1361 Interlachen DrREQUEST FOR ELECTRICAL INSPECTION ?
? Seetslructtons tor completing this form on back ot yellow copy.
E•; 702 5 4` "X" BeJow Work. CpuerW by This Requast
e Add Rep. lype of Building Appiiances Wired Equipment Wired
•.' Home Range Temporary Service
? uplex Water Heater Electric Heating
flpt. Building Dryer Other (Specity)
Comm./Industrial Furnace
Fartn Air Conditioner
Ottier (spaclly) ConVSCtorS Remarks:
, Compute lrrspection Fee Below:
# Other Fea # Service Entrance Size Fee # ClrcuiRs/Feeders Fee
Swimming Pool 0 to 200 Amps o OQ 1111 0 to 100 Amps Z)?14
Transformers Above 200 Amps Above 100 Amps so
Signs lnePecto.'s use ony:, TOTAL Sp
Irrigation Booms 3 9 -?
Special Inspection ,
I
Alarm/Communication
f 1-.
?.
Other Fee •
I, the Electncal Inspector, hereby,
certify that the above inspection has
been made. R' h-in -
F? p?
oace
OFFICF USE ONLY Thia requeat void 18 month& hom .? -
,
E 70254 13 ?? ?2,??t???,
Request Date
? I
Fre No. Fou?-in In ion
Requl
QAfs ? No ? Ready Now otiry Inspector
When Ready?
I p.#Kensed contractor ? owner hereby request inspection of above electrical work at:
Job Addreas (Street 8ox w Route No.)
i Gy ?
Secfion No. Township Name or No. Rargp No. Coun
?e??
Occupant (PRINT)
. ; f1 /J PQAJST, Phone No.
lv o '
Pawer S lier
Cer qdd„esy
-
Eledr(cal ConVector (CqmPe^Y Neme) CoMractork License No.
Malling i4ddrriss (Co ntra or or pwner Making Installation}
/
Authorized Signatu (Con :Zng 77n) na Number
? - -6 //
MINNESOTA STATE BOAOF ELECTRICITY
Griggs-Mldway Bldg. - oom S173
1821 Universtty Ava„ St Paul, MN 55104
Phone (612) 642-0B00
THIS INSPECTION REQUEST WILL NOT
BE ACCEPTED 6Y THE STATE BOARD
UNLESS PROPER INSPECTION FEE IS
ENCLOSED.
CASH RECEIPT
CITY OF EAGAN ?
3830 PI?OT KNQB ROAD
EAGAN, MINNESOTA 55122
DATE 19
RECEIVED ' . . ?
FRO.,
.AMOUNT $
DOLLARS
,ro
? CASH [3 CHECK
Ft]i1 • 1 ._ .• . . - .
BY
Whke-Payers Copy
Yellow--Posting Copy
Pink-file Capy
Thank You
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21 •199, Eagan, MN 55121
PHON E: 454-8100
BUILDING PERMIT
To be used for ~?' ??? t? ??"AR
Est. Value 3143 s,44G Date
SiteAddress 1361 INT?? ::LACHBI4 DR.
Lot 13 elock 1 Sec/Sub. FAIR4IAY HILLS YI
Parcel No,
a Name AL HHRR..IANN COtiSTRUCTIOH
z Address
3
° City •` Phone t)
¢ Name SAM
,o
? ? Addoess
?M- City Phone
Nartre
Address,
City Phone
I hereby acknowledge that 1 have read this application and slate that the
information is correct and agree to comply with all applicable State of
Minnesota Stetutes and City of Eagan Ordinances.
Signature of Permittee
P.Building Permit is issued to: AL i4FRR!'•ANN O.'N57
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
Receipt
OCTOBiLA 31
19
OFFICE USE ONLY
On Site Sewage Occupancy R-3 11-1
MWCC 5ystem Zoning R'i
On Site Well (Actual) Const V"111
City Water % (Allowable) Y-F,
PRV Required of 5tories
Booster Pump Length
Depth 39'
S.F. Total
Footprint S.F.
APPROVALS FEES
Engr./Assess. Permit 714'00
Planner Surcharge 71.50
Council Plan Re++iew 357.00
BIdg.Off. SAC.City 100•00
Variance SAC, MWCC 550.04
Water Conn. 550• 00
Water Meter 67• 00
Road Unit 325.QU
Treatment Pt 704.
Parks
TOTAL • , 938• 50
c,i I r vr cNUian
3830 Pilot Knob Road, P.O. Box 21-194
` PHON E: 454-8100
BUILDING PERMIT
To be used tor
Site Address ' 1 11411;n1.AGHi;:1 tjR
Lot Block I Sec/Sub. FwIIIWAY HIE.LS Ij
Est. Value $149„Q00
Eagan, MN 55121
Receipt #
Date ,19i: ",
Address
City Phone
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 ot Eagan Ordinances.
Signature of Permittee
A Building Permit is issued to: A'' P-"A'''LKNN .COr`5T
on the express condition that all work shall be done in accordance with all
applicable Slate of Minnesota Statutes and City of Eagan Ordinances.
Building Official--___- --- -- .---- -.-, -
OFFICE USE ONLY
On Site Sewage Occupancy R-3 14"1
MWCC System ? Zoning
Qn Site Well " (ACtual) Const
City Water k (Allowable) V"H
PRV Required # of Stories
Booster Pump Length
Depth 39'
S.F. Total
Footprint S.F.
APPROVALS FEES
Engr./Assess.
.. Permit 714.00
Planner
Surcharge , 1 . ?
Council Plan Review 157.00
Bldg. Off. SAG City _ 100.00
Variance SAC,MWCC )50•00
Water Conn. ?)50• 00
Water Meter 67. C7O
Road Unit 32.G,.{)('j
TreatmentPt f`C
Parks
TOTAI . 5?1
?- Permit No. Permit Holder Date Telephone
Plumbing /T?% ?
. Y
H.V.A.C.
Electric 41
42 A ,
Softener
Inspectlon Date Insp. Comments
Footings I S'? j•j/UZ `v? ?5-i„? ,se? S•
Footings II
Foundation
Framing ? X) ?S, yG 7`'
Roofing Gc - ?CtlJ iY ? - / c?l?
Rough PIb9• _ SK•
Rough Htg.
isui. C6.cir, orG To ?"rQcc. -? ?i
Fireplace
Final Htg.
Final Plbg.
Bldg. Final
CiBft. OCC.
z ` a rn
64 I' AeBf/pf* f'O co..crel4e 1"?BO y
Temp. LP
Deck Ftg.
Deck Final
Well
Pr. Disp.
PERMIT 1k
PLUMBING PERMIT
CITY OF EAGAN RECEIPT #
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: ?
CONTRACT PRICE PHONE: 454-8100
Site Agdress BLDG. TYPE WORK DESCRIPTION
Lot
__ Block SeC/Sub Res. New -
_
' Mult Add-on
? Name Comm. Repair
? Address Other
c Ciy '•' 1 ' Phone ;-^'r' f RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
;s FIXTURES TOTAL.
. _ ., ._ ;
Name Water Closet - $3.00 S
k
3
Address Bath Tubs - $3.00
$3
00 ?
L
t
ava
ory
-
.
p Ciry Phone / -bid_Shower - $3.00
--l_Kitchen Sink - $3.00
FEES Urinal/Bidet - $3.00
COMM/IND FEE - 196 OF CONTRACT FEE ? Laundry Tray -$3.00
APT. BLDGS - GOMM RATE APPLIES ? Floor Drains -$1.50
ToWNHOUSE 8 CONDO - RES. RATE APPLIES .
?Water Heater -$t.50 '
MINIMUM - RESIDENTIAL FEE - $12,00 ? Whirlpool - $3.00 .
MINIMUM - COMM/IND FEE -$20.00 ' Gas Piping Outlets -$1.50
STATE SURCHARGE PER PERMIT - .50 (MINIMUM - 1 PER PERMIT)
/
(ADD $.50 S/C IF PERMIT PRICE GOES Soitener -$5.00
BEYOND $1,000.00) Well - $10.00
. ?-Private Disp. - $10A0
' Rough Openings - $1.50
SIGNATURE OF PERMITTEE FEE:
STATE S/C: '
FOR: CITY OF EAGAN GRAND TOTAL•
, .
.. PERMIT #
MECHANI CALPERMIT
?
? '
CITY O •-
F EAGAN RECEIPT # -=--"I
3830 PILOT KNOB R OAD, EAGAN, MN 55122 DATE:
CONTRACT PRICE: PHONE: 454-8100
Site Addrqss t-r
BLDG
TYPE
SC
P
O
, . ! .
WORK DE
RI
TI N
Lot ' Block . 1_ Sec/Sub Res. New
R Mult Add-on
? Name ?
Comm. Repair ?
Address O a ?
?
c
City ?C?of^ L
e.lu-- Phone 'ly Other
'
FEES
c Name
5
0? RES. HVAC 0-100 M BTU -$24.00 ?i
!
,
4
Addre s ADDITIONAL 50 M BTU - 6.00
p City Phone - (RES. HVAC INCLUDES A/C ON NEW
CONSTRUCTION)
GAS OUTLETS (MINIMUM - 1 PER PEkMIn 50 EA
- 1
TYPE OF WORK
COMM/IND FEE - 1% OF CONTRACT FEE .
.
Forced Air M BTU ? APT. BLDGS. - COMM. RATE APPLIES
TOWNHOUSE 8 CONDOS - RES. RATE APPLJES
Boiler M BTU MINIMUM RESIDENTIAL FEE - ALL AOD-ON & I,
Unit Heater M BTU REMODELS - 12.00 '
Air Cond M BTU MINIMUM COMMERCIAL FEE - 20.00
_ STATE SURCHARGE PER PERMIT - .50
Vent. CFM $. (ADD $.50 SiC IF PERMIT PRICE GOES
Gas Piping Outlets # -? ? BEYOND $1,000)
?
Other
FEE ?b ?
-
?`I
? •?
.
S/C: ' y? SIGNATURE OF PERMITTEE
a? ?
TOTAL:
FOR: CITY OF EAGAN
_ .?
. . y„ -- W , , . . . . . .?. ,. ..
CITY OF EAGAN ?
454-8100
DEPT. OF BUILDING INSPECTIONS "
Correction Notice
Located at
I have this day inspected fhis structure and
these premises and have found the following
violations of city codes governing same:
?fl ' 1?1 ?77 0,."Z/7"s 7-
When corrections have been made, please
call 454-8100 for inspection.
Date
Inspectar City of Eagan
DO NOT REMOVE THIS TAG
I OF.EAGAN PermR No: 11209 Date: i I--4"88
! Rilot Knob Road ,,.$/ P No: ` ? f' 7^Date: I0-11°8 f
'Box 21195
an, MN 55121 ,
.
ier. 'e
Address: In Pryachen Drive L1l Hi F^iroav tsil1R
:.C: Zoning- .
if • (Trl;' NO. Of UllitS:
Chg:
. Dep: I agree to comply with the City of
iit Fee: v Ordinances.
harae: SEWER SERVICE PERMIT
,ITY OF F,AGAN Permk No: 10 10 fl 9 pate, ;1- 4 88
630 PIJct Knob Fioad Meter No: - Size:
.O. Box 21199, Reader No: Date:
adan. MN 55121
. Chg: 5150. Of?pd Zoning: ._
Dep: i' •(11 T) ? No. of Units:
t Fee:
?rge: •'""`? I agree to compty with the City of Eagan
rt 2 3t' • 00pd Ordinances.
r,7 npaA
WATER SERVICE PERMIT
IF
i-
CITY OF E''AGAN Permlt No: 10069 paW. ;
3830 Pilol Knob Rosd. Meter No: q15 407 ? S6 Size: v?'?K'
P.O. Box 2119A(1,Q,?p? ader No: Oate:
Eagan, MN 5512'f Y
Site Address: 1161 Tntprl arl)pn TirIi ' 1? R1 F?
nn. Chg: 55?) . C0n'l Zoning:
ct. Dep: LS •00?'?I No. of Units:
rmit Fee: t+' . 0??-i
rcharge: .'")(' I ayree to comply wMh C of Eagen
Plant •' l 0 D c' Ordlna .
eter. .
sc.: ?m By
WI?TER SERVICE PERMIT
/ - i - g7'
REQUEST FOR ELECTRICAL INSPECTION _Fe...nnn-ooom-07
? ? See ins(rutuons br compleM1ng ihrs fortn on back of yellow mpy
V
? 70254 X" Below Work Covered by This Request
ew Add Rep. TypeofBuiltling AppliancesWVed EquipmentWired
Home Range Temporary Senrice
Duplex Water Heater Eleccric Heating
Apt. Building Dryer Other (Specrfy)
Comm./Industrial Furnace
Fartn ' Air Conddioner
Offier(spapfy) CanVadw§Ramarks:
Compute Inspection Fee Be/aw:
# Oiher Fee # ServiceEnVanceSize Fee # Circwts/Feeders Fee
Swimming Pool 0 to 200 Amps pB
1
-1
0 to 100 Amps
-W pg
Transformers A6ove200_Amps Above700_Amps So
Signs Irieper.iors llse Ony: TOTAL r('O
Imigation Booms
Special Inspection
Alarm/Communication
Oiher Fee
I, the Elecirical Inspecror, hereby Rough-in
.
?
certify that the above inspection has Finai ?
oai,
been made. i
OFFlCE USE ONLY
This repuest voitl 18 monlhs Imm
/?/ / / J O
7 0 ,
d 'j'`JJ 7 4°
°Z'
2 5 4 a
R a U9
RequestDete
? (? a fire No. Roug?-n Ins ion
ReGw .
? ReBtly Now
Nohty Inapeclw
Wh
R
tl
?
(J Q e3 ? No en
ea
y
I ensed coniractor ? owner hereby iequest inspection of above electrical work at:
Job AtlCress (Street, Bw or Route NoJ Ciry
Seclion N. Tovmship Name or No Range No Cou
C???i
v ??"?
Occupant (PRINT) - l
N
NV/. PMn/q N_o.Q?J
(?VA / _
(?(
Power Su pLer AtlEress
e1` Z G-Ta
Electncal Corrlractor (Canpany Neme) Comractar5 Ucense N.
? - Dyo s -
Mving Adtlress ( ntra a or qvner Meking Imtelletron)
--7
. J'.s37
Aulhorrsed Sgnat e(Co cmr r M king In/s?ry? on)
lJ_.__
__- ?Kona Number
MINNESOTA STATE BOngo oF ELECTRIC w_ THIS INSPECTION REQUEST WILL NOT
OriggaMbwey BIOg. - Aoom &773 BE ACCEPTED BY THE STATE BDARO
1821 Unlveraity Ave., SL PouI, MN 55f04 UNLES$ PROPER INSPECTION FEE IS
Phone (612) 642-0800 ENCLOSED
CASH RECEIPT
0
.CITY OF EAGAN ?
3830 PILOT KNOB ROAD
EAGAN; MINNG? OTA 55122
onrE
1
FPOM
AMOUNT
---R? DOLLARS
Whrte--Payers Copy
N? 88879 P ??;y°°?
? CASH ? CHECK
BLDG. PERMIT NO. I
L-c, t" '• '? ? 1 cc,d<- I_;=
07-3210
` Ot-342,?
n 01-3445
(01-3446
? 01-2155
75-3860
? 20-2275
+ 20-3865
? 20-3868
? 20-3716
? 20-2252
20-3713
20-3743
79-3866
28-3855
Bldg. Permit 1 ?l ' Ci )
Plan Check 3S ? Ce
Surch./Adm.
SAC/Adm.
Surcharge
Road Unit
SAC
Water Conn.
Water Trmt.
Water Meter
Acct. Dep.
Water Permit
Sewer Permit
Sewer Conn.
Park Ded.
TOTAL
0
CITY OF EAGAN
3830 Pllot Knob Road, P.O. Box 27-199, Eagan, MN 55121 N? 1rj806
?C,
BUILDING PERMIT PHONE: 454-8100 Receipt ? 7--1 t ?!
#_?
Tobeusedfor SF DWG/GAR Est.Value $143,000 Date OCTOBER 31 ,1988
SiteAddress 1361 INTERLACHEN DR
Lot 13 elock 1 5ec/Sub. FAIRWAY HILLS II
Parcel No.
a Name AL HERRMANN CONSTRUCTION
W
= Address 8723 HIGHWOOD
o Cdy APPLE VALI.E7FPhone 688-0696
a Name SAME
.o
? Q Address
`CityPhone
u`w
W w
Name
?
i za
Address
aw City Phone
I hereby aCknowletlge that I have read this appliCaLOn and State Ihat the
mformation is corre ct and agree o complY with all apphcable State ot
Minnesota Statutes and Cif E an Ordinances
Signalure ot Permittee
A Bwldmg Permn is issued Io. AL RRMANN CONST
on the express cond ihon that all work shall be done m accordance with all
appticable Slate of Minnesota Statutes and G[y of Eagan Ordmances
BuildingOfficial?ltu1Pi IKOLfA,i WC-
OFFICE USE ONLY
On SRe Sewage - Occupancy R-3 M-1
MwCC System X Zoning R-1
OnSiteWall _ (ActuaqConst V-N
City Water X (Allowable) V-N
PRV Repuved X _ # of Stories
Booster Pump _ Length 68 '
oePm 39'
S.F.TOtal
Footprint S.F
APPROVALS FEES
Engr./ASSess. Permit 114.00
Planner Surcharge 71.50
Council Pian Review 357.00
BIdg.Off. SAC,CiIy 100.00
Vanance SAC,MWCC $$0•00
Water Conn. 550.00
Water Meter 67.00
Road Unit 32_.5-0
Treatment P1 _204..,00
Parks
TOTAL 2s938.50
REQUEST FOR ELECTRICAL INSPECTION
?} ? See inslmdrons tor compieting tMS fOrm on back of yellow copy.
I? 1 U 7 4 p p 'X° Below Work Cavered by This Request
r Cp
..?35/-?5
e Add Rep. TypeofBUilding AppliancesWired EquipmenlWired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt Buildmg Dryer Other (Specity)
Comm./Industrial Furnace
Farm ? Air Conditioner
Olhar(spemly) ConVactor5 Remarks'
Compufe Inspection Fee 6elow:
# Other Fee p ServiceEniranceSize Fee # Gircuits/Feeders Fee
SWimming Pool ? 0 to 200 Amps 15 /?j O to 100 Amps
Transformers Above 200 _ Amps A6ove 100 _ Amps
SignS Inspedor? Use Only: TOTAL
Irrigation Booms ?j y/ , SO
Special Inspection
Alarm/Communication
Oiher Fee (
I, the Electrical Inspector, hereby
certify that the above inspection has
6een made. Rouyndn ,
F,,,M oat' y ?
a?
oe;
F?
OFFlCE USE ONLY This rapuest wW 18 morifhs from
(5 /" 8,94ir &
70748?, 0? o-P
RequestD ? Flre No Po m Inspectlon
Req tl? ? Reatly Now ?'ll NohFy Inspector
'
es ? No When ReaRy
+
Ixlicensed contractor ? owner hereby request inspection ot above electrical work at
Job Aadress (Srceet, Bu or Rwte NoJ * Clty
13C01 ..Tn All / .e IU 4?
Seclion No Taunship Name or No Range No. Co nry `'
?all fPfi1N
G
?
? Phorre No
I
l!?h14^
OnS 6
F?-
PowerSUpplier Atldress
,anM.
Elecmtal Con!U1ac[or (COm!peny Name)
' Contractor5 Lroen9e Na.
cJ
4, d c4C ?((o[d
Maling Adtlress (COnhaqor ar Qvner Making Installebon) ?
/,ro?'S AK/?CJL U.-:.? S ? $??S??IIK SSj37
Ainhonzed Sgnature (COnnaclor/Own ?rg I IeHon) Phona Number
??'lOC4 U<U
MINNESOTA STATE BOAflO OF ELECTNI¢fF1rJ/ THIS WSPECTION REOUEST WILL NOT
GriggaMttlway BItlB. - pmm S93 %r? BE ACCEPTED BY THE STATE BOARD
1821 Umveniry Ave., SL Poul, MN 55109 UNLESS PROPER INSPECTION FEE IS
Phona (613) 662-0800 ENCLOSED.
RESIDENTIAL
BUILDINC PERMIT APPLICATION 1 4.?
o, CITY OF EAGAN
d I` 3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675
New Construction Raouirements RemodeUReoair Reauirements
• 3 regrslered site surveys showing sq. R. of !ot, sq fl, of house, antl all roofed areas • 2 wpies of plan
(20% maximum lot cove2ge allowed) . 1 set of Eneryy Calculalions for heated additions
. 2 copies of plan showing beam 3 wmGOw srzes; poured found design, etc.) . 1 sde survey for extenor addiUOm 8 decks
• 1 set of Eneryy Calculations . IrMicate if home served by septk system for additions
• 3 copies of Tree Preservalion Plan rf lot Flatted aRer 7l1193
. Rim Joisl Oelail Opnons selecnon sheet (bldgs wAh 3 or less units)
DATE 1-((-U z-
Water SoFtener
Water Heater
No. of Baths
SITE ADDRESS MULTI-FAMILY BLDG _Y _ N
TYPE Of WORK ?V-Ff- W0 (cat- hAUV ?- .ra je-_ FIREPLACE(S) _ 0 _ 1 _ 2
APPLICANT SELA ROOFING & REMODELir(-
EISIOR BLVC)
STREET ADDRESS ST LOL114 PARK, nnnI rS4 7e CITY STATE_ZIP
TELEPHONE #&7-W'3-9-0?4G, I ? ECCYR&NE # fAX #
PROPERTYOWNER?/I??SG TELEPHONE#
........................................ ------------------------------------------ -............
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Ca[egory M[V rEgp1':\ RGI.LS 7670 C:1"I'F:GORY I ?[I
(J submission rype) . ResidenGal Venfilation Category 1 Worksheet Submitted • ?_ e y Cot'd@NV?r?CS?
• Energy Envelope Calculations Submitted
? JUI 112002
Plumbing Contractor:
Plumbing system includes:
Mechanical Conhactor:
Mcch.uiic,il sv,[cm indu(ie,:
Sewer/Water Conhactor:
----------•----------°-°--------------
A1C COII(Illl0ill11g
E-[eal Rccovcry Systcm
Phone k
Phone #
Ccr. $70.00
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply
with all applicable State of Minnesota Statutes and City of Eagan Ordi ances. /
Slgnature of Applicanf t???? 64 ^^? _?
------------------- ---------- __._.-------- --"--------------- ---------_____------°---°----
OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Upaated 4102
Phone #
??2 -) C) . O-Z>
VALUATION
I.awn Sprinkler `
No. of R.I. Baths
OFFICE USE ONLY
? 01 Foundation ? 07 05-plex ? 73 16-plex ? 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 Ext. Alt - SF
? 04 02-plex ? 10 OS-plex ? 18 Deck ? 23 Porch (screened) ? 36 Multi
? OS 03•plex ? 11 10-plex ? 19 lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
? 31 New ? 35 Int Improvement ? 38 Demalish (interior) 0 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (FOUndation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)" ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement "Demolition (Entire Bldg only) • Give PCA handout to appiicant
Valuation Occupancy MC/ES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED IN SPECTIONS
_ Footings (new bldg) FinaVC.O.
_ Foonngs(deck) Final/No C.O.
_ Foonngs (addition) _ Plumbing
_ Foundahon HVAC
_ Dram Tile Other
Roof _ Ice & Water _ F inal _ Pool
Ftgs AuiGas Tests Final
_ Framing _
Siding Stucco Stone
_ Fireplace _ R.I. _ Air Test _ _
Final _ Windows (new/replacement)
_ Insulation _ Retaining Wall
Approved By
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
W ater Suppty & Storage
S8W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Building Inspector
Total
J
1'988 BUILDING PERMIT APPLICATION - CITY OF EAGAN - -
SINGLE FAMILY DWELLINGS I?? O 4
INCLUDE 2 SETS OF PLANS, 3 CERTIFI,CATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MOST DESIGNATE WHICH ADDRESS
IS DESZRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
MULTIPLE DWELLINGS RENTAL ONITS FOR SALE UNITS
# OF UNIT3
INCLUDE 2 SETS OF PLANS, CERTIFICi1TE OF SURVEY - CHECK WITH BLDG. DEPT.t
1 SET OF ENERGY CALCULATIONS
COMMERCIAL
IVCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS
- - ,QG7 27
198Q .
? yg ?o 0
To Be Used r^or:,el%LG(J I17C(J Valuatio Date:
n
Site Address
Lot , ? Block ?
Parcel/SuD??"
Owner
Addres
City/Z
Phone
Contractor m4w~4!/???//P',(.?
Address
City/Zip Code
Phone -667?i "
Mch./Engr.
Address
City/Zip Code
On site sewage_ Oecupancy
MWCC system ? Zoning ?
On site well Actual Const yd!
City water z/ Allowable
PRV required if of stories
Booster Pump ? Length l'„ 8
Depth 39
S.F. Total
Footprint S.F.
APPROVALS FEES
Engr/Assess Permit
Planner Surcharge 92. sa
Council Plan Review 35_2
Bldg. Off. .'-jL7Z?_jqf2e, SAC, City 10 E7
Variance SAC, MWCC SSo
Water Conn S s_9
Water Meter 67
Road Unit 3zr
Treatment Pl ? 1Y -
Parks
Copies
TOTAL ?.
?
Phone 16
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ENGtNMING
COM('nNY, INC.
1000 CAST 146tlh STf1EET,
4?& /gSZ,O/
cnnsULTlilo lNOINEE!iS
ftnNNEns ond LOHD ?unvEVOns
9unt+5vILLE, ullltiESOtA 6t337 PII 4=2-3000
Ce P--Z zz c cz i e c Sz?-Y'e ?r
LOT 13, BLOCK l, FR1RW.9Y HIGGS 2ND ADD/T/ON,
DAKoTA COUNTY, MINN9S0TA
fjo,Ko7 pENOTES EX/$T/NG ELEI/qT/ON
(1044.0) DENOTES PROPoSEO EGEI//ITioN
-?-- lND/CATES D/RE'CT/ON aF SURGACE DRf?/NA6E
1044.33 = FlNISHED 6A,29GE FLD02 ELEI/471O/V
gCAt,r- : /" = 30,
?L036j/
? 6p e
y
Q03+5 (?T;7 '' ?'Qv
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A
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vj
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/ ? y?o Q,??? 336 a13
?- ORA/MA6E ANO
,?,,? UT/uTY EA.S'EAZNT
\ ?
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pp ?0?•33 ,?ti 1 ?
d0' FRONT BUILD11V6
$ETBAGe L lNE
? le¢'¢3'-
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O,Q?`?? ? ''% •-?
o ° pM?vp ?si=?Gt-',!U I:IV?;i??`,jRIF?G DEP?.?'
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REOWRCD
1alndraaYahaoxniandtdeeCribedihereonUe AadPr°P rad bypmeaontthian_26'w daYcof `
OCToBEf-, 19 88 • '
No. /^ 5
Jiinn. Agd,
nuI,,uiIIa UFPAE2'1'I•ICIIT
, F:X'xE12I01i'EIiVF;LppF7 AYEiA4C flUit CObIPUTATION "
.? _ . (To be eubmibted ttitll building permi6 application), ~
One or 1'tvo Family Dwelling
o ener
All Other
, 61te Addrees
Coulraatax -??- ` ^- -
Date 't7CC9--RPltotte ??-+f/?rf24,
_
LIilE,11L FECT oF N 7
EJUPoSED YJALL `A ? .
it, a6ove grade ? ? 7 1 O
• 1bTAL EXP08ED WALL AREA 6Q. pmo
oPAqUE WALL COtIS'lItU0T1U1i 1 IlUll Valua x Areet •
Dataii
r 2 13?.-?
eterenoe x 3q. F'T. ?? (p)(n) • liull i•om ' i?u_'L?w x 9R. FT. = M (R) ?
f ?
attached nUn-yE2_2?{' x sQ' U)(n)
slievke npn x $R. FT. _ ?p??n?
. ,
' upn x SQ. F'T._ = (U)(A?. '
x gQ. £T. (U)(A).
YritIDOW81 ifUll
Vulue x Arott
Flalce & TYPa I 9 (?}C??'
u
u a n x SQ. FT.--4!Yi`',?°_ q/?77(?)(A) . .
" ,o ? x eq. FT.
i? „ ??Un = (u) (A)
u x ae. FT.
= (u)(n)
Doousi I?, ll x sR. F°r. ? (u)(n)
U Va1ue x Areu ,
Ilahe & Type tiqU,"
n n x 8q. FT.
::Up:l
o ,? `L uu -?-?
u n ?ip?i R sQ. Fr.-'N(U)(n)
x sq. FT. - M(A)
' To'tALB Z(P1j? S F"P. ZZZ? ?`J?? M(A)
TOTAL M(A) VflLUEg AVE1tAclE itUii 4•
L ?G?I ? n I O ??
DIVIDEll BY TOTAL 17A(,(, /?ttEA
114E1iA(lE npn *115 or 1.eoe ior 1&2 iamily dtiiellinge .
f?00 P/O gI LI1101 •
TOTAL AIIEA f ? Q=` :
Uetail reierenoe iiUll ? . C7Zl
[rom IIp??, x 9Q. FT.
?(QC) - ZZ?Z(fj?U (A)
nttacl?ed sl?eete. n??? x sQ. FT. K (U)(A)
Ueocribe oponin?s ? u??? X$Q. FT.? (U)(n)
in root. • upn x gR. F'T.?
x 3q. FT. r (U)(A)
ToTA[, M(A) VALUES DIVSllIib 8Y
zZi 2(v , 1?,??5 -L1a25Q.rr ZzIz0?u??
''f0'1'AL Ii00F/CEILI.IIU AtiEA /
AVEItAaB ??Un ,02$ ior venEilnled roO ??O
? 0 Z?I
?
,
• ? .
?54 X4(v
1(07 ?C 144 = 1l0, 48
83x 5z-
,N???,s
7z?
? i i c 3Zu 2? ?? = I 1 ? 2 s,? ?- ? 4 S, o
z2,
I ?1-Zoul?a = ?4?1 I = ?? ? o
sx I = /J
l?q r?
? s
r-lz,
??? P(- I 21 ? o
Pt?w I? ?-, = 4240
9?,1:7
-% eL?PD IiTL,?
0a?Z_
G? 4a? lm,?
r-im,
i? klr-'A)
? qzo
2????
--wntr, sECTioN--
Determining 11U!l valuee at Roofp Walls' Rims nnd Conc. Block
ROOF/CEILINa
1.) Interior Air t'i1m
2.) 5/8" ayp. Ha.
3.) Insulation
4.1
50 Exterior Air Film
(BTILL)
(R) VALUE
0.61
.56
44.Ro
.61
uUn - 1/R= iOTAL (R)='¢S•7S
WALL
6.) Interior Air Film
7.) 1" aYp. Ba.
8.) Inaulation
90 bufL.T-P-ITF
10.) Masonite Siding
11.) Exterior Air Film
R VALU
0.68
.45
19• oa
.67
4
.17
nplf a 1?Re • O47? TOTAL (R)= 23.O f
RIM
12.) Interior Air Filro
13.) Ineulation
14•) 211 Fir Rim Joiat
15.) E-oiZT- RiTG
16.) Ataeonite Siding
170 Exterior Air Film
R VALUE
0.68
19•00
1.88
27,0 4
.67
.17
Irpn = 1/Re .04-D TOTAL (8)n Z¢.gg.
_-
=r
FOUNDATION
18.) Interior Air Film
19.)
zo. ) ?-?I 57?IPr?D
21.) 1211 (Soncrete Block
z2.)
23.) Exterior Air Film
R VALU
0.68
//.co
1.28
.17
npu a 1/12= .o7(D TOTAL M=
?-
r
CITY OF EAGAN
APPLICATION FOR PERMIT
SEWER AND/OR WATER CONNECTION
xxrxxxxxxrxxxxxxwxxx:::::wxxxxxxxi
*10'1W3: PA7a%4FNP OF k'F.E AT TIME OF
ADPT.TcATI«a noFS NOr oONsrxTUTE
APPROVAL OF PF.RNIIT.
irsencriori oF sDM r,rm/CR MTEa
rMrar.ramrONS F7ITd, NOT BE SC1HED-
tLEn vrriIL rERMIT xA.s BEEv
APPROVID.
P ease Print)
1) PROPERTY ADDRESS:
LEGAL DESCRIPTION:
IF EXISTING STRL'CIiTRE, DATE OF ORIGINAL BPILDING PERMIT ISSL'ANCE: '
Mon Year ..
pRESENT ZONING/PROPOSE9 USE:
q CONMCIAI./REPAIL/OFFICE
[D IbIDL'STRIAL
n INSTZZSPPIONAL/GOVfRDMET1T
R-1 SINGLE FAMILY
R -,2 DCPLEX (Tt,o LTnits)
? R-3 TCIIWNHOUSE (Three + Units) ( Units)
rl R-4 APARThENPP/CONIDOMINKM Uni.ts )
2) ?ko
NAME:
AnDREsS: SOS .u_ &
CITY, STATE. ZIP: P(, if Mwn{ M?.G . SS0LA1
PHONE: S? S- Co C-1 .,S O
3) • i: • For City Use.
NAI"E=_?f? Pliunbers License:
aoDxsss: ?C?' i,?? ti; n FaYt ??, C,? 2? ve
? E?tpired
? CITY. STATE. ZIP: Pl.qI/Vfo'?lrl '?'? 1?r Not recorded
PHONE:'EC( 5'(d? CC7 MASTEF2 LICENSE#
S?tial
4) •• • i?-
NAM:
ADDRESS:
CITY, STATE, ZIP:
PHONE: LOk& - U (o LL' (o
5) ? w •?• .a • ? - ??
w CONNECTION TO' CITY SEWE2 ?j CONI?CrION TO CITY WATER ?( O?PHER ' .
??--'
6) ?? • • E3 PLEASE HOLD APPROVID PERMIT FY)R PICK-L?P BY ONE OF ABOVE
PLFASE MAIL APPROVID PERMIT 10 1, 2, 3, 4, ABOVE
(1? n 0 „ I tin (Circle one)
FOR -CITY USE ONLY
PERMIT # ISSC?ED
m? ln %
Pd w/Bldg. Permit FEES:
$ $ 10-5-6 SEWER PERMIT (INCLUDE SURCHARGE)
$ $ /0- ? WATER PERMIT (INCLUDE SORCHARGE)
$ (r.?B O $ WATER METER/COPPERHORN/OUTSIDE
READER
$ $ WATER TAP (INCLLDE CORPORATION STOP)
$ $ SEWER TAP
$ $
??`?(J-?) ACCOUNT DEPOSIT - SEWER
_
$ $ ACCOLNT DEPOSIT - WATER
$ J'?5-D d-U $ WAC
$ 6 ?D • (T G? $ SAC
$ $ TRUNK WATER ASSESSMENT
$ $ TRLNK SEWER ASSESSMENT
$ $ LATERAL BENEFIT/TRUNK SEWER
$ $ LATERAL BENEFIT/TRUNK WATER
$ WATER TREATMENT PLANT SUR
H
R
_ C
A
GE
$ $ OTHER:
$ l 7! ? '" ? $
TOTAL
fef 7?
RECEIPT RECEIPT
DOES UTILITY CONNEC TION REQLIRE EXCAVATION IN POBLIC RIGHT OF WAY?
Q YES 'IF YES, THEN A"PERMIT FOR WORK WITHIN PLBLIC
Q
NO ROADWAY" MUST BE ISSOED BY THE ENGINEERING
DIVISION
LIS
.
T AS A CONDITION.
SUBJECT TO THE FOLL OWING CONDITIONS:
APPROVED BY:
TITLE:
DATE :
CLAIM VOUCHER - REF'[JND REQUEST
CITY OF EAGAN
CLAI?fANT B 6 i, FfRr'TRT!; II?7'.
ADDRESS 13874 ITITCA AVME SIXTIII
SAVME_ 2EI 55378
Location 1361 rr.*nU.erEy*D-RIVE
L 13. B 1, FAIIdJAY FffI.IS II
Receipt No./Date 89556-12/I/88
Reason for Refund pER raRAr-?q rMIE57
Type of Refund Electrical Permit 01-3211 $ 39,0o
Plumbing Permit 01-3212 $
Mechanical Permit 01-3213 $
Surcharge 01-2155 $
Water Connection Permit 20-3713 $
Sewer Connection Permit 20-3743 , $
Account Deposit 20-2252 $
Utility Account Over-Payment 20-2250 $
Other: $
$
TOTAL S 3o_m
I declaze under the penalties of law that this account, claim or demand is just and
that no part of it has been paid.
' F'EBBUARY 21, 1989
Signature Date
?p i 33W/3
`' ? (Q DS I I PLUMBING (RESIDENTIAL)
Permit Application
City Of Eagan ? ?`J • ?
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5674
Please complete for: Single Family Dwellings
Townhomes and Condos when pernvts are required for each unit
Date
,
?
1
U
it #
Sit
Add
J(
I k y/C
ress
_ •
n
e
y
Property Owner ?.l (? Tjjyu Telephone # 66' ) lp W(p - q6-74
Contractor
McGuire & Sons
Address
City
state HOpkllls, MN 55343 Zip Tetepeone #((Q51)
The Applicant is _ Owner X- Contractor _ Other
Septic System New _ Refurbished Submit 2 sets of plans and MPC license $ 100.00
Includes Counry fee. Additional consultant fees may apply.
Alterations To Existing Dwelling Unit, Including $ 50.00
_ Adding fiMures to lower levels or room additions, excluding water softener and water heater
_ Abandonment of septic system
_ Water tumaround (+ 5/8" meter if needed -$121.00)
Other:
_ RPZ _ new installation _ repair _ rebuild $ 30.00
_ Lawn irrigation system
_ Water softener ? Wa[er heater $ 15.00
? replacement
additional
_
np -, j
U?
$ .50
State Surcharge
L'
Total s
I hereby apply for a Residential Plumbing Permit and ac}nowledge that the informarion is complete and accurate; that the work will
be in conformance with the ordinances and codes of the City of Eagan and with the Plumbing Codes; that I understand this is not a
pernut, but only an applicarion for a pernut, and work is not ro start without a pemilt; that the work will be in accordance with the
approved plan in the case of work which requires a review and approval of plans.
U llU 6 Lht f awe?
Applican's Printed N e Applicant's S gnature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA107151
Date Issued:09/27/2012
Permit Category:ePermit
Site Address: 1361 Interlachen Dr
Lot:13 Block: 1 Addition: Fairway Hills 2nd
PID:10-25601-01-130
Use:
Description:
Sub Type:e-Windows/Doors
Work Type:Windows/Doors-New/Replacement
Description:House
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings, call for framing
inspection. Call for final inspection after installation.
Carbon monoxide detectors are required by law in ALL single family homes .
Valuation: 4,000.00
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 -
David G Bergh
1361 Interlachen Dr
Eagan MN 55123
Berghomes LLC
1361 Interlachen Drive
Eagan MN 55123
(612) 968-5127
Applicant/Permitee: Signature Issued By: Signature
Use BLUE or BLACK Ink
�-----------------
� For Office Use �
' j Permit#: l �� I
��6� O� L���11 � P rm' : � I
� e d Fee �
3830 Pilot Knob Road
Eagan MN 55122 j Date Received: j
Phone:(651)675-5675 1 I
Fax:(651)675-5694 1 Staff: I
I 1
a��������'������`�J
2015 RESIDENTIAL BUILDING PERMIT APPLICATION
Dffie: Site Address: Unit#:
, �
�
` Name: �i/� � ���-c�� Phone: CoS l- �\5`1- i�15
r s ���. : � _
� � � " � � AddFess�c�ty i z�p_ l3�1 ��,-1-��IA�h��-► D���v�-e F�.��.� M,� SS1a.3
�� �
� �.
� ` :: Applicant is: �Owner Contractor
r n.
� x �
,� x - k .: . ci .
Description of work: c�tGl.i �n� �.Qp`/,�C�v►�c�` �r rap�r.J �s�p���v�.-�"
�����
ss � � c� �.—
� � , �: Construction Cost: �I�E�� Multi-Family Building:(Yes /No�
{
�
` ` Company: Contact:
t
t ���,,,��,�� � , Address: City:
�
�
� State: Zip: Phone: Emaii:
l� �
�,
; ,
� �_ a , y , License#: Lead Certificffie#:
If the project is exempt from lead certification, please explain why:
� �,. �- — �-b,�-e bL:�� t�, �`�I�c�3
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 ba�d on a master plan?
Yes No If yes,date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer&Water Contractor: Phone:
Fire Suppression Contractor: Pnone:
r ��i.�j;��.�f�������j�����y ������, ,�' ����� ..
��i�1��3`SF�al�`:#��i!'.���y"�:f`���f��J.��� ��L����`��M�� � �r �.�il������"`.� #
'.} . ;t' � ., 4 C v �� Ni,�{� t. �{ $` h r� ,. Y. �
( i£ � }f � �' S � �` h� � -..n }� r
y:5 .�.�� ?i, r 3. »w. ..'1'/.s��
CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0�2 for protedion against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground util�ies. www.qopherstateonecall.ora
I hereby acknowledge that this infortnation is complete and accurate;that the wor4c will be in confoRnance with the ordinances and codes of the City of
Eagan; that 1 understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permlt issued In accordance wlth the Minnesota State Building Code must be completed within 180
days of permit Issuance.
X D�v�d G. t�•e��.��. X . .
Appllcant's Printed Name V Applicant's Si ature
Page 1 of 3
Use BLUE or BLACK Ink
For Office Use
Permit#: /g006 CC..
City of Eapft
/ cN)
jPermit Fee: 6C%).-
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651)675-5675 Date Received:
Fax: (651)675-5694
Staff:
L
2016 MECHANICAL PERMIT APPLICATION
❑ Pleas submit two(2)sets of plans with all commercial applications.
Date: I A.1 1 Site Address: 1 �j `�rJ r t-(Z. LAc-N N Q
Tenant: Suite#:
(012-) elw$�S1 ��
Re
, Name: � � st_ f� Col-� Phone:
,; Address/City/Zip:
c. . License#:
Address: J 11 O '1 'Nil-C/ 5
�flJa 'i N Ci
t
y:
�fl W
ontractOr k
State:I(Y\ N (05 1 Zip: SS �� Phone: 35�—00 O z
rt Contact: C - \1L Email: 5 l J 1 r rrt E c $s \O L ,L.f)
New \ Replacement Additional Alteration Demolition
/pe`of Work` Description of work:
ss
*14:z NOTE R;® 1 me•% ® round mounted avec calx;® „tit Is a t a to be s
Code a lit schsnical Inspecto ® info-1 • on pe ascreening •e
RESIDENTIAL COMMERCIAL
Furnace New Construction Interior Improvement
n • Air Conditioner Install Piping Processed
be
$ Air Exchanger Gas Exterior HVAC Unit
_Heat Pump Under/Above ground Tank ( Install/ Remove)
1,4 Other
RESIDENTIAL FEES
$60.00 Minimum Add or alteration to an existing unit, includes State Surcharge
$100.00 Residential New, includes State Surcharge =$ TOTAL FEE
COMMERCIAL FEES Contract Value$ x.01
$60.00 Permit Fee Minimum
$70.00 Underground tank installation/removal =$ Permit Fee
=$ Surcharge
Surcharge=Contract Value x$0.0005
If the project valuation is over$1 million, please call for Surcharge =$ TOTAL FEE
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.
f7x
Applicant's Printed Name Applicant's Signature
FOR OFFICE US �n a01*
,Required Inspetlons Re 1"
ndergrou . ® Air t Oas ervice Test r;-floor Final . c
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA162562
Date Issued:07/20/2020
Permit Category:ePermit
Site Address: 1361 Interlachen Dr
Lot:13 Block: 1 Addition: Fairway Hills 2nd
PID:10-25601-01-130
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:Does not include skylight(s)
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and leave on site.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Valuation: 5,000.00
Fee Summary:BL - Base Fee $5K $118.00 0801.4085
Surcharge - Based on Valuation $5K $2.50 9001.2195
$120.50 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 -
David G Bergh
1361 Interlachen Dr
Eagan MN 55123
Xlnt Built
8500 Normandale Lake Blvd., Suite 350
Bloomington MN 55437
(612) 562-1487
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA166487
Date Issued:01/13/2021
Permit Category:ePermit
Site Address: 1361 Interlachen Dr
Lot:13 Block: 1 Addition: Fairway Hills 2nd
PID:10-25601-01-130
Use:
Description:
Sub Type:Windows/Doors
Work Type:Overhead Garage Door
Description:
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings, call for framing
inspection. Call for final inspection after installation.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Valuation: 1,500.00
Fee Summary:BL - Base Fee $1500 $62.50 0801.4085
Surcharge - Based on Valuation $1500 $0.75 9001.2195
$63.25 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 -
David G & Stephanie Bergh
1361 Interlachen Dr
Eagan MN 55123
Applicant/Permitee: Signature Issued By: Signature