4090 Johnny Cake Ridge Rd
Use BLUE or BLACK Ink
For Office Use 1
I Permit
G
City of (Ion
I
Permit Fee:
3830 Pilot Knob Road
Eagan MN 55122 j Date Received:'
Phone: (651) 675-5675 1 I
1 Staff: I
Fax: (651) 675-5694 1 I
2011 RESIDENTIAL BUILDING PERMIT APPLICATION
j i~,
Date: - 6 Site Address: D y~ l 6Z_ Unit
Name: !'tdi`I / Phone:
RESIDENT /
OWNER Address / City / Zip: 6 2, Applicant is: Owner / `Contractor
Description of work:v
TYPE OF WORK - ( _
Construction Cost: Multi-Family Building: (Yes / No (X )
Company: 'i~~'' Contact: z
CONTRACTOR Address:/ 37 ~ City:
State: 01, Al Zip: Phone: CB~~ - l7 7 y -i
License Lead Certificate
Does this project require Lead Remediation? ❑ Yes VIINO (see Page 3 for additional information)
If no, please explain:
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:
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 the are trade secrets.
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.gopherstateonecall.orq
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances 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 per at the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Applic nt's Printed Name Applicant's Signature
Page 1 of 3
Address 4090 Johnnv Cake RidQe Rd ZIp 5512 2
Lot 6 Blk 5 Sub
Oakbrooke
THESE ITEMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECITON.
Date: L2,o Qo Yes No Inspector:
Final grade (6" from siding)
Permanent steps (garage)
Permanent steps (main entry)
Permanent driveway
Permanent gas
Sod/Seeded grass
Trail/wrb damage
Porch
Basement finish
Deck
Please verify with the builder the rcmoval of roof rest caps from the plurobing system and the shut-off of water supply to
lhe outside Iawn faucet before freeze potential euisu. Contact engineering division at 681-4645 before working in rightof-way or installing underground sprinkler system. ?
White - Ciry Copy Yellow - Resident Copy Pink - Contracror Copy
C.l'TY UF EAGFlN
CASHSER: ,]S TFRMINAt_ N0: 769
llATE: 12/31/33 1'IMC: 150.2:0
ID:
NAM't: F'ULTE MASTEF IiUILDEfi
22`.12 9220 4030 JOHNNY CK 30.00
3r^..10 3009. 4030 J01-0NNY CY. 1.?469.75
3866 3379 4030 JUHNNY Ct, 100.00
3422 9001 4090 JOHNNY Ct: 355•34
2275 `.3^2Q 4030 JQHi'!NY CY 1. y 039.50
3446 9001 4030 JOHNNY CI: 10.50
2155 91701 4090 JOHNNY CF. 0.50
3743 9220 4030 JOHNAlY CK 50.00
21.55 9001 4090 JOHNNY Ct: 92.50
3868 32211 4090 JDhIhiNY CY. 468.00
CFi:L27.835 CCiNTINUE
USER IU: JAN CONTINUE
CONTSNUE
CITY OF EAGAN
CASHIE:R: J5 TFRHINAL N0: 769
DATE: 12/3i./39 7ZME: 15:12:11
IDa
NAME: F'UITE MASTE:fi IiUILUF-R
3716 3220 4050 JOHNNY CY 114.00
W13 9220 4030 JOHNNY CK 50.00
38E,5 9220 4090 JOHNNY GK 825.00
Ta#a1 kereip+. Amoun+,? 5y?05.03
CF 1E:1.S95
IJSEFi IDe JAN
C? 1999 BUILDING PERMIT APPLICATION (RESIDENTIAL)?aC) ?
'
CITY OF EAGAN
3830 PILOT KNOB RD - 55122
651-681•4675 L
Naw Conatructlon Reauimmenla RamodellReoair ReaulremeMa
D 3 raplstared slte survays ehowing sq. R oi bt, sq. R M house
and all rootod veas (20% maximum bt eovenae allowed)
D 2 wpies of plans (show beam 8 window shas; poured fid. desipn; atc.)
D 1 set of enargy ukulelWns
? 3 copias of tree precenation plan H bt p1eGeA after 71193
DA7E: Q/ 1 ? _
DESCRIPTION OF WORK;
STREET ADDRESS: 7_?-
LOT: BLOCK:
e
2 apies of plan
1 set of energy cakulaUone Por heffied addMions
1 ake survey for exterior addPoons b decks
CONSTRUCTION COST: ???? ? )F,)
SUBD.IP.I.D.#: o
Name:
PROPERTY Last First
OWNER
Street
City
State:
Zip:
Company:/U?' /r61C ? Phone#: ?SI ?-;°Z'SaDb
(area code)
CONTRACTOR
Street Address: ??'?F Jo?G &91? PUcd Lieense I?? Sj ? Exp.&?.??J 6
cky iG1c,,,A?4 A_ staee: 41, zip: Z?0h C)
ARCHITECTI
NG NEER Company: Name:
Telephone #: ( )
Street
City
State:
Zip:
Sewer 8 vster Ikensed plumher Inew sonstruetion onlvY. PI/, Y`L- Z, v !j A /(" Telephone t: ell-I ) -2 1? /
Penalty applies when eddress change and lot change h requesEad once permk is lasued.
.
I hereby aclmowledge tliat I have read this appUcadon, sfate that the infonnatlon is cortect, and apree W comply wiM all appifcable State of Minneaota StaWtes and Cit
of Eagan Ordinances.
Signature of AppllcanL•
OFFICE USE ONLY
Certificates of Survey Received ?Yes _ No
Phone #:
Registretion #:
Tree Preservation Plan Received _ Yes _ No :0JNot Required ?
OFFICE USE ONLY
BUILDING PERMIT TYPE
??? Foundation ? 06 4-plex ? 11 10-plex ? 16 Fireplace ? 21 Porch (3-sea.)
?OZ SF Dwelling ? 07 5-plex ? 12 12-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.
? 03 1 of _ plex ? 08 6-plex ? 13 16-plex ? 18 Deck ? 23 Porch (screened)
? 04 2-plex ? 09 7-plex ? 14 Apartments ? 19 Lower Level ? 24 Storm Damage
? 05 3-plex ? 10 S-plex ? 15 Lodging ? 20 Pool ? 25 Miscellaneous
WORK TYPE
ltr31 New ? 35 Tenant Impr ? 39 Gas Line On ly ? 43. Siding/Soffits/Fascia
0 32 Addition ? 36 Move Bldg. 0 40 Gas Insert ? 44 Windows/Doors
? 33 Alteration ? 37 Demolish Bldg.` ? 41 Wood Stove 0 45 Fire Repair
? 34 Repair ? 38 Demolish (Interior) ? 42 Reroof
' Give PCA handout to applicant for demol ition permit
GENERAL INFORMATION
Const. (Actual) Basement sq. ft. I i Srs? Census Code lG I
(Allowable) Main level sq. ft. ! ? ti I SAC Code o i
UBC Occupancy 2 0 -I 2..a I<"i sq. ft. /yqy No. of Units ?
Zoning P O H,R ? sq. ft. 6ci 3 No. of Bldgs ?
# of Stories ? sq. ft. MC/ES System
Length 56 sq. ft. City Water
Width Footprint sq. ft. i SrSrN Booster Pump
PRV ?
Fire Sprinklered
APPROVALS
Planning Building Engineering Variance
Permit Fee Valuation: $
Surcharge
Plan Review
Co?« ;yU x/S YZ,lGo
License Cow«
MC/ES SAC rok IO ??uu p
CitySAC q6,r,21) ? ti2a .jDYs- x2S = 26,a-UO
WaterConn.
WaterMeter M°?•'^ ?zo
Acct. Deposit y b X 1 ? .4
zs ,- i u= zq s, 115 l x S?f
aN .?
??`i •
S/W Permit .
2 X ,
5NV Surcharge
Treatment PI.
ParkDed. ?ix21.s -?? L(,?s?? ??pf676
Trails Ded. ZX i3•5? =2$
5
Other ?/6 x 30 = 13?W
Copies ?
6?I 1 USr?
N
(??,•5? 22 x 31 ,S = 66 3
)
Totai:
SAC Units
% SAC
?
' LOT SURVEY CHECKLIST FOR RESIDENTIAL
BUILDING PERMIT APPLICATION
PROPERTY LEGAL: L-o 7" 65,?S'GOC/( S !%A?'R•PGY???
n DATE OF SURVEY: I?ff'
H
?
w LATEST REVISION:
?
p DOCUMENTSTANDARDS
O
¢
O
? o • Registered Land Surveyor signature and company
?
? El e . Building Permit Applicant
q ? ? • Legal descnptian
? ? ? • Address
? ? ? • North arrow and scale
? ? • House type (rambler, walkout, split w/o, split enVy, lookout, etc.)
ry ? ? • Directional dreinage arrows with slopeJgradient %
? ? o • Proposed/ebsting sewer and water services 8 irnert elevaUOn
q ? ? • Streetname
?j ? ? : Driveway
? Lot Square Footage
v ? • Lot Coverage
ELEVATIONS
Existina
Er/? ? . Sewer service (or Proposed) .
? ? ? • Property corners
?? ? • Top of curb at the dtiveway
3? ?/? • Elevations of any exdsting adjacent homes
c y? Adequate footing depth ot structures due to adjacent utility trenches
Prooased
M/ ? ? • Garage floor
e? ? o • First floor
? ? ? . Lowest exposed elevalion (walkouWrindow)
; cy ? ? • Property corners
o ? . Front and rear of home at the foundation
? PONDING AREA (A aodicade)
? /o • Easement line
? m'/ ? . NWL
e p ? . HWL
c ?/? • Pond # designadon
? 4' ? • Emergency OverAow ElevaUOn
? e
B" c ?
?a ?
?
o ?
DIMENSIONS
• Lot Iinesl8earings 8 dimensions
• Right-of-way and street vndth (to back of curb)
• Proposed home dimensions induding any proposed decks, overhangs greatet than 2', porches, etc.
(i.e. all strudures requinng permanentiootings)
• Show all easements of record and any City utititles within those easemenis
• Setbacks of proposed structure and sideyard setback of adjacent epsting structures
• Retaining wall requirements, 'rf any
Reviewed:
O-
March 7998
cwucMLocrnnrt.FM
DEC-16-1999 14 29 P.02i05
• • EXT6RIOR EHVElOPH'AVERAGE "U';? COMPU1'ATIOH
' ' or= /1?.?r " • - .
ONNCR: .P?. d ry. •?• ,. ..
51TE ADDRESS:
C
CaHTMCTOR: 'DATE s ?-?PHONE: -[TZ-rzeo _
pETERl1lNE WORKIttG S(kUARE FOOTAG$ OF EAC}ie
].
2.
3.
3
TOTAI EXPOSED NALL AttEA,..,.... aq ft x"U" +?I 'r
TOTAL ROOF/CERIHC AREA,,,,.... I? . sq !t x"U" C5
_. _.. ., , , .. _.,_ ....
T07AL EXPOSEO WAII AREA CALCULATitlNS:
Total exposad wa11
area above floor,,;,,... Z? ?q ft
a) Total wa11 Nthdow areaa • _
DOLIBLE 910ted,..... ?--sq ft x"v' , tJ0 ._r 107¢-
T`-E glazed...... `- s4 gt x1.1IJ"
...r.__?
?-- sq ft x 1.Iju. •Irf¢, ., 5
61 -Total docr area ... ? ..... . -.:s?.,..---_..- .?.--
c) Total ¦ITdiMg qisss doar area:
a,fj 'uuu... ef?'J
Jlazed..:... eb rC X
llVii y ?yi ..
i" ?! X
glazed...... !q
d) .Total f(replaca wall araa .g9 Ft x"U"
e) Total walt framing area
(AoaraAe loX}.....:..:.. Z 7 -S4 ft x"Uo
f) Total nnt xall area aiwve
floor (Inaula!!d)....... 20tt . I4 tt x "U"
g) Total rin jotst aree......Zbos4 ft x"U"
Total foundatton
araa (Exposed) -•:•••••••? e4 ft
h) Total foundatlan ''r_ ? t ' ' •
??u?l • ? w ??
windov area ............. 6C ft X
?,?_ •' -
i) Total nat feundation ?
area ebave grade........ sQ ft x"U"
TOTAL a) thru 1)
IF iten $3 15 ehe same as, ar lsss than item,;i, You have mes ehe Intent of
2 rtCAR 1.1600e e sad a.
paAe 1
DEC-16-1999 14:2? P.03i05
. . . .. . :p`rM:
' . . . . ' . . .. ', .. .• t . -
IF. tOTAL E7fPDSEp AOOF/CElLIN6 CALCULA7IONS:
Totel exvQaed
raoE/wTlln4 area........ r?f95 $q ft . .
J) Taesi skyTiaht eroe....... sq.ft x"U"
k) Tob) roof/calltnq freming ' A02'7
araa (Averaae tAi,)...... sq ft x "U"
1) Yotai net insulatad R
roof/eslting area....... ? oq ft x"U"
TOTAE .1 r i h ru .J ) -?
If total of S4 Is the samr as, or less phan.12, you have met the intent of
2 tSCAR I.16008 A and 0.
? i ?•'-
ALTEICIA'I'E BUfI.DlNft ENVELOPE DFSIGN
To ut(Tlxe the Cotel envatopc system Msthod, the valua9 estab}ished by the sum
of items I; and y4 shall,not be greacar thaa the sum of items BI and 02.
1. + 2. n
3. +
cExr?F?tAriaH
! hareby cetLify that ! have caleulated efie "f!" faetora and "A"
vaiues heretn and that cha bulldinq here.desorlbed meets or exceeds tha Stata
of ilinnesota EnergY Conservaelon Aet.
Slqnature
(DatO}
Pagc 2
DEC-16-1933 14:30
A
CONSTRUGf10H ''.. '
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CONSTRUC7IQM B VALM
CEII.ING SHCTiO14 (INSIJLA'iE0): '
i 1n?er(or alr fl1?n ' A 6
• 2 ? • +St1E CK .;yc
3 a.? i i
Exsorior air ffln atili I1, 1
. , TdTAL R =
. U + 1/R - ?
GEiLING FltAMIN6 SECTiON:
1 lnlerior af r F.11m
1 19* •
3 r7. ?r ? 5; ,? -ro? ?t nn
4 ncer or a r lm jstlll? 11,51? •
5 /z hclfea m t++uad d
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T AL R A
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VEN7ED
CEiIM FRAMiqN SECTION:
T• Inter(or air film 0.61
2
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6 ter or a r f Im SC 1 4.61
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TOTAL R
pr 1/Ra?
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RECAP
ADDRESS 4090 Johnny Cake Ridge Road
COMM: OAKBROOKE SF
JOB #: 0320 006 05
LEGAL: Lot 6, Block 5
OWNERS: Naiyer & 5eema Usmani
PHONE #: 612/435-3629
QUANTITY Option Description
1 18261 Base House
1 LOT PREMIUM
1 18039 ELEVATION #4
1 22019 3 CAR GAR4GE W/BRICK
1 19000 UPGRADE EXTERIOR DOOR
1 21008 GAS FIREPLACE - BRIQUETTE
1 26011 VAULT CEILING- MASTER B.R.
1 26043 WOOD RAILING - 2ND FLOOR
1 26047 WOOD RAIL VS 1/2 WALL REAR STAIR P.F.
1 14007 1ST CARPET PAD UPGRADE
1 14084 1 ST CARPET UPGRADE
1 40038 OAK FLOOR FOYER
1 40040 OAK FLOOR BATH #3
1 40049 OAK FLOOR KITCH. & DINETTE
1 10055 SPACEMKR MICROWAVE
1 28046 UPGR4DE CABN'TS R'SD P'NL
1 28057 42 UPPERS - SQ RAISED PANEL
1 36019 WATER LINE FUTURE ICEMAKER
1 13021 BRASS TRIM BATH
1 23008 3 1/2 TON AIR CONDITIONER
1 23015 MECHANICAL VENTILATOR
1 32012 T.V. JACK-CABLE READY
1 32021 PHONE JACK ON SEP. LINE
1 15026 Vinyl Upgrade Baths #1 & 2
1 22017 Insulate & Sheetrock 3 Car Garage
1 99000 NSO - Add 2 Lookout windows & 1 Egress in bsmt
1 99000 NSO - vent microwave to outside
1 99000 NSO-Finish basment-see attached
1
99000 N50-move wall btwn owners suite and bed #4:over 1
ft. into bed #4
1 25020 6 PANEL CRAFTMASTER DOOR
2 32020 ADD'L PHONE JACK
5 17024 CEILING ELECTRIC OPENING
1
99000 Add manningto Wood Floors in Dining Room in lieu
of Carpet
1
99000 Buyer is finishing F.R. originally priced out with
laminate floors in rec area-would like berber carpet
instead
NALKOUT FOUNDATION PLAN
CPI.E I/4'= I•_0•
11lx,Wd,tqvUS CaS Sh,?.?.?u??, W'? ;
?O ?r ?? 2 LO wll^d?
NOTE:
SEE ELEV. FOR FRONT
FACING CONSTRUCTION
@ GAR., STOOP & HOUSE
LOOKOUT FOUNDATION PLAN
C,NE 1/4'= Y'U' . • -
f
-? OPCL ? ;:I ? i ?'n/ 1X4 NRPorv4 ?f 14' O.C?
SfiG6- .H. 6'-0' SS OR.
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1.01 ME
- t? - ? IGRONi UF HWCE VN
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ICP OF M1NOU -?/ - - - - - - - - - - - ? ? ?
ft.0. 22 1? 2k6 WALL' ON I I I
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.F Surveyor's Cert2ficate
SURVEY FOR : PuLTE
DESCRIBED AS ; Lot 6, Block 5, OAKBROOKE, City of Eagan, Dakota County, Minnesota ond
reserving eosements of record.
A.
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roe R= 93yP
Ex;st Home
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oFe 2 1999
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Plon # 18261
PROPOSED ELEVATIONS
Top of Foundotion = q3`1,7
Goroge Fioor = q3Y,3
Basement Floor = '?/ZSo
Aprox. Sewer Service = 919.2±
Proposed Elev. _ C=>
Existing Elev.
Drainage Directions = -
Denotes Offset Stoke = .
HEDLU/VD
PLANNlNC E'NC/NBER/NC SURVEY/NC
2005 Pin Oak Drive
Eagon, MN 55122
Phone: (657) 405-6600
Fox : (651) 405-6606
L O T SQ. FOO TA GE
HSE. SQ. FOOTAGE
LOT COVERAGE _
SCALE: 1 inch - 30 feet
BENCHMARK,
E443/
MIN. SETBACK REQUIREMENTS
Front - 25 House Side - 25
Reor - Garage Side -
I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT REPRESENTATION
OF THE BOUNDARIES Of THE ABOVE DESCRIBED PROPERTY AS SURVEYED
BY ME OR UNDER MY DIRECT SUPERVISION AND DOES NOT PURPORT TO
SHOW IMPROVEMENTS OR ENCROACHMENTS, EXCEPT A SHOWN,
DnTE • &
Re? ??•?g.qq F EY . LINOGREN, LAND URVEYOR
MIIJNES TA LICENSE NUhABER 74376
JOB N0:
99R-606
BOOK: PAGE:
CAD FILE:
OAKBROOKE
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QPr.FivED nEC 2 8 9
2000 BUILDING PERMIT APPLICATION (RESIDENTIAL)
?? ? 3 N I ?ITY oF EAGAN
3830 PILOT KNOB RD - 55122
651-881-4675
New ConsMiclion Reaulremenh i
> 3 reglstered slte wrveya ahowing aq. ft ol lot, aq. fl. of house
and gU roolad areas (20% maxlmum lot eovemae allowecb
> 2 coplea ol plarxi (show bepm & window sizes; poured Ind. tleslgn; etc.)
a 1 aet ol enargy calculanan
? S Coples ol hee preaervatlon plan Il loT platted dter 7/t/93
DATE:
DESCRIPTION OP WORK'
Remotlel/Reoalr Reautremenls
?b0.50
c411fd bi I aloo
,11I1
2 copies of plan
1 aer a energy cala,lanons ror nealea aaNnona
l.sife wrvey tor axteAor addiHons 8 decks
coNSrRUCnoN cosr:
STREET ADDRESS:
LOT: ?e BLOCK: ? _ SUBDJPJ.D. #: 3 0 -? Vl?SC?'ICJ?
A/L? S{Y! A. h1
Name: Phone #:
PROPERTY wsI Flnt
OWNER
D; h h
'e-
C?4
Sheet Address: ?4 e.
Clty L-? State: Zip:
.
Company Q p t
C?C ? rlR.v"'v 0?NiITklhoneri: V12-•S1?an1-
(area code)
COMRACTOR
Sheet Address:
rJ Z D?' ?? e ?
C /- A?e- ?o tlcense # J( 3 0 Exp ` 3)6?
ciri ( e-' k -P, e l:? Srote: Al tJ ZIp:
ARCHITECT/
ENGINEER Company: Name:
Telephone q: ( )
Skee1 Address: Ref}ishation u:
CNy Sfate: Zip:
Sewer/water licensed plumber (if installina sewer/waterl: Phone #:
I hereby acknowledge Mqt I Fwve read Ihis applicaiion, state thaf Ihe intomnaHon Is cortect, and agree b comply wHh all appacable Stat
of Minnesofa Stalutes and City of Eagon Ordinances.
Signafure of Applicant
OFFICE USE ONLY
Certificates of Survey Received ? Yes _ No '
Tree Preservation Plan Received _ Yes _ No Not Required
?
L C? BL S CITY USE ONLY
p? ?
SUBD. Q C'?.S_-?1.JL "Jk?a?
RECEIPT #: ? ?a`? faYJ
RECEIPT DATE:
PERMIT#
j6m fLIJM$IN6 PERMl1' (ft£5ID£N11AI.)
,Z)Jt)v L`ITYOFEAB"
3830 Pu ur Kxos Ro
$AflkN, MN 55122
(651) 691-4675
Please complete for. ? single family dwellings
? townhomes and condos when permits are required for each unit
? backflow preventer for underground sprinklersystem
FIXTURES EACH # TOTAL
F?fh t:lb ? 3.00 X - ?
Floor drain 3.00 x = $
Ga5 i in outlet ` minimum -1 3.00 x = $
Hot tub/s a 3.00 x - $
Kitchen sink 3.00 x - $
Laund tra 3.00 x - $
Lavato 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 dwellin under construdion 5.00 x - $
Water softener if existin dweliin 30.00 x - $
Water turnaround 30.00 x $
State Surchar e .50 --> ---> ----> $ .50
Total --> --> ---> ----> $
Reminder: Call for inspeclions of aVterations, i.e. water heaters, water softeners, etc.
--------------------------•----------------------...-----------------------------------ree to compl-----------y -with a-----ll ---------------------- ? ------ •---
I hereby acknowladge that I have read this applipUOn, state that Ne infortnation is mrrect, and ag applicaDie City of Eagan ordinances.
It is ihe appliranPS responsibiliry to noGty the property owner fhat the City of Eagan assumes no liabiliry for any damages caused by the Ciry during its
normal operatlonal and maintenance activities to the faciliGes constructed under this permit wifhjq City property/nght-of-v?y/easement. ?
SITE ADDRESS:
OWNER NAME: :
INSTALLER NAME:
TELEPHONE #:
(AREA CODE)
TELEPHONE #:
(AREA CODE)
STREETADDRESS: aKXJ _7" T.4//f',dl'/// /
CITY: --Z???'??C Z/'2 STATE: ZIP:
? /l?/%"
SlGNATURE OF PERMITTEE
CI1'1' USE ONLY
LOT BL -CJ PERMIT #: 59 55 lSJ
SUBD. (%A RECEIPT #: fd?J I??
RECEIPT DATE: D - % - 0a
2000 MECHANICAL PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT IINOH RD
EAGAN tM! 55122
651-681-4675
Date• o<
Complete this section onlv if you are insffiIling HVAC in a single family dwelling, townhome or condo under
construction and not ownedoccunied.
• HVAC: 0-100 M B T U $ 30.00
ADDITIONAL 54 M B'Pj 5.40
00
• Gas outlets (minimum of one required @ $3.00 ea.)
State Surcharge .50
? Total $ _?59 57
Complete this section onlv if you aze remodeline, addin?to,. or reosirine an existing single-family dwelling,
townhome, or condo. Please indicate if it is a new item, aiteration, or repau.
_ New _ Alteration _ Repair _ Other
_ Fumace _ Air conditioning
_ Airexchanger pther
Fee $ 30.00
Sta#e Surcharge .50
Total $ 30.50
Reminder: Call for inspectians
SIT'E ADDRESS:
OWNER NAME:
INSTALLER NAME:
STREET ADDRESS:
CIT'Y:
oa /
1?57 _ _ 5?S 3 S?oo
( CODE)
- ?S? 04os`
5537?
STATE: ZIP:
-?
SIGNATURE OF PERMITTEE
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA112942
Date Issued:08/27/2013
Permit Category:ePermit
Site Address: 4090 Johnny Cake Ridge Rd
Lot:6 Block: 5 Addition: Oakbrooke
PID:10-53760-05-060
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Air Conditioner
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Stephanie Vought
3451 W Burnsville Parkway Suite 120
Fee Summary:ME - Permit Fee (Replacements)$55.00 0801.4088
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 -
Naiyer A Usmani
4090 Johnny Cake Ridge Rd
Eagan MN 55122
Burnsville Heating & Air Conditioning
3451 West Burnsville Parkway, Ste. 120
Burnsville MN 55337
(952) 894-0005
Applicant/Permitee: Signature Issued By: Signature
Use BLUE or BLACK Ink
r - - - - - - - - - - - - - - - - -
I For Office Use I
I
Permit
City of Ea~36 I Permit Fee: _ I
3830 Pilot Knob Road
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I
Fax: (651) 675-5694 I Staff:
I
} 2013 RESIDENTIAL /BUILDING PERMIT APPLICATION
Date: Site Address: D
dK&;y l_,4 )C-L 7-a Unit
Name: 1 V A ]'J 4_9~ M a yL I) Phone:&/Q
Resident/ y ~J p
Owner Address/ City/ Zip: 1I ~ Z~I1y# CA X IZ t -L.sL~. Q_D ~
Applicant is: Owner Contractor
Type of Work Description of work: 9L=
,y~
Construction Co`t; Multi-Family Building: (Yes / No
I Company: Contact:_D6,QA)Y
Address: 4-,:n>P2>r j Aj,)L- __5 city:
Contractor # )
State: Zip: 3 Phone:
License W Iq &7 / Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
f
S
B
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
i
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
i
_Yes No If yes, date and address of master plan:
Licensed Plumber: Phone:
i
i
Mechanical Contractor: Phone:
i
Sewer & Water Contractor: 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. 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.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.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days:) 2of perm-.it1issuance. p
Applicant's Printed Name Applicant's Signature
Page 1 of 3
