4568 Kirkwood Cir? CASH RECEIPT
CITY OF EAGAN
3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE
19 _
rteccIveo
FROM
AMOUNT $ I
& ooLLnRs
10.
E] CASH [:] CHECK
POR
?
--
BY
White-Payers Copy
Yellow-Posting Copy
Pink-File Copy
Thank You
?D-?.
, cIrY oF E?GAN,
?•` ' 3795 Pilot Knob Rood Eegan, MN 55122
PNON E: 454-8100
BUILDING PERMIT
Receipt #
Siro Address , `` ^
Lot Block Sec/Sub.
Porcel #
W Name ? ^ri4t2."UCt? - : ?"
; Address ? O1'lOT C{:
b ?-.? ...
,o Name
?
?? Addrett
? CI Phone
G? Ncme
WW
FW
Z
•.1.1n AJJWrQss
Ered [J Occupanry
IAlter p Zoning
Repoir ? Fire Zone
Enlarga p Type of Const.
Move ? # Stories
Demolish ? Length '
6mde ? Depth Sq. Ft.-
Avororolf Fees
Assessment
Wcter & Sew.
Police
Fire
Enp.
Planner
Council
Permit
$urchorge
Plan check
SAC
Water Conn.
Water Meter .__ _
Road Unit
I hereby acknowledge that I have reod this application ond stote that gldp. Off.
the intormotion is torrect and agree fo comply with all applicable
State of Minnewta Statutes and City of Eagon Ordinonces. APC Total
Sipnoturc of Permittee -
A Building Permif Is issued to: on fhe exprcg tondition tMt
uli work shall be done in ocrnrdonce with oll opplicoble State of Minnesota Statutes ond City of Eayan Ordinancea.
Buildinp Official
Parmit No. Permit Holder Miu. Parmit No. Holder
Plumbin9 Z l? ? 81`LIC?MU4FJ 7`36
H.V.A.C.
cJZ 5£QS ?
Con?ro( -Z3^frZ
Wall
Weter
Disp.
Sewer
Elect.tc T79YlvY kak--r'FC-t..
`141(W 1' .z2-82
InapecKion Dats Insp. Other
Footinp .I •
Foundetion
. . ?y
. ?
4
HVAC
ar'tg
Final Pibp. W
Fin
al HVAC
?
Final
Water Dsseribe Location:
VYell
Sawer '
Pr. Oqp•
11
Raceipt ? MECHANICAL PERMIT Permit No.
CITY OF EAGAN
Fee
Fill in numbered spaces S/C
Type or Print /egibly Tot. ."
, _.
7. Date `2. Installation Cost
3. Job Address Lot7Blk Tract
4. Owner
5. Contractor
6. Address
7. City f! - State
8. Building Type: Residential ? Commercial ?
3
Zip ?- ?
Institutional ?
9. Work Descri ption: New f3 Add ? Alter ? Repair ?
10. Describe , Fuel Type : -? /',.?
11.
No. Eauinment BTU - M. Ea.
Forced Air ' ? ` No. Equipment CFM
Air Handlin
:
Mfg. g
Boilers 1 0 ? C t %
-
Mfg. -
Mech. Exhaust i
Unit Heater
Mfg. Other
Air Cond.
Mfg.
Gas, Piping Outlets i
12. I hereby certify that the above information is true and correct, and 1 agree to
comply with all ordinanCes and codes governing this type of work.
Signed: for
Rough Pinal
Inspections: Date Insp. _ Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-6100
Receipt
PLUMBING PERMIT
CITY OF EAGAN
I Fill in numbeied spaces
Type or Prinf legibly
Permit No.
Fee ?
S/C
Tot.
? -,
1. Date J f:. 2. Installation Cost
3. Job Address /?? Lot__Z_Blk. ? Tract
4. OWnef
5. Contractor /z, /Phone
6. Address [
7. City/24L) ?State Zip .? i
8. BuildingType: Residential n
9. Work Description: New 14
10. Describe
11.
Commercial ? Institutional ?
Add ? Alter ? Repair ?
No,
i Fixtures
Water Closet No. Fixtures
Cesspool/Drainfield
Bath tubs $eptic Tank
i Lavatory Softner
Shower Wel I
? Kitchen Sink
Urinal/Bidet Other
Laundry Tray
i 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
Rough
Inspections: Date Insp.
for
Final
Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN
454-8100
INSPECTION RECORD ?? z?fl
I CITY OF'EAGAN PERMIT TYPE:
I 3830 Pilot Knob Ro2d Permit Number.
Eagan, Minnesota 55122-1897 - Date Issued:
I (612) 681-4675
? SITE ADDRESS: }' l 0' 1 1'„j APPLICANT:
, ` i i<t Lln?i(l C 1;.. u• rt}; i I ? r•? 1`f
? ? III '. 19I1t; I r+`. f t'? 1 i(?1 .' 1 ra;r, i 1 t<r: ,
PERMIT SUBTYPE:
1111,1 : 1!111
TYPE OF WORK:
....
{, 11 u1 Ctl' I t
T( F Ml1V b 1, A'-;EF'RI+R fF PE ttN11 i I,{:' iJU 1 14 f' 1) f'i.?R AN 4-' !! itMi< t Nlt, 9) 1< i t F f. i f; 1 CA ! t.lt) I zt
Permlt No. Permlt Holder Date Telephone #
ELECTRIC Irv
PLUMBING
HVAC
Inspection Dete Insp. Comments
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
fiL'DC' fINAL ? ,?`??7 I M8
BS6ITR.I.A ----- - I -'- -
BSMT FINAL
DECK FTG
?oL
r-5
/??J
. INS
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
? ?agan, Minnesota 55122-1897
Date Issued:
f (612) 681-4675
I SITE ADDRESS: APPLICANT:
? PERMIT SUBTYPE: TYPE OF WORK:
• ? r;; ,
?.
INSPECTION ,.
. DA
,I
F
L
r?
?
?
Permit Holder Data Telephone #
PLUMBING
HVAC
Inspection Date Insp. Comments
FOOTINGS
FOUND
FRAMING
ROOFING 'Ir
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
DOMESTIC
METER
IRRIGATION
METER
FLUSH
MAINS
CONDUCTNITV
TEST
HYDROSTA7IC
TEST
BSMT R.I.
BSMT FINAL
DECK FfG
DECK FINAL
CITY OF EAGAN
Addition Lot Blk 3 Parcel 10 17150 07171 03
Owner Street 4568 ?c pWrr? .irrla ?r,g?
State ?n- MN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREETSURF. f 1982 2622.14 24.4 2097.72 A011325 8-6-82
STREET RESTOR.
GRADING
SANSEWTRUNK // 1()8.00 A01132 -- 2
i,SEWER LATERAL 2037.12 it it
WATERMAIN
ANATER LATERAL
WATER AREA ,?/0 168.00 A011325 8-6-82
STORM SEW TFK 210.66 A011325 8-6-$2
i.STORM SEW LAT 1981
CURB & GUTTER
SIDEWALK
STREET LIGHT
ROAD I _ _
WATER CONN, 420.00 n i
BUILDING PER. 7-296
SAC it n
PARK
;
3795 Pilot Kno6 Read PERMIT NO.:
Ed9an, MN 55122 DATE:
Zoning: No. of Units:
Owner: -
Address:
Site Address:
Plumber:
Meter No.: Connedion Charge:
Size: Acwunt Deposit:
Reader No.: Permit Fee:
1 agrea ro Gomplr with !Ua City of Eagan Surcharge:
Grdinenea. Misa Charges: '
Totcl:
BY Date Paid:
Date of Insp.: ?nsP,;
CITY OF
3793 Wlot Kno6 Road PERMIT NO.:
F;agan, MN 55142 DATE:
ZOning' No. of Units:
Owner:
` -aoz t 3-114; - ?T
Address:
Site Addreu: _ ..v.?a 7 -
Plumber:
1 egme fo eemoly wiM the Ciry of Eagan Connection Charge:
Ordinaneos. Acwunt Deposit:
Permit Fee:
Surcharge:
8Y Misc. Charges:
Dote of Insp.: Total;
Insp.: Dote Paid:
BUiG.DING PERMIT
Est.
Site Addreu
Lot 7
Parcel # -
Block 3 $ee/Sub. Che5 MdL' EdSt 1
10 17150 070 03
oWC Name Rl i 1 i P C'nnc nx+i rm C'n
Z Address 644 SLAper'ioY' Ct
9 ..:_. Eaaan 454-1438
w
ip
O
u?
Name cxnmer
Address
City _
Ncme _
Address
N° 7296
Receipt # / (>
Erect ? Occupancy PQ
Alter ? Zoning PD-Pd
Repoir ? Fire Zone NA
Enlarge ? Type of Const. V
Move ? # Stories
Demolish ? Length 41
Grode ? Depth 48 Sq. Ft.-
Approvals Fees
Assessment _
Water & $ew.
Police
Fire
Eng.
Plonner _
Council _
Pelmit 3L?.UU
Surcharge 32.00
Plon check 162.50
5AC 525_00.
Water Conn. 420 _ no
Woter Meter 60 _ 00
Rood Unit 940 - nn
I hereby acknowledge that I have read this opplication and stote that Bldg. Off, '
the inlormation is torrect and ree to comply with,all oppliccble APC Totol 17'?+4 5(1
Stote of Minnesom Smtutes a, d City of Eogon Or rances. _
$ignature of Permittee
A Building Permit is issued tec en the expres tondition thai
all work shall be done in nctoropnte v,{ith all ppplicoh}e $tMe of Minnesota Statutes ond City of Eagen Ordinontes.
cirY oF EAcaN
3793 Pilot Knob Road Eegan, MN 55122
PHONEi 4548100
Buildinq Officiol
"r 79 9io y
f>a,k - TE c ?
s-z0 -kw, p
CITY OF EAGAN Include 2 sets of plans,
/7 1 site plan w/el.evations &
BUILDING PERM2T APPLICATION 1 set of ene.rgy calculations.
Zb Be Used Fo ?? 't7aluatiorDate ^-% --?Z_--?.?(?
site Address : oFFICE uSE ONLY
Ivt Blocx _3 sec. /sub. CV E 5 (17x] ? Erect ?_ occupancy
Parcel #: L_ 171?vC? 670 d3 ?A5T ?ter Zoning
Repair Fire Zone ?
Owner:
Addresss
City/Zip Code:
Phoxie # :
Contractor: '?B l.-Ci A-3 n '- ?-v _
Addx'255: (}, y y ?..? ?r r crz---r-
City/Zip Code: 'ac3,
Phone # :
Arch. /Eng. .
Address:
City/Zip Code:
Enlan7e Type of Const.
Move # Stories
Lennlish Front ft.
Grade Depth 48' _ft.
APPMATALS FEES T
Assessments
Water/Sewer
Police
Fire
laxmer
Council
Bldg. Off. APC
Phone #:
?o t?_ an BP, - FIFC. ?£rr,? 794[a? .I?aX---rE c
Permit
Surcharge Za
Plan Check -SP-
SAC ev
Water Conn. c9 _
Water Meter 60 -a
Road unit ?. y0 ?-
' =pL &qSC?
?-'- ,;
S 20 -$'Z C-?-v- "
.1?
. .
y/aoV
?/, yo 0
?y ?
` y ^/yREQUEST FaR ELECTRICAL INSPECTION
/ Q p? q{? See instructions fnr completin9 lhis form pn back of yellow copy.
T
1 ! V V
P'` i Nork Covered by This Request
? EB-00007-03
(0 7--'
New dd Rep. Type of Building Appliances WiroA Equipment Wired
Home Range Temporary Service
Duplex Water Heater Lightiny Fixtures
Apt. Building Dryer Electric He.atin
Commercial eldg. urnace Silo Unloader
Industrial Bldg. Afr Conditinner Bulk Milk Tank
Ferm OLh,r Specilv, OtherlSPecHy)
ther (SUFr.ify Other piher
Compute inspectron I-ee Helow
N Fee . ServiceEniranceSize k Fee Pexde.rs/Subfeeders N Fee - Circuits
• 0 to 100 Am s 0 to 30 Am 0 to 30 Am s
101 to 200 Amps 31 to 100 Amps 31 to 100 Am s
Above 200 Amps Above 100_Amps Above 100_Amps
Transiormers RemoteControl Circ. Partial%Othe -e
Signs Special Inspection 0
$ L
Renu?rks
TOTAL F E_
Rough-in Dato.? (i thn Electrical
' ? Inspectur, her¢by
tit
th
t lh
b
Final
Date
?-?? cer
y
a
e A
ov¢
!;y s been
d
O ma
e.
This revuest void
16 months from
799 6L-7( 63/ cl?fstitar?.as?f- )s?- 3o(o(o (?o
?fl'mon troin ? zZ
Request Uate
^ Fire No. Rouqh
-in Insper,tion
Reu 1i'ed?
?Ready No ill Nolify Insper.-
)
??
L'
_- ?
s ? No t r Whrn Ready
35?1 censed Electrical Contractor 7. I hereby request insvectiun of above
? Owner . electrical work installed al:
Street Address, Box or Ro te u. . ^
? /?e/l ? ?
G Citv
?
UL l.^,
eGuoi o. TownsM1iU Nnme or No. , Ranye N0. l.uu 0
??LC
Oc. upa (PpiN Pho? No.
Power AdAr?
LW
Electric ntractor IC.omp?y,?lar?el
J?- Contr ctor's LicS2se No.
(D 3: S-3 3
Mailin0 AdJress (Coniractor or 9,oO/?er ki Inst ilatio?
?? ? 'q n ???
Authorized nature iC tractor/Owner Maki I alla 'o
? Phnne Numbe,r
LJ
, 1
MINNESOTp STq1FB6}tR0 OF ELECTRICITY I /7HIS INSPECTION REQUEST Wlll NO7
Griggs-Midway Bldg. - Room N-191 . gE ACCEPTED BY THE STqTE BOARD
1821 University Ava.. St. Paul, MN 55104 UNLESS PROPEH INSPECTION FEE IS
pF - M21 997 7111 ENCLOSED. -
REQUEST FOR ELECTRICAL INSPECTION es-ooooi-oa
T , 7': np? {A'
y ' See instructions for completing this form on 6ack of yellow copY•
?..v J V ?t°
""X elow Work Covered by Ihis Request. ? 30 1'7 S
e Add Rep. TYPe of Building Appliances Wired Equipment Wired
Home Range Temporary Service
Duplex Water Heater Lightiny Fixtures
Apt. Building Dryer Electric Heatin
Commercial Bldy. Fumace Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tank '
Farm Otne, speury other fSOeclfyl
O[lier Specify Other pITF f G
Compute lnspection Fee Below !' ! f G
# Fee ServiceEntranceSize t! -.Fee Feeders/Subfeeders f! Fee V Cirg:' uits
() to 100 Am s 0 to 30 Am s 0 to 30 Am s
101 to 200 Amps 31 to 100 qmps 31 to 100 Am s
Above 200 Amps Above 100_Amps Above 100_Amps
Transiormers Remote Control Circ. Partial, , Other Eae?
Signs Spec la I Inspectlon
$
a
Remarks TOTAL
F E ro:
Roueh-in Date
1, the Electrical
Inspector, hereby
certif
that th
6
Final
N y
e a
ove
i"Inr+;..n has 6oen
i aflfde.
?
This request void
18 months from
This requas! void -5( Zb
T ?64
,$n:T99
L 7, g3? ???F?1 g? 3oc`Z S
/b- on
Renuest Date Fire No. Rough-in InsUer.tiun ???///
eq ed? ?Heady Nowill Notify. InsPec-
e
es ?No r WYien Rca(ly_
4 ,?censeA EIeCtrical Contractor `herehy request inspection of abnve
4 ,)wner electrical work installed at: . .
St,9et Addresg, Bux or Roule o.
-
1 ` , City;
.
er.tionO. Township me or No. Range No. Counl /
•
[?A
l
Occuy3nt WRINT)
V
? Phone No.
\
v
?
Po e uppLaer ir Address
Eler. •al Comractor (Company Name) . Comractor's License Nu.
?
?
n
3
,3 ,
MailinA Address (Cont tor or OWner Making I tallation)
y
'
?
Au[horize 'gna r( onva r/ ner
M ing Installatiorif
'41-11 "I . Phone ?Number '
MINNESO7p STq7E BOABO OF ELECTpICITY O- THIS INSPEC710N REQUEST WIIL NOT
Griggs-MidwaV Bldg. - Room N-797 - ? BE ACCEPTEO BV THE STqTE eOARD
1821 llniversity A4e., St. Paul, MN 55704 , UNLESS PROPEfl INSPECTION FEE IS
vh- 16121 297-2111 ENCLOSED.
27?] ?? C O ?
J J O
PLEASE PRINT OR TYPE OFFIC US ONLY This requesl vold 18 manths (mm validation dafe pnnred in this boz.
Q,
Request Dgk ??
l?
I
Rough-in inspeclion required2 Yes o
[You musl mll ihe inspedor v+hen readyJ
Inspection Other Than Raugh-Ire [] Ready NowAr-I+lill Call
Oote Ready:
I, E] licensed contractory[i owner hereby request inspecfion of The above electrical work at:
lob Adress (Stree?„PAi, or o N lr i?o.), ?? vr
04 5! U tw( City Zp Code
$atlion No. Township Name ar No. Range No. Fire No. Counly
Occu nt (
n Ne? Phona No.
Power upplier Address
Elednc I Confrocior (Compony N?a?m)e)
?m COW e4_?_ Conhador License No. Master lia No. (Planf Flect. Only)
Mai mg (Contmdor or Owner Performing InsMllaKon)
0
Pg..dnafura (Con m r r wn - ing Inst -on) Phane No.
s pao
EB-OOOOlA-10 6/95 tl STATEBOARUCOPY-SEEINSTRUCTIONSONBACKOFYEILOWCOVY
I??I II II?II (IIII REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board of Electricity
1821 University Ave., Rm. S-12 , St Paul, MN 55104 ?
* 0 2 7 3 2 5 8 4* Phone (612) 642-0800 Cpy(p _
Home up ez Apt. Bldg. l A
Other: 6
? New ddn
Commercial Indusfial Farm ,
? 4?
D I' ?u Remod Re air
Air Cond. Htg. Equip. Water Hir. Load Mgm . Other:
D er Ran e Elec. Heat Tem . Service
X" above 1he work covered by }his reqvest. Enter remarks in this space and on the back of Ihe white copy only.
.
Calculate Inspection Fee - This Inspeclion Request will not be accepted without the correct fee:
Olher Fee # $ervice Enhance $'ize Fee # Cirwifs/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street LTg./Traffic Sig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY T T
Sign/Ovtline Ltg. Xfmr. ?
Alarm/Remote Conirol
Swimming Pool
I hereb cetli thaf I Ins tled tha elednml inslollation descn6ed herein on the dales stated
Irrigation Boom Rough-In Dafe
edion
S
ecial Ins
p
p
Invesfigative Fee Finai ? oata' ?y
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
SEDGWICK HEATING & AIR CONDITIONING CO. HEATING JOBNO.1, °;2?
8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) 881-9000 TEST RECORD
ADDRESS I{?
y--? ? ; /' I: In 'r-F fY C' :^P.
,
OCCUPANT ??. ??t'.?• d' ?lf? O'?NQ-IL
SOLD BY ??• . ?' 6% l'"7 ?' !?(J?"?
MAKE LCN J
`?? o (
SEFIAL NO.
8'cjoD
THERMOSTAT
VALVE 0
*Z ?
LIMIT_ ?
I ? a
LIMIT SETTING
FAN SETTING
PILOT TYPE
IGNITION MODEL ( 'f4OC"J CC)(
PILOT TIMING
?
PRESSURE PERCENT CO2
INPUT CFH pERCENT Oz
?
STACK TEMP. PERCENT CO
Cirv ?/ao.o t?
OWNER -TR41Il
? I
INSTALLED AY
MODEL U °
INPUT
VENT SIZE -
TYPE OF LINER
LINER SIZE 6
- ?7
FILTERS: SIZE G G`? G?NUMBER ,
WIRING Le S V. J??
TEST TAG r_
LIGHTING INST. ?-
DATE TESTED
COMPANY TESTING
---
NAME OF TESTER ,
FORM 235 (REV. 11/89) FORM OISTRIBUTION: WHITE COPY - JOB FILE YELLOW COPV-CIN
(Irr#ifira?t of (Orrupttnril
Citp of (eagan
Brpttrtmt rrf Building Jnsprrfirnc
Tbit Certificate is.raed puriuant to the requrremcnu of Sation 306 of tix Uniform Building
Code cnti f ying that at the timt o f itsuanct thir structurr war in rom pliancc with the various
ordinaruu a f the Cuy rrgulating brrilding connrrution or use. For the following:
um ciawsmnm SF DWG/GAR Na&P,,,,,;t Na. 7296
PD R1
R3 o con.wcnao V FUezoQe NA zo,insoi.izic< <
omwarryve 'M
a,.,fDadj., Blilie Const. Co. ,wuR„644 Superior Ct., F.agan
&mwg„d,R, 4568 Kirkwood Circlt-mYT^'' '°.1nrk ?-rhes Mar E+
By:
Qd-???
Da[a: JLlly 29 • 1982
e orna.t
.a,m A ?ww* ruc,
LITNOIN U.S.A.
Oco?s ?ai
dju
??
2007 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone 4 651-675-5675 FAX # 651-675-5694
New ConsUuction Requirements
3 registered site surveys showing sq. tt. of lot, sq. fl. of house; and all rooted areas
(20% maximum lot coverage albwed)
1 Soils Report if proposed building is to be ptaced on disturbed soil
2 copies of plan showing beam & window sizes; poured found design, etc.
1 set of Energy Calculations
3 copies of Tree Preservation Plan "rf lot platted after 711193
Rim Joist De4ail Options selection sheet (buildings wifh 3 or less units)
Minnegasco mechanical ventilation Form
RemodellRepair Reouirements
2 copies of plan showing iootings, beams, joists
1 set of Energy Calculations for heated addiGons
1 site survey for additions & decks
Addition - indicafe i/on-site septic system
??
Offce Use OniV
Cert of Survey Recd Y N
Soils Report ; Y _ N
Tree Pres Plan Recd _ Y _ N.
Tree Pres Required Y _ N
On-site Septic System ' _ Y N
PIAYIc; aPP_ f`AttStfIACP_fI t]IlE?IIC It't'FOP"fi18t10!'t ll11IeSS VOII St8t2 tfl@V are fCBdB SGCrBt a11C{ tlle C@15OI1.
- --------- ------------ ---- -
Date 06 / G
/ Z? Construction Cost c?r
_
Site Address UniUSte #
l=. •. ?> a h, ?
Description of Work
Multi-Family Bldg _ YXN Fireplace(s) _ 0 2
Property Owner o?v.3 U; O? 1 e s? Telephone #(651) 7 1F IS
Contractor
Address City
State Zip Telephone # ( )
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Categorv 1 Minnesota Rules 7672
Energy Code CatBgory . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(4 submission type) , Submitted Submitted
• Energy Envelope Calcuiations Su6mitted
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 pian:
Licensed Plumber
hanical Contractor
Telephone # (
Telephone # (
Telephone # (
I hereby apply for a Residential Building Permit and acknowledge that the intormation is comptete ana accurace;
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; th.?'the work will be in accordance with the approved plan in thE case of work which requires a review and
approval,, of plans.
???".? ?? `?': 0 ??) j k
Applicant's Printed Name App1icanYs Sig
DO NOT WRITE BELOW THIS LINE
Sub TVpes
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 01 of _ plex ? 09 07-piex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo/pergola) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex ? 19 . Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex ? 25 Miscellaneous
Work Tvpes
? 31 New ? 35 Int Improvement ? 38 Demolish interior ? 44 Siding
? 32 Addition ? 35 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteration ? 37 Demolish Building* ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement *Demolitfon (Entire Bldg) - Give PCA handout to applicant
DBSCript10n: Water Damage _ Yes
Valuation Occupancy MCES System
Plan Review 100% or 25°/o Code Edition
Census Code Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footings (new bldg) _ Sheehock
_ Footings (deck) _ FinaUC.O.
_ Foorings (addition) , FinallNo C.O.
Founda6on HVAC
Drain Tile Other
Roof _ Ice & Water Final Pool Ftgs Air/Gas Tests Final
_
_ Fraxning ?
_ Siding _ Stucco Lath _ Stone Lath Btick
_ Fireplace _ R.I. _ Air Test _ Final _ Windows
_ Insularion Retaining Wall
Approved By:
Base Fee
Surcharge
Plan Review
MC/ES 3AC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
Building Inspector
?C' CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS:
P.T.N.: 10-17150-070-03
DESCRIPTION:
1.
PERMIT
PERMIT TYPE:
Permit Number:
Date Issued:
4568 KIRKWOOD CIR
LOT: 7 BLOCK: 3
CHES IMAR EAST 1S7
(,46ov)~d )
Permit Type SWIM POQL
JO,r k Type NEW
1 329 NONBL[lG STRUCT.
de.x_'`4
?.w .
BUILDING
027728
06/03J96
REMARKS:
A SEPARATE PERMTT IS REQUIRED FDR ANY PLUMBTNG QR ELECTRTCAL WORK
FEE SUMMARY:
VALUATION $3,000
8ase Fee $74.75
Surcharge $1.50
Total Fes $76.25
0
CONTRACTOR: OWNER: - Applicant -
Q'NETL PATTY
4568 KIRKWQOD CIR
EAGAN MN 55123
(612)686-7188
. S 1 j ?^ CJ1v E'? _ T4 ..< 'F 3
?i
T her`eby acknow2edge°uthat". T" haue;, rea.dF th-i
znformatian isa?tsrre,c? an? agre? to ,Cnmpl
S? BSR°'?Fli? 73HYiC@S `
° ? . _
0
APPLICANT/PERMITEE SIGNATURE
CITY OF EAGAN ? ?? ?
l 3830 PILOT KNOB RD - 55122
? 1996 BUILDING PERMIT APPLICATION (RESIDENTIAL) r.a r.?
6814675 L.r_? , Ue•t
New Construdion Reauiremenls RemodeUReoair Reauirementg
? 3 reglstered site surveys ? 2 copies ot plan
? 2 copies of plans (inelude beam & window sizes; poured fnd, design; etc.) ? 2 site surveys (exterior additions & decks)
? 1 energy calcuiations ? t energy ealculations tor heated additions
? 3 copies of tree preservation plan if lot plelted efter 711/93
required: _ Yes No
DATE: 6` .? Cj CONSTRUCTION COST: 3CM00
DESCRIPTION OF WORK: I ? L` I a?n+?? ? % lf okvlc3C /J o 0 ? ol
STREET ADDRESS: ? _
?J
LOT ?7 BLOCK SUBD./P.I.D. #: CLe 5
?a,Qr 53 q ?d t (
PROPERTY Name: 1 e? l 4 Phone #: -LD?tL ±?
O??/\ILp ' U6T fIRSi
t11\GR
Street Address: "r c, LJ'0 o 4-:0-12 c
City: ?c:j- 1 -?- ,
CONTRAC70R Company:
Street Address:
City:
ARCHITECTI Company:
ENGINEER
Name:
Street Address:
City:
5tate:
Zip:
Sewer & water licensed plumber: Penalty applies when address change and lot
change are requested once permit is issued.
I hereby acknowledge that I have read this application and state that the i ation is correct and agree to comply with all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant:
?
OFFICE USE ONLY
Certificates of Survey Received _ Yes
Tree Preservation Plan Received _ Yes
State: N Zip: 5 I a 3
Phone #:
License #:
State: Zip:
?Cc?f?dMl?L7
No
No
i ---
Phone #:
Registration #:
OFFICE USE ONLY
BUILDING PERMIT TYPE
0 01 Foundation ? 06 Duplex
? 02 SF Dwelling ? 07 4-plex
? 03 SF Addition ? 08 8-plex
0 04 SF Porch o 09 12-plex
? 05 SF Misc. ? 10 _-plex
WORK TYPE
,iK31 New ? 33 Alterations
? . 32 Addition ? 34 Repair
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
Planning
T'? s 4
? 11 Apt./Lodging a 16 Basement Finish
? 12 Multi Repair/Rem.-,,-?7 Swim Pool
? 13 Garage/Accessory o 20 Public Facility
? 14 Fireplace ? 21 Miscellaneous
? 15 Deck
? 36 Move
? 37 Demolition
Basement sq. ft.
Main level sq. ft.
sq. ft.
sq. ft.
sq. ft.
sq. ft.
Footprint sq. ft.
Building
MC/WS System
City Water
Fire Sprinklered
PRV
Booster Pump
Census Code. O S
SAC Code o /
Census Bldg
Census Unit 0
Engineering
Variance
Permit Fee
Surcharge
Plan Review
License
MCNVS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
SIW Permit
S/W Surcharge
Treatment PI.
Road Unit
Park Ded.
Trails Ded.
Other
Copies
Total:
Valuation: $ S,000
$
°h SAC
SAC Units
C7:T`! t_I- •?'?'1i:,;a?'
cr=_I)Ni:!:r:.,:,r
e
^?y3
.....i .3? 1; :
a].:I i.?
ynvr.- r
,?.ry: .. ...
,,l.l..
,......?.. ...?..,.., ..?r ?., ?..?:.,j_I ? r ..,?i
10l..)}..1
A
?r.yYe?1??.leJ:J:? 1 .:v . 4?y.li i...l.ar??l::yv! i. • '.J.. ..i.?.
PERMIT
CKY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS:
RERnoF
Permit Type SF (MTSC.)
gork 7ype RLT"ERATION
434 ALT. RESTDENTIAI.
4568 KIRKWOOD CTit
LQTs 7 BLQCK: 3
CHES MAR EAST 15T
P.I,N.: 10-17150-070-03
DESCRIPTION:
Pt G 5E dk
?
nn a?t. 3i}kz qt?3?
$74.75
$1.50
$76.25
4 ? gS *1 Hf Ip. ? t
l} itH ?r IgC
.emn3 ?Sa(: .".._L9 ?r a 26 i.<
m+roG
BUILDING
032186
P6/65/98
REMARKS:
FEE SUMMARY:
VALUATIQN
8ase Fee
Surcharge
Total Fee
CONTRACTOR:
zRcs
120 ALIEN WflY
I'NVER GROVE HGTS P1N
`1,612) 433-0278
PERMIT TYPE:
Permit Number:
Date Issued:
S+?v§S el?
$3,000
- Applicant - S7. LIc OWNER:
14330278 2000543 0'NEAL
4568
55077 EAGAN
DAM
KIRKWOOD CIR
MN
APPIIC /PER ?ATURE
? 1998 BUILDING PERMIT APPLICATION (RESIDENTIAL) l? ?? •?
57.4 CITY OF EAGAN
3830 PILOT KNOB RD - 65122
681-467b
New Construction Reauirements
RemodeVReoair Reauirements
• 3 registered site surveys 4 2 copies of plan
? 2 copies of ptans (fnclude beam & window saes; poured ind. design; etc.) ? 2 site surveys (exterior additions 8 decks)
? 1 energy rzlculations ? 7 energy calculations for heated additions
? 3 copies of tree preservation plan if lot platted after 7/1/93
' required: _ Yes _ No
DATE: ?Z 5/?f- CONSTRUCTION COST; ?-
?
^
DESCRIPTION OF WORK: ?P- ^- ov' OQ F
STREET ADDRESS: 'K' 5- 6 P
LOT: - 2_ BLOCK: 1? SUBD./P.I.D. #: ?
r
Name: O 6,?7Q ? 0a y Phone #:
PROPERTY Last Firsc
OWNER /('i / wO vo/
Street Address: l idC I7°
ciry
State: Aft/ Zip:
Company: 1 /?i• c - S Phone #:
CONTRACTOR
Street Address: `7 / o? G Xfi/r-v, (,.c,/ o y License #?
,
city ?4 ('.?
ARCHITECT/
ENGINEER
Company:
Name:
Street Address:
Ciry
Sewer & water licensed plumber (new construction only):
and lot change is requested once permit is issued.
Penalty applies when address chang
I hereby acknowledge that I have read this appiication and state that the information is correct and agree to comply with alf applicabl
State of Minnesota Statutes and City of Eagan Ordinances.
V/0,0 Signature of Appiicant
OFFICE USE ONLY
Certificates of Survey Received _ Yes _ No
State: Zip: Z- f
Phone #:
Registration #: _
State: Zip:
Tree Preseroation Plan Received _ Yes _ No - Not Required
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Duplex
? 02 SF Dwelling ? 07 4-plex
? 03 SF Addition ? 08 8-plex
? 04 SF Porch ? 09 12-plex
? 05 SF Misc. ? 10 _-plex
? 11 Apt./Lodging ?
O 12 Muiti Repair/Rem. ?
? 13 Garage/Accessory ?
? 14 Fireplace 0
? 15 Deck
16 Basement Finish
17 Swim Pool
20 Public Facility
21 Miscellaneous
WORK TYPE
? 31 New ? 33 Alterations
? 32 Addition ? 34 Repair
GENERAL INFORMATION
? 36 Move
? 37 Demolition
Const. (Actual) Basement sq. ft. MCIWS System
(Allowable) Main level sq. ft. City Water
UBC Occupancy sq. ft. Fire Sprinklered
Zoning sq. ft. PRV
# of Stories sq. ft. Booster Pump
Length sq. ft. Census Code.
Depth Footprint sq. ft. SAC Code
Census Bldg
Census Unit
APPROVALS
Planning Building Engineering Variance
Permit Fee
Surcharge
Plan Review
License MCNVS 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
SAC Units
?
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pasodoad pue lol 'slaails }o uoiaeaol nnoys lsnA,
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F ???? ?'^i'"'jp"'xT"?^'Tx`R°'•?t-^•-?.,- ?.T.-«..--.?.-..:
?????/S??
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$ e EXTER.IOR fNVELOPE- AVfRAGf. "U" CQINPUTATION '
\
0'viNEk
_ F,TTf_ ADDRESS
?
C(}Nrttyir()R riA;
__. . ?.
"
-
PfiG fvE ?S?i ?
. .
. . _. .._.._? __. .
?
. . . _. c.._. _ JC_ ..1 ..L??.?.
, • Uetermine worl:i na squ,: t-e footaq?? ?, P earF?
1. Total exposed wal l area ...... sy: ft. x_y]L =UTZd?
2. Total roofJceiling area ... sq. ft. x_,05
Total exposed wall area above fioor'=
? a. Total wall window area .................
h
Total door are
.
a . .......... . .
c. Total sliding glass doorarea ..........
' . . .. . .. .
. -?p - -
d. Total fireplace wall area.......... ... ........ ?v --
e. Total wall framing area (average 10%).... ...,....
f. Total net wa.ll area above floor ......... ........ 131o2
Q3
g• Total rim joist area .................... ,
.... .. /%:g3^
Tatal exposrd foundatian area
h. Total foundation window arca ............. .... S6
i. TOaI net foundation area aLcve grade .... .... ... ??_"` ,
Detennine "U" value cF 'each wa11 segment_'
?.
?j ?? it
' a. x u
b ?7 77 X „ulf
• c . X f, u„ ?.?3-:2 0
d. ?p. x „?„ , 72
e: :P'71??:z X ltuti
f. 1362.03 X $lu,l
9. ?y`/• ?3 X °u,?,,
h._ z °uN ?
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. ' . . .. .. . . ' ? fi
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?
3 . ..... ......:... ...... .....:.:Total
If item p3 iS the same as, or less than item #i, ?
yau.have met the in.terrt "
of SBC 6006(c)2.
;:.. .
. i ' ' .. . .. ?:
. . . . . ,y
1
?.y
CITY USE ONLY
L ? BL RECEIPT #:
SUBD. RECEIPT DATE: ? 7
1998 PLiJMBING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, NN 55122
(612) 661-4675
Piease complete for: ? single family dwellings
? townhomes and condos when permits are required for each unit
A backflow preventer for underground sprinkler system
FIXTURES
Shower
Water Closet
Bath Tub
Lavatory
Kitchen Sink
Laundry Tray
Hot Tub/Spa
.W ea er ?
oor rain
GeS Plping Outiet * minimum -1
Rough Openings
Water Softener * for dwellings under construction
Water Softener " for existing dwelling
U.G. Sprinkler '` for dwelling under const.
U.G. Sprinkler '` for existing dwelling
Alteretions " to existing residence
Water Turn Around
Private Disposal System ` MPC iic.
(new and refurbished systems)
Private Disposal Systems * Abandonment
EACH # TOTAL
3.00 x =
3.00 x =
3.00 x =
3.00 x =
3.00 x =
3.00 x =
3.00 x =
3.00 x =
3.00 x =
3.00 x =
1.50 x =
5.00 x =
20.00 x =
3.00 =
20.00 =
20.00 =
20.00 =
75.00 =
20.00 =
STATE SURCHARGE .50
Sa
TOTAL ? /
------------ -- ----- ---------------------------------------------------------
- is corted, and agree to comply with all applicable City of Eagan ordinances.
I hereby adcnowledge that 1 have read this application, stete thet the - infortnation -
R is the applicanYs responsibility to notity the property owner that the City of Eagan assumes no tiability for any damages caused by the City during its
nortnal operational and maintenance activities to the facilities constructed under this permit within City property/right-of-way/easement.
SITE ADDRESS: 41 c, o d '7j0 - p
OWNER NAME: c-
INSTALLER NAME: ?1r6 i ri'r- Ez(" 0-1 6 >",v Gi TELEPHONE #: .?rPy -7/o Y
STREETADDRESS: y Cdc// s^6?GCITY: f l S{ STATE: ;IA/` ZIP: 7?5-
51GNATURE OF
JS/FORMS BLDGIPLBG PERMIT (RESIDENTIAL) 1998
PERMIT #: ? ? ? 1-4
RECEIPT DATE:
2002 RESIDENTIlAL 14I?CHANIC?? ?ERMIT APPL11CA1'IlON
C1TY OF EtkfiAA
3830 Pv.oT Kvos Etn
EAG,aN buN 55122
651-6$1-4675
al-b?S'-"ZS'
Please complete for: ? single family dwellings
townhomes and condos when permits are required for each unit
Date: J _1?1-0_3
SITE ADDRESS:
OWNER NAME: 'ddm&? CJ TELEPHONE #: &?_l ' l?
INSTALLER NAME: _?: ---•^!? ?, ??; ? ??:?=:: ?•••eWTELEPHONE #:
m??.,....... _ .
ntworth Av;:. 50. --
STREET ADDRESS: Minneapolis, MN 55420
CITY:
CITY USE ONLY
STATE:
Place a check mark next to the permit work type
ZIP:
? Add-on, modification or alteration to existinq dwel ing unit $ 30.00
• fumace replacement /-e,n nd X
• air exchanger
• air conditioner,GPih 4"-;,X /j?-c'D.ID
• other ????
Nature of wor
FEJAN D
0 9 2003
State Surchar e $ .50
Total $?
e
"' i'/,%%Gf?
SIGNATURE OF P
1/02
S _ sta4l
PERMIT #:
APPROVED BY:
CITY USE'ONL.Y
INSPECTOR
RECEIPT DATE:
2002 COMMERCIAL MECHANICAL P£Rbi17f APPLICATIC1N
CITY OF EAfiAN
8$30 {'ILOT KNOS EtD
EA6i4N, MN 55122
651-681-4675
Please complete for: all commercial/industrial buildings
multi-family buildings when separate permits are not required for each dwelling unit
DATE: - -='?
STTE ADDRESS:
OWNERNAME: PHONE #:
TENANT NAME (IMPROVEMENTS ONLY):
WAS THERE A PREVIOUS TENANT IN THIS SPACE? Y N. NAME:
INSTALLER:
STREET ADDRESS:
CITY: STATE: ZIP:
TELEPHONE #:
WORK TYPE: New construction Install U.G. Tank
_ Interior Improvement Remove U.G. Tank
_ Processed Piping
SpecifyNature of Work:
When installing/removing underground tank, call 651-681-4675 for irespection by Fire Marshal and
Plumbing inspector.
Fees: 1% of contract price OR $50.00 minimum fee, whichever is greater.
Underground tank removaUinstallation = m;n;,num fee
Contract price: $ x 1%_$ (Base Fee)
State surcharge calculate at $.50 for each $1,000 Base Fee
TOTAL $
SIGNAT[JRE OF PERMITTEE
Updated 1/02
RESIDENTIAL
BUILDINC PERMIT APPLICATION
CITY OF EAGAN
?
Q? 3830 PILOT KNOB RD - 55122 ?sn4_1-1
651-681-4675
New Construction Reauirements
• 3 registered site surveys showing sq. ft of lot, sq. R ot house; anll roofed areas
(20% maximum lot coverage albwed)
• 2 copies of plan showing beam & window sizes; poured found design, etc.)
• 1 set ot Energy Calculatlons
• 3 copies ot Tree Preservation Plan if lot platted after 711193
• Rim Joist Defail Op6ons seleclion sheet (bldgs with 3 or less units)
DATE r OOI
JOB SITE ADDRESS 6 g i? c_ c.._,o Q C
IF MULTI-FAMILY BUI DING, HOW MANY UNITS?
PROPERTY OWNER ati. ;k c. e t
TYPE OF WOR e ? Q y
APPLICANT Q '
ADDRESS?C '& -[?.',r(< i.? oo?
PAGER # CELL PHONE #
MINNE50TA RULES 7670 CATEGORY 1
- Residen6al Ventilation Category 1 Worksheet Submitted
- Energy Envelope Calculations Submitted
. ,A
NEW RESIDENTIAL BUILDING ONLY- FILL OUT COMPLETELY
Energy Code Category
(check one)
Plumbing Contractor: _
Plumbing SysCem Includes:
Mechanical Contractor:
Mechanical System Includes:
Sewer/Water Contractor:
MINNESOTA RULES 7672
- New Energy Code Worksheet Submitted
Phone #:
Water Softener Lawn Sprinkler
Wacer Heater No. of R.I. Baths
No. of Baths
FAX #
Fee: $90.00
Phone #
- Air Conditioning Fee: $70.00
_ Heat Recovery System r _ _ . _ - - - - -- - -
Phone # ? i
rV\ cl\/ ? , I i,
All above information must be submitted prior to processing of application. C-I\ ?
. -- -------_="
I hereby acknowledge that I have read this application, state that the i rmation is c ect, and agree to compiy
with all appiicable State of Minnesota Statutes and City of Eagan dinan es.
Stgnature of Applicant
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
• Updated 1101
ReenndnllRnmirRenuimmnnT¢ I 1 - ( r"D ' 6
• 2 copies of plan '
• 7 set of Energy Calcula6ons for heated addi6ons
• 1 site survey for exterior additions & decks
• Indicate if home served by septic system for additions
VALUAfION 4 3mo oV
FIREPLACE(S) _ 0 _ 1 _ 2
PHONE#
P CODE :5S( a 3
OFFICE USE ONLY
? 01 Foundation
? 02 SF Dwelling
? 03 01 of _ plex
? 04 02-plex
? 05 03-plex
? 06 04-plex
? 31 New
? 32 Addition
? 33 Alteration
? 34 Replacement
Valuation
Census Code
SAC Units
Nbr. of Units
Nbr. of Bldgs
Type of Const
Footings (new bldg)
Footings (deck)
Footings (addition)
Foundation
Drain Tile
Roof Ice & Water Final
Framing
Fireplace _ R.I. _ Air Test _ Final
Insulation
Other
_ Pool _ Ftgs _ Air/Gas Tests _ Final
_ Siding Stucco Stone
_ Windows (new/replacement)
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
? 07 05-plex ? 13 16-plex
? 08 06-plex ? 16 Fireplace
? 09 07-plex ? 17 Garage
? 10 08-plex ? 18 Deck
? 11 10-plex ? 19 Lower Level
? 12 12-plex Plbg_Y or_ N
? 20 Pool
? 21 Porch (3-sea.)
? 22 Porch/Addn. (4-sea.)
? 23 Porch (screened)
? 24 Storm Damage
? 25 Miscellaneous
? 30 Accessory Bidg
? 31 Ext. Alt - Multi
? 33 Ext. Alt - SF
? 36 Multi
? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 36 Move Bidg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 37 Demolish (Bldg)* ? 43 Reroof ? 46 Windows/Doors
"Demolition (Entire Bldg only) - Give PCA handout to applicant
Occupancy MC/ES System
Zoning City Water
Stories Booster Pump
Sq. Ft. PRV
Length Fire Sprinklered
Width
REQUIRED INSPECTIONS
FinaUC.O.
FinaUNo C.O.
_ Plumbing
HVAC
Building Inspector
City atEapil
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
r
Use BLUE or BLACK Ink
For Office Use
Permit #:
Permit Fee: -1,0 bt
Date Received:
Staff: n
2011 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: /0 Z 7 `i'/ Site Address: / 56 v l / _ ocr rC
Name: /Ojy Rio
Address / City / Zip: Rioou.Q 5 4-e Aoldv' S"S
Applicant is: Owner X Contractor
Description of work: (
Unit #:
Phone:
Construction Cost: 7500 .00
Multi -Family Building: (Yes / No v,
Company: kl t v LlAv4u✓ al/ ds'e A f2 -e -
Address: /6 %Z% 13 'is c )1,e.. f/-vi
State: M TV Zip: SS. -62, y Phone: / Z
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:
de red to be public informal on. Portions o
Citic. a easons matt ui pent the GitY
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.orq
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 /(iVL1 hrGty-
Applicant's Printed Name
x
p•,' Zature
Page 1 of 3
4,11.
City of Earn
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
1
For Office Use /
1,0().
Permit Fee:
Date Received: 1 - ! 1 3
Staff: 'ntml
INFLOW & INFILTRATION PERMIT APPLICATION
)( Plumbing / Sewer & Water
Date: C7/ ` 201S Site Address: i' 5C4//T /(>bl; oc1)6/ A f C / _ f.--_c3uY,
�obe,,-t --v- omit/
Name: 0 girl- 1- 05 ems(
a RESIDENT / OWNER I
i
Address / City / Zip: 4/568 /4� ✓lvt� C�ve.Lei G?,,p r-/ 12 3
Tenant
Phone:
Suite #:
J
/Z
CONTRACTOR
TYPE OF WORK
DESCRIPTION
Name: License #:
Address: City:
State:
Contact: Email:
Zip: Phone:
1 PLUMBING (Within the building envelope) SEWER & WATER (Outside the building envelope)
1
s 4/ Sump Pump Repair
Other:
/?
Description of work: r o �� v ✓�
10 (1(S OVA, 54,.J f V L�'t.� n. C�1
J �L
FEES
$60.00 / Each (includes $5.00 State Surcharge)
*Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submit I/1 repair costs for
reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors
can be found by visiting www.citvofeagan.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.qopherstateonecall.org
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and
codes of the City of Eagan; that I understand this is not a permit, but only an a
permit; that the work will be in accordance with the approved plan in the case, �f f ork which rest:Ores a review and approval of plans.
lication for a permit, and work is not to start without a
Applicant's Printed N e
x
Applicant's Signature
FOR OFFICE USE Reviewed By: Date:
Required Inspections: _Under Ground __Rough -In Final
City of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Use
11 I
Permit #: l I o4 { l � 1
Permit Fee:
Date Received:
Staff: ( �A
r > 2013 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date:-- /O %_3 Site Address: "/ e JLj.Z� t ,t / /"'�
Tenant:
Resident/Owner'
Suite #!
psiName: Ai( � �/� e � `` Phone: J��
Address / City / Zip: 4/36 7Z/•Q!-- i eek,/
Name: MILBERT COMPANY INC dba CULLIGAN WATER License #: 063031 -WC
Address: 1801 50Th STREET EAST City: INVER GROVE HGTS
State: MN Zip; 55077 Phone: 651-451-2241
Contact: BILL MILBERT Email:
_ New iReplacement Repair — Rebuild _ Modify Space Work in R.O.W.
Description of work:
RESIDENTIAL
Water Heater
Lawn Irrigation ( RPZ / _ PVB)
Septic System
New
Abandonment
'Water Softener
Add Plumbing Fixtures ( Main / _ Lower Level)
Water Turnaround
RESIDENTIAL FEES:
$60.00 Water Heater, Water Softener, or Water Heater and Softener (Includes $5.00 State Surcharge)
$60.00 Lawn Irrigation (includes $5.00 minimum State Surcharge)
$60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge)
*Water Turnaround (add $200.00 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)
TOTAL FEES $
CALL BEFORE YOU DIG. Call Gopher State One CaII at (651) 454-0002 for protection against underground utility damage.
r Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.orq
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 t ll« frl�Q./,.
Applicant's Printed Name
x
A'?p ca is Signat re