1424 Kingswood Ponds Rd
WC1.`ttfiCRtC of CCCltpQ1iC?
Mttj of Wagatt
#?e?rartmcttt oi'8ui[bing 3nav¢ction
This Cenificate issued pursuant to the requirements of rbe Uniform Buildrng Code
cenifying thar at the trme of issuance this structure was in compliarzce with the variaus
ordinartces of the City regulatirtg building constructiors or use. For the following:
Uu Ciassifiotion: SF DWG Bidg. Pmnit No. 32250
Occ'F-ncr ?Yve R-3,, U-1 zonN6 oiso;a R' 1 rype const. Vn
o? orewiaing M WJaW9M OCNSf Aaam 17645 J[JNIPE.R PAIIR, ?CEVILJ?
? Building Address 1424 KRCSWpOD F'C7NIDS RD ,oca,;ry LQ B2 (.? PONDS i$t
oau?
m
IN A CONSPICUOUS PLACE
, -- ? ?-- - - - - - -- - ? - -- - - - --
? CiTY OF EAGAN ? PERMIT TYPE: 3830 Pilot Knob Road Permit Number: `. r±
Eagan, Minnesota 55122-1897 Date Issued:
(612) 681-4675
SITE ADDRESS: APPLICANT:
? ?..: 1'ifl P5?N0i1 kO ;
?
? ?,: ;• t ?- 1 . ? C:.'ti94a
PERMIT SUBTYPE:
TYPE OF WORK:
14 1 1a
INSPECTION D. . D,
kEMakK';- PEAN KrvW;,; s,•; Mrr:t f;,tr:; k
S&W f't UMRi? t, t;ti? r72Y? i. Mi t?Sit1h1 t
? ?
Pe it Holtler Date Telephone #
BING
7
HVAG L1
* ? 98 ? (e'7
Inspection
Date nsp. Comments
FOOTINGS ? 'e1f
FOUND aO d
O
FRAMING
4 G
ROOFING
ROUGH
PLUMBING
g
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
?7lO
GYP80ARD
FiREPLACE
f-
FIREPLACE
AIR TEST
FINAL PLBG
vu
PINAL HTG P
ORSAT
TEST
BLDG FINAL
/
DOMESTIC
METER
IRRIGATION
METER
FLUSH
MAINS
CONDUCTIVI7V
TEST
HYDROSTATIC
TEST
BSMT R.I.
BSMT FINAL
DECKFTG
?S
DECK FINAL p
6t ihr 4
Address 1424 xlNC,swnnn vnNns un Zip 55129
_
LOt ° Blk 2 SubKINGSW00D PONDS
THESE ITEMS WEIjE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECTION.
Date: g ?? 9
cir Yes No Inspector:
ZAZE
Final grade (6" from siding) ?
Permanent steps (garage) i/
Permanent steps (main entry) ?
Permanent driveway
Permanent gas ?
Sod/Seeded grass t/
Trail/curb damage ?
Porch
Basement finish ? i'' z??
Deck
Please verify with the builder the removal of roof test caps from the plumbing system and the shut-off of water supply to
the outside Iawn faucet before freeze potential exists.
Contact engineering division at 681-4645 before working in right-of-way or installing undetground sprinkler system. ?
White - City Copy Yellow - Resident Copy Pink - Coniractor Copy
U
) -? q6 ?
2007 RESIDENTIAL PLUMBING PERnnir aPPLicATiorv
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please complete for modifications to existing residential dwellings
oate S / Z 3 ? ,)1
Site Street Address k" --? ?UMS LY3DCOA Unit #
PropertyOwner Telephone# )6 & (P _qo&
Contractor °4' Te?[epChone # ((a5 )7i?'-6D1 ?
Address City c? State (`rIC\ Zip `SZID2-
? Q--O?U`(.'Qb\ ? •R-
The Appiicant is: _ Owner -,#.- Contractor _Other
Refurbished Submit 2 sets of plans and MPC license
New
Septic System Includes County fee
_
_ $ 100.00
Per as-built $ 10.00
Fire Repair (repiace burned out fixtures, etc.) $ 90.00
Alterations to existing dwelling $ 50.00
Add plumbing fixtures. This fee includes installation of a water softener and/or water
heater at the same time. If you are insfalling only a water softener and/or water
heater, do not complete this section; move to the next section and check the
appliance(s) you are installing. e
t I? [E?C? RE 0 W E
?l
_5eptic System Abandonmen
_ W a t e r T urnaround (add $136.00 if a 518" meter is required)
MAY 2 5 2007
Other:
Water Softener ? Water Heater $ 15.00
new " replacement
_ Lawn Irrigation _RPZ _PVB _new _repair _rebuild $ 30.00
State Surcharge $ 50
? ?•?
Total
I hereby apply for a Residential Plumbing Permit and acknowledge that the information is complete and accurate; that the
work will be in conformance with the ordinances and codes of the City of Eagan and the plumbing codes; that I
understand this is not a permit, but only an application for a permit, work is not to start without a permit and work will be in
accordance with the approved plan in the event a plan is required to be reviewed and approved.
? V\
TN0V, ALUPAOK?
ApplicanYs Printed Name App icanYs Signature
?~ f 2005 RESIDENTLAL BiJILDING PERNIIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan ibIN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Construction Reauirements
3 registered site surveys showing sq. k. of lot, sq. ft. of house; and all roofed areas
(20% ma)imum bt coverege ailowed)
2 copies ot plan showing beam & window s'¢es; poured (ound design, etc.
i set of Energy Calcula6ons
3 copies o(Tree Preservation Pian if lot plaUed afler 711193
Rim Joist Detail Options selection sheet (buildings with 3 or less units)
??? ?
RemodeUReoair Reauirements Otfice Use OnN
2 copies of plan Ced of Survey Recd r:;-Y _N
1 set of Energy Calculations tor heated additions Tree Pres Pian Recd _Y _ N
1 sitesurveyforadditions8decks TreePresRequlred _Y _N
Addffion - indicate r/on-site sepfic system On-site Septic System `. _ Y_ N
Date ?/
SiteAddress (f ?
1` /? K (',n o)5 W o o(?.
1(4 7,q
64611--2 I /?,?,-?
6 n?15 g°Construction Cost ?J?-"--??
UnitlSte #
Description of Work Oc.)l&J->t &A?
Multi-Family Bldg _ Y kN Fireplace(s) _ 0 ?..? 1 _ 2
Property Owner ? r
C;7U CLJ C- I C-
?,?,
Telephone # ( GS1
Contractor ? n
5 l ! f
Address
State bo?)) 13)
Zip %V7 City
9,v
Telephone#q5,Z)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 CateQOrv 1 Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(4 submission type) Submitled Submitted
. Energy Envelope Calculations Submitted
Have you previously constructed a building in Eagan with a similar plan? _ Y _ N If so, 25% plan review
fee applies.
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone # (
Telephone #(
Telephone # (
I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a
permit; that the work will be in accordance with the approved pl ' t e case f ork etr`_re?,u r? d
approval of plans.
JUL 2 0 2005
Applicant's rintedName Appli t's Signature IBy`_
OFFICE USE ONLY
Sub Types
? 01 Foundation
? 02 SF Dwelling
? 03 01 of _ plex
O 04 02-plex
? 05 03-plex
? 06 04-plex
Work Types
? 07 05-plex ? 13 16-plex ? 20 Pool
? OS 06-plex ? 16 Fireplace ? 21 Porch (3-sea.)
? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.)
? 10 OS-plex ? 18 Deck ? 23 Porch (screen/gazebo)
? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 12 12-plex Plbg_Y or_ N ? 25 Miscellaneous
? 30 Accessory Bldg
O 31 Ext. Alt - Mufti
? 33 Ext. Alt - 5F
O 36 Multi Misc.
? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteration ? 37 Demolish 8uilding* ? 43 Reroof ? 46 WindowslDoors
? 34 Replacement •Demolitlon (Entire Bid g) - Give PCA handout to applicant
Valuation Occupancy MCES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bidgs Length Fire Sprinklered
Type of Const Width
_ Footings (new bldg)
_ Footings (deck)
_ Footings (addition)
Foundation
Drain Tile
Roof Ice& Water Final
_ Framing
_ Fireplace _ R.I. _ Air Test _ Final
_ Insulation
Approved By:
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
REQUIRED INSPECTIONS
_ FinaVC.O.
_ Final/No C.O.
_ Plumbing
HVAC
Other
_ Pool _ Ftgs _ Air/Gas Tests Final
_ Siding _ Stucco _ Stone _ Brick
_ Windows
Retaining Wall
Building Inspector
\ V?
CIT1+ OF FA? `
CAS€ilEFie S TERERaNAL NOa 7$2 .
DATEn 06/22I38 TEMEa 13e49a39
ILi s
i4AMEe ti W 3OHAtSON. CEhNSTRECTIfi3s ING
2256 9001 f 414 h'AEGS WL= FN 4767501
2256 90€I3 1424 .fNGS 14D PN 4,622.71
,
To+,al Recaip#, Amaunf;e a7237.19-42
f.R093737
tt5rcEi ILf e NAi3tCY
X?X i??kY,cz????k?k?tY,z?C?:?X??X? #rgc #Xc?XtXe?k.rt?t?X?XtXc?;?:_::Y??X?
? CI•TY-OF EAGAN
3830 Piiot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS:
p.I.N.: 19-42050-090-02
DESCRIPTION:
FERMIT ?
PERMIT TYPE:
Permit Number:
Date Issued:
1424 KTNGS WOOD PONDS RD
L,QT: 9 BLQCK: 2
KINGS WOOD PONpS
SF DWG
NEW
1\ t'
-J q ll-1
VN
R-1
72
68
2
2,654
101 1 - FAM. L1ETflCW
,??
?a?
as`m ?y ` aai .• , .
A,q
a??..
suxLozNG
032250
06/19/98
REMARKS:
PLAN FiEVEWED BY MTKE BARCK
S&W PLUMBER: WENZEL MECHANTCAL
FEE SUMMARY:
Base Fee
P1an Review
Swrcharge
5AC
SAC %
5AC Units
Subtotal
VALUATTDN
$1,182.25
$768.46
$79.50
$1,000.00
100
1
$3q V J0. L.1
$159,D@0
MYSC FEES 11,592.50
7ota1 Fee $4,622.71
CONTRACTOR: - Appiicant - sT. Lzc OWNER:
JOMNSON CONST, M W 18925200 0062207 MW JdHNSON CONSTRUCTION
,-3.7645 JUNTPEFt PA7H 17645 JUNIPER PflTH
LflKEVTLLE MN 55044 LAKEVILLE MN 55044
(612) 892-5200 (612)892-5200
PPLICANT/PERMREE IGNATURE
, . . gt3u?ING PERMIT APPLICATION (RESIDENTIAL) ??'2?•?I
CITY OF EAGAN
3830 PII.OT KNOB RD - 65122 V 1 (
681-4675
! l r'.
New Conatruction Re uirements RemodeVReoair Reauirements
?• f3 registered sRe surveys ? 2 copies of plan
? 2 copies of plans (inGude beam 8 window s¢es; poured fid. design; etc.) ? 2 site surveys (exterior addkions & de
7 energy caiculations ? ? 1 energy ralculadons for heated additions ?? ( r
? 3 eopies of tree preservation plan iF lot platted aRer 7/1/93 l
? required: _ Yes ?T/ No
DATE: (r ?
CONSTRUCTION COST;
DESCRIPTION OF WORK: C O12°?An.l7r1y) -
STRE T ADDRESS: Kjna,S?OCY?, `-yhryckj Q C) .
OT: ? BLOCK: L SUBD.lP.I.D. #:
Nar„e:-W K,/ jOk:06/ ?jRaof) Phone C7 Z` C32.jco
PROPERTY Last First
owrrEx S?.?U
Street Address: 1-1(?p ,? cver
City State: 3fl/j Zip:
Company: - ( I / l\I ? J?Wqk C60-R[1(PWPhone#: b`"l 2 - . /nLoo
CONTRACTOR ???
Street Address: 17? License # 000RC/30_1
ctry LAKFAll LLE state: Ml1l zip:
ARCHITECT/
ENGINEER Company:
Name: ,?Qdb
Street
Phone#: b')???
Registration #:
.?
Ciry State: 111? I Zip:
Sewer 8 water licensed plumber (new construction only): LJP?Zt . Penalty applies when address chang
and lot change is requested once permit is issued.
I hereby acknowledge that I have read this applicaNon and state that the info tion is correct and agree to comply wfth all applicabl
State of Minnesota Statutes and City of Eagan Ordinances.
?
OFFICE Signature of Applicant:
D ?
Certificates of 5urvey Receiv 7Yes LY
ed No ?/?--
Tree Preservation Plan Received _ Yes _ No ? Not Required '._ _ ?
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Duplex
)402 SF Dwelling ? 07 4-piex
0 03 SF Addition ? 08 8-plex
0 04 SF Porch ? 09 12-plex
? 05 SF Misc. ? 10 _-plex
WORK TYPE
& 31 New ? 33 Alterations
? 32 Addition 0 34 Repair
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
Planning
? 11 Apt./Lodging ?
? 12 Multi Repair/Rem. ?
? 13 Garage/Accessory 0
? 14 Fireplace ?
? 15 Deck
? 36 Move
? 37 Demolition
?A/ Basement sq. ft.
Jti( Main level sq. ft.
f2 ?o _t 4"??a sq. ft.
R-/ sq. ft.
i sq. ft.
'7z' sq. ft.
s T Footprint sq. ft.
I L, Cl 2 MC/WS System
I G 2v City Water
7 S3.s Fire Sprinklered
PRV
Booster Pump
Census Code. i o r
SAC Code 0(
Census Bldg ?
Census Unit i
Building /fltg Engineering Variance
._A
Permit Fee Valuation: $ 17-90
Surcharge
Plan Review 44V 19 -,a
License 11 zv
MCMIS SAC z
City SAC
Water Conn. b 33s
Water Meter
Acct. Deposit 1 vqz rb A 2s=
S/W Permit
S/VV Surcharge s? r,?u 5 ? ? 4 Z
Treatment PI. 'Zy? zoK
Park Ded.
Trails Ded.
Other e7,412
ie
ap _._
;
?
10
)c 't
?
% SAC
' SAC Units
??----'
? k Za ro? sy= W3,
yd
rb 4
157?-7 /4i. .?
1 , 7-t?U
-?_
1 5? ?/(o ?-
.
???`
4
16 Basement Finish
17 Swim Pool
20 Public Facility
21 Miscellaneous
LOT SURVEY CHECKLIST FOR RESIDENTIAL
BUILDING PERMIT APPLICATION
?
a S ?
?O ?
0-`? O
a"? o
6---E3 ?
6'0 ?
M-`? ?
0-'o ?
Er'0 ?
? ?
? ?
M-`0 ?
iEr'O ?
0--'? ?
? O-'?
PROPERTY LEGAL:
.
.
.
.
.
.
.
nr'o ? •
0/p ? •
L9--D ? •
C? ? ? •
B??O ? •
0' ? ? •
0 ? ? •
? ? ? •
? ? ?
? ? •
? 0' ? •
0"o ? •
G7/'? ? •
? O ? •
0?' ? ? •
8? ? ? •
? Q% ? •
January 1996
CRA1Ci79B81BlOGPRMT. FM
DATE OF SURVEY: ? O
LATEST REVISION:
DOCUMENT STANDARDS
Registered Land Surveyor signature and company
Building Permit Applicant
Legaldescription
Address
North arrow and scale
House type (rambler, walkout, split w/o, splR entry, lookout, etc.)
Directional drainage arrows with slope/gradient %
Proposediexisting sewer and water services 8 invert elevation
Street name
Driveway
ELEVATIONS
Existln
Sewer service (or Proposed)
Properly comers
Top of curb at the driveway
Elevations of any exisUng adjacent homes
Prooosed
Garage floor
First floor , I
Lowest exposed elevation (walkout/window)
Properly corners
Front and rear of home at the foundaUon
PONDING AREA (if apalicable)
Easement line
NWL
HWL
Pond # designation
Emergency Overflow Elevation
DIMENSIONS
Lot IinesBearings & dimensions
Right-of-way and street width (to back of curb)
Proposed home dimensions including any proposed decks, ovefiangs greater than 2',
porches, etc. (i.e. all structures requiring pertnanent footings)
Show ait easements of record and any City utiliUes within those easemenis
Setbacks of proposed sVucture and sideyard setback of adjacent existing structures
Retaining wall requirements, if any
Reviewed:
Iama / Dete
1
.
Norui tor use with Mintiesota ltules Pazt167U.U475, Subp. 2
• . , 1 & 7amily Residential "Cookbook" N iod
SITE AW772 Tty
?? Z.'-t IC t U1/)h tx/flf `l I?v1n?C ??r).v? T-- ('1rkr1 Y-1
Date `j
(r,. T-q
11flnimum Criteria:
Rim Joist: R-19 insulation Foundaton Windows: lnsulated glass, 1!2" air space, aood or viny) frame
Enw doon: I1/? inch solid wood with storm or better
STEP 1 Window & Door Area I I STEP 2 Calcu)ate area as a perceat of wall
Total Window & Door Area in Sq. Feet Box A(window & door acea) divided by Boz B(tota]
WINDOWS (including foundation windows): wall area) times 100 equals the window and door area
Dimensions Qnty. Area as a percent of wail area (Box C).
10 X ' >0
? x
2-4- X 4-,,,,
?
. ? X
j === x
X
=v x
,ao x !" v
DOORS- 1 - ? , -,
l(? g
X
-,
?/
/?
Total Area of
Window & Doors i 0/,? : ?A
Total Wall Arta in 5q. FL
Wall Total Pcrimeter Hei¢ht Area
?"?Z ( 154?
2 I(7 ? Z o
Total Ate.a
_ of wall
BoxA ?9T, Cpol z 100=
BozB 2t.Qo 4 C
STEP 3 Design Features
ASSFMBLY OE'TION
FRAME WALL:
STANDARD FRAhIING
ADVANCED FR41rIING
CAVITY IIVSULA770N R- Z
SHEATEQIVG:
LESS 7'HAN R-5
R-5 OR MORE
WINDOWS (except foundacion windows):
U-FACTOR
.
From the table, determine the mazimum percent window
& door ama tor the design options selected and enter the
value in box D below: ,
l s. ¢n
Box C must be less t6an or equai to Box D
?
CERTIFlCATE OF SURNEY
for
M. W. JOHNSON
sI (6B/. i9
sm'oo'
It -1 cn/-%r
`J-
?r ?
?pf?t•?91?_
?y-
?
?,
R . . 1Y
p
L . 7
5AA
/$2 3?j ??z
Scale: 1" = 40'
? J
?
?. _ ..
•
s??? ?0903AI
e
0 oged hou9° ?
egmt e? F?76.zZ4 10
\ A/ o ?,? 11
1 ?91
il?v 4 ,?<Jll C.*twooll"' 11
8I 95?
7/'
, j ,o._-
?
1
1
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1
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1
1
1
1
r?: 11
1424 Kingswood Ponds Road
Lot 9, Block 2,
KINGSWOOD PONDS FIRST ADDITION
Dakota County, Minnesota
Plat bearings shown
o Denotes iron monument
? Exi g j Proposed
i
?N?qro?
. `?_- ? ? ?• n.9
J27-99-98
r?/ 1
l??J
TfJ ?('
?``al
L-
DESCRIPTION
I hereby certify that this survey, plan, or _ ?-
report was prepared by me or under my direct
supervision and that I am a duly Registered
Land Surveyor under the Laws of the State
of Minnesota.
Date U/d qU,{/ Iqgg Reg. No. 8140
BUILDING INSPECTION5 -- "PT•
506"01.WE ? i
,
?1,
:,i'_k:?
zaj T^. ?rT ??,,'•=?`d'6abtls`rTi
?C. _
BRANDT ENGINEERING & SURVEYING
1600 West 143rd Street,
Burnsville, MN 55306
: (612) 435-1966
,
J27-99-98 `:
1
1
1
1
1
1
1 ;
1
1 ti
1
1 ?
Suite 206
CITY USE ONLY
LOT 9 BL ? RECE[PT#: 95 gqS
SUBD. ?
?
, ? .,
?'
RECEIPT DATE: YG/9 ?'
199$ HI£CHA1VICAL P£RMIT (QES1D£NTIAL)
CITY OF £dkfiAN
3$30 P[LOT KNOB RD
E}kfii4N 1HN 55 ] 88
?l'7n (s,Q) 661-4675
Date:
Complete this section onlv if you are installing HVAC in single family, townhomes or condos under
construction and not owner /occupied '
? HVAC: Ci-i0OMB T U $ 24.00
ADDITIONAL 50 M BTU 6.00
. Gas outlets (minimum of one required @$3.00 ea.) 9, w
• State Surcharge: .50
• TOTAL: '39. 5-1)
Complete this section onlv if you are remodeling, adding to, or repairing existing single 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 fumace 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:
. ., - J - -
OWNER NAME: ,/L U --! 4 PHONE #: ?Q " ?d'o V
INSTALLER NAME: SQ [Xe ]Tc(,At`I-?? ? i l- [ d- AC PHONE #: 47 3 -d`J-677
STREETADDRESS: 1476S- 5"'l' k
CITY:
]S/FORMS BLD/MECH PERMIT (RES) - 1998
STATE: ZIP: JiJ ? L
? ?
GN URE PERMITTEE
L BL
SUBD.
APPROVED BY:
199$M£Cfii°ENICAL PEEiMIT (COMMERCIlkL)
CITY Of' £fk6A1V
S$SO PILOT KNQ$ {tD
EA6ikN, MN 55188
(618) 6$1-4675
Please complete for: all commerciallindustrial buitdings
multi-family buildings when separate permits are not required for each dwelling unit
DATE: CONTRACT PRICE:
WORK TYPE: NEW CONSTRUCTION
DESCRIPTION OF WORK:
FEES: 1% of contract price OR $25.00 minimum fee, whichever is greater.
Processed piping - $25.00
CONTRACT PRICE x 1%
PROCESSED PIPING
PERMIT FBE
STATE SURCHARGE
TOTAL
SITE ADDRESS:
O WNER NAME:
TENANT NAME (IMPROVEMENTS ONLY):
INSTALLER: _
ADDRESS: PHONE #:
CI'I'Y: STATE: ,i
cmr use oNLY
RECEIPT #:
RECEIPT DATE:
INTERIOR IMPROVEMENT
($.SO per $1,000 of permit fee due on all permits.)
PHONE #:
ZIP:
SIGNATURE OF PERMITTEE
v
L 9 BL ?
SUBD. . ?
CITY USE ONLY n, s I? ?
RECEIPT#: ??'?
RECEIPT DATE: -I
1998 PLUIABING PERMIT (RESIDENTIAI,)
CITY OF EAGAN
3830 PILOT IQQOB RD
EAGAN, MN 55122
(612) 681-4675
Please complete for. ? single family dwellings
? townhomes and condos when permits are required for each unit
? backflow preventer for underground sprinkler system
FIXTLRES
EACH - - - - ---
# - - ----------
TOTAL
Shower 3.00 x _L = 3.400
Water Closet 3.00 x _114 -
Bath Tub 3.00 x 614040
Lavatory 3.00 x
Kitchen Sink
3.00
x ?
Laundry Tray 3.00 x
Hot Tub/Spa 3.00 x =
Water Heater 3.00 x -7- - 3, DD
Floor Drain 3.00 x 7- _ '3. lJt7
Gas Piping Outlet * minimum -1 3.00 x -v. DD
Rough Openings 1.50 x =
Water Softener " for dwellings under construction 5.00 X =
Water Softener ' for existing dwelling 20.00 x =
U.G. SprinklEr * for dwelling under const. 3.00 =
U.G. Sprinkler "forexistingdwelling 20.00 =
Alter'atiDns * to existing residence 20.00 =
Water Tum Around 20.00 =
PrivaCe Disposai System * MPC iic. 75.00 -
(new and refurbished systems)
Private Disposal Systems * Abandonment 20.00 =
STATE SURCHARGE .50
TOTAL
------ - ------------------------------
--------------------
I hereby adcnowledge thet I have read this application, state thet the information is correct, and agree to comply wkh all applica6le Ciry of Eagan ordinances.
It is the applicant's responsibility to nolify the property owner that the City of Eagan assumes no liability for any damages caused by the City during its
normal operational and maintenance activities to the facilities construded under this permit within City property/right-of-way/easement.
SITE ADDRESS: /
v
OWNER NAME: ? LU
Q6
INSTALLER NAME: TELEPHONE #: ?ara?-/S(oS
STREET ADDRESS:
GITY: CC.9,h/Y! STATE: In A/ ZIP: 6'S1021z-
?
TURE OF PERMITTEE
JS/FORMS BLDG/PLBG PERMIT (RESIDENTIAL) 1998
CITY USE ONLY
L ? 8L ? RECEIPT li: a
SUeo. I????SWo?? Pondc.,? RECEIPTDATE: `Gd
PERMIT #
8000 PLUMaINfi PERMTI' (RE51DENTLmILL)
crrY oF Etsax
sgso Pu.or xrros sn
EA6AN. MN 5518E
651-6$1-4675
Please complete for: ? single family dwellings
? townhomes and condos when permits are required for each unit
? backflow preventer for underground sprinkler system
CIvT11DGC
FO('H
TOTAL
Alterations to existing dwelling - minimum fee
Describe:
$ 30.00
Bath tub $ 3.00 x = $
Floor drain 3.00 x = $
Ga5 i in outlet ' minimum -1 3.00 x = $
Hot tub/s a 3.00 x = $
Kitchen sink 3.00 x = $
laund tra 3.00 x = $
Lavato ' 3.00 x = $
S@ tIC S stem new/refurhished ' re uires MPC lic. 75.00 X = $
Se tIC S St2m abandonment 30.00 X = $ I
RPZ new insqllation/repairhebuild 30.00 X = $ ?
Rou h o enin 1.50 x = $
Shower 3.00 x = $ '
Undef roUllds 1'inklef ifdwellin isunderconsGVCtion
Under round s rinkler irexistin dweuin 3.00
30.00 x
x _
= $
$ 30 '
W ater cioset 3.00 x = $ I
Water heater 3.00 x = $
Water softener if dwelling under consVUetton 5.00 x = $
W ater softener N existing dwelling 30.00 x = $ ?
Water turnaround 30.00 x ---- _ $
State Surchar e .50 --> ----> ---> $ .50
Total
-->
-->
--->
---->
$ O
Reminder: Call for inspections of alterations, i.e. water heaters, water softeners, etc.
••---•----------•----------•--------------•----------•---------------•- •-------•----------•---------------•
- ordinan- ces.
-p -ble-Ciry•of Eagan-
-
-correct, and-agree ta comply with•all-appli-
-I-have-read-this application,- stale that-the information- is-
I-hereby acknowledge-that-
It is the applicant's responsihility to notlty the property owner that the Ciry of Eagan assumes no liability for any damages qused by the City during its normal
operetional and maintenance activities to the facilitles consWCted under this permil within Ciry propertylright-of-wayleasement.
SITE ADDRESS: /yoZ y ?C?^lG,S ?o-?t D ??
OWNER NAME: : TELEPHONE #: !?yf IqFSC9 -`?? ?CO
(AREA CODE) _
INSTALLERNAME:?JJP`?-?? TELEPHONE#:,11?? T???SCo
?? (AREA COOE)
STREET ADDRESS: `J'!S ?JV.f ?c-I
CITY: STATE: ZIP:_ ??f?•?
SIGNATURE OF RMITTEE
v 610
2007RESIDENTIAL BUILDING rERMiT nrrLrcaTiorr
City Of Eagan
3830 Pitot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New ConsWCtion Reauirements
3 registered site surveys showing sq. 2 of lot, sq. R of house; and all roofed areas
(2096 ma)imum lot coverage allowed)
1 Sa7s Repott if propased building is to 6e placed on disfurbed soil
2 copies of plan showing beam & window sizes; poured found design, etc.
1 setof Energy Calculations
3 copies of 7ree Presenration Plan if lat Platted after 711193
Rim Joist Detail Options selec6on sheel (buildings witlh 3 ar less unifs)
Minnegasco mechanical ven6lation farm
ans a
Date -/ / ?q /? 0? / p Construction/Cost,?
Unit/Ste #
Site Address ? 7 y /? /n 9 S(.v?Oe?
J rD e?d S
C? ?
t P co
Description of Work (
Malti-Family Bldg _ Y j? N Fireplace(s) _ 0 2
f 7 e rle?c- ? -P f
V ? Telephone # ( G)) I E 6
-
Property Owner
Contractor 3 ig2?1 S cl1 l_cov1 S
?? Zo WQ,/CeI' S
Add
n
?r%/G 0,1
i citv Sf Go? r3 /'4F
ress
State Zip ?'L/ 2 4, Telephone # js^Z) 920- O 217
RemodelfReoair Reauirements
Z copies of plan showing footirtgs, beams, joists
1 set ot Energy Calculations for heated additlons
1 site survey for addi6ons & decks
Addition - indreate if on-site sep5c system
Office'Use 0'nlu
Cert of Survey Recd _ Y _ N
S6ils Raport Y _ N
Tree P[es Plan Recd Y _ N.
Tree Pres Required _ Y _ N
Onsite Septic System _ Y _ N
PI re considered ublic information unless ou state the are trade secret and the reason.
COMPLETE THIS AREA ONLY !F CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Categorv 1 Minnesota Rules 7672
Energy Code CBtegory , Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(V submissiontype) Submitted Submitted
. Energy Envelope Calculations Submitted
In ihe last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_ Y _ N If yes, date and address of master plan:
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
c /`q rq EL4 l
Applicant's P mted Name
Telephone #(
Telephone # (
Telephone #(
I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; I understand this is not a,permit, but only an application for a permit, and work is not to start without a
permit; that the work will be in accordance with the approved plan in the case of wark which requires a review and
approval of plans. ,
Applicant' ignature
DO NOT WRITE BELOW THIS LINE
Sub Tvaes
? 01 Foundation
? 02 SF Dwelling
? 03 01 of _ plex
? 04 02-plex
? OS 03-plex
? 06 04-plex
Work Tvpes
? 37 New
? 32 Addition
? 33 Alteration
? 34 Replacement
? 13 16-plex
? 16 Fireplace
? 17 Garage
? 18 Deck
? 19 Lower Level
? 20 Pool ? 30 Accessory Bldg
? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
O 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF
O 23 Porch (screen/gazebolpergola) ? 36 Multi Misc.
? 24 Storm Damage
? 25 Miscellaneous
? 35 Int Improvement ? 36 Demolish Interior ? 44 Siding
? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 37 Demolish Building* ? 43 Reroof ? 46 Windows/Doors
'Demolition (Entire Bidg) - Give PCA handout to applicant
DeSCI'IDt1011: Water Damage -Yes
Valuation Occupancy MCES System
Plan Review _ 100% or _ 25%
Census Code Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bidgs Length Fire Sprinklered
Type of Const Width
REQiJIl2ED INSPECTIONS
Eootings (new bldg) Sheetrock
Footings (deck) _ Final/C.O.
Eoorings (addition) _ Final/No C.O.
Foundation _ HVAC
Drain Tile Other
Roof Ice & Water Final Pool Ftgs Air/Gas Tests Final
Framing _ Siding _ Stucco Lath _ Stone Lath _Brick
Fireplace _ R.I. _ Air Test _ Final _ Windows
Insulation _ Retaining Wall
Approved By: , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
? 07 05-plex
? OS 06-plex
? 09 07-plex
? 10 08-plex
? 11 10-plex
? 12 12-plex
Use BLUE or BLACK Ink
r-----------------�
I For Office Use �
I �V
Clt of Ea a� j Permit#: �
y � � �. �� �
� Permit Fee: �
3830 Pilot Knob Road I I
Eagan MN 55122 � Date Received: �
Phone: (651)675-5675 i I
Fax: (651)675-5694 i Staff: i
2015 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: J �Q 1 � Site Address: Unit#:
� ) I _(
�� �4� ' Name: 1i1 ��1-2�T�.VI�� Phone:
Address/City/Zip: � �"I F�i S�,J JO � �� �
Applicant is: Owner V Contractor
Description ofwork: �2-VZX7�
Construction Cost: �� Multi-Family Building: (Yes /No✓
Com an : 1`OOS� �X��� O Ir S �v1 C.. ' � �
p y Contact: i e. �c�vt C.lY��e
� � �, . Address: 1 C�b�'�1 W O U� /�/2. U� City: ���e.�t,.�I 7�,
.�� : ,�� ` State:�Zip: �s i a$ Phone: �Io�3g�`f US7-zEmail: S<'�+r' ���'oa�2��,-�-i��5;�o
License#: L���b� � �3 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:
�'
° Q �._ . :� _ � _: _
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.aoaherstateonecall.ora
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 J"`�-r 1� l�f�1-��t- �.�1 c�lir�vt Ce,� X •
ApplicanY rinted Name plican s ignature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA133494
Date Issued:10/16/2015
Permit Category:ePermit
Site Address: 1424 Kingswood Ponds Rd
Lot:9 Block: 2 Addition: Kingswood Ponds 1st
PID:10-42050-02-090
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:One Window/Door
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 or installing Bay or Bow
windows, 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: 500.00
Fee Summary:BL - Base Fee $500 $40.00 0801.4085
Surcharge - Based on Valuation $500 $0.50 9001.2195
$40.50 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 -
Gene Tste A Fletcher
1424 Kingswood Ponds Rd
Eagan MN 55122
Renewal Andersen
1920 County Road C West
Roseville MN 55113
(651) 264-4777
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA136719
Date Issued:05/26/2016
Permit Category:ePermit
Site Address: 1424 Kingswood Ponds Rd
Lot:9 Block: 2 Addition: Kingswood Ponds 1st
PID:10-42050-02-090
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 -
Gene Tste A Fletcher
1424 Kingswood Ponds Rd
Eagan MN 55122
(952) 212-2229
Bonfe's Plumbing & Heating
505 Randolph Ave
St Paul MN 55102
(651) 228-9071
Applicant/Permitee: Signature Issued By: Signature
Use BLUE or BLACK Ink
• For Office Use
Permit#: i 6ot�9
City of EaR,all Permit Fee:
0
3830 Pilot Knob Road
Eagan MN 55122 RECEIVED Date Received:
Phone: (651) 675-5675 Staff:
Fax: (651 - 94 AUb 1 8 7017
I 2017 SIDEN�jTIAL PLUMBING PERMIT APPLICATION
Date: -I -' Site Address: `�.A* ` �'�" "6" —` '1�'^.A, 11.4... fAJ
Tenant: (' Suite#:.
ti
..`,:-.%-'411.,. ,,.t 2 '�l sr'•';' ," I , -)-(0—I") ,
r }( Name: �A. �' Phone:
P's.'s�.s4i ii-� '#''. f ;at = , / �J �.
� titf,ek%,A'af ,,ss�fi c Address/City/Zip: ' 6cs (� /�
,rf V ((� l� , - ♦_I c
l,, ,s„,� .t`)a r,,�t `� `. Name: Y U 1�1t�'V /ia�J�! cif fo4g.
. a License#:
��i"� r r)e ib1 r s r D1 ��.r/ L i\ , (L 5+ Cit ;OXY \ � l 2((
}44.1 `fr�`�'k, h '� �'�A: Address:
kt,i ku4vfrac • 4-,, city- Corot-
`G ( �'
IV', ri sire4:0, .(. , .., State:Y_ u v Zip: .1� Phone: (S'` `''.. I-��"(, 1
<ft`itt i
A" �, _:,4140-10'S' 1 kth;.ti t Email: � Du , a65 Q l l9l "l.U�i'"firit ci/ r v
� � r t? f' !� �!a�,; Contact: y-\ IT\�
ii u t r,
r_t
New Replacement
placement _Repair _Rebuild _Modify Space Work in R.O.W.; e ” tc' _
3.:''''`"'%'';'`V=-1 .: 4:
'x,'t, ,t a!2 ; Description of work:
0,',,,,,,,,,,,'pksn,,,{t tf ' ,, t y1. RESIDENTIAL
Vii!(.1, (`>'f' 4,, pe,
jy ° j+ y( Water Heater
7'ix f �rfj'14 LNN ,r"S�i<
3 ..�id- '',44:'''[.t tY F�•.
rt1z , f Water Softener
Utz ,il �;e`.,,t' x Lawn Irrigation(_RPZ/_PVB)
� �: Add Plumbing Fixtures ( Main/_Lower Level)
j , ,, l=1, rLafpr ,; _Septic System
t ;rij'� NV '�` —New Water Turnaround
Ota 4;}"
)�.4 1%Mit,r r,,;'`ki _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 $
t
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.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 on y an application for a permit, and work isl not to start without a permit; that the work will be in
accordance ith the approve pl In th se of wor whL) ._). \ ich requires a review and approval of plans.
{ X
A..:
Applicant's Printed��ttName Applicant's Signature
i11V! �"",atv. }>t' ,vi "' „� i1 A" ;4 ''f*r'ii 3 + Ik �a ,,p a yt 'r � t 7,17 . T7r f,
ail A M ni ��—n 'orf"tt,i'ft s ¢-) P �`j��}q- i 4`:.1.4 t.j {� t' ` t x
tIP
S .t'z�'t,d-t�� � 'S" >^� ��9t .� t,,i, !� i�'.'�,'4Y.^1P Lr'i � b l i a f *•'-,,'i
L e S~, �t5 t P.• ', 'T , 'I,. �siS.-{ , R V ed ?' ij? it �` ,tif f, y1,z12� ® 3. } 6i'`FQCe �� w,iR[. . k51! } gs �'Sj � 3� Y M N tL T jai S � � ;�.a� } i �. W 5, ,r�k 4= . 4gt�}y/'. f4:04 k ).11. , i' ,iI I 'G}t p.t'P T{ .; ,-,t ' ;" , te*j ., .�f `7.7 , ;'.{tg' `,` � 'is t a •yY/- i:f 1 to, ,��i. t $F5 .,b �'�i+3 �h -ey�t'y �S+t���TY�2 ti�# � .,�$7� ;'i"t b� �..5t (, S t ''<� tt i2Sj Xz:
' e. re° S. c � �,iig ` nder.Group'.aa a t! rRoucl i siAlrc }tle Q°t i 1t, tea
f ,.. } ,y, a . ,:::. u 1 , tl r k e j` { FAS, ",.,}�,t. � .1,10, �2 l',ty � a tiS: .C:44:004:':; :
F t, sx #e
r�y^':E,!;41 .,}���`r1b.;}k_1'�5` F y�7�nr#}+```l ...'�..' ir�.je"x��11.��t3. F+1'3Th;)s�4�t .�'!i.... � s.;q1 t,. �.e�l�!�tttq`f°A kC�t F� < i;:: { t�#b�;ft`��,� t..'�ict t�3 F
5 �` ��-�'��,� aoloi_ReaO t �� }lytarto �;te � �., � >>:� ;,;•,�� ' �,
��„Q,�.��.R.�����te� ter�s��. r�y�:lze�� .�R .� !:��,�A;4 s� ,'
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA150881
Date Issued:07/27/2018
Permit Category:ePermit
Site Address: 1424 Kingswood Ponds Rd
Lot:9 Block: 2 Addition: Kingswood Ponds 1st
PID:10-42050-02-090
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:Two or More Windows/Doors
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 or installing Bay or Bow
windows, 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: 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 -
Gene Tste A Fletcher
1424 Kingswood Ponds Rd
Eagan MN 55122
Renewal Andersen
1920 County Road C West
Roseville MN 55113
(651) 264-4777
Applicant/Permitee: Signature Issued By: Signature
/10\\•C' /.
'II
' U i716
For Office Use t4
, D
AG A.
,1--,i,',1„
Permit*
E ,,,:, ,,3 zola i Li V-7
Permit Fee: / / 4--• ' 0
Date Received: I
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651)675-5675 I TDD: (651)454-8535 I FAX: (651)675-5694 Staff: 111(51
buildinqinspectionst&cityofeaqan.com L _i
2018 RESIDENTIAL BUILDING PERMIT APPLICATION
10-23-2018 1424 Kingswood Ponds Road
Date: Site Address: Unit#:
Gene Fletcher
Name: Phone: 952-212-2229
Rent!'
esid
_ ' Address/City/Zip: 1424 Kingswood Ponds Road, Eagan, MN 55122
owner
•
X
Applicant is: Owner Contractor
. '
'
'
Type of Work Description of work: t-FePair Liiii 7;14 00///,4,/t•
'
00 000.
Construction Cost: $3, Multi-Family Building: (Yes /No X
Contact:
Company:
HHC Inc Hartley Huber
11100 Wets River Road Champlin
Contractor Address: City:
State: MN Zip: 55316 Phone: 763-422-8958 Email: hhc@hhcadditions.com
BC452069 NAT-108595-2
License#: Lead Certificate#:
If the project is exempt from lead certification, please explain why:
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:
i Fire Suppression Contractor: Phone:
NOTE Plans and supporting documents that you submit are considered to be public fhfOireeheh;.Peitianaalihet,OieehehttiaiOai=4".j'
classified as non-'ublic if .ii .rovide .ecific reasons that would .,,reit the C ' to conclude that the eretreOesecreli
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's
website at vvww.cityofeaqan.com/subscribe.
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.
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.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 appr v I o !ans.
x Hartley H Huber
x 1
Applicant's Printed Name Appli n Signature
DO NOT WRITE BELOW THIS LINEt1
f
d.` Pd. /--- ----d-q.. .--.
SUB HYPES
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
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 30�� Occupancy 5,+,L.-/ MCES System
Plan ReviewCode Edition Aiplj SAC Units
(25%_ 100% 1/) Zoning a s/ City Water
Census Code h/ 347 Stories — Booster Pump
#of Units i Square Feet -- PRV
#of Buildings / Length Fire Suppression Required ----
Type of Construction Width
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
Footings (Deck) Final/C.O. Required
Footings(Addition) 12.- Final/No C.O. Required
Foundation Foundation Before Backfill HVAC_Gas Service Test Gas Line Air Test Hood
Roof:_Ice &)Vater _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
Insulation Windows
Sheathing Retaining Wall:_Footings_ Backfill_Final
Sheetrock Radon Control
Fire Walls Fire Suppression:_Rough In_Final
Braced Walls Erosion Control
Shower Pan Other:
Reviewed By: e�%! , Building Inspector
O ' I /
RESIDENTIAL FEES
Base Fee 0 ' '5,'
Surcharge
Plan Review ?4,Tl
MCES SAC
City SAC
Utility Connection Charge
S&W Permit&Surcharge
Treatment Plant
Copies , _____
TOTAL
Page 2 of 3