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
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-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:
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Wayne_ D ordes. Minn. Reg. No. 14675
_. ? 18675L
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gIQMA
9URVEYINO
SERVICEB
3730 Pilot Knob Road
Eagan. Minnesota 55122
Phone: (612) 452•3077
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-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
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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.'
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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