4673 Cambridge DrCITY-Of EAGAH SEWER SERVICE PERMIT
8795 Pilot Kno6 Rood - PERMIT NQ.:
Eagan, MN 55122 DATE:
2oning: No. of Units: ?
Owner: ';tt 1a],^_ ;itIZIde3's
Address:
Site Addr
Plumber:
I agree ta compFy with the Cirr of Eogon
Ordinontea.
By
Dote of Insp.:
Connection Cherye:
Acwunt Deposit: _
Permit Fee:
Surcharge:
Mlst. Chorges: -
Total:
Dote Paid:
CITY AF EAGAN WAYER SERVICE PERMIT
3795 Pilot Keob Raod PERMIT NO.:
Ecgan, MN 55122 DATE: -
Zoning: - No. of Units. ?
Owner. x-
Address:
Site Address: ,'-
_?.
Pfumber: T'- f
Meter No.:
Connection Charge: ,-
-
Size: Account Deposit:
Reoder No.: Permit Fee: - i?,_;? :-•„?
1 agree ro oomply witk the City of Eagan Surcharge: _--
Ordinances. Misc. Charges:
Total:
BY Date Paid:
Dete of Insp.: Insp.:
3795
BUILDING PERMIT
Te " umd fer
OF EAGAN
eed Eeean_ AAN S3144 .
Recelpt # '
"7.'lf}6?
. ?r
7n .•?
,o
Site Address Erect p Occuponcy
Lot Bl?lr ?' c/Sub. Alter ? Zoning
Porcel # Repoir ? Fire Zone
Enlarge ? Type of Const.
W No? ' Move ? # Stories
;
Address
Demolish
? ,
Length
b
Ci
Phone
Grode
p
Depth
Sq. Ft.
? Avprovals Fees
zF Nome _
?? Address
F- rs...
Name _
Address
Assessment
Water & Sew.
Police
Fire
Enp.
Planner
Counci I
Permit
Surcharge
Plon check
5AC
Woter Conn.
Woter Nleter
Road Unit
I hereby acknowledge thot I have read this application ond stote that gldq. Off.
the information is cotrect ond agree to tomply with oll applicable
Stote of Minnesota Stotutes and City of Eagon Ordinonces. APC Total
Siynoture of Permittee
A Building Permit 1s issued to: ' on the axpress condition thnt
all work sholl be done in accordance with all applicable Stote of Minnesoto Statutes and Gty of Eopon Ordinances.
8uildiny Officiol
Permit IVo. Permit Holder Misc. Permit No. Halder
Plumbing -7 ;L Z) 2-22
H.Y.A.C. r7
?,c ?? ? i
Vi?? ?'? 5
2' Z 2' 1?
weu
Water
Disp.
Sewer
eiecc.ic
Intpection Date Insp. Other
Footingt ? .
Foundatinn
Framing
Rough Plbg. ? z- 2_ 1
RouBh HVAC .23 cl
Insulation V-)
Final Plbg. - z2- /,j
Final HVAC
J
Final
Water Desa'ibe Location:
weu ?
,
Sswer
Pr. Disp. _
:- '
Receipt PLUMBING PERMIT - ,
Permit No. ?
CITY OF EAGAN • ?
Fee
fill in numbered spaces ?
S/C
Type or Prrnt legibly - - ?
Tot
-
' .
1. Oate 2. Installation Cost ?
,
' "
3. Job Address ^=
Lo Tract '
4. Owner
5. Contractor
Phone
6. Address 1? 7'
7. City State 2ip ?.? •-
_ ;
8. Building Type: Residential ;0
9. Work Description: New
10. Describe
11.
Commercial ? Institutional ?
Add ? Alter ? Repair 0
No. Fixtures
Water Closet No. Fixtures
Cesspool/Drainfield
% Bath tubs Septic Tank
Lavatory Softner
: Shower Well
Kitchen Sink
UrinallBidet
Qther
Laundry Tray
` Floor Drains
Drinking Ftn.
Slop Sink
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 Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
Receipt,
f MECHANICAL E? RM17' Perrnit No.
CITY OF EAGAIV
Fee
Fill in numbered spaces S/C
Type or Print legibly
Tot.
1. Date :> ?. 2. Installation Cost ?
,
3. Job Address Lot -?Tract
4. flwner
I 5.
ye .S
Phone ,. "
6. Address `r-?
7. City State Zip - - ? .
8. Building Type: Residential EY Commercial ? Institutional ?
/ ?
' 9. Work Description: New 0" Add ? Alter ? Repair ? ?
;
10, DesCribe Fuel Type
I11.
1
Nn, Eauinment 8TU - M. Ea.
Forced Air No. Equipment CFM
dlin
Ai
H
:
Mfg. r
an
g
- Boilers
Mfg, Mech. Exhaust
Uni# Heater
Mfg. Other
Air Cond.
Mfg.
- Gas, Piping dutlets
,
,
12. I hereby certify that the above informatian is true and correct, and I agree to
comply with all ordinances and codes governing this tYpe of work.
Signed : for
Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and apRroved.
Approved CITY OF EAGAN 454-6100
CITY OF EAGAN Remarks
Addition BEACON HILL ADDITION Lot 1$ slk 4 Parcel 10 13500 180 04
owne? a A r P , • Street 4673 Cambridj;e Drive State Eagan, MN 55122
1 1>> LCIGGR. 6' Df Y, i1i'!v, rr, -> >, -7
Improvement ? Date Amount Annual Years Payment Receipt Date
STREETSURF. 1982 1848.67 205.41 9
STREET RESTOR.
GRADING 5 1982 537.84 59.76 9 418.32 C 08420 4-20-83
SAN SEW TRUNK Q ? $4z0 4-20-83
*SEWERLATERAL 1982 3182.83 353.65 9 -2 -83
WATERMAIN
*WATERLATERAL 1982 9
WATER AREA (g$" 19$2 202.00 22.44 9 4- -$3
* Stubs 1982 9
STORMSEW TRK 47, 1982 367.77 40.86 9 86 05 C 0$420 4-20-83
*S70RM SE1N LAT 19$2 9
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN, rr n
BUILDING PER. 7042
sAC 525.00 „ "
PARK
(WIrrtifirtt#t of Orrupttnry -
Citp of eagan
Drpxrhttrnf of %ilDittg 3taprrtimt
Tbit CMificate istued pursuaat to tbe nqxirrmtntt of Sution 306 of 11x Unifonn Buildirog
Codc catiNug thae at tix dmc of ituismt tbir strrutun war in tompliann witb tbt variaat
ardirrdruu of t/x City rrguloting building tonstrnrtian or ure. Far the f ollowing: '
th. I.tlm SF DWG/GAR MB P? No 7042
awpwyryp R3 rypC.wo? V Fin? NA ?%?, Rl
0 M„fBwmft Feature Builders ?dd„„ 15513 Logarto La., Burnsvi
4673 CambridQe Dr. i,,.;y Lot 18,Block 4,Beacon Hill
by February 25, 1983
? Wu:
.a.. 1. . w..nooew .a.c.
BUILDING PERMIT
CITY OF EAGAN
9795 Pilot Kno6 Read Eagon, MN 55121
PHONLs 454•8100
Site Address ?o ij t.cutu.a.iuyc va.ivc
Lot 18 Blosk 4 Sec/Sub. BeaConH11
Porcet # ?10_1350Q 180__ 041
W I Name FEdtiS ' e Bll{1dETS
,?reu 15513Ioqarto Iane
?
., ...I
o I Name ?r
f
Addreas ,
F e`t... D6.....
Ncme
Address
I hereby ackrwwledge tMf 1 have reod this npplication and stote that
the inlormotion is correct ond agree to comply with oll applicabla
State of Minnewtn Stotutea and Ciry of Eogan Ordinonces.
N? 7042
Reteipt # 2.P,,) 5-9
e.ecr ? Occuaoncy R-3
Alrer ? zoninq R-1
Repalr ? Fire Zone VA
Enlarge ? Type of Const. V
Mpve ? * Stories
Demolish ? Length45
Gmde ? Depth '14 Sq. Ft.-
Avvrornls Fees
Assessment _
Woter & Sew.
Police _
Fire
Enp.
Plonner _
Council -
Bldg. Off. _
APC
Permit -And - 00
Surcharge 28•50
Plan check 152.00
SqC 525.00
Water Conn. 335- nn
Water Meter 60_ nn
Road Unit 7 pS nn
Toeol $1589.50
Siqnoture of Permittee I
A Bullding Permit Iz istued to: FOdtllY'?-' BUl PT's on the express tondition thnt
oll work sholl be done in acwrdonce with oll opplicabla Stptp of Minne,s?o/fq +S?tatutes and City of Eogan Ordirwnces.
Buildiny Official ??
18snwn rreIahs uesfmm t vod '*9- L? g
/1 }
T 67582 loa
Renuest Dale Fve No. Rough-in InsPecbon '
2_25_1982
I Re.4ulreA? acatly Now Q W,II NoLiy c-
?Nu tor When Reatly
ftLicensed Electnwl ConVrvctnr 1 hareby request mspec[ion of ebove
? Owner electricel work installed at.
S[reec Address, Bax or Route No. Crty
4673 Cambrid e Drive Eagan
ecuun o. TownshiD Name or No. Rnn9e No. Counry
Dakota
Or.cuGAnt (PFINT) Phone Nn.
Feature Builders
Power Sunplier Atleress '
Dakota Cty. Farmington
Electncal ConVavmr (COmUany Name) ConVactor's License No.
O.B. Thompson Electric Co. A40602
Matlmp AtlJress IConVacYOr or Owner Making InmallaLOnl
12201 Mtka Blvd.l, hItka 55343
a?
Authorized S a[ re IConvemor/Ownar yq?ciny In o
II ionl Phone Number
U 933-25%'•
MINNESOTA STqTE BOARD OF ELECTNICITY
riggs•Midwey 61dg. - Noom N-791
1821 Univers,ty Ave., St. Paul, MN 55104
06....e 16171 49L21111
THIS INSPECTION PEQUEST WILL NOT
BE.ACCEPTED BY THE STqTE BOAPD
NLESS PflOVER INSPECTION FEE IS
ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION K..« EB-00001-03
' See msLUCtions for completing this (orm on bxk of yellow coVY.
T 67582 " ,s
1('" Below Work Covered by This Request ?7 C75?
New Adtl Rep. Type oi BuiitlinB APPlmnce3 WveA Equapment Wired "
Home Range • Temporary Service
Duplex Water Heater 13. Lighting Fixtures
Apt. Bwlding X Dryer , Electric HeaUn
Commercial Bldg. Fumace 2,50 Silo UnloaAer
Industnal Bldg. Air Conditioner Bulk Milk Tank
Farm 5ff a'B E •• oiher Itiuer,itvl
ther u1•ufV Olher Othier
Cnmpute lnspecUOn Fee Below
# Fee ServiceEnirance5iie k Fae Fextlors/5ub(ee.tlers +t Fee Circuits
0 to 100 qm 5 0 to 30 Am ps '? Z. to 30 Am s
1J 12• 00 101 tqnips 31 to 100 Amps 31 to 100 Am
Abo00 q?ppy Abovc 100_Amps Above tU0_Amps
Tranmers RemoteControl Circ. , Partial'Othe e
Signs Speaul Inspection
S
Remi rks Jeff D. 52.? TOTALFEE tJd.?
15
Rouuh-in ? ?? ? U??" I, the Elechlcel
In
t
h
b
r esi,/J sPec
or.
ere
y
Final
?
Dn rtity that the nbove
w
nsoechon has bean
•'??,?? tY..
l
E
` ?7e tr made.
,
r
., ,
rn- . ,..?n ----
18 months hom
1999 BUILDING PERMIT APPLICATION (RESIDENTIAL)
J ?? 1 CITYOFEAGAN (?pyrn,?,?' I2S:25
3830 PILOT KNOB RD - 55122 ZIV 3CS?
(651) 651-4675
NewConstruchonReauirements RemodeUReoairReduirements
? 3 registered site surveys
? 2 copies of plans (inGude beam R window sizes; poured fnd. design; etc.)
? 1 energy calculations
? 3 copies of tree preservation plan if bt platted aker 7/1l93
required: _ Yes _ No
DATE: jj-A3LIqQ
? 2 copies of plan ? 1 site surveys (extenor addihons & decks)
? 1 energy calculahons for heated addifions
CONSTRUCTION COST; -+ ?JS?10• Iq
DESCRIPTION OF WORK: tr17..r Cf f ard Y2-i'??T
STREET ADDRESS: -'-FlP I LCxM L3r•
LOT: ? BLOCK: SUBD./P.I.D. #:
\;vne:_-_ V IGLYIG{O ---- - 1? Yhonc #:
-?- -- - ----- ---
PROPERTY ?t Fmt
OW'VL'R pp? y?
S[ree[ Address:-- -??+?---el1'YY (=C-=b,r_-LN_r ------ ------
City ----------&L?-- - -- State: --Y1_-------- zi ?' s ? oZ?------
Comp:wy:_-il?!d.l.A,1-? -- Plione#:
COV'P1LNC COR ? p? Sveet Address:__= ?eC?_/?y?ti??a • License #Z0-L4]333P-r.xp 3 ZaM
cit. Yus'n5uujLJL sLate: rnn_------- zip: -5-15-533 --------
-------- - - ---
ARCHITECT/
ENGINEER Compvry:
Strcct
City
Sewer & water licensed plum6er (new construction only): _
change and lot change is requested once permit is issued.
Phone #:'I
_ Registra[iou k: ---
----------- ?-----
State: --,------ Zip:
Penalry applies when address
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable
State of Minnesota Statutes and City of Eagan Ordinances.
SignatureofAppiicant: I11,AA, R6?LA
OFFICE USE ONLY
Certificates of Survey Received _ Yes _ No
Tree Preservation Plan Received _ Yes _ No _ Not Requiretl
?
1bp ,q CITY OF EAGAN Include 2 sets of plans,
?? ?? ? ? 1 site plan w/elevations &
-? /o /? BUILDING PERMTT APPLICATION 1 set of energy calculations.
' Ew NoM? S7,aod -
To Be Used Fbr/J r, n m.4 ? Valuation Date /ez'got j$/
Site Pddress ?_?? _( AM B!?/aG?E DR _ OFFICE USE ONLY
LotrL? Block`-?_I ISU? . H t LL J?ect T? Occupancy 3
Parcel #: 10 l3 S;c%0 Alter Zoninq
laepair Fire Zone /IL ?
OWrtex: EEATu l2E BujlbE25 Enlar4e _ TYle of Const. _
Address: ? "/3- GoG+4R7c L611 » M°ve # Stories ?t
- ?5 - Demolish Front
City/Zip Oode: Sv, R NS v i L Le, SS337 Grade Depth ?y ft.
I Prione #: ?i3s-8?f-?-F3
Contractor: F"Qq Tu R,F R kw t l t? 7- k S
Address: , M Z- L!? 6 A RYo L(11
City/Zip Code: II u R)vsVt L t?w- .<?Z_
Phore # :
Arch./Ehg.:
[4ater/Sewer Surcharge _
Police Plan Check
Fire SAC
E'ng, Water Conn.
Planner Water Meter
Council Road Unit
Bldg. Off. ?
APC
Address:
City/Zip Code:
Phone #:
r
OWNER
SITE AOORESS
EXTERIOR ENVEL"OPE AVERAGE "U" CDMPUTATION
CONTRACTOR iZn ?utZC: Yi L/7/i'( DATE PHOME $°I ¢- 7 S?> 8
Deternine working square footape of each.
1. Tota 1 exposc,d wa 11 area ,..,.`! 377, b7 sq, ft, x, 17 - Z 4.10
2, Totat rvoF/ceili1-1,j ar¢a. .,,,. D Srr7t1- sq. ft. z ,05 •
Total exposed e;ail area above floor =
a. Totai wail window area ........................... $ 3•61?
b. Total door area ., . „ ....................... :37.B/
c. Total sli6ing ylass door area ................... d o.02•
d, Total fireplace wall area........................
e, Total wall frarniny urea (average 10%)...,.....,,. t 3 7. yo
f, Tota1 net wall area above floor ................. = 6.g?
g, Total rim joist ar?ea ............................ ? 8
Total cxposed foundation ar?a = $/-07
h. ToYal foundztic; window area ..................... t3,,i 7
i. 7oa1 net foundation area above graLa4 .......... .. l y.qs
Detcrniine "U" value of eacVi ::411 segment.
c. 4O.02
2, xRUIt w S3% = QS'.G8
b, 17S/ _ X "U" `/T ? 4.1/
a. ----
X ° u
z „u;, ? . -
e. 137.70 X ^U" -11 = /(o.SZ
r, 914 ? z °u^ -07 • G -3y
9, 96.4 $ x „up 406 . s??s
n,! z „up .0 •
X "u" . ?47 • 3 / 93
3............ 13 ?7.'.0.7 ............... TOta1 ` ?
If item 0 15 the same as, or less than ttem /1, you have met the fntent
of SBC 6006(t)2.
f
?otal exposed roof/ceiling area = (00 .
j. Total skyliqht area.............................
k. Totai roof/ceiling Framing area (average 10%)... ?
1. Total net insulated roof/ceiling area........... ?p a.ag_
Determine "U" vaiue for each roof/cetling segment.
X ,lull ,
k. X "U" ¦
) . (099W _ x .,u„ p.S = 441
a ................. lQS$'Pd,..,...,.7ota1 = 3r-?
If total of 04 .Ss the same as, or less than 42, you have met the intent, of
SBC 6006(c)l,
Alternate Buildin9 Envelope Design
To utilize the total envelope system method, the vatues established by the
sum of items 43 and 44 shall not be greater than the sum of item5 !1 and 02.
1. ZV.10 ---- + 2,_S</-0 = 2 g.52
s. cq7,5t + a. sYCro ?_ 2s(,9f-
1804 Melody Lane 8903063
Bumrville, Minnesota
WEPJA CO. PL,A1V SERVICE
ED ANOERSON
pRGHITGCTVHAL OESIGNWG ANO PLANNING
OS11C8:
RrG61: RIP-SCr Otnoe:
Bumwille, Minnesota rlMC44 8904636
. . , ,
CERTIFICATE OF SUR
r
y? . .
el%"
o ?0ti /
?
?
?. /
?4j1.4C \ ELEVATIONS SIHOWN ARE EXISTING
@ GRADES AND ARE ASSUMED DATUM.
? s
p0u Ty 9p
4s ? 2s F ?
F?
LOT I 8
?,.
? BLOCK 4 \
? 9 3
\ PROPOSED
LOCATION
S ? R pQ0 JS?v
QQ, ?
04, \ ? 9
?A •.
9,
`bi 89 8 . \ 94 6
2s .
DaLad thls 21at day of
December, 2981 ?
91 0\
\ \
r• ?
/
? 22, I
95„
I hereby certify that thie ia a oorredt 81
represeatation of a aurvey of: /
Lot 18, Blook 4, Beacoa Hills. DQkota
County, Mismsaota, aooording to the plat
thereoP on File and of reoord.
and that I am a duly registered land aurveyor undar the
laws of the 3tate of Jdinnesota. I /
Gane L. Jacobao Minn.
.Xzr DR. Btl GLJ SCALE - I= 30- o DENOTES IRON MON.
prepared for:
Featura Buildera.
16613 Logarto Iane
Hurnavills, Ninn. 553°u7
?
/
/ , p0 0
/ a?y ?b
/ ?0 9
/ i CA
i0 , ? O?+
?
' VP?
87•9
? A
. IQa .
Q?.
BEARINGS ARE ASSUMED DATUM
JAC06SON SURVEYORS
LAKEVILLE, MINN. 55044
PHONE 469-4328
9x- ?1,
2000 FIREPLACE PERMIT APPLICATION
C(TY OF EAGAN
3830 PILOT KNOB ROAD - 55122
651 681=4675
Date: 1,d " -c'/'aO
-
Description of Work: _ Construct new fireplace _Gas _Masonry
?-, Install eas insen on[v ?, )?L
Other
Job address:
%77 Ca„o,
I2"?'00
Alterations to existing
Install eas line onlv
Lot: Block: Subdivision/P.I.D. #: &(.1(.oVI t]l ?? _
Applicant (circle one only): Owner on cto Permit Fee: $60.50
PROPERTY
OWNER
L19i/a.vio Qk1^-_s
Last First
? Phone #:
Street Address: ?? ? y 123` 6f,*
City Cialror• State: Zip:
Company: Sfo#G/•Av 6-.,, `;Vrtr ' Phone #: 661 J/XX-
(area code)
FIREPLACE ?3ya ?ia-.rt ? S?
INSTALLER Street Address:
City State: 10 bAl Zip: 53?_y 7
Company: ? Phone #:
(area code)
GAS LINE
INSTALLER Street Address:
City State: Zip:
I hereby acknowledge that I have read this application and state that the information is conect and agree to
comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances.
SigFatuK
F?D 4 ZD00 ?
RESIDENTIAL
BUILDING PERMITAPPLICATION
i ? Na, ?j
CITY OF EAGAN I
/S
3830 PILOT KNOB RD - 55722
657•681-4675 r
New Conslructbn Reauiremenls RamodeVReoair ReauiremeMs
• 3 regislered s@e surveys showing sq, ft of lol, sq. ft. of house; antl all roofed areas • 2 coplas of plan
(20% maz'vnum lot coverape allrnred) . 1 set of Energy Calculadons for heated addRbns
• 2 copies of pfan showing beam & window sizes; poured taund design, etc.) . t site survey Tw exlerbr additiore 6 decks
• 1 set of Energy Calculatbns . Indicale'rf hame served by septic systern for addNons
• 3 copies of Tree Preservation Plan If lot platled after 711/93
• Rim Joist Detail Options seleGion sheet (bldgs wAh 3 or less units) ,
DATE ?7•-90'Oj VALUATION ICQC?o
JOB SITE
IF MULTI-FAMIIY
PROPERTY
HOW MANY UNITS?
TYPE OF WORKKiQb! GL FIREPL'ACE(S) _ 0_ 1_ 2
APPLICANT ?i?I S?fO?IM/1RY1E ?fo?'? PHONE# ?-QIZ ?Qgg3
ADs ZIoi "p114 EdIS ACfSo,(50715 ? zircone S644D5
CELL PHONE # FAX # (-012 49 ?9 g6,66
NE1V RESIDENTIAL BUILDING ONLY - FILL OUT COMPLETELY
Energy Code Category
(check one)
Plumbing Confractor: _
Plumbing System Includes:
Niechanical Conhactor. _
Mechanical System Includes:
Sewer/WaFer Contractor:
Phone #
Fee: $90.00
Fee: $70.00
All above information must be submitted prior to processing of application.
I hereby acknowledge that I have read this application, state that the
with all applicable State of Minnesota Statutes and City of Eagan fs
Signature of
?f
MINNFSOTA RULES 7670 CAT'EGORY 1?
- Residentlal Ventilation Category 1 Worksheet Subn
- Energy Envelope Calculations Submitted i
_ MINNFSOTA RULES 7672
- New Energy Code Worksheet Submitted
Phone #:'
_ Water Softener _ I.awn Sprinkler
Water Heater No. of R.I. Bathsi
No. of Baths
Phone # I
Air Conditioning ?
_ Heat Recovery System
and agree to comply
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Requlred _
Updated 1/01
12- qo.IX)
City of Eap
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
g Y 55-_?
------------------
? I
; Permit 0: 3 Ol? ?
? Pertni[ Pee: ?
? Date Received:
i Statt:
I
e.. J
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
/
Date: ? ?Vv_ Site Address: H l!J 4? C cinnb- I ic? 1'?
F/e-.
Tenant: Suite #:
RESIDENT/OWNER Name: 1?-?i'?nl? C) rIG(I Q PhoneG6 ?, q?2S
Address ! Ciry / Ztp:
Applicant is: _ Owner x Gontractor
TYPE OF WORK Description of wark: -TP(`? 4- Ke
Conshuction Cost. (-ffc)Iq.L/d
Multi-Family Building: (Yes No?
CONTRACTOR Name:`?M License#: ;vORQr'IS'!
Address ?%Lfl m (VnX"IC7ll M N.
city: S4? ll(xv&e1' scate: fY11Y ziP: 55
Phone: G51 - y39-I-13-?10 Contact Person: KQCM
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Cateaorv 1 Minnesota Rules 7672
Energy Code . Residential Venfilation Category 7 Worksheet
Category sudnmed
(4 submission type) • Energy Envelope Calculazions Su6miried • New Energy Code Worksheet
sunmaced
In the IaSt 12 monThS, hes the City ot Eagan issued a permN }or a similar plan based on a meater planl
_Yes _No If yes, date and address ot master plan:
Licensed Plumber: Phone:
Mechanical Cantrector. Phone:
Sewer 8 Water Contractor: Phone:
I hereby acknowledge that this IMOrmatian is complete antl accurete; ihat the work vAll be m conformanCe with the ordlnances and codes of the City of
Eagan; that 1 understand ihis is not a pertntt but onty an appliCatlon tor a permit, and work is nU M starl without a pertnk; that the work vrill be in
accordance witfi ihe spproved plan in the case M M,ork which requires a review and approval W plans.
XP,--?,,n Ick- L iAcl ( oj-t" X Yt .
AppiicanYs Printed Name ApplicanYs Signature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA148925
Date Issued:04/27/2018
Permit Category:ePermit
Site Address: 4673 Cambridge Dr
Lot:18 Block: 4 Addition: Beacon Hill
PID:10-13500-04-180
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener).
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
$60.00 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 -
Dennis D Orlando
4673 Cambridge Dr
Eagan MN 55122
(651) 925-6449
Champion Plumbing
3670 Dodd Rd., #100
Eagan MN 55123
(651) 365-1340
Applicant/Permitee: Signature Issued By: Signature