4191 Lexington WayINSULATION INSPECTION CHECKLIST FOR RESIDENTIAL
BUILDING PERMITS
PROPERTY LEGAL: ? ?l ? ?/?y/'PBvt S t ,rg
PROPERTYADDRESS:
INSPECTOR:
INSPECTION DATE:
m o ¢
r Z Z SITE GRADING
? fd ? All slopes 3:1 or flatter? , ?
? kl' ? Slopes steeper than 3:1 require retaining wall Are re ing walls present?
0 Does grading conform to As-Built Grading Plan (+/- 1 foot approximately)?
?? Does perimeter grading tie in well with adjacent properties/undisturbed land?
.g' ?? Is there proper grading and/or drainage around Lookout or Egress Windows?
EROSION CONTROL
?? ? Is Silt Fence (or approved equal) installed and in good working order?
?'Er ? Is Sod/Fiber Blanket installed behind curb?
?a' 0 Is the Rock Construction Entrance/Driveway installed and in good working order (proper
type/size of aggregate, clean-not covered with soil, etc )?
?.e G Is temporary vegetative cover w/ mulch present?
?.s' ? Is permanent vegetative cover w/ or w/o mulch present?
(cirde ane)
CITY EASEMENTS AND UTILITIES
.E' ?? Are all easements clear-no part of any 6uilding/deck/porch/retaining wall/etc.
encroaching in easement?
?? Jd' 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?
?,g ? 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?
MlSCELLANEOUS ITEMS
??? Is there tracking present on Public Right-of-Way/Street from construction site?
-Er ?? Is the driveway at the proper width at ROW line? (22 ft. max.)(Curb stop is at ROW line)
? 0 ? Is the site clean, no trash antl/or construction debris lying around?
.B' ?? Was the proper type of building constructed according to the approved grading plans?
(L0, WO, FB, R, etc )
Address: 4191 LEXINGTON WAY Zip: 55123 Pel71567
THE FOLLOWING TTEMS WERE/WERE NOT COMPLETE AT FINAL INSPECTION ON : 11-10Z
Yes No Comments
Final grade - 6" from siding
Permanent ste s - arage
Permanent steps - main entry
Permanent drivewa
Permanent as
Retainin Wall or 3:1 Max Slo e
Sod/Seeded lawn
TraiUcurb dama e
Porch C 6e.N
Lower level finish
Deck
Fireplace U ?? 9 l? 1L?.
• 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
irrigation system.
V EUIL?ING INSPEC70R:
GBidg Insp/Focros/2007/Checkhsts
right-of-way or installing
0
New Construction
Project #: 1422
Lot: 2 Block: 1
Subdivision: Evergreen Enclave
MN Contractor License #:2197
Office Ph: 952-895-8448 Fax: 952-736-9174 Cell Ph:
Address 1: 14311 Ewing Avenue S. , suite 200
City: Burnsville State: MN Zip Code: 55306
Date: 6I6/2007 Revision Date: 616/2007
Site information
Address 1: 4191 Lexington Way
Address 2:
City: Eagan County: Dakota
Application Information
Business Name: Windwood Homes
Contact Person: Darrell Judkins
House Details
Square Feet: 3268 sq. ft. Avg. Ceiling Ht: 9 ft. Number of Bedrooms: 3
Ventilation : Balanced
Total Ventilation Capacity : 129 cfm.
Minimum Continuous Ventilation :60cfm.
intermittent Ventilation: 69 cfm.
Combustion Appiiance
Water Heater: ?
Fumace/Boiler: Direct VenUSealed Combustion Input BTUs: 100,000 Independently Vented
Other Combustion Appliances
Gas Fired Direct Vent Fireplace(s): ?el 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
ExhauEn Rating (cfm): 75
Make-Up Air
No Make-Up Air Required by Code
Combustion Air
Minimum Combustion Air Requirements Have Been Met.
--_- -- - ----?-_ _?
/?
Applicant Name (print): -??r r rc- u?/0 n s SignaturelDate:
Code Offcial (print): Signature/Date:
0 2004 CenterPoint Energy Minnegasca. 2004 Mechanical Code Guidelines.
Page I
?
Site address: Lot""L Block ? Subd. ?= ion poM ? ??y Y?yy`e?
On April 15, 2000 the Minnesota Energy Code, Category ! Building Requirements for insufation protection, air
tightness, and ventilafion, was adopted. As a result, the City of Eagan is requiring that the following information be
submitted prior to issuance of a Certificate of Occupancy.
? This shucture: is constructed to meet minimum requirements of the Mn Energy Code, Chapter 7670
OR
_ This shucture: will be construcfed to meet more restrictive requirements of Chapters 7672 or 7674
APPLIANCE GAS ELEC MANLIFACTURER MODEL BTU'S VENTINGTYPE
Water Heater
Furnace
?
Dryer
EXHAUST SYSTEM
LOCATION
TYPE
MODEL
CFM's VENTED
vES No
Kitchen kitchen N U n_ ? p ? •
Bathroom 1 Y
Bathroom 2 ftlo?
Bathroom 3 L?
Bathroom 4
Other -
FIREPLACE 5
LOCATION
GAS
W00D
MANUFACTURER
MODEL
BTU'S VENTMG i
DIRECT ATMOS
?
/17(( !`A4 1 1 4 r? I ?- mn" i?- V-)P42 -r,i.._
MAKE-UP AIR MODEL TYPE CFM`s
r B? /00
a .
I hereby acknowledge that the above information is correct and agree to comply with the Minnesota Energy Code and City of Eagan
requirements
A I
Si9natqef /7 /J ; j Date
Company Name
* This form is the responsibility of the General Contractor
5??9-567 7,O-78,3?1
2006 RESIDENTIAL BUILDING PERMIT APPLTCATION PL_'7S51v SS
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694 ?1 ?6 -7
New Constmc6on Re mrements
3 registered site surveys showing sq fl of lot, sq fi ot house, and all roofed area:
(20% maximum loi coverege allowed)
(?,2 copies of plan showing beam & window sizes, poured found design, etc
1 set of Energy Calculahons
copies of Tree Preservahon Plan if lot plafled after 711/93
Rim Joist Detail Options selechon sheet (buildings with 3 or less units)
,Afinnegasco mcchazucal venhlahon fonn
RemodellReoair Reauiremenis
2 copies of plan showing footmgs, beams, joists
1 set o( Energy Calculations for healed addtlions
1 sde survey for additions 8 decks
Adddron - mdirafe 6 onsde septic sysfem
l1? ? ? 25/ 0
DI(fCB U58 OFllV
GertofiSuNeYRGGd 1C"¢ rti
kee Pres Plan Recd -Yk--EJ
Trpe Pres Requhed _ Y i.,,,.fV
On-siEe3sp{ie5}stem -Y _N
Date Construction Cost 77D
Site Address Unit/5te #
Description of Work /
Multi-Family Bldg _ YXN Fireplace(s) / 0 _ 1? 2
PropeMy Owner Telephone # ( )
t
Contractor
Address City
State Zip+? Telephone # 0XS? Q? ? ,??T?
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
? Minnesota Rules 7670 Categorv 1 Minnesota Rules 7672
EnOfgy Code Category
• Residential Ventilation Cate9ory 1 Worksheet • New En /
(Jsubmissiontype) Submitted Submitt FT??LJ v?
. Energy Envelope Calculations Submitted
?UN 7 4 2007
In the last 12 mon,fhs,_has the City of Eagan issued a permit for a similar plan based on a master plan8
Y X N If yes, date and address of master plan: TL
Licensed Plumber Telephone #(af)
Mechanical Contractor Telephone #(? l ?
Sewer/WaterContractor d?Jn?z-{?%?o.t ?Telephone #??ll?T
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 MN
Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a
permit; that the work will be in accordance with the approved plan in the case of work which requires a review and
approval of plans
?YrP I?Z?J. r'rs ?
Applicant's Printed Name App icant's Signatur
DO NOT WRITE BELOW THIS LINE
.
Sub TVpes
? Ot Foundation
?
07
OS-plex
?
13
16-plex
?
20
Pool
? 30
Accessory Bldg
A 02 SF Dwelling ? OS 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 EM. Alt- Multi
? 03 01 of _ plex ? 09 07-plex O 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Exl. Alt - SF
? 04 02-plex ? 10 OS-plex ? 18 Deck ? 23 Porch (screenlgazebo) ? 36 Multi Misc.
? 05 03-plex C] 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex ? 25 Miscellaneous
Work T es
37 New ? 35 Int Improvement ? 36 Demolish Interior 0, 44 Siding
? 32 Addition ? 36 Move Building ? 42 Demolish Foundation Q 45 Fire Repair
? 33 Alteretion ? 37 Demolish Building* ? 43 Reroof ? 46 WindowslDoors
? 34 ReplaCement 'Demolition (Entire Bldg) - Give PCA handout to applicant
DBSCriptl0il: WaterDamage_Yes
s
Valuation -30pi"06V
Occupancy
-3 MCES System
'-"
Plan Review k?-' 100% or _ 25%
Census Code /0/ Zoning City Water
SAC Units 0/ Stories Booster Pump !A°
# of Units Sq. Ft. ? PRV
# of Bldgs Length fpQFire Sprinklered ?
Type of Const ?. Width 215 '
REQUIRED INSPECTIONS
? Footings (new bldg) Sheetrock
_ Footings (deck) ? FinaUC.O.
Footings (addition) _ FinaVNo C.O.
? Foundation _ HVAC
Drain Tile Other
Roof ? Ice & Water ? Final Pool Ftgs Air/Gas Tests Final
? Framing _ Siding _ Stucco Lath _ Stone L.ath _Brick
? Fireplace _k R.I. -i-Air Test t Final _ Windows
JL Insulation _ Retaining Wall
Approved By: , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
5&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
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Permit Number
REScheck Compliance Certificate cneckea sy/Dace
2000 Minnesota Energy Code
REScheckSoftware Versioa 3.5 Release ld
Data filename: C:\Ptograui Files\ChecklREScheck\Customer Files11422 Czaplewskisck
PROJECT TITLE: Czaplewski Residence
COLINTY: Dakoh
STATE: MinnesQta ,. ,
ZONE: 2
CONSTRUCTION TYPE; Single Family ,
DATE: 06/20/07
DATE OF PLANS: May 29, 2007
PROJECT DESCRIPTION:
Lot 2, Block 1
Evergteen Enclave
4191 Lexington Way
Eagan, MN
DESIGNER/CONTRACTOR:
Windwood Iiomes
COMPLIANCE: Passes
Maximum UA = 486
Your Home UA = 402
173% Better Than Code (UA)
Gross Glazing
Area or Caviry Cont, or poor
Perimeter R-Value R-Value U-Factor UA
Ceiling I: Raised or Energy 1Yuss 1872 44.0 0.0 41
Wa11 1: Wood Frame, 16" o.c. 2493 19.0 0.0 116
Window 1: Alwve-Grade:Vinyl Frame:Double Pane.with Lqw-E 427 0.350 149
Door 1: Soiid 40 0.100 4
Door2:Glass, 66 0350 23
Basement Wall I: Solid Concrete or Masonry 1197 11.0 0.0 69
Wall height: 9.0'
Depth below grade: 8.0'
Insulation depth: 9.0'
Fwnace 1: Forced Hot Air, 94 AFUE
Air Conditioner 1: Electric Central Air, 10 SEER
Proposed and Maximum U-FaMor Averages
Proposed Maximum
Average U-Factor Allowed U -Factor
Above-Grade Windows and Glass Doors ' 0.350 0.370
includes Foundation Windows > 5.6 ft2
COMPLIANCE STAT'EMENT: The proposed building design descnbed here is consistent with the building plans, specifications,
and other calculations submitted with the permit appl'catioa The proposed building has been designed to meet the 2000 Minnesota
Energy Code requirem m RES chec Version 3 Relea ld (formerly MECchecq and to comply with the mandatory
requiremems listed i the RES checkl}pectip5 ecklisj.? ?
Date -- e 7
LOT SURVEY CHECKLIST FOR RESIDENTIAL
BUILDING PERMIT APPLICATION
L
PROPERTY LEGAL FJ??' ?I E ICNL:.IS l C VCf?1 ! CT%4
DATE OF SURVEY:
LATEST REVISION:
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DOCUMENT STANDARDS
,2( ? ? . Registered Land Surveyor signature and company
? ? • Buiiding Permit Applicant
? ? ? • Legal description
? ? ? . Address
'2 ? ? • NoAh arrow and scale
.et ? ? • House type (rambler, walkout, split w/o, split entry, lookout, etc.)
,g ? ? . Directional drainage arrows with slopelgradient %
.8' ? D • Proposed/existing sewer and water services & invert elevation
,g ? ? • Street name
?? ? • Driveway (grade 8 width - in R!W and back of curb, 22' max )
? ? . Lot Square Footage
'0 ? ? • Lot Coverage
ELEVATIONS
Existina
,B 0 ? • Property comers
,d 0 0 • Top of curb at the driveway and property line extensions
,g ? ? . Elevations of any existing adjacent homes
,Pf ? ? • Adequate footing depth of structures due to adjacent utility trenches
? ,B ? . Waterways (pond, stream, etc.)
Prooosed
? ? D • Garage floor
J2' ? ? • Basement floor
? ? ? . Lowest exposed elevation (walkout/window)
.Ja ? ? . Property corners
g• ? ? • Front and rear of home at the foundation
PONDING AREA (if applicable)
? fa ? • Easement line
? jd ? . NWL
? '0 ? • HWL
? ?w ? • Pond # designation
? F2r ? . Emergency OverFlow Elevation
? ,H ? • PondlWetland buffer delineation
. Shoreland Zoning Overlay District
? N • Conservation Easements
DIMENSIONS
? • 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 strudures requiring permanent footings)
? ? ? • Show all easements of record and any City utilities within those easements
Z o ? • Setbacks of proposed structure and sideyard setback of adjacent existing structures
;' ? ? • Retaining wall requirements:
Reviewed By: Date???7-
G:/FORMS/Bu ilding PermitApplication Rev. 11-26-04
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COMANV, INC.
`1000 FA.4f 14lN SREET. BUWiSN.LE YIMffSDTA 55537 PH 1
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6:AGAM £sRIC'ndNEERiNG DF,f'fG
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\ CERTIFICATE OF SURVEY
Legal Description: Lor 2, BLOCK 1. EVERGREEN ENCLAVE,
DAKOTA COUNiY. MINNESOTA
975s DENOTES p(ISTING ELEVATION
(980.5) DENOiES PROPOSm ELEVA110N
INDICAiES DIRECiION OF SURFACE DRAINAGE
aeo.aa a FlNISHm GARAGE FLOOR ELEVATION
snso a gqgpAENT FLppR ELEVATION
981-? = TOP OF FOUNDATION ELEVA710N
•sas DENOTES NUMBERED TREE PER PRWECT PLANS
LOT AREA: 51,911 S.F.
HOUSE AREA: 2993 S.F. ( COVERAGE = 5.8% )
SCALE : 1" = 40' (INCLUDING PORCHES)
HOUSE TYPE : RAMBLER - FBWO
ADDRESS: 4191 LEXINGTON WAY
BENCHMARK: iNH AT L5-B7
ELEV.=985.89
HfliEBT CFAIIFY IHAT iM15 PUN WAS PRFPMm REIVISIONS PREPMED FOR: ?? ??
IY ME OR UNDQ2 MY DIRECT SIIPFRY190H ANO /7L7DTTT?/? ? T11
1HAT I A4 A DULY IICQlSED UND SURVEYOR UNOEIt pyw
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_P 7656 -7
PHONE N0. : 612 931 0669
N/9l Lex. ody
Nov. 29 2006 04:59PM PS/
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- In Place Deisity: . '? ASTM o-1622
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orceilingsmaypmsent anumea5onadeflre hazordunlessthefoamisproMC[ed
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A IwlKing code definrtion U an aPProved tnermal bamer is one, which is equal
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'NutMalSaferyP5u5neetsareavallableonthispolyurettianefoam .
matenaL Arry IfWividual who may mim in contattwith these protfuccs
shouldreadandunderitandMeM5D5. Hantlling ana Sufery
" Respvatery pmtection is MANDATORV! Contact UCSC LLd. (or a cOpy af
the Moeel Rrpiratwy Protecnon Program developed 6y API or visrt iheir
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amine aad/ororgaiwmetalGr camlysu with blowln9 agenK Both matenalt
, mus[ be handled and uscd with ade7uale ventilation. The vapors must rrot
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vapors.wearaNlOSHapproveamspirocor.lfinhalauonofvaporsacur,
remove hctim hom corrcaminated area and administer wrygen if breathing
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. Cdll a physkian. In caze oF Sk1n contact wa;h area vnth eeyp and watCr.
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dioxide, ary diemical, w inert gas Apphcannn of large yuaotrti?c ofwater
:pray is recommended for spll flres Per,nnnef fighring the f re mus[ 6e
equipped with WoSH approved self•cwtained breathirq apparacus.
Cleeningof 5pi11saLeakage Cover the area wah an inert absorbc?tt materal such os Glay or vermkulKe
and twnsfer m metal waste containers. sacumce wAh waeer birt do rwtseal
the con[ainer wkh the isoeyanates and wa[er miz[ure fhe area xhould ihen
'be flushed wnfi Izye amaunts of wacec in che tase of the'B"component.
W d 5%aquCOUS ammonia, in Me case of tllf "A'compUnenL Dispoxe of
Uese materials in compliance with fecleral. naie and local requlations.
Caution:ISOCydnaMs wifl reaCt w¢h w2rer dnd genemtc Wrbon ditixitl¢.
' This couM rewlt m nipNre oi closed comamers
DiSGlaimer
The tlata {xesented hareln's not m[ended far ur Yry nnnpmkssiofxll
8ppVoPlof£ Of [hOSe pet5ort;wlq do not pUr4hase ot WiY2e thi5 produR
in the rrormal course Of their busines: The potentiM User mvst per(orm
any pertlnerttcesu in ofdHto determine the product's perfvrmence and
5uitabilily in the incende0 applicu[ion, Since fiml detertnindtion offi[ness of
the produa for arry partlcular use is the respon:ibifiry M the 6uycr.
All guaraM2P5 dnd warteMiM dS to produl'SS SUpplied by t1C5C ltd. shall
hOVC Ohly Nose guA2nWes and wdlfdrtties expR55Pd Oyttle manufdrturer.
1he huyarY sale remedy as to any matercal ctums Nn1l be agalnst the
manulacturer o/the produR The a(olietnentioned daca on this produtt
rs to be usetl as a guitle and is sublw to change wirhout nonce. The
information herein is heliev9d to be reliable, Dut unkrawn risks wy be
present NOWnaRANTIES,EXPrsESSEDORIMPLIED.INCLUDING
Pq7ENTWAqRANTIESOR WAARANYIES OF M£RCHANTABIIfTY
OR FITNE55 FOR USE, ARE MADE BVUCSC Ltd.VVITH RESPECTTO
PRODUC75 OR IMFpRMATiON SET FORTH FfEREIN. Nothing r.oncained
herein 5hall corwdsuce a perml551on or rxonnru`ndition [o pracn<e any
itlvenilon covered by e patent wiMOUt p IKCnSe M1om the owner of the
patenc Accorc)mgly, buyer assumes ail risks wi+atsoever os co the use af
mete materkls and buyerL exdusW 2medy az to erry breach of warcanry,
negLgerx.e, or other aam slwll be Ilmrted ta the purcha5e price of the
matenals Failute[Oadheretoarryrcctm+mendedprxMuresslullml'wwe
UcX Ltd. and the m,anufacturer of all Fabdity wim respCCt to the materials
and their u5ethemof
[IC :C
P.O. 9oa 6460
Phoenlx, AZ 85005
? ?? Call SU0.6UY-UCSC (1-800-289-8272) tou Lee
p ? 602-269-9717 dlrect
????„?e' ? ? r•?l f?rY• 602Q69-9115 fDk
xi
a?ociallonat cRp 0 a SPFA? .?a.??,,... ' tnfoobuy..csc.com email ,
PHONE N0. : 612 931 9869 Nov. 29 2006 05:91PM P,
Cr edenuals; CertihI', 1 tiom
ThSs prodUrt is ivaJablc ?n l!dss II 1411YImdUnWy t nicr?e, ,?•. %ci fnnh under
UnA,vwnte, s tdlooiatnnn! W L 11 i. AS f M C N11, nnd pp5;"ss the tl,vnmahdiry chdr-
dCCensnc; b21ow'
?? Oa 2006 RESIDENTIAL BUILDING PERMIT APPLICATION
•? City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone 4 651-675-5675 FAX # 651-675-5694
New Consiruction Reauirements
3 registered site suroeys showing sq fl. of lot, sq. H of house; and all roofed areas
(20% maximum Iot coverage allowed)
2 copies of plan showing beam & window sizes, poured found desigq etc.
1 set o(Energy Calwlations
3 copres of Tree Preservatian Plan if lot platled afler 7/1193
Rim Joist Dehail Options selechon sheel (6uildings with 3 or less umts)
Minnegasco mechanical ventilahon fonn
c?v q3 . 4?X5_
RemodellRepair Reouiremenis Offrte lkC.l71114
2 copies of plan showing foofings, beams, joisls CeffqfSUrteyRe.cd: i
isefofEnergyCalculalionsforheatedaddiions TtCePr2.5P12A.??CB.>'-:::_Y`_N.,
1 sde survey for addiLons & decks 3`4i'.restRtiqyiied'- : -::1''"_N
Addifion - indicateifonsdesepticsystem Dn?sSteSepticsy§fein',Y:-,,;,,N
0,rA.A l 01 ? 7
Date?/
Site Address
L2y4nG14pn. ?kY ConstructionCost a(S 0oc)
Unit/Ste #
Description of Work /n5J?11 ?n X.?? /f7 ' 9?nu/1 ??di i I
Multi-Family Bldg _ YKN Fireplace(s) _ 0 _ 1 _ 2
PropertyOwner Vic ICT LZ/ 9IPW5k? Telephane#(6Ja ) Sfda' 133S
Contractor J S?
S li?h n C,, 5 -
Address ,?ir)l
State {'dl(/1hG p
??-?i?, z?p ?5337 !?
City [7I,tYA.$Yi1k-
Telephone#(`ISL) Hl'?''/?lCI?U
- - _ i
n OCT 2 6 2007 rj
COMPLETE THIS AREA ONLY IF
Energy Code Category - Minnesota Rules 7670 Categorv 1
(? submission type) • Residential Ventilation Category 1 Worksheet
Submitted
. Energy Envelope Calculations Su6mitted
A NEW BUILDING
Minnesota Rules 7672
. New Energy Code Worksheet
Submitted
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_ Y _ N If yes, date and address of master plan:
Licensed Plumber
Mechanical Contrpctor
SewerJWater Contractor
Telephone #(
Telephone # (
Telephone #(
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 MN
Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a
permit; that the work will be in accordance with the approved plan in the case o£work which requires a review and
approval of plans.
?
&J ?i/ Me ???o?.
ApplicanYs Printed Name Applic, s Signature
DO NOT WRITP BELOW THIS LINE
'- :
Su6 Tvpes
? 01 Foundation ? 07 05-plex ? 13 16-plex >1?20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 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.) ? 33 EM. Alt - SF
? 04 02-plex ? 10 OS-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc.
? OS 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex ? 25 Miscellaneous
Work Tvpes
X 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
X 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteration ? 37 Demolish 8uild ing' ? 43 Reroof ? 46 VJindows/Doors
1I-3a Replacement 'Demolition (Ent ire Bldg) - Give PCA handout to applicant
DeSCfiDtioll: Water Damage _ Yes
Valuation ? Occupancy f C - o. MCES System -
Plan Review /J& 100% or _ 25%
Census Code G/3Y Zoning City Water ?
SAC Units - Stories ? Booster Pump `
# of Units " Sq. Ft. 7aZG PRV J
# of Bldgs - Length Fire Sprinklered '
Type of Const - Width ?-/ D
REQUII2ED INSPECTIONS
_ Footings(new bldg) Sheetrock
_ Footings (deck) Fina]/C.O.
_ Footings (addition) FinaUNo C.O.
_ Foundarion HVAC
_ Drain Tile Other
Roof _ Ice & Water _ Final Pool ? Ftgs ?t'. Air/Gas Tests *Final
- FIanung
_ Fireplace _ R.I. _ Air Test _ Final _ Siding _ Stucco Lath Stone Lath Brick
Windows
_ Insulation _ Retaimng WaU
Approved By:
------- ----------- , Building Inspector
- ---- ---------------
Base Fee -------- - -
- - -? -----------°
-----------------------------------------------------------
-----------------------
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
?
7
Address:
POOL PERMIT - APPLICATION SUBMITTAL REQUIREMENTS
Applicant Name:
0
?
GENERAL INFORMATION
s
U
o z a
? ? Applicant name and contact information
? ? ? Property owner name
? ? Address of property
? ? North arrow, scale (1" = 30' or 40')
fdr ? ? Site Plan, drawn to scale showing location of house, pool, and other existing or proposed
structures, including retaining walls.
? ? ? Location and name of all streets adjacent to property
? ? Directional drainage arrows (existing and proposed)
ELEVATIONS
Existinca
,ZI ? ? House corners
? ? Property corners
?? If applicable, ground elevation at each end of retaining walls and at wall's greatest height
Prooosed
A ? ? Finished pool deck comers
0 ?? Top of proposed retaining walls (if any) and at each different elevation (if it changes)
fd ?? Pool bottom (or max. depth)
DIMENSIONS
Existin
,Gf ? ? All property/lot lines
00 ?? All Easements on the property
Proqosed
Zi ? ? Pool
,d ? ? Pool plus integrated deck/patio
JZ ?? Shortest distance from outside edge of pool ?o lot lines and house
Reviewed:
Date
G.FORMS/Pool Permit CheckhsU02-13-07
r
3:1 RRawmvm
or Fietaining We6 WAI
Be Required __j
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ORAINRGE AND
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94s.o i62.84 n?00•48'32' R-11534_.14 964.5 ??•» 97•9
ses•as'a(rw (9n.e) Le9al DescriPtion:LOT 2. BLOCK 9. EVERGREEN Etrcu?vE.
DAKO'fA COUN7Y. MINNESOTA
975s DENOiES E70SfING ElENAT10N
........................... ........... ....:::......?::.:::...................................................... .....................................
- ° (sao.s) DENOTFS PROPOSED ELE1/ATION
.................................................................................................... ....... ....... ..... . .... ................ .. ........
.. $ ?- MdGTES DIRECf10N OF SUIffACE DRAINAGE
eao.ea - FlNISHm GARAGE fL00R ELEVATION
72,50e 80.5EMEM FLAOR ELEYATION
81.1= TOP OF FOUNDATION ELEVATION
EAGAN
C? ??C?p/Cn C.S.A.H. N IFFLEY ROAD) _ .? •sos DENpiES NuMBERm TFffE PER PRO.IECT W1?N5
B C.YJ.C 1i.\Lr e? ?? - LOT AREA: 51,911 S.F.
B? ? vi?'r p ?f/9/ L,???,UC]B . HOUSE AREA: 2993 S.F. ( COVERAGE = 5.8% )
/ ? SCALE : 7° = 40' (INCLUDING PORCHES)
???(r 02i6 h??g?? - HOUSE TYPE : RAMBLfR - FBWO
p??M ?.ogo? ADDRESS: 4197 LEXINGTON WAY
-_---- r gpGp?Id ENGINEEWNG DEP'i: BENCHMARK: TNH AT 1-5-87
7''T10NS DIVI ON pLEv=9e5.89
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ROOE n?AW?+sOW LAND ewreiorts
ENGINEEAWG
COMPHNY, INC.
?100G EilSf 1KM SRIEEf. 8UR113Y11G MWl60TA SSSS] PX
lFR?T CFRTIFY 7WR 71115 PIAN tlIAS PI?ARm
ME OR ? MY DW4= SUPSMSM ,ND
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? CERTIFICATE OF SURVEY
Legal Description: LoT 2 BLOCK 1 EVERGREEN ENCLAVE.
DAKOTA COUNiY MINNESOTA _
975.5 DENOTFS EXMIING ELEVATiON
(980.5) pENOTES PROPOSm ELEVATION
INDICATES DIRECTION OF SURFACE DRIUNAGE
9eo.ea o FlNISHm GRRAGE FlAOR ELEVATION
?2so ? gkSEMENf fL00R ELEVATION
aet.t o TOP OF FOUNDATION ElEYATION
•sos DENOTES NUMBERm TREE PER PROJECT PUWS
LOT AREA: 51,911 S.F.
HOUSE AREA: 2993 SF. ( COVERAGE = 5.8% )
SCALE 40' (INCLUDING PORCHES)
HOUSE TYPE : RAMBLER - FBWO
ADDRESS: 4191 LF_XINGTON WAY
BENCHMARK: TNH AT 1-5-131
ELEV.=985.89
CERTIFICATE OF SURVEY 1
LOT 2 HLOCK i
EVERGREEN ENCLAvE
,
J
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA172894
Date Issued:10/20/2021
Permit Category:ePermit
Site Address: 4191 Lexington Way
Lot:2 Block: 1 Addition: Evergreen Enclave
PID:10-24875-01-020
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Air Conditioner
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Pete DeGrood at (507)
210-0754.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
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 -
Steven T & Jennifer L Anderson
4191 Lexington Way
Eagan MN 55123
(952) 334-9222
Mikes Custom Mechanical Inc
P O Box 171
Champlin MN 55316
(763) 568-7148
Applicant/Permitee: Signature Issued By: Signature