873 Govern Cir
PERMIT
City of Eagan Permit Type: Building
3830 Pilot Knob Rd Permit Number: EA080458
Eagan, MN 55122 . Date Issued: 10/15/2007
(651) 675-5675~~~ EPermit Category: ePermit
www.ci.eagan.mn.us lflflUl tflflLLL
Site Address: 837 Govern Cir
Lot: 12 Block: 5 Addition: Gardenwood Ponds
PID 10-28800-120-05
Use
Description:
Sub Type: e-Reroof Construction Type:
Work Type: Replace
Description: House & Garage
Census Code: 434- Occupancy:
Zoning:
Square Feet: 0
Comments: 4130/08 Notification letter sent regarding expired permit pf
If there is no ice protection inspection prior to final, you must meet inspector with ladder and flat bar. Pictures are not
acceptable in lieu of inspections.
Fee Summary: BL - Base Fee $3K $88.50 0801.4085
Surcharge - Based on Valuation $3K $1.50 9001.2195
Valuation: 3,000.00
Total: $90.00
Contractor: -Applicant - Owner:
Royalty Remodelers Zachary J Meyer
4411 Slater Rd 837 Govern Cir
Eagan MN 55122 Eagan MN 55123
(612) 414-8199
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
,
e
. J
' C11TY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
' SITE ADDRESS:
, rtROE N00011 PONllt; ;'N11
I PERMIT SUBTYPE:
I
PERMIT TYPE:
Permit Number:
Date Issued:
APPLICANT:
4 r? i, 4 - 4 1 » ca A ,
TYPE OF WORK:
INSPECTION .. . ..
, , =;, ,
Permit No. Pertnlt Holder ' Date Telephone S
ELECTRIC
PLUMBING ?s g ? - ?
HVAC
Inspection Date Insp. Camments
FOOTINGS All
FOUND
FRAMING G'"?,-='+y ?-M? n/o1 i?"dl
ROOFING
ROUGH
PLLJMBING
-? ?
PLBG
AIR TEST I ('
?
ROUGH
HEATING
GAS
TESTSVC
?
!(
INSUL
GYP BdARD
FIREPLACE
L
FIREPLACE
AIR TEST
?
FINALPLBG
l0
/7
FINAL HTG
ORSAT
TEST
BLDG FINAL l
/4'
E3SMT R.I.
BSMT FINAL
DECK FfG
DECK FINAL
AddCess 'Tt 7 -t mcrFaN rTR`'f F. Zip 55123_
I.ot a Blk 2 Sub cama*m rorros 2rm
TfIESE TI'EMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECI'ION.
Date: Yes No Inspector:
Final grade (6" fcom siding)
Permanent steps (gazage) ?
Permanent steps (main entry)
Permanent driveway
Permanent gas
Sod/Seeded grass
TraiUcurb damage
PoPeh
Basement finish
Deck
Please verify with the builder the removal of roof test caps from the plumbing system and the shutroff of watec supply ro
the oufside jawp faucet before freeze potential exists.
Contact engineering division at 681-4645 before working in rightof-way or ins[alling underground sprinkler system. ?
Whice - City Copy Yellow - Resident Copy Pink - Convactor Copy
6 ?7-3zH
2004 RESIDENTIAL PLUMBING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please complete for modifications to existing residential dwellings.
?# So.so
oate /0? / 3 / 0
Site Street Address 877 G e?erie C'c rc Unit #
Property Owner Telephone # ( )
contractor Telephone# (df/j
Address 781,6 _rdL 4&,d City (/kjG'_ll, State_,Off,/ Zip SS?a6'
The Applicant is: _ Owner _ Contractor _Other
Alter ions to existing dwelling $ 50.00
_Add fixtures to rooms, excluding water softener and water heater
_Septic System Abandonment
_ Water Turnaround (add $121.00 if a 5/8" meter is required)
Other: is0.-zli-?il ":r? , i ?
Water Softener -Water Heater
- $ 15.00
_ replacement _ additional !
Lawn Irrigation System RPZ_ new _ repair _rebuild $ 30.00
State Surcharge $ .50
Total $ 5?'S
I hereby apply for a Residential Plumbing 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 plumbing codes; that I understand this is not a permit, but only an application for a
permit, work is not to start without a permit and work will be in accordance with the approved plan in
the event a plan is required to be reviewed and appignature Applica s Printed Name
DEC 0 3 2004 ?
?.
$3a.sd
2004 RESIDENTIAL MECHANICAL PERNIIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please complete for. single family dwellings & townhomes/condos when pemtits are required for each unit
Date C)')
Site Address _ I "nyP??r) ev v-kQ, Unit #
PropertyOwner Telephone #
Contractor '?C xq- G?CUVIa LY K"
? •
' ?
' ?
Crt
PL
Street Address ll ?
•
}
State MI 1 Zip 95C) r) Telephone #((?S
Bond #: Expires:
The Applicant is _ Owner V C ontractor _ Other
J
Add-on or alteration to existing dwelling uuit ?
v $ 30.00
furnace _Additional _Replacement
air exchanger /
air conditioner
? New v Re placement
h
?
?
otner J5 n
Q
ve?rh J ?e, rr? ? s?edo
State Surcharge $ _50
l $ 3c)`
Tota
I hereby apply for a Residenual Mechanical Pemvt and acknowledge that the information is complete and accurate; that the work will
be in conformance with the ordinances and codes of the City of Eagan and with the Mechanical Codes; that I understand ttris is not a
pemrit, 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 wluch requues a review and appioval of?ptazs-'?""?---
?, r ??l ?-?'?
Applicant's Pnnted Name Applicant's Signature
2004 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3530 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX 9 651-675-5694
New Construclion Requiremenis
3 registered site surveys showing sq fl of bl, sq. R. of house; and ? roofed areas ?temodeVReoair Reauiremenis
? 2 wpies of plan off?'ue`??
?t?
'
?
(20% maximum lot coverage allowed)
t
d f
d d
i
i
d hfA- 1 sei of Energy Calculations for heated addilwns
P/^' 1 sile survey for addrtwns & decks #tRes
gn, e
c
ow saes; poure
oun
es
n
2 copies of plan showing beam & w
7 set of Energy Calculalrons fIA' Addftron - mdmate if on-sRe septic system
3 copies of Tree Preservation Plan if bt platled after 711/93
Rim Joist Detail OpUons selec6on sheet (bldgs with 3 or less units
ConstructionCost
Date?_/-//
Site Address 8?3 ? G /
I PO` e' IInitlSte #
tion of Work ,0"4 '`l
Descri
p
Multi-Family Bldg N Fireplace(s) ? 0_ 1 _ 2
PropertyOwner gGLk/vV-i f"$? fl?eY`L Telephane#(?S/)
M6&44 Ql4.4,06c (
Contractor
Address ?/ 57 CLfGI #tlDO CitY ,?,y?t/U?T U^'?!R Qf,f ?
State Zip SS07(P Telephone#(6-37() SS4` ??-3?
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cazeeoiv 1 _ Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(J submission type) Submitted Submitted
• Energy Envelope Calculations Submitted
Have you previously constructed a building in Eagan with a similar plan?
fee applies. ,
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
N If so, 25% plan review
Telephone # 1I D
Telephone #
C ( ?, c 2004
Telephone #(
I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a
permit; that the work will be in accordance with the approved plan in the case of work which requires a review and
approval of plans.
::T?q 4e?
Applicant's Printed Name Appli nt s ignature
OFFICE USE ONLY
Sub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3sea.) ? 31 Ext. Alt- Multi
? 03 Otof_plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn.(4-sea.) ? 33 Ext.Alt - SF
? 04 02-plex ? 10 DB-plex ? 'IB Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or_ N? 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 32 Add'Rion ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
33 Alteration ? 37 Demolish Buiiding` ? 43 Reroof ? 46 WndowslDoors
?
? 34 ReplaCement 'Demolitfon (EMire Bldg) - Give PCA handout to applicant
Valuation Occupancy MCES System
Census Code ? Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const ? Width
_ Footings (new bldg)
_ Footings (deck)
_ Footings (addition)
Foundation
Dtain Tile
Roof Ice & Water Final
? Framuig -
Fireplace _ RI. _ AirTest _ Final
?C, Insulation
T
REQUII2ED INSPECTIONS
Final/C.O.
FinaUNo C.O.
Plumbing
HVAC
Other
_ Pool _ Ftgs _ AirlGas Tests Final
_ Siding _ Stucco _ Stone _ Brick
_ Windows
_ Retaining Wall
Approved By: , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S8W Pertnit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
?? ?' ?
RESIDENTIAL
BUILDINC PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122 f ? U
651-681-4675
New ConehucM1Oa ReuuiremenM
. 3 registered sile surveys showirg sq. fl. ol lot, sq. R of house; and all roofed areas
(20% maximum lot coverage allowed)
. 2 copies af plan showing Ceam & wiiMax sizes; poured found desgn, etc.)
• 1 set of Energy Calculatrore
• 3 copies of Tree Preservation Plan'rf lot platted after 7/1193
• Rim Joist Detail Options seleclion sheet (hldgs wilh 3 or less units)
DATE & -077 `Oa
RemodellReoair Reuuirements
. 2 coDies of plan • 1 set of Eneyy Calculations for heated additions
. 1 sRe survey far ezlerior additions & decks
• Indicate H home servetl by sepfic syslem For additions
VALUATION ??lSclc? ??
SITE ADDRESS 973 ?'7OV£RIJ C.' ,R• MULTI-FAMILY BLDG _Y _ N
TYPE OF WORK & - 1F00F' FIREPLACE(S) _ 0_ 1 _ 2
APPLICANT
STREETADDRESSro..5ff(5
TELEPHONE # 76?o2-c17q -6'63c5rCELL PHONE #
' R+ STATEMA/ ZIPCSr(,2
FAX # Rra-2ft -/cSB?
PROPERTYOWNER't?'t/vd? /iA e,CTELEPHONE#Lo?/•loS/-988f
------------------------------------------°---------------°----------------------------------
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
L?rS?' ?(i72' I ;. '
Energy Code Cate9orY - MINNESOTA RULES 7670 CATCGORY 1 M[N pf$v
(J submission l?pe) • Residential Ventilation Category t Worksheet Submitted N gyode Worksheet Subr
. EnergyEnvelopeCalculationsSubmitted UN 2 7 CUu2
Plumbing Conhactor:
Plumbing system includes:
Mechanical Conhactor:
Mcchanical systcm includes:
Sewer/Water Confractor:
Air Condiuoning
Hcat Recovery System
Phone #
Phone #
Fee: $S)0.00
rcr. 570.00
--- °-- ° ------------- ° --- ° ------ ° ° ---------------- ° ------ ° ------------- ° ----- ° -------------------- --------------
I hereby acknowledge that I have read ihis application, state that the information is correct, and agree to comply
with all applicable State of Minnesota Statutes and City of Eagan Ordinances.
SlgnWure of Applicant ? ? ?J ? • ??
OFL'ICli iJSI: ONI.Y
_ Water Sottencr
_ Water Heater
_ No. of Baths
_ Phone #
Lawn Sprinklcr
No. of R.I. Baths
Certificates of Survey Received - Tree Preservation Plan Received _ Not Required _
Updated 4102
t I
(?,, ?
'"? L-) 3830P I
NewConstructionReauiremen ? 5?-L
. 7 registereA site surveys >hcwing sq ft of b[. sq R of house; and all roofed
(20% maximum lot coverdge allowed)
* ? woles oi olan showing heam 3 wir.dew ;iz=s; poured found ees;gn, ztc ?
• t ;et of Energy Calculauons
• J coFies of Tree Preservatbn Plan d lot platted aRer 711l93
. Rim Joist Oetatl OpUOns selechon sheet ibidgs with 3 or less unds)
DATE / O :. VAL
SITEADDRESS lToUeR?' Ci2C?2.
TYPE OF
- RGJ+1
APPLICANTA liC-GV-e yKvaAk,-S so- S(?
STREET ADDRESS ? S?'S 1?GQ R lr.? vC,\ e [31
TELEPHONE # 015'ol 97Y 5035'' CELL PHONE #
PROPERTY OWNER ' ?44• Fi
--------------------------------------
COMPLETE THIS SECTION
Energy Code Category _ M[\VFSOT.1 RG
(J submission type) • Residenhal Ventily/?
• Energy Envelope/C
Plumbing Contractor:
Plumbing systcm includcs:
Mechanical Contractor:
Mcchanic>il s%+tcm mcludrs:
Sewer/Water Contractor:
:lir Candi(ioning
Flcal Rccoccn' $%'s(riii
ATEtMrL-ZIP S-ilYl
FAX #
Phone #
Phone #
7SO"f:1 R["I.1:5 7672
Energy CaCe Warksheet Submitted
?:2
P'cc: 870.00
-----°-•-----------------------------°--...--------------------------•-----------.._._....-------°----------°---....--
I hereby acknowledge that I have read this application, state that the intormatioh is correct, and agree to comply
with all applicable State of Minnesota Statutes and City of Ecgan Ordinances'.? ',,?
Signature of Appllcani
OFFICE USE ONI.Y
_ Water SoF[cncr _
Water Hcater
No. oC Baths
. 2 ccvies
• lsetcf'.
. t >ite sL
. . Indicatz
a5
5
ss? z ?I as ?
- S?2. O b
ir uirements
: n
yyy Calculauons for heated additions
y br extencr adtl;bons & decks llu?
cme serveC Oy septic system for addihons ? f-
1?r-I'?"-c.L
S, S5 S SU ???' ?02.
MULTI-FAMILYBIDG _Y _N
FIREPLACE(S) _ 0 _ 1 _ 2
rnone =
Lawn Sprinklec
No. of R.I. Baths
RESIDENTIAL
G PERMIT APPLICA
CITY OF EAGAN
)T KNOB RD, EAGAN MN
\ 651•681•4675
y? -I RamodellReoa
E#
---------------------- ----------------------------
"NEW" RESIDENTIAL B-LDINGS ONLY
S 7670 C.A f 1:GORF 1
Category 7 Worksheet Su6mitted ,
ilalions Submitted
Certificates of Survey Received - Tree Preservation Plan Recerved _ Not Required _
Updated 4102
,
411?dtV oF eagen
PACRICUI E. AW.4L)A
Maror
PAUL BAKICEN
PEGGY CARISON
CYNDEE F1ELD5
MEG TILLEY
Council Members
THOMAS HEDGFS
CiryAdmmigrazor
Municipal Cen[er.
3830 Pibc Knob Road
Eagan, MN 55122-1897
Phone: 651.68l.kG00
F:uc: 651.681.4612
TDD: 651.454.8535
Main[enance Faciliry:
3501 Coachman Point
Eagan, MN 55122
Phone: GS L681.4300
Fax: 651.68I.4360
TDD: 651.454.8535
www.cityofeagan.com
THELONEOAKTREE
Thc rymbol uf s[rength
and growch in uur
communiry
7uly 23, 2002
ALCOVE ROOFING & SIDING
6585 EDENVALE BLVD #130
EDEN PRAIItIE MN 55346
RE: REFUND OF BUILDING PERMIT #53095
TO WHOM IT MAY CONCERN:
On July 15, 2002, permit #52447 to reroof 873 Govern Circle was issued to your company. On
July 16, 2002, permit #53095 was issued for this same type of work at this address.
As this is a duplicate permit, the City is canceling permit #53095 and refunding a portion of the
base fee ($75.25) to you under separate cover. $tate surchazge ($3.00) is non-refundable. A
$50.00 administrative fee applies to all permits that have been processed and receipted.
If you have any questions, please feel free to give me a call at 651-681-4695.
erely,
`i
J Severson
Office Supervisor
cc: Dale Schoeppner, Chief Building Official
CLAIM VOUCHER - REF[TND REQUEST
? CITY OF EAGAN
MAKE CHECK PAYABLE TO: ALCOVE ROOFING & SIDING
ADDRESS: 6585 EDENVALE BLVD #130
EDEN PRAIItIE, MN 55346
LOCATION: 873 GOVERN CIIt
RECEIPT #/DATE: 31195 7/16/02
REASON FOR REFUND: DUPLICATE PERMIT PERMIT k: 53095
TYPE OF REFUND:
Plumbing Peraut 9001.4087 $
Mechanical Pemvt 9001.4088 $
Building Permit Fee 9001.4085 $ 75.25
Plan Review Fee 9001.4222 $
SAC (MC/WS) 92202275 $
SAC (City) 9379.4681 $
SAC (Admin) 9001.4246 $
WaterConnecuon 92203865 $
Sewer Pemrit 9220.4532 $
Water Pemvt 9220.4507 $
Account Deposit 92202252 $
WaterMeter 9220.4509 $
Water Treaunent 9220.4685 $
Surchazge 90012195 $
Ovetpayment 90012250 $
Curb Box Deposit Refund 92202253 $
ConstrucHon Meter Dep Refund 92202254 $
Other $
TOTAL $ 75.25
I declaze under the penalties of law that this account, claim, or demand is just and tha t no part of it has been paid.
7/23/02
SIGNATiJRE DATE
:fs;*,;:r.ra:u:?,?";:"4<.X(>;:x1:6Y,5;;4:?%i<>,F*1 'f<iSk;I `XM I >;:KI Y(iM ;:
cIrv OF Enc,av
Inl'tMEI'i: JS "ICF:P'ILIYAI. NO`u 1.194
DarE: ri3i0519a r:C141':: 1040c:37
'i1 .
NA'M1E;, Ii R FiPF'tTf:?N 7:N?.-
?'r'.Git; [?fJpJ. E:73 f:,'..1l,lC-1CPi C;.a.li -,'I."ii,,fiG
Tnk<.. H'ecei.n' A%o,_!r,' : 591° ,.,4t,
[R( j9:104 i `.
Uci-;i :fI)t' JAN
CITY OF EAGAN
? 383l Pilot Knob Road
Eag n, Minnesota 55122-1897
(612) 681-4675
PERMIT
PERMIT TYPE:
Permit Number: B u z ? o i N ?
031918
Date Issued: @ 5/ 0 5 i 9 8
SITE ADDRESS:
p.I.N.: 10-28801-040-02
DESCRIPTION:
873 GOVERN CIR
LOT: 4 BLOCK: 2
GARDENWOOD PONDS 2ND
,-.
Build3n6-,Permit Type
tBuilding GJo-r.k Type
?"UBC Occup'8noylt ;
ConstP^uctian T yp e
2Qning
BW9,.l.di.rtg LengC.h„
Bu?sd'ns? Wi,sith
.t?.
Build?.ng `rt?rie?s?
- .m?S<qu`a.re F?ee'?'s"t
C GI??J'LI JN"N'tSPtl e?
SF DW6
NEW
R-3 U-1
VN
R-1
65
43 '
2r? p
G922V
101 1 - FAM. DE7ACH
ar „, ,a
X;?
?l-J? ???s
y
REMARKS:
S&W PLUMBER - M&W WATER & 3EWER
FEE SUMMARY:
VALUATION
Base Fee
Plan Review
Surcharge
3AC
SAC ?
SAC Units
Subtotal
$3,563.96
PLAN REVIEWED 9Y MIKE BARCK
$226,000
MISC FEES $1,592.50
Total Fee $5,156.46
CONTRACTOR: - Applicant - s7. I.IC.OWNER:
TON TNC pF MN, D R 14544663 2000565 D R HORTON INC
H R
?9 WASHING70N DR 204 3459 WASHINGTON DR 204
AN MN 55122 EGAN MN 55122
( 12) 454-4663 (612)454-4663
I hereby ecknowledgt th8t'F tiave <re8d "Ghis?_'rsPP?ica;tAirnrarad s,tate that ?ths ?
Yrifi'srntatibn is eo-rrsct and agr" ,tcs,a,vmAlvy:.w,Fth ak'I appl,}cable. State ofibMrt.
? 5t u'tes •and Gity afi :fagan ;Ordinancts.
..1?
?-
APPLICANT/PERMITEE SIG r ? ISSUED BY: SIG TURE
$1,487.25
$966.71
$110.00
$1,000.00
100
1
??1 5?.V?
1998 BUILDING PERMIT APPLICATION (RESIDENTIAL)
3 C?? cl CITY OF EAGAN
t) 3830 PII.OT KNOS RD - 66122
681-4675
New Conatruction Reauirements
? 3 registered site surveys
? 2 copies of plana (inUWe beam & window s¢es; poured fitl. tlesign, Mc.)
? 1 energy catwlatbns
? 3 wpies of tree preservetion plan H lot platted after 7/1/93
required: _Yes Y_ No
DATE: LI - a 9- 9F
DESCRIPTION OF WORK: Al2w 6,„ c?,vn
ST?ETADDRESS: ?'73 ?ovev? Gr??.?t.
?i
LOT: V BLOCK: ? SUBD./P.I.D. #: ;7nw
RemodeVReoair ReOUiremeMs
? 2 wpies of plan
? 2 ske surveys (eaderior additions 8 dacks)
? 7 energy calculaGons for heated addKions
CONSTRUCTION COST; /LZ V7Ga
PROPERTY
OWNER
First
Phone #:
Street
City
State:
Zip:
Company:U.liun??e? -h9r/ n(Ab/a T? /e'lGrlk6,wnPhone#: NSV-41663 Px/.a9
CONTRACTOR
Street Address: 3,(S? !?0 5?ti N f IKy -sk. a20/ License #4?2Oot1S/SJ
City OyG'n State: /YIA/ Zip: S51o72
ARCHITECT/
ENGINEER
Street Address:
City
Phone #:
Registration #: _
State: Zip:
Sewer & water licensed plumber (new construction ony): YY),FAj l.claacr ??w", . Pertalty applies when address chang
and lot change is requested once permit is issued.
I hereby acknowledge that I have read this application and state that the information is correct and agree to compty with all appiicabf
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant
OFFICE USE Y
Certificates of Survey Received Yes _ No
Tree Preservation Plan Received _ Yes _ No _ Not Requ'
r
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Duplex
'JB-- 02 SF Dwelling ? 07 4-plex
? 03 SF Addition ? 08 8-plex
? 04 SF Porch 13 09 12-piex
0 05 SF Misc. ? 10 = plex
WORK TYPE
,O? 31 New O 33 Alterations
? 32 Addition ? 34 Repair
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
OFFICE USE ONLY '
? 11 Apt./Lodging ? 16 Basement Finish
? 12 Multi RepaidRem. ? 17 Swim Pool
? 13 Garage/Accessory ? 20 Public Facility
? 14 Fireplace ? 21 Misceilaneous
? 15 Deck
? 36 Move
? 37 Demolition
V/J Basement sq. ft.
J n? Main level sq. ft.
R 3•v_! 7 sq. ft.
Fz - ! [,A2 sq. ft.
? sq. ft.
? s sq. ft.
Footprint sq. ft.
APPROVALS
Planning
Building AAG
441-7( MC/WS System
114V City Water
« 2 Fire Sprinklered
PRV
Booster Pump
Census Code.
z z2 SAC Code
Census Bldg
Census Unit
Engineering Variance
to i
oi
I
I
Permit Fee Valuation:
Surcharge
Plan Review
License Z u ?
MC/WS SAC =Y?y
City SAC 3 r N 3?
Water Conn.
Water Meter
Acct. Deposit ?=--?-
S/W Permit 5? ME Pl-JS
SNV Surcharge
Treatment PI.
Park Ded. ? N
? f
Trails Ded. J
Other a s K s?
Copies
r
. . .?
'
Total:
%SA,(', ^
A..
SAC!Uni
ts
L
s
$ z ao vvv, -
Z?1.zs
s
vl?
?izo
+?-I? i. 15
"VaV fz !d sy; Sc?? ?cl?9.S
? 4D
??
i??z ?71 !1 5d=
-P os
2? el
711 1/ 9O-/•-
7- Let ) 122. -7S'
,
. HI]MESOTA STATE S1IERGY CO E C.AI,.S"Mj.ATIONS ?
BA9ED ON CNAPTE[l S OF TFIE ?ql. Z/?
MODEL ENFRGY COpE - 1483 FOiTTON
(I Adaption EYfeative
L11 /1 //?; i/' /? / 1
owner
SLte.Addt
i
Huildinq claseificatloni Type A1 (single Family L Duplex
Type A2 (Residential, 3 storlee or less) (Qver 3 skoriea) (ather;
HOTEt Complete paaes 3 and 4 firet.
GENEHAI, 7NFORMATI0N ?(LjE'i
1. euilding Perimeter ft.
N
2. Wall height (ground to eave) ft.
a. 1. R 2. (above) gross vall area .3? I?_eg.ft.
4. euiiding dlmenslons (L) ? X(W) -?4 A(5&q.ft.xonf 6 floor araa
5. 5q. foot area of rim 9oist - F oor joist sixe (2 X'.1D,
_?n__. X ".z?(Perimeter) _ ?s?;.tt.
12 •
6. Doors - Area CIU '?
Thicknes in U. pactor r1 t ??
Type of construction Perimeter ___._ft.
. Mattufacturer .?
7. Total dnorfs perimetier Pt.
8. Wlndows: Many[acturer-W1lA, Stflte approved_
U f ackor I ? &I
TYPE SIZE AREA (6q.Ft.) HUMB£R OF TOTAL
FACH UNI'PS 5Q FEET
?(?CJ
? ?1J ^'Z___
9. Total sy.ft. Glass ;J
lo. Fireplaoe areas Width X Neight = X - sq.ft.
11. Exposed foundatlon: Height X Perlmeter,G 7 X1-7L--n-1&-aq.ft.
COl4RLETION OP TftIS FOFUf I3 REQUIREb F'OR AI.I, NEW CONSTRUCTIOtI, MAJOR
REl10DELINCi AND EUILDING3 BLYNG MoVED WHERE 8tt8RGY, OTHER THAN 4't1E HINIM7?L
CODE ALLOWANCE, IS USED.
SOiTO'd 559£ 2Sb 2T9 T 'ONf 'UJFIy-Id 8£:SS h66S-Ttl-d35
1;. Framing area - 101 of groes wali sren.
13. Gross wall area eq.fE,
Window area A sq. ft. q wihdoWn
Rim joist area AT___,Lag. Et. U rim joist- . C?q r
Door area A S/ sq.ft. U daar area=
Other doors area A p eq.fk. U athor doora= l-I7
Exposed fndh A sq.ft, lI fouhdstlotl= j,(,?,J&
Framing area A W1 By,Et U Praming area=,r?f
Net wall area A? 7iL ??.3 sq, Ft. U well? 943
(178 ) TOTAL . . . . . . . . .
4 qL? - Z4`i
UxA -
UxA =
?
UXA =
W
UxA a
Ux1?
UXA ]
UxA - _g0
UxA m k! 1?.?
14. Gross wall nrea ac 0.11 (A-1 single famlly & dtaplex) = ellowabla Ux.A/Code
(13. above )
x 0.23 (!,-2 other reaidentiel) x .23 (other buildinge)
x .29 (ovpr 3 etories)
Zy, ) HTUti must be lerger than or same
AJJ 8 p Code ?2!j °F. as 13B aboVe _-
15, ceiling fraining area (y ayuele 1Dt of aeilirtq area
15A. Gross ceiling area =(L) `? x(W) ? d?Ul?sq,lt.
r
15H. ,Iolst area (AE) A lot ceiling area .. eq.ft.
15C. Net asiling area (Ac) (15A - 15B) ? W_gq,f t.
[1 ceiling x A. _ L x •_ ??
U frsming x Af x01, 7 =-1
15p. T4TAL U x A........ , ................
......?,
16. Ceiling aren (1511) x 0.026 (T.-1 ningle lamiky i duplex)
= sllowable UxA/Cjpde
x 0.033 (A-2 other residential)
x 0.06 (other)
I HTUH must De laKger than or same
A(15A)1?5Z.x U Code_1Q?,,fO °F. as 15U aOoVe
11oTt: Uee U sml A values obtained itom pagea 1, 3 and 4.
CE@M=8TI01: I hereby certify that I heve oalaulated the "U" Psator¦ end
Ilii?? veluea hnroln and thae tha bui]dinq liera doscribed meers or exoef:da tha
5tate oP Mlnnegute Enargy Conservation Aat.
bate
9lgnatura
S9i2A'd 6592 2Sb 7i5 S '?hll 'D`kM-Id 5£:SL h6ET-M-d3S
-- --... .. , . . _. . . .
C? - X ? ?. . . ......_ .. . .. ?...... .. .. ._ . .
--
----.. . __ ?-?L_._....__ ?.?? =?[?k ? . . . _ ?:? D_..... .. .___ __ __....._...... _... . . . .. _
?? =??
? ......_--.._-?------._._. ._.
L
?•=
.. .,,.
_...,. ....
----_ ..
,._.
--------._.__....... .
- .--- -?-----_____... __-
. ? . _. ...._
-?---..... .__.
__.... ? . ....__.
----- .
._.__..._.__.___. _ . ... . . ....... ._ .
.
? ?.
-----
------
-- -
__ --?--.... ---- -- ..
ES9E ZSf' 2T9 T 'DNI `C7DNd"ld E£!ST VF5T-Tli-d35
NALL '
SECTIUN
a-VniuE ' U YALUE
tnoida alr Eilm ,68 •? '
_?.11!lCLOC wall .' ?'? •45 '.`(Nal!) U . R
lnsulatlon
Sfiga[hlag ... ; 2,.p(!? 'i?
?$ldtnB . . (p7
<•. .
OuKelde plr fttm • .17
R roTaL C)?; • .
?? .
a
.-
fnCerlur aIr [t,im ,
R'+ .68 "
RtH ? ? tniulat[on ` I f•oQ ;'•
?-
JO15T - •
i„ch eoE[ wnoJ
p=1.08 (RIm ll }
¦
?- .. Joist) ' '
? Shcethtng : x•?? , p?I
ixterlor.'Wa?l cove
. ring .(v-1
.t • ""--•-?
', ?_?
?xt?clod s{r [llm RA .17 .
_
'R 7'QTAL
I 46
i , t
?
Entprlor alc Ellm R= ,68
Ia¦ulatton ??•d V
? 4oundailon ? ?•7'a ?, (Fdn.) U ? R =
?Ixter[or alr flim R. .17 :
? '• ?- ? ,:, i` a TOTAL
x
o
k ?
d 9L
.
p
se
uc
...
.
4
.. ` : ,
59-'hO"d 5592 2Sr Z[9 T .')FII 'O0hIH-Id 9h:sT h65T-1??- ?135
Aa•d -iulul
?
o-rr run WTTH YEKTED ATTIQ 9PACE_,?Q}Z
R V1+LUE
FRAMING
R vAI,UE
CEiLING
_n_?,? ? ?irFilm, 5.1
?"lO• D Tnsulation--4L•_O
4.36 Jolst - - _,
R, 56 Ge111t1cJ
n 6? _RirFilm !?•61
iz-Ao Tota1R??.??
u - i/R •v2_2...
Iaindow ingiltratlon o.5 cEm/lineal Poot of orack
Rasidential door infiltration 0.5 afm/equare foot or dooz and minimtlm Qode
requirement
Non--residential door lnfiltration ll.o otm/lineal taot aY crack
ttb 121, ooncreta block no insulation °.47 A 2.1
Ub 12" concrete block insulated cores W.26 R 7.8
Ub 12" 1lghtweight block =.32 it 7.1
Uq 12" lightweighL• black insulatad cvren p.12 R B.:!
U eingle glass a 1.13; with storm Window .54
U doUble gla9s = .55
u triple glass = ,41
All extarior wa11e and celxinyg must hava e vapor harrier (0.10 perm imax.).
Vapor barrier muet be on kha inmlde (Ileate4i B1de) of wall.
vnpor barriera of the palyethelene thln [Llm hava na R value.
F,
SO/SO'd 6S92 FSh Z'[9 T.
-PII 'OJFitild OG.SL h56T-Ti,-d35
• /• CITY USE OPiLY
L? 9as? ?
LOT ? BL RECEIPT #:
SUBD. cW /?O RECEIPT DATE:
1998 MECHANICAL PERMIT (RESIDENTIALJ
CITY OF EAGAN
3830 PILOT HIN0H RD
EAGAN t+IId 55122
o P (612) 681-4675
Date: ?!
Complete this section onlv if you aze installing I-NAC in single family, townhomes or condos under
construcrion 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.) 10-CO
• State Surcharge: .50
. TOTAL: 3to -SD
Complete this section onlv if you aze remodeling, adding to, or repairing existing single family dwellings,
townhomes, or condos. Note: Mechanical permit is not required for alteration/add-on to ductwork in
existing residential units; but is required for the following:
_ Install furnace _ Tnstall air conditioning
_ Install air exchanger, i.e. Vanee system, etc. _ Other
Minimum fee appiies to all remodel or add-ons of existing residences $ 20.00
State Surcharge .50
Total: $ 20.50
SITE ADDRESS: 2-? n -a)
OWNERNAME: PHONEA_??4 4 (0 6Q?
INSTALLER NAME: PHONE #:
STREETADDRESS: \?")If_)
CITY: STAT'E: W ZIP:
SIGN OF PERMITTEE
!5lPORhiS BLD/MECH PERMIT (RES) - 1999
T
CITY USE ONLY
SU86. BLO?P?LU??
,/--
RECEIPT#: q-1cl( I
RECEIPT DATE:F? « 01A_
1998 PLLINBING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PZIAT FINOS RD
EAGAN, 14[I 55122 (612) 681-4675
Please complete for: ? single family dwellings
? townhomes and condos when permits are required for each unit
A 6ackflow preventer for underground sprinkler system
FIXTURES ^ EACH #' TOTAL
Shower 3.00 x ?- _ 3.00
Water Closet 3.00 x . O
Bath Tub 3.00 x ? _ .
Lavatory 3.00 x
Kitchen Sink 3.00 x = ?, no
Laundry Tray 3.00 x = ;?( U
Hot Tub/Spa 3.00 x =
Water Heater 3.00 x -? _
Floor Drain 3.00 x ?- _
Gas Piping OuGet " minimum - t 3.00 x
Rough Openings 1.50 x
Water Softener ' for dwellings under construction 5.00 x =
Water Softener ' for existing dwelling 20.00 x =
U.G. Sprinkler ' for dwClling under wnst. 3.00 =
U.G. Sprinkler ' kr existing dwetling 20.00 =
Ali@f3t10nS ' to existing residence 20,00 =
Water Turn Around 20.00 =
Private Disposal System ' MPC iic. 75.00 =
(new and 2turbished systems)
Private Disposal Systems' Abandonment 20,00 =
STATE SURCHARGE 50
TOTAL "51 3> DD
-•------------------------•--- • --- •------------------------- --- • •-------------• • ----------to--- ----- •w---ith-atlappl------ic--a6l-eCi----ty --of• -Eagan--------ordinances----
•- • --
I hereby adcnowledge that I have read Mis appliqtion, state that the IMOrtnation is cortect, and agree comply
It is the apD?icant's responsibility to notify the property owner that the City of Eagan assumes no liabiliry Tor any damages caused 6y the City during its
nortnal operetional and maintenance activities to tFAe facilities construded under this pertnil within City propertylright-of-wayleasement.
SITE ADDRESS:
OWNER NAME:
INSTALLER
TElEPHONE #? 423-11`f4
STREETADDRESS: /i /UZf-J
CITY: sf//.H'// Y I _
?' UJY LV STATE: ? I_ ZIP: 56D65F
SIGNATURE OF PERMITTEE
JS/FORMS BLDG/PtBG PERMIT (RESIDENTIAL) 1998
*******i*?****?*************k*****?**W*
CITY OF EAGAN
CASHIER: JS TERMINAL NO: 669
DATE: 07/31/00 TIME: 12:13:58
ID:
NAME: DECK & DOOR COMPANY
3210 9001 873 GOVERN CIR 60.00
3430 9001 873 GOVERN CIR 0.25
21_55 9001 873 GOVERN CIR 0.50
Total Receipt Amount: 60.75
CR135060
USER ID: JAN
?*+*?******************??*******?****??
? k 2000 BUILDING PERMIT APPLICATION (RESIDENTIAL)
41C? 2I., CITY QF EAGAN
1aV 3830 PILOT KNOB RD - 55122
651-681-4675
New Conshuctlan Reaulre ments Remotlel/Reuodr ReaWrements
> 3 registered sHe surveys ahowUip sq. N. o} bt, sq. H. o( howe
and gl{ roofetl areas t20§9 maxlmum I01 covemae allowedi
> 2 copies of plana (aFww beam & window sizes; poured Ind. design; etc.)
* 1 set of energy calculallons
> 3 coples of hee preservaNOn pian If l01 plaMed alter 7/1/93
DAiE: % Z-v ` o-
3 (0o.1S
U. t'6W
l.ilX??
2 coplea of plan ij
??
1 sei W energy calcWadons (or heated addiNons ?
1 slre sunay 1or exterlor additlons & tlecks
CONSTRUCTIONC05f: 4V °I000 m
DESCRIPfION OF WORK: A D» l Tia /.1 If mulH-famlly bldg., how many units7
SiREET ADDRESS: !S? 73 G d?I°Az.y C,
LOS: ? BLOCK: SUBD./P.I.D. N:
\
d h
PROPERTY
OWNER
CONTRACTOR
ARCHITECT/
ENGINEER
Name: ?4?krLC, Phone#: i5w_ zir/- ?'1dvd'??
last Flrst
Sheet Address: Llr7 ? 6 o fi,9a.r
Ci}y 94, /d Stafe: Zip:
Company?.,?/,/L.d 7J.?c.f fr^ln r. ? ncc Phone q: 6/Z
(area code)
SheetAddress: 114.? 2 ,9r?/le.v ??? /Z License?V??7 Exp? ? °i
Cliy l>t/d"f..t S-ao?.,£ }?i?ta•g`rl State: Zip: .5:!r+7 7
Company:
Telephone #: ( )
Name:
Sheef Address: Regishaflon #:
r ci,y
State:
21p:
Sewerlwater Iicensed plumber (if installina sewer/waterl: Phone #:
I hereby acknowledge thaf I have read this appllcatbn, atate iFwt the information h correct, and ogree to comply wilh aq apPCmcible Sfate
ofMinnesota Statutes and City of Eagan Ordinances.
Signature of Applicant =?a?.al
Certificates of Survey Received _ _
Tree Preservation Plan Received _ Yes _ No -LZ) Not Required JUL Z 4
/11Y 5
OFFICE USE ONLY
v Yes No
?
OFFICE USE ONLY
BUILDING PERMIT SUBTYPES
? 01 Foundation ? 07 05-plex
? 02 SF Dwelling O 08 06-plex
? 03 01 of _ plex ? 09 07-piex
? 04 02-plex ? 70 08-plex
? 05 03-plex ? 11 10-plex
? 06 04-plex ? 12 '12-plex
WORK TYPE
? 31 New
? 32 Addition
? 33 Alteration
? 34 Repair
? 13 16-plex
? 17 Garage
O 18 Deck
? 19 LOwer Level
Plbg _Y or_ N
? 20 Pool
? 21 Poroh (3-seaJ
? 22 Porch/Addn. (Msea.)
? 23 Porch (screened)
? 24 Storm Damage
? 25 Miscellaneous
? 30 Accessory Bldg.
? 36 Move Bldg. ? 43 Reroof
? 37 Demolish (Bldg)' ? 44 Siding
? 38 Demolish (Interior) ? 45 Fire Repair
? 42 Demolish (Foundation) ? 46 Windows/Doors
" Give PCA handout to applicant for demolltion permit
GENERAL INFORMATION
SAC Code 19?
Na. of Units 4
No. of Buildings ?
Const. (Actual)
(Allowable) ?
UBC Occupancy k --3
Zoning ?
# of Stories
Length
Width
Basement sq. ft.
Main level sq. ft.
sq.ft.
sq.ft.
MISCELLANEOUS INSPECTIONS
? Stucco/Stone
APPROVALS
Planning Building Engineering
Permit Fee ValuaUon:
Surcharge
Pian Review
License
MC/ES SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment Pi.
Park Ded.
Trails Ded.
Other
Copies = a5
Total:
sq.ft.
sq. ft.
Footprint sq. ft.
Census Code
MC/ES System
City Water
Booster Pump
PRV
Fire Sprinklered
Variance
? 31 Ext Alt - Multi
? 33 Ext. Alt - SF
O 36 Muid
1
5AC Units
°!o SAC
LOT SURVEY CHECKLIST FOR RESIDENTIAL
.
PROPERTYLEGAL:
? DATE OF SURVEY:
?
? s LATEST RE1/ISION:
DOCUMENTSTANDARDS
m? ? • Registered Land Surveyor signature and company
M---o ? • Building PermRApplicant
o • Legaldescription
FY ? ? • Address
0-'o ? • North arrow and scale
9--?o ? • House type (rambler, walkout, split w/o, split entry, lookout, etc.)
R-?o ? • Direcdonal drainage arraws with slope/gradient %
Or' ? ? • Proposed/exdsting sewer and water services & invert elevation
9' ? ? • SVeet name
2-,o ? • Driveway
ELEVATIONS
Ebstina
Cf? 0 ? • Sewer service (or Proposed)
o' ? ? • Property comers
-11, ? ? • Top of curb at the driveway
o'? ? • Elevations of any ebsting adjacent homes
Prooosed
0'?-o o • Garage floor
El-'? ? • Firstfloor
ET" ? ? • Lowest exposed eievation (walkout/window)
er- ? ? • Properly corners
0 ? ? • Front and rear of home at the foundation
PONDiNG AREA trf aoolicable)
p;?:70 ? • Easement line
e% ? • NWL
&r? ? ? • HWL
0? ? ? • Pond # designation
? o r'o • Emergency Overtlow Elevation
ET` ? ? •
B' ? ? •
.? 0 0 •
? o ? •
Cd? 0 0 •
? 0-? •
Lot IinesBearings 8 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 City utilifies within those easements
Setbacks of proposed sVucture and sideyard setback of adjacent existing structures
Retaining wall requiremen if any
Reviewed:
!
January 7998
CRA1G1908IBLOGPRMT.FM
CERIIFlCATE OF SURNEY
for
JOE MILLER HOMES
N?g•465? ?' _ ?
i
/
/
?
/
/
?
?
/ -
/
/
/
?
?
\
\
?
JY.?
? Oh
?99,6
. ? ? a
n
C)
F
?
i
i
? Drainage &
A ? Utlllty
a easement
Giry ry /
? f
?
L
Au
/a>lll? i N =+ .. n
0"3sP o Fi,
ed h
q proPose1 qoq,yt ?
p`b` 4 Bsmt ?gor g' ob gy ''
1 Ei
lOQ
N 8?2AO glk tit. J
?915??? g?°'°9 $
? t- ,z? • r . s? .
5+•50
&` 1
/
. ?
?
' OS
- ?0/
?
, kfil I ?r
, iu ?
.IJ >
z
J
ui?pp? °
' u-i IX]
idL
>. ?<
?
L = 2.010
= 95'53'48"
?
??'
oj \ . ?
? /
BRANDT
supervision and that i am a duty Registered
tand Surveyor under the Lows of the 5tate
of Minnesota.
1Watr._,.LS
Date 'JZL? 14PR ) 99g Reg. No. 8140
ERING & SURVEYING
1600 West 143rd Street,
Burnsville, MN 55306
(612) 435-1966
15,41 ?
M32-1713-98
??-
N
9p? 361
3
R
N M
? -?
N ?
O
?
?
Scale: 1" = 30'
Jt'i,?3;
5. ib,?
J q16y-
o _--
? k0?` ?q15,b9i
?-
873 Govern Circle
Top curb to Gor slab
Top block =
Lowest bsmt flr = 909?4t
DESCRIPTION
Lot 4, Biock 2,
6'S GARDENWOOD PONDS SECOND
Dakota County, Minnesota
Plat bearings shown
o Denotes iron monument
'?- Existing j Proposed
? I hereby certify that this survey, plan, or
. , report was prepared by me or under my direct
Suite 206
M32-1713-98
-.
CERIIFlCATE OF SURi/EY
for
JOE MILLER HOMES
ty7g'4? .' - -
JY•
i ? o
- ? ? o
i ?s o
/ ?o\'o
F
i
\ \%
\ \
?
?
`90
?
?
/
/
/
? I
? I
? I
? I
? I
? Drainage & ?
•? ? Utlllty I
easement ?
?
cy?
o?
43.1'1
q ProPosed
e` q?qyt ?
qoy~ gsmt (" S?db
E1r
ZOP q\'0'j
?? g N
? I N `b?2Aa m glk ti'
10
t2?g? F' .
` ?S=7Z
1 L? a
?
?
/
_ OS
,G9I/
?
IG
uu i% Va
CD
I u? 4Y]
?J F-J-
,_ {
.?. m o
L = 25.01
= 95'30'4E
, ? ?;._? •?
--..
M32-1713-98 - i '
?'-P'S
NWL ? ? a
??L z ?g4?
?95,?
9?? 3d 1
3
z
N ?
N M
O
?
'31,?3i
?
Scale: 1" = 30'
'?; 1.?5 Top curb to Gar slab =_?L31_
Top block
Lowest bsmt flr = 909??It
?D?? /9L5 b9i
873 Govern Circle
DESCRIPTION
Lot 4, Block 2,
63. GARDENWOOD PONDS SECOND
Dakota County, Minnesota
Plat bearings shown
o Denotes iron monument
? Existing j Proposed
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
-and Surveyor under the Lows of the Stote
_ Y of Minnesota.
Date A-P1Z ) 9g9 Reg. No. 8140
BRANDT ENGtNEERING & SURVEYING
1600 West 143rd Street, Suite 206
Burnsville, MN 55306
(612) 435-1966
M32-1713-98
.-----------------i
I
j Permit
City of Eajan I Permit Fee: 4~10` I
I I
3830 Pilot Knob Road
I
Eagan M Date Received:
N 55122 I
I I
Phone: (651) 675-5675
Fax: (651) 675-5694 1 Staff:
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: CjA . AIAI
Tenant: Suits RESIDENT / OWNER Name: bY. Phone:
Address / City / Zip: 1 J-7 Cku AlAj
Applicant is: Owner X Contractor
TYPE OF WORK Description of work: ca_~-6r
Construction Cost: Multi-Family Building: (Yes / No
CONTRACTOR Name: V7,;;J- J5 i t n License
Address: 5.2✓ ` r a c A
City: State: r"JL- Zip: rh~z a 7
Phone: VS 7, ~7 y Contact Person: 1 <-i-V4 y (j r-~-+QYV
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
_ Minnesota Rules 7670 Cateaory 1 _ Minnesota Rules 7672
Energy Code . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
Category Submitted Submitted
(d 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 _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 submlt sm considered to be public information. Portions of
the information may be c4assMW as non-public if you provkW sped reasons HW mwid pw7j* the City to
conc/u* that ftcart! rats.
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.
s
x f x
Applicant's Pfinted Name Applicant's" Signature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA119917
Date Issued:01/02/2014
Permit Category:ePermit
Site Address: 873 Govern Cir
Lot:4 Block: 2 Addition: Gardenwood Ponds 2nd
PID:10-28801-02-040
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 -
Kevin R Tiberg
873 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:EA127563
Date Issued:10/06/2014
Permit Category:ePermit
Site Address: 873 Govern Cir
Lot:4 Block: 2 Addition: Gardenwood Ponds 2nd
PID:10-28801-02-040
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace & Air Conditioner
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Scott Lofgren
5708 Upper 147th St W #102
Fee Summary:ME - Permit Fee (Replacements)$55.00 0801.4088
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 -
Kevin R Tiberg
873 Govern Cir
Eagan MN 55123
Lofgren Heating & Air
5708 Upper 147th St W
Suite 102
Apple Valley MN 55124
(952) 431-5811
Applicant/Permitee: Signature Issued By: Signature
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For Office Use CR
t .,„• •„,, EAGAN
•i Permit#:
Permit Fee: 75 . C �
ECEIVE S—q cDe
Date Received:
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651)675-5675 I TDD: (651)454-8535 I FAX: (651)675-5694f A ., Staff: 24
buildinainspections(c�citvofeagan.com °�° 4 LWJJ
2020 RESIDENTIAL BUILT APPLICATION
Date: S.41 •2020 Site Address: ¶513 GOVerr1 L'iY'Gle Unit#:
Name: Kevhrn 4- KIM " T Phone: Cas% ZeseD—53Z
Resident/ r.
Owner Address/City/Zip: .7 . -ALA
Applicant is: Owner X Contractor /� LI / /'aal1 /-S
Type of Work Description of work: Ka-cYne.,n
Construction Cost:4'1, iertAr.ble 63004C— Multi-Family Building: (Yes /No Pc )
Company: —3 S 'tee ... Th.AId Contact: --SCwi". M.<<ter•
Contractor Address: Scat) ii4 ' . ti. 4100 City: A _ 4
State:/ Zip: 35!Z'/ Phone: 9 •ir9,47/J'Email: 3d 33)0d10-b I 7,—
License
License#: SC.IOl41 23 Lead Certificate#: L24 ,212040-/the project is exempt from lead certification, please explain why:
#4vx acs//,f)// /996•
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:
Fire Suppression 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 they are trade secrets.
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.citvofeanan.com/subscribe.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
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.gopherstateonecall.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 •• = .rt without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and appro - . plans.
x 1A473k•e- x
Applicant's Printed Name pp'-'nt's Signature
DO NOT WRITE BELOW THIS LINE C -7-3 00u6'-d2pt /�� /
SUB TYPES
_ Foundation Fireplace Porch(3-Season) Exterior Alteration (Single 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 i' 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 P.1C" I MCES System
Plan Review jC Code Edition'?.OaOYNNrkC►SAC Units
(25%_100% )C ) Zoning R•,t City Water
Census Code Stories Booster Pump
#of Units Square Feet PRV
#of Buildings Length Fire Suppression Required
Type of Construction VS Width
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
Footings (Deck) Final/C.O. Required
Footings(Addition) X Final/No C.O. Required
Foundation Foundation Before Backfill )! HVAC_Service Test Gas Line Air Test" Hood
Roof:_Ice &Water _Final Pool: Footings _Air/Gas Tests Final
j( Framing 30 Minutes 1 Hour Drain Tile
Fireplace: Rough In _Air Test _Final Siding: Stucco Lath _Stone Lath _Brick_EFIS
)C Insulation Windows
Sheathing Retaining Wall: _Footings_Backfill_Final
Sheetrock Radon Control
Fire Walls Fire Suppression: Rough In_Final
Braced Walls Erosion Control
Shower Pan Other:
Reviewed By: , Building Inspector
RESIDENTIAL FEES 1
Base Fee DO = �S�3� V .
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit&Surcharge
Treatment Plant
Radio Meter Read
Copies
TOTAL
Page 2 of 3
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA161455
Date Issued:05/27/2020
Permit Category:ePermit
Site Address: 873 Govern Cir
Lot:4 Block: 2 Addition: Gardenwood Ponds 2nd
PID:10-28801-02-040
Use:
Description:
Sub Type:Residential
Work Type:Alteration
Description:Fixtures
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.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Fee Summary:PL - Permit Fee (miscellaneous)$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 -
Kevin R Tiberg
873 Govern Cir
Eagan MN 55123
(952) 431-1670
Diversified Plumbing & Heating Inc
125 E Railroad St
Norwood Young Americ MN 55368
(952) 583-9646
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA165578
Date Issued:11/06/2020
Permit Category:ePermit
Site Address: 873 Govern Cir
Lot:4 Block: 2 Addition: Gardenwood Ponds 2nd
PID:10-28801-02-040
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Softener
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
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 -
Kevin R & Kirsten R Tiberg
873 Govern Cir
Eagan MN 55123--246
Haferman Water Conditioning
12142 12th Ave.
Burnsville MN 55337
(952) 894-4040
Applicant/Permitee: Signature Issued By: Signature