1608 Clemson DrFqR-.,SAI,.E T . ?. . CITY OF EAGAN 13010
- .y:YG 1
3830 Piiat Knob Road, P.O. Box 21-199, Fagan, MN 55121
' • PHONE:454-8100
BUILDING PERMIT Receipt# ?To be used io, 1 t)F 4 PLEX E v I +64,00 0 D1:CEMBER 29 ? 86
st. a ue Date ,
9
Site Address 1608 LLEMSON nR Erect ? Occupancy R3
Lot 1 Block 1 Sec/Sub. TRAILS 4F Remodel ? 2oning t'D
Parcel No THOMAS LAKE Repair ? Type o( Const. V
. Addition ? No. Stories
Q
_
t'IC 14
Name
f.ORIZON
HOMES
'
Move
Demolish
?
? 44
Length
? ?
Depth
3
° ? . C1. ?OX 3 ?
Address
^
PLS
4 T int Impr. ? Sq. Ft
-:
?ity . 20
Pnone -3900 mstau ? 1
Assessment _
Water & Sew.
Police
Fire
I hereby acknowiedge th
information is correct ar
Minnesota Statutes and
A Buildir
all work
Building
to:
State of Bldg.
Permit .0 J,& J•v%I
Surcharge 32.00
Pian Review 162 . 50
SAC ?00
Water Con n. 500.00
Water Meter 63.50
Road Unit 290.00
Tr. PI. 156.00,
Var. Date I Copies
Total $?. ?104 .
on the express condition that
Statutes and Ciiv of Eaaan Ordinances.
' Permit No. Permit Holdx Daie Tetephone M
Plumbing
H.V.k.C.
Eloctric
P
sonener
Inspection Date Insp. Commsnb
Footings I
FooNn9sll
Foundation
Framing
Roofinp
Rough Plbg. -?-8? A91 ^Q' r
Rough Htg.
Insul. /; '97
Flroplace
FInaI Hty. 4 ?:?•?9 ?' ?/-.
FinalPlbs.
Bldq. FMaI y..zY- $7 G- L??-C.lCX?° ?t c c et s oit- ?l•sP'J
Ceri. Occ. 5'• .??. ?7 ?'. er .
? ?•
Deck Ftg.
Deck Frmg.
Well
Pr. Disp.
PERMIT # ? /?/7
PLUM8ING PERMIT RECEIPT # C-V
. CITY OF EAGAN JAN 1987
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: 2. ,
PRICE PHONE: 454-8100
Site Address , I
Lot ? Block i SeciSub
Name THdMPSO'N PLUMBING
,
?a Address
(
c 11-33-2521
Ciry MTKA Phone
? Name NEW HORIZON HOMES
f
c Address
p Ciry f•1PLS Phone 420-3900
FEES
COMM/IND FEE - 196 OF CONTRACT FEE
APT. BLDGS - COMM RATE APPLIES
TOWNHOUSE 8 CONDO - RES. RATE APPLIES
MINIMUM - RESIDENTIAL FEE - $12.00
MINIMUM - COMM/IND FEE - $20.00
STATE SURCHARGE PER PERMiT - 50
(ADD $.50 S/C IF PERMIT PRIGE GOES
BEYOND $1,000.00) j
?
SIGNATURE OF PERMITTEE
FOR: CITY OF EAGAN
BLDG. TYPE WORK DESCRIPTION
Res. > New r
Mult. Add-on
Comm. Repair Other
? RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
NO. FIXTURES TOTAL
' Water Closet - $3.00 $
1 Bath Tubs - $3.00
Lavatory = $3.00 "
Shower - $3.00
; Ki!chen Sink - $100
Urinal/Bidet - $3.00
, Laundry Tray - $3.00
Floor Drains - $1.50
Water Heater - $1 50
Whiripool - $3.00
Gas Piping Outlets - $1.50
(MINIMUM - 1 PER PERMIn
Softener - $5.00
Well - $10.00
Private Disp. - $10.00
Rough Openings - $1.50
FEE
STATE S/C:
GRAND TOTAL:
?.
PERMIT #
. • MECHANICAL PEHMIT RECEIPT #
a CITY OFjAGAM:x
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: _
RACT PRICE: PHQNE: 454-8100
S+te Address _4.11;
Lot Bloq
? . ?r_uuvvR
m Name
m Address .?#
? Ciry
Name ?1s
c Address
O CitY
TYPE OF WORK
; Forced Air
Boiler
Unit Heater
? Air Cond.
i Vent
; Gas Piping Outlets #
L5/2 M BTU
M BTU
M BTU
M BTU
CFM
/
BLDG.TYPE
Fies. k?
Mult
Comm.
Other
WORK DESCRIPTION
New ?'.
Add-on
Repair
FEES
RES. HVAC 0-100 M BTU
ADDITIONAL 50 M BTU
(RES. HVAC INCLUDES A/C ON NEW
CONSTRUCTION)
GAS OUTLETS (MINIMUM • 1 PER PERMIT)
COMM/IND FEE - 1% OF CONTRACT FEE
APT. BLDGS. - COMM. RATE APPLIES
TOWNHOUSE & CaNDOS - RES. RATE APPUES
MINIMUM RESIDENTIAL FEE - ALL ADD-ON 8
REMODELS
MINIMUM COMMERCIAL FEE
STATE SURCHARGE PER PERMIT
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND $1,000)
- $24.00
- 6.00
1.50 EA. 1
- 12.00
- 20.00
- .50
FEE:
? . ?
S/C: -? SIGNATURE OF PERMITTEE
TOTAL•
FOR: CITY OF EAGAN
Foa T. I i.
CITY OF EAGAN o
N
13011
?-- ? 3830 Pilct K rab Road, P.O. Box 21-199, Eagan, M _
N 55121
BUILDING PERMIT PHONE:454-8100 ?
Receipt # ,
To be usedfor I np 4 PLEX Est Value $64,000 Date DECEMBER 29 19 86
Site Address 1608B CLEMSON DiZ Erect EY Occupancy R3
Lot 2 Block 1 Sec/Sub. TRAILS Oc Fiemodel ? Zoning po
Parcei ?vo. THOMAS LAiik' Repair ? Type of Const. v
Addition ? No. Stories
¢
Name rQ ew FiOR I 20I3
HONIFS Move ?
Length 4
= P.O. I30}? 13 6 Demalish ? Depth ?7
;
0 Address
,.. m p:.s _. 42 Int.lm r?
0-19nn P. S Ft
q.
x
OV
?Q
?
Name SA`E 534-7388 (MARTY)
Address PAGER
Assessment
Water 8 Sew.
Police
Fire
Permit Y ?• ""
Surcharge ' O 0
Plan Review 162.50
SAC 575.00
Water Conn. 500.00
Phone
t W Name D• K• GR I3WOLD
_u Address 11975 PORTLAND AVE SO
i W City B' V I L LEPhone 8 9 4- 6 2 d7
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 Epgan prdinanFes.
i- -7`_ ? , .
Signature of Permittee-?/ --= - "'?--
?
ZON OAiES
Planner Water Meter
Council Road Unit_
Bldg. Off. tc/zy/ urr. PI.
APC Parks
Var. Date Copies 0
TOtal ' ?
A Building Permit is issued to: NEW HOR I H on the express condition that
all work shall be done in accordance with all applicable State of Minnesota Statutes and Ciry of Eagan Ordinances.
Building Official ?,'_
? PermN No. Pwmk Holder Date TNophone M
PIum4i49 - ? ' 7
H.V.A.C. >G
EleeMe 719 .G•' C?
SO}IMlr
ImpecNon Daft Insp. CommeMs
Footln9sl O
FooNnysll
Foundatlon
Fnminy
Roofiny
Rouyh Piby.
Rouyh Hty.
Imul. /? •? 7 Aw,
Fireplace ? PQ
Final Hty. .x7 L" • A.
Flnsl Plbq. ?
BI69. Final y. 29, e'7 C. A.
Cert. Occ. C_
-?f ?
D ? Grt
Aa/
Dock Ftq.
Deck Frmy.
WNI
Pt. Dlap.
. '???'
' • • . PERMIT #
• PLUMBING PERMIT RECEIPT #
CITY OF EAGAN ,. ,
3830 PIIOT KNOB ROAD, EAGAN, MN 55121 DATE:
CONTRACT PRICE pNeNE. ass_e1ee
Site Address
? rvan
? Add
c City
J,tli lw
BLDG.TYPE
? Name
3 Addre
0 CttY -
_ Sec/Sub
FEES
COMM/IND FEE - 146 OF CONTRACT FEE
MINIMUM - RESIDENTIAL FEE - $10.00
MINIMUM - COMM/IND FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND $1,000.00)
0
SIGNATURE OF
FOR CITY OF EAGAN
Res.
Mult
Comm.
Other
WORK DESCRIPTION
New _
Add-on
Repair .
NO. FIXTURES
Water Closet - $3.00
Bath Tubs - $3.00
Lavatory - $3.00
Shower - $3.00
Kitchen Sink - $3.00
Urinal/Bidet,,- $3.00
Laundry Tray\fi3.00
Floor Drains - $1'50
Water Heater - $1.50
Whirlpool - $3.00 •
..4_Cas Piping Outlets - $1.50
Softener - $5.00
Well - $10.00
Private Disp. - $10.00
Rough Openings - $1.50
FEE
TOTAL
s
\
STATE S/C:
GRAND TOTAL•
? ?
? T Name _
q Address
? c City _
Name _
c Address
p CitY -
TYPE OF WORK
Forced Air
Boiler
Unit Heater
Air Cond.
Vent
Gas Piping Outlets #
Other
MECHANLCAL PERMIT RECEIPT #
• CITY OF-E/IGA?)
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE:
? ?LJA\C. IGI Phone
? M BTU
M BTU
M BTU
M BTU
CFM
I
BLDG.TYPE
Res. v
Mult.
Comm.
Other
WORK DESCRIPTION
New
Add-on
Repair
FEES
RES. HVAC 0-100 M BTU
ADDITIONAL 50 M BTU
(RES. HVAC INCLUDES A/C ON NEW
CONSTRUCTION)
GAS OUTLETS (MINIMUM - 1 PER PERMIT)
COMM/IND FEE - 1% OF CONTRACT FEE
APT BLDGS. - GOMM. RATE APPLIES
TOWNHOUSE & CONDOS - RES. RATE APPLIES
MINIMUM RESIDENTIAL FEE - ALL ADD-ON 8
REMODELS
MINIMUM COMMERCIAL FEE
STATE SURCHARGE PER PERMIT
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYOMD $1,000)
$24.00
6.00
1.50 EA. {
I
- 12.00
- 20.00
- .50
FEE ?
S/C: lik SIGNATURE OF PERMITTEt ?-,,AJ
TOTAL: 2 •
FOR: CITY OF EAGAN
GJ ? u V QV ,d //
MECHANICAL PERMIT
`
' • . RECEIPT # ?
R ' C171?QW EAC74A
j 5 f -7
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE:
CONTRACT PRICE: PHONE: 454-8100
Site Address / ' BLDG. TYPE WORK DESCRIPTIpN
Lot ? Block ? Sec/S ub Res. New
Name SE DGWICK Mult Add-on
Comm. Repair
?o Address 8910 WENTWORTH
c Cit MINNEAN4}% M N 55420 Other
y
881-9000
Name
? FEES
RES
HVAC 0-100 M BTU -$24
00
1 .
.
c AddreS3 4 ADDITIONAL 50 M BTU - 6.00
p City Phone (RES. HVAC INCLUDES A1C ON NEW
CONSTRUCTION)
GAS OUTLETS
MINIMUM
t PER PERMI
- 1
50 EA
-
n
.
.
(
TYPE OF WORK COMM/IND FEE - 1ai6 OF CONTRACT FEE
Forced Air M BTU ?-' APT BLDGS. - COMM. RATE APPLIES
TOWNHOUSE & CONDOS - RES. RATE APPLIES
Boiler M BTU MINIMUM RESIDENTIAL FEE - ALL ADD-ON &
Unit Heater M BTU REMODELS - 12.00
Air Cond. 2, I M BTU MINIMUM COMMERCIAL FEE - 20.00
50
R
?
i Vent. CFM $ (ADD $.50 SCC F
ERMIT PRI E
GOES
? Gas Piping Outlets # i i 6z BEYOND $1,000)
FEE:
S/C: !L SIGNATURE OF PERMITTEE
TOTAL• y
FOR: CITY OF EAGAN
_,
?: .: .
PERMIT #
i
` PLUMBINCa PERMIT RECEIPT #
' qTY OF EA(3AN
3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE
CONTRACT PRICE PHONE: 454-8100
Site Address BLDG. TYPE WORK DESCRIPTION
Lot Block Sec/Sub
Res. New
? Name Mult Add-on
.q Address Comm. Repair
c Clty Phone , Other
NO. FIXTURES TOTAL
L Name Water Closet -$3.00 t
c Address Beth Tubs - $3.00
p City Phone Lavatory - $3.00
Shower - $3.00
Kitchen Sink - $3.00
FEES Urinal/&det -$3.00
COMM/IND FEE - 1% OF CONTRACT FEE Laundry Tray -$3.00
MINIMUM - RESIDENTIAL FEE -$10•00 Floor Drains - $1.50
MINIMUM - COMM/IND FEE - 20.00 Water Heater -$1.50
STATE SURCHARGE PER PERMIT - •? Whirlpool -$3.00
(ADD $.50 S/C IF PERMIT PRICE GOES Gas Piping Outlets -$1.50
BEYOND $1,000.00) So(tener - $5.00
Well - $10.00
Private Disp. - $10.00
i
- $1
50
R
h O
.
oug
pen
ngs
SIGNATURE OF PERMITTEE FEE
STATE S/C:
FOR: CITY OF EAGAN GRAND TOTAL•
i FO R SAI.E T. H•
NQ
x 2G
? 13012
-
i s9, Eaga
3830 Pilot Knob R dl P o. Bo n, M N 55121
PHON E: 454-8100
BUILDING PERMIT Receipt #
Tobeusedfor 1 OF 4 PLEX Estvalue S64,OU0 pate DECl:i-tE3E:? 29 ? 1985
Site Address 1610B CLEMSON DR Erect C? Occupancy R 3
Lot 3 Block 1 Sec/Sub. TRAILS OF Remodel ? Zoning YU
Parcel No. THOMAS LAKE; Repair ? Type of Const. V
Addition ? No. Stories
? Name NEVl FiORIZUN F10MES Move
Demolish ?
? Length
Depth
27
=
o Address P. O. BOX 13 67
I
I ? Ft
S
City '4P nt
mpr.
LS Phone 420-3900 Instau O q.
o Name SAME 5 3 4- 7 3 8 8 ( MARTY ) APProvab Fsel
? Q Address PAGER 0 Assessment Permit S
~ Ciry Phone Water & Sew. Surcharge _
W D.:t. GR I SWOLll
D.R.
N Police Plan Review
W ame
11975 PORTLAND AVE
SO
Fire
SAC
¢ _
? W Address
City H , VILLE phone 1394-628
7 Eng. Water Conn.
Planner Water Meter
Council Road Unit_
I hereby acknowledge that I have read this application and state that the Bldg. Off. 12 / 2 9/ 6T?, p?, 156 .
information is correct and agree to comply with all applicable State oi
Minnesota Statutes and City of Eagpn Ordinances. APC Pat'ks
Signature of Permittee Var. Date COpies ,
Total '
? S
A Building Permit is issued to: NEW EIORIL4N HOME: on the express condition that
all work shall be done in accordance with all applicable State ot Minnesota Statutes and City of Eagan Ordinances.
Building Official
' PermN No. Pormk Holder Date Tdephone M
Plumhlnq
H.vA.e.
Elechic ?-
SOIIMlI
Inspecdon Dafe Inap. Comm?nb
FooNnys l ?
Foodngsil
Foundatlon
Framinq
Rooflng
RouyhPlbp. AOL
Rouyh Nfp.
li»ul.
Fireplacs
Ffnal Hty.
Final Plbp.
Bldy. Final
Cert. Occ.
? /l-E'7 - 30 ?S( Q,;? ?,,. ' •
Deck Fty.
Dock Fnny.
WNI
Pr. Dbp.
FnR SALfi T. fi. rCITY OF EAGAN ? Q 13013
3830 Pilot Knob Road, P.O. Box 21•159, Eagan, MN 55121
PHONE: 454-8100 BUILDING PERMIT Receipt # ? `To be used tw j OF? 4 PLnX Est. value $ b4'000 Date DEC Ei?:I3E K 29 19 86
Site Address 1610 CLEMSO:V DR Erect U Occupancy H3
Lot 4 Block 1 Sec/Sub. TRAILS OF Remodel ? Zoning pD
Parcel No. TliOh1AS LAI(E Repair ? Type of Const V
Addition ? No. Stories
? Name NELl HORIZON HOMEB Move ? Length 44
= L36
P
O
BOX 7 Demolish ? Depth 27
.
.
; Address
°
MPLS
420
-3900 Int.lmpr ? S Ft.
Q
city Phone Install ?
o Name SAME S 34- 7 3 g 8 (MA RTX ) Approvals Fees
?°,? Address pA??ER # Assessment Permit ? •00
? ciry Phone Water & Sew.
P
li Surcharge 32.00
162.50
Pl
R
i
0-
? W Name d• R. GR I SWOLD ce
o
Fire ev
an
ew
SAC 575.00
_= Address 11975 FORTLAND AVE SO
Eng. 500.00
Water Conn.
`W c;ty B' VILL,none 8 9 4- 6 2 8 7
Pl 63. SU
W
t
M
t
anner
Council er
e
er
a
Road Unit 290.00
Iherebyacknowledgethatlhavereadthisapplicationandstatethatthe BIdg.Off. 12/29/ 6Tr. pl. 156.00
information is correct and agree to comply with all applicable Siate of
Minnesota Statutes and City of Eagen Ordinances. ,. APC Parks
Signature of Permittee' -' -??-' - -r` Var. Date Copie
, • 00
. Total
' O ES
A Building Permit is issued to: NEW HOR I ZON H M on the express conditlon that
all work shall be done in accordance with all applicable State of Minnesota StatuteS and City ot Eagan Ordinances.
Building Official '"?
_ Wrmit No. Permit HMdsr Date TN"hons N
Plumbiny .? /-":'-" ' 4,4 1t'
H.V.A;G
ElaclrlC
8o(tensr
InspecUon Date Insp. Commanit
Footlnps I &
Foorinysll
FoundaHon
Framiny
Roofin9
Rouyh Plbg. .ao47 AA1 _ Q.
Rouyh Hty.
Insul.
Ffreplace
Final Hty.
Final Plbq. s"??
Bldy. Flnal
GR. Oce.
oock Fro. 10
Deek Frmy.
Well
Pr. Dhp.
PLUMBING PERMIT PERMIT # ?J "
CITY OF EAGAN RECEIPT i1 1 2,,-)(, ,9
3830 PILOT KN08 ROAD, EAGAN, MN 55122 DATE: JAN 20• 1987
CONTfiACT PRICE: PHONE: 454-8100
Site Addre*s '
Lot ? Block ? Sec/Sub
? Name
m Address 12201 MINNETONKA BLVD
c Ciry MjKA Phone 933-2521
Name
c Address
o Ciry MPLS Pnone 420-390[}
FEES
COMM/IND FEE - 195 OF CONTRACT FEE
APT. BLDGS - COMM RATE APPLIES
TOWNHOUSE 8 CONDO - RES. RATE APPLIES
MINIMUM - RESIDENTIAL FEE - $12.00
MINIMUM - COMM/IND FEE - $20.00
STATE SURCHARGE PER PERMIT - 50
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND $1,000.00)
L
SIGNATURE OF PERMITTEE
FOR: CITY OF EAGAN
BLDG. TYPE WORK DESCRIPTION
Res. A New
Mult. Add-on
Comm. Repair
Other
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
NO. FIXTURES TOTAI
' Water Closet - $3.00 $
?
Bath Tubs - $3.00 -
? Lavatory - $100 -'
Shawer - $3.00 -
Ki!chen Sink - $3.00 Urinal/Bidet - $3.00
' Laundry Tray - $3.00 -
' Floor Drains - $1.50
Water Heater - $1.50
Whirlpool - $3.00
Gas Piping Outlets - $1.50 f a J
(MINIMUM - 1 PER PERMIn
Softener - $5.00
Well - $10.00
Private Disp. - $10.00
Rough Openings - $1.50
FEE: STATE S/C:
GRAND TOTAL:
w F'tFiMl I iF rV,oc v 7
MECHANICAL PERMIT RECEIPT #
r CITY OrbEAGRle ?
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE:
•.,.....,.,...?_ 9 , .,? _ -••--•- --- ----
I Sit@
? Name`
.T Address
c City 4QiM66e
? Name _
3 Address
o ?ity -
TYPE OF WORK
' Forced Air
Boiler
' Unit Heater
' Air Cond.
, Vent.
Gas Piping Outlets #
Other
? M BTU
M BTU
M BTU
M BTU
CFM
i
FEE
S/C:
TOTAL:
BLDG. TYPE WORK DESCRIPTION
Res. New
Mult Add-on
Comm. Repair
Other
FEES ?
RES, HVAC 0-100 M BTU - $24.00 '
ADDITIONAL 50 M BTU - 6.00 '
(RES. HVAC INCLUDES A/C ON NEW ?
CONSTRUCTION)
GAS OUTLETS (MINIMUM - 1 PER PERMIT) - ?
1.50 EA_
COMM/IND FEE - 1g'a OF CONTRACT FEE
APT BLDGS. - COMM. RATE APPLIES
TOWNHOUSE & CONDOS - RES. RATE APPLIES
MINIMUM RESIDENTIAL FEE - ALL ADD-ON &
REMODELS - 12.00 i
MINIMUM COMMERCIAL FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND $1,000)
SIGNATUFiE OF PERMITTEE
FOR: CITY OF EAGAN
? ..
? '" ?
SEDGWICK HEATING & AIR CONI?ITI??ING CO?. ?
HdUSE HEATING TEST RECORD
ADDRESS CITY
OCCUPANT OWNER N G..I +-1 r? ?4 t? c nl :-t
HEAT LOSS DATE HTG. INST. -
SOLD BY INSTALIED BY «-?-
Electrical Work By $rrea fZ Gas Line By L U «?k?f-
TYPE OF HEAT GA_ FA_ ? HW_ STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN CONVERSION
MAKE 17-?w% ,.+ ia
Model ? g 4C',1 ?w {? a.?ioSo
Serial 37BL A o Z? ?g
INPUT 50, oon
CONTROLS
THERMOSTAT=Z? Heat Plug
Valve SX 345 rti'sn
Limit Z>T-=Lan?c o -
Limit Setting a S-8 ° f?
Fan Setting 10 0 ° V7-
Pilot Type
Pil ot Make 5-P A d2 K 1 G. tA t_-= R
Pilot Model 1-45c- 1
Pilot Timing _ 1iN y--"T 6 r,!`C
L.W. Cut Off
Pressure 5 • 5 " -J_ c _ Percent CO2 ?a 070
Input CFH Sb Percent OZ (p°
Stack Temp. IP,n° F Percent CO
MAKE OF BURNER -
Mode I
Max. BTU Rating
MAKE OF FURNACE
Vent Size
KIND OF LINER SIZE NONE
Draft Hood 14_ Regulator ?law-°=.
Filters Size Number Chimney Location Inside -" Ouuide
Chimney Construction
Smoke Bomb Wiring n ig-
Draft Test Tag *= ?
Door Pressure Lighting Inst. ?-
Date Tested Co " d--Z) -
Cumpany Testing SC--I AJ iGK_
Name of Tester -r1,7, "
Form 235
SEDGWICK HEATING & AIR CONDITIONING CO.
HOUSE HEATING TEST RECORD 1-14,
ADDRESS 1 ? 0 ?J I L.CL'?'t SoN D?rZ,CITY
OCCUPANT OWNER Ne,i.1 XcIR \-La r.l 40MC-S
HEAT LOSS DATE HTG. INST.
SOLD BY INSTALLED BY S?c?u1?L-3G-
Electrical Work By Gas Line By _ ??? ??•1 t ?--?--
TYPE OF HEAT GA _ FA >e HW_ STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN CONVERSION
MAKE MAKE OF BURNER ---^
Model 39 4 g,?a w-)?.s!-c? ? o Model rT'
Serial 3'7 8 lo A C-Z 9?7 Max. BTU Rating
INPUT 5 Or !Do o MAKE OF FURNACE
Mndal _
CONTROLS
THERMOSTAT Heat Plug '-
Valve Sx ?? 5?U' Sc? SC ?-
Limit
Limit Setting
Fan Setting 1 00 ° F:7-
Pilot Type ?1.??-?rZd?1 fc_
Pilot Make i-T
Pilot Model
Vent Size -=>
KIND OF LINER S12E NONE
Draft Hood i NilAtLc--L?> Regulator _?GS
Filters Size Number ?
Chimney Location Inside -'? Outside
Chimney Construction C_LiASS ?
Smoke Bomb
Pilot Timing I r-4 STvA nXT Draft
L.W. Cut Off Door Pressure
Wiring nK_
Test Tag
Lighting Inst.
Pressure 3-S %W • C_r Percent C02 -_ Date Tested -- S - D-;;;L-- g -7
Input CFH Li 1? Percent OZ {L'}' !la- --/o Company Testing S? C4 vtiiC-t<
Stack Temp. _2-3 4 ° 1r Percent CO -1'? or-J iSw Name of Tester C,?> ri
Form 235
.??.
„ ?w
SEDGWICK HEATING & AIF??ON,DITION'
HOUSE HEATING TEST RECORD
ADDRESS i Lo I C2 13 G--S-E-aN1S<?>nI C?\2l\/E CITY (=-?
OCCUPANT OWNER NJ t-I
HEAT LOSS DATE HTG. INST. ?'-'- --
SOLD BY INSTALIED BY
Electrical Work By Gas Line By ?•= nrt,?.i+c-t?--
TYPE OF HEAT GA _ FA-X-' HW_ STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN CONVERSION
MAKE ti?2 ?t n.,Q T MAKE OF BURNER
Model Model
Serial 03 81 C. t-} 1S 3 9 Max. BTU Rating
INPUT "1 ? i nao MAKE OF FURNACE
?.
CONTROLS
THERMOSTAT? Heat Plug - Vent Size
Valve SX 3-4 5NS?C- KIND OF LINER -- ---- ?-" SIZE NONE
Limit 5T6- 6'Y1 Lto
Limit Setting e- e-.) ?'_E
Fan Setting
Pilot Type
Pilot Make - fZ-)f1r'+R K 1 tT ?t?Q?
Pilot Model C1 90 - I 4 S
PilotTiming - ? r?1S'rA?VT
L.W. Cut Off
Pressure -3' s (' W • C-- o
Percent C02
Input CFH -7 O Percent 02
Stack Temp. -1 ---? 4 °r- Percent CO N o??
Draft Hood Regulator ?s
Filters Size Number 1
Chimney Location Inside X Outside
Chimney Construction _S
Smoke Bomb - -?`-Draft
Wiring n ?
Test Tag ?1 ?-S
Door Pressure `--Lighting Inst.
Date Tested ? - a`'f - f;; f
Company Testing S E o G--Q ic 1e--
Name of Tester N?? ?
Form 235
?........?? i ?..-?._.
? INSPECTION, RECORD
CITY OF EAGAN ? I PERMIT TYPE:
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
SITE ADDRESS:
i : i , ? { ; ?t .i?N ??y•
1 WiMA'. I Ai 1
PERMIT SUBTYPE: ?
: , ! f? I rf I I I 1! i f;
I ! 1, r1rN ! Mii
ilIliill 1 M !' 1 81,
Permit Number:
Date Issued:
, APPLICANT:
TYPE OF WORK:
I 1 f?? r, 1
{t/yh1=11: 1%
I 11 Fr/1 I 1111
? 1tf M AI;K S : k? # NA kA t t' 1 `t f, n I r'. qt: I 1.1 I J :i 1 ?,- I lo I I I 1: nro ' i•! ,iwr$ 1 N+, til; r I h V 1 t: i t.A? 1.4U1cp
? E f i ??,?_? I3). F
? ?j.???ti'? _- ' ? - _ - _ _ . ? __.' _ . ' -? • _ ? P? LL: t:? ??t??"-?. 1 .- - rI ?
I- J
- - - - - - - - - - - - - - - -- - ---- - - ---- - - - - - - - - - - - -
PsrmR No. PermR hlolder Date Teleptrona •
S/IN
PLUMBING
HVAC
ELECTRI
ELECTRIC
Inspectlon Dete Insp. Comments
Foptings I
Foundation
Framing ?? Gl
Rooflng
Rough Pibg•
Rough Htg.
Isul.
Flreplaoe
Final Htg.
Orset Test
Final Pibg. Plbg. Inspector- Notify Plumber
Const. Meter
Engr.lPlan
Bldg. Final ?
Deck Ftg.
Dedc Final
Well
Pr. Disp.
A -7/ /
SEDGWICK HEATING &AIR CONDITIONING
HOUSE HEATING TEST RECORD
ADDRESS ?G 1 O e-?.EW1 S ? s?! -oR k VE. CITY E to' c? `F''t'A
OCCUPANT OWNER 1 f)"SG A?n1S7u't?
HEAT LOSS DATE HTG. INST. ?
SOLD BY INSTALLED BY ? D w kc
Elecirical Work By Gas Line By _ _ Dc-,w «K
TYPE OF HEAT GA _ FA,-,_ HW_ STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN CQNVERSION
MAKE MAKE OF BURNER
Model _rcA , O,?{ b S Q Model '--
Serial ? A -Ze_? C-:i `7 Max. BTU Rating
INPUT MAKE OF FURNACE
Model
COMTROLS
THERMOSTAT Heat Plug ? Vent Size S
Valve ?: r?j SC Y, -?... _ KIND OF LINER SIZE NONE
Limit .?n c o Draft Hood ? ,L 5 t.i Regulator ?'I ES
Limit Setting . -_2 Sc °v- Filters Size Number I
Fan Setting _ c nn `r-- Chimney Location Inside X Outside
Pilot Type - [=?? ?-t ?X C% *`?c Chimney Construction C 1 09 5 S ?
Pilot Make ?0 p+Ck tc lCt IS lC? z,
Pilot Model _
Pilot Timing.
L.W. Cut Off
-
Pressure ? - = "t-I•C - Percent COZ rr
Input CFH S=` Percent O 2 GI-a `l,
Stack Temp. 1 & c' ? t-?7_ Percent CO ??o rQ ?_-
Smoke Bamb Wiring Q K
Draft ?---- - Test Tag _ ?!(C:- ?
Door Pressure Lighting Inst. 0 K
Date Tested -'
Company Testing ji o C? ?•J ?GK
Name of Tester - Go ??,l `< z?
Form 235
ClTlf OF EA GAN WATER SERVI CE PERMIT
3830 PIl- ? d% nob Road (
P.O. Sox 211 l
99 3v ? PERMIT NO.:
8391
Eagan, MN 55121 DATE 1-3?-g7
Zonin9: r' ? No. of Units: 4-T1 ex
Owner. ?'ew Horizon Ilomes
Address:
SiteAddess: 160AB CLem$on Drive L2 P1' Trails of Thomas Ltc
Plumber. ihom son Plumbin?
nnecer Na.: 76 g/ n Charge: 500. OOr,L'
Size: " ocJC VIFA ineposit: 15.0012d
ReaderNo.:() 3f I15IS2 PfnrN rl?nr.;.,rt „op fw •. 1(7.00(i
I agrss to comply wflh the?""km EL r • S?? d
Ordin. Mh? .
v1ftEV'??? At? pa?Tmeter
_ Date Paid:
Date of sp.: Insp.:
?-zc - X 7
. mr oF Eac??M. WATER SERVIC?3PERMIT
830 PIIM 'nob Rosd 3Vr , ?,/.,.,?
.O. Box 2?•199 ,/?( PERMIT NO.:
agan, IY1N 55'(? DATE
oning: No. o} Units:
. ? ew or s on omes
ner.
w
lSAddress-
ess: MOE 8O O v ,l :; _ s o _,om s .
ite Add
Plumber: oII?Pso um g
? Meter
( e:_... .
Reader
I agree to comply wRh !he Ci*6iWW - tJQAU?e!?A$
Ordinances. RC Q1 ? Ip EOta
4?. N J< g ?
#
BY J Date Paid:
Date ot In InSR•:
F7
CITY OF EAGAN SEWER SERVECE PERMIT
3830 Pilot Knob Road -
P. O. Box 21199 PERMIT NO.: ."- -?
Eagan, MN 55121 DATE: `'?.; . c 7
Zonlrq: ` 1 ~ No. of Units: -ti12:c
Owner: P'ieFl ;?O?'t2oi1 7lOCi.Bs
Add?ess: -
Stts Addross:
Plumber: _
L2 B1 Trail
Lk
I.on. to ee.Ny vr" eM Cily of E.w. C.,annsctlon Charp.: 4 7 5. OOiLd
OriiMeaM. llcoourn Depostt:
Permif Fes:
ty
?Dnb of Irap.:
?nsP.:
SurtFwrpe:
Misc. Chorpes:
Totol:
Dote Poid:
ox 21199 PERMIT NO.:
MN 55121 DATE:
No. of Units:
1 qm h awly wi& !w CIly of gww
Ordliwnam
By
Date of I rqp.:
( nsp.:
CCranttion Choepr.
AcoourM Depowt:
Perrnk Fee:
Sureiwrpr
Misc. Charpes:
Total:
DON Pold:
Charge: +-v.-v~"
- • P
;ribb Road
, 99
55121 3W?2
Owner. I't esa Uo
Address:
Site Addess: 161 [lA
Plumber. Tlininpa
Meter No.: -3 La L J{°
Size: ?
Reader No.: ' 3-
I ayree to comply wkh iho
I By ?I
; Dete ot Insp.:
7-, d-??' 7
WATER SERVICE PERMIT i CITY OF EAGAN WATER SERVICE PERMIT
I 3830 Pibt lfo,jb Road
PERMIT NO.: B3.9.3 P d3ox 71199 ?j( f,2 PERMIT NO.: h'? Q?
Eegan, MN 55121 ???! ? 1--'?fl_A7
DATE: .1=r0-87 DATE:
No. of Units: 4-:?evc Zoning: 7 3 No. oi Units: 4--nlex
?Owner. :inriZnn 'TnmpS
` I Address:
xe :14-:94-3-9 -9f 'I'h---- "- ? Sit@Add9SS: ir1 tl %:1 nnjann rricrp T.1, r?1 "'rni? a rir T}7nmac T k
' Plumber.
?
ConneoMeter No.: tion Charge: 5C1f1 _ Mpc?
ACCbU?1?idCharge: • i
° Size: '/ •c/?C , NOWnt ?PO3? ?: 15 t1i)n?
f D"Ap0_§ Gopd
oa.,s2tig?1 l1t'1?i?'? . Reader No.: CaH ? • 112 40^?-
P 4H1/? •
fiLS EtC. . ?.? . _ I agree to comply wN?f-e City A?cr?pr M -S?
Misc. ?: ??? Ordinances. Qu1RF/1
rD
z
Date Paid: By
_y : Dste of Insp_
?n
CITY OF EAGAN SEWER SERVlGE PERMIT
3830 Pilot Knob Road
P. Cy. Box 21199 PERMIT NO.:
Eagan, MN 55121 D^TE: ,
Zoninp: R3 No. of Units: ----
OwMr• '-'?E-'W HOrizwi -ROmt"! `
Addrcss: '-'
Site /lddross:
Plumber: ,._.s,?;??i Pli;:•.??;i^_;
69453 , "••
I yne !o earrtfr wNii !M Gep d fslon
OrJi"saes.
By
Dote of Insp.:
Conrnctlon Chorpe: 4??. v:? na
Aocount Deposit:
PemMt FM: 10. 002d
Surdwrpa: .? n,x
Misc. GFaroas:
Tatoi:
Daft PaW:
Date Pa`id r
Insp.:
I
CITY OF EAGAN SEWER SERVlCE PERMIT
3830 Pilot Knob Road
P. O. Rox 21199 PERMIT NO.:
Eagan, MN 55121 DATE:
Zoninp: No. of Units:
OWMf:
Add?lSS: . ? .
Site I?ddress:
Plumber.
??-
1ayrw to oowq* wMr tM C11p oi Mwa
Ordiwaeea.
By
Date of Insp.:
ConnaCNon ChOrpe:
Acoounr avoWr:
Permit Fes: ?
Surtharpe:
Misc. Chorpss:
ToRol:
Date Paid:
FOR SALE- T. H. CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 N0- 13 012
ItUIL6ING PERMIT PHONE: 454-8100 Receipt n C
7abe usedtor 1 OF 4 PLEX Est.value $64,000 pate DECEMBER 2 1986
SiteAddress 1610B CLEMSON DR Erect IN Occupancy R3
Lot 3 Block 1 Sec/Sub. TRAILS OF Remodel ? Zoning PD
Percel No THOMA$ LAKE Repair ? Type o( Const V-
. Addition ? No. Stories
W Name
s
NEW HORIZON HOMES
Move
Demolish
?
? 44
Length
Depth 27
3
?Address P
.O. BOX
13 67
Int Impr.
?
Sq. Ft
0
city MPLS Phone 420-3900 Install ?
a
0
°u<
:
?
nlame SAME 534-7388 (MARTY) APProvals Fees
Address PAGER # Assessment Permit 325.00
Phone
water&Sew. Surcharge 32.00
Police Plan Review 162 . 50
Fire SAC 575.00
Eng. WaterConn. 500.00
Planner Water Meter 63.50
Council RoadUnit 290.00
sIdg. off. 12/29 67r. P?. 156 . 00
APC Parks
Var. Date Copie $ O ?
Total
W W Name D.R. GRISWOLD
'; nddress 11975 PORTLAND AVE SO
aw CiryB'VILLEPhone 894-6287
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 Ea Ordinance
Signature ot Permitlee ?
A Building Permit is issued to: NEW HORI ZON HOMES on the express condition that
all work shall be done in accordance with all applica6lehtle of Minnes a Sta tes and Cily of Eagan Ordinances.
Building
v
DaLE T. H. CITY OF EAGAN !?J ?
'v 13013
3830 Pilot Knob Road, P.O. Box 21-1 99, Eagan, MN 55121
PHONE: 454-8100
BUILDING PERMIT Receipt#
7obeusedlor 1 OF 4 PLEX Est.Value $64,000 Date DECEMBER 29 19 86
SiteAddress 1610 CLEMSON DR Erect ? Occupancy R3
Lot 4 Block 1 Sec/Sub. TRAILS OF Remodel ? Zoning PD
Parcel No. THOMAS LAKE Repair ? Type of Const. V
Addition ? No. Stories
a NEW HORIZON HOMES
Name Move ? Length 44
i
3 Address P.O. BOX 1367 Demolish ? Depth 27
? ciTy MPLS phone 420-3900 IInt. nstmpr. O Sq.Ft.
o Name SAME 534-7388 (MARTY) Approvals Feea
$ i Address PAGER # Assessment Permit $ 375.00
w City ahone WaterBSew. Surcharge 32.00
1-w Police Plan Review 162 . 50
?W Name D.R. GRISWOLD Fire SAC 575.00
?? nadress 11975 PORTLAND AVE SO En WaterConn. 500.00
a W Ciry_B' VILL$none $94-6287 Plan ner Water Meter 63.50
1 hereby acknowledge that I have reatl this application and state that the
information is correct and agree to comply with all applicable State ot
Minnesota Statutes and City of gan Ordinanc .
Signature ot Permitlee
A Building Permit is issued to: NEW HORIZON HOMES
all work shall be done in accordance with all applicable State of Minnesol
Building Official
Council
BIdg.Off. 12/29/S
APC
Var. Date
Road Unit 290.00
rr. Pi. 156.00
Copies? 0 0
T.JnI ?
on the express condition that
and Ciry of Eaqan Ordinances.
r
FOR EALF. T.H. CITY OF EAGAN ?
_. : 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 N-? 13011
PHONE: 454-8100
BUILDING PERMIT aeceipt#
7obeusedtor 1 OF 4 PLEX Esiva,ue $64,000 oate DECEMBER 29 1986
SiteAddress-_1f08B CLEMSON DR Erect CN Occupancy R3
Lot Z Block 1 SeUSub. TRAILS OF pemodel ? Zoning pn
Parcel No. THOMAS LAKE Repair ? Type of Const. y
Addition ? No. Stories
W Name NEW HORIZON HOMES Move ? Length 44
3 Demolish ?
Address P• O. BOX 1367 Depth ??
° MPLS 420-3900 Int.lmpr. ? Sq.Ft
City Phone Install ?
o Name SAME 534-7388 (MARTY) Approi
$ nddress PAGER # qssessment
g Phone
?W Name D.R. GRISWOLD
=n Address 11975 PORTLAND AVE SO
`W c4B'VILLEphone 894-6287
I herehy acknowledge that I have read this application and state that the
in(ormation is correct and agree ro comply with all applicable State o(
Minnesota Slatutes and Ciry ot gan Ortlina es.
Signature of Permittee? ?V
A Building Permit is issued t? W HORI ZON HOME$
all work shall be done in accortlance with all applicable S(ate ot Minneso
Water & Sew.
Police
Fire
Eng.
Planner_
Council _
Bldg. Ofl.I.
Permit $ 325.00
Surcharge 32.00
Plan Review 162.50
SAC 575.00
Water Conn. 5 0 0. 0 0
Water Meter 63 . 50
Road Unit 290.00
Tr. PI. 156 . 00
Var. Date 1 Copies?p
Total ?
on the express condition Mat
Ciry of Ea9an Ordinances.
BuildingOfficial i(V ?k 1<fl o?C1
L
FoR SALE T•. H. CITY OF EAGAN A, 0
_ 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121'v 13010
" PHONE:454-6100 ? ?
BUILDING PERMIT Receipt u ? ?i
7o be used tor 1 OF 4 PLEX Est value $ 64 , 000 Date DECEMBER 29 ?
SiteAddress 1608 CLEMSON DR Erect ? Occupancy R3
Lot 1 elock 1 Sec/Sub. TRAILS OF Remodel ? Zoning PD
Parcel No THOMAS LAKE Repair ? Type ol Const. V
. Addition ? No.Stories
a NEW
Name HORIZON HOMES Move ? Length 44
=
O
P
BOX ].367 Demolish ? Depth 27
3
° .
.
Address
MPLS
c
420-3900 Int. ImPr ? Sq. Ft
iry phone Install ?
o Name SAME 534-7388 (MARTY) APProv;
i
$ ? nddress PAGER # qssessment _
? Ciry Pnone Water R Sew.
Police -
? W Name D R GRI SWOLD Fi
za ?
Address 11975 O re
RT AND AV SO E
n
g.
a W City B' VTL.L.tbhone - 894-6287 Planner-
I heie6y acknowledge that I have read this application and state that the
in(ormation is correct antl aqree to comply with all applicable State of
Minnesota Statutes and City oi agan rdinan es.
Signature ot Permittee
A euilding Permit is issued to: t EW HORI ZON HOMES
all work shall be done in accordance with all applica State of I innes
Building Otticial -C.
Bldg.
Var.
Fees
Permit a ? `' ? • ""
Surcharge 32.00
Plan Review 162.50
SAC 575.00
Water Conn. 500.00
WaterMeter 63.50
RoadUnit 290.00
Tr. pi. 156.00
Parks
Copies
rotal $2 ,104.00
on the express condiUon that
and Ciry of Eaqan Ordinances.
This request void
18 nwnchs fmm .
_ C 44358/-:_-'??
7yv :3 .i ?f'
IEJReatly NowE!PLYill Nntity Inspec-I
? 1C3' ?N 1 Wh R dy
? L cen ed Etectncal Con[ractor
I heteby request inspaction of above
Owner
elen.l.si .
Stre
e
t Atl
d
res
s, Boz
o
r Rou?e No.
..
.._......o.a.?City
I
/
/?
q
!?
I
/ ?fJ ! V '?J 1.??£YLt?'r?yv
ec t
wn
o. Towns?ip Name or No.qange No
.
County
I I ??'?
Occupam (PqINT)
r4A' LJ Phone Nn.
,
P 8 7? 3
dv+e( Suer f e Atldress
t? I ,
£ ? 7;j,? /
yf I
,{74,fj lo?v
Electrical Con?ractnr ICOmOany Name)
Con[rar.tor's License No.
MailiCng AdJress (ConVactur or Owner Makinp Ins,ailatioN
JJ97j
Au horized ' na[ur o ractor/Ow7r Making Installation) Phone Nwnb¢r
IN zqp3
STA BOAND OF ELECTRICIT
?Gr' a idway Bidg. - floom N-091
1821 University Ave„ St. Paul, MN 55104
Phone (612) 297.2111
TMIS INSPECTION flEQUEST WILL NOL
BE ACCEPTEO BY TNE STqTE BOAflD
UNLESS PFOPEP INSPECTION FEE IS
ENCLOSED.
REQUEST FOR ELEC7RICAL INSPECTlON ee.aaooi.oa/?
1 Sae inshuctiens for compie?ing ihis torm on pack oi 3 J ry vellow covv.
_"C'" 3 5 8 X" Below Work Covered by 7his Request
Weo4 Add flep. Tyoe ol euileine Aooliencas wired Equiument Wired
Home Tertiporary Service
ptBuildinc? i ater Heater
ryer Lightiny Fixtures
Eiectrie Heatin
Commereial 81dg. rnace Silo Unloader
Industrial Bldg. Air
Conditioner 8ulk Miik Tank
Farm o?he, pecry oine? isue??tv)
t er Specify Othor Other
4 Fea SarviceEn[ranceSize p Fee Feeders/Suhfeeders # Fee Circul?s
? to z00 qm s
Above 200 qmps 0 to 30 Am s
31 to 700 Ainps 0 tn 30 Am s
31 to 100 A
s
Swimming Pool A6ove 100_Amps Ahove 100_Am ?
Transiormers
Signs rrigation l3oorcis
SpeclallnsUection Partial/Other Fee ,
eem?rks TOT L FE
?T ?
Rough-in
?<ha E
spector, hareby
Final ertity Ma? the above
insuecxion nes oae.
'-? ?ae.
?,?....,,.??.......e_,._.M...._
This request void
,emo.ms_from_ i
Electncal Coolractor
?Gi?S
THIS IN57ECTION REQUEST WLLL NOT
BE ACCEPTED BY THE STATE BOARD
UNLESS PROPEH IMSPECTION FEE IS
ENCLOSED.
/ EB-00001-05
= REQUEST FOR ELECTFICAL INSPECTION
See inslrucliens tor completing this torm on back oi Vellow coOV. 732 8? ""X" Below Work Cnvered by This Request
?::Atl Rep" Tyoe oi Building Aouliuncee WireO EquiUmeN Wired-
I I I I Duplex I I Water Heater j>rrLiyhting Fixtures J
Commercial Bldg. urnace Silo Unlonde,
Industrial Bldg. Air Conditioner BWk Milk Tank
Farm otner oeci y OtnFr ISPer.lty)
t r Soecifv Other Oth.r
w
N Fee ServiceEnimnca5ize M Fae Feeders/5ubfeeders # Fee Circuits
0 to 200 Am 5 0 to 30 Am s 0 tn 30 Am s
Above 200 qmps 31 to 700 Amps 31 to 100 A s
Swimmin Pool Above 100-Am s Above 100-Am s
Transiormers Irrigation Booms PartialOther Fee
signs special Inspection TOTAL 6EE ?
Remarks
flouBh-in ? Date ?.the Elecnical
Insoector, hereby
ff cartilv thet iha above
Finai ? t
?!?? , U? ??.?? ?t Date
? ?a_yj inspection hes baen
„aaa.
Rtla request vold 18 momhe lrom
I hereby reqvest insPection of above
elactrical work instBlied aY _
MINNESOTA STATE 90AN0 OF ELECTRIGITY GripYe-Midway eldg. - Aoom N-191 104
1827 Universilv p.ve.. St. Paul. MN 55
Phone (672) 642-0800
y? ?? .3.s3 ys
?
? 4 4 4 4 ';5?0
Pequest Date
?
?? Fire No. RougM1-In 1
?1'ou mu ection Requiretl
call inspectar when reatl y) pection Otner Tnan ough-I?
? qea0y Now Will NouN InspecWr
?
T Ves ? N. Date Read
I O licensed contractor 75 owner hereby request inspeciion of above electrical work at:
Job Atldress (SVeel. 8ox or Roule No-) Cily
?
4-
Section No. Township Name or No. Ranqe No. Counry
Occu antIPRINT? PM1One No.
Power Supplier Atld ress
Eieckdwi Contmcb, 1Company Namel Conlractor5 License No.
M 'il e4-'
Mamng Aatleass IConvactor or Owner Making Inslalle[ionl &/a ,)
l+mnonzee(/y?5?u tContractovOw
?df a m9 Instal onl /?
h/,t1Lw. Phone Numbe?r
MINNESOTA STATE BOAFD OF ELECTRIC(TY THY?NSPECTION REOUEST WILL NOT
Griggs-Mitlway Bltlg. - Room S473 BE ACCEPTED 8Y THE STATE BOARD
1821 Oniversity Ave.. SL PauL MN 55104 UNLESS PROPER INSPECTION fEE IS
Fhane (612) 642-0900 ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION X!`s'l, E8 00001-08
?q p See'mstmctions for completin9 t?is form an back o( yellow coOY???? 353 9 S
1.
H6/?F64'-P - "X" Below Work Covered by This Request
Home
CommJlndustrial Furnace
Farm Air Contlitioner
OIDer (speafy) GonVactor5 Femerks:
Compure Inspection Fee Below:
Omer Fee Service EntranceSize
# Fee # Circuits/Feeders Fee
#
Swimming Paol 0 to 200 Amps 0 to 100 Amps
Transformers Above 200 _ P.mps ? Abova 100 - Amps
S19n5 Insptor's llse Only.
ec TOTAa /
Irrigalion Booms
Special Inspection
R SCON ED IF NOT
Alarm/Communication THIS INSTALLATION M O
? Other Fee COMPLETED WITHIN TN oaie
1, the Electrical Inspector. hereby Rouqn-?n ?-/(
certify that the above inspection has F;,,,i
been made.
OiFICE USE ONLY
This reques[ voitl 18 momhs Imm
This requESf voitl
78 months tmm
(C 73283
70 I Feques? D te " Fire No. RouPh-in InsDection
? Required? ?Ready Now-1117-11l Notily Insoec-
.. f ? ?? ?es ?No mr When Peady
::W, censed ElecVical Convactor 1 hereby request inspection al ebove
? Owner elactrical work installed at
Street AAdress, Bo o Houte No.
.
V c?
a. ,
ecuon o. Township Name nr No. Hange No. County
Ocw - ?PFINT) ' `- Phone No.
Powe plier A.tldress
EI al ConhMacto?r (IC'o?mpanny N
?I.C-'l'...?L Con rar,mr"s Lice s/e?No.
MailingAtlJress 1 onVa tor o wner Ma
r/) kin ?? ; la[i
? 6 ?
ti
Author' ed Si r nV r/9 ?r
?I?? n Phnn umber
3a?
MINNESOTA STATE eOAPD OF EL.ECTRICITY
Griggs-Mitlwey Bldp• - poom N•197
1821 Univerxitv Ave. S, P.o-. MN 56104
TMIS INSPECIION HGLLUtSI WILL NO1
BE ACCEPTED BV THE STATE 90AND
UNLESS PROPEP INSPECTION FEE IS
ENCLOSED.
7/- 7 (tEQUEST FOfl ELEC7RICAL INSPECTION ?e->s-ooooi-os
0 See instruCtions br cample<i?q this torm on back ot Vellow coOY• / U7?2_?
Ff' ?;X?O 7 "X" Below Work Covered bv 7his Request
?
i 1 J L V J
Type of 6uilding
Ap9liancea Wired
Equipmant Wiretl
Home Range Temporary Service
Duplex Wa[er Heater Lightinq Fixtures
Apt. Building Dryer Electric Heztin
Commercial Bldg. - umace Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tank
Farm +n«. oec' v omo. (so,>,,iN
t gr Syccify ther Other
ompute Inspec[ion Fee Below
N Fea ServiceEMroncaSiie R Fee Feeders/Subtaeders f? fee Circuits
0 to 200 qm 5 0 to 30 qm s 0 to 30 Am s
Above 200 qmps 31 to 100 qirips 31 to 100 A s
Swinvnin Pool Above 100_Amps Above 100-Amps
TranSformer5 Irrigation Booms ?drtial.'Other Fee
$igns Special Inspection S % TOTAL FEE-'
\,
emsrks l .
. r.i(L??`/
flough-in D`?f I, the ElacUical
, S r
? InsDector, heraby
Certify that the bave
Findl /? ? ?'fFe?•?
aa InspBCtion he8 b9811
U?>?J..... . mada.
ThIB repuast voi0 t9 montm rrom
This request void
18 months tmm i
f 7'? ? R ? ;_e n
Request Date • ?
o' ? Fir¢ No. Rough-in Insvectlon
flequired?
? ?,,..,?6yp'?
?Ready N°?? ill NotifY InsPec-
/ ior When fleadY
es ?NO
15?ensed Elecvical Conhaclor 1 hereby requast inspaction of abova
n Ownn.r electrical work instelled at
She t Add ss, Bo or Ro te o. C
I ? . ? ? ?
ec ion o. Township Name or No. RanBe No. County
NT1
FI
Oc u- nt IP Phone No.
? •
I
,
: W . Y ? G-
Powe Dlier Atldress
Elect j I Convactor (CompanY name c
Contr?cto
7
O
?
l??? ?
??
;
S
Maili 0/1d ress?l nVactor or ner Making l!S ailaLOl
ft ? V 6 o"
Au onze`d Signa e ontracl
, ly , er Ma inB Installati ? Phon umber (?
MINNESOTq STATt BOART) OF EGCTNIC119 J- THIS INSPECTION REQUEST WILI NOT
aE qCCEPTED BV
Grigpa-MiAway Bldg. - Noom N•191 THE STATE BOApD
1827 Universitv Ava.. St. Paul. MN 55104 UNLESS PXOPEP INSPECiION FEE IS
. ENCLOSEO.
, ,, ..
?1,
7/g 7 REQUEST FOR ELECTRICAL INSPECTION ee-00001 0e
I0 See instructions tor completing this brm on back of veliow copy. '701 i
"T'X" Be/ow Work Covered by This Request
INeA HAdTReo. Tvoe ot BuilEina 1 Aool?ancea WireA EquiVment Wired
I I I I DUOIHx I I Water H¢ater Lightiny Fixtures
tap[. owiaing uryer ciecunc neaun
Commercial Bidq. urnace Silo Unloader
r
ina /ncnnrt?nn
k Fee ServiceEnhance5ize k Fea Faxders/Subfeeders # Fee Circuits
0 to 200 Am s 0 to 30 qm s 0 to 30 Am s
A6ove 200 qmps 31 to 100 Ainps 31 to 100 A s
Swinuning Pool Above 100-Am s Above 100_Am 5
Transformers Irrigation Boortis Partial.bther Fee
SignS Sp2ciallnspection '?.
Hemarks ? TOTAL ¢ E ?
? u 1
s l?%rr
Inougn-m o< I theElecTlica??
Inspectoq hereby
? -artify the? the above
Finai ?//? ( ?^le
?s apection hes been
? made.
?
5
0565 ,??;
Requesi Oate Fire No. Roughdn InOSeclion Require tl
(VOU must call ins0ector when ready) Insp tron Omer Tnan aougn-In
? dy Naw ?WIII Nolify Inspector
?-`3- fy ? ves IE' No oateReatly
I)U licensed contractor ] owner hereby request inspection of above electrical work at:
Jo0 Acaress ?SVeet Box or Foute No.I
i6t7? l? G\a,.,`7ti. Gity
e A
5ection No. Township Name or rvo. Fan9e No. Counry
DAV?-40-
n
[fPRINT1
Occupa Phone No-
,
1
Yi?-L?IY
Ppwer
Plcr
S
uG Atltlress
?
^
`
V?
Eleclncal Contraclor IComDany Name1 sLicense No.
tor
o
nlr
ac
C
?.X}Q'QlL'ii Qt' ,_ ?
.
p
_
?
Maiting Atldrass fConhatlor or Ownar Mekmg InstelleLOn)
`P 0 rl?vl V'1S . " ` , `'
Nufior¢e naWre IGOniracton nar M Ir;btalla0on, ?
.? ?: Phone Number
?
MINNESOTA STATE BONflO EL CTPICITY Q? TMIS INSPECTION REOUEST WILL NOT
Griggs-MiEway Bldg. - Hoom 5-193 BE ACCEPTED BV THE STATE 80ARD
1821 Universily Ave., 51. Veul. MN SSiDC UNLESS PROPEP INSPECTION FEE IS
Phone (612) 642-0500 ENGLOSED.
.e?
REQUEST FOR ELECTRICAL INSPECTION 9 y E9
? ?
? Seeinstmciions lor completiny Ihis lorm on beck oi yeilow copy.
C
'zi
M ri -"X" Below Work Covered by 7his Request N???l? v AppliancesWiretl EquipmenlWiretl
ew ` Rep. TypeofBUilding
Temporary SeNice
Home Ranqe
ElectriC Heating
Duplex Water Heater Load Management
Apt. Building Dryer
city)
Other (Spe
CommJlndustrial Furnace
Farm Air Conditioner
Othar(spec0y) Gomreator's Remarks ,
1
A-te
Pr
C
Compute inspecfion Fee Below:
# Circuits/Feeders Fee
I
p Other Fee Fee
# ServiceEntranceSize
Pool
Swimmin 0 to 200 Amps / 0 to ?00 Amps
g Amps
tiove400
'P
Transformers _
.
Above 200 _ Amps
?
Signs
. inspector5 Usa Onry.
?, TOTAL
?
Irrigatlon Booms
Special Inspection
CTED IF NOT
i
ti IS INSTALLATION MAY BE ORDERED DISCONNE
ca
on
AlarmlCommun TH
Other Fee i COMPLETED WITHIN 18 MONTHS.
oaie
I, the Eiectrical inspector, here6y
RaugRm
certify that the above inspedion has F,,,ai oa1e _ CJ ?yG
been made. ?
OFFICE USE ONLV
This request voitl 18 monms Imm
L
This ?eauest wid
18 months fmm
ff' 7 q 9 R 1 I I i2 l .%! / . i%. ? /.,,??.? .,• ??,'?n;.
Nil ' _ _ _ _ ti.i , n„ I I,_, ..
e
Henuest Dat ?
/
'? O - ? Fi re No. ; cUon
? Hauph-in Insp
eQU [ed?
?
N
?Aeady Now SWGII Notify InsDec-
?'fo, wnen Feady
Ves ?
O
?icensed ElecVical ConVactor I hereby request inspec[ion ol ebove
I-l nwoo, elactrical work instelled at:
5[r7 AdOre s, 60 ?J oute Na.
ecUOn o. Townshio Name or No. Range No. County
O cu ant IPIiINTI • Phone No.
v+
Power plier Address
Elec I Convacto' (Company Name) Conhacto r?s License o
Op
Mailing Address (CO trac?r r'Owner Mak?ngfn5tailonl ? -
ul U ?
Author zed ntr od aking Insta [- 1 Ph? Number ^
MINNESOTq STATE BOAPD OF ELECiA1CITV
Grie9s-Midwey Bldg. - floom N-191
1921 Universitv Ave.. St. Geul, MN 55104
BE?ACCEPTE? eV THE STqTE•BOARD
UNLESS PPOPEF INSPECTION FEE IS
ENCLOSED.
7 REQUEST FOR ELECTRICAL INSPECTION E?C?? y
' See inshuctions lor completinq this lorm on beck oi Vellow coOV.
'"1(" 8elow Work Covered by 7hrs Request InewlAAd Nao- Tvoe ol BuilOlna AOOliancea Wired Equiument Wired ?
Duplex WaTer H¢ater Lightiny Fixtures
Apt Bu'Id'ng Dryer ?Elec[riC HeaUn
I I Cnmmercial Bldo. umace Silo UnlOnder _
Industrial Bldg. Air Contlitioner bWK IVIIIK ianrc
Farm tnxr Pen v Other Isnecilvl
t,r ueci y Other Oiber
N Y Fe r5ervice EnvanceSize p Fee Fexdars/SuEfeetlers # Fue Gircuits
0 to200Am s 0 to30Am s 0 m30Am s
Above 200 qmps 31 to 100 qmps 31 to lOD Am s
Swimming Pool Above 100_Amps Above 100_.4m s
Transinrmers frrigation Booms Partial•'Other Fee
Signs 5peciai inspeccion $ TOTALFEE '
PertN,ks ?f? ;
/
Pou h-in
0 Oace ?
I, the E ni<al
? ?"_, T Insoec?or, ne.eby
cenify thet the above
Pinal ?ALe
c 4?; inspaetion hes Deen
maea.
This requesl vo101B monMS irom
18is repuest aoid
monlhs /mm
Q 73190
6 r_?4? 4.
Nill NntitY InsP"-
for When Ready
.eJ'Licensed Electrical ConVaclor I heFeby request insoecHan of eDova
? Owner j /, I-Y,7 elecbical work instalied aY
Sve t
.,
I
1 ? C?
?
ection or No.
7 Range o . County
Oc n
(PRINT) - Ppone No.
Pow Su rAdd,sss
..
0cal ConVacto m
r ICOpany Namel f
?
Contr
?
??.
iddress 1 ontr 1 r r ner Making
Autho zed u ont /Own akin I II
to Ph?NUmber
? --
MINNESOTA STATE BOAND OF ELECTRICITY
Grigga•Midwey BId9. - Room N-191
7821 Universicy Ave.. 5<. Peul, MN 55104
Phone (672) 642-0800
THIS INSPECTION HEQUEST WILL NOT
BE ACCEPTED BY TME $TA7E BOAND
UNLESS PNOPEN INSPECTION FEE IS
ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION ee-C0.00/01-05
, See instructiens for compleling this larm on beck ol yellow copy.
1 q n "X" eelow Work Covered by Ihis Request
u.ea aeo. " rvoe ot euiieine nool+encea wcrea EpuiVmanl WireA
Home Range Temporary Service
Duplex Water Heater Lightin,y Fixtures
Apt. Building Dryer Electric He2tin
Commercial Bldy. furnace Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tnnk
Farm omTr oeci v Tnnr Isnacltvl
t r pecify 1ho, piher
q Fee SarvicaEntrence5ize p Fee Feaders/Subfeeders d Fee Circuits
Uto200qm s Oto30qm s 0 to30Am s
Ahove 200 qmps? 31 to 100 qmps 31 to 100 q y
Swimming Pool Above 10
0_Amps ? A6ove 100_P,m s
Transiormers &
rrigation ?oms Partial/Other Fee
Signs Special Inspection
S ?
Pertwrks I`S . ?
J? TOTA FE ??
V
flouBh-in Date
I, the el
Inspectoq heraby
Final
D.I. cerlily fhet the above
{nypection has bean
marde.
,,,,,w- ,.u- ,o,,- „L,e„-,,, vf?. ?'(
G...vwu
c1??-
?
2007RESIDENTIAL BUII.DING PExnaT nrPIAcaTTOrr
Ciiy Of Eagan
3830 Pilot Koob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
N?e fonSVUftm Remi6emk '
3 regisimed sde wrveys slrowkg s4 R. of lat s9. @ of house; arid aA roofed mm
(2076 madmum bt aurerage aqaw0
150ft Repat Nproposed WOang is lo bepWeed an dsRUheti sod
2 oopm dPan showeg bemm 8 xmiAow sizes; Paiued tound desw. e?.
t set of Energy CalcWetions
3 oop¢es of Tree Preservalion han N bt Plafted afler7/V93
Rim Jast OetO Optians sedecM1On yied (6wldngs wilh 3 w less unils)
ASmeg? marhenital ventilatian toim
RmnOdBVRB081f RB0111?115 ORG9I18B 01i7
2caqesafPlendOVringfootings•bemns.jasts Certa(SunreyWecd _Y _H
1seLofEnergy Galwlationskf fiested•ad6Ciotw _ SalsReput _Y _N
isitesurvey(oredditionsBdetlte TreePresPlan.Red _Y _N
Ad66on-hdcalerYOnsb sVk Syafem TteePresReored_Y _N
p,sb SepM1c S)5isot _ Y_ N.
Ptans are cansidered public information untess vou state thev are trade secret and the reason.
i.
??=l /
b S/0-7
Construction Cost d) Q, D d d "'-?-
Site Address L? n a - / (p p $ ?3 /n UniF/Ste #
G / C rti. .,.d
Description of Work ? /?
o o?L I ?-
J
i
Molti-Fsmily Bldg ??Y _ N Fireplace(s) _ 0_ 1 _ 2
ProPe1'b' O+'ner r
a
? T? o n, c t L t?<< Telephone #((' f1 )? 4 4' 7J O
Coetractor L Y S /i ?! .
Addreas . O• 604 ? Cit_y ?LCTAJrJUQ .
State 1 Z &( , Zip Telephone # &"2) ZV
COMPLETE THIS AREA ONLY IF
Ene Code C - MinnesotaRutes 7670 CareQOrv 3
? g????? ? ry • Resldentlal Ventilation Category t Wurksneet
Submitted
• Energy Envelope Calculations Submitted
A NE1M BUfLDING
Mionesota Rules 7672
• New Enetgy COde WofkSheEt
Submitted
In the last 12 months, has The Ciiy of Eagan issued a permii For a similar plan based on a master plan2
_ Y _ N If yes, date and address of master pian:
Licensed Plumber
Mechanical Confractor
SewerlWater Contractor
apply for a
Building Permit and
complete and
,
that the work witl be in conformance with the ordinances and codes of the Ciiy of Eagan and the State of MN
3tatutes; I understand this is not a permit, but only an appticarion for a permit, and work is not to start without a
permit; that the work will be in accordance with the approved ptan in the case of work which requires a review and
approval ofplans.
C-[JCr l?a?cr.rf tyr?aJ .TJ6- _ ?
?'e..« /do
Appiicant's PrintedName L,-? t£ 3 p-?Y ApplicanYs Signature
Telephone # (
Telephone #(
Telephone #(
1986 BIIILDING PERMIT APPLICATION - CITY OF SAG9N
NOTE: gib COPTRACTOHS MOST SE LICENSSD tiITH THE CITY OP EAGAN
SINGLE F9lIILY D1iELLINGS
INCLUDE 2 SETS OE PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIO
MOLTIPLE Dii6L.LINGS _ gg3IDENTIAL RENTAL DeTITS FOR 3ALS ONITS
INCLUDE Z SETS OF PLANS, CE[i
1 SET OF SNERGY CALCULATIONS
COHI9ERCIAL
OF SDR9EY - CHECB iiITH BLDG. DSPT.0
INCLUDE 2 SETS OF ARCHITECTURAL & STRIICTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF
ENERGY CALCULATIONS,
$2,000 LANDSCAPE BOND
uQIT P?E?x c?4,aoo
To Be Used For: Valuation: Z??
Site Address zgD'4 ?(lL?'15ON Qi
Lot / Block ? i
Parcel/Sub TP,AIL?5 OF (k:t'1q5 Lla-?
Owner p-lfl?
,/? T-'
9ddress /" zc'?;-7-_
City/23p Code .
PhoneC?/?
Contraetor EW lzienm
aMES
Address / •Q. Sox 130
City/Zip Code !y`p LS }mN.
T
Phone LF LO -
Arch./Engr. -0-??L
Address
City/Zip
Phone #
nate:
Erect ? Oecupancy ?Z-3
Remodel Zoning P?
Repair _ Type oF Const ?
Addition # of Stories
_
Move Length 4
Demolish Depth 2"7
Int.Impr. Sq Ft
Install
9PPR0V9LS FEES
f
Assessments Permit 3 Z S,
Water/Sewer Sureharge 37- .
Poliee Plan Review 16 Z. 2a
F3re SAC 5 -7S •
Engr Water Conn SCp.
Planner Water Meter
Couneil Road Unit Z9 D.
Bldg Off Treatment Pl ? 5[0.
APC Parks
Variance Copies
ZOTTAI. ?
NOTE: 9DDHESSES FDR CORIdBR LOTS - CONTRACTOR/HOMEOiTNEA MUST DESIGN9YB WHICH ADDRESS
IS DESIRED. NO CHANGES WILL HE ALLOiiED ONCIi BUILDING PERMIY IS ISSOED.
'O{{?l -OFFtcC Bc.vC,S. 3 z,33, 34 4c? pac- a-P PuAu Desr6?(
MP2'f`T -Fic!!-i.C>
• ????/
1986 BQILDING PEMIIT APPLICATIOA - CITY OF EAG9N
NOTE: ALL COPTRACTORS MOST BE LICENSBD iiITH THE CITY OF EAGAN
SINGLE F91+IILY DWELLINGS
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATION?-
- - /
MpI.TIPLS DHELLIliGS - RSSIDENTIAL RENTAL QNITS FOR SALE DNITS V
INCLUDE 2.SETS OF PLANS, CSRTIFICATE OF SQRVSY - CHECB WITH BLDG. DEPT.,
1 SET OF ENERGY CALCULATIONS
COMASE9CIAC
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
t SET OF SPECIFICATIONS AND 1 SET OF
ENERGY CALCULATIONS, y
$2,000 LANDSCAPE BOND
uNir 9q ?04,o,?
To Be Used For: zdaa? Valuation: '•?- Date:
G
/LO?? 6J- LF_MSOw4 Site Address ?. OFFICE II
Lot ? Block ? I Ereet _
Parcel/Sub
Owner f`/???J???.,?
_?
Addreas
City/Zip Code'?',??
"?-
Phone??l ??- ?1,9ylTj
Contractor
Address
City/Zip Code
Phone
Arch./Engr. 1
Address
City/Zip Code/S?i?.sr_?,s.vf'?
Phone #
Remodel _
Repair _
Addition _
Move _
Demolish _
Int.Impr. _
Install
APPSOVALS
Occupancy
Zoning
Type of Const
JF oF Stories
Length
Depth
Sq Ft
Assessments Permit
Water/Sewer Sureharge
Police Plan Review
Fire SAC
Engr Water Conn
Planner Water Meter
Council Road Unit
Bldg OfF Treatment P1
APC Parks
Varianee Copies
?OTgI.
NOTE: 9DDHESSBS FOR CORNER GUTS - CONTRACTOR/HOMEOSiNER MOST DESIGH9TE AHICfl ADDRESS
IS DESZBED. HO CHANGFS WILL BB gI.LOWED ONCE BOILDING PEBMIT I3 ISSQED.
1986 BOILDING PERIiIR APPLICATIOH - CI1R OF EAGAN
NOT6: ALL CONTRACT08S MQST BE LICSNSSD WITH THE CITY OF EAGAN
SI9GLE F9lIILY DWELLIBGS
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS,
MOLTIPLE DWELLINGS - HSSID6NTIAL RE6T9L UeIIRS FO& SALS ONITS
INCLUDE 2 SETS OF PLANS, CERTIFIC9TB OF SQR9SY - CHEC% iiITH BLDG. DEPT.,
1 SET OF ENERGY CALCULATIONS
COAAfERCTAi:
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF
ENERGY CALCULATIOHS,
$2,000 LANDSCAPE BOND
uN I T- qq (,4a`Xo
To Be Used For: Valuation:?_ Date:
Site Address ?(pl? -eM?oN Dw•
Lot ? Block
Pareel/Sub
Owner ?p+r? sz-a?
Address Z-??Z
City/Zip Code ::42?_?s?yyiJ
Phone 4:?? )`-.F9djy
Contractor /VEW ry(E$
Address /`•"Q&Av?
City/Zip Code
Phone
J ,
Arch./Engr.
Address
City/Zip Code
Phone
Erect _
Remodel _
Repair _
AddStion !
Move _
Demolish _
Int.Impr. _
Install `
APPFOVALS
Oecupaney
Zoning
Type oP Const
# of Stories
Length
Depth
Sq Ft
FSES
Assessments Perm3t
Water/Sewer Surcharge
Police Plan Review
Fire SAC
Engr Water Conn
Planner Water Meter
Council Road Unit
Bldg Off 1reatment Pl
APC Parks
Variance Copies
TOT9L
AOTE: ADDHESSSS FOR CORNER LOTS - CONRRACTOR/HOHEOiTNEB MDST DESIGN9Tfi AHICH ADDRBSS
IS DSSIRED. NO CHANGES iIILL BE ALLOfiED OHCE BUILDING PEBMIT IS ISSDED.
1986 BOILDING PERMIT APPLICATIOH - CITY OF EAGA9
NOTE: ALL CONTRACTORS MOST BE LICENSED i1ITH TH6 CITY OF EAG9N
3I9GLE FANIILY DAELI.INGS
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATI?
MOLTIPLS DSiELLINGS - RfiSIDSNTIAL RENT9L i1BITS F08 SAGE D6ITS
INCLUDE 2 SETS OF PLANS, CERTIFICATfi OF SORV6Y - CHiC% WITH BLDG. DffiT.,
1 SET OF SNERGY CALCULATIONS
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND t SET OF
ENERGY CALCULATIONS,
$2,000 LANDSCAPE BOND
UtitIT 9cj
To Be Used For: Valuation: ?
Gcp4xu
Site Address o D2. I OFFICE U
Lot ? Block -,- I I Erect
Parcel/Sub
Owner -1!?
Address
City/Zip Code
Phone
Contraetor I?(EW Riw ?i?iMES
Address
City/Zip Code'7.Gj
Phone
Areh./Engr.
Address
City/Zip Code
Phone U a/) 89y lGi???
Remodel _
Repair _
Addition _
Move _
Demolish _
Int.Impr. _
Install _
APPHOYAIS
Date:
Occupancy
Zoning
Type of Const
# of Stories
I.ength
Depth
Sq Ft
Assessments Permit
Water/Sewer Sureharge
Police Plan Review
Fire SAC
Engr Water Conn
Planner Water Meter
Council Road Unit
Bldg Off Treatment P1
APC Parks
? Variance Copies
lY1TAL
HOTE: ADD6ESSSS FOR CORNE@ LOTS - CONTRACTOR/HOMEOiiNEB lSIIST DESIGH9TE AHICH ADDRESS
IS DESIRED. NO CHANGES WII.L BE ALLOTiED ONCE BIIILDING PBRMIT IS ISSQSD.
31aIrroi(S ?P ---rbamas ka1??i,,jt-.)
IVtX GV, IS?
, . .?.i
HEAT LOSS CALCULATIONS HEATING &AIR CONDITIONING CO. MINNEAPOLIS, MINN.
Wenthersirips A,S.H.V.E. ConstruCtion No. Insulation
gindows Doors Guide
RefarenCe Out. Wall Int. Wall Ceiling Rooi Floor Kind How Applied
Ves-No Yes-No 19 _
FI.L_,vtNi,(F, _rHoom Length ^j„2- Width Height' ? Fl. Mt:cv'P. P+`-)Ropn Length 0 -YµiAFh HeigM ?
Wi ndows a nd Doors- Cracka ge and Ar ea Windows a nd Doors- Cracka ge and Are a
No. 'n'.'jIh
ol a
ne Heiphl
OI pana No. ol
li pis L?neal It.
of crdGk A?ea
sq. 11.
N,' WiA,h
ol
a
n0 Noip?l
01 pane Nn. o/
li h IS Lrnea? ?t.
o1 cratk Area
5a. 11.
`
? l. _? ?' ? .? y
ir•'t ? ?
j
1? .?': ? ?- ? 1-7
, •1 \ Y
? ?•' & 57?
Coef Btu Coet Btu
Infiltration R ??3 Iniiltration 21 3?1 -I='Q
Glass Glass 5
Exp.wall a4:.4?'.(; Exp.wall iQ>'
Net enp. wall Net exp. well Y^ 9. ? 2? ?
"hT. wdH' QOc 1 y LL T 2223 Int. well
Ceilin9 ,..2 ,?<1?- Cailin9
Ploor - Floor
Total Btu. 7S'1 Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Rqquired sq. ft. E.D.R. or sq. ins. W.A. Leader area
F1, Room Length ?`-; Width Height FI. r..?-? .4lt(?qom Length Width I(1 HeiyM i1
Wi ndows a nd Doors- Cracka ge and Ar ea Wi ndows a nd Doors- Cracka ge and Ar ea
No. Wid?h
ol ane Meiqht
ol ane Na. ol
li hts Linael It.
of crack 4n,a
?a. I.
NO' W???h
ol ane HeqM1!
?f ann No. u1
?? hts Linaal 1t.
of crack Area
sa. h.
.
-2
Coet Btu Coef Btu
Infiltration
-
7
22q0
Infiltration ???
ciess L? ra SO ;?Oc' b Giass
Exp. wall Exp. wall
Net exp. wall Net exp. wall 32
InT. wall Int. wnll
Ceiling ? J Y..??
9 ?
]Z•S
2
Ceilinp
1?Q
'•`? C
.37J
Floor Floor 9
Totel BtU. S Totdl Btu.
Required sq, ft. E.D.R. or sq. ins. W.A. Leader are. Required sq. It. E.D.R. or sa. ins. W.A. Leader area
F?• ??T U.c .? Roam Length 1;?, Width ?r Height ? 1 FI. F-%?-? ?. Noom Length ?() Width Height
YJindows and Doors-Crackage and Area W indows a nd Doors -Crack age and Ar ea
NO' Widrb
ot ann He?9h1
0f pana Na. ul
li hig Lineol IL
ot crack Aeo
sp. fI.
NO' w?nn
ui anB H'-qhl
ul oann No. of
h Ms Lmeal l?.
oi C?aCk Areq
eq. it.
Coe1 Btu Coel Btu
Infiltration InfiltratiOn
Glass Glass
Exp. wall Exp, wall
Net exp. wall Net e.p. wall
Int. wall Int. wall
CeiUng l1"?. ? F?l^:.? '1.'.? 2 10 Ceiling ;;rl 12
Floor '._Finor ? i. _
Total Btu.
Total Btu.
Required sq. tt. E.D.H, or sy. ins. W.A. Leader area 2- ci Reqaired 5q. h, E.D,P., or sq. ins. W,A. Leader area
.
lHEAT LOSS CALCULATIONS
HEATINGBAIR
ukc6
CONDITIONING CO.
MINNEAPOLIS, MINN.
Wentherstrips A.S.H.V.E. Construction No. Insulation
Windows Doors Guide
Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied
Yes-No Yes-No ig__ _
y FI. fLy ?{, ' ? Rown Length Width Height FI. Room LenBth Wid[h Height
YJi ndows a nd Doors- Crecka ge and Ar ea Windows a nd Doors- Cracka ge and Are a
No. WiAih
ot ane Heipht
of Oane No. ol
li hts Lmeal ff.
of crack Area
D. il.
NO' W???h
ol ana Haiqhl
al ane Nn. of
?? hts lineal It.
of oack Aiea
su. [I•
Coef B tu Coef B tu
Intiltration '?? 71pO Infiltratim
Glass ( &a) Glass
Ezp, wall "ll!' ? J Exp. wall
Net exp. wall Net exp. well
Int. wall Int. well
Ceiling Ceiling
Floor r{?'l 7C („p?J Floor
Total Btu. Total Btu.
Required sq. ft. E.D.H. or sq. ins. W.A. leader area Required sq. ft. E.O.R. or sq. ins. W.A. Leader area
? FL -t-.,rRoom Length Z Width I ? Height fL Aoom Length Wid1h Haiyht
Windows and Doors-Crackage and Area Wi ndows a nd Doors- Cracka ge and Ar ea
No. WiC,n
ol ene Helpht
al ane No, ol
li hb L,neal h.
ol tra
ck 4rea
4• ft•
.^+ No
' Width
ol one Hiaqhl
nf ann No. of
li hts l?n eal It.
o/ crack Arefa
60. ?•
Y q
J ^
.[ .
` f?_i ..q> ?p
l
Coe( Btu Coef Btu
Iniiltretion V 11^1 2223 Intiltretion
Glass QQD Glass
Exp. wall Exp. wall
Net exp. w 11 2 gZ 4.1 1 U07 Net exp. wall
I^t ?µ 7? - ? Z 7U .22 InI. WAII
COiHng Ceilinp '
Floa aZ 'S A K Floor
Total Btu. 1? Total Btu.
Required sq. ft. E.D.R, or sQ. ins. W.A. Leader area Required sq, ft. E.D.R. or sq. ins. W.A. Leader area
Fl•? f•:;[( r' RI??9oom Length 13 Width -7 HeigM FI. Roan Length Width Height
Windows a nd Doors-Crackage and Area W indows a nd Doors -Cracka ge and Ar ea
NO' Widin
of ane Hei9h[
of pxne No. of
li hls Lmeal ft.
af ueck 4rea
sV. ??.
NO' Wini??
ol nna IU pbt
ul an Na ol
li hts Lineal 1t.
o1 crack Area
BV. «•
Coef Bw Coef Btu
Inliltration infiltration
Glass Glass
Exp. wall Exp. wall
Net exp. wall Net exp. wall
IM. Well Int. WAII
Ceiling Ceiling
-------
Floor ir a -
iotal Btu. Total Btu.
RequireJ sq. It. E.D.R. or sy. ins. W.A. Leader area Raquired sq, ft. E.D.R, or sq. ins. W.A. Leader area
2004 RESIDENTIAL BUILDING PERNIIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
T ? p c) ?
New Core Wc6on Reauiremenfs RemodellReoair RequiremeMs Offrce llse {7?1u
3 regisiered site surveys showing sq. fl. of lol, sq. ft. of house; and sll roofed areas 2 copies of plan
(20%maximum lot coverage allowed) 1 set of Energy Calwlations for heated addtions ireePces Af6tiR?tl 'f U7
2 copies of plan showing beam & window sizes; poured found design, etc. . 1 siie survey fir adcFitions & decks ?ree Pres keqtiired ,^,Y _,,,N
lsetofEnergyCalculations Addifion - indicateifor?sitesepficsysfem Dlt-Site3epiic:5yslem ?:Y.:..?N
3 copies oF Tree PreseNation Plan if bi pladed afler 711193 ,
Rim Joisl Detail Options selec6on sheel (bldgs wAh 3 or less unAs '
Date _[L_ / Constructian Cost ?`I?? J
.
Site Address ???1" ?\?-- U niUSte #
w
Description of Work _fl?-ku pJ-i- 1??) ?1 Q
I_A, g '" ??L
,
Multi-Family Bldg \J?Y _ N bY'replace(s) _ 0? 1 ^ 2
?p
Property Owner
Telephone # ( (0i)
) 6bCD"y ?L
Contractor
Address Ho'l 13 City
State ? Zip -?5)3) Telephone#07Z-) `c37,) -47?
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Ca[e¢orv 1 Nlinnesota Rules 7672
Energy Code Category , Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(4 submissiontype) Submitted Su6mitted
. Energy Envelope Calculations Submitted
Have you previously constructed a bui{ding in Eagan with a similar plan? _ Y _ N If so, 25% plan review
fee applies.
Licensed Plumber
Mechanical Conhactor
Sewer/Water Contractor
Telephone #(
Telephone #(
Telephone #(
I hereby apply For a Residential Building Permit and acknowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a
permit; that the work will be in accordance with the approved plan in the case o work whirh_requir€s-a-rt,w'ixe?w-and
IS
approval of plans. U
S)41? 2G04 ?
Applicant's Printed Name Applic t's Signature ;-? L
UOA?? MECHANICAL (RESIDENTIAL)
Permit Apptication
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5694
Please complete for: Single Family Dwellings
Townhomes and Condos when pemiits are required for each unit
c3a. S-T)
D
t
/ / ? / n15
a
e
Site Address )L, I(-?) -6 CT),- ' Unit #
Property Owner LC1f?(f./'1 Q<S-rrcLrvd Tetephone #(C.eS1 )LA.5Q - S`7 q?
Contractor Wohlers Southside Htg. & Air, Inc.
6950 W. 146?' St., 9 106
Street Address
Apple Valley, MN 55124 C't3'
gtate (952) 431-7099
l Tetephone # ( )
r-
The Applicant is _ Owner ? Contractar _ Other
Add-on, modification or alteration to eaisting dwelling unit $ 30.00
furnace replacement
air exchanger
? air conditioner
other
State Surcharge $ .50
-l
Total $
I hereby apply for a Residantial Mectianical Pernut and acknowledge that tlie, information is completeju?d accurate; that the work will
be in conformance with the ordinances and codes of the City of Eagan andI with the Mechanical Codes; that I understand this is not a
pemilt, hut only an applicatlon for a pernrit, and work is not to start without a perxnit; that the work will be in accordance with the
approved plan in the case of work which requues a review and approval of plans.
?.7ar-?i?{ I . U?r`hlers Aocl-?j i"? L
ApplicanYs Printed Name ApplicanYs Signature
PERMIT
? ?CITY OF EAGAN C??334?
3830 Pilot Knob Road PERMIT TYPE: aurLorNe
Eagan, Minnesota 55123 Permit Number: 024983
(612) 681-4675 Date Issued: 12 /z z/g q
SITE ADDRESS:
1610 CLEMSON DR
LOT: 4 BLOCK: 1
THE TRAIlS OF 7HOMA9 LAKE
P.I.Ne: 10-75865-040-01
DESCRIPTION:
ild3ny=_.Permit Type
i.lding W1'6.rk Type
BASEMEPIT FINISH
RL7ERA7ION
r
REMARKS
SEPARATE PERMT75 ARE REQUIRED FOR ANY PLUMBING QR ELECTRICAL WQRK
FEE SUMMARY:
Base Fee $35.00
Surcharge $.S@
Tota1 Fee $35.50
CONTRACTOR: OWNER; - Applicent -
AMSTUTZ BARBARA
1610 CLEMSON qR
EAGAN MN 55122
(612)454-4888
I hereby acknpwletlge that 2 have rsad this applicatian and state that the
information is carrect and agree to comply wiGh a.L1 aPP],icable State of Mn,
StatutBS and City Qfi Eagan 4rdinonees. ZL
,
rn
APPLICANT/PERM EE SIGNATURE ISSUED B. SIG TURE
-i
CITY OF EAGAN
1994 BUILDING PERMIT APPLICATION
681-4675
• 1?0
CC:.?l'1?? ??,-21
SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site survi ys, 1 cap°y ?of'ene gy
calcs.
COMMERCIAL 2 sets of architectural & structural plans:
I set
of
_
_
_-__
specifications, 1 copy of energy calcs.
Penalty applies: 1) when permit is typed, but not picked up by last working day of month
in which request is made, 2) address is changed or 3) lot change is requested once permit
is issued.
Date /2, -'21 Valuation of work o `
'
Site Address: /6 /0 e/£?+60 ni?n
STREET SUITE !1
Tenant Name: (commercial only)
?
IAT ? BIAC& SUSD. %j)Ctt?-b P.I.D. *
Descri tion of work: f-'j
The applicant is: ? Owner ? Contractor ? Other (Describe)
Name tf44ZG,P6,QQ? P h o n e lkw_
Property lAST FIRST
Owner L'16
*
Address
1,
?Ao ^--
STREfT STE #
City State %'7-k -1- Zip `
Company Phone
Contractor Address License # Exp.
City State Zip
Company Phone
Architect/
Engineer Name Registration #
Address '
City State Zip
Sewer & water licensed plumber . Processing time for
sewer & water permits is two days ance area has been approved.
I hereby acknowledge that I have read this application and state that the information is
correct and agree to comply with all applicable State of Minnesota Statutes and City of
Eagan Ordinances.
! l //
Signature of Applicant:
OFFICE USE ONLY
BUILDING PERMIT TYPE
? OI Foundation ? 06 Duplex ? 11 Apt./Lodging
? 02 SF Dwg. ? 07 4-Plex ? 12 Multi. Misc.
? 03 SF Addition O 08 8-Plex O 13 Garage/Accessory
? 04 SF Porch ? 09 12-P1ex ? 14 Fireplace
? 05 SF Misc. ? 10 Multi. Add'1. ? 15 Deck
WORK TYPE
? 31 New 033 Alterations ? 35 Tenant Finish
? 32 Addition ? 34 Repair ? 36 Move
GENERAL INFORMATION
Const. (Actual
(Allowable
UBC dccupancy
Zoning
# of Stories
Length
Depth
APPROVALS
Planning
Engineering
RECIUIRED INSPECTIONS
D.Site
? Wallboard
Basement sq. ft.
lst F1. sq. ft.
2nd F1. sq. ft.
Sq. Ft. total
Footprint Sq. ft.
On-site well
On-site sewage
Building
Variance
0 Footing
drMinal
0 Framing
? Draintile
41?ly
O/
-?
49-Insulation
? Fireplace
Permit Fee
Surcharge
Plan Review
License
MWCC SAC
City SAC
Water Conn.
Water Meter
Acct. Ueposit
S/W Permit
S/W 5urcharge
Treatment P1.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total:
vetuec;on: g 1_3SsxT-
:
.? ?; .. ?
?....:1
... 4 dii-4!I'd
?&16 Basement Finish
O 17 Swim Pool
? 18 Comm./Ind.
? 19 Comm./Ind. Misc.
O 20 Public Facility
[3 21 Miscellaneous
? 37 Demolish
MWCC System
City Water
PRY Required
Booster Pump
Fire Sprinkler
Census Code
SAC Code
Census Bldg
Census Unit
Assessments'
SAC %
SAC Units
PLEASE COMI'LETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMES AND
CONDOS WHEN PERMTTS ARE REQUIRED FOR EACH LTNIT.
NU. FIX1'URES EACH TOTAL
SHOWER 3.00
WATER CLOSET 3.00
BATH TUB 3.00
LAVATORY 3.00
KITCI-EN SINK 3.00
LAUNDRY TRAY 3.00
HOT TLTB/SPA 3.00
WATER HEA'I'ER 3.00
FLOOR DRAIN 3.00
GAS PIPING OUTLET • minimum - 1 3.00
ROUGH OPENINGS 1.50
WATER SOFTENER 5.00
PRIVATE DISP. • naILay. Rc. 20.00
U.G. SPRINKLER • nome und? wmc. 3.00
ALTERATIONS • co ws«g 20.00
WATER TURN AROUND 20.00
STATE SURCHARGE .50
TOTAL:
STTE
OWN
INSTALLER: Z) W.t.s 4:,
AnDRESS:_ 161o C l ? nlsy 1-Lj
CITY: ' STATE: _7W Au ZIP CODE: ?--
PHONE #:
f ? ?s
SIGNATURE OF PE EE
1994 PLUMBING PERMIT (RESIDF.NTIAL)
G1TY OF EAGAN
3830 PILOT KNOB RD
EAGAN MN 55122
(612) 6814675
CITY OF EAGAN
APpL1CATION FOR PERMIT
SEWER AND/OR WATER CONNECTION
1) PROPERTY ADDRESS:
LEGAI, DESCRIPTION:
? R-1 SINGLE FAbffLY ? R-2 DUPLEX (1t.o C?nits)
? R-3 TOWBIIiOUSE (Three + Units) ( units)
R-4 APAAThIF=/CONIDOMINit'M ( Units)
. -,,y--Ai aunaivision or Tax Parcel ID -jj-
IF E}QSTING STRC'CISJRE, DATE OF ORIGINAL ELILDIM PERMIT ISS[.'RNCE; .
PRFSENf ZONING/pROpOSID CSE: IMon ear
? COMMERCIAI./RE'PAIL/OFFZCE
Q =NX'STRIAL
? INSTI'I[,*PIONAL/GpVaU02=
Z)
P1AME:
ADDRFSS:
CZTY, STATE, ZIP:
PHONE:
3) • c ?•
NAME:
ADDRFSS:
CITY. STATE, ZIP:
PHONE:
4) ?r •
NP.PE:
_ ADDRFSS:
CITY. STATE. ZIP:
PHONE;
2
-------
F D10T?:: PAYMFTTS OF FEE AT TIME OF
: APPLICATIoN DOES NOr CCNSTIWM
; APPR0VAL OF PFRMIIT.
: rrSrEc.'rtorr oF sEWER Arn/M WAMx
. If1iTAiT.ATTQN,S WILL IxO'1.' BE Sf??
: ULFD OATPII. PIItMIT AAS Bffi4
: APPROVID.
LICENSE#
C1WIIIZiS j-Lcejlse:
Active
bcPired
Not recorded
Staff Initial
.5)
_ • a orq y?ya •
a? CONMDC,`i'ION 1O CITY SEWER CODAIIX..TION TO CITY WATER C] OTSER_
6) '+ • • 1- [? PLEA6E HOLD APPR0VfD PEHNIIT FCH2 PICK-C'P BY ONE OF ABOVE
PI,EASE MAIL APPROVID PERMIT 70 1, 2, (3p 4, ABO{7E
(Circle one)
7) n? (J/A - .,_
FOR CITY USE ONLY
PERMIT # ISSUED
Pd w/Bldg. Permit FEES: `
$ SEWER PERMIT (INCLUDE SURCHARGE)
$ WATER PERMIT (INCLUDE SIIRCHARGE)
$ ? 3 WATER METER/COPPERHORN/OL'TSIDE READER
$ S WATER TAP (INCLC'DE CORPORATION STOP)
$ $ SEWER TAP
$ $ / 50 Z) ACCOUNT DEPOSIT - SEWER
$ $ i
ACCOt
NT DEPOSIT - WATER
$ C'", $ C
. WA
$ 5- , ? e ?i L7 $ SAC
$ $ TRUNK WATER ASSESSMENT
$ $ TRL'NK SEWER ASSESSMENT
$ $ LATERAL BENEFIT/TRDNK SEWER
$ $ LATERAL BENEFIT/TRL'NK WATER
$ $ WATER TREATMENT PLANT SURCHARGE
$ $ OTHER:
$ $ TOTAL
RECEIPT RECEIPT
DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
F--j YES IF YES, THEN A"PERMIT FOR LVOAK WITHIN PPBLIC
Q
NO ROADWAY" MUST BE ISSUED BY THE ENGINEERING
DIVISION
. LIST AS A CONDITION.
SUBJECT TO THE FOLLOWING CpNDITIONS:
APPROVED BY:
TITLE:
DATE: I / ? U IJ /
CITY OF EAGAN
APPLICATION FOR PERMIT
SEWER AND/OR WATER CONNECTION
NOT?': PAYMBTfP OF ? AT TM pg
AppLicaloN DOES NDr OONMTM
APPROVAL OF PERFffT.
INSPECTION OF SESM ArID/OR WA'!ER
rnSmnr.r.AmrpNS FTaS. NCYf BE SCHED-
ULF9 IJNI'IL PERMIT HAS BEET]
APPROVID.
. • ^ Y[Yf'A'A']FF9[9?i9[]tR]['RY?I[Rl[xiC1[?][lxzxxix'Rl['Rl[i
P ease Print)
? 1) PROPERTY ADDRESS:
LEGAL DESCRTPTION: ?7 ) T(? •^
_(LotJ8lock Subdivision or Tax Parcel ID )
If' EXI6TING STRCCiSJRE, DATE OF ORIGINAL BL'ILAING PERMiT ISSL'ANCE:
i
IMon Year
PRE'SENT ZONING/pROPOSID L'SE:
? COIMRCIAL/REI9IIL/OFFICE ? R-1 SINGLE FAMILY
Q INIDCTSTRIAT, ? R-2 DL'PLEX (7A.v Cfiits)
n INSTI'1[;TIONAL/GOVERNMENT ? R-3 TUWMOUSE (Three + Units) ( [7nits)
R-4 APARTMENT/CONIDOMiNIDNl ( Units )
2)
NAME:1?l? 1 T1?21ZOn ) tlz?
P,DDRESS:
CZTY, STATE, ZIP:
PHONE:
3) ?
NAME:
ADDRFSS:
i
CITY. STATE. ZIP:
PHONE:
4)
•.. • ? ;
NAt+E:
P,DDRMS:
CI'Y^[. STATE, 2IP:
PHONE:
?lumbers License:
Active
Ecpired
Not recorded
St?f =nitlai
•53 ? :? v? ? r. • ?• : ai • • - ?s -
? CONNECTION TD CITY SEWIIt Lt CpNNE(,TION 70 CITY WATER Q OTfER_
6) '? "• '??- ? PLEPSE HOI,D APPROVFD PERMT FOR PICK-UP BY ONE OF ABOVE
Pf,EASE L APPROVFD PII2MIT TO 1, 2. 3 4. AHUVE
r , j , ?., ? (Circle one} , 7)
FOR CITY USE ONLY
PERMIT # ISSUED
E, 5 2 /
Pd w/Bldg. Permit
e
S
$ ? 3
$
$
$
$
$
$
$
$
$
$
$
$ FEES:
5-z-'D
$
S
$
$
$
$
S
s
$
$
$
$
$
$
.l
SEWER PERMIT (INCLUDE SURCHARGE)
WATER PERMIT (INCLUDE SPRCHARGE) .
WATER METER/COPPERHORN/0[.`TSIDE READER
WATER TAP (INCLL'DE CORPORATIO[d STOP)
SEWER TAP
ACCODNT DEPOSIT - SEWER
ACCOUNT DEPOSIT - WATER
WAC
SAC
TRL'NK WATER ASSESSMENT
TRLNK SEWER ASSESSMENT
LATERAL SENEFIT/TRCNK SEWER
LATERAL BENEFIT/TRL'NK WATER
WATER TREATMENT PLANT SURCHARGE
OTHER:
$ $ TOTAL
RECEIPT RECEIPT
DOES UTILITY CONNECTIOIV REQUIRE EXCAVATION IN PLBLIC RIGHT OF WAY?
Q YES IF YES, THEN A"PERMIT FOR WORK WITHIN PUBLIC
Q ROADWAY" MUST BE ISSUED BY THE ENGINEERING
NO DIVISION. LIST AS A CONDITION.
SUBJECT TO THE FOLLOWING CONDITIONS:
APPROVE6 BY:
TITLE:
DATE:
- ?
CITY OF EAGAN
APPLICATION FOR PERMIT
SEWER AND/OR WATER CONNECTION
*XYP4: PAYMhNP OF FEE AT TIME OF
APPI,ICATION DOFS DIl7R' COTSPITLTl'E ?
APPROVAL OF PERHffT. *
,
.
nNSPEczzoN oF sEWER aND/cax MM *
?
Tuornr.ramrONS WIIM NOP BE SCHED-- *
[RS•D UNPIL PIItI•ffT FIAS SFEN *
APPROVID. *
?
r
?
?**#*******X********?#?****k*****'??'?
P ?IICG ?Tl l??
1) pROPERTY ADDRESS:
LEGAL DESCRIPTION:
IF E}QSTIN3- S1RCC1[7RE, DATE OF ORIGINAL &IILDING PERMIT ISS[.'ANCE; .
PRESETTf ZONING/PROPOSID LSE: I"bn 177e-ar-7-
R-1 SING[,E FANIILY
Q INDc-'sTxu+r. p x-2 ocMM cTWo UnitSJ
p iNsxIzLYTIoNAr./oovmraE,n. Cj R-3 1OWNHOOSE (Three + vnits) ( «itsl
• Q' R-4 APAR1SgNP/CONIDUMiIVILm ( Units)
2)
N
ADDR
CITY, STATE,
PH?
3) • ?:"• NANE: For City Use
A2% Plumbers License:
ADDRESS: Active
CITY. STATE, ZIP:JIr ?pired
Not recorde3
Pxo?: mAszER r.icaNsE# J--)lp?V../
st mitiat
4) ?• • i?•
NAME:
. ADDRFSS: •
CITY. STATE, ZIP:
PHONE: .
5) ? v? r: • a?• : o aa • ?r •
corNEcriorr m ciiy sEMm [0' corsmcriorr TO ciz^r wAxEa p oTHER .
6} '? •' ??• ? PIZFISE HOLD APPROVFD PERMIT FY)R PICK-C'P BY ONE OF ABpVE _--
PLEASE MAIL APPROVID PERMIT 10 1, 2, ? 4. P.BOVE
? (Circle one)
7) A
FOR CITY USE ONLY
PERMIT # ISSOED .
?0 /?-?
Pd w/Bldg. Permit FEES:
$ $ JG -- SEWER PERMIT (INCLUDE SDRCAARGE)
$ $ WATER PERMIT (INCLUDE SURCHARGE)
$ $ WATER METER/COPPERHORN/OL'TSIDE READER
$ $ WATER TAP (INCLC'DE CORPORATION STOP)
$ $ SEWER TAP
$ $ ACCOUNT DEPOSIT - SEWER
$ $ ?S C' U ACCOL'NT DEPOSIT - WATER
$ 0 • U 6 $ • WAC
$
$ SAC
$ $ TRUNK WATER ASSESSMENT
$ $ TRUNK SEWER ASSESSMENT
$ $ LATERAL BENEFIT/TRONK SEWER
$ $ LATERAL BENEFIT/TRUNK WATER
$ $ WATER TREATMENT PLANT SDRCHARGE
$ $ OTHER:
$ I 2 L/
TOTAL
?5 ys3 7oz? ?
RECEIPT RECEIPT
DOES DTILITY CONNECTION REQLIRE EXCAVATION IN PC'BLIC RIGHT OF WAY?
? YES IF YES, THEN A" PERMIT FOR 4VORK WITHIN PUBLIC
Q
NO ROADWAY" MUST BE
DIVISION ISSDED BY THE ENGINEERING
. LIST AS A CONDITION.
SUBJECT TO THE FOL LOWING CpNDITIONS:
APPROVED BY:
TITLE:
DATE:
' CITY OF EAGAN
APPUCATION FOR PERMIT
SEWER AND/OR WATER CONNECTION
NOTE: PAYMKW OF 1?EE AT TIIM pg
APPLscATIorr noES Nom oorMTum
APPR(7VAL OF PII214IT.
INSPDLTION OF SETM ADID/OR NTP,TII2
rnSTar.r.Amrpr75 WIIS, NCri' BE SC?HED-
UISD UNTII, PERMIT AAS SEIN
APPF20VID.
. - xxxxxx,r::xz,n.?nr?rxxxx+eae?r::rarr?r=r.?a«
P ease Print
? 1) PROPERTY ADDRESS: It) P-)
LEGAL DESCRIPTION: '•-
_ka.ULinlocxiSUAaivision or Tax Parcel ID q)
IF EXISTZNG ST12C'GZL'RE, DATE OF ORIGINAL B(7ILDIIVG PERMIT ISSL'ANCE: ?
i
(Mon Year)
PRESENT ZONII?/PROPOSFD L'SE:
? Ca44ERCIAi./REPAIL/0FFICE
0 IIIDL?STRIAI,
n INSTI'IL'TZONAL/GOVERNAEN'P
2) ? R-1 SINGLE FAMILY
R-2 DLPLEX (Zwo Onits)
? R-3 'IOWNiO0SE (Three + Units ) ( IInits )
R-4 APARTMENT/CO.IDOMINILfi1 ( Units)
NAr`???mzc)N Jr?
AnDxESS:-pyj I, " f?ln7 -
crrr, srAxE, zzP _?C.? M N ??4-4()
PHorE:-42L 3?(A-L
3) u ?: ?• ??• For City L?se .
L Plumbers License:
ADDRFSS: Active
CITY. STATE, ZIP: Expited
i P Not recorded
PHONE: MASTER LICEPISE# St?ltlal
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NAME:?? ?
. ADDRFSS: .
CITY. STATE, ZIP:
PHONE: •
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d CONNE(,'TION 1U CITy SEWIIt ? CpNNFx'1'ION TO. CITY WATER p7'IM ' .
6) ?? r• •? i. ? PLEA,gE HOLD APPROVED PERMIT FOR PICK-L?P BY ONE OF ABpVE ---- --
Ed PLEASE MAIL APPROVID PERMIT TO 1, 2, 3, ¢, pBpVg
?J? ? (Ci.rcle one)
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7) ??1{?`?l? r.s.?.. ?f/A,n la-, r/,N1?'7
FOR CITY USE ONLY
PERMIT # ISSUED
? J
Pd w/Bldg. Permit FEES:
$ $ ?G ' CZ SEWER PERMIT (INCLUDE SURCHARGE)
$ $ WATER PERMIT (INCLUDE SC'RCHARGE)
$ S-D $ WATER METER/COPPERHORN/OL'TSIDE READER
$ $ WATER TAP (INCLUDE CORPORATION STOP)
$ $ SEWER TAP
$ $ ACCOLNT DEPOSIT - SEWER
$ ACCODNT DEPOSIT - WATER
$ S D O cr?D $ WAC
$ S ? S? cl? $ SAC
$ $ TRUNK WATER ASSESSMENT
$ $ TRLNK SEWER ASSESSMENT
$ $ LATERAL BENEFIT/TRONK SEWER
$ $ LATERAL BENEFIT/TRL'NK WATER
$ `L'o $ WATER TREATMENT PLANT SURCHARGE
$ $ OTHER:
$ l z y 7 S? $ TOTAL
RECEIPT RECEIPT
DOES UTILITY CONN ECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
Q YES IF YES, THEN A"PERMIT FOR WORK WITHIN PUBLIC
Q
NO ROADWAY" MUST BE ISSUED BY THE ENGINEERING
DIVISION
LIST AS
ONDITION
. .
A C
SOSJECT TO THE FOLLOWING LbNDITIONS:
APPROVED BY:
TITLE:
DATE: 1_1 3(J /??
--i n4q
2005 RESIDENTIAL PLUMBING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please complete for modifications to existing residential dwellings.
87 60 ??
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Date
_
,
Site Street Address 100`6 &-rM,S ov- Unit # /ft
PropertyOwner Telephone# ((oS?) 5y?'?? ??
?
?
Contractor?? Jn
v Telephone# ( )
Address
City State Zip
The Applicant is: Y, Owner _ Contractor _Other
Septic System _ New _ Refurbished Submit 2 sets of plans and MPC license Includes County fee
$ 100.00
Per as-built $ 10.00
Alterations to existing dwelling $ 50.00
X Add plumbing fixtures. This fee includes putting in a water softener and/or water
heater at the same time. If you are installino onlv a water softener and/or wafer
heater, do not complete this section. Move to the next section and check) Itlie
appliance(s) you are installing.
_Septic System Abandonment IDE? . ?.? ??
_Water Turnaround (add $125.00 if a 5/8" meter is required)
,?0 „
5
-Other. - _--- - _
?
Water Softener _ Water Heater $ 15.00
_ new _ replacement
_ Lawn Irrigation _RPZ _PVB _new _repair _rebuild $ 30.00
State Surcharge $ .50
Total $ 'TQ.,SO
I nereby apply for a Residential Plumbing Permit and acknowledge that the information is complete and accurate; that the
work will be in conformance with the ordinances and codes of the City of Eagan and the plumbing codes; that I
understand this is not a permit, but only an application for a permit, work is not to start without a permit and work will be in
acco(dance with the approved plan in the event a plan is requireck to be reviewed aFd approved.
r4 ) ; i I i a?K L-G??N IA),&?
ApplicanYs Printed Name Applicant's Signature
'I 19 4S
2005 RESIDENTIAL BiTII.DING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone 4 651-675-5675 FAX 4 651-675-5694
New Construction Reauirements
3 registe2d site surveys shaving sq. ft. of lot, sq. K of house; and all roofed areas
(20°b maximum lot coverage allowed)
2 oapies of plan showing beam &window sizes; poured found desgn, etc.
1 setof Eneyy Calculations
3 copies of Tree Preservation Plan H bt platted after711193
Rim Joist Defail Options selection sheet (buildings with 3 or less units)
RemodeUReoair Requirements
? 2 copies of plan
1 set of Energy Calculations for heated addition:
1 site survey for additions & dacks
AddBion - indicate if on-site septic system
?-'10,6-t
+Pfw?^
Office Use OnN
CedofSurveyRecd _Y _N
Tree Pres Plan Recd _Y _ N,
TreePresRequiretl _Y _N
Ori-siteSepticSystem _Y _N Date Construction Cost ?30Ob
SiteAddress ?O$ 0 `P?JLSZ),(1 ? c ') v e Unit/Ste #
Description of Work ?'t +7[fh baSPivt Fn'r ry t T1 u'A h.o ty+P
Multi-Family Bldg 5( Y_ N Fireplace(s) _ 0_ 1 _ 2
Property Ow¢er ? i(?? Q w? 1,0k "o n Telephone #(G S l)??J a'? ?[?
ContracWr
Address
S[a[e ?O V,y
- o
?
Zip City
Telephone # ( ) 1/7
',-
?r _
COMPLETE THIS AREA ONLY IF CONSTRUCTING A
- Minnesota Rules 7670 Cateeorv 1 mmnesora xuies ic
Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code
(Jsubmissiontype) Submitted Submitted
. Energy Envelope Calculations Submitted
In fhe last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan2
_ Y _ N If yes, date and address of master plan:
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone #(
Telephone #( )
Telephone #(
I hereby apply for a Residential Building Pernut and aclrnowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a
permit; that the work will be in accordance with the approved plan in the case of work which requires a review and
approval of plans.
< <?' ?: 7
Apphcant's Printed Name Applicant's Sigiature
OFFICE USE ONLY
Sub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pooi ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 EM. Alt - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 PorchlAddn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex ? Plbg_Y or_ N? 25 MiSCellane0us
Work Types
? 31 New ? 35
? 32 Addition ? 36
,a 33 Alteration ? 37
?0` 34 Replacement
Valuation o6ro
Plan Review 100% or 25%
Census Code
SAC Units
# of Units
# of Bidgs
Type of Const V6_
Int Improvement ? 38 Demolish Interior ? 44 Siding
Move Building ? 42 Demolish Foundation ? 45 Fire Repair
Demolish Building" ? 43 Reroof ? 46 Windows/Doors
'Demalition (Entire Bldg) - Give PCA handout to applicant
Occupancy MCES System
Zoning City Water
Stories Booster Pump
Sq. Ft. PRV
Length Fire Sprinklered
W idth
_ Footings(new bldg)
_ Footings (deck)
_ Footings(addition)
Foundation
Drain Tile
Roof Ice & Water Final
? Framing
F'veplace _ R.I. _ Air Test _ Final
X Insulation
y?
REQUIRED INSPECTIONS
FinaUC.O.
-x FinallNo C.O.
_ Plumbing
HVAC
Other
_ Pool _ Ftgs _ Air/Gas Tests Final
_ Siding _ Stucco _ Stone _ Brick
Windows
_ Retaining Wall
Approved By: f C/ , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
L L ??rr?ISS fi
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7qq7,9.-
2006 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagau
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651fi75-5675 FAX # 651-675-5694
New Construction Reuuemrenls
3 registered sAe surveys shoviinp sq. tt. of Id, sq. fl. of house; and all reofetl areas
(2096 maximum lot wverage alloued)
2 copies of plan shovnng beam 8 vnndow sizes; poured found design, etc.
lsetdEnergyCakulations 3 copies ol Tree Resuvaibn Plan if bt platled after 711193
Rm Joist DeNail Options selecton sheel (buildings with 3 a less unils)
Mivnegasco mechanical ventilationfortn
RemodNlRewir Reuuiemenis ?
2 coDies M Plan showing fodinBS, beams, joisis
u o
i site survey fa addAons 8 dxks ?'
Addifion - indicafeifon-sife septicsys(em
17
70. &YD
P?" fa j8
Date l)7 /;20 ConatructionCust 70
9ite Address 10 D?J Y'J ?? UniUSbe #
DescriptiouufWork d /ox/c- QPck- ^}z__ AbWiL'
Multi-Family Bldg x Y_ N Fireplace(s) 0 1 _ 2
Property Owoer TelepLone # ( (o
r
Contractor 1
?GYScv? 3 ?O-? f n ,
ntF w^i- SP l'J lcr 5, ? a.
Address (p C P611_1;;P I'A City h,,G?-.
State J'14N Zip S Io? ?2- Telephone#4_S() -Si'61,5
aC a 7 o$s
COMPLETE THIS AREA
Energy Code Category
(+l submission type)
IF CONSTRUCTING A NEW BUILDING
1 Worksheet
Envelope Calculations Submitted
in ihe last 12 months, has the City
_ Y _ N If yes„f
Licensed Plumber ? elephone # (
Mechanical Confrac r_ IlT?lephone #(
sewer/water co ractor : : JUL 2 1 2006 elephone #(
I hereby ap{ly for a Residential Building Pemrit and aetmowledge that the informarion is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the StaYe of MN
Statutes; I understand this is not a pertnit, but only an application for a pemrit, 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.
f ,
?Ccr5cv,,
ApphcanYs Printed Name ApplicanYs Signature
Mimiesota Rules 7672
• New Energy Code Worksheet
Submitted
Eagan issued a permit for a similar plan based on a master plan8
e and address of master plan:
, .. „
.
DO NOT WRITE BELOW THIS LINE
Sub Tvoes
O 01 Foundation
? 02 SF Dwelling
0 03 01 of_ plex
? 04 02-p1ex
? 05 03-plex
O 06 04-p1ex
Work Tvpes
? 31 New
)SC 32 Addition
? 33 Alteration
? 34 Replacement
? 13 16plex
? 16 Fireplace
? 17 Garege
,K 18 Deck
? 19 LowerLevel
? 20 Pool
? 21 Poroh (3-sea.)
? 22 Poroh/Addn. (4-sea.)
O 23 Porch (screenlgazebo)
? 24 Stortn Damage
? 25 Miscellaneous
? 30 Accessory 81dg
? 31 Ext Ak - Multi
? 33 Ext Alt - SF
? 36 Multi Misc.
? 35 Int Improvement 13 38 Demolish Interior ? 44 Siding
? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 37 Demolish Building' ? 43 Reroof ? 46 Windows/0oars
•Demolition (Entire Bldg) -Oive PCA handout to appliwrH "
D@SC?iDtI0I1: WaterDamage_Yes
Valuation , i V Oxupancy MCES System
Plan Review 100°h or 25%
Census Code Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const ? Wid[h
Footings (new bldg)
? Footings(deck)
_ Footings (addition)
Poundation
Drain Tile
Roof Ice k. Water Final
_ Framing
_ Fireplace _ R.I. _ Air Test _ Final
lnsulation
REQUIRED INSPECTIONS
_ Sheetrock
Final/C.O. .
? FinellNo C.O.
HVAC
Other
_ Pool Ftgs Air/Gas Tests Final
_ Siding _ Stucco Lath _ S[one Lath _Brick
_ Windows
_ Rclauting Wall
Approved By: f -1_, Building Inspector
Base Fee
Surcharge
Plan Review
MClES SAC
City SAC
Utility Connection Charge
S&W Permit 8 Surcharge
Treatment Plant
License Search
Copies
Other
Total
f) 60C 2?&9 tyv
0 70 _../
Y'
.. .. p
? 07 OS-plex
? OS O6-plex
? 09 07-plex
? 10 OB-plex
? 11 10-plex
? 12 12-plex
JSMap Output Page
rera
isiz
Page 1 of 1
?u'???,s?lo 4
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_ ______------
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Use BLUE or BLACK Ink
a For Office Use
I r `~-)~j I
Permit l I
Clay of Ealu I 0~
Permit Fee:
3830 Pilot Knob Road
Eagan MN 55122 j Date Received: 13
Phone: (651) 675-5675 1 I
: I
Fax: (651) 675-5694 1 Staff
L-
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 1L6 Site Address: f ~~ll) f~ ~Q~ 1~ ~ ~GYnSanr nc. Unit
Name: L RO t f s G f 7h a M c L... r~ ke /~djg Phone:6/: Z~/ 7 7 S /
Resident/
Owner Address/ City/Zip: 14117 & Me3i Met 13
Applicant is: Owner 9 Contractor
Type of Work a Description of work: Ae rye dspkt II I< nc fee& f ieces
_1 -a-So ~ Dllulti=Fa deiin Yes if -tNo
Construction Cost;,
o 0. Ue,,V Ir
Company: ~ A, Contact:
N `~'wl1 ,Lc, (
Address: ~1.3q~ Kay Cit. cte e.
Contractor i city.
Stater Zip:,' Phone:-7~
lzv~mrrse mad Certi icate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
Vi V y 1 S 1 1) 1 nc- M to ( 50 6C"= f tL FA s -r o - Alo Pri t ty t"
COMPLETE THIS AREA ONLY IF. CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents that-you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the -City to
i
conclude that they are trade secrets
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.aol)herstateonecall.org
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
x Tae 7t>Q_0~"es x
Applicant's Printed Name Ap c nt's Signature
Page 1 of 3
,j.
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA144037
Date Issued:07/10/2017
Permit Category:ePermit
Site Address: 1608 Clemson Dr A
Lot:1 Block: 01 Addition: The Trails Of Thomas Lake
PID:10-75865-01-010
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace & Air Conditioner
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Mabeth A Dorman
1608 Clemson Dr Unit A
Eagan MN 55122
(612) 618-2236
H2c Inc Dba Heating Cooling And Plumbing
820 N Concord St
South St Paul MN 55075
(612) 791-0850
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA144668
Date Issued:08/03/2017
Permit Category:ePermit
Site Address: 1608 Clemson Dr A
Lot:1 Block: 01 Addition: The Trails Of Thomas Lake
PID:10-75865-01-010
Use:
Description:
Sub Type:Residential
Work Type:Alteration
Description:Fixtures
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.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Fee Summary:PL - Permit Fee (miscellaneous)$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 -
Mabeth A Dorman
1608 Clemson Dr Unit A
Eagan MN 55122
(612) 618-2236
H2c Inc Dba Heating Cooling And Plumbing
820 N Concord St
South St Paul MN 55075
(612) 791-0850
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA160526
Date Issued:03/16/2020
Permit Category:ePermit
Site Address: 1608 Clemson Dr
Lot:1 Block: 01 Addition: The Trails Of Thomas Lake
PID:10-75865-01-010
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Standard Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener).
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Mabeth A Dorman
1608 Clemson Dr Unit A
Eagan MN 55122
Champion Plumbing
3670 Dodd Rd., #100
Eagan MN 55123
(651) 365-1340
Applicant/Permitee: Signature Issued By: Signature