4291 Hawksbury Cir_, _.
I '?? CITY bF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
SITE ADDRESS:
'Nf+
PERMIT SUBTYPE:
?,_ .
4 APPLICANT:
I M
? . . , , 1 •?_ ? . t
TYPE OF WORK:
t-.I t w
INSPECTION .. . .A
? . , t;;?l•:?,.`; ? F'Hi
aN REcoRD
PERMIT TYPE:
Permit Number:
Date Issued:
t=ll I I It
041/1 :'/'44
:: 1.J 1'4.t:[d
-1
Permit No. Permft Holder Date Telephone #
SNV
PLUMBIfvG
HVAC ; ?J g?/-?oav
ELECTRIC P
ELECTRIC
Inspection Date Insp. Comments
Footings I i?// ,2/9y
Founcation I??(t/?(y
?
Framing
Roofing
Rough Pibg.
7
Rough Htg.
I$UI.
? ?
- - L -
Fireplace
Final Htg.
Orsat Test
Final Plbg. PI g. Inspector - Notrfy umber
Const. Meter
Engr./Plan
Bidg. Final 9 S o.,/ C/ 47l*V.
Deck Ftg.
Deck Final
Well
Pr. Disp.
I '
/
v , 4 1 ,r
• :•
yF
lf ',
?p• _ ? ?
WerttfiCRte Df CCCltpaliC4
MM oq cfagan '
?fltparbxent of $xiiiutg att6pectian
Tlus Certificate issued pursuant to the requirements oj ihe Uniform Building Code
certifying thal at the time of issriance tius stnecture was ia compliance with the various
orrlinances of the City rrgulating building cautruction or use. For the following:
use cbmrxatm: SE DG1G sag_ ??;t xo. 23248
OcaPancy 7ype R3M1 Zoning Distrid R i Type Const. 1vm
ownff or suilaing JIIM KtFSIE.tIlE HOMES DC wabm 7270 148'LH ST, SAiAM
swk%og Aa&m4291 AAW.SM CI= LocWity L3, B2, HAWHMVE 4J170[?S 2NID
Dm:
suikli otrK;.i
P0.ST IN A CONSPICUOI)S PLACE
4*/g?1
? 15627
REDUEST FOR ELECTRICAL INSPECTION
? See mstmcOQOS for car.zlel?.ting this form an beck oi yellow copy
"X" 8elow Work Covered by This Fequest
9-'O?M,%' ?EB-?i°.
ew Atld fiep ` Typeof6wltling ApphancesWiretl EqwpmentWiretl
Home Range Temporary ServiCe
Duplex Water Heater Electric Heating
Apt. Building Dryer load Management
Comm./Indusinal Furnace Other (SpeCify)
Farm Air Condrtioner
00er (syecAy) Cantraotor5 qemarks // ?
Compute Inspecfion Fee Below. Iv`?) 6"? ?
# Other Fee # Service Entrance Size Fee # Crtcuds/Feeders Fee
Swimming Pool ( 0 ta 200 Amps 0 to 100 Amps
Transformers Above 200 _ Amps Cove440 _ Amps
Signs Inspactor's Use Onry /' ? 7pTAL
?
Irngauon Booms / / 1,,, o,J /ao
Speciallnspection ?
r?V
Alarm/Communicatwn \
THIS INSTALLATION MAY BE OR'ERED D NNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONTH . '
I, !he Electncal Inspector, here6y
certity that the above inspection has
been made Ro?yn-?? ?
p,nai o ce I?T ?
a a?_ p
?
OFFICE USE ONp
This repuest voitl 18 moNhs irom
? 5s? o °°
Repuest oate
r g re No- Fough-In InpsMron qeqwretl
(YOU must cali mspeclor when ready) Inspedion Olner Tnen Rovgnin
? qeatly Naw? WAI Notity InsOector
1" Yes ? N. Date ReaEy
IXlicensed contractor ? owner hereby request inspection of above electncal work at:
Job Atlaress (SVaet. Box or Route No I
it'loUl Ciry
AW
Secuon No Township Name or No Range No County
Occu0anl(PRINT) POOne No
?
-
y I,
O '1'6/
?
Y
? IV+iO r
c
N r?? (
!
PowerSu/p?pber
ICl9? ?"^? _
Atltlress
pGO?(.l
Elecincal ConVacto, ICOmOany N&me ?
' Gonvactor5 Lwense No
GfJ R? 0l96
Mamng Atltlre s ICAnVacror or Ownar Maving Installalion?
aoz? f? 9?
?
A&
A I/ho?rrzeo SignaWr?e iC•O?nV?ac,onOwner Makm Instailatmnl . Phone NumOer
MINNESOiA STATE BOARD OF ELE RICITY THIS INSPECTION REOUEST WILL NOT
Griggs-Mitlway BIEg. - Poom 5-173 BE NCCEPTED 9V THE STATE BOARD
1821 Universily Ave., 5t. Paul. MN 55104 LINLESS PROPER INSPECTION FEE IS
Phone (612) 602-0800 ENCLOSED
Address 4291 HAWKSBURY CIR!7 Zip 5512 3
L.ot 3 Blk 2 Sub t3awnioxM woons zrID
THESE ITEMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECTION.
Date: Yes No Inspector:
Final grade (6" from siding)
Permanent steps (garage)
Permanent steps (main entry) ?
Permanent driveway
Permanent gas
Sod/Seeded gtass
TraiUcurb damage
Porch
Basement finish
Deck
Please verify with the builder [he temoval of roof test caps from the plumbing system and the shut-off of water supply [o
the outside lawn faucet before freeze potential exis4s. '
Contac[ engincering division at 681-4645 before working in righ[of-way or installing underground sprinkler sys[em. ?
White - City Copy Yellow - Residcnt Copy Pink - Contrecror Copy
RUr--= °"?.; 01 :23FT9 Ci 15T011 f9ILLbJGFr. P. 2i4
?.
C@,A?TO9d, MILLWOi1K, INC.
i qE51DENTIAL . CpMMEHCIAL • INSTITlJT10NAL
SERVICE & QUALITY
UOR7H 2ND 57REET • NORTH SAINT PAUL, MINNESpTA 55109
(672)770-2356 FAX:770-0439
August 25, 1994
Ms. Pat Schumacher i
Jin Koestering M
7270 148th eet
Sau, 3e innesota 55378
Pat:
Your ternperpd window replaCement i_ cj,- ntly on order with Lincaln
ti'indows, but will not be here ir, i,iine .r• your final inspection and
This error was made by our purchasing.department and is in no v y the
., fault of Jim Koestering Nomes. Enc[osed you will find a copy of the work
order to show the bailding inspecto-.
Ovr hope is that the gla5s will b in the r-xt 3 weeks and our service
c' tment will instoll as soon a! arrives-
I nope the huilding inspector ,_.1 grant a certificate of occupancy based
on this information. We at Custom ^iitiwork apologize for our error, and
promise prompt attention to this ma-".Yew unce the glass arrives.
If the building inspector has a^,
us here at 770-2356.
:stions at all, please have him cail
Sincerely,
'1 1 .
UudlOlson
Sales Representative
Custvm Millwork, Inc.
DJO:mf
i
RUS "34 01:24Phl CLISTGPi hIILLldO,-^,K
ORIGIVAL
,
Custom Millwork91nc.
2298 NorYh SeCOnd St, . NOrth St. Paul, MN 55109
f'hone: (612) 770•2356
SOL6 TO
7IM KOESTERIMfi HOMES
7270 148TH STREET
SAVAGE MN 55378
- .. aF41P.F0
4291 HflWKSBiJRY CR
FAGAN, MN ?
F.a/a
** WORK ORDER *+r
ORD?R NO'
18?37 1 oF 1
?P•i
02
s?7 ,0
4
g
s?7r.
S
DAYS ;
viA: CM7 ?
SFRViCE
REFER SVBJECYS; TE?NIS S, CONbITIONS, MtNNESOTA LIEN PIQTICE, CMI PO:
FCRMALDEHYpE ri':.PNING, SAG'KSIDE OF IPob'pICE. ?
,
ROERED e)p SHiPPED UlM ?
. :. .UES£RIPSIOni _ ' • : <-: ,. ,-',I ..1, y,r.. '. ,'- .PR(?x ?.., , 7.
3 0 3 EA SP£CIAL QRf7ER 2068 TEMpERED IG W/ INT B6E GRS LoFS
QRIG Wq # 12676
NO CHARGE
1 8 1? E„ SHOP SPECIqL CMI LRBGR TO INSTALL
NO CHLIRGE
u 25, 1444 13:22:37 OT: li Q r"" "?'?'' "SUB TOTAL
? . W f SALE$ ?
?i`,7? ' . . TAX
---? CITY O`F EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
PERMIT
PERMIT TYPE:
Permit Number:
Date Issued:
tLINBG`! ?
@23248
04/12/94
SITE ADDRESS:
4291 HAWKSBURY CIR
1.0T: 3 BLOCK: 2
NAWTHORNE WOODS 2ND
P.I.N.: 10-32151-030-02
DESCRIPTION:
SF DWG
NEW
R-3 M-1
V-N
R-1
2
?A c]!
v u
Bw3lding'Psrmit Type
Building Wo,rk Type
?UBC pccupancy?
Construction Type
Zonzng
? Building Length >
? Building Width
` Building stories T?
-
REMARKS:
PRV
FEE SUMMARY:
S & W PLBR -
Base Fee
Plan Review
Surcharge
SAC
SAC %
SAC Units
5ubtotal
VALUATION
$1,007.00
$654.55
$102.50
$800.00
100
1
$2.564.05
$205,000
70
43
MISCELLANEOUS
Total Fee
CONTRACTOR:
KOESTERING HOMES INC
7270 148TW ST
SAVAGE MN
(612) 440-9611
- Applicant - ST. LIC
. JIM 14409611 0001667
55378
$1,828.50
$4,392.55
OWNER:
IM KOESTERING HOMES INC
270 148TH 5T
AVAGE MN 55378
612)440-9611
S hereby acknawledge that T have read this
infiormation is correct and agree to comply
Statutes and City of Eagan Ordinances.
- ?r
PPL CANTlPERMITEE SIGNATURE
applicetion and state that the
with all applicable State of Mn.
-j
ru?n 6.u?. I
ISS ED : SI NATURE
INSPECTION RECORD
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
SITEADDRESS: LoT: s BLOCKe
4291 HAWKS6URY CIR
HAWTHORNE WQOD5 2N0
PERMIT SUBTYPE:
SF DWG
PERMITTYPE: euzLoiNs
Permit Number: 0 2 3 Z 4 8
Date Issued: 0 4 J 12 / 9 4
2 APPLICANT:
KOESTERING HOMES INC, JIM
(612) 440-9611
TYPE OF WORK:
NEW
INSPECTIONTYPE
FOOTINGS .. .
FOUNDATION
..
FRAMING ROOFING
INSULA7ION FIREPLACE
RQUGH IN PLBG ROUGH 2N HTG
FINAL PL66 FINAL
REMARKS: PRV
F
L
S & W PLBR -
. ? ,.
?
?
CITY OF EAGAN
1994 BUILDING PERMIT APPLICATION
681-4675
? ('U '+. 'i
. PR 0 S iaiT..6
?'??.g?lZ•_ L? ? ...
SIN6LE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy
calcs.
COMMERCIAL 2 sets of architectural & structural plans, 1 set of
specifications, i capy of energy calcs.
Penalty applies: 1) when permit is typed, but not picked up by last working day of month
in which request is made, 2) address is changed or 3) lot change is requested ance permit
is issued.
Date Valuation of work ?• oZ OS ?? U _
Site Address: +y2q/ l7-?fv A?Sb L,CCrp- ?e ?
STREET SUITE ;7
7enant Name: (commercial only)
LOT BLOCK Z SUBD.//_
?
?P`J P.I.D. #
?
r?
T?t
Descri tion of work:
The applicant is: ? Owner Contractor ? Other (Describe)
Name !2?inint_ Phone
Property LAST FIRST
Owner
pddress
STREET STE #
City State Zip ?
Company -:J-l m 6::?E5 lcri nvi Phone
Contractor Address License #00044 Exp.3--3/-
City S?Lqe .17 ? State /21 /? Zip
Company 757,7m? Phone
Architect/
Engineer Name Registration #
Address '
City State Zip
Sewer & water licensed plumber Lneqv?,, Processing time for
sewer & water permits is two days once area has been approved.
I hereby acknowledge that I have read this a lication and state that the information is
correct and agree to com?ly wi appl' e State of Minnesota Statutes and City of
Eagan Ordinances.
`- i
Signature of Appli .
"
?
OFFICE USE ONLY rt
,
, ,
BUILDING PERMIT TYPE 4
?
01
Foundation
?
06
Duplex
?
11 Apt./Lodging
'p? lAY ?O'.SSiy
16 Basement Finish
IM 02 SF Dwg. ? 07 4-Plex ? 12 Multi. Misc. O II Swim Poo1
El 03 SF Addition ? 08 8-Plex ? 13 Garage/Accessory 0 18 Comm./Ind.
? 04 5F Porch ? 09 12-Plex 0 14 Fireplace ? 19 Comm./Ind. Misc.
E] 05 SF Misc. ? 10 Mult9. Add'1. ? 15 Deck O 20 Public Facility
? 21 Miscellaneous
WORK TYPE
0 31 New ? 33 Alterations ? 35 Tenant Finish ? 37 Oemolish
? 32 Addition ? 34 Repair ? 36 Move
GENERAL INFORMATION
Const. (Actual) /1? Basement sq. ft . ? S MWCC System
(Allowable)
UBC Occupancy 7?
? / lst F1. sq. ft.
2nd F1
ft pv SS City Water ?
PRV R
uired
. , sq.
. ?4a80 eq
Zoning ? Sq. Ft. total Booster Pump
# of Stories Footprint 5q. f t. fire Sprinkler
Length 7 On-site well Census Code se/
Depth ? On-site sewage SAC Code ?
Census Bldg
APPROVALS Census Unit ?
Planning Building Assessments
Engineering Variance
REGIUIRED IN SPECTIONS
? Site fi3 Fo oting k$ Framing 42 Insulation
? Wallboard 93 fi nal ? Uraintile (B Fireplace
Permit Fee veiLmc;m: g ? p.?`aU ?
Surcharge
Plan Review .Ae
License
MWCC SAC yV X 76
city sAC
Water Conn ?a,sk?l.s = sG
.
Water Meter 3 krS', y= ?!G
Acct. Deposit I K t?;Y = ' 7
s
9 a4'
:
S/W Permit 6
?y
5/W 5urcharge
Treatment P1.
Road Unit
d
Park Ded.
7rails Ded. 9 ?ADl,a0
Copies
Other
Total:
3 ? !o K
SAC Y
SAC Units
I
?
f ?
IAT snvLY CLtCZLIBT !OR SLSIDLIQR'M
sais+a=xo LRXIT JLP LZG?TI
PRopaRTy ..R.,.: J 2 - ?
nate et s ey: -2
DDCOlSLNT RT unAena -Ur-
eII
8?0 O
D •
• Registered Land Surveyor siqnatuss atsQ eompany
8
il
8'O
D
• u
Qinq permit Applieant
Leqal deseziption
D' D D • 1ledrass
HrD D • xorth arrov and ses seais •
?"a 0 • 8ouse type (rambiss, valkonL, split split
D
• lookont, ete.)
Directioaal drainsq* azrovs vith slope/qradient i.
? D • Proposed/axistinQ sawsr and rates aervioas
0 • Strset name
D D • Driveway
sL?v??s=ops
D?O
t7?0
D
D
• t2[3.etin4
sevez serviee
• Lot eoznors
O? 0 D
8? 8?0 •
• Top of eurb at the dzivevay
Elevations of any existinq adjaesat homas
?G D • 4reses?d
caraqe lloos
0 D • First iloor
D"0
D'"D 0
D • Lovest axposed elevation (valkouL/vindov)
D?D
D' •
• property oorners
Fzont anQ rsnr of bomt at the ioundation
D D
?
• p02iDi106 LRLRB /i! ?s?lietbl?l
Tassmsnt line .
D L!
o rT O
a • xwz,
•
a ?d f aesigr?atien
iT D fter9eney Overilov =itvstion
a=xtxsroNs
enuY.
Lr?D O • =.ot 213205
B??D D • Riqbt-of-vay and stzest vidth (to baek of curb)
?" D D • proposed Aome dimensions Sneludinq any proposed deeks,
overhanqs qreater than =•, poroAes, eLe. (i.e. ali
structuzes requisinq permanent Sootinqs)
1?D 0 • Show a11 eesementa of secosQ and any City utiiitiss vitAin
tAose aas:ments
8'0 D • Setbaeks of pzoposea structure ar?a setDaek of adjaeeat
existing homes,
DDOI)- • Retainir,q ll r?quiremaats, ii any
Revisved:
Y'E?r
3 -
:.?
c,
:u
/
P
,
6 ? I/32 BEND-1
n_D?
-cF s*yy `•[J
s
?
„
• 6 GATE VALVE
?
-
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-
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? ?
13 7 I ? 6i/326END
I ?.
12' I I ? ? ?
? ? I 0 9 g
CI i Y OF EAGAM DOES f?C?? CU?RANl°E?
i hir
I 16 TF i E A C C U R A C V O F U T I L I T L O C A T I O f V S
F. SEE SHEET N0.9 ANDIO ELEVATIO NS. THIS DATA IS FOR
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EXTERIOR ENVEI.OPE AVBFIIGE °U" COMPDTATIUN
owtIEx Ly LE P-?D A t?l r?l ?' GP PS'?'1 G? ?
SITE ADoRv-Ss LO 3$? 6, rwo s
ODNTRACfORM 1 ic\ 4V ??? (D WTE'T 15 Iq I PF30:E 40 -
Determine working square footage o£ each.
1. Total exposed wall area ...... 2 Z L.? sq, ft. X r ) I -1354j4_Z.
2. Total roof/ceiling azea .... sq. ft. R??2? - , Q
A. Total wall window area ..........................
? 0 I
B. Total door area .................................
C. Total sliding glass door area .................:?
D. Total £ireplace wall area ......................
E. Total wall framing azea (average 10e).......__..
F. Total Ria joist area......................
..•
G: Total Net wall area above floor................. ZIZ
Total er.posed foundat=on area - ?
?s
H: -1'otal foi:ndation window azea ....................
I: Total net foundation area above grade._-.........?
Determine "O^ value of each rrall segment.
a. x «n'
? b. - X `o"
C. 4 L X "D^
• d.?_ X ^D^
C. ?,ZZ X *Qn
X ^D'.
$? I ZA Y °U".
< )(
11. `II"
i. l(p'? X "U"
, Z? ? 4,2
,?= 2 IZ
-- ? ??
2-
e04• ° 14
3 ...................................7bta1
3LI/ I
If item 03 is the svnc as, or less than itcm 01, you liave mt thc intent of
SDC 6006(c)2.
.':• . .
Totul exposad rooP/cciling arca aI ?
j. 'Potal s}:yliglit arca .................:............. ?
k. Total roof/cciling framin9 arca (avcragc 102)......
1. Total net insulate:d roof/cciling arca ..............
Determine "U" value for etch roof/ceilinq segment.
C/ X nUu t9- a O .
• k.? x l'U"
1. I Vl1 X?Vlf ? DZ14 .'?so2?
4 .....................................TOtd1 4 zII z
If total of fl4 is the same as, or less than fl2, you have met the intent o£
SBC 6006 (c)1.' _. . . - •
Alternate Building Envelope Design
To utilize the total envelope system method, the values established by the
sum of items #3 and 84 shall not be greater than the sum of items #1 and #2..
?
1. , ? ? ? ? 1 (?r.?.. t Z. 41 40
a
IZ. ZD
3.' 7i(Dq,Q.?? +a. 42-1
/1_ wa? ?,
PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMES AND
CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNTT.
i/ "dEW CONSTRUCTPON ,Z?/e,?I fo M
ADD-ON A/C l)
ADD-ON FURNACE
FIREPLACE INSERT
DATE 6?-d 4 - Ci L/
FEES
HVAC: 0-100 M BTU $ 24.00 -
ADDITIONAL 50 M BTU 6.00
vAS i'Ji.TT`l.E. (14R:TN.UM is- 33.aD F_ACh7 "
ADD-ON/REMODEL (EXISTING CoNS'rRUCI'ION) $ 20.00
STAT'E SURCHARGE .50
TOTAL el7 -fo
SITE
OWNER
TELEPHONE #:
INST,
a AtR copnmoNiNC co.
CITY: °$J'um STATE: ZIP CODE:
TELEPHONE #: tfiY1-4QGo
? ._. , ,,.. . ., ..
SIGNATURE OF ERMMEWj?
1994 MECHAHICAL PERNIIT (RESIDENTIAI.)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN MN 55122
(612) 6814675
1994 MECHANICAL PERMIT (COMMERCIAL)
CITY OF EAGAN
3830 PIIAT KNOB RD
EAGAN MN 55122
(612) 6814675
PLEASE COMPLETB FOR ALL COMAERCIAL/INDUSTRIAL BUILDINGS. ALSO COMPLETE
FOR APARTMENT BUILDINGS OR OTHER MULTI-FAMILY BUILDINGS WHEN SEPARATE
PERMITS ARE NOT REQUII2ED FOR EACH DWELLING UNIT.
DATE:
NEW BUILDING
IN1'ERIOR IMPROVEMENT
WORK DESCRIPTION:
CONTRACI' PRICE: $
FEES
1% OF MNTMFEE $
PROCESSED PII'ING:
MINIMUM F'EE:
STATESURCHARGE
TOTAL
SITE
$25.00
$25.00
$.50 FOR EACH $1,000 OF FEE.
$
OWNER NAME: TELEPHONE #:
TENANT NAME: (nMPROVEMENzs orLY)
INSTALLER:__ c ? • • ?; '. ,
CTTY:
TELEPHONE #:
STAT'E: ZIP CODE:
SIGNATURE OF PERMITTEE CITY INSPEGTOR
PLEASE COMPLETE FOR SINGLE FAMTLY UWELLINGS. AISO, FOR TOWNTIO MES AND
------ - -----
CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT. 'NO. FIXT[TRES A?CH TQTAL "
? 5I-IOWER 3.00
T WATER CI.OSET 3.00
BATH TUB 3.00
LAVATORY 3.00
KITCHEN SINK 3.00
LAiJNDRY TRAY 3.00
HOT TUB/SPA 3.00
WATER HEATER 3.00
? FLOOR DR:AIN 3.00
GAS PIPING OUTLET • mi,amum - i 3.00
3 ROUGH OPENINGS 1.50
WATER SOFTENER 5'.00
PRIVAT'E DISP. • oak.cYy. tic. 20.00
U.G. SPRINKLER • bome under co,w. 3:00
ALTERATTONS • to wumg 20.00
WATER TURN AROLTND 20.00
STATE SURCHARGE
TOTAL:
SIT'E
ON:'I`.'ER
INST,
&41)
?
S • ? 0-
:5A
5?v OO,
CITY: Ap, Gt9'.aAT STATE: /h 2IP CODE: ; vr
PHONE #: ( lp/d-) 115 Z- -/SC? 5
9IGNATURE OF-PERl`vfIT-TEE
1994' PLUMBING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN MN 55122 (612) 6814675
PLEASE COMPLETE FOR ALL C0141MERCIAI./INDUSTRIAL `BUILDINGS. eALSQ FOR.'MLJLTI-
FAMILY BUIL.DINGS WHEN SEP:4R.ATE PERNITTS ARE: >NOT REQiJIItED FOR BACH
DWELLING LTNTT.
_ NEW CONSTRUCTION
ADD ON
REPAL°.
WORK DESCRIPTION:
CONTRACT PRICE: $
FEE: L% OF CONTRe?CT FEE,
STATE SURCHARGE $:50 FOR EACH $1;000 , OF , FEE,
DIINIMIIM FEE: S 25.00 ?
CONTRACT pRICE If 1% $
STATESURCHARGE $
TOTAL $
k
`
SITE ADDRESS:
.:.
TENANT NAME• STE. #
OWNER NAME:
INSTAI.LER:
ADDRESS:
CITY:
PHONE #:
STASI'E:_
ZIP "GODE:
- t? - _
FOR:
CITY OF EAGAN APPLICAN1i
1994'RLUMpBING PERNIIT (CUMMERCIAI:)
CITYAOF`EAGAN
3830 RII.OT ICNOB `RD
EAGAN, MN 55122 (612)G81-4675
7?7 7V
2007RESIDENTIAL BUILDING rExNnT nrrLicaTiorr
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New ConsWction Reouirements
3 registered site surveys showing sq. ft. of lot sq. ft. of house; and pll roofed areas
(20% maximum lot coveraqe allowed)
1 5oils Reporl if proposed building is to be placed on dislur6ed soil
2 copies of plan shawing 6eam 8 window sizes; poured found design, elc.
1 set of Energy Calculalians
3 wpies of Tree Preservation Plan ff lot plalfed after 711/93
Rim Joisl Delail Options selection sheel (6uildings w(ith 3 or less units)
Minnegasco mechanical ventilation form
RemodeVReoair Reouiremenfs
2 copies of plan showing faolings, 6eams, jalsis
1 sel of Energy Calculadons far heated additions
1 sile survey for additions & decks
Addition - indicate if onsite seplic system
2 0'" [
Office Use Onlv
CetlotSurveyRecd _Y _N
SoilsRepoA _Y _N
Tree Pres Plan Recd _ Y_ N.
TreePresRequlred _Y _N
On-sileSepGcSyslem _ Y _N
Plans are considered public information unless you state they are trade secret and the reason.
Date 9 / / z-
/ o I) Construcfion Cost s/? p 7
_
/
Si
Add
,? /
`
te
ress v 2 R 1 aW K h u e Unit/Ste #
? lC
Description of Work Re 1,0n-F,
Mu?H-Family Bldg _ Y -.? N Fireplace(s) _ 0_ 1 _ Z
Pmperty Owner / /G /-P /C ?/`?.N.y Telephone # ( &5-() .?,? ? _ Gyy Z
Contractor P) GJYIOC! 4 (e A S
Address y?/ l /?? City
State lovl-I Zip Telephone # (457) p- l ?
CaMPLETE THIS AREA ONLY IF
Energy Code Category - Minnesota Rules 7670 CateQOrv 1
• Residential Ventilation Categary 1 Worksheel
(J submission type) Submitted
• Energy Envelope Calculations Submilled
A NEW BUILDING
Mixmesota Rules 7672
• New Energy Code Worksheei
Submitted
In the last 12 months, has the City of Eagan issued a permit for a similar plan based oh a mpster plan2
_ Y _ N If yes, date and address of master plan:
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
I hereby apply for a Residential
is comulete and accurai
e;
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; that the work will be in accordance with the approved plan in the case of work which requires a review and
approval of plans.
?
Z /?nPt?o l
Applicant's Printed Name AppJ cant's Signature ZIl
Telephone #(
Telephone #(
Telephone # (
?
rd¦.e?a?
? uArN1G.?5?uR.Y CtRGL.? LA
722 a0i APa es 194 iv:ia
• -..Nw I
do ltw ... ,_
ovv ???
4 +c„°9i9?Y
° ? 29.5 "? ? tS r _S C:Al'•'e' ' a$a'
j. 5' Iz.v ?
1 ?' AA.L FSC-pR1tJLiS A5SLSt+II?D
PiZoPos?a ? I e0'rNn'CElp lRa?d MoNuMEniT
r
? ? m P,6 ? 1?0?79E o -1
??l.y. • ? /j"?!b ?R?MP.?\..?, e? UJ
?o ? aas Sq
? ap p ? rz,?? ? ? ?ol .
?
S
EAGAlv E GI?EE G DEFT.
?
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? 9 •
.
? ? A Q AR
P
Y &t }AI E fl
' -
A ???._. . .
?
? , •l?ls.?t.lTl-Te5t7.K6 Woe?05
' ? iaD ACp l'?(' 1o1.1y
pAlcaa?T'A GouNTY? •
?
I ? Mi?*l?SoTA
j?11'_??' ? .
? n LL
I hereby certify that th3.e swCVey wa8 pa`epax'ed by me or
? under my direot supervision and that I am a du],y Registered
; Land Surveyor under the laws of the State of NLinnesota.
Date: 12, /5 ? .? .?c._.k.
'
`? ?pY H. ohen
? 42r°-44Registered Land Surveyor No. 10795
IT: F A.y. ian, 44-o - 94014
;?;97% 04-05-94 04:19PM P001 #23
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA109715
Date Issued:04/01/2013
Permit Category:ePermit
Site Address: 4291 Hawksbury Cir
Lot:3 Block: 2 Addition: Hawthorne Woods 2nd
PID:10-32151-02-030
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Kris Oien
3670 Dodd Rd
Eagan, MN 55123
Fee Summary:PL - Permit Fee (WS &/or WH)$55.00 0801.4087
Surcharge-Fixed $5.00 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 -
Hung T Tran
4291 Hawksbury Cir
Eagan MN 55123
Champion Plumbing
3670 Dodd Rd., #100
Eagan MN 55123
(651) 365-1340
Applicant/Permitee: Signature Issued By: Signature