857 Govern Cir
Use BLUE or BLACK Ink
For Office Use
I I
City of EaRdfl Permit
I
00
I Permit Fee: 127,
3830 Pilot Knob Road I r ;
Eagan MN 55122 RECEIVED i Date Received: >f` j
I
Phone: (651) 675-5675 I jEr
Fax: (651) 675-5694 NOV U 8 2010 1 Staff:
- J
i
2010 RESIDENTIAL BUILDING PERMIT APPLICATION CA ( `Ctt
Date: j 1 i Q Site Address: b S 7
Tenant: Suite M
RESIDENT/OWNER Name: T P-5 116(1 J~1fY I Phone: 6s/ +s6- 0~,7L
Address/ City/ Zip: 957 I C?'~ll 11~G{.~ .
Applicant is: Owner X Contractor
TYPE OF WORK Description of work: Rod sfyvcruye_ uyyl- Fvox,,- JoLT',/-
vc~
Construction Cost: 1500 Multi-Family Building: (Yes / No,,X-L)
CONTRACTOR Name: S JET t N' ISO c d`'~1 License
Address: q3 Ljctvd1avLck Ty-'A,t~ City:
State: l~ Zipj:~ 5' j Z 3 Phone: ~Li j~ - ~3 S ? 3
Contact: Av LJ~ ~ Email: J T~VI~y U 5 C~ GGVi
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that the 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.goi)herstateonecall.org
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
X. ?A 'U w1 ~il tttuIr - x
Applicant's Printed Name Applicant's Signature
Page 1 of 2
(c-
DO NOT WRITE BELOW THIS LINE
SUB TYPES
Foundation _ Fireplace - Porch (3-Season) _ Storm Damage
Single Family _ Garage - Porch (4-Season) - Exterior Alteration (Single Family)
Multi _ Deck Porch (Screen/Gazebo/Pergola) _ Exterior Alteration (Multi)
_ 01 of _ Plex _ Lower Level T_ Pool _ Miscellaneous
Accessory Building
WORK TYPES
_ New _ Interior Improvement _ Siding _ Demolish Building*
Addition _ Move Building _ Reroof _ Demolish Interior
- Alteration _ Fire Repair _ Windows _ Demolish Foundation
_ Replace _ Repair _ Egress Window _ Water Damage
Retaining Wall *Demolition of entire building - give PCA handout to applicant
DESCRIPTION
Valuation Occupancy MCES System
Plan Review Code Edition 1114 J~,2 2V07 SAC Units
(25%_ 100%) Zoning City Water
Census Code Stories Booster Pump
# of Units Square Feet PRV
# of Buildings Length Fire Sprinklers
Type of ConstructionWidth
REQUIRED INSPECTIONS
Footings (New Building) Sheetrock
Footings (Deck) Final / C.O. Required
Footings (Addition) Final / No C.O. Required
Foundation HVAC
Drain Tile Other:
Roof: -Ice & Water `Final Pool: -Footings -Air/Gas Tests -Final
i~ Framing Siding: -Stucco Lath -Stone Lath -Brick
Fireplace: -Rough In -Air Test -Final Windows
Insulation Retaining Wall: _ Footings _ Backfill _ Final
Meter Size: Radon Control
Erosion Control
Reviewed By: Building Inspector
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC L
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant ~j
Copies
TOTAL
Page 2of2
-7 '()C-A0 Ct , 4C46-
CERTIFICATE OF SURVEY M 3 2 -16 71- 9 8
for
JOE MILLER HOMES '
`yg01 a ~ ~
1 ~ D~ 9~ s~ 2
IN,
pr
EAGAN
V1
ED <
\ z~:
70 W'
BY ~U_ , ?6 9Z
-3 -3
i
DING INS~'MT10 S ;SEPT. OrQ~.
- _ \ fir. a i ? Y
Og, 'N
7 1 `go6p'5
1 G
o G
r9o9.9 5 0,
00
Top curb to Gar slab
Top block =051
Lowest bsmt flr = IoD,81_
Scale: 1" = 30'
857 Govern Circle
DESCRIPTION
I hereby certify that this survey, plan, or Lot 8, Block 2,
report was prepared by me or under my direct GARDENWOOD PONDS SECOND
supervision and that I am a duly Registered Dakota County, Minnesota
Land Surveyor under the Laws of the State
of Minnesota. Plat bearings shown
o Denotes iron monument
Date 20 ~FG13 199 d Reg. No. 8140 Existing j Proposed
R- E v Irl rM 199g REV Z /x n
BRANDT ENGINEERING & SURVEYING
1600 West 143rd Street, Suite 206
Burnsville, MN 55306
(612) 435-1966 M32-1671-98
CIl'Y OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
, (612) 681-4675
SITE ADDRESS:
PERMIT,$UBTYPE:
SPE
1
R -?-
oN
rt Ot OCK • 2
I i Y, ? .
1CORD
PERMIT TYPE:
Permit Number:
Date Issued:
klc?c? I1) po i fvf: 91 r Pnn .1) 1
TYPE OF WORK:
INSPECTtON .. . D•
? ?? :? , • ? ??, I
I
1'I /3N fiF'ti17'i11f 0 14 Y f4 1 k! #.'tAFi1- 1
., Permit No. Permit Holder Date Telephone A
ELECTRIC
PLUMBING
HVAC 1 3 q ?GO- O
Inspection Uate Insp. Comments
FOOTINGS
FOUND
FRAMIIVG
r C
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST . ? ?
ROUGH
HEATING
- ?-
GAS SVC
TEST
!vSUL ?/j A ?
GYPBOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG Ind
oo, ?
FINAL HTG
?57
ORSAT
7EST
BLDG FINAL ,. ?
BSMT R.I.
65MT FINAL
DECK FfG
DECK f"INAL
Address $57 GOVII2N CIR Enc',Av, MN Zip 5512 ?,3
Lot S Blk 2 Sub ['d+unrnx,xrx? Bmmc ?nm
THESE ITEMS WE5i/ WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECTION.
Date: W'(945 Yes No Inspector:
Final grade (6" from siding)
Permanent steps (gazage)
Permanent steps (main entry)
Pertnanent driveway
Permanent gas x
Sod/Seeded grass
TraiUcurb damage
Porch
Basement 5nish
Deck
Please verify with the builder the temoval of roof test caps from the plumbing system and the shutro@' of water supply lo
the outside lawn faucet before freeze potential exisLS.
Contad engineering division at 6814645 before worki¢g in right-of-way or instalGng underground sprinkler system. ?
W6iu - City Copy Yellow - Resident Copy Pink - Contractor Copy
1%
2009 RESIDENTIAL BUILDING PERMIT APPLICATION CO?e?-?d `'
??? IE 1: 1 W r? ? g
II 1?1
APR 2 S 2009
? Pertnit #. _
?
? PermitFee: &242Y I
? Date Received: C9 I
I I
I Staff: I
I
- - - - - - - - --- - - - - -
a?
Date: 4 Z ? Site Address: WJ 7 6we-rki- cIi"cje
Tenant:
Suite #:
RESIDENTIOWNER Name: TY`SVf-/{d- et--PrlPhone: 65-1 7S6' 067z-
Add ress ! City / Zip: R S 7 CVV64''vl ci l'G6-
Applicant is: Y Owner _ Contractor
TYPE OF WORK Description of work: SC??h 2.e?S?-/ ? G? ?Yc/? -k-pOf !/Wt' 6& K-l.?-'K1
Ou
ConstructionCost /Oi(JOU Multi-Famtly6uilding* (Yes_/No2oJ
CONTRACTOR Name: D J+0?V?? ?2k'w0&i+1 V? ?y License#: ZOU3SGJ 70
6
)
Address: ; )
`T7 64
0U
City: & 1&4,L- State kKh Zip J S1Z 3
Phone: 61Z e75' 3 F73 Contact Person:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Cateaorv 1 Minnesota Rules 7672
Energy Code . Residential Ventilation Category 1 Worksheet • New Eneryy Code Worksheet
CateyOry Submitted Submitted
(4 submission type) • Energy Envelope Calculations Submittetl
In the last 72 months, has the City of Eagan issued a pertnit for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
ri?ation ?'Portrohs of ?P.
MOTE: Plans'afid su'pportirtg docurrie`nts t6ai?y6u su6mit'areconsidered !o be.?u6tic.info
r
the infonna6on inay i?e classified as non-publia if you prov de specifrc rnasons thaf would perriut the City,to ?=;
conclude tIiat.the ',ace "`? ` • ? . . ?
I here6y acknowiedge that this infortnation is complete and accurate; that the work wnll be m confortnance with the ordinances and codes of the City of
Eagan; that 1 understand lhis is not a pertnit, but only an appliration for a permit, and work is not to start without a permit; thal the work will be in
accordance with the approved plan in the case of work which requires a review and approvX I-r?w I v? l?u ?-?. L (-?- X ApplicanYs Printed Name AppiicanYs Signature
Page 1 of 3
5 fl?,) )
AW
DO NOT WRITE BELOW THIS LINE
SUB TYPES
Foundation
Single Family
Multi
01 of Plex
_ Accessory Building
_ Fireplace _ Porch (3Season) _ Storm Damage
_ Garage _ Porch (4Season) _ Exterior Alteration (Single Pamily)
_ Deck 7- Porch (ScreenlGazebolPergola) _ Exterior Alteration (Multi)
Lower Level Pool Miscellaneous
WORK TYPES /',? 04?? P?"??
New / _ Interior Improvement
? Addition ? _ Move 6uilding
_ Alteration _ Fire Repair
_ Replace _ Repair
_ Retaining Wall
DESCRIPTION
Valuation
Plan Review r
(25% _ 100%?
Census Code
# of Units
# of Buildings
Type of Construction
5G-0 fv?"t? )9rn,6,1k dN° AOO
_ Siding Demolish Building*
_ Reroof Demolish Interior
Windows Demolish Foundation
_ Egress Window _ Water Damage
*Demolition of entire builtling - give PCA handout to applicant
Occupancy MCES System
Code Edition A4h,/ 2UJ'7 SAC Units
Zoning City Water
Stories Booster Pump
Square Feet PRV
Length Fire Sprinklers
Width
REQUIRED INSPECTIONS
_ Footings (New Building)
_ Footings (Deck)
Footings (Addition)
7 ? Foundation
Drain Tile
Roof: Ice & Water Final
? Framing
_ Fireplace: _Rough ln _Air Test _Final
Insulation
Meter Size:
_ Sheetrock
Final 1 C.O. Required
Final / No C.O. Required
HVAC
Other:
Pool: _Footings _Air/Gas Tests _Final
_ Siding: _Stucco Lath _Stone Lath _Brick
_ Windows
Retaining Wall
Erosion Control
Reviewed By: Building Inspector
RESIDENTIAL FEES ? i
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S8W Permit 8 Surcharge ?
Treatment Plant
Copies
TOTAL Yr„ ???yl ? ?„/j? ?(J?
(??7 ? Page 2 of 3
¢ ll
I?i??v
?)o??I
2007 RESIDENTIAI, BUU.DING PERMIT APPLICATION
City OF Eagan
3830 Pilot Knob Road, Eagan NIN 55122
Telephone # 651-675-5675 FAX 4 651-675-5694
New CansWCtion Reoulrements
3 reqistered site surveys shov+inq sq. R. of IoC sq, ft of house; and aB roofed areas
(20%mazimum lot coverage allowed)
1 Soils Report "rf proposed buiWirig m to be placed on disWrbed sdl
2 wpies of plan shovnrg beam 8 windax sizes; poured found design. Mc.
7 set af Energy Calalatlons
3 copies of Tree Reserratian Plan'rf lot pladed eRer 711193
Rim Joist Detail Options selection sheel (buildings wiN 3 or less units)
Mmnegauo mechanical venNatlon form
W C
RemodeUReoair Reauirements -Olfici?Ilse OnN
2 copies of plan shaving footlngs, beams, Jols4s Cert of Survey ReM ' ?'_Y _N
isetofEnergyCalculadonsforheatedaddiCOns Sa75Repal, . ' _Y _N
7 site wrvey lor additions 8 decks Tree Pres Plan Recd _ Y _ N,
Additrtron-iMicateilorrsdesepficsystem TreePresRequ"ved. _Y- _N
0o-site5ep6tSystem _Y _N
Planc arp rnnsirtarPrl nuhlir. information unless vou state thev are trade secret and the reason.
Date Construction Cost ?
Site Address ?
C Unit/Ste #
Description of Work
Mult'rFamily Bldg _ Y'?L N Fireplace(s) _ 0_ 1 _ 2
?
Property Owner ?D CFc 1)0, ?Q el Telephone # ( )
Contractor U
Address ( CitY
State Zip ? Telep6one # (??)
COMPLETE THIS AREA ONLY IF CONSTRUCTING•A NEW BUILDING
- Minneso[a Rules 7670 Cateeorv 1 _ Minnesota Rules 7672
Enelgy Code Category . Residential Ventilation Category i Worksheet • New Energy Code Worksheet
(J submission type) Submitted Submilted
. Energy Envelope Calculafions Submitted
In the lasi 12 monihs, has The CiTy of Eagan issued a permit for a similar plan based on a ma5ter plan?
_ Y _ N If yes, date and address of masTer plan:
Licensed Plumber
Mechanical Contractor
Sewer/water Contractor
Telephone #(
Telephone #(
7elephone #(
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
oval of plans.
,
? ApplicanYs Printed Name ApplicanPs Signature
PERMIT #
RECEIPT DATE:
2002 RESIpENTIAL, PL?BING PERMIT APPLICATION
Cl1'Y OF EA6AN
3$30 PILOT KNOB $D
EAfiAN, MN 551EE
651-681-4675
Please complete for: single family dwellings, townhomes and condos when permits are required for each unit,
backflow preventer for irrigation system
SITE ADDRESS:
OWNER NAME: : lkS m-A'1) Jri %"de ? TELEPHONE #:
(AREA CODE) '
INSTALLER NAME: 1RS)-12M ?A-kj TELEPHONE#:
(AREA CODE)
STREET ADDRESS: (?1-C?-6'rrW
CITY: ?H1, STATE 44)ti' ZIP:
SEPTIC SYSTEM, newlrefurbished (requires two sets of plans and MPC license) g 100.00
includes $40.00 County fee
Note: Additional consultant fees may apply
. MODIFICATION/ALTERATION TO EXISTING DWELLING UNIT, INCLUDING:
Adding fiMures to lower levels9r room additions, excluding water softeners and water heaters. $ 50.00
_ A6andonment of septic system.
_ Water turnaround - existing dwelling unit (+ 5/8" meter if needed -$118)
Other.
_ RPZ: new installatioNrepaiNrebuild $ 30.00
tion system
lawn irnga
2002
V
L
r
ReplacemenUadditional: water softener gl
L -
$
15.00
State te Surcharge $ 50
$ ? • ?
Tpt01
I hereby acknowledge that I have read this applicatioq statethatthe information is correct, and agree to complywith all applicable Ciryof Eagan ordinances It
is the applicanPs responsibility to notiy the property owner that lhe C@y of Eagan assumes no liability for any damages caused by the City during its normal
operationai and maintenance activRies to the facilities construded under this permit vithin City property/right-of-way/easement
SIGNATURE OF PERMITTEE o 1102
RESIDENTIAL
BUILDINC PERMIT APPLICATION
? ? CITY OF EAGAN ? ? O • ? ?
1 3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675 ? p ? •V?„???
•?C.1Jt-?•
New Canstruction Reauirementa RemodellReoeir Renuiremenffi v c c E
• 3 registered site sunays shaxing sq. ft. of bt, sq, fl, ol house, aM all roofed areas • 2 copies of plan
(20% maximum IM coverage allowed) • 1 set o( Enreqy Calculations for heated additions 3-
• 2 copies af plan showing beam 8 mndow s¢es; poured fouM design, etc.) . 1 site survey for eztenor addi6ons & decks
• i set of Eneryy Calculations . Indicate if home served 6y sepGc sysfem for addilians
. 3 copies of Tree Preservation Plan if lot platted after 711/93
• Rim Joisf Detafl Options selectlon sheet (bldgs with 3 orless units)
DATE _1? 2-6 I° Z VALUATION ?'-
SITE ADDRESS PS 9- G? Vkr-k? Cl2cLG , ` • " L` `'?? MULTI-FAMILY BLDG _Y V'N
TYPE OF WORK l34S.CFiLivT Cu' MPI.4 Tio n1 FIREPLACE(S) _ 0 ?_ 2
APPLICANT _1k51-fif6 STREET ADDRESS PF4 j o vE,en/ Ct2cLE p CITY STATE /"/N ZIP ??-3
TELEPHONE # 6s?' ?? "6d ? Z CELL PHONE # faqzr ? 6(2 -STa -9G Y Z FAX # 6 s?-2?Y- (Sr3
PROPERTY OWNER 1 RS/fAp `\ FARoo+q tlfl Jq FRI TELEPHONE #?O Sl- ??6 -O 69- 2
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNESOTA RULFS 7670 CA"I'EGORY 1 P
(J submission type) • Residential VentilaUon Category 1 Worksheet SuGmitted •
• Energy Envelope Calculations Submitted
Plumbing Conhactor:
Plumbing system includes:
Mechanical Contraetor:
Mechutical system includes:
Sewer/Water Contractor.
Phone #
Phone #
JUN 2 6 2002
Fee: $90.00
Fee: $70.00
------------------------------------------------------------------------°---------°--------------°---------------------
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply
with ail applicable State of Minnesota Statutes and City of Eagan Ordinances. ) p n,
Signature of Applicant
OFFICE USE ONLY
_ Water Softener
_ Water Heater
No. of Baths
_ Phone #
Lawn Sprinkler
No. of R.I. Baths
_ Air Conditioning
_ Heal Recovery Sys[em
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4102
OFFICE USE ONLY
? 07 Foundation
? 02 SF Dwelling
? 03 01 of _ plex
? 04 02-plex
? 05 03-plex
? 06 04-plex
O 07 05-plex ? 13 16-plex
? OS 06-plex ? 16 Fireplace
? 09 07-plex ? 17 Garage
? 10 08-plex ? 18 Deck
? 11 10-plex 'g?19 Lower L,evel
? 12 12-plex Plbg _?Y or _ N
? 20 Pool
? 21 Porch (3-sea.)
? 22 Porch/Addn. (4-sea.)
? 23 Porch (screened)
? 24 Storm Damage
? 25 Miscellaneous
? 30 Accessary 81dg
? 31 Ext. Alt - Multi
? 33 Ext. Alt - SF
? 36 Multi
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ?, 44 Siding
? 32 Addition ? 36 Move 81dg. ? 42 Demolish (FOUndation) ? 45 Fire Repair
(
33 Alteration ? 37
1!, Demolish (Bldg)' ? 43 Reroof ?, 46 Windows/Doors
? 34 Replacement 'Demolition (Entire B ldg oniy) - Give PCA handout to applicant
Valuation a D O Occupancy 9-3 MClES System
Census Code Llrsii? Zoning City Water
SAC Units ? Stories Booster Pump
Nbr. of Units ? Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinkiered
Type of Const --
Width
REQUIRED IN SPECTIONS I
_ Footings (new bldg) FinaUC.O.
_ Foohngs(deck) ? FinaUNo C.O.
Footings (addition) ? Plumb'
?
Foundarion ? HVAC
Drain Tile Other
./ Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests _ Final
? Framing _ Siding _ Stucco _ Stone '
Fireplace R.I. Air Test Final Windows (new/replacement)
- -
? Insularion _ Retaining Wall
?- LZ- di--
Approved By ? p , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
W ater Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
'RESIDENTIAL
BUILDINC PERMIT APPLICATION
-1_CITY OF EAGAN
j I l? O- 3830 PILOT KNOB RD, EAGAN MN 55122
651-881-4875
New Constructlon Reoulrements
• 3 registeretl sfle surreys showmg sq. N. of lot, sq, fl. W house; and II roofed areas
(20Ho mauimum lot cove(age alloweG)
. 2 copies of plan showing beam & wintlow sizes; pouretl found design, etc.)
. 1 set of Enefgy Cekulatbns
• 3 coples of Tree Preservatbn Pen H bt platted afler 7/1193
• Rim ,bist Deteil Options selectbn sheet roldgs wHh 3 or less unh)
DATE toI
Water Softener
Water Heater
_ No. of Baths
SITE ADDRESS (157 `?VI MULTI-FAMILY BLDG _Y `( N
TYPE OF WORK0&1) R.(1('P FIREPLACE(S) _ 0_ 1_ 2
APPLICANT I N WrC ?' "`f4'L /7) YWt_ _
STREET ADDRESSJ S C) I ?ri
' d?'11 N1?Y1 STAiE
TELEPHONE 1?l0)-`a-QL $66O CELL PHONE # FAX #
08l US& 0(o72
PROPERTY OWNER vA P?L ) 74% TELEPHONE #??4fik- 00.
-------------------° ------------------°------°---°---°-°-------------------------------°
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MIVNESOTA RULFS 7670 CATEGORY 1 MINNESOT.4 RULES 7672
(J su6mission type) . Residential Ventilatlon Category 1 Worksheet Submitled • New Energy Code Worksheet Submitted
• Energy Envelope Calculations Su6mittatl
Plumbing Conhactor: ____
Plumbing system includes:
Mechanical Conhactor:
Mechanical sysCem includes:
Sewer/Water Contractor:
Air Conditioning
Heat Recovery System
I hereby acknowledge that I have read this appllcation, state that ihe
with all applicable State of Minnesota Statutes and CiTy of Eagan C7rd
Signalure of Applicant
OFFICE USE ONLY
1as-,a?
RemaleUReoalr Reauhemems
• 2 copies of plen
• lsetolEnergyCakulationstorhealedadd'Abns
• lsitesurveyforeMerioratlditions&decks
• IrWicate A home served by septic system for additbns
VALUATION (nO000b
Phone #
_ Iawn Sprinkler
No. of R.I. Baths
Phone #
Phone #
Fee: $90.00
Fee: $70.00
ct, and agree to comply
7 To w Tn
Certificates of Survey Received _ Tree Preservation Plan Received _ Noi Required _ -
uvaated 4102
cAsH1Er;: s rE-F;ntNAi._ rao. 761
DAri.:;; ns; 0ai98 r.r.Mc: 14:,3;::aA
ID.
NFlMEc D F HOfiTON IN(:
2256 9001 8:i7 C,OVEFiN C:IR :i93.`ii'.ti
,
Toka] Fiere:ipt Amour.4: 5.:35i'.i1
cKna7mi9
us« i:n; hAracv
k CITY OF EAGAN
3880 Pilot Knob Road
. Eagar., Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS:
P.I.N.: 10-28801-080-02
PERMIT
PERMIT TYPE:
Permit Number:
Date Issued:
857 GOVERN CIR
LOT: 8 BLOCK: 2
6ARDENWOOD PONDS 2ND
BUILDING
031511
03/02/98
DESCRIPTION:
BGildibzj Permiti Type
;"la uildIhg'?t?ork 7ype
P'° UBC QccupaK"cy,
'? Construction ??t?pe
? Ton3ng
? Building Wid-th
? Bui'lding stories
??-^--, iSQuars Feet'
PLAN REVIEWED 8Y MIKE BARCK
Mp?? ?-,
???
REMARKS:
S& W PERMIT: M& W
FEE SUMMARY:
Base Fee
Plan Review
Surcharge
SAC
SAC %
SAC Units
Subtotal
VALUATION
SF pWG
NEW
ft-3 U-1
VN
R-1
61
74,
2
2,672
101 1 - FRM. DETACH
$243,009
$1,602.25
$1,041.46
$121.50
$1,000.00
100
1
$3.765.21
MISC FEE $1,592.50
Total Fee $5,357.71
CONTRACTOR: - Applicant - sT. 1.IC.OWNER:
HQRTON INC OF MN, D R 14544663 20005657 D.R. HORTON
3459 WASHIN6TON OR 204 3459 WASHINGTON DR
EAGAN MN 55122 EAGAN MN 55122
(612) 454-4663 (612)454-4663
? . . :., ,_. .. . sw ,r'a '-.v : 'E ., r . ? ? '•`- ? . I ,
I hereby acknowledgethat Z'have read th?s,"app?icatiiorr".and s?ate th?'t tha
information Ss correct and agree to comply with all a-pplicable State of Mn.
City Qf Eagan;Ordinarrcea. ., ?
E ITEE SIGNAT E ISSUED Y: S A URE
f qAPPL::
1998 BUILDING PERMIT APPLICATION (RE3IDENTIAL)
CITY OF EAGAN ? 1/? 5?,?
? 3830 PII.OT RNOB RD - 85122 -?
681-46T5
New Construction Reauirements RemodeVReoair Reauirements
? 3 reglstered site aurveys
? 2 copies of plana (Include beam & window sizes: poure0 Md. design; etc.)
? 1 energy calwladons
? 3 copies of tree preservatio lan H lot platted aRer 711/93
required: _ Yes No
DATE: a- atI- SP
? 2 copies of plan
? 2 site surveys (exterior additions 8 decks)
? 1 energy nlalations for heated additions
CONSTRUCTION COST; »a? 4a0
DESCRIPTION OF WORK: w Cav+SI>ucAvin
STREETADDRESS: fS7 (?'ove,,h G,rc,Li.
LOT: lS BLOCK: ? SUBD./P.I.D.#:
PROPERTY
OWNER
CONTRACTOR
ARCHIT'ECT/
ENGINEER
Last
Street
City
State:
Zip:
Company: D,Q. -/ti'!,v d1b14_TpeIrl:llu kr*ts Phone #: NS-/- 51663!'yl• /a4
StreetAddress:3SrS4 G?cS?i.h? rvt, Si, .a?y License# 26005(?7
City J54C,4r+ State: MN Zip: .5'5/.ZA
Neme:
Street
City
State:
Phone #:
Registration
Zip:
Sewer 8 water licensed plumber (riew construction only): (Yl+uJ Sews.r +- la-ra?u . . Penalty applies when address chang
and lot change is requested once pertnit is issued.
I hereby acknowledge that I have read this appiication and state that the iMortnation is correct and agree to comply with all applicabl
State of Minnesota Statutes and City of Eagan Ordinances. _
Signature of Appiicant:
OFFICE 77Yes Certificates of Survey Received _ No LWd
Tree Preservation Plan Received - Yes _ No t N t Required „
Phone #:
,
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Duplex
8'02 SF Dwelling ? 07 4-plex
? 03 SF Addition 0 08 8-plex
? 04 SF Porch ? 09 12-plex
? 05 SF Misc. ? 10 _ plex
WORK TYPE
,or'31 New ? 33 Alterations
? 32 Addition ? 34 Repair
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
Planning
Permit Fee
Surcharge
Plan Review
License
MCNVS SAC
C.ity Sf1f,
Water Conn.
Water Meter
ACCt. Deposit
S/W Permit
S/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
? 11 Apt./Lodging ?
? 12 Multi Repair/Rem. ?
? 13 Garage/Accessory ?
? 14 Fireplace ?
? 15 Deck
? 36 Move
O 37 Demolition
16 Basement Finish
17 Swim Pool
20 Public Facility
21 Miscellaneous
V" Basement sq. ft. ?I 2"/ MC/WS System ?
?I M Main level sq. ft. 4 w City Water ?
- sq. ft. 1-7 88 FireSprinklered
j2e=r_ sq. ft. 938 PRV
2 sq. ft. Booster Pump
sq. ft. Census Code.
3 Footprint sq. ft. 247 y SAC Code oi
Census Bldg i
Census Unit _L
. Buildi ng hu% Engineering Variance
Valuation: $ 2?13. vov -?
Sa s e,n-awf-
. z?/
eu?4 ? ?a
v? Y C.
Sv37 1 2 ?Cde-
Yriz ?y4 2v0
Zy1? ND?
. Ls?-
•zr_ alo5
iv u ?y
2? e)
37Y3z
??JYZ
? Z Y?(
C?
7s/:s-X 35
i o ? 0
«3?!
i43o ??lI54
52$
I I $ 9?
ZL
??ib !r S `I -
gs7.g
go l
A Sj
z `,v rv, -
ivy, zzv.---
q (-, 4 q "/. -"
iC. = lS,WO,--
4
z4Z,
Ax""'t?y, f!L.
74750 Galaxie Ave. Suile 104
Apple Vailey, Minnesota 55124 "
(612) 432-2044
FXTrRIOR ENVEI,OPF. AVERAGE "iJ" CONIl'OTATION
NA[QE: D. fz , Hc 272o N PLAN NI]N15ER !-f A i`7f'T4/V .
Determine workirg square footage of each
1. Total exposed wall area...... 31)%Z sq.ft. X .11 4"gG.9z
2. Total roof/ceiling area...... sq.ft. R .026 90.2'7
Total exposed wall area above floor = 3 52?"T
a. Total vrall vrindow area .................. "5'z 7,19
b. Total door area ......................... .=.a.'?
c. Total sliding glass door axea........... -7?
d, Total fireplace wall area ............... -
e. Total wall framirg area (average 10y)... ',??`r
f. Total net wa1l area above floor......... ?.7n`x.si
g. Total r1m joist area .................... Y
Total exposed foundation area =
h. Total fowxlation window area............
i. Total net foundation area above grade... <p'7
Determine "[J" value of each wall seonent
a. X lfUti .52 - ?-, v, i'7
b. x uUli .139 = ?. -?s
c. x lfUll ,52 = <.9.5>_
d. X "U" .68 = -'
e. x IIUfI , 096 a ? ll i{ 4?
f. X tiUlt ,043 = 11?,v!
9. X nUit .041 r
h. X "Un .52 e ?
1. X llUli ,082 = -+, 9 5
3. ToTAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If itan N3 is the same as, or less than item #1, you ha.ve
met the intent of SBC 6006 (c) 2.
-1-
qw,
Total exposed roof/ceilirg area w-7 Z.. _.
Total gross roof/ceiling area = -
1. Total UYylight area ................... -
k. Total roof/ceiling framing area....... L i 'I
1. Total net Snsulated roof/ceilirg area. -•, i-7_ W .?d
Deterniine "U" value for each roof/ceiling seEgnent
j - X uUn =
k. }C flUff .024
1. X "U" .022 = 6?:.7 11
4. `I17i'AL ... . .. .. ... ... . ... . ... . .......
Zf total of #4 is the same as, or less than 1{2, you have
met the intent of SHC C096 (c) 1..
To utillze the total envelope systen method, the values
established by the swn of Stems #3 and N4 shall not be
greater than the swn oP items #1 arxt N2.
1. , I7 -7 +2. vn.z-'r = 52?,19
g, -?,9-? .vk + 4. »,07 = Li?v.0
Ma.terials Thernial resistance "R"
Fxterior air.........
Siditg material......
Sheathing............
Insulation,..........
Sheetrmck............
Interior air.........
sbuAdf 4 ...o,., .......
Rim ................
Concrete blocks......
-2-
LOT SURVEY CHECKLIST FOR RESIDENTIAL
BUILDING PERMITAPPLICATION
PROPERTY LEGAL: o< (J
/) r/,/e?...,.?
? ? *
DATE OF SURVEY: ?
> LATEST REVISION:
DOCUMENT STANDARDS
°z
? ? • Registered Land Surveyor signature and company
g O • Building PermitApplicant
L9L9?Cl ? • Legal description
o • Address
? i ? • North arrow and scale
? • House type (rambler, walkout, split w/o, splR entry, lookout, etc)
r? ? o • Directional drainage arrows with slope/gradient %
a-10 D • Proposed/ebsting sewer and water services 8 inveR elevation
O?E a • SVeet name
o? ? 0 • Driveway
ELEVATIONS
/
Y
?
• 6dstina
d
S
i
P
o
[ ropose
)
ewer serv
ce (or
0?? ? • Property comers
[? ? ? • Tap of curb at the driveway
cr? a ? • Elevations of any exdsting adjacent homes
Prooosed
? ? • Garege floor
? • First floor
?
?O ? • Lowest exposed elevation (walkouUwindow)
? • Property comers
G ? O • Front and rear of home at the foundation
PONDING AREA Cf aoolicablel
/
? [?/ ? • Easement line
? ? ? • NWL
O 2r' ? • HWL
? ? • Pond # designation
? ef ? • Emergency Overtlow Elevation
DIMENSIONS
ET" ? ? • Lot IinesBearings & dimensions
[?g ? • Right-of-way and street width (to back of curb)
?? ? ? • Proposed home dimensions including any proposed decks, overhangs greater than 2',
porches, etc. (i.e. all structures requiring permanent footings)
13-11 ? • Show all easements of record and any Clty utili6es within those easements
[3- ? ? • Setbacks of proposed structure and sideyard setback of adjacent ebsting structures
? e? ? • ment
s, ?'
f?any
Retaining wall require
?
/?
?
'/
-S
/
f 'O
Reviewed: / (
L
Y
1
January 7986
LM0019G8IBlDGPRMT FM
? CITY USE ONLY
L ? BL
SUBD.
RECEIPT #: O 71,1)
RECEIPT DATE: 131919
U
1998 PLiJ1yIDING PERMIT (RESIDENTIAL)
CITY OF EAGAN
' 3630 PIIAT ICNOH RD
EAGP,N, AIId 55122
(612) 681-4675
Please oDmplete for: D single family dwellings
? townhomes and condos when permits are required for each unit
? backflow preventer for underground sprinklersystem
FIXTURES EACH # TOTAL
Shower 3.00 x =
Water Closet 3.00 x =
Bath Tub 3.00 x -
Lavatory 3.00 x
Kitchen Sink 3.00 x T = ?
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 1.50 x =
Water Softener ' for dwellings under construdion 5.00 x =
Water Softener *for existing dwelling 20.00 x =
U.G. Sprinkler " for dwelling under const. 3.00 =
U.G. Sprinkler ' far exisBng dwelling 20.00 =
Alterations ' to existing residence 20.00 =
Water Turn Around 20.00 =
Private Disposal System ' MPC itc. 75.00 =
(new and refurbished systems)
Private Disposal Systems',4tandonmenc 20.00 =
STATE SURCHARGE .50
TOTAL (.l?? ?
l
----------°-•-------------------------------------------------------••- ------ ------------------------•---------------------------------
I hereby ackno;wledge that I have read this application, state that the infortnation is cor*ed, and agree to wmpty wkh all applicable City of Eagan ordinances.
It is the applicanYs responsibility to notify the property owner that the City of Eagan assumes no liability for any damages caused by the Ciry during its
nortnal operational and maintenance activities to the facilities construded under this pertnit within City property/right-of-way/easement.
SITE ADDRESS:
OWNER NAME:
INSTALLER NAME: ,7 TELEPHONE #!
STREET ADDRESS:
ciTV:
STATE: ornN ZIP: ?t?LL(L
OF PERMITTEE
JS/FORMS BLDG/PLBG PERMIT (RESIDENTIAL) 1998
QCITY USE ONLY
L U BL ? RECEIPT#:
SUBD.;KILC,/C.O????? ?? REGEIPTDATE:
1997 PLUMBING PERMIT (RESIDENTIAL)
cinr oF Er?caN
3830 PILOT KNOB RD
EAGAN, MN 55122
(612)681-4675
?
h
/
Please complete for: . single family dwellings
• townhomes and condos when permits are required for each unit
? backflow preventer for underground sprinkier system
FIXTURES EACH NO. 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 Outlet "minimum-1 • 3.00 x =
Rough Openings
Water Softener `for dwellings under constructian 1.50
5.00 x
x
o zis "n li 20.00 X =
U.G. Sprnkler " fur dwelling under canst 3.00 =
U.G. Sprinkler • for existing dwelling 20.00 =
ARefetions ' to existing residenca 20.00 =
Water Turn Around 20.00 =
Private Disposal System ` Dek Cty lic. 75.00 =
(new and reTurbished systems)
Private Disposal Systems •Anandonmenc 20.00 =
5TATE SURCHARGE .50
TOTAL
I Aereby acknowledga that 1 have read this apptication, state that the inTormation is Cortect, and agree to comply wkh all appliceble City
of Eagan ordinanoes. It b the appliwnl's responsibility W notify the property owner that the Ctty'ofEagan assumes no liability for any
damages eaused by the City during its normal operatlonal and mainDenance activities ta ihe fadlities consWcted under thjs permft within
Cily property/rightof-wayleasement.
SITE ADDRESS: Z27
OWNER NAME:
INSTALLER NAME: TELEPHONE #: 7?? ? ?v 7
STREET ADDRESS:
CITY: STATE: /ZiP, ZIP:
?
SIGNATUR OF PER ITTEE
L CITY USE ONLY
? BL ?
SUBD .
?a'4d
RECEIPT#:
RECEIPT a47E:
1997 PLUMBING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
" EAGAN, MN 55122
(612) 681-4675
Piease complete for. ? single family dweliings
? townhomes and condos when permits are required for each unit
. 6ackflow preventer for underground sprinkler system
FIXTURES EACJj ?Q TOTAL
Shower 3.00 x =
Water Cioset 3.00 x =
Bath Tub 3.00 x =
Lavaton, 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 OuGet ' minimum - 1 • 3.00 x =
Rough Openings
' 1.50 x =
5
00
for dwellings under wnsWction
Water Softener x
.
VNater Softener ' for racisting dwelling 20.00 x =
U.G. Sprinkler • ior dwetling undar wnst. 3.00 =
U.G. Sprinkler ` for existing dwelling 20.00 =
Alterations 'toexistingresidence 20.00 =
Water Tum Around 20.00 =
Private Disposal System ' Dak Cty lic. 75.00 =
(new and refurbished systems)
Private Disposal Systems `Abandonment 20.00 =
$TATE SURCHARGE .50
TOTAL
1 hereby acknowledge Mat 1 have read this application, stete that the irrfommtion is correG, end agree to compty with all eppiicable Ci[y
of Eagan ordinanoes. ft is the applipnPs resporisbiiity W notity Ne property owner that the City M Eagan assumes no liahiliry for any
damages causad by the City during its nortnel operetional and rtaintenance aeUviba to the fadfities constructed under this permit within
City propertylrigM-of-wayleaxmeM. ,
° s
SITE ADDRESS: .
OWNER NAME:
INSTALLER NAME: TELEPHO E#:
STREET ADDRESS:
CITY: 0 ?i STATE: / 7-iP.
GL/'
SI?N/ATUI?i OF PERMITfEE
/ CITY USE ONLY
? Z.
LOT BL RECEIPT
SUBD. RECEIPT DATE:
nete: \-1 -G ?
Complete this section onlv if you are installing HVAC in single family, 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 ( minunum of one required @$3.00 ea.)
• State Surcharge: .50
• TOTAL: 3'?'S U
Complete this section onlv if you are remodeling, adding to, or repairing existing single family dwellings,
townhomes, or condos. Note: Mechanical permit is not reauired for alteration/add-on to ductwork in
existing residential units; but is required for the following:
_ Install fumace _ 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 Surcliarge .50
Total: $ 20.50
SITEADDRESS: 4\) ?l 6
OWNERNAME: PHONE#: xkS4_4?-?0(fD3
INSTALLER NAME: PHONE #: ? ??? (-} /_
ADDRESS:
CITY:
!5/FORMS BLD/MECH PERMIT (RES) - 1998
1998 MECHANICAL PERMIT (RESIDENTIAL)
CZTY OF EAGAN
3830 PIIAT IINOB RD
EAGAN MIII 55122
(612) 681-4675
_ STATE: ZIP:
SIG A OF PERMITTEE
?
s
1 i
?
CERTIFlCATE OF SURVEY
for
JOE MILLER HOMES
?
?
1 ?
1 ?
1
'g95,3?
,
,
,
e^
cl? (,? ? ? 38 2`?10
.?
"I ,
"
?
M32-1671-98
?•a??;'? t ?. (?9
< ??? ? ?x9R3a)
\
?a ?>
< rvA
ai??
10
?
eJS
r°
ea
Qto ?? e\
DATE 3 '
BUILDING INSPECTIONS 1-)EP1.
?
? y
?
7 1 ?qoc?5
1
, -
,
? -
0
?q.o9 4 5
1 ?eo
.), P?f
tN N 1 ' ?
N ? 1
.?.? ?
LW t
G°??M?D
gv
,
Scale: 1" = 30'
Iq /I I/
,
?
?
0000
i ? ,?6,c
. ,11??:
DQ %
/
.? `
?
. C\e
.?
?
E1L1.'
Top curb to G? ?r_ slab =
Top block = '?oLl si
Lowest bsmt flr = 9OD,B,_
857 Govern Circle
DESCRIPTION
,-?
I here6y certify that this survey, plan, or
report was prepared by me or under my direct
supervision and that 1 am a duty Registered
Land Surveyor under the Laws of the State
of Minnesota.
Date
Reg. No. 8140
Lot B. Block 2,
GARDENWOOD PONDS SECOND
Dakoto County, Minnesota
Plat bearings shown
o Denotes iron monument
? Existing j Proposed
lZ V 2`l FE I'M? `126 Z 11
BRANDT ENGINEERING & SURVEYiNG
1600 West 143rd Street, Suite 206
Burnsville, MN 55306 -
(612) 435-1966 ` M32-1671-98
V Use BLUE or BLACK Ink
^-----------------
� For Office Use �
' j Permit#: � � I I
�1�� 0� ����Il � �
� Permit Fee: �
3830 Pilot Knob Road
Eagan MN 55122 �'����°��,� j Date Received: ' �'� j
Phone:(651)675-5675 I I
Fax:(651)675-5694 ���ry '� � �(��� � Staff: � i
�---------------��-V
)rA
2014 RESIDENTIAL BUILDING PERMIT APPLICATION �� �-�1�`�
Date: � �5 i¢ Site Address: ��� ( '��n ����`�-- � ��
Unit#:
Name: -+-V'S�� �" �GL,V'(J`0 Q�1(.�— a-7�V"� Phone:
Resident/ /� �
'' OwneC ' Address/City/Zip: ��� C�(�h- �� ��
Applicant is: Owner �Contractor
' Description of work: �r v U,c,'J�-P/i� I�JG-''l�'Vl., Ic�G�Zti1�J�
�Type of Work`=
' Construction Cost: � �� �w Multi-Family Building:(Yes /lys'� )
� °� ��, � r���,-
= Company: � � ►'�-�•�� � Contact:
� � Contractor, ��'�� Address: ��i 7 3 �IJZF���urvLu- �rw� � City: L�d�y�
State: i y�h Zip: S12 3 Phone:6�Z �'�S 3���Email: Uh�`iz�v- d S L"' l���A'c� � �7�.
License#: �e Q3cS�� � 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: Phone:
Mechanical Contractor: Phone:
Sewer 8�Water Contractor: Phone:
NOTE:Plaris and supporting documents that you submit are consitlered'to be public ir►formation Por#ions of::�
the information may be classifietl=as non-public;'if you provide specific reasons fhat would perr»it the:C�ty fo .�
conclutle thaf the .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.aopherstateonecail.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 Buil ' g Code must be compieted within 180
days of permit issuance.
x ��� � �V 7� X
ApplicanYs Printed Name Applicant's Signature
Page 1 of 3
�� C-���rein ��\�� '
DO NOT WRITE BELOW THIS LINE Ca� Z��
SUB TYPES
_ Foundation _ Fireplace _ Porch(3-Season) _ Exterior Alteration(Singie Family)
� Single Family _ Garage _ Porch(4-Season) _ Exterior Alteration(Multi)
_ Multi _ Deck _ Porch(Screen/Gazebo/Pergola) _ Miscellaneous
01 of_Plex Lower Level Pool Accessory Building
WORK TYPES
_ New _ Interior Improvement _ Siding _ Demolish Building*
Addition Move Building Reroof Demolish Interior
�Alteration Fire Repair Windows Demolish Foundation
Replace _ Repair _ Egress Window _ Water Damage
Retaining Wall *Demolition of entire building—give PCA handout to applicant
DESCRIPTION
Valuation � Occupancy y�� MCES System
Plan Review � Code Edition ��rJ�� -�}'1 SAC Units
(25%_100% ) Zoning �(/; City Water
Census Code Stories r�s� Booster Pump
#of Units Square Feet PRV
#of Buildings Length Fire Sprinklers
Type of Construction �/�/'� Width
�'T
REQUIRED INSPECTIONS
Footings(New Building) Meter Size:
Footings (Deck) Final/C.O. Required
Footings (Addition) � Final/No C.O. Required
Foundation HVAC Gas Service Test Gas Line Air Test
Roof:_Ice &Water _Final Pool:_Footings _Air/Gas Tests _Final
�, Framing Drain Tile
Fireplace:_Rough In _Air Test _Final Siding:_Stucco Lath _Stone Lath _Brick
�Insulation Windows
Sheathing Retaining Wall:_Footings_Backfill_Final
Sheetrock Radon Control
Fire Walls Erosion Control
Braced Walls Other:
Reviewed By: �� , Building Inspector
RESIDENTIAL FEES
Base Fee ��;�"�'��j��
Surcharge ,
Plan Review ��������
MCES SAC �{�,.����±�� ���`
City SAC ��
Utility Connection Charge
S&W Permit 8�Surcharge � � (,� � �
Treatment Plant � /� °
Copies �
TOTAL
Page 2 of 3
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I For Office Use I
619 I�
,` a Permit#: I I
A ,
1 Permit Fee: t Q v 0
,.-awl_.'" I
i Date Received:
3830 PILOT KNOB ROAD I EAGAN,MN 55122-1810 I
(651)675-5675 I TDD:(651)454-8535 I FAX:(651)675-5694 � Staff:
avidin it f octionsi s itvnfe;a3an.com
2018 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: 5/3/18 Site Address: 857 Govern Circle
Tenant: Suite#:
Resident/Owner
Name: James Barton Design Build, Inc. Phone: 952-431-1670 I
Address/city/Zip: 5920 148th St W, Apple Valley, MN 55124
Name:
Diversified Pluming License#: PC667869
Address: 125 E. Railroad St City Norwood Young America
Contractor �'
MN 55368 952-448-0756
State: Zip: Phone:
Contact: Jacob Sams Email:jacob@diversifiedph.com
E
Type of Work —New ✓ Replacement Repair Rebuild _Modify Space Work in R.O.W.
i
Description of work:
RESIDENTIAL
Water Heater j
I Water Softener
—Lawn Irrigation( RPZ/_PVB) 3
Permit Type X Add Plumbing Fixtures(4/ Main/_Lower Level)
Septic System
New Water Turnaround
Abandonment
t RESIDENTIAL FEES:
$60.00 Water Heater,Water Softener, or Water Heater and Softener(includes State Surcharge)
$60.00 Lawn Irrigation(includes State Surcharge)
$60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround*(includes State Surcharge)
"Water Turnaround(add$280.00 if a 3/4"meter is required) 60.00
$115.00 Septic System New(includes County fee and State Surcharge) TOTAL FEES$
CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454.0002 for protection against underground utility damage. Call 48 hours before you
intend to dig to receave locates of underground utilities. . vtor; r tpt „ f rr1
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's
website at www.city/ctfeanaf,,;omisubscribe.
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 ap« a .1 of plans.
xJacob E. Sams 444.-
Applicant's Printed Name Applic: 's Signatu'-
FOR OFFICE USE Reviewed By: Date:
Required Inspections: Under Ground Rough-In Air Test Gas Test Final
Meter Related Items: Meter Size Radio Read Manometer Staff: