4187 Lexington Way?oq •7.?/a? 31-. 5, ?33, oj
2006 RESIDENTIAL BUILDING PERMIT APPLICATIONPp 9fj.S?
- - City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694 /07?'Z Tif • ??
New Constmchon Reowremenls
3 registered sde surveys showmg sq ft of lot, sq ft of house, and all wofed areas ?
(20% maximum lot cwerdge allowed) [?I
2 copies of plan showing beam & window sizes, poured found design, etc ? ?p?
1 sel of Energy Calculahons ?
3 copies of Tree Preservahon Plan if lol platled afler 711193 No ?
Rim Joist Detail OpUons selechon sheet (hmldings wdh 3 or less units)
Minnegasco mechanical ventilation form
RemodeUReoair Reamremenis OfFice.EJse.Oalv
V
2 copies of plan shawing footings, beams, jois1s Cedaf Smcy Reed Y N
1 set of Energy Calculahons for heated addtlions Tree Pres Plan Recd _Y _N
1 site survey for addtqons & decks 7E0L Pr65 ReqUkCtl Y 3(N
Addihon - indicafei/on-sitasepficsystem Orrsi€e5epticsysiem _ _k' v4
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Nrl T t,45-11 l ??
<^lat.? -?•? //-7 . l.J? ?J qJ
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Date / -A-T / _Zq?, Construction Cost ? ?oon
Site Address UniUSte #
1 E?+e ree e_
/?
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Description of Work ?A K l?,?
T ILJ
?? 1
7
Multi-Family Bldg _ YXN Fireplace(s) _ 0? 1 _ 2
PropeRy Owner ? Telcphone #(?ca,l
AJ.
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Contractar
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Address q;
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City
State Zip,_,C,!?,3a? Telephone #
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
XMmnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Enef9y COde Cateyofy . Residential Ventilation Category 1 Worksheet • New Eoergy Code Worksheet
submission type) Submitted Submitted
. Energy Envelope Calculations Submitted
E n
Licensed Plumber 91I???? Telephone
? U y5v? ?J
Mechanical Contractor ?-!-?? $I el?phone
Sewer/WaterContractor .?8-?, -L??+?'d? , ? Telephone #??.
In the last 12 mont s, has the City of Eagan issued a permit for a similar plan based on a master plan8
_ aster plan:
Y A, N If yes, date and address of m
I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of IvIN
Statutes; I understand this is not a permit, but only an application for a permit, and work is not to staR 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
Applicant's Signature
DO NOT WRITE BELOW THIS LINE
Sub Tvpes
? 01 Foundation
?
07
OS-plex
?
13
16-plex
O
20
Pool
X 02 SF Dwelling ? DS 06-plex ? 16 Fireplace ? 21 Porch (3-sea.)
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.)
?' 04 02-pfex ? 10 08-pfez ? 18 Oeck ? 23 Porch (screen/gazebo)
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 72-Alex ? 25 Miscellaneous
c ---'i
? 30 Accessory Bldg
? 31 Ext. Alt - Multi
? 33 Ext. Alt - SF
? 36 Multi Misc.
Work Tvpes
A I? 31 New
, ?
35 Int Improvement
? 36
Demolish Interior ? 44 Siding
/ '
? 32 Addition
,?
36 Move Building
? 42
Demolish Foundation O' 45 Fire Repair
? 33 Alteration ? 37 Demolish Buildin g* ? 43 Reroof ?46 WindowslDoors
? 34 Replacement 'Demolition (Entire Bidg) - Give PCA handout to applicant
D05C1'IptiDn: WaterDamage_Y es
Valuation ?j
? ?D? •
Occupancy
?
MCES System ?
Plan Review _ 1000/c or_ 25% a
Census Code
Zoning
' ?
J
- / - "
/?
City Water
SAC Units Stories -2- Booster Pump _
# of Units Sq. Ft. PRV `
# of Bid s
9 - ?l Length 6e?_ Fire Sprinkfered
Type of Const Width Footings (new bldg)
Footings (deck)
Footings (addition)
? Foundation
Drain Tife
Roof Ice & Water 7'' Final
Framing
? Fireplace _jf- A.I. _g-Air Test $ Final
? Insulation
Approved By: _
Base Fee ?
Surcharge
PIan.Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies I ldzk
Other
Total
REQUIRED INSPECTIONS
Sheetrock
? FinaUC.O.
FinaUNo C.O.
HVAC
Other
- Pool Ftgs Aid as Tesu Final
Siding _ Stucco Lath tone Lath _Brick
Windows
Retaining Wall
Building Inspector
? 3 y0 9?i -----
/ 5T
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Pennit Number
REScheck Compliance Certificate Checked By/Date
2000 Minnesota Energy Code
CtEScheck5oftwaze Version 3.5 Release ld
Data filenazne: C:1Program Files\ChecklRESchecklCustomer FileslMaacwellrck
PROJECT TITLE: Maacwell Model
COUNT'Y: llakola
STATE: Miimesota
'LONE: 2
CONSTRLJCTION TYPE: Single Family
DATE: 09/12/06
llATE OF PLANS: August 18, 2006
PROJECT DESCRIPTION:
Lot 3, Bbck I
1'svergreen Enclave
4787 Lexington Way
liagan, MN
DES IGNERICONTRACTOR
4Vindwood Homes
COMPLIANCH: Yasses
Mutimum UA = 528
Your Home UA = 411
22.2% Better Than Code (UA)
Ceiling 1: Raised or Energy Truss
Wall I: Wood Frazne, 16" o.c.
Window 1: Above-Grade:Viny] Frame:Double Pane with Low-E
Door l: Solid
I>oor 2: Glass
Basement Walt 1: Solid Concrete or Masonry
Watl height: 9.0'
Dep[h below grade: 8.0'
lnsulation depth: 9.0'
F3asament Wa112: Solid ConeteYe or Masomy
Wall height: 4.0'
Deplh below grade. 4.0'
Insulation depth: 4.0'
Furnace I: Porced Hot Air, 94 AFUE
Air Conditioner 1: Electric Central Air, IO SEER
Gross C1lazing
Area or Cavity Cont. or poor
Pernneter R-Value R-Value U-Pactor UA
1696 44.0 0.0 37
2896 19.0 1.2 137
399 0350 140
41 0.100 4
89 0.350 31
860 11.0 0.0 50
192 13.0 0.0 12
Proposed and Masimum U-Factor Averages
?
Proposed Maximucn .
Average U-Factor Allowed U-Factor
Above-Grade Windows and Gtass Doors 0350 0370
Includes Founda[ion Windows > 5.6 fl2
COMPL1t1NCE STATEMENT: The proposed building design described here fs consistent with the building plans, specifications,
wd oilter calculations submitted with the pemut application. The proposed building has been designed to meet the 2000 Mimiesota
Lnergy Code requirements in RES checkVexsion 3.5 Release Id (formerly MEC chec? and to comply wi[h the mandatory
requirements lisCed in tlta RE?S heckInspecfion Checklist.
RuilderlDesigner ? ?- ~ Date--f?`?-?`-?---
Date: 8/2812006 Revision Date: 8/2812006
Site Information
Address 1: 4187 Lexington Way
Address 2:
City: Eagan County: Dakota
Application Information
Business Name: Windwood Homes
Contact Person: Doug Cutting
New Construction
Project #:
Lot: 3 Block: 1
Subdivision: Evergreen Enclave
MN Contractor License #:2197
Office Ph: 952-345-5283 Fax: 952-736-9174 Cell Ph:
Address 1: 14311 Ewing Avenue S. , suite 200
City: Burnsville State: MN Zip Code: 55306
House Details
Square Feet: 3574 sq. ft. Avg. Ceiling Ht: 9 ft. Number of Bedrooms: 4
Ventilation : Balanced
Total Ventilation Capacity : 141 cfm.
Minimum Continuous Ventilation :75cfm.
Intermittent Ventilation: 66 cfm.
Combustion Appliance
Water Heater: NA
Furnace(Boiler: Direct VentlSea4ed Combustion Input BTUs: 90,000 {ndependently Vented
Other Combustion Appliances
Gas Fired Direct Vent Fireplace(s): Yes Gas Fired Power Vent Fireplace(s): No
Gas Fired Natural Draft Fireplace(s): No Solid Fuel Appliance(s): No
Exhaust Equipment
Continuous Exhaust Ventilation Capacity (cfm): NA Clothes Dryer (cfm): 135
Exhaust Fan Rating (cfm): 75
Make-Up Air
No Make-Up Air Required by Code
Combustion Air
Minimum Combustion Air Requirements Have Been Met.
Appiicant Name (print): iNo kloa) 9nre- s Signature/Date:
Code Official (print):
Signature/Date:
C 2004 CenterPoint Energy Minnegasco. 2004 Mechanica] Code Guidelines. Page 1
. . '?
TECHNICAL DATA SHEET
CF 108-1.7 / FE 800
` The CF 108-1.7 is a polyurethane rigid spray foam system designed for insulation of stud-wall cavities and
other applications where high yield and low density are desired. Building codes currently require a 15
minute thermal barrier system, such as a'/:" sheet rock or certain types of sprayed cementitious or
cellulose systems, or an ignition barrier be applied over the spray insulation depending. upon the
application. Check with your local building offcial for final determination.
r'. CF 108-1.7 may be applied in 1" to 3" passes. CF 108-1.7 is NOT recommended for use as an exterior
roof deck system due to the fight density of this product. CF 108-1.7.should NOT be used in refrigerated
structures or where rapid change in temperature can occur. CF 108-7.7 is to be applied to surfaces
between 40°F to 120°F. Foam Enterprises' technical service personnel should be consulted in all cases
where application conditions are questionable.
,
R LIQUID COMPONENT PROPERTIES
PROPERTY TEST FE 800 CF 108-1.7
s. i Mix Ratio By volume 1.0 1.0
Specific Gravity ASTM D-1638 1.22 - 125 1.16 - 120
Viscosity (cps) Brookfeld RVF 150 - 250 200 - 500
PHYSICAL PROPERTIES(')
(Foam Cat 400. D-Gun w/70 chamber - hose 0 125°F, preheat @ 125°F)
PROPERTY TEST RESULTS
Density Minimum (core) (pcfl ASTM D-1622 1.65 - 1.80
Compressive Strength
Parallel (psi) ASTM D-1621.
15 - 25
Tensile Strength (psi) ASTM D-1623 (Type C) ' 30 - 40
Shear Strength (psi) (max.) ASTM C-273 20 - 30
Closed Cell Content, % ASTM D-2856 90 - 96
R-value per inch, (Initial) BTU In. / Ft.Z Hr. °F ASTM C-518 7.1
Flammability Characteristics 14 (3.5" thickness)
? Flame Spread
? Smoke Developed ASTM E-84 ?2j
25
320
~Permeability (perm-inch)
I Perineance (Perms) at 1 inch
? (Perms) at 2 inches ASTM E-96
ASTM E-96 1.95
1.87
0.935
` Antimicrobial Performance " ASTM G-21 no observed growth
Antimicrobial Performance (3) Zone of Inhibition No biocide leaching
(1)These physical property results are typical for this material as applied at our development facility under
controlled conditions, The resultant physical properties can vary with changes in the application
parameters; i.e., temperatures, thickness; processing equipment, mix head variations, tliroughput, etc As
a result, these published properties are useful for evaluation guidelines. Physical property specifications
should 6e determined from actual production processed material.
(2)This numencal flame spread rahng is not intended to reFlect hazards presented by this or any other
material under actual fire conditions.
(3) Refer to CF 100/ FE 800 Technical Addendum I. Antimicrobial Performance.
F I R S T I N F ? AM COMFORT FOAM Divisian af FOAM fNTEAPPISES, INC.
13630 Watertower Circle / Minneapolls, MN 55441 / 612-559-9390 / 8DO-888-3342
-)r,,T N'Ot}it111\L;UL.47'701V . Fax:612559-0945 IntemetAddresshl[plMmw.camioTtloam.com
LOT SURVEY CHECKLIST FOR RESIDENTIAL
' BUILDING PERMIT APPLICATION
- • PROP ERTY LEGAL: i-of 3 m'? g.rJRaP.
DATE OF SURVEY: 8?l-.S??OIv
LATEST REVISION:
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DOCUMENT STANDARDS
r? ? ? • Registered Land Surveyor signature and company
? ? ? • Building Permit Applicant
? ? ? • Legal description
0 0 • Address
,0 ? ? • North arrow and scale
JZ ? ? • House type (rambler, walkout, split wlo, split entry, lookout, etc.)
?B ? ? . Directional drainage arrows with slopelgradient %
? ? ? • Proposed/existing sewer and water services & invert elevation
,2 ? ? • Street name
0 ? ? . Driveway (grade & width - in R/W and 6ack of curb, 22' max.)
? ? • Lot Square Footage
? ? • Lot Coverage
ELEVATIONS
Existin
? ? p • Property comers
7 ? ? • Top of curb at the driveway and property iine extensions
? ,Pr ? • Elevations of any existing adjacent homes
.8 ? ? • Adequate footing depth of structures due to adjacent utility trenches
,g ? ? • Watenvays (pond, stream, etc.)
Prooosed
? ? ? • Garage floor
.0' ? 0 • Basement floor
z ? ? • Lowest exposed elevation (walkouUwindow)
.0` ? ? • Property comers
0 ? ? . Front and rear of home at the foundation
PONDING AREA (if applicable)
? 0 • Easement line
? ? ? • NWL
p ,s' ? • HWL
? ? ? • Pond # designation
? .B ? • Emergency Overflow Elevation
0 .PJ ? • PondNVetland buffer delineation
. Shoreland Zoning Overlay District
?Y • Conservation Easements
DIMENSIONS
,W ? ?
? 0 ?
? ?
? ? ?
fd' 0 ?
? ? ?
• Lot Iines/Bearings & dimensions
• Right-of-way and street width (to back of curb)
. Proposed home dimensions including any proposed decks, overhangs greater than 2', porches, etc.
(i.e. all structures requiring permanent footings)
. Show all easements of record and any y tilities within those easements
• Setbacks of proposed structure and ey setback of adjacent existing structures
• Retaining wall requirements: ?
Reviewed By:
G:/FORMSBUilding Percnit Application Rev. 11-26-04
?NROBE
GINEEtiING
CONSULTING ENGINEERS,
PLANNERS and LAND SURVEYOf25
CoMnRNY, iNc.
L_ iaaa EAST 146th STREET, BURNSVILLE, MINNESOTA 55337 PH
?
CERTIFICATE OF SURVEY
Legal Description:
LOT 3, BLOCK 1, EVERGREEN ENCLAVE,
DAKOTA COUNTY, MINNESOTA.
Sg p 5 *0 AREAS
LOT = 26,187 SQ.FT.
HousE = 1,990 sa.h, (76%6005R46F)
(INCLUDING CANT.)
/lbDfZE55: +187 LExi+J6TarJ o/yy
9EVCy
E?? - 9li589
OUfE 7?ff TVa STCR y- W4U('?W
??EWED v
BY
Dare 411/16 ? - - F
. _i
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z
RAQ'aPe1d EPIG'iINBEWNG D1EF'!f.
?
3:1 Max9mum Slopes ??• ??
o- G aining lMaII Wil4
ga ia,::quired -j 1
dASRAdL
? ? fim???? COMM?'s???
'WED
DAV(E:
DOVBSBORf
C2s`?,-5)
srALE : 1" = so'
L91-D DENOTES EXISTING ELEVATION
(456, ?i DENQTES PROPOSED ELEVATION
-?---
8ti?? INDICATES DIRECTIDN pF SURFACE
FIN
= ISHED GARAGE FLOOR ELEVATION
9 16 - B,qSEMENT FLOOR ELEVATION
94-93 - = TOP OF FOUNDATION ELEVATION
580 4- DeN07E5 -iuEES pFK P2oJec7
71ZEF PLs4?J. C?Aa966
WINDWOOD HOMES
? PROJECT N0. 13639.00
BOOK
PAGE
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INGTON WA
I hereby cartify that this is a true and correct reprasentation of a tract os shown and describe
hereon. As prepared by me this _25f doy of AuSU5-7- , 20 0 6. Sqr?,/)N
/??? •= 96?.45
/?? I T 4ff"?Minn. Reg. No. 19086
INSULATION INSPECTION CHECKLIST FOR RESIDENTIAL
BUtLDING PERMITS
PROPERTY LEGAL A -r 3 BiDGK l
PROPERTY ADDRESS: 'i I R'I LeK? NR'L0Ail 11 7?il
WSPECTOR: ?r=g,nl L.(.C?? (a/VA
INSPECTION DATE: •?o - /3 - 00
cyi o a
} Z Z SITE GRADING
? f? ? All slopes 3:1 or flatter?
??? Slopes steeper than 3:1 require retaining wall Are retaining walls present?
??? Does grading conform to As-Built Grading Plan (+/- 1 foot approximately)?
a ?? Does perimeter grading tie in well with adjacent properties/undisturbed land?
p?? Is there proper grading andlor drainage around Lookout or Egress Windows?
EROSION CONTROL
2 ?? Is Silt Fence (or approved equal) installed and in good working order?
iM ?? Is Sod/Fiber Blanket installed behind curb?
m?? Is the Rock Construction Entrance/Driveway installed and in good working order (proper
type/size of aggregate, clean-not covered with soil, etc.)?
lm ?? Is temporary vegetative cover w/ mulch present?
'S ?? Is permanent vegetative cove w/ r w/o mulch present?
e one)
CITY EASEMENTS AND UTILITIES
? P? Are all easements clear-no part of any building/deck/porch/retaining wall/etc.
encroaching in easemenY?
om ? Are catch basins present within the property or in the street in front of the property, if so
are they clean, do they have the proper erosion control in and/or around them?
?2 ? Does the property have an Emergency Over Flow (EOF)? This can be found on the
Certificate of Survey. If so, is it present and has it been graded properly?
MISCELLANEOUS ITEMS
?lb ? Is there tracking present on Pu61ic Right-of-Way/5treet from construction site?
III ?? Is the driveway at the proper width at ROW line? (22 ft. max.)(Curb stop is at ROW line)
p m? Is the site clean, no trash and/or construction debris lying around?
a ?? Was the proper type of building constructed according to the approved grading plans?
(LO, WO, F6, R, etc.)
FOR ALL 1TEMS REQUIRING ADDITIONAL FOLLOW-UP:
NAME OF PERSON CONTACTED FOR FOLLOW-UP:
COMPANY NAME: 14 1, Nr4 U,lQ0 bf',dT e 5
COMPANY ADDRESS: J?I :3 ! I Ew,'Nq r41?e ?
COMPANY TELEPHONE NUMBER:
DATE CONT
DATE OF FOLLOW-UP INSPECTI
INSPECTOR:
COMMENTS:
G:/FOrms/INSULATION INSPECTION CHECKLIST FOR RESIDENTIAL.doc Revised 2-06
Address: 4187 Lexington Way Zip: 55122 Per 't: 75109
THE FOLLOWING ITEMS WERE/WERE NOT COMPLETE AT FINAL INSPECTION ON
I /
Yes No Comments
Final grade - 6" from siding
Permanent steps - garage
Permanent steps - main entry
Permanent driveway
Permanent gas
Retaining Wall or 3:1 Max Slope
Sod/Seeded lawn
Trail/curb damage
Porch
Lower level finish
Deck
Fireplace
• Verify with your builder that roof test caps from the plumbing system have been removed.
• Turn off water supply to the outside lawn faucets before freeze potential exists.
• Call the City's Engineering Department at 651-675-5646 prior to working in right-of-way or installing
irrigation system.
BUILDING INSPECTOR:
II'I
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA114163
Date Issued:09/11/2013
Permit Category:ePermit
Site Address: 4187 Lexington Way
Lot:3 Block: 1 Addition: Evergreen Enclave
PID:10-24875-01-030
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar.
Pictures are not acceptable in lieu of inspections.
Carbon monoxide detectors are required by law in ALL single family homes .
Barbara Bessent
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 -
Daniel Sagstetter
4187 Lexington Way
Eagan MN 55123
Minnesota Exteriors
8600 Jefferson Hwy
Osseo MN 55369
(763) 391-5514
Applicant/Permitee: Signature Issued By: Signature
j Use BLUE or BLACK Ink
' �---------------- �.
� For Office Use � , ���
. I / �
C�t of �� aIl � Permit�:_,�-� � ��(O I ��
� � � Pertnit Fee: �' �°�� �' '
3830 Pilot Knob Road
Eagan MN 55122 j Date Received: j
Phone:(651)675-b675 I Q� �
Fax:(651)675-6694 1 Staff: A �] i
i I
v����_�`������`��J
2015 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: l Q � Unit#:
f �a
Name: :sC�it1, �J'��\'Q%(- Phone:��.'y 3.Z-�C�� �--
Resident/ �</
Owner Address/City/Zip: ��ts ��-� � - �e , U,°� /�'t� 5�,�'(Z 3
Applicant is: `�Owner Contractor
Type Of Work �`�'ption ofwork: � "'
Construction Cost:�- ��U��3 Multi-Family Building:(Yes /No �
Company: Contact:
Contractor Address: City:
State: Zip: Phone: Email:
License#: Lead Certificate#:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
_ �
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
� In the last 12 months,has the Ciiy 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:Ptans and supporting alocuments that you submit ane consic�r+ed to be pub/ic i�ormation. Portions of
the information may l�classified as rton�rubtic if you provide spec�c ne�sons that would permit the City�b
', conclude�at 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 uUMies. www.Aopherstaleonecall.orq
1 hereby acknowledge that this ir�formation is comptete 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 of pertnit issuance. ....._ h.
;L/ `
,
X {S � S S i r � R �^--�''
� ! i
Applicant's Printed Name ApplicanYs Signat
Page 1 of 3
, � v1
• Jf '� L�'�re1G-t-fJ�'� �`4 I 1-���1��
`�l I� 1 DO NOT WRITE BELOW THIS LINE
SUB TYPES
_ Foundation _ Fireplace _ Porch(3-Season) _ E�cterior Akeration{Single Family)
_ Singie Family _ Garage _ Porch(4-Season) _ Exterior Alteration(Multi)
_ Multi _ Deck _ Porch(Screen/Gazebo/Pergola) _ Miscellaneous
01 of_Plex Lower l.evel Pool Accessory Building
WORK TYPES
_ New _ Interior Improvement _ Siding _ Demolish Building*
_ Addition _ Move Building _ Reroof _ Demolish Interior
_ Alteration _ Fire Repair _ Windows _ Demolish Foundation
_ Replace _ Repair _ Egress Window _ Water Damage
_ Retaining Wall *Demolition of entire buiiding—give PCA handout to applicant
DESCRIPTION
Valuation ���� Occupancy � MCES System
Plan Review Code Edition ��'` SAC Units
(25%_100%� Zoning City Water
Census Code Stories Booster Pump
#of Units Square Feet PRV
#of Buildings Length Fire Suppression Required
Type of Construction _�� Width
REQUIRED INSPECTIONS
Footings(New Building) Meter Size:
� Footings(Deck) Final/C.O. Required
Footings(Addition) x Final/No C.O. Required
Foundation T HVAC Gas Service Test Gas Line Air Test
Roof:_Ice&Water _Final Pool:_Footings _Air/Gas Tests _Final
Framing Drain Tile
Fireplace:_Rough In Air Test _Final Siding:_Stucco Lath _Stone Lath _Brick
Insulation Windows
Sheathing Retaining Wall:_Footings_Backfill_Final
Sheetrock Radon Control
Fire Walls Erosion Control
Braced Walls Other:
Reviewed By: � , Building Inspector
�
RESIDENTIAL FEES
Base Fee � /
Surcharge � �""'
Plan Review
MCES SAC
City SAC
Utility Connection Charge � �
S8�W Permit 8 Surcharge � � � r� � � �
Treatment Plant C! " �t
j �
Copies v
TOTAL
Page 2 of 3
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INDICATES DlRECTIDN QF' SURFACE DRAINAGE o.d'�, � � �
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I hereby certi�y that this is a true and ct�rrect reprssen�ation o� a tract as shown and describe
fiereon. As prepared by m� this �"a day pf A_v�u5-�- , 200� y��1,u,�/
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