3630 Crestridge CtCity of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 3630 Crestridge Ct
Lot: 061 Block: 01 Addition: Buffer Hills
PID:10- 15400- 061 -01
Use:
Description:
Sub Type: e - Air Conditioner
Work Type: New
Description: Air Conditioner
Comments: Questions regarding electrical perm
952- 445 -2840.
Fee Summary:
Contractor:
Angell Aire
12253 Nicollet Ave S
Burnsville MN 55337
(952) 746 -5200
ME - Permit Fee (Replacements)
Surcharge -Fixed
Total:
Applicant/Permitee: Signature
PERMIT
City of Eaan
- Applicant -
Permit Type:
Permit Number:
Date Issued:
Permit Category:
equirements should be directed to Mark Anderson, State Electrical Inspector,
Owner:
Georgene A Christenson
3676 Pilot Knob Rd
Eagan MN 55122
$50.00 0801.4088
$0.50 9001.2195
$50.50
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply
of Minnesota Statutes and City of Eagan Ordinances.
h all applicable State
Issued By: Signature
Mechanical
EA083612
06/17/2008
ePermit
Wertificate vf Ccc"anc?
WU4 af Cfagan
Imepartmeut of 13ni[bing anopccHon
This Certiftcate issued pursuanr to the requirements of the Uniform Building Code
certifying that at the time of issuance this structure was in compliance with the various
ordinances of the City regulating building construction or use. For the fo!lowing:
DUPElC 1434
use cLissiecu;on: sag. Pennic rb.
?? VN CDBSL
?r TYve ? n? e' ryICP? UUB I? F.AC?iN
Owner of Buildiog Address 3676 , s f
Btild'mg Ad&ess Locality
03/12/Q3
Daze:
Building Official
POST IN A CONSPICUOUS PLACE
t!?
r ---,
Cfertificate of Cccupanc4
CM4 of Cfagan
eeoartmcnt of 13aftixg 3K"tien
This Cenificate issued pursuant to the requirements of rhe Uniform Building Code
certifying that at the time of issuance this structure was in canpliance wilh the various
orrlinaRCes of the City regulating building construction or use. For the following:
SF IWG DUpiEX 1534
use aassiacation_ sWy. Pumit Wo.
Occupancy Type 7,oni_ng pi_sgict
tl1?U[i W s
Owner of Building pddmss
3630 CEEMWE r.T
f f
g Address ??ity
03/25/Q3
7
/ ? 1S nau:
Building icial
POST IN A CONSPICUOUS PLACE
Address 3632 CESuupm coU-RT Zip 5512 3
Lot' 4 Blk t Sub swmHIIZS
THESE ITEMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECTION.
Date:
03/12/93 Yes No Inspector: ?
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 plumbing system and the shut-off of water supply to
the outside lawn faucet before freeze potential exists.
Contact engineering divisioo at 681-4645 before working in right-of-way or installing underground sprinkler system. ?
White - City Copy Yellow - Resident Copy Pink - Contractor Copy
Address
Zip 5512 3
hot 6 Blk 1 Sub sFm frrr T S
THESE ITEMS WERE / WERE NOT COMPL.ETE AT THE TIME OF THE FINAL INSPECTION.
Date: 03 25 43 Yes No Inspector:
Final grade (6" from siding) ?/
Permanent steps (garage)
Permanent steps (main entry) V,
Permanent driveway
Permanent gas ?
Sod/Seeded grass
Trail/curb damage ?
Parch
Basement finish ?
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.
Contact eagineering division at 6814645 before working in right-of-way or instailing underground sprinkler system. ?
White - City Copy Yellow - Resident Copy Pink - Contrxtor Copy
CITY OF EAGAN Remarks
Additio BUFFE HILLS ADDITION Lot 6 Blk 1 Parcel 10 15400 060 01
Owner ? ?• ? ? ? > Street X _-
4?2L12 G'-?L`• State Eagan, MN 55123
?(? ?s:? r?? ..? ? . ? 1 .? Q •3? ,t t. - ? :a"i ' ?. ; ,-
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. ?. 1
STREET RESTOR.
GRADING
SAN SEW TRUNK 1971 under oI'1 inal arcel
SEWER LATERAL
WATERMAIN
WATER LATERAL 1973 under OT1 1 2.1 32'C
WATER AREA 1 2
STORM SEW TRK ?15' 455.70 45.57
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
8UILDING PER.
SAC
PARK
:-?3:?- - - - - -
INSPECTI4N RECORD
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Rflad Permit Number:
Eagan, Minnesota 55123 Date Issued:
Control No. 1128
0011,.:4
A9 /1y/ 92
(612) 681-4675
SITE ADDRESS: LuTr h tit oc ? t APPLICANT:
36:;M ff3a CRESTRiD4E c1' f,tIRIfiTEN%DN BI.DA CO. GaN
HUFi- Ek 1111 1?i ( G1?) 4b2-1061
PERyff,p?UBTYPE:
TYPE OF WORK: Nrw
I i 1 • A R I P T I O N *em"??R'??#?E -- C 1
.
?0i1 1 I Ni; .A .
1'RAM t N0 .?
I w.m a rj uw t[ Na$.
f I RFF'l l1t f.
kF MAtrr .
<i I (3N i kAt I lift
?•
?I
PermM No. Permk Holdw Dde Tilephone #
SJVY
PLUMBING
HVAC
ELECTRIC
EIECTRIC
inspection Date Inep. ComnNnts
Fooengs I l?s?L 11J,?
FounAatlon
Framing `?l?/??2 g
RW" 3
Ro"g' Plbg. W - - l,? .? '
Rough Me-
?.
Flreplace
FinW "tg'
°'se' jOM
Fnel abg. II' ,l3?i PIb9. Inspector - NMiiy Plumber
Carist Meter
EnyrJPlan
eag. Final
Dedc Ftq.
Deck Final
weu
Pr. Dfsp.
r3? 3O
?
INSPECTION RECORD
CIlY OF EAGAN
? 3830 Pilot Knob Road
Eagan, Minnesota 55123
? (612) 681-4675
SITE ADDRESS: e01- 6
1 f;:3A i:atsikxosiE r:r
Hi1rF'trR IiJl.t;4
PERI?ff,?,UBTYPE:
PERMIT TYPE:
Permit Number:
Date Issued:
I Gontroi No. 1119 !
H{+1 i..hINQ
00 1 W44
Y<I1a919?.
APPLICANT:
cHkrIII?iFNI.nN Fitnci c:o, uaM
( t, 1. :) 4 b"..1bi,1
TYPE OF WORK: N} w
R!" MARK'". : ) Wf. I UUF.Sr 3632 f If V.S tRiI3Eil' 1::'I
`? G LJ 1'tWI (tAC i UR - :
Permn No. wrmft hlowsr Date reNpnons s
S/W
PLUMBING ? - / / 99,- cf9v-
HVAC
ELECTRIC laa 0O!'J ??
ELECTRIC
inppeotlan Deh ksp. Commerts
Footfngs I
FOUrbetlon
Framing
I
Roofing bs
B°ugh Plbg.
"ro. !7/9 3 • 1,.
lsul.
Fireptece
FinW„HW. 4w
Oreat Te9t •
Flnal Plbg. Plbg. Inspeclor- Notify Plumber
Const. Meter
Engr./Plan
eldg. Ffti zsI
Deck Ftg.
Deck Flnel
weli
Pr. Disp.
- ,? --I -/jA ?/o?as??---
K
5 ? ?
`
30 J
Req esl Dat Fire ilouq0-In Inspec[ion
ReQUired? ? Reatly Now >?Will Notily Inspeciw
?Q-??? ?} Ves _No WMn Rea4Y?
IXlicensed contractor ? owner hereby reque5t inSpeCtion ot above electrical work at!
Job Atltlress ISVeeL Boa or Rmte No.I
r- ciry
91vi
F?AC-
-"*W CRE. iDGF- cT
3ia3c ,
Secbon No. Townsnip Name or No. Ranqe No. Counry
t?, .4?-- eT
OccuPdnt(PRINT) Phone No.
I[7/p1
Power SvOPlier Atltlress
1), FA R ra 7 u c-r
Elec?ncal Gonlratlor ICOmpany Namel GonttactorS License No.
?2'jyp i
it??l? n
q Atltlress iGOnlractor or Owner Making Installationl
in
Mail {F
? (
J
?`
/?'6c ? ri ?'L\b'U 1??? dJd?
Aotn i Slqnalure ICOnVac Owner M king In51ai1atioN
? a . o ? ? ,?.11 d a,,, P?one Number
MINNESOTA STATE 90RRNOF ELECTF
GrigghMlCway Bldg. - Room 5-173
1821 University Ave.. 51 Peul, MN 55104
PMM (812) 802-0800
THIS INSPECTION REOUEST Wlll NOT
BE ACCEPTED BY THE STATE BOARD
UNLE55 PROPER MSPECTION FEE IS
ENCLOSED.
a?R?cp
REQUEST FOR ELECTRICAL INSPECTION
a 15834 , See insVUdions lor completing this brm on back oi yellow wpy
"X" Below Work Covered by This Request
EB-00001-OB
13
ew Add R lCing AppliancesWired EquipmentWired
Range Temporary Service
Water Heater Electric Heating
F Dryer Othec(Specity)
ial Furnace
Air Conditioner
Camrecmr5Remerks'
Compute Inspectian Fee 8elow:
8 Other Fea # ServiceEntranceSize Fee # CircuitsWJFeeders Fee
Swimming Pool A 0 to 200 Amps o 0 to 100 Amps y
Transtormers Above 200 _ Amps Above 100 - Amps
$IeOS Inspectar's Use Only.
TOTAL
I ?
Irrigation Booms J J?
Special Inspection
Alarm/Communication THIS INSTALLATION MAV B ORDERED ISCONNECTED IF NOT
Other Fee ?o COMPLETED WRMIN / HS. ?
I, the Electrical Inspector, hereby Rou9n.in la
certify that the above inspection has F;nai oa
been made. 44
,
OFFICE USE 3NIY
ThiS tpQU85t Witl 18 mOn1h5 hOm
K1 836 . 4`1
-
/o ? 9? ?/ 6
eQst Date
• Rini RougRin Inspetlion
ReQUiretl?
? Ready NOw ,Nlill Notity In90ecmr
°
. ..Yes r No W,an ReatlY?
I'g. licensed coniractor p owner hereby request inspection of above eledrical work at:
JoD AOtlress ISIreaL Box or Route No.) Cily
Section No. Townslii0 Neme or No. Parge No. Counp?.
\ J
Occupant IPRINT) Phone No.
Bev? `Inri'J2.u?: , c1i `E5a_?p
Power Sup
plier Atltlress
1 t
Electrkal ConVacior (Company Name) Cqnvac1or5license No.
Cc, rk..,,, ? 1e ?tY', G ?l SC 8
Mailing Aearess IConi clor or owner Making Installalion?
-), ' 475
Autnon 4tl Signawre ?COnVaclonOwne?ry'aking Installavwn) PM1One Number
ti1 C?dh,t ` cl ) `133 - ? 13
MINNESOTN STRTE BOA OF ELECTRIQTY THIS INSPECTION REOUEST WILL NOT
GrigghMitlwey Bldg. - Room S-173 BE ACCEPTED BY THE STATE 60ARD
18t1 Univerelty Ave.. St. Paul, MN SStOC UNLE55 PROPER INSPECTION FEE IS
PWne (612) 661-0800 ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION eeaoom os
?
^? A36 See insrmctions for compieting this iorm on back ol yenow copY
W
"X" Below Work Covered by This Request
e Add Rep. 7ypeofBuilding AppliancesWiretl EquipmentWired
Home Range Temporary Service
?- Duplex Water Heater Electric Heating
Apt. Building Dryer O[hee (Specity)
Comm./Indusirial / Furnace
Farm ( Air Conditioner
OUier (specityl Contractor5 Remarks.
Compute lnspection Fee Below:
# Other Fee # ServiCeEMranceSize Fee # CirCUits/Feeders Fee
Swimming Pool 0 to 200 Amps 15 v 0 to 100 Amps 4Q
Transtormers Above200_Amps A6ova1D0-Amps
SignS Inspector§ Use Onty: T TAL
Sa
Irrigation Booms l 5? ?)
Special Inspection ?
Alarm/Gommunication THIS INSTALLATION MAY BE ORDER ONNECTED IF NOT
Other Fee COMPIETED WITHIN 78 MONTHS.
I, the Electrical Inspector, hereby ROO9n-'" ,-7- . oere YA.V
certity ihat the above inspection ha5
been made. F;nei i ate
OFFICE USE DNLY
This request voitl 18 monMS Irom IJ `
I
:-
- PERMIT Control No. 1119
CITY
OF
EAGAN
3830 Pilot Knob Road PERMIT TYPE: e u z L0 7 NG
Eagan, Minnesota 55123 Permit Number: 001534
(612) 681-4675 Date Issued: 0 9/ 2 9/ 9 2
SITE ADDRESS:
3630 CRE5'fRIpGE C'r
L[JT: 6 f3LOCK: :L
EtUFFER N]:I.LS
DESCRIPTION:
-8uilda:ng Permit Type DUPI.EX
Building Work Type NEW
UBC Occupanc.y R-3 M-1
Construction i'ype V--N
Zoning R-2
6uilding Length BB
Building Width ? 54
„ .
J
REMARKS:
INCLUUES 3632 CRES'1'RIDGF C7
S & W CONTRACT OR -
FEE SUMMARY:
vaLuarroN $17s>00e
Base Fee $916.00 CITY SAC $200.00
Plan Review $595.40 WATER CONNECTION $1,350.00
Surcharga $89.50 WATER METER $190.00
SAC $1,400.00 ACCOUNT DEPOSTT $60.00
SAC ? 100 S&W PERMI7 & SUR $61.00
SAC Units 2 TREATMENT PLAN7 $600.00
Li.c. Search Fee ROAD UNTT ,
Y 760.00
Subtotal ,
$3,005.90 Total Fee $6,226.90
CONTRACTOR: - Applicant - 5T. LI pyyNER:
CHRISTENSON BLDG CQ, DON 14521061 000761 DCJN CHRISTEN50N BLC1G CO
3676 PILOT KNOB RD 3676 PIL07 KNOf3 RD
EAGAN MN 55122 EAGflN MN 55122
' (612) 452-1061 (612)452-1061
I hereby acknowledge that I have raad this appli.cation and state Chat the
information is correct and agree to camply with all applicable State af Mn.
States and CiT.y ot Eagan Ordinances.
L
ICANT/PERMITEE IG ATURE
J
!
ISSUED 8 51ONATU E
PERMIT lf
IZEACTI\'D,,?E _
133?
CITY OF EAGAN
1992 BUILDING PERMIT
681-0675
APPLICATION $G1 221,.70
SINGLE 6 MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy
calcs.
COMMERCIAL 2iets of architectural 8 structural plans, 1 set of
spkcifications, I copy of energy calcs.
Penalty applies when typing of permit is requested, but not picked up by last working day
of month in which re uest is made or lot chan e is re uested once ermit is issued.
Date I ? 1?GZ Valuation of work ? Zro}C7??- -
Site Address:_?lo30/?'?2.
STREET SUITE /
Tenant Name: (commercial only)
LOT BIACK ? SUBD._f:;k?E-i-- HIL1.5. P.I.D. if
aescri tion of work: t'iEW
The applicant is: ? Owner El Contractor 0 Other (Deseribe)
Name GWZlST'E?J? 17 1 Phone9'GZ Ib(fl I
Property LAST FIRST
Owner
Address `567( Pitor 14Nb5 RD
STREET STE R
City State FNlhl Zip rzlZZ
Company `p?t GHtll?i?.t I?»ti. -N z;I?? /'Yn. Phone --f?Z lD( (
COMreCtOf Address _`56 '7(o ?JL6l" W65 R,p License N0go7<c1z Exp. s-Sl• ?i
City f-i6y-'an_1 State U%1.1 Zip JFZ;;j 22-
Architect/ Company Phone
Engineer Name Registration #
Address
City State Zip
Sewer 6 water licensed plumber . Processing time for
sewer & water permits is two days once area as been approved.
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:
BUILDING PERMIT TYPE
O 01 Foundation
?0.02 SF Dwg.
0 03 SF Addition
? 04 SF Porch
? 05 SF Misc.
WORK TYPE
`?.'31 New
? 32 Addition
OFFICE USE ONLY
w
? 06 Duplex
07 4-Plex
? 08 8-Plex
? 09 12-Plex
? 10 Multi. Add'1
> 13 33 Alterations
? 34 Repair
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
Planning
Engineering
REQUIRED INSPECTIONS
? Site
? Nallboard
Y_N Basement sq. ft.
lst F1. sq. ft.
_
?3 rt ? 2nd Fl. sq. ft.
R_2 Sq. Ft. total
Footprin t Sq. ft.
? On-site well
53'/z On-site sewage
? 11 Apt./Lodging -?
O 12 Multi. Misc.
O 13 Garage/Accessory
? 14 Fireplace
O 15 Deck
? 35 Tenant Finish
? 36 Move
Building
Variance , -T7- 9 2
0 footing
? Final
Assessments
MWCC System YES
City Water YES
PRV Required
Booster PumP
Fire Sprinkler
Census Code
SAC Code
cen5us bu i ir?js 2Z
Census units 2,
? Framing
O Draintile
.
B 16 Basement Finish
? 17 Swim Pool
? 18 Comm./Ind.
O 19 Comm./Ind. Misc.
? 20 Public Facility
? 21 Miscellaneous
? 37 Demolish
O Insulation
? Fireplace
Permit Fee
Surcharge
Plan Review
License
MWCC SAC
City SAC
Water Conn.
Nater Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment Pl.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total:
r.tuat;m: g_?'7y'? 000 "?
S , L-/D UN_ I_T I'•
?
00 r.00
:)u,oo
50, 00
10. oo ,
?v, oo uNIr z:.
Laloo
SAC % 1,00 `Iwo SE'i6 (SF
SAC Units 2. SEnurcES
GnRq(,s; 2_,3xz2 =
asrr,r: ?srz x c? ^
!I x 33=
?6 x 43 =
Sxa)=
H OuSE ; BSkf,-_
CaARA6E'. Z Zx Lo =
6smr; & x is?/2 =
s3xq_
sw zic
1bx v3_
HouSE; ?? _
)a,zr7o
6y,554
'7,oyo
?S?Ios
63? 9?f
?----
178,90°0
yyOX I(. ?? `1,040
62
363
688
i2iT x s3 =
4yo Ki6=
53
363
63
688
j zo-7 xis'r
i1-o'? x53;7
Certificate For:
bon ChFistenson
.
/ 36 - 4{<
DELMAR H. SCHWANZ
LAND SURVEYOR9, INC.
RepIN?nE Undsr Lwn ol iM Sbro al Mlnnnolo
14750 SOUTH ROBEqt tqAIL ROSEMOUNT, MINNE30TA 55068 012/423-1789
, SURVEYOR'S CERTIFICATE
<'. ?1NF "-
N
CF??ST F' i uC.E
80? ,y " 30.0
,0 3 0 ?--
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893v I
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a8" i!- p n
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0
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Scale: 1 inch = 30 feet
X
WESr tQ?3 = Existing spot elev.
loo, ao
Sl ?- D8?•'' Q= Proposed elevation
7???_. - - ? •, '
"If.
I
I
I
?- -- ---
I
?
I
1
I ?
?
?f
C
-??I-
4119Y?
I ^
ii
Unit 1
v ?
1
z
I H
?
N
4
/
?
?
Unit 2 r 1` w
a ?v i ? n h?
__f I ?, ?
.. __. ?( ..__
?%IS
?
( +`y S\` ? .,........, ,
SC WANZ
Y
asas -
NQ.SURj..,R
Proposed garaqe floor elev.
Unit 1 88?• ?
Unit 2 g, J
Top of block elevation
Unit 1 8;r• 4
Unit 2 884.6
Lovest level elevation
Unit 1 88S 6
Unit 2 R85.b
' -? /_..Z-BM: Top nut o£ hydrant at northeast
quadrant of intersection of
E}aCaART gWGjNE:FRINf" DL" Crestridge Lane ana Krestwoofl
Description: " Lane. = 886.48
I.ot 6, Block 1, BUFFER HILLS, according to the recorded I hereby certlly thet tAla lurvey, plen. or rapoA wes plat thereof, Dakota County, MN. -
prepared by me w under my direct aupervielon and
tASt 1 em e duly Regleterod lenA 8urvayor under Also showing the 1 at n of roj9s)fd buildinq thereon_
tha lawe ol tM Stele ol Minnefoh. ? ?
08-19-92 Delmer H. 9ehwenx
oeted Minneeote RsqlNrNlon No.S62S
Revised 09-24-92 '
1?
t
? .
.
ENERGK CONSERVATION•SUPPLEMF.NT TO BUILUINC PERMIT APPLICATIUN
JOB LOCATION,
OWNER(5)
CONTRACT(
A. Determine the Total Exposed Wa11 Area as follous.
1. Total ttall. xindow area
2. Total door area ?L
3. Total sliding Rlass door area 2-
4. Total Fireplace area U
5. Total wall framing area (average LOx) ?.?
6.. Total net xall are., aUove floor OL
7; Total rim joist are_a //(J
SIJBTOTALt Total expa,ed area ahove fioor
8. Total foundation,1windott area O
9. Total net foundationiarea above grade O
SUBTO'TALI!Total exposed foundation area
Grand Total Exposed'Nall Area
B'. MULtipl'y the GRAND TU"CA1. EXYUSEll WAI.L AREA X?-
. rt
C. DpCermine [he 'fotal Exposed Roof/Ceili.ng area as follows$
10. Total Skylite area O
111. Total raof/ce11Yng framing area /LZ
12..Tbta1 net insulated roof/ceiling area // o L.
Grand Tbtal Exposed Roof Ceiling Area 2. Z.
C;
PHONE ySZ -J o 6 >
PHUNE rl
Item I AX, ]L
9-7-d1
D., MU1'tiply the Grand Tbtal Exposed Rnof/Ceiling Area X y9K - Item II ?
8 026 3/, 8'L.,
, .
$. Determinr. the "U" value nf each segment (1-9) and rnultiply Gy the area as bllowst
1.. j o y g U., .49
2.. ? z X •' U" .13
3. 7C $U's .49 `/G
4, p X t.Uot _ .O
5:. 'kV' X IOU,, ,074 - 6•3/
64 y x „iil,.. .01#9 - zy?o
7• g „u„ .046 - ?b6
8: X ^lln 1119 _
9: X "U" .004 -
ADD 1-9 FOR TOTAL HALL SECMENTS - Item III 9?oS?
F. IIetermine the "U" value of ench segment (10-12) and multiyly by the area as follovso
100. a X "U" .55 -
11. X "U" .041 - '5"9
12. //bt X "U•' ,025) - L7.SS"
ADD 10 - 12 FOR TOTAL ROUF/CELLING SEGMENTS
- ICem IV
_-? L, !?' 9?
C. If Item No. III is the same asp or less than Item No. I. you have met the intent
of State Bllildinp, Code 6006 (c) 2.
HN If Item No. IY• is the same as, or less than ICem No. II, you have met the intent
oE Sta[e Building Code 6006 (c) 1.
°, 3l. sz - 12q,S d
P.. Add item Na. I + Item No. II 49-14- - 2-/7 . 6P?
.P..Add Item No. III q$;v$? + Item Nb. IV jZ•s!;- - 1"IG. 6
`--/14.SZLL-,?1'f7o7•1 L'.-'1L4-IF /yt-?FDS /Z> B? 1JVCQ.C-qBL-4) SC./Gf/TC-`'
K. If the sum of items III and IV'are less thaniItems I and III ynu havd met the intent
05 the code for total envelope system (State BUilding Code 6000 and NPS 607-3.5
Overall Structure PerEbrmance Alternative ).
The undersigned, as applicant for a Duildinr Permit, hereby aEfirms the above informatiom
has been prepared and submitted by himself or under his direction, hereby acknowledges the
information,to be corfect and accur.atei anxd'here6y presents the information with required
plans in suTport of the BUilding Permtylvgplicatigne
i_r Bl / CITY OF EAGAN
SUBD.'??__???IZ- PLUMBING PERMIT
? (612) 681-4675
PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS
WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
CITY USE ONLY
RECEIPT ? CP ?P
DATE
ALSO, FOR TOWNHOMES AND CONDOS
WORK DESCRIPTION
NEW CONST _
ADD ON _
REPAIR _
OWNER NAME:1?"'\ Cw' cl?S?f:1SCr1 ?lC?',. C?U•
SITE ADDRESS:ZLc, (?-
INSTALLER: ? G ?\E' C'??c•_?l CA ?
ADDRESS:???1 L? • ?Lc`4- ?c-
CITY: ZIP:
rxorrE
COMPLETE THE FOLLOWING:
N0. FIXTURES EA. TOTAL
REPAIR/ADD ON 15.00
? SHOWER 3.00 ?
WATER CIASET 3.00 `L
? BATH T[TB 3.00 ? IAVATORY 3.00
? KITCHEN SINK 3.00
? IAUNDRY 1RAY 3.00
HOT TUB/SPA 3.00
? WATER HEATER 3.00
? FLOOR DRAIN 3.00 t.?
GAS PIPING OUT.
? (MINIMUM - 1) 3.00
ROUGH OPENINGS 1.50
_ OTHER
WATER SOFTENER 5.00
_ PRIVATE DISP. 15.00
= U.G. SPRINKLER 3.00 ?
w. Tvxxnxourm 15.00
STATE SURCHARGE .50
2? -
TOTAL: S ?J?' S0
PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS. ALSO FOR MULTI-FAMILY
BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT.
WORK DESCRIPTION:
OWNER NAME:
SITE ADDRESS: _
TENANT NAME: _
SUITE #:
INSTALLER:
ADDRESS:
CITSf:
PHONE
FOR:
ZIP:
CONTRACT PRICE:
1% OF CONTRACT FEE. .
STATE SURCHARGE - $.50 FOR.
EACH $1,000 OF PERMIT FEE.
$25.00 MINIMUM FEE.
CONTRACT PRICE x 1% $
STATE SURCHARGE
TOTAL:
$
(SIGNATURE)
CITY OF EAGAN
? BL I CITY OF EAGAN
?? PLUMSING PERMIT
??-?-""fj?,") (612) 681-4675
REBIDBNTIAL
PLEASE COMPLETE,UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS
WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
WORK DESCRIPTION
REPAIR LDAT TY USEONLY
NEW CONST _
ADD ON _
EIPT # E
AL50, FOR TOWNHOMES AND CONDOS
OWAIER NAME: 02? CJVV(?S?ir?Scx'? {?)\C?-,_ l-l).
SITE ADDRESS:' C?-
INSTALLER: b-JC'-.
annxsss:__lM lAn, cS?-CITY• ZIP:
PHONE ??&
COMPLETE THE FOLLOWING:
N0. FIXTURES. EA. TOTAL
REPAIR/ADD ON 15.00
f sxowEx 3.00
,
L
? WATER CLOSET 3.00 ..
l BATH TUB 3.00
,:?_ LAVATORY 3.00 ,
A KITCHEN SINK 3.00
?
I LAUNDRY TRAY 3.00
HOT TUB/SPA 3.00
1 WATER HEATER 3.00 ?u?
? FIAOR DRAIN 3.00
• ?'?
GAS PIPING OUT.
I (MINIMUM - 1) 3.00
ROUGH OPENINGS 1.50
_ OTHER
WATER SOFTENER 5.00
_ PRIVATE DISP. 15.00
U.G. SPRINKLER 3.00
_ W. TURNAROUND 15.00
STATE SURCHARGE .50
?
TOTAL: S ?Cc.S
PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS. ALSO FOR MULTI-FAMILY
BUILDINGS WHEN SEPARATE PIItMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT.
WORK DESCRIPTION:
OWNER NAME:
SITE ADDRESS'
TENANT NAME:
SUITE #: _
INSTALLER:
ADDRESS:_ _
CITY:
PHONE #:
FOR:
CITY OF EAGAN
STATE SURCHARGE
ZIP:
CONTRACT PRICE:
lY OF CONTRACT FEE. .
STATE SURCHARGE - $.50 FOR.
EACH $1,000 OF PERMIT FEE.
$25.00 MINIMUM FEE.
` CONTRACT PRICE x 1%
TOTAL:
$
(SIGNATURE)
CITY OF EAGAN CITY USE ONLY
L G B • MECHANICAL PERMIT RECEIPT #/Oe 9
SUBD. ? (612) 681-4675 DATE
RESIDENI7AL
PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DR'ELIdNG3. AiSO, COMPLEI'E FOR
TOWNHOMES/CONDOS WBEN SEPARATE PF.RMI'1'c pRE REQUIRID FOR EACH DWELidNG UNTf.
OWNER- DOn 0 Y7y5 O ADD-ON A/C ADD-ON FIIRNACE?
S1TE ADDRFSS:
96 D? f"KI Cj e, • ADD ON/REMODEL (ERISTING
CONSTRUCI'ION ONLl) $ 15.00
INSTALLER: HVAC: 0-100 M BTU ? 24.00
PHONE #: I /q -$Io2 ADDITIONAL SO M BT[T 6.00
nnn-xFSS: 16 8D Gc1 F L(?o m6 e. S?. css ourZrs - rrmr-?rM i@ $a E?. ? .? - 00
crrY: r,,oz A-lc.? ZIP: JCS.37 suxcxnucF_: a .so
SIGNATURE: TOTAL: $ oZ 7-50
U
NO PERMIT REQUIRED FOR DUCTWORK ONLY!
COMMERCIAL
PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAIIIIVDUSTRiAL BUILDINGS. ALSO COMPLEI'E FOR
APARTMENT BUILDINGS OR OTISER MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMTTS ARE NOT REQUIRID FOR
EACH DR'ELLING UNTl'.
WORK DESCRIPTION: CONTRACf PRICE: FEES
196 OF CONTRACf FEE.
STATE SURCHARGE IS $.50 FOR Fr1CH
S1,000 OF PERMIT FEE. $
PROCFSSED PSPING - 525.00
a
hIINIIMfUM FEE - $25.00
OWNER: TOTAL: $
SITE ADDRESS:
TENANT:
SUITE
INS1'AId.ER:
ADDRESS:
CI1'P: ZIP:
PHONE #: CT1T SIGNATURE:
SIGNATURE:
CTTY OF EAGAN cITY USE ONLY
MECHANICAL PERMIT RECEIPT # 99
SUBD. (612) 681-4675 DATE
RESIDENTIAL
PLF.ASE COMPLEPE UPPER PORTION ONLY FOR SINGLE FAMII Y DWELI.INGS. ALS O, COMPLEI'E FOR
TOWNHOMFS/CONDOS R'HEN SEPARATE PERMITS ARE REQUIRED FOR EACH DWELLING i7NIT.
0ViNER° I) & K'?Sf'Eda9AJ [{ . - ADD-ON A/C 11 ADD-ON FURNACE?
S1TE ADDRESS:
3a
r,?_st2,?
? - ADD ON/REMODEL (EXISTING
coxsTRucrcox oivrN) $ 15.00
INSTALLER: ,? t-,' C_, FiVAC: 0-100 M BTU ? 24.00
PHONE #: - g/d2 ADDTI'lONAL 50 M BTU 6.00
ADDxESs: /6 8 0 ?fe A? . S F_ uAS OuTx.Ers -MUGMuM 1 @$3 Ea'?/ 2.00
crrsr: ; aic l? K-? zrn: 53 suitcHutcE: a.so
SIGNATURE TOTAL: $ 5(j
NO PERMIT BEQUISED FOR DUCTWORK ONLY!
COMMERCIAL
PLEASE COMPLETE TfIIS PORTION FQR ALL COMMERCIAIJiNDUSTRIAL BUII,DINGS. ALSO COMPLETE FOR
APARTMENT BUILDINGS OR OTIiER MULTI-FAMILY BUII.DINGS WHEN SEPARATE PERMITS ARE NOT REQUIItED FOR
EACH DR'ELLING UNIT,
R'ORK DESCRIPI'ION: CONTRACf PRICE: FEES
1% OF CONTRACT FEE.
STATE SURCIIARGE IS $.50 FOR EACH
$1,000 OF PERMIT FEE. $
PROCESSED PIPING • $25.00
$
MINIMUM FEE - $25.00
ORNER. TOTAL: $
STfE ADDRESS:
1'ENANT:
SUI1'E #:
INS1'AI.I.ER:
ADDRFSS:
CITY: ZIP:
PHONE #: CT11' SIGNATURE:
SIGNATURE.
1
1
11 city oF eagan
. THOMASEGAN
Mayoi
April 30, 1993 PATRICIA AWA9A
SHAWN Hl1NTER
SANDRA A. MASIN
THEODORE
WACHTER
MR DON CHRISTENSEN Cou
ncil
3650 PII.OT KNOB ROAD
EAGAN MN 55122 THOMAS HEDGES
clly Adminiarroror
Buffer Hills Addition
Re: F-Lot B
BlOCk 1 E. J. VAN OVERBEKE
,
?
,
LWalver oT Plat/Lot Split Approval cnv aaik
Vacatlon ot Puhlic Easement
Dear Mr. Christensen:
You have recently Inquired into the status of the lot split and vacation applications recen[ly processed
through the City Council. The following Informatlon should be helpful to assist you in your schedule to close
on the property sale.
Lot Sulit
The Waiver of Plat allowing the lot split was approved by the City Council a[ a regular meeting held on Aprll
5, 1993, w(th the following conditfons
1. Each unit shall be served by separate utility services.
2. All applicable City Code requirements.
When all conditlons have 6een satisfactorily complied with or assured through a formal contract, a re9olution
executad by the Mayor and CRy Clerk will be released allowing thls lot splft to be recorded at Dakota
Counfy. The only condNlon yet to be complled with is #1. IPs schedule Is at your discretion.
Easement Vacation
The vacation of the 35' drainage and utifity easement along the south side oF Lot 6 was approved by formal
Cvuncl action upon completion of the public hearing held on April 20, 1993. The City Anorney's Office has
prepared the recordable documents which are being processed for the Mayor's and City Clerk's signatures.
I anHctpate this process will be completed and recorded by the City at the County wfthin the next week to
ten days.
I hope this Information meets your needs. Please le[ me know if I can be of further assistance.
Sincerely,
? iLg-u.eab /C:r?-&t'V4--?
o as A. Colbert, P.E
Director of Public Works
TAC/jj
cc: Marqyn Wucherptennig, Planning Aide
MUNICIPAL CENTER THE LONE OAK TREE MAINiENANCE FACILITY
3830 PILOi NNOB ROAD
EAGAN, MINNESOiA 55122-1897 THE SVMBOL OF STRENGTH AND GROWTH IN OUR COMMUNITY 3W I COACHMAN POINI
EAGAN. MINNESOiA 55122
PHONE: (612) 681-4600 PHONE: (612) 681-4300
fAR•.(612)681-ae12- EqualOppoiluntlylAfflrmallveACtbnEmployer FAX:(et2)5et-a36o
iDD: (612) 454-8535 , 1DD: (612) 454-8535
PAGE 12/EAGAN CITY COUNCIL MINUTES
September 1, 1992
REQUEST FOR RECONSID]
TdBY T SfEVENS
Mayor Fgan invoduced this item as a Request for Reconsideratioq Building Permit Prior to Platting
Property, Toby T. Steveas, Government Lot 7, SeMion 18, Township 27, Range 73. No action was taken on this
item as Mr. Stevens has witbdrawn his request for reconsideration.
DEERWOOD MIDDLE SCHOOL PROJECT
This item' was handled eazlier on the agenda.
D41N CHIt3STfANSON DUPLEX/I.UT COVERAGE
? Ma}ror Egan inUOduced this item as a request from Doa Christianson regarding lot coverage for a
duplex on Crestridge Drive. DireMor of Community Development Runkle said tbat the lot coverage exceeds
the maximum by 13%, which is less than originally thought. He said the garage could be acaled down in order
. to meet lot coverage standazds, however, the 13% overage would have little impad. Mr. Runkle noted that the
surrounding progerty owners have been surveyed and there Lave been no objections. Don Christianson advised
the Council that if he had realized thaz the building would exceed maximum standazds, he would not have
designed it in suc6 a manner.
After discussion, Egan moved, Awada secoaded, a modon to approve issuing a buildiog permit for pon
Christianson for the property on CresVidge Drive conditioned upon application for a varianbc and subject [o
compliance with all application procedures.
Aye: 3 Nay: 0 Abstain: 1(Wachter)
FIRE TRUCK OP770NS
Fue Chief Ken Soutbom apologized to the City Council foc not tequesting action of the City Council
earlier in the meetiug for the options being proposed with the purchase of the pumper Wck. Mayor Egaa asked
witL a$1'I9,000 bid, how muc6 the pumper wck wu under budget. Chief Southorn said S205,000had been
budgeted for Wis purchase.
Wachter moved, Pawlenty seconded, a motion to approve the options for the pumper truck for the Fue
Depaztment as outlined in Exhibi[ A. Aye: 4 Nay. 0
UPDATE/APOTHECARY
The City Administrator requested diredion of the City Council regarding any incentives the GSty might
offer Apothecary, Inc., to locate in the C1ty of Eagan. After discussion, the City Council voiced its opposition
to any type of financial incentives but directed staff to obtain more information regarding Apothecary and work
with We firm to encourage its relocalion to Eagan.
NAIVER AGREEMENT
This Aqreement, made and entered into on the [??" day
of 4? r;l , 1993, by and between DONALD D. CHRISTENSON and
GEORGENE CHRISTENSON, husband and wife, (hereinafter referred to
collectively as "Christenson"); and ELLIOTT G. HAWK, (hereinafter
referred to as "Hawk").
WHEREAS, Christenson granted a drainage and utility easement to
the City of Eagan, Dakota County, State of Minnesota, by an Agreement
dated June 27, 1988, and recorded with the Dakota County Reoorder's
Office as Document No. 877195. Said easement is over, across and
under certain real property owned by Christenson and legally
described as:
South 35 feet of Lot 6, Block 1, Buffer Hills, according to
the recorded plat thereof, Dakota County, Minnesota.
WHEREAS, Christenson petitioned the City of Eagan to vacate the
above-described easement;
WHEREAS, Christenson and Hawk are the only parties benefitted or
subjected to the easement;
WHEREAS, Christenson has provided Hawk with a private easement to
benefit the property owned by Hawk.
NOW, THEREFORE, in consideration of the foregoing facts, the
parties hereto waive any rights to notice of hearings, hearings or
appeals relating to the vacation of the above-described easement by
the City of Eagan.
IN WITNESS WHEREOF, the parties hereto have executed this
Agreement on the date set forth above.
?
? ?L
Donald D. Christenson _x?
George e Christenson
E iot G. Hawk
STATE OF MINNESOTA
COUNTY OF
,
On this 4CJ` h day of , 1993, before me a Notary
Public within and for said ounty, personally appeared Donald D.
Christenson and Georgene Christenson, husband and wife, to me
personally known to be the persons described in and who executed the
foregoing instrument and acknowledged that they executed the same as
their free act and deed.
MARY SWENSON
NOTARY Pll8L1C-MINNESOTA
DAKOTA COUNTY
STATE OF MINNESOTA )
? SS.
COUNTY OF?
On this ? day
Public within and for
Hawk, to me personally
executed the foreqoing
the same as his free act
Commission Expires Oct, 23, 1994
of , 1993, before me a Notary
said ounty, personally appeared Elliot G.
known to be the person described in and who
instrument and acknowledqed that he executed
and deed.
THIS INSTRUMENT WAS DRAFTED BY:
SEVERSON, WILCOX & SHELDON, P.A.
600 Midway National Bank Building
7300 West 147th Street
Apple Valley, Minnesota 55124
(612) 432-3136
SKH/Wkt
No ^y Public,
NOMARRYpugdE?iSQNNESOTA
DAKOTA CCUNTY
< My ?Commission Expires Oct. 23, 1994
A
?y? IS
BASB!lSNT
877195
THIS EASEMENT, made this a 7!hday of June, 1988, between DONALD
D. CHRISTENSON and GEORGENE CHRISTENSON, husband and wife, herein
referred to as "LANDGWNER° and the CITY OF EAGAN, a municipal
corporation, organized uncler the laws of the State of Minnesota,
hereinafter referred to as the "CITY".
WITNESSETH:
That the Landowner, in consideration of the sum of One Dollar ($1.00)
an8 other good and valuable consideration, the receipt and
sufficiency of which is hereby acknowledged, does hereby grant and
convey unto the City, its successors and assigns, permanent easement
for drainage and utility purposes, over, across and under the
following described premises, situated within Dakota County,
Minnesota, to-wit:
South 35 feet of Lot Six (6), Block One (l), BIIFFER HILLS,
according to the recorded plat thereof, Dakota County,
Minnesota.
The grant of the foregoing permanent easement for drainage and
utility puzposes includes the right of the City, its contractors,
agents and servants to enter upon the premises at all reasonable
times to construct, reconstruct, inspect, repair and maintain pipes,
conduits, mains or ponds and the further right to remove trees,
brush, undergrowth and other obstructions. After completion of such
construction, maintenance, repair or removal, the City shall restore
the premises to the condition in which it was found prior to the
commencement of such actions, save only for the necessary removal of
trees, brush, undergrowth and other obstructions.
The Landowner, its heirs and assigns, does covenant with the
City, its successors and assigna, that it is the Ownex of the
premises aforesaid and has good right to grant and convey the
easement herein to the City.
IN TESTIMONY WSEREOF, the Landowner has caused this easement to
be executed as of the day and year fir above written.
DONALD D. CHRISTENSON
?? ?A.
GEORG,OE CHRISTENSON
L`6024'45"-
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STATE OF MINNESOTA
) SS
COD OF DAROTA )
?
he foregoing instrument was acknowledged before me this
0?7 day of Junep 19881 by DONALD D. CHRISTENSON and GEORGENE
CHRISTENSON, husband and wife.
¦
KiRx s. euN^??'..c?t
NOTARY PUCLrf_
DAtt?T:g
THIS INSTRUMENT WAS DRAFTED BY:
f.'.Y COMh1. [XPiE:'ri F-FB. 22. 1 SSD
t MMyWNJVJ?r?VWNJJVNI`NNJV' •
MCMENOMY & SEVERSON, P.A.
7300 West 147th Street
P.O. Box 24329
Apple Valley, MN 55124
(612) 432-3136
MGD
-2-
7g /6o
2007 RESIDENTIAL PLUMBING PeRnntr aPPUCArioro
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please com lete for modifications to existin residential dweliin s
Date ? /
1 -
StteSU?eetAddress r .S?l"1? UnH#
Property Owner Telephone #(b5j) f0w 710 )n
Contractor iLUVM?1N101 Telephon.# r,a ?t?g?,1oa
Address ?? e?s1n I,n i Cily C'S'C1^.lCt.tn Statetj ZIP 5535'?
The Applicant is: ? Owner 8 Oceupant Licensed Plumbing Contractor
SepUc System _ New _ Refurbished Submit 2 sets of plans and MPC license InGudes County fee
S 100.00
Per asbuiH $ 10.00
Fire Repalr (replace bumed out fixtures, etc.) $ 90.00
This fee a ies when extensive umbin re irs are made to a buildin .
AlteraUons to exlsUng dwellfng $ 50.00
_ Add plumbing fixtures to main level bwer level. This fee indudes
installation of a watw softener and/or water heater ffi the same time. H yrou are
installMg OnIV a water softener and/or water heate, do not complete this secdon;
move W the next section arW place a checkmark naxt M the appliance(s) you are
installing.
_,Septic System Abendonment
_Water Tumaround (add $138.00 'rf a 5/8" meter ia required)
Other:
_ Water Softener _ Water Heater $ 15.00
_ new _ replacement
Lawn Irtigatloa _RP2 PVB _new _repafr _rebuild $ 30.00
State Surcharge $ .50
Tofal $
I hereby apply for a Residential Plumbing Pertnft and acknowledge that the infwmaation is complet e and accurate that the
work will be in confortnance with the ordinances and codea of the City of Eagan and the plumbing codes; that I
understand this is not a permit, but only an application for a permit, work is not to start without a permit and urork will be in
accordance with the approved plan in the event a plan is required t be revi d and approved.
;usc, `„tC [E c???w [ED
Applicant's Printed Name plicanPs Signature
JUN 0 5 2001 ? rS
41
S'a
7stl?) Z
zaa7 REStDENT1AL PLUMBING PeRMrrAPPiIcaTioN
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55722
651-675-5675
Please complete for modifications to existina residerrtial dwellinas
Date Jr I 3o! d
?
Slte 3treet Address ??10 3
.(P ?? i Di?, LT • Unk #
?
Properly Owner Ltm l .VL?? SC51n Telephone # (?j ) lv ? ??P? ?
Contractor V
?
? S f l XUIy.JI ?101 Telephon. # ?,a x1y8 ?t loa
?
+
Address 0? J•sSei7tvn ?n,,,fi i Vt) r.a.. _ C'S'('C1CtAA Stata-Utj ZiP s535'?
TAe Applicant is: _ Owner & Occupant Licensed PIum6ing Contractor
Sepdc System _ New _ Refurbished Submit 2 sets of plans and MPC license Includes CouMy fee
$ 100.00
Per as-buitt $ 10.00
Fire Repair (replace bumed out flxtures, etc.) $ 90.00
This fee a ies when extensive umbin re irs are made to a buildin .
AReradons to existlng dwelling • $ 50.00
_ Add plumbing fixtures to main level lower level. This fee indudes
installation of a water soitener andlor water heater at the same tlme. H you are
lnstaUfng on a water sofltener and/or water heater, do not complete ihis section;
move to the next seetion and place a checkmark rrext to the appliance(s) yai are
installing.
_Septlc System Abendonment
_ Water Tunaround (add $136.00 'rf a 5/8" meter is required)
Other.
_ Water Softener _ Water Heater $ 75.00
_ new _ replacement
Lawn Irrigation _RP2 4PVB _new. _repalr _rebulld $ 30.00
State Surcharge g Sp
Total $.
1 nereoy appry ror a Kesiaennai Nwmwng Permit and acknowledge that the infortnation ia complete and accurete; that the
work will be in coMormance with the ordinances and codes of the City of Eagan and the plumbing codes; that I
understand this is not a permit, but only an application for a partnit, work is nof to start withaft a pertnd and work will be in
accordance with the approved plan in the everrt a plan is required t e revie and approved.
ZaIra.,
Applicant's Printed Name ,00licariff Signature D I? u?? ?? II Il
U
JUN 0 5 2001 ?
Sr?"? ?
9527588098
APR-29-2009 11:11 From:D&D MECHANICAL 9527588098 To:651 675 5694 P.1'1
1
City of Eaau U
31830 Pilot Knob Road Permit Fee.
Eagan MN 55122 Onto Received:
Phone: (551) 675.5676
Fax: (651) 675-5694 Staff;
L----------------
2009 RESIDENTIAL PLUMBING PERMIT APPLICATION
o r-i Cie (-r
Onto: Z8 -O9 Site Address; KMO Is
Tenant: Suite 0'
RESIDENT / OWNER Name: Goo r e?1 e_ C 4-i s+enson Phone__ _W_2-
q)
Address / City / Zip: .3 0 Cr e s OA G A 1•!
CONTRACTOR Name: n,L Liconso Qt,. ZSZf t1
Address: (a2Qi6in 5t_ b JJ
City; N_ W ___A t, U G1 state,-M.6L \ Zip: 66-7)
Phone: 3 s 2- g b l5contact Person: t h?
TYPE OF WORK -Now Replacement _Repair Rebuild - Modify Space _ Work in R.O.W ,
Description of work:
PERMIT TYPE RESIDENTIAL
Water Heater Wator Softener
Lawn Irrigation Add Plumbing Fixtures
RPZ / PVS) Main _ Lower Level)
Septic System Water Turnaround
New
Abandonment
RESIDENTIAL FEES:
$50.50 Minimum Water Heater Water Softener, or Water Heater Softener (includes $.50 State Surcharge)
$30.50 Lawn Irrigation (Includes $,50 Stale Surcharge)
$60.50 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround" (includes $.50 State Surcharge)
'Water Turnaround (add $165,00 It a 5/8" motor is required)
$100.50 Septic System N ft ($10.00 per as built) (Includes County fee and $.50 State Surcharge)
$90.50 Fire Repair (replace burned out appliances, ductwork, etc,.) (includes $,50 State Surcharge) 5D
TOTAL FEES $
1 hereby acknowledge that this In armat cn is complete and accurate; that the work will be In conformance with the ord nancea and codes of the City of
Faganr 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 witr the approved plan in the case of work which requires a review and approval of pl s.
Ap n s Printed Mama Appll nt's signature
FOR QF ICE USE Reviewed By: w _ Oats:
.M..FInaI
Requlra Inspections:! ____Under Around __Rough-In _Air Test Gas Test
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