4376 Hamilton Dr? CASH RECEIPT - ?
GITY OF EAGAN
3830 PILOT KNOB ROAD '
EAGAN, MINNESOTA 55122
DATE 19?? ?
, , _ CF ?? J ? • i
necerveo
FApA 1..? r
AMOUNT wZ;g
Q CASH
KCHEGK
8Y "
C 11377
d, DOILARS
100
vVhite--Payere Capr
YMbw--Pa61fnD COPY
Pinlc?ie Ccpy?.
Thank You -
??1?
?'? L? ??
CITY OF EAGAN F q? ?BbQ?
• 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 5512?
PHONE:454- 8100 ?
BUILDING PERMIT Receipt ?
a80'00
sF ???/GAR 0 bEC t 1 90
Est. Value
To be used for Date 19
Site Aqrss 4376 fIAMILTO!! Dg TLr- OFFICE U5E ONLY
Lot Block Sec/Sub. ?TU
Q-3
?'?-1
Parcel No.
occupancy FEES
2
NORSI?CA I#0!!?S II?C oning
SS0.00
¢ Name (Aclual) Const Bldg. Permit
3 Address (Allowa6le) - S
rchar
e 40.00
° City EAG" PhOnB 452-7449 # or stories ?
-? g
u 357.00
Plan Review
SAME Length 1
? ,?.?
o Name Depth SAC, City
o Q Address S.F. Totai - Mcwcc
s
C 6M.00
¢ City PhOn2 S.P. Footprints - A
, 625.00
Water Conn
On Site Sewage _ ???
W w Name On Si1e Well Water Meter
w
Address MWCC System
- 30.OQ
? Acct• DePosit
<W City Phone CiN Water - 3p.pp
SAN Permit
PRV Required _ ??
I hereby acknowlege that Iave read this appliCation and state that the Booster Pump - S!W Surcharge
information is correct and ree to, comply with all applicable State of 252,00
Minnesota Slatutes and CA? ot Eagan Ordinances.
t
I Treatment PI
335•?
-. -
Signalure of PermRee
..- APPROVAL8 q?d Unit
?
110it5Kl1 80MLS ING Planner -
A Building PermR is issued to: Pa?k Ded•
on the express condition ihat all work shall be done in accordance with all Council
applicable State of Minnesota Statutes and City ot Eagan Ordinances. Bldg. Off. - COPies 3,029. 50
Building Official - ' Variance - TOTAL
- Permil No. Parmlt Holder Date Telephons #
1NATER ? 0/0? '
SEWEB
PLUMBING p2 ? r ??7 Q 0???
H.V.A.C.
ELECTRIC
Mspectioa Date Insp. Comments
FoornysI ?z?Z 0
Foundation
Framing
Raofirg f U?
Fough Plbg. Q/ 19 !r 2
Flough Htg.
Isul.
Fireplace
Final Htg. 40
Final Plbg. i% I
Const. Meter Plbg. Inspector - Notify Plumber
Engr./Plan
Bldg. Final ? Z? ?F+ .S ??• 2? p2
Deck Ft9• 7• Z -97 A? h0 Co L
Deck Fnal
weii aL Cq/W- 4-0142
Pr. Disp.
_.?
RE:
4r 4,r
DATE: DEC il, 1990
4376 HAHILTON DR (IiORSRA HOMES IL7G)
X Your Sewer & Water Permit for the above property has been completed. It will be held at the ?
Public Works Garage' (3501 Coachman Road) untit the meter is picked up. BE SURE TO ?
CALL PUBUC WORKS (454-5220) FOR YOUR PERMANENT WATER TURN ON.
Your Sewer & Water Permit for the above property cannot be completed for the following 1
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 PROJECTS ONLY: Please pay for meter at City Hall. Meter size must be
confirmed by Bill Adams or Oirk House (Plumbing Inspectors - 454-8100) before issuance.
WAiiNING: BEFORE DIGGING, CALL LOCAL UTfLfT1ES - TELEPHONE, ELECTRIC, GAS, ETC.
- REQUIRED BY LAW.
CONTACT COMMUNITY DEVELOPMENT DEPARTMENT FOR WATER TURN ON POLICY.
Secretary, Bu+iding Inspections Dept.
41L?
4r_ • i' +"
e ,
(grx#tftr?tt of (Orrupattry
Cifip of Cagan _
Drparbanrt a# Ittildncg Jnsperttvn
This Certijrcate &suedpursuant to the requiremenls of Sertion 306 of the Unijorrii Building
Cocle cerrifyinglhat at the unre of issumrae lldssovchm was in compliance wuh the various
ordinQncec of tlse L7ity regulatittg bur7din8 conshudian or uw- For the fallowrirg:
SF_?i IG1R ewg. F=vlic No. 18608 p-P-CyTya R9/141 7mug D;bda PD/R'~ Type VN
• pwoer or Bwwm_biIRACA ixfrNS Aftxz 45 l5 OE1K QH1A.SE FMs EAGAN
Bwld*Ad*? Locwq L14, S2. IMMUZCK PoMlE 6IH
2/27/91
e?ama - /
? POST IN A ODNSPNx10US PLACE
GITY Vh'tiZ(9AN METER #
3830 Pilot Knob Rd. cHiP #
Eagan, MN 55122-1897
METER SIZE
DATE DEC 12. 1990 ISSUE DATE
SITE ADDRESS 4376 liA'.3ILTON DR
"
LOT 14 BLOCK 2 SEC/SUB LExI E bTH
NGTON TOIZiZ
APPLICANT:
ADDRESS:
-
CITY, STATE ZIP
PLUMBER: \ IVIA '- 3) ttizi/?ti o-' t f I v, f.. 1,r .,
Meters are to be Installed
stic Meters on Water Line.
" be given for Deduct Meters.
rnvrvC. - v
I A?pA O COMPLY WITH CITY
OWNER: NORBiCA 1111IN$8 IllC - EAGAN ORDINANCES
ADDRESS: 4515 0/?1C CHAU RD
CITY, STATE EAGAN MN ZiP gS123
PHaNE: 452-7449 SIGNATURE WHEN METER ISSUED
PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. CALL 454-5220 FOR INSPECTIONS. FOR STORM
SEWER PERMITS, CONTACT ENGINEERING DEPT.
1 & WATER PERMIT
F EAGAN
lot Knob Rd.
MN 55122-1897
DEC 11 111990
ADDRESS 4376 iiAI?iILTOIi llR
_.-BLOCK 2 SEC/SUB LEXINGTON POINTE 6Tti
, STATE
BER: 1 4JA C 11) Ztic??_ti,- 1 1, 'c-
oFFiee u
METER ? 4W--4 12 a 7`3
cNiP # e/ff 7 ? 83
METER SIZE ?
ISSUE DATE
ZIP
ESS: 1200 LL°ISURE Liv STATE
,
iE:
PERMIT DATE iZ
PERMIT # -?1
B.P. RECEIPT #
B.P. RECEIPT DATE
_ BOOSTER PUMP
PERMIT REOUESTED
A SEWER X WATER
TAP
COMM/IND x RESIDENTIAL
X NEW _ EXISTING
PERMIT DATE 12/I l /9Q
PEFMIT #
B.P. RECEIPT #
B.P. RECEIPT DATE 12 1 1 90
_ PRV - BOOSTER PUMP
PERMIT REQUESTED
_A__ SEWER WATER - TAPS
COMMiIND X RESIDENTIAL
X NEW - EXISTING
Laym,:Sari?lkler Meters are to be Installed
Ahea?l ?1 • omestic Meters on Water Line.
Gr$dit WIL?NOT be given for Deduci Meters.
Y wiTH
OWNER: 1QORSKA HOltES IIQC ' ADDRESS: ?+g1S OAK CHASE RD
CITY, STATE EAGAN MN ZIP 55171
PHONE: 4 5 2 - 74`, `? 2A?TURE'
PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. CALL 454-6220 FOR
SEWER PERMITS, CONTACT ENGINEERING DEPT.
INSPECTIONS. FOR STORM {
?- ? j`
CITY OF EAGAN NO 18608
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100 /b
BUILDING PERMIT Receipt #
To be used for SF DWG/GAR Est. value $80, 000 Date DEG 11 , 7g_QO_
Site Address 4376 HAMILTON DR
Lot 14 Block 2 SeclSubLEXINGTON POINTE OTH
Parcel No.
Name NORSKA HOMES INC
W
3 Address 4515 OAK CHASE RD
° City EAGAN phone 452-7449
o Name SAME
g¢ Address
? City Phone
ww Name
Address
City Phone
I hereby acknowlege that I a?e r this application and state that the
information is correct ree comply ?ith all applicable Slate ot
Minnesota Statules C o4 Ordmar,lces.
Signature of Permi e ` VL
A Building Permit is issi d i NORSKA HOMES INC
on the express condrtion that all work shall ba done in accordance with all
applicable State of Mmnesota StpaWtes antl C?,iry ? ?ot Eagan Ordmances.
Builtling Official r M A I\O?f1.Iy I II_CI
?
OFFICE USE ONLY
Occupancy R-3`f=1 FEES
Zoning PD R-1
(Actuap Consl y=N Bldg. Permrt _
(Allowable) v-? Surcharge 40.00
A' of srories
?n9th 50 ? PlanReview 357.00
Deplh 46.1 SAQ City 100.00
S.F. rotai - snC, MCwCC 600.00
S.F. Footpnnis -
On SAe Sewage _ Water Conn 625.0?
On Site Wall - Waler Meler 90,0
n
MwCC System X 00
30
City Water Acct. Deposil .
PRVReqmred - S/1NFermtl 30-00
Boosler Pump - S/W Sumharge .50
7reatment PI 252.00
APPROVALS Road Unit 355.00
Planner - Park Detl.
Council
BICg.Ofl. _ Copies
Varience - TOTAI 3.029.50
Address: 4376 HAMILTON DRIVE Lot 14 Blk 2 Sec/SubI,EXINGTON POINTE 6TH
?These items ware/were not complete at the time of the final inspection.
DATE: 2/27/91 Yes No INSPECTOR: D
Final grade (6" from siding) v
Permanent steps - garage
Permanent steps - main entry
Permanent driveway ?
Permanent gas
Sod/seeded grass
Trail/curb damage ? S"W ?
Porch
Basement finish
Deck
Please verify with the builder the removal of roof tast caps from tha plvmbing
system and tha shut-off of water supply to tha outside lawn faucet before
freeze potantial exists.
White - City copy Yellow - Resident copy Pink - Contractor copy
77777
0, mo
Requast Date Fire W R Inspeclion
in
q
v ? Reatly Now ?II Notdy Inspeclor
?L Yes ? No Wlian ReaOy'
IWicensed contractor ? owner hereby request inspection of above electrical work et:
Job Mtlress (Sfreel, Box or ROUre No.) Ciry
U V
SecliOn No Town3hip Neme w No Range No. CAUnty
Occupant (PRINn Phone No.
PowerSupplrar AtlEress
?` "
00 rn N
?
Elenncal CoMradm (COmpany Neme) Conirectar§ Lkense No
F
Mailing Aatlress COnVaclor or Owner Makmg Instalienon)
1 SS3'7
Aullronzetl $ignature (C Va or hrer Making InstalW4onj Phone Number
n
K -
MINNESOTA STATE BORND OF ELEC7RICITY THIS INSPECTION REOUEST WIW NOT
"B9"idwey Bldg. - Noom S173 BE HCCEPTED BYTHE STATE BOARD
1811 Unlvaniry Aw., St Peul, MN 55106 UNLESS PROPER INSPECTION FEE IS
PMna (812) 842-0800 ENCLOSED.
/fAi
u Y" ?TRLL LL
REQUEST FOR ELECTRICAL INSPECTION
No See inslmclions for completing ihis lorm on beck of yellow copy
"X" Be/aw Work Covered by This Request
? .?
9997?
ew Atltl Rep. rypeof8uiltlmg AppliancesWired EquipmentWired
Home Range Temporary Service
Duplex Water Heater EleIXric Heafing
Apt. Building Dryer Other (Specify)
Comm./Intlusirial '
K Furnace
Farm IC
! Ar Conditioner
Other(speciry) ConVactor§ Femarkr
Campute Inspection Fee Below:
# Olher Fee # ServiceEntrance5rze Fee # Crtcwts/Feeder5 Fee
Swimming Pool 0 to 200 Amps /S o to 100 Amps
Transformers Above200_Amps Apova100_Amps
Signs Inspecror5 Uae Only `I TOTAL
?e?'?
?
Irri9ation Booms e
5
Special InspeC[ion
Alarm/Communication THIS INSTALLATION MAY BE ORDEFiED DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONTHS.
I, the Eleclrical Inspector, hereby R°'gh"" o _Q
•
certify that the above inspection has
been made.
_6
o7
a
OFFICE USE ONLV
This repuest wa 18 monNS hom
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
-' 3830 PILOT KNOB RD, EAGAN MN 55122
651•881-4875
Naw Constructbn RaauiremeMs
. 3 registered siie surveys ahowing sq. R. oi bt, sq. tt. ot house; antl II roofed areas
(20% maximum bt coverage albwed)
• 2 ooptes of plan showing 6eam & wlndow slzes; poured found deslgn, etc.)
• lsetofEnergyCakuletbns
• 3 coples ot Tree Preservatbn Plan tt lat pletled atter 711l93
. Rim Jolsl Deteil OpCrons seleclion sheet (blAgs wM 3 or less units)
DATE '91I 3 .JG?
RemodeUReualr ReauiremeMS
• 2 copies of plan Ic/ir .
• lsetotEnergyCalculationsforheaiedadditbns
• istesurveytorextetloradtlitions8decks
• IndiCate N home sened by septic System for additbns
VALUATION iF 9(nii "?'-
SITE ADDRESS 4 3-7 Co F*IQwt I -Ivv. __Py ' , MULTI-PAMILY BLDG _ YIi? N
NPE OF
FIREPLACE(S) _ 0 _ 1 _ 2
APPLICANT ov.r -- ztr?o STREETADDRESS M CITY (?+kAC, STATErY\l\j* ZIKS'5?LS
TELEPHONE #?(Z-1 ZZ {=?-Il?fc CELL PHONE # LolZ-ZZI -?t-/?"j FAX# 9SZ- ? Z?'i??J
PROPERNOWNER ?A?seI _\t7-CCQ--k TELEPHONE# G5?-14OS--9/
------- ------------- ------------------------------------------------ ------------°------
COMPLEiE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINATFSOTA RUI.ES 7670 CATEGORY 1
(4 submission lype) • Residential Ventilation Category 1 Woftheat Su6mittetl
• Energy Envabpe Calculations Submiried
Plumbing Conhactor: ___
Plumbing system includes:
Mechanical Conhacior:
Mechanical system includes:
Sewer/Wafer ConhaCtor:
_ Air Conditioning
_ Heat Recovery System
Phone #
Phone #
Fee: $70.00
I hereby acknowledge that I have read this application, state ihaT The information is correct, and agree to comply
with pll applicable State of Minnesota Stotutes and City of Eagan Ordinances.
Signature ofApplicant
.................................................
......._..._..._.?..r?.r.r..r..?
OFFICE USE ONLY
_ Water Softener
WaCer Heater
No. of Baths
_ Phone #
Lawn Sprinkle
No. of R.I. Baths
• N ? Or h ittad
MAY 2 9 2002 °
r . •
?
, ..;
,.
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4/02
OFFICE USE ONLY
? 01 Foundation ? 07 05-plex ? 13 16plex 0 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling O 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 PorchlAddn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck 0 23 Porch (screened) ? 36 Multi
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex O 12 12-plex Plbg_YOr_ N ? 25 Miscellaneous
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addition ? 36 Move Bidg. O 42 Demolish (FOUndation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)* O 43 Reroof ? 46 WindowslDoors
? 34 Replacement 'Demolition (Entire Bldg only) - Give PCA handout to applicaM
Valuation Occupancy MC/ES System
Census Code Zoning City Water
SAC Units Stories 8ooster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const W idth
REQUIRED INSPECT10N5
_ Footings (new bldg) _ FinaUC.O.
_ Footings (deck) FinaVNo C.O.
_ Footings (addition) _ Plumbing
Foundation HVAC
Drain Tile Other
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests _ Final
_ Frammg _ Siding Stucco Stone
_ Faeplace _ R.I. Air Test _ Final _ Windows (new/replacement)
_ Insulation _ Retaining Wall
Approved By
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Building Inspector
ToWI
1990 BUILDING PERMIT APPLICATION
CITY OF EAGAN
SINGLE FAMILY DWELLZNGS
MULTIPLE DWELLINGS
COMMERCZAL
2 SETS OF PLANS 2 SETS OF PLANS 2 SETS OF ARCHITECTURAL
3 REGISTERED SITE SURVEYS REGISTERED SITE SURVEYS - & STRUCTURAL PLANS
1 SET OF ENERGY CALCULATIONS (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 APPLZES WHEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY LAST WORKING DAY
OF MONTH IN WHICH REQUEST IS MADE.
LOT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED.
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER M[JST DESIGNATE WHICH ADDRESS IS
DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DAYS ONCE A PERMIT HAS BEEN COMPLETED.
PERMIT MUST SHOW A LICENSED PLUMBER.
To Be Used For:
Site Address
S,'4'qIQ P4Wt-,l?t? Valuation: Date:
-I i_
Lot I L? Block 2.
TL
Parcel/Sub
Owner /-bQ-SICA gaYwLi
Address L{ S 1 S OVl? GL A(+e_ RiD -
City/Zip Code ?AQAN /uAJ '
Phone
Contractor nJ oask a PoMe? TO-'-
Address LlSIS OPk LkALz flo _
City/Zip Code FA q Q?n. IU/U• 5S123
Phone Vs2-, (4 Li ?
Arch./Engr.
Address
City/Zip Code
SEC 0 ? Recp
12-')-qo
ooo - OFFICE USE ONLY
FEES
Occupancy -R 3 M -I
Zoning PD TZ-1
Actual Const V-N
Bldg. Permit
5570•oa
Allowable Y-/`{ Surcharge 140•00
# of stories
- Plan Review 35, DO
Length 5? SAC, City 1OD,DO
Depth 14 SAC, MWCC (p00.OfJ
S.F. Total Water Conn 11- ,O17
Footprint S.F. Water Meter qp,c?
Acct. Deposi t 30,00
On site sewage_ S/W Permit 'O,O?
On site well S/W Surcharge ?Sa
MWCC System ? Treatment P1 . 2,$ DO
City water ? Road Unit DO
PRV Park Ded.
Booster Pump _ Copies
SUBTOTAL
APPROVALS Penalty
Planner TOTAL
Council
Bldg. Off. I?Jv
Variance
Phone #
vAcLV.?TIp
G ARAGE '
02vx22-=. yyo x?5= ?600
02y ?c y6 = ll04 X 14= 15`-/S?
Isr PLop?
ssm-r_ ll b?
12y?%z= !g
2 x '7 - / L/
_----
1 I 3?? 5 I= S 7? 3L
pian
? engir
* ? *?c
ering..
CerEificate ot Survey fpr:
3
n1
?
O
?
z
0
?
N^
Ay
;
2122 Enre,pr13e Drive
Mendoea Heightti, MN 55120 (612)681-1814
?I
/1D/<SKA
aA o1I L i O tN/ pR i U E'
79 /9 N 89
i o
g I ?
?y.19 M12733 T ?5,Q
? o
T N C? N I I?
n N
I o ?Ra/'?]En M I
( H ?'??VS? Q
trif9 4b.o N IS.o _
? 4g,o
I
?
,
78,79 N89°59
r 900.00 Denafes Exisf,nq Elevations
K ao.oo Denofes proposed Eievafions
------- DenofcsOrajnn0e fc%'r/ify Easeme17{
-- -- DenofPS Orcrina?P T-low xlrrows
o Uenofey Monumen l
iqeorinj5 Shoavn are p,?jUn}pd
?
M
d'
4
?
'Z
NORt}4
;r
:
?
;
_--
? . . .....
?
P ` ?^5
7.-i.E;
P,vocns?o NovsE EcFVAr oros
(owesl Floor Eicvqtian _ 98Z .2Fs
F ot"Slock Elevolion g es. 2?
ra?e S%ab clevahon y q g q..q.5-
q UPRpICS oF'{'se* llvb
TG
ry
d
r'y
?
LoT!4 BL oc?_2, L EX?NqTON POIIVT ADD! 7"CON A/0. 6.z
DAKOTR Caurvr;-m1NN f
an? :nr,=cc rnpi..sen.,,?nn p! a;urv.ry of rh= bnund????;+r,( in? nho?.• r•;.•?hrd I nd inil nf hi
oCatio. of all
yil rr,ibl5 =nrrn.;:??n'??i,•• ?f any, from oi on rvitl I?nA A5 survaYed I+y m= th.5?l?_•?.?y ^f? A.D. 19?.
I£ ?nch
SCa- ?---
?
.?_'___" _'"____'_'____"_'_______'____________ " __"_____"__'___'_______"_'"'____ " " "_'_______'__--..
?
, ,geraem-.1 #121i4
MINNESOTA STATE ENERGY CODE CALCULATIONS
BASED ON CHAPTER 5 OF THE
MODEL ENERGY CODE - 1983 EDITION
Adoption Effective 1/1/
Owner Phone Date' e
?JSite Address l..CtT' 14+.5 1-0GrK ? LEX/NG'fVN PbiNrE 6714,4DDTl00
. I
Contractor (VC71et:?? HOIv1F_S Phooe
Building Classification: Type Al (Single Family E Duplex)ype A2(Res(dential)
(3 stories or less
NOTE: Complete pages 3 and 4 first. ; (Other) (Over 3 stortes) GENERAL INFORMATION
1. N +
Building Perimetert-? 11,pF?, ?-T ft.
2. Wall height (ground to eave) N ft. , -
3. ?Y ? Z
1. x 2. (above) gross wall area (.?/ /i ft.
4. Building dimensions (L) - X(W) ft.2 roof b floor area
5. Square foot area of rim joist - Floor Joist 'size (2 x ct )
2
?
Cal
/G? X Perimeter = Rim oist area = ft
. ..
,
12 3 . . .
.,; ?;,;,
. .
6. Doors - A'rea t!51'i I?
Thickness in
Type of Construction
Manufacturer
7. Total door's perimeter
ft.
?
8. Windows: Manufacturer lf\KUL State approved
, U factor
TYPE SIZE AREA (Ft.2)
. EACH
?GE?T N
9. ToCal ft.Z Glass ZO`j,tJ
NUMBER OF TOTAL FEET 2
UNITS '.
10. Fireplace area; Width X helght = X =
1?
11. Exposed foundation; Height X Perimeter X- 7,
COMPLETION OF THIS FORM IS REQUIRED FOR ALL , N TR CU TION, MAJOR REMODEL
MOVED WHERE ENERGY, OTHER THAN THE MINIMAL CODE ALIOWANCE, 15 USEO.
U factor r ? i?1 •
Perimeter ft.
Ft.?
2
5 BEI
?2. Eraming area = 10% of gross wall area.
? /?
13. Gross wall area l?(DT i zZ
ft.2
Window area A ft.2 U windows U x A =
Rim joist area A ft.2 U rim jolst =0_ U x A 3 4? 19>7_
' Door area A' ft.2 U door area = o U x A =
D
I I '?yhfe?area. A ?Z ? ? ft.Z
U,?e = U x.
A
=
(?? 2
Exposed foundation A ft.z
U foundation U x
A d
=
framing area A?(O( ?17?r SLft.Z U framing area =.0?5_ U x A = `?? ?7
Net wall area A ft. U wall = ?0?3 U x A = 53,25
TOTAL . . . . . . . . . . U x A - I-IS'
•
14. 6ross wall area z 0.11 (A-1 single family & duplex = allowable U x A/Code
(13. above) .
A
x 0.23 (A-2 other residential)
x .23 (Other buildings) •
x .28 (Over 3 stories) .
(N l?? r ZZ x U Code..o
15. Ceiling framing area (Ap) equals 10% of ceiling area
r1 Z?710?BTUH Must be larger than
L F. 136 above
or the. same as) .;
15A. Gross ceiling area =(L) ? x(W) ? = Z Z ft.2
158 Joist ared (Af) = 10% ceiling area = ! I? ?i ft.Z
.I
15C. Net ceiling area (Ac) (15A - 15B) = 1 0 ?? ft. 2
U ceiling x A c_ 107"2 x D?? =• ZZ, 7,7
?
U framing x A{= t 02?j x t I7i = CJ
15D. TOTAL'U x A ........................................ 4. ?
16. Ceiling area (15A) x 0.026 (A-1 single family & duplex - tode allowable U x A
x 0.033 (R-2 other residential)
x 0.06 (other) '
? I I pZ(p -7 BaUH Must be larger than -15D (above),
A(15A) x U(code) = 2? I ? I F (or the same as )
NOTE: Use U and A values obtained from pages 1,-3 and 4.'
CERTIFICATION: I hereby certify that I have calculated the "U" factors and "R" values
herein and that the building here described meets or exceeds the State of Mlnnesota
Energy Conservation Act. •
te
gnacure
2.
??s4k(?f?4c?+ ZS,S.tzs?s)= 13c??2Z _
-- -
? I I z z ? -- _ - - - -- - - - =
---
I? __---
- - - _____ ---- . ? -
I71? !' ??/? ?V/ ? F/? l ?x ? ? /?17? j -? - -- ___ .. . . . . ... . . ......
???c< O - - _ . _. ......,
??° ----- - - ----- - ? --
---_.
- ---- - - -
- - ? _ . . :..; t. ...
??-°-- - -- - -- - - -- - --- ? _ . . --
? -- --- ----- - -- - ---------- - ------ ? . .
WALL '
SECTION
I, '_
STUD
SECTION
2N0 NALZ
S EC'f I ON .
v ¦nLuG bnWUlHI [VI\J . . ... . ..
ALUE U VALUE
Inaide air Eilm .68 '
Interior wall (Nall) U . R
Insula[ion 11,0o '
Sheathing Z,GYp
Siding ,(p-]
Outalde air Eilm .17
R 'fOTAL
? . -
Inaide.atr film ? .68
Interlor wali •?
syd R= e(i?AO (0,= (Ftaming) U= R `• OC]?
r ,
Sheathing , 7-1 D(O
Siding
Outside air fllm ' .17
68
(41a11 ) ?U - R •
[ning
Extertor ws ring
ExGerior air f[lm R ..
R1M
JOIST
y ? ?? Y ~ Ina[de 1air?Eilm
Interlor watl
... ..
\
• ? ''?. `,ra e
lntertvr air film R= .68
Insulation lI,Oo I
1h inch soft wood R=1.88 (Rim U
3? E
JOiSt)
Sheathing Z'0(o
Exterior wall coveting ,(07
ExterSor air film Ftz ,17 .
R TOYAL z4
+0
•
Interior air Eilm R= ,68 ,• ?
Insulatton J?.DO
FounJa[ion
1. ZS (Fdn.) ,
U
Extertor air film R= .17
-
F TOYAL 71I 3
?
`Bxposed Hluck ,
R 'fOTAL
3.
41.rVIt,
CEILING WITH YENTED ATiIC SPACE ABOVE
? R 'lALUE UE . ,
FRAMIN6 CEILIWG
? 0.61 Air Film 0.61 -r .
Insulation
s q-.38 Joist . .
?
0.61
Z.
.d Z ?J
•T?
Ceiling .5(4P "
Air Film 0.61 "
Total R 4j5;. -70
1
u=?
FLAT ROOF OR CATHEDRAL CEILING
R Value R VALUE
FRAPIING CEILING "' .. '
0.61 Inside air film 0.61
• Ceiling
? Joist (stu '
Insulatian
Air space •
Roof decking
Insulation
Buitt-up roof
0.17 i Outside air film 0.17
' Total R -
1
- •
_ u
R
lindow infiltration .5 cfm/lineal foot of crack
tesidential doar lnfiltration 0.5 cfm/square foot or door and minimum code requirement
,lon-residential door infiltration 11.0 cfm/lineal 'foot of crack
Jb 12" concrete block no insulation =.41 R 2.1
!b 12" concrete block insulated cores =.26 R 3.8
1b 12" lightweight block =.32 R 3.1
Jb 12" lightweight block insulated?cores =.12 R 8.3
1 single glass = 1.13; with storm window .54
J double glass = .55
J triple glass = .41
all exterior walls and ceilings must have a vaaor barrier (0.10 perm max.).
:avor barrier must be on the inside (heated side) of wall.
lapor barriers of the polyethelene thin film have no R value.
,.
4.
PERM? t?
'
(.1to i
/
CITY OF EAGAN
1992 BUILDING PERMIT APPLICATION APR 2 0 RECo
681-4675
SINGLE 8 MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy
calcs.
COMMERCIAL 2 sets of architectural & structural plans, 1 set of
specifications, 1 copy of er?ergy calcs.
Penalty applies when typing of permit is requested, but not picked up by last working day
of month in which re uest is made or lot chan e is re uested once ermit is issued.
Date 4 ?- Z?o Valuation of work
Site Address: Y3-7-.6 ?'//1s.i 6S/43
STREET STE ¦
Tenant Name•?M?-r,tis -
LOT ?'E' BLOCK ? SU80.
tl
C4 P.I.D. I '
Descri tion of work: c-
The applicant is: 4 Owner ? Contractor O Other (oeccriee)
u-/an?5 22? Phone
Name? {
Property T
LAS4 FIRST
Owner pddress Y3??
STREET STE #
City State m^-' Zip 551 -Z' 3 _
Company Phone
Contractor Address License # Exp.
City State Zip
Company Phone
Architect/
Engineer Name Registration #
Address
City State Zip
Sewer 8 water licensed plumber . Processing time for
sewer & water permits is two days once area as been approved.
I hereby acknowledge that I have read this application and state that the information is
correct and agree to comply w' h all applicable ate of Minnesota Statutes and City of
Eagan Ordinances.
? '
Signature of Applicant:
Urrwe uar unLr
BUILDING PERMIT TYPE
? 01 Foundation ? 05 Apt. Bldg 0 09 Basement Finish
? 02 SF Dwg. O 06 Garage/Accessory ? 10 Swim Pool
? 03 Two family ? 07 Fireplace ? 11 Res. Add./Porch
O 04 Multi-fam. T.H. F OS Deck ? 12 Comm./Ind.
WORK TYPE
31 New
? 32 Addition
? 33 Alterations
? 34 Repair
? 35 Tenant Finish
? 36 Move
GENERAL INFORMATION
Const. (Actual
(Allowable?
UBC Occupancy ?
Zoning
# of Stories
Length
Depth «•X ? 2•
APPROVALS
Planning
Engineering
RE(dUIRED INSPECTIONS
? 37 Demalish
? 99 Undefined
? 1;3 Public Fa?.-
? 1?4 Agxicultural-
? 15 Miscellaneous
Basement sq. ft. MWCC System
lst F1. sq. ft. City Water
2nd F1. sq. ft. PRV Required
Sq. Ft. total Booster Pump
Footprint Sq. ft. fire Sprinkler
On-site well Census Code ?
On-site sewage SAC Code
Building LS % 2i•9z
Yariance
? Site 17? Foating
? Wallbaard CCFinal
? Framing
? Draintile
0 Insulat9on
? Fireplace
Permit Fee .23. c-30 yaiuatip„
Surcharge So
Plan Review `
license
MWCC SAC
City 5AC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Trails Ded.
Copies o 0
Other
Total:
SAC %
SAC Units
s
Assessments
eerina..
#
?1 n
Certificate oi Survey for; I"/Or, S/\ ,4 J T QmC S
?
NoatN
(-IA m 1L7 ON DR!
y9/9
A
3
n?1y
_y
Q
, ?z
11?
,^M
?
91
?5.?9 Zo.33
n
}I N C? ? H
1 N
I ?u
?I
N 89 °59 '17"L
? 19.0
I IM
o Reel?o?ev ?^
M I
? N NOVSE p
40.o N I5,0
O
as•° ?-3`!? ?
?
M
?
?
0
?
2,1:: Enlv.pnsG Driv! Mendota Heighfs, MN 55120 (612) 681.1914
1 VY " (
78,19
! 300. 00 Denotes E.Yist,r,j f%evahons
? oo.oo Denofes Oroposed Erevafrons
----- -- Ornofcs Ora?r?-17je i"r/,'r/;{y Ep5en72q/
-- -- Denofes Oraina?e clow xlrraw•s
o Uenofeg tilonumeni
QCafil7J¢s shown vre as-lruv7ed -
?
.. .. . , .-.? %. . .
pA0Po5£D NOUSE ELEi?AT ONS
Iowesl Floor ElFVOtron 937 zg
7" o,'elcc? £levofron q es. ze
((ra?e Sr`ab E/cvaft on _ q g ¢.q5
o Uennlcr of'f`'sef u,,,b
L0T!4 aL ock_?, LEXIIVG'TON POIIVT ADDI7"ION N0. G
Darlara Co[iNrr , MINN
t harery certify rhae `- 11 a 111,,, .:..d ?pr.oct roOfe?E??t.pinn nf , ;i,rrvey of rhe bUUndarif- nf rho ?hn,., ;,ii,•%j 13,{ anp Vf :ha Ioeition o1aII
bulldlllp:. +hPrpnn, ?r,n all .,ihlp enf.rn..chn'ipurs, rf pn'i. from of on ?i(1 13nr1. A: SarvFVed hY m_ thotA.D. 79-90.
i ?
S`U/l? ?InC{l:
Il Zv3 -- "--- R?J8F0 Il. nlP:i =F1 l S 0.[.?.. V O. ]?Q 1
?
? CITY OF EAGAN
, 3830 PIIAT KNOB ROAD
EAGAN, MN 55122
PHONE: (612) 454-8100
"GW
??E?TTTAS.`:; PLEASE COMPLETE IIPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS &
?TOWNHOMES/CONDOS WkiEN PERMZTS ARE REQUIRED FOR EACH IINIT.
WORK AESCRIPTION
NEW CONST
ADD ON _
REPAIR _
OWNER NAME : wea 5K/9 ????'7G25
SITE ADDRESS: y326 N?w/t- 710'-?
LQT:? SLOCK A StiBD. 6
INSTALLER: I'vG o&'40mvrr?-5 /?GUM/E g? /??
ADDRESS: 12.33"D 42102 /21/JIQ s& ,:od 4dD
ciTx: Bo/a..'?svic,"A ZIP: S S_? ? J
PHONE #: xf ? O --7 D $eV
FEES
G.A?IM?YtCT¢lIi/1NnIT5xRUA7:?' PLEASE COMPLETE THIS PORTION FOR ALL COMMERC IAL/INDUS TRIAL BUILDINGS,
APARTMENT BUILDINGS, AND MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE
NOT REQUIRED FOR EACH DWELLING UNIT.
CONTRACT PRICE:
OWNER NAME:
SITE ADDRESS:
IAT: BIACK _ SUBD
INSTALLER:
ADDRESS:
CITY:
PHONE #:
FOR:
CITY OF EAGAN
( S IGNATITRE )
ZIP:
FOR CITY USE ONLY
PERMIT # A? ?Y"Y
RECEIPT # D /O S
DATE: ? ?
FEES
ADD-ON MINIMUM $15.00
HVAC 0-100 M BTU 24.00
ADDITIONAL 50 M BTU 6.00
GAS OUTLETS - MINIMUM 3.00
OF 1 PER PERMIT
SUBTOTAL: $ Z 7
STATE SURCHARGE: .50
?
TOTAL: $ 2 7
S'GNATURE OF PERMITTEE
V
18 OF CONTRACT FEE.
STATE SURCHARGE _ $.50 FOR
EACH $1,000 OF PERMIT FEE.
FROCcSSEU FIFING = ?25.00
$25.00 MINIMUM FEE.
CONTRACT PRICE x 18
STATE SURCHARGE $
TOTAL:
CITY OF EAGAN
3830 PILOT KNOB ROAD
EAGAN, MN 55122
PHONE: (612) 454-8100
rmpq7pw%
FOR CITY USE ONLY
PERMIT # A?24f:r
RECEIPT # 4O10 0:75
,
DATE: 1117191
j?u?F.?TTTAYi?= PLEASE COMPLETE IIPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS &
TOWNHOMES/CONDOS WHEN PERM2TS ARE REQIIIRED FOR EACH UNIT.
---------------°-----------------------------------------------------------------
WORK DESCRIPTION
NEW CONST _
ADD ON _
REPAIR _
OWNER NAME
SITE ADDRESS.
:.oT:? s:.ocx ? susD.
INSTALLER;
ADDRESS: ?ddSO ?VEO.? /?O'?' ?2VO'?
CITY: ???/?^?^SV/G?.? ZIP: .J5337
PHONE
SIGNATURE OF PERMITTEE
COMPLETE THE FOLLOWING:
N0. FIXTURES EA. TOTAL
ADD-ON MINIMUM 15.00
SHDWER 3.00
1 WATER CLOSET 3.00 ?=
/ BATH TUB 3.00 8
? LAVATORY 3.00 3
? KITCHEN SINK 3.00 5_
? LAUNDRY TRAY 3.00 `S
HOT TUB/SPA 3.00
? WATER HEATER 3.00 1_
_ Fr.aoa D?,?.a 3.00
GAS PIPING OUT.
? (MINIMUM - 1) 3.00 'S
? ROUGH OPENINGS 1.50 .4,To
_ OTHER
WATER SOFTENER 5.00
_ PRIVATE DISP. 15.00
U.G. SPRINKLER 3.00
SUBTOTAL S 1 S • ?O
ST. SURCHARGE .50
TOTAL: S 1(? , o D
?'OMMERGIlII:??NI1tI$TI?Ii47::: PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS AND
MULTZ-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH
DWELLING UNIT.
CONTRACT PRICE:
Ow?-ER IQAMB:
SITE ADDRESS:
LDT: BLOCK _ SUBD.
INSTALLER:
ADDRESS:
CITY: ZIP:
PHONE #:
FOR:
CITY OF EAGAN
NG/?5/y/q 4o1'1?ES
. IL44/'?iL To nl
FEES
1% CF CON::kCT FEE.
STATE SURCHARGE _ $.50 FOR ?
EACH $1,000 OF PERMIT FEE.
$25.00 MINIMUM FEE.
CONTRACT PRICE x 18 $
STATE SURCHARGE $
TOTAL: S
(SI NATURE)
145?1
2006 RESIDENTIAL MECHAMCAL rExntiT ArPLicnTioN
City Of Eagan
3830 Pitot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please comple[e for: single Family dwellings & townhomes/condos when pertnits are reyuircd for each uni[
?" C?o
Date 5 / ? / 0cp
Si[eAddressyYtn Ha+n,t`-?m ?, A Unit#
PropertyOwoer UY\?4TI)m LQ C?.?S? Telephone#((fl5' )3y1-?9ZT
Contrector ?hVPx mi?Li?P?`?' ?Q \C).Y1-?
StreetAddress 51t5 lY&1.S11 1.A ? /,11Ce±- City
State rn?\) Zip 55354 Telephone#
Bond #: 9Z9z_A RICA Expires: II LO ) b (-P
The Applicant is _ Owner X_ Contractor _ Other
Add-on or alteratioo to existing dwelling unit $ 30.00
? fumace *Additional ?Replacement _ New
air exchanger
air conditioner
X_ heat pump
other
State Surcharge $ .50
$ .
Total -
1 hereby apply for a Residential Mechanical Permi[ and acknowledge that the infortnation is complete and accurate; that the work will
be in wnformance with the ordinances and codes of the City of Eagan and with the Mechanical Codes; [ha[ 1 understand this is not a
permit, but only an application for a permit, and work is not to start withou[ a pemiit; [hat the work will 6e in accordance with the
approved plan in the case of work which requires a review and approval of planf. ^ n
Applicant's Prihdd Name xCpplicant's SignatiQfe
Use BLUE or BLACK Ink
i For Office use
4bo 1
Eap Permit* City of Ul I Permit Fee: 6 1~ a I
3830 Pilot Knob Road 1 - 1
Fagan MN 55122 Date Received:
Phone: (651) 675-5675 I i
Fax: (651) 675-56% 1 Staff 1
t
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: site address- Y 3 / (D unit M
Name: Phone:
Resident/
Owner Address / City I Zip: CA-<.- RAJ MA 51 Q-
i Applicant is: Owner Contractor
pry of Work Description of work: Re f,6 (}F
Type
Construction Cost 0d Multi-Family Building: (Yes I No
Company: 4)V'C'5+&r 9,N Jq0 Dr UC- Contact V 'e o i/\
Contractor Address: 22,01 L' G-~-- City: 13UI'A Uz
s
State: _ Zip: 3d b Phone: Cg~~^ L~'® 3
License Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
a 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 plant?
Yes No If yes, date and address of master plan:
u
Licensed Plumber: Phone: j
Mechanical Contractor: Phone:
1
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. Cali 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:oooherstateonecall.org
I hereby acknowledge that this information is complete and agate; that the worts will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit,, that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authortzed by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
S
X. X
Applicants Printed Name Applicant's Signature
Y~,eo r Page 1 of 3 A f, e-, A -5,
Use BLUE or BLACK Ink
4b~ Co I For Office Use---- I
on t ~S
ity Of l ~1 La on Permit#: E Permit Fee.
3830 Pilot Knob Road
Eagan MN 55122 Date Received: j
Phone: (651) 675-5675 I
Fax: (651) 675-5694 I Staff. I
L
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: 437to Ar^ \)+/5A Unit
Resident/ Name: TOM Phone:
Owner Address / City / Zip: LI 3 -7~ Moni 11 aQ DF_
Applicant is: Owner Jsl Contractor
Teeg- d Ff f3Rck SI E ® /~vyse and re si c
Type of Work ` Description of work:
Construction Cost: 000 Multi-Family Building: (Yes / No
Company:
~~5 Contact:
3 Address:) 20t City:
Contractor i
State: ~ l Zip: m O ~ Phone:
License Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
p the information may be classified as non-public if you provide specific reasons that would permit the City to
i conclude that their 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 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 wort( which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be mpleted within 180
days of permit issuance.
x IeVIA Ems- x `
Applicant's Printed Name Applicants Signature Page 1 of 3
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA139984
Date Issued:11/17/2016
Permit Category:ePermit
Site Address: 4376 Hamilton Dr
Lot:14 Block: 2 Addition: Lexington Pointe 6th
PID:10-45090-02-140
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:One Window/Door
Census Code:434 -
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: 500.00
Fee Summary:BL - Base Fee $500 $40.00 0801.4085
Surcharge - Based on Valuation $500 $0.50 9001.2195
$40.50 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 -
Thomas J Walsh
4376 Hamilton Dr
Eagan MN 55123
Renewal Andersen
1920 County Road C West
Roseville MN 55113
(651) 264-4777
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA164098
Date Issued:09/18/2020
Permit Category:ePermit
Site Address: 4376 Hamilton Dr
Lot:14 Block: 2 Addition: Lexington Pointe 6th
PID:10-45090-02-140
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Softener
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
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 -
Thomas J Walsh
4376 Hamilton Dr
Eagan MN 55123
(651) 341-1927
Milbert Company (culligan)
1801 50th St E
Inver Grove Heights MN 55077
(651) 451-2241
Applicant/Permitee: Signature Issued By: Signature