906 Lakewood Hills Rd SPERMIT
City of Eagan Permit Type:Building
Permit Number:EA128864
Date Issued:12/11/2014
Permit Category:ePermit
Site Address: 906 Lakewood Hills Rd S
Lot:20 Block: 0 Addition: Lakewood Hills
PID:10-44350-00-200
Use:
Description:
Sub Type:Fireplace
Work Type:Gas Insert
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home may require smoke detectors in all bedrooms. Chimney / flue must be inspected prior to
concealing.
Carbon monoxide detectors are required by law in ALL single family homes .
Valuation: 3,000.00
Fee Summary:BL - Base Fee $3K $88.50 0801.4085
Surcharge - Based on Valuation $3K $1.50 9001.2195
$90.00 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 -
Keith H Olsen
906 Lakewood Hills Rd S
Eagan MN 55123--191
Glowing Hearth and Home LLC
100 Eldorado Dr.
Jordan MN 55352
(952) 492-9276
Applicant/Permitee: Signature Issued By: Signature
? PERMIT #
PLUMBING PERMIT RECEIPT q d d
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: ?' '?? •P
CONTRACT PRICE_ q?? / '/?('
,,.,„j u,q/pBHONE: 454-8100
itite Address I?kf f. G
Lot r? BIOCk ?ec/Sub
I
? Name CIIP - (tp
, ?a Address
c Ciry =?>;E Phone ` - ?
Name
3 Address
p Ciry Phone
FEES
COMM/IND FEE - 1% OF CONTRACT FEE
APT. BLDGS - COMM RATE APPLIES
TOWNHOUSE 8 CONDO - RES. RATE APPLIES
MINIMUM - RESIOENTIAL 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)
, .1
4"
X
y1%
'
-
?
_
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!
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SIGNATURE.Qf PERMITTEE
CITY OF EAGAN
BLDG. TYPE WORK DESCRIPTION
Res. New
Mult. Add-on
Comm. Repair
Other
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
NO. FIXTURES TOTAL
-Water Closet - $3.00 $
_Bath Tubs - $3.00
-Lavatory - $3.00
-Shower - $3.00
_Kitchen Sink - $3.00
-Urinal/Bidet - $3.00
_Laundry Tray - $3.00
_Floor Drains - $1.50
-Water Heater - $1.50
_Whirlpool - $3.00
-Gas Piping Outlets - $1.50
(MINIMUM - 1 PER PERMIT)
Softener - $5.00
=Well - $10.00
_Private Disp. - $10.00
_Rough Openings - $1.50
?, -
FEE:
STATE S/C:
? ;
GRAND TOTAL• '/?
PERMIT #
• PLUMBING PERMIT RECEIPT It
' • . CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE
>NTRAGT PRICE
i 0HONE:454-8100
Site Address - ?? ?•
Lot ??A
Block Sec/Sub
? Name ,v-!.?
7ii Address
y
c City Phone
Name
3 Address
O City Phone
FEES
COMM/IND FEE - 196 OF CONTRACT FEE
APT. BLDGS - COMM RATE 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
aEVOrvo $1,000.00)
SIGNATUREO PERMITTEE
BLDG. TYPE WORK DESCRIPTION ?
Res. New
Mult. Add-on ?
Comm. Repair
Other ;
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
NO. FIXTURES TOTAI ?
-Water Closet - $3.00 $
(
_Bath Tubs - $3.00 j
r.
_Lavatory - $3.00
Shower - $3.00
Ki!chen Sink - $3.00
-Urinal/Bidet - 33.00
_Laundry Tray - S3.00
_Floor Drains - $1,50
-Water Heater - $1.50
_Whirlpool - $3.00
_Gas Piping Outlets - $1.50
(MINIMUM - 1 PER PERMIT)
SoRener - $5.00
-7-Well - $10.00
_Private Disp. - $10.00
_Rough Openings - $1.50
FEE: "
STATE S/C: ?
FOR: CITY OF EAGAN GRAND TOTAL: y
,
_? - -- _ _ __ ? ? -.____--------- -- - ----- - _'
PERMIT# ' -=-
• PLUMBING PERMIT RECEIPT #
' • CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE:
'RAGT PRICE: PHONE: 454•8100
J'
SiteAd?re?s `
Lot ock ?GlSub
'.
?
m Name
(D AddreSs
c City? ,fi •t c4-' Phone ,c.
Name ?ok r.{c?•'-
3 Address
O City Phone
FEES
COMM/IND FEE - 1% OF CONTRACT FEE
APT. BLDGS - COMM RATE APPLIES
TOWNHOUSE & 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)
? a
?
_F . .. i i?i ...r! e ???) ?:.:'?
SIGNATURE OF PERMITTEE ?
CITY OF EAGAN
BLDG. TYPF
Res. ?- WORK DESC,RIPTION
New X
Mult. Add-on
Comm. Repair
Other
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
FIXTURES
?Water Closet - $3.00 TQTI,L
$
? Balh Tubs - $3.00
Lavatory - $3.00 ?-
?Shower-$3.00
Ki?chen Sink - $3.00 ?
UrinaliBidet - $3.00
-rLaundry Tray - $3.00
=Floor Drains - $1.50 ??-
11 Water Heater - $1 50
Whirlpool - $100
=
Gas Piping Outlets - $1.50
(MINIMUM - 1 PER PERMIT)
_Softener - $5.00
-Well - $10.00
-Private Disp. - $10.00 ?-
.Rough Openings - $1.50
FEE: ?-?STATE S/C: - ??
GRAND TOTAL• '1=i , -rr,
?' • • .
kdaress
?
?, Name _
? Address
c City _
? Name
? Addre
O Ciry _
PLUMBING PERMIT
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAI
Phone
FEES
COMM/IND FEE - 146 OF CONTRACT FEE
APT. BLDGS - COMM RATE APPLIES
TOWNHOUSE & 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
OF EAGAN
BLDG. TYPE WORK DE $.CRIPTION
Res. New ???
Mult. Add-on
Comm. Repair
h
Ot
er
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
NO. FIXTURES TOTAL
-Water Closet - $3.00
S
-Bath Tubs - $3.00
-Lavatory - $3.00
-Shower - $3.00
-Kitchen Sink - $3.00
-Urinal/Bidet - $3.00
-Laundry Tray - $3.00
_Floor Drains - $1.50
-Water Heater - $1.50
_Whirlpooi - $3.00
-Gas Piping Outlets - $1.50
(MINIMUM - 1 PER PERMIn
-SoRener - $5.40
Well - $10.00
?
Private Disp. - $10.00
_Rough Openings - $1.50
FEE:
STATE S/C:
? ??..?.
GRAND TOTAL: Z 2 • t"V
MECHANICAL PERMIT X ?
RECEIPT #
. CITY OF EAGAN
3830 PILO T KNOB ROAD, EAGAN, MN 55122 DATE:
CONTRACT PRICE: PH NE: 454-8100
Site Address
LotBlock
?
? $ec/Sub BLDG. TYPE WORK D rIPTION
Res. x New
?.
Mult. Add-on
°-' Name Comm. Repair
?n
c Address
c/ in?- Ph
City'
Other
? one
J
FEES '
? Name RES. HVAC 0-100 M BTU -$24.00 ?
Address ADDITIONAL 50 M BTU - 6.00 ,
3
p City ' Phone (RES. HVAC INCLUDES A/C ON NEW ?
CONSTRUCTION)
GAS OUT
ETS
MINIMUM
1 PER PE
MIT
(
L
-
R
) - 1.50 EA.
TYPE OF WORK COMM/IND FEE - 1% OF CONTRACT FEE I
Forced Air M BTU d APT. BLDGS. - COMM. RATE APPLIES .
Boiler
M 8TU TOWNHOUSE & CONDOS - RES. RATE APPLIES
MINIMUM RESIDENTIAL FEE-ALLADD-QN& ?
i
UnitHeater '' - MBTU $ - REMODELS _ 12.00 .,
Air Cond. M BTU MINIMUM COMMERCIAL FEE - 20.00
Vent.
CFM $ STATE SURCHARGE PER PERMIT - 50
Gas Piping Outlets #
?
U (ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND. $1,000) !
?
Other
FEE:
-G1i Z-P '
S/C: IGNATURE OF PERMITT E !
!
TOTAL:
FOR: CITY OF EAGAN
. ..
. CITY OF EAGAN
3830 Pllot Knob Road, P.O. Box 21 •198, Eagan, MN 55121
? PHON E: 454-8100
BUILDING?PERMIT Receipt ik
To be used for ' Est. Value Date ,19 Site Address
Lot Block ' Sec/Sub.
Parcel No.
a Name
z Address
° City Phone
0
.` Address
I
P City Phone
Address
City _
I heraby 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.
SignaWre of Permittee _
A Building Permit is issued to: ' - on the express condition that all workshall be done in accordance with all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
OFFIC E USE ONLY
OnSiteSewage _ Occupancy - "?
MWCC urystem Zoning
On Site Well (Actual) Conat
City Water _ (Allowable)
PRV Required of Stories
Booster Pump Length
Depth
S.F. Total I
Footprint S.F. ,
APPROVALS FEES
Engr./Assess. Permit
Planner Surcharge
Council Plan Review
Bldg. Ofi. SAC, City
Variance SAC, MWCC
Water Conn.
Water Meter
Road Unit
7reatment P1
Parks
TOTAL
f)!? .,itt1 ?
i
I
? I
.' Permit No. Permit Holder Date Telephona #
Plumbing
• ?1 ??.5 ?'?/? ?Y[iatcl?,. `??.5??1 b'
,?(y J Y (c- ??7?? Gcl4k?L
Electric
Softener
Inspectlon Dats Insp. COmments
Footings I
Footings II
Foundation
Framing ? ?6l
Roofing
Rough Plbg. _
Rough Htg. ? e
Isul. r
Fireplace
-z5?',?'?iO
Final Htg. 1.,d
Final Plbg.
Bldg. Final
Cert Occ. ?zg
Temp. LP ?
Deck Ftg.
Deck Final
Well
Pr. Disp. _2
d7-? .
CITY OF EAGAN N2 15 2 2 5
3830 Pilot Knob Road, P.O. Box 21•199, Eagan, MN 55121
' PHONE:454-8100 ?2??C?
BUILD,ING PERMIT Receipt ??
#
Tobeusedfor SF DWG/GAR Est.Value $113,000 Date NNE 21 19 88
SiteAddress 906 LAKEWOOD HILLS RD (S) I OFFICEUSEONLY
Lot 20 Block 00 Sec/Sub. LAKEWOOD HILLS On Site Sewage X Occupancy
Parcel No,
MWCC System _
On Site Well X
Zoning
(ACtual) Const
(Allowable)
# of Stories
Length
Depth
S.F. Total
Footprint S.F.
R-3/M-1
R-1
V-N
V-N
50'
50'
x Name BROFIN BUILDERS City water
= Address 10000 JUSTEN PRV Required
3
0 City MAHTOMEDI Phone 426-4370 Booster Pump
-
tiQlName SAME I
o? Address
? City Phone
U?
W W Name _
?W
_z
a Address
U
aW Clty-
I hereby acknowledge that I have read this application and state that the
information is Correct and agree to co ly with al pplicable State of
Minnesota Statutes and =oga ilres
Signature of Permittee _ x
A Building Permit is issued to:_ BROWN BUILDERS
on the express condition that all workshall be done in accordancewith all
applicable State off ?Mi_n?n?e_sota Statutes and City of Eagan Ordinances.
Building Olficial '?1KV?L_I_m,t'
APPROVALS FEES
616
00
En9r./Assess. Permit .
Planner Surcharge 56.50
Council Plan Review 308.00
81dg. Off. SAC, City ___
Variance SAC, MWCC -
Water Conn.
Water Meter
Road Unit _32 ?500
Treatment Pt _
Parks
TOTAL 1,305.50
This re0uest void C/??`
18 mpnthS from ??7
C 8640172i-s?v .
b?(n `7SL5
Hequest Date ' Fre No. RouBh-in InspeCtion
Required7 ' eady Now Q Will Notity, Inspec-
? r ? Il'"1?/_S ONo tor When Ready
4k'°
icensed Electncal Contractor I hereby requestinspection of above
? Owner electrical work instalied et:
Street Address, Box or Route No. `/
4'(? ? ? ?.?tvD p p /?rGc- 5 e Cit?
ecuon o.
I
I Township Name or No._
anee o.
County
'
C'
0
G
rj
4?
.
OccUpant (PRINT) Phone No.
Power Supplier
? Address
?-•r
Ele cal Contractor ICompan?y Namel
14
?V??/????? f---' VF-(..?? CQontral,ct?o!rs liconse No.
!!TV TV T Y
Mailin9 Addre 5 (Contractor or Owner MakinB Instailation)/?
uthor' ed Signeture (Co actor/Owner a
ng Installationl Phone Number
)
r 7/'r3d ?-,7
MINNESOTA STqTE BOAND OF ELECTi11CITYTHIS INSPECTION HEQUEST WILL NOT
Grigga-Midwey Bldg. - Noom N-191 BE ACCEPTED BY TNE STATE BOARD
1821 UniversitvAve.. 8t. Paul, MN 65104 UNLESS PNOPER INSPECTION fEE IS
Phone(612)642-OS00 ENCLOSED.
?J(S /pf REQUEST FOR ELECTRICAL INSPECTION .
Q
I0, See inatructions for eompietirg this form on beck oi Yeltow copy. %Wcyr,P
-
'~• "X" Below Work Covered by Ihis Request
(' "y??A (5 0
NOWN AAd ReO. Tvpe of BuilOinB ADDliances Wired EquiVment Wired
Home Range Temporary Service
Duplex Water Heater Lightin,y Fixtures
Apt. Building Dryer Etectric Heatm
Commercial Bldg. Fumace Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tank
Farm ther oeci v ther (5pecify)
t Rr Sueci y t er Other
Compute fnspection Fee Below
N Fee Service Entrence5ize d Fee Faeders/Subfeeders # Fee Circuita
` 0 to200Am s 0 to30Am s C? Oto 30Am
Above 200 qmp5 31 to 100 Ainps ? 31 to 100 Amps
Swimmin Pool Above 100_Amps Above 100_Am '
Transformers Irri ation Boorc?s . SU Partial-'Other Fee
Signs Special inspection SQ TOTA FE
emarks - 1
?
RouBh-in Date !.? the Electrical
Inspectoq hereby
ce tily thet the a6ove
Final ??j ? ( ??1e
44' spection hes been
J/.1 ? _ _ /1?' t//^j' made.
TMS request voltl 18 monlhs irom
I , " . a
1988 BOILDING PERMIT APPLICATION - CITY OF EAGAN
..
SINGLE FAMILY DWELLINGS
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS
IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
MULTIPLE DWELLINGS RENTAL [JNITS FOR SALE UNITS # OF UNITS
INCLUDE 2 SETS OF PLANS, CERTIFICbTE OE SURVEY - CHECK WITH BLDG. DEPT.v
1 SET OF ENERGY CALCIILATIONS
COMMERCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS;
1 5ET OF SPECIFICATIONS. AND 1 SET OF ENERGY CALCULATIONS
To Be Used For: * c ¢Rm=/? Valua
LjC.'(. 4-..cLw:cu P-I10I-1?:rr1D 6
Site Address -'.a 4-r,
Lot 20 Block G r' L4, kE Woa( 9 "?/s
.A> >17/a
Parcel/Sub
, er
OpAddire
&+ t)'1 i?1 r
City/Zip Code ggAIJ S,i"l a 3
Phone
Contractor
Address /O.UpD
City/Zip Code //l.a &lrtFd %
Phone ?66- 4;/3 ')b
Areh./Engr. r----
Address
City/Zip Code `-
. 1/3 000' Date:
6 - /? b'8
On site sewage -z Oecupaney R-3 M-I
MWCC system Zoning R-I
On site well :2- Actual Const V- N
City water _ Allowable
PRV required _ # of stories i
Booster Pump _ Length d j
Depth 50'
S.F. Total
Footprint S.F.
FEES
Engr/Assess
Planner
Couneil
Bldg. Off.
Varianee
Permit (0I6, o0
Surcharge 561so
Plan Review cR oa
SAC, City /po, vo
SAC, MWCC 0S0, po
Water Conn s?0, oo
Water Meter
u
(-,r7,0
Road Unit 3 ZS.i 00
Treatment Pl 1 04, o0
Parks
Copies
TOTAL
Phone Il
,
' VAL c-k AT?Ot4
P ?
Za
Izxt t-l- i?, s
2 yq = iB
I I y o
z r? (,
Vzl16= I,?
llZq2y
Mr. Russ Grimmer 9O& ..,04K!;:A?
nn rakeview-Heights-Road f
Eagan, MN 55123 `5)' 124/21
(?/p DELMAR H. SCHWANZ
UNO $UAVEYORS, INC.
, Hop91NS0 UnAer Uwa ol The Stus o1 Minnseota 14750 SOUTH ROBERT TRAIL R03EMOUNT; MINNESOTA 55088 612/423-1759
_... • .
•-
oo%
..?i:?f
Scale: 1 inch = 100 feet
2
/=oUNO Ilce/ 3 ?' I
SnufJ! oFCo,e,yW ?
FE7VfE PoSr -?
360- o ?
SURVEYOR'S CEATIFICATE
?
?
'/4S s
SCTI/lan/ o fOUiJO ]ROI! . . a
R/W As D2dicated-On Piat
Y '
S? 16 -7»n/- 2234v •
Survey of the common lot line of Lot 19 and 20, LAKEWOOD HILLS,
according to the recorded plat thereof, Dakota County, Minnesota.
1 hereby certify that thfa auney, plsn, or report wse
prepered by me or under my direct auperviaion entl"' •' ° • -
that 1 am a duly Regiatered Land Suneyor under
the Iaws of the State of Minneaote.
Field Work 12-17-87 Deimar H. Sehwenz
Dated ? Minneaote Reglstretlon No. 8825
Certificate Drawn 01-14-88
•'. : ?
• ` • • . UE1KT ::?S t?r?t'? EIa?Jt'711
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if L:wf 1 i! iti{ :1?f1 ?in? ?Q. SH?9t10 •fiN1Q1?IH ?f![ :-?f •ea??*r-?nts. E
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less :-an AnG 1i+a S is 1eu vian tIr.E S, pr;,azet ss.tr.D ; let lee: _oet
? tS. :f t:nf 2 rS qrta:or :emn dent 3. D? linf 7?r•.i:l• :t.dn i,n!
'?•,^?:n lt!e^+:Af a1::-qa.+ 1-ra`-4c for totdt txur,tr sa.e'cos.
4u1 'l:^? 1) ?:1zA 'l?:+e G), ; 1
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s,ss .L;.?e I> ? U•??ive L,^e )? ¦ {
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#Zoo(ol
.,
:
? .
;
j lteusLl
telliag/ltoe! Tasulatsd Assa: Z Z 4q. Tt.
(+riLh attie area)
R-valum
r--
:nce[ior als Fila
.61
? ?asulaciaa 4-?; OD
j Coc[iauoua 'apoc 3arzios 0.00
? *.aterior r!aisa •5 ?
! Iacgr!oc A.ir Fila .61
? Tocal.;.saembly 3-oalue
?ssembip C-Va3ue (1/it)
Late* on ?a3e 1
7
'3ure 2 Ceiliag/ltooi Framing Azea: Sy. Ft.
(+ich accic area)
A-Va1ue
?
! iatarior Ur Fflm
.61
: Icsulat:on 33,5
; %:ood `!eaber
? Cuntiauous :*apor 3aTrier 0.00
I :ace?lar eiaish 'S&
i
! :acerior Air Film
.61
Total ?ss?biq R-4alue 3 ,?
s
a4snmblY C-L'a!ue (1/R) ' Q ZyL
Eater oa Page 1
Por addi[ional rxf asafsbtias, $se paqea 7 and B.
.
E
., Fir. tA c.:ISas/Uor tnaulacad sru: L R sa. Fc.
(vichout atite at")
a-Qalue
vesced Air Spaee .
Incsrior ais EiL .61
! ,:su2acloo 30,OU
Conc:auoua 7apor 4arriar 0.00
:ncer:oz Finish t5(&
Lneartor Air EiL ,61
70ca2 A.ssembly Et-value
A.sse=bly ;;-Value (1/a)
:n*_ar -in 2agt 1
riQure `.a CeilingiRoof Framing area: Sq. Ft.
?,(vithout actie area)
,.y
R-Va.tue
? Exterior air Fila .17
locfiag ,144-
i 3ooE Sheaching
?
?ood `!emhe*
L Contizuoue ?Jaeot 3arrler 0.00
Iatericr riaiah 1.5&
Lacariar Air Flla ,61
I '.atal kaseab:y $-Vala* , v
3.sse-bly C-74lum (l/!U • 011 ?
Eacer on Page I
For addic:cnal toof aasemblies, sk paqes 2 and 8.
3
.
,
f!_ 7
tW:od We11 toffulaemt A.rsa: I Z,S7 sq. rc.
R-vaiw
2ncerior A.is riL .6A
Iztttior °inish ?k'?
Conci_uous ^apoc Barsiee 0.00
Insu'_stiaa L •p C)
Exc:rior FinisD '47
Exterlor 3ir rila .17
i
i Totai Xssemblv R-valua
XSSexb:q G-'JSlue f1JR)
Eacer oa Page 1 • wr?
Figure 4 Ezeoeed Vall framing Ares: 1 a0 Sq. Fe.
B-Valcsc
Iaterior ?,ir rilm .58
I Iacerior Fiaisn ?y 5O.
Ccncinueus Capor Bazrier 0.00
I .ood !!ember _yy?r
Sheathing
Exterior Einish
Excerior Afr FiLm .!7
Tocal assambl7r fl-Value
:'asembly C-t:alue (1/x) ' 107
=16er on ?age t
!or addlcional w:ll assemblies, see paqe A.
?
Ti?r? ! Psaos?d Va1.2 RSA Joiat Asss: zo ISq. lt.
q•ralw
Zacsrior Atr f!L -N
Vapar 9trrieT 0.00
Ia?ulati? ?; ?J 0
, 'lood `!embtr
! Sheach3ng
? ' S 1
E[:Gr:4L e iIIS3h ?V I
E.xcsrior Air FiSA .11
Tocal A.99embly R-value
.Assembiv ',;-Vatus (1/8)
Eater oa 2age 1
Yotes: 1) Ploors over uaheated spaces`. Por floors of t^.ese*d or aochanically
cooled sQaces ovez ur.heated spaces, the ovesall L'-value,
far the [loor sLs1I eot exceod 0.05. For floocs ovot out3oor
, aiz, such aa overlangs, ehe overal2 C-Jalue for t!ie floor
shall aeet the same requi:ement as Cor coots, a-Ja2ue of
0.04.
2) 52ab-on-qrade Iloors. For alab-an-qrad*,-t.*.G insu2ation
arounG th* parime!er ot eho axpoaeQ lloor tka:l .`.ane a
minimum I-vala* o[ 6.4. Thf insulatfon must ex2and 3ovnvard
fram the Cog ot the a:ab a minimum o[ 3'6' ar 3ov!:war3 to the bottoa oi [ha slab Lhen horizoneally beneat4 th•
sIab fot an eqvivalent distance.
3) vapor barr£crs. Tifo maximua pera rating foc the vapor
harrior is O.I. Aminimum ot 4 mil polyethelina, or equal,
ia required to achieve this. Thi vapor Sarri*r muet ba
coneiauous rith all joines overlaEped and made over :saminq
membars or alxkiaq.
4) For notes on taundstion wall see rsqe 6.
S) For additional sssamblies noc illustraced uss .orksheat
an paqe 8.
5
; '' ? • ts?iis• d [s?oeee ro?mise:oa ?li Ass?
Coaeraea Q1ae2 os ?oured ,?r 7 • woe?d FoundaLfoe Iaiulaemd
Coacrecs Fo?daLias itrsa? ,_ 3q. R. Ar•a: sq. K.
R-value
Interiot Ais Fi2m bg
tanc!nuous Vapor Darrier 4.00
fouadatlon Val:
:nsuiatioa
E,ccerioc Air Fi,a • Z 7
7oc:l ksseTblr R-value 3A
Assemblv U-Value (1/fl) ' V7 (c
Enter on ?a;e I
I
)nlr ch* ibove ;rad• &n a 3f cN• !oun2aci.n •a:: :s
:o !• :ac:_dRa :a cie r..sr;r -at.j iat:aaf.
cr.o
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tafasent n ::,%rl ipau is aac -r.9ut4ced, :s• :::.nea•
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i-'s iafu Ut:on cpplitd aver •:• !%c: ni.undat:3n
•ali. 7S0 2-7slue s;ee:c=*d u `?r :`• :^Iulac:oa
taurial aety•
.. (i rid?ii ::ii °-?3'sL3LC?A '.s :o :• ?pet_?Q •? .??
•st&rwr af :?ts ?:::ada!:-a ?a1I. c'O aoova ;ra3•
aor;:on susc :o pr3:rc:ed ?na cni ;4a, s•`.• -sa:ner
i,a Pnr+jczi aeuu.
ll :C r:lstd f:ts :afuiiC::n if !o y• ie:lcv4 e] tSe
:ntat_qr. ie -Auat So }roceccsi Sw +i1:a y t-' t+?.
oosrd 3r eaaa; :av epec.c:ed :a s*t:szn . .. 2f :ne
:ni`'J-% )u::1:af :AAi.
i1 ;^_uaQat*.2e .al: :z2u11tion :'3r w od E?vndlt::ns auSt
:t :asti1:eS u ,a?c:c:sd yr s!!a =ar:t:
7raduc:i kisac:sc:oe'i ?*aLP vu uat.
O
t
700 ? u
? O o ^ zwQ ^„?
?
p??Q? ?fye'?D
e
t:ood Foundacion Eramed
?.rea: SQ. ft.
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Concinuous Vapor 8arrier 0.00
Faundation Vlil ::jood)
%:aoQ Yenb
E ior Air Fil. l7
Tocat Assemblr R-t'alus
f.aatmbtr U-vilus (t/R)
Encer on Pag! t L
SI[yUGMt, wtNOCIM an0 70QR sSStUttlL:ts
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2/25/0] Watcr/Wastewalcr- IS F51.31
J?L Compliance Inspection Form for Existing Minnesota Pollution
Individual Sewage Treatment Systems
i%a_wr Control Agency
:omplefion o( this (orm lullills !he minrmal requiremenfs of Mrnn. Stat. § 115.55 (2001) and Minnosola R. ch. 7080 (1999). Plcase refcr
o local ordinances (or other requirements or information especially for compliance requirements for bedroom additions
3eneral•
3ate of Inspedion: y /O - U6
?roperty Owner(s) ? l1 I t clY I
'erson requesting inspedion -1
Telephone (Ls>I)'??4-• 33?3L>
Telephone (&51)0 ! -14-22
;ite Address IOlr LG kCW DUfI, 1{'1 jlS Rd• City E(lll A Yl Zip Code 55123
=ire No./ Parcel No. County DA k C}'G(, Township Eal a t'1
egal Description 2`7 tl P. 1`) NI S. -2 L
.ocalRegulatory Authority EUn
)ate system constructed 1140 System in Shoreland Area: yes(]jq-? System in Wellhead
)rotection Area: yes i!?)System serving a MDH licensed facility: yes 6_?Iocal Permit #(if any)
Systems built prior to Apri( 1, 1996 and not located in
Shoreland or Wellhead Protection Area or Serving a Food,
Beverage or Lodging Establishment
Is the svstem an imminent threat to Public health or
safe ?(a yes answer is an ITPHS sysfem)
- Discharge of sewage to the ground surface? YES NO
Discharge of sewage to draintile or surface waters? YE5 Sewage backup into dwelling? YES - Situation with the potential to immediately and
adversely impact or threaten public health or
safety? YES NO
Is the svstem failing? (a yes answer is a failing system)
- Less than TYVO feet of vertical separation between
system bottom and saturated soll or bedrock? Y E S NO ?
- A seepage pit, cesspool, drywell, or leaching pit? YES N6
Is the system non-compliant7
- Is the system regulated under a monitoring plan or
operating permit? (if no, go to page 2) YES N?
!f yes,
- Has the required monitoring taken place? YES NO
(lf no, !he system is non-complying)
Systems located in Shoreland or Wellhead Prote ion
7 reas or Serving a Food, Beverage or Lodgi
Establishment, or systems Built after
March 31 1996
is the svste an imminent threat to a lic health
or safetv? (a s answer 15 an ITPHS syst&m)
- Discharge of sewa e to the ground surface?/ YES NO
- Discharge of sewage o draintile or surfac waters? YES NO
- Sewage backup into d Iling? YES NO
- Situation with the uotentiN to immediatklv and
adversely impact or threa[ public
safety?
Is the system failina? (a yes
- tess than THREE feet of vertica sep
system bottom and saturated/ oil or
i or
YES NO
is a failing system)
n between
II, or teachi pit?
- A seepage pit, cesspool, Zliant?
Is the s stem non-co - Is the system re lated under a moni
operating perm7dmc no, go to page 2)
It yes,
- Has the requi nitor ing taken place?
(I( no, the sy?m is non-complying)
YES DJO
YES NO
ng plan or
YES NO
ES NO
Ooes the monitoring indicate that the system meets - Does t monitoring indicate that the system meets
performance expeclations? YES NO pe ormance expectations? YES
(!f no, fhe system is non-complying) (1 no, Ihe system is non-complying)
Reason for inspection: FYO?.CY}V? TYllmfa-
Page 1 of 2 wq-wwists4.31
Property Uwcicr(s)
Fu(: No./ #'arce! Nu.
_ . 'a..
Svstem Comuonents (Please describe the system components and attach site sketch showing systeit? locvLion):
ss> b r? C,? 1?10??r -
Wha t methods were used to make Gh e de terminations for the comaliance insa_e_rAioh7 (Note: No standard protocolexists.
The fodowing /is[ is not exhaustive, orln seqiienfia/ order nor indicates which combination.s may ncressary fo make,7 deternrinationJ
WateKight tank(s) Hydraulic Functioniny Vertical Separation Distance
0 Probed tank bottom 'n Searched for surFace outlet i? Conduded soil borings
l
l
t Depth to limiliny laycr ?. y Fr-
? Observed low Iiquid level ? es
ic
Performed hydrau
U Examined const. records 0 Searched for seeping in yard Depth to system bottom
? Examined empty (pumped) tank ? Checked for back-up in home u [xamined records
? Probed outside tank for "black soil" ? Excessive ponding in soil system/D-boxes U LGU Limiting Layer Verificalion
? Pressure/vacuum check Cl Homeowner testimony o Other
o Other v Examined for surging in tank
? "[31ack soil" above soil system
o Other_
Status of the svstem
Based on the compliance criteria, the system status is: (check one) ? failing (to protect groundwaler) ? an
imminent threat to public health or safety (ITPHS), ? non-compliant (monitoring issue) 0 compliant (none of tlle 3
previous conditions). Therefore, this document is a: iM Certificate of Compliance U Notiice of NoncorTipliance
Is this system an EPA Class V Injection Well? ? yes 4D no
Certification
I hereby certify as a state of Minnesota licensed Inspedor and/or Desiyner I or Qualificd E'mployce Inspector and/or Qualified Employec
Designer I that I conduded an investigation [hat accuretely determined the compliance stalus of this. system and that my recorded
observations are accurate as of this date. No determination of future hydraulic performance has been nor can be made due to
unknown conditions during system construdion, abuse of the systern, inadequatc rnaintcnance, or futurc watcr usayc.
Inspector's name (print) Phone ??r? Z_qw?=`_?'UUq-?----
Licenseand/orRegistretionNumber JU9"? Address
Empioyed by Y1 ? I ? Address
Signature? ?? - -_- -- Date
Uaclrade Renuirements [denvedrrom M;nnesora srarures y1ls.ss>
An ITPHS must be upgraded, replacEd, or iCs use discontlnucd within tem months of receip( of fhis nofice or wilhin a shoiter /xriod i/
repuired by local ordinance. If the sysfem !ails to provlde sulTicient groundwater proteclion, fhen the system must Ue uAyraded,
replaccd, or iLs use disconlinued within the trme requlrad by rvle or fhe loca/ ordinance. If an existing system is nof faUing as deflncid in
law, and has at least t wo feef of design soil separation, then fhe system need not be upgradcd, repaired, rePlaced, or i_n use
discontinuerJ, notwrfhstanding any local ordinance lhaf is more s(rict This does not apply to systems in shorelartd areas, wrllhead
profecYion areas, or lhose used rm mnnection wifh food, Geverage, and lodging eslablishmenls vs deTrned rn law.
Suggested Attachments
1) Site sketch could also include: well, well setback to system, dwelling or other buildings, tank(s),reserved soil treatment area,
surface water and soil borinq locations. Include as-built drawing if available.
2) Soii bo(ng logs, showing each horizon. Indicate the texture, color, redoximorphic features depth to bedrock, stan(liny waLer and
whether the material is fill.
3) A list of any and ail requirements of the local ordinance that are di(ferent from the state requirements referred to on thi; form.
4) A homeowner survey of system performance, signed by the homeowner as being fadual.
5) Monitoring dala as appropriate.
Page 2 of 2
5oi( t3oring Log
M
Date: `7'- /l/ ' 06
r'rv?e?;i Locacion:
Client:_ !i(jle &rlffimCY
Address:
CitY Statn
BOnf1 method: au er Pit ZiP
Probe Other
eoring Number ?.S /.?
Surface Elevation
Soil type at system depth:
Texture Color
3/
?G
r
IO
-2-
3 , /
D D < /? yl
---
4 ---
5 ---
6 ---
7 ---
StfUCtUfe: Blocky Platy Pris matic None
Slope: %
/
End of boring at (a feet.
Standing water table: yes no
Present at feet of depth,
hours after boring.
Mottled soil:
Observed at r feet of depth.
N /Dy?-
ot present in boring hole
Observations and comments:
Borings made by:
GAi'Y U '
104,3
Lic. A
Color classification system: nnunseu otner
Boring Number
Surface Elevation
Soil type at system depth:
Depth Texture ColOf ?
ir__.1
1 ---
2 ---
3 ---
4 ---
5 ---
6 ---
7 ---
StfUCfUfE: Blocky Platy Prismatic None
Slope: %
End of boring at feet.
Standing water table yes no
Present at feet of depth,
hours after boring.
Mottled soil:
Observed at feet of depth.
Not present in boring hole
Observations and comments:
?T-
druin r_i?Qfc?
Ta I',/K
0
S 15?
L-?] Sq- f1
2/25/02 Water/Wastewater-iSTS9.31
Compliance Inspectian Form For Existing
Individuai Sewage Treatment Systems Minnesota Pollution
Control Agency
Completron of this form fulfi!!s the minimal requirements of Minn. StaL § 115.55 (2001) and Minnesata R. ch. 7080 (9999). Please refer
to local ordinances for other reauirements or information, especially for compliance requirements for bedroom addilions
General:
Date of Ins ection: ?
P ( ` 9?- 07 Reason for inspection:
Property Owner(s) Tele hone
P (6-1 5-'(.
Person requesting inspection Telephone ( )
SiteAddress g?-City ?? ti ?.,
?? Zip Code
Fire No./ Parcel No. County .,?2s 1v,fe' Townshi - '
p -
Legal Description
Local Regulatory Authority _ (? V`<
_j ---
/l
A
4
?` ,
2
C` nr
Date system constructed System in 5horeiand Area: yes Oo System in Wellhead
Protection Area: yes no System serving a MDH licens ed facility: yes no Local Permit #(if any) -
Systems built prior to April 1, 1996 and not located in
Shoreland or Wellhead Protection Area or Serving a Food Systems located in Shoreland or Welihead Protection
A
,
Beverage or Lodging Establishment reas or Serving a Food, Beverage or Lodging
? Establishment, or systems Built after
March 31 1996
Is the system an imminent threat to aublic health or Is the svstem an immine
t th
safe ?(a yes answer is an ITPHS s
st n
reat to oublic health
y
em)
- Discharge of sewage to the ground surface? YES NO or safetv? ( yes answer is an ITPHS system) :
- Discharge of sewage to draintile or surface waters? YES - Discharge of wage to the ground surface? YES NO
- Sewage backup into dwelling? YES - Discharge of s age to draintile o surtace waters? YES NO
- Situation with the potential to immediately and - Sewage backup to dwelling? YES NO
adversely impact or threaten public health or - Situation with the otential immediately and
saFety?
? adversely impact thre en public health or
YES safety? YES NO
Is the system failina7 (a yes answer is a fa!ling system)
- Less than TWO feet of vertical separation betw Is the s stem fail'fi . a yes answeris a failing system)
een /
system bottom and saturated soil or bedrock? YES - Less than THREE feet of v tical separation between
system bottom nd satu
t
il
?
- A seepage pit, cesspool, drywell, or leaching pit7 YES ra
e so
or bedrock? YES NO
- A seepage pit,
eesspool
drywell
r leachin
it?
?
,
, ,
g p
YES NO
Is the system non-comoliant?
- Is the system regulated under a
it
i Is the system non-cotnoliant7
mon
or
ng plan or
operating permit? (if no, go to page 2) YES NO - Is the system regulated under a monitoring plan or
operating permit? (if no, go to page 2) YES NO
If yes, If yes
- Has the required monitoring taken place? YES NO
(If no, ihe system is nai-complying) ,
- Has the required monitoring taken place? ' YES NO
(If rio, the system is non-complying)
- Does the monitoring indicate that the system meets - Does the moniloring indicate that the system meets
performance expectations? YES No
(If no, the system rs non-complying) perfonnance expectations? YES NO
(!I no, the system is non-com 1Yin ?
P g)
Page 1 of Z wq-wwists4,31 *Pl'
44tJ
Property Owner/s
V )_
Fire No./ Aarcel No.
(P se des,c?ri
?0/2 c
the system
attach site sketch stiowing system /ocation).•
l ? .. /J
What methods were used to ake the det rminations for the com liance ins ectiona (Note: No standard prp[ocoi erists
Tne fol%wrng lrst is not exhaustive, ol- in sequentia/ order nor indicates which combinations may necessary to make a determination)
Watertight tank(s)
Probed tank bottom
? Observed low liquid level
0 Examined const. records
O Examined empty (pumped) tank
L! Probed outside tank for "biack soil"
J Pressure/vacuum check
o Other
Hydraulic Functioning
?r Searched for surface outlet
O Performed hydraulic test
? Searched for seeping in yard,
? Checked for back-up in home
Cl Excessive ponding in soil system/D-boxes
?` Homeowner testimony
? Examined for surging in tank
o "plack soil" above soll system
? Other
Vertical Separation Distance
? Conduc[ed soil borings ,
Depth to limiting layer , 4er !
Deptli to system bottoni A_;?' --I Jv
Cl Examined records
U LGU Limiting Layer Verification
? Other
eased on the comp(iance criteria, the system status is: (check one) ? failing (to pr tect groundwater) p an
imminent threat to public health or safety (ITPHS), ? non-compliant (monitorin9 issue) compliant (none of the 3
previous conditions). Therefore, this document is a:?Certifcate of Compliance Notice of Noncompliance
Is this system an EPA Class V Injection Well? ? yes W no
Certificakion
I hereby certify as a state of Minnesota licensed Inspector andJor Desiyner I or Qualified Employee Inspector and/or Qualifiecl Employee
observations Designer I that are I accurate conducted as an invzstigation that accurately determined the complianc status of this system and that my recorded
o f this date. No detennination of future hydraulic e performance has been nor can be made due to
unknown conditions during system construction, abuse of the system, inadequate maintenance, or futwre water usa9e.
Inspector's name (print)
_ Phone65,_:/
License and/or Registration Number Address
Employed
Address. r ? ` r
Upqra e R2g ment5 (derivedfromMinnesota5'tvtutes§JI5.55) Date
An ITPHS must be upgraded, replaced,, a its use discontinued within ten months of receipt of this norice or within a shorter period if
r2quired by locv/ ordinance. If tne system fails to provide su?ciei?t grou??dwater p?otectinn, ,
replaced, or i!s use d?scontinued Hvithin the then Che system must be upgraded
tin7e required by rule or the local oidinance. If an existing system is not failing as derined in
law, and has at leasr two feet of design sorl separation, then the system need not be upgraded, reparred, replaced, or ifs use
discontrnued, notwithsfandinq any Iocal ordrnance thaf is more sfrict This does not apply to systems in shoreland areas, wellhead
protection areas, or thosz used in connection with foocl treverage, and lodging establishments as defined in law.
Suaaested Attachments
1) Site sketch could also indude: well, well setback to system, dweliing or other buildings, tank(s),reserved soil treatment area,
surface water and soii boring locations. Indude as-6uilt drawiny if available.
2) Soil boring logs, showing each horizon. Indicate the cexture, color, redoximorphic features depth to bedrock, standing water and
wheth2r the material is fill.
3) A list of any and ail requirements of the local ordinance that are difFerent from the state requirements referred to on this form.
9) A homeowner survey of system performance, signed by the homeowner as being factual.
5) Monitoring daia as appropriate,
e Page 2 of 2
CityofEa�all
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
r
Use BLUE or BLACK Ink
For Office Use
Permit #:
Permit Fee:
Date Received:
Staff:
7'i'-(3
467
2013 RESIDENTIAL BUILDING PERMIT
/�APPLICATION
�
Date: � Site Address: 04 ckt/4-1-0 0 Unit #:
Name: /K wc.� �.ey'� Phone: 44 5si '8l
Address /City /Zip: qOt, /4416.-ErS' attgeL
Applicant is: Owner )(Contractor
Description of work:
Construction Cost: 10,440
o, t4O t Multi -Family Building: (Yes_ /Noy )
Company: EI, S
r Ir` %4t, Contact: c ct✓rl CY S. �1%
Address: 1??/ 3 1 16-c City: alACn f`QlIS
State: $11) Zip: c6009 Phone: (vi2-- /22--
License #: 6C20 73
Lead Certificate #:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Phone:
Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting docu-.
the information may be classified
ents that you submit: are considered to
s non-public if yc a provide specic real
conclude that, they are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.00pherstateonecall.orq
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.
x Dot Jodi NW 0'66
Applicant's Printed Name
x
Applicant's Signature
Page 1 of 3