1546 Clemson DrIN5PECTION RECORD
? CITY QF EAGAN PERMIT TYPE: 111) 1111 r M6
3830 Pilot Knob Road Permit Number: f14 4
Eagan, Minnesota 55122-1897 Date Issued: t' ?? ;•" '`' '
(612) 681-4675 ?
' SITE ADDRESS' • APPLICANT•
i t ft i[f i} ? '
! < <!it ? + I hr'.??rA Oi? 1:1 ! ?, f ! t t 1 I il
I It??MAI?, k AF F: HI. 1 t,ll 1?MD ? i E, ?.` ? q,?4i ?,r,??+3 '•3'
PERMIT SUBTYPE:
('00 1 1 Hti,
TYPE OF WORK:
rtNni
P6rmR No. Pern?R Holder Date Talephone M
ELECTRIC
PLUMBING
HVAC
Inspretlon Dete Insp. Comments
FOOTINGS
FOUND
FRAMING
RQOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TE5T
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
BSMT R.I.
BSMT FINAL
DECK FTG AID IN710,
DECK FINAL !I • ?G ' '?1? ? .
Lot
Psrcel No.
Remodel D
Repeir ? Type of Const. t?
Enlerge ? No. Stories
Move ? Length
Demotlsh ? Depth 2 f
Grade ? Sq. Ft.
W Narr?e - - ----- .__ __ ,.
? . . = . (:,. _... 6
Address
City Phone t)
it
4
Name _
Address
?W Name 1.J • l]1L 1 ?: 5. \?.:,?aJ
?W
i? Address
?W City Phone
I hercby ocknowledpe thot I fiaw reod this applicction and sta
tlr informotion is correct ond ogree to comply with oil apF
5tab of Minnesoto Stctuter ord Ciry qf Ecqcn. Ordicwnces.
` J
Siqrwfuro of Permittes ?'` ?-= , ?."?`t?.'•
/? Buildinq Permit Is Issued to: .4" _. . ' ?
dl work sholl be done in accordonce wlth oll epplioobl• State
BWldlnp Officiol
Assessment
Water a Scw.
Poliu
Fin
Enp.
P1anner
Council
Bldg. Off. •? ! ? ? .`t? ?
APC
Var. Date
Permit -
Surthorpe
Plan Review
SAC ' `
Wcter Gonn.
Woter Meter
Roud Unit
. !?
Total on tF+e express conditlon Ohat
ato Statutes cnd Gty of Ecflon Ordinonces.
CITY OF EAGAN ? 0 Q 11
3830 Pifot Knob Road, P.O. Box 21-199, Eagae, MN 55121
PHONE: 454-8100
eU1LDING PERMIT R??a #
i Permit No. PNmh Holder Dste Telaphons it
Piumbinp L1
H:?A.C. 3 S.c e.t S l 5?-,
e'.ct'c c, 1 ? ?g5 1 L
Soft?r
Inspeetion Daft Insp. Other
Footinqs
Foundation
Frsminy
Rootinq /
Rouph PIlq.
Rouph HVA
Inwl ion 7
'
Final Plbp. ? ,? •? -
Final HVAC ' 13G ?
Final
Cort/Ooc.
-Z ?
Waar Dhc?ibe Loeation:
VYatl
Ssawr
?
Pr. Oap.
Reoeipt
PLUMBING PERMIT
CITY OF EAGAIN
,
? Fill in numbered spaces
Type ar Print legibly
FM
S/C
Tot
1. Date 2. Inatallation Cost 7
3. Job Address -? L-ot " Blk. Tract?`
?-
4, Owner
6. Contractor THfIMPCr:N aLUMQING ..O ?....Phone - -
12201 MINNETONKA BLVD. ,
6. Address
7. City
State Zip
8. Building Type: Residential ? Commercial O Institutfonal ?
9. Work Description: New Q Add ? Alter O Repair ?
10. Describe
11.
.
No. Fixtures
Water Closet No. Fixtures
Cesspool/Drainfield
Bath tuba Septic Tank
l..avatory Softner
Shower Well
Kitchen Sink
Urinal/Bidet Other
' Laundry Tray
f Floor Drains
Drinking Ftn.
Slop Sink
Gas Piping Outlets
12. I hereby certify that the above information is true and correct, and 1 agree to
cnmply with all ordinances and codes governing this type of work.
Signed: for
Rouph Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454,8100
Permit No.
Receipt MECHAIVTCACPERMIT Permit Na_, _
CI=Y OF ElkGAN
Fee
Fill in numbered spaces S/C
Type or Print legibly T
t
o
.
1. Date 2. Installation Cost
3. Job Address ' LotBlk. ? Tract
l .?
4. Owner
5. Contractor -Phone ,
6. Address
7. City Sfat6`' i? Zip
8. Building Type: Residential 0 Commercial ? Institutional 11
9. Work Description: New Q Add 0 Alter ? Repair ?
10. Describe Fuel Type r
11.
No. Equioment BTU - M. Ea.
Forced Air ' No. EquiPment CFM
Ai
H
dli
Mfg. r
an
ng:
Boilers
Mfg. Mech. Exhaust
Unit Heater
Mfg. Other
Air Cond.
Mfg,
Gas, Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed : for
Rough F lnal
Inspections: Date Insp. _ Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS:
1 h1'.ttCl 1?It
i li<<i?'. 1 Ah i ?IF i 4) 11 f'.? : h}1I
PERMIT SUBTYPE:
:oI I it i INri:;
?
?
CTION RECORD
PERMIT TYPE:
Permit Number:
Date Issued:
y? ? 1 "" °' APPUCANT:
i?? let ar.K : ?
f{ t?, i tl ,' i I J;
f Ei 1:) 410. 6 f?h0
TYPE OF WORK:
f TNAi
.?
RI i [ t I i r Nr
4!:'9RQh
04/;'1i/9;
?
J
----------------
Permk No. Permk Holdar Dete 7elephone #
ELECTRIC
PLUMBING
HVAC
Inapection Dato Inap. Comments
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FlNAL
BSMT R.I.
BSMT FINAL
DECK FfG , FOOTmfypi DOA?END / I
OECK FINAL /?.?b • ? ?J GL[?
2)
e1JiLDINa ?ERMIT
Te w wsd hr i. i)
Site Addrea •! 5 4 i;E
r
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21•199, Eaapn. MN 55121
PHONE: 454-8100
4
58
Parcel No.
? Name
Addre
City _
Name
? Address
? Citv Phone
thot I hova read this oppiication ond stote
rred ond oaree to comply with oIl opplk
Sipnoture of Permiftee
N Building Permit Is issued w:
oll work sholl be done in acoondance with oll
Buildinp Off{cial
Rece+at *
Erect 0 Occupancy '
Remodsl ? Zoning
Repair ? Type of Con:t. ?
Enlarge ? No. Stories
Move ? Length
Derr+oli:h ? Depth
Grsde ? Sq. Ft.
Assesament
Woter b Sew.
Polics
Fin
Ew•
Plonnsr
Council
Bldg. Off.
APC
Var. Date
Permit ' U
Surcharye
Plen Review ' L
SAC " :i G
Woter Conn. 06
Woter AAste? - - li 13
RooA Unit . ? 0
. U il
Total , 7 C
? on the oxpesst candlNon tho+
euxsoto Srotutes nnd City of Eoqon O?diranus.
Pwmk No. Pwmit Holdw Dab Tole hone #
Plumbinp
H.,,A.C. 5
E?^a G S AAr- 1 r
Saft«»r
IrapWion Dete Insp. Other
Footinpt +??
Foundation
Framinq ]/
Roofing
Rouqh Plbp. /la ?
Rouyh HVA
? ?.
Inwlation 8 ?
Final Plbp, ?
Final HVAC
Final
C.rt/Ooc. (!J Cb -? Q -5 - ?S
Water Dftcribs Locscion:
Weil
Sever
Pr. Oap.
Receipt - MECHANICAL PERMIT Permit No. i
, Clvf OF EA'GAN •
Fee
? Fil1 in numbered spaces S/C
Type or Print legrbly
? Tot. ?
1. Date 2. Installation Cost t
3. Job Address LotBlk. ? Tract `
?-?
, --
4. Owner
5. Contractor ? •_ ?. ;- _, ... _ . . _ . . . Phone
6. Address
.. ? f
7. City State Zip
8. Building Type: Residential El Commercial El Institutional ?
9. Work Description: New 0 Add ? Alter ? Repair O
10. Descri6e Fuel Type
11.
No, Equipment BTU - M. Ea.
Forced Air No. Equiament CFM
Ai
H
dli
Mfg. r
ng:
an
Boilers
Mfg. Mech. Exhaust
Unit Heater
Mfg. Other
Air Cond.
Mfg.
' Gas, Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed : ' for
Rough ' Final
Inspections: Date Insp. Date Insp.
This is your permit when numhered and approved.
Approved CITY OF EAGAN 464-8100
?
PLUMBING PERMIT Permit No. !
CIT1f OF EACaAN v Fee '•
fill in numbered s,peces S/C
Type or Prini /egibly To? . ' ' "
;
, -
1. Date ? '- 2. Installation Cost ;
,
3. Job Address - '.Lot Blk. Tract
4. Owner
5. Contrector ", .2b.one 6. Address 12201 MINNETONKA BLVD.
7. City State Zip
8. Building Type: Residential ?l
9. Work Description: New E'3
Commercial ? Institutional O
Add E3 Alter O Repair ?
10. Describe
11.
No, Fixtures
Water Closet No. Fixtures
Cess
ool/Orainfield
,Bath tubs p
Se
tic Tank
L.avatory p
Softner
Shower Well
? Kitchen Sink
Urinal/Bidet Oth
Laundry Tray er
Floor Drains
Drinking Ftn.
/ Slop Sink
Gas Piping Outlets
12. 1 hereby ceRify that jhe above inforrt?ation is true and correct, and I agree to
comply with all ordtriances end codes governing this type of work.
S+gned : . -
for
? Rauyh Final
Inspectioni: Date Insp. , Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
-,
?
Reaipt MECHANICAL PERMIT Permit No. ;
CITY OF EAGAN Fn
? FIl1 in numbsred apecea S/C
TYPe or Print feDlbly Tot b ?
1. Date 2. Installation Coat
3. Job Addreu Lot ? O Blk. f Tract
4. Ownar ; e
5. Contractor ' I n n e a a s c o phm1e 3 4 3- 7' 19
8. Addrosa f00 L i rtdcn Avt. ""•
7. City !. ? ` • Stets • r ` • Zip
8. Building Type: Residential El Commercial 13 Institutional ?
9. Work Description: New 0 Add ? Alter 13 Repair ?
10. Deacribe n ' ? * - y :: r , . . Fuel Type
11.
No. Enu*nment BTU - M. Ea.
Forced Air No. Eauiament CFM
Ai
H
dli
:
Mfg. r
an
ng
Boilers
Mfg, Mech. Exhaust
Unit Neater
Mf9• Other
Alr Cond.
Mfg.
Gas, Piping Outlets
12. I hereby certify that the above informetion is true and correct, and I agree to
comply witfi all ordinances and codes governing this type of work.
Signed .
for
Rough Fiml
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
INSPE
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
` SITE ADDRESS: `
s t f M•,fllV [)it
I'tttr', , 1 Ani Nf'tAN'fS 2MU
PERMIT SUBTYPE:
:j
F111,17 i NIi';t
CTION RECURD
PERMIT TYPE:
Permit Number:
Date Issued:
APPLICANT:
a
(61Z) 4:' H t, 5'+ N
TYPE OF WORiC:
f I N A I.
F?ll ! 1 It i Nt3
H a:
014l: H/97
I
Pemk No. Pertnit Nolder Date Telephone M
ELECTRiC
PLUMBING
HVAC
Inapection Dats Insp. Commenta
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYPBOARO
FIREPLACE
FIREPLACE
AIR 7EST
FINAL PLBG
FINAI HTG
ORSAT
TEST
BLDG FINAL
BSMT R.I.
BSMT FINAL
DECK FTG AlQ Pm . /Wew,
DECK FINAL J /• /G • lie
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-] 897 Date Issued:
(612) 681-4675 SITE ADDRESS: APPLICANT:
;? . r' ! E M'.0N Ufr t I. i f?i
.j
ItiPiFi'. i n!. k HF I[iNT'si ?.N{1 ?, ??' ? 470--6660
PERMIT SUBTYPE:
i
TYPE OF WORK:
i?F ";E;k iP"t I iIM
lSaHR CI FMS0N DR
llN
PF hIAaKS: 1 Nr! liLIFS 1646, 1?+4Ct
I 1 F' ! i 1
?
,*a,.
RFpA1R
fri k+It11Mi;
Permit No. Permk Holder Date Te{ophone M
ELECTRIC
PLUMBING
HVAC
Inspecdon Date Inap. Comments
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYPBOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TES7
BLDG FINAL
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
srafN' !?- rb •?
Reoeipt
PLUMBING PERMIT
CITY OF EAGAN
Fill in numberied s,pecea
Type or Prini /egibly
1. Date 2. Installation Cost
3. Job Address
4. Owner
5. Contractor
? A -
Permk No.
Fsa
S/C
Tot
?
Phone
6. Address THOMPSCN PLUMBING CO., [NC.
7. City MINNETONKA,S%WN, 55343 2ip
S. Building Type: Residential 11 Commercial ? Institutional ?
9. Work Description: New tl Add ? Alter O Repair ?
10. Describe
11.
No. Fixtures
Water Closet No. Fixtures
Ces
ol/Orainfi
ld
Bath tubs spo
e
Se
ti
T
k
Lavatory p
c
an
S
ft
e
Shower n
r
o
Well
' Kitchen Sink
Urinal/Bidet Oth
?
Laundry Tray er
Floor Drains
Drinking Ftn.
Slop Sink
Gas Piping Outleu
12. I hereby certify that the above information is true and correct, and I agree to
comply with alhordinances and codes governing this type ot work.
Signed : / / -
' ` for
Rouph Final
Inspectibns: Date lnsp. Date Insp.
This is your permit when numbered and approvad.
Approved CITY OF EAGAN 464-8100
:f.o'lroar
lf fet_?
QUILDING PERMIT
CITY OF EAGAN
3830 Pilot Knob Rosd, P.O. Box 21•199, Espen, MN 55121
PHONE: 4548100
Reoeipt
To w w"A fa ' Est. Volue `-{ ' Date _
Erect
Site Address
Remodel
Lot Blxk - Sec/5ub. ? _ ?
Repair ?
Parcel No. Enleryp ?
Move ?
ro Nama Danolish ?
; Address Grode ?
? City Phone Install ?
Name
? Addrea
City Phone
GW
Name
?u,,,
?V Address .? .
tc Z. City Phone " I he?eby ocknowledge thot I how read this opplication and state tho+
the inlormotion is correct and ogree to comply with oll applicoW
Stote of Minnesotc Stututes ond City of Eagap Ordinonus.
Sipnoture of Penniftaa
A 6uildinp Pern+lt Is issued to:
oil work sholl be dons in accordance with
I ype vr wnsL.
No. Staries
Length
Depth
Sq. Ft.
Assessrnent
Woter & Sew.
Pol ice
Fin
ErW
Plonnsr
Countil
Bldg.Off. ?
APC
Var. Date
I11TC
Pem+it ? 0
Swchorpe ? I'
Plan Review. ' 1)
SAC l f
Water Conn. { y 0
Wotar Meter J a
Rood Unit U
,
Total
pn f1w exprats corxlitian thol
ond City of Eayan Ordinoncas.
Wrmit No. Pnmit HoldK Daa Telephons #
Plumbirq
H.VA.C. ,? o? dC i I L -I? ?
Electric -?
;
' r
/ l,, ? , •,
? i , i -
/ .? ?.?
$OnlfNf
InWaetion Data Insp. Other
Footin9t
Foundation
Frsmina ? Ld
Roofiny 4
Rouqh Plbp. •7?
Rouph HVAC
%
Inw ation ?? ?
Final Plbp.
Finsl HVAC 3r
Final
riMWDOC. r C u 1 i
l
Water Dewibe Location:
Yllell
Sewer
Pr. Dbp.
Receipt MECHANIC/iL PERMIT Permit No.
CITY OF EAGAN
^
Fee '
? ??' ? ' ?
•` fill in numbered spaces
P
l
ibl
T
i S/C
•
_ eg
ype or
y
r
nt t
T
o
.
1. Date • 2. Installation Cost - ?
' , .,. <_i?
?
' ? r
3. Job Address
- Lot /
Blk. Tract
? y
4, Owner
, ?,?...,,...,..? ?._,-...., ? ...? ,.....,..--,? ,..,? -?
c? . ,.?.
5. Contractor .L Phone
1f i
6. Address 11 _ . _ . , .... ? ....
7. City
8. Building Type: Residential Cl
9. Work Description: New El
-7
State
Zip
Commercial ? institutional El
Add ? Alter ? Repair ?
10. Describe Fuel Type -=?-;
11.
No, Eauinment BTU - M. Ea.
Forced Air No. Equipment CFM
Ai
H
dli
Mfg. r
an
ng:
Boilers
Mfg. Mech. Exhaust
Unit Heater
Mfg. Other
Air Cond.
Mfg.
Gas, Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed :
for
Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 464-8100
Rspipt PLUMBIN(i PERMIT Permk No
.
l
'r ? CITY OF EAGAN F»
. . . fill in numbered spaces S/C ?
--
TyPe or Print legiblY Tot ,-
;
-//- f J?
D I
2
C
ate
1. nstallation
ost
. q
/" L
k
J
A
B
3 ? T
!
?
ddress
.
ob .
:ot
l ract
-
4
O
.
wner
5. Contractor ; i
i
Phone i ?
6. Address
f
7. City
State I
Zip _
8. Building Type: Residential
Q Commercial ? i
Institutional ? ,
9. Work Description: New E:)-" Add O Alter ? Repair ?
10. Describe
11.
No. Fixtures
Water Closet No. Fixtures
Cess
infield
o
l/Dr
? Bath tubs p
o
a
5e
tic T
nk
? Lavatory p
a
ft
r
S
i Shower ne
o
Well
j Kitchen Sink
Urinal/Bidet Ocne
?
Laundry Tray r
Floor Drains
_ Drinking Ftn.
Slop Sink
Gas Piping Outlets
12. 1 hereby certify that the above information is true and correct, and I agree to
comply with a?I ordinances and codes governing this type of work.
Signed : for
Rough Final
Inspections: Date "Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
'
0 ` l -
34
SV
2 PERMIT # ?s n v ? •
MECHANICAL PERMIT
1
'
i
. RECEIPT #
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE J -7
CONTRACT PRICE: PHaNE: 454-8100
Site Address ? gLpG. TYPE WORK DESCRIPTION
LotBlock ? SeqlSub
Res. ? New
Mult Add-on t-'*'
Name Comm. Repair
Address R910 W FNTWORTH V S0.
Other
F c City MINN EAPOWheMP; 55 420
881-9000
N
--
- FEES
? ame + RES. HVAC 0-100 M BTU -$24.00
c Address ADDITIONAL 50 M BTU - 6.00
O Ciry Phone (RES. HVAC INCLUDES A/C ON NEW
CONSTRUCTION)
GAS OUTLETS
MIN
M
(
I
UM - 1 PER PERMIn - 1.50 EA.
TYPE OF WORK COMM/IND FEE - 19`o OF CONTRACT FEE
Forced Air M BTU APT. BLOGS. - COMM. RATE APPLIES
Boiler
M BTU TOWNHOUSE & CONDOS - RES. RATE APPLIES
Unit Heater
M MINIMUM RESIDENTIAL FEE - ALL ADD-ON 8
BTU REMODELS - 12.00
Air Cond ? M BTU MINIMUM COMMERCIAL FEE - 20.00
Vent STATE SURCHARGE PER PERMIT - .50
CFM $ (ADD $.50 S!C IF PERMIT PRICE GOES
Gas Piping Outlets # BEYOND $1,000)
Other
FEE ?
S/C: ' U 51GN
TOTAL: /a - 3 a
M?'
FOR: CITY OF EAGAN
INSPE
ON
CITY OF EAGAN PERMIT TYPE: 1+It 11. rp ,
3830 Pilot Knob Road Permit Number: ti+?'ORq 3
Eagan, Minnesota 55122-1897 Date Issued: ?' ? ? •' ? ? '' ?'
(612) 681-4675
SITE ADDRESS: APPUCANT:
, 1: ? 1 ; hl?.,!tJ f??r 0 ? I #;:a f t ; (FI
I ,tt?hti, l Ar. I ilt 1141? tt?I..) 4.'w e'650
PERMIT SUBTYPE:
I r
t t1(31 I N fa !-'.
TYPE OF WORK:
F"tNAL
N i {J
?
. +
?
PertnR No. Parmft Holder Date Telephpne 11
ELECTRIC
PLUMBINQ
HVAC
Inspectlon Date Insp. Comments
FOOTI NGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBO
FINAL HTG
ORSAT
TEST
BLDG FINAL
BSMT R.I.
BSMT FINAL
DECK FfG A)p Aa. I^/C1'.
DECK FINAL
Receipt ?- n
MECHAIQFCA'CP RMIT Permit No.
_
. CITY OF EAGAN
't Fee ..
Fill in num6ered spaces S/C '
Type or Print legibly
T
?
ot.
1. Date 2. Installation Cost
3. Job Address Lot?Blk. Tract
?
4. Owner
5. Contractor Phone
6. Address
7. CitY State
Zip
8. Building Type: Residential n Commercial 0 Institutional ?
9. Work Description: New Add O Alter ? Repair ?
10. Describe Fuel Type -?-h
11.
No, Equipment 8TU - M. Ea.
Forced Air No. Equipment CFM
Ai
H
d
i
Mfg. , . _ r
ng:
an
l
Boilers
Mfg. Mech. Exhaust
Unit Heater
Mfg. Other
Air Cond.
Mtg.
' Gas, Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed : - fi
for
Rough Flnal
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 464-8100
i .. J=r;.., .. ;
.. .
lUILDING PERMIT
i
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-198, Eapn, MN 55121
PHONE: 454-8100
ReceiP? #
Erect 0 Ocwpency
SiteAddren Remodal ? Zoning
Lot ' !-`??
Block ?- ?1Sub
. Repeir ? Type of Const.
Parcel No.
Enlarqe ? No. Stories
?
Narrve
4 ? iv.'? ?_' ?, ;. ??3•i l' ?. i? l' Move ?
? Length - ?
h
D
' . 'r:C?:i 1 3
Add Demolish
? ept
? res s i Grade Sq. Ft.
14 1-.n11 n
u?
E I,hercby ocknowtedpe that I Fwre read this
.?F?". `
, '
Sipnoturo of PermiltN
/? euiiainq Pem,ir Is issued ro:
oll work sholl be done in occordance wlth all
8uildinq Offidal
- - Assessment Permit Water 3 Sew. 5urt?w?"
Poliu Plan Raview - L'
Fin SAC ?
Enp. Woter Conn.
Plonnsr Woter lrkter
Council Road Unit -- •.'s '?3/? `_' . ?i)
ond stofe that Bldg. Off. • 1 -
all oppliwblo APC Total .. , ,
ancas.
Var. Dste
M C`.
Of1 t'M !Xpron COfldlflOfl fh01
Io Stote of Minnesota Statutes ond Gfy of Eopon Ordlnonus.
Pwmit No. Psrmit Holder DaN Tel! hone ?
Plwtthinp C C' 11--o S ?? s
H.vr?.c.
5/1 y
Elocidc /S 5?.
-?`? ??a n? " 'Y " 'c• t;
Softener
Inapaction Dats Insp. Other
Footinqt
Foundation
Fnminy ?
Roofiny
Rouyh Pibp. ? -
Rouph HVAC
,
In ta ion
Final Plbq.
Final HVAC
Final
Cw't/Ooc.
wmr Dacriba Locstioo:
YWII '
Sewe?
P?. Disp.
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE: t llTNli
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued:
(612) 681-4675
SITE ADDRESS: ' APPLICANT:
, , i 1 hhl'?1?N Utc ? ,?t,? 1.? 11 ? U
?it'•1it . 4 ??? t fli IIiN I'i ..'lilL) ??, 1. . 'i:'B-•Af111
PERMIT SUBTYPE: TYPE OF WORK: '
r:i TFanl inN
rlf:rh? t, rci*, ONi ?
11 1 1 Nro ,
Permk No. Parmit Holder Date Talephona N
ELECTRIC
PLUMBING
HVAC
Inspection Date Insp. Comments
FOOTINGS
FOUND
FP,AMING
ROOFING
ROUGH
PLUMBIN(3
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYPBOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
BSMT R.I.
BSMT FINAL
DECK FfG y
DECK FINAL
GEO. SEDGWICK HTG. & AIR COND: CO.
- A? HOUSE HEATING TEST RECORD
ADDRESS CITY f- ?
OCCUPANT
OWNER
(-?, rfdi
HEAT LOSS DATE HT% INST. I
SOLD BY L I e? 1 1?FL ?? _ INSTALLED BY SQ ' 11'^j C, i
'Electrical Work By Gas Line By _ ?? ?" •- ? = c{r N . • ? ?
? TYPE OF HEAT GA_ FA_ HW_ STEAM SPACE HTR. UNIT HTR. OTHER 1
GAS DESIGN N
E????
? MAKE nin C= a' MAKE OF BURNER
;
`
Model ? - - - - -_ _ R E V I E '
Modei
Serial S 4Y9 s G?? ?(w - Max. BTU Rating
INPUT MAKE-OF-FURf1CACE
, Model -- - ?
CONTROLS
"? ?
'
5 DATE
THERPJIOSTA Heat Plug
! Vent Size
Valve '?' `? h«w KIND OF LINER SIZE NONE
Li
i F7 nn S T FJ T" l
D
ft H
d ''+ '"?
? %'- i•' ? R
t
m
t egu
ra
oo
•
a
or
Limit Setting a C) O s 1- Filters Size fVumber
Fan Setting /0 Chimney Location Inside- "Dutside
Pilot Type
? Chimney Construction C
Pilot Make
Pilot Model Smoke Bomb Wiring
Pilot Timing Draft " Test Tag 1 ?
L.W. Cut Off Door Pressure ? Lighting Inst.
Pressure Percent CO ? Date Tested
Input CFH?? Percent 02 Company Testing ?=; ?'`' :?_ ?= ?' ?-? • ? ?
Stack Temp. ` `•' ? ? Percent CO ' r '
- Name of Tester - ? -? 1
?
,
-------_» _._. ?
HTG. & A1 R COND. CO.
.?
d
., ' HOUSE HEATING TEST RECORD
ADDRESS PMSs? ri 'D;- ,.' L- CITY Z:?? AN
OCCUPANT
HEAT LOSS
DATE
OWNER
SOLD BY INSTALLED BY
Electrical Wnrk 6v ,f 14 ? Gas Line By _ ??>'' • ? N r ; ? I.u ': ?
TYPE UF HEAT GA _ FA1_ HW_ STEAM SPACE HTR. UNIT HTR. OTHER
GA5 DESIGN CONVERSION
MAKE FN ;`-% ?,( MAKE OF BURNER
Model C; 1 c?N a. ?L_ - cg o'Z Model
Serial Max. E?TU R?rin;
INPUT L4 0? C r? c? MAKE OF FURNAC? E' 7
Model
-
-r -LV 3 CONTROLS
THERPJIQSTAT Heat Plug Vent Size
Valve ?3o ?r?' c?-.a.,t. KINDOF LINER 1116 ' NONE
Limit <a rv ^.s 7 0 T Draft Hood L)( egulator ?1 L N?-
Limit Setting a o v°/-- Filters Size Numher
Fan Setting Chimney Location Inside Outside
Pilot Type Chimney Construction 1<?• =? '
Pilot A4ake IZ o loer--4 s j+a --I
U?
Pilot Model F-S 'S Smoke Bamb ? Wiring
Pilot Timing i4 t..T Draft ' Test Tag S
L.W. Cut Off -" Door Pressure Lighting Init. ?
Pressure S??'''?• f Percent CO Date Tested " c:' S
Input CFH 8a /'? Z a
Percent 0 R f
Company Testing
'6 p?
Stack Temp. 90 ?/? Percent C02 Q u? Name of Tester
HOUSE HEATING TEST RECORD
ADDRESS `J[ L, -',,. CITY ?11-1? ??
OCCUPANT OWNER
HEAT LOSS DATE HTG. INST.
SOLD BY G/I fj? INSTALLED BY? ? 'Electrical Work By Gas Line By
TYPE OF HEAT GA_ FA_ HW_ STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN CONVERSION,
MAKE .:? ..--
Model •? 1 'z
Serial ' -- `? -'
INPUT
CONTROLS
THERMOSTAT Heat Plug
Valve
Limit
Limit Setting
Fan Setting 4
Pilot Type
Pilot 11Aake --?
Pilot Model
Pilot Timing
L.W. Cut Off
MAKE OF BURNER
Max. BTU Rating -
MAKE OF FURNACE
Model
Vent Size '
KIND OF LINER
Draft Hood
Filters Size _
Chimney Location
Chimney Construction
Smoke Bomb
Draft
Door
NONE
Number
Inside Outside
Wiring
Test Tag '
Lighting Inst._
Pressure Percent C02 Date Tested
Input CFH Percent OZ Company Testing
Stack Temp. Percent CO Name of Tester
GEO. SEDGWICK HTG. & AIR COND. CO.
' HOUSE HEATING TEST RECORD
ADDRESS CITY ?-?-
OCCUPANT OWNER
HEAT LOSS DATE HTG INST.
SOLD BY LIQ?QI 1ZN Z- _INSTALLED BY
Gas Line B
? r
Electrical Work By ri r
..? Y
TYPE OF HEAT GA_ FA_Z_ HW_ STEAM SPACE HTR. UNIT HTR. O HER_
GAS DESIGN CONVERSION
MAKE MRiW,.QF BURNER
Model Model
5erial Max. BTU Rating
INPUT ?a O? v MAKE F-FIHWACE
r? CONTROLS
THERMOSTAT ? -? '4 Fjeat Plug
Valve 'r:-r ` ?«-"?
Limit ? Yr' 1 l ? i
Limit Setting ?-
Fan Setting / ° r
Pilot Type _ -S ~
Pilot R4ake
Pilot Model FS - /
Pilot Timing ::Z 11 S T14 fyT
L.W. Cut Off
0
Pressure ? i' '?' • t • Percent C02 -
Input CFH Percent 02---? g ?
Stack Temp. Percent CO
Vent Size ?
KIND OF LINER S NE
Draft Hood 'J P?4,`- `?` i???stiaEa r ?l.' 0 rU t
Filters Size fdumber
Chimney Location Inside Outside
Chimney Construction c 0.S-> j?
Smoke Bomb wirin9 C ?
Draft "- Test Tag
Door Pressure - Lighting tnst. U?
Date Tested
Company Testing ?.= F v S?•? /. ,: 1`
Name of Tester
,¢G? A .u
CITY OF EAGAN ? Remarks /AO Aql
Addition _7hntrinC .akP H P4 ,gFi __ • cldi i0I1 Lot * A-Blk ? Z Parcel #t-'75gs?0 `260 02-
owner l ?aJ street 1546 .('ilemsoll DT1Ve state Eagan, NIlV 55122
Improvement Qate Amount Annua) Years Payment Receipt Date
STREET SURF,
u
1.8 A0?.2Z 2 - -8
STREET RESTOR. ?
GRADING
SAN 5EW TRUNK ?JQ??
* SEWER LATERAL 3'] . 0 7 .. S Z 15• O5 A012172 5-5-83
WATERMAIN
• WATER LATERAL
WATER AR EA / fJ 7
STpRM SEW TRK 1981 7022 249.91 A012172 5-5-83
* STORM SEW LAT 1981
CURB & GUTTER
SIDEWALK
STREET LIGHT
WRTER CONN. 500.00
n
n
SUILDING PER. 0009-10012
SAC
PARK
CiTY OF EAGAN Remarks 2M-W a& QZ
.
Addition ?• Lot ??Blk L Z Parcel # 10 764600-940-09
Owner ???.?.?? j'?"-7i- str?c 1546 B Clemson Drive state Eagan, NIIV 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREETSURF. 1981 279.71 $5.94 5 ul.$ .A0121 2 --$
$TREET RESTOR.
GRADING
' SAN SEW TRUNK
• SEWER LATERAL , 5
2 1.0 A0121 2 --S
.
-
I WATERMAIN
• WATER LATERAL
WATER AREA
STORM SEW TRK 3 1981 312.37 20.82 15 29.91 A012I72 5-5-83
F STORM 5EW LAT 1981
CURB & GUTTER
SIDEWALK
STREET LIGIiT
WATER COMN, 500.00 n a
13UILDiNG PER. 10012
SAC 525.00
PARK
CITY OF EAGAN ? Remarks TSm /10 . 101
Addition ? Addition Lot-TIZ BIk Parcel #10
Owne?? streec 1548 Clemsori DY'iVe state Eagan, MN 55122
Improvement Date Amount Annual Years Payrnent Receipt date
STREET SURF, ?
STREET RESTOR.
GRADING
SAN SEW TRUNK 191.5
* SEWER LATERAL 1981 .6 7. SZ .O A0121 2 --S
n
WATERMAIN
* WATER LATERAL 1981
WATER AREA rJ 7
? STORM SEW TRK
1981
312-37
20.82
15
249.91
A0321'r2
5-5••83
STORM SEW LAT 1981
CURB & GUTTER
SIDEWALK
STREET LIGHT
280. 0 50451 3 27 85
WATER CONN. 500.00
BUILOING PER, 09-1001-2
SAC 525-00
PAR K
CITY OF EAGAN Remarks
Rddition Tfionlac .ak . H.ight_ _ Addi ti cm Lot ? IZ) Rlk 3..,4 Parcel #IO
Owner4 ?'i r?`-.T ?"_' : ?I, r.S? 1c str?t 1548 B Clemson Drive stete Eagan, NIN 55122
Improvement Date Amount Annual Years Payment Receipt date
STREET SURF. . S A012112 5-5-83
STREET RESTOR.
GRAOING
SAN SEW TRUNK 1973 0'L4Z*-j
* SEWER LATERAL 61 2 1.0 A0121 Z --8
WATERMAIN
* WATER LATERAL
WATER AREA 7
STORM SEW TRK 249.92 A0121 Q -5-83
,t STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. u n
BUILDING PER. 10009-10012
SAC
PARK
? Site ^ddrcss: '
' Plumber: _
Meter No.: Cannection Chorpe: '? ? ,•,?
Size: Acr
ourrt De
ostt: j
;
.
p
. . ?
Readar No.: Permit Fee:
1 prN to emPly wilh tiN Cier of Espm Sv?charoe:
.
Onineoom Misc. Chorfles: ?^ nn ,..v ...a* g
Totcl: 132 Qn p a
BY Dcte Paid:
.
Dote of Insp.: Insp,;
?.
P. O. Box 211 °+g hiO
:
Esgan, MN 55121 .
Zontnp: No. of Units:
O1Yfllr:
Address: A _.
Site /4ldrcss: - •'? .. ? I F' C
'
L, _ ?,' ' '
?
'
Pf umber. -
,-
?---?
.,_
6
Mater No.: 3 Connettion Chorpe:
?
Size: /ltaount Deposit:
Reoder No.: Oto m_?.?? Permit Fee:
1 qwe h am* with !M CMp of Eprn Surchorge: T??--c--
Ord1ngeoM. Mist. Charpes: nrriGti„-
\
' Totol:
BY Dole Peid:
Date of Irup.: (mp,;
CITY OF EAGAIV
3830 Hot Knob Road ' 7229
P. O. Box 21799 PERMIT NO.:
y
Eagan, MN 55121 ,; pA?; '?y J
un fi^._.!rv^ r-lt
Zoninp: No. of Units:
, c.1 •.'ri?on '?o:,es
Owner:
Add
1 a9rM to osmpir wieh ebe Gty ef Wger
425.f10 d
Connectlon Charpe:
Oediaenaas. AcoouM Depoait: 5' p
Permit Fee: P'
5uid?arpe: • - n`
gy Misc. Uwrqex
Date of Inap.: Totol:
Inse_- Dah Poid:
CITY Of EAGAN
3830 Pilot Knob Road
P. O. Box 211
Eagan, 91AN 5521
WATER SERVICF PERMIT
PERMIT Np.:
DATE: '
No. of Units: + -- •- - - ?
llddress:
No..
No..
to Gemaf' wia 110 C.ilp of yNn
of Insp.:
Cannection (harge; nc._
Acsount DePasit:
Permit Fee; ' .
Surchor9e:
Mltc. Chorpes; _ j, 1 ?,7 ; rr er
Totol:
Qote Paid: ?-?
Insp.:
CITY OF EAGAN
3836 PElot Kawb Road
P. O. Box 21199
Eagan, MN 55121
Plumber. WATER SERVICE PERMlT 303 ZcA
Zoninp;
Owner:
Address;
Slte AddrOn:
uv"?{?V ?? b'? t1 R Con'ne/?ct`io`n Cholye: 500.'•1(1
Si
? LI-i ti-? LL YAcpol?ArY?Sepo, sit: 1 7
n
Reoder No.: lZk_? 7D _a ?3_1_
Permit Fee:
I yF" !o oomply wuh !At Gty of Esqp¦ Surchorye: -
O?t.?eas. Mtac. Cho
?yes: nd mer c;:
B TotoL•
e Paid:
Date of Insp.:
Irtsp.:
GI 1 Y UF EAGAN SEWER SERVICE PERMIT
3830 Pilot Knob Road -
P. O. Box 21199 PERMIT NO.:
Eagan, NFN 5512?, D/1TE: 4
Zoni '
ng: No. of Units:
Owner el.'T ''o2'izon I(or.es
Address:
Site /lddress• 1 "4t o r?. ?T; c n;? ^T ""'?!?n ? g ??'.• ?, „ ? ?.
Plumber. rri:.?%
--? ? ??.?? j., ?.....
I y!M t0 00111* wkb lho City of EI/O¦
of Insp.:
;? 7 r , lfl P?P
COf1FlectiOf1 (}I0nl: . • Acwtw?t Deposit: ?• i? ? i:
?
Pemilt fw: . ,
Surclwrpa: . 7 ' Misc. Charpes:
Totol:
r.
PERMIT NQ.: _ 601? 1
DI1TE:
No. ot Units: _ ? ?r .; ?_y •
6ITY OF EAGAN WATER SERVIC E PERMIT
3830 Pilot Knob Road 6042
P. 0. Bc+- 21199 PERMIT NO.:
55
9
121
M DATE: -
4-
Esgan,
N 55
' 1imit tnhse
i
?ing; R No. of Units:
3ZOn Nrnn
n3"
Na
O c
.
vrMr:
GT
Add
re5X
$? ???; 154_n1 a++-?+n ilr
T 11 $1 nmaa
T.qlrp Aatc h ?--
,; Thomnson P1bQ
pl
b -
„ry,
e
3
59 F 2
23 Connsctton Chorya: 500.00 ud
.
Metor No.: :
- i 15.00 pd
Stze; t:
Acoount Depos d
Reoder No.: 1261 !'Yf Y210 3-2 Psm+ir Fee: 12.00 p
. 50 pd
1 Nm ft a- apls wili lM Cilp of !oww Surcharyo: - 00 pd met e
63
Mi? ??? .
; Toral: 132.00 pd slc
! g
XjkZ
Dot. Paid:
-,54- /7
Date of I
'
I^sD•:
;
-
Pilot Knob Road
Bc:.'21199
i, MN 55121
to A?ER SM. M i'ERMiT
PERMIT NO.: 6'}L, _
D/1TE: 4-9-
No. of Units: 1 unit ttZt:se
-
'JG'S ' , 4'7nn TInm R
No.:
te eon%* wok ew City oi 4qsw
Connecflon Q?orys:
Account Deposit: _
Pertnit Fee:
Surtharye:
Misc. Chorpes: -
Totoi:
Dots Paid:
CITY OF EAGAN
3830 Pilot Knob Road
P. O. Bo? 21199 P
Eagin, MN 55121 ?
Zoninp:
•ew "urizon ?+omes
Add?ess:
Site Address: 154 R Cl e.ns on "r T
Plumber l ompson . 15r
,- -
SEWER SERVICE PERMIT
ERMIT NO.: 7
DATE: -?-No. of Units: un
sus
1 pr« to oaMoyr wiM Nha City oi Seges Connactton Chorge:
Orllw?neM. /loaamt Deposit: _
i Pemnit Fae:
? Surchorpa:
j By Misc. Chorpsx _
i Date of Insp.: Totnl:
Dob Pafd:
425.00
Box 2119,9
i, AAN 55121
Owner:
/lddross:
PERMIT NO.:
DATE:
. No. of Untts:
w
Site Addras: 1'4F9 Glemson Pr L10 13 Thores a7,e .•i- 5
Pluenber. T*.'i ^so.^. Pl
Meftr No.: Connection CFwrpe: •_ P
5iu: AcoourK Deposlt: 15.00 pd
Reoder No.: Perrnit Fee: 1 n. 00 pd
Isom !e eo=* wNw !Iw Clryr ef 16926 Surcha?ys: •];} pc?
Ora"mmm Mtac. Chorpes: > -'• ?? P me er
Totcl: 132.00 P s e
P. o. 3ox 2. 3s
Eagen, MN 55121
Zaninp: P.3
OWMf: - CW I???A?1?`?{r
Add1lfs: .. t , ,
5ft Addf!!i: ? ? ?• _ C?': F. 11 I:
PlUfTIbfC .•..•. . ... . r 1 (i:r
Mater No.: •3 q 8 7 3 3
Size: ?1f'r ?ai?
Reader No.: !L, /, M e-1 7 /
1aOrN !o eova* wqh !M C1ey Of Epp¦
Dote of Insp.:
PERMIT NO.: ''043
DATE: 5
No. of Units:
:)':lA fi
ivt-F. vk. Pc
ConneCtbn CF+arys:
AccoU?It D@pWt: 15. n( i ,.
Permit Feo: '
SuRharya:
Misc. Charoes: 17 p` r- `` -'
Totol: 1'2.' 0 pd s, c
Dote Pald:
CITY OF EAGAN SEWER SER1fICF pERMIT .f
3830 Pilot Knob Road
P. O. Box 21199 PERMIT NO.: '-' -s
Eagan, MN 55121,.. pATE:
Zoninp; No, of Units:
•-W .:or on .16mes
Owner.
/lddross:
! cr ?;on 'r
Site Address: - --- ar?as a?e r_ s
Plumber.
I a/rN t0 OOIMply wfth HN cky OF t0W11
of Insp,;
_ . ., z
r.Of1ROCtiOfl Q?Q1p; •, ?t
ACODNfM QlpOSIt: • ? n, Pefrdt FM2 . ' ?? T>Q
SurchCrge:
Misc. Chorpm
Totol:
SEDGWICK HEATING & AIR CONDITIONING CO. HEATiNG JOBNO .?1?2gC4 ?
8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(672) 881-9000 TEST RECORD
J '
ADDRE55 A-5?,?/S S"r-,U ? CITY lftac?..??_
OCCUPANTq OWNER / 6 ? µ
SOLD BYlSIk.'-' N MSTALLED BY _
MAKE [, f 'LI sMODEL l7" 61?41 4 ' O'IO " O l
SERIAL NO. ?/???7 l S?7 .3 INPUT ?AS3, /J!3 a
THERMOSTAT =20 VENT 52E
VALVE v.
LIMIT ( / -. ,n n?L
LIMIT SETTING
FAN SETTING ':2!?/? - ^I
/
PILOT TYPE
IGNITION MODEL t ?t•w,o_,},
TYPE OF LINER X`? ?
q
LINER SIZE ?
FlLTERS. SIZE ?-?h?????-'Jt? NUMBER ?
WIRING [rl. J
TEST TAG
LIGHTING INST i. < ?2 /ti 2 fl flll ?
PILO7 TIMING /-2.,,_
DATE TESTED
PRESSURE PERCENT CO, i>
INPUT CFH l G C'F/? PERCENT Oz
COMPANY
STACK TEMP. ?F.O ?G PERCEN7 CO e`?'16i? NAME OF TESTEF
FOHM 2J5 (fiEV 1 1r89) FORM DISTFIBUTION,iWHITEICOPV - JOB FILE YELLOW COPY - Cltt
Tin= ell.,est W.d g (-,
,a ,?
,?'?b? 8 L o r ?.k
ReQVest Date Fve No. Ro qh-in Insper.tion
-./' /? S 11equ 1? ?PeadY N?wv ill Natify Inspec-
?`7 Y?s ? No tor When Iteady
ucensed Elechical Camra??or 1 h¢rab
y request insoecLOn ol above
? Owner eleetfieal work ins1n11M n,
5[ree.t AtlAress Bos or Noute No. ?
1-SL48 A Gti?emSon C\ Ciiy
Ca un
cuon o. Townsh?0 Name or No. q..ge
7\" ?(
/ Yr rf7?
c pant IPRI T
{?
,/ I '• 4?
Pho No. y?
?? l?Q
Po r Su
POlier -
Addr
E ctr ? Comractor (COnpany m¢I
? Co?ntrnctor's Gcense No .
?
?
I
Mailin0 AdJr
s tractor or Ow?r Makmg
latfon)
f ?
?n ss3 -7
A n?ed SiO?mre lCOntracmrZOwner Makiny Installationl Phone Numbe,
MINRIESOTA STATE BOAflD OF ELECTf11C1TA5?- THIS INSPECTION pEQUEST NILL NOT
Griggs-NidweY Bldp. - R. N-191 gE ACGEP'IEO BY THE STATE HOqqD
1821 Univwryity Ava.. St Peul, MN 55106 UNLESS PBOPEP INSPEGTION FEE IS
Pho. 1612) 2972111 ENCLOSED.
5(EeIoaooi?
() l?
236658 REQUEST FOR ELECTqICpL 111?pECT10N
i.mo-acno.. ro. •Sxs fmm. - pack of vallow X" ge/ow Work Covered b This R
_ Y equest
Th s request void
f(???
%InII15 OT
? 0_ 6 3 9 ` G/o
Request Dat¢ Rre o. Rpu?,n Ins ?
pection • U U
9-3-1985 Reu?ined? HCady NnwUWill Nobfv Inspec
?YCS }QNO tor When Ready
ULicensed Electncal Conhractor
? Owner I hareAy request inspection of above
aie
. . .._... .._.., ....,.
SVee[ Atldrxss, Boz or Hout¢ No. ....o., a..
City
1548 B. Clemson Drive Eagan
ec?'On o. Township Ndme or No. Rnnpu No. COVnty
Dakota
Occupdnt (PRINT)
Phone Nn.
New Horizons
Power Suo0lrei Adtlress
Electnral Convacto1 IComuanv Namel
ConVar,tor's Lmense Na
,
O.B. Thompson Electric Co., Inc. A40602
Mailinp AAJress (Cuntractor or Owner Makmg InstailaUOn)
12201 Mtka Blvd., Mtka 55343
Authonzed $iBnawre IConvactodOwner MnkinA InstallaLUnI Phone Numbw
-, ? 933-2521
----- u vr cLcciniciTr 1 nIs irv5pecilON REQUEST WILL NOT .11 Grie9s-Midwey Bltlg. - Room Nd91 ' eE ACCEPTED BV THE STqTE BOAND
7821 Uni Ave., St. Paul, MN 55104 UNLE55 PROPEfl INSPECTION FEE IS
Phone (612) 297_2111 ENCLOSEO.
REQUEST FOR ELECTRICAL INSPECTION
' See nstruebans Ior tomDlehng this lorm on beck oi Vellow copy,
7_-X" Below Work Covered 6y This Request
ee-ooooi.oa
qkffl?
This repuest wiA G
18 m]onhs Trorm?y Ji ? ? o f
o:7 P1 ?1.`l l L l i R I -h,, l 1,? !Iz` 2--
Feques[ pate
//
? `Y 8 5 Fre No. Nough-in Insue:ruon
ReQu?r ?
Dfleady Now r?II Nnlfly InsOec-
lor Wh
n p
d
ex ?No r.
ea
y
69-Licensed Elec[ncal Contnctor 1 hereby request insOecfwn oi above
? Owner electrical work installed at
Street Atldress
~? , Box or floute No. '
C c r, ?? ?rc1 ? Gity
ECA c a n
edion n. Townsmo Namc or No. IL nge No. Co tv
O r aM IRiINT
r, or?
-e s Phone Ne.
y b 3 D a
Po SunVher
r
A s
'
?n
-
? cv I Conuactor ICompc N mel
?? ?r Conlra mr's Licens
e No
G? Id ?-s?
?-s?
Madinp Addre
5 IC tractor or Owrwr Maki Ins[ailatio
c n 'gv
44
rI l"}'IIU SS3a
?
A oriced SiB?[ure IConvactar ner ki? Insial tion)
?? Ph ne Numbe
r "'
?
'q ? /
? /
MINNESOTA STATE BOARD Of ELEC7RICITX?-?
Griggs-lAitlwaY Bldg. - Rnom N-191
1821 Umvarsity Ave.. Sc Paul, YN 65104
Plqna (612) 2972111
THIS INSPECTION REQUEST WILL NOT
BE ACCEPTED 8Y THE STATE BOARD
UNLESS PROPER INSPECTION FEE IS
ENCLOSED.
?? ?REQUEST FOR ELECTRICAL INSPECTION EB-ooIoo[i j
' See i?atrwtions fa completi? this fwm on hack of yellow copK ??? ?( l?
23(6657 ?U
'X" Be/ow Work Covereo by Thrs Request
0 Fee rS.,vic.EMr.n..So?i, Fee Feetlars/SUbfeetlacs Fee Grcwts
Oto30qm Otn30Am s
®
m? 37 to 100 qmps
Above 100_Amps Abov1(10Am '
Irtigation Boorrs PartiavOther Fee
Remarks ? TOTAL F /
E?E71 ?j
(?; - V/
? 11 1, the Elecbrca"f
j;- Ircpeetor, bere?y
F.nal ..aetV/Y t?t the abova
^ . ?fte , ? spect{on has bcen
This repues[ void 5517 ? ry /^
18 nwnths/ Irom ) 1
D [J[]iQ ll f]
Rpquest Da[e Fira No. HuuPh-'n InspecUOn
9-3-1985
I Renuired> OReatly Now ?f4Jill NnUfy InsUec-
p?y?'
?ycs M.
inr When fleatly
.R..icensetl Eiectncal Contractor
? D.vner
I hareby repuest inspachon of above
Blectncal wnr4 inctallnd st
Svee[ AdAress, Box or Route No. City
1548 Clemson Drive Eagan
ecuon o. Township Name or No. Range Nn. County
Dakota
Occupant IPflINT) Phone No.
New Horizons
Power SupDher Addretis
Eiecincal Contractor ICOmpany Namel Cnmractor's Lmense No.
O.B. Thompson Electric Co., Inc. A40602
Mailmg Atldress ICOn[mctor or Owner Making Insmilauon)
12201 Mtka Blvd., Mtka 55343
Authorizea S?e?ature IConhanndOwner Making Installa[ion) Phono Numbcr
, ?f??a•??a?1
MINNESOTA $TATE BOARD OFELECTflICITY
GriBUS-MiEway Bldg. - Noom N•191
1827 Umversity Ave., SL Paui, MN 55104
Phone 16121 297-2111
THIS INSPECTION NEQUEST WILL NOT
eE ACCEPTED BY THE STATE BOAND
UNLESS PflOPEfl INSPECTION FEE IS
ENCLOSED.
'd? REQUEST FOR ELECTRICAL INSPECTION EB-00001.04
/J' See instructions tor completing this form on beck of yellow cooY. v7 (?
q nR '"X'Below Work Covered by 7his Reqiresl u 1$7
HAd Fep. Type of 9mltlsng Ap0liancas WiteA EquiUment Wired
Home Range Temporary Service
Dupiex Water He?ter Liyhtiny Fixtures
Apt. Bwlding Dryer Electric HeaUn
Commeraal Bldy. Fumace Silo Unluader
Indus[rial Bldg. qir Conditioner Bulk Milk Tank
Farm Oiher „pemty .lher ISUCr,ityl
...
.......
_ i_ ther uec?fy
"_'..__ ? .. . Other Other
N Fee ServicaEntrenceSae k Fee feeders/SUbfeetlers b Fee C?rcurts
0 to ZUO qm s 0 to 30 Am s 0 to 30 Am ps
A6ove 200 qrnny 31 to 100 Ainps 31 to 100 Am s
Swimming Pool Above 100 _qm s Above 100_.Qmps
Transtormers Irtlgation Boorc?s ParLal-'Other Fee
Signs Special Inspection g 10
RemTrks .50
TOTAL-FEE ?
Final Inspectio //0 ,66 J
Roueh-in
e
a
I, th
Elechic
l
insuector, hereby
Final / p } e erldy thet the above
inspection has been
matle.
s. ..,
Stree[ Address, Boz or Route No. V Crty
1546 B Clemson Drive Ea an
erLOn o. Township Nime or No. qanqe No. Count
V
Dakota
OccuOani IPflINT)
Phune No,
New Horizons
Power Suppiier Adtlress
Elecvical ConVactor ICOmuanv Namel Conlrncmr's Lncense No.
O.B, Thompson Electric A40602
Ma?linp Address IContractor or Owner Makinp Insiailauonl
12201 Mtka Slvd., MEka 55343
Authonred Signa. ure (ConNacmr/Owner Making Installa[ion) Phone Number
? _ ? r) f 833-2521
-----^ +?v vr c1c1i11Gny lma irvsr[GIION qEQUEST WILL NOT
Griggs-Midway Bltlg. - Roam N-191 BE ACCEPTED BV THE STqTE eOARD
1821 University Ave., St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS
Phone 16121 2972117 ENCLOSEO.
? REQUEST FOR ELECTRICAL INSPECTION EB-00001-04
See msquc[ions for complebng this farm on beck of yellow copV. 10
-"X" 8elow Work Coverti by This Request
Tvpa of B??Itl?ng Appliancea Wiratl
Home EquipmBnl WjreA
Flange - Temporary Service
Ouplex wn.e, u.,,...._ .
Ef
ir l,ontlitioner
0/AOUt@
Milk
r ISUn
M Fee ServoeEntrence5ize h Fee Fexders/SubineAers p Fee
c?.??
r
U to 200 qm ps
Above 200
0 to 30 Am s ?
s
0 to 30 Am>s
qmp5 37 to 700 qmps 31 to 100 Am
Swimminy Pool
Transiormers
Above 100_qmps 5
Above.100_Am>5
?
Irrigabon Boonis . 0 Partial.'Other F
ee
rcemarks r V
I
Final Inspectio S10.50 TOTAL FEE--'
Foueh- in /, /V ,00
1. the Flecir,icel?
thisrequest
Inspector, heraby
?eertify thTt the Above
inspechon has baen
matle.
giLfcensetl Elecarcat Convnctor
Owner I , herab , y request ins0action of ebov.
? ___
requestvmd ??I_?
Ims 1.. ?a
511) tt 5
`-(L a,
" --- -- -??...?... V?..,•,,°•°? I hereby reqaesf inspecGOn of above
? C3wnei electncal wnrk -fa11M at
SVrei Adtlress, Bux or Pou[e No.
tsykPP> G)e on Grd
ctroa o. 7ownshio Name or No. qange No. C??y
a n
County
Occ,panl IPflIryT 1 1
%??b
3?0Z>
Powpr Supplier
Atl s
cfcl
EI ric 1 ConVactor (Comoany Namel
c aer . -Enc, Convactor's License N
((? ?
dres C nacmV ol wner Makine instailaLo
r) L U
k
?53? 7
?dAu,,.
Signature IonhactndOwner Maktng Installavon)
nCZ Phone Number (
-
qv
MIPINESOTA STATE BOAPD OF ELECTRIC
Griggs-Midway eidg. - 0.oom N-191
4921 University Ave., SA Paol, MN 55104
Phone (612) 297-2111
THIS INSPECTION REQUEST MILL NOT
BE ACCEPTED BY THE 5TAlE 80AR0
UNLESS PROPEq INSPEGTION FEE IS
ENCLOSEO.
REQUEST FOR ELECTRICAL IMSPECTION Eg-00001 -o+
? ' See Instrucyons for complet,ng this form on back oT Yellow cooV. ??? ft5
36656 "'X" Below Work Covered by This Request ?
Adtl ReP. TVp¢ of BuilAing APnliances WireJ E9uipmqnt Wired
Home Range Temporary Service
Duplex
Apt Bwlding Water Heater
Dryer Lighfing Fixtures
Elecuic Heatin
Commercial Bldg. Fumace
Si !o Unloader
lndustrial BIAg. Air Conditioner Bu1k M0k Tank
Farm other soec7y Otne, ISUecrtvl
.,.
.,.,...
.. /..,. Iher $cufy
.._.,.._._ r_ _ .. , OthCi
Other
# Fee ServiceEnirance5¢e k Fee Feeders/SUhfeeders # Fee Grcui?s
-Oll 0 to 200 Am 5 0 to 30 Am s ?
tn 30.^.m
A?ve 200 Amps 31 to 100 qinps 31 to 100
Swinvnmg Pool
Transiormers
Si?s qbove 100_Amps
IrrigaLOn Eiooms
Special Inspection Abpye ](10_Amps
Partial/Other Fee,
?i
Rem3rks
/ .
11 Sy? ? 7'OTAL FEE ?1
(1 1.?.
Aouah-in /
Oate ?i
• /1 r
Y
/? 1. th¢ Elece 'cal
i
? tnspactur. he.eby
i?nal
Oate cerlih tlat ihe above
-
?
?- • % ?c??-6?
_d 3 ? ??t?? ?s 6een
??
.
This request void -211197
18 nwnths trom
@ 18627
?Lir.ens?Elec?l Contranler
? Owner
Street Address, Boz or Rauta N.
OcCU4.nt
er
- on[ract0r iCOTpany P
HARRISON ELECTRIC
.IinoAdJ.n< n _
miNNESOTq STATE BOARD OF ELECTNICITY
Griees-Midwey Bttlg. - qoom N•791
1821 Umversiry qvA.. SL Peul, MN 55104
Phone (612) 662-0800
-7
?s
uAh-in InsuecLnn
auvetl? ead No
]Yes ?"No Y w Q Will NuutV Inspec-
[or Wh q dv
1 hereby rep.ast inspecfion ol abova
efeclncal work installedaL
9 a./z
No.
?4 - jd0-:?
421867
No.
Mpls., MN 55412
ikiny Instyll,a.t,,
,onl Phone Number
-?.y 521-0520
THIS INSPECTION REQUEST WILL N07
BE ACCEPTED 8Y iHE STqTE BOARO
UNLESS PROPEfl INSPECTION FEE IS
ENCLOSED.
7 REQUEST FOR ELECTRICAL INSPECTION es-ooooi-os
/ Sea instrucOans for comple11n9 Ihis form on bxck of yellow copy.
n_I Q-97 ..,"- Rai.,. w,,,c ji,., rA.,, a-
- - -, _ .. _.,.. .,.
HAd Rep. Type ol Builaing Appliancan ri,red Equipmenl Wned
Home Fange
Temporary Service
Duplex Water Heater Lighnny Fixtures
.4pt. 8wldmg Oryer Electnc HEaLn
Commeraal Bldy. Fumace
S.lo Unloader
Industrial Bldg. qir Conditioner Bulk Milk Tenk
Farm omr. sPe,ry en,e, tsoo
t er Sueci(y Other
Oth?r
017 JflUf F IAR Oartrnn Fao R.,l.... _
M Fee Setvice EnVencaSize M Fee Fe
d
/S
bi
n
ers
u
eeders
? to 200 Am s 0 to 30 Am s
Above 200 qn???y, 31 to 700 Amps
Swimming Pool Above 100_Amps
Sig Irngation Booms
s SVecial InsUection / 9
urts
m us
Am s
0_Amp
her Fee
2TOTAL/F
flouBh-in ?
Date
1. the Elac al
" trSpactor, hereby
Final ertify that the above
Insoechon nes eaen
maAe.
Thia reauest vala 1e monihn irom
Th s request wid ? /b
q
wnths lrom (A
°?063904 16. o v
Auques[ pate Fve No. qnuyh-in InsVeclion
9-3-1985 pey? ed, E]Readv Now7QWfll NobfV InsPeo
?y•° 43N c Wh Ready
ja?k.censed Electncal Contnc[or I herehy request inspection of above
? Owner e1e ... -
Svee[ Address, Bou or fioute No. T City
1546 Clemson Court Eagan
ettion o. Township Name or No. Range Na ??."ty
Dakota
OccuuantlPRINTI Phone No.
New Horizons
Power Suppher Atltlress
Eiechncal Contractn? ICOmpany Namel Cnntrar.mr's Licensx No.
O.B. Thompson Electric Co., Inc. A40602
Maihng AtlJiess (Contractor or Owner Making Instailanonl
12201 Mtka Blvd., Mtka 55343
Authm¢ed SiBna[ure (Coniractor Owner Mak?ny Installation) Phone Number
?. • ' :.-..? ° 933-2521
^^•••?-n aiwtt nUAHU Ot ELEGTRICITY I nI5 INSVECTION REQUEST WILL NOT
Grigas-Midway Bidg, - Roam N•197 BE ACCEPTEO 9Y THE STATE BOAPD
1821 Univari,ty Ave., St. Peul, MN 55104 UNLESS PROPEN INSPECTION FEE IS
Phone (612) 297-2111 ENCLOSED.
'3? REQUEST FOR ELECTRICAL INSPECTION EB-00007-04
' See instructions for comOleting this form on baek of yellow copy. p
'-X'" 8elow Work Covered by This Reqtrest ?({ ?
Id Pep. Type of 8wldmg Apphences Wirod Equipment Wiretl 1
? ..- __......,, tlectnc Heatu.?
Comineraat Bldy Fumace S'lo U load
? intlustnal 81Ag. I I Air Cond?tioner B Ik M Ik Ta k ?
I I I I Farm I Ome. _oeii v n111.., io.,......?
N iee SarvmeEntranceSize p Fae Fxpders/SUhteeAers n Fee C?rcwts
11 to 200 qm s 0 to 30 qm 5 0 to 30 Am s
Above 200 qm ?s 37 to 100 qmps 31 to 100 q s
Swimming Pool qbove 100Amps Above 100_A mps
Transiormers IrrigaUOn E3oonis Partial-'Other F
c ee
S
Remarks Flndl Iri$p2CtlOri TOTAL F,EE- ?
r n
[he?Elecbic? ?
InSDectOf-h6re?y
P?nal ^ erhty that the nbpve
??13peCf?On hd5 bean
° made.
i
voi
5tl h,?5-,_
gfr-) rK
Y-a. "
I/ 1 (j S Reqwre >'-- - IQHeatlY Now Q'Syill NoL(V InsPeol
K `! ?7 -(S ?YL? ?No 1ur Wh¢n qeatlv
ETIU....ed Elechical Convactm 1 herebY requesi mspx[ion ot aEOVe
? 4'^'^e' elec[rical work installed at:
SVeet Address, eo or Route No. City
' ? ? )i
ecLOn o. Towrtship Name or No. an9e No. Counly
r Vv
O c punt (PNI TI' Phonc No.
, ?me N ? 9 '00
Po wer SuOUlfa Ad s
rmon n
Electnca
C wvacta ICw?aury mel
?
0
2 Con:racmr's I.icense N
inp Atldress ( ractor .
1
F neI Makinp I ns ilationl
Au rizeE Sig.1ure (COnvacirn/ ner Ma4ing Ins allaGon) p? utirp,
LB , c _ y7
MINNFSOTp g7pTE BOARD OF ELFCIRICITY ? THiS INSPECTION REUUEST WLLL qOT
Griqgs-Midwar Bldp- - ppan N-191 UNLESSEPNOPEN I SPECTAION FEERS
1827 Universiry Ave.. St Peul. MN 5570!
phone I61212974711 ENCLOSED.
5f ?/- C REQUEST FOR ELECTRICAL JNSPECTION ee-ooooi-oa
? ?f/ J ' See ctims for rompletiM this /orm m beck ol Yellow copv.
O O!
?3 6 6-5 C J Be/ow Wark Covered by This Request
HAA NeD- TypaotBuiWi?p APnliarrcesMireJ
EQ
UipmgntWired
F'?? Temporary Service
Duplex Water Heater Lightiny Fixtures
Apt. Building Oryer Electric H n
eaU
Comnercial Bldg. Furnace Silo Unloader
Ird?stnal BIAg. Air Conditioner Bulk Milk Tenk
Farm om?.? soe.,? y mo. ?sue??tyi
t r $pecdv Othcr Other
ompute lnspeciron Fee Below
M Fae
U ScrviceEtM1'ameSize
O b Fee Fneders/Subfeedars M fee Grcuits
/ ' to? 0 to30qms , Oto30Am
Above 200 qmps 37 ta 100 qmps 31 to 100 q
Swimmirg Ppol Above 100_Amps Ahove 100
Am??S
Transformers Ivigation Boortc _
Partial'Other Fee
Re S{?ecial inspec[ion
marks
S
TOTAL FFE
?j\
/,,
?IJ71h+?
flouph-in ?? ?
Dwe
f
? I, the Electr?ce?
'01 9 IOFpeetor, ?e.eby
Final
? teHi1V thet the abpve
?'3& ;.??„on w= ??
i ?vdo.
llda re0uest vaiE 1B maMS ham
COMMERCIAL
2002 BUILDING PERMIT APPLICATION
CITY OF EAGAN
651-681-4675
?
a Vyas
Foundation Onl New Construction Interior Im rovement
• SlrucWral Plans (2) sets • Architectural Plans (2) sets • Architectural Plans (2) sets
• Civil Plans (2) • Structural Plans (2) • Code Malysis (1) "
. CertificateofSurvey (1) • CivilPlans (2) • ProjectSpecs (1)
• CodeAnalysis (1)" . LandsrapingPlans (2) • KeyPlan (1)
. Project Specs (7) . Code Malysis (1) " • Master Exit Plan (1)
. Spec. Insp. & Testing Schedule " • Certifcate of Survey (1) • Energy Calculalions (1) not always"
• Soils Report (1) . Spec. Insp. & Testing Schedule (1) •` • Elec. Power & Lighting Form (1) not always"
• Meter size must be established . Meter size must be established • Meter size must be esl2blished - if applicable
• PrajeclSpecs (t)
1 • EnergyCalculalions (1)
1 • Electric Power & Lighting Form (1)
L . Master Exit Plan (7) 1
1 • Emergenry Responsa Site Plan (1)
d • SoilsReport (1) 1
• MGES SAC determination letter • MGES SAC determination letter • MC/ES SAC determination letter
rall 651-602-1000 rall 651b02-1000 call 651-602-1000
Food 8 beverage or lodging facilities - submit plan to MN Department of Health. Call 651-215-0700 for details.
Contact Building Inspections for sample.
permit for new buildings or additions will not be processed without Emergency Response Site Plan. Ask Building Inspections for requirements.
DATE: 1,3 WORKTYPE: _ NEW w REMODEL CONSTRUCTION COST: l? ge;7-9-
SITEADDRESS: I S?? mol_"2 1'e"" S, PI- /
TENANT NAME:
FORMER TENANT NAME, IF APPLICABLE:
DESCRIPTION OF WORK To
Nazne:
PROPERTY
OWNER
Phone #: ( ;K3 ) 7 z5 ' ?t7 3 C
City: State: /a?11 Zip: S,?j y?`xf
Company: ? i?-ez Phone #: ( 6/? ) ?? ?% ? y 3
CONTRACTOR ?Q S ?j
Sheet Address: ? ?? 6 ? 7? 7-
City: ?IWJ5 State:
ARCHITECT/
ENGINEER Company:
Name:
SUITE #:
Last
Street Address:
City:
Phone #: (
Registration #: _
State: Zip:
Licensed plumber installing new sewerlwater service: Phone #:
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable State of
Minnesota Statutes and Cily of Eagan Ordinances.
Signature of Applicant:
Updated 7/02
THOMAS LAKE HEIGHT5 2ND 75951
PERMIT
DATE &
TYPE LOT BL ADDRESS
10i86 a-Ptrx 010 Ol 1538/ CLEMSON DR
020 01 1538B/
030 01 1540B/
040 01 1540
siss 4-13LF;X 050 01 1542/ CLEMSON DR
060 01 150.2B/
070 01 1544B/
080 Ol 1544
3i85 4-PLEX 090 01 1546B CLEM50N DR
100 01 1548B/
110 01 1548/
120 O1 1546 ? ?
aiss a-Pt,ex 130 01 1552/ CLEMSON DR
140 01 1552B/
150 01 1554B/
160 01 1554
5l85 4-13trx 170 01 1556/ CLEMSON DR
180 01 1556B/
190 01 1558B!
200 01 1558
siss a-rLex 210 01 15621 CLEMSON DR
220 01 1560/
230 Ol 1560B/
240 01 1562
ioiss a-Ptex 250 01 1566/ CLEMSON DR
260 01 1564/
270 01 1564B/
280 01 15G6B
APPROVED 3/85
PAGE 1 OF 5
31
? . ? • }9t?? .? ? op ? J
30 (935,5)
'h 0? ? op SS?
? ?OO
1 izo I j ??
, ho
q?\0
X ? q
3 J , h
b'' z0
p?k
r b
3
? O
a~ ?933.5) o ??33 QQ' pb Ay,\ ?O°M1 9,ye /
o ?
? ?V ?93?.s) d^?° ? I
?
,
o ?
O. ()')
oN O
O Denotes Iron Monument
D Denotes Wood Stake
X000.0 Denotes Existing Elevation Proposed Top of Foundation Elevation=
(000.0) Denotes Proposed Elevation Proposed Garage Floor Elevation= 936. 5
F- Denotes Direction of Surface Drainage Proposed Lowest Floor Elevation= 937.0
I hereby certify Mat this is a true and correct representation of a survey of the boundaries of.
Lots 9, 10, 11, and 12, Block 1, THOMAS LAKE HEIGHTS 21v'D ADDITION, Dakota
County, Minnesota.
And of the location of all buildings, if any, thereon, and all visible encroachments, if any, from or
on said land. It also shows the location of the stakes as set for a proposed building. As surveyed
by me or under my direct supervision this 13th day of March 1985
i
Paul A. Johnso
Land Surv eyor, Minn. Reg. No. 10938
?%` 40' CERTIFICATE OF SURVEY
OOOK IwGE ?Q?
COMBS-KNUTSO N ASSOCIATES, INC. ?w ???? ?y?fY1G?7
fTry ?c
CDNSUIIIYG (61M[Ellf N LUO iUAVRDR{ 0 SITf PIAXM[RS FIIE N0. r!\if11L
wwNEUOtu w MRCII?NSON,wIWFtOTA
FD:ir 7430
1985 BUILDING PERMIT APPLICATION - CITY OF EAGAN
NO'fE: ALL CONTRAC?ORS MUST BE LICENSED ilITH TEIE CITY OF EAGAN
INCLUDE 2 SETS OF PLANS
3 CERTIFZCATES OF SURVEY
1 SET OF ENERGY CALCULATIONS
To Be Used For: REsi'DEiJCG Valuation:gp Date: 3-il8s
Site Address: J,f-S/&8 CLENise,J ?,???
Lot: Block _L
Parcel #
OFFICE USE OHLY
Sect/Sub o..,?.. L.o?cErect
Akffsys Remodel
Repair
Enlar¢e
Ouner A/p._I ?t,loRizc,? A/,"es_ 2.>? Move
Demolish
Address p0 $ox 13&7 Grade
?
City/zip Coae -------
Contractor APPROVALS
Address
City/Zip Code
Phone 0
Arch,/Engr 9. (?'{t?seJoLd
Address
Phone 0 y3s- 752i(
_ Occupancy
_ Zoning ?
_ Type of Const
_ p of Stories
_ Length
_ Depth
_ Sq Ft
Assessments Permit
Water/Sewer Surcharge
Police Plan Review
Fire SAC
Engr Water Conn
Planner Water Meter
Council Road Unit
Bldg Off Parks
APC Treatment P1
Variance
rornL
(TOWNHOUSE)
_ CITY OF EAGAN N° 10009
3830 Pilot Knob Road, P.O. Box 27-199, Eagan, MN 55121
PHONE: 454-8100 / U , / i/
J Y
BUILDING PERMIT Receipt # S
I Te M vad hr 1 OF 4 PLEX Est. Volue $58,000 pote N1ARCH 28 I q85
' 1546B CLEMSON DR erect KI ocwpency Rl
SiteAddrees
Lot 9 Bixk 1 SeclSub THOM LK HTS 2ND Remodel ? 2oning PI]
. Repeir ? Type of Const. 11
Parcel No.
Enlarge ? No. Stories
ff Neme NEW HORIZON HOMES INC Move
D
li
h ?
? Length
th
D 44
27
I
i
Z
,
?
Address
P.Q.
SQ){ 1367
emo
a
Grade
?
ep
Sq. Ft.
City MPLS Phone 420-390 0 ??steu ?
I
1 9 I Name _
?? Addresa
f r.irv
SAME
Assessment
Warer 8 Sew.
Police
Fire
Erp.
Plonner
Council
BIdg.Off. 3 Z3 $5
APC
var. Date
Permit 307.00
Surchorpe 29 • 00
li Plan Review 153.50
?I SAC 525 _ 00
Water Conn. 900 00
Woter Meter _63w 0 0
Rood Unit 7R(1 QQ
T.P. 132_00
j Total $1 _989-S0
?w Name D. GRISWOLD
?W
itq Address
,W city Phone 435-7524
1 hereby acknowfedgs tMt I have read this aDVlicohon and stote thot
fha {nlormofion is correcf and ogree fo comply with oll opplicable
State of Minnesoto Statu nd City of Eaon Ordinances.
'i Sipnature of Pertnittee
A Buudiny Pe.mir is lssued ro: NEW HORIZON S
? oll work zhalt 6e done in occordunce wilh oll oppti Stat
Buildirp Officiol
?
m fM axpreu caditlon Ihat
Statutes ond City of Eopan Ordinances.
>._ .
r!
F
1985 BUILDING PERlIIT APPLICATION - CITY OF EAGAN
AOTE: ALL COlil'RACTORS MUST BE LICENSED ufITH THE CITY OF EAGAN
INCLUDE 2 SETS OF PLANS
, 3 CERTIFICATES OF SURVEY
t SET OF ENERGY CALCULATIONS
To Be Used For: ?pF3.ot?cL Valuation: ,s7oyV,oo Date: g.jpg,s?
Site Address: Jsy(o @/r.nseJ aA?ug- OFFICE USE ONLY
Lot: / s- Block _L Sect/Sub o,.,.. L,okcErect _ Occupancy
Parcel 0 A'e 11 s*-S Remodel Zoning
- '
Repair _ Type of Const
Enlarge 0 of Stories
Oianer Ne.?) //oRizo.? {/o,?,rs Sva. Move _ Length
Demolish Depth
Address Pp. 8ox 131,7 Grade _ Sq Ft
?
City/Zip Code Zne.1s ---------------------------------
Contractor APPROVALS
Address
City/Zip Code
Phone 0
Arch./Engr V. GrcrLWoLd
Address
Phone 0 y3s- 752y
Assessments Permit
Water/Sewer Surcharge
Police Plan Review
Fire SAC
Engr Water Conn
Planner Water Meter
Council Road Unit
Bldg Off Parks
APC Treatment P1
Var3ance
TOrAL
(TOWNHOUSE)
. a
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55721
. 1
_? „ .. .t
N! 10012 I .
PHONE: 4548100
BUILDING PERMIT Recelot #
Te be ""a fm 1 OF 4 PLEX Ert. Volue $58,000 pam MARCH 28 1985
siteaddrm 1546 CLEMSON DR Erect 50 Ocnipancy Rl
Lot 12 elock 1 THOM LK HTS
S,,/Sub 2NDAemodel ? Zonin9 vn
. Rapair ? Type of Cons[. ?
Percal No
. Enlarge ? No. Stories
r Name NEW HORIZON HOMES INC Move ?
? L.enqtn
h 44
Demolish Dept 27
Z Address P.O. BOX 1367 Grade ? Sq. ft.
? Citv MPLS phone 420-3900 Instan ?
SAMF. Approvab Faas
p NamE
6? Addn
City
Phone
?rcl D. GRISWOLD
Neme
?W
x? Address
?W city Pnone 435-7524
I hereby acknowfedge tFwt 1 hove reod this applicotion and state thut
tha intormation is torrect and ogrre to comply with all applicoble
Sfote of Minrwmta Stofuteflqnd Ciry 9f?Eaga2 Ordinonces.
Assessment
Woter 8 Sew.
Police
Fire
Enp.
Plonner
Cowxil
Bld9. Off. 3/23/$ 5
APC
var. oate
Permit $ 307.00
5urchorge 29-00
Plan Review153.50
sAC 525.00
Woter Conn. 500.00
WoterMeter 63.00
Raad Unit -280 r 00
T.P. 132_00
Taai $1,989_50
Slpnoture of PermiMee ` I
w 8uilding Permit is luued to: NEW HORIZON HOM INC on fhe axpress eonditbn Ihot
all work sholl be done in occordonea wilh pplicoble St innewfa-StOtutes ond City of Euqan Ordiwncas.
Bulldirq Offtcial
0
1985 HUILDIHG PERlIIT APPLICATION - CITY OF EAGAN
NOTE: ALL CONTR6CTORS l1USi BE LICENSID UITH TNE CITY OF EAGAN
INCLUDE 2 SETS OF PLANS
3 CERTIFICATES OF SURVEY
1 SET OF ENERGY CALCULATIONS
To Be Used Por: RES.ec?c? Valuation: grgooo.O° Date:
Site Address: ?yg C/e.nao.? Ipvt OFFICE USE ONLY
Lot: -IL_ Block _L Sect/Sub 77A.., EcErect _ Occupancy
??)S*3 Remodel Zoning
Parcel # Repair _ Type of Const
Enlarge 9 of Stories
Owner /?/p .? ?51o,¢?zo,? //o.o,rs 5,??. Move _ Length
Demolish Depth
Address _Pp, Box _1;31o7 Grade _ Sq Ft
>
City/Zip Code ---------------------------------
Contractor s L. APPROVALS
Address
City/Zip Code
Phone #
Arch./Engr fl, Gftlte,JoLd
Address
Phone $ y3.7-- 752y,
Assessments Permit
Water/SeWer Surcharge
Police Plan Review
Fire SAC
Engr Water Conn
Planner Water Meter
Council Road Unit
Bldg Off Parks
APC Treatment P1
Variance
TOTAL
(TOWNHOUSE)
I . ? CITY OF EAGAN N! 10011
r 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55727
PHONE: 454-8100
BUILDING PERMIT eeceiot #
To M wed hr 1 OF 4 PLEX Est. Value $58.000 pme MARCH 28. 1 985
SiteAtldress 154$ CLEMSON DR Erect gl Occupency Rl
Lot 11 Block 1 sedsub. THOM LK HTS 2ND Remodel ? 2oninq pp
Parcel No. Repeir ? 7ype of Const. V
Enlarge ? No, Storiec
?
Name NEW HORIZON HOMES INC H1ove ? langth 44
I . O. X Demolish ? Depth 2 7
?
A?rmg
?
ciey
LS Pnooe Grada
420-3900
? Sq. F[.
Install
, g Name S?E_ ApO?'ols Faes
Z
u?u
f
Phona
D. Name D• GRISWOLD
iy Addras
'
1 3 City Phone 435-7524
1 hereby ockrwwledge rhat I hove read this applicafion ond sfote ffwt
tha inlormation is carrect and cgree fo comply with nll apPlica6le
Stote of Minnesoto Stotuteaeaad Citv oLEaoon O.dioances.
Assessment
Water 8 Sew.
Police
Fire
F?lonner
Council
Bldg. Off. -1 /2 3/19 S
APC
Var. Date
vermir $ 3 00
Surchorqe 29.00
Plan Review 15 3_ 5 0
SAC 525.00
Wohr Conn, 500.00
Warer Meter 63?00
Rood Unir 290. 00
T.p 132.00
Total S1.989.SO
Sipnofure of Pemittee ???!? 2?C1.? I
A Building Permit Is iszued ro: NEW HORIZON 6? ES INC ? the a?? ????? ehat
oll work sholi be done in ocwrdonce with all c?ppylibla Srote in soto Statutes and Ciry of EcOOn Ordirpncef.
Buildirq Ofliclal
•? ' ? ?? / ?
1985 BUILDING PERMIT APPLICATION - CITY OF EAGAN
NOTE: ALL CON?RACTORS NUST BE LICENSED ifITH YHE CITY OF EAGAN
INCLUDE 2 SETS OF PLANS
3 CERTIFICATES OF SURVEY
1 SET OF ENERGY CALCULATIONS
To Be Used For; g&SiDEwCG Valuation: S7 moo.mo Date: 3-l8-Pf
Site Address: I,SyQ g C.le.nse„i lpQluL OFFICE USE ONLY
Lot: /o Block Sect/Sub kt-Erect _ Occupancy
11 sr3 Remodel Zoning
Parcel p Repair _ Type of Const
Enlarge $ of Stories
Owner Move _ Length
Demolish Depth
Address Box _/3L7 Grade _ Sq Ft
?
City/Zip Code ??p?r. /l7..i.r. SSy(1f) ' ---------- ---------------------
Contractor r?` APPROVALS
Address
Assessments Permit
Water/Sewer Surcharge
Police Plan Review
Fire SAC
Engr Water Conn
Planner Water Meter
Council Road Unit
Sldg Off Parks
APC Treatment P1
Variance
20?AL
City/Zip Code
Phone 4
Arch./Engr p. G RisugoL d
Address
Phone 0 413S- 7r2y
( TOWNf30USE ) (V° 10 01 a
CITY OF EAGAN
3830 Pilot Krrob Road, P.O. Box 21•198, Eagan, MN 55121
BUILDINd PERMIT PHONE: 454-8100
Recelpt #
Te M wed fe, 1 OF 4 PLEX Est Value $58, 000 MARCH 28
1548B CLEMSON DR ?Ofe ?q 85
SiteAddreu Erect Ex opuLot 10 aancy Rl
elock 1 Sec/Sub. THOM LK HTS 2NCflemodel ? Zoninq PD
Parcel No. Repair ? Type of Const. V
EnlarBe ? No. Stories
W Neme NEW HORIZON HOMES INC Move ? Length 44
z .Add.ess P• O• BOX 13 6 7 oemolish ? oeptn 2 7
City MPLS phone 420-3900 Grade ? Sq, Ft.
Install ?
Faes
?t Nama SAME Approrob
? Addreas
? Citv
Name D. GRISWOLD
Address
city Phone 435-7524
1 herebv ackrowledge tFat I have read this opplication ond state thot
Hha inlormotion is correcf and ogree lo comply with all appliceble
Srote of Minnesoto Sroruteenee rln. „r c..,..._ .,_.:___
Sipnofuro of Permittee
A Building Cermir is iuued to: NEW HO IZON HOr
all work shall be done in ocmrdonce with all applimbla State
8ufldirp pfficiol
Assessment
Woflr $ SeW.
Police
Fire
Enp.
Plonne.
Councll
Bldg. Off. 3/2$/85
APC
Var. Date
e
Permit +:? -iU7• 00
Surchorpe 29.00
Plan Review 153.50
SAC 525.00
WorerConn, 500.00
i
Woter Meter 63z0 0
Rood Unit 280-00
T.P. 132. 00 1
Total 51.989 50
o^ fha expreas condition Ihoi
Statures ond Ciy of Eoyan Ordirancet.
?,N??a t??? zati ?.q ??? ?"?,?:b? /? 1
tGhL Ta r.? ' ' ''?' ????`?:,
' Hear Loss caLcuLanotus ' HEATINGB AIR CONDITIONING
gtS 2c; , -? s
CO. MINNEAPOUS. MINN.
Weatherstrip6 A.S.H.V.E. CanaVUetionNO:'' ' Insulation ?--'
Wndows Doors Guide
Reference Out. Wall Int. Well
?ili^B
-'f
?
Floor pP ed
Kird HowA li
Yes-NO Yes-No Iy; .. ,
--
Fl.L_%Vju(, RRoom Length ZZ Width 12- HeigM ? FI. (AM-I ?Noom Length "Y0 -W+dN+ "'. Haiyht Q
?
YJi ndows a nd Doors- Cracka ge and Ar ea Windaws a nd Ooors- Cracka ge and Are a
Na WrA,h
ol ana Neipht
ol ane Na, ol
li Ms Lineel h.
of rac Aroa
a. It. '
.
NO• ?y??
o ?yf ane He.pM
of ane Nn. of
li hta L??eel 1i.
ol creck Area
s4? ft.
1 ?i 2 2 A ? l 2 21 1 ?
l ? ? 1 R 9 ,t
?_ ! b 1 1 O
Coef Btu Coef Bcu
IntilUation ?3 Infiltretion 1'? 11
Giass 2q Gleae
Exp. wall 3.1 X 0 Z Exp. wall lO x
Net exp. wall 11 q, 1 31 Net exp, well ?? ? `?• _!__
-+nT""Watt O0ti"' 1 117 22,2 Int. well - -
ceuine ;L2-A 12 2b ceuine
Floor ' Floor
taal etu. Total Btu.
Required sq. ft. E.D.R. Or Sq. ins. W.A. Leeder aree ' p9quired eq. tt. E.D.R. Or 8q, in6. W.A. Leader area
FI. , iN1? ? Haam Length ? Width Heipht Fl. `C 2+11!(jjQ,am Length I 5 Width t i; H
Wi nciows a nd Doors- Cracka ge and Ar ea Wi ndows a nd Doors- Cracka ge and Ar ea
No. V/?d?„
ol ne Ha?Oht
af ane No. Of
li ghla LinBal it.
of cr
c Area
+G. fi.
N?• WiMh
o
f
en Hxiqhl
of nntl No. ul
l,ani8 LinBai IL
rBCk
o
f
c 4refl
eq. il.
O g Hr?p ?
]
i. ^
p
<O 2 l
?
'
4 1-1
coar stu coorj- otu
Intiltration 2240 IntiltroLOn
Glass S? Ob(? GI88fi
Exp. wAll aG ? So ' ExP. wall r.
^Net exp. wall 1 N91 exP. Well
Int. wall Int. wAll
Ceiling f J?C? ? ( ..$ Ceilinp
Floor Floor t ^ ?
iotal stu. s iotal Btu.
Requued sq. it. E.D.R. or sq. ins. W.A. Leader area R9qwred Sq. N. E.D.R. or sq. ins. W.A. Leader area
Room length 1'2 Width HBight ? fl. Room Leng[h ?( Width ^i Heigtit
YJindows and Doors-Crackage and Area W indows a nd Daors -Crack age,and Ar ea
NO' WlmM1
ol ane Helpnt
of nne No, uf
li his LinBal le
of rack 4•ea
sa. IL Wm?n N_ ?plit
uf pnu No. nl
h h?s L.neaL 11.
ol rack /.,ea
9. It•
/
i
Coef Btu Coef l 8tu
' In4ltreuon Inlilbation ' .
Glass Glass
Exp. wall - Ezp. wnll ?-, -_-
Net exP. wall Nat exp. wall ----
Int. wall Int. well _
----
1?3?,
Ceiling
? Q Ceilin
9
----
'
Floor Flcwr •j ' ? _ . ._,?
Total BW. Totel Btu.
Raquired sq. IL E.D.R. or sq. ins. W.A. Leader area ? O Requfrod 6q. It. E.D.R. or sQ• ins. W.A. Leader area ,
' _;R•?r"`°??,.?t?7?+.f ? t':?,' ? .
/Ii?.f,??/w?'?'? . ' .
., ?`ca ..cis+jw?w
'HCnr Loss cnLcuL,aTiorrs HEATINGB AIR CONDITIONIN(3 CO.
MINNEAPOII :. A111dtJ,
Weatherstnp3 A.S.H.V.E. Construction NO.'i ? " Insulatron
Winduws poors Guide
Peference Out. Wall IM. Well Ceillnp ° tbof Floor Kind Now Applied
- ------
Yes-tdo Yes-No 19__
Room Length 1Q Width Heipht ° FL Noom Langth Width _Heighl ----- -
Wi nduws a nd Doors- Cracka ge and Are a Wi ndows a nd Ooors- Cracka ge and Are a
Nu. ritron
o? ana Me,pht
of ane No. ol
b h?s Lfmeel kI6
o
cra Area
s4. ??•
No' W?0??
ol en HoiyM
o? pene Nn. of
b hta L?nael O.
ol crack Area
sa. ??•
a 2. 2 2o Ib _
---- -
Coef Btu Coet f)v,
?nliltretion ?Q ?(?Q Infiltretion _ _
Ci I ass G 1a56
F.ap. wall ? 'fxp. Well
Net exp. wall 2 Nel exp. wsll
Int, wall Int. Well
Ceiling CBiling
Floor 10 JC UT Floar
Toiai eiu. raai eeu.
Repuired 6q. ft. E.D.R. w sq. ins. W.A. Leeder aree Requirad aq. ft. E.D.H. or eq, ins. W.A. Leader area
Roan lenqth 1 Width Height FI. Room Length Width Heiyht
^
Windows and Doors-Crackaqe and Area Wi ndows a nd Doors- Cracka ge and Ar ea
No. W?tl?h
of ane He?pht
of ene No. o/
h hta Lineal It.
of cr ck Aren
cq. f1.
No' WeAth
al ene Nx.pht
ol antl No. of
li Me L??eal It.
of <t Ck A?ea
sQ. ??.
r .2
Coef Btu Coef 6tu
_.
Inrlnati«, ? 11"7 2223 Infntrabw, --
Glass ' ' QO Glass ' --_---.
Exp, wall EXp. well
NBt exp. II X92 Net exp. wall
?u r z 170 22 lnt. Wall
Ceiling ' Ceilinp _
Floor )..x 1 4Z j Floor .
TotelBtu. `TotalBtu.
Paquired sq, it. E.D.R. or sq. ins. W.A. Leader ereu ' psquired sa. It. E.D.R. or sq. ins. W.A. Leeder area
F1.? .-,?. pf Leng[h l Wid[h Height ' FI. Room Lengtb Width Height _
Windows a nd Doas-Crackage and Area Windows a nd Doors -Cracka ge and Ar ea
No. Wd?n
ol ? ane Me?qbt
of ane No. of
li hu lmeal A.
ol crec Area
cq. N.
.. . No.
ul ene m?qbt
ul ?nn No. nl
I. hts L?neal h.
af crack Area
s4. ft•
Coef l Btu Coet Btu
Intiltrat?on Infiltratipn
Glass Glase
Exp. v.?all i Exp. well
Net exp. wall 2. ? Net axp. well
Int. wal! Int. well
Ceil?ny Ceiling
lotal Otu. ' Totel Btu.
RpquiiecJ sq. ft. E.O.R. or sq. ins. W.A. Leader area ' Requir6d aq. It. E.D.R. or sq. ins. W.A. Leader area
._ ,
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
PERMITTYPE:
BuILDzNG
Permit Number: 0 2 9 8 4 3
Date Issued: 0 4/ 2 8/ 9 7
SITE ADDRESS:
1546 CLEM50N DR
LOT: 12 BLOCK: 1
THOMflS LAKE HEIGHTS 2N[7
P.S.N.: 10-75951-120-01
DESCRIPTION:
aYiildin#}, Permit Type DEGK
??Iu31ding bb?rk Type NEW
Census G.ode " 434 ALT. RESIDENTIAL
d. , - . .. . '??
i
?
. , . .
? ?.. ,
,
?t
/
t ? 4
3
tf
REMARKS:
FEE SUMMARY:
Base Fee $50.00
5urcharge $.50
Total Fee $50.50
CONTRACTOR: - applicant - OWNER:
NELSON, KEITH 14206550 BIOMKER DENISE
18511 86TH PL N 1546 CLEMSON DR
MdPLL= GROVE MN 55311 EAGAN MN 55122
($12) 420--6550
L
I h'srehy acknowl,edge th,at?I
information is corre??t and
StaCUCes and City bfEagaa''r'APPLICA /PERMITEE SIGNATUFE
PERIi?IIT
k?awe - reod °thzs',_;app.??.¢ati,an ansJ ?tate° that
ayroe tQ cc?rnPYY w5.th, r?ll ,apgl icable State
tlyd3nances. '
the 5
of Mq.
? ISSUED 8 EAIGNATUfi
?? ?1997 BUILDING PERMIT APPLICATION (RESIDENTIAL)
cin oF eacaN Sin.-s-0
3830 PILOT KNOB RD - 65122
681-4675
? 3 registered site surveYa ? 2 eopies of plan
? 2 copies of plans (induda beam 8 window aaes; pourad fid. tlesign; eta) ? 2 stte surveys (exterior a00ftions 8 decks)
? 1 energy ralculations ? 1 energy caialetions for heeted addftlons
? 3 mpies of tree preservetion plan M lot platted aRer 711/93
requlred: _ Yes _ No '
DATE: "7 ` /S(-9 7 CONSTRUCTION COST: 07_'
DESCRIPTION OF WORK: E QU lC- p ) v X!t) F,)
STREETADDRESS: ? ? -? ?
LOT I°Z BLOCK
PROPERTY
OWNER
CONTRACTOR
ARCHITECTI
ENGINEER
a c) Q IZ
SUBD.lP.I.D. #: 04-4-? 4`k, vt?-
Name: Phone #:
u..
Street Address:
City: State: Zip: s S/Z' Z
Company: L--a A-1 Phone #: qZo (05?7>
Street Address: License #:
City: 19&/1- G/ccOVL State: ?N Zip Ss3 / I
Company:
Name:
Phone #:
Registration #:
Street Address:
City: State: Zip:
Sewer & water licensed plumber (new construcdon ony): . Penalty applies when address change
and lot change are requested once pertnit is issued.
I hereby acknowledge that 1 have read this application and sfate that the infortnation is co rect and agree to omply with all applicable
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant
OFFICE USE ONLY RECEIVED
Ceriificates of Survey Received _ Yes _ No APR 1 1997
Tree Preservation Plan Received - Yes - No _ Not Required BY'
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
PERMI'T
PERMITTYPE: BuzLozNG
Permit Number: @ 2 6 9 5 6
10 / 0 2/ 9 6
Date Issued:
51TE ADDRESS:
P.I.N.: 10-75951-120-01
1546 CLEM50N DR
LOT: 12 BLOCK: 1
THOMAS LAKE HEIGHTS 2ND
DESCRIPTION:
DECK FTGS ONLY
Bt-ildin'g,' Permit Type MISCELLANEOUS
Building,?Wv,rk Type ALTERATION
?Ceneus Code434 ALT. RESIDENTIAL
r , 7
/
t
`?' •y?f?4..:f?., ., p ??-..r
f
E -
7,
r
l•`,:?, ? '?_ ,..r? L -__ _
r -,'c, ?'»Sr ? . _
REMARKS:
FEESUMMARY: vALuarioN $200
6ase Fee $21.00
Surcharge $.50
Total Fee $21.50
CONTRACTOR: - Applicant - ??J E
J&C CONCRETE CO 18280877 9 Lb-?iKri DENISE
8904 MT CURVE RD 1546 CLEMSON OR
BLOQMINGTON MN 55438 EAGAN MN
(612) 828-0877
?
I hereby ackndw3edge thet'2?have'read tFiis applioation and sCate that the
information is correot and ageee to comply wi,th'all appl3ceble StiaCe oP Mn.
Statutes and City of Eagan Ordinances.- -• . ?
APPLICANT/PERMITEE SIGNATURE
ISSUE SIGNATURE
?
, - CITY OF EAGAN
3830 PILOT KNOB RD - 55122
1996 BUILDING PERMIT APPLICATION (RE5IDENTIAL)
681-4675
New Conatruction Reauiroments
? 3 regislered site surveye
? 2 copies ot plane (incJude beam 3 window sizes; poured ind. design; etc.)
? 1 energy calculations
? 3 copies of tree pmservation plan H lot platted afler 7/1193
requlred; _ Yes No
Remode m oair R arir m nta
? 2 eopies o( plan
? 2 site surveys (exterior addRions 8 decks)
? 1 energy calculafions for heated additions
DATE: I -D C' ( 4 CONSTRUCTION COST:
DESCRIPTION OF WORK: a7 'S STREET ADDRESS: J ?•?? ??o ( CQ?'+'r/-?°- ?'v ?/ur.?
LOT BLOCK SUBD./P.I.D. #: J 1i.C'l?&, jak A J' Lft
PROPERTY Name: -M Plv j l-Plfli?i, Phone
OWNER """
Z)-
Street Address-
City: State: Zip:
CONTRACTOR Company: O/Y CJl?E r? (! C Phone #:
Street Address: ZZ711 ?C?2-u.F ?Y r License #: *1"N?
City: 1,9G`L'/Yl tB /? State: n 41 Zip:
ARCHITECT!
ENGiNEER
Company: _
Name:
Street Address:
City:
Sewer & water licensed plumber:
change are requested once permit is issued.
*P J
? _i
Phone #:
Registration #,
State: Zip:
Penaity applies when address change and Iot
I hereby acknowledge that I have read this application and state that the infortnation is correct and ree to comply with all
applicable State of Minnesota Statutes and Cfi/ of Eagan Ordinances.
Signature of Appiicant:
OFFICE USE ONLY
CeRificates of Survey Received _ Yes No
Tree Preservation P1an Received _ Yes _ No
PERMIT
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
PERMIT TYPE: e u x Lo rn G
Permit Number: 0 2 9 8 4 2
Date Issued: 0 4/ 2 8/ 9 7
SITE ADDRESS:
1546 CLEMSON DR UNIT B
LOT: 9 BLOCK: 1
THOMAS LAKE HEiGhITS 2NCi
P.I.N.: 10-75951-090-01
DESCRIPTION:
?
P"uzkdin§_,Permit Type
I.Building (43a_rk Type
F?
Censu s CQde
J ?x ? .. .
DECK
NEW
434 ALT. RESSDENTIAL
? ?? ',_,rr??•?-'?t?,a'? r`?i._a`(-^ jf:;.._[ '_' ,-? _??....
°?
?
REMARKS:
FEE SUMMARY:
Base Fee $50.00
Surcharge ?50
Total Fee $50.50
CONTRACTOR: - Applicant - OWNER:
NELSON, KEI7H 14206550 EXLEY PATRICK
18511 86TH Pl N 1546 CLEMSON DR B
hjAPLE GROVE MN 55311 EAGAN MN
(612) 420-6550
X hereby aclcnowledqe that, I have rsad..this: a,pplioation aiTd state that the
xab7e, $Cate •bfi Mn.
infonmation 3s ear:nect aft , 6 agr-ee, to r'6rfiply'.49 th jiai•l aPp3.i
$tatutes and City of Eagan Ordivtances. L
`
APPLIC T/P MI E SIGNATURE
ISSUED B IGNATURE?
1997 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN S OIS V
3830 PILOT KNOB RD - 55122
681.4675
New Construdion Reauirements
BemodeURenafr ReauiremeMs
? 3 registered aRe surveys ? 2 eopies of plan
• 2 copies of Dlans (InUude beam & window sizes; pnured fid. design; etc.) ? 2 site suneys (exterior edditions 8 decks)
? 1 energy calculations ? t energy qlwletions Por heated additlons
? 3 eoples of tree preservation plan tt lot platted eRer 717/93 .
required: _ Yes _ No DATE: _- /t " GT -7 CONSTRUCTION COST:
DESCRIPTION OF WORK Rt AU jc- D /aX 1 t, C),Lz /`
STREETADDRESS:
LOT ? BLOCK
C J??mSd
?
Z-7LA
SUBD./P.I.D. #:
? ,,/?,? ?
PROPERTY Name: _?_"r""? Phone #:
owNeR -? u ma
Street Address:
City: State: Zip:
CONTRACTOR Company: Ke 177-I /A?ZS0A-/ Phone #: 200 612-5
Street Address: Y67-r-r1' '- License #:
City: Mf/?45- G/Zf-?E State:,127/?/ Zip:
ARCHITECT/ Company:
ENGINEER
Phone #:
Name: Registration #:
Street Address:
City:
State:
Zip:
Sewer & water licensed plumber (new construction only): . Penalty applies when address change
and bt change are requested once permit is issued.
I hereby acknowledge that I have read this application and state that the iMortna6on is correct and agree to comply with all applicable
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant: - '?
OFFICE USE ONLY RECEIVED
Certifiqtes of Survey Received _ Yes _ No APR 1 ffi W
Tree Preservation Plan Received _ Yes _ No _ Not Required $
PERMIT
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
PERMIT TYPE: B U I L D I N G
Permit Number: 029841
Date Issued: 0 4/ 2 8/ 9 7
SITE ADDRESS:
P.I.N.: 10-75951-090-01
1546 CLEMSON DR UNTT 6
LOT: 9 BLOCK: 1
THOMAS LAKE NEIGHTS 2NU
DESCRIPTION:
REMARKS:
INCLUDES
MULTI. (MISC.)
REPAIR
434 AL7. RE5TOEN7TAL
^ f? _s
\?\ S ? L MYf ..?
1 4 ,?
?li?.. ??? ?? ? 1? 1 ' ?'?i t e ^', j N ?a.:'7"T /?: i ./""rn {?? ',,:? r;,???
a?fb7S.?l?..?JS?! ?S
?... .. ,.n ..__
,-. RE5IDING
B-d"ifr`ih-§, Permiz Type
,6 uile3in- g rk Type
r.'`Cerrsus `CQ
r
t
s J
?
i
*
\ .n al
?
' ?iusrx r - ' :-J
1546, 1548, 15488 CLEMSON DR
L12 L11 L10
FEE SUMMARY:
VALUA71'ON $15,080
Base Fee $224.75
Surcharge $7.50
Tote{1 Fee $232.25
CONTRACTOR: - Applicant - OWNER:
NELSON, KEITH 14206550 OWNERS MULTIPLE
18511 86TN PL N 1546 CLEMSON OR B
144PLE GROVE MN 55311 EAGAN MN
.(512) 420-6550 '
? I hereby acknnwled{te CYrat S have read Chis ?application and sYAte that thff
infinrmatian is cqrrset and, a_gree ta compl;y wiCh a].l ap.Rlicable StaCe oF h1n- _
Statutes ant! Ci„ty of Eagan flrdinancess ,. .^--
APPLICAN RMITEE SIGNATURE ISSUE BY: IGNATURE
1997 BUILDING PERMIT APPLICATION (RESIDENTIAL)°??a ? a S
p ? CITY OF EAGAN
3830 P I L O T K N O B R D - 55122
681-4675
New Construction ReouiremeMS RemodeVReneir Reauircmenfs
f 3 regiatered site suneys ? 2 eopiea W plan
? 2 copfes of pWns (Indude baem 8 window saea; poutod fitl. design; etc.) ? 2 ake surveya (exterior adCitions 8 Eedcs)
? t energy celculations ? 1 energy calculations for heated eddkions
? 3 copies of Vee preaervetion plen H bt platted eRer 7J7/93
iaquired: _ Yes _ No
DATE: c - Z l -q7 CONSTRUCTION COST.
FESCRIPTION OF WORK iq e S I ar t? / V 6 V,1L ? Cr SU ?
? '- L,!'' t n is?8= L/o1Bi,
STREETADDRESS: ? G" _ A J?_YI?I Sd'Aj JJ 6?
61 6= L e,4 , 2?vt.tQ
LOT BLOCK SUBD.IP.I.D. #:
PROPERTY
OWNER
CONTRACTOR
Name:
u.,
Phone #:
Street Address:
City:
State: Zip:
Company: f?e- 1t-1+ Phone#:
Street Address: License #:
City: ???? ??''LL State: Zip:S
ARCHITECT/ Company:
ENGINEER
Phone #:
Name: Registration #:
Street Address:
City: State: Zip:
Sewer & water licensed plumber (new construction only): . Penalty applies when address change
and lot change are requested once permit is issued.
1 hereby acknowiedge that I have read this application and state that the information is cor?ct and agree to compl with ali applicable
State of Minnesota Statutes and City of Eagan Ordinances. / %
------ ? -
Signature of Applicant: ?'-?-- ?
OFFICE USE ONLY RECEIVED
Cefificates of Survey Received _ Yes _ No ? Q7
Tree Preservation Plan Received _ Yes _ No _ Not Required B.
PERMIT
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS:
P.I.N.a 10-75951-180-01
PERMIT TYPE:
Permit Number: '
Date Issued:
1548 CLEMSON DR UNT.T B
LOT: 10 BLOCK: 1
THOMAS LAKE MEIGH7S 2ND
JOHN
CLEM50N DR
MN
DESCRIPTION:
E{uildin2,,Permit Type
? r'Building `Wtt,rk l`ype
CettSU5 'Co.ds
, i
?
ik
DECK
NEW
434 ALT. RESIDENTTAI
Zi
REMARKS:
FEE SUMMARY:
Base Fee $50.00
Surcharge .50
Total Fee $50.50
CONTRACTOR:
NELSON, KEITH
18511 85TH PL N
M'APLE GROVE MN
(612) 420-6550
- Appiicant -
14206550
55311
OWNER:
THOMPSON
1548
EAGAN
?
I Mereby acknowledge that, I have read tihis
informatinn is 'cori'ecC an? eqree"ta camply
Statntes and°City of' agan O.rdf.nsn"ces.` •
APP ANT/PERMITEE SIGNATURE
BUILDING
029845
04/28/97
B
applioatinn and state that the .
iaith a'll appl3cable SCate aF Mn.
ISSUED : IGNATURE
. 1997 BUILDING PERMIT APPLICATION (RESIDENTIAL)
?? cirr oF E?cnN
Cc? ???? 3830 PILOT KNOB RD - 65122
681-4675
New Construction ReauiremeMs
? 3 registered ske surveys ? 2 copies of plen
? 2 copies of pWna (Indutle beam 8 vWndow sizes; poured fid. design; etc.) ? 2 sKe surveys (exterior addRions 8 tledcs)
? 1 energy calwlations ? 1 snergy ealculations for heatetl atlddions
? 3 eopiea of tree preservatlon plan ff bt platted after 7N/93
iequired: _ Yss _ No ?
DATE: 7 CONSTRUCTION COST:
,
DE$2RIPTION OF WORK: ??j?'
'S'TREETADDRESS: ?SYr4l a
LOT )0 BLOCK ? SUBD./P.I.D. #:
L
PROPERTY Name: Phone #:
OWNER ... .?..
Street Address:
City: State: Zip:
CONTRACTOR Company: ?L Phone #: `l zv b-Lfo
Street Address: A,) License #:
City: State: !Wlt/ Zip: 553
ARCHITECT! Company: Phone #:
ENGINEER
Name: Registration #:
Street Address:
City: State: Zip:
Sewer 8 water licensed plumber (new construction onty): . Penalty applies when address change
and lot change are requested once permR is issued.
1 hereby acknowledge that I have read this application and state that the information is co ct and agree to c vply with all applicabie
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant
OFFICE USE ONLY RECEIVED
Certificates of Survey Received _ Yes _ No NPR 1997
Tree Preservation Plan Received - Yes _ No _ Not Required
PERIVIIT
?CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
PERMITTYPE: suzLrasNr
Permit Number: 0 2 9 8 4 4
Date Issued: 0 4/2 8( 9 7
SITE ADDRESS:
1548 CIEMSON DR
LOT: 11 BLOCK: 1
THOMAS LAKE HEIGHTS 2ND
P.I.N.: 10-75951-110-01
DESCRIPTION:
D?ta?ileli'n'g.,Pei'mit Type
}Building,Work Type
°'CensuS t bde ?z
a`
? ° . ?
DECK
NEW
0.34 ALT, RESIDENTIAL
1
jF_.:1
REMARKS:
FEE SUMMARY:
8ase Fee $50,00
Surcharge $.50
Total Fee $50.50
CONTRACTOR: - Applicant - OWNER:
NELSON, KEITH 14206550 EROMAN PETEft
18511 86TH PL N 1548 . CLEMSON DR
?IAPL[ GROVE MN 55311 EAGFIN MN
',(612) 420-6550
I hersby acknouledg-e tibaCrT have, read this app3.%rat3i',an.and. etpterthaZ Che
infiormation is correct,and agree to comply w3th aI1 applicable BtaCi of Mn.
Statutcs andi=CiCy df 54aga,o Ordin,ances. r L
LICA 7P TE IGNATURE
I U D ?
BY: SSIGNATURE
" .
?
? (?j , /; ?1997 BUILDING PERMIT APPLICATION (RESIDENTIAL)
j d y? CITY OF EAGAN
' f 8850 PILOT KNOB RD - 55122
681-4675
nstruetion Reouirements RemodeVReoair
? 3 rogistered afte surveys • 2 wpies of plan
? 2 eopies of plana (indude beem 8 window sizes; poured fid. deaign; ete.) ? 2 stte aurveys (extodor edd'uions 8 dedcs)
? t energy calculations ? 7 enargy ealalations for heated additions
? 3 copies of tree preservatlon plan B lot platted after 711/93 required: _ Yes No '
DATE: .,- ?? -,?, -/ CONSTRUCTION COST:
DESCRIPTION OF WORK: ,YS Lg oG 1? ?G? X I v U
STREET ADORESS: 1 1) / x cy ?e- /IFi
LOT I I BLOCK ? SUBD./P.I.D. #:
Name: -ZL Phone #:
PROPERTY
OWNER
V
CONTRACTOR
w.,
Z
A...
Street Address:
City:
State: Zip: -SS l? 2'
Company: /felt-1-4 A/7?1SbA-/ Phone#: y ZU "(D
Street Address: 19S`?/ Ae7L /L ? License #:
Ciry: State: /lOti Zip: SS3//
ARCHITEC71 Company:
ENGINEER
Name:
Phone #:
Registration #:
5treet Address:
City:
State:
Zip:
Sewer 8 water licensed plumber (new construction ony): . Penalry applies when address change
and lot change are requested once pertnit is issued.
mply with all applicable
I hereby acknowledge that I have read this application and sMate thet the iniortnation is co7ct and ag7-/
State of Minnesota Statutes and City of Eagan Ordinances. ??? Signa
ture of Applicant: Z 2
OFFICE USE ONLY RME CEI?D
Certificates of Survey Received _ Yes _ No AP 1997
Tree Preservation Plan Received Yes No Not Required
- - - LBI ,_-----
,
? 2/84
((
? ??C? . , r CITY OF EAGAN
APPLICATIOAI FOR PETZi'4IT
SEWER AND/OR WATER CONNECTIOrT
(PLEASE PfilNi) '
1) PROPEY!^! ApDRESS:
i ErAr. DESCRIPTTCv:
(LO /B1 /Subdivisicn or Tax Parcel I.D. Ntur;7er)
? .]"r S_Ri:C.^ cE . Dr1T' O° CRIGI.Ai, ;UIL^I:`:G =:.= ISSUc?.NCE-:
ea,
PRESL^ ?.^.`7I:F;/?ROPOS7[) L'S: O r2-1 Sl^.:= cPmSLY .
? R-2 DLP?,::.: M%a GT'.ITS)
-'3 'ICr.,lyuCricg (?'ITnW ?- L:IITS}
[3
R 5)
? ?
,?
? IC-4 Ap: v T fF'.?/cm':Da,nN??l ? UilITj )
? CCi%??SE.'2C?A:?/R..F'T'?;II,/OF'F'IC::
p ?'CL'ST2I.?S,
? L?'STI:LTIC\Ai../G."V??P.?ZE.\"T
z) APpLIG±lr (PLEASE PRItii)
LSAi-]E: .t? ? `-?tJ c-C-?1
aDOREss: aSC /3?
crrY, sraTE, zrn; -
3) Pu.,sEpl (PLi.„SE PRINT) FOR CITY USE ONLY
NA
P?:
PDDRESS: THON-PLUMB}MF s0„Ms.
12201 MINNETONI<A 6LVD. PIUNBERS IICEYSE:
`
Active
-
CITY, STAT?1, ZIP: MINNETONKA, MINN. 55343 F ] Expired
PHOVE; ? "?`° /763?
9 3 as,?? PLU,MBER LICE45E N 0 Not of Re ord
atr nttia
4) CCC(J'PA:\J'I`/Cf'iT:Q2 IYLLq?L YHlill)
??.:
ADDRESS:
CITY, STi,'IE, ZIP:
PEiO^7E:
5) INDZG,TE WElZCH PERIIlIT IS BEI\G RFF'OL7ESTGD;
[2'CONNECPION 'IO CITY ?E*VIgt
Ly' 6CNNmrION 'IO CITY WTATER
? CI"iEIER (PL,EASE DESCRIBE)
oJ cz+c:
7) SICA'iL'RE:
E3 PIyASE f?OID APPRC7VIID PER'VLIT FOR PICi:-U BY ONE OF 21B()VE
? PIEASE ?*AZL APPROVID P.?r:•LLT 'PJ 24 A£OVE
/? :"„ (Circle one)
DATE: T 0
-r
- 'O --?
MR o! nlalawfet?s! r a Er:aarl? at ?a wr?sa?s??a ar a rf ?ss:a:a a aa ???????.,? a? re ?s atssaa? r
F 0 R
PER'NSUE
I T Y U S E O N L Y
FrES: $
$ /D. -??
$ S
$
SEi^iE.°. PER51rT (INC,L.:LL JTIP.C :aRCGJ
WATEc2 PERP4IT (IIICL'JDE SliRCHARGn')
WATER METER/COPPERHORN/OUTSIDv- READE2
WATER TAP (INCLUDE CORPORATION STOP)
SE;vEQ TAP
$- /.?" °?+' : C??'i::i'I' .,?:GSi: - .:_:.
$ ACCOIINT DFPOSIT - FIATER
$ WAC
$ SP.C
$ TRliNK SQATER ASSESSi?E.`dT
$ TRli:1K SE[dER aSSE55DL.IT
$ LATERAL BENEFIT/TRUNK SE?:ER
$ LA'T'ERAL BENEFIT/TRUNK WATrR
$ WATER TREATMENT PLARTT SURCHARGE
$ OTHER:
$ TOTAL
$ 02° ??s ..:AMOL:QT PAID/gEC°IPT R -t%- ° 7
/ -!t,-
DOES UTILZTY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF S9AY?
YES IF YES, THEN n"PERMIT FOR WORK WITHIAI
PUBLIC ROADWAY" MUST BE ISSUED BY TY.E
?NO E[VGZNEERING DIV:SION. LIST AS A CONDI-
TION.
SUBJECT TO THE FOLLOL9ING CONDITIONS:
APPROVED EY:
TITLE:
DATE:
?4?. ?i 2/84
CITY OF EAGAN
(lltl APPLICFITION FOR PERMIT
SEWER AND/OR WATER CONNECTION
(PLEASE P NT .
1) PROPER'!'Y ApDRE55: &
rFrar• DESCRIT''PICV: U ?
(Lo /Block/Subdivision or Tax Parcel I.D. N?nber)
I i E,.'`iIS:'=:G ST4L'CP^:2E . De\TE 0?' OR:G?,LAi, ci1ILD?:G ?.j:?s? ZSs";:-=:
PDFCLT Z?.Jr;?P--npCSc'"rJ L'S: ? R-1 SD;GL: FPmSLY
? R-2 DUPL...?'Y ('IS:o T-TLN]ITS)
Q R- :.-NHCL!SE ('I?LR-E- + L':]ITS) ( TTVITS)
-a cr.;zTs)
? caMj=c,U/R=r,/oFFzCE
? IINDusTRL-T,r,
? INsrz=zc.Ar,/ccvEPa?M-r
Z) FyppLIGyT: P EASE PRIVi)
?
NPi•tE:
ADD'RESS:
CT_', ST::T°, ZZP:
PxoiNE: ??-
3) P??mEll (PLE?SE PRINTJ FOR CITY USE 04LY
NAi?: 7daMPRf?N PI ?rABIfl? ?? (Np
ADDRESS: _
12201 MINNETONI<A 6LVD. PLUJFBERS LICEYSE:
?
`
L
? pctive
CZTY, STATE, ZIP: ' ' 0 Expired
PHOVE: 33- ?sai H??cn
P Not of Record
?
LUNBER IILEYSE q
atr nttia
4) pCCr?PANT/CrvrlFt NkME IYLCAbG rHiritJ
:
ADDRESS:
CITY, STAi'E, ZIP: :zfi?Q
PIiONE:
5} INpIGtTE :VHIC'ri PERtiLiT IS SEING REQUESTL;D:
n-'CONINECI'ION 'IO CITY Sa)ER
n-?ONNEcfION 'IC) CITl' WATER
? OT[IER (PLI'115E DFSCRIBE)
b) L':GiG;1: C.`r.:
E] PL°.ASE F?OID APPRWEU PER.'NIT FOR PICi:-GP BY ONE OF AGCNE
? PLFASE ?%?SL APPROVm PE.°..?IIT TYJ 1, 2. 3. 4 A£OVE
(Circ one)
7) SICZaTL'R: :??[stC-? DATE:
?
MOR i! Ol:ili1l_?i!! !l.a?tl? f? t IY fii:a?# Y I?f s Y?'.saCi:a a!!!!1lyllES! ?!?! istY?a? r
F O R C I T Y U S E O N L Y
PE2*1IT °- ISSUED
F°ES: $
$
$ S
$
$ $
$
$ S
$
$
$
S $ /???• o-?
$
SEi^iEP. P°3?17T (I`.ICL::iZ SURC!i?RGE)
WATE:2 PERP'lZT (IL,CL'JDE SliRCHARGc.)
WATER METER/COPPERHORN/OUTSIDE REABER
WATER TAP (INCLUDE CORPORATION STOP)
SE;dER TAP
ACCOUNT DEPOSIT - WAT°R
WAC
SPC
TRCNK WATER ASSHS5M£:IT
TRliLNK SESdER aSS:SSMENT
LATERAL SE:IEFIT/TRUVK SE?• E4
LATERP,L BENEFIT/TRU:IK L9AT°R
WATER TREATMENT PLANT SURCHARGE
OTHER:
TOTAL
AMOli:v'T PAID jREC°I?T 'n' G 7
DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIG'riT OF WAY?
? YES ZF YES, THEN n"PER6IIT FOR '40RK WITHIN
PUBLIC ROADWAY" MUST BE ISSiJ£D BY THE
NO ENGINEERZNG DIVISION. LZST AS A CONDI-
TION.
SUEJECT TO THE FOLLOSJING CONDITIONS:
APPROVED BY: C??J
T I : LE :
DAT°_:
MR W•mEm w=sn mcw ocn st W*?mw
? --
?
Y`
?
? °
•
?
CI
Y
EAG 2/84
T
OF
AN
APPLICATZON FOR PE&'4IT
SEWER AND/OR WATER CONNECTIODI
(PLEASE PflINi) „
1) PROPE7I^! ADDRFSS:
r.FrAr Dr5C3I_=CV:
(Lot ock/, ut,.clivision or Tax Parcel I. . N??r)
I I'r' STRL'C.^.,^.'<E, DATE OF OiZTGi AL. EiiIIDL:G =.y,-il: ISSU?.NC::
PPESE.:: ::^:7Iir'/P?OPOS-? C'S'-': ? R-1 SINGL: FPYSLY
? R-2 DiJPi.?...°K (T.iO UNITS )
R-3 ZG[:?C{JSE (?7- = L'?IITS) ( W I"_'S)
?
R-Y a??.?T+x-•;.r/cc:?.rrrtii ( u,;zTs)
Q CCl11"EP'CI.AL,/RE.^.'AI:?OE'FI=-
? T?1'DL'ST:tIAL
? I:;STI?'C.TIO`lIAI./GM=.?,'T
2) APPLIG.?"P / lEasE PRlNi)
tu?tE:
ADD?2ESS:
CTT'_', ST:,TE, ZIP: -
PHO'L?E: ?Q -
(PLEkSc PR1YT)
3) Fui1Er-R NAME FOR CITY USE ONLY
-
. PLII ERS LICE4SE:
ADCRESS= 12201 MINNETONKA BLVD. Active
CITY, STATE, ZIP: MINNETONKA, MINN. 55343 Q Expired
a?ic
PHOJ7E_ pLUMBEnR LICENSE N_ C] Not af Re ord
?
drr nttid
4) Q"C[,PPSJT/CS•TIER ?YLLRJt rnini?
N14ME:
ADDRESS:
CITY, STA'IE, ZIP:
PFiONE :
5) INDIG,TE h'HZCH PENt4ZT BEI\G REK?UESTID:
?,t,?
?IO:7 TO CITY SEU7ER
L7 CONNFCrIO:I I 'IO CZ71' SVATER
? dTIIER (PLPASE DFSCRIBE)
6) -UJDiG;.:: C::e.: •
. ? PL?%SE f?OLD APPROVID pgi.v.IT FOR PIC?:-L'P BY O:JE OF AFOVE
LI °LEASE "VUL APPROVID PMdST TJ 1, 2 3, 4 ASWE
(Circl oney
7) SIC:A'iL'RE: DATE:
?
MR "AaliR}?1r Ml=:gW;W! s'1t?.»Ri# ?If ? i ?is?:a i ?R f!!!?l1?l? ? ?! ?! ?CitYSaiY ?
FOR C I T Y U S E ON;,Y
PERMIT °- ISSUED
co
....5: $
/ C,?O
SEi^iEP. PEBMrT (I`ICL[;DE SU°CS?RGE)
? e
LO. -5;
WATER PERb4IT (INCL'J?E SliRCHARGE)
$ 1d.3• °-"? WATER METER/COPPERHORN/OUTSZDE READER
S WATER TAP (INCLUDE CORPORATZON STOP)
$ SE:dER TAP
ACCOUNT D.F,POSIT - PIATER
WAC
$
SPC
$ TRUNK WATER ASSESS.fE.?T
$ TRli;IK SEWER ASSESSMENT
$ Lr1TEP.AL BENEFIT/TRUNK SE:-:ER
$ LATERt1L BENEFIT/TRUNK WATER
$
WATER TREATMENT PLANT SURCHARGE
$
S
$
t
OTHER: _ _
TOTAL
APSOU::T PAID/RECEIPT
DOES UTZLITY CONNECTZON REQUIRE EXCAVATION IN PUBLIC RIGi-IT OF WAY?
YES ZF YES, THEN .y "PERMIT FOR WORK WITHIV
? PUBLIC ROADWAY" MUST BE ISSUED BY THE
NO ENGZNEERZNG DIVISIO[V. LIST AS A CONDZ-
TION.
SUBJECT TO THE FOLLOWING CONDITIONS:
APPROVED BYi ? ?`J?
TI . LE :
DATE: ?-+?--
?
?
r =? .
? 2/84
CITY OF EAGAN
?
APPLICATION FOR PE41?4IT
I1111
SEWER AND/OR WATER CONNECTIODI
1) (PL SE PRIHT)
PROPERTY
ADDRESS:
r.Frar• DESCRItiI'ICV: /
Io /Bl Subdivisicn or Tax Parcel I.D. Nts;iSer)
? I" -XI57=:G S'?'4L'CP=,?E„ Dr1'Ia; 0F ORIGi L?1i, LiiII.DDNG P?:?ST ISS??\C.:
FjpFSL+P --,,,•1I:;6=/pvOPOSr..'T? US: ? R-1 SZ;GL:. rPYSLY -
? R-2 DUPT?`..'`{ ('P,tio LTIITS)
f
E3!-3 iYxv?Ci?SE (Tf?: + L':1IT5)
?Pf?
'
T 2'^S)
W
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_
?`iT
?C
i
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S?CS'SS?IL?tI ?
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-
i(isTRI[-?
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? LNST=IO:IAL/GGVE.4:`2.IE;`'T
Z) ApPLIC ?NI' (PLEASE PAINi)
N?4?IE :
ACD:2ESS:
CITY, STAT:', ZIP: .
PHOM:
3) pu,ffiER (PLEASE PRINI)
NAME: TNOMPSCW ?LUflIBING CO., INC. FOR CITY USE ONLY
ADDRESS: 12201 MINNETONI<A E3LVD. PLUyBERS LICEYSE:
M4l{VNET9PFIN. MIAIN 55143 ? Active
CITY, STATE, ZIP: 0 Expired
Aaitr.
PHONE: PLUMBER LICEYSE N Not of R cord
?
' aft nitta
4) OCC'[JPpNP/C!?i:Eit NPME: lrLcuae rntr11)
ADDRESS:
CITY, STATr-, ZIP:
5) IiVDIG'1TE :VHICH PE,RL
_.h.,?iT IS BEINC REX?UESTID:
?,
,? /C1??'ECPION 'I17 CITY SE,Ti?7ER
? CONNf=IGN 'IO CZTY ATATII2
? C!i'[Mft (PIFASE DPSCRIBE)
7) sicZazt,RE:
? PI.EASE E?OID APPP,WED PER',LIT FYJR PICI:- BY ONE OF 11BWE
B r=+SE DT'
.?ZL APP?2pVp PEP:IIT TJ 24 AFOVE
(Circle one)
nATE: ? ? ??_'
MIR R A-w_iRJ6JO ? i
F 0 R C I T Y U 5 E O N L Y
PE?2-MIT °- ISSUED
rr?S:
$
'S /A ?!P
$
S
S
$
$
?
S
S
$ '
$
$
$
E'••n.. ;^o nr R--- ?4rT .C ._. L..,,°?_- or?•
. (I_1 SU..?.q.r,RGE)
WATER PERP1T_T (INCi,i;DE Si;RCHr12GE)
WATER METER/COPPERHORN/OUTSIDv. READER
WATER TAP (INCLUDE CORPORATION STOP)
SE;dE4 T?P
=CCGi;:??' ??GSI'= - ?c..=3
ACC.OliNT DEPOSIT - WATER
wac
SP.C
TRliNK WATER ASSLSS.'1F:.'T
TRliNK SEIvER ASS?SS??ENT
LATEP.AL BE:IEFIT/TRU:IK SL:':.r.R
LATERaL BENEFIT/TRUNK WATER
WATER TREATMENT PLANT SURCHARGE
OTHER:
TOT?L- -•
Ah10L':dT PAID/qECEIPT R ?S'a 7 /?-
DOES UTILITY CONNECTION REQUIRE EXC.aV?.TION IN PUBLIC RIGiIT OF WAY?
7-7 YES IF YES, THEN n"PERMIT FOR :40RK WITHIN
PUBLIC ROADWAY" MUST BE ISSUED BY THE
NO ENGINEERING DIVISIO[V. LIST AS A CONDI-
TION.
SUBJECT TO THE FOLLOWING CONDITIONS:
APPROVED BY:
TI':LE:
DATE:
msa? ? ? ? aoom"w ?c? w ?cw ?r+ w ? w +-? w? ?t+ wt? r?e ?? ?? ?ta rF ? sa ?? w? ?c? ? sr w ?.
?I ? SD za.,3 CITY USE O;VLY
I t ' '
LOT I O BL 1 PERMIT#: y? g? t
SUBD. i k0YVl0.p LG J. RECEIPT
RECEIPT DATE:
2000 MECHANICAL PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PIIAT IINOB RD
EAGAN MIIt 55122
651-681-4675
Date:
Complete this section onlv if you aze installing HVAC in a single family dwelling, townhome or wndo under
construction and not ownedoccupied.
• HVAC: 0-100 M B T U $ 30.00
ADDITIONAL 50 M BN 6.00
• Gas outlets (minimum of one required (a3 $3.00 ea)
State Surcharge .50
Total $
Complete this section onlv if you are remodeline, addin¢ to, or reairin an existing single-family dwelling,
townhome, or condo. Please indicate if it is a new item, alteration, or repa'v.
New Alteration _
? Fumace'4._yvn? ,(l NbGL? ? f} -D'71J
_ Air exchanger
Reminder: Call for inspections
SITE ADDRESS:
O WNER NAME:
INSTALLER-NAME:
STREET ADDRESS:
Repair _ Other
_ Air conditioning
Other
gee $ 30.00
$iste SiitGa'7'nigc .SQ
Total $ 30.50
^_DaWK 4EkTlWJL coNamewNG
PI-IONE #: (O? / - n
( CODE) Q?l?7?dd
PHONE #: ?"sa -
:
CITY: _ STA1'E: _1 ZIPa(I'
\
ir ' -rn.liiP ° ----Ildreitspos..?"--
'A 1 : 4 Ar00,311110 .01■MPF A,
I
1 41 - .... i lt- - 0 1,1 Alli.V,
_ -
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1 7' 1 1 k
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Use BLUE or BLACK Ink
-
For Office Uset
j Permit # VJ a c6 7_~ 1
C14 of Eapo
I Permit Fee: 11 0____ 1
3830 Pilot Knob Road
1 1, ;
Eagan MN 55122 I Date Received:
Phone: (651) 675-5675 1 i~
Fax: (651) 675-5694 I Staff.
1
2013 RESIDENTIAL BUILDING PERMIT A
PPLICATION p~°q
17~ 1d
Date: - 13 - Site Address: 15y b iV.63 CiO4~ -C
~ Unit`lf:•i
kws
Resideinf Name: __4t, r Zn_ r I(, _74 tin c*mAe_S___ Phone: 721- .,£'t'G d -
Owner Address / City / Zip:
Applicant is: Owner Contractor
Description of work: Rfr o~--- _
Type of Work
Construction Cost: l 51_ •-~D Muni-Family Building: (Yes. _ ! Na
Company:g Contact: eA_--
Co[1#tdCtQt Address:Q !"I t/EYlA/'1~_- _ City: 1Y~/t°__QTP~71r•.3
State: ! )2AL_ Zip: 5-5-OYO (a Phone: (+Z ,2 2- 5,5d6
License#:St- 194062- Lead Certificate 2,F? -1
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'Itlformation may be classed 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 Cali 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.,QwtgMtateonecail:ora
1 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.
_ L r
x_! t ZtP_ i4 r) cap Ch
_
--u- x
Applicant's Printed Name --ter- Applica s Signature
Page 1 of 3
Use BLUE or BLACK Ink
�-----------------,
� For Office Use I
�1� Qf�� �� f ��� s
� � � Permit#: �
� I
I
3830 Pilot Knob Road � Permit Fee: �
Eagan MN 55122 I �
Phone:(651)675-5675 � Date Received: �
Fax:(651)675-5694 � I
� Staff: �
������_����������J
2015 MECHANICAL PERMIT APPLICATION
❑ Please submit two(2)sets of plans with all commercial applications.
Date: /z"Z��Z01� SiteAddress: ��7v (,�-��'�`/S'dJ'' �r>vC �a�l�'/ �� J�.�/Z�
Tenant: Suite#:
�m,�,�, .,,m,y.�.. ..,��, €.�,�,,�,�
� n �, - s
Resident/Owner � Name: �1�71,� 1��,a�i�'��-.,�, ,__�h ,.,.,_� -_M��W�r �._� Pno►,e: �S/-226�-�`6'�
� Address/City!Zip: /S7 � ��1�+ ��" ��Q�N �� ��� Z
�
�.,,�,� .,��.� k��..�.�. ���� '
A�, _ �.�,.....�_--.�._ ,
/e .�
� Name: � i ��l /�� License#:
' Address: �� � r� �� City: ��G /<�'�t §
Contractor ; p� �
; State: � Zi J IF1dr`/� Phone: sZ v l-�"` 2�-7G
, � p�
' Contact J /� ��k'•��G Email:l-�-��,C�} ����C ryJ,���i'[�%o'"
,�.,,.,m ,�„���...., a.o _e,a,� .�,.,,.:r � �,..�.�,.,,,,,m�., <,,,.,�, �x,.� � �,,�»,��,,o��..�,,,��,� ,�.�....;
� _New � Replacement _Additional Alteration Demolition
Type of Work � Description of work: ��/�s�<G ��u � �
�NOTE:Roof mounted and ground mounted mechanical equipment is required to be screened by City �
$ Code. Please contact the Mechanical inspector for information on permitted screemng methods. %
� x.�.,� ��.��,�.�,. �,,,� � �:�, � ,��� � � .��,�,,,�,�_„�� � �
� RES/DENTIAL '
� � COMMERC/AL
� �Furnace = New Construction _Interior Improvement
a
P@1'1111t Typ@ � —Air Conditioner ` _Install Piping _Processed
Air Exchanger F Gas Exterior HVAC Unit
€ —
� _Heat Pump � Under/Above ground Tank �Install/_Remove)
� �
Other �
— ,,�.�»_ v�, � ..�,.�,�.„.
,,,.,,,,,, .,,wW.,.�_,_...-..r�.�,�����„��,_„ ,�.,,u,>,,��.� _. ..::._ .,:w,,.�.,,,�w�,,,�.,,,.�
; RESIDENTIAL FEES
$60.00 Minimum Add or alteration to an existing unit, includes State Surcharge �
1
$100 00 Residential New, includes State Surcharge =$ TOTAL FEE �
��Kw�:.�, .,.M.n.�.,,� w.v..�,. �.�,,,..�„�,.,:,.�., � �.,��„��,, ,,,,�,�,� .��m��,�.k��,�,,�< �. >„�,.��,.��
!
COMMERCIAL FEES Contract Value$ x.01 �
i' $60.00 Permit Fee Minimum
' $70.00 Underground tank installation/removat =$ Permit Fee
_$ Surcharge �
� Surcharge=Contract Value x$0.0005
i` If the project valuation is over$1 million, please call for Surcharge =$ TOTAL FEE
,.,,,..,, ...�.,,�.�,,ra,,.�,.,��,..,�., .., ,,�.,., ,,�,,..,��,�,,, ,,,��� �
I hereby acknowledge that this infortnation 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.
�� � ____
x �f� ��',
ApplicanYs Printe Name ApplicanYs Signature
FOR OFFICE USE
Required Inspections: Reviewed By: Date:
Underground Rough in Air Test Gas Service Test In-floor Heat Final HVAC Screening
Use BLUE or BLACK Ink
For Office Use
� . .t
City of n S I
Permit ����
Y (�f�� �ll Permit Fee: ` 4a?•6"
3830 Pilot Knob Road I r
Eagan MN 55122 Date Received: 7-4,24.-/7
Phone: (651)675-5675
buildinginspections(a.citvofeagan.com Staff: I
2017 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: SiteAddress: tip' 'Jr Unit#:
Name: 4',4,77fr/?' Phone:{ /'7 24)Z- 7/
Resident/ /
owner Address/City/Zip: 8,% .lts✓azCd!/ 1e,..6 /'l �i���i✓ ✓✓ S�/Z�
Applicant is: Owner Contractor '` I
Type of Work Description of work: ' ..407. 0' /'f,%J64 �?"1/;;'l f
Construction Cost' �G'�� • J Multi-Family Building:(Yes /No )
Company: /%'�®.® 4.r4t J «e. Contact:G .d'.4 /7 rf.✓d4?e-40
Contractor Address: /J, ' fc`ir/.e✓f7�A' -1,c AZ City: ,4e/lrc-"d'&
Stater/7A/ Zip: 5—.S773 Phone: 6 2'7/Jf/.17Email: C/AOr,/67ele-le E '
License#: 7/7Z6)40 Lead Certificate#:
If the project is exempt from lead certification, please explain why:
emss', 17/4' iS4//e44'/ v.,." /5 Xi,/ tee,,
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
„iri'th last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
o If yes,date and address of master plan:
Licensed Plu er: Phone:
Mechanical Contractor: Phone:
Sewer&Water Contractor: Phone:
Fire Suppression 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.
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on
the City's website at www.cityofeagan.com/subscribe.
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.
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.
x e7,9494 S /�'G� 1Afed✓iC 7
Applicant's Printed Name Applicant's Signature
Page 1 of 3
I54(e CleiMs D(
DO NOT WRITE BELOW THIS LINE /7?On
SUB TYPES
_ Foundation _ Fireplace _ Porch(3-Season) _ Exterior Alteration(Single Family)
Single Family Garage Porch(4-Season) _ Exterior Alteration(Multi)
Multi _ Deck _ Porch(Screen/Gazebo/Pergola) _ Miscellaneous
01 of_Plex _ Lower Level _ Pool _ Accessory Building
WORK TYPES
New Interior Improvement Siding _ Demolish Building*
Addition _ Move Building _ Reroof _ Demolish Interior
x Alteration _ Fire Repair _ Windows _ Demolish Foundation
Replace Repair _ Egress Window Water Damage
Retaining Wall *Demolition of entire building-give PCA handout to applicant
DESCRIPTION
Valuation ) ,,
aluationOccupancyMCES System
Plan Review Code Edition i 15/ SAC Units
(25% 100%)c) Zoning City Water
Census Code Stories Booster Pump
#of Units Square Feet PRV
#of Buildings Length Fire Suppression Required
Type of Construction Width
REQUIRED INSPECTIONS
Footings(New Building) Meter Size:
Footings(Deck) Final/C.O. Required
Footings (Addition) X Final/No C.O. Required
Foundation Foundation Before Backfill X HVAC Gas Service Test Gas Line Air Test
Roof: Ice&Water Final Pool: _Footings _Air/Gas Tests _Final
XFraming 30 Minutes 1 Hour Drain Tile
Fireplace: _Rough In Air Test _Final Siding:_Stucco Lath _Stone Lath Brick EFIS
Insulation Windows
Sheathing Retaining Wall: Footings_Backfill Final
Sheetrock Radon Control
Fire Walls Fire Suppression: Rough In_Final
Braced Walls Erosion Control
Shower Pan Other:
Reviewed By: 11/ , Building Inspector
RESIDENTIAL FEES
Base Fee
Surcharge 6 r 9'r 1.i;,-010
Plan Review
MCES SAC Dir)
City SAC 0
Utility Connection Charge )
a
S&W Permit&Surcharge �,/
Treatment Plant
Copies
TOTAL
Page 2 of 3
Use BLUE or BLACK Ink
r
For Office Use /
Permit#: (4// j 7
* City of Eaall
Permit Fee: l' 0 C
3830 Pilot Knob Road
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 Staff:
Fax: (651) 675-5694 �
2017 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date:/c7//Z2//7 Site Address: /S'/,
Tenant: Suite#:
Resident/OWner Name: Phone:
Address/City/Zip:
Name: //// /" /e4 I' 1 / )1_3" License#: �GC�L�I� 7
Contractor Address:c2 //z
/777 -/4/x'7 -7; City: ....f://.°17"7
6 ��
State:.,./1/./1/.,./1/./1/ Zip: 5-S.-Z."5-S.-Z."7 9 Phone: ���-2 7S � -�
Contact: 7--4e/Email: Email: //i,e//Gl //'! x 14-14( & r1e/%e6,/,•'I
Type of Work —New —Replacement _Repair —Rebuild —Modify Space Work in R.O.W.
Description of work: /'/. /r'c-/e/ 34E.,61---)--74
RESIDENTIAL
Water Heater
Water Softener
Lawn Irrigation( RPZ/—PVB) yPermit Type VAdd Plumbing Fixtures ( Main/ , �
L�Lower Level)
Septic System
New Water Turnaround
Abandonment
RESIDENTIAL FEES:
$60.00 Water Heater, Water Softener, or Water Heater and Softener(includes State Surcharge)
$60.00 Lawn Irrigation (includes State Surcharge)
$60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround*(includes State Surcharge)
*Water Turnaround (add $280.00 if a 3/4"meter is required)
$115.00 Septic System New(includes County fee and State Surcharge)
TOTAL FEES$
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.00pherstateonecall.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.
x /r'v
Applicant's Printed Name Applicant's Si nature
FOR OFFICE USE Reviewed By: Date:
Required Inspections: Under Ground Rough-ln Air Test Gas Test ' Final
Meter Related Items: Meter Size Radio Read Manometer Staff:
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA160608
Date Issued:03/26/2020
Permit Category:ePermit
Site Address: 1546 Clemson Dr
Lot:12 Block: 01 Addition: Thomas Lake Heights 2nd
PID:10-75951-01-120
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Softener
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 -
Andrew J Haugerud Bahl
1202 Overlook Ln Nw
Preston MN 55965
(612) 236-8490
Milbert Company (culligan)
1801 50th St E
Inver Grove Heights MN 55077
(651) 451-2241
Applicant/Permitee: Signature Issued By: Signature
A
For Office Use
,i. po,,,,,,
.,.. # 7 'F'If;::.'-.L.,.-. '
.. . . ,
oycl 1 g 7512- e m
', • -, ,.);.. ':,_ ..):: , .,-. ,7:---2-3'.-- ---"-
2020 RESIDENTIAL BUILDING PERMIT APPLICATION
Datc,' 'Qiffii-44.4C Site Address: /6--lit Ct en! sou Die7ve . Unit#:
.... _____....
/ //•,(26-- /707,t.t50-71,44_ aeilft•-CiitAvit Phone
Residepti
Own .,r AcId:e,,-5 '-.‘A';, ' 71r -
„...
Type of Work
...,s. ,_„ c,r-: .,0,,.
- 1E‘' 24:00 - Multi-Far-Ay Budding (Ye ( _ ' No _ ,
._ ....... .
- -- 1,0,-, Ayr (0,rene t,e c,r‹,rine VD_ /lame i rP,firitact /311,4 _j_idryr
: . , //3-. 6-010: /9-Ye ' C•11%, /1-12,t e 1/.02-LeY
Contractor
r. in t.,r.:"-;- 470-V- --:- : G.57-:1V I. `416'; Emati [Oki.-te-)Altyr 4.114rieoeitost4,,,C..6 vs-A.
License i.? 2-7‘i.'/ Z 1.-- Lead Certificate
, ll,, , • - , nli.,i `,:-.-; lead certification. ,,0eS.-- 02)!3i' Why
hir) ,Ade;t040!
Alts41 117
..t.hekri' _i - •
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEWBuILDING
:„ the )...,y,i., ' months. has the City of Eagan issued a permit for a similar plan based on a master plan?
rtti'.E; ard address c:'n'aste'pia
Licenseo PhiniberPhone:
-- —
wirchop.;,,;,1: C ontractor: Phone:
ivilt,,,, Contractoi- Phone: - —
._. .__ _
Fire 5uppre.i,s;01) Contractor _ _ Phone:
. . . .. . . . . .
NOTE:Plans and supporting documents that you submit are considered to be public information. PordOns 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,awcT.g4..,.
-•iics.iiho to t 0 e_eive all electronic notification from the City of proposed ordinances by signing up for an email update on thk, C.iv.f.
.4:' ,- --.,L
xtP,', ' YY._,',, ltithbfiZeb by a htidding permit issued tn accoraance ,...,tr,the Minnesota State Building Code must be completed WIthi'', 'BO
,.),,,, t.t, t1t -- It . 230,.,
it f....q.E., vULt Ulf, Y Gopher State One Ca,,t . 551,454-60u2 t ' ,,, <.•, t3t-Ist .;Itlerc.IrCh.1 :(i Jtt!tt\. damaue Can ',L,'',,t-- '
.. . ' . .. '-i.., '. ..7. :n .'f.. :. . : .• .:._. '-n. ' , n..... :...3 ..i COfop,.inne At',1-, he cr,ltntartt.es .0-t;
". ' -•:-' . ' - t , -er'''''-':. t,_," ' ' --' ,-!:‘1-''..,,-',- - ',-E--1' t',3rAi , -, ,..., .3tart volt uti' 0 T..err-IleL liol. the
,
AOC 14, r ___ . _ _
.
/ / , /iii it, /
Ar4-1144.7. .it s Prnted N.4me Apolvcant's Signature
f � 4a
DO NOT WRITE BELOW THIS LINE /��� C�E/� n be /6c'7D 7
SUB TYPES
Foundation _ Fireplace _ Porch(3-Season) _ Exterior Alteration(Single Family)
Single Family _ Garage _ Porch(4-Season) _ Exterior Alteration(Multi)
_ Multi x Deck _ Porch(Screen/Gazebo/Pergola) _ Miscellaneous
01 of Plex Lower Level Pool Accessory Building
WORK TYPES
New _ Interior Improvement _ Siding _ Demolish Building*
_ Addition _ Move Building _ Reroof _ Demolish Interior
_ Alteration _ Fire Repair _ Windows Demolish Foundation
_
7' Replace _ Repair Egress Window _ Water Damage
Retaining Wall *Demolition of entire building-give PCA handout to applicant
DESCRIPTION
Valuation `A.07)000. (11:�;,,,,,,,.,) Occupancy 2-Rc- I MCES System
Plan Review _ Code Edition Vo i c SAC Units
(25%_100%_) Zoning P. City Water
Census Code 1/M4/ Stories Booster Pump
#of Units _ / Square Feet PRV
#of Buildings Length Fire Suppression Required
Type of Construction t--/3 Width
REQUIRED INSPECTIONS
Footings(New Building) Meter Size:
Footings(Deck) Final/C.O. Required
Footings(Addition) X Final/No C.O. Required
Foundation Foundation Before Backfill HVAC_Service Test Gas Line Air Test_Hood
Roof:_Ice&Water _Final Pool:_Footings _Air/Gas Tests Final
Framing 30 Minutes 1 Hour Drain Tile
Fireplace:_Rough In _Air Test _Final Siding:_Stucco Lath _Stone Lath _Brick EFIS
Insulation Windows
Sheathing Retaining Wall:_Footings_Backfill_Final
Sheetrock Radon Control
Fire Walls Fire Suppression:_Rough In_Final
Braced Walls Erosion Control
Shower Pan ,, /l Other:
Reviewed By: s• A%/So— , Building Inspector
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit&Surcharge
Treatment Plant
Radio Meter Read
Copies
TOTAL
Page 2 of 3