4256 Beaver Dam RdThis request void
18 months from
A
? u, C,Q? (s-t
? '!o 4?
3
Request Date Fire No. Rough-in Inspection
Required?
ady Now ? WilI Notify Inspec-
? ??°-- es N. tor When ReadV
? Licensed Electrical Contractar T 1 herehy request inspection of ahove
? Owner electrical work installed at:
Street Address, Box or Route No. City
ection o. Township Name or No. Range No. County C
Occupant (PRINT) Phone No,
?
Power Supplier Address
Eiectrical ContracSOr (Company Name) Contractor's License No.
e 1-2 A _ C?
Mailing Address (Contracior or Owner Making Instailationl
I ?? /1 l./,E?. '. J 36
w
Authorized Sig ure ati n) Phone Number
:;?
?. _., ?-?
MINNESOTA STATE BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT
Griggs-Midway Bldg. - Room N-197 BE ACCEPTE? BY THE STATE BOARD
1821 tlniversity Ave., St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS
Phnnw (6721 297_2111 ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION Ee-00001-04
?' See instructians for compieting thie form on back of yeliow copy.
"X" Below Work Ctweredky This Request
Add Rep. Type of Building APpliancea Wired Equipment Wired
Home Range Temporary Service
Duplex Water Heater Lightin,y Fixtures
Apt. Building Dryer Electric Heatin
Commercial Bldg. Furnace Siio Unloader
Industrial Bldg. Air Conditioner Buik Milk Tank
Farm Other TS-P-e-C-1 v other ISuec+fyJ
t er pecify Other Other
Comnuie Insoectron Fee Below
# Fee ServiceEntranceSize # Fee Feeders/Subfeeders t! Fee Circuits
0 to 200 Am s 0 to 30 Am s 0 to 30 Am s
Above 200 Amps 31 to 100 Arnps 31 to 100 Am •
Swimming Pool Above 100-Amps Above 100_Amps
Transiormers Irrigation Booms Partial-'Ot er Fee
Signs Special Inspection
$
TO FEE
Remarks 3? ?S Roueh-in r Date t cal
Inspector, hereby
Final ? certify that the above I
I D?ajte jnspection has been 'i
II t - .. A1 /-,1/ -S` made.
ihia reauest void 18 months tram
r-.-.,...---- r..s--.sx:.-?? ?a.,?-.? . . ?.-i-...^.?-?„•o7ievsawr.a'-s.r?.+^s.?a•?....-?s..r,.-------•-- . -- -- _
CITY OF EA(3AN _
, -A 3830 P11ot Knob Rosd, P.O. Bax 21•199, E,agan, MlY 55121 N? "84
' PHONE: 454-8100
_
au1LDINQ PERMIT - Rece+pt -72
_Te M wnd fa SF DWG/GAREst.Volue $57,000 _Dote_APRIL 19 -- --j9 84 -
Site Ad r 4 2 5 6 BFAVER DAM RD
Lot slock 1 Sec/Sub. SUNCLIFF IST
Parcel wo. 10-72975-1$-01 W N?e JFFF b FSTHER OLDEHBURG
a A?ress 2094 CLIFFVIEW DR
? Citv EAGAN Phone 4 5 2- 9 2 7 6
MCKLYN CONST INC
IO Neme
Addrea9
City ? Phone 432-4298
Name •
Addres$
City Phone
1 hereby acknowledye tMt 1 hove recd thia opolicotion ond statie that
tHe informotion ls correci ond, ogree to qompjly with; oll oppiicable
Stote of Minnesotc Statutes and City of :Eogon Ordinontes. '
Sipnotu?e bf Psnnit#"
Ereet 0 (kcupanCy ,..,
Ri
141ter ? Zoniny
Repoir ? Fire Zone N A
Enlar`Oe D TYVe of°Cflnst. V
Move ? ,# Stories _
Demoliah p 44
Length
-
?
Grode ? Oepth Sq. FL
ApProvab iMs
Assessment
Woter & Sew. _T-
-a
fite _??
-
E"°. ? ?'IANCE
Ptonner
Cour+ciG
stdo. oH.
APC
Permit • 00
Surchorps 28. S 0,
Plon cheek 152.00
SAC 525.00
Water, Conrt: 470.00
wawnere. r ' 63.00
Road unit 260.00
, .50
Total
M KLYN CONST INC
A Building Pertnif is iuWd • on tl'ie ezplam daWWon thni
all work sholl be,done in a with o I State of Minnesota Stotutss and Gty af &gan Ordbonew "
Bufldin9 Officiol
Pkeah No. wnmit Howr? Mae. hnnit No. tioMs.
Pw"9
N.V.,r.c.
wraI
?
oaa.
S.YMr
E1retrie
IalpaeYen Doq Inep. 4thsr
Foe
Founistbm ? lt!
frudne
i?surll p16?, r
Hb
F'irwd Plh?
RMd ffWAC
Final -qy
y? DMer? Lee?aw:
N!N! ..
?wwr .
ft. Dip.
,_. . _.. _ ,.. _. ; ., ?.. .: .? .. .. ?z., y..:,, w.,.. . - ??
iNECHAmICA1. PeftMiT Pemit nv. ?2
C1TY OF EAGAN
Frlc2U • 012' •a
S l ? . -' ----?-?-- ;
FIll in numbered spaces
Type or Print leaib/y Tat. av
1. Date S JO 2. Installation Cost ?q5'0 ' DO !
3. Job Adtiress 4Z5'6 t3tavN PI" t'' L I? B{k0 ? T ar?ctU'66
4, Owner mCKlYN Co^S7
5. Contractor Phone 9'69,
8. ?+ddress 7Z?7 ?lQlSd-tl/ s(yr
7. City P1 tI/1fi-eld State 171/V 2ip-5-57 Z3
--•--
8. Building Type: Residential M Cornmercial ? Institutional ?
9. Work Description: New gj Add ? AI#er 13 ReRair O '
10. Describe Fuel Type c1qos A.
11. No, F?iuipmnt 8TU - M. Ea.
Forced Air !10j 400O
Mfg. L Qr`1Mp)e
Boilers
' Mfg.
lMit Heater
Mfg.
r
?s. Air 4ond.
.
?. . ?
?-
"?
s.• _
i'
?
Gas. Piping dutlets
?
.. .. °. -'
d a.
Fj" _ .
. .
No. I Eauipment CFM
Air Hand{ing:
Mech. Exhaust
t]ther
.?
_ a
on
. ., . , ._
Receipt PLUMBING PERMIT Permit No.14 -J a 7
CITY OF EAGAN
5 - Fee ?
Fill in numbered spaces S/C
Type or Print legibly Tot. ao. 5o_
1. Date 2. Installation Cost '
,?'y' c' ?
3. Job AddressU 2 S?t?y Lot Blk. ? ra(ct (. 117_
4. Owner-)')"7 C'
5. Contractor Phone
-J--
6. Address
7. City State Zip _
8. Buitding Type: Residential O Commercial ? Institutional ?
9. Work Description: New ? Add 0 Alter ? Repair ?
10. Describe
11.
No.
<'.. Fixtures
Water Closet No. Fixtures
Cesspool/Drainfield
? Bath tubs Septic Tank
-Z Lavatory Softner
1 Shower Well
? Kitchen Sink
Urinal/Bidet Other
1 Laundry Tray
_L Floor Drains
Orinking Ftn.
Slop Sink
Gas Piping Outlets
12. 1 hereby certify that the abcnre informetion is true and correct, and 1 agree to
i?ances and codes goverr?ing th+s type of work.
camply with all or ,;
5igned : ;? _ ?::?'?,?-t ::?r_•.cJ.?? for
? Rough-' Finel
(nspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Appravei CITY OF EACiAW 46"100
? .",?????' 4.5;"?s?n :-rc;a1' ... • . .: h r . ?`;??r
CASH RECEtPT ,
CITY t)f EAGAN `
P. 0. BOX 21-799 ,
EAGAN, MINNESOTA 55721
ATE(
AMOUNT j
$
& DOLLARS
•? too
? CASH ? GNECK
?
i
r .WYD. ?? ? CODC AMOVNT
)
5f
7
b^G??,??, .G
Than ou-'?_.??A?`?-f'
B Y
UVhite-Payers CoPY •
Yellow-Posting Copy
• . Pink-Flle Copy
CITY OF EAGAN Remarks Bit "
Addition MN CLTFF 1ST Lot 18 Blk
Owner m?. KI ?r n CbnS?'r. 1'a " Street 4256 HUVER DAM ROAti
State -----
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. $ 19 5 1 Q - 40
STREET RESTOR. 1981 2030.40 03.04 10
GRADI_NG
5AN SEW TRUNK 76.5 3.0 2§ 30.64 C00$7$8 $-7-84
SEWER LATERAL S 1
* 4197 441.97 10
24651.96
WATERMAIN
• WATEH LATERAL 1981 O
WATER AREA 20 1973 93.55 .Z 15 18..7 C0087$8 5-7-84
STORM SEW TRK 1971 322.29 16.11 Zp 95. 75 C008758 5-7-84
STORM SEW LAT
CURB & GUTTER '
SIDEWALK
STREET LIGHT
ROAD UNIT 260.00 #42679 4-19-84
WATER CONN.
470.00
BUILDING PER. 8984
sac 525.00
PARK
, CITY OF EAGAN ?T
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 jr ? 8984
' PH ON E : 454•8100 -
BUILDING PERMIT Receipt .# ? ?
To be uaed for SF DWG/GAR Est, yalue $57, 000 Date APRIL 19 , iq 84
Site Address 4256 $EAVER DAM RD Erect Yj Occupancy R 3
Lot 18 Biock 1 SeclSub. SUNCLIFP_ 1 ST Alter ? Zoning R1
Parcel No. 10-72975-18-01 Repair 0 Fire Zone N/A
Enlarge ? Type of Const. V
a: Name JEFF & ESTHER OLDEHBU RG, Move 0 # Stories
Z Address 2094 CLIFFVIEW DR - Demolish p Length 44
City EAGAN Phone 4 5 2- 9 2 7 6 Grade ? Depth 4 4 Sq. Ft.
?
MCKLYN CONST INC
Approvals Fees
o
ou Name
7340 13 0 TH ST W
dd
Assessment Permit $ 304.00
ress
A
APPLE VAL phone 4 3 2-4 2 9 8
cit Water & Sew. Surcharge 28, 5 0
y P I' PIn check 1 5 2. 00
?
yVjW Name
H
i? Address
?W City Phone
I hereby ocknowledge that I have read this opplicotion and state that
the intormotion is torrect and ogree to comply with oll oppli[able
State of Minnesota Statutes and City of Eagon Ordinonces.
Signoture of Permittee
A Building Permit Is issued t• MCK:
pll work sholl be done in ccor o ce with
Build(ng Offtcial
o ice
Fire
En9. SETBACK
Picnner VARIANCE
Council 4/3/84
Bldg. Off.
APC
a
SAC S 1; - 0 0
Water Conn. 4 7 n- n 0
Water Meter 63- n 0
Road Unit 2Ln n 0
Toca I , • 50
T I N C on the express condition thai
5tate of Mlnnesoto Statutes ond City of Eagon Ordinances.
Include ? sets of plur.s,
CITy pF EAGAN
, • 7? 1 Gertificate of Survey??&"
BUILDING PERMIT APPLICATION 1 set of energy calculations.
'Ib Be Used For Valuation Date 4 I l?-
site Address 4 -7- z it4-,AIV. LltAo Lot BZoCk ? Sec./Sub. 4% R c t..1FC (,Sr Erect
Parcel # : ? ?.91 S Alter
Repair
Owner :''"'^ - c=
Address• ? ?4-? Q C? ?large
??7 i4- ?-?.tFF? Demolish
City/zip Code: EAACzlJ --. S51 Zz- Grade
Phone # : 4c2 ? 'T 20 ( e
Contractor: ? c-
Aaaress: r13 40 ? `?•? ?-?.?- k\1
City/Zip Oode :A?k.v- Y.awz
Phone # : 4-32- - 4 Z5 '? - - -
P,rch./Eng. : `,?) 4, /V.1t..
A[ldress :
City/Zip Code:
Phone #:
OFFICE USE.ONLY
occupancy
zonirg ?l7`1
Fise Zone 114
Type of Const. # Stories
Front yy ft.
Depth yy ft.
APPFKSVAIS FEES
Assesstnents Permit -Zrd y
iaater/Sewer Surcharge ,;5 g
Police
a)
Plan Check ?
Fire ? SAC s ? s
Eng- Water Conn. -<170 =Z-
Planner Water Meter fa3
Council - 3 • 7 .? Road Unit
Bldg.
P,PC
TOTAL jJ
,; j i
?
,? • • ??? c. 1. wIMQEN a AssocIAiEs, IHt.
? t+?ND SEiRVEYOltS Tet 545-3646
138I EUSTtS ST.. ST. PAUI, MINM. i9109
Far:
McKlyn Construction, Inc. h'
?
a.
? A/ /o h ?a Scale: 1" = 30'
C.) Denotes Iran
Monument
a ,?. ? •
,
?i ,°/
?°
Alr?r`?S
f
-, ?
NOTE: d
o Denotes Wooden Stake 1\ ?Proposed Garage Floor EL900.63
(900.3) Denotes Froposed
Finished Ground E1.
--q-- nenotes Direction qq?.
Of Surface ?rainage •?
Vertical Datum - N.G.V.D. 1929 ?
LOt 18, B10Ck 1, SUN CLIFF FIRST
AbDITION, Dakata County, Minnesota.
wE MEREbr CERTIFY THAT fMIS e5 A IRUE AN0 CORREGT REPRESENTATION t7F A SuRVEtr OF THE
LpvNDARIE# OF TNE tANa ASdVE CFSCMSED AND OF THE lOtl1TIQN OF All lLJFLDtNGS, tf ANY,
THEREON, ANQ All VISIS4E ENCRQACHMENTS. IF ANY, FROM QR ON SAED tANC.
Dared rhi. 10+h dor sE Mor=-h A.D. 108141 C. 11. WIwDEN & A550C4ATE3, tNC.
Surwrvr, iM?wn?tela RNittroti?n Ne ?,.?'?•6
tMiv
? •
l
. ,
r .
EXTERIOft ENV,ELOPE AVERAGE. "U" COMPUTATIOn
O1rJNER
?
' SITE ADDRE55..
AID-
CONTRACTOR -uc--, DATE 4 2_ PFiON E ¢.-3 Z-4.a?
Determine warking square footage of each. .
1. Total expased wa1 l area '. . . . . . o4 ? sq - ft• X _ t 7
2. Total- roof/cei7ing area .....: Gj?? sq. ft..x .05 ? 1 46,
Total expasEd wall area a6ove floor
a. Total wall window area ............................. 43 .
b. Tatal doar area ................................. _ c. Tota7 sliding glass door area ................. 5-;.-
d. Total fireplace wa71. area........... ............ .
• e. Tota1 wall framing area (averagelQ??...:......:. - , Z.:q f. Tatal net waZ 1 area abav¢ fT oor ................... i.5J
g. Tota1 rim joist area .............. ...._... ? 3Z,
. , . . . . - Tatal ezposed foundati on area h. Total foundation windaw area..... .. .. -•. -
i. Taa1 net foundation area a6nve grade ......:::.:. 94 0 - ' "
_ Qeteraine "U" - va1u2 of each wall segment. - . - . .' a, (43. (¢, L X lou„ @ 5:5`
' b. x Srun ? . -7
• . ' C. 3et.?i.??o 'x null ; ' .
. d. - ? X .i,u?? b7.._
e- ?,??1 i? 5 x u U n . C^)c1.1
'F. r s'?-'t Z. q-? x n??? g-
? 9- I 3z. ? X uull
? • h. X liu„ _
X liU,t
3 . .................... .............TotaT -
If item #3 is the same as, or 7ess than item #7, yotr hsve met the inteRt
of S8C 6006(c)2.
,,;;.
. • ,? ? - .
. . ? ?,
.. . . ? ' ? ? . . • • ' .
.. . . . Total" exposed Yoof/cei i i ng area
.
. , : .. ;
...? ?,?
. 3. 'Fatal skylight area..........................
k. Total roof/.ceiling frzming area(Lverage
?-. . 1. Total?net insulated roofjceiling area._.._..:._. Q.._.
Deternti ne "tJ" val ue for each roofjcei 1 i ng segment.
. ._... .?• x nu'i
x u???
. ?
. ..
S4c._q-- X "u"
4- -._.?........ ................. To?al"
If total af #4 is the same as, or less than 02, you have met tha inient af
. SBC 6006(c)1. -..... _ . . . . . ? : . _ . . . ? . . : . . ?
. . - - . ?. Al ternate Bui 1 di ng Envelape.Desi grt
? To uti 1 i ze-the total envzl ope system .methad, the 'val ues establ z shed by the ?
sccm of items V13 and #4 shaTl not 6e*greater than.the.sum of items llr1 and 712..
+2.
? ? - 3. +4. • ?. . - . . _ .. ? . . •
. . ? . .. . . . .. .. . ,? ._,- . ..
?'_-. . . :_ . _ . . . .
J. • ?aa?z.?r..v.. ...,? .?.....-.-- - - - - - - - - - - - - ' - -
?• ?Z,1 rLf?Y rl} rS ?+t..? ?? ,
BASICI
3. . i y 1p1;,_ e1
ZcaC
5. OsQCu4pi-,'?
b. Exteriar air filrs .............0.17.
• _ ? ?..?. d? 3
• • _ Total,.:
. .
1. Interior air filn .............f;,68 _
2. ?? I'i`? •R',.?' . f-? BtCt?l.?4SJ 1.?ou? ??i_t ??
3.
ripharal 4.
5. ?'S ?.?? k t. o. ? ?7 -
6. Exterior air €ilm ....... :.....0.i7 ?
- . , Tota.l
. . . • ?••
1. Interioz air film............. 0.68?. .?
2.
3. ! 2.` C.s2g&., I 1. Z?,• .
4.? Exteri.or air tilm .............0.I7• ?
. . _ .. , _ . . • . ? . _.. . Total
. . - ? . ? RooFIcSrr.zti? ? , • • .• ? - . - . . - . . u?i?x
. ? ? . , . • , ?
. .. . , - . . . . ? -:-
. . ..; .. - ? -
Cons truction R VAT.[;E.
. . . • . ?
1. Yn exi.or air f ilm .. . .... . ....0.61
--- .2. ? S' .
r 7;''?'?:
?• ?'l't `??? ? l?1 ? i ?S ? 3• Tns111prinn -44-L J. .
4
? ? .??tE l? ? t;;t:?l ?•? ? ? • Exterior air fi.lm (sti.ll) 0.61 _
r • . . . , • ? . ?oCal ' ' . ' ZR- - Z '.
, - - r • _ ? ' ' . . . . : ?. • . . .
Vented Keat f Zecr " ' - •. ? ' . : . ' ' , _ • " . .
up . , , . • _ ? ?. ' - . • • • : ? .
RODF/C-r.IZLIG ' •• . - ? ? .
_ 3 ? ? • ? Constraction .. . ? ? R-VALUE •_
- - a' a
i. "znsiae air film........... _...0.62 ? .
. ? . .?-= : : • _.. .
2. '
?-r-1.??- yf= ;'?.? ` /? ? • 3. 2r.SUlation ' .
? . .
Outside zir f il m 0.17
?
? .
v- ?lll/? Total
v ? . .
2+O:i-TI?TT'='?
__._._ z, _.: .._.?... - . .. ?, '. . ... ?
. •
. ?. _ . . ..... ---•-- ?
. ._ . , .
,.. - . ? . . .
... .:,. ._ . _,. ... ., ?
• GUIDELXNE TO (R) FACTORS FP.OM (ASHRAE MAi1UAL) ?? e ?• '
• . .. ? { y •
`
1
OF TYPICALLY USED PRODUCTS -
.
.
. ?
(R) ?
? .
. ,
?
Interior Air Film '(Edalls ) .0. 68
- Exterior Air Film tVlalls3 • 0.17 '
. ? Interior. Air Film (Ven-ted Ceiling)
.'
0.61
?.?
. Exterior Air Film (Vented Ceiling) 0.61
Interiar Air Film (Nan Vented) Q.61• ?
Exterior Air Film (Non Ven'Led) , 0.17 • _
I/jF" Plywood Panel ' . ? .0.3I
? 318" P1ywood PaneZ ? • 0. i,? • . • ? ?
. 1/2" Fiberboard Sheathing . . 1.32 , . . -?
? 25/32" Fiberboard Built Rite Shg. 2.06 ?-
? Aluminum Siding 0.61
.
• . w/Backer • ? 1.82 - • ? .
. . ? %.r/BacY.er- & -'Foiled ? ?. .• ' . - 2.96
? .
? 1/2 x 8 Lap Sicti.ng (Wood) 0.83
.
. • 7lI6 x 12 Hardboard_ Sicling . . 0.67
? Asbestos Sidings 1/4 Lapped ? 0.21 _? -
? - ? Stucco (Brown & Finish Coat ). _ ? ? - ? '. - . ? ? • . ? ?,
?
- ? ? Built-up Roofs . . . ? 0.33
t
? Plus Insl
3f 8" GyPsum Boards ? ? _ _ • ? - C.32
- . '?. .
. 1/2". GYPsum Boards . ? . ? 0, 45
5/,8". GYPsum Boards 0. 56
?. - 3/4t'*Wood-Subfloor or Sheathing 0.91E - • _ ' ? ? ?
- 1/2T' Plywood Sheathing ? 0.6:Z .? _- . ? .. - .
. ?. ? 1/2" Particle Board . , . . - - - 0.65 . ? Filled ' ? - -
' ? . ' ? ? • .Vermiculite
8" Concrete Block CS & G Reg.3
' . .12" Concrete Block .( S & G Reg. ) - . - ? . 1.28
. . 8" Light t•le ight • ? . . . . . . 2.18 ? . . . _.: 5. 03 •?
? . • 12 t' Light trTeight . ? ? . - ' . 2 . 4 8 - ? - 5 . 82 • . - : .
? -
? Insulation - 3 1/2" Fiberglass . ? 11.00:.?.? ?+-•. ? ' ? - . .-? ?.
_
?
? . 61' Fiberglass 19:00. ? -
? . All other ihsulation raaterials must be verified CR factor3 • '.' .?
, • . ^ ,' . A ? • , ^ -
. ? . . _ . ? • . . .
•R .
.? . . - ._ Note: CUj x arzA. sq. ft. -
All. jaindows _ (wlstorms lt' to 4" space) ,` ? . 56 ?' .• •
Removal double glazing (RDG)
? Thermp or caelded 3/16" air 'space
. . ' 1I4" air. space . , F 15 ' .
' 1/2" air space
(0-ther windows •specifzcally tested;'can- us e better ratzngs)
.1 3iIi Solid core door' .116
. . " :
. w/storm, LJOOCI ? • , . .31 . . ' .
.
. w/ s-tor,-n. metal . `; • , ?
? - ? . 2 6 ; . '
.
,
? ing Giass ? Door, UFOOa ' •j:,. '.. ? ? 65 . .
? metal - ? .715
Pease Door Steel Insl_' (No/Gl) R?.5 .
._..____.___._ .._.? _.. _ _ ? .. _ _ . .. _, ___ .. . _ ._ . ._ . __. . . . _ ..._ -13
.. ._ : ? _. _
._. ' .. . _ ..._.
ciry aGAti WATER SERYICE PERMIT
383' aob Road 5451
P. O. ?a?c 1 9 PERMIT NO.:
Eagan,'MN 551Zi DATE: 5-3--$4
Zo^in9: R No. of Units:
pwn,r, 1tcKlyn Const
Z Z. ress: 4 2 ???
Address. &W6f'`D#A Road L18 1Sunc1 • st
umber
Meter No. i ?UD ;?-a?`-??` •?? ?' ~? ?r?ned
Reader o.: "(? : Z3. "? ?p- e`?n_nitm
1 as" ta vf?r wHl? ? C?r of Eagas
wHl
Ordise .,
By
,
Dote of Insp.:
)n Charge• r _
Depwit: 15.00 p
Fee:
Surchorye:
10.0 p
P
Mlsc. Charpes: P meter
Total:
Qate Poid:
Insp.:
cirY oF eacaN WATER SERVICE PERMIT
3830 Pilot Knob Road 5451
P. O. ?jx 2T-09 PERMIT NO.:
Eagah, MN 551?1 DATE: 5`3"' ?
Zoning: No. 'of Units:
?
Qwner: OA?t
Address:
Site Address: AiV@rr 81a li= 1
Plumber. poine Plbg
Meter No.:
Connedion Chorge: 4 • p
Stze: AccouM De
osit: 15. p
p
Reoder No.:
Permit Fee: '
1 ograe to emnpy wub !6a City of Eagen Surchorge: ' ' p
Ordlnanoes.
Misc. CFarges: " 8ir
Total:
BY Dote Pcid:
Dufe of Insp.: Insp
:
.
ciTV oF EaGaN SEWER SERVICE PERMR
3830 Pilot Knob Road ' 6641
P. O. Bak 27199 PERMIT NO.:
Eagan; MN .55121
DATE: 5-3--8$
Zoning: Ri No. of Units:
Owner, HCX? COIIBt
Address:
Site Address: 4256 Btevar Dam RoBd Ll8 SSttAClt dt.
Plumber: painei P3bg
4-1 -8 679
425.40 pd
i agrea to wmply wUh the Ciyr of Eaass Connection Charpe:
Ordiaanees. A?ount Deposit: ?
10
00
Fae: .
Sunehorpe: '
, Bv Mise. Charges:
Dote of Insp.: Totol:
Insp.: . Date Pafd:
,?
t ? ? - -
?
2%$4
!
CITY OF EAG11N
? APPLICATION FOR PERMIT
;
'
SEWER AND/OR WATER CONNECTIQN
(Pi.EASE PRINi)
1) PROPERI'Y ADDRESS : a
I.DGAI. DFSC?ttIPTIOV : ,( o ]~ ! f 6/,C / rcc n /J' 7
(IAk/Block'vi.sion or Tax Parcel I.D. Nunber)
?
IF EXIS'^?`?', SI'ft(JCTt7f2E , DATE O?' ORIGINAL HUILDZNG PM1TT I5S?;GANC?: {
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PRESFW --^"lIIVr:/PROP0.SID LiSE: R-1 S?? FA'HILY
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Q R-4 AFARIlffW/CONC]CNI?NI[X ? UNITS )
E3 COMMERCIALf RETAIi,/CFFICE
O I1MUSTRIAL .
Q INSTITUTICNAL/C0MH4EbT
2) APPI.ICAiQT PLEASE PRINT)
NAM:
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r??ss: _ ? y?.? ? ??
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PHorE:
3) pLUMBER
NAP4E: PtEASE PRItIT
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' FOR CITY USE OMLx
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PE MBERS tiCEMSE:
: ?
yy? Active
CITY, STATE, ZIP: ti?6"
1urmi
? Expired
--' AE?'?'?if? ` Net af Recard
PIiODIE: 4P ,?? PLUMBER LTCENSE # 0
a ni ia.
4) OCCt1P11N'I'/OfqNM (PLE E PR I t.ET).
P1AME: _91n_5.,?....1,11??CL._
AUDftE.SS : 73 f O 7X S' ?, l'.J e
CITY, STAT'E, ZIP: iqle- ?/?y /?.??,?
PFiONE : fldp ?
5) INDICIITE WHICH PEf*IIT IS BEING REQi1E.S'TE.D; ?
? BMNNECTION TC) CITY SE-o1ER d /
2rCON:?a?,'TIdN TCl CITY WATEI2 [] C7I'EM (PL.EASE DESCRIBE)
6)
? P: !-AS!; I IOiI) APPt2c7VU) PF:RMIT MR PIC,K-LJP BY ONF C?F Vk3,'E
9"*1''I,1:,'?.S1: MAIL 1%J'PRMT i'EFtivttT `tY? l, 2, 3, oFA30VL:
(circie nne)
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. L ?' 2/84
. CITY OF EAGAN
` •?-.
APPLICATION FOR PERMIT
- SEWER AND/OR WATER CONNECT20N
(PLEASE PRIHT)
1) PROPEFrI'Y ADDRESS :
LEGAL DESCFZIPTICN:
(Lot/Block/Subd.ivision or Tax Parcel I.D. Ntmber)
i?{I ST.4L'C'I[„'RE, DATE G_' ORIGi 1AL :UIMLITG F=T ISJ0???iC'-1:
; = -?'" _-• - -" ,
Pt2 :S=17 :^`IIir'/P ,?G`PGS? U'S-E. ? R-I SINICZE r??rt.ILY .
? R-2 DUPLEX ('Iti%70 Wi ITS )
? R-3 Tav"NHOLSE (T'HE2E" + UNITS) ( UNITS)
p R-4 ApAR21`!EN7T/CONIDC??LPi12UM ( Wi ITS}
p CONMEI2CIAL/RETAII,/OFFICE
? IN7L'STRIAL
? INSTITUTIONAL/GO-v-fR-T=
Z) APP?CA-N'r
NAME: (PLEASE PRINT)
ADDRESS:
CITY, STATE, ZIP; -
PHOiNE:
3) P=. ER NANIE: PLEASE PRlNT) FOR CITY USE ONLY
PLUMBERS LICENSE:
ADDRESS:
; ?
Active
CITY, STATE, ZIP: [ ?] Expired
MAS ! t. Not af Record
PHONE: pLUMBER LICENSE #
arr nitia
4) OCC.-Ch'AN'r/OwNER NA1,IE: (PLEASE PRINT)
ADDRESS:
CITY, STATE, ZIP:
PHO:VE:
5) INDICA'I'E WHICH PERMIT IS BEING REJQUESTEp:
? CO;VNF.CTION ZO CITY SETrIER
? CONIVDCTIOU TO CITY 4+IATER
? CJI'fM (PLEA.SE DESCF2IBE)
6) LNDICNIE 0:E:
? P=E f:OLD APPRC7VED PERMIT FOR PICK-UP BY OIVE OF ABOVE
? PI.EA.SE ?]AIL APPROVEU PIIR}lIT 'PO 1, 2, 3, 4 ABUVE
(Circle one)
7) SI?,TL,'RE: DATE:
r
`•
.. 99 ?rrass:a? a? a?i .s ?rr:aicas:s iaw a. at i.r?.t?.4 .r?e? s? ?e ark w? ac:;-.? ?-.,?.rc es
F O R
PERMIT '-' ISSUED
C I T Y U S E O N L Y
FEES : $ 9 d. C. .3'
$ ,•? . ? es
$
$
S
$
$ .? _S7:
$
$
$
$
$
$ ' •
gEr;ER n?'p?trT (?"ICL:;DE JUP.CHc1RC1L)
WATER PERri'[IT (INCLUDE SURCHARGE)
WATER METER/COPPERHORN/OUTSIDE READER
WATER TAP (INCL'JDE CORPORATICN STOP)
SEWER Tap
ACCOUNT GEPOS IT - SE'vJER
ACCOUNT DEPOSIT - WATER
WAC
SAC
TRUNK WATER ASSESSMENT
TRUNK SEWER ASSESSMENT
LATERAL BENEFIT/TRUNK SEWER
LATERAL BENEFIT/TRUNK WATER
OTHER
$ TOTAL
$ AiMOUIVT PAID/RECEIPT #
DOES UTILITY COIVNECTION REQUIRE EXCAVATION IIV PUBLIC RIGiiT OF WAY?
YES IF YES, THEN A"PERMIT FOR WORK WITHIIV
? PUBLIC ROADWAY" MUST BE ISSUED BY THE
NO ENGINEERING DIVISION. LIST AS A CONDI-
TION.
SUBJECT TO TFiE FOLLO:aING CONDITIONS :
APPROVED BY :
TITLE:`??',,?f'
DATE :
.
?! s? t? i.t r ? ? ? ? ? ?:w ?•? w an ? s-.s! w? w.+? +?+r ?I ? ? s? !? ? ? ?t s.ts ?a.a ?.? rit ?? ?...
::;•..:.. , . ;. ?.- . ,.... ,,.
CA9H RECEIPT `
?,. ? :...- CITY OF EAGAN , . .
P. O. BOX 21-199
EAGAN, MINNESOTA 55121 ?
DATE
Z?4L
AMOUNT $
1 I'
[] CASH --"Q_CHECK
ROR +!'? A- `i_
?
RUND - CODE AMOUNT
i?^
371 -'? AGJ ?-'-t
4! y ? ? ?
Thank You
?
gY
J,,
TIN
& DOLLARS
too
White-Payen CoRy
Vellow-Posting CopY
Pink-Fila Co1ri
CITY USE ONLY
L? BL / RECEI PT #: 7/ 17'/&
SUBD. 4yAtj:j, ? RECEIPT DATE: -31-711?7
1997 MECHANICAL PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55722
(612) 681-4675
Please complete for. ? single omes wellin s
? town n condos whenpermits are required for each unit
New construction Add-on fumace
? Add-on air conditioning Add-on air exchanger, i.e. Vanee system, etc.
Date: 3- o-), 8- ? 7
FEES
? Minimum Fee: Add-on/Remodel (exiating residence only)
$ 20.00
? HVAC: 0-100 M BTU 24.00
Additional 50 M BTU 6.00
? Gas Outlets (minimum of 1 required (a3 $3.00 each)
? State Surcharge .50
TOTAL 0 • S0
SITE ADDRESS: Z/ aS ? ??? ve.v- L J e?,vn K ?I • ,
?? f? aLLi PHONE#: ??
OWNER NAME: In h
INSTALLER NAME: -e f c PHONE #: S`3 /- 70 Z?i
STREET ADDRESS: -/y.7 3rZ ??!! oc ft' ?v?.
CITY: STATE: ?ZIP:
r
SIGNATURE OF PERMITTEE
/7h)
CITY USE ONLY
L BL RECEIPT#:
SUBD. • RECEIPT DATE:
1997 MECHANICAL PERMIT (COMMERCIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
(612) 681 -4675
Please complete for: • all commerciaUndusfial buildings.
• multi-family buildings when separate permits are no required for each dwelling
unit.
DATE: CONTRACT PRICE:
WORK TYPE: NEW CONSTRUCTION INTERIOR IMPROVEMENT
DESCRIPTION OF WORK:
FEES: ?$25.00 minimum fee g[ 1% of contract price, whichever is greater.
? Prxessed piping - $25.00
? State surcharge af $.50 per $1,000 of permit fee due on all permits.
CONTRACT PRICE x 1 %
PROCESSED PIPING
STATE SURCHARGE
TOTAL
SITE ADDRESS:
OWNER NAME:
TENANT NAME: (IMPROVEME1+RS ONLI)
INSTALLER:
ADDRESS:
CITY: STATE: ZIP:
PHONE #:
SIGNATURE:
SIGNATURE OF PERMITTEE
TELEPHONE #:
CITY INSPECTOR