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4567 Hay Lake Rd SCITY OF EAGAN Remarks Addition OVERHILL FARM 1ST ADDN Lot $ slk Z Parcet 10-56150-080-02 Owner ` Street 4567 S. Hay Lake Road 5tate Improvement Date Amount Annual Years Payment Receipt Date STREETSURF. ,51?_ 1981 310.74 15.54 20 STREE7 RESTOR. I' ?gg4 4874.94 974.99 S GRADING PA3 1 85 264 8 SAN SEW TRUNK 57 1981 359.28 17.96 20 W+ SEWER LATERAL x 1985 $67 95 5 3 5 9. VzSAN SEw TRK LAT BEN 198 559. 37.29 15 WATERMAIN WATERLATERAL 1981 172.42 8.62 ZO WATER AREA 1981 359.28 17.96 20 STOFiM SEW TR1G 1984 1073.68 71.58 15 STORMSEW LAT -]f'r1 1984 192.8$ 12.86 15 88'2'* SS L Services ' CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN, BUILDING PER, SAC PAR K ' CITY OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55122-1897 (612) 681-4675 SITE ADDRESS: 1'.fl: , ! ,; I F:1+ PERMIT SUBTYPE: 1,j i : FllOl 1 Ni, 1 ?.GS G,rtN -a. r? t„ (ir p . 4N RECORD PERMIT TYPE: Permit Number: Date Issued: tsi? ? i i? i w?? APPLICANT: VuN',I 1 6 1,') 44'.P: HHI fi IiCt`l i 11 TYPE OF WORK: I 1 NA! !i1 iJ , J Permit No. Permft Holder Date Telephone N ELECTRIC PLUMBING HVAC Inspection Data Innp. Comments FOOTINGS FOUND FRAMING ROOFING FiOUGH PLUMBING PLBO AIR TEST ROUGH HEATING GAS SVC TEST INSUL GYP BOARD FIREPLACE FIREPIACE AIR TEST FINAL PLBG FINAL HTG ORSAT TEST BLDG FINAL BSMT R.I. BSMT FINAL DECK FTG DECK ?L ??- ?'""""" 0-90- --- ? -- -- - - -- --- --- -- - I - ? CITY OF EAGAN i n 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 ?PHONE: 454-8100 BUILDING PERMIT , Receipt # To be used for Est. Value $80,000 Date APRI L 14 , 19 4567 SO HAY LAKE RD Site Address Erect ? R3 Occupancy ? Lat Block 2 Sec/Sub, OVERHILL ? ARM5 Remodel ? Zoning Rl Parcel No. jST Repair ? Type of Const V Addition ? No. Stories ¢ N DA?CdT'a BLDRS INC Move ? Length 62 z ame 1 Q 2 2 0 W 176TH Demoiish ? Depth-:3.0 o Addr ess I I t ? Ft S cir LAKEir'3_k" 435-7419 n mpr. . I ll ? q_ y nsta o Name SA'"E ? i Address ~ City Phone Name PHILLIPS P.C.AIV SERVICE ? W ? ? Address ? W City '? • V • Phone I hereby acknowledge that I information is correct and ? Minnesota Statutes and Ci1 A Building Permit is issued all work shall be done in ac with all applicable State of nances. :OTA BLURS INC ?pplica4l# State oi Minneso Assessment Water & Sew. Police Fire Eng. Planner Council Bldg. Off. 4/11/8? Var. Permit ? 373.00 Surcharge 40.00 Plan Review 186.50 SAC 575.00 Water Conn. 500.1010 Water Meter 63.50 Road Unit 290.00 Tr. PI. 156.00 Parks Copies Total $2,184.00 - on the express condition that Eagan Ordinances. PWmR No. PNmit Moldw Dab Tebphom k Plumbiny M.V.A.C. ENctrie ? Softenar Inspectlon , Dab Insp. Commtnq FootinQs 1 Footinys II FoundaNon Framing 1 13- ?A?g ? dEw? j udlJ pooHny Rouyh Plbp. -0'-, ,( Rouyh Hty. Insul. Flreplacs FMsI Htq. Ffnal Plby 7-1-?li . Bldp. FInM c.d. oce. Daek Fty. Doek Frmy. WMI Pr. Olap. 4 CONTRACT PRICE Site Address? ? ? ;' . '? Lot _5 --: Block rvame Addr 1031 ? C?2 i'i?l'rfr,L ? Name &< <'' c Addr ? • O TYPE OF WORK Forced Air M BTU Boiler M BTU Unit Heater M BTU Air Cond. M BTU Vent CFM Gas Piping OuUets # Z Other FEE S/C: TOTAL• PERMIT # __7n MECHANICAL PERMIT RECEIPT # / 2 ? CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE: Phone BLDG. TYPE WORK DESCRIPTION Res. x New X- Mult Add-on Comm. Repair Other FEES RES. HVAC 0-100 M BTU - $24.00 ADDITIONAL 50 M BTU - 6.00 AOD-ON AIR CONO. 0-24 BTU - 12.00 ADDITIONAL 6 M BTU - 6.00 GAS OUTLETS - 1.50 EA. COMM/IND FEE - 1% OF CONTRACT FEE MINIMUM - RESIDENTIAL FEE - 10.00 MINIMUM - COMM/IND FEE - 20.00 STATE SURCHARGE PER PERMIT - .50 (ADD $50 S/C IF PERMIT PRICE GOES BEYOND $1,000.00) 7 GO L"_?_`,? ? /?! ? SIGNATURE OF PERME FOR: CITY OF EAGAN ' PERMIT # f ? r « . ' PLtSMBING PERMIT RECEIPT # =^ V, CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE: CONTRACT PRICE: PHONE: 454-8100 Site Address ( , -7 r• A' BLDG. TYPE WORK DESCRIPTION LotBlock ? S c/S b Res. ?- New ? m Name Mult Add-an 1 Address:L Q' , A Comm. Repair .5 c City? W- Phone Other ` • c e NQ. FIXTURES TOTAL Name ?- W Clos t - $3 t 00 ? ? ? ?' c Address 7 a er e . ? Bath 7ubs - $3.00 p City LAk e v;1 I? Phone ?Lavatory -$3.00 Shower - $3.00 I Kitchen Sink - $3.00 ? FEES COMM/IND FEE - 1?i6 OF CONTRACT FEE .00 Urinal/Bidet - $3 ? Laundry Tray -$3.00 MINIMUM - RESIDENTIAL FEE - $10.00 i F1oor Drains - $1.50 MINIMUM - COMM/IND FEE - 20•00 ? Water Heater -$1.50 STATE SURCHARGE PER PERMIT - .50 Whirlpool -$3.00 (ADD $.50 S/C IF PERMIT PRIGE GOES Gas Piping Outlets -$1.50 BEYOND $1,OU0.00) Softener - $5.00 Well - $10.00 Private Disp. - $10.00 = Rough Openings - $1.50 SIGNATURE OF PERMIT7EE FEE STATE S/C: FOR: CITY OF EAGAN GRAND TOTAL• - s°? " ?, r GITY OF EAGAN SEWER SERyeCE PERMR 3830 Pilot Koob Road - - P. O. Box 21199 PERMI7 NO.: Eagan, MN 55121 DATE: - Zonirp: No. of Units: ? Owrer: . Add?ess: Site /lddross: '; `?67 4ouCh HjaY La 4-n `ng? £'g=s " Plumber: . . . . 10':? 1 yrM te ewI wNb !Ae d1p of 4NO ConrweHon Chaeq: 4,25-1 Oromenar. Moount Deposit: ., •' `? ?? Wnr+lt Fee: Surchorpo: sy misc. C+a.o.s: Daft af Insp.: Totol: Irsis.: DoM Pald: CITY OF EAGAN WpTER SERV4CE PERNUT 3830 Pilot Knob Rosd . P. O. Box 21199 PERMIT NO.: Eagan, MN 55121 DATE: Zoninp: No. of Units: Owner . Address: Site Address: --`-- Plumber - . Meter No.: Connection Chorge: Sixe: Accoufft Deposlt; Reader No.: Petmit Fee: 1 Nn* !e oswuh t1N Cihr of Eoww Su?chorge: OAlM Misc. Chargas: : TotoL• - By Dats Poid: ? Date of Insp.: Irop.: CITY OF EAGAN WAtER SERVICE PERMIT 3830 Pilot-Knob Road P. 0. Box 21199 PERAAIT NO.: Eagan, MN 55121 DATE: Zonirg: No. of Units: ? Owner: ;.?akota '3uilde_r?7 /lddness: Sits Address: '. ?67 -t ? - r?.e „--,i"n ,--n q Plumber. _ • Meter No.: 701 00 ? ?! p,o,ye: Size: '' ;Z°?! C),?"p?p?t: 15 Oond Reader No.O W- 10. OOQc' 1 .or.e te ee?.pilr'"te" """"'g°` . 5C1kd O.1t Misc. Choroes. 156. M)od Ti' Totai: 61 `Onc; metPl - BY Date Paid: Dote of I nsp.: I nsp.: CITY OF EAGAN AI p 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 I v_ 17 9 9 PHONE: 454-8100 BUILDING PERMIT fieceipt # 7obeusedtor SF DWG/GAR Est.value $$0,000 DBte APRIL 14 ,1986 Site Ad ess r ? 4567 SO HAY LAKE RD Erect Lu af Occupancy R3 Lat Block 2 Sec/Su6. OVERHILL FARMS Remadel ? Zoning R1 Parcel No ZST Repair ? Type of Const. . Addition ? No. Stories ? DAKOTA BLDRS INC Move ? Length F2 Name 3 10220 W 176TH Oemolish ? Depth I.Q Address ? ° LAKEVI 435-7419 Cit T?r1e Int.impr. I f ll ? sq.Ft. y ns a 'o Name SAME ? i Address : City Phone ?WI PHILLIPS PLAN SERVICE W w Name _ Z5 Address a wz Ciry A• V• Phone I hereby acknowledge Ihat I have read this application and state that [he information is correct and agree t omply with all applicable State oi Minnesota Statutes antl C i E gIn Ordi n es. ,q 'Signature ot Permittee ?'???8' ?•-- A Building Permit is issue o: DAKOTA BLDRS INC all work shall be done in cordance with a lica ?,E State oi Minne c ? Building Official ? Assessment Water R Sew. Police Fire Eng. Planner Council eldg. Off. 4 /11 /8 E Feea Permit $ 373.00 Surcharge 40.010 Plan Review 186. 50 SnC 575.00 Water Con n. 500.00 Water Meter 63 . 54 RoadUnit 290.00 Tr. PL 156. 00 Var. Date I Copies Total $2.184.00 _ on the express condition that of Eagan Ordinances. A?-REQUEST FOR ELECTRICAL INSPECTION ee-ooam_w -?q?r?,?"`F" ' See instrucliuns far camoleting this torm on 6nck of yellow coDY• /3 j-7?j'? i 1? 1 J J ""X"" Be/ow Work Covered by This Request ?U 1O Y o( 9uiltlina 1 Aooliances Mired 1 Equioman[ Wired Water Furnace p Fee Se'vi enceSiza q Fee Fxeders/5ubfaeders N Fee Circui<s Ot 200 s 0 to30qm s Z * cp 0 tn30Am s Above 00 qmpu 31 ro 700 Amps 37 to 100 A Swinvning Pool Above 100_Amps Above 100_Am ' Transtortners Irrigation Booms Partial.'Other Fee Signs Special Inspec!ion - STOTA E Id J- Rermrks e.. ... i cne IecLiea nspecto , erebv. Final Date / p inspectian has bee. ? ns t".?,a ? - ( I'-? ?????9 ?? -? - s ?? . ? Heque t Date 1 ? 1 Fire No. Roug?-in Insoection R - eA? ?ReadY Nuw II NotitY. Inspec- to n q d ?No .s ¢a Y icensed Electrical Con[ractor ? O - 1 hemby revuest inspection ot ebove wner elecvicel work iM1Stalled at Sveet Adtlres5. Box or flou[e No. CitY 4E 56 ? S ffi? E' Af-y .fs.. ecuoy o. Townshiv Name or No. Range No. ot " Occupnnt IPflINTI [ & 0 4 Phone No. u- 44 1-4 Power Supplier Atldress LC lectrical Contractar ICOmpany N meI ? GoMractor's Licease No. A V ilinB Addres5 (Contrac r or Owrier M Insmilation) ' 7 AuMoriz iBnari (COn or Ow Making Installatio Phone Nytnber F G n MIN O STATE BOARO Of EIECTNICITV THIS INSPECTION REQUEST WILL NOT Griggs- ?dwey Bitlg. - Room N-781 BE ACCEPTED BY THE STATE BOABD 1827 UniversitY A,ee., St Peul. MN 55106 UNLESS PROPEN INSPECTION FEE IS PIone (byZ) 2972111 ENCLOSED. REnUEST FOR ELECTRICAL IIYSPECTION ;e' 00001 -04 See instruetions tor camDletiaq [his formon back oi yellow coDY ? 1 a? 1 ZJ H "X" Below Work Coveied by This Request - fto AAd peD- Type ol Builtling Aaliaetne Wired Eauipmenl Wired -Hop?e we Rangg TemporaryScrvice Duplex Wa r Heater Lighting Pixtures a Apt Building D„ryer Electnc Heatin Commercial Bldg. FWnace Siio Unloader Industrial Bldg. a4ir Corditioner Butk Milk Tenk Farm other speci v tncr(snecflyl t r SV?dW Ot er Other Comuu[e lnspeciion Fee Below, <i Q Fee ServiceEntrenceSiz¢T # Fee Feeders/SUbleetlers H Fee Circuits 0 to 200 qm s:)' 0 to 30 ATILs 0 tn 30 Am A6ove 200 qm ps 31 to 100 Amps 31 to 100 q Swimning Pool Above 100_Amps Above 100_Amps TransPormers rtigation Boorrs Partial.'Other Fee Special Inspection 1 $ TOTAL 1, tne ElecViwl Insoector, heroby certify tAat the above inspaction has been .tle. rnfs reaues[ void s- f/cA. fI ths ?1 'truiq frorn R Nr.quest mte Fire No. Rough-in InsPecifon Repuired? C]Aeady Nryr??i Nolify, Insuec- 6 s ?NO Ed When qeady M iceMed Electrical Cmnactor . I hemby request inswection of above ner electrical work iretalled a[: Stre¢t AdAress, eox No. . oraute Gtv ? 444 Lon Tow shi0 Nallne or o. ange No. Coun / Ocwpant IPPI T) ' one No. ier Adtlress ? ontractor (COmpany Name ? C Co actors Licens e Na. r ress C? ctoLor Owner M i Instailat4on) uthiUe?d Siurratur e (CO?traytodOwner aking I stallation) PM1One Nu beJr / ' YfN ESO7A STATE 80AX0 OF ELECTftIC1TY THIS INSPECTION REQUEST WILL NOT gE ACCEPTEO BY THE STATE 80ARD Grigs-Yidwey Bldg. - Room N491 . UNLESS PROPEfl INSPECTION PEE IS 1@t University Ave., St. Peul, MN 55104 ENCLOSED. PMro 1612129]_2til /0 '?5? a ? J 5 4 0 61 g a Request Date Fire iJo' Rough-in Inspection Requiretl? Ready Now ? Will Notity Inspadw ? ? Ves o When Ready? ? licensed contractor p owner hereby request inspection of above eledrical work at: JobAtltlre55 $ir xprRO N?- qk? ,4 K^ i ?F ? City Section No. Townsbip Name or No. Range No. Co ? Occupant FRIWT? ? ? Phone Power Supplier Adtlress . 1 Electrical Goniroci Compa Nar, C-1 ?acty?§ Lyg a l` Mailin e c? or Ow r Tg Installabon) Gve. s- Is' mn 55 y0' AulM1Onre Si IConlracl0r wner M king Inslallation - PM1ppB? er !? (' ? MINNESOTA STATE 60AR? q{'E?TRICITY THIS INSPECTION REOUEST WILL NOT1 Griggs-MlOway BIEg. - Roo i 3 6E ACCEPTED BV THE STATE BOARD ? 1821 niverel[y Ave.. SI. Paul. MN 55104 UNl.ESS PROPER INSPEGTION FEE IS PMne (61I) 602-0800 ENCLOSED. REQUEST FOR ELECTRICAL INSPECTION lir See Instmclions lor comple[ing this form on back al yellow copy. "*" Belom?Work Covered by This Request J54001 EB-pp001-08 e AOtl- Rep. TypeofBUilding AppliancesWired EquipmentWired Home Range 7emporary Service Duplex Water Heater Electric Heating ApL Building Dryer O[her (Specity) Comm./Industrial Furnace Farm Air Conditioner 01her (s4ecify) ontrector's Hemarks: Compufe Inspection Fee Below: # Other Fee # ServiceEntrance Size Fee # Circuits/Feeders Fee Swimming Pool 0 to 200 Amps 0 to 100 Amps hansformers A6ove 200 _ Amps Ahove 100 _ Amps 51905 Inspector5 Use Only: TOT ? Irrigation Booms r?Y U Special Inspection Alarm/Communication THIS INSTAILATION MAV BE ORD DISCONNECTEO IF NOT Other Fee COMPLETED WITHIN 18 MONTHS. I, the Electrical Inspector, hereby Rougn-in oate certify that the above inspection has been made. F;,,ai ? oa?e i OFFICE USE ]NLY • This request wi0 18 manths irom 2005 RESIDENTIAL BUILDING PERNIIT APPLICATION City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 -;? 113.?-5 (.q4- ?tig w/ao/c s. ";Tj New Construction Reauiremenfs RemodellReoairReaulrements Otfice Use Oniv 3 registered ske surveys showirg sq. fi. of IoL sq. ft. of house; and all roofed areas 2 capies oi plan CeR of Survey Recd ,. _ Y_ N (20% maxunum lot coverage allowed) 1 set of Energy Cakulations for healed additions T(ee Pres Plan Recd - Y_ N - 2 copies of plan showing beam 8 window s'¢es; poured found design, etc. 1 site survey for addi[ions & decks Tree Pres Requi2d Y N t set of Energy Cawulations Addfion - inMicate 'rf on-sife septic system On-s'rte Seplic System _ Y. _ N 3 copies of Tree Preservatlon Plan'rf lot platted afler 711193 Rim Joist Detat Oplians selection sheet (bufldings with 3 or less units) Date 4 /kZ- ? B S Construction Cost? ocyd . e.0 Site Address dr?tj-t ? H'l"A I.1lv-ii' 2-9 $. ? UniUSte # Gll"'(-? n1 E55iZ3 Description of Work rs,gb?<? GMM0'J b `P6oC., Multi-Family Bldg _ Y_ N Fireplace(s) _ 0 _ 1 _ 2 PropertyOwner -Dq46% jlaA `'?4at.i Telephone#(b5l ) 43rS6 -6F5Sb Contractor Address City State Zip Telephone # ( ) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING - Minnesota Rules 7670 Cateeorv 1 _ Minnesota Rules 7672 Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet (+lsubmissianlype) 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 Mechanical 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 5tatutes; 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. 'bV 6 iJ SCsL_ Applicant's Printed Name r Applicant's Signature T ? m u l'J T APR 13 2005 OFFICE USE ONLY Sub Types ? 01 Foundation ? 07 05-plex ? 13 16-plex 'K 20 Pool ? 30 Accessory Bldg ? 02 SF Dwelling ? OS 06-plex ? 18 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi ? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 PorchfAddn. (4-sea.) ? 33 Ext. All - SF ? 04 02-plex ? 10 OS-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 MuIG Misc. ? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage ? 06 04-plex ? 12 12-plex Plbg_Y or_ N? 25 Miscellaneous Work Types ? 31 New O 35 Int Improvement ? 38 Demolish Interior ? 44 Siding iyr 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair ? 33 Alteration ? 37 Demolish Building* ? 43 Reroof ? 46 Windows/Doors ? 34 ReplaCCment 'Demolition (Entire Bldg) - Give PCA handout to applicant Valuation ? Occupancy MCES System Census Code "?7 )A Zoning City Water SAC Units Stories Booster Pump # of Units Sq. Ft. PRV # of Bldgs Length Fire Sprinklered Type of Const ? Width _ Footings (new bldg) _ Footings (deck) _ Footings (addition) Foundation ? Drain Tile Approved By: _ ' Roof _ Ice & Water _ Final _ Framing _ Fireplace _ R.I. _ Air Test _ Final _ Insulation Base Fee Surcharge Plan Review MC/ES SAC City SAC Utility Connection Charge 5&W Permit & Surcharge Treatment Plant License Search Copies Other Total REQUIRED INSPECTIONS _ FinaVC.O. _ FinaUNo C.O. _ Plumbing HVAC Other ? Pool Ftgs X AidGas Tests ?CFinal _ Siding _ Stucco _ Stone _ Brick W indows ? Retaining Wall Tz , Building Inspector ?OOL, ST 0 6p t7 POOL PERMIT - APPUCATION SUBMITTAL REQUIREMENTS Address: +S GJJ Applicant Name: ? ? G d ? o z GENERALINFORMA170N ,d ? ? Applicant - name, address, phone & fax numbers, signature fd ? ? Property owner name ? ? ? Legal description and address of property fd' ? ? North arrow, scale (1" = 30' or 40') and date .J;d ? ? Locarion and name of all streets adjacent to property ,0 ? ? Site Plan drawn to scale showing location of house, pool and other existing or proposed strucxures J3 ? ? D'uectional drainage arrows (existing and proposed) ELEVATIONS Existin .d ? ? House comers J0 ? Q Property comers ?,U ? On property lines at point of ineasured dimension to pool (see below) ?0 ? If applicable, ground elevation at each end of retaining walls and at wall's greatest height Proposed ? A ? Finished pool deck comers ?4 ? Top of retaining wa11s (if any) and at each different elevation (if it changes) -Z ? ? Pool bottom (or max. depth) DIMENSiONS Ecistina ,W ? ? All properry/lot lines Proaosed 4 ? ? Pool ? ? Pool plus integrated deck/patio ?? ? Shortest distance from outside edge of pool deck to lot iines and, house ? Reviewed: Name (}:FORMS/Poal Pecmit C6edclist/06-02-04 ? V? ? w i14P ?^ro? w J 6 N ° ?• ?, w n @Xt ? , 0 eu ? ?'•' ?^/r ? 1O?\ F? `v? ?°? / ??v? " 1?' IV?G y Ay -. i z: `•.9 Y ?It.?? f YI ? .3 ? ? d a, 1 + ?a / o? ? NORTK G+ I OZ+AM i"ti 4.ae' 01 AA-- WAMW4 4%UMID d DPc007'is lRoN 1NOMUNIENT c ,, 73) z ?93m. 3 _ ? Fp P ?v.. ? / Mn ?? /4% r ? ;?. Z. 4svv 4 \ , , 4t+> j 9 ? iA • ?? ?,?c ° ?E y, ? \ Y?? ? a •D ? v w 3?0 M6G21P'ryoAi L.aT b, Bl.oc1G- 2) OVE1LE1tLL WAtLdA F?W.iT AbOITIow.* O4A-oTA Co1J1NTYo M 1 NWGSaTA ? I hereby certify that triis survey was prepared by ae or i under my direct supervision and that I am a duly Registered , Land Surveyor under the laws of the State of Minnesota, Date: I`?'l?n_-?'---'+-???° ?=-._?: f • ? .? !?, ??-?[.? LeRoy . Bohlen - Registered Land Surveyor No. 10795 r ?T \934.? ' j ? w =a ?? ?. .:N ? ?' ? ' ? ? Ap N ,J.? •? ? O? RESIDENTIAL BUILDING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB RD, EACAN MN 55122 651-681-4675 New Constructian Reauiremants • 3 registerea site surveys showing sq. h, of loG sq, ft. of house; and all roofed areas (20°a maaimum lot coverege alloweG) • 2 coples of plan snowing beam 8 vdnCOw sizes; poured found 4esign, eta) . t sat ot Energy Calculations . 3 copies of Tree Preservation Plan if lot platted afler 7J1l93 . ,Rim Juist DeUil Optians seleCtion sheet (hldgs with 3 or less unAs) oATE _ 11 - 1 `7 - o a fIREPIACE(S) _ 0 _ 1 _ 2 SITE ADDRESS ???? ?• '`??I h.?l?-?. 9C0td MULTI-FAMILY BLDG _Y /` N TYPE OF WO APPLICANT STREET ADDRE?S TELEPHONE ?ELL PHONE # Lt056sa - {qaaj., PROPERTYOWNER FAX iR I04IJ4Sa ''TO r-J? 3 TELEPHONEC# (os+ )4?? - 0^9 ' B -------------------------------------------.------------------------.....---------------------- COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category _ ytINNF;S01'A RUI.ES 7670 CXCEGOItY t ?[IVSESO'C:1 RCLLS 7672 (J submission type) . Residential Ventilation Category 1 Worksheet Submitted . New Energy Code Worksheet Submitted • Energy Envelope CalculaGOns Submitted Plumbing Contractor: ___ Plumbing sysCem include•s: Mechanical Contractor: Mcch.mic.il svstcm includcs: Sewer/Water Conhactor: Watcr Softener Water Heater _ No. of Baths Air Condiuonin,- I-ieat Rccoccry Systcm Phone # ? ? Fee: $90.00 Fcc ,570.00 ? I, ?!-51, - - ----------°-------°° .............°-----------------°------------°----------- I hereby acknowledge ihat i have read this applicotion, state th he inform- - with all applicabie State of Minnesota Statutes and City of Ea inances. Signature of App1lc ------------------------------------------------------------------°------------°------------°°--°-------- - OFF[CE USE ONLY RemodeVReoair Reauiramants • 2 copies of plan . 1 set of Energy Calculations for heate0 additions • t site survey for eztenor additions 8 decks • Indicate if home served 6y septic system ror additions ? ?l A 7 / VAIUATION? 5 ?v `? _ Phone # I.awn Spnnkler No. oF R.I. Baths to comply Certificates of Survey Received Tree Preservation Plan Received _ Not Required _ Updated 4/02 OFFICE USE ONLY ? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg ? 02 SF Dwelling 0 OS 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi ? 03 Ot of _ plex ? 09 07-plex 0 17 Gara9e ? 22 PorchlAddn. (4-sea.) ? 33 Ext. Alt - SF ? 04 02-plex ? 10 OS-plex ? 18 Deck ? 23 Porch (screened) ? 36 Multi ? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage ? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Misceitaneous ? 37 New ? 35 Int Impravement ? 38 Demolish (Interior) ? 43 Siding ? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair ? 33 Alteration ? 37 Demolish (Bldg)' ? 43 Reroof ? 46 Windows/Doors ? 34 Replacement •Demolition (Entire Bldg only) • Give PCA handout to applicant Valuation Occupancy MC/ES System Census Code Zoning City Water SAC Units Stories Booster Pump Nbr. of Units Sq. Ft. PRV Nbr. of Bldgs Length Fire Sprinklered Type of Const W idth REQUIRED INSPECTIONS _ Footings (new bldg) FinaVC.O. _ Footings (deck) Final/No C.O. _ Footings (addition) _ Ptumbing Foundation HVAC Drain Tile Other Roof - Ice & Water _ Final _ Pool _ Ftgs _ AiriGas I'zsG _ Final _ Framing _ Siding S[ucco Srone _ Fireplace _ R.I. _ Air Test _ Final _ W indows (new/replacement) _ Insulation _ Retaining Wall Approved By Base Fee Surcharge Plan Review MC/ES SAC City SAC W ater Supply & Storage S&W Permit 8 Surcharge Treatment Plant Plumbing Permit Mechanical Permit License Search Copies Other Total Building Inspector ? 1986 BDILDIAG PEI?IIT APPLICATION - CITY OF EAGAA AOTS: ALL CONTRACfOHS MQST BB LIC@iSED KITH THS CITY OF EAG6N SINGLE F9MILY DWEL.LINGS INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS MpLTIPLE DiiELLIAGS -@ESIDSNTIAL REQTfgI, i1NiT3 FOR SALS DNITS INCLUDE 2 SETS OF PLANS, CfiRTIFICATE OF SDRVSY - CHEC[ WITH BLDG. DEPT., 1 SET OF SNERGY CALCULATIONS INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS, 1 SET OF SPECIFICATIONS AND 1 SET OF ENEHGY CALCULATIONS, $2,000 LANDSCAPE BOND To Be Used For: S1N?,L? ?4? . Valuation: Site Address 215 lo ` -?-U • pA L4kc ? Lot S Bloek Z Parcel/Sub C>VE-?41tU,, JZAP_cn? Owner ????D STten,?a;? Address City/Zip Code fytyL$ - (yVJ E68?k7 Phone 1 C"7 6 Contraetor ?l?L? ?. x? LSAS>R?, 1RJ Address v??-zz's> City/Zip Code L1?*&4t:aX-, 'YAt? .L?.64I1j-?!n, Phone Areh./Engr. -D-It?i7? V? Address ?? ?Lg&?+ City/Zip Code aGr doc> Date: .4-q - E3?0 Ereet Remodel Repair Addition Move Demolish Int.Impr. Install Occupaney 3 Zoning Type of Const t-E # of Stories Length ? Depth Sq Ft _ APPBOVAIS FSES Assessments Permit Water/Sewer Sureharge r,/? -=% Police Plan Review ?=- Fire SAC Engr Water Conn Planner Water Meter Council Road Unit Bldg Off Treatment P1 fS6•O`? APC Parks Variance Copies TOT9L Phone # NOTE: ADDRESS6S FOR CORNER LOTS - CONTRAC?OR/HOMEOHNER MQST DESIGBATfi BHICH ADDRESS IS DESIRSD. NO CHANGFS iiILL HE ALLOitED ONCE BUILDING P6RMIT IS ISSOED. YC ?? J ?,?. , ? NOR?4A 74AL& t~L ?Aw ??I"4 A'YiUMEO ei pSlp'ri$ I001I M0t+lUN1EN1' % V •o n. t.oT b, ovEa.Ns+.L. ??•'R-M 91Q3T AD41TIoD.1 P 04"TA couNZY, M 1 N1Ji"s+o74 I hereby certify that triis survey was prepared by me or under my direct supervision and that I am a duly Registered Land Surveyor under the laws of the State of Minnesota. Date: L oy it' . Bohlen Registered Land Surveyor No. 10795 PtIILLIPS PLAN 5titVi,,t ' 7sa(l w. usm suxw ` 'Appla V2?1ey, MN 65120 E%TERIOR ENVELOPE {tiVERAGE "U" COMPUTATION 041NER bAavtb `-4 -2-C7rj [.:) SITE ADpRESS `r`^ CON7WICTOR 'L.?.ut-s iOc. OATE A-O- PNONE Determine working square footage of each. 1. Total exposed wall area ..... I LpqZ. ? sq. ft. x •) l = ?B .9 2. Total roof/cei l i ng area ....... _ 1 I52, sq, ft. x_ • 02 1,= Total exposed waTl area above floor = ?qqp a. Total wall window area ........................... Qn,Z b. Total doar area ................................. 38 ' c. Total sliding yiass door area .................... . p?B d: Total fireptace wall area ............... e, Total wall framing area (averagel0%)...:........ f. Total net wall area above floor ................. 10 51,q Z g. Total rim joist area ............................ l?ib Total exposed foundation area = Z, h. Total foundation window area ..... ............. i 1. Taal net foundation area above grade ............ ? Determine "U" value of each wall segment. a. 9r1, Z, X"U" I5 ? 48• lD e. 38 x "u" . ?39 = 5 ,Zg C, ga x „u.. ,s = yy d- U8 x "Uli ,31p = J,q. zQi e._ 1 I to-8g g?v, ?QcI to = 11 "ZZ f. Ios1,97- x liu° , 043 = qS.Z3 e• rqD x I.ull o ( = 5,? n. ? X „U„ ;. qZ..J X „u„ , ogZ = 9.57_ 3 . .........................Total If item k3 is the same as, or less than item #1, you have met the intent of SBC 6006(c)2, k , . . , Total exposed roof/ceiling area = ?? 5 Z Total gross roof/ceiling area = fl 5 Z j. Total skyiight area .. ................... - k. Total roof/ceiling framing area ............ ?) $, Z 1. Total net insulated roaf/ceiling area....... (p 3to, S Deternrine "U" value for eacli roof/ceiling segment. J- X "U" k. 1 15.2 x-,u,- , nz4 = z,? i. ?o3(,.S x „u„ ,Qz.z = Zz.8 4 ........................... 7ota1 If totai of #4 is the same as, or ]ess than N2, you have met the intent af SBC G006(01. To utiiized the total envelope system method, the values established 6y the sum of items #3 and y4 shall not be greater than the sum of itens 01 and N2. 1. ? 83,5U + z. z9,95 = z13691 MATERIALS 3. 1 P>LI.9 Z. + 4. ZS , Jr lo = Z I C). q a EKterior Air 3iding Material Sheathing Insulation Sheetrock Interior Air ' Studa Rim Conc. Blks. Tlierm. Itesistance "R" ,Iq ,45 Z,Dto i9 Iy5 g 18? i, za CITY 4F EAGAN APPLICATION FOR PERMIT SEWER AND/OR WATER CONNECTION *XYJ'': PAYMFTTC OF FEE AT TIM OF nrPLicATiorr noFS Nar mNSTITUTE APPROVAL OE' PERbffT. INSPF]CTZON OF SEWM ADID/O2 FII1M TT1ST'AT.i.ATTON$ Y7ILT• NdY HE.' SQ'IED- ULED UNTIL PEk2MIT HAS BEEN APPROVID. iriease rrlnt/)' - 1) PROPERTY ADDRESS_ _/7/,'? (, f„? le-&- e-j - LEGAL DESCRIPTION: •- _ Lot Block Subdivision or Tax Parcel ID ) IF MSTING SIRCCIS.'TtE. DATE OF ORIGINAL BLILDIN6 PERMiT ISSPANICE: ' PR£SENT 7ANIN3/PROPOSID L'SE: (14on Year) [] CONMEFtCIAL/REPAIL/OFFICE r7 IDIDCSTRIAL n INSTITL'TIONAL/GpVERNMENT 2) F?gII i ? R-1 SINGLE FAMILY ? R-2 DL'PLEX (1t.o Units) Cj R-3 TUWNE30TISE (Three + Units) ( LTnits) M R-4 APARTMENT/COAIDOMINIUM ( [hiits ) NANE: RoDxESS: CITY. STATE. ZIP: PHONE: 3) 2 i:?• NAA1E: ft/L.?... ADDRESS :? CITY, STATE, ZIP: PHONE: ?G_? 4) ?ar • • ? i?- NAME: ADDRF.SS: CITY, STATE, ZIP: PHONE: Plumbers License: Active fO EScpired <" . Not recorded /-MASTER LICENSE# St In1t1a1 5) ? r• i a• • ?• : a • o? • r? ? CONDIfS..T10N ZU CITY SEWIIt Ej CpNNfX.TION ?l7 CITY WATEK ? p'i'FIEtit ' . 6) ? ?• '• r ? P7,EASE HOLD APPROVFD PE1:ZMIT FOR PICK-OP BY ONE OF ABOVE ------ - PLEASE MASL APPROVID P/ERMIT 'It7 1. 2,304. ABOVE - (Circle one) 7) r,e /6 Z 2fa w' ., /'l(' " SIL FOR CITY USE ONLY PERMIT # ISSL?ED Pd w/BJ.dg. Permit FEES: $ $ SEWER PERMIT (INCLUDE SURCHARGE) $ $ WATER PERMIT ( ZNCLL'DE SL'RCHARGE ) . $ $ WATER METER/COPPERHORN/OL'TSIDE READER $ $ WATER TAP (INCLUDE CORPORATION STOP) $ $ SEWER TAP $ $ / jD-7 ACCOLNT DEPOSIT - SEWER $ $ ? O-7) ACCODNT DEPOSIT - WATER $ WAC S .? 7 G?} $ SAC S $ TRL'NK.WATER ASSESSMENT ? $ TRL'NK SEk]ER ASSESSMENT $ $ LATERAL BENEFIT/TRUNK SEWER $ $ LATERAL BENEFIT/TRC!NK WATER O c? $ WATER TREATMENT PLANT SLRCHARGE $ $ OTHER: %/ !J ?J TOTAL !-?'i ?4/c?.s6 RECEIPT RECEIPT DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY? Q YES IF YES, THEN A"PERMIT FOR WORK WITHIN PLBLIC Q NO ROADWAY" MUST BE ISSUED BY THE ENGINEERING DIVISION LIST DI . AS A CON TION. SUBJECT TO THE FOLLOWING CbND2TIONS: APPROVED BY• TITLE; DATE: ? C7:7Y i]P EAGFlN t:ASI-?.T.E=hr, S T'FCiM:[NAt.. N(:l. 36 1)A'1'1=:; 0843C1/96 T:f.N-e ii.:f.1900 ID;: NAMEr, DAVTD ?iPDNSE:L 32W 9001 4567 Hnv Lic RD 45.00 205 7001 4567 IiAY I...K FiI1 L'1,5U 34:30 9001 41567 I-Ir1Y I...I( FtTJ 0.50 'rotal. heceipt Amourit,n 46.00 CFi06.?73s3 LISE.R IDe NANCY 'KXCYF9F?k>k?YF>X ??F?F%(?YI.PFY,C?M 'M?'F?FYF 'M>k?m?F??7K? 'MYn?YFW.x'.?RCM , ... PERMIT CITY dF EAGAN 3830 Pilot Knoh Road PERMIT TYPE: B U I L D I N G Eagan, Minne50ta 55122-1897 Permit Number: 028625 (612) 681-4675 Date Issued: g 8/ 3 0 i 9 6 SITE ADDRESS: 4567 HAY LAKE RD S LOT: 8 BLpCK: 2 OVERHILL FARM 15T P.I.N.: 10-56150-080-02 DESCRIPTION: DECK NEW 434 ALT. RESIDENTTAL REMARKS: FEE SUMMARY: Base Fee Surcharge Subtotal $45.00 $.50 $45.50 COPY $.50 Tptal Fee $46.00 CONTRACTOR: ? T herol OWNER: - Applicant - SpONSEL DAVLD 4567 HAY LAKE RD 3 EAGAN MN (612)466-0818 ?J?g .?ac,? R??r? l APPLICAKT/PERMITIE-E RMI SIGNATURE ISSUEDBYSIG TURE 7 CITY OF EAGAN 3830 PILOT KNOB RD - 55122 1996 SUILDlNG PEI2MIT APPLICATION (RESIDENTIAL) 681-4675 New Construction Reauiremenls ? 3 regislered site surveys ? 2 coples oF plans (inelude beam & window sizes; poured fnd. design; ete.) ? 1 energy calculations ? 3 wpies of tree preservation plan if lat plaried afier 711/93 required: Yes _ Mo S? 7 ?141+ y L_oq-K? DATE: ,--I? a.3 - -/ lp CONSTRUCTION COST: DESCRIPTION OF WORK: STREET ADDRESS: LOT BLOCK Z SUBD./P.I.D. #: ??I G C?1 ?-L(' ,"/ CP??v??? J?? PROPERTY OWNER CONTRACTOR Name:S?loti L DA"'4 lf? Phone USi fIRSi Street Address- u City: Zip: RemodeVReoair Reauirement Z;71k,UU ? 2 copies of plan ? 2 site surveys (ezterior addkions & decks) ? 1 energy wiwlations for heated additions State: Company: 5ct rn e- Phone #: Street Address: City: Zip: ARCHITECTI Company: ENGINEER Name: Registration Street Address• City: Sewer & water Iicensed plumber: change are requested once permit is issued. State: Penalty appiies when address change and lot I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with a!1 applicable State of Minnesota Statutes and Ciry of Eagan Ordinances. Signature of Applicant: OFFICE USE ONLY REMIEVED Certificates of Survey Received ^ Yes _ No AUG 2 3 296 Tree Preservation Plan Received Yes No License #: State: Phone OFFICE USE ONLY BUILDING PERMIT TYPE ? 01 Foundation ? 06 Duplex ? 02 SF Dwelling ? 07 4-plex ? 03 SF Addition ? 08 8-plex ? 04 SF Porch o 09 12-piex ? 05 SF Misc. ? 10 = plex WdRK TYPE ,z' 31 New ? 33 Alterations ? 32 Addition ? 34 Repair GENERAL INFORMATION Const. (Actual) (Allowable) UBC Occupancy Zoning # of Stories Length Depth APPROVALS Planning ? 11 Apt./Lodging ? ? 12 Multi Repair/Rem. o ? 13 Garage/Accessory ? 0 14 Firepiace ? 15 Deck ? 36 Move 0 37 Demolition Basement sq. ft. Main level sq. ft. sq. ft. sq. ft. sq. ft. sq. ft. Footprint sq. ft. Building 614 Engineering Valuation: $ Permit Fee Surcharge Plan Review License MCNVS 5AC City SAC Water Conn. Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment PI. Road Unit Park Ded. Trails Ded. Other Copies Total: , 1!; u 16 Basement Finish 17 Swim Pool 20 Public Facility 21 Miscellaneous MC/WS System City Water Fire 5prinklered PRV Boosker Pump Census Code. SAC Code Census Bidg Census Unit Variance / 43 or i d % 5AC SAC Units ?0- NoRTK O4lL.E 1*4L 4-0' AA-. WEaaOW..s A%uMEo o pSOloYis 19011 McNIJMEN7 DE?stRIPTtoIJ ovEa-NtL? F,b.t?M FlR-ST AIDOITiopl# 04"TA COUNTY, M I IJ W ?'s4faTd I hereby certify that tltis survey was prepared by me or under my direct supervision and that Z am a duly Registered Land Surveyor under the laws of the State of Minnesota. Date: !?. ?d ' ?`-' Le'Roy?} . Bohlen Registered Land Surveyor No. 1070' ? . ks - e ? ??6 s? LOT: _ S BLOCK: I SUBD./P.I.D#: QreY6It FRrIYI ILt 2000 BUILDING PERMIT APPLICATION (RESIDENTIAL) 1 3830 PIL0T KNOB RDN 55122 ??? 1• °? 651-881-4675 Colk I?z,,M New Construetion Reauirements Remodel/Reoair Reauirements ? ? 3 registered sMe surveys showing sq. R. ot lot, sq. ft. of house 2 coples of plan and ?II roofed areas (20% maximum lof coveraae allowed) 1 set of energy calculations for heated addttions D 2 copies of plans (show beam 8 window sizes; poured fnd. design; efc.) 1 site survey for exterior addNions 8 decks ? 1 set of energy calculations ? 3 coples of hee preservation plan M lot plaNed aRer 7/1/93 ? Rim Jolst Defall Opfions selection sheet (butldinas with 3 or less unNs) DATE: f ti` 1' 0?-` CONSTRUCTIONCOST: 1 Z; 06D DESCRIPTION OF WORK: J??r- /apv i-rio #J H multi-family bldg., how many units? _ STREEf ADDRESS: 466`1 ? , -k-? ?AlL5 VLD Name: ?-SPGh1SC?L ??}v lD Phone#: C?St- Q.Sb -o81g, PROPERTY last First OWNER StreetAddress: 466-? S. 1-Ewl, L{a1lc. T-,J Cify ??.Arf Zip: 6S IZ?j State: r"-',S CONTRACiOR ARCHIiECT/ ENGINEER Company: ?SeL-- Phone #: (area code) SheetAddress: 5C'cl-- license# Exp. City Company:_ Telephone 8: ( SheM Address: Cily State: Name: Registrailon #: _ State: SeweNwater licensed plumber (if installfna sewerlwater): Phone #: Zlp: I hereby acknowledge that I have read this applicafton, state that the informatfon is correct, and agree to comply with all applicable State of Minnesota Statutes and City f Eagan Ordinances. Signature of Applicant: lb??? OFFICE USE ONLY Certificates of Survey Received ? Yes _ No REC"'IVE Tree Preservation Plan Received _ Yes }C No _ Not Required NOV 0 1 2900 Zip: OFFICE USE ONLY ? 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 O 03 01 of _ plex ? 09 07-plex O 17 Garage 10 22 PorchlAddn. (4-sea.) ? 33 Ext. Alt • SF D 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screened) ? 36 Multl ? 05 03-plex ? 11 10-plex ? 19 Lower Leve l ? 24 Storm Damage ? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous p 31 New ? 35 Int Improvement ? 42 Demolish (Foundation) ? 45 Fire Repair ? 32 Addition O 36 Move Bldg. ? 43 Reroof ? 46 WindowslDoors ? 33 Alteration ? 37 Demolish (Bldg)' ? 44 Siding ? 34 Repiacement ? 38 Demolish (Interior) ' Demoiition (Entire Bldg only) permit - Give PCA handout to applicant VALUATION J?. !J 00 (Z? '? Occupancy ? MClES System Census Code ?/.341 Zoning RCity Water SAC Units 19? Stories Booster Pump Nbr. of Units Sq. Ft. PRV Nbr. of Bldgs ? Length 1161, Fire Sprinklered Type of Const Width 14Z INSPECT IONS REQUIRED _ Footings: New Bldg Insulation _ Windows - new/replacement Footings: Deck FinaUC.O. _ Siding Footings: Addirion ? FinaUNo C.O. _ Stucco/Stone Foundation r.i. Fireplace: Final Roof: _ ice & water _ final air test ? Framing = = Pool: frgs = air/gas tests fmal APPROVALS Planning ----------- - ---- - --------- - - - -- Building -------------- --- Engineering Variance --------- - ------- - ----------------------------------------- - - - - Base Fee surcnarge Plan Review MC/ES SAC City SAC Water Supply & Storage S&W Permit & Surcharge Treatment Plant Park Dedication Trails Dedication License Search Copies Other Total: ??. . ? ?•,• ., 4i ? ,??• ??G ?o NOR1K 7ZAL& 1NL 4.a a.? ?I"s a%uMSc a OSMD'TiS IRoM MoNLUKENI' I.oT b , B ?.ca K.. 2 = ovEa.NtLL P1R.ST ACOIT1o*.1,# DqK.oTA CDUN?Ya M IWhtic*vTA I hereby certify that triis survey was prepared by me or under my direct supervision and that I am a duly Registered Land Surveyor under the laws of the State of Minnesota. Date: f?-...??? ?'4'? :.' L ?r ?!-? ??. /????? ? LeRoy ffl. Bohlen Registered Land Surveyor No. 10795 ??v 0 (?/ ? , 50 zoos RESIDENTIAL PLUMBING PERnniT aPPLicaTioN CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN MN 55122 651-675-5675 Please complete for modifications to existing residential dwellings. Date/h l$/ ? IL2 i < Site Street Address 4i WCf " J Unit # Property Owner Telephone# ((:55t ) q5?0 ?ll? Contraator -m ipeuuorks Telephone# (ieGl ) I`N U Address. 3670 o oQ City State Zip agcan, The Applicant is: _ Owner '-::'Contractor _Other Septic System _ New _ Refurbished Submit 2 sets of plans and MPC license Includes County fee $ 100.00 Peras-built $ 10.00 Alterations to existing dwelling $ 50.00 _ Add plum6ing Wures. This fee includes installation of a water softener and/or water heater at the same time. !f you are lnstalling onlv a water softener and/or water heater, do not complete this section; move to the next section and check the appliance(s) you are installing. _Septic System Abandonment _Water Turnaround (add $130.00 if a 5!8" meter is required) Other: Water Softener ? Water Heater _ new _Y?replacement $ 15.00 Lawn Irrigation _RP2 _PVB _new _repair _rebuild $ 30.00 State Surcharge $ 50 Total $ Ls-S a I hereby apply for a Residential Plumbing Permit and acknowledge that the inforrt+ation is compiele and accurate; that the work will be in conformance with the ordinances and codes of the Ciry of Eagan and the plumbing codes; that I understand this is not a permit, but only an application for a permit, work is not to staA without a permit and work will be in accorda ith the approved plan in the event a plan is required to e eviewed ano apprpved. nce ?ridoieo ApplicanPs Printed Name ApplicanYs 'ignature OCT 2 6 2005 ? City of Eagan 3830 Pilot Knob Rd Eagan, MN 55122 (651) 675 -5675 www.ci.eagan.mn.us Site Address: 4567 Hay Lake Rd S Lot: 8 Block: 2 Addition: Overhill Farm 1st PID:10- 56150- 080 -02 Use: Description: Sub Type: e - Fixtures Work Type: New Description: Basement Fixtures Meter Size Meter Type Comments: Fee Summary: Contractor: Farmington Plumbing & Heating 21034 Chippendale Ave Farmington MN 55024 (651) 463 -7824 daniel thelen 21034 chippendale ave. farmington , mn 55024 Manufacturer PL - Permit Fee (miscellaneous) Surcharge -Fixed Total: Applicant/Permitee: Signature PERMIT City of Eaan - Applicant - Permit Type: Permit Number: Date Issued: Permit Category: Serial Number Remote Number Owner: David I Sponsel 4567 Hay Lake Rd S Eagan MN 55123 $50.00 0801.4087 $0.50 9001.2195 $50.50 I hereby acknowledge that I have read this application and state that the informa of Minnesota Statutes and City of Eagan Ordinances. on is correct and agree to comply h all applicable State Issued By: Signature Plumbing EA092198 12/02/2009 ePermit Line Size City of Eagan 3830 Pilot Knob Rd Eagan, MN 55122 (651) 675 -5675 www.ci.eagan.mn.us Site Address: 4567 Hay Lake Rd S Lot: 8 Block: 2 Addition: Overhill Farm 1st PID:10- 56150- 080 -02 Use: Description: Sub Type: e - Furnace & Air Conditioner Work Type: New Description: Fumace & Air Conditioner Comments: Quesetions regarding electrical permit requirements should be directed to Mark Anderson, State Electrical Inspector, (952) 445 -2840 Fee Summary: Contractor: Farmington Plumbing & Heating 21034 Chippendale Ave Farmington MN 55024 (651) 463 -7824 ME - Permit Fee (Replacements) Surcharge -Fixed Total: Applicant/Permitee: Signature PERMIT City of Eaan - Applicant - Owner: David I Sponsel 4567 Hay Lake Rd S Eagan MN 55123 Permit Type: Permit Number: Date Issued: Permit Category: $50.00 0801.4088 $0.50 9001.2195 $50.50 Mechanical EA092199 12/02/2009 ePermit I hereby acknowledge that I have read this application and state that the informa of Minnesota Statutes and City of Eagan Ordinances. on is correct and agree to comply h all applicable State Issued By: Signature Use BLUE or BLACK Ink r For Office Use / " City of Win I Permit I I Permit Fee: 3830 Pilot Knob Road I I Eagan MN 55122 Date Received: .3 Phone: (651) 675-5675 I I Fax: (651) 675-5694 i Staff: 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: Unit Name: A ,&c `~76 Phone: X51- 5~, - ©8 f it) Resident/ Owner Address / City / Zip: 0-ts Applicant is: >4-, Owner Contractor Type of Work Description of work: RV_- 7-0©'r- Construction Cost: 71'S Op Multi-Family Building: (Yes / No Company: Contact: Contractor Address: City: State: Zip: Phone: I t 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 the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that they are trade secrets. CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. 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 5'7t)&J Ste, x Applicant's Printed Name Applicant's Signature Page 1 of 3