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1419 Kingswood Ponds Rd
.'.: OwnerofBuilding M WJOHNSM CCWr Addmuus 17645 MUM PAM! m BuildingAddscss 14 l9 R.R'GSWOOD PCHWTD Lqm?ityL3. B?? ???M PCWS ISt Date: " BuildiogOfficiat , . 1 POST IN A CONSPICUOUS PLACE ITY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: Eagan, Minnesota 55122-1897 Date Issued: "' '?`? ?`'? (612) 681-4675 SITE ADDRESS: .. .A .. ` PERMIT SUBTYPE: TYPE OF WORK: INSPECTION .. . D• 1? {. :1 'M ( y, , . , 'I; i f,f rl tJ itFVEI•JPl1.fiY MiKF BAitr:k . 4J Fl ItMNFI:: 41FN :'F 1. ME r'11AN lt' q! ? ? ???{??•k : , APPLICANT: /.1rZ f 41e /%/9 ir Al-73 a96 -7 Permit Holder Date Telephone # PLUMBING ?J p?4 9V -15o?as HVAC 477 Inapection Date Inap. Comments FOOTINGS FOUND ( FFAMING ROOFING ROUGH PLUMBING ? ? CJ PLBG AIR TEST O ROUGH HEATING / ti( ? l nf ? G G S Q?J7 c GAS SVC TEST A? r ?C p t ?? INSUL GYPBOARD FIREPLACE FIREPLACE AIR TEST FINALPLBG FINAL HTG It ORSAT TEST BLDG FINAL DOMESTIC METER IRRIGATION METER FLUSH MAINS CONDUCTIVITV TEST HVDROSTATIC TEST BSMT R.I. BSMT FINAL DECKFTG DECK FINAL 7p., I i _ J Address 1419 KINGWOOD PONDS RD Zip 5512 2 LAt 3 Blk I $ubKINGSW00D PONDS THESE ITEMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL WSPECTION. Date: Yes No Inspector: Final grade (6" from siding) t/ Permanent steps (garage) Permanent steps (main entry) Permanent driveway ? Permanent gas Sod/Seeded grass ? TraiUcurb damage Porch V Basement finish ? Deck ? Please verify with the builder the removal of roof test caps from the plumbing system and the shutoff 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 rnXWSXn::4 fX=>:«=?;;': Y,c?r,:ca.a.c GITY Oi cAGAN G4SHZER: S TERifZR.4'N Si!Oe 7$2 I1ATEa 06/22/98 TIMEe 13a49e23 IL? e im;"fEa M W JQHNSIIN C014STRUCTIQN £NC 2255 S+JOi 1439 h'idCS WU FN 47675.21 22?% 9041 1424 E-:NGS h;D !PN 4 y fr?2. i f Tatal f;eceipf. Ano+zrsfi e 9yc37e°2 CRQ`?3i 3i iLq;-c:-R 3L!e NANGY ?o;cY?;:?:Y,sX+z:c$a;cY,tz;YdrnY?;[x,Y,nY.,cs:c;n:??a?;:?;tXc?:{Y,cX?Y,n;: ;;Y,cfUY?kY,c I?- CITY OF EAGAN 3830 pilot Knob Road tagan, Minnesota 55122-1897 (612) 681-4675 PERMIT ' PERMIT TYPE: Permit Number: Date Issued: BUII.DTNG 932258 06/19/38 SITE ADDRESS: P.I.N.: 10-42050-030-01 DESCRIPTION: 1419 KTNGS WOpQ PQNDS RD LOT: 3 BLOCKc 1 KINGS WOpD PONDS FIR5T SF DWG NEW R-3, U-1 VN R-1 54 41 2 1,889 101 1 - FAM. DE7ACH ? ;? s F? ;??? r?. V REMARKS: PLAN REVEWED BY MIKE BARCK S& W PLUMBER: WENZEL MECHANICAL FEE SUMMARY: VALUA7ZON Base Fee Plan Fieview Surcharge SAC SAC ? SAC Units Subtotal $1,212.25 $787.96 $82.50 $1,000.09 100 1 $3,9$2.71 $165>060 MISC FEES $1,592.50 Tatal Fee $4,675.21 ?rV1V 11'iHV IVR: - nppltcqn u - 5 i. L 1L VYVIVCI'f: ?QHNSON CONST, M W 18926200 0002207 MW JOHNSqN CONSTRUCTIqN 17645 JUNIPER PATH 17645 JUNTPER F'ATN LAKEVILLE MN 55044 LAKEVILLE MN 55044 4612) 892-5209 (612)892-5200 ; .0) Jg&98 BUILDING PERMIT APPLICATION (RESIDENTIAL) 4q oG- zlZO, . ? New Construdion Reauirements registered site surveys ??i? /2 copies of pians (include beam S window s¢es; poured fnd. design; etc.) W 1 energy celculations ? 3 copies of tree prebervation p1en H lot platted after 7l1/93 required: Yes i,, No? DATE: CITY OF EAGAN 3830 PII.OT KHOB RD - 55122 681-4675 RemodeVReoair Reauirements ? T" pies oi pian - ? , - ? ;Re surveys (extenor add?' ons 8 decks : ) ??t,energy lations for heatea addnw ' ne(? CONSTRUCTION COST; DESCRIPTION OF WORK: _ N6W ?ON?lt21a?:? nnl -? N c??l: ??FAM1Ly '?jVeLL-i NC-7 STREET ADDRESS: ,I- 1: ? BLOCK: SUBD./P.I.D. #: Name: t1i AmIU NfflVlUIY Phone#: A?? PROPERTY I.esc First OWNER / -f StreetAddress:_11(?? U???pa:?. ?ga City LAOGvtu1? State: Zip: Company: MAI VrJ C(!U AV &/KI-29U9bl Phone #: ffl'i '521cr) CONTRACTOR 1? Street Address: I7(,P?J (JU1 J1I/)DE-p , 41-,} License #/ 2-M City L&E//u-e State: /fw Zip: IDW4+ ARCHITECT/ ??" /!,, / ENGINEER Company: ????? .?t71?/lP5 ??1[g?/V Phone #: ? "/? ' ?lo ?2 ? Name:(j?l ??/ ??IILG?? J Registration #: Street Address: ?za-46 Vu ? ?peg ?PmK City L,4Ki?ILL.,r, .;?? 3tate: Zip: Sewer & water ticensed plumber (new conshuction onty): Penalty applies when address chang and lot change is requested once permit is issued. I hereby acknowledge that I have read this application and state that the State of Minnesota Statutes and City of Eagan Ordinances. OFFICE Certificates of Survey Received Tree Preservation Plan Received Yes No Signature of Applicant: U7,Yes LY _ No OFFICE USE ONLY BUILDING PERMIT TYPE ? 01 Foundation ? 06 Duplex 11 02 SF Dwelling ? 07 4-plex ? 03 SF Addition ? 08 8-plex ? 04 SF Porch ? 09 12-plex ? 05 SF Misc. ? 10 = plex WORK TYPE U 31 New ? 33 Alterations ? 32 Addition O 34 Repair GENERAL INFORMATION ? 11 Apt./Lodging ? ? 12 Mutti Repair/Rem. ? ? 13 Garage/Accessory ? ? 14 Fireplace ? 13 15 Deck ? 36 Move 11 37 Demolition M ? ? . 16 Basement Finish 17 Swim Pool 20 Public Faciliry 21 Miscellaneous Const. (Actual) v?] Basement sq. ft. i 2 3 3, S MC/WS System (Allowable) Jn! Main level sq. ft. tz Z(q.s City Water UBC Occupancy 12 "3•U _i zN° sq. ft. rz 33•s Fire Sprinklered Zoning R-1 sq.ft. G150'i PRV # of Stories 2 sq. ft. Booster Pump Length ' sq. ft. Census Code. Depth Footprint sq. ft. rg? SAC Code o? Census Bldg / Census Unit ? APPROVALS Planning Building _ Mg Engineering Variance Permit Fee ?aluation: $ I ?S, oav, r Surcharge ???M r--- Plan Review 417 'e `' License 3.q, s s MCNVS SAC ?Z. `C, -sg - City SAC iZ'?3- s???? _ ?8, s-ox. s Water Conn. r2?3. s Water Meter ZX Z Acct. Deposit zN_ ?zvq . s -b ? sy = ?-7 S/V1! Permit S/W Surcharge ?aq - Treatment PI. . Park Ded. Trails Ded. 2O ,? ?o ?oo Other z u ra . ? ?;Copies , A'- -2 l: Tota J % SAC SAC Grvits ? 'L. tomi tor use with Micuiesota Kules part /67U.U4'J5, Subp. 2 , ?1 & '4mily ResidenHal "Cookbook" N aod I S jD]D!:E4SS BUILDER Minimum Criteria: Rim Joist: 12-19 insulation Foundatan Windows: Insulated glass, 1!2" air spacc, wood or vinyl frame Enay doors: 13/i inch sotid wood with storm or better STEP 1 Window & Door Area Tota] Window & Door Area in Sq. Feet WINDOWS (including foundation windows): Dimensions Qnty. Area Z X -)C) x 20 X ?.LP ? T X ? .- i' x x 2 ? x x x x DOORS- X ? "` I 40 ! r(? x X Total Area of wiadow & Doors Total Wall Atea in Sc}. Ft Wall 7'otal Pcrimeter Heieht Arca I ?4- ? Total Area of wall STEP2 Calculate area as a perceut of wall Box A(window & door atza) divided by Box B(total wall area) times 100 equals the window and door area as a percent of wall area (Box C). BoxA 15 12-, . -1 -7 Is BoxB ?U? z 100= STEP3 Design Features ASSEMBLY OE'TIOlN FRAME WALL: 5TAt3DARD FRAMNG ADVANCED FRAMIIdG CAVITY INSULA'i'ION R- Z L SHEATHIlVG: L.ESS THAN R-5 R-5 OR MORE WINDOWS (ezcept foundation windows): U-FACfpR From the table, determine the maximum percent window & door azra for the duign options selected and entcr the value in box D below: , , Box C must be less than or equa] to Box D f . ' , CERTIFICATE QF SURifEY for M. W. JOHNSON ? ?• ? F?- Cf) < O a Q- -Tj 0 3 ? I Vl 7U 0 Q Q IZ.S,? I ii I ? II p II -P o ? (A ?N 1'y oQor.? ? 00 I? r 1\ ? i0 } . U)? , Q ? , 6 0 y m ?l ff U? 10 I? cn ? I 588'47' 00" W 137.02 __--- !?78. S6' 1 r--? !.? 1 ---, / • I ,'g,? o m ?2 ? ?" ° . m -i A . 0 ??? v ?° 76.87 ?-- 4!J tn N \14 o , I o3. ,,.oo , .,- o 3A c'' (D 0 J ° j o p ?(D ?--Ct ---- g?/, .ss ?. '00e %q./ U) LO O 0 (0? ao ? ? m 7D. ?/) J27-98-98 ? ? N --- i 10 ? ? I 0 .? ?' ? I ? N I (D? ? I ? ? ?- --- i io r v`? 30.00 ati.W t 879. zV) I ?- - , 37. N89'050'00"E `v O I ? ? ? ,.? t; ?. ll uL ? U;, - ?- !z ~?8 ?I N ? I 1"tsP 'c crIav"El"r. A..l t'v ie?f? Scale: 1" = 30' 1419 Kingswood Ponds Road DESCRIP710N I hereby certify that this sur°vey, plnn, or i_ct 3, E31ock 1, report was prepared by me or under my dil-ect supervision and that I am a duly Registered KINGSWOOD PONDS FIRST AUDITION Land Surveyor under the Laws of the State aakota County, Minnesota of Minnesota. Plat bearings shown o Denotes iron monument ...? ^? Date }1l ?11N )q9u Reg. No. 8140 ? Existing j Proposed ._ ._ - BRA1VD°T EIVGINEERING & SURVEYING 1600 West 143rd Street, Suite 206 Burnsville, MfU 55306 (612) 435-1966 LJ, 7 ? ,. ? ? ?d C7' O [?/?? P1 0 [7' ? C? O ?o 3Y' ? [3" O 0--? ? 5 ? ? ? ? ? ? ? ? ? ? O ? ? PROPERTY LEGAL: . . s . • . Q?' ? ? o ca?' ? ? • ?- ?' ? • Q?? ? • a-' ? ? • ? ? ? s ?O ? • ? ? ? • F,r' ? ? • 0 Ef' ? • ? CJ' ? • ? C]' D • ? p"' ? s ? G+''- ? • CT' ? ? • )a ° 0 • p' ? p • Q ? ? • ?? . ? ? • LOT SURVEY CHECKLIST FOR RESIDENTIAL BUILDING PERMIT APPLIC/ATION DATE OF SURVEY: iATEST REVISION: 6' / / ' / 617 /!?? DOCUMENT STANDARDS Registered Land Surveyor signature and company Building PermitApplicant Legaidescription Address North arrow and scale House type (rambler, waikout, split w/o, split entry, lookout, etc.) Directional drainage arrows with slope/gradient % Proposed/ebsting sewer and water services & invert elevation Street name Driveway ELEVATIONS Existin9 Sewer service (or Proposed) Property corners Top of curb at the driveway Elevations of any existing adjacent homes Proposed Garage floor First floor , 4 Lowest exposed etevation (walkouUwindow) Property corners Front and rear of home at the foundation PONDING AREA fif annlicable) Easement line NWL HwL Pond # designation Emergency Overflow Elevation DIMENSIONS Lot Iines/Bearings 8 dimensions Right-of-way and street width (to back of curb) Proposed home dimensions including any proposed decks, overhangs greater than 2', porches, etc. (i.e. ail structures requiring permanent footings) Show all easements of record and any City utilities within those easements Setbacks of proposed structure and sideyard setback of adjacent ebsting structures Retaining wall requirementq, if any Reviewed: 4 I January 1996 CRA101 BBBlBLDGPFiMT.FM / ?. ? CITY USE ONLY L BL RECEIPT #: 7 fY ? 1 SUBD. RECEIPT DATE: / ?g/ ? 1998 PLUMING PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOS RD EAGAN, NAi 55122 (612) 681-4675 Piease compiete for: 9 single family dwellings ? townhomes and candos when permits are required for each unit ? backflow preventer for underground sprinkler system - - - - - - - --------- - ------------- - - - - - - - -- FIXTURES ------ EACH # TOTAL Shower 3.00 x _L = , 00 Water Closet 3.00 x = 9'1 00 Bath Tub 3.00 x "65 x = .lJO Kitchen Sink 3.00 x = 3 4 60 Laundry Tray 3.00 x 5,06 Hot TublSpa 3.00 x = Water Heater 3.00 x ? = 3.00 Floor Drain 3.00 x Gas Piping Outlet " minimum -1 3.00 x s- OD Rough Openings 1.50 x 3 Water Softener ' for dwellings under construction 5.00 x = Water 5oftener * for existing dwelling 20.00 x = U.G. Sprinkler * for dwelling under const. 3.00 = U.G. Sprinkler ' for existing dwelling 20.00 = Alterations ' to existing residence . 20.00 = Water Turn Around 20.00 = Private Disposal System ` MPC iic. 75.00 = (new and refurbished systems) Private Disposal Systems * Abandonment 20.00 STATE SURCHARGE .50 TOTAL ? ----------------------------------------------•----------•-------- -------------------------------------------------- I hereby adcnowiedge that I h-ave read this application, - state - that the - information is correet, end agree to comply with all applicable City of Eagan ordinances. It is the applicanYs responsibility to notify the property owner that the City of Eagan assumes no liability for any damages caused by the City during its nortnal operational and maintenance activities to the facilities constructed under this pertnit within City propertylright-of-way/easemeM. ' ` - • SITE ADDRESS: OV1lNER NAME: INSTALLER NAME: TELEPHONE #: STREET ADDRESS: I ?S ? ??1 ?Qi?t'?'?? CITY: L? L?'CLdl1'1 STATE: tn /V ZIP: aa- NATURE OF PERMITTEE JS/FORMS BLDG/PLBG PERMIT (RESIDENTIAL) 1998 / CITY USE ONLY ' LOT ? BL RECEIPT #: SUBD. Ic????u?D( RECEIPT DATE: 199$ bi£Ci{A1VICAL P£RMIT (RESIDENTIAL) CITY OF EAfiRN 3$80 PILOT KNUB RD EkfiAN MN 551 EE Date: (618) 6$1-4675 `-? Complete this section onlv if you are installing HVAC in single family, townhomes or condos under construction and not owner /occupied ' • HVAC: 0-100 M B T L' $ 24•00 ADDITIONAL 50 M BTU 6.00 • Gas outlets (minimum of one required @$3.00 ea.) `°00 • State 5urcharge: .50 • TOTAL: a1 `??o Complete this section onlv if you aze remodeling, adding to, or repairing existing singie family dwellings, townhomes, or condos. Note: Mechanical permit is not required for alteration/add-on to ductwork in existing residential units; but is required for the following: Install furnace Install air conditioning Install air exchanger, i.e. Vanee system, etc. Other Minimum fee applies to all remodel or add-ons of existing residences ? 20.00 State Surcharge .50 Total: $ 20.50 SITE ADDRESS: OWNERNAME: Qzy-\-S?-_PHONE#: C3 ?-SdvV INSTALLER NAME: PHONE #: (o STREET ADDRESS: C) VIL?.,? CITY: \ C1A, `(Y\ ? `!\ ON?L-Y? `l 0 1 ? STATE: ZIP: JS/FORMS BLD/MECH PERMIT (RES) - 1998 SI ATURE OF PERMI7TEE L BL SUBD. APPROVED BY: CITY USE ONLY RECEIPT #: RECEIPT DATE: 199$ MECHAP1CAL PERM1T (COMMERCIAL) CITY OF EfFfiA1V 3$30 PILOT KNO$ RD EAsAv, M1v 551E2 (612) 6$1-4675 Please complete for: all commercial/industrial buildings multi-family buildings when separate permits are not required for each dwelling unit DATE: CONTRACT PRICE: WOt-tK TYPE: NEW CONSTRUCI'IUN NTERIOR INiPROVEMENT DESCRIPTION OF WORK: FEES: 1% of contract price OR $25.00 minimum fee, whichever is greater. Processed piping - $25.00 CONTRACT PRICE x 1% PROCESSED PIPING ' PERMIT FEE STATE SURCHARGE ($.50 per $1,000 of nermit fee due on all permits.) TOTAL SITE ADDRESS: O WNER NAME: TENANT NAME (IMPROVEMENTS ONLY): INSTALLER: ADDRESS: CITY: iNSPECTOR PHONE #: PHONE STATE: ZIP: k SIGNATURE OF PERMITTEE PERMIT City of Eagan Permit Type:Building Permit Number:EA107403 Date Issued:10/11/2012 Permit Category:ePermit Site Address: 1419 Kingswood Ponds Rd Lot:3 Block: 1 Addition: Kingswood Ponds 1st PID:10-42050-01-030 Use: Description: Sub Type:e-Reroof Work Type:Reroof Description:House Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar. Pictures are not acceptable in lieu of inspections. Carbon monoxide detectors are required by law in ALL single family homes . 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 - Angela Wellik 1419 Kingswood Ponds Rd Eagan MN 55122 Schmidt Roofing Inc 13401 County Road 5 Burnsville MN 55337 (952) 888-4889 Applicant/Permitee: Signature Issued By: Signature Use BLUE or BLACK Ink 1i1 ` For Office Use ::::( t gl!/ ( j/� fl l�ity 1 �� �� L ` 3830 Pilot Knob Road 1tk t 3 0 i 1017 -^� Eagan MN 55122 Date Received: J-30`1r3 Phone:(651)675-5675 (161 Fax:(651)675-5694 Staff: ter)) ` J 2017 RESIDENTIAL BUILDING PERMIT APPLICATION Date: 3/29/17 Site Address: 1419 Kingswood Pond Road Unit#: ; Name. Dustin and Angie Wellik� ... ..r.. . .._ Phone: .. ..._ . __._._ ,_ ...... ..,.. _.�.� , 507-269-2012 I Resident/ I ©caner Address/city/zip: 1419 Kingswood Pond Road t I I Applicant is: Owner X Contractor .................. I 1 Basement finish Description of work: Type of Work Construction Cost: 26000 Multi-Family Building: (Yes /No X ) fi Company: Dean _ _,... _,..._. ,.. �M�.,�_.. __. n.a��._.. ... .......� _ �_. �_. e Johnson Homes contact. Dean Johnson Address: 4700 County Road 19 city: Medina Contractor State: MN Zip: 55357 Phone: 763-479-4820 Email: djohnson@deanjohnsonhomes.com I i BC639439 NAT-116213-1 License#: Lead Certificate#: If the project is exempt from lead certification, please explain why: w. . :_ 2\ Home is newer than 1978 I COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING I In the last 12 months,has the City of Eagan issued a permit for a similar plan based on a master plan? I Yes No If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer&Water Contractor: Phone: Fire Suppression Contractor: Phone: 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 reasonsthat would permit the-City:to .conclude that the are trade secrets. I 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.gooherstateonecall.orq 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. x Dean Johnson "x---i" :„....._ ___,U7,..„.________, Applicant's Printed Name Applicant's Signature Page 1 of 3 e)cl -e0/14_ ad. Hi 6'()(?� DO NOT WRITE BELOW THIS LINE /Ili g6 / . . SUB TYPES Foundation _ Fireplace _ Porch(3-Season) _ Exterior Alteration(Single Family) Single Family _ Garage _ Porch(4-Season) _ Exterior Alteration(Multi) — Multi _ Deck — Porch(Screen/Gazebo/Pergola) _ Miscellaneous 01 of_Plex Lower Level _ Pool _ Accessory Building WORK TYPES New _ Interior Improvement _ Siding _ Demolish Building* Addition _ Move Building _ Reroof _ Demolish Interior IS, 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 $IlaOccupancy L. ! y MCES System Plan Review Code Edition i t\\4 1,c/ SAC Units (25%_100%\_) Zoning WICity Water Census Code Stories Booster Pump #of Units Square Feet PRV #of Buildings Length Fire Suppression Required Type of Construction V Width REQUIRED INSPECTIONS Footings (New Building) Meter Size: Footings(Deck) Final/C.O. Required Footings (Addition) X Final/No C.O. Required Foundation Foundation Before Backfill HVAC_Gas Service Test Gas Line Air Test Roof:_Ice&Water _Final Pool:_Footings Air/Gas Tests _Final Framing )( 30 Minutes 1 Hour Drain Tile Fireplace:_Rough In _Air Test _Final Siding:_Stucco Lath Stone Lath _Brick_EFIS \f, Insulation Windows Sheathing Retaining Wall:_Footings_Backfill_Final Sheetrock Radon Control Fire Walls Fire Suppression:_Rough In_Final Braced Walls Erosion Control Shower PanOther: Reviewed By: \ , , Building Inspector RESIDENTIAL FEES Base Fee o ''S ! Surcharge I/ 1` Plan Review MCES SAC l j� City SAC i( ..°2° / (9 S111 Utility Connection Charge 2'-' � S&W Permit&Surcharge Treatment Plant Copies TOTAL Page 2 of 3 Use BLUE or BLACK Ink r For Office Use n� Cityof En nn Permit#:QQ1111 // Permit Fee: (RO� 3830 Pilot Knob Road Eagan MN 55122 Date Received:s411 7 Phone: (651) 675-5675 Fax: (651) 675-5694 L staff: //'t% 2017 RESIDENTIAL PLUMBING PERMIT APPLICATION IL iC Date: Site Address: l t I 'el'/113 (,,J Pew) 6GCf Tenant: Suite#: Phone:Name: Ph ..__ ,.._ I ' Resident/Owner Address/City/Zip: Name: k 0C e C6'erPhA4/114C1.47 r'l C License#. r ► a (7 a 7 /5 Contractor Address:3613a - (OS " s - NJ ()-) City: �vr P_\ v\ State: N`N Zip: 553 7 ( Phone: (0 ta- SOS- eigoo .} I Contact: /5 rt Z, 14-edele(6 ?.--- ,Email:... kiJ Y�.p/, ,._...,I,/-1 e„,4,0,.,. 'l` C'ca1�v� , _ . . , . ,.. , _� _,_ x New XReplacement —Repair Rebuild —Modify Space Work in R.O.W. Type of Work — Description of work: RESIDENTIAL t t , Water Heater Lawn Irrigation( RPZ/—PVB) # Water Softener Permit Type Add Plumbing Fixtures ( Main/ 4fLower Level) ISeptic System I I 1 _New Water Turnaround Abandonment RESIDENTIAL FEES: $60.00 Water Heater, Water Softener, or Water Heater and Softener(includes State Surcharge) $60.00 Lawn Irrigation (includes State Surcharge) $60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround*(includes State Surcharge) *Water Turnaround (add$280.00 if a 3/4"meter is required) $115.00 Septic System New(includes County fee and State Surcharge) TOTAL FEES $ CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage. :.all 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.orq 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 p-ns. ori Sge(�.( X ,%� kpplicant's Printed Name •plicant"P-nature 'OR OFFICE USIA Reviewed By Date'.` tequired Inspections: Under Ground Rough-fn AirTest Gas Test Final Meter Related Items: Meter Sty; ,:: . , Redo Read Manometer €tatf: ., PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA155629 Date Issued:05/28/2019 Permit Category:ePermit Site Address: 1419 Kingswood Ponds Rd Lot:3 Block: 1 Addition: Kingswood Ponds 1st PID:10-42050-01-030 Use: Description: Sub Type:Residential Work Type:Replace Description:Air Conditioner Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952) 445-2840. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088 Surcharge-Fixed $1.00 9001.2195 $60.00 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Angela Wellik 1419 Kingswood Ponds Rd Eagan MN 55122 Sedgwick Heating & Air Conditioning 1408 Northland Drive, Suite 310 Mendota Heights MN 55120 (952) 881-9000 Applicant/Permitee: Signature Issued By: Signature