4198 Countryside Dr. , . ,r
.: «. . ? . •4
BUILDING PERMIT
To be used for Sr 1
. _. t: -- . . .?.,,,;c•,. .,,:w,,w^. . . .. .. . r . . . .., .. . . ' ,.?.p?:;? ,? .
CITY OF EAGAN ? 6? 0 ?
3830 Pilot'Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100
? v?Cz- Receipt # C 2957
Site Address 41111`6 UUUW[$TS?
Lot I Block 1 Sec/Sub.
Parcel No.
W Name JOSEPli M MII.U
? Address 18133 CEDAR Ai
O _. pAtrbTfliMVlv
Name SANZ
City
Name _
Address
Phone
Occupancy °
2oning
(Actuaq Const
IAllowable)
# of Stories
Length
Depth
S.F. Total
S.F. Footprints
On Site Sewage
On Site Weil
MWCC System
City Water
PRV Required
I hereby acknowlege that I have read this application and state that the Booster Pump
inlormation is correct and agree to comply with all applicable State of
Minnesota Statutes and City of Eagan Ordinances.
Signature of Permitee APPRDVALS
A euilding Permit is issued to: JO$EPIi !! MILLEjt CONST Planner
on the express condition that all work shall be done in accordance with all Council
applicable State oi Minnesota Statutes and City of Eagan Ordinances. gldj, pry.
Building Official ' j Variance
Phone
V-11 .. . ?. _?
V ? Bidg. Permit 636.00
- Surcharge 49•50
52' Plan Review 316,00
$41 sac, City 100000
- SAC, MCWCC 575'00
WaterConn 580•00
?- Water Meter 40•00
xx AcCt. Deposit 30' 00
-jx SNY Permit 20'00
- SrWSurcharge 1*0D
Treatment PI 228'00
? Road Unit 340•oo
- Park Ded.
Copies
967.50
2
- TOTAL ,
PermH No. Permk Holder Date Telephone #
WATER ? ? 7 O
SEWER
PIUMBING C/ ? O/A
H.V.A.C.
ELECTRIC
Inspection Date insp. Comments
Foo6ngs I (414
Foundation
Framing ?jy tS
Rooling
Rough Plbg.
Rough Htg.
Isul.
Firepiace f ???•? #1
Fnal Hlg.
Final PIb9 40• 47..ti-.
Const. Meter Plbg. Inspector - Notify Plumber
Engr./Plan C r-
? C l
81dg. Final
Deck Ftg.
Oeck Final
Well
Pr. Disp. ja ! Q
% ',
CONTRACT PRICE:
Site Address
Lot Block ?
m Name
? Address '
c City ?- ' Ph
?
Name c Address
p City Ph
TYPE OF WORK
Forced Air
Boiler
Unit Heater
Air Cond.
Vent
Gas Piping Outlets #
Other
MECHANICAL PERMIT
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN
PHONE: 454.8100
M BTU
M BTU
M BTU
? M BTU
CFM
FEE:
S/C:
TOTAL:
#
'#
DATE:
For Office Use
-
BLDG. TYPE WORK DESCRIPTION
, r , ?•
Res. New
M ult. Add-on
Comm. Repair
,. Other
FEES ;
00 t
HVAC 0-100 M BTU -$24
RES
.
.
ADDITIONAL 50 M BTU - 6.00 ?
(RES. HVAC INCLUDES A/C ON NEW
CONSTRUCTION)
50 EA
GAS OUTLETS (MINIMUM - 1 PER PERMIn - 1
.
.
COMM/IND FEE - 1°r6 OF CONTRACT FEE
APT. BLDGS. - COMM. RATE APPUES
TOWNHOUSE & CONDOS - RES. RATE APPl1ES
MINIMUM RESIDENTIAL FEE - ALL ADD-ON 8
REMODELS - 12.00
MINIMUM COMMERCIAL FEE - 20.00
? STATE SURCHARGE PER PERMIT - .50
ADD $
50 S/C IF PERMIT PRICE GOES
.
(
BEYOND $1,000) ?
?
r; ? • i. - '
• - • " SIGNATURE OF PERMITTEE '
FOR: CITY OF EAGAN ?
_ .... . . . .,;.?.,.,.:,.??,_ ?
?
Site Addrsss ` / ? ? ?°L"?r •? ? "' '?
Lot ? Block / SeedSub '
Name <-
?
o? Addre?s
c City Phone
-? <
Name 'C.-F
c Add3kssTr -s
p Phon4;!?E a!UU
FEES
COMM/IND FEE - 1% OF CONTRACT FEE
APT. BL.DGS - COMM RATE APPLIES
TOWNHOUSE & CONDO - RES. RA7E APPLIES
MINIMUM - RESIDENTIAL FEE - $12.00
MINIMUM - COMMlIND FEE - $20.Q0
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND.$?1,000.00) f'
.
'
51GNATURE OF PERMITTEE
I
OF
BLDG. TYPE WORK DESCRIFTION
Res. ' New -
Mult. Add-on
Comm. Repair
Other ?
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
Nl?. FIXTURES ?
TOTA!
"'`- Water Closet - $3.00
_
?_ S
7
Bath Tubs - $3
00
.
Lavatory - $3.00
?Shower - $3.00
Kitchen Sink - $3.00
Urinal/Bidet - $3.00
--i--
?
Laundry Tray - $3.00
=Floor Drains - $1.50
? Water Heater - $1.50
Whiripool - $3.00
=
Gas Piping Outlets - $1.50
(MINIMUM - 1 PER PERMin
Softener - $5.00
Well - $10.00
Private Disp. - $10.00 ?-
O
$
50
Rough
penings -
1.
FEE:
STATE S/C:
'..
GRAND TOTAL: -
?
E
?..
'ER & WATER PERMIT
OF EAGAN
Pilot Knob Rd. ?.
Box 21199 `.t
?n, MN 55121
, STATE
AIC• ?-? I -
PERMIT DATE 7 120/''q
WATER PERMIT #10564 SEWER PERMIT #
METER ? 70o. B.P. RECEIPT # ; 2957
I R# 9? pd ?'? Y D B.P. RECEIPT DATE 7 j 141 ti9
METER SIZE ?$ Roclf
I S S U E D A T E IQ? - 1-7-,0 )'==? P R V _ B O O S T E R P U M P
? y PERMIT REQUESTED
_C/SUB ''t?- 'J
, ? C2 A-EWER __?'WATER _ TAPS
' ' - COMM/IND /-RESIDENTIAL
ZIP?V
-k-NEW _ EXISTING
Z?-
??J? r
I AGREE TO COMPLY WITH CITY OF
" ZiP EAGAN ORDiNANCES:
? OWNER:
ADDRESS:
SIG TURE WHEN TER ISSUED
CITY, STATE ZIp
PHONE: ?
PIEASE ALLOW TWO WORKING DAYS FOR PROCESSING. FOR STORM SEWER PERMITS, CONTACT
ENGINEERING DEPT.
.,_ _ . . . `
Address: 4198 ?YSIDE DRIVE Lot 1 Blk ] Sec/Sub COUNM HOLUpW
These items were/were not complete at the time of the inal inspe ion.
DATE: JANtIARY 10, 1991 Yes No INSPEC ?
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
Deck
Please verify with the builder the removal of roof test caps from the plwnbing
system and the shut-off of water supply to the outside lawn faucet before
freeze potential exists.
White - City copy Yellow - Resident copy Pink - Contractor copy
• - • . ,
?
?Ross ?XP?s? `
/ !•5 X C34+34+4?0?-9?0? 'r ??7?r?4?
??.
.-
•?71? C34t34+?t?, ="-Iol.Zo
f?? ? T . . - ... .
, 83 1,1 C34f3¢-f?v?-4?? _ . 13Z.go ?
wldwws
Ilnx3(o = 4-.0 x 4=- Ilo. o0
ZOX3lo = 5, v ;e, (v -= 30.00
24 x3(v =?v.o X?}- = Z4. o0
2¢)48 )c Cv = ? 9S.ao
ZvX4,o _ 0-7 go
..?:...., •a• :.? ? . ,.?_..,?y!¢A:?O ? _ . . . .,
l.
?? .
3' ST?• wf 5L. _ . 2S,vo ' .
Z? 57L? 5E? = Z?•t?0
(v ° PA r/o = oo . '
?f •DO ? .
1?6T
&Xpe,S w,gL?' ? Z?Zo•oo ,
G?S? ?'o?c , 107. z o
?475. ga ,
i, 1?pw ? 144, So . . .
00
V 184. zo . .
. ?
,
, ..?.... _ . . . .. •
YAZE
?* = 1n 69
8 x8 - ?4
RESIDENTIAL
' BUILDING PERMIT APPLICATION
3830 PILIOT KNOB RD - 55122 1/0,o0
651-681-4675 ?J 2
NewConstructionReauirements RemodellReoairReauiremenfs Call? / ?/ " ?
• 3 registered site surveys showing sq. ft. of lol, sq. ft. of house; and all roafed areas • 2 copies of plan ?
(20% mazimum lol wverage allowed) . t set of Energy Calculatiore for heffied additions
• 2 copies of plan showing 6eam &window saes; pou2d found design, etc.) . 1 site survey forexlenoraddNons & decks
• 1 set of Energy Calculatbre . Indicate'rf lwme served by septic system for additiore
• 3 copies of Tree Preservatbn Plan H lot platted after 7l1193
• Rim Joist Detaa Optiore selection sheel (61dgs with 3 or less units)
DATE VALUATION
JOB SITE ADDRESS ???GD?a?-/,eSSa e ???
IF MULTI-FAMILY BUILDING, HOW MANY UNITS?
PROPERTY OWNER??.P
TYPE OF WORK?o%tCi4c? FIREPLACE(S) _ 0_ 1_ 2
Y?6-l ?S 7
APPLICANT PHONE# 65il-
ADDRESS ZIPCODES
PAGER #
# 7 rI FAX #
NE1V RESIDENTIAL BUILDING ONLY - FILL OUT COMPLETELY
Energy Code Category MINNESOTA RULES 7670 CATEGOR (??
(check one) - Residential Ventilation Category 1 Worksheet ?tt?tl
- Energy Envelope Calculations Submitted D
_ MINNESOTA RULES 7672 1 A
New Energy Code Worksheet Submitted
Plumbing Contractor. _
Plumbing SysCem Includes:
Mechanical Contractor:
Mechanical System Includes:
Sewer/Water Contractor.
Water Softener
Water Heater
No. of Balhs
Air Conditioning
Heat Recovery System
Phone #
Phone #
Fce: $70.00
All a6ove information must be submitted prior to processing of application.
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply
with all applicable State of Minnesota Statutes and City of Eagan Ordi nces.
Signature of Applicanf,
Certifcates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 1/01
Phone #:
Lawn Sprinkler Tee: $90.00
No. of R.I. Baths
OFFICE U5E ONLY
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace O 21 Porch (3-sea.)
? 03 01 of _ plex 13 09 07-plex O 17 Garage ? 22 PorchlAddn. (4-sea.)
? 04 02-plex ? 10 08-plex f?18 Deck 13 23 Porch (screened)
? 05 03-plex ? 11 10-plex ? 19 Lower l.evel ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
? 31 New
? 32 Addition
? 33 Alteretion
? 34 Replacement
?g..
? 30 Accessory Bldg
? 31 Eut. Alt- Multi
? 33 6d. Alt - SF
? 36 Multi
? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
O 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
0 37 Demolish (Bldg)" ? 43 Raraof ? 46 Windows/Doors
*Demolltion (Entire Bldg only) - Give PCA handout to applicant
Valuation o?OOp ?O`-61
Census Code Y C/
SAC Units
Nbr. of Units ?
Nbr. of Bldgs
Type of Const
Occupancy /?_z MC/ES System
Zoning /V ? City Water
Stories Booster Pump
Sq. Ft. PRV
Length Fire Sprinklered
W idth
REQUIRED INSPECTIONS
Footings (new bldg)
?_b Footings (deck) FinaUNo C.O.
_ Footings (addirion) Plumbing
Foundation
Drain Tile
Roof Ice & Water Final Other
_ Framing _ Pool _ Ftgs _ Air/Gas Tests _ Final
_ Fireplace _ R.I. _ Air Test _ Final _ Siding Stucco Swne
_ Insularion _ Windows (new/replacement)
Appraved By ?6 , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
FinaUC.O.
?
HVAC
I 57 "'
RESIDENTIAL
BUILDING PERMIT APPLICATION
? CITY OF EAGAN ?
?j (D ??? 3830 PILOT KNOB RD, EAGAN MN 55122
851-881-4875
New Conatructlon Beaulrements pemoEeVFlanelr Bequlrements
• 3 repisleretl stte wrieys showing sq. tt. of ht, sq.1t. W house; antl AD roofed areas . 2 copies of plan '
(20%meximumbtcoveregealbwed) • lsetofEnargyCakulatansforheatedaaaAbns
• 2 copies of plan shaxing beam 8 winCOw sizes; poured found UesIgn, etc.) . 1 sAe survey for exterior add'Abns & decks
. 1 set of Energy Calalatlons • Indicate If home servetl by septic system Inr atld'Abns
• 3 capias of Tree Preservetbn Plen tl lot platted afler 7/1193
• Rim ,bisl Defall Optbns selectlon sheet (bidgs wiN 3 or less unMS)
DATE 2k A7 VALUATION-700
SITE ADDRESS 1796 Co.,.,.,I„ , s;&, 112. MULTI-FAMILY BLDG _ Y K N
TYPE OF WORK Raroo.?' FIREPLACE(S) _ 0_ 1_ 2
APPLICANT A teipwz or -rqc ?'rtw,«r X,,.
STREETADDRESS 11041 /oa*l fibE ,dW NJ CITYNIapc? G?r? STATE / u ZIP 5r?r6 P
TELEPHONE # 763- ?.?3aa y CELL PHONE # 61d- vS?6-6uP0 FAX #?E?-`t?- ys?
PROPERTY OWNER 61o,V Fars? _TR TELEPHONE # 3223
------° °-----------------------------------°--------------------------------------------°--
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNESOTA RiJI,ES 7670 CATEGORY 1 M
(d submission type) • Residentiai Ventilation Category 1 Worksheet Submitted
• Energy Envelope Calculations Submitted
Plumbing Conhactor: Phone # i
Plumbing system includes: _ Water Softener _ Iawn Sprinkler
Water Heater _ No. of RI. Baths
No. of Baths
Mechanlcal Conhactor:
Mechanical system includes:
Sewer/Wafer Contractor:
- Air Conditionin°
_ Heak Recovery System
Phone #
Phone q
MAY 2 1 2002
Fee: $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 Stcrfutes and City of Eagan Ordinances.
SignalureofApplicant QLL a<a.??,?seFTrfg
---°-°---°° --......... _......... ..-°......... _.__
OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4l02
.
1989 BSTILDIBG PENMiIT APPLICATION
' CTTY OF EbGAN
11??0(
3INGLE FAMILY DiIELLINGS
2 3ET3 OF PLANS
3 RE6ISTEltED SITE SOR9EY3
1 SET OP ENEAGY CALCS.
!lULTIPLE DIiELLINGS AENTAL UNITS
COlBiERCIAL
2 SETS OF ARCHTfECl'URAL
& STHOCTORIL PLANS
1 SET OF SPECIFIC9TIONS
1 SET OF 88EAG1 CALC3.
FOH SALE DRTT3 / OF QNITS
60TEt LDDRF53FS P06 CORNER LOT3 - CONY'RACTOR/HOMEOWNEA !lOST DE4IGN9TE iiHICB iDDAFSS
IS DFSIRED. AO CAdAGES AII.L BE ILLOWED ONCE BDILDII9f3 PERlSIT 13 ISSOED..
SEWER 6 W9TER PfilH+II'£ FEES lND ACCOONT DEP0.RIT lEFS iiILL Sfi INCLDDED iiITH THE HUILDING
PERMIT FEE. PROCESSING TIME FOR SEViEA !HD W9TER PE9MIi3 I3 Ti10 DAYS ONCE A PERMTT HA3
BEEA COMPLETED INDICATIHG A LICENSED PLDMBEA.
PENALTY IPPLIE.% 61HENs PERMIT IS NOT PAID FOR IP1 S9ME MOPTTH IT IS REQIIESTED.
LOT CHANGE I3 REQUESTED 0@ICE PERMIT IS ISSUED.
To Be llsed For:
Site Address Z/
lIIILTIPLE DIiELLINGS
2 3ETS OF PL9A3
AEGISTfiRED 3ITE SDA9ET3 -
(CflECb YITH BLDG DI9.)
f SBt OF EAEAGY CALC3.
Valuatio?t??7,=? Date:
Lot I Block
Parcel/SubL?f2L?
Owner
6ddress
City/Zip Code
Phone
Contractor
AddI'eS9
. ( ?9 oo0? ? .?r.,? ,,.?o ,...,..
Occupaney R_3 M_i FEES
Zoning V ,-N,
Aetual Const Bldg. Permit 636.ao
Allowable Sureharge y9.50
# of stories Plan Revierr ,Da
Length 5L' SAC, City 100.00
Depth SAC, MWCC 5'7 .oo
S.F. Total Water Conn SRa, a?
Footprint S.F. ilater Meter qo,oo
On slte aexage
? On site xell
? MWCC System ?
Cit water v
/Im . v ..-
City/Zip Code -=/???
iPPA0V9LS
Phone Planner
Couneil
Arch./Engr. Bldg. Off.
Yariance
Address
City/Zip Code
Acet. Deposit D w
S/Yi Permit d['+.00
S/il Sureharge 1,00
Treatment P1. a ,a
Road Unit 4o 40
Park Ded.
Lvn
Copies
SQBTOTAL
Penalty
SOTAL ?
tKt7/Z
? ? 0
/
so
Phone 9
,
CITY OF EAGAN N2 16801
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-6100 '
BUILDING PERMIT Receipt # C 2957
-
To be used for SF DWG/GAR Est. Value $99,000 Date J1fi Y] 4 , 19$9
C Site Address 4198 COUNTRYSIDE DR
? Lot -L Block ?L Sec/Sub. COUNTRY HOLLOW
Parcel No.
w Name JOSEPH M MILLER CONSTRUCTION
3 Address 18133 CEDAR AVE S
° City FARMINGTON phone 431-2001
E
o Name _
$: Address
? CIIy _
Phone
?W Name
?gAddress
aw City Phone
I hereby acknowlege thall have read Ihis applicafion and state thatthe
intormation is correct and agree to comply with all applicable State of
Minnesota Slatutes and City of Eagan Ordinances.
SignaWre of Permitee
A Building Permit is issued to: JOSEPH M MILLER CONST
on the ezpre55 Condition that ali work 5hall be done in accordance with all
applicable State of Minnesota StaWtes and City of Eagan Ortlinances.
Builtling OHicial
u'?..v
Cy • Y`: ,p
OFFICE USE ONLV
Oaupancy R-3 -M--J FEES
Zaning V-N
(ACtual) Const V-N Bldg. Parmit 636.00
(Allowable) - Surcharge
0
49.5
+v ol Stories - 318
00
Lenglh
52'
Plan Review .
Depih 54? SAGCity 100•0?
S.F.TOtal - SAC.MCWCC 575.0
O ?
S.F. Footprinis -
580
00
On Site Sewage _ Water Conn .
On Site Well . Water Meter
0
90.0
Mwcc sy:tam YX
Acct. Deposil
0
30.0
Ciry Water X
PRV Required xx S/W Permit 20.0?
Booster Pump - SM/ Surcharge 1.0
?
Treatment PI
0
228.0
APPflOYALS qoad Unit 340 _ 00
Planner - park Ded.
Council -.
BIOgAfl. _ Copies
Variance - TO7AL 2.967.50
% I
(gtx#ifirafr of """rrupanry
Citp of Cagan
/ lot'mu1Mtt of Ww"M jt16}iPttittt[
This Certifiaale i.xrued pursuartt mlhe requ'vemenu ojSectioa 306 ojfhe UniJorni Building
Code ceRifldn8 tlwl at the time ojrssuance rhis sfruclure Kas u compl'wnce with the varrous
ordinanoer ojthe Cyry regula6ng buildLig oonarnruion or use For rhe follawing:
v,eclik'al Crr na^_9r.eR ew8.w?nw. IhAfll
Oon"„W7ra R'i/MI zmivs pko;a VN ryacMm V'T
p„W,fg„lfiv '9'iQr.R7 M_ 1f1T71R Add? IAI'1-4 (7tf1AR AVR C, FA*MGIdN
POST W A CONSPICUOUS PUCE
, ulrx vr' BUILDIHa llEPAf2'PHliNT
q . kXTERIOR ENVELOPE AVERA(lE IIUII C0I4PUTATION
. 4 (To be suhmStted with building permit application)
One or mwo Family Dwelling Owner
All Other
Contractor );e?{ ?jLLE? `01yS?
LINEAL FEET OF ?? !f '
EXPOSED Yl1tLL ?` ?E . tt-.0DIZK qE? f t.
Site Addraes LDT ?. 6LocK I _
?
Date Phone
above grade = 2 5ZO•00
? 'TOTAL EXPOSED VYALL AREA SQ. FT.
OPAQuE WALL CONSTRUCTIONs "Ull Value x Area
Detaii FR,40)E itull .043 X •se,.
reference 01M& t -itUll ' 0740 x SR•
from ?IN? lipll x SQ.
npo x SQ,
attached iipn x SQ,
sheete npn x SQ.
FT. I •LO. 77, (7(U)(A)
FT. Jo7!7-p= 0.19 (U) (A)
FT. 132.So= S•i l SU) (A)
FT. (U)(1t)
FT. - (U)(A)
FT. _ (U) (A)
WINDOWSS "Ull Value x Area
Plalce & Type eSIJI'r 'lUll • Q'$ x SQ. FT. HQ-.$O= ?09,SO (U)(p)
" 't liUll x Sq
. FT. _ (U)(A)
u n uQu x ,
5Q. FT. - (U)(A)
" ° IIUII
x
SQ.
FT. -
(U)(A)
DOORS: "II" Value x Area
Ilalce & Type _?-l(LM16Lr "U" .14' X SQ.
ii u -?nn ,Q7 x BQ.
n n upu x SQ.
n u _ nUu x SQ.
ToTnz,s 23ZO.00 s@,
At/ERADE "Ull
TOTAL (ll)(A) VALUE5 ' J?jCd S? _
AIVIDED BY TOTAL 1'iALL AREA Z320iOD
AVEIZAOE "U ,115 lesa for 1&2 family dwellings
ROOF/CEILIN(I s
TOTAL AREA: Z(p0T
FT. 9,0V _ (O, BCP (U) (A)
FT. 4zioa (U)(A)
F'T. - , (U) (A)
FT. - (U)(A)
r•T. I88•Slo (u) (a)
Detail reference IIUII-- pOLt x SQ. FT. Ju00 = 2(0+ ?ll)(A)
from ilUto x Sq. FT. ? (U) (A)
attached sheete, lollto x SQ. FT. - (U)(A)
Describe openinga IIUII x SQ. FT. - (U)(A)
in roof. 'IUII x SQ. FT. - (U)(A)
TOTAL (U)(A) YALUES DIVIDED BY 21o?ti,CO 7O-r4? ??tl N•ft x&"'-ff0`U(A)
?
TOTAL ROOF/CEILIN(1 AREA I2?00 •d?j
AVERA(lE VOUI? ,025 or ventilated roofa. -
,
SJ?/?'y 9..3.? ?s
P 212 72 ,c/ / .?? z?
Request Date Fire No. . Ro ? n Inspedion
'
7_'Z 8_$(? R ir
d4 ? Reatly Pbw Will Notity Inspedor
?es ? No ?en Ready?
I licensed contractor ? owner hereby request inspection of above electrical work at:
Jab Mtlress (Sheep Box or Route NoJ City
4198 Countryside Drive Eagan
Section No. Township Name or No. qange No. Counry
Dakota
Occupant (PRINT) Phorre No.
Joe Miller Construction Co. 431-2001
PawerSupplier Address
Dakota Electric Farmin ton, MN 55024
Elecincal Conhapor (COmpany Name) Comractor§ Lkense Na.
Alidland Electric Inc. 041610
Mailing AEdress (COmractor or pwner Making Installation)
14055 Grand Ave So, Suite E, Burnsville, MN 55337
AWM1?' Conlraclor/Ower Makirg Ins Ilati
7 hone Number
7 892-6688
MINNESOTA STATE BOAqO OF ELECTRICITV ?THIS INSPECTION REQUEST WILL NOT
Grtgga-Midway Bltlg. - qpum 5173 BE ACCEPTED BY THE ST.4TE BOARD
1821 Univerelty Ave., St. Peul, b1N 55101 UNLESS PqOPER INSPECTION FEE IS
PhoM(812)642-0Bp0 ENCLOSED.
g///ryn, _ REQUEST FOR ELECTRICAL INSPECTION ee-ooool-o7 ?
d 7 lir See insVUCtions !ar mmplefirg ihis tortn on beck of yellow copy. ~• ??i3/)J
r? n.
2 1 C 7 L 'J(° Below Work Cavered bv This RmuP.ct
ew
Adtl
Rep.
- TypeofBUiltling -
AppliancesWired - --i
EquipmenlWired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Ap[. Building ?ryer Other (Specity)
Comm./Indus[rial Purnace
Farm Air Contli[ioner
Ol?er (spec?y) Contrac[or9 Ramarks:
Compute lnspectian Fee Befow:
# Other Fee # ServiceEntrance 5ize Fee # Cirai[s/Feeders Fee
Swimming Pool
Transformers D to 200 Amps
A6ove 200 _ Amps to 700 Amps
A?Inve-794_ Amps
Signs Inspecrorg Use only: - TOTAL
Irrigation 8ooms
Special Inspec[ion
? S
AlarmlCommunication
O[her Fee
I, the Electrical Inspector, hereby
certify that the above inspection has
' been made. RO°9n-'n ? Date
?
Final ? ?
?
[OFi.FICE USE ONLY reques[ wid 18 months fmm
-' ?
'Determining "Ull valuee at Roofs Wall, Rimt And Conc. I3loclc
RooF/CEII,INa R VAI.UE
I.) Interior Air N'i1m 0,61
2.) 5/81, aYP. ad. .56 .
3.) Ineulation 41" 00
4.1 .
5.) Exterior dir Film .61
(STILL)
'lull _ ,/n, , oz! ToTni. (R)= g-,5-,7g
..-r--
, .?---
_
WALL
6.) Interior Air Film
7.) P ayn. sa.
8.) Insulation
'9.) .??rca=Ptrr
10.) hiaeonita Siding
11.) Extarior Air Film
R VALUE
0.68
.ii5
19?ov
.61.
.17
n1ln = ll?='-. ' ? ? TOT1lL (R)=
RIIt
12.) Interior Air Film
13.) Insulation
111,) 211 Fir Rim Joiat
15. ) .Pvlt-r? rr7'F
16.) Ffasonite 5iding
17.) Exterior Air Film
[t VAI,UE
0.68
19,00
1.88
? 67
.17
upn = 1/R= TOTAL (A)=
.._.t._ T
FOUIIDATION R VAI,U
180 Interior Air Film 0.68
i9.)
zo.?
K-!1 yTKW!'eA
//O°
21.) 12't Concre ta Bloclc 1.28
22.)
23.) Exterior nir Fxiro .17
nUn = ,/R= , p7(D
TQTRL (H)=
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DESCRIPTION
/ NEREBY C£RT/f Y TNAT TH/S SGPVEY, R.AN 044 Rf/'A4T
Ws15 PR£PAR£O BY ME OR UNDEH MY D/RECr SwERV/S/OW
ANO TNAT I AM A DULY Rf'G/STER£O LAND SURVEI'C)YP
UNAER TN£ LAWS Of' THE STAr£ AF M/NN£SOrA.
o.+rE ,yEr. nro 8140
Lot 1, Block 1,
COUNTRY.IIOLLOW
Dakota County, Minnesota
Plat bearings shown
o Denotes iron monument,
l? Denetes right-ef-access
ClExist ng, Proposed
r
brondt anginaaring 11 iurvayln-
2705 woodt trail
burn.rvilla, minnarote 55337
(VIZ) 4351966
M3a -i9s-B4
M3 2- l95 -a9
CERT/F/CATE
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ry
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Scale: 1" = 30'
"RE L?Evv ? p
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EAGA1V EIVGIPI ERI
DESCRIPTION
Lot 1, Block 1,
COUNTRY HOLLOl4
Dakota County, Minnesota
/ N£R£BY Cf/9T/FY THAT tH/S SU4VFY ftAN OR RfP0Y9T
Wi1S PREPARED BY M£ ON UHDER MY D/NECT SwERV/S/QM
ANO THAr! AM A AULY REG/ST£RED LAND S(/RYEYqq
uroaER rHf cAWs oF rHE sr.er€ cF Mea,vt-sora.
OATE S'_?s RtG M0. 8140
Plat bearings shown
o Denotes iron monument
0 Denotes right-of-access
_ ?Exist n, Proposed
P.R.V. REQMOG°3E10
brondt anglnaaring P. rurvaying
2705 uroodi trAil
burniuilla, minnarota 55337
(bIR) 435 -I966
of ArvvEr
vi
' 142.0 0
rtQon- o_ _ T i?"?) N
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ry I ?
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/113z -195-$9
Use BLUE or BLACK Ink
r
For Office Use
Permit
City of Ea ~,"`n I Permit Fee: J 05-~
3830 Pilot Knob Road I c~ t~' I
Eagan MN 55122 Date Received: ! e 13
Phone: (651) 675-5675 I 2 1
Fax: (651) 675-5694 1 Staff: I
I I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit
lys Y
Name: G Cep ter. Phone: 05_1-ti 56-
Resident/
c(l4uti <
Owner Address/ City /Zip:
's
I a. Applicant is: Owner Contractor
Description of work: CCI_. 1, c r z, >v~' O c~J~ ~y,cr/r_w_.•~Gs
Type of Work
Construction Cost: 1 ~~UUZ}. Multi-Family Building: (Yes / No
Company: V-r J o4 +i-_ F ~ ~ Contact: Js4u :~~Yr.v"
Contractor Address: I L) c ( (00 Yom. Iq city: ~lJ~ V ✓°-K
State: *1-1 44 Zip: Phone: G l '`cr d L
License (3C3 I oC7 0 Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
I 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 submi_t are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
i conclude that they 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.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
x l 1AgL6 11[e- en_%
App icant's Printed Name Applicant's Signature
Page 1 of 3