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4658 Bristol Blvd. . INSP ECTIUN RECORD _ 3 CITY OF EAGAN PERMIT TYPE: - 3830 Pilot iCnob Road Permit Number: Eagan, Minnesota 55123 Date Issued: (612) 681-4675 SITE ADDRESS: APPLICANT: f PERMIT SUBTYPE: TYPE OF WQRK: INSPECTION .. .A . ??i! i t ili, ?;.•1'?hl j?'? ; F'2 ,t11 r,t ?, ( irll i t ii;? i t lt!1'.r'F . I?" ? 1f i q 1!; „ .. ? ? Permit Na. Permit Holder Oate Telephone # S/W PLUMBING " l,fg• ??90 HVAC ELECTRI ELECTRIC Inspectlon Date Insp. Comments Footings I ? V/?? z,? Foundation Framing Roofing Vfl a- u AltA. KkYw Rough Plbg. q Rough Htg. 1 3 ?[ n - ??? . o -/ ` ? GY w Isul. /a Fireplace D. Final Htg. !U Orsat Test t Final Plbg. Plbg. Inspector - Notify Plumber Const. Meter Engr.lPlan Bidg. Final t Deck Ftg. Deck Final Weil Pr. Disp. K, --J _? W-trflfiCQte of cCClipliltC? , ?i#?j o f ?agan Teparttueuut This Certificate issued pursuant to rhe requirements of the Uniform Building Code certi.fyiRg that ut the titm of issuance ihis structure was in compliance with the various orrlinances of the City regulating building construction or use. For the following: llseClusification: SF DWG/GAR B(dg_PertnitNo. 22025 pccupancy Type R- 3 M-1 7nning Distritt R-1 Type Const. Vn ownerorftiiding KDONA D;;ONST nadress 1 R IfFRtLj• RAT RD _ _ BURNSVILLE BWMi.g Address 4658 BRISTOL BLVD Locaj;ry L4, B3 WLST61N R1LLS 6 ng Olficial POST IN A COtJSPICUOUS PLACE Address 4658 BRISTOL BLVD Zip 5512_ . Lot 4 Bik Sub WESTON HILLS THESE ITEMS WEP / WERE NOT COMPLE'TE AT TfE TIME OF THE FINAL INSPECITON. Date: Yes No Inspector: z Final grade (6" from siding) Permanent steps (gazage) ? Permanent steps (main entry) ? Permanent driveway r/ Petmanent gas Sod/Seeded grass Trai1/curb damage Porch ? Basement finish Deck IL/ Please verify with the builder the removal of roof test caps from the plumbing system and the s6utoff of water supply [o the outside lawn faucet before &eeze potential exisis. Contac[ engineering division at 681-0645 before working in right-of-way or instaRing underground sprinkler system. White - City Copy Yellow - Resident Copy Pink - Contracror Copy ? //i 9/Y-i- fleq es ate . Fire No HougRm speclwn Reqwredl L+P'es ? No NOTICE: You Must Call Electncal Inspedor It A Rough-In Irrspectiaq ? Is Requiretl. y?T???- - - , I fj]Jid9nsed contractor ? owner hereby request inspeclion of above electncal xrork.at:=? "" .be ?aqFe (S mElyol ????? ???y"? c?. rf ? CJ Qry Section No. Township Name or No. Raige No Coun ' I •, f?n ? A)/ ! i,V ? ? ? f Phon p9 ? _ / ? ?/ ?.J P(YwerS X. Addreas Ele 1 BI Contractor (Camparry Namel ? Contr r9 en No. Mail' g re on c r Own aking Inslellation) Futhor e SignawrB (Co rac rlO rier Makinq Instellatron) PO a ber MINNES01i BOAflD OF ELECTFi1CT' I` I THIS MSPECTION REQUEST WILL NOT Griggs-Mitlway eltlg. - Room 5773 V BE ACCEPTED BV THE STATE BOAFD 1821 Unlveralty AvB., St. Paul, MN 55109 UNLESS PROPER INSPECTION FEE IS Phone (612) 642-0800 ENCLOSED ???9?3 REQUEST FOR ELECTRICAL INSPECTION ? See instmctions br wmplehng this form on back of yellow copy X" Below Work Covered by This Request ?? EB-00001-08 •' ?? ? e Add FTep TypeoBuilding AppliancesWved EquipmenlWired HomB Range Temporary Service Duplex Water Heater Eleclric Heating Apt. Bwlding Dryer Load Management Comm./IndUStrial ufnaCe Olher (Speafy) Farm Air Conditioner piher (spectly) Contrnpor9 Remarks. Campuie Inspectian Fee Below: # Olher Fee # ServiceEniranceSize Fee # Circuits/Feeders Fee Swimming Po01 0 ?0 200 Amps 0 ta 100 Amps Transformere Above 200 _ Amps Above 100 _ Amps SIg05 Inspec(or5 Use Onry: U T A IrrigationBOOms y,`'O ?d(,i q7'S ?J i Speciallnspection .f. p? i Alarm/Communication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT Olher Fee COMPLETED WITHIN 18 HS. I, the Electrical Inspector, hereby R0°9n-'" - oate /6 ??0 3 ? f certiry that the above inspection has been made. F,nei oaie /? p OFFlCE 115E ONLV This raquest wid 18 moMhs irom ? _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ - ? Permit#: I ?? I ? Permit Fee: I ? Date Received: ? I I I Staff: I I 2008 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: Tenant: Suite #: RESIDENTlOWNER Name: i Wl J-SUSA? I<K.rjJEK,T Pnone: 6 S1 ?5?3 Y rI75- Address I City I Zip: '[G b-9 CAC,I S7-ci L.. t-S L.y Y. A li t i O `? pp can s: _ wner Contractor TYPE OF WORK Description ofwork: NE-t•? (Z046 T Construction CosY. Multi-Family Building: (Yes _/ No ? CONTRACTOR Name: C--Ap1TAk C lTJ ?JC.?IZ1otL5 License#: 9L04 02 661 Address: I6,+ 3&) • O 0 0 Lh p cSf No 5-?-Ioo S - " t City: State: Zip: I 1 A ") Phone: 3 6? Contact Perso . !a 1'"? G??.??A ?rlf COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Minnesota Rules 7670 Cateaorv 1 Minnesota Rules 7672 Energy Code . Residential Ventilation Category 1 Worksheet • New Energy CoCe Worksheet CatBgOry Submitted Submitted (+I submission type) • Energy Envelope Calculations Submitted In the last 12 months, has the City of Eagan issued a pertnit 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 8 Water Contractor: Phone: ; NOTEs Plans armi srrpporting docufnents tha;,you'sGbrpit are consialereb=to be pubfic infonriaGon. Partion°s of ?i the inforntafion May be c/assWiedas non'public if you proyfd `e, apeciric reasons that "would `perrhit the City to ? trade.secrets:°.conolude that the are I hereby acknowledge that this infortnation is complete and accurate; that the work will be in conformance with Eagan; that I understand this is not a permk, but only an applicatwn for a pertnit, and work is not to rtaccordance with the approved plan in the case of work which requires a review and approval of plan X &k"p 5 6:111L1312A 113f (S?L ApplicanYs Printed Name anYs S' ure and codes of the City of tMithe work will be in Page 1 of 3 "ACITY OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55123 (612) 681-4675 4658 BRISTOL BLVD LOT: 4 BIQCK: 3 WESTON HILLS C?/2 /??e3 UILD?IZNG? 022025 09/22/93 SITE ADDRESS: P.I.N.: 10-83750-040-03 DESCRIPTION: FB ' [1dirY Permit 7ype ilding rk Type E.OCOU=pan.c Canstruction F e Yohing Bulrd"ing Leng th B.uild.ing Wid'th • j' PERMIT PERMIT TYPE: Permit Number: Date Issued: 62 48 d REMARKS: PRV 3 & W PLBR - FEE SUMMARY Base Fee Plan Review Surcharge SAC SAC 8 SAC Units Subtotal VALUATION $723.50 $470.28 $62.00 $750.00 100 1 $2,005.78 SF OWG NEW R-3 M-1 V-N R-1 $124,000 MISCELLANEOUS $1,744.50 COPY $.50 Total Fee $3.750.78 CONTRACTOR: - MCDONALD CONST INC 7601 145TH ST W APPIE VAIIEY MN (612) 432-7601 Hpplicant - ST. LIC. OWNER: 14327601 0002376 MCDONALD CONS7 INC 1212 BLUEBILL BAY RD 55124 BURNSVILLE MN 55306 (612)432-7601 I E hereby acknowl,2dge_thax I hav? read ttris applieatitin••e?d state•t14at the I informatinc? is correct and agr.ee .tq,4ompl,y with aY1 appliycatile S•tate ofi Mn. ? ' StaCates and City ofi Eagart Ordinances,. APPLICANT/PE TEE SIG AT E ISSU D BY TURE IN5PECTION RECORD CITY OF EAGAN PERMIT TYPE: B u r Lo i H G 3830 Pilot Knob Road Pertnit Numher: 022025 Eagan, Minnesota 55123 Date Issued: 0 9/ 2 2/ 9 3 (612) 681-4675 SITEADDRESS: Lor: q BLOCK: 3 APPLICANT: 4658 BRISTOL BLVD MCDONALD CON5T INC WE5TON HIILS (612) 432-7601 PERMIT SUBTYPE: SF DWG TYPE OF WORK: NEW INSPECTION FOOTING .. • FRAMING .A INSULATIQN FTNAI FIREPLACE REMARKS: PRV S& W PLBR - ? - •-- - - --- - - - r-- ---- -- - - _- . _ _ ___._,_ .r_ _.__? ?_.._ ?. _- - - - 7 • , , . . , , t REACTI!(ATE _ ? CITY OF EAGAN PEnMIT`e ?c???I?? 993 BUILDING PERMIT APPLICATION ?'9??Q• ?'b ??O -- 681-4675 rnQQd4-2! SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy calcs. COMMERCIAL 2 sets of architectural 8 structural plans, 1 set of specifications, 1 copy 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 permfit is issued. Date 9 93 Val uation of work 0 Site Address: 'y(a5 ? &o \ SiREET SUlTE / Tenant Name: (commercial only) LOT - 4L BLOCK ? SUBD. W85 o? M P.I.D. Descri tion of work: The applicant is: O Owner Contractor ? Other coescr;be> Name Phone Property LAST FIRST Owner Address STREEi STE Y City State Zip Company Ae mA v, S? T w, c- Phone ?? 3? , ? 6 0 1 Contractor Address fal2 fl(.,e bM 84X License #6Od23>G Exp. $4 City liup nJs ?..??F State 94r" Zip SS 3 a Co Company Phone Arch(tecU Engineer Name Registration S Address City State Zip Sewer & water licensed plumber . Processing time for sewer & water permits is two days once area has been approved. I hereby acknowledge that I have read this application and state that the information is correct and agree to comply ith all applicable State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant: ? ?.h?? OFFICE USE ONLY BUILDING PERMIT TYPE I . ? 01 Foundation ? 06 Duplex ? 11 Apt./Lodging K 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 0 05 SF Misc. ? 10 Multi. Add'1. ? 15 Deck . ??(rBase?nt,?igf sh [!t17 Swim Pool ? 18 Coimn./Ind. ? 19 Comm./Ind. Misc. ? 20 Public facility ? 21 Miscellaneous WORK TYPE A 31 New 0 33 Alterations ? 35 Tenant Fin ish ? 37 Demolish 0 32 Addition 0 34 Repair ? 36 Move GENERAL INFORMATION Const. (Actual) y_ N Basement sq. ft. MWCC System Yc3 (Allowable) v_n? lst F1. sq. ft. City Water YC'S UBC Occupancy 3 M_1 2nd F1. sq. ft. PRY Required ES Zoning R-I Sq. ft. total Booster Pum P N of 5tories Footprint Sq. ft. Fire Sprinkl er Length -6-Z7' On-site well Census Code 161 Depth y Bl On-site sewage SAC Code oL APPROVALS ` Planning Building Assessments Engineering Variance REQUIRED IN SPECTIONS ? Site ? Footing 0 Framing ? Insulation ? Wallboard ? Final ? Draintile ? Fireplace Permit Fee I v.w.cion: $ 1044,00 Surcharge Plan Review GA?so.??t 3Z X 22 c 7pLJ ---? License Z ? t2 c ?2y? MWCC SAC City SAC Zk Z? 6• ,? }p ._. 1ti ? ? Water Conn. Water Meter . . .? - )k/ tD S 14 Acct. Deposit 2y K 24 = S?L x 1V S/W Permit S/W Surcharge IS7 F%. *an; Treatment P1. Road unit 6p $-F 63k = 12°!7 X 54 = 70 0349 Park Ded. 2Nfl R,on; Trails Ded. Copies Zy x 3 ZyZ y rj?p Other Total : Y2 --- N 2 14 v ?t ? SAC % o SAC units ? Ze _L ? 23' j * PIONEER * engineering * * * * 2422 Enterprise Drive Mendoto Heights, MN 55120 612) 681-1914•Fax 681-9488 ARCHIffCTS 625 Htghway 10 Northeast Bloine, MN 55434 (612) 783-1880•Fax 783-7883 Gertificate of Survey for: McDonald Construction, InC. House Address: 4658 Bristol Boulevard. Eagan. MN ( ! .' Mndr+l NnmPr I ? / / NOTE: CONiT2ACTOR MUST VERIFY ALL DIMENSIONS AND DRIVEWAY DESIGN ¦0=o Denotea Exlating Elevatlon pROP05ED HOUSE ELEVATION • ? Denotes Propoaed Elevation Lowest Floor Elevation:939.75 - Denotes Drafnage Ec Utility Easement To of Blodc Elevation:947.86 -? Denotea Drafnage Flow Directfon „ P -- Denotes Monument Garage Slab Elevotfon:946.83 -e- Denotea Offset Hub Bearings shown are assumed LOT 4, BLOCK 3 WESTON HILLS DAKOTA COIfNT`/, MINNESOTA 1 hereby certHy that this zurvey, plan or report waz prepared by me or under my direct supervislon aml that I am duly Repislered Wnd Surveyor undK the laws ot the State oi Minnesota. Oated thh9071daY oF A.D. 19?, /? p ? . - / ?• v S\/Ql\/: 1tn -ch- -30fe-d ROBERLJa. IC L..REG.N0.34891 m sa212.o0 m ? a ? a s? LOT BORVEY CHECRLIBT FOR RESIDENTIAL BUIL PROPERTY LEGAL• DOCIIMENT BTANDARDB e0? • Registered Land Surveyor signature and company ? ? 0 • Building Permit Applicant fl 1 • Legal description ? 0 0 • Address ? ID' 0 0 • North arrow and bar scale [3?0 0 • House type (rambler, walkout, split w/o, split lookout, etc.) ? • Directional drainage arrows with slope/gradient t. ? • Proposed/existing sewer and water services ? ?¦ 0 • street name D 0 • Driveway ELEVATIONS Exiatina 0 e 0 ? • Sewer service 0 ? 0 • Lot corners p P • Top of curb at the driveway 0 • Elevations of any existing adjacent homes Prooose8 P?? ? • Garage floor ? 0 ? • First floor 2' ? ? • Lowest exposed elevation (walkout/window) 0 0 V • Property corners p? • Front and rear of home at the foundation PONDING AREAS (if applicable) fl 8' ? • Easement line . 0 H? ? • xwL ? Q?? • Pond # designation p P"p • Emergency Overflow Elevation DIMENSIONB [7 ? 0 • Er 13 . 0 ? 0" 0 ? • ;a' ? o • p q,- ?13 . entry, Lot lines Right-of-way and street width (to back of curb) Proposed home dimensions including any proposed decks, overhangs greater than 21, porches, etc. (i.e. all structures requiring permanent footings) Show all easements of record and any City utilities within those easements Setbacks of proposed structure and setback of adjacent Reviei OCtober 1992 ?, 3 Date of 8urvey: _ V .: .... . ,::?;.. . .......,.,.:.:. •- , ?.;.; . • _ ' . , ? '?s ?IN1lFqOTA ??TE EHERGY CODE CJ,[LCULATION4 ? ? • • BaSEU GH CIiAPTER 5 OF TIIE . ?DEi, F,N?.ciy_CO?t? - 19,8? FnTmroN , ' . 1ldoptlon Effective '. te Type A2 (Reeidentiel, 3 etorias or lees) (over 7 stories) (Other) NOTEt Gomnlete Raae4 ? and 4 Eiret. , GPHERAL INFORM?TION 1. Building Perimater • U 2. Wall height (qround to eave) ft. • ]. 1. X 2. (above) gross wall area eq.ft. 4. Buildinq dimensione (L) t.roof S tloar area 5. Sq. foot area of rim jolst - Floor joiet eiza (2 X '.• • ._.f.,0 X 1JI-_(Perimeter) _ • 22&sq.ft. 12 . 6. Doore - area Thicknese in U. factor Type ot Constructlon Perimetar ft. . Manufacturer 7. Total doorte perimeter it. B. Windowss HanuEacturar????L State approved U tactor TYP& - 9IZE 11REA (Sq.Ft.) . NUNBER OF • TOTAL .??? EAC1l llNIT9 SQ FEET 9. Total sq.Pt. Glaea lo. Fireplace area: Width X tieight ? X a sq.ft. , ht X Perimeter Hei ti e) e ft 11. &xposad Youn g ont . da q. . COMPLETIOH OF TilI9 FORM I9 REQUTAED FOR ALL NEW CON9TRUCTIOli, FIAJOR REHOOELIIIG 1+tID BUILDItIGS BEING HOVEO WIIERS E1IERGY, OTI fER T11Ai1 T11E HIIITMAL CODE ALLOWANCE; IS USED. • , Bullding ClaeeiPication3 Type al (9inqle Family 6 Duplex) 4 •_..yy..,.- . ..,.ec : fv „ . . . . . -- - •.;.... i Y? ni.;'..'. • -:•:. -`J,wc.P .. _- __ - .::..? ` . . ' • . . .. i . - ?u... - . `, •. -_ ._n. . , . 'f6t nii...e , :.: .- . . .f . - ..: .. . '.. _ - . . ' . . .. . . 12, Framingetea a lo} oP groae Wsll srea, 17. Groea wall nrea sq.ft, Wlndow area a?sq,ft, U windowg ? r-12? UxA = R3 Rim jolet area a?eg.ft. U rita Joiet=o4i UxA A _ Door.area J? 5- eq.it. _ U door area= uXA. - _ ?D '•.other doors aras T eq.[E, ll other doore= , UxA - t? Exposed fndit 11_?eq.tt, . / U foundation= . 4!7 Uxa = r? Framing area A 115 eq.lt, U trnming area= ,!? -UxA - Net wall area a(O?e ft U w ll? . q. . a UxA - ? (178 ) TOTaL. . . • - - . . UxJ! = ZZ- 5 --- 14, Grose wall prea x 0.11 (A-1 eingle family 6 duplex) ? allowable Uxh/Cade (13, above) x 0.23 (A-2 oEh er raeidential) • . , x .23 (other b uildinge) ? x .28 (OVer 3 Z5? etorie ) BTUtI must be larqer than oY eame a x u coae #- (.i °F . ae 13B above 15. Ceiling fraiainq area (Af) equale 10} of cellinq area 15b. Groes ceilinq area - (L) sq,ft. 158. Joist area (AE) A lOt ceilinq area • 1? ?Z`" ey, ft, 15C. Net ceiling area (Ac) (1511 - 18B) eq.ft. U cailing x Ao U Lraming x A f A?0? ' x•p2? 4 ) 15D. TOTAL l1 x A .............. .??......?.... ? 1 . . 16. Celllnq aren (15A) x 0.026 (11-1 elnqle temlly & duplex) ? allowahle UxA/ ?ode x 0.037 (a-a other reeidential) x 0.06 (ather) ?? ?'f?Z ?BTUIt muet be lnrger than or eame ll(15A X U COde? ? °F. HB 15D abOVe NOTEs Use U anil A valuae o6tained fram paqee i, 3 and 4. CEflTIEICATIONt I hereby certily that I have calculated the "Ulf Pactore and "R" Valuee tterein and that Ehe 6ulldlnq here deearibed maets or exceede the state ot Hlnneeota tnergy ConeervaEion Act. Date . signature _?, W - -- 8.?3x?Z4?-Z?-t33?33)_!?4 - --- - - - - -- ------ -- _. -- - ------ --?.s3 s _ ------------------ - - - ;-??;?°Z------------- . _ -- ------------------_ IJD?I?s -------------- ---- ?fh'!1-?'-``-?? --'---ItZ6-x_ (Z,_Z --- ??I__. ----------------- --------------?? - - - -- - ------ ------------ ---- ---- -- - - s°AMWI -_Zg--Sfc 5??--,D?-- - ?- -`Il- -- - - 7 ?-- ,..r. ,.. 'WALL SECTION STUD 5 ECI' ION SECTION. R1M JO1ST inaiiie a ??' .. ia iide U YRLUE •Eilm` ' :68 ' +• ? ? .: • 45 ?;.(u8ll) u - R : .. . • •'% i y7 .. Z:oco • : ,P.? .r film ? .17 R YOiAL z ..3 , O ??' , ' :i.. • Instde.air ftlm ? .68 ' Intetior ''vall . . 4fj' 4" stud : . R= 40g. (p -?j (Framing) U - R . Sheathing ? Z.O(O • Slding Outaide air filn ' ,17 . R TOTAL ; Inteclot.uall Inaulation ?all ) U ? R Extecior:vall cover n 1 ExterLoialr Ellm' K ..11 " R TOTAL ? ln[eclor:alr film R= .68 • ? insulatipn tnch ;SOE[ wnod R=1.98 (Rim ' ? :: • •: ': = Joist) . . $heathing Z..olO • ? . Exteiior?Wa; 1 covering ?i (01 . Ex[etlor?:alr fitm q= ;IV ] .. x _ . • " 4 R TOTAL 4(p Interlor_aic fllm 'R=.;68 Fnavlaelon ? FoundaCl,on . I ? Za ; (Fdn. ) ? I Exteriar:aii ftlm R= :17 F TOYAL '?;. I 3, I 3 ? ?Exposed';Bluck ?,GradeJ - 3. . . ., ? U?A= ? U=R= : , 07(p M73,ING WITILYEdTER-ATTIC SPBC-F,-LD-OYE R VALOE FRAMING R VALUE CEILTNG 0.61 AirFilm 0.61 Insulation 417- 4.39 Jo1st 0.56 Ce111ng 0,56 0.61 AirF11m 0.51 , v23 U _ I,R , 02 I Window intlltration 0.5 cPm/lineal Yoot oE crack Reaidential door infiltration 0.5 cPm/square foot or door and minimum code requirement ' Non-residential door inEiltration 11.0 ctm/lineal foot of crack Uq 12" concrete block no lnsulation = .47 R 2.1 Up 12" concrete block lnsulated cores = .26 R 3.8 Ub 12" lightweight block a .32 R ].1 Ub 12" lightweight hlock insulated coree = .12 R 8.3 U eingle glass ? 1.131 wlth etorm wlndow .54 U doubla glass .55 u tripla glass a .41 All exterlor walle and cailings must have a vapor barrler (o,lo perm max.). Vapor barrier muet be on the lnslde (heated elde) of wall. Vapor barriera of tha polyethelane thln P11m have no R value. , ? •'? 1993 MECHANICAL PERMIT (RESIDENT7AL) C1TY OF EAGAN 3830 PILOT KNOB RD EAGAN MN 55122 (612) 681-4675 PLEASE COMPLETE FOR SINGLE FAMILY DWELLIIVGS. ALSO, FOR TOWNHOMES AND CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNTT. NEW CONSTRUCTION ADD-ON A/C ADD-ON FURNACE DATE lo 'l I ? -_? HVAC: 0-100 M BTU ADDITIONAL 50 M BTU GAS OUTLETS (MINIMUM 1 @IS3.00 EACH) cD_ ADD-ON/REMODEL (EXISTING CONSTRUCr'ION) 3TATE SURCHARGE TOTAL 3ITE ADDRESS: 4?S OWNER NAME:? INSTALLER: ADDRESS:? CITY: ?A C'M,\ TELEPHONE #: _? FEES $ 24.00 6.00 (o Oc) $ 15.00 .50 = '!?;o TELEPHONE #: '4'z?ca- ? b() ( STATE: m?n f-) ZIP CODE: SS6 a -' ? PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMES AND CONDOS WHEN PERMITS ARE REQUII2ED FOR EACH UNIT. NO. ? SHOWER WATER CLOSET BATH TUB LAVATORY KTTCHEN SINK LAUNDRY TRAY HOT TUB/SPA WATER HEATER FLOOR DRAIN GAS PIPING OUTLET ? ?. m - i ROUGH OPENINGS WATER SOFTENER PRIVATE DISP. • nercty. lic. U.G. SPRINKLER • nome una« ?nst. ALTERATIONS • w cdsting WATER TURN AROUND STATESURCHARGE TOTAL: EAcH To a?, 3.00 00 3.00 ; D 0 3.00 3.00 1 a. o 0 3.00 3. n n 3.00 'k 0 0 3.00 ;z. o 0 3.00 3, 60 3.00 -T o 3.00 a. fJn 1.50 5.00 15.00 3.00 15.06 15.00 .50 STTE OWNER WSTALLER ( V E' ?Ol r mb? h annuFSS- 10 / 3 (XC?If/P ? U(?I S?CTTY: STA ZIP CODE: PHONE #: ( . ? ? SIGNATURE OF PERMITTEE 1993 PLUMBING PERMIT (RESIDEIV7'IAL) CI1'Y OF EAGAN 3830 PII.OT KNOB RD EAGAN MN 55122 (612) 681-4675 , � (�r��-" � �, ��t- � Usa BLUE or BLACK Ink �__----------------, � For Office Use � t f I � ����_ I C�4 Ol �� �� i Permit#: � I � � � � Permit Fee:(Q[� • (�Q I 3830 Pilot Knob Road Eagan MN 55122 I �ate Received: — �I' �5 I Phone: (651)675-5675 � I Fax: (651) 675-5694 � Staff:S� � . ����������������J 2015 RESIDENTIAL PLUM��NG PERMIT APPLICATION Date: _Site Address: Tenant ,���� ���`�"�.� ��'� Suite#: � � ,��������`�� �}��� ;��F��SId�:11�1�W11�� Name: �L� Phone: �-�� ��F�3� ���� �� � . � ������ � � �`�� � ' Address/City/Zip: ,��� �'� � � �.�� � �� ������k ������ '��� ��� � ��� ��� `�� Narrie: �bert Corr�pany Inc dba Culligan Water �WC6�1376�. 3'' ��;� °��'� , �� � License#: � � � ������` � � r: � � a � Add�ess: 1801 50`h St East Inver Grove H ts. ;�a� �orltra�or City: b � � ��� �� p 55077 651-451-2241� ,� �_ r��� ° �� State: Mn Zi : Phone: � ° ��,� � r � � � � ��� �� � � Contact: Wllliam R Mllbert � ��;��:�� _ EmaiL �� . A� �� . . � -. . ��T��"����"� k �s�� �New _Replacement Repair Rebuild Madify Space � � Woric��in�R.O.W. ' � ��/� Af_ (�� — — — _ ` ��,- �a � � � Description of work: . r°� `� �� RESIDENTIAL � � � � ��� H �"' Water Heater �� a �(' - � �;� Lawn Irrigation(_RPZ/ PVB) �'r—water Softener �� TS::� _ � � N��� , p �'� , Septic System Add Plumbing Fixtures�Main/_Lower Level) � �,.� � � � '�.��-� ��n �� � _New � Water Turnaround _��� �f � �" Abandonment i�E�if�EN71AL FEES: $60.00 Water Heater,Water Softener, or Water Heater and Softener(includes$5.00 State Surcharge) $60.00 Lawn Irrigation(includes$5.00 minimum State Surcharge) ��0.�0 Add Piumbing Fixfures, Septic Svstem Abandonment,Water Turnaround*(includes$5.00 State Surcharge) *Water Turnaround(add$200.00 if a 5/8"meter is required) $115.00 Septic System New($10.00 per as built)(includes County fee and$5.00 State Surcharge) /� TOTAL FEES$ V � O 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.qopherstateonecall 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- �r'� � �/%i� X • � _ Applicant'�Wrinted Name Applicant's:Signature . ,w ��„� F_ � ���� „ . ,ti. � _ � �� � � �t� �� � � �. e�i{ui �.,�ris f r ��� �a 4 �e' r����r �,��� #e; � i� ,� .�. .�