4094 Johnny Cake Ridge Rd
Use BLUE or BLACK Ink
f'
For Office Use I
r;xa I I
City of Eayn ;Permit#: c. 0 0
I Permit Fee:
3830 Pilot Knob Road
Eagan MN 55122 j Date Received: j
Phone: (651) 675-5675
Fax: (651) 675-5694 Staff:
2010 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Q r~ ~l✓ Site Address: `1 U 9L J06i►v y l..a/4 12ldg e
Tenant: Suite
RESIDENT/ OWNER Name: t A 6--i r 11C r el Phone: 6 .S-t !v 2- 06
Address / City / Zip: a 9!Z n I'41( f fl I° J 9 -e n~
Applicant is: Owner -J(_ Contractor
TYPE OF WORK Description of work: lc'2 f' 12a_,02
Construction Cost: j 6, 0 UZ) Multi-Family Building: (Yes / No )
CONTRACTOR Name: 6-)l /rq License
Address: I ~Y~I j1 w io ~ f City: ' Z,4_51 Ad
State: ~ Zip: Phone: 7 ~3 elly - 3.-e I
Contact: r Email: e'rv, r e i 1 u/e,1,j ~r4-4 of
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.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.
Applicant's ,Printed Name Applica ature
Page 1 of 2
Addtess 4094 .Tohnnv Cake Ridge kd Zip 5512 2
I.ot 5 Blk 5 Sub
Oakbrooke
THESE 1'TEMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECI'ION.
Date: Yes No Inspedor:
Final grade (6" from siding)
Permanent steps (garage) >1
Permanent steps (main entry) ?C
Permanent driveway X
Permanent gas k
Sod/Seeded grass x
TtaiUcurb damage x
Porch x
Basement finish X
Deck
Please verify with the builder the removal of roof test qps from the plumbing system and the shuboff of water supply to
the outside Iawn faucet before freeze potential exists.
Contact engineering division at 681-4645 before working in rightof-way or installing underground sprinkler system. ?
White - City Copy Yellaw - Residenl Copy Pink - Contraclor Copy
C.T,TY OF 1:-AGAN
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2000 BUILDINC PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
? 01 C? () ? 3830 PILOT KNOB RD - 55122 ??
-? ??
New CanMnicHon ReaArerr?Ms 851-881-4875 RemotleURaoalr R u?i_Q(j ? ? A? -2. 'a- .- C/ U
? 3 reylatered sile wrveye showinp aq. ri ot bt, sq. fl. d house 2 eoples ot pian
and aa rootetl areat (ZOX mmdmum lot eoveroae igbwedl 1 wt of eneryy cdcWalions for heatad ad<9MOna
Y 2 coplee d Pkns (alww beam d wlrxbw sizes: Da+red tnd dealpn: etc.) 1109 wrveY tor exdeAor adtlHlona 8 decks
? 1 tef d en6rpy cdculcllqts
D 3 copleS of hae pres9natlqi pkm M Ipt plalfed a119r 7/1 /99
DAiE: Co?UC,oN Co?: !?aaa
DESCRIP'fION OF WORK: __ 2S lOC n'?'? Ci I
STREETADDRES3: 7-'77' ?
LOT: S BLOCK: "r
04 /WOoKF
PROPERiY Name: laat Flrat Phone t:
OWNER
Sheet
CNy
State:
Zip:
Company: PU I t?? 1A.PA t.5 0'f J(? ?) C o;FJ P? Phone #:
COMRACTOR (area code)
Sireet Address: &iAE ndnts f?-Fs k oacJ ucense e013 ?? Exp. `Ih,1oa
. City _/NPnd'o'h ffy±5 State: )AN Zip: (D
4RCHITECT/ t
:NGINEER Comparry: ,?,4mrAS QbU?e Name:
Telephone #: (
Sheet Address: RegisfraHon 11:
citY
State:
Lp:
ewedwater licensed plumber (ii instauina seweNwater):Y 101-UMj3LqG phone #: ( 64a ) H 2-11 --)J
6ereby acknowledpe Ihaf I have read ihis applicaHon, alaFe Mwt the intomwlbn Is cortect, and agree to comply wNh a9 aPpOccble Sfofe
f Mlnneaota Stalufes ond CNyr of Eapnn Ordinances.
l? e?is
Siynalure of ApplicarM: 0,
OFFICE USE ONLY
?
3rtificates of Survey Received es _ No ' ,?
J,? ` 2 6
ee Preservation Plan Received - Yes _ No Z?"ot Requfred ??
OFFICE USE ONLY
n 3
BUILDING PERMIT 3UBTYPES
0 01 Foundation O 07 05-plex O 13 76-plex O 21 Porch (3-sea.) ? 31 Fxt. Att - Multi
X 02 SF Dwelling ? 08 06-plex ? 17 Garage 0 22 PornNAddn. (4-sea.) O 33 Ext. Alt - SF
0 03 01 of_ piex O 09 07-plex ? 18 Deck O 23 Poroh (screened) ? 36 Multi
O 04 02-plex q 10 08-plex ? 19 Lower Level p 24 Stortn Damage
? OS 03-plex ? 11 10-plex Plop Yor_N ? 25 Miscellaneous
? 06 04-plex ? 12 72-piex ? 20 Pool ? 30 Accessory Bldg.
woRK nrPe
A 31 New ? 36 Move Bidg. O 43 Reroof
? 32 Addition ? 37 Demolish (Bldg)• O 44 Siding
? 33 Aiteration p 38 Demolish (Interior) O 45 Fire Repair
? 34 Repair ? 42 Demolish (Foundation) 0 46 Windows/Doors
' Give PCA handout to applicant for demotitlon permit
GENERAL INFORMATION
SAC Code -01 # of Stories sq. ft.
No. of Units J_ Length sq. ft.
No. of Buildings I_ Width tJ I Footprint sq, ft. ?
Const. (Actual) Basement sq. ft. Census Code
(Allowable) M in i vel sq. ft. MC/ES System
UBC Occupancy `?.. sq. ft. Ciiy Water
Zoning ft. C2 Li Booster Pump
PRV ?
Fire Spdnklered
MISCELLANEOUS INSPECTIONS
A Stucco/Stone 6((,'jj(1K,
APPROVALS
Planning Buiiding Engineering Variance
Permit Fee Valuation:
Surcharge
Plan Review
License 14L 17,010
MC/ES SAC . City SAC ?
Water Conn. rn
Water Meter t 4o, ?,j
Acct. Deposit
S/W Permit / t.' q? 1-1
S/W Surcharge
Treatment PI.
Park Ded.
7(gq
Trails Ded.
Other
Copies
Total: . S
,.
SAC Units
°k SAC
. 'A fA JOB INITIATION ORDER
Pulte Homes of
Minnesota Corporation
1355 Mendota Heights Road, Suite 300
Mendola Heghts, MN 55120-1172
Phone: (651) 452-5200 Faz: (651) 452-5727
JOB NO.oo4
COfM9UNT': Y v ? /,N,,.•
BUILDINaADpRE55:?? /+?j?L{°C.. / l/VYl
MODEL NPME: _ ?G?-l ? I`
?
C"
CON 7RACTOR/SUPPLIER:
IEGAL DESCRIP710N: L07 5 BLOCK ?5- UN(!
MODELNtfi76ER: _L
BVYER'S NAME: 7 M14
CURRENTADDRES/S:
HOMEPHONE:__(?J? aa? ? 3? y BUSINESSPHONE:
SAlES REPRESENTATNE COflj:?
a&- CIN: .r?-STATE:?/IVLP: VSIaa
Z ELEVATION: OCl OARA6E: LEFT WOHT
DATEOFORO.yE?R.,:,, / '? 2
7 77q?
CITY: + STATE:?/ ?? V ZIP: ? SI U Z
BUSINESS PHONE:
? . . ? ? '. . ? . ?.'..
0000 BASE PRICE 990
OQQ
? ----
. LOTPREMIUM i-ni ? ?j?Cp ? ,
OaU
L E
l ELEVATION #
o C????.C?C? ? -700
a?)OI q 3 Cc?" c? G f.(f? r 57,20
1 a mo I/oo
a i oQ so
i ?50( v>- 5 a-lG .70c)
i aWll msfr ? 500
? ?& aY-o - sv
1 a&045 71D
I (yoa-) c c ? aov
? og l st C?? ? t orra wL&W-r kK
15 2, AWLtt-" Z??Qx 64'L dYAa J-e+- &, GA '0 Z ;?So
Oat, F100v etoti `? RECD - a7S
?
C ?
Builders License q0007371
?J
?co 14 3
APPROVED BY BUYER ( ?
APPROVED BY SALES: ?
RELEASED TO START CONST: EOUAI HOUSING
OPPORTUNITY
This Constitutes a contract between the Seller and ihe Purchaser(s) for the above items.
JC'3 INITIATION OR['ER
Pulte Homes of
Minnesota Carporation
1355 Mendota Heights Road, Suite 300
Mendota Neights, MN 55120-1112
Phone: (651) 452-5200 Fax: (657) 452-5727
JOBNO. -L??o , .? L{5
conm?urxn: rhjr(X)U_ S'p
naooE. wnnne:
BWER'3 NAME: ?
CURRENT AODRESS:
HOME PHONE: 5y
SALES REPRESENTATIVE
CONTRACTOR(SUPPLI ER:
/?? LEGAL DESCRIPTION: LOT 05_ BLOCK (05 UN1T
arr: -4?-J
ELE1/A710N:
131SINE55 PHONE:
i OAR4GE: LEPf
DATE OF ORD?ER?:
? STATE'yl?/?![_LP:a?--
BUSWESS PHONE:
.,C?7Y.' :;OP;TION#;
0000 ,?sw.,?x4ti" ??'?s;;s?•,?a?t',,.s?,???.,.,,;;D?SGRIPTI¢1Pl8:?,'?'?;?? k",', '?`?? '" ????'?9.??
BASE PRICE r;".WPRICE*.,..;
---- LOTPREMIUM --_,
ELEVATION # ?-
q0a 9 Oat L(ow 0 00
i?DDO ?Pz c? ?eQ{-c vc-c-? la 7S
9 600
-12011
! ? 3oa ??,-??s ? y,
I
r i 3v7
?
-
? 3002 Z-0W r+ C, ?73SU
l 32-o/ Z TV a-Cf2. ?
2 3 2 oz-p /a "' (00
ftOTAL COyi
M
1%: ••
Builders license q0001371
ptac?-3
APPROVED BY BUYER ( ?
APPROVED BY SALES: ?
RELEASED TO START CONST: EGUAL t{pUSII1G
OPPOflTUNIT'1
This constitutes a contract belween the Seller and the Purchaser(s) for the above items.
JOB INITIATION ORDER
Pulte Homes of
Minnesota Corporation
1355 Mendota Heighis Road, Suite 300
Mendota Heights, MN 55120-1 112
Phone: (651) 452-5200 Fax: (651) 452-5727
CONTRACTOR/SUPPLIER:
JOB No. ??? p, O c? S, r7 S
BVIIDINO ADDRESS: O q
MODEL NUMBER:
LEGALDESCRIPTION: LOT 015 BLOCIC
MORION:
cin: U
ELEVATION:
euveaswwM: ? Y,yL (A,el/ IVV-j-(AkJ,
CURRENTADORESS + - o
MOME PHONE: BUSINESS PHONE: Y*
SALES REPRESEN7ATIVE
^-- WI YKtMIUM
ELEVATION # `
3 (Lfo-3 Necttf
fi :%q?59 2 1t-q? a7 , J-)_
°j?®r)
3
? .
Builder's License #0001371
APPROVED BY BUYER ( ?
APPROVED BY SALES: ?
RELEASED TO START CO EOIIAI 110If51NG
OPPOH7UN11Y
This constitutes a contract between the Selier and the Purchaser(s) For ihe a6ove items.
UNff
?STATE:!`VV nP: 55/ 22
? OARAGE: LEPT PoG
DATE OF ORDER: L
? STA7E:M& 21P: ?J I?Y
BUSINE35 PHONE:
L
.
. EXTERIOR ENUELOPE AVERACE "U" GOMPUTATION
? .
Ol1HER: ?.?rL. ?.?+?' s Or A-1
SITE AOORESS:
DATE: o
??
/
'
/N'y ?
//s?
¢7
PNONE: fSz-szoo
r c h
w z
o
CONTRACTOR:
Z ?
DETEAMINE 410RKItIG SOUARE f007AG E OF EACH:
?
). TOTAL EXPOSEO 41ALL AREA,,,,,,,, 2.6 sq ft x
f "U"
"U" ?? °%7 •?y
2. TOTAL ROOF/CEILING AKEA,,,,,,,, /q Nq Sq [ x
3. TOTAL EXPOSEO iJALL AREA CALCl1LATIONS:
Total exposed wall
sq
area above floor,,,,,,,, Z 3 Lv ft
r
t
a) Total wal1 wlndow area: •
DOUELE glazed,,,,,, 3 o Z. sq ft x "U" .4q */`19 58
H' p glazed,,,,,, "- sq ft x "U"
.... ., ?17 3q
b} Total doar area ft x "U" ?2 ° •o?
...
c) Total sliditig glass door area:
DOUBLF: 9lazed...... 1_/0 -sq ft x uU" Ai4Q
g l azed ., , , , , sg f t x "U" '
d) .Total ffreplace wall area sq ft x"U"
e) Total wall framing area „„ aqZ = 2 1•l6
(Aoerage 10:!)..... :?... Z 3 O sq ft x U 1
f) Total net wall area a6ove
floor (Insulated)....... /&82- sq ft x."U" •?? ` ?`/•o?
• ?L?- a
'
g) Total rim Jolst area...... 2Y 9 sq ft x nUn
Total foundatian
area (Exposed).......... 9 / sq ft ;
s
3
h) Total foundation
' .•?? _°
window area............. 9 s9 ft x"U"
t) Total net foundation
area above grade........ / Do sq ft x"U"
TOTAL a) thru 1) ? Z90.99
D? 6 ? 7-6
if ftem N3 Is [he same as, or less than item ,Al, you have met [he Intent of
2 tiC.1R 1.16008 A and 0. PaRe 1
TOTAL EXPOSED RQOF/CEILINf, CALCt1LATI0t15:
Tota) exposed
rooP/cef l tng area........ sq ft
J) Totai skyltaht area.......
sq ft x "U" ?
k) Total roof/ceil(nq framtng
?
area (Averaae 1119;)..... sq ft x"U" ??? ° 3' 7?
1) 'Total net lnsulated „„ O? e 7- g.6
roof/celling area....... /3 o D sq ft x U .
h TOTAI J) thru i) 3z.3y
If total of #G is the same as, or less than.92, yau have met the Intent of
2 ltCAR 1.16008 A and 0.
.. ?
? i;...
ALTERtlATE BUILDING ENVELOPE DESIfN
7o utillze the tota) envelope system method, the values established 6y the sum
of items !%3 and w4 shail,not oe grea[er than the sum of items N.1 and #2.
1. 290. S/ + 2.
2 9 + 4.
37. Sy a
32.3y
3Z8. oS
?Z3.33
___TiFI_ATinra
I here6y certlfy that ! have calculated [he "U" factors and "R"
values hereln and that the hulidinn here descrlhed meets or exceeds the Sta[e
of Hinnesota Energy Conservatfon Act.
(Siqnaturej
z/
/.`'i "7
(Date)
Pagc 2
?x? ?1?/Lr/ `JI?7' ??./IL:C?I? i"??..??/Y? JIVIIV\.J l "Y^-`V"
CONSTRUCTrOT! R VALUE
NALL FRAHING SECTION:
1 Interlor afr film n•FR
2 ?/Z° 'JL{ 'frLOC' _ds
g 510 -7 inches soft waod
A
or afr
WALL SECTION (INSULATED)
-41 Interlar air film
?
or aIr
RIN JOIST SECTIG17:
-?1 Intertor atr film
C
t ?J
4zyj
TUTAL K ? I0•
U ? 1/R
n.6A
.
14?00
1. CCo
• O.i7
TOTAL R ? 21
U ? 1/R
n.6R
IGGC?
'I ySR .
Vlr3YL- 'S11
5 ?1QC'-3 Co 1
_
6 Exterior alr film
n•?7
70TAL R. Q 7-4.4J.
FOUNDATION INSULATION REQUIRED: '
?°??R
Min. R-5 an entire wall OR
Min. R-10 down to frost-depth -
p p.::; e.
'
fOUN?ATION SECTION: n
hR
1 Interior air film
.
••a: . t-• 2 TZ-1 I fi,Cf'[1 .
.
?':, s. ::•
•• --'A'
t3" f nl.ic
3
4 Exteriar air
f i lm
-
LZ?
n• 17
p,' (g
4: Q / TDTAL R a 13,1?
?
u - i /R - ??ll b
SLAH ON GfL4DE
s? ,Q,,• u, 'a: 'Q.4'• J ? rCi i
E • ;•, Heated Slahs:
Minimum R = 8.5
.p; ..a Unheated Sla6s:
•v Minimum R = 6.2
a•? a ,..'a . 'a '0`?: `: 4'..
?,'?.. c?' •,. .? 7. '` S?
? ?.
q?i. `l'•'?'4
(
? .
°.
'
`
: a
? .
?.q ,
• `,•
'.`
;
d
Y
4
?
,
'
•
.
,
? . .4' ?.4'
?
.
.
?
.
? .
141l
?
, a . , a
. a
• ..
9•
.
. . ?
, 4 ,
'
a
. 4, .
.
,
, , Page 3
CONSTRIICT I ON
CEILING SECTIQN
1 Interlor
2 s?.?
3 :2-e,': I ?
4 Exterior
R VAWC-
(INSULATED):
aTr fllm
?YUL ti"?Dti! 4a CO
a(r film (sti11) q,F?
TOTAL R ?
U - 1/R = ?'?
?
CEILING FRANING SECTI4N:
1 Interior air film n,61
2 5/FS " -SHEL-T2:)"_K d(
3 V. -RI i < )i ?-in j
4 incerior air film 'still 0, 1
571Z Inches soft woorl q qS
TOTAL a e ai ?
U - I/R a 1JG7
?
CEILlNG SEf.TION (INSULATEO):
1' Interior air film n.bl
2
3
4 Exterior air ilm still n. 1
TOTAL R =
U- I/R°
VENTED
CEILINr, FRAHING SECTION:
l- fnterior air film A.bl
z
3
4 Extertor air film still n. 1
S Inches soft waod
TOTAL R
U= 1/R=
?
1 Inside air film n•'1
2
3 •
4
S Outside air film (1•17 .
TOTAL R =
Un 1/R°
Page 4
0
, • LOT SURVEY CHECKLIST FOR RESIDENTIAL
DING PERMIT APPLICATION
? PROPERTY LEGAL:
n ?f OATE OF SURVEY:
H
w
LATEST REVISION: ?
0?
(V-
DOCUMENTSTANDARDS
Q
g ? Registered Land Surveyor signature and company
a?q ? •
BuildingPermitApplicant
? .
legal description
?u ? • Address
ra? ? North anow and scale
'e .? :
House type (rambler, walkout, split w/o, spGt entry, lookout, etc.)
? ? .
Directional dreinage arraws with slope/gradieM %
? a .
Propased/epsling sewer and water services & invert elevation
p ? SVeet name
e?,d ? :
Driveway
? .
Lot Square Footage
a' ? ? • Lot Coverege
ELEVATIONS
Existina
/
d/o ? Sewer service (or Proposed)
LY?o ? :
Prapertycomers
? p ? .
Top af curb at the driveway
m? o y .
ElevaUOns of any ebsbng adjacent homes
o m? o Adequate footing depth of structures due to adjacent utiliry trenches
? Prooosed
? ? •
Garagefloor
ra'/ ?
r o ?
? • Firstfloor
t
L
l
ti
lk
U
i
d
? •
owes
exposed e
eva
on (wa
ou
w
n
ow)
? Property corners
? ? :
Front and rear of home at the foundation
PONDING AREA ('d aodicable)
/
? m
o
/ • Easement line
? ra
?
? m/ ? . NWL
- FIWL
? [J" p • Pond # designatian
? e? • Emergency Overflow Elevation
EPI/i ?
2Y/ ? ?
o ?
?5 o a
G? O p
a m?o
DIMENSIONS
Lot lineslBeadngs & dimensions
Right-of-way and sVeet widN (to back of cur6)
Proposed home dimensions induding any proposed decks, ovefiangs greater than 2', porches, etc.
(i.e. all structures requiring permanent footings)
Show aU easements of record and any Ciry uti4tles within those easements
Setbacks oi proposed structure and sideyard seffiack of adjacent epsdng structures
Retainingwali re-u ?-----" `--"
Reviewed:
Mareh 1999
cRNCYffiocvRMf.FM
!
. I I " Surveyor's Certificate
SIJRVEY FOR :PULTE
DESCRIBED AS ; lot 5, Block 5, OAKBROOKE, City of Eagan, Dokota County, Minnsoto ond
- reserving easements of record.
RECEIVED
PM JAN 31 ?000
1-3
ud 9,-:0
U i
y i
? i Exist liome
7 ' TOB ?Q 9 = 9347 ;
i
931.3 ?,`?'o ,`---- ---? N 5PL f
1?1', ^?1, ?? 0 21'3j„ '4
3 2
7,3Z, 0,y"'.3
.?4/
?\ 0 2?oO?oo 260 3?0?? _ 3.t7
a o ?po >
`? ?'i e o 33. Sy . 9+3, o
o?' a
\\ 7'33.1 Q°y&?
S `oy?3 .. ??,'S ,°j? 2? Q ti?Q? o0 3 •
1
,
Exist Home
Toe = 93? 6 `, - ?
- v
, .
?- ? J ? ?•?
_, -? ' ? j A34•q?
Rf?v?? LO7 SQ. FODTAGE = 8,477
l? HSE. SQ. FOOTAGE = 1,819
LOT COVERAGE = 21 %
_-_%Qc2
.':'til 4 ?'? T6?T"f'.??TA'uEyYT?'1 L:f DJry?
L 2?.
E
Plan // 18052
PROPOSED ELEVATIONS
BENCHM
Top of Foundation - q34.8 ARK,
Garage Floor = 43,1,y 7N+? ?Z`BIKS
Bosement Floor ?L ?Y;y y
= 9zS.8
Aprox. Sewer Service = q2d,7 t
Proposed Elev. _C:--D MIN. SETBACK REQUIREMENTS
Existing Eiev. -
Droinage Directions = Front-25 House Side -25
Denotes Offset Stoke = . Reor - Garoge Side-
SCAIE: 1 inch = 30 feet
JOB N0:
HEDL(„/ND I HERQBy CERTIF7 THAT THIS IS A TRUE AND CORRECT REPRESENTATIDN OOR-040
OF THE BOUNDARIES OF THE ABOVE DESCRIBEO PROPERTY AS SURVEYED
BY ME OR UNDER MY DIRECT SUPERVISION AND DOE$ NOT PURPORT TO 800K: PAGE:
PLqNNlNC ENC/NEER/NC SURVEYlNC $HOW IMPROVEMENTS OR ENCROACHMENTS, EXCEPT A$ SHOWN,
2005 Pin Ook Drive ! ?j
Eagon, MN 55122 OATE _,j_/L9/09 CnD FiLE:
Phone: (651) 405-6600 E MDGREN, LAND SU EYOR
Fpx; (651) 405-6606 M N 50 uCENSE NUMBER 14376 OAKBROOKE
CITY USE ONLY
1
LOT --/ BL C_ PERMIT #: 1 I D 7 U
SUBD. v Q.?`1 6Y'OCV??- RECEIPT #:
RECEIPT DATE: 3-2 "CiO
2000 MECFiANICAL PERMIT (RESIDENTIAL)
cxxY oa Ea6ax "
3830 PILOT IINOH RD
EAGAN bA1 55122
Date• 651-681-4675
Complete this section on if you are installing HVAC in a single family dwelling, townhome or condo under
conshvction and not owner/occupied.
• HVAC: 0-100 M A T U $ 30.00
.4DDITIONAL SiJ M BTU 6.00
• Gas outlets (minimum of one required @$3.00 ea.) 3.?Q
State Surcharge .50
Total $2- '.?J?
Complete this section onlv if you aze remodelin¢. addine to. or repairing an existing single-famity dwelling,
townhome, or condo. Please indicate if it is a new item, alteration, or repair.
New Alteration
_ Furnace
_ Air exchanger
_ Repair _ Other
_ Air wnditioning
_ Other
Fee $ 30.00
State Surcharge .50
Total $ 30.50
Reminder.• Call for inspections
SIT'E ADDRESS:
?" J •
OWNERNAME: y.?( )??e- u WL 0? PHONE #: ?- t45--? SDOO
CODE)
INSTALLERNAME: qo( f15V'k\k2. kG[LRln('n-?- ?I PHONE#:(AREA?.'Z - S94'? 0DLLS
SMET,aDDxESS: 1?-v. S_ ("`?" con?
crrr: 5,")q 9e- STA"I'E: 14x) ZIP: 5,5`37 p
?
SIGNATURE OF PERMITTEE
590
/?
L J r BL E5 CITY USE ONLY RECEIPT#: /.? 1J7(?I
SUBD. OQ K6rO OKe- RECEIPT DATE:
PERMIT # J I 4' ?5
2000 PLUMBING PERMIT (RESIDENTIAL)
CITY OF EAGAN ?
3830 PIIAT I4NOS RD
EAGAN, MN 55122 `
651-681-4675 ?
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 = $
Floor drain 3.00 x = $
Gas piping outlet • minimum - 1 3.00 x = $
Hot tub/spa 3.00 x = $
Kitchen sink 3.00 x = $
Laundry Vay 3.00 x = $
Lavatory 3.00 x = $
Septic S stem new/refurbished ' requfres MPC Ilc. 75.00 x = $
Septic System ebandonment 30.00 x = $
RPZ new instellatioNrepaidrebuild 30.00 X = $
Rou h opening 1.50 x = $f r
Shower 3.00 x = $
Under round sprinkler 'rfdwelling is underconstruction 3.00 x = $
Undergroundsprinkler if existing dwelling 30.00 x = $
Water closet 3.00 x = $
Water heater 3.00 x = $
Water softener if dwelling under coristructlon 5.00 x = $
Water softener Ir exisnng dwenin9 30.00 x = $
Water tumaround 30.00 x $
State Surcharge .50 -> -> --> S .50
4oial _-> _.a
"giln
$
Reminder: Call for inspections of alterations, i.e. water heaters, water softeners, etc.
--- • -------------------------------------------------------------------------------•---------------- • -----------------------•--------------
i hereby adcnowledge Mat I have read this appliation, state fhat the iMOrtnation is correU, and agree to compty with all applicable City of Eegan ordinances.
It is the applipnPs responsibility to notify the property owner that the Ciry of Eagan assumes no liability tor any damages wused by the City during its
nortnal operational and maintenance adivities to the facilities constructed under this pertnk within Ciry property/right-of-way/easement.
SITE ADDRESS:
OWNER NAME: :
INSTALLER NAME:
STREET ADDRESS:
TELEPHONE #:
- (AREA CODE) . .
CITY: STATE: 1,22,17 ZIP:
SIGNATURE OF PERMITTEE
-? CITY USE ONLY ?? Q 7?a ?aJV• ??
L ? BL RECEIPT ti:
SUBD. ? RECEIPTDATE: dD
PERMIT # qohoo
8000 PLUM$IRfi PEiMTP (iiESIDENTIAL)
crrYoF ErtsnN
5990 PILOT KNOB RD
Ei48AN, MA 55122
ss1-01-as7s
Piease 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 = $
Floor drain 3.00 x = $
G8s i ifl 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 = $
Se tic S stem newrrefurbisned • re utres MPC tic. 75.00 x = $
Se fiC S Sf@rtl a6andonment 30.00 X = $ ?
RPZ new installationlreidrebuild 30.00 x = $ ?
Rou h o enin 1.50 x = $
Shower 3.00 x = $
Under round s rinkler if dwellin is unaer conswction 3.00 x = $
Under round s rinkler ifezistin dwenin 30.00 x = $ I
Watercloset 3.00 x = $
Water heater 3.00 x = $
Water softener if dwelling under construetian 5.00 x 30: _ $
Watersoftener irexistin dwelling 30.00 x = $
Waterturnaround 30.00 x --- _ $
State Surchar e .50 --> ----> ----> $ .50
Total -> -' --"> ----? S
Reminder: Call for inspections of alterations, i.e. water heaters, water softeners, etc.
-------•--------••----------------------•---.....---•---------._.....------- -----------• ---------------------------•-----•-
I hereby aUcnowledge that I have read this appliption, state that fhe intormation is correc4 and agree to comply with all applicable City of Eagan ordinances.
It is the applicant's responsibility to noofy the property owner Ma[ Me Ciryof Eagan assumes no liability for any damages raused by the City during its nortnal
operational and maintenance activities [o tpe taFilities consWCteg untler tliis permit within City property/righbof-way/easement.
SITE ADDRESS: z 0 Gt_?
OWNER NAME: : " ?Cf-d ??UYJ _ TELEPHONE #:
(nRe.a cooe)
INSTALLER NAME: TELEPHONE #: ?") - K? S ?
STREET ADDRESS' (a,aEn cooe)
CITY: y i/?/ I?J?YJX STATE: `1?J YI ? ZIP:
SIGNATURE OF PERMITTEE
Use BLUE or BLACK Ink
--------�
� For Office Use �
I
Permit#:� �a�(L j
��� ���� �� � � �� j
� � Permit Fee: � �-- � (,�
3830 Pilot Knob Road � 1 �
Eagan MN 55122 � Date Received: q o'- � j
Phone:(651)675-5675 I �� �
Fax:(651)675-5694 I Staff: I
I I
`________________J
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: � ` �c��7� Site Address: 7�� !� � Unit#:
��'' ' � Name: CO � Z" �� Phone:
''��� 3�� �� �� � �
� ������{�;� y,: ;r �j
�� �'M�'.��C' �' Address/City/Zip: �� +'✓1�� ��� ��c'�. �:�l 1�� �f7
�rh , � � -�
� ��,E„� `�`���E�€E Applicant is: Owner Contractor' �
���v -
� �;� € - � �
� 3� ° Description of work: �� ��
��' ���� �3 ' .
`
�;3 ' Construction Cost: Multi-Family Building: (Yes /No_)
� E
�`� ��°� Company: �q�v�t� �.����vW �n,c Contact �_r�e,�,�"�
�Y'{�� � �
��€ �. Y:k EH�4 /
'��� �.° � ����'`'= Address: ('��� �- �e'v�(�.rrr'� � � City: � �� �aK,fu-
��3
�' ��Zip: .��� f,,�����:�� �
� � ` State: Phone: mail: x
� 3 � �,
����� � ���� � �
��� �� '� `,;'� License#: � Lead Certificate#: � ��
��1, �.
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTWG 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:
�
��r � , � �� �.�
QT� �'lans�c���ppartrn c� t yau su#mrt�re cc�r�srd+�re t� �Ei��r�rra
E E r�r',��a�ati"�n,m� � � e cla�s�ed as�o� �c,'�f,�ctu������`�specr�'c r� �� � � ��������€ �
F � E E� �� �����. �
� [�.� �� Gi��t�l �3 �
��� �
��_ �?�_ F ���_ [�,..�� '��� �E 4 �._ � � � � E'�� ������ �.. � '��� ,�� ` a��,�a.�, ���� . . `.��°�
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.aopherstateonecall.orp
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 m�st be completed within 180
days of permit issuance.
` r I
�,�
X , ,� X ..
Applica�nYs Jrinted Name Applica 's ' nature
Page 1 of 3