1266 Deerwood DrAddiCSS 1266 DEEkWGOD llBIVn Zlp $$12 3
L.ot ' Blk Sub
GOETZ IST
THESE iTEMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECI'fON.
Date: Yes No Inspector: ?
Final grade (6" from siding) k
Permanent steps (garage) )c
Permanent steps (main entry)
Permanent driveway
Permanent gas
Sod/Seeded grass X/
TraiJ/curb damage
Porc6
Basement finish
Deck
Please verify with the builder the removal of roof test pps from the plumbing system and Ihe shut-off of water supply W
the outside lawn faucet before freeze potential exists.
Confact engineering division at 6814645 before working in rightof-way or installing uaderground sprinkler system. ?
White - City Copy Yellow - Resident Copy Pink - Contractor Copy
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j County, MinnPanta,
t Also showin4 tte locatjoai of a p
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posed tqi.: of blorx elev. ?76.3
posed laWe st level elev.
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, 2000 BUILDINC PERMIT APPLICATION (RESIDENTIAL)
? CITY OF EACAN
3830 PILOT KNOB RD - 55122 % S 1 ??? 9?-
?
? 651-881-4875 ?1. /aeoair Reauiramenb
IJew con:mucnon Reoulre tI?
menfs ? I?+ ?,o
> 3 regbtered qfe wrveY= OmMng aq. fl. of lot. aq. R. of house
and go rooled areas (211'4 mmdmum bf coveroae allow"
n 2 coples ol ptans (ahow beam 8 wlndow slzea; poured fnd. deslgn; etcJ
D t sel ol energy catculaNoru
D 3 coples ol hee prefervalion plan N lol platled aHer 7/1 /9J
DAiE:
DESCRIPTION OF WORK: ' '?V ?`? dcld?
STREETADDRESS: /-?2/4 j?°`? ?
LOT: f
BLOCK:
2 coplas of Dlan
1 aet of energy catculaNons lor heated addlNOna
1 Qfe Eurvey (or extedor addlMOna & tlecks
CONSTRUCTION COST:
PROPERTY
OWNER
G.?
Name:
latf Flrai
G
_ C)
3 o -?)- o 0
PhoneM: ??S-G
Z50/'
Cly Stdfe: ZIP:
Sheet
SUBD./P.I.D. #:
ie #:
(area code)
COIYTRACTOR
ARCHITECT/
ENGINEER
IPZ
Telephone i: )
Sheet
Cly
Sewedwater licensed plumber
?
Ucense # Exp.
Zip:
Name:
/
?1?? /?{ •? '?
Regishaflon A:
State: Zip:
Z 1 (??j -?- S'}- i Slo 5
Phone :
do
I hereby acknowledge Ihaf I have read lhis appllcaHon, afate fhaf Ihe
of MlnnesoM Staiutes and Cily of Eagan Ordinancea
Signature of Applieant
aNon is , cnd agree to comply-?p'aU appAcable State
OFFICE USE ONL ?YCPS Pres I
tr G1+
oK p
Certifcates of Survey Received ? Yes _ No '
MAR 2 2
Tree Preservation Plan Received ? Yes _ No _ Not Required
?
CHy Sfatl?
OFFICE USE ONLY
BUILDING PERMIT SUBTYPES
? st Exc ntc - nnulfi
O 33 Ext. Aft - SF
? 36 Mu1N
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 21 Porch (3-sea.)
K 02 SF Dwelling ? 08 06-plex ? 17 Garage ? 22 Poroh/Addn. (4-sea.)
? 03 01 of _ plex ? 09 07-plex ? 18 Deck ? 23 Porch (screened)
O 04 02-plex ? 10 08-plex ? 19 Lower Level ? 24 Storm Damage
? OS 03-plex ? 11 10-plex Plbg _Y ot _ N ? 25 Miscellaneous
? 06 04-plex ? 12 12-plex ? 20 Pool ? 30 Accessory Bldg.
WORK TYPE
K 31 New ? 36 Move Bldg. O 43 Reroof
? 32 Addition ? 37 Demolish (Bldg)• ? 44 Siding
? 33 Aiteration ? 38 Demoiish (Interior) ? 45 Fire Repair
? 34 Repair ? 42 Demolish (Foundation) ? 46 Windows/Doors
' Give PCA handout to applicant for demolition permit
GENERAL INFORMATION
SAC Code # of Stories d. sq. ft.
No. of Units Length ? sq. ft.
No. of Buiidings Width Footprint sq. ft.
Const. (Actual) ?J Basement sq. ft. Census Code
(Aliowable) T Main level sq. ft. MC/ES System
UBC Occupancy 2 1%) 0_ sq. ft. City Water
Zoning >(6<dhAWsq. ft. Booster Pump
PRV
Fire Sprinklered
)-4-
MISCELLAN J?S !Ng IONS
K ucco/Stone /)j??, y
APPROVALS
Planning Building ? fb7,? Engineering Variance
Permit Fee
Surcharge
Plan Review
License
MC/ES SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
SNV Permit
S/W Surcharge
Treatment Pi.
Park Ded.
Trails Ded.
Other
Copies
Total:
valuation: $ r b t?17
/q A JW
d-d".`?
&fmet
1,7 osr s? = q z,o?0
13311,r 7)-/ d 3?
?1 v 1? '? ?" ??/ 3 yO _
?l? 3sf
sc?aS.aS
SAC Units
% SAC
. ENERGY CODE WORKSHEET FOR 1& 2 FAMILY DWELLINGS
SITE AOURESS ' aT?'
COMPLE7ED BY: PHONE f DATE
?
BUIIDING CLASSIFICATION: O category 1(must Include supplimenml ventllanon) or category 2(3pndard)
MINIMUM CR1TE W A '
'ounAaGon InsulaUOnR10 Walia 3 Wnaows Root Attic Insulation !
3lab on G2de Insolatlon-R10 (See table on reverse sbe'or allow2ble R44-WM Attic No Heei
percenlages)
=1ow over unheatetl spaces-R24 R9&WiN ANC Raised Heel
°oundaoon Wndows 12" insulateG Glass. R98 & RSSoIiA.RaRers
-WOW W Nn Frame
STEP f Wlndow L DoorArea SiEP 3 Calculate area bs a percent o( wall -
k 7olal Window & Doa Area in Sp. Feel
WINDOWS (IntlWing Foundafion WnCOws):
If)
I
G A?
V
MNDOW MANUFACTURE NAME:
U C. From Step 1 divide box A(Window.& Door Area) by box 8
NINOOW MANUFACTURE TYPE??? ' ITotal Wall Area) times 100 equals C(the window and door area
i percent to wall area )
MNOOW MANUFACTURE V FACTOR t
Nea
R
DimenSi
nCrt
SG
?2
U
Q ?
3ox A?+ Box B?"??' X 1CO = C=?Y.
.
?
?
.
or?S
ua
y
li5rl X 1-5N "? O?
? S7EP7 Assembty Oesign Features
1 „ x ? N FRAMING TYPE:
X I , I, I ? STANCARO FRAMING 4-siucs 16' o.c.
`10VAtiC`cC) FfL1MING sNCS ?s' 20.
^
X ?
I;\ WALLCA'dIT/INSUTATfCN R
x?'
1-x
" I1"')
5 SHEATHING TYPE: R Value
11i1 1
?
o
T ?
tFSS n+av < R-s
R-5 > CR MORE
STEP l
O
X ?
5
From the table, (reverse side) determine the maximum percent
window 8 door area for the design options selected and enter
O ?
X f D the °/. value on D below based on the window mfg. U•factor.
?
D= %
2
,vmean a Ooa Area ?dfAL Aa L aq:R
J -'
3. Taca+ wau aeea in SQ. Ft The °/. value from the table on D shail be equal to or greater than
the°/.inC
Watl Total PeametH pai9ht FVea ?
,O
1
II i
8,83 ?
Ta
1?
B+ s4fL
I
ONE' & TWO-FAMII.Y RFSIDFNTIAL BUTI.DING PRESCRIPTIVE (COOK-SOOIn
APPROACH
MAXIMUM WINDOW AND DOOR AREA AS A PERCENT OF OVERALL WALL
AREA
From Minn Rules part 7670.0475 subpart 2, item F
Cavit Exterior Window U-Factor
Framin Insulation Sheathin 0.49 6.36 0.31 0.27
STANDARD R-13 > R- 7 13.4% 17.8% 21.3% 24.3%
STANDARD R-13 > R- 5 12.4°/u 16.4% 19.7% 22.5%
STANDARD R-15 > R- 5 12.9°/a 17.1°/a 20.1°/a 23.4%
STANDARD R-18-19 < R- 5 12.1% 16.0% 18.8% 22.0%
STANDARD R-18-19 > R- 5 14.0% 18.60/6 21.5% 25.3%
ADVANCED R-18-19 < R- 5 12.9% 17.1°/a 20.1°/a 23.4%
ADVANCED R48-19 > R- 5 14.5% 19.2% 22.5% 26.1°/a
STANDARD R-21 < R- 5 12.8% 17.0°la 19.9% 23.1°/a
STANDARD R-21 > R- 5 14.5% 19.3°/a 22.5% 26.1%
ADVANCED R-21 < R- 5 13.6% 18.1% 21.2% 24.6%
ADVANCED R-21 > R- 5 15.0% 19.9% 23.2% 26.9%
Additional calculated values
STANDARD R-17 < R- 5 11.9% 15.7% 18.4916 21.5%
STANDARD R-17 > R- 5 13.80% 18.4% 21.5% 25.0%
ADVANCED R-17 < R- 5 12.6% 16.8% 19.6% 22.9%
ADVANCED R-17 > R- 5 14.3°/a 19.0% 22.2% 25.7%
Notes:
Window area equals rough opening minus installation cleamnces.
Window U-factor must be determined by either the National Fenestration Rating
Council standard 100-91, or ASHRAE 1993 Handbook of Fundamentals, Chapter 27,
Table 5.
Flu-tl
? 714
TREE PR?56VAt0-wiar-,-.sp .;.?.a..'Il.'liG?.`.'-^.....'?:
(SEE ATTACHMENTS)
Development 'vJAW\
Lot Number ? Block Number
Address LZl?O l?p?/urut? d?Y?v(, /owv??s (?ei2tiL acldTJS?
J
Builder
Tree Pro3ection Reauirements:
X Tree Fencing Mpc? Z7
Oak Tree Pruning (Seal wounds during-Apr#45 to July 1)
Therapeutic Pruning
Retaining Wall
Other:
Reolacement Trees:
Not Required
As Follows:
Attachments:
Yes
No
Additional Notes:
6AC11M ??RE-871f1? DOQ908B011
ft = ab
?Q'? 1?1 T-=C.)
./?
TREE PRE5ERVATION PLAN
FOR
GOETZ FIRST ADDITION
A: APPLICANT / OWNER / DEVELOPER:
Name: Daniel and Deborah Phone Number: 651/ 452-4759
Address: 1260 Deerwood Dr. Eagan MN 55123
B: Building Delineation
Reference Diagram A
C: Grading Areas
No urading PrOVOSed
D: Eaisting Tree Identification
Reference Diagram A and B for location and size of 30 existi trees
E: Removal Tree Identification
Trees "C". and "O" Reference Diagram A and B for location type and size
F: Protection Measures
i._ Install snow fencing azound impacted uees
?
?
5ignature: ? ?/ ? ^ Date: y ?9 ?
LTREE IDENTIFICATION (DIAGRAM BA
EXISTING TREES ( 30 total ):
Diagram A Label Tree Type and Size Diagram A Location Coordinates
A 5" White Oak L-19
B 6" Red Oak A- 20
C 9" White Oak E- 18
D 8" Red Oak J-20
E 17 " White Oak C-16
F 5 "Red Oak M-16
G 15 " White Oak F- 12
H 15 " White Oak D- 12
I 8" White Oak A-12
J 18 "Red Oak F-8
K 18 " White Oak D- 8
L 11" White Oak D-6
M 20 " White Oak H-8
N 21 " White Oak 7-8
O 18 " White Oak K-11
P 14" White Oak M-10
Q 14" White Oak L-13
R 14" White Oak M-13
S 16" White Oak N-13
T 10 " White Oak N-12
U 17" White Oak N-11
V 16" White Oak N-9
W 9" White Oak M-9
X 21" White Oak L-7
Y 14" White Oak 0-7
Z 7" White Oak 0-5
AA 7" Red Oak M-6
BB 5" Red Oak K-5
CC 18" White Oak M-3
DD 18" White Oak N-2
TREES TO BE REMOVED ( 2 total ):
Diagram A Labe1 Tree Type and Size Diagram A Location
Coordinates
C 9 " White Oak
Q 14" White Oak
E-18
L-13
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. . LOT SURVEY CHECKLIST FOR RESIDENTIAL
BUILDING PERMIT APPLICATION
?
laaL7"LOnI
PROPERTY LEGAL 41r ILcYit' ? /? ?-TZ ?Gai<'sT
n DATE OF SURVEY: 4-
?
w LATEST REVISION: 4 -Zt? -617
?
fv
DOCUMENTSTANDARDS
O
O? Q
? ? • Registered Land Surveyor signature and company
? ? • Building PermR Applicant
q' ? ? • Legal description
? a ? ? Address
m' p? North arrow and scale
o? • House type (rambler, walkout, spftt w/o, split entry, lookout, etc.)
s' o? • Directianal dreinage arrows with siope/gradient °h
?v e ? • Proposedlebsting sewer and water services 8 invert elevation
V ? ? • Street name
D/ o ? • Driveway
d/ ? ? • Lot Squaie Footage
d ? ? • lot Caverage
ELEVATIONS
F.xistina
? • Sewer service (or Proposed)
m?/o ? ? Property corners
d? p Top of curb at Uie driveway
El ra? ?
? • ElevaOons of any ebsting adjacent homes
Old
h
d
t
c m
a y
renc
es
jaceM u
Adequate footing depth of structures due to a
Prooosed
?? ? • Garagefloor
?/? ? • Firstfloor
?f o ? • Lowest exposed elevation (walkouUwindow)
m/ ? ?
? • PropeM1y comers
ti
t h
t th
f
d
o ?
a • oun
a
on
Front and rear o
ome a
e
/ PONDING AREA (A aodiqde)
? ? ?
? • EasementGne
?
? );'
? V/ ? .
• NWL
HWL
u ??
/ • Pond # designation
? o
? • Emergency OverAow Elevatlon
/ DIMENSIONS
/ ? ? • Lot lineslBearings & dimensions
yr ??
? • Rightof-way and sVeet width (to hack of curb)
orches
etc
tha
2'
t
h
? ? • ,
.
er
n
, p
angs grea
Proposed home dimensions including arry proposed decks, over
?9' ??
• (i.e. ali structures requiring permanent footings)
Show all easements of record and any Cily utilitles within those easements
c? o?o • Setbacks of proposed structure and sideyard setback of adjacent epsOng strudures
? ?4' ? • Retaining wall requirements, if any
Reviewed:
Nama / D2t8
MefGh 19W
CR/iKygLppPpMT.FM
CITY USE ONLY
LOT ? BL q PERM[T #: 41040
SUBD. Abt'tlh ?7d RECEIPT #: ? ?56 yI ?
RECEIPT DATE: S- )&- 00
2000 MECHANICAI, PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PII.OT KNOS RD
EAGAN LMI 55122
651-681-4675
Date:
Complete this section onlv if you aze installing HVAC in a single family dwelling, townhome or condo under
construction and not owner/occupied.
• HVAC: 0-100 M B T U
ADDITIONAL 50 M BTU
• Gas outlets (minimum of one required @$3.00 ea.)
State Surchazge
Total
$ 30.00
6.00
?
.50
$i
Complete this section onlv if you are remodeline, addinQ to, or reairin an existing single-family dwelling,
townhome, or condo. Please indicate if it is a new item, alteration, or repair.
_ New _ Alteration
_ Furnace
_ Air exchanger
Repair _ Other
Air conditioning
Other
Reminder: Call for inspections 0
SITE ADDRESS:
Fee $ 30.00
State Surchazge .50
Total $ 30.50
OWNER NAME: 'I J? ?? _?`y7P 1? PHONE #: -
(AREA CODE)
INSTALLERNAME: ( An? ? 1A Y? paorrE #: L?,?! - y23 -1 14N
(AREA CODE)
STREf
C[TY:
?-1' CITY USE ONLY RECEIPT #: CR 171101
L i1i I?, gL 17?
SUBD. RECEIPTDATE: 151 u OO
? PERMIT# . 404C)
2000 PLUMBING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT IQTOB RD
EAGAN, NA7 55122
651-681-4675
Please complete for: ? single family dwellings
? townhomes and condos when pertnits are required for each unit
? backflow preventer for underground sprinkler system
FIXTURES
EACH #
058 ,
TOTAL
Alterations to existing dwelling - minimum fee
Describe: $ 30.00
Bath tub $ 3.00 x = $ -
Floor drain 3.00 x = $ 30°
Gas plpln outlet ' minimum -1 3.00 x = $ p°
Hot tub/spa 3.00 x = $
Kitchen sink 3.00 x = $ 3°?-
Laundry tray 3.00 x = $
Lavatory 3.00 x = $ i26°-
Septic System nrewireturtisned ' requires MPC lic. 75.00 x = $
Septic SyStem abandonment 30.00 x = $
RPZ new installatiaNrepair/rebuild 30.00 x = $
Rou h opening 1.50 x = $ '?5?
Shower 3.00 x = $ o°
Underground sprinkler if dwelling is under construction 3.00 x = $
Under round sprinkler ifexisting dwelling 30.00 x = $
Water closet 3.00 x = $
Water heater 3.00 x = $ :2?e
Water softener if dweiling under constroc2ion 5.00 x = $
Water softener if ezisting dwelling 30.00 x = $
Water turnaround 30.00 x $
State Surchar e .50 --> -> --> $ .50
rotai -> --> -> -> $
Reminder. Call for inspections of alterations, i.e. water heaters, water softeners, etc.
1 hereby adcnowlerlge that I hsve read this epplicetion, state thatthe inforrnation is corteU, and agree to comply with all eppliceble City-nf Eagen ordinenc;s.
It is the applicant's responsibility to notify the property owner that the City of Eagan assumes no liability for any demeges caused by the Ciry during its ?
normal operetional and maintenance adipities lo the facil@ies construded under this permit wRhin City propertyfrighbof-wey/easement. SITE ADDRESS:
OWNERNAME:: ?-IJ (??PT7 TELEPHONE#: Cnh1 USZ?LF?rJ°]
(AREA CODE)
INSTALLER NAME:
TELEPHONE#: loSl Lf2-?5 -II4 U
(AREA CODE)
STREET ADDRESS: I l.M%-{ S 'TQ ql L
CIN: ? wlo f aT STATE: ZIP: ?S
SIGNATU OF RMITTEE
Certificate of House Location Eor. Dan Goetz -
1260 Deetwood Drive „
Eagan, !Ild 55123 _ ' -
DELMAR H. *CNVIIANZ
uwo sunvEroae. INc.
RpIWFtl 11nOM LM d TM !bN M YMnM01?
14750 SOUTH ROBERT TRAIL A03EMOUNT, MINNESOTA 5460le sei /423- 1789
- SURVEYOR'S CERTIFICATE - \
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I hereCy ceAily Ihet Ihis survay. Olan, or npoN waf =
propusd by me w undar my dirset supsrvhbe and - 8625 -;?,` .
Ihat 1am a Auly Repista"d Land Simeyor un0er
Ine Iawt ol tM Smb ol Mlnnnols.????i?'?... ?y?
Vas
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, 04-19-00
DtloA
Revised 04-20-00 Nlded hse type, square footage, uti.lity info
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MinnMOU Mohernlm No. eezs
v=
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. RESIDENTIAL
.
BUILDING PERMIT APPLICATION
cirY oF eacaI
-,/?(?/f / - 7 3830 PILOT KNOB RD • 55122 ??0`?
j ? c/ 651-681-4675
New Connmcfion Reaulremenh
• 3 registered site surveys stwwirg sq. R of lot sq. ft. ot house; aM all mofed areas
(20qa mazimum bt average allowed)
• 2 copies of plan showing beam 8 winAaw saes; poured tountl design, etc.)
• i set of Energy Calculatlons
• 3 copies of ?ree Preservatlon Plan'rf lot platted after 711193
• Rim Joist Detad Optlons selection sheel (bldgs with 3 or less unils)
DATE
JOB SITE
RemodeVReoairReauiremenb ?`` IIL?
. 2 wpies of plan ?? ?I
• 7 sel of Energy CalcWalions for heated additmns
i d 1or M' addiii &d cks
011-0
• s esurvey e error ofs e ?
. Indicale if hame served by septic system fw addiUoris
VALUATION
IF MULTI-FAMILY BUILDING, HOW MANY UNITS?
PROPERTY OWNER(21?1
TYPE OF
APPLICA
ADDRESS -S/'? ? 9--
PAGER # CELL PHONE #
REPLACE(S) _ 0 1 _ 2
PHONE#lOS? `-'?L-y7s
ZIP CODE
PAX #
NEW RESIDENTIAL BUILDING ONLY - FILL OUT COMPLETELY
Energy Code Category _ MINNESOTA RULES 7670 CATEGORY 1
(check one) - Residential VentllaUon Category t Workshe
- Energy Envelope Calculations Submitted
- i i lJ D
MINNESOTA RULFS 7672
- New Energy Code Worksheet Submitted
Plumbing Contractor. Phone rr ?
Plumbing System Includes: _ Water Softener _ Lawn Sprinkler Fee: -39"Or
_ Water Heater ? No. of R.I. Baths
No. oE' Baths
Mechanical Contractor: _
Mechanical System Includes:
Sewer/Water Contractor:
_ Air Conditioning
Heat Recovery System
All above informalion must be submitted prior to processing of application.
I hereby acknowledge that I have read ihis application, siate that the
with alt applicabie State of Minnesota Statutes and City of Eagan Or(
Signalure of Applicanf
Phone #
Fee:
Phone #
ati n is cqFre,cjo&
To cornply
Certificates of Survey Received ? Tree Preservation Plan Received _?/Not Required _
? Updaled 1107
$70.00
OFFICE USE ONLY • ,
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bidg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 01 of _ plex 13 09 07-plex ? 17 Garage 0 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex p 18 Deck ? 23 Porch(screened) ? 38 Multi
? OS 03-plex ? 11 10-plex ? 19 Lower Levei ? 24 Storm Damage
? 06 04-plex 0 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
# 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demoiish (Foundation) ? 45 Fire Repair
? 33 Aiteration ? 37 Demolish (Bldg)' ? 43 Reroof ? 46 WindowslDoors
? 34 Replacement "DemoUtion (Entire Bldg only) - Give PCA handout to appllcant
Valuation am
Occupancy
R- 3 MC/ES System
Census Code Zoning A-1 City Water
SAC Units ? Stories Booster Pump
Nbr. ot Units ? Sq. Ft. PRV
Nbr. of Bldgs ? Length Fire Sprinklered
Type of Const S-!l? Width
?
Footings (new bldg)
Footings(deck)
Footings(addirion)
Foundation
Drain Tile
Roof Ice & Watec Final
Franung
Fireplace _ R.I. _ Air Test _ Final
Insularion
Other
_ Pool _ Ftgs _ Air/Gas Tests _ Final
_ Siding Stucco Stone
_ Windows (new/replacement)
Approved By U46 , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
W ater Supply & Storage
SRW Permit & Surcharge
Treatment Piant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
REQUIRED INSPECTIONS
FinaUC.o.
?j FinaUNo C.O.
Plumbing
HVAC
*'
City of Ea�all
Date: u
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
S
r
Use BLUE or BLACK Ink
For Office Use
Permit #: I ) a 3a)
Permit Fee: 10,57
a5
Date Received: 84-13
-13
Staff:
2013 RESIDENTIAL BUILDINGJ�PERMIT APPLICATION
(3 Site Address: / j' ' cJ ems`' d
Unit #:
Type of Work
Name: /,11 Z_ Phone:
Address / City / Zip: / a (:)
Applicant is: Owner Contractor
Description of work: Re — C-`oc:s o 0.4:e
Construction Cost:
Multi -Family Building: (Yes / No )
Company: � l �--- Contact: j -S11 V e-ff
Address: %j0O > ee%5iL— .Vlv" ` City: ,571 Zaz/fX
-57-5- (71/�ci ,'yam
State: ✓q' Zip:, �� (Q Phone: 6(-2-/ 2-cf a —775/6
License #: 0 0 0 / Oc-00 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 informat on. Porti
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 mu t r'ted within 180
�I %�
days of permit issuance.
d e �1 '-'-
x �
Applicant's Printed Name
pplicant's Sig
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