1219 Balsam Tr ECITY OF EAGAN WpTM gERYICE PER
8830 Pilot Knob Rcad
P. O, Box 21199 PERMIT NO.: ?
Eegan, WJ • 55121 DATE:
?
ZaAnD, ` No. of Units:
OWMr:
I,ddfESl:
SK! /??1'lS3: :... ?'a?r R <: Fe3.i:1`Ta.-..L .. . . . 1.... , . , . r' ,
Plumber: .erz-?_vrtn _
Metar No.: 3"-7 1-Z / •?`I., `?'
$i2E: 0, f l GI? Ms t 1 . kf76 ^
Reoder o.: ??, ?-? ?lfl(.e
I pme te ooopilr wilM 60 City oF Enyme lt` ,,.-?-?--
.
Or?INear. sc. ?ur??
8y Dots Paid:
Date of Ins .. 1Aa "/4-r(4 Imp.:
q- 15. 9f h+e. st -V'YA --
cirv oF EnGati WATEQ SERVICE PERMR
3830 Pilot Knob Road
P. O. Box 27199 PERMIT NO.:
Esgan, XN 55121 DhTE:
Zoniig: No. of Units:
Owner:
Addrcsx
Sitr Mdness:
Plumbee - - -- --
11Aetar No.: Connectfon Charqe: .
Siu: Accamt Depoait:
Reader No.: permit Fee:
1 pnw Io eoW* w" tle Cihr ef Eeyew Surcharge:
OrdiMneM. Misc. Charges:
rOtOl:
By poce Pa1d:
Dote of Irup.: Irmp.:
.
1988 BOILDING PERMIT APPLICATION - CITY OF EAGAN
? I`Tq I I
SINGLE FAMILY DWELLINGS
?
INCLUDE 2 SETS OF PLl4NS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS
NOTE: ADDRESSES FQR GORNER LOTS - CQNTRACTOR/HOMEOWNER M[TST DESIGNATE WHICH ADDRESS
IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BIIILDING PERMIT IS I53UED.
MULTIPLE DWELLINGS RENTAL QNITS FOR SALE UNITS # OF ONITS
INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SURVEY - CHECK WITH BLDG. DEPT.,
1 SET OF'ENERGY CALCi1LATI0NS
COMMERCIAL
INCLUDE 2 SETS 0F ARCHITECTURAL & STRUGTURAL PLANS,
1 SET OF SPECIFICATI4NS AND 1 SET' OF ENERGY CALCULATIdNS
a?a X-,1.2 '
To Be Used For: ?fS/ A aluation: 406D ? Date:
Site Address ,46-4/aj :* ie OFFICE USE ONLY
Lot 9 Block ?
Pareel/Sub
dwner Aww..
Address oz/ f Ag!??-<O"
City/Zip Code
Phone
Contractar
Address AOEI?o?
City/Zip Cade IeSPc-)i
Phone
Arch./Engr. _
Address
eityazip coae
Phone #
On site sewage
MbdCC system
On site well
City water
PRV required
Booater Pump
APPROVALS
Engr/Assess
Planner
Council
Bldg. Of f .
Varianee
Occupaney
2oning
Aetual Const
Allowable
# of storiea
Length
Depth -?
S.F. Total
Footprint S.F.
FEES
Permit
Sureharge
Plan Review
SAC, City
SAC, MWCC
Water Conn
Water Meter
Road Unit
Treatment P1
Parks
Copies
ToTai.
? N, o ?
. S?
?sZ?
CITY OF EAGAN ?j A
• 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100
BUILDING PERMIT Receipt #
To be used tor S F:7:dG/GAR ESt_ VAIt1R $122 000 na,p JUr1E 27 ,a $6
Site Address 1219 E. . F3AI'SAM TR Erect IN Occupancy R3
Lot 8 elock 4 S eciSub. V'JILDERNES PK Remodel ? Zoning Rl
Parcel No Repair ? Type of Const lln
. Addition ? No. Stories
Name s. 'ETyRSY:N CONST IiVC Move ? Length 72
$
Address 4701 tir 110TH ST Oemolish ? Depth -22
o
City ' APLS Phone
884-5144 Int. Impr. ?
Install ? Sq. Ft
W
0
u
<
?
?
?
?
UW
W
o' z
U?
CC W
<
Name SAME
City Phone
Name
Address
information is correct and agree
Minnesota Statutes and City of E
Signature of
Assessment
Water & Sew.
Police
Fire
Planner
ation and state that the gld .Off. 6/27/8E
all appticable State of 9
es. :-. APC •
i? -' - -----Var. Date
Permit $ 4 .00
Surcharge 61.00
Plan Review-2 .QO
SAC -57T.- 00
Water Conn. - 500.00
Water Meter 63.50
RoadUnit --79-0.00
Tr. Pf. 5b . UO
Parks
Copi
T,,,,i ? . . 50
A Building Pe?mit is issued to: S. PETEr'ZSEPj C:n:VST on the express condition that
all work shall be done in accordanoe with all applicable State o) Minnesota Statutes and City of Eagan Ordinances.
Building
II . 1 Pal,n No. I wrn* Maa.. I wt. I ro.o- x I
,,
Hty.
Wsp.
t + PERMIT # / r `y "?
RLUM8IHG PERMIT ' RECEIPT #
49
dTY OF EAGAN
3830 PILOT KNaB ROAD, EAGAM, MN 55121 DATE:
? PRICE: ' PHONE: 454-8100
Site Addr ss
LotBlock Sec/SUb
? L. 2' 1I? S ? ?-
? Name
m
m -
L_.
Addres&
c Phone
? Addres
s
p ?
City - y.?;...%s., ;,.., r? Phone
FEES
COMM/IND FEE - 1% OF CONTRACT FEE
MINIMUM - RESIDENTIAL FEE - $10.00
MINIMUM - COMM/IND FEE - 20.00
STATE SURCHARGE PER PERMIT - = .50
S
(ADD $.50 S/C IF PERMIT PRIC?.GO6
BEYOND $1,000.00)
-?/-
SIGNATURE 65rRNfl1'TEE
FOR: CITY OF EAGAN
BLDGsTYPE WORK DESCRIPTION
Res. New
Mult Add-on
Comm.
Other Repair
f_ 0. FIXTURES
`- Water Closet - $3.00
?-Bath Tubs - $3.00
Lavatory - $3.00
Shower - $3.00
? Kitchen Sink - $3.00
Urinai/Bidet - $3.00
?Laundry Tray - $3.00
1-_Floor Drains - $1.50
? Water Heafer - $1.50
Whiripoof - $3.00
/ Gas Piping Outlets - $1.50
Saftener - $5.00
Well - $10.00
Private Disp. - $10.00
?,?Rough Openings - $1.50
TQiT?
$ ??-
ir_ ? .
/.
s:. .
.° .
/. '
?
FEE
STATE S/C:
GRAND TOTAL•
.?
"'`? ? ?
. • ' PERMIT # ? JI-) 1
MECHANICAL PERMIT RECEIPT # C ?' S I2 f
GTY OF EAGAN
_ 3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE:
CONTRACT PRICE- ' , ; • PHONE 4548100
Site Ad ress <- - • - BLpG. TYPE WORK DESCRIPTION
A/
Lot Block -
. "
New
? Name
''
? Mult Add-on
? . , - ? . ?'
Addr ss ? ; ?-• . ? ? ? i
? Comm. Repa
r
c CiN
-- ; Phone-
Other
Name FEES
3 ss ?iN'
Addre RES. HVAC 0-100 M BTU -$24.00
p ,
City,?-- -'- - ?^ ?- -' ? Phone ADDITIONAL 50 M BTU - 6.00
ADD-ON AIR COND. 0-24 BTU - 12.00
ADDITIONAL 6 M BTU - 6.00
TYPE OF WORK GAS OUTLETS - 1.50 EA.
Forced Air ? M BTU -?• COMM/IND FEE - 1% OF CONTRACT FEE
Boiler M BTU MINIMUM - RESIDENTIAL FEE -- 10.00
Unit Heater M BTU MINIMUM - COMM/IND FEE i? - 20.00
Air Cond. M BTU STATE SURCHARGE PER PERIv11T - .50 -
(ADD $.50 S/C IF PERMIT PRICE GOES
Verit CFM BEYOND $1
000.00)
Gas Piping Outlets # , /'
Other - :
FEE /
S/C: SIGNATURE OF PERMIP?E
TOTAL• -
FOR: CITY OF EAGAN
? CONTRACT PRICE:
Site Address i;
RECEIPT #
CITY OF EAGAN ?
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE:
PHONE: 454-8100
' ' • ''
Name : <10
a?
? Address ?
? c Giry ? PFidne
Name _
Address
p Ciry ?
TYPE OF WORK
Forced Air
Boiler
Unit Heater
Air Cond.
Piping Outlets #
M BTU
M BTU
M BTU
--?r M BTU
l CFM
FEE:
S/C:
roTaL:
6LDG. TYPE / WORK DESCRIPTION
Res. New
?Ault Add-on
,omm. Repair
)ther
FEES
RES. HVAC 0-100 M BTU - $24.00
1DDRIONAL 50 M BTU - 6.00
RES. HVAC INCLUDES A/C ON NEW
;ONSTRUCTION)
iAS OUTLETS (MINIMUM - 1 PER PERMIT) - 1.50 EA.
:OMJy1/IND FEE - 1a/a OF CONTRACT FEE
%PT. BLDGS. - COMM. RATE APPLIES
'OWNHOUSE & CONDOS - RES. RATE APPLIES
AINIMUM RESIDENTIAL FEE - ALL ADD-ON 8
REMODELS - 12.00
AINIMUM COMMERCIAL FEE - 24.00
?TATE SURCHARGE PER PERMIT - .50
4DD $.50 S/C IF PERMIT PRICE GOES ,
tEYONp $1,000) .
??6
/ , _ FOR: CITY OF EAGAN
CITY OF EAGAN Remarks
Addition Wilderness Park Lot 8 Blk 4 Parcel 10 84250 oso 04
owne?, ?t?.,-,Q`,cStreet 1219 East Ba18Hm Z'Y'a3.1 state Eagan,MN 55123
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF,
STREET RESTOR.
GRADING
SAN SEW TRUNK - 1973 176.o5 8.80 20
SEWER IATERAL
WATERMAIN
WATER LATERAL
WATER AREA
STORM SEW TRK
*
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER.
SAC
PARK
CITY OF EAGAN 149; 7
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHON E: 454•8100
BUILDING PERMIT Receipt #
Tc he,.,s2d for Est. Value ?Date `119
Site Address "LS Th
1'k- 1
Lot Block Sec/5ub.
Parcel No.
or Name ? :MRK
z Address
3 r,uA,
O (:itv
. o Name , ?•:` `
o ` Address
U F' City Phone
City
I hereby acknowledge fhat I have read this application and state that the
information is conect and agree to comply with all applicable State of
Minnesota 5tatutes and City of Eagan Ordinances.
Signature of Permittee
A Building Permit is issued to:
on t he express condition that all work shal I be done in accordance with all
appiicable State of Minnesota Statutes and City of Eagan Ordinances.
Building OHicial
On SRe Sewage Occupancy
MWCC System Zoning
On Site Well (,4ctual)Const
City Water (Allowable)
PRV Required # of Stories
Booster Pump Length
Depth
S.F. Total
Footprint S.F.
APPROVALS FEES
Engr./Assess. Permit GL.UI.
Planner Surcharge
Council Plan Review
Bldg. Off. SAC, City
Variance SAC, MWCC
Water Conn.
Water Meter
Road Unit
Treatment P1
P
k
ar
s
TOTAL
I I Permit No. I Permit Holder I Dste I Telephone * I
I Inepsction Dato I Inap. I Comments I
Pr. Disp.
This reques[ voidp?
18 rtpn[hs from /J/?„1,/8? ? '?1. 3
??
D 35373 1?0
Requ [ at?
?
Fire No.
pooPh-in InsVection , .,4'
I
/ ReQVired?
?Y ?eady Nuw Q WiII NntifY. Inspec-
l
Wh
es No or
en FleadY
S?..e??anu uec.ncai ?onlractor 1 heraby request inspaction of ebove
Owner
elechieal work installed at
veei wOQI855, tlo% OI HOUtQ O.
' C?tY
.-
e ion o. TownshioNama or No. qanee o. 'Cnwn
OccuOant (PRINT) Ph'/Qne o.
Pow¢r SupPlier Apdress
Eleyc? al Contrac1or ICompany N' el Contrar,tor'S License No.
?
/%
- 'e_ o aas?
Mailmg AdJress Contractor or wner MakmP ??stallationl
? /
,e . (?-
uthorizeq Sign ture IC nha "lOwner Makine lustnllationl Phpne NumOe
??.s
MINNESOTA STAT€BOARD OF ELECTqIGITY THIS INSPEGTION HEQUEST WILL NOT
Griggs-Midwav Blde. - poom N•191 BE ACCEPTED BV THE STqTE 80AflD
1821 Universitv Ave.. St. Peul, MN 55104 UNLESS PROPER INSPECTION FEE IS
Phone(6t2) 642-0800 ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTlON ea-ooooi-os
Ii, See inshactions lor comOletinp this form on back ol yellow copy. ?-21
[] ?S.? 71 ` "X" Below Work Covered by This Request
AdJ Hep. TVPe ol BuilEinO Apolio.cea Wiretl Equiument Wire!i
Home Ranye Temp1rarv Service
? i.ommeraai niay. rurnace Silo Unlonder
Industrial Bldg. Air ConditiOner Bulk Milk TaNa
W)
N Fea Sarvice EntranceSize d Fae Fexders/5ubfeeders p Fea Circuits
o to 200 qm s 0 to 30 qm ?s 0 ta 30 F?n+, s
Above 200 qinps
I
EI 31 to 700 qmps 31 to 100 A s
Swimming Pool Above 100_Amps Above 100_P.mps
Transtormers Irrigation Booms Partial.0iher Fee
argis Speuai InsUection
Nemarks TOT
n,?Ea
flouah-in D;rt
e
I 1, tha lecbi
Inspecloq e?eby
Final
.
.
ie certily that the above
.
insoeotlon nas n,eo
•i.J. ?•ii l made,
imarequesivow
This request void {?7?j ?? t.,,if2.d-.?C?u-,?µL•cA.?'? ?,?j ?? ?
18 monihs Irom
C 9632
Request Date ?k ?
,??, ?
•
- ??No. Fouph-in Insoeccion
ired?
?Ready Nuw ill NotifY Insoec-
? (? 1'es ?NO ?or When ReaCy
Licensed Elecvical Convactor I heraby reQUest inspection oi ebove
Owner elechical work installed at: _
Street Address, Box or Route No.
A 1 tae7" 43c, `s /777 71-,Q i? Ciry
a q")
ecuon o. Township Name or No. Range No. County
k
Oc uu.nt ftIN I
?r Phone Nn.
Power SupDlior
v C
k
f z-- Adtlress
pc
e
o
Ele Cont a torICOmpanv Namel ? Contrur.torws License No.
7/ _
/7 Ot"e/7?D /Z ?
MailinB Atldress (COnvactor or Own r M kinB hhstallationl
?l?C?j
14 S 3
AuNori' ed SiOnawre 1 o r ctor O er Making n allati i Phone Nupiber ?
p ?Bc?J? D /
MINNESOTq STpTE BOAXD OF ELECTNICITV THIS INSPECTION NEQUEST WILI NOT
Grig9s-Midwey BICg. - Raom N•191 BE ACCEPTED BY THE STATE 80AFD
1821 University Ave., St. Paul. MN 55104 UNLESS PqOGEN INSPECTION FEE IS
PP"w (612) 297 Z111 ENCLOSEO.
g??/_ T QUEST FOR ELECTRICAL INSPECTION . EB-0?0? -04
? See instructions tor complati'q lhis form on beck o1 Vbllaw copV. 4
a
L ? 57
9632 X" 8elow Work Covered by Ihis Request
AAd ReO. ? YyDe of Building Appliancxe Wiretl Equiumenl Wired
Y Home Rang2 Temporary Service
Duplex Water Heater Lightiny Fiztures
Apt. BuilAing psyer- Electrlc Heatin
Commercial 81dy. Fumace Silo Unloader.
Industrial 81dg. A4-E4rnditioner Bulk Milk Tank
Farm otne, oe, v m,?,(sno, nv)
? er uecify Ot cr - Oth?r
ompute Inspection Fee Below
p Fae Servica nce5ize H Fee Feeders/Subfeede,s b Frte Circuits
r 0 t 200 s 0 to 30 Am s .'^ 0 to 30 Am
Abo00 qml?y 37 to 100 qmps 31 to 100 Am
Swimming Pool A6ove 100_Amps Above 100_AmPy
Trans*ormers Irrigation Booms ?T artial-'0 e
Signs Specialinspection $
S ?IrOT
F
Re?rks y. » ?. •T JL? ..i+ - / 7
1 ? / 7
/ L
E
?7?Y?1 ?
Ii ` JC.+Yr i/ /
lechic
flouBh-in th Eo. ereby
Inspac
? certify thxt the above
Final ? ? )pxte {?apection hes been
thb reCUast voltl 18 montM fmm
RESIDENTIAL
BUILDINC PERMIT APPLICATION
(?( CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675
New Construction Recuiremenb
• 3 registered sRe surveys showing sq. ft. of lot, sq. ft. of house; and all roofeE areas
(20% mazimum lot coverage allowed)
• 2 capies ot plan showing beam & window sizes; poured found design, etc.)
• 1 set of Eriergy Calculal'ans
• 3 copies of 7ree Preservation Plan if lot platted aRer 717193
• Rim Joist Detail Options seleclion sheet (bldgs wilh 3 or less units)
DATE l" -°_? I `6Z
SITE ADDRESS
TYPE OF WORK_
APPLICANT?
STREET ADDRESS
TELEPHONE #
MULTI-FAMILYBLDG _Y _N
FIREPLACE(S) _ 0 _ 1 _ 2
- ? `- STATE ZIP
CELL PHONE # lc>?? - ?/D Y FAX #
PROPERTYOWNER TELEPHONE#_
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNESO"fe\ RULES 7670 CATEGORI 1
(J submission type) • Residen6al Ventilatlon Category t Worksheet Submitted n 72G02
• Energy Envelope Calwlations Submitted JUN 2 Plumbing Contractor: _ Phon
Plumbing system includes: _ Water Softener _ Lawn Spnn er
Water HeaCer No. of R.I. Baths
No. of Baths
Mechantcal Contractor.
Mechanical systcm includes:
Sewer/Water Confractor:
Phone #
Phone #
7672
?sheet Submitted
$90.00
Pee: $70A0
----------------------°--------°--------------------°--°-------------------------------°----------------------------
I hereby acknowledge that I have read this application, state that The information is correct, and agree to comply
with all applicable State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicanf
OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4/02
_ .Air Conditioning
_ Heat Recovery Systcm
/ Yd - 7S
RemodellRewir Reauiremenb
. 2 copies af plan
. i sel of Energy CalcWations forhealed additions
• 1 sde survey for eztenor additions & decks
. Indicate if hwne served by sepfic system tor addNons
VALUATION
CITY OF EAGAN
3830 Pilo1 Knob Road, P.O. Box 21-199, Eagan, MN 55721 N2 12199
9
PHONE: 454-8100
BUiLDING PERMIT % Rece+ptn
7obeusedior SF DWG/GAR Est.Value $122,000 Date JUNE 27 1y86
SiteAddress 1219 E_ BALSAM TR Erect m Occupancy R3
Lot $ Block 4 Sec/Sub. WILDERNES PK Remodel ? Zoning R1
Parcel No. Repair ? Type of Const. ???..E.r-
Addition ? No. Stories
s S. PETERSEN CONST INC Move ? Length 79
i Name Demolish ? Depth28
3 Address 4701 W 110TH ST Intlmpc ? SQFt
° ciry MPLS phone 884-5144 Instell 1-1
a Aoorovals Fees
o Name SAME
=
$ a Address
? City Phona
F w Name
Address
?e w City Phone
I hereby acknowledge that I have read
inibrmation is correct and agree to a
Minnesota Statutes and CiN of E?j
SignaW re of
Assessment_
Water 8 Sew.
Police -
Fire
Planner
Council
ationandstatethattne 6 86
all appli9abJe St?ot gld9' Off.
A euilding Permit is issuetl to: S. PETERSEN CONST
all work shall be done in accordance with all aoolicable SiateA Minr
Building OHicial
Permit $ 488.00
Surcharge 61.00
Plan Review 244. 00
SAC 575.00
Water Conn. 500.00
Water Meter 63 . 50
Road Unit 290.00
rr. PI. 156.00
Parks
Copies
Total $2 ,377.50
- on the express condition that
oi Eagan Ordinances.
?
,e 6?-y o?L:e ; .a -? S!/n« /a,47 986 BOILDING PEMT APPLICATION - CITY
HOYE: ALL CAdTRACTOFS MQSY BE LICEBSED iiITH THE CITY OF fiAG9H
SIBGLE FAFIILY DWELLINGS
OF EAGAN
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OE SURVEY, 1 SET OF ENERGY CALCULATIONS
MU[.iIPLE DiiE[.LINGS RESIDSNT7?.Ay + BENT6L ONITS FOE SALS ONTTS
INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SOROEY - CHECB FiITH HI:DG. DEPT.,
1 SET OF SNERGY CALCULATIONS
COMRCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
7 SET OE SPECIFICATIONS AD1D 1 SET OF
ENERGY CALCULATIONS,
$2,000 LANDSC9PE BOND
IGZoo& .
To Be Used For: a? /1 Valuation: ? Date:
Al?'
Site Address la ?( t: '?/Sarj ?a .
Lot ce Bloek -///
Parcel/Sub 4,11L1)6F;ewt'z r
Ownefi/ ;7?E7L-WS',,E-,v 40NS2--7 iiv¢1
Address L/?O l w /lU 7-'y
City/Zip Code
Phone
Contractor ?
Address
City/Zip Code
Phone
Arch./Engr. _
Address
C3ty/Zip Code
Phone 4
Ereet ? Oceupaney
Remodel Zoning
Repair _ Type of Const ?
Addition li of Stories
Move ! Length ?
Demolish Depth
Int.Impr. _ Sq Ft
Install _
APPROV9LS FEES
Assessments Permit
Water/Sewer Surcharge
Police Plan Review
Fire SAC
Engr Water Conn
Planner
Water Meter G?
Council Road Unit 1'y"0
Bldg OfF?- Treatment P1
APC Parks
Varianee Copies
iOTAL o?3
L)
90TE: ADDHESS6S FOR CORNER LOTS - CONTRACTOR/HOMEOIiNER MDST DESIGPATE WHICH ADDRESS
13 DESIRED. NO CHANGFS SiILL BE ALLOiiED ONCE BQILDING PBRMIT IS ISSUED.
2C'o ° le>?z x ?m _ ?S 55?;
Zz n ?z = 76?VX Iz ? ??Ve
z,x /9= s6pX/01= ?/Ez
/zx
i2l,?M.Co
?
w, .. ?
Certificate for: - ? Hk: 100/12
? Sverid Peterson
4701 West 110th Street ? Bloomington, Minnesota 55437
DELMAR H. SCHWANZ
lANDSURVEVOR$ INC
PnO,fleepd Undrr Lawe o1 inr cIMI M Min?M
14750 SOUTH ROBERT TRAIL ROSEMOUNT, WWIIElOTA S606B ?NOME 612 4a17sY
SURVEVOR'S CERTIfICATE
?I LAKE
i ? ? E?.: 84•g ? ? ?
T?A, , o
G
7oPIIJb
9o,ti . ?6?
J
'1 . j/,?'y?? 9`?
Z y4, tiy ?O ? O
3 ?1 Proposed
\
Hous ? i . 1 ? ??
j y
19 Garage q0 ''m
Scale: 1 inch = 30 feet ? 1,?{ ?? ? ? 310
O Denotes iron monument ° f t0p
?' o% iV
? Denotes set wodd hub
Denotes existing elevation
C? Denotes proposed elevation ?471` / f
?
?,D o
I hereby certify that this is a true and correct representation of Lot 8,
Block 4, wILDEEtNESS PARK ADDITION, according to the recorded plat thereof,
Dakota County, Minnesota.
Also showing the location of a proposed house as staked thereon.
Dated: June 24, 1986. ?/Jn n
MINNESOTA
CITY OF EAGAN . Na 14 917
.3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
BUILDING PERMIT PHONE:454-8100
Receipt# ???
To be used for DECK Est Value $1 , 000 Date MAY z ,19 $$
Site Address 1219 BALSAM TR
Lot 8 Block 4 Sec/Su6. WILDERNE55 PK 157
Parcel No
a Name MARK BENGTSON
z
W Address 1219 BALSAM TR
o City EAGAN Phone 454-4995
,o Name AMRE
?Q Address 1935 CO RD B-2
¢ City ROSEVILLE Phone 631-0450
W W Name
i zu Addre
aw City_
I hereby acknowledge that I have read Ihis application and state that the
information is correct and ree to comply with all applicable State of
Minnesota Statutes and C y of Ea an Ordinanc s. ^
SignaWreofPerm e y'/ -
A Building Permit is issued to: AL'!?E
on the express condition that all work shal I be done i n accordance with 211
applicahle State of Minnesota Statutes and City ot Eagan Ortlinances.
BuildingOfficial??,(A?d/f
OFFICE U5E ONLY
On Site Sewage _ Occupancy
MWCC System - 2oning
On Site Well (ACtuap Const
City Water - (Allowa6le)
PRV Repuired # of Stories
Booster Pump - Length
DePth
S.F. Total
Footprint S.F.
APPROVALS -Engr./Assess.
Planner
Council
Bldg. Off.
Variance
FEES
Permit
Surcharge
Plan Review
SAQ City
SAC, M WCC
Water Conn.
Water Meter
Road Unit
Treatment P1
Parks
TOTAL
24.00
.50
24.50
, ?i?ff**#?*#xt****x:tffxfxkff*c:ft:? #
C I T Y O F E G A i? **?F' PAYME?lC OF F'EE AT TIPT OF ;
_ . * r,PPLsCATIorr poss Nar mrSTzTC71E ;
* APPROVAL OF PERMIT. *
APPLICATION FOR PERMIT *
*
INSPEGTION OF SEWE2 ArID/OR WATE2 *
.. * TT1sI`?iS.ATTONS WIId. NCYP BE SQiID-
F
SEWER AND/OR WATER CONNECTION *ULED UWL PM"aT HAS BEEN
APPE2C3VFD.
. *
*
•
. . ?**************kt*****ie*#*****!3*ASr.
P ease Print) `
? 1) PROPERTY ADDRESS: •_
LEGAL DESCRIPTION "
IF EXISTING SiRCCILTRE, DATE OF ORIGINAL KIILDING PERMIT ZSSL'ANCE: '
- (Nbn Year)
PRFSENT ZONING/PROPOSID LISE:
C] CONNERCIAL/RETAIL/OFFICE
? IAIDC'STRIAL
? INSTI1i]TIONAL/GOVERIag1NT
2) U?
R-1 SINGLE FAMILY
Q R-2 DOPLEX (74,o Onits)
C] R-3 ?UWNHO[)SE (Three + Units) ( Units)
q R-4 APARZTV=/CONIDOMINIUM ( Units)
NAME: SCM PETERSEN CONSTRUCTION INC,
ADDRESS: 4701 West 110th Street
CITY, STAT'E, ZIP: Bluomington, hIN 55437
PHONE'
3) • a c ?--
NAME: GENZ-RYAN PLUMBING & HEATING COMPANY
ADDRESS: 14745 South Robert Trail
CITY, STATE, ZIP: Rosemourit, MN 55068
PHONE= 423-1144 MAS'I'ER LICENSE# 1849M
4) oca4•:.i ?
DAME :
ADDRESS:
CITY, SPATE, 2IP:
PHONE:
Plumbers License:
Active
Expired
Not recorded
St?£ Initial
I
•5) ? ? i d• . ?. F, . ? _ .
, ? •ooa-tiwa.
?X ODNNECTION T0 CIT'Y SEWEI2 E? CpNNECrION RO CITY-WAZ'ER ? p'TfIEEt .
6) ? ua o c:. E] PLFASE HOLD ApPROVED PERMIT FOR PICK-UP BY ONE OF ABOVE .--' ---
. ?C PLE1aSE MAIL APPROVID PERMIT TO 1, 2, ? 4. A&JVE .
(Circ e one) ,??
7) r S_iu:' f/hlJ??
FOR CITY USE ONLY
PERMIT #-ISSUED
7!?-
Pd w/Bldg. Permit
c
$
$
$
$
$
s 3bo • ?
S J? c}-o
S
$
$
FEES:
s
s
SEWER PERMIT (INCLUDE SURCHARGE)
WATER PERMIT (INCLUDE SURCHARGE)
WATER METER/COPPERHORN/OC'TSIDE READER
$ WATER TAP (INCLC'DE CORPORATION STOP)
$ SEWER TAP
ACCOLNT DEPOSIT - SEWER
S /S CrU ACCOC'NT DEPOSIT - WATER
s • wAc
$ sAc
$ • TRUNK WATER ASSESSMENT
$ TRC'NK SEWER ASSESSMENT
$ LATERAL BENEFIT/TRU[VK SEWER
$ $ LATERAL BENEFIT/TRUNK WATER
$ $ WATER TREATMENT PLANT SURCHARGE
$ $ OTHER:
$ $ O ?j TOTAL
(p ?b ? ? ??? J/
RECEIPT RECEIPT
DOES ['TILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
F-I YES IF YES, THEN A"PERMIT FOR F]ORK WITHIN PUBLIC
Q ROADWAY" MUST BE ISSC?ED BY THE ENGINEERING
NO DIVISION. LIST AS A CONDITION.
SGBJECT TO THE FOLLOWING CpNDITIONS:
APPROVED BY:
,
TITLE:
DATE : ? ? ? ? ?
? 12,q ? PI,UMBING (RESIDENTIAL)
fe: mit Applicat:zin
City Of Eagan
3330 Knob Road, Eagan htn 55122
Telephore'f 6M-675-5675 FAX # 651-675-5674
Please complete for: Single Family Dv, eLi^gs
Townhomes and Condos when permits are required for each unit
Date / / 8 / ??? - -
- -
Site Address BENGTSON, MARK ?Unit #
- 1219 BALSAM TR.41L EAST
. ? EAGAN, MN 55123
Property Owner (651)454-4995 i 7'elephone # ( )
l ?
Cnntractor NvI?BL'.SM PUM??
----'
-
---------------..?...._.?..
--
(6'Y2) d2i'-awr74?;o4
-
Address ?z
- City
--------
State ` ???p Teleohone # ( )
The Applicant is _ Owner 17i? Cer.ffector _ Other
Septic System New Refurbished Submit 2 sets of plans and t•APC license $ 100.00
Includes Counry fee. Additional consuitant fees roay apply.
Alterations To Existing Dwelling Unit, Inchidini
_ Adding fixtures to lower levels or rcom ad(iitions, excluding water softener and water heater $ 50.00
_ Abandonment of septic systern
_ Water turnaround 518` ma[er it sieedad - $121.00)
Other:
_ RPZ _ new ins[aiiation _ repmr _ reouild ? 30.00
_ Lawn irrigation sys[em
??
?
_ Water softener ? Water;ae,.?r I u $ 15
00
Sr?. .
X
_ replacement
au•;i;ior,al .. J .,.., ,
_
State Surcharge
- "- '- - - - 50
Total g iS, So
1 hereby apply for a Resid°ntial Plumbing P•r.rit and aclmowledge that the infon.natiun is complete and accurate; that the work will
be in conformance with the ordinanr,=s :md c,:ci:s oi ,iie Cibi of Eagan and with ihe Plumbing Codes; that I understand this is not a
pertnit, but only an appiication fn a;; :r ait, : nA wsrk is not to start without a permit; that the work will be in accordance vnth the
approved plan in the case of wor: ,;1:; -: ieq..r, :s a.°view and approval of plans.
?
Applicant's Printed Nar:e ,. t`s Signature
Use BLUE or BLACK Ink
r------'---------_.-.
I For Office Use
~zn?fig ; Permit City of EaV
I Permit Fee:
3830 Pilot Knob Road
Eagan MN 55122 ; Date Received: 3 I ;
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff: I
I I
4 2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Unit
Date: Site Address: 2 14 2~alswm Ty
Name: Vl wyt 1 C,t/Y► Phone:
Resident/ Z
Owner Address / City / Zip: lagli& M_T
Applicant is: Owner _1L Contractor
Type of Work Description of work:T aA, eaa!(
Construction Cost: 3/ Q OD Multi-Family Building: (Yes / No
Company: Contact: A0 L40 scig ig. L
Contractor Address: tC3 3 City: 77t//A&AC4 69-
State: Zip: SSt Phone: l Z~ 3 26" Z-~
License ,bG 637,1V Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
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:
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.
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 plan 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 must be completed within 180
days of permit issuance.
M
x1 Z•--
Applicant's Pri a ame Ap licant's Signature
Page 1 of 3
Use BLUE or BLACK Ink
/4111For Office Use �j 1 `��
::e:
1111 U to of aan ,Nd .o >1
� ',
3830 Pilot Knob Road
Eagan MN 55122 Date Received: 1- I�
Phone:(651)675-5675 /3
Fax:(651)675-5694 Staff: (f
2017 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit#:
Name: Ti r" 4._t Z. Phone: k /-755- £1707
Residentl
Owner Address/City/Zip: h2/01 9Q I s a,rr. T R E
Applicant is: Owner X Contractor
Type of Work Description of work: /Qt..) D tc.K
Construction Cost: 17t 0 0 0 Multi-Family Building:(Yes !Noel' )
Company: De(. (GS urn I i r.. Contact: Ro.noi y M o
Contractor Address: S 40 3r..4 s r City Co Karo
State:phi/ Zip:55 ) Phone: ilk?-811-OSoo9Email: prlotmot)! °' yq Kov. E 0444
License#: L3 C teal }CS Lead Certificate#: ,(/o,r 1 t'(0 ? ) 'a
If the project is exempt from lead certification, please explain why:
"i-cr )a (,\
.2l. 7' l
/JU'(.i /Al &L'
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:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer&Water Contractor: Phone:
Fire Suppression Contractor: Phone:
NOTE:Plans and supporting is that you submit are considered to be pubTx Inforrnatlon,'`Portions of
the informsion 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 u City damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.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.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
x 0.nat7 tlq, x
Appi nt's Printed Name Applicairoture
Page 1 of 3
.D-,--
ic--7 i i DO NOT WRITE BELOW THIS LINE J�
SUB TYPES
—
Foundation _ Fireplace _ Porch(3-Season) _ Exterior Alteration(Single Family)
Single Family _ Garage _ Porch(4-Season) _ Exterior Alteration(Multi)
—
MultilG
,q Deck — Porch(Screenazebo!Pergola) Miscellaneous
01 of Plex Lower Level Pool Accessory Building
WORK TYPES
New _ Interior Improvement _ Siding _ Demolish Building*
_ Addition Demolish interior
_ Move Building _ Reroof _
Alteration _ Fire Repair _ Windows _ Demolish Foundation
Replace _ Repair Egress Window _ Water Damage
Retaining Wall *Demolition of entire building-give PCA handout to applicant
DESCRIPTION lb
Valuation 6 slat, v Occupancy la G -/ MCES System —
Plan Review Code Edition ,2.0/.9- SAC Units ---
(25%
(25% 100% V Zoning it - 1 City Water
Census Code 1713 4 Stories Booster Pump —
#of Units / Square Feet 3 0 r PRV
#of Buildings ) Length °,l 4 Fire Suppression Required
Type of Construction ini Width 1 7
REQUIRED INSPECTIONS
Footings(New Building) Meter Size:
Footings(Deck) Final/C.O.Required_
Footings(Addition) Final!No C.O.Required
Foundation Foundation Before Backfill HVAC_Gas Servide-Test Gas Line Air Test
Roof:_Ice Water _Final Pool:_Footings Air/Gas Tests _Final
Framing 30 Minutes_1 Hour Drain Tile
Fireplace:_Rough In Air Test _Final Siding:_Stucco Lath _Stone Lath _Brick_EFIS
Insulation Windows
Sheathing Retaining Wall:!Footings_Backfill_Final
Sheetrock Radon Control
Fire Walls Fire Suppression:_Rough In_Final
Braced Walls Erosion Control
Shower Pan Other:
Reviewed By: 101
� Building Inspector
RESIDENTIAL FEEfil �. ow
Base Fee /.�� 3 g �!j /34 c� 10 / b).a
Surcharge
Plan Review S/G
MCES SAC
City SAC
Utility Connection Charge
S&W Permit&Surcharge
Treatment Plant
Copies
TOTAL
Page 2 of 3
M19 , /.sem Jr 4=-_,-, / 39V, —
Certificate for: �S
� ' Bk: 100/12
Sverld Peterson •
4701 West 110th Street '►IV.
Bloomington, Minnesota 55437
DELMAR H. SCHWANZ
I AND SURVEYORS INC
R.a I.,.d Und.,i awe of TI,.Slat.M Mhnnr.OI$
14750 SOUTH ROBERT TRAIL ROSEMOUNT, MINNESOTA 55068 PHONE 61Z 451188
SURVEYOR'S CERTIFICATE
levee
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Q2c,,, 777 .
AP
10PJNe
° 90.5 4
.
a� .c i� ` p
EAGAN ,, ` a°o
RE- '' ,f',. ':V‘i E a „-
:,.., ikv ,), ' ,if.,
,,
EY: ,4� Proposed �';� \',
1 `DATE: .7/§//7 ,,,_ '� \ PIOUS; /-� 1�y S
, foeevi
BUILDING I. n 3� 'u \ '
®�?p D�VI.yr %. 8 Garage / V
91�
�K,9 � 0)0' d
Scale: 1 inch = 30 feet cp 14 4 7 ' 42cl
o Denotes iron monument — " S iO
'� ly.�g 7 / L,i 0 3 V
O Denotes set wood hub , '99 � ti oik'''
,�� 11(1
I Denotes existing elevation O, . .
\ _ SQA ll� '
(
Denotes proposed elevation ` /b loo �l7�
00.g n �+PC��6
.0 ,..0
I hereby certify that this is a true and correct representation of Lot 8,
Block 4, WILDERNESS PARK ADDITION, according to the recorded plat thereof,
Dakota County, Minnesota.
Also showing the location of a proposed house as staked thereon.
Dated: June 24, 1986. /
IAL
4 21 /
11 / / /
MINNESOTA REGIS RATION NO. 8625/