1472 Kingswood Ponds Rd
Use BLUE or BLACK Ink
I For Office Use
I I
Permit ficin
City of EaEd
I Permit Fee:`
3830 Pilot Knob Road j
Eagan MN 55122 I Date Received: I
Phone: (651) 675-5675 I I
Staff:
Fax: (651) 675-5694 L _________________I
2010 RESIDENTIAL PLUMBING PERMIT AP LICATION
tl~ /~C7 y
Date: 42-2Lo Site Address: 7 2 A; ~ /J!2 S woo A)
Tenant: Suite
RESIDENT/ OWNER Name: J~ Ir k` 66 / Portex
Address / City / Zip: I W /T N
CONTRACTOR Name: ,,~lGcrk~ll0l~/U.Qi Z7ftC- License (C~ S'~-~dY!
Address: q 7 ~O S- g C7 17114 Ulf City:
State: " Zip: S-9-3.30 Phone: -7& 7- S_ ~ 9
Contact: r'oeo Email:
TYPE OF WORK _ New _ Replacement _ Repair - Rebuild Modify Space - Work in R.O.W.
Description of work:
PERMIT TYPE RESIDENTIAL
Water Softener
Water Heater
Lawn Irrigation RPZ PVB) Add Plumbing Fixtures (4 Main Lower Level)
Septic System Water Turnaround
_ New
Abandonment
RESIDENTIAL FEES:
$55.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge)
$35.00 Lawn Irrigation (includes $5.00 State Surcharge)
$55.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge)
*Water Turnaround (add $166.00 if a 5/8" meter is required)
$105.00 Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge)
$95.00 Fire Repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge)
TOTAL FEES $
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.goi)herstateonecall.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 wit 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 pl s
x jO~, MnNV /~l~W .`,el x
Applicant's Pri ted Name Applicant's Sign ure
FOR OFFICE USE Reviewed By: Date:
Required Inspections: -Under Ground -Rough-In Air Test Gas Test -Final
CITY OF EAGAN
CASHIER: JS TERMINAL NO: 767
DATE: 08/18/00 TIME: 13:33:17
ID:
NAME: JIN JOO HYUN
3716 9220 1472 KNGWD PD R 114.00
3713 9220 1472 KNGWD PD R 50.00
3865 9220 1472 KNGWD PD R 840.00
Total Receipt Amount: 5,771.35
CR136101
USER ID: JAN
************?**************************
CITY OF EAGAN
CASH IER: JS TERMINAL NO: 767
DATE : 08/18 /00 TIME : 13:33:15
ID: •
NAME : JIN JOO HYUN
2252 9220 1472 KNGWD PD R 30
00
3210 9001 1472 KNGWD PD R .
1,744
15
3866 9379 1472 KNGWD PD R .
100
00
3422 9001 1472 KNGWD PD R .
1,133.70
2275 9220 1472 KNGWD PD R 1,089
00
3446 9001 1472 KNGWD PD R .
11.00
2155 9001 1472 KNGWD PD R 0
50
3743 9220 1472 KNGWD PD R .
50.00
2155 9001 1472 KNGWD PD R 117.00
3868 9220 1472 KNGWD PD R 492.00
CR136101 ** CONTINUE
USER ID: JAN ** CONTINUE
2000 BUILDING PERiaiA?PLfA'i1d- 11?(R?S?DENTIAL)
CITY OF EAGAN
?3830 PILOT KNOB RD - 55122
651-6814875
JOL4"+?
New ConahucHon Reaulremenls Remodel/Reoair Reatd?
v 3 reglatered aite auneys ahowing aq. H. of lot, aq. 8. of house 2 copies of plan ?
and gi roofed areaa (2096 ma)imum lot coveroae alloweN 1 set of energy calculaHons for heated addiflona
> 2 coples of plana (ahow beam & window slzea; poured fnd. deslgn; efc.) 1 alte aurvey for axtedor addlflons d decks
> i set of energy calculatlons
> 3 coples of hee preaervatlon plan It lot pWtted aHer 7/1 /93
DATE: '*?j CONSTRUCTION COSi: ? ? Da, Oo o °O
V
DESCRIPTION OF WORK: 1C'rt.r+'?J /y /V",?? ?,O?ST7^uCt?o?'/
STREET ADDRESS:
o Y? S
LOT: BLOCK: 2 SUBD./P.I.D. ri: 'r
Name: nl?? `,'h Phone #:
PROPERTY 'rast First
OWNER D??? ?QJ
Sheet Address: ?Ir
Clry '61a0'**inq State: Zlp:
• Company. Phone #:
' (area code)
COMRACTOR cl:D
Sheet Address: Da /V'V• Ucense # N? Exp.
City /3 /o o rr, 7 nI Z-7cn _ State: 11-f"'J 2ip: 5S'S? 3'
ARCHITECT/
ENGINEER Company:
Telephone f: ( )
Name:
Sheet Addreas: Regtstratlon #:
City
State:
Zlp:
'
.
Sewerhnrater licensed plumber (if installina sewerlwaterl: Phone M
I hereby acknowledge that 1 have read this applicaHon, state that the infomwtion is cortect, and agree to 7comply with ap applicable State
of Minnesota Stalutes and City of Eagan Ordinances. / vv?-W-
Signature of Applicant:
.
OFFICE USE ONLY
Certificates of Survey Received ? Yes _ No
Tree Presenration Plan Received _ Yes _ No ? Not Required ?
BUILDING PERMIT SUBTYPES
? 01 Foundation ? 07 05-plex
?V 02 SF Dwelling 0 OS 06-plex
? 03 01 of _ plex O 09 07-plex
? 04 02-plex ? 10 08-plex
? 05 03-plex ? 11 10-piex
? 06 04-plex ? 12 12-plex
WORK TYPE
CW 31 New
? 32 Addition
? 33 Alteration
? 34 Repair
OFFICE USE ONLY
,
? 13 16-plex 0 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Att - SF
? 18 Deck ? 23 Porch (screened) ? 36 MuRi
? 19 Lower Level ? 24 Storm Damage
Pibg _Y or _ N 0 25 Miscellaneous
? 20 Pool ? 30 Accessory Bldg.
? 36 Move Bldg. ? 43 Reroof
? 37 Demolish (Bldg)" ? 44 Siding
? 38 Demolish (Interior) ? 45 Fire Repair
0 42 Demolish (Foundation) ? 46 WindowslDoors
' Give PCA handout to applicant for demolition permit
GENERAL INFORMATION
SAC Code 0/'
No. of Units
No. of Buildings ?
Const. (Actual)
(Allowable) ?
UBC Occupency -Q
Zoning -
# of Stories
Length
W idth
Basement sq. ft.
Main level sq. ft.
?6?t Sq. ft.
MISCELLANEOUS INSPECTIONS
? Stucco/Stone
APPROVALS
Planning Building L-46
? Gh g6E sq. ft. ?! 7
-52_ sq. ft. ?
71 Footprint sq. ft. a6dfc)
i0°a ? Census Code 1 D/
i767 MC/ES System
1571/ CityWater YK,3.
8 17 Booster Pump
PRV
MA
Fire Sprinklered
Engineering
Variance
Permit Fee
Surcharge
Plan Review
License
MC/ES SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
0
Valuation: $ . 3 epOIJ
X sS
?z.?!r= ay,??rs'_ 3G3o
a-7 3Y S a?
• / ? ,'?„Qcr?2
--
?
i5,7
r
.
=a6? /,v?
SAC Units 3 31 9p?
/o SAC
MNcheck C(kMPLIANCE REPORT
Minnesota Energy Code
MNcheck Software Version 3.0
COUNTY: Dakota
STATE: Minnesota
ZONE: 2
CONSTRUCTION TYPE: Single Family
DATE: 7-25-2000
TITLE: 00-338
PROJECT INFORMATION:
Jeffrey & Kim Hyde
COMPLIANCE: PASSES
Required UA = 844
Your Home = 707
16.2% Better Than Code
Permit #
Checked by/Date
Area or Cavity Cont. 6lazing/Door
----- Perimeter R-Value R-Yalue U-Value UA
----------------------------
CEILiNGS ------ ------
2297 --------
45.0 ---------
0.0 ---------- -------
62
WALLS: Wood Frame, 16" O.C. 3745 19.0 2.0 210
NALLS: Stress-Skin Panels 508 8.4 60
YALLS: Concrete, Interior Insulation 236 11.0 0.0 22
BSMT: Conc. 8.8' ht/8.3' bg/8.8' insul 495 11.0 0.0 28
BSMT: Conc. 3.5' ht/3.0' bg/3.5' insul 35 11.0 0.0 3
GLAZIN6: Windows or poors, Above Grade 793 0.310 246
GLAZIN6: Windoas or poors, Above Grade 148 0.330 49
GLAZIN6: Windows or poors, Above 6rade 25 0.350 9
DOORS 18 0.230 4
FLOORS: Over Unconditioned Space 512 38.0 0.0 13
FLOORS: Over Outside Air 28 38.0 0.0 1
HVAC EQUIPMENT: Furnace, 90.0 AFUE
C(MPLIANCE STATEMENT: The proposed building design described here is
consistent with the building plans, specifications, and other calculations
submitted with the permit application. The proposed building has been
designed to meet the r quirements of the Minnesota Energy Code.
?.
Builder/Designer f,?i Date?2, ? O° 0
AFFIDAVIT OF EXEMPTION FROM STATE CONTRACTOR LICENSE.
State of Minnesota ) ss Affidavit of Jin Hyun
) (Building Permit Applicant)
County of Dakota )
Tv? being first duly sworn, upon oath, deposes and states the
(Building Permit Applicant)
the following:
1. This Affidavit is submitted in connecrion with the building permit application made by
Jin Hyun (BuildingPermitApplicant) for a proposed work project
located at 1472 Kingswood Ponds Road , Eagan, Minnesota.
2. I acknowledge and understand that Minnesota Statutes, s326.84, requires all residential
building contractorshemodelers to obtain a license from the Minnesota Department of
Commerce, unless otherwise exempt under the statute.
3. 1 am exempt from the residential building contractor license requirement pursuant to
Minnesota tatute s326.84, Subd. 3, for reason(s) indicated below (check those that apply):
a. I am the owner of the residential real estate on which the home shall be built and I
will do the work myself or jointly with my own employees or agents that I am
building such home as my own personal residence and intend to permanently live
therein.
b. I am an architect or engineer engaging in professional practice as defined in
Minnesota Statutes, Chapter 326.
c. My annual gross receipts are less than $15,000.
d. My contracts on individual projects in aggregate do not exceed $2,500.
e. I am a mechanical contractor, plumber, or an electrician.
f. I am a speciality contractor, remodeler, ar material supplier involved only in part
of the proposed improvement to the residential real estate.
4. I acknowledge and understand that the statements in this Affidavit are made under oath and if
I make any statement in this Affidavit that I know to be false or incorrect, I understand that I
could be subject to criminal prosecution or denial or revocation of the building permit or
both.
FURTHER YOUR AFFIANT SAYETH NOT.
Dated: 9 3- J 9-C7lj
U V'k
-J 1 h To b
(Building Permit Applicant)
Subscribed and sworn to before me
this day of ,
Jin Hyun
9501 Dakota Road
Bloomington, MN 55438
(Print/Type Appltcant's Name and
Address)
Notary Public
.
,•
.
LOT SURVEY CHECKLIST FOR RESIOENTIAL
BUILDING PERMIT APPUCATION
• ? PROPERTY LEGAL: Znr 721XR' Z KxIVF-Sk/OOD ONOS 'SFr'?I NQ ?IDDlTLO/?I
h DATE OF SURVEY: ?'i 17/0 0
?
?
LATEST REVISION:
?
? DOCUMENTSTANDARDS
? p
O?
fa ? .
Regi.stered Land Surveyor signature and company
? • Building PermitApplicant
? • Legaldescription
? • Address
:9?1 North arrow and scale
33 .? • House type (rambler, walkout, spiR w/o, spiit entry, lookout, etc.)
vl? ? • Directional drainage arrows with siope/gredient %
r?a??? ? • Proposed/exosting sewer and water services 8 invert eievaUOn
?' ? ? • Street name
? • Driveway
p ? • Lot Square Footage
?/a ? • LotCoverage
ELEVATIONS
Existina
? ? • Sewer senrice (or Proposed)
? • Property corners
m? o
? •
• Top of curb at the driveway
Elevations of any ebsting adjacent homes
?? Adequate footing depth of structures due to adjacent utility Venches
Prooosed
a o • Garage floor
g?o ? • First floor
g? o? • Lowest exposed elevation (walkoutlwindow)
? o • Property corners
C3 ? • Front and rear ot home at the foundation
PONDING AREA ('rf aoolicable)
p/ ? ? ? Easement line
p/? ? • NWL
r? ? ? • HWL
? ? ?
V • Pond # designation
?
o • Emergency Overflow Elevation
o' p ? .
?
? ?
o •
a/? ? .
r?
? p?? ? p .
•
DIMENSIONS
Lot GnesBearings & dimensions
Right-of-way and sUeet width (to back of curb)
Proposed home dimensions induding any proposed decks, overhangs greater than 2', porches, etc.
(i.e. all sVuctures requiring permanent footings)
Show aA easements of record and any Ciry utilities within those easements
Setbacks of proposed structure and sideyard setback of adjacent exasting structurea
Retaining wall rer+uirpmpntc if anv
Reviewed:
Maroh 1988
caaIGMUocaaMr.FM
CERTIFICATE OF SURVEY
Survey fcr: JEFFERY HYDE
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HOUSE
UNDER-CONST.
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8'uusoN = ' DESCRIPTION: Lot 7, Block 2, KINGSWOQR,?; PONDS SECOND ADDIT!ON
V##
&%OF Proposed Grades: Top of block 863_0 Goroge Floor _ 862•5 Basement Floor 834.0
V7D SURVEYoRS NOTE: Circled elevations are proposed; others ore existing. Arrows denote direction of drainage.
330-77
Revised 8-8-2000
BENCHMARK
TOP NUT HYORAM SE CORNER
OF LOT 12 BLOCK 2
ELEV. = 850.23
AREA
LOT AREA = 40,403 sq.1t.
ROOF AREA = 3,238 sq.ft.
I hereby certify that this survey was prepa
registered land surveyor under the lows of
CARLSON & CARLSON, INC.
LAND SURVEYORS
Tele. No. (952) 888-2084
,
N
SCALE; 1° = 30'
N
J l
am
m
* Denotea Iron Monument Found
0 Denotes Iron Monument Set
red by me or under my direct supervision, and that I om a
the State of Minn o a. Dated this 7th day of August, 2000.'
Larry;R. Couture, Lond Surveyo
Minnesota License No. 9018
RECEIVED AUG D 8 2000
PERMIT# '/ ( ?9I
RECEIPT DATE: ?
MIDENTIAL PLiJMIM PERMTf APPLICATION
CiTY Of ER6i4N
S$SO PII.OT KNOB RD ?
EAfiAN, MA 55122 651-6$1-4675
Please complete for: ? single family dwellings
? townhomes and condos when permits are required for each unit
? backflow preventer for irrigation system
SITE ADDRESS:
OWNERNAME:: TELEPHONE
(AREA CODE) b ? 3?p
INSTALLER NAME: L,vcx,??d`Q C JELEPHONE #: ?1Sa - 5l3a.-?
STREET ADDRESS: (AREA CODE)
CITY: -i?>JC- t/\:s L'? t I.t C
STATE: (?•L.,?\? ZIP: . S 375 --,?
Place a check mark next to the aermit work tvne
x New residential dwelling unit under construction and not owner/occupied $ 90.00
Add-on, modification or alteration to existin dwelling unit, including: $ 50.00
• abandonment of septic system
• new installation/repairlrebuild of RPZ
• lawn irrigation system
• water turnaround
Nature of work:
Septic System, new/refurbished - $ 225.00
• includes County & Consulting Inspector fees
• requires MPC license
?
II
APR 1 2001 U
State Surcharge $ .50
Total $ 9'b.50
Reminder. Be sure to schedule inspections of alterations, i.e. water heaters, water softeners, etc.
I hereby acknowledge that I have read this application, state that the information is c rrect, and agree to comply with all applicable Cityof Eagan ordinances. It
is the applicanYs responsibility to notify the property owner that the City of Eagan KtwthinCity s no liability for any damages caused by the City during its normal
operational and maintenance activities to the facilities consVUCted under this pe- ay/easement.
SIGNATURE OF PE MITTEE
Updated 1/01
PERiVIIT #: 4u (.-., I ?
CITY USE ONLY
RECEIPT DATE:
ftUIDENTIAL MECHANICAI. PERM1T APPL1CATION
crrY oF EAsAx
S$SO PILOT KNOB RD
£A6AN 1HR 55122
651-6$1-4675
Please complete for: ? single family dwellings
townhomes and condos when permits are required for each unit
Date: c) )
SITE ADDRESS: 1r:.
OWNER NAME: czo 'T? v ? TELEPHONE #:
AREA CODE)
INSTALLER NAME: "??21 TELEPHONE #:
(AREA CODE)
STREETADDRESS:
.
CITY: T,Q?-? ,?yrp? STATE: ZIP:
-?'
P18ce a thetk mark neYt to the earmit wnrk tunP
_ New residential dwelling unit under constructionand not owner/occupied $ 70.00
_ Add-on, modification or alteration to existina dwelling unit $ 50.00
• furnace replacement
• air exchanger
• air conditioner
• other
Nature of work:
State Surchar e I
$ .50
Tota I
Ren:inder: Call for inspectio?ts.
SIGNATt'RE 4t P
u r
? AUC
?
I j
?j
Updated t!O]
CITY USE ONLY
PERMIT #:
APPROVED BY:
INSPECTOR
RECEIPT DATE:
COMMERCLdtL M£CHAN1CAI. PFJtMIT APPL1CAcT10N
CTI'Y oF EA614N
3$30 PILOT KNOB itD
EAsA1v,Mv 55122
651-681-4675
Please complete for: all commerciaVindustrial buildings
multi-family buildings when separate permits are not required for each dwelling unit
DATE:
SITE ADDRESS:
OWNER NAME: PHONE #: -
(ARFA CODE)
TENANT NAME (IMPROVEMENTS ONLY):
WAS THERE A PREVIOUS TENANT ]TV THIS SPACE? Y N. NAME:
INSTALLER:
ADDRESS:
CITY:
PHONE #: -
(AKL-.A CODE)
STATE: ZIP:
WORIC TYPE: New construction Install U.G. Tank
_ Interior Improvement Remove U.G. Tanl:
_ Processed Piping
Specify Nature of Work
Wlien installirag/removing ui:derground tank, call 65I-681-4675 for inspectiat by Fire Marskal ai:rl
Plum6ing Iinspector.
Fees: 11/o of contract price OR $50.00 minimum fee, whichever is greater.
Underground tank removallinstallation = nnnimum fee
Contract price: $ x 1%= $ (Base Fee)
State surcharge calculate at $.50 for each S 1,000 Base Fee
TOTAL $
SIGNATURE OF PERiV11TTEE
Updated I/O1
Use BLUE or BLACK Ink
r-----------------+
I For Office Use �
' � Permit#: �� °�� I
Clty of ����� � �/ �� �� �
� Permit Fee: �O
3830 Pilot Knob Road � �
Eagan MN 55122 � Date Received: �
Phone: (651)675-5675 I 1
Fax: (651)675-5694 I Staff: �
I I
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit#:
' Name: � Phone: � �2�� L ""r
Resident! � �,�� � 0.w
Quyng� ' Address/City/Zip: � � 2 ` ��V� ',�U_ .�72.
' Applicant is: Owner Contractor
=, � p � � ►-s
� q :� Description of work: � � � �
Ty�e�rf W�rk
Construction Cost: Multi-Family Building: (Yes /No�
Company: 2�`-;1/\ 1J�� �-- � Yt���ontact: 1��' � u'�S
COt1tPaCtOt' , Address: ��,5� l��St S� v�' City: � � l, e—
Stat�.�Zip: S '�(� � Phone(Q�2+��1"��ll�mail: Q� 6--�. � �h
�Co3o3F5�
License#: 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:
N(?T�;Plans anal suppctrting��d�icumer�ts°�fhat yv�submit�r�cnr�side�ed f'c�#��publi�infcrrmat�pn. P�trtions of �
th�inform�tiori=rn�y be�cfassi�eal�s�r}ari�n�rbl�c�ff;yc�u;�rc���ale s�a�eific reas�ns��that woulal permif t�ie City ta
�arrctud .t�raf#hsy are trad�se`�re��.
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.aoqherstateonecall.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 �C�-e-i� r�,s X
Applicant's Printed Name c ApplicanYs Signature
Page 1 of 3
Use BLUE or BLACK Ink
r-----------------'+
I For Office Use {� � / �
� � Permit#: � �1� I I�
City of ���a� � ��- ; ��
� 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
I I
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit#:
' Name. e. ''CG l Phone:C��2..�� (� C�Z� (
Res�dent! � � o"�. �K �2
Qyyn�r Address/City/Zip: 2 � O�n
' Applicant is: Owner Contractor
� (
= � Description of work: G- �� V Q. f• � g.... `C�,�2„
���Y.I?�g�,11�Ic�Ck �
sy t /�
^ � ` '. Construction Cost:
l V 0 U Multi-Family Building: (Yes /No�
Company: o C�U I,�Q_��-- Contact:
Contractor ' Address: City:
State: Zip: Phone: Email:
License#: 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:
Nt7TE:Plans and supporting dact�mei��.fh�t ytr�sr�b�ni�`are�ons�tlerec���be pu_bl��infarr��tiar�, Pvr#ions af .
ttie information ma�if be clas�ified as nc�"rr;�:Rublic if yo�:pra��aC��pecrfi��e�s�n�t�rat wc�uid p�rrnet fite°City'#Q
+�an�l,ude'thai't�+�:are tr�de se�r�#�. ', ,.
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.orp
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; th he 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 completed within 180
days of permit issuance.
XJ� � X
Applicant's nted Name p ig e
Page 1 of 3
Use BLUE or BLACK Ink
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' � Permit#: l J���� I
City of �a��� �
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� 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
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2015 RESIDENTIAL BUILDING PERIMIT APPLICATION
Date: Site Address: Unit#:
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���� � Description of work: -�`t�.�.C�..� ��G`; � S
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� State: Zip: Phone: EmaiL•
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';' License#: Lead Certificate#:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTIIVG A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan ��ased on a master plan?
Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer�Water Contractor: Phone:
� NOTE�PIans��nd sup�o��rigtlocum% s��h�af}ro`"�subm�t are co�►siale��d�o be �ub�"��"','for "ai`ror� �P'o o�s;�of��;
�the rnformat�on ma �be"`�c/ass fretl as non ublic�� ou r4�+' e s ecii�c e�so�s#haf ould� r �!�� � ta
r �
����..;;. �h ���� ��� , ���.,��canclud��:fha���ey re�aal'e s�ecrefs �,���� � _��. � .� � ���
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.popherstateonecall.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 Sltate B ' ode must �pleted within 180
days of permit issuance. y"'�.,:�%%"
x J-e � � X /'��`�.�i'F*rf f� f
.
ApplicanYs P nted Name App4i gnature -
�,; y'� Page 1 of 3
r`�
, Use BLUE or BLACK Ink
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I For Office Use � �
' �� � �� �
Permit#: `� I ��
Clt� of Ea��� ; . ;�� ,� ;��,
Permit Fee. � �
3830 Pilot Knob Road � �
Eagan MN 55122 � Date Received: �
Phone: (651)675-5675 I I
Fax: (651)675-5694 I Staff: I
I I
2015 RESIDENTIAL BUILDING PERMIT APPLICATION ��
Date: Site Address: Unit#:
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�N� � �� Name ">>�� �� , / �'7"7 Phone: �!�' "
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QW � Address/City/Zip:1°� �'S/�/�J�'S"filt�cJGf ��'� �_' �'�76�✓f,� -��/��r�Z
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����} �� ��k��h2 Construction Cost: �. .k� Multi-Family Building:(Yes /No )
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�ntact:
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�.�n � Sta: Phone: Email: �"'
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�a�� ���� �,�. License#: tl�"..�ead Certificate#:
If the project is exempt from lead certification, please explain why:
�U��.7' /�J aZR�'G �2 � �
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: �
x , • a�
Fire Suppression Contractd`r: . ' Phone:
� ���'E Pla��ana� ��vor�i "�' �cume #� ou s�� ��e'`� z�li���fo�►n����� �n�s��
�����e rnfc�►�nat�on rn� e �ed as� ic rf � �1 �r� �.w,� �������rc���d �� �i#y
n �
, ° ��x: ���'`.. r � ude�tt� t ,., �d�"seci�#s� #� �f� f ���: �
�
,���.: ..., ,�' �u � . p�.F m... � m{..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.aopherstateonecall.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 ?'�'' l`-� � / e�,� x .. `:-C� ,`�,�,,, "�` ,. :,:,.
Applica Ys Printed Name Applicant's Signature �
Page 1 of 3
�` �� fi'p/�S �C�DO NOT WRITE BELOW THIS LINE �� ��
�"7 7� �r �SG;�[[��� ` .
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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
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 �D A� Occupancy ��G -/ MCES System '–""
Plan Review Code Edition �Ol� SAC Units �
(25%_100% !!) Zoning y� City Water """"
Census Code �1��! Stories Booster Pump '"'
#of Units � Square Feet (�Z 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) � Final/ No C.O. Required
Foundation HVAC Gas Service Test Gas Line Air Test
Roof:_Ice &Water _Final Pool: _Footings _Air/Gas Tests _Final
� Framing Drain Tile
Fireplace: _Rough In Air Test _Final Siding: _Stucco Lath _Stone Lath _Brick
Insulation Windows
Sheathing Retaining Wall: _Footings_Backfill_Final
Sheetrock Radon Control
Fire Walls Fire Suppression:_Rough In_Final
Braced Walls Erosion Control
Other:
Reviewed By: , Building Inspector
RESIDENTIAL FEES Gl�r�� /�,�ri/� Q /��/j� ���
Base Fee �9/ �
Surcharge
Plan Review /�„H ✓
MCES SAC
City SAC
Utility Connection Charge
S8�W Permit 8�Surcharge
Treatment Plant
Copies
TOTAL
Page 2 of 3
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�
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA172036
Date Issued:09/13/2021
Permit Category:ePermit
Site Address: 1472 Kingswood Ponds Rd
Lot:7 Block: 2 Addition: Kingswood Ponds 2nd
PID:10-42051-02-070
Use:
Description:
Sub Type:Residential
Work Type:Alteration
Description:Basement Fixtures
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Fee Summary:PL - Permit Fee (miscellaneous)$59.00 0801.4087
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 -
Mieso Koji
1472 Kingswood Ponds Rd
Eagan MN 55122
(612) 481-0380
Weld & Sons Plumbing
3410 Kilmer Lane North
Plymouth MN 55441
(763) 475-0296
Applicant/Permitee: Signature Issued By: Signature