624 Hackmore Dr
Use BLUE or BLACK Ink
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
For Office Use 1
j
I Permit q4,577
C
ity of Ea~d
~I Permit Fee: 0y 1
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff: I
2010 RESIDENTIAL BUILDING PERMIT APPLICATION
Date; ZZ e d j,b Site Address• 4 l' d^z~ (cJ~;
Tenant: I Suite
RESIDENT / OWNER 3" d(n
Name: Phone:
Address/ City/ Zip: Iv Z 7 ~C ~!a✓~ 1 G
Applicant is: tef' ~ ner Contractor
TYPE OF WORK
Description of work: {O C
Construction Cost: 1 V Multi-Family Building: (Yes / No )
CONTRACTOR Name: l L S f r 20, ( rn License 3 y
Address: City:
State: Zip: ~5 ~i Phone:
Contact: Email:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
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.aopherstateonecall.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 a" Cc,-- t
Applicant's Printed Name cant's Signature
Page 1 of 2
0 CASH RECEIPT ?
CITY OF EAGAN ?
,
3830 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE 19
. r
Fi1p1 1 ? /
, AMOUNT
DOILARS
?ro
? CASH VCHECK
FM
„
BY
C 11994 ?t?s? ?
Yek---po""l Copy
Pink-Fda Copli
Thank You _
CITY OF EAGAN
_ 3830 Pilot Knob Raad, P.O. Box 21-199, Eagan, MN 55121
PHONE:454-8100
BUILDING PERMIT Receipt #
To be used for sF ?/CAR Est. value $108'000 Date p?$ s , 19 $1
Site Addle ss
Lot Biock
Parcel No.
Name RU0111Ans az "arawMawK
? Address _
City LAKEVILLE Phone
o Name 8ANZ
0? Address
City Phone
OFFICE USE ONLY ?
?
R- 3M-1
k Occupancy FEES
?•. ,? ' Zorting 66$.00 ?
(Actual) Const
(Albwable) .?.N
- Bidg. Permit
54•00
* 01 Swries ? Surcharge
P
R 634.00 ?
Le?+n
-?? lan
eviaw
100.00
Depth
-
SAC, City ?
S.F. Tolal - 6 ?I.OQ
SAC, MCWCC ?
S.F. Footprints - 660.00
On Site Sewage _ Water Conn
???
0n Site Well ? Water Meter
MWCC System
?
ao??. oePosa 30.00
city water -x- 30.D0
PRV Requued _ S/W Permit ? j
?
Booster Pump - S/W Surcharge
276.00
Treatment PI
APPROVALS Rpad Unit 370.?
Planner - Park Ded. ?
Council
BIdg.Off. _ Copies
Variance
-
TOTAL s
1-t4
... 18691
I t I ?y
WW Name
Address
< W Ciiy Phone
I hereby acknowlege that I Fyav# read! this application and state that the
information is correct and to o?mply with all a icable State of
Minnesota Statutes and City??9gan Ordi: ces; 1?
/
Signature of Permitee ? '• ?•?
r,usrohs aY r.RZvt.nreir,ic
on
and1
all
Building
+• Permit No. Permit Holder Date Talephone #
war?R ' A. ? ? 9/
Y
SE1fVER
PLUMBING
H.V.A.C.
ELECTRIC ?J83 4?"j 11
Inspsetion Date qtsp. Commwnts
Footings I 'i?6 L¢!
Foundation
Framing
Roofirg
R-0 Pbs. j::
Fiai9h Ht9• ?
Isul.
Fireplace
Final Ht9- r ?
Final Pibg.
Const. Meler Plbg. Inspector - Notify Plumber
Engr./Plan
eby. Final ' Z
Deck Ftg.
Dedc Final
Pr. asp.
.?? '
" ?.
iL
?
DATE: FE$ 7, 1992
624 HAClQNQRE DR (KUSTQ!!S BY KRZYZANIAK)
X Your Sewer & Water Permit for the above property has been completed. It will be held at the
Public Works Garage (3501 Coachman Road) until the meter is picked up. BE SURE TO
CALL PUBLIC WORKS (454-5220) FOR YOUR PERMANEMT WATER TURN ON.
Your Sewer & Water Permit for the above property cannot be completed for the following
reasons:
Your Sewer & Water Permit for the above property has been completed, but the meter cannot
be issued or occupancy allowed until further notice.
COMMERCIAL PROJEC7S ONLY: Please pay for meter at City Hall. Meter size must be
confirmed by Bill Adams or Dirk House (Plumbing Inspectors - 454-8100) before issuance.
WARNING: BEFORE DIGGING, CALL LOGAL UTILITIES - TELEPHONE, ELECTRIC, GAS, ETC.
- REQUIRED BY LAW.
CONTACT COMMUNITY DEVELOPMENT DEPARTMENT FOR WATER TURN ON POLICY.
Secretary, Building Inspections Dept.
, ?.
«.°.?;-??, ? ?t
s• . . •
Trrti#iraft of (Orx??aury
Citp of (tagan
lltprtmnd a# %i[,d'atg 3mvertiatc
71ris Certificate issued pursuant to lhe requiremenls of SecAion 306 ojthe Uraform Building
Code cerrilyt+i8 tlra[ a1 the time ojissuanc+e tlrisslrrtcum wrrs in compl "tautce wilh the Harious
ordinanaes of 1he City regulating building consmdion or use For (he following.
lJ.seQaffmtioa Sn "1n M BidE. Permit Na M9.I
°oar-7 Tyae Zoui+a aw;a R?l rya camr AIN
TWTIM 85
Locari L`+
AuZ ZbN R=
,
r
r nmc 5,424.491
? 11l
POST IN A CONSPICUOUS PLACE
ITY 0F EAGAN METER # PERMIT DATE 02107141
830 ?ilotKnob Rd.
agai7, MN 55122-1897 CHIP # PERMIT # ?i??
METER SIZE B.P. RECEIPT # C 11996
' ISSUE DATE B.P. RECEIPT DATE 92 /05 191
1991
ATE FED S.
-L- PRV - BOOSTER PUMP
ITE ADDRESS 626 HACKl4DRE DR PERMIT REOUESTED
DT S BLOCK S SEC/SUB AUTUMN RIDCE
x SEWER X WATER _ TAPS
PPLICANT:
DDRESS: - COMM/IND X RESIDENTIAL
IN, STATE ZIP -X-- NEW - EXISTING
HONE:
S Lawn Sprinkler, ters are to be Installed
1lAIN LIIiE lLIJlMIIiG
LUMBER: Ahead of Domos c Meters on Water Line.
DDRESS: 14169 BHORL Lli iIE CrediX WIL N07 t?e given for D uct Meters.
ITY, STATE PRIOR I.AIfE !?1 ZIP 55372 l`+Ij 1
HONE: 496"3348
I Ai&FiEE O COMPLY CI OF
WNER: KUSTOKS $Y MAK AUR EAGAN ORdINANCES
DDRESS: 11736 177TH
ITY, STATE LA3CLVI LLE biN ZIp 5 5n44
HONE: 892-1 S33 SIGNATURE WHEN METER ISSUED
'LEASE ALLOW TWO WORKING DAYS Fa R PROCESSING. CALL 454-5220 FOR INSPECTIONS. FOR STORM
EWER PERMITS, CONTACT ENGINEERING DEPT. ,
SEWER b WATER PERMIT
CITY OF EA.GAN
3830 Pilot Knob Rd.
? t -Eagan, MN 55122-1897
?
?DATE FEB S, 1991 _
t
:i:.-, . . .. .
? - OFFICE USE ONLY
METER #y.?Y--?a S PERMIT DATE OZ /O7 f 91
CHIP # 4113 3 1` !. -7 - PERMIT # 11802
METER SIZE ?? B.P. RECEIPT # C 11994
ISSUE DATE B,P. RECEIPT DATE 02 05 91
-1- PRV - BOOSTER PUMP
SITE ADDRESS 624 RA(,i<1!0!21, P.R
LOT 5 BLOCK 5 SECISUB AUTUMN RID('F
APPLICANT:.
ADDRESS:_
CITY, STATE
PHONE: -
ZIP
PERMIT REQUESTED
x SEWER X WATER - TAPS
_ COMM/IND XL RESIDENTIAL
X NEW
EXISTING
Lawn Sprinkle t ers are to be Installed
e
PLUMBER: 'MAIN LINE PLIIliBING Ahead of c Meters on Water Line. i
Domj
ADDRESS: 14169 SROBE I.N NE Crldi WI NQr ? pe given for D uct Meters. ?
CITY, STATE PRIOR I.AKE MN ZlP 55372
1 ?
496-3348 j
PHONE:
! 1 AG EE t0 CO PLY W C OF
I OWNER: KUSTONIS BY MUYZANjA$ EAGAN ORDI NCES
ADDRESS: 11736 177TH
i
1
AKFVIt 1 h MH ZIP
44
55t`
CITY, STATE
, . ,
? PHONE:
P.92._1 ;17.
IG ATURE WHEN METER ISSUED '
PLEASE ALLO W TWO WORKING DAYS FOR PROC ESSING. CAtL 454-5220 FOR INSPECTIONS. FOR STORM
SEWER PERMI TS, CONTACT ENGINEERING DEPT.
- -- - - 'a
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
" PHONE:454-8100 C
BUILDING PERMIT Receipt #
7obeusedfor SF DWG/GAR Est.Value $108,000 Date FE.
Site Address 624 HACKMORE DR
Lot 5 Block 5 Sec/Sub. AUTUMN RIDGE
Parcel No.
IName KUSTOMS BY KRZYZANIAK
o Address 11736 177TH
City LAKEVILLE Phone _ 892-1533
o Name _
H. Address
? Citv
Name _
Address
City -
Phane
Phone
I hereby acknowlege that #a, rea tmh application and state Ihatthe
informahon is correct and to o y with licable State ot
Minnesota Slatutes aa Ord ances.
SiqnaWre of PermRee
A Bmlding Permit is issued ta: KUSTOMS BY KRZYZANIAK
on lhe express condttion that all work shall be done in accordance with all
apphcable State oi Minnesola StaWtes and Crty of Eagan Ordmances.
8uilding ORicial
N2 18641
i 1 Cl
Is_91-
OFFICE USE ONLV
Occupancy R-31`L-1 FEES
Zonmg R-1
(nctua0 Const y-N Bldq Permit 668.00
(Allowa6le) -Y? Surcharge $4.00
8 olstones -
52
'
Pian Rewew
0
434.0
Langtn -
-
Oepth 421 SAC, City 100.0?
S.F. Tolal - SAC, MCWCC 650.00
S F. Foolprints -
On Srte Sewage _ water Conn 660-0
I1
On Site Well - Waier Meler 9l1 _ nn
MWCCSystem X
00
30
Ciry Water x ?t, Deposn .
PRV Ra9wred x SIW Permtl 30.00
Booster Pump - SIW Surcharge • 50
Treatment PI 776- nn
APPROVALS Road UnR 't 7n _ nn
Planner - park Oad.
Couricd
Bldg Off. _ CaPies
Variance - TOTAL j+362.5n'
3/?/v
a 57859
REQUE%T FOR ELECTRICAL INSPECTION
li? See insvudions for completing Ihis form on back oi yellow mpy
"X" Below Work Covered by This Request
EB-00001-08
3,60 5
e Add" Rep. " TypeoiBuddmg AppliancesWirad EquipmeniWired
Home Ranqe Temporary Service
Duplex Water Heater Elechic Heating
Apt. Building Dryer Other (Speaty)
Comm /Intlustrial Furnace
Farm Air Conditioner
Omer (speciry) ConVaclor5 Remarks.
Compute Inspection Fee 8elow:
k Other Fee # ServiceEntranceSize Fee # Circwts/Feetlers Fee
Swimming Pool 0 to 200 Amps 0 to 100 Amps ?
Transformers Above 200 _ Amps A Amps
Signs Inspectors use OnN G? TAL
Irrigaaon Booms ?
Special Inspection
Alarm/Communication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 M HS.
I, the Electrical Inspector, hereby Rouqn-?? oace?
Certi fhat the above ins eCtion has
? P
been made.
Final
Oale ? p
r
OFFICE USE ONLY
This request voitl 18 monihs lrom
3 6/4/ t .? /OfJ3?v5
a 7?59 `e?a°°
Request ?D?@
?/
?? Fire No Rough,in Inepedwn
ReQUiretl?
? Re9tly Now?ill NoLiy Inepector
When Fe9tl
'
? ?es ? No y
I licensed coniractor O owner hereby request inspection of above electrical work at:
Job Atltlr (Street, ox or Roule o)
l(J L1
i Qly
$ecLOn No Townshi0 Name or No Range No Cou ?
Occupan?(P Phone No
Power S er r s ?
ElecVicai niractor COmpany Name) ? ConVattorS ense No.
MaiLng Adtlress (C nVacNr or Owner Maki g Installalion)
Nuthonzetl ature (ConVactorrOwner aking Install Von) Phone Number /
? ?O -?.!/3
MINNESOTA STATE J?ARD OF ELECTPICITV THIS INSPECTION REOUEST WILL NOT
Grl89s-MlOway Bitlg. - Poom 5173 BE ACCEPTED BY THE STATE BOARD
1821 Unrvenlty Ave., S[. Paul, MN 55106 UNLE55 PRDPER INSPECTION FEE IS
Phone (612) 664-0800 ENCLOSEO.
/J //. /6 /
`7`(834 -
?? 5
Request Date rre No Rough-in InspeMion
'
Re
? Reatly Nav ?II Notify InspeMr
When Reetl
'
?
G N. y
i,P1 Kicensed contractor ? owner hereby request inspeciion of above electrical work at:
JoE Atldre ( treet. Box or Route No ) ,jj L(tLp ?Y/N Q6? C
,V
a 2?mv-?- ?
Seclron No Township Name or No Ranqe No
Occu nt PFINTl, Phone No
.2 , " /-? le
Powar Supo??er Adoress
Elecv I Convacmr (Company Name? Comractor ense No
MaiLng Address tGomraaor or Owner Making Installauon)
7 , ? /3
Authoraetl Si ature (ConVactor/Owner Making Ins?ella n) Phone Number
S? ??-?31
MINNESOTN STAT OAqUOF ELECTPICITY
GrIB9s-Mitlway BIGg. - Poom ^s173
1821 Unlvenlty Ave., 51. Peul. MN 55109
Pfwna(612)802-0800
THIS INSPECTION FEQUEST WILL NOT
BE ACGEPTED 8Y THE STATE BOARD
UNLE55 PFOPER INSPECTION FEE IS
ENCLOSED
_?3 /??? REQUEST FOR ELECTRICAL INSPECTION
??
0. $ee ippir?„?tions Ik wm0leting Ihis form on back oi yellow copy
rMi 5 7_8 34 `X" Be/ow Work Covered by This Request
'?-
?
ew Add Rep. Typeof6mlding AppliancesWired EquipmeniWired
Home Range Temporary Service
Duplex Water Heater Electric Heallng
Apt. Buildmg Dryer Other (Specity)
Comm./Industrial ' FUrnace
Farm Air Conditioner
OMer (spenfy) Convactor5 Femarks
Compute Inspection Fee Below
# Other Fee # ServiceEniranceSize Fee # Cvcuits/Feeders Fee
Swimming Pool 0 to 200 Amps ? 0 to 700 Amps
Transtormers Above 200 _ Amps Above 100 _ Amps
SIgOS Inspecior5 Use Onty x/ OTAL j?
Irrigation Booms
Special Inspection
AiarmlCommunication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IP NOT
Other Fee COMPLETED WITHIN 18 MONTHS.
I, the Electrical Inspector, hereby Ro°9n-'" oata
cerhfy that the above inspection has
been made. F,nai
-42 oace
-5 y?
OFFICE IISE ONLY
This request voitl 18 months irom
AdCress: 624 HAaQYIPE DRIVE Lot 5 Blk 5 Sec/Sub ?M RIDGE
These items ware/were not completa at the time of the final inspection.
Yes No
Final grade (6" £rom siding)
Permanent steps - garage
Permanent steps - main entry
Permanent driveway i/
Permanent gas
Sod/seeded gYass
Trail/curb damage Il
Porch ?
Basement finish
?eck
Please verify vith tha buildar the removal of roof test caps from tha plwnbing
system and the shut-off of water supply to the outside lawn faucet before
freeze potential exists. m
?FCRIFOMRR
White - City copy Yellow - Resident copy Pink - Contractor copy
CITY OF EAGAN
3830 PIIAT RNOB ROAD
EAGAN, MN 55122
PHONE: (612) 454-8100
,>+,egqwfiP}X:;,i p
DWELLINGS &
"SgE#jW PLEASE COMPLETE IIPPER PORTION ONLY FOR SINGLE FAMILY
TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
-----°-----°---------- ------°----------------------------------'
WORK DESCRIPTION FEES
NEW CONST ?-
ADD ON _
REPAIR _
OWNER NAME: ?G95`(?a,-? S ?L? /?? L?fL??
SITE ADDRESS:
IAT: Jr BIACK ? SUBD. r fJ
INSTALLER: Y7+?" ?5 ?'Gr+1 f 2L,
ADDRES S:
CITY: ZIP:
PHONE SD
ADD-ON MINIMUM $15.00
HVAC 0-100 M BTU-_LTi.-0
AD TIONAL 50 M BTU 6.00
? GAS OUTLETS - M
OF 1 PER PERMIT
FOR CITY USE ONLY
PERMIT #
RECEIPT # 9 O
nnTE: a r /
00
SUBTOTAL: $ ?;>
STATE SURCHARGE: .50
TOTaL:
?%?--
SIGNATURE"OF PERMITTEE
C4MMtRCYA?:fTNDUSTiLTA?.}' PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS,
::.... ... . .:..... ..... .....:... ..:. ...
APARTMENT BUILDINGS, AND MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE
NOT REQUIRED FOR EACH DWELLING UNIT.
-------------
CONTRACT PRICE:
OWNER NAME:
SITE ADDRESS:
IAT: BLOCK _ SUBD.
INSTALLER:
ADDRESS:
CITY: ZIP:
PHONE #:
FOR:
FEES
18 OF CONTRACT FEE.
STATE SURCHARGE - $.50 FOR
EACH $1,000 OF PERMIT FEE.
PROGESSEL rIrlr]G = $25.00
$25.00 MINIMUM FEE.
CONTRACT PRICE x 18 $
STATE SURCHARGE $
TOTAL: $
(SIGNATURE)
CITY OF EAGAN
CITY OF EAGAN
3830 PILOT KNDB ROAD
EAGAN, MN 55122
PHONE: (612) 454-8100
Tm'
FOR CITY USE ONLY
PERMIT #
RECEIPT # O Oo7
DATE: oZe2i;'/
PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS &
TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH iTNIT.
WORK DESCRIPTION
NEW CONST )</-
ADD ON _
REPAIR _
OWNER NAME: kUs4r"S -?E?)LI?.a
SITE ADDRESS: LPa`t N?dC ICXY?C?r"??GZ-?\/t',
LOT:? BIACK ? SUBD. ?.o
INSTALLER?l?! ) c?p ?
annxESS:15C`?j
CITY: ZIP:
PHONE #:
SIGNATURE OF PERMITTEE
COMPLETE THE FOLLOWING:
N0. FIXTURES EA. TOTAL
? ADD-ON MINIMUM 15.00
SHOWER 3.00 ,O
WATER CIASET 3.00 , U
BATH TUB 3.00 oC)
LAVATORY 3.00 / ,D O
KITCHEN SINK 3.00 Ob
I IAUNDRY TRAY 3.00 00
? HOT TUB/SPA 3.00
WATER HEATER 3.00 5,np
_ FLOOR DRAIN 3.00 ?aD
GAS PIPING OUT.
a (MINIMUM - 1) 3.00
3 ROUGH OPENINGS 1.50
_ OTHER
WATER SOFTENER 5.00
_ PRIVATE DISP. 15.00
U.G. SPRINKLER 3.00
SUBTOTAL S U (a .
ST. SURCHARGE .50
TOTAL: S 4/, m
COMMEkCIA_'IE1D?{STRIAL': PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS AND
. _ ? - . -. . ? .. _. ., . ... . ,...
MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH
DWELLING UNIT.
______ __--°--°--°----------°--_-____--°____._----°°-°_____-°-----_-_____
CONTRACT PRICE:
OWNER NAME:
SITE ADDRESS:
LOT: BLOCK _ SUBD.
INSTALLER:
ADDRESS:
CITY: ZIP:
PHONE #:
FOR:
CITY OF EAGAN
FEES
18 OF CONTRACT FEE.
S'1ATE Su7i(:HAttGE _ $.50 FOR
EAGH $1,000 OF PERMIT FEE.
$25.00 MINIM[IM FEE.
CONTRACT PRICE x 18 $
STATE SURCHARGE
TOTAL:
(SIGNATURE)
? ..
668•00+
54•00}
434•00+
2)205•50+
3)362•50*
. 668•00+
54•OOF
434•OO+
21206•50+
3Y362•5U*
. . It Ioq I
1991 BIIILDING PERHIT APPLICATION
CITY OF EAGAN
SINGLE FAMILY DWELLINGS
2 SETS OF PLANS
3 REGISTERED SITE SURVEYS
1 SET OF ENERGY CALCULATIONS
liULTIPLE DWELLINGS
lk
CO?IIiERCIAL
2 SETS OF PIANS 2 SETS OF ARCHITECTURAL
REGISTERED SITE SURVEYS - & STRUCTURAL PLANS
(CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFICATIONS
1 SET OF ENERGY CALCULATIONS 1 SET OF ENERGY CALCS
_# OF RENTAL UNITS
_# OF FOR SALE UNITS
PENALTY APPLIES WEiEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY IAST WORKING DAY
OF MONTH IN WHICH REQUEST IS MADE.
IAT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED.
NOTE: ADDRESSES FOR CORNER IATS - CONTRACTOR/HOMEOWNER M[JST DESIGNATE WHICH ADDRESS IS
DESIRED. NO CHANGES WILL BE ALIAWED ONCE BUILDING PERMIT IS ISSUED.
PROCESSING TIME FOR SEWER 6 WATER PERMITS IS TWO DAYS ONCE A
PERMIT MUST SHOW A LI?CENSED PLUMBER.
To Be Used For: Valuation: at,
Site Address ??Q,t? rylb-fi,_ ,o.7,0OV OFFICE US:
r
Lot tr siock J
Parcel/Sub AutT
Owner 1_NWA?
Address
City/Zip Code
Phone ?
Ps+oh%s g
Contractor
Address A-L-L
City/Zip Code
Phone - l
Arch./Engr. I
Address ]
yo?;dk „ ,1
City/Zip Code
0
Phone # ?-1 I 3 ? . 7
occupancy 1?=3 M-I
Zoning 9-1
Actual Const Y- N
Allowable V-h!
# of stdries
Length S2'
Depth
S.F. Total
Footprint S.F.
On site sewage _
On site well
MWCC System ?
City water ?
PRV l?
Booster Pump _
APPROVALS
Planner _
Council
Bldg. Off. ?-?e-9/
Variance
FEB 4 1991
.FEES
Bldg. Permit 668,00
Surcharge S!?, o0
Plan Review Jv
SAC, City OO+Oa
SAC, MWCC (0675'00
Water Conn. O,OD
Water Meter D,O ?
Acct. Deposit 30,0 0
S/w Permit 30ZO
S/W Surcharge .SJ
Treatment P1. (.,cJo
Road Unit 0,00
Park Ded.
Trail Ded.
Copies
SIIBTOTAL
Penalty
Lot Change
TOTAL 3 9? agrees that all work shall be done in accordance with
of
all applicable State of Minnesota Statutes and City of Eagan Ordinances.
V Y`-1 L u AI /
?fAr?q Gl=.
2?xZ2=5?2 X15=$SSo
3E>MT-
3k?=
?I X I =
?X ?Z =
3'?2 x 3'?Z =
( IS)
53 ?.aar 3 6 ?
ZI
9 !?
IZ
14= 11
I S t ?-,-onn-
asm i = ?s 3y . ? 2xZ2 = u`i- - -
? X51= L1?111?
Z n? 1) F??orZ
?
1s5 WrT -
?xy -
Z X'? _
Z x9 =
$ 3 ?(
ry
---y
19 30 XSI= y?3?o
0 12 IOFS, 0 0
i
?a..?._ _._.....A.?.,.«.,.a,?y?q:,?,?•qm._?Lle_.__.V...Ytk./aCYiN'VK..n_.n. ...nvSMV a . ...,
!
! EXTER.IOR ENVELOPE AVERAGE "U" COMPU7A710N
0'aNE R:
$ITE ADDRESS:
CONTfiACTOR: DATE: j r PHONE:
DETERMINE NORKINC, SOUARE FOOTAGE OF EACH:
1. TOTAL EXPOSED NALL AREA 36
? "
"
,,,,... 2 sq ft x
U .11 = 3q?.$6
4. 70TAL ROOF/CEILING AREA . "
"
...... . SQ ft x
U .026 =
3. TDTAL EXPOSED WALL ARE.A CALCULATfONS:
Total exposed wail
area above floor
••••••• 3 ?$g
f
•
- sq L
a) Total wall window area: ?
qlazed..... _;0$ sq ft x "U"
3
.
. /oy.7z
-- glazed '- +-
...... eQ ft x ?lull
b} Total door area ......... sq ft x "U"
c) Total sliding gTass door area:
9lazed...... sq ft x 'lliil 3I
9lazed...... sq ft x „U"
d) Total fireplace wal) area - sq ft x "U" ?
? "?-
e) Total wall framing area
(Ave raae 109.)......... Z$jj sq ft x "U" ?
qy
Z7.
f) Tocal net wall area above
floor (InsulaLed) "
"
....... sq ft x
U
.oyti = /i3,12
9) Total rim joist area. ..... ??(µ sq ft x"U" _ ?ayZ
Total foundation
area (Exposed)..... ..... 4/ sq ft
h) Total foundation
reTndow area........ ..... - N- sq ft x"U"
_-
i) Tata) net foundation
area above grade... ..... sq ft x"U"
TQTAL a) [hru 1)
If item ?3 fs the same as, or less than Item 01, you have met the intent of
2 MCAR 1.16008 A and 0.
Page 1
? .
4. TOTA! E%POSED ROOF/LEILING CALCULATIOt75:
Total exposed
sq
ft
roof/ceiling area,.......
Sq ft x
J) Total skyllaht area......
k) Total roof/cetlinq framing
l Sq ft x "U" ' Oz g ° Y, IZ
area (Averaae 1?9)•••••• -
1) Total net lnsulated /yz7 s ft x "U" ,vL4_° 3y,Z?
roof/ceiling area....... ?- q
TOTAL j) thru 1) 3$,67
or less
,
than N2
you
have
met
the tntent of
If total of °4 is the same as,
2 MCA.2 1.16008 A and 0.
ALTERt1ATE BUILDING ENVELOPE DESIGPJ
To utilize the total envelope system method, the value5 established by Lhe sum
of items f3 and #4 shall not be greater than the sum of items #l and 02.
o• 07
?' 2.
98?•g6
?.
3
. 3S/.y7
3• ..
3 ?t .g0 + 4. 39' 47 `
, L E R T I F I C A T I 0 N
"R"
1 here6y certify that 1 have calculated the "U'1 factors an
values herein and that the buildinq here described meets or exce ds the State
of Minnesota Energy tonservation Act.
.
ure
V O
/Jo--Hjp<
Print name
= r>
(Oate) page 2
r-
?
?
? ?v .; a
R VALUE
0.
, L
+ /U. 16
U s I/R - ?O II
a
?;Qa a
? •;??. .
U a 1/R = ovs
HSTRUCTtON
WALL AMING SECTIDN:
Interlor air fllm
1/1 V, q
'L 1ncRes.sof
' L 5tS
I-?f d
xterior air
r?
14ALL SECTION (INSULATED)
--(1 Interlor air film
-{2 1/z
--? 3 ^
-?4 ' z Sl,r
-?5 ?Idl.?
-?F+ Exterior air film
RIM JOIST SECTION:
?
--(1 InterTor air f11m 0.68
--?2 -, 1 15, 00
--(3 cj?? t.?S
-?{4 %L Sl.-r, i. iZ
---{5 fld 6.J° 1.67
-?fi Exterior ait fi?m 0.17
TOTAL R - ;U. u
?
A'G ?e
e,-
.? • :
.?j • " ,e.
•' •A v
d •a_ .•.
'•d-
.' Q • ?'- "-
a?
FOUNDATION INSULATIOPI REQUIRED: '
Min. R-5 on entire wall OR U= 1/R =,04 z
Min. R-10 down to frost depth
FOUNDATION SECTION:
--{1 Interior air film 0.68
?Z Oe.M .S. VC)
----f 3 28'
-{4 Exterior air film 0.17
(5
(F
TOTAL R = 7. /3
U = 1/R = ,q
SLAA ON CRADE
E
Heated Slabs:
Minimum R = 8.5
, Unheated Slabs:
,?'Q Minimum R = 6.2
G'?•1o1'6 ., ,4' 'a..., .??-, q.Q
' qi ? •? ??. ?'• 'Q'Q,
? .A??•?? 14
?'Q ?y ` a-.Q .?.•Q•, •;.'a ;?
•4' ? .4
. Q4??•41 Q;a ,o
. ?, . • a'. ',
Page 3
CONSTRIJtT I ON
K.P
?S .
R VALU[-
CEILINf SECTIQN (INSULATED):
1 Interlor atr fTlm 0. 1
AIR 2 .56
CHUTE 3 ? O.oa
4 Exterlor a(r film sti111 0.61
TOTAI R ? . ,7
U - 1/R - oa
F
CEILING FRAMING SECTION:
1 Interior air film 0.61
z s s6_
g ? , o0
4 Interior air film st, ll 0. ?
5 ?c. inches soft wooA y•?f
70TA1 R
U - 1/R = ?ozg'
?0
IMI
1 inside alr film 0•61
2
3 '
4
,5 Outside air film 0.17
TOTAL R ° _,_
U = I/R ' _._
Page 4
CEILING SELTION (INSULATED):
1' Interior alr film 0•61
2
3
4 Exterfor air ilm still 0. 1
? - - TOTAL R =
- a,-r: .. ........, ?_
p. 1/Ra_
. . .':
CEILINr, fRAMING SECTION:
1• Intertor air film 0.61
Z ..
' 3
4 Extertor air ilm stiil 0. ?
' S Inches so t wood
T07AL R =
U- 1/R=
VENTED
,• .•. 95$274
aaroxiT asuas
rxaseoaa xmcnro va:,va AW=XZMT .
Tb;s Aqraement, made and eatered into the ./LL? a°Y
o! !1 U!?el / ST . 1990, by and betreen the CZTY OF EAGAN, e
nunicipaliLy of the Stata of Minneeota, (herainatter called the
s
City), and the O+mer and the Daveloper identified herein. y
Tha term •Dgveloper" as used harein refers to: AUTt1lIIi RIDGE
yMIITEp pARTNEASHIP, a Minnesota limited partnership, c/o JATtES
pgygyppllENT CoMPANY whose addrBSS is 7808 Creekridge Cirele, Suite
310, Bloomington, Minnesota 85435.
Tha Lerm "OMR6I" as used herein refers to: AUTUt41 1tIDGE LIMSTED
pARTN8R5HIP, a Minnesota limited partnership, c/o JNSES DEVELOPMENT
COKP1?!tY vhose address is 7608 Creekridge circle, Suite 310,
Bloominqton, Minnesota 55435 and RUTH CONRAD vhose address is 5015 -
35th Avenue South, Apaztment 215, Minneapolis, Minnesota 55417. . .'
fiHg.RgAS, the Developer hae applied to the City Por approval oP tha plat or subdivision known as AUTOlW RIDGE, located within the
Cityt and
pqgRgAs, tqe pyner and Developer aqree to notiPy the proposed
potantial buyers of all loCS vithin AUTOMa 7tIDGE that L°ts 1-7, Block
1, Lote 1-6, Blxk 2, Lote 1-9, Blxk 3, Lots 1-17, Slock 6 and Lots
1-5, Block 5, are in a hiqh vater pressure zone and a Prassure
seducing valve shall be installed in eaeh home belov !he elevatioa of
966 feet. All wsts shall be the responsibility of the Ovner and
Developer and shall be installed to prevent 8amaqe due to high vater
pressura.
,?,??
?
NOW. TFEtEFORE, tde City, Ovner and peveloper aqree as follovs:
1. Recoraina. This aqreement shall be recorded vith the Dakota
CountY Recordar so as to provide notice to the mfers of Lots 1-7,
Block 1, Lots 1-8, elock 2, Lots 1-9, Hlock 3, Lots 1-17, Block 6,
and Lota 1-5, Block S. The Wner shall provide end execute any and
all documenLS naeassary to implemant tha recordirni of Lhis aqreement.
2• Noticg. TAe recordinq of this documeni shall eonstitute notiee
Lo sll owners and futuze ovners of property in the AUTI1l4i RZDGE
au6diviaion that Lots 1-7, Block 1, Lots 1-8, Block 2, Lots 1-9,
Block 3, Lots 1-17, Block 4 and Lots 1-5, Slock 5 are in a hiqh veter
prQSSUre zone and that a pressure reducing valve shall be installod
in each 6ome below the elevatioa of 966 feet. All costs sIIall be the
r"ponsibility of the Owner and Developer and shall be installed to
pravent damage due to hiqh vater pressure.
3. Validitv. If any portion, section, subsection, seatence,
olause, paraqraph or phrase of this aqreement is foz any reason held
to ba 3nvalid, such decision shall not affect the validity of the
remaininq portion o! Lhis Contract.
d. eindina Aareement. The parties mutually recoqnize and aqree
lhat all terms and conditions of this recordable agreement shall run
vith the land herein Cescribed and shall be binding upon the heirs,
suceasaors, administrators and assiqns of tha ovners and developers
referenced in this Contraci.
f
ZN MITMESS wHEREOF, ve have hereunto set our hands.
i
Hy; Date
Its:
a
R CONRAD at
OEVEIAPER:
ASTfpM41 RIDGE LZMITED PARTNERSHIP,
a Minnesota limited partaership,
By: JAMES DEVELOPMENT COMPANR,
a Minnesota Corporation
Its: General Partner
?
By: I' ? Ddte
its:
.p
CITY OP
• .1,Ir-
AUTUlIIJ RZDGE 7.IKZTED PARTNERSHZP,
a Ninnesota limited partnership,
I By: JA!ffiS DEVELOPISENT COMPANY,
na A. n a Hinnesota Corporation
•Ib: Nayor Its: General Partner
t?st . J. Vanoverbeke y: Date
=t8
Sta: ity Clerk ?
:--' ?
?
gy; Date
its:
bTATE OF ltINNE50TA
COUNTY OP DAROTA
SB.
On thia rff? day of le? , 1990, betore me a Notary
Public within and !or said Coun , personally appeared THOMAS A. ECAN
and E. J. vanOVERBEKE to me rsonally known, who beinq each by me
duly swora, each did say that they are respectively the llayor and
Clark of the City of Eaqan, the municipality named in the loregoinq
instruaent, and that the seal attixed on behalf of said munieipality
by authority of its City Council an8 said xayor and Clerk
acknwladged said instrument to be the tree act and deed of said
aunicipality.
Wr,n l NRBEAPFF1116
y? yt tq:axr rLc.r. - wIxes=
DAKOTA CCUNTY N r R1b11C i1y [emmnaan 6P iro 1 t^1
j
STATE OF PQIiNESOTA )
) ss.
CODNTY OP )
On this Le day of ?. 1990, before me a Natary
Public vi in. nd torsaad County, personally
appaarnd I_.??M ?pQ to me
parsor?ally knovn, vho being each by me duly s n, epch d say that
thay are respectively the ??
am of JAMES D EIAPMENT CoMPANY, a
ltinnasota corporation, ganeral partner of A9TU[9N RIDGE LIMITEC
P11RTNffitSft a ltinnesota limited partnership, to me personaliy known,
vho me duly svorn, did say that they are
the and of the
corporation and lim3ted partnerstiip named in the foregoinq
instrumant, and that the seal affixed to said instrument vas signed
aad 8?aled on !?hp f of said corporation and limited partnership and
said ap& acknoxledged
said instrument to be the free act and deed of said corporation and
limited partnership.
G.
Notary PUIY ic
t . . ,. . .
. ?- ?r4 _
.?..? ? ?
STATE OF MINNESOTA )
ss.
COUNTY OP
On this ? day of 1990, before me a Notaiy
Public vithia and for said County, rsonally appeared RUfH CONRAD to
ae pezsonally knovn to be the person deseribed in and vho executed
the foreqoinq instrument and acknovledged that she executed the same
as har iree act and daed.
? Wr+r Noiary Pu lia
APPROVSD 115 TO F'OR}!:
o
giti'Attorn
/Oatod: ?
APPROVSD 115 TO CONTENT:
11M ??
Public Norks partment
DatYd: 8' 7- 9 0
THIS INSTRD!ffiiT WAS DRAFTID BY:
SSVffitSON, ttII.CO% i SHELDON, P.A.
600 Midway National Bank Bldq.
7300 Uest 147th Street
Appla valley, 14t 55124
(613) 432-3136
lIGD
--•.-"'?'r?gs? _ ,.? ?" . ?
-;04q
2005 RESIDENTIAL BUII.DING PERMI'C APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
-tr10 -pO
Ca-?rd 'i1`l ?
New ConsWdlon Reauiremenls Remodelhi ei ir Re uiremenb OKce Use Onlv
3 registered site surveys showirg sq. ft. of lot sq. ft. o( house; and all roofed areas 2 copies of plan Cert of Suney Recd _ Y_ N
(20°,6 maxunum lol coverage allowed) Nk 1 set of Energy Calculatians for heated additions Tree Pres Plan Recd
' _ Y_ N,
2 copies of plan showing beam & window saes; poured found desgn, etc. ? 1 site survey for additlons 8 dek5 Tree Pres Required
' _ Y_ N
1 set of Energy Calculafions 0 Addition - indicate ilaisite septk sysfem On-srte Sepfic System _ Y_ N
3 copies of Tiee Preservatbn Plan if lol phBed after 711/93
Rim Jolst Delail Options selectlon sheet (buildings witli 3 or less unils)
G
Date
SiteAddress /o.aSD ?
Construction Cost
14fir4-_m0re_6 DA_ UniUSte #
Description of Work z>i er_K-
Multi-Family Bldg _ Y / N/ Fireplace(s) _
-C..? 0_ 1 _ 2
Property Owner ?? T1zl (?ie L-11ye Pl G Telep6one #(O?q )??y" ?? Sd
Contractor 1?? ?CVK 04 4.C_ee,2.5 1 ???-' • ?
I
Address
State ? ZiP ? y 20 City T3400ft.i,Y)J
_ Telephone #
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 CateQOrv 1 Minnesota Rules 7672
Energy Code Categary , Residantial Ventilation Category 7 Worksheet • New Energy Coda Worksheet
(Jsubmissionype) Submitted Submitted
• Energy Envelope Calculations Submitted
Have you previously constructed a building in Eagan with a similar plan? _ Y _ N If so, 25% plan review
fee applies.
Licensed Plumber
Mechonical Contractor
Sewer/Water Contractor
Telephone # (
Telephone # (
Telephone #(
I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a
permit; that the work will be in accordance with the approved plan in the case of work
approval of plans. n
C,,?A'( WI.O64,,0sq-lj
Applicant's Printed Name
Applicant's
I?1,?iJ? uu1_s?,?
IUN 2 0 2005
OFFICE USE ONLY
Sub Types
,
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Eut. Alt - SF
? 04 02-plex ? 10 08-plex ?< 18 Deck ? 23 Porch (screen/gazebo) ? 38 Multi Misc.
? 05 03-plex O 11 10-plex ? 19 LowerLevel ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or_ N? 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
`J( 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteration ? 37 Demolish Building" ? 43 Reroof ? 46 Windows/DOOrs
? 34 Replacement "Oemolition (Entire Bldg) - Gl ve PCA handout to applicant
Valuation (0 (9 0 Occupancy MCES System
Census Code
?
T
T Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const 9f ? Width
Footings (new bldg)
Footings (deck)
Footings (addition)
Foundation
Drain Tile
Roof Ice & Water Final
4 Framing
_ Fireplace _ R.I. _ Air Test _ Final
Insulation
REQUIRED INSPECTIONS
FinaVC.O.
X' Final/No C.O.
Plumbing
HVAC
Other
_ Pool _ Ftgs _ Air/Gas Tests Final
_ Siding _ Stucco _ Stone _ Brick
_ Windows
_ Retaining Wall
Approved By: TZ , Building Inspector
Base Fee
Surcharge
Plan Review
MClES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Totai
6 /1?/CL !! o 0 ?
i'
-f 20 -
?..
PROPERTYIDNIIMBER 10.12300-050.05
FEEO`NNER . JAb1ESD8PAlRICEAIARpE
824 HACKMORE IXt
SMNT PFI/L MN 551233092
PftOPEftn'ADDRESS' 624HACKMOREOR
EAGAN MN 561Z2
ppYABLE200.5TAXE5
NETTAX 2.2]1.]0
.SPECIALASSESSAIEMS 0.00
TOTAL TAX 8 SA 2.2]1]0
PAVA&.E 2008 FSMNT IISAGE.RESIDEMIAI
sc t t. 6: = I? "= v (0 *4
LDING INFORMqTION (PAVABLE2008)
NPE SFMIRES
VEARBUILT 1891
ARCWSME TVOSTOIiV
FOIINDATION SQ Ff 988
FWISHEDSQFf 1998
BEOROOMS 3 -
BATHS 2.25
FRAME WOOD
GARAGESOFf 484
OTFIQ2GARAGE
MISC BLOG
,
NOTE Oimensions rwnded W nearazttmt
Copynght 2IX35. dakota Gwnry -
SiTE nnAP,
Z1105 ESTIMATED MARKEf VALUES [PAYFBLE 2006)
LAND N,]OD LOTSIZE(OtCWOES
BUILDING 192,W0 ROADEASEMENTS)
TOTAL' 262.700
17.814 SO FT
SCHOOLDISTRICl' 196 OPBACRES
LOCAPON 5Wt14NE1145ECTION25-00-23
PAYF9LE2006HOMESTFAOSTATUS FULLHOMESfEAD
WqTERSHEDOISfRICT GUNGLUB
NEW CON5IRUCTION SALE-
OATE. 111981 FMOU' 199,242
TNS Cravnng is neiRiet a legally recorEed map nor a survey and is not mtentleol ro be usetl as one
This dravnng is a compilation oi recortls, informahon and tlab located in vanous ciry, counry, and
siate olfices and other sources, affacting ihe ajea shown, and is b be used fa reMerce puryoses
anly. DakobGwnryisM[responsibkforanyinacaacieshadeimmmamed Hdiscrepanaesare
faund, please contact Oekota County Survey and Land InfortnaHon tlepahment
PLATNAMB AURIMNRIDGE
TAXDESCRIP110N 5 5
N
Map Datn: May 3, 2005 Parcels Uptlated 4R0/2005 Aenal Phomgraphy 2004
ia:;= -'ks r- rdAyAs PE
?!: , 7"'?a 7J h2„I 6;1a'9`lSa SJ il14 13 U nf ,a F I.S l.P, 0
THH M1NNE50%A SOqRO OP AACHITBGTUAE, ENGIN86AtING, LAND S[1RVE4TNQ,
LANpgCAPE ARCH[T6CTURE, G809Ci9NCH at. YN7ERIOR DesIcn
July 11, 2005
I4It'. Ayman Al-Nahas
11804 Robertson Parm Cir
Fairfax VA 22030
Dear Mr, A1-Nahas:
`AGE Vl?
!=elGu2jVD3
The receipt of your application for licensure aa Professionnl Engineer, with fee oE $100.00
is acknowledged. Your canceled check is yovr reeeipt.
Your applicaHon appears to be in order and you may practice youx profession while yout
application is pending parsuant to Minnesota Stetutee 326.13(2)(2000), and Minnesota
Rulea, Part 1800.0900, Subpart 6(1999), Enclosed ia Board Porm AEi.,q-2R (Procedure for
Signii?g and llating Plans by Applicant4 for T;ce.,s,m by Comity) for your information and
use.
TJhe Board wfll review your applicaHon at its next aeheduled meeting. You wlll be
informed of their detertnination.
If your applical3on is approved, a license fee will be requeetec{. A lieense to pracHce will be
assued to you and a Ceraficate of LicenstxYp, sui(able far framing, will be ordered. IE you
do noc meet the rec7uirementa of Minnesotg Law, you will be advised es to any additional
requirements necessary in order to quslify for licensure ln NJinnesota.
Sincerely, .
Sheri L. Linde
1Cicensing Coordinator
Encflosure
B.3r (Rev. 6/99)
PS Exst 9ch Plaee, Suice 160, Sc, P.tul. MN 5510I
o. e561 .2?523btD p f, 551 .297.5310 u T'TY 890d27.M39
w,?,w,aaptsla?id.staea rnn.us
nht pclU:\6 ^F110RSI1Mi rY ZISIPI.OVRR-
4'
.y??- ._?_. . - .. ,.•irW?..w,'?-^?^?Y'++++'?'^_..,.... . '-Ml]?#
H`1 Nr;HtiS ,--'E
';59?57597n :iid ST 0D oS A_?_? r
..
THE A91NNESOTp $OqRO OP ARCFIITEC7UR¢, ENGINEHAING, LAND SURVBYdNG,
LANDSGAPE ARCHITECTURB, GEp$CI6NCfs & INT6RIOR DESlGN
PROCEDURE FOR SIGNING AND DATING PLANS BY APPLICANTS
FOR COMITY LICENBURE
This Board daes not have the etatutory authorlty to issue temporary permits.
PAGE ljJ
C:I ??3/ot?3
An architect, a professlonal engineer, a land surveyor, a iandscape architect, a professional geologiet, or
a professional soil scientist, currently Iicnnsed te practice in another State, upon notiflCation that his/her
application has been received and is in good order, may prdctice his/her profession while the application
is pendinp flnal Board approval. The application will be apprvved/disapproved by this Board withln 30
days of recelpt.
An application that has net been acted upon by the Board within six months of receipt, because of tha
faflure of the applicant to fumiah nequ(red informativn to the Boerd In support of the appllcation, shall be
denied.
The plans, spec'fiications or other documenfs prepared bythe applicant during the pariod In which his/her
application is pending, must bear the seal of the State in which the appllcant was orieinally licensed,
signed across the seal and daled. The notatlon "Minnesota license pending° and the date of this notice
muat be plaeed adjaeent to the aeal. The seal, slgnature end date of signature, atong with the ebove
natation and date, shell be placed on each sheet of the sat of drewinga he/she has prepered for the
project and on the twe or first shaet of !he specifications_
Pvlinnesata law does not permit architects to slgn englneering doeumenta nor profeasional engineers to
sign architectural documents. Your signature on a document Intended f0r construction or use In the
State of Mlnnesota means that the documerrt embodies your own profess(onal skill and judgement end
wes either prepared by you or under your direet eupervislon.
Please aign, dete and retum a copy of this form letter wlthin flve days of receipt of the letter. The
purpase of signing and retuming the yallow eopy of this letter signfie9 that you have read and understend
thTS requirement and that you wllf compty with the requirement. Fallure to retum the yellow copy, s)gned
end daeed, to this office renders thia authority vold. The authorily for sealing plens, specificaUons or
o4her d cument9 expires 30 days following the dete of thia letter.
A(4nt Shsrl Lindemann
g ture Mlnnesota 6oard oPAE1.SLAGID
85 E 7t4 Place 3ulto 160
St. Paul, MN 55101-2113
ddame (pleasa print) (651) 298-2388
AELA-2P {Rev. 634I43}
e5 6est 7rh ?"Iflce, SVlle 18G, S[. Peul. MlV 55101
2388 tJ f. 651.297.5310 o'I'I"Y d09.027.5529
'trww.MeLSfa4id.scaCO.Ynn.us
,91•d @??ll;?I. OPPDFd'UNI I Y'? AAPSU"1e4
f.
?
. ..,- .: . . . ..? ,,.: . . . ? . _
:,,s:?;,...?.r .u.... , .... . .......:.::.? ?,r.,,r;,., ,.a. ;:-..
THII-?'?-'?] TI11= Ll:0i.: Ip:INPIF_'S P I-i1LL [II?.
'9fOH'S GiERTIF8?ATF
WI%Vrc
?
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• „=,,,,?-?....
r 1??
s r ` -- - _.- -. ,.--
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R f
M
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KUSTOM$ dY KRZYZIANIAK
?
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a 1300 f)a'36"C
47?-?-_.?z?,.sa
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N Q;?° Q655° E
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NOTE: ? D?MENSIONS SNONN ME FOFt FqRQONTAI
LOCATION OF STIA/C?TW?E OM4LY. E6S£
1k4. I"LNf3 I'OR oU1LQ0i0 a Fl1l1NIM'fION
MM; Np ?p1C gp16S INVESTRATIOfJ HAS BEEN COMf'IETED
?I
lOLf ?ED ?
TO l4P1'Gf1T THE !r'0?.lY? 11WS£ F?
wr
.r----- THE }ms"pfllN„ITY OF THE SUfIVEYOR
- DEN07ES PROPOSED SURFACE DRAINAGE
U DENOTES IRON MONUMENT SET
0 DENOTES IRON MONUMENT FOUND
X000.0 DENOTES EXISTING ELEVATIUN
(000.0) DENOTES PROPOSCD ELEVATIUN
10
?i
00
H
- j 10 ,
.? 1
32.41 30
a
V- ?
?-.
30
?
1
ANSCA_LE?'IF1?? Cf T FEET
PROPOSED GARAGE FLOOR - yV6 / FEET
PROPOSEU LOWEST F1.00R - 936•Ll FEET
NROPOSED TOP OF 6LOCI< - 9'/G, 5 FEEf
, ,,, ,,?)
WE HEREBY CERI"IFY TO {<USTOMS BY KRZYZANIAIC THAT THIS IS A TRUE AND CORRECT
REPRESENTATION OF A SURVEY OF THE f30UNDARIE5 OF:
LOT 5, BLOCK S,AUTUMN RIDGE, ACCORDING TO THE FiECORDED
PLAT 'fHEREOF, DAKOTA COUN7Y, MINNESOTA.
IT DOES NOT FURPORT TO SHOW IMPROVEMENTS OR ENCROACHMENTS, EXCEPT AS SHOWN. AS
SURVEYED BY ME OR UNUER tAY UIRECT SUPEF2VISION 1'NIS 29T1f DA`! OF JANUARY . 1931
rRaPOSeo crenoEs srawN wErE TAW-" SIGNE MES R. HILL, INC.
FROM THE GRAOING PLMI FOR AUTUMN ?
pIppE, pIKPAhEO 0v PIONEEt+ ENGiNEERiNG
' ^- __. -
BY: ' -- - ---
JOHIJ C. LARSON, LAND SURVEYOR
MINNESUTA LICENSE NUMBEFi 19828
. •
?a.i"1"eS R. HIll, Ir1C.
PLANNERS / ENGINEERS / SURVEYORS
9401 JAMES AVE. S. • gLOOMINGTON. MN. 55431 • 672-884-3029
Use BLUE or BLACK Ink
I I
I I
Ej Permit 25 ! ~ I
City of I
I Permit Fee:
3830 Pilot Knob Road I
Eagan MN 55122 j Date Received:
Phone: (651) 675-5675 i
Fax: (651) 675-5694 Staff: t
2010 MECHANICAL PERMIT APPLICATION
Date: Site Address: /2-14 OadLMOO- `Y
Tenant: 1 Suite
RESIDENT / OWNER Name: - xft"Ct ! Q1 dI~ Phonef6l-4sq-oQ ~F
Address City, Zip: rL
CONTRACTOR Name:
Address: ,~tr7 J1L11~V City:
State: (y11 Zip: ,e l l Phone:
Contact:
TYPE OF WORK New Replacement Additional -Alteration Demolition
Description of work:
tgr°t e h~9P. egt~e c$~ned
Ift easy R. it~irallechanipal;(nspec,ordfotinforma, on on~.petir~tte : Vic.ening?mett~o ,s
a, "-01 .
RESIDENTIAL COMMERCIAL
PERMIT TYPE Furnace _ New Construction _ Interior Improvement
)Atr Conditioner _ Install Piping _ Processed
-Air Exchanger _ Gas _ Exterior HVAC Unit
Heat Pump _ Under/ Above ground Tank 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 S to Surcharge) moo $90.50 Fire repair (replace burned out appliances, ductwork, eta) (includes $.50 State Surcharge)
$ m~I TOTAL FEE
COMMERCIAL FEES:
$70.50 Underground tank installation/removal OR Contract Value $ x1%
$50.50 Minimum (includes State Surcharge)
Permit Fee
- If Pe 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 $1.00 surcharge).
TOTAL FEE
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you Intend to dig to receive locates of underground utilities. www.aooherstateonecall.orn
I hereby acknowledge that this information Is complete and accurate; that the work will be In conformance with the ordinances and codes of the City of
Eagan; that I understand this Is not a permit, but only an application for a permit, and work Is not to start without a permit; that the work will be in accordance
with he approved.plan in the V ass of wort which req s a review and approval of plans, r
X x y~ a
Appl cant's Printed Name Appl s Signature
'V`1: "i:.yt ..'.S~! ..j' ,.~j "`4. 1' -Y ,:1 _.F..r ~•.1;. ,.x W~;. ..^P,.
F ` :6: y, ask. 5N
'Z'1 evie @d. B• e.~ ~y ';~-~+.I;~i t'~ at enE ce ;~s
ea~?LtE$+??';~,~FxFAIL M.
~
Use BLUE or BLACK Ink
I I
I I
Ej Permit 25 ! ~ I
City of I
I Permit Fee:
3830 Pilot Knob Road I
Eagan MN 55122 j Date Received:
Phone: (651) 675-5675 i
Fax: (651) 675-5694 Staff: t
2010 MECHANICAL PERMIT APPLICATION
Date: Site Address: /2-14 OadLMOO- `Y
Tenant: 1 Suite
RESIDENT / OWNER Name: - xft"Ct ! Q1 dI~ Phonef6l-4sq-oQ ~F
Address City, Zip: rL
CONTRACTOR Name:
Address: ,~tr7 J1L11~V City:
State: (y11 Zip: ,e l l Phone:
Contact:
TYPE OF WORK New Replacement Additional -Alteration Demolition
Description of work:
tgr°t e h~9P. egt~e c$~ned
Ift easy R. it~irallechanipal;(nspec,ordfotinforma, on on~.petir~tte : Vic.ening?mett~o ,s
a, "-01 .
RESIDENTIAL COMMERCIAL
PERMIT TYPE Furnace _ New Construction _ Interior Improvement
)Atr Conditioner _ Install Piping _ Processed
-Air Exchanger _ Gas _ Exterior HVAC Unit
Heat Pump _ Under/ Above ground Tank 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 S to Surcharge) moo $90.50 Fire repair (replace burned out appliances, ductwork, eta) (includes $.50 State Surcharge)
$ m~I TOTAL FEE
COMMERCIAL FEES:
$70.50 Underground tank installation/removal OR Contract Value $ x1%
$50.50 Minimum (includes State Surcharge)
Permit Fee
- If Pe 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 $1.00 surcharge).
TOTAL FEE
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you Intend to dig to receive locates of underground utilities. www.aooherstateonecall.orn
I hereby acknowledge that this information Is complete and accurate; that the work will be In conformance with the ordinances and codes of the City of
Eagan; that I understand this Is not a permit, but only an application for a permit, and work Is not to start without a permit; that the work will be in accordance
with he approved.plan in the V ass of wort which req s a review and approval of plans, r
X x y~ a
Appl cant's Printed Name Appl s Signature
'V`1: "i:.yt ..'.S~! ..j' ,.~j "`4. 1' -Y ,:1 _.F..r ~•.1;. ,.x W~;. ..^P,.
F ` :6: y, ask. 5N
'Z'1 evie @d. B• e.~ ~y ';~-~+.I;~i t'~ at enE ce ;~s
ea~?LtE$+??';~,~FxFAIL M.
~
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA125946
Date Issued:08/08/2014
Permit Category:ePermit
Site Address: 624 Hackmore Dr
Lot:5 Block: 5 Addition: Autumn Ridge
PID:10-12300-05-050
Use:
Description:
Sub Type:Siding & Windows/Doors
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of house wrap and leave on site for final inspection.
When installing ventilated soffit material, remove existing material (i.e. debris that could block vents) and take steps to
ensure maximum ventilation to attic. Call for final inspection after installation.
Valuation: 8,000.00
Fee Summary:BL - Base Fee $8K $162.25 0801.4085
Surcharge - Based on Valuation $8K $4.00 9001.2195
$166.25 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
James D Lardie
624 Hackmore Dr
Eagan MN 55122
(612) 213-7435
Midwest Exteriors Plus Inc
6451 Sycamore Ct N
Maple Grove MN 55369
(763) 427-9696
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA138604
Date Issued:09/08/2016
Permit Category:ePermit
Site Address: 624 Hackmore Dr
Lot:5 Block: 5 Addition: Autumn Ridge
PID:10-12300-05-050
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
James D Lardie
624 Hackmore Dr
Eagan MN 55122
Champion Plumbing
3670 Dodd Rd., #100
Eagan MN 55123
(651) 365-1340
Applicant/Permitee: Signature Issued By: Signature
A ,
e t s
e � is For Office Use
,,,,,,°%,.` EAGAN
Permit#:
rZECEIVED Date Received:
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651)675-5685 I TDD: (651)454-8535 I FAX: (651)675-5694 AUG 01 2018 Staff:
planninqacityofeagan.com
2018 ZONING PERMIT APPLICATION
p Please identify improvements on a scaled site plan drawing that shows lot lines, structures and
existing conditions.
property Site Address: # I
k/&-G 4--iy1b p-�. Di ,� 66 mow. MA! 53�/-2-3
pY /
Information
Owner Name: G 0n-e5 L.,V e' , C
Name: A / C (CG'S r -t''e'i,"c e- _ Phone: (,,5-(---(15-7 -Z27 /
i LA/Address:C > , (}` ( G�c.. v.,-e. � City/State/Zip: 5'4) 51- ti) -,,,,, �` 2:'7_
Contact
Applicant Signature' : -...._____ Date: 773 a//
l ,
Email address: U� m i ccl t,,eST '> r‘Le._C oW`
1 ❑ Retaining Wall<4 feet 0 Driveway 0 Other:
❑ Patio 0 Sport Court
Type of Work 0 Sidewalk ,ence
i
i Description of work: I j 2, tsi3 O0 d_. Pr, va c rce 4,--)
Planning Setbacks, hard surface coverage,shorelandt zoning,,bluff zone/setbacks,etc.
Approve DeniedDate:
pp ... . �.-,/, �j�-
A Staff: G r ix �� .eClt�-4,.
Notes: jj
y 5 5 or.. K . ' d y 4 fr` , Property lines to be verified
I by contractor/owner.
Revised Plans
Approved: Yes/No
! Date: Staff:
Engineering Grading,drainage,utility easements,wetlands erosion.=control improvernents`in the Right-of-Way, etc.
Approved/Denied Date: Staff:
Notes:
Revised Plans
Approved: Yes/No Date: Staff:
Comments
CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage. Call 48 hours before you
intend to dig to receive locates of underground utilities. www.qopherstateonecall.org
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's
website at www.cityofeagan.com/subscribe.
Page 1 of 1
1C'Z7.lre
Dakota County,MN
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Map Scale
14
Disclaimer:Map and parcel data are believed to be accurate,but accuracy is not guaranteed This is not a legal document and should not be ]inc =50 fee
subst Luted for a title search,appraisal,survey,or for zoning verification. 7/30/2018
about:blank 7/30/2018
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA160559
Date Issued:03/19/2020
Permit Category:ePermit
Site Address: 624 Hackmore Dr
Lot:5 Block: 5 Addition: Autumn Ridge
PID:10-12300-05-050
Use:
Description:
Sub Type:Residential
Work Type:Alteration
Description:Fixtures
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Fee Summary:PL - Permit Fee (miscellaneous)$59.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
James D Lardie
624 Hackmore Dr
Eagan MN 55122
(651) 242-1113
Window Concepts Mn
291 Eva St
St Paul MN 55107
(651) 905-0105
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA161992
Date Issued:06/22/2020
Permit Category:ePermit
Site Address: 624 Hackmore Dr
Lot:5 Block: 5 Addition: Autumn Ridge
PID:10-12300-05-050
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:Two or More Windows/Doors
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow
windows, call for framing inspection. Call for final inspection after installation.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Valuation: 5,000.00
Fee Summary:BL - Base Fee $5K $118.00 0801.4085
Surcharge - Based on Valuation $5K $2.50 9001.2195
$120.50 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
James D Lardie
624 Hackmore Dr
Eagan MN 55122
(651) 242-1113
Apex Energy Solutions
9655 Newton Ave S
Bloomington MN 55431
(651) 688-2739
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA161992
Date Issued:06/22/2020
Permit Category:ePermit
Site Address: 624 Hackmore Dr
Lot:5 Block: 5 Addition: Autumn Ridge
PID:10-12300-05-050
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:Two or More Windows/Doors
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow
windows, call for framing inspection. Call for final inspection after installation.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Valuation: 5,000.00
Fee Summary:BL - Base Fee $5K $118.00 0801.4085
Surcharge - Based on Valuation $5K $2.50 9001.2195
$120.50 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
James D Lardie
624 Hackmore Dr
Eagan MN 55122
(651) 242-1113
Apex Energy Solutions
9655 Newton Ave S
Bloomington MN 55431
(651) 688-2739
Applicant/Permitee: Signature Issued By: Signature