4312 Kirsten CtCASH RECEIPT
' CITY OF EAGAN
P. O. BOX 21-199
EAGAN, MINNESOTA 55121
DATE
'7_
19
' A
RECEIVED
FROnT ? ?' ??-? ???._... r._?"x.r..L'LtGC-_ .• .,. y,?_?
AMOFIN?T
$/ !i? .?"?
? CASH M CHECK
1 oo
DOLLARS
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White-Payers Copy
Yellow-Posting Copy
Pink-File Copy
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 85386 - 7(6/88
PHONFE: 454-8100
BUILDING PERMIT Receipt #
To be used for Est. Value ` Date ,7 9 88
Site Address ' i 1 - I
Lot Block ? Sec/Sub. "a`: r', 1• T,
Parcel No.
a Name
= Address
° City Phone
oa Name
?Q Address
P City Phone
On Site Sewage Occupancy
MWCC System _ Zoning
On Site Well (Actual) Const
City Water (Allowable)
PRV Required # of Stories
Booster Pump Length
Depth
S.F. Total
Footprint S.F.
APPROYAtS FEES
Engr./Assess. Permit??0 00* '
Planner Surcharge • 50+
Council Plan Review
Bidg. Off. SAC, City
Variance SAC, MWCC
ADD ON FEES water Conn.
CQLLECTED - water Meter
$16.00 PERMIT Road Unit
.50 SURCHARGFfireatment P7
$16.50 TOTAL parks
$16-00
7/6/88 - COLLE CIVITAL
GR AND TOTAL = .35.00
Name
City Phone
I hereby acknowledge that I have read this application and state that the
intormation is correct and agree to comply with all applicable State of
Minnesota Statutes and City of Ea9an Ordinances.
Signature oi Permittee
A Building Permit is issued to: - 'on the express condition that all work shall be done in accordance with all
applicable State ot Minnesota Statutes and City of Eagan Ordinances.
Building Official
Permit No. Permit Holder Data 7eiaphona #
Plumbing ;''c C? ?
H.V.A.C.
Electric
Softener
Inapection oate insp. Comments
F
to.
isul.
-, '
Fireplace
Final Htg. ??r
Final Plbg. ?i7??
Bldg. Final r1/?'j
Cert. Occ.
Temp. LP
Deck Ftg.
Oeck Final
Well
Pr.Disp, c'qzc.r0 -52-??- O nl.,- l=?Mr,sccp
CITY OF EAGAN ? 4 .1 r 6
3830 Pilot Knob Road, P.O. Box 21-199, Eegen, MN 55121 ?
PHON E: 454-8100
BUILDING PERMIT Receipt?
To be used for '-Est. Value Date 'iL'' 6".'{ i, 19 J
SiteAddress `+J1 ' ?'•`Lot ? Block Sec/Sub. .•_ ;'? ? ? .'
Parcel No.
Site Sewage
rCC Syatem
Site Well
Occupancy
Zoning
(Actuap Const
(Allowable)
# ofStories
Length
Qbpth
S.F. Total
Footprint S.F.
a Name City water
W PRV Required
z Address
0 CityPhone f}:.' BoosterPump
¢ Name sC`::. .• •'.t.??* :.
0
v` Address i.:'N!'F.!' ,
? City Phone .. A !
?- ¢ -
yVj W Name
?
Address
Q W City Phone
I hereby acknowledge that I have read this application and state ihat the
information is correct and agree to comply with all applicable State of
Minnesota Statutes and Ciry of Eagan Ordinances.
Signature of Permittee -
A Building Permit is issued to: ?on the express condition that all work shall be done in accordance with all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building Official
APPROVALS FEES
Engr./ASSess. Permit
Planner Surcharge
Council Plan Review
Bldg. OTf. SAQ City
Variance SAC, MWCC
Water Conn.
Water Meter
Road Unit
Treatment P1
Parks
TOTAL ? k?
Permit No. Permit Holdsr Data Telephone #
Plumbing
H.V.AC.
Electric
Softener
Inspsction Dete Insv Comments
Footings I
Footings II
Foundation
Framing
Roofing
Rough Plbg.
Rough Htg.
Isul.
Fireplace
Final Htg.
Final Plbg.
Bldg. Final
Cert. Occ.
Temp. LP
Deck Ftg.
Deck Final
Wel I
Pr. Disp.
CITY OF EAGAN t?7
s ' 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 IfJ ? 9238
PHONE: 4548100
BUIL?ING PERMIT Re«ipt #
Te be wod fer ciF DWG/GAR Est. Volue $59,000 Dare JULY 2 , 19 84
SiteAddress 4312 KIRSTF.N CT Erect R3
? ?cupancy
10 1 SUNSH,T 2ND
Lot Block c¢?/Sub. Alter ? Zoning
Parcel No. Repair ? Fire Zone
?e p Type of Const.
c Name 07iFORD CONSTRUCTION INC Mov
?
W
k
? # Stories
Z
• O• OX "
Addres
Demolish ?
571 7
?R Z C?
o
? Length 6?
26
h
ne
City
Gmde ? Depth
Sq. Ft.-
SAME Approvals
o Foea
Name .00
89 Address Assessment Permit
50
? City Phone Water & Sew.
P
l Surcharge
ko U
Pl
h
o
ice an c
ec
?00
?W Name Fire SAC
_? Address Enp.
Phon
?W Cit Water Conn. ' ?U
-OU
? '
y
e
Plonner WaterMeter
260.00
Council Road Unit
I hereby acknowiedge that I have reod this opplicotion ond state that Bldp. Off.
ihe informotion is correct and agree to Comply with all applicable
APC ?
Total
Stote of Minnewto Stotutes and Cify of Eogan Ordinances.
Sipnoturc of Permittee
ORi) CONS_ U, ION
A Building Pertnit Is issued to:
on the exprcu tondition Ihni
all work shall be done in attordonce with all qpplicable $tote of Minnesofo Stotutes ond City of Eaflan Ordinances.
Buildirq OfHciol - ?' ' • - -'
Psrmit No. Permit Holdar Misc. Permit No. Holder
Plum6in9
H.V.A.C. '4
Wall
Watsr
Disp.
Sewer
Elactrie e
Irapection Date Inap. Other
Footin{R `
Foundetion
Framing
Rouyh PI6¢ ? - Lj*
Rough HVAC
Inwlation
Final Pibg. Z .
Final NVAC
Final ?
Water aseribe Location:
MVell
Sewar .
Pr. Disp.
Receipt MECHANICAL PERMIT
j CITY OP EAGAN
Fill in nombered spaces
Type or Print /egibly
No.
Fee 2v•
S/C
Tot.
1. Date Y 2. Installation Cost '_? ?
?"`?
3. Job Address Lot ?U Bik. U! Tract?-
- r-?`-
?..
4. Owner
5. Contractor Phone '
6. Address i • , `' y ? ? ' ?.-'??.?' "?---'?
7. City State -11- Zip
8. Building Type: Residential a Commercial ? Institutional ?
9. Work Description: New C'r Add O Alier ? Repair ?
10. Describe
11.
Type'
No. Equipment BTU - M. Ea.
Forced Air No. Equiament CFM
Air Handlin
:
Mfg, g
_ Boilers
Mfg. _ Mech. Exhaust
Unit Heater
Mfg. Other
Air Cond.
Mfg.
Gas, Piping Outleu
12. I hereby certify that the above information is true and correct, and i agree to
comply with all ordinances and codes goyerni
, ng this type of work.
?
Signed: ?12--r?--l- =. 1.??•?for
Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8700
Cities Dijzital
ity Control
The following image represents the best
available image from the original page.
Every effort was made to capture the content
from the original page.
VVR 11{A{..1 rnn,?:
Site Address
lot Block
PERMIT #
PLUMBING PERMIT RECEIPT q
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE:
y Name
? Address ?
c Ciy Phone
Name
3 Address - ?
p City Phone
FEES
COMM/IND FEE - 146 OF CONTRACT FEE
APT. BLDGS - COMM RATE APPLIES
TOWNHOUSE & CONDO - RES. RATE APPLIES
MINIMUM - RESIDENTIAL FEE - $12.00
MINIMUM - COMM/IND FEE - $20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND $1,000.00)
BLDG. TYPE WORK DESCRIPTION
Res. New
Mult. Add-on ?
Comm. Repair
Other
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
NO. FIXTURES TOTAL
I-Water Closet - $3.00 $
_Bath Tubs - $3.00
I_Lavatory - $3.00
? .-ShOwef-$3.00
_Kitchen Sink - $3.00
-Urinal/Bidet - $3.00
_?_Laundry Tray - $3.00
_Floor Drains - $1.50
?Water Heater - $1.50
_Whirlpool - $3.00
_Gas Piping Outiets - $1.50
(MINIMUM - 1 PER PERMIn
_Sottener - $5.00
-Well - $10.00
_Private Disp. - $10.00
-Rough Openings - $7.50
SIGNATURE OF PERMITTEE ? FEE: -T_
?:.
STATE S/C:
FOR: CITY OF EAGAN GRAND TOTAL:
? _ _ __ ------------ J
Receipt `I PLUMBING PERMIT Permit No.
CITY OF EAGAN
? .
? I Q `! Fee
Fill in numbered spaces S/C '-
Type or Prinf legibly
Tot.
1. Date 2. Insiallation Cost '= ,? ? - ? •
3. JobAddress Lot.10 Blk. / Tract ; 7,.?;i? `?
4. Owner f'I G--?;" I? ?c': .i • -L,lt??
5. Contractor, (/'? N ? ?/2??y? Phone ?1 -
?T -?-
6. Address /iF , i,
7. City KG State ,414Zip ? c.
8. Building Type: Residential E7-' Commercial ? Institutional ?
9. Work Description: NevVff? Add ? Alter ? Repair ?
10. Describe
11.
No,
? Fixtures
Water Closet No. Fixtures
Cesspool/Drainfield
Bath tubs $epticTank
Lavatory Softner
Shower Well
Kitchen Sink
Urinal/Bidet
Other
? Laundry Trey
.? Floor Drains
Drinking Ftn.
L Slop Sink
Gas Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed : for
Rough Final Inspections: Oate Insp. Date Insp.
This is your permit when num6ered and approved.
Approved CITY OF EAGAN 454-8100
?s
INSP
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS:
1 ?. r fF?',ilP! +1
PERMIT SUBTYPE:
1 ut, ) I Mir
TYPE OF WORK:
NF:W
F1NA1
tI D tM±+
H ? I? ;S f; i
(A) /24 /'9ti
?ty , c?q
5'?V
TION RECORD
PERMIT TYPE:
Permit Number:
Date Issued:
tcs t+i 0> r ; APPLICANT:.
i . , , 1'. ; . . .
-1
Permit No. Permit Holder Date Telephone #
ELECTRIC
PIUMBING
HVAC
Inspection Date Insp. Comments
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYPBOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
BSMT R.I.
BSMT FtNAL
DECK fTG
DECK FMAI.. 7`---
'.?l?I?fG_ ?^C/ .. _. . •
;
?t-'M ;?4?l" flN/?D ?E?: /?'1J9v?bMP?q7L ?1'1
;
f ? I
Y
s
TY OF EAGAN WATER SERVICE PERMIT
30 Pilot Knob Road
O, Box 2', 199 PERMIT NO.:
gan, MN 55121 DATE:
ning: No. of Units: '
crd Conat
ice Address: A A2 Kirsten Court L'J ?:7 Ssnset _n
lumber: ?.!:+z R an
470.00 No.: Connection Charge: p?
ize: Account Deposit: 1.5 .`,JO pd
eader No.: Permit Fee: I'; .!"` pci
ayree M eomyly wifh Hhe GFy of Eagon Surchorge: . 5 G n<i
.00 pci nieter
adtnancas. Misc. Charges:
Total:
v Qate Paid:
of Insp.:
30 Pilot Knob Road r, ; 37
0. Box 21199 PERMIT NO.:
gan, MN 55121 DATE; e- -`
ninp: "j No. of Units:
fner: Ux£or3 Const
Site Address: 4312 Kireten ourt L10 B1 Sunset n
Plumbar: Cenz 7vau
7-2-2,.:+ ti+ 2 LUV. P
i.gro. b?mply ..nti ,h. c+M.f cogo. Conneaion Charoe: 425.00 Pa
ordieeeew. Acrnunr neposir. 15.00 pd
PermM Fee: 10•00 ne
Surchorge: .50 pd
By Misc. CFaroes:
Uate of Irsp.: Total:
Insp.: Dote Poid:
TY OF EAGAN WATER SERVICE PERMIT
30 Pilot K^.ob Ro?d °
0. Sox 21;I99 PERMIT NO.: _` 7_?'
gan, MN 55121 DATE:
ning: ?}-;ford E:a?sC - No.ofUnih:
ner:
/kldress:
set
AAeter No.• t5?ib?"tlion Charge:
Size: Acwunt Deposit: l.5 r'0 s'
eader No :69-L Z S Permit Fee: 10.00 pa
1 agros fa aomply wi& tra City of Eegan Surcharge: 50 ci
Ordineeaa. Misc. CFarges: 3.0 pd e2*_e[
Total:
Byrq., Date Paid:
Date of Insp.: Insp.:
. .,r tAGAN Remarks
Addition SUNSET 2IId ADDITION Lat 10 celk 1 Parcel 10 72986 100 01
owner Street 4312 Kirsten Court stace Eagan, MN
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK s^S 1981 196.67 9.83 20 aid unde original par el
SEWER LATERAL
WATERMA W
WATER LATERAL
WATER AREA 57L 1981 146.67 9.83 20 aid unde original par el
STORM SEW TRK 1985 668.45 44.56 15 668.45 C009432 9-7-84
STOfiM SEW LAT
CURB & GUTTER •
SIDEWALK
STREET LIGHT
Road Unit 260.00 4144442 7-2-84
WATER CONN. 470.00 it IT
HUILDING PER. #923$ 17
sac 525.00
PARK •
REMOVE SEARING WALL/
INSTALL BEAM CITY OF EAGAN N_ 14466
-
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE:454-8100 ?,- 1-
BUILDING PERMIT Receipt # ? ? ?J ?
To be used for RFPIODEL Est. Value $800 Date DECEMBER 1, 19 87
Site Address 4312 KIRSTEN CT
Lot 10 Block 1 Sec/Sub. SUNSET 2ND
Parcel No.
¢ Name DAVE MICHALETS
3 Address SAME
° City Phone 454-2612
Name ANDERSON SODERMAN
0
? Q Address 9309 LYNDALE AVF
P City BL.M(:TN Phone 881-5044
rm
U ?y
W y?
F=
xZ5
u=
? W
Q
Name_
Address
C ity _
I hereby acknowledge that I have read this applicalion and state that the
information is correct and agree to,com? ly with ali applicable State of
Minnesota Statutes and City of Ea?an Ordinances.
Signature of
A Building Permit is issu€d to: ? AWnF.RS(1N SODFRMAN
on the express condition that all work shall be done in accordance with all
applicable State of Minnesota S tes and City of E? ?an ?Ord?inJanc?es.
Building Official •-"--???
.??
OFFICE USE ONLY
On Site Sewage _ Occupancy
MWCC System Zoning
On Site Well _ (ACtuap Const
Ciry Water _ (Allowable)
PRV Required _ # of Stories
Booster Pump Length
Depth
S.F. Total
APPROVALS
Engr./Assess. _
Planner _
Council _
BIdg.OfL _
Variance _
Footprint S.F.
FEES
Permit
Surcharge
Plan Review
SAC, City
SAC, MWCC
Water Conn.
Water Meter
Road Unit
Treatment P1
Parks
TOTAL
$17.10
.50
$17.60
? i
BUILDING PERMIT
To 6e wed for "° CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 27-199, Eagan, MN 55121 N? 9238
PHONE:454-8100 Receipt #
DWG/GAR Est. Volue $59,000 pOfe JULY 2 19 84
SiteAddress 4312 K TRSTEN CT Erect [?X Occupancy R3
Lot 10 Block 1 Sec/Su6. SUNSET 2ND Alter ? Zoning Rl
Parcel No. Repair ? Fire Zone N/A
`9e ? Type of Const. V
oc Name OXFORD CONSTRUCTION INC Mov
? # stories
i P.O.
Address BOX 29287
Demolish ? Length 60
? City BROOKLYN Cne 571-8257 Grade Q Depth 26 Sq. Ft -
O Neme SAME Approvala Fees
o
0 Address Assessment Permit 310.00
u§
I.-
City
Phone Water & Sew.
Surcharge
29 • 50
Polite Plan check 155.00
r
FW Name Fire SAC 525.00
?? Address - Eng. WaterConn. 470.00
?W City Phone Plonner WaterMeter - 63, 0
Council __
1 hereby ocknowledge that I have read this opplication ond state thot gldg. Off. _
the information is correct and agree to comply with oll applicuble APC
State of Minnesota Statutes and City of Eagan Ordinonces.
$ignature of Pertnittee
A Building Permit is issued to: OXFORD CON
cll work sholi be done in acmrdarxe with o11'pDaliwble
Road Unit 260 _ 00
Total , - 0
on the express conditlon thni
Statutes and City of Eogan Ordincnces.
Building Officioi
--'= CITY OF EAGAN N_ 14 8 2 3
' 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
BUILDING PERMIT PHONE: 454-8100 Receipt D-1 01 C?
RASEMENT
To be used for
EMODEL Est.Value $700 Date APRIL 13 ,19
Site Address 4312 KIRSTEN CT
Lat 10 Btock 1 Sec/Sub. SUNSET 2ND
Parcel No.
m Name DAVID MICHALETS
z Address 4312 KIRSTEN CT
3
o City EAGAN Phone 454-2612
xp Name
0 Q Address
? City Phone
U?
W
WW
F
z
x?
Uz
¢W
Q
Name _
Address
City -
I hereby acknowledge that I have read this application and state that the
intormation is correct and agree to comply with all applicable State of
Minnesota Statutes and C?iqt ?o{?f Ea]ga,n?O(Jdina?nces.
Signature of Permittee _y?1ct?J_J"?_L_? _
A Building Permit is issuEd to: UHV lL Ci1GtlALC Lb
on the express condition that all work shall be done in acCOrdance with all
apPiicable Sfate of /M?i_nn??esota Statutes and City of Eagan Ordinances.
Building Official_ ? ? n??r' ?? `r.
?
OFFICE USE ONLY
On Site Sewage _ Occupancy
MWCC System _ Zoning
On Site Well _ (Actual) Const
City Water _ (Allowable)
PRV Required # of Stories
Booster Pump _ Length
Depth
S.F. Total
APPROVALS
Engr./Assess.
Planner
Ci0Uf1Cll
Bldg. Off.
Variance
Footprint S.F
FEES
Permit
Surcharge
Plan Review
.SACii City
SAC, MWCC
Water Conn.
Water Meter
Road Unit
Treatment P1
Parks
TOTAL
_ 18.00
.50
18.50
f//f4f89 REQUEST FOR ELECTRICAL INSPECTION . ea-oooot-(o?s
g? , See instructions for complbting ihis form on baCk o1 yellow copy.
c /
?Q !j 6 19 r'v "X" Below Work Covered by 7his Requesr
A.dd Nep. Type ol Builtling APPIfUnCns Wlfed Equipment Wiied
Home Ran,ye Temporary Service
Dupiex Water Heater Lightiny Fixtures
Apt. Building Dryer Electric Heatin
Commercfal Bidy. Fumrce Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tenk
Farm Ocner Der.ify .lhcr (sner,Tfy) Ot..Ttl°Pg
t Pf SUCI:I()/ Q/hCf Oih(:f
omuure lnsoection Fee Below
p Fee Service EntranCeSize q Fee Feeders/Suhfeeders # Fee Circuits
U to 200 Am s 0 to 30 Am ps 0 tn 30 An s
Above 200 Amps 31 to 100 Amps 31 to 100 'Am s
Swimming Pool Above 100__Amps Above 100_Amps
Transformer5 Irrigation Booms Partial,'Other Fee
Signs Special hispection $ C!l
?"
T AL FI
E
Remarks r / . c
?Jn.??
Ic.oir.:? .,.? ,.,o , n^...rM..A.A • - 1 i
Rough-in Daie
I
•
?r? ,
Inspector, hereby
- certily that the a6ove
Pinal .??. . D'??
jY inspection hes 6een
/
j made.
mis request volA 18 moniPa from
This request void
18 rnonths from ??" ? l?/J,c1/Y7
9
10 6 6 J,9 Q-.i/? kl?l
lyl_?? U T Y
?
rRequest Uate
( ? ir? No. Rough-in Insper,tion
Required?
?Ready Now?fWill Notify.lnspec-
/ e? l Rye5 [3 No tor When Ready
? Licensed Electrical Contractor I hereby request inspection ot above
?Ovvner electrical work installed at
Street AdAress, Boz or Route No. City
'f 3 1 7' tf (Ks rv. Ca.:rGT G n/
ecLOn o.
Township Name or No.
Range No.
Cou
niy
I I ^
V AIL07n
O cuG:?nt (PRINT) Phone No.
I`tv I / C C Q J .? - Z() L
Power Supplier Address
ElecLical Contractor (Company Name) Conlractor's License No.
Mailine AdJress IContractor or Owner Making Instailation)
Au ed Signat e(Contractor/Owner Making Installation) Phone Number
?
MINNESOTA STATE BOARD OF ELECTqICITY THIS INSPECTION HEQUEST WILL NOT
GriB9s-Midwey Bldg. - floom N-191 BE ACCEPTED BY THE STATE 90ARD
1827 lJniversitv Ave.. St. Paul. MN 55704 UNLESS PROPER INSPECTION FEE IS
Phone (612) 642-0800 ENCLOSED.
fEQUEST FOR EIECTRICAL INSPECTION ?-?0?d by
y ?o l? 7?23 ' See inrstruetiasc for wmpleting this fom m 6ack ot yollar rnpy.
A p? p E79x.q > A ""X'" Be%w Work Covered by This Request .
P'fpAAddj Reo.1 Type nf Building I Applianees Mirad I Equipment Bired I
I I I I lndusvial Bldg. I I Air Conditioner I I Bulk Milk Tank I
a Fee ServieeEnhaneeSiza q Fee 'Feeders/5ubfaeders 7t Fee Circuiis
U? 200 0 to 30 A 0 to 30 Anys
Above 2_q? 31 to 700 Amps 37 ? 1(!0 AnWs
Swinening Pool A6ove 100_Amps A6ove 100_A ?-
Transiom?ers Irrigation Boortts Partial:`Other Fee
Signs Special Inspec.-tion S ?or)
Remarks
Nougb-in Date
f 1 ?cal
??,?.
Final (
`?t ? m ify that tAe a6ove
tion 6as
been
,
i
i V/
iMB reQuBSI void t monttis hmm
Tnis??uest „oia ??g ga
,s,m?tnsrr?
A 0 7 2 9 2 6 L-I o4 1 ,5cu,•? ? ct7 _ 5?
Request Date
I ?i
1)11i -O Fire No. ppugMin Inspeclion
u ed 2
?No
?Waady Now 06ill Notih/
When peady
Wcensed £lec[ricai Contractor I heeyy request inspectioo of ahwa
Owner electriral work installed at= .
Street Ad`dress, Bor or Route . a Ci
./"es N
ecUOn o. Township Name m Na qange No. County
Occu (PRI , . Phune No.
?
Power uo lier /C n i Address .
Electricai ntractor (Coffwny Namel Contractor s Lice+rse Itlo.
Coe,
MaLWng AdVA s(Contrac w Owner
? ? Making InSFailation)
?
`?? ?
l
Gf ld S
Z.,
Authoriz 'gnat re ICo ct Owner MMking Insbllation) Phone NusAer
1NINNESOTq $TATE BOARD OF ElECTRIClT1/ THIS INSPECTION REQUEST MILL qOT
Griggs-MidwaY Bldg. - Room N-197 BE ACCERim 81/ iHE 5fA7E BOAOD
UNLESS PROPEW INSiECT10W iEE IS
1821 University Ave.. St. Peu1, UM 55104
on...,e IR121997_2111 ENCLQSED.
4g/ /-?S'33
? _ _ _ _ _ _ _ _ _ _ _ _ _I
? FoeO?cetIse ?
? Permit #:
I ?
? Permit Fee: `v O? I
? Date Received:
I ? I
I Staff: ?
L _ _ _ _ - _ _ _ ' - - _ - - _ _ -?
2008 MECHANICAL PERMIT APPLICATION
Date:; -Z,2 i /a Site Address: Xa:2 ,e4,1a,f..v 6?
c.
Tenant:' Suite #:
RESIDENT / OWNER Name: Phone: ?S/• 069- 6177V
Address I City I Zip: -413/.2 k4n?., l;! Ca'
CONTRACTOR Name: U"Q 1//(, License
Jca
Address: Y/ J/ OM
j
City: ?,02,44, State: JIVA.)_ Zip: Sr/, Z
Phone: 6Sh SFy- 9,".2 Contact Person:
TYPE OF WORK _ New ? Replacement _ Additional _ Alteration Demolition
Description of work:
?I.mechanicaJ, eqru?p'trrentas requrred
NOTE ABoth°=roo`f mo'unYed( and gro'und nraunf?
k
Meciianica! lnspecto°r,or one: of the "
be screeneaFby City Code. "PI'ease contact the
,
"xPlann'ers forinformatian on permittedscr'"e`enin mefhotls.
RESIDENTlAL COMMERCIAL
PERMIT TYPE JZFurnace _ New Construction _ Interior Improvement
Air Conditioner _ Install Piping _ Processed
Air Exchanger _ Gas _ Exterior HVAC Unit
*
_ HVAC uni[s must be screened
_ Heat Pump Under / Above ground Tank Install ! Remove)
Other '* When installing/removing tank(s), call for inspection by Fire
Marshal and Plumbin Ins ector
RESIDENTIAL FEES:
$50.50 Minimum Add-on or alteration to an existing unit (includes $.50 State Surcharge)
$90.50 Flfe r2p2if (replace burned out appliarices, ductwork, etc.) (includes $.50 State Surcharge)
$ ?/9 TOTAL FEE
COMMERCIAL FEES:
$70.50 Underground tank installation/removal OR Contract value $ x 1%
$50.50 Minimum (includes State Surcharge)
_ $ Permit Fee
- If Permit Fee is less than $1,000, surcharge is $.50.
- If Permit Fee is > $1,000, surcharge increases by $.50 for each =$ State Surcharge
$1,000 Permit Fee (i.e. a$1,001-$2,000 Permd Fee requires a$1.00 surcharge).
$ TOTALFEE
I hereby acknowledge thal this iniormation is complete and accurate; that the work will be in confortnance with the ordinances and codes of the Glty oT Eagan; that
I understand lhis is not a permit, but only an application for a permit, and work.is not lo staR withoul a permit; that the work will be in acwrdance with the approved
plan in the case of work which requires a review and approval of plans.
x ?6,,?ftf2 TAiaFR x ?? .
ApplicanYs Printed Name Applica s Signature
I FOR OFFICE-USE ; Reviewed By: [late:
Required.lnspections:, _Under Gr,ouncl = Rough; rn _Air Test -'?Gas.Sqr,vice Test _ _In-floor Heat ,_Finai.;.
2005 RESIDENI'IAL BUII,DING PERNIIT APPLICATION
? City Of Eagan
3830 Pilot Knob Road, Eagan NdN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Construction Reauirements RemodeVReoair Reauirements Office Use OnN
3 registered site surveys showing sq. ft. of lot, sq. ft, of house; and all mo(ed areas 2 copies of plan Ced of Survey Recd Y• N
(20% maximum lot coverage allowed) 1 set o( Energy Calculations for heated addi6ons Tiee Pies Plan Recd _ Y_ N,
2 coples of plan showing beam 8 window s¢es; poured found design, etc. 1 site survey (or eddilions & decks Tree PresRequired Y_ N
1 set oi Energy Calculations Addtion - indicate if on-site sep6c system On-site SepUe System _ Y_ N
3 copies of Tree Preservation Plan'rf lot platted after7l1193
Rim Joist Defail Options selec6on sheet (buildings with 3 or less units)
Date (?:) l/0 l cU5 Construction Cost ?,, ov0
SiteAddress z/31L /'<,`???r,?.y, 011% Unit/Ste #
?'
? SS/a3
Description of Work %Lo o4?7 12<a / u&e.
Multi-Family Bldg _ Y? N Fireplace(s) 3e D_ 1 _ 2
Property Owner 61A ?,`S Telephone#( 65l) ''uL9--o'77`1
Contractor
Address City
State Zip Telephone # ( )
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy Code Category
• Residential Ventilation Category 7 Worksheet • New Energy Code Worksheet
(4 submission type) Submitted Submitted
• Energy Envelope Calculations Submitled
Have you previously constructed a building in Eagan with a similar plan? _ Y _ N If so, 25% plan review
fee applies.
Licensed Plumber
Mechanical Contractor
Sewer/Water 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 of work which requires a review and
approval of plans.
Applicant's Printed ame Applicant's Signature
OFFICE USE ONLY
Sub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? OB 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 PorchlAddn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Pibg_Y or _ N ? 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 32 Addition ? 36 Move Buiiding 0 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteration ? 37 Demolish Building• ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement *Demolition (Endre Bldg) - Give PCA handout to applicant
Valuation Occupancy MCES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bidgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footings (new bldg) _ FinaUC.O.
_ Footings (deck) _ Final/No C.O.
_ Footings (addition) _ Plumbing
Foundation HVAC
Drain Tile Other
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests Final
_ Framing _ Siding _ 3tucco _ Stone _ Brick
_ Fireplace _ R.I. _ Air Test _ Final _ Windows
_ Insulation _ Retaining Wall
Approved By:
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
Building Inspector
PERMIT ; ItITY OF EAGAN
3830 Pilot Knob Road PERMIT TYPE: B U I L D I N G
Eagan, Minnesota 55122-1897 Permit Number: 028361
(612) 681-4675 Date Issued: 0 7/ z 4 I 96
SITE ADDRESS:
4312 KIRSTEN CT
LQT: 10 BLOCK: 1
SUNSET 2ND
P.I.N.: 10-72986-100-01
DESCRIPTION:
Permit Type
GJ2ryrk Type '
.<,
a W 4 ? ?
DECK
NEW
434 ALT. RESIDENTIAL
IJ
s »s, ra.
*.«.._? u
}x q
'&.'??
?
REMARKS:
FEE SUMMARY:
Base Fee
Surcharge
Tatsl Fee
CONTRACTOR:
OWNER: - APPlicant -
MALLQY THOMAS
4312 KIR5TEN CT
EAGAN MN 55123
(612)454-3975
r.a-d th;i,s apPlfcation and s?tete that ths
;of " Mli°r.
?co°rcip°?.`y 'v`ith" 2°all app'l,cab5l`e'5ta?te-
?
.
?es ? X
_ ..?. ?. . s
-TISSUED B?Y'.?SIG? R ? ?E-
$45.00
$.50
$A5.50
" CITY OF EAGAN
3830 PILOT KNOB RD - 55122
1996 BUILDING PERMIT APPLICATION (RESIDENTIAL)
681-4675
RemodeVReoair Reoyiirements
4?"n
? 3 registeted aite surveys ? 2 copies of plan
? 2 copies of plans (inGude beam 8 window sizes; poured fnd. design; etc.) ? 2 ske surveys (exterior eddRions 8 decks)
? i energy calcutatlona ? 1 energy caiculetions for heated additfons
? 8 copiea of iree p?eservation plan H bt platted after 7/1193
requfred: _ Yes _ No
DATE: 7- /9 -9d CONSTRUCTION COST: .6,/ Z, OQp , °o
DESCRIPTION OF WORK: Q e G k
STREET ADDRESS: ? ?'3 / 2 Kr• r T?? .? cT,
OsT. P/w7"
LOT 10 BLOCK D L SUBD./P.I.D. #: 1 O 7 z 4 86 lrjn rL° T 2n alAfy
PROPERTY Name: !Yl a Il g? Th o? 4 s Phone #: 45y- 3 9 71,
OWNER 1AO M"
Street Address• q311 fs', •..r Te,-, C T."
City: eG _:r 4 r, State: f'''l n• Zip, -r's / z 3
CONTRACTOR Company: Phone #:
Street Address: License #•
City: State: Zip:
ARCHITECTI Company: -J4 -?• ? Phone #ENGINEER
Name: Registration #•
Street Address•
City: State: Zip:
Sewer 8 water licensed plumber: . Penalty appties when address change and lot
change are requested oncg permit is Issued.
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 Ciry of Eagan Ordinances.
Signature of Applicant:
OFFICE USE ONLY
Certiflcates of Survey Recefved , Yes _ No Lj'
Tree Preservation Pian Received _ Yes _ No --- --- s,q
BUILDING PERMIT TYPE
a 01 Foundation o 06 Duplex
a 02 SF Dwelling ? 07 4-plex
a 03 SF Addit+on o 08 8-plex
0 04 SF Porch o 09 12-plex
0 05 SF Misc. 0 10 = plex
WORK TYPE
o' 31 New
0 32 Addition
0 33 Alterations
? 34 Repair
GENERAL INFORMATION
Const. (ActuaO v tj
(Allowable) VN .
UBC Occupancy ? -3
Zoning +2 - ?
# of Siories
Length
Depth
APPROVALS
Pianning
OFFICE USE ONLY ,_ , ; •' j ?;,
? . ..
.. ?:.
?.
? •
0 11 Apt./Lodging ? 16 Basement Finish
0 12 Multi RepaidRem. ? 17 Swim Pool
? 13 GaragelAccessory o 20 Pubiic Facility
0 14 Fireplace ? 21 Miscellaneous
15 Deck
? 36 Move
? 37 Demotition
Basement sq. ft. MC1WS System
Main level sq. ft. City Water
sq. ft: Fire Sprinkiered
sq. ft. PRV
sq. ft. Booster Pump
sq. ft. Census Code. u 3q
Footprint sq. ft. SAC Code ?
Census Bldg 1
Census Unit 0
Building ?;-PM3 Engineering Variance
Permit Fee Valuatian: $
Surcharge
Plan Review
License
MCNVS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
SNI! Surcharge
Treatment PL
Road Unit -
Park Ded.
Trails Ded.
Other
Copies
Total:
96 SAC
SAC Units ?
?
? ! r •
?
?
?
z
?
?
ON
O
?
Q
?
?
I
I
?
?r
Bz.SS f
Sk?se7- Seco?,cl ?rfc1 ?'7?'0•?
?
loT' Q?a? ? A,zr P/4 r
/oo v? ? 0 -72S 86
?
I
?
W
Y
F .
1988 BUILDING PERMIT APPLICATION - CITY OF EAGAN ?
SINGLE FAMILY DWELLINGS
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS
IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
MULTIPLE DWELLINGS RENTAL QNITS FOR SALE UNITS # OF UNITS
INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SURVEY - CHECK WITH BLDG. DEPT.,
1 SET OF ENERGY CALCULATIONS
COMMERCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & STROCTURAL PLANS,
i SET OE SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS
G+S76 .? Ga.•r-
To Be Used For: ?MUvC??n,6 Valuation: ? Date: M/c/(-Site Address 43I 2 KIYL.CTEn, l.)Wrc..:
Lot 10 Block I
Pareel/Sub f?tvS&T' Z"'D
Owner ?p M 1 ? 474 C. eT ?
Address L Kile i-rv
City/Zip Code 6746i} 1?nJ S J / Z3
/ d
Phone ({o ? t?l Y.) L(- 26 r Z !I
Contractor
Address
CityfZip Code
Phone
Arch./Engr._.,
City/Zip Code
Phone #
r`/DO? OFF:
On site sewage_
MWCC system _
On site well _
City water _
PRV required _
Hooster Pump _
APPROVALS
Oecupancy
Zoning
Actual Const
Allowable
# of stories
Length
Depth
S.F. Total
Footprint S.F.
FEES
Engr/Assess Permit f8,o a
Planner Surcharge ?
Council Plan Review
Bldg. Off. I"4,/l z SAC, City
Variance SAC, MWCC
Water Conn
Water Meter
Road Unit
Treatment P1
Parks
Copies
TOTAL -
021 6i n#ftt 26'hJVe2 p L!q 1J DM+-,J 131
AnqtEl?s-a? dv'n%5c•1tq.?
I?
f Tv torL?aoK,v}TL`!?
P6-AM 1T 4- 1qy6? ( U C I / !48`?)
9u'r1''1 I N
1988 $UILDING PERMIT APPLICATION - CITY OF EAGAN
C -? -
SINGLE FAMILY DWELLINGS
t.-
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEYt 1 SET OF ENERGY CALCULATIONS'"r?`
/
NOTE; ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWRiER MUST DESIGNATE WfiICH ADDAESS
IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BIIILDING PERMIT IS ISSUED.
MULTIPLE DWELLINGS RENTAL UNITS FOR SALE UNITS # OF UNITS
INCLUDE 2 SETS OF.P[,ANS, CERTIFICATE OF SURVEY - CHECI{ WITH BLDG. DEPT.9
1 SET OF-ENERGY CALCULATIONS
COMMERCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAI. PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS
I N STAU.. SSA /k
To Be Used For: ? Valuation: ? Date:
Site Address ? 12 6611' OFF:
Lot ( J Bloek ? On site sewage_
MWCC system `
Pareel/5ub On site well
City water ?
Owner X1 (C_H_-A LL-rj PRV required ?
Booster Pump
Address ?_ S ?'Z F y
._rlCJ ?-? Cr(-- `
City/Zip Code t??4,,, ?? ] ) LS
Phone /Q_ APPROVALS
Contractor Engr/Assess
Planner
Address Couneil
Bldg. Off.
City/Zip Code Variance
Phone
Arch./Engr
ress
City/Zip Code
Phone #
L1 t6A`
Occupancy
Zoning
Aetual Const
Allowable
# of stories
Length
Depth
S.F. Total
Footprint S.F.
FEES
Permit
Surcharge
Plan Review
SAC, City
SAC, MWCC
Water Conn
Water Meter
Road Unit
Treatment P1
Parks
Copies
TOTAL
16: 0D
. SD
LL-7 T-rf
o?
?nry;W?-2s?.?. J? rJc"?'t •,.t?'8tii
+ . t v
0•A
310•U0+
29?SG+
155•Ov+
525o UC-?
4.70a0C+
63?OC+
250•OG+
1812^50*
klL
?
? ..
_ CITy pF EAGAN Include 2 sets of plans,
1 Certificate of Survey &
BUILDING PERMIT APPLICATION 1 set of enerTT. cal.culations.
Zb Be Used For 1. Valuation ?j`?,0? Date lo "" ?'J`C??
,
Site Address : °?f ? $TE ? &T.' OFFICE USE ONLY
Lot _Zj?Z_ Blocx _t sec./subr-:?/l/S?T?i1l?Erect ? rxcupancy 12-3
Parcel #: ??r Zoning -
Repair Fire Zone N k?
Owner: 0T i C)nT Enlarge Type of Const. "?.
6?-?-? ? Nbve # Stories
Address: Deirolish _ Front Cv0 ft.
City/ZiP Code?QnA k ??. Grade Depth ZCo ft.
Phone # : APPROZTF,IS FEES
Contractor: Rn 6E
Address_
Gity/Zip Code:
Phone #:
Arch./Ehg• : cS'A MC /9 5 /9 ig U VE-
Pddress:
City/2ip Code:
Phone #:
Assessments pemit 2D
Water/Sewer Surcharge
Police Plan Check 755.?
Fire SAC s Z-s . -
g1g, water Conn. ¢70 `?'
planner water Nteter
Council Road ilnit Z(o0. °-°
Bldg. Off.
APC
TOTAL j,) CY/a I s(3
\
^.
D 4q32 ?
;.------
;
i
_ __?__
RI -U int.#.
` SURVEYING
? SERVICES
_ 4 Eagan, Minnesota 55121
..ct riricuic ur our-vely rur : ?--?
OXFORD CONSTRUCTION INC.
.
r
/
h3?5/ ? NB9 °45 5/ ?E q34?
.m
30 ? o
0 I
?4
J o
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? ry ? (b O
(\ ?1 7 I O
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V
I
Z h -/8G.03 . 'n y?.s.
l N69°45'46"E
? 2s
t .
I
ti?
S CA[. c.' 40,
L EC, AL DES CR/PT/On1 :
LoT /O, l3.40CK / SUNSET SECONO AOoiT/OrL
SEC. 25, TwP. 27, RGE. 23. QAKOT.a Co., MN.
o DENOTES /KON SET
. 9 38 ° OENOTES PRoPasEO F/N/SNEO E[E?!
? 938-° DEN07'ES 4ARAUE FLOOR ELEV.
A
H / G, 1IG>6 CTS
I hereby certify that this surve'y, pVan '
or reporf was prepared by me or utder
my direct supervision and thaf 1 qm o Br adley J. wenson Mn. Reg No. 15235
duly Registered Land Surveyor under the Date; S/z9/8v
Laws of ihe State of Minnesota. -
,, ? ' . . .
. '
?
ENERGY CALCULATIONS
TYPE A _
int, air film
. 1/2" gypsum board'
3 1/2" insulation w/ V.B.
, 3/4" high R-Sheathing
12' masonite lap siding
ext. air film
TYPE B
type A
- lap siding
+ cedar lap siding
TYPE C
type A '
- lap siding
+ brick veneer
+ air space • "
, TYPE D
windows
patio doors
ext.,doors, wood ext. doors, steel .
?•
TYPE E (rim 7oist area)
int. air film '
1 1/2" softwood
3 1/2" insulation
• high R-5heathing,
lap siding
ext. air film:
?
3-BEDROOM BASE RAMBLER
/41C/fRLETS; PLAN
PLAN #.2/e'ZD Ar
JOB # rsqp d
i'
.68
.58
14.OU• '
5.60
.50
.17
21.53 U= .046
t
21.?3
- .50
+ .81 '
21.84
, .. U= .046
.?. ,
21.53
- .50
+ .44 _
+. .84
22.31 U= .045
U= .55
U= .55
- s U= .133
U= .066
.68
1.89 ,
14.00 ,
5.60 ' ' • .
:50
.17
22.84 TJ= .044
?
.
, ? .
.?:
. - ? ' . . . .
^ PAGE 2
,
.
•
?? TYPE F
(foundation)
?.
int air film ,68
12" concrete block 1.28 '
, va?or barrier ' -----
2" blueboard 10.80' '
, ext. air film ,17
12.93 U= .077
TYPE G ,(roof/ceiling)
int. air film .68
5/8" gypsum board ,5.8
ce'llulose insulation 38.00
asphalt shingles ;qq
ext. air film ,17
39.87 U- .025
TYPE H (overhang) _ ..
• '
•?. ,
int. air film' .68
• 3/8" plywood soffit .47
6" insulation 19.00 _
ext. air film ..17
?0.32 U= .049
TOTAL EXPOSED WALL AREA 1214 x '49,= 29. Y? 133.54 ?
wall type ' square footage U-Value
type A 774.0 .046 35.6
tYPe B .046 . ----
tYPe C ----- .045 ----
type D . ' .
windows 101.0 .55 55.6
patio doors ----- 55 ----
ext. doors, wood 38.0 .133 ' 5.1
type E ' 106.0 .044 4.7
type F 195.0 .077 . 14.7
1214.0 , 115.7 ?
_ p? .., . .
TOTAL EXPOSED ROOF/CEILING AREA 1296sf x,,9C = 5.<8 2?1X
;
type G ' 1152.0 .025 28.9
type H 144.0 .049 , 7.2
1296.0 36.1 )C.
• ? -
??3.Sq fi 33,? = I(07
%
1987 BDILDING PERMIT APPLICATION - CITY OF EAGAN
SINGLE FAMILY DWELLINGS
INCLITDE 2 SETS OF PLANS, 3
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMSOWNER MIIST DESIGBiATS WHICH ADDRESS
IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BDILDING PERMIT IS ISSQED.
MULTIPLE DWELLINGS - RESIDENTIAI. RENT6L [1NITS FOR SALE QNITS
INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SIIRVI3Y - CHECK WITH BLDG. DEPT.,
1 SET OF ENERGY CALCULATIONS
COLMMRCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF
ENERGY CALCULATIONS,
$29000 LANDSCAPE BOND ,
OF SQRVEY, 1 SET OF ELVERGY CALCUI.ATIONS
Rr=MtWG?3?fdtNG dalAa.l ?r
To Be Used For: t??q,? BE?q_U,4 Valuation:
Dat e :
?
Site Address??12 KIejYBiI? ?
Lot Block ?
Parcel/Sub Owner
Address Ll ? ?;z, iz?- i R5 r j 40,C t-
City/Zip Code n04A-fj
Phone L{ ?y-- 26 1 2On Site Sewage_
MWCC System ?
On Site Well
City Water
Occupancy
Zoning
Type of Const ?I
(Actual)
(Allowable) # of Stories
Length
Depth
S.F. Total
Footprint S.F.
FEES
Contrac tor
Address
City/Zip Code
? Phone
99P - 304? y
Arch . /Engr . ? (eE7r,v6 z ? S
Address ,57/9-;+?!-e
City/Zip Code
Assessments
Water/Sewer
Police
Fire
Engr
Planner
Council
Bldg Off IZ l1
APC
Variance
Permit 19,jO
Sureharge ,,$O
Plan Review
SAC, City
SAC, MWCC
Water Conn
Water Meter
Road Unit
Treatment P1
Parks
Copies
TOTAL 1?) .60
Phone 1F
I
2/84
; CITY OF EAGAN
APPLICATION FOR PERP4IT
SEjdER AND/OR WRTER CONNECTIODi
(PLEASE P9IHT)
1) PF.OP' ADDRESS : l
"
57
4)
( ?) y
4_
2?;
i•F(';L DESGRI°TIC:I: 07- /0 < LOCK /
(Lot/Blocx/Subc+svision or TaJc Parcel I.D. .itumzer)
lr S:;L'CT;,:tE , D'nT' G=' ORIG-IAI, El?iZi•L`:G
? PP."'S.-?7. R-i SL;GI::. rP`,!iI.Y ' --- ?-- -_- • . •
? R-2 GLTP= ('iZ%-o L11ITS )
? R-3 TC{v1il'rICi;SE ('PF.=- + L1]ITS) ( iTiQITG)
? R-4 CI;iITSi
? C0Mi??CI.=?L/'2t ETAII.,/OFFT_CE
? 1:'m ?s?z
? NSTI'IL'I'ICi:AI,/GC4???=-T
APPLI= (PLEaSE PRI4i )
ACo??--: ?o ,r3?c a9a? ?
crrY, sTATE, zrP: C?iPDOlt?.fl? ??? h?n1 ?z,?ra9
-
-
PHONE:
?
3) Pj,[i,.r$EP,
NAi4E : (V ?ASE PRlNT) FOR CITY USE ONLY
ADDRESS:
?Q545ADUA17) yjJX--/ ?g PLUP ERS LICE4SE:
` Active
CIT1', STATE, ZIP: f tfl yc?j ,sv a jz,¢ A9Q6&X7- Expired
PH4NE= MfW) i c.,
PLUMBER LICENSE
- 0Notof Reca r d
?,
arr initia
lrLLH3c rnini!
NA('? _
ADDF2ESS: /,----,
CITY, STATE, ZIP:
PHC}:+E:
5) INDIG,TE P7HICIi PEP.?LIT IS BEItiG REQUEST:D:
VCaTNECTION ;'?IF'.CTICN 'IL? CITY S?.?•IER
'IC) CITY WP,TER
? CTIM (PLFASE DESCP,IEE)
7) S=,A2L:?E:
? r-YnSE IiOLD AI'PROVD PERAIT FOR PICn-UP BY ONE OF ABC7VE
L"J `-'LZy-SE tiAIL APPROV^D pg'•iIT Tl7 1, 2,0 4 r'1E9.7E
_ (Circle one)
DATE: ,
E=t_N*-AWZa = a.t r"=CVNPUW4=:a ?s WA s ms:ss:m:m .n pot wt?r.fo:?r0-mwm so aw;mw i'?Aa mr=aa? s
F O R
PERyIT ii ISSIIED
C I T Y U S E O N L Y
FEES : $ / o • ? °
$
$
$
S
$ ?7 ? crc?
$ ?S
$
$
$
$
$ ?
WATER PERP'lIT (INCLL'DE SURC::ARGE)
WATER METER/COPPERHORN/OUTSIDE RE'?DER
jaAT^_°, TAP ( ZNCiGDE CORPORATI^vN S'"0? )
sE:rER ^.*-_p
ACCOUNT GEPOSIT - SE;':ER
ACCOUNT DEPOSIT - WATER
WAC
$AC
T'_2UNK WATE.°. ASSESS.-?Ei1T
TRli.7I? SE:vER ASSESSMENT
LATEP,AL BE^IEFIT/TRUNK SE?•:ER
LATE:2AL BENEFIT/TRU:]K WATER
OTHER
$
TOTAL
P,M0U:IT PAID/RECEZpT ;
DOES UTILITY CONNECTION REQOIRE EXCAVATION IN PUBLIC RIGiiT OF GdtlY?
YES IF YES, THEN A"PERMIT FOR WORK WITHIN
? PUBLIC ROADWAY" MUST BE ISSUED SY THE
NO ENGINEERID]G DIVISION. LZST AS A CONDI-
TION.
SUIIJECT TO TF1E FOLL0;4ING CONDZTIONS:
APPROVED BY:
TITLE:
DATE :
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