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4165 Ethan DrCity of Eagan 3830 Pilot Knob Rd Eagan, MN 55122 (651) 675 -5675 www.ci.eagan.mn.us Site Address: 4165 Ethan Dr Lot: 5 Block: 2 Addition: Oak Bluffs PID:10- 53400- 050 -02 Use: Description: Sub Type: Work Type: Description: Meter Size Meter Type Comments: Fee Summary: Contractor: Champion Plumbing 3670 Dodd Rd., #100 Eagan MN 55123 (651) 365 -1340 e - Water Heater New Water Heater Permit closed wit Kris Oien 3670 Dodd Rd Eagan, mn 55123 PL - Permit Fee (WS & /or WH) Surcharge -Fixed Total: Manufacturer Applicant/Permitee: Signature PERMIT City of Eaan - Applicant - Permit Type: Permit Number: Date Issued: Permit Category: Serial Number Remote Number Owner: Hilary C Lincoln 4165 Ethan Dr Eagan MN 55123- -490 $50.00 0801.4087 $0.50 9001.2195 $50.50 Issued By: Signature Plumbing EA090861 08/25/2009 ePermit Line Size hout required inspection(s). Letter & correction notice sent to applicant on 2/2/2010. (pf) I hereby acknowledge that I have read this application and state that the informa of Minnesota Statutes and City of Eagan Ordinances. on is correct and agree to comply h all applicable State CITY USE ONLY .L BL ? sueo. d RECEIPT #: r ???? ` _ RECEIPTDATE: ?J ? ?? PERMIT # ? l ?? 8000 ?PLUM$INfi ?MiT (f?SID?NTI?kL) crrYoF gnsnx s8so eaor xivos so f.lk6AA, MIV 551 EE esi-sgi-ss?s Please complete for: ? single family dwellings ? townhomes and condos when permits are required for each unit ? backflow preventer for underground sprinkler system FIXTURES EACH TOTAL Alterations to existing dwelling - minimum fee Describe: $ 30.00 Bath tub $ 3.00 x c'1- _ $ •?G Floor drain 3.00 x = $ 3- ? Gas i in outlet ' minimum - t 3.00 x oZ = $ •? Hot tub/s a 3.00 x = $ Kitchen sink 3.00 x / _ $ 3• ? Laund tra 3.00 x / _ $ 3? ? Lavato 3.00 x = S ?- ? Se tic S stem newlrefurblshed • ra uires MPC Ilc. 75.00 x = $ Se tic S stem abandonment 30.00 x = $ ? RpZ new InstallatioNre aidrebuild 30.00 X = $ Rou h o enin 1.50 x = $ Shower 3.00 x r?- _ $ ? • ? Under rounds rinkler ifdwellin isunderconstrucuon 3.00 x = S Under rounds rinkler ife?cistln awenin 30.00 x = $ ? W ater closet 3.00 x = $ ??? ? ? Water heater 3.00 x / _ $ 3?? W ater softener If dwalling under construMion 5.00 x = $ Watersoftener iPexis?n dwemn 30.00 x = $ Water tumaround 30.00 x ---- _ $ State Surchar e .50 -> --> ----> $ .50 Total __> _> --> --.> S S . .SO Reminder: Call for inspections of alterations, i.e. water heaters, water softeners, etc. •-•------- ---••--------•- ---------•••--------------------•-----------•••------------• ---•----------••---------••----------•-•---------•---- I hereby adcnowledga that I have read this appliption, state ?hat the informatlon is correc4 and agree to comply with all applicable Ciry ot Eagan ordinances. It is the applicant's responsibility lo notliy the property owner that the Ciry of Eagan assumes no IieGility for any damages caused by the Ciry during its nortnal operatlonal and maintenance adivities to the facAdies consVUded unCer Mis permit wilhin City propertylright-of-way/easemenl. SITE ADDRESS: 7??? C T n?-^-- ?r? ? OWNER NAME : ?rJLt-/7/+?-? ?307L?y5 TELEPHONE #: (AREA CODE) IfVSTAL?ERNAME: rS/1LL?iC ?'J'J'JPGhCt?C°?-? TELEPHONE#: L?/?-'?Q? ay?D (AREA CODE) STREET ADDRESS: ?"?? S ??? t ?'?? ? C?TY: ? o?'?'?- °?- STATE: ?-,^- ZIP: -?S?S°z' ?? ?5?.??,C ? SIGNATURE OF PERMITTEE CITY USE ONLY LOT ? -J BL 6? PERMIT #: N SUBD. ( /Gv1') gI ,(i(? RECEIPT #: l -33,9,2?,l RECEIPT DATE: ?7' b " 00 2000 MECHANICAL PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PIIAT IINOS RD EP,GAN tMt 55122 651-681-6675 Date: Complete this section onlv if you are installing HVAC in a single family dwelling, townhome or condo under construction and not owner/occuoied. • HVAC: 0-100 M B T U ADDITIONAL 50 M BTU • Gas outlets (minimum of one required @$3.00 ea.) State Surchazge Total $ 30.00 6.00 .2ou $ 3G..5"'0 Complete this section onlv if you aze remodelin¢, addine to, or reoairine an existing single-family dwelling, townhome, or condo. Please indicate if it is a new item, alteration, or repair. New _ Alteration _ Repair _ Furnace Air exchanger Other Air conditioning Other Fee $ 30.00 State Surchazge .50 Total $ 30.50 Reminder: Call for inspections SITEADDRESS: -x11-lO S OWNER NAME: 1"Ct /7 ?{?i /^O PHONE l?: -? - (AREA CODE) 'L INSTALLERNAME: C pC !!i1'?? PHONE#: .ti/A - y?a ?y9D STREET ADDRESS: (MtEA cone) CITY: STATE: Itt-11- ZIP: SIGNATURE OF PE ITfEE L BL SUBD. APPROVED BY: INSPECTOR PERMIT #: RECEIPT#: RECEIPT DATE: 2000 MECSANICAL PERMIT (C0M3ERCIAL) CITY OF EAGAN 3830 PILOT IQIOB RD EAGAN, NN 55122 651-681-4675 Please complete for: all commerciaUindustrial buildings multl-family buildings when separate permits are not required for each dwelling unit DATE: WORK 1'YPE: New conswction Listall U.G. Tank _ Interior [mprovement _ Remove U.G. Tank _ Processed Piping When insta![ing/iemoving underground tank, call 651-681-4675 jor inspection by fue marshal and plumbing inspector. Description of work: Fees: 1%of contract price OR $30.00 mioimum fee, whichever is greater. Underground tank removallinstallation = minimum fee Contract price: $ x 1% _$ (Base Fee) State surcharge calculate at $.50 for each $1,000 Base Fee TOTAL $ SITE ADDRESS: OWNER NAME: PHONE #: (AREA CODE) TENANT NAME (IMPROVEMENTS ONLl): WAS THERE A PREV IOUS TENANT IN THIS SPACE7 Y N. NAME: INSTALLER: ADDRESS: CITY: PHONE #: - (AREA CODE) STATE: ZIP: CITY USE ONLY SIGNATURE OF PERMITTEE I v `4? . 2000 BUILDING PERMIT APPLICATION (RESIDENTIAL) ' CITY OF EAGAN 3830 PILOT IaVOB RD - 55122 Q 3.?S 3 (? u\0? 651-881-4875 ? New Conefiucfion ReaWremenh 6? J,(-)O D J replstered site wtv6Ys fhovAft W. fl. d lot. W. ft. 01 house and gn rooletl qreaa (20X, maWmum bt eovemoe allowetl) n 2 copies w pla,s canow bean s+wnaow sIzea; pourea ma aeatgn: acJ D 1 te1 of eneryy cdaulctlona D 3 coples ot hae Prelervallon Plan H bt plaMed alt9r 7/1/93 DAiE: : 71 t-t1 t JU 2 coWeS d plan t aef of enerpy cdCWallons foc heated nddMom 1 sNe wrvay lor exKAOr adc9Xau 3 decks corisrRucnoN cosr: sZovl 600 "? DESCRIPTION OF WORK: bLv v? STREET ADDRESS: LOT: 5 BLOCK: -2' SUBD./P.I.D.O: Name: slef" Ilri ic,?s l.xJ N Phone M: PROPERTY taat Flrst OWNER ,534 00 OSO 0 2 Sireef Address: Cly State: Zip: . Company:lAJ 3J?-tJs l?N?• Phone o: (Q(2 li? ' I lS/? ? (area code) Oz?131 corrrancroa 3?J? Sheet Address: FWA D?.C? ?? • SO ucense t 32? Exp. 2ao ? cnr .?$L I?1?? ?? L{ S srare: zip: ARCHRECT/ ?p1 /??? ENGINEER Company:,? (.9 \?I?+W ? l? C• Name: /?'?1 1 I/I`A TeOephone A: ((,Pq, ) ?74_ Sfreef Address:3(6 rp OMUM cch U? 1 UQ DZ ReglstraNOn Jf: CNy State: VUII? Lp: I ?s S_kf:J, t,c.0U gy i a/IN ?l o Fs? 3 1 Sewer/water licensed piumher (if installira sewerlwaterl: rw?)(C.jO(l ne #F: ( I hereby xknowledye that I have read Ihis appficalion, atWe thW Ihe Mfortn is conect. and a?ea to compy wilh aA aPP?le State ol Minnesota Slahrtes and Cify of Eayan Ordinaneea ?^ ? / A ? ? Si9nafure of Applicant ? / ??-?1/?? ?.? OFFICE USE ONLY Certiflcates of Survey Received _ Yes _ No MAY - 5 Tree Preservation Plan Received _ Yes _ No ?Not Required d? % OFFICE USE ONLY BUILDING PERMIT SUBTYPES O 04 Foundation ? 07 05-plex 0 13 16-plex O 21 Porch (3-sea.) Xr, 02 SF Dwelling ? OS 06-plex ? 97 Garage ? 22 Poreh/Addn. (4-sea.) O 03 01 of _ plex ? 09 07-plex O 18 Deck O 23 Poroh (screened) ? 04 02-piex 0 10 OB-piex 0 19 Lower Level O 24 Storm Damage O 05 03-piex ? 11 1 apiex Plbg _Y or _ N 0 25 Misceilaneous ? 06 04-plex ? 12 12-plex 0 20 Pool ? 30 Accessory Bldg. WORK TYPE P?j1 New ? 36 Move Bldg. ? 43 Reroof O 32 Addition ? 37 Demolish (Bldg)• O 44 Siding p 33 Aiteration ? 38 Demolish (Interior) ? 45 Fire Repair O 34 Repair E3 42 Demolish (Foundation) [3 46 Windows/Doors • Give PCA handout to applicant for demotltion permit GENERAL INFORMATION ? 31 Fxt. Alt - Muld ? 33 Ect. Alt - SF ? 36 MuRi SAC Code 01 # of Stories y _ sq. ft. No. of Units Length 6SS sq. ft. No. of Buildings l Width SG Footprint sq. ft. a38114 Const. (Actual) Basement sq. ft. ;N srG Census Code )0( (Allowable) Main level sq. ft. 1S u r MC/ES System UBC Occupancy 2+ a„d le.d sq. ft. ?2s ? City Water Zoning {??k sq. ft. sft? 3 Booster Pump PRV Fire Sprinklered MISCELLANEOUS INSPECTIONS 0 Stucco/Stone APPROVALS Planning Building ? Engineering Variance Permit Fee Valuation: $ jw Surcharge Plan Review License 'Yd6 yy/S MC/ES SAC .v? ., ISO i x?S y="kll0 s N 2^?1 1Kw l 1`?-5 7 " `54 WaterConn. ? 2 5r ? Water Meter ?^? S e p?3 X iH j 16 : Acct. Deposit S/W Permit SNV Surcharge Treatment PI. Park Ded. Trails Ded. Other Copies Total: `J ()'J . g 3 SAC Units % SAC NOTES 1, MAXIMUM WALL LENGTH WITH A CONl'ROL JDINT 50'-0", 2. PRIOR TO BACKFILLING, FND VALLS MUST BE LATERALLY SUPPORTED BY FLOUR CONSTRUCTION AT BOTH TOP 6 BOTTON OR BY ADEOUATE TEMP. BRACING. 3. SPECIAL REVIEW REQUIRED FOR WAILS HIGHER THAN 9 FT. 4,WALLS WITH EQUAL BACK FILL ON HOTH SIDES REQUIRE NO REINFORCING EXCEPT DOWELS, FOR WALLS LENGTHS LESS THAN 30' LONG AND HOR1Z. REINFORCING & DOWELS ONLY FOR WALLS LONGER THAN 30'. 5. A MIN OF <2)1/2" 0 x B"A.B.W/(l) NUT & WASHER OR SIMPSON MA6 ANCHOR EACH PLATE. ONE WITHIN 12"EA. END. 6.FND DRAIN TILE MUST COMPLY W/ UBC APPENDIX 1824,3 &1824.4 OR APP'D EQUAL 7.INSTALL A SIMPSON A34 BETWEEN SILL & RIM JOIST 2 ALL A.B. LOCATIONS. (Yeq)=35 PCF e i SIMPSON A34 ? ANCHOR W/4 8d NAILS EA, LEG N.S. OR F.S. OF JOIST 2 16" O.C. CCeq)=45 PCF e ? SIMPSON A34 -' ANCH13R W/4 8d NAILS EA, LEG N.S. 8 F.S. OF JOIST 2 16" O.C. MATERIALS CONCRETE: 3000 PSI Q 28 DAYS AGGREGATE: FTG - 1 V2" MAX WALLS - 3q" MAX REINFORCING; ASTM A615 GRADE 40 : ASTM A615 GRADE 60 BACK 100 % GRANULAR - GROUP I FILL: EQUIVALENT FLUID PRESSURE (Yeq) = 35 PCF GRANULAR 8 LIGHTCLAY - GROUP II EQUIVALENT FLUID PRESSURE (YEQ) = 45 PCF HEAVYCLAY - GROUP III EQUIVALENT FLUID PRESSURE <7eq> = 65 PCF GROUPS HASED ON CODE, SEE SHT. S-5 V SLQPE -? 8„ GRADE AWAY FROM FDN, , i (1Ceq)=65 PCF e SIMPSON A34 ANCHOR W/4 Sd NAILS EA. LEG N.S. & F.S. OF JOIST 8 16" D.C. (4) #4 HaRIZ. BARS ON TIES #4 x 2'-0" D?WEL -@ 61-0" O,C, ? OR ? +n siz ? r, ----?? ? TYP. PCF i l/z" 65 PCF 31/2" ? ONLY H = 9'-0" HIGH WALL N 8 8 8 10 10 10 (I ) (P CI) 35 45 65 35 45 65 352 452 652 352 452 652 (PLF) TL V R NONE N[]NE # 8„ @ NONE NONE NONE S V R 6? NONE QO S 2"@ NONE NONE OOP S , p P 1 O S 1/A.B. 40 32 24 40 32 24 SPAC,CIM 6 40 32 24 40 32 24 IN) SPAC DRAINO TILE S" x 16" FTG (MIN) - FTG SIZE BASED ON SDIL CONDITIONS 2 EA, SITE BY (ITHERS, _v ",.,, STEEL t SEE SCHEDULE) ? U- f m -2" CLR FLOOR SLAB \ e WALL SECTI?N N?"-NOTE HIGHER STRENGTH CONC REQ'D FOR NO REINF. P?URED FOUNDATIONS, INC, `°98 W. °f?" ? J. H. Dahlmeier Engineering Inc. 9' HIGH 8836 UPPER 89th CIRCLE S S_ 2 MN 55016 GE GROVE T JHD , COT A ?? 2434 comme:ce &ouieverd e12-472-4746 11/30l98 Phone: 1612) 458-3927 JHD Mouad, MN 55364 Fez612-473-4761 - _r¢7 ENERGY C JE WORKSHEET FOR 1& 2_AbfILY DWELLINGS ITE BY nviLDING CLASSZFICATION: ? c. HINIMUM CRIT6RIA Foundation Insulation-R10 Slab on Grade SnsulaLion-R10 Floor over unheated spacee-R24 Foundation Windowe 1/2'1 ineulated Glass. -Wood or Vinyl Frame DATE 1(utandard) or * ca[egory 1(muat include vantilation Y7allo & Windowu (See [able on reverce cide Eor allowable percentages) STSP 1 Window & Door Area A. Total Window & Door Area in Sq. Feet WIN?OWS (Incliiding FoundaCion Windows); WINDOW MAN[JPACTURE LIAMS: WINDOW HANUPACTCJRE TypB: G ,//Vf G? 'T WINDOW MANIIPACTUR6 U FACTOR: .3 (!/ R. O. Quantity r,q.(l.Area Dimensions ?0? x 7C Y -?)?? ? ?O ? ?,.(JN Y, x?l'-?y X 7 ` 04;f ?.? x 3..u L-? X?-ti'? ?;.08 Z?IY ? X SLO? X i X DOORS: Z ? X :o xCi Y'otal Area of A__rroq.ft. Hindows 6 Doors 8. Total Wall Area in Sq. FC. Wall Total fleight Area Perimeter 11 ? ?-?---{ Roof Attic Inoulation: R49-Witli Attic No ffeel R38-With Attic Raised lieel R38 4 RS-SOlid RaEters STSP 2 Calculate area ae a pereent o£ Wall c. Fcom Step 1 divide box A(47indow & Door Area) by box [3 (to[al wall area) Cimes l00 equals [he window and door area as a percene oE wall area (box C), P.l?X A?_ X ]00 = C E?oF fi ? t I 4 STEP 3 F.SSEDI6LY PRAMIt7G TYPC: S1'At1DARD FRFNtING ADVRNCED FRMIING CAVITY INSULATION Deoign Featureo X ceuas 15^ o.c. f;tude 24" O.C. R1-2- SH6ATFiItIG TYPE: LESS THAN < R-5 R-5 > OR P10RE U-FACTOR u From the table, (reveree side) determine the maximum percent window 6 doot atea fot the design op[ions eelected and enter the t value in Box D 6elow based on the window mfg. U- factor: ? J D ? The : v?7ue from the Cable in E3ox D shall Uu cyual to or greater than the } in Dox C ,. Total Area of Walls_ I D=771bq.ft 0 ONE- & TWO-PAbIILY RFSfDE1VT7AL OUTI,DING PRESCR(P7NE (CppK-BOOK) nprROACx MAXlMUM WINDOW AND DOOR AREA AS A PERCGNT OF OVERALI, WALL AREA From Mlnn It u[ s part 7670 0;75, DubFg;t 2+tam r Cevll Exterior Wlndow U-Fqctor Frsmin Ineulation Sheathin 0.49 0.36 0.31 0.27 STANDARD R-13 Z R- 7 13.49?0 17.8% 21.3% 24.3% STANDARD R-13 R- 5 12.4% 16.4% 19.7% 22.5% S7'ANDARD R-15 > R- S 12.4°Ao 17.1% 20.1% 23.4% STANDARD R-18-19 < R- 5 12.19'e 16.096 18.8% 22,0% STANDARD R-18_19 R- 5 14.096 18.6% 21.8% 25.3% ADVtaNCED R-18-19 < R- 5 12.9% 17.1% 20.1% 23.4°/0 ADVANCED It-18-19 > R- 5 14.5% 19.29'0 22.5% 26.1% STANDARD R•21 < R- 5 12.8% 17.0% 19.9% 23.19'0 STANDARD R•21 > R- 5 14.5 ?e 19.396 2 26.1% ADVANCEQ R-21 < R- 5 13.696 18.1°/0 21, 26.6% AI?VANCED R-21 R- 5 15.09'0 14.9% 23.2Yo 26.9% Additional Sa1culated values STANDARp STANDARD R-17 R-17 < R- 5 ?R- 5 11.9% 13.8% 13.79'0 18.4Ye 18.4% 21.5% 21.5% 25.0% ADVANCCD R-17 <[Z • 5 12.696 16.8% 19.fi'o 22.9% ADVAN?.'ED R-17 > R- 5 14.396 19.0°/v 22,29'0 25.7% Notea: Window ares equals rough opening minu9lnetallation clearances. Window U-factor muet be determined by either the National Fenestration Rating Council standard 100-91, or ASHRAE 1993 Handbook of Fundamentals, Chapter 27, Tsble 5. FostdM FoK Note 7871 0;W p..r? *o ?ran Coi0ot Co. ph? f piwey a N? YI LOT SURVEY CHECKLIST FOR RESIDENTIAL BUILDING PERMIT APPUCATION L n ? W ? C 0 0 O? A ? ? (}?y7 ? ? 0 ?131 ? ?? ? e? ? ? p/p o b? ? ? DOCUMENTSTANDARDS • Registered Land Surveyor signature and company • 8wlding Permit Applicant • Legal description • Address • North arrow and scale • House type (ram6ler, walkout, spli[ w/o, split entry, Iookout, etc.) • Directonal drainage arrows with slopelgradient % • Proposed/ebsting sewer and water services 8 inveR elevaUOn • Street name • Driveway • Lot Square Footage • Lot Coverege ELEVATIONS Ecistin U/? o • Sewer service (or Proposed) ? ? ? • Property corners p? ?? • Top of curb at the dmeway ?-'o ? • Elevations of any ebsUng adjacent homes ru/ ?? Adequate foating depth of structures due to adjacent utiliry Venches Prooosed q1 ? ? • Garage floor q/ ? o • Firstfloor i/ ? ? • Lowest exposed eleva6on (walkouWaindow) n/ ? ? • Property corners v ?? • Front and rear af home at the foundation PONDING AREA (if applicade ?p ? • Easement line a?/ ? ? • NWL Va ? • HWL ckl ? p • Pond # designation ? q/ ? • Emergency Overflow Elevation m/o ? m/? ? V? ? ? ? ? • g/ o • a ? • DIMENSIONS Lot Iines/Bearings & dimensions Right-of•way and street width (to back of curb) Proposed home dimensions indudiny any proposed decks, overhangs greater than 7, porches, etc. (i.e. all structures requiring permanentfootlngs) Show all easements of record and any Cily utiliUes within those easements Setbacks of proposed structure and sideyard setback of adja t ebsting structures Retaining wall requirements, A any ?. _--:7 Reviewed: PROPERTYLEGAL: LoT ?j BLOCK Z ( /AKPSLI,Il?S DATE OF SURVEY: '00?\ LATESTREVISION: ? - IO'?J?? 7 ? /< / Date Mareh 1989 CpAICIgIDGPRMT.FM Use BLUE or BLACK Ink For Office Use I i (,~j I Permit City Eap I l VOof I - I 3830 Pilot Knob Road j Permit Fee: Eagan MN 55122 I I Phone: (651) 675-5675 I Date Received: - I I - I Fax: (651) 675-5694 Staff: - _ I 2013 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: --_R Site Address: 10q 64~v alk - Tenant+-= Lr ore, y Suite Resident/Owner Name: _ 1~n X ~~,t r p r) c Phone: 07S 11`(~ ✓ Address / City / Zip: 4 t ID 5 C V1 r _ Name; Appliance Connections Inc. _ b1 z0cl ~6est;lut BIVd. License#: _ PrM I i Address: Contractor City: state: zi 952-445-4803 - - I p - - ~ Phone: I p JciYYt~~1 -Contact: C, ~PP t,6h S f VA O& DO C062 I° - Email: Gt I tiZYt~Qcon n eC fi Type of Work New ~L Replacement Repair - Rebuild Modify Space Work in R.O.W. I 1 Description of work: RESIDENTIAL ---.tea- i Water Heater Water Softener Permit Type Lawn Irrigation RPZ PVB) tl Septic System Add Plumbing Fixtures Main / Lower Level) s New _ Water Turnaround - Abandonment R IDENTIAL FEES: I $60.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surchar e $60.00 Lawn Irrigation (includes $5.00 State Surcharge) g) 1 $60.00 Add Plumbing Fixtures, Septic Svstem Abandonment, Water Turnaround* (includes $5.00 State Surcharge) ''Water Turnaround (add $200.00 if a 5/8" meter its required) p $105.00 Septic Svstem New ($10.00 per as built) (includes County fee and $5.00 State Surcharge) n° _ - - TOTAL FEES lp 0 00 CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 4540002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.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 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_- x Applicant's Printed Name Applican Signature FOR OFFICE USE Reviewed By: Date: Required Inspections: Under Ground --Rough-In __Air Test ---Gas Test Final Use BLUE or BLACK Ink r----------------- For Office Use City o R d IlIl , Permit#: I I + 1' I Permit Fee: I UD 3830 Pilot Knob Road Eagan MN 55122 2016 Date Received: Phone:(651)675-5675 APR 19 I I Fax:(651)675-5694 I Staff: I I I ii 2016 RESIDENTIAL BUILDING PERMIT APPLICATION Date: q I (10 Site Address: 9 1 (.a C 0.n Df i V Unit#: � aJ( l '� G Y Q Name: Phone: �QYltit. Wti w. Address/City/Zip: Applicant is: Owner Contractor o Description of work: s of - J h Wrk .v . } Construction Cost: 1 O, Q®0 Multi-Family Building:(Yes /No xr: Company: �j Q Jr r^l_C y- F X �-f r 1 C Y"S Contact:_ 0..lL XZL C � ' L ri ? tpr Address: P G 1 Lki�i GJ�7 fie r�C City: 1 1 S State:_MN Zip: 5cD j Z Z Phone: IQO Email:(�yl�t 5ct rru, b r�Q�r- c %C VS, License#:_ (�"� 20 Lead Certificate#: IJ {SIT- i'2.2 If the project is exempt from lead certification, please explain why: bcAlu_lc buA_uk 0_f4_e_k_ 1q_1 8 LA 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: Fire Suppression Contractor: Phone: N07E Plans a upp �ocumts: s bmr`ar ; to bey o .v, ��� Starm ma c%assfied as tic if i c reasojt :trial Mfr©ul t 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.aopherstateon,!ecall.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 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 aut ized by a building permit issued in accordance with the Minr*esota State Building Code must be completed within 180 days 776_74LtICL uance. x SOJ Fr i.n x Applicant's Printed Name Applicant's Signature Page 1 of 3 • A � JlT` n u u rym• q �- x ryxy}� •a Retrofit Repair, tilr ti�t Remediate red area Including , . addingAmproving kick r out flashing;Scope * assumes stone is in good working order. Retrofit Repair. Instaifiimprove kick out flashing. Scope assumes adjacent areas are in good working order,but additional rot may be present determined once kick out is installed.(normal moisture,but"staining noted at site 3) Repair Red zone- includes removing stone as necessary. Replaced ' stone may not be an ,. x exact match to existing 7 FAL City of Eaali 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Date:61 CD r Use BLUE or BLACK Ink For Office Use Permit #: D Permit Fee: ' J Date Received: Staff: 2016 RESIDENTIALfBUILDING PERMIT APPLICATION /67 Site Address: % ( c - Unit #: Name: o A 1'e-- 6f,„ fl kv -. Phone: ®e�// W Address / City / Zip: Y// C iia-.. 6 - Applicant is: Owner >d Contractor Description of work: /1/3,p o -r -re49,-..v. -^^ -99� ' 11.4....t_ 4/�r"s�� r e- b C�, 61 e o Wor y Construction Cost: o 7 . ori Multi -Family Building: (Yes / No A') x /f Company: 6�' r r' 1:::k -1-4"-' 0j5 Contact: -37,-.S IN 6 / 2 "3‘C 1Z3? II Address: .5/ lI ; yvvy, - 5 -da.„' . Sc'o 0 City: )7i ' li 'uG/d% r: •11tr Ctor State: (nil) Zip: 09/2 2 Phone: 26 3-51/C " »iEmail: License #: Lead Certificate #: If the project is exempt from lead certification, please explain why: 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: Fire Suppression Contractor: Phone: NOTA fans and supports g • meats that you s i l i `are consid o be c i #l� �,• ' i . ma 8 • e clan ifs • as non-pubi provide sp+ c c reasonsit trot c pp. s c ts. • ?M ons of r to 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.00pherstateonecall.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 Build' g C •de mu;t be completed within 180 days of permit issuance. x s/A-- * ) Applicant's Printed Name A. • Iicant's nature Page 1 of 3 z://e drt/ DO NOT WRITE BELOW THIS LINE /T6�'��j SUB TYPES Foundation Single Family Multi 01 of _ Plex WORK TYPES New Addition Alteration Replace Retaining Wall DESCRIPTION Valuation Plan Review (25% 100%.) Census Code # of Units # of Buildings Type of Construction Fireplace Garage Deck Lower Level Porch (3 -Season) Porch (4 -Season) Porch (Screen/Gazebo/Pergola) Pool Interior Improvement Move Building Fire Repair Repair Siding Reroof Windows Egress Window Exterior Alteration (Single Family) Exterior Alteration (Multi) Miscellaneous Accessory Building Demolish Building* Demolish Interior Demolish Foundation Water Damage *Demolition of entire building — give PCA handout to applicant Occupancy _ :t- — Code Edition 1t� 2t Zoning Stories Square Feet Length Width REQUIRED INSPECTIONS Footings (New Building) Footings (Deck) Footings (Addition) Foundation Roof: _Ice & Water _Final Framing 30 Minutes 1 Hour Fireplace: Rough In _Air Test _Final `^ Insulation Sheathing Sheetrock Fire Walls Braced Walls Shower Pan p--1 MCES System SAC Units City Water Booster Pump PRV Fire Suppression Required Meter Size: Final / C.O. Required t Final / No C.O. Required HVAC Gas Service Test Gas Line Air Test Pool: _Footings Air/Gas Tests Final Drain Tile Siding: _Stucco Lath Stone Lath Brick Windows Retaining Wall: _ Footings Backfill _ Final Radon Control Fire Suppression: _Rough In Final Erosion Control Other: • Reviewed By: % �' 14A )')l r>r'`_' li , Building Inspector RESIDENT!AL FEES Base Fee Surcharge Plan Review MCES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant Copies TOTAL Page 2of3' PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA154473 Date Issued:03/25/2019 Permit Category:ePermit Site Address: 4165 Ethan Dr Lot:5 Block: 2 Addition: Oak Bluffs PID:10-53400-02-050 Use: Description: Sub Type:Residential Work Type:Replace Description:Furnace & Air Conditioner Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952) 445-2840. Please call Building Inspections at (651) 675-5675 to schedule a final inspection. Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088 Surcharge-Fixed $1.00 9001.2195 $60.00 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 - Robert W Burgoyne 4165 Ethan Dr Eagan MN 55123 (651) 994-9134 H2c Inc Dba Heating Cooling And Plumbing 820 N Concord St South St Paul MN 55075 (612) 791-0850 Applicant/Permitee: Signature Issued By: Signature