1910 Covington Lane,
CITY OF EAGAN
38$0 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 Nd 8830
' ?• PHONE: 454-$100 ?
BUILDING PERMIT Receipt
To be und for Sr DWG/GAI: Est y4,., y 61,000 Da1e FEB RU 1R :! 17 94
Site Address 1910 COVINGTON LN Erect [?K Occupancy r 3
Lot 1 2 Block 3 Sec/Su6. P21 PI; RIDGE Alter ? Zoning R1
Parcel Na l!' •- 567 5 0--12 0- 0 3 - Repoir p Fire Zone N4A
` Enlarne ? Type of Const. ?7
,
?a Name I-'.C'SL:?2i & B?Ei1EE EE?O Move p .# Stories
Z2 Address 9215 N I COLLET AVE., # 2 2 2 pemolish ? Length 4 4'
fi _ - n n A w n A n _ .., ? Name RUSCON HOMES INC. - Approvals Fees
?U qddress 1000 E. 14 6TH ST., #150 Assessment I Permit -
?- Ciri 1-?i7R'1fiVTT,T,7- Phone 4'1;k-1 4 13 Woter 8 Sew.
yvjW Surchorge
Name MARK NA(;F.L.,/PR0RF. F.NrR
H
_0 Address 111 !1 11 F' _ 14 rTH S T
?L?u City 7,11^'1 V l' ? r" Phone 415) -2f]44 -
f hereby acknowledge that 1 have read this opplication and stote that
the information is torrect ond ogres to comply with cll opplicpble
State of Minnesoto Storutes ond City of Eagcn Ordinonces,
Official .
-
Plon check _
SAC
Woter Conn.
Woter Meter
Rood Unit -
.40
.00
.00
.00
.00
.00
.00
Totol ; 1,792.00
to: RUSCOTI FiOMES on tho express tondition lhnt
scordonce with oll opplicoble Stofe of M1nnesota Statutes and City of Eapan Ordinonces.
i
Permit No. Permit Holder Misc. Permit No. Holder
Plumbing ,,z.? ?r, a3 g ,
H.V.A.C. 33?
Well
water
Disp.
Sswar
ElectriC 3?(63 ?y + L y-z3 -'i q 3.).5o
Inspection Oate Insp. Other
Footinga
Foundatian
Freming
Rough Plbg.
Rough HVAC t/o7?
Inwlation ?o-
Final Plbg.
Final HVAC
'AhaA
Final ? W /lLe
Weter Deacribe Location:
7
Well ,
Sewer
Pr. DisP.
Raceipt MECHANICAL PERMIT Permit No.
CITY OF EAGAN
Fee
fill in numbered spaces S/C
Type or Print /egibly Tot-
1. Date 2. Installation Cost
3.JobAddre!_1a0-()viN6>oAJ Lot Bik. Tract -
4. Owner ?
5. Contractor
6. Address Phone '
7. City State Zip
8. Building Type: Residential Q- Commercial ? Institutional O
9. Work Description: New 13-- Add ? Alter O Repair ?
I 10. DBSCfIbE
I 11.
"? J T •
Type
No.
? Equipment 8TU - M. Ea.
Forced Air No. Equiament CFM
i
Mfg. A
r Handling:
Boiters
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 C1TY OF EAGAN 454-8100
U5;' ;) ;?/
Receipt PLUMBING PERMIT Permit No.
CITY OF EAGAN - ?
Fee
FiII in numbered spaces S/C _-------
Type or Print legibly Tot.
1. Date 2. Installation Cost
, ??-' ,-:?:• , ? ? ?-3. Job ddress Lot Bik. ? Tract
4. Owner
5. Contractor Phone
6. Address ! ' ? ' ?-'-' ? • ?T
7. City State
?
Zip
8. Building Type: Residential Commercial 13 Institutional ?
9. Work Description: New 'Q Add ? Alter ? Repair O
r
1 10. Describe
1 11.
No.
~ Fixtures
Water Closet No. Fixtures
Cesspool/Drainfield
8ath tubs Septic Tank
Lavatory Softner
Shower Well
; Kitchen Sink
? Urinal/Bidet
Laundry Tray Other
Floor Drains
Drinking Ftn.
? Slop Sink
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 inal
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved _ CITY OF EAGAN 454-6100
CITY OF EAGAN Remarks I -'
/>ddition PARK RIDGE 1ST ADDN Lot 12 Blk -
wer-
flwnar C.oee
cz.... EAGAN
Improvement Date Arriount Annual Years Payment Receipt Date
STREETSURF. ? 1982 149.13 104.40 14 34 -12-84
STREET RES70R. qjA I 4
GRADING
SANSEW TRUNK 1982 147.21 9.81 15 117.78 A014034 6-12-84
SEWER LATERALy1-*
WATERMAIN
WATEFi LATERAL ?
WATERAREA 1982 147.21 9.81 15 117.78 A014034 6-12-84
STDRM SEW TRK IfI 'I
STORM SEW LAT9 ?,* 1985 109.58 31 15 8 C009665 10-11-84
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. 450.00 n t I
BUILDING PER.
SAC 1? ?t
PARK
f ? (
OCCUPANT
HEAT LOSS DATE HTG. INST.
SOLD BY
HOUSE
? "HEATING TEST
APT. RECORD L1;- 15 3
Jo 54") so
FLOOR CITY ??- (466E RMr1
1;Z0 03
SUBURB
nWNER
TALLED BY
Electrieol Work By Gos Line By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR.
A
? GAS DESIGN
` ((-Q
? ?
M
KE ? MAKE OF BURNER
Model Modsl
SeriOl Max. BTU Ratiny
INPUT MAKE OF FURNACE
Modsl
CONTROLS ?
THERMOST Heat Pluy
u Vsnt Size
Yalvs a, -aco KIND OF LINER SIZE NOFIE
Limit w Drah Hood Rpulamr
Limif Settin9 Filter: Size f1111 umber Z
Fan Setfin9 ? 4b Chimney Location
In
d- Outside
Pilot Type ?
_V
Chimne
Construdion 1'? [
_ y
Pilot Make ? C4Y\Pilot Model ?-
Pilot Timing
L.W. Cut Off
?
Prsssure - Peresnt C02
Input CFH Psreent 02 d
Stock Temp. ?,,?_ Peresnt CO
Smoks Bomb Wiring
Draft Test Tay
Door Prossuro Liqhtinq Ins*-
G
Date Tostsd
Company Testin I
Nams of Testsr "
Fwm 235
CITV OF EAGAN WA;TER SERVICE PERMIT
3830 Pilvt Knob Road ' PERMIT NO.: -
P. O. Box 21199
Eagan, MN 55121 DATE:
?ing; ? . . No. of Units: '
Owner;
? Address:
-- - 3 ?
Aater No o conne?tia, ?roe:
.? .. R ? 1 4 i? Ll ??u
ize: J ?
;ender No. Permit Fee:
•
c ?,, i?-,,.-?;1„•.?I
?lim t0 ttl6§urcharge:
4.L? ? RiC •GAS
?l-?J
?
NA
R D I Lf=;N?g?
3Y
?te af lrup.: Insp.:
C: tY OF EAGAN SEWER SERVICE PERMIT
3830 Pilot Knob Road
P. O. Box 21199 PERMIT NO.:
Eagan, M?? 55121 DATE:
Zonirg: - No. of Units: j
Ownar.
llddress: - -
Site Address• l?1+0 Co??n?'c>? o? <•u. :.1_' i;_: Parti: '?id?::•
?u?r: Star ?l:?s
I .Ar.s ro ea.?1, .vt? e1?. cier oi R.,d. ca,nscrio?? aaroe:
Ordinenaes. Account Depodt: _
Parmit Fee:
Surchorps:
u:.? f-?......«
?
?_ .
. \'
a
Z
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N
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This request void
18 months irom
A ?7L1R'? ?a?83
3-? •sa
Request Date Fire No. Rouph-in Inspection
Required7 ?
FiiReady Now [?Vtl'?II Notify Inspec-
? - -? ? ?No tor When Ready
Cg-+_?ensed Electrical Contractor I here6y request inspection of abave
? Owner lectrical work installed et:
Street Address, Box or R te No. Citv
y _ ,
ection o. Township Name or No. Range No. County
Occup (PRINT) Phone No.
V
c A"e
rz?
I
-
Power SupDlier Address
Elect
l Contractor (Company Namel Contractor's License No,
?
r C? ?- 1? O ON 3,SS
Mailfng Address (Contracior or Owner Makinp Instailavon)
?
Authorized Si r ontra or/O er Maki g Installa
32-
MINNESOTA ) Phone Number
STATE B?Of ELECTRICITY
Griggs-Midwey Blde. - Room N-191
1821 University Ave., S[. Paul, MN 66104
Phone (612) 297-2111
THIS INSPECTION REQUEST WILL NOT
BE ACCEPTED BY THE STATE BOARD
UNLESS PROPER INSPECTION FEE IS
ENCLOSED.
l, 7-1'4 '] REQUEST FOR ELECTRICAL INSPECTION EB-00007'04
' See instructions for completing this form on back Of yellow copy. Y,
P'
A c?. F. ?,? ""X"' Below Work Covered by This Request
Now Add Rep. Type of Building AoPliances Wired Equipment Wire1
' Home Range Temporary Servite
Duplex Water Heater Lightin,y Fixtures
Apt. Building Dryer Electric Heatin
Commercial Bldg. Furnace Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tdnk
Farm Other peci y ther (Spe?r.ify)
t _r pecify ther Other
ompute Inspectron Fee Selow
!t Fae Service Entrance5ize q Fee Feeders/Suhfeeders # Fee Circwts
U to 200 Am 5 0 to 30 Am s 99; 0 to 30 Am s
Above 200 Ampsl 31 to 100 Amps 31 to 100 Amps
Swimmin Pool Above 100_Am s Above 100_Amps
Transformer5 Irrigation Booms artial%Other Fee
Signs Special Inspection S ?
emarks OTKEE
1 _1"0
RouOh-in Date I the Electrical
spector, hereby
- '
Final certily that the above
(3;
?_ ) nspection hes been
made.
fhis reaueat vad 18 montAS from
1075 S'/E
' CITY OE' EAGAN Include 2 sets of plans,
1 site plan w/elevations &
BiIILDING PERMiT APPLICATZON 1 set of energy calculations.
Zb Be Used For Single FamilV Valuatio e
Site Ad3rpss aAWMPR?/?60 Date
Ir?t 12 Block 3: Sec./Sub. Park
Parcei #: - zS e-7 ?r2-0-b3
Ovmer: Robert & Renee Erko
Address: 9215 Nicollet pvenue, #222
City/Zip Code: Bloomington, MN 55420
Phane #: 884-4040
Contractor; _
Address: _
City/Zip Code;
Phone #:
Arch./Eng.:
Address:
ituscon Homes, Inc.
1000 E. 146th St., #100
Burnsville, MN 55337
432-1433
Mark Nagel/prohe N3ngineering
looo East 146th st.,
City/2ip Ccde: Burnsville, MN 55337
Phone #: 43z-2044/432+3000
OFFICE USE ONLY
Erect DC Occupancy 13
Al.ter Zoning
Repair Fire Zone
Enlarge _ 7ype of Const.
Nbve # Stories `
Dennlish Front y ' ft.
Grade Depth y ft.
APPRpVAiS FEEs
Asses-snents Permit
Water/Sewer Surcharge ??
Police Plan Check 4F4-
Fire SpC
Eng- Water Conn. ?t50
Planner ' Water Meter
Council , Road Unit stSO ?
Bldg. Off.
APC
TO'I'AL ?, ? 9 a.
CITY OF EAGAN ?0 8830
3830 Pilot Knob Road, P.O. Box 21•199, Eagan, MN 55721
PHONE: 454•8100
BUILDING PERMIT keceivt #
To 6e uteA ier SF DWG/GAR Est. Value $ 61,000 Date FEBRUARY 17 19 84
SiteAddress 1910 COVINGTON LN Erect [JK Occupancy R3
Lot 12 elock 3 Gec/Sub. PARK RIDGE Alter ? Zoning Rl
rarcel NO. 10-56750-120-03 Repair ? FireZone N/A
Enlarge ? Type of Const. V
s Name ROBERT & RENEE ERKO Move p # Stories
Z Address 9215 NICOLLET AVE., #222 pemolish ? Length 44
? CityBLOOMINGTONphone $$4-4040 Grade ? Depth 48? Sq.Ft.-
Avvrorala Fees
j Name RUSCON HOMES INC.
u Address 1000 E. 146TH $T. ,#100 Assessment_
8
r TT
City B N.UT1•T,F•Phone 432-1413
R WaterBSew.
Police -
Ww I Name MARK NAGEL/pROBF FNGR_- -
1-W 1000 F 146 H m
2 Address
?
'W City BURNSVILI.E phone 432-2044
I hereby acknowledge that I have reod ihfs opplication ond stote that
ihe inlormation is Correct and ogree to comply with all aOPlicable
$tate of Minnewta Statutes and Ciry of Eogon Ordirwnces.
Fire
Eng.
Plonner _
Council _
Bldg. Off. _
APC
Permit
00
Surchorge 30.00
Plon check 158.00
SqC 525.00
WoterConn, 450.00
Woter Meter 63.00
Rood Unit 250.00
rotal 51,792.00
$Ignoture of Permittea I
A Building Permit is iuued to: RUSCON HOMES on the exDreu condition 1hnt
oli work sholl be done 'yff9efordance yrlF9 al4ypplicable State of Minnemto Statutes ond City of Eagan Ordinances.
Building Officiol
/AOBE
ENGINEEAING
COMPANY, INC.
?1000 CAST 1461A STRE[T,
COMSIILTIN6 tMOIHEtRf
PlliNNE11i and IAHG IUAVtYOIIf
sUfIHSVILIE, HINHESOTA 53337 PM 432'1000
jdstat Iae.?cr4-4a-f0Pr-0, LO-T- 121 aLOV-K 3,
tN-?' / DAKOTA COUNTYi
01RAINP.4,5 F{Npt
uTILi ry CIi?E MGNT
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SCALt 1"= 30
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? ?? .?C? C?25.'3j DENOTES ?XISTINC? =1?JA? ?Jh:
ry'?QO ?.4 ,ry,-..e .,v PROPOSGi:; ?lrvA^'1Jh'
? i
's
>
INDIGATEs OtRtGTION OF
/O
o ?
?
i
I ??ereby certity that this in a true and carreet r+prarentation ot a tnct ot
land at •1?own'and described hereon.., As prepared by fie on this i`_ dar ot
F?? Y 0 1984.6
'
lfinne )?es. llo? i??
?
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a Z
75, ?
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G DRAin?P.6E
SU CL
() ,G FAG
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a 4oE Fwo?'2 FlE\1.= 9z'`?•o
F?jNIstJEO CARA
?
P E AOBE
NGINEEAING
COMPANY,
? ._aoo cAsT 14E1h
?C?c=t fk trs+1Pat0n ' LOr 12 ,SIIX.K 3,
/ DAKOTA COUNTY,
pRaiNa(.E ANo
uTi Li ry MFa!?-Er?104T
;-
°
9
NoRr P
SCALt 1"= 30
r4J., /;
?./
c123j OEN)TZs ?Kis71N(v E4E.A?
PROPose.?: ?tivc
\ ?
COHSULTIHO lNOIHtlIIf
PIRHNEIIi and LfIND IU!{VfYOAi
I N C,. ?
STIIECT, OURNSVILLE, MINHESOTA 5533T PH 43Z-3000
Sso
"?.. 6S SS k,
v \
0
v
P/?kRK RIDGE?
MiN?lEtia??,
?
?
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m 0? ?°1'?' ry0
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a
l`
5
0'
f
//p INOIGATES
SU R F:AG6
\Q
?
Q1RtGTION OF
DRAivP.bE
? '' / a F/NISµED ?ARAer FL002 Ft,E??, = 9z`?.e
?
?
?
1 1+erebr eertity that this im a true and carrect r+prarentation of a tnat ot
land a• tham' and described hereon.. As prepared by me on this 171?1- dar ot
19 84. '
rui Liic rK ur.
i
IAIrC?2?aQ Cnr?Q :
1
?x,-
. - .,._ -? r
-0?2:. N
-L<ZAt,SeJ rJ rrtli.? IAILLIJDES ?
JW0 ?
Z?' f
v?LjyL_ ra bE- 1" : f 14-
LIbT
r I, ?
2 /T li
I 1 I?
..
i
arc?-
TV-V
i ?
, . . ..
EXTERIOR ENYELOPE tiYERAGE "U" LDMPUTA7ION
4WNER
:•.: . ,
en,.
.
• ; .; STTE ADDRESS
:. . ..: ::. : ... ..:..:.. - '_ ' . . . .
' CONTRALTOR H c) nn F DATE
PHILLIPS PtANf SEIMCM2
10700 Lyoclale Ave. Sp. E??Q
Bloomiagtoa, MN SSt2{1;,;e
Suitc / IoA; .
. ` j
I `J•"I J i'?.....'.. .?rv.'?
L:.yK
.,'1
A
777
. -, nc.?,-i?
• Determine vrorking square footage of eacA.
1. Total exposed wall area ...... IQ?q sq. ft. x .17 a?
2. Totai roof/ceiling area ..... sq. ft. x .OS a
Total exposed wall area above floor = I7i?
a. Total wa11 windox area .......................... Qo.? -
b. Totai door area ................................. ==?y?
c. Total sliding glass door area ...................
d. Total fireplace wall area ........... ........
e. Total wall framing area (averagelOS)...:........ T'-
f. Total net wall area above floor ................. '''t
g. Totat rim joist area ........................... _
Total exposed foundation area
h. Total fcundation Wind rn+ area ..................... -
1. Toal net foundation area abvve grade ............ -•--.?
re:ermine "U" value of eath walJ segment. _' . :.
)( iiUli
C. X - u,-
d. "- X "u" r?? s -
e.X ??u„
f. X?????
X .C)?o = ?•?
h. - X I. U.,
X 'lu., t?f ? _ v
3 . . . . . . . . . . . . . . . . . . . ..? . . . . . ... . . . . .Total
Ii ?3 is the sa?me as, or less tnan item 01, you have m_t the intent
_f ,.:;i. ?_.;?•??!
-,
Y o r*w
..r?? .
R-ta.+3`w"'. `` .
?
k. O X "U"
?. cl ?ylL _ X uU° . ??Z a 3?. 31
4 ............... 1P7C> ........... Total '
If total af 14 is the same as, or less than #2, you have met the intent of
SBC GOOfiic)i.
To util:zed the total enveTape system method, the values established 6y the
sum of iterns 13 and $4 shall not be greater than the sum of items 01 and #2.
].
3.
MATERIA;3
Extarior eir-
sining xateriai
sheatkitig
Inauyl?ation
uuOQ?y k
Interfr kir
Studa
Ris
Corfc. 87.ks.
+ 2.
+ 4.
Therw. Resistance "k"
.19
u?
r
?.
s
€:;s:
. . . . h.i`. .
i mc - o 1
1I_nr+,E OwuE2'. ?- ?
S t7E. S-DnP?..SS: ocy
'
Fa?,_rr- as-r--v" "8?• 141505E- siz`: D7
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n
T/P? oE WiN
fr-?:
TYPE oF TfL ?,,-\
f(.?
/?
.?
D.1?aWU • P6Y10 nm2
?1
e1_J?pUT 'y[?_. PATIa 2
UP
wauL 7dw 6nru 214
?
621c.1? TYP?'
x?
FitzEP?&cf- Foa-ri?c?5 oa?v
F?QIt? oti t-loosE ?
M
C?LST. P.?Loe.: LT. Dd¢.Y FIF?
CaLi,IrE-L ToPs: IkYYI
TFIr-
APfLtAtY_E LoLO2: D 14cnYUP3' lLAntErE D2ve¢
S A
luT LirE PKLT - F_x7. L.1TIL ??CG :
IAITf_JLIO2 LoLafL : EXT Co1?2: S N
Y2ir?.: 'SE.4L5 ? TfLiix. I1JLLtJDES ? ?
gID??7 ?
.
Vio vL- To tSE. iu IC ?
L.ier I
r II? ?
h
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Dw. F1uri% b i FiEV-
? D;Sp,
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iTrd
I
2/84
; CITY OF EAGAN
APPLICATION FOR PERMIT
SEWER AND/OR LdATER CONNECTIO.i
1) PPOP? ?D?sS : IPLFASF P9iNTl_
^ / 9 I 0 C° p V/?L/G Tti iv?
r rr.,i, nFSCRT=cN: ga, 3 P `"
(Lot/3iock/Subdivision or Tax Parcei I.D. Llniber)
?EilS='= :G Si'?L'CIL'i2E , Drl-; G' ORIGi :AL EtiiI.D2,`IG F-:.Sm IcSi:?.,::
'- ---' ---
? P2.S: Z.^`T-'IX;/pRC_°OSED 'U5=: SE-?GLE rP`4ILY
? R-2 GUPLEX ('ILo'p UNTITS)
? R-3 TCWNHOUSE (7= + [JnITS) ( Wi ITS1
? R-4 ApARm."?'`T/CC??CSLL:IL^1 ( UVITSi
? COtANIE4CIP.L/RETASI,/OFFICE
? L?.'CL'STRIAL
? INSTIT'u'PZONF1L/Cm-EIRHMEN':
2) APPLIC\T (PLE"E PR14i)
NAhfE:
ADDRESS: S
CITY, STATE, ZI?: ?
-
Pho-NE: -413 z- iy '3 3
3} PLL;mBEi? NAME P'?ItIT) fOR CITY USE ONIY
ADDRESS: -?-+ PLUMBERS LICE4SE:
Q Active
CITY, STATE, ZIP:
PHOi?1E: Z/?2
a?icR ^
PLUMBER LICENSE 2 ? 22 C] Expired
Q Not of Record
arr initia
4) OCC[lTj12N'P/U,,^]&? IIE. ? f l LtRSt YHINIJ
ADDRESS: ?,I?11.? ?? ?•?
CITY, STATE, ZIP:
PHC}:IE:
5) INUZCATE WHICIi PEPh1IT IS BEING REQUESTID:
?'?'?IF.CI'ION 'It? CITY SETi?lER
.-?? /
L?rco::?rr?rsG,r TO CiTc «TER
? 0'I'f?ER (PLLASE DESCRIBE)
bj L':I]1(i'ii: 0:E :
? PI.E,?SE f:OLD APPR(NID PERtiLIT FOR PICF:-UP BY ONE OF ABOC E
? PiE-iSE MAiL APPRM7ID PER%tIT TO 1, 2, Q, 4ABCVr-
(Circle one)
7) SZCm'iC.-RE: D?.TE:
. . . . . ?ss??a?srsr;ss:a???erif?:rr?a?r?ss?r:sarrw
FOR C I TY [I S E ONLY
PERMIT °- ISSUED
FErs= $
ia.s o
$
$
$
$
$
$
$
$
$
$
$
$
$ S::^iE? nrn%Jri !I`_iC:.i:D? SUaCH
WATER PER*1IT (IPICLUDE SURCHARGE)
WATER METER/COPPERHORN/OUTSIDE READER
WATER TAP (INCL'"JDE CORPORATICN S;OP)
S?:dER ':'Pp
ACCOUNT DEPOSIT - SEP;ER
ACCOUNT DEPOSIT - WATER
WAC
SAC
TRU.7K ?4ATER ASSESSi-IE:7T
TRliNK SET4ER ASSESSMENT
LATED.AL BENEFIT/TRUNK SEFIER
LATERAL BENEFIT/TRUNK WATER
OTHER
dr 9 , °-a TOTAL
$ ?-/. ?---? A-M0UNT PAID/RECEIPT # ?y / <-'
DOES UTILZTY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
? YES IF YES, THEN A"PERMIT FOR WORK WITHIN
PUBLIC ROADWAY" MUST BE ISSUED BY THE
? NO ENGINEERING DIVISIO[V. LIST AS A CONDI-
TION.
SUBJECT TO TIIE FOLLO:JING CONDITIONS:
APPROVED BY:
TITLE:
DATE:
OR sw w" wM i? ?? ?? MIR W.Aw w:+mpa mre w:m wP@ Ra wtM wW?Mfpq w.4Wo&Ws4 f?" MIUM VcRgwt sjmo
w?
Jb"5b
CITY USE ONLY
LOT I? BL k PERMIT
SUBD. AlrK N RECEIPT #:
RECEIPT De4TE: $ ? 00'
2000 MECHANICAL PERMIT (RESIDENTIAL)
Date: / ` 7 -U6
Compiete this section onlv if you are installing HVAC in a single family dwelling, townhome or condo under
coastraction snd nat owr.er,'ocaaoied.
• HVAC: 0-100MBTU
ADDITIONAL 50 M BN
• Gas outlets (minimum of one required @$3.00 ea.)
$ 30.00
6.00
State Surcharge .50
Total $
Complete this section onfv if you aze remodelin¢, addine to, or renairine an existing single-family dwelling,
townhome, or condo. Please indicate if it is a new item, alterafion, or repair.
- - ?- ° ?CrC? AJ
New Alteration _ Other
? Fumace
_ Air exchanger
Reminder: Call for inspections
SITE ADDRESS: / 1 IO
OWNER NAME:
INSTALLER NAME:
STREET ADDRESS:
?ITY:
CITY OF EAGAN
3830 PIIAT KNOB RD
EAGAN tMI 55122
651-681-4675
? Air conditioning
Other
Fee $ 30.00
State Surcharge .50
Total $ 30.50
f,,T C-PHONE #:tP?_- (D X?'6('I (p?
-4-- "A? ??
CO? E) _ 3? 3-? 3R3
PHONE #:
(AREA CODE) .
? L
STATE: M)Q. ZIP:
?S GNATURE OF PERMI'I`I'EE
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Use BLUE or BLACK Ink
. r-----------------+ I
I For Office Use � I
' � Permit#: ` ��� I II
Clty of �a��� � � � � ; �
� Permit Fee:
3830 Pilot Knob Road I I
Eagan MN 55122 � Date Received: �
Phone: (651)675-5675 I I
Fax: (651)675-5694 I Staff: �
I I
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: o ���5 te Address: � • Unit#:
�.�.� A�� �r � � ���
k ' Name: ����_����� Phone: �
Re�fdent/ � ��� ��V1� � �. �� �2�
t?wner : Address�city�zip:
' Applicant is: V Owner Contractor
Description of work:��.' �l��C`
7y,p.e of'1Nork ;
� ' Construction Cost: Multi-Family Building: (Yes /No�
��' � Company: Contact:
�����,���8�, �, Address: City:
' State: Zip: Phone: Email:
License#: Lead Certificate#:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer&Water Contractor: Phone:
Nf�TE-Pfans and sup�lar�rn�i��lac�mer�t����t yac�submit are�onsidar�d tc�b�pr�blf�i�fa�ati4n. Porti4ns s�f
#hr��nfpir"r�atrar�:_may be cl�s�rfi�d-�as nQ�-�u�1Fc rf���u,!�r�vid�specl�c re���ns t�rat wcr�c��e�rrxiit�afh��ty ta �.
. >>.�x co»c/r�al #iiaf'�he 'are trad���c�t�. ' . , . .:
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.qopherstateonecall.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.
Exteriorwork authorized by a buifding permit issued in accordance with the Minnesota State Building Code must be completed within 1$0
days of permit issuance. .�
x X
Applicant's Pri t Name ApplicanYs ign ture
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