4754 Nicols RdRESIDENT /OWNER
CI
N ame: � f�iire Phone: 2 / 3 - -//& 0
Address I City / Zipy ?T / �/
/v., c.n /s /e, � y e.e .3" 2,L_
CONTRACTOR
Name: License #:
AN( ELL AIRI; INC
,
Address: 12252 Ni collet Ave. S. City:
State: $ 'nsville, MN 554.3Z
Tel. 952- 746 -5200
Contact: Email:
TYPE OF WORK
PERMIT TYPE
New Replacement Additional Alteration Demolition
Description of work: ' - /clef .e,✓ack
,/ RESIDENTIAL
Furnace
COMMERCIAL
New Construction
- s e
Interior Improvement
Air Conditioner
Install Piping Processed
Air Exchanger
Gas
Exterior HVAC Unit
Install / _ Remove)
Heat Pump
Under / Above ground Tank (
Other
_
** When installing /removing tank(s), call for inspection by Fire
Marshal and Plumbing Inspector
RESIDENTIAL FEES:
$55.00 Minimum Add -on
or alteration to an existing unit (includes
burned out appliances, ductwork, etc.) (includes
$5.00 State Surcharge)
$5.00 State Surcharge) $ S5 ' TOTAL FEE
$95.00 Fire repair (replace
COMMERCIAL FEES:
$75.00 Underground tank
$55.00 Minimum (includes
installation /removal OR
State Surcharge)
$10,010, surcharge is $ 5.00
surcharge increases by $.50 for each $1,000 Permit
Fee requires a $ 5.50 surcharge)
Contract Value $ x 1%
_ $ Permit Fee
- If the Permit Fee is less than
Fee = $ Surcharge
- If the Permit Fee is > $10,010,
(i.e. a $10,010 - $11,010 Permit
= $ TOTAL FEE
City of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
RECEIVE
JUN 0 71011
2011 MECHANICAL PERMIT APPLICATION
Date: OA Site Address: 4 / 7 S/ /(/i G41/
Tenant: ���aIe/
Use BLUE or BLACK Ink
Permit #:
Permit Fee:
Date Received:
Staff:
Suite #:
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 t case of work which requires a review and approval of plans.
x 6
C
x
Applicant's Printe
✓GI , G ✓J'ldl M
Name
A ican s Signature 9 nature
. INSPECTIUN REC4RD I Gontrol No. u4i3
CITY 01: EAGAN PERMIT TYPE: Hi? l 11 11111111110
3830 Pilot Knob Road Permft Number. 00039'111
Eagan, Minnesota 55123 Date Issued: 06 l11/92
(612) 681-4675
SITE ADDRESS: LaY f 3 R t O C R , 1 APPLICANT:
n!V,q HICOLS RD R'•. M HOME5
Pr7 { r, ( 612) 440-6901
PERMIT S?IlBTYPE:
TYPE OF WORK:
NeW
INSPEc . .. .
Ut, l" I N6
F?NAMLNC?
_
.,....,,..?... LNSItLAI'TON
t illar FtREPiACE
aF HARK<, t kCcr r v'r t
pav S&w r>LeR. .. tAkEsxaF pt.ee.
7" M?F+?-?.'--zTin1: - .. '..'K?.•.-. ? .?
i?..'r?_ '?`' ?V. .l::g'?r •k • '. i
?"•J?P__ ?i fl,?z..?.?ha.
i3e'.
ae.mn No. wrmn Moia.r Date re?ne#
siw
PlUM81NG /Tlev
HVAC Nzo' s'Z 0aw"0005
ELECTRI
ELECTRI
Inepwtlon date Insp. CommeMs
Footings I S
Found8lioA ?
Framing Q?
t D
Roonng
Rotgh Pmp X ./ ?
Rough Htg. • ?-7-2. ?31?- /fK r? "' w
isui. ,??sZ S
Fireplace
Final Htg. 7 l -fA
Orsat Test ''7l'!? ?
Final Plbg.
_ . Plbg, l
-1VaWv Plum
.x " aqc
Gonst. AAeter
EnprJPlen
Bldy. Fh181
Deck Ftg.
DeClc Final
weu
Pr. Disp.
?
?
J 65446
REOUEST FOR ELECTRICAL INSPECTION
? Sae Instmclions for tompleting thls (orm on back ot yellow copy.
'X" Be/ow Work Cs;hered by This Request
EB-00001 a
?:? ??'•
.., V/
ew Add Fep. ` TypeoBuiltling AppliancesWired EquipmentWired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apl Building Dryer Other (Specity)
Comm./Industriai Furnace
Farm Air Conditioner
Other(sueciyi GonVacbrk RemaBS:
Compute lnspection Fee Below:
# . Other Fee # ServiceEMranceSize Fe # CircudsiFeeders Fee
Swimming Pool 0 to 200 Amps 0 to 700 Amps -
Trensformers Above 200 _ Amps Above 100 _ Amps
Signs inspecmr§ Use Only: ?0 TpTAL p
Irrigation Booms
Special Inspection
Alarm/Communication THIS INSTALLATION MAV BE ORDERED DISCONNECTED IF NOT
Other Fee ? COMPI.ETED WITHIN 18 MONTNS.
I, the Electrical Inspector, hereby
certify that the above inspection has
been made. Rough-in
Fi„ai
?? -
OFFICE USE ONLY -
This request voitl 18 manths Imm
J 65446 a
Request 0ate '
--g- 5?'9' Fire No. Rougn-iYlnspection
Fequi?ed?
es ? N.
? Ready Nowl No?ify InspectOr
Wlcen Reatly?
I,;;415censed conhactor ? owner hereby request inspection of above electrical work at
Job Atldress ?Slreel. Box or Raute No.) ?, Ciry
Section No. Townshlp Name or No. Pange No. Cou '
7 Phone No.
PowerS her Atlaress 19
•
Eledrical ConVaclor (Gompany Nam l Contrdcbr5 ' nse No.
?
Meiling Adtlress fn[raclor or Owner Making nstalletion?
Authorizetl Slgn ure iConlrectorlOwner Makinq Inslallajn?an, P ne N?umber
MINNESOTA STATE BO/ HD OF ELECTqIpTY , THIS MSPECTION REQUEST WILL NOT
Griggs-MiCway Bltlg. - Hoom 5493 BE HCCEPTED BV THE STATE BOARD
1821 UNVerslly Ave., SL Paul, MN SSiOq UNLESS PROPER INSPEGTION FEE IS
Plrone (612) 642-0800 ENCLOSEp.
Address: 4754 NIGOLS ROAD Lot 3 Blk I Sac/Suh P0TrS
These items were/were not complete at the time of the final inspection.
Date: 7/2/92 Yes No (,U':f,
Final grade (6" from siding) C.IX
Permanent steps - garage kx
Permanent staps - main entry kll?
Permanent driveway V"
Permanent gas ?
Sod/seeded grass
Trail/curb damage ?
Porch ?
Basement finish
Deck ?
Please verify wlth the builder the removal of coof test caps from the plvmbing
system and the shut-off of water supply to the outslde lavn faucet before
fxeeze potential exists. &
PEMlFOM1ER
White - City copy Yellow - Resident copy Pink - Contractor copy
? t - 0 1
CITY OF EAG1'?N 3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
PERMIT 7
PERMIT TYPE
Permit Number:
Date Issued:
BUILDING
000399
0b/11/92
SITE ADDRESS:
4764 NICOL5 RD
LOT: 3 BLOCK: 1
POTTS
DESCRIPTION:
BuildYng Permit Type SF DWG
% Building Work Type NEW
UBC Occupancy R-3 M-1
Construction Type VN
r' Zoning R-1
Building Length ; 60
Building Width 36
- ._ ,..
.?
'??, ,? ?;-_-??, r;1??, ,-??'" ?rr"r ? ",••
REMARKS:
RECEIPT N C 0l$?I00- PRV S&W PLBR. = LAKESIDE PLBG.
FEE SUMMARY:
Base Fee
Plan Review
3urcharge
SAC
SAC $
SAC Units
Subtotal
VALUATION
$818.00
=531.70
=75.58
$700.00
100
;2,126.20
=isi,e00
MISC FEES $1,610.50
Total Fee ;3,736.70
CONTRACTOR: - APPlicant - sr. lx pvyNER:
R S N HOMES 14406901 000345RSM HOMES
16817 DULUTH AVE 16817 DUIUTH AVE
PRIOR IAKE f4N 65372 PRIOR LAKE MN 65372
(612) 440-6901 (612)440-6901
I hereby acknowledge that I have read this application and state that the
intormation is orrect end agree to comply with all applicable State of Mn.
Stat e? and ty ot Eagan Ord3nances.
? -
&X,n R.# r 111?1?
APP ANT/PERMITEE SIGNATl1RE IS5UED Y: IGNA7ORE
I Control No. 0413
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
SITE ADDRESS•
INSPECTION RECORD
PERMIT TYPE:
Permit Number:
Date Issued:
Lor: s BLOCK: 1 APPUCANT:
9754 IVICOLS RD R 3 M HOIqES
POTTS (612) 440-6901
PERMIT SUBTYPE: TYPE OF WORK:
SF DWO
Control No. 04-13
BUILDING.,_.,.
000399
05/11/92
NEW
INSPECTION
SITE ., .
FOOTZNG .,
FRRMING INSULATION
FINAL FIREPLACE
,...„.REMARKS: RECEIPT M PRV
F
L
.
S&W PIBR. ffi LAKESIDE PLBG.
ftti? iiLl cl 11i1q???? Zf•
(
'?t.tll'Id i? t
?•„?i ?t.ri? ?•?, u inL? i,?i
11". iir.r 10 cA
•?t? i??Iilii M"I.K U, I?
Ir.?ll..l.t
! il i' 4 ;; i DC{: ? I
.{d 117 t;0 1??
%t I I ?6 ,
11;i(j
? 0 1
. ,
3 ?
CITY OF EAGAN
1992 BUI@_DING PERMIT APPLICATION
681-4675
(h3 7 3 ?', ? C)
r
? ?° ?12'
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 when typing of permit is requested, but not picked up by last working day
of month in which re uest is made or lot chan e is re uested once ermit is issued.
Date %.: IA Valuation of work ?000- &_/ 000
Site Location: N?CO(S Kd/
STREET STE M
Tenant Name:
LOT ? BLOCK FsUBD. ?1? _ ,, 11 C1
R a huY.oG P. I.D. #
Descri tion of work: ? a.w..
The applicant is: ? Owner M-fo_?ntractor ? OLIIBY' (Deseribe)
Name Phone
Property LASt FIRST
OWner
Address
STREET STE M
I City State Zip
Company 9'5 Vy\ N4w?,Cn Phone 0'001
Contractor Address I6`bl1 M'C License # 3461
City CCZiOv\. Uikc- State Mo Zip i2A'GX)'A
-
Company Phone
Architect/
Engineer Name Registration #
Address
City State Zip
licensed plumber ?..A.?cS??e» i?tioc Processing time for?
r permits is two days once area has been.a ved.
nowledge that I hav read this plication and state that the information is
E
agree to comply wi all ppl' able State of Minnesota Statutes and City of
nces.
Applicant:
A
OFFICE USE ONLY
,. .
BUILDING PERMIT TYPE
? OI Foundation
J3 02 Single Family
? 03 Two-family
? 04 Multi-fam. T.H.
? OS Apt. Bldg.
? 06 Garage/Accessory
O 07 Fireplace
? 08 Deck
? 09 Basement Finish
O 10 Swim Pool
? 11 Res. Add./Porch
0 12 Comm./Ind. New
? 13 Comm./Ind. Add
? 14 Comm./Ind. Rem.
? 15 Public Fac.
WORK TYPE
? 16 Agricultural
? 17 Building Move
? 18 Demolition
O 20 Miscellaneous
P 90 New ? 93 Remodel ? 96 Move
? 91 Addition ? 94 Repair ? 97 Demolish
? 92 Alterations ? 95 Tenant Finish ? 99 Undefined
GENERAL INFORMATION
Occupancy '-? ,?y ?
'- Basement sq. ft. // SZ MWCC 3ystem
Zoning , -7 lst Fl. sq. ft. ii,sz City Nater ?
Const. (Actual) v41 2nd F1. sq. ft. i9 PRV Required
(Allowable) v/y Sq. Ft. total Booster Pump
# of Stories z Footprint Sq. ft. Fire Sprinkler
Length &0 On-site well Census Code
Depth 3 G,33 On-site sewage SAC Code ?
APPROVALS
Planning Building Assessments
Engineering Variance
REQUIRED INSPECTIONS
0 Site (3 Footing P Framing Q Insulation
ja Wallboard JD Final ? Draintile ? Fireplace
1,
Permit Fee vatuac;m: $ IS 60a
?i-
Surcharge
Pl
R
i 9sso
- 3Ok-Z? _ 6'yo
(?
ev
an
ew 5
3/, 2o _?8 a G r
-
License zdk G
MWCC SAC 17 Z = 3 z
` ?-z? z o ?%f•a
Ci ty 5AC
Water Conn p o -
//S'z,?-?p= 7833 ? z mpr /o : zao
.
Water Meter ?S Z?,? yo ?, ?? .. ?o z yo
Road Unit 30
Treatment P1.
Road Unit 30
15'0 ?k z ?2
Park Ded.
Trails Ded. 300
380
Copies 53= ?Z 3zg
Other J f50, ?Dy
Total : ? :3C-7 _-"__--
SAC %
SAC Units
, ?.
r
exz•eretou IiNVEI.Ori: nvi:Rner "U^ COnru•rA•riuu
owurri GC.:S.?_UV?,??
st•rr
CONTIU1CCOft I? "A • Iti
on•re__4L?V'.L`??` riio?ie ??-?5.4l?
Determine worAiny :quace footage oC each.
1. 'COW1 cxpo5ed •.rall arca ....... 2SB •y .y. ft. x .IL = 28 V. .5
2. 'rotal coof.cciling arca ....... 17t3q,e cy. ft. x .025 = tr4. l,.
Total exposed wall area above floor =.9 5t%q•,
a. 2'otal wall vindow area .................................... .2 oT nr/
b. Total door arca .. . . . . . . . . . . . . . . . . . • • • . .. . .. . . . . . . ... . . . . . . 77?
c. Total sliding glass door'area ............................. ;3,52-• _
J. Total Cireplace vall area ................................. o (t,-r?RC? ?
e. To[al wall Eraming area (averaqe lOC) ..................... ??,-? 3`??
f. Total net va11 area above Elooc ........................... .R(.r419 -45L.
g. TOta1 rim joist area ....................................... e2G? • 4Z.
Total exposed Eoundation arca = 133- 33
Vi. Total foundation winc]ow arca .............................. e?
i. Total net foundation area abovq yrade ..................... 1?• 3•33 _
Getermine "U" value of each wall Sr.cpnent.
a. X"U..
b. %'?.r; x °u°
c. :33 >a. x °o- . 75 =
d. C% x ..U.. (; (r _
P. ?5b. tf x .,U.,
r. 2G?yq_t_ x..U..
.?. z?>jv, y Z :•: ?????• , ? Y?__ --
:,.
. ?-u1-? ?3s 33 ...., , o fs? 1?? `( ?r
_ . .._. . ,?,
) ................................._...To cal -l 7 K._ 3y
(C itcm ql is the samc as, or es. than item ql. You I?ov?: uaet ch?t ioC?ont
o[ SilC GOOF,fc12. ?39 ) c,y$M-? 1 Z.ki4• 3""? ??`t'
q
. Total exposed roof/cciling arca a (7``?Ou) _
. j. T9ta1 skylight area ....................................... O
1;. Total rool/eeiliny framiny aroa (averayu lU'r•) • • • • • • • • • • • • • 1'7 K ,?
? 1. Total net inculated roof/ceilinli area..................... c'S:L-
Ontermine "U" valur: for cach eoof/ceiling seymenr.,
j. v x.,U,. p _ U
k. l7b, ? x..U.. . 02'4 y• z`f
.. i. Il(,os.tp X..U„ , p;aZ = 3s°. sz.
a ............................ . ......Tota1 = 35'4)
IE total of N4 is the same or less than R2, you liave met tlic intenS of
5BC 6006 (c)1. 9-Aa.K • q 6 r414, .) ""A
s A c. t? o o r.. C? ? 1
- Alternate Huilding Envelope Design To utilize the total envelope sysCem methal, tLcvalucs establish-_d by [he
sum oE items N7 and 04 sha11 noC be greater Chcin tlic sum of item> al and k?.
+ 2. 3?h'1_-
3. J7??3y + 4. 31.4,1
?. ?
C3 I 7. ?i ti J t:wLs < .
r?o.A:... 7 •I,u..,?t??,j
CITY OF EAGAN
3830 PZLOT RNOB ROAD
EAGAN MN 55122
PHONE: (612) 454-8100
Maxx? ;????
. .,.,:.._.f..<...:,
FOR CITY USE ONLY
PERMIT #
RECEIPT # U
DATE: CO
PLEASE COMPLETE UPPER YORTION ONLY FOR SINGLE FAMILY DWELLZNGS &
TOWNNOMES/CONDOS WHEN PERMITS ARE REQIIIRED FOR EACH UNIT.
WORK DESCRIPTION
NEW CONST
ADD ON
REPAIR
OWNER NAME: ?7S/+-? f/ri+'/L J
SITE ADDRESS: 3f'74_Y ?/Jc.lk?.cS R V
IAT: ? BLOCK I SUBD. ?'n 9' ?? /1 ?(l /?
INSTALLER: 14XEJInt P?,g !
ADDRESS: A?yE> ?/i?.?'9,Jnu'a- .IO
COMPLETE THE FOLIAWING:
N0. FIXTURES EA. TOTAL
ADD-ON MINIMIJM 15.00
/ SHOWER 3.00 1,.0
T WATER CLOSET 3.00 f,w
.Z' BATH TUB 3.00 i."
`/ LAVATORY 3.00 %d-W
? KITCHEN SINK 3.00 J-w
/ LAUNDRY TRAY 3.00 d-w
HOT TUB/SPA 3.00
{ WATER HEATER 3.00 3_?
J FLOOR DRAIN 3.00 3••o
GAS PIPI..G OJ:.
_j (MINIMUM - 1) 3.00
3 ROUGH OPENINGS 1.50 '/.4'D
_ OTHER
WATER SOFTENER 5.00
PRIVATE DISP. 15.00
U.G. SPRINKLER 3.00
SUBTOTAL $ ST. SURCHARGE .50
TOTAL: S ?• 1'3
?i1`tRiERGIALfI?IpII$?'&?AL; PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS AND
MULTI-FAMILY BIIILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH
DWELLING UNIT.
-------------
CONTRACT PRICE:
OWNER NAME:
SITE ADDRESS:
LOT: BLOCK _ SUBD.
INSTALLER:
ADDRESS:
CIT'Y: ZIP:
PHONE #:
FOR:
CITY OF EAGAN
FEES
18 OF CONTRACT FEE.
STATE SURCHARGE - $.SO FOR
EACH $1,000 OF PERMIT FEE.
$25.00 MINIMUM FEE.
CONTRACT PRICE x 18
STATE SURCHARGE
TOTAL:
(SIGNATURE)
CITY: ?9e%:9t:G 4?,J ZIP: .54-X8
?
5I NED TZAL
- --.,.- .- ..................
CITY DF EAGAN ??j? b
3830 PIIAT RNOB ROAD
EAGAN, TIIi 55122
PHONE (612) 454 B100
wHANICAI..;T?RMLT
FOR CITY DSE ONLY
PERMIT if
RECEZPT # /0
DATE: S ?
PLEASE COMPLETE QPPER PORTION ONLY FOR SINGLE FAMILY DSJELLINGS &
TOWNHOMES/CONDOS WHEN PERMITS ARE BEQIIIRED FOR EACH IINIT.
WORK DESCRIPTION
NEW CONST ?
ADD ON _
REPAIR _
OWNER NAME:
SITE ADDRESS: `? Z'L`t` dU lC?d ?S ??f IAT:J_ BLOCK / SU&D.
FEES
ADD-ON MINIMUM
HVAC 0-100 M BTU 614?.
ADDITIONAL 50 M BTU 6.00
GAS OUTLETS - MINIMUM ?
OF 1 PER PERMIT
Ov
SUBTOTAL:
STATE SURCHARGE: .50
:CTAL:
INSTAId.ER: Burnsvllle Heaiino PY d jP. Inr.
12481 Rhode Island Aue. So.
ADDRESS: Savggg„ M N Sci_17R.1129 SIGNATURE OF PERMITTEE
894-0005 e_& ?- ?'1 e r-(IA rv?C--
CITY: 2IP: S-g pAV 0'ISTG
PHONE Vt_n+ __.?
tO?IMERCiALJ1NbS55TRZi4T.;: PLEASE COMPLETE THIS PORTION FOR ALL C0MMERCIAL/INDUSTRIAL BUILDINGS,
APARTMENT BUILDINGS, AND IS[JLTI-FAHILY BUILDINGS WHEN SEPARATE PERMITS ARE
NOT REQUIRED FOR EACH DWELLING IINIT.
------------ ____________________•._____----------------- ___-_____----__
CONTRACT PRICE:
OWNER NAME: _
SITE ADDRESS:
IAT: BIACK _ SUBD.
INSTALLER:
ADDRESS:
CITSf: ZIP:
PHONE #:
FOR:
FEES
19 OF CONTRACT FEE.
STATE SURCHARGE - $.50 FOR
EACH $1,000 OF PERMIT FEE.
F.ZOCESSED PIPING - $25.00
$25.00 MINIMUM FEE.
CONTRACT PRICE x 18 $
STATE SURCHARGE
TOTAL:
S
(SIGNATURE)
CITY OF EAGAN
??& e- 7
2007 RESIDENTIAL BUILDING rERmiT nrrLicnTrorr
City Of Eagan
3830 Pilot Knob Road, Eagan NIN 55122
TelepLone 9 651-675-5675 FAX # 651-675-5694
New Conshuction Revuirements
3 registered sife surveys showing sq. R. of lot, sq. R of house; and all mofed areas
(20%marimum lot Eoverage allowed)
1 Soils Report'rfproposed buiWing is to be placed on disWrbed wil
2 copies of plan showing beam 8 windor+sizes; poured found design, etc.
1 set of Energy Calculations
3 wpies of Tree PreseNation Plan'rf bl platted after 7l1193
Rim JoistDetail Options selection sheet (6uildings with 3 or less units)
Minnegasco mechanical venfila6on form
RemodeUReoair Reouiremenk
2 copies of plan showmg footings, 6eams, joisfs
1 set of Energy Calculations for heated addi6ons
1 site survey for additions & decks
Adtlition - indicate if on-site septic system
??o -oa
Otfice?UseDrtiv
Cert MSurveylRecd:. Y `-?N
Soils Repod Y _ N .
Tree Pres Plan Recd _Y N.
TreePresRequired' _Y N
On-sReSep4cSystem Y _N
Plans are considered public information unless vou state they are trade secret and the reason.
Date ? l/d 7?'j"Z Constructiou Cost ??4_R2900
n
SiteAddress ??5?? /vLLrJ/S /CO c,,(? e2??Cid, IInit/Ste iF
/
Description of Work lY e{-?n?'
Multi-Family Bldg _ Y / N J Fireplace(s) _ 0 _ 1 _ 2
?J? ?
Property Owner /I/( J3(.p'?,
4?? Telephooe #('jr5j ) 3 0?! " l?•b O
? Lt C
Coutractor
,
Address
49 4
. ,(l?e. ?a / City t
State A Zip Telephune # ?p (2
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv I _ Minnesota Rules 7672
Energy Code Category . Residential Ventilafion Category 1 Worksheet • New Energy Code Worksheet
(d su6mission type) Submitted Submitted
. • Energy Ernelope Calculations Su6mitted .
In the last 12 mon}hs, has ihe CiTy of Eagan issued a permit for a similar plan based on a master plan?
_ Y _ N If yes, date and address of masier plan:
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 ordinarices 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 c work which requires a review and
approval of lans. j
Ap's Printed Name JApplicant's Signature
DO NOT WRITE BELOW TFII5 LINE
Sub Tvpes
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bidg
? 02 SF Dwelling ? DS 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 PorchlAddn. (4-sea.) ? 33 E#. Alt - SF
? 04 02-plex ? 10 OS-plex ? 18 Deck ? 23 Porch (screen/gaze6o/pergola) ? 36 Multi Misc.
? 05 03-plex ? 11 10-piex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex - ? 25 Miscellaneous Work Tvpes
? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
El 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteration ? 37 Demolish Building* ? 43 Reroof ? 46 WndowslDoors
? 34 Replacement •Demolition (Entire Bidg) - Give PCA handout to appiicant
D@SCrIptlon: 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 Bldgs Length Fire Sprinklered
Type of Const Width
REQUII2ED INSPECTIONS
_ Footings (new bldg) _ Sheetrock
_ Footings (deck) _ Final/C.O.
_ Footings (addition) _ FinaUNo C.O.
Foundation HVAC -
Drain Tile . Other
Roof
Ice & Water Final _ Pool Ftgs Air/G as Tests Final
_
_ Framing _
_ Siding _ Stucco Lath _ Stone Lath _Brick
_ Fireplace _ R.I.
Ai r Test
Final _ Windows '
_
_ Insulation _
_ Retaining Wall
Approved By: , 6uilding 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
Surrve?or?s G'ert?f<cate
SOD'41'49'E 92 50
8URVEY FOH: R 5 M Ilomes Inc.
DE8CftIBED AS: I,ot 3, B1ock 1
F'07'TS AUDITION, City of }iagln,
pakota County, Alinnesota and
reserving easemerits of recorJ.
N
E,iwst Nowe
?
I PROPOSED ELEVATIONS
Top o) Foundalbns ' . qr,r.o
Q818fJb FlOW v 94.0.6
B8401T6ft FbOf s q529
Approx. Sewer Service Elev. e"/n
Ptoposed Elevalbns e O
Exlsting Elavelbns e
breinege Oirecllons e ....... r
Deirotes ol(sel Slake a O
HEDLUND
Planning Engineering SuivWng
fi01 Eat l?naniM?a,a^ ??y #?7l? MYw?aqlMiO
ti
O
W
m
w
?
W
Ln
e.
R
?
m
z
0
s? --- - _ . -y5
?--
i
I)
?I
?I
?I 1
?
I
I
I
f
!
?I
1
-tl- -
I I
I I
x? ?0
?
- ?
I
I
I
?
?
?
9?x
? I
I ?
mN ?
I
I
?? 2 952
? I,
I 0
I 50'BO 8
? r 1
A ? l
r???e 14GD 1400
T R
!s e
?ia?
g te s?
?? ?
a
,
i
816.0 _
460. 1
? Pring ? '
-- ? -J
i
?
? oj?4
?L - ------
qs? ?N00•
N 92 50
NICOLS
BENCNMARI(, S„n mp &D z,Y
?
?
tV
?
W
Of
m
z
4b?
By
?EAGAAT
As9.4b
rc
ROAD A
fZim=953.(09
OT SQ. F,OOTAGE = 28, 6n??? RE??0RED
L Allt? SE7BACK FiEQUIREMEN
?---?
SCALE* 1 Incfi a 30 Feet
Ftont - ? Novse Slde - to
Rear - 15 (lwago Side -s
1 HERE9Y CEIITFY T11J1t iH13IS 11 Tfll1E AN[)C011RECT 11EPIlESENTATION
OF iH6 BOUNOIIRIES OF THE ABOYE DESCRmEp pROPERiY AS Sll11-
VEYEOBY 1+E OFI UMER MY DIRECT SUPERYI3M M1NU OOE8N0T PUNPORT
TO SF{[NM IMPROHEMENT3 OA ENCROACHNIEHiB, EXCEPT 113 SHOWN.
wte 4 , ?0.1?2 O, ?? ,.u
.liNOC3REN. LAND SURVEYOR
M NES07ALICENSElA1MBER 14318
?
n?o
J08 F10.:
'i2R-IS!
snotc: racE:
CADD FILE: OVYO. CNK.
Rsm92-2 I
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 4754 Nicols Rd
Lot: 3 Block: 1 Addition: Potts
PID:10- 58550- 030 -01
Use:
Description:
Sub Type: e - Underground Sprinklers
Work Type: Backflow Preventer
Description: New
Meter Size Meter Type Manufacturer
Comments:
Fee Summary:
Contractor:
Preferred Plumbing
6400 High Point Trail
Prior Lake MN 55372
(952) 447 -5761
Dan Clough
3880 Willowwood St
Prior Lake , MN 55372
952- 447 -5761
PERMIT
City of Eaan
PL - Permit Fee (Res Modifications)
Surcharge -Fixed
Total:
Applicant/Permitee: Signature
- Applicant -
Permit Type:
Permit Number:
Date Issued:
Permit Category:
Serial Number Remote Number
Owner:
Laurie J Kaltenbach
4754 Nicols Rd
Eagan MN 55122
$30.00 0801.4087
$0.50 9001.2195
$30.50
I hereby acknowledge that I have read this application and state that the informa
of Minnesota Statutes and City of Eagan Ordinances.
on is correct and agree to comply
h all applicable State
Issued By: Signature
Plumbing
EA079166
08/06/2007
ePermit
Line Size
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA168310
Date Issued:04/16/2021
Permit Category:ePermit
Site Address: 4754 Nicols Rd
Lot:3 Block: 1 Addition: Potts
PID:10-58550-01-030
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: 5,000.00
Fee Summary:BL - Base Fee $5K $118.00 0801.4085
Surcharge - Based on Valuation $5K $2.50 9001.2195
$120.50 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Mark John Huffington
4754 Nicols Rd
Eagan MN 55122
Great Lakes Home Renovations
14690 Galaxie Ave, Suite 100
Apple Valley MN 55124
(952) 891-3400
Applicant/Permitee: Signature Issued By: Signature