1511 Deerwood Bend
2005 RESIDENTIAL PLUMBING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please complete for modifications to existing residential dwellings.
iSo,?.
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Date IV / .2 e / D S
?
site s4reet Address /S%/ T_)c.e_v, wgc?j Le
unit #
PropertyOwner14 u-, Telephone# ( )
Contractor _<?e ,..,6 Telephone # (70) )8 33 .
Addressa?CY? C? City ?o• crs- State NlecJ Zip "537
The Applicant is: _ Owner ?Contractor _Other
Alterations to existing dwelling $ 50.00
? Add plumbing fixtures (excludes water softener andlor water heate r--complete next
section if installing these appliances).
_Septic System Abandonment
_Water Turnaround (add $125.00 if a 5/8" meter is required)
Other:
Water Softener _ Water Heater $ 15.00
_ new _ replacement
_ Lawn Irrigation _RPZ _PVB _new _repair _rebuild $ 30.00
? State Surcharge $ .50
Tota l u
I hereby appiy for a Residential Plumbing 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 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 work will be in accordance with the approved plan in
the event a plan is required to be reviewed and approved,
,/ /:; )
G?-? ?,.ri s?tJ
ApplicanYs Printed Name ApplicanYs Signature
2005 RESIDENTIAL BUILDING PERIVIIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone 4 651-675-5675 FAX # 651-675-5694
New Conslrucfion Renuiremenls
3 registered stte surveys showing sq. fl of IoL sq. ft. of house; and all roofed areas
(20°h maximum bt coverage allowed)
2 copies of plan showing beam & windowsizes; poured (aund desgn, etc.
1 set of Energy Calculatiore
3 copies of Tree Preservation Plan if bt platted afler 711193
Rim Joist DetaU Options seledion sheet (buddings with 3 or less unNs)
H"' t
RemodeVReoair Reauiremenis Office Use Onlv
2copiesafplan CeAOfSurveyReoi _Y _N
1 set o( Eneryy Calculatbns for healed addftions Tree P`es Plan Recd _ Y_ N
1 sile survey for addilions 8 decks Tree Pres Required Y _N
Addifion - indicate i(on-site septic system On-stte Septic System _ Y_ N
Date //0? / 6 s Construction Cost /94? ea0o4Dd
SiteAddress /.S'/( Off/e 4,7000 Is£ND UniUSte #
jj?Al, 17;7,U. 15'.r/
Description af Work 1`"??S/{ lor.vfA 4::? !!£[ <,ff£ "aLfJ,?>
Mul[i-Family Bldg _ Y ?N Fireplace(s) _ 0 1-1 1 _ 2
PropertyOwner ?C/
7-?Y6a"?f
Telephone#(4?SO 26
Gr9o K = - o fle -?? - W/ S - ,sb -o
Contractor
Address City
State Zip Telephone # ( )
COMPLETE THIS AREA ONLY IF
Energy Code Category - Minnesota Rules 7670 Cateeorv 1 _
• Residential Ventilation Category 1 Worksheet
(Jsubmissiontype) Submitted
• Energy Envelope Calculations Su6mitted
Have you previously constructed a building in Eagan with a similar plan2 _ Y
fee applies.
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone #(
Telephone # (
Telephone # (
N If so, 25% plan review
I hereby apply for a Residential Building Permit and acknowledge that the informati ate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; 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.
R cl" X. /&cKE 41vi GQ?l
ApplicanYs Printed Name A plicant's Signature
A NEW BUILDING
Minnesota Rules 7672
• New Energy Code WoAcsheel
Submitted
OF'FICE USE ONLY
Sub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 07 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 OS-plex ? 18 Deck ? 23 Porch (screenlgazebo) ? 36 Multi Misc.
? OS 03-plex ? 11 10-plex P( 19 Lower Levei ? 24 Storm Damage
? 06 04-plex ? 12 12-plex PIbgXY or _ N ? 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement ? 38 Demofjsh Interior ? 44 Siding
? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair .
? 33 Alteration ? 37 Demolish Building' ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement •Demolftlon (Entire Bldg) - Give PCA handout to applicant
Valuation Occupancy MCES System ?
Census Code Zoning ? City Water
SAC Units - Stories ? Booster Pump
# of Units - Sq. Ft. ? PF2V ?
# of Bldgs ` Length Fire Sprinklered
v `
Type of Const Width
REQUIRED INSPECTIONS
_ Footings(new bldg) FinaUC.O.
_ Faotings (deck) ? Final/No C.O.
_ Footings (addition) Plumbing
Foundation HVAC
_
Drain Tile Other
Ice & Water
Roof F inal Air/Gas Tests
Ftgs
Pool Final
?
_
Framing _ = =
=
Siding Stucco Stone Br ick
Fireplace R.I. AirTest Final Windows
? Insulation _ Retaining Wall
Approved By: , Building Inspector
-------------- ---- ' -------- ---- ---- --------- ------- ------------- ---- °-------- ------- ---- ------------- ------ - ------------------ ---------
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total - ` '
_?-t- i a 2D
W C:570 aZ-jrl?
o ct- 1 ?S? (00-3-xt * Lc02c10
-F() k.j,ti kes vva?o
RESIDENTIAL BUILDINGfYIQ (,P p ,29
Permit Application
City Of Eagan PP L! 0 2-9
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 , FAX # 651-675-5694
- ? 49'l9 21
- ? 7a 05b
Zil C10.Sb
?- S I'-l O ,.2, G
Offim ?
se On
C R of Survey ReW I? I?3
?e Pres Plan Recd l
'?lde Pres Not Reqd
_ On-site Septic System
NewConstructionReauirements odeVReoairReauiremen6
3 registered site surveys showirg sq. iL of lot, sq. ft. ot house; and all roofed areas 2 mpies of plan
(20% mazimum lot coversge allwred) i setof Energy CalculaUons for heated addi6ons
2 copies of plan showing beam & window sizes; poured found desgn, etc. 1 site survey for addi6ons & decks
7 set of Energy Calculations Add'rtron - indicate i/on-sde sep8c syslem
3 copies of Tree P2servatbn Plan if bt platted after 711193
Rim Joist Detail Optbns selection sheet (bldgs with 3 or less unBs t5- l`H
V
Date S /C;)"7 / CL'
SiteAddress /J`-// I,?-t_.WI/? I Construction Cost 1?0j 0?
CJGj'iG1 UniUSte # 101
Descripfion of Work kLcJ ?6ya.e
Multi-Family Bldg x Y_ N Fireplace(s) _ 0 -kl _ 2
Property Owner m' V" •?J(//I {? Sp yi Telephone #(R6-) 7-7??
Contractor m .(N. John i'1
Address 1 -7 LG`fS ,?Gl.x4J?iY
State /'Q,Z/k-v /6Z) CityLtv12P,iy-t,C.Q,Y ,
Zip?l.? Telephone#(`'FS3)$9a--? '72i)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
x Minnesota Rules 7670 Cateaorv 1 Minnesota Rules 7672
Energy Code Category • Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(J submission type) Submitted Submitted
• Energy Envelope Calculations Submitted
LicensedPlumberp,Ikm6v,?C Telephone#(?O)
Mechanical Contractor ?r1Y aup(CGNS Telephon #_((.a5/) ?4'0- ??-
?r;
Sewer/Water Contractor \Nul?L1p Telephone #(1td? J ?5a"?5???
II:? n n III
I hereby apply for a Residential Building Permit and aclrnowledge that the infkation_is_completewavd accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; 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.
-hmrn4 C ar ? Ua;y
Applicant's Plrinted Name Applicant' ignature
OFFICE USE ONLY
Sub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.)
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 PorchlAddn. (4-sea.)
` 04 02-plez ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo)
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex aibg_Yor_ N ? 25 Miscellaneous
Work Types
x 31 New ? 35
? 32 Addition ? 36
? 33 Alteration ? 37
? 34 Replacement
Valuation
Census Code ?
SAC Units
Nbr. of Units 2
Nbr. of Bidgs I
Type of Const ?/V
? 30 Accessory Bldg
? 31 EM. Alt - Multi
? 33 Ext. Alt - SF
? 36 Multi Misc.
Int Improvement ? 38 Demolish (Interior) ? 44 Siding
Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
Demolish (Bldg)" ? 43 Reroof ? 46 Windows/Doors
'Demolltion (Entire 81dg) - Give PCA handout to applicant
Occupancy /? 3 _Wd- MC/ES System
Zoning City Water
Stories Booster Pump
Sq. Ft. PRV
Length l' /
015? Fire Sprinklered
Width ?.0
X Footings (new bldg)
_ Footings(deck)
Footings (addition)
? Foundation
Drain Tile
Roof Ice & Water Final
Framing
Fireplace _ R.I. _ Air Test _ Final
X Insulation
REQUIRED INSPECTIONS
FinaUC.O.
? FinaUNo C.O.
_ Plumbing
_ HVAC
Other
_ Pool _ Ftgs _ Air/Gas Tests _ Final
_ Siding Stucco Stone
Windows (nw/replacement)
? Retaining Wall
Approved By??Z , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
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? ??1 )7- 0?
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MNCheck COMPLIANCE REPORT ?
Minnesota Energy Code I Permit #
MNcheck Software Version 3.0 ?
?
? Checked by/Date
?
COUNTY: Dakota
STATE: Minnesota
ZONE: 2
CONSTRUCTION TYPE: Single Family
DATE: 5-30-2003
DATE OF PLANS: 05/30/03
PROJECT INFORMATION:
Lot 12
Woodstone
Eagan, MN
COMPANY INFORMATION:
MW Johnson Construction Inc.
17645 Juniper Path #100
Lakeville, MN 55044
COMPLIANCE: PASSES
Required UA = 666
Your HOme = 584
12.3$ Better Than Code
Area or Cavity Cont. Glazing/Door
Perimeter R-Value R-Value U-Value UA
CEILINGS 2690
WALLS: Wood Frame, 161, O.C. 1260
WALLS: Wood Frame, 16" O.C. 1530
BSMT: Conc. 4.0' ht/4.0' bg/4.0' insul 176
BSMT: Conc. 8.0' ht/4.0' bg/4.0' insul 656
GLAZING: Windows or poors, Above Grade 266
DOORS 38
FLOORS: Over Outside Air 20
SLAB FLOORS: Unheated, 42.0" insul. 126
HVAC EQUIPMENT: Furnace, 90.0 AFUE
44.0 0.0
19.0 2.0
19.0 2.0
10.0 0.0
10.0 0.0
30.0 0.0
10.4
0.480
0.350
73
71
86
12
104
137
13
1
87
------------------------ ------------------------------------------------------
COMPLIANCE STATEMENT: The proposed building design described here is
consistent with the building plans, specifications, and other calculations
submitted with the permit application. The proposed building has been
designed to meet the e'reme of the Minnesota Energy Code.
Builder/Designer ?ate ? ? O (f
I??Gek-TJA? C?
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Job Site Address:
"CATEGORY 1" ALTERle1ATE FOR
ONE & TWO FAMILY DWELLINGS
INSTRUCI'iONS: This alternative may be used for one- and hvo-family dwellings built to meet the Category 1 requirements of
Minnesota Rulea, Chapter 7670. Complete Par[sA, B, and C. Clearly mazk plans with: insula[ion R-values; window and skyligh[ U-
values; size and type of equipment; equipment contro(s; and location of vapor retarder and windwash barriers. More detailed
infonnation can be found in the Minnesota Energy Code summary sheets available from the Minnesota Departinent of Commerce.
Part A. BUILDING ENVELOPE
"Cookbook" Worksheet
INSTRUCI'fONS
S[ep 1. Check item(s) [hat design meets on Afinimum RequiremenKS lis[
to the right Must meet all items to use "Cookbook" option.
S[ep 2. Indicate pmposed wall Type on table below.
Step 3. Indicate Window U-value and source.
Step 4. Verify totat window (includi¢g area of all foundarion windows)
and door area is equal or less tiian allowable pucentage.
d? ? • ?- ,?onl???-??
?y'?'?4-, rdr:?(ioo°?o b?k," P ?NT
? Ceiling Insulatian: Minimum R-38 wich 7'h" energy heel; or
Minimum R-44 with low huss heel; or
Minimum R-38 with R-5 sheathin when no attic.
? Entry Doors: Mas. U-value of 030 or 1'/d' solid wood with storm
? Rim Joist Insulation: Minimum R-19
? Floors over uncouditioned aces: Minim? R-24
? Foundation Insulation: Minimum R- ? Foundation windows: 'h" insulated lass, wood or vin 1 frame
MINNF4nTd FNF_RGY CODE - WHICH RULES MAY l USE ?
Part D. DEPRESSURIZATION PROTECTION
Check opdon used: *-_,Fuel burning equipment (complete schedules below) ? No fuel buraing equipment
Step 1. Complete the Cambustion Eguipment Schedule below. Only equipment
with a Y(Yes) may be selected under the "Category 1" altemate.
Step 2. Complete ExhausdMake-up Air Schedule on the right if direct or power
vented or solid fuel atmospheric vent space heating equipment is
selected. w?Awsu**,-W
WSIRi]CTIONS
",'?Ousfi??evlc` 4?#ekr30ox...
?We:
Part Cz. VENTILATION (Submit Part Cz upon completion of system veriticariont)
------------
-------------------------------------------------
Job Site Address: ? Permit Nwnber
Comptiance Statemeut: Installed ventilation system is in compliance wit6 MN Energy Code and is sized to provide the design a'u
flow.
Applicant (print name)
Signature
Date Telephone number
Part Cl. VENTILATION
Statement of Compliance: 1'he proposed 6uilding design represented in these docutnents is consistent with the building plans,
specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the
requ ments of.the Minnesota Energy Code. ?? ? SV DS I??- 'Z ??- ??
?..?;4=,??P..P? -
Applicant (print name) Signature Date Telephone number
`
, LOT SURVEY CHECKLIST FOR RESIOENTIAL
BUILDING PERMIT APPLICATION
PROPERTY LEGAL: l- trCS I I ?T I? gibcK j IA)UVLi.S'f'Dry)? n? Ld"'d'S _
DATE OF SURVEY:
00
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LATEST REVISION:
DOCUMENT STANDARDS
• Registered land Surveyar signature and comparry
• Building Pertnit Applicant
• legaldescripdon
• Address
• North arrow and scale
• House rype (rambler, walkout, split w/o, split eMry, loakout, etc.)
• Directional drainage arrows with slope/gradlent Yo
• Proposed/existing sewer and water services 8 irnert elevation
• Street name
• Driveway
• Lot Square Foofage
• Lot Coverege
ELEVATIONS
?? ?
5? ? ?
?0/ ?
? fd ?
? 1[?/ ?
G 0 o
Existin
• Sewer service (or Proposed)
• Property comers
• Top of curb at the driveway and property line extensions
• Elevations of any existing adjacent homes
• Adequate footing depth of structures due W adjacent utility trenches
• Waterways (pond, stream, etc.)
/ Prooosed
p ? C . Garage floor
? ? • Basement floor
? ? • Lowestexposed elevabon(walkouVwindow)
? • Properry comers
?? . Front and rear of home at the foundaUon
PONDING AREA (ff aoolipblel
? V? • Easement line
? LN( / O . NWL
? G
d 0
/ • HWL
? ?
E7' ? • Pond # designation
? ?'/ ? • Emergency Overflow Elevatlon
? Q' ? • Pond/Wetland buffer delineaNon
DIMENSIONS
2/?o ? • Lot lineslBearings & dimensions
v a . Right-of-way and sVeet width (to back of curb)
U • Proposed home dimensions including any proposed decks, averhangs greater than 2', porches, etc.
(i.e. all swctures requiring pertnanent footlngs)
f? ?? . Show all easements of record and any City utili6es within those easements
v ? n • Setbacks of proposed structure and sideyard setback of adjacent e ting sWctures
? • Retaining wall requirements, ff any 4 4 -
?
Reviewed:
Name ? Oate
G:lFORMS/Building Permit Appllcatlon
, CERTIFICA TE OF SUR VEY
M. W. JOHNSON CONSTR UCTION
,c8,50 ? ",,1>?
te8;,9 `L
ALL OF LOT 25 IS A ^?•??0+? a °+ ?OO
DRAINAGE & UTILITY EASEMENT ?o?,?
S ? ?T .? ' • °
, ?M o° ,8 ^+6 hPga? `?j• ? ? 1
F9 80 B6r°9
12
O ry ST ?p ? ?
O'QY SFp
+ o? ?S
877x1
OF "3
869x4
35
31,
?
NorE:
ALl HOUSE DIMENSIONS ARE TO
OUTSIDE POUNDATION
? b' p Va
STROA
°?'y°sFo
2
\ 1 1 ?e ??`O
? 69°02.
PROPERTY DESCRIPTION:
LOTS 17 & 12, BLOCK t, WOODSTONE TOWNHOMES,
b'
HYD
y y
,?''* ,? • ?' CABLE
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CITY OF EAGAN. DAKOTA COUNTY, MINNESOTA.
BENCHMARK - TNH WEST ENO STONEWOOD LANE = 888.36
LOT 11 1513 DEERW00D BEND
PROPOSED GARAGE FLOOR ELEV: 885.0
PROPOSED TOP OF BLOCK ELEV: 885.3
PROPOSED BASEMENT FLOOR ELEV =877.3
LOT 12 1511 DEERWOOD BEND
PROPOSED GARAGE FLOOR ELEV =881.5
a"G,atq ; R7G-TINEE, PdiNCrI)FE"M
'`x{
30` ?
LOT 11 AREA = 3697 SQ...F.L__..._.._._.__..
HSE AREA = 1727 S4. FT.
LOT 12 AREA = 3600 SQ. FT.
HSE AREA = 1513 SQ. FT.
SEWER SVC LOT 11 = 872•8 (PER PLAN)
SEWER SVC LOT 12 = 871.5 (PER PLAN)
PROPOSED TOP OF BLOCK ELEV =883.9 DENDTES PROPOSED DRAINAGE DIRECTIC
PROPOSED GARAGE FLOOR ELEV: 875.9 OOOXO DENOTES PROPOSED ELEVATION
OOOXO DENOTES EXISTING ELEVATION
? DENOTES HUB SET
• DENOTES FOUND IRON PIPE MONUMENT
* DENOTES SERVICE LOCATION
I HEREBY CERTIFY THAT THIS SURVEY WAS PREPARED BY ME OR UNDER
MY DIRECT SUPERVISION ANO THAT I AM A DULY REGISITERED LAND Bohlen
SURVEYOR UNDER THE LAWS OF THE STATE OF MINNESDTA. Slltveying & Engineetirig
31462 Foliage Avenue 4735 123rd Street W.
5-7-03 ?n?/???_Jr?L-? North/ield, MN 55057 suite 200
DATE' Savage, MIJ 55378
LEROY H. ffOHLEN, LAND SURVEYOR Phone: (507) 645-7768 B F Phone: (952) 895-9212
MINNESOTA IICENSE NO. `-10795 Fax: (507) e45 -7799 Fax: (952) 895-9259
19-868-03s FILENAME NE/lots 1 1 n I Lcert bav
n Slopes
waN wiu
Address: 1511 Deerwood Bend Zip: 55122
Lot: 12 Block: 0 1 Subdivision: Woodstone Townhomes
"CHE FOLLOWING ITEb1S WF.RE/WERE NOT COb1PLETF. AT FINAL INSPECfION ON 3 - /` .,4? (./
Yes No Comments
Final grade - 6" from siding
Permanent ste s- ara e
Permanent ste s- main entr
Permanent driveway ?
Permanent gas
Sod/Seeded lawn
Trail/curb damage
Porch
Lower level finish
Deck
Fire lace
• Verify with your builder that roof test caps from the plumbing system have been removed.
• Turn off water supply to the outside lawn faucets before freeze potential exists.
• Call the City's Engineering Department at 651-675-5646 prior to working in right-of-way or installing
irzigation system.
V BUILllINC INSPECPOR:
CONTRACTOR:
MW Johnson Construction
17645 Juniper Path,#100
Lakeville MN 55044
Site address: 15 I1 ?Kv.iq4 Lot _ Bbck _ Subd.
On April 15, 2000 the Minnesota Energy Code, Category I Building Requirements for insulation protection, air
tightness, and ventilation, was adopted. As a result, the City of Eagan is requiring that the following information be
submitted prior to issuance of a Certificate of Occupancy.
This structure: is constructed to meet minimum requirements of the Mn Energy Code, Chapter 7670
OR
This sUucture: will be constructed to meet more restrictive requirements of Chapters 7672 or 7674
APPLIANCE GAS ELEC MANUFACTURER MODEL BTU'S VENTING TYPE
Water Heater A ro s Lb
Furnace
Dryer
EXHAUST SYSTEM
LOCATION
TYPE
MODEL
CFM's VENTED
YES No
Kitchen kitchen
Bathroom 1
r
Bathroom 2
-,?b
SO
Bathroom 3
Bathroom 4
Other
FIREPLACE S
LOCATION
GAS
OOD
MANUFACTURER
MODEL
BTU'S VENTING
DIRECT A7MOS
-f- N l?14x.d !/ C/
MAKE-UP AIR MODEL TYPE CFM's
? {?2? t--tS"0 f??? - Lennax lS-C7
I hereby acknowledge that lhe above information is correct and agree to comply with ihe Minnesota Energy Code and City of Eagan
requiremenGs.
(k I ? ?I S-- fo?
nature Date
,,,,i ?--
CompanyName
' This form is the responsibility of the General ConVactor.
' Use BLUE or BLACK Ink
t bo , a0- For Office Usse/l~ / I
yh 1 P rmit / 365 6
I
city of Eagan eD '
~ Permit Fee:
3830 Pilot Knob Road 1
Eagan MN 55122 ~),ECEJVED I Date Received:
I
Phone: (651) 675-5675 Staff:
I
Fax: (651) 675-5694 APR U 2 2012
.2012 RESIDENTIAL PLUMBING PERMIT APPLICATION
r,
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4 I - .25) ?
~Date: , SiteAddr ss: ~1 I am t
Tenant: V~ "I Suite
6 q(0,
L/
6
RESIDENT / OWNER Name: C 1 P&A Phone: '
Address / City / Zip: M
Name: 1 License
CONTRACTOR Address: 4A A l 4 City:
State: Zip: SGOO Phone:
Contact: Email:
TYPE OF WORK - New Replacement _ Repair - Rebuild Modif Space _Work in R.O.W.
Description of work:
RESIDENTIAL
Water Heater
/ Water Softener
Lawn Irrigation RPZ / - PVB)
PERMIT TYPE Add Plumbing Fixtures L- Main / - Lower Level)
Septic System
s
New Water Turnaround
I -
Abandonment
RESIDENTIAL
FEES:
6 . M' imum Water Heater Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge)
60.00 Lawn Irrigation (includes $5.00 State Surcharge)
$60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge)
*Water Turnaround (add $189.00 if a 5/8" meter is required)
$105.00 Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge)NO
TOTAL F 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.orq
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 wo is t to start withou a permit; that the work will be in
accoanwith the approve plan in the case of work which requires a review and approval p
x x
Ap ri ted Nam m Applica gnature
FOR OFFICE USE Reviewed By: Date:
Required Inspections: Under Ground Rough-In Air Test Gas Test Final
City of Eaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Use
Permit#: 06501 I"J501
Permit Fee: IA05
Date Received:
Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit #:
Resident/
Owner
.
Name: / c/a QdO�'/1.e 164 Phone: .,,c-/— 725--g7-53—
2.Sg7 3—
/
Address / City / Zip: / cif,. ,. IP3 _e_,,c„,)oc c1 �e..6( cc/7 1 --
Applicant
Applicant is: Owner Contractor
Type of Work
Description of work: ell &h -r
Construction Cost: `>a 60 ') Multi -Family Building: (Yes / No )
Company: 1 i ..at �4 1' i r cit, ontact: ,it,. %'!i
Address:2�O0 -i'Ci 4U� j x%fl City: /,pcI�l /4
1Contractor /
State: f Zip: J ,5��q 7 Phone: 7Cl � `�s(�" 00Li c,f-1 --7 S
)
? Lead Certificate #: o cs/:5 —
License #: 7 y, o
(0
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
In the last 12 months,
_Yes No If
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Eagan issued a permit for a similar plan based on a master plan?
yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
Phone:
NOTE: Plans and supporting documents that you submit 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
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.orq
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 per it issuance. ,/
R/,
Appl ant's Printed Name
Appirca
ure
Page 1 of 3
City of Eaftall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
r
For Office Use
Permit#:
Permit Fee:
Date Received: (ID(I /� 9
Staff:
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address:
Unit #:
Owner
a/
Name: ii
J��C` � �1� Phone: (P5�_ %7j -��
J p1/0ls�Resident/
Address / City / Zip: f/ // — 45-2.3 s_a,-r-L IO4t &id/ -1 ? "Z_.
Applicant is: Owner ✓ Contractor
Type of Work
Description of work: h �frt f f' `r-
7?e (� S id,
Construction Cost' / OO(.) Multi -Family Builds.: (Yes / No )
Contractor
Company: S Cic (Di- [clntact: C -L 0 L.`,
Address: 36730 VI' (30,re / � . Il) . 9 ,L t 1 Pi
`tet ` y VFIO
]
State: Alt. /11 Zip: j3 »f) Phone: 7
License #: 00 t(:79%7 Lead Certificate #:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
In the last 12 months,
Yes _No If
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Eagan issued a permit for a similar plan based on a master plan?
yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
Phone:
NOTE: Plans and supporting documents that you submit 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
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.orq
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
days of per it issuance.
x � pid /C
Appli ant's Printed Name
:uilding Code must be completed within 180
6i o�
a ure
Page 1 of 3
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA155394
Date Issued:05/14/2019
Permit Category:ePermit
Site Address: 1511 Deerwood Bend
Lot:12 Block: 1 Addition: Woodstone Townhomes
PID:10-84900-01-120
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener).
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Dcfj Llc
465 Nicollet Mall Ste 2108
Minneapolis MN 55401
(612) 227-8700
Weld & Sons Plumbing
3410 Kilmer Lane North
Plymouth MN 55441
(763) 475-0296
Applicant/Permitee: Signature Issued By: Signature