3973 Northview Ter/ 7 ?? ?
??
INSPECTION RECUKll
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued:
(651) 681-4675
SITE ADDRESS: N ' 10 - 4`' O 3 `' - 0 H 0 ' APPLICANT:
PERMIT SUBTYPE: TYPE OF WORK:
?
?
7
I
OrFWkARO:':• CF41NNl 5'/1"I Uf M11 ;T Bu 111sN1;t Ti lt HrFoNi` CoNi'i l11 I1411
Permk Holder Date Telephone # .
SEWER/
WATER
PLUMBING
HVAC
Inspection Dete Insp. Comments
FOOTINGS
FOUNO
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AiR TEST -
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
DOMESTIC
METER
IRRIGATION
METER
FLUSH
MAINS
CONdUCTIVITY
TEST
HYDFOSTATIC
TEST
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
; CITY OF EAGAN "
_ .. .._.,
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHON E: 454-8100
BUILDING PERMIT Receipt ?
To be used for ? Est. Value Date ,19
Site Address
Lot Block _
Parcel No
¢
o Nan
.
? s Add
? City
,
Phone
yVj W Name
F W
Address
WZ City Phone
e
have read this application and state that the
gree to comply with all applicable State of
, of Eagan Ordinances.
Signature of Permittee -
A Buitding Permit is issued ta_-
applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building OffiCial
On Site Sewage Occupency
MWCC Syatem- Zoning
On Site Well . (Actual) Conat
City Water (Allowable)
PRV Required # of Stories
Booster Pump Length
Depth
S.F. Total
Footprint S.F.
APPROVALS
Engr./Assess. _
Planner _
Council _
BIdg.Off. _
Variance _
FEES
Permit
Surcharge
Plan Review
SAC, City
SAC, MWCC
Water Conn.
Water Meter
Road Unit
Treatment P1
Parks
TOTAL
Permit No. Permit Holder Dats Talephone ik
Plumbin9 a ? ? n , ,? . • ? ?'%?- :!?';
. L, .
H.V.A.C.
w-0 7
Electric
? ? ?yC'?
?.?. ??_
? '?? ?
? •.?
Softener
Inspsctfon Dats Insp. COmments
Footings I
Footings II
Foundation
Framing
Roofing
Rough Plbg.
Rough Htg. 2
ISUI. .?5G87
Fireplace L? c4 - 2-2
Final Htg. ?.
Final Plbg.
Bidg. Final
Cert Occi. ?
a
Temp. LP
Deck Ftg.
Deck Final
well ?xp c9,
Pr. Disp.
' 6
??: ;?;??s?'?? ?r,.r??.?.?'h?aE.?Jf?f- ':?3'? `??••4 z_='a',?
MECHANICAL PERMIT
CITY OF EAGAN
3830 PILOT KNOB ROAD, EACAN, MN 55122
CONTRACT
Site Address
m Name
? Address
c City V Phone - -
? Name /.. - ti
c Address
p Ciry ? y Phone
TYPE OF WORK
Forced Air f '?s?? BTU
Boiler M BTU
Unit Heater M BTU
Air Cond. M BTU
Venk CFM R
-
G
as Piping Oudets #
_Yz
:z4
V ther _. _ .?.
FEE
S/C:
TOTAL:
PERMIT #
RECEIPT #
DATE: BLDG. TYPE WORK DESCRIPTION
Res. New - -
Mult Add-on
Comm. Repair
Other
FEES
RES. HVAC 0-100 M BTU -$24.00
ADDITIONAL 50 M BTU - 6.00
(RES. HVAC INCLUDES A/C ON NEW
CONSTRUCTION)
GAS OUTLETS (MINIMUM - 1 PER PERMIn - 1.50 EA.
COMM/IND FEE - 1% OF CONTRACT FEE
APT. BLDGS. - CaMM. RATE APPLIES
TOWNHOUSE & CONDOS - RES. RATE APPLJES
MINIMUM RESIDENTIAL FEE - ALL ADd-ON &
REMODELS - 12.00
MINIMUM COMMERCIAL FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND $1,000) ,
st?_20`0
i? . `_ •
SIGNATURE OF PERMITTEE
0 0 FOR: CITY OF EAGAN
PLUMBING PERMIT
CITY OF EAGAN
3830 PILOT KNBB ROAD, EAGAN, MN 55122
Site Address
Lot ? Block
? Name _
?c Address
c City ?
? Name
3 Address
O CitY Phone
FEES
COMMIIND FEE - 196 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
FOfi: CITY OF EAGAN
PERMIT #
RECEIPT # g ? C/ o'
DATE: !-?f -
BLDG. TYPE WORK DESCRIPTION
Res. New .--?"
Mult. Add-on
Comm. Repair
Other
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
NO. FIXTURES TOTAL
1 Water Closet - $3.00 ? ?- -"
Bath Tubs - $3.00
_.J.-Lavatory - $3.00
,j Shower - $3.00 ?
Kitchen Sink - $3.00 ?
Urinal/Bidet - $100 ?
?-Laundry Tray - $3.00 -
?._Floor Drains - $1.50
,4_Water Heater - S1.50
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: -
GAAND TOTAL• - % ? -
CASH RECEIPT ' CITY 4F EAGAN
' 3830 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
. DATE ' 19
REC6IYED ? . "
FROM
AMOUNT` $ -
6 OOLLARf
oo
? CASH CHECK
FUND CODE RMOUNT
?
-- - ir)ft'J
• -' / r . i
Thank You
gY
White-PaYen CoPV
-' Yellow-Posting Copy
Pink-File Copy
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PH O N E: 454-8100
BUILDING PERMIT Receipt #
Tc be used for Est. Value Date OC1'ABER 26 ,19 67
SiteAddress i973 iNORTi1ViEW TERRAGE
Lot Block 1 Sec/Sub. LEXIiiG1" PAkK-
Parcel No. V1fiW
? Name ziGHAEL 6 CAROLYN P11.11EY
3 Address 3415 !iEt.. #lUl
0 CitY e,c.an Phone 6b,3-86U2
°Co Name
.
? ? Addre
?°C- City _
Name _
Address
City _
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
Minhesota Statutes and City of Eagan Ordinances.
Signature of Permittee
A Building Permit is issued to: ''.1GtfAt;f. dc ??lt+i(ILYi? YULN
on the express condition that all work shall be done in accorAance with all
applicable State of Minnesota Statutes and City of Eagan Ordinances
Building Official_
OFFICE USE ONLY
On Site Sewage Occupancy
MWCC System ? Zoning
On Site Well (Actual) Const
City Water X (Allowable)
PRV Required # of Stories
Booster Pump Length
oepm
S.F. Total
Footprint S.F.
APPROVALS
Engr./Assess. -
Planner _
Council _
BIdg.Off. _
Variance _
FEE5
Permit
surcnarge
Pian Review
saC, City
SAC, MWCC
Water Conn.
Water Meter
Road Unit
Treatment P1
Parks
TOTAL
R:i
kl
Vn
Vn
66
39.5
i 551.SO
58,00
275.75
1(lu.OU
525.00
S?S.W
67.UU
305.00
tav•UU
*2,537.as-
BLDG. PERMIT N0.
01'3Z10 Bldg. Permi
01-3422 Plan Check
01 3445 Surch./Adm.
01-3446 SAC/Adm.
01-2155 Surcharge
17-3860 Road Unit
20-2275 SAC
20-3865 Water Conn.
20-3868 Water Trmt.
20-3716 Water Meter
20-2252 Acct. Dep.
20-3713 Water Permi
20-3743 Sewer Permi
79-3866 Sewer Conn.
11-3855 Park Ded.
TOTAL
? CASH RECEIPT ??-
CITY OF fAGAN
3830 PILOT KNOB ROAD
,EAGAN, MINNE50TA 55122
DATE 19
AMOUNT $ , I
A? DOLlARS
?oo
? CASH CHECK
i , .
. ,
BY
White-Payers CoPY
Yellow-Posting CopY
Pink-File CopY
Thank You
CITY OF EAGAN Permit Na
3830 Pllol knod Road Meter No:
P.O. Box 21198 Reader No:
Eagan, MN 55121
.,.....,.? = ici;aE1 1'i].u'ev
nn. Chg: 52 ; A
ot Dep;
1J. ?
mit Fee:
rcharge: •'-'?'
Plant 16`3•0'p:'
ter. r
f,7 _ n:lwi
%
Zoning: _
No. of Units:
V-11-.,
Date: ? ' 47
Sixe:
Date:
RL
I agree to comply with the CRy of Eagan
Ordinances.
By
WATER SERVICE PERMIT
J CITY OF EaGAN Permit No: y 1`: Date: .- ?
3830 PilsxKnob Road B/P No: " Date:
P EL Box 21199
_ Eagan, MN 55121 ?
Site Addi
Plumber:
nnwcc: D-1 D
City Chg: ?. •_: , . , :! : ? '???.?CP
Acct. Dep:
Permit Fee:
Surcharge: • Stlp(i
Misc.:
R1
E,iC.
SEWER SERVICE PERMIT
CITY V" F-AGAM Permit No: Datec
3830 Ph- *nob Road Meter No: SiZe. 7•• ot ?
P'(%-Box2yy9g ReaderNo: ------f- Date: ?-_.5
Eagan, MN 55121 T?-
Owner,
SiteAddress: 3973 I<iorthview Terr co L6 -"_ l,e-_ •.???? Park-view
Plumber.-
Conn. Chg;
525. 00.d 911a r`34y"
'?. 1f 1t?es ; ,
i
?'
Acct Dep: 15 ^n ??nlt1 ???o
? i• l
Permit Fee:
Surchar9e: I ` ? • ? - ? - ti 1.1
Tr. Plant 1
IVewic o comply ith the City of Esgan
Ordinan
Meter. -
Misc.: - B
WATER SERVICE PE
This re9uest voitl
18 nwmhs fmm
D 18 9 0 5 /,ff" /?/ , ; ,
I Rxquest Date ' Fire No. //
? RouPh-in Inspection
ReQwretl? ?
Reatly Nowg]Wili Nnlify Inspec-
12/ g/ 87 ID Ves ?N" lor When ReadV
? LicenseA ElecVical Contractor
1 hereby requast inspection ol abova
? Owner
elecvical work instelleA et:
Street AtlAress, eoz or RoWe No.
r Cryy
ecl?on o. Towns?ip Name or No. Fange No. Counly
Dakota
OcwUant (RtINT) , Phone No. '
Bruce Colon 452-7312
Power Supplier Atldress
Elechical ConVactor (Comvany Name) Coneracmr's License No.
Hilite Elect;ric, Inc. 040445
Mailine p.dJress (COn[rnclor or Owner Making Ins[ailation)
1953 Shawnee Road Ea an
AuShyci;?ed`SiB^at C ract dOwn?r MakinO ?nstallationl
r ? Phone Nvmber
Ti Phi" ' 45 - 6
MINNESOTA STATE BOAflO OF ELEC{NICITY iHIS INSPELTION FEQUEST WlLl NOT
Grie9s-Midwey Bldg. - Noom N•181 BE ACCEPTED BY TME STATE eOARD
1827 Universitv Ave.. St. Paul. MN 55106 UNLESS PqOPER INSPECTION FEE IS
Phone (612) 642-0800 ENCLOSED.
flEQUEST FOR ELECTRICAL INSPECTION 00% ea-oooai-os
/ See inshoctions ior completinq this form on back ol Vellaw copv.
- ?
? 5??--
D`18 9 0 5 "X' BeloW Work Covered by 7hrs Request
ff? Fdtl XeO. Typa of Builtling Applinncee WiroE Equiumenl WireA
Home $ Range Temporary Service
Duplex Water Heeter LiGhtiny Fixtures
Apt Building Dryer Electric Heahn
Commercial Bldg. X Furnace Silo UnloaJer
Industrial BIAg. $ Air Conditioner Bulk Milk Tunk
Farm ntlii+r aecilv _mcr ISnr.ulvl
1 r pecify Othei Other
Compute lnspection Fee Below
p Fee Service EntmnceSize b Fee Fe«ders/SuAlaeders N Fae Circults
L 15.00 0 to 200 Am s 0 to 30 qm s O. Otn 30 Am s
Above 200 qmps 31 to 100 Amps 31 to 100 Am s
Swimming Pool Above 100_Amps I Above 100_AmVs
Transrormers Irrigation Booms • rtial.'Other Fee
Signs $Veciallnspection
5
TOTA
Hem>rks
'i A 1 9 7 75.50 L E?.
7.?Oo)
Rou9h-in .r •?!? ? • ihe EIecH Y
Inspector, bereby
carlily thnt the Tbove
Final ' inspaction has bean
D i' maae.
fhis reauest ro1018 mantlu Irom
s I CITY OF EAGAN N_ 14354
3830 Pilot Knob Road, P.O. Box 27-199, Eagan, MN 55121
BUILDING PERMIT PHO N E: 454-8100
Receipt .? g r ?
l
Tobeusedfor SF DWG/GAR Est.Value $116,000 Date OCTOBER 26 19 87
Site Address 3973 NORTHVIEW TERRACE
lot 8 Block 1 Sec/Sub. LEXINGTON PARK-
Parcel No. VIEW
m Name MICHAEL & CAROLYN-PILNEY
w
z Address 3415 FEDERAL DR., #101
0
City eagan Phone 688-8802
°C Name SAME I
0
oQ Address
? City phone
OFFICE USE ONLY
On Site Sewa9e - Occupancy
MWCC Sys[em X Zoning
On Site Well (ACtual) Const
Ciry Water X (Allowable)
PRV Required # of Stories
Booster Pump _ Length
Depth
S.F. Total
Footprint S.F.
R3
R1
Vn
Vn
66
39.5
°w Name_
WW
?
_z. Address
U
aw Clty-
I hereby acknowledge that I have read this application and state that the
information is conect and agree b comply with all applicable State of
Minnesota5tatutesandCi[yofEaganOrdin nces. .
Signature of Permittee
A Building Permit is issued to: MICHAE & CAROLYN PILN
on the express condition that all work shall be done in accordance wiih all
appliCable State of Minnesot tatUtes and Ciry q' Eag9anCes.
Y?
BuildingONicial
?
APPROVALS
En9c/Assess.
Plenner
Council
eldg. Off.
Variance
FEES
Permit
Surcharge
Plen Review
snc, city
SAQ MWCC
W ater Conn.
Water Meter
Road Unit
Treatment P1
Parks
TOTAL
$ 551.50
58.00
275.75
100.00
525.00
525.00
67.00
305.00
180.00
$2,587.25
;
,
-
... t' ' . ' . . ?
,
?r ?i . .. I .. ? . . ? . .
f74'{c'??'Xt?lk?l(?Y.?.km'Yik.'1.-?0.t?k.?A(l:k:?
={;.T,D'V? =ni=?.. -4.4 ?. .. _. ?
. ?
JN'?w;1L"'
9ChJ 4?4`E? "?µ?s' b+ ;fn
i.T 'l.fjw?..
, .
? ..6' ? •. ?IF' ?. . .. ?
II''
A ... I , ' .
. it
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' . .
IO1"'R..;.L? 'F`.61
aY?•R?M?er.th???x*?K'??,+ ?'?k#*R?'#:kfiA?A!'k#?Y???FW.??
. k
1999 BUILDING PERMIT APPLICATION (RESIDENTIAL)
? CITY OF EAGAN
3830 PILOT KNOB RD - 55122
651-681-4675
Mew ConsWeGon Reauiremenb
? 3 reghlerad sfte surveyc elwwing eq. R of bt, sq. R of house
and all rooted areae L20% muimum lot coveraae ellowed) > 2 wples of pWns (show beam 8 windowshes; poured fid. design; etc.)
D 7setotanergytakulatlons
D 3 copies of Vee yreservatbn plan N lot platted aflar 711193
DATE: ?
RamodallReoeir ReaulremeMa
2 rnpbs of plan
7 set of onergy ulculetfona lor heffied addWonc
1 ake survey for erterior additions 3 decks
coNSrRUCrioN cosr: 1700
DESCRIPTION OF WORK: ?lo i2cT?S ? i ?v Dou/ 4- Ak r--ft Lue-«
STREET ADDRESS: -?)Y /-5 1 V cT-r<tb-? i
LOT: U BLOCK: / SUBDJP.I.D. #:
LO 'R c; s
PROPERTY
owNeR
CONTRACTOR
ARCHITECTI
ENGINEER
Name: G 2 ifiriN ?ae.K 4- Aar y Phone #: loS 6'0 S9 I
Lnst FiM
sveet nad?ess: 39 73 hl omuew -Tag?-
City EA-c A* State: M N Zip: ? z-?-
Company: ?ttvL Lowue- (24N5t- jhr . Phonep: 06 -5/86
(ares code)
StreetAddress:J`JZ+ GlleNTRy' Cr. License# 35`SU Exp, T'?S?t//Zbcb
-
City )4EN Oki711 NFi 6/6M State: Nr A! Zip: SN//16
Company: Name:
Telephone #: (
Street Address: Registration #:
City
State:
Zip:
Sewer 8 weter Ilcensed plumber (new wnstrucfion onlvl: TNephone #:
Penally appltes when addrass change and IM changa h requested onee permk ie heued.
I helleby aclmowledpe tliat I have read fhia applkatlon, sfa[a thffi fhe Information ia cortecf, and agree to compty wNh all applicable Sfate of Minnesofa Sfatutes and Ck
of Eagan Ordinances.
I Slgnature otApplican•
OFFICE USE ONLY
Certificates of Survey Received _ Yes _ No
Tree Preservation Plan Received _ Yes - No _ Not Required
OFFICE USE ONLY
BUILDING PERMIT TYPE
O 01 Foundation ? 06 4-plex ? 11 10-plex ? 16 Fireplace P ? 21 Porch (3-sea.)
? 02 SF Dwelling ? 07 5-plex ? 12 12-plex ? 17 Garage I ? 22 Porcd/Addn. (4sea.
? 03 1 of _ plex ? 08 6-plex ? 13 16-plax ? 18 Deck 1 ? 23 Porch (screened)
? 04 2-plex ? 09 7-piex O 14 Apartments ? 19 Lower Level l! ? 24 Storm Damage
? 05 3-plex ? 10 8-plex ? 15 Lodging ? 20 Pool I? ? 25 Miscellaneous
WORK TYPE
? 31 New ? 35
0 32 Addition ? 36
? 33 Alteration ? 37
? 34 Repair ? 38
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Width
APPROVALS
Planning
Tenant impr ? 39 Gas Line Only ? 43 I' Siding/Soffits/Fascia
Move Bldg. ? 40 Gas Insert ? 44 Jj Windows/Doors
Demolish Bldg.* ? 41 Wood Stove ? 45 I Fire Repair
Demolish (Interior) ? 42 Reroof i
' Give PCA handout to applicant for demolition permit ?i
Basement sq. ft.
Main level sq. ft.
sq. ft.
sq. ft.
sq. ft.
sq. ft.
Footprint sq. ft.
Building Engineering
Valuation: $
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:
Census Code
SAC Code il
No. of Units lI
No. of Bidgs I,'
MC/ES System
City Water 11
Booster Pump
PRV 1I
Fire Sprinkleied
.
i
SAC Units
% SAC
o•a
571•yu+
58•00+
275•'ID r
(17•UU+
525•UU+
6 7 •UU+
j05•UU+
130•UU+
?:
2>>81 `l °2?,
• - , / ? ? ? .. .. , .
1987 BOILDING PERMIT APPLICATION - CITY OF fiAGAN
X SINGLE FAMILY DWELLINGS
INCLUDE 2 SETS OF PLANS, 3 CERTIFIC9TES OF SQRVEY, 1 SET OF ENERGY CALCQ[.ATIOHS
HOTE: 9DDRESSES FOH CORNER LOTS - CONTR9CTOR/HOMEOANER MQST DESIGAATS WHICH ADDRESS
ZS DESIRfiD. NO CH9NGfiS WILL BE ALLOWED ONCB BIIILDING PERMIT IS ISSIIED.
M[1LTIPLE DWELLINGS - RESIDENTIAL RENTAI, iTR1ITS FOR S9LE UNI4S
INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SIIRVEY - CHECK iIITH BLDG. DEPT.,
1 SET OF ENERGY CALCULATIONS
COLMMRCI9L
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF
ENERGY CALCULATIONS,
$2,000 LANDSCAPE BOND
To Be Used For: S.F. Residence Valuation: Date:October 21, 1987
Site Address 3973 Northview Terrace
55123
Lot 8_ Block 1
Parcel/Sub Lexinaton Parkview
Owner Michael and Carolvn Pilnev
Address 3415 Federal Dr. Apt. 101
City/Zip Code Eaaan. 55122
Phone 688-8802
Contractor Self
Address 3415 Federal Drive, Apt.10
City/Zip Code Eagan, 55122
Phone 688-8802
Arch./Engr. Kieth iieaver
Address1130 Smith Avenue South
City/Zip Code West St. Paul. 55118
Phone # 451-9090
OFFI
On Site Sewage_
MWCC System i/
On Site Well
City Water ?
Assessments
Water/Sewer
Police
Fire
Engr
Planner
Counc3l
Bldg Off ?DI2,
APC
Variance
oecupancy R-3
Zoning R- I
Type of Const
(Aetual) y' N
(Allowable) V-M
# of Stories
Length -(6
Depth 39.5"
S.F. Total
Footprint S.E.
FE&S
Permit 5S1• 0
Sureharge 58,6D
Plan Review Z75•?
SAC, City 100,00
SAC, MF1CC S 5,00
Water Conn 525.00
Water Meter 6"7•00
Road Unit -305.Oo
Treatment Pl 80,00
Parks
Copies
TOTAL
When building permit is ready please contact Bruce Colon at 452-7312
Thank You
v
6-
G.eanGe' ? ? ,? ? '
IyX l'/ti=
693xiz= $31G
SSMT. ? 1ST Ftoo? 18'/Zxl4= 259 '
3s x 2S= 950 ?
II6IX58=67338
i
2n,? R
3Z X 2?= 864
I k 1? = t'2 ?
I?x IG 24 '
500 kuy= 34600 ?
115254 - ?
,
I?
? ._
CITY OF EAGAN
APPL1CATlON FOR PERMIT
SEWER AND/OR WATER CONNECTION
1) PROPERTY ADDRESS:
LEGAS, DESCRIPTION:
? irlease YT1Ilt)
d9?3 No,f y-hUiecJ Te
* *R7T5: PA`LMFNS OF FFE AT;,T22i'G'
? aPPiscATIorr noEES Nar Caa-rMIUM
,*f APPRbVAL OF PF22MffT. -
? ..
? INSPFX:TIOtQ OF SE? ADD/Qt: VUL7E
? IHSTALLATIOTLS WII Z., 2J.7T ?-SZl=
? ULID LRNTII. PERMIT HAS BEEN'".
? APP.ROVED. •
*
?
» -
***x*?x?#**r?x#?,r<:?.,::fa*-a?'r*<rw
Lo? Block Sub ivisior. or Tax Farcei ID ?)
IP =, STINS- S'IRUCI'L,RE. DaTE OF ORIGZNAI, .E;)II,DIZorG PE2MIT ISSL'?i'(..,,.: " ...
PRZS-?NL ZONIW/PROFOSID C1SF' . ' (M7:It Yeesl .
n
C.j _T,ZC'S=T,Z
El INSTITt'TIOiVF1I,/C-0VERN[•g,?*r
2)
?"-G= IyliKc
aDD?.ss: 9 7
CI'I'Y, STATE, 22P: r ?tJ 4
PEONE: .
? R-1 - SII'GI.F.- FAMSLY ? R-2 DLPLEX (? Units)
R-3 2DWPII-IOUSE (T.hree ? Units)
R-4 APARTb1EN'^/COt\DOMINILM
o? ¦:Ir
ADDRF-SS= 3500 K=NNEEEC DftIVE, EAGAN, SiINN.551T2
CIT'Y, STATE, -ZIP: . , - . . .
PHONE: MA.STIIt r,2CINSE# 001445M2
41 Q?.a.u• . ??:7g _.
ADDRESS: '-
CITY. STATE, ZIP:
` PHONE: ,
, 5) c l r u- ,•l r• • Dt• ?
. • aa
.• ? CONNECPION ZU CITY SE47M P!rCONNECTTON TO CITY WATE?2
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PLEASE HOLD APPROVID PERMIT E'OR PICK-LTP BY ONIE OF A&7VE
PLEASE lKATL APPROVED PERMiT 2U 1, 2, 3 9, ABovE
(Circle one) '
Y•.lI t? Yn .. .. _ ??
F4R CITY USE 4NLY
:,
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-
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_ .
..._
; --- $ lO.
- SEFIER PERMIm
$ ?Q•aJd Wi'?TER PERe9I"_'
.Ilo J' tl ?i $ ;4ATER ME^_E3/CG?'_., p?' ....... ......
$ WP.TEP. TAP (?^;CL;:--E
. _ $ SEti'ER TP.P
r RCi.'\i^, DE.?C:S" - .
-O-Z) ACCOUNT D--P?OS='I' - ,; _-- .
' .. ? Z S0'? $ WAC . . . .
SAC ,
Tltl'VK WriTO;
.. . ? - j LATER.-°,L n?i`.?= _,_'/"._"._:::' ..-._-•
s fk? .?-z? s WAr?R TREATNE_`:_
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REQU TRE EXCA V:.TION IN PC?bLIC
? IF YES, THEN A" PE_.MT_m FOB SQ03{
- :G.IDSJAY"° P9iS'P UE ISSCL•D BY THB
D7'•,'- SIODI. LIST AS A CONDITZON.
Cl:I'vG CONDI^ICNS :
.............. _.. )
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CITY OF EAGAN
EXTERIOR ENYELOPE AVERAGE 'U' COMPUTATION
oxNER: _Mj,chael and Carolvn Pilnev
SITE ADDRESS: 3973 Northyiew Terrace. Eaaan MN 55125
CONTRACTOR: Self DATE:1Q/zl/87 PHONE: 688-8802
Determine working square footage of each:
1. Total exposed wall area .. 2.684.0 sq. ft, x,17 = 295.2
2. Total roof/ceiling area .. 1,275.0 sq. ft. x.026 = 33.2
Total exposed wall area above floor = 2.601.0
a. Total wall window area ............................ 234.18
b. Total door area ................................... 37.82
c. Total sliding glass area .......................... 40.02
d, Total fireplace wall area ......................... 6.00
e. Total wall framing area (average 10%) ............. 228.30
f. Total net wall area above floor ................... 2054.68
g. Total rim joist area ............................. 137.80
Total exposed foundation area = 83.0
h. Total foundation window area ....................... 15.99
i. Total net foundation area above grade .............. 67.01
Determine 'U' value of each xall segment:
a. 234.18 x
b. 37.82 x
e. 40.02 x
d. 6.00 x
e. 228.30 x
F. 2054.68 x
8. 137.80 x
h. 15.99 x.
- i. 67.01. x
'U' 0.55 - 128.80
'U' 0.13 - 4.92
vU' 0.55 - 22.01
'U' 1.06 - 6.36
fU' 0.090 - 20.55
lUt 0.043 - 88.35
' u' 0,041 = 5.65
'U' 0.55 = 8.79
IUI 0.126 - 8.44
3 . ................................................... Total - 294.9
If item U3 is the same as or less than item p1, you have met the intent of SBC
6006(c)2.
Total exposed roof/ceiling area = 1 275_0
J. Total skylight area................................ -_-_-
k. Total roof/ceiling framing area (average 70%) ..... 127.5
1. Total net insulated roof/ceiling area .............. 1.147,5
OVER
Determine 'U' value for each roof/ceiling segment:
i . x 'U' -
k. 127.5 x'U' 0.022 - 2.80
1. 1,147.5 xf[Jr 0.019 = 21.80
4 . ...................................................... Total = 24.61
If total of #4 is the same as or less than #2, you have met the intent of SBC
6006(c)1.
Alternate Building Envelope Design
To utilize the total envelope system method, the values established by the sum
of Items 03 and 04 shall not be greater than the sum of Items 1/1 and 02.
1. ;95.2 + 2. 33.2 = 328.4
3. 294.9 + 4. 24.61 = 319.51
2
t • Jr.?r?
. CITY OF FAGAN •
TIINIrN;i "U" VALUE A,\'D R-FACTOR AT ROOF, WALL, RIPI A?\D CO^CRETE BLOCf;
_RooF ? C?IL?NC, 5100 j0l?.
(Y) VAL
Q It1-(E?lo(? F;tR Fl??'1 61
O S?s G'sP Y,D. .
? I?SUIF??I?N 3gyi?" doe
? ?.4J51 y?..y . . . ?;g. `
OO EX?Ei?laF- PtR FILM
j?(Z 7:: ozs' TaTAI.y?R?= S1.?B
? ?p) = o.?a?. ?.a19
. WALL l?c? VALt;
Q 101-U-10(= AlR FlLM ? !NS?? 'I-)!' GYP.' BD.?
?o (?la ?oNlTc_ SiD?rCa a.06
i7
rJ - o.?ra9?
-j-oTAL (R)=?3.rP
??M J v ? n?3
01- 111TC110r. AIr, FiL11 - : 06 .
i; 5 1/2!' ItsUU?Ytc;a ''' ! 9• W
10 'Z F1C-
105
;u r,1;5or???'E sio?rG : ; 8?- .
_ ?JR= :, J; • 1'oTP.' (R)-A
. y.6?
foJf?DATIO??? .0
Ctt) VRW?
0 iN -1E171Z Atu FIU-i
? -
C
01) ? Ir o
?? EXj?C?lo,^. AIR FICM
_ _ (J = o,? a.(o
Floors ove; unhezted spaces must have mininum R-factor of R-20 (tuc.l•-under gara;es).
Floors ov, r outdoor air (ovcrhangs) pust liave a nininum P,-fac[or of F-33. ' .
***************************************
CITY OF EAGAN
CASHIER: JS TERMINAL NO: 781
DATE: 09/07/00 TIME: 15:04:09
ID:
NAME: METRO CUSTOM EXTERIORS INC
3210 9001 3973 NRTHVW TER 167.25
2155 9001 3973 NRTHVW TER 4.50
Total Receipt Amount: 171.75
CR137150
USER ID: JAN
2000 BUILDING PERMIT APPLICATION (RESIDENTIAL)
?1709 cirir oF EAcari
3830 PILOT KNOB RD - 55122
851-681-4875
New Canahucflon Reaulremenh
>? 3 reylalered tlte wrveYS sfrowing sq. B. of bt, sQ. tt. of Irouse
and gfi roofed areas f4076 maxlmum lot covemae allowedf
> 2 coples of plaru fatww beam a wlndow sizes; poured fnd. deqgn; etcJ
> t set a energv caculan«„
n 3 copiea W hee preaervaflon plan N lot plaMetl aRer I/1/93
DATE: 9 /7 /00
2 coplea of plan
1 tet of energy Cadculallona for healed addlHOns
1 site wrvey for exteAOr addltiona 8 decks
CONSiRUCTION CO5f: g Z`t t.
`Z
DESCRIPTION OF WORK: i?? o o--'
STREET ADDRESS: J1173 < C 4-.
LOT: AL BLOCK: SUBD./P.I.D. q: AM
Name: Sack_ Phone#: (aS I (0 86 -os?7?
PROPERTY last Pint
OWNER 3 y ? 3 r1a???
Sheet Address: , i- ) f t"' r a c c .
City $tate: rY\ ?. Zip:
. Company: An?+ro lJX7'CY10Y11='..phoneM: 8?9?36rs-
(area code)
' CONTRACTOR _
SheetAddress: S6 a7 ?tla?ri b. f??? S. ucenses zo-z 199 zz E,cP.
Gty (11 N.. r. C.. V2e1;. State: Iip: -5S 1119
ARCHITECT/
ENGINEER Company: Name:
Telephone #: ( )
Street Address: ReglsfraHon M: _
CNy . State: Lp:
Sewer/water licensed plurPber
I hereby acknowledye ttwl I have read this applkaHOn, sFafe thaf Me
of Minnesota SMlufes and Cify of Eayan Ordinances.
Signalure of Appliccnf
OFFICE USE ONLY
#:
wHh a0 appUcable Sfate
Certificates of Survey Received _ Yes _ No '
Tree Preservation Plan Received _ Yes _ No _ Not Required
OFFICE USE ONLY
BUILDING PERMIT SUBTYPES
? 01 Foundation ? 07 05-plex
? 02 SF Dwelling ? 08 06-plex
? 03 01 of _ plex ? 09 07-piex
? 04 02-plex ? 10 08-plex
? 05 03-plex ? 11 10-piex
? 06 04-plex ? 12 12-plex
WORK TYPE
? 31 New
? 32 Addition
? 33 Alteration
? 34 Repair
? 13 16-plex ?
? 17 Garage ?
? 18 Deck O
? 19 Lower Level ?
Pibg _Y or_ N ?
? 20 Pool ?
1 I
i
I
Porch (3-sea.) j
22 Porch/Addn. (4-sea.)
23 Poroh (sCreened)
24 Storm Damage i
25 Miscellaneous
30 Accessory Bldg• i
? 36 Move Bldg. ? 43 Reroof '
? 37 Demoiish (Bldg)' ? 44 Siding ?
? 38 Demolish (Interior) ? 45 Fire Repair
? 42 Demoiish (Foundation) ? 46 Windows/Doors
` Give PCA handout to applicant for demolition permit i
GENERAL INFORMATION
SAC Code
No. of Units
No. of Buiidings
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Width
Basement sq. ft.
Main level sq. ft.
sq. ft.
sq.ft.
MISCELLANEOUS INSPECTIONS
? Stucco/Stone
APPROVALS
Planning Building
Permit Fee
Surcharge
Plan Review
License
MC/ES SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
SNV Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
sq.ft.
sq. ft.
Footprint sq. ft.
Census Code1
MC/ES System
Ciry Water
Booster Pumpi
PRV
Fire Sprinklered
?
Engineering Variance
i
Valuation: $
?
I :
O 31 Ect. Alt - Multi
? 33 Ext. Alt - SF
O 36 Muw
SAC Units
% SAC
•k, 'l
?:•?:: ?$:.JC d6..>;;?i.;Y?
C.i.?'r' OF C:AG;!1Pi
r;a1 S iJ,rrF:., .. rrRMr.n!al_ i40" '(i i
D9'fFi.c 1107/98 'I":CiiF.:c ,.5323-24
ID ;
NnME: Ai._L!:tD r- ir,ESIDr, ?r,C„
32:10 9001 3973 Npf'.T!:VII:-W 50.00
215t5 `.iGO.I. 2973 NOfilF"J'l:F_I4 0.50
p
_fota:t F;.er,;>:i.pt, Amourr!:e. 50.,50
rR(.:t99463
UsEry: 1D: NF,NC,,
:'? {::l fi'I•%kkc$.d.rYFJ:?X?kY.C?;y?y:i;<8'.I'M:nMYr%r'Y'Fi' :';i;;XY,:>8S":F$:$:YR
PERMIT
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(651) 681-4675
PERMITTYPE: Bi?I?or.Nc
Permit Number: 034 52
Date Issued: 11117 /98
SITE ADDRESS:
3973 NCJR7HVIEW '1`ER
LOT: S BLOCK: 1
L[X:INGTON RARIiV1:.r-.W
P.I.N.: 10-45035-080-01
DESCRIPTION:
Bfjildiny--Permit Type FIREPLACE
8ui.lding Wo'rk Type 14EW
Census Code ? 434 NLT. RESIDENTIAL
t
REMARKS:
ChiIMNEY(FLUE MU3T FSE INeiRECl'ED REPORE CONCGF1l.71V0<
FEE Sl1MMARY:
Base Fee $50.00
Surcharqe
? -s = 50
-
1'otal Fee t 50 .5m
+CONTRACTOR: - r?pplicant - sT. L.r.c. OWNER:
FIFiESIDE CORNER INC 16331042 20090911 GRIFFIN JACK
;700 N FAIftVIEW AVE 3973 NORTHVIEW TER
F205E:VILLE MN 55113 EAGAN MN 55123
(612) 633-1042 (651)686-0591
I hereby acknowledqe that T have read this applicat'ion and state that the
infiormation is correct and uqree to comp.ly w5.th all applicable StaCe ot Mn.
L StetuCes and City of Fac!an Orclinances,
?
f?z? v ,? @ J
APPLICANT/PERMITEE SIGNATURE SSUED BV: SIGNATURE
CITY OF EAGAN
3830 PILOT KNOB RD - 55122
1998 FIItEPLACE PERMIT APPLICATION
681-4675
DATE: b cl
DESCRIPTTON OF WORK: ? Construct new fireplace _
-s so
ll-t-1 - 9C?
PERMIT FEE: $50.50
Aherations to existing
_ Instnll Eas insert oalv _ Install eas line onlv
Other
JOB ADDRESS:
I.O'I'. y BLOCK: ` SUBDMSION/P.I.D. #: ?-Cxi e?g ' n r? CC, {? V i
APPLICANT (circle one only): OWNER CONTRACTOR
I hereby acknowledge that I have read this application and state that the inforntation is correct
and agree to comply with all applicable State of Minnesota Statutes and City of Eagan
Ordinances.
Name: Phone #: z4? ('2 2 0sv/
PROPERTY Last F'vst
OWNER
sUW Aaaress: ? i v(')P' iYl l./y tj2 w-1 ?PrfncP?
CrtY L State: ZiP:
Company: Phone #:
FIREPLACE r
INSTALLER Signature: ? 0-4
Street Address: 3SSC Licease #_ 9V0 7' o`Z /,
City vt ?` ??? u ? 1_ ? P. State: // l/ 1! . Zip:
GAS LINE
INSTALLER
Phone #:
Street
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 14 Firepiace
WORK TYPE
O 31 New
D 32 Addition
13 33 Alrewtions
? 34 Repa'v
GENERALINFORMATION '
Census Code. 434
SAC Code Ol
REMARKS
Chimney/flue must be inspected before concealing.
6 lb j Z l MECHANICAL (RESIDENTIAL)
Permit Application
, City Of Eagan
(' . 3830 Pilot Knob Road, Eagan Mn 55122
? Telephone # 651-675-5675 FAX # 651-675-5674
Please complete for: Singlc Family Dwellings
Townhomes and Condos when permits aze required for each unit
Date to / 30_ / _0"?7)
Site Address ` q 1 _? nbnlV my 1 e:"afib Uuit #
Property Owner C? f 1 Y y l o, fi v, -{'fm Telephone # ( VGj o 2/r1
Contractor
StreetAddress '^1 ?C/ V • /\.U/s"l.?'C? ?/?/` ' City
State 614 Zip Telephane #
The Applicant is _ Owner _cConlractor _ Other
Add-on, modification or alteration to eaisting dwelling unit $ 30.00
Y furnace repiacement
air exchanger
? air conditioner
other
- '
I
i
- -- - -?
State Surcharge ; $ .50
Total $ OV • GD
I hereby apply for a Residential Mechanical Pemut and aclanowledge that the informarion is complete and accurate; that the work will
be in conformance with the ordinances and codes of the City of Eagan and with the Meclianical Codes; that I understand tkus is not a
permit, but only an appGcarion for a pernut, and work is not to start without a permit; that the work will be in accordance with tLe
apprcKed plan in the case of work which requires a review and approval of pla . ?
l: ?I l2( Sh ?f?(.S
ApplicanYs Printed Name ApplicanYs Signature
CER-rIFICATE OF SURVEY
N 89 °4Z3 o3'Jv
l2500
5
3
?
ND
°o
0
? p
?
l
LOt 8, B10Ck 1,
LEXINGTON PARKVIEW
Dakota County, Minnesota
Pr.oposed yar.age floor elevation = 101.0
Proposed baserient floor elevation = 92.83
00f.0) llenotes existing elevation
[00.?7 Denotes proposed elevation
Denotes surface drainage
o Denotes ir.on monument set
• Denotes iron monument found
Benchmark: Ton of hydraiit at the S.E.
corner oi the pr.operty
Elevation 100.00, assumed datum
I hsraby etrtify ihat Ihie surrsy, Clan or raport
was prapnred Oy me or untler my Jlrect supervisien
anE fhaf I am a tluly Repistarad LonE Surveyor
unAer tha laws of tha Sfafe of Mlnnasota.
Jame6/E Boerhava FLS ?/
Date ?ThB?.Q 4r??Re9. No. 7095
14243 Mitoka Circle N.E.
Prior Lake, Minnesota 55372
612-045-9154
?
I?o W
O Q'
V
i
i
Prepared f.or: ^4r.. & D9rs. Mike Filney
- . 7/0
x
-?s
! W 2 0 ??'_?
?i a , ow ?o I
7--L
1 o zs o
?
lI0 `I
(I ov. 97)+J ?.m/. /Z?+- 30. o -.
LeIC4/NA?E f /fT/L/TY E93EN/ENT? ? ?O
iaz. c0r) /ZJ?.OD ?(98'°7)
/./ 5 9044 o3"W
O
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8
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NOTE :
R. L. S.
v
7095
24' LONG IRON MONUMENT AND
IDENTIFICATION DISC (ACTUAL SIZE)
$ET AT ALL POINTS INOICATED•
MINN. qEG. LAND SURVEYOR ,r7095
-N-
SCALE IN FEET
0 IS 30 60
BOERHAVE LAND SURVEYING
.
zov RESIDENTIAL BUII.DING rExmrr nrrucnTTON
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
Neu Comhurhon Reauiremenis
3 re9s0ered a6a simeya ahowtrip sq.1t of bC 54 R dhouse; antl all toofed arem
(7995 mexinwm lot cvmage dbwed)
t Soik RepoitiFpmposed budding66D 6ePbedondishnbedsad
2 apiesaf plan showing beam BraMar s¢es; qurced kwd desigq eEc
t setorEnmarGabArtion%
3 copas of Tm Preservatlon Pfan iFld pkfted aflet 717193
Pom.loat0elaiOptioncseledionslreet(diJdingswith3arlassuMfs) .
Minn*asm mehenrcal veiti6limi fam
2 copias olPbn elve9n8 faotings. baeme.losts
1 setafEreigyCelddetlonafwlwEUdaddi4ons
1 s'tesmraytwedditions&declo,
Ad&4m - vdmie Banade mp& sYabrn
arm un anw
CeRdSw?e4Reod-.- "-_Y--_N
5[plsRepmt _Y._N
TmeP?eePle?tRecd _Y_N,
TreePresRe9umed. ":- ._Y _N
o"msolft syaem'. ,.._y _N
Pfans are considered ublic information unless ou state the are trade secret and the reason.
Date IC91 / q / AL 2AI53. ?3
C
i
C
onstrnct
oa
ast
Site Addren Unit/S[e #
bD
. , ?
Description of Worlc 1e-
Mvlti-Family Bldg _ Y_ N Fireplace(s) _ 0 _ 1
Pmperty Owner Teleghone q(4,5J) ?OQ LO "? ?'rJ 9?
Contractor ?
j??--- - -
Address
o• ? Clty
l'^,?
State Zip ?_2--Tdep6one # ( ? . - Z.-
COMPLETE TNIS AREA ONLY IF CONSTRUCTIN6 A NEW BUILDING
Energy.Code Categoiy - Minnesoh Rules 7670 Ceresarv t _ M??? Rules 7672
(J suhmission type) • ResiAential VeMilatlon Category 1 Waksheet . New EnergY Cade Worlmheet
SubmAtetl Su6mated
• Ener9Y Emelape Caiculat? Submilted
In the last 12 moMhs, hcu the Ciiy of Engan issued q perrttit fa o smilar plon based on a masFer plan2
_ Y _ N IF yes, daTe and address of master plan:
Licensed Plumber
Mechanical Contractor
Sewer/Water Conhactor
Telephone #(
Telephone #(
Telephone #(
I hereby apply for a Residentiai Buiiding Permit and acknowledge that the informadon is complete and accurate;
that the work will be in confomnance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; I understand this is not a peimit, but only an applicarion for a pemut, and wor ' not to stazt without a
permit; that the work will be in accordance with the approved plan in the case of wor ch requires a review and
/ap?proval of plans. /
,? I I• •?? 1?N/VldY?rI" .i1 I n I ?
ApplicanYs'?rinted Name p ic 's S e ! n ? ?
I II DEC 08 2008
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 3973 Northview Ter
Lot: 8 Block: 1 Addition: Lexington Parkview
PID:10- 45035- 080 -01
Use:
Description:
Sub Type: e - Underground Sprinklers
Work Type: Backflow Preventer
Description: New
Meter Size Meter Type Manufacturer
Comments:
Fee Summary:
Contractor:
Ryan Mechanical
1547 Hay Creek Valley Rd
Red Wing MN 55066
(651) 388 -1510
Amanda Church
1547 Hay Creek Valley Rd
Red Wing, MN 55066
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:
John W Griffin
3973 Northview Ter
Eagan MN 55123
$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
EA078585
06/28/2007
ePermit
Line Size
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA161087
Date Issued:05/05/2020
Permit Category:ePermit
Site Address: 3973 Northview Ter
Lot:8 Block: 1 Addition: Lexington Parkview
PID:10-45035-01-080
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:Does not include skylight(s)
Census Code:434 - Residential Additions, Alterations
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 within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
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 -
Nicholas Parins
3973 Northview Ter
Eagan MN 55123
(651) 233-9004
American Building Contractors
2960 Judicial Rd Suite 100
Burnsville MN 55337
(952) 707-6959
Applicant/Permitee: Signature Issued By: Signature