1517 Deerwood Bend
Use BLUE or BLACK Ink
For Office Use
Permit
City of EaRd~
J I Permit Fee:
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 i Staff:
2011 RESIDENTIAL BUILDING PERMIT APPLICATION~lS
Date: Site Address: Unit !c5-! 9
Name: wvoD~': D~ .4 JJ_C. Phone: CG ia~ 3a 9 -17,~~
RESIDENT /
OWNER Address / City / Zip: /34A,14
Applicant is: Owner 0/Contractor
TYPE OF WORK Description of work: 1~~-4001C ✓~oD~'
Construction Cost: `V 3R, op a Multi-Family Building: (Yes /No
)
Company: ULe /16S'ia2~1-7t J 4-i461L,4Contact: TIVneiZ, t7,44EZ
Address: -73 9dx-®-71' City:
CONTRACTOR `t c..er
State: 47,-L/ Zip: -r-J`e y Phone: 3'7e' •FOO O
License 2 0 63 3 7 ;X 3 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
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:
I
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 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 Print 6d Name Appl' an 's Signature
Page 1 of 3
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RESIDENTIAL BUILDING
Permit Application w _ , -e I (y0LI
City Of Eagan Pf
3830 Pilot Knob Road, Eagan Mn 55122 (gi (p?
Telephone # 651-675-5675 FAX # 651-675-5694
New ConstrucGon Reouiremen5 RemodeVReoair Reauireme?ts
3 registered site surveys shaving sq. ft. of lot, sq. fi. of house; and all roofed areas 2 wpies of plan
(20% mazimum lat coverage allowed) i setof Energy Calculations for heated addilions
2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey for additions & decks
i sel of Energy Calculations Addition - indicate tlarsite septic system
3 copies of Tree Preservation Plan if lot platted aiter 711193
Rim Joist Detail Options seleclion sheet (bldgs wBh 3 or less units
§5sti4.a I
? ?Q.,,Sb
? 50
Use Onl
ert of Survey Recd
Tree Pres Plan Recd
X Tree Pres N Re d
_ naite Septic System
Date { I I I /O'? Construcdon Cost 1701 bLD
Si[eAddress UniUSte #
Description of Work I`Rw
Multi-Family Bldg -4 Y _ N Fireplace(s) _ 0 _ 1 _ 2
Yroperty Owner M. W . ?,]Ur `???Vl Telephone # (?Z ) <YIZ
Contractor ?' W' ?JVYVYIS?V?
Address n6r7jaw'Llr City LAy .Ll/ll hti
State MA Zip 55014Telephone # T?Z-) 4M" !710
COMPLETE TIi1S AREA ONLY IF CONSTRUCTING A NEW BUILDING
Energy Code Category Minnesota Rules 7670 Cateeorv 1 _ Minnesota Rules 7672
(J submission type) • Residential Ventilation Category 1 Worksheet • New Enargy Code Worksheet
Submitted Submitted
• Energy Envelope Ca_IculaGansSu6mittetl
Licensed Plumber A ?elephone # j )2-4
Mechanical Contractor JTelephone #((p51)??PI3"?P?7iZ
SewedWaterContractor lephone#([QQO "?7?1S?PS
?D cl-c-L. 1?w. 't /?-
I hereby apply for a Residential Building 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 State of MN
StaYutes; 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.
mrn
Applicant's Pr ted Name
Applicant's ?$ gnature
U
:I
OFFICE USE ONLY
Suh Types , •
r
? 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 01 of 'plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screenlgazebo) ? 36 Multi Misc.
? OS 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y Or_ N ? 25 Miscellaneous
Work Types
?l- 31 New ? 35 Int Improvement ? 38 Demolish (Inlerior) ? 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)* ? 43 Reroof ? 46 Windows/Doors
? 34 ReplaCement 'Demolition (EMire Bldg) - Give PCA handout to applicant
Valuation ?1?/ 000 Occupancy MC/ES System
Census Code 1)
/ - Zoning City Water
SAC Units 0/ Stories ? Booster Pump
Nbr. of Units ? Sq. Ft.
? PRV '
Nbr. of Bldgs / --
Length ? Fire Sprinklered
Type of Const Width ?
REQUIRED INSPECTIONS
Footings (new bldg) ? FinaUC.O.
_ Footings (deck) FinaUNo C.O.
Footings (addirion) plumbing
?C Foundation HVAC
_ DrainTile Other ro?N, {.
RooF Ice & Water Rinal Pool Ftgs Au/Gas Tests Final
Franung
Fire
l
?
R
I
-
Ai
T Siding Stucc Stone _
?
p
ace
*
.
.
?
r
I
l est ?, -
Final Windows (new rep acement)
nsu
ation ? Retaining Wall
Approved By 7- G, , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S8W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
(3#-sC- 1 sc? 3 X 0'
65X Sy _
19q x s`V =
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21S /Z
2s v v ?
171,96 9-`
,
MNCheck COMPLIANCE REPORT
Minnesota Energy Code
MNCheck Software Version 3.0
Permit #
Checked by/Date
COUNTY: Dakota
STATE: Minnesota
ZONE: 2
CONSTRUCTION TYPE: Single Family
DATE: 9-3-2003
DATE OF PLANS: 09/09/03
PROSECT INFORMATION:
Lot 9
Woodstone
Eagan, MN
COMPANY INFORMATION:
MW Johnson Construction Inc.
17645 Juniper Path #100
Lake,vi].le, MN 55044
?-
COMPLIANCE: PASSES
Required UA = 624
Your Home = 547
12.3% Better Than Code
Area or Cavity Cont. Glazing/DOOr
Perimeter R-Value R-Value U-Value UA
------------------------------ - - ---- ------ ---------- ------- - ----------------
CEILINGS 1503 44.0/ 0.0 41
WALLS: Wood Frame, 16" O.C. 3294 `T5 0 2.0 184
BSMT: Conc. 4.0' ht/4.0' bg/4.0' insul 152 10.0 0.0 10
BSMT: Conc. 8.01 ht/4.01 bg/4.01 insul 816 10.0 0.0 130
GLAZING: Windows or poors, Above Grade 324 0.480 156
DOORS
FLOORS
O
U
di
i 38 0.350 13
:
ver
ncon
t
oned Space 320 30.0 0.0 11
FLOORS: Over Outside Air 50 /
l 30.a/ 0.0 2
HVAC EQUIPMENT: Furnace, 90.0 AFUE
------------------------------------ - ---- - ---------------------- - --------- -
COMPLIANCE STATEMENT: The proposed building design described here is
consistent with the building plans, specifications, and other calculations
submitted with the permit appltion. The proposed building has been
designed to meet t requ' ements of the Minnesota Energy Code.
Builder/Designe r/ Date O? '? U
Job Site Address:
"CATEG4RY 1" ALTERNATE FOR
ONE & TWO FAMILY DWELLINGS
INSTRUCTION5: TNis alternative may be used for one- and two-Family dwellings 6uilt to meet the Category 1 requirements of
Minnesota Rules, Chapter 7670. Complete Parts A, B, and C. Cleazly mazk plans with: insulation R-values; window and skylight U-
va(ues; size and type of equipmcnt; equipment controls; and location of vapor retarder and windwash bazriers. More detailed
information can be found in the Minnesota Energy Code summary sheets available from the Minnesota Deparhnent of Commerce.
Part A. BUILDING ENVELOPE
}?r ;" , %'?'?" ?,i? Performance (attach U-value calw(ations) 70` Systeme Malysis method (athech analysis)
"Cookbook" Worksheet
INSTRUCTIONS
Step L Check item(s) thaz design meets on Minimum Requirements list
ro the right. Must meet all items to use "Cookhook" option.
Step 2. Indicate proposed wall type on ta61e below.
Step 3. Indicate Window U-value and source.
Step 4. Verify total window (including area of all foundation windows)
and door azea is equal or less than allowable percentage.
g?; ? ??t,? ?'MIDII14i?REQTY?L''14?SIN?.? --
? ?.-
? Ceiling Insulation: Minimum R-38 with 7%a" energy heel; or
Minimum A-04 with low truss heel; or
Muvmum R-38 with R-5 sheathin when no attic.
? Entry Doors: Marz. U-value of 030 or 1'/1' solid wood with s[onn
? Rim 7oist Insulation: Minimum R-19 -
? Floors over uncondiflaned s aces: Minimum R-24
? Foundation Insulation: Minimum R-10
? Foundation windows: %x" insulated lass, wood or vin 1 frame
MlNNESOTA ENERGY CODE - WHrcH RucES Ma r I Use ?
Part'B. DE?RESSURIZATION PROTECTION
Check option used: Fuel burning equipment (complete schedules below) ? No fuel burning equipment
INSTRIICTIDNS
Step 1. Complete the Combusdon Equtpment Schedule below. Only equipment
with a Y(Yes) may be selected under the "Category 1" alternate.
Step 2. Complete Exhaust/Make-up Air Schedule on the right if direct or power
vented or solid fuel ahnospheric vent space heating equipment is
BGlBOSOd.
Statemeot of Comp?iance: The proposed building design represented in [hese documents is consistent with the building plans,
specifications, and o[her calcularions submitt d?w th th perm -application. The proposed building has been designed to meet the
re irements of he Minnesota Energy Code ?
- l ? D G? ?/?Z -?S?/Z-/??aCS
Applicant (print name) i re Dat Telephone number
Part Ca. VENTILATION (Submit Part C2 upon completion of system veritication})
x --------------------------------------------------
Job Site Address: Pertnit Number
Applicant (print name)
Signatuce
Date Telephone number
Part Ci. VENTILATION
Compliance Stateroent: Installed ventilarion system is in compliance with MN Energy Code and is sized to provide the design atir
flow.
LOT SURVEY CHECKLIST FOR RESIOENTIAL
BUILDING PERMIT APPLICATION
PROPERTY LEGAL: NloGlC II fjClaBc(S? ?e ?w?r? ?H?S
DATE OF 5URVEY: 1- 9- 4 3
LATEST REVISION: !?-- Zrp - D 3
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DOCUMENT STANDARDS
• Registered Land Surveyor signature and company
• BuildingPertnitApplicant
• Legal description
• Address
• North arrow and scale
. House type (rambler, walkout, split w/o, split entry, lookout, etc.)
t,-Directional.drainage•arrowswith slope/gradient %-(n me stie?:vd+?
. Proposed/existing sewer and water services & inveR elevatan
• Street name
. Driveway
• Lot Square Footage
. Lot Coverage
ELEVATIONS
Existin
? ? ?
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Pr ? ?
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• Sewer service (or Proposed)
.?.P.roperty-comers (ns'o,.?:.e -ac ?Q=rn?:ss r'y9)'
. Top of curb at the driveway and property line extensions
•.-Elevationsofarryexisting.adjacent.homes-(Go?`&-fc S?>'• Adequate footing depth of structures due to adjacent utility Venches
• ,.Waterways.(pond; stream, etc.),. ,
Prooosed
0 ? ? • Garage floor
a d ? • Basementfloor
? d ? • Lowest exposed elevation (waikouUwindow)
? ? 0?- • PropeAy comers- ?a l(-+utSSr'n ? -- ?
? 0 ? • Front and rear of home at the foun ation
PONDING AREA (iFaoplicable)
? ?, ? • Easemynt fine
? ? ?8?•?__TNWL_C5-?m«"j--
? ? ?._-----•-HWL-(-SL+ow?--.
? ? ? • Pond # designation
)C?R.#?•---•-EmergencyOverflow•Elevation..(S.l.,mw)_*,' ?
? )( ? • PondlWetland buffer delineation
DIMENSIONS
? 00 • Lot Iines/8earings 8 dimensions
??? • Right-of-way and street width (to 6ack of curh)
?? ? • Proposed home dimensions including any proposed decks, overhangs greater than 2', porches, etc.
(i.e. all structures requiring permanent footings)
j% ?? . Show all easements of record and any City utilides within ihose easements /'e /
? w* •_$ethacks.of proposed.sWCWre.and•sideyard selback of adj8cent°ezisting'sttuctures?3?' o?? )
ID' 0 ? . Retaining wall requirements, iT any S 2P %
Reviewed:
Name Date
G:/FORMS/Building PermitApplicatlon
CE'RTIFICA TE OF SUR VEY
Fo?
M. W. JOHNSON CONSTR UCTION
3:1 A1iaArraxn SEoRss
Or Retaining yl+a11 NII
BB RBcciUIfOd
DRAINAGE AND UTIUTY
EASEMENT OVER ALL
OF LOT 35
35
NWL = 868.0
HWL = 871.0
E.O.F. = 873.0
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NOTE:
ALL HOUSE DIMENSIONS ARE TO
OUTSIDE FOUNDATION
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LOT 9 1519 OEERWOOD BEND
PROPOSED GARAGE FLDOR ELEV: 883.8
PROPOSED TOP OF BLOCK ELEV: 884.1
PROPOSEO BASEMENT FLOOR ELEV =876.1
LOT 10 1517 DEERWOOD BEND
PROPOSED GARAGE FLOOR ELEV: 883.8
PROPOSED TOP OF BLOCK ELEV =884.1
PROPOSED BASEMENT FLOOR ELEV =876.1
6039``?LDTSEOAAREA 1783 OS ?. F T.
.. HSE AREA = 1783 SQ. FT.
4 SEWER SVC LOT 9= 872.7 (PER PLAN)
SEWER SVC LOT 10 = 873.3 (PER PLAN)
BENCHMARK - TNH WEST END
STONEWOOD LANE = 888.36
SEP 26 REC'D
PROPERTY DESCRIPTION: DENOTES PROPOSEO DRAINAGE DIRECTII
LOTS 9& 10, BLOCK 1, WOODSTONE TOWNHOMES, OOOXO DENOTES PROPOSED ELEVATION
CITY OF EAGAN. DAKOTA COUNTY, MINNESOTA. 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 AND 7HAT I AM A DULY REGISITERED LAND Bohlen
SURVEYOR UNDER THE LAWS OF THE STATE OF MINNESOTA. Surveying & Engineering
31462 Foliage Avenue <735 123rd Street W.
DATE• 9--?3 Northfield, MN 55057 suite 200
Savage, MN 55378
J
REVISED 9-23-03 LEROY H. BO LEN, LAND SURVEYOR phane: (507) 645-?768 B F Phone: (952) 895-9212
REVISED 9-25-03 MINNESOTA LICENSE NO. 10795 Fau: (507) sas-nss Foz: (952) 895-9259
M9-1081-03s
1" = 30'
Site address: IS 11 K Inf A'? Lot _ Biock _ Subd. 46'ftM-2 -
On April 15, 2000 the Minnesota Energy Code, Category I Building Requirements for insulation protection, air
tightness, and ventilation, was adopted. As a resuit, 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 shucture: will be consWCted to meet more restrictive requirements of Chapters 7672 or 7674
APPLIANCE GAS ELEC MANUFACTURER MODEL BTU'S VENTINGTYPE
waterHeater ,D SrAA,^ rPSt+ 56 2-7 0 E 0#q) UC,
Fumace ? ?.c n GS" YYt 6- d -1 o GbU
Dryer
EXHAUST SYSTEM
LOCATION
TYPE
MODEL
CFM's VENTED
YES ao
Kitchen kitchen
Bathroom 1
MQ-"rt
6
Bathroom 2
N
0
Bafhroom 3 d
Bathroom 4
Other
FIREPLACE S
LOCATION
GAS
WOOD
MANl1FACTl1RER
MOOEL
BTU'S VENTING
OIRECT AiMOS
1 1 ? , i.s-Gco
MAf(E-UP AIR MODEI TYPE CFM's
iw So (?e no /sv
I hereby acknowledge that the above information is correct and agree to comply with the Minnesota Energy Code and City of Eagan
requirements.
2410?
Si n lure Date
_Lss,.?
CompanyName
' This form is the responsibility of the General Contractor.
Address: 1517 Deerwood Bend Zip: 55122
Lot: 10 Block: 1 Subdivision: Woodstone Townhomes
THE FOLLOWING ITEMS WERF,/WERE NOT COMPLETE AT FINAL INSYECTION ON Z- // - p Ii/ ....r 8 /,( JOf.
Yes No Comments
Final grade - 6" from siding
Permanent steps - gara e
Permanent steps - main entry u?A
Permanent driveway x
Permanent as
Sod/Seeded lawn
TraiUcurb damage S' ?W c,?U =tiy
Porch
Lower level finish
Deck
Fir lace
• V erify with your builder Wat roof test caps from the plumbing system have been removed.
• Tutn offwater supply to @ie outside lawn faucets before freeze potenrial exists,
• C all the City's Engineering Department at 651-675-5646 prior to working in right-of-way or installing
_ vrigation system.
? BUILDING INSPF,CTOR: `
CONTRACTOR:
MW Johnson Construction
17645 Juniper Path N100
T1111-1
Lakeville MN 55044
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 #:
Permit Fee: /
Date Received: L9 W .. '
Staff:
2013 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: 6/4/13 Site Address: 1517 Deerwood Bend
Tenant:
Suite #:
Name: Ross Wolff Phone: 952-237-3974
Address / City / Zip: 1517 Deerwood Bend, Eagan, MN 55122
Name: K&S Heating, A/C & Plbg. LLC
License #: 5 9 6 2 0 PM
Address: 4205 Hwy 14W City: Rochester
State: MN Zip: 55901 Phone: 507-282-4328
Contact: Heidi Brown Email: Hbrown@ksheating. corn
New XX Replacement _ Repair _ Rebuild _ Modify Space _ Work in R.O.W.
Description of work:
RESIDENTIAL
XX Water Heater
Lawn Irrigation ( RPZ / _ PVB)
Septic System
New
Abandonment
Water Softener
Add Plumbing Fixtures ( Main / _ Lower Level)
Water Turnaround
RESIDENTIAL FEES:
$60.00 Minimum 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 $200.00 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)
TOTAL FEES $ 60 . 00
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.
xRandall A Holtan
Applicants Printed Name
x
Applicants ignature
Use BLUE or BLACK Ink
r
I
I For Office Use
Permit #A City of Ea
Permit Fee. `l
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received: ;
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff:
I I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: / Unit
Name: Phone:
Resident/
Owner Address/ City/ Zip: -.5 / 7 a!~~-- -f ~•?(~E "~f~
Applicant is: Owner -Contractor
Type of Work Description of work: & &4 ,/}n -C
Construction Cost: $20o o Multi-Family Building: (Yes / No )
r
Company: . derma a '4d 5contact:
Contractor Address: ~~O 69C~S6Ur'~ L~ City: ~lf,~c1
F
State:/W_ Zip: ~~~'1 7 Phone: 7 C~0
License 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
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 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.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 per it issuance.
X x
Appl' ant's Printed Name ~4pplica s > ure
Page 1 of 3
City of Evan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Use
Permit #: I ;aG`f
Permit Fee:
Date Received:
Staff:
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address:
Unit #:
Resident/
Resident/
Owner
% ®/. �/� SGYI
p�l
Name: it° (%C( / --5'3'_
#04- Phone: 6'57- 775-7-F5'5.—
.`�T�)f'� l
Address / City / Zip: M77-6767 / t..JlXd _,_rq' 4-S722-
-'22Applicant
Applicantis: Owner 4� Contractor
Type of Work
Description ofwork: JQ/>tiQl tif' �� /'a' `
R9/
�
Construction Cosi' /, 000 Multi -Family Buildi : (Yes / No )
Contractor
Company: . S ( y L G < 'l ", (.ntact: -.c-0 Niat'C
Address: 3 VI GkAL),re1 /i�.c+t,44� k
y PitirlOtAll
J
�L/ i
State: ,/( Zip: , c� Phone: J(� ST D 7YAIR.
License #: '.90 (1/7f3 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 Building Code must be completed within 180
days of permit issuance.
Appli ant's Printed Name
x
I' 1 Alikallb
a
ure
Page 1 of 3
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA168550
Date Issued:04/26/2021
Permit Category:ePermit
Site Address: 1517 Deerwood Bend
Lot:10 Block: 1 Addition: Woodstone Townhomes
PID:10-84900-01-100
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace & Air Conditioner
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Pete DeGrood at (507)
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
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 -
Ross L Walhof
1517 Deerwood Bnd
Eagan MN 55122
(952) 737-7674
Home Energy Center
2415 Annapolis Lane N #170
Plymouth MN 55441
(763) 476-1990
Applicant/Permitee: Signature Issued By: Signature