, agfee` td eoirvply w`fCh? 6?,l,ap{z?cable State.o# 1In .
Statutes art?d Cit?r of EA'giar 6rda.r4grt6e t:
` r
4-
. _.?._, a _ ,u _.c....,. ? ,._ .. ..,_...? .,. .?.. °. ? .u_: b . .......... ........ . ..:.13 , _ ^ ,. . ? •. ....... ,. . ", • _
APPLICA /PERMITEE SIGNATURE ISSUED SIGI TURE ??
i -
CITY OF EAGAN
3830 PILOT KNOB RD - 55122
1995 BUILDING PERMIT APPLICATION (RE
881-4675
? sregisterea.roe.uiwys ? 2eopie:orplso
? 2copbs of plana (indude beam 8 wirMow sizes; poured fid. dpign; etc.) ? 2 slte surveys (ex[erk
? 1 enerpy alculaGons ? 1 errergy ealaletiona
? 9 copfes W hee preaervstion plan H bt plat[od after 7l1/93
nquired: _ Yes _ No
DATE: ?D r, ? ?2 /
DESCRIPTION OF WORK:
STREET ADURESS:
CONSTRUCTION COST:
LOT ?2 (o BLOCK -/ SUBD./P.I.D. #:
Name: j Phone #: i'SL 90 SV
PROPERTY
OWNER
CONTRACTOR
ARCHITECTI
ENGINEER
Street
City: a CO a a State:
odditions & dedu)
M hested atldRlona
Gta?-
Zip•
Phone #:
Street ess: ILicense
?
CiN: State: ?
Company:
Name:
Street
Sewer 8 water lioensed ptumber:
change are requested once permit is issued.
! hereby admowledge that I have read this application and state that th
applicabte Stete of Minnesota Statutes and Ciry of Eagan Ordinances.
Signature of Applipnt
OFFICE USE ONLY
Certificates of Survey Received _ Yes _ No
Tree Preservation Plan Received _ Yes _ No
Phone #•
Penaliy epplies when address change and lot
OFFICE USE ONLY
BUILDING PERMIT TYPE
0 01 Foundation o 06 Duplex
0 02 5F Dwelling o 07 4-plex
a 03 SF Addition o 08 8-plex
a 04 SF Porch o 09 12-plex
0 05 SF Misc. 0 10 _-plex
? 11 Apt./Lodging o
0 12 Multi RepaidRem. o
0 13 Garage/Accessory o
0 14 Fireplace o
c,,-P:f 15 Deck
WORK TYPE
--e'-31 New o 33 Alterations
0 32 Addition o 34 Repair
GENERAL INFORMATION
0 36 Move
? 37 Demolition
? -. ..?
4Y
. ?. u.????'i b'.:so' i Si . x
16 Basement Finish
17 Swim Pool
20 Pubiic Facility
21 Miscellaneous
Const. (Actual) Basement sq. ft. MGWS System
(Allowa6le) Main level sq. ft. City Water
UBC Occupancy sq. ft. Fire Sprinklered _
Zoning sq. ft. PRV
# of Stories sq. ft. Booster Pump
Length sq. ft. Census Code. 4175P,
Depth Footprint sq. ft. SAC Code oL
Census Bldg
Census Unit 0
APPRaVAL5
l
Planning Building Engineering Variance
?
Permit Fee Valuation: $
5urcharge
Pian Review
License '
MCNVS SAC
City SAC
Water Gonn.
Water Meter
Acct. Deposit
SNV Permit
S/W Surcharge
Treatment PI.
Road Unit
Park Ded. Treils Ded.
Other
Copies . 50
Total:
% SAC
5AC Units
4 .?^ .4:43 TO 612 591 40E1
CERTIFICATE OF SURVEY
n toNSUIiINO EHOINEEIIS ~f 'l?? "?'?L?? ??mEg
/,7
0 B C PLpNNEIIS and IqND 9UNVEYOfIf P"
ENGINEEfiING
? 'COMPANY iNC. 9x i9s
? p8• 39
L- - IOpo EAST 118m atqEflT, BunNavIL6E. MINNEBOtA 66337 pH 432-3000
Legai Description:
I
$CAIE 1 1' e 30'
94;pb
W
v, ?
O
\?q
`? .
.
(2g=0 )
(947,0 )
947• 33
.62
7. 66
FROM PROPE ENGINEERING T-189 P.02
D[NOTES EXISTINQ ELEVATION
UEt30TES PROPOSED ELEVA7tON
INbICATES DIRECTION OF SURFACE DRAINAGE
= FINISHED GARAGE FLOOR ELEVATION
= BASEMENi' r-LOOR E4EVATION
= TOP OF FOUNUA710N ELEVATION
?O l
q 9
It. \OP ?,?oo
,
-.--? fA
mtiO
x
30 FT. Fk'ONT ,B[/iLpiN6
sErWee Li.vE -----_.
NO745 : $7A2EE' j /.5 NOT CON$TRUC760.
PRoPaS?.o STREET EcE?/qTiarv$
SNaw,v ARG' 744?'v ILIqoM FiQoI?FlrfT
C-,RADlN6 Pt.4n.l.
I hereby certify that this is
land as ehown and described
_ ,/v"y , 191; -.
,.
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a true aiid oorreat represetttation of a tiraot oE
lieraon. As prepared by me this I9'r day oE
rtinn.
qKID?
p?h
Reg. Na. 14085
2000 FIREPLACE PERM[T APPLICATION
CITY OF EAGAN
3830 PILOT KNOB ROAQ - 55122
651 681-4675
Date: /
Description of Work: _ Construct new fireplace ?G Masonry _ Alterations to existing
_ Install gas inser[ onlv _ Install gas line only
Other
Job address: ?( o ? 245?1?, &_ (j /K)
Lot: 2h Block: L_ Subdivision/P.I.D. #: VYeS h NuS
Applicant (circle one only): Owner Contractor
Permit Fee: $60.50
Name: Phone #:
PROPERTY Last First
OWNER / p
Street Address: C? ro ? /??/ ?? a
City ? 211?4:;n 2 Stau: /-? Aj Zip:?`/2 3
Company: &7,?'A'l4'T/C Phone#: 26!? ?/S 75?7
' (azea code)
FIREPLACE G}2/v
INSTALLER Street Address: I
?
i-
City SVZ-C??41- VA J /?VL State: Zip: ?
Company: 4:?QlScj L- Phone#:
(area code)
GAS LINE
INSTALLER Street
City
Zip:
State:
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.
C L 1 ?
Signature
CITY OF EAGAN
? 3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
SITE ADDRESS:
DESCRIPTION:
,.
PERMIT
PERMIT TYPE:
Permit Number:
Date Issued:
4661 BRI5TOl BI.VD
LOT: 26 BLOCK: 1
WESTON HILLS
B14jq Permit Type
144,1rk Type SF OWG
NEW
R-3 M-1
" n:? . e VN
3 R-1
... _• 1"????? C aAM x r.??x?FNlk1.4
4
??? F?
:•
?
94
79i
BUILD 1?4
021504
07J19J93
? adVan
I
REMARKS:
S&W CONTRACTOR - GENZ-RYAN PI.UMBIN6
FEE SUMMARY
VALUATIQN
Base Fee
Plan Review
Surcharge
SAC
SAC 8
SAC Units
Subtotal
$811.00
$527.15
$74.50
$750.00
100
$2,162.65
PRV
$149,000 '
MISC FEES I $1,744.50
7ota1 Fee $3,907.15
CONTRACTOR: - Applicant - 5T. Lrc. OWNER:
JOE MILLER HOMES 14544663 0602431 MILLER HOMES 'JOE
3459 WASHINGTON OR 3459 WASHTNGTON DR 204
EAGAN MN 55122 EAGAN MN 65122
(612) 454-4663 (612)454-4663
..,r ;a=,
" •?" xty{ ve?`
"?r?? r?•?` ;?.? A ????a ??s t??`??R?°?:?r'?=n
;?t?E?_ ??5?, .???s?l?????? `?;?; ,?za??+??a?? =???r.,= r
?.: `? ?i? ?? ?,?;?! v ?` ??r`?:•.
?c?;:fi" rr "40 1?
?e ? ir :??.v,r...N,
=:*y?
?._. ?..?.,Y^_..-. .............w?...?...?..?.r....u?..air.?.._.?r...s..aiwu.vtl-4.'.Y,...A'.ueu?.Y.x rr.a.....«.......?. 'L"«utumu*?..??.. .. ? N4
??,
APPLICANT/PERMITEE SIGNATURE - I§S-Y ED B: SI NATUH
_.k•-
INSPECTION RECORD
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
SITEADDRE55: LoT:
,. A661 BRISTOL BLVD
WESTON HIILS
PERMIT SUBTYPE:
SF DWG
PERMITTYPE: euiLoxNG
PermkNumber: , 021504
Date Issued: ,. 07/19 /9 3
ae BLOCK: 1 APPLICANT: I
JOE MILLER HOMES
(612) 454-4663
TYPE OF WORK:
NEW
INSPECTION
FOOTING .
FRAMING .A
INSULATION FINAL I
FIREPLACE
REMARKS: 5&W CONTRACTOR - GEM2-RYAN VLUMBING
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REACTIYATE _ ???GENET CITY OF EAGAN
PEwMIT aY .• • 1993 BUILDING PERMIT qPPLlCATION
, p „?
:? 681-4675 (p ?
? ?sa ? o? ? -
SINGL 8 MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy
calcs.
COMMERCIAL 2 sets of architectural & structural plans, 1 set of
specifications, 1 copy of energy calcsti;
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 /&/ Yaluation of wor ?(P
Site Address: 11061 ' ld"+?? &A"I
STREET il SUITE M
Tenant Name: (commercial only)
LOT O?(O BIACK I SUBD. P.I.D. k
Descri tion af work: ?
The applicant is: O Owner 01Contractor ? Other (oesorina)
Name Phone
Property LAST FIRST
Owner
Address
STREET STE M
City State ? 2ip
Company JOE MILLEfi HC)MES Phone
COI1tf8CtOP Address SUITE204 License #00DaV3 / Expq!K
City #0002431 State Zip
Company Phone
Architect/
Engineer Name Registration #
Address
City State Zip
Sewer & water licensed plumber . Processing time for
sewer & water permits is two days onc rea hi's been approved.
I hereby acknowledge that I have read this application and state tYiat the information is
correct and agree to comply with all applicable State of Minnesota?'Statutes and City of
Eagan Ordinances.
t
?5 `
f
li
can
:
Signature o
App
OFFICE USE ONLY
BUILDING PERMIT TYPE
0 01 Foundation ? 06 Duplex ? 11 Apt./Lodging
? 02 SF Dwg. ? 07 4-Plex ? 12 Multi. Misc.
03 SF Addition ? 08 8-Plex ? 13 Garage/Accessory
? 04 SF Porch ? 09 12-Plex ? 14 Fireplace
? 05 SF Misc. ? 10 Multi. Add'1. ? 15 Deck
WORK TYPE
'. . .
? 16 Basement Finish
? 17 Swim Pool
O 18 Cortnn./Ind.
? 19 Comm./Ind. Misc.
? 20 Public facility
0 21 Miscellaneous
PC 31 New ? 33 Alterations ? 35 Tenant Finish ? 37 Demolish
? 32 Addition O 34 Repair 0 36 Move
GENERAL INFORMATION
Const. (Actual) V_ N Basement sq. ft. MWCC System Z5
(Allowable) v_ M lst F1. sq. ft. City Water c
UBC Occupancy 9 •3 M_I 2nd fl. sq. ft. PRV Required
Zoning 9_1 Sq. Ft. total Booster Pump
#? of Stories Footprint Sq. ft. Fire Sprinkler
Length ? On-site well Census Code ho/_
Depth 70_ On-site sewage SAC Code oi
APPROVALS I
j
Planning Building Assessments
Engineering Vartance
REQUIRED INSPECTIONS
? Site
? Wallboard
? Footing
? Final
O Framing
? Draintile
? Insulation
? Fireplace
Permit Fee
Surcharge
Plan Review
License
MWCC SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total:
SAC % 1 Qt7
SAC Units _I
Vehot;o,: s l 4 9, o a v?
(AAL 32.x Zg? = 7oq
Zx1I :
13s.m'f;
ss K ab = 98s
?9 K ?v? ?zG
?IIM XI S:.--
fsT FcoorL;
gsmT4 )!Iv
(,'? yJ
'i`Srx I 5' s
l6 7/o
113oxSy= dl?o2u
2? D FLoorL ;
1S5YV)7-A iirv xsy= 0,lS`G
J M ?, ?GG
(9 hhl-,3
93 14:43 TO Elc 591 4061 FROM PROBE ENGINEERING T-189 P.02
?t?Iic?z Ho.?E?
coasKrino ENOmEEIIf
A013E rcnNNEns a„d Lnr+o 9unvevons ' .?5??/ O/
NGINEEAING ?K /95
COMPANY, iPlC. ps. s9
..?r 1000 EABT 116ih BTqEfiT, 9URN8VIlLE, MINNE80TA 66337 pH 4!2-El000
CERTIFICATE OF SURVEY
Legat Description: ?I-o?
U?KOTA GDU.c/7Y it?l /?tJ/C1?-'?
'- _
(S??o ) D[NOTES EXISTINQ EI.EVATfON
C q47 , o) UENO7'ES PROPOSED ELEVATION
?-- INDICATES DIRECTION OF SURFACE DRAINAGE
9¢ = FINISHED C3ARAGE FLOOR F-lEVA710N
939• 6Z = BASEMENT fLOOR ELEVATION
' 1117,66 = TOP OF FOUNpA710N ELEVATION
$CALE i 1' n 30'
5 ?g. l3' 54`? w
94 ?b
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%
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:'"a ? ?• ?+ ?\'\
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30 FT. F,FONT BUILOiivd
SETQACK L/NE ------.?
* NoTS : 571,2E6 T iS nior caNs7-Ruc79,0.
PROPOS'VAP ST',?'EET E&eV47-10i1$
SNotvN AW 74,e6W pRoM F,C'oJecT
GIZAVlN6 pLM1.
D.QA/W6E AVd
UT/L17Y e49E/,
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9p?3 oo \
I hereby aertiiy that this is a trus
land as shown and described 3iereon.
,/vc y , 19 93 . '
. /?. ?
-o
aitd correet re
As praparsd
'9'
W.,
0A
,
cC, o `90
'° '
0 5z ?p?49
V
?
egentation of a tiraot oE
by me thie / $T day of
-- ?.? Minn.
Reg. No. 1408S
LOT BURVEY CHECRLIBT FOR RESID£.'::AL
•
, ? • BUILDIN PERMIT APPLICATION
w YROPERTY LEGALs
?
Date of 8urvey:
DOCUMENT BTANDARDS
?0 0 • Registered Land Surveyor signature and company
?0 0 • Building Permit Applicant
[{?p ? • Leqal description
0 L? ? • Address
Q??1] p • North arrow and bar scale
tr
lit
o? 0 0 • y,
en
House type (rambler, walkout, split w/o, sp
lookout, etc.)
pe-?p ? • Directional drainage arrows with slope/gradient $.
j] [3'?? • Proposed/existing sewer and water services
[Y D 0 • Street name
?/t] 0 • Driveway
ELEVATIONB
Existinq
0 6-? 0 • Sewer service
Z? p •
p?? • Lot corners
Top of curb at the driveway
[] ?? • Elevations of any existing adjacent homes
Prooosed D-? Q ? • Garage floor
[r ? p • First floor
['J' 0 ? • Lowest exposed elevation (walkout/window)
p' ? p • Property corners
e' ? ? • Front and rear of home at the foundation
PONDINa AREAB (if aDplicable)
ur p ? • Easement line •
Dr ? 0 • NWL
a' 0 0 • HWL
0 0 0 • Pond # designation
@ ? ? • Emergency Overflow Elevation
AIMENSIONB
e 0 0 •
D' 0 ? •
p- 0 ? •
0' ? 0 •
0 0 0 •
? 0/-?? •
Lot lines
Right-of-way and street width (to back of curb)
Proposed nome dimensions including any proposed decks,
everhangs greater than 21, porches, etc. (i.e., all
structures reguiring permanent footi,ngs)
Show all easements of record and any City utilities within
those easements
Setbacks of proposed structure and setback of adjacent
exi
Ret
Reviewed;
Oetober 1992
,? , , „41INNESOTI?STA'1'E E;tJ?'tliC?_COUE CALCl1LATIONS???_+??J
• . BASED DN CIIAPTEIt 5 OF TIIE
MODEL. ENERG 'ODN,=198J EDrT?ON
` '? " ' • , Adoption Effective
Owner Ptlone Date
Site Address
Contractor?? ?4?C..? ?7? ???.,.??? phone:
euilding Classificationt Type A1 (single Family & Duplex) Wl-
Type Az (Residential, 3 stories or less) (over 9 stories) (other)
HOTEt ComolPfo qagBC 3 ,.r„d e si.-et
GFNFRA . TNF'O f A'piON
1. Building Perimetec???".-?1 ft,
2. Wall heiglit (qround to eave) ,} ft.
3. 1. X 2. (above) qrose wall atea1?q.ft.
4. euilding dimensions (L) ""r" X(W) _k (Uo sq.ft.roof 6 floor area
5. Sq. foot area of rim joist - F q?,F jo s slie (2 X? )
?f/ X(Perimeter) ?O/???Olbq.Et.
]` 12
6. Doors - Area,?`'?/ ? ? d
Thlckness in U. factor l? '4
Type of Construction Perimeter ft.
Manufacturer
7. Total door's perimeter ft.
e. Windows: M?nuf??eturer0N1 -#L1L20 '` C?a. N1?1 I state epproved
U f
t ?"'l L
ac
or ,
?
TYPE SIZE MEA (Sq.Ft.) NUMBER OF TOTAL
? kiv-i EACII UNIT9 Sq PEBT
9. Totel sq.ft. Glese 1 V?o
?
10. Pireplace area: Width R lleight = X = sq.ft.
11. Exposed foundation: lleight X Perimetert 0 X\:;;(O =.10qk.?q.ft.
COMPLETION OF TItI9 FORM I3 RE(2UIRED FOR ALL NEW C0N9TRUCTION, l1AJOR
REMODELINa AND HUILDINO9 BBINO HOVED WItERE BNEROY I OTIISR T!!AN TIIS HINIHAL
CODE ALLOWANCE, I9 U3ED. .
-1-
100raming area"= 10$ of grose wall area.
17.; GV"ss tiall area?611?? ?t gq. ft.
Witidow area A?-1D?1?i?(/ sq.ft. U wihdowe =kt??P`
Rim joist area AZWi"_q.ft. U rim joist=
Door area A?' % {(0 sq.ft. U door area=
Other doore area Aj??Iv Zq, ft. U other doors= M
Exposed fndn A10C5S sq.ft. U foundation=ta (a
framing area A?sq,ft. U framing area=lQa %P
Net wall area A??s sq.ft. U wall=I C>`-C:?-P
(17B) TOTAL
UxA = 9?.-W
UxA = o?
UxA =
UxA =
UxA = 4_
UxA m Sqlo
UXA a9n, t4
. . . . . . . . UxA =
14. Gross wall area x 0.11 (A-1 single family 6 duplex) = allowable UxA/Code
(13. above)
x 0.23 (A-2 other residential)
x .23 (other buildinqe)
x .28 (Over J etories)
??G?"? =qBTUl1 must ba larqer than or aame
A"?-'?LS? Code 1 ?J I °F. es 13B above
15. ceilinq framinq area (Af) equals lot of ceiling area
15A. Gross ceilinq area =(L) -? x(W) _? I SIZ% sq.ft.
158. Joist area (Af) = lot ceiling area =.A tli I, -sq.ft.
15C. Net ceiling area (Ac) (15A - 15B) _' ? q.ft.
u ceilinq x Ac _• (00 I x tcMV
U framing x AE x
15D. TOTAL U x A .............................(it? l!
16. Ceilinq area (15A) x 0.026 (A-1 sinqle family & duplex)
= allowable UxA/Code
x 0.033 (A-2 other resldential)
x 0.06 (other)
A 15A t('" 10 BTUII must be• larger than or same
( ) x U Code s OF. as 15D above
NoTES Use U and A values obtained from paqes 1, 3 and 4.
CE(2TZFICATION: I hereby certify that I have calculaEed the "U" factare and
"RII values herein and that the building here deearibed meets or exceede the
state of Minnesota Enerqy coneervation Act.
Date
slgnature '
-2-
BRANDT E
1600 West
Burnsville,
(612) 435
NGINEERING &
143rd Street,
M N 55337
-1966
SURVEYING
Su ite 206
Address:
City. __
Poured concrete walls, replacing cancrete block walls
as shown on the ottoched plan, are as strong or
stronger than the concrete block walis.
I hereby certify that this survey, plan, or
report was prepared 6y me or under my direct
supervision and that I am a duly Registered
Land Surveyor under the Laws of the State
of Minnesota.
fllpl?
Q ?
Date Rect. No. 8140
i... .
PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. AISO, FOR TOWNHOMES AND
CONDOS WHEN PERMITS ARE REQUIlZED FOR EACH UNTf.
---- - --- - -------
NO.
SITE
OWNER N
INST
3HOWER
WATER CLOSET
BATH TUB
LAVATORY
KITCHEN SINK
LAUNDRY TRAY
HOT TUB/SPA
WATER HEATER
FLOOR DRAIN
GAS PIPING OiTI'i.ET • minimum • 1
ROUGH OPENINGS
WATER SOFTENER
PRIVATE DISP. • DakCry.lic.
U.G. SPRINKLER • Aome uneer conct.
ALTERATIONS • w adsung
WATER TURN AROUND
STATESURCHARGE
TOTAL:
y?? I & ee?
CITY:?fl.,J.Z S STATE:1
PNONE #: (bo_) ! ? 331l(1?
EACg 1 TOTAL
3.00
3.v'0
3.00
3.00
3.00
3.00
3.00
3.00
3.00
3.00
1.50
5.00
15.00
3.00
15.00
15.00
.50
ZIP CODE: ?"?'lld
SI NATURE OF PERMITTEE
?
1993 PLUMBING PERMIT (RESIDEN'TIAL)
CITY OF EAGAN i
3830 PIIAT KNOB RD
EAGAN MN 55122
(612) 681-4675
LOT O?? BLOCK ,L SUBD. ??d.? ?J?? ?
RECEIPT # ?5003 DATE
1995 GITY'O'F','E/AG;AN*-'
IRRIGATION PERMIT (FOR,BA{OKFLO.W''PRE1/E-,NTER) `
COMMERCIA ST LATIONS: FORM?MUST"BE COMPLETEU'BN!!LICENSEU PLUMBER ", ., .
. ' ' " ; ?? ,-' ' ? e_.?4;???=`.p. , : ,+ ??' ' • !
Date: Commercial.?:.?°?"?,= GPM
- Residential,?(bouleu.,ards)> GPM,
3< ExistinTesidentialx•
• ' k .YY'? ,i -4 ? 3 Y ? ¢.
Area/address to-be irrigated? ???? ?? ` =" ? ?K ? `?? %- ' '
Installer: 'Ownerl? ' RI'umber
?U.???
Street address• ?'?y-s ' ?
I ? .? ? c
i, ?GCJj .: Pfione"?#° ?:: s ??????
?ci'_'.ty'" ?state & zip code > ,?q y
h 'W f ''Y5 4?...J?'
--
'Owner Name r
i ? , r , > .? : a zy '?c , uw sr.lx?r • ? '? ?#' ? ?y' ? , ?y?, ? _ '
?street-add'ess k? :"?::'??? Y ?
• ' , ? , 1 . ., . ? , k , - .
i`tyg,state & zip code Ptione?`# w- °?'7??`??.?,?,? ???? ? p??`?' '
?t
+A,?r ?
?ImigatiorLCOntr,a`cto?;.ifdifferentqhastaller?'r ???`?-?"''?
.?.;•>a • ? v
? T.eIeP?hone?`#. ?J? .`7 ?l ? `7? r.? ?t ? ? ? ? ?.*??. ? ?E°:=• . . '` ` ? ?
11:T?3. tR.t?
_ ??? ??? ? '_ ? e?? ?g 1^ S. L 1 F "k ? A 9 -? - • ? , ' 1?j ?• ? ? s
T tYL ?' 4
P
I hereby acknowled:ge that IFhave reatl this?applicatwn?sfate?th°ath?`eginformati is c?or'rectk?and agree
fo.;c,omply°:with all=ap`plicabfe City,tof gan,zordinances~?it?isItyh"e;pqlican,t's respons ?b??litya;tdanatifiy.
thegp?r,operfy owner: that?the Cityiof?,Eagan?assurr,Qes; nogliab?l?ty?f,orvanjy?damwages cajused by?-?the-City.;
dur:ing its normal'operational,?and 3m?aintenance?acti"v?itie?s??to`?the facilitieswconstr?uc,te?dg?uncJer?this?
? perinit,within Cit?:prop'ertylright=of wayleasement?
• 1, . , . , n`s-
, ??'f' ? ? • ?le ? ` y' ?K4 ?i?? S? ?? y
tir • ? } ? ?j` ?l f '? P R + A f i? A. If ? ' ',
u
"
? f{p?plIC811,S•"SIg118tUr@?' TM614
ApprovecJ by:,???? 'Date ,W?"??'??J
"
y -
PRV ? Yes- O?No . ' New?nservice,f` ;E] Yes Not°?
efe'r-Size ? &:Cosf
M?
. ?
F,ee"s.due: o?B Calculatecl bv-?'?=?---- °
, •
• . ? `
PROCEDURE FOR; IRRIGATION SYSTEMS - 1905, 5 An irrigation permit is required - please?.contact Protective Inspections at 681_-4675:-; >
Fees
Commercial project: ' $25.50=irrigationverrriit'to cove[:instal(ation of backflow-pceyeriter. -' ?
$50.50"wa4er?permit fee onlv if new service is installed.
$300,00 p@r tap if-installed by City.
, . ,. Residential'projecY: $20.50,irngation pecmit to cover installation of,backflow. preveriter. ;
$50.50 water permit fee• if, new service, is instailed..
$750.OO,per.conne'ction-=,WAC.
' $372.00-p'e? eonnection - water treatment.facility.
Existfng residence: $20.50 irrigafion per`rriit to ',cover instailafion of ,backflow ,preuentei -, (not .
_ required?if-`backflo,w preventer p,reuiously in,stalletl). - Meter charge: If gallons-1p,er ininute-are less, than`25;;a,-,1'^yrnetertwill be;requi`r.eii,;ato a cost oi
$170.00.ltgall`oh$:per minute arer`raore;,than-;25?,a:-2s t;uGtiq;?vr(ith`s?strainer-w,ili ?
be required{.at a cost `of $860.00.: Tiiis;infqrmation sis Co?;be.=supplie`d tiy 'the
, designer of the system.
--------- - - - ---
;} , . ?. .
No meterwill be sold before all sewe&,anwater?,inspections?"aie?cbmplete on-a n'ew'?senii,ce:° If new
service lines are not reauired, one check±may be}writtemfor meter and!,permd costs Re.ceipt?will;e coded
to 20-3716 (meter portion only) with: pink copy fonroarded to. UtihtyBillin.g' Cler`,k?- '
Th?e installeris to contact Protective?lnspecfions-at 681-4675 for'inspecti6nr,of the inside water°line and '
backflow preventer. The Publie WorksRQ.epartment? may be reaehed =at 681-4300 fo'r watej?irturn,=,oni,and set '
and seal of the'meter. Inspection hours`?aae 8:30 arm. to 3:30 "p..m:`?Mon'day.'ft'irough Fri?d'ay;::Requests for '
A:M. inspections should be made on the.;p"receding work day. Requests forPMFinspections^wiil:;tie accepted
until 12:00 noon.
p : - ° - ,
? PLUMBING PERNIIT (RESIDENITAI.)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN MN 55122
(612) 6814675
PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. AISq
CONDOS WI-IEN pERMTTS ARE REQUIRED FOR EACH UN1T.
•
SrF
OWNER
INST.
NO.
?
?
!
T
T
1
?
TOWNHOMES AND
FIXITJRES
cuOurFn EACH
3.(y1 ; TOTAL
3
WATER CLOSET
BATH TUB 3,00
3.00
?
?
LAVATORY 3,00 I
KITCHEN SIIVK 3.00 3
LAiJNDRY TRAY 3.00 1
HOT TUB/SPA 3.00
-
WATER HEATER 3.00 '?
FLOOR DRAIN 3.00 3
GAS PIPING OUTLET • minim„m -1 3.00
ROUGH OPENINGS 1.50
WATER SOFTENER 5.00 '
PRNATE DISP. • DaLay. um 15.00
U.G. SPRINKLER • e? ? cmuL 3.00
ALTERATIONS • w edmmg 15.00
WATER TURN AROUND 15.00 '
STATE SURCHARGE .50
TOTAL: I ' ?v, D D
/ -;Z-"1
14745 5outh Robert Trail
Co.
CI'I'y; Rosemount
PHONE #: (612 ) 423-1144
STA
rR
ZIP CODE: 55068
0
?
_ - . ,.
i
1993 MECHANICAL PIItMIT (RESIDF.IVI7AL)
C1TY OF EAGAN
3830 PILOT KNOB RD I
FAGAN MN 55122
(612) 6814675
PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMFS AND
CONDOS WNEN PERMITS ARE REQUIRED FOR EACH UNTT.
--------------- ------___-...... ._...._ ?
NEW CONSTRUCTION
?y
ADD-ON A/C
ADD-ON FURNACE '
DATE _7`" v' ?1 / E
"ES
HVAC: 0-100 M BTU $ 24.00
ADDITIONAL 50 M BTU 6:00
GAS OUTLETS (MINIMUM 1@$3.00 EACH) 3 9".00
ADD-ON/REMODEL (Exis'nNG CONSTRUCI'ION) $ 15.00
STATE SURCHARGE 150
TOTAL 3 8, So
SITE ADDRbSS: °?-I'(o(o I
OWNER NAME:?T_%_e--
TELEPHONE #: "i??--?(a E
CTI'Y:
STATE: I f t? ZIP CODE:`5Q9_?f
TELEPHONE #:
Use BLUE or BLACK Ink
r-----------
I For Office Use
Permit
City of Ealln I ~s
Permit Fee:
I I
3830 Pilot Knob Road
Eagan MN ;55122 Date Received:`
Phone: (651) 675-567,6 I I
Fax: (651) 675-5694 I Staff: I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit
Name: Qvr<i WDi F Phone:I6I. Zcan_ 773"7
Resident/
Owner Address ll/ City/ Zip: ZI LPLoI
Applicant is: Owner Contractor
Description of work:.
7T,., of Work
Construction Cost: 49S It Multi-Family Building: (Yes / No
Company: Contact:
Contractor Address,,
t
i Stater Zip: ~~1 Z Phone: Ld ~19g
l
License #:96 Lead Certificate
I
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
i
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
Yes No If yes, date and address of master plan:
l
Licensed Plumber: Phone:
i
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
I NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that 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 plain 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 mu a completed within 180
days of permit issuance.
x i x
Applicant's Printed Name Applicant's Signature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA138279
Date Issued:08/18/2016
Permit Category:ePermit
Site Address: 4661 Bristol Blvd
Lot:026 Block: 001 Addition: Weston Hills
PID:10-83750-01-260
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace & Air Conditioner
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Jamie C Wolf
4661 Bristol Blvd
Eagan MN 55123
(651) 260-7737
Holmin Heating & Cooling Llc
3432 Denmark Avenue, #228
Eagan MN 55123
(651) 405-3853
Applicant/Permitee: Signature Issued By: Signature
4/6 / te,ef k etl
1 E; ES 1 0 77 6
YOUR COMPANY NAME &
PHONE NUMBER HERE
SERIAL NO. 134314182
DATE 15
TIME I5522e
FUEL Nat Gas
COMBuSTI ON
02 % 11.3
CO2 % 5.4
CO ppm 14
FLUE .; 323.b
INLET ..; 4-7. 4
NETT li.!,
25I.1
EFF 79.7
LOSSES 20.s
XA IR % 117.7
00/002 0.0002
CO AIR FREE 30
PRs mbar -0.01
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Cus o ;YIP r
Appliance
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