2050 Kings Rd? , ..- ., .
? • • ?
r
T
W/et.11fica#e nf cccupanc4
" of Cfagatt
mcwxamcat o? smug" 3s"rca.n
This Certificate issued pursuaret to the requinements of the Uniform Buitding Code
cenifying that at the time of issuance this structure was in compliance with the various
ordinances of rhe City negulaiing building eonstruction or use. For 1he following:
Use classifcaum: DUPLEX (1 OF 2 UNITS) B? Pmuit No 20$00
R-3 M-1 R-2 PD V-N Tir ??? DIEDRIC $LDR?S?I?NC? 13337-HU INGT
Owner of Building Addrea
OS KINGS RD L? B, VIENNA WOODS
Suilding Address Locality
`(m ?U .L ? n? AUGUST 2, 1993
sumag owww
4f.
POST IN A CONSPICUOUS PLACE
..
CIl'Y OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
oN RECORn
PERMIT TYPE:
Permit Number: •
Date Issued:
SITE ADDRESS:
`J 1 t 1'JfJlt 1 tijU1?',
PERMIT SUBTYPE:
TYPE OF WORK:
INSPECTION .. . .•
i i I! I., ? 1
v
! : • 11 l11- M
i.LJ L0141'tiAC-IoFf I)AhU'r A I'1 I1FIHIN(i
? J
M` APPLICANT:
i : it,, I . ,i 1,11 + 1
(6 12 ) A-a:' -2 ?"9 :!
-
1 w
PermR No. Permn Holder Date Tilephone M
S/VN
PLUMBING
HVAC
ELECTRIC
ELECTRIC
Inspectian Date Insp. Comments
Footings I S
S-j 4 s}z s oK
Foundation £ ZS,
7 ?1f/?,yO1w / •
Framing +r,v: R'r
r-
Roofing
Rough Plbg.
N
Rough Ftlg.
lsul. -7 l3 - 0- 2
Fi`ep'a'ce
Final Htg.
(?
"C
Orsat Teat d??jlIH47'?S .
Flnal Plbg. Pobg. Inspector - Noti(y Plumber
Const. Meter
Engr./Plan
Bldg. Final ?-2 9 3
Dock F?g. -7 10? ro ?,
Deck Fnel
ir v
Weil
Pr. Disp.
zo •? ?
a
?. -. .?
•.•?
(?? ert??cate of C"anCv
? Of @"as
This Certificate issued pursuant to the requincnuats of the Uniforire Building Casde
certifying that at tlu tinre of issmiuce dus stsiectun was in compliance with the various
ardirrances o, f tlie Ciry irgukuing building canstnrctiae or use. For tite following:
20MM IlI11PiEX 2074q
use c7assiscuion_ Bma. PerrtdINo. -VN
?? ? Type DnsL
?l ffi?fi.S Il? ?? I?JN [
o?.?oer ot auiwins DI-EDlti Addess 13337 r-IR, APPIE VALTEY
y F. s{»? ?
R({
%TA?ding Addess Ioniiy
/ '/
Daim
Etaiwing colone
P06T IN A CONSPICUOUS PLAGE
: INSPECTIUN RECORD
' CI iw.+OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number. •
Eagan, Minnesata 55123 Date Issued:
(612) 681-4675
SITE ADDFiESS:.
V f 1 hlld;t IJUU11' . ?
PERMIT SUBTYPE:
TYPE OF WORK:
INSPECTION .. . ..
y
.?.,. .?, •.,?.t,?. t:i11i') f,rii' 1??f+ t?fjh (i.?'?y, t k IIM?{ 1 M1i?i
? ?.
APPLICANT:
l4-3 ;'.. .1..., .
7
Permit No. Permit Holder Date Telephone #
S/1N
PLUMBING
Hvnc
ELECTRIC
ELECTRIC
InspecHon Date Intp. Comments
Footings I ( Q V' JIIkQ
?y • ` g '1} 3 bs
FourKlatm
Framing
4? r O o?7 - o o/L
Roofing .4-r ? IYS "C . i.c.5 .
Rough Ptbg.
Ftou9h M9• 93
Isul.
7 ?
Fireplace 7? _9 3 ? s -?, 3 3- ?_ S-
Final I-ttg.
!k
Orsat Test
Fnal Plbg.
I F'Ib9. Inspector - Notily Plumber
CiOnSt. M9IBf
Engr./Plan
Bldg. Final ? L o
Deck Ftg.
7 o ?
Dedc Finel ? .
weli
Pr. Disp.
v
CITY OF EAGAN Remarks
Addition VIENNA WOODS Lot 3 Rik 5 Parcel 10 81950 030 05
Owner 5treet2050=52, Kings Road state Eaqan, MN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREETSURF. 84.4 2 4 1
STREET RESTOR.
GRADING ;/,Ji' 5
87•.73
_ 5$
77
.
SAN SEW TRUNK 1973 129.78 8.65 15
* SEWER LATERAL .'•, ? 9
* services 9
WATERMAIN
* WATERLATERAL 1981
* WATER AREA
* STORM SEW TRK 1981 10
• STORMSEW LAT 1981 IO
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN,
13UILDING PER.
SAC
PARK
5 I vN A'J?i
r°ORWARU Tfl
THE CITY
Address 2052 KINGS xn Zip 5512o2_,
LAt, '' 3 Blk 5 $llb VIENNA WOODS
THESE I'TEMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECfION.
Date: AUGUST 2, 1993 Yes No Inspector:
Final grade (6" from siding)
Permanent steps (garage)
Permanent steps (main entry)
Permanentdriveway
Permanent gas
Sod/Seeded grass
Trail/curb damage
Porch
Basement finish
Deck
Please verify with the builder the removal of roof test caps from the plumbing system and the shuboff of water supply to
the outside lawn faucet before freeze potential exists.
Contact engineering division at 681-4645 before working in right-of-way or installing underground sprinkler system.
White - City Copy Yellow • Resident Copy Pink - Contractor Copy 0
Addtess _ 2050 xrwx Rnan Zip 55122
Lot . -.3 Blk 5 Sub VIErIDtA 4xbDs
THESE ITEMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECI'ION.
Date: ? Yes No Inspector:
Final grade (6' from siding)
Permanent steps (gatage) V
Permanent steps (main entry)
Permanent driveway
Permanent gas
Sod/Seeded grass
TraiUcurb damage ?
Porch
Basement finish ?
Deck
Please verify with the builder the reoval of roof test caps from the plumbing system and the shut-off of water supply to
the outside lawn faucet before freeze potential exists.
ConWCt engineering division at 681-4645 before working in righ[of-way or installing underground sprinkler system. ?
White - City Copy Yellow - Resident Copy Pink - Contracror Copy
9 93
J!(o3o( f %?
`?
Re es, ate
? re No. Roug -?n Inspectwn
Feqwr
es C Na
? Reatly Now
JI No?ty
W?e
I icensed contractor ? owner hereby request mspection ot above eleciric#work at?-
r
Joo A/i Ir.,p! pov or Rout N)4 Qry
Sect uo Toy nsmp Name or o Ran9e No.
I Cou
Occ t lefl Pp n N _%,,, ^
%J\
I?..v
Power Su
`
n Atleress ?
EI T al ConVact ? ?Company
Na e7
I I
F Co
aclo li
Ma i tlCre s 1C nt6ior or r Makmg InsialleLOn)
Am nzea Sig aWre;G tremu0wneMakmsC1?yuonl I '
• C 1C._1 ILY?_1 ...__i P n
_?_
• ? -
MINNESOTA STA BOARD OF ELECTRICITV
Grlgga-MlEway BIOq. - Raom S773
1821 Unlversity Ave. SL PeuL MN 55104
Phane(612?66t-p800
THIS INSPECTION REQUEST WIIL NOT
6E ACCEPTED Bv THE STATE BOARD
UNLESS PROPER INSPECTION FEE IS
ENCLOSED
REQUEST FOR ELECTRICAL INSPECTION
? See insuvc4ons IorypmpleUng iNS lorm on oack M yeilow copy
"X" Be/ow Work Covered by This Request
d 33424
ew tl Rep, TypeoBuiltling AppliancesWiretl EquipmenlWiratl
Y Home Range Temporary Service
Duplex Weter Heater Electric Heating
Apt Bmlding Dr r Othar-(Specify)
Comm./Industnal umace
Farm Air Contlinoner
• OtM1er(syealy, Ccntractor's Remerks ? y
Compute Inspechon Fee Below.
# Other Fee # ServiceENranceSize Fee # Girowis/Feeders Pee
Swimming Pool 0 to 200 Amps 0 to 700 Amps
Transformers Above 200 _ Amps Above 100 _ Amps
Sgns lispectorS use only ,= --'? TOT L
Irrigation Booms / p'), f0 ¢3 •
?
Special Inspection [1
rQ 'Y L?' l? " z 4e)
Alarm/Communication THIS INSTALLA 10 MN BE ORDERED ISCONN CTED IF NOT
Other Fee COMPLETED WITHIN 18 NJP%THS. r
I, the Electncal Inspector, hereby
tif
th
h
b Rouqn-in
?
cer
y
at t
e a
ove inspection has
been made. F,,,ai ete
OiFICE IISE ONLY
TM1is request vore 18 montM1S irom
d 3 4 5 9??8/9`? /?Slll ? f y3??.
R est Date Fi No Rough-In InSpectian
q?o
es ? No
,] Ready Now ?..A
ill Novly InspeEtm ?
R ?
I* icensed contractor ? owner hereby request inspection of above elect I wo o'O
Jo tlress (S I x or FoVj
, Qry
Se0o7No 7 wnshi0 Name or No. Fange No Cou
Occ IiPRI T ' P o e - Izi
Pawar Suppli Atltlres
EI 1ri I Comracror ? ompany Nam ? Co acror' Li n N
M i tlr 1 n ctor wner Meking InslallaLO '
Aul n2etl Si naWre ICO r or/Owner Maki 5 li y? f\ 1
V?i
P on be
?
MINNESOTA STA14 BOAHD OF ELECTFICITV THIS MSPECTION REOUEST WILL NOT
Gtlggs-Midway Bltlg - Aoom 5-173 BE ACCEPTEO BV THE $TATE BOARD
1811 Ilnlversity Ava., St PauL MN 55104 l1NLES5 PFOPER INSPECTION FEE IS
Vhane(612)61P-OB00 ENCLOSED
REOUEST FOR ELECTRICAL INSPECTION ee-ooom-ae
/ ? See msirucUOns tor compleung Ihis brm on beck af yellow copy.
33425 - ''X„ Below Work Covered by This Request
F{ep. Typeoiewidmg AppliancesWired EquipmentWirecr-
IV Home Range Temporary Service
Duplez Water Heater Electric Heatmg
Apt Building D yer Othev-(Specify)
Comm /Industrial umace
Farm Air Conditioner
Otnar (sVectly) Comractor's RemaMS'
Compute lnspechon Fee 8elow:
# Other Fee # Serv?ceEntrsn?'eSiie" Fee # Cuwns/Feeders Fee
Swimming Pool 0 to 200 Amps 0 to 100 Amps
TranSfOrmerS Above 200 _ Amps Ahove 100 _ Amps
SIgf15 Inspector5 Usa Only T AL
Irrigationeooms r
G? J^(? /?,? ov ?
Speciallnspection L
T?/f}' ?' ,?' 3?
Alarm/Communicatwn THIS INSTALLATION MAY BE OR R D DISCON ECTED IF NOT
Other Fee COMPLETED WITHIN 16 MONT 4, i
I, the Electrical Inspecior, hereby
th
t
ti
h
6
i Rough"in F? oate
?
ry
cer
a
t
e a
ove
nspection has
beenmade. F?nei ' •,????,? oei
l
OFFICE USE ONLY
Thrs request witl 18 mOnlhs from
04i28/93 13:14 $ 612 423 2255 CHNS NOUGK RRCMT
CPrtkficetc o$ Houso 2.ocakion [Por: Ciedric'h Huilders, Inc. 13337 Huntington bxive Sheet 1 of 2
Apple Velley, HU .55124
- DELMAR H. SCHWANa
UMVIVORtAW. '
, RpWqM11ndw LttiN WMMMMntlMM
. 11760 SOUTH ROBERT TMIL fW OUNT, MINHE80TA 64088 8121473AM
IVp?f
0
?- 'yr \
Ta ?
? a
r.
a
?
lbtal Oescriptlans
?ot 3, elock 5. op
VL?ieU? fPOObS, accordi ?
to tne recorded piet $ _
khereof, Dakota County,? ?
iinneeotn.
?
?
?
r'
o - iron pipe monwoent
p e Set ?tood hu6
*q?0 e SX1gting spot elevatlon
Q a Proposed elevatian
el
N
proposed gerege flonr elev.
?A;?r 739•? _
a?a psoP08ed top of blpck elev.
....q11,?'3
\ Propoaed lonest level eiev.
S
\ ? o
° n
?
?.
Pacael B
?
? •
L??E
ra .o ?" 1
?. ??jJ6{
91so shoving the lacation oE p pcyposai duples thareon.
tsta?a 04-27-93f R?
L!-o?a Vo ??
?EVo E?? t'bN
2MOI-WEERING .
BLS?L?i D?PT
1 flerpby CN(11y 1hAt Ihb lunay, plln. Of ropolt wes
propsrod by ma or under my dhBCl tuparviobn end
1hat I sm p Euy fleqltlered L.snd Buroeyor under
1hs lews ol tfia SiNB of Ml?pta.
w
?
B
N
?B
?Q
`?u
L ?
.?
?
3
?
?j
4VE ?
RED
? 1??-93
h
ou? 04-22-93
04-28-93
?asa K1NCS lzoAv = fARC?c
?O.Sz IC;nGS I?oad - I'AKC_r:? A
R=94%
\ +
?
L?•
r?
,
. ?-'?'°? M ? \
?
1 e?
'o
?
}i ?4?y 1
0
,
•: .?o?t9T.'aaJ
Sceiee 1 inch = 30 feet
?
?pR
,
I^'k'?C?
\
` paroel 11
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N ?
w
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u ?
dl RgI ?
? Delmar H. 9Chwen2
Mlnnecole RaplHrollpn No. 8825 ?
612 423 2255 04-28-93 01:35PM P001 #12
.,i , - .a - p -i_ Y - . -GJD l.n11 IIVVMh NK411I V!
Ceitificate Of Descriptiott For.
.• 171a.?lr'icti IIuilders, Inc. Shent 2 of 7
DELMAFi H. SCH'aVAfdZ
iRHO eunverons. wc
a,plobrM U?du Uw, 01 ma 81r19 ef Mlnnaooq
t4750 90UTH ROBERT TqAIL ROSEMOUNT, MINNE80T11 55D88 812/123-1789
SURVEYOR'S GERTIKICA?E
Ref: Lot 3, B.lock 5, VIFNNn WC)OD5
PropOSed Pivision DOFCrikItIDI15:
Parcel A:
That part pf I.ot 3, Rluck 5, VIENNR WOODS, according to 1-hc recordcd plnt.
thBYeoF, Dakota County, Minnesota lying uouf.bprly TnA wcstet'ly of t1tt'.
following described },ine: Commnnciny aC the soukhwesterly coYn2r of
said bot 3, Block 5; thenre Nortli 35 ticqrees Oc7 minut.es, 00 sccondr East,
assumed bear.ing, alony the northwasterly line of said Lot 3a dist.ancc of.
50.00 Leet to the point of beginnint,i oL the line Y.n be dencribedi th'enco
South 55 deUrees 00 minutes OU secondG East, parallel with thr e,outhWer,terly
line of said T.ok 3 adistance of 266.04 feeC to the southca::torly ]ina of
seid l.ot 3 and said Line there Y.enninating.
Parcel B:
That part of J.ok 3, R.lock 5, V11:NNn WOODS, accordinq Lo the rer.ordrd plat
ther.eaf, ?akota County, Mlrulesota lying northerly and east.orly Uf Chc
fnlloWinq described line: CnmmEncing at the sovthwest.erly coYner of
sald I,ot 3, I31ock 5; thnnce North 35 deg[ees 00 minut.as 00 <•ernnds F:aF[,
assumed bearing, along tHe northwesterly line of said I.oC 3 a clist'.r+nce of
50.00 feet. t.o Y.he point of bc9lnning nf the line to be de,cribed; thAncP
South 55 degrees 00 minuYr.s 00 seconds East, paralle.l with thr± routhwasrcrly
llne of sdid Lot 3 a distance of 266.04 feet tu lhr. soUthP.nstcrly linc of
sd3d Lot 3 and said line there terminatinry.
?
s
I heraby cCrUly Ihet lhls Survay, plen, or repoK Wea
prepAfed by ms o1 under my dlreCllupenlalon tnA
Ihel l Am s duly Replil6rad Lend 3vrvayor under
the Imws 0) the Siefe ol Mlnvel0te
Detad 04-22-93
0etmar H. 9chwenx
Mlnnesote pepislrallon No. 0625
INSPECTION RECORD
CITY OF EAGAN PERMITTYPE: euzLoiNG
3830 Pilot Knob Road Permit Number: 0 2 0 7 9 9
Eagan, Minnesota 55123 Date Issued: 04 / 36 / 9 3
(612) 681-4675
SITEADDRESS: LoT: s BIOCK: 5 APPLICANT:
2050 KINGS RD DIEDRICH BUILDERS INC
VIENNA WOODS (612) 432-2292
PERMIT SUBTYPE:
DUPLEX
TYPE OF WORK:
NEW
INSPECTION
FOOTING .. .
FRAMING DA
INSULATION FINAL
FIREPLACE
REMARKS: S&W CONTRACTOR - DAKOTA PLUMBIM6
PRV
?
' CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
PERMIT PERMIT TYPE:
Permrt Number:
Date Issued:
eui
020799
04/30/93
51TE ADDRESS:
2050 KINGS Rq
LOT: 3 BLOCK: 5
VIENNA WQQqS
DESCRIPTION:
Bui.lding-.PermiY Type DUPLEX
Bailding Wo,r_k Type NEW
UBC pcaupancy R-3 M-1
Construction Tyoe VN
ZonYng R-1 PD
Buil.dYng 4ength ; 69
Building W3dth 48
?•??1 i4?fi7 s• ,?'f? •?J??wn}?'???_{{ ?-v
+_..}i?'...... t?{iry(?_ .. . \u?.-i .?.?b?ir iJ
REMARKS:
5&W CONTRACTOR - DAKOTA PLUMBING
FEE SUMMARY:
VALUA7IpN
Base Fee
Plen Review
Surcharge
SAC
5AG $
SAC Units
Lic. 3earch Fee
Subtotal
$549.50
$357.19
$40.00
$750.90
1@@
1
$5.00
$1,701.68
PRV
$80,000
MI3C FEES 1 744.50
7ota1 Fee $3,446.18
CONTRACTOR: - Applicant - 5T. I.IC. OWNER:
pIEpRICH BUII.pER5 ZNC 14322292 0002946 DIEDRICH BUILOERS INC
13337 HUMTINGTON CIR 13337 HUNTINGTON CIR
APPLE VALLEY MN 55124 APPLE VALLEY MN 55124
(612) 432-2292 (612)432-2292
I hereby acknowledge that T heve read this appliaation and state that tha
informatian is correct and agree ta camply with all appliaabls Stete af Mn.
Statutes and C3ty nf Eagan Ordinances.
L ?
APPLICANUPERMITEE SIGNATURE -ISSUED B: SI NATUfi?E n
RLMbIlINIC ?
PERMI7_* .
uuu.,\4:0 L5pv r. ai vi¦ vr cn%ar+1?
APR 2 2 1993 993 BUILDING PERMIT
____ 681-4675
APPLICATION
$?3?q L. /?
SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy
calcs.
COMMERCIAL 2 sets of awchitectural & structural plans, 1 set of
specifications, 1 copy of energy calcs.
Penalty applies: 1) when permit is typed, but not picked up by last working day of month-
in which request is made, 2) address is changed or 3) lot change is requested once permit
is issued.
Date fvQic- /a 2- Yaluation of work
Site Address:
STREET SUITE /
Tenant Name: (commercial only)
IAT 2 BIACK S SUBD.
NA P.I.D. k
c+?ooUr
1/iC N
Descri tion of work: ( 2
The applicant is: 0 Owner Contractor ? Other (Describe)
Name Phone
property ??ST FIRST
Owner
Address
STREET - - STE X
City State ZiP
Company r /FJeYC17-1_,T?i?ci7?f ???c- Phone g0-'7> -
A
Contractor Address 13??3Z r/.?ccc- License # 0-)yr Exp 3&/
-5
City ltve-ecz?-- State Zip -s`s i2,Y
Company Phone
Architect/
Engineer Name Registration N
Address
City State Zip
Sewer 8 water licensed plumber Processing time for
sewer & water permits is two days once area has been approved.
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.
Signature of Applicant:
OFFICE USE ONLY
BUILDING PERMIT TYPE
O OI Foundation
13 02 SF Dwg.
? 03 SF Addition
? 04 SF Porch
? 05 SF Misc.
WORK TYPE
)K31 New
O 32 Addition
'gOb Duplex
? 07 4-Plex
? 08 8-Plex
? 09 12-Plex
? 10 Multi. Add'1.
? 33 Alterations
? 34 Repair
GENERAL INFORMATION
? 11 Apt./Lodging
O 12 Multi. Misc.
O 13 Garage/Accessory
? 14 Fireplace
? 15 Deck
? 35 Tenant Finish
? 36 Move
. <
? 16 Basement Finish
0 17 Swim Pool
? 18 Comn./Ind.
O 19 Comm./Ind. Misc.
? 20 Public Facility
O 21 Miscellaneous
O 37 Demolish
Const. (Actual) \&N Basement sq. ft. MWCC System ??S
(Allawable) V. N lst F1. sq. ft. City Water
UBC Occupancy R; 3Y-1 2nd F1. sq. ft. PRV Required ?
Zoning PD R-2 Sq. Ft. total Booster Pump
y of Stories Footprint Sq. ft. Fire Sprinkler
Length ? On-site well Census Code /!S 2
Depth On-site sewage SAC Code 02
Ca,titSv,a 54
.?
APPROVALS
e,r,?,,.? ,?,K;,;c ?
Planning Building Assessments
Engineering Variance
REQUiRED INSPECTIONS
? Site
? Wallboard
? Footing
? Final
? Framing
O Draintile
? Insulation
O Fireplace
Permit Fee
Surcharge
Plan Review
License
MWCC SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total:
8%, o '.0
79. J-0
.S49.90
G 6l
J SDU, ?o
a00, pp
13 Ro,oo
alo.oo
6o,oa
a.o u u o
.So
614S , vO
n80?00
saC %
SAC Units i
G// 29a
?5??
l?C 2
15?? gvJ
V.tuat;o,: s "?? SS''b, b?"t)
z 4>9 Z I?- 53a. Y? r? _ as-6 0
?35mT' 23'?? x23s ?y0
•---^..,'""'
?G?3???% clefoe
Tr 49a? .r ,
G ax- : s?
LCT /QAPIY CnCzLifT !OR
?
?
D 8' D
0? D 0
D' D 0
• Reqisterea Iaaa suiveyor aiqaature and eompany
• suildinq parmit Applicant
• Lgal Qeseripsion '
• llddrasa
• tterth arrov u,d Das soal•
• House type (samblas, vaikovt,, Split w/o, split
Iookout, iste.)
• Directional drainaqe arrovs ritA alopO/qradisnt 0.
• Psoposed/existinq sewes aad wLes sosvioss ootc-
• Stre:t nsme
• Drivavay
sntry,
ss.avaTioxe
? tYistina
D G • Sewez strvic•
H? D 0
? • Lot eoznert
? • Top of ourb at the drivevey o•IG.
D D • Elevations of ar,y txisLinq aajacent bomes
?SODO!!E
• Gazage 11oor
D' 0
? D • Fizst iioor
?L
' 0 • Lovest expose0 alevation (valkout/viaeow)
fl
D
?D D
D • Pzoperty oornezs
• Front and rsaz ot homa at the toundation
POKDING ARiaB [ii ?flaSieaDl?]
Easemant line _
X1+'L
ICS+L
L1' D'l-p • Pond f aesiqnation
D II 0 • Lmerqency Ovartlov Ilevation
DS}!fN6IONS '
?D D • Lot lin?a
0 • Riqht-oi-vay aad strott vidtA (to baek et Curb)
0 0 • Proposed Aom* dimensions inciudiaq any proposea doelu,
overAnnqs prsater tAan 20, pozches, etc. (i.e. ail
structures requisinq permanent tootinqs)
?D D D . Shcw ail •asemeats ot reeozd and any City ytilities vithin
those ensements
D 0 D • betbacks oi pzopossd strueture and setbaek et adjaosnt
/ •xioting bomes -
D ty a ? Rstaininq vall sequistments, if any
• Revieved:
.
nste er suv.ys y/??/ 9__
INSPEC CORD
CITY OF EAGAN PERMITTYPE: 8uxLozNG
3830 Pilot Knob Road Permit Number: 020800
Eagan, Minnesota 55123 Date Issued: 04 J30 /93
(612) 681-4675
SITE ADDRESS: APPLICANT:
LOT: 3 BLOCK: 5
2052 KINGS Rp DIEDRICH BUILDERS INC
VIENNA W0005 (612) 432-2292
PERMIT SUBTYPE:
DUPLEX
TYPE OF WORK:
NEW
INSPECTION
FOOTING .. .
FRAMING DA
INSULATIQN FINAL
FIREPLACE
REMARKS: S&W CONTRACTOR - DAKOTA PLUMBING
?
PRV
?
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
PERMIT TYPE:
Permit Number:
Date Issued:
i?t?r? 5 ??y
BUZLDING
020800
04J30/93
SITE ADDRESS:
PERMIT
2052 KINGS RD
IOT: 3 BLOCK: 5
VIENNA WOODS
DESCRIPTION:
B"uilding.Permit Type
8uilding Wo.rk Type
UBC Occupancy'
Construction Type
Zoning
Building Length ,
Building W3dth
,
DUPLEX
NEW
R-3 M-1
VN
R-2 PD
59
48
REMARKS:
S&W CONTRACTOR - DAKOTA PLUMBING
PRV
FEE SUMMARY:
VALUATION
Base Fee
Plan Review
5urcharge
SAC
SAC %
SAC Units
Subtotal
$549.50
$357.18
$40.00
$750.00
100
$1,696.68
$80,000
MISC FEES $1,744.50
Total Fee $3,441.18
CONTRACTOR: - Applicant - sT. Lzc. OWNER:
DIEDRICH BUILDERS INC 14322292 0002996 DIEDRICH BUILDERS INC
13337 HUNTINGTON CIR 13337 HUNTINGTON CIR
APPLE VALLEY MN 55124 APPLE VALLEY MN 55124
(612) 432-2292 (612)432-2292
I I
I hereby acknowledge that I have read th3s applicatian and state that the
3nformation is correct and agree to comply with all applicable State of Mn.
Statutes and City of Eagan Qrdinances.
J4,
APPLICANTIPERMITEE SIGNATUFE
? nufl
i s o e. Nnru e i
R-LAtTIVATE i
PEkMIT '#
1 0 o 0OU
CITY OF EAGAN
1993 BUILDING PERMIT APPLICATION
681-4675 0
Y?4?' /t
SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy
calcs.
COMMERCIAL 2 sets of architectural & structural plans, 1 set of
specifications, 1 copy of energy calcs.
Penalty applies: 1) when permit is typed, but not picked up by last working day of month
in which request is made, 2) address is changed or 3) lot change is requested once permit
is issued.
Date / Z z Valuatio of work
Site Address:
STREET SUITE Y
Tenant Name: (commercial only)
IAT ? BIACK 5 SIISD. P.I.D. iP
Descri tion af work: i Z
The applicant is: EZ Owner KContractor ? Other (Deseribe)
Name Phone
Property LAST FIRST
Owner
Address
STREET STE M
City State ZiP
Company ???dn ?? Phone ?3o1
Contractor Address / 33 3 7 LLw..??^-i 4-r'l P--?_j Li cense # -29. Exp 3l 31 5?
City V ^ State -11"? Zip
Company Phone
Architect/
Engineer Name Registration #
Address
City State Zip
Sewer & water licensed plumber . Processing time for
sewer & water permits is two days once area has been approved.
I hereby acknowledge that I have read this application and state that the information is
correct and agree to comply with all applica6le State of Minnesota Statutes and City of
Eagan Ordinances.
ignature of Applicant:
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Duplex ? 11 Apt./Lodging 0 16 Basement Finish
13 02 SF Dwg. ? 01 4-Plex ? 12 Multi. Misc. ? 17 Swim Pool
? 03 SF Addition ? OS 8-Plex ? 13 Garage/Accessory ? 18 Comm./Ind.
? 04 SF Porch ? 09 12-Plex ? 14 Fireplace O 19 Comm./Ind. Misc.
? 05 SF Misc. ? 10 Multi. Add'1. ? 15 Deck ? 20 Public Facility
? 21 Miscellaneous
WORK TYPE
? 31 New ? 33 Alterations ? 35 Tenant Finish ? 31 Demolish
? 32 Addition ? 34 Repair O 36 Move
GENERAL INFORMATION
Const. (Actual) Basement sq. ft. MWCC 5ystem
(Allowable) lst F1. sq. ft. City Water -
UBC Occupancy 2nd F1. sq. ft. PRV Required -
-
Zoning Sq. Ft. total Booster Pump
# of Stories Footprint 3q. ft. Fire Sprinkler -
-
Length On-site well Census Code
Depth On-site sewage SAC Code =
APPROVALS
Planning Building Assessments
Engineering Variance
REGIUIRED INSP ECTIONS
13 5ite ? Footing ? Framing ? Insulation
? Wallboard ? Fi nal ? Draintile ? Fireplace
Permit Fee
Surcharge
Plan Review
LicenSe
MWCC SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total:
wluac;m: S ?'S U f lYl7-L
SAC % lw
SAC Units /
?
?
n??i o
D
?D 0
o?
'w 0
Pn
Lor aaAPLY C'UCZLIfT !OA niZDznIu
• Rsqistssed iana surveyor siqrsature anQ oaapany
• suildinq Permit 11,pplieant
• L qnl Qesesiption '
• 11ddresc
• North azrov ared bar saal• •
• Sousa type (zamblaz, valkout, spiit tr/o, split antry,
lookouL, otc.) '
• Diz*etiorsal drsinaqe asravs ritA alopo/qradisnt •.
• proposed/axistinq s*vaz and wies sarviees oK.
• street nam•
• Dzivsvay
sirvxxtoxs
? tYistiaa •
a n • a.aer .ervsce
D D •
? Lot eozners
? 8 • Top of eurb at !he drivevay c•«.
D D • Elevations oi any sxistinq adjaeent homas
f:eeosee
?? D • 6araqe iloor
LY 0 0 • Fizst lloor
8???D 0 • Lovaat txpesed alevatien (»alkout/vindov)
D' 0
E?D ? •
D Pzoperty eorne rs
• Fzont and rear
POr'DIZC ARLAB ei Aoms at g?se toundation
(if anp3ieaD2a)
L? D
? 0 • iasement
D
0
dD 0
n • V; L ,
• KWL
D' D?p • For,d 1 Qesiqattion
D C( 0 • tnerqency Overtlov =lovation
? ?ia2x6ioxs '
D D • Lot lir+es
D • Riqht-oi-vay and streat vidth (to baek ei eurb)
D 0 • Pzoposed noms dimensions ineluQinq any psopeseG Aoeks,
overhanqs Qzsatez than Z', porehes, ete. (i.*. ail
` struciures zequisinq permanent tooiinqs)
'D D D • Shov all •asements oi sooord and any City ntilities rithin
? those •assaents
II D D • ieLDaeks of proposad sLrueture and setbaek ef adjsesnt
axisting homes
n D • Retainir+q vall zsquiraments, if any
- Rev ieved: _
_s
3mto e:.u".T, g=
, rY_f VS[ U346
J2 u.
„ 14750 Galaxie Ave. Sude 104
, Apple Valley, Mjr.nesola 55124
(612) 4324044
nX'I'ERTOR ENVE;,')Pg qVr-"?r A('rr "T1" COME'U`CATION
/ y
PI.a?i
Deterniine vror;dna souare `ootage of e2ch
1. Total exposed wall area,,.,,, Z1 3a sq.ft.
' X .11 _?
1
-1
2'. Total roof/ceiling are2...... 1129 sq.ft.
X
.026 ?
?
?
?
; Total er.posed wal] ama above floor
a. Total wa11 window a.rea .................. 13_
b. Tota'! door area ........................ 3cr
c, Total. slid.l.rg glass docr ar.-ea,.. .. . . . . . ._
d. Total *_'ireolace wwll areu ...............
e. Total wall :rarnirL; a:,ea (ave: ar:e 103) ,,, 1 ,
f, ?'otal net wall area aUove `ioar.........T-ILLIL
g. Total rim ,joist a-rea .................... .LP17, ?
Total expcsed fcmdaticr, Fsea = (oS
h. Total founclatSon wirutow cirea.. . . . . . . . , . . ---
i. Total net !'cundation area above grade,,. L, 15-
Deter.nir.e "U" vaiue oT each orall segrent
a. ?r X "L,lt .52
b. g ?,Uvl .139
c. X liUl;
.52
,
d. g ilJir
.68
=
e. 4 2 X itL.t, ,096 = in,2
? f, ? y riUii _ .Ok?
B, X n[J" .041
h. X flUn .52 =
f• Y "' .082 = ---?
L--
3. :rnai . . . . . . . . . . . . . ,
,
If iten #3 is the s ar.;e as, cr less than you have
rr,et the intent cf SEC 6006 (c) 2.
Y01
-1-
I'3\ 432 D:lllli POY
, ? . .
Total exposed ;roof/ceilirg area = 1( o q
Total gross rocf/ce11izrv, a:ea = i e 6 g
J. Tota1 sYylight area ..................
k, Total *vo£/ceiling framirg area....... III
1, Total net insulated roof/ceili:r a: ea.
i
Deter^ine "U" va.lut fcr each rroof/ceiltng segnent
i , x TrUll _
Y,. J?\i ,Y, nUii _.024
X"U" .022 4. `ib'PAL .............................
..? f
If total of #4 is the s2me as, or less than N2, you have
met the inten? of Sc'3C C006 (c) 1..
?'o utilize the total envelope systm method, the.values
estzblished by the siun nf 1.terr•s #3 and N4 shall YIOt bP
greater than the s?.?n of ltems #l anc' #2.
1. k 2. _
3. + 4. _
T•laterials T:^.er-al resistance "R"
Exterior air
Siding m2.terial......
Sheathirg,...........
Insulation.........,.
Sheetrvck............
Interio: a.ir.........
Studs ...............
Rlm .................
Concrete blocks......
-2-
PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. AISO, FOR TOWNHOMES AND
CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNTT.
T?O, FIXTURES
SHOWER
WATER CLASET
BATH TUB
LAVATORY
? KITCHEN SINK
I LAUNDRY TRAY
_ HOT TUB/SPA
WATER HEA'I'ER
? FLOOR DRAIN
GAS PIPING OUTLET • minimum -
ROUGH OPENINGS
WATER SOFTENER
PRIVATE DISP. • neI.cn-. iic.
U.G. SPRINKLER • bome under mnct.
ALTERATIONS • to eusting
WATER TURN AROUND
STATE SURCHARGE
TOTAL:
EACH TOTA
3.00 6
3.00 c1 ?
3.00 ,3=
3.00 ?
3.00
3.00 3
3.00
3.00 3
3.00 3
3.00 ?)
1.50
5.00
15.00
3.00
15.00
15.00
y .s
11
STTE ADDRESS: 2O ,?d ;1/) ?v 6?c;? 2 17 -
OWNER NAME: r? .%) Z
WSTALLER: L) A ?D -i?c O?i, L
ADDRESS: 3 6 S?U Yll????? G
CTTY: STATE: ZIP CODE:
PNONE #: ( ) lySLI- (c/' ti, S'
SIGNA F PERMITTEE
1993 PLUMBING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PII.OT KNOB RD
EAGAN MN 55122
(612) 651-4675
PLEASE COMPLETE FOR ALL COMMgRCIAL/INDUSTRIAL BUILDINGS. ALSO FOR MULTI-
FAMILY BUI:.DINGS WHEN SEPARATE PERMTI'S ARE NOT REQUIRED FOR EACH
DWELLING UN:T.
_ NER' CONS7'RUCTION
ADD ON
REPAIR
WORK DESCRIPTION:
CONTRACT PRICE:
FEE: 1°k OF CONTRACT FEE.
STATE SURCHARGE: $.50 FOR FACH $1,000 OF p??' FEE.
MIIVIhfUM FEE: $ 25.00 ":. . ?._?°"
CONTRAGT PRICE X 1% $
STATE SURCHARGE $
TOTAL S
SI1'E ADDRE3S:
TENANT NAAiE: s ?11_ #
OWNER NAME:
W STALLER:
ADDRESS:
CITY:
PHONE #:
STATE: ZIP CODE:
FOR:
CITY OF EAGAN APPLICANT
1993 PLUMBING PIItMIT (COMMERG7AL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN AIIH 55122
(612) 681j1675
PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. AISO, FOR TOWNHOMES AIZD
CONDOS WHEN PERMTTS ARE REQUIRED FOR EACH UNTf.
NO. FIXTURES EACH
o1 SHOWER 3•? -?--
? WATER CIASET 3.00 a
_T_ BATH TUB 3.00
?
LAVATORY 3
.00 9
HITCHEN SINK 3•00 ?
LAUNDRY TRAY 3.00
HOT TUB/SPA 3•00
? WATER HEATER 3.00 ?
L FLOOR DRAIN 3•00 ?
__
I
I GAS PIPING OUTLET • minimum • t 3.00 ?
r ROUGH OPENINGS 1.50
WATER 50FTENER 5•00
PRIVATE DISP. • nercty. iic. 15.00
U.G. SPRINKI..ER • home ?aer wmt. 3•00
ALTERATIONS • to aosiing 15.00
WATER TURN AROUND 15.00
STATE SURCHARGE
TOTAL:
.50
Z591_?
SITE ADDRESS: c? d?a V, I ?12 UA 1-7
OWNER NAME: C i7 U'L-.
INSTALLER: DA V U
ADDRFSS: 3 b 5 Lm? ie7r?
CITY: 155Fl [y Pc-aJ STATE: ZIP CODE:
PHONE #: ( ) LI'? y- & Lo 11 `?-
i
SIGNATU E F PERMITTEE
1993 PLUMBING PERMIT (RESIDEN'I7AL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN MN 55122
(612) 6814675
PLEASE COMPLETE FOR ALL CONAERCL4L/INDUSTRIAL BUILDINGS. ALSO FOR MULTI-
FAMILY BUPLDINGS WI-IEN SEPARATE PERMTTS ARE NOT REQUIItED FOR EACH
DWELLING U'::T.
_ NEW CONSTRUCfION
ADD ON
_ REPAIR
WORK DESCRIPIYON:
CONTRACI' pRICE:
FEE: 1% OF CONTRACT FEE.
STATE SURCHARCE $.50 FOR FACH $1,000 OF ?!?11;?' FEE.
MINIMUM FEE $ 25.00 '"" "'"'
CONTRACI' PRICE X 1%
STATESURCHARGE
TOTAL
STfE ADDRESS:
S
a
$
TENAIVT NA111E: S3'E. #
OWIr'ER NAME:
WSTALLER:
ADDRESS:
CITY:
PHONE #:
STATE:
ZIP CODE:
FOR:
CITY OF EAGAN APPLICANT
1993 PLUMBING PERMIT (CONA4ERCIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN MN 55122
(612) 681-4675
1993 MECHANICAL PERNIIT (RESIDEIVTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN NIN 55122
(612) 6814675
PLEASE COMPLETE FOR SINGLE FAMII.Y DWELLINGS. AISO, FOR TOWNHOIvfES AND
CONDOS WHEN PERMITS ARE REQUIIZED FOR EACH UNTT.
X NEW CONSTRUCTION
? ADD-0N A/C
ADD-ON FURNACE
DATE
Qj&LL
HVAC: 0-100 M BTU
ADDITIONAL 50 M BTU
GAS OUTLETS (MINIMUM 1 @ $3.00 EACH)
ADD-ON/REMODEL (ExISTTNG CoNST[tucnoN)
STATE SURCHARGE
TOTAL
SITE
OWNER
INST.
(41 C? (
a
FEES
$ 24.00
6.00
3 ? 0 t?
$ 15.00
.50
' TELEPNONE #: `7
?
CITYI?/?d U(.?-?? V STATE: ? ZIP CODE: ??
TELEPHONE #: sqr2_ 00/0
c-, Q
SIGNATURE O PE ITTEE
1993 MECHANICAL PERMIT (COMIVVIERCIAL)
C1TY OF EAGAN
3830 PII,OT KNOB RD
EAGAN MN 55122
(612) 6814675
PLEASE COMPLETE FOR ALL COMMERCUAI,/INDUSTRIAL BUII.DIIVGS. AISO COMPLETE
FOR APARTMENT BUILDINGS OR OTFIER MULTT-FAMII,Y BUILDINGS WHEN SEPARATE
PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT.
DATE:
NEW BUILDING
INTERIOR IMPROVEMENT
WORK DESCRIPTION:
I?o *?
1% OF Cq?NT'.'?" FEE $_
PROCESSED PIPING: $25.00
MINIMUM FEE: $25.00
CONTRACT PRICE:
STATE SURCHARGE $.50 FOR EACH $1,000 OF MItMg FEE.
TOTAL $
SITE ADDRESS:
OWNER NAME: TELEPHONE #:
TENANT NAME: (IMPROVEMENT'S ONLY)
INSTALLER:
ADDRESS:
CITY: STA
TELEPHONE #:
ZIP CODE: .
SIGNATURE OF PERMITTEE CITY INSPECTOR
1993 MECHANICAL PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN MN 55122
(612) 681-4675
PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMES AND
CONDOS WHEN PERMITS ARE REQUIl2ED FOR EACH UNTT.
w NEW CONSTRUCTION
? ADD-ON A/C
ADD-ON FURNACE
DATE 4IA2"oZy
% 3
FEES
HVAC: 0-100 M BTU $ 24.00
ADDITIONAL 50 M BTU 6.00
GA5 OUTLETS (MINIMUM 1 @ $3.00 EACH) 0-b
ADD-ON/REMODEL (ExrsTING CortsTRUGTION) $ 15.00
STATE SURCHARGE .50
TOTAL -Z" ` ST)
,
-4?>
SIT'E ADDRESS: (-7J (.6`c'S /L" Lr r L(/ eA-W
OWNER NAME: LVOWC./? &dd&t"J-- TELEPHONE #:
INSTALLER: co *Uk4 _Oln Iq C ADDRESS: I`T I F- ' '
CTTY:6ki-mv w L STATE: ZIP CODE: °55_y,?;7
TELEPHONE #: O 9q- 031t)
STGNA'Y[JRE OF PERMITTEE
1993 MECHANICAI, pERMIT (COMMERCIAL)
CITY OF EAGAN
3830 PIIAT KNOB RD
EAGAN MN 55122
(612) 6814675
PLEASE COMPLETE FOR ALL COMMERCIAI.JINDUSTRIAL BUILDINGS. AISO COMPLETE
FOR APARTMENT BUILDINGS OR OTHER MULTT-FAMII.Y BUILDINGS Wf-EN SEPARATE
PERMTI'S ARE NOT REQUIRED FOR EACH DWELLING UNTT.
DATE:
NEW BUILDING
INTERIOR IMPROVEMENT
WORK DESCRIPTION:
CONTRACT PRICE: $
FEES
1% OF f?QN'TTL,'AG."T FEE $`
PROCESSED PIPING: $25.00
MINIMUM FEE: $25.00
STATE SURCHARGE $.50 FOR EACH $1,000 OF f.VYM1'I; FEE.
TOTAL $
STTE ADDRESS:
OWNER NAME: TELEPHONE #:
TENANT NAME: (IMPROVEMENTS ONL7)
INST.
ADDRESS:
CITY
ST.
ZIP CODE:
TELEPHONE #:
SIGNATURE OF PERMITTEE CTTY INSPECTOR
CITY OF EAGAN Page 1 of 5
PERMIT
TO WORK WZTHIN CITY PROPERTY/RIGHT-OF-WAY/EASEMENTS
!
?1
1. LocationJ?(? ?J?oL. ?MA92
2. Nature of Work ?.QA,,}e.v '(- (cJ'A't.
3. Indicate below items to be affected and include a sketch or plan of work to be done.
Curb & Gutter ? Street Surface
Trail/Sidewalk Trees:
Pond/Wetlands Public
Traffic Control Devices/Signs Private
Drainage Utilities
Structures/Buildings Other
626q /
4. Method of Installation or Construction •- /?4. ???i`-'i?-nYi.,... .
5. Work to start on or after:2-15'?- and shall be completed by: 7-.Z?n unless an
extension granted to: _ by:_
DATE STAFF/DATE
6. Will detouring of traffic be necessary? /Ntr- . If necessary to detour traffic,
describe suggested route:
DETOURS: The Director of Puhlic Works shall be notified in writing at least 72
hours in advance of any detour being established, changed or discontinued.
NAME OF APPLICANT j9-.p? PHONE ??7 _7?5??
ADDRESS
STREET
STATE
NAME OF PARTY OF
CONTACT PERSON:
)
ADDRESS/0 /f{ 5 3 9L"_.O DAY PHONE 5?6Y"'?2 S'O
STREET p CITY TATE ZIP
The undersigned herPwith accepts the terms and conditions of this permit by the City of Eagan
as herein contained and agree to fully comply therewith to the satisfaction of the City of
Eagan.
Signed:?-- __ Title ?_ --- DATE:??f ? 21
FOR CITY USE ONLY AUTHORIZATION OF PERMIT
FINANCIAL SECURITT: AMOUNT:
Fee: $S--O_ -a? Receipt No
TYPE:
(Cash,bond,IAC,etc.)
Permit No.
In consideration of agreement to comply in all respects with the regulations of the City of
Eagan covering such operations, and pursuant to authorization duly given by said City of
Eagan; permission is hereby granted for the work to be done as described in the above
application, said work to be done in accordance with special provisions as hereby stated: .
Z 0C70 ?? cO^xp
APPROVED BY: DEPT. OF PUBLIC WORKS
BY:
/DATE
ALL LEGAL REQUIREMENTS SHOWN ON REVERSE SIDE AND ON ALL "SPECIAL PROVISIONS" TO BE COMPLIED
WI ! THE DATE WHEN WORK IS COMPLETED MOST BE REPORTED TO T EAGAN CITY ENGINEER.
7? ??? •????%?? i ? ??i
i
?
Permit No. Page 2 of 5
PERTINENT REGUTATIONS
Safety
1. Traffic shall be allowed to pass and to be protected at all times. If it is not
possible to allow traffic to pass, a suitable detour must be provided and plans
submitted to the Director of Public Works 72 hours in advance.
2. Barricades shall be erected in a manner which will provide suitable visibility in all
directions. All barricades shall be in good condition, and all signs shall be of such
size and legibility to provide adequate warning to oncoming traffic. At least two 7"
flashing amber lights shall be mounted on each end barricade with one on an advance
warning sign.
3. Excavations must be shored or sheeted when necessary to prevent under-mining of
roadway, trailways, utilities, or for safety reasons.
4. Guys or staye shall not bc actache:i to t:ees on right-of-way or pLivate property
without written permission.
5. Flagmen shall be furnished by the party or organization performing the work whenever
the work being done creates a hazard either to the traffic using said road or the
personnel engaged in the construction, or when dixected to do so by the City.
OPERATIONS
1. Permit on 1ob--Permits or copies shall be kept on the site of the work while it is in
progress in the custody of the individual in charge, and shall be exhibited upon
xequest made by any City official.
2. Provisions and Specifications--These general provisions, specifications and Std. Plate
P-1 shall be considered as forming an integral part of each and every permit issued for
operations within Eagan. The work authorized by this permit shall be done at such time
and in such manner as shall be consistent with the safety of the public and shall
conform to all requirements and standards of the City. If at any time it shall be
found by the City that the work is not being or has not been properly performed, the
permittee, upon being notified by the City, shall immediately take the necessary steps,
at his own expense, to place the work 3n condition to conform to said requirements or
standards.
3. Execution--The permittee shall use diligence in the execution of the work authorized
under this permit in order not to endanger or unnecessarily obstruct travel along any
road or trailway. Operations shall be so conducted at all times as to permit safe and
reasonable free travel over the roads and trailways within the limits of the work
herein prescribed. All safety measures for the free movement of traffic shall be
provided by the permittee at his own cost.
4. Conformity to I.aws--The installation shall be made in conformity with all applicable
laws, regulations and codes covering said installations. All installations shall be
made in conformity with regulations of governmental agencies for the protection of the
public.
a. The applicant shall furnish a bond or financial guarantee in the amount to be
determined by the City which is required to ensure adequate 6 timely completion
of repair. This bond or financial guarantee shall remain in effect for 2 years
subsequent to completion of street repair to protect the City from defects in
material, worlmanship or non-compliance with City Standards or specifications.
Permit No. Page 3 of 5
b. The applicant shall furnish evidence of public liability insurance of not less
than $100,000/300,000 and property damage of not less than $25,000 issued by an
insurance company authorized to do business in the State of Minnesota on which
the City is named as an additional insured party.
c. Except for the negligent acts of the City, its agents and its employees, the
permittee shall assume all liability for, and save the City, its agents and its
employees, harmless and defend same at its sole cost and expense from any and all
claims for damages, actions or causes of action arising out of the work to be
done herein and the continuing uses by the permittee, including but not limited
to the placing, constructing, and reconstructing, maintaining, protecting and use
of said facility under this application and permit for construction.
5. Existing Facilities--The utility facility and installations shall not interfere with
any existing utility facility on the City's right-of-way or easements. It is the
responsibility of the applicant to call for necessary locations of existing utilities.
(Gopher One 454-0002)
6. Private Property--The work permit or permit for construction as issued does not in any
way imply 'an easement on private property.
7. Quality of Work--Finished surface, base and sub-base of road or trailway upon
completion of work shall be at least equal to or better than specifications of
originally provided road or trailway in accordance with City Standard Specifications.
Surface shall be finished within 48 hours unon comnletion of backfill
8. Cutting Trees--The permission herein granted does not confer upon the permittee the
right to cut, remove or destroy trees or shrubbery within the legal limits of the
right-of-way, easements that are not specifically identified on the plan attached to
this permit or relieve permittee from obtaining any consent otherwise required from the
owner of the property ad,jacent thereto.
9. Drainage--All waterways and lines of drainage shall remain operative.
10. Pole Anchors--Pole anchors, anchors, braces or other construction will be permitted
within right-of-way or easements and will be approved on a case by case basis.
11. Driving Limitations.
a. Driving or parking on City trails or sidewalks shall only be permitted for thosel
op..ratione rsguiring dirECt access to ths boulsvard area.
b. Vehicles operating or parked within the right-of-way area shall utilize their
warning flashers at all times.
c. Vehicles driving on trails or sidewalks shall not operate in excess of 5 miles
per hour. Vehicles shall operate at slower speeds when weather conditions, trail
conditions, poor visibility, obstructed sightlines or other conditions raquire
special precautions to ensure the safety of trail users and the general public.
d. Driving shall not be permitted within those boulevard areas where damage to turf
trailways or other infrastructure may occur.
e. Vehicles shall not be parked on trails or sidewalks in such a manner as to
unnecessazily impede the safe and efficient use of trailways by the general
public.
Permit No. Page 4 of 5
12. Vehicles or equipment traversing roads or trailway surfaces shall not utilize studded
or chained tires, caterpillar traction, or any other form of traction which will result
in damage to the surface.
13. Clean-Up--Street, trailways and affected right-of-way shall be scraped clean at the end
of each work day and swept clean after construction is completed and left in a neat and
presentable condition.
14. Trees and Vegetation-Burning or disking operations and/or the use of chemicals to
control or destroy trees, brush and other vegetation is prohibited without prior
approval from the City.
15. Replacement of Sod--Wherever top-soil and sod are disturbed, they shall he replaced and
maintained satisfactorily until the turf is estahlished.
The undersigned herehy declares he/she has read and will comply with all the PERTINENT
REGULATIONS as stated above and relevant City Ordinances.
DATE: SIGNED:
Revised 5/93
LTS#l-PERMIT.FM
PAGE 5 OF 5
PROPERTY LINE
I
?
?
SAME AS REMOVED
(3" M1NIMU/A)
SAN1E AS FiE1AOVED
(6" MINIMWA)
TRAILWAY
1. Curb and Gutter shall be removed only after saw cutting at joints and replaced
according to specifications or Standard Plate.
2. Bituminous pavement area removed shall be saw cut prior to patching.
3. Boulevard sod removed shall be replaced with minimum 4" of topsoil and cultured sod.
4. 2341 bituminous wear course shall be paved between May lst "and November 15th for
permanent patch. Temporary cold mix patch should be used November 16th to April 20th
(or as permitted by weather).
5. Class 5, 100% crushed aggregate base.
6. Roadway closures in accordance with Appendix B- Traffic Control for street or highway
work zones - MnDOT/MUTCD.
7. Bituminous trailway closure rzG,:irements same as roadway in #6 above
8. Backfill shall be thoroughly compacted by the "Specified Density Method" of compaction.
All suitable backfill material placed below a depth of five (5) feet below the final
pavement surface shali be placed in maximum lifts of twelve (12) to eighteen (18)
inches and compacted to a minimum ninety-five (95L) percent of ASTM Specification D698-
64T (Standard Proctor Density), method "A". All suitable backfill material placed
within five (5) feet below the final pavement surface shall be placed in lifts not to
exceed twelve (12) inches and compacted to a minimum of one-hundred (100%) percent of
the above ASTM Specification.
c ity of eagan STREET AND BITUMINOUS TRP.I! WAY approved :PSjate #?
P U B L I C EXCAVATION/PATCH DETAIL
WORKS 5/93 P-1
?
DE PARTMEN TRAFFIC CANTROL REQUIREMENTS
L?ase C?i-? ?"- '
? ? ?
??/ ?-?6 ? a? ? ,
?F =
?
LICENSE BOND No.
FEDERATED MUTUAL INSURANCE COMPANY
Home Ofiice: 121 East Park 5quare, Owatonna, MN 55060
KNOW ALL MEN BY THESE PRESENTS:
THAT WE, STAR PLUMBING 6 EXGAVATING INC
9207759
of 1018 MOUND SPRINGS TERRACE BLOOMINGTON MN 55420 asPrincipal,
(City) (State)
and FEDERATED MUTUAL INSURANCE COMPANY with principal offices at OWATONNA, MINNESOTA and authorized
to do a Surety business in the State of MINNESOTA
as Surety, are held and firmly bound unto C I TY OF EAGAN
(Obligee)
3830 PILOT KNOB RD EAGAN MN 55122
in the sum of TWO THOUSAND AND NO/ 100----- ---- Dollars ($? 000. 00 ) for the
payment of which sum, weli and truly to be made, we bind ourselves, our heirs, executors, administrators, successois and
assigns, jointly and severally, firmly by these presents.
The condition of this obligation is such that WHEREAS the above named Principal is desirous of obtaining a license from-
CITY OF EAGAN
to engage in the business of STREET EXCAVATION AT: 2052 KINGS RD EA6AN MN
NOW, THEREFORE, in consideration of the issuance of such license, if said Principal shall well and truly comply with such
Ordinances, Rules and Regulations and any Amendments thereof, as require the execution of this bond, then this obligation
shall be void, otherwise to be and remain in full force and effect.
This obligation shall become effective on the 19TH day of JULY , 1993 , and shall remain in
force for a one year period thereafter.
If the Surety herein shall so elect, this bond may be cancelled at any time by the Surety hetein by gving the Principal and to
the Obligee TEN ( 10) day's written notice of such cancellation
IN WITNFSS WHEREOF, the said Principal and the said Surety, have hereunto affixed their hands and seals tMs
19TH day of JUL.Y lg 93
STAR PLUMBING 6 EXCAVATING INC
(Seal) pri„ci
By
0
(Seal)
Countersjgped:
BF-2 Ed.B-92 Agent
FEDERATED MUTUAL INSURANCE COMPANY, SURETY
Attomey-in-£ac
?
?OWER OF ATTORNEY
riNOW RLL MEN BY THcSE PRESEilTS:
That FEDERATED MUTUAL INSURANCE COMPANY, a Corporation duly organized and
existing under the laws of the State of Minnesota, and having its principal office
in the City of Owatonna, State of Minnesota, does hereby constitute and appoint:
MARION 70HNSDN of the Clty of OWATONNA SCdte
of *tzrtNESOTn its true and lawful attorney for the following
purposes:
To sign its name as surety to, and to execute, affix the seal, acknowledge and
deliver any and all surety 6onds and penalties not exceeding:
TWENTY FIVE THOUSAND DOLLARS ($25,000) EACH
The execution of such bonds or undertakings in pursuance of these presents
shall be binding upon the Company as if they had been executed and acknowledged by
the regularly elected officers of the Company.
This Power of Attorney granted by Federated Mutual Insurance Company shall
terminate when the designee ceases to be:
1) Employed by Federated Mutual Insurance Company or
2) Empioyed by Federated Mutual Insurance Company in a job for which
such Power of Attorney is required.
IN WITNESS WHEREOF, the said FEDERATED MUIUAL INSURANCE COMPANY has caused this
instrument to be signed and its corporate seal to be affixed by its Senior Uice
President and Assistant Secretary this the 5TH day of NoVe*mtR 19 92.
FEDERATED MUTUAL INSURANCE COMPANY
8Y - 4?
(SEAL) Senio Vice es ent
and BY (?
Assist t Secretary
STATE OF MINNESOTA
COUNTY OF STEELE
On this 5'rH day of Nove?taER 19 92 personally appeared 6efore me, the
undersigned notary public, DONALD RAY HUFF and LLQYD C. NELSON to me personally
known, who, each being duly sworn by me, did say that they are respectively tfie
Senior Vice President and Assistant Secretary of the FEDERATED MUTUAL INSURANCE
COMPANY and that the seal affixed to this instrument is the corporate seal of said
Corporation end that this instrument was signed and sealed on behalf of said
Corporation by authority of its Board of Directors and said DONALD RAY HUFF and
LLOYC C. PJELSON acknowledge said instrument to be the free act and deed of said
Corporation.
CO&INRE IIYEHG00D
(SEAL) ? NOTARY PI13tiC-911103TA
strnE counTr
h1y Commission Expires April 23, 1995
?
?
.
COPY OF RESOLUTION
"8E IT RESOLVED that the President or any Vice President in conjunction with
the Secretary is hereby authorized and empowered under the corporate seal of the
Company, to appoint any person or persons as attarney or attorneys-in-fact, or agent
or agents of the Company, in its name and as its act to execute and deliver,
anywhere in the United States or Canada, any and all honds and undertakings of
suretyship and other documents that the ordinary course of surety business may
require."
"BE IT FURTHER RESOLVED that the Power af Attorney or other document appointing
such person or persans as attorney or attorneys-in-fact or agent or aqents of the
Company may either 6e personally signed by the President, any Uice President, the
Secretary or may be executed by said afficers by means af facsimile signatures. The
said personal signatures or facsimile signatures shall not require the Company seal
or any ather seal and shall be valid and binding on the company if executed either
by personal signature or facsimile signature and with or without the Company seal
being affixed thereto."
I, the undersigned, herehy certify that I am a Senior Vice President of the
FEDERATED MUTUAL INSURANCE COMPANY, a Corporation duly organized and existing under
the laws of the State of Minnesota and that the foregoing is a true and complete
copy of the original Power of Attorney given 6y said Company to:
*1ARION JOHNSON
OWATONNA, MINNESOTA
authorizing and empawering such person to sign bands as therein set forth, which
Power of Attorney has never 6een revoked and is still in full force and effect.
I further certify that said Power of Attorney was given in pursuance of a
resolution adopted at a regular meeting of the Baard of Directors af said Company
duly called and held at the office of the Company in the City of Owatonna, Minnesota
on the 20th day of April , 19 82 at which meeting a quorum was present and that
the foregoing is a true and correct copy of said resolution, and the whole thereof
as recorded in the minutes of the said meeting.
PURSUANT to the By-Laws of Federated Mutual Insurance Company, Article 8,
Section 1; in the absence or inability of the Secretary to act, his duties shall be
performed by the Assistant Secretaries in the order af their rank.
IN TESTIMONY WHEREOF, I have hereunto set m hand and affixed the al of the
FE?ERATED MUTUAL INSURANCE COMPANY this the day of,- - /l9•
FEDERATED MUTUAL INSURANCE COMPANY
(SEAL)
Senior Vice Pre!flder.t
PERMIT
City of Eagan Permit Type: Building
Eagan. Permit Number: EA095174
Date Issued: 07/30/2010
OR Permit Category: ePermit
41 it~ of E3
E
Site Address: 2050 Kings Rd
Lot: 031 Block: 05 Addition: Vienna Woods
PID:10-81950-031-05
Use:
Description:
Sub Type: e-Siding Construction Type:
Work Type: Sidin,
Description: House
Census Code: 434- Occupancy :
Zonin,:
Square Feet: 0
Comments: When installing ventilated soffit material. remove existing material (i.e. debris that could block vents) and take steps to
ensure maximum ventilation to attic. Call for final inspection after installation.
Carbon monoxide detectors are required bn law in ALL single family homes.
Fee Summary: BL - Base Fee S3K $88.50 0801.4085
Valuation: 3.000.00 Surcharge - Based on Valuation S3K $1.50 9001.2195
Total: $90.00
Contractor: - Applicant - Owner:
Homesure Inc Benito Cruz Jr
2924 Anthony Lane, Suite 115 200 Kings Rd
St. Anthony NIN 55418 Eagan NIN 55122
(612) 33-781
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 Cite of Eagan Ordinances.
ApplicantiPermitee: Signature Issued Bv: Signature
PERMIT
City of Eagan Permit Type: Plumbing
Eagan. Permit Number: EA102931
Date Issued: 02/06/2012
OR Permit Category: ePermit
41~ it~ of E3
E
Site Address: 2050 Kings Rd
Lot: 031 Block: 05 Addition: Vienna Woods
PID: 10-81950-05-031
Use:
Description:
Sub Type: e - Water Heater
Work Type: New
Description: Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments: dean Kamrath
13791 jonquil In n
davton, mn 55327
612-205-6060
Fee Summary: PL - Permit Fee (WS &or WH) $55.00 0801.4087
Surcharge-Fixed $5.00 9001.2195
Total: $60.00
Contractor: - Applicant - Owner:
Adam's On Time Plumbing & Water Heaters LLC Benito Cruz Jr
13791 Jonquil Lurie N 200 Kings Rd
Dalton MN 55327 Eagan MN 55122
(612) 20-6060
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 Cite of Eagan Ordinances.
ApplicantiPermitee: Signature Issued Bv: Signature
Use BLUE or BLACK Ink
r
For Office Use 1
Permit City of Ea I D 1
1 Permit Fee: 1
3830 Pilot Knob Road I I
~ u
t...+ Date Received: Z'
Eagan MN 55122 RECEIVED j
Phone: (651) 675-5675 I A6,
Fax: (651) 675-5694 MAY 18 2012 1 Staff:
2012 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit
Name: S t J~- Phone0_57/A 0J'RESIDENT /
OWNER Address / City / Zip:
Applicant is: Owner Contractor
TYPE OF WORK Description of work: K
Construction Cost. / Multi-Family Building: (Yes / No )
F_ If
Company: G,~ C~~rsfrUl'cn C Contact: r%(~rz
540 City: P1404-
CONTRACTOR ~ Address:
State:/ ►''.,,4,' Zip: 5.5107 Phone: ~'01 ++C °'169
License //-?c 6o ? Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
p NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that they are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
xd x
Applicant's Printed Name Applicant's Signature
Page 1 of 3
A
DO NOT WRITE BELOW THIS LINE f U5 S-7
SUB TYPES
- Foundation _ Fireplace _ Porch (3-Season) - Storm Damage
Single Family _ Garage _ Porch (4-Season) J Exterior Alteration (Single Family)
Multi _ Deck _ Porch (Screen/Gazebo/Pergola) _ Exterior Alteration (Multi)
01 ovl-~lex _ Lower Level _ Pool Miscellaneous
Accessory Building
WORK TYPES
New _ Interior Improvement _ Siding _ Demolish Building*
Addition _ Move Building _ Reroof _ Demolish Interior
Alteration Fire Repair Windows Demolish Foundation
Replace _ Repair _ Egress Window _ Water Damage
Retaining Wall *Demolition of entire building - give PCA handout to applicant
DESCRIPTION
Valuation Occupancy MCES System
Plan Review Code Edition iAAfy )n2 SAC Units
(25%_ 100% ) Zoning ID City Water
Census Code Stories Booster Pump
# of Units Square Feet PRV
# of Buildings Length Fire Sprinklers
Type of Construction- Width
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
Footings (Deck) Final / C.O. Required
Footings (Addition) Final / No C.O. Required
Foundation HVAC _ Gas Service Test Gas Line Air Test
Drain Tile Other:
Roof: -Ice & Water -Final Pool: -Footings -Air/Gas Tests -Final
Framing Siding: -Stucco Lath -Stone Lath -Brick
Fireplace: -Rough In -Air Test -Final Windows
Insulation Retaining Wall: _ Footings Backfill Final
Sheathing Radon Control
Sheetrock Erosion Control
Reviewed By: ~ Building Inspector
RESIDENTIAL FEES
Base Fee
SurchargeV " h
Plan Review
MCES SAC e~
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant l~ 0/ 9
Copies / r
TOTAL
Page 2 of 3
04/28/93 13:15 $ 612 423 2255 CHAS HOUAK RRCHT 01
CP_rti:fi.cate o$ House Location Far: !1~°1 • • t// vJ
Diedrich Guilders, inc.
13337 Huntington Drive Sheet 1 of 2
Apple Valley, MN .55124
D
- DEl.MAR H. SCHINANZ
uNb eupv6vop o.
Rp41gW 1=11 tlW or 11 of MMnaaia
14750 SOUTH ROBERT TRAIL. RO OUNT. MINNESOTA 55000 11121423-1769 ~
vE'YOR'S CERTIFICATE FOP 9- . A-- 17
p r'
is ,vaw 111eg6
ttp
t~~~ q~~sU'~4 ,rkr r~I4 Scale: 1 inch - 30 feet
F
X 11fly a cr' . ~+b O - Iron pipe monument
C4 0 0 7 L
,y4• - Set wood hub
f ~e oa volt s I W - Existing spot elevation
Ar- 4`°~ , 41P.1 Proposed elevation
Proposed garage floor elev.
tD.
G Proposed top of block elev.
q4t, AA
` Proposed lowest level, elev.
'L>. A~y~ 1 is rf:
0~
Parcel A !a Parcel $
Lai'
rota, Description:
Lot 3, Block 5,
VIENNA WOMB, accordineL t .t t„
to the recorded plat !!/f
thereof, Dakota County,
9innesota.
k1so showing the location of g 4ti
a proposed duplex thereon. +
(Staked 04-27-93)
PAN.
= 4 REV.EWED
s
Is B
E I E W E V 41
v \ ® lE Lx y q 3
Date _AJO-k
ill, SIRINDEPT
1 hereby certify that this Survey. plan, or report was ~,r }r
prepared by me or under my direct Supervision and
that 1 am a duly Registered Land Surveyor under
the laws of the Stale of Minnesota.
04-22-93 DaIntar H. BChwan2
Dated Mlnnovota Registration Na S625
04-28-93
0 S-6 K 1 )4( ,.5 0A 17 j'Ax e- r t, f;3
X0,52 )Z-;,465 c?`t_ A
R=94% 612 423 2255 04-28-93 01:35PM P001 #12
Use BLUE or BLACK Ink
r - - - - - - - - - - - - - - - - -
I For Office Use
I (O v(
I Permit
n0fl
City of EaEd
I Permit Fee:
3830 Pilot Knob Road I P I
Eagan MN 55122 i Date Received: o a,U~ 2-
Phone: (651) 675-5675 j staff:
Fax: (651) 675-5694 L -----------------I
2012 MECHANICAL PERMIT APPLICATION
Date: Site Address: r~ /C.
Tenant: Suite
RESIDENT / OWNER Name: Phone:
Address / City / Zip:
Name: 7- a en 6 License C/ 4P l~
CONTRACTOR Address:
State/0, Zip: Phone: ~ l•~
Contact: 41 Email:
New Replacement Additional Alteration Demolition
TYPE OF WORK Description of work: ' i~ /y A N ~ L i\ ogLl 9! rf$ h
NOTE: Roof mounted and ground mounted mechanical equipment is required to be screened by City
Code. Please contact the Mechanical Inspector for information on permitted screening methods.
RESIDENTIAL COMMERCIAL
Furnace New Construction Interior Improvement
PERMIT TYPE -Air Conditioner Install Piping Processed
Air Exchanger Gas Exterior HVAC Unit
Heat Pump Under / Above ground Tank Install Remove)
Other
RESIDENTIAL FEES:
$60.00 Minimum Add-on or alteration to an existing unit (includes $5.00 State Surcharge)
$100.00 Fire repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge) _ $ TOTAL FEE
COMMERCIAL FEES:
$75.00 Underground tank installation/removal (includes $5.00 State Surcharge) OR Contract Value $ x1%
$60.00 Minimum (includes State Surcharge) Permit Fee
- If the Permit Fee is less than $10,010, surcharge is $ 5.00
- If the Permit Fee is > $10,010, surcharge increases by $.50 for each $1,000 Permit Fee - Surcharge
(i.e. a $10,010411,010 Permit Fee requires a$ 5.50 surcharge) TOTAL FEE
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before
you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is ut 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 p
x P? le -C C
Applicant's Printed Name Applicant's Signature
FOR OFFICE USE
Required Inspections: Reviewed By: Date:
Underground Rough In Air Test Gas Service Test In-floor Heat Final HVAC Screening