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4359 Bent Tree Lane 0 0 RESIDENTIAL BUILDING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB RD, EAGAN MN 55122 651-681-4675 L'J 3 rv~ 2 W -r New Construction Requirements J J RemodeUReaair Reauire=nta • 3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and all roofed areas • 2 copies of plan (20% maximum lot coverage allowed) + 1 set of Energy Calculations for heated additions • 2 copies of plan showing beam & window sizes; poured found design, etc.) • 1 site survey for exterior additions & decks • 1 set of Energy Calculations • Indicate if home served by septic system for additions • 3 copies of Tree Preservation Plan Slot platted after 7/1/93 • Rim Joist Detail Options selection sheet (bldgs with 3 or less units) DATE VALUATION SITE ADDRESS 7 T14eff ~~C4_ MULTI-FAMILY BLDG yY TYPE OF WORK ~S/ FIREPLACE(S) _ 0 _L,~ 2 APPLICANT STREET ADDRESS 4~s~ /Ae CITYe1;aL-411f1C STATE/Olff)ZIK+~ Osy TELEPHONE # l 876 CELL PHONE # FAX # PROPERTY OWNER I E q"ua" TELEPHONE # COMPLETE FOR "NEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category _ MINNESOTA RULES 7670 CATEGORY 1 T'6 (4 submission type) + Residential Ventilation Category 1 Worksheet Submitted • n fc7jy Workshe bmitted + Energy Envelope Calculations Submitted S EP 1 12002 Plumbing Contractor: Phone # _ Plumbing system includes: r Water Softener Lawn Sprinkler' Fee: $90.00 Water Heater _ No. of R.I. Baths No. of Baths Mechanical Contractor: Phone # Mechanical system includes: A Air Conditioning Fee: $70.00 Heat Recovery System Sewer/Water Contractor: Phone # 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 Ordi ances. Signature of Applicant - - - OFFICE USE ONLY Certificates of Survey Received _ Tree Preservation Plan Received Not Required Updated 4/02 OFFICE USE ONLY ❑ 01 Foundation ❑ 07 05-piex ❑ 13 16-piex ❑ 20 Pool ❑ 30 AccessoryBldg ❑ 02 SF Dwelling ❑ 08 06-piex ❑ 16 Fireplace ❑ 21 Porch (3-sea.) ❑ 31 Ext. Alt - Multi ❑ 03 01 of piex ❑ 09 07-piex ❑ 17 Garage ❑ 22 Porch/Addn. (4-sea.) ❑ 33 Ext. Alt - SF ❑ 04 02-piex ❑ 10 08-piex ❑ 18 Deck ❑ 23 Porch (screened) ❑ 36 Mufti ❑ 05 03-piex ❑ 11 10-piex ❑ 19 Lower Level ❑ 24 Storm Damage ❑ 06 04-piex ❑ 12 12-piex Plbg,_Y or _ N ❑ 25 Miscellaneous ❑ 31 New ❑ 35 Int Improvement ❑ 38 Demolish (interior) ❑ 44 Siding ❑ 32 Addition ❑ 36 Move Bldg. ❑ 42 Demolish (Foundation) ❑ 45 Fire Repair ❑ 33 Alteration ❑ 37 Demolish (Bldg)' ❑ 43 Reroof ❑ 46 Windows/Doors ❑ 34 Replacement 'Demolition (Entire Bldg only) - Give PCA handout to applicant Valuation Occupancy MC/ES System Census Code Zoning City Water SAC Units Stories Booster Pump Nbr. of Units Sq. Ft. PRV Nbr. of Bidgs Length Fire Sprinklered Type of Const Width REQUIRED INSPECTIONS Footings (new bldg) _ Final/C.O. Footings (deck) Final/No C.O. Footings (addition) Plumbing Foundation _ HVAC Drain Tile Other Roof Ice & Water _ Final Pool _ Ftgs Air/Gas Tests -Final Framing Siding _ Stucco _ Stone Fireplace i R.I. i Air Test _ Final Windows (new/replacement) Insulation _ Retaining Wall Approved By , Building Inspector Base Fee Surcharge Plan Review MC/ES SAC City SAC Water Supply & Storage S&W Permit & Surcharge Treatment Plant Plumbing Permit Mechanical Permit License Search Copies Other Total 0 -2 3 7 0 r-24 aa Req t Date Fire No. Rough-In Inspection Required spection Other Than Rough-In 'You usE~ll inspector when ready) ❑ Ready Now Will Notify Inspector Yes E) No Date Ready I 194,censed contractor ❑ owner hereby request inspection of above electrical work at: Job ddress (S et, Boz or to No.) / City,,- Section No. Township Name or No. Range No. County a Occupant (PRINT) a Phone No. Power Supplier Address Electrical Contractor (Company Name) Contractor's License No. Mailing Address ontraotor or Owner M king Inst Ilation) f y y 1 V ~~~r Authorized Sign ur (Contractor/Owner Making Installation) Pho umber 3 9, MINNESOTA STA BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT 1821 University Ave., St. Paul, MN 55104 Griggs-Midway Bldg. -Room S-128 Ilil~ i!!i !I1lI IIlII 911! VIII IIIII 111118111 lilll UNLESS PROPER INSPECTION BY THE STATE BOARD Phone (612) 642-0800 I r_ REQUEST FOR ELECTRICAL INSPECTION jl~ see instructions for completing this form on back of yellow copy. t (3'00001-09 4~+~ X' Below Work Covered by This Request Ne Add Rep. Type of Building AppliaTtces Wired Equipment Wired jC Home Range Temporary Service Duplex Water Heater Electric Heating Apt. Building Dryer Load Management Comm Andustrial Furnace Other (Specify) Farm Air Conditioner Other (specify) Contractor's Remarks: Compute Inspection Fee Below: # Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee Swimming Pool 0 to 200 Amps 0 to 100 Amps Transformers Above 200 Amps I 1__ Above 100 Amps Signs Inspector's Use Only: TOTA 2% Irrigation Booms Special Inspection Alarm/Communication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT Other Fee COMPLETED WITHIN 18 MONTHS. 1, the Electrical Inspector, hereby Rough-in ate ;rr off certify that the above inspection has Final Dat been made. OFFICE USE ONLY This request void 18 months from a 1 r ~ 43058/ Request Date F e No. Rough-in Inspection OTICE: You Must Call Electrical Inspector - / - ~1 Requird? If A Rough-in Inspection l4a ~ gees ❑ No Is Required. L- llicensed contractor ❑ owner hereby request inspection of above electrical work at: Job Addr s (Street, Box or Route No.) City 73.5 1 Section No. Township Name or No. Range No. Co Occupant PRINT) Phone No. Power plier Address ` Electrical tractor (Company Na e) Contractor's ense No. Mailing Address ontractor or Owner Making Installation) / W L Authorized S nature (Contractor/Owne aking Installation) Phone Number S, -63 ~ MINNESOTA STATE BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL. NOT Griggs-Midway Bldg. - Room S-173 BE ACCEPTED BY THE STATE BOARD 1821 University Ave., St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS Phone (612) 642-0800 ENCLOSED. REQUEST FOR ELECT°a-4SPECTION Ee-ooool-0 See instructions for completi ion back of yellow copy. It. M 4 3 0 5 8 Below Work Covered by This Request e Add ? e7' - TypeofBuilding Appliances Wired Equipment Wired Home Range Temporary Service Duplex Water Heater Electric Heating Apt. Building Dryer Load Management Comm./Industrial Furnace Other (Specify) Farm Air Conditioner Other (specify) Contractor's Remarks: Compute Inspection Fee Below: # Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee Swimming Pool 0 to 200 Amps - 0 to 100 Amps Transformers Above 200 Amps e 100 Amps Signs Inspector's Use Only: TOTAL Irrigation Booms Special Inspection Alarm/Communication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT Other Fee COMPLETED WITHIN 18 MON oa I, the Electrical Inspector, hereby Rough-in D 1 /3-$ 3 certify that the above inspection has Final D t been made. OFFICE USE ONLY This request void 18 months from PERMIT ' CITY OF EAGAN 3830 Pilot Knob Road PERMIT TYPE: BUILDING Eagan, Minnesota 55122-1897 Permit Number: 0 2 7 6 8 5 (612) 681-4675 Date Issued: 05/23/96 SITE ADDRESS: 4359 BENT TREE LANE LOT: 6 BLOCK: 3 AUTUMN RIDGE 3RD P.I.N.: 10-12302-060-03 DESCRIPTION: t Building Permit Type DECK Building Work Type NEW "Census Cade 434 ALT. RESIDENTIAL REMARKS: FEE SUMMARY: Base Fee $45.00 COPIES 1.00 Surcharge .50 Total Fee $46.50 Subtotal $45.50 CONTRACTOR: - Applicant - ST. LIC.OWNER: REPUBLIC HOMES INC 15466439 0009183 FINK ANDREW 2505 CHEYENNE CIR 4359 BENT TREE LN MINNETONKA MN 55343 EAGAN MN 55123 (612) 546-6439 (612)688-3256 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 Mn. L Statutes and City of Eagan Ordinances. PPMANT/PERWEE SIGNATURE ISSUED BY-.-NQNATURE- 44~ 14stf CITY OF EAGAN 3830 PILOT KNOB RD - 55122 1996 BUILDING PERMIT APPLICATION (RESIDENTIAL), 681-4675 New Construction R2ouirements Remodel/Regpir Re_ouirements ♦ 3 registered site surveys ♦ 2 copies of plan ♦ 2 copies of plans (include beam & window sizes; poured fnd. design; etc.) ♦ 2 site surveys (exterior additions & decks) ♦ 1 energy calculations ♦ 1 energy calculations for heated additions ♦ 3 copies of tree preservation plan if lot platted after 7/1/93 required:f_ Y/es No DATE: CONSTRUCTION COST: 620°!' DESCRIPTION OF WORK: l'/ A ad STREET ADDRESS: `35'9 ~rc~ ! Inc e G~ LOT BLOCK SUBD./P.I.D. - autau, R Au, 3N( i 1< PROPERTY Name: Ilmd'c -J Phone 3,.2 5- OWNER LAST FIRST ~•1~ Street Address: "-/3 5-9 deic~ c n, City: c r y State: Zip: 5-5-f>3 CONTRACTOR r-, . Company: RTp~c.~l~c Phone .21&--k`1 ~ 2 IF Street Address: License* d ?Z 3 City: kt,J A State: b"-✓ Zip: ARCHITECT/ Company: Phone ENGINEER Name: Registration Street Address: City: State: Zip: Sewer & water licensed plumber: Penalty applies when address change and lot change are requested once permit is issued. 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 SAY 14 1sss I Certificates of Survey Received Yes No Tree Preservation Plan Received Yes No _ _ _ _ _ _ . _ _ I~ OFFICE USE ONLY BUILDING PERMIT TYPE ❑ 01 Foundation ❑ 06 Duplex ❑ 11 Apt./Lodging ❑ 16 Basement Finish ❑ 02 SF Dwelling ❑ 07 4-plex ❑ 12 Multi Repair/Rem. ❑ 17 Swim Pool ❑ 03 SF Addition ❑ 08 8-plex ❑ 13 Garage/Accessory ❑ 20 Public Facility ❑ 04 SF Porch ❑ 09 12-plex ❑ 14 Fireplace ❑ 21 Miscellaneous ❑ 05 SF Misc. ❑ 10 - plex 15 Deck WORK TYPE PP 31 New ❑ 33 Alterations ❑ 36 Move ❑ 32 Addition ❑ 34 Repair ❑ 37 Demolition GENERAL INFORMATION Const. (Actual) Basement sq. ft. MC/WS System (Allowable) Main level sq. ft. City Water UBC Occupancy sq. ft. Fire Sprinklered Zoning sq. ft. PRV # of Stories sq. ft. Booster Pump Length sq. ft. Census Code. Depth Footprint sq. ft. SAC Code l Census Bldg y=~ Census Unit APPROVALS Planning Building Engineering Variance Permit Fee Valuation: $ Surcharge Plan Review License MCJWS SAC City SAC Water Conn. Water Meter Acct. Deposit SM Permit SM Surcharge Treatment PI. Road Unit Park Ded. Trails Ded. Other Copies 100 Total: % SAC SAC Units sate of House Location For: ;,oerworks Builders, Inc. File d29 Trotters Ridge Road Eagan, MN 55123 DELMAR H. SCHWANZ LAND SURVEYORS. INC. M0t«N IMMr Low$ of The Sate Of M,nnofd/ 14750 SOUTH ROBERT TRAIL ROSEMOUNT, MINNESOTA 55069 812/423.1769 SURVEYOR'S CERTIFICATE glB.ti ~ (Z'')I~ Scale: 1 inch = 30 feet E3 i~ I 0 = Iron pipe monument 1 O = Set wood hub / y1 x93 = Existing spot elevation tirV (o 3 ` Q = Proposed elevation L.° / • / ~ ~ ~ ~•y~ Q ~ Proposed garage floor elev. a Proposed top of block elevb_ h,~\~° R32 yy \Y;' 3 i- Proposed lowest level elev. ~ SEAS ~ N ~ { ,43 05~ v N t V \ \ t o0i `r' caps. o , 1\h / a~ 0~ S`-d a QELfVIAR H.' Zy d'Z 9P`~=G,~r6 ' SC~HCVVANz ~f ell P Description: Lot 6, Block 3, AUTUMN RIDGE 3RD ADDITION, according to the recorded plat thereof, Dakota County, Minnesota. Also showing the location of.a proposed I hereby certify that this survey. plan, or report was house as staked thereon - - Prepared by me or under my direct supervision and , that 1 am a duly Registered Land Surveyor under Z&& the laws of the Slate of Minnesota. 09-09-93 Delmar H. Schwanit Dated Minnesota Registration No. 8625 PERMIT C CITY OF EAGA N / 3830 Pilot Knob Road PERMIT TYPE: BUILDING Eagan, Minnesota 55123 Permit Number: 021940 (612) 681-4675 Date Issued: 09/23/93 SITE ADDRESS: 4359 BENT TREE LANE LOT: 6 BLOCK: 3 AUTUMN RIDGE 3RD DESCRIPTION: Building Permit Type SF DWG Building Work Type NEW UBC Occupancy R-3 M-1 Construction Type V-N Zoning R-1 c Building Length 63 ' Building Width 54 ' REMARKS: PRV S & W PLBR - VALLEY PLBG FEE SUMMARY VALUATION $171,060 Base Fee $888.00 MISCELLANEOUS $1.744.50 Plan Review $577.20 Total Fee $4,045.20 Surcharge $85.50 SAC $756.06 SAC % 166 SAC Units 1 Subtotal $2,300.70 CONTRACTOR: - Applicant - ST. LIC. OWNER: TIMBERWORKS BLDRS INC 16866911 0006352 TIMBERWORKS BLDRS INC 829 TROTTERS RIDGE RD 829 TROTTERS RIDGE RD EAGAN MN 55123 EAGAN MN 55123 (612) 686-0911 (612)686-6911 I hereby acknowledge that I have read this application and -tate that the information is correct and agree to comply with all applicable State of Mn. Statutes and City of Eagan Ordinances. r APPLICANT/PERMITEE Slq~ATUAFE` ISSU BY: SI ATURE I 1 REACTIVATE " U%~~ ~~~-~C ECITY OF EAGAN PEi-tMI ~ ~ 1993 BUILDING PERMIT APPLICATION . y 3 1993 681-4675 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, I ,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 Valuation of work 5 &V-0 Site Address: - Z,4,, -I E STREET SUITE # Tenant Name: (commercial only) LOT BLOCK 3 SUBD. 14v7VrwN P. I. D. 0 Descri tion of work: 51A)te L~ The applicant is: Owner ❑ Contractor ❑ Other (Describe) Name ~ 5 4~ zovgj Phone 6,86 -09// Property LAST FIRST Owner Address STREET STE City f4G.✓ State Zip Company Phone Contractor Address License # aQ? 52 Exp. City State Zip Company ~o,✓ /-~,ot,a~G Phone Architect/ Engineer Name Registration # Address 313/ ~ar/~ yF City State &,44,1_ z =5' Sewer & water licensed plumber l/~ ~1 ~~t/~iacG Processing time for sewer & water permits is two days once arlea has been approved. I . 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: Cv~•3eje~ ./r~2S OFFICE USE ONLY BUILDING PERMIT TYPE ❑ 01 Foundation ❑ 06 Duplex ❑ 11 Apt./Lodging ❑ L6.Basement Ftish W02 SF Dwg. ❑ 07 4-Plex ❑ 12 Multi. Misc. ❑ It Swifi Pool ❑ 03 SF Addition ❑ 08 8-Plex ❑ 13 Garage/Accessory ❑ 18 Comm./Ind. ❑ 04 SF Porch ❑ 09 12-Plex ❑ 14 Fireplace ❑ 19 Comm./Ind. Misc. ❑ 05 SF Misc. ❑ 10 Multi. Add'l. ❑ 15 Deck ❑ 20 Public Facility ❑ 21 Miscellaneous WORK TYPE 31 New ❑ 33 Alterations ❑ 35 Tenant Finish ❑ 37 Demolish ❑ 32 Addition ❑ 34 Repair ❑ 36 Move GENERAL INFORMATION Const. (Actual) Basement sq. ft. MWCC System vES (Allowable) 1st Fl. sq. ft. City Water -YES UBC Occupancy R-3 M 2nd F1. sq. ft. PRV Required Zoning R {1 Sq. Ft. total Booster Pumpp # of Stories Footprint Sq. ft. Fire Sprinkler Length G 3 ' On-site well Census Code Depth 5th, On-site sewage SAC Code APPROVALS Planning Building Assessments Variance Engineering REQUIRED INSPECTIONS ❑ Site ❑ Footing ❑ Framing ❑ Insulation ❑ Wallboard ❑ Final ❑ Draintile ❑ Fireplace Permit Fee valuation: $ 1Tt~~~ Surcharge Plan Review 6AIeAG- 3~ x (a ~ License Z x ~T_ m (z u" MWCC SAC City SAC = l Water Conn. III Water Meter Acct. De osit ~ S/W Permit 2, X I = l -Z) 032 S/W Surcharge 30x 56 I6$v Treatment Pl. 7-1 = 3,3 t~' Road Unit 15 Ll0 Park Ded. 3 x 2~~2 = Trails Ded. Copies 'S X 1s- -3 39w5 Other Total: ~ous~ SAC % /Do ,c~ I I SAC Units 5'41 ~ ~2L1 `1~1N E w Certificate of House Location For: Ti.mberworks Builders, Inc. File 829 Trotters Ridge Road Eagan, MN 55123 DELMAR He SCHWANZ LAND SURVEYORS. INC. 1HOtstMO/ Under Laws of the State of Mlnn"otta 14750 SOUTH ROBERT TRAIL ROSEMOUNT. MINNESOTA 55066 612/423-1789 SURVEYOR'S CERTIFICATE o0j I Scale: 1 inch = 30 feet p3 / o = Iron pipe monument Cl = Set wood hub / „434 = Existing spot elevation (D= Proposed elevation t1 ~ ~0 vpu / q y~oQ Proposed garage floor elev. L~s9 94o. S Proposed top of block elev. q3Z 5~ P Proposed lowest level elev. D a 0 o- S i o C o s .02 i DELMAR H. ti D-'2 g3TP-~`~rb SCHVvtN~: Z N25 Description: ~j Lot 6, Block 3, AUTUMN RIDGE 3RD ADDITION, according to the recorded plat thereof, Dakota County, Minnesota. Also showing the location of_a proposed 1 hereby certify that this survey. plan. or report was house as staked thereon - prepared by me or under my direct supervision and that I am a duly Registered Land Surveyor under the laws of the State of Minnesota. A&-O 09-09-93 Delmar H. Schwartz Dated Minnesota Registration No. 6025 u a LOT SURVEY CHECKLIST FOR RESIDENTIAL .~w m BUILDING IT APPLI ATION m > m ' PROPERTY LEGAL: MW, Ono= -IMP.0% as m W < co Date of survey: TZ 8 '1 zz 2 DOCUMENT STANDARDS ❑ Registered Land Surveyor signature and company 121~0 Building Permit Applicant B~ Q Legal description ❑ ❑ Address ❑ North arrow and bar scale Q ❑ 0 House type (rambler, walkout, split w/o, split entry, lookout, etc.) • Directional drainage arrows with slope/gradient W00-O Proposed/existing sewer and water services Street name 0 0 Driveway ELEVATIONS Existing t7 Sewer service V0 ❑ Lot corners ❑ Top of curb at the driveway io-OQD 0 Elevations of any existing adjacent homes Proposed ❑ Garage floor ❑ First floor g~ ❑ Lowest exposed elevation (walkout/window) ❑ 0 Property corners ❑ Front and rear of home at the foundation f PONDING AREAS (if applicable) 0 2 0 Easement line ❑ 0--*' ❑ NWL ❑ 0 HWL 0 C~ 0 Pond # designation 0 ~0 Emergency Overflow Elevation DIMENSIONS 0~0 0 Lot lines D/❑ 0 Right-of-way and street width (to back of curb) C7el"0 ❑ Proposed home dimensions including. any proposed decks, overhangs greater, than 21, porches, etc. (i.e. all structures requiring permanent footings) U K"6 ❑ Show all easements of record and any City utilities within those easements ❑ Setbacks of osed s ucture and setback of adjacent existing me 0 Retain' r ments, if any Reviewed: < ame / a e October 1992 Certificate of House Location For: Timberworks Builders, Inc. File 829 Trotters Ridge Road Eagan, MN 55123 45w DELMAR H. SCHWANZ LAND SURVEYORS. INC. naafabrd Under Laws of The Slale of Wnnasola 14750 SOUTH ROBERT TRAIL ROSEMOUNT. MINNESOTA 55048 412/429-1749 SURVEYOR'S CERTIFICATE I Scale: 1 inch = 30 feet 5 / I o = Iron pipe monument O = Set wood hub 1 x43 = Existing spot elevation IV Proposed elevation -f I 0 / • ~ ~ ~ U' ~ qy~ Q Proposed garage floor elev. Proposed top of block elev. Proposed lowest level elev. I - 93Z S~*h 1 N N j rv_ ~ gg9.S G1~~~ \ WL to I ` f i( rr~ v a0' ~c1 % qav ~ i ~~,.68 ' DELMAR H. s oz' SGHIY'VANZ Zy D Tr~G~rb --8625 j A rh 1.A '.~~Description : Lot 6, Block 3, AUTUMN RIDGE 3RD ADDITION, according to the recorded plat thereof, I~ Dakota County, Minnesota. Also showing the location of_a proposed I hereby certify that this survey. plan. or report was house as staked thereon - - prepared by me or under my direct supervision and % that 1 am a duly Registered Land Surveyor under the laws of the State of Minnesota. ij~ y~ wt/ vv~, 09-09-93 Delmar H. Schwan= Dated Minnesota Registration No. 4425 HTM0 exposed tr Z iota! f . Wall calcujatioi.~ . window area ibe--.0 WWI door Total glass ,door area Total wall framing Net Wsulated wall area y Total rim joist area Total foundation area -3ilw Total foundation window if item 3 to th. same as, or tess than item 1, yo~ Roof/ceiling Total sky! ight Total roof/ceiling framing Net insulated root area VTots! item 4 is samo as, or less than 2, you mot We intent if Aiternste building envelope desigi..i tO ut"!Lze the total envelop" system metnod the Eum of items 1 and 2 shall he greater Van the sum of ltem-.i~: certitty that the building here desoribud meeH~--, or exceeds We state of minnesota energy conselvatic" acU • :..f : i i pis i 'Fi to Q! LA 4 Yj S 'A CA yj Em al yj M 31 IN 71 L AN y. CA at vj to C4 so 14 0 1 CA UT to -M K 0 so -,*D, 04 K, v? in Q CITX OF EAGAN PERMIT 3830 Not Knob Road PERMIT TYPE: B U I L D I N G Eagan, Minnesota 55122-1897 Permit Number: 0 2 5 7 2 2 (612) 681-4675 Date Issued: 07/26/95 SITE ADDRESS: 4359 BENT TREE LANE LOT: 6 BLOCK: 3 AUTUMN RIDGE 3RO P.I.N.: 10-12302-060--03 DESCRIPTION: Building Permit Type BASEMENT FINISH Building Work Type ALTERATION REMARKS: SEPARATE PERMITS REQUIRED FOR PLUMBING AND ELECTRICAL WORK FEE SUMMARY: VALUATION $1,500 Base Fee $35.00 COPIES 6.00 Surcharge $.50 Total Fee $45.50 Lic. Search Fee 5.00 Subtotal $40.50 CONTRACTOR: - A p p l i c a n t- ST. L I C. OWNER: PAULSON CONST INC 14270033 00006329 FINK ANDREW P 0 BOX 247 4359 BENT TREE LANE ANOKA MN 55303 EAGAN MN (612) 427-0033 (612)688-3256 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 Mn. Statutes an City of Eagan Ordinances. APPLICANTJPERMITEE SIGNATURE ISSUED B : SI TUR CITY OF EAGAN 3830 PILOT KNOB RD 56122 1998 BUILDING PERMIT APPLICATION (RESIOENTIAL) 6814878 2 COPW d` pi *WkWe beam & WMW oftc Pwrod fnd. ds~n, Ste.) 2 oft SWOP ~ Sddkm & dit*lg) 1 armor s adClit~ons 2 ftow of V" promwwMm pion p far piptted aRer 7m93 mq&*W: _Yes No DATE: CONSTRUCTION COST: 0ESCRI13TION OF VORK: s ra ADDRESS: ' ~3 L ST!~IFT Lt~T BLOCK ~ SLW.IP.i.D. p'i'tOPERTY Name: ~tl Al"'Pew Phone # POW CItR Street Addrsss• city: gg ' State; zio* 41 Co vt- C CTOR Company: 41s7" Phone #:.,._......,Q, Street Address: )d~o. ,eox LI Stem: cv:.,._. _ _ ARCHiTECTI Company: kles Phone 7? 0110 5 19 EER + Name: U) L ' Street Address- s 4 , 3_-, City: _-S yuL k State: ,Feuer S water licensed plumber. # as4y apposs, when address oange and tot dwVe are requested once permit is rued. i hw*W acknowledge that l have read this opkation and state ttrat the itft"a t is-oorred and to J With 24 appkWe State of Wnnesota Statutes and City of Eagan Ordinances. Signature of Applicant OFFICE USE ONLY -Cettillowles of Survey Received . Yes No 30 MAY 30 Tree Preservation Plan Received Yes No OFFICE USE ONLY BUILDING PERMIT TYPE a 01 Foundation a 06 Duplex 0 11 Apt.A odging 1s- Bas rent Firdsth a 02 SF Dwelling o 07 4-plex o 12 Multi Repair/Rem. o 17 Swim Pool 0 03 SF Addition o 08 8-plex a 13 Garage/ spry o 20 Public Facility 0 04 SF Porch o 09 12-plex o 14 Fireplace a 21 Miscellaneous a 05 SF Mme. a 10 -plex o 15 Deck WORK TYNE a 31 New X33 Aerations o 36 Move 0 32 Addition a 34 Repair a ` 37 Demolition GENERAL INFORMATION Co t. (Actual) Basement sq. fit. M ' S Syste rn (Allow") Main level sq. ft. City Water UBC Occupancy sq:'ft. Fire 3prfn . Zoning sq. ft. #tV # of Stories sq:,ft. Witter Pump Length sq. ft. Cetus Code...... Depth Footprint sq. ft. SAC Code Census BWQ Census Unit APPROVALS Planning Building„ EngineeringVariance Permit Fee Valuation: $ lr~ Surcharge Plan Review License >5~ MC/WS SAC City SAC Ws W Conn. Water meter Acct, Deposit SAN Permit S/W Surcharge Treatment Pl. Road Unit Park Ded. Trans lied. Other Copies Total: % SAC AC Units s INSPEMON ORD ~ Pitt 4(nob Road Port Nurnar. Wit. inr*sota 5512OM Issued: t. I:t r s. TYPE Oll Wolf. I_ELr(; MORN ~ trt 1 f4At4r ii 14-5. f 1 i A. Ut It 1+1 f TR f? L a ' t 1441 F' 1' A(' 1' Rf 14Arxt POV 1„1 Vt 140 VAt t 1': V 1''1 t PLUMOM: tt~11rC MsAf `aIA6 1~~►l` rte' o d ,y► L + ft FNwpbo. - lr MUM4W Corot mew EnWA%n Bldg. Fk* Deck wag pr. Dip.--- . w Address 4359 BENT I121E LANE Zip 5512„x,_ d < . Lot 6 Blk 3 Sub _ Aunm Rnxx 3RD THESE ITEMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECTION. Date: 13/94 Yes No Inspector: 0 1/ Final grade (6" from siding) Permanent steps (garage) j/ 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 6824645 before working in right-of-way or installing underground sprinkler system. White - City Copy Yellow - Resident Copy Pink - Contractor Copy INSPECTION RECORD CITY OF EAGAN ' PERMIT TYPE: 3830 Pilot Knob Road Permit Number: 7a6 Eagan, Minnesota 55122-1897 Date Issued: 0 /2 /143 (612) 681-4675 €'.t. t. 0- 1 40~~.f 5 SITE ADDRESS: APPLICANT: 4 3!',4f1 W'1041 114 F 1 "t ~11 1 it13~ It- 110 _ tN r A 11.1104 R40fif 11.13 i s1 Y1 fy46..,643 r S PERMIT SUBTYPE: TYPE OF WORK: , Id V. W PWU* No. Porn* Hoid®r Mft ToiWwne # ELECTRIC PL i HVAC InaWtlon. Dow Msp. Comments FOOTINGS %lf~ FOUND FRAMING ROOFING ROUGH PLULMING A TEST RE HUGH GAS SVC TEST INSUL GYPBOARD FIREPLACE FIREPLACE AIR TEST FINAL PLBG FINAL HTG ORSAT TEST BLDG FINAL BSMT R.I. BSMT FINAL DECK FTG DECK FINAL INSPECTION ARVOORD, Cr Y OF EAGAN "PERmrr TYP : , .M Pilot, Knob Road Permit Number. Win, Minrwsota 55122-1897 Dates hued: (812) 681-4675 " Fes" SUBTYPE: TYPE OF WORKO* R A M I N to f t# kk ~ Pd Uri V' MA t a J r~ t<~ ! cif! ~.tity Pi~ppit Ito. 1~Mnalt llMr # PLUMBM NOW" caft r, FOUM FRAitBlt4 ' i f ROOM". i k ft j TIM i i GYP BOARD FIFBWLACE~ E A1R TEST FW& KM ORSAT TIM BLDG ICOM 88kR R.I. OECK "0 DECK FPM I Werti f icate of Cccnpanc~ with of Wagan ZCV 1 r tment of znitbing anepection This Certificate issued pursuant to the requirements of the Uniform Building Code certifying that at the time of issuance this structure was in compliance with the various ordinances of the City regulating building construction or use. For the following: Use Classification: SF i14d(: Bldg. Permit No. 2 IQ4W Occupancy Type R3AII Zoning District R 1 Type Const. VN Owner of Building TIl {S ]RIMS TIC Address 879 TRtyM-q RTC RDA EAGAN Building Address 4359 EM ITM TANS Locality TA, R3 AIM MST RT= 3RD Date: 0 11 W% Building Official POST IN A CONSPICUOUS PLACE, PERMIT City of Eagan Permit Type:Building Permit Number:EA144651 Date Issued:08/03/2017 Permit Category:ePermit Site Address: 4359 Bent Tree Lane Lot:6 Block: 3 Addition: Autumn Ridge 3rd PID:10-12302-03-060 Use: Description: Sub Type:Reroof Work Type:Replace Description:Does not include skylight(s) 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 within 10 feet of all sleeping room openings in residential homes (Minnesota State Building Code). 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 - James R Rock 4359 Bent Tree Lane Eagan MN 55123 Hoyt Exteriors Inc 16626 Flounder Ave Rosemount MN 55068 (651) 246-4801 Applicant/Permitee: Signature Issued By: Signature 1 DEPARTMENT OF HEALTH Protecting, Maintaining and Improving the Health of All Minnesotans February 20, 2020 City of Eagan—Planning Commission 3830 Pilot Knob Road Eagan,MN 55122 City of Eagan: The Minnesota Department of Health in consultation with the League of Minnesota Cities and the Minnesota Association of Townships, has agreed to notify local government officials when a Housing with Services Establishment subject to Minnesota Statutes 144D has been registered by the Minnesota Department of Health. This notice is to inform you that the establishment listed below has been registered in your community. Brookview Cottage 4359 Bent Tree Lane Eagan,MN 55123 651-340-6540 This notice does not require any action by your local unit of government, nor does it create a right of the local unit to intervene in the registration process of the establishment. It is being provided as a courtesy only. Because the above named establishment may provide services to residents who would need special assistance in the event of an emergency,you may wish to notify the emergency service providers for your city or town that this establishment is now located in your community. A list of currently registered Housing with Services Establishments may be accessed on the Minnesota Department of Health website,through the following link: http://www.health.state.mn.us/dies/fpc/directory/providerselect.cfm Additional information about Housing with Services registration may be accessed through the following link: http://www.health.state.mn.us/divs/fpc/profinfo/lic/lichws.htm If you have any questions about this notice, please contact 651-201-4101. Other questions should be directed to your local government association or legal advisor. Thank you for your attention to this matter. /4 � UMelissa Poepping, Health Program Representative Senior "p` se'/ ��' Program Assurance I Licensing and Certification Minnesota Department of Health 9V010 P.O. Box 64970 SU Saint Paul, Minnesota 55164-0970 Phone:651-201-4117 Email: melissa.poepping@state.mn.us CC: Licensing and Certification File An equal opportunity employer. 2/27/2020 HB101 Minnesota-Assisted Living at Housing with Services Establishments Housing Benefits 1 Your Home.Your Choice. Assisted Living at Housing with Services Establishments updated December 24,2019 Add to favorites Many seniors and people with disabilities live in housing that is described as including"assisted living"or being an"assisted living facility."Any place that says it offers assisted living must be registered by the Minnesota Department of Health (MDH)as a Housing with Services establishment. Housing with Services establishments Housing with Services establishments include many types of housing for seniors and people with disabilities.Housing with Services establishments can be individual apartments where you get services or can be more like group homes,such as Board and Lodge or Housing Support(formerly Group Residential Housing).You won't usually see places with the words"Housing with Services"in their names;that's just the name of the state registration. Each Housing with Services establishment offers a different set of services.Some offer minimal services,such as one meal per day or weekly housekeeping,while others may have 24-hour assistance on-site to help with things like dressing,bathing,and toileting.All Housing with Services establishments have to have a full description of the services they offer and detailed information about how much their rent and services cost.You can ask any establishment for this information. What It Is While all Housing with Services establishments include some services,Housing with Services establishments that are described as having assisted living must have a staff person awake and available at all times to help residents. These establishments may offer services that help with your daily living,such as: • Cooking • Cleaning • Laundry • Help taking medications,and • Personal care assistance services,like help during meals,toileting,bathing,and dressing. Similar services in your home You can get services in your own home that are similar to the assisted living services at Housing with Services establishments.For example,you can get help with cooking,cleaning,bathing,and more.One way to learn what services or programs might help you with your needs is to contact your local county human services agency and request a MnCHOICES assessment. You can request a MnCHOICES assessment,even if you think you don't qualify for public benefits.Within 20 days,the county must send an assesor to help review your situation and see which long-term care programs or services might help you.If you might qualify for public benefits,the county will help you fill out the application forms. How You Pay You pay a monthly amount that includes your room,board,and services.Many people pay with money they have in savings or income.If you qualify for Medical Assistance(MA),you may be able to get help paying for services through the Elderly Waiver(EW)program,Brain Injury(BI) waiver program,or Community Access for Disability Inclusion(CADI)waiver program. You may qualify for Housing Support(formerly Group Residential Housing)benefits that help pay for your room,board,and sometimes services in Housing-Support-approved locations,including some Housing with Services establishments. Get Help To learn more about assisted living at Housing with Services establishments: • Chat with a Hub expert • Call the Senior LinkAge Line®(SLL)at 1-800-333-2433 To find a Housing with Services establishment that offers assisted living,see Minnesota's Senior Housing Directory and the Twin Cities Senior Housing Guide .You need the Adobe Flash Player to view these guides,so they won't work on most mobile devices(most laptop and desktop computers already have it installed). C"'.1 Local Services More on Housing Benefits 101 https://mn.hb101.org/a/16/ 1/2 2/27/2020 [ pt HB101 Minnesota-Assisted Living at Housing with Services Establishments MinnesotaHeIp in o Services Personal Care Assistance(PCA)Program Try these searches: MA-Waiver Programs Adult Foster Care • Assisted Living Facilities • Registered Housing With Services Establishment Housing Support(formerly Group Residential Housing) Board and Lodge Copyright CO 2020 Housing Benefits 101.Technology O 2002-2020 Eightfold Way Consultants . https://mn.hb101.org/a/16/ 2/2 2/27/2020 Housing with Services Establishments/Assisted Living Designation/Uniform Consumer Information Guide-Minnesota Dept.of Health Skip to Content (/index.html) WW DEPARTMENT OF HEALTH • HOME (/index.html) • TOPICS • ABOUT US (/about/index.html) 'Search Licensing and Certification • Becoming Licensed/ Federal Certification (/facilities/regulation/licensure.html) • Health Care Facility and Provider Database (/facilities/regulation/directory/index.html) • Nursing Home Survey Results (/facilities/regulation/directory/surveyfindings.html) • Resident and Provider Information (/facilities/regulation/consinfo.html) • Nursing Home Inspections (/facilities/regulation/nursinghomes/nursingpamplet.html) • Nursing Services Agencies SNSA (/facilities/regulation/snsa/index.html) • Paid Feeding Assistants in Nursing Homes (/facilities/providers/pfa/index.html) Health Regulation - Facilities and Professions • Facility Certification, Regulation and Licensing (/facilities/regulation/index.html) • Facility Manager Resources (/facilities/regulation/managerresources.html) • Choosing a Facility(/facilities/regulation/choosefacility.html) • Find a Provider(/facilities/regulation/findaprovider.html) • Verify a Facility License or Professional Credential (/facilities/regulation/verifyalicense.html) • File a Complaint(/facilities/regulation/filecomplaint.html) • View Facility and Provider Complaint and Survey Findings (/facilities/regulation/viewcomplaint.html) • Resident and Provider Resources (/facilities/regulation/consinfo.html) • Reports (/facilities/regulation/legislativerpts.html) • About Health Regulation Division (/about/org/hrd/index.html) Related Sites • Health Care Facilities, Providers and Insurance (/facilities/index.html) Housing with Services Establishments/Assisted Living https://www.health.state.mn.us/facilities/regulation/hws/index.html 1/3 2/27/2020 Housing with Services Establishments/Assisted Living Designation/Uniform Consumer Information Guide-Minnesota Dept.of Health Designation/Uniform Consumer Information Guide This page contains information and forms required to register as a Housing with Services Establishment(HWS) in Minnesota. These forms are intended to be downloaded and completed by individuals and organizations seeking to acquire an initial registration. Required forms for initial registration that must be submitted are: HWS Registration and Assisted Living Designation Form, Uniform Consumer Information Guide, and Addendum to HWS Registration Form. Please do not use these forms to renew a current registration. Currently registered establishments will receive separate notification and instructions for renewal from the Department of Health. If you are unsure this is the correct registration for your business or have questions, please contact the Licensing and Certification Program for additional clarification. Notification of Updates and Changes To receive notification of changes to this site, please subscribe to Information Bulletins. Forms HWS Registration and Assisted Living Designation Form (PDF) (/facilities/regulation/hws/docs/fpc926_1.pdf) Uniform Consumer Information Guide (UCIG)- 1/2014 (/facilities/regulation/hws/uciguide.html) This does not apply to an HWS establishment serving the homeless. Addendum to HWS Registration Form -5/2017 (PDF) (/facilities/regulation/hws/docs/hwsaddendum.pdf) HWS Closure Form (PDF) (/facilities/regulation/hws/docs/hwsclosure.pdf) Use this form if closing an HWS. HWS Change of Information Form (PDF) (/facilities/regulation/hws/docs/hwschange.pdf) Use this form if making changes to the HWS name, management agent or agent. Related Statutes Minnesota Statutes: 1144D (http://www.revisor.leg.state.mn.us/stats/144D/) 1144G (http://www.revisor.leg.state.mn.us/stats/144G/) I 325F.72 (https://www.revisor.mn.gov/statutes/?id=325F.72) Information Bulletins Information Bulletins (/facilities/regulation/infobulletins/index.html) See the Information Bulletin Index (/facilities/regulation/infobulletins/index.html)for bulletins coded "HWS" and "All Providers." Scroll down to "Information Bulletins by Year" and then click on the list for each year to find the appropriate bulletins. To receive email notification of new Information Bulletins posted, please subscribe to Information Bulletins. Dementia Training Information Housing with Services Dementia Training Information based on August 1, 2017 Online Renewals (/facilities/regulation/hws/hwsdata.html) Contact Information https://www.health.state.mn.us/facilities/regulation/hws/index.html 2/3 2/27/2020 Housing with Services Establishments/Assisted Living Designation/Uniform Consumer Information Guide-Minnesota Dept.of Health If you are unsure this is the correct registration for your business or have questions, please contact the Licensing and Certification Program for additional clarification: 651-201-4101 health.fpc-web@state.mn.us (mailto:health.fpc-web@state.mn.us) • Share This (http://www.addthis.com/bookmark.php?v=250&pub=mnhealth) Spotlight Minnesota eLicensing (https://mn.gov/elicense/agencies/#/list/appld/0/fi lterType/Agency/filterValue/230678/page/1/sort//order/) Questions? Please contact our Health Regulation Division: health.fpc-web@state.mn.us (mailto:health.fpc-web@state.mn.us)or 651-201-4101. See also: Health Regulation Division (/about/org/hrd/index.html) • Individual & Family Health (/people/index.html) • Health Care Facilities, Providers & Insurance (/facilities/index.html) • Data, Statistics and Legislation (/data/index.html) • Diseases & Conditions (/diseases/index.html) • Healthy Communities, Environment &Workplaces (/communities/index.html) • About MDH (/about/index.html) • Locations& Directions (/about/locations/index.html) • Comments &Questions (/forms/feedback/mail.html) • Privacy Statement& Disclaimer(/about/privacy.html) • Equal Opportunity (/about/equalopp.html) 651-201-5000 Phone 888-345-0823 Toll-free Information on this website is available in alternative formats upon request. (https://mn.gov/portal/) Wednesday,January 22,2020 at 10:57AM (https://www.phaboard.org/) https://www.health.state.mn.us/facilities/regulation/hws/index.html 3/3 EAGAN 3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 (651) 675-5675 I TDD: (651) 454-8535 I FAX: (651) 675-5694 bui ld i nainspectionsacitvofeagan.com rceiveio AY 16 �p BY: 2019 RESIDENTIAL BUILDING �1NY APPLICATION r 7c //6/ °C;$ Permit Fee: For Office Use Permit#: Date: 5/26/2020 Site Address: 4359 BENT TREE LN Date Received: Staff: .20 J Unit #: Resident/ Owner Name: ROB NEWHOUSE Phone: 651-308-1074 Address / City / Zlp: 15140 DUPONT PATH, APPLE VALLEY MN 55 24 aApplicant is: Owner i Contractor /4t1-itii,i iLiG6 Type of Work Description of work: INSTALL EGRESS CASEMENT 28"Wx42"H. HEADER: GABLE END, ADD TO EXISTING RIM JOIST. Construction Cost: $1800 Multi -Family Building: (Yes / No X ) Contractor Company: THE EGRESS WINDOW COMPANY AKA REVAMP REMODELING & DESIGN Contact: MARY M . D EVEN S Address: 4707 HWY 61 N #146 City: WHITE BEAR LAKE State: MN Zip: 55110 Phone: 612-231-0010 Email: revampdesign@comcast.net License #: BC634654 Lead Certificate #: F 114840-2 If the project is exempt from lead certification, please explain why: In the last 12 months, Yes No COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING has the City of Eagan issued a permit for a similar plan based on a master plan? If yes, date and address of master plan: Licensed Plumber: Mechanical Contractor: Sewer & Water Contractor. Fire Suppression Contractor: Phone: Phone: Phone: 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. You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's website at www.cltvofeagan.com/subscrlbe. 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. 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.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. .MARY M. DEVENS "Y14 Applicant's Printed Name Applicant's Signature DO NOT WRITE BELOW THIS LINE gc-m--T�i‘,/e/0/ Addition Alteration _ Replace Retaining Wall DESCRIPTION Valuation Plan Review (25%_ 100%* Census Code # of Units # of Buildings Type of Construction SUB TYPES ' Foundation Single Fami4 Multi 01 of _ Plex WORK TYPES New _ Interior improvement Move Building Fire Repair Fireplace Garage Deck Lower Level _ Porch (3-Season) _ Porch (4-Season) Porch (Screen/Gazebo/Pergola) Pool Repair 0.0 REQUIRED INSPECTIONS Footings (New Building) Footings (Deck) Footings (Addition) Foundation Foundation Before Backfill Roof: _Ice & Water _Final Framing ' 30 Minutes 1 Hour Fireplace: _Rough In Air Test Insulation Occupancy Code Edition Zoning Stories Square Feet Length Width Sheathing Sheetrock Fire Walls Braced Walls Shower Pan Exterior Alteration (Single Family) Exterior Alteration (Multi) Miscellaneous Accessory Building Siding _ Demolish Building* _ Reroof _ Demolish Interior _ Windows Demolish Foundation Egress Window _ Water Damage *Demolition of entire building - give PCA handout to applicant MCES System SAC Units City Water Booster Pump PRV Fire Suppression Required Meter Size: Final / C.O. Required Final / No C.O. Required HVAC _ Service Test Gas Line Air Test _ Hood Pool: _Footings Air/Gas Tests _Final Drain Tile Final Siding: _ cco Lath _Stone Lath _Brick _ EFIS Windows O.( 1,/\J I:NOOW Retaining Wa I: _ Footings _ Backfill _ Final Radon Control Fire Suppression: _Rough In _Final Erosion Control Other: Reviewed By: , Building Inspector RESIDENTIAL FEES Base Fee Surcharge Plan Review MCES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant Radio Meter Read Copies TOTAL Page 2 of 3