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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