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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 ? i.u:o; -<, ;suc :;-fou.l 10-1) •suoIsuawip 101 eni6 's6wp?mq (•palsanba? si jesie?ddp ajo}aq pa4e?s aa oi ;?ie pasodoad pue lol 'slaails }o uoiaeaol nnoys lsnA, a ? ,... ?.:.. -r----? - ?y at ? , • - . _.- _ - ? 44 -; ? ? -*- fi-- h t ; "?'1 .11 L ~ 1 .. ?. .. ?._..? .61 :1: ' L ? ? C:I 1 : (l f ?,? I f ( t , . , ; , ri , _ r?r t I, a + j - .? - ? r ? . r+t ?-t r .? ? :1 .,-. I { I ; , ? ? ?a1 ? : t ? t l ? ? ' # , ?.. , -1 ; ; __. . ? {: ,l; .? ..?+_ i :1 ?* ? ' , ?--r ?;? , !_f ?u' ? '•k': r iG ? ' ? 1 , ;?-, !=C? -• ?:~ , c 1.?'"- W ?k? t -,_ t ? ?' r C? $? - - --- ? . f -F? - 1 . . _.. ? • ? r :?.11 ? 'j- i. L' - C _ ? - . ;.:. . r; ` ;. _ . ( ill t.? 1 -? S '+'y._. - tri ? hJ. . _ ,.. *- r r, „ .?t; . , T ? 1. • . ,' _ ? 4 ?. . ? .? ? 4 I ? 1 l? ' '?? '1 ? . ? .? 1. L A 11: 44 ' -? . ? I' 41 11 - _ . I" ? r -_1ij? ?Tj? iH I Tr'.'+ ? -- r . --t-- 'i7-T I- ; .. '! 11 + ; rt11'r- 44 -1 it tl+. Z :Z. ' a. , ? K_ 7-1 . . _?? ,..? 1 . LI 1 1 ...? ? 12 -} T . i. I a f 4/ ; M G Qt ? ?a( ;a 001 :b Nrdld 101d I. . ._. ?? 1 v o-aur SI13, o,? ?ry?-. F ???? ?'^i'"'jp"'xT"?^'Tx`R°'•?t-^•-?.,- ?.T.-«..--.?.-..: ?????/S?? ? Q?? $ 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 ? ? <1 - --- ; X plu„ ? ? . ' . . .. .. . . ' ? fi " . t ' . ..1'. ? . . ? 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