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509 Hawthorne Woods DrLITY OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55123 (812) 681-4675 SITE ADDRESS: SPECTION RECORD PERMIT TYPE: Permit Number: Date Issued: 1 11 t = 37 Ili.?)i I ?ttll??ti?N? tt+?i?Ir?: tri; PERMIT SUBTYPE: APPLICANT: i Mt • ?? . h . TYPE QF WORK: INSPECTION .. . .. , ! it t M!!i:l: '. . f'1 ? 14 {' 1 f+l* .;_ 111 A it 1' 4 1 ? ? Permft No. Permit Holder Date Telephone # 5NV PLUMBING 5O HVAC ELECTRI ELECTRIC Inapection Date Msp. Comments Footings I Foundation ? Framing ! Roofing ?O Plbg' Rough Htg. _z? cf Isul. 911 Fireplace .?? I/ l I7' `! y_ ?. - 9y Final Htg. Orsat Test Final Plbg. Pibg. Inspector - Notily Plumber ConsL Meter Engr./Plan Bldg. Final ? G??? S?• ?l J l?a? Deck Ftg. At 460 IIOAC.' Deck Final Well Pr. Disp. r- CITY OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55122-1897 (612) 681-4675 SITE ADDRESS: i ??? :sl rs?,?? r 11AW11101:141 WOOb:; OR :;?6?? ?tuFrlt ii??n?r; :FlD ? f PERMIT SUBTyPE: ; : ;•, • . I r.s, ? ? , ; ? r1 ? NI PERMIT TYPE: H"" 11 ' Permit Number: ?? •? r '? ?'? Date Issued: '"• f ??' ? "NA1:IIMIAN ( E, 1 .' ) 4 56 - Sr,F, r- TYPE OF WORK: fIAl I INSPECTION DA • .A ; I?tli?l! I f{ ! I(??? I f N!1 i ? i•: MAtti+ys n 5f.iIARAlF wfltlntI 1•-, Rf:Oto tHF[? NAi< 'ANY t-°tt114HFNO nR F.- LErftili:At WOui 7 ¦ r Permft No. Permit Holder Date Telephone N ELECTRIC PLUMBING HVAC Inspection Date Insp. Commenta FOOTINGS FOUND FRAMING ? ROOFING ROUGH PLUMBING PLBG AIR TEST ROUGH HEATiNG ? GAS SVC TEST INSUL GYP BOARD FIREPLACE FtREPLACE AIR TEST FINAL PLBG FINAL HTG ORSAT TEST BLDG FINAL 1 -s WtL'tiftCRte Df CCClilpQ1[C4 ?it?j of ?agau ?- cur ? ???? ??Otction This Certificate issued pursuant to [he requirements of the Uniform Building Code certifying that at the time of issuance this structure was in compliance with the various oidirtances of the City regulating bui[dirrg corrstruction or use. For the following: Use Classifiption_ SB m BWg. Permi[ No. 221W ooup-y Type R3/M 1 zoniog oasmia R 1 Tya Const. V`1 owner orewiaing fleatrF M1S TW. ndaren G304 LYrIDA1E AVE S, EIIM sLuwing Aearcs 5pq HAWTHIRNE_ki]MS i]liiVR t.«caiiry I37. B2. HA4IBOM WCICOS 2M BaildingOfF" " POST IM A CONSPICUOUS PLACE !Mfe2rdi L! REQU EST FOR ELECTRICAL INSPECTION ''? esaooo, oe ?J ? See msUUCtions lor Itns form on back oi yellow capy 3 5 0 •XWork Covered by This Request e ...,d Rep. rypeofBuildmg ApphancesWired EquipmeniWired Home Range Temp0r2ry Service Duplex Water Heater Electric Heatlng Apt Bwlding Dryer Load Management Comm./Industrial Furnace Olher (SpeCify) Farm Air Conditioner Othei(specityl Contractoi Remarks Compufe Mspechon Fee Below. X Other Fee S ServiceEnfranceSize Fee # Circuits/Feeders Fee Swimming Pool 0 to 200 Amps ? 0 to 100 Amps Transtormers Above 200 _ Amps Above 100 _ Amps SI(JOS Inspecror5 Usa Only. TOTAL Irrigation Booms Special InSpection Alarm/ COmmunication VDS)ISCO A*A E O E NNECTED IF NOT THIS INSTALLATION Other Fee COMPLETED WITHI ON I, the Electrical Inspector, hereby Rougn-m oaiei a,y certify that ihe above mspection has been made. F,nai ? aie (p- OFFICE USE ONLV This request voitl 10 months Irom / / C9 ??3 5 0 3 ? ReQUest Dete r No Rough?ln InOSecnon Reqwmtl Inspecnon Other T a ougn-In (VOU m tall i?s0ector when readyl 0 qga0y Now?W AI Nohly Inspector Vea ? N. DateFeaC ? ? Alicensed contractor ? owner hereby request inspection of above electrical work at: Jo0 Atltlresel BOx or Rome No ) Qry D ? ?_ Section No Township Name or No Range No Coun ? Occup ?PRINTI ? Phone No Power Sup _ aaress Elecmcal haclor (COmpany Name ? ConVactor5 License Mailin atlre ss fC Irachor or Owner Making Installabonl ? j / Autborrzed Sig Wre fConhacmr/Owner Makin g InstallaLOnl Phone ber / C./ MINNESOTA STATE BORND OF ELECTRICITY v? THIS INSPEGTION REOUEST WILL NOT ? GrIgga-MidwaY Bltlg. - Hoom S-113 BE ACCEPiED BY THE STATE BOARD 1821 Umversity qve, SI Paul, MN 55104 UNLESS PROPER INSPECTIpN FEE IS Phane (BtY) 642-0800 ENCLOSED 1N I I 0 I?I II REQUEST FOR ELECTHICAL INSPECTION ????,?_ Minnesota State Board of Electricity ? 1821 U( ivereiry Ave., Hm. 58,St Paul, MN 55104 ??? * ? 3 24 3 6* Phone siz) saaoeoo Home Apt.8ldg. New Addn Commeraol Indusfrial Farm Remod Re air Air Cond. H}g. Equip. Water Hh. Load Mgmt. Other: D er Ran e Elec. Heaf Tem .$ervice 'R' above fhe work covered by this request. Enter remarks in this space ond on fhe 6ock of ihe white copy only. Cafculafe Inspection Fee - This Inspechon Requesl wJl nof be a<cep}ed without ffie correcf fee: Olher Fee A $ervice Enhance $ae Fee # Circuih/Feeders Fce Mo6ile Home Park Stall 0 to 200 Amps 0 to 100 Amps Sireet Ltg./rraHic Sig. Above 200 Amps Above 100 Amps Tronsformer/Generotor iNSPEC7oR'SUSEONir TOTAL Sign/Ou}line Ltg.Ximr. 6 Alarm/Remate Con}rol $wimming Pool I here <afi th im the eleanml in onon esmbed herei an Me daks swkd Irrigation Boom Rough-In Daro S etial Ins ecfion ? p p Investiguhve Pee final THIS INSTALLATION MAY 8E ORDERED DISCONNECTED IF NOT COMPLETED WRHIN 8 M N S. ? 27 /` ?* 243 OFfl E USE ONLY Th,s requesf void 18 momhs fmm validahon dob pnnled in Ihu 6ox. ,1'6/7/s'17 ? PLEASE PRINT OR TYPE 7 ? ?jn ??p ?d / Requezt Doie Rough-in inzpedion reqmred2 Yes ? No Inspecnan OlherThon Rough-In. 0 Aeady Now ?II Call ?? S lYoo most call Ihe mspecror when dy? 0ote Ready I, ? licensed confracfor owner hereby requesf inspecfion of }he above elecfntal work at, Job Pddress (9reet, Box, or R.O. No ) Gry Zip Code 3 G o ?e ? ? ?e ss/? Sedion a Township Name or Na Ronge N. fire N. Coanry Ocwpant b Phone No Power Supplmr ndd,i.. Elecmwl Contracror (Campony ome) N Contrador Lcense No Masror Lc Na ?Plam Elect.Only) ?r ? S? r Mailing Address (Conlmtlor or Owner Perfortning Insmllanonl Authonxed Sign ao ao er Performing Ins lanon) - ? Phone Na. r? Lj?Lo A EB-OOOOlA-10 TW v - "A77YFEBOA1iDCOPY•SEEINSTRUCTIONSONBACKOPYELLOWCOPY Address 509 xawixoRNP woons njpvE Zip 55123 Lot° 37' Blk ? Sub Nawiunuw, r.mT)s ?.,n THESE ITEMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECTION. Date: f Yes No Inspector: Final grade (6" from siding) Permanent steps (garage) Permanent steps (main entry) Permanent driveway L/ Permanent gas Sod/Seeded grass TraiUcurb damage Porch Basement Finish L/ Deck V/ Please verify with the builder the removal of roof [est caps from the plumbing system and the shut-off of water supply to the outside lawn faucet before freeze potentlal exists. , Contac[ engineering division at 681-4645 before working in righbof-way or installing underground sprinkler sys[em. White - City Copy Yellow - Resident Copy Pink - Contractor Copy (D ( ' 'f CITY OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55122-1897 (612) 681-4675 SITE ADDRESS: P.I.N.: 10-32151-370-02 PERMIT PERMIT TYPE Permit Number: Datelssued: 509 HAW7NpRNE WOOpS DR LOT: 37 BLOCK: 2 HAWTHORNE WOODS 2h1D oyw 15?oAk5'7 BUILpING 927994 05/@7/96 DESCRIPTION: BflSEMEN7 FINISH ALTERATION 434 ALT. RESZDEN7IflL a? ?a .a?i sie ?2, iw-= '.-a ?e `aafi REMARKS: A SEPARATE PERMIT IS REQUIRED FQR ANY PLUMBING OR ELECTRICAL WORK FEE SUMMARY: 8ase Fee $50.00 Surcharge $.50 Total Fee $50.50 CONTRACTOR: OWNER: - Applicent - NACHMAN DALE 509 HAWTHORNE WQQOS DR ? EAGAN MN 55123 (612)456-5666 I E a .f Y? ...4 I tE ?.t• E• :•• ? A• ?} . Lak ?v? g ? •? T 61?k"???a+ „i?0AS75EY??S1?? C?7?.k' Sfl? :d[7Cl S"??-`?''?`? '??7i?'G ?C}78' - `.xr?fi?rmat:tvn e" tcy`, cr?jmply vxtE? r??1 ?pp??b?.e g `S tatu?es ??.? a<< e ? 1 1f1lt/1 ?,nir? ? ? APPL -A R E RE 'f58V . 51 T CITY OF EAGAN 14434 3830 PIIOT KNOB RD - 55122 '??Q •?Q 1996 BUILDING PERMIT APPLICATION (RESIDENTIAL) 681-4675 New ConsWdian Reauirements RemodeVRepair i ^ ? 3 re9istered ske aurveys ? 2 eoPies of plan ? 2 aopies of plans (inchide beam 8 wfndow skes; poured fnd. design; etc.) ? 2 site surveys (ezterlor additions & decks) ? i emtgy ??latwnq ? 1 energy wlculaGons tor heated addilians ? 3 eopiea ot tree preservetion plan H IM pleHed eRer 7l1193 required: _ Yes _ No DATE: CONSTRUCTION COST: DESCRIPTION OF WORK: LOIULYC LLJ-/L-L 6/rrN20ln- -` r3'DYIGY/1"- - STREET ADDRESS: ,{??FAU??6 wmg DIZI(16- LOT BLOCK ? SUBD.IP.I.D. #: f 1i,ift - PROPERTY Name: Uw Phone #: OWNER Street Address• Ciry: State: bAi`} Zip: CoNTRACSOR Company: Phone #: Street Address: License #: City: State: Zip' ARCHITECT! Company: Phone #- ENGINEER IVame: Registration #- Street Address• Ci{y_ State: Zip: Sewer & water licensed plumber: change are requested once permit is issued. Penalty applies when address change and lot i hereby acknowledge that I have read this application and state that the information \ corcect and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. I 5ignature of Appiicant: AIV , . 3 OFFICE USE ONLY (?C?C?L?0?91?D Certificates of Survey Received Yes No - - ?ap" g ? ??? Tree Preservation Plan Received ` Yes _ No OFFICE USE ONLY BUIIDING PERMIT TYPE r, ? . . . +? '? r+ "? `• 3a r ?; ...i . ...' w .++ +A+?i.. ? 01 Foundation ? 06 Duplex ? 11 Apt./Lodging 6 Basement Finish ? 02 SF Dwelling ? 07 4-plex ? 12 Multi RepaiNRem. ? 17 Swim Pool o 03 SF Addition o 08 8-plex ? 13 Garage/Accessory ? 20 Public Facility 0 04 SF Porch ? 09 12-plex ? 14 Fireplace ? 21 Miscellaneous 0 05 SF Misc. ? 10 = plex a 15 Deck WORK TYPE ? 31 New Altera6ons ? 36 Move 0 32 Addftion o 34 Repair o 37 Demolition GENERAL INFORMATION Const. (Actual) Basement sq. ft. MC/WS System (Allowabie) Main level sq. ft. City Water UBC Occupancy sq. ft. Fire 5prinklered Zoning sq. ft. PRV # of Stories sq. ft. Booster Pump de ? C C Length sq. ft. . ensus o Depth Footprint sq. ft. 5AC Code Census Bldg _L Census Unit 6 APPROVALS Planning Permit Fee Surcharge Plan Review License MC/WS SAC City SAC Water Conn. Water Meter Acct. Deposit S/W Permit S/W 5urcharge Treatment PI. Road Unit Park Ded. Trails Ded. Other Copies Total: Buiiding Engineering Valuation: $ Variance % 5AC SAC Units ? CITY ?J? EAGAN 3830 Pilo Knob Road Eagan, Minnesota 55123 (612) 681-4675 PERMIT 0 PERMITTYPE: guzL o:cNc Permit Num6er: 022960 Date Issued: 02( 2 7/ 9 4 SITE ADDRESS: P.1.M.e 10-32151-370-02 DESCRIPTION: 5o9 Nr1WTNORNE WQQDS Dft LOT": 37 BLOCK: 2 HAWTHpRNE WUODS 2N0 6Y11dinq'LPermit Type t?uEldirig W&r'I< t.YPe /"E1BC dCoCtpBnCy`ti f Gbns'CrUGti9t1 ° Bu#lding Widtir. B.yei,ItEia.g •a`Gariss tt SF DWG NEW R-3 M-1 V-N R-1 68 40 2 ????Vy (59 ??g(an REMARKS: PRV FEE SUMMARY: S & W PLBR - STAR PLI3G Hase FeP plan Review Surcharge SAC SAC % SAC Units SubCntal VALUATION $670.50 $565.83 $83.00 $ 8 0 0 .0 O 100 $2,319.33 $166,000 MSSCELLANEQUS 1828.50 Total FeE $4,147.83 CONTRACTOR: - w p p 1 i c a n t- s T. I_ z c. pWNER: DAHLE EftQTHERS INC 18856866 0001647 DAHLE BRDS INC 9304 LYNUHLE AVE S 9304 LYIVDALE AVE S BLOOhIIiVG70N MN 55470 BLOOMTNGTON MN 55420 (612) 888-6866 (612)888-6566 T hereby acknawlodge that I haue read phas apRlicat9.on arad3 stdte that tho ' Infipr `Ca. n Is co r'T;g at?d agree ta ec?mp3.y with alk op?rllcab?.? 3 te t0 6'? ?4r?. ,pi Statute 'P Eagan tard3nan? _ ?.P.(LI. I f I1dJ APPLICANT/P RMITEE SIGNATURE ' ISSUED B: SI NATUR CITY OF EAGAN - , m ift 1994 BUILDING PERMIT APPLICATION v?----%? 681-4675 -. 15 71': r, SINGLE & MULTI-FAMILY 2 sets of plans, 3 reglstered site surveys, 1 copy of energy calcs. COMMERCIAL 2 sets of architectural & structural plans, 1 set of specifications, 1 copy of energy calcs. Penalty applies: 1) when permit is typed, but not picked up by last working day of month in which request is made, 2) address is changed or 3) lot change is requested once permit is issued. Date Valuation work ?AC5 S Sey-t Site Address: "- STREET SU1TE # Tenant Name: (commerc9al only) LOT BLOCK ? ') SUBD. \?d??L?? v???5L \ \,4w I.D. # Descri tion of work:?? The applicant is: ? Owner rwGontractor ? Other (DescrSbe) Name Phone Property LAST FIRST Owner qddress STREET STE # City State Zip Company Phone 88?-LPB?t? COntl'BCtOf Address License # k(04-1 Exp, ? State Z i p City Company Phane Architect/ Engineer Name Registration # Address ' City State Zip Sewer & water licensed plumber Processing time for sewer & water permits is two days once area has been app ved. I hereby acknowledge that I have read this a Plication and state that the information is correct and agree to compl it all ap ic 1 State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applican : ? OFFICE USE ONLY BUILDING PERMIT TYPE ? 01 Foundation ? 06 Duplex ? 11 Apt./Lodging E1 02 SF Dwg. ? 07 4-Plex ? 12 Multi. Misc. ? 03 5F Addition O 08 8-Plex ? 13 Garage/Accessory 0 04 SF Porch ? 09 12-Plex ? 14 Fireplace ? 05 SF Misc. ? 10 Multi. Add'1. ? 15 Deck WORK TYPE ,o 31 New ? 33 Alterations ? 35 Tenant Finish O 32 Addition O 34 Repair ? 36 Move GENERAL INFORMATION Const. (Actual) Vl#, Basement sq. ft. / ylo0 (Allowable) 0Y lst F1. sq. ft. p UBC Occupancy 3/rr i 2nd Fl. sq. ft. 123 Zoning ? Sq. Ft. total # of Stories Z _ Footprint Sq. ft. Length CY__ On-site well Depth 4133 On-site sewage APPROVALS Planning Building Engineering Variance REDUIRED INSPECTIONS ? _Site ? Wallboard ? footing ? final 6 Framing ? Draintile %2 Insulation ? Fireplace Permit Fee Surcharge Plan Review License MWCC SAC City SAC Water Conn. Mater Meter Acct. Deposit 5/W Permit 5/W Surcharge Treatment P1. Road Unit Park Ded. Trails Ded. Copies Other Total: SAC % SAC Units Vetuatfo,: s lo G oa 0 le'?- 3Co,p 30 /?p 7 z ? -5 9,6 r2?o kG9? g? ?? 3,Sk 2z " ?, Z = 12a 13•5?- 11,? _ /55,7$ (ox(? - 3b _ ,?S l23 sa , 64 ? 16 Basement Finish ? 17 Swim Pool ? 18 Comm./Ind. O 19 Coimn./Ind. Misc. ? 20 Public Facility ? 21 Miscellaneous ? 37 Demolish MWCC System City Water ? PRV Required Booster Pump Fire Sprinkler Census Code 5AC Code ? CensUS Bldg Census Unit Assessments . , IAT BIIRVEY CBECRLSBT FOR REBIDENTIAL SIIILDIN pERMIT 71 PLICA ON S? PROPERTY LEQAL: Data of eurvey: DOCIIMEN7° BTANDARDB 0 • Reqistered Lnnd surveyor signature and company 00 • BuilBing Permit Applicant ' 8 • Legal description Address • North arrow and bar scale ?D 0 • Houae type (rambler, valkout, spiit v/o, split entry, lookout, etc.) D-?D 0 • Directional drainaqe arrows with slope/qradient g. 0- 0 0 • Proposed/existing sewer and water services 0 • Street name 0 0 • Driveway ELEVATIONS Sxiatina 13 e-?0 • Sewer service 0'0 0 • Lot corners D • Top of curb at the driveway D?? • Elevations of any existing adjacent homes Yroposed B?0 ? • Garage floor • First floor 0? 0 0 • Lowest exposed elevation (walkout/window) D'.0 0 • Property corners • Front and rear of home at the foundation PONDING AREAS (if apDlicable) 0 0? ? • Easement line D ? ? • NwL O D? El • xwL 0 C3?0 • Pond # designation D 0?- 0 • Emergency Overflcw Elevation D" 0 0 • . 0?D 0 • P,-D 0 • a, n o • D 0% • Lot lines Right-of-way and street width (to back oP curb) Proposed home dimensions fnclu8ing any proposed decks, overhangs greater than 21, porches, etc. (i.e. all structures requiring permanent Pootings) Show all easements of record and any City utilities within those easements Setbacks of proposed structure an8 setback of adjacent existfno homes Ret Reviewed; Cctober 1992 $ITE AD EXTERIOR ENVELOPE AVEiAGE "ll" CDMPUTATION CONTRACTOR: ??? -r-_1 MICx Iki C DATE: 2--j;4-1, 1+ PHONE: DETERMINE tiIORKINf SO,UARE FOOTAGE OF EACH: 1- TOTAL EXPOSEO WqLL AREA,,,,,.. _??gZ ?Q sq ft x"U" 2. TOTAL ROOF/CEILiNG AREA,,_,... gq ft x"U" .026 . ' ? 3• TOTAL EXPOSEO WALL ARE.4 CAL[ULATIQNS: Total exposed wall area above floor,,,,..., sq ft e a) Total wal! wirtdow area: LBL__ 9lazed...... .S - e?21 1? ..s6fL? Q fY x ??U" * '- qlazed...... Sq ft x U b) 7ota1 door area , v ........ sq ft xflu., c) Total slidtng glass door area: 71YBL glazed...... ??.C120 sq ft x 'pull . qlazed....,. d) Tota1 flreplace wall area sq ft x "U" -? sq ft x "U" e) Total wall framing area (Averace 109.),,,,,,,,,, '? tSD sq ft x "U" f) Total net wall area above a a ---_-'-?--- ° ? floor (Insulated)....... _2046??? gq ft x"U" ?L?.? a Z?¢ g) Total rim Joist area...... 25I.Ll.? qp pi x:'U" Total foundation area (Exposed).......... s9 ft h) 7otal foundatlon w(ndow area............. sq ft x"U" t) Total net foundation area above grade........ sq ft x"U" 3. TOTAI a) thru i) • ?,?j if ltem x3 Ig the same as, or less than Item PI, you have met the Inten[ of 2 MCAR 1.16008 A and 0. Page 1 b. TOTAL EXPOSED iIQOF/CEILINf CALCUTAT!OHS: Total exposed • roof/ceiiing area........sq ft J) Total skylloht area....... sq ft x"U" ? k) Total roof/cefTlnq framing area (Averaae In3,)...... 26P,za sq ft x"U" .OZ •_3,41 i) Total net Insulated ?p roof/ceflinq area........sq ft x"U" . D? • ,'7"/ ?+• TOTAL J) thru 1) If to[al of #4 Is the same as, or less than R2, you have met the tntent oF 2 MC.1R 1.16008 A and 0. ALTERtIATE BUILDING ENVELOPE DESIGPI To util(ze the total envelope system method, the values established by the sum of ttems 03 and #4 shall not be greater than the sum of items M1 and 02. i. _ 394, 07 + 2. 3?. ?P OR? 3. 350 .5:5' + a. 2??10 - C E R T i f! C I! T! 0 N I hereby eertTfy that 1 have calculated the "U" factors and "R" values hereln and that the bufldinq here deseri d ets or exceeds?Fhe State of Mlnnesota Eneruy Conservation Ac L ?? "haturel ? - A Print name (Date) Page 2 CITY USE ONLY L ,?,L BL ? ? RECEIPT #: 5(457 5U8D.? Irti??t2. ?? ?n DATE: `5 7 1996 PLUMBING PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55122 (612) 681-4675 Please complete for: ? single family dwel{ings ? townhomes and condos when permits are required for each unit FIXTURES EACH ?Q. TOTAL Shower 3.00 x = Water Closet 3.00 x = Bath Tub 3.00 x = Lavatory 3.00 x = Kitchen Sink 3.00 x _ Laundry Tray 3.00 x = Hot Tub/Spa 3.00 x = Water Heater 3.00 x = Floor Drain 3.00 x = Gas Piping Outlet ' minimum - 1 3.00 x = Rough Openings 1.50 x = Water Softener 5.00 x = Private Disposal * Dakota Cty. license 65.00 = (new and refurbished systems) U.G. Sprinkler' home under const. 3.00 = Alterations ' to existing 20.00 _ Water Turn Around 20.00 STATE SURCHARGE .50 TOTAL ? ?-D SITE ADDRESS: -5-6? j ?"/k g? OWNER NAME: D?C.? 1- ??'1Ty N?rGM INSTALLER NAME: STREET ADDRESS: CITY: ????4 41`? STATE:_ liti t? ZIP: PHONE #: (6I2--) G% '???6 fi n U---7 OFFICE USE ONLY L BL RECEIPT #: SUBD. DATE: 1996 PLUMBING PERMIT (COMMERCIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55122 (612) 6814675 Please complete for. P all commerciaVindustrial buiidings. 0 multi-family buildings when separate permits are = required for each dwelling unit. DATE: WORK TYPE: NEW CONSTRUCTION DESCRIPTION OF WORK: CONTRACT PRICE: ADD ON _ REPAIR fS WATER METER REQUIRED? _ YES _ NQ. !F SO, PLEASE PROVIDE THE FOLLOWING: WATER FLOW: GPM. ARE FLUSHOMETERS TO BE INSTALLED? YES NO. FAILURE TO PROVIDE THIS INFORMATION WILL RESLILT IN A DELAY OF METER ISSUANCE. WILL YOU BE INSTALLING A METER FOR A FUTURE U.G. SPRINKLER SYSTEM? _ YES _ NO. IF SO, YOU MUST APPLY FOR A SEPARATE U.G. SPRINKLER PERMIT. FEE: $25.00 minimum fee or i% of contract price, whichever is greater. State surcharge of $.50 per $1,000 of oermit fee due on all permits. CONTRACT PRICE x 1% STATE SURCHARGE TOTAL SITE ADDRESS: TENANT NAME: OWNER NAME: INSTALLER: ADDRESS: CITY: PHONE #: SIGNATURE: OFFICE USE ONLY STE. # STATE: ZIP: APPLICANT METER SIZE: DATE: INSPECTOR: CERTIFICATE OF SURVEY 1"2 CA14coww, Pus. ? ?M?w , 8773 pUPONT'AVENUE SOUTH ???p? BLOOMIN6TON, MINN. 68420 ?W# 888-7084 LANDSURVEYORS ? • o ' `? ? • ¢'? 9 w ° 4? ' aN/ o ` irao ? '(v ? ? p5 ? N i 0 ? +/?1?, .•8siq??" ? ? -*??_ ?IbiJ z 4- a¢9 '?58 o yy ?' ti^' ?? ¢ _ ? 41 3 CD 1 = ?YJ ? ? A ?? ? ?jz?? S c z ?e N ^ \l???? ? ?\ x O ?/7 m m M ? ° E?aGh?? m ' M ?- °? u, ,.? ? 0 REVIEWED ? L Q ? J ! Q? d) C J 0 o a, r ? o n 9 Z M. / q ? o ? ?W 2-_ l? ( Cii a o r c w a ?? Jrl(/ ? ? L o a ? U m i? l U > cn ? o D - ? ; N F'.Pi(s'AN 1VGIlVE R G I)EPT. IV o , I CL) w ? ?p (?(? f1 (? r?o?oVo [I`uL?Cr2))t? kJR E 0 'o ? % U Q ?? \ .. \\? O Z ? / / ? /¢5,37 N?°/s'7B"G? _- -- -- We hereby certify that this is a true and correct representation of a survey of the boundaries of the land above described and of the location of all buildings, if any, thereon and all visible encroachments, if any, fr r on said land. Dated this 14thday of February ,19 c4 . ? -? by , , innes a cense o. 2010 9: 5 7 A V No. 7484 P. 2 Use BLUE or BLACK Ink j Permit --j-04 C _ I I City of Ea I I Permit Fee:! 1 3530 Pilot Knob Road Eagan MN 66122 ` Date Rece 010 j Phone. (651) 675-5675 I staff: I Fax: (651) 675-5694 I I 2010 RESIDENTIAL BUILDING PERMIT APPLICATION C...'q~~ ' Date: fQ 1t~ Site Address: 1~~►~-~-~t~t't~l~ LS. C ~i 1) r1iY Tenant: Suits RESIDENT / OWNER Name: _ (nA e. j( .h ma 1-Phone- Address/ City/Zip' C~`L 1~f 1 t~C : 5tJ~'A cu■1'~'tufjy 1~~~~(`~ Applicant is: Owner /Contractor TYPE OF WORK Description of work: .L~ c Construction Costjr~( i~' I lC )C)( - Multi-Family Building: (Yes /Noz CONTRACTOR Name:' I~Pit~_y~ License Address; r, L 1~l' 1 i ev1~~ 1 ~~fl A Lie City: State' L0,1,1 Zip: ) tC1 Phone: I Q r'r3 91, 1 Lp ! Contact: q C 11CJ I I Z) t?_ t °n Email: W , ChP ►tita QCi'nn Cdd?'fY)t( ~ u}~?ct 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_gopherstateonecall.oEg 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; th t 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 accordag with the approved plan i e case of work which requires a reView and approval of piano. App c nt's Printed a Applicant's Signature Page 1 of 2 A5. 2014 9: 584 No. 7484 P. 3 iqol~N6 (t s i DO NOT WRITE BELOW THIS LINE q;? a6;-, SUB TYPES Foundation _ Fireplace _ Porch (3-Season) _ Storm Damage Single Family _ Garage i Porch (4-Season) _ Exterior Alteration (Single Family) Multi _ Deck _ Parch (Screen/Gazebo/Pergola) Exterior Alteration (Multi) _ 09 of Plex _ Lower Level Pool _ Miscellaneous Accessory Building WORK TYPES New _ Interior Improvement _ Siding _ Demolish Building" v_ A ition _ Move Building _ Reroof _ Demolish Interior Alteration _ Fire Repair _ Windows Demolish Foundation Replace _ Repair Egress Window _ Water Damage Retaining Wall 'Demolition of entire building - give PCA handout to applicant DFSCRIPT(ON _ Valuation 3 Occupancy 12G + MCES System Plan Review Code Edition 2007 SAC Units (25%_ 100% Z Zoning City Water Census Coded Stories - Booster Pump - # of Units Square Feet _ PRV # of Buildings - Length Fire Sprinklers Type of Construction --r Width REQUIRED INSPECTIONS Footings (New Building) Sheetrock Footings (Deck) Final 1 C.O. Required Footings (Addition) Final I No C.O. Required Foundation HVAC Drain Tile Other: Roof: -Ice & Water -Final Pool: -Footings Aft/Gas Tests -Final Framing Siding: -Stucco Lath -Stone Lath Brick Fireplace: Rough In Air Test -Final Windows Insulation Retaining Wall: Footings Backfill _ Final Meter Size: Radon Control Erosion Control Reviewed By: , Building Inspector (Pv~ RESIDENTIAL FEES Base Fee v- Surcharge _ Plan Review J~7 MCES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant Copies a Y@A TOTAL Page 2 of 2 PERMIT City of Eagan Permit Type: Mechanical 3830 Pilot Knob Rd Permit Number: EA074818 Eagan, MN 55122 . Date Issued: 08/21/2006 (651) 675-5675~~~ EPermit Category: ePermit www.ci.eagan.mn.us lflflUl tflflLLL Site Address: 509 Hawthorne Woods Dr Lot: 370 Block: 02 Addition: Hawthorne Woods 2nd PID 10-32151-370-02 Use Description: Sub Type: e - Air Conditioner Work Type: Replacement Description: Air Conditioner Comments: Questions regarding electrical permit requirements should be directed to Mar k Anderson, State Electrical Inspector, 952-445-2840. Cindy Lilienthal 21210 Eaton Ave Farmington, mn 55024 651-344-4253 clilienthal@controlleda ir.net Fee Summary: Surcharge-Fixed $0.50 9001.2195 ME - Permit Fee (Replacements) $30.00 0801.4088 Total: 530.50 Contractor: -Applicant - Owner: Controlled Air Dale H Nachman 21210 Eaton Ave 509 Hawthome Woods Dr Farmington MN 55024 Eagan MN 55123 (651) 460-6022 X253 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. Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type: Building 3830 Pilot Knob Rd Permit Number: EA077190 Eagan, MN 55122 . Date Issued: 04/04/2007 (651) 675-5675~~~ EPermit Category: ePermit www.ci.eagan.mn.us lflflUl tflflLLL Site Address: 509 Hawthorne Woods Dr Lot: 37 Block: 2 Addition: Hawthorne Woods 2nd PID 10-32151-370-02 Use Description: Sub Type: e-Windows/Doors Construction Type: Work Type: Windows/Doors-New/Replacement Description: House Census Code: 434- Occupancy: Zoning: Square Feet: 0 Comments: If altering the opening size, a framing inspection is required. Smoke detectors are required in all sleeping rooms prior to final inspection. When wall studs or Fee Summary: BL - Base Fee $3K $88.50 0801.4085 Surcharge - Based on Valuation $3K $1.50 9001.2195 Valuation: 3,000.00 Total: $90.00 Contractor: -Applicant - Owner: Minnesota Rusco Dale H Nachman 5558 Smetana Dr 509 Hawthorne Woods Dr Minnetonka MN 55343 Eagan MN 55123 (952) 935-9669 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. Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type: Building 3830 Pilot Knob Rd Permit Number: EA083512 Eagan, MN 55122 . Date Issued: 06/12/2008 (651) 675-5675~~~ EPermit Category: ePermit www.ci.eagan.mn.us lflflUl tflflLLL Site Address: 509 Hawthorne Woods Dr Lot: 37 Block: 2 Addition: Hawthorne Woods 2nd PID 10-32151-370-02 Use Description: Sub Type: e-Windows/Doors Construction Type: Work Type: Windows/Doors-New/Replacement Description: House Census Code: 434- Occupancy: Zoning: Square Feet: 0 Comments: A framing inspection is required when installing a Bay or Bow window or if the opening is altered. Smoke detectors are required in all sleeping rooms prior to final inspection. When wall studs or ceiling joists are exposed, hard-wired detectors are required. Battery operated types are acceptable if the wall/ceiling finish (i.e. sheetrock) has to be removed to install a smoke detector. Fee Summary: BL - Base Fee $3K $88.50 0801.4085 Surcharge - Based on Valuation $3K $1.50 9001.2195 Valuation: 3,000.00 Total: $90.00 Contractor: -Applicant - Owner: Minnesota Rusco Dale H Nachman 5558 Smetana Dr 509 Hawthorne Woods Dr Minnetonka MN 55343 Eagan MN 55123 (952) 935-9669 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. Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type: Building Eagan. Permit Number: EA092541 Date Issued: 01/12/2010 OR Permit Category: ePermit 41 it~ of E3 E Site Address: 509 Hawthorne Woods Dr Lot: 37 Block: 2 Addition: Hawthorne Woods 2nd PID: 10-32151-370-02 Use: Description: Sub Type: e-Windows iDoors Construction Type: Work Type: Windows Doors-New ; Replacement Description: House Census Code: 434- Occupancy : Zonin,: Square Feet: 0 Comments: Improvements to the home require smoke detectors in all bedrooms. If altering window openin,s, call for framing inspection. Call for final inspection after installation. Carbon monoxide detectors are required by law in ALL single family homes. Fee Summary: BL - Base Fee S3K $88.50 0801.4085 Valuation: 3.000.00 Surcharge - Based on Valuation S3K $1.50 9001.2195 Total: $90.00 Contractor: - Applicant - Owner: Minnesota Rusco Dale H Nachman 5558 Smetana Dr 509 Hawthorne Woods Dr Minnetonka 1\1N 55343 Eagan 1\1N 55123 (952) 935-9669 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 Cite of Eagan Ordinances. ApplicantiPermitee: Signature Issued Bv: Signature PERMIT City of Eagan Permit Type: Plumbing Eaaan. Permit Number: EA093145 Date Issued: 03/22/2010 OR Permit Category: ePermit 41 it~ of E3 E Site Address: 509 Hawthorne Woods Dr Lot: 37 Block: 2 Addition: Hawthorne Woods 2nd PID: 10-32151-370-02 Use: Description: Sub Type: e - Fixtures Work Type: New Description: More Than One Floor Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments: Alex Barna PO Box 188 Cedar. MN 55011 Fee Summary: PL - Permit Fee (miscellaneous) $50.00 0801.4087 Valuation: 1.780.00 Surcharge-Fixed $0.50 9001.2195 Total: $50.50 Contractor: - Applicant - Owner: SoNvada and Barna Plumbing Dale H Nachman PO Box 188 509 Hawthorne Woods Dr Cedar MN 55011 Eagan l\1N 55123 (763) 444-0292 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 Cite of Eaaan Ordinances. ApplicantiPermitee: Signature Issued Bv: Signature PERMIT City of Eagan Permit Type: Building Eaaan. Permit Number: EA099544 Date Issued: 06/14/2011 OR Permit Category: ePermit 41 it~ of E3 E Site Address: 509 Hawthorne Woods Dr Lot: 37 Block: 2 Addition: Hawthorne Woods 2nd PID: 10-32151-02-370 Use: Description: Sub Type: e-Reroof Construction Type: Work Type: Replace Description: House & Garage Census Code: 434- Occupancy : Zonin,: Square Feet: 0 Comments: If there is no ice protection inspection prior to final, the contractor must meet the inspector a ladder and flat bar. Pictures are not acceptable in lieu of inspections. Carbon monoxide detectors are required by law in ALL single family homes. Fee Summary: BL - Base Fee S3K $88.50 0801.4085 Valuation: 3.000.00 Surcharge - Based on Valuation S3K $1.50 9001.2195 Total: $90.00 Contractor: - Applicant - Owner: Home Depot At Home Services Dale H Nachman 656 Mendelssolm Ave. N 509 Hawthorne Woods Dr Golden Valley 1\1N 55427 Eagan MN 55123 (763) 42-8826 I hereby aeknowledae 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 Cite of Eaaan Ordinances. ApplicantiPermitee: Signature Issued Bv: Signature City of Ea�all 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BLUE or BLACK Ink For Office Use Permit #: Permit Fee: Date Received: 1S f t 1 Staff: 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: Unit #: Resident/ Owner Address / City / Zip: 617- 5i679‘175 Type of Work Applicant is: Description of work: Construction Cost: Multi -Family Building: (Yes / No'( ) Company:fr // f`es-5,/ i Address: /33 7 aLJi!x/(44) d% City: State: j' I/) Zip: 5 73-, E Phone: &/) bjf m 'ice" 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: Mechanical Contractor: Phone: 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 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.orq I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 days of permit issuance pi icant's Printed Name icant's ignature Page 1 of 3 SUB TYPES Foundation Single Family Multi 01 of _ Plex WORK TYPES \J New 1 Addition Alteration Replace Retaining Wall DESCRIPTION Valuation Plan Review (25%_ 100% Census Code # of Units # of Buildings Type of Construction 5O9 tixathorpLe Woe -'J Di^ DO NOT WRITE BELOW THIS LINE Fireplace Garage Deck Lower Level Interior Improvement Move Building Fire Repair Repair REQUIRED INSPECTIONS Footings (New Building) Footings (Deck) Footings (Addition) Foundation Drain Tile Roof: _Ice & Water Final Framing Fireplace: _Rough In Air Test Insulation Sheathing Sheetrock Reviewed By: RESIDENTIAL FEES Base Fee Surcharge Plan Review MCES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant Copies 4 v TOTAL Porch (3 -Season) Porch (4 -Season) Porch (Screen/Gazebo/Pergola) Pool Occupancy Code Edition Zoning Stories Square Feet Length Width Final Siding Reroof Windows Egress Window Exterior Alteration (Single Family) Exterior Alteration (Multi) Miscellaneous Accessory Building Demolish Building* Demolish Interior Demolish Foundation Water Damage *Demolition of entire building — give PCA handout to applicant MCES System SAC Units City Water Booster Pump PRV Fire Sprinklers Meter Size: Final / C.O. Required Final / No C.O. Required HVAC Gas Service Test Gas Line Air Test Other: Pool: _Footings _Air/Gas Tests _Final Siding: _Stucco Lath Stone Lath _Brick Windows Retaining Wall: _ Footings _ Backfill _ Final Radon Control Erosion Control , Building Inspector 6/yt../c JJ r -scol f c(o /9 5 'AA perktiGv Page 2 of 3 LAND SURVEYORS 8713 OUPONT'AVENUE SOUTH BLOOMINGTON, MINN. 55420 888-2084 y i/ 41.0t/TY.l,�/ C`) , polo . REal We hereby certify that this is a true and correct representation of a survey of the boundaries of the land above described and of the location of all buildings, if any, thereon and all visible encroachments, if any, frr r on said land. Dated this 14thday of February ,1994- -, . license 1( Use BLUE or BLACK In V For Office Use 1 City of Eaall Permit#: �7 (/C(i 11/0: Permit Fee: /'�`� C 3830 Pilot Knob Road RECEIVED Eagan MN 55122 Date Received: -7- `/ Phone: (651)675-5675 Fax:(651)675-5694 JUL (l 62017 Staff: __ 4-. J 2017 RESIDENTIAL BUILDING PERMIT APPLICATION Date: 7/6/17 Site Address: 509 Hawthorne Woods Drive unit#: ►varve: Patty & Dale Nachman Phone: 651-456-5444 Residents 509 Hawthorne Woods Drive Owner _ = Address/City/Zip: Applicant is: Owner X Contractor Description of work: Bath Remodel- See Attached Drawing Type of Work = Construction Cost: 7818.00 Multi-Family Building:(Yes /No X Company: US Patio Systems Contact: Ray Madden 218 N RiverRidge Circle Burnsville Contractor Address: City: _.. MN 55337 952-314-9885 asnook@uspatiosystems.com State: Zip: Phone: Email: License#: BC661813 Lead Certificate#: F119453-1 If the project is exempt from lead certification, please explain why: Built in 1994 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: Fire Suppression 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._ — W 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.:cnherstateonecall.orq I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 days of permit Issuance. x Wendy Rache Pod7r& Applicant's Printed Name App Ica'ts Siytrt'at re Page 1 of 3 O.? hlfitolkazle & � • NOT WRITE BELOW THIS LINE SUB TYPES Foundation _ Fireplace _ Porch(3-Season) ' Exterior Alteration(Single Family) Single Family _ Garage _ Porch(4-Season) _ Exterior Alteration(Multi) _ Multi Deck Porch(Screen/Gazebo/Pergola) Miscellaneous 01 of Plex Lower Level i Pool _ Accessory Building WORK TYPES New _ Interior Improvement _ Siding Demolish Building* Addition Move Building Reroof Demolish Interior Alteration _ Fire Repair —_ Windows —_ Demolish Foundation Replace Repair Egress Window _ Water Damage Retaining Wall _e *Demolition of entire building-give PCA handout to applicant DESCRIPTION Valuation '4000 Occupancy 41f-'C - MCES System Plan Review Code Edition N e© SAC Units (25%!100% X) Zoning /l City Water Census Code Stories Booster Pump #of Units Square Feet PRV #of Buildings Length Fire Suppression Required Type of Construction t ill Width REQUIRED INSPECTIONS, Footings(New Building) Meter Size: Footings(Deck) Final/C.O. Required Footings(Addition) Final 1 No C.O. Required Foundation Foundation Before Backfill HVAC^Gas Service Test Gas Line Air Test Roof: Ice&Water _Final Pool: Footings _Air/Gas Tests Final Framing 30 Minutes 1 Hour Drain Tile Fireplace: Rough In _Air Test Final Siding: Stucco Lath ^_Stone Lath Brick EFIS Insulation Windows Sheathing Retaining Wall:—Footings Backfill Final Sheetrock Radon Control Fire Walls Fire Suppression: Rough In Fina! Braced Walls Erosion Control (�[, Shower Pan Other: Reviewed By: I �/ , Building Inspector RESIDENTIAL FEES Base Fee Surcharge Plan Review (A MCES SAC 1-v City SACail . Utility Connection Charge '\°' S&W Permit&Surchargel(), , 0 Treatment Plant Copies ' '1 TOTAL AAJ J(.1 . 1F Page 2 of 3 Use BLUE or BLACK Ink For Office Use I C6/ CityU R f Eaaall Permit#: e---/ve6 16 it Permit Fee: p 3830 Pilot Knob Road Eagan MN 55122 RECEIVED Date Received: / Phone: (651)675-5675 VI/ Fax: (651) 675-5694 JUL 0 6 2017 Staff: -- _--- '�- J 2017 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: 7/6/2017 Site Address: 509 Hawthorne Woods Drive Tenant: Suite#: Resident/Owner Name: Patty & Dale Nachman Phone: 651-456-5444 Address/city zip: 509 Hawthorne Woods Drive, Eagan, MN 55123 Name: US Patio Systems License#: PC708206 Address: 28 N River Ridge Circle City: Burnsville Contractor -- State: MN Zip: 55337Phone: 952-314-9885 contact: Ray Madden Email: asnook@uspatiosystems.com Type Work — New t/ Replacement Repair _Rebuild Modify Space Work in R.O.W. Description of work: Bath Remodel-See Attached Drawing RESIDENTIAL Water Heater Water Softener Lawn Irrigation ( RPZ/ PVB) Permit Type Add Plumbing Fixtures( Main/ Lower Level) Septic System New Water Turnaround Abandonment RESIDENTIAL FEES: $60.00 Water Heater,Water Softener, or Water Heater and Softener(includes State Surcharge) $60.00 Lawn Irrigation(includes State Surcharge) $60.00 Add Plumbing Fixtures, Septic System Abandonment,Water Turnaround*(includes State Surcharge) *Water Turnaround(add$280.00 if a 3/4"meter is required) $115.00 Septic System New(includes County fee and State Surcharge) TOTAL FEES$60.00 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:gooherstateonecail.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. 000119--- Appçecant sPrinCed ame A s. Itcan s .na re FOR OFFICE USE Reviewed By: Date: Required Inspections: Under Ground Rough-In Air Test Gas Test Final Meter Related items: Meter Size Radio Read Manometer Staff: PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA161873 Date Issued:06/16/2020 Permit Category:ePermit Site Address: 509 Hawthorne Woods Dr Lot:37 Block: 2 Addition: Hawthorne Woods 2nd PID:10-32151-02-370 Use: Description: Sub Type:Residential Work Type:Replace Description:Water Softener Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection. Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener). Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087 Surcharge-Fixed $1.00 9001.2195 $60.00 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Dale H Nachman 509 Hawthorne Woods Dr Eagan MN 55123 (651) 456-5444 Milbert Company (culligan) 1801 50th St E Inver Grove Heights MN 55077 (651) 451-2241 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA161873 Date Issued:06/16/2020 Permit Category:ePermit Site Address: 509 Hawthorne Woods Dr Lot:37 Block: 2 Addition: Hawthorne Woods 2nd PID:10-32151-02-370 Use: Description: Sub Type:Residential Work Type:Replace Description:Water Softener Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection. Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener). Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087 Surcharge-Fixed $1.00 9001.2195 $60.00 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Dale H Nachman 509 Hawthorne Woods Dr Eagan MN 55123 (651) 456-5444 Milbert Company (culligan) 1801 50th St E Inver Grove Heights MN 55077 (651) 451-2241 Applicant/Permitee: Signature Issued By: Signature