854 Govern Cir• il\IJl L' l? 11V1\ 1\1?1?V1\L ?
CITYOF EAGAN PERMIT TYPE:
3830 Wilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued: '
(612) 681-4675
SITE ADDRESS: APPLICANT:
.
:11 teM, A R
',t?llF:lHWti) CIl3 f"t1Nt)s. .'Mtl f ti 1 .11 4 4 F+4 -4mb;i ".,
PERMIT SUBTYPE:
TYPE OF WORK:
aart
INSPECTION DA . DA
. . ; ? ry A ,
PFIMAl2kSr 4 -&114 F'1.!!NlBFk lK&41 Rft17FA h Sf WFR
fi'1 AN FdF.V]C'4.11 (1 f1Y MTNF EiAPir1
t'
Parmft No. PermR Holder Dete Telaphona #
ELECTRIC
?.
PLUMBING
HVAC
Inspection bate Insp. Comments
FOOTINQS Y??S/?
! ?•
FQUND y?6 G ? o?b y?=
FRAMING
dy G` ?
ROOFING
ROUGH
PLUMBING
??
_??t' ?,?'?f- ?67 ?F?i,q
PLBTEST
AIR ? 4s
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYP BOARD - _,
FIREPLACE
FIREPLACE
AIR TEST ,
FINALPLBCi y
!i"+C!
FINAL HTG
?J
ORSAT
TEST •
BLDG FINAL
(?J
BSMT R.I.
BSMT FINAL
DECK FfG
DECK FINAL
Address` r 854 Govmtv cr?tCLE A Zip 5512 2
I.ot 3 Blk 4 Sub c.aunmuvin wmms mvn
THESE ITEMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECTION.
Date: -] a_p 9 g' es No Inspector:
Final grade (6" from siding)
Permanent steps (gazage) r/
Permanent steps (main entry) ?
Permanent driveway
Permanent gas
Sod/Seeded grass ?
TcaiUcucb damage
Poreh tl
Basement finish ?
Deck ?
Please verify with the builder the removal of roof test caps from the plumbing system and the shuboff of water supply W
[he outside lawn faucet before freeze potential exisis.
Contact engineering division at 681-4645 before warking in rightvf-way ot insfalling underground sprinkler system.
White - City Copy Yellow - Resident Copy Pink - ContraMOr Copy ?
.
City of EapIl
3830 Pilot Knob Road
Eagan MN 55122
Phone: (657) 675-5675
Fax: (651) 675-5694
2008 RESIDENTIAL BUILDING PERMIT
? forOffce?U'se --------- -
? Permit?? ?y/ o I
? Permit Fee:
? Date Received.
i i
? Staff: ? i I
APPLICATION Clqlld
Date: 5ite Address: O 59 (0 0 v a n ti) C 2
Tenant:
Suite #:
RESIDENT / OWNER Name: M r? L? n? Fc. ?h o Phone: (D 014 q, 11 $2.
Address / City / Zip: SS 4 ?n ? cti ti (? (Z
Applicant is: _ Owner C Contractor
TYPE OF WORK Description ofworic: Q p: ?OOM
c
Construction Cost :?, c7-t7u. Multi-Family Building: (Yes _! No K-)
CONTRACTOR Name: License #: a N S 2? y J
Address: r'1 ?61'? T?v? G Pa{L. ??l??5?'tFR'S
City: State: MN) Zip: S S OLl N
Phone: (D ?a 3?3 - 7`I s"Z Contact Person: ? ?r-
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDtNG
Minnesota Rules 7670 Cateqorv 1 Minnesota Rules 7672
Energy Code . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
CBtCgOry Submitted Submitted
(4 submission type) • Energy Envelope Calculations Submitted
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes ?lo If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phane:
Sewer & Water Contractor: Phone:
,?. NOTE: Plans and?supporiing;docurrienCs tha`t yoa submit are considered `to be pu,blic information. Port ions of
`the information'may be classified as non=public if you provide,speciiic reasons;thaf would permifthe City to
-condude thatlhe are trade seciets:
I hereby acknowledge that this information is complete and accurate; that the work will 6e 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 lhe work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
-----------------
X ?,J X -?
ApplicanYs Printed Name ___. i a ure
Page 1 of 3
DO NOT WRITE BELOW THIS LINE
SUB TYPES
? ? Foundation ? 05-plex ? 16-plex ? Accessory Building ? Pool
pf, Single Family ? 06-plex ? Fireplace ? Porch (3season) ? Ext. Alt. - Multi
? 01 of _ Plex ? 07-plex ? Garage ? Porch (4-season) ? E#. Alt. - SF
? 02-Plex ? OS-plex ? Deck ? Porch (screen/9azebo/pergola) ? Multi Misc.
? 03-Plex ? 70-plex ? Lower Level ? Stortn Damage
? 04-Plex ? 72-plex ? Miscellaneous
??^?"' ? 0"Kf\,
? ? ?-/ E?-?
WORK TYPES ?
? New ? Interior Improvement ? Siding ? Demolish Building°
? Addition ? Move Building ? Reroof ? Demolish Interior
?L Alteretion ? Fire Repair ? Windows ? Demolish Foundation
? Replacement ? Egress Window ? Water Damage
` Demolition (entire building) - 9ive PCA handout to applicant
DESCRIPTION:
Valuation Occupancy ? MCES System
Plan Review Code Edition SAC Units
(25°l0_ 100% ?/ 1
?J Zoning City Water
Census Code Stories Booster Pump
# of Units Square Feet PRV
# af Buildings Length Fire Sprinklers
Type of Const. Width
Y ?J
REQUIRED INSPECTIONS
Footings (new bldg)
Footings (deck)
Footings (addition)
Foundation
Drain Tile
Roof: Ice & Water Final
Framing
? Fireplace:4R.l. -**4irTest ]?Final
Insulation ?
Sheetrock
Fina1/C.O.
Final/No C.O.
HVAC
Other:
Pool: _Footings _AirlGas Tests _Final
Siding: _Stucco LaTh _Stone Lath _Brick
Windows
Retaining Wall
Reviewed By: r 1 (,?' , Building Inspector
RESIDENTIAL FEES:
Base Fee
Surcharge
Plan Review
MClES SAG
City SAC
Utility Connection Charge
S8W Permit & Surcharge
Treatment Plant
Copies
Total
W
Page 2 of 3
)Y}YA:'?Y)W:*M?tw*Ym
t:'7:'tv t,4: rAGAN
CA';hf!.cRs 1S 7Ef't+SINAL Nqe 709
TiA41-:: 04!i.`:i/90 'i'7'M!rr 1503244
:i.W
NAM'.:; U Fr HORTC)N I`!C;
???-?; .?n`J,'I Fi'-i4 r ?.]J ri ? ,,i?d ;'I.ft r - ? ...::;. s:?•;? . r.
r_c...i =? 3?
?.
1 .
T7tB]. EiElCrypi, AttiCiit'Yi;;; 0820,.2i.
(;12tJli"9533
l;SL"R !iie JAN
? ?;?k:?"? rt%?;Y'*?1<;;A;ac;;i:qX??>?:?.>}:>;c.k:?;?„•a>"?%??'?:?;: ?;o;:x;;;;.RC;t
? -.CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS:
P.I.N.: 10-28801-030-04
PERMIT
PERMITTYPE: BuiLoxNG
Permit Number: 031775
Date Issued: 0 4/ 14 / 9 8
854 60VERN CIR
LOT: 3 BLOCK: 4
GARDENWOOD PONDS 2ND
DESCRIPTION:
Building_.Permit Type
Building Wo,rk Type
UBC occupayncy=.?t
CorlaCructinn T"y'pe
2 o n f n g
j square Feet
r Cenrus,.Ca.efg
??\ 41?.g f , . ,
SF OWG
NEW
R-3 U-1
VN
R-1
2,917
101 1 -- FAM_ DET•.ACH
f.i i"5? r ?E 7
?i
Lf?
REMARKS:
5&W PLUMBER - M&W WATER & SEWER
FEE SUMMARY:
Base Fee
Plan Review
Surcharge
5AC
SAC %
SAC Units
Subtotal
VALUATION
$1,872.25
$1,216.96
$148.50
$1,000.00
100
$4,237.71
pLAN REVIEWED BY MIKE BARCK
$297,000
MISC FEES $1,592.50
Total Fee $5,830.21
CONTRACTOR: - Applicant - sT. Lzc.OWNER:
I{ORTON INC OF MN, D R 14544663 2000565 D R HORTON INC
3459 WASHINGTON DR 204 3459 WA3HINGTON OR
LAGAN MN 55122 EAGAN MN 55122
(?612) 454-4663 (612)454-4663
204
?
I hereby acknowledge that-.I, have read=this',application .and sCate that, tiMe
in'fortnation is correot an_d agr-eo ?'to cvtlrply"w'i;Ch-
Statutts APERM,Tr fi Eagan Ordirs ances.=hLC.l-c,--
ATURE ISSUED BY' IGNATURE
a a/
jf 25- 1998 BUILDING PERMIT APPLICATION (RESIDENTIAL) '
CITY OF EAGAN
5830 PII.OT KHOB RD - 68122
681-4675
New Constrvdion Reauirements RemodeVReoair Reouirements
? 3 registered sRe auneys
? 2 copies ot plans (inGuCe beam 8 window saes; poured fnd. Cesign; elc.)
• 1 enargy wlalffiions
? 3 copies of tree preaervetion plan if IM pWtted efter 7l1193
required: _ Ves X No
DATE: W- 9- 1S
Name: Phone #:
Last Firsl
DESCRIPTION OF WORK: AIGW CohSt>' c.-fibv,
STREETADDRESS: ?SGI ??7vC+?n Gi? I
LOT: 3 BLOCK: SUBD./P.I.D. #: G???sJwx? 4Nd S
PROPERTY
OWNER
CONTRACTOR
ARCHIT'ECTI
ENGINEER
? 2 copfes of plan
? 2 site surveys (euterior addRions & dedcs)
? t energy cslculations for heated addkions
CONSTRUCTION COST; _I960S3v
Street Address:
CiTy
State:
Zip:
company: dle/a SneMr/1cr/?vuSPhone#7: 41YS14kk-? ??/a7y
Sneet Address:?? br"ve-0 SIG..Zvy License # r,7GZ4a5-&57
City ??Cs? State: /}9,(/ Zip: .$`S/?a
Campany: Phone #:
Registration k:
Street
City
State:
Zip:
Sewer 8 water licensed plumber (new construction only): A1 ?? ale,, (- ?Ck/Gr . Penalty applies when address chang
and lot change is requested once pertnit is issued.
I hereby acknowledge that I have read this application and state that the infortnation is correct and agree to comply with all applicam
Stete of Minnesota Statutes and Cily of Eagan Ordinances. .
Signature of Applicant
OFFICE USE Ot?IcY
Certificates of Survey Received 1/ Yes _ No
Tree Preservation Plan Received - Yes _ No I
BUILDING PERMIT TYPE
O 01 Foundation ? 06 Duplex
J;r-02 SF Dwelling O 07 4-plex
? 03 SF Addition 0 08 8-plex
? 04 SF Porch ? 09 12-plex
0 05 SF Misc. ? 10 = plex
WORK TYPE
13? 31 New O 33 Alterations
? 32 Addition ? 34 Repair
GENERAL INFORMATION
OFFICE USE ONLY
? 11 Apt./Lodging ?
? 12 Muiti RepaidRem. ?
? 13 Garage/Accessory ?
13 14 Fireplace ?
? 15 Deck
? 36 Move
? 37 Demolition
Const. (Actual) VAJ Basement sq. ft
(Allowable) vN Main level sq. ft.
UBC Occupancy R?T i 2`'?`? sq. ft.
Zoning fL- I ?.NqQ
'G?T sq. ft.
# of Stories 2- sq. ft.
Length sq. ft.
Depttt Footprint sq. ft.
APPROVALS
Planning
Building A4e
t
16 Basement Finish
17 Swim Pool
20 Public Facility
21 Misceilaneous
llw MGWS System ?
City Water ?
23y Fire Sprinklered
9 sl PRV
Booster Pump
Census Code. i ca 1
7- 1 SAC Code ?
Census Bidg ?
Census Unit !
Engineering
Variance
Permit Fee Valuation
Surcharge
Plan Review
License g u
MCNVS SAC ?O?
City SAC 411 '/ 3
W8t8P COnh ?3. ?s Ks
.
Water Meter Z„?y
Acct. Deposit Z u 4
S/W Permit
S/W Surcharge ??-
Treatment PL
Park Ded. 7 y
Trails Ded.
Other
?
Copies -
.-: ???, c.tyr??l
r:
TOSdI:
% 5AC ?vY Z
SAC Units <-
'
-.?-
$ Zq "1 r vv0. ?
i
390 ?40, 5 x z 2.(.
Z7, s
zg
?--- i--
iqs?.sro?lzs_ v8,?87,s
iGSy. S
L. 7?
? f 1
?
z9z?? 9.57,_
c-. zs rl tl sq = 10 4.1 1'7 7.5
z v 74
?(.
LS
a?
i.?--
a3??4 rI?s<?- ia?-,s7L.-
A
?
u? ? >
s q
? ?
? ?
? ?
?
i?o ?
?
> ?
? ?
C?p ?
C? ? ?
-0' 0 ?
,e-'o 0
or' O ?
? ? ?
PROPERTY LEGAL:
LOT SURVEY CHECKLIST FOR RESIDENTIAL
BUILDING PERMIT APPLICQTION ,
DA I t Oh SUKVCY:
LATEST REVISION:
DOCUMENTSTANDARDS
• Registered Land Surveyor signature and company
• Building Permit Applicant
• Legaldescriptlon
• Address
• North arrow and scale
• House type (rambler, walkout, split w/o, split entry, lookout, etc.)
• Directional dreinage arrows with siopelgradient %
• Proposed/exassdng sewer and water services 8 invert elevation
• Streetname
• Driveway
ELEVATIONS
ExdsHna
• Sewersenrice(orProposed)
• PropeAy comers
• Top ot curb at the driveway
• Elevations of any existing adjacent homes
Prooosed
o'0 ?
d ? ?
,a' ? ?
Cr ? ?
Er?o ?
• Garegefloor
• Firstfloor
• Lowest exposed elevadon (walkouUwindow)
• Property comers
• Front and rear of home at the foundation
PONDING AREA (iatoolicable
? a--,0
O Q' ?
? ?ff' ?
? 6, ?
? cl-? ?
E3- ? ?
cr ? ?
[3? ? ?
l3? ? ?
O'- ? ?
? m?
• Easement line
• NWL
• HWL
• Pond # designatlon
• Emergency Overflow Elevation
• Lot IfnesBearings & dimensions
• Right-of-way and street width (to back of curb)
• Proposed home dimensions including any proposed decks, overhangs greater than 2',
porches, etc. (.e. all structures requiring permanent footings)
• Show all easements of record and any Cily utiliGes within those easements
• Setbacks of proposed structure and sideyard setbac of adjacent existing structures
• Retaining wall requiremenLs, if a
? O
Reviewed:
January 1996
cpA1G19B813LOGPRMT FM
' 14750 Galaxie Ava Suite 104
Apple Vailey, Minnesota 55124
(672) 432-2044
rX7TRIOR FNVE:I,OPF AVF RAGE "U" COMPTJTAT.LON
NnME F. i<. , I 1 f? A 7`f'n1 PLAAI NUMT3ER W u Li A L- = P U P6,
Detennine viorkiry; square footage of each
1. Total exposed wall area. ..... sq.ft. X .11
113,a
2. Tota.l roof/ceiling area...... 4i.?->! sq•ft. X .026
Total exposed wall area above floor =4 ', 9C2
a. Total vrall vrindow area . . . . . . . . . . . . . . . . LI 13CK, z
b. Total door area ......................... --?•Y
c. Total slidlrg glass door area........... -F(-
d. Total fireplace wall area .............. --
e. Total ivall framirg area (averag,e lOq) ... =t ?• 9.6?
f. Total net wall area above floor.........
g. Total rim joist area ................... YU`Total exposed foundation area = Jk!
h. Total foundaL•Son window area............. '-'
i. Total nct foundation area above grade... Xki
Determine "U" value of each wa11 sepgnent
a. X [fU° .52 = Z4: 7..7r:
b. X "U" .139 = S•Z?
c. Y, nUff .92 = 5 2
d. x "ir" .68 = -
e. x iiUif 096 = Lai , / L,
f. x "U" .043 = rilkl
g • X nUil .041 = 1-•G
h. g tiUll .52
_ ?.
.082 = 9 I
3. TOTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If iten N3 is the same as, or less than iten /fl, you have
met the intent of SBC 6006 (c) 2.
-1-
? - -.
Total exposed roof/ceilirg area
Total gross roof/celling area
1. Total sY.ylight area ................... -
k. Total roof/ceiling framing area.......
1. Total net 17sulated roof/ceilirAg area. ? 91.7,.
Deterniine "U" value for each roof/ceiling seP3nent
1. X "U" _
k. xITUII .024
= 1 a• ?! ?-.i
1. X vUn .022
_ $G, Z
4. 'lUTAL ..............................
If total of H4 is the same as, or less than #2, you have
met the intent of SBC C006 (c) 1..
To utilize the total envelope systen method, the values
established bv the siun of itans #3 and #4 shall not be
greater than the swn of it rnts N1 and N2.
1. `a-,7 ,I`?) + 2. i 1 -?,2 _ 6 4",.(,
g, + 4. 9 (r.ti`?
P•Taterials Thetmal resi:>tance "R"
Fxterior air.........
Sidj,tg material......
Sheathing ...........
Insulation...........
Sheetrock............
Interlor air.........
?1Til .................
Concrete blocks......
-2-
cr.rv oF r_nr,AN
f:AF.iFI:f.F'R. Jti 71=RMTNAL. R0; 768
DFl7E ; 0'7/23/99 TIMF_." 12:07:55
Ilt :
NAHE:: TFlE FIF:FF'LACE CENTER
321A 9001 654 GOVf::F'N C.T.fi 60.00
2155 9009. FS`.ih G(1VF:fiN C'Sfi 0.50
/
Tol::a7. ReceiN+, Amuunt;a 60.50
f,F i i.40`.:)3
USF.R 1Dc :7r1N
?) (? Q! (°<?-
Date: rl -Z 1
Description ofWork:
-1 (?? o
1999 FIREPLACE PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB ROAD - 55122
651 681-4675
?1
? Construct new fireplace 4Gas _Masonry _
_ Install ¢as insert an/y _
Other
Job address: 8 S[ (?(? ??.?IGK? ? L 2?i??
Lot: Block: ?4_ Subdivision/P.I.D.#:?? (J ??(J ?
Applicant (circle one only): Owner nhactor
/
Alterations to existing
Install pas /i»e onlv
A
Permit Fee: $60.50
PROPERTY
OWNER
FIREPLACE
INSTALLER
GASLINE
INSTALLER
Name: 761Y () V 1 \Q i ?n.' L t v/l v1 Phone #: (o?? 4,?
Last FirstQ!
Street
City
Company:
Phone #:
(area code)
Sheet Address: /4-``f uru W jf'Tlq . 11j4 V U-k
City d'/,IjLA State:///4i
Zip: ?
Company: ( r tc- Pl{QCe-, • •wi?..? Phone #: (?l Z'SZ{S_??Jn(
(azea code)
Street
City
State: Zip:
State:
Zip:
I hereby acknowledge that I have read this application and state that the information is cortect and agree to
comply with all applicable State of Mianesota 5tatutes and City of Eagan Ordinances.
Signature
L ? gL ? CITY USE ONLY
sueo, Cc.no?¢????o2?'d
RECEIPT#. 9?7
RECEIPT D„E:
1997 PLUMBING PERMIT (RESIDENTIAL)
CITY OF EAGAN
(?/
3830 PILOT KNOB RD 3/
r>
EAGAN, MN 65122
(612) 681-4675
Please complete for: ? single family dwellings
? townhomes and condos when pertnits are required for each unit
? backflow preventer for underground sprinkler system
FlXTURES FACH NQ. TOTAL
Shower 3.00 x =
Water Closet 3.00 x =
Bath Tub 3.00 x =
Lavatory 3.00 x =
Kitchen Sink 3.00 x =
Laundry Tray 3.00 x =
Hot Tub/Spa 3.00 x =
Water Heater 3.00 x =
Floor Drain 3.00 x =
Gas Piping OuUet ' minimum - 7 • 3.00 x =
Rough Openings
' 1.50 x =
00 x
5
.
for dwellings under consWdion
Water Softener
Water Softener ' for existing dwelling 20.00 x =
U.G. Sprinkler ' for dwelting under const 3.00 =
U.G. Sprinkler ' for exiating dwelling 20.00 =
fUterdtlons ` to existing residence 20.00 =
Water Tum Around 20.00 =
Private Disposal System ' Dak Cly lic. 75.00 =
(new and returbished systems)
Private Disposai Systems ' Abandonmerrt 20.00 =
STATE SURCHARGE .50
TOTAL ?ah-?
I hereby adcnowled8e that I have read this applieation, staM that Me intomiation is corted, and agree to comply wi[h all epplicable City
M Eagen ordinences. tt Is the applicaM's responsiblllly to notHy the property owner thet the City of Eagan asaumes no IieGiliry for any
damages causeC by the City during Ms normal operational ard mahrtenance ecfivitles to the fsdlilies construGed umler this pertnk within
Cily proparrylright-of-wayleesemeM.
&?
SITE ADDRESS:
OWNER NAME: " o
INSTALLER NAME: TELEPHONE
STREET ADDRESS:
CITY: STATE: ZIP: If,
-7
SIGNATURE OF PERMITTEE
?YW,Yf•?tY.*',<'-;:Y,tn"•?h'k.?:'4:?,Y,;'KA; 8'Y,??;.7yk?:'.!?`K?',cri[?YYi?%F'R'i<'?''k.h'iW:?YF
cfTY OF EAr;AN
CA:>1-t'I:ERe S rl:"F2NINFd_ NO: 71.^
DR(L=m 0409199 'Y'it1}:.:, 104500
ZDa
tJAP1F:: h1AF:Y LYt•!N f-"(aF';RO
t''!.t 5 9001 834 GC?YFIRN r:71i 0.50
32:LO J(]Cli. E351 t';i)!1ENrN tv7.l; >,U.t:lq
ti
?
Tn!,a:!. Fiec:espt (imc,un*.,a 60.50
Cf' i fl6°s::•! !.
t.liEb: 'I:rrv NAtaGY YF?X1KXt.4:??F%fi?k?(?k:kMYF??n:?t#;rW 'M>'F%??Y?k;?'?kMRtkW:%nM?'?h"•?i'%;
1999 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN c? (o 0 tTo
3830 PILOT KNOB RD - 55122
651-681•4675
New Constructlon Reauiremenls
? 3 regfatered sHe surveys showing sq. fl. of lot, sq. tt. oF house
and aIl roofed areas (20% maximum loi coveraae allowed)
? 2 copies o1 plans (ahow beam & wlndow skes; poured intl. destgn; eic.)
? 7 sei ol energy calcvlations
> 3 copies of iree preservation plan N lot plafled aHer 7/1/93
DATE: ?g /? /
DESCRIPTION Of WORK: H!?o/ l"lt1
STREET ADDRESS:
Remodel/Reoair Reauirements
2 coples of plan
1 sef ot energy calculations lor heated addflions
1 stte survey for exterior addflions 3 decks
CONSTRUCTIONCOST:
f2CG ? , ??9
LOT: :?-) BLOCK: 'A SUBD./P.I.D. #: G
14ic.? , Aiv 5 5 jL?'
?cn,"c? -') K-0
PROPERTY
OWNER
CONTRACTOR
ARCHITECT/
ENGINEER
Name: /-ila raJ 61 F? L Phone #: (9-5?1 7' -5?Z "' J V?U 60
Lasi Fhat
Street Address: ("O(/eJi?/(/ (_'//?re4?C.
/V ?
city /=0? state: h5V ziP: 5 S?°?3
Company: Phone #:
(area code)
Street Address: License # Exp.
City
State: Zip:
Name:
Tetephone #: area code ( )
Street Address: Registration #:
City
Sewer 8 water Itcensed plumber (required for new conshuction onlv):
State:
Penalty applies when address change and lof change is requested once permit Is issued.
I hereby acknowledge that I have read this application, state fhat fhe Informatton is cortect,
State of Minnesota Statutes and CNy of Eagan Ordinances. <:?') A -
Sfgnature of
OFFICE USE ONLY
Certificates of Survey Received _ Yes _ No '
Tree Preservation Plan Received Yes _ No _ Not Requi
Zip:
ree to comply with all applicabie
`° I?JJ
I
OFFICE USE ONLY
BUILDING PERMIT TYPE
r " 1
? 01 Foundation ? 06 4-piex ? 11 10-plex ? 16 Fireplace ? 21 Porch (3-sea.)
? 02 SF Dwelling ? 07 5-plex ? 12 12-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.)
? 03 1 of _ plex ? 08 6-plex ? 13 16-plex J?r, 18 Deck ? 23 Porch (screened)
? 04 2-plex ? 09 7-plex ? 14 Apartmen ts ? 19 Lower Level ? 24 Storm Damage
? 05 3-plex ? 10 8-plex ? 15 Lodging ? 20 Pool ? 25 Miscellaneous
WORK TYPE
LK- 31 New ? 35 Tenant Impr ? 39 Gas Line On ly ? 43 Siding/Soffits/Fascia
? 32 Addition ? 36 Move Bldg. 0 40 Gas Insert ? 44 Windows/Doors
? 33 Alteration ? 37 Demolish Bldg. d 41 Wood Stove ? 45 Fire Repair
? 34 Repair ? 38 Demolish (Interior) ? 42 Reroof
GENERAL INFORMATION
C
t
A
t
l 5- J L `
ons
. (
)
c
ua Basemsnt sq. ft. Census Code
(Allowable) 5 --;j Main level sq. ft. SAC Code v I
UBC Occupancy R, g sq. ft. No. of Units ?
Zoning fL• I sq. ft. No. of Bidgs ?
# of Stories sq. ft. MC/ES System
Length sq. ft. City Water
Width Footprint sq. ft. Booster Pump
PRV
Fire Sprinklered
APPROVALS
Planning Building ? Engi neering Variance
,?,, e4? .
?
Permit Fee Valuation: $ V ?- +??
Surcharge
Plan Review
License
MC/ES SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
SNV Permit
S/W Surcharge
Treatment PI.
Park Ded.
Trails Ded. .
Other
Copies ,
Total:
SAC Units
% SAC
BL CITY USE ONLY
RECEIPT#: pq
O I(Q3 ?
SUBD. ? RECEIPT DATE: &_
1998 PLUNE11ING PERMIT (RESIDENTIAL)
CITY OF &AGAN ,
3830 PILOT KNOS RD
EAGPSI, M 55122
(612) 681-4675
Please complete for: ? single family dwellings
? townhomes and condos when permits are required for each unk
? backflow preventer for underground sprinkler system
'
FIXTURES
EACH
#
TO AL
Shawer 3.00 x =
Water Closet 3.00 x
Bath Tub 3.00 x =
Lavatory 3.00 x =
Kitchen 3ink 3.00 x _L =
Laundry Tray 3.00 x
Hot Tub/Spa 3.00 x =
Water Heater 3.00 x
Floor Drain 3.00 x
Gas Piping Outlet ` minimum -1 3.00 x
Rough Openings 7.50 x
Water Softener ' for dwellings under construction 5.00 X =
WaterSoftener "forexistingdwelling 20.00 x =
U.G. SpfinklBf ' for dwelling under wnst. 3.00 =
U.G. Sprinkler ' for existing dwelling 20.00 =
Alterations ' to existing residence 20.00 =
Water Turn Around 20.00 =
Private Disposal System ' MPC iic. 75.00 =
(new and refuPoished systems)
Private Disposal Systems'Abandonmant 20.00 =
STATE SURCHARGE .50
TOTAL 21-1-dD
---------------- • - ------------------- ? -------------• --------------------------------------------------------------- - • ----- -------------
i hereby adcnowledge that I have read this applica6on, state that the information is wned, and agree to comply with all applicable City of Eagan ordinances.
It is the apD?icanYs responsibility to notify the property owner that the City of Eagan assumes no liability for any damages caused by the City during its
nortnal oparationat and mainienance activitias to the facilities wnstruded under 1Ms pertnit wilhin City propartylrigM-of-wayleasement.
SITE ADDRESS:
OWNER NAME:
MSTALLER NAN
STREETADDRE
cirr: ?IYJD[.!/7f STATE: ZIP:
OF PERMITTEE
JSIFORMS BL6GlPLBG PERMIT (RESIDENTIAL) 1998
? CITY USE ONLY
? _.
LOT ? BL RECEIPT k:
SUBD.)<?/irO(2yu.rf07JD( (? GY ? RECEIPT DATE:
RECEIVED 1998 MECHANICAL PERMIT (RESIDENTIAL)
cxxY oF EAcax
N'10 12 3830 PIIAT IQNOS RD
EAGAN MA7 55122
BY, (612) 681-4675
Complete this secrion onlv if you aze installing HVAC in single fanuly, townhomes or condos under
construction and not owner /occupied
• HVAC: 0-100 M B T U $ 24.00
ADDITIONAL 50 M BTU 6.00
• Gas outlets ( minimum of one required @$3.00 ea.) ?? OD
• State Surchazge: .50
• TOTAL: . SD
Complete this section onlv if you aze remodeling, adding to, or repairing existing single family dwellings,
townhomes, or condos. Note: Mechanical pernut is not required for alterarion/add-on to ductwork in
existing residential units; but is required for the following:
Install furnace _ Install air conditioning
Install air exchanger, i.e. Vanee system, etc. _ Other
Minimum fee applies to all remodel or add-ons of existing residences $ 20.00
State Surchazge .50
Total: $ 20.50
SITE ADDRESS: Q? o '(? 6? ? ' '/-
OWNER NAME: 'C' ? PHONE
INSTALLER NAME: PHONE ?0 U? ?O C) a
STREET ADDRESS:
CITY: STATE: vl_ ZIP:?
?-----?
SIG OF PERMIT"fEE
1S/FORMS BLD/MECH PERMIT (RES) - 1999
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for
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OF SURVEY
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Lowest bsmt flr = 900,Zy.
Scale: 1" = 30' 854 Govern Circle
DESCRIPTION
I hereby certify that this survey, plan, or
report was prepared by me or under my direct
supervision and that I am a duly Registered
Land Surveyor under tha Laws of the Stote
of Minnesota.
Date 23 v?NA-12- 1998 Reg. No. 8140
Lot 3, block 4,
GARDENWOOD PONDS SECOND
Dakota County, Minnesota
Plat bearings shown
o Denotes iron monument
? Existing j Proposed
BRANDT ENGINEERING & SURVEYING
1600 West 143rd Street, Su ite 206
Burnsville, MN 55306
(612) 435-1966
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BUiLDING INSPECTIONS DEPT.
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To curb to Gar slab = Z_1 _
Top block = 9o7.4S
Lowest bsmt flr = 9001??i
Scdle: 1" = 30' - 854 Govern Gircle
DESCRIPTION
I hereby certify that this survey, plan, or
report was prepared by me or under my direct
supervision and that 1 am a duly Reqistered
Land Survevor under the Laws of the State
of Minnesota.
Date _ Z3 Uitf6-n.- 1995 Reg. No. 8140
Lot 3, block 4,
GARDENWOOD PONDS SECOND
Dakota County, Minnesota
Plat bearings shown
o Denotes iron monument
? Existing j Proposed
BRA9NDT ENGINEERING & SURVEYING
1600 West 143rd Street, Suite 206
Burnsville, MN 55306
(612) 435-1966
.-
M32-1695-98