4857 Knottingham Cir
Use BLUE or BLACK Ink
I For-O-tfi-ae -tJ-e~e
I
I
~ I
I
Permit City of Eajan ,
RECEIVED I ~ I
I Permit Fee:
I
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675 NOV 0 9 201 i Date Received: ~
Fax: (651) 675-5694 I Staff: j
2010 MECHANICAL PERMIT APPLICATION
Date: l-5- / O Site Address `
Tenant: Suite
RESIDENT /OWNER Name: Phone: b, 7- , joj'2'L COO 2 ~ A~'7
Address / City / Zip: 1
CONTRACTOR Name: BURNSVILLE HEATING &A/C, 17C,
License L/l
3451 VV. Burnsville a way
Address: - Suite 120 City:
State: -Burnsville, MN 55337 phone: S ~"C `7 CJ(J~
Contact. -ELM- Email:
TYPE OF WORK New )4 Replacement Addition/all Alteration Demolition
l7 ( I
Description of work: ".00
NOTE: Roof mounted and ground mounts mech.nlcal equipment is required to be screened by'City
Code Please contact the Mechanic..I lrtspector for information on permitted ltcreisning methods:
RESIDENTIAL COMMERCIAL
PERMIT TYPE Furnace _ New Construction _ Interior Improvement
Air Conditioner _ Install Piping _ Processed
Air Exchanger Gas Exterior HVAC Unit
Heat Pump _ Under / Above ground Tank Install / _ Remove)
When installing/removing tank(s), call for inspection by Fire
Other Marshal and Plumbing Inspector
RESIDENTIAL FEES:
$50.50 Minimum Add-on or alteration to an existing unit (includes $.50 State Surcharge)
$90.50 Fire repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) $ ` TOTAL FEE
COMMERCIAL FEES:
$70.50 Underground tank installation/removal OR Contract Value $ x1%
$50.50 Minimum (includes State Surcharge)
= $ Permit Fee
- If Permit Fee is less than $1,000, surcharge is $:50.
- If Permit Fee is > $1,000, surcharge increases by $.50 for each = $ Surcharge
$1,000 Permit Fee (i.e. a $1,001-$2,000 Permit Fee requires a $1.00 surcharge).
= $ TOTAL FEE
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.gophergtateonecatl.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 t approved plan' the case of work which requires a review and approval of plans
x x UZA
App rcant's Printed Name Applicant's Signature
FOR OFFICE USE Reviewed By: Data:
Required Inspections, Under Ground Rough In Air Test Gas Servloe Test ln4oor Heat Flnal
Exterior HVAC Screening Inspection
,.i r UF EAGAN Remarks
Addition BRITTANY $TH ADDN. Lot 2 B,k - 2 Parcel 10 15007 020 02
Owner Street 4857 Knottingham CT'. State Eagan, MN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF,
STREET R£STOR.
GRADING
SAN SEW TRUNK 197Ej 12 . 23 1?j
SEWERLATERAL
WATERMAIN
WATERLATERAL
+ WATERAREA /Cf ]_ $fj E?.OO 35.74 1
STORM SEW TRK /Q O 1$?j 942.00 62.80 1
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
Rnad Unit 280.00 58678 12/31/85
WATER CONN, 500.00
BUILDING PER. 11404
sAC 52
PARK
I - PERMIT #
PLUMBING PEiiMR RECEIPT #
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE _
PHONE 454-8100
TYPE WORK DESCRIPTION
y Name _
? Address
c City -
- Name _
3 Address
a CitY -
FEES
COMM/IND FEE - 146 OF CONTRACT FEE
MINIMJM - RESIDENTIAL FEE
MINIMUM - COMM/IND FEE
STATE SURCHARGE PER PERMIT
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND $1,000.00)
- $10.Q0
- 20.00
- .50
r?
FOR: CITY OF EAGAN
Res. New
Mult Add-on
Comm. , Repair
Other
NO. FIXTURES TOTAL
Water Closet - $3.00 $
Bath Tubs - $3.00
Lavatory - $3.00
Shower - $3.00
Kitchen Sink - $3.00
Urinal/Bidet - $3.00
Laundry Tray - $3.00
Floor Drains - $1.50
Water Heater - $1.50
Whirlpool - $3.00
Gas Piping Outlets - $1.50
/ Softener - $5.00
Well - $10.00
Private Disp. - $10.00
Rough Openings - $1.50
FEE
STATE SIC:
GRAND TOTAL• ?
. . . t
PEFiMIT # CITY OF EAGAN FeE -' r
MECHANICAL PERMIT -
RECEiPT # 454-8100 S/C _
?' -
' MINIMUM RESIDENTIAL FEE - $10.00 + $.50 TOTAL ' -' -?
DATE MINIMUM COMMERCIAL FEE - $20A0 + $.50
._?
1. Bldg. Type: Res L'Comm- Tist 2. New `'" Add -- Alter Repa?` ' 3. Total Bid Price ' ~?J-'?•-M 4. Job Address
Lot Block ? Sec 7-7-A"4 67C 5. Owner
6. Contractor /'. - `?`o-, •y -_ • Y':sl
(Name) (Street) (CitY) (ZiP) 7. Contractor Phone #
RESIDENTIAL HEATING - 01-100,000 BTU's -$24.00. Each additional 50,000 BTU's or naction -$6.00
RESIDENTIAL COOLING - 01-24,000 BTU's -$12.00. Each additional 8,000 BTU's or fraction -$6.00
MO DI FICATIO NS /ALTERATIONS -$10.00 minimum fee
i HEATING VENTILATING HOT WATER STEAM AIR COND.
eIR PIPING PROCESSED PIPING AIR HAND. EQUIP. RtFRIG.
RES. GAS PIPING OUTLETS -$1.50 TANKS: LP. UNDERGROUND OTHER
COMM./IND. RATE -TOTAL Blp PRICE PLUS $.50 STATE SURCHARGE FOR EACH $1,000 OF FEE.
, Signed: far
Y
Approved Inspections: Date Rough Insp. Date Final Insp.
PtpM1T
RECEIPT # ?-!
DATE
1. Bldg.
3. Total Bid Price li
Lot L- Block ?C-
6.
7. Contractor Phone # _;
NO. FIXTURES
Z-Water Closet - $3.00
j R°th Tubs - $3.00
?Lavatory - $3.00
Shower - $3.00
,/-Kitchen Sink - $3.00
-Urinal/Bidet - $3.00
CITY OF EAGAN FEE
PLUMBING PERMIT
454-8100 S/C
MINIMUM RESIDENTIAL FEE - $10.00 +$.50 TOTAL
MINIMUM COMMERCIAL FEE - $20.00 + $.50
NO. FIXTURES
J Laundry Tray - $3.00
_L__Floor Drains - $1.50
--/-Water Heater - $1.50
Whirlpool - $3.00
?LGas Piping Outlets - $1.50
-Softener - $5.00 `
COMM.IIND. RA - 196 OF
Signed:
Approved
for
Add Alter
5. Owner TU I I e _`Z,-2 J,/ &3L- 0 R 5
NO. FIXTURES
-Weil - $10.00
-Private Disp Syst - $10.00
-Rough Openings w/o
Fixtures - $1.50
FOR EACH $1,000 OF FEE.
Inspections: Date Rough Insp. Date Flnal Insp.
. ,, CITY OF EAGAN ?
• 3830 Pllot Knob Road, P.O. Box 21-199, Eagan, MN 55121 ?1 `T n 4
' PHONE: 454-8100
BUILDING PERMIT
_"; OG?
Ta be ussd for SF D*?I$. Est Value S94 _OOd Date , 19 35
SiteAddress 4857 Kaottin$ha/1 Erect ? XOccupancy R•?3
Lot-LBlock Z Sec/Sub. w..+••e.. 8 . 14 Remodel ? Zonina
Parcel No
10-1 SQ(k7-020-01
Repair ?
Type of Const y
? . Addition ? No. Stories
T Move ? Length 46 -
? QLLEFSON BOILDERS
Name
W Demolish ? Depth 5
o Address 12617 Fairgreen Ave. Int. Impr. ? Sq. Ft
City APP1e Vp??Y 431-1100 Install ?
A PProv ab Fees
Phone
Assessment
Water & Sew.
? a Police
F W Name Fire
? ? Address Eng.
oc =
-C W City Phone Planner
Council
I hereby acknowledge that { have read this application and statethatthe Bldg. Off. 12?23?85
information is correct and agree to comply with all applicable State of
Minnesota Statutes and City of Eagan Ordinances. APC
Var. Date
Signature of Permittee
Permit -: ? dl S-?
Surcharge ?? - ?
Plan Review 207. SO
SAC 52S_M
Water Conn. .500-M
Water Meter
Road Unit2liG 00
Tr. PI. 132.00
Copies
Total 2169.50
A Building Permit is issued to: on the express condition that
all work shall be done in accordance with a tate of Minnesota Statutes and City of Eagan Ordinances.
8uilding Official , ? " ? ^ "
. Psrmlt No. Permit HoWe? date Talaphon* fl
Plum" K- F `?" •Y ?- ' ?'- ' .? t? J ?? ? e? ? "'/????
H.vA,c.
EIoChIC
$OHeINf ,
InspaeNon Dab InsP. Commmvh
Footlrps I
Footinps II
Foundalbn
Framinp
Rootiny
Rouph Plby.
R«ua, Hro.
Insul.
Fkeplace
Fi?.l Hno.
FfnN Plbp. ?? ?G O PS
Bldq. Final
CWt.Occ. ? u)
Doclc Fty.
Dock Fmp.
Wdl
. Pr. Obp.
I
?cr-rv
3830
P. O. B
Eagan,
OF EAGAN
Pf-ot Knob Road SEIAIER SERbICE PERMIT
ox 21199 PERAAIT NO.:
MN 55121
Zontnp: D/?TE:
Owmr: No. of Unlta:
1lddrtss:
SiM Addroas: 't' 57 Ki2o L g?
Piwnber. --
y
? fr' Cos d /.?.w
By
Dofa of Insp,:
Cw?»ctlan (harge; :
llcoount OieDoslt:
Pamlt FN:
Surdwgo;
Mlu. Chorom
Totol;
CoM Pold: -
'CITY OF EAGAN WATER SERVICE PHtM
3830 Pili,t Knots Road R
P. O. Box 21199 PERMIT NO.:
Esgan,'•/IN 55127 pATE;
ZO^i^g: - No, of Unlts:
Owrwr: .
Addr+ess:
Slh Addrots:
' T }-
- ' ?
Plumber.
M*ftr No.: Connsction Charge: ?
Size: Account Deposit:
Reoder No.: Permit Fee:
1 Nrr 1o aoopy wilb !M Cihr ef Eegas Surrhorye:
OnilMww. Mtac. CFar+pss:
Totol: .
BY Dote Poid:
Dafe of Insp.: insp.:
CITY OF
EAGAN 1NATER SERYICE PERMIt
0 Pilo# Knab Road
•P. Q. Box 21199 PERMIT NO.:
`Eagan; MN 55121 DATE: y
Zoninp: - "
:
No. of Units:
Owrwr. ?•:I:?fson ?Ic:rs.
Addrosx
51te Addross: 4,9" Knotti: V . L2 .Q }'rit?any t`
?Itxnber. ?` •. ?'i':
)Aetsr No.: #? C06 Choroo: ?0'1 , 0n?d
. iopoalt.
Reo
No, . ,
r
G/NM tO 00111* was IV Rh0fQQ:
7
uasor. ? I f?r ?
Mim Choryges: TP
R TotaL• 6 3.0meter
Ar pote Putd:
ts of Ir?sp.: Irtip.:
This re_quest voitl
-?-.C-;Z c)
CO) 239 Request Date Fire No. Roueh-in InspecUOn ? ?r
fleou reA? Readv Now Ly._Will Noulv InsPec-
a??? ?Ves ?No ?or When Ready
?Licensed Electncal Conhactor , i hereby raqaest inspection of above ? Owner r elactncel work mstelled at
Sveet Address, Box or F ut No.
?N? Gty
ti
ecLOn o, Township Name or No. Range No. ' Counly
OccuOIPN,
_j
I 0
Power SuoPlier Address
EI tncal Conttacmr ICOmpany Namel
? /
-7KD ?CV C!"??--f \ ?j
JJ ?? Chom'ra'ctor's L4icense No.
C; J?
Mailing ddress (Cont artor or Owner Makin0lnstaila 1 ?
--}w
Authonzed Signa[ure IConvact r/Owner Making
?? . allaLOnl Ph ne Numb¢r
MINNESOTA STpTE BOARD OF ELECTNICITY THIS INSPECTION NEQUEST WILL NOT
Griges•Midwey Bldg. - Noom N•197 . BE ACCEPTED BY THE STATE 90ANO
1821 Universitv Ave., St. Poul, MN 55104 UNLESS PROPEfl INSPECTION FEE IS
Phana (812) 297-2111 ENCLOSEO.
CASH RECEIPT
• CITY OF EAGAN ?
P. 0. BOX 21-199
EAGAN,MI NESOTA 55121
ATE
neceWeo
FROM
AMOUNT $ /Iy I k_DOLLANS
ioe
FVND CDOE M'AOUNT
a? 3 io ?
?U v c?
- P/
, ? .
Thank You
? -
N_ 59607
WAite-Payers Copy
Yellow-Posting Copy
Pink-File Copy
n-., rT-,-u
CITY OF EAGAN
BUILDING PERMIT
Receipt N
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 -
' PHONE:454-8100
11404
TobeusedforSF Dwlg, EstValue $94,000 Date 12-31
195
,
SiteAddress 4857 Knottingham Erect ?X Occupancy R-3
Lot 2 Block 2 Sec/Sub. Ari ttg ny gth Remodel ? Zaning R-1
1
Parcel No 0-15007-020-02 Repair ? Type ot Consl V
. Addition ? No. Stories 46
w N
m TOLLEFSON BUILDERS Move ? Length
a
e 12617 Fair
reen Ave oemoiisn ? Depth SZ
3 Addres5 g
. ?nt.lmpr. ? Sq. Ft
° clApple
ry V?7t 431-1100
`PhD? Install ?
a Aoarovals Fees
o Name
=
? ¢ Atldress
Ciry Phone
? w Name
x a Address
z
i w City Phone
I hereby acknowledge that I have read this application and statethatihe
information is correct and gr?ee to comply with Iapplicable State ot
Minnesota Statutes and ry?i EagaT Ordinan ls. 1
Signature of Permittee ? ??
A Budding Permrt is issued ta ?
all work shall be done in accordance wit {I
h a x tate of ' reso
Assessment
Water & Sew.
Police
Fire _
Planner
Council
eldg. Off.12-23-85
APC
Var.
NO
Permit-', 415.00
Surcharge 47.00
Plan Review 207.50
SAC 525.00
Water Conn. 500.00
Water Meter63 00
RoadUnit 2R0_O(1
Tr. PI. 132.00
Parks
Copies
Total 2169.50
on ihe express condition that
City of Eagan Ordinances.
Building
REQUEST FOR ELECTRICAL INSPECTION _es-ooooi.oa
See instruetions for completing this form on back at yellow cooV.
'"X'" Below Work Covered by This Request
Q f?g77?9 `-
P'law4 Aadi Rep.I Type of Builtling I AoPliantea WireC I EOUipment Wired I
urnace
p Fee Service EntreneeSite N -Fea Faxtlars/5ubteetlers N Fee Grcurts
0 co 200 qm s /3 . 0 to 30 qm vsc ? 0 to 30 Am s
s? Above 200 qmps? -? 31 to 700 Amps 31 to 100 Am
Swimming Pool Abvve 100_Amps A6ove 100_AmNs
Transtormers Irrigatwn Booms ?Ci Partiai.'Other Fee
Signs - - I I _TSpecial Inspection ] 5?:. w •? TOTAL E_6E i, . ?,
?IaA4?( 1
A I, tphe EI tri qt?
Insactor, e?eby
certdy thet the abov
inspechon has been
mede.
1985 BUILDING PERMIT APPLICATION - CITY OF EAGAN
NOTE: ALL CONTRACTORS MUST BE LICENSED iIITH THE CITY OF EAGAN
COMMERCIAL
INCLUDE 2 SETS OF ARCHITECTURAL
& STRUCTURAL PLANS, 1 SET OF
SPECIFICATIONS AND 1 SET OF
ENERGY CALCULATIONS
$2,000 LANDSCAPE BOND
SINGLE FAlIILY DIiELLINGS
INCLUDE 2 SETS OF PLANS
3 CERTIF'ZCATES OF SURVEY
1 SET OF ENERGY CALCULATIONS
To Be Used For: SFta Valuation: !j4,cz?C) Date: T7PZ0, 1G8S
Site Address 465"1 :6VX)-Mp?' -Uq4 OFFICE USE ONLY
Lot ? Block _?: N-l?tb?_o?? Erect x Occupancy .3
Remodel Zoning 2 I
Parcel/Sub 'RvjT(.AtI Repair 4 Type of Const
Addition li of Stories
Owner Move ?
'- Length (v
Demolish Depth 52
Address Int.Impr. T Sq Ft
Install ?
City/Zip Code --------- -------------- ---
Phone APPROVALS FEES
Contractor 'jc)LzF-FG0
nlJ;?,4 )I IsQej??
Assessments
Permit
?
I?
Water/Sewer Surcharge
? ?
Address Police Plan Review
Fire SAC ZS
City/Zip Code 0-?Q Engr Water Conn
Planner Water Meter (03.
Phone I(L:) Council Road Unit .
Bldg Off) s Treatment P1 Z.
Arch./Engr. APC Parks
Variance Copies
I
Address TOTAL -/
City/Zip Code
Phone li
t?? k l?s ( ?-3
v
0
1??2Co= 41cp ? 4q- = 16 3o4
-
12 x 2.C?
3 I v?
S? ?
I?c7q ?
24 ?c2'Z " s2? x tZ = ?33?
K zo - H2v
1[? n t 2° I°I 2 x g = I 53b
G 4
t(P
11 ?c ZG, ° 442k44 ? H 4?8
Lbri i lit
'"?V q 3 9q2
Cerc-?il caUe ior: -- - -
R`ol;eTs Qn 3ui iders Bk: 48/36
?.
1
E3ELMAR H. SCHWANZ
:sNCCJr?F??~.tc IMC
Pe: c.r.T l'???r ?x?a . ?M $itl?f MmtManl?
? tm'SU SCUTH PGBEriT TRAIL RC$ENOCcWT, @btM`tE8p7A 65069 PHCMfE 6E1 483-178y
SURVEYOR`S GENT6FFGATE
F?
f
i?
?
Z '
?
?
a
?
?
-D
.?
ro
?
-t
Lsrairsge and `tio
,L'tility Easenentl,,.
1y'4 y?r
? ? ss
ZSC7 --'? Z2.3f
I
;sosad!
I L
i ?t9
5cale: 1 inch - 30 :eet N469 77•17E
ni d9;3 7: 37 E i36?z
? p9,? 0P 5
?
c?b.B iIZ.'7
ys
toDM
9f'3 l ?
z9 I
as -Z L ?o
95 3
/? r I
O
!N
u
?
?
?
$
- au.b
III.
?
?q
?a
I3
I
n
?
9Y• 3
o DEnctes set aplke at of.*Bet 94.3 T}enotee exietir.g e:evatian
'?Q Denctea ?rapoaed rlarsge Floor Elevatian
I hereby certify t^at thi5 is 3 treie and correct repk-e8er,*ation aY'
L,?t 2, Block 2, BR=7Ah'Y 3';`Ft ADDY'I`Z04I, acoarding to tP.e recarG?d plat
tP,ereof, Dskota Ccrctnty, MIr.neao«a.
Alao showing the ]ncation of a propased ?seus•e ae etaked therecn.
Becember 16, 1985
I
?
. MIK„'ESQ?A PEG;STRATrON NO 81625
? .-1a
?
11
--?'(G3•''
Y:X'1'P:tC1VH P:14VP;6VY1l: AVP:t<AIiL'' "U" tiUMYUTA11Vir
(To be suhmitted with buildittg permit application)
One or Two Family Dwelling
All Other
Contractor
OwnerIA i ?(?i1P1!s
?"J
Site Address
Dat? Phone -&873
LINEAL FEET OF
EXI'OSED FlALL 6?e, Yto above grade - 7a??r/
?lo - LL
TOTAL EXPOSED WALL ARE.A SQ. FT.
o?AQUE Wl.LL COP:STRUOTI01I: "U" Value x Area
"U" 040 x S2.
Detail x sq.
reference
jjt4 npn , nq(? x SQ.
from nUtt x $Q.
attached flUff X SQ.
sheets nUII x SQ.
WINDCIWS: flUff Value x Area
FT. D 6. cj (U) (A)
FT. ???SU)(A)
FT. _ (U) (A)
FT. _ (U) (A)
FT. _ (U) (A)
Piake & Type "U° • 4A x SQ. FT. 4t.40) (A)
n n nUfi x SQ. FT. = (U)(A)
n n null x SQ. FT. - (U)(A)
a n npn s SQ. FT. _ (U)(A)
DOORS: "U'l Value x Area
id?ace & Tyne liUll x SQ.
n u itpn x SQ.
n u nUti g gQ
.
n n nUn g gQ
.
TOTALS4_Z. ??SQ.
AVERAaE "II"
TOTAL (U)(A) VALUES 15¢•g3 =
- 6(11
DIVIDED BY TOTAL 1'IALL AREA Z?f ?(?•(c?
AVERAOE "U" ,115 or less for 1&2 family dwellinga
ROOF/CEILINQ:
TOTAL AREA:
(U) (A)
FT.
(U)(A)
FT. - (U) (A)
FT. - (U)(A)
!'T. (U) (A)
Detail reference "Ull •oZr x SQ. FT.9,Y-)- /9. y?? (U)(A)
from flUff x SQ. FT. . (U) (A)
attached sheete. IOUlt x SQ. FT. _ (U)(A)
Describe openinga "U" x 8Q. FT, e (U)(A)
in roof. u0n 8 SQ. PT. _ (U)(A)
TOTAL (U) (A) VALUES DIVIDED BY ly 53 a T??FLLJ .3q.? `Uy 2>
TOTAL RO0F/CEILITi(3 AHEA 9,30 + ?z
AVERAC3E "Ult .025 for ventilated roofe.
w0gb5i?
&= UPZ?LD WALL
950 X
?
9?83 x (-ZI/ 4a1 130 4.30
CoNC- /p ? X (-30
t3Qj -l-3? t3?F> >
-gLM
• 83 x +57, +t4a-5z) --
,.
= i?o6 . oO
96•98 -x
/07.5P*
?
24 x6b = io• or? X 3 = 30? o
20 x3& = 50 ? ? -. ?5.0 .
Z4K3? _ (0?0, X? ! _._`-...._ y• O _
3? 5TL .. V?1/5J? = Zg• ?d .. ?,
Zg ? ? _; Zl? ol?
(o' F(th-o
-'F-
I?7"_
??.• •
GYa55 l?fall ? , ? - ?' "_z,?f??• ?6
Ce? Cm?c . ? G6. Z/O?,
erM /87• 58
" WIW1606 .t-1. oo
,.- . ? .. ? f .
. ,
.-
' ? ' ' .3'?` x 30 = 93b ?
.-
'??'
. ?
?
?.
, ' . ,?. .?.
.? .
?
? •
-'N1eL @E4TI4N--
Detarmining "Ulf valuea at Rool$ Wu'llg 'li7ro# aid Oono. 111oo1c
ROOF/0ETI.7N(I
1,) Interior Air r'ilm
21) 5/811 ayp. u(t.
3.) Ineulstlon
4. /
5.) Exterior Air Film
(S'PII.G )
SR VAi.UE
0.61
.56
44.170
.61
npu o 1/Ro i'OTAL (R)=4s•791
----
. =-
.
WA1J,
6.) Intarior Air Filaa
7.) '1" an). aa.
8. ) tneiilatiorl
90) t513z!' Bv1tT-piT6-
10. ) 14unonitn si alug
11.) Exl:orJor d]r Fllro
(R VAI,UE
0,68
.4S
19. vo
Z.or
.17
??pn n 1?12a ?p?}? TOTAI, (R)=Z3.oj
?
I?IM '
12.) Inturior Afr Milro
13.) Inwilullou
lh. ? 21, V1 r Itf In iloi.et
1J.) Z?/?S:l' l?•?u:r-?irL"
rtWwuito i,itilli,s
Extat-.tor Afr bllm
iR VALUE
0.68
jq,oo
1.8t3
Z 67
.17
UpU o. 1?Nr ??'-r('7 7'OTAI. (R)=24,11
YAOUDAT7qH
18.) Intorlor A1r Film
19.)
20. )
21.) 12" oonarete Hloclc
22. ) igILIA IA?St?L.
23.) Exteri.or Air Film
(R) VALUE
0,68
1.28
$ •OO
.17
TOTAL (R)= 1?,r3
-.--_:-_
r?
- !` ?CITY USE ONLY
L BL v
SUBD. I IA kA
Va-
RECEIPT#: 1 I i5G S
RECEIPT DATE:
PERMIT #
1999 PLUM$IN? PER14IIT (RESID£N1'IAL)
? crrY oe EALsAiu
? 3830 PILOT KN08 RD
£A6RN, MN 5578E
(ssi) 681-4675
Please complete for: ? single family dwellings
? townhomes and condos when permits are required for each unit
? 6ackflow preventer for underground sprinkler system
FIXTURES
EACH #
TOTAL
Bath tub $ 3.00 x = $
Floor drain 3.00 x = $
Gas i in outlet ` minimum • i 3.00 x = $
Hot tub/s a 3.00 x = $
Kitchen sink 3.00 x = $
Laund tra 3.00 x = $
Lavator 3.00 x = $
Minimum fee alterations to existin dwellin 30.00 x = $
Private Dis osal S stem new/refurbished ' re uires MPC iic. 75.00 x = $
Private Dis osal S stem abandonment 30.00 x = $
RPZ new installation/re air 30.00 x = $
Rou h o enin 1.50 x = $
Shower 3.00 x = $
Under round s rinkler if dwellin is under construction 3.00 x = $
Under round s rinkler if existin dwellin 30.00 x = $
Water closet 3.00 x = $
Water heater 3.00 x = $ ?
Water Softener if dwelling under construction 5.00 x = $
Water softener if existin dwellin 30.00 x = $
Waterturnaround 30.00 x ---- _ $
State Surchar e 50 --> ----> ----> $ 50
Total --> --> ----> .... > $ 3 0, sa
Reminder: Cali for inspections of alterations, i.e. water heaters, water softeners, etc.
----------------- ------------------------------------------------------------------------------------------------------------------------
I hereby acknowledge that I have read this application, state that the information is cortect, and agree to comply with all applicable Ciry of Eagan ordinances.
It is the applicanYs responsibility to notify the property owner that the City of Eagan assumes no liabiliry for any damages caused by the City during its
normal operahonal and maintenance activiGes to the facilities constructed under this permd within Ciry property/righl-of-way/easement.
SITE ADDRESS.
N,
OWNERNAME:: /I .f/AiYICZlq- K TELEPHONE#: 6 S/ VSCo p2- 3?
(AREA COOE)
INSTALLER NAME: TELEPHONE #: 6(Z 6 SSS
' (AREA CODE)
STREET ADDRESS: ?O C%D?wi/Li,UL G9'l_ YJ
CITY: STATE: /W N ZIP:
%
PERMITTEE
FF--
j
2/84
1 CITY OF EAGAN
? AP PLICATION FOR PERMIT
i
SEWER AND/OR WATER CONNECTION
(PLEASE PRINT)
/ •
1) PROPEFTPY ADDRESS: ?
1?5 ,Qfj,Yr?J
r'Frar• DESCRIPTION: Q 6
(Lot/Block S '
vision or Tax Parcel I.D. uTber)
iF E,=-'__ :G S?RC;CIUT?, Drl' OP ORIGi1tlL nliI=L`?G F.=":•1':' ISSJ?'r?C:
PRES??i _'-?:7SP:C;/?ROFOS=-D U:.?• ?R-1 S-17C,ZE F: MI=
L7 R-? DUPT= (T.•:O LtiITS)
? R-3 TKP1NHOlJSE ('PHI2EE + UDIITS) ( UNITS)
? R-4 APAR'L"1IIVT/CONDQMINI(M ( UNITS)
? CaMMERCIAL/RETAIZ,/OFFT_CE
? LNMUSTRIAL
Q INSTITUTIONAL/C',aVERNMENT
2) APPLICANT (PLEASE PRINT)
NPME: s!Sli.Q? .
ADDRESS: r
CITY, STATE, ZIP: ?
PHONE: " /zoo
3) P?MDZ ¢ PLEASE PRINT) FOR CITY USE ONLY
rArE: ?P ? f?
PIUMBERS LICE45E:
ADDRESS: Q ? Q Active
CITY, STATE, ZIP: Expired
PHONE:
pLUM6ER LICENSE # Not of Record
3'E-aTfTn"i t i e?
4) OCC[JPAN•f/CWNER NAME: (PLEpSE PAINT)
ADDRESS:
CITY, STATE, ZIP:
P[IO:IE:
5)
INDICATE WFIICH PERM?T IS BEING REQUESTID:
? ONNI'.cPION 'IO CITY SE(^]R
KCONNAPION TO CITY WATER
C] CYPHR (PLL•',ASE DESCf2IBE)
6) INDIG,TE 0.'v'E:
M PLFASE fIOLD APPROVID PII2MIT FOR PICK-UP BY ONE OF AHC)VE
w(PI,EASE MAIL APPROVID PII2h1IT TO 1, 2, 3, 4 ABOVE
(Circle one)
7) SIG1dA'IURE:
DATE: ?
M,a 0ewa?'wmll"iolr Saaawsm n! ii1[a?+asa?7iai ril ?ii?rris!+4wa? ril rltrc?t:.?ieir:?? ? ssitfascus:a? w
F O R C I T Y U S E O N L Y !
PERMST u ISSUED
F°ES: $ %D SEWER nEB,qST (INCLliDE SUP
CHARGE)
.
$ /G - SZ WATER PERMIT (INCLUDE SURCHARGE)
$ (
'?
?
-Crb WATER METER/COPPERHORN/OUTSIDE READER
$ WATER TAP (ZNCLUDE CORPORATION STOP)
$ S°SVER TAP
$ n-7) ACCCUNT DEPOSI"_' - SEWER
$ b a ACCOUNT DEPOSIT - WATER
$ ???a • 6?9-O WAC
$ SAC
$ TRUNK WATER ASSESSMENT
$ TRUDiK SEWER ASSESSyIENT
$ LATERAL BENEFIT/TRUNK SEWER
$ LATERAL BENEFIT/TRUNK WATER
$ OTHER
$ TOTAL
$ AMOUNT PAID/RECEIPT # $a? ? ls?/
77 c?
DOES UTILITY CO NNECTIOIV REQUIRE EXCAVATION IN PUBLIC RIGiIT OF WAY?
YES IF YES, THEN A"PERMIT FOR WORK WITHIN
YUBLIC ROADWAY" MUST BE TSSUEll BY THE
? NO ENGINEERING DIVISION. LIST AS A CONDI-
TION.
SUBJECT TO THE FOLLOWING CONDITIO[VS:
APPROVED BY:
TITLE:
DATE:
Moo"w wM mm=su wq?w Wkft a+Wirt=se sw wL40 feWja W"+ ??
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA163403
Date Issued:08/31/2020
Permit Category:ePermit
Site Address: 4857 Knottingham Cir
Lot:2 Block: 2 Addition: Brittany 8th
PID:10-15007-02-020
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:Does not include skylight(s)
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and leave on site.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Valuation: 5,000.00
Fee Summary:BL - Base Fee $5K $118.00 0801.4085
Surcharge - Based on Valuation $5K $2.50 9001.2195
$120.50 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
James A Adamczak
4857 Knottingham Cir
Eagan MN 55122
(651) 456-0236
Legacy Restoration Llc
15350 25th Ave N, Suite 114
Plymouth MN 55447
(763) 354-7660
Applicant/Permitee: Signature Issued By: Signature