991 Northview Park Rd
Apr, 5. 2011 5:51PM 5072821338 K S HEATING No,0117 P. 1/1
Use BLUE or BLACK Ink
17 ------i
I F~r,f9(Hce, I
z
City of EaRdR I permit: ll`D-/ I
I
3$30 Pilot Knob Road Permit Fee: o
Eagan MN 55122 I I
I Date Received:
Phone: (651) 675-5675 I
Fax: (651) 675-5694 Staff: 1
2011 MECHANICAL, PERMIT APPLICATION
Date: 3-,;29-1/ ! Site Address: _
Tenant; Sulte
RESIDENT I OWNER Name: t& U te - Phone:
Address 1 City/ Zip,
CONTRACTOR Name: License /J& -
Address: City. C,,.4lrak,7'+1"'-
State: zip; phone: 6a t7 t cMZ
Contact: 1' ~"il/7 Fall:
TYPE OF WORK -New ~Repleoement ,Additional ~Alteration Demolition
Description of work: _
NOTE: Roof mounted and ground mounted mechanical equipment Is required to be screened by City
Code. Please contact the Mechanical Inspector for information on permitted screening methods.
PERMIT TYPE RESIDENTIAL COMMERCIAL
XFurnace _ New Construction ` Interior Improvement
Air Conditioner Install Piping -"Processed
Air Exchanger Gas _ Exterior HVAC Unit
- Heat Pump Under/ Above ground Tank Install / _Remove)
" When installfng/removing tank(s), call for inspection try Fire
Other Marshal and Plumbing Inspector
RESIDENTIAL FEES:
$55,00 Minimum Add-on or alteration to an existing unit (Includes $5.00 State Surcharge)
$95.00 Fire repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge) 5L 0ZITOTAL FEE
COMMERCIAL FEES:
$75.00 Underground tank installation/removal OR Contract Value $ x 1 %
$55.00 Minimum (includes State Surcharge)
_ $ Permit Fee
- If the Permit Fee Is lass than $10,010, surcharge is $ 5.00
- If the Permit Fee is;- $10,010, aurcharge increases by $.50 for each $1,000 Permit Fee = $ Surcharge
(Le. a $10,010-$11,010 Permit Fee requires a $ 5.50 surcharge)
_ TOTAL FEE
CALL 13EFORE YOU DIG. Call Gopher State One Call at (651) 4540002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.nopherstateonecall.om
1 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 wo(k which requires a review and approval of plans.
Applicant's Printed Name Applicant's Signature
FOR OFFICE USE Reviewed By: Date.
Required Inspections: -Under Ground _ Rough In Air Test Gas Service Test -in-floor Heat -Final
Exterior HVAC Screening Inspection
CITY OF EAGAN 15440
3830 Pflot Knob Road, P.O. Box 21-199, Esgan, MN 551 21
PH O N E: 454-8100
BUILDING PERMIT Receipt?
To be used for n= Est. Value ' Date - ,19
Site Address OFFICE USE ONLY
1 4 L . • ?..k • .i.:
Lot 81ock Sec/Sub OnSiteSewage OccuPancy • ',- ?
.
MWCC System ?
Zoning
? K"1
Parcel No.
On Site Well (Actual) Conat
m Name Ti! BFkWC?r.K .; ''•, t, ,i-;?•- ? City Water (Allowable) v-'`
z
Address
`I PRV Required # of Stories
il: ° ti?`• ?-?1 1?:
City ? Phone Booster Pump Length ,
4 u
Depth 52 `
, p Narhe ' S.F. Total
oQ Addrpss Footprint S.F.
P City Phone APPROVALS FEES
~ ¢
yVj W
Name Engr.lAssess. Permit 546.00
`
fl
1 = Planner Surcharge `?' ?
Address 273.00
?ZW City Phone Council PlanReview ?
1?
Bldg. Off. SAC, City •
I hereby acknowledge that I have read ihis application and state that the Variance SAC, MWCC 550 •00
informetion is correct and agree to comply wkh all applicahle Sfate of Water Conn. 550' 00
Minnesota Statutes andCity of Eagan Ordinances. fi7
v0
Water Meter .
Signature of Permittee - Road Unit 3 2.5•vc'
A Building Permit is issued to: tS?'? ?. Treafinent P1 2 0 L . 0o
on the express condition that all work shal I he done in accordance with al I
Parks
appJicable State of Minnesota Statutes and City of Eagan Ordinances. t
' 1 ' 5d
Building Official
TOTAL
CASH RECEIPT
CITY OF EAGAN
3830 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE 79
RECEIVEO , , .
FqOM
AMOUNT $
& DOLLAFS
iao
? CASH C] CHECK
I . , 1j E ? ?1 4 1
? .
BY
White-Payers CopY
Yellow-Postirg Capy
Pink-File CoPY
Thank You
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
SITE ADDRESS•
INSPECTION RECORD
PERMIT TYPE:
Permit Number:
Date Issued:
• 1 011 ; I I ril 114.r
, ;t?it (I??V I k.4! 1'AFta NC?
PERMIT SUBTYPE:
fitl l! ft I Nfi
3.P.,
dA/11/174
APPLICANT:
TYPE OF WORK:
NJ 1.1
I 7
Pertnit No. Permit Hotder Date Telephone #
S/W
PLUMBING
HVAC
ELECTRIC
ELECTRIC
Inspection Date Insp. Comments
Fooiings I
Foundation
Framing
Roofing
Rough Plbg.
Rough Htg.
Isul.
Freplace
Final Htg.
Orsat Test
Final Plbg. Plbg. Inspector - Notify Plumber
Const. Meter
Engr./Plan
Bldg. Final
Deck Ftg.
Deck Final /r 9 j--
weli
Pr. Disp.
CITY OF EAGAN , 4 4 0
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHON E: 454-8100
BUILDING PERMIT Receipt#
To be used fpr ? Est. Value Date ,19
?
Site Addr6t8s r1l S2K Eii OFFICE USE ONLY
Lot ` Block ` Sec/Sub. I'? Xp'?jGTJ?; :it: On 31te Sewape Occupancy
^ ?'1
Q I
MWCC System Zor?ing
Parcel No. .
On Site Well (Actual) Conat
ir Name i"1C City Water k (Allowabie) V'"N
W Address ` j PRV Required # of 5tories
461
o ?_D 11 ?
City ' Phone 8ooster Pump Length ? ? ,
Depth
¢o Name S.F. Total
,
? `
Address _
Footprint S.F.
? Ciry Phone APPROYALS FEES
v
? . JU
''4
Q
WW
Name
Engr./Assess.
Permit
? g Address Planner Surcharge
??
`W City Phone Council Pian Review -T-V7-1.
Bidg. Off. SAC. City
? ?
I hereby acknowledge that I have read this application and state that the Variance SAC, MWCC .
information is correct and agree to Comply with all applicable State Of
WetefCOnn. ??
Minnesota Statutes and City of Eagan Ordinances. Water Meter 67.00
Signature of Permittee Road Unit 525.00
w.:
A Building Permit is issued ta _
Treatment P1 -104.00
on the express condition that all work shall be done in accordance with all p
applicable State of Minnesota Statutes and City of Eagan Ordinances. arks
TATA1
2,6W.35
Building Official
Permit No. Permit Holder Date Telaphone i?
Ptumbing <?
H.V.A.C.
f
E lectric
Softener
Inapsction Dats Insp. CoMments
Footings I
Footfngs II
Foundation
Framing
Roofing ?V
Rough Plbg. 9? 11
Rough Htg.
IsuL
F ireplace
Final Htg. l F ?
Final Plbg. . .?' ?
Bldg. Final
cert oco.
Temp. LP
Deck Ftg.
Decfc Final
Well CP??G?? i/Z ?l ^ 2-? r-T?' /i?
Pr. Disp.
!..• „ v
(gex#if iratit af (Orrupttnry
(Citp of (Eagan
ap#iorhilMlf Df lLttlbttlg ji1B,pPtfintt
This Certrcate issued pursuant to tlie requiremenls of Section 306 of tJre Unijonr= Building
Code cernj'ying that at the time ojrsstrance this siructure was in compliance with the vanous
ordinances of the Cuy regulating 6uilding construclion or use. For the following.•
use C1essiGnrioo SF DW'LCAR Bwg. Rmvi No. 15440
p-W-YTYPe ?mi Tooingpist:iu PD/RI 'lypeComt_ VN
Owner of Bw7ding fDORM40RKS M.r? , PC• Addrtss 1821 WALM YAM, ' WIS
a,wahng adaress 991 IJOI.MtVII?{+I PARK F40AD LmlitY L 11, S2, I.EAiIUM 9(7lIARE IH
: JUNE 14, 1989
POST IN A CONSPICUOUS PIACE
. . .. .- .1'tiY` . . _. . - , . . .
"
• ' •~; ' ' - PERMIT # -
'
MECHANICAL PERMIT
"
, • ` ' CITY OF EAGAN RECEIPT #
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE
CONTRACT PRICE: PHONE: 454-8100
Site Address ?? ?• ?= ' BLDG. TYPE WORK DESCRIPTION
Lot
Block ?-
Secl?ub
. , Res. New -
?
?.
Name • , j%__,
,. _ Mult Add-on
m Address Comm. Repair
Other
c Ciry
Name ' FEES
RES. HVAC 0-100 M BTU -$24.00
c Address ADDITIONAL 50 M BTU - 6.00
p City Phone ,- (RES. HVAC INCLUDES A/C ON NEW
CONSTRUCTION)
GAS OUTLETS (MINIMUM - 1 PER PEka+AlT) - 1
50 EA
.
.
TYPE OF WORK COMM/IND FEE - 1% OF CONTRACT FEE
BLDGS
- COMM
RATE APPLIES
APT
Forced Air M BTU .
.
.
TOWNHOUSE & CONDOS - RES. RATE APPLIES
Boiler M BTU MINIMUM RE5IDENTIAL FEE - ALL ADD-ON &
Unit Heater M BTU REMODELS - 12.00
MINIMUM COMMERCIAL FEE - 20.00
Air Cond. M BTU STATE SURCHARGE PER PERMIT - .50
Vent CFM $ - (ADD $.50 S/C IF PERMIT PRICE GOES
Gas Piping OuNets # BEYOND $1,000)
Other ?
FEE:
S/C: -? SIGNATURE OF PERMITTEE
TOTAL•
FOR: CITY OF EAGAN
ities Diizital Oualitv Control
The following image represents the best
available image from the original page.
Every effort was made to capture the content
from the original page.
PLUMBING PEIiM1T
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN $5122
Site Address ' 'I `' I
Lot jl Block -? Sec/Sub
? Name
? Address
c Ciry Phone '
- . ,..
Name ? - - - ' ?
c Address
p City Phone
FEES
COMM/IND FEE - 1% OF CONTRACT FEE
APT. BLDGS - COMM RATE APPLIES
TOWNHOUSE & CONDO - RES. RATE APPLIES
MINIMUM - RESIDENTIAL FEE - $12.00
MINIMUM - COMM/IND FEE - $20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
SIGNATURE
FOR CITY OF EAGAN
PERMIT #
Jn GY ?
RECEIPT #
DATE:
BLDG. TYpE WORK DESCRIPTION
Res. ?? New E
Mult. Add-on
Comm. Repair
Other
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
NO. FIXTURES TOTAL
D Water Closet - $3.00 $
LBath Tubs - $3.00
? Lavatory - $3.00 Z
1 Shower - $3.00
Kitchen Sink - $3.00
UrinallBidet - $3.00
?-Laundry Tray - $3.00
? Floor Drains - $1.50
? Water Heater - $1.50
Whirlpool - $3.00
? Gas Piping Outlets - $1.50
(MINIMUM - 1 PER PERMIT)
Softener - $5.00
Well - $10.00
Private Disp. - $10.00
=Rough Openings - $1.50
FEE:
STATE S/C:
GRAND TOTAL: •' '
^x p p ' 4W`°rV'gW"" v
PLUMBING PERMIT For Offic,
CITY OF EAGAN PERMIT# -L
CONTRACT
PRICE
Site Adss
Lot , --??
- Name
? Addre,
? City`-
?C5 Add
8 cRy
3830 PILOT KNOB ROAD, EAGAN, MN 55122 I RECEIPT #
, . PHONE 4548?f O0 QATE: -
SeclSub
Phone
FEES
COMMJIND. FEE -196 OF COMTRACT FEE
APT. BLDGS. - COMM. RATE APPLIES
TOWNHOUSE & CONDO - RES. RATE APLLIES
MINIMUM - RESIDENTIAI FEE $12.00
MINIMUM - COMM.IND.IFEE $20.00
ST?TE SURCHARGE PER PERMIT .50
(AD'DA.50 S/C PER EACH $1,OOQ OF PERMIT FEE)
BLDG. TYPy WORK DE5GRIP111
Res. New
Mult. Add-an
Camm. Repair
RES. PLBG. QNLY - COMPLETE THE FOLLOWING:
NO. FIXTURES TOTAI
Water Closet - $3.00 $
Bath Tubs - $3.00
Lavatory - $3.00
Shower - $3.00
Ktchen Sink - $3.00
Urinal/Bidet - $3.00
Laundry Tray - $3.00
Floor Drains - $1.50
Water Heater - $1.50
Whirlpool - $3.00
Gas Piping Outtets - $1.50
(MINIMUM -1 PER PERMIT)
? Softener - $5.00
Well - $10.00
Private Disp. -$10.00
Rough Openings - $1.50
PERMIT FEE:
? 5TATES S1C:
GRAND TOTAL: 5 • JU
_ ?: . _ ?
CITY OF„EAGAN Permit No: Date: `
3830 Pilot Knob Road Meter No: ///40 11 elO Z3 Size: -??
P.Q. 6ox 21199 Reader No: Date:
Eagan, MN 55121
vwrinr: ;Mharsanrka Kni ? ? rt;
Site Address: '<<, 1 Alc•rtt1t7icw Dar4 gnad ? j' 1:.7 OiPlumber. ;;@; 1 PT ?1whi n-f fOh1iA'7II E'5CC
Conn. Chg: Zoning:
Acct Dep: - No. of Units:
Permit Fee:
Surcharge: 1 agree to comply with the City of Eagan
Tr. Plant_ ?• • kl)Opa Ordinan
? Meter.
Misc.: Br ?
WATER SERYICIE PERIUII'I'J
f CITY OF EAGAN Permit No: Date:
3830 Pilot Knob Road _ B/ P No: Date: ? r-.' IR
? P.O. Box 21199
? Eagan, MN 55121
By
SEWER SERVICE PERMIT
Eagan, MN 55121
Permit No: Date:
Meter No: Size:
Reader No: Date:
Cann. Chg: _ 550.00p2
Acct Dep:_ _ 15 .OOpd
Permit Fee: 10. Surcharge: - • 50PKI
Tr. Plant_ -
Meter. ?
Misc.:
Zoning:
No. of l
I agree to comply wiih the City of Eagan
Ordinances.
ey
CE PERMIT ?
MWCC: ' ? ` • '?"`? Zoning• ",
City Chg: r,, •-, No. of Units: 1
Acct. Dep:
Permit Fee: I agree to comply wifh the City of Esgan
. . Ordinances.
Surcharge:
• CASH RECEIPT •
CITY OF EAGAN
. 3830 PILOT KNOB ROAD
EAGAN, MINNESOTA 5 122
DATE 18
?
1 $
a oow,as
,m
? GASH U CHECK
FUND OBJECT AMOUNT
oe? ?? !l ?j
? a< <<
Thank You
z
BY
N? 86715 , Whle-Payera Copy
Vellow-POSG'g Copy
Pink-File Copy
BLDG. PERMIT NO. ? d
LtmA?tU & &.
01-3210 Bldg. Permit
01-3422 Plan Check
01-3445 Surch.iAdm.
01-3446 SAC/Adm.
01-2755 Surcharge
75-3860 Road Unit
20-2275 SAC
20-3865 Water Conn.
20-3$68 Water Trmt.
20-3716 Water Meter
20-2252 Acct. Dep.
20-3713 Water Permit
20-3743 Sewer Permit
79-3866 Sewer Conn.
28-3855 Park Ded.
60,
TOTAL
'CITY OF EAGAN ?? 15440
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
BUILDING PERMIT PHONE:454-8700 qeceipt x &D5??L4
To be used for SF DWG/GAR Est. Value $93,000 Date AUGUST 15 ,19-8&-
Site Address • 991 NORTHVIEW PARK RD
Lot 1'I Block 2 Sec/Sub. LEXINGTON SQ 6TH
Parcel No.
a Name - TIMBERWORKS BUILDERS, INC
; Address 1821 WALSH LN
° CityMENDOTA HGTSphone 681-0112
a Name SAME
?0 a Address
¢ City Phone
City
I hereby acknowledge that I have read this application and state that the
information is correct and agree lo comply with all applicable State of
Minnesota Statutes and City of Eagan Ordinances.
Signature of Permitteese?.-•?
A Building Permit is issued to: TIMBERWORKS BUI ERS
on the ezpress contlition that all work shall be done in accordance with all
applicable Sta[e ot Minnesota Statutes and City of Eagan Ordinances.
8uildingOflicial -t,d2y.? T?-uM._I
OFFICE USE ONLY
On Site Sewage _ Occupancy R-3 M-1
MWCCSystem X Zoning PD R-1
On Site Well _ (qctuaq const V-N
City Water X (Allowable) V-N
PRV Required _ # of Stories
Booster Pump _ Length 461
Depth 52 '
S.F. Total
Footprint S.F.
APPROVALS FEES
Engc/ASSess. Permit 546.00
Planner Surcharge 46.50
Council Plan Review 273.00
Bldg. Off. SAC, City 100.00
Variance SAC,MWCC $50.00
Water Conn. 550.00
water Meter 67.00
Roatl Unit 325.00
rreatment Pi 204.00
Parks
TOTAL 2,661.40
II II II ?!I II II I II I I? II _REQUEST FOR ELECTRICAL INS ? UF
Minnesota State Board of Electncrty 7821 UmversAyAve Rm S 128 St Paul M
0 3 2 L 4 2 5 2Phone (612) 642-OB00 ome Duplez Api. Bldg. Oiner: '-' New Addn
mmerciol Indusirial Farm Remod Re ir
I Cond. Htg. Equip. Wafer Wr. Lood Mgmt. Other:
D
er Ran e Elec. Heot Tem $ervice
e
"X" above fhe work mvered by this request Enfer remarks in this space and an the back of fhe whife ropy anly.
Colcula}e Inspedion Fee - This Inspecfion Requesf will nof be accepfed withouf fhe corted fee:
Olher Fee # $ervirn EMrance $ize Fee # Circuils/Feeders Fee
Mo6ile Home Park $tall 0 fo 20Q Amps 0 fo 100 Amps
Sfree} lfg./(mHic Sig. Above 200 Amps Above 700 Amps
Tronsformer/Generator INSPECTOp'SUSEONLY TO AL
$ign/Outline Lig. Xfmr. d
Alarm/Remofe Conirol
Swimming Pool ?
I hereb ceni 1 t I Inx etled Nie elednml tnslollarion descnbed hereln on ihe dare
Irriga}'?on 8oom R«gh-In ?
tc
$pecial Inspedion ,
'
Investiga}ive Fee Fino?? ? ?'/t
`?t?
Dore
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 7 MO THS.
32 O- 4 2 5 0 OFFIC USE ONLY This reqoest void 18 monihslmm validvlion dole pnntad in thi, b.
c?+ 6a G
PLEASE PRINT OR TYPE
Request ote Roaghin inzpetlion reqolred2 ? Yes InxpMian Olhcr Thon Rough-In: R dy Now Q?II Call
? a ?Yov musf call the Inspeclor when reody) Dare Reody:
I, Wcensed contmdor ? owner here6y requesf inspeciion of fhe a6ove elecfrical work af:
Job Mdresx (Streel, Box, or Raute Na.) Gty Zip Co§51zz
Secrion o Towmhip Name or No. Ronge No. Fire No. Counry
?
Occupant Phone No.
La ? L
Power $opplier Addraz
Eletlncol Conhador (Compa, Name) Conrcador Liceme No. Mashr Lic. Na (Piam Elea. Only)
1 a iZ3
Mailing Addmi (Convoaor or pwner Pedo Insmllalion)
Auihon nawre?Co r r0+ er AorminglnsklMNan)
?r ?_ Phone NO. ?
1 I?L?Zi
EB-00&34,JV6/95 `J STATEBOARqCOPY-Ift,1NSTflUCT10NSONBACKOPYELLOWCOPY
_.9/??gs
E ?42 1"f` 37
REQUEST FOR ELECTRICAL INSPECTlON Ee-ooooi-os
1 See instructions for complating Ihis form ort back of yellow copy.
"X" Below Werk Covrred by This Reqiiesf
AAtl Nep. Tyoe of Bailtline Applinncea Wirad Equiu.+ent Wired
Home - Range Temporary Service
Duplex Wate, Heater Ligh[iny Fixtures
Apt. BuilAing Dryer Electric Heabn
Commercial Bidg. Furnace Silo Unioader
Industrial Bldg. Air Conditioner Bulk Milk Tank
Farm Othxo pou v OlFer ISp??cityl
me, suefv omi. an,;, Compu[e Insoeciion fee Below
p Fee ServiceEnhanca5ize H Fee Feadere/Sublenders b Fex Circuiis
% 0 ro200Ams 0 to30Ams Z 0 tr;30Ams
Above 200 qmps 31 to 100 Amps 37 to 100 Anyd
s
Swimming Pool Abave 100_Amps Ahove 1Q0-Amps
Transformers Irngation Booms Pertial-0th
Signs SUecial Insuection
TOTAL F
'
Nerr
v?rks
?y
,
E Cd,?5?
HouBh-in ? Da" 4)-ntp he Elec<icl
'
ecxr, nreev
thet the above
I Final %'?paclion has been
de.
sTOis repuesl voiE 18 manUS Iro.
This reques? void 9j?Q/??
18 momhs from
E 2 1 7--? 71 ji lzo
??y ??ce??sea ?iecenca? ?,unuacwr I hereby repuasl inspection oi ebove
\
? Owner elactricel work inatalled at:
Slreet AAA e]ss, Box or Ro le N
/
/ ? CitY
j
( O ir-
ectron o. Township Name or No. Range o. Cou
?
OccuV IPR1INi)
) Yf?V?L1-VL)6Y" `?, ? - ?
T ?`?CMY? Pho./? o. ^/
( ?C.^ o
0
ul rer
`
Address
?
C
ElecUi a Con ractor ICOmpany Namel Conhaclor's L- .ense Nn.
a?
Mailinp Adrdress (Con[ractor or Owner
O \ - -1 ?'/Z
l9 aking Instailation
)
?T
"
ed $iB`[ur Contr tor er xki Installation) Phone Num
I er_'
0 ]
MINNESOTA STATE eOAND OF?{LECTHICITY THIS INSPECTION flEQUEST WILL NOT
GrigBS-Midwey Bldg. - Room a 197 BE ACCEPTED BY THE STATE BOARD
1821 Universitv Ava.. St Paul. MN 55104 UNLESS PROPER INSPECTION FEE IS
an....e faili anI_nann ENCLOSE?.
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
17_?'? 3830 PILOT KNOB RD, EAGAN MN 55122
651-681•4675
New Construction Reauirements
• 3 registered site surveys showifg sq, fl. of lot, sq. ft. of house; and all roofed areas
(20°h maximum lot coverege allowed)
• 2 copies of plan showing 6eam & window sizes; poured found design, etc.)
• 1 set of Energy Calculations
• 3 copies of Tree Preservation Plan if lot platted aRer 711193
• Rim Joist Detail Opt selectan sheet (bldgs with 3 ar less unRs)
DATE
SITE ADDRESS
TYPE OF
??UA,P" t(
ar
7q0?0 . ev
MULTf-FAMILYBLDG _Y _N
_ FIREPLACE(S) _ 0 _ 1 _ 2
APPLICANT 0 ?" l(/ L? 2 Q
STREET ADDRESS ? I71 glINA CITY 10 STATF,ft?ZIP gm
TELEPHONE # Z- 4Z 70S CELL PHONE # OI2 ',7736" FAX # 9??- gfZ -5705:?"
PROPERTYOWNER 1411CYIG &I 4?7 TELEPHONE#
COMPLETE FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNFSOTA RULES 7670 CATEGORY 1 MINNESOTA RiJLES 7672
(4 submission type) . Residential Ventilation Category 7 Worksheet Submitted • New Energy Code Worksheet Submitted
• Energy Envelope Calculations Submitted
Plumbing Contractor:
Plumbing system includcs:
Mechanical Contractor:
Mechanical system includes:
Sewer/Water Contractor.
Water Softener _
Water Heater _
No. of Baths
Air Conditioning
Heat Rccovcry System
Phone #
Phone #
Fee: $70.00
I hereby acknowledge that I have read this application, state that the information is cd', ?? ?c???rje+"?td ? Iy
with all applicabie Stote of Minnesota Statutes and City of Eagan Or i an es. I I
? ?' AUG 2 6 ZOD2
Signature of Applicant ?l
---------__..-°-----------------------____--. ------------------- ---- __---------------°---------- y -- -------°-..._---- --
------- -
OFFICE USE ONLY --??-
Certificates of 5urvey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4/02
RemodeVReaair Reauirements
. 2 copies oi plan
• 1 set of Eriergy Calculations for heated additbns
• 1 site survey for eatenor additions & decks
• Indicate if home served by septic system tor additbns
VALUATION
_ Phone #
Lawn Sprinkler
No. of R.I. Baths
I S `7
Fee: $90.00
OFFICE USE ONLY
? 01 Foundation ? 07 05-plex ? 13 18-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt- Multi
? 03 01of_plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn.(4-seaJil ? 33 Ext.Alt - SF
? 04 02-plex ? 10 OS-plex ? 18 Deck ? 23 Porch (screened) ij ? 36 Multi
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
l
? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? i
25 Miscellaneous II '
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) O 44
II Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) 0 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)* ? 43 Reroof ? 48 Windows/Doors
? 34 Replacement *Demolition (Entire Bidg oniy) - Give PGA handout to ap Ip, Ilcant
Valuation Occupancy MC/ES S Ist , em
i
Census Code
Zoning l
City Water ,
?i
SAC Units Stories Booster Pii mp
Nbr. of Units Sq. Ft. , PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const W idth
REQUIRED INSPECTIONS
_ Footings (new bldg) FinallC.O. I'I
_ Footings(deck) _ FinaUNo C.O.
_ Footings (addirion) PlumUing il
_ Foundarion _ HVAC „
Drain Tile Other il
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas? Tests _ Futal
_ Framing _ Siding Stucco Stone ?
_ Fireplace R.I. Air Test Final Windows (new/replacement) I
_ Insularion I
_ Retainivg Wall ' II
l
i
Approved By Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE: B u zLn z N e
3830 Pilot Knob Road Permit Number: 0 2 3 2 7 5
Eagan, Minnesota 55123 Date Issued: 0 4/ 11 / 9 4
(612) 681-4675
SITE ADDRESS: Lo r: 11 B L 0 C K: 2 APPLICANT:
991 NQR7WVIEW PARK RD BLACKMtlN LONNIE
LEXINGTON SQUARE 6TH (612) 686-8618
PERMIT SUBTYPE:
DECK
TYPE OF WORK:
NEW
INSPECTION .. . ..
FOOTINGS FINAL
?
7
? ?
? CI7Y "OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
SITE ADDRESS:
P.I.N.: 10-45080-110-02
DESCRIPTION:
PERMIT
PERMIT TYPE:
Permit Number:
Date Issued:
991 NpR7HVIEW PARK RD
LOT: 11 BLQCKe 2
LEXIN6TON SQUARE 6TN
?.. _.
Buildin:g'.Permit Type pECK
Su3lding WYSrk Type NEW
1 ? (
( 4 l
4 ... ... ../'
_ J .
?
..:??_^.....e'.?1P??.. ' . . . -..F/.
. ??
suxL z{?G' (
023275
04J11J94
4
11, ?. 4 , r
REMARKS:
FEE SUMMARY:
Base Fee $30.00 COPIES $.50
Surcharge $.50 Total Fee $31.00
Subtotal $39.50
CONTRACTOR:
OWNER' - APPllcane -
LACKMON LONNIE
91 NORTHVIEW PARK RD
AGAN MN 55123
612)686-8618
I hereby acknawledge Chat I have read t'hi&
infiarmaCaon ie correct and agi-ee ta comply
SCatutes attd' C pf Eagan Ordinances.
L
APPUCANT/PERMITEESIGNATURE ?
application and state that Lhe
With ali appliealsls State of Mrn, (RA
pid, -IS EO B SIG ATUR'?-
-1
? ?q-6
CITY OF EAGAN
1994 BUILDING PERMIT APPLICATION
681-4675
P/1 a r(t- i?
0
$3I.00 _-----------
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
specificatians, 1 copy of energy calcs.
Penalty applies: 1) when permit is typed, but not picked up by last working day of month
in which request is made, 2) address is changed or 3) lot change is requested once permit
is issued.
Date i Valuation of work %?L)D./Jl3
Site Address: xled'?? l//CG'i le?le /rW / 14.daa,-/ 5-5-12 ?
STREET ? SU1TE #
Tenant Name: (commercial only)
LOT ? BLOCK ? SIIBD.
?
Ze
P.I.D. #
?
Descri tion of work: jlori
The applicant is: Owner ? Contractor ? OtI181" (Deseri6e)
Name Phone el,/2
D
Property LAST FIRST
Owner 0
2
pddress
g?l / X
:
STREET STE #
City L'4a State ;6'biX/ Z i p
Company C?A-J, e- Phone
Contractor Address License # Exp.
City State Ziq
Company Phone
Architect/
Engineer Name Registration #
Address '
City State Zip
Sewer & water licensed plumber . Processing time for
sewer & water permits is two days once area has been approved.
I hereby acknowledge that I have read this application and state that the information is
correct and agree to comply with all applicable State of Minnesota 5tatutes and City of
Eagan Ordinances.
Signature of Applican .
OFFICE USE ONLY
BUILDING PERMIT TYPE
0 01 Foundation
? 02 SF Uwg.
? 03 5F Addition
? 04 SF Porch
? 05 SF Misc.
WORK TYPE
31 New
32 Addition
? 06 Duplex
? 07 4-Plex
? 08 8-Plex
? 09 12-Plex
11 10 Multi. Add'1.
? 33 Alterations
? 34 Repair
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# af Stories
Length
Depth
APPROVALS
? 11 Apt./Lodging
? 12 Multi. Misc.
? 13 Garage/Accessory
14 Fireplace
15 Deck
O 35 Tenant finish
? 36 Move
Basement sq. ft.
lst F1. sq. ft.
2nd F1. sq. ft.
Sq. Ft. total
Footprint Sq. ft.
On-site well
On-site sewage
Planning Building
Engineering Variance
REGIUIRED INSPECTIONS
? Site 6 Footing ? Framing
? Wallboard Of Final ? Draintile
:?E_E
!
-2
? Insulation
? Fireplace
Permi t Fee vei,mc;m: g I?,
Surcharge "
Ptan Review
License
MWCC SAC
City SAC 'i
Water Conn.
Water Meter
Acct. Deposit ,
S/W Permit
S/W Surcharge
Treatment P1. 'Road Unit II
Park Ded. aG
Trails Ded. ?
Copies
Other II
Total:
SAC %
SAC Units
?i
?I .
'% .,
?0 15 Basement Finish
0 17 Swim Pool
IO 18 Comm./Ind.
?iO 19 Comm./Ind. Misc.
;i? 20 Public Facility
O 21 Miscellaneous
37 Demolish
MWCC $ystem
City Water
PRV Required
Booste'r" Pump
Fire Sp'rinkler
CensusCode
SAC Cad'e
Census Bldg
Census Unit
Assessments
?
,I
?? £ 3
?
? .? -?Z
? ?
-- --- „?
- , - .?
!? ? ---
` ? I ?? F?? ?
v
?? i
? ,
?U ? ?
??
, I ?
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? ? ??
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i ?? ' ? '7
?I ?? j
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ii ? ?
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, ? ? ? ? -s? £S
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i _?? ?
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. -_?-?-y ? ?
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+ I L ?
i ? ??i - ------ ' h V
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L ? ?
, ; ?- ? ?,
? I ___ \?pa ? -
4 ''r
ut
y
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. -----_ ?
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??1 (/ i Cn? ??'?n"?? ??? ?_ ? w,
/I ?
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S;F?,•iiu
<,;..;u+
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I,?rs?;•uu+
.
1988 BUILDING PERMIT APPLICATION - CITY OF EAG9N
SINGLE FAMILY OWELT.TNA3 ¦/ I I D
,
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OE SURVEY, 1 SET OF ENERGY CALCULATIONS
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH 6DDRESS
IS DESIRED. NO CFIANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
MULTIPLE DWELLINGS RENTAL ONITS FOR SALE UNITS P OF UNITS
INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SURVEY - CHECK WITA BLDG. DEPT.r
1 SET OF ENERGY CALCULATIONS
CONMERCIAL I
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS;
1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS
To Be Used For: 51„IbLE )C;lw?aluation: c?3, 00, ? Date:
Site Address 191 /vO,z77Ju/S.a P n OFFICE USE
Lot " Block .L
Pareel/Sub 574)1JA1tE f2
Owner / /•?f?L-G?oi1?4S 13e1464eS
??/
Address /?Z1 (Nq-tSlf I-,tAE
City/Zip Code I{?/G/QOT7h
Phone - / /a
Contractor 1'1m3F't1JJnrLr_S AdiclJAir-
..-? -
Address
City/Zip Code
Phone
Arch./Engr. .57o/f,.l 13A-rE.OcFH T.NG
Address 3/3/ Lq.r?e
City/Zip Code MN ,SS
Phone # ) - 9617 0
On site sewaget _
CC system ?
n site well
City water r
PRV required _
Hooster Pump `
8
APPROVALS
,
Occupaney R-3 M-I
Zoning Pp Q-I
Actual Const V-_N_
Allowable ? N
tk of stories
Length ?
Depth S 2`
S.F. Total
Footprint S.F.
FEES
Engr/Assess
Planner
Council
Hldg. Off . ?1?i5
Variance
Permit ,S 6, oD
Sureharge -/C , So
Plan Review o2Q,3, eZ1
SAC, City /00, 00
SAC, MWCC g? rn?
Water Conn , oo
Water Meter 67 °`I
Road Unit ;32c;,all
Treatment Pl t2 o 4 ?oa
Parks
Copies
TOT6L ? !o ,5n
Gs1 r??? e ?. ' p , . ?
• .v.? ,,,,; . %
gs? ,
728 xq(?= i z as
s x? ; ?o
_?--
13z? x r3 = I`126?
B mT5
22 = •?2' i?-
I X ( ? _ 3n.-
I3KLu '-l5= G7?lK
?Z3-7
`f
?
Certificate for:
Meritor Development
DELMAR H. SCHWAN2 Book Page
uwo aunvcvoa. nrc.
Mpbtw?! WMn ? d 1M M d Wnn?ol?
14750 80UTH ROBEHT TRAII ROSEMOUN7. MINNESOTA 56M 614/473-t7lY
3URVEYOR'S CERTIFICATE
81Z8
89a.7 r5 $?3.1
?0
?
?
?- 613.YD O
Z
Scale: 1 inch = 30 feet
rr? m?
Denotes iron monument AW ?
?
? Denotes set wood hub
,`?C.YI.O Denotes existing elevations
CDenotes proposed elevations
? ? from development plan
? Denotes direction of drainage
? 1
? (
Drainage & Utility
Easements
LoT
I,
UG
Z ?rqr ENY.»
ilon
?/
,
$9y p
N I
I ?
JI
O
M
? ;R?Z7 /0
/V
r\ 00
?
18
p'j 6Ar--
Z
?j ??P Cwea = gy2.3o
/YoQr?JVi?vJ ?AizK
Lot 11, B1ock 2, LEXINGTON SQUARE 6TH ADDITION, according to
the recorded plat thereof, Dakota County, Minnesota.
1
? ?P _ 9y; 79
_ Y
N
Jo
I
Ta°C?ea = 89z-81
Also showing the location of a proposed house as staked thereon.
I heroby certffy thtl UN suney. Plan, or ropoR was
propare0 Ey me or undx my dlrsctsupsrvfabn an0
that I am a duly Rplatsrod UrM Surwya unOSr.
Ms lavn ol 1M StNa o/ Minrnaotm.
oatw 5-5-/988
1
?
DEI_ti!AR FI.
= Jv rlVinNL
:?/?;• ,e
i
DNmw M.achwwu
MNmMOb N -, , bn Ib. l11P6 .
Bradley
- ?rchitecturo?!? consultants ?
.?. ?._. ... oma UK ..D.. .H. (")-494-972 -- --
Plan
DO te
t{ - r?k/C-L
n
rn
Slte Address:
1)TOTAL EXPOSED 1MALl AREA . ? 2 3 Z- s4ft a"U"sLI..
2)TOTAL EXPOSED RQOF/tElLIHO AREA s4 ft.:"U° ' 02(.=
iMALL AREA CIALCULATIONS:
TOtAL?•W?I?N?DOW AREA
GLAZED
TOTAL DOOR AREA
TOTAL GLASS DOOR AREA
-• nb?- GIAZED
TOTAL FIREPLACE WALL AREA
TOTAL WALL FRAMING AREA
NET INSULA7ED WALt AREA
TOTAL RIM JOIST AREA
TOTAL FOUNDATION AREA(EXPOSED)
TOTAL FOUNDATION WINDOW AAEA
1-7-7 sq.ft.x,U', .41 = 72.s?
'4 2 eq.ttxv°_4L= La ,ZZ
Sq.?G X ?IJ° ? J ? r
I:o ? 1q.tt.X?IJo ??. ' I 2,.BP?
ZCo2 _ sQ.ft.xU`? !P?= ? O' 4B
aQ.iLS"U° !?=
3) TOTAL ?
H ifem 3!s ihe same as, or less thon item l, you have mel ihe lntMt of
2 MCAR 1.I6006 A ond D.
ROOF/CEILINO CALCUlAT10N3?
TOTAL SKYLIGHT AREA
TOTAL ROOF/S.fILING FRAMING ARfA
NET INSULATED ROOF CEILING AREA
- ,a.nx'u" -0 _ '
12 5 3 sq.Ri U' :g?z= 2?
4} TOTAL . .?.
!I i?sm 4 Js the aame oa,or ?ess Ihan 1lsm 29 rou Aovs met }he JnfaM ol
Z MCAR 1.16008 A an0 0.
ALTERNATE dU1WfNe ENVEIOPE DEStON
To ufiJizs Hw totat a+v"pe sysNrn rrNMod, fAe sum af 1rorns f ond 2 sholl
be preatx thon fM sum of items J and 4.
S1 +4) _
r ns?ok ea.+rrr mm n?e arndrny n.r# aeacrraea xwft or oxceaft na staro ot ANnne:oto
EWOY ConrervaNon Ac?. ?? ?
F'
.n.' . . .. . ' "?.r . . . ?
' CEIUiIi KCflON ( IMSULATEDI
? O ?lt?rfa eir /i!m 0.6t
N-F. .5(0
(S 54.0%,? 1aS .a
(4 ilxfrfa alr tJlm (sHlf) Q.61
. . TOTAL N:±2.$
, . U • 1/R .oZL
t C£ILIIG rRAMtNG SECTION
l?9falot oir rlm
? ac.o,....., ??...?s
(4 faH?fa o(r /7fm
I (S VzWtAts ol loH
0
.TOTAL N ??•''?
y s i /N • oz(d
I
CEIUNG SECTION (INSULATEDl 0.61
( ? lnt?rlw atr /ilm
_ (Y
(3
(q ute?iw aJr tlfm istll!) O.W
TOTAL R
. U ¦ I/R
CEIUNG FRAMIHG SECTION • O_61
( ?,fnt?rla atr film
. te
/tlm '
(4 ifllorla oTr 0.61
in'cMs of soN rood -
. _TOTAL R
p(p05,£D eEA1N CEILINB`SECTlON
v (pf ?- ehr !Um 0.6
• It .
{3
(4 ` 0.11
(a a?i<rt? s(r ft
TO?AL R ?_-
y s J/R
I
- YENTED
.
op .
,
AL " • ?;
FRAYINfi 5ECTIOM
.
? ?lor atr Iflm 0.88
i
; ' n s 1 aoft w od ?"? '
4 ? 32 P?I?Dp-?tEr z l?Ea
5
0+!fLrior oir film 0.17
TOTAL R ? ? •?I'
U = 1/R.?
SECTION (INSULATED)
I lnferlor air film
2 s!L
; Sn f'?S
4 f??Lm?p--4 E.-
5
g ?af?rior ofr lilm
z
Tor,?'
u' r??-va
,j.
.. . . ??
? . . ? . : . _ ? ' _.
...
' ,.
.
ST SECTION
' feri i ir fflm 0.68
, !=foriot oir film 0.17
' TOTAL
U ¦ I/R 'D
TION 9ECTION
tnfHfor air film
I.- 1- YR[?, , .a
IZ c. * a?' : ? .ZS
:- tat?d?r air film t,; ti .
0.17
TOTAL R_.SWi! 3
' U U.1 /q.. .. ' l!
. :Fy .?. __ • ?h? ^' ? ,
, J
1
? -?
?
i
?
APFLIC?ATION FOR PERMIT
SEWER AND/OR WATER CONNECTIQN
1 R-1 SINGLE FAMILY
?R-2 DUPLEX ('itvo C?nits)
Q R-3 TOWNfi0U5E (Three + Oraits) ( Onits)
Q R-4 APARTMENT/CONDOMINIUM ( Units)
OF czCIqcPi
r nr nr nr. nr?Tnvn
1) PROPERTY ADDRFSS:
T,FGAT• DESCRIPTION;
IF EXISTING STRL'CTCTRE, DATE OF ORIGINAL BUILDING PERMIT ISSUANCE:
Nbnt Year
PRESENT ZONING/PROPOSID USE:
Q COn'IERCIAL/RETAIL/OFFICE
Q INDL?STRTAi•
Q INSTITUTIONAL/GOVERNAETIT
2) '?"'' NAME: JWnJd^ -,--A
ADDRESS: 10.Pd S" (V't _? l
.
?NOTE: PA)2IINf OF FEE AT TSME OF
; nrrr.icazzoe ooFS rrUr corv- ;
; sriivre r,rrxcrni. or eERnuT. ;
.
; tNseECTIaa oF sE?Ix t+nD/ox wnTm .
:.
; nNsra[a.r,rioNS wII.r, rrur ee scmttnm ;
w['NfIL PII24IIT HFS HE@] ApPROVID. :
•x?w?rt???sa?x??ats,tii?fya+,?e?+?++ta:tw
CITY, STATE, ZIP: vr r /^ev e_ A47T--D 7 S?
PHONE : 447/ - 4" jF a
3) NAME: Plumbers License:
ADDRESS: Active
Expired
CITY, STATE, ZIP: Not recordec
PHONE: MASTEE2 LICENSE # Sta Initia?
4) ? '• ?•
rtn,rE:
ADDRESS:
CITY, STATE, ZIP:
PHONE:
5) ? ? ` a a?• • ?r .r ??
C2j_CONNECTION TO CITY SEWER EZ`CDNNECTION TO CITY WATER O OTHER
6)
(?r -IO rtl ip
*?*?,r?*******?*********.???*?**,?*,r****+******???.*****??**?*??**********??***?t***?*******?***?**?,?X
*
* THE GpLD COPY OF 7i]E PERMIT WILL BE SENP DIRFX'1Z,Y 'PD PUBLIC WJRKS 'IO FACILITATE NIEPIIt PIQC-DP. t.
* PLEA.SE ALUOW TWO WORKING DAYS FOR PROCESSING. SOMEONE FROM Tm CITY WILL COLVr7ILT YOL? IF T4IERE ;i
* ARE ANY PROBLk21S. ?
FOR CITY USE ONLY
PERMIT # ISSDED
xf 7, .
Pd w/Bldg. Permit FEES:
$ SEWER PERMIT (INCLUDE SURCHARGE)
$ $ ?D • ??? WATER PERMIT (INCLL'DE'SURCHARGE)
$ WATER METER/COPPERHORN/OL'TSIDE READER
$ $ WATER TAP (INCLUDE CORPORATION STOP)
$ $ SEWER TAP
$ i
$
ACCOUNT DEPOSIT - SEWER ,
$ $ ACCOQNT DEPOSIT - WATER
$ SS0 $ WAC
$ ?i,? • GrD $ SAC
$ $ TRUNK WATER ASSESSMENT
$ $ TRO[VK SEWER ASSESSMENT
$ $ LATERAL BENEFIT/TRDNK SEWER
$ $ LATERAL BENEFIT/TRL'NK WATER
$ $ WATER TREATMENT PLANT'SURCHARGE
$ $ OTHER:
$ I`i" V` ?n $ TOTAL
?& 5-?p c/ 8 E7?s
RECEIPT RECEIPT
DOES DTILITY CONNEC TION REQUIRE EXCAVATION IN PDBLIC RIGHT OF WAY?
Q YES IF YES, THEN A"PERMIT FOR WORK 6VITHIN PUBLIC
ROADWAY" MUST BE ISSLED BY THE ENGINEERING
Q
NO DIVISION. LIST AS A CONDITION.
SUBJECT TO THE FOLL OWING CONDITIONS:
APPROVED BY:
TITLE:
DATE:
--?
PERMIT
City of Eagan Permit Type: Plumbing
Eaaan, Permit Number: EA093416
Date Issued: 04/12/2010
OR Permit Category: ePermit
41 it~ of E3
E
Site Address: 991 Northview Park Rd
Lot: I I Block: 2 Addition: Lexington Square 6th
PID: 10-45080-110-02
Use:
Description:
Sub Type: e - Water Heater
Work Type: New
Description: Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:
Kris Oien
3670 Dodd Rd
Eagan, mn 55123
Fee Summary: PL - Permit Fee (WS &or WH) $50.00 0801.4087
Surcharge-Fixed $0.50 9001.2195
Total: $50.50
Contractor: - Applicant - Owner:
Champion Plumbing Mark D Rehm
3670 Dodd Rd., =100 991 Northview Park Rd
Eagan NIN 55123 Eagan MN 55123
(651) 365-1340
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 Citv of Eaaan Ordinances.
ApplicantiPermitee: Signature Issued Bv: Signature
Use BLUE or BLACK Ink
For Office Use I
I~
City of Eapn I Permit
Permit Fee: C v I
3830 Pilot Knob Road
Eagan MN 55122 I Date Received:
Phone: (651) 675-5675 j
Staff:
Fax: (651) 675-5694 L---------------
INFLOW & M111-TRATION PERMIT APPLICATION
Plumbing / Sewer & Water
Date: Site Address:
Tenant: Suite
RESIDENT OWNER Name: a?A- or- S OSr.n Phone: f S ~r $
Address / City / Zip: T ° MV~y w I"~ K~ ~trA S~ `3
Name: Q U License
p4
CONTRACTOR Address: R t2 ' S~ r'~ City:
-
State: MN) -S ISQ S Phone: ~S 5~~ 133
Contact: Email:
PLUMBING (Within the building envelope) SEWER & WATER (Outside the building envelope)
TYPE OF WORK Sump Pump Repair Repair
Other: Other:
Description of work: ' ~C U I " b a ~xl E ri o f
DESCRIPTION
FEES
$60.001 Each (includes $5.00 State Surcharge) TOTAL FEE $
*Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submit 1/1 repair costs for
reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors
can be found by visiting www.cityofeacian.com/inflow, or City Hall at 3830 Pilot Knob Rd.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call
48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and
codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a
permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans.
X #1 ~r~_ D, X
Applicant's Printed Name Applicant's Signature
FOR OFFICE USE Reviewed By: Date:
Required Inspections: -Under Ground -Rough-In -Final
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA130477
Date Issued:04/27/2015
Permit Category:ePermit
Site Address: 991 Northview Park Rd
Lot:11 Block: 2 Addition: Lexington Square 6th
PID:10-45080-02-110
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and leave on site.
Carbon monoxide detectors are required by law in ALL single family homes .
Description:Re-roof house and attached garage
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 -
Jesse J Madsen
991 Northview Park Rd
Eagan MN 55123
(612) 825-2800
Ungerman Construction Company Inc
4450 Nicollet Ave S
Minneapolis MN 55419
(612) 825-2800
Applicant/Permitee: Signature Issued By: Signature