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2075 Cliff Rd Use BLUE or BLACK Ink For Office Use j &7t Permits: Zne 0 A/ City of Eap P/~ ( I Permit Fee: - I 3830 Pilot Knob Road I I Eagan MN 55122 Date Received: Phone: (651) 675-5675 1 I Fax: (651) 675-5694 I Staff. I t 2011 FIRE SUPPRESSION SYSTEMS PERMIT APPLICATION* ' Date: Site Address: Tenant , Suite PROPERTY OWNER Name: Phone: Address ! City 1 Zip: Applicant is: Owner Contractor -4 DP 7 /~!t w ~~r~/p~N7 s~/t !N!c[.r/~ "1714®1, A(-cp4 1411 r/ TYPE OF WORK Descnptit,._ aTwork: Construction Cost: -r j&j A a. Estimated Completion Date: 1l3 0/1- CONTRACTOR Name: #0A071a C-7.-.-*/Ci License a 8/f. Address: 2.Z1-75Afit-Al>c71. -AAoolc 41-Ir I,,- City: SCA /Crh/I( State: 1,1k Zip: 19'5'0'M Phone: C!L _ Z 4-L _ 15 7G Contad:1067rA 1-*L>,0r%A1/c4 Email FIRE PERMIT TYPE WORK TYPE 7 Sprinkler System of heads _ New - Addition _ Fire Pump - Standpipe , Alterations - Remodel Other. - Other DESCRIPTION OF WORK: Commercial - Residential - Educational FEES $55.00 Minimum (includes State Surcharge) OR Contract Value $ t3~ X1% _ $ .SCl Permit Fee - If the Permit Fee is less than $10,010, surcharge is $ 5.00 - If the Permit Fee is > $10,010, surcharge increases by $.50 for each $1,000 Permit Fee 5 Surcharge (i.e. a $10,010411,010 Permit Fee requires a $ 5.50 surcharge) $ TOTAL FEE 3/4" Displacement Fire Meter - $203.00 $ Fire Meter $ TOTAL FEE *Requirements: 2 complete sets of drawings and specifications, cut sheets on materials and components to be used I hereby apply for a Fire Suppression System 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 with the Minnesota Budding/Fire Codes; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. X Pr-7rlL X Applicanrs Printed Name Applicant's Signature -L BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Al 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org FOR OFFICE USE REQUIRED INSPECTIONS Hydrostatic Flow Alarm Drain Test Rough In Trip Pump Test Central Station Final Conditions of Issuance: Permit Revie bY: Date: / / ~J Use BLUE or BLACK Ink - ~ Fe~~E,fice.lJse I I City of Eatan l Permit ~~~S7 I I l Permit Fee:' 3830 Pilot Knob Road I I l Eagan MN 55122 Date Received.- r y i l Phone: 651 675-5675 l I Fax: (651) 675-5694 Staff-- 2011 COMMERCIAL PLUMBING PERMIT APPLICATION Date: Site Address: Tenant: Suite PROPERTY Cti OWNER Name: \W~ C_ Phone: CONTRACTOR Name: r~ A ~l~tr 1CJ;~F'.~ License LMS 50 l 0 Address: `Y)S f ,'AA 16aUlm City: \ State: AVZip:SSL T Phone: (I<<, ° ~S 1- ~i Email: TYPE OF -New Replacement _Repair T Rebuild - Modify Space _ Work in R.O.W. WORK Description of work: COMMERCIAL PERMIT TYPE New Construction _ Modify Space -Irrigation System (_yes/_ no) ( _ RPZ / 41 PVB) • Rain sensors required on irrigation'systems • Avg. GPM (2" turbo required unless smaller size allowed by Public Works) Meters Call (651) 675-5646 to verity that tests passed prior to picking up meter. - Domestic: Size & Type J t ~~1 Fire: 1 Avg. GPM High demand devices? -Yes No Flushometers _Yes No COMMERCIAL FEES: $55.00 Minimum (includes State Surcharge) OR Contract value $ x 1 % _ $ Permit Fee Required on ALL new buildings and boulevard irrigation systems 4 = $ Radio Meter Read If the Permit Fee is less than $10,010, the surcharge is $5.00 = $ Meter(s) If the Permit Fee is > $10,010, the surcharge increases by $.50 for each $1,000 Permit Fee r (i.e. a $10,010-$11,000 Permit Fee requires a!$5.50 surcharge) State Surcharge Following fees apply when installing a new lawn irrigation system. $ Water Permit Call the City's Engineering Department, (651) 675-5646, for required fee amounts. $ Treatment Plant $ Water Supply & Storage $ State Surcharge TOTAL FEES $ CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start wit a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. Applicant's Printed Name Applicant's Signature FOR OFFICE USE ` Approved By: Date: Required Inspections: Under Ground Rough-In Air Test Gas Test Final PRV Required: Yes No Page 1 of 3 SAINT P' jL REDUCED PRESSURE BACKFLOW PREVENTER TEST REPORT OR WATIQ SERVI~j TESTABLE DOUBLE CHECKS Service Name: _ gl ex,~ s ~p r Contact Person/Tele: Address: ot~~ 5 CL~ RA City: F-c..,QI-,% State: Zip: Device Location: Serve what system: 2r c, a c n Account No: Serial Number: Type: !~~o Make: I us Model: Size: I Rebuild Due Date: Test Due Date: Annual Check Valve'i>t1 Check Valve #2 Differential Pressure Relief Valve Report Pressure LA, D Pressure Opened at 49psid reduced pressure. Did not open Cleaned Cleaned Cleaned Replaced Replaced Replaced R Disc Disc Disc E Spring Spring Spring P Guide Guide Guide A _ Pin Retainer Pin Retainer Diaphragm, Large I Hinge Pin' Hinge Pin Lower R Seat Seat Upper S Diaphragm Diaphragm Diaphragm, Small Other, describe Other, describe Lower Upper Spacer, Lower Other, describe r i Sign and date Tag The above is certified correct Signed'-- DateTested: Tested by (Print Name) r-, S{e~ Certification Number=D` Company Name: Cr0- PciJec.~r~lr:~`~15 License Number L~SGl7s~' Company Telephone Number SI5i-! All sections of this report must, be completed. Return to: Saint Paul Regional Water Services N r of Devices Fee per Device ATTN: Lynda Prcciado - Production First $ 4 1900 Rice St Devices' 35 Saint Paul, MN 55113 Return with fee: Payable to the Board of Water Commissioners ` - e!`:?OF EAGAN 3834 Pilot Knob Road Eagan, Minnesota 55123 (612) 681-4675 SITE ADDRESS: , I I 1 1 1 j ,.i-! .,.j : r .p, ? ; "Il! PERMIT SUBTYPE: INSPECTIUN RECORD PERMIT TYPE: Permit Number: Date Issued: APPLICANT: i?,a.?? ..'? ?<+.1? TYPE OF WORK: 1?1 .? ;? ! ; ! 1 t?N I I id .lI I Io 1 tI I hA Iifr i 1 t? 1 0! if .' .' 1 1 S I?'ll{tll?? W ti tIi1oChN11';Itk V1lii1)? J Permit No. Permit Holder Date Telephone # S/W PLUMBING HVAC ELECTRI LM ELECTRIC Inapection Date Insp. Comments Footings I Foundation Framing Roofing Rough Plbg. 49 , s Rough Htg. Isul. Fireplace Final Htg. Orsat Test Final Pibg. Plhg. Inspector -Notify Plumber Const. Meter Engr./Plan Bldg. Final DeCk Ftg. Deck Final Well Pr. Disp. G?qa?wrr?a,Q.,eu?,d4-f 10o/9.4- CITY'OF EAGAM 3830 Pilot Knob Raad Eagan, Minnesota 55123 (612) 681-4675 SITE ADDRESS: I PERMIT,SUB,TYPE: I I i t roi, F+ W !1hK Itf I1 1 4 Af 1I IN . . r WECTIUN RECORD PERMIT TYPE: Permit Number: Date Issued: APPLICANT: TYPE OF WORK: ,, I .i,; ,.,I.. I 14 111 1 iIl itf O.ll 1 1 nPa Nf 11 . fHl (114611',"If i'i V1Itf 1)1 ? Permit No. Parmit Holder Date Tetephone 8 SNV PLUMBING HVAC ELECTRIC ELECTRIC Inspection Date Insp. Comments Footings I Foundation Framing Roofing /J Rough Plbg. L P' zh: Rough Htg. Isul. Rreplace Final Hig. ( Orsat Test Final Plbg. , Plbg. Inspector - Notily Plumber Const. Meter EngrJPlan Bldg. Final Deck Ftg. Deck Final Well Pr. Disp. .. 6 1 ocy?? COMMERCIAL BUII.DING PermitApplication City Of Eagan 3830 Pilot Knob Road, Eagan Mn 55122 Telephone # 651-675-5675 FAX # 651-675-5674 Foundation Onl New Buildin Interior Im rovement • Structural Plans (2) sets • Architecturel Plans (2) sets . Ardiitectural Plans (2) sets • Civil Plans (2) . Structurel PWns (2) . Code Analysis (1) • CertifirateofSUrvey (1) • CivilPlans (2) . PrqectSpecs (1) • Code Analysis (1) `• • Landscaping Plans (2) . Key Plan (1) . ProjectSpecs (1) • CodeAnalysis (1) ° . MasterEcitPlan (1) • Spec. Insp. & Testing Schedule " . Certificate of Survey (1) . Energy Calculations (1) not always" • Soils Report (1) • Spec. Insp. & Testing Schedule (1) " . Elec. Power & Lighting Form (t) not always" . Meter size must be established . Meter size must be established • Meter size must be established-rf applicable 1 . ProjectSpecs (1) y • EnargyCalcula6ons (1) .l 1 • Eledric Power & lighting Fortn (1) " y y • Master Ewt Plan (1) l 1 • Emergency Response Site Plan (1) l ? • SoilsReport (1) 1 • SAC detertnination - rall 651-602-1000 . SAC determination - call 651-602-1000 SAC determination - pll 651-602-1000 Call MN Dept of Health at 651-275-0700 for details regarding food & beverage or lodging facitities. " Contact Building Inspecrions for sample and if required when it states "not always". **• Permi[ for new building or addition will not be processed without Emergency Response Site Plan. Date sT /a/_ 6,3 Construction Cost DOC? Site Address o'b 75? ('LJFF ? M nA1 ,1 L1A l) UniUSte # Tenan[ Name i Former Tenant Name Description of Work c ),?e`c-i P7> TD Property Owner YS!()(j(ti A Fj_'1p? Cy7'c? Telephone # (4,57) 6'5-3y Contractor Z6'19? ?17ZD(r LLL d.'E, r-%H 21 z5 Address IfJ43S( QqLV-4t, Qa)r- r3u J City N1z LMCC- 5tate Zip 55367 Telephone#(/o%?) fO'7 -.jdV,,7- Arch/Engr ? r5 Address ?Pp ? ' r \ U ? n Registration # City State ? p'. 2113 Zip Telephone #( ) Licensed plumber installi;0? er service: Phone #: I hereby apply for a Commercial 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 understaxid 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. WELT7Fi Tslz?6o Applicant's Printed Name ApplicanYs Signature OFFICE USE ONLY Sub Types ? 01 Foundahon ? 26 Public Facility ? 30 Accessory Bldg. ? 14 Apartments I1/ 27 Commercial/Industrial ? 32 Ext Alt - Apts. ? 15 Lodging ? 28 Greenhouse ? 34 Ext Alt - Comm. ? 25 Miscellaneous ? 29 Antennae ? 35 Ext Alt - PF ? 37 Nail Salon Work Types ? 31 New 0*""32 Addition ? 33 Alteration ? 34 Replacement Valuation 13+ 000 .0 Census Code _z{3'7 SAC Units Nbr. of Units - Nbr. of Bldgs Type of Const ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair ? 37 Demolish (Bldg)` ? 43 Reroof ? 46 Windows/Doors 'Demolitbn (Entire Bldg only) - Give PCA handout to applicant Occupancy v MC/ES System Zoning i'D City Water Stories Booster Pump Sq. Ft. /G 6`'', PRV ? r Length Fire Sprinklered -- Width Za ? REQUIRED INSPECTIONS _ Footings (new bldg) Foorings(deck) f oorings (addition) ? Foundahon Drain Ti]e Roof Ice & Water Final _ Framing _ Fireplace _ R.I. _ Air Test _ Final Insulation FinallC.O. v-' FinallNo C.O. _ Plumbing HVAC Other _ Pool _ Ftgs _ Air/Gas Tests _ Final _ Siding Stuceo Stone _ Wmdows (new/replacement) _ Retaining Wall Approved By f-t, , Building Inspector Base Fee Surcharge Plan Review MC/ES SAC City SAC Water Supply & Storage Utility Connection Charge S&W Permit & Surcharge Treatment Plant License Search Copies Other Total aa3.as 6• ?U 1 ?fs, I / ,210 3 . s? X 69TY. OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55123 (612) 681-4675 PERMIT PERMIT TYPE Permit Number: Date Issued: ??/z 3 _? i4j suzLpiNG 021864 09j01/93 SITE ADDRESS: P.I.N.: 10-56723-010-01 2075 cLxFF Ro LOT: 1 BLOCK: 1 PARK CENTER 4TH DESCRIPTION: _.? (BLOCKBUSTER VZDEO) Btri'1dift,Permit Type FOUNDATION Bfuildithg ??,rk 7ype NEW ,d1BC 4ccu:panC}+,\ B-2 ;`ConstCUCtiom T}7pe V-N ? xahirvg PO C3C / I3ui1•din5 LengGFf j 111 ( Build3,riCJ W,idCh ' 71 ?. aui1dirflo stories ? " ' i !_r.. S,q,rjaro Feet :. 7,028 ?? (nd gil??,?3[n REMARKS: S & W PLBR - PARK DEDICA7TON & TRAIL DEDICATION PAID 08/16193 RECEIPT # CR011917 FEE SUMMARY VALUA7ION $30,000 8ase Fee $284.50 CITY SAC $200.00 Plan Review $184.93 5& W PERMIT $100.00 Surcharge $15.00 S & W SURCHARGE $.50 SAC $1.500.00 TREATMENT PLANT $684.00 SAC t 100 ROF1D UNIT $1R0N3.58 5AC Units Z Total Fee $3,972.51 Subtotal $1,984.43 TiQS-7W?IiODNONS7 SERVICESPP1i22238516 23 EMPIRE DR ST PAUL MN 55103 (612) 223-9516 L.. 29"-&RNENNEPIN CNTR PTNR 527 MARQUETTE AVE S MINNEAPOLIS MN (612)338-1000 I hsreby a0know3:edg•e tNat I have rsad th;ta applioa:tian aur+,d staCs thmt the infqrmation is ca•rreat a•n,d a9rae tQ aQmplywitYi a11 applieakie State of fitn, Statrates b,nd City ef Eagan,Qrdiria#teprs. . _ ? C::?? ? AtIn R??s f.A..?.? APPLIGANT/PERMITE GNATURE ISSUED B SIG ATURE CITY OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55123 (612) 681-4675 SITE ADDRESS: Lo r: 2075 CLIFF RO PARK CENTER 4TH PE?IjaSAU?BJJPE: BUILDING 021864 es/ei/e3 TYPE OF WORK: NEW DESCRIP7ION (BLOCKBUSTER VIDEQ) FOOTIN6 REMARKS: S & W PLBR - PARK DEDICATION 6 TRAII qEDICA7I0N ? - L- - INSPECTION RECORD PERMIT TYPE: Permit Number: Date Issued: 1 B L 0 C K: 1 APPLICANT: R05EWOOD CONST SERVICES (612) 223-8516 PAID 08/16/93 RECEIPT # CR011917 i ? .,r_ . ..4.? _ . . .. . . _ REACTIVATE _ PERW.4 , ` . 2jittA CITY OF EAGAN 1993 BUILDING PERMIT APPUCATION 681-4675 SINGLE & MULT1-FAMILY 2 sets of plans. 3 registered site surveys. l copy of energy calcs. AUG 16 s93 COMMERCIAL 2 sets of architectural 6 structural plans, I set of specifications. 1 copy of energy calcs. Penalty applies: 1) when permit is typed, but not plcked up by last working day of mooth- in which request is made, 2) address is changed or 3) lot change i.s requested once permit is issued. Date (S Valuation of work ? - SiteAddress: Avor ?ef ASJ/6NE'd ao'7,?- CtIFr- CZoRA tIREEi iUtTE I Tenant Name: (commercial only) (3C_0C-K8v.rr&"e 11/6cD _ LOT I B1ACK _L SUBD P.I.D. M ' l'"/;RK C'esJlh?G. i??iCi?+/J?d Descri tion of work: DUEw gv?Ld/N(? The applicant is: CJ Ow.ner Lontractor ? Other (D*ccribt) Name 2441 Aloo 1ieA1,VeA11V C°c&1Ae,e phone 336--/000 Property L.5, ?IRS, Owner Address sa7 o,9).f4QJC'r7zF AtiE So (ll(crc l-/a05e2 ) &.)ffe..;?ooo fiREEt iTE N City 9?7PcS State Iip SS Company osc,..ooo L?'NJMVcne,-? 5??1Ca_J Phone .2 23-?5/jr- COI1tr8CtOf Address c23 E/yior.Pc' 42?v&5' License 1 Exp. c;ty ST 'e4vz- State m/ A?^-) Zip S5-/03 Company ?o2rFe??c 4?cs?e.?, Sc.cv?crs Phone 2Z3 -o?f/L Architect/ Englneer Name Pcf?L 2 6 E.2 Registration # 15-86 2 . Address ?.3 Q?,v? City 5 T 5tate 1'71•vti Zip SS/o3 Sewer 3 water licensed plumber . Processing tfine far sewer 8?+ater permits is two days once area has been approved. I hereby acknowledge that I have read this application and state that the lnformation is correct and agree to comply with all applicable State o Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant: v5 I ¦wr vv. ?.•?. BUILDING PERMIT TYPE Ef01 Foundation O 02 Sf Owg. ? 03 SF Addition E3 04 SF Porch O 05 SF Misc. WORK TYPE M31 New ? 32 Addition O 06 Duplex O 07 4-Plex O OB 8-Plex D 09 12-Plex O 10 Multi. Add'1. ? 33 Alterations O 34 Repair GENERAL INFORMATION ? 11 Apt./Lodging ? "O 16 Basemerit Finish ? 12 Multi. Misc. -- »O 17 'Swie?Poo1 E3 13 6arage/Accessory 11 18 Coma./Ind. ? 14 Fireplace 13 19 Comm./Ind. Misc. ? 15 Detk O 20 Publit Facility O 21 Miscellaneous ? 35 Tenant Finish D 36 Move Const. (Actual) ?. Basement sq. ft. Allowable) ? v-N lst F1. sq. ft. ccupancy UBC 2nd F1. sq. ft. 2oning Pp csc Sq. Ft. total OL 1 of Stories I FoDtprint Sq. ft. oZ8 length On-site well Depth On-site sewage . APPROVALS Planning Building Engineering Variance REDUIRED INSPECTIONS O Site 0 Wallboard a1 ? Footing ? final ? framing ? Draintile O Insulation ? Fireplace Permit Fee Surcharge Plan Review License City SA? Iater`Conn. Water Meter Acct. Deposit S/W Permit Park Ded. Trails Ded Lopies Other Total: 28q.50 lS.00 Js 4?93 ISOo Ino,a)o . Q ,Oa ?oo3•ss ? ? SAC % 100 SAC Un' s a Yaluatim: Roaau kw 4T .C'?a . , fi5176 Ar_4W K 'I r'/o= /bo3,s-lvp )? PA I'D V16113 R6teivf-4 G R 11917 O 37 Demolish MWCC System YEZ, tity Mater YES PRY Required Booster Pump Fire Sprinkler Census Code ? 0 SAC Code 0ao"sus bfrlt ? G4so? ?( o Assessments -k C`1TY OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55123 (612) 681-4675 SITE ADDRESS: P.I.N.: 10-56723-010-01 ;.-.- (BLQCKBUSTER 15,01183ntgi-,Permit Type Ouilding Wbrk Type ItBG 4ccupon?6-y:t„ Cohstructfnn T?V,pe ? 9 Y1 ?. YI 9• '-.-..? BW?ldiltkJ l.e6gt1h ) Suild,tng Witlth Bui3xdilig Vtaries % 4kkklPB?Fect' S \ ? v ?a-u-93 BUILDING 022113 1@/01(93 DESCRIPTION: VTDEO) COMM./IND. NEW B-2 V-N pD CSC 111 71 i 7,@28 cts? ? cc?-??? REMARKS: FEE SUMMARY: Base Fee Plan Review Surcharge Tntal Fee PERMIT GK INbNq PERMIT TYPE: Permit Number: Date Issued: 2075 CLIFF RD Ltl7: 1 BLOCK: 1 PARK CENTER 4TH VALUATION $1,497.00 $973.05 t172.50 $2,642.55 $345,000 CONTRACTOR: - Rpplicant - OWNER: RtlSEW000 CONST 5ERVICES 22236516 247H/WENNEPZN CMTR PTNRSHP 23 EMPIRE OR 527 MARQUE7TE AVE S 2000 ST PAUL MN 55103 MTNNEAPOLIS MM (612) 223-8516 (612)338-1000 i' I hereby aoktt.owTedge tilat Z have read thi.srApplicetio•n ensf stata thaC Yhe infcarmatian is 4oorrsct and agree ta camPiq;,u3.th a11 aAplioab.ke 5tatt a'F Mn. 3tatute5 antl C,Ety oP "gj?n Qrdinan.css.. ?m 6a f rnA11 ISSUED13V:SI NATUR CITY OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55123 (612) 681-4675 SITE ADDRESS: 2075 CLIFF PARK CENTER 4TH INSPECTION RECORD PERMITTYPE: BuzLorNG Permit Number: 022113 Date Issued: 10 / 01 / 9 3 LOT: 1 BLOCK: 1 APPLICANT: RD ROSEWOOD CONST SERVICES (612) 223-8516 PERMIT SUBTYPE: TYPE OF WORK: COMM./IND. NEW DESCRIPTION (BLOCKBUSTER VIDEO) REACTIYATE PERMIi i auq 11, CITY OF EAGAN 1993 BUILDING PERMIT APPLICATION 1?,??.`?• err 681-4675 A -? SINGLE Q MULTI-FAMILY 2 sets of plans. 3 registered site surveys, 1 copy of energy calcs. AUG 1:6 1993 COMMERCIAL 2 sets of architectural 6 structural plans, l 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 wAich request is made, 2) address is changed or 3) lot change is requested once permit is issued. Date e 93 Valuation of work 3 7? O O O _ Site Address: ao-' y2? f}-rj/6n1Ed ao7 , CL 1 F1r RoaV tiREEi WITE t Tenant Name: (commercial only) ?vL oC-& Bv-rrEZ v/?c0 IAT BIACIC SUBf), P.I.D. N ' (•'/?kK (?e&1te,G FoviC?1Jld Descri tion of work: DUEw Bv?Gtl/N(? The applicant is: C1 Gwner Contractor ? Other (Descri6e) Name 244h Aloa l4envnreP?N C°cA,#e,e ?A?er.ve-esH,a phone 33?-?000 Property :xST FIRSi owner Address sa2 1A19KQJ677ZF Avf Sa (re«V- STREET STE f City OY1P6 S State 177"-) Zip 5s` Company 6?1se4'100o C°an?.cn??cne.? Se.e??cE'I Phone 23-?5/6 Contractor Address c?3 ElyioiR? D/?tt,c= License # Exp. City 57- P.4uL State 12'71^IA?) Z9p 5-5-/03 Company Po2TFoz.1o tac3/6.u Sc.tv1cts Phone 2Z3 -4r?b Architect/ Name pcfc2 6E2 _ Registration 1? /S86 Z Engineer Address 23 City State 11"71tiA-1 Z;p 57-Slv3 Sewer & water licensed plumber . Processing time for sewer & water permits is two days once area has been approved. I hereby acknowledge that I have read this a lication and state that the information is sota Statutes and City of Mi t gR nne e o e Sta correct and agree to comply with all appllca Eagan Ordinances. ?? °° 5lgnature of Applicant:C=? OFFICE U5E ONLY BUILDING PERMIT TYPE O 01 Foundation. ? 02 SF Dwg. O 03 SF Addition ? 04 SF Porch ? 05 Sf Misc. ? 06 Duplex ? 07 4-Plex ? OB 8-Plex ? 09 12-Plex ? 10 Multi. Add'1. WORK TYPE .? - 0 11 Apt./Lodging '? 16 BaiementYfinish ? 12 Multi. Misc. 0? 17 Swim Pool ? 13 Garage /Acce s sory IW 18 Comm./Ind. ? 14 Fireplace ? 19 Comm./Ind. Misc. O 15 Deck 0 20 Public Facility ? 21 Miscellaneous 12?'31 New ? 33 Alterations 0 35 Tenant Finish 0 37 Demolish ? 32 Addition ? 34 Repair O 36 Move GENERAL INF ORMATION Const. (Actual) Basement sq. ft. MWCL System ? (Allowable) ?G lst F1. sq. ft. -? City Mater UBC Uccupancy B.a 2nd fl. sq. ft. • PRV Required Zoning pD Ga,G 3q. Ft. total 7a24} Booster PumP M of Stories I Footprint Sq. ft. 7bzp Fire Sprinkler length _ in ; On-site well Census Code 3 2-t Oepth '7134., On-site sewage SAC Lode APPROVALS Planning Building Assessments Engineering Variance REQUIRED INSPECTIONS ? Site ? Wallboard ? Footing 0 Final O Framing ? Draintile ? Insulation ? Fireplace Permit Fee f 1, uo wimtia,: g 3 t1so D on Surcharge . T4 Plan Review q?31 0 5' j7s-vv,? 7aTr? License MWCC SAC •, ;? City SAC ? FrjS ?pvvD?lOaJ ?H? ??". Water Conn. _.------------ Water Meter Acct. Deposit o 5/W Permit S/W Surcharge Treatment P1. Road Unit Park Ded. Trails Ded. Copies Other Total: ? SAC % SAC Units 1993 MECHANICAL PIItMIT (CONIIISERCIAL) CITY OF EAGAN 3830 PIIAT KNOB RD FAGAN MN 55122 (612) 681-4675 PLEASE COMPLETE FOR ALL COMMERCL4LJINDUSTRIAL BUILDINGS. AL50 COMPLETE FOR APARTMENT BUILDINGS OR OTfER MULTI-FAMILY BUILDINGS WI-EN SEPARATE PERMTI'S ARE NOT REQUIRED FOR EACH DWELLING UNTf. DATE: CONTRACT PRICE: $ ? NEW BUILDING INTERIOR IMPROVEMENT WORK DESCRIPTION: FEES 1% OF CONTRAGT FEE $ .,::? 8e ? PROCFSSED PIPING: $25.00 MINIMUM FEE: $25.00 STATE SURCHARGE $.50 FOR EACH $1,000 OF ?POW FEE. TOTAL $ goG9 SITE ADDRESS: OWNER NAME: v? TELEPHONE #: TENANT NAME: (IMPROVEMENTS ONL`t) INSTALLER: A y s / ix-? -IV4- A` ? CITY:STATE: /? ZIP CODEi'??? TELEPHONE #: eeIll-7- % 6 "?/ ? ?TK- BL. ,.. Ci . • PLEASE COMPLETE FOR ALL COMAERCIAUINDUSTRIAL BUII.DINGS. ALSO FOR MULTI- FAMILY BUI: DINGS WHEN SEPARATE PERMITS ARE NOT REQUIl2ED FOR EACN DWELLING 6__? CONSTRUCTION ADD ON REPAIR WORK DESCRIPTION: CONTRACT PRICE: $ G??-o v ? FEE: 1% OF CONTRACT FEE. STATE SURCHARGE $.SO FOR EACH $1,000 OF P£RMTf FEE. MINIMUM FEE: $ 25.00 CONTRACT PRICE X 1% $ ?I, V STATE SURCHARGE $ • 6O TOTAL S 11. !lO SITE ADDRESS; ?-Q 7.5? GL/GF ?m TENAri`T NAME: Br/ST_f_/2 /ZfZf o S1'E. # OWNERNAN4E: 0?ck /?L1ST't.c 444E0 INSTALLER: ADDRESS: G?u,_ 4,, ZZ-470LF_ S 7? -- - CIT'Y: 4? fa ,W £d ; STATE: ZIP CODE: PHONE #: 4S3 ?73 90 FOR: ` J fis?v CITY OF EAGAN 1993 PLUMBING PERMIT (COAZMERCIAL) CTI'Y OF EAGAN 3830 PII.OT KNOB RD FAGAN MN 55122 (612) 681-4675 . ? ? 888CI71L INSPBCTION ]1lTD TBBTING SCHEDIILE ?• -?4tTo be nsed in accordanee with the "CUidelines for Special 2nepection and Teating^) ?. PA(VECT l1AN8 LOCATl<tN CoC,CBvsTE? v / /J e o PROJECT NO. _ ?. PERHIT NO. Z j(eC? lverrar. •ven:~.nv e..v?,.•.. ? Spec 90 Type of Report Aeei d a ric -- gne irm . C MtaS-•...,e S?{L ER:pp:G. Z T??{ti ?a? ?T- D Thia echedule to be filled out and included in the project apecification. InformatLon unavsilable at that time to be filled out when applying for a buflding permit. ? (1) permit N q Official. (2) deacriptiona per U.H.C. Section 306 (3) Spec a fnepec oz, eating Agent or Fabrieator. (4) Firm contracY.ed to perform eervicee. 8ach appropriate representetive muat siqn below: ownersdy' °ftu qvE JnnRrhze4H/P Firm: u.raucE. Keqt, ES'TAIr- _(W»<<Date: bL7?/?3 Contrector: Date: f 7? Azchitect: Firmc 7 t?JL?i,a cu:??Date: 73 :S SI:1 Flim: L? c:L L N(.i:2.? Date: Firm: Date: 'SI= Firm: T?. Date: Fir^- Date: Ffsm Date: 'F:' ?RIDi4LY (CiC/? Fi : Date: • . F: L? _ a'lZc..: I'/9ry/L?.?Ki .?..? Fiim: Date: 09%ji- i • The individual namee of all proepective epeoial inspectore and the work they intend to obeerve must be identified on the reverae eide of thie form. Leqend: SER ? Struetural Enqineer of Reeord SI ? Special Inepaetor TA ? Teating Agent F ? Fabricator 1lceepted for the Building Depaztment ey Date: ?7?? 0 07?5 245 0 l Request Da[e ' ve No Rouyhin Ins ion Reqmretl (VOU must ca I vupeolnr, w an reatly) ? Inspecbon Olher Than Rough-In g Ready Now ? Wtll Nolity Inspeclor S. ? q s NO ? V¢s pate Reatl IIKlicensed contractor ?owner hereby requesf inspection of above electrical work at Job Aadress (Blreet Box or Route No ) ao 75 C I, PF 904d Gity Ea a+%i Section No_ Township Name or No Range No Gounry Q a1C o4?o Occupant(PRINTI L 1 _'O? PM1One No yS 2- 85 3 y Power Supplier Atltlress Elemocel Conirector (COmpany Nrram??e) ` 4!J L ConVaotor's Lmense No C/+o `J0ep Mailmq Atltlress (Comrector or 01 ner Making Installallon) W r $I VIhl 575 qY 9 : 4 9.2,06 ?.S,o^4 . ,atrq., ? S AuIDOnzetl Signature (Go ractor/Owner Making In Ilation) Phone Number 783 - 45 MINNESOTA STATE BOAHD OF ELECTPICITY III plll Ilry? III IIIII qlll IIn Il?p ?? Iqll ? ?' ?ivor?? i ivv nw?=., •?.? •? Griggs-Mitlway Bltlg. - Room 5-128 II A 11 IIIII IIII II II BE ACCEPTEO 8V 7HE STATE BOAFD Q 1821 UnlversitY Ave., 51. Peul, MN 55104 II b 11 IIIII IIII II l1NLES5 PROPER INSPECTION FEE IS II pU4W IIII 0 - Phone (612)602-0800 ENCLOSED ! arz.,- p??,?7 / S REQUEST FOR ELECTRICAL INSPECTION ='•"?, Ee-aooai-as O/! 9 See inslmclmns for complebng this form on back oi yellow copy ?+ n c ?.- ?? V O C 4:7 °X' Below Woik Coverad Nv Thi.¢ Ranl Ne Add Type of 8uilding _A? ired Equipment Wired me Temporary Serv plex C Electric Heating 7 Building Apt Load Management mm./Industrial Other (Specify) m r (specily? Conrcacmr's Remarks .)? O? !,C p_ ? vt QO 9,,?mc .V<7 wl'/ lIa Compute Inspection Fee 8elow: dS PC,/' nIATIJrl W{ d4 S70IlR. pRD9xq y?1, ! # Other Fee # Service Entrance S¢e Fee # Cvcuits/Feeders Fee Swimmin Pool Transformers Si ns 0 to 200 Amps / 0 to 100 Amps Above 200_Amps Above 100 _Amps insPeomrs usa omy TOTAL Irrigation Booms ?O ? C Special Inspection ?? aO. O J Alarm/COmmunication THIS INSTALLATION MAY 8 D D Other Fee ISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. I, the Electncal Inspector, hereby certify that the above inspection has been made. ROO9n-'" Dale OFFICE USE ONLY This reduest voitl 18 monlhs imm n aDIDBLINEB lOR BPECI]1L INBPECTIOH 1121D T88TIpO PVRYOBEe To provide a method for eomplying with the speeial inepaction and teetinq requirementa of tha Unifocm Buildinq Cade (U.B.C.) and other required eCructural inapectione ae authorized by U.B.C. 8action 302(c) 4. DStoRE !1 PERx2T GN 8E IssVED8 TTs enqinear of rscord shell complete the Speciel Inepection and Teeting Schsdule. The caapleted echedule ie en element of the conetruction documents and aftar permit iseuanca, bacanee part nf tha building dapertment epproved plans snd epecificatioas. The canplelad eahadula shall include !ha followinq. 1. A epecitie lieting of the iteiea requiring observation and testinq. 2. The eeaociated epecification esation and azticla which definee the applicable etandnrde by ahich to iudqe conformance with the npproved plena end epecifications in aceordance with U.B.C., Section 306. The epecificstions section ehould sleo include the degree or basie of obeervation and tasting; i.e., intermittent/vill-call or full-time/eontinuoue. 3. The frequency of reporting, i.e., intermittent, weekly, monthly, per floor, etc. 4. The parties responeible for performing the obeervntion and teeting work. 5. The required acknowledgemente by each deeignated party. REQVIREILLdNTB: "Special Inepection" (vork requiring obeervation and judgamant) and "Teeting" (work analyzing materiale in accordance with approved etandards) ehell meet the minimum tequiremente of the Minneeota State Building Code which includes U.B.C. Saction 306, and the npproved plane and epeciLicatione. (NOte: Obeervation and teetLng r+ork doee not prevent he normal field involvement aad record review proceee of the Enqineer of necord, nor shall it relieve the contractor of any reeponeibility [o complete the work in accordance with the approved drawinge end specificatione.) RESPOIiSI82LITIES: Special Inapector\ `-1. __obeerve- the work aeeigned foz conformence vith the building department approved plane, epecificatione and appliceble vorkmanship provieione of the U.B.C. 2. Submit inepection reporte to the building officlal, the atructural engineer of reeord, and other deeignated pereone in eccordance with the Special Snepection Schedule. 3. Bring nonconforming iteme to the Smmediate attention of the contractor for correction, then, if uncoriected, to the engineer of record and to the 6uilding official. ? Submit a final ei nad re ort etsting whether !he work requiring epecial ` pect on wae, to the baet of hie/her knowledge, in conformance with the approved plane, epecificetione and the epplicable workmanehip provisione of the code. ?Teating Agent 1. Teet the work eeeSgned for confornanoe aith the building depnrtment approved plane end epecificetiona. 2. Submit reporta of the teet raeulte to the building official, the etructnral engineer of record, and other designated pereone in aeeordance with the Testinq Schedule. r.h C I a?? - ? ? 2 0 3 5 ?. ? 4;1 Fequesf Date Flre No Rough-in Inspeclion NOTICE: Vou Must Call Electrical Inspector Reqwretl' II A Rougb-In InsOecoon .i ? No Is Reqmred IX licensed contractor ? owner hereby request mspection of above electrical work at: Job AtlOress (Sireet. Box or Route No ) t Qry y?• n f? r' ? L' Section No Township Name or No Fange No Cou y' Occupant(PPINT) L / - O r' Phane No a. t?G f?vS Power!SU plie? ? Adtlress ? , f Goniractor5 License No Eleomcal ConVaotor (Gompany Nama) rr?c// ' n ? C???'P'?d'?'? ? . Mailing Adtlrass (COrtlra or,o?r Owner Making Ins?allation) //Z 4 /c?`??- S? :S? ?? ,/'??'4^F AuMo Si na cWNC?uec? Installatio PhUone vNumber / 9??--2 ? 4 • THIS INSPECTION REQUEST WILL NOT MINNESOTP STATE e0AR0 OF ELECTRICITV BE ACCEPTED BV THE STATE BOAFD Griggs-Mitlwey Bldg. - Room 5-173 UNLESS PROPER INSPECTION FEE IS 1821 Univarairy Ave., St Paul, MN 55100 ENCLOSED - Phone (612) 892-0800 REQUEST FOR ELECTRICAL WSPECTION ??'`?" ee??oep ? ? See inslmcLOns tor camplehng Ihis tortn on back oi yellow o?pY ???? ? 2 2 0 3 5 - x" Below Work Covered by This Requesf ? New Add Rep. TypeoiBwlding AppliancesWved EquipmentWiretl Home Range Temporary Service Duplex Water Heater Electric HeaM1ng Apt. Building Dryef Load Management Comm /Indusirial Furnace Other (Specify) Farm Av Conditioner Other(spi Contmcbr5 Remarks Compute Inspedian Fee 8elow. # Other Fee # ServiceEntrance Size Fee # Crtcuits/Feeders Fee Swimming Pool D to 200 Amps c 0 to?ikiAmps Q Transformers Above D_Amps iv`-° Above Amps SI(fn5 Inspectork Use Only OTAL IrrigationBooms 2Z1 Special Inspection ? Alarm/Communication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT Other Fee COMPLETED WITHIN 18 MONTHS. I, ihe Electrical Inspector, hereby Roughm oai ` certify that the above inspection has been made. Finai oa?e OFFICE USE ONLY This request void 18 monlM1S fmm .. ? 3. Bzing nonconforming iteme to tha imnediate attention of the contractor for correction, then, if uncorrected, to the engineer oP record and to the building official. 4. Submit a final eigned report_otating whether the work requiring testing was, to t e eet of hie/her knowledge, in conformance rith the approved plane, aad epecilLentione. c. corttractor 1. Yost or make availnble the Bpecial Inepection and 4eeting ScheOule within its office st the iob eita. Also, provide edequnte notifieation to those partiea deeiqneted on the echaQole so thay may properly prapare for snd achedula thelr ++ork. 2. Pronide the epecial inapector and testing agent accaee to the approvad plane and epecificatione at the jobsite. 3. Retnin et the job eite all reporte eubmittad 6y the epecial inepector and testing aqant for revlew by the buildinq department'e inepector upon request. 4. Correct in a timely manner, defieiencies identified in obeervation and testing reporte. 5. Provide the epecial inepector and testing agant safe acceee to the work requiring oDeervation or teatinq. 'D. Fabricalor ? -------1: 8ubmit e Certificate of Complianee to the building official and to the etructural englneer of record thet the wozk wae performed in accordance with the approved plane and epecificalione. E. Building Deparlment 1. Approve all epecial inepectore. The epecial inepector ehall be a qvalified person who shall demonstrate hie/her competence, to tha eatiefaction of the building offlcinl, for inepection of the particular type of conatruction or operntion requiring epeciel Snepection. The namea of all proepective epecial inepectore and the work they intend to obeerve, muet be identified in the 9peeiel Inepection nnd Teeting Sohedule. 2. Approve all testing egente vho perform work required by the State fluildinq Code. 3. Approve all fabricatore who perform work in their ehop which requiree epecial inepection. 4. Approve the completed Special Inapeation and Teetinq Schedule. 5. Honitor work requirinq epecial inepaction and testing includinq the reporting of the epecinl inepactor and testing eqent. 6. Review reporte and recommendetiane eubmitted by the epecisl Lnspector nnd testing agent. 7. Review the "final eigned report" eubmitted by the epecial inepector(s) end testing egent(e) ee well ae the "Certificate of Compliance" eubmitted by [he fa6ricator(e). These documents musi be eceepted and approved by the bvildinq departmant prior to issuanee of a Certificete of Occupancy. , u -in InsPecuo?C? tlY Now II NaliN Ins?or N 3j 4?/ /-•/r I/ Pva No Rougn ? When Peatly= ? iequ sl0ate Peawred, ]Yes ? hereby request inspection ot above electrical work at: ?^ icensed contractor owner ? ci+y {} t Y I I ?T v I J b AadfeSs I51 , Bo or or Owner MaWnq Instaliano-i MINNESOTA STAT RooOF Etect^ Gd99s'MlCway Bltlg. - m S-178 1821 Unrveleity Ave . St Paul. MN 55104 phene (61]) 661-0800 cto? Lice?se No Contrn ? Phone NUmber THISINSPEGTI NREoUESTW??? ?T BE_AGCEPTEDBq NTHE SPEC ION?FEEDS /?ag/pd 2" RE?UEST FOR ELECTRICAL INSPECTION ? ??See mstmclions ?or completing this lorm on back ol yellow caPN k Covered by This Fequest g elaw Wor ? 7 ?4..1" ? A olancesWied ? requesl voitl 10 mon[hs Imm ?'^y.'°?++t EB0000108 4 V W 17 . . • ' Date: 'fo City or County of: - ^ Address: _ Ciry: - Attention: Re: Final Project Report ProjectName. - Address: To whom it may concern: 7'his is to certif} that I performed special inspection on the following portions of tFie work at the above address which required continuous inspection, and which I was employed to inspect Based upon my personal observation and wntten reports of this work, it is my judgment that the inspected work was performed, to the best of my knowledge, in accordance with the approved plans, specifications, and the applicable workmanship provisions of the Uniform Building Code. Very vuly yours, (Specia] Inspector's Signamre) Date Print Full Name ID Number cr. Client/Owner ArchitecUEngineer SPECIAL INSPECTOR FINAL REPORT State: Zip Code: 25 P/ // /"?// C'?)Arl_k /?)!?L ,. THOMAS EGAN Moyoi PATRICIA AWADA SHAWN HUNTER SANDRA A. MASIN August 30, 1993 THEODORE WACHIER Council Members THOMAS HEDGES Qty Atlministrofor THOMAS G TO'TZKE E. J VAN OVERBEKE ROSEWOOD CONSTRUCTION SERVICES ciw aere . 23 EMPIRE DR ST PAUL MN 55103 RE: BLOCKBUSTER VIDEO ? 2075 CLIFF R?AD?? -- --? Dear Mr. Totzke: We have completed our review of the construction documents subaritted in pursuit of obtaining a building permit for the above-referenced project. The commenu listed below are limited iri scope to selected azeas of special concem and are not intended to comprise a complete and exhaustive report. This report includes items discussed in our prior conversation and also a few additional items for your attention It is our hope that ttris report will be of benefit to you in achieving a project that complies with the various state and local codes, laws, and ordinances. Review comments: 1. Please note that the Uniform BuIlding Code Standazds referenced in the building code (listed in Chapter 60) are a part of the code. Other standazds providing equivalent performance may be used only when such altemates aze approved by the Building Official under the provisions of Section 105 of the code. Refer to Uniform Building Code (U.B.C.), section 6001. 2. Provide space for recyclable materials. See U.B.C., section 513, as amended by Minnesota Rules, chapter-part 1305.1370. Please note that storage space for recyclable materials and uash must also comply with Section 11.20(d) of the Uniform Fire Code. 3. Provide appropriate signage visible from inside a vehicie parked in the handicap accessible stall. Refer to Minnesota State Statute 169.346 for addidonal informatioa MIINICIPAI CENTER 3830 PIIOi KNOB ROAD EAGAN. MINNESOIA 55122-1897 PHONE: (612) 681-4600 FAX: (612) 681-4612 iDD' (6}2) 454-8535 THE LONE OAK TREE THE SVMBOL OF STRENGTH AND GROWTH IN OUR COMMUNITY Equol Opportuni}y/Affirmailve Action Employer MAINTENANCE FACILIiY 3501 COACHMAN POINT EAGAN, MiNNE50iA 55122 PHONE (612) 681-4300 FAX',(612) 681-4350 TD D', (612) 454-8535 4. No merchandising plan was submitted. Aisles must be maintained in accordance with U.B.C., section 3315. 5. Provide exit illumination and signage as required by U.B.C., sections 3313 and 3314. 6. Exit doors shall swing in the direction of exit uavel. Refer to U.B.C., section 3304(b). 7. Provide signage stating, "II-IIS DOOR TO REMAIN UNLACKED DURING BUSINESS HOURS" at the main exit as required by U.B.C., section 3304(c) Exception 1. 8. Identify and provide documentation that wall parallel to and which are also closer than 20 feet to property lines are of one-hour fire-resistive construction. Refer to U.B.C. 504(b) and Table 5-A Additional Submittals Required: 9. Provide a letter of SAC unit determination from the Metropolitan Waste Control Commission. 10. Provide verificadon that the proposed lighting power budget complies with the Model Energy Code (M.E.C.), section 505 as amended by Minnesota Rules, chapter-part 7670.0800, subpart 2. Please note that this amendment requires, with certain modifications, the budget to be calculated in acrnrdance with the 1993 criteria as specified in the Code of Federal Regulation, tide 10, part 435.103. An informadon packet is available from the Department of Public Service Energy Information Center, telephone #296-5175. 11. Submit caiculations substantiating that the building's overall thermal envelope is in compliance with the Minnesota Energy Code (Minnesota Rules, chapter 7670). Refer to M.E.C., section 104.2. 12. T6e certification of the professional responsible for the preparation of the design shall be shown on each sheet of the plans and on the title sheet of the project specifications. Please resubmit two copies of sheets A2.0, A3.0, A4.0 and A5.1 after obtaining the appropriate signed certifications. Additionally, please submit two copies of certified H.V.A.C., plumbing, and electrical plans and specifications. Refer to U.B.C., section 302(b) and Minnesota Rules, chapter 1800, parts 4200 and 5200. 13. T'he swctural engineer of record must complete the Special Inspection and Testing Schedule form. Please retum the form to our office after obtaining all of the proper ac}nowledgment signatures. Each special inspector, fabricator, and testing agent must submit a Final Inspection/Test Report or Certificate of Compliance as applicable to our division before a Certificate of Occupancy will be issued for the building. Guidelines for the special inspection and testing accompany tbe schedule - refer to U.B.C., sections 302(c), 306(c), and 306(g). Sincerely, Joe Merchak, Construction Analyst Protective Inspections Division Department of Community Development JM/js cc: Cluef Building Official Reid City of Eagan Construction Inspectors A. Peter Hilger, Portfolio Design Services Brian David Long, Ulteig Engineering Inc. Vemon Colon, Developer / // 13 i(9a, t ? - 0,tn, w , MEMO TO: JIM- BTIIRM;_ =CITY- PLANNSR)\)-?? JOE M$RCHARe CONSTRUCTION ANALYBT DALB WECiLEITNER, FIRS DEPARTMENT BILL A1CIN8, BLBCTRICAL IDiBPECTOR PUBLIC WOARS/SNGINEERING DEPARTMEDiT IITILITY HILLZN(i CLERR FROM: DODG REID, CBIEF SIIILDING OFFICIAL DATE: /O?J019-Z BIIBJECT: FINAL INBPECTION The Protective Inspections Department will be performinq a final inspection of GPQ7 ; q on ?ac??bus er ?' eo A Certificate o Occupancy will be issued following our approval. If you are requesting that the Certificate of Occupancy be held, please fill out the proper hold request form. Failure to return the hold request form within five working days from the date of this notice will be considered your approval. The person or department requesting the "hold" is responsible for notifying and resolving any problems with the affected parties. I 8i04f-A'1 CE:NERALINFORMATION I3-9 CONTRACTOR'8 MATERIAL b TEST CERTIfICATE FOR H00VEOROUND ?IYINQ reoceouaE Upon comMktlan ot woik. inystlon and tau Ma11 W mda DY MM m^troWr', npn?n4[IV? 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Of {YgTNM MAKE MOOEL YEAROP MM1USACTIM 0111rICi QUµrYY 'iYMf11ATME M71p0 OIIIMKLEM WPE CONfONMS TO IIkFfA I fTAMDAIIO ?"o '??E ANp RITTIfqi CONfpIIM TD l.)f:P4 t; ST/1NOI.NO ?.W ONO llrnMOt if ^p• [x?LniH ALARM DEV IC6 MNfM1M TiE 700rHM1L' 7MIOUW 1M PME AuRM VAIVf TVPE MANI MOG[L MIN. 1KC. 0111LOW u•'J O IMDMAT011 M E TIME TO TRIP WATfM Alll tPI??OINT REACNlD WERATEO TMRU TF.D7111E* %1F8WAF /11ltW11E M 1RMU11! TMTOUYLETO Pp y ON V PIVE MIN. 3!C MI ql KI MIN. ?fC. Y RKI qERAT1N0 TIiT WiMwt O.O.O. WiM o.o.o. iv No, [xotwin 'MEASUREO PROM TIME INSPECTON'S ThST P1PE IS OPENED. JOVEp) II&q ppp) P111NTED IM USA Conv.c?or'. pLu" t Tea Ceni6uu tor A6ovqroud Pipm{ i3-io SPRIN%I.ER SYSTEMJ tl4 DELWE & I5 TMEME AH ACCESSI?LE I1IGLRV IN CqtM CIPCUIT 1011 T[t?INO IF NO. [XVUUN ?11[ACTION QyES ONO VAWEf _ MAKE MODEL M?4?a'??? ppp ?,?p? ?M?rALMI' Tt VES MO ?'[S NO M'N. SCC. MvDRQ3TATICHYaroRnlc tnU ?n?ll b? m?p? ?t no? bu t??n ppwl 110! Wn) br two Iqun a 60 pY iA Mnl ?oM,111k J p.?nan in e?c?p ol 160 qi 1101 bml for two ?ouq. Difl?rnrU?l dry91p? Nlw clpp?n NMI b 4fi ap?n u.ma ?.n ?o v?w.m e?n?. M(ayovpr wnd PfPfnp Iookq MFf p. Rappwl F HIN Fl 1 i d TEfT ow t 1? ,Wu q qM un111 w.nr ?, eIOM Y I/WiC?[b bV na COll?tliOn ol bnq? m?brlN U1 bY11q EM tl OYIMb ?Od? / ??y" blowalh FIUN ?t Na.?y noc I?n ?n?n Mp GPM 11611 U ? l ap0 0?M 7271 lliNnl l i l b I ? M I H DElCRI?TtON . r - m n nc p u n O p? 1 750 GNM (2939 L/miw) loi B,rich p.p? 1000 GI'M (3]88 Llm?n) Ibr 8?1nd? y?W. 1600 CB?jA 45810 llmU)1or f W?h pip Nnd 7ppp GPM I)510 Uminllor 1 t-InM dp* V?M? ?WOIr nnnm D?? NlpulnM Owv rnn. opuln mplmwn MibbN. Embibn 40 pu 17 ] Mnl ..I pnuun ?M mware Erop MrhlcT ?hMl nat eMnmd I.K pl 10.1 Wnl in ? Opin. TN/ p.nw,a un i u nonm.l .ur b.l .na u. o,•..u...ne .run.i, arFxune.m wnicn Mun not.xad Lx WI l0 1 Wnl In 24 hwn- VEI F011 HRY. If MO, lTnT[ 11lAfON 111L o1VINO MYOAOSTqTICAILV TCSTEO AT ? DRVPIVINOPNfUM11TICALLVTCSTlO fuYE6 OND FquiMMENTOPEPMTESCPpVEnLV ?VE6 []NO DRAIN PEAOINOppME{pU?tEp RWqTFRlIAiLYTE1TPIV[. 61131IXMLO? 1MIFIVK WI TEST STATtC P A A O TEty REbBU E: _ v81 .> t1 MI UMwpound mlro mnd lmd In aonmetlar m sywm rNm11uAnd 6Aa? eonmetlen odbIs *rMNn y1dog. 0THEA l%PLAIN VENIRIEOOVCOVVOf1MCUrDNMryp,0ye ?yEe ?NQ 1 iLl1SME0OV INSTIILL[ROf yNpf11- OROUNOSPpINNL[NPVINO ?rEs ?ND ???MOM NV • R US LOCATIONS ' ry m(ypyap OAfk[TS f-J0 .0 *6 WELDEOPIPINO ?yES NO iv vee ... OO vOV CERTI?Y Af iHF SPPINNIEN CONTpACT0R THAT WELOINO VMOCEpUp[t COMKV WITN TNE PE.QVIMFMCNTI Of AT LENfT AWi 010.0. L[V[L Al1-3 ?rall ?NO DO YOU CE11T I fY THAT TN[ WlLDINO W 11! Y[q/OI1Mt0 GY W[LD[R6 OUIILIII[G IN ??O?NY ?1 CaMVLIAMC[WITNTMFRFpUIREM[Nf50IqTLf1?fTAV/S 070.0,LEV[LAR-1 ?Jre/ ?NO OOYOUC[RTIfYTNATWEIplNOWMCAqplEOOUTINCOM'LIANCEWITMA ' OOCUMEM7Ep pUA4TV CONTROI V110C[OVRf TO INSVN! THAT ALL OIlCf Al![ RETXIEVEO, THAT OVENINO! IN OIPINO I1RE SMOOTM, THAT {LAO ANO OTMlR WEIDiNG qEy1DUEARER[MOVCO,11NDtMAT1M[INTEqMALOIMMETlRiO/ pra ?/1? V IOINO AR[ NOT KN[TRIITEO H/? LIC NAMECVIT[VqOVID[D ir NO,E%n1111N `? _NAMEPLAT! qES ?Np DNT[ LliT IN S[R V ICE W ITH 1111 CONT a OL vi1lV C5 0'EN. Rwn?K! I I ( 0 R. BACN ? -- Contnctor'o Iyal<rial t Tnl CaniSute far A6ovepvued Pipiot PHONE 812-571-2500 FA% 812-571d168 ULTEIG ENGINEERS. irvc. 5201EASTRIVERROAQSUITE308 MINNEAPOLIS,MN55d21 December 1, 1993 Joe Merchak City of Eagan P.O. Box 2119 3830 Pilot Knob Road Eagan, MN 55122 Subject: Blockbuster Video - ' 2075 Cliff Roaa CtY' y/?_.,_ _.- Eagan, MN -- - " UEI Project No. 93465 Dear Mr. Merchak: This is to certify that Ulteig Engineers, Inc. (UEI) performed special inspections on the following portions of the work at the above address which required periodic inspection. l. Masonry per section 306 Article 7. 2. Concrete foundations per section 306 Article 1. Based upon UEI's observations and written reports of this work, it is our judgement that the inspected work was performed to the best of our knowledge in accordance with the approved plans and applicable workmanship provisions of the uniform building code. If you have any questions, please call. Very Truly Yours, Brian D. L g Project Engineer c: Peter Hilger, Rosewood Construction Tom Totzke, Rosewood Canstruction 8?ECIAL INBPECTION AND T88TINf3 SCHBDIILE ? (To be used in eccordance aith the "Guidelinee for Special Znepection and Testing") PROJECTNAMB V//-)C'O PROJECTNO. • LOCATION a?07S L?-/ F/= ?CUHL? (1) C%?G/? y/y1 ii??i PERHIT ND. Z 1VC.?- Roerrai. rnana?rnv QPVQMR f Dec, a Type of Re ort Asei d ect o Iftrticle ee tion 2 m p i re e` c gne Firm-_ d ? co - m+?.s-•...??, sc? PEie:o?:c t? r?;,c,. ? ? - ---- "_srran :rwvnm.r. ? ?. .c:o --- - ? c:c. - ; __-.- 3[Xs l ?.xLn.; azti?:??? i Pt r AS ?EDEO ? NOLpSi Thia echedule to be filled out and included in the project apecification. Information unavailable at tnat time to be filled out when applying for a building permit. ? (l) Permit No _be_grovided--by-Che-gu nq Official. . (2) deacripiione per U.B.C. Section 306. (3) Spec a nape-r, e-'S t-ing Aqent or Fabricator. (4) Firm contracted to perform eervicea. Each appropriate repreeentative muat eign below: Owner:c?YYh%."o /R' f,w. . AL'E AQTN£C-?H)P Firms ?2uppcE. KcAL EYTi9W .SEC.wccDate: Contractors Cc.c..;T ,- vi:CSFirm: (/fcSe?%:a. A:chitect: Firm: yDate: ' 0??3 ? Firm: Date: 'SI: r? Firm: Date: ? SI: Firm: Date: TA: Firm: Date: ??° Firm - Date: lF:_?/ W¢LL 6Xi0 Fi Date: X> Firm: Date: ol' ? • The individual naaiee of all proepective epecial inspectore and the work they intend to observe muet be identified on the reveree eide of thia form. Legend: SER ? Structural Engineer of Record TA ? Teeting Agent SI = Special Inepector F = Fabricator ? Accepted for the Building Department By SPECIAL INSPSCTION A11D T88TINQ SCSEDOLE (To be ueed in accordance aith the "Guidelinee for Special Inepection and Testing^) PAOJECT HAMS LOCATION aovrrar. rvcnRrrrnx segsniII.B PROJECT NO. (1) PERMIT NO. Z 1 cation Type of Report Aseigned ec ion Article- eec i tion 2 Firm F e enc Firm 4 m+aSO..,?. S?iZ TESTINU SCHEDULE i N Tf't Hotesi Thie echedule to be filled out and included in the project epecification. information unavailable at that time to be filled out when applying for a building permit. (1) Permit No. to be provided by the Building Official. (2) Uee deecriptione per U.B.C. Section 306. (3) Special Inepector, Testing Agent or Fabricator. (4) Firm contracted to perform eervicea. Sach appropriate repreeentative muet aign below: owner:a:N-kaIYND ll%vue?,rJ FWE PN2rNEK?CH)P Fitm: ;Q¢.Uq'NC.t ?CHL ES?s`R"tEDate: Yz7 3 Contractors 2 tain o ,u,;' ?e v;:cSFirm: eSZ??'c.v aNST..Se2u:('c.T Date: 9-3 A:chitect: Firm:, SERi' c-.. ° Firm: %J ULNC,i,uee/L? Date: * SI: Firm: Date: * SI: Firm: Date: TA: Firm: Date: TA: Firm ? Date: • 3 . ,. F: &Ag? Fir Date: F: qpA2l Za;? f-Fi91.?2tc.?yoX1 Z...z Firm: nate: • The indlvidual names of all prospective special inepectore and the work they intend to obeerve muet bs identified on the reverse eide of thie form. Legend= SER = Structural Engineer of Record SI = Special Inapzctor TA ? TesEing Aqent F= Fabricator Accepted for the Buildinq Department By Date: U-VALUE.XLS Blockbuster Video, Eagan Minnesata Energy Code, Building Envelope Method Calculations Prepared By: A. Peter Hilger, Architect (Mn. Reg. # 15860) AREA U-Value Uw4 Code Total Wall Area 6,108.06 n/a Less Glass Area 1,216.00 0.55 668.80 Less H.M. Door Area 24.09 0.35 8.43 Less Alum. Door Area 42.00 1.13 47.46 Net Wall Area 4,825.97 005 23224 Total U x Area ? 956.93 Avera e Wall U-Value 6,108.06 956.93 0,76 < 0.23 Average Roof U-Value 6,417.63 0,03 < 0.06 Wall R-Value Calculation Inside Air Film 0.68 5/8" Gyp. Board 0.45 Vapor Barrier 0.00 6" Fiberglass Batt Insulation 18.72 1/2" Airspace 0.68 1" Concrete 0.08 Outside Air Film 0.17 TOTAL R-Value 20.78 0.05 U-Value Roof R-Value Calculation Inside Air Film 0.68 Metal Deck 0.00 Thermal Barcier 0.45 Roof Insulation, 4"/11b Poly 17.60 Rubber Membrane & Rock 0.00 Outside Air Film 0.17 TOTAL R-Value 18.90 0.05 U-Value Page 1 MINNFSOTA EN?iGY CODE COMPLIANCE FORM Page 1 x Electrical and Lighting Power Budget Project Title: Blockbuster Video Address: Cliff Road/Park Center Road Bldg Type: One story concrete retail Gross F1opI Are2; 6750 ACKNOWLEDGEMENTS, Fach appropriate representative must sign below: Representing Signature Date Designer: ContrdCtor: Donnelly Electric 9-2-93 Accepted for the building department by: \ Individual units in multifamily dwellings are provided with separate metering. x _ filectricai panel feeder and all branch foader wiring in nonresidential buildings 3 stories or less are capable of accepdng a ciamp-on meter. 1 IGHTING: MIIVTMUN RFI]i1iRFMM X Each endosed space has at least one htin control or li8 B , equivalent control, for each 450 square feet of floor area, x Controls for spaces used as a whole do not control more than one 20 ampere circuit with minimum of three controls. X All fluorescent lamp ballasu must meet the Foderal standards for energy efficiency as indicated by a circle 'E" printed on the label. X Use of single-lamp fluorescent ballasts is minimu.ed by tandem wiring one- and thrce-lamp luminaires. LIGFITIIv`G: FX . lOR X T'he ezterior connected lighting power as designaJ and installed is less than or equal to the ezterior lighdng power allowance, and documentation is attached. pagtG 2 Blockbuster Video tlcw??"I'?1T?• II1T7'F °??`%?.; X 'q'he intetiaT c_,snner„xt ;?f Ptrwr,ry J?-;iamrf :umi irs,;afteae, iS less thx equai Go the sntencr ;;..)twa "d d.,camentaeaosa ei aqacheL Me interior cesrunev.:tt,:v ,.&:;;-"q? Poµ'e.';nc1udC:S ?.e: manC-idy %nstalled Iigrir%.,,I.,. suppler.sental os by rr,aiva,_le cr plug-Ira lu?str..c,,,?s.g a dct?.?mnine c.areaplimm, . ' presceipfive .r ,•±es ??, ?. ?t?:??. per4`a9tf7t$ISix $1-zmaCd'cq; *,U EtlE['i. ... .? , X.. EDect,-jc.4-j, conscimpe;on ::• ' s`r,e?rna.lly, s?3unsir??s? ?ait s;,;?ss ?oes sac: ex:?.v.<. v(:, ?vat`ts of res?€•e pf;..veg,.<tnd q maxisr:i:m of 4-0 wut1 ZE7im .?. _X AC3 permartently wintrl, ?in?;e•b , ?igrt :4, ? 3 ??;:pha,e ?ducticm mot?Px cP t hotsepawe: e?r ero?°?; ??:?v?; A iomittaJ w;aich maet ctY ?Xcet.l in ttre tabie be bw: . ?. .,?. ? ??q_-.-..?......... n'?E,'inlC-f Y 1 3? ?? I PitY,7 ;,PxS p' T'7t Wv.4 9p0 ItPi,e"? ?. ?. ?D?l92:P 8&31k? 89.?? e+G.1iY ti BG_Y`i _ ???-- - S4?:a?{p? yrr.2R ( 91.tl'? ?' ?3Y 4?3 f IuilkL! SK.16 4,79 ? a 93.6f?. !6' 252C+ 93,69f SWMO?MD ' ..Y.?.,p ? 2bCM7 fiY4d?Pl?rikf RP1r4 t 1 y0u 4Yft ?Cti) p•i ?? _......_....?.......,?.....,.. ,-. .?.?.., .....__., _. a1.?,9'a, 5Y.99G ? ;t73? 85.$Sb ? . .u.,?..d,.r. ..._ SKt.97s ' 2u.S?.? { 64.54F 855?= . +--? ?. ?...,..i_._ ? 9'1353 ii?.0?; , ? 97.IIR 31.7??5 r?...,.b......,..??. # 4x.6i& ? %k.94?. y % 99. ? , , (ILPA COMPLIANCE FOKM) ; ; - ILPA - INTERIOR'LIGHTING PQWER ALLOWANCE ?. : ;-?, . °• ` ?':,',- : ? PERFORMANCE ?PROCEDURE ? :X. ._ - . ° i ' ?4: ? , k? .4 ? • - . . 4. PROJECTA77TLE: 'BTockbuster Video . ? ?.? 'DATE: '9-7 "93 . , Colutm 1 Column 2 Column 3 Column 4 'Columa S ? Colurm 6 Column 7 Mea M Aru/Acliviry Gtegory UPD Area at Work Pluw Aru Facror lig6ling Power BudgU (UPD x Awp x AF) Comxted Lighting Powa 1 Retail-Area 2:7 ? 6,160. • 1.0 A 6,632- 14,016 2 Bathrooms . - .5 300 " 1 .S, 270 ` ?292 ' 3 Of£ice/WOrk 'ROOm 1.8 290 7 1 .12 ? 585 584 ' ,.• ' _' . 4 • . . { . . Unlisted Space 0.2 I ToW ILPA 17,517 14,892 R coMPLIAvcE FoxK CLP -- CONNECTED LIGHTING POWE(CLP LIGHTING POWER CQNTROL CREDITS PROJECT TITLE: DATE: • . T .+, :.s ugmm g rower Cantro l Credhls Columo I Columo 2 Columo'3 Column?4 Column 5 Column 6 Columo 7- ,.Coluqm 8 ?? 9 Ara N Luminairo _ M Insulled Input Connxted L.tg Power M of Lum.' wiW Adv: ;.'Control e &_'>.` .7' L,PCC - `. (CLP Adj?sted (,? Description Watts . (CLP - Co6trols ,,. yp PAF ;,^? a p ? Power . , ; ) (CLP-I.PCG) , - 1' - '" "" , - ?_ • ?1r j? . . • . _ • .. . Tota1 CLP ? Toul qLP ? >. : . (ELPA COMPLIANCE,'FORMy; . „a ... .; . _ EXT'ERIOR LIGHTING POWER AI:LOWANCE _?_v:?.. _?•t:a - PTOjact tide Blockbuster Video 4 Date 9_7793 , ?.. . . . , ir• . .. , - .. ,. ? Column 1 Column 2 Column 3 Column a' v Column S zicrior Area Description Any or LAmeN (A) Unit Power Demnr NPDI fiom ub{e 4 -1 Exterior Lighting Power iwow.nx":, A 7t VPD Connected Lightinc Power Parking Lot 28,458sq.f ;:.25W' 7,114.50-. 2,236 Door 6 linear f . 30W ft. 180.00 -. .-. : o?.:,• . . TouL.- 7,295.00 = 2;236 : (ILPA COMPLIANCE FORM) ILPA -- INTERIOR LIGHTING POWER ALLOWANCE , PRESCRIPTIVE pRpCEDURE PROJECT TITLE nA.i.F Column I Column 2 Column 3 Column 4 Column S Building Type/Function Retail Gross Lighted Area (GLA) 6,750 Unit Lighting Power Ailowance 2.52 W/ft. ILpq (GLA x UPLA) 15,187,00 CoMecled Lighting Power 74,892 Outside 28,458 sq, ft. - .25 W/ft. 7,114.50 2,236 y . 22,301.50 ? 17,128 ---?- ? , - ' ----------'----- 11 -?- , ? Serial # . q'I I m Y Cnip # y??- Permit # Z?-q3 0 Address: -_._ . .. . . . . _ ---- - ... .. . . . _ _? " ? 1 AGREE TO COMPLY WITH CITY OF EAGAN • ! ORDINANCES Ia??k??*???%?*?ti?, .? ? -- -- : . - _'. CITY f?i= EFiG(?t?k. ,.?;;:F: 5'UM',. TEM7NAE?tK?y T]:ML::,'„"' lc : : ;;...... . , . ?: .: - .. .. ? ? .. . . .. . . . _ . ...; . . , - . ur?"f.: 3?J 6`?c?() , 4`, t'II'iE MEi e_R ri iSCi 00 ' r a J6 / J 4-J-?n? ?ro? R _k ? . . - ' . . -,. . . ??{.. . ,.?.: ? 'rcjt,zi: I;ecei.Frr P;inount: ' 00.4C1:7`; % L:HLl15632 IJ SElILI: L1EWi CC +""i **#v ?? a :!z.._'.r,'. •. . ? - 1 .4 iN&?? '.,p?? ? "?.:?• . _ _ ?. ? . ? : . ? ? : . ..:., , . • ,. . , ?.. . -..' .,:.?.: . .: , . . . . . ?.", . ' ' ' -, .. . . . :, , . . . . .., ., . . ?' ; _ ..... . r -- / '-?`/gf-3-- .i Serial # _ %V"70 cn;p# 10 Permit #- o?? ? 3 a Address: 7-5- , A6 i AGREE TO COMPLY WITH CITY nF Fer_eM ? ' Seriai # _ Chip # Permit # 10 Address:_ 1 AGREE ? V '?7/ Da a 3 9 - f 3SS'5'8/7 ?a ? 3a TO COMPLY WITH C1TV nc cwr_AN Use BLUE or BLACK Ink / I For Office Use 7" s ep i dl~ ne Permit City of Ea ~11 Cs LI~ I Permit Fee: C ~ /11 I 3830 Pilot Knob Road ~R l Mt V14. II I D l Eagan MN 55122 ~L; I Date Received: Phone: (651) 675-5675 I Fax: (651) 675-5694 1 Staff: 2011 MECHANICAL PERMIT APPLICATION Date: Site Address: Z 01 F C (I f-f- -12,,9,o Tenant: ~ 14Sf% -3 wid i n r ~C I P6 L.7-L IY Suite RESIDENT / OWNER Name: Phone: Address ! City / Zip: Name: License 1/U~} CONTRACTOR Address: S 2 D3 W. -23 City: ED State: - M l~ Zip: S S Phone: ~L 5' 3 j - c9 ©o / Contact: MA& 1G K 124~ _ Email: 4v F A)2_ c- J, 3t y-jtjaK c c•~ q New _ Replacement Additional Alteration Demolition fah ` TYPE OF WORK Description of work: I mS~ ctas rwe i -E e~- Fut~►e CY1r&4jrLE NOTE: Roof mounted and ground mounted mechanical equipment is required to be screened by City Code. Please contact the Mechanical Inspector for information on permitted screening methods. RESIDENTIAL COMMERCIAL Furnace New Construction Interior Improvement PERMIT TYPE -Air Conditioner _ Install Piping _ Processed - Air Exchanger _2~Gas _ Exterior HVAC Unit _ Heat Pump _ Under / Above ground Tank L- Install Remove) Other RESIDENTIAL FEES: $55.00 Minimum Add-on or alteration to an existing unit (includes $5.00 State Surcharge) $95.00 Fire repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge) TOTAL FEE COMMERCIAL FEES: $75.00 Underground tank installation/removal OR Contract Value $ (c5 x1% $55.00 Minimum (includes State Surcharge) = $ 52) Permit Fee - If the Permit Fee is less than $10,010, surcharge is $ 5.00 = $ S Surcharge - If the Permit Fee is > $10,010, surcharge increases by $.50 for each $1,000 Permit Fee (i.e. a $10,010411,010 Permit Fee requires a$ 5.50 surcharge) = $ Ss TOTAL FEE 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.oopherstateonecall.or_q 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 1 understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. X_ x ~44A- le iogL- A icant1Printed me Applicant's Signature P FOR OFFICE USE ` /0 Required Inspections: Reviewed By: J i Date: 1 I Underground Rough In Y Air Test Gas Service Test In-floor Heat Final HVAC Screening Use BLUE or 13LACK ink I. For Office Use.!-...._ _ i My of 1 Ea ~ I Perna # j Permit Fe t 3830 Pilot Knob Road l ' i Eagan MN 55122 J lu X 2 6 date Received: I Phone: (651) 675-5675 V' i I Fax: (651) 675-5694, staff: t 2411 COMMERCIAL BUILDING PERMIT APPLICATION Date: 25 July, 2011 Site Address: 2075 Cliff Road,1tar'R to Tenant Name: Chipotle Mexican Grill (Tenant is: x New i _ E)isting} Suite 100 FornterTenant: Blockbuster Video Chipotle Mexican Grill, Inc. (303) 595-4000 PROPERTY OWNER Name: (Contact. William Turner) Phone: Address I City l Zip. 1401 W Tkoop St., Suite 500 f Denver 1 80202 Applicant is: x owner _ Contractor TYPE OF WORK Description of work: Tenant build-out for a new Chipotle Mexican Grill restaurant. $350,000.00 Construction Cost- CONTRACTOR Name;: Six o4t -rwO Cc*,rj"(~la(~ I Df~ i icer~se # T.B.D. Address: ISIIo W. LbM `3T• 0 11 ID city.,W4Pt~/S state: 1~~~ Zip: ~S ~I~"t;~ ~ Phone: (v 1Z - 5'C~ ' It? (e I Contact: 8I?JAJ PAC41 Email: rice G ib G~t~t>tuclttcn . Ga ~✓1 ARCHITECT / Name: Michael J. wilkus Registration ENGINEER Andress: 11487"Valley view Road City: Eden Prairie State: MN Zip. 55344 Phone: (952) 941-8660 Contact Person: John Lemieux Email: 5i31$wilkusarch.com Licensed plumber installing new sewerlwater service: Phone NOTE: Plans and supporting documents that you submit are considered to be public Information. Portions of the information may be classified as non-public If you provide specific reasons that would permit the City to conclude that th am Beads secrefis. CALL. BEFORE YOU DIG. Call Gopher State One Call at (631) 454-0002 for protection against underground utility damage. Cali 48 hours before you intend to dug to receive locates of underground utilities, m-yw goopherstateonecaii orc~ 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 1 understand this is not a permit, but only an application for a permit, a work is not to start without a permit; that the work will be in accordance with the approved plan in the case of w ry h r u' s view and approval of plans: x William Turner x Applicant's Printed Name Applicant's Signature Page 1 of 3 - „ 01) Ci► ~aac~ DO NOT WRITE BELOW THIS LINE SUB TYPES _ Foundation _ Public Facility _ Accessory Building Apartments V/ Commercial / Industrial _ Exterior Alteration-Apartments Lodging _ Greenhouse / Tent _ Exterior Alteration-Commercial Miscellaneous Antennae Exterior Alteration-Public Facility WORK TYPES / New t Interior Improvement Siding _ Demolish Building* Addition _ Exterior Improvement Reroof _ Demolish Interior Alteration _ Repair Windows _ Demolish Foundation Replace _ Water Damage Fire Repair _ Salon Owner Change _ Retaining Wall *Demolition of entire building - give PCA/handout to applicant DESCRIPTION V// Valuation 350 wo Occupancy A-7- MCES System J Plan Review Code Edition 700'7 M5AW, SAC Units (r L (25%_ 100%26 Zoning City Water Census Code Stories Booster Pump # of Units y Square Feet 2~ZZS~ PRV # of Buildings Length Fire Sprinklers Type of Construction V • L5 Width REQUIRED INSPECTIONS Footings (New Building) Sheetrock Footings (Deck) Final / C.O. Required Footings (Addition) Final / No C.O. Required Foundation Other: Drain Tiled Pool: Footings -Air/Gas Tests -Final Roof: ✓ Decking -Insulation ✓ Ice & Water ✓ Final Siding: -Stucco Lath -Stone Lath -Brick Framing Windows Fireplace: -Rough In -Air Test -Final Retaining Wall 1 Insulation Erosion Control Meter Size: / Final C/O Inspection: Schedule Fire Marshal to be present: " Yes No Reviewed By: 6`(0' , Building Inspector Reviewed By: i , Planning COMMERCIAL FEES Base Fee 2 5S~ .7~ Water Quality Surcharge 7 S • e' b Water Supply & Storage (WAC) Plan Review ~ L I • Storm Sewer Trunk MCES SAC 3$d . s-o Sewer Trunk City SAC 100010-0 Water Trunk S&W Permit & Surcharge Street Lateral Treatment Plant 41510 . e-~ Street Treatment Plant (Irrigation) Water Lateral Park Dedication Other: LkAp .P lwo itZ' O . Trail Dedication 56 "ry Water Quality TOTAL ?C 213 Page 2 of 3 Metropolitan Council Environmental Services August 2, 2011 Dale Schoeppner Building Official City of Eagan 3830 Pilot Knob Road Eagan, MN 55122 Dear Mr. Schoeppner: The Metropolitan Council Environmental Services (MCES) Division has determined SAC on behalf of the City for the Chipotle Mexican Grill to be located at 2075 Cliff Road, Suite 100 within the City of Eagan. The City will be charged 6 SAC Units for this project, as determined below. SAC Units Charges: Restaurant Indoor seating 61 seats @ 10 seats/SAC Unit 6.10 Outdoor seating - 75% outdoor discount applied 304 sq. ft. @ 15 sq. ft./seat @ 10 seats/SAC Unit x 25% 0.51 Total Charge: 6.61 Credits: Retail (Look-Back Period - paid 9/83) 2293 sq. ft. @ 3000 sq. ft./SAC Unit Net Charge: 5.85 or 6 As you may know, the SAC Task Force that convened last year recommended the Met Council adopt a single restaurant criterion of 10 seats/SAC. On December 8, 2010 the Council adopted this change to be effective January 1, 2011. The business information was provided to MCES by the applicant at this time. It is the City's responsibility to substantiate the business use and size at the time of the final inspection. If there is a change in use or size, a redetermination will need to be made. If you have any questions, call me at 651-602-1118 or email karon.cappaert@rnetc.state.mn.us. 3 Sincer ly, K n Cappaert SAC Technician Environmental Services Division KC:kb:110802C2 Determination expiration: August 2, 2013 cc: J. Nye, MCES Peggy Fleck, Eagan (email) John Lemeiux, Wilkus (email) www.metrocouncil.org 390 Robert Street North • St. Paul, MN 55101-1805 • (651) 602-1005 • Fax (651) 602-1477 • TTY (651) 291-0904 An Equal Opportunity Employer l l~ - ~Use BLUE or BLACK Ink Z } For Office Use I i i4 > I Permit I City of Eajan Y I Pilot Knob Road Permit Fee: ( 3830 Eagan ,o Date Received: ° Eagan MN 55122 Phone: (651) 675-5675 - I I (651) 675-5694 Staff: Fax: 2011 MECHANICAL PERMIT APPLICATION Date: Ll Site Address: 207~ Tenant: C I D t 1 Q Suite M RESIDENT / OWNER Name: Phone: Address / City / Zip: 1 Name: CLYYIme(U Cj jJl uml01 rc, License OSGiq V-1 0 lA CONTRACTOR Address:2yu2i (~(etX~v.lcc~ e- City: (n+ W" State: Zip: SSO 2 Phone: -LOS) -((o to - 1e18 eq Contact:&~Q ~tStill~t:l Email: Ol/l New Replacement Additional ~ Alteration Demolition TYPE OF WORK Description of work: NOTE: Roof mounted and ground mounted mechanical equipment is required to be screened by City Code. Please contact the Mechanical Inspector for information on permitted screening methods. RESIDENTIAL COMME CIAL - Furnace New Construction X Interior Improvement PERMIT TYPE -Air Conditioner stall Piping _ Processed Air Exchanger Gas Exterior HVAC Unit - Heat Pump Under / Above ground Tairi install Remove) Other RESIDENTIAL FEES: $55.00 Minimum Add-on or alteration to an existing unit (includes $5.00 State Surcharge) $95.00 Fire repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge) _ $ COMMERCIAL FEES: TOTAL FEE $75.00 Underground tank installation/removal OR Contract Value $ vlJ x 1 $55.00 Minimum (includes State Surcharge) _ $ '2q®, Permit Fee - If the Permit Fee is less than $10,010, surcharge is $ 5.00Q - If the Permit Fee is > $10,010, surcharge increases by $.50 for each $1,000 Permit Fee J$ Surcharge ~ _ OTAL FEE (i.e. a $10,010-$11,010 Permit Fee requires a$ 5.50 surcharge) , 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.aooherstatoonecall.org I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes .044e City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start wit ut a permi t the work will in a cordance with the app oved plan in the case of work which requ' es a review and approval of plans. c x x Applicant's Printed Name Applicant's Sig ature FOR OFFICE USE Required Inspections: Reviewed By: 5 Date: Underground Rough In Air Test Gas Service Test In-floor Heat __t' Final HVAC Screening Use BLUE or BLACK Ink I For Office U e I d Permit V I C~~r City of Eajan V I Perm it Fee: 3830 Pilot Knob Road I Date Received:' Eagan MN 55122 Phone: (651) 675-5675 I Staff: Fax: (651) 675-5694 -----J C'(1 MIT APPLICATION 2011 COMMERCIAL PLUMBING PER Date: Site Address: C 1144 1`LJ ~t C1 Tenant: C Y `1 C-) LQ Suite M PROPERTY OWNER Name: Phone: Name: yom rn l ~ , License C) SCI L4 Le Ci CONTRACTOR Address:?-i4g2a E10'.@k City: _ 0. l ;A State: WJ Zip: ~Z J Phone: t~~ I -t-! (,*c/- Z4388 Email: ' 6L vvS. X-.i ~s,CI h ° C0," TYPE OF -New _Replacement -Repair _ Re ild Modify Space _ Work in R.O.W. C, V )ns ~ L-1; t WORK Description of work: COMMERCIAL _ New Construction _ Modify Space Irrigation System C- yes / _ no) RPZ PVB) • Rain sensors required on irrigation systems PERMIT TYPE . Avg. GPM (2" turbo required unless smaller size allowed by Public Works) I _ Meters Call (651) 675-5646 to verity that tests passed prior to picking up meter. Domestic: Size & Type Fire: 1 Avg. GPM High demand devices? _Yes No Flushometers _Yes No COMMERCIAL FEES: $55.00 Minimum (includes State Surcharge) OR Contract Value $ x1% = $ jS y , °I C- Permit Fee Required on ALL new buildings and boulevard irrigation systems 4 $ Radio Meter Read - If the Permit Fee is less than $10,010, the surcharge is $5.00 $ Meter(s) - if the Permit Fee is > $10,010, the surcharge increases by $.50 for each $1,000 Permit Fee $ J ` State Surcharge i.e. a $10,010-$11,000 Permit Fee requires a $5.50 surcharge) Following fees apply when installing a new lawn irrigation system $ Water Permit Contact the City's Engineering Department, (651) 675-5646, for required fee amounts. $ Treatment Plant $ Water Supply & Storage $ State Surcharge = $ ! / TOTAL FEE CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is n Qt to start ' out a permit; that the work will be in accordance ith the approved plan in the case of work which requires a review and approval of pl JJ J! L Applicant's Printed Name Appli t' n re FOR OFFICE USE Approved By: Date: (0 Required Inspections: ~'"6nder Ground _LRough-In Air Test Gas Test Final PRV Required: _ Yes No Page 1 of 3 Use BLUE or BLACK Ink - - - - - - - - - - - - - - - - I For Office Use I / Permit#. 6 651 I k of Et y 6Z, City Permit Fee: t 3830 Pilot Knob Road I I Eagan MN 55122 Date Received: Phone: (651) 675-5675 Fax: (651) 675-5694 EF _ 9 li st aff: t 2011 COMMERCIAL BUILDING PERMIT APPLICATION S cll' T -r t`D°W L fy\ Date: Site Address: f-.,)75-- Tenant Name: M 4 ' 7e h q k e- (Tenant is: New / Existing/) Suite Former Tenant: b k `'7L V PROPERTY OWNER ( Name:C/ < /O/ /k J6 6.0 Phone: E Address/ City/ Zip: 170S A444541' 5'}1 • lute a~ S AfAl 55413 Applicant is: Owner Contractor TYPE OF WORK Description of work: Fif Pill -0 We b t /,4 yS '~r loi. K 1~t - 7`ek 4h ti f c j Construction Cost: 14 113, QQ® CONTRACTOR Name: - 411i VR h 6~ s l ~T t License Address: ~O 3 D f71G r ba S Cow City: ~fy CrtOK~~i State: A A) Zip: 515147 Phone: 7(a-'-0231 `Z411 Contact: i5TBI/e l~4 Email: y &0, 1-t ff ✓4l •e-o ARCHITECT / Name: C 1h e ' Registration ENGINEER n~ Address: 2lo fL, $ r 67ff - 3DO City: ✓ /'1 rl Cy°l, S State: Zip: 5 -4d / J4 Phone: (012 4 7 9 rQ~ 22)~~ Contact Person: ~LvJ ~Itiiii b ° Email: c1~d Leto e Tcihe, k • &o&o Licensed plumber installing new sewer/water service: Phone M NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that they are trade secrets. CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. X ~5& 4th H- ✓4 x I Applicant's Printed Name Appli is Signature Page 1 of 3 r - (:~90-7 Cyr DO NOT WRITE BELOW THIS LINE SUB TYPES _ Foundation Public Facility _ Accessory Building - Apartments Commercial / Industrial - Exterior Alteration-Apartments _ Lodging _ Greenhouse / Tent _ Exterior Alteration-Commercial Miscellaneous Antennae Exterior Alteration-Public Facility WORK TYPES - New v terior Improvement Siding - Demolish Building* Addition Demolish Interior Extenor Improvement Reroof - - Alteration - Repair Windows - Demolish Foundation - Replace - Water Damage Fire Repair - Retaining Wall - Salon Owner Change *Demolition of entire building - give PCA handout to applicant DESCRIPTION Valuation I ~3 t 6~D Occupancy AT MCES System Plan Review / 17 Code Edition wt, Be, SAC Units ~ro (25%-100%-/) Zoning TV City Water Census Code Stories Booster Pump # of Units U Square Feet PRV # of Buildings Length Fire Sprinklers Type of Construction V•~ Width REQUIRED INSPECTIONS Footings (New Building) Sheetrock Footings (Deck) Final / C.O. Required Footings (Addition) Final / No C.O. Required Foundation Other: Drain Tile Pool: -Footings -Air/Gas Tests -Final Roof: Decking -Insulation -Ice & Water -Final Siding: -Stucco Lath -Stone Lath -Brick V/ Framing Windows Fireplace: -Rough In -Air Test -Final Retaining Wall Insulation Erosion Control Meter Size: Final C/O Inspection: Schedule Fire Marshal to be present: "/Yes No Reviewed By: " & , Building Inspector Reviewed By: , Planning COMMERCIAL FEES Base Fee r!~ 13' - ?S' Water Quality Surcharge S'G Water Supply & Storage (WAC) Plan Review 737.5 Storm Sewer Trunk MCES SAC Sewer Trunk City SAC Water Trunk S&W Permit & Surcharge Street Lateral Treatment Plant Street Treatment Plant (Irrigation) Water Lateral Park Dedication Other: Trail Dedication Water Quality TOTAL # Page 2 of 3 Metropolitan Council O Environmental Services September 14, 2011 Dale Schoeppner Building Official, City of Eagan 3830 Pilot Knob Road Eagan, MN 55122 Dear Mr. Schoeppner: The Metropolitan Council Environmental Services (MCES) Division has determined SAC on behalf of the City for the Lupe Retail Development project to be located at 2075 Cliff Road within the City of Eagan. The City will be charged no additional SAC Units for this project, as determined below. SAC Units Charges: Retail (speculative) I 6616 sq. ft. @ 3000 sq. ft./SAC Unit 2.2 Credits: Retail (Look-Back Period - paid 9/93) 6735 sq. ft. @ 3000 sq. ft./SAC Unit 2.2 Net Charge: 0 It is the Council's understanding this project is speculative retail. At the time the finishing permits are issued, if the use changes from its speculative use to a different use, then the SAC assignment needs to be reviewed based on that change. The business information was provided to MCES by the applicant at this time. It is the City's responsibility to substantiate the business use and size at the time of the final inspection. If there is a change in use or size, a redetermination will need to be made. If you have any questions, call me at 651-602-1378 or email jessica.nye@metc.state.mn.us. Sincerely, - Jessie Nye SAC Program Administrator Environmental Services Division JN:kb: 110914B3 Determination expiration: September 14, 2013 cc: File, MCES Peggy Fleck, Eagan (email) www.metrocouncil.org Steve 17ay, TT Sullivan (email) 390 Robert Street North • St. Paul, MN 55101-1805 • (651) 602-1005 Fax (651) 602-1477 TTY (651) 291-0904 An Equal Opportunity Employer Use BLUE or BLACK Ink / yca CI/ -----------------1 'felt- ~ I For Office i/se I i I 4t 0 11 Permit * City of EaEdn 1 k op , l Permit Fee: t 3830 Pilot Knob Road d C` Eagan MN 55122 i~Sb 1 n C~ E j Date Received: Phone: (651) 675-5675 nn Q I l dt~ f f I 1 Fax: (651) 675-5694 staff: ~1~} 'PERMIT ! 2010 MECFIANICAL PERMIT APP ICATION Date: Site Address: Tenant: T Suite RESIDENT I OWNER Name: Phone: Address / City / Zip: CONTRACTOR Name: ! - License Address: / Spa City: ~~~c.~ lam. State: G,'Ilj Zip: Phone: - 5-~~ - ~~~34 -2 3 ,11 Contact: ✓ z ~'~cc t s Email t~~ S7`oe.., o TYPE OF WORK New Replacement Additional Alteration Demolition Description of work: G t r1 JA6' L g~ NOTE: Roof mounted and ground mounted mechanical equipment is required to be screened by City Code. Please contact the Mechanical Inspector for information on permitted screening methods. RESIDENTIAL COMMERCIAL PERMIT TYPE Furnace New Construction _ Interior Improvement Air Conditioner Install Piping _ Processed Air Exchanger Gas _ Exterior HVAC Unit _ Heat Pump _ Under / Above ground Tank C_ Install / _ Remove) " When installing/removing tank(s), call for inspection by Fire Other Marshal and Plumbing Inspector RESIDENTIAL FEES: $50.50 Minimum Add-on or alteration to an existing unit (includes $.50 State Surcharge) $90.50 Fire repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) $ TOTAL FEE COMMERCIAL FEES:! $70.50 Underground tank installation/removal OR Contract Value $ y x1% $50.50 Minimum (includes State Surcharge) = $ Permit Fee - If Permit Fee is less than $1,000, surcharge is $.50. - If Permit Fee is > $1,000, surcharge increases by $.50 for each = $ Surcharge $1,000 Permit Fee (i.e. a $1,001-$2,000 Permit Fee requires a $1.00 surcharge). = $ ,.59 32) TOTAL FEE 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.copherstateonacall.o Y 9 r'a I hereby acknowledge that this information is complete and accurate; that the work will be in Orman a 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 i of to s art 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 )_0-,,, _ C 144`e) x Applicant's Printed Name Ap 's Signature FOR OFFICE USE Reviewed By: Date: D Z r Required Inspections: -Under Ground - Rough In -Air Test -Gas Service Test ,.In-floor Heat ---Iinal Exterior HVAC Screening Inspection s_ " Use BLUE or BLACK Ink I______________ r f I For Office Use I kce 4~- cV~ i Permit#: Ila CIRY of EaEd R I Permit Fee: I 3830 Pilot Knob Road I Eagan MN 55122 Date Received: Phone: (651) 675-5675 I Fax: (651) 675-5694 staff: I 2/011 FIRE SUPPRESSION SYSTEMS PERMIT APPLICATION* Date: f D/ I I I Site Address: Tenant• 0'~I f l C r t I Suite Name: ~i e X~ a. A`&WIOPhone: PROPERTY OWNER !Address /City /Zip: J7 d J l i Applicant is: Owner Contractor TYPE OF WORK Description of work: ry / Construction Cost' / 3 D ! 1 tt--'~ Estimated Completion Date: 19 Name: I- O i r o i Ott f - Fi reJ-t License N CONTRACTOR Address: 2-dl l~ol f"~Gf.~I7 Za city: P /)-I State: _/Y fJ Zip: d-~ Phone: E, y Contact: LU ~8444^ntJibo- Email: Ica; rmvn t-A re A by ma% Ce,rn FIRE PERMIT TYPE WORK TYPE Sprinkler System of heads New _ Addition _ Fire Pump _ Standpipe _ Alterations _ Remodel Other. QJeAjjA t--LA t- Other: DESCRIPTION OF WORK: Commercial Residential Educational FEES $55.00 Minimum (includes State Surcharge) OR Contract Value $ x1% - If the Permit Fee is less than $10,010, surcharge is $ 5.00 Permit Fee - If the Permit Fee is > $10,010, surcharge increases by $.50 for each $1,000 Permit Fee (i.e. a $10,010-$11,010 Permit Fee requires a $ 5.50 surcharge) Surcharge - TOTAL FEE 3/4" Displacement Fire Meter - $204.00 Fire Meter TOTAL FEE *Requirements: 2 complete sets of drawings and specifications, cut sheets on materials and components to be used I hereby apply for a Fire Suppression System 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 with the Minnesota Building/Fire Codes; 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 rr2w res a review and approval of plans. x ~L x Applicant's Printed Name Applicant's Signature ")-16z0/7 70 '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.aooherstateonecall.org FOR OFFICE USE 3 REQUIRED INSPECTIONS ? Hydrostatic Flow Alarm Drain Test Rough In Trip Pump Test Central Station Final Conditions of Issuance: d Permit Reviewed by``~ Date: i 10/27/2011 16:06 6514335165 ITERNATIONAL FIRE PO PAGE 01 ~rPI'~G v 3 GAS ~a ;AL~ Use BLUE or BLACK Ink - ForOfticeu i City of I Permit T. ~ a1LL~11a~ ° I Permit Fee: 3830 Pilot Knob Road I I Eagan MN 55122 1 Date Received: Phone: (651) 675.5675 I I Fax: (651) 6755694 Staff: 2010 FIRE SUPPRESSION SYSTEMS PERMIT APPLICATION* Date: 012-114' Site Address: z0-7,, G L11= P AP. Tenant -el-1 Suits PROPERTY OWNER Name: Phone: Address / City / Zip: Applicant is: farmer Contractor TYPE OF WORK Description of work: /NCG L-/.)!U /PP&A,#jA-?,f oA- Construction Cost: ' t. O3 a..0. Estimated Completion Date: CONTRACTOR Name: t Fire Proteetioii (-icense C. 084, Address:22275 Meadowbrook Ave. N City: State: SCWdia, MN one: G/L _ Z4L- 67C Conrad: ~rZ (/•S tz~'!►Nt Email: FIRE PERMIT TYPE WORK TYPE Sprinkler System of heads _ New _ Addition Fire Pump Standpipe ;<Alterations _ Remodel Other. Other. DESCRIPTION OF WORK: Commercial Residential _ Educational FEES $SO.60 Minimum (includes State Surcharge) OR Contract Value $ Lf'030.'' x1/o If = $ Permit Fee Permit FM Is lags than $1,000, surcharge is t.50. - If Permit Ege- Is > $1,000, surcharge Increases by $.50 for each ; $ S CO State Surcharge $1,000 Permit Fee (Le. a $1,00142,000 Pert Fee requires a $1.00 surcharge). $ ~S• TOTAL FEE 314" Displacement Fire Meter - $203.00 $ Fire Meter $ TOTAL FEE *Requirements: 2 complete sets of drawings and specifications, cut sheets on materials and components to be used I hereby apply for a Fire Suppression System pert 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 with the Minnesota Buiiding/Flrs Codes; that 1 understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. X (2-r rZ A ve Dr2_1 K x I'm c Applicant's Printed Name App cants Signature 10/2712011 16:06 6514335165 ITERN TIONAL FIRE PO PAGE 02 -7- JAC- -20 CALL_BEFORE YOU DIG. Call Gopher State One Call at (651) 464-0002 for protection against underground utility damage. Call 48 hours before you Intend to dig to receive locates of underground utilities. wwwog pherstateonecall ora FOR OFFICE USE REQUIRED INSPECTIONS Hydrostatic Flow Alarm Drain Test Rough In e Trip Pump Test Central Station Final Conditions of Issuance: Permit Reviewed by 10/27/2011 16:06 6514335165 ITERNATIONAL FIRE PO PAGE 03 w InternadonW Fire Protection Contractors for fire suppression systems 10/26/2011 Job description for Chipolte Mexican grill Install 2 new Dry Pendent sprinkler heads in walk in cooler. Install 8 new Upright sprinkler heads. Change 8 existing Pendent sprinkler heads to new Upright sprinkler heads. 22275 Meadowbrook Ave. N. * Scondia, MN 55073 * ,Fax 651-433-5165 * Cell 612-242-4676 R 'fin Use BLUE or BLACK Ink For Office Use I ' Permit#:b2S32 !1 I t1 I City of 1Nl-~ajan I I I Permit Fee: _15 5- o o I 3830 Pilot Knob Road I Date Received: h;) Eagan MN 55122 : CEIVED I I Phone: (651) 675-5675 I Staff: Fax: (651) 675-5694 BEL Z 0 2011 I---------------- 2011 COMMERCIAL PLUMBING PERMIT APPLICATION (10 Date: uor i l Site Address: _X 75 C f t~ Rd _ Tenant: Mobs 6e, Suite PROPERTY OWNER Name: ZUDC? 0161,1 35 cof Phone: Name: 6+e l i1kray5 f'llrmbl'o r 1nC. License 0 ~ ~'.S$ CONTRACTOR I ~ t" p~ Address: Ila 525 SftaTeto[city: CW,, State: 9/1 Zip: 553 19 Phone: ( ~ a~ 3&1 _Old g Email: ~o ~f71t;~aUS 6U a ,e_® TYPE OF _ New _ Replacement r_ Repair _ Rebuild X Modify Space -Work in Ri.O.W." WORK Description of work: PII~ 0 to 1'lQW e4foo K M Solk I- u 4i / e-?4e r COMMERCIAL New Construction X Modify Space Irrigation System L_ yes no) RPZ PVB) • Rain sensors required on irrigation systems PERMIT TYPE . Avg. GPM (2" turbo required unless smaller size allowed by.Public Works) Meters.Call (651) 675-5646 to verity that tests passed Prior to Picking up meter. Domestic: Size & Type Fire: 1 Avg. GPM High demand devices? Yes No Flushometers -Yes No COMMERCIAL FEES: 00 _ $55.00 Minimum (includes State Surcharge) OR Contract Value $ 5 200 x1% $ Permit Fee Required on ALL new buildings and boulevard irrigation systems 4 $ Radio Meter Read If the Permit Fee is less than $10,010, the surcharge is $5.00 $ Meter(s) If the Permit Fee is > $10,010, the surcharge increases by $.50 for each $1,000 Permit Fee i.e. a $10,010-$11,000 Permit Fee requires a $5.50 surchar e $ State Surcharge Following fees apply when installing a new lawn irrigation system $ Water Permit Contact the City's Engineering Department, (651) 675-5646, for required fee amounts. $ Treatment Plant $ Water Supply & Storage $ State Surcharge 55.00 TOTAL FEE CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. X 7)asoti S ►f►eyRUS X_ V Applicant's Printed Name A icant's Signature FOR OFFICE USE Approved By: ~ Date: Required Inspections: /Under Under Ground Rough-In t Test Gas Test Final PRV Required: Yes No Page 1 of 3 Use BLUE or BLACK Ink For Office Use I a j Permit f City of Ea ~a~ 1 , RECEIVE Permit Fee: C~ 3830 Pilot Knob Road I c~ I / Eagan MN 55122 I Date Received: ® Phone: (651) 675-5675 DEC 2 p 2011 , Fax: (651) 675-5694 Staff: 2011 MECHANICAL PERMIT APPLICATION Date: 2 Site Address: ZD 7S C I Ff 2 aA n Tenant: Suite Name: Phone: RESIDENT I OWNER Address / City / Zip: Name: AZ So L✓77C_ t-1eL ItoAA cttf 6 License CONTRACTOR Address: :5-2- c-13 (-J, '?.T "p City: t✓ ptli State: HA) Zip: SS y35 Phone: f'5z- 831 - Oc e I Contact: x` A-4 lg- T" 12.E-- Email: M-I P-4 ,j .r; A-&f MEC ff G a ~.Y Replacement Additional _ Alteration Demolition TYPE OF WORK Description of work: -47 nAb .y tJ S Td'v rvt-u c. D~~f DwFr ~r<~ NOTE: Roof mounted and ground mounted mechanical equipment is required to be screened by City Code. Please contact the Mechanical Inspector for information on permitted screening methods. RESIDENTIAL COMMERCIAL €I _ Furnace New Construction 12~- interior improvement i i PERMIT TYPE - Air Conditioner Install Piping _ Processed Air Exchanger _~Gas _2~-Exterior HVAC Unit Heat Pump Under / Above ground Tank Install Remove) Other RESIDENTIAL FEES: $55.00 Minimum Add-on or alteration to an existing unit (includes $5.00 State Surcharge) $95.00 Fire repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge) _ $ TOTAL FEE COMMERCIAL FEES: _ $75.00 Underground tank installation/removal OR Contract Value $ ~1 pUd x1% $55.00 Minimum (includes State Surcharge) 41 ' Permit Fee i - If the Permit Fee is less than $10,010, surcharge is $ 5.00 S Surcharge i - If the Permit Fee is > $10,010, surcharge increases by $.50 for each $1,000 Permit Fee (i.e. a $10,010411,010 Permit Fee requires a$ 5.50 surcharge) 7 ~(o_ TOTAL FEE CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.orcg I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. Applicant's Printed Name Ap lican s Signature FOR OFFICE USE ~Q Required Inspections: Reviewed By: ~S Date L lk Underground Rough In "Air Test X Gas Service Test In-floor Heat ~j~ Final HVAC Screening Use BLUE or BLACK Ink j - For Office Use Ci 1 Permit < 1 ty of Ealan 1 Permit Fee: i 3830 Pilot Knob Road I t Eagan MN 55122 Date Received: ° Phone: (651) 675-5675 1 1 Fax: (651) 675-5594 1 Statf: I i 2010 FIRE SUPPRESSIaN SYSTEMS PERMIT APPLICATION* Date: cal 4/ Site Address: Z. O-7S C L r(' r' A0 Tenant: Suite PROPERTY OWNER Name: Phone: Address / City / Zip: Applicant is: Owner Contractor 1P474tL / 14ty w 1 1CAl0/iAr'7 -SPA0494-ts^r►. A464 4 iaovti S Rxis~ic.` TYPE OF WORK Description of work: PrzA-,N%sSeA lAWAC rTA A4tiA~ AeJvt [Pn./~uL~s/cus4.~ot7o ~%o'n'str c o'26o T s 1' Esfimatdd Completion Date: //3//!t If too. -A - CONTRACTOR Name: -Intl Fix- rotectI011 License G O $ Lr.. Addre City: State: r Phone: ~p "L 4-L - -67o Contact: V001? A/!<k Email: FIRE PERMIT TYPE WORK TYPE ,<Sprinider System of heads 4 _ New - Addition Fire Pump - Standpipe ~~fterations _ Remodel Other. Other. - DESCRIPTION OF WORK: commercial _ Residential Educational FEES $50.50 Minimum (includes State Surcharge) OR Contract Value $ CEO • x1% r Permit Fee - If Permit Fee is less than $1,000, surcharge is $.50. e - if Permit Fie is > $1,000, surcharge increases by $.50 for each = $ S • State Surcharge $1,000 Permit Fee (i.e. a $1,001-$2,000 Permit Fee requires a $1.00 surcharge). $ SS. TOTAL FEE 3/4" Displacement Fire Meter - $203.00 $ Fire Meter $ TOTAL FEE *Requirements: 2 complete sets of drawings and specifications, cut sheets on materials and components to be used I hereby apply for a Fire Suppression System permit and acknowledge that the information incomplete and accurate; that the work will be in c:onfornance with the ordinances and codes of the City of Eagan and with the Minnesota Building/Fire Codes; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. x V~O~~/GIG x Applicants Printed Name Applicants Signature 20-7 (f ltF4 -mod- 5,~? 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.gopherstateonecalLorq FOR OFFICE USE REQUIRED INSPECTIONS Hydrostatic Flow Alarm Drain Test Rough In Trip Pump Test Central Station 1 Final Conditions of Issuance: Permit Reviewed b )~1`-L-, Date: / ! Use BLUE or BLACK Ink -----------------i For Office Use , , I City of Eapn I Permit I I 3830 Pilot Knob Road , Permit Fee: 1 Eagan MN 55122 I Date Received: Phone: (651) 675-5675 Fax: (651) 675-5694 I Staff: 1 2011 COMMERCIAL BUILDING PERMIT APPLICATION . 11-15-11 Site Address: 2075 Cliff Road, Eagan 55122 ~ Date. T-Mobile Tenant Name: (Tenant is: New / Existing) Suite Blockbuster JQ5-g,~4t,(- . Former Tenant: PROPERTY OWNER Name: Lupe Holdings Corp. Phone: 612-436-3200 Address / City r zip: 1701 Madison Street NE. Ste 111, Minneapolis, MN. 55413 Applicant is: Owner Contractor ~ f 6Gepj'r~ Fb~- ~ ~AN'i ~r ►q JyE TYPE OF WORK Description of work: Tenant Improvement; Work to include new finishes, fixtures, and lighting. Construction Cost: $40,000 CONTRACTOR Name: CW-L-C'mi tAft o C, . License Address: I MS PkwwP.1 le City: fz /I Liz- Stater M N Zip: 51~ 11 12) Phone: (o 95"1 - 303 - $ Z L 2 Contact: pmC.I.1 Email: Q'~gCk 501111["IAt° ~Gb ARCHITECT / Name: Donald Rethman/Design Forum Registration 26347 ENG:; INEER Address: 7575 Paragon Road City: Dayton State: OH zip: 45459 Phone: (937) 312-8974 Contact Person: Andy McLoud Email: andy.mcloud@interbrand.com Licensed plumber installing new sewer/water service: Phone NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that they are trade secrets. CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www gooherstateonecall.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 applicatiog,fer permit, a d work's not to start without a permit; that the work will be in accordance with the approved plan in the case of work. "hich equires a eview a proval of plans. X~%AS I r~c(~1S X Applicant's Printed Name 4kVpfl-ca-5-ft Signature Page 1 of 3 DO NOT WRITE BELOW THIS LINE SUB TYPES _ Foundation Public Facility Accessory Building _ Apartments _V/ Commercial / Industrial Exterior Alteration-Apartments _ Lodging _ Greenhouse ! Tent Exterior Alteration-Commercial Miscellaneous Antennae Exterior Alteration-Public Facility WORK TYPES - New /Interior Improvement Siding Demolish Building* Addition Exterior Improvement Reroof - Demolish Interior Alteration - Repair Windows _ Demolish Foundation _ Replace - Water Damage Fire Repair Retaining Wall Salon Owner Change *Demolition of entire building give PCA handout to applicant DESCRIPTION Valuation 44Y 00c) Occupancy MCES System Plan Review Code Edition 2uG7 A41, 9.,-- SAC Units O (25%_ 100%!6 Zoning City Water ✓ Census Code Stories Booster Pump # of Units b Square Feet 14D$ PRV # of Buildings ( Length Fire Sprinklers v7- Type of Construction- Width REQUIRED INSPECTIONS Footings (New Building) ✓ Sheetrock Footings (Deck) Final ! C.O. Required Footings (Addition) Final ! No C.O. Required Foundation Other: Drain Tile Pool: Footings -Air/Gas Tests -Final Roof: -Decking -Insulation -ice & Water -Final Siding: -Stucco Lath -Stone Lath -Brick Framing Windows Fireplace: -Rough In -Air Test -Final Retaining Wall Insulation Erosion Control Meter Size: Final CIO Inspection: Schedule Fire Marshal to be present: V/Yes No Reviewed By: Building Inspector Reviewed By: Planning COMMERCIAL FEES Base Fee ~7. ZS Water Quality Surcharge 2~ • Water Supply & Storage (WAC) Plan Review 3'3.2 Storm Sewer Trunk MCES SAC Sewer Trunk City SAC Water Trunk S&W Permit & Surcharge Street Lateral Treatment Plant Street Treatment Plant (Irrigation) Water Lateral Park Dedication Other: Trail Dedication Water Quality TOTAL qG7• Page 2 of 3 Metropolitan Council Environmental Services November 23, 2011 Dale Schoeppner Building Official City of Eagan 3830 Pilot Knob Road Eagan, MN 55122 Dear Mr. Schoeppner: The Metropolitan Council Environmental Services (MCES) Division has determined the SAC to be charged for the wastewater capacity demand for T-Mobile to be located at 2075 Cliff Road within the City of Eagan. The City will be charged no additional SAC Units for this project, as determined below. SAC Units Charges: Stock 387 sq. ft. @ 7000 sq. ft./SAC Unit 0.06 Retail 897 sq.. ft. @ 3000 sq. ft./SAC Unit 0.30 Total Charge: 0.36 Credits: Retail (110914133) 0 46 1374 sq. ft. @ 3000 sq. ft./SAC Unit Net Charge: 0 The business information was provided to MCES by the applicant at this time. It is the City's responsibility to substantiate the business use and size at the time of the final inspection. If there is a change in use or size, a redetermination will need to be made. If you have any questions, call me at 651-602-1118 or email karon.cappaert@mete.state.mn.us. 3nSincerrel., Cap aert SAC Technician Environmental Services Division KC:kb: 111123A4 Determination expiration: November 23, 2013 cc: J. Nye, MC;ES . - --poggydeck, Eagan (email)___ TasiaKallies, Burnham Nationwi4%4p 4oundl.org 390 Robert Street North + St. Paul, MN 55101-1805 + (651) 602-1005 • Fax (651) 602-1477 • TTY (651) 291-0904 Are Equal Opportunity Employer • la>1S reiV~ _ Use BLUE or BLACK Ink " j ,ems I For Offlce Use I Y10 U I I a ~~~j I City of Ea aIl RECEIVED Permit I E I Permit Fee: Q b 3830 Pilot Knob Road Eagan MN 55122 o 202 1 Date Received: 1 I Phone: (651) 675-5675 1 I Staff: Fax: (651) 675-5694 1 cj - ` 2012 COMMERCIAL PLUMBING PERMIT APPLICATION Date: ! Site Address: ~U7 l.~lt Q dl, ai+e 10a _ Tenant: hgt1+as,4c. Sm. Land l J WA Suite 110,i2 PROPERTY OWNER Name: Phone: : Name: sts)A~ qas pram6tA~ ; J/1C, License 059(o5b CONTRACTOR s d4~ `Address: ~ IaZ E Jt, , 5tt i~-e lot city: C' ~,25120. State: !"t Zip 553i9 Phone: 0121Email: t ' , TYPE OF New _ Replacement _ Repair _ Rebuild Modify Space _ Work in R.O.W. WORK Description of work: Cu ~1 ;n 01 " J M S es Ul: y ri iJ~CIS COMMERCIAL _ New Construction X Modify Space _ Irrigation System yes no) RPZ PVB) • Rain sensors required on irrigation systems PERMIT TYPE ? Avg. GPM (2" turbo required unless smaller size allowed by Public Works) _ Meters Call (651) 675-5646 to verity that tests passed prior to picking up meter. Domestic: Size & Type Fire: 1 Avg. GPM High demand devices? Yes No Flushometers _Yes No COMMERCIAL FEES: $60.00 Minimum (includes $5.00 State Surcharge) OR Contract Value $ x1% = $ Permit Fee Required on ALL new buildings and boulevard irrigation systems 4 $ Radio Meter Read - If the Permit Fee is less than $10,010, the surcharge is $5.00 $ Meter(s) - If the Permit Fee is > $10,010, the surcharge increases by $.50 for each $1,000 Permit Fee i.e. a $10,010-$11,000 Permit Fee requires a $5.50 surchar e $ State Surcharge Following fees apply when installing a new lawn irrigation system $ Water Permit Contact the City's Engineering Department, (651) 675-5646, for required fee amounts. $ Treatment Plant $ Water Supply & Storage $ State Surcharge $ TOTAL FEE CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.ora 1 hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. e } x meson Ste►n64us x k-2 Applicant's Printed Name Ap icant's Signature FOR OFFICE USE Approved By: Date: Z L Required Inspections: Y Under Ground d" Rough-In Air Test Gas Test Its Final PRV Required: Yes No Page 1 of 3 Use BLUE or BLACK Ink I For Office Use I Permit _Z City of Ed I I I Permit Fee: l 3830 Pilot Knob Road ~ I Date Received: Eagan MN 55122 RE %.,,EIVED Phone: (651) 675-5675 Fax: (651) 675-5694 FEB 10 2012 staff----------------- 2012 MECHANICAL PERMIT APPLICATION C I ~ `LAW t~ Date: Site Address: 2_07,'g Tenant: (I Tip C T"I r- ~ 09-IVIL Y Suite M RESIDENT / OWNER Name: Phone: Address / City / Zip: Name: ~T S S UL_L; -F r'l EG IfEF/~)iLla-L LlZ_License CONTRACTOR Address: z~_2_0 3 1,-J. City: 7~ O I VAS State: -i Zip: S$ Y 3 q Phone: 9 2 /--U y l Contact: H aQ LL Y_'1 Zhu Email: rtit ~C lid . A ~i /!ZC"C Gf~ L~^-~ New Replacement Additional Alteration Demolition TYPE OF WORK Description of work: $nAa -10,u w - coAtgr 4y At, -Na wow- r-- 74,_ NOTE: Roof mounted and ground mounted mechanical equipment is required to be screened by City Code. Please contact the Mechanical Inspector for information on permitted screening methods. RESIDENTIAL COMMERCIAL Furnace New Construction 7~-Interior Improvement PERMIT TYPE -Air Conditioner Install Piping Processed Air Exchanger 4-Gas _2~fxterior HVAC Unit _ Heat Pump Under / Above ground Tank Install Remove) Other RESIDENTIAL FEES: $60.00 Minimum Add-on or alteration to an existing unit (includes $5.00 State Surcharge) $100.00 Fire repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge) = $ TOTAL FEE COMMERCIAL FEES: @8c~ $75.00 Underground tank installation/removal (includes $5.00 State Surcharge) OR Contract Value $ 6 V X1% $60.00 Minimum (includes State Surcharge) eg . SO Permit Fee - If the Permit Fee is less than $10,010, surcharge is $ 5.00 Surcharge - If the Permit Fee is > $10,010, surcharge increases by $.50 for each $1,000 Permit Fee (i.e. a $10,010-$11,010 Permit Fee requires a$ 5.50 surcharge) 7 3,,S-,O TOTAL FEE 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.ciopherstateonecall.org hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. X mkg L. j6tZ,KW-2 x Applicant's Printed Name A" plicant's Signature FOR OFFICE USE Required Inspections: Reviewed By: Date: "z / Underground Rough In Air Test Gas Service Test In-floor Heat Final HVAC Screening ~4 n S Use BLUE or BLACK Ink V1 C, -----------------i For Office Use I j~ I Permit lJ I I City of f Eajan I Permit Fee: 3830 Pilot Knob Road 1~~ I I Eagan MN 55122 Date Received: ~T] Phone: (651) 675-5675 I I Fax: (651) 675-5694 I Staff: I I - 2012 FIRE SUPPRESSION SYSTEMS PERMIT APPL.ICATION* Date: 02-15-2012 Site Address: 2075 CLIFF ROAD Tenant: FANTASTIC SAM'S Suite 3 Name: Phone: PROPERTY OWNER Address / City / Zip: i Applicant is: Owner Contractor TYPE OF WORK i Description of work: RELOCATE (8) PEND SPRINKLERS & ADD 2 Construction Cost: 1,260.00 Estimated Completion Date: 02-23-2012 Name: GENERAL SPRINKLER CORP. License C002 CONTRACTOR Address: 1863 BUERKLE ROAD City: WHITE BEAR LAKE State: MN Zip. 55110 Phone: 651-484-5903 s Contact: GREG RICHARD Email: grichard@generalsprinkler.com FIRE PERMIT TYPE WORK TYPE " Sprinkler System of heads New _ Addition Fire Pump _ Standpipe Alterations Remodel Other: _ Other: DESCRIPTION OF WORK: Commercial Residential Educational FEES $60.00 Minimum (includes State Surcharge) OR Contract Value $ 1260.00 x1% - If the Permit Fee is less than $10,010, surcharge is $ 5.00 = $ 6 0 . 0 0 Permit Fee - If the Permit fee- is > $10,010, surcharge increases by $.50 for each $1,000 Permit Fee (i.e. a $10,010-$11,010 Permit Fee requires a $ 5.50 surcharge) included Surcharge _ $ 6 0 . 0 0 TOTAL FEE 3/4" Displacement Fire Meter - $231.00 Fire Meter TOTAL FEE *Requirements: 2 complete sets of drawings and specifications, cut sheets on materials and components to be used I hereby apply for a Fire Suppression System 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 with the Minnesota Building/Fire Codes; that I u tand th' 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 approved plan the case of work which requires a review and approval of plans. x GREG RICHARD x Applicant's Printed Name Ap a Sig ature Kd --1-3 t CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. 11 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.ora FOR OFFICE USE _ _....,.W,,.~. _...v~~..., .....~..,,s. _ _._...,_..y~...W.._...._~.....~..,4_,,...__ REQUIRED INSPECTIONS Hydrostatic Flow Alarm Drain Test Rough In 4 Trip Pump Test Central Station Final Conditions of Issuance: e c Permit Reviewed b Date: 7/ r mi iw L ~ Use or BLACK Ink I For Office Use I n~ ~ I I Permit C) City of Eon J 6 I Permit Fee: I 3830 Pilot Knob Road R'~ I L I Eagan MN 55122 I ! I Date Received: Phone: (651) 675-5675 I Fax: (651) 675-5694 Staff: I - - - - - - - - - - - - - - - - - J 2012 COMMERCIAL BUILDING PERMIT APPLICATION Date: ZJ i 7/1 Site Address: o2 7,5- 6 Tenant Name: FA V7-,g S T i L Jcla M s (Tenant is:1 t- New / Existing) Suite ) Q Former Tenant: 131 oc e-6 uS~e'r, Uldco Name: k 04-ro"'i Phone: E PROPERTY OWNER Address / City / Zip: Applicant is: Owner Contractor c~c~sc wclls ` 2 r~ll S TYPE OF WORK Description of work. r2ri vA r, N h L VA zNf Ti ~gl oorl' j 3~aC{ r Construction Cost: Name: T&Ab1tSMAkK /"0zWl,V Co., L -~-Cicense 0,1-~9 300q e `b Address: 1`6451 ~Gr'✓t+C2. l N City: 1.1 CONTRACTOR State: MAI Zip: Phone: t? 12 ~9~'" 5"3 f CQc c~ l~ ks Contact. G Y ~ Email: Vii,, h S2, ®`NCl~~ CAhn Name: V) Gk 11< Jo NeFj- Registration ARCHITECT/ Address: ;_I KO City: (~!~/t-1~~✓f) ENGINEER / State: T 11i Zip: 3 ?0 Phone: 1 0 l - 1p9 1 ,53 q Contact Person: I C-K) _ y0k74?-5 Email NliQ Licensed plumber installing new sewer/water service: Phone NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that they are trade secrets. CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. 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 w rk which requirevie and approval of plans. Applicant's Printed Name Applicant's Signaturel~r Page 1 of 3 333 DO NOT WRITE BELOW THIS LINE SUB TYPES _ Foundation Public Facility _ Exterior Alteration-Apartments Commercial / Industrial _ Accessory Building Exterior Alteration-Commercial Apartments _ Greenhouse / Tent - Exterior Alteration-Public Facility Miscellaneous Antennae WORK TYPES New x Interior Improvement Siding _ Demolish Building* Addition _ Exterior Improvement Reroof _ Demolish Interior Alteration _ Repair Windows Demolish Foundation Replace Water Damage Fire Repair Retaining Wall Salon Owner Change *Demolition of entire building - give PCA handout to applicant DESCRIPTION Valuation Occupancy MCES System V Plan Review Code Edition /NSiG SAC Units oL Le,4C,4" (25%_ 100%z) Zoning City Water ytS Census Code Stories Booster Pump # of Units / Square Feet / PRV # of Buildings Length 70 Fire Sprinklers Type of Construction' Width 14 REQUIRED INSPECTIONS Footings (New Building) heetrock Footings (Deck) ~inal / C.O. Required Footings (Addition) Final / No C.O. Required Foundation Other: Drain Tile Pool: -Footings -Air/Gas Tests -Final Roof: -Decking -Insulation -Ice & Water -Final Siding: -Stucco Lath -Stone Lath -Brick Framing Windows Fireplace: -Rough In -Air Test -Final Retaining Wall Insulation Erosion Control Meter Size: Final C/O Inspection: Schedule Fire Marshal to be present: Yes V No Reviewed 6Y: Building Inspector Reviewed BY Planning COMMERCIAL FEES Base Fee ~9~• `7•s Water Quality Surcharge 00 Water Supply & Storage (WAC) Plan Review /.24 Storm Sewer Trunk MCES SAC 2s Y730 . oo Sewer Trunk City SAC '100.00 Water Trunk S&W Permit & Surcharge Street Lateral Treatment Plant S 0~ Street Treatment Plant (Irrigation) Water Lateral Park Dedication Other: Trail Dedication Water Quality TOTAL q. 39 Page 2 of 3 Metropolitan Council Environmental Services February 27, 2012 Dale Schoeppner Building Official City of Eagan 3530 Pilot Knob Road Eagan, MN 55122 Dear Mr. Schoeppner: The Metropolitan Council Environmental Services (MCES) Division has determined the SAC to be charged for the wastewater capacity demand for Fantastic Sam's to be located at 2075 Cliff Road, Suite 102 within the City of Eagan. The City will be charged 2 SAC Units for this project, as determined below. SAC Units Charges: Hair Stations 9 stations @ 4 stations/SAC Unit 2.25 Credits: Retail (10/11) 1110 sq. ft. @ 3000 sq. ft./SAC Unit 0.37 Net Charge: 1.88 or 2 The business information was provided to VICES by the applicant at this time. It is the City's responsibility to substantiate the business use and size at the time of the final inspection. If there is a change in use or size, a redetermination will need to be made. If you have any questions, call me at 651-602-1118 or email karon.cappaert@metc.state.mn.us. Sincerely aron Cappaert SAC Technician Environmental Services Division KC:kb: 120227A6 Determination expiration: February 27, 2014 cc: J. Nye, MCES Peggy Fleck, Eagan (email) Erik Fyksen (email) www.metrocouncil.org 390 Robert Street North . St. Paul, MN 55101-1805 • (651) 602-1005 • Fate (651) 602-1477 • TTY (651) 291-0904 An Equal Opportunity Employer 4 eg_ _ _ _Use BLUE or BLACK Ink I For Office Uset 1~ I in y 'NV L) gly of Permit c t t I l Permit Fee: 3830 Pilot Knob Road RECEIVED l I Eagan MN 55122 + Date Received: Phone: (651) 675-5675 MAR 2 3 2012-~' I Staff: Fax: (651) 675-5694 2012 MECHANICAL PERMIT APPLICATION Date: Site Address: P ZIP' Tenant: Suite RESIDENT / OWNER Name: Phone: Address / City / Zip: Name: e®c ~;-3;t~(,License CONTRACTOR Address: W- tf 4i 1_~+•-~~ City: ?7 State: -AJA Zip: c3 Phone: 715-e270 Contact e4-- Email: r New Replacement Additional K_Alteration Demolition TYPE OF WORK Description of work: NOTE: Roof mounted and ground mounted mechanical equipment is required to be screened by City Code. Please contact the Mechanical Inspector for information on permitted screening methods. RESIDENTIAL COMMERCIAL _ Furnace New Construction Interior Improvement PERMIT TYPE Air Conditioner Install Piping Processed Air Exchanger Gas Exterior HVAC Unit Heat Pump _ Under/ Above ground Tank C_ Install / _ Remove) Other RESIDENTIAL FEES: $60.00 Minimum Add-on or alteration to an existing unit (includes $5.00 State Surcharge) $100.00 Fire repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge) = $ TOTAL FEE COMMERCIAL FEES: $75.00 Underground tank installation/removal (includes $5.00 State Surcharge) OR Contract Value $ r~j -F X1% $60.00 Minimum (includes State Surcharge) Permit Fee If the Permit Fee is less than $10,010, surcharge is $ 5.00 Surcharge - If the Permit Fee is > $10,010, surcharge increases by $.50 for each $1,000 Permit Fee p (i.e. a $10,010-$11,010 Permit Fee requires a $ 5.50 surcharge) _ $ ~ TOTAL FEE 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. wwwr.aogherstawnecall.org I hereby acknowledge that this information is complete and accurate; that the work will 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 i not to start without a permit; t~ork will be in accordance with the approved plan in the case of work which requires a review and approval of pl s: App rc t"s Printed Name A plicant"s Signature FOR OFFICE USE Required Inspections: Reviewed By: ` Date: Z~J Underground --I/- Rough In Air Test Gas Service Test In-floor Heat Final HVAC Screening _ U_s_e_B_LUE or_B_LACK Ink Office Use ` I For -3 City of Eap I Permit F I I Permit Fee: I 3830 Pilot Knob Road Date Received: -jr Z to 2-. I Eagan MN 5517$ I I Phone: (651).675-5675 I Staff: Fax: (651) 675-5694 L___________-'_T 2012 COMMERCIAL PLUMBING PERMIT APPLICATION Date: Site Address: ,310-75' L.1+TT Tenant: A-a yl i- .5c, V., 5. Suite P~--ROPERTY OWNER Name: Phone: Name: 81ue. WCAP PIVw.6"'Ij, eV. License ~mZb33 CONTRACTOR I Address: Sloes w 41~ city: pHno,44-1 State:.n!✓Zip: 5 3 Phone: sc1~3~-1i~,- Email: 1,A,& 06 a TYPE OF New - Replacement _Repair -Rebuild I Modify Space _ Work in R.O.W. WORK i f 1 /Lo6,,-jnr T.. Description of work: of Z fe Ll S ^ COMMERCIAL _ New Construction Modify Space Irrigation System yes / _ no) RPZ ! ! PVB) • Rain sensors required on irrigation systems PERMIT TYPE . Avg. GPM (2" turbo required unless smaller size allowed by Public Works) Meters Call (651) 675-5646 to verity that tests passed prior to picking up meter. Domestic: Size & Type Fire: 1 Avg. GPM High demand devices? Yes No Flushometers _Yes No COMMERCIAL FEES: $60.00 Minimum (includes $5.00 State Surcharge) OR Contract Value $ - $00 x1% 3 = $ Permit Fee Required on ALL new buildings and boulevard irrigation systems -)p $ Radio Meter Read - If the Permit Fee is less than $10,010, the surcharge is $5.00 $ Meter(s) - If the Permit Fee is > $10,010, the surcharge increases by $.50 for each $1,000 Permit Fee (i.e. a $10,010-$11,000 Permit Fee requires a $5.50 surcharge) $ State Surcharge Following fees apply when installing a new lawn irrigation system $ Water Permit Contact the City's Engineering Department, (651) 675-5646, for required fee amounts. $ Treatment Plant $ Water Supply & Storage $ State Surcharge = $ TOTAL FEE 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.ciot)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 approv of ans. x. Job A-ZG' x Applicant's Printed Name A icant's Si ature FOR OFFICE USE Approved By; Date:,,~ Required Inspections: Under Ground Rough-In &Air Test Gas Test 1,nal PRV Required: Yes No Page 1 of 3 C 3LIn- BLUE WATER PLUMBING INC. 5026 Alpha Rd. Princeton, MN 55371 763-238-1002 DATE: 3-26-2012 TO: City of Eagan SUBJECT: Plumbing permit for 2075 Cliff Rd. To Whom it may concern, The only plumbing that we are adding is for the new bathroom. The rest of the sinks are already roughed in. We will however be installing the 4- hair washing sinks, 1- Laundry sink, and 1- 80 gallon electric water heater. If you need any further information or have any questions please call me. Thank You, Josh Deziel 763-238-1002 I FX-01\ Fill A \ nml VT / -7 I> a - FIX F C ry N! _ 1 Z \ ~ 1~ u ~ ~ I f 1 1 TTT 11 ® N 11 ` \n CA, Av !t ` N Y~ ~ t9 1 ~y t \ ~ ' ! p F~ _ to 1.5Z .3 o ~ ° ~ ~0 1 of I 1 I p ~,c § f I 1 e nFb p~ - 6`W~ mQ ~ ~ 1 I m f l 1 I ,T ' \ 1 Q a / I f \ o - X m lI` 1 I s 7Y a f~ ~ m I f 6 _ k~ of p I - I a / z I = m ' / ` /1 1 E ~ ~ z J I -I _ ~J 11 i Allw ~ ;1 ~ 1 if I I =P mr-b.- I g eon °6 m s51% p r y 111 b( y 4 6 Q I \ o~ o g o m m a l!ei ms o 1-I1 b 3° i i?~I ° m q;bnta i mss ® Tfic W.~ones o m Cl) s m° ID$ D INTERIOR DESIGNER A ' P EAGAN, MN 2760 PARK CRESTCOVE < CORDOVA, TN38016 Tom: CEILING ! POWER / PICTURE PLAN TEL (901)486-1539 E.VWJDESIGNS@AOL.COM 411111 CityofEaali 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 9t1 Use BLUE or BLACK Ink For Office Use Permit #: Permit Fee: Date Received: l (?\ O//' Staff: 2016 COMMERCIAL BUILDING PERMIT APPLICATION Date: l U "l `" O I Co Site Address: a'o? 5 C "14- Coad r �cr'ci3c\A /V"/ S 5 i a-'7- Tenant Name: 91aWnrf0'1(1ncn1 P1(ae +-e-C-ti.r°t(Tenant is: i/ew/ Existing) Suite #: Former Tenant: 9( C b v3 QJ 1..s, ,1l1iAT Name: P - HU (d INA('QCNOO,)'C Cphone:V0-,`4Jco � U Address/City/Zip: no 1 Makd\far, S+- NT' , t,,, -to'yt(S rt/t, -5943 Applicant is: '-70wner Contractor Description of work: I— CN -d 1, O r d W iTCW Construction Cost: S 1 00C -)1Q �� � c- 0E//1 l /i1& A Name: L. u Pt, tD-t -e Lc/ P/►'t-f l� 1— License #: AfR Ce I Address: i 7 0 t MAA1S G r\ S+ A/ City: /A INAA 1 (S 9 Gi 5s II3 CO1a• _y3co - ��� SO7-g State:, v ^n `N Zip: Phone: Contact: am eJ b r\ Email: C ovntro n . f—lown.t.42 Oe rtdP/" X01 ; Co plumber installing new sewer/water service: CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.orq I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which reauires-a review and approval of plans. C, (AmeruA F (anYuit Applicant's Printed Name x App nature Page 1 of 3 iteei DO NOT WRITE BELOW THIS LINE SUB TYPES Foundation ✓ Commercial / Industrial Apartments Miscellaneous WORK TYPES New Addition Alteration Replace Salon Owner Change DESCRIPTION Valuation Plan Review (25% 100% Vi Census Code # of Units Public Facility Accessory Building Greenhouse / Tent Antennae v' Interior Improvement Exterior Improvement Repair Water Damage # of Buildings 1 Type of Construction V • J3 REQUIRED INSPECTIONS Footings (New Building) Footings (Deck) ✓ Footings (Addition) Occupancy Code Edition Zoning Stories Square Feet Length Width ✓ Foundation Foundation Before Backfill Drain Tile Roof: _Decking _Insulation Ice & Water Final V Framing 30 Minutes 1 Hour Fireplace: Rough In Air Test Final Insulation Sheetrock Windows Final C/O Inspection: Schedule Fire Marshal to be present: Reviewed By: C'xc' , Building Inspector 13953i Exterior Alteration—Apartments V Exterior Alteration—Commercial Exterior Alteration—Public Facility Siding Reroof Windows Fire Repair Demolish Building* Demolish Interior Demolish Foundation Retaining Wall *Demolition of entire building — give PCA handout to applicant wt (vs) -cts- i'ieL / e 1 MCES System SAC Units 0{LrTE'0--- City Water ✓ Booster Pump PRV Fire Sprinklers Final / C.O. Required Final / No C.O. Required Other: Pool: Footings Air/Gas Tests _ Siding: Stucco Lath Stone Lath Retaining Wall Erosion Control Concrete Entrance Apron Meter Size: Electronic Plans Required Yes No Final Brick EFIS Reviewed By: , Planning COMMERCIAL FEES Base Fee Surcharge Plan Review MCES SAC City SAC S&W Permit & Surcharge Treatment Plant Treatment Plant (Irrigation) Park Dedication Trail Dedication I;28. o ZZ • YO Water Quality Storm Sewer Trunk Sewer Trunk Water Trunk Street Lateral Street Water Lateral Other: 4/ /, /0 5 8,70 Page 2of3 MCES USE: Letter Reference: 161026A1 Address ID: 4915 Payment ID: 397241 I 3 537 Date of Determination: 10/26/16 Greetings! Please see the determination below. Determination Expiration: 10/26/18 Project Name: International Office Technologies Project Address: 2075 Cliff Road Suite #/Campus: na City Name: Eagan Applicant: Cameron Flakne, Lupe Holdings Corp Special Notes: na Charge Calculation: Retail: 1709 sq. ft. @ 3000 sq. ft. / SAC = 0.57 Total Charge: 0.57 Credit Calculation: Retail (10/11) Retail: 1806 sq. ft. @ 3000 sq. ft. / SAC = 0.60 Total Credit: 0.60 Net SAC: -0.03 — or — 0 SAC Due The business information was provided to MCES by the applicant at this time. It is the City's responsibility to substantiate the business use and size at the time of the final inspection. If there is a change in use or size, a redetermination will need to be made. If you have any questions email me at: tory.mccullough@metc.state.mn.us. Thank you, Cory McCullough SAC Technician Please visit our SAC website by going to: http://www.metrocouncil.org/Wastewater-Water/Funding-Finance/Rates-Charges/Sewer-Availability-Charge.aspx 390 Robert Street North St. Paul, one 651.602.1000 ± Fax 651.602.1550 ! 77Y 651.29 .090L ! rrl trc council.orq } 0 0 0 3 0 3 d 9 i3c1S'3-7 03aa dam r h ,` egos JY mo REFER TO FRAME DRAIN..w ID MERIDA GULAG SHALL EE MBJ.MD. WTI TmE AND COLOR 10 MATO! DASD Yy PROVIDE TEMPERED GLAZING ADJACENT TO OPERANLE DOORS OR MEN ROAM COMPLIANCE ON IEC 3ACEA C. EXTERIOR D.PAINT R0LLW'rt4 RPROM FRAME TOOGIC 1rPE,RANI.. AM COLOR OF DOGE WAND COAR CP DOSE AALLED ELWINEFE m WILDA. HARDWARE GROUP GENERAL NOTES a . b 3 3 3 q $ �. g Y 1 1 11 k g RRR_i p a IP t I) s §1e �` pii ggi 6 tl $ N a g a ty § �® 1 && hg N p it 'sg 1 G Rt ; all 0 Eag`g -a� p B W 2� pp " rih D 5 e. NOV-3-2016 08:07 FROM:SMSM 7637854937 TO:6516755694 P.1/1 1c`r\5 PI raise Call ‘P'' City of Eke La ,,,a rt c -a c 3830 Pilot Knob Road Eagan MN 55122 "I ' 1?-3COCa Phone: (851) 675.5875 S f1 ...� (�,L r Fax: (651) 6754684 vt. e.�1`a 1 Use BLUE or BLACK Ink L For Office Use �{ 44 Permit 0: 1 31 c 0©.DaPermit Fee: (0'0,- Date te Received: ,-Y1(4. Staff: +`')C1 2016 MECHANICAL PERMIT APPLICATION ❑ Please submit two (2) sets of plans with all commercial applications. Date: Site Address: aQl.6 C rt9 t.t Tenant; L \o( 41&04/6 I LL Suite if: 1 Resident/Owner 1 Name: Phone: Address / City ///Z p: Contractor `l _ N1 p Nome: 'MOLel �7r1eti. . ro a 5o. Li ' i(9 /' / ©to 3 !' lxo Address: '-7q 40 5 La\'' , nQ-aity:l 6pi 1 < R4 . �., State: fit N Zip: 55 Phone: ! (p3 ...2S1+"- t 3�r �-I Contac fx v'4 Y\ACj. Op Email: 1\>r'�Ttnesm tow! Type of Work New Replacement Additional V Alteration Demolition Description of work: NOTE: Roof mounted and ground mounted mechanical equipment is required to be screened by City Code. Please contact the Mechanical Inspector for information on permitted screening methods. Permit Type RESIDENTIAL Furnace COMMERCIAL New Construction Interior Improvement —Air Conditioner —Air Exchanger Heat Pump _ -X,_ Install Piping Processed _ _ Gas Exterior HVAC Unit _ Under/Above ground Tank (_ Install / Remove) Other _ _ t- R4 xv-ko d' 1e...VIL 'L,A RESIDENTIAL FEES 060.00 Minimum Add or alteration to an existing unit, includes State includes State Surcharge , , fi1Lf\ Surcharge $100.00 Residential New, f�may, = $ S'j✓ TOTAL FEE COMMERCIAL FEES 060.00 Permit Fee Minimum x .01 Contract Value $ POO 4 X = $ Permit Fee 075.00 Underground tank installation/removal, includes State Surcharge Surcharge ■ Contract Value x $0.0005 If the project valuation is over 01 million, please call for Surcharge _ = $ Surcharge = $ 100 ' 5 - TOTAL FEE I hereby acknowledge that thls Information Is complete and accurate: that the work will bo In conformance with the ordinances and codec of the City of Eagan: that I understand this is not a permit, but only an application for a permit, end work Is not to start without e 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. Applleanrs Printed Name x Apptl FOR OFFICE USE.S49I Required Inspections:�/ Reviewed By: Date: ( )l Underground f Rough In Air Test Gas Service Test ___. In -floor Heat YFinal HVAC Screening City of Eaai 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 NOV U 9 2016 Use BLUE or BLACK Ink For Office Use Permit#: j— 0� Permit Fee: ®` 0 0 Date Received: Staff: 2016 FIRE SUPPRESSION SYSTEMS PERMIT APPLICATION Date: 11/7/2016 Site Address: 2075 Cliff Road Eagan Mn, 55122 Tenant: International Office Technology Suite #: Name: International Office Technology Phone: 612-567-8919 Address /city /zip: 2020 Silver Bell Road Suite 34 Eagan MN 55121 Applicant is: Owner ✓ Contractor Description of work: Raise 4 sprinkler heads to new ceiling elevation Construction Cost: 785.00 Estimated Completion Date: 11/10/2016 Name: Breth-Zenzen Fire Protection License #: C-126 Address: 8053 Sterling Drive Suite 101 City: St. Joseph State: MN N Zip: 56374 Phone: 320-363-0900 Contact: Nick VanDonsel Email: nick@bzfire.com FIRE PERMIT TYPE 1 Sprinkler System (# of heads 1) Fire Pump _ Standpipe Other: WORK TYPE New Addition 1 Alterations Remodel Other: DESCRIPTION OF WORK: iK Commercial _ Residential _ Educational FEES $60.00 Permit Fee Minimum Surcharge = Contract Value x $0.0005 If the project valuation is over $1 million, please call for Surcharge $100.00 Residential New (includes State Surcharge) Contract Value $ 785.00 x .01 =$ 60.00 Permit Fee = $ Surcharge _ $ TOTAL FEE 3/4" Fire Meter - $280.00 = $ Fire Meter = $ TOTAL FEE **Requirements: 2 complete sets of drawings and specifications, cut sheets on materials and components to be used I hereby apply for a Fire Suppression System 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 with the Minnesota Building/Fire Codes; that 1 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 ip the case of work which requires a review and approval of plans. x Nick VanDonsel Applicants Printed Name Applicants Signature /zgo-f Use BLUE or BLACK In r For Office Use, ~� //6 y Ci'''Eaaau leo/�6:::e �, : -7d- - .6 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Date Received: / �� Fax: (651) 675-5694 staff: I._ 2016 COMMERCIAL BUILDING PERMIT APPLICATION Date: ) JJ g / til Site Site Address: Ziu� c C,L a �C (�o� )j y `j4�l /vim Z Z Tenant Name: l 07— 1 ("/4_ LJlTh&_t4. (Tenant is: New/ Existing) Suite#: f n(/ Former Tenant: .,--------- r- ------ Name: �(..,2P E I-40 c.401,....)Ci 5 Phone: Property ty Owner Address/City/Zip: 11 aI MA52)I SO/`-) S / i E Applicant is: ,� Owner Contractor I1 Description of work: Z ,��uA Gt,c I / h"C� Type of Work NT 's J Q E i Cost: 3, 0 '- `� Construction ..�� .gin �..wh-.�.��.,�,,. t Name: /O (---,„\, �..�,.,��-.�_._u I� ",.� License#: ,�Contractbr Address: Z02 S I l,V - _g ... P it �. . _- State: M NiZip:(-I-1____ Phone: („T-' - I ca - c 3 0 Contact: eiJ,.JN(a)...s Email: .11.04s. 0 /T iNL Call___._„ Name: '''IA(\) EK Registration#: Address: ' \ � Z0 774' J `'a3 o�ity: M k1UN t%N-a(.Ct S Architect/E'ngineer _ ,i-- s p AN I State: r'\!v Zip: 't CY a (I Phone: CP( 2.• g'75^ b 22 S I '`p� Contact Person: �c Email: gwAst.0 e TJ ,IV_ .49 e.m Licensed plumber installing new sewer/water service: Phone#: �..,. _.. —w, .. � � NOTE:Plans and supporting documents that you submit are considered to be public information "Portio the information maybe classified as non-public if yds provide speci ,reasons,that would permit th Ctty to 9 conclude that the are trade secrets. CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit;that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. O Q'ep J Applicant's Printed Name Applicant's Signature Page 1 of 3 -, 1264 */(// 1( r C 5 ( I i C" DO NOT WRITE BELOW THIS LINE /z-1/0/6 SUB TYPES ,Foundation Public Facility _ Exterior Alteration—Apartments Commercial/Industrial Accessory Building _ Exterior Alteration-Commercial Apartments _ Greenhouse/Tent Exterior Alteration-Public Facility Miscellaneous Antennae WORK TYPES New Interior Improvement Siding Demolish Building* Addition Exterior Improvement Reroof _ Demolish Interior Alteration Repair Windows _ Demolish Foundation Replace Water Damage Fire Repair Retaining Wall Salon Owner Change *Demolition of entire building-give PCA handout to applicant DESCRIPTION Valuation 3S00 •a-o Occupancy /N MCES System V Plan Review ✓i Code Edition 2©/S MBG SAC Units 6ikery- (25%_100% +.") Zoning k'' City Water I/ Census Code Stories ' Booster Pump #of Units 0 Square Feet /6'f,5.- PRV #of Buildings I Length Fire Sprinklers Type of Construction 71-'8 Width REQUIRED INSPECTIONS Footings(New Building) ,Final I C.O. Required Footings(Deck) ✓7 Final/No C.O. Required Footings(Addition) Other: Foundation Foundation Before Backfill Pool:_Footings _Air/Gas Tests _Final Drain Tile Siding: Stucco Lath _Stone Lath Brick EFIS Roof:_Decking Insulation Ice&Water Final Retaining Wall V Framing 30 Minutes 1 Hour Erosion Control Fireplace: Rough In _Air Test _Final Concrete Entrance Apron Insulation Meter Size: Sheetrock Electronic Plans Required Windows Final C/O Inspection: Schedule Fire Marshal to be present: Yes �/ No rte' Reviewed By: , Building Inspector Reviewed By: 2,: .. , Planning COMMERCIAL FEES Water Quality Base Fee /63*L( Storm Sewer Trunk Surcharge 2 60 Sewer Trunk Plan Review 7, ft Water Trunk MCES SAC Street Lateral City SAC Street S&W Permit&Surcharge Water Lateral Treatment Plant Other: Treatment Plant(Irrigation) Park Dedication if Trail Dedication TOTAL: /72 .3L Page 2 of 3 'Craig Novaczyk From: Peggy Fleck Sent: Tuesday, November 22, 2016 10:05 AM To: Craig Novaczyk; Michael Grannes Subject: FW: 2075 Cliff Road -Tenant SAC Letter Attachments: 2075 Cliff Road - SAC.pdf;IOT SAC APP.pdf;IOT tenant build out.pdf; a010-site-plan - revised final.pdf FYI From: McCullough, Cory [mailto:Cory.McCullough@ametc.state.mn.us] Sent: Tuesday, November 22, 2016 10:01 AM To: Dale Schoeppner Cc: Amy Griffin; Peggy Fleck Subject: FW: 2075 Cliff Road -Tenant SAC Letter Good morning Dale, We have reviewed the SAC determination application for the above project and location and have concluded a determination will not be required. It is the Councils understanding that the scope of work for this remodel project will not be changing the use or size of chargeable spaces from those spaces determined in the October letter#161026A1 . Therefore, a new determination will not be required nor will SAC be due. Thanks, Cory McCullough SAC Technician I MCES Finance Cory.McCullough@metc.state.mn.us METROPOLITAN P. 651.602.1118 I F. 651.602.1030 COUNCIL 390 North Robert Street I St. Paul, MN 155101 I metrocouncil.orq Please visit our SAC website by clicking: www.metrocouncil.orq/SACprogram From:Cameron Flakne [mailto:Cameron.Flakne@lupedevelopment.com] Sent: Friday, November 18, 2016 11:27 AM To: McCullough, Cory<Cory.McCullough@metc.state.mn.us> Subject: 2075 Cliff Road -Tenant SAC Letter Hello Cory, My name is Cameron Flakne, I am an assistant project manager for Lupe Development. I have been working on a project located at 2075 Cliff Road, Eagan MN 55122. Back in late October,you provided the SAC determination units on the space,which is attached. Currently my tenant is looking to pull his permit for his build out.As you may know,the city of Eagan requires every permit, no matter the relationship,to have a new SAC determination. It is my hope that I would 1 • RAC'ES USE:Letter Reference: 161026A1 Address ID:4915 Payment ID:397241 i/-/67// 47 Date of Determination: 10/26/16 Determination Expiration: 10/26/18 Greetings! Please see the determination below. Project Name: International Office Technologies Project Address: 2075 Cliff Road Suite#/Campus: na City Name: Eagan Applicant: Cameron Flakne, Lupe Holdings Corp Special Notes: na Charge Calculation: Retail: 1709 sq.ft. @ 3000 sq.ft./SAC=0.57 Total Charge: 0.57 Credit Calculation: Retail (10/11) Retail: 1806 sq.ft. @ 3000 sq.ft./SAC=0.60 Total Credit: 0.60 Net SAC: -0.03 —or— 0 SAC Due The business information was provided to MCES by the applicant at this time. It is the City's responsibility to substantiate the business use and size at the time of the final inspection. If there is a change in use or size,a redetermination will need to be made. If you have any questions email me at:tory.mccullough@metc.state.mn.us. Thank you, Cory McCullough SAC Technician Please visit our SAC website by going to: http://www.metrocouncil.org/Wastewater-Water/Funding-Finance/Rates-Charges/Sewer-Availability-Charge.aspx 390 Robert Street North I St. Paul, roN 5510130:3 Phone 651 602 100G Fax 651.602.1550 I C I ,`551.;'91.090 s rnetrccounctl.orcg ..ER O I ;COUNCIL` i Or'"Ir CONSTRUCTION ENGINEERING LABORATORY, INC. TESTING FOR QUALITY AND STRENGTH Mr. Cameron Flakne December 2,2016 Lupe Development Partners LLC 1701 Madison Street NE,Suite 111 Minneapolis,MN 55413 e Pt �/y!T 4 /39' 537 RE: Special Inspection and Construction Materials Testing Report, Eagan Retail Building, 2075 Cliff Road, Eagan,MN, CEL Project Number L-16123 Dear Mr.Flakne: We have completed the required Special Inspections for the remodeling/tenant build-out at the Eagan Retail Building at 2075 Cliff Road in Eagan, MN. Lupe Development retained Construction Engineering Laboratory (CEL)to perform the required Special Inspections and tests in accordance with the Special Structural Testing and inspection Program Summary Schedule. Our services included: field welding observations, field bolting observations and general structural framing observations. Special Inspections were performed on October 28Th, 2016. The following are brief descriptions of completed inspections and tests: 1) Structural steel welded and bolted connections were observed on a periodic basis. Visual observations were performed. The observed connections were determined to be satisfactory. While on-site we observed that concrete for an interior footing (stoop footing) had been placed. Although the Special Structural Testing and Inspection Program Summary Schedule did not specifically require concrete testing, we reviewed the concrete delivery ticket for compliance with project plans. The project plans required that concrete placed for footing attain a 28 compressive strength of 3,000 pounds per square inch(psi)in 28 days. The concrete delivery ticket dated October 28, 2106 showed a product code of 4046 which indicates a 4,000 psi concrete mix. It appears that the concrete delivered and placed at the Eagan Retail Building was in conformance with project plans. I's We were also provided a copy of the concrete delivery ticket for November 1,2016. A review of that document also appeared to indicate that the concrete delivered to the site was in conformance with project plans. Based on the inspections, testing and evaluations performed, it is our professional judgment that, to the best of our knowledge, the inspected work was performed and completed in accordance with the approved plans, specifications, engineer provided modifications and/or applicable workmanship provisions of the International Building Code. Copies of our Field Report and the concrete delivery tickets are attached for convenience. Inspecting Firm: Construction Engineering Laboratory I hereby certify that this plan, specification or report was prepared by me or under my direct supervision and that I am a duly Licensed Professional Engineer under the laws of the State of Minnesota. - * , 5661 International Parkway • Minneapolis, Minnesota 55428 • (763)533-9534 • FAX(763)533-9586 E-mail:paul g(a.cel-inc.com -1- L.. CONSTRUCTION ENGINEERING LABORATORY, INC. TESTING FOR QUALITY AND STRENGTH Paul Gionfriddo P.E. Geotechnical Engineering and Laboratory Department Manager MN License 23093 Attachments; Field Report 10/28/16 Concrete Delivery Tickets Special Inspection Form 1 l 5661 International Parkway• Minneapolis,Minnesota 55428 • (763)533-9534 • FAX(763)533-9586 E-mail:paul q(a�cel-inc.com -2- CONSTRUCTION ENGINEERING LABORATORY, INC. TESTING FOR QUALITY AND STRENGTH Iiiiilii..::.,ilii.::: :.:.:...:.:.:...:.:.:.:.:...:.: ::....................... . .. ::illi:. ,. Project: Eagan Retail Date: October 28,2016 2075 Cliff Road, Eagan Project No: L-1623 4:162/c,&,;, at Report to: Lupe Development Partners, LLC Report No: 1701 Madison Street NE Present at Site: Suite 111 Minneapolis, MN 55413 Attention: Aaron Diederich Roof Framing, West Wall Opening Visual inspection of field welds was completed per AWS D1.1-2010 section 6 and applicable notes, details from VAA, LLC structural drawings. The following items were checked: 1. Channel to column seat angle, fillet welds-satisfactory 2. Clip angle to channel, fillet welds-satisfactory 3. Tech screw to clip angle/CFS stud-satisfactory 4. Clip angle to channel/column, fillet welds-satisfactory 5. Brace angle to channel, fillet welds- satisfactory 6. Brace angle to beam, fillet welds-satisfactory As 8 1 FYI). 1 Copy: 1. Cameron Flakne, Lupe Report By: 2. Dale Schoeppner, City of Eagan Reviewed By: ,,} „,/,‘ 5661 International Parkway-Minneapolis, Minnesota 55428-(763) 533-9534-FAX(763)533-9586 lab@cel-inc.com Special Structural Testing & Inspection Program Summary Schedule Project Name .�E► ,(7 k` Project# Location o07 5CL' FF b- 4-10'74"•'-') Permit# (1) Technical(2) Description 3 Type of O p Spedfic Report Assigned Firm(6) Section Article Inspection(4) Frequency(5) 1705.2 1705.2.1 Field welding SI-S Periodic 1705.2 1705.2.1 Bolting SI-S Periodic General Structural 1705.2 1705.2,1 Framing SHS Periodic • — I Note:This schedule shall be filled out and included in a Special Structural Testing and Inspection Program. (If not otherwise specified, assumed program will be "Guidelines for Special Inspection & Testing" as contained in the State Building Code and as modified by the State adopted IBC. `A complete specification-ready program can be downloaded directly by visiting CASE/MN at www.cecm.orq, 1. Permit number to be provide by the Building Official 2. Referenced to the specific technical scope section in the program 3. Use descriptions per IBC Chapter 17, as adopted by MN State Building Code. 4. Special Inspector-Technical(SIT);Special Inspector-Structural(SIS) 5. Weekly, monthly,per test/inspection, per floor,etc. 6, Name of firm contracted to perform services Acknowledgements (Each appropriate representative shall sign below) OWnti er G�` % �..� Firm L i e. C Date /d ' L b- Contractor Firm L OW C Date /C) Z6 - �„ten' Architect Firm .I '`”"e Date 1 01 Z.c/)i SER Firm VA4 LL C.... Date it-ZS— 20 I V `r v�siEl�CTrcA.) SI-S p - -- Firm7/../F/.c) =2/A./� ")8th'A7 /© o2Cv - c'7 & TA - Firm Date F Firm Date If requested by Engineer/Architect of Record or Building Official,the Individual names of all prospective Special Inspectors and the work they Intend to observe shall be identified as an attachment. Legend SER=Structural Engineer of Record SI-T=Special Inspector-Technical TA=Testing Agency F=Fabricator SI-S=Special Inspector-Structural Accepted for the Building Division By Date BCSD-PR019 4/03 1I 47/, r •i,j PLANTS IN MINNEAPOLIS, ST.PAUL, & RAMSEY 7 0822 � � 2610 Marshall Street N.E., •am CONCREE PRODUCTS INC. Minneapolis, Minnesota 55418• (612) 789-4305 CAUTION: CONCRETE BURNS! • READ THIS WARNING BEFORE USING CONTACT WITH WET((UNHARDENED)CONCRETE,MORTAR,CEMENT,OR CEMENT MIXTURES CAN CAUSE SKIN IRRITATION,SEVERE CHEMICAL BURNS,OR SER10U6 EYE[3tAMAOE. Wept weimproot gloves,a bntr•sioeved stu d,(u11•IeAgih trousers,end proper eye prolecllon when working with those maleduls.11 you have to stand to wet concrete,use Waietproot boots thnt are high enr��t�h io keep aonaroto kohl mowing Into them,Wash wet conorate,mortar cement,.or cement minturen from your Skin Immediately after coated.Indltect contact though ctolhing can be ea seduce as direct contact,eo promp doers cut wet coiWrolo model?, cement,orcementmhrluree from ciotlrl Seek Immediate medical attention If you have ereNtent or eacere diecomiod. In nee of eye contact gush with ptenl of water for al leaett 1 ml nulea. Consult a plrp°ictan Immediately. KMEEP OUTOTHE CEMENT,OR CEMENT OF CHILDREN. MIXTURES.USER AGREES TO CONVEYpTHIS WARNING TO ALL PERSONS WHO MAY PURCHASE,USE OR COME IN CONTACT W MTH WET(UNHARDENED) BY X DRIVER: 1 p DATE: CU TQ'(�y(R(D1 Z,',,, tj �.. uz 4%.,,,,,, a ys I'st mt' � 1x° 6U1t ..,,' s#{ }? T, .� �s. P1 U i'�; }y �,' ,`D'/��� '� •,,,,..,,...- ''}.. l t1Y � . .., t tt'1 d ?�t ,'' . `Kt' � ?':, A "' :R. 7 , -~ "' V.1 DG: ti S 1 t?., - .l (� _,E!M LN `' � �,r irk � ��r.= d n � -_:.�a I x .v.�., , ..� � �-• � r � r,i,.>?1 F!i� �1'1 Cs'. DELIVER TO DIRECTIONS 2075 CLIFF RD 14902 EnGnN TIME DUE TIME BATCHED TIME ARRIVE TIME START FINISH POUR OVERTIME 7 i0 AM 5---0 ( • ! A , c ��pp�'�r 1 O ` �' tti t "`� rF aj 1, �st!..l,tl�i tft�� �,� S�l��IF�1�1 tg .'0',-t.'.a(p�rh z 4I,t)iy}`t ,� i�i� !�`� t.�i.�/ k`�i4 '� " 2 . ` L47 ,,4m 1;t„7., }r4 .rts r t " ins4 -}1 2 1 r 3,- m$ _,,.;11-41t„-;s:z_ e 10 3's:i 3}"u it 074-;Ts iiT:''I�ririf# :�"`" Cr13c01lcat , i",ITelPlL frit lU 011iIcr)+ ail'lir' va ltl qts) x-"r d {,, 6 ' 0 N e . ; o ijl�Y�.�f,l e T.:,:',I'00,;.. : 10-r c ll l' }t',,''' ` l .1'::,i, t,,1 ' i? IrI4II I _ 0444204 .1 4 "'-R_ It ,- '?Fe re ''1:..' , r re fiZ a '.-it',!041'6V. , rte s ,/' f ; ti 'xic, y+' .� _r " rG.. v -- �''1 " 1 £r ,,,.' ' }��Z'(1" IOW i rgllll� i .>�. ' ;.. i ,r ' $ +h,r '• * cxhi.. �r�.2� }Y-::.,.ir iktc vai i''''` _.::-�S}_uc.:v?>.c:.:....y.".....-..�,2"Y _L'`.i;.•._. �l u..o-k. ....._ .:J{,:v_va:r�ca;--1,i:s?:2 2. 00 1. 001 2. 00 CAI..i 0O 1. 00% CALCIUM CHLO R I CY 1. IZlO 1. SIO i. 00 ENV ENVIRON DISPOSAL FEE LI) 1. 00 1. 00 1. 00 FS FUEL SURCHARGE LD c�': 00 1. 00 00 HOT HOT WATER ADDED TO M CY 1. 00 1. 00. 3.. 00 ML MINIMUM LOAD LD GALLONS TO FULL LOAD ;tiro!OXY!rti'Iori EXCESSIVE WATER IS DETRIMENTAL ___a_- GALLONS TO 3/4 LOAD ' 001 d <i•5 Iii,`FE•d v( TO CONCRETE PERFORMANCE. a _ GALLONS TO 1/2 LOAD F(;)1t 41 t F GALLONS TO 1/4 LOAD to.N.01)/4,'- '.%.y.-.5. ., CERTIFICATE OF COMPLIANCE I I WATER ADDED FIT PLANT:_ l S. P. /PO4i: BRIDGE# TOTAL ACTUAL WATER _ Truck DISP TICKET NUM TICKET ID Time Dat e 51 5 209621 10005 6:3B 10/2/,16 LOAD SIZE MIX CODE Seq LOAD I I) 2. 00 CY 404G d - 10617 Ingredient Source MCFac AbsFac OD ABS SSD Free Mst CY TARE TargetActual Free Wet r 3/46V AVFI 49001 Fischer 0.030 M 0.014 1760 lb 1760 281b 1788 3576 lb 3560 56 lb l C. Sand FI 27003 BARTON 0.064 A 0.009 1370 lb 1370 751b 1445 2890 lb 2860 148 lb FIBER BUCKEYE FIBER lb DAVENPORT CONDAIA 564 lb 564 564 1128 lb 1160 r WATER Water Totals 275 lb 275 lb 144 287 lb 274 274 lb BASF P0180 AMPOZZ80 3.00 /C .00 16.92 33.84 az 33.00 CALCIUM UNIVARCC 1.00 % .00 180.48 360,96 az 384.00 BASF MB AE MAIR90 .60 /C .00 3.38 6.77 az 6.00 ctual Nue Batches: 1 Manual 6.38:12 Load Total: 7860 lb Design W/C: 0.488 Water/Ceeent: 0.413 A Design Water: 550.0 lb Total Water: 478.51b In Add: 8.56781 Sluep: 4.00 in Water in Truck: 0,0 lb Adjust Water: 0.0 lb / Load Tris Water: -15.0 lb / CY 1 LATER ADDED ON JOB AT CUSTOMER'S REQUEST. CUSTOMER ASSUMES FULL RESPONSIBLITY FOR ANY DAMAGES DONE TO/OR BY OUR TRUCK INCLUDING TOWING,WHEN ORDERED OFF PUBLIC,ROADWAY. UTHORIZED BY: Received By:__�� By signing I agree to terms on back. i atithai PLANTS IN MINNEAPOLIS, ST.PAUL, & RAMSEY 6 6 9 91 I i 2610 Marshall Street N.E.,II 1 ■No CONCRETE PROP(IC?S INT.. Minneapolis, Minnesota 55418. 612 789-4305 M n ((J CAUTION: CONCRETE BURNS! • READ THIS WARNING BEFORE USING gCONTACT go eaAa T WITH gI oteeved hint,NARength tr)uco eCe td prop r MORTAR, ye protec ion when waarPinp withMIXTURE? I eta mn o l(elaN II ya u have io enphd InTwet crete tier alorrpr000gbuoRole meat w e h of h enouppgh to kkeeptconoroto 1 m flow ul hno them.Week wet concrete,mortar,cement,or cement notice tram your skin Immadlatelyd agar contact, Indirect oonteut thiouph dashing cobs as Woo as direct contact,eo N(Asia out wot conamte,mortar, content,oryycement mixtures from doting. Book Immediate medical attention It you have cdeiatoM or aovore discomfort. In aaeo ai eve conlaol flush with Plena of water lot at Ieaa 144 minuloe, Consult o pph elGon Immediately. KEEPEour GEMENT REACH OF CHILDREN. I DI1EN. USER AGREES T t CONVEY THIS WARNING TO Au PEIISONS WHO MAY PUkCHASE,USE OR COME iN CONT CT W*TH WET(UNHAtiDENEP) ay K DRIVER; t•.. ;.t.-.,'4,:.,*, DATE ri, )H NMB ER5,:'•. . is 1PUT0lRPXE 5 r s 8 . Y .'YWO ,. UMYf' tV, � i . 4 /7 � ,- '..,---t, . jr. +"1P+ X,440N, f m : " ar •_ r r 1, ' FiMx3T+`to!:: 1-$5 "4I ° '; Jitsil 1. ,:. • s'e f ' . DELIVER TO DIRECTIONS 2075 CLIFF RD 149132 EAGAN 1',,> P FINISH POR OVERTIME TIME DUE TIME BATCHED TIME ARftiV y,� '"' TIME S/. O T � y 1 .O@PM f kt4 vi , .at r ; x: y 1I /4n 'Cr.-!-.11-144441‘i b1yt. c9 , v1A V;e-,N4,,..;-ii.': 51 /G ,.ter r.Y is R4 ,11� tJI � a f v • < �fi:: 1 1' L.-. i"fr .fi•s •ro r-.,•-_-::::-,-, ..-,,,;.0•d.7�-�°Y��t''S :: � �'`� � t4 L�zYy � .. i, � , .��,, n y: L--1.'":„.,-re,.-,,-:q6�.K ..?�g7�; ,13;,,,,,),•-•14 --- . -:' ','-'''r-- 1 .1 ..y - - -, `"'i .x.'''tk iO4rt) .IJ ,Iw+[,rk1 S ih �g„.rA?34•` .1t-Phi i ilx =}%P_ s '4- P.rc 1 N„'Y..,i,:.,.. ' Es. ,!''i J, ZM �P ��9� ,04;,,,,}, , S` I'r'•-,.:,:y_.: ^' F OJ }Y' .F M...= ( f/}Ibt r. V1'; • y1 A ., 8 6 ',al . � '' 1 i ll Io 5 ccvb1 t t- ioi p�I It 1T IU tF 5 . 1,..: { 9..H b {Uikiff 1.1;:,-0,e014:'; r , ,S`• x � `,•4,,c,-;,.4. � %,', om !}r,,-,- °?rj • £d 7 1 1? Y 3-��,;=• I r) • t -�: �' } F.� r .�+iikY itiiM4;%r - ilf4. -0,4 .• 6Y,--A Lif,Ls:1,ir��;nA ;/.rg hent. L._i xr::..•1:114/t,:u thiJi LL011,1.-,43,_2. ,,ki_ iiixte ,,.:_ •ad,_,,Y,:u .,7xt,...,..5 1. 00 1. 00 1. 00 AIRS 6% AIR ENTRAINMENT Y '" 1. 00 1. 00 1. 00 CAL 100 1. 00% CALCIUM CHLORI ..Y 1.00 1. 00 1. 00 ENV ENVIRON D I St='OSAL. FEE D 1. 0s0 1. 00 1. 00 FS FUEL SURCHARGE D 1. 00 1. 00 1.00 HOT HOT WATER ADDED TO M Y i.:00 1. 00 1. 00 ML MINIMUM LOAD D ,i, 01 ----6 ---- GALLONS 70 FULL LOAD t, ' v V:,_ :, EXCESSIVE WATER IS DETRIMENTAL GALLONSTO3/4 LOAD ��(cjitt e,y#1*P1 IC► TO CONCRETE PERFORMANCE. GALLONS TO 1/2 LOAD MO:. r GALLONS TO 1/4 LOAD r}r rrc r(f 'nI 4�4t1E to-.J v CERTIFICATE OF COMPLIANCE WATER `ADDED AT PLANT: /0 S.P. /PO# BRIDGE#: TOTAL ACTUAL WATER Truck Driver Driver User Disp Ticket Num . Ticket ID Time Date 522 0016 user 41556 - 2499 12:05 11/1/16 Load Size Mix Code Returned 6lty - ' I+1ix Age Beg Load ID 1.00 CV 4046 r D 2712 Ingredient Source MCFac AbsFac OD ABS SSD. :: -. Free Mst. CY TARS Target Actual Free Wat 3/4GV AVF1 19130 Fischer 0.040 M 0.014 1730 lb 24 1754 45 lb 1799 1799 lb 1780 45 1 SAND 82004 AI 0.047 A 0.1/'4 350 lb 1 351 15 Ib 366 366 Ib 360 i5 lb BASF VMA 5M14AT358 2.00 /G00 11°.28 11.28 az 10.00 HOT SAND 82004 Al 0.030.14 0.010 1000 lb 10 1010 0 lb 1030 1030 lb 1040 20 lb DAVENPORT CONDAIA • 564 lb 564 564 97.8 lb 100.1 100.1 lb WATER Water Totals 275.0 lb 275.0 lb 97. BASFPOZZ80 AMPOZZ80 i'':t 3.00 /C .00 16.92 16.92 oz 18.00 CALCIUM UNIVARCC 1.00 % .00 180.48 180.48 oz 176.00 BASF MB AE .MAIR90 .62 /C , •.00 • 1 50 3.50 az 4.00 FIBER Bt KEYE FIBER .00 .00 .00 lb .00 Actual NAI-Batches: 1 OD Manual 12:05:29 Load Total: 3848 lb Design WIC: 0.488 Water/Ceeent: 0.324 A Design Water: 275.0 lb Total Water: 180.0 lb Ta Add: 11.4 gl Slump: 4.00 in Water in Truck: 0.0 gal Adjust Water: 0.0 gal / Load Trill Water: -10.0 gall CY NATER ADDED ON JOB AT CUSTOMER'S REQUEST. CUSTOMER ASSUMES FULL RESPONSI8LITY FOR ANY DAMAGES DONE TO/OR BY OUR TRUCK INCLUDING TOWING,WHEN ORDERED OFF PUBLIC,ROADWAY. AUTHORIZED BY: _,,. Received By: ------- By signing I agree to terms on back.