1567 Ashbury Ct? . ..?. ' CITY OF EAGAN . --- ? -. ? ?
, . . i. ,
3830 Pilot Kno6 Road, P.O. Box 21 •199, Eagan, MN 55121
PHON E: 454-8100
BUILDING PERMIT Receipt #
I To be used for Est. Value ' Date
Site Address OFFICE USE ONLY
uL:.N t
Lot BIoCk SeC/Sub On 5ite Sewage _ Occupancy
. MWCC System ' Zoning ?
Parcel No. On 5ite Well _ Type of Const
City Water y (ACtuaq
a Name (Allowable)
w y
' # o( Stories
z Address
'. Length
. ,
City Phone .
Depth - -
' F
Total
S
.
.
Footprint S.F.
?` Address APPROVALS FEES
? City Phone Assessments _ Permit
yVj W Name Water/Sewer
Police _ Surcharge ' •'
_ Plan Review
W
vz Address
Z
Fire
Enyc
= SAC, City
SAC, MWCC
?
W City Phone
t Planner Water Conn.
_
counoiI _ water Mete?
I hereby acknowledge that I have read this application and atate 81dg. Of1. _ Road Unit
that the information is correct and agree to comply with all applicable APC - Treatment Pt
State of Minnesota Statutes and City of Eagan Ordinancea Variance _ Parks
Signature of Permittee Copiea
TOTAL
A Building Permit is issued to: on the express condition that
all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinancea
Building Official
Permit No. Permit Holdsr Date Telsphon* ?
Plumbing
? •.?5 ? ?
Cr ?`? ?c, ??.c?+ ? ?7
H.V.A.C. ,?; qC' q/D
Electric
r-
Softener
Inapectfon Date Insp. Comments
Footings I :??/ ?
Footings II
Foundation
Framing yQ
Roofing
Rough Plbg ?
Rough Htg.
Isul.
Firepiace
Final Htg. ?
Finai Plbg. / p, R. V.
Bldg. Final
Cert. Occ.
Temp. LP
Deck Ftg.
Deck Frmg.
Well
Pr. Disp.
• MECHANICAL PERMIT RECEIPT #
' • CITY O F EAGAN
3830 PILOT KNOB R OAD, EAGAN, MN 55122 DATE:
CONTRACT PRICE PHONE : 454-8100 '
Site Address <- °" { BLDG
TYPE WORK DESCR
PT
O
.
I
I
N
Lot Block
' ?,zL Sec/S ub
,
: %' fp' ? ., Fies. ? New
2 c?.
-
,.
A }?Ault Add-on
m Name
? ? 4 . '
0 W0 Comm. Repair
'
Addre
sI Other
c
I
City
Pof-
L-• 1u- Phone
i! L- 4 0 3.c:
FEES
c Name
y
`
??
< RES. HVAC 0-100 M BTU _$24.00
Addre _
u+ .4.? ADDITIONAL 50 M BTU 6.00 .
p City ?! a? "?- Phone (RES. HVAC INCLUDES AiC ON NEW '
• CONSTRUCTION)
GAS OUTLETS (MINIMUM - 1 PER PEIiMIT) - 1
50 EA
'
.
.
TYPE OF WORK COMM/IND FEE - 1% OF CONTRACT FEE
Forced Air M BTU -APT. BLDGS. - COMM. RATE APPLIES
?
Boiler
M BTU TOWNHOUSE & CONDOS - RES. FiATE APPUES
MINIMUM RESIDENTIAL FEE - ALL ADD-ON 8
Unit Heater M BTU REMODELS - 12.00
?
f-Air Cond. M BTU $ M1NIMUM COMMERCIAL FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
? Vent. CFM ? (ADD $.50 S/C IF PERMIT PRICE GOES
? Gas Piping Outlets # BEYOND $1,000)
Other $
n
? FEE:
S/C: SiGNATURE OF PERMITTEE
TOTAL•
?
,
FOR: CITY OF EAGAN
' PLUM9ING PERMIT
CITY OF EAGAN
3830 PIIOT KNOB ROAD, EAGAN, MN 55122
iNTRACT PRICE PHONE 45d-8100
Site
Lot.
d
-
?
...
y
c
i
a?
c
3
, O
Name
Address
Ciry SA24?9L Ak Phone
Name
Ciry
Phone
RECEIPT # ?
DATE: ?
BLdG. T1fPE WORK DESCRIPTION
Res. v- New ? -
Mult. Add-on
Comm. Repair
Other
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
NO. FIXTURES TOTA,o
?
Water Closet -$3 00 S Z'`
Bath Tubs -$3.00 3 00
_1Lavatory - $3.00 3 v U
-40P-Shower - $3.00
_LKitchen Sink - $3.00 ?27-C) 0
Urinal/Bidet - $3.00
-LLaundry Tray - $3.00 3 • d
J Floor Drains - $1.50 5
_41_1 Water Heater - $1.50 f 5
1
Whirlpool - $3.00
-LGas Piping Outlets - $1.50
(MINIMUM - 1 PER PERMIn
Softener - $5.00
Well - $10.00
FEES
COMM/IND FEE - 196 OF CONTRACT FEE
APT. BLDGS - COMM RATE APPLIES
TOWNHOUSE 8 CONDO - RES. RATE APPLIES
' MINIMUM - RESIDENTIAL FEE - $12.00
MINIMUM - COMM/IND FEE - $20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
PERMITTEE
CITY OF EAGAN
Pnvate Disp. - $10.00 1
Rough Openings - $1.50
FEE:
STATE S/C:
GRANO TOTAL: ? ? V
i` ?' ? ?
(gtr#t#iratie uf Mrxupanry
Citp of Cagan
]Brpwtnmt o# lWiding Jwprttmt
This Certif cate issued pursuant to the requiremenu of Section 306 of the Unifor?n Building
Code certifying lhat at the time of issuu,ice this structure was in compliance with the various
ordinances of the City regulating buildrng consirncrion or use. For the following.
vx c?.xi6nflon `•t' Il.dG/GAR elds. R?it r1o. =i':Y, ?,
OCCUWxY TYP? R3 Zaoin` Distriu Ri ' Typx CMBL VJl
POST IN A CONSPICUOUS PLACE
/ ! ?.../
BLU'G. PERMIT NOJ
0I-3210 Bldg. Permit
01-3422 Plan Check
01-3445 Surch./Adm.
01-3446 SAC/Adm. -a ~ :F
01-2155 Surcharge
17r3860 Road Unit
20-2275 SAC
20=3865 Water Conn.
20-3868 Water Trmt. ? ?6; ??GJ ;
20-3716 6,-ater Meter
20-2252 Acct. Dep.
20-3713 Water Permit
20-3743 Sewer Permit
79-3866 5ewer Conn.
11-3855 Park Ded.
s
j
TOTAL
? CASH RECEIPT ?
CITY 4F EAGAN
3830 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE 19 _
wccEIv`n
FROM
AMOUNT, $ I
s ooLLwwa
' oe
? CASH C)CNECK
ROR
! . . ? ! . I ? ._ .. ?
FUNG CODE AMOUNT
Thank You
BY
77471
White-Payers CopY
Yellow-Postinp CopY
Pink-File CoPY
? CASH RECEIPT ?
- -CITY OF EAGAN
3830 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
?
DATE 19
11tCE1YtD r. .
FROM ? .. i ! •
AMOUNT' I • $ ,
8 OOLLARS
?ao
? CASH [?] CHECK
- - ?
/ ??, ?' . 4??r /I ? ? J• y(- 'i ? ' ?? jJ ..
J? i
"'1 ? l8' i • ? . . . ._ !: . i . . -
FUNO I CODE I AMOUNT
7
?vu :?..
Thank ?
B Y
s? !? White-Payers CoPY
76/j 3 r? '.: Yallow-Posting Copy
Pink-File Copy
CITY OF EAGAN
3830 Pilot Knob Road
P.O. Box?119g
Eagan, MN 55121
Site Address:
Date: 9`13-07
Size:
Date:
To ae
Conn. Chg: 52 5• 00pd
Acct Dep: 5'0??pd
s
Permit Fee- 1L' 000d ?
Surcharge: ' SOp d
Tr. Plant
?
Meter ?7 ?
?i'rd?-
.
MISC.: .. . .•- tr Z7aT.1fi
Permit No: 9074
Meter No: _
Reader No:
Zoning:
No. of Units:
I agree to comply with the City of Eagan
Ordinances.
Br
WATER SERVICE PERMIT
cmr oF EacaN - SEWER SERVICE PERMIT
3850 Pllot Knob Road
P.O. Box 21199 PERMIT NO.:
Eayan, Ma 55121 DATE: Zoning: F1 No. oi Units: I
Owner. Keqland iZo+aes
I Address:
1567 Ashbury Court L9 B2 Blackhawk ('len IZ j
i Si6e Address: ?
t D r VechauiCal
Plumber:
; .. - '-::7 7542,", 10?.??J?d
i I ayree !o comply wNh the Cily 191 Eayan Connection Charge: 59 5_ iltl33ti j
? Ordinances. ? Account Deposit: I s- 00r%ti j
4 Permit Fee: 10 _ i)fl"'i ?
, Surcharge:
?
gy Misc. Charges: ?
: Date of Insp.: Total: ?
Insp.: Date Paid:
-- - ---- --- -- 1
CiTY OF EAGAN Permit No: pate:
3830 Pllot Knob Road Meter No,3 Size:
P.O. Box 21't09 Reader No: tl?? Date: 6- Z -?Z
Eagan, MFI 55121
Owner. xevlar.d 'aoffcs
I SiteAddress: 1567 Asatihtsry -,.9 ^.) :;l:arki,aw;. ie-, -i T
i Plumber.
i Conn. Chg: 525
Acct. Dep: 15
Permit Fee:
?
Surcharge:
Tr. Plant
, Meter.
IosAlatiWrift
f R ikc . (;AC '- ,.
i a ree t F ply wtth the Cky of Eayan
?rin
r 1??-
??? SERVICE PERMIT
WATER
P.R.`J. REQliIRED CITY OF EAGAN No 14045
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 J
7?? ?!`
BUILDING PERMIT PHONE: 454-8100 Receipt# ?
Tobeusedfor SF DWG/GAR Est.Value $66,000 Date AUGliST 13 19 87
Site
Lot 9 BIocM
Parcel No. _
a Name KEYLAND HOMES
= Address 14450 BliRNSVILLE PKWY
? City B' VILLE phone 894-2636
,o Name SAME
z.? Address
? City Phone
UQ
w W
w
Name
i? Address
aw City Phone
I hereby acknowledge that I have reatl this application and stete I
thattheinformationiscorre ndagreetocomplywithallappliceble
State of Minnesota Stat and GI of F,Bga in nces.
?? ?
Signature of Permittee
A Building Permit is issued to: KEYLAND HOMES
all work shall be done in accordance with all applic le State of M
8uilding Official
1567 ASHBURY CT
2 BLACKHAWK GLEN 2
OPFICE USE ONLY
On Site Sewage _ Occuoancy R3
MWCCSystem X Zoning Rl
OnSiteWell _ TypeofCons[ Vn
City Water x (ACNaq V.1
(Allowable)
# of Srories 4.2 _
Length
Depth 4R
S.F Total
Footprint S.F.
APPROVALS FEES
Assessments _ Permit $ 34$.50
Water/Sewer _ Surcharge 33.00
Police Plan Review 7 Q 9- 9 5
Fire _ SAC, City i nn . nn
Engr. _ SAC,MWCC 575_(10
Planner _ WaterCoan. 595_00
Council _ WaterMe[er 67_00
BIdg.Off. _ Road Unit 305.00
APC Treatment PI
0
180.0
Variance _ Parks
Copies
-
TOTAL 73
$7-?ZT5
J
on the express condltion that
Statutes and Ciry of Eagan Ordinances.
This reQVesl wltl
18 momhs (mm ?
D 4736i q 12 ,2
RPnuesfOaie _
? R
^?
7 Fire No. Rouph-in InspecIion
Reqwr 1+ ?
Reatly Nuw ill Not?ty Inspec-
V ?
es N
tor When p tlv
Ra?
U u?enseo uec[ncai conVaclor I hereby request inspecbon ul abova
? Owner electrical work instelled at.
Sveet AdAress, Boz or Route No. Crtv
ecLOn o. TownshiD Name or o. Range No. Counry
o
/
Occuu.??t IPflWTI Phone No.
?Y C?
P er S ppher Addres
?
El/e?cin?cal Cronhactor (Comoany Namej) ?,.?-. o/n?r?ar.tor's License NoC.
// I 7 LG Lifil
Mailmg Address IComracto or Owner Makinq Ins[ai vu n)
.e APP ? zc ,? ?$!2
Authon Siennture (Contrac r O ncr Makine 1,?sullation) Phone Number
-73 O
MINNESOTA STATE 80AN{[/OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT
Gr.ggs•Midwav Bld9. - Noom N-791 BE ACCEPTED BV THE STATE BOAHD
1821 Universitv Ave.. St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS
PhOne4612)fi42-OBOO ENCLOSEO.
REQUEST FOH ELECTRICAL INSPECTION es-ooooi-o?sI
? Seo instroctions lor compleLng Ihis fprm on back o} yellow copy. a.c?
n A 7'1 R "X'" Below Work Covered by 7his Request
6Vew?AJI Ne0:1 'rvua oi eueiaurg ? Aoclianc«a WveC ' Eqoiumen? Wved ?
Home Range Temporary Service
bnu Fi
Lommerciai tsiag. 1 ? rumace ? I ?
iiu ??nioader ?
? Industrial Blda. Air Condrtmner Bulk Milk Tank ?
p Fee SarviceEnirancaSae N Fee Featlers/SubfeeAers N Fne Crtcwts
U to 200 Am s 0 to 30 Am s -0 0tn 30 l?n! s
Above 200 qrnpsi 31 to 100 qmps 31 to 100 Am s
Swinvning Pool Above 100_Amps Above 100_nmps
Transtormers Irrigation Booms , fj0 Partial.bther F
5igns Speaal InsPection 5 ?
flemnrks ?Z.`j TOTA
i /if
Nouen-in
U unte
? nS thepeceK?V+EaI
Itoq here0y
cerldy thet the above
Final p .
LL ?%ir
/h inspeclion has baen
/
/v mede.
Thiierepueslvoltll8manthalrom ?
1987 BDILDING PERMIT 9PPLICATION - CITY OF EAGAN
SINGLE FAMILY DWELLINGS
INCLIIDE 2 SETS OF PLANS, 3 CERTIFICATES OF SQBVEY, 1 SST OF ENERGY C9LCOLATIONS
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MIIST DESIGHATE WHICH ADDBESS
IS DFSIRED. NO CHANGES WILL BE ALLOYiED ONCE BIIILDING PERMIT IS ISSQED.
MULTIPLE DWELLINGS - RFSIDEFIRIAL RENTAL ONITS FOR SALE ONIYS
INCLUDE 2 SETS OF PLANS, CERTIFICARS OF SIIRVSY - CHECB NITH BLI)G. DEPT.,
1 SET OF ENERGY CALCULATIONS
COMMf?RCTAi.
INCLUDE 2 SETS OF ARCHITECTURAL
1 SET OF SPECIFICATIONS AND 1
ENERGY CALCULATIONS,
$2,000 LANDSCAPE BOND
To Be Used For:_,?..
Site Address ( f;?6
Lot ? Block C:3?-
Parcel/Sul}r'" ?,
Owner
Address ? ?V-S6)
.4 _ n
City/Zip Code
& STRQCTURAL PLANS,
SET OF
Phone
Contractor
Address
City/Zip Code
Phone
Arch./Engr.
Address r
City/Zip Cod c5'?'-Ke? ^
Phone #
d00
On Site Sewage_
MWCC System ti
On Site Well
City Water v^
APPROVALS
Assessments
Water/,Sewer
Police
Fire
Engr
Planner
Couneil
Bldg Off f. 8 t2
APC
Variance
Date: -6 -J
Occupancy R-3
Zoning R- I
Type of Const
(Actual)
(Allowable)
li of Stories
Length S/2.o
Depth 4?:v
S.F. Total
Footprint S.F.
FEES
Permit 3 yg,so
Surcharge 33? °o
Plan Review 1qQ.?S
SAC, City oa
SAC, MWCC ?25°
Water Conn $2 S
Water Meter ? pO
Road Unit
Treatment P1 )gO.o°
Parks
Copies
TOTAL ?
d
SURVEYOR'S CERTIFICATE
?' ?lif\11"1,VvJ I<
?-SL 1
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S g9° 3T ? 29IIE
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SIENNA CORPORATION
r, rN?'? il/IV
1-4 L/L)? ?
75.-qj?--`-
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?-?BRAINAG£ 9 UTlLITY 5
EASEMEN7' P£R PLAT
5 ? LOT 9 ? ?
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? V m
I 4 ? ROPOSED
m N /HOUSE
ol 22D /
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( Ns,o rx??
co I '?C84Sio)
p ? ?
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? ASHBUf3Y
2
27
14
W
41
1 O •
:
ZON
R
23
. 25 COURT
o
?
- ?
- DENOTES PROPOSED SURFACE DRAINAGE •
O QENOTES IRON NONUMENT SET SCALE: 1 INCi1 = 30 FEET
,
• DENOTES IRON MONUMENT FOUt10 PROPOSED GARAGE FLOOR - 94?;,3 FEET
X000.0 DENOTES EXISTTN(i ELEVA710N PROPOSED LOWEST FLOOR - 84Z,s FEET
(000.0) DENOTES PROPOSED ELEVATION PROPOSED TOP OF dLOCK - g 4.5,`1FEE7
b!E IIEREBY CER7IFY TO SIENNA CORPORATION TIIA7 7f115 IS A TRUE ANO CORRECT
REPRESENTA7ION OF A SURVEY Of 7f1E UOUNDARIES OF;
Lot g BIock 2 BLACKHRWK GLEN 2 ND ADDITION, according to the recorded plat
tllereoP, Dakota County, Mtnnesota.
1T l10E5 NOT PURPORT 'TO 5H0W 1MPROVE11ENTS OR ENCROACIiMENTS, IF ANY. AS SURVEYED UY
F1E OR JNDER MY DIRECT SUPERUISION TN:S 30TH DAY OF D[CCh'SER , 19 86,
JAM?S R. HILI.,
THE LEGAL DESCRIPTI[SN USED ON SIGhIED: INC.
THIS SURUEY WILL BECOME UALID
UPON FILING THE PLAT OF BLACK-
IIAWK GLEN 2ND ADDITION. • DY;
REVISEO 7-6-'e7 TO SHOW A ItAROLD C. PETERSON, LnrIn SURUEYOR
PROPOSED HOUSE FOR KEYLAND p11NNE50TA L1CEN5E NU144ER 12294
HOMES.
CT NO.
85618 ?8'7tiO0)
BOOK ! PA
JAMES R. HILL', INC,.
Alanners / Engineers / Surveyors
FILE NO,
FOLDER
8200 Humboidt Avanu• South
6toomington, Mn, 65431 812-884-3029
APPROVED FOR SIENNA
BYI
DATED;
W
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Page 1 of 4
, ?. .
OWNER
EX RIOR.CNVfLOPE /IVfR/1GC " U" CpMP11 T/1'ffON '
.?.3 ?. S
V"
_-----...------ nnrr :----?'- ? - ?5
SITE ADDRESS: PIIONE:
CONTRFlCTDR:-??`
Determine workiny square fooT.aqe of each
1. Total exposed wall area..... _- I-• ?'4__sq. ft. x .11 = Z10•S?
-Y?
2. 7otal roof/ceiliny area..... ____?_Q4fl sq. ft.. x_07.6 = Z1
n
-- -
Total exposed wall area al)o vc floor=
-- l
a. Total wall window area .....................
......................
b. Total door area ....................... ...........................
39
c. 7otal slidin9 glass door area ..............
......................
d. Total fireplace wall area..................
...................... ... ,
e. Total wall framing area (average 10%) ............................
f. Total rim joist area....................
9. net wall area above floor ..................................... .13 f 4--
h• wall area above floor .........................
............
i. wall area above floor.... ;:t. -
..............................
J. frame wall area at foundation..`' .,..................... -
...... Y
lbtal exposed foundation ai-eo=__Le(Q`_
k, Total foundation window area ....................... ?
l. Total net foundation area above grade ..............
Determine "u" value of each wall segment
(e,g, window, door, each sepirate wall ser.tion)
a x U„-=-=1-?--- -?-
b. X 'lull .31
= 11 1
?. Q,p X u?, , ?.
-. 9?------ 19 • S?
d. X 'lu„ _
e.1777, _ X " U', . 0f,--- ----?-1
f._ r3Z x ?lull 04-= --?--
9• 1315 _ X„U,, . 05 ?_?4?----
n.
;.
?.
k.
x ?V,
X u
x u
X 11 u 1,
1 ',---?0?0---- K ,lul, -?!2$_-'---5.-.3--
3 . .................................Total =
_ _...?....._,.._. T1q.?l?=
Ti' item N3 is the sam
as, or less than item
N1, you havP met,the
InCent of SOC 6006 (c
Envelopo Average "U" ComputaCion
Total exposed roof/ceilin9 area
Page 2 of 4 m. Total skyli.qht aYed ............................ I
n. Total roof/cciling framin9 area (avcragc lOfi,)...
?t
o. ToL-al net insulaL-ed rooC/cciling ar.ea...........
, Determine "U" value for each roof/ceiling segment
M. x V. _
n. }; ????, .67* _ - ?
o. _13to. x„U„ , DL = 1 B''?
4 ........................... ToLal = Zi - Z
If total of 1#4 is Che same as, or less Lhan 42, you have met the intent of-
5»r 6006 (c) l.
Alternate
. L6 ut.ilize tlle total envc.
Vi.t-ems I13 and $4 shall not
z. z?o. s
3.
Suilding EnveJ.ope Design
Lope'system method, the values esL-ablished by the s;un of
be greater than the stun of items tkl and Il2.
-1 z. Z,7 70 7.S
+ n. 21•2 = -,L1(0.$
-....... ?4
?
? ' WA1,L t,f,f7'PiON i
o1 c,I?unun uall ?ren for
Irnm?: c:oii:;t rucl fun Con :l ru(.i inii
_• - - -- --.._..
-- -'--°- ,
YP ?p_. _ _....__.. __..?.
_..: ._.._ ? ;; 3;?•??,,.??,,: ..,?? ,, _... .....4?'
SIC " . 6. }:xLCrit?r nir U.17
AI,I. ' ` -'------ -_'-
Iz.Z"j
?_. °-- Vd
FIC. Nl 7?G1'VIF1?1 OF (NrjUl.•
. FIlA:4: lJALL 1. InCr•clc?t'--;iii !ilm O.GII
z . _ YZ-?-V-y.P .?S P_ • . ... - --- -- - --? 45
4. (??o-f_FK.,.. _ ... - ---._..._ . _ ----b• D ?/
._.? " ._ .._-'------{?+ s • .. ? fD. ie? b.. ... _ _ .. . - ---- ...... . .. .. ..,?v.Z.
G. ErLcrior ail Cil).,_?
FIC. 02 C_ •Po tal ZO•?
? - ------0 ? V = • o s
O
R
1. Jntct i_.rr_nir_lilm 0_6!1
..•;.? - - - '-? ------------' ---
__.??_r.r_ • C?? s.
S(AL-°x
tiu-al `(3)
i;,? •E: ? ----Q 6. F:xtr,rfor nir Cilm---,
? "'; r;';-??. ?v" I.. • ' l?=.09
__ ?? ..._, ---------0
. c
?l, .r ::_.!,_ _----.--?_Qi ? 1. r,`E?•? i.?,c air rit?? 0.6n
? ??• - -__._._. _..---
.? . -
? tt • . ?'Z.._f?2NG?. _8_(..? _ .. L.
?
i , d. , •o. >.-------__.--?j . n. ?,.-???Y -- lQ•D
?. • u .-._`-'TnoC s. .. ? ---? --- ----
'?,-. , -. - _ .. -- - -- --- - ? -- - -
In I? .?•?,?'` G. 1::<lrrii?t' .?ir lilri Q.1?1
, ? n . ? . -- -----' ---. _ ......----.._-.--'-- ?---..
/ Z , ! 3
,
u =141.1
st,Au or; ?:icnui.
__. _...-- - --.._..--------------?-?
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Aeeded for details and ealcu2atians,
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CITY OF EAGAN
APPLICATION FOR PERMIT
SEWER AND/OR WATER CONNECTION
1) PROPERTY ADDRESS:
LEGAL DESCRIPTION:
ase
F*70TR: PAYMFTlf OF FEE AT TIME OF
F F+rPLIcATIoN noFS riom caaTITUIE
; APPxovat, oF rrRMsr.
f
F INSPDG'PION OF S?.iN12 AAID/CR kMER
F iNsnuLmOm WIIL NOT BE SC?HED-
E ULFD UNTII, PII2NIIT AAS BF:ESi
F APPROVID.
?--
? ?
. %LuLia.Locxiaupaivision or •rax Yarcel iD A)
.
IF EXISTING STRCCIVRE, DA'IE OF ORIGINAL BL?II,DING PERMIT ISSL'ANCE: -
PRFSENr 7ONIING/PROppSID USE: (Nbn Year
[] COhM432CIAL/RETAII,/OFFICE R-1 SINGLE FAMILY .
Q IrmLIsTRIAL R-2 Dt?PLEX (zt.,o Llnits)
f-1 INSTITUTIONAL/GOVERNMENp ? R-3 TOWNFIOUSE (Three + Units) ( Units)
R-4 APARTMW/CObIDOMINILTI ( Units )
2) ?
Nn,ME:
16
ADDRESS:
CZTY, STATE, ZIP: `?
PHONE: ? 7 _
3) NAP9E:
ADDRFSS:
CITY, STATE, ZIP:
PHONE:
4) •• •s.i e, i
NAME:
ADDRESS:
CITY, STATE, ZIP:
PHONE:
e--- ?4 rlucwers racense:
Active
Z > > "" E7cpired
Not recorded
MASTER LZCENSE# Staff Initral
5) '? «: • ?• : o • a - ?s
CONNECTION T+D CITY SEWER CONNBC'PION TO CITY WATER ? OTfM_
6) ?? • • r ? P E HOID APPROVID PERMIT FOR PICK-UP BY ONE OF ABOVE
E PROVID PERMIT 10 1, 2,?3, 4, ABOVE
/ O (CircY one)
FOR CITY USE ONLY
PERMIT # TSSOED
Pd w/Bldg. Permit FEES:
$ $ /O • S? SEWER PERMIT (INCLUDE SURCHARGE)
$ $ WATER PERMIT (ZIVCLLDE SURCHARGE)
$ G 7•d7) $ WATER METER/COPPERHORN/OOTSIDE READER
$ $ WATER TAP (INCLUDE CORPORATION STOP)
$ S SEWER TAP
$ ACCOUNT DEPOSIT - SEWER
$ AC60ONT DEPOSIT - WATER
$ ? z ? • Q-o $ WAC
$ (n 2- S' 0? S SAC
$ $ TRUNK WATER ASSESSMENT
$ $ TRLNK SEWER ASSESSMENT
$ $ LATERAL BENEFIT/TRDNK SEWER
$ $ LATERAL BENEFIT/TRUNK WATER
$ WATER TREATMENT PLANT SURCHARGE
$ $ OTHER:
$ TOTAL
. &
RECEIPT REC IPT
#
DOES UTILITY CONNECTION REQLIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
ED YES IF YES, THEN A"PERMIT FOR WORK WITHIN PUBLIC
Q R6ADWAY" MUST BE ISSLED BY THE ENGINEERING
NO DIVISION. LIST AS A CONDITION.
SUBJECT TO THE FOLLOWING CONDITIONS:
APPROVED BY:
TITLE:
DATE:
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Ps Guii? Conetructioa Na INSULATION
lowu Doars Refercnce Out. Waq Int. Wall Ceding Roof Floor Kind
-No I Ye-No 19? ?I
Windowe and
a Width .2 ?
and Ares
No. W Idth
of Dane He16M
of Dane No. o[
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` $
Net exp. wall ?000 000
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loGl Blu.
Required aq. ft. E.D.R. of aq. im. W.A. L,eader ares
F1.1 Room Lengt6 Width
Windowa and Doott-Cteckaee and Area
Ne. Wldlh
of pane Halgbt
et 0a*s Ne. e[
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p. ft.
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In6ltrstion
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Net exp. wa11
Int. wall
Ceiling
Floor lolal tf[u.
Required sq. ft. E.D.R. or eq. im. W.A Leader sna
_ Fl.1 Roam I l.ength Widt6
Windowa and Doon-(:r.rk.e. .n.1 A...
No, Wldth
of p?no Hetght
of Dao* No. o[
11[?l- Ltn?tl tt,
ot enek Area
p. fl.
? Coef. Btu
lnfiltration
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Exp. wsll
Net e:p. wall
lnt. Wall
Ceiling
Floor 1 otal Htu.
Required p. h. E.D.R. or sq. ies. W.A. Leeda area
Room I Length Wideh
n . . .
WI OODWf a O0 UOOIv-\.rSCii BC 6nO NRa
Ne. Wltllh
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Infiltntioo
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Ceiling
Floor
Tatal Bta
Required q. ft. E.D.R. ot q. ins. QI.A. l.eader srca
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PERMIT
City of Eagan Permit Type:Building
Permit Number:EA116143
Date Issued:10/03/2013
Permit Category:ePermit
Site Address: 1567 Ashbury Ct
Lot:9 Block: 2 Addition: Blackhawk Glen 2nd
PID:10-14351-02-090
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and leave on site.
Carbon monoxide detectors are required by law in ALL single family homes .
Elizabeth Hess
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 -
Scott C Josephson
1567 Ashbury Ct
Eagan MN 55122
Sela Roofing Remodeling
4100 Excelsior Blvd
St. Louis Park MN 55416
(612) 823-8046
Applicant/Permitee: Signature Issued By: Signature