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4623 Kingsbury Dr, •,? , ., ;?.,.:? ,. ,.- ^' CITY OF EAGAN . ? 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHONE: 454-8100 BUILDING PERMIT Receipt # 7o be used for GARAGE ADDTTION Est. value ?? ,000 Dalle $Rp Site Address 4623 KINGSaURY DR Lot 28 Block 3 Sec/Sub. BEACON HILLS Parcel No. W Name RICKIE & KATHL£EN M$'C[CE o Address 6 3 KINGS$URY UR City EAGAN Phone 452-0699 n?• en.• Zo Name SAME $u Address City Phone w W Name l- Address _ a W City Phone I hereby acknowlege that I have read ihis application and state that the Building Official 17406 inlormation is correct and agree to comply with all applicable State of Minnesola Statutes and City of Eagan Ordinances. i Signature ol Permitee - -i w4lti A Building Permit is issued ro: RICKIE do KATHI.EEN MET6C$ on Ihe express condition that all work shall be done in accordance wilh all applicable State of Minnesota Statutes and City of Eagan Ordinances. ? 1 f v !7 is &9 OFFICE USE ONLY Occupancy FEFS Zoning - (Adual) Const - Bldg. Permil 90•? (Alfowable) - Surcharge 3.50 # ol Stories 20' Pl R i Length an ev ew 2' Depth SAC, City S.F. Total - SAC, MCWCC S.F. Footpdn[s - On Site Sewage _ Water Conn On Site Well - Wa1er Meter MWCC System - Accl. Deposit Ciry Water _ PRV Aequired , S/W Permit Boosler Pump - S/W Surcharge Treatmen[ PI APPROVALS Road Unil Plartner - park Oed. Council BIdg.Ofl. _ Copies 93.50 Variance - TOTAL Permk No. Permit Holder Date Telephone # WATER SEWER PLUMBING H.V.A.C. ELECTRIC Inspection Date Insp. Comments Footings I A Z Foundation Framing l b /'k, Roofing Rough Plbg. Rough Htg. Isul. Fireplace Fnal Htg. Final Plbg. Const. Meter Pibg. Inspector- Notily Plumber Engr./Plan . Bldg. Final Deck Ftg. Deck Final Well Pr. Oisp. CITY OF EAGAN Remarks Addition BEACON HILL ADDITION Lot 28 Blk 3 Parcel 10 13500 280 03 Owner Street 4623 KingsburX Drive State Eagan,, NIN 55122 Improvement Date Amount Annual Years Payment Receipt Date STREETSURF, 1982 1806.93 200.77 9 1806.93 C007569 10-1-81 STREET RESTOR. GRADING 1982 526.46 58.50 9 526.46 C007569 10-1-81 SAN SEW TRUNK 1976 3 g7 9.06 15 90.67 A008956 3 18 80 SEWERLATERAL 1982 3116.46 346.27 9 3116.46 C007569 10-1-81 WATERMAIN I * WATER LATERAL 19$2 ) WATER AREA g" 1982 198.01 22.00 9 198.01 C007569 10-1-81 Stubs 1982 9 STORMSEW TRK (?? Z 1982 359.82 39.98 9 359.82 C007569 10-1-81 * STORMSEWLAT jJ$Z 9 CURB & GUTTER SIDEWALK STREET LIGHT ROAD UNIT 250.00 36465 6-15-83 WATER CONN. 450.00 11 11 BUILDING PER. HZSO SAC 525.00 u n PARK CASH RECEIPT CITY OF EAGAN 3795 PILOT KNOB ROAD EAGAN, MINNESOTA 55122 REC EI V EO & DOLLARS ?- ? 00 E) CASH ? GNECK FOR FUND DATE /?. 19 AMOUNT $ ( T?aank You V CODE BY AtnOUNT White-Payers Copv Vellow-Posting CopY Pink-File Copy Receipt '- MECHANICAL PERMIT ClTY OF EAGAN Fill in numbered spaces Type or Print/egibly 1. Datei"-'?•?? i./installation Cost ? -) -- ?. ' .._.%....; 3. Job Adc 4. Owner 5. Contrac 6. Address 7. City _ Z i p (?_1?,0 r- . 8. Building Type: Residential,'< Commercial ? Institutional ? 9. Work Description: New ? Addl Alter ? Repair ? 10. Describe Fuel Type 11. No, Equipment BTU - M. Ea. Forced Air No. Eauipment CFM Ai H dli : Mfg. r an ng _ Boilers Mfg. _ Mech. Exhaust Unit Heater Mf9• ' • li/: Othe - -'"? Air Cond. ;??'`iJ'_: , r . Mfg. Gas, Piping Outlets - _ 72. I hereby certify that the above information is true and correct, and I agree to comply with all.qrdoances aqd codes governing this type of work. Signed : for Rough Inspections: Date Insp. Date Insp. ` t This is your permit when numbered and approved. Approved CITY OF EAGAN 454-8100 Permit No. ?"1 6 'C- Fee S/C • =' `>> Tot. S, ? ± BUILDfNG PERMIT CITY OF EAGAN 3793 PYoF Knob Raod Eoyae, MN 55122 VHONEs 45a-e100 Receipt Te be wed fer SF i1WG/GAR Est. Value $f 3.0Q0 Date Tuno 15 19 }21 51te Address 4623 Kingsbuir Drive Erect ? Occuponcy p-3 Lot 2 S BI«k3_ Sec/Sub. Beacon Hi11 Alter ? Zoning P. Porcel # 10 13500 280 03 Repair ? Fire Zone Enlarge ? Type of Const. V W No? Oak Chase Bt 1 t,l e, Tnc. ?,re U # Stories ; Addreu 4525 Okk Chase idav Demolish ? LengthQ_ b r:.., i:as-an 55123 a....._ 457-11093 Grade f-1 Depth `'-) So. Ft.- Name ChqnzT A Addresa C'itv Dhnn. Nome _ Address 1 hereby acknowledge ihat I have reod this opplication and state that the information is correct and agree to comply with all opplicable Stote of Minnewto Stotutes and Ciry of Eagan Ordirwrxes. Siprwture of Pertnitfee A Building Permit Is issued to: Oak C' ? i 1,? nra all work shall be done in accordance with oll avaliwble State ob Miy ..??........ Assessment Water 8 Sew. Police Firo Enp. Planner Councll Bldg. Off. APC Permit 312-00 su.churge 31.50 Plan check 161.00 SAC 525.00 Woter Conn. G S(1 nn Woter Meter F,lt !ln Road Unit Z 50 - n') Totol Y 1799 _ SD n the express condition thm of Eapan Ordinonces. Buildinfl Officiol Permit No. Parmit Holder Mise. Permit No. Holder Plumhin9 7-?-?5 . H.V.A.C. lNt?l? Well Water Disp. Sewer Eiect.ic W 76 ?aan. t-? -17-VA Inspection Data Insp. Other Footings Foundation Framinp Rouph Plbp. Rough HVAC 7 Inwlation FinalPlb¢ .?T [da Final HVAC Final Water Deacrihe Loeation: Wal I Sewer Pr. Dkp. Recaipt PLUMBING PERMIT Permit No. ! . ?"-- '?-- CITY OF EAGAN Fee Fill in numbered spaces S/C Type or Print legibty T t o 1. Date 2. Installation Cost 3. Job Address Lot _ Blk. Tract , 4. Owner I 5. Contractor Phone ,- 6. Address 7. City ? State 1J Zip _ 8. Building Type: Residential 0 Commercial ? Institutional ? 9. Work Description: New iC]-' Add ? Alter ? Repair 11 10. Describe 11, No. Fixtures Water Closet No. Fixtures Cesspooi/Drainfield Bath tubs Septic Tank ? Lavatory Softner Shower Well Kitchen Sink 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 454-8100 Cities Di?ital Quality Control The following image represents the best available image from the original page. Every effort was made to capture the content from the original page. Receipt MECHANICAL PERMIT CITY OF EAGAN Fill in numbered spaces Type or Print legibly 1. Date 2. Installation Cost 3. Job Address Lot 1;22? Blk. 4. Owner F- , '--•:s-t? ,"-.v__ ?,._x..?J?,e..,?. -- Permit No. Fee S/C Tot Tract 5. Contractor _ Phone 6. Address 7. City State Zip _ 8. Building Type: Residential El Commercial ? Institutional ? 9. Work Description: New ? Add ? Alter ? Repair ? 10. Describe Fuel Type 11. No. Equipment BTU - M. Ea. Forced Air No. Equinment CFM Air Handli : Mfg. ng 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 ; CITY OF EAGAN 3830 Pilot Knob Road ' P. O, Box 21799 Eagan, MN 55121 Zoning: p? Owner: Oak Cha Address: Site Address: _ 462 Plumber: iJeieriCe a-1?-a3 36a6? 100.00 -d ?.9.se ro e«nob wtei, e6 caer ef E.seo Connectlon Chorpe: ic: Ordinenw. Aecount Deposit: ^ Permit Fee: B Surchorge: . 5 : Y Mix. Chorges Date of Insp.: Total: Insp.: Dote Pcid: G#TY £1F EAGAN WATER SERVICE PERMIT 3830 Pilot Knob Road P. O. Box 21199 Eagan, MN 55121 Zonin9• • ---- Owner, nn r'r.BBC FSldra Address: Site Address: a ?a < "i rQatuy^r ' Ptumber. vpieri;e ^rearh s %: Meter No.: Size: Reoder No.: 1 ayree M emnply wiMe fhe Ciry of Eagan Ord7nonw. By Date of insp.: SEWER SERVICE PERMIT PERMIT NO.: DATE: _ No. of Units: PERMIT NO.: ??"? DATE: c.-:!'? -31 - No. of Units: 1 ?r#.ve " 13eschor. }iill gC _ Connection Chorge: "5:=•00 nd _ Actount Deposit: _ Permit Fee: ? ? • OSi ; i Surcharge: • `J? Misc. Charges: _ ` 7)•10 rd Total: - Dote Paid: - Insp.: ' CITY OF EAGAN Np 17106 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHONE: 454-8100 1 3 4Q j BUILDING PERMIT Receipt # ? To be used for GARAGE ADDITION Est. Value $7, 000 Date SEP 27 , 1989 Site Address 4623 KINGSBURY DR Lot 28 Block 3 Sec/Sub. BEACON HILLS OFFICE USE ONLV Parcel No. occuPancy M-1 FE FS ' Zoning - w Name RICKIE & KATHLEEN METKE (Actual) Const Bldg Permit 0 90.0 - . ? Address 4623 KINGSBURY LlR ?Allowable) 3 50 0 City EAG? Phone 452-0699 # ot Stories Surcharge . 2 ' Plan Review Length 0 o Name SAME Depth 2? ? SAG Cit ? ?¢ Addf2SS S.F.Total - y SAC,MCWCC ? C12y Phone S.F. Foolprints _ C W F On Site Sewage _ ater onn w F Name On Site Well W ? - Water Meler ? -y Address MwCC System ? Acct. Deposit c W City PhOn2 City water _ PRV Required _ S/VJ Permit I hereby acknowlege that I have read this application and state that the Booster Pump - SMl Surcharge information is wrrect and agrea to compty with all applicable State of Minnesota Slatutes and Cit ol E an Ordinances. 7reaimeni PI Si nalure of Permitee 9 ? ?/ O ? APPROVALS Road Unit A Building Permit is issued to: RICKIE & KATHLEEN METKE Planner - park Ded. on the express condition that all work shall be done in accordance with all Council -, applicable State of Minnesota Statutes and Ciry of Eagan Ordinances. gidg. Ofi. ^ Copies ryy, Building Official ? 9 Y,(?? I I i Variance - TOTAL 93.50 P 44185 Fiequest Date ' !O ire No. Rough-in Inspection Required7 ? Ready Now rj] WJli?lalily InspeciW ?G/h R d ? d v ? Yes ? No en ea y I VA6ensed contractor ? owner hereby request inspection of above electrical work at: Job Address (Street, Box or Raute No.) {/ Ciry ?33 1 .J6s 8uk i? 07676J Section No. Township Name or No. Renge No. Counry Ti?! Occupanl (PRINT) Phone No. 5-oZ - Power Supplier Atldress ,DAK0714 f=f-if./?'1 J.J6 l"o A.J Eleclrical Corrtractor (Company Nama) Corrtractor's License No. ? SAI04rsrd10 E1,Ecr??C 4 /?94 Mailing Address (Contractor or Owner Making Installation) %(o f'.0 Authoriz fature actor/Owner Makirg Installation) P?one Number . r_ -779 MI TA ST B A OF ELECTRICITY THIS INSPEGTION REQUEST WILL NOT GH s-Mitlw Bld Room &173 BE ACCEP7ED BY THE STATE BOARD 18 UniverSi St. Paul, MN 55704 UNLESS PROPER INSPECTION FEE IS Pho 612) 64 ENCLOSED. REQUEST FOR ELECTRICAI INSPECTION • ? See insWClions for completing th* /ortn on back W yellow copy. r- 44185 X" Below Work Covered by This Request ?'. es-00001-07 e Kdd Type of Building - AppliancesWired _ EquipmentWired Home Range Temporary Service Duplex Water Heater Electric Heating Apt. Building Dryer Other (Specify) Comm./lndustrial Furnace Farm - Air Conditioner Other (specafy) CoMrectorS Remarks: Compute Inspection Fee Below: # Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee Swimming Pool 0 to 200 Amps a a to 100 Amps , 00 Transformers Above 200 _ Amps Above 100 _ Amps Sign5 Inspector? Use Onty: TOTAL Irrigation Booms ! Special Inspection Alarm/Communication Other Fee I, the Electrical Inspector, hereby if h i b Rough-in oete cert y t at the a ove nspection has been made. Fi,ei ' ' 4.4 Date t? ?6 ?• p_ OFFICE USE ONLY ? This request voitl 18 months irom n-1 qq REQUEST FOR ELECTRICAL INSPECTION ee-oooot-oa ? ????? See instructions for completing this form on 6ack at yellow coDY• ' "X" Below Wnrk Covered by This Aequest Nev4 AcWj Retz. Type of Building ApplionCes Wired Equipmenl Wired Home Range Temporary Service Duplex Water Heater Lightiny Fixtures Apt. Building Dryer Electric He2tin Commercial Bldy. Fumace Silo Unloeder Industrial Bldg. Air Conditioner Bulk Milk Tenk Farm other Pecifv .1ner (specirv) thr,r Specify Othcr Olher Compute lnspection Fee Below # Pea ServiceEntranceSize k Fee Feeders/5ubfeeders b Foe Circuits 0 to 200 Am 5 0 to 30 Am s O.00 0 to 30 Am s Above 200 Ampsi 31 to 100 Amps 31 to 100 Am s Swimmfng Pool Above 100-Amps Above 100_Amps Transformerg Irrigation Booms Partial%Other Fee Signs Special Inspection S .?? TOTAL Remarks ?/ RouBh-in Date I, the c' Inspectof, hereby certify that the above Finel Di11e inspection has been ? ?1y'J . made. fhis request void 18 montns irom ia months fromie tI-) 119 1 A 40199 L1 ' cs ib?. tls Request Date ire No. Req9hed7 1nsnection eatly Now Q Will Noufy. ?Yes EWNo [or When R, ULicensed Electrical Contractor I hereby request inspection o( above ? Owner electrical work installed at: Streel Address, Box or Route No. Ciry a ?ik s6?a? v. 4 4kl ? yoh/ ecuon o. Town ip Name o o. Range No. Coun Occupant(PRINT) Phone No. Power Suppii Atldress Etectrical Contractor (Company Name) Contractor's License No. /':::? / G 6 ? MailinB Address (Contractor or Owner Making Instailation) 1J / l U 5-e-. st,, C? 1ONGIF'LL ?nrized SfBnature IContractor Owner Making Installationl Phone Number ?? l-Sde., LECTRICITY THIS INSPECTION REQUES WILL NOT RD OF E hbhLBI? poom N•791 BE ACCEPTED BY THE STATE BOAHD St. Paul, MN 55104 UNLESS PROPEfl INSPECTION FEE IS ENCLOSED. This request void ?/ ..? !? M . La$, R:,3?-, 0 << t -?c0 q q I 18 months from ? ? . ' - '? l • J_? Requ . a i Fire No. Rouuh-in Inspeclion eqireA? ?p ?Readv NowlpQWil! Notify Inspec- ??l Wh R vC5 ?N? or en e.idy censed lectrical Contrar.toc I here6y request i nspection ol a6ova ? wner electrical work installed:at: Street Ad r s. Box or Rou o. N '? ? Citv fj 6 S 2??/f # ectio . 7ownship Name r No. Range No. Count . Occupan I) . Q Phone No C.lR'/''? SL - O pplief - Address ? J ectrical Cont ct (CompanY Na -? ' ontracior's I_icense No. c c QZ/Z Maily,pIContr?or?% nr^Ow^ne7r?? g Instail onl ` % / ? L L._ .- ? A d Signature n[r c r/ ner Making nstallation) Phone Number MINNESOTA STqTE BOAHD OF ELECTFICITY THISINSPECTION REQUEST WILL NO7 Griggs-Midway Bidg. - Noom N-191 ' BE ACCEPTED BY THE STqTE BOARD 1821 University Ava., St. Paul, MN 56104 - UNLESS PROPEN INSPEC710N FEE IS Phone (672) 297-2111 ENCIOSED. . REQUEST FOR ELECTRICAL INSPECTION „_„ EB-00001-03 ? See inshuctions for completing this form on 6ack of yellow copy. M44430 ` iJ ' ? l9 ? "'X"" Befow`Wark Covered by 7his Request 3New td Rep. 7ype o! euilding Appliances Wired Equipment Wired " "Home Range . Temporary Seroice Duplex Water Heater Lightin,y Fixtures Apt. Building . Dryer Electric Neatin Commercial Bldg. Furnace Silo Unloader Industrial Bldg. Air Conditioner Bulk Milk Tank Farrn Other aecify Other (SPecify) ther Specify Other - - Other Compute Inspection Fee Belaw # Fee Service Entrance Size Jt Fee Feeders?Suhfeeders d Pr,e ej ? Circults 0 to 100 qm s 0 to 30 Am ps D to 30 Am s 101 to 200 Amps 37 to 100 Amps 31 to 100 qm s Above 200 Amps Above 100-Am s Abuve 100_Amps Transformers Remote Control Circ. PHrtiallOther Fee - Signs Special Inspection S TOT Rema rks - r AL ? ,, r? Rpugh-in ?? B"' I he I Elecirical pector, hereby " ceriify thal thC above Final LD;. ?!?t!''pyction has been 7his request void 18 months fiom TbiJ Ccrtrficate itsued purrunnt to the rrquiremenu o f Seuian 306 of ihe Uni fmm BHilding Codc arti f ying tbat at tix time u f is.cuanct thit .rtrHtYure suat in com pliance with tht variotu ordinanaa a f tht C#y agxlating bwilding connrrrttion or ure. For the following: UNSF DWG/GAR " BId{. Pemtia No. 8150 ?{?ym O-warTYw R3 7Ywcm,w<ewn V eiRz? NA udogEh.wci Rl O? of Wd;,` Oak Chase Bldrs. A4drcm4525 Oak Chase Way, Eagan B„aa,,`Aamnn 4623 KinQSbury Dr. L.,.d;,YLot 28 Block 3,Beacon Hill ? %WdftofficW Data. August 25, 1983 Mc! . -• M?i N A COwRCYW. CITY OP EAGAN Np g 1 J? O ' . 3795 Pilet Knob Road Eagan, MN 55122 • PNON E: 434-87 00 BUILDING PERMIT Receipt To bs wed for SF DWG/GAR Est. Value $63,000 Date June 15 19 83 Site Addreu 4623 Kingsbury Drive Erecr ?g Occuponcy R-3 28 3 Beacon Hill Lot Blxk 5ec/Sub. Alter ? Zoning R-1 parcel 10 13500 280 03 Repair ? Fire Zone NA Enlorge ? Type of Const. V 19 W Nome Oak Chase Builders, Inc. Move p .# Stories ; Address 4525 O?.k Chase Way Demolish ? Length? b ci Eagan 55123 Phon. 452-3083 6rode p Depth-29--Sq. Ft.- Name O?eY Approvolt Fees p u Address Assessment permit 322.00 ? C{t Phone Water & Sew. Surchar9e 31.50 ? Police 161. 00 Plon check Name ? Fire SAC 525.00 ?,-? Address Eng. Woter Conn. 450 . 00 iW Ci phone Plcnner WaterMeter 60.00 Council Rood Unit 2$0•00 I hereby acknowledge that I hove reod this opplicotion and state thot gldg. Off. the informotion is Correct and agree to tomply with all opplicable $1799 50 State of Minnewto $totutes and City of Eagan Ordinances. APC . Total Signoture of Permitfee A Building Permit is issued to: Oak Chase Builde nll work shall be done in accordance with oll oD¢gcpble Stqte4 Mii on the express condition thai Statutes ond City of Eagon Ordinances. 8uiidiny Officiul RESIDENTIAL BUILDING r? f L? (p Permit Application City Of Eagan 3830 Pilot Knob Road, Eagan Mlv 55122 Telephone # 651-675-5675 FAX # 651-675-5694 tP`10, L--)o New Construction Reauirements RemodellReoair Reauirements Office Use Onlv 3 registered site surveys showing sq, ft. ot lot, sq. ft. of house; and atl roofed areas 2 copies of plan Cert of Survey Recd Y N (20% maximum lot coverage allowed) 1 sat ol Energy Calcula6ons for heated additions Tree P2s Plan Recd _Y _ N 2 copies of plan showing beam & window sizes; poured found design, etc. 1 sile survey for additions & decks Tiee Pres Not Reqd Y_ N 1 set of Energy Calculations Adddion - indicate if on-site septic system On-site SepGc System _ Y_ N 3 copies of Tree Preservation Plan it lot platted a(ter 711193 Rim Joist Detail Options selecUon sheet (61dgs with 3 or less units Date e) 6, 7 4 42 Site Address 13 Gc.l2 y , Construction Cost 17,01 ot q ?d i7IJ 6: UnitlSte # Description of Work 41L= L4J j]4enck- Multi-Family Bldg _ YYN Fireplace(s) _ 0 ? 1 _ 2 Property Owner j2Lr,/1/,Vl,S ?j?11G /I Telephone #(4!5!r1) Contractor 0,?:F/?itl/S P/?%GI/°lol Address /M- `..2,3 ks06S j? GL (L State /4? /(/ N ( VC Zip s?/2 L City 4 17VA;?10 Telephone #(??? y/gJ__ COMPLETE THIS AREA ONLY IF CONSTRUCTlNG A NEW BUILDING - Minnesota Rules 7670 Cateeorv 1 Minnesota Ruies 7672 Energy Code Category • Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet 0 submission type) Submitted Submitted • Energy Envelope Calculations Submitted Have you previously constructed a building in Eagan with'a similar plan? _ Y _ fee applies. i Licensed Plumber ! /-Y 0 nn " ? - Telephone # ( -- Mechanical Contractor ; SEP J 17 ?., Il l Telephone #( «u,3 ? i' Sewer/Water Contractor L ? Telephone #( N If so, 25% plan review 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 accardance with the approved plan in the case of work which requires a review and approval of plans. De/U41/s PM1_)PP1 _.Fi?i? Applicant's Printed Name Applicant's Signature OFFICE USE ONLY Sub Types ? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 04 02-plex ? 10 OS-plex x 18 Deck ? 23 Porch (screen/gazebo) ? 05 03-plex ? 11 10-piex ? 19 Lower Level ? 24 Storm Damage ? 06 04-plex ? 12 12-plex PI6g_Y or_ N 0 25 Miscellaneous Work Types x 31 New ? 32 Addition O 33 Alteration ? 34 Replacement Valuation ? Census Code SAC Units - Nbr. of Units ? Nbr. of Bldgs - Type of Const ? , ? 30 Accessory Btdg ? 31 Ext. Alt - Multi ? 33 Ext. Alt - SF ? 36 Multi Misc. ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding ? 36 Move Bidg. ? 42 Demolish (Foundation) ? 45 Fire Repair ? 37 Demolish (Bldg)' ? 43 Reroof ? 46 WindowslDoors 'Demolition (Entire Bldg) - Give PCA handout to applicant Occupancy g - I MC/ES System _ Zoning AD City Water - Stories -? Booster Pump ? Sq. Ft. 36 ? PRV ? Length l li Fire Sprinklered " Width Footings (new bldg) ? Footings (deck) _ Footings (addition) Foundation Drain Tile Roof Ice & Water Final _ Framing _ Fireplace _ R.I. Air Test _ Final Insulation REQUIRED INSPECTIONS FinaUC.O. ? FinaUNo C.O. _ Plumbing HVAC Other _ Pool _ Ftgs _ Air/Gas Tests _ Final _ Siding Stucco Stone _ Windows (new/replacement) _ Retaining Wall Approved By Base Fee Surcharge Plan Review MC/ES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant License Search Copies Other Total ---------------------- ?? Building Inspector GC3L'L111" Gi?c .v. Oak ?'I1ase Huilderfs .?;-•°"°.,,"? ?I'i?e? Hocd 4 5? a t?:?k Chase W3y Eden Prairia, Mn. ?5344 Eagan, Minnes??ta ' S?123 I a DELMAR H. SCNWANZ LANOSUavEVORj._4?=- Re9iflend UnGU Law1 0l Tha $W41 of Minnotola ? 297B - 146TN STREET W. - BOX M ROSEMOUNT, MINNESO7A 66088 PMONE $11 493-1769 SURVEYOR'S CERTIFICATE 1U W { 7 ? II C? t. ci r ? ? `?.C -??jF •r'?i I rvr'N.!L' 7A ?V` ? `] ? ? ? ; ? ? ?-??? _ i 3 ?' ?' ZZ r ? .. -- I i I ? T r PROroseo M ? OUSE n 116 E1; ze u-r 1c I r Y EPseMENTS' M ? 13Lb.o Penotes exiating elev3tion ? Uenotea setback monument.a (Q) Det»tes proposed eleval-]on Denotes direction of aurface ? dra3.nage Propo9ed tnp ()f block elevatik)n i ? Propased baserent 1'loor rlevat ri ? 1 - ?J --? .?.- ? ?J ? 1 ?? ' ? t•l I ? \N1 ?\ I I FT. '• ? OVERH4NG o ? ? ?• ,1 f? ( ? `) ?J .._i_J ?] ^ • ' 2 ? ??. - ?= 59d?16 ? ? " J? `i :% 1 1 ` { ? ? ?fE l 9 / _ (r? ?Propoeed garaf5e i'laor elevation ?1 n`? ?, I hereb,y certlfy that t;his is a t,rue dnd correct rep"selitation uf I.ot 28, Block 3, BEACOM HTLI..S, aecording ta t}ie recorded plat Chereof, Dakota County, Minnesot:a. I)at.ed: .fanuary C3, 19tsi? Fievised ttils 11l day of Febroat'Y, 19?S3 tn snow t,he pt•nposed l?zcaClon ot' a huusc r,c;t sY.aked thcraorl. ' ??J?;r, .,? ?1 ,?a ??`?., •;?: ? ?' MiNNESOTA REGISTRa.T10N N0.86251,/r ?v qO tco ^.?7 - ___--__-___^ ? 'e . ?? i c? ? s j Permit #: U a? ?? I I ??y I ? Permit Fee: ?L" ? I / I ? Date Received: I Staff: ( I ? - J 2008 RESIDENTIAL BUILDI Date: Site Address: l L? {? Tenant: PERMIT APPLICATION Suite #: RESIDENT / OWNER Name: Lknr) s Phone:l Address 1 City / Zip: Applicant is: _ Owner Contractor TYPE OF WORK Description of work: Construction Cost: 5,219,_40 Multi-Family Building: (Yes ^/ No CONTRACTOR Name: License #: _?)()Qpg-1a'7 Address: 5G?l Mf'm(`)( IC1l.1 TCY e N. City: State: Zip: S6080 Phone:?OJ?'-1 ContactPerson: KQ?1? COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING _ Minnesota Rules 7670 Cateaorv t Minnesota Rules 7672 Energy Code • Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet Category Submitted Submitted N submission type) • Energy Envelope Calculations Submitled In the last 72 months, has the Ciry of Eagan issued a permit for a similar p{an based on a masier plan? _Yes _No If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer & Water Contrector: Phone: AIDTE Ple?rsat?d suppor?lt???f ??qju??b a? f j k kc S 4? ( e ?y k 4 ra-'?rMfr?'? "?t}? c`? 3 R' `:. +y? y -a +. g {?yy? F ? .s.t I ?? ?j} ??i . Jg ? y? y 41?fl?2i ? ?FVI?i'??.? As:2 s. I I hereby acknowledge that this intoRnation is complete and accurate; that the work will be in Conformance with the ordinances and codes of the Ciry ot Eagan; that I understand this is not a permit, but only an application for a permit, and work is not tp 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 fftIL 6&_? X LA Applicant's Printed ame Applicani's Signature Page 1 of 3 PERMIT #: 5 3 ? 3 5 CITY USE ONLY RECEIPT DATE: 4SIS 0z EOOQ RESIl3ENTIAL bIECHANICAL PEiMIT ?PPLICATION crrY og EAsAx 3$30 PILOT KNO$ RD EAfiAP MA 55122 651-6$1-4675 Please complete for. .. 9 single family dwellings townhomes and condos when permits are required for each unit Date: V Q- SITE ADDRESS: D`?) K? OWNER NAME: TELEPHONE #: INSTALLER NAME: TELEPHONE #: STREET ADDRESS: F^? V 1 vwl LJ J _ CITY: STATE: qlv? ZIP: ?L) Place a check mark next to the permit work type Add-on, modification or alteration to existin dwelling unit $ 30.00 • furnace replacement • air exchanger • other U '4"? AU G 0 2 20 rv f 2 ature o work: ? ?v -- State Surchar e $ .50 Total qn 1 V l ? SIGNATURE OF4ERMITTEE ll02 CITY USE ONLY PERMIT #: RECEIPT DATE: APPROVED BY: , INSPECTOR SOOE CObIMEItCLVEL MECHMICAI. PEtM1T APPLICATION C1TY QF KA6" S$SO P1LOT KNO$ EtD KAsAv, Nuv 55 122 651-6$1-4675 Please complete for: all commercial/industrial buildings mulfi-family buildings when saparate permiis are r.ot required for sach dweiling unit DATE: SITE ADDRESS: OWNER NAME: PHONE #: TENANT NAME (IMPROVEMENTS ONLl): WAS THERE A PREVIOUS TENANT IN THIS SPACE? Y N. NAME: INSTALLER: STREET ADDRESS: CIT'Y: TELEPHONE #: STATE: ZIP: WORK TYPE: New construc6on Install U.G. Tank _ Interior Improvemeiit Remove U.G. Tank _ Processed Piping Specify Nature of Work When installing/removing underground tank, call 651-681-4675 for inspectian by Fire Marshal and Plumbing inspector. Fees: 1% of contract price OR $50.00 minimum fee, whichever is greater. Underground tank removaUinstallarion = m;nimlun fee Contract price: $ x 1% _$ (Base Fee) State surcharge calculate at $.50 for each $1,000 Base Fee TOTAL $ SIGNATURE OF PERMITTEE Updated 1/02 1999 BUILDINC PERMIT APPLICATION (RESIDENTIAL) G4D-7 CITY OF EAGAN 3830 PILOT KNOB RD - 55122 651-687-4575 -cl ? New Conshuctlon Reaulremenis Remodel/Reoair Reaulrements ? 3 regisfered sNe surveys showing sq. ff. of lof, sq. ff. of house and ?II roofed areas f20% maximum lot covera4e albwed) ? 2 coples of plans (ahow beam 3 window sizes; poured tnd. design; etc.) ? 7 set of energy cakulaflons ? 3 eopies of hee preservaNon plan B lot platfed aNer 7/1 /93 DATE: !A- /' ( / DESCRIPTION OP WORK: blWi'ti5 - st.c' ? illln L 2 copies of plan 1 set of energy calculatlons for heated addNfons 7 stte survey for exferlor addiHons 3 decks CONSTRUCTION COST: STREETADDRESS: 4/6a' 3 ?i/l55l?'??? DlZ • a ? LOT: BLOCK: -3 SUBD./P.I.D. #: ?D Q?C 0 V` Name• v[ ?!( ?P; Phone #• `f°Iv- PROPERTY Last Fint OWNER Street Address: y& a 3 3 Az PR - City FQGA 0 State: Zip: Company: A z. 7-E C C uw5T2 4r-e-T 0 4'" Phone #• &12 0/ J-cxxlv (area code) CONTRACTOR C n Street Address: ?? S o 3 /? zl? l?2 license # Exp. ctty 2'o s(?? ,- L state: zip; 6 S 3 3'7 ARCHITECT/ ENGINEER Company: Name: Telephone #: area code ( ) Sheet Address: Registration #: Clty State: Zip: Sewer 8 water Iicensed plumber (reaulred for new conshuction onlv): PenaMy applies when address change and lot change is requested once permit is issu d. 1 hereby acknowledge ihat I have read ihis appllcaHon, sfate that the Information is ct, a agree to c ply wNh all applicabl State of Minnesota Statutes and City of Eagan Ordinances. ? 3lgnature of ApplicaM: OFFICE USE ONLY Certificates of Survey Received _ Yes _ No Tree Preservation Plan Received _ Yes _ No _ Not Requi"red-- -°- OFFICE USE ONLY BUILDING PERMIT TYPE ? 01 Foundation ? 06 4-plex ? 11 10-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 02 SF Dwelling ? 07 5-plex ? 12 12-plex ? 17 Garage ? 22 Porch/Addn. (4sea. ? 03 1 of _ plex ? 08 6-plex ? 13 16-plex ? 18 Deck 0 23 Porch (screened) ? 04 2-plex ? 09 7-piex ? 14 Apartments ? 19 Lower Level ? 24 Storm Damage ? 05 3-plex ? 10 8-piex ? 15 Lodging ? 20 Pool ? 25 Miscellaneous WORK TYPE ? 31 New ? 35 Tenant Impr ? 39 Gas Line Only ? 43 Siding/Soffits/Fascia ? 32 Addition ? 36 Mave Bldg. ? 40 Gas Insert ? 44 WindowslDoors ? 33 Alteration ? 37 Demolish Bldg.* ? 41 Woad Stove ? 45 Fire Repair ? 34 Repair ? 38 Demolish (Interior) ? 42 Reroof * Give PCA handout to applicant for demolition permit GENERAL INFORMATION Const. (Actual) (Allowable) UBC Occupancy Zoning # of Stories Length Width Basement sq. ft. Main level sq. ft. sq.ft. sq. ft. sq. ft. sq. ft. Footprint sq. ft. Census Code SAC Code No. of Units No. of Bldgs MC/E5 System City Water Booster Pump PRV Fire Sprinklered APPROVALS Planning Building Engineering Variance Permit Fee Surcharge Plan Review License MC/ES SAC City SAC Water Conn. Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment PI. Park Ded. Trails Ded. Other Copies Total: Valuation: $ SAC Units % SAC ? , .,. •r ^ J U ` v U } ?Gr'1-4 y • 50'F 9 3•JU; . .. SINGLE FAMILY DWELLIPGS 1989 BQII,.DIRt3 PERMTT IPPLICATION ' CITY OF EAGAN ? ? lpLTIPLE DWELLING3 COMSERCIAL 2 SETS OF PLANS 2 SEI'S OF PLAN3 2 Sh'fS OF 1RCHIlECTURAL 3REGISTERED SITE SURVEYS BEGISTfiEIED SITE 30RVE2S - & ST80CTURlL PLANS i SET OF E'IPERGY CAI.CS. (CHECH WITH BLDG DI9. ) 1 SET OF SPECIFIC6TIONS 1 SET OF EIIERCT CiLC3. 1 SET OF F•AERGT CALCS. WLTIPLB D1iELLINCS EN'IgL TMS FGR SaI.B VHIT3 f OF DNITS iOTE: 1DDAESSES FOb CORNER LOTS - CONTAACTQB/HOMEOiiAER lIDST DWI4NATE i1HICS 1DDHF5S IS DESIRED. NO CHAtiGFS iiILL BE lS.LQiiED ONCE BUILDIpG PEM31T IS I3SUED.. SEWER 8 iTATER PERMIT P'EES lAD ACCOIIRT DEPOSIT FTsE.S i1ILL BB INCLIIDED itITH THE HOILDIN(i PERHTT FEE. PROCESSING TDM FOR SEfiEA lAD iTATER PEEMIT3 IS TiIO DIYS OIiCE A PERMIT HAS BEEIi COMPLETED INDICATIHG A i.ICENSED PLOlIDER. PENALTY APPLIES WHENs PERMTT IS NOT PAID FOR IN 3AME MONTH IT IS REQUESTED. LOT CA6NGE I3 REQUESTED ONCE PERMIT IS I5S[JED. SEP 2 1986 lo Be Used For: Site Address 0#4F?'oE 171/Y81U8t30n: ?/&a3 ?,jA?X D?. , 1 Date: OFFICE OSE Oecupancy M _ I 2oning Actual Const Allowable # of atories Length ? Depth ?_ Lot 20 Bloek y3 Parcel/Sub , !?? ?? /T4J Oimer Address q6 13 /v"?NG,S4ur?x ?/R. _ , City/Zip Code 4?96A*! MN, .M.2 2 ArwE °- Phone HurA*e)4-o9k u-Tre WoK Gf2 - 8'.7f -19J? 0 Coatractor bddress CiLp/Zip Code Phoae irch./Engr. Address r City/Zip Code S.F. Total Footprint S.F. On aite aewage On aite xell _ MWCC Syatem _ City irater _ PRV required _ Sooster Pump _ U-AM Bldg. Permit Surcharge Plan Reniew SAC, Citq SAC, MWCC Water Conn Water Heter bcet. Deposit S/W Permit S/W 3urcharge Treatment P1. Road Unit Fark Ded. Copies SQBTOTAL Penalty ?OT1L qD,o n 3, So 77 0 iYPHOVALS Planner • Couneil. Bldg e Qt'f. , 9lne Tariance Phone 0 iL ,- . ... ?: . ? j'L1LIC46C 1CJL" : uCil'71,11 Vlal`c ava , entex 3IoNes rLidweat Tric. Oak 1,Iiase E3uildera 3601 I)gr°r?e1'i Road 452? Clak Chaa? Way Eden Prairie, Mn. 55344 Eagan, Mirii-ie?t'ita 5'i723 DELMAR H. SCHWANZ LANO SURVEVOPy?.ZN'= Reqiitar4q Untlu Uws o1 7ba Slita oi MinnesoU • 2078 - IIBTM STREET W. - BOX M ROSEMOUNT, MIMNESOTA 6608 PNONE i11 423-1769 (U w ? rt ? - _ .v L f? q? 'l? n? Q ,..? ? ?E D N F70 7- I I ? L. oc r? J t SURVEYOR'S CERTIFICATE '???,i.r; ? ???N?G ?'?__ ?.3L? ?1 7•7- 'f?? ` ??;?r,'1.^.? `, -- -+- - ?^+- - t _. 22 ? 6A(: G AR` )?UJJ N I A'DD 414) w ? ! I 14A,r/ As E ? U7 « r 7 y' ERS€MENT>'J -- _ ! GROPOSEO ?o NOUSE n I ?. _ , ?. `14 ?j ?,•, ? I ± y ? -< ? Proposed top oP blor.k elevatlort i Proposed baser:uent; f'loor elevat n P ? T? FT OYERHANGI 7a . -l? ?PropQaed garafge t'loor elevation I?(A.o nenotes ex:lating elevat,iun (iiDI)etwtea propased elevat:]ori I El Deriote8 sc:tback monumenl;a T)enotes directian of surfa(.e jlr? draina.ge I hereb,y certify ttiat thIs ie; a t.ruE dI1d correct representdtion uf [.ot 28, B.iock 3, BEACOrI HIt,I:,, accordin, to Ltie recorded plat l;Ysereof, Dakota County, Minnesot:a. Dated : January l_3, 19it0 ReviBed tliia l`1 day of Febrit tiry, 19t;3 to show i.he pWOp0?30d lacatiloi) oI' ;i housc nct Btaked thereori. ? /'' ' ?... f . ' .. - ' S ._ MINNESOTA REGISTRATION NO.B625 (__?.? u 1 ? ? k = 5 98•'!G f ;, . ?? CITY OF EAGAN Include 2 sets of plans, 1 site plan w/elevations & ?? BUILDING PERIATT APPLICATION 1 set of energy calculations. Zb Be used Fbr ,?1?- (?? valuation Qdh Date Site Address L} 6 P-3 K i n?s E v ( ?1 P, OFFICE Lot X Paroel #: slock 3 sec./sub. V nW Erect occupancY L?.3- Q ( `?a -5-0 C) Z 90 D Is Alter Zoning ^ 41 Repair Fire Zone Owner: ?- C t{A3?.= 3V i?Dr2S? \ v\C IIzlazge Zype of Const. Ad?dress: I"b? # Stories Dennlish Fnont ? ft. City/Zip Code: ;;An M rk Grade Depth ft. Phoae # : qS2 3 0 g Contrackor : ,S Ayn -2 Address: City/2ip Code: Phone #: Arch./Eng.. APS Add=ess: City/Zip Code: l h?qrci^P 4t, . Phone #: 4-?b-09-0 AFPROVAIS FEF.S Assessments Petmi.t [4ater/Sewer Surcharge Police ?7 Plan Check- Fire __ SAC S? 5 Ehg. Water Conn. Planner ater Meter Council oad Unit ,;?,s-'D Bldg. Off. ? APC 7Grj-.5-0? 'POTAL -I11 t USE ONLY ?G ? ? i S ? ??? 3 g 3? ?; ?a a _ f? ? ? ? Cartificate fccr ; pentex Homen Piidweat Inc. 8601 Da7Pne11 Roafl F.den Prairie, F4n. 55344 ? DELMAR H. SCHWANZ LAND SURVEVOR:?'-f/V4 . . Repisteratl Untla LaWf Of Tbe Statm of Minnawta 2978 - 748TN STREET W. - BOX M ROSEMOUNT, MINNESOTA 56088 W V?o? _ ?+ a- - ? O P, kf, \qj Q 0 C) ? v Certificate for: Oak Chase Bu9.lcierB 4525 Oak Ghaae 5day Eagan, hfiinnesota S51?.3 PHOHE 872 423-1789 SURVEYOR'S CEHTiFICATE .?. 6 (,ff D I ?!f? r T?tiuB 1A .,N `? `1 % 3 S ; z ` ?,?? ? o q5? °fTv? `---a?---- ? ?? ?O ? L I? t? C U?. ,?C 5?' I 1 I I ? ?b r ? Dr4 A6- E ? UT rL r T?' ERS? ME NTS .o , zz G4R. ` PROPOSED ? NOUSE a a 1 m Iy I FT. OVERHAN6 -- ? N ? ? () ? J, '{ I ?1 :. I. 6'f'r - R= S q8 9G I? l? ; " ; g 3 ? „w p /71 L 5- i I ? ??f?''`' , q6? A N 4j `?Praposed garage 1'loor elsvation +`?3 r ?1Ic I _ Propaoed to p oi' black elevation r ' Proposed basQment Ploor elevat n ? °Nmbro Denotes existing elevation [ Denotes setback monuments ? Denotes prpposed elevation Denotes directian of sarface O*r? dra3nage I hereby certify that this is a true and correct repre3entation of Lot 28, Block 3, BEACOA7 HII,I.g, according to the recorded p2at thereof, Dakota County, Minnesota. Dated: January 23, 1980 RevlsQd this la day of February, 1983 to zhow the proposed locatI.on oP a house not ataked thereon. ; ' •j ?`' ?. ry MINNESOTA REGISTRATION N0.8625? s If; . a. Total wall windo-vi area ................ Z b. Total daor area ....................... D.9 c. Total s2iding glass area ............... ?3.9 d. Total fireplace vrall area .............. o e. Total wall framing area (average 10%).../ f. Total net wa1Z erea above floor ........ io , S. Total ric. joist area ................... /oya. Total exposed fcundation area 6 7a•g h. Total foundstion vrindow area .......... o 1. Total net foundation area above grade . 870•8 Determine '",U' value of each wall segraent. 8. /7,.;• 7 g ti U 1" i..:C:r s ? b. ?•g }( rrUr. c.3?.A X ?:U:' D. D X "U" e.?.i }( 1.v?f ,/? ° ao•3 f g ,: U?: . ds? _ ? • G F??OS?•.1 X 'I U.. .bY = eo h. o X `'U' - o = o i.?-9?+ . X F . EXTERIOR ET1V?,'.TCPE AVERAGE 'U ' COi1?TJTATI03I ot•rvER l!52a - 0a.l SITE ADDHESS CONTRACTOR DATL PI?Ot•JE 515?2 -30S-„3 Determine yrorking square footage of each. 1. Total exrosed wall area ..../G yo. y eq. ft. x.19 2. Total roof/ceiling area ..../i9yf< o sq. ft. x.04 Total exposed wall area above floo'r =/G 90- :?? _ /• 3 .................... .............. ........... Tota1 a 147a,R If item #3 is tne same as, or less than item l11, you have met the in*_ent of SBC 60-16(c)2. ,?? # 3 9 O?F•8, e, 321.L 4?4 /X-? 543 c G oG b? -) L F_ . ? • G_ . ?-• Total exposed roof/ceiling area ?. iotal akylight area .................. o k. Tatal rooflceiling frar?ing 2rea (average lOn /o .G _ 1. iotal net insulated rooi'/ce311nG area ....... ZP9•% Determine "i3l value for esch roof/ceiling aegr,ient. j, . o X „U;: a ? o k., Oq,G X U" 1.789 / x ,:Ufl o?/ • ,?9. / 4 ....................... ..................Tota1 = .3y'.y Zf total o: f4 is the same as, or less than E2, you have met the intent of SBC 6006 ( c) T. ?, '* y 3gI p`c9a;-? µ y W. 8 olru.? Alternate Buiiditig Envelope DesiF,n G To utf?ize the total envelope syster, aethod, the values established by the sun of items 43 and 04 shall aot be greater than the sur.:.of itens #1 an3 r;2. i. 3zi. z + 2. eli,B = gG3-a 3. a of. 8 + 4. 39. 9 5e8• ?7 ,P2 $19,7 4 ,3 4 3. 0 ole a.. ,c? s4 CITY USE ONLY PERMIT #: ? RECEIPT DATE: SOOE RESIDENTIAL NlECEkNICAL PERM1T APPLICATION crr7t og EAsArr . 3$30 PILOT KftOB {iD EA6lk14MN 5S18E 651-6$1-9675 Please complete for: ? single family dwellings townhomes and condos when permits are required for each unit Date: 11 SITE ADDRESS: I;VCc_?3 p??v?er OWNERNAME:?d" poJkni5 1TELEPHONE#:VIJ) 40`' qf95 INSTALLER NAME: TELEPHONE #: ... ._ :... . . ._ _ .. . . _ ... _....?.p. _ _ . ... _ STREET ADDRESS: ?U" v, v CITY: STATE: ZIP: 1 ? Place a check mark next to the permit work type Add-on, modification or alteration to existinq dwelling unit $ 30.00 • fumace replacement • air exchanger • air conditioner • other Nature of work: ` v CmC ? ? ??IcoZ ? State Surchar e $ .50 Total bhm SI NA F ERMI7TEE Uo2 CITY USE ONLY PERMIT #: APPROVED BY: INSPECTOR RECEIPT DATE: 8008 CObIMEftCIAL MECHAN1CAI. PEftM1T APHLICATION CITY 0r EA6m 3$30 P1LOT KNO$ RD KA6M, Mlv 55182 651-6$1-4675 Please complete for: ail commerciallindustrial buildings multi-family buildings when separate permits are not required for each dwelling unit DATE: SITE ADDRESS: OWNER NAME: PHONE #: TENANT NAME (IMPROVEMENTS ONLY): WAS THERE A PREVIOUS TENANT IN THIS 3PACE? Y N. NAME: INSTALLER: _- STREET ADDRESS: CITY: STATE: ZIP: TELEPHONE #: WORK TYPE: New construction Install U.G. Tank _ Lntesior Improveanent - Remove U.G. Tank , Processed Piping SpecifyNature of Work: N'hen installing/removing underground tank, call 651-68I-4675 for inspection by Fire Marshal and Plumbing inspector. Fees: 1% of contract price OR $50.00 minimum fee, whichever is greater. Underground tank removaVinstallation = mvnimum fee Contract price: $ x 1%= $ (Base Fee) State surcharge - calculate at $.50 for each $1,000 Base Fee TOTAL $ SIGNATURE OF PERMITTEE Updated 1/02 Use BLUE or BLACK Ink For Office Use I Permit L I City of Ea I Permit Fee: Ed 3830 Pilot Knob Road I Eagan MN 55122 I Date Received: I Phone: (651) 675-5675 I I I Staff: Fax: (651) 675-5694 L -----------------I INFLOW & NFILTRATION PERMIT APPLICATION Plumbing / Sewer & Water Date: 0/ 0 Site Address: Tenant: /G`%l✓%U< s ~ ~L ~~1~ Suite M RESIDENT / OWNER Name: ,yz~%l//(/,`S A,1114 Phone: 4; 95_ Address/ City/ Zip: Name: License CONTRACTOR Address: City: State: Zip: Phone: Contact: Email: PLUMBING (Within the building envelope) SEWER & WATER (Outside the building envelope) TYPE OF WORK ZL' ump Pump Repair Repair Other: Other: DESCRIPTION Description of work: 1-71-EX 7-0 PI/C- P/IDLE FEES $55.00 / Each (includes $5.00 State Surcharge) TOTAL FEE $ *Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submit III repair costs for reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors can be found by visiting www.cltvofeagan.com/inflow, or City Hall at 3830 Pilot Knob Rd. 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.oro 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 eview and approval of plans. XDVL //"kS ox~&0'1217 11,111A-1; Applicant's Printed Name '*-Applicants Signature FOR OFFICE USE Reviewed By: Date: Required Inspections: -Under Ground -Rough-In -Final