738 Golden Meadow Rd
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CITY OF EAGAN Remarks
Addition OvPrvi F?w F.Stateq Replat Lot
pOwner?.r?Ck ',? Street 738 GO.
T?Aif/lA_ IAl `. ?M]etn ?Y??Vti 1 --1,2 n A( nA/
GJ . Z(I4-. -2ry 7 !"ACp'tn'/ 1O_
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF,,59 Im . 1981 3242.41 216.16 15
STREET RESTOR. f 1981 1021.16 68.08 15 816.95
GRADING
SAN SEW TRUNK Sgg 1981 300 . 00 20.00 15 240.00 A012769 9-16-83
* SEWER LATERAL Q 1981 5096.85 339.79 15 4077.48 " "
WATERMAIN
* WATER LATERAL 1981
WATER AREA 1981 300.00 20.00 15 9-16-83
STORM SEW TRK 1981 591.82 39.45 15 473.47 A012769 9-16-83
* 5TORM SEW LAT 1981
CURB & GUTTER
SIDEWALK
STREET LIGHT
RO IT 250.00 36322 -9-83
WATER CONN. 4SO.00 it
BUILDING PER. 8128
SAC ?? rr
PARK
il \ IJJ
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS:
, .. 1,411 C?t`iM M1 A00I4 Irf?
UVF kv1F-t) t`;fq'if `. RLF'I A1
PERMIT SUBTYPE:
.. . ,,.. . ,?;,
PERMIT TYPE:
Permit Number:
Date Issued:
0 "0 0 ` APPUCANT:
ftr W;
0 1s•1E L f URF
r f. 1:• ? r?4F,-0
TYPE aF WORK:
tlF `&R (11, i 100
i?'? 1 I Ni,'?
I 11 tNcll
I ,Akr ', : n',c VnRn i t i, > k N iI i
i Nl1M 1 N(,
kil?ir $1t? hNV I i iI is?Ir.ni s.JO Er?
W) il,to lN[i
cyr6.• i 6
O?t/1 1195
ra t w
fntlilrF9Fr!}
?
.
Permit No. Permit Holder Date Telephone N
ELECTRIC
PLUMBING
HVAC
Inepection Date Inap. Comments
FOOTINGS
7
FOUND
FRAMING 79
!r4•
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
RQUGH
HEATING
GAS SVC
TEST
INSUL
GYP BflARD
flREPLACE
FIREPLACE
AtR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
BSMT R.I.
BSMT FINAL
DEClC FfG
DECK FINAL
CITY OF EAGAN
3795 Pilot Knob RAaA Eagan, MM 56122 ,.?.??
, PHONE: 454-8100
BU1LD1NG,PERMIT Receipt ?-
_ 1 ,.
Site Address 738 GQl den rLadota Rnarl
Lot 6 B1ock 3_ Sec/Sub.QVEj?'iea7 Eetates
Parcel #- 10 5621 n ;)6{1 0? k2ep18t
W ?.Jpmg . ath _w F. .ringenfe7d
Z Adaress p.A . Flox 21-362, 1636 8a s•er luf f
? - -- ----- •-• ----
0: Nome Nichael D. DuPont, Inc.
,o
?? Address 240 218t Ave. So. ,#X.6
f- r:.., S. Sr_ . FAUl 5307 raw- 540-29151455--0371
Name _
Nddre53
1 hereby acknowledge that I hnve read this oF
the inlormotion is torreCT'?and agree fo coR
oof Ec?
Stote of Minnesota Stat I\J?n1
5iflnuture of Permittee A Building Permit is Issued to: 1
'LiC:1&el
all work sholl be done in accordance with oll
8uilding Offfciol
Erecr
? Occupancy ?' -
Alter ? Zoning „
Repoir p Flre Zone
Enlorqe p Type of Const. j?'
Move p # Stories
Demolish ? Lengjh_i?.9_
state
Assessment
Woter & Sew.
Police
Fire
Enp.
Plonner
Council
Bldg. Off.
APC
Permit 104 O?.??
Surcherge ?>Y 50
Plon check 1 "I?
SAC ""
Wnter Conn. 16 g
Water Meter <?l? ?=- ?
Road Unif
Totol $1769
on the Express tonditlon thnl
State of Minnesoto Stotutes and City of Eagan Ordinnnces.
Permit No. Permit Holder Misc. Permit No. Holder
Plumbing -2z --$?3
H.v.a.c.
E ?(pq( C9Wi1tr' G-7?g3
w.u
w?..
Disp.
Sewer
Electric
InapeMion Date Insp. Other
ti
lFraming IV&
Rough HVAC
Inaulation 1 /
Final Pibg.
Final HVAC
1
Final r -
Waur Describe Lacation:
WeN •
Sewer
Pr. Diap. .
Receipt ---~ ?'' MECHANICAL PERMIT Permit No. " iCITY OF EAGAN
Fee "
Fip in numbered speces S/C
Type or Prrnt /egib/y Tot
1. Date 2. Installation Cost
3. Job Address l?- Lot Blk. Tract .;,,
4. Owner r5. Contractor > •r / ? Phone
6. Address
7. City ??•,? / ; State Zip r'' "`
.
8. Building Type: Residential 0
9. Work Description: New [I
Commercial ? Institutional O
Add ? Alter ? Repair ?
10. Describe p ?1 Fuel Type
11.
No.
` EquiyZment 8TU - M. Ea.
Forced Air e^ '
^?' C? No. Equiament CFM
,
Mfg. C 7 :j j ? Air Handling:
Boilers
Mfg. Mech. Exhaust
Unit Heater
Mfg. Other
Air Cond.
Mfg.
Gas, Piping Outleu
12. I hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work,
Signed :
for
Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8700
Receipt PLUMBING PERMIT Permit No.
CITY OF EAGAN
Fee
;? • fill in numbered spaces S/C
Type or Print legibly Tot. ,
1. Date 2. Installation Cost
3. Job Address 1??' =--? LotBlk. Tract ?•-°? ,
?=-----?.c
? , _ ^ v
4. Owner
5. Contractor
6. Address
Phone ii ? ; - r_', ._ ', ^
7. CitY State '% Zip _? -
8. Building Type: Residential e} Commercial O Institutional ?
9. Work Description: New E3 JAdd 0 Alter 11 Repair ?
10. Describe
11.
No. Fixtures
Water Closet No. Fixtures
Cesspool/Drainfield
Bath tubs Septic Tank
Lavatory Softner
! L Shower Well
L Kitchen Sink
Urinal/Bidet Other
' Laundry Tray
' j= Floor Drains
Drinking Ftn.
Slop Sink
Gas Piping Outlets
1 1
12. I hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed: for
Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
.
eU1LDING PERMIT
F ' i
Ta be uwd for : ;
CITY OF EAGAN
3830 Pilot Kno6 Road, P.O. Box 21-199, Eagan, MN 55121
PHONE:4548100
ReceiOt # ?-
:" i Dcte 1 9 h, 1
_, ? -- -
738 ME.Ti )OV? Rfl Erect m Occupancy
Site Addrgaa
Bl
k °
L {J '. • " ...
/ ° .'?Bf^?el ? 2oning
ot
oc Sec
Sub. Repair ? Type of Const.
Percel No. Enlarge ? No. Stories
Move ? Length
N?^8 Demolish ? Depth
€ Address ? Grode ? Sq. Ft.
b City ?
Phone ' 79':-'
Install
?
-•,,.1%
Name 45-.)-3205 14; Anwovoy
?
Address Assessment
?
? City Phone Woter b Sew.
t Police
?
?W Name Fin
Address E?g.
D:W City Phone Plonner
CouncH
I hercby acknowledpe thot I haw read this opplication and state thof
the information is torrect ond ogree to comply with oll opplicoble
State of Minnesotc Statutea aid City of Ecqan Ordinonus-
Sipnofure oF Permittee
r , .
I? 8uilding Permif Is iuued to:
oll work shall be done in ocoordonce witbfall opplicoble SfotR of M?r
Buildinp Ofilclal
Permlt Y -? ? • "
Surchorye • 5i
Plen Review.
5AC
Woter Cflnn.
Wote? Meter
Road Unit
Bldg. Off. Parks
APC Total 5 •
Var. Oete
on ths -xpreaa condiNon thot
riewto Stotutes or?d Ctty of Eapen Ordinances.
Permit No. Prrmit Holdw Dew Telephone s
Plumbinp
H.VA.C.
Elsetrie
Soheror
Irupection Date Insp. Other
Footinyt ? JS ?S f? lf
Foundatan
Framiny
Roofing
RouOh Plbq.
Rouph HVA
Inwlation
Final PlbO.
Final HVAC
S?_
Final y,
Grt/Oa.
Water Dstc?ibe Locstion:
Mfall
5ewer
Pr. Dbp.
CITY OF EAGAN
3830 Pilot Knob Road WATER SERVICE PERMIT
P. O. Box 21199 PERMIT NO.:
Eagan, MN 55121 DATE: '
?
Zoning: • No. of Units:
is?hP w * ?, ?
ow?,e?: -ang., ? .. _ ela
/lddress:
Slte Address: 738 i'fo Goldea -'•!eadotir Fsd Li; B? Overview rst Pe?
Plumber: ji, hul ihan f;r,
Meter No.: 4 ??; .-,?
Conrtection Chorge: l •
Size: Account De
posit:
Reoder No.: Permit Fee: ' "
1 agree to wmPly wille IiN Ci1y ef Eogen Surcharge: • C'
Ordinances. Misc. Charges: ?-'C•00 Eteter
Totol:
BY Date Puid:
Date of I nsp.:
Insp.:
CITY C}F EAGAN SEWER SEItViCF PERMIT
3330 Pilc;t ICnob Ruad
P. 0. Box 27199 PERMIT Np.:
Eagan, MN 55121 pqTE.
Zoning: No. of Units:
Owner: - :hew izavenfeld
Address:
5ite Addi
Plumber:
I a9ra M eaaplr wlth Nro Clfy af Eo9a• Connectlon Charge: _? 2`- QQ.,.,'?c'
Ordiaaneas. Accourrt Deposlt:
Parmit Fee: '
Surchorpe:
BY Misc. Chorges:
Date of Insp.: Total:
Insp.: Date Poid:
' CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
14745
PHON E: 454-8100
BUILDING' PERMIT ' - Receipt ?
?
To be used for Est. Value ?- Date
Site Address
Lot Block 11 Sec/Sub. " • ? W Fl 1 ' ''
Parcel No.
m Name
W
;
Address
? City Phone
0°C
, Name
? Q Address
?M_ City Phone
?
V
yj W
W
Name
I
? ? Address
Q 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 of Eagan Ordinances.
Signature of Permittee _
A Building Permit is issued to:
on the express condition that all work shall be done in accordance with all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
OFFIC E USE ONLY
On SRe Sewage Occupancy
MWCC System Zoning
On Site WeU (Actual) Const
City Water (Allowable)
PRV Required * of Storiea
Boaster Pump Length
Depth
S.F. Total
Footprint S.F.
APPROVALS FEES
Engr./Assess. Permit
Planner 5urcharge
Council Plan Review
Bldg. Off. SAC, City
Variance SAC, MWCC
Water Conn.
Water Meter
Road Unit
Treatment P1
Parks
TOTAL
Permit No. Pormit Holder Date TNephone i?
Plumbing
H.V.AC.
Electric
Softener
Inspectlon Date Insp. Comments
Footings I
Footings II
Foundation
Framing ,.
Roofing ?
Rough Plbg. ?
Rough Htg.
Isul. _
Fireplace ?
Final Htg.
Final Plbg.
Bidg. Final
Cert Occ. '
Temp. LP
Deck Ftg.
Deck Final
Well
Pr. Disp.
CITY OF EAGAN jvo- 14 7 4 5
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100 .?
BUILDINC PERMIT Receipt# ' v
To be used for FIREPLACE Est Value $700 Date MARCH 30 ,1988
Site Address 738 GOLDEN MEADOW RD
Lot 6 Black 3 Sec/Sub.OVERVIEW ESTATES
Parcel No
elName MATT & DEB LANGENFELD
w
,z Address 738 GOLDEN MEADOW RD
° City EAGAN Phone 454-7975
o Name SAME
?a Address
P City phone
w w Name
?
xz.
AddreSs
aw City phone
I hereby acknowledge that I have read this apPlication and state Ihat the
in(ormation is correct and agree to comply with all applicable State ot
Minnesota Statutes and Cit f E gan inances.
Signature of Permittee •
A Buildin9 Permit is issued to: MATT & 19FB
on the express condition ihat all work shall be tlone in accordance with all
applicable State of Minnesota Slatutes and City of Eagan Oidinances.
Building Official__L,I^AA
Q
OFFICE USE ONLY
On Site Sewege - Occupancy
MWCCSystem _ Zoning
OnSiteWell _ (ACtual)Const
Ciry Water _ (Allowable)
PRV Required _ # of Stories
Booster Pump _ Length
oevtn
S.F. 7otal
Footprint S.F.
APPROVALS FEES
Engr./Assess. Permit 24.00
Planner Surcharge • 50
Council Plan Review
Bldg. Off. SAC, City
Variance SAC, MWCC
Water Conn
Watef Meter
Road Unit
Trea[ment P1
Parks
z4.S0
70TAL
'.? ??ee-I ? v y - . clz^r oF, ?c,?v
?a?.
gZJTr DING PERMIT APPLICATION
r3? 7, o'v?
Zb Be Used For S? tyJ% (G0. Y' Valuation ?_
site Pddress 73g Gold$N a Q/.?0[,1 /?t?. A
pUCrv?cyi
Iot SQ_ Block Sec./SUb. asit _!4f Erect ?
Parcel #: (0 S(P -) lb b to D 0? Alter
Repair
I.Owner: 1F L 4mA Pft)? Enlarge -
- - „ Move
Address: f' U ISOY alrSV.C -/G+stQ tipur,++•yv?T
City/Zip Cocle: ?qo? . A1 SSI al __
Phone #: ySy -`19? S
Contractor: M}chaeI D DyOm.d, 1-rNC.
psldreSS: 2qV 21 r,l /JU0 G
City/Zip Code: ;n ¢. O4(iLg lrlA-) 5-5'625
,
Pnone #: ?'y? ? 9 i s wk 42S5- D 371 - h.•-
Arch./Eng-• -
Address:
Grade
Include 2 sets of plans,
1 site plan w/elevations &
1 set of ener9Y calculati°ns.
Date
OFFICE USE ONIX
OccupancY `
Zoning
Fire Zone
'Iype of Const -
# Stories ft.
Front ya ft.
Depth
APPRWALS FEES
Assessments Permut 30
laater/Sewer ' Surcharge o?5- --?'?
?
Police Plan Check I S.?
T
Fire SAC 5 cZS`
P Water Conn. ,/5-0
water Meter Go ?-
?eY
CAUncii Rnad unit .2 s-
Bldg. Off.
APC
City/Zip Code: aMAL -tmDq(S0
Phone #:
CITY OF EAGAN
° 8128
N
3795 Pib! Kno6 Rood Eogan, MN b5122 •
PHONEs 4S4-B100
'3c?1
BUILDING PERMIT ' ReceiDt #
Te be wed fe. SF DWG/GAR Esr. Value $57,000 pate June 9 1 q 83
Sire Addreu 738 Golden Meadow Road Erect ?g Occuponcy R-3
Lot 6 BI«k 3 Sec/SubOverview Estates Alter ? Zoning R-1
parcel # 10 56210 060 03 Replat Repoir ? Fire Zone NA
V
Enlarge ? Type of Const.
z
W Name rlathew F. Langenfeld Move ? # Sfories
? Addreu P.O. Box 21-362. 1636 River Bluff Demoiish ? Length 42
C; EaQ an 55121 pF,o„e 454-7975 Grode ? Depth 26 Sq. Ft._
a Michael D. DuPont Inc. Acorovais Fees
a Noma I
o`~' Addmss 240 21st Ave. So., #16
u? r:.,.S.St.Paul 55071,___ 540-2915/455-0371
Nome _
Address
I hereby acknowied9e thqj? I have reod this applicotion and stote thot
the informofion Is to? ct nd oqree to Co w lirqble
Stofe of Minnesota StL te ond ?fy otnE on rdirw f)
1y
SiOnature of PermiMee AjQ
-F13c iT-ael D.?nt, lnc.
Assestment -
Water & Sew.
Police -
Fira
Enp.
Planner _
Countil _
Bldg. Of£. -
APC
Permit .3U4 . V V
Surcharge 28.50
Plan check 152.00
sAC 525.00
Water Conn. 45e. nn
Water Meter 60.00
Road Unit 250.00
Taol $1769.50
A Building Pertnif is issued to: on the eaDress condition thm
oll work sholl be done in ocmrdarxe wi Kp oll applimfilP State of Minnesota Stotutea ord Ciry of Eayan Ordinonces.
Buildinp Offlciol
CITY OF EAGAN N° 0 9 9 9 3
99 E MN 55121
3830 Pilot Knob Road, P.O. Box 21-1 , agan,
' PHONE: 454-8100
BUILDING PERMIT rteceipt #
DECK
$750
Site Address 738 GOLDEN MFp.pOW RD Erect %] occupency
Lat 6 Bloek 3 S,clsub. OVERVIEW EST RElRemadel ? 2oning
Repair ? Type af Const.
Parcel No.
Enlarge ? No. Stories
MATT LANGENFELD
W Name
$AME
Address
? City Phone 454-7975
ffi Name SAME 456-3205 (W)
?? Address
City Phone
Ga
Name
=Z- Address
V
mw Ci2y Phone
Move ? Length
Demoli9h ? Depth
Grade ? Sq. Ft.
Install ?
ADprorals Faae
Asuzsment _
Woter 3 Sew.
Police -
Fire
Erp.
Planner _
Council _
Permit 519.5U
Surchorpe .50
Plan Review
SAC
Wafer Conn.
Woter Meter
Road Unit _
I hereby ackrwwledpe thof I Mve read this application ond stote that gldg. Off. 3 2 S 85 Parks
tM inlormotion Is correct and agree to comply with oll applicoble APC Total $15. ??
Stata of Minnesoto Stotutes a City of ogan Ordino ces.
Var. Date
/x?
Slpnaluro of PermiHee ,
A Building Permit Is iuued b• MATT •7lN _? NFRT p on the expresf condiflon thal
all wo.k sholl be done in eccordance witiyf+oll applicabl ta of Minnesota Statutes ond City of Eopan Ordirwncet
Buildirq Officiol
va 1'rtl RESIDENTIAL MECHANICAL
Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675
Please complete foc Single Family Dwellings & Townhomes and Condos when permits aze required for each uni[
? "5o S0
Date /;- / -? 3 / d 3
Site Address Rd C<:q c?• Unit #
i
Property Owner (a y7
( 6 SI ? y?Z - ?j g
Telephone # G
Contractor / Gqy+1 Wp c4 r,
Street Address 3?6 0 Sh e4?i,. c? v S City L s
State ?vt /? Zip '5S Y41 1 Tetephone #(? ? 2) 7?`3 - r? Y U
Bond k:_ 7 a?;? 7' ? 7oZ q Expires: ?)'e G a oo ?
The Applicant is _ Owaer ? Contractor _ Other
Add-on, modification or alteration to existing dwelling unit $ 30.00
furnace replacement
air exchanger
air conditioner _ New _ Replacement
-ix other
State Surcharge $ .50
Total $
I hereby apply for a Residential Mechanical Pernvt and acknowledge that the information is complete and accurate; that the work will
be in conformance with the ordinances and codes of the City of Eagan and with the Mechanical Codes; that I understand this is not a
permit, but only an application For a permit, and work is not to start without a pernut; that the work will be in accordance with the
approved plan in the case of work which requires a review and approval of plans.
11 Pn/144 S ??o ? O?^
pplic?A anYs Printed Nam ApplicanYs Signa?
C,f- *
C-o< n,
RESIDENTIAL BUILDING
Permit Application
City Of Eagau
3830 Pilot Knob Road, Eagan MN 55122
? v Telephone # 651-675-5675 FAX # 651-675-5694
NewConsWctlonReauirements RemodeUReoairReauiremenGs (
3 registered sRe surveys showing sq. R of l04 sq. R. of house; and all roofed areas 2 copies of plan
(20% maximum lot coverage aliowed) 1 set of Eneyy Calculatiais for heated addNons
2 copies of plan showing beam 8 window sizes; poured found desgn, etc. 1 site survey for additions & decks
1 set of Energy Cabuptlons Addition - indipte il onafte septic system
3 copies of Tree Preservation Plan'rf lot platted after 711193
Rim Joist Detail Opfions selection sheet (hldgs with 3 or less unhs
o ? offlce u5e on? ?
Cert of Survey Rectl _Y _ N
Tree Pres Plan ReW _ Y_ N
Tree Pres Reqd _ Y_ N
On-site5epticSystem _Y _N
Date 1U l? l Constructlon Cost ??a
-!
Site Address ?.je ?Q UC?1 UniUSte #
DescripdonofWork 141'rt.fL,,y.)S (Jp/enle o
r ?
Multi-Family Bldg _ Y l-? Ftireplace(s) v 0- 1 _ 2? ?
Property Owner P??J6L /'6?/l1G35'Gl? Telephone #4c?S 7) K5"2- - 6 1 O/
Contractor vt? S;lr? ? p f
Address tbx
State Zip Telephone # )
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesob Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy COde CategOry . Residential Ventilatlon Category 1 Worksheet • New Energy Code Worksheet
(Jsubmissiontype) Submitted Submii[ed
• Energy Envelope Calculations Submitted
Have you previously constructed a building in Eagan with a similar plan? _ Y
fee applies.
licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telepnone#( 1I1fi DCT 21 2003
Telephone #(
Telephone #(
?C?-
I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; I understand this is not a pemut, but only an application for a permit, and work is not to start without a
permif; that the work will be in accordance with the approved plan inAe case of work which requires a review and
approval of plans. ?? ,4 // A _ /J
???? ?? ? 11
Applicant's Printed Name icanYs ignature
.
V
OFFICE USE ONLY
Sub Types
0
01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Poal ? 30 Accessory Bldg
111
ttt
02 SF Dwelling ? 08 06-plex ? 16 Fireplace O 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
r? 03 01 of _ plex O 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Ait - SF
? 04 02-plex ? 10 OS-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 MuIG Misc.
? OS 03-plex ? 11 10-plex ? 19 LowerLevel ? 24 Storm Damage
? 08 04-plex ? 12 12-plex Plbg_Y ar_ N? 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
O 32 Addition 0 36 Move Bidg. ? 42 Demolish (Foundation) O 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)• ? 43 Reroof ? 46 WindowslDoors
? 34 Replacement •Demolition (Entire Bldg) - Give PCA handout to applicant
Valuation UC?' Occupancy MC/ES System
Census Code ? Zoning City Water
SAC Units Stories Baoster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footings (new bldg) Final/C.O.
_ Footings(deck) FinallNo C.O.
_ Footings(addirion) Plumbing
_ Foundation HVAC
Drain Tile Other
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ AirlGas Tests ` Final
_ Framing _ Siding Stucco Stone
Fireplace _ R.I. _ Air Test Final
Windows (new/replacement)
?C Insularion _ _
_ Retaining Wall
Approved By TL. , Suilding Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
?P/5n 7rA/
?
t?? ?
? (l
RESIDENTIAL BUII.DIlVG
Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
l0%l03
New Construc0on Reauirements RemodeVfteoair Reauirements Office Use Onlv
3 re3istered site surveys shaxirig sq. R of lot sq. ft at house; and all roofed areas 2 wpies of plan CeR of Survey Recd _ Y_ N
(2(rh maximum lot coverage allowed) i set of Energy Calculations for heated additions Tree Pres Plan Recd _ Y_ N
2 copies o( plan showmg beam 8 window s¢es; poured found design, ela i site survey for addiUans & decks Tree Pres Reqd Y N
lsetofEnergyCalculations Addifion-indicafeAon-Oeseptksystem On-siteSepGcSystem _ Y _N
3 copies of Tree Pmservation Plan i11M platted after 711193
Rim Joist Dehil Options selection sheet (bldgs with 3 or less units
Date 6/ ".? I U3 Constructlon Cost o2/ 00 r)
Site Address 7,3 9 6,? /-f ??A,5,6 /l ? Unit/S[e #
/
Description o[ Work ?T,
Multi-Family Bldg _ Y_KN Fireplace(s) P?/-- 0 _ 1 _ 2
Property Owner Telephone # ( )
Contractor I'Zl/ L? ?S? ? S
Address us- ?
GtJ, 1?j3 20
?S?
Ciry
State ?.? Zip S3-3 Telephone # ° b
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 M?esota Rules 7672
Energy Code Category . Residential Ventilatlon Category 1 Worksheet • New Energy Code Worksheet
(J submission type) Suhmitted Submitted
? • Energy Envelope Calculations Submitted
Have you previously constructed a building in Eagan with a similar plan? _ Y _ N If so, 25% plan review
fee applies. ?
Licensed Plumber Telephone #( )
Mechanical Contractor " Telephone # (
Sewer/Water Contractor gv-Telephone # (
I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; 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 ofplans.
?-
Applicant's Printed Name Applian's Signature
OFFICE USE ONLY
Sub Types
? 01 FoundaGon ? 07 05-plex ? 13 16-plex ? 20 Pool
? 02 SF Dwelling ? OS 06-plex ? 16 Fireplace ? 21 Porch (3-sea.)
? 03 01 of _ plex ? 09 07-plex ? 17 Garage 22 Porch/Addn. (4-sea.)
? 04 02-plex ? 10 OS-plex ? 18 Deck ? 23 Porch (screen/gazebo)
? 05 03-plex ? 11 10.plex ? 19 lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y w_ N ? 25 MiSCellaneous
Work Types
? 31 New ?
? 32 Addidon ?
? 33 Alteration ?
? 34 Replacement
Valuation ?00
Census Code
SAC Units
Nbr. of Units
Nbr. of Bldgs
Type of Const ?
? Footings (new bldg)
_ Footings(deck)
Footings(addirion)
? Foundation
Drain Tile
Roof Ice & Water Final
? Framing -
Fireplace _ R.I. _ Air Test _ Final
? Insularion
4
? 30 Accessory Bldg
? 31 Ext. Alt - Multi
? 33 Ext. Alt - SF
? 36 Multi Misc.
35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
36 Move Bldg. ? 42 Demolish (Foundatlon) ? 45 Fire Repair
37 Demolish (Bldg)" ? 43 Reroot ? 46 Windows/DOOrs
'Damolitlon (Entire Bldg) • Give PCA handout to appliwnt
Zoning City Water
Stories Booster Pump
Sq. Ft. PRV
Length Fire Sprinklered
Occupancy /C.,? ? r/MCIES System
W idth
REQUIRED INSPECTIONS
FinallC.O:
:'C FinaUNo C.O.
_ Plumbing
_ HVAC
Other
_ Pool _ Ftgs _ Air/Gas Tests _ Final
_ Siding Smcco Stone
_ Windows (new/replacement)
_ Retaining Wall
Approved By / Z, , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
61K-,?, pyx;-<? --
1vv,?`' qly X ? -
(?,?-?•,?,r? j-4-mv-r
/ D? 3sti
/ s 00v
P'AY.21.2001 :; 35FP1 N,j.3E4 P.2%3
Jot Sitc Addresy: City ai i3umsville
44CA''EGORY
1" ALTERNATE FCR
? 100 Crvic Center
?
ONE & TWO
FAiVIILY llWELLINGS
q52'595-444 ,
30i1e, NfN
5?3z7
INSTrtUCT10NS: This alternati%'e maq be used Coi onc- and two-fnmily dwellings 6uilt to meCt thc Categury 1 requtremencs of
Minnesota Rula', Chapler 7670. Colnylefe Pans A, B, and C. Cltaxly inuk plans wifh: insulation A•values; window ar.d skylight U•
vn?u'_s; eiu and type of rquipm.enc; equipmeut tontrols; and locarion of vapor raarder ,nA windwaslt ba:ricrs. Moie datailed
informaeior. caabe fuu+:d in thc SQimne;ora Rnergy Code sunumry sheets availabte from dht Minnesota Departmant of Commerce.
Part A. BLTILDING En'VELOPE
CI•.ak proposeJ envclopejoint eealing option 4 6F-P'1!Sc11D?jvz I
Cbetk the!'mel energy cnlcvietinn opnm: ?iseC 4 „( "Cookbook"
? Pcrfcrmmicc
°GCookbook" Worksheet
IccTaI.cnTIs
Siep l. Chede rtcm(s) dial design meets on d4lnirnu.vi Raquirnnentr list
co du right. hi:,ec n'+ee.t all i[ems tc ucc "Cool:book" opt,on.
STep 2. I.1Cica'.e proposcti wal! type on table lxlow.
Siep 1. ludicut¢ N'ir3ow u-Vrelue and source,
51cp G Vcri!y total •.vindow (inctuding urea of all foundation windowu)
and door nreq is e luxl or less than allowable pecccnage.
pcr
_____""._.._........... ..nunnme?unl?fl(1RdRRA
- TAQLENVKUL•16KM?nuwrv?nnu. awn
!u.axi!num AIIo+aGle lb'al W indow and Door Aroa as
'
^
a
.2%
29"
a Pcrcc?tage of L'xposed ?ual! .-- -% 12% tay. 1G
% 18
, .
u'allTvpe (Standerd taming)? MaximwnAvtrage WindowU-value(exceptfoundadonwindows):
023
? zza, C•17 insu!aucn, [t.7eheutlling 0.55 O.a7 i7.41 56 0.33 0.30 0.2 0.2
0
A 0
22
O 2z=, R•IS insu!ation. A•5 sxathing 0.52 0,45 0,79 0,36 .11 0.28 0.26
4 .7
22 .
0
21
-0 20: R-19 inaulation. < R•5 slsathing 0.aS O.A1 0.36 U.32 0.29 0.26 R2
028 .
26
0 .
4
7x6, R1 insulatien, R•5 s eet iing 0.56 0.45 ,42 0. 7 . d U31
2 .
0
27 .
u72
2x6, R-21 nsolaoion, <R-5 sheuthing 031 .a3 0.)f 0.11 5
.30 .
029
0 .
0
7 0.25
2xti721 :nsulapon, -i shcet?ir.g 0.5 o.SU D.aA 0.39 .
0. 5 .
Wfl I Typc (.ndve?mcd ?ram Marimum hvcra e un ation "'indows):
Window U-valuc (cscc
0
25
i1
24
22
2x6, - 9;nsulatinn, . l2-5 aheeching 0-52 1 0.45 1 .39 0.15 1 0.28
1 .
2 .
2 _
25
11
R-5 ,1e;.tLi.^,g
R•I9 ineaiehon
2x f1.)U .4ti 0.39 35 0.72 9
0 .
1 .
,
. 31
J0
0 0
27 0.2: 0.73
< R-i sl;eztLing
R•21 insu n[iar.
? 2x5 0.55 lI.A7 0.41 0.?G . .
,
,
O 2xii.R-21 ?nsulntion, R•5 sbc.ath+rg 0,60 11.52 .4G 0.41 036 U.73 0. ?.ZB GZG
Wrodow L'•vaW^_?. 3y---? Source:
ard??
? NrRASHRAE 1993
0d x ? oa. 9f
1 ?. Lr ''??',_?+
<
l3 0? °
`--.1?.?
1.M!7 .--- %1
window & daorx.res? grwss expoxe we I a;en D GN ALLO?VABL? (fran tabte abovc)
MINNESOTA ENERGY CODE - WHICH RULES MAY 1 USE ?
TYPE OF RESIDlNTIAL, UUILDL'V APYC.ICASLE AULES
DetachcdR3ou4pancql•and.-tamilydwtllinss
Examplas: single fwrjlv, b•?in hoincs, dupleses C1+opteri672; or .
Chepter 7570 "Cucegwy 1" %+-ieh seartrtor dc *essurizaTion and vrntilation requunncnu
Attacbed R3 occupancy dwellia?
Ex:unplcs. uio(cC tm"mhouses 31d row houscs Chaylcr ?,4: or
Chapttt 7670 wiUi ciiher "Cnregory I" or "Ca!egary 2" provisians
It-1 occup0.nry, Duildingn aY 3 stmics or Iess
Ezmuplescoadommiums or apat[ments h;ipter 7G79; ar
CF.ap[<r 7G7!l wiN cithcr "Caccgory l" or ?'Category 2" pro??isions
It-loceupancybuildingsoverstorleshiph Clr,?pter7G7(
Exainplashigh risc aondos or a0xrtiments
!
:tc workshcet below) ? MnCheck emlMd (attach report)
U-value wltuletions) ? Syo[ems Annlysis method (ettach anilysis)
I '
--
&oide- N_ m-e adew ,
Ext 9q6
fi.v q117
?
?
?
I
CITY OF EAGAN
` 3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS:
PERMIT
PERMIT TYPE:
Permit Number:
Date Issued:
738 GOLDEN MEApOW RD
LOT: 6 BLOCK: 3
OVERVIEW ESTATES REPLAT
P.I.N.: 10-56210-060-03
DESCRIPTION:
(ATTACHED)
GARAGE/ACCESSORY
NEW
c?4 v0
BUILDING
026216
08/11J95
? : F??._. .... .... ,...
J } r
? . . .
R6i2dfng-Permit Type
Building Wo`r_k Type
1
,
? . `
REMARKS:
fi SEPARATE PERMIT IS REQUIRED FOR ANY ELECTRICAL WORK
FEE SUMMARY:
VALUATION
Base Fee
Surcharge
Lic. Search
Total Fee
$10,000
$162.25
$5.00
Fee $5.00
$172.25
CONTRACTOR: - Applicant - s7. LzC
SUSSEL CORP 16450331 0001934
1852 COMO RVE
ST PAUL MN 55108
(612) 645-0331
?
OWNER:
MOWSON MARK
738 GOLDEN MEADOW RD
EAGAN MN
(612)452-6909
I hereby ackriow2edge that I'fiave read t'his application and state that the
information is correct and agree to eomply with a11 appli,caale £tate o'f Mn..5tatutes and CiYq of Eagan Ordinances.
n
?APPLICANTIPERMITEE SIGNATURE ISSUED BY: IG TURE
-j
CITY OF EAGAN
' 3830 PILOT KNOB RD - 55122
1895 BUILDING PERMIT APPLICATION (RESIDENTIAL)
681-4675
? 3 repblerod slte surveYg ? 2 coplea of pian
? 2 copes of ptens (6idude Deam 8 window sizes; poured fid. design; etc.) ? 2 site surveys (extertor a0didons 8 decks)
? 7 energy eakulations ? 1 energy calwlatlons for Mated additions
? 3 oopies of Vee prseervation plan ff IM plelted after 717/93
mqulrod: _ Yes _ No
DATE: S17!`'lj- CONSTRUCTION COST: ?J • ?g?
DESCRIPTION OF WORK: &LL() A'1[ AZ? r, AwAer:?-
STREET ADDRESS:
LOT
(o_ BLOCK 72 ?3
y? SUBD./P.I.D. IZD
?
#:
PROPERTY Name: ! Yc?Y?c.l? ?nw? Phone #:
OVUNER ""T `"`T '
Street Address, M?bvw ?
City: Z?W-,4y.) 5tate: Zip:
CON
RACT S ?
(
T
OR
p y
oSS
Com an :
?(
o--
? Phone #:
Street Address: /:?? p License #-
City: State: Zip..?.
ARCHITECTI Company: Phone #-
ENGINEER
Name: Registration #•
Street Address*
City: State: Zip:
Sewer 8 water licensed plumber. Penally applies when address change and lot
change are requested once pertnft is issued.
1 hereby acknowledge that I have read this application and state that the infortnation is cortect and agree to comply with all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant
OFFICE USE ONLY ??CM?J
Certificates of Survey Received _ Yes _ No AU G p 7 1995
Tree Preservation Plan Received _ Yes _ No _ _ _ _ _ _ _ __ _ _ _ _ _ _
OFFICE USE ONLY
BUILDING PERMIT TYPE
o 01 Foundation o 06 Duplex o 11 Apt./Lodging a 16 Basement Finish
0 02 SF Dwelling o 07 4plex o 12 Multi.RepaiNRem. ? 17 Swim Pool
0 03 SF Addition a 08 8-plex z53,4'13 Garage/Accessory o 20 Pubiic Facility
0 04 SF Porch o 09 12-plex ? 14 Fireplace o 21 Miscellaneous
0 05 SF Misc. 0 10 _ plex ? 15 Deck
WORK TYPE
0 31 New o 33 Alterations ? 36 Move
?32 Addition o 34 Repair o 37 Demolition
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
Planning 15; "
Basement sq. ft.
Main level sq. ft.
sq. ft.
sq. ft.
sq. ft.
sq. ft.
Footprint sq. ft.
Building
Pertnit Fee
Surcharge
Plan Review
License
MCNVS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Pertnit
SIW Surcharge
Treatmerrt PI.
Road Unit
Park Ded.
Trails Ded.
Other
Copies
Total:
Engineering
Valuation: $
6"r C) -
MGWS System
City Water
Fire Sprinklered
PRV
Booster Pump
Census Code.
SAC Code
Census Bldg
Census Unit
Variance
/o, o0 0
2? X z?: s7Z x
?/38
or
?-
0
% SAC
SAC Units
?
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'0 - i
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CITY OF EAGAN ?
3830 PILOT KNOB RD - 55122
VV303995 BUILDING PERMIT APPLICATION (RESIDENTIAL)
681,4675
New Canstruetion Reouiroments RemodeVRppair Reauirements
? 3 re8istered eite suryeY$ ? 2 copies ot pian
? 2 copiea of plens (induda beam & wfndow saes; poured fid. deaign; etc.) ? 2 site surveys (exterbr atldftlons & dedcs)
? 7 enerpy calculationa ? 1 energy calwlations for heated additions
? 3 copies M Uee pieservation plan M lot plened after 911/93
requimd: _ Yes _ No
DATE: !?z - C1s- CONSTRUCTION COST:
DESCRIPTION OF WORK: -- k GtTUje E'
STREET ADDRESS: / i ,A An /1
LOT BLOCK SUBD./P.I.D. n? ?
PROPERTY Name: -F n%/ _nP J?n P_ Phone #:
OWNER ?* ""*
Street Address- IS Z,S ?vinc,?n ?-h ?
City: EROGn State: d4 Zip:
CONTRACTOR Company: I-rPl 9,c-1n rk Coo-J• Phone#: `-`j]'3?3-3
Street Address: ll?u?f> 1,Jr44c/' ('14, License #:1?
City: ll;or L-u ?t?_ State: NA. Zip• s: S -- 3 ??
ARCHITECT! Company: Phone #-
ENGINEER
Name: Registration #•
Street Address-
Ciry: State: Zip:
Sewer & water ficensed plumber: . Penalty applies when address change and lot
change are requested once permit is issued.
I hereby acknowledge that i have read this application and state that the information is correct an agr e to comply with all
applicable State of MinnesoTa Statutes and City of Eagan Ordinances. Signature of Applicant:
OFFICE USE ONLY
Certifiptes of Survey Received _ Yes _ No
Tree Presenration Pian Received Yes No
BUILDING PERMIT TYPE
0 01 Foundation o 06 Duplex
0 02 SF Dwelling ? 07 4plex
0 03 SF Addition ? 08 8-plex
0 04 SF Porch ? 09 12-plex
a 05 SF Misc, 0 10 = plex
woRK nrPE
•g- 31 New o 33 ARerations
0 32 Addition o 34 Repair
GENERAL INFORMATION
Const. (Actuai)
(Allowable)
UBC Occupancy
2oning
# of Stories
Length
Depth
APPROVALS
OFFICE USE ONLY .? •-,, '?: ??
?• fi'?
0 11 Apt./Lodging ? 16 Basement Finish
? 12 Multi RepaidRem. 0 17 Swim Pool
0 13 Garage/Accessory ? 20 Public Facility
? 14 Fireplace o 21 Miscellaneous
0- 15 Deck
?fL ? ?tff ??lfl Cd? nru`' d?s
/;Ths s?? c 5 ?? furut t ly?lz
? 36 Move 100,04a 2N
?M?19?t
a 37 Demolition ? 2'.•? ?
Basement sq. ft.
Main level sq. ft.
sq. ft.
sq. ft.
sq. ft.
sq. ft.
Footprint sq. ft.
Planning Building
Pertnit Fee
Surcharge
Plan Review
License
MCNUS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
SNV Surcharge
Treatmeryt PI.
Road Unit
Park Ded.
Treils Ded.
Other
Copies
Total:
% SAC
SAC Units
MC/WS System
City Water
Fire Sprinklered
PRV
Booster Pump
Census Code.
SAC Code
Census Bldg
Census Unit
Engineering
Valuation: $ 12-00 IS
Variance
V-757-
aI
I
a
. ?. •?
r•
I
,iOBE
GNG1NEERING
? COMPANY, INC.
4 1D00 EA57 1461A STREET.
??vl '?
COMSUtT1N0 ENGIN(E115 PLANNEAS end tAHD iUAYEYOIlS
OURNSVILLE, MINHESOTA 55337 PH 432'3000
Amoa1 IkocrL diorz: LOT 7, BLOCK l, PARK R/OGE 2ND
ADD /T/ON, D4K07"A CDUNTY, M/NNESOTA,
NORTH
SCALE: /"=30'
--?--
S B9° 351'34"E
70. 00
DRA/N,qGE ? r9'
UT/L /TY EASEti/E,
30' FRONT 8!/vLD/iYG
S£TE.4Ck L /NE `
?
? 9z i o; DENOTES EX/ST?NG
EL Eli.9T/ON N
( 92 i• °) DENOTES P?POSED 'y, p
ELEY?'T/ON
.?? /ND/CfITES D/RECT/ON p?
OF SURF/?CE O.P,9/NAGc' Z
..?;,
F/N/SNED GARAGE
FLOOR ELE?.dT/O/V = 923.83
0
?? 9 8 N I1
R
o .o
IN ?a N I?
I<q 2, 3? N NI
I ?13.5 uJ_J- - 2.S?M ?
I n
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(V MauSfi y? ?
N ry
?f0.0
23.5) (9L 5? I
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I O?7
? I
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LANE
0
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V
?
O?
O tl,
ON
?e
O
.- .. . ? _,
70.00 c=<-,.?,
S 69° 35'34'"E <qzq.a?
I her:by certify that thia ia a lrue and correct rapreaentation of a tract of
land aa ¦hpwn' ard deacribed hereon.• As preparad by Me on this zy+a day ot .
it 3?a3o
"J I `-G `.C (
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OP EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4875
Naw Conswctbn ReauirameMa
• 3 re9istared sXe surveys showing sq. 6. of bt, sq. tt o1 housa; and II roofed areas
(20 % maxanum bt coverege albwed)
• 2 aoples of plen showing beam & window sizes; poured found desgn, etc.)
• tsetofEnergyCakulations
• 3 copies of Tree Preservation Plan'rf bt platled atter 7l1/93
• Rim ,biSt Detail Optlons SBIeCtbn She9t (bldgs wilh 3 ar IBSS unfls)
DATE 6I??/a ?
BemotleUHeoah FleuuiremeMs
• 2oopiesofplan
• lsetofEnergyCaloulatronsforheatedadd'Abns
• isResurveyforezterbraddaions8decks
• Indicata M home served by septic system tor add'Abns
? ?
VALUATION Sl??? 6 ?JQD
SITE ADDRESS 73 g ro 0,6jijr, OvQdB2J lCd . MULTI-FAMILY BLDG _ Y >?-'N
TYPE OF WORK FIREPLACE(S) _ 0 _ 1_ 2
APPLICANT
STREETADDRESS 9S0,1? I_ /?YndCt..('o 4- w- .S?6k CIN DOrY1/ ` STATE&&/ZIP?
TELEPHONE # 9J2-99y- yKO CELL PHONE # (p 0-?LI06 - 7VO P # gf? 89y- F?rg-'
PROPERTY OWNER /"l'k? TEIEPHONE # IO,S I- qy-2 -68' f
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNESOTA RULES 7670 CA1'EGORY 1 MINNESO 71
(4 submission type) . Residenfial Ventilation Category 1 Workaheet Submitted • New Ene e orksheet Suhmitte
• Energy Envelope Calculations Submitted p JUN 0 7 2002
Plumbfng Contractor:
Plumbing system includes:
Mechanical Confracfor.
Mechanical system includes:
Sewer/Water Conhactor:
_ Water Softener ,
_ Water Heater _
No. of Baths
Air Condiaoning
Heat Recovery System
Phone #
Phone #
Fee: $90.00
Fee: $70.00
I hereby acknowledge that I have read this applicatlon, state that the informaTion is correct, and agree to comply
with all applicable State of Minnesota Statutes and Clty of Eagan Ordin?lS.
Signature of Applicanf
. -f
OFFICE USE ONLY
_ Phone #
I.awn Sprinkler
No. of R.I. Baths
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4102
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AUr
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i
24:30 9001 738 coi_.Den? nFAn 0.25
2155 9001 738 r.,ni.nEN MEAn 4.00
300 9001 738 GOLDFN Ml_ACi 153.25
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ro,:ai. r,eceipr, Aiupurii:r, 07.50
f H0i891.
USFfi .T.Xte A!ANCY
1999 BUILDING PERMIT APPLICATION (RESIDENTIAL)
., CITY OF EAGAN
3830 PII,OT KNOB RD - 55122 ? ---
651-681-4675
New Construction Reauirements Remodel/Reoair Reauireme? i S?
I
? 3 registered site surveys showing sq. ft. oflot, sq. ft, ofhouse ? 2 copies of plan <° p ?-
and afl roofed areas (20°/, maximum lot coverane allowed) ? 1 set of energy calculations?tl adtldions
? 2 wpies of plans (show beam & window sizes; poured fnd. design; etc.) ? 1 site survey toi exteTior additions & decks
? 1 set of energy C3lculations
? 3 copies of tree preservation plan if lot platted after 711l93
DATE: CONSTRUCTION COST:
DESCRIPTION OF WORK: ?-Scc_Sa,7 y?ulcy
STREET ADDRESS:
LOT: L BLOCK: ? SUBD./P.I.D. #:
PROPERTY
OWNER
CONTRACTOR
ARCHITECT/
ENGINEER
` J
Name: oI?i?J17 A1114 _ Phone?#???_?`?-?
last Fint
StreelAddress:__2?s' 60'?CC?df. ?I?C'_L1DW
Cit} ?k-? ----------- Siate:J_`??/1--- Zip:S3-/Z.3 ]E1?.L_
Companp:_ Phone
Street
Cih
State:
Company: -Y,- /I
Street
License k ____Ecp.
--- ZiP' ---
Phone ti: ---
RegistraUai ti:
Ciry State: Zip:
Sewer 8 water licensed plumber (repuired for new construction oniv):
i
Penalty applies when address change and lot change is requested once permit is issued.
I hereby acknowledge that I have read this application, state that the information is c rrect, and agr e to comply with all applicable
State of Minnesota Statutes and City of Eagan Ordinances
Signatijreof .
Applicant:
D'La ?2I~;I
OFFICE USE ONLY
'
Certificates of Survey Received _ Yes _ No MR . 251999
Tree Preservation Plan Received Yes No Not RequveI??' d ?
r?
- - - I
OFFlCE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 4-plex ? 11 10-plex ? 16 Fireplace
Q 02 SF Dwelling ? 07 5-plex p 12 12-plex ? 17 Garage
? 03 1 of _ plex ? 08 6-plex ? 13 16-plex ?K, 18 Deck
17 04 2-plex ? 09 7-plex ? 14 Apartments ? 19 Lower Level
? 05 3-plex ? 10 8-plex ? 15 Lodging ? 20 Pool
WORK TYPE
'0 21 Porch (3-sea.)
? 22 Porch/Addn. (4-sea)
? 23 Porch (screened)
? 24 Storm Damage
? 25 Miscellaneous
? 31 New ? 35 Tenant Impr ? 39 Gas Line Only ? 43 Sid ing/Soffits/Fa scia
W, 32 Addition O 36 Move Bldg. ? 40 Gas Insert ? 44 Windows/Doors
? 33 Alteration ? 37 Demolish Bldg. ? 41 Wood Stove ? 45 Fire Repair
? 34 Repair ? 38 Demolish (Interior) ? 42 Reroof
GENERAL INFORMATIOId
Const. (Actual) r? Basement sq.
S ft. Census Code ?
(Allowable) I Main level sq. ft. SAC Code o!
UBC Occupancy 1Z" 5 sq. ft. No. of Units ?
Zoning 2-I sq. ft. No. of Bldgs a
# of Stories - sq. ft. MC/ES System
Length - sq. ft. City Water
Width ` Footprint sq. ft. Booster Pump
PRV
Fire Sprinklered
APPROVALS
Planning 8uilding l-??
" Engineering Variance
Permit Fee
Surcharge
Plan Review
License
MC/ES SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
SIW Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
o-+o
Valuation: $_ 6,omo,-?-
3- 5EAsoti1 B0 2u-+- Aff= [s-gx L4= (0720.
DeCIL_ = l7y.ptP=
I
SAC Units
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DATE
BUiL01NG INSPECTIONS:DEPT
. . ., ;?
' .t .
'
?°
1988 BUILDING PERMIT APPLICATION - CITY OF EAGAN
SINGLE FAMILY DWELLINGS
INCLUDE 2 SETS OF PLANSO 3 CERTIEICATES OF SUAVEY, 1 SET OF ENERGY CALCULATIONS
NOTEs ADDEiESSES FOR CORNER LOTS - CONTRACTOR/SOMEOWNER MUST DESIGNATE WHICH ADDRESS
IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
MULTIPLE DWELLINGS RENTAL UNZTS FOR SALE UNITS # OF UNIT3
INCLUDE 2 SETS OF PLANS, CERTZFICATE OF SURVEY - CHECK WITH BLDG. DEPT.t
1 SET OF ENERGY CALCULATIONS
COI•ASERCIAL
ZNCL[IDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1_ SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS
To Be Used For: `/? e? c`C, Valuation: -?? 7ZV - CIO Date:
Site Address
Lot ---? Block ? On site sewage_
MWCC system
Parcel/Sub On site well
ity water
Owner A Y?ly to. PRV required _
Booster Pump
Address 2 3 ?w
0 l'
??(l/?(/?,J -
City/Zip Code t49G/s-7,
Phone 7.6 1 APPAOVALS
Contractor oU??e,?E Engr/Assess
Planner
Address ??h? ? AS ??vUP Council
Bldg. Off.
City/Zip Code Variance
Phone
/i
Areh./Engr. I/
Address I/
Oecupancy
Zoning
Aetual Const
Allowable
U of stories
Length
Depth
S.F. Total
Footprint S.F.
FEES
Permit
Sureharge
Plan Review
SAC, City
S9C, MWCC
Water Conn
Water Meter
Road Unit
Treatment P1
Parka
Copies
TOT9L
?
City/Zip Code
Phone U ? ?
rn*lt c*,??06Cld
lot g B/ock3
Oueru%ew 6srQtkS Repbt
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-,-?"1""
• :?; :
tion 3uPPtonwnt To duilding Permit APPlication
wnoarc; ANO swfeTr ?ARrMMT
Sagan Decembe! 3. 1982
t ?QITY OF OATE:
. ;:$TMs wpplement is provided to essist the applicent In computfnp the EXTERIOR BNVELOPE
YERAfiE "U" FACTOR INFORMATION. This infwmation is required so the BUILDING
`$lFFICIAL can dete?mlns that the submittsd plans comply with the ENERGY CONSERVATION
aE51GN CFiITERIA of ths STATE BUILDIN(i CODE (SeCtion 6001). It Is the APPUCANT'S
reaponsibifity to accu?ately and completely compute tM data: retlect the proper DESIGN
CRITERIA in the plans; submit product spscificatlon, as reeded to support the "A" and "U"
hctors used; ond to assure ihat construcUOn Is aCCOmplished per the apprwed plans.
JOB LOCATION U.B.C. 8918
OWNER(S) Matt Langenfeld PHONE
CONTRACTOR PHONE
A. Oetermina the Total Exposed Well Aree as follows:
1. Total wall whWow area insul.
2. TWeI door area
3. Total siidinp plass door area
4. Totel Mmpleeswall area , windows tri-pane
5. Total wall framinp area (averape 1096)
B. total net wall area above floor
7. Total rim ioist area
7a,Tota1 area, garage clg. 6 ovhg.
Subtotal: Total exposed wall area ebove tloor
8. Total toundation window area
9. Total net foundation area above prede
Subtolal: TWai exposed foundatfon area:
64 sa. ft.
38
39
81
159
1225
136
542
69 sq. ft.
ORANOTOTALEXPOSEOWALLAREA 2353 sq. ft.
rx
B. Multiply the ORAND TOTAL EXPOSED WALL AREA X.185 =
?
?
C. Dstxmine 1M Total Exposed Roof/Csilinp Arga as follows:
10. Total skylfyht area
.
11. -Total rooi/ceiifnp lraminp area
12. Total net insulatod roof/csllirp area
ORAND TOTAL EXPOSED F100F/CE1ONG AREA.,:'; ,.
O. iWitiply fhs GRAND TOTAL EXP08ED ROOFICEILING AREA
?i .
--?-, _.
108 eq.?ft.
978
2284 sq. f[.
5 f,i i I
Item I 435.31
1086 eq. ft.
x.oa=
Item 11 . 4 3. 4 4
.
E. Determine the "U" velue of each Yspment (1-9) and multiply by the area as follows:
1. 64 sq. ft. X ..V.. .52 _ 33.28
2. 38 X ••u•• .45 _ 17.10
3. 39 X ••U•• .58 _ 22.62
4, 81 x ••V•• .33 _ 26.73
5. 159 x .?.. .084 = 13.36
g, 1225 X ? .049 _ 60.03
7, 136 X L .046 =
6.26
.
7a 542 X '•U" -030 - 16.26
:D, 69 X ••V• .047 = 3
24
.
ADD 1 -9 FOR TOTAL WALL SEGMENTS =
Item II1 198.88
F. Determine the "U" value of each sepment (10-12) and multiply by the erea as Tollows:
10. ---
11. 108
X
X
..V . ---
.lV.. .029
12. 978 X „?.. .024 '
ADD 10-12 FOR TOTAL ROOF/CEIIING SECaMEN7S
_ 3.13
_ 23.47
- Item IV 26.6D
G. lf item No. I!I is the same as, a/ess fhan Item No. l, you Aeve mat the infenf of State Buifding Code 6006(c)2.
H. It itenr No. IV is the same as, a less Ihen Ifem No. N, you have mef the infe»t u! Siefe Buildrng Cutle 600ti lcl 1,
1. Add Item No. I 435.31 + Item No. II 43.44 _ 478.75
J. Add Item No. 111 198:88 i Item pb. IV 26.60 _ 225.48
K. ll tlO sum W Items f!I en0 IV are lesa fAen Ifems ! end !l, you irave met the lnfent G the code !or total envelope
ayarem.
In addition to the above items you may have to edd ta such items as tloors over unheated spaces, such
as caMileverd areas, etc. '
To arrive at "U" value divide the total of the R values tor each segment (as above) into 1,000. Answer
you have is the "U" value fa that sepment.
Example: A total '•R" of 35.08 divided into 1.000 .- .028 "U"
I herebY certi{y tLet this Plan. speclficeNon oT
report woe prepared by me or under my direct
sucervision snd that I am a duly 1teRiatered
Ar?h?ct,under the lar of ?e State of Minap
e?otgJ/ 1 1 A'/ ix n
Date f ?1i Reg. Na 10833
The undersfyned, es applicant for a Buildinp Permit, hereby
afflrms the above intormation has been prepared and submit-
ted by himaelf or wMer hia direction; hereby acknowledges
the information to be correct and accurate: and hereby pre-
senta the infamatfon with requlred plans in supprnt of the
8uildinp permit Application „
Uext. walls
U = 1/20.50 = .04cf
u ext. wall fr.amin(
U = 1/11.88 =- .??b4
u Yllil ]O15t
::4 b
ufouncJ. wa]1
U = 21.07 = .097
int. air fi.!m 1: - 0.68
1/2" gypsum bd. = n,q;
3-5/8" F.G. insul. - 3.00
3/4" shthg. 'I'uff R. = 5.40
I/2" hardbcl. sdg. or I» ick - n,81i
ext. air film ??.1-
?i
1 .2"
?;-I ,"' ,.:nl:w?>?r.i 4. '
,.,?:. ::litliy. ,..f i
J; _ li,ar?ll,?l.
li\C. d I C' 1j1III
1-1i"2" sGfY.v?ood ?
3:4" 5hthq.
1/2" harcit-cf. ;;i i,:?'_rr:
c,xt .a i i- t; IIn
1: :' i . 5 3
int. air f.ilm k - O.i.H
1./2° 9YVskuu h(l.
6" F.C. insu.t. 1'>•?'?'
5/8" 9ypsum bd. plywood = 0.7'
ext. air film = 0.1'
R = :, 1
u clg./roof
U = 1/41.76 = ,024
Uclg./roof framing
U = 1/34.46 = ,029
U
garage clg,
U = 1/33.06 = ,030
int. air film
5/8" 4YPsum bd.
12" blown cellulose
ext. air film
R = 0.61.
= 0.56
= 40.00
= 0.61
R = 41.?8
int. air film R= 0.61
5/$" gypsum bd. = 0.56
3-1/2" softwood = 4.38
8-1/2" blown cellulose = 28,30
ext. air film = 0,61
R = 34.46
int. air film R= 0.61
1/2" part. bd. = 0.66
1/2" plywood = 0.62
9" F.G. insul. = 30.00
5/$" gypsum bd. = 0.56
ext. air film = 0.61
Assigned value Taylor steel walk doors
Assigned value Semco casement insul. wdws.
Assigned value Semco insul. sl. ql. door
lls;siqned value Semr_o tri-pane casement windows
R = ??.n6
0 = .45
U _ .:2
Li = .58
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?e?rerer?e o?,r Sn? w*+orcwwo 2X4F SOU PINE DN SEL STR KD
mruwwwLou 55~ w"' 2X4F S8U P1NE 13 KD
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T 2o -2369 8 2a 3460 Y 2m 1661 Y 3o -1631
T 3= •4357 B 3a 5233 w 4w 1339 Y 5n -1310
T 4m -9915 B 4a 6576 M 60 1018 Y 7m -989
T Sm -7043 B 50 9490 V 8o 697 M 9m, -668
T 6a -7741 8 6ow 7995 Y10m 376 V11= -350
T 7a -8034 B 7¦ 6099 Y12¦ 137 Y13m -108
T 8n -8032
D6F1.t LIVEs .84 IN. L/979 T9TA Lm1.16 IN. L1976
STD PANEI. D1Mm 86.01 tN.
p4 STD YEBS¦ 18.37 3N. 44.9 D8
SPC PANEL DIM= 6.31 1N.
P SPC VEHSom 14
IN
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LUMBERMAT`n CCMPAN'/
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2650 1550 PISO 'IIC YEMIIECT 11N0 [MGINEG IN M[PNUITION Of TMEIN fINK
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LUMBER Fb TOP CHORO BOT CHORD
SOU. PINE 01 DN 2250 26-0o 24-4*'
DOU6. FIR Yl DN 2050 24'-6' 23-0"
DOU6. FIR il 1750 2f-9 21'-9'
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ocSMN wio a anau [suru11ue n nu mua nr,E
800 475 bnn Inm? ?+or• n nx iutaM ram nRooucn
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REGISTERED
: PRO+':S510NI11
; ENGIYEcR
,0 ? PE, tG;,99
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CITY USE ONLY
LOT BL RECEIPT
SUBD. RECEIPT DATE:
1997 MECHANICAL PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN MN 54122
? Z • f ? ? (611)6814675
Date: f
<Comglete this section ontv if vou are instaltine HVAC in sinele familv. townhome, or condos tLat are
under construction and ace noY owner:/occupied:.
• HVAC: 0-100 M B T U $ 24.00
.4 .??
nT?I?ONAT 50 ?VT RTTI r
• Cras outlets (minimum of one required @$3.00 ea) -?
. State Surcharge: .50
• TOTAL: zy. S?D
Complete this section onlv if vou are remodeling, adding to, or repairing eaistine sinele familv
dwelliaes, townhomes, or condos.
-)( Add-on fumace _ Add on air conditioning
_ Add-on air exchanger, i.e. Vanee system, etc. _ Other
Minimum fee apnlies to all remodel or add-or.s ef exisr+r' *ese3er_ces
State Surcharge
Tatal:
STTE ADDRESS:
1??? ?l/I??da?.? ?Z? •
LA.JV
OWNER NAME: ??f V/( I vr ?,sv ,! PHONE #: r S?' ?0 9 a/
INSTALLER NAME: - ' '
PHONE #:
STREETADDRESS:RESS?ss,?M 1 VMNa'o:nsn, egn
cITY: 1815 Ea9t 4164 Str8et, Sllft9 A. STA E: ZIP:
Minneapol?s, Mr'V 55407- 2
(812) 724•1899
SIGNATURE OF PERMITTEE
CITY USE ONLY
L _ BL
SUBD.
RECEIPT#:
RECEIPTDATE:
1997 MECNANICAL PERMIT (COMfltE?C1AL)
CITY OF EAGAN
3830 PILOT KNOB RD --
EAGAN, MN 55722
(612) 881-4675
Please complete for. . all commerciaUndustrial buildings.
P multi--family buildings when separate permits are MI required for esch dweliing
unit.
DATE: , 7" CONTRACT PRICE:
2064
WOf2K TYPE: NEW CONSTRUCTION INTERIOR
DESCRIPTiON OF WORK: ?v n'??A'+cC- ?''?5? °?
FEES: ? $25.00 minimum fee 2[ 1% of contraet price, whichever is greater.
? Processed piping - $25.00
? State surcharge of $.50 per $1,000 of certnit fee due on ail permits.
CONTRACT PRICE x 1%
PROCESSED PIPING
STATE SURCHARGE
TOTAL ? Z? • 0 3
CI TF pQf1GCCR: 3S?O ???VjW
OWNER NAME:_ YvI H-2I C- YO o-rj .5 6-ril TELEPHONE ?` 7 z -6 / D ?
TENANT NAME: (:• :?ROVEMErtrs ONLr)
INSTALLER:
ADDRESS: RES3DENTIAL HEATItdG & AIR, iNC.
arr: _ Minneapolis, MN 55407-$425 STATE: ZIp:
PHONE #:
SIGNATURE:
CITY INSPECTOR
3
1985 BUILDING PERHIT APPLICATION - CITY OF EAGAN
NOTE: ALL CONTRACTORS I9UST BE LICENSED WITH THE CITY OF EAGAN
INCLUDE 2 SETS OF PLANS
3 CERTZFICATES OF SURVEY
1 SET OF ENERGY CALCULATIONS
?,?c. ? 3
To Be Used For: UeC? Valuation: (?9O?Date: ?Z
Site Address: OUe/'vl&W E5*MS /iP!"
nikt- OFFICE USE ONLY
Lot: 6 Block -? Sect/Sub Erect Y\ Occupancy
Parcel II
owner ??N Z-5i?Jb9 9H17"e/41
Address 739 Me4c{QL,1 ec(,
City/Zip Code
Phone (?/Z- ys y- 7?7s
Contractor OLJ?jer' - (1;?4 tl )
Address Sq/h c-
City/Zip Code !i
Phone
Arch,/Engr.
Address
City/Zip Code
Phone /1
Remodel
Repair
Enlarge
Move
Demolish
Grade
APPROVALS
Zoning
Type of Const
fl of Stories
Length
Depth
Sq Ft
Assessments Permit
So
Water/Sewer Sureharge $°
Police Plan Review
Fire SAC
Engr Water Conn
Planner Water Meter
Council Road Unit
Bldg Off 3 Uparks
APC Treatment P1
Variance
D D
'??S
TOTAL •
Cul( Dee ??,??e,?feW wkl ys?-?as
.'k
6o ideN rnea dow
,
/
Gurb
RJ
3830 PILO7 KN08 ROAD, P.O. BOX 27799
EAGAN, MINNESOTA 5921
PHONE (612) 454-8100
May 9, 1984
SUNWAY SOLAR SYSTEMS
245 ROSELAWN AVE E
MAPLEWOOD, MN 55117
L fp f3
D ?L? ? I L7 G[,??7 n?
sEn eLoMauisT
Mayor
THOMASEGAN
JAMES A. SMITH
JERRV THGMAS
THEODORE WACHTER
Coancil Mambers
iHOMAS HEDGES
Gity Atlminisirabr
EUGENE VAN pVERBEKE
OF ST PA[JL, INC c.!vaa?k
RE: ALLEGED SOLAR HTG INSTALLATIONS FOR:
RON GREINER, 2095 CLIFFVIEW DR, EAGAN, MN
GARY KLUENDER, 4358 LODGEPOLE DR., EAGAN, MN -
MATTHEW LANGENFELD, 738 GOLDEN MEADOW RD., EAGAN, MN
TRIEM & KIM ANH HGUYEN, 4390 BEAR PATH TR., EAGAN, MN
VERCELL & MYETTA VANCE, 4639 BEACON HILL RD., EAGAN, MN
It has come to my attention that Sunway Solar Systems allegedly
installed solar heating systems at the above referenced addresses
without inspections. This is in violation of City Code 4.03 (Per-
mits) 6.42 (Contractors Licensing) and M.C.A.R. (Mn. Code Agency
Rules) 1.1603 Solar Disclosure Statements to be provided to the
building official and the homeowner. Each of these violations is a
misdemeanor.
Take immediate steps to provide the City of Eagan with the necessary
electrical permits, heating permits and Solar Disclosure Statements
by properly licensed contractors and obtain the necessary inspec-
tions for all of the referenced dwellings or provide proof that the
installations were not of your doing. Please note that permit fees,
after the fact, are required to be doubled.
If you have any further questions, feel free to contact me.
Sincerely
Dale Peterson
Chief Building Official
DP/js
CC: Bill Akins, Electrical Inspector
Bob wieken, Mechanical Inspector
Doug Reid, Fire Marshall
Bill Adams, Plumbing Inspector
Parcel File
THE LONE OAK TREE. ..THE SYMBOL Of STRENGTH AND GR04VfH IN OUR COMMUNIiY
rnis aauas oia
18 mon[hs from .
A 41985 ?- U ? 3
V'--n
Request qate
I Fire No. Rouph-in Invuoccion
Hequiretl?
[?$eatly Nuw Q Will NoGfy Inspec-
??, - ? ? ?Yev ?Klu lor When fleadY
ELicensed Electrical Coniractor 1 heraby raquest insoectlon of above
? Owner elacVicel work instelled at
Sveet Address. Boa or qoote No. C ity
7 3 l? ? t? /i F?.% /Yl 5' c r.? /
?r !?_>?
ecLOn r,io. 7ownshio Name or No. Range No. Coun
ly
L
,/ ,?[
??l? /?Q /' T
Occupant (PflIM) Phone No.
7 -f /7 t 1CL?iJ
Power SuGVlier Adtlress
r?. ; ? /L,/•+
Elec[rical Cnn[rar,tor ICompany Namel Contrxcmr's License No.
I?'??/? ?a-
Mailinq Address (COn[racmr or Owner Making Instailation)
?
?
???? 1 ? - ?(<:•.? /" /'iii n
? '
Authorized iBnature (COnVactodOwnet Makiny Installation) Phone Numbm
',
:?-?
, ,
? v THIS INSPECTION NEQUEST WILL NOT
MINNESOTA STATE BOARD OF ELECTNICITY BE ACCEVTED BY THE STATE BOAPD
Griggs•Mitlway Blde. - Noom N-191 UNLESS PflOPER INSPECTION FEE IS
1821 UniversityAVe., St Peul, MN 55106 ENCLOSED.
Phone 16121 297.2111
This ?eq„eSt voia 0-1 L.(o, /33? 011ErUi ; ? 3(n? ?q
18 monxhs trom
27629
Request Date Fire No. H>ugh-in Inspection
qui ed? . ?Reatly Now ill Notify, InsPoc-
6 " 7 " ?'es ?No ?or When Peady
] Licensed ElecVical Con[nc[or I heraby request inspection ot above -
r? Owner ' electrical work inatelled ac .
Streat Address, Boxor Route Na City
C? ldeo eado ? iv
ecUOn o. Tpwnship Name or No. Range No. Covnty
n ta
OccupAniIPRINTI Phone Nn. ry ?7
^
7 ! ! ?
5
Po er $upplier Atldress -
DakbAf Jp/ectIi
Electrical Conlractor (Company Na
, Cnntractor's Licensa No.
?
J
MailingAtlJress (COnVacmr or Owner Making Installation)
(J J -' CY V
Auffiorize ignat-r IContractor 0 nerMakinB ?ns latio 1 Phone Number
p?
S ? ! 75--
MINNEGA STATE BOARD - OF ? ELECT THIS INSPECTION NEQUEST WILL NOT'
Y Grigge•Midwey Bide. - Aoom N-797 BE ACCEPTED BY THE STA7E BOARD
7821 Univeraity Ave., St Peul. MN 65104 . ' UNLESS PROPER INSPECTION FEE IS
V6o.o 1612129Z2t11 ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION EB-00o01:15M
See instructions for completing this torm on back
'027629 of yellow copy.
? "
"X" Below WorK'CoveZd by Thrs Request ?)
?(p2 a?{
N Add Pep. ^+Type ol Builtling AoPliences Wiretl Eqvipment Wired
Home Range . Temporary Service
Duplex Water Heater Lighting Fixtures
Apt. BuflAing Dryer Electric Heatin -
Cummercial Bldg. x . Fumace Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tank
Fyrm Other pea y Other (Sper,ify)
t r SVecify Other ' Oth.r
Compute lnspection Fee Below '
p Fee SarvicaEntrenceSize M Foa Feaders/Subteetlers k Fee Circuita
0 tot00qms 0 to30Ams q.2,570 0 to30Am
707 to 200 Amps 31 to 100 Amps 31 to 100 qm
Above 200_qm Above 100_Am s Above 100_Am s
Trensiormers Remote Control Circ. Partial%Other Fee
Signs Special Inspection S (•C7
OT FE
Remarks (O OO E
y
?
Rough-in ?( ? ? ? e Elactrical
C./, ??• ?ectoq heraby
fly th t th above
Final inspection has been
This reo,,est voitl
16 monlhs fwm
REQUEST FOR ELECTRICAL INSPECTION
See instructions lor comoi ej+a9 this torm on back ot vallow copy.
A "X" Below Work Covered by 7his Request
FAd N6p. , Type of Building Appliancea Wired EquiVment Wired
Home Range Temporary Service
Duplaz Water Heater Lightiny Fixtwes
Apt. 8uilding Uryer Electric Heatin
Commercial Bidy. Fumace Silo Unloader
Industrial Bldg. Air ConAitioner Buik Milk Tank
Farm ooner vxm v orher f5neciM
t er SVeoify Other Othc,
Compute lnspection Fee Below
p Fee ServiceEniranceSiza k Fee Feeders/5u4ineAers # Foe -0ircuits
0 to 200 qm s 0 to 30 qm s 0 tn 30 Am s
Above 200 qm ?s 31 to 100 Amps 31 to 700 Am
Swimming Pool Above 100_Am s Above 100_Amps
Transiormers Irrigation Booms Partial,'Other Fee
Signs Special Inspection
5
TOT
F
Hertarks ;;Q 5-43 ^
E E
- i i
I RouBh-in , ??1e I, the Electrical
Inspec?oq heroby '
certify thaf the above I
Final e ' spection has baen
meae.
This reQUesl voitl 18 months from