4295 Hawksbury Cir.? ?
CiTY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
INSPECTI
SITE ADDRESS:
ri„t:rr
i j 1 111ftiiJE Wt??117'
PERMIT SUBTYPE:
RECORD
PERMIT TYPE:
Permit Number:
Date Issued:
!1!1 F 1 !1 ! lA!r
_I01IW'•,0M FI??M1-.'; INt . l?"NAi U
( c-) ?.' i V,0 HN 14
TYPE OF WORK: '
N f LJ
INSPECTION DA • DA
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i fJ ,lll ri I I??Iv i I ? ??' f iti1 I
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Permit No. Permit Holder Date Telephone #
S/VN
PLUMBING
HVAC ?$ Cf ?-??D
ELECT / x I
7
ELECTRIC
Inspectfon Date Insp. Commerits
Footings t
Foundation ? ,g'-W ?
Framing ^Z?
Roofing
Rough Plbg. 7 ?5
Rough Htg.
- .? 9'5/
l5ul. 7 7 7
Fireplace LIj
Fnal Htg. y Q
Orsat Test ?
Final Plbg. ??z 9 Pibg. Inspector - Notify Plumber
Const. Meter
EngrJPlan
Bldg. Final ? q
/
Deck Ftg.
Deck Final
Well
Pr. Disp.
0 /
r. -. . ^%
?0".j- . - r
W-ertificate nf Cccoanm
WRq of Cfagan
Toortucnt af lowoing anboection
This Certifecate issued pursuant to the requrrernents of the Uniform Building Code
certefying that at rhe time of issuance this stnicture was in comp[iance with the various
ondinances of tfee City regutaling building cwistructiore or use. For the followiRg:
U. C7assifiaOac SF DW Bldg. Ptrmit Na. 23876
?Y ?'Pe ?/M I 7oninB Qsh-ict RI ZYpe Conxt. VN
ovm" or s?ikhJCH+i90N HIES AmnJ463Q PAiK RIDC,E DR, F.AC',AN
BU;wffi7 Aaerm 4296 HAWKSKM CEUE B2, EiAWRIOM W1IM 2BID
oace:
BniWing OfCtcial ,
PosT iN a causPIcuous PLAcE
E437 7/,a
ReQUest Oal'? fpe No Fouph-In In(uec0on Repwred
(Yau mus cell inspedor wlien reatly)
Yes ? N. Inspeclion Other Then Rough-ln
0 qeatly Now ?WAI No1Hy Inspector
Oale Reatly
IVt licensed contractor r] owner hereby request inspection of above elechical work at:
Job Atl/tlre?s7s I?Str`eet Box ar RoNe No
Z°?'7 ? ?A'L.?l?.J ?Fl C..TlL l?/4 CAy
i?f/ O?/?
Sec[ion No. TownsM1?p Name or No Range No Coun%?) //_? ?y
Occu am iPRINT?
?fJ ? w i'b Phpre No
Powe?Suppher/ ?
r?-C G ?f? ?iG Atltlress G
-'?i?6ii r 6 ?
Elect onvactor iCompany Name)
.e 51, 2, ar, z Gonvxtor5 License No
Madi g AOCress ICOnirector or Owner MaAnq Insbllahon,
?A //' .?ic??r? /??-?. 1-?1????1? ?/.r?`?.C?'
4utnor a Sign ure IContr ttor• ner MaWng I stall ioni Phone Number
3 z
MINNESOTA STATE BOARD OF ELECTqICITY THIS INSPECTION REQUEST WILL NOT
Griggs-Mitlwey Bltlg - qoom S-173 8E AGCEPTED BY THE STATE BOAFD
1821 University Ave. SL Paul. MN 55104 UNLE55 PROPEq INSPECTION FEE IS
Pbane (612) 6024800 ENCLOSED
4/????_
M43787
REQUEST FOR ELECTRICAL INSPECTION
tf? See insimctions lor completing this form on Deck ol yellow copy
"X" Be/Ow Work Covered by This Request
E8-00001-08
ew Add Rep TypeofBUilding AppliancesWued EquipmentWired
Home Range Temporary ServiCe
Duplex Water Heater ElectriC Healing
Apt. Bmlding Dryer Load Mflnegement
Comm /Industrial Fumace OthBr (Specity)
Farm Air Conditioner
Other [syenryl Comraotor§ Remarks'
Compute lnspechon Fee Below.
# Other Fee # ServicaEnirenceSize Fee X CuCUlts/Peeders Fee
Swimmmg Pool 0 to 200 Amps 0 to 100 Amps
Transformers A6ove20D-Amps Atiove100_Amps
Signs . inspecmrs use onry
G? 7pTAI??j
rngahon Booms ?
/! ? /
pecial Inspection
V
4 AIarm/Communication THIS INSTALLATION MAY BE ORbEREDDISCONNECTED IF NOT
ther Fae
O COMPLETED WITHIN 1 THS ? ? ?
I, ihe Elechical Inspector, hereby
t
th
h
6 Rouqn-io ? ate
cer
iry
at t
e a
ove inspechon has
been made. F,nei
? ? o
-/•f?
OFFICE USE ONLY
Tnis repuest voie 18 monins fmm
__i-_t_i . . . ... _ . . . .
Address 4295 HAWKSBURY f.I&rj.F Zlp 5512 3
I.ot z Blk 2 Sub HAWIli0Rr1E [,ooDS 2rID
THESE ITEMS WE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECI'ION.
Date: Yes No Inspector:
Final grade (6" rom siding)
Permanent steps (garage)
Permanent steps (roain entry)
Permanent driveway ?
Petmanent gas ?
Sod/Seeded grass
TraiUcurb damage
Porch
Basement 5nish ?
Deck
Please verify with the builder the removal of toof tes[ caps from the plumbing system and the shuhoff of water supply to
the outside lawn faucet before freeze potential exists.
Contact engineering division at 681-4645 before working in righbof-way or installing underground sprinkler system. ?
White - Ciry Copy Yellow - Resident Copy Pink - Coniractor Copy
RESIDENTIAL
J S ??7 BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675
New Construction Renulrementa
• 3 registered site surveys showirg sq. ft. of lot, sq. fl. of house; and all roofed areas
(20% max'unum lot coverage allowed)
• 2 copies of plan showing beam & wiMow sizes; poured found design, elc.)
• isetMEnergyCalculallons
• 3 copies of T2e Preservation Plan if lot platted ailer 717/93
• Rim Joist DetaJ Options selection sheet (bldgs with 3 or less unBS)
DATE
SITE ADD
TYPE OF
ULTI-FAMILY BL4G _Y ? N
( ) _ 0 _ 1 _ 2
FIREPLACE S ?
APPLICANTCatactrnnhP RpStnrafinn Ca,r,Uiroc Inr
STREETADDRESS 'j4RQ Rira Ct Ci-li+p 7f1 CITY Rnco??..,;,I;P_STATE-WIPEF4113
TELEPHONE # 651-734-9433 CELL PHONE # FAX # 661 483
PROPERTYOWNER 'CC`f_g VZ(CC-- TELEPHONE#
COMPLETE FOR KNEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNESOTA RULES 7670 CATEGORY 1
(J submission type) . Residential Ventilation Category 1 Worksheet Submitted
. Energy Envelope Calculations Submitted
Plumbing Coniractor: ___
Plumbing syslem includcs:
Mechantcal Conhactor:
Mechanical system includes:
Sewer/Water Contraetor:
Phone #
Phone #
Fee: $70.00
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply
with all applicable State of Minnesota Statutes and City of Eagan Ordin ces.i
Signature of
OFFICE USE ONLY
_ Water Softcner
_ Watcr Hcater
No. of Baths
??? , c), s
RemodellReoair Reaulrements
. 2 copies of plan
• 1 set of Energy Calculatbre for heated additbrts
• 7sitesurveyforexlerioradditions&decks
• Indicate'rfhomesenedbyseplicsystemforadditions
VALUATION
_ Phonc #
Lawn Spruiklcr
No. of R.I. Balhs
_ Air Conditioning
_ Hcat Rccovery Syslem
MINNESO"PA RULES 7672
INFew neE rgyCodeWorksheelSubmitted
•
7
I
I jU ,
_ Pee: -$90.00 Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4102
OFFICE USE ONLY
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? OS 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) O 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screened) ? 36 Multi
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)' ? 43 Reroof ? 46 WindowslDoors
? 34 Replacement 'Demolition (Entire Bldg only) - Give PCA handout to appllcant
Valuation Occupancy MC/ES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footings (new bldg) FinaUC.O.
_ Footings (deck) FinaUNo C.O.
_ Footings (addition) _ Plumbing
Foundation HVAC
Drain Tile Other
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ A"u/Gas Tests _ Final
_ Framing _ Siding SNcco Stone
_ Fireplace _ R.I. _ Air Test _ Final Windows (new/replacement)
_ Insulation _
_ Retaining Wall
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
Building Inspector
<CiTYkOF tAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
PERMIT TYPE:
Permit Number:
Date Issued:
BUILDING
023876
ee/z4J9a
51TE ADDRESS:
P.I.N.: 10-32151-020-62
DESCRIPTION:
PERMIT
4295 HAWKSBURY CZR
LOT: 2 BLOCK: 2
HAWTHORNE WtltlDS 2ND
Building ?!ermit Type
Building We.r.k Type
UBC Oeeupartey `? }
Construction Type
Xoning
jBuiiding Length !
Buildircg Width ?
?
- 6,Iuilding stor-ies r"
,-
;_?
,
SF DWG
NEW
R-3 M-1
V--N
R-1
70
36
2
` a n t?
?.•??????lk?'L'L Li
REMARKS:
PRV S & W PLBR -
FEE SUMMARY:
VALUATION
Base Fee
Plan Review
Surcharge
SAC
SAC %
SAC Units
Subtotal
$660.00
$559.00
$81.50
$800.00
100
1
$2,300.56
$163,000
MISCELLANEOUS 1 628.56
7ota1 Fee $4,129.90
CONTRACTOR: - ppplicant - sT. Lzc. OWNER:
JOHNSON HOME5 INC, DONALD 14560834 0001603 DONALD L,70HNSON HOMES INC
4639 PARK'ftIDGE DR 4639 PARK RIOGE DR
EAGAM M,N 55123 EAGAN MN 55123
(612) 456-0034 (612)956-9034
S hereby aoknowledge that Z have reed this
information is carrect and agrae to comply
Statutes „and, City ofi Eagan prdinaRCes.
- ? crr RITEESIG6T-URE
appl3,cation and state thra•t the
with all applicable State af Mn.
I
.fiaron R 1nl I
ISSU D :SI NATUR
L
2.wil
CITY OF EAGAN
1994 BUILDING PERMIT APPLICATION 681-4675
tl? .Y.s'•?i? i.
SINGLE & MULTI-FAMILY ,
2 sets of plans, 3 registered sit s KVII-EE energy
cal cs . 0a 1?94
COMMERCIAL 2 sets of architecturat & structu 1 plans, 1 set of
specifications, 1 copy of eneryy "'°-------
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 once permit
is issued.
Date &_ fr / A¢ / Valuat9on of work
Site Address: ?Z 9S , N"LX,fu?
STREET SUITE M
Tenant Name: (commercial only)
IAT a BIACK SUBD. y?G(I ? Kk ?lllZ?
? P.I.D. #
?id
Descri tion of work: _4W- t-0
The applicant is: ? Owner U'GOntractor ? Other (Describe)
Name Phone
Property LAST FIRST
Owner
Address
SiREET STE #
City State Zip
Company & o-? 9?4? :2Jie? Phone 0034
Contractor Address 4( a39 i'sn ??a x2 License #//003 Exp. -3/31 I9
City State /Lkn_. Zip 01z-2
Company Phone
Architect/
Engineer Name Registration #
Address '
City State Zip
Sewer & water licensed plumber Processing time for
sewer & water permits is two days once area has been approved.
I hereby acknowledge that I have read this application and state that the information is
correct and agree to comp ly with all applicable State of Minnesota Statutes and City of
Eagan Ordinances.
Signature of Applicant:
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Duplex ? 11 Apt./Lodging
Ct] 02 SF Dwg. ? 07 4-Plex ? 12 Multi. Misc.
? 03 SF Addition ? 08 8-Plex ? 13 6arage/Accessory
O 04 SF Porch ? 09 12-Plex ? 14 Fireplace
? 05 SF Misc. O 10 Multi. Add'1. ? 15 Deck
WORK TYPE
0 31 New 0 33 Alterations ? 35 Tenant Finish
? 32 Addition ? 34 Repair ? 36 Move
GENERAL INFORMATION
't *#A p ft
?.c= i 'L r''?%
? 16 Basement Finish
? 17 Swim Pool
? 18 Comm./Ind.
0 19 Comm./Ind. Misc.
? 20 Public Facllity
? 21 Miscellaneous
? 37 Demolish
Const. (Actual) !I/ Basement sq. ft. j Z'1 3 MWCC System
(Allowable) i/? lst F1. sq. ft. >>3 City Water ?
UBC Occupancy 2nd fl. sq. ft. ? PRV Required ?
Zoning Sq. Ft. total Booster Pump
# of Stories z Footprint Sq. ft. Fire Sprinkler
Length . On-site wetl Census Cade ?
Depth 32 On-site sewage SAC Code
Census Bldg
APPROVALS Census Unit ?
Planning Building Assessments
Engineering _ Variance
REQUIRED INSPECTIONS
?.Site
O Wallboard
0 Footing
&3 Final
,E] Framing
? Draintile
a Insulation
? Fireplace
Permit Fee vetumc;a,: g )!03,0??
Surcharge
Pl an Revi ew
License
MWCC SAC
Ci ty SAC ?
Water Conn. ---?-
Water Meter !L-'=•'s;
Acct. Deposit ? ?.;.s
S/W Permit
S/W Surcharge
-
Treatment P1. °?
Road Unit
Park Ded.
Trai 1 s Ded. 7 ?"/o
Copies ?-
Other
Total:
?
SAC %
SAC Units -?
??.?r- -?'•? ?SS,d4
? •?
?
w
¢ w°
m 0
w ? w
L7 J ¢
a < m
W y
K s2
?0 ? •
?o o
C3? ?
.
0 .
?? a •
?? 0 •
Dl? o o •
L? ? ? •
LOT SORVEY CHECRLIST FOR RESIDENTIAL
SOILDING PERMIT
PROPERTY LEGAL•
Date of Su y:
DOCUMENT 8TANDARDS --
Registered Land Surveyor signature and company
Building Permit Applicant
Legal desaription
Address
North arrow and bar scale
House type (rambler, walkout, split w/o, split entry,
lookout, etc.) Directional drainage arrows with slope/gradient t.
Proposed/existing sewer and water services
Street name
Driveway
Euistina
3,11 ? • Sewer service
p'p ? : Lot corners
D?? ? Top of curb at the driveway
? • Elevations of any existinq adjacent homes
Pro osed
O??C] ? : Garage floor
o'?E] ? First floor
ct 0? • Lowest exposed elevation (walkout/window)
C?? ? • Property corners
C?0 ? • Front and rear of home at the foundation
PONDING AREAS (if aoDlicable)
? Q ? • Easement line
0 0 • rrwL
D L? ? • HwL
0 Cr ? • Pond # designation
? B?? • Energency overflow Elevation
DIMENSIONS
? ? ? • Lot lines
? 0 ? • Right-of-way and street width (to back of curb)
H' 0 ? • Proposed home dimensions including any proposed decks,
overhangs greater than 21, porches, etc. (i.e. all
? structures requiring permanent footings)
{
LI ? • Show ali easements of record and any City utilities within
those easements
B? ? ? • Setbacks of proposed structure and setback of adjacent
? existing homes
? 0/
• Retaining?hna7 requirements, if any
Reviewed:
October 1992
. 13 6"-I/16 BEND 6"-I/326END-f
.
?
?
12 11 1
? 10 9
I
2 .?
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F .
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Donald L. Johnson Homes, Inc.
Energy Code Worksheet
Name: Hawthorne Woods Model
Address - 4295 Hawksbury Circle
Contractor - Donald L. Johnson Homes, Inc. Lic #1603
4639 Park Ridge Drive
Eagan, Minnesota 55123, Phone 456-0034
Building Classification. Type A(Single Family & Duplex)
General Information:
1. Building Perimeter - See Worksheet
2. Wall Height - See Worksheet
3. Gross Wall Area 2382.84
4. Square Foot Roof Area 1274.00
5. Square Foot of Rim Joist 124.00
6. Doors - Area 34.20
U Factor 14 &.47
7. Total Door's Perimeter
8. Windows - See Worksheet
Crestline Insulated Casements
9. Total Square Foot Glass 193.51
10 . Fireplace Area -0- Clearance
11 . Exposed Foundation .67* 161 83.08
12 . Framing Area = 10% Of Gross Wall Area
U Factor
13 . Gross Wall Area 2382.84
Window Area 193.51 0.36 69.66
Rim Joist Area 124.00 0.04 5.08
Door Area 34.20 0.14 4.79
Other poor Area 0.00 0.47 0.00
Exposed Foundation 83.08 0.14 11.63
Framing Area 238.28 0.10 22.64
Net Wail Area 1709.77 0.04 73.52
187.32
14. Gross Wall Area 2382.84 0.11 262.11
15. Grass Ceiling Area 1274.00
Joist Area 127.40
Net Ceiling Area 1146.60
U Ceiling 1146.60 0.02 27.52
U Framing 127.40 0.02 2.93
30.45
16. Ceiling Area 1274.00 0.03 33.12
08-Jun-94 Page 1
Donaid L. Johnson Homes, Inc.
Energy Code Worksheet
ti
Name: Hawthorne Woods Model
Address - 4295 Hawksbury Circle
Contractor - Donald L. Johnson Homes, Inc. Lic #1603
4639 Park Ridge Drive
Eagan, Minnesota 55123, Phone 456-0034
Worksheet
26+50*8.33 633.08
26+50+14+38* 13.67 1749.76
2382.84
Roof 1274.00
Windows
2636 4*5.01 20.04 4
2040 2*2.18 4.36 2
2640 7*8.36 70.00 7
3040 1 *11.65 11.65 1
205010*3.37 33.70 10
1636 2*1.83 3.66 2
2036 0*2.18 0.00
2650 6*8.35 50.10 6
193.51
Doors
atrium 34.20 1
6'0 Patio
3420
I hereb certify that I have completed the above information
an t at it complies w"e Minnesota Starte Energy Code.
F----,-?------- ----------------r--'
M. Johnson Date
08-Jun-94 Page1
1994 PLUMBING PERMIT (RESIDENI7AL)
C1TY OF Ee1GAN
3830 PILQT KNOB RD
EAGAN MN 55122
(612) 681-4673
PLEASE COMPLETE FOR SINGLE FAMILY DWELLWGS. ALSO, FOR TOWNHOMES AND
CONDOS WHEN PERMITS ARE REQUII2ED FOR EACH UNIT.
NO. FIXT[TRES EACH .TUTAL
? SHOWER 3.00 ? • ?
? WATER CLOSET 3.40 C>0
? BATH TUB 3.00 (? - a o
C; LAVATORY 3.00 I E; - -o ct5_
? KITCHEN SINK 3:00 3• c5. C?',
I LALTNDRY TRAY 3.00 3• d??
HOT TUB/SPA 3.00
? WATER HEATER 3.00
? FLOOR DRAIN 3.00 3. 0o
.
? GAS PIPING OUTLET •minimum - i 3.00 czw%Z>:
? ROUGH OPENINGS 1.50
r WATER SOFTENER 5.00
PRIVATE DISP. • oatay. tia 20.00
? U.G. SPRINKLER • nme unaa cousL 3.00 3•??
ALTERATIONS • to oosune 20.00
WATER TURN AROUND 20.00
STATE SURCHARGE .50
TOTAL: (cl . 04_
9?
L}?
STTEADDRESS:
.
0W1`!L"1Z Nl11Y?r,'
INSTALLER:
ADDRESS:
CITY: kola??,--a- STATE: {M? ZIP CODEr:
PHONE #: ((??2) "'Z'3- 373u
PLEASE COMPLETE FOR ALL CQIVIIvtERC1AL,/INDUSTE2IAL $UILDINGS: ,ALSQ FOR MCJLTI-
FAMILY BUILDINGS WHEN SEPARATE PERMIT'S ARE NOT REQUIRED FOR EACH,
DWELLING IIN1T.
_ NEW CONSTRUCPION
ADD ON
REPAIR
WORK DESCRIPTION:
CONTRACT PRICE:
FEE: 1% OF CONTRACT FCiE,
STATE SURCHARG& $:50 FOR EACH $1,000 OE '? FEE.
MIlVIMi7M FEE: $ 25.00 "'""
CONTRACT pRICE X 1%
STATESURCHARGE
TOTAL
SITE ADDRESS:
$
$
$
TENANT NAME: STE #
OWNER NAME:
INSTALLER:
ADDRESS:
CITY:
PHONE #:
STATE:
ZIP CODE:
FOR:
CITY OF EAGAN APPIdCANT
1994 PLUMBING PERMI.T (GOMMERCIAL)
C11'Y OF EAGAN
3830f PtLUT K1YOB RD
EAGAIY MN 55122
(612) 6814675-
PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMES AND
CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNTT.
? NEW CONSTRUCTION
? ADD-ON A/C
ADD-ON FURNACE
REPCE INSERT
DATE , LA 4
FEES
HVAC: 0-100 M BTU
ADDITIONAL 50 M•BTU
GAS OUTLETS (MINIMUM 1 @ $3.00 EACH)
ADD-ON/REMODEL (EXISTING CoNSTRUCriorr)
STATE SURCHARGE
TOTAL
SITE
U
$ 24.00 ?
6.00
3,00?
$ 20.00
.50
? .?
W 1at
OWNER NAME:Nn V ) iY tk LEPHONE #: U161U -Q5""4
INSTALLER: ,- AG 11
ADDRESS: Ii ?I ('7+ •
CITY?1 rt7??-e, STATE: ZIP CODE:
TELEPHONE #: /7 "! `7? QZ)1Q
r"" (VAie -
SIGNATURE OF PERMITTEE
1994 MECHANICAL PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN MN 55122
(612) 681-4675
PLEASE COMPLETE FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS. ALSO COMPLETE
FOR APARTMENT BUILDINGS OR OTHER MULTI-FAMILY BUILDINGS WHEN SEPARATE
PERMITS ARE NOT REQUII2ED FOR EACH DWELLING UNIT.
DAT'E: CONTRACT PRICE: $
NEW BUILDING
INTERIOR IMPROVEMENT
WORK DESCRIPTION:
FEES
l % OF GgFEE $_
PROCESSED PIPING: $25.00
MINIMUM FEE: $25.00
STATE SURCHARGE , $.50 FOR EACH $1,000 OF FEE.
TOTAL $
SITE ADDRESS:
OWNER NAME: TELEPHONE #:
TENANT NAME: (IMPROVEMENTS ONLY)
lNSTALL,ER:
ADDRESS:
CITl': STATE: ZIP CODE:
TELEPHONE
SIGNATURE OF PERMITTEE CITY INSPECTOR
1994 MECHANICAL PERMIT (COMMERCIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN MN 55122
(612) 6514675
JLN S0 '99 11:06 T] 612 6E31 4612
r
<
"' a,-/
CERTIFICATE , QF SURVEY
Legai DescriEion:
?
scnlE : i• - su•
Fli013? ca?in+iiEns ° a„d infio'?tunvevans
MtNMlNG
' COMPANY, INC.
? 1000 EABT 1481h BTREET, BUfINSVILLE, MtNNE90TA 56337
FROM PROEE EhGINEfRING T-166 P.02
I
4Z95 'wWK6-S2'2Y C/?PCGE
$4,y *y, No.27y E.vy sF pA,2TMOUTy
'7bP = 9n7 4
i
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BENCN •YA,e4C:
arzaiA146E Avn
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(91?0 ) DENOTES E?t19tTINti ELEYA7IUN
( qn, b) DENOTES PROPOSEU ELEVATION
-+---- INDICATE3 LIIREC'I"ION OF SURFACB DRAINAGE
917, 33 =,FINISHED GARA(3E FLODR ELEVATIdN
= BASEMEN'i' FLUOR FLC_VAt'ION
_lLjL, b6 = TpP OP rOUNU/Cf1UN CLEVAI'IUN
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i lieraby eerl:iL'y 1:tial: lldn its ax L•xua aitiQ 'uorreat inpronetil•al•.Luli of titincl: oL
lanel as qliuvni aiia Qc-nc;z-ibecl 1iereaii. Aa pec??nr.??l by nie l:lti.lr. $7N_, Q1y vI
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A=95% 612 432 3723 06-10-94 11:04AM Pd02 itd8
Clly of Etall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
'_ D
'-
7 :1017
Use BLUE or BLACK Ink
For Office Use
Permit #:
Permit Fee:
Date Received:
Staff:
2012 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address:
Unit #:
RESIDENT /
OWNER
Name: j,.v.., p.„4„_ Phone:
Q•
Address / City / Zip: �. / fj
Applicant is: OwnerContractor
TYPE OF WORK
Description of work: Net,..) tj� °�`� 'ri'D
03,1‘
Construction Cost: �''� J Multi -Family Building: (Yes / No ) )
CONTRACTOR
Company: D , - t Contact: Dq,✓t�
l
Address: . 71- ? 3) g -,tit- �':-� Weir ----City: lrtdh (.r I f s
State: l' VV Zip: 5001 Phone: (9IZ - 72-2,'! Pitt
t
License #: 339'1 Lead Certificate #: NA1- — 1066119 — \
If the project is exempt from lead certification please explain why: (see Page 3 for additional 'nformation)
LC0'I1- (e1 7 Lir)
In the last 12 months,
_Yes No If
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Eagan issued a permit for a similar plan based on a master plan?
yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that they are trade secrets.
CALL BEFORE YOU DIG. Cali 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.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 Min ota State Building Code must be completed within 180
days of permit issuance.
x W°tVIA)- la,\(\r Presxa„LOgr-ib.a.-
Applicant's Signature 1
Applicant's Printed Name )
Page 1 of 3
DO NOT WRITE BELOW THIS LINE /Dc2 G 2 27
SUB TYPES % 114, c,s r7 C -
Foundation Fireplace Porch (3 -Season) Storm Damage f
Single Family Garage Porch (4 -Season) Exterior Alteration (Single Family)
Multi i Deck Porch (Screen/Gazebo/Pergola) Exterior Alteration (Multi)
01 of _ Plex Lower Level Pool Miscellaneous
Accessory Building
WORK TYPES
New Interior Improvement Siding Demolish Building*
Addition Move Building Reroof Demolish Interior
Alteration Fire Repair Windows Demolish Foundation
Replace At Repair Egress Window Water Damage
Retaining Wall *Demolition of entire building - give PCA handout to applicant
DESCRIPTION Z,da
Valuation -" Occupancy
Plan Review Code Edition
(25% 100%_ Zoning
Census Code ti"ei Stories
# of Units / Square Feet
# of Buildings / Length
Type of Construction SA Width
REQUIRED INSPECTIONS
Footings (New Building)
Footings (Deck)
Footings (Addition)
Foundation
Drain Tile
MCES System
SAC Units
City Water
Booster Pump
PRV
Fire Sprinklers
Meter Size:
Final / C.O. Required
Final / No C.O. Required
HVAC Gas Service Test Gas Line Air Test
Other:
Roof: Ice & Water Final Pool: _Footings Air/Gas Tests Final
Framing Siding: Stucco Lath Stone Lath Brick
Fireplace: Rough In Air Test Final Windows
Insulation Retaining Wall: Footings Backfill Final
Sheathing Radon Control
Sheetrock Erosion Control
Reviewed By: 1 ate_ , Building Inspector
RESIDENTIAL FEE
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
73 7-J1-
17'7 -
y7
Page 2 of 3
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA119789
Date Issued:12/18/2013
Permit Category:ePermit
Site Address: 4295 Hawksbury Cir
Lot:2 Block: 2 Addition: Hawthorne Woods 2nd
PID:10-32151-02-020
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:Two or More Windows/Doors
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings, call for framing
inspection. Call for final inspection after installation.
Carbon monoxide detectors are required by law in ALL single family homes .
Valuation: 4,000.00
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 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 R Koloc
4295 Hawksbury Cir
Eagan MN 55123
(651) 688-8490
Scherer Brothers Lumber Company
9401 73rd Ave. N
Suite 400
Brooklyn Park MN 55428
(952) 277-1600
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA124956
Date Issued:07/15/2014
Permit Category:ePermit
Site Address: 4295 Hawksbury Cir
Lot:2 Block: 2 Addition: Hawthorne Woods 2nd
PID:10-32151-02-020
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:
Census Code:434 -
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 by law in ALL single family homes .
Amy Jilk
Valuation: 4,000.00
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 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 R Koloc
4295 Hawksbury Cir
Eagan MN 55123
Lindus Construction
879 Hwy 63
Baldwin WI 54002
(715) 684-4647
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA129520
Date Issued:02/17/2015
Permit Category:ePermit
Site Address: 4295 Hawksbury Cir
Lot:2 Block: 2 Addition: Hawthorne Woods 2nd
PID:10-32151-02-020
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.
Applicant: Eric Bruckmueller
3992 Pennsylvania Avenue
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 -
James R Koloc
4295 Hawksbury Cir
Eagan MN 55123
Bruckmueller Plumbing Inc
3992 Pennsylvania Ave
Eagan MN 55123
(651) 686-6696
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA129520
Date Issued:02/17/2015
Permit Category:ePermit
Site Address: 4295 Hawksbury Cir
Lot:2 Block: 2 Addition: Hawthorne Woods 2nd
PID:10-32151-02-020
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.
Applicant: Eric Bruckmueller
3992 Pennsylvania Avenue
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 -
James R Koloc
4295 Hawksbury Cir
Eagan MN 55123
Bruckmueller Plumbing Inc
3992 Pennsylvania Ave
Eagan MN 55123
(651) 686-6696
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA163015
Date Issued:08/11/2020
Permit Category:ePermit
Site Address: 4295 Hawksbury Cir
Lot:2 Block: 2 Addition: Hawthorne Woods 2nd
PID:10-32151-02-020
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Softener
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
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 -
James R Koloc
4295 Hawksbury Cir
Eagan MN 55123
(612) 419-8630
Bruckmueller Plumbing Inc
3992 Pennsylvania Ave
Eagan MN 55123
(651) 686-6696
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA163695
Date Issued:09/10/2020
Permit Category:ePermit
Site Address: 4295 Hawksbury Cir
Lot:2 Block: 2 Addition: Hawthorne Woods 2nd
PID:10-32151-02-020
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace & Air Conditioner
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
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 -
James R Koloc
4295 Hawksbury Cir
Eagan MN 55123
(651) 688-8490
Prior Lake Heating & A/c
16584 Pebble Brook Ct
Prior Lake MN 55372
(952) 447-8110
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA163831
Date Issued:09/14/2020
Permit Category:ePermit
Site Address: 4295 Hawksbury Cir
Lot:2 Block: 2 Addition: Hawthorne Woods 2nd
PID:10-32151-02-020
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:Two or More Windows/Doors
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow
windows, call for framing inspection. Call for final inspection after installation.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
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 R Koloc
4295 Hawksbury Cir
Eagan MN 55123
Scherer Brothers Lumber Company
9401 73rd Ave. N
Suite 400
Brooklyn Park MN 55428
(952) 277-1600
Applicant/Permitee: Signature Issued By: Signature