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
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CITY OP ERGAN
/
APPLICATION FOR PERMIT
SE[4ER AND/OR WATER CONNECTZODI
(PlEASE PRIHT)
1) PROPE.RTY ADDRESS : L? rj 3 7 L
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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: _-
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! 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
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- FDR CITY USE ONLY
NPa?1E _ n f-?0 -
A7DRESS:
. 06p0,y(rN DRIVE EAGAN MINN.55122 ,eluttB?RS'tI?SE:
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CITY, STATE, ZIP: 452•1565 c
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PHONE: PLUMBER LICENSE N 001445M2 No oi Record
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NAME :
AODRESS:
CITY, STATE, ZIP:
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trLcHat rntnl)
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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:
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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
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$ 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
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-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'
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?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