4781 London Lane,.__._ .. . _.r .
I .CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21 •199, Eagan, MN 55121 PHON E: 454-8100
BUILDING PERMIT Receipt#
To be used for SF/GAR Est. Value '?i8 7.t%0C Date !:Fiii"rif 3; ,19-il-
Site Address 4781 LJN!)O'J Lli
Lot ''' Block 1 Sec/Sub. $R1"fT'!u`JY 1CiT:i
Parcel No.
c Name_ MLLRFSON BUTWERS. ZdtC
; Address 12E17 PAIRGREL*N AYE
o CityA4'PLS VwLL"r'.Yphone 431-1100
1
°Co Name SA!(@
.
? Q Address
? City I _ Phone
yVj W Name
F W
_zz5 Address
?Z City Phone
aW
I hereby ackrlowledge that I have read this application and state that the
nformation is correct and agree to comply with all applicable State of
Iinnesota Statetes and City of Eagan Ordinances.
Sigqature of Permittee 'A Building Permit is issuetl to: IryLL: FSvV $L'ILE3ERS
on the exeress condition that ali work shall be done in accordance with all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building Official
OFFICE USE ONLY
On Site Sewage _ Occupancy R-3
MWCC System X Zoning R"1
On Site Well (Actuaq Const Y-N
Ciry Water X (Allowable)
PRV fiequired _ # of Stories
Booster Pump Length 701
Oepth 441
S.F. Total
Footprint S.F.
APPROVALS FEES
Engr./Assess. Permit 858•00
Planner Surcharge 93.50
Council Plan Review 438.00
BIdg.Off. SAC,City I00•00
Variance SAC, MWCC 550.00
WaterConn. _550.00
Water Meter 67.08
RoadUnit 125-00
Treatment P1 204•GU
Parks
TOTAL
$•!73`50
,
BLDG. PERMIT N0. ' --`
,i'?",.-?-k-C?,i,?-?.L 1U?b?
01-3210 Bldg. Permi
,01-3422 Plan Check
01-3445 5urch./Adm.
01-3446 SAC/Adm.
01-2155 Surcharge
r?f-3860 Road Unit
20-2275 5AC
20-3865 Water Conn.
20-3868 Water Trmt.
20-3716 Water Meter
20-2252 Acct. Dep,
20-3713 Water Permi
20-3743 Sewer Permi
79-3866 Sewer Conn.
?8-3855 Park Ded.
TOTAL
CASH RECEIPT
CITY OF EAGAN
3830 PILOT KNOB ROAD
' r
EAGAN, MINNESOTA 55122
DATE-
?F=
AMOUNT
. ?
, & DOLLARS
im
? CASH 1]' CHECK
FM
?-
A!
BY
?
WhXe-Payers Copy ;
Vellow-POSting Copy y1
Pink-File Copy ]
?
?
i
Thank You
- - ----•
CITY OF EAGAN • _
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHON E: 454-8100
BUILDING PERMIT Fieceipt#
To be used for Est. Value ??' J• ??'` Date ,19
Site Address OFFIC E USE ONLY
Lot Block ' Sec/Sub.
On Site Sewage -
Occupancy
MWCC System _ Zoning
ParCel No.
On Site Well (Actual) Const
a Name i. City Water r (Allowable)
W PRV Re
uired # of Stories
3 Address q
? City Phone B?ster Pump Length
Depth '
p Name S.F. Total
,
o?
L) < Address FootprintS.F.
? City Phone APPROVALS FEES
?Q
W
Name
Engr./Assess.
Permit
''S?>•:
,,-
S?
?= Planner Surcharge
fe?
Q Z C ty
phOn2 Council
Bidg. Off. Plan Review
SAC, City
I hereby acknowledge that I have read this application and state that the
information is
rr
nd
l
ith
ll
li
bl
State o(
t
t Variance SAC, MWCC
agree
y w
co
ec
a
o comp
a
app
ca
e
Minnesota Statutes and City of Eagan Ordinances. Water Conn.
Water Meter
Signature of Permittee ' Road Unit
A Building Permit is issued to: . Treatment Pt
on the ezpress condition that all work shall be done in accordance with all parks
applicable State of Minnesota StaWtes and City of Eagan Ordinances. ; ?-
'
Building Official ? TOTAL
.I Permit No. Permlt Nolder Date Talophone at
Plumbing
H.V.A.C.
" Z/p
,
Electric ,,?' ?C??{ L , r? ?IQ,C i'• ? C
Softener
Inspection oate Insp. Comments
Footings I
Footings II
Foundation
Framing -/ &F • ?
Roofing
Rough Plbg.
Rough Htg. V!r
13UL PS l,S.n? 1.st C FC?eii' QI?' %'Ga^:+*
Fireplace
Final Htg.
Final Plbg. -m
Bldg. Final
Cert Occ.
Temp. LP
Deck Ftg.
Deck Final
Well
Pr. Disp.
/a
(gpr#if'trate of COrrupanry
Citp of (tagan
ap}tax"tritPtlf pf iltdbittg jitBwPttiIItt
This Certif:cate issued pursuant to the requiremenu of Sectlon 306 of the Uniform Building
Code cenifying that at rhe rime of issuance this strucrure was in compliance with !he various
ordinances ojthe Ciry regutatiag building construction or use. For the fo!lowing.•
Use Cleseifiation ? ux"pl Bldg. }lrmil No. 14756
I :?1
Occupeocy Typc ? 7oning Dittrict T Ct?t , ,._ _7f i
Owimr of 8u,lding Ad&m
n8 ?y .
tildi Addrect T? • - .J' ?•-;.. . T?i vY, ?I, . ?. r p.` , ti. i ? .
& .
.,..?T7tiR'
Dea:
Building Offidal
POST IN A CONSPICUOUS PLACE
, .
F' >
CONTRACT PRICE: ; , , ?
PERMIT #
PLUMBING PERMIT RECEIPT q S ~
CITY OF EAGAN ?
3830 PILOT KNOB ROAD, EAGAN, MN 55122 OATE:
PHONE: 454-8100
Site Address
Lot Block Sec/Sub
y Name
? Address
c Ciy Phone
Name
;' Address
p City Phone
FEES
COMM/IND FEE - 1% OF CONTRACT FEE
APT. BLDGS - COMM RATE APPLIES
TOWNHOUSE 8 CONDO - RES. RATE APPLIES
MINIMUM - RESIDENTIAL FEE - $12.00
MINIMUM - COMM/IND FEE - $20.00
STATE SURCHARGE PER PERMIT - 50
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND $1,000.00)
SIGNATURE OF PERMITTEE
BLOG. TYPE WORK DESCRIPTION
Res. New
M ult. Add-on
Comm. Repair
Other
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
O. FIXTURES TOTAL
Water Closet - $3.00 $
?Bath Tubs - $3.00
Lavatory - $3.00
! Shower-$3.00 -
?KitcFhen Sink - $3.00
_LUsiFkdlg?det - $3.00
? , Laundry Tray - $3.00
! Floor Drains - $1.50
?-Water Heater - $1 SO
_LWhirlpool - $3.00
--/--Gas Piping Outlets - $1.50
(MINIMUM - 1 PER PERMIT)
-Softener - $5.00
-well - $10.00
_Private Disp. - $10.00
Rough Openings - $1.50
FEE:
STATE S/C:
GRAND TOTAL:
?:?
MECHANICAL PEFiM1T
CITY OF EAGAN RECEIPT #
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: Al
PHONE: 454-8100
Site Address -
Lot 19
(D Name c-enZ-Ryan Y&H
? Address 14745 Sottth Rober
c City Rogemunt, MN phone _
BLDG.TYPE
Res. XXXXX
Mult.
Comm.
Other
New XX%XX
Add-on
Repair
Name Tollefs on Buildars Inc. FEES
RES
HVAC 0
100 M BTU
2
.
- -$
4.00
c Address 12617 F ai.r een Ave nue ADDITIONAL 50 M BTU - 6.00
p V
l
ll
A 1 IRES
HVAC INCLUDES A!C ON•NEW
e .
a
Ciry
Pp
$ , ev. Mone 4
--- -- 3
-1I00r .
CONSTRUCTION)
GAS OU
TLETS (MINIMUM - 1 PER PERMIn - 1.50 EA. ,
TYPE OP WORK COMM/IND FEE - 1%OF CONTRACT FEE
Forced Air 125 M BTU 30.0 APT. BLDGS. - COMM. RATE APPLIES 1
Boiler
M BTU
$ TOWNHOUSE & CONDOS - RES. RATE APPLIES il
MINIMUM RESIDENTIAL FEE - ALL ADD-ON & ?
Unit Heater M BTU $ REMODELS - 12.00 ?
Air Cond. M BTU R MINIMUM COMMERCIAL FEE - 20.00
Vent
CFM
$ STATE SURCHARGE PER PERMIT - .50 ?
.
1 (ADD $.50 S/C IF PERMIT PRICE GOES ;
Gas Piping Outlets # .q, 1•5 BEYOND $1,000)
Other $
, '
i
FEE: 141
i
S/C: 'S SIGNATURE F PERMITTE ,
TOTAL: 32.0 ?
i
FOR: CITY OF EAGAN 1
1
?
CITY OF EAGAN
?
1$095
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE:454-8100
BUILDING PERMIT Receipl #
To be used for um Est. Value :1 Date '1ULY 3 , 19 9c)
Site RddiVs 4781 WNDOM Lt
OFFICE USE ONLY
Lot Block SeclSub. BRITTANT rmw
PflfC81 NO. Occupancy - FEES
JOSEPA A Zl?II6M zoning 25*00
?
W Name (?lual) Const - Bldg. Permit
; Addf85S 4781 LONDO11111 L" (Allowable) - S
rchar
e 450
0 City ZAGM Phone 569-14-147-
N ol Stories g
u
-
Plan Review
o Name SAM Length
Depth _
- SAC, City
,
?Q Address S.F.TOtal -
¢ SAC,MCWCC
r City Phone S.F. FoolPrints
-
Water Conn
On Site Sewage _
?
0,
Name
On Site Well
- Water Meter
~
=
AddrBSS MWCCSYslem
-
uZ qcct. Deposit
a W City Phone City water -
S/W Permil
PRV Required -
I hereby acknowlege that I have read this application and state that the Booster Pump - SfW Surcharge
information is correct and agree lo comply with all applicable State of
Minnesota Statutes and City of'l?agan Ordimanys,-? • Treatment PI
Signature oi Permitee ` APPROVALS Road Unit
.l?$? w ??
A Building Permit is issued lo: / Planner
- Park Ded.
on lhe express condition that all work shall be done in accordance with all Council -
applicable State of Minnesota Statutes and City of Eagan Ordinances. Bldg. Ott. _ Copies ?
Buildinq Official
Variance
- TOTAI .
.
Permil No. Pxmk Holder Date TslspAone #
WATER
SEWER
PLUMBING
H.V.A.C.
ELECTRIC
Inspeetion Date Insp. Comments
Footirgs I
Famdation '
Framing
Roofing
Rough Plby.
Rough Mg. . .
Isul.
Freplace
Fnal Htg.
Final Plbg.
Consl Meter Plbg. Inspeclor - Notily Plumber
Engr,%Plan
BMg. Final
Deck Flg. ? - -29p S
oeck Final 'G-
.
Well ^
Pr. Disp. I
_?,..
_. ?
I Permit No: Date:
Road B/P No: Date:
MN 55121
ier.
Address -
Zoning• ,
No. of Units:
Chg:
. Dep: . . ;;:.?
_ ?,? I agree to comply with the Cily of Ea9an
nit Fee: Ordlnances.
By
L-
CITY OF EAGAN
3830 PiIol'Knob Road
P.O. Box 21199
Eagan, MN 55121 '
Owner. •'CoiIe1
Site Address: 4781 1
SEWER SERVICE PERMIT
Permit No:
Meter No:
Reader No:
?.
Date:
Size:
Date:
Conn. Chg: 55G' i1Qcd Zoning F?
Acct Dep:_ IS fl(1n? No. of Units: i
Permit Fee: _ 2!3 OOpd
Surcharge:
' I agree to comply with the City oi
Tr. Plant_ 2{
1? OOq?! Ord(nances.
Meter.
Misc.: By
WATER SERVICE PERMIT
CITY OF,EAG:,A Permit No: Date: 4
'
3830 Filol Knob Road Meter No: uU Size:
P.O. Box 21199 Reader No:OSP 17a Date: a(e - ??l '
Eagan, MN 55121
Owner. Tollefaon BuildsTs
SiteAddress: ';'I London Lan,- I.11"1 Prittany lOth
Plumber - = r _°lumb in-
Conn.Chg: Si?_0Gpd 2oning:
Acct Dep: 1-` •'?Opd No. of Units: '
Permit Fee: 111• ;)Opd
Surcharge: -5npc1 1 agree to comply with the Clty ot Eagan
Tr. Plant 01 f' ,,' Ordinances.
Meter. - ,^ , C J..?T?-•J`??_
Misc.: gy ?
WATER SERVICE PERMIT
- CITY OF EAGAN No 14758
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHON E: 454•8100 ?
BUILDING PERMIT Receipt# UC>M I
Tobeusedtor SF/GAR Est.value $187,000 Date MARCH 31 ,19 88
Site Address 4781 LONDON LN
Lot 19 Blo ck 1 Sec/Sub. BRITTANY lOTH
Parcel No.
W Name TOLLEFSON BUILDERS, IIdC
z Address 12617 FAIRGREEN AVE
3
° CityAPPLE VALLEYPhone 431-1100
¢
.o Name SAME
? a Address
?w City Phone
U?
y W
Name
Address
Q W City Phone
I hereby acknowledge that I have read this application and state that the
information is correcf and agree to comply with all applicable State of
Minnesota Statutes and City?of Eagan Ordinances. ,
Signature of Permittee
A euilding Permit is issue to: TOLLEF&ON BUILDERS--
on the express condition that all work shall be done in accordance with all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building Official_twi f? -.t ,,f1, J-T?1.--. --
OFFICE USE ONLY
On Site Sewage _ Occupency R-3
MWCC System X Zoning R-1
On Site Weli _ (Actual) Const V-N
City Water X (Allowable) V-N
PRV Required # of Stories
Booster Pump . _ Length 701
_
Depth 4-
S.F. Total
Footprint S.F.
APPROVALS FEES
Engr./Assess. _ Permit _ 8$6.00
Planner Surcharge 93.50
Council Plan Review 428.00
Bldg. Off. SAC, City 100.00
Variance _ SAC,MWCC ?5.501 00
Water Conn. ._550 _.00
Water Meter 67 _ n0
Road Unit 3 - flfl
Treatment Pt 204.00
Parks
TOTAL 3,173.50
..
BUILDING PERMIT
To be used for DECK
CITY OF EAGAN NO 18095
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE:454-8100 ? ? ???
Receipt #
Fcr vaiiia $1.000 oate JULY 3 , 192D-
Site Address 4781 LONDON LN
Lot 19 Block 1 SeGSub. BRITTANY lOTH
Parcel No.
W IName JOSEPH A ZEMIEN I
o Address 4781 LONDON LN
City EAGAN Phone 869-1414
o Name SE1ME
Address
? City Phone
Ww Name
? ; Address
aW City Phone
I hereby acknowlege that I have read Ihis application and state lhat ihe
information is correct and agree to comply with all applicable Slate of
Minnesota Statutes and Ciry agan Ordii anGqs -
Signature of Permitee _ - `
A 6uilding Permit is issued to: J SEPH A ZEMIEN
on Ihe express condition that all work shall be done in accordance with all
applicable Slate of Minnesota Statutes and City of Eagan Ordinances.
Building Ofticial l
Occupancy
Zoning
(ACtual) Const
(Allowable)
# ot Stories
Length
Dapth
S.F. Total
S.F. Faotprints
On Site Sewage
On Site Well
MWCC System
Ciry water
PRV Required
Booster Pump
APPROVALS
Planner
Council
Bldg. Off.
Variance
OFFICE USE ONLY
FEES
Bldg. Permit
Surcharge
Plan Review
snC, cry
SAC,MCWCC
Water Conn
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Trealmen! PI
Road Unit
Park Ded.
Copies
TOTAL
25.00
.50
7 C SA
Ihis reQUest void
/?/`'r/-3-51
78 months from ?L J?'
E 2 1 nas /. /G P /
yti
yue?? vam n?e rvo. n p -mmSVeCUOn
R gured? O (DReaAy Now Will Nolify. Inspec-
? Yes No [ur When Ready
Licenaed Elec[ncal Contractor 1 hereby requestinspaction of above
Owner electrical work installad at:
Street Address, Boz or Route o.
- City
f 1 1-o
O n<-,
ection o. Township Name or No. Range No. Cou?
?
Occupant RINT ? Phone No.
Pow Supplier ' Address
:;l - - ec rr) '?-?
Eleclncal Contractor (Company Name) Contraci ' License No.
29sQen CJf,G_ d r9?s-3
MailinB ddress (Contractor or OMaking Instailation) ?'`
( -/S0)). [ /2' ?.Je ?/?
? ( .
Auth ' ed Signa ure ( tractor/Own akfng InsWllalionl P46 ne Number
MINNESOTq STpTE BOAHD OF ELECTqICITY 7H15 INSPECTION REQUEST WILL NOT
Griggs-Midway Bldg. - Room N-191 BE ACCEPTED BY THE S7ATE BOAHD
1821 Univereitv Ave.. St. Peul, MN 56104 UNLESS PROPER INSPECTION FEE IS
Phnnn Ia191 649-(8ioo ENCLOSED.
!, -ny REQUEST FOR ELECTRICAt INSPECTION . ea-oooot-os
?
See instructions for completing this torm on back o1 Vellow copv. ?
E 21045 ,"X" 8e/ow Work Covered by Ihis Request
At{Q, Rep. TypB o} Builtling Appliancee Wired Equipment Wired
'flome Range Temporary Service
Duplex Water Heater Lightiny Fixtures
Apt. Building Dryer Electric Heatin
Commercial Bidg. Fumace Silo Unlonder
Industrial BIAg. Air Conditioner Bulk Milk Tank
Farm Otnr. oer.i y otherlspacifyl
thnr SUr.ci(y Other Olhi;r
e lnspeetion Fee Below
p Fee Serv ice EntrenceSize R Pea Feeders/5ubfeeders # Fr,e Circuits
,cX7 U to 200 qm s 0 to 30 Am s
? . 6D
0 to 30 F?m
Above 200 qR?pS, 31 to 100 Amps .CTn 31 to 100 A s
Swimming Pool Above 100_Amps Ahove 100_Amps
Transtormers Irngation 8oom5 S6 Partial-'O ee
Signs SUecial Insuection
TOT L
Remarks
v -
Rough-in ntel7.?
• ?? I, the EleCtnpal
insvectar, hereby
"certify that the a6ove
Final insDection has 6een
made.
rhie request voia itl momm Trwn
19i92i2006 12: 14 ERGRN. ENG+CQM _DEV j 94561865 1-r--
_,----.. .
-- - - - - - - - - - - - - - - - i
?? I f0( Q?jCB 1?6Q I ?
I I ?
I pertnh Fe
Ealan ? I ? '
Cit of ?? ---?=
3830 Pllot Knob Road ? paie Receivod:
Eagan MM 55122 ?
? Stan: I
Phone; (651) 675-6675 i -------------'
Fax: (651) 695-5694 `J--
2008 RESIDENTIAL $UII.QING PERMIT A?PLICATION
?Sfte adOress: ?r71r
08te: /"?) J ?O" ?
su?te a:
Tenemt:
71 ?---L?e G- , 1`?1?'V Pnone,
RESIOEPIT I OWNER Name: 1?? l??
Address I Ciry / ZiP:: •
qpplicam is: __ Ovmer AContraclor ! . . I'
n ?
TYPE OF WORK Descriplion ofwark: u ?
Multl-Pamiry 6uildlrg'. (Ves ? / No ?
Construetion Cost:
1?1 Q?-? S?S ??.-?p ? Ucense A".
GOMRACTOR Neme: (?J ?? s C
??b bC O ? U r c?v -
Address: " ?J 3
?l 5iaie:f'_'?.Y? 2Ip_ ? f?`'---?
Ci1y: TL)?
:Comact Person,
Phono r
COMPLETE THIS AREA ONLY IF GONSTRUCTING A NEW BUILDING
e,niLrnesota Ruies 7672
Minnesola Rules 7611111 o11 -, New Enef9V Code Wor?sheei
Energy Code Reeidenli2l VonliifldonCamgory1 Workshecl gupminod
Category suemaleo ?
(? SuGmisslon type} ? Energy Enveiopa Calculnllone Subminad
In the laal 12 months? hes tne Clty ol Eagan Issued a permlt 1or a simlier plan Cased on a master plan? ,
_Y9s _NO 1f yes, date and adtlrass ot master plen:
Phona:
Llaensed Plumber:
Phone:
MechNnlcel Conlractor:
Phone:
Sewer & Water Comractur: -
NOTE: Plans and support+ng documenls that yov subm/f are consldered to be pub!!c informatlon. Port)nns of
ihe !nlormatinn mey De Classlfled x?nclude r that the srre V trade set+frefseasons Ihaf wouid Perrrrll the Cify fo
ihat tna wOrK wlil Ue fn conformence wiin tno erdinances and co0ea at Th?'?p l
I hereby acknowlad9e ibat Ihis Informadon is complale and eaurale;
EBpan; Ihai I undenland thia '?s nol a pormil, bui only an appliCdGon lor a Aem+it, and work 1 nol lo start wilnout a Dormll; lliai the w
/
aa0rdnCO v!!Ih.lhe. appYOVOtl plarl In Ihe case ol work wnich reqvI a re-A and appr0vaio1 ene.
11
Lt,
'i ?ppil Ignature
x ---- Paga I of 3
Appllc nt's PrtnteQ Name
_q; _00
2005 RESIDENTIAL BUILDIIVG PERMIT APPLICATION
City Of Eagan
--I 1 a31 3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Construction Reauirements
3 registered site surveys showing sq. ft. of l04 sq. fl. o( house; and all roofed areas
(20% maximum lot coverage allowed)
2 copies of plan showing beam 8 window sizes; poured found design, etc.
1 set of Eneigy CalculaUons
3 copies of Tree Preservation Plan'rf lot platted after 7!1193
Rim Joist Detail Options selection sheet (buildings with 3 or less units)
?------- --?
RemodeVReoair Reauirements
2 copies of plan
1 set oE Ertergy Calwlatioas for heated additlons
1 site survey for additions & decks
Adddion - indicate if on-sde septic system
Office lJse OnN
CertofSurveyRecd _Y _N
T,cee Pres P{an ReW _ Y_ N.
Tree Pres ReGuired _ Y_ N
On-sfte Sep6c System _ Y_ N
Date I f) / 1'5_ Construction Cost co
Site Address WIS I L( )y)dp? La-m o, G&? UniUSte #
Description of Work ?Z?\ Qxnr
Li ?A a.? p, ? SkL? r('fr?
Multi-Family Bldg T
_ Y` N Fireplace(s) _ 0 _ 1 ^ 2
Property Owner A
,b
E' $ 0AYlal??y?(\i py'1
1
Telephone
Contractor 1
ifet ^
^ !^
6mA &
dir?
e^? del' d
-
Address g
,
..?
.
11825 Point Douglas Dr. S. .
City
State Hastings, MN 55033 Zi Tele hone #
P P (65) CU$1-1q
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
(q submission type) Submitted Submilted
• Energy Envelope Calculations Submitted
In the last 12 months, has the City of Eagan issued a perrnit for a similar plan based on a master plan?
_ Y _ N If yes, date and address of master plan:
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone # (
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 startwithout 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. ? ?
M2LiS? cow(N ? CT 2 8 2005 ' j'?'
U 1 i
Applicant's Printed Name Ap icant's Signature ? j
PLUMBING (RESIDENTIAL) d? ?Sa
?Q 4! ? Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5694
Please compfete I'or: Single Family Dwellings
'I'ownhomes and Condos when permits are required for each unit
Date?/??/03
Site Address ?2JL-2 Unit #
Property Owner ?°LYyl Q.yx.? Telephone #(??) ys y? ?ss?
'
'
'
/
?
?
^
J
19
l/?JI
?Cl
Contractor ??}
C?)/'J
/
0 (`
Address /Jl ?Lz) 11/ P_ City lQ/C`e IJI G1 V°
Statc Zip sS?Y? Telephone# c9S4 _y(B`j- ?199?
The Applicant is Owner ontractor _ Other _
Septic System New _ Refurbished Submit 2 sets of plans and MPC license $ 100.00
Includes Coun[y fee. Additional consultant fees may apply.
Alterations To Existing Dwelling Unit, Including $ 50.00
_ Adding fixtures to lower levels or room additions, excluding water softener and water heater
_ Abandonment of septic system
_ Water turnaround (+ 5!8" meter if needed -$121.00)
Other:
_ RPZ _ new installation _ repair _ rebuild $ 30.00
Lawn irrigation system
Water softener Water heater
- -
$ 15.00
_ replacement _ additional
i
p I?I???1L? $ 5a
State Surchar
e
g
T
[UU. J
Total
I hereby apply for a Residential Plumbing Permit and acknowledge that the information is complete:and:a?curate; that the worl< win
be in conformance with the ordinances and codes of the City of Eagan and with the Plumbing Codes; that t understand this is noi 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 wilh ihc
approved plan in the case of work which requires a review and approval of plans. ?
?n
S?eeY\
Applicant's Printed Name Appli Ys Signature
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
851-881-4675
Naw Constructbn Reaulrements RemodeVRepAir ReauiremeMs
• 3 registered site surveys showing sq. it. ot lot, sq. fl. of house; and alt rooted areas • 2 Copies oi pPan
(20o maximum lot coverage allowed) • 1 set of Energy Calculations for heated addflions
• 2 copies oi plan showing beam & window sizes; poured found design, etc.) • 1 site survey tor exterior additions & decks
• 1 set of Energy Calculations • Indfrate ii home seroed by septic system for addftions
• 3 copies o1 Trea Preservation Plan if lot platted aiter 7/1 /93
. Rim Jofsl Detail Optioris selection sheet (bklgs with 3 Or less units)
DATE c7c;2_
Water Softener
Water Heater
_ No. of Baths
SITE ADDRESS ?''Zr-Z ??,?.Lor- ?r-• MULTI-FAMILY BIDG _ Y _ N
NPE OF WORK Ar- -n?< FIREPLACE(S) _ 0_ 1_ 2
??--
APPIJCANT ?? ?J ???.?f •- l7?rr s,? ?v ?%/ ? r_ ,
STREETADDRESS Xf?1-2 ?G/GXi•e ??e• CIN ,'lr //?%/? STATEsrN ZIP ff??y
TELEPHONE # j'l-7" G2/-4'3 CELL PHONE # FAX #
PROPERTYOWNER ?c ?????•?- TELEPHONE# ?fi-y'Jy ?.ff?
-------------- ------ ------------------ ------------------------------------------ ---------------
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MIlVNESOTA RiJLES 7670 CATEGORY 1 MINNESOTA RULES 7672
(?l submission type) • Residential Ventilatlon Category 1 Worksheet Submitted • New Energy Code Worksheet Submitted
• Energy Envelope Calculations Submitted
Plumbing Contractor: ___,
Plumbing system includes:
Mechanical Contractor: _
Mechanical system includes:
Sewer/Water Contractor:
- Air Conditioning
- Heat Recovery System
Phone #
Phone
--------?-------
I hereby acknowledge that i have read this application, state mat the information?? omply
with alt applicable State of Minnesota Statutes and City of Eagan Or 'nances.
Signature of Applicant
OFFICE USE ONLY
VALUATION /9 ?91 7 ;E'
Phone #
_ Iawn Spriukler
NO. of R.I. Baths
Fee: $90.00
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4102
y 1? 2
-- D
r
11045
1990 BUILDZNG PERMIT APPLICATION
CITY OF EAGAN
SINGLE FAMZLY DWELLINGS MULTIPLE DWELLINGS COMMERCIAL
2 SETS OF PLANS 2 SETS OF PLANS 2 SETS OF ARCHITECTURAL
3 REGZSTERED SITE SURVEYS REGISTERED SITE SURVEYS - & STRUCTURAL PLANS
1 SET OF ENERGY CALCIILATIONS (CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFICATIONS
1 SET OF ENERGY CALCULATIONS 1 SET OF ENERGY CALCS
# OF RENTAL UNITS
# OF FOR SALE UNITS
PENALTY APPLIES WHEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY LAST WORKING DAY
OF MONTH IN WHICH REQUEST IS MADE.
LOT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED.
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS
DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DAYS ONCE A PERMIT HA5 BEEN COMPLETED.
PERMIT MUST SHOW A LICENSED PLllMBER. ?,
i?y`l 8 pFrn
To Be Used For
Site AddTess
N?? Valuation:
4161 L?Q tj-.- L,/1' I
Lot I ? Slock I_
Parcel/Suh ,11911,1A.(ihel ??.?v
'?I n'T
owner -l -1n5E PtT fit r 2fFmItp
Address U, L}
City/Zip Code EA'Cm?vJ t"(v? SSf2'Z-
Phone 1`{S`}? bSs? A? g(?q-?414
Contractor SCLF
Address
City/Zip Code
Phone
Arch./Engr.
Address
City/Zip Code
Phone #
l?d0
Date: locp'??'0
OFFICE USE ONLY
Occupancy
Zoning
Actual Const
Allowable
# of stories
I Length
I Depth
S.F. Total
Footprint S.F.
On site sewage_
On site well _
MWCC System _
City water _
PRV
j Booster Pwnp _
iAPPROVALS
Planner
Council ?
Bldg. Off.
IVariance
FEES
Bldg. Permit
Surcharge
Plan Review
SAC, City
SAC, MWCC
Water Conn
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment P1.
Road Unit"
Park Ded.
Copies
SUBTOTAL
Penalty
TOTAL
Z?
?
2? •_??
' . .
TLLEFSO?I/ ?ll/LDE?'.5
Ari (3 E
CLl1i5UlTlli0 Etlc31lIEfRS
FIENGINEEflIMG pLn?irtEns and lAN[1 iunvEVons
COMPANY1 INC,
? I000 EaST 14611 57FiEET, BURNSVILLE , LIII11iESOTa 5=:!37 Pfl 1=2-3000
C4e Y--Z
'Yz cri.1 e c
L_oT 0, 91-oCK i, 82i7"TAA/Y /077I ADD/T/OM
DAKaTA COW77! MiNA/ESaTA
C?•3'? DEND7`i5S EX/S7/NEG ?5LEV,4710!V
040•3 ) 0EN07E5 PKOF'DSEp E1-E?/A710A/
?,? INOiCATES DiKECT/on/ OF SuRFACE ORAiNAGE
i?0• 33 = F/N /SHED
..n .??
5 ?r
I
I
I
( T-y
ORAin/AC E An/D
U'iiLlTy EASEMEAIT
?
?
\
?
?
. ?
6AR46E FLOOR EGEMT/D/V
?
s -,
s?
e
.
ar ?'?B °? • i .: ?
d?l „ .. .i
$CAGE / ° = 30 ,
o I 30" FRaA/T 6U/LD1A/6?
; g I ? , ??oG \ SETBqCK L./ME
o°
I ! ?\
I ,•?. ? ? \ • 32°° ?? ?
..i ,j,• o.? o r? S,
.? o \ 8\
, `40,
7 00 7?1 ?7 1
a?T
?a38 a: N /
? ?° ar y a3; 2433 ? to ^li ? ?oNOD?'1
I_ - - ? _ _J
? ?? b / ?ANE
(C q0 .1') , J
RADiAL) t0.'`'
L ? 184.6b
S' B9° 29. 49?„E f.??Q,n ?
= ?i4?•31 ?
; hereby cartify that thia ie/n t:ueJand corract rapraaantition ol?jtract of
.}?{! as Shoxn' and ?! ecribcd hernon?• Ae praparad by mn an thii ?23? day ot
u?..,( ltinn. Re6. No. Gog'?'.
?
,
S • . -.. - . .. t _
1988 BUILDING PERMIT AFPLICATION - CtTY OF EAGAN,
- _"7I?7
SINGLE FAMILY DWELLINGS
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY? 1 SET OF ENERGY CALCULATIONS
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS
IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BOILDING PERMIT IS ISSUED.
` MULTIPLE DWELLINGS AENTAL [JNITS FOR SALE UNITS # OF UNITS
- INCLUDE 2 SETS_OF PLANS,- CERTIEICATE OF SURVEY - CHECK WITH BLDG. DEPT.;-
1 SET OF ENERGY CALCULATIONS "
COMMERCIAL
NCE SPE
OITURIL
1 SET OF
3q ry J
?S
I?ECI? N;
L
S
U
CIF
SET
ICATIONS AND ATIO
ENERGY CALCU
OF %
NS -
?
To Be Used For: Valuation: ?8?? ?}'d'f?• ? Date:
Site Address OFFICE USE ONLY
p 000 !
???
?
Lo t B lock ? - ?
On site sewage_
Oecupancy p
1\`?
MWCC
system ? Zoning
,
Pareel/Sub i _
On site we11 Actual Const W ?11
City water r% A1lowable
Owner ?o
dp R ? , , PRV required # of stories ••
i
0 ' _
Booster Pump Length_. r/D ?
Address _ Depth y51 ?
S.F. Total
City/Zip Code Footprint S.F .
Phone APPROVALS - FEES
Contractor p Vip Engr/Assess Permit 85Cn, ?O
_ Planner ` Surcharge Q3.S0
Address Council Plan Review Z , b?
Bldg. Off. ?Z $ SAC, City 100,00
"
City/Zip Code Variance ' SAC, MWCC ,(0 _isp
Water Conn
Phone Water Meter 4oh, O d
Road Unit 3251 tb
Areh•./Engr. Treatment P1 2 oy,oo
' Parks
: Address - Copies
. ' TOTAL 3,
City/Zip-Code .
Phone #
_.. „
` _
r - i/,y L U A-f iQN
G,4R AC,E
3?Z
j? X zZ ?. 3a?
13x
1539 x t 3= 2c?ov?
2_ WA PLQo ra.
106 '-f
I x ,? I 2
i. y t;.a ...
k' m = q?
_-?-
1?I 9?? '? ?I? ='? 3? 5 f
IsT- G",oot-L.
IS 19
? X
?? ?' K4 1 G
F ?.? pc_
1
?IL/__.
Z-?
/ gb -z
To??EFSOM Btl/LDER.S
ROQG [011SUI.TI114 (114111EER5
ENGINEEIIING PIAtIl1EA5 ond lAFip ,URVEYOffS
COMPANYI INC.
1000 U5T 1461n 57flEE7, BIJAtISVILLE, uINNES07A 5t237 Pil 4=Z'3000
C4CP"Z Z?Z C LZ Ze "
?..ti1C.J LOT I 9, BLoCK BR/TTANY /077-/ ADD/T/Oti!
DAKaTA CDOAl7Y, M/MNESOTA
C?`3,--5D DENOTES EX/S7/N9 ELEVAT/ON
C 9q-o.3 ) OENOTES PRoooSEO ELEVA710A1
s? /Np/CATE$ OiRECT/oN aF SuRFACE O941NA6E
0a
x
I heriby cartify that thia ie a t:ue and corract rnprcaentition ot ? tract ot
lfrk¢ aa haxn' 4nd ecribcd hcrnon•• As prapared by mn on thi: ; day ot
l? ) , 19?.
?D•33 = F/N/SNEO 6ARA6E FLOOR ELEV,47-10/V
EXTERSOR ENV£IAPE AVERAGE "U":'COMPUTATION • ?
? OWNER• T?O L L E F 501.1 ?j Ll t l. r;??c ? 5 ?5 c o TT "H ? cr L 3? Prcl?l? .
? .
? .. .
? SITE ADDRESS LD"t" O B ' 'ELoGt 1 A ??'TTAuw /07t*-???,'??.' . .
CONTRACTOR , ? ,,.-<.? - , : , • ? ,., ,;. , i? : r, . ? ., : , . _ . ,
J _
; DATEPHONE , , . ..,. r,. . ? ? : ?. . '. ..
? . .
' ' . • .. ., ._, .. . , :? .:; ^:::. '.•'*. .e,i=:,, '+?'' ?a ?';r.+?-.^<.
°Determine?warkinq aquare footage of each. .
_ , ? .? . .. . ,?,,,• :t .
` , . l. Total exposed wall area ¢n :t Z 8q. tt." X ' • ? ? - 4- 4 ( . 3 Z
? 2. Total roof/ceiling area *.... .. ':_F 38 d, sq* ft. X -• ? 2`: .- , ,
. .
.I , • , 3 5. 8 8 -
.,
? _. _ . . _ . . . ,? . ._ : ... ? . .? ... . .
? . . _ . ___. ?...,?._u... . . _ .. . .,...: w .__ __ ..?.._ _ _
., . _ , . . . .
-, ,. ., .=.. ..: ,..... ,, .
; A. Total wall window area .......................... 3 4Z
? B. Total door area..".???????????????????????????• .
C. Total slidin - ? ?
1. Z, o. ..:..:; , . : .> ,
9 qlass door area............. .......• _ .. <
i' D. Total fireplace wall`area.....'......... .......
..
, E. Total wal2 framinq area (averaqe 103)........... 'S 11
F• Total Rim • ---
, joiat.area............................ 3
G: Total Net wall area above floor.••••••••••••....
. ' f . ` Total exposed foundation area
. .. . . , , . .. --------
H. Total foundation window area.................... •
1. Tota1 net,foundatiori area above gzade........... •
q- 0 1 2
betennine "U" value of each wall segment.
a. 34'Z', S( °U„ .54' a 104.be .
b. So X "U" •z3 . I8.40
. .
C. ?'L O ]( nUN q
. . .??? L .4d .
d. g „Un. ? • ; ' '
,
e. 3 ?1 x"U" '.10 ?. 51.10
f. 3G2 X "U" . 04 . . .
. 14. 48
y. 21 91 x^vM _ 04 . t ? 1. 88 '
h. g NUn
. . i• X "tl^ ,.
3 ............._......................Total •
`
.: If item #3 is the same as, ar less than item #1, you have met the fntent of
SBC 6006(c)2.
=1
I• • .
.• •
' . . . .? . .. . . . . ..+.. . . . .
. ' 'Total exposed roof/ceiling area
. j. Total'skylight area ................................ .. 1.? .
k. 4bta1 roof/ceilinq'framing area (average 10%)..... . { 34•
' l. Total net insulated.roof/ceilinq asea....:......... .
. -i Z 28
• . . L38 0 .
Determine "U" value for each roofjceilinq.seqment.
'.. :: . . ,.: ,; . . ?..,.: .:.. . . ,. ,
i• 1co : "x n U« 59 ? 9.44 , .
..
; ..
L _oi ..
n• X ~U~ r?irW s ? ?7 ?
. . 1? • F Z.Z U A pA wV*? A .•0 t7 L n.. 1 . - .
,. ? ? F ( ?? ? •
'. ' 4 ................................:....Tota1 3 3. S ? ' .
. .
,
If total of #4 is the same as, or less than #Z, ycu have met the intent of
_ 5BC 6006(c)l.
, Alternate Building Envelope Design ? To utilize the total envelope system method, the values established by the
-?sum of items #3 and #4 shall not be greater than the'sum of items #1 and #2.
l. + Z .
• a
3• + 4. . ?
i •
?
? ,
FIG. Nl
,
Construction ,
.;' ?. Ure
15• of c+paqua wall area for
, trarae conaeructian l.
R-Value
Z* '/2" GptYINALI..
3. 5!/L inches soft wood
4• 1
5FIEpTNI?JG
, , ZOG
5. -StflING 67
6.. Exterior air'film ' r 0.17
Zbtal
• . . ... , t o. t5
. . .
1. Interior air film 0.68
2. ?/Z.?? CLYWALL' .45
3. ?Irz" 114suL. 19.00
4. S" g,pTLl i N Ci 2 OG
5. '??flt?.tG ' ,67
6. Exterior air €ilm 0 17
Total Z;,o3
V =.04
l. interior air film 0.68
20 19,00
3. f 117- " wcop I
SS
4. 75HEATN11J4 • .
? c(
5. SsDIWG • .4?
6. Exterior air film • 0,17
, Totai 2.4.4G
, .Uc .c4
1. Interior air film 0.68
2. 1111PUL. A1JV fli'YWel.l. 8,66
' 3• 1Z" 6?oa? 1 28.
4.
5.
6. Exterior air film 0,17
Total ? 0.19
SL71B ON GRADE
..
?
. 4?? f?' ? •?
tr ' ' e•
•• o . '
. a ?.. •
i , ? . . ` ? . .
. .
^ • .i . '
,. .
FAA1fE
'. ,
y..,!;.
.,. ..t ?.
.. . ?.;:?>. °
:, • ?''a.'?.._ . ?.
. • .
.
• ?
,
? . _......_? . ; ? : .
.._._
.,,?
. •. •
.
? ?
v
K ?
?
?• '
.??r
?. ..
.
FIG, 04
NOTE:
.c . • .
. : ?(.
Yi k _. : _
??
???
.
:r .
_...__ ? • •
. .:. ._. .. •. ' ?i . _ ' ..
.
f
!? ( ,
u .
•
'
- ' a ' ?
??i
?
• `
?ff
?r? /?l
?. •, o ?
?
.
/I ( ? lrr s Jir -
Indicate tyne, value, depth and
placenen t of insulation.
'G. ' #3
. ,• • .
.'." ? ' . ROOF/CEILING . . ? ? ., ?
• ?? . • : .
? , • • ,r . . , . .. . .
Constzuction
...,
•? . ,. (Use !or ILem L) K-Value
• ' ' : `w?;+ 1. Interior ?air film .: ' 0.61
ww-
2. ' S SHEET2oct, _ • ? Sfi •
,
3 . ?.t s u L. -3-8-ao 5 S.a ?
?? , ( ; (1? 1 ? `,.., _' • 4. Exterior air film (still
: ?.??. .?.,_?. . . ? - ?. ... . i Tqtal 54.77s
? . • ' ' -V t-(D
, . •• . . . . , . ?
. .. . z:_ . _ ...?4? ,?, . • ?. ;, •
. . .
_. _.. ' ...__ .
CLG. FRAMING(Use for Item K)
Vented Heat flov " '? •
• up • 7 1. Interior Air. film .
• _ 0.61
_ ? ' . . ' . • _: . 2. 5l8" s+1 E, F *T R.ac y- . 5 em `
. .
' FIG. #5 ' • • 3. Inches soft wood ,(-,sr S
4. Inches insul above framin
,, . .
... . . . ? . 5. Air Film . 0.61
- -• . .
, '" - • , ? V = .?'?
1. In.Lerior air film ' 0.61 •
2.
3. .
' 4. Exterior air film (still) 0.61 ' •
` Total
. . , . .
• .
_ >.
? Heat flov up. vented ? " •
.? .
, . , , , . _.... . •
, ? .
..FIG. #6' . ' ' •
3 ? 5.._ .
? u? Inside air film •• 0.61
.. . ( . ... 2.
j•
4.
-?j, ' :: ?' t? •?!? `, t . . •'.:?•;:.:; .;..• °`:?
?1,1 ??.?. ? ?`` . • _ ..--+ .
r,;. ?,. • .
Outside air film 0.17 ?
??-
, Total
: .
NoL-ez Usa additional shcuts if ?more cpacc i3
•• . • " . Leeded for dr.tails and calcul:,tions.
. Heat ' .._' .
• . flov up . . . . . :
. . . • •
FT,R. 0 7
APFLICi4TION FOR PERMIT
SEWER AND/OR WATER CONNECTION
................ .
.
* AA7tE: PAYNIINP OF FEE AT TIME OF
,.
.*k
* nprUC.AMoN ooEs Nom coN- ;
STINPE APPRCSVAL OF PERMIT. ,*t
?*. IKSPBCPION OF SEWffit AND/OR WA1gSt *.
t Tt1S`PATTA'j'jQj? wnL Nofr g$ scEuiLED t
* l!NPIL PII24ffT HAS BEEN APPROVID. ?
•itti:+t?r:+.r*:rx,r*?xtt+*r*rfr+.+*?*+r*x
oF ecigcin
(PLEASE PRINT
1) PROPERTY ADDRESS:
7 E;A7' DESCRIPTION;
IF EXISTING STRL'CT[JRE, DATE OF ORIGINAL BiIILDING PERMIT ISSUANCE:
Mon Year
PRESENT ZONING/PROPOSID USE:
Q WNA9ERCIAL/RETAIL/OFFICE
Q INDUSTRIAL
? INSTITJTIONAL/GOVERNA7ENP
2) LYtY•JL : ( b ??r
- ADDRESS: -
CITY, STATE, ZIP: ---
PHONE:
,=fR-1 SINGLE FAMILY
E-1 R-2 DUPLEX (3Wo Lnits)
? R-3 TOWNHOL?SE (Three +'Units) ( Lnits)
Q R-4 APARTMENT/CONIDOMINIUM ( Lnits)
3) : ?rrArE: -j) +n k ?
ADDRESS: ?t
CITY, STATE, ZIP : _vi, ? ILA
PHONE: ?
?MASTER LICENSE #??
rlumpers License:
Active
Expired
- Not recorded
Sta Imtial
4)
NAME:
ADDRESS:
CITY, STATE, ZIP:
PHONE:
5)
_GZrCONNF.CTION TO CITY SEWER C
? J.
TO CITY WATER a QTHER
6) kTi:3A
********************** ** ***********************************************************************?
*
* THE GOLD COP_Y OF TIiE PII2NffT WILL BE SE[dP DIRECTLY TO PUSI,IC WORKS TD FACILITATE METER PICK-UP. *
*E PLEASE ALLOW" TTnlO-WORKING-BAYS FC)R PROCFSSING. SMIDONE FROM TfM CITY WILL COPTPACP YOL IF THERRE *
* ARE ANY PRQSLENIS. ?
?***********??***********************************************************************************?
DA.T_ ,
.'FOR CITY USE ONLY
PERMIT # ISSUED
?2? / ,
Pd w/Bldg. Permit
c
$
s / 7,? c?
$
FEES:
$ $ $
r
$ $ SEWER TAP
$ $ ACCOUNT DEPOSIT - SEWER
$ ACCOUNT DEPOSIT - WATER
$ C •CI--C+ $ WAC
$ ?• ?D , c? ? $ S
AC
$ S TRUNK WATER ASSESSMENT
$ $ TRONK SEWER ASSESSMENT
$ $ LATERAL BENEFIT/TRC[VK SEWER
$ $ LATERAL BENEFIT/TRUNK WATER
$ $
WATER TREATMENT PLANT SURCHARGE
$ $ OTHER:
$
TOTAL
CTZ ;. . q SY/ ?
RECEIPT RECEIPT
DOES LTILITY CO NNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
F__j YES IF YES, THEN A"PERMIT FOR WORK WITHIN PLBLIC
Q
NO ROADWAY" MUST BE ISSUED BY THE ENGINEERING
_
DIVISION
LIST AS
O
. A C
NDITION.
SUBJECT TO THE FOLLOWING CONDITIONS:
SEWER PERMIT (INCLUDE SURCHARGE)
WATER PERMIT (INCLUDE SURCHARGE)
WATER METER/COPPERHORN/OOTSIDE READER
WATER TAP (INCLL'DE CORPORATION STOP)
APPROVED BY:
TITLE:
DATE:
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA138215
Date Issued:08/16/2016
Permit Category:ePermit
Site Address: 4781 London Lane
Lot:19 Block: 1 Addition: Brittany 10th
PID:10-15009-01-190
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:Two or More Windows/Doors
Census Code:434 -
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 -
Joseph Zemien
Cindy Daszkiewicz
4781 London Lane
Eagan MN 55122
(651) 260-5766
Wellington Home Improvement
3938 Meadowbrook Rd
St. Louis Park MN 55426
(952) 933-6300
Applicant/Permitee: Signature Issued By: Signature