588 Autumn Oaks Ct? + 4? •?• .+
4h P
(Itrfi#ira#t of (IOrrupaury
titp of (Eagatt
loppirtmptlt Af Iltdbttig iwPttiDtt
This Cer[ificate issued pursuant to the requirements of Section 306 of the Unifornt Btrilding
Code cernjying that at the tinve of issuance this structure was in complinnce wrth the wArious
ordinances of the City regulaling building construction or use. For the followmg.•
u. ck,.rwi. SF I]WG/GAR eaog. rtrniis No. 158
O-UP-y T."M R344I Zmm DWma R 1 Tya Com VN
Owm of Bwkbng EVERLASTING EiQIES IlC Ad&.. P.O. B(aX 4 14, B' VIIl.E
BuMas Aod„ 588 ALTiuTI QAK.S JU]RT U-Hty I3, B3, flOUDTIlZY FOIDW
g/ 14/q2
POST IN A CONSPICUOUS PLACE
` INSPECTION RECORD eonirvl No. 0163
,.,.?
; `?iTY OF EAGAN
RF..ACTIVA'IED MR DECK 09/01/92
PERMtT TYPE:
(iu 11- 1z MA
• 3830 Pilot Knoh Road KEITK HANNASCH 688-0931 permit Number: Qoo l t`s
Eagan, Minnesota 55123 Date Issued: 04/02 /qx
(612) 681-4675
SITE AQDRESS: t ofi t .y ti: i.1,.: ?e .1 APPLICANT:
; 68fi AUTUliN (IAKS CT kVERLAS7'ING Ni,1ME:i ING
? COUN1RY 1401.LQW (612} 436-21+0 PEFiMlT,.§UBTYPE:
TYPE OF WORK: IOEW
.
; ou ij r# .. .
FftAlit wk ..
I#lSl1t.AT1ON FtpAI
wFtt??tia? r_
? RVNAFtr"it r-Rv
S & W fONTitACTOR - MfAtTNE:4d CtANIF1S PIRQ
t
s;_4'r ff:. ? '??1
--
?. . '
_ _ J
Parmn No. PermR Nolder Date Telephone If
S/W
PLUMBWG
HVAC
ELECTRfC
ELECTRIC
Inspectlon Date Insp. Camments
Footings I
FoundaNon ko L?jTIl. /?'pc Q .I'!? ! G'
. -ow?? ??s?'SG?'.
Framing
Roofing
Raugh Pibg.
/ /p????4 G??
Ro??h Htg.
Isvl, l/?9z
Fireplace
a a
/ r?t,tS
Rnal Htg.
orsat rest
Fona1 P1bg, ?? c3?
/ Pibg. Inspector - NotNy Plumber
Const. Mster
EngrJPlan
Bldg. Final
Deck Ftg. -Z,
!
Dedc Fnal ! A/
weu
Pr. Disp.
1J, ?_
S `
?S ?
suas I
v-
Adaress: 588 AURM pAKg r,OURT Lot g Blk g Sec/Sub rAUNTRy HOLI,OW
These items wera/were not complete at the time of the final inspection.
D te: $/14/92 Yes No
Final grade (6" from siding)
Permanent staps - garage
Permanent steps - main entty
Permanent driveway
Permanent gas
Sod/seeded grass
Trail/curb damage
Porch '?
Sasement finish
Deck
Please verify vith tha bullder the removal of roof test caps fzom tha plum6ing
system and the shut-off of water supply to the outs3de lawn faucet before
freeze potential exists. ?
R[[YLtFOMRR
White - City copy Yellow - Resident copy Pink - Contractor copy
/058'/ g
J I U 1 tJ V t? ?Z?' , 7?- c? ? v
?-
Request Date . -' Fre No Rou ?-?n Inspeclan
e retl> ? /
R¢atly Now NIII NOhty Inspeclor
? r.ryo When ReeEy'+
I hcensed contractor ? owner hereby request mspechon of above electncal work at
Job A ress $pee?'?ax or Rowe No ) ?
p ? Gry
0
• ?G''
Secwn No Township Name or No Range No. CovMy op'
Occupant(PRWT) Phone No
Ler
Power SuOP AtlErew
/
Hemncal Conhacror (Company Name) Contractors license N.
e ,? CJ P??•fi-!c 1tic_ C a?
?
Maihng A
O
tlress (Comracb Owner Making Installation)
(
)
AufM1Orrzetl 9gnaWre ConvactovOwne, Makmg Instaliatron) ?Phorie N
mber
u
J
Q
?
MINNESOTn STATE BOARO OF ELECT Y
Griggs-Midway eltlg. - Haom 54]
1821 Universiry Ave., St. Paul, MN 551
Chone(612)602-0800
TMIS INSPECTION REOUEST WILL NOT
BE AGGEPTED 8Y THE STATE BOARO
UNlE55 PROPEfi INSPECTION FEE IS
ENCLOSEO
J 13758
REQUEST FOR ELECTRICAL INSPECTION
? See insfmcimns for completing ihis brm on Dack of yellow copy.
'X=' Below Work Covered 6y This Request
sM N ES-O00i
105 ?P
e Adtl Rep. TypeofBuAding AppliancesWired EqwpmantWired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Other(Specity)
Comm./Industnal Pumace
Farm Air Condinoner
Offier(syecdy) ConVa[ror§ Remarks
Compute lnspecfion Fee Below:
# Other Fee # ServiCeEniranceSrze Fee # CirCmtsiFeeders Fee
Swimming Pool 0 to 200 AmpS J 0 to 100 Amps 8
Trensformers A6ove 200 _ Amps Above 100 _ Amps
SignS inwectors Use Only TOTAL
Irriqation Booms ?o[ D
Special Inspection
Alarm/COmmunication THIS INSTALLATION MAY 8E OflDERED DISCONNECTED IF NOT
Ofher Fee COMPLETED WITHIN 18 MONTHS.
I, the Electncal Inspector, hereby Rougnin omaJ? -Y
certity that the above inspection has
been made F,nai oa?; _,? =Ya
OFFICE USE ONLY
Tms request witl 18 momhs from
PERMIT
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
PERMIT TYPE:
Permit Number.
Datelssued:
BUILDIN6
000156
04/02/92
SITE ADDRESS:
588 AUTUMN OAKS CT
LOT: 3 BIOCK: 3
COUNTRY HOLLOW
DESCRIPTION:
REMARKS: (,' OI FS
Building Permit Type SF DWG
8uilding Work 7ype NEW
UBC Occupancy., R-3 M-1
Construction Type V-N
Zoning R-1
Building Length 57
Building Width . 48
?
rj.. -:,-
.
-
, . ,?;? •_
PRV
S& W CONTRACTOR - MATTHEW DANIELS PLBG
FEE SUMMARY: vALuArzoN $136,0ee
Base Fee
Plan Review
Surcharge
SAC
SAC %
5AC Units
Subtotal
$765.50
$497.58
$66.00
;700.00
100
1
$2,931.00
MISCELLANEOUS E1,610.50
COPY i.50
Total Fee $3,642.08
COTV-ERIA$TIN6 HOP9ES INC APP1114352148 0003 24WEVERLASTING HOPIES INC
P 0 BOX 914 P 0 BOX 914
BURNSVILLE MN 55337 BURN3VILLE MN 55337
(612) 435-2148 (612)436-2148
I hereby acknowledge that Z have read this appliaation and state that the
information is correct and agree to comply with all appliceble State of qn.
Statutes and City ot Eagan Ordinancss.
I L
Control No. 0163
IGNAT
/ APPLICANT RK EESIGNAT?R ISSUED?RE ?
INSPECTION RECORD I Control No. a y b 3
CITYOFEAGAN PERMITTYPE: BuzLDZroG
3830 Pilot Knob Road Permit Number: 000158
Eagan, Minnesota 55123 Date Issued: 0 A/ 02 / 92
(612) 681-4675
SITEADDRESS: Lor: s 6lOCK: 3 APPLICANT:
588 AUTUMN OAKS CT EVERLASTIN6 HOMES INC
COUMTRY HOILOW (612) 435-2146
PERMIT SUBTYPE: TYPE OF WORK:
sF owa New
INSPECTION
FOOTIN6 .. .
FRApIING D.
INSULATION FINAL
FIREPLACE
REPIARKS: PRV
S& W CONTRACTOR - MAT7HEW DANIELS PLBG
?
?
PEttMIT-8
-
?
CITY OF EAGAN
1992 BUILDING PERMIT APPLICATION
681-4675
MA R 3 0 RECo
w? ??i-?
SINGLE & 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 calcs.
Penalty applies when typing of permit is requested, but not picked up by last working day
of month in which re uest is made r lot chan e is re uested once ermit is issued.
r
k
-!
Da e ? //?? Val a,? tion. of wo
?
`
?
?l
Site Location:
STREET 8TE 1
Tenant Name: nj,J e s cL
LOT ? BLOCK ? .
SUBD
?
C
/ P.1.D. ?
r?., a
oc?„u
ati1
Descri tion of work:
The appl i cant i s: ? Owner ud'[;ontractor ? Other (Describe)
NameClJr-., f! ??...? /%.?. __?r -Z?-j Phone
Property LAST FIRST
OWI1@f 6
0
Address 0
-.0 .
X 4
SiREET STE 0
City /-5 4-1•?...? State ? •^? ? Zip
Company ?= v?N /c r,,f.j r 121c,??.r ,L--?c• Phone 5«-5-- -
Contractor Address /? d -1-1?ax S'/y License #6O6d64NX6.3 '3/ 9
City /J c=?..? ? ?? //t r State ?-? -? --) Z i p
Company Phone
Architect/
Engineer Name Registration N
Address
City State ZjP
Sewer 8 water licensed plumber ^IZ°--i <? /:-E/?- . Processing time for
sewer 8 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 with all applicable State of Minnesota Statutes and City of
Eagan Ordinances.
Signature of Applicant:
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Garage/Accessory ? 11 Res. Add./Porch
)j 02 SF Dwg. ? 07 fireplace ? 12 Comn./Ind. New
? 03 Two family O 08 Deck ? 13 Comm./Ind. Add
0 04 Multi-fam. T.H. ? 09 Basement Finish ? 14 Comm./Ind. Rem.
? 05 Apt. Bldg. ? 10 Swim Pool ? 15 Public Fac.
WORK TYPE
?.. _ _
0 16 Agricultural
? 1-7 Building Move
? 18 Demolition
0 20 Miscellaneous
% 31 New ? 34 Remodel ? 37 Move
? 32 Addition ? 35 Repair 0 38 Demolish
? 33 Alterations ? 36 Tenant Finish O 99 Undefined
GENERAL INFORMATIO N
Occupancy R-3 M-I Basement sq. ft. MWCC System Yes
Zoning R_1 lst F1. sq. ft. City Water YEs
Const. (Actual) V- N 2nd F1. sq. ft. PRV Required YEs
(A1Towable) ?..1 Sq. Ft. total Booster Pump
# of Stories Footprint Sq. ft. Fire Sprinkler
Length 5'7?
-
-
-
- On-site well Census Code
Depth
q
8
7 On-site sewage SAC Code . 01
APPROVALS
Planning Building LE d/-/ -9? Assessments
Engineering Variance
REQUIRED INSPECTION S
O Site ? Fo oting p Framing ? Insulation
? Wallboard ? Fi nal ? Draintile O 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 Y ?oo
SAC Units _I
9GS. So
68 , 00
49'l , 59
100100
Ioo,oo
ro , o?
95190
30,00
30.oo
.??
OD.oo
o , oIa
vatLmc;on: s`t3?=-
GARAC+Ei 37- X7-V. r7 619
?xr2_(ra?
BsM T; ?56 ?C IG =!2?'OR?i
16x 34= 544
C,ISy
3*4IS' ? 45
4,35 X 15= ? S 2 S
2r?? Fi,aa2;
3z Y. z4 ? 96?x 53=
14o1-7oy
I ST FL.oDR 7rVTAiL ? 15 0 y ?
•So 46x2N= IISZ 1
6A2S=15o
ol• 08? ?I ?t 14- 56
? ? 7= , 4
I 3'i2, x 53 ;'7 ;? I l.
8-5124324492 NF'FLE FF.IHi1HG
%h
1 ?
,n
14yo
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m =?....?iS,is M
.ft
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a? , - -
5' „
::. a.?7 N.BL• 533 5
P64'MFTl oAi
LOT 3, BLOCK 3,
COUNTRY N01LOW
DA KOTA C oUNT V,
MINNESOTA
gs'' b
_ NOR'rN
S CAL E 1"= 3 0'
Alt gFAR/NSt RSSlIMgD
o pF.NOT94 lRON MONUMENT
--Te P i??.o?+•?. ?`t?? 83fi?5
??OURED
I hereby certify that ttiis aurvey was preparsd by me or
under c supervision
the g laws a of the t State of duly Minnesotatered
Land Su
DatesA-,.Ad4 /f?? _? J /? ?.
LeWoy H, ohlen
Regi.nterAd Land Surveyor No. 10795
Lor 3, 3, eouNTR,. ?10U-LXJ
? . ?
ONE AND TWO FAMILY
ENERGY CALCULATIONS - AVERAGE "U" COMPUTATION
OWNER: E{4t4NA.54.E{ SITE ADDRESS: DATE: 3/11/92
CONTRACTOR: EVERLASTING HOMES CALCULATIONS BY:ROOSEN PHONE:507-451-1
Determine working square footaqe of each that applies.
1. Total exposed wall area .............2649.8 sq. ft. x 0.110 -291.49
2. Total [oof/ceiling area ............. 1528 sq. ft. x 0.026 - 39.73
3. Floors over unheated space.......... 0 sq. ft. x 0.050 - 0.00
4. Roof/ceiling area (no attic space).. 0 sq. ft. x 0.026 - 0.00
5. Unheated slab on qrade .............. 724 sq. ft. x 0.160 -115.84
6. Heated slab on qrade ................ 0 sq. ft. x 0.120 = 0.00
TOTAL WOOD WALL AREA 2478.58
a. Total wall window area........... 273.36
b. Total door area .................. 55.63
c. 'rotal glass door area............ 33.35
d. Total fireplace wall area........ 0.00
e. Total rim joist area ............. 160.84
f. Total wall framinq area..... ..... 195.54
q. Total net wall area above floor.. 1759.86
TOTAL EXPOSED FOUNDATION AREA 171.29
h. Total foundation window area.......... . 10.45
i. Total net foundation area above grade. . 160.84
j. Total unheated slab on grade area..... .
k. 'rotal heated slab on grade area....... .
Determine "U" value of each wall segment
a. 273.36 x "U" 0.360 = 98.41
b. 55.63 x "U" 0.070 = 3.89
c. 33.35 x "U" 0.360 = 12.01
d. 0.00 x "U" = 0.00
e. 160.84 x "U" 0.043 = 6.98
f. 195.54 x "U" 0.106 = 20.74
9. 1759.86 x "U" 0.046 a 81.51
h. 10.45 x "U" m 0.00
i. 160.84 x "U" 0.062 = 9.94
j. 0.00 x "U" = 0.00
k. 0.00 x "U" = 0.00
7 ...................... ....... .. ........ TOTAL = 233.48
If item #7 is the same as, or less than item #1, you have meet the
intent of SBC 6006(c)2.
NOTE: FOUNDATZON WALLS
E'ull basement (Rambler) entire exterior wall must be not less than
R-5.
Half basement (Split Foyer) entire exterior wall must be not less
than R-10.
:?
, .,
TOTAL EXPOSED ROOF/CEILING AREA 1528
1. Total skylight area ....................
M. Total roof/ceilinq framinq area........ 152.8
n. Total net insulated roof/ceiling acea.. 1375.2
Determine "U" value for each roof/ceilinq seqment.
1. 0 x"U" m 0.00
M. 152.8 x"U" 0.028 = 4.35
n. 1375.2 x"U" 0.025 = 34.57
8 .......................................TOta1 = 38.92
If the total of #8 is the same as, or less than #2, you have met
the intent of SBC 6006(c)1.
To utilize the total envelope system method, the values
established by the sum of items #7 and #S shall not be
qreater than the sum of items #1 and #2.
WALL SECTZONS
"U"= 1/R
WALL FRAMING AREA CONSTRUCTION R-Value
1. interior air film 0.68
2. 1/2" Gyp. Bd. 0.45
3. 5-1/2inches soft wood 6.89
4. 7/16" OSS 0.67
5. Vinyl Siding 0.62
6. Exterior air film 0.17
Total 9.43
"U" Value 0.106
NET WALL AREA ABOVE FLOOR
1. Interior air film 0.68
2. 1/2" Gyp. Bd. 0.95
3. F/G Ins. 19.00
4. 7/16" OSB 0.67
5. Vinyl Siding 0.62
6. Exterior air film 0.17
Total 21.59
"U" Value 0.046
RIM JOIST AREA
1. Interior air film 0.68
2. F/G Ins. 19.00
3. 1-1/2" softwood 1.89
4. 7/16" OSB 0.67
5. Vinyl Siding 0.62
6. Exterior air film 0.17
Total 23.03
"U" Value 0.043
.. .
FOUNDATION AREA AeOVE GRADE
1. Interior air film 0.68
2. F/G Insul. 13.00
3. 10" Conc. Blk. 2.33
4.
5.
6. Exterior air film 0.17
Total 16.18
"U" Value 0.062
ROOF/CEILING FRAMING AREA
1. Interior air film 0.61
2. 5/8" Gyp. Bd. 0.56
3. Cord depth 3-1/2" 4.38
4. insulation 29.00
5. Exterior air film 0.61
Total 35.16
"U" Value 0.028
INSULATED ROOF/CEILING AREA
1. Interior air film 0.61
2. 5/8" Gyp. ad. 0.56
3. Insulation 38.00
4. Exterior air film 0.61
Total 39.78
"U" Value 0-025
PERMIT #
REACTIVATE ?
r iiri)
CITY OF EAGAN
1992 BUILDING PERMIT
681-4675
t'Yla; I Plan _'/0 /Jomfvu,?.,Er
APPLICATION
aus 2 s RECo
SINGLE 6 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,,l,copy of energy calcs.
Penalty, applies when typing of permit is requested, but not picked up by last working day
of month in which re uest is made or lot chan e is re uested once ermit is issued.
Date a / LS /112- Valuation of work
Site Address:S89 Aztru.rr--) D.ft:s &42?-
STREET SUITE /
Tenant Name: (commercial only)
IAT 3
BIAC& 3
1 -
SObD.
L
P.I.D. k
Descri tion of work: Nt-k=
The arplicant is: 19 Owner ? Contractor O Other coes«+ne>
Name ?v Phone 1688 093 /
Property LAsr FIRST
Owner Address _ SBS ,qo41UK.J 04-A!::6 Cv' 4&Av-
STREET STE 1
CitY State ?Al Zip .5yy723
Company Phone
Contractor Address License fi Exp.
City State Zip
Company Phone
Architect/
Engineer Name Registration ?
Address
City State Zip
Sewer 6 water licensed plumber . Processing time for
sewer h water permlts is two days once area as been 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.
Signature of Applicant:
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation
? 02 SF Dwg.
? 03 SF Addition
? 04 SF Porch
? 05 SF Misc.
WORK TYPE
31 New
32 Addition
? 06 Duplex
? 07 4-Plex
? 08 8-Plex
? 09 12-Plex
? 10 Multi. Add'1.
? 33 Alterations
? 34 Repair
GENERAL INFORMATION
O il Apt./Lodging
O 12 Multi. Misc.
? 13 Garage/Accessory
? 14 Fireplace
/Vt, 15 Deck
O 35 Tenant finish
? 36 Move
Const. (Actual) Basement sq. ft.
(Allowable) lst fl. sq. ft.
UBC Occupancy ? 2nd Fl. sq. ft.
Zoning Sq. Ft. total
# of Stories footprint Sq. ft.
Length On-site well
Depth _12 On-site sewage
APPROYALS
Planning Building
Engineering Variance
REQUIRED INSPECTIONS
? Site 1?r Footing ? Framing
11 Mallboard q Final ? Draintile
? Insulation
? Fireplace
Permit Fee 01-4- v,i,mt;a,:
Surcharge
Plan Review
license
MWCC SAC
City SAC
Water Conn.
Water Meter .
Acct. Deposit
S/Y Permit
5/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total:
$
'LJ 16 Basement Flnish
? 17 Swim Pool
? 18 Comm./Ind.
? 19 Comm./Ind. Misc.
? 20 Public Facility
0 21 Miscellaneous
? 37 Demollsh
MWCC System
C1ty Water
PRV Required
Booster Pump
Fire Sprinkler
Census Code
SAC Code
Assessments
sac %
SAC Units
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.
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7.6ri J'YJt'33??
v?scx itrio,v
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LO T 8, BLOCK 3,
COUNtRY NOtlOW,
DA KOTq C ouNT V,
L_ M/NNBSOTA
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ALf..BEARINAf RSSlIMED
o pANOT6s IRON MONuMEN?
-Ta ? PS V eA-M-• E C.- • IW.4 oS
BAS a N.,6..?T 91,. . 8 Z4. 1
I hereby certify that this survey wae prepared by me or
under my direet aupervisa.on and that I am a duly Registered
Land Surveyor under the laws of the State of Minnesota,
Date:/? X,?,.
e oy H. ohlen
Register=d Land Surveyor No, 10795
CTTY OF EAGAN
L`3 B? MECHANICAL PERMTT RECEIPT # 0 S(? a 3
SUBD. _ (612) 681-4675 DATE
RESIDENTIAL
PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS. AISO, COMPLEI'E FOR
TOWNHOMES/CONDOS R'HEN SEPARATE PERMITS ARE REQUIRED FOR EACH DWELLING UNIT.
OWNER: FEES
SPfE ADDRESS:??? 'n 1 ?0OK5 /IL ADD ON/REMODEL (FJIISTING
CONSTRUCfION ONLl) $ 15.00
HVAC: 0-100 M BTU 24.00
INSLMLEYO ADDITIONAL 50 M BTU 6.00
ADD S? S GAS OU1'LEfS - MIIVIMiTM 1@ $3 FA,
z- Do
CITY: ZIP: SURCHARGE $ .30
SIGNA . TOTAL: $ JV
COMMERCIAL
PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAUINDUSI'RIAL BUILDINGS. ALSO COMPLETE FOR
APARTMENT BUILDINGS OR OTHER MULTI•FAMILY BUILDINGS R'HEN SEPARATE PERMITS ARE NOT REQUIRED FOR
EACH DWELLING UNTT.
WORK DESCRIPTION: CONTRACI' PRICE:
1% OF CONTRACT FEE. FEES
STATE SURCEIARGE IS $.50 FOR EACH
$1,000 OF PERMTT FEE. $
PROCESSED PIPING - $25•00
hIINIMUM FEE - $25.00 . $
OWNER: TOTAL: $
SITE ADDRESS:
1'ENANT: , .
SUITE #: , . . '
INSTALLER:
ADDRESS:
C11'Y: ZIP:
PHONE #: CITY SIGNATURE:
SIGNATURE.
l?- eL ? CITY OF EAGAN
?n PLUMBING PERMIT
SUBD. (612) 681-4675
REBIDENTIAL
PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS
WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
WORK DESCRIPTION
NEW CONST _
ADD ON _
REPAIR _
CITY USE ONLY
RECEIPT # ?-6ID'Sii
DATE t4 -:3b-q2_
ALSO, FOR TOWNNOMES AND CONDOS
COMPLETE THE FOLIAWING:
OWNER NAME: CUFiPC<JS'7/Llr?i- /?7/?tEt'
SITE ADDRESS: Sm AU7??e5wq G1,E'T
INSTALLER: ?G!//r9?lJl?lfi-
nnDxESS:
CITY: Sf 2IP:
PHONE jj: GCN
N0. FIXTURES EA. TOTAL
REPAIR/ADD ON 15.00
? SHOWER 3.00 3,?0
? WATER CIASET 3.00 6,e0
? BATH TUB 3.00 3.G0
? IAVATORY 3.00 4,fo
? KITCHEN SINK 3.00 4,00
1 IAUNDRY TRAY 3.00 3.0e
HOT TUB/SPA 3.00
WATER HEATER 3.00 3.00
? FIAOR DRAIN 3.00 j,M
GAS PIPING OUT.
(MINIMUM - 1) 3.00 3•00
? ROUGH OPENINGS 1.50 Sa
_ OTHER
WATER SOFfENER 5.00
_ PRIVATE DISP. 15.00
U.G. SPRINKLER 3.00
W. TURNAROUND 15.00
? STATE SURCHARGE .50
-// U U
SIGNATURE OF PERMITTEE TOTAL: S -34K36'
COMMEACIAL
PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BIIILDINGS. ALSO FOR MULTI-FAMILY
BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT.
WORK DESCRIPTION:.
OWNER NAME:
SITE ADDRESS: _
TENANT NAME: _
SUITE #:
INSTALLER:
ADDRESS:
CITY:
PHONE
FOR:
CITY OF EAGAN
CONTRACT PRICE:
1% OF CONTRACT FEE. .
STATE SURCHARGE a $.50 FOR
EACH $1,000 OF PERMIT FEE.
$25.00 MINIMUM FEE.
CONTRACT PRICE x 1%
STATE SURCHARGE
TOTAL:
$
$
(SIGNATURE)
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