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4567 Lake Park Dr Use BLUE or BLACK Ink 1-----------------, 1 f=or Office Use I Z I Permit City of Ea an 1 Permit Fee: 3830 Pilot Knob Road 1 Eagan MN 55122 i Date Received: Phone: (651) 675-5675 1 Staff: 1 Fax: (651) 675-5694 1 2011 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: } G Site Address: ~/cS - Z~ lt;e AC j- ~ Tenant: 44W pli~- Suite RESIDENT I OWNER Name: <J C4 k- Bolduc Phone: ` Z G g~ ~y S~, Address / City / Zip: ` CONTRACTOR Name: License Address: City: State:/'IA Zip: -';37l Z Z Phone: 645-0 3-5y- yl~/ Contact: ~s Email: TYPE OF WORK INew _ Replaceme t _ Repa' _ Rebuild _ Modify Space _ Work in R.O.W. Description of work: LL~' ~ 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.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 w is not to without a permit; that the work will be in acc nce with approved planin the case of work which requires a review and appro I o plans. X l~ r; Diu' X Ap a tint d Name Applican Signa re FOR OFFICE USE Reviewed By: Date: Required Inspections: Under Ground Rough-In _Air Test Gas Test Final 05/31/2011 19:27' 16157900512 PAGE 01/01 Use BLUE or BLACK Ink ~ W~ l I City I Permit# j J~~ I Pemyt Fee: 3830 Pilot Knob Road I I Eagan MN 5512 -kAA-1 5 I DowRnoahred: Phone: (651 675-5675 VA%J 4151- OLY-8 -3C10 3 I I StatF I ax: 1651) 6754694 L-----------------i / 2011 MECHANICAL PERMIT APPLICA710N Date:G t Site Address: IV-49-6- Tenant: li'~ D f AJ 13 C7 Loo Suite RESIDENT I OWNER- Name: a'"b R-ri 12)d1-0(j I- Phone: 41a --o s- 7L/,,9-4 Address I City / Zip. CONTRACTOR Name: t'111 ASI-`=1- S Licanse Address: ^ 1 17Jc L-. City; hh > '57 ~r~ slate:. . Zip: I _ . 7. Phone' I a/- a ^ 31, Contact DAW Email: Q ~ 5t7 2' 9-(i'IK2 L-5:1 New _Replacement _Additio I Alteration Demolition TYPE OF WORK ~ryvbh,-,,7 trw `I , ~G t.~c~ 2P~ 5~I7' Descrtpt,on of 1ltnork NOT15 item nt d d.ground mounted naeh'aoii;at 4gnlpmeittis fttyullred td•biE! n*&byCity . ~ Cod®_ Please contact tuts fXet:lepltlcal IrYspe~lcar fat' le4Tb~lfrt,'rtlerb+bti; piprin~it'&d aizrMwfitrtr~ n+atFiorln. ii A RESIDENTIAL COA MERCIAL PERMITTYPE ^ Furnace _ New Construction i Interior Improvement Air Conditioner Instal Piping -Processed Air Exchanger _ Gas Exterior HVAC Unit _ Heat Pump _ Under / Above ground Tank L_ Instal t_ Remove) tf /t CPJ6 ~r " W*n kwalwnWrarrm wing tank(s), sal for inspection by Fire Marshal and Plumbl 1 RESIDENTIAL FEES: $55.00 i m Add-on or alteration to an existing unit (includes $5.00 State Surcharge) $95.00 Fire repair (replace burned out appliantxs, ductwork, etc.) (Includes $5.04 State Surcharge) $ TOTAL FEE COMMERCIAL FEES.' x 196 $75.00 underground tank installation/removal OR Contmct value Ti $55.00 MkftM (includes State Surcharge) = $ Permit Fee - If the PC Fee Is Ion than $90,01% surcharge Is 3 540 If the ie } 510,410, eurchoa creases by $.50 for each $1,000 Permit Fee = $ Surcharge ~ (.e, a $90,040491,010 Permit Fee requires a $ 5.50 urcharge) S TOTAL FEE CALL BEFOR F- YOU DIG. Call Gopher State One Cal at (651) 454-MM for protection against underground utility darnage. Ca148 hours hafore you intend to dig to receive loeatea of underground utilities. I hereby aclowwAadge that this Iniomation is complata and accrete; that the work wil be in oorlformance with the drdmanm and codaa of the Cry of Eagan; that i underaland ft ,la root a permit, but only an application for a pemllt, and wo to start wMtwut a will be in accordance wnh t"P arom ml phmn In tho mvap of w~nrk(u*" n%MArra q ra AAW and anpmval of hie Applicant's Printed Name: Appileanrs Signature II , t`t9R OFFICEUSE itevlwed, gY Daft RegahudAn:r pectbns; Under Ground ' /tough. In ~ it tasE Gas. Service rest In-tkror Hec f Final Exit n6r,HVAd Salsertft..k ppecfiofr CITY OF EAGAN Remarks Addition LAKE PARK(ADDITION SI107Ces #10 442 ? ? Lot 4 Bik 1 Parcel Owner Street 4567 Lake Park Drive state Eagan, MIIN 55122 Improvement Date Amount Annual Years Payment Receipt date STREET SURF. 35 1982 2529• 52 505. 90 5 STREET RESTOR. GRADING ? 19,81 1419-14 9461 15 - SAN SEW TRUNK 1976 a essed *SEWER LATERAL ? WATERMAIN IyUATER LATERAL WATER AREA Lf 1980 2280.00 7 STORM SEW TRK 5 I 1991 813 86 54 26 ,STdRM SEW LAT lqgl CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. BUILQING PER. SAC PARK ? CASH RECEIPT • CITY OF EAGAN 3830 PILOT KNOB ROAD EAGAN, MINNESOTA 55122 v DATE 19 AMOUNT•" I$ ?- & DOLLAR4 ?oo []CASH ? CHECK BY White-Payers Copy Yellow-Posting Copy Pink-File Copy Thank You ;' BLDG. P,ERMI'T NQ. 01-3210 B1dg. Permi 01-3422, , Plgn Check 01-3445 Surch./Adm. 01-3446 SAC/Adm. 01-2155 Surcharge 17-3860 Road Unit 20-2275 SAC 20-3865 Water Conn. 20-3868 Water Trmt. 20-3716 Water Meter 20-2252 Acct. Dep. 20-3713 Water Permi 20-3743 Sewer Permi 79-3866 Sewer Conn. 11-3855 Park Ded. TOTAL ?/' .?.- ,... , . . CITY OF EAGAN ? A ' -• 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 ??-- ??1i2 PHONE: 454-8100 BUILDING PERMIT Receipt p - To bs-used for ='F U'41-? ??;AR Est. Value $127,000 Date JANUARY 16 1?i7 4567 LAKE PARR Site Address DR Erect Occupancy R3 Lot 4 eloc k SeclSub. LA ICF, PARK SH E&modei ? Zoning Rl Parcel No. Repair ? Type of Const V Addition ? No. Stories ¢ Name 'PZBERON ItdC Move ? Length z 4555 LAKE PAF2K I)R Demolish ? Depth 56 o Address ? }:? A C AN 454- 6463 Int. Impr. Sq. Ft ?ity , . pnone Install ? = o Name SAMR ? ? Address ~ City Phone ?Q F W Name _z ? n Address i W City Phone I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City ot.Eagan ptdinanCes. Signature of Permittee A Building Permit is issued to: TYBERON INC all work shall be done in accordance with all applicable State of Minnesota Statutes Building Official Assessment Water & Sew. Police Fire Planner Council Bldg. Off. APC Var. Date Permit a 584.50 Surcharge 63• 5a - Plan Review SAC ? 2?5T2.2S •00 Water Conn. 525 . 0Q Water Meter 07..00 Road Unit 305.00 Tr. Pi. 180.00 Parks Copies ? Tota I ? , 64 7.2 on the express condition that of Eagan Ordinances. I - I awn* Mo. I P.." How« I Dw I Tel.pn-. n I od FMM OCC. Disp. MECHANICAL PERMIT CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN Site Address BLDG. TYPE Lot Blxk Sec/Sub ? , . T Res. m Name ''?:.?F:?? . ...:<.r. , ?:.?:..-???-• Mult Address ? c?, ..:s..an, Phone ' ,--?77'; Other, Name a ?ri:,if c Address p- City Phone , TYPE OF WORK Forced Air Boiler Unit Heater Air Cond. Vent Gas Piping Outlets # Other M BTU M BTU M BTU ` -M BTU GFM / . FEE S/C: .51 TOTAL ? PERMIT # RECEIPT # DarE .5 7 WORI( DESCRIPTION New . Add-on - Repair - FEES RES. HVAC 0-100 M BTU -$24.00 ADDITIONAL 50 M BTU - 6.00 ADD-ON AIR COND. 0-24 BTU - 12.00 ADDITIONAL 6 M BTU - 8.00 GAS OUTLETS - 1.50 EA. COMM/IND FEE - 196 OF CONTRACT FEE MINIMUM - RESIDENTIAL FEE - 10.00 MINIMUM - COMM/IND FEE - 20.00 STATE SURCHARGE PER PERMIT - .50 (ADD a50 S/C IF PERMIT PRICE GOES BEYOND $1,000.00) SIGNATUFiE OF PERMtTTEE FOR: CITY OF EAGAN PLUMBING PERMIT CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55122 Site AdcJress ?>> 44 7j,tAI'l- 4,?/ Lot ±j_ 81ock ,L.?_ SeciSub m rvame !7 l1Ini 1-(1?.4 j -- ?o Address 5 (r c City ? A ?3 A Phone L Name 'PA ; Address O City ,,Q"[ Phone FEES COMM/IND FEE - 1% OF CONTRACT FEE APT. 6L-DG$- COMM FFATE APPLiES TOWNHOUSE 8 CONDO - RES. RATE APPLIES MINIMUM - RESIDENTIAL FEE - $12,00 MINIMUM - COMM/IND FEE - $20.00 STATE SURCHARGE PER PERMIT - .50 (ADD $.50 S/C IF PERMIT PRICE GOES BEYOND $1,000.00) SIGNATURE OF PEFiMITTEE PERMIT N RECEIPT f# 7 DATE: ` oZ S 1ty f BLDG. TYPE WORK DESCRIPTION Res. ? New y Mult. Add-on Comm. Repair Other RES. PLBG. ONLY - COMPLETE THE FOLLOWING NO. FIXTURES OTAL __?-Water Closet - $3.00 0 -,4_Bath Tubs - $3.00 _?e_Lavatory - $3.00 .?_Shower - $3.00 3 . !)? _?Kitchen Sink - $3.00 3 . G t) Urinal/Bidet - $3.00 --/-Laundry Tray - $3.00 3.06 ?Ftocir Drains -:51.50 - 4G -- Water Heater - $t 50 f1 _SO Whlrlpool - $3.00 ?Gas Piping Outlets - $1.50 (MINIMUM - t PER PERM17') Softener - $5.00 well - $10.00 Private Disp. - S10.00 -_3---Rough Openings - $1.50 FEE: 4/? STATE S/C: -J? GRAND TOTAL• /t 3 J? CITY OF EAGAN PERMIT TYPE: "1' ["`` 3830 Pilot Knob Road Permit Number: ".' t0 Eagan, Minnesota 55123 Date Issued: (612) 681-4675 SITE ADDRESS: APPLICANT: ,.: ? rtik t t, nr_ ti rc ,,N M r? i , ? ?,r ? E ?„? r .ri???rF_ •, • ? ?. ? .? , ?? ?,.? i s, :. . PERMIT SUBTYPE: , .I ! I r wi r 144t, ? ? TYPE OF WORK: t Ih1 A ! F4? t-i .?..?. Permit No. Permit Hoider Date Telephone N S/W PLUMBING HVAC ELECTRIC ELECTRIC Inspection Dete insp. Comments Fooiings I FoundaCron Framing Roofing Rough Plbg. Rough Htg. ISUI. Fireplaee Finai Htg. Orsat Test Final Plhg. PI6g. inspector - Not'rfy Plumber Cansi. Meter Engr./Plan Bidg. Final Deck Ftg. 7 Deck Final Well Pr. Disp. CITY OF EAGAN PERMIT TYPE: 111 1 Et T Or 3830 Pilot Knob Road Permit Number. ? Eagan, Minnesota 55122-1897 Date Issued: (612) 681-4675 SITE ADDRESS: APPLICAMT: . . ? . 'i' . • ' PERMIT SUBTYPE: TYPE 4F WORK: I ? . .. INSPECTION .. . .. . r i ? _J - - - - - - - - - - - - - - - - - - - - - - - - - - - - Pertnit No. Permit Holder Date Telephone M ELEC7AIC PIUMBING HVAG - Inapection Data Insp. Comments FOOT7NGS FOUNO FRAMING RDOFING ROUGH PLUMBING PLBG AIR TEST ROUGH HEATING GAS SVC TEST INSUL GYPBOARD FIREPLACE FIREPLACE AIR TEST FINAI PLBG FINAL HTG OiiSAT TEST BLDG FINAL BSMT R.I. BSMT FINAL DECK FTG DECK FINAL CIT1F OF EAGAN Permit No: Oate: +--9 1 383f1 Pilot Knob Road Meter No: ?? 3 0 6 gi=g. SIg'? P.O. Box 21199 Reader No: Dat? ?5?1,247 Eagan, MN 55121 Owner. e:rc_? Itii:. Site Address: 4 r?J ia'--t? 1'3 j, ? -?r' , 7 1, _ . . f v _ ? _ _ l ? r _ _ L _ _ . - ; `- ??`? -- •,?,??n9' Conn. Chg. Acct Dep: ?.1`'a`•??c??f Units: Permit Fee: -?* •OvkM `? Surcharge: .s = IpT?1 !a comply with the City ot Eagan Tr. Plant ' `- - • '?? ??' Qrdlnances. Meter. M isc.: By ' WpTER SERVICE PERMIT Conn. Chg: `" Zoning: ? Acct. Dep: • Q0pa No. of Units: ' ? - Permit Fee: '- ) • OO'3d ? Surcharge: • 5?PLI I agree to comply with the Cih? of Eagan - Tr. Plant ? ? ? `?' • `? d Ordinances. Meter. Misc.: BY . WATER SERVICE PERMIT CITY OF EAGAN 3830 Pilet"Knob Road P.O. Box 21189 Eagan, MN 55121 Zoning: Z T i eron, ?nc. Owner. Address: ? F? kF d Site Address: • enze _,ec a.i c:a: Plumber: r.'_ - 9 : 3 I agree to comply with the City of Eagan Ordinances. By Date of insp.: Insp.: SEWER SERVICE PERMIT ,tir rr PERMIT NO.: No. of Units: Connection Charge: Account Deposit: ? Permit Fee: Surcharge: Misc. Charges: -- Total: Date Paid: CITY OF EAGAN Permit No: 2 508 Date: 1-2--97 3634 Pi{ot Knob Road Meter No: Sixe: P.O. Box 21199 Reader No: Date: Eagan, MN 55121 0 CASH RECEIPT • CITY OF EAGAN FUNO COGE AMOUNT U G • o ?7/ U U d Thank You B N_ 71087 Whne-PaVers CoPY Yellow-POrting Copy Pink-File Copy 3830 PILOT KNOB ROAD CITY OF EAGAN R' B 'v 13112 3830 Pilot Knob Road, P.O. Box 21-1 99, Eagan, MN 55121 - BUILDING PERMIT PHONE:454-8100 Receiptx ?7Gd3?1- e? To be used for SF DWG/GAR Est Va1ue $12 7,0 0 0 Date JANUARY 16 1987 ? 4567 LAKE PARK DR Sitend e3S Erect 47 Occupancy R3 1 Sec/Sub LAKE PARK SHORESemodel ? Lol 4 Block Zoning Rl Parcel No Repair ? Type of Const. V . Addition ? No. Stori85 a Name TIBERON INC n4ove ? Length z 4555 LAKE PARK DR Address Demolish ? I t I ? Depth 56 S FL a City EAGAN phone 454-6463 n . mpr. Install ? q. o Name SAME Approvals Fees up Address Assessment Permit $ 584.5( ? city Pnone Water&Sew. Surcharge 63.5( ? a Police Plan Review Z 9 2• 2' F W Name Fire SAC 62 5• 0( Address m, c i Eng. 525.0( Water Conn. aw City Phone Planner WaterMeter 67.0( Council Road Unit 305.01 Iherebyacknowledgethatlhavereadthisapplicationandstatethatthe gldg.Off. Tr.PI 180.01 information is correct a a to c th all applicable State of Minnesota Statutes and Ci rdina es. APC Parks Signature of Perminae Var. Date Copie 2 Total , 642.2: A Building Permit ?s issue to? BERON INC on ihe express condition that ail work shall be done in ccordance with all app??cab State of Minneso tatutes and C iTy of Eagan Ordinances Building Otticial ? , y /?7 REQUEST FOB EIECTRICAL INSPECTION Ea-oopo?oi os ?/' , See insimebo-s for complBting Ihis tmm o. back of yellow copy. .y //3(.F'/ p I- i1 S/1 A ..Y.. G.,/..... Oi...& !`.....,.ed h. T6.? .. .... /Ja...,e?? - ......... ... .. ............, ..........y_..... AAd Rep• Typa oi BuilCinp ADVliancea WiroC Eqmumant Wiretl Home Rpnge Temporary Service Ouplex Water Heater Lightiny Fixtures Apt. 8uilding Dryer Electnc HeaUn Commercial Bldg. Fumace Silo Unlonder Industnal Bldg. Air Conditioner Bulk Milk 7ank Feffil tha Othqr (Snecily) ?-r pecify Oiher t??l Other ompute Jnspection Fee Below p Fea ServieaEntrencaSize k Fee Feadars/3ubfeetlers % Fee Qremta U to 200 Am 5 0 ro 30 Am 5 0 to 30 Am A6ove 200 qmps 31 to 100 Amps 31 to 100 Amps Swimmin Pool Above 100_Amps Above 100_Am s Transiormers Irngation Booms SD Partial-"Other Fee Signs Special Inspectwn Sp $ TOTA Nemarks ?? L W qou0h•in 4 r 2 ?^% I, the EI ctrica 4 9 ' Insoector, eby , cervty tnat the abovo Final p ? e inspeclion has baen ? /?l Q ??v4wSd /O-s made. _ ttih repueat voltl 18 monihs irom Itl9UBSt vDld /C/P??J 18 lII?IS ffOT 3J 5V ? C 3 72 2 ,C //,g/ ? ???? Request Date ?.r./1, [3 ? - F,re No. Roug?-?n Insuection ??Q?yiredl . ?Reatly NowKWill Noufy Insoec- ? • /} p ?jd(es ?No tor When Ready mensed Electncal Convactor 1 hereby reQUest insoactian of abova ?Owner elecbicel work installad et: Sveet AdArass. Box or Noute No. City ? ectao o. owns?i0 ame or No. Hange No. County Occupant IP NT) Phone Ne. lp9r-y-r Power SupPliar ?^? ? Address ?1 Dh'Koi?1 G/fcT, Elec[rica?lp on?rdetor IComDany Nam Contra or's lmense No. Madme Address (Contractor or Owner MakmB Ins?ei!anon) / Amh Signature (Contra o Ow r Mak?ng InsU?llation) Phone N GerY/3i? ?? MINNESOTA STATE BOARD OF ELECTflICITY THIS INSPECTION PEQUEST WILL NOT Orippe•Mitlwey BId9• - Noom N•191 BE ACCEPTED BY THE STATE BOAflO 7821 Univereltv Ave.. St. Peul, MN 66104 UNIESS PflOPEP INSPECTION FEE IS Phone(672) 642-0800 ENCLOSED. REQUEST FOR ELECTRICAL INSPECTION ee-ooooi-os O O 2 1 3? See insimctions for compleUng lhis iortn on back oi yellow copy. j 14-5 '-"X" Below Work Covered by This Request ?.ro?•,... '` 9Y e Add Rep. Type of Building Appliances Wired Equi ment Wved Home Range Temporary Service Duplex Water Heater Ele ric Heating Apt. Building Dryer oad Mana ement Comm.Andustnal Fumace Other ?Sprgclfy) Farm ir Conditioner Olher (speafy) Contraclors Remarks Compute Inspection Fee Below: # Other Fee # Service Entrance Size Fee # CircultslFeeders Fee Swimming Pool 0 to 200 Am S 0 ta 100 Am s Transformers Ahove 200_Amps _ Abave 100 -Am s $Ig11S Inspecror's Use Onry 1 TOTA Irrigation Booms r1/f?i ,Gr% Special lnspection ? ?t/ " Alarm/Communication iHIS INSTALlATION MAY B \ORDERISCONNECTED IF NO7 Other Fee COMPLETED WITHIN 18 MONTAS? I, the Electrical Inspector, hereby tit ih t th 6 Rough-in ` Data cer a e a ove inspection has y been made. Fm ai ?? OFFICE USE ONLY 1!C-Ji " a l This reques[ void 18 mortlhs lrom ?`?-- ? (?0 22K13? ? ? Request Date F-e No. Rough-In Inspecnon ReQwred Ins aciro OMer Than Rough-In (VOU mvst call inspactor w hen reatly) eady No ? W Notl ns or Q ' - G ? ? Ves ?n'o Da?e Rea ' ? ? I LG7licensatl contractor owner hereby request inspection of above electrical work at: Job Atltlress (Shaet, Box or Route No ) Ciry SecUOn No. Township Name or No Ranqe No. Counry OccupeM (PRINT) Phone N. ,?K Po er Supplier Atltlress Electncel Coniractor (COmpany Name) Conlrectofs LKense No i Ln/T ?, I ? ` V •• • Maibng AOdress (COMrepor ot ner eking Inslellalion) I Author2etl ' re (COnVacbtl ne Making Installetio Phone Number I TA STATE 1391ARD OP ELECT ITY ? THIS INSPECTION pEOUEST WILL NOT Gr gga•MlCway BIOg. - Noom 5-120 BE ACCEPTED BV THE STATE BOARD 1821 Univereiry Ave., St. Paul, MN 55100 UNLESS PROPER INSPECTION FEE IS Phone(612)BC2-080) ENCLOSED. SEDGWICK HEATING & AIR CONDITIONING CO. r+eariNC J06N0. '{? 3-1 8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) 881-9000 TEST RECORD ADDRESS OCCUPANT ??V'e SOLD BY CITV ?"??•,`^°?e OWNER ? ?? L y INSTALLED BV ? 10" 5 % MAKE 6? h'4 G 1( f a SERIAL NO 6? ? C) Z THERMOSTAT / F6 11 a y l v? (' VALVE ` ' LIMIT , ` Z' / LIMiT SETTING FAN SETTING ? i Z ? PILOTTYPE r IGNITION MODEL 74 PILOTTIMING ? ooceciioo i ? ?/ J omrvuTm !! INPUT CFH 116 PERCENT Oz ? STACKTEMP. ? v PERCENTGO d FORM 235 (REV 11 I88) MODEL V GO q` 1-/ CJ c- I( is //u poc9 INPUT VENT SIZE % T ! ' l'1 T TYPE OF LINEF ? v- ?' ??? f+I ?HN 1 3 ZQO? LINEF SIZE FILTERS S2E ??7V? Z f tNU R WIRING /l G'? G f ?e 1 TEST TAG LIGHTING INST DATE TESTED I?? z (.1? 6 Z COMPANY TESTING S't cl Y t-YL- NAME OF TESTER FORM DISTRIBUTION WHITE COPY -JOB FILE YELLOW COPV -CITV ? /3 2 SINGLE FAMILY DWELLINGS INCLDDE 2 SBlS OF PL9NS, 3 CEIClIFIC9iSS OF SQRVEY, 1 SET OF ENERGY CALCOLATIOHS NOTE: ADDBESSES F08 COHBEA LOYS - CONTRACTOR/HOMEOWNER MDST DESIGHA2E AHICH ADDBfiSS IS DESIRED. NO CHANGES WILL BE ALLOWED ONCS BIIILDING PBRMIT IS ZSSDSD. MOLTIPLE DiiE[.LINGS - RBSIDENTIAL RSNTAL IIAITS FOR SALE pBIIiS INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SORVEY - CHEC[C iiITH BLDG. DEPT., t SET OF ENERGY CALCULATIONS CONRMERCIAL INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS, 1 SET OF SPECIFICATIONS 9ND 1 SET OF ENERGY CALCULATIONS, $2,000 LANDSCAPE BOND I27(cr?XO To Be Used For: E&1. dr+)w1Z4 Valuation:-2J,dee- Date: 1-0-47, Site Address Gf?kG- A?P..it a, , Lot Y Bloek I Parcel/Sub 4.14A/; ??4?K SEbeG''S &W> Owner 1 / %3E'7rC'Ot? ?,VG Address 1/ S-375` &?ke' t"!+Q K/.Z- City/Zip Code (?4&k4h.) ??- Phone C S `ti/- ? ?/ 6 3 Contractor Address ?1S ,S3 A 0?k G` qw kle. , City/Zip Code Z- Phone % 5 3 Arch./Engr. Address City/Zip Code Phone ll On Site Sewage? MWCC System On Site Well City Water ? Assessments Water/Sewer Police Eire Engr Planner Council Bldg Off APC Variance Oecupancy 1Z • 3 Zoning R i Type of Const (Actual) ? (Allowable) "27_ # of Stories Length Sl Depth 5?„ S.F. Total Footprint S.F. FEES ? Permit 584, Surcharge (03, $O Plan Review 2`l Z., ?S SAC, City I c30. SAC, MWCC SZS, Water Conn 52S• Water Meter (o-7. Road Unit 1?505, Treatment Pl ( SO. Parks Copies TOTAL ? f S? 1 I Z? 2(? ? 3 f Z x S? t = f8c?? c? "' 4Y,o K ? ? 2?84c? 7x 12 ? ?121C? 1Z x 2.? = 33Cp x ?F4- °14?434- I? ? 3d = q_go x ?? t 2( (2 ? ?2 x 2v " 33h x 4-?4- -(476?- 12Co,qSZ ' NINt1E50TA STATE E:lERGY f:ODE CALCULATiONS BASED OV f,fIAPT2H j GF THE MpUZL--ENERGY CODE - ly EDiTLON Aduptlun EEfr.etlvr: 111/84 )wner ;ite Address -W 8(o - 40? Phone rarP :ontractor Phone fuilding Classification: Type Al (Single Fa:nily S Ouplex)_ZL-Type A2 (Residential? (3 stories or ess (Other) (0•rer 3 storles) SENERAI, INFORMATION I. Building PerimeterL,???OW5471"ft. ?. Wall height (ground to eave) 11 ft. 2 3. l. x 2. ('abave) gross wal lorgg. Z 754,cgft. 3. Building dimensions (L) - x(H) ft.2 roof S flaor area i. Square fcot area of rim joist - Floar joi:L si:e (2 x?? ) - I ZZ 2 14 x Perimeier = Rim jotst area ¦ _r! fL !48 6• Doors - Area Thic ness n. actor 04 4- Type of Construct on . . Perimeter ft. Manufacturer 7. Total door's perimeter ft ' . , ? 8. WindoNS: Manufacturer1/l)`i(/L' G#4-3vl,d" 5tate approved U factor ' TYPE SIZE AR:A (F;.2) tIUM2ER OF TOiAi, FEET Z EACH UNITS . • g. Total ft.Z Glass 2 711? I D , I DL fireplace area: Width x heiaht • '"` x ^- = Ft.Z 11 . Exposed foundatian: Helght :c Perimeter i-] 1 x Ft.2 ;JPIPLET[ON Of TH15 FORM IS R:QU[RED FOR ALL tlEU COtISTRUCTiON, MAJOR REI•IOO:LING AN0 BUllD1NGS BEING q)VED 'ANERE ENERGY, OTHER THAV THE t1INIMAL CODE ALLQ:•IAtICE. IS USED. .. . . . . . ? . :_ . , .. 12. 'F:iming aree • 10z of gross Hall arees ' • 13. Gross Hall area 27'J? 4iOg) ft.2 •.•• ' Nlndow area A' 277210 (t,Z % `1'?P U x A 1 ZSlbg U wlndaws ? ¦• R1m Joist area A 1 Z2?k3? ft.Z ' U Mm Jotst ¦??'? U x A¦ SCo Ooar area A ??f ? ? . ft.2 I?/y? ????ep3 .aea area A_ tt.Z Exposed faundaNon-A_ io5',0$ ft.2 Framing area A '7i?? ("q2.lft.? Net wall area A 4-, 1 l0 ft. ? U door area ¦14-_ U x A¦?1 0( x;) 0 Hfei}aa e'7_ U x A¦ I (D *? U foundatlon ¦114 U x A¦ rl;,/ ll framing area ¦,n S. U x A- ZCoi 17 '?"r U wall • (138) TOTAI . ¦- ? 04 ?> U x A•,?(?5 . . .... .. . .' UxA¦Z?(?,2II 14. Gross xall area x 0.11 (A=1 single famlly 6 duplex • allowabla U x A/Code • (13, above) ,' . . x 0.23 A-2 other residential) x .23 Other bu11d1ngs) ' . x .E8 Over 3 startes) a 2? ? qg eTuii Must be larger t • > x U?gAp. ,? .• 2.? "OF, 138 abave 15. Ce111ng framinq area (Af) equals•10% ot celling araa' (or the same as) 15A. Gross ca111ng area ¦ ?L? x (W) ---- ¦ ?.Q'I ? ft.2 158 Jo1st area (Af) ¦ lOx ce111ng area ¦ M10 ft.2 iec. Net ce111ng area (Ac) (15A - t5a) •' /D?f ?", S tt.2 U ce111ng x A c? ?QZ2 x G?-?'j?-?'j ¦ ?7'?j?prj f • U framing x A f• 10 2- 3 x-_ 15D. TOTAL U x A ..:....................................... 2 51 (0l09 16. Ce111ng area (15A) .02§„ p=1 single famlly 6 duplex - coda allowable U x A x 0.073 (A-2 othar resldential) x 0.06 (other) • !0A_(15A1 I? x ?l(codel5' J// BaUll Must be larger than 150 (abave , F , (ar the same as) • 1bL?D . ' • . . NO1E: Use U and'A values ahtatned from nps 1, 3 and 4. - -- - - 9r ?f- x( ze+ za +? 8+ 4v1-4z? = 14 l l, 9z g'z +4z±??-F I 34- Z? 1? 27 54,08 -AIE- °p - ZfoX 4'D 2X(?= I?X Z - 4X I? _ 104-D Iz z-cP ?/IN , t? D? ?wpw5 = -lVrTkL I?11 Z- 7?,X9-?=z2?s?( 4 ? 90 24X?= = 17,sx 4 14 ` -7o ,? 2c?X?o = Il x 2 ? zZ I ? ?I Z-?x?= IZ ? 2 = x ? 3-9.-. Z73 ,o *- tsaj;? 2? S1Z, ?R? ?-' Pqlzl V Wl t7? ? = ZI,? -_? ?4,? WALL ? SECTION sn?n SECTION :.xn uALL SECSION &IH ' JOIS1 lAIUE U VALUE Insid• air film .68 Idtarior va11 • •? (Nall) U . a . [nsulatton Shesehiag SLdLng . 67 • . •-? ' Outa[de atr [Llm ,17 s rorac 7-3,63 Inaida-atr Ellm .68 Intariac vall I 4r Iri stud (6M R' .lr.3i•t6. rjp(Framing) U.? . Sheaching 21&0 Sldtng 1(07 .Qc?S Outalda air tila .11 •- ? Q TDTAL I6,?3 Inatd• air Film Ra ,68 InterLor vall ' Insulaeton ' (Slall ? U . & . Shia Extetiot vall ring Ezeaetar ilr flLm & ., ' g TOTAL • interlor air ELlm Rs .68 LnaulaCtoa lh laah. soEt woud li=1.88 (R1m p Jaist) Sheathing Cxterioe wa11 eovering .47 ? Extarior air ftim Re ,17 ' 8 TOTAL `-ito Inte'rlae air filw ? InsulatLort R= .68 'S,IY? • foundacioa (.2B (Fdn.) U ? A ¦ 6xtarior air fllm Rm .17 , f " - R TO TAL :cposed 9luck 'S E-:E,dT?l?JG CEIL[PIA 'aliH 4EH?gll ATTIC SPACE ABOVE ?A '1A UE A`l?IUE ? FMt41fIG CEILIHG ? 0.61 A1r F11m 0.61 r j(O?bb Insulation i 3 a Jo1st ' . . Ce111og r ? . • . ? . . ' ' ,• O.fil ' , ? • . • . d?.''S • ... ? . A1r F11m O.til Total a 1 U ¦ ?' , ,??i FIAi RqOF 0_R CaT{IE AA1 CE(LRIG FRA1•I I N6 ' . . . . . 0.17 R 9AI,UE CEfUMG Inslda a1r film 0•61 C?illn • Jniet ls u antulatian Ir spacs NQOf Jocfcing insulatian Bu11t-up roof Outslds a1r film 0.17 Total R . • •; • 1lndow infiltratlon .5 cfm/lineal foot of crack • lesidential door infiltratiaa 0.5 cfm/square.foot or door anJ minlmum cade raquirement lan-resldential doar lnfiltration 11.0 cfm/11nea1 faot of craCk . lb 12" concrete black no lnsulaelon •:47•R 2.1 ? . Jb 12" concrete 61ack insulated cores '¦.26 R 3.8 ; l5 12" 1lglit:ieiuht block '¦.32 R 3.1 . ., . lb 12" 1lghttireight black lnsulat:d-cores ¦.12 fl 8.3 • ' 1 single glass • 1.13; wlth storm,wlndow'.54 1 dau6le glass a :55 • , ' ' . 1 triple glass ? .41 • . , . 1i1 exterior walls and ceitings must have a vapor 6arrler (0,10 perm max.). ;apor barrier must he on the 1nslde (heateA 51de) of t+all. -,. japor barriers af the palyethelene thin film havs no R value. . ; /)- ?.YV PERMIT #: 5?1 S ? -7 CITY USE ONLY 3$80 P1LOT KNO$ RD EAfiRN MN 55122 651-6$1-4675 Please complete for: Date: /°t' It SITE ADDRESS: KECEIPT DATE: 2002 itESIDENTIAL MECHA1VICAL PEfi14[IT APPLICATION crrY or EAsaN ? single family dwellings townhomes and condos when permits are required for each unit _0d- OWNERNAME: 7?i/AG, ?D/1/1iI71111') TELEPHONE#: C??1 4v -7Iii.3°t' INSTALLER NAME: I""°I?t'f; A L11'3 CP„'A"I(];', ;ZELFt,PHONE #: E?"i3 V,'antvlorth Ave. So. STREET ADDRESS: MInn38p01iS, MN 55420 CITY: STATE: Place a check mark next to the permit work type ZIP: ? Add-on, modification or alteration to existinq dwelling unit $ 30.00 • furnace replacement 'X?t- /fo?DDO • air exchanger ?z ' 6 • air conditioner • ,; ? • other Nature of work: ???(,?/OnGf. ? State Surchar e .$ .50 Total l C9, SIGNATURE OF PE E t/oz RESIDENTIAL BUILDINC PERMIT APPLICATION 3830 PILOT KNOB RDEAGAN MN 55122 651-681-4675 New Construction Reauiremenh • 3 registered site surveys showing sq. ft. of lol, sq. ft of hoiue; aiW all roofed areaz (20°h maximum lot coverage allowed) . 2 copies of plan showing heam & windax s¢es; poured found design, etc.) • 1 set of Energy CakWatlans • 3 copies of Tree P2servation Plan d lot platted after 711/93 . Rim Joist Detail Options sdecfion sheet (bldgs wrth 3 or less unAs) DATE SITE ADDRESS TYPE Of FIREPLACE(S) _ 0 _ 1 _ 2 ??0 t2 , APPLICANT / 6 d r ? ,,(?? STREETADDRESS ^ ? CITYl. Y` ATATE / ?1/ZIP0/a TELEPHONE #?S-Z-'LI.3 PHONE # ?7 2'_4AX # 76 PROPERTYOWNER?f/?? ?B??tI?IDY1 TELEPHONE# COMPLETE THIS SECTION fOR "NEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category _ MI.VNESOTA RULCS 7670 CATEGORY 1 (J submission type) . Residen6al Ventilation Calegory t Worksheet Submitted • Energy Envelope Calculations Submitted Plumbfng Conhactor: _ Plumbing system includes: Mechanical Contractor. Mechanical system includes: Sewer/Water Conhactor: Air Condiuoning _ Heal Recovery System JUI_ 0 2 2002 Pcc: $90.00 Phone # ree: $70.00 Phone # ---°------------------------°------------------°-----------------------------°----------------°---°---...----------- I hereby acknowfedge that I have read this application, state that the information is correct, and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant OFFICE USE ONLY MULTI-PAMILYBLDG _Y _N VALUATION ZL/), DOCD _ Water Softener _ Watcr Heater _ No. of Baths RemadellRaoair Reauiremants . 2 wpies of plan • t set oi Eneyy Calwlations for heated addi[ions • i sde survey for eztenar add'Aions 8 decks . Indicate if hame served hy septic syslem for additions _ Phone # L I.awn Sprinkler No. of R.I. Baths Certificates of Survey Received - Tree Preservation Plan Received _ Not Required _ Updated 4/02 CITY 0F EAGFlN CASHT.ER: S 7ERMINAL N0: 614 Lif.7C: 12/17/97 TIIM1E: 1.5r.36:27 ,. IDn M1iaMC: MON-RAY TNC 320 9001 456' L_AY,E F'AkK 74.75 2155 3001 4567 I._AISE FAftK 1.50 To+a1 fiecei.pt, Amalnt: 76.r5 CfiOB4S?Ci USFfi SII: NANCY PERMIT ? CITY OF EAGAN 3830 Pilot Knob Road Eagan,.Minnesota 55122-1897 (612) 681-4675 PERMIT TYPE: Permit Number: Date Issued: BUILDING 031288 12/17/97 SITE ADDRESS: 4567 LAKE PARK DR LOT: 4 BIOCK: 1 IAKE PARK 5H012E5 P.I.N.: 10-44200-040-01 DESCRIPTION: 8?u 11 d i n g.--P 8uilding W '?Census Cod (DOOR/SIDE ermit Type G,Yx? TY P e ? . . . .. .:'ix,. v. . • ' r,? ..?,?' ?, 4m? -,? ?'i ?1 ? ./s.-•...,= r LIGHT) SF (MISC.) REPAIR 434 ALT. RESIDENTIAL ? ? 7 REMARKS: FEE SUMMARY: VAIUATION $3,000 Base Fee $74.75 Surcharge $1.50 Total Fee $76.25 ? r CONTRACTOR: - ppplicant - ST. l.ZC OWNER: MON-RAY WINDOW & DOOR 1546$625 0005111 BOHANON MICHAEL 8224 OISON MEMORIAL HWY 4567 LAKE PARK DR GOLDEN VALLEY MN 55427 EAGAN MN 55122 (612) 546-8625 (612)452-7632 I herebk _acknowledge that Z,- haye r0ad ,thz?.,appli4?ti'e?ct anQ state tha.t C#?a - in#orrtiatTon is correot andagree to{ca?'npij7wi?h 4_?:1 appliaab"le S'tate of Mn.? nanCea. Statutes and Gity of Eagan 4rd? ;,. ISSVED BY: IGNATURE ? APP AN /PERMITEE SIGNAT? CITY OF EAGAN $qG. t6 311§6 1994 BUILDING PER!?AIT APPLICATION 681-4675 SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy calcs. COMMERCIAL 2 sets of architectural & structural plans, 1 set of specifications, 1 copy of energy calcs. Pena 'ty applies: 1) when permit is typed, but not picked up by last working day of month [ in which request is made, 2) address is changed or 3) lot change is requested ance permit is issued. Date / / Valuation of wark $2394.00 Site Address: 4567 I:AKE PARK STREET SUITE JI Tenant Name: (commercial only) LOT ? BLOCK ? SIIBD.??? 4U !L'WY P.I.D. # Descri tion of work: REPI'ACE (1) PRIME DOOR & SIDE L'IGHT The appl i cant i s: ? Owner 97 Contractor ? Other (Deseribe) Name BOHANON MICHAEI' & L'OIS Phone 452-7632 Property LAST FIRST Owner Address 4567 L'AKE PARK STREET STE I! City EAGAN State MN Zip 55122 Company MON-RAY INC Phone 546-8625 Co ntractor Address $224 Olson Memorial Hwy License # 0005111 EXp, 3-31-98 City Golden Valley State MII`1 Zip 55427 Company Phone Architect/ Engineer Name Registration # Address ' City State Zip Sewer & water licensed plumber Processing time for sewer & water permits is two days once area has been approved. I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. u ? ? ? /f Signature of Applicant: _ ? CITY OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55123 (612) 681-4675 PERMIT ? PERMIT TYPE: Permit Number: Date Issued: (?61? y? BUILDING 021360 06/30/93 SITE ADDRESS: P.I.N.: 10-44200-040-01 4567 LAKE PARK DR LOT: 4 BLOCK: 1 LAKE PARK SHORES DESCRIPTION: r Buildin-gl?Permit Type OECK Building Wbrk Type NEW -'Building Length 53 Building Width20 { 00? a?QcLru L j ?Yz,i'-?-?t. ;; REMARKS: FEE SUMMARY: Base Fee $25.00 Surcharge $.50 Total Fee $25.50 CONTRACTOR: iL OWNER: - Applicant - BOHANON MIKE 4567 LAKE PARK DR EAGAN MN (612)452-7632 I hereby acknowledge that I have read this application and state that the infiormation is oormect end agree to comply with all applicable State of Mn. Statutes and City of Eagan Ordinances. APPLICANT/PERMITEE SIGNATURE ISSUED BY IGNA UR INSPECTION RECORD CITY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: Eagan, Minnesota 55723 Date Issued: (612) 681-4675 SITE ADDRESS: LoT : q B L 0 C K: 1 APPLICANT: - 4567 LAKE PARK OR BOHANON MIKE LAKE PARK SHORES (612) 452-7632 PERMIT SUBTYPE: TYPE OF WORK: DECK NEW ? ? liir , i y ri)r.i P! , 114.61 1f; ,;i ?1 11 ruo r andf l' rt e;ri;lr.;l?lu M nt.?? Irth? IqV":t IArG „ ?•??•- rc? d'! ,ror ro..iv e1 I'JF':- h1114k JHUF:1: 2 d:•?" f 'lk ?? :.t ;<o ???? ? - BUILDING 021360 06/30/93 01 0 " i:?1 I I l? i?1U ? ? REACTIYATE _ PERMI,T # , -v3(0? 411 T Vt tAlaNiV 1993 BUILDING PERMIT 681-4675 APPLICATION ?s SQ SINGLE fl MULTI-FAMILY 2,sets of plans, 3 registered site surveys,, 1 copy of energy alcs. COMMERCIAL 2 sets of architectural & structural plans, 1 set of specifications, 1 copy of energy calcs. Penalty applies: 1) when permit is typed, but not picked up by last working day of month. in which request is made, 2) address is changed or 3) lot change is requested once permit is issued. Date z9?i? /?2 o'/9.3 ation of work 7 ?? V ??1 ? L_ 0 ? f Site Address: STREET SUITE N Tenant Name: (commercial only) IAT BLOC& _L S U B D "' P.I.D. N Descri tion of work: ..fl.s.c The applicant is: 133/owner ? Contractor 0 Other coe.or;ee> Name ?n-- 4- `+= D'zo Phone ?Z6,)763 ?-- Property LAST FIRST Owner qddress ?f5(?? ,?a?p ?a.?.. P??. - STREET STE Y City GC?Q?rti. State Zip Company Phone Co ntractor Address License # Exp. ' City State Zip Company Phone Archttect/ Engineer Name Registration N Address City State Zip Sewer & water licensed plumber Processing time for sewer & water permits is two days once area has been approved. I hereby acknowiedge that I have read this application and state that the information is correct and agr•ee to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant: OFFICE USE ONLY BUILDING PERMIT TYPE O 01 Foundation ? 06 Duplex ? 11 Apt./Lodging ? 02 SF Dwg. ? 07 4-Plex O 12 Mutti. Misc. ? 03 SF Additian ? 08 8-Plex ? 13 Garage/Accessory ? 04 Sf Porch ? 09 12-Plex ? }'? Fireplace ? 05 SF Misc. ? 10 Multi. Add'1. ? C?'15 Ueck WORK TYPE M 31 New ? 32 Addition ? 33 Alterations ? 35 Tenant Finish ? 34 Repair E3 36 Move GENERAL INFORMATION Const. (Actual) Basement sq. ft. (Allowable) Ist F1. sq. ft. UBC Occupancy R-3 2nd F1. sq. ft. Zoning Sq. Ft. total # of Stories Footprin t Sq. ft. length ? On-site well Depth ? On-site sewage APPROVALS Rianning Building . Engineering Variance REQUIRED INSPECTIONS ? Site ? Footing ? Framing ? Wallboard ? Final ? Draintile H3 4 T ..- 0 ? Insulation ? Fireplace Permit Fee Z,S,uo 5urcharge +,so Plan Review License MWCC SAC City SAC Water Conn. Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment P1. Road Unit Park Ded. Trails Ded. CoPies Other Total: SAC % .. 5AC Units vluecion: $ ? 16 Basement*finish ? 17 Swim Pool ? 18 Comm./Ind. O 19 Comm./Ind. Misc. ? 20 Public Facility ? 21 Miscellaneous 0 37 Demolish MWCC System City Water PRV Required Booster Pump Fire Sprinkler Census Code SAC Code Assessments CITY OF EAGAN APPLICATION FOR PERMIT SEWER AND/OR WATER CONNECTION PAITIEOT.C OF EFE AT;`TIIIl? pg APPLICATION DOES NdS CONS3Z= APPROVAL OF PERhffT_ zrrsPECrxorr oF sEWx Arm/caz;MaER IrlSrar.r.amrONS F7ILL NOT geSCM= UI,ID L7NrII, PEP14IT AAS RYMi _ APPROVID. ' .. - ? . : =: •,;. .: . -- *?******x*******:*,?***::?x?r?*x??x P ease Print ::1) PROPERTY ADDRESS: 7 Slc,' LEGAI, DESCRIPTION: ? . _ ._ _ Lot Block Sub ivision or Tax Parcel ID ) IE' EaZST2NG STRL'CI[]RE, DATE OF ORIGINAL B[.+ILDIN3.PII2MIT ISSL'ANCE: ? . P?SENP ZONII?/pROPOS? L'SE; (?n Y? f-?l CO,11MEE2CIAL/REPAIL/OFFICE Q IrIDC'STRIpL INST22TITIONAL/GpVM2NENT 2) KMM? NAD9E: ADDRESS: CITY. STATE. ZIP: PHQNc,: ,2,_rR-1 S2MLE FAMILY ' ? R-2 DT-IPLEX (Ztap Units) ? R-3 TOWNKOUSE (Three + Units) ( unyts) R-4 APARTMEN'I'/CODIDOMINILTM ( Units) 3) ' ? NAME: ?R?G?nFi MECHANICAL C?+ : ADDRESS: 3600 KENNEuEC DAI4E, EAGAN, S11NN.55171 i CITY, STATE, ZIP: " . PHONE: MASTER LI(E[9SE# 001445M2 '1) •• • i?- c?: ADDRESS: • CITY. STAM, ZIP: . PHONE: . 5) n v i w: •?• CONNECTION T& CITY SEG1II2 & CpNNECi'zON 7U CITY WATFR ? PGt1Ve"`_ .. . Rcpir?d. Not`"z?carded . St , ? ta.al ^=:fi . ':._r•.'. 01'HER ' • PLEASE HOLD APpROVID PERMIT E0R pICK_Up gy ONE OF ABOc7E PLF.ASE MAIL APPROVFD PERMIT 7O 1. 2, 3, 4, P.BOVE ? (Circle one) 6) '? • '' ? Q FOR CITY IJSE ONLY PERD7IT :; ISSCED ?? ? . Pd w/Bldg_ Permit FEES: $ $ 5-0 SEWER PERMIT (INCLUDE SCRCHA3GE) $ $ D WATER PERMIT (INCLUDE SURCHARGE) / $ WATER METER/COPPERHORN/OL'TSIDE READER $ $ WATER TAP (I NCLUDE CORPORATION STQP) $--- _ $ SETNE:; TAP S $ ACCOUNI DEPGSIT - SEWER $ $ ACCOLNT DEPOS IT - WFTER $ ? ? S^r 0 '0 S _ WAC . $ ?• z-.?Ilr? S SAC $ $ TRQNK WATER ASSESSMEVT S $ TRQNK SEWE R ASSESSME.IT $ - $ ' LATERA -------- -. ._ L BF.D]RFTT/TRC'^:K SE[qEP. $ $ LATERAL BENEFIT/TBUNK WATER WATER TREATMENT PLF,NT SURCH ;RGE S $ 3O ' 0 O OTHER : TOTAL -- RECEIPm ;; RECEIPT # DOES GTSLITY CONNE CTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY? ? YES Ir YES, THEN A" PERMIT FOR WORK WITHIN PUBLIC Q h0 ROADWAY" MLST BE ISSUED By THE ENGINEERI?VG DIVIS ION. LIST AS A CONDITION. SU BjECT TO 'I`Hc FOLLO[>>ING CONDITIONS: AP?R0VEC BY: /U .r , TITLE: nATF: ??z?y 7 ------------------ i Foro?u? ? i i ? Pertnit #: .? ? ? Permi[ Fee: ? ? Date Received: I ? I C? ? I Staff: ? I ----------------- 2008 RESIDENTIAL BUILDING PERMIT APPLICATION Date: q a?- 8 Site Address: q S(O 7 Tenant: S,rr,v 4. iplL'Z t5i;ii IJ v Z poc , Suite #: RESIDENTlOWNER Name: Sotbv L b"_ Phonelos!> 686? 06a3 Address / City / Zip: i4S67 4?6K£ i42 K. W (Z Applicant is: 7-, Owner _ Con[racror TYPE OF WORK Description of work: R4n&),'? mo Construction Cost: 7 0750 Multi-Family Building: (Yes _/ No CONTRACTOR Name: Cz4FnWi1,5rm6 Q mnoA tn a?+ b License #: 0204 a 7a y 3 Address: o? ?S Lr Ciry: //yl?//F4c¢ow,4 State: /l/n l Zip: SSN? Phone: 65 1' 757" ql 0'O Contact Person: COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Minnesota Rules 7670 Cateaorv 1 Minnesota Ruies 7672 Energy Code . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet Category Submitled Submitled (4 submisslon type) • Energy Envelope Calculations Submitted 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 documenis thai you submit are considered fo be pu6lic intormafion: Portions ot . the information may be classified as non-public if you provide specifiq reasons that would permit the City to ` ` ? ? conclude that the are tiade secrets. I hereby acknowledge that this information is complete and accurate; [hat ihe work will be in confortnance with the ordinances and codes of the Ciry of Eagan; that I understand this is not a pertntt, but only an application for a permit, and work is not topart vnthout a permit; thffi ihe work will be in accordance with the approved plan in the case of work which requires a review and ap val of plans. ? x bFh+NT x AppllcanCs Printed Name AppllcanYs gnature Page 1 of 3 SIOMA SUAVEYINO SEi4VICE8 3730 Pilot Knob Road ` Eagan, Minnesota 55122 Phone: (612) 452•3077 House Certificafe For: Homes 6y PQRRANTO ? ?h P \"O 9/q0 w 918.u ?? -z?N,?, ??s ^ ?o ,?sou?.? / ' - 9 °.sy •/? p O T.c L ? , i i / .11B.4q I-o?ql9. ? v ? O A 11 p. / or?va.Ja?i '•? ,?? i9a ?/ 0 ? ???,? .? ?. 9• F T.C. O?BB ` vte.?o \ '?'? n??4 d 97A.9 ?t9zo.6 o p• \ f ?`1e\b ? ?0 ?y33Z6 S±A? ti e ?\6; ???. ? ?\?1 VZ uOi .?h. ? yb? qs Ty \?J ° vzb.ovc,`` '\`? : ?• l? ti/ 0 \ TR A ? I LOT 400?\??,ti?' ? ?•? ?S ? •• g M yW \? ? ? \ r? ? o" S3 Co N 5? \ ; y? 6e62 I=40' 0 IoP - - - - - -- -\J, S ? tz 4ti g .' - N 84034' Z 1" W 123.00 •'?9za.? \ ?`?? ? -LEgEND" O Denotes Iron Ala'w.m'nt m Denotes Woaf Hub Set x9zs.s Denotes Existirg Spot Elevation G,mHwr„N1 Denotes Proposed Spot Elevation Denotes Orainege Direction -PROPERiY OESCRIPTlLNI- Lor `I ,ei.a?c i L/}KE, PARK SHoRES accordiiy to the ?eccrded plat thereof. ? DaKoN Lounty. Ninnesota PROPOSED GARAGE FLOOR ELEVATION= 9? ? PROPOSED Top af Block ELEVATION PROPOSED BASEMENT FLOOR ELEVAT ION= 916.0 NOTE Verify all floor hei9hts with Fina1 House Plans. aiaicwm rF17fIFfG9ICW- 1 hereby certify thet this survey, plan or report wes prepared by me a' u'ber my direct supervisian, ard urderhthe laws otut ?atee??'ruies4f????uErtS??q? '?5,.`.: • ;, W a^4ti.1.?, .? =( ?48kyAYNE D. ' Dete: E / Wayne_ D ordes. Minn. Reg. No. 14675 _. ? 18675L ? . ,! . '. .??. gIQMA 9URVEYINO SERVICEB 3730 Pilot Knob Road Eagan. Minnesota 55122 Phone: (612) 452•3077 v ',soi `•dq ?? d!? ?? / ? e q: ? 4 p vA .- (Z-vflb? ?R? 'Q41 A 'Fn LOT 4 ?o\ , oti n Co ? N 6e62 ? 0 5I ? s d ;? - - - - - --. -?..? -•'928.1? /y •- rv av°34'zr"w 123.00 ,l -LEGEND- O lknotes Iron maxmnt m Llenotes Woai Hub Set x9zs.s (knotes Existirg Spvf £levation Sµ?T,,N) Aerotes Proposed Spnt Elevation ',?Glenotes Drainage Directian -PADPERTY DESCRIPiILNI- Lor--LL . BLaK i LaK? PAOK SHoRES according to the recorded p1et thereaf' .'Ja W a Caunty. M;nrVsota House Ceriificpl9 Fpr: HQ11les ? by PARRANTA • : , ?, ? i °p o r.c' I -f/B.4q , ?I , / ?S' , o 917• ? ,? ??• / ? PrivFANy' 't, ro"?o ?(? ?r.i?,?/ ?P• ? ? D 9zo, +P' ?3 T.C. ? ? YI6.co 9 . ai A 20, '7 ? 10 ? •o ?:' ?°A ?its 9?3 z?? ? ? lq +?.`\ ? 9 I"=4o' PROPOSfD GARAGE FLDOR E4EVAil010: qL"O PROPOS£0 Top of @lock ELEVAl1ONNN? 97-q'V PROPOSED BASEMENT FLOOR ELEyATIONm 91`•0 M?pTE: Verify all floor heights with Fin#l House Plpns. _ql!#= CM14CAT1-- ! hereby certify ihAt thi; ;ufV4Y, Pl4n a' repat wss pre/xred by me or Lrder iAY dirpct supg .. ????i',r ard that 1 am a duly Registeroc! lsrld $?? E$Q???>r? urder the laws of the Stqtp 4f NiR?-"""' I ` (? o,t¢: : VFAYNE D.' w i,? aQ Wayre A. Cordes. Yinn. Re9. No, 14q5 ? ? - 14675 PERMIT City of Eagan Permit Type: Building 3830 Pilot Knob Rd Permit Number: EA084589 Eagan, MN 55122 . Date Issued: 07/23/2008 (651) 675-5675~~~ EPermit Category: ePermit www.ci.eagan.mn.us lflflUl tflflLLL Site Address: 4567 Lake Park Dr Lot: 4 Block: 1 Addition: Lake Park Shores PID 10-44200-040-01 Use Description: Sub Type: e-Reroof Construction Type: Work Type: Repair Description: House & Garage Census Code: 434- Occupancy: Zoning: Square Feet: 0 Comments: Permit closed without required inspection(s). Letter sent to applicant on 4/10/09. (pf) If there is no ice protection inspection prior to final, you must meet inspector with ladder and flat bar. Pictures are not acceptable in lieu of inspections. Fee Summary: BL - Base Fee $3K $88.50 0801.4085 Surcharge - Based on Valuation $3K $1.50 9001.2195 Valuation: 3,000.00 Total: $90.00 Contractor: -Applicant - Owner: Tyther Contracting Melissa A Buhrsmith 10159 James Avenue NE 4567 Lake Park Dr Otsego MN 55362 Eagan MN 55122-2501 (763) 295-3000 I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Applicant/Permitee: Signature Issued By: Signature Use BLUE or BLACK Ink 1-- --------------i Far Office Use I Permit (y 5C ~ non City of Ea V I ~151 t 1 ~ Permit Fee:' 3830 Pilot Knob Road I Eagan MN 55122 1 Date Received: Phone: (651) 675-5675 j 1 Staff: Fax: (651) 675-5694 L--------------- 2011 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: Site Address: 6! !rK r Tenant: ) Suite RESIDENT / OWNER Name: 1 ~J co ~ C I J C> L O L4_C Phone: Address / City / Zip: `7 -7 6 Le-& 6 R~t CONTRACTOR Name: ~1E c ~ Q(d ACM ~ P1 "L4 (,L-6 4 F License Address: `~t_ V e City: E.~' a4 State: Zip: Phone: 3 jc- ya)/ Contact: - i _ Email: TYPE OF WORK - New X Replacement _ Repair - Rebuild _ Modify Space - Work in R.O.W. Description of work: t,~ y P etc wti 7Zr iA PS W, A h ecc3 ZGC N PERMIT TYPE RESIDENTIAL 'ex f b~ SF" tH T "~•6/ S"7 ~loc~ ; x f PP Water Heater P Water Softener S Lawn Irrigation RPZ li 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.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 apps v of plans. j x 21 ~ x ' Applicant's l nted Name Applican s ature FOR OFFICE USE Reviewed By: Date: Required Inspections: Under Ground -Rough-In -Air Test Gas Test Final PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA151717 Date Issued:09/10/2018 Permit Category:ePermit Site Address: 4567 Lake Park Dr Lot:4 Block: 1 Addition: Lake Park Shores PID:10-44200-01-040 Use: Description: Sub Type:Residential Work Type:Replace Description:Water Heater & Water Softener Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection. Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener). Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087 Surcharge-Fixed $1.00 9001.2195 $60.00 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Chris B Ziemer 4567 Lake Park Dr Eagan MN 55122 (612) 412-6066 Bonfe's Plumbing & Heating 455 Hardman Ave South St. Paul MN 55075 (651) 228-7140 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA161495 Date Issued:05/29/2020 Permit Category:ePermit Site Address: 4567 Lake Park Dr Lot:4 Block: 1 Addition: Lake Park Shores PID:10-44200-01-040 Use: Description: Sub Type:Residential Work Type:Replace Description:Air Conditioner Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952) 445-2840. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088 Surcharge-Fixed $1.00 9001.2195 $60.00 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Chris B Ziemer 4567 Lake Park Dr Eagan MN 55122 (612) 412-6066 Bonfe's Plumbing & Heating 455 Hardman Ave South St. Paul MN 55075 (651) 228-7140 Applicant/Permitee: Signature Issued By: Signature