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1218 Balsam Tr EINSPECTION RECORD CITY OF EACAN PERMIT TYPE: ? Pilot Knob Road Permit Number: Eagan, Minnesota 55122-1897 Date Issued: (612) 681-4675 ? N I ?D ,?.-, •. ,?? ?, SITE ADDRESS: W1 L QE P Mt',:, 1'AttY f', I PERMIT SUBTYPE: :I ; APPLICANT: TYPE OF WORK: i F' ! I (IN t;tl I I I?I M( Glr'4%y!i??• ?, l r t I i n r i Rf wAl ?t (6l1M1M41 PFPI A(:t MPMf} ?') a?UV 1A ad'3 ¦ Permit No. Parmk Holder Date Tekphone ? ELECTRIC PLUMBING HVAC Inspectlon Date Insp. Comments FOOTINGS FDUND FRAMING ROOFING ROUGH PLUMBING PLBG AIR TEST ROUGH HEATING GAS SVC TEST INSUL GYPBOARD FIREPLACE FIREPLACE AIR TEST FINAL PIBG FINAL HTG ORSAT TEST BLDG FINAL BSMT R.I. BSMT FINAL DECKfTG DECK FINAL INSPECTION :CORD PERMIT TYPE: Permit Number: Date Issued: CITY OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55122-1897 (612) 681-4675 ? . 7.. ?ADDRESS: , ,, , . . 1,:,I •;nr1 ri< I i „trK I PERMIT SUBTYPE; 12 t) t OcK , . APPLICANT: f hIn .l TYPE OF WORK: ft,l i i GI :3 11 .! N P!' l / H:' ./ tl t1 INSPECTION D. . .. . ? IRKSt RI AM REVIEWF:CI !1l1t,f 'if,ti (1f".1'1'PIi.K ? 51(a (eo yY1?j _l Permit Holder Date Telephone p PLUMBING HVAC Inspection Date Insp. Comments FOOTINGS FDUND FRAMING ROOFING ROUGH PLUMBING PLBG AIR TEST AOUGH HEATING GAS SVC TEST INSUL GYPBOARD FIREPLACE FIREPLACE AIR TEST FINAL PLBG FINAL HTG ORSAT TEST BLDG FINAL DOMESTIC METER IRRIGATION METEfl FLUSH MAINS CONDUCTIVIN TCST HYOROSTATIC TEST BSMT R.I. BSMT FINAL DECK FTG DECK FINAL 6.; "G , 3795 Nlof Kaob Raed Eagaw, MN SS122 ` PHONE: 454-8100 BUILDING PERMIT aeceipt # Te 6e wed for Est. Volue Date , 19 Site Address • Erect ? Occupanty Lot Block Sec/Sub. Alter ? Zonlrq Pcroel # Repoir ? Fire Zone Enlorpe Q Type of Consf. aWc Name Move p # Stories ; lldd?ess Demolish ? Length ? Grode ? Depth Sa. Ft. Gr? o?,.,..? ?0 Nome ?U /lddress ?- ?:... .,? - - Name _ Address I hereby acknowledgs thot I how reod this opplicotion ond state thot the intormation is correct and ogree to wmply with all applicoble Sfote of Minnesoto Statutes and Ciry of Eogon Ordinances. /lsxssment Water 8 Sew. Police Ffro En0• Plonner Council Bidg. Off. APC Permit Surthorpa Plun check SAC Water Conn. Water Meter Rood Unit Totol Siynoturc of Permittes I A Bullding Permit Is issued to: on ths expross conditlon thai oll work shall be done in accorclance with oll applicoble Stote of Minnesota Statutea ond City of Eoyan Ordinances. BuildJnp Officlol Parmit No. Prrmit Halder Mise. Parmit No. Holder Plumbinp H.V.A.C. ?. I V-'(`ea VO 7-743 w.n w.csr Disp. Sftwr Ekctric wo-774q$ iiErw?? E(?c 7-1q`13 InWection Deft Insp. Othor Footinps 2. _ Foundetion Framiny - Rouph Plba Rough HVA Inwiation Flnal Plba. Final HVAC 15$3 ?- Final ?-2 Water Dosaibe Loeation: YYell ' S?w?r Pr. D'up. ? Reoeipt MECHANICAL PERMIT Permit No. ' ' CITY OF EAGAN I • Fae fill in numbered spaces S/C I Type or Print /egib/y I Tot. 1. Date 2. Installation Cost I 3. Job Address Lot -= ? Blk. Tract 4. Owner 5. Contractor Phone 6. Address 7. City State Zip 8. Building Type: Residential ? Commercial ? Institutional ? 9. Work Description: New ? Add 0 Alter O Repair ? 10. Describe Fuel Type 11. No. Equio ment 8TU - M. Ea. No. Equipment CFM Forced Air Ai H dli Mfg. r an ng: Boilers Mfg. Mech. Exhaust Unit Heater Mfg. Other Air Cond. Mfg. Gas, Piping Outlets 12. I hereby certify that the above information is true and correct, and I agree to comply with all ordinances and codes governing this type of work. Signed : for Rough F{nal Inspections: Date Insp. Date Insp. This is your permit when numbered and approved. Approved CITY OF EAGAN 464-8100 INSPECTION RECORD ? CITY OF EAGAN PERMIT TYPE: ? 3830 Pilot Knob Road Permit Number: ? Eagan, Minnesota 55122-1897 Date Issued: ; (612) 681-4675 I SITE ADDRESS: ', ? ?: :?1 •.nM ?1. !.. ? tfi 1 lIl kMt.'?', i'nl:k ? PERMIT SUBTYPE: ? I I , ,',m i Ni, APPLICANT: TYPE OF WORK: ?+r. I ,r1,rt1iic1 ?a i INn[ C R{ MAffF '. : `,( PAliA Tf t'#- kM l l f?V tj 111 ftP U t i+l: ANY l I 1 1 . TFr 1 C AI 11f1N1 ?I n I MfI W7lA.1 /p7, Us i i I i : ,.i Nr is ,iic 41 I ? _ ? ? ? , „ - .. . ?? . _ . .? ? ' ` - ------- ---- - - - - - - - PermR No. Permit Holder Oate Talsphone # ELECTRIC PLUMBING HVAC Inspecdon Date Insp. Comments FOOTINGS FOUND FRAMING 1! ? r ! ? ROOFING ROUGH PLUMBING PLBG AIR TEST ROUGH HEATING GAS SVC TEST INSUL GYP BOARD FIREPLACE FIREPLACE AIR TEST FINAL PLBG FINAL HTG ORSAT TEST BLDG FINAL ' L BSMT R.I. BSMT FINAL DECK FfG DECK FINAL - t 1 7 CITY OF EAGAN Remarks Addition Wilderness Park Lot 22 Rik 1 Parcel 10 84250 220 01 ownp?- '?L r Street 121$ East B21Sam Trail state Eagan,MN 55123 ,t0 {_ : . Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. STREET RESTOR. GRADING SAN SEW TRUNK ?? 1973 17 .05 8.80 20 SEWER LATERAL WATERMAIN WATER LATERAL WATER AFEA STORM SEW TRK STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. BUILDING PER. ? SAC p0 PARK ?7 67556 L A? aw'? ? 0 Ir Request Oaie - o Fire No. Roughin Inspection Required7 ?Reatly Now ? Will Notity Inspactor ? 3? .11 ? Yes ,jkNO When Reetly? I O licensed contractor A owner hereby request inspection of above electrical work at: JOb AtltlrBSS (SVBet, Box a RoNe No.) City 1A l c- Nk )FAG- Fectim No. Tavnship Name or No. Range No. ComuMy Pr 1? !/ OccupantlPRINT) 17 i Phone No. 4. /. Ppwer $upplier Adtlress 0A-k?r Electncal ConVaclor (COmpany NamB) ConVflctor's Lbense No. Mailing Addr ss (Contredor or Ownar Making Installation) numonzetl Sign (COmracror/Own Installa' n) ' Phone Number MINNESOTR STATE BORpD OF ELECTRICAY Grigga-MlAway Bldg. - Raom S•173 1821 Univerelty Ave., St. Vaul, MN SStOC Pho. (613) 602-01100 THIS INSPEGTION REOUEST WILL NOT BE ACCEPTED BV THE STATE BOARO UNLESS PROPER INSPECTION FEE IS ENCLOSEO. ? ,/? REQUEST FOR ELECTRICAL INSPECTION 5` ? See instmctions for completing iM1is lorm on back oi yellow capy. a 6 7 5 5 6- -JC" Below Work Covered by This Request 6 ?" EB-00001-08 ?? e tld ep. Typeof8uil0ing AppliancesWired EquipmentWired Home Ran9e Temporary Service Duplex Water Heater Electric Heating - Apt Building Dryer Other (Specify) Comm./Industrial ' Furnace rf ? Farm Air Condltioner wL Olher(specity) CoMractor§Pemahs: &-L F wi il0. /" Compute Inspection Fee Below: # Other Fee # ServiceEnirance5ize Fee # Circuils/Feeders Fee Swimming Pool 0 to 200 Amps 0 to 100 Amps Transformers Above 200 _ Amps Above 100 _ Amps Signs Insvector5 Use On1y TOTAL Irriga[ion Booms /,? ?U ? 5'?,Fj O Speciallnspection ? ? Alarm/Communication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT Other Fee 11 16 COMPLETED WITHIN 18 MONTHS. , I, the Electriral Inspector, hereby Rough-in oate certify that the above inspection has been made. F;,,ai ? oare ?l•? 7 OiFICE USE ONLY ' This requesl voi0 18 months trom Req est Oate jre No. Rou h-in Inapectlon Piratl7 Yes G No ? Aeatly Now Will Notity Inspe<tor Whan Reatly? ID licensed contractor 4wner hereby request inspection of above electrical work at: 2 .bb atlr ss ? ec Bo a[.ROUte o. l . ! alsam (r. Ciry Seaion No. Townsnip Name or No. Range No. Counry Occvpantl ,) ?` ? VJ C V Phane No. Power Supp6er qdtlress Elemn i C no-acror (COmpany Name) ?C ?n, cun £ Conttacror5 License No. Mailing Atleress on rattor or Ownar Making Installatmn? 1) Aolnon etl 9q e iComrac uOwner Meji I,ng Ins[al no ) ? t -_ Phon`e Nyum?Oer MINNESOTA STATE BOARD OP ELECTpICITY THIS INSPECTION REOUEST WILL NOT GrlpgrMltlway Bltlq. - Roam 5173 BE ACCEPTEO BV THE STATE BOnPO 1811 Univerelty Ava.. SL Gaul. MN 55104 VNLESS PFOPER INSPECTION FEE IS Phona1612) 662-0800 ENCLOSED. REQUEST FOR ELECTRICAL INSPECTION ? Sae instmctions lor completing tnis form on Eack of yellow copy. d?3 9 8 8 5 X" Below Work Covered by This Request X4 EB-00001-08 'r is?y-?" ew tlU R6ji. Typeof8uilding AppilancesWiretl EquipmentWired Home Range Temporery Service Duplex Weter Heater Eleciric Heating Apt. Building Dryer Other-(Specify) Comm.lindustriel Furnace Farm Air Conditioner Other(sVecMy) Convacmr's Pemarks: ' G4 Compute Inspeciion Fee Below: # Other • Fee # ServiceEntranceSize Fee S Circuits/Feetlers Fea Swimming Pool 0 to 200 Amps D to 100 Amps Transformers Above 200 _ Amps A 100 _ Amps SIgnS frispi Use Cnly. ?v TOTAL Irrigation eooms Special Inspection Alarm/Communication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT Other Fee COMPLETED WITHI ONT ' f I, the Electrical Inspector, hereby RoUgh-in ;;6 oal _ certify that the above inspection has been made. Finei a ,? r oaie G OFFICEUSEONW This request voi0 1B monihs Irom This repues[ voitl 7-1q 18 mpnths irom W077448 La?, B?1 w?'Id•?k? ls?' 3700-7 /0'Sb flaquast Date Fire No. Nnuph-in InsVec[io Rr.quired? ady Nuw0 WlII Noti ty Inspec- -? ? Dyes tor Wh¢n HeatlY icen sed ElecVical Contractor I hareby request inspection of above ? Owner - elactrical work insealled at $treec Address, Bo• flout No. Ciry cLOn o. TownshiD Name or Na. RanBe No. County Occupnt (PRINT) Phone No. ?/L ?i Power SapDlier Address Electrical ConVactor (COmpany Namel BERND7 ELECTRIC SEflVECE, WC. Concrar.tor's License No. 9 Mailinp Address"WWW Instailationl sum4 `. a Auqho'. tl' iia[ur o 1 1-717111 B:lhstallatinnl ?Jir Phone Number ' THIS INSPECTIbN HEQUESIrWILL IOT MINN S WI? A STqTE BOARD ELECTqICITY Griggs-MiEwey 61dg. - Noom N•797 BE ACCEPTED BY THE STATE BOAPO 1821 University Ave., St. Paul. MN 56704 UNLESS PROPER INSPECTION FEE IS e1___ 1c.o1 ae, a... ENCLOSED. REQUEST FOR ELECTRICAL INSPECTION ' See instructions for completing this torm on back of Yellow cooV. 077448 X" i9elcw Work Covered by This Request EB-00001-04 ..: 3-7oo-7 AAd Rep. BuiltlinB Appliances Wiretl Equinnient Wired Ho flange Tertiporary Service Duplex Water Heater Lightiny Fixtures Apt. Building D r Bectric Heatin Cominercial Bldy. ace Silo Unloader Industrial Bldg. Air Conditioner Bulk Milk Tanl< Faml otber .peo y othar ISUecifyl T r lSUeci y pthm nthcr ompute lnspec[ion fee Below # Fee ServiceEnhancaSiza A Fee Faeders/SUbfeetlers b Fee Circuits 0 to200Am s 0 m30qm s 0 m30Am Above 200 qin ?s 31 to 700 Amps 31 to 100 Am s Swimming Pool Above 100_Amps Above 100_Amps Transtormers Irrigation oms Partial,'Other Fee Signs SU ia is -on 5 ? fleina rks TOTAL FEE flov0h-in Da[e the Electrlcal InsDactoq horeby tertiiy thflt the abova Flnal ??Oactimi has been ? " !?f.?.•. meda. ? Thls reaueet voiA 18 months irom wP? czmY or raGav /o ??I ?p ddd O/ 3795 Pilot ISr.ob Road • Eagan, Minnesota 55122 PtRNff'F N0: : 741 The City of Ea.gan hereby grants to Thompson Plumbinq Co. o£ Minnetoaka a PLUMBING . Permit for:(Owner) Richard Ceass E. at 1218/salsam Trail' ? pursuant to application dated 11/76 _ billed Fee Pit7tdCac 20.00 dated this 8 day of November , 19 76 . .50 s/c - Statement 1019 Building Inspector Mechanical Permits: Bid Total: CJ.'I'Y . GF E& CikN 3795 Pil.ot I{r:ab Rcad • Eagan, idinnesota 55122 PERl+UT N0. : 827 The City of Sa.gan hereby grants to Fred Vovt # cq of 3260 Gorham Ave So. Mpls. 55426 a HEATING Permit for: (Owner) Richard Cease at 1218 E. Balsam Trail 9 pursuant to application dated 10/28/76 , Pee Paide $20.00 dated this 8 day of November ? 19 76 • .50 s/c $uilding Inspector Mechanical Permits: Bid Total: HOUSE HEATING TEST RECORD Arj'7?I7 / OCCUPANT??APT. ' R OR YSUBURB? HEAT LOSS OWNE TE HTG. IN?.,i SOLD BY INSTALLED BY Elecfrical Work By 'Gns Line By TYPE OF HEAT GA _FA HW _STEAM SPACE HTR. _UNIT HTR. OTHER GAS DESIGN MAKE MAKE OF BURNER_ Model Model $erial Max. BTU Roring- INPUT MAKE OF FURNACE / CONTROLS THERMOS?T 7 Heat Plug Vnlve v Limit Limit Setting Fnn Setting Pilot Type Pilot Make Pilor Model ? Pilot Timing ..?QG L.W. Cut Of( p Ptessure !/ O ` Percent COZ ? InputCFH cL___percent 02? $taek Temp. ZO<? Percent CO d Form 235 Model "lq Vent $ize KIND OF LINER SIZE NONE Druff Hood Filters Size_ Chimney Location Chimney Constructian m6er Inside Outside ?? Smoke Bomb Wiring Druft ?? Test Tog Door Pressure Lighfing Inai. s Date Tosted Campany Testing Name of Tester CONVERSION ciTr oF E?GAN ,. 3793 Pilef Knob Rmd Eagon, MN 55122 Np 7674 , PHON[i 434-8100 . BUILDING PERMIT rteceipr # Site Address 1G10 L. ualsam trau Erect gx Occuponcy Lot 22 Block 1 sec/Sun.Wilderaeas Park lst Aue. p Zoning Porcel # 10 84250 220 Ol Repoir ? Fire Zone Enlarge ? Type of Const. a Nome William L . Scott Move ? # Staries ; Address 1218 E. BalBam TT8i1 pemolish ? Length_ b Ci Ea gan 55123 phano 452-6615 Grode ? Depth Sq. Ft._ ? Name Ted Wa2hter Conatruction AoP.o.ob Fea. 0 ?? Addreu 4550 Blackhawk Road /- r:... Aawsin 557 72 ??___ 454-27 40 Nome _ Addreu I hereby ockrwwledge that I hava read this ap0lication ond state thaf the inlormotion is wrrect and agree to wmply wirh oll applicable $tote of Minnesotn $tatutes and City of Eogan Ordinonces. Slpnoture of Permiftee A Building Permit Is issued to: Ted ull work sholl be done in accordance with Bullding Officiol t Assessment _ Water 8 Sew. Police - Fire Enp. Plonner - Countil _ Bldg. Off. - APC Permit 3c av Surchorge 1•00 Plon check SAC Woter Conn. Water Meter Rood Unit Torol $33.50 _ on tha express conditlon 1hnl and City of Eaqnn Ordinances. m ?.? (9-7 4 CITY OF EAGAN BUILDING PII2MIIT APPLICATION Include 2 sets of plans, 1 site plan w/elevations & 1 set of energy calculations. 7b Be Used For ??tA Ity'. uation Z; 04nD !?v Date IZ ' 2- -4' l Site Address: ?g,? ? tg .Rsawq `Ct,. / oFFzCE usE oNLx Lot 2-2 slocx sec./sub.l.c), Erect occupancy _ Parcel #: iv g?qZ S o zzO C)1 A-lter zoaing - Repais Fire Zone Owner: Enlarge _ 'Iype of Const. _ Move # Stories Addz'ess: 1-2 Denblish _ Front ft. City/Zip Code: _:A Qa ?? SS 1'Z :j Grade Depth fte Phom # : fD (Q ( S ' i . .z- Contractor: ? a- }- Address: bRe4- V1 A,u7?- Z City/Zip Gode: Sa"kq r'N, 5 5 12: Phone #: ? Sq - 2 l3 C-D Arch./IIzg. : Address: City/Zip Code: Phone #: - APPROVALS FE&S Isw Assessments Water/Sewer Polioe _ Fire Eng. Planner Council Bldg. Off. - y ? APC Perinit -- Surcharge Plan Chec7c SAC Water Conn. water Mzter Road Unit r.-. ? TOTAL 2007 RESIDENTIAL MECHANICAL rExMnT aPrLicATioN ?o ? C? City OfEagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 Please complete for: single family dwellings & rov?nhomes/condos when pertnits are required for each unit Date_[?_ /1U /? Site AddressOd?T Unit # Property Owner Telephone # ( 4w (1i Contractor 431 Street Address City State Zip Telephone # ( ) Bond #: Expires: The Applicant is ?Owner _ Con4actor _ Other Fire repair (replace burned out appliances, ductwork, etc.) $ 90.00 This fee applies when extensive mechanical repairs are made to a building. Add-on or alteration to existing dwelling unit $ 50.00 ? furnace ?Additional _Replacement _ New air exchanger air conditioner heatpum p j ? ? /? ? ? other ?asL SEate Surcharge $ .50 Total I hereby apply for a Residential Mechanical Pemut and acknowledge that the information is complete and accurate; that the work will be in conformance with the ordinances and codes of the Ciry of Eagan and with the Mechanical Codes; that I understand t}ris is not a. percnit, but only an application for a pemut, and work is not to start without a pemut; that the work will be in accoxdance with the approved plan in the case of work which requires a review and approval of plans. ? liYi ??1? ? QF 51-D?J` Ld?S jV, ApplicanYs Printed Name Applicant's ignature 2007 COMMERCIAL MECHANICAL rERvtlT arrLicATioN City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 Please complete for: commercial/industrial buildings multi-familv buildines when senarate oerrsuts are not reouired foc each dwellin¢ unit Date Site Street Address E A.?Q?//1.b/}Y?, Unit # Tenant Name (if applicable) Previous Tenant Name O P t Tele hone # (i?67 ) `7? %? ? l?? ? roper wner y p .\ ? .\ Contractor Stree[ Address City ? State \ Zip TelephOne # ( ) Espires: Bond #: \ ? \ 1-/ The Applicant is Owner _ Contractor _ OffieT Work Type *New Construcrion _Interior Improvement _Install Pig i / Processed Gas Exterior HVAC Unit** - ? \ **HVAC units must be screened ? / Under(Above gcound Tank Install Remove _ When installing/removing tank(s), call for inspecrion b Fire Mazshal and Plumbing Inspector Nahue of Work: (?/? ? ?r /?? ? ?G7 l I V ?? "? i' Pel'llllt Fees $70.50 Underground tank installation/removal - $50.50 Minimunn (includes State Surcharge) \ OC Contract Value $ ix 1% _ $ PemutFee $? State Surchazge \To calculatesurcharge ?Lf Permit Fee is less than $1,000, surcharge is 50 cents. If Pertni[ Fee is> $1,OOD, surchazge increases by $.50 00142 000 Permit ut Fee (i e a$1 h $1 000 P f , . . , o eac , em Fee equires a$ 1.00 surchazge). i $ Total Fee I hereby acknowledge that tliis infozmation is complete and accurate; that the work will in conformance with the ordinances and codes of the City of Eagan and with the Mechanical Codes; that I understand this is not a pe 't, but only an application for a pemrit, and work is not to start without a pemut; that the work will be in accordance with the ap roved plan in the case of work which requires a re w and approval of plans. IT ApplicanYs Printed Name Applicant's Signature Approved By: , Inspector Date: Required Inspections: - U.G. - R.I. - Air Test - Gas Service Test - Infloor Heat - Final RESIDENTIAL BUILDING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB RD, EAGAN MN 55122 651-681-4875 New Construction ReuuiremeMs . 3 registered site surveys showing sq. ft. of lot, sq. t4 0( house; and all rookd areas (20% manimum lot coverage allowed) . 2 copies of plan showing beam & windax sizes; poured faund design, e[c.) • 1 sel of Energy Calculations • 3 copies of Tree Preservadon Plan if lot platted after 711193 • Rim doist Defail Oplians selectlon sheet (Ndgs vnth 3 or less units) DATE /-I "d- I (+ ?-_-1 s- RemodeUReuair ReauiremeMs . 2 copies of plan • t set of Energy Calcula6ons for heated addfions . 1 site survey for extenor additbns & decks . IMicate'rf hane served by septic system far additions ? VALUATION ?OSITE ADDRESS J I ??SRNI?• MULTI-FAMILY BLDG _ Y _ N TYPE OF WORK 2DaS` FIREPLACE(S) _ 0_ 1_ 2 APPLICANT STREET ADDRESS I-7715- I-27= iQt}C.J AI. CITY?STATE_ZIP TELEPHONE # CELL PHONE # FAX # PROPERTYOWNER TELEPHONE# -----------------------------------°---°--°°--------------------------------°------------- COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category _ MINNliSOTA RULBS 7670 CATEGORY I MINNESOTA RULLS 7672 (J submission type) . Residential Ventilation Category 1 Worksheet Submitted • New Energy Code Worksheet Submitted • Energy Envelope Calculations Submitted Plumbing Contractor: Plumbing system includes: Mechanical Contractor: Mcehanical syslem inclucles: Sewer/Water Confractor: _ Air Conditioning _ Heat Recovery System Phone # Phone # Fee: .$90.00 Pee: $70.00 ----° °--------------------------°---------°----^--• °---°----------°-----°--°-----° -----°--°-----------°----- I hereby acknowledge that I have read This application, state that the information is correct, and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordin ces ?. Signafure of Applicanf OrTICE USI: OIVI.Y Certificates of Survey Received _ _ Water Softener _ Water Heater _ No. of Baths Phone # Iawn Sprinkler No. ol'R.I. Baths Tree Preservation Plan Received _ --- Not Required _ Updated 4/02 VILi?.p6+6•9E EAGAN 3795 Pilot Knob Road Eogan, MN 5512$ Zoning: RI Owner: Ri rhgZ WATER SERVICE PERMIT PEHMIT NO.: 2072 DA'I'E: __ 1-1/£3/7E No. uf Units: Address: Site Address: 1218 E. _Balsam __ 4 ?- I.22 Bl WP c -Th9.Wp5.4ri-P_1ilIIlhin Plumbec a !'n - ___ Meter No.: 220.00 Pa Connection Charge: Size: Account Deposih -. Rea o.: Permi[ Fee: 10 . 0 0 b i 11 e d I ogree e?op?? ly with the Villa9e of Eagan "?y. Surcharge: .50 b i 11 P. d ?? L O 19 6? p Ordinanc/ 7 / / Misc Charges: Total: / / By 1?LX9% Date Paid: Date of Insp.: Insp.: vuav eaoaH SEWER SERVICE PERMIT 3795 Pilot Knob Rood PERMIT NO.: 2822 Eagan, MN 55122 DATE: 11 / 11 / 7 Fi Zoning: RT No. of Units: i Owner. Richard Ceass Addrese: T r a i 1 SiteAddress: 1218 E. Balsam Ilaam L22 A1 WPk Plumber: T!lompson P7.umhing Co. 9/21/76 t14157 100.00 pd 1 oyree to eomply with th* yipuye ef Eogon Connection Chaz¢e: 3 5 0. 0 0 pd Ordinnnces. SY: Date of Inap.: Inap.: - Account Depoeit: Permit Fee: 10 . 0!1 b i 1 1 ad 7 019 Surchazge: • 50 h i 1 d Miea Chazges: Total: Date Paid: Certifica,we Fcr. ?._ Arnold Carlson '•° 1157 WSldzrneas Run Foad Eagarr, N;i?anesota 55143 I ? ' DELMAR H. SCNWANZ . LANDSUHVEVOR Re9,steretl UnCn laws oi 1 ne 5Iate nr Mnnnu?a . 10.515 SOUTH ROBERT TRAtI P.O. BOX M ROSEMOUNT, MINNESOTA 55088 SURVEYOR'SCEFTIFICATE / da 6??`h?m;?o 50?¢ i Of lLI ;D I 2 .?: ? Q ? 3 ? N c? c- N O QU 0 ? N Z- .7C/lCF• 0 = Z4N oi,oE T lt? " ? ro? , 3 -? . -s ? _ -? V ,., ,.?....:_ T 22i OGI( f 4 ?69 . o . ? I hereby certi*y that tnls is a true and corrert renresentatlon of a survpy of the boundarler nf Lhe follow;ng der,cr!bed tract nf 2and: 1.,nt 22, fi?ock 1 0.* r:ir rPrc?rdr_c3 plat ot W7111-7RNF35 PAPK AI'DT,TI:)N, Dakota County, Minnesota. September 1:, nniNNESUTn qE61tiTRtitiON O 8615 - ? 10 79 F12ef^+llldernesa Park PMONE 812-423-1789 CITY OF EAGAN L'taSHCEF`.: 5 TEf+MINAI_ hl0. 59 PA'iE" 05/1.2/9' 1'IHE.U 14:,51:43 IDa NqryE; MRS WM 4EE SGCITT 32:1(J 9001 ir 16 BAi_SAM rR J13.? 21:i.; 9C.1[]i. 121.E3 RA1..SFti1 Tk TaW. FinceiPt ArnnUnta 1.1.5.25 CR073F.JE, IJ,F:R :f.Li: NANCY ?%?yF#?7K7k%t?'FW7k?F1X?, 7k?k7l??%??AY#?7Y7k?CAt?k?XYFaY?k?M'M71??k7??11 PERMIT CITY OF EAGAN 3830 Pilot Knob Road PERMIT TYPE: a u I Lo y NG Eagan, Minnesota 55122-1897 Permit Number: 0 2 S 9 5 5 (612) 681-4675 Date Issued: @ 5/12 /g 7 SITE ADDRESS: 1218 BALSAM TR E . LOT: 22 BLOCK: 1 WILDEftNESS PRRK 15T P.I.N.o 10-89250-220-01 DESCRIPTION: (WINDQW REPLflCEMENT) #144,1-c{aA?a,,Permit Type SF (MISC.) ,.kkA_,Gk Type REPAIF? 434 ALT. S2ESIDENTZAL . a ?< I ?yg{ ? M Y t5R W5? ?H ??' ay ? I ^E'lv ?e*?ffiV. • -? (;, REMARKS: FEE SUMMARY: VALUR7TON 6ase Fee Surcharge Total Fee CONTRACTOR: 10 ? ? I '-ho Ye;by ?dcl?riow C.,._ . . _ .. . . " < < .. $112.25 $3.00 $115.25 APPLICANT/PERMITEE SIGNATURE $6qNam OWNER: - Appl.icant - SCOTT WILLIAM 1218 SALSAM TR E EAGAN MIV 55123 (512)452-6515 ?rubn 1p, , ,r1,f ISSUED Y:5 NATU E ? r,<n .r 97 BUILDING PERMIT APPLICATION (RESIDENTIAL) F?? qm CITY OF EAGAN 3830 PILOT KNOB RD - 55122 681-4675 New Construction Reouiremenfs !- -?? ? 3 rogisteretl aite surveY$ ? 2 copiea oF Plan ? 2 coples of Dlans (inGude beam 8 window sizes; poured fid. tlesign; etc.) • 2 site surveys (exlerar edditfons & dedca) ? 1 eneigy calwlations • 1 ene rgy cakulabons for heated additions ? 3 copies of tree preservetion plan iF IM platted efter 7/7/93 required: _Yes _ Ne • DATE: S- i-^' '? 2 CONSTRUCTION COST: ?? "'? ? DESCRIPTION OF WORK: ?, -ur? -L? ?`?t ?r?-?r _ L!?% ?•. STREET ADDRESS: ' ? - -J ? 7,? c ry ?' .-?, n-i, o` 5 • ? ? LOT 12 BLOCK ? SUBD./P.I.D. #: . PROPERTY Name: sc?rl-r i Phone #: 5`s 7- GG/S- OWNER StreetAddress:-1???' City: '4Z4.a State: 'ol ZiP: CONTRACTOR Company: Phone #: Street Address: License #: City: State: Zip: ARCHITECT/ Company: Phone #: ENGINEER Name: Registration #: Street Address: City: State: Zip: Sewer & water licensed plumher (new construction only): and bt change are requested once permit is issued. Penalry applies when address change 1 hereby acknowledge that i have read this appliqdon and scate that the infortnation is eorrect and agree to comply with all applipble State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant: OFFICE USE ONLY Certiflcates of Survey Raceived _ Yes _ No Tree Preservation Plan Received - Yes _ No _ Not Required BUILDING PERMIT TYPE OFFICE USE ONLY n(" i? ??\1 < 0 01 Foundation ? 06 Duplex o 11 Apt./Lodging ? 16 Basement Finish n 02 SF Dweliing o 07 4-piex ? 12 Mufti RepaidRem. 0 17 Swim Pool 0 03 SF Addition o 08 8-plex n 13 Garage/Accessory ? 20 Public Facility n 04 SF Porch ? 09 12-plex ? 14 Fireplace ? 21 Miscellaneous ? 05 SF Misc. ? 10 _-plex o 15 Deck WORK TYPE 0 31 New o 33 Alterations ? 36 Move 0 32 Addition o 34 Repair ? 37 Demolition GENERAL INFORMATION Const. (Actual) (Allowable) UBC Occupancy Zoning # of Stories Length Depth APPROVALS Planning _ Basement sq. ft. MC/WS System _ Main level sq. ft. City Water _ sq. ft. Fire 5prinklered _ sq. ft. PRV _ sq. ft. Booster Pump _ sq. ft. Census Code. _ Footprint sq. ft. SAC Code Census Bldg Census Unit Building Engineering Variance Permit Fee /?a?. ds Surcharge o0 Plan Review License MCNVS 5AC City SAC Water Conn. Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment PI. Road Unit Park Ded. Trails Ded. Other Copies Total: //S. 45 Valuation: $ % SAC SAC Units ! CITY of EAGAN J n BUILDING PERMIT Ownsx f':Ff.:................................ 'Z4 Addeeu (Psasan!) ..?.9.?f...---._.............. .V...t..?.? ................. Huilder .... .?. .................. ................... ............... ................ .................... Addreae A/..k?.?......??/:-_e--...r..1..??1 s?...l..----........?S Y,,•Z..?/ ! DESCRIPTION ? e ;a N4 4079 3795 Pilot Kaob Road Eagen, Minnesofa 55122 454•8100 Dele :sl:..??.?1...??...... 6torisa To Be Ueed Fox Fson! Deplh Haighf I Eei. Cn! Permt! Fsa Rsmesks ' 4s°? '"9 ? This permit doec not suShorise the use of straeis, soade, alleps or afdewalks nor doea It give the owner or h[e agen! the righ! 2o creafe anp siSualion whlah is a nuisanae or whioh praeenls a hazard fo !he heallh, aafelp, eonvsaIeacs and ganeral welfare !o anyoae in the eommuniip. THIS PERMIT MUST SE EP ON H PF? AEMISE WHILE THE WORK IS IN PAOG Thia is !o cerlifp, lhat.t .... .......q.._L.:eau?-°-°..._....has parmiasion !o araet a.. '..? ._... ..._?.?..?.{....?...:........_npoo the above described premi ubjeaf 30 the provisions of all applic Ord y?co fox f e Ci gan ................. ?--------..?.......----.......... ..... p..?.?Su ..?...._................... Mlidinq Iaspeelor . ? qoz9 ?: • Aate: - LpT '?, v BLOCK ADDITIOIV PARCLL E SLCTIOPI PI[TAIIIER IF IINPLP.T'PED - ADDRRSS OF PARCEL `l,0N`tTTG`J24-OCCUPANCY I ESTIMATED WST O 0 l orn:Ea 14- Tr.t,srxotv$ ivo. ADDRESS _?? F? L TELEPHONE SdO. `f- SS '" J`?(Q COIVTRACTOR , AADRESS idote: Include site plan, building plans, and enecalculations vaith this application ? /, 1 \ Signed?T ' A OE'FICE USE VALiJATIOiI '?? SAC YdATSR COtI1VECTI017 vaaTEx MExEx BUILDING PERPAIT FEE SURCHARGE FEE PL}1TT CFECK FM, PARK DEDICATI011 FEE OTfOR TOTP:L* ..Z' o-t7 n v loo APPROVALS: ASSESSME,IT CLERK BUIId)ING DEPT. POLICE DEPT. BUILDIFlG PERMIT APPLICATION PTATER & SL'4dER DEPT. FIRE DEPT. PARK DEPT MASTER CARD LOCATION ?j?,?., ?' ?Z?? ??•?I?(/?? s-?r?_sar owN_ eR 4(raAcAa .., ` r? STRUCTURE AND ?/^ ,?? tor. LAND USED AS /?- Permit No. Issued Issued To CoMractor I Owner BUILDING PLUMBING O > t?f ? ? _J e•? A?V CESSPOOL - SEPTIC TANK _ - WELL ELECTRICAL HEATING i/ GAS INSTALLING SANITARY SEWER I OTHER I OTHER I Items Approved (Initial) Date Remarks Distance From Well FOOTING SEPTIC FOUNDATION CESSPOOL FRAMWG TILE FIELD FT. FINAL ELECTRICAL HEATING DEPTH OF WELL GAS WSTALLATION SEPTIC TANK CESSPOOL DRAINFIELD PLUMBING WELL SANITARY SEWER ? Violations Noted on Batk COMMENTS: CertiPicate Fcs: .. Arnold`Carlson -° 125> Wildernesa Run Road Eagan, Mi°innesota 55123 ? " DELMAR H. SCHWANZ . LANDSUHVFVOR Re9,teretl unoet Laws ot i ne.5[ate o1 Minne'ota tA$l5 SOUTFI ROBEHT TRAII P.O. BOX M ROSEMOVNT, MINNESOTA 55088 SURVEVOR"SCERTIFICATE z ? 6, ?o g?.o0 E5p?,E? C) F11;> ? N (n ? N m _ o m 0 ? N ? SC/ILE?r? ?, 0 = T44? T.22, o ? ? o 0 0 d ? Z hpreby CP1'tLfV t!12t 4:it8 i.3 a t.i'liK' ,'til(j corrert :"f`nI'E'!i°Ri`.%itLOII of a survay o}' the boundaries of r.Y,c roiiawing dQFC•riord tr3ct o;' 13nd: Tot 22, b1o.r,k 1 of thF rercrtied p?<'zt oC 4'Ti`.`''NNRSS PAFK AL'I:rml 'N, Dakota Cuunty, Minnesot:a. SeptemGer 1'., ! 91r'., i ,-? I . f7?v? l' 1 k-7 ' ? • ?? r ? MiNNESWA RE, tiTHATiOWNO 8625 t </b ?9 Filef^dildernea3 Park PHONE 612 423-1789 ? ? \? Z ,3 ? . ;•i;::;i..i?.II?.:R.!; -.., ..Fj. tl7': p?,:?r•:[.?: M6: I41!..!._:1'.(??4 ?:'•E.'.:4.(:? 900]. 1.:i.i.''_,.2..j .: , i:?...: ..?r,,. c _-.; . ? ,_...... _r....i..,. ?¢e:.:i2?.i.C,.^i i?'?17?[;?.1;..,I?,• .I. •?_ ?...i`.:f1:.,4( .I..i."j !\I°iP•??.?1` 4..:?r:-f.yF :. ua v 7F-,'k's n:UrYf.7K:;• ? CITY OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55122-1897 (612)681-4675 PERMIT PERMIT TYPE: Permit Number: Date Issued: BUILDING 030205 07/01/97 SITE ADDRESS: 1218 BALSAM TR E LOT: 22 BLOCK: 1 WILDERNES5 PflRK P.I.N.: 10-84250-220-01 DESCRIPTION: • MISCELLANEOUS NEW 328 OTHER NONRES. n??.'Ea REMARKS: SEPARATE PERMIT REQUIRED FOR ANY ELECTRSCAL WORK FEE SUMMARY: VALUATION $6,000 Base Fee $112.25 Surcharge $3.00 Total Fee $115.25 CONTRACTOR: OWNER: - Applicant - SCOTT WILLIAM ' 1218 BALSAM TR E EAGAN MN ? (612)452-6615 T hereby acknOwledge that I have-read this applicatson and state tfiat the infiormation is correct and agree ta comply with all applicable State of Mn. Statutes and.Caty of Eagan Ordinances.•. ? ? ? ? A LICANT/PERMIT E IGNATURE ISSUED BY: IGNATU E SHED Bu'ildig`;,Permit Type 8uilding Wct?rk Type CensuS Code' - i ' ? ? CGAIM VOUCHER - REFUND REQUEST CITY OF EAGAN MAKE CAECK PAYABLE TO: ADDRESS: , LClll.ftX1 ?]1?. ?? ?1 ? `?.? LOCATION: JA, 1 ?i..??aJi?1DAL4A. RECEIPT DATE VALUATION REASON FOR REFUND k1 MTU1'iftLYtdh ? ? , P.1x?,m A"? 'i' CUm,9t ' ?`c .? V ? 3450-qeol B .?5.00 TYPE OF REFITND sLECTxtC ai. ?E T 3211-9001 ? PLUMBING PERMIT 3212-9001 $ MECHANICAL PERMIT 3213-9001 $ BUILDING PERMIT FEE 3210-900I $ PLAN REVIEW FEE 3422-9001 $ SAC (MGws) 2275-9220 $ SaC (CITY) 3866-9379 $ SAC/ADMIN 3446-9001 $ WATER CONNECTION 3865-9220 $ SEwER PERMIT 3743-9220 $ WATER PERMIT 3713-9220 $ ACCOUNT DEPOSIT 2252-9220 $ WATER METER 3716-9220 $ ROAD uMT 3860-9375 $ WATER TREATMENT 3868-9220 $ SURCHARGE 2155-9001 $ UTILITY ACCT OVERPAYMENT 2250-9220 $ CURB BOX DEPOSIT REFUND 2253-9220 $ CONSTRUCTION METER DEP REFUND 2254-9220 $ WATER USAGE CHARGE 3711-9220 $ ToTAL $ -5. I declare under the penalties of law that this account, claim or demand is just and that no part of it has been paid. Signafure Date ? cLAIM.vou ?Ag? 1997 BUILDING PERMIT APPLICATION (RESIDENTIAL)? 3oaoS' CrTy OF EAGAN 3830 PILOT KNOB RD - 55122 681 -d675 New Canstruction Reouirements RemodeVReoeir ReauiremeMs ?-?-? ?ll3 ? 3 registered site surveys ? 2 eopies M plan • 2 eopies of pians (inGude beam 8 window slzes; poured fid. tlesign; etc.) ? 2 site surveys (exterior adtlitions 8 decks) ? t energy calculations ? 1 energy calalffiions for heated addRions ? 3 topies W trea preservation plan if lot platted aRer 7/1l93 required: _Yes No i?( ?/DATE: ?i CONS R CTION COST: ?? 7?, bD DESCRIPTION OF WORK: ? STREET ADDRESS: ? f ? LOT BLOCK SUBD./P.I.D. PROPERTY OWNER CONTRACTOR Name: Phone #: Street Ciry: State: Zip:?j jow Company: ? P one #?*. 5treet Address: All rAw.LJ Id L 1A License #: 016181/ l?l??'? City: ? /, Pf? State: _ Zip:??? ARCHITECT/ Company: ENGINEER '`-- Phone #: Name: Registration #: Street Address: CIty: Sewer 8 water licensed plumber (new construction only): and lot change are requested once permit is issued. r----- State: Zip: ? . Penatty appiies when address change I hereby acknowledge that I' have read this applip6on and state that the infortnation is cqrrect QIagre e to com ly with all applicabl Stste of Minnesota Statutes and City af Eagan Ordinances. Signature of Applicant: ?--??'- ? OFFICE USE ONLY RECEIVED Certificates of Survey Received _ Yes _ No JUN 1 1997 Tree Preservation Plan Received _ Yes _ No _ Not Required g• OFFICE USE ONLY ' BUILDING PERMIT TYPE ? 01 Foundation ? 06 Duplex 0 02 SF Dwelting ? 07 4-piex ? 03 SF Addition ? 08 8-plex ? 04 SF Porch ? 09 12-plex ? 05 SF Misc. ? 10 _-piex WORK TYPE 31 New o 33 Aiterations C a\32 Addition ? 34 Repair GENERAL INFORMATIdN Const. (Actuaq (Ailowable) UBC Occupancy Zoning # of Stories Length Depth APPROVALS Planning ? 11 Apt./Lodging ? 16 Basement Finish ? 12 Multi Repair/Rem. 0 17 Swim Pool x 13 Garage/Accessory ? 20 Public Facility ? 14 Fireplace ? 21 Miscellaneous 0 15 Deck ? 36 Move ? 37 Demolition vo 7A Basement sq. Main level sq. ft. ft. ? ? sq. sq. t sq. sq. ft. ft. ft. ft. Footprint sq. ft. Permit Fee Surcharge Plan Review License MClWS $AC City SAC Water Conn. Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment PI. Road Unit Park Ded. Trails Ded. Other Copies Total: MC/WS System City Water Fire Sprinklered PRV Booster Pump Census Code. ? ? SAC Code 04 Census Bldg Census Unit f)_ Building Pli Engineering Variance Valuation: $ jpUd?• 04 3$`?Xl?? ???1?D4 °k SAC SAC Units ?e ?m .. ..'?arlson - WiZdzrness Pun Road y Eaga~, Mi'.znesota 55123 DELMAR H. SCHWANZ . LANDSUHVEvUR ••. We9islered Vnaef Laws nf 1 ne Sute or M.nnnula 185L5 SOUTM R08ERT TRAII P.O. 60% M ROSEMOVNT, MINNESOTA SSOBB SVRVEYOH'SCERTIFICATE ?a B+kLya ?? 5? ? T da D; oo ?.p?i? - g1• E,?, . 5C/?LF•' / f? ? , ' = Z4oN O?,oE 3 N ? N N O cU o ? ? N Z <1b 79 File;"+lildernesa Park PNONE 872 423-1789 3 =9 _s ? o e? \s vc- M -io „- . . . .. _..- ... ?k:-?.-... ? o . ? ? I hereby certify th3t *..^.ls iF. a t:se and cnrrect renre.sentatlon of a survPy of tnF `uoundarlAr? o[' tne !'o:lowin{, dPr•cr:bed t^act'oo 13T1C1: Tat 12. bloe!1[ '_ oC ±hP rerc•.dr_t1 p? at of WT_:Si'?RN _iS PauK AI'DTTT.:.`N. Dakota County, M1nnASOT.a. ' SeptemGer 1:, ? i ? •` '?.^? i'j'?!L ' 1 r ?-. X. YMiNNES,_Iin HEi.?`,i?1..7?6N n A? *??:kX+?FXC#'?k?"?F? ?W :M•w;:k??t:Y? #?:„k??u?C:k?'K?K:?:::g?:yFSK:#•?kNc;? `i::I:TV CJF` I".Rt;tahd ?a3; L:Ac>ri:Cf:Rn `.:i r'F:?FM:W6?.. 4{?:; i.ii??11 II 11910r'.'_J?JES I vIttII::.I' M16::52 TD " FFlttF-e MII...I..:[AM I...E:I:.: SCOT• 32:Lf1 t:ran1 i.27.ri E•A!_F.3(1M YFt E;r'.'r.'S 21.`i5 900:!. i.c?i.s? f?Fai_SAM iFt I...p(] TL?'} k u 1 %.:1.?. fifi?CrE?7.(?.. Alil(:..,l71:.. 63.,25 i,R(l96848 U5r:r.: 02 t!ANCY 1 ITY OF EAGAN 30 Pilot Knob Road Eagan, Sf?l?nesota 55122-1897 (612) 681-4675 SITE ADDRESS: P.I.N.: 10-84250-220-01 DESCRIPTION: PERMIT PERMIT TYPE: Permit Number: Date Issued: 1218 BRLSAM TR E L07: 22 BLOCK: 1 WILDERNESS pARK Btu.f'ldirig?,xPermit Type Bui1'tli?ig lbxk Type „L?"BTYBtfS C2Ydieq` ?x ? yz' r ? ji4 GARAGE(ACCESSORY ADDITION 438? RLT. GHRAGE re? .F azl s.5utn `"s"INe.-kx??u SI§' BUILDSNG 033120 09/02/98 P ? Ei& I AV d ?r?'?L at IBS??Ss-'rt am,nas?%oc mias?m: ?,e minn REMARKS: PLflN REV2EWED BY DALE SCHOEPPNER. FEE SUMMARY: VALUflTION $2,000 Base Fee $67.25 Surcharge _ $1.00 Tutal Fee $69.25 1998 BUILDING PERMIT APPLICATION (RESIDENTIAL) CITY OF EAGAN ? 3830 PII.OT KNOB RD - 55122 681-4675 New Construcxion Reauirements RemodeUReoair Reauirements ? 3 registered site surveys ? 2 copies of plans (inGude beam & winAOw sizea; poured fnd. design; etc.) ? 7 energy wlculations 4 3 copies ot Voe preservation plan 'rf lot plattsd after 7/7193 required: _,Yes _ No DATE: " `4 DESCRIPTION OF WORK: STREET ADDRESS: LOT: -D--J- BLOCK: PROPERTY OWNER SUBD.IP.I.D. #: First Sheet City ? 2 copies of plan ? 2 site surveys (exterior add'Rions 8 decks) ? 1 energy calculations for heated addkions CONSTRUCTION COST; 2 a 0 d .. // - . t Phone #: Company: Phone #: CONTRACTOR ' Street Address: City State: ARCHITECT/ ENGINEER Company: Phone #: Name: Regisuation #: Street Ciry Sewer 8 water licensed plumber (new construction only): and lot change is requested once permit is issued. License # Zip: Zip: Penalty applies when address d2ang ind agre to comply with all applicabi I hereby acknowledge that I have read this application and state that the infaX State af Minnesota Statutes and City of Eagan Ordinances. e Signature of Ap plicank OFFICE USE ONLY Certificates of Survey Received _ Yes _ No Tree Preservation Ptan Received _ Yes _ No „ Not Required Statc: BUILDING PERMIT TYPE ? 01 Foundation ? 06 Duplex ? 02 SF Dwelling ? 07 4-plex 0 03 SF A.t;dition ? 08 8-piex ? 04 SF Porch 0 09 12-plex ? 05 SF Misc. ? 70 = piex WORK TYPE ? 31 New ? 33 Alterations p 32 Addition ? 34 Repair GENERAL INFORMATION Const. (Actual) (Allowable) UBC Occupancy Zoning # of Stories Length Depth APPROVALS Planning Permit Fee Surcharge Plan Review License MCNVS SAC City SAC Water Conn. Water Meter Acct: Deposit S/W Permit S/W Surcharge Treatment PI. Park Ded. Treils Ded. Other Copies Total: OFFICE USE ONLY ? 11 Apt./Lodging ? ? 12 Multi RepaidRem. ? ja 13 Garage/Accessory ? ? 14 Fireplace ? ? 15 Deck ? 36 Move ? 37 Demolition :. 16 Basement Finish 17 Swim Pool 20 Public Facility 21 Miscellaneous Basement sq. ft. MC/WS System _ Main level sq. ft. City Water _ sq. ft. Fire Sprinkiered _ sq. ft. PRV _ sq. ft. Booster Pump _ sq. ft. Census Code. ?%3k _ Footprint sq. ft. SAC Code G/ Census Bldg ? Census Unit ? Building Engineering Variance Valuation: $ 2 cD 7 7.?eC R(X?if,'oh 'fo ? V`1'e/s"`,d % SAC SAC Units . esota 5512 3 a Pun Poad y r,l DELMAR H. SCHWANZ . LANOSUNVfr(IR N?4ffeeO VnOeL?++ n? 1 v S?+le ar At.nnnnl? 14515 SOUTM ROBERT TqAll P.O. 80X M ROSEMOUNT, MINNESOTA 55088 ??IL' SURVEYOR'S CERTIfICATE ? 5' 144 'f ° - ° 1 o E' ,N ? ,D / r? lT? ` 3 </b 79 °ile;"dildernesa Park PMONE 812 423-1788 . ?". Q s\ ?` ?C/lGE. ? :'- 4p = 14n/ PiPE ? -? ?? o 0 .? _. ? , f 3cv 'Y o m , t? N ?••? ??yM ? 00 , °oo I hereby cPrttCy thaf. `.r.l^ ILs a t:ae anc1 corrPe!Y renrenentatlon of a surv-sy oC tnc boundarle.^• c!' *.ne fq? low;n{, dPr•cr:bed tract o.^ 13nd: T,ot 12, B?ork : o!' *hP r?r?--ctCd )I=t r;C WT:I}??RN_3S F.1PK AI'D?T?:`N, Da:cota County, MinnASOta. I Seoteabcr . . ,?? M'NNEF?.`fA HE.."iij..i,?)N O'?t Rfi25 / ? ?ql?s 2007 RESIDENTIAL PLUMBING PeRMiT aPPUCarioN CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN MN 55122 651475-5675 Please comptete for modifications to existina residential dwellinas. 3o -'?? 6 oateI l3 r o? Ske Street Address T?-A- UnR # Property Owner ?Vl QAM ? CO?f Telephone # ?y51) ES ;' ? (c Contraetor qwlU1vi np1 Tslepnon.#(&,a szt?8?t?oa Address_aS, S, e s-Pn tn v City W?^ Ct,ln State-WJ- 21P s53Sa. 7he Applkant is: _ Owner & Occupant Licensed Plumbing Contractor Sepde System _ New _ Refurbished Su6mit 2 sets of plans and MPC license Includes County fee $ 100.00 Per asrbuiB $ 10.00 Fire Repalr (replace 6umed out tixtures, ete.) $ 90.00 This fee a lies when extenshre umbf re irs are made to a buildin . Alteradons to exlstlng dwellfng $ 50.00 _ Add plumbing fixtures to main level lower level. This fee indudes installation of a water softener and/or water heater at the same time. N you ana installing on a watar soltener andtr water healer, do not complete this section; move to the next section and place a chedcmark rrexd to the appliance(s) you are installing. _Septic System Abandonment _ Water Tumaround (add $136.00 if a 5/8" meter is required) Other: _ Water Sottener ? Water Heater $ 15.00 _ new _ replacement Lawn Irrigation _RPZ XPVB _new _repalr _rebuild $ 30.00 State surcharge $ 50 Total JUN 2 5 2007 $ 30,sz) i nereoy appry ror a rteswennal Plumbing Permit and acknowledge that the information is complete and accurate; that ihe work will be in conformance with the ordinances and codea of the City of Eagan and the plumbing codes; that I understand this ia not a permit, but only an application for a pertnit, work is not to start without a permit and woHc will be in aceordance with the approved plan in tlie event a plan is required,E e revie d and approved. -X, Apptlcant's Prirrted Name i, plicanY Signature ?S ? 3?? Date: City o(Eagan 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BLUE or BLACK Ink For Office Use J Permit #: , v //�/�( U Le Permit Fee: �vu; Date Received: 1? -3 Vl &— Staff: 1% INFLOW & INFILTRATION PERMIT APPLICATION Plumbing / Sewer & Water Tenant: Site Address: Suite #: RESIDENT0 ERS1JX.JIK2 Name: 1� ( liAL 6- 0 Phone: f A3 1V --- ,� Address / City / Zip: CONTRA TOR# Name: License #' Address: City: State: Zip: Phone: Contact: Email: TYPE OF WORK PLUMBING (Within the building envelope) S p Pun3p Repair SEWER & WATER (Outside the building Repair envelope) O er: G Other: ��3DESCRIPTION�� Description of work: rC.'Yt..c. - 5U r-. 1).-.1 Sc-�. � ciIar'q, . \ 7_. 11 �j Iay7v/l� FEES $60.00 / Each (includes $5.00 State Surcharge) TOTAL FEE $ * *Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submit I/I repair costs for reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors can be found by visiting www.citvofeagan.com/inflow, or City Hall at 3830 Pilot Knob Rd. 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 . .ermit, 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 ires :. and approval of plans. x 1 ) . til- ge- in Applicant's Printed Name xl Applicant's ignature FOR OFFICE U' Required Inspections: Under Ground Rough -In =Final