865 Govern Cir,. ? INSPEC'I
"C1TY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS:
e,yiJVf:fiN (:1h'
I , i?' t.; ,:t? :y,lis?. •?•3Fi
PERMIT SUBTYPE:
? ? ?. •
ON
PERMITTYPE: r i riToci
Permit Number: 0 H A I
Date Issued: ,: ., h / 4 7
APPLICANT:
TYPE OF WORK:
INSPECTION
D• • D.
F Fz F Iq A 12 V'5 : 1't+ & 14 I' 1 R 12 - M1 Ei 14 '. f 141 1: A Pd rl L f/1 i I' 1
Parmit No. Permit Holder Date Telephone #
ELECTRIC
PLUMBING 47
HVAC
Inapection Date Insp. Comments
FODTINGS 7
FOUND
?
-i7 fG?
? 7,:!id]
FRAMING
-v
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
?-lj
LL
GAS SVC
tEST
W SUL
GYPBOARD
FIREPLACE /
FIREPLACE
AIR TEST ?
FINAL PLBG ?
FINAL HTG
ORSAT
TEST
(!a a
BLDG FINAL
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
Ad'dress 865 GOVERN CIR
Lot ° Blk ` Sub
GARDENWDOD PONDS 2ND
Zip 5512?
THESE TTEMS WER / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECTION.
,
Date: f? Yes No Inspector:
Final grade (6" from siding) L/
Permanent steps (gatage) L-?
Permanent steps (main entry) ?
Permanent driveway ?
Permanent gas
Sod/Seeded grass ?
TraiUcurb damage
'Porch ?
Basement finish ?
Deck ?
Please verify with the builder the removal of mof test caps from the plumbing system and the shu[roff of water supply to
the outside lawn faucet before fteeze potential exists.
Contact engineering divisioa at 661-0645 before working in rightof-way or insplling underground sprinkler system. ?
Whik - City Copy Yellow - Resident Copy Pinlc - Contractor Copy
2007RESIDENTIAL BUILDING rExnuT nrrLicariorr
d City OfEagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Construction Reauiremenis
3 registered site surveys shaxing sq. k of lot, sq. ft of house, and all roofed areas
(200/o maximum lot coverage allowed)
1 Soils Report if propased building is to be placed on disWrbed soil
2 copies of plan showing beam & window sizes; poured found design, etc.
1 set of Energy Calcutations
3 copies of Tree PreservaGon Plan if lot platted after 711/93
Rim Joist Depil Opfions selection sheet (buildings wiN 3 or less uniis)
Minnegasco mechanical ventilahon form
RemodeVReoair Reauiremen4s Office Use OnN
2 copm of plan showing footings, heams, 7oisGS CeA of Survey Recd _ V_ N
7 sef oi Eneigy Calculations for heated addNOns Soils Repod _ Y_ N
1 sfle survey fir addi6ons & decks Tree Pres Plan Recd '_ Y-N.
Addifion - indicafe if on-sde sep6c system Tree Pms Required _, Y_ N
OneiteSepUcSysfem _Y _N
oi?.,g ?Pg ...,.,cG.aarnA nnhlir infnrmafinn iiniPC-q vnu state thev are trade secret and the reason.
Date ? /
Coo9tructioo Co5t
Site Address O? Unit/Ste #
Description of Work
Multi-Family Sldg _ Y >?- N Fireplace(s) X 0 _ 1 _ 2
Property Owner 6 ??^/,?Cn2 Telephone # ( /o lL)
Contractor Ale?,J Lj-jCLG
Address ?q ']P S 6,1&LWI?U3 City ?1?/'?/°CG{?3'7
Zip ?
Telephone # ( (PS n ? ? ? - ? ? ?
State ,
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 _ Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(d submission type) Submitted Submitted
. Energy Envelope Calculations Su6mitted
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_ Y _ N If yes, date and address of master plan:
Licensed Plumber
Mechanical Contractor
SewerJWater Contractor
herebv anrolv for a
Telephone #(
Telephone #(
Te{ephone # (
and acknowledge that the information is complete and accural
e;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the atate ot iviN
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 ork which requires a review and
approval of plans.
Applicant's Printed Name Ap 'cant's Signature
2005 RESIDENTIAL BUILDING PERMIT APPLICATION
? City Of Eagan
?? 3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Consimction Reuui2ments RemodeUReoair Renuirements Office Use Onlv
3 registered stte surveys shaxing sq. ft. of lot, sq. fl. of house; and all roofed amas 2 copies of plan Cert of Survey Recd _ Y_ N
(20% maximum lot coverage allowed) 7 set of Eneigy Calculatbns for heated addNOns Tree Pres Plan Recd _ Y_ N_
2 copies of plan showing beam 8 window sizes; poured found design, etc. 7 site surveyforaddiGOns & decks Tree P2s Required _Y _ N
1 sel of Energy Calculahons Add'Rion - rndeafe Aon-site septre system On-sile Septic Syslem _Y _ N
3 copies of Tree Preservation Plan if lot platted after 111193
Rim Joisl Detail Options seledion sheet (buildings wilh 3 orless units)
Da[e --(.r-/ _7,? / 0-?_ Construction Cost ?
!l T
SiteAddress ??(,0? Cr[,
j L?A-) C UniUSte#
CflbAl?
Description of Work //J5 %)01l.(. G/jzi A!-LA14c,L5
Multi-Family Bldg _ Yb4_IY Fireplace(s) _ 0 KJ _ 2
Property Owner XIM f? lL 00)•'j Telephone # (L
Contractor
J
Address 3b-?;N C..? /7,L- `L / 3 tY /J V6.lC
Ci
State /114? Zip !9? 3Y Telephone #
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(dsubmissionrype) Su6mittad Submitted
• Energy Envelope Calculations Submitted
Have you previously constructed a building in Eagan with a similar plan2 _ Y _ N If so, 25% plan review
fee applies.
Licensed Plumber
Telephone # (
Mechanical Contractor
Sewer/Water Contractor
Telephone #(
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 playNin th?,.oas eo(v+k which requires a review and
approval of plans. aJ3
t v
)c N ;? c?c? J)
Applicant's Printed Name Ap licanYs Signature
?J
1 :4{Y". )id, X.
71i: [.',^1f ..AN
,.
l:mLii:i91. i'f,1G .:?3
!,,,. ?. ,';,•?.j..:');?
r-? ??? ._.. ... . ,
?:_ .r;?r.?rf1V ir
..rJi:.;il c`.:,rr•?1?:'?I; filA;:tl'il` ?, 9,1 19`;, ,.ii?':
iri A `i C l i??l.. YPJi??
N:;m.M.fn.n, ?, !tlf\i,?:4jiJ??:.?i?`?`??. )?t H.: I ?f X, Ii Sin/ ?,?.?h:i?iti
i??
PERMIT
CITY, OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
PERMIT TYPE:
Permit Number:
Date Issued:
BUILDING
030837
09/26/97
SITE ADDRESS:
865 GOVERN CIR
LOT: 6 BLOCK: 2
GARDENWOOD PONDS 2Np
P.I.N.: 10-28801-069-02
DESCRIPTION:
li
a. C
rmit Type
T y p e
e
SF DWG
NEW
R-3 U-1
V-N
R-1
65
43
2
2>264
101 1 - FflM. DETACH
, . ?9°
?f o ?,? ?? ??-
?? ? ? ? . .? ? ? ? ? _
<?
REMARKS:
S& W PLBR - M& W SEWER AN? WATER
FEE SUMMARY:
VALUATI4N
Base Fee
Plan Review
Surcharge
SAC
SAC %
r, SflC Units
? Subtotal
$1,432.25
$930.96
$104.50
$950.00
100
1
$3,417.71
$209,000
MISCELLANEOUS $1.539.50
Total Fee $4.957.21
CONTRACTOR: _ Appzqcant - sT. LIC OWNER:
HORTON INC OF MN, ? R 14544663 2000565 JOE MYLLER HOMES
3459 WASHTNGTON DR 204 3459 WASHINGTON DR 204
EAGAN MN 55122 EAGAN MN 55122
(612) 454-4663 (612)454-4663
.e,;; _
' -tpC! ?:Ly 5j1!,?Tn1=4.p?t?MA L,],y,?>?a?
L . . _ . s ris?c...?.......,s_...... ...?
APPLICANT/PERMITEE SIGNATURE
naun R?¢i'l.f lh?l
E SI'NA
7 BUILDING PERMITAPPLICATION (RESIDENTIAL) -`A',i?1j. ?l
0fif CITY OF EAGAN
45 3830 PILOT KNOB RD - 55122
681 -4675
New Construction Reouirements
• 3 registered site surveys * y ppPigg p{ plgn
? 2 copies of pWns (inGude beam & window saes; poured fid. dasign; etc.) ? 2 si[e surveys (exteriw additions 8 dedca)
0 1 enargy calculations ? 1 energy celwlations Por heatad add'Rions
? S copfes W tree preservation plan if bt plet[ed aRer 7f7/93
requlred: _ Yes V- No -
UATE: 9' I-?f ? 1rT CONSTRUCTION COST:
DESCRIPTION OF WORK: /t/ew C0051?,c4h.
STREETADDRESS: f6f G uvEr,n G??,IG
LOT ?0 BLOCK ? SUBD./P.I.D. #: G?ra?GnWotJ? ?ov? ?5 o`Tn .
PROPERTY
owNeR
CONTRACTOR
Name:
?
, ,,,
Phone #:
Street Address:
City:
State: Zip:
Company: vc i'ndjer ? me S Phone #:
Street Address: 345?,?u„ ? S?-,2z'51 License #: ??ZX11657
City: ?G??n State: /hA! Zip: ,53-/,w
ARCHITECTI Company:
ENGINEER
Name:
Phone #:
Registration #:
Street Address:
City:
State:
Zip:
Sewer & water licensed plumber (new construction only): i1't f-(.cf ?u/8r ?- l?G ?('+•. Penalty appiies when address change
and lot change are requested once permit is issued.
I hereby acknowledge that I have read this appliraqon and state that the infortnation is cortect and agree to comply with all applicable
State of Minnesata Statutes and City of Eagan Ordinances.
Signature af Applicant: ,
OFFICE USE ONLY RECEIVED
Certificates of Survey Received _Z Yes _ No SEP 19 1997
Tree Preservation Plan Received _ Yes _ No ? Not Required BY'
OFFICE USE ONLY
BUILDING PERMIT TYPE
0 01 Foundation ? 06 Duplex o 11 Apt./Lodging ?
02
? SF Dwelling ? 07 4-plex o 12 Multi RepaidRem. o
0 03 SF Addition ? 08 8-plex ? 13 Garage/Accessory o
? 04 SF Porch ? 09 12-plex ? 14 Fireplace n
n 05 SF Misc. ? 10 _ plex o 15 Deck
WORK TYPE
? ? 31 New ? 33 Alterations o 36 Move
32 Addition o 34 Repair o 37 Demolition
GENERAL INFORMATION
Const. (Actual)
(Allowabfe)
UBC Occupancy
2oning
# of Stories
Length
Depth
f
?
Basement sq. ft.
Main level sq. ft.
sq.ft.
sq. ft.
sq. ft.
sq. ft.
Footprint sq. ft.
?
?
,
16 Basement Finish
17 Swim Pool
20 Public Facility
21 Miscellaneous
MCIWS System
City Water
Fire Sprinklered
PRV
Booster Pump
Census Code.
SAC Code
Census Bldg
Census UnR
APPROVALS
Planning
Permit Fee
Surcharge
Plan Review
License
MCNVS 5AC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI.
Road Unit
Park Ded.
Trails Ded.
Other
Copies
Total:
% sac
SAC Units
Suiiding FM Engineering Variance
Valuation: $ - `.
UtJFint Is?
._._---
15%X )S? Z3'k.00
F, IeS AP'L
?CJ%X 54` $Z,144,DD
?GOIJD ??
??D7? X?`? '" ld??P?0?0•?
12$ X )la = 11) b41 .60
T_VL_
? 20`d? Z51.0o
LOT SURVEY CHECKLIST FOR RESIDENTIAL
• BUILDING PERMIT APPLICATION
? PROPERTYLEGAL: v? 4zz- z I"a.
DATE OF SURVEY: LATEST REl/ISION:
? m DOCUMENTSTANDARDS
• Registered Land Surveyor signature and company
Gli6 ? • Building PermitApplicant
? • Legal description
&?--'o ? • Address
0?'[ ? • North arrow and scale
b7? ? ?
R"?O ? •
• House type (rambler, walkout, split wlo, split entry, lookout, etc.)
Cr'?? ? Directional drainage arrows with slope/gradient %
2"'?O ? • Proposed/ebsting sewer and water services 8 invert elevation
• Street name
B-?'0 ? • Driveway
ELEVATIONS
Existina
? ? • Sewer service (or Proposed)
? • Property corners
/? ? • Top of curb at the driveway
C? ? ? • ElevaBons of any ebsting adjacent homes
Prooosed
?o ? • Garage floor
?0 ? • First floor
?o ? • Lowest exposed elevation (walkouUwindaw)
? ? • Property corners
? ? • Front and rear of home at the foundation
PONDING AREA fif aoolicablel
? ?" ? • Easement line
? ?? • NWL
o ?? • HWL
? 0' ? • Pond # designatioh
? o • Emergency Overtlow Elevation
DIMENSIONS
gy"
? ? • Lot Iines/Bearings 8 dimensions
-/
0 0 • Right-of-way and street width (to back of curb)
0' ? ? • Proposed home dimensions including any proposed decks, overhangs greater than 2',
/
P? ? ?
• porches, etc. (.e. all strudures requiring permanent footings)
Sh
ll
ow a
easements of record and any Ciry utilrdes within those easemenis
[? ? ? • Setbacks of proposed structure and sideyard setback of adjacent ebsting structures
? m?o • Retaining wall requirements if any
Reviewed: v?/
?
Wame Date '
7
January 7996
CRAIG198&BLDGPRMT FM
? HINNESOTA STATE ENERCY COQF CB?.Cq?ATIONS
• 8A9ED OH CIiAPTIiR 5 QF TttE
MooEL ENERCY Cot7B - 1983 FkITI4H
' I Adnption Effeative
rn.rnar 11411/ l _ar k ----_PhOTIe
site
contraotor
/.r}\! i
Building classif.lcation: Type Ai (single Family & Uuplex)
el- ZG94i
Type A2 (Residential, 3 stories or less) (Qver 3 etories) (othar)
HOTES Coma ete paaes 3 and 4 first.
GRNE(2Ai, 7NFORMATION
1. Building Perimeter pt•
?
2. Wall height (ground to eave) Et.
3. 1. X 2. (above) gross wall area_ aq.ft.
q. Huilding dimenslons (L) r X(W) r ? 1b 5`-?q.ft,raof 6 floor sraa
5. 3q. faot area of rim joist F oor joist Bize (2 % 10 ,
,l? X 1"?(Perimeterj = ?aq.tt.
iZ •
6. Doors - Area f ? '?
Thickne s in U. factor r I Q6?
Type of constructlon Perimater ft.
. ManuPacturer ---
7. Total dnor's perimetier ft.
8. Windaws: 14anufacturer?r„1J?7t?? Stcte appraved_
I) fnctor I ? //i
TYPE SIZE IfREA (Sq.Ft.) NUMBER OF TOT?,L
Id i - EACH UNI'PS 6Q FBET
9. motal sq.tt. ciess ??-i?2 2--
to. Fireplaae areae Width x Neiqht -- X ° sq.tt.
lI. Exposad foundatlon: Height X Perimeter,(-.2 X_L7a-mI . -aq.lt.
COMEI.ETIOtd oF 'fHIB FOF2M IB REQUIRE4 FoR ALT, NBSV CONSTRUCTIOtI, Ml1JOR
REMODELIN(i AND BUILDINGS BLING 144VED WHERE Et1$RGY, OTHER THAN 4'l1E HINIMAL
CoDE ALLt7WANCE, IS USED.
S9iT0'd 6G92 ZSb ZT9 i 'DNi '00Ntl-1d 8£:SS 666L-T0-d35
1j. Framing area = lOb of groae wall area.
11. Gross wall area 2+ sq.ft,
Wlndow area A 33 L sq.ft. U windnws
Rim joist area Aeq, ft. ll rim joist= . oQ 1
Door area A_ S? sq.ft. U doqr afrea==l?_
Other doors area A p eq.ft. U othor cioors=_,4__
Expoged Pndh A sq.Et, U foundstiiotl= 07&
Framing area A eq,ft. U Praming area=.l.Id1,2
Net wall area A7iZ 27.3 eq.ft. U wall- +A /
(13B) TOTAL . . . . . . • . .
.?94" Y,o4
UxA = ?0
WxA ? IZI
UXA = 7
UxA ? Iq
uxA = r
UXA %
Uxt, - ,q(l)_
ux1? r%3
m Z!(?57_
19. Gross wall area ac 0.11 (A-1 aingle fntul.ly & duplex) m allowabla Ux.A/Code
(13, abnve)
x 0.23 (r-2 other Yeaidential) '
x .23 (other buildinge)
x .28 (ovet' 3 etories)
HTUH must be larger than ar eama
A.?W1_k U Coda °F. as 13H above
15. celling fraiainq area (A£) equnle lot of aeillrtg area
15A. Gross ceiling area ={L) ? x(N) ? °+??2/ sq.ft.
?.
15H. Jaist area (Af) A 10t cailinq area sg.ft.
15c, Net oeiling area (Ac) (15A - 15B) -sq.ft.
U ceiling xA? = tA? x •??! ? T
U framing x A f 7t •?" _?
15D. TOTAL U x A .............................. 16. Ceiling area (1511) x 0.026 (A-1 aingle femily & duplex)
= allowable UxA/cPae
x 0.033 (a-2 other residential)
x 0.06 (ather)
r? BTUH must be lexgsr thatt ur eame
l?(151?)?tU`3 L U CodeI'j°F. as 15IJ abave
?IOTP,t Uee U anil A values obtainad ftom pagee 1, 3 and 4.
C$BTjpICATIONs I hereby certify that I hnve oalaulated the MUOI factnre and
??RII values hereltt and that tho buiidinq here dasoribad meeta or exaeeds the
Stata oP Mlnneaotn Etiergy Conaarvetion Aak. .
Date
I
9ignature
S9iz0'd 6S9£ ZSC i,t9 L 'IXII 'O--hlFiId 6£:ST h664-M-d3S
. ,. . _ i
,
_ . .. . .. ?.'?.:?a?l??" .. . . . .. .. . . - - .
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--
..
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???-`?-? ---- ...------ -?---
-- ---?--? - ------ ---.._.._. .
--..... . - ? ---- --... . _.
- - --- -- ?-----_ -?-- .... _. .._.
. -- - ?- ------- __. ..._._
I/Uf uD0 Wy . . .. .- -
- --- - ------- - _ ----. .. ----------- -?-- ----
.
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_ .._.... . _.1-__ LeoLa .?. ZSx2 _...._ _ _z_-`?.??? _. . ...._ ...._..._..-- -. . ... . ._ .. .... --- -------
---...... --
---
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. _ ? - - ------ ----. _ ?_ .- - ?- ----- -- . .
.. .
----?-----.. ..
n
ES9£ ZSC Bi4 S 'DN1 'OJNtlld 6£:ST 1,65ti-Til-d75
vz ? CITY USE ONLY 7
L U BL ?-RECEIPT#:
r
,
SUBD.ti 'Pf?O:Pi.,.;?;-vr??+ RECEIPTDATE:
1997 PLUMBING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
(672) 6814875
Please complete for: . single family dwellings
. townhomes and condos when permits are required for each unit
. backflow preventer for undergraund sprinkler system
FIXTURES? EACH M?
Showe
r
3.00
x _
Water Closet 3.00 x ? E
Bath 7ub 3.D0 x l
Lavatory 3.00 x
Kitchen Sink 3.00 x
Laundry 7ray 3.00 x ? = D
Hot Tub/Spa 3.00 x =
Water Heater 3.00 x
Floor Drain 3.00 x =
Gas Piping Outlet ' minimum -1 3.00 x = s?. D?O
Rough Openings 1.50 x = ff'??
Water Softener `for dwellings under construction 5.00 x
Water Softener " for existing dwelling 20.00 x =
U.G.SprinklCr 'fordwellingunderconst. 3.00 =
U.G. Spflnkler ` for existing dwelling 20.00 =
Alterations 'to existing residenee 20.00 =
WaterTurn Around 20.00 =
Private Disposal System ' Dak Cty lic. 75.00 =
(new and refurbished systems)
Private Disposal Systems'nbandonmene 20.00 =
STATE SURCHARGE .50
oo
?
TOTAL ?
I hareby acknowkdge that I hsve read this apptication, state that the infortnation is cortect, and agree to comply with all applicable Ciry
of Eegan ordinances. tt is the applicanPS responsibility M notify the property owner that the City of Eagan assumes no liability for eny
damages caused by the City dunng its normal oparetional and maintenance adivities to the facilities mnstructed under this pertnfl within
City propertylright-of-waveasee,.,enr
SITE ADDRESS:
OWNER NAME:
INSTALLER NAME: GENZ-RYAN PLUMBING & HEATING
STREET ADDRESS: 14745 SO ROBERT TRL
CiTy: ROSEMOUNT STATE: MN Zlp; 55068
SIGNATURE OF PERMI EE
TELEPHONE #: 423-1144
CITY U5E ONLY
?LOT ( _ BL oZ RECEIPT #: SeLo2 ?Cp
SUBD. RECEIPT DATE:
1997 MECHANICAL PERMIT (RESIDENTIAL)
CTl'P OF EAGAN
3830 PILOT KNOB RD
EAGAN MN 55122
Date: S`00 (612) 681-4675
Complete this section only if you are installing HVAC in single family, townhome, or condoa that are
under construction and are not owner /occupied.
• HVAC: 0-140 M B T U $ 24.00
ADDITIONAL 50 M BTU 6.00
• Gas oudets ( m;.»T„um of one required @$3.00 ea.) '?T oo
• State Surcharge: .50
• TOTAL:
Complete this section only if you are remodeling, addin2 to, or repairing egisting single family
dwellines, townhomes, or condos.
Add-on fiunace
Add-on air exchanger, i.e. Vanee system, etc. _
Minimum fee applies to all remodel or add-ons of existing residences
State Surcharge
SITE ADDRESS:
OWNERNAME: ?Ych:?
INSTALLER NAME:
Add on air conditioning
Other
$ 20.00
.50
Total: $ 20.50
PF'oNE #: -4 S 4-4c?(? ?
PHONE #:
STREET ADDRESS: & ? q \ (7 --'L
CITY: I C^??C L(\ \, ? o'_? STATEM_ ZIP:
SIG VATURE OF PERMITTEE
CITY USE ONLY
L BL RECEIPT #:
SUBD. RECEIPT DATE:
1998 PLUMBING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
E7+GAN, MA7 55122
(612) 681-4675
Ptease complete for: ? single family dwellings
? townhomes and condos when permits are required for each unit
? backflow preventerforundergraund 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 =
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 - t 3.00 x =
Rough Openings 1.50 x =
Water Softener ' Por dwellings under construction 5.00 x =
Water Softener " for existing dwelling 20.00 x =
U.G.Sprinkler `fordwellingunderwnst. 3.00 =
U.G. Sprinkler ' for existing dwelling 20.00 =
Altef2tlOn5 ` to ezisting residence
20.00 n, ?
Water Tum Around 20.00 =
Private Disposal System * MPC lic. 75.00 =
(new and refurbished systems)
PfVVBtE D'ISp0381 SyS1BrT15' Abandonment 20.00 =
STATE SURCHARGE .50
TOTAL ?-LO -M
- - - - - - - - - • - - -------- ---------° --------------------- --- ce---
1 hereby adcnowledge that I have read this application, state that the infovnetion is correct, and agree to comply wdh all applicable Cityaf Eagan ordinans.
tt 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 tts
nortnal opera4onal and maintenance activities to the facildies construc[ed under this permit within City propertylright-of-wayleasement.
SITEADDRESS: <lS& -!S- 61-2 ef "2lc /C
OWNER NAME:
INSTALLER NAME: [rUGI D ? Scs?('?S PIU---/dvc^r(,? TELEPHONE #:
STREET ADDRESS: ?7 ?S J Uv-?e Aa{ L?
CITy: STATE: Aol? ZIP: ?
SIGNATURE OF PERM
JSlFORMS 8LDG/PLBG PERMIT (RESIDENTIAL) 1998
?*********************???*************?
CITY OF EAGAN
CASHIER: JS TERMINAL NO: 773
?ATE: 09/14/00 TIME: 09:11:32
ID:
NAME: TODD J OLSON
3210 9001 865 GOVERN CIR 153.25
2155 9001 865 GOVERN CIR 4.00
Total Receipt Amount: 157.25
CR137290
USER ID: JAN
2000 BUILDING PEaMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN I ??. ??
3830 PILOT KNOB RD • 55122 11 (nj 651•681-4675
Naw ConahucMon ?ail ?meMs Remodel/Reoalr Reaulrements CQ II? 9I1
« *
? 3 regisfered sNe wrveys showing sq. B. ot lot, aq. tt. ol house 2 copiea ot plan
antl QII roofed areas G20% maximum lot coveroae allowem 1 set d energy calculaHOna lor heotetl atltlifiaq
D 2 coples of plans (ahow beam & window aizes; poured Intl. tlesfAn; etc.) 1 site wrvey for extedor addiHons & decks ?
Y 1 set o( energy calculaHOns
? S Copfes of hee preservatlon plcn H lot plalletl Wter 7/1/93
DAiE: - 'DD CO?NI?S?TR.UCTIONCOST:
DESCRIPTION OF WORK: ? c?""" I mulN t mlly bidg., how many units?
STREET ADDRESS: _ 75 LDO oOVej'Yl c
LOT: 6 BLOCK: ig SUBD./P.I.D. #:
Name: 0ISDY1 lad4o, Phone M:
PROPERTY Lost First
OWNER Sheet Address: `,i (D5 /? ri1 /,prn (?i rel P ,
?_.i
i city state: MAI zlp: SSL23
Company: a? a?? Phone #:
(area code)
CONTRACTOR
Street Address: License N _
City State: Zip:
ARCHITECT/ ?d
ENGINEER -6er?penyc-_ -?'?? e Name: Uu''1rj /LP. &AnliYh
Telephone #: ( &TI ) l -
Sheet Ad ress: 8 e Regishaflon A:
cly U/ dIP r tATC L state: W_ Zip: 6-6-I ID
Sewedwater licensed plumber (H InsWllinn sewedwaterA/4_ Phone #:
I hereby aeknowledge that I have read ihis applicalfon, stafe thaf 1he information Is coJ?ect, and agree to compty wNh all applicable StaFe
of Minnesota Statutes and City o( Eagan Ordinances. i// ,,, ,I
Signature of ApplicanY
OFFICE USE ONLY
g ` 2000
Certifcates of Survey Received _ Yes _ No S?P
Tree Preservation Plan Received _ Yes _ No _ Not Required $Y
OFFICE USE ONLY
BUILDING PERMIT SUBTYPES
O 01 Foundation ? 07 OS-plex . ? 13 16-plex 0 21 Porch (3-sea.)
O 02 SF Dweliing O 08 06-plex O 17 Garage O 22 Poroh/Addn. (4-sea.)
? 03 01 of _ plex O 09 07-plex 11 18 Deck Jb 23 Poroh (screened)
0 04 02-plex O 10 08-plex ? 19 Lower Level ? 24 Storm Damage
O 05 03-plex ? 11 10-plex Pibg _Y or_ N ? 25 Miscelianeous
O 06 04-plex ? 12 12-plex ? 20 Pool ? 30 Accessory Bidg.
WORK TYPE
IN 31 New ? 36 Move Bldg. ? 43 Reroof
? 32 Addition ? 37 Demolish (Bldg)' ? 44 Siding
? 33 Alteration ? 38 Demolish (Interior) ? 45 Fire Repair
O 34 Repair ? 42 Demoiish (Foundation) ? 46 Windows/Doors
* Give PCA handout to appl icant for demolition permit
GENERAL INFORMATION
SAC Code l9/
No. of Units
No. of Buildings
Const. (Actual) S A/
(Allowable) ?
UBC Occupancy
Zoning
# of Stories
Length
W idth
Basement sq. ft.
Main Ievei sq. ft.
sq.ft.
sq.ft.
sq. ft.
sq.ft.
Footprint sq. ft.
Census Code
MC/ES System
City Water
Booster Pump
PRV
Fire Sprinklered
MISCELLANEOUS INSPECTIONS
? Stucco/Stone
APPROVALS
Planning _
Permit Fee
Surcharge
Plan Review
License
MC/ES SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
SNV Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
Building 1.cad Engineering
Variance
? 31 Fxt. Alt - Multi
O 33 Ext. Alt - SF
? 36 Mufti
Y.?:z
f D141/,) 0?
Valuation:
?-
a
SAC Units
% SAC
, .
,
,
,
,
,
,
CER7IFlCATE OF S'l1RVEY
for
JOE MILLER HOMES ?
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N82 03 25"W 9 pl •b \1
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7
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wr-
LU{LUiNG 1(dSPLC 10 JS Ui i •
Top curb to Gar slab = I0
? ?/?? Top block
/ Lowest bsmt flr = _?9
Scale: 1 ° = 30'
865 Govern Circle
DESCRIPiION
I hereby certify that this survey, plan, or
'report was prepared by me -under my direct
supervislon and tha} a duly Registered
Land Surveyor u the laws of the State
of M/??
• Oate 1 S'E 1997 Rea. No. 8140
Lot 6, Block 2,
GARDENWOOD PONDS SECOND
Dakota County. Minnesoto
Plat bearings shown
o Denotes iron monument
? Existi_g j Proposed
BRANDT ENGINEERING & SURVEYING
1600 West 143rd Street, Suite 206
Burnsville, MN 55306
(612) 435-1966 M32-1615-97
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CERTIFlCATE OF SURVEY
for
JOE MIILER H4MES
?
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Scale: 1" = 30'
?: .
1 ?+
?• ?
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N82'03'25"W
,
M32-1615-97
i
Top curb to Gar slab
Top block = 2-67
Lowest bsmt flr = 9(L9
t 6-.
J
b i
1
rE? 6
865 Govern Circle
DESCRIPTION
Lot 6, Block 2,
GARDENWOOD PONDS SECOND
Dakota County, Minnesota
Plat bearings shown
o Denotes iron monument
0" Existing j Proposed
BRANDT ENGINEERING & SURVEYING
1600 West 143rd Street, Suite 206
Burnsville, MN 55306
(612) 435-1966 M32-1615-97
0 ffI
I hereby certify that this survey, plan, or
report was prepared by me ar under my direct
supervision and that I am a duly Registered
Land Surveyor under the Laws of the State
of MinnESOta.
Date 16 ?S'E3? 1997 Reg. No. 8140
PERMIT
City of Eagan Permit Type: Building
Permit Number: EA106499
Date Issued: 0812412012
~it~ of 11QR Permit Category: ePermit
Site Address: 865 Govern Cir
Lot: 6 Block: 2 Addition: Gardenwood Ponds 2nd
PID: 10-28801-02-060
Use:
Description:
Sub Type: e-Reroof Construction Type:
Work Type: Replace
Description: House & Garage
Census Code: 434 - Occupancy:
Zoning:
Square Feet: 0
Comments: If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar. Pictures are
not acceptable in lieu of inspections.
Carbon monoxide detectors are required by law in ALL single family homes.
Fee Summary: BL - Base Fee $4K $103.25 0801.4085
Valuation: 4,000.00 Surcharge - Based on Valuation $4K $2.00 9001.2195
Total: $105.25
Contractor: - Applicant - Owner:
Thompson Exteriors Todd J Olson
3757 Cedar Ave S 865 Govern Cir
Minneapolis MN 55407 Eagan MN 55123
(612) 722-8428
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.
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA122723
Date Issued:05/16/2014
Permit Category:ePermit
Site Address: 865 Govern Cir
Lot:6 Block: 2 Addition: Gardenwood Ponds 2nd
PID:10-28801-02-060
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Eric Bruckmueller
3992 Pennsylvania Avenue
Eagan, MN 55123
Fee Summary:PL - Permit Fee (WS &/or WH)$55.00 0801.4087
Surcharge-Fixed $5.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Todd J Olson
865 Govern Cir
Eagan MN 55123
Bruckmueller Plumbing Inc
3992 Pennsylvania Ave
Eagan MN 55123
(651) 686-6696
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA140341
Date Issued:12/09/2016
Permit Category:ePermit
Site Address: 865 Govern Cir
Lot:6 Block: 2 Addition: Gardenwood Ponds 2nd
PID:10-28801-02-060
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Thomas H Hansen
865 Govern Cir
Eagan MN 55123
(218) 329-6298
Controlled Air
21210 Eaton Ave
Farmington MN 55024
(651) 460-6022 X253
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA149162
Date Issued:05/09/2018
Permit Category:ePermit
Site Address: 865 Govern Cir
Lot:6 Block: 2 Addition: Gardenwood Ponds 2nd
PID:10-28801-02-060
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:Two or More Windows/Doors
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow
windows, call for framing inspection. Call for final inspection after installation.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Valuation: 4,000.00
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Thomas H Hansen
865 Govern Cir
Eagan MN 55123
(651) 503-5499
Property Claim Solutions Llc
2005 Pin Oak Dr
Eagan MN 55122
(651) 994-2028
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA158616
Date Issued:10/22/2019
Permit Category:ePermit
Site Address: 865 Govern Cir
Lot:6 Block: 2 Addition: Gardenwood Ponds 2nd
PID:10-28801-02-060
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Softener
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener).
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Thomas H Hansen
865 Govern Cir
Eagan MN 55123
Haferman Water Conditioning
12142 12th Ave.
Burnsville MN 55337
(952) 894-4040
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA176043
Date Issued:04/27/2022
Permit Category:ePermit
Site Address: 865 Govern Cir
Lot:6 Block: 2 Addition: Gardenwood Ponds 2nd
PID:10-28801-02-060
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:One Window/Door
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow
windows, call for framing inspection. Call for final inspection after installation.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Valuation: 1,500.00
Fee Summary:BL - Base Fee $1500 $62.50 0801.4085
Surcharge - Based on Valuation $1500 $0.75 9001.2195
$63.25 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Thomas H Hansen
865 Govern Cir
Eagan MN 55123
Pella Northland
15300 25th Ave N #100
Plymouth MN 55447
(763) 745-1400
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA179114
Date Issued:09/19/2022
Permit Category:ePermit
Site Address: 865 Govern Cir
Lot:6 Block: 2 Addition: Gardenwood Ponds 2nd
PID:10-28801-02-060
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:Does not include skylight(s)
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and leave on site.
If water damage is encountered, please call (651) 675-5675 to schedule a site visit to verify the extent of the damage. Any
repairs must be inspected prior to covering. The inspector will determine if an additional permit will be required to repair the
water damage.
Valuation: 5,000.00
Fee Summary:BL - Base Fee $5K $118.00 0801.4085
Surcharge - Based on Valuation $5K $2.50 9001.2195
$120.50 Total:
This permit shall be null and void if work does not start within 180 days of issuance, or if work is suspended for 180 days or more after
started.
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Thomas H Hansen
865 Govern Cir
Eagan MN 55123
Sela Roofing Remodeling
4100 Excelsior Blvd
St. Louis Park MN 55416
(612) 823-8046
Applicant/Permitee: Signature Issued By: Signature