4817 Four Seasons Dr
Use BLUE or BLACK Ink
1 For Office Use
_q6Q?6'
ina
City of Ea dn ; Permit:
Permit Fee: -
~~GS l 1
3830 Pilot Knob Road ; 6_1 ;
Eagan MN 55122 M AY 6 2011 1 Date Received: I
Phone: (651) 675-5675 .~~Cq)~ i sta
Fax: (651) 675-5694 j
i 1
J
2011 RESIDENTIAL BUILDING PERMIT APPLICATION
V9 7 ,ptJG!~ Se ( SQ 1-7S f7f^ ,-V 4Unit r
Date: S_ / 411 )-0111 Site Address:
Name: Q Is U It CILr r Phone: -,S
RESIDENT 1 -47
OWNER Address 1 City 1 Zip: 1 0 ~ 7 / o ui"e .S' OfV V C
Applicant is: Owner V/Contractor
TYPE OF WORK Description of work: .~TQ f r /.?/I C/1 ~ 11 hock rinn r Construction Cost: Multi-Family Building: (Yes / No P,--)
Company: Ef rh r t r~Pl^NrT n C Contact: 9c'Pl1 e'
CONTRACTOR Address: G J t4 AV 5 City: - A VI Y1 C I ®I S
State: Zip: YB0 Phone: 61Z-727-F76_6
License #:2063 T~7 l~ W Lead Certificate he)h r -31- 201 a
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
bi,idi H79
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE. Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that the are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage.
Cali 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonerall.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 1 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
l of ans.
accordance with the approved plan in the case of work which requires a review and 7"(_'/r
x 'u
icant's Printed Name Appli s Signature
Appl
Page 1 of 3
r-60 (-r~S pr~L qjY63
DO NOT WRITE BELOW THis LINE
SUB TYPES
_ Foundation _ Fireplace Porch (3-Season) , Storm Damage
_ Single Family _ Garage _ Porch (4-Season) - Exterior Alteration (Single Family)
Multi 1( Deck Porch (Screen/Gazebo/Pergola) T Exterior Alteration (Multi)
_ 01 of Plex T_ Lower Level Pool Miscellaneous
Accessory Building _
WORK TYPES
_ New _ Interior Improvement _ Siding - Demolish Building"
Addition _ Move Building _ Reroof - Demolish Interior
- Alteration _ Fire Repair _ Windows - Demolish Foundation
Replace Repair i Egress Window - Water Damage
Retaining Wail "Demolition of entire building - give PCA handout to applicant
DESCRIPTION
Valuation Occupancy t- MCES System
Plan Review Code Edition ~o-7 SAC Units
(25%100% ) Zoning City Water
Census Code "T Stories Booster Pump
# of Units Square Feet PRV
# of Buildings Length Fire Sprinklers
Type of Construction t ~r•~ Width
F/ 4F
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
Footings (Deck) Final ! C.O. Required
Footings (Addition) Final I No C.O. Required
Foundation MVAC Gas Service Test Gas Line Air Test
Drain Tile Other:
Roof: -Ice & Water -Final Pool: Footings -Air/Gas Tests ----Final
Framing Siding: Stucco Lath -Stone Lath Brick
Fireplace: _,,.Rough In Air Test -Final Windows
Insulation Retaining Wail: - Footings _ Backfill - Final
Sheathing Radon Control
Sheetrock Erosion Control
Reviewed By: Building Inspector
RESIDENTIAL FEES
Base Fee,
Surcharge
Plan Review f
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
Page 2 of 3
WtL'tifiCQ#e of CCC1IpQ1iCv
,
(Mt) at Cfagan
mepartmeat of 13xitbiug 3x6pection
This Certificate issued pursuant to the requirements of the Uniform Building Code
certi,fying that at the rime of issuanee this structure was in compliance with the various
ardinnnces of the City regulating building construcrion or use. For the following:
UscQassificalion: SF' Tic Bldg. Pem+ii No. 9.177
Oocupancy Type H3.MI Zoning DistricY R I Type Const. vu
ow.a ocsu;lmng M CObEMIMON ne*ess 2.:500 r? dt n W; MMOTrF
Building Addnst 4817 FCU-R SEA.? DRIVE l.ocaliry L2. B 1 • WM.+ IM tiCCUS 5TH
, Da[er
Burtldiog OfFiciaf ?
POST IN A CONSPtCUOUS PLACE
*F `1
?' '
. . -- : -? . . .
.
. . . INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number: 4? ???•?' ;
Eagan, Minnesota 55123 Date Issued:
(612) 681-4675
SITE AQDRESS: APPLICANT:
?. i ?+??f ? r•,?.??r? , ???? ? ,???,r r?v;
PERMIT SUBTYPE:
, i-
TYPE OF WORK:
r.r r w
INSPECTION .. . „
i ra•.??i a, i i ??N f i NnI
i I i 1 ? I r!! t
f Ili M/1ftF ':, aJ? w F' i H 11 '>cjiuI I i
-1
? !
Permft No. Permit Holder Date Telephone N
SNV
PLUMBING
Hvac y S 3 ?f p
ELECTRIC 0 a.12
ELECTRIC
InspecHon Date Insp. CommsMs
Footings I
Foundation
Framing
.i'•
Roofing
RoughPlbg. !J -v
Roug?, M9. 9 lQ? Ui,l? 02.??
ISUl.
Freplace -?a93 qld
Fnal Htg. a tv
?
ofsat Test
Fnal Pibg.
O Plbg. Inspector- Notity Plumber
Const. Meter
EngrJPlan
Bldg. Final
Z
Deck Ftg.
Deck Final
Well
Pr. Disp.
4*C..
/"/q' /i? AlIL 7?ST 3366S r //1DI r3 'fip
Address 4817 FOUR sEasolvs n2Jvs Zip 5512 3
I.ot 2 Blk- I Sub wKZSrauNc WooDs sht
THESE ITEMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECTION.
Date: L4/q Yes No Inspector:
Final grade (6" ftom siding)
Pertnanent steps (gatage) r/
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 roof test caps from the plumbing system and the shuboff oF warer supply to
the outside lawn faucet before freeze potential exists.
ContaM engineering division at 681-4645 before working in rightof-way or installing underground sprinkler system. ?
White - City Copy Yellow • Resident Copy Pink - Contractor Copy
P,
2928
Requesl Date Frte Na Rough-in InSpedion NOTICE: Vou Must Call Eleclncal Inspector
7-28-93 ImreE?
ves G No IfA Rougn-Inlnspechan
is Aequiret
I Iffi licensed contractor ? owner hereby request inspection of above electrical work at:
Jab Atltlress (Street Box or Route No ) Ciry
4817 Four Seasons Drive Eagan
Sedion No Township Name or No Range No Couny
Octupant (PFINT) Phone No
FSB Construction
PowerSuppher AtlEiess
Dakota Electric
Eleancal Coniredor (COmpany Name) ConVamors License No.
Lazer Electric, Inc. CA 01110
MaAmg Atltlress (COniraclor or Owner Making InstallaLOn)
8383 Sunset Road N.E., Minnea lis, MN 55432
Author¢etl SiBnature (COnVactorNwnerMaking Installavon) Phone Number
_41 1 ? ?WL4 784-3729
MINNESOTA STATE BOAflO OF ELECTHICITV THIS WSPECTION REOUEST WILL NOT
Griggs-Mitlway Bldg. - floom 5-173 BE ACCEPTED BY THE STATE BOARD
1821 Umvers'ity Ave., SL Pauy MN 55109 UNLESS PROPER INSPECTION FEE IS
Plione (612) 862-0800 ENCIOSED.
?REQUEST FOR ELECTRICAL INSPECTION
?
r?p See inshuclions for crompleting ihis torm on back oi yellav capy
lol 02928 'X" Below Work Covered by TMs Request
0
?
???
??
ew Add Rap. Typeaf8uiltling AppliancesWrted EquipmentWired
}( Home Range Temporary Service
Duplex Waier Heater Electnc Heatmg
Apt Building Dryer Load Management
Comm./Industrial Furnace Other (SpecRy)
Farm Air Conditioner
OIM1er (specdy) Conlractor5 RemarksCompute Inspechon Fee Below:
# Other Fee # ServroeEnlranceSize Fee # Circuns/Feeders Fee
Swimming Pool 0 to 200 Amps 0 to 100 Amps
Transformers Above 200 _ Amps Above 700 _ Amps
Signs Inspector5 Use Only -_ TOTAL
Irrigation Booms \
?
96. 86.50
Special Inspection (
Alarm/Communication THIS INSTALLATION MAY BE ORDE ECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONT o? (
I, the Electrical Inspector, hereby Rouqn-in Z/
certify that the above inspection has
been made. Finai
OFFICE USE ONLY
TNa request vaid 16 manihs fmm
INSPECTION
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
RECORD
PERMIT TYPE:
Permit Number:
Date Issued:
auxLozNe
021223
06/15/93
SITEADDRESS: 1Q7; 2 gLOCK:
4817 FOUR 5EASON3 DR
WHISPERING WOODS 57H
PERMIT SUBTYPE:
SF DWCr
1 APPLICANT:
F S 8 CQNST ZNC
(612) 890-3000
TYPE OF WORK:
NEW
INSPECTION
FOOTINfa .. .
FRAMING .A
IMSULATION FINAI
FIREPLACE
i
REMARKS: 5& W PLBit - SCHULTIES PLBG
I--- - -
_ - --?
?
-+CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
PERMIT
PERMIT TYPE
Perrnit Number:
Date Issued:
?%30
?
BUILD G
021223
06/15/93
SITE ADDRESS:
P.I.N.: 16-83954-020-01
4817 FOUR SEASONS DR
LOT: 2 BLOCK: 1
WHISPERTNG W0005 STH
DESCRIPTION:
8,tt.1],di"1 Permit 7ype SF OWG
?6vi.ldittq Wqrk 7ype NEW
'UBC OceupaneS41 R-3 M-1
,
Corlstrupt3oFT T-, e V-N
ZOf1?tt4Y ?-*`-z R-1
gu3.?ldi.ng Lecvgth ? 72
Bui.lding Width 44
i
c???? ? ?-lI ??
REMARKS:
S& W PIBR - SCHUL7IES PLBfa
FEE SUMMARY:
Base Fee
Plan Review
3urcharge
SAC
sac %
SRC Units
Subtotal
VALUATION
$706.00
$458.90
$59.50
$750.00
iae
$1,974.40
$119,000
MISCELLANEOUS $1,744.50
Total Fee $3,718.90
CONTRACTOR: - Applicant - sT. LIC OWNER:
F S B CONST INC 18903600 0003885 F S 8 GQNST INC
2500 W COUNTY RD 42 9 2500 W CtlUN7Y ROAD 42
BURNSVILLE MN 55337 BURN5VILLE MN 55337
(612) 890-3000 (612)890-3000
?
I hereby acknoalodge that I have realf th3.is appkication an•d state that the
znforMatian 3e corract and agxee to comply Gfittt all aRPlieabke State af 74n,.
StaCUtes a»?cf City of Ear4an Qrtiiaances.
L.ou Rj;rL 1U
SSUED B : SI NATUR
I
2EACTI'VATE ?
PERMIT #
ifall all
CITY OF EAGAN
1993 BUILDING PERMIT
681-4675
APPUC LV'L?D
MAY 2 5 1993
SINGLE & MULTI-FAMILY ---------------
2 sets of plans, 3 registered site surveys, 1?n'ernJY'
calcs.
COMMERCIAI 2 sets of architectural & structural plans, 1 set of
specifications, 1 copy of energy calcs.
Penalty applies: 1) when permit is typed, but not picked up by last working day of month
in which request is made, 2) address is changed or 3) lot change is requested once permit
is issued.
Date 2'5- Yaluation of work 120oao
???c.- sf.?4sa..r ?? •
Site Address: 41S!17"
STREET SUITE M
Tenant Name: (commercial only)
IAT C2 BIACK L SUBD. 5 7t wv?? Y.I.D. N
GJrfiSQfn,- L
Descri tion of work: 5 DW G•
The applicant is: ? Owner LrGOntractor ? Other (o"«;ne)
Name "? s;'? - Phone
Property LAST FIRST
Owner
Address
STREET STE !t
City State ZiP
Company /Ae. Phone 9?Po-30cY2
Contractor Address o2500 rs ei 1& ??'?? License #cavn3ARs Exp.
City State r'/w Zip gS317
Company Phone
Architect/
Engineer Name Registration #
Address
City State Zip
Sewer & water licensed plumber A?r/j??? . Processing time for
sewer & water permits is two days once area has been approved.
I hereby acknowledge that I have read is applica ' n and state that the information is
correct and agree to comply with all licable e of Minnesota 5tatutes and City of
Eagan Ordinances.
Signature of Applicant:
OFFICE USE ONLY
BUILDING PERMIT TYPE
O 01 Foundation ? 06 Duplex ? 11 Apt./Lodging Useg&ntFi h
T16
W02 SF Dwg. ? 07 4-Plex ? 12 Multi. Misc. O h
17 Sw m Pool4op
? 03 SF Addition ? 08 8-Plex ? 13 Garage/Accessory ? 18 Comm./Ind.
? 04 SF Porch 0 09 12-Plex ? 14 Fireplace O 19 Comm./Ind. Misc.
? 05 SF Misc. ? 10 Multi. Add'1. O 15 Deck O 20 Public Facility
? 21 Miscellaneous
WORK TYPE
0 31 New ? 33 Alterations O 35 Tenant Finish ? 37 Demolish
? 32 Addition ? 34 Repair ? 36 Move
GENERAL INF ORMATION
Const. (Actual) V'-A1 Basement sq. ft. MWCC System
(Allowable) U- N lst F1. sq. ft. City Water c3
UBC Occupancy R-3 M_k 2nd F1. sq. ft. PRV Required
Zoning R_1 Sq. Ft. total Booster Pump
# of Stories Footprint Sq. ft. fire Sprinkler
Length '7 -Z_? On-site well Census Code
Depth On-site sewage SAC Code
Cel'' T3
?
APPROVALS j(
t
? r
„ti
Planning Building Assessments
Engineering _ Variance
REQUIRED INSPECTIONS
? Site
? Wallboard
? Footing
? Final
? Framing
? Draintile
? Insulation
E3 Fireplace
Permit Fee
Surcharge
Plan Review
License
MWCC SAC
c; ty sac
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total:
sAC % ?
SAC Units
v tuet;o9: S Oc7D?
?rRR• .
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z n a = C2?)
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(j <,3)
33
ISIS ?c(S%
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IS2??s?%- ll X -7i`l
,
• 06i04i93 09:41 JfXHES R. HILL 002
? SURVEYOR'S CERTIFICATE
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EAlsAN
IiOTEj NO spECFiC Soi49 iNVESTGqTiON NAS BEBN COMPLETED"; DN TTtls Lo7 BY TItE SURVEYOR. TFE BtIITABIl,11Y';OF 50145 70 SUPPORT TF1E SPFCIFIC FIOUSE PqpPOSEp [S NOT 7NE RESPONSlBIlI7Y
• OF THE SURVEYDR
?- DENOTES PROPOSED SllRFACE DRAINAGE
O DENpTES IRON MONUMENT S£T
• DENOTES IRON MONUMENT FOUNp
X000.0 DENOTES EXiS71NG ELkVAT10N
(000,0) DENOTES PROPOSED ELEVATION
NOTE; BUILDINfi qIMEHSIONS HMOW?1 ARE
FDR HORI OM" TICAt' L.OC-
• ATtON 0 BTJt?Y ON4Y: $EE
nRCtinBCTUa?. Pp?t 9ux.owo
6 PdtN1DAT10N D{MEHSfDNS. .
SCALE: 1 INCH - 30 FEET
PROpOSED QARAGE FIOOR -1$G.'7 . fEET
PROPO5ED LOWEST FLOOR -7791, FEET
QROP05E0 TpP OF BLOCK-`j?. ? FEE'f
WE HEREBY CERTIFY TO FSB . THAT TH13 IS A TRUE ANO CORRECT
REPRE5ENTATION OF A SURVEY OF THE BOUNDARIES OF;
Lot 2, Block 1,•WMISPEitING WOODS FlF7N ADDITION, accordinp to-the reoDrdad ,
plot fheroofo DokoM O;.unty, NUnneaofo, , •
IT DOES N07 PURPORT TO SHOW IMPRQvEM?TlTS CR ENCROACMNlENiS, IXCEPT AS SHOWN• AS
SURVEYED BY ME OR UNDER MY DIRECT SUPERVISIOId 7HI5 29RD DAY OF MAY ,1893.
EXIS7iNk3 EI.EVAYION 9qWN ydEqg SIG : J M R. HILL, INC. 7AKEN FROM PLAN4 'Pfi0Vt0EU BY
OTHERS.
oO" JOHN C. LAR$ON, L4ND SURVEYOR
MINNESGTA LICCNSE NUMBER 19828
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James R
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PLANNERS / ENGINEERS / SUFiVEYORS
?: m
2500 W. CTY. R.D. 42 6 BURNSVJLLE, MN; 55387 ?$12-N0•6D44
R-94'6 612 890 6244 06-04-93 09:43AM P002 1f31
Buil . der License #0003885 FSB Construction, Inc.
2500 W. County Road 42, Suite #9
Burnsville, MN 55337
EXTERIOR ENVELOPE AVERAGE "U" COMPUTATION
PLAN #: 540 DATE: "5/24/93
OWNER: FSB CONSTRUCTION
CONTRACTOR: F58 CONSTRUCTION
SITE ADDRESS: 4817 FOUR SEASONS DRIVE PHONE: "890-3000
_---------------------------
" 1) TOTAL EXPOSED WALL AREA
* 2) TOTAL EXPOSED ROOF/CETLING AREA
WALL AREA CAICULATIONS:
* TOTAI WINDOW AREA
* 70TAL DOOR AREA
* TO'TAL GLASS DOOR AREA
^ TOTAL FIREPLACF WALL flREFi
TOTAL WALL FRAMING AREA
NET IN SULRTION WAl_L AREA
" TOTAL RIM .]OIST AREA
TOTAL FOUNDATION AREA(EXPOSED)
" TOTAL FOUNDRTION WINDOW AREA
Ifi item 3 is the same as, or less
intent of 2 MCRR 1.16008 A and 0.
ROOFJCEILING CALCULATIONS:
TOTAL SKYLIGHT AREA
TOTAL ROOF/CEILING FRAMING AREA
NET INSULATION ROOF CEILING AREA
Square "U"
Footage
--------
-- Factor
-------
2325 x 0.11 = 255.75
1845 x 0.026 = 47.97
275 x 0.41 = 112.75
84 x 0.07 = 5.88
42 x 0.41 - 17.22
46 x 0.36 = 16.56
139 x 0.08 = 11.12
1320 x 0.043 = 56.76
210 x 0.04 = 8.40
160 x 0.16 = 25.60
0 x = 0.00
--
3) ----------
TOTAL =
--- ?"s?
-254.29
than item 1, you have met the
0 x = 0.00
185 x 0.026 = 4.80
1661 x 0.022 = 36.53
-------------- ° -
4) TOTAL = 41.33
Ifi item 4 ie the same as, or less than item 2, you have met the
intent of 2 MCAR 1.16006 A and 0.
I hereby certify that the building here descr3bed meets or exceeds the
State of Minnesota Energy Conservation Act.
PA ? 2?c k3
Signature Date
1999 BUILDINC PERMIT APPLICATION (RESIDENTIAL)
CITY OF BAGAN /
3830 PILOT KNOB RD - 55122 7 7
? 3? ? 651-681-4675
New Constructlon Reaulremenfs ? Remodel/Reoair Reaulremenfs
? 3 regbfered sHe surveys showing sq. H. of lot, sq. ll. of house
and gLI roofed areae (20% maximum lot eoverace allowed)
D 2 copies of plans (show beam 6 wlndow sizes; poured Ind. deslgn; e1c.)
? 1 sef of energy calculalions
? 3 cepies of hee preservaNon plan B lof plaHed alfer 7/1/93
DATE: -7-3 0^ I - +
DESCRIPTION OF WORK:
STREET ADDRESS:
2 copies of plan
1 set ot energy calculaflons tor heWed addRions
1 sMe survey for exAerlor addMions a decks
CONSTRUCTION COST: q'-'5-00
LOT: -,,2- BLOCK: SUBD./P.I.D. #:
?J
Name: &kj1(N?I .7RVe- Phone#: 1651-M?3ffl'
PROPERTY Last First
OWNER ,?n,?, (1 C? -?? _
Street Address: 7 Q/ / i OW JK-Fr3O" ) v?•
City !R-l.l State: yK'fJ Zip: SSI Z 2-
CompanyTl'IM?I(./? F7w?Wf! l.u"?y*01b'SPnone#:L17-_ -7o-7 - bRS?!
• (area code)
CONTRACTOR r ,/??? Zo I(p9 3H,y .3,?,p0lr
Sheet Address:1Z147 N(Ld1 ?G? nT4 • S' License # Exp.
City jj I.tW-til$ (M (A State: 1'K ? Zip: SS .3.3 7
ARCHITECT/
ENGINEER Company: Name:
Telephone #: area code ( )
Street Address: Registration #:
City State: Zip:
Sewer 3 water Ifcensed plumber (reauired for new constructlon ontv):
Penaly applies when address change and lot change is requerted once permM Is Issued.
I hereby acknowledge thaf I have read this appllcafion, state that the information ls cortect, and agree to comply wRh all applicabl
State of Minnesota Statufes and City of Eagan Ordlnances.
Signature of Applicant: ?-"
OFFICE USE ONLY
Certificates of Survey Received _ Yes _ No
Tree Preservation Plan Recewed _ Yes _ No _ Not Required ' ? .
?
.?.,>;.. .
1993 PLUMBING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PII.OT KNOB RD
FAGAN MN 55122
(612) 6814675
PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMES AND
CONDOS WHEN PERMITS ARE REQUII2ED FOR EACH UNTT.
NO. FIXTURES E&CH TO
/ Suno?ER 3.00 - ? -
WATER CLOSET 3.00
I BATH TUB 3.00 ?
?- LAVATORY 3•00 --?-
KITCHEN SINK 3•00
-?
? LAUNDRY TRAY 3.00
HOT TUB/SPA 3 ? -
/ WATER HEATER ?
?
I FLOOR DRAIN 3•00
-? GAS PIPING OUTLET • minimum • 1 3.00 ?
? ROUGH OPENINGS 1.50
W.ATER SOFTENER 5•00 ------
PRIVATE DISP. • Dercry. iic. 15.00
U.G. SPRINKLER • eome uneer const. 3•00
ALTERATIONS - to ausunq 15.00
WATER TURN AROUND 15.00
STATE SURCHARGE .50
TOTAL:
SITE
OWNER
INSTALLER: ?
' itqv^.
121 RcCVdOOD D91VE '
ADDRESS: OPPI F 1/AI I t-v r.nni c4n4„? -
CITY: STATE: ZIP CODE:
PHONE #: ( ) ??E z??.?--
SIGNATURE OF ERMITTEE `
MECHANICAL PERMTT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN MN 55122
(612) 681-4675
PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMES AND
CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
? NEW CONSTRUCTION
ADD-ON A/C
P.DD-ON FURNACE
DATE JLt Ly
FEES
HVAC: 0-100 M BTU $ 24•00
ADDITIONAL 50 M BTU 6.00
GAS OiTTLETS (MINIMLTM 1 @ $3.00 EACH) I -
ADD-ON/REMODEL (Exisr[NG coNSTxucTION) $ 15.00
STATE SURCHARGE .50
TOTAL d 2 G
SITE ADDRESS: d! l rULC& 1 T/iJU?vJ (1/cc
OWNER NAME:EI?_? ('O (J ,STY?S,J._,(• i ((Z41_ TELEPHONE #: P: - __?OQo
INST
CIT'Y
STA'I'E: A IV ZIP CODE: s?
T
TELEPHONE #:? S?S rI ? Co D
SIG ATURE F E
/
2005 RESIDENTIAL MECHArTICAL PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please complete for: single family dwellings & townhomes/condos when peamts aze required for each wn[
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Date??/??/
SiteAddress Unit#
P
O Tele
hone #((psl ) D O J' 5,UY ?
roperty
wner p
Contractor
SEDGWICK FJOdTI"Ir pAlr r ,
".^'*'TIING LLC
Street Address zu City
State • Zip Telephone # ( )
Bond #: Eapires:
The Applicant is _ Owner A/ Convac[or _ Other
Add-on or alteration to existing dwelling unit $ 30.00
furnace _Additional _ Replacement
v air exchanger f?f/n JnQjj, \/Ofd 3
airconditioner _New _Repl acement
other
State Surcharge $ 50
Total
I hereby apply for a Residential Mechanical Permit and acknowledge that the information is complete and accurate; that the work will
be in conformance with ihe ordinances and codes of [he City of Eagan and with the Mechanical Codes; that I understand this is not a
pemrit, but only an application for a pemut, and work is not to start without a pemut; that the work will be in accordance with the
app W gf wg,.%?. ? e es a review and approval of plans.
Applicant's Printed I3ame- -
Signature
?, I 0 C' 2 s2G05
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zoos RESlDENTIAL PLUMBING PeRnniT aPPUCaTioN
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please complete for modifications to existing residential dwellings.
Date ? 1 ? I
site Street Address d,? - 1 7 C14 Unit #
ProPertYOwner Telephone #
-r-cr,--?
Contractor
Address
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Telephone# qn:-ZA)m
City 1r /? State4?&L ZiP
The Applicant is: _ Owner ? Contractor _Other
Septic System _ New _ Refurbished Submit 2 sets of plans and MPC license Include$ ?00. Ofee
$ 50.00
Alterations to existing dwelling
Add plumbing fixtures. This fee includes installation of a water softener and/or water
heater at the same time. If you are insfal7ing onl a water sofiener and/or water
heafer, do not complete this section; move to the next section and check the
appiiance(s) you are instailing.
_Septic System Abandonment
Water Turnaround (add $130.00 if a 518" meter is required)
Other:
Water Heater ? $ 15.00
? Water Softener -
_ new ? replacement ?
Lawn Irrigation _RPZ _PVB _new _repair _rebuild I $ 30.00
State Surcharge
g 50
Total
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
accor ce with the appyqved plan in the event a plan is required reviewed approved
C)
A p icanYs Printed Name Appli anYs Signature
Use BLUE or BLACK Ink
J r - - - - - - - - - - - - - -
~ I I
City of Emn PermitI I
I Permit Fee:
3830 Pilot Knob Road I I
I
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 ; Staff: I
Fax: (651) 675-5694
2010 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: 1 Site Address:
Tenant: ~PC
Suite
RESIDENT I OWNER Name: (1 f~~-~ / ~l Z- (AS --/,ZPhone: <kl - fT2- ~_Cj
Address /City /Zip: CONTRACTOR Name: CA ✓~''t if License
Address:9-6/9' i 7 "~~,c 1V City:
State _ Zip: 3,::i j Phone: 17~2-
Contact: /Vx t~f- bbl b>r'1 Email:
TYPE OF WORK New _ Replacement _ Repair _ Rebuild - Modify Space _ Work in R.O.W.
Description of work:
PERMIT TYPE RESIDENTIAL
_25 awn Heater Water Softener
Water `Lawn Irrigation RPZ / 1< PVB) Add Plumbing Fixtures Main Lower Level)
Septic System Water Turnaround
_ New
Abandonment
RESIDENTIAL FEES:
$55.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge)
$35.00 Lawn Irrigation (includes $5.00 State Surcharge)
$55.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge)
*Water Turnaround (add $166.00 if a 5/8" meter is required)
$105.00 Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge)
$95.00 Fire Repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge)
TOTAL FEES $
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage.
Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.om
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
x'rc~-c x ~
Applicant's Printed Name Applicant's Signature
EFORtOFFIC'E USE Reviewed By: Date:
ired Inspections: Under Ground Rough-In Air Tesl_Gas Test Find