4739 Bristol BlvdCITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
SITE ADDRESS: 1 „ i : '6
I H 1, VI)
PERMIT SUBTYPE:
RECORD
PERMIT TYPE:
Permit Number:
Date Issued:
APPLICANT:
(,,f;'' dki '•7ild f'?I i H
40 1
t; f' 1 1 •I ???ti f:S ii ?'
TYPE OF WORK:
Ni IA
INSPECTION TYPE .DATE INSPTR. INSPECTION TYPE DATE INSPTR.
f10ffj1, I'tliil I I'i'.
111 11 (} '1 1 1 1 i$ I .. i I I ,I
MARK ?t 1•1 1' 1 1-1 Ik • 14 • 1. Ia V C E ,a• 1.; A V A I I N I
I t l l l 1 11 I ?.! (?
I
Permit No. Permit Holder Date Telephone #
S/W
PLUMBING
HVAC
ELECTRI __v 7S y
ELECTRIC
Inspection Date Insp. Comments
Footings I US' it/L - DoT ,??
J q P-14 jetz?-
Foundation ? J 7 (? rat, I o r OL.I
Framing
7
S -rcED G? ?c? mfr
Roofing
Rough Plbg.
Y
Rough Htg.
d a? c- 9f f
_v
]Sul.
Fireplace
Final Htg.
9e
?1?-- ?- ?(
Orsat Test 1
Final Plbg. / r PIbg. Inspector - Notify Plumber
Const. Meter
EngriPlan
Bldg. Final ?iC)
Deck Fig.
Deck Final
Well
Pr. Disp.
y
019
.1)v
ertt tcnte of Z cc"ancj
it1 of Wagan
ze4a eut of h.Ubiug Znoec#on
This Certificate issued pursuant to the requ
certifying that at the time of issuance this stru
ordinances of the City regulating building con:
Occupancy Type -R3 /M I Zoning District
Owner of Building MTA(s CIISMFSCN
Building Address 4739 BRISTOL BOULEVARD
nts of the Uniform Building Code
was in compliance with the various
on or use. For the following:
_ Bldg. Permit No. 23424
.o®lity L6, B1, WE ITtI ml T s 2ND
1
POST IN A NSPI?S PLACE
Address 4739 BRISIUL BOIII.EVARD Zip 5512 3
Lot ' _ 6' Blk I Sub WES1CZ1 All r S 2ND
THESE ITEMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECTION.
Date:C, Yes No Inspector:
Final grade (d' from siding)
Permanent steps (garage)
Permanent steps (main entry)
Permanent driveway
Permanent gas
Sod/Seeded grass
Trail/curb damage
Porch
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 to
the outside lawn faucet before freeze potential exists.
Contact engineering division at 681-4645 before working in right-of-way or installing underground sprinkler system.
White - City Copy Yellow - Resident Copy Pink - Contractor Copy
71s P
M04850,
a d a-Y
$?1'7
Request Data
June 22, 1994 Fee No- Roug In Inspection Required
(you mus all Inspector when ready) Inspection Other Than Rough-In
? Ready Now ? Will Notify Inspector
Yes ? No Date Ready
I licensed contractor D owner hereby request inspection of above electrical work at:
Job Address (Street Box or Route No) City
M=ice-8nstafson 4739 Bristol Blvd 3a pan
Seceon No Township Name or No. Range No. County
)akota
Occupant PRINT) Phone No
Mike Gustafson 45-3882
P? er supplier
L
Bkota Electric Address 4300 220h
Farmington, }t 55 0?4W.
PI 5
laalfanear l` 1ec"t"s i
T Contra LNense No.
c CA, 01236
Mei4sy IT's 4Goenhactor groOwwner Drng
L LV71 1C a 1' 11 (nslellationl
Lal(eville,MN 55044
Au rued Sig I e 1 ntraclor/Owner M8'mng installation) Phone Number
461-1444
MINNESOTA STATE BO MD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT
Griggs-Midway Bldg. - Room S-173 BE ACCEPTED BY THE STATE BOARD
1821 University Ave.. S1. Paul. MN 55104 UNLESS PROPER INSPECTION FEE 15
Phone (612) 642-0800 ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION ?4"
? See,inSlruceon3 for completing this form on pack of yellow copy.
4 U " X" Below Work Covered by This Request '?.
ew Add Rep Type of Building AppllancesWired EquipmentWlred
Home Range Temporary Service
Duplex- Water Heater Electric Heating
Apt. Building Dryer Load Management
Comm./Industrial Furnace Other (Specify)
Farm Air Conditioner
Other ispeciiyl Contractor§ Remarks
Compute Inspection Fee Below,
# Other Fee # Service Entrance Size Fee # Clmults/Feeders Fee
Swimming Pool 0 to 200 Amps 0 to 100 Amps
Transformers Above 200 _ Amps Amps
Signs Inspectors use Only. OTAL
Irrigation Booms 7
?/ / pn?
Special Inspection D /
Alarm/Communication THIS INSTALLATION MAY BE ORD CONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 HS
I, the Electrical Inspector, hereby
certify that the above inspection has
been made. Rough+n ate
Finai Oa
OFFICE USE ONLY
This request void 18 months from
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
PERMIT
PERMIT TYPE:
Permit Number:
Date Issued:
BUILDING /'f`j7
023424
04/26/94
SITE ADDRESS:
P.I.N.: 10-83751-060-01
4739 BRISTOL BLVD
LOT: 6 BLOCK: 1
WESTON HILLS 2ND
DESCRIPTION:
B ildingCPermit Type SF DWG
Auilding W+?rk Type NEW
'UBC Occupa•ndy> R-3 M-i
Construction Ty e V-N
Zoning ; R-1
Building Length 72
Building Width 42
By:ijditxg.eCgries' 2
on V
REMARKS:
PRV S & W PLBR - WEIRKE EXCAVATING
FEE SUMMARY:
VALUATION
Base Fee
Plan Review
Surcharge
SAC
SAC %
SAC Units
Subtotal
$818.00
$531.70
$75.50
$800.00
100
1
$2,225.20
$151,000
MISCELLANEOUS $1,828.50
Total Fee $4,053.70
CONTRACTOR:
OWNER: - Applicant -
GUSTAFSON MICHAEL
9049 W HWY 101
SAVAGE MN 55378
(612)445-3882
I hereby acknowledge that I have read this applic;atidn?.and state that the
information is correct and agtee to comply with all applicable State of Mn,
Statutes and City 'Of Eagan Ordinances.
1y
0EMIT*ETREISSUED eY I ATU
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE: B U I L D I N G
3830 Pilot Knob Road Permit Number 0 2 3 4 2 4
Eagan, Minnesota 55123 Date Issued: 04/26/94
(612) 681-4675
SITE ADDRESS: LOT: 6 BLOCK: 1 APPLICANT:
4739 BRISTOL BLVD GUSTAFSON MICHAEL
WESTON HILLS 2ND (612) 445-3882
PERMIT SUBTYPE:
SF DWG
TYPE OF WORK:
NEW
INSPECTION TYPE
FOOTINGS .DATE INSPTR. INSPECTION TYPE
FOUNDATION DATE INSPTR.
FRAMING ROOFING
INSULATION FIREPLACE
ROUGH IN PLBG ROUGH IN HTG
FINAL PLBG FINAL
REMARKS: PRV
F
?,
S & W PLBR - WEIRKE EXCAVATING
`m.
zs?zd
CITY OF EAGAN
1994 BUILDING PERMIT APPLICATION
681-4675
rnO1'A ML
44, o,-3.10
%61ZZW
SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, I copy of energy
calcs.
COMMERCIAL 2 sets of architectural & structural plans, I 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 permit
is issued.
Date 4+ Valuation of work /56Oi (o17
Site Address: 4739 t cJbI 81?cl c oga.n t W SSr2 3
STREET SUITE #
Tenant Name: (commercial only)
LOT BLOCK SUBD.?
(-
i
l P.I.D. #
loY1
/CC
C
l
Description of work: 14 Gtn/ COn ?u.c fiiol IG F ?? o me.
The applicant is: IR Owner ? Contractor ? Other (Describe)
Name gus't' owl Hi Ch _ Phone 4+5-3862-
Property LAST FIRST
Owner Address 90119 y-Ics/- HY41 10
STREET STE #
City 50-''e-C- State 14 Zip 5YS75
Company Fkot&.E O µ.cnE9-- Phone
Contractor Address License # Exp.
City State Zip
Company John 13r-a-dtcy Phone 553-9x70
Architect/
Engineer Name Registration #
Address 3r3/ F rn hrb0K- AV 5- Sfc /20
City July rvi ou- 01 State Mf4 Zip 5544
Sewer & water licensed plumber eie? ?anchi a C^icc vahr?q . Processing time for
sewer & water permits is two days once area has been approved. J1
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.
Signature of Applicant:
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Duplex ? 11 Apt./Lodging
Z 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'l. ? 15 Deck
WORK TYPE
O 31 New ? 33 Alterations ? 35 Tenant Finish
? 32 Addition ? 34 Repair ? 36 Move
GENERAL INFORMATION
? 16 Basement Finish
? 17 Swim Pool
? 18 Comm./Ind.
? 19 Comm./Ind. Misc.
? 20 Public Facility
? 21 Miscellaneous
? 37 Demolish
Const. (Actual) Basement sq. ft. 21 GS' MWCC System
(Allowable) 1st Fl. sq. ft. +sso City Water
UBC occupancy 2nd Fl. sq. ft. 89y PRV Required
Zoning R-1 Sq. Ft. total Booster Pump
# of Stories z Footprint Sq. ft . Fire Sprinkler
Length Z On-site well Census Code T
Depth /z On-site sewage SAC Code
APPROVALS Census Bldg Z
Census Unit
Planning Building Assessments
Engineering Variance
REQUIRED INSPECTIONS
? Site I8 Footi ng ® Framing ® Insulation
? Wallboard 133 Final ? Draintile ? Fireplace
Permit Fee
Surcharge
Plan Review
License
MWCC SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment Pi.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total:
SAC %
SAC Units
valuntian: $ Isr ®®0
QG'm f
220
3/oS= 357
ysr 2G l1?
iYtS = 10
14?9G0I
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ls+
2, Sks -- l2, ;
?srYS !/, 25
rz
13?9,?Sks`f
2..)
22 6 -. 6So
Id, 2%V
?3k/,s= 19.5
zzk ?? 20o
za z
2VYx/6 //?90y
IS?F/?5f7
t)l
X93 sa ss yep 2yt
UO?E CURT ,jC//Roeaeie
?y CONSULTING ENGINEERS
I PLANNERS and LAND IURV4VORS
NGINEERING I?x,
COMPANY, INC.
1000 EAST 1461h STREET. BURNSVILLE, MINNESOTA 55337 PH 432-30 0
RTIFICATE OF SURVEY
Legal Description:
SCALE : 7' = 30'
•- At. 14-•- --
JN
(33_0) DENOTES EXISTING ELEVATION
(9445) DENOTES PROPOSED ELEVATION
.r INDICATES DIRECTION OF SURFACE DRAINAGE
944,8? = FINISHED GARAGE FLOOR ELEVATION
937, 12 = BASEMENT FLOOR ELEVATION
c 16 = TOP OF FOUNDATION ELEVATION
/ /•- r-
I\/ 86° 57'30'
8 /68,48 lIva- A9 H°6 = 943,14 N ??
Olosq ;2/.9r
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ID
APDRE y : 4739 9215T6L aVD.
0eWA AJAPK-= TIJH 4T UJTS
Ia414,f3LOCK_I.
ELEV. = 94.3,68
r
- p?
0
T, o? ?19R
F.7 z
942,9` ? '??%9`?/•/9
A G A.N
REVIEWED
0 8Y ? 7
?1-25 9`
OA
FRa.V7 Ye"CO/N6
r
5??
5 ,
1.'
0"o DUT/L/TY &AOE/h,5NT
I hereby certify that this is
land as shown and described
AFRIL , 19 94 .
EAGAN E&GINEERINO DEPT.
U li II IPSO ,.?'?
P. R. YI O mw
a true and correct rnprenentatlon of a tract of
hereon. As prepared by me this , day of
141nn. key. No. 16085
LOT svznr cnenm FOR R282DLNTIAL
EDILDINO FERMiT AFFLICATION
PROPERTY Lu
nt
Date of Surveys
Doe zz STAnA ns
8' O
W D D
D Regqistered Land Surveyor signature and company
Eliding Permit A
D' D
0 pplicant
Legal description
0'D D Address
8' D
B^ D D
0 North arrow and .bar kale
House type (rambler, walkout, split W/o, split entry
D'?D
V ID
D
0 ,
lookout, etc.)
Directional drainage arrows with slope/gradient I.
0' D
0 Proposed/existing sewer and water services
D?0
D Street name
Driveway
ELEVATIONS
0
13
• Zxistire
Sewer service
ff? Q
0 Lot corners
Top of curb at the driveway
0 0 Elevations of any existing adjacent homes
f
•
0 D reeeeed
Garage floor
0 D First floor
0
8,, D Lowest exposed elevation (walkout/window)
DAD 0 Property corners
Front and rear of home at the foundation
PONDINO AREAS (if soRlieab1e
8' D D Easement line
0 D D NWL
0 D
D? D 0
0
• BWL
Pond • designation
D O' D Emergency overflow Elevation
DAD
D
• DIMTNBIDNB
Lot lines
DD Right-of-way and street width (to back of curb)
Proposed home dimensions including any proposed ,decks,
overhangs greater than 2', porches, etc. (i.e. all
8?D D structures requiring permanent footings)
Show all easements of record and any City utilities within
? these easements
D ? Setbacks of proposed structure and setback of adjacent
existing homes
D 0 ,
Retainin wall r irements, if any
Reviewed:_
YY IL LIU. 56 IF- %W?- t
M. ELEV. @ PL 931.31 >
8 AN \ \ WYE 0F88 \ \ SAN. ELEV. 00 PL 932-86
WYE 2+87 \ \
/SAN. ELEV. (g1 PL 931.79 7 W YE 0+08 \ \ \ \
WYE 0+22 SAN. ELEV. (n1 PL 932.38 8
/ \ \ /
5 SAN, ELEV. (a) PL 932.09 \ \ + \ \
6
BENCHMARK -SPIKE_IN POWER POLE 100 FEET NORTH OF
CLIFF ROAD ON THE EAST SIDE OF T.H. NO. 3-ELEV. 931.60
........... .......... ...................... ..:.. .......... ..
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5 hlCT.GUARANTEE
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'
TH AC i1RACY OF U
E
iLITY LOCATIONS
_.:..._
.+87.87.
STA::T1
Ft RT
AN JL1 ? ELEVATIONS.: IS FOR
HIS DATA:
;:
1.6,
84D:3i
TUfi' lerFORl ;Ai`a0N PURPfl
' ES Ain't'! AND
THE
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D.Or ELEVATIONS...T IS DATA I ..E ...:° :::::._:::::.. ....:'::
INFO IM ATiON PURPOSES O;;LY At G . ...:::::::: . ..:::. .. .
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EXTERIOR ENVELOPE AV'ERaGE T' COMPUTATION
Plan--' a4o47 Date 4 /'t /94
Owner -. a t 1 ,nnt 1 ?y
Contractor v.E d
Site Address MONN OMW 47g q ri t B1-VP
1) Total Exposed Wall Area Z81to sq. ft. .11 = 3 41' 'T 7(0
2) Total Exposed Roof/Ceiling (3(.o sq. ft. .026 = 3
Wall Calculation
Total Window Area Z¢o sq. ft. 35 = 3Lo
Total Door Area 36 sq. ft. .07 = Z.7
Total Glass Door Area sq. ft 35 = zg?
Total Fireplace Area sq. ft 36 = /
Total Wall Framing Area 2?fs' sq. ft. .09 = Zt.1
Net Insulated Wall Area 2Zr sq. ft. .043 = 00-JS
Total Rim Joist Area ?y/x sq. ft .04 = IZ•5
Total Foundation Area sq. ft. .14 = Zt._
Total Foundation Window sq. ft. 35 = 1_
3) Total
If item 3 is the same as, or less than item 1, you have met the intent of 2
MCAR 1.16005 A and O.
Roof/Ceiling Calculation
Total Skylight Area tva• sq. ft. 35 = /
Total Roof/Ceiling Framing 134F, sq. ft. .026 = -36
Net Insulated Roof Area 12Z_ sq. ft. .022 = Zro _
4) Total 3o.4
:if item 4 is the same.as,-or less than item 2, you have met the intent of 2
MCAR L16008 A and O.
Alternate Building Envelope Design
To utilize the total envelope system method the sum of items 1 and 2 shall be
greater than the sum of items 3 and 4.
. 1) +2) _
3) -+4} =
I hereby certify that the building here described meets or exceeds the state of
Minnesota Energy Conservation Act. %
Signed
PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMES AND
CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
NO. FIXTURES EACH TOTAL
SHOWER 3.00 3 o-O
WATER CLOSET 3.00
BATH TUB 3.00 3 o-fl
LAVATORY 3.00
KITCHEN SINK 3.00
LAUNDRY TRAY 3.00 3.
HOT TUB/SPA 3.00 3 0
WATER HEATER 3.00 2 .CD
FLOOR DRAIN 3.00 S.
GAS PIPING OUTLET • minimum - 1 3.00 3?-
ROUGH OPENINGS 1.50
WATER SOFTENER 5.00
PRIVATE DISP. • Dak.Cry. lie. 20.00
U.G. SPRINKLER • home under Donal. 3.00
ALTERATIONS • to existing 20.00
WATER TURN AROUND 20.00
S`• 5
STATE SURCHARGE .50
TOTAL:
SITE ADDRESS: q735? E r r s'fo 1 (j/vl
OWNER NAME:
PHONE #: (6 1 2) £(c47 - 6 :2q7
1994 PLUMBING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN MN 55122
(612) 681.4675
CITY: Prior o.?c? STATE: Mho ZIP CODE: .ST37Z
-a5Gt{
PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMES AND
CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
- - ---- - - - --------- - ------ - ------ - - - - - - - - --------- - ---
X NEW CONSTRUCTION
ADD-ON A/C
ADD-ON FURNACE
FIREPLACE INSERT
DATE 4-2,1- -17t
FEES
HVAC: 0-100 M BTU $ 24.00
ADDITIONAL 50 M BTU 4:00'
GAS OUTLETS (MINIMUM 1 @ $3.0o EACH) 12.00
ADD-ON/REMODEL (EXISTING CONSTRUCTION) $ .20:00'
STATE SURCHARGE .50
TOTAL 3(9.5 0
SITE ADDRESS: 41/Blvd
OWNER NAME: M l '- 4 ft, P---Y G-(/ -dJ e vl TELEPHONE #: 44Y 3 Hz-
INSTALLER: I-1 o?E 0V4 NC--
6
0
CITY:. __G? ?GL e STATE: ZIP CODE: 5537/
TELEPHONE #: A- 4S' 388 2
-/?, i,?, , LL,?
SSIGNATU?E OF PE E
1994 MECHANICAL PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN MN 55122
(612) 681-4675
LOT BLOCK f U)ad4y tjt&
RECEIPT # DATE
1995 CITY OF EAGAN
IRRIGATION PERMIT (FOR BACKFLOW PREVENTER)
COMMERCIAL INSTALLATIONS: FORM MUST BE COMPLETED BY LICENSED PLUMBER
Date: Ic? Commercial GPM
Residential (boulevards) GPM
'I Existing (residential
Area/address to be irrigated 4?3 ? ?Il ?m1(, ?LV --i
Installer. 1,- Owner Plumber ?
Street
City, state & zip code: Phone #: L RJ - R7/9
Owner
Street
City, state & zip code:
Phone #: W1 -in
Irrigation contractor, if different than installer.
Telephone #:
I hereby acknowledge that I have read this application, state that the Information Is correct, and agree
to comply with all applicable City of Eagan ordinances. It is the applicant's responsibility to notify
the property owner that the City of Eagan assumes no liability for any damages caused by the City
during Its normal operational and maintenance activities to the facilities constructed under this
pernUt within City propertvlriaht-of-wavleasement.
Title
Approved by: Date:
PRV ? Yes ? No New service ? Yes ? No
Meter Size & Cost
Fees due: Calculated by:
X-7- ?s 7 2 0 - ft /'7/I3 ,6
PROCEDURE FOR IRRIGATION SYSTEMS - 1995
An irrigation permit is required - please contact Protective Inspections at 681-4675.
Fees
Commercial project: $25.50 irrigation permit to cover installation of backflow preventer.
$50.50 water permit fee only if new service is installed.
$300.00 per tap if installed by City.
Residential project: $20.50 irrigation permit to cover installation of backflow preventer.
$50.50 water permit fee if new service is installed.
$750.00 per connection - WAC.
$372.00 Per connection - water treatment facility.
Existing residence: $20.50 irrigation permit to cover installation of backflow preventer - (not
required if backflow preventer previously installed).
Meter charge: If gallons per minute are less than 25, a 1" meter will be required at a cost of
$170.00. If gallons per minute are more than 25, a 2" turbo with strainer will
be required at a cost of $800.00. This information is to be supplied by the
designer of the system.
No meter will be sold before all sewer and water Inspections are complete on a new service. If new
service lines are not required, one check may be written for meter and permit costs. Receipt will be coded
to 20-3716 (meter portion only) with pink copy forwarded to Utility Billing Clerk.
The installer is to contact Protective Inspections at 681-4675 for inspection of the inside water line and
backflow preventer. The Public Works Department may be reached at 681-4300 for water turn-on and set
and seal of the meter. Inspection hours are 8:30 a.m. to 3:30 p.m. Monday through Friday. Requests for
A.M. inspections should be made on the preceding work day. Requests for PM inspections will be accepted
until 12:00 noon.
City of Eaaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
-----------------
For Office Use
Permit #:
Permit Fee: 9ld ` 0e)
Date Received: I Staff:
2009 RESIDENTIAL BUILDING UILDING PERMIT APPLICATION
Date: 2 `/# _ oe) Site Address: /,-',/ 4 J4 5 L /// 4
Tenant: j (?_f (?`` &' (&i 1SGY) Suite #:
RESIDENT / OWNER Name: ( el.. S ?Sg 7 Phone:
Address / City / Zip: / 7Xl/
Applicant is: Owner Contractor
TYPE OF WORK Description of work:
___
Construction Cost: Multi-Family Building: (Yes / No )
CONTRACTOR Name: Gtirrj??%? ?l ?JS? ?Ol? . License #:l j
Address://?
City: Li J State: MA j Zip: /
Phone: ?*)1Z - 3 ?j 7 2 z Contact Person:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7672
Minnesota Rules 7670 Category 1
_
Energy Code • Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
Category Submitted Submitted
submission type) • 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?
_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.
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to staU3
accordance with the approved plan in the case of work which requires a review and approval of pla
Applicant's Printed Name Applicant's Signa u
and codes of the City of
that the work will be in
Page 1 of 3
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA140430
Date Issued:12/19/2016
Permit Category:ePermit
Site Address: 4739 Bristol Blvd
Lot:006 Block: 001 Addition: Weston Hills 2nd
PID:10-83751-01-060
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:Two or More Windows/Doors
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 or installing Bay or Bow
windows, call for framing inspection. Call for final inspection after installation.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Valuation: 4,000.00
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 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 -
Michael S Gustafson
4739 Bristol Blvd
Eagan MN 55123
Craftsmen Home Improvements Inc
7455 France Avenue, #194
Edina MN 55435
(651) 430-1388
Applicant/Permitee: Signature Issued By: Signature