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4537 Lake Park Dr Use BLUE or BLACK Ink For OEficr, Use City of Ea ; Permit VL I S`T H"i I Ed G Permit Fee: ✓ lJ 3830 Pilot Knob Road 1A 6-/ Eagan MN 55122 I Date Received: T- I Phone: (651) 675-5675 I ; I Staff: 8f 2~ Fax: (651) 675-5694 L _ _ _ _ - _ _ _ _ _ _ _ _ _ _I 2010 RESIDENTIAL PLUMBING PERMIT APPLICATION rr Date: d Site Address: :%ez r4-- P y GEZ-~G 2,2- Tenant: Suite RESIDENT / OWNER Name: Y i ~l~~eS Y Z22!;z :w Phone: 6 SRC p 7 Address/City/Zip: ja'L-- a y S~~ CONTRACTOR Name: License Address: City: State: Zip: Phone: Contact: Email TYPE OF WORK _ New _ Replacement _ Repair - Rebuild Modify Space _ Work in R.O.W. ' r Description of work: 0 2!2 M !-•'J U r~+r N 52-,d& je I? PERMIT TYPE RESIDENTIAL Water Softener Water Heater Lawn Irrigation RPZ PVB) Add Plumbing Fixtures Main Lower Level) Septic System Water Turnaround _ New Abandonment RESIDENTIAL FEES; $55.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge) $35.00 Lawn Irrigation (includes $5.00 State Surcharge) $55.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge) 'Water Turnaround (add $166.00 if a 5/8" meter is required) $105.00 Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge) $95.00 Fire Repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge) TOTAL FEES $ 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.gogherstateonecall.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 lans. Ap hcan s Printed Name ht% i FOR OFFICE USE Reviewed By: Date: Required Inspections: Under Ground Rough-In Air Test Gas Test Final ? 6UILDING PERMIT T. Ir rs?I A. . . 11201 Receipt # Site Address Erect Lk Occupancy Lot Blcek %c/Sub. - Remodel ? Zoning Parcel No Repair ? Type of Const. ? . qddkion ? No. Storiea W Name Move m D li h ? ? Length e o s Depth ? Address Int Impr. ? Sq, Ft. City Phone Instell ? k •. A Name ?? Address Citv Phnna Name _ Address I hereby acknowledgs that 1 have read this ar fFN information is torrect ond agree to con Stote of Minnesoro Stotutes and City of Ea, Sipnaturo of Permittea h Buildiny Permlt Is iuued to: oll work shalt be dona in occordance with oll Buildinp pfficiol Phone CITY OF EAGAN 3830 Pilot Knob Rosd, P.O. Box 21•199, Eagan, MN 55121 PH ON E: 454-8100 and stote thot oll applicobie Assessment Permit Water b Sew. Surcharge Police Plen Review Fira SAC ' Enp. Water Conn. ' Planner Water Meter Council Road Unit Bldg. Off. Tc PL APC Perke Var. Date Copiea Total ' on tM express Condition Ifiat soto Srotutes ond City of Eopon Ordinonces. Permit No. Psrmk H oldw Date TeIephons s Plumbinp , . • . • , _ - H.VA.C. q? J)75 ENetrfe ?? '? j j"? ? •?;? ? , ?? i `/ . ?l? ?%:. y t ?? q k?,.. ,? a .ad Saftwor Irqpaetion Date Insp. Other Footlnys I Footinys II Foundatlon 10 IA < Framin9 RooHng ? & ? Rouph Plbq. l _ Rough Hty. Irtsul. Firoplau Finsl Htg. Finsl Plby. - Ffnal ? CfAt/Occ. Water awibe Locstion: w•u 8ewor Pr. Disp. Reaipt ? . MECHANICAL PERMIT CITY OF EAGAN f!l1 In numbered t,paces Type or Print /egib/y Pe?mit No. Fse S/C • `; ? Tot ? a i ?.-b-85 9 1. Date 2. Installation Cost ? 4537 }.n,J:e Park: 3, Job Address Lot ' Blk. Tract 4. Owner ,, - s 1,?• t arraritc ., 6. Contractor Fid'URICKSOt+i Ii'i'G. &A.C. Phone 452-:171:, 8. Address 7. City State _ Zip ; - _ $. Building Type: Residential Commercial ? Institutional O 9. Work Description: New ? Add ? Alter O Repair O 10. Describe FuelType 11. No, EquinmYni 8TU - M. Ea. Forced Air 1`'0 No. Eauipment CFM Air Handling: Mfg. T,i?1JN(?i: Boilera E Mfg. Mech. xhaust Unit Heater Mfg. Other Air Cond. Mfg. Gas, Piping Outlets 12. I hereby certify that the above information is true and correct, and I agree to comply with all ordinances and codes governing this type of work. Signed : " for Rough Final Inspections: Oate Insp. Date Insp. This is your permit when numbered and approved. Approved CITY OF EAGAN 454,8100 Receipt PLUMBING PERMIT Permit No. CITY OF EAGAN Fee Fill in numbered spaces S/C Type or Print legibly Tot. 1. Date _ 2. Installation Cost 3. Job Address Lot Blk. Tract 4. Owner 5. Contractor Phone 6. Address 7. CitY State Zip 8. Building Type: Residential ? Commercial ? Institutional O 9. Work Description: New 0 Add ? Alter O Repair ? 10. Describe 11. No, Fixtures Water Closet No. I Fixtures Cesspool/Drainfield I Bath tubs Septic Tank Lavatory Softner ? Shower Well ? Kitchen Sink Urinal/Bidet Other I ' Laundry Tray ...?i t ; ? Floor Drains Drinking Ftn. Slop Sink I Gas Piping Outlets ' 12. I hereby certify that the above information is true and correct, and I agree to comply with all ordinances and codes governing this type of work. Signed : for Rough Final Inspections: Date Insp. Date Insp. This is your permit when numbered and approved. Approved CITY OF EAGAN 454-8100 ITY Of EAGAN Pilot Knob Road WATER SERVICE PERMIT P. O. Box 21199 PERMIT NO.: ' Eagan, MN 551A7 DA7E: I Zaninp: No. of Unirs: , I Owner: t Mdrosa: ? Sih Addross: PltMl'bRf: . Meter No.. d , Siu: " oc aTg l4 I Reoder Nc.:Ll&?YMgs-i F1n ? I.oh. ro aopn* w1eh 60 CIY 4f,FB-y.M OI+IMf1CY. R L ? V By Dnte of I nsp.: 6, y 3830 Pilot Knob Road P. O. Box 21199 Eagsn, MN 55121 Zoninp: Owner: t S.beIC Address: Site Address: " S? 7 I Plumber. ' t'11?E i-1-E A???1?r. - ermit ?e} / _" . , • ? , )?? Misc. oCFarpes: TOfGl7 ?. • (i1 !n`J IiiE.'t. DCiQ POId: I nsp.: SEWER SERVICE PERMIT PERMIT NO.: DATE: - No. of Units: ive L! Bl Lake Park Shores I o!m to eempy whk 1iw G1r ef ba¦ O?dim By Dote of Insp.: Cannectron Cltoys: %•"4 /lowurrt Deposit; Pom?it Fee: Surdwrpe: Misc. Chorpes: Total: I^sp.: Llot* Paid: CITY OF EAGAN WATER SERVICE PERMR 3830 Piiot Knvb Road P. O, Boa: 71199 PERMIT NO.: Eagan, MN 557,??7 DATE: Zonirg: _ No. of Urdh: L ?1Y?1lf: _ K)P_r0?1 I Siilddrrss: ''''i $ ar : 1.t r<<•= ..-.t .ct? at?r: .. o5Ce3 Plunbvf: Melsr No.: ConneeFian Chorge: ? Size: Acwunt Deposit: . . 1 Reoder No.: Pertnlt Fee: i 1 pns !o oowpy? wkb !M Cihr ef 169e0 Surtharqe: Orliwwwer. Miaa CF+orpes: ° . . firyT77 7orai: BY Dato Paid: Dote of Insp.: Iraio.: ..i T UP EAGAN Remarks Addition LAKE PARKCADDITIONTI SfLOxes Lot q eik L Parcel #10 44200 090 01 Owner Street 4537 Lake Park Drive State Eagan, Improvemeni Date Amount Annual Years Payment Receipt Date , STREET SURF. 2529, 52 505.90 STREET RESTOR. GRADING S SAN SEW TRUNK I 1976 ssessed un er Rasmusse Add tion I * SEWER LATERAL 4142.41 WATERMAIN WATER LATERAL 1981 ? WATER AFEA STORM SEW TRK 5/ 19$1 $13.86 54.26 STORM SEW LAT 19$1 I CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. 500.00 BUILDING PER. 11201 ? SAC ? PARK . • CASH RECEIPT • CITY OF EAGAN P. 0. BOX 21-199 EAGAN, MINNES TA 55121 / i //? DATE wecerveb / , , / - /? / FRO?. Y ?aA.. / ?t/ .1 AMOUNTJ ? CASH .8'CHECK row • ?/ 7 ? FUxO COOE AIADUNT /G v <% ? G ? n ? c J, Thank You N_ 57292 ? BV i White-Payers Copy Vellow-Posting Copy Pink-Fila Coov 4 BUILDING PERMIT Ts 6e wed fop SF CITY OF EAGAN N_° 11201 3830 Pilot Knob Road, P.O. Box 21-198, Eagen, MN 55121 ? PHONE: 454-8100 ?? j ? Receipt ?F DWG/GAR $125,000 , 1 SiteAddreu 4537 LAKE PARK DRIVE Erect Ex Occupency R3 Lot9 e1 ock 1 Sec/Suh. LAKE PARK SHOREBqemodel ? Zoning R1 Peroel No Repair ? Type of Const. V . AddlUon ? No. Storias Name TIBERON INC Move ? Length 92 W Z 3908 SIB MEM HWY Demolish ? Depth S? ? q?r"s IntImpc ? sy,Ft, City EAGAN pnone 454-1600 ?nstau ? ? N SA-ME ApOmvalf Fees Z,? ame _ Addrebs ?- City _ Phone f! W r Nema V? Address I W City Phone 1 hereby aGknowledge that I hove read this applicafion ond state thot the inlormotion Is correct ardporee tocpawly with all oovlicoble Sfofe of Msnnesoto $tatufes a/%Xify of p? 9orlNOrdinances. Slpnaturo of PermiMee ? ? A BuHding Permlt Is issued te: T ERON INC oll work shall be done in occordonce wilh oll upplicab??ypy/ Bufldin0 Officiol ??Y Assessment Permit $ - 495.50 Woter & Sew. Surcharge 62, 50 PoHce Plen Review __2A1 7 rJ Fire SAC 525.00 Enp. WaterCOnn. 500.00 Plonner weterMeter 63.00 Council Road Unit 280. ? 0 BIdg.Off, 10I17?$ T[PI. 132.00 APC Parke Var.Oate Copies rotai $2.305.75 on ehe axprcss corditlm Ihat •so es ond City of Eoqcn Ordinonces. \C REQUEST FOR ELECTRICAL INSPECTION es-oowi.oa ?` ? Sea insbuctions br comoleting this form on Eeek of yellow ropy. p ? ""X" Below Work Covered by 7his Request lihey Atl Aeo. Type ot Hmltling Applinnces Wired Equipment Wired ne Range Temporary Service Duplex Water Heater Liyhtiny Fiztures Apt. Bwldmg Dryer Electric Heaun Commeraal Bldy. jff FlArnace Silo Unloader d i Industnal 81dg. Air Conditioner Bulk Milk Tank Farm Otber souci vi ?hrrlsner iv: 1 P! SUCI.Ify Othl'! O1M1L'f Comnute lnspectron Fee Below N F¢e Servica Enhence5ize » Fee Faxders/5ubieatlers N Fee Grcuits 0 to 200 qm s 0 to 30 Am s 0 to 30 Am ns Above 200 Amps 31 to 700 Amps 31 to 100 Am s Swinunin Pool Above 100-Am s Above 700_AmPs Trans£ormers IrrigBtion Boorris Partial-'Other Fee Signs Special Inspecuon 5 TOTAL F Pemarks. Q .?? I ? Rough-in ?ate I, the EI'ectrical/ InspectoW;,haraby certHy thet the above , Final inspectian has been made. Thle reouesl voltl 18 montlns Irom This repuesl voitl 18 nqnths lrom (?1332 ?- 9 -? 1 L ?? o? s?? Raque [ ate ?? Fre No. Rouph-i Insoer,uon ? ?. FeyunreA, ReaAV Now?W;II Noufy Inspec - ?Yes ?NO I.r When qeady I 1 0L1censed Elec[ni,al Convac[or I hereby request inspaction of above ? Owne,r eleetncal work installed ab Str¢e AddrRS Box or Fou o. J e ? City ?? e ion o. To s'hiD amo ur Nu. Fany.; o. CountyA _A'L Oc?v nt (PRINII P????e N ?s'"_ . -o t 3 F Pawer Supolier Atldmss - A"?6 Electncal ConVactor ICompany W !'? C`si?. ConVar.m' ? s Lmense No. cc ? g E Mrar,ior?-{LqO?Y t: r??• pLiN?Y\.l ns?aj}i3on1 Ar.40 Authonz ign4yvr¢71 Owner Making Instxllationl PPL''' ? Phone Number MINNESOTA STATE BOAPD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT Griggs•Midway Bldg. - Noom N.191 ' 0E ACCEPTED BY THE STqTE 90qRD I/NLE55 PROPER INSPECTION FEE IS 1821 University Ava., St Paul, MN 55104 Phone 16121297-2111 ENCLOSED. REQUEST FOR ELECTRICAL INSPECTION jf% es-uuou,.ua u: Sea instrucLOns for comoletine thia iorm on back o1 Yallow copy. ?r ""X" Below Wnrk Covered by This Request tl Neo• Tyoe of BuilAinB APOliancea Wired-- Equipmant Wired Home Range Te poiary Service Duplex Water Heater rghting Fixtures Apt Buildmg er Electnc Heatin Commeraal Bldy Fumace Silo Unloader Industnal Bldg. Air ConAitioner Buik Milk Tank FBrnt Otnei aeci v tner ISnecifvl 1 . Uecify thor Othcr Compute Inspection Fee Below M Fee ServiceEntranceSize 11 fae Feeders/SUbfeeAers N Fna l, Cirowts 0 to 200 qm 5 0 to 30 Am s j/, ,j0•00 .i to 30 Am Above 200 qmps? 31 to 190 Amps ?_.11 to 100 A s Swimming Pool Atwve 100-Am s .y~O Above 700_Am y Transiormers Irriqation Boorcis °nrLal.'Other SgnS Special InSpection ?.? f0 • Re.rks ?'???? ?5? •. caSLfytthxttheb bove n Final . ` D?F pechon has been / ?C?O'V nde ihis request void ta mwnms tmm ? T/?/?? Owner /(a GO?:) Elec[ncal Contractor (-« - SL .' 1. ... IQReady Nnw r5yWi InsVec- No o tor When Ready I hereby request inapectmn ot above electncal work mstalled aC Sveet/Atldc¢sBO r H No. T ? Citv L ecuon o. To shl p ema or No. Ranue o. Coumy ? Or an?l ?, Phon?o- r?C 9 ? 7 Power Supplier Addross Elecincal Convac[nr (COmpanY Name) tract 's Li en se No. I Q / MaJinXMiii{Cp?{?i.?ia?ry?0yvngr MWicnstallaLOn? ; r.E?'? AuNonzed 1 r i g 21h1ion) f L 9 Phone Number THIS INSPECTIDN qEQUEST WILL NOT MINNESOTA STATE eOAflD OF ELECTRICITV BE ACCEPTED BY THE STqTE BOARD Griges-Midwey Bldg. - Room N-191 1821 Universrty Ave., St. Vaul, MN 55104 UNLESS PROPER INSPECTION FEE IS Phone (612) 297-2171 ENCLOSED. . 4 7 114a D -. 1985 BUILDING PERMIT APPLICAiION - CITY OF EAGAN NOTE: ALL CONTRACTORS !?UST BE LICENSED YITH THE CITY OF EAGAN C0141ERCIAL SINGLE FAMILY llifELLINGS INCLUDE 2 SETS OF ARCHITECTURAL INCLUDE 2 SETS OF PLANS & STRUCTURAL PLANS, 1 SET OF 3 CERTIF'ICATES OF SURVEY SPECIFICATIONS AND 1 SET OF 1 SET OF ENERGY CALCULATIONS ENERGY CALCULATIONS $2,000 LANDSCAPE BOND To Be Used For: S&A. fgd&4y Valuation: m(] 4531 Site Address ? zru1- y,e,K 10?. OFFICE Lot ? Block Parcel/Sub -Lg k} eaPk q6e4?h'S Owner _7ra2f{?5 CJ3PR13=. Address /,?Gp City/Zip Code ?&apJ 122/1) ?5 /Lv Phone Contractor 7'/jj6fgyv j nir? Address '"590 fJ ik/;-?1'J?ffi?, City/Zip Code -San/ 5''s /Z/ Phone y.S-y -1642?Z Arch,/Engr. PLan/C,a_ Address City/Zip Code )--- 44?/¢&/ Phone fi 'j Erect X Remodel , Repair , Addition Move _ Demolish , Int.Impr. 1 Install ? APPROVALS Date: /C? Occupancy Zoning Type of Const I! of Stories Length Depth Sq Ft FEES Assessments Permit Water/Sewer ' Surcharge Police Plan Review Fire SAC Engr Water Conn Planner Water Meter Council , Road Unit Bldg Off/,a /7 reatment P1 APC Parks Variance Copies TOTAL jS' Z?K2v' 1Z8x 58 = ?22zq- p i .. ?d -. ZY? K 32, xsb ? 2?X foX-S ' O°?)C? 45-7 2 ?28x ?Z - =>33? x Sg " ?74-4 I?X (? " Z3?>c 12 -Zsc?g 1242i? A ? 4 . t ? . , , One or Two Family CITY OF BUILDINd DEPARTMENT EXTERIOR ENVII,OPE AVERQ(}E 11U 16 C0I4PUTATION (To be submitted with building permit application) Dwelling Owner All Other Contractor ?OMES ?Y 7RR?1?7"0 Bite Addresa Date Phone LINEAL FEET OF '/ EXPOSED F?ALL ?E= ??(Ooo)?" y4r-Eft. above grade : .Zi-750.00 TOTAL EXPOSED 4YALL AREp SQ. FT. 0?pQUE lN1:LL COP:STRU:.TIOt:: "ll" Value x Area Detail h'?"qA"') "U" _X S2. ref'erence 'tU" •D x 5Q. from "U° O x SQ. attached liU° x SQ. sheeta nUu x SQ. 'NINDOSVS: "U" Value x Area FT.2IS7a{j .7 - o.,51U)(A) FT. l63,g8= IG.oCn(U)(d) FT. IVP,lz-- . 44(U) (A) FT. _ (U)($) FT. _ (U) (A) FT. _ (U) (A) P1ake & Type _ lel?cJL. ilUto .Sa x SQ. FT. 13(o•&0= (v . o(ll)(A) n nUII x SQ. FT. _ (u)(A) u n nU n x SQ. FT. - - (U)(d) n n npn x SQ. FT. _ (U)(A) DOOR5: "U" Value x Area i•l':ce & TY_oe _'2TL. /A?SUL, nUn •)4' x SQ. _ i',a4-rro up" .47 x s@ n n ' nUll x SQ. ii n _ itun X SQ ToTALS Z750.oo SQ. AVERAC3E IIU" TOTAL (U)(A) VALUES Z7-'7•7, 2 _ •OSo1 DIVIDED BY TOTAL WALL AREA 2750.00 ,-? AVERA(3E °Ull ,115 or lesa for 1&2 family dwellinge ROOF/CEILIN(3 : TOTAL AREA: FT. 12,00 = S,$ (U)(A) FT. ,oo = 9 4•4S (U) (A) FT. _ (U)(A) FT. _ (U)(A) r•T. 22-9. r-z (o) (p) Detail reference IfUlt 002s x SQ. FT. ?f /(O = 361•No(U)(A) from ilUto x SQ. FT. . (U) (A) attached sheete. isllll x SQ. FT. ? (U)(A) Describe openings liUlt x SQ. FT. - (U)(A) in roof. °IIff x 3Q. FT. = (U)(A) ToTAL (U)(A) VALUES DIVIDED $Y za0 z(e = T7ALy 13E? 5Q•f( 30'26 CU?? TOTAL R00F/CEILIidC} AREA J3/0 .D.?3 AVE;RA(3E "U" .025 for ventileted rooYs. ? If 0& R r, ?,?ass EXPoS? leJ, L ,c... 14.5v x (45+48 +a9r?? = 9.5o X (Sts) - SaoX 4l0 = 3. oa X Cq+4) = Co c, - .lo7X(48+4$ tz9tz.g +-iv? _ ?,oaX (9 t9) _ Z? Z33.ao 9s•ao 3(o$.vo 54, o0 /o9.8g /lo?.b8 -?- &a is? • S.3 X ?5?$fgSf29t29+?/0, = f ?. ?Z ?' (?_ tr?Dou?S 16x3z - 5;.S X Z ? ?.oo zo x 3Co = s, o X?} = zo, 0o zgx Iz. = 7.o X 4; zs,oo Zdx'?Pv = 54 x 4 = 3 31 (.00 ?4x4s = 0,0 x &= 48,00 13(p, loo Dmo?s z? STGS?• _ !o °- P4Mo G?' Z '- N?f A(OCIc! VfI LC... LE55 deAle.. I63.8g r? ?irrt i?.?Z ,r y?Jpw's l3lo.rvo ?' ?,ba?5 lZ?, o0 zl,oo zl.oa gg,on IZ(v. C,4 LL E'R?5 z,zso.oo loy? (c)(z4= (,pzs x zz = &? (9x 7 = 4 z- l.SxiS = Z 3 Ixlr = 11- ? !31(?.co --WALL SECTION-- Determining "U" values at Roof, Wall, Rim,, and Conc. Block ROOF/CEILIN6 (R) VAi,ii? 1.) Interior Air r'ilm 0.61 2.) 5/811 Gyp. Bd. .56 3.) Insulation 40,00 4.1 5.) Exterior Air Film .61 (STILL) nIIu = 1/R= "OTAL (R)= ! 1•78 s WALL R VALUE 60 Interior Air Film 0,68 7.) }n Gyp. Bd. .45 8.) Insulation ,1 2 19,ob 9.) 3z 2,04- 10,) Masonite Siding .6? 11.) Exterior Air Film .17 nU" = 1/R= TOTAL (R)=Z?,.Or RIM R VALUE 12.) Interior Air Film 0.68 13. ) Insulation ? 4.00 14.) 211 Fir Rim Joist 1.88 16.) Masonite Siding .67 170 Exterior Air Film .17 nuu _ 1/R= TOTAL (R)=z¢.4j EOUNDATION (R) VALU? 18.) Interior Air Film 0.68 19.) 20.) 21.) 7211 Concrete Block 1.28 2z. ) Pi&tD )/U?uL. 8 ? 23.) Exterior Air Film .17 npn'_ 7/g= .OQ?j TOTAL (R)= IO.I? ciTr use oNLr L ? BL RECEIPT#. 7? %IO SUBD. ?!? a•?Qe- ,Q.?r.mieq RECEIPT DATE: y y lC 1997 PLUMBING PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55122 (612)6814675 Please complete for. ? single family dwellings . townhomes and condos when permits are required for each unit ? backflow preventer for underground sprinkler system FIXTU ES F-ACH N( . 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 Saftener "for dwellings under conatruction 5.00 x = Water Softener " for existing dwellin0 IlcPia-er.rn)r 20.00 X U.G.Sprinkler 'fordwellingunderconst. 3.00 = U.G. Sprinkler ' for existing dwelling 20.00 = ARerations ` to exisnng residence 20.00 = Water Turn Around 20.00 = Private Disposal System ' Dak Cty lic. 75.00 = (new and returbished sysfems) Private Disposal Systems `Abandonment 20.00 = STATE SURCHARGE .50 TOTAL CIV I he2by acknowledge fhat I have read this appiication, state tha[ the iMortnation is cortect, and agree to comply wi[h sll appliqble Cdy of Eagan ordinances. It is the applicanYs respensibility M noGiy the propeRy owner that the City of Eegan assumea no liability for any damages eaused by the Ciry during its nortnel oparetional and maintenance edivkies to the faeiWes conshuded under this pertnR within City property/right-of-wey/easement. SITE ADDRESS: LISJ T OWNER NAME: INSTALLER NAME: TELEPHONE #: 021- 7 LO'7 STREET ADDRESS: D' by wlOyl°" "'ti -S CITY: S I, /? f? r STATE: ZIP: SIGNATURE OFg RMITTEE L u?- l ?r??.¢? •?,? , ?? /r`?? _ - 2- r i : 2/a a 4LL CITY OP ERGAN / APPLICATION FOR PERMIT SE[4ER AND/OR WATER CONNECTZODI (PlEASE PRIHT) 1) PROPE.RTY ADDRESS : L? rj 3 7 L U I 1 ' ' F l?' - ?c / f r.Frar. DFS=PTIO;I: Q I ?.RL (I.0t/Block/SLbdivislon or Tax Parcel I.D. Niun?r) .i: STF(;'CP*;2E, DATE 0_° ORIGiiSAL uJII.DD-IG P:'?_•ST ISS,2;?NLCE: _- ?._b_=_-?-_- , ! PZS? ??^;,T::?:/F:•(,1DCS? u5=: Z R-i SaiGLE r^PMILY ? R-2 GUP= ('Ih'0 Wi ITS) ? R-3 ZO[vNHpt;SE (TIII2F.^ + UNITS) ( UDTITS) ? R-4 A.pAR'ITA3_-+T/COi1DCi`tiLNILM ( LNITS) ? COMIIECtC7AL/FETAII,/Olr ICE Q LMUSTRTAL [( INSTITUTIONAL/GOVERNMENP Z) ApnLTCz?_NT (PLEASE PRIHT) NAb1E: ?, ?le ?" •. ? A r?DREss: 3io? S,biE {?. n? " ..?a En, crrr, sTATE, zzP: ?.??. << ?. ? • ? PHONE: °I ?? - (?•UG j) pLUmBER PLEASE PRINr) - FDR CITY USE ONLY NPa?1E _ n f-?0 - A7DRESS: . 06p0,y(rN DRIVE EAGAN MINN.55122 ,eluttB?RS'tI?SE: ? A ti CITY, STATE, ZIP: 452•1565 c ve Q Expir d t PHONE: PLUMBER LICENSE N 001445M2 No oi Record ? ptr, 1n1 la 41 C,Ll:U1'?N'1'/V,ViIF..R NAME : AODRESS: CITY, STATE, ZIP: PHCY:IE: trLcHat rntnl) ?1 P? ?n r?'LV? -? f0 5) INDICA'I'E 6d[IICfi PEPrLIT IS BEIN'G REQUESTLD; X? CONNECTZON TO CITY SaIER Q CO^INECTION TO CITY WATET2 ? dPI'.ER (PLEASE DESCRIgE) -- ? PI.EaSE HOID APPROVEp PERXIT FOR PICi:-UP SY ONE OF ASGVE Q°LEaSE "TPSL APPROVID PER,%iIT 'IO 1, 2, 3 4 AEC)VE (Circle one) 7) sic??=: DaTE: ?J ? ??e a?.srs??-jo J? nr fa ??a?-:Ln sf a.a ?4t ?a'a:a:l? s cf ?f rfss:a ?r a ?t ?.It ?-.f?:x? `•'-1? a?1/.f ?t essa? F 0 R C I T Y U S E 0 N L Y PERtitIT ?i ISSUED I I FEES: S /CJ'SG $ $ $ ??.cU S ? .S uo.cA.v $ $ $ $ SE;'iE°, ngnMrm (?11,CL-7Di SliRCt+?,_RG : i WATER PEIU4IT (Ilv'CLUDE SURCHARGL) WATER METEF./COPPERHORN/OUTSIDE READER WATER TAP (INCiUDE CDRPORATICN S'"CP) SEWER Tao ACCOUNT BEPOSIT - SEFIER ACCOUNT DEPOSIT - WATER WAC SAC TRUNK SQATER ASSESSinEDIT TRliNK SEWER ASSESSME:IT LATE°,AL BENEFIT/TRUNK SEWER LATERAL BENEFIT/ R NK WAT?'R / i OTHER /•i?.r ? a,?-- $ TOTAL r $ S 2L 5 L AMOUNT PAID/RECEIPT # „J/, DOES UTILITY CONDIECTION REQUIRE EXCAVATION IN PUBLIC RIGiIT OF WAY? ? YES IF YES, THEN A"PERMIT FOR WORK WITHIN PUBLIC ROADWAY" MUST BE ISSUED BY THE ? NO ENGINEERING DIVISION. LIST AS A CONDI- TION. SUBJEC'S TO TIiE FOLLOWING CONDITIONS: APP20VED 3Y: TITLE: D aTE : a! Flw EW.fa fR a i04 oH" Rm l4 WaiE N11W R40 i! FJ4 Rpg !l? /tmm f4 m -m iinl R# )4 m 34 !J0 R+0 /kas 14 i04 a SlOMA SURVEV6NG SERVICEB 3908 Sibtey Memorial Highway ` Eagan, Minnesota 55122 Phone: (612) 452-3077 Mf: & nllf^5. MARK , PAF?RANTO a? iy o1ti / q0% ?? q? ` • / ? / ? ? ??g IC _ ? ar?s+ a^? / ? , 0 0 N pra?n v ? O tl "-S8po2 , i ? // ? 914 ase..ie.?fi ? ? i F r??4 ! L OT ?5?,N ? 9 ( ? O(aA°? ? ? ?^ ? ? i?--•---?_ ----- -}- M 89°!5'!8°\ Z \ y 1\ L??i i C?\ ? $ \ .7 P ? o p'.\e / V\G4• s...o , i L Go^ ?? , 0 rx v ? 302168 --`>?ir- ?^` ?9r 4aw_?t _. q???1% u+o I? il I ol?? ? ?e ? I ? ? I l? I I ID ? .?? , . t -N- -LE6END - O Qenotes Iron MonLNnsnt m Denotes Woa1 Hub Set x q?`'s Lenotes Existirg Spot Elevaticn rx916.8 ? Denotes Proposed Spot Elevation ?-- Denotes Drainage Direction -PAOPERTI' OESCRIPf I LW LOT 9 BLGCK 1 Lnwf- P9R, SH.0AF-s accordirg to the recarded plat thereaf, 6 b4i 2 County, Mirnesota House Certlficate For: I"- So' Q ?Y PROPOSED 6ARA6E fL00R ELEVATION= 9IIo•7 PIdOPOSED Top of B l ock ELEVAT 10N= q 17.0 PROPOSED???SEMEN7 FLOOR ELEVA,TION= 13,5 wIo Laaer ?a5eme„?t = -91 NOTE= Verrfy all floor heights wrth Final Nouse rla/is• 3u??rs c?rIFrcaTioN- f hsreby certify thet this survey, plan or report wes prepsred by me or wder my direct supervision ard that J am a duty Registered Larri Surveyor urder tie laws of the State of Minnesota. _?)a",h< U, ?? Dete: 9/4 I85" k'ayne d Lardes, Minn. Reg. No. 14575 Staked 9114/85 / Use BLUE or BLACK Ink r For Office Use I Permit#: lb-7 I City of Ea an I s I Permit Fee: ! C/ 3830 Pilot Knob Road Eagan MN 55122 Date Received: /o (Z Phone: (651) 675-5675 Fax: (651) 675-5694 I Staff: r I I / 2012 RESIDENTIAL BUILDING PERMIT APPLICATION Date: I 79Z, 7 Site Address: !!E53 1 D tRK Unit M Name: A(R6 L ,'-n\t6 J `t,fY""C`" l bA6i tS Phone: (~:S ! bU(->-(063 / RESIDENT / OWNER Address / City / Zip: Applicant is: Owner V--contractor TYPE OF WORK Description of work: " i~ ~ -6 10, Construction Cost: dw . Multi-Family Building: (Yes / No V ) Company: C" l'J G L" -Contact: cam/ V CONTRACTOR Address: 133116 I[OR01`1 C City: ~l State: Zip: 5"5- Phone: (~o lZ- - 81Z- - 6773 License 13 10 Z t 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 )A.,J'ssu nce. x ~ , x t /k/M Appl' nt's Prin d Name Applic nt's Signa re Page 1 of 3