812 Ivy Lane•x
?, •?:?..
?
.-, (grx#i#iratt of O.r.cupanry
(Cirp of Cagan
Brparb"tz# of Wuildittg itts.prpr#imt
This C,ern'ficate issued pursuaxt to the requirernenls of SecAion 306 af she Urrifonri Buiid'ing
Code cenifXirrB diai at the lime of rssuaxae tdrris snucture wrs in rnrnplicxce wilh the various
orfinanars of the City regulatirtg building oonsmrdion ar use Fvr 1he falfowing.
Use CLUMTknio, k OF DUPLEX M&P Tim 2011b
paap,ecprppe R-3 M-1 zooaqp;arirt PD TraCa.m Y-N
p,,,,.,,,fg„U;.g HIEIQKANN CONST Ad&cu 6648 RUSTiC RD SE
g„l&g Add,c$ 814 I VY LN L,,,ft i.R, H3_ '1E tMJ?AH1S TIlM
I, (U " (J ! MAY 7, 1997
a.adioa oe5"
POST IN A CONSPICUOUS PLACE
opuponown*a
BUILD(NG PERMIT
To be used for_ z OF
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 ?.i?? 11 G_
PHON E: 681-4675
Receipt #
Est. value s93r000
19 92
Site Address 814 IVY LN
Lot ` 8 Blo,ck 3 SeclSub. THE WCX
?. Parcel No.
?
Name S I8K!lANN CONST
?
?
i W pddreSS 6648 itilSTIC RD SE
city PitI08 LA1CE MN Zp
55372
cc Narne awnm
OO AddrESS
? cky Zip
Phone
8 ucense # 0001436
I hereby acknowlege that I have read this application and state that the
inlormation is correct and aqree to complv with all aoolicable State of
to:
with all
OFFICE USE ONLY
R-3
O M?-1 FEES
ccupancy p ?
?
? 608.00
Zoning .
(Adual) Corut V-N S-ter;ge 46.50
(Allowable) V-N plan Reyiew 393•00
# ot stories 32 ? ?w 5.00
Lerigtn
oecm 78' sac, city 100.00
S.F. Total - SAC. MCWCC 700900
S.F. Footprints - 675.00
On Site Sewage _ Water Conn
On Site Well Water Meter 93600
nnwcc syster„ x 30.00
ciry warer 7( accc. ?er?os?c
PRV Required _ S/W Permit 30•00
Booster Pump - SMI Surcharge • 30
Trealment PI 300.00
APPROVALS RoadUnit 360•00
Planner - Park Ded.
Council ? ?
•
Bidg.Oif. _ Copies
Variance - TOTAL ? .365' 30
PermiWo. Permk Holder Date Telephone ?
&W
PWMSinG
HvAC
E-EcrRic
ELEc7MC
hespeetion Date Msp. Comments
Footings I
?? • ?
Foundation
Framing `3 ,3??y ?y D S
Roofing J
Rough Ptbg.
914
Rough Htg.
Isul.
F,?eplace
Final Hig.
Orsat Test
Final Plbg. Plbg. Inspeclor - Notily Plumber
Const. Meter
EngrJPten
Bldg. Final
Dedc Ftg. .. .oi G.
Oedc Final
we?i
Pr. Disp.
_3-J - 9 S
v
?,•
w??t'cficate nf Ccrupancv
wim of Cpagan
etoarbu"t ? ???? ?oad"
This Certificate issued pursuant to the requirements of the Uniform Building Code
certifying that at the time of issuance this structure was in compliance with the various
orrtinances of the City regulating building construction or use. For the following:
? of DUPIEX 20115
use classifirafion: O Blag. Pemmt No.
Occupancy Type Zoning District Ty?e Co?q.
Owner of Buitding $? ?T Addmss J!'Q1 ?L` I
1 1VY LRH a s -
Boilding Addtess Locality
?12/17/q2
Date:
sWWmg official
POST IN A CONSPICUOUS PLACE
sa•? v.?s?..?p.: -. -
i T
,?A?E 1lKT':•.
. . „ .. . . --..... ..r. -'?lsa!'"+?3.`„7f7?R?T'!'r'T?yBry-rlF .• sr,? •-. .
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 681-4675
Receipt #
?F DUPLgK Est. value $a9+000 oate FEE
81 LYY Ltt
Site AdcSress
Lot 7 Block 3 Sec/Sub. TH£ ?a?BS OFFICE USE ONLY ?
FEES
NOK Parcel No. R-3
pcc„Pancy M-1
590
00
2onin PD eklg. PermR .
?
Na1'1@ S?ROIAM CMW g
(Actuaq Const v_-N Sumtmrge ?• Sd
isJ
? Addr2SS 6646 Ri1S1IC RD SE (A,uowatite) V-?
pM pe,?
384?00 .
?. City PRICaR 1.AiX t3N ZjP 53372 L°??ones .?.r ?M 5.00
?
Phpll@ 4117-2424 Deplh 78? SAC, City 100•00
cc: N?fi'le rvA? S.F. Total - SAC, MCWCC 7?'?
0 S.F. Footprints - 675
00
i?(?reSS On Site Sewa
e Water Conn .
? (;jty Zip g
On Site well _ water Meter g s' ?
y
? Photle MWCC System ?
x Acct
Deposit
?
? .oo
O
U
# ??14??
V
City Water .
.O C?
30
ce? PRV Required _ S/W Permit I
1 fisreby acknowlege that f have read lhis appfication and state that ihe Booster Pump - g/Vy Surcharge 'SID
information is correct and agree to comply .with all applicable 5tate of
M
d C 3??? ?
innesota Statutes an
ity of Eagan Ordinphces. Treatment PI
Signature ot Permitee APPROYALS Road Unit 380•00
A 6uilding Permit is iq ed to: ? jEKKAHN CnNST Planner - park Ded. ?
on ihe express condin that aU work shall be done in accardance with alt Councd --
50
applicable State of Minnesota Statutes and City of Eagan Ordinances. gld9, p{f. _ Copies •
„
Building Official Variance - TOTAL 3,334.50
L20115
.3 ., ,
---Iq
PermN No. Permit Holder Date Tekphw+e #
SAtV o
PWM6ING
FNAC r/.? ?%D-• ?QI
ELECTR,C z
ELECTRIC
Inspection Date Insp. Comments
Foofings I
7?.0/ ? riZ. GlJ?
Foundation
Framing ? -
Rooling
Fough Plbg. ? -?`•? i; _?"- /.
/
Fough Htg. ?`/ '7 b( 1VY .?
'l 5??.
Fireplace ;
-
--
--
Final Htg. / ? - a _
T
--
OrsBt Test
Final Pibg_ Plbg. Inspeclor - Notity Plumber
Const. Meter
Engr./Plan
Bldg. Final 1'117I Z 4?j
Deck Ftg.
Dedc Final
weli
Pr. Disp.
?
34
; SEWER & WATER PERMIT
I CITY flF EAGAN
3830 Pilot Knob Rd.
Eagan, MN 55122-1897
DAT4 ~ FEB 18, 1992
OFFICE USE ONLY
METER #`+T5S7 7/ b? 7 PERMIT DATE 02/20/92
CHIP # Q a 9 I D?? 02 PERMIT # 12551
METER SIZE e? k B.P. RECEIPT #?'C?.0 4-? L
tSSUE DATE B.P. RECEIPT DATE (17 / ()1() 9
_ PRV _ BOOSTER PUMP
SITE ADDRESS 814 IVY LN
LOT 8 BLOCK 3`SEC/SUB 'CAE WOOD .AxnS NnRTH
APPLICANT:
ADDRESS:_
CITY, STATE
PHONE: _
ZIP
PERMIT REDUESTED
..X- SEWER Y WATER - TAPS
COMM,'IND
X_ NEW
_.x_ RESIDENTIAL
_ EXISTING
r"`tawn Sprinkler Meters are to be Installed
PLUMBER: GENZ-RYAN PLBG Ah ead of Domestic Meters on Water Line.
ADDRESS: 14745 5 ROBERT TR Credit WILL NOT be iven for Deduct Meters.
CITY, STATE ROSFMOIINT MN ZIP 55068
PHONE: 423-1144
AGREE TO IC?OIVIPLY WITH C17Y OF
OWNER: SIEKMANN CONST EAGAN ORDINANCES
ADDRESS: 664$ BUSTIC RD SE
CITY, STATE PRTnR I-At-F Mnu ZIP 55372
PHONE: 447-2494 SiGNATURE W N METER ISSUED
PLE'dS?,?CLt?1fG TW?RkIN4`bAYS FOR-RROL?ESS(?IC;. e`ALL?454-5220 FOR
SEWER pERMITS, CONTACT ENGINEERING DEPT.
INSPECTIONS. FOR STORM
?-???;
SEWER & WATER PERMIT
CITY OF EAGAN
3830 Pilot Knob Rd.
Eagan, MN 55122-1897
DATE ?'EB 18, 1992
OFFICE
METER #
CHIP #
METER SIZE
ISSUE DATE
iE ONLY
PERMITDATE 02/20/92
PERMIT # ? ? Sh 1
B.P. RECEIPT #
B.P. RECEIPT DATE 02119199
- BOOSTER PUMP
? SITE ADDRESS 814 IVY I.N
LOT-8 BLOCK3 SEC/SlIB T?E 1?IOODLANDS NQRTH
APPUCANT:
ADDRESS:_
CITY, STATE
PHONE: -
ZIP
PLUMBER: GENZ-RYELN PLBG
ADDRESS: 14745 S ROBERT TR
CITY, STATE RCISEMOitt.T MN ZIP 55n6A
PHONE:
OWNER: SIEKMANN CONST
ADDRESS: 6648 RUSTIC RD SE
CITY, STATE pRrnR i•AKF MN ZIP 55372
PHONE: 447_2424
PERMIT REGIUESTED
-X- SEWER -X- WATER _ TAPS
COMM/IND -X- RESIDENTIAL
X- NEW - EXISTING
Lawn Sprinkler Meters are to be instafled
Ahead of Domestic Meters on Water Line.
Credit WILL NOT be given for Deduct Meters.
1 AGREE TO COMPLY WITH CITY OF
EAGAN ORDINANCES
SIGNATURE WHEN METER ISSUEQ
I PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. CALL 454-5220 FOR INSPEC7taNS. FOR ST4HM
SEWER PERMITS, CONTACT ENGINEERING DEPT.
?
CASH RECEIPT ?
CITY OF EAGAN ' 3830 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE ' / j ig .
nECEivEO f ?
fROM 4•? ? ? ?r? ! I ',J
AMOUNT $ -
& DOLLAR$
,oo
CJ CASH ? CHECK
Fw
i
? ?'? _ ,•_ ? ,1
l' .1
Thank You
ev
C(), 17 3 8 0 mi«e? wY
Y??? ?„ ?
PiN(--Fne copy
SEWER & Wj?TER PERMIT
CITYDF EAGAN
.. 3830 pilot Knob Rd.
Eagan, MN 59122-1897
DATE FGB 18. 1992
OFFICE USE ONLY
METER # PERMIT DATE 02/20/92
CHIP # PERMIT # 12561)
METER SIZE B.P. RECEIPT # . , .
ISSUE DATE B.P. RECEIPT DATE 02L19L92
_ PRV - BOOSTER PUMP
SITE ADDRESS 819 T vv I N
LOT _I_BLOCK 3-SEC/SUB THE FlQODLANDS IvORTN
APPLICANT:
ADDRESS:_
CITY, STATE
PHONE: -
ZIP
PLUMBER: GENZ-RXAN PL$G
ADORESS: 14745 S ROBERT TR
CITY, STATE ROSF.MOUNT MM ZIP 55069
PHONE: 423-1144
OWNER: SIEKMANN CONST
ADDRESS: 6648 RUSTIC RI3 SE
CITY, STATE PRIOR LAECE MN ZIP 55372
PHONE: 447-2424
__X_ SEWER X WATER - TAPS ?
_ COMM/IND X RESIDENTIAL
PERMIT REQUESTED
X NEW
EXISTING
Lawn Sprinkler Meters are to be Installed
Ahe+ad of Domestic Meters on Water Line.
Cre.rtlit WILL NOT bc,?i?en r Deduct Meters.
?C/?/2'dlf•??? ??r.2'?j ?
: TO COMPLY WITH CITY OF
ORDINANCES
SIGNATURE WHEN METER ISSUED
PLEASE ALLOW TWO WORKING UAYS FOR PROCESSING. CALL 4545220 FOR INSPECTIONS. FOR STORM
SEWER PERMITS, CONTACT ENGINEERING DEPT.
? SEWER & WATER PERMIT
i CITY pF EAGAN
3830 Pilot Knob Rd.
? Eagan, MN 55122-1897
OATE FEB 18, 1992
OFFICE US6 ONLY
METER # ? 64976ff3d PERMIT DATE 02/20/92
cHiP * (1313 4123 ? PERMIT # 12560
M£TER SIZE 2513F 4?.P. RECEIPT # I I i ` ? L^)
ISSUE DATE B.P. RECEIPT DATE 02 19 92
_ PRV _ BQOSTER PUMP
SITE ADDRESS 812 IVY L.N
LOT 7 BLOCK 3-SEClSUB THE WOODLANDS NORTH
APPLICANT:
ADDRESS:_
CITY, STATE
ZIP
PHONE: -
PIUMBER: GENZ-RYAN PLBG
ADQRESS: 14745 S ROBERT TR
CITY, STATE RQSEMOUNT MIlV ZIP 55068
PERMIT REQUESTED
--X- SEWER -X- WATER _ TAPS I,
_ COMM/IND --X- RESIDENTIAL ,
X NEW
EXISTING
Lawn Sprinkler Meters are to be Installed
A d of Oomestic Meters on Water Line.
Gr it WILL NOT be-ai;uen fsr Deduct Meters.
ov
PHONE: 4[:1-1144 ` " " "
GREE TO COMPLY WITN CITY OF
OWNER: SIEIQMANN CONST EAGAN ORDINANCES
ADORESS: 6648 RUSTIC RD SE 4
CITY, STATE PRIOR LAKE MN Zlp 55372 ?
PHC)NE: 447-2424 SIGNATURE WHEN METER ISSUED
1 - ?;?-''--
PIEAS"??ALLOW ?O WO?tKING DAY$ FOR PHOCEStING. CALL 454-5220 FOR INSPECTIONS. FOR STORM
SEWER PERMITS, CONTACT ENGINEERING DEPT. !"
O?4 ?9 1 a
J
ow
/Vo, ? ?
•
Request Oate
3 -/? Rre No kough-in InspecUOn
ppqu l
u W ? Reatly Now,?'ll NoUry Inspactor
When Reatly'
I licensed contractor O owner hereby request inspection of above electrical work at:
Joe Atldress (Street Bax or Rou a 1 / ? ? ? Crty is
SecLOn No • Tavnship Name or No Rarge No. Coun ?a?OV-'wL
OccupantIPRIN , Phone Na.
PowerS p er Atltlress '
EConVactor (COmpany Name) ? Contr dork L nse No y^
MaAing Atldress I nlractor or Owner Making InStallation
AWhorrzetl nature ICOnlracton0 ner Makm Installauo f
_ 1i?tL2
4-?? Phone Number
S'/o-lo3C?
MINNESOTA STATE BOARD OF ELECTHICITV THIS INSPECTION REOUEST WILL NOT
Gri99s-Midwey BIEg. - Room S173 BE ACCEPTED BY THE STATE BOAFD
1821 llniversrty Ave.. SL Paul. MN 55100 UNLESS PROPER INSPECTION FEE IS
Phone(61Y)662-0800 ENCLOSEO
(311
:
REQUEST FOR ELECTRICAL INSPECTION
? See insimctions lor crompleling Mis form on back oi yeilow copy.
"X" Beloiv Work Covered by This Request
EB-000014)8
e Adtl Rep. TypeofBmldmg AppliancesWired EqmpmenlWired
Home Range Temporary.Service
Duplex Water Healer Eleciric Heating
r1pt. Bwlding Dryer Other (Specity)
Comm /Industrial Furnace
Farm Air Conditioner
? Other(spenyl ConVadorS Femarks
Campufe Inspection Fee Below:
k ' 01her Fee # ServiceEmrenceSrze Fee # CircwislFeeders Fee
Swimmmg Pool 0 to 200 Amps ? 0 ro 100 Amps
Transbrmers Ahove 200 _ Amps Above 100 _ Amps
Signs Inspector§ Use Only. TOTAL- -:0
Irrigation Booms ?6.? /Q
Special Inspection
Alarm/Communication THIS INSTALLATION MAY BE OR RED ONNECTED IF NOT
Other Fee ? COMPLETED WITHIN NTHS.
I, the Electrical Inspector, hereby
if Ro1 r
. oay /?yz
5
y that the above inspection has
cert
been made Final r,
" oete
_-P `
OFFICE USE DNLY
This reQUest voitl 18 manths irom • .,
?G
y o
G
J
3 4 2
,
Request Date - ' Fie No Rough-in Inspedwn
Reqwred'+
? Reedy Now CJA411fNoGty Inapecror
es ? No When Reatly+
licenseq con[ractor ? owner hereby request mSpeChon of above electrical work at:
Job AtlOress (Slraet. Box or Rou C
w/LC-
Seclion No Township Name or No. Fange No Counly
Occupant (PRI
l?V / ? ? • Phom No.
P er Supplr Atltlress •
?
Electncal C dor (Company Name) Con IorS L¢ense No
C ? ?
MaiLng Ftloress !CO ractor ar Owner Making Installa0on?
?
?
AutM1Onzed S wre ICOntracto,;Owner Makm Ins?ailauon? Phone Number
'
C
36
5z
f g
-
o
?
MINNESOTA STATE BOARD OF ELECTPICITY THIS INSPECTION FEOlIEST WILL NOT
Grigqs-Mitlway Bldg. - Foom 5-113 BE ACCEPTED 9Y THE STATE BOARD
1821 UnlveraHy Ave. SL Peul. MN 55104 UNLESS PPOPER INSPECTION FEE IS
Phone (610) 842-0600 ENCLOSED ,
/ REQUEST FOR ELECTRICAL INSPECTION
3 ?G So'Z ?„
J ` ? n ? See insVUCtions for completing [his lonn on back ol yelbw copy
X" Bebw Work Covered by This Request
ew Adtl Rep. TypeofBuAtling ApphancesWired EquipmeNWired
Home Ranqe Temporary Service
Duplex Water Heater Eleciric Heating
ApL Building Dryer O[her (Specity)
Comm.Andusinal Fumace
Farm Air Condinoner
Omer fsuemry) Conhactor5 Femarks.
Compute Inspecfion Fee Below'
# Other Fee # Sermce Entrance Sae Fee # Cimurts/Feetlers Fee
Swimming Pool 0 to 200 Amps 0 l0 100 Amps
Transformers Above 200 _ Amps Above 100 _ Amps
SignS inspecror's Use Only TOTAL ?v
Irrigation eooms 76 . ? ?Q
Speaal Inspection '
AlarmlCommumcation THIS INSTALLATION M R?D_11ISCONNECTED IF NOT
Other Fee ? COMPLETED WITHIN 7MONTHS.
I, the Elecirical Inspector, hereby
td
h poug0-in L, ,, -
/
cer
y t
at the above inspecLOn has
been made. Flnal ?r., .
, i Oate
? ?`r
OFFICE USE ONLY
This request voitl 18 monPoS irom
Address; 814 IVY LN Lot 8 Blk 3 Sec/Sub THE WOODLANDS NORTH
These items were/were not complete at the time of the final inspection.
Date: MAY 7 1992 Yes No TnqPPrtnrD.AV?, CO
Final grade (6" from siding)
Permanent steps - garage x
Permanent steps - main entry
Permanent driveway ?
Permanent gas
Sod/seeded grass
Trail/cuib damage
Porch X
Basement finish
Deck x
Please verify vith the builder the removal of roof test caps from the plumbing
system and tha shut-off of vater supply to the outside lawn faucet before
freeze potential exists.
w
White - City copy Yellow - Resident copy Pink - Contractor copy
A+ddress: 812 IVY IANE 1.ot 7 Blk 3 Sac/SuhTHE wppDLAmS Npm
Thase items wera/weYe not complete at the tlme of the final inspection.
Date; 12/17/92 Yas No
Final grade (6" from siding) ?
Permanent stepa - garage ?
Permanent stepa - main entry ?
Permanent dciveway
Permanent gas
Sod/seeded grass
Trail/curb damage
Porah
Basemant finish ?
Deck ?
Please verify vith the builder tha removel of roof test caps from the plumhing
system and tha shut-off of vater supply to the outside Lavn faucat bafoze
freeze potential exists. m
VX9
?rnumwrs
White - City copy Yellow - Reaident copy Pink - Contractor copy
DATE: FEB 21, 19
RE: $12 & 814 IVY LN (SIEKMANN CONST)
X Your Sewer & Water Permit for the above property has been completed. It will be held at the
Public Works Garage (3501 Coachman Road) until the meter is picked up. BE SURE TO
CALL PUBLIC WORKS (454-5220) FOR YOUR PERMANENT WATER TURN ON.
- Your Sewer & Water Permrt for the above property cannot be completed tor the tollowing
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
contirmed by Bill Adams or Dirk House (Plumbing Inspectors- 454-8100) before issuance.
WARNING: BEFORE DIGGING, CALL LOCAL UTILITIES - TELEPHONE, ELECTRIC, GAS, ETC.
- REDUIRED BY LAW.
CONTACT COMMUNITY DEVELOPMENT DEPARTMENT FOR WATER TURN ON POLICY.
Secretary, Bwlding Inspections Dept.
Lvrs 7 & a
FoR-sA1E WIY CITY OF EAGAN ?d?O 1 1 6
- 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
BUILDING PERMIT PHONE: 687-4675 Receipt # ?
L? ?
To be used for ? OF DUPLEX Est Value $93,000 Date FEB 18 19 92
Site Address $14 IVY LN
Lot 's Block _-3 Sec/Sub. THE WOODLANDS
Parcel No. NORTH
N2RIe S1EKMANN CONST
Address 6648 RUSTIC RD SE
? Cjry PRIOR LAKE MN Zp 55372
? Phone 447-2424 OR 835-4126
cc Narne SAME
? Address
Ciry Zp
? Phone
o
U License N 0001436
I hereby acknowlege a? I h ve read this application antl state that the
informanon is corr,
t and) gree to compty th all applicable Stale of
Minnesota Stawt and h o agan O dma C?s.
Signature of Perm e '?
A Building Permit is i s d to: gIR?N1d CONST
on the ezpress contli on that all work shall be done in accordance with all
applicable State of Minnesota Statutes and Crty of Eagan Ordinances.
Building Oflicial
OFFICE USE ONLY
R-3
Occupancy
M=1
FEES
Zoning PD BId9. Perme 608.00
(ACtuap Const Y_L9 Surclwge 46. 50,
(Allowable) VL-d plan Review 395.00
# olStories
Length 19, Lbem r 5.00
Depih 78' SAC, City 100.00
S.F.TOtal - SAC,MCwCC 700.00
S F. Footprints -
00
675
On Sile Sewage _ water Conn .
On Site well warer Meter 95.00
MWCCSystem X 00
30
City Warer AocC Oeposit .
PFVRequrteE - S/VJPermit 30.00
Booscer Pump - SNJ Surcharge _ Sn
Treatment PI 300.00
APPROVALS qoad Unn
0
380.0
Planner - park Detl.
Counal -- 50
BIdg.Off _ Copies .
Variance - TOTAL 3,365.50
Lors 7 & a
FUR-sAtE L.'?nT CITY OF EAGAN 11020115
3830 Pilot Knob Road, P.O. Box 21-199. Eagan, MN 55121
PHONE: 681-4675
BUILDING PERMIT Receipt #
Tobeusedlor ? OF DUPLEX Est.Value $89.000 Date FEB 14 , 19 92
SiteAddress $12 IVY LN
Lot 7 Block 3 SeGSub. THE WOODLANDS
Parcel No. RT
w
0
NBrtte SIEK1fANN_CONST?.
Address 6648 RUSTIC RD S
P e
Zp
cc Name z)Amt
? Address
City ZiP
Phone
g LjceMe q 0001436
I hereby acknowlege thal I have read this application and state that the
inlormation is correc rdgree to comply ith all appticable Sta1e ot
Mmnesota Statutes d y of Eagan O din r?es.
Signature of Permi e +
A Building Permit is i ed to: SIEKMANN CONST
on Ihe express condi n thal all work shall be done in accordance with all
applicable State of Minnesota Statutes and C?/iry of Eagan Ortlinances.
Building 0f6cial ?$,Q/!e1, J ?1 L,
PRIOR LAKE MN
OFFICE USE ONLV
R-3 1
M FEEs
Occupancy
=
PD
Bldg. Peimlt
590.00
zoning
(ACNap Const V'N Sumtmrge 44. 50,
(Allowable) V-N'
%an Revie?v 384.00
A` oi stones
32 1
?m 5.00
Length
oepm 7' snGary 100.00
S.F.Total - SAC,MCWCC 700.00
S F. Footprinis -
675
00
On Si1e sewage - Water Conn .
On Site Weil Water Meter 95.00
MWCC System X 30.00
City water
-
x Acct Depasil
30.00
PRV Required _ S/N Permn
Boosler Pump - S/VJ Surcnarge • 50
7reatment PI 300,00
APPRO4ALS RoadUnit 380.00
Planner - park Ded.
CouncA - 50
BIdg.0f1 _ CoPies .
Vanance - TOTAL_ 3,334.50
2422 Enterprise Drive
PIONEER LRNOSUHVEY0115•CIVIIENGINEERS _J MendotaHeigh[s,MN55120
A
????'?Op?'?J^?Y
? QngIneering ? LIINOPLRNNERS. L/?NOSCIIPEI?RCHITECTS
?
.
Certiticate of Survey for: W00dLAND COUNTRYn0MCS?,[V
LANE Bqb.y? oi tio?l
TU Y ° 37 R' ti
R=Soz.so „r?e=
t2•° N ? ? /
0
0
z $9
a
5.4? ' o?0 1•? .Yi? `
a l0.a
?a o q,bi $yb•3
' to,a ;.o
o s \
013.a
L m C? - b'
s ? •,
m Z.o
qp?,g 1? La e ?? °
s` qa
0 28•° ? ?
?-
r- ?
"T\. Ng "?
r 1
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c?
,;-°_? • i Cr 1 ?-"
C ?y ??}
v ? ri.
? ?%?_
D? o?-
?E ING DEPT
1..:;"' >
54.02 "
x 9uO.o Denoies txdin Elevaiion PFtoPOSEO HousE EGE?a ?p;??? ?
? oo.o Ueno>es Propo?ed Eleva/ion Lowes loor Eleva ioh p
--'----- Denotes brainaoe F Ulilily Easem.?nt Top o,l?Blockllevation -?'
-Y--- Dendes Drainoy& F/oWDirPClian Garaot Slab Elevalion
o OPnotes ,Nonuffienf gearin?s shown are assumed oDeno es o{ise hbb
LOTS 7ANO S 8LOCl13- TNE WOODLANDS NORTH
DAKOna COUNT? MINNESOTq ? SUB?ECT TO E4SEME/Vr5' 5f fZECbRD
I hereby CEYIIfY IM1Bt tF11S IS A IlUC dll(I COffBCt f2nf25ff1{2I100 OI x survey of the bounAaries nl ihe above ti,efcrihed land I nI ihe localion pqI ?all?
buildmgs, [hereon, and all visihle encroachments, i( any, from or on said IatiJ. As surveyeJ hy me this-?day of A.D. 19?C.'
ai{ --I
Scqle :1'nCh. 30 , ee{
Q 1of / aJ NcJAERT P. SIKICFI L.S. REG.1V0. I4891
I( D7. Y
2004 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
l,?70 -c) ()
New Construcfion Reauirements RemodeVReoeir ReauiremenLs CHfce Use OnN
3 registered site surveys shaving sq. R of bt, sq. ft o( house; and all mofed areas 2 copias of plan Cert of Survey Recd _Y _ N
(20% mauimum lotcoverege allowed) 1 set of Energy Calculations for heated additions Tree Pres Plan Recd _Y _N,
2 copies of plan showiig beam 8 window sizes; poured tound design, etc. 1 site survey for addillons 8 decks Tree Pras Required _ Y _ N
1 setofEner9yCalculaEons Addifion-iMicate'rfaraitesep6csysfem On3iteSepticSysiem _Y AN
3 copies of Tree Preservatbn Plan if lot platted afler 711193
Rim Joist Detail Options selectian shcet (bldgs wBh 3 or less unils
Date
Site Address T Constr1 uc 'on Cost
V )i UniUSte #
Description of Work V 2i4c,U't
Multi-Family Bldg ? Y_ N Fireplace(s) _ 0_ 1 _ 2
Property Owner l( V?•, ,n Telephooe -??GG
Contractor L`'C, ,` ?d v k? J 4. q cf" ? f-T< f?kJ' S
Address 76&u Oc?(Cfn,-r!
State V/ k/ /
? IEIf City
Zip !S57tG Telephone # (&$"( ) yu:? -
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
(Jsubmissiantype) 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 # ( D ?I
I hereby apply for a Residential Building Permit and acknowledge that the informatiok9uonu?lelcte;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a
petmit; that the work will be in accordance with the approved plan in the case of work which requires a review and
approval of plans.
Applicant's Printed Name
???L(?- ?'?k?(-"""'""? -
?
Applicant's Signature
REQUIREMENTS:
SINGLE F.4MILY
1992 BUILDING PERMIT APPLICATION
CITY OF EAuAN
zo iff
2 SETS OF PLANS, 3 REGISTERED SITE SURVEYS,
: :
1 SET ENERGY CALCS.
MULTIPLE DWELLINGS 2 SETS OF GISTERED SITE SURVEYS, 1 SET OF ENERGY CALCS.
COMMERCIAL 2 SET ITECTURAL & STRUCTURAL PLANS, 1 SET OF
SPECIFICATIONS, 1 SET OF ENERGY CALCS.
PENALTY APPLIES WHEN TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY LAST WORKING
DAY OF MONTH IN WHICH REQUEST IS MADE Q LOT CHANGE 15 REQUESTED ONCE PERMIT IS
ISSUED.
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOI -Ik1f,V?f? M,U$T/p?SRC1?ATE WHICH
ADDRESS IS DESIRED. NO CHANGES WILL BE ALLOWED
FEB 12 1992
To Be Used For: Re s i den t i a 1 Valuation:
Site Address 812 I
Lot 7 Block 3
Parcel/Sub
# U RENTAL FOR SALE
?
OF 1 of 2
T,a n a
Address 6648 Rustic Road S. E
Cfty%GIR SamP
Cfty/Zip Prior L
Phone 447-242
Contractor Same
AddrBSS Same
Phone Same LiCe115e 0001436
Arch./Engr.
Address
Ciry/Zip Code
Phone #
a?? 000 ?
Occupancy
Zoning
Actual Const
Allowable
# of stories
Length
Depth
S.F. Total
Footprint S.F.
On-site sewage
On-site well
MWCC System
City Water
PRV
Fuoster Pump
APPROVALS
Planner
Council
Bidg. Off.
Variance
R-3M-I Bldg Permit
V-N License Fee
pl> Surcharge
v_ N Plan Review
SAC, City
? SAC, MWCC
? Water Conn.
? Water Meter
Acct. Deposit
S/W Permk
S/W 5urcharge
Treatment PI.
?- Road Unit
-? Park Ded.
Trail Ded.
Capies
SUBTOTAL
Penalry
Lot Change
TOTAL
SG
2-13-$2 flS
Sewer/Water Licensed Contr. . Processingtime
for sewer/water permits is two ays once area as een approve .
agrees that all work shall be done in accordance with
ignature o Permittee
all applicable State of Minnesota Statutes and City of Eagan Ordinances.
r ,
. 1992 BUILDING PERMIT APPLICATION
CITY OF EAGAN
REQUIREMENTS: Cto ' I (r
SINGLE FAMILY 2 SETS OF PLANS, 3 REGISTERED SITE SURVEYS, 1 SET ENERGY CALCS.
dAULTIPLE DWELLINGS 2 SETS O , ISTERED SITE SURVEYS, 1 5ET OF ENERGY CALCS.
,.
COMMERCIAL 2 SETS =- HITECTURAL & STRUCTURAL PLANS, 1 5ET OF
SPECIFICATIONS, 1 SET OF ENERGY CALCS.
PENALTY APPl1ES 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 TE WHICH
ADDRESS IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING P S,I,GU?1EDi ?-'
?
S
L
ToBeUSedFOr: Residential Valuation: ? Date: 02/10/ 7FE81 2jq92
10!1
Site Address 814 Iv Lane
Lot 8 Block 3 ? 3 D? ?.
• FFICE U E O
FEE
- Occupancy R 3?. S Bldg Permit 668.00
Parcel/SubThp Zoning PD Surcharge '/6. o
S1e o? ?s?-
? Actuai Const d-N Plan Review 3 .Da
Owner --
a?r?i =?ou s??e. Allowable V•N License Fee .oo
# of stories SAC, City /oo, 0 0
Address 6648 xustic Road S. e. Length Q SAC, MWCC qoo.00
Depth Water Conn. ? , a?v
City/Zip Prior Lake, MN 55372 S.F. TOtal Water Meter q,y,a 6y
Footprint S.F. Acct. Deposit .?ue*
Phone 447-2424 S/W Permit ??
On-site sewage S/W Surcharge 50
Contractor Same On-site well Treatment PI. 3ao.oo
MWCC System Road Unit 880.?
Address Same City water Park Ded.
. PRV Trail Ded.
C?j,/ziP Same esooster ??ump Copies r
SUBTOTAL
Phone Same License 0001436 APPROVALS Penalt?r
Planner Lot Change
Council TOTAL ..5?
Arch./Engr. Bidg. Off. 2?3 sz(x.
Variance
Address
Ci.ry/Zip Code
Phone #
Sewer/Water Licensed Contr. r?-? Processingtime
for sewer/water permits is twoc'ays on area rms een approve .
agrees that all work shall be done in accordance with
igna4ure o ermittee
all applicable State of Minnesota Statutes and City of Eagan Ordinances.
# OF U' S 1 o f 2. RENTAL FOR SALE X
L . . .. . . . _ ITA/'/ z?
.? `
DATE: 11-12-86 ENERGY CODE CALCULATIONS
----------------------====----------------------_-___
COMM NO:
8661
-----------------
CHASNEY pSSOCIATES INC. '
------------
PROJECT- --^_--^----
-----------
OAK RUN ....---- -°-
---------
4979 OL."iON MEMORIAL HWY. LOCATION: BURNSVILLE
MINNEAPOLIS, MN: 55422 BLDG TYPE: TYPE A2
PHONE: 612/546-3355
-------------------------------------
- DEGREE DAY3: • 8300
-
-----
INDOOR DESIGN TEMP +72 DEGREE5 ------------ -----------
ENGIIVEER: ----------
DRB
OUTDOOR DESIGN TEMP -15 DEGREES
--------•----°------------==---==--==-
---------°-- FILE:
-------?-- E-8661-1 .
'
-
CEILING _
ROOF ASSEMBLY
-----------------------
--------
=========- -------^___
AREA-50 FT'
-- -
--.---------
. U VALUE, ---
--_„p? _'__
U x`'A
-
-
--------
INSULATED AREA
-•--=====-===
1152'
-=?°?------
°' . .025-
----------
----28
92
FRRMING AREA 117. :
.070 .
8
19
SKYLIGHTS 0 ,
.
O .
OTHER (DESCRIBE)
O .
'
: 0
01'HER (DESCRIBE)
. .
0
:.. " 0
- --------------- O 0
---
-----------
1 TOTALS
--------?---
1269,r?
°----^?---
..3 *?****** ;'
-----=-----
:: 37.11
2 AVERAGE U VALUE (UxA)/(R) LINE 1 *Y:***?:?i,i;'r'"!'z^,`''''•'''"""
:024 " ?
3 REQUIRED U VALUE
------'--'---
-'-
== "
******??r. .
'-- .
, ..033
---'--" -
_=_=__
_^`EXP05ED WALL AcuSEMBLY
-------
---------------------==-=--=--
------ -- "_--'_
AREA-59 FT
----------- .•__-'?__:'_
U VALUE __-=__--`-
U X.A
-
-------------
-
TNSULATED WALL t{1 AREA -
------------
575 -------------
--°------
.OSq ---_-------
--_---.._
30
£38
F fi/111ING AREA 1t1 c•1 .355 .
22
r,•-l
WINDUWS 129 .610 .
78
69
DOORS :,3 .510 .
16
871
FiIM JOIST AREA
101
.055 .
5
57
FTRFPL7ICE WHLL p .
INSULATED WALL 42 AREA
91 V
.101 0
9
19
FRAMING AREA 92 ].0 .219 .
2
1?
UTHER (DESCRIBE) .
OThIER (DE^•uCRIBE) 0
0 0 0
-------------°-----------
= Q 0
------
h TOTAL.S
5 AVERAGE U VAWE (UxA)/ (R) LINE 4 --------
---^
1C1t)3 _--------
. *:K******'.
---166 U4
6 REQUIRED U VALUE
,
166 *****a?* i
_ _------?--- *****??:c
-=---------- .230
-
----------
_ 70TAL ENVELOPE
----------
METHOD ----------
----^------ ----------
---?-----•
7 AREA (LTNE 1) + AREA (LINE 4) 1269 1003
8 UxA (LINE 1) + UxA (LSNE 4) 37,11
166.p4 2272
03
1?
2
9 AREA (LINE 1) x U
(LTNE 3) 1269
Ua .
4
10 AREA (LTNE 4) x U (LINE G) 1003 .
23 41.88
11 BUDGET (LINE 10) +(LINE 9) 230.69 .
41
03 230.69
1:' U VflLUE (LTNE 11) /(l_INE 7) 272.57 .
?
227 27257
----?------ ?
---
=
=e .12
SUMMFIRY -------- x=ce===== __====---..
U VALUES
------------------------ ----_ REBUIRED ACTUA? DIFF
- -
CEILING/ROOF ASSEMBLY U VALUE --------.---- --- -° --
--
-
EXPOSED WALL HSSEMQLY U VALUE 033
. .029 ,00?1
TO7AL ENVELOPE BUDGETS .230 .166 .064
272.57
203.14
69.43
IF EACH ACTUAI. U VALUE OR IF BUDGCT IS t_EuS
COMPUTER
CALCULf-1TES IJ TO TtiAN REqU'IRED, BLUG M EETS COPF
_
_faCCURACY_UF_^OOC7000U1_BUTI.C!i11 ^I8 SHOWM'FOR_CLARSTti'
L-?,c.. ?eL ? - - CITY OF FAGAN
SIIBD.?,/ Liv . _292::t? () 681-4ERM675
RESIDBHTIAL
PLEASH COMPLETE IIppgt p0RTI0N ONLY FOR SINGLE FAMILY DWELLINGS. ALSQ, FOR TOWNHOMES AND CONDOS
WHEN PERMITS ARE REQUIgED FpR EACH UNIT.
t70RK DESCRIPTION
NEW CONST _qt?,
ADD ON _
REPAIR _
OWNER NAME:
i
SITE ADDRESS : b 2- 0,2, //h 0
INSTALLER: GENZ-RYAN PLUMBING
ADDRESS: 14745 South Robert Trail
CITY: Rosemount Zip; 55068
CONTRACT PRICE:
1% OF CONTRACT FEE. .
STATE SURCHARGE - $.50 FOR
EACH $1,000 OF PERMIT FEE.
STATE SURCIiARGE .50
TOTAL:
. S
COIMRCIAL
PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS. AISO FOR MULTI-FAMILY
BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT.
WORK DESCRIPTION:
OWNER NAME:
SITE ADDRESS:
TENANT NAME:
SUITE J: _
114J'1'AIA.E_K
ADDRESS:
CZTY;
PHONE
FOR:
CITY OF EAGAN
ZIP:
$25.00 MINIMUM FEE.
CONTRACT PRICE x 1% $
STATE SURCHARGE $
TOTAL:
CITY USE ONLY
BECEIPT ? L S 7` 7?
DAT
COMPLETE THE FOLIAWING;
N0, . FIXTIIRES EA. TOTAL
REPAIR/ADD ON 15.00
? SHOWIIt 3.00 fj?rL
2 WATIIt CIASET 3.00 dv4?La
BATH T[JB 3.00 ?p
LAVATORY 3.00 c%L(C
? KITCHEN SINK 3.00
? LAUNDRY TRAY 3.00
? HOT T[TS/SPA 3.00
WATER HEATER 3.00 ,-.1-0 c)
? FtAOaZ DRAiN 3.00
GAS PIPZNG OUT.
? (MINIMUM - 1) 3.00 JdC)
_ ROUGH OPENINGS 1.50
_ OTHER
_ WATER SOFfENER 5.00 L ?
_ PRIVATE DISP. 15.00
_ U.G. SPRINKI.ER 3.00
_ W. TURNAROUND 15.00
$
(SIGNATURE)
PHONE #: 423-1144
- ? CITY OF EAGAN FOR CITY USE ONLY
3830 PILOT RNOB ROAD
EAGAN, MN 55122 PERMIT #
PHONE: (612) 454-8100 RECEIPT #?
?'?#1NG`sP??CT DATE:
PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY
TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
---------------°------- ----------------------------°--------------
DWELLINGS &
WORK DESC PTION COMPLETE THE FOLLOWING:
N0. FIXTURES EA. TOTAL
NEW CONST _ ADD-ON MINIMUM 15.00
ADD ON ? SHOWER 3.00 4aL7(1
REPAIR WATER CIASET 3.00 {oUd
OWNER NAME:
SITE ADDRESS: 7" ,?.
LOT:? BLOCK ? SUBD ?INSTALLER:
ADDRESS : / `Z / f! S -'
? BATH TUB 3.00 JnU D
LAVATORY 3.00 (L2 69 O
KITCHEN SINK 3.00 3p D
LAUNDRY TRAY 3.00
3 I ? HOT TUB/SPA 3.00
? WATER HEATER 3.00 <3 D 0
? FIAOR DRAIN 3.00 &O-L)
? GAS PIPING OUT.
(MINIMUM - 1) 3.00 30.0
,f ROUGH OPENINGS 1.50 S
OTHER
WATER SOFTENER 5.00
_ PRIVATE DISP. 15.00
U.G. SPRINKLER 3.00
SUBTOTAL S ?3!j sv
ST. SURCHARGE .50
TOTAL: $ 3 :5(?v
COMMERGIAlij.It7DIt5T&IAIi;; PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUI
MULTI-FAMILY BUILDINGS WtIEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH
DWELLING UNIT.
----------------- _____
CONTRACT PRICE:
OWNER NAME:
SITE ADDRESS:
LOT: BLOCK _ SUBD
INSTALLER:
ADDRESS:
CITY:
PHONE #:
FOR:
CITY OF EAGAN
ZIP:
FEES
18 OF CONTRACT FEE.
STATE SURCHARGE a $.50 FOR
EACH $1,000 OF PERMIT FEE.
$25.00 MINIMUM FEE.
CONTRACT PRICE x 18
STATE SURCHARGE
TOTAL:
(SIGNATURE)
CITYZIP: <`???
. CITY OF EAGAN FOR CITY USE ONLY
3830 PILOT KNOB ROAD
- EAGAN, MN 55122 PERMIT #
PHONE: (612) 454-8100 RECEIPT
DATE: S
1?STbE?"IAIi: PLEASE COMPLETE IIPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS fi
sTOWNHOMES/CONDOS WHEN PERMZTS ARE REQUIRED FOR EACH UNIT.
------------------------ -------------°----------°--------------------°--------
WORK DESCRIPTION COMPLETE THE FOLIAWING:
N0. FIXTURES EA. TOTAL
NEW CONST ? ADD-ON MINIMUM 15.00
ADD ON SHOWER 3.00
REPAIR WATER CIASET 3.00
BATH TUB 3.00
LAVATORY 3.00
OWNER NAME: _ KITCHEN SINK 3.00
?j` LAUNDRY TRAY 3.00
SITE ADDRESS: h'q HOT TUB/SPA 3.00
1 ? 4??C?r""`N"v '(•
LOT: B WATER HEATER 3.00
/TICK v SUBD. ? FIAOR DRAIN 3.00
GAS PIPING OUT.
INSTALLER: o _ (MINIMUM - 1) 3.00
1 ROUGH OPENINGS 1.50
ADDRESS: ? OTHER _
n WATER SOFTENER 5.00
CITY?l<? ZIP: PRIVATE DISP. 15.00
? -in I? ? ?--I _ U.G. SPRINKLER 3.00
SUBTOTAL $ 5•M
ST. SURCHARGE .50
TOTAL: $ ?• ?
oO*{ERGIf.I:;i9DUS?RIAI:i`. PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS AND
? .. .....:......._,.,
MULTI-FAMILY BUILDINGS WNEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH
DWELLING UNIT.
CONTRACT PRICE:
nt.nacn *IP.M.E:
SITE ADDRESS:
LOT: HIACK _ SUBD.
INSTALLER:
ADDRESS:
CITY: ZIP:
PHONE
FOR:
CITY OF EAGAN
FEES
i% CF ^vGNTRr1GT FEc.
STATE SURCHARGE - $.50 FOR
EACH $1,000 OF PERMIT FEE.
$25.00 MINIMUM FEE.
CONTRACT PRICE x 18 $_
STATE SURCHARGE $_
TOTAL:
$
(SIGNATURE)
SIGNATURE OF PERMITTEE
? CITY OF EAGAN
3830 PILOT KNOB ROAD
EAGAN, MN 55122
PHONE: (612) 454-8100
"q?A?m;
FOR CITY USE ONLY
PERMIT #
RECEIPT #
DATE : 37w ?--
12?S?DE?TTTA?::' PLEASE COMPLETE IIPPER PORTION ONLY FOR SINGLE ]
;,.:. ...... ,......... . : . : ..: .._.: .
TOWNNOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
-------------------
WORK DESC PTION
NEW CONST _
ADD ON _
REPAIR
OWNER NAME: C ?\w--
/
SITE ADDRESS: ??TJ
LOT:,?/_ BLOCK ? SUBD.
INSTALLER:
ADDRESS: ?l l? I L? ??ro-??n ??-
CITY: ZIP:
PHONE #:
FEES
ADD-ON MINIMUM
HVAC 0-100 M BTU
ADDITIONAL 50 M BTU
GAS OUTLETS - MINIMUM
OF 1 PER PERMIT
JUD 1 U'1F1L:
STATE SURCHARGE:
TOTAL:
DWELLINGS S
$15.00
24.0
6.00
3.0
.50
? n 0 O r? ?- v... 1
SIGNATURE OF PERMITTEE
Cb?R4ERG?AF.J?NDfI?TRTA?I? PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS,
APARTMENT BUILDINGS, AND MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE
NOT REQUIRED FOR EACH DWELLING IINIT.
-------------
CONTRACT PRICE:
OWNER NAME: _
SITE ADDRESS:
IAT: BLOCK _ SUBD.
INSTALLER:
ADDRESS:
CITY: ZIP:
PHONE #: _
FEES
19 OF CONTRACT FEE.
STATE SURCHARGE - $.50 FOR
EACH $1,000 OF PERMIT FEE.
PROCESSED PIPING = $25.00
$25.00 MINIMUM FEE.
CONTRACT PRICE x 18
STATE SURCHARGE
TOTAL:
$
$
(SIGNATURE)
FOR:
C:TY OF EAGAN
,. ? CITY OF EAGAN
3830 PILOT KNOB ROAD
EAGAN, MN 55122
PHONE: (612) 454-8100
t4gqoICA?.:<Y?1?'?
FEES
1?SIp??JTTAT:? PLEASE COMPLETE IIPPER PORTION ONLY FOR SINGLE ]
TOWNAOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACA UNIT.
-------------------
WORK DESC IPTION
NEW CONST
ADD ON _
REPAIR _
OL?NEP NAME:
SITE ADDRESS:
LOT: 91 BLOCK ? SUBD.i/? DGQO'G'??G6?
INSTALLER:
ADDRESS:
CI71': ZIP:
PHONE #: O I
FOR CITY USE ONLY
PERMIT #
RECEIPT
DATE: 3 L/
ADD-ON MINIMUM
HVAC 0-100 M BTU
ADDITIONAL 50 M BTU
GAS OUTLETS - MINIMUM
OF 1 PER PERMIT
SUBTOTAL:
STATE SURCHARGE:
TOTAL:
DWELLINGS &
$15.00
4.00
6.00
3.0
$ ` AQl
.50
$- r Lr2c >
`
e a
` SIGNATURE OF PERMITTEE
?Qh?iERGIAE.jZNbO$TKIAf:i.: PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS,
APARTMENT BUILDINGS, AND MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE
NOT REQUIRED FOR EACH DWELLING UNIT.
-------------
CONTRACT PRICE:
OWNER NAME:
SITE ADDRESS:
IAT: BLOCK _ SUBD.
INSTALLER:
ADDRESS:
CITY: ZIP:
PHONE #:
FOR:
FEES
18 OF CONTRACT FEE.
STATE SURCHARGE - $.50 FOR
EACH $1,000 OF PERMIT FEE.
PROCESSED PIPING a $25.00
$25.00 MINIMUM FEE.
CONTRACT PRICE x 18
STATE SURCHARGE • $
TOTAL:
(SIGNATURE)
CITY OF EAGAN
11/01/2012 12:20 Les Jones Roofing, Inc. (FAX)9528817009 P.0031006
Use BLUE or BLACK Ink
For Office use - 7 - j I
• ; Perms / / c
City of Ea Zan I Permit l=ee: i6
3830 Pilot Knob Road
Eagan MN 66122 j Date Received: j
Phone: (651) 675-6675 I I
Fax: (661) 675-5694 2 1 1 staff: I
i
2012 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 1 i f 1 %1 Slte Address: Unit
Name: -5b ACr Ml4N 4k9j& j-r Phone: 76s - 231- 6-11V
IlESIDENT I
OWNER Address/ Clty / Zip: M DECATUR. AV E k 2.4 CtOtoEd UYa1,1.d S9;4Z7
Applicant is. Owner -AContractor
TYRE OF"WORK Description ofwork: AI MOVE AND REP14" ROOF T12. qF ROOF
Construction Cost: it ~wy Multi-Family Building: (Yes _.K_l No__)
Company: LEg JOHE'S ROOFtnlCs._Irte- Contact:_"ItIS AMDER50 I
Address: qq I W. 36,, Smes:T"
OONTRAMOR City: Bt.ooMlufinnl
State: zip: S5t}20 Phone: ~l S2, - 8 S l 22~ 1
License 31 ( Lead Certlflcate _MAT- qD-b-72-1 V A'd l s-
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:
' dMi Plans anciAsufiparlding.d'ha marl Ma -you ,su lt:ade•cons dare effiiiblia•in' brrlla n, Portions 4T
the•lnformatlon•msy-be•classified as~non public if yowprovide-speoifia reasons-that-wouldipermlt,,the•Ctty to
Q ,oJd st t t t., Or, ts~
CAI 6 BIFOB9 YOU RIG,. Call Gopher State one call at (661) 464-0002 for protection against underground utility damage. Cal 48 hours
before you Intend to dig to recelve locates of underground utilities. www.aonherstateonacali.2m
I hereby acknowledge that this Information 18 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 wll 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. /
001-0
x COP is AA1Pf, tSON x Au- Applicant's Printed Name Applicant's Signature
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