4940 Dodd Rd
Use BLUE or BLACK Ink
F-----------------
I For Office Use I -
1 ~
Permit C / 7 j
City of EI
I Permit Fee:
3830 Pilot Knob Road 1 I
Eagan MN 55122 j Date Received: j
Phone: (651) 675-5675 I 1
Fax: (651) 675-5694 1 Staff: I
2010 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: J Site Address: -1 1-) ~q j
Tenant: Suite
RESIDENT / OWNER
Name: vs~ . t Phone:
Address / City / Zip: 6, L L,l ,Cvl~Er
Applicant is: Owner Contractor `-20 7- `7 7
TYPE OF WORK Description of work: lJ''/1
Construction Cost: Multi-Family Building: (Yes / No>c-)
CONTRACTOR Name: License
Address: City:
State: Zip: Phone:
Contact: Email:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE. Plans and supporting documents that you submit are considered to be public information. Portions of
the information maybe classified as non-public if you provide specific reasons that would permit the City to
conclude that the are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage.
Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Applicant's Printed Name Applica is Signatu e
e1bf2~
q Z-/ ~ C(. R
DO NOT WRITE BELOW THIS LINE
SUB TYPES
_ Foundation _ Fireplace _ Porch (3-Season) _ Storm Damage
Single Family _ Garage _ Porch (4-Season) Exterior Alteration (Single Family)
- Multi _ Deck _ Porch (Screen/Gazebo/Pergola) _ Exterior Alteration (Multi)
_ 01 of _ Plex _ Lower Level _ Pool _ Miscellaneous
Accessory Building n ~J/
WORK TYPES I W T / 6 4000,15 -/Jr~yue
New _ Interior Improvement _ Siding _ Demolish Building*
_ Addition _ Move Building _ Reroof _ Demolish Interior
Alteration _ Fire Repair _ Windows _ Demolish Foundation
Replace Repair _ Egress Window _ Water Damage
Retaining Wall *Demolition of entire building - give PCA handout to applicant
DESCRIPTION Valuation /:~;Zx Oc
cupancy MCES System
Plan Review Code Edition SAC Units
(25%- 100%-X) Zoning City Water
Census Code Stories Booster Pump
# of Units Square Feet PRV
# of Buildings Length Fire Sprinklers
Type of Construction Width
REQUIRED INSPECTIONS
Footings (New Building) Sheetrock
Footings (Deck) Final / C.O. Required
Footings (Addition) Final / No C.O. Required
Foundation HVAC
Drain Tile Other:
Roof: -Ice & Water -Final Pool: -Footings Air/Gas Tests -Final
Framing Siding: -Stucco Lath -Stone Lath -Brick
Fireplace: -Rough In -Air Test -Final Windows
Insulation Retaining Wall: _ Footings _ Backfill - Final
Meter Size: Radon Control
~ Erosion Control
Reviewed By: L~ , Building Inspector
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge 0
l
Treatment Plant
Copies v
TOTAL
Page 2 of 2
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 1 97F9
PHONE: 454-8100
BUILDING PERMIT Receipt # -
Site Address 4440 DODD RD
Lot 3 Block Z Sec/Sub. SKY Y19V
Parcel No.
W Name
Addre
01 -
city
Phone
Name _
Address.
I hereby acknowlege 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.
1
Signature of Permitee
A Building Permit is issued to: MIKE OR F-USK SDICH
on the express condition that all work shall be done in accordance with all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building Official
OFFICE USE ONLY
Occupancy R-3 -kfn1 FEES
Zoning A
(Actual) Const -!L-" Bldg. Permit 804.00 1
(Allowable) Surcharge 73.30
# of Stories 77
i
Length 1Z? Plan Review 323,
1
)
Depth SAC, City
S.F. Total SAC. MCWCC
S.F. Foolprints )
On Site Sewage X Water Conn
On Site Well Water Meter
MWCC System I
City Water Acct-
Deposit
PRV Required S/W Permit
Booster Pump S/W Surcharge
Treatment PI
APPROVALS Road Unit 370.00
Planner Park Ded.
Council -
Bldg. Off. Copies
Variance - TOTAL 1,770.30
Permit No. Permit Holder Date Telephone #
WATER
fB WER( Yla 5 I G Ox vtj
PLUMBING
H.V.A-C. 1990 -408
ELECTRIC kt ab
Inspection Date Insp. Comments
Footings 1 9117 Q? !?v
?'w ?ccQ
Foundation
Framing (^ / j 3/ 2 ?,_ S ?t %?s
Roofing
Rough Plbg.
Rough Htg. -71 IV 0 13 1,15, Z'
[Sul.
Fireplace ?e?11 /0
91
Final Hig.
J(
1,7
Orstat Test
Final Ptbg. _ J Plbg. Inspector - Notify Plumber
Const. Meter
EngrJPlan
Bldg. Final
Deck Fig.
Deck Final
Well
Pr. Disp. `, ? 2
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-189
(612) 681-4675
SITE ADDRESS: ' I
Inl
1 1:1 F;
1 •r VI( W
PERMIT SUBTYPE:
I" rl It T 1 N 6
? I NA1
INSPECTION RECORD
PERMIT TYPE:
Permit Number:
7 Date Issued:
HIIII DING
a. ;h(."
" ;" " I APPLICANT:
fitnfh.
(f•1 1 44
TYPE OF WORK:
;i1 ( 1.; ; I 1 1 i'N
I VAM I Nil
NF I.J
(6r1I'[ Ito fe DECK
Permit No. Permit Holder Date Telephone 8
ELECTRIC
PLUMBING
HVAC
Inspection Date Insp. Comments
FOOTINGS
FOUND
FRAMING
! !O let
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
BSMT R.I.
BSMT FINAL
DECK FT:_. -
q
-S?
57-/-,
? I
-
DECK FIN;0- /
i
( I - -
_
I {
CITY OF EAGAN Remarks / 9?
Addition DODD VIEW ADDITION Lott' (litt1OtRBlk Parcel
Owner_e?6J State
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK
SEWER LATERAL
WATERMAIN
WATER LATERAL
WATER AREA
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER.
SAC
PARK
` CITY OF EAGAN ?0 19559
3830 Pilot Knob R d P O 0 21 199 E MN 551
... oa , ox - , agan, 21
BUILDING PERMIT PHONE: 454-8100 Receipt# /aJ`?r zJ , 199cr
"?
To be used for SF DWG/GAR Est, Value $147,000 Date AUG 16 , 19 21
Site Address 4940 DODD RD
Lot 3 Block 1 Sec/Sub. SKY VIEW
Parcel No.
w Name MIKE & KAREN SKRBICH
Address 12757 DIAMOND PATH
City APPLE VALLEY Phone 423-6001
o Name 5Amt
Address
E City Phone
ww Name
Address
a W City Phone
I hereby acknowlege that 1 have read this Lion _gLqd state that the
information is correct and, 9rse to co wi a p is Ie.SState of
Minnesota Statutes and C - ban i as
Signature of Permitee
A Building Permit is issued lo: MIKE OR KAREN SKRBICH
on the express condition that all work shall be done in accordance with all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building Official ppp
I1,D1lA,'ll
OFFICE USE ONLY
Occupancy R-3 M-1
Zoning A
FEES
804.00
73.50
523.00
(Actual) Const _Y-NB Bldg. Permit
(Allowable) V-N
# of Stories
Length
Depth
S.F. Total
S.F. Footprints
On Site Sewage
On Site Well
MWCC System
City Water
PRV Required
Booster Pump
APPROVALS
Planner
Council
Bldg. Off.
Variance
X
Surcharge
Plan Review
SAC, City
SAC, MCWCC
Water Conn
Water Meter
Acct. Deposit
S/W Permit
SNd Surcharge
Treatment PI
Road Unit
Park Ded.
Copies
TOTAL
1,7/U...DU
Address: 4940 DODD MAD Lot 3 Blk I Sec/Sub SKY VIEW
These items were/were not complete at the time of the final inspection.
12126/91 Yes No
Final grade (6" from siding)
Permanent steps - garage
Permanent steps - main entry
Permanent driveway
Permanent gas
Sod/seeded grass
Trail/curb damage
Porch
Basement finish V-14
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. "ITA
R[C21[?MRP
White - City copy Yellow - Resident copy Pink - Contractor copy
2 6 3 0 1 ( ® OFFICE USE ONLY This request .d 18 months hom validation date printed in this
9/r
00
PLEASE PRINT OR TYPE 9. D
Request Dote
'
1 Rough-in impedlon mquir T Ye: No
Y
ll
h
d
h Inspection he, Than Ro?hdn: ? Reody Now WII Call
D
k R
d
7 -)
- 9 I
au mwl ca
t
e impeeor w
en
y; o
eo
y:
I, licensed contractor ? owner hereby request inspectn of the I
above electrical work at:
Job Address (5heet, Bat, or Route No.) ty Zp Code
^A
Section No. Township Nome or No. Range No. 'e No. C my
Ocau ant Phone No.
i
Pawer Supplier Add®ss
Electrical Conhaaor Company Name)
2, k ?mmcgi, ltoeme No.
yf
F/}I r J1:5 Most., Da No. (Plant Eled. Only)
Address ctor or Owner Pedarming miallationl t
k T M/v
t
Au ed 5ignolu (COnhacto!` erP dormin Installan Phol?Nqq,_LfioT-
EBIDWIA-1a 6/95 STATE BOARD COPY- SEE INSTRUMNS ON BACK OF YELLOW COPY;
1111 II?II I II II II I it II Ills REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University * 4- 2 60 3 0 7 7 0 * phone (6u2 642-o8oo S- 28, S Pau l, MN 55104
Home Duplex Apt. Bldg. Other: `. New
Commercial Industrial Farm I .d
Remod Re air
Air Cond. Htg. Equip. Wafer Htr. Load Mgmt. Other: I
D er Range Elec. Heat Tem . Service
"X' above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
(a4XZ.Q-liv-
i
Calculate inspection Fee - This Inspection Request will not br accepted without the correct fee:
Other Fee # Service Entrance Sae Fee # Cirdufts/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps to 101) Amps
Street Ltg./iraffic Sig. Above 200_kmps 100 Amps
Transformer/Generator 1NSPECTOWSUSEONLF mG TOTAL
Sign/Outline Lig. Xfmr. 40s SD
Alarm/Remote Control !.
Swimming Pool I
i hereby cem I t i i ei as d., ed hema as the'dam, ,p
Irrigation Boom Ravgh-ie one `
ecial Ins
ection
S
p
p
Investigative Fee Final
t
114) Date
U2
THIS INSTALLATION MAY BE ORDERED DISC IF T M D'WITHIN 1S MONTHS.
(d5&&_]
2004 RESIDENTIAL MECHANICAL PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please complete for: single family dwellings & townhomes/condos when permits are required for each unit
50 -SD
/
_/
Date o
/
I ry (Lo
Site Address '1 I 1Q A ??
j I `?' Unit #
P
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O
1 O
4
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X Tele
hone #
roper
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wner
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_
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Contractor S
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Street Addres V
/ City
State 4Y -? ,
'
/
Zip ? l _ /
Telephone #
Bond #• Expires:
The Applicant is Owner " Contractor Other
Add-on or alteration to existing dwelling unit $ 30.00
furnace -Additi onal -Replacement
air exchanger
diti
N
i
/
l
t
r con
oner -
ew
a p
acemen
other
FR _50 0
State Surcharge JUL 3 0 204 $ .50
l BY
t
T $ -VV
o
a
I hereby apply for a Residential Mechanical Permit and acknowledge that the information is complete and accurate; that the work will
be in conformance with the ordinances and codes of the City of Eagan and with the Mechanical Codes; 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. / e
r 1.? LosKsL t
Applicant's rinte Name Applicant' t ature
?,. 1991 BUI117PLICATION
CITY OF EAGAN
SINGLE FAMILY DWELLINGS
2 SETS OF PLANS
3 REGISTERED SITE SURVEYS
1 SET OF ENERGY CALCULATIONS
MULTIPLE DWELLINGS
COMMERCIAL
2 SETS OF PLANS 2 SETS OF ARCHITECTURAL
REGISTERED SITE SURVEYS - & STRUCTURAL PLANS
(CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFICATIONS
1 SET OF ENERGY CALCULATIONS 1 SET OF ENERGY CALCS
_# OF RENTAL UNITS
# OF FOR SALE UNITS
PENALTY APPLIES WHEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY LAST WORKING DAY
OF MONTH IN WHICH REQUEST IS MADE.
LOT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED.
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS
DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DAYS ONCE A PERMIT HAS BEEN COMPLETED.
PERMIT MUST SHOW A LICENSED PLUMBER, ,
n r
To Be Used For: DLL 657- Date: _
Site Address y g yo D??? ?,?
Lot t:52 Block
Parcel/Sub ,</'/% L/ /04t
Owner
/('? rCi ei[??/J?SlCr?f
G Add ess / Z7S'7A'44x-x (/?fyi/rf
City/Zip Code /--CzzGjL //A44 cl
SSA,
Phone Z/Z_'F 6001
Contractor pLJsye/? a-e c,/ 76
Address As s?v?Cy?4?
City/Zip Code
Phone
Arch./Engr. ?}aL?G( 70/iL Kc?
Address 3G1 ?? Lcf? ?ti1 Q?
OFFICE USE ONLY
Occupancy
K 3 Af'/ FEES
Bldg. Permit
CGS'
Zoning Surcharge 3, p
Actual Const / Plan Review S23
Allowable VA/ SAC, City
# of stories SAC, MWCC
Length ?9 Water Conn.
Depth 30 Water Meter
S.F. Total Acct. Deposit
Yootprint S.F. S/w Permit
S/W Surcharge
On site sewage ? Treatment Pl.
On site well ? Road Unit 3 o
MWCC System _ Park Ded.
City water Trail Ded.
PRV Copies
Booster Pump
SUBTOTAL
APPROVALS Penalty
Planner Lot Change
Council TOTAL =70 0
Bldg. Off.
Variance
City/Zip Code f AW 2 7
Phone # 'W5
/nZ?iD? GJL? ca^
i?
(Signature
agrees that all work shall be done in accordance with
all applicable State of Minnesota Statutes and City of Eagan Ordinances.
Z ?5 ?S f
l? Ii:3
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3(ok 2(, =
4r, ?
M yy •.'M' M w
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S??3y?s
1 3) 131 3
t
MINNESOTA STATE ENERGY CODE CALCULATIONS II~ ?? I
BASED ON CHAPTER 5 OF THE
MODEL ENERGY CODE - 1983 EDITION
+ Adoption Effective
.Owner I/?n I r 11 &E? ??c??N JKI? ?j Lf'?' Phone Date
Site Address
Contractor Phone
Building Classification: Type Al (Single Family & Duplex) 4
Type A2 (Residential, 3 stories or less) (Over 3 stories) (Other)
NOTE. Complete pages 3 and 4 first.
GENERAL INFORMATION IV ??}??
1. Building Perimeter, eE `5i'1`ft.
2. Wall height (ground to eave) V% ft.
3. 1. X 2. (above) gross wall area L+1`T`4' g> sq.ft.
4. Building dimensions (L) -X (W) sq.ft.roof & floor area
5. Sq. foot area of rim joist - F1por joist size (2 X 10 )
cp X _ (Perimeter) = ZZ149Isq.ft.
12
•6. Doors - Area I rD 101 Thickness ss in U. factor I
Type of Construction Perimeter ft.
Manufacturer
7. Total door's perimeter ft.
8. Windows: Manufacturer- 'N JV?imt? State approved
U factor
TYPE SIZE AREA (Sq.Ft.) NUMBER OF TOTAL
/: ? NW, 0V-I- `at?GL?1N EACH UNITS SQ FEET
9. Total sq.ft. Glass 711 r 5
10. Fireplace area: Width X Height = X = sq.ft.
11. Exposed foundation: Height X Perimeter iO X Isq.ft.
.COMPLETION OF THIS FORM IS REQUIRED FOR ALL NEW CONSTRUCTION, MAJOR
REMODELING AND BUILDINGS BEING MOVED WHERE ENERGY, OTHER THAN THE MINIMAL
CODE ALLOWANCE, IS USED.
-1-
??
IF
42. ,Framing area = 10% of gross wall area.
13 G
ll
G
??????
. ross wa
area
sq.ft.
• ?,1
Window area A JG1 1 P5
sq.ft. U windows = !'?o UxA
Rim joist area A I 2'Q? sq.ft. U rim joist= 04-1 UxA =
-III V
? 7?
I0
Door area A
sq. ft. U door area= I
r UxA 1
=
Other doors area A?'?sq. ft. U other doors=-11-7- UxA = .1
E
d f
d
9b,41 1 -4j
I72 i
xpose
n
n A
sq.ft. U foundation= UxA 1
=
Framing area ArZ f l" sq.ft. U framing area= UxA =
Net wall area A Iq.ft. U wall= r? 4,27 UxA = 3I
TOTAL
(13B UxA =
. . . . . . . .
) .
14. Gross wall area x 0.11 (A-1 single family & duplex) = allowable UxA/Code
(13. above)
x 0.23 (A-2 other residential)
x .23 (Other buildings)
x .28 (Over 3 stories)
Z?G??
2? Q BTUH must be l
arger
than or same
I
.11
A
U
??
77 O
d
x
Co
_
1
e
F. as 13B above
15. Ceiling framing area (Af) equals 10% of ceiling area (I1?
?5A. Gross ceiling area = (L) x (W) sq.ft.
15B. Joist area (Af) = 10% ceiling area sq.ft.
15C. Net ceiling area (Ac) (15A - 15B)I = r v sq.ft.
U ceiling x Ac = IdZ2- x ( / = Z?71-7
U framing x Af = /? x Imo`
15D. TOTAL U x A ............................
16. Ceiling area (15A) x 0.026 (A-1 single family & duplex)
allowable UxA/Code
x 0.033 (A-2 other residential)
x 0.06 (other)
BTUH must be larger than or same
A(15A) +1 r? x U Code OF. as 15D above
NOTE: Use U and A values obtained from pages 1, 3 and 4.
CERTIFICATION: I hereby certify that I have calculated the "U" factors and
"R" values herein and that the building here described meets or exceeds the
State of Minnesota Energy Conservation Act.
&ate
signature
-2-
54XC6.;p4 X3,5+ OiP4
4- 31,5 +rai , 5,
1ll? wLrw?
?4x
z-4 X4v : I1 5
II Ivx4g = (?,I v, 2- 13 5
• I1 low
III ZQX?c?
= 8,75x (o- 52.,5
z = I?, o
?,?x z Ico,s
Z a G , Q? W?Z G
? SGT, ?{? ?' u<o
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1402. 1 -?S
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PERMIT #? 00 RECEIPT DATE:
2008 RE.SIDENT1141. PLUM$IN6 PERMIT APPLICATION
CITY OF IEAGAN
3830 PaOT KNOB BD
EAGAN, MN 35122
651681-4675
Please complete for: single family dwellings, townhomes and condos when permits are required for each unit,
backflow preventer for irrigation system
SITEADDRESS: 40146 bCeAd Rb
OWNERNAME:: AGR'pF PAQ,A[jAQ-V-r--+ TELEPHONE #: (051 _3ZZ-S3 Iq
(AREA CODE)
INSTALLER NAME: H , P . P i (2<,WC5 rlCf? TELEPHONE #: (A (-3(a&- ISO
STREET ADDRESS: 56-1o De>?C(A Rd (AREA CODE)
CITY: t kl UA STATE: Nil 0 ZIP:
_ SEPTIC SYSTEM, new/refurbished (requires two sets of plans and MPC license)
includes $40.00 County fee $ 100.00
Note: Additional consultant fees may apply
• MODIFICATION/ALTERATION TO EXISTING DWELLING UNIT, INCLUDING:
- Adding fixtures to lower levels or room additions, excluding water softeners and water heaters. $ 50.00
- Abandonment of septic system.
- Water turnaround - existing dwelling unit (+ 518" meter if needed - $118)
Other:
- RPZ: new installation/repair/rebuild D ,lUl 0 8 2002 D $ 30.00
- lawn irrigation system
B
Replacement/additional: _ water softener water heater $ 15.00
State Surcharge $ .50
TOtal $
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable City of Eagan ordinances. It
is the applicant's responsibility to notify the property owner that the City of Eagan assume 5,4;p, liability for any damages caused by the City during its normal
}i? ofRw?yleas? em
operational and maintenance activities to the facilities constructed under this permit 'thi ityU1prrooperty
5?rNATWRE OF PERMITTEE 1 1 1/02
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS:
4940 DBDD RD
LOT: 3 BLOCK: 1
SKY VIEW
P.I.N.: 10-69000-030-01
DESCRIPTION:
PERMIT TYPE
Permit Number:
Date Issued:
(GAZEBO & DECK)
ermit Type SF (MISC.)
p?k Type NEW
434 ALT. RESIDENTIAL
PERMIT
7? 3w &' r '? tlr4 0' '*??
'Gain a.s as.:a ,km I?yt: ?s.;n'q 'eiiE '4^"i?'„ q?SjG S;,
W57a5?-
BUILDING
027560
05/20/96
REMARKS:
FEE SUMMARY:
VALUATION
Base Fee
Surcharge
Lic. Search Fee
Total Fee
$149.75
$4.50
$5.00
$159.25
$9,000
CONTRACTOR: - Applicant - ST. LIC.OWNER:
FULL DECK 14432485 2000670 MACRAE
1420 MARIGOLD CIR 4940
VICTORIA MN 55386 EAGAN
(612) 443-2485
I
`I he:r4,by
?tatu?e5
cJ po . _ Q n
APPLICANT/PE ITE SIGNATURE
MARGARET
0000 RD
MN 55123
ISSUED BV SI TUR ?-
CITY OF EAGAN
4 3830 PILOT KNOB B RD
RD - 55122
0996 BUILDING PERMIT APPLICATION (RESIDENTIAL)
\ 681-4675
New Construction Requirements Remodel/Repair Reauirements
3 registered site surveys
2 copies of plans (include beam & window sizes; poured Ind. design; etc.)
1 energy calculations
3 copies of tree preservation plan if lot platted after 7/11/93
required: _Yes _ No
DATE:
? 2 copies of plan
? 2 site surveys (exterior additions & decks)
? 1 energy calculations for healed additions
CONSTRUCTION COST: 4 9 sDO ,Oct
DESCRIPTION OF WORK: C'?ec v kQ Ln, SA-ro-CA
STREET ADDRESS: L19 etc) I-)oaA VA.
LOT I ) BLOCK _L SUBD./P.I.D. #:
PROPERTY
OWNER
Name:
Street Address:
City:
Sewer & water licensed plumber:
change are requested once permit is issued.
State:
Zip:
Penalty applies when address change and lot
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: 411 ! MlY..__ ?? ?- -
OFFICE USE ONLY [REC: E Q
Certificates of Survey Received Yes No AY i9g6
Tree Preservation Plan Received Yes No -
CONTRACTOR
Name: FLOE r la. 'r Phone #:
Wi RRBT
Street Address: `L9uQ t?aaA- 1
City: F-aaa." State: ?, . Zip: S?IaZ
Company: Phone #: Llu3-aa8s
Street Address: Igao c..-ate License* cW606--200
City: Jt r-?Or'kc? State: Zip: ,?s ZBF
ARCHITECT! Company:
ENGINEER
Phone
Registration #:
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Duplex
? 02 SF Dwelling ? 07 4-plex
? 03 SF Addition ? 08 8-plex
? 04 SF Porch
4a= 05 SF Misc.
47,.t 2geo
WORK TYPE ? 09
? 10
t,.,r rr+ 12-plex
_ plex
p'- 31 New ? 33 Alterations
? 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
SNV Surcharge
Treatment PI.
Road Unit
Park Ded.
Trails Ded.
Other
Copies
Total:
OFFICE USE ONLY
? 11 Apt./Lodging ?
? 12 Multi Repair/Rem. ?
? 13 Garage/Accessory ?
? 14 Fireplace ?
4v&` 15 Deck
? 36 Move
? 37 Demolition
16 Basement Finish
17 Swim Pool
20 Public Facility
21 Miscellaneous
Basement sq. ft. MCNVS System
Main level sq. ft. City Water
_
sq. ft. Fire Sprinklered
sq. ft. PRV
sq. ft. Booster Pump
sq. ft. Census Code. Y3°f
Footprint sq. ft. SAC Code 01
_ Census Bldg
Census Unit D
Building Engineering Variance
Valuation: $ p00
% SAC
SAC Units
LOT c? BLOCK-L- SUBD.
RECEIPT # 484&6 DATE '?01710/4el
1996 CITY OF EAGAN
IRRIGATION PERMIT (FOR BACKFLOW PREVENTER)
COMMERCIAL INSTALLATIONS: FORM MUST BE COMPLETED BY LICENSED PLUMBER
Date: 0 / 6
Area/address to be irrigated: I v II r
Installer: IRS- Y'- d. I -? I V
Street address:
> Z Q SO Yv U
Commercial GPM
Residential (boulevards) GPM
Existing residential
T Owner ? Plumber
I 1) --P-
City, state & zip code: L S?-- y?-1 Phone #:
Owner Name--M
Street address: Z-r / Z/d
City, state & zip code: L r-\ ?t ox N rh Phone #: ZZ S 3 / O
irrigation contractor, if different than installer:
Telephone #:
I hereby acknowledge that I have read this application, state that the information is correct, and agree to
comply with all applicable City of Eagan ordinances. It is the applicant's responsibility to notify the property
owner that the City of Eagan assumes no liability for any damages caused by the City during its normal
operational and maintenance activities to the facilities constructed under this permit within City
property/right-of-way/easement.
Applicant's signature
Approved by:
PRV ? Yes ? No New service
Meter Size & Cost
Title
Date:
? Yes ? No
Fees due: 070 Calculated
Irv, V pU?s
PROCEDURE FOR IRRIGATION SYSTEMS - 1996
An irrigation permit is required - please contact Protective Inspections at 681-4675.
Fees
Commercial project: $25.50 irrigation permit to cover installation of backflow preventer.
$50.50 water permit fee only if new service is installed.
$300.00 per tap if installed by City.
Residential project: $20.50 irrigation permit to cover installation of backflow preventer.
$50.50 water permit fee if new service is installed.
$760.00 oer connection - WAC.
$396.00 oer connection - water treatment facility.
Existing residence: $20.50 irrigation permit to cover installation of backflow preventer - (not
required if backflow preventer previously installed).
Meter charge: If gallons per minute are less than 25, a 1" meter will be required at a cost of
$182.00. If gallons per minute are more than 25, a 2" turbo with strainer will
be required at a cost of $822.00. This information is to be supplied by the
desianer of the system.
No meter will be sold before all sewer and water inspections are complete on anew service. If new
service lines are not required, one check may be written for meter and permit costs. Receipt will be coded
to 20-3716 (meter portion only) with pink copy forwarded to Utility Billing Clerk.
The installer is to contact Protective Inspections at 6814675 for inspection of the inside water line and
backflow preventer. The Public Works Department may be reached at 6814300 for water turn-on and set
and seal of the meter. Inspection hours are 8:30 a.m. to 3:30 p.m. Monday through Friday. Requests for
A.M. inspections should be made on the preceding work day. Requests for PM inspections will be accepted
until 12:00 noon.
L 3, 8 ?? sK'd vt?
DAKOTA TESTING
11960 East 230th Street
Hastings, Minnesota 55033
RICK REAMER (612) 437-8345
437-8345
Ll') `(v Uapn 4?b.
LEROY BAUER
(612) 437-2490
y 9 yo
TESTS & SEPTI
•
The Borings & Tests were performed on
,1 7-20 /,Z
/, h.1 -e3i? aTel- X// i AL The perk tests were performed in accordance
with the provisiorKof W.P.C. -40. Individuate ge System Standards. Locations of perk tests and
their readings are on the following pages.
The proposed design is based on water usage of a Type I three bedroom house. Design specs are
ROCK COVER: GEOTEXTILE [ ] RED ROSIN/KRAFT PAPER P<TaL,5TWle'
OTHER BACKFILL: TYPE UNSi c DEPTH d-
TRENCH LINER: TYPE
DEPTH
NOTE -
This is a proposed design, it should be gone over with the local inspector to insure proper installa-
tion and to meet local code.
The soil conditions and perk tests have been established at the test hole locations only. There may
be variations in soil stratigraphy between and around borings, and interpolation or extrapolation
of the results is not warranteed.
LeRoy Bauer
•
PERK TEST • SEPTIC SYSTEM DESIGN • SOIL BORINGS
coi 103W
TOOT.??T1MT AREA 6 361 sq. ft. LATERALS: NO/LENGTH 3 - 026y.??
a[SLTOT. LATERAL LENGTH --70-ft. WIDTH '76_ in. ON-CTR SPACING
ROCK: DEPTH UNDER PIPE Za in. AT/ABOVE PIPE -Q in. AMT S
• • 0 .
PERCOLATION TEST DATA
Percolation ten readings made by on (date) 7y/
:0-?J 7
Hole number Date hole was preparod Hole number. ? Date hole was prepared ' 9'1 Depth of hole bottom inches, Diameter of hole w inches Depth of hole bottom 7 inches, Diameter of hole
to inches
Soil data from test hole:
Depth, inches
sue.-l-
snll tavlum
Depth of hole
Soil data from test hole:
Depth, inches
Maximum water depth above hole bottom during test
Soil data from test hole:
Depth, inches
Soil texture
inches Depth of holebaMe&z1-
Soil data from test hole:
Depth, inches
inches
Date hole was
Inches, Diameter of hole
inches. Maximum water depth above hole bottom during test
TIME TIME INTERVAL,
MINUTES MEASUREMENT,
INCHES DROP IN WATER
LEVEL,INCHES PERCOLATION RATE,
MINUTES PER INCH
REMARKS
M4 `4o S
`?U r eu
C? S? D
U EU
/a " e15- 90,0
Date hole was
inches, Diameter of hole
inches.
TIME TIME INTERJAL,
MINUTES MEASUREMENT,
INCHES DROP IN WATER
LEVEL,INCHES PERCOLWION RATE,
MINUTES PER INCH
REMARKS
V 7 r' v
a
103j, / / / cv
mj7
Percolation rate = /q, minutes per inch. Percolation rate = 01/-? • minutes per inch. GIN 10509
• LOGS OF SOIL BORINGS
Location or Project ?,e? - ?UCir/ ?L. !i'(2.f/
Borings made by Dakota Testing. Date--7--c;2 0 - /
Classification System: AASHO; USDA-SCS_; Unified; Other
Auger used (check two): Hand-, or Power; Flight-, or Bucket;
other /?iQC r..lUE
Depth, Boring number Depth, Boring number
in
feet
Surface elevation in
feet
Surface Elevation
0 0
?j
2 2
3
4 r-rlia L04?4 3 7
5 /J
S'"'q J- Ac K
S ((??
Sig// ; LO/JH'I
6 6
7 7
8 8
End of boring at b
Standing water table:
Present at feet of
hours after borin
Not present in boring hole
Mottled soil:
End of boring at feet.
Standing water table:
Present at feet of depth,
hours after boring.
Not present in boring hole v
Mottled soil:
Observed at feet
Not present in boring hole
•
Perc. Tests &
?,yE ? ep 3'
?VVVVV?.V ?
vFw : -.
Depth, Boring number Depth, Boring number
in
feet
Surface elevation in
feet
Surface Elevation
0 0
r,?c=0??Iocvv G'T.6tX S
2
3 ?b LLY
/7'
/ z
3 L-
/`
J
4
5
S.//Ov d-/rdCf-` 4
5
C/
6 b
7 7
8 8
End of boring at t0
Standing water table:
Present at feet of
hours after
Not present in boring
Mottled soil:
End of boring at feet.
Standing water table:
Present at feet of depth,
hours after boring.
Not present in boring hole
Mottled soil:
Observed at feet of depth-
Not present in boring hole
Observed at feet of depth. Observed at feet of
Not present in boring hole gdi 10351 Not present in boring hole
IND
city of
3830 PILOT KNOB ROAD THOMAS EGAN
EAGAN, MINNESOTA 55122-1897 Mayor
PHONE: (612) 454-8100 DAVID K. GUSTAFSON
FAX: (612) 454-8363 PAMELA McCREA
TIM RAWLENTY
THEODORE WACHMR
Council Members
THOMAS HEDGES
Crry Adminstrator
30
1991
,
e EUGENE VAN AN OVERB
RBEKE
City Clerk
BOYD MILLER
NORWEST MORTGAGE
100 W BURNSVILLE PKWY STE 201
BURNSVILLE MN 55337
Re: 4940 Dodd Road, Eagan MN (Lot 3. Block 1. Skyview Additionl
To Whom It May Concern:
Our records indicate that an inspection of the private disposal system installation
regulated by Minnesota Rules, Chapter 7080, was performed at the above-referenced site
on September 17, 1991. No observed violations of said rules were noted.
Sincerely,
kA
Joe Merchak, Construction Analyst
Protective Inspections
JM/mg
THE LONE OAK TREE ...THE SYMBOL OF STRENGTH AND GROWTH IN OUR COMMUNITY
Equal Opportunity/Affirmative Action Employer
3, Uli..J
-All ?
Ordinance No. 114: Permit No.
WELL CONSTRUCTION AND ABANDONMENT
91-0099
WELL PERMIT.-
DAKOTA COUNTY PUBLIC HEALTH DEPARTMENT
FNVIRONMENTALHEALTH SERVICES SECTION
WATER QUALITY MANAGEMENT UNIT
14955 Galaue Ave., Apple Valley, MN 55124
Telephone: (612)891-7556
WHEREAS# the NON-TRANSFERABLE
YERNITTEE/DBA: Maher Well Drilling ISSUED TO # 19301
ADDRESS: Rt. #1 REVIEWED BY DS
Hastings, MN 55033
has submitted a permit application, has paid the sum of two hundred
fifteen ($215) dollars to the County of Dakota as required by Ordinance
Number 114 and has complied with all of the requirements of said
Ordinance necessary for obtaining this permit to construct the well(s)
described herein:
A private water supply well(s) will be constructed with a finished
casing diameter of 4 inches, drilled to a depth of approximately 300
feet and terminating in the Prairie du Chien Limestone aquifer. The
well(s) shall be properly cased, grouted with bentonite slurry (at
least 10% bentonite) to seal off overlying unconsolidated formation
materials, and completed with an open hole in the aquifer.
The well is located in the municipality of Eagan as follows:
Well Location: Property Owner and Well Owner and
Address (if different) Address (if different)
4940 Dodd Road Mike Skribrich
Eagan, MN
NOW, THEREFORE, Maher Well Drilling is hereby permitted and authorized
to construct the well(s) described and located above for the period
September 1991, to September 1992, subject to all provisions of said
Ordinance, the Minnesota Water Well Construction Codes and any
conditions attached on the reverse side of this permit.
Given under my hand this 20th day of September, 1991.
ATTEST ! K?'1Gt'?ec?
ENVIRONMENTAL HEAL PERVISOR E ,NM TAL HEALTH DIRECTOR
FROM OAK CTV SOC SVC 9.20.1991 13:54 P. 1
DAKOTA COUNTY
BLIC HEALTH DEPARTMENT
Public Health Nursing
ServiCCs
REPLY TG
C Northern Service Center
$0 Eaa1 NbnlwpNh Av9nuo
Wait St. POLd. MN 55110
16121450.2614
Fax IS 121450.29,0 -
Pkslam Somma Center
14955 Galaxle Avonua
APPI, P411c7• MN 551¢4
4612169t-7560
Fax 16121661-ma
Emergency Metlicoi
Services
DAKOTA COUNTY PUBLIC HEALTH DEPARTMENT - WATER QUALITY MANAGEMENT
WESTERN SERVICE CENTER, 14955 Galaxie Ave. West, Apple Valley, MN 55124; (612)891-7556
FACSIMILE (612) 891-7473
MUNTCIPAL NOTICE OF WELL PERMIT APPLICATION
SEND T01DO1DO Qroto ? MUNICIPALITY:_
.OFFICE: Mir fiALL _ TELEPHONE:( ) FACSIMILE:A%---Avn
FROM: INSPECTOR # TELEPHONE:
DATE/TIME FORWARDED: COMMENTS:
REFER TO WELL PERMIT NO. DAKOTA COUNTY WATER QUALITY MANACEMENT HAS RECEIVED TtIE WELL PERMIT APPLICATION(S) DE-
SCRIBED BELOW. PLEASE NOTE.: IF YOU REQUIRE FURTHER REVIEW OF THIS APPLICATION(S) OR
IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT IT, CONTACT OUR OFFICE. AT 891-7556 OR THE
ENVIRONMENTAL HEALTH SPECIALIST LISTED ABOVE. IF THERE IS NO RESPONSE FROM YOUR OFFICE
WITHIN 24 HOURS_ (EXCLUDING WEEKENDS AND HOLIDAYS), STAFF WILL ASSUME THAT 'YOU HAVE NO
OBJECTIONS TO THE ISSUANCE OF THE PERMIT. ALSO PLEASE NOTE THAT PERMIT ISSUANCE IS
ALWAYS CONDITIONED ON THE OBSERVANCE OF AND COMPLIANCE WITH ALL APPLICABLE. LOCAL BE-
QUIREMENTS AND ORDINANCES. A COPY OF THE 14ELL PERMIT WILL BE FORWARDED WHEN COMPLETED.
PROPERTY OWNER: MIKE IRS WELL OWNER:
_-? -
LOCATION OF WELL(S): ADDRESS Q? ? ?Im 07m
PROPERTY 1D NO, COORDINATES: OF OF OF OF SECTION
TOWISHIP NORTH, RANGE-WEST. MUNICIPALITY.--
WELL DRILLER: DATE RECORDED:
ANTLCIPATED DRILLING/SEALING DATE (IF KNOWN):
WELL(S) DESCRIPTIO\: PR alARY USES ? NEW CONSTRUCTION RECONSTRUCTION
TEMPORARY CAPPING . PER11\NENT SEALING_ A\\tiaL tblINTENANCE: RECLAIM/F?D?„ REGISTERED-
-
WELL DIAMETERkISCl1ES. WELL DRP'[1L=FEET. AQUTFLR ?{? l?Fl l ?
NOTES
DONNA M. ANDERSON
PUBLIC NEALI II UIRECTOA
(612) 450-2614
Env_ironl'gz! al HealLh
1
Certificate For: -
Mike Skrbich /
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Scale: 1 inch = 50 feet
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elev. 96?D
I
DELMAR H. SCHWANZ
taro SURVEYORS. INC.
gpburM uml to" 0 TM SWe of MInINMU
W50 SOUTH ROBERT TRAIL ROSEMOUNT, MINNESOTA 55068 6IV423.1769
SURVEYOR'S CERTIFICATE
Certificate For:
Mike Skrh%h
12757 Diamond Path
Apple Valley, MN 55124
DELMAR H. SCHWANZ
LAND SURVEYORS. INC.
Regiala UM Lt of TIw SIX* of Mlnnwola
11750 SOUTH ROBERT TRAIL ROSEMOUNT, MINNESOTA 55688
157/26
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SURVEYOR'S CERTIFICATE
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1 hereby cartity that this survey, plan, or report was
prepared by me or under my direct SUpervlsion and
that I em A duly Registered Lend Surveyor under
the laws of the State of Minnesota.
Daled 08-12-91
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Delmer H. Schwan
Minnesota Registration No. Ill
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Mike Sk`rhi.ch
12757 Diamond Path
Apple Valley, MN 55124
DELMAR H. SCHWANZ
LAND SURVEYORS. INC.
R.riUwrr Undw Law M irq SMIr of Mlm,rrolr
14750 SOUTH ROBERT TRAIL ROSEMOUNT, MINNESOTA 55066
SURVEYOR'S CERTIFICATE
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I hereby Certify that this survey, plan, or report was
prepared by me or under my direct supervision and
that 1 am a duly Registered Land Surveyor under
the laws of the State or Minnesota.
Dated 08-12-91
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Delmar Schwartz
Minnesota Registration No. x625
PERMIT
City of Eagan Permit Type: Building
Eagan. Permit Number: EA093793
Date Issued: 05/04/2010
OR Permit Category: ePermit
41~ it~ of E3
E
Site Address: 4940 Dodd Rd
Lot: 3 Block: I Addition: Skv View
PID:10-69000-030-01
Use:
Description:
Sub Type: e-Reroof Construction Type:
Work Type: Repair
Description: House
Census Code: 434- Occupancy :
Zonin,:
Square Feet: 0
Comments: If there is no ice protection inspection prior to final, the contractor must meet the inspector Nva ladder and flat bar.
Pictures are not acceptable in lieu of inspections.
Carbon monoxide detectors are required by law in ALL single family homes.
Fee Summary: BL - Base Fee S3K $88.50 0801.4085
Valuation: 3.000.00 Surcharge - Based on Valuation S3K $1.50 9001.2195
Total: $90.00
Contractor: Owner: - Applicant -
Margaret A Macrae
4940 Dodd Rd
Eagan MN 55123
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 Cite of Eagan Ordinances.
ApplicantiPermitee: Signature Issued Bv: Signature
PERMIT
City of Eagan Permit Type: Building
Eagan. Permit Number: EA096028
Date Issued: 09/21/2010
OR Permit Category: ePermit
41~ it~ of E3
E
Site Address: 4940 Dodd Rd
Lot: 3 Block: I Addition: Skv View
PID:10-69000-030-01
Use:
Description:
Sub Type: e-Siding Construction Type:
Work Type: Sidin,
Description: House
Census Code: 434- Occupancy :
Zonin,:
Square Feet: 0
Comments: When installing ventilated soffit material. remove existing material (i.e. debris that could block vents) and take steps to
ensure maximum ventilation to attic. Call for final inspection after installation.
Carbon monoxide detectors are required bn law in ALL single family homes.
Fee Summary: BL - Base Fee S3K $88.50 0801.4085
Valuation: 3.000.00 Surcharge - Based on Valuation S3K $1.50 9001.2195
Total: $90.00
Contractor: Owner: - Applicant -
Margaret A Macrae
4940 Dodd Rd
Eagan MN 55123
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 Cite of Eagan Ordinances.
ApplicantiPermitee: Signature Issued Bv: Signature
!"
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