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910 Lakewood Hills Rd Use BLUE or BLACK Ink G For Office Use I~ q,75q Cit of Ea an Permit non I Permit Fee: 115` 00 I 3830 Pilot Knob Road Eagan MN 55122 RECEIVED I Date Received: i Phone: (651) 675-5675 L j1- staff: Fax: (651) 675-5694 JUN 0 3 2011 1 2011 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: Site Address: Ct `D ~-'6"'~- ea \ ~S 4 Tenant: Suite RESIDENT OWNER Name:~Y\01a \6(_ &4ZV-r12iVn Phone: Address / City / Zip: t D C ~ N)~WL CONTRACTOR Name: 1 ~IA k t License 103 Ill X Address: 19n.190 -D~Li V-" \Ij Sul 01 City: Ja*L, 47 >7t-1 ` State: Zip: Phone: ~15a - L T 3 - LKb Contact: Ga.udi d r Email: Y WeA . aTrVL TYPE OF WORK -New Replacement _Repair -Rebuild Modify Space - Work in R.O.W. Description of work: PERMIT TYPE RESIDENTIAL Water Softener Water Heater Lawn Irrigation RPZ PVB) Add Plumbing Fixtures Main Lower Level) Water Turnaround y Septic System 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 ($10.0.0 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 $ J Q C,~' 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 II_ 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 plus.. x- x Applicant's 'nted Name Applicant's Signature FOR OFFICE USE Reviewed By: Date: Required Inspections: Under Ground Rough-In Air Test Gas Test Final INSPECTION RECORD I CITY OF EAGAN PERMIT TYPE: I 3830 Pilot Knob Road Permit Number: Eagan, Minnesota 55123 Date Issued: I (612) 681-4675 I SITE ADDRESS: f ? '! " I.1i-t I.I11itf) ii ? 1 I ,tdl? ? PERMIT SUBTYPE: 11 I 1 ? APPLICANT: .?r I ' f?' ? iiPl, I TYPE OF WORK: N 1 1 1 ?10 i i It i N(a 01444 t 0 M/.?r.?/ () a i PermR No. Permit Holder Date Telephone 1! S/W PLUMBING HVAC ELECTRIC ELECTRIC Mspection Date 1nap. Comments Footings I Foundation Framing Roofing Rough Plbg. Rough Htg. Isul. Fireplace Final Htg. Orsat Test Fnal Plbg. Plbg. Inspectar - Notity Plum6ar Const. Meter Engr./Plan Bldg. Final Deck Ftg. S JpZqp AA Deck Final T Well Pr. Disp. CITY OP EAGAN Remarks $45DC ?i6l ?..p.:? Lot 2. 0 Blk 1 Parcel 10 ti.4r? 00 ? - Addition.. Lakeweed 6?" Owner ,- t'. r" i ?$creec 910 LakeWaoti ui> > S Rd State F.agan, Mn 55123 I Improvement I Date ' Amount I Annual I Years I Payment I Receipt I Date STREET RESTOR. GRADING SAN SEW TRUNK SEWER LATERAL WATERMAIN WATER LATERAL WATER AREA STORM SEW TRK STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. BUILDING PER, SAC PARK Owner Remarks 1? Lot Rlk Parcel 10 84300 0r? 72 00 screec 910 Lakewood Hills Rd, stace Eagan+MN 55123 Improvement Date Amount Annual Years Payment Receipt Date STREETSURF. STREET RESTOR. GRADING SAN SEW TRUNK SEWER LATERAL WATERMAIN WATER LATERAL WATER AREA STORM SEW TRK , STORM SEW LAT CURB & GUTTER SIDEWALK I STREET LIGHT WATER CONN. BUIIDING PER. SAC PARK ..v i r OF EAGAN Remarks - nj ?'% ? ^ r,n- 1 i ii.ocn o?n Addition. - 6?1I??ufn?"t ir1L4C?CJ Lot 20 Blk 1 Parcel 10 ??° 0 0 Owner I I--(I i1 'I `%in i„^t Street 910 Lakewood H3115 Rd. sTate Eagan, MN 55123 Improvement Date Amount Annual Years Payment Receipt Date STREET SUflF. STREET RESTOR. GRADING SAN SEW TRUNK SEWER LATERAL WATERMAIN WATER LATERAL WATER AREA STORM SEW TflK STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. BUILDING PER. SAC PARK . . .. CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 ; BUILDING PERMIT PHONE: 454-8100 Receipt To be used for POOL ? DEGK Est. Value :20000 Date MA7( 22 , 1991_ ? 1 Site Address 910 HI LLS iD d Lot aSb Block 0 SeGSu647I 1.DE NESS R F? OFFfC E USE ONLY ? PerCBI NO. Occupancy Jim-Z FEES { ? Zoning - W Name _ .18E'PgEY A BLi9 (ACtuaq Consl - ?I Bldg. Permit 6S_m ; ? Address 910 I.AICE1100D HI -t a (nllowable) - I e 1.A0 Surchar LAC,AN Clty Phone ?Sfi.J1 SSt ,v ot Stories I g Lenglh -32-s Plan Review I Zo Name $? Depth 16? ? SAQCiry ----------- ? ° Address S.F. Total . I F C11y Phone S.F. Footprints - SAC,MCWCC I F ¢ F W Name On Site Sewage _ On Site Well Water Conn I ?? AddfeSS - MWCCSyslem _ Water Meter Acct Deposit ? a W CitY PhonB City water _ ? PRV Required _ S/W Permil I hereby acknowlege ihat I have read"this apq information is correct and agree to comply wi lication and state that the tTl all applicable State of Booster Pump - S/yy Surcharge Minnesofa Siatutes and City of EaganOrdirifinc es. Treatment PI , Signature of Permitee APPROVAIS Road Unit A Building Permit is issue?1?.10?-'°`?rra? ? Y AR? Planner - park Ded, on the express conditiofi T?al all work shall be done in accordance with all Council applicable State of Minnesota Statutes and City BuiltlingOfticial . ot Eagan Ordinances. gldy, ph. _ Variance - CoDfes TO7Al 46•00 PsrmH No. PermR Holder Date Telaphone p WATER SEWER PLUMBING H.V.A.C. ELECTRIC Inspeetion Date Insp. Comments Footings I Foundation - Framing Roofing Rough Plbg. Rough Htg. Isul. Fireplac9 Final Htg. Orstat Test Final Plbg. Plbg. Inspector - Notify Plumber Const. Meter EngrJPlan Bltlg. Final Deck Ftg. ? / Deck Final Well Pr. Disp. , ka llo. k INSPECTION RECORD ?Jlo CITY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: H, f, i rr 'I Eagan, Minnesota 55122-1897 Date Issued: ?w+? • I (612) 681-4675 I SITE ADDRESS:' "'," ¢" APPLICANT: 1;1 PERMIT SUBTYPE: TYPE OF WORK: INSPECTION .• • D• ,, ;??_ ?•, I+! fAilVr'.? P'1 '•f :+11 I'! i.1411 I 11Il1 !i It 1 15I. :0'1-i ? I', ? li, {t t 1•i,{.? Permit No. Permk Holder Date Telephone M ELECTRIC PLUMBING HVAC Inapecdon Oau Insp. ?-- Comments FOOTINGS ! .,/Qr 7 ? FOUND FRAMING ROOFING ROUGH PLUMBING PLBG AIR TEST ROUGH HEATING GAS SVC TEST INSUL pYPBOARD FIREPLACE FIREPLACE AIR TEST FINAL PLBG FINAL HTG OHSAT TEST BLDG FINAL BSMT R.I. BSMT FINAL DECK FTG DECK FINAL Z 5vq \ CITY OF EAGAN N2 19101 3830 Pilot-Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHONE: 454-8100 C 13 BUILDING PERMIT Receipt # To be used for POOL & DECK Est. value $2, 000 Date MAY Z Z , Ig 91 Site Address 910 LAKEWO OD HILLS RD Lot 056 Block 0 Secl SubWILDERNESS RETREA OFFICE uSE ONLY Parcel No. occuPancy 1`L-2 PEES Zoning - W Name JEFFREY A RUD (ACtuaq Const Permit 45 _[ln Bldg _ . o AddreSS 910 LAKEWO OD HILLS (Allowable) - 1 00 . Surcharge City EAGAN Phone 456-0553 r ot swdes - 321 Plan Review Length o Name 5AME Depih 16' SAC Cit - y , ` o Addf2SS S.F. Total - u SAC, MCWCC ? CItY Phone S.F. Footprints - W t C r On Site Sewage - er onn a W W Name On Site Well W M 1 - ater aler ?? AddfeSS MWCCSystem _ a W Clty Phone Ciry Water _ Accl. Deposil PRV Required _ S/W Permit I hereby ackrawlege that I have re this i on and state that the Booster Pump - SM/ Surcharge information is correct and agree to mply wi I applicable State of Minnesota Statutes and City of a O ' s. Treatment PI Signalure of Permitee ` APPROVALS qoad Unit A Building Pertnit is issu j?w FFREY A RUD Plenner - park Ded. on the expres5 conditio hat all r shall be tlone in accordance with all Council -- epplicable State of Minnesota Stat es and Cit yf of Eagan Ordinances. gyg. pry, Copies Building OHicial ,?.un R.o?' ? I I ?JJ Variance - TOTAL 46.00 io-???soc-o??-oo ?--o-?-- ?? VILLAGE OF EAGAIV 3795 Pilot Knob Road Eagan, Minnesota 55122 PERMIT NO:: 173 The Village of Eagan hereby grants to PoA Ki611nq Excavatina of 9735 So. Robert Trail. IGH 55075 a 3EpTIC s CS38POOL Permit for: (Owner) Gausman at 910 Lakewod Hiils TM*m , pux'suant to application dated 11/14/73 . . Fee Paid: S10.00 dated this 14th day.of Nonember , 1973 .50 e/c • Building Inspector Nechanical Permits: Bid Total: `.3 ?!.5 00 / 0 -f4s1? 0-? ??- G 6 ?et& `„ • ? l.??ldern? ?e-??rer,f VILLAGE Or EAGAN 3795 Pilot Knob Road Eagan, Pliruiesota 55122 PERNlIT NO.: 43g The Uillage of Eagan hereby grants to pU=L GAUSMAN of 4158 Rahn Road. Aat. 21 a BEATiNG Permit for: (Owner) aame at 910 Lakewoofl Hille B?a, pursuant to app].ication dated 11/29/73 . Fee Paid; $20 00 dated this 29th day of November , 19 73 . .50 s/c Building Inspector Iiechanical Permits: Bid 'Potal. - ? 2,;o C'r 2I u VILLAGE ON' EAGAN 3795 Pilot Knob Road Eagan, Minnesota 55122 PERIqIT IdO. 0 410 The Village of Eagan hereby grants to nAnz Ryan plumbina & Heating ino• of a pLUpqglNG Permit f or: (Owner) `Dan Gausman ? at 910 Lalcewood Hills ?pursuant to application dated 11/13/73 . Fee Paid: $20.00 dated this 14th day of NOV• ? 19 73 . .50 s/c Building Inspector 1 echanical Permitsc i3id Totalo EAGAN TOWNSHIP BUILDING PERMIT owae: r...... Address (Present) ---Xe/ ....... •••!?-'--••-•?'... Builder ...... -....... s.!•..??=r.eJ. . ..... Addresa ---f- -°-° -----?--°°------° ---------------------------°°---°--...._.............. N° 3154 Eagan Tomnship Town Hall Date 4--/J.... 7.3 ....... 5tories To B Used JFor ?X? i- L? ? Front J b Depth J Z Height I Esi. Cosi .C J? 7U ? Permi! Fee ?C?? D ? Remarks ,? . . LOCATION 31/ s:reet, noaa or osner uescnnsion o: Locaxion i 1,01 i n?ocx i naau3on or 'rraa q16 ?I.?./' na?llwl /? This ?permit does aot aulhorise the use of streels, soads, alleys or sidewalks nor does it give the ownsr or his agenf the right fo ereate any situation which is a nuisanae or which preseats a hasard !o the health, safety, conveaienee and general welfare !o anpone ia ihe community. THIS PERMIT MUST KEP O THE PREMISE WHILE THE WORK IS IN PROG??- This is !o certify. 3hat?.---------------------- haspermisaion !o erect a---- .---•_-_-•------•••-•••- • upon •• • •••--...--°........__ --Towns ip adopled April 11, the ahove descr' d premise subject to the provisions of the Building Ordiaance for Eagan 1955. ........ ..-----?•- ° •--- -?.•••••.......-°°-----....-•----•--•-----... Per/____/???- ... - - - -?-- 9 •• .............................. airman of Tnwn Boerd Buildin Insecto: I821QU E ersity'Ave., R? SR 28AS .f PauP MN 5?5104 X??{ ? * 0 ` 3-3-6 4 3 7 9 * Phone (612) 642-0800 I?^le ?5 Home Duplex Apt. Bldg. Other: New Addn ommercial dushial Farm Remod e air Air Cond. t tg. Equip. Water Hh'. Load Mgmt. Other: D er Ra n e E lec. HeaT Tem . Service "X" above fhe work covered by this request. Enter remarks in this space and on the 6ack of the white copy only. Rc)?? ` ?'S1 0.R& -"? ?\ '?\ \5?-? Calculaie Inspection Fee - 7his Inspection Requesf will not be accepted without the correct fee: Olher Fee # Service Entrance Sae Fee # Circvits/Feeders Fee Mobile Home Park Stall 0 l0 200 Amps 0 to 100 Amps S}reet Ltg./Traffic Sig. Above 200 A e 100 Amps Transformer/Generator INSPEC TOT Sign/Outline Ltg. Xfmr. D Alarm/Remote Conirol m Swimming Pool I hereb -1% 'cal' imfillafion descri6ed herein on the doMS sbied '- thotl Irrigdtion Boom Ra -In Date Special Inspedion TH InVe5fi9a1ive Fee IS INSTALLATION MAY BE OR _ Final Dafe DE CON CTED IF NOT COMPLETED WITHIN 18 N HS. 3 3 6- 4 3 791 OFFIC SE ON V This request vaid 18 monlhs from validation date prinkd in fhis box. ?3Jo ? 9?c? . Lv PL SE PRINT OR TYPE Request Date Rough-in inspeciion required2 Yes [] No Inspeclion Other Than Rough-In: Q Ready Now ill Coll i? (You must mll fhe inspMOr whe rea f Date Ready: I, icensed contractor 0 owner here6y request ins ction o( the ahove electrical work at: lob Ad us (Sheet, Boz, Rovte No.J ? Zip Code Sedion No. Township ome or No. Range No. Fin No. unty Occupant ? Ph e No ?. Power $up lier ? Addresz ? Elecfn Confmdor ?Company NamaJ ' Contmdor License No/.? n, C O ` V Master Lic. No. (Plant Eletl. Only) Mailinq Addmss (Cantmclor o ner PeAormilg Installoti nI q-o r rized $ignature ConAnctor or Owner Pedorming Insbllafion) .6?? a Pha No. - EB-000011-10'6/95 STATEBOARDCORV-SEEINSfRUCTIONSONBACKOFYELLOWCOPY 9 8 Request Date O ? Fire No. R uqh-In nspeclion Aequiretl (You must t-944nspector when ready) Inspection Other Than Rough-In ? Ready Now M Will Notify Inspector ? Yes ? No Dale Reatl atl I ? licensed contractor ? owner hereby request inspection of above electrical work at: Job Address (Streei, Box or Route No.) I? U)ood "?15 City , Section No. Township Name or No. Range No. County Dl/,?" ?o+v? Occupant(PRINT) Phone No. S ? -r o Power Supplier Address Electrical Contractor (Company Name) Contractor 5 icense No. ? L E e? ?c. . Sn,? ooa 1? Mailing Adtlress (COntractor or Owner Meking Installalion) 3 t ae- 537e? A or u ( act ner M ing I ailetion) Phone N mber ' A I - ) ? & a - 9-q4k3,333 O B O 'CIry 7 G 2 9 u g 1 1 11 111 1 ?I I( 1 1 1 D F 8 Unl St ?P l , MN 55104 ve s?y Ave., 1 1 II II I I I III 11 111 11 1 11 1 11 EE I OP ER INSPEC TON S ULSS Phone (612) 642-0800 NCEOSED E O^, ?,L? / p(,?I REQUEST FOR ELECTRICAL INSPECTION F?4 P??`'?\ EB-00007-09 See instmctions for complefing this fortn on back of yellow copy. ?? •??%? /- ? 0 9? "X" Belaw Work Covered by This Request ?s?,?;d Ne Add Rep. Type of Building . Appliances Wired Equipment Wired Home Range Temporary Service Duplex Water Heater Electric Heatin Apt. Building Dryer. Load Management Comm./Industrial Furnace Other (Specify) Farm Air Conditioner Other (specify) Co?n`tr},actor's Remarks 1Kr-c-r P"Q?.. W Compute Inspection Fee Selow: # Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee Swimming Paol 0 to 200 Amps 0 to 100 Amps Transformers Above 200 Amps ve 100 -Am s Sigfls Inspeclors Use only TOTAL ?4 Irrigation Booms c fp • av y? ? S ecial Inspection Alarm/Communication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT Other Fee COMPLETED WITHIN 78 MONTHS I, the Electrical Inspector, hereby certif that the b i ti h Rough-in Dale .) f y a ove nspec on as been made. F'"al oa OFFICE USE ONLY This request void 18 months ham /-0/a/d'y / Request Date Ca ?? Fire No. Rough-in Inspeclion Required? ? Ready Now Notify Inspector n R Wh d ? [ ? Ves ? No e ea y Ioicensed contractor ? owner hereby request inspection of above electrical ork at: Jub Address (Slreet, Boz or Route No.) A /? ily Section No. Township Name or No. Range No. County Occupant ( P a No. Power Sup r Add?ess - .f ?L?v aaa .. . - Eleqric Nam n Contractork License No. 210r n(%?Lfn - O Mai' g Address (ConVactor or r Making Installation) Authorized Sign re ntractorlOwn akirg Install lPhonfi Number J MINNESOTA STATE 80ARD OF ELECTRfCITY TNIS INSPEG7lON REQUEST WILL NOT Grigga-Midway Bldg. - Room 5773 BE ACCEPTED BY THE STATE BOAHD 1821 University Ave., St. Peul, MN 55704 UNLESS PROPER INSPECTION FEE IS Phona (612) 642-0800 ENCLOSEO. J? jz /8.g REQUEST FOR ELECTRICAL INSPECTION -y? ji? See instruqions for completing this fortn on beck af yellow copy. ? 6 2 4 3 3 `X" Below Work Covered by This Request W". ee-00001-07 . e ,4dd Rgp. TypeofBuilding AppliancesWired EquipmentWired Home Range Temporary Service Duplex Waier Heater Electric Heating Apt. Building Dryer Other (Specify) Comm.llndustrial Furnace Farm Air Conditioner Other (spedty) Conlractor5 Remarks: [ Compute Inspecfion Fee Be%w: # Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee Swimming Pool 0 to 200 Amps 0 to 100 Amps Trensformers Above 200 _ Amps , Above-100-_ Amps SignS InspedoYS Use Onty: i TOTAL - Irrigation Booms J ?, DU ' - 1,5- Special Inspection cJ Alarm/Communication Other Fee I, the Electncal Inspector, hereby Roughdn ? 17-2 Date certify that the above inspection has been made. Final 06.4 7 ? OFFICE USE ONLY This request wid 18 momhs /rom 1NSPECTION RECORD CITY OF EAGAN PERMIT TYPE 3830 Pilot Knob Road Permit Number: Eagan, Minnesota 55122-1897 Date issued: (612) 681-4675 euILorNG 026184 08r07/g5 SITEADDRESS:P'I.N, e 10-44351-020--01 LOT: 2 BLQCK: 910 LAKEWOOD HILLS RD LAKEWOOD HILLS 2ND PERMIT SUBTYPE: SWIM POOL 1 APPLICANT: VALLEY POOLS INC (612) 894--1480 TYPE OF WORK: DESCRTP7ION NEW (IN-GROUND) ., . _ _ ? - . ? . . , vSa; m'env . _ . . _ . ? _. . . . . _ _ - _ ? .; d?... ... . . ? ` e? ? REMARKSs A SEPARATE PERMIT IS REQUIRED FOR ANY ELECTRTCAL WORK ? CITY OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55122-1897 (612) 681-4675 SITE ADDRESS: P.T.N.: 10-44351-020-01 PERMIT PERMIT TYPE: Permit Number: Date Issued: 910 LAKEWOOD HILLS RD LOT: 2 BLOCK: 1 LAKEWOOD MTLL5 2ND BUILDING 0261$4 0s/a7/s5 DESCRIPTION: (TN-GROUND) B_U 1, Xdln???p ,ermit 7ype SWIM POOL TYPe NEW ? m, A ts.t ?-m ¢# ev '€ stip? -31: REMARKS: A SEPARATE PERMIT I5 REQUIRED FOR ANY ELECTRICAL WORK FEE SUMMARY: VALUATIQN Base Fee Surcharge Total Fee CONTRACTOR: VAILEY POOLS SNC 651 CLIFF RD BURNSVILLE MN (612) 894-2480 $162.25 $5.09 $167.25 - Applicant - 18941480 55337 $1'U g YJ00 OWNER: OEHRLETN pON 910 LAKEWOOCI HILLS DR EAGAN MN 55123 (612)405-9055 gAq ) &??& J)Oflp " APP ICANT/PERMITEE SIG A RI E$- ISSUED BY: lGNA RE 1LIi4 CITY OF EAGAN 3830 PILOT KNOB RD - 55122 1995 BUILDING PERMIT APPLICATION (RESIDENTIAL) 681-4675 RemodeVReoair Reauirements ? i ? ? 3 registered site surveys 2 eopies of plans (inciude beam 8, window sizes; poured fid. design; etc.) 1 energy cakuletions 3 copies of tree preservation plen if lot platted after 7l1/93 required: _ Yes _ No DATE: DESCRIPTION OF WORK: G ? 2 copies of plan ? 2 site surveya (exterior add'+tiona & deeka) ? 1 energy ealwlations for heated edditions CONSTRUCTION COST: STREET ADdRESS: GIf 1-Ecci°9? lllz-LS LOT -?_ BLOCK _I SUBD./P.I.D. #: PROPERTY Name: P h o n e #: OWNER `^" `""T ? Street Address* ??G ?zLS City: ??-?„?t-?? State: Zip: CONTRACTOR Company: Phone #: Street Address: L"-G A,I,v License #: City: State: ,? Zip• ARCHITECTI Company: Phone #- ENGINEER Name: _ Registration #- Street Address• City: 5ewer & water licensed plumber: change are requested once permft is issued. State: d6) Zip: Penaity applies when address change and lot 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. 5ignature of Applicant: OFFICE USE ONLY Certificates of Survey Received _ Yes -, No Tree Preservation Plan Received Yes No .., BUlLDING PERMlT TYPE OFFICE USE ONLY ?. _ M ? 01 Foundation ? 06 Duplex ? 11 1 Apt./Lodging o 16 Basement Finish 0 02 SF Dwelling ? 07 4-plex ? 12 Multi Repair/Rem. 17 Swim Pool ? 03 SF Addition ? 08 8-plex ? 13 Garage/Accessory o 20 Public Faciliry ? 04 SF Porch ? 09 12-plex ? 14 'Fireplace o 21 Miscellaneous 0 05 SF Misc. ? 10 = plex ? 15 Deck WORK TYPE cn`31 New o 33 Alterations 4 32 Addition a 34 Repair GENERAL INFORMATION ? 36 Move 0 37 Demolition Const. (ActuaQ Basement sq. ft. ; MC/WS System (Allowable) Main level sq. ft. City Water l1BC Occupancy sq. ft. Fire Sprinklered Zaning sq. ft. PRV # of Stories sq. ft. Booster Pump Length sq. ft. Census Code. 321F Depth Footprint sq. ft, , SAC Code ? I Census 81dg r Census Unit ? APPROVALS Planning Building Engineering Variance Permit Fee Valuation: ; $ 122, o,ncD M Surcharge Plan Review ' License MC/WS SAC City SAC Water Conn. Water Meter Acct. Deposit ' SN11 Permit S/W Surcharge Treatment PL Road Unif Paric Ded. Trails Ded. Other Copies Total: % SAC SAC Units ? ? 1Q$ J,)o ? y`rT ,?? ?? INSPECTION RECORD CITY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: Eagan, Minnesota 55123 Date Issued: (612) 681-4675 SITE ADDRESS: 4 o r: 2 B L 0 C K: g APPLICANT: 910 LAKEWOOD HZLLS RD ALLEN CONST LAKEWOOD HTLLS 2ND (612) 688-8109 PERMIT SUBTYPE: TYPE OF WORK: DECK BUILDING 024443 08/26/94 NEW INSPECTION .• . .A F007IN6S FINAL ? .?--?---? ? ? . PERMIT CITY OF EAGAN PERnnIT TYPE: 3830 Pilot Knob Road B U T L D I N G Eagan, Minnesota 55123 Permit Number: 024443 (612) 681-4675 Date Issued: @ g/ z 6 J 9 4 SITE ADDRESS: 910 LAKEWOpD HILLS RD LOT: 2 SLOCK: 1 LAKEWOOD HILLS ZN[l P.S.N.: 10-44351-020-01 DESCRIPTION: < Bui?CliFlg'?ermit Type DECK Buildirtg Wkk Type NEW ? _ ?- ey ?414 F REMARKS: FEE-SUMMARY Base Fee $30,00 Surcharge $,50 Tota1 Fee $30.50 CoNTRACTOR: - ppplicant - s7. Lzc. OWNER: AL4EN CANS7 16888100 0001062 NALL KETTH 4649 112 PENKWE WAY 910 LAKEWqpD WTLL5 RD EAGAN MN 55122 EAGAN MN 55123 (612) 688-8100 (612)686-0195 T hareby acknawledge'; at ?`haue..rsad ttt?„.s -apP?.:ttat?.qO -40s#•.; s?At* that=t?e ' informatia?r is earr tt? anO 4gree.;_to °compiy ap:plieabJ.e, °????? ,Of Nn. ? 'Stafiut s and City b? agar??krdS.nances - APPUCANT/PE TEE SIGNATURE --I SUED B 51G URE 14443 CITY OF EAGAN 1994 BUILDING PERMIT APPLICATION 681-4675 ? (` rr SINGLE & MULTI-FAMILY 2 sets of plans, 3 e? s e su eys, 1 copy of energy calcs. ?` ?. ? 4.? .?;tj ,'-'11i S,? . ?? ..?!..e'.1 1 COMMERCIAL 2 sets of architect ral & structural p ans, 1 set of specifications, 1 c ' . 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 Valuation of work '?glw Site Address: '?'m??-?w,q,,?n STREET SUITE # Tenant Name: (commercial only) LOT 2 SLOCK __Z_j SUBD. ;? Q- . •, s ?:, / FP.I.D. # --? ' C ? c , Descri tion of work: The appl i cant i s: ? Owner 40 Contractor ? Other (Describe) Name Phone Property LAST FIRST Owner Address 9'/0 A?z s,,w0 k 4& STREET STE # City &fndsJ State /*N Zip Company Phone ?i,?- Contractor Address i4101-4&1?? License #//l('2, Exp. 7 ? City ?&aAk State sl(I/t/ Zip S1%Ti? 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 app ica ion and state that the information is correct and agree to compl W. all app 'cable S ate of Minnesota Statutes and City of 7 Eagan Ordinances. • Signature of Applicant: -aer? ,6 ,` RECORD OF COMPLAINT Date ? r-7 / Complaint taken by ?To e- ? Type of building E)P-Ck. .4-r Name _ J (A I> Address y 10 L????? ??LUS, 'P,0,4;b Legal description Phone number 4/SG "- 0,5S 3? /3 Complaint T>=-EJ? Tos7- rY*-S, b-r L-E>Fb7-- 1 1 fru-I ? ?S ? KKK Action taken KE-F? "rb F)EL? ?'?sS ?o?? Comments OwNiE'R WauLD PRErgIR A ZND aPrr?r?? FAdIn AN /PlsPE?4cp2 wHO DiD NoT z>z) !NS F+e:Z 770,tJ Signature °JflE. - t?rvi • 1991 BUILDING PERMIT APPLICATION ? - CITY OF EAGAN SIN6LE FAMILY DWELLINGS 2 SETS OF PLANS 3 REGZSTERED SITE SURVEYS 1 SET OF ENERGY CALCULATIONS MULTIPLE DWELLINGS COMMERCIAL 2 SETS OF PLANS 2 SETS OF ARCHITECTURAL REGISTERED SITE SURVEYS - & STRUCTDRAL PLANS (CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFICATIONS 1 SET OF ENERGY CALCULATIONS 1 SET OF ENERGY CALCS # OF RENTAL UNITS # OF FOR SALE UNITS PENALTY APPLIES WHEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP SY IAST WORKING DAY OF MONTH IN WHICH REQUEST IS MADE. LOT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED. NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED. PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DAYS ONCE A PERMIT HAS BEEN COMPLETED. PERMIT MUST SHOW A LICENSED PLUMBER. To Be Used For: Oa ?--? Valuation: 000 Date: 5 zx_-q ( Site Address c1(O C<C)\ OFFICE USE ONLY Lot _L?LL Block ? d rG - c10 c,.r ;t Je rncst Pi ?,?.?I- $? -d ?p Parcel/Sub -Wi j,fAdn,Y1.tAL ? p,?j?d- Owner Address 4l0 City/Zip Code MAJ ,s°sfa3 Phone yy(o - 05:5-3 Contractor . Address City/Zip Code Phone V-!- (477, Arch./Engr. Address City/Zip Code Phone # ( Signatue/ y?ractor Occupancy FEES Bldg. Permit = Zoning Surcharge Actual Const Plan Review Allowable SAC, City # of stories SAC, MWCC Length Water Conn. Depth Water Meter S.F. Total Acct. Deposit Fo.otprint S.F. S/w Permit S/W Surcharge On site sewage _ Treatment P1. On site well Road Unit MWCC System _ Park Ded. City water _ Trail Ded. PRV _ Copies Booster Pump _ SUBTOTAL APPROVALS Penalty Planner Lot Change Council TOTAL Bldg. Off. Variance * ABQt/e-C*JwNh agrees that all work shall be done in accordance with all app-lTc-able StaYe of Minnesota Statutes and City of Eagan Ordinances. Survey For• • • ?: `r?u Grimmer . 51-esiew Heights Rqad ' EaN -.55123 DELMAR H. S HWANZ LAND SURVEYORS INC. . .? _ RepNlerad Undar Lerw ol Tns ale ol Mlnrro?Mt 7475b SOUTH ROBERT TRA ROSEMOUN MINNESOTA 55068 ? I S RVEYOR'S CER IFICATE Sheet 1 of 2 sheets 124/21 ANP f"9 812/423-1769 ?I Scale: 1 inch =1100 feet z 600ND 1zov 3 SDUn! nlrCo,eNEA° FE7V?E 0oor 36? D Js 5? ?6 -T,?n? ,e23cv 1 r \ 1 0 z ? . 1 Sr 9 ? fouhlA 7RdN Revised 11-30-88 1 PooL i Nous C= Survey of the common lot line of Lot 19 and 20, LAKEWOOD HILLS, according to the recozc?ed.,plat thereof, Dakota County, Minnesota. s I hereby cerlify fhet thfa aurvey, plan, or report was . ,. ?;. prepered by me or under my direct aupervialon and ? Ihel 1 am a duly Registered Lend Surveyor under - - n the lawa ot the State of Minnesota. ?Field Work 12-17-87 Detmer H. Schwanz ? Dated Minneeota Registration No. 8825 Certificate Drawn 01-14-88 • ?., ? ,.. rl o r `f.!;) 9 CA?U-= ? y I?sh ? 63`s . r fic " K ? ?J?. \x', ? I t--__. 10 - tz; i l de rn?s p? MASTER CARD Il LOCATION !/r OWNER STRUCTURE AND ? x 3 ?? LAND USED AS Permit No. Issued Issued To Coniractor Owner BUILDING _???r.' Q i ?d /?' ? PWMBWG CESSPOOL - SEPTIC TANK ? le ph ?? ??•„ WELL 17 ELECTRICAL HEATING & GAS INSTALLING SANITARY SEWER I OTHER I OTHER I Items Approved (Initial) Date Remarks DisTance From Well FOOTI NG FOUNDATION -I- ?_L• 1 ? SEPTIC CESSPOOL FRAMING TILE FIELD FT. F NAL ELECTRICAL HEATING DEPTH OF WELL GAS INSTALLATION i SEP71C TANK CESSPOOL DRAINFIELD PLUMBING l WELL SANITARY SEWER Violations Noted on Back COMMENTS: I COMPLIANCE INSPECTION REPORTS TO BE USED ONIY IN EVENT OF OBSERVED VIOLATIONS PERMIT NO. DATE OF INSPECTION CONDITIONS OF CONSTRUCTION AT THIS INSPECTION ? NO EVIDENCE OF NON-COMPLIANCE OBSERVED. F-I NON-COMPLIANCE. BUILDER DOES NOT INTEND TO COMPLY. ? ACCEPTABLE SUBSTITUTIONS OR DEVIATIONS. ? NON-COMPLIANCE. BUILDER WILL COMPLY WI7HOUT DELAY. ITEMIZED AND DESCRIBED AS a COMPLETION OF CERTAIN IMPROVEMENTS WILL BE DELAYED BY CONDITIONS BEYOND CONTROL. ? REINSPECTION REQUIRED REINSPECTION REVEALED DATE OF REINSPECTION CERTt FICATION - i certify that I have carefully inspected the above in which I have no interest present or prospective, and that I have reported herein all significant conditions oLserved to be at variance with ordinances of the Town of Eagan, approved plans and specifications, and any specific require- ments for off-site improvements relating to the property inspected. ? ALL IMPROVEMENTS ACCEPTABLY COMPLETED BUILDING INSPECTOR DATE COMMENTS: 2. . ? IV' ? ? ? ? and. Add:.--e s s L ? -?n - Date WEI.I, RECORD VILLAGE OF E.2GAN / Xo, t?4g/ AgI 9' Lr . _.ing Cump?a_g Address Telepho^o Size of I7e11 ?f Inches ¢ Water Level _ We:il D2ptr Feet ? Draw Down Fee t at Caaing Depth. f!J ? Feet Capacity Gallons oc?) P°'"Aim• 3 ence No. Thickness Started Ehded I of e?2 Exterior Spa.ce Around Casing Sealed With: p Cement Grout Disinfeei;ant U Hours Left in C'tlOri ePuddled Cizy 0 Other IrKCTRN THIS RECORD AFT''r,R COMPLETION ?_ -- / , . % ? ?-- -- • f ?? r ? ?? ? ???? • , • ,.. Y ?'..-E ??p?* 3; <' f ?r2''? K?", tv? V-<' _ ?"'d' + + ?t WAIVER OF HEARING NO. SPECIAI, ASSESSMENT AtITHORIZATION We hereby request and authorize the City of Eagan, MN (Dakota County) to assess the following described property owned by us: (See Exhibit "AM attached hereto.) for the benefit received from the following improvements: Storm sewer trunk The quantity and uniformly applied rate to be determined at the time of assessment of the general area for storm sewer trunk improvements. The undersigned, for themselves, their heirs, executors, administrators, successors and assiqns, hereby consent to the levy of these assessments, and further, hereby waive notice of any and all hearings necessary, and waive objections to any technical defects in any proceedings related to these assessments, and further waive the right to object to or appeal from these assessments made pursuant to this agreement. Dated this _-.21 Sf day of May, 1993. SELLERS: Patti Graper R d STATE OF MINNESOTA) ) ss. COUNTY OF DAROTA ) On this day of May, 1993, before me a Notary Public within and for said County, personally appeared JEFFREY A. RUD and PATTI GRAPER RUD, husband and wife, to me personally known to be the person described in and who executed the foregoing instrument and acknowledged that they executed the same as their fre act and deed. ELAINE M. JAE8B66N MOTARY PVBLIC - MINN6$OSA HENNEPIN COUNTY My Cpmm. ExPlree Apr. 12. 1298 EXHZBIT nA° PARCEL I: That part of Lot Twenty (20), Lakewood Hills described as beginning at the Northwesterly corner of said Lot 20; thence south along the West line of said Lot 20 a distance of 148.6 feet; thence Northeasterly a distance of 237.5 feet more or less to a point on the Northerly line of said Lot 20, distant 32.9 feet Southeasterly, as measured along said Northerly line, from the Northwesterly corner thereof; thence Northwesterly along said Northerly line 32.9 feet to the point of beginning. Subject to reservation of all minerals and mineral rights by the State of Minnesota. PARCEL II: The South 617.2 feet of Lot Five (5) of Wilderness Retreat lying east of the west 360 feet thereof according to the plat thereof on file and of record in the office of the Reqistrar of Titles in and for said County and State, EXCEPT THAT PART DESCRIBED AS FOLLOWS: Commencing at the northwest corner of Lot 20, Lakewood Hills, according to the recorded plat thereof, Dakota County, Minnesota, said point being on the east line of said Lot Five (5), Wilderness Retreat, thence south along the east line of said Lot Five (5) a distance of 148.6 feet to the point of beqinning of land to be described; thence continuing South along said east line of Lot Five (5) a distance of 270.93 feet to the southeast corner of said Lot Five (5); thence West along the south line of said Lot Five (5) a distance of 54.00 feet; thence northeasterly to the poiat of beginning. Subject to reservation of all minerals and mineral rights by the State of Minnesota. _ ,. STATE OF MINNESOTA) ) ss. COUNTY OF DAKOTA ) On this ;,21Sr day of May, 1993, before me a Notary Public within and for said County, personally appeared MURIEL J. HALL and KEITH HALL, husband and wife, to me personally known to be the person described in and who executed the foregoing instrument and acknowledged that she executed the same as her free ac and deed. i C I ELAtNE M• JA80BBON Notary Public NoSARY PUBLIC - MINNBSOTn ? HENNEpIN COUNTY ? MY COmm. ExPitta 0.Pr. 12, 1090 -2- AGREEMENT TO PLAT AND CONVEY LOT THIS AGREEMENT made and entered into this ??/ s? day of May, 1993 by and between JEFFREY A. RUD and PATTI GRAFER RUD, husband and wife (5ellers of the parcel described in Exhibit MA^' attached hereto), and MURIEL J. HALL and KEITH HALL, wife and husband, Purchasers of said property. WHEREAS, Sellers desire to replat the property described in Exhibit ^Ay hereto, and retain ownership of the northerly lot as c3escribed in the survey attached hereto as Exhibit nBO; and WHEREAS, the Purchasers desire to purchase the southerly lot described in Exhibit yB", along with the dwelling thereon; and WHEREAS, the parties entered into a Purchase Agreement to sell the southerly lot to Purchasers for a price of $159,000.00, or alternatively, the entire parcel for $185,000, if it is not economically possible to divide or to plat the property into the two lots described in Exhibit n8" hereto. NOW, THEREFORE, the parties agree as follows: l. Sellers agree to convey to Purchasers the entire property described in Exhibit pAn hereto subject to the covenants and conditions herein. 2. Purchasers agree to enter into all documents necessary to plat the entire parcel into two lots as described in Exhibit HB" hereto, and to convey the northerly lot to Sellers if the property is platted, if the property is platted by September 1, 1993. 3. If the parties are unable to obtain a plat to the property as described in Exhibit nBn hereto for whatever reason, including imposition of substantial costs for said platting, the Purchasers shall pay to Sellers the sum of $26,000. 4. As security for the payment of the amount described in paragraph 3 above, Purchasers agree to execute a Second Mortgage against the entire parcel in the amount of $24,000. 5. Further, the Purchasers agree to execute with Sellers the Waiver of Hearing in regard to potential storm sewer trunk assessments which may be imposed by the City of Eagan, when the general area is assessed. W I T N E S S E T H: The parties hereto have set their hands on this a/ St day of May, 1993. SELLERS: Je-f$,f'ev-,Pl. ' ce'd Patti Grape Rud PURCHASERS: Mu el J. Hall i ` K all -2- • Y . EXHIBIT MA° PARCEL I: That part of Lot Twenty (20), Lakewood Hills described as beginning at the Northwesterly corner of said Lot 20; thence south along the West line of said Lot 20 a distance of 148.6 feet; thence Northeasterly a distance of 137.5 feet more or less to a point on the Northerly line of said Lot 20, distant 32.9 feet Southeasterly, as measured along said Northerly line, from the Northwesterly corner thereof; thence Northwesterly along said Northerly line 32.9 feet to the point of beginning. Subject to reservation of all minerals and mineral rights by the State of Minnesota. PARCEL II: The South 617.2 feet of Lot Five (5) of Wilderness Retreat lying east of the west 360 feet thereof according to the plat thereof on file and of record in the office of the Reqistrar of Titles in and for said County and State, EXCEPT THAT PART DESCRIBED AS FOLLOWS: , Commencing at the northwest corner of Lot 20, Lakewood Hills, according to the recorded plat thereof, Dakota County, Minnesota, said point being on the east line of said Lot Five (5), Wilderness Retreat, thence south along the east line of said Lot Five (5) a distance of 148.6 feet to the point of beginning of land to be described; thence continuing South along said east line of Lot Five (5) a distance of 270.93 feet to the southeast corner of said Lot Five (5); thence West along the south line of said Lot Five (5) a distance of 54.00 feet; thence northeasterly to the point of beginning. Subject to reservation of all minerals and mineral rights by the State of Minnesota. PERMIT City of Eagan Permit Type: Building Eaaan. Permit Number: EA097646 Date Issued: 01/05/2011 OR Permit Category: ePermit 41 it~ of E3 E Site Address: 910 Lakewood Hills Rd Lot: 2 Block: I Addition: Lakewood Hills 2nd PID:10-44351-020-01 Use: Description: Sub Type: e-Reroof Construction Type: Work Type: New Description: House & Garage Census Code: 434- Occupancy : Zonin,: Square Feet: 0 Comments: If there is no ice protection inspection prior to final, the contractor must meet the inspector a ladder and flat bar. Pictures are not acceptable in lieu of inspections. Carbon monoxide detectors are required by law in ALL single family homes. Fee Summary: BL - Base Fee S3K $88.50 0801.4085 Valuation: 3.000.00 Surcharge - Based on Valuation S3K $1.50 9001.2195 Total: $90.00 Contractor: - Applicant - Owner: Sela Roofing Remodeling Donald J Oelirlein 4100 Excelsior Blvd 910 Lakewood Hills Rd St. Louis Park NIN 55416 Eagan MN 55123 (612) 823-8046 I hereby aeknowledae 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 Cite of Eaaan Ordinances. ApplicantiPermitee: Signature Issued Bv: Signature j i Use BLUE or BLACK Ink For Office Use j Permit City of Eajan PermitFee: 3 3830 Pilot Knots Road Eagan MN 55122 1 Date Received: i Phone: (651) 675-5675 j Staff: I Fax: (651) 675.5694 I I ~ ----------r- 2013 RESIDENTIAL BUILDING PERMIT APPLICATION ~6~ Date; Site Address: unit -T 143 -~~--t-1=/~ fJ. L V y 1 1~4'V~..~ Phone: 01Z_q~ l Name: } Residentl Owner I Address / City 1 Zip: VD Applicant is: Owner Contractor _ d v XIP r& 3 6J iA ✓"71V Type of Work Description of work: Construction Cost: CPU(/ Multi-Family Building: (Yes /No Company; Contact: Contractor Address: City: State: Zip: Phone: Y License Lead Certificate If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) L/ c c o &'/G Z /,i 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 J the information may be classified as non-public if you provide specific reasons that would permit the City to I conclude that they are trade secrets. CALL BEFORE YOU DIG. Call Gopher State One Call at (661) 454-0002 for protection against un&i ground utility damage. Call 48 hours before you intend to dig to receive locates of underground uni Pies. www nopherstateonecall.om 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 issuance- I ~JDA x 11111)44-~Q x plicant's Printed Name leant' Signature Page 1 of 3 DO NOT WRITE BELOW THIS LINE SUB TYPES 10 L lr-c W~%6,J Foundation _ Fireplace _ Porch (3-Season) _ Storm Damage Single Family _ Garage _ Porch (4-Season) _ Exterior Alteration (Single Family) Multi _ Deck _ Porch (Screen/Gazebo/Pergola) _ Exterior Alteration (Multi) 01 of _ Plex Lower Level _ Pool _ Miscellaneous Accessory Building WORK TYPES New _ Interior Improvement _ Siding _ Demolish Building* Addition _ Move Building _ Reroof Demolish Interior Alteration Fire Repair _ Windows _ Demolish Foundation Replace _ Repair Egress Window _ Water Damage Retaining Wall *Demolition of entire building - give PCA handout to applicant DESCRIPTION Valuation Occupancy C, MCES System Plan Review Code Edition 1007 SAC Units (25%_ 100% Zoning City Water - - Census Code j Stories Booster Pump # of Units / Square Feet PRV # of Buildings / Length 3®' Fire Sprinklers NO Type of Construction Width REQUIRED INSPECTIONS Footings (New Building) Meter Size: Footings (Deck) Final / C.O. Required Footings (Addition) Final / No C.O. Required Foundation HVAC Gas Service Test - Gas Line Air Test Drain Tile Other: Roof: Ice & Water,Final Pool: -Footings -Air/Gas Tests -Final jj, Framing Siding: -Stucco Lath -Stone Lath -Brick Fireplace: Rough In 4Air Test Final Windows Insulation Retaining Wall: „ Footings *BackfillFinal Sheathing Radon Control Sheetrock E Erosion Control Reviewed By: , Building Inspector RESIDENTIAL FEES n moo4l. Base Fee ~9 OklJZ2 L. v G► ~G NCI lTi ~"0 3 Surcharge Plan Review /L ~l / 7AP MCES SAC /✓+d19t.~'J~%rjp,✓ City SAC r1/iJ ~IQG'C g99 f6~ 7? 3~ Utility Connection Charge L. L UyriN fGd iY1 S&W Permit & Surcharge _ ~w qq Treatment Plant 03 G._.. Copies a A +YA- 0 Y ~oZ 9134, TOTAL -5 1 0U Page 2 of 3 Date: 7114/2012 Revision Date: 7/14/2012 New Construction Site Information Address 1: 910 lakewood hills rd Project Address 2: Lot: Block: City: eagan County: dakota Subdivision: Application Information Business Name: south mech. MN Contractor License #:55186415 Contact Person: Ron Office Ph: 9524922440 Fax: 9524922446 Cell Ph. 6122215995 Address 1: City: State: Zip Code: House Details Square Feet: 4560 sq. ft. Avg. Ceiling Ht: 8 ft. Number of Bedrooms-0 Ventila on : Balanced Total Ventilation Capacity : 160 cfm. Minimum Continuous Ventilation :75cfm. Intermittent Ventilation: 85 cfm. Combustion Appliance Combustion Zone 1 Water Heater: Power Vent Input BTUs: 75,000 Independently Vented Furnace/Boiler 1: Direct Vent/Sealed Combustion Input BTUs: 80,000 Independently Vented Combustion Zone 1 Furnace/Boiler 2: Direct Vent/Sealed Combustion Input BTUs: 80,000 Independently Vented Combustion Zone 1 Other Combustion A .~liances Gas Fired Direct Vent Fireplace(s): No Gas Fired Power Vent Fireplace(s): Yes Gas Fired Natural Draft Fireplace(s): No Solid Fuel Appliance(s): No Exhaust Eg_uipment Continuous Exhaust Ventilation Capacity (cfm): NA Clothes Dryer (cfm): 135 Exhaust Fan Rating (cfm): 300 ? Make-Ua Air ~v No Make-Up Air Required by Code Combustion Air Combustion Zone One Round Rigid Required: 6 inches or insul ed Flex: 7 inches Combustion Zone Two. Minimum Combustion Air Requirements Met_ Applicant Name (print): Signature/Date: Code Official (print): Signature/Date: New Construction Energy Code Compliance Certificate Per N1101.8 Building Certificate. A building certificate shall be posted in a permanently visible location inside the building. The Date Certificate Posted certificate shall be completed by the builder and shall list information and values of components listed in Table N1101.8. Maiimg Address of the Dwelling or Dwelling Unit VIZ) City Yin Yc LLS IZ) ra6A ~:AGAA3 Name of Residential Contractor MN License Number - 1 N F (bpj THERMAL ENVELOPE RADON SYSTEM Type: Check All That Apply Passive (No Fan) w fl w Active (With fan and rnonometer or F ? other system monitoring device ) a - Qo .E W Pa N ❑ a T o v v o iw x c Insulation Location ° z o w a tt v ti y ~ nn call r! i Other Please Describe Here Below Entire Slab Foundation Wall - /Q Type in locafio inteno exterior or integral Perimeter of Slab on Grade Rim Joist (Foundation) -/U U~ b IYej!/ Type in location: interior exterior or integral Rim Joist (lu Floor+) i2 -(d -A- Type in location: interior exterior or integral Wall Ceiling, fiat Q 13t ,,ft,- IL Awt L4~1 1,X-H-- I Ceiling, vaulted Q Bay Windows or cantilevered areas 50 Bonus room over garage Describe other insulated areas Windows & Doors He tin or Cooling Ducts Outside Conditioned Spaces Average U-Factor (excludes skylights and one door ) U: a Not applicable, all ducts located in conditioned space Solar Heat Gain Coefficient (SHGC): X <6 R-value MECHANICAL SYSTEMS Make-up Air Select a Type Appliances Heating System Domestic Water Heater Cooling System Not required per mech. code Fuel T c Passive Manufacturer Powered Interlocked with exhaust device. Model Describe: Input in Capacity in Output in Other, describe: Rating or Size BTUS: Gallons: 't'ons: Heat boss: (feat Gain: Location of duct or system: Structure's Calculated AFUE or SEER: HSPF% Calculated EfSciene cooling load: Cfm's " round duct OR Mechanical Ventilation System "metal duct Describe any additional or combined heating or cooling systems if installed: (e.g. two furnaces or air Combustion Air Select a Type source heat pump with gas back-up furnace): Not required per mech. code Select Type Passive Heat Recover Ventilator (HRV) Capacity in cfms: Low: IHigh: Other, describe: Energy Recover Ventilator (ERV) Capacity in cfms: Low: Hi : Location of duct or system: Continuous exhausting fan(s) rated capacity in cfms: Location of fan(s), describe: Cfm's Capacity continuous ventilation rate in cfrns: " round duct OR Total ventilation intermittent + continuous) rate in cfms: " metal duct Created by BAM version 052009 1FGC Appendix B, Worksheet V-1 rReskiwitial t 1 •n Air • 1 f • 1: andlor wow +imter 'n the Same Spam) stop is Umpiete- Witted s trF.:st,o awtai inton at on. Fuic=~?~dll~r: Drain iood Fan Assist Direct Vent jnpLt (Not j.,i assisted) p(mer Vera ~ Sttttttr 1 Draft Hood Fan Assisted ~ Dlrect Vent Input (Not Jaa amstedl Power Van" Step 2; alculate 1;1e.voturne of ttte C:=MWn Ap S (CAS conWning-combLm ion apoian 7 s UA;, ttad~ aii spas atttr,~ to rote Witter Y ~e rttt~tant ' ,has. GAS vittut_f~3 . Step 3: Deterrtlne A4 Changes per Rout ( H) ' DeTaultACH valt s have been incorporated t into Tablte c. use with ~.,e,rtad 4b (KAIR Vc.tpN c, it i;n~ rear of constr icUon ccACH is not known, use et ~ 4a ( tandar I.Fi~ttita Stop 4' De rive R uirgY Vo:un+e for Co busti A,:. 4a. S-Mdard Method g' Total 8t0,t it mA of ati :,ornbust a g s (D NOr; " ~3NTI)IRECTVENTAPPLIANCES' Input' Use Standard Meth ' cohirnn in TaWle, E-t to fi Tc al Rc: :c Vo',Wne JRV; TRV:.2d_W tt It G, .Vblume'4mm Step 2j is greater than TRV then no ai-xiodrormings -are needed. If CAS Volume (from Step 2) is less thaol) titengo to STEP S. 4b. Own Air Infiltra€ion Rate MAIR) Meth Total Bt:tlir input of ak fari-assisted rt g=r v n ap €an-ces (D; ` NOT COUNT D!RECT VEfN APP1L1ANCES) i total: Btuftir Use Fai ~-heist 14ppPtan es column in Tabie E-t to tart Reouire ,Volume Fan Ass stt d (RVr ; RVFA:_ fig 1 Tt :ai 5u`,tn.* tnp.;s cf ate mr4s ass:stett appkancess Input: Or tven t a,i ussiste A{~pli., es caiumrt da 7a~ E-1 toftti j F e~,t:red Voi tmt: r 1 i a;:.As is:e~ tRttrfW F;vNF- : 1S Tc°,:' Requir-ed'Velume r rRV, = iW.- t * RVNFA. RV= V5 If CAS Volume (t r'St 2) is greater fttan TRV then no outdaor c-- : r~s . needed. It CAS `Volume (from Step'?') Is- is s than TRV t:.': t, etc to SMP S, Step 5: ca:Uate'the rat'ltt of available inteTic, v- . Cte WW a u c vo: sr,e. 5'3q /aR/D Pal: = CAS Volta (f ora Step 2) divided by T'RV ifrom -Step 4a : r Stel', 4b' Raft = OX'A = ay } ~ Stop 8:. calculate Redrcti-on Factor (RF) FF = I minus Patarn RF f w ~ • 7 S;ep Ca daze ogle" .doo= Opening- as if aul Conti ustion air is`#rom ou! S de. To;~t3tuiiirlrtput~at'Ctxntxtst~ttsJ~ppliartce€irt~sarneCAS.(t<}ttrFFT'?lR~.,. ;w~~T; tttpt:t;~`"di:t;i?' 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J 0 m / % Y1 m - ~ ~ / ~ ####gym!!!!!!#~!s##!a!!e!■!#t#~,~;,. - / I 0 / / C 0~ ~ ~ i ~ , ~ ,l u m Z / ~ a~ ~ ~ ~ ~ m I ~ _ / / o x * J ~ - ~ l ~ E ~°m ~ 1 / c r~ mod ~ / ~ L ~ O \ _ ` ~ ,i / / i"w ry Q ~ 0 ~ ~ / ~ N I ~ w .,u, ! i ~s`! ~ ~ / i 1 ~-~ai'a~ ! / r`' / a~~ n ~ , 5ti#mEi}#!!f#H##msns / 1 / j ~ / ###d8 t .8~.,4~#_ #~E893i§rt4i3E#gms8#8E####i!#fifffic9##!!a!#~A„n. ~ / i~ ~ i W > i / j O ~ ~ - - / ~ / J 7'-y„ Y gf!Sp t ~ - - - r / ~ ~ f r ~ j / y~41 i .C 4; N - - - - - \ O / iuaugm3 ~Nt9lI W a6nu!wC! ~ f i ~ ~ ` ]O y .rte" ~ r _•____.._._._~w~_._..._.-.___._-.._,.._.____...e. / ~ t~ ~ ~ N U i r ~ ~ / ~ / / t _ ~ ~ n V~ / a ~ N i v J / ~ h ~ ~ i I cat ~ 7 U ~ ~ ~ / ~ i ~ ~ i ~ ~ ~ .y ~ a ~ 0 0 ~ ~ i ~ ! mcn 4 ai ~~'Z o: i ~ ~ i t ~ ~ o -o t O I 7 O { r_ > o a , Q ~ ~ c ~~r, o rn ~ i c s NN I ~~Z~~ oo~~ 3N _ a'dib City of Etan 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BLUE or BLACK Ink For Office Use // __ Permit #: , 0/(00 0 rW Permit Fee: Q U°) Date Received: Staff: 3 J 2014`/ - l RESIDENTIAL PLUMBING PERMIT APPLICATION Date: ' L c2 '+ 0/1/ `1 Site Address: / 0 � Kkt wacL 4 / (s ask ?q4- cf ( Tenant: Resident/Owner / Address / City / Zip: 9/0 L t'e w �� '� '//s Name: 2--1.4 '.I Fl( /°6-k t C License #: Address: SO % Pei( Hol 4e x2 City: )J)Q w Pi -a q1,. State: V' r Zip: 67 ( Phone: (p / (9c>2 / - 7S/ Name:3bSt‘ t•---2 c - Suite #: Phone: Contact: c Le,e \t e T Zer Email: •G1--- p12ef C -1D/ _ New _ Replacement�// Repairs, s. _ Rebuild j\ Modify Space _ Work in R.O.W. Description of work: e C�%v ��'t K i3tG 40/l 2 get `t11 S RESIDENTIAL Water Heater Lawn Irrigation ( RPZ / _ PVB) Septic System New Abandonment Water Softener V Add Plumbing Fixtures ( Main / Lower Level) Water Turnaround RESIDENTIAL FEES: $60.00 Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge) $60.00 Lawn Irrigation (includes $5.00 minimum State Surcharge) $60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround (includes $5.00 State Surcharge) *Water Turnaround (add $200.00 if a 5/8" meter is required) $115.00 Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge) TOTAL FEES $ CALL BEFORE YOU DIG. Call Gopher State One CaII 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.gooherstateonecall.org 1 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 wor is not to start without a p-rmit; that the work will be in accordance with the approved plan in the case of work which requires a review and approva •• plans. �/ 1 x w 4ef 7 e. T x WPM" Applicant's Printed Name Applic. is Sig FOR OFFICE USE Reviewed By: Date: Required Inspections: Under Ground Rough -In Air Test Gas Test Meter Related Items: Meter Size Radio Read Staff: Final PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA120209 Date Issued:01/24/2014 Permit Category:ePermit Site Address: 910 Lakewood Hills Rd Lot:2 Block: 1 Addition: Lakewood Hills 2nd PID:10-44351-01-020 Use: Description: Sub Type:Residential Work Type:Replace Description:Furnace Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952) 445-2840. Michael Carlson 3508 Snelling Avenue Fee Summary:ME - Permit Fee (Replacements)$55.00 0801.4088 Surcharge-Fixed $5.00 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 - Melinda Rutzick 910 Lakewood Hills Rd Eagan MN 55123 (612) 729-5646 Team Mechanical 3508 Snelling Ave S Minneapolis MN 55406 (612) 729-5646 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA123615 Date Issued:06/12/2014 Permit Category:ePermit Site Address: 910 Lakewood Hills Rd Lot:2 Block: 1 Addition: Lakewood Hills 2nd PID:10-44351-01-020 Use: Description: Sub Type:Residential Work Type:New Description:Garage Heater Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952) 445-2840. Michael Carlson 3508 Snelling Avenue Fee Summary:ME - Permit Fee (Replacements)$55.00 0801.4088 Surcharge-Fixed $5.00 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 - Melinda Rutzick 910 Lakewood Hills Rd Eagan MN 55123 (612) 729-5646 Team Mechanical 3508 Snelling Ave S Minneapolis MN 55406 (612) 729-5646 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA123616 Date Issued:06/12/2014 Permit Category:ePermit Site Address: 910 Lakewood Hills Rd Lot:2 Block: 1 Addition: Lakewood Hills 2nd PID:10-44351-01-020 Use: Description: Sub Type:Residential Work Type:Alteration Description:Stove Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952) 445-2840. Michael Carlson 3508 Snelling Avenue Fee Summary:ME - Permit Fee (Replacements)$55.00 0801.4088 Surcharge-Fixed $5.00 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 - Melinda Rutzick 910 Lakewood Hills Rd Eagan MN 55123 (612) 729-5646 Team Mechanical 3508 Snelling Ave S Minneapolis MN 55406 (612) 729-5646 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA123617 Date Issued:06/12/2014 Permit Category:ePermit Site Address: 910 Lakewood Hills Rd Lot:2 Block: 1 Addition: Lakewood Hills 2nd PID:10-44351-01-020 Use: Description: Sub Type:Residential Work Type:Alteration Description:Dryer Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952) 445-2840. Michael Carlson 3508 Snelling Avenue Fee Summary:ME - Permit Fee (Replacements)$55.00 0801.4088 Surcharge-Fixed $5.00 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 - Melinda Rutzick 910 Lakewood Hills Rd Eagan MN 55123 (612) 729-5646 Team Mechanical 3508 Snelling Ave S Minneapolis MN 55406 (612) 729-5646 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA123618 Date Issued:06/12/2014 Permit Category:ePermit Site Address: 910 Lakewood Hills Rd Lot:2 Block: 1 Addition: Lakewood Hills 2nd PID:10-44351-01-020 Use: Description: Sub Type:Residential Work Type:Alteration Description:Dryer Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952) 445-2840. Michael Carlson 3508 Snelling Avenue Fee Summary:ME - Permit Fee (Replacements)$55.00 0801.4088 Surcharge-Fixed $5.00 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 - Melinda Rutzick 910 Lakewood Hills Rd Eagan MN 55123 (612) 729-5646 Team Mechanical 3508 Snelling Ave S Minneapolis MN 55406 (612) 729-5646 Applicant/Permitee: Signature Issued By: Signature