4380 Kaufmanis WayCities Diizital Oualitv Control
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? CASH RECEIPT ?
• CITY OF EAGAN
3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE 19
RCCHIVGO
AMOUNT $ I
& DOLLARS
?oo
? CASN r-1 GHECK
FOR
% White-Payers Copy
Yellow-Posting Copy
Pink-File CoPY
Tha k You
C/ 8 Y
BUILDING PERMIT
6 "rs?cw
Reteipt ? •r" ?' lT-
Site Addrcss 43tsu ic8t1Im8D18 w8 Erect .,?
Lot 24 Block 4 Sec/SubWilderneaa Park 2nd Alte, d
Parul # 10 34251 240 04 Repoir ?
Enlarye C]
W Name - 11ark DQherty, MoVe ?
? Address^^1690 ?3lckory Hill Drive pe?l;s, ?
_ .. ct,l),) aco c,14a -
Name i'eaLUre uuilaers
Nddress 15513 Logarto Lane
Nome _
Address
I hereby ackrawledge thot I have read this opplicotion and state that
fhe information is wrrect ond ogree to comply with oll applicable
Stote of Minnesota Stotutes and City of Eaqon Ordinonces.
Siynoturc of Pertnittee
Feature
A Bullding Permit is Issued to:
olI work sholl be done in occordonce wlth all
Bulldinp Offtciol
cirY oF EAcaN
3745 PIW Knob Rood Eegen, MN 55122
PHONE: 454-8100
Occupancy R-3
Zoni„y R81
Fire Zone +A
Type of Const. v
# Stories
Length 43
Assessment pertnit 403.017
WatCf & SGW. SurCF1O?yQ E+r)• 00
Police Plan check 201.50
Firo SAC 525.00
Enp. Water Conn, 4 50 0
Plonner Water Meter 60,00
Council Road Unit 250 . 0
Bldg. Off.
APC Totol $1934.50
on ths express conditbn thnt
and City of Eapon Ordinances.
Parmit No. Permit Holdar Misc. Pe*mit No. Holder
Plumbiny ? to,-kUlt ??L k"t V 4a
H.V.A.C.
Well
yVatsr ?
Disp.
- S?vrer
ENctric W G4 D37 3 Cr4 A 11EC . i11/ "&3 C44k
g04Q ?` ?? 4-2Z$?
Ir?epsction Data Insp. Other
Footinys
Foundtt{on
Frsminy ? -
`
Rou Plby.
Rouph HVAC -
Inwlation
Final Plbq.
Final HVAC
Final ?i .
Wa"r Dftcriba Location: •
YYell ?
Sewer
Pr. D'up. ' •
Raceipt MECHANICAL PERMIT Permit No.
CITY OF EAGAN • •
Fse
Fill in numbered spaces S/C
Type or Prrnt /egib/y Tot. 1. Date 2. Instatlation Cost
3. Job Address Lot Blk. -1 Tract
4. Owner
5. Contractor Phone -'
6. Address ' ' •
7. City State i Zip -_ -•r'`'
8. Building Type: Residential El Commercial ? Institutional O
9. Work Description: New tT Add O Alter ? Repair ?
10. Describe Fuel Type -
11,
No. Equjoment 8TU - M. Ea.
Forced Air No. Equiament CFM
i
Mfg. A
r Handling:
Boilers
Mfg. Mech. Exhaust
Unit Heater
Mfg. Other
Air Cond.
Mfg.
Gas, Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed :
for
Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY UF EAGAN 464-8100
Reoeipt f? PLUMBiNG PERMIT
CITY OF EAGAN
•? ? ?,-
Fill in numbered spaces
Type or Print legibly
1. Date 2. Installation Cost
3. Job Address ?Lot ?
4. Owner
1 5, Contractor
Permit No.
Fee S/C
Tot. •
31k. ? Tract
CT ??
- Phone
?
6. Address ? ? '.? ? ?• -~ 1
7. City State Zip `.
8. Building Type: Residential Q Commercial ? Institutional 11
9. Work Description: New 0 Add ? Alter 0 Repair 0
10. Describe
11.
No.
f
' Fixtures
Water Closet No. Fixtures
Cesspool/Drainfield
Bath tubs Septic Tank
= Lavatory Softner
_ Shower Well
Kitchen 5ink
Urinal/Bidet Other
- Laundry Tray
` Floor Drains
^
Drinking Ftn.
Slop Sink
Gas Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
?
Signed : {?-; % for
Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 464-8100
INSPE C TION RE C URD Control No.- a?; S
CiTY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
P14/?.'Q/9t
Eagan, Minnesota 55123 Date Issued:
(612) 681-4675
S{TE ADDRESS: i, 01_ 24 111 «4 r: ; k APPLICANT:
•4 ?8e KAufNaNYS unY -.SouERNaw rMe
-uILDERNFsS PakK zNr? (612) 8e1-6044
PERMIT ?t??T?lIP?: TYPE OF WORK:
?< ? ? ? ?? ft ?. ?t NEw
INSPECTION
? ?i?? ? ? r??, .. .
F?tilM1N41 .
INS,ltl A f 1 UM FINAL
. I
r e w-t-1 11- .._ 7
?:. - . ? _ _ ti? .. .-- , -r? n i: t'_'?1?_ _ '_t' ? .._ ... . . - • . -
? ??. -•-? ?'- i?• f . -?.r S ??
P3cmit No. Permft tiolder Date Tetephona M
S/4V
PLUMBING
HvAC n-91900
ELECTRfC
ELEGTRIC
Inspection Oale Insp. Comments
Footings t G1 ?
?
20
Foundetion
Framing '
RooBng
Rough Plbg.
Aough Htg.
lsul. z
Fireplaw
Final Htg.
Orsat Fest
Fnal Ptbg. Albg. lnspector - NotPfy Plumber
Const. Metar
EngrlPlan
Bldg. Firtal
Deck Ftg.
`
Deck Flnal
Well
Pr. Disp.
No..
fe eomPy willr the CiFy of l"on
Connection Charge: , ' _ 00 d
Account Deposit;
Permit Fee: ? ? • 'l ?? ;?
Surchorge: . S J nti
Misc. Ctwrges:
Total:
Dote Pcid:
CITY OF EAGAN SEWER SERVICE PERMIT
.4$30 Pilot Knob Road
P. O. tdox 21199 PERMIT NO.:
Eagan, MN 55121 DATE: 7-20-33
Zoninp: ? L No. of Unlts: 1
pwner; Feature 3uilders
Address:
Site Address: 3' r Kauman1e ?asv L24 B4 ",'ildenzess l'ar'- ZI
Lukeville PibT
Plum?r: w s, . s.. - - -a- ? - ..,
1aym to aanphr wiM Nw Ghr ef Eqee Connection Charps: 425.00 p r.
Ordieowoa?. kcow?r Deposir. 10.00 pd
Permit Fee:
Surcharge: .50 pd
Br Misc. Chorpea:
Dote of Insp.: Totd;
Insp.: date Pnid:
CITY OF EAGAN Remarks
Addition WILDERNESS PARK 2ND ADDITION Lot 24 elk 4 Parcel 10 84251 240 04
oWner I?rc F' Iti`i Street 4380 Kaufman;s Way state Eagan, N 55123
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
d
I
GRADING
. t,
SAN SEW TRUNK '
SEWER LATERAL
WATERMAIN
WATER LATERAL
* WATERAREA .rf 1979 584.20 $8.42 10
iF STORM SEW TRK 1979
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
250.00 36978 7-11-83
JVATER CONN. 450. OO if of
BUILDING PER. 8737
SAC n it
PARK
?-
?
CIZy pF FAGAN Include 2 sets of plans,
1 site plan w/elevations &
BUILDING PERMIT APPLICATION 1 set of energy calculations.
? 5?bu)?-jC'oQ.C? `lOid00
Th Be Used For?• Valuation ? Date 76443
Site Pddress So -Li aAr OFFICE USE ONLY
Uj? ? p? ?/ --------^
Lot 2 ? Elock sec./sub. ?,._r,?, Erect /? OccuPancY 1?r_3
Parcel #: tv Sy a s ) ;?U o p y- A1ter Zoning /
Repair Fire Zone
Oaner: Ehlarge _ 'Iype of Const. ?
ries
Address: Datnlish Fmtnot y? ft.
City/Zip Code: Cea.g.y?,? S S 1?-Z Grade Depth <// ft.
Pnone #: ?S Z- S 3? 8'
r?s
Contractor: A;5,4a./t., a 44__?
Address: % s - ? -rd?n? _
City/Zip Cnde: A&wn.e.n 0 1-Y&41 _ 5'5337
Phore # : 4 3 S- 8 +f !t3
Arch.//E,hhg. :
Address:
City/Zip Code:
Phone #:
APPFtOVAL.S
Assessments Pezmit y0 3
?aater/Sewer Surcharge </S -s
Police Plan Check O / ?
Fire SAC Sas
gng. Water Conn. </So
Planner water Meter (.,o ?
Council Road Unit a S-y?
Bldg. Off.
APC -
?? 3 T, 5 O
? r
?? ? J?
3 Sa2 g d
y?vav
$7?
a 7ss?--
?????g
CITY OF EAGAN No 8232
1793 VAof Knob Road Eagon, MN S5122 .
iHONE: 4548100
BUILDING PERMIT Receipt # c
Te ba wad 1or SF DDG/GAR Est. Value $90,000 p0fe July 11 _ jq 83
Slte Mdress 4380 Kaufmanis Way Erecr )ft Occuponcy R-3
Lor 24 Block 4 Sec/Sub.Wilderness Park 2nd AIter p Zor,ir,g R91
Parcel # 10 84251 240 04 Repoir 0 Fire Zone NA
Enlorga ? Type of Const. V
ac Nome N13rk DoheTtV INUVe ? # Staries
z Addre# 1690 Hickory Hill Drive Demoiish ? Length 48
ci EagBri 55122 Phone 452-5368 Grode p Depth 41 Sq. Ft.-
pr Name Feature Builders Avoro.ob Fees
Addreas 15513 Logarto Lane
u
? c; Burnsville pho„e 435-8443
F
Ww Nome
r
?? Address
i W CiN Phone
I hereby acknowledge that I heve reod ihis opplication and state that
the in(ormation is torrect and agree fo comply with all opplicable
State of Minnesota Statutes and Ciry of Eugon Ordirarxes.
SlBnoture of PertniMea
Feature Bu' ders
A Building Permit Is Issued to: _
all work sholl be done in accordance with all o 61e Sta
Buildinp pffictal ?
Assessment pemit '+vj.vv
Water & Sew. Surcharge 45•00
Police Plon check 201.50
FIre SAC 525.00
Enp. Water Conn. 450.00
Planner Water Meter 60.00
Council Road Unit 250.00
Bldg. Off.
APC TMOI $1934..50
on the express conditlon Ihoi
totutes ond City of Eagan Ordirwntes.
REQUEST FOR ELECTRICAL INSPECTION ee-oouoi-oa
' See instructions (or completing this torm on back of Yellow copy. ?
?FISqRq "X" Below Work Covered by This Request
NW4 AAd Neo. Tvpe ol BuJtline Appliancae WireG Equiument N reo'
Home Range Temporary $ervice
Duplex Water Heater Liyhtiny fixtures
Apt. Buiiding Dryer Electnc HeaLn
Commercial Bldy. Fumace Silo Unloader
Industnal Bldg. Air CondiUOner 8ulk Milk Tank
Farm OI . P c Othor Bpr.ufy7
t er ue,fY Oth r Other
Compute lnspection Fee Below '
p Fee ServiceEnfrenceSae k Fee Fee.ders/5ubleeders b Fee Crtwrts
0 to 200 Am 5 0 to 30 Am ps 0 to 30 Am>
Above 200 qm?s 31 [0 100 Amps -G 1 co 700 Am s
Swimmin Pool Above 100-Amps : Above 100_Amps
Transiormer5 ?rriyation Booms ? ParUal'Other Fee
Signs Specialinspection $
TO
FEE
Nemarks
• `
ry ?/?
Rough-in ncal
?,? ?l p Inspector, nereby
cerbty that the abova
Final
'nspecpon has Ceen
mede.
Thia raaueal voltl 18 montlis fram
This requesI voiA q ?zZ /?(r t D 1/ ?. t?( d?{ /?SS ???s 3
18 monffis tram
A 6 aRg Park zn -J' Y9 Iso
Bequest Date Fre No. Rough-in InspecLon yy,, - .?
9 p?Vee' ?NO dReatlY No W?fl Nuu(v in?pec
?or When eead
?Licensed ElecVwol Contractor I hereby requast mspection oi ebove
] Owner elactncal work installad at.
$[reet Address, Box or Houte Na. Ciiv
2f3?c? ? ` J
c? c?ti
ecLOn o. Township Name nr No Fange No. (.pwrty
rJ'D kotv??
Occupent(PPINT) Phone No.
F I ?.
Power Supplier AAtlress
Elect cal ConVacIor (Company Name) Connar.tor's Lmense No.
/ 3-
Maflmg Ad ess 1COniracior or Owner Mabng InstailaLON \
S. "LA- St •
AuMorized Signature Vactor/Own
er
Mz
king Iostoilation) Phon
e
Nvmbe
r
?
?
C
L '1 ?
/
/
C?
CL?(D '?? ? /
,MINNESOTq STATE BOAflD OF ELECTRICITY THIS INSPECTION REQUEST WlLl NOT
Grie9s-Midway Bldg. - Room N•197 BE qCCEPTED BV THE STAh BOAND
: 1821 University Ave., St. Peul, MN 55704 UNLESS PflOPEN INSPECTION FEE IS
Phona (812) 297-2111 ENCLOSEO.
114
Request Date
S Frte No. Rough-in Inspeclion
R? '
Ready Now O Will NotiTy Inspecror
'+
Z?
Z Bs G No When Reetly
I)(licen5ed contractor ? owner hereby request inspec[ion of above electrical work at:
Jo0 Adtlrew fSlreel. Bw or Route W . Ciry
fl ?u? AniS E+¢ .v w
Seciwn No
Township Name or No
Range No-
Cou
1 1 19 f'A
OccupaM (PRINT)
? Phone No
ar
D
PowerSuppber AtltlreSs
Eiectncal ractor !Company Name)?.
? Conirdclor5 Ljcense No
R- ??`/ r?
Maibng AOpress IConVactororOwnerMakin/9 1Instauatmn/)/
-
i(ok es/.If?L6/?
15
Aulh etl S?gnalure IC VaGtor/Owner Making Installation) Phone Number
MINNESOTA STIAE BOAflD OF ELECTflIqTt_J__ THiS INSPECTION REQUEST WILL NOT
GriggsMlEway BIOg - Hoom 5413 BE ACGEPTED BY THE STATE BOARD
1821 Universily Ave., SL Peul, MN 55106 VNLESS PROPER INSPEGTION FEE IS
PhoneJ614) 642-0800 ENCLOSEO
; J 08114
REOUEST FOR ELECTRICAL INSPECTION
? See msimcuons lor compleLng ihis form on back oi yellow copy
"X" Be/ow Work Covered by This Request
'sMR? EB-00001-08
.=?-;A1
ew Mld- Rep . TypeofBmldm9 AppliancesWired EqwpmentWired
Home Fange Temporary Service
Duplex Water Heater Electric Heating
ApL Bmlding Dryer Other (Specity)
Comm./Industnal FumaCe
Farm Air Conditioner
Other (syecify) Comractor5 Remarks-
Compute Inspection Fee Be/ow
# Other Fee # ServweEntrancaSize Fee # Circmts/Feetlers Fee
Swimming Pool 0 to 200 Amps 0 to 700 Amps 30,
Transformers Above 200 _ Amps Above 1 _ Amps
SIgnS Inspectors Use only: TOTAL
Irrigation Booms
Special InspecGOn
Alarm/Communication TFIIS INSTALLATION MAY BE ORDEREO DISCONNECTED IF NOT
Other Fee COMPLETEO WITHIN 18 MONJJq.
I, the Electrical Inspector, hereby
f
h
h Aough-in oa,?,?
cerU
y t
at i
e above inspection has
been made.
? oete
;>
OFFICE USE ONLY A
This request void 1B monffis hom
This renuest wid 7-z (,0
18 monffis imm
W 09.0343
L2418 Lf, w?(d•Pkr oi 37yZq
/o•oo
ReqLL@st-0a[e•.
..?'7
-? q ? Fre No. Rough-in InvVeanon
ABq ired7
DHeatly Nuw ?II Notrtv Inspec-
T[or Wh
n R
tl
/ Y¢s ?No ?
ea
y
? LlcenseA Elecuncal Conhactor I hereby requast inspecvon of abova
Owner electrical work installad at:
Street Address, 9ox or Route No. , CitY
?3 K
ecuon o. TownshiD Name or No. Range No. Caunty
Occupanc IPflINT? Phone No.
( 2
Power SupDlier Address
l'
Electnr.al Contractor (C
omp
a
ny Name) Co/r1tlrac s L,cnnao N?./
?
t?
?
?
l.a??a?
Mailinp`A-d-d? ss ICon[racmr or?Oiw/ner Mapking yIns?t?ailationl .
"'+` ?I NWl
Authonzed SiBnature (Ca
ntractodOwner Makine Installauon) Pho u
mber
m
? /
???P-8?
MINNESOTA STATE eOARD OF EIECTBICITY THIS INSPECTION NEQUEST WILL NOT,
Griggs•Midwey Bldg. - Hoom N•197 BE ACCEPTED BY THE STATE BOA!{D ?
MN 55104 UNLESS PROPER INSPECTION FEE'(S
e821 University Ave., St. Peul, ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION oFot Ee-ooooi-oa
u
' See instrmtions for completing this form on back ot yellow copy.
-?-??43
'K"' Below Wor Covered by This Request 37 7 `, 2-1
Adtl Aep. Type of 9mltling Appliancxs Wired Equipment Wired
Home Range Temporary Service
Duplez Water Heater Lightiny F'xtures
Apt. 8wldinq Dryer Electric Heatin
Commercial Bldg. Furnace Silo lJnloader
Industnal 61dg. Air Condrtioner 8ulk MiIk Tanlc
Farm Orner necirv .mer (suec?fv)
-77t cr Speuty Ot er Other
Campute inspectron Fee Be/ow
# Fea ServiwEntrenceSize q Pee Faedars/SUbiaeders N Fee Cvcwts
U to 200 qm s 0 to 30 Am s 0 tn 30 Am
Above 200 qin s 31 to 100 Amps 31 to 100 Am -
Swimmin Pool Above 100-Am s Above 100_Am,s
Transiormers Irngation Booirs i Partial.'Dther Fee
Signs Special Inspection S ?
TOT
Pemarks
10 EE
N,
V .w
flough-in Date
1, 1 he rwal
InsPectoq horoby
certit
that the ab
Fmal
??u1 7 y
ove
inspechon has been
? meae.
?
ihis reauest voi018 moniRa irom
?PxttfittttP rif Otr1IvMttCy ,
Citp of (eagan
lorpttrtmrni nf Bixilding 3nsperiinn
Tbit Ccrti firase istucd panu4nt to the nqwtemenu of Stttion 306 0( the Uniform Building
Codr rntifying that at the time of ixctuttut tbit rerruture wat in com pliance witb the variour
mdirmrurt af the City rtgalatirog buildrng tonttrrution ar utt. Fer ebt follounng:
SF DWG/GAR 8232
Ubn _ ?
0-? 1yp. R3 Tywc? V FRz. - NA z.no.?c Rl
Mark Doherty,,,,,1690 Hickory Hill Dr., Ea
4380 Kaufmanis Way ?„?I.ot 24,Block 4,Wilderness
Park 2nd
?
Ot o p.???-?._ m?, November 14, 1983
?a??eo?z.a
BUILDER: FEATURE BUILDERS
2006 RESIDENTIAL BUILDING rERMIT arrLicaTioN
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Construdion Reauirements RemodeVReoair Reauirements
3 registered site surveys shaxing sq. N. of l04 sq. fl. of house; and all roofed areas 2 co xnrg footings, beams, joisls
(20% macimum lot coverage albwed) 5 4§?t??r ula6ons for heated additions
1 Soils RepoR i( proposed building is to 6e placed on disWibed soil s?{e s rvey for Nons & decks
2 wpies of plan sfrowing beam & window sizes; poured fiund desgn, et U Add"Aion - indicat on-sde sepfic system
1 set of Energy Calculations 2 4 2007
3 copies of Tree Preservation Plan'rf lot platted after 711193
Rim Joist Detail Oplions selechon sheet (buildings with 3 or.less units)
Minnegasco mechanical venlilahon fomi
Ofice Use OnN
CeROfSurveyRecd _Y _N
SoilsRepoR - . _Y _N
TreePresPlanRecd _Y _N
TraePresRequired _Y _N
On-siteSepticSystem -. _Y _N
-?
Construction Cost c`?+?
Date I / ZZ- /07
N,^.r'`
SiteAddress y3'6
P/1?f'!?'f??"J W J l
a Unit/Ste #
?
)
Description of Work P-5/,Y7'C CA3 kJ? 61t, L"""'
Multi-Family Bldg _ Y ? N Fireplace(s) _ 0k 1 _ 2
WlL JO G f?;??
P
O
t hone #(?7?
Tele
wner
roper
y p
IMYfba I??M6?
S
Contractor as Flai
Address gm a. fai? Ap• City
S[ate Zip Telephone # ( )
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy Code Category , Residential Ven6lation Category 1 Worksheet • New Energy Code Worksheet
(J submission rype) Submitted Su6mitted
. 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?
_ 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 start without a
permit; that the work will be in accordance with the apprpvf d plaon the cas#f work which requires a review and
approval of plans.
< \L1
Applicant's Printed Name
DO NOT WRITE BELOW THIS LINE
Sub Tvpes
? 01 Foundation
? 02 SF Dweiling
? 03 01 of _ plex
? 04 02-plex
? 05 03-plex
? 06 04-plex
Work Tvpes
? 31 New
? 32 Addition
? 33 Alteration
? 34 Replacement
30 Accessory Bldg
31 Ext. Alt - Multi
33 Ext. Alt - SF
36 MuRi Misc.
? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 37 Demolish Building* ? 43 Reroof ? 46 Windows/Doors
`Demolition (Entire Bldg) - Give PCA handout to applicant
DBSCriptl00: Water Damage _ Yes
Valuation Occupancy MCES System
Plan Review 100% or 25%
Census Code Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. AV
eY1 sElg"q
?
# of Bidgs Length Fi?kT@?ane
yb
Type of Const
Width
ertaa oots
wre j ?
ao
r?
??S
REQUIRE D INSPECTIONS
_ Footings(new bldg) Sheetrock
_ Footings (deck) FinaUC.O.
_ Footings (addition) FinaUNo C.O.
_ Foundation HVAC
_ Drain Tile Other
Roof _ Ice & Water _ Final _ Pool Ftgs Air/Gas Tests Final
_ Framing _ Siding _ Stucco Iath _ Stone Lath _Brick
_ Fireplace _ R.I. _ Air Test _ Fina] Windows
_ Insulation _
_ Retaining Wall
Approved By:
Base Fee
Surcharge
Plan Review
MCIES SAC
City SAC
Utility Connection Charge
S8W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
? 07 05-plex ? 13 16-plex ? 20 Pool ?
? 08 06-plex ? 16 Fireplace ? 21 Porch (3sea.) ?
? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ?
? 10 08-plex ? 18 Deck ? 23 Porch (screenlgazebo/perola) ?
? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 12 12-plex ? 25 Miscellaneous
Building Inspector
RESIDENTIAL
T ? BUILDING PERMIT APPLICATION --?rj
?CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675
New ConaUuction Raauiremenls RemodeVRenalr Reauirements
• 3 registe2d sRe surveys showing sq. ft. of lot, sq. fl. of house; aM all roofed areas • 2 copies of plan
(20°b mazimum lot coverape allowed) • 1 set ot Energy CalculaGons for heated addition.s
. 2 copies of plan showing beam & window sizes; poured found desgn, etc.) • 1 site survey far exterior additions & decks
• 1 sel of Eneigy CatcWations • Irerate iF home served by sepCz syslem Por addiEwns
+ 3 coples of Tree PreservaGOn Plan'rf lat platfed a%er 711/93
• Rim Joist Defatl Qption,s selection sheet (bldgs with 3 or less units)
DATE VALUATION 3?
SITE ADDRESS ? f?-LcA^"M/'+j'S MULTI-FAMILY BLDG _ Y ?N
TYPE OF WORK?A2 FIREPLACE(S) _ 0-(tjl _ 2
APPLICANT
STREET ADDRESS
TELEPHONE
PROPERTY
!tSfATED!?ZIPI-'Z537
?-?'2• ? ZS?T?
TELEPHONE# 3CL?
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - r ---°-------------------------------°--------------°
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNESOTA RiJLFS 7670 CATF.GORY 1 MINNESOTA RULES 7672
(J submission type) . Residential Ventilation Category t Worksheet Submitted • New Energy Code Worksheet Submitted
• Energy Envelope Caiculafions Submltted
Plumbing CoMractor: __
Plumbing system includes:
Mechanical Contractor:
Mechanical system includes:
Sewer/Water Contractor.
_ Air Condirioning
_ Heat Recovery System
Phone #
Phone #
??' v 10 2001
? n
--°--------°------------•------------•----------°°----------------°-----°---------° °----------°--------------
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply
with all applicable State of Minnesota Statutes ond City of Eagan OrdiVncAes. _
Slgnafure of Appllcant
OFFICE USE ONLY
Water Softener
_ Water Heater
, No. of Baths
_ Phone #
I.awn Sprinkler
No. of R.I. Bad
Certificates of Survey Received - Tree Preservation Plan Received _ Not Required _
Updated 4102
OFFICE USE ONLY
F
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory B1Cg
? 02 SF Dwelling ? OS 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt -Multi ?
O 03 01 of _ plex ? 69 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) l? 33 Ext. Alt - SF
? 04 02-plex O 10 OS-plex O 18 Deck ? 23 Porch (screenetl) i? 36 Multi
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damaga I
? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous I
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) O i?44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 145 Fire Repair
? 33 Altera6on ? 37 Demolish (Bldg)* ? 43 Reroof ? 46 WindowslDOOrs
O 34 Replacement 'Demolition (Entire Bldg only) - Give PCA handout to applicant
Valuation Occupancy MC/ES System
Census Code Zonii;g City Water i
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const W idth
REQUIRED INSPECTIONS
_ Footings (new bldg) FinallC.O. I
_ Footings (deck) _ Final/No C.O.
_ Footings (addirion) _ Plumbing
_ Foundafion _ HVAC i
Drain Tile Other
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests , Final
_ Framing _ Siding Stucco Stone
_ Fueplace R.I. Air Test
? Final Windows (new/replacement) i
_ Insulation _ Retainiug Wall
Approved By
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
i
_, Building Inspector
1
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
PERMIT
PERMIT TYPE:
Permd Number:
Date Issued.
BUILDIN6
000292
04J20J92
51TE ADDRESS:
4380 KAUFMANI3 WAY
LOT.: 24 BIpCK: 4
WILDERNESS PARK 2N0 .
DESCRIPTtON:
Bd3ldYnga.Permit Type
f3utiding Wprk Type
,
%
RE5. ADD/PORCH
NEW
=-????? <; ??-, --'- '-' .--_, -•
• - (?;
tj r
G?S t.7
R
FEE SUMMARY:
VALUATION
Base Fee
Surcharge
Su6total
$108.00
$4.50
$112.50
$9,000
LICENSE SEARCH S5.00
ToCal Fee $117.50
CONTRACTOR: - Applicant - sT. IIC. OWNER:
APIDERSON-SODERMAN INC 16815044 0001291 DOHERTY PIARK
9309 LYNDALE AVE S 4380 KAUFMANZ3 WAY
BLOOPIIN6TON MN 55420 EAGAN MN
(612) 881-5044
I hereby acknowledge that I have read this appYication and state that the
information is correct and agree to comply with all applicable StaCe af Mn.
Statutes and City af Eagan Ordinances.
?
APPLICANUPERMITEE S GNATURE I ED Y SIGNATURE
Control No. 0258
-j
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55123 Date Issued:
(612) 681-4675
SITEADDRESS: Lot: 24
4380 KAUF64ANIS WAY
WILDERNESS PARK 2ND
PERMIT SUBTYPE:
RES. A00/PORCH
Control No. 0 9 ?
..?
BUILDING ,
000292
04/20/92
BLOCK: 4 APPLICANT:
ANDERSON-SOpERMAN INC
(612) 8$1-5044
TYPE OF WORK:
NEW
INSPECTION .. . ..
FOOTING FRAMINfa
INSUlATION FINAL
?
?
litl??rlll:ll ??t?d?•?i? IAIl
bi , ( ?
:`lill'.!?•?4f..= t't?,y, ,1,5??
!!I 0?.4 " 'd
?'-.R!! k'k;flI-bIVt91s !1•:1
?
?
!3 I 5 :.?? ' ,
','ll I ? u I l,?'
4
PERMIT " ? '
?''a
CiTY OF EAGAN
1992 BUILDING PERMIT APPLICATION
681-4675
t1r7- s-6
APR 1 5 ?
SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy
calcs.
COMMERCIAL 2 sets of architectural & structural plans, 1 set of
specifications, 1 copy of energy calcs.
Penalty applies when typinq of permit is requested, but not picked up by last working day
of month in which re uest ts made or lot chan e is re uested once ermit is issued.
Date April .' ? is ? 1992 Valuation of r?ork 1 ee:t?e- 6?6
SiLE Addt'BSS:_ 4380 Kaufmanis Way
STREET STE /
Tenant Name: rtark ana Roxanne Dohertv
LOT ? BLOCK ?/'
( SUBp.
C,{/ t.?0? C.eilqL o J P.I.D. M
Descri tion of work: c
The applicant is: ? Owner 13 Contractor ? Other (necc.sbe)
Name Mark and Roxanne Dohertv Phone
Property LASr FIRST
Owner qddress 4380 Kaufmanis way
STREET ' ffiTE #
City Eagan $tate Minn. jjP
Company Anderson-Soderman, rnc. Phone $$1-5044
Contractor Address 9309 Lvndale Avenue so. License M 0001291 EXp, 3131/93
CIt,Y Rlnomingrnn State Minn Llp 55420
Company Phone
architect/
Engineer Name Registration M
Address
City State Zip
Sewer & water licensed plumber . Processing time for
sewer & water permits is two days once area as een approved.
I hereby acknowledge that I have read this application and state that the information is
correct and agree to comply with all applicable Stat of Minnesota Statutes and City of
Eagan Ordinances. ^
f1
Signature of Applicant: `
Ll?
urri" uat UnLT
BUILDING PERMlT TYPE
? 01 Foundation ? 05 Apt. Bldg ? 09 Basement Finish
? 02 SF Qwg. ? 06 Garage/Accessory ? 10 Swim Pool
? 03 Two family 0 07 Fireplace f3 11 Res. Add./Porch
? 04 Multi-fam. T.H. ? 08 Deck 0 12 Comn./Ind.
woRK nrPE
?'31 New
AEr32 Addition
? 33 Alterations
0 34 Repair
? 35 Tenant Finish
? 36 Move
0 37 Demolish
? 49 tlndefined
GENERAL INFORMATION
Const. (Actuat)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
Basement sq. ft.
lst F1. sq. ft.
2nd F1. sq. ft.
Sq. Ft. total
Footprint Sq. ft.
On-site we]7
On-site sewage
Planning Building
Engineering Yariance
REQUIRED INSPECTIONS
? Site M footing
? Yaltboard ,@ fina;l
JO Framing
? Draintile
43
,C$ Insulation
0 Firep]ace
Permit Fee /og- v.?u.c;on: s Doo
Surcharge , so
Plan Review 931? yd
MWCCnSAC
City SAC
Water Conn.
Water Meter ?
Acct. Deposit
S/W Permit
5/w Surcharge
Treatment P1.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total: ?
SAC %
5AC Units
. . ,
O 13 Public Fac.
? 14 Agricultural
0 15 Miscellaneous
MWCC System
City Water
PRV Required
Booster PumP
Fire Sp'rinkler
Census Code
SAC Code
Assessments
, . _ _.. ,. .
? .' ? • '
OwNER Ajj- f'
i
SITE ADDRESS L?=t ?
GATIiRIOR LNVELONE AVI:RAGE "U" COhiPll'fdC!OfJ
CONTRACTOR ??pIE/^ 40h '?O a?°V?rJ U,1T PHONE
'--??`-
Determinn working square footage of each.
1. Total exposed wall area ...... OQ sy. ft. x_?/
2. Total roof/cciling area ...... . 5-14_ sq. ft. x,
Total exposed wall arca abovc floor =
a. Total wall window area .................... ........
??
b. Total door area ........................... _
........
c. Total sliding glass door area ............. ........
d. Total fireplace wall area ................. ........
e. Total wall framing area (avernge 10-h) ..... ........
f.
7ota1
net wall area above floor ...........
...... ..
-
g. Total rim joist arca ,,,,,,,,,,,,,,,,,,,,,, ,,,,,,,, - ?
Totnl exposed foundation aroa =
h. Total foundation window area .............. ........
i. Total net foundation area above grade ..... ........
Determine "U" value of cach wal l scgment.
a. IT X ?lull
b. x OJu.1 _
c. aG X.,u„
a. x lu„ _
e. XIPUll
X „U„
9. ?._ x „u, l
n
i.
x "u"
X "U"
3 . . . . . . . . . . . . . . .'. . . . . . . . . . . . . . . . . . . . . . 'f0'I'AL - C?,L?! ?
If item w3 is the same as, or less than item kl, yuu h;ivc mct thc intent of
SBC 6006(c)2,
- ovcr -
Total exposed roof/ceiling area
Total gross roof/ceiling arca =
?
j. Total skylight arca ................................
k. Total roof/ceiling framing area ....................
1. Total net insulated roof/ceiling area .............. aIFp
Determine "U" value for each roof/ceiling segment.
i . x ?lull
k. 3?2 x ,.u„
1 . ?ya x „u„ , ozs?
a . ........................................ . roTai.
If total of N4 is the same as, or less than M2, you have met the intent of
SBC 6006(c)1.
To utilize the total envelope system method, the values established by the sum of
items H3 and N4 shall not be greater than the sum of items H1 and N2.
1. ,40 . Z. 8.37" = Sa.37
3. , + 4. _7 99 - - '6?4,_-1-
?
;-°- --
CERTIFICATE OF SURVFY
?
? • ? I S 69' 3 7' 28" W I
I jU. GD
(2 84?T
o
8 gA; JO OO
?
5 ? ORIVE ?, ? .
' SEW£R ' vAY N (9 ?O
i
LOT
Z4 I
• (n StRVICE" Iv 9.33 pu
W
7 ?
L I
ft y ?i ?)
(
O
I 26 33 Jc
p I .
l
L
e
p ?
I b
9
DHAI?GE
_
y ? ! uYlt/Iry
,
/0 ( 1
N
E95EMPNY
JS
! [
Glovatiuna shuwn are existing
graJea and are assumed datum.
130.00
S by°3`7':CB'W
8
O ?
46 o
?
j I
!
I hereby,certfly [hai this is a correct representacion cif a survey of:
Lot 24, Rlock 4, WILllERNESS PARK SECOND ADDI'L10N, Uakot.a County; MinI nesu[a,
according [o the plat thereof on file and of recard. ? I
i
and that I am a duly registered land surveyor under the laws of Lhe'State of Dlinnesota.
?
c ?
i ?
•. , tQ ?, ? -?l ,°,1 , ?1?? _
Cene L. JacoLsuUf Minn. Reg; No. 7734
I
Dated this SUi Day of July,?1983
?
DR. BY GRJ I SCALE - I*8 = 40' I o DENOTES IkON MON
Prepared for:
Fea[ure Builders
15513 i.ognrw I.ane
Burnsville, MN 55337
dEARINGS, ARE ASSUMED DATUM.
I
JACOBSON SWRVEYORS
LAKEVI!LLE, MINN. 55044
NtiONE 40 - 4 328
, CERTIFICATE OF SURVEY
I / 1 S B90 .5-7' za" W
/30• 00
?
`? v,
? •,? `
8??
$Ar
} ' 30.00
10 ? `?.?? m -_-----_-_--l
89 I.
`E/. 33
SEWER ? PRI?f
? wAY
H?
k°,
LOT 24 I
f
? WRrER ?
, 86 3
I
(n SeRVICE 'I
I ?
s ? y ? gLOr+K 4
I
26.33 'XP
6 I
? p I i o ?bb? DRRJNAGE <:f4-
y unury ?
?
N
?[ /OI ERSEMENT J
?
_
Elevations shown are existing
grades and are assumed datum.
/30. DO
S a9° S7' ZB'W
O 6
O y.
0
h
I hereby certify that this is a correct representation of a survey of:
Lot 24, Block 4, WILDERNESS PARK SECOND ADDITION, Dakota County, Minnesota,
according to the plat thereof on file and of record.
and that I am a duly registered land surveyor under the laws of the State of Minnesota.
f \ ! .Pil^-P /1 :t" GG'?
Gene L. Jacobso Minn. Reg. No. 7734
Dated this Sth Day of July, 1983
DR. BY GAJ SCALE - I" = 401 I o DENOTES IRON MON. I BEARINGS ARE ASSUMED DATUM.
Prepared for:
Feature Builders
15513 Logarto Lane
Burnsville, MN 55337
JACOBSON SURVEYORS
LAKEVILLE, MIN N. 55044
PHONE 469 -4328
/o0-ZZ
I EXTERIOR ENVEL'OPE AVERAGE "U" COMPUTATION
OwNER
5I7E AODRE55
CONTRACTOR ff,2 iZ?6t P/; J DATE
PHOME `t'? 1^-kf/?/l
Detei-niine workinq square footage of each,
1. Total exposed wall area .,,.,, 2Z>.,?'4? sq, ft, x,s?17 ? ? _v•
2, Total r-vof/c.elling are,a .,.,.,Sq, ft. x___,OS' • r.?
Total expoaed uall area above Eloor •2d95 - ?C!
a. Total wa'il window area ........................... I z?.33
?
b. Total door area .................................
c, Tvta1 sliding ylass door area ...................
?"-
d, Total fireplace wall area........................
e, Total wall frarainy ar^a (average 10%)...,..,,,.., 7`;,5'•s?l
f, Total net walt area above floor ................. ?
g, Total rim joist area ............................ ?U4 2 0.G
Totat c:<posed foundation aiaa = ri? P?
h, Totai fa.andaCio, vindow area ..................... ?
i. Toal net foundaY,ion area dbove gremQ ,...........
De4.cWne °U" value of each taz,tl segment.
.
X " U??
b, 3 7-a?, z nu° l?---__-- - = 4-I/
x uUn a '
d , `-? X ,tul, ?-- r'
9
e . X "U" • 7 ? 06
f. C4CX „U it 9-2
y, 2j/.2U X "U° -fJ(3 = CZG7
h. X
`Ip
iiV
i. I I X "u" .. 4 7 = $-l-
3..,...,...Z2'?3.'.V:? .................Total • !?'d
If item 13 is the same as, or less than item 41, you have met t1+e fntewt
of S8C 6006(c)2.
:
?otal exposed roof/ceiling area = /1 {'? .t'tl
j. Tatal skyliqht area ............ ........ .... . _-
k. Totai roof/ceiling framing area (average 10%) ..,
_.?
1, Total net insulated roof/ceiling area........... ??o .e?YJ
Determine "U" value for each rooflceiling segment.
± X 11 u 1. ,
k. X "U" •
,. r33?,ou _ z „U" v s-
4 ...................... Totat
If total of 44 is the same as, or less than 12, you have met the inten? of
SBC 6006(c)1.
Alternate Bullding Envelope Design
To utilize the total envelope system method, tne values established by the
sum of items A3 and 44 shall not be, greater than the sum of items 41 and 02.
* 6 0 - = 4 s?/-E53
3. 3( G'•Igr ____ + a. 1?; 11/1 •GO ° '3z- •7ej
1804 Melody Lane 69U3083
Bumsville, Minnasata
WEPJA CO. PLAN S6RVICE
ED ANDERSON
ARCHITECTUML DESIGNING ANO PLANNING
oslice: l001G'lIL2G'Pl1?' L. lilt u
-Lt2a?? Office:
Burnsviile, Minnesota 890-4636
l?k- CITY OF EAGAN
SUBD.I??? lS? ?B PLUMBING PERMIT
? (612) 681-4675
REBIDENTIAL
PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS.
WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
°--°------------------ -----------------------------
WORK DESCRIPTION
N0.
NEW CONST _
ADD ON
REPAIR _
OWNER NAME: _
SITE ADDRESS:
INSTALLER:
ADDRESS:J
CITY3-m
PHONE #: _
ZIP: tf?2?2?
CO?IIQERCIAL
CITY IISE ONLY.;
RECEIPT #
DATE
ALSO, FOR TOWNHOMES AND CONDOS
COMPLETE THE FOLLOWING:
FIXTURES EA.
REPAIR/ADD ON 15.00
SHOWER 3.00
WATER CIASET 3.00
BATH TUB 3.00
LAVATORY 3.00
KITCHEN SINK 3.00
IAUNDRY TRAY 3.00
HOT TUS/SPA 3.00
WATER HEATER 3.00
FIAOR DRAIN 3.00
GAS PIPING OUT.
(MINIMiTM - 1) 3.00
ROUGH OPENINGS 1.50
OTHER
WATER SOFPENER 5.00
PRIVATE DISP. 15.00
U.G. SPRINKLER 3.00
W. TURNAROUND 15.00
STATE SURCHARGE
TOTAL
$/SSU
PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL SUILDINGS. ALSO FOR MULTI-FAMILY
BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT.
WORK DESCRIPTION:
OWNER NAME:
SITE ADDRESS:
TENANT NAME: _
SUITE #:
INSTALLER:
ADDRESS:
CITY:
PHONE #:
FOR:
CITY OF EAGAN
ZIP:
CONTRACT PRICE:
1% OF CONTRACT FEE.
STATE SURCHARGE - $.50 FOR
EACH $1,000 OF PERMIT FEE.
$25.00 MINIM[7M FEE.
CONTRACT PRICE x 1%
STATE SURCHARGE
TOTAL:
$
$
(SIGNATURE)
CITY OF EAGAN
? 3830 PTLOT 'AI?OS ROAD
EAGAN, MN 55122
PHONE: (612) 454-8100
. .. . . .... ... ..
?4EGS?ANT . .
CP,?;;?
FOR CITY USE ONLY
PERMIT #
RECEIPT # O , ?
DATE: S G ?
?STLI?NxIAL:` PLEASE COMPLETE UPPER PORTION , ONLY FOR SZNGLE FAMILY
TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
-----------°----------- --------------------------°--------------
WORK DESCRIPTION FEES
NEW CONST _
ADD ON _
REPAIR
OWNER NAME: G4?d?1`1?An -
SITE ADDRESS: 7'_?PD Q?I?Q74me
LOT: BLOCK ? SUBD.
INSTALLER: Q G UVh0.9K
HEATING & AIR, CMITIOI;ING C0.
ADDRESS: 8910WF.IJNd6RTHA"E SO
MINNEAPOLIS, .iiN 55420
CITY: 881°^C3 ZIP:
SUBTOTAL:
STATE SURCHARGE:
TOTAL:
DWELLIN6S fi
$15.00
24.00
6.00
3.00
$-L-L, _"
.50
$?d
a -/?
SIGNATURE OF PERMITTE /fYlGti
PHONE # : 5?-' Y LGT,e l ALLQ.C 4462n
P !7
G9lII4ERCIALJiND'?5?'K?AL`7. PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS,
APARTMENT BUILDINGS, AND MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE
NOT REQUIRED FOR EACH DWELLING UNZT.
CONTRACT PRICE:
OWNER NAME:
SITE ADDRESS:
LOT: BLOCK _ SUBD.
INSTALLER:
ADDRESS:
CITY: ZIP:
PHONE #:
FOR: ..
ADD-ON MINIMUM
HVAC 0-100 M BTU
ADDITIONAL SO M BTU
GAS OUTLETS - MINIMtJM
OF 1 PER PERMIT
FEES
18 OF CONTRACT FEE.
STATE SURCHARGE _ $.50 FOR
EACH $1,000 OF PERMIT FEE.
PROCESSED PIPING - $25.00
$25.00 MINIMUM FEE.
CONTRACT PRICE x 18 $
STATE SURCHARGE
TOTAL:
(SIGNATURE)
CITY OF EAGAN
Use BLUE or-.BLACK Ink
-_--_-_-__e-_-,._.-
I For Office Use I
~ Permit
City of Ea
Permit Fee. I
3830 Pilot Knob Road
Eagan MN 55122 Date Received: / f
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff: l
I
2012 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit
Name: T'1c7~C ti \ Phone: 4:, I_ o
RESIDENT /
OWNER Address / City / Zip: i'1~ 19 <r\N S
Applicant is: Owner _~!<L Contractor
TYPE OF WORK Description of work: r yw S
Construction Cost: Multi-Family Building: (Yes / No S
Company QI~u ar~' f,1 Contact
CONTRACTOR Address: I S City: Q r'c
State: Zip: Phone: - ~ Z - 2-9 Z
License #L j 1 c~) Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A .NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & 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 they are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org
I
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
X ®t O x
Applicant's Pri d Name Applicant Si
Page 1 of 3
Use BLUE or BLACK Ink
~ -
For Office Use
• ; Permit 1
City of Eap I Perm Fee: - ~
3830 Pilot Knob Road i ( / 3 I
Eagan MN 55122 1 Dale Received: 1
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 1 Staff: I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit
Name: _ , a 4 li AL 12A 4 ilk h 14 ge 444 Phone: iff/ -'_'~01'
Resident/ T-
Owner Address/ City/ zip: _y 39..A U42 M Iv t S to
+4>r
Applicant is: Owner ~ntraCtDr
` v
Type of Work Description of work: _K-e l,u C.
Construction Cost: " -3 CIO Multi-Family Building: (Yes / No
Company. P R o 01 '51s i~4 C 4-l,4 :!J • Contact &Ld
Contractor Address: 19 ` a K (4 -k,~ to o f City.
State: pn'_ ap: Phone: t y K ~I~ wS
License A'9Q o) 6 Lead Certificate
If the project is exempt from lead certification, please explain why. (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING ANEW BUILDING
In the last 12 months, has the City of Eagan Issued a permit for a sknilar plan based on a master plan?
Yes No Fps, dale and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer S Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit ate considered to be public information. PoftiDns of
the information may be classed as non-public if you provide specific reasons that would permit the City to
conctude that they are bade secrets.
CALL BEFORE YOU DIG. Cal Gopher Stale One Call at (661) 4640002 for protection against underground utility damage- Call 48 hours
before you intend to dig to receive locales of underground utilities- www.oooherstateonecall.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
accordanoe with the approved plan in the case of work which requires a review and approval of plans-
Exterior work authorized by a building permit issued In accordance with the Minnesota Stale Building Code must be completed within 180
days of permit issuance.
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Applicant's Printed Name Applicant's Signature
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