4387 Nybro CirCITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 5512?1
(612) 681-4675
SITE ADDRESS:
:1 ct.: NYF;ftr, r
tJt 1 fI i kPit 1;11 y r1111
PERMIT SUBTYPE:
,J ,
INSPECTION RECORD
PERMIT TYPE: Permit Number:
Date Issued:
Ei l 01h . APPLICANT:
F:0 iax Icr?.; 14(r11-l r;f qr?t,r I rNr; tMC:
i i 4 .' ) ,.,'q +}'1
TYPE OF WORK:
•. i; i ? i; r?i { I? ti ?.i l I N?i }
INSPECTION D• . DA
i . , i?! ? I? ? . . .
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M
d-?i 3 m .rfi-
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Permit No. Permit Holder Date 7elephone #
S/W
PLUMBING
HVAC
ELECTRIC
ELECTRIC
Inspection Date Insp. Comments
Footings t
Foundation
Framing
Roofing
Rough Pibg. _
U i r
Rough Htg.
Isul.
Freplace
Final Htg.
Orsat Test
Finai Plbg. Plbg. Inspector - Notify Plumber
Const. Meter
EngrJPlan
Bldg. Final
Deck Ftg.
Deck Final
Well
Pr. Disp.
CITY OF EAGAN Remarks
Addition Wilderness Run 4th Addition Lot 9 Rik 3 Parcel 10 84353 090 03
Owner Street 4387 N=b*'O Circle State Eagan, MN 55123
u
Improvement Oate Amount Annual Years Payment Receipt Date
STREET SURF,
STREET RESTOR.
GRADING
SAN SEW TRUNK 1973 $163. 26 $8.16 20 PAID
SEWER LATERAL
WATERMAIN
WATER LATERAL
WATER AREA Paid ith WSteT connection 11 5
STORM SEW TRK 276-00 276.00 C00 44$ 6111/80
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. $320.00 1568 11-12-75
BUILDING PER. ??89 299
sAC 425.00 299 5-30-75
PARK -
VILLAGE OF EAGAN WATER SERVICE PERMIT
3795 Pibt Knob Road PERMIT NO.: 18 87 '
Eagon, MN 55142 DA'CE: 11/ 18/75
Zoning: RI No. of Units: 1
Owner:
Address: ?'- ?3 Zt,)i11 4'1262 `j 1&1/ 2 f?.
SiteAddress:_Jj3R'] NVbr n !`irrln
Plumber: 42r ' ?E9.
Meter No.?`! ? Connection Charge`?'?'-??'
Size: Account Deposit:
Reader No :_ 7 lG.6r' / Permit Fee: 10.00 pd
I agrae To cemply with tha Villoga of Eogan 5urcharge: .50 d
Ordinanws. 1/ rJf Misc. Chargea: ?-
? ? . ?
Totat:
BY Date Paid:
DatL•'ofInsp.: ?
Insp.: ?
VILLAOE OF EAOAN SEWER SERVICE PERMIT
3795 PitotKnobRoad PERMITNO.: 2644
:a9an, MN 55122 DATE: 11/18/75
Zoning: Ri No. of Units: 1
Jwner: Svend Petersen
Address:
31ce naaress: 4387 Nybro Circle L9133WR4
Plumber: Proiect Plumbing
i a9ne fo compir with the Villogs of Eogon Connection Chazge: 425.00 pd 5/30/!
D.diiwnees, Account DepasiC
Permit Fee: 10.00 pd
Sumharge: • 50 pd
3yo - Misc Chuges:
.)ate oFlnsp.: Total: ?•
:nep.: DatePaid: i
?
CITY af EAGAN
BUILDINCi PERMIT
Ownex --.?.?J......... d ../?}?.tr..Q../._?............
?ld..-?...xv..(.....N/?4i ~S?3 7
Addsess (Presan!) ...••7•••./..Q..1 .....l?/.... .3
Bulldes ............ ..................................................
Addraca .................................. -......................... .................. ..............--
?
s,iM
N2 3589
3795 PiloY Knob Road
Eagan, MinnesoYa 55122
454-8100
Dela n. mI.l,??.....
Storiea
` To Be Uaed For
?
? /?/iZq?9ar
?avP Fsox!
p?
60 Daplh
3 Haigh! Eet. Coe!
?S??? Permi! Fea
/
? ??.??o Ramarks
?r? ar
or
LOCATION
-4-397 A/? 4-1) lo I / 16 1 Gt>r??4horr IF, ,. .4
This permit does ny'i aufhorise the use of slxeels, zoads, alleys or sidawalks nor doee it give the owaas os hia ageaf
ffie righ! !o create anq sihation mhieh is a nuisance or whieh presenls a haaasd !o the health, safefp, eoavenience and
K PREMISE WHILE THE WORK IS IN j
qeaeral welfare !o anpone in the aommunifp. THIS the above deso PERMIT nbed MUST rem BE ise sub ec to t?i? b?6ion ZoCeSI PROGRE •
This is !o ceriifp, fhai---...T .. ON T p e! a.......... .fn.}a-fyl ....................... _upoa
' p prov'?sions of all applica for the Cifp 91 Eagan./
.---lY...... ............................................... rer ...??..?.n.?. 1---...............................
Mayor Buildi._....nq....... Impeclor
Eagan Township
., ' Dakoia Counfy, Minnesola
. • - Applicat9on for Bnilding Permit
Type of building or work eanlamplafed.
Resxdential Commereial IndusYrial
Euild Enlasge Aller Repair
Dimensions._..'--.o "-"_'-K"
3 i-•? - ??ct?.
--'---------- -
?
Deiails or remasks..................... ._....................
Locafion
Cirela eorrecS descriplions.
Insiall Move Wreck
Cosi---- ---`• `----- --- E?
----'
PEAMIT NO. ...;?5---A?/
Dale
Oiher---------- ..__ _--------
Number Slree! Be.}.Neen what cross slreels Sizo £si. Valualion
Lo! Block AddiYion Reurrangement or Traci
? ? 411d L//F-lO&-g-a YJU/-/ 21-75!"/DPf T/Ol'J A?jD% J¢ 61001J17I
Owner
Add:ess
?/O"rr?-
ConlracYOaJGE/v ?_" _??Cr"?i??11 ..'_ ' - . Addrass ??--------'-`:'-'_'-'-.-."- i_....`.!`. c? .3.._?
.. .. ..."'-""_"'
The undersigned hereby makes apalication for a permif !o
$ do work as hereiin ap i[?ed, agreeing to do all worlc in siriai
"'"'""""""'""'"'-" accosdance wilh ui flin ordinance adopled Apsil 11. 1955
Total fee collecied.
bp !he Eagan T ns ' oard u visors.
Pexmif fees are no!
refunda6le.
9--3
CITY OF Ei1GAN
3795 Pilot Knob Road
Eagan, Minnesota 55122
PERNIIT NO.:
765
w..?_ y
The City of Eagan hereby grants to Genz-Ryan Plwobina 6 Heatina Eac.
ap Iaoaemount, MAI 55068
a Heatinq Permit for: (Owner) S Peteraon
at 4387 Nvbro Circle , pursuant to application dated it/,?5/7S
Fee Paid: $20.00 dated this _10 day of nar.,.19 75 •
.50 s/c
Building Inspector
Mechanical Permits:
Bid Total:
9-.? A.F
i
cz'-rY oF En saN
3795 Pilot Knob Road
Eagan, Minnesota 55122
PERMCT NO.: 633
The City o£ Eagan hereby grants to Proiect Plumbing cx.
sf 9793 HumboldtAVe. So.
a PLt&IDING Permit fbr: (Owner) Svend Petersen
at 4387 Nvbro Circle , pursuant to application dated 11/13(75
Fee Paid: $20.00 dated this 18 day of DTOV. ? 19 75
.50 s/c
Building Inspectar
Mechanical Perarits:
Bid Total:
CITY USE ONLY
PERMIT #:
APPROVED BY:
INSPECTOR
RECEIPT DATE:
8008 COMMCli4l. MECHAAICAI. PERM1T Ai'PLICATION
Cl'PY oF E4sAA
3$30 PILOT KAOB !iD
K4fiJ4N,1HN 55188
651-6$1-4675
Please complete for: all commerciaUindustrial buildings
multi-family buildings when separate permits are not required for each dwelling unit
DATE:
SITE ADDRESS:
OWNER NAME: PHONE #:
TENANT NAME (IMPROVEMENTS ONLl):
WAS T'fiBRE A PREVIOUS TENANT IN THIS SPACE? Y N. NAME:
INSTALLER:
STREET ADDRESS:
CITY:
TELEPHONE #:
WORK TI'PE: New construcrian
_ Interior Improvemen[
_ Processed Piping
STATE:
ZIP:
_ Install U.G. Tank
_ Remove U.G. Tank
SpecifyNature of Work:
When installing/removing underground tank, ca[l 651-681-4675 for inspection by Fire Marshal and
Plumbing inspector.
Fees: 1% of contract price OR $50.00 minimum Fee, whichever is greater.
Underground tank removallinstallarion = minimum fee
Contract price: $ x 1°/a =$ (Base Fee)
State surcharge calculate at $.50 for each $1,000 Base Fee
TOTAL $
SIGNATURE OF PERMITTEE
Updated 1/02
CITY USE ONLY
PERMIT #: RECEIPT DATE:
2008 RnIDEPTIlEL MECHlk1VICAI. PERMTf APPLIClkTIOA
crrY og E*ewv ,
3830 Pv.oT xxos [tn
EA8f4A MlY $S14Y
681-681-4676
Please complete for: ? single family dwellings
townhomes and condos when permits are required for each unit
Date: 7C? /o '?.)
SITE ADDRESS:
i
OWNER NAME: ? TELEPHONE #:
INSTALLER NAME: TELEPHONE #: _92-&4!. ?7a-:?e
STREETADDRESS: ?j?/U y?`GiyClp Lu,i.liY
CITY: EzOi,LQc.Z STATE: ? ZIP: ST?3 ?
Plate a check mark next to the permit work type
Add-on, modification or alteration to existina dwelling unit $ 30.00
• furnace replacement
• air exchanger
• air conditioner
• other
Nature of work: o ?(= D?2 11
a??
ini 4 ? 2002 ` I
By
State Surchar e $ .50
E Total
F PERMITTEE
t/oz
? CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
SITE ADDRESS:
PERMIT
PERMIT TYPE:
Permit Number:
Date Issued:
4387 NYBRO CZR
LOT: 9 BLOCK: 3
WILDERNESS RUN 47H
P.I.N.: 10-84353-090-03
917
BUILpING
024820
11J04/94
DESCRIPTION:
(ROOFING)
B,M'ilding'-,Permit Type
Building Wo•rk Type
REMARKS:
5F (MISC.}
REPAIR
? --I ? I 1
s??1 L i
FEE SUMMARY:
VALUATION
Base Fee
Surcharge
Total Fee
$54.00
$1.50
$55.50
$3,000
CONTRACTOR: - applicant - sr. Lzc. OWNER:
ROBERTS RES REMODELING INC 18944148 0006885 GARVIN MARGO
4456 CINNAMON RIpGE TR 4387 NYBRO CIR
EAGAN MN 55122 EAGAN MN 55123
(612) 894-4148 (612)452-5065
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 Mn.
Statutes and City af Eagen Ordinances.
L
APPLICANT/PERMITEE SIGNATURE
JIMn kjUV I Mj
ISSUED Er. SI AT RS
I
INSPECTION RECORD
CITY OF EAGAiV PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55123 Date Issued:
(612) 681-4675
BUILDING
024820
11/04/94
SITE ADDRESS: Lo r:
4387 NY8R0 CIR
WILDERNESS RUN 4TH
PERMIT SUBTYPE:
sF (MZSC.)
9 B L 0 C K: 3 APPLICANT:
ROBERTS RES REMODELING INC
(612) 894-4148
TYPE OF WORK:
REPASR
[JESCRIPTION (ROOFING)
INSPECTION
FRAMTNG .. .
ROUGN IN PLBG ..
ROUGH IN H7G FINAL
I
F
?
? J
, -.
14I ??
CITY OF EAGAN
1994 BUILDING PERMIT APPLICATION
681-4675
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: 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 Valuation of work 3 u oa
Site Address: 4f3 P7 rc L>
STREET' SUITE #
Tenant Name: (commercial only)
LOT ? L ?_ SOBD. P,I.D. #
Descri tion of work: CP/'OD
The applicant is: ? Owner Ea Contractor ? Other (Describe)
Name GQ r v, ? vz-/? ra?, Phone
Property LAST F1R5T
Owner qddress 7 12?Ib/-a c-
STREET STE #
City Eca?,?, State [i-t? Z i p
Company gdPr-..r' 6?4r,sA-,,7-.9 e _ /LP?a-?uOPCrnn ,ti< Phone ?X 3`iS<<F
Contractor Address /3iisr License # Exp. 1,5?9s
City _SAvAG£ State Zjp SS3>?
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 Statutes and City of
Eagan Ordinances.
Signature of Applicant:
OFFICE USE ONLY
BUILDING PERMIT TYPE
O 01 Foundation ? 06 Duplex ? 11 Apt./Lodging-
? 02 SF Dwg. ? 07 4-Plex O 12 Mu1ti. Misc.
? 03 SF Addition ? 08 8-Plex ? 13 Garage/Accessory
? 04 SF Porch ? 09 12-Plex ? 14 Fireplace
? 05 SF Misc. ? 10 Multi. Add'1. ? 15 Deck
WORK TYPE
0 31 New 0 33 Alterations ? 35 Tenant Finish
? 32 Addition ? 34 Repair ? 36 Move
GENERAL INFORMATION
Const. (Actual) Basement sq. ft.
(Allowable) ist F1. sq. ft.
UBC Occupancy 2nd F1. sq. ft.
Zoning Sq. Ft. total
# of Stories Footprin t Sq. ft.
Length On-site well
Depth On-site sewage
APPROVALS
Planning Building
Engineering Variance
REQUIRED INSPECTIONS
? .Site
? Wallboard
? Footing
? Final
0 Framing
? Draintile
O Insulation
? Fireplace
+I
Permit Fee veiuaeim: g
Surcharge
Plan Review
License
MWCC SAC il
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge i
Treatment P1.
Road Unit
Park Ded. II
Trails Ded.
Copies
Other
Total: +I
SAC %
SAC Units ;I
.
?
E3 16 Basement Finish
?i ? U Swim Pool
? 18 Comm./Ind.
1i 0 19 Comm./Ind. Misc.
? 20 Public Facility
[3 21 Miscellaneous
?i
'O 37 Demolish
MWCC System
City Water
PRV Re,quired
Booster Pump
Fire Sprinkler
Census,? Code
SAC Code
Census' Bldg
Census UMt
Assessments
--;?e 3, t' 2?- y
/"L/'L3
Clyde H. Parker Registered Land Surveyor end Profeseional &ngineer
1Vone 88 1-7252
N
rr•-1:,ared for:
PLAT OF SURVEY
f'.r. Svend PeterSen, 4701 1 '+'g . 110 t^ St. Bloon,int;tor. :,5437
i.'i r:nesota.
Tel . 884-`.;144
Describea as t'cllo,:s:
LOt 9, BloiK 3, :uILllERN&S5 RUI' F6I;Y,'P11 llar:ot:i i'aount.y, N.ln'.Z:'.SOt3
F°^
qo 14.9
?
?
?
1ND.o3 899•B
? •
1040s
Portlend Ave. So.
Minneapolls. Minn.
O denotu iron monumcnt
Srele 1 inch 30 feec
avs s
I
30
-?
?r?ZG.??
N' (` (
/y 33 ??ap /M
?N /? 997 0
q
I iJ
q
0
W
0 0 ' J
? M ?
I?' ? r v W ? U
l?
m
1 30
r ?
I T ? ?
q ? 1g,? N/ ? ? ?1
??10 ,. B98 • 7
_-?'?, +ly yo11e8?
907.0
9 /o• 5 \
?
\
CERTIFICATE OF SURVEY ?
\
f hereby ceretty choc on Ma?9 191f7 I surveyed the property described e6ove end thet ehe ebove plet is e wnect
represencation of said survep.
L!g?b //&4..._
Srete Reg. No. 2055
MASTER CARD
STRUCTURE AND
LAND USED AS
Permii
No.
Issued Issued To
Coniractor Owner
BUILDING
PLUMBING ?.??
_
. 22-Ar
-ra w% C
'
CESSPOOL - SEPTIC TANK
WELL
ELECTRICAL
HEATING G b ? ? •• O' ?,
GAS INSTALLING
SANITARY SEWER
OTHER
OTHER
Items Approved
(Initial)
Date
Remarks
Disiance From Well
FOOTING ..,-2 SEPTIC
FOUNDATION CESSPOOL
FRAMING TILE FIELD FT.
FINAL
ELECTRICAL
HEATING DEPTH
OF WELt
GAS INSTALLATION
SEPTIC TANK
CESSPOOL
DRAINFIELD
PLUMBWG 'c7'o(`/•5 ???J?'/?/
WELL
SANITARY SEWER
Violations Noted
on Back
COMMENTS:
OWNER .srend_-_Ave-c etr-smn
COMPLIANCE INSPECTION REPORTS
TO BE USED ONLY IN EVENT OF OBSERVED VIOIATiONS
PERMIT NO.
CONDITIONS OF CONSTRUCTION AT THIS INSPECTION
? NO EVIDENCE OF NON-COMPLIANCE
OBSERVED.
? ACCEPTABLE SUBSTITUTIONS OR
DEVIATIONS.
DATE OF INSPECTION
? NON-COMPLIANCE. BUILDER WILL COMPLY
WITHOUT DELAY.
NON-COMPLIANCE. BUILDER DOES NOT
INTEND TO COMPLY.
COMPLETION OF CERTAIN IMPROVEMENTS
WILL BE DELAYED BY CONDITIONS BEYOND
CONTROL.
ITEMIZED AND DESCRI6ED AS FOLLOWS:
? REIhSPECTION REQUIRED DATE OF REINSPECTION
REINSPECTION REVEALED
CERTI FICATION - I certity that I have carefully inspected the above in which 1 have no interest present or prospective, and that I have reported herein
all significant conditions obszrved to 6e at variance with ordinances of the Town of Eagan, approved plans and specifications, and any specific require-
ments for off-site improvements relating to the property inspected.
? ALL IMPROVEMENTS ACCEPTABLY COMPLETED
BUILOING INSPECTOR
DATE
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Usa BLUE or B�ACK Ink
------- —,
� FOr Of�lto Use T �
' ' �1��.5 � ��
Clty �f����:Il ; pe�,E�:
�
� Pertnit Fee: I
3830 Pllot Knob Road � I
Eagan MN 55122 � Date Recelved: �
Phone:(&51)6755675 � �
� Staff: �
Fax: (651)675-5694 L__`______^�__`__J
2015 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: � -�2r.5"—/,� Site Addre9s: 7 �j g� �y b �-D i�'/—Lf
Tenant: Sulte!�;
e �: Name: t�l� 11�1 Phone:
Address/City/Zip: $cs,.rvt�
Name: �L n �dN� ; License#: Pc6�36,��` ,
Address: ���_ �f rit�f�.�,e .r�.c�cy: ,��Yl'�tD�J�
.e SMte:�� Zlp: lJ L7 % ! / Phone: 7i�.3' y�✓� 0�7�
Contact: i� Emall: ri'YII+'L�lJ+����Sb n S •C.o rt^
�New _Replacement _Repair _Rebuild �Modify Space _Wor1c in R.O_W.
► r, Descrlptlon of work:
� I
RESID�NTIAL
� ,�� Water Heaier
Water Sokener
�
Lawn Irrigation�RPZ/`PVE)
Septic System ,�fldd Plum6ing Fixtures(�Main/_Lower Level)
� 1 �I � _New Water Tumaround
�' ,�Abandonment
RESIDENTIAL FEES:
$60.00 Water Heater,Water Softener,or Water Heater and Softener(includes$5.00 State Surcharge)
�60.00 Lawn Irrigatloh(lncludes$5.00 minimum State Sur�ha�ge)
$60.00 Add Plumbing Fixtures, Sentic Svstem Abandunment,Water Turnaround*(includes$S.00 state surcharge)
'Water Tumaround(add$200_00 If a 5/8"meter is requlred)
$115.00 Se tic S tem New($10.00 per as bullt)(includes County fee and$5.00 Stete 5urcharge)
TOTAL F�ES$ ���Ov
CALL BE�ORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against urxierground utillty damage.
Call 48 hours before you Intend to dig t0 recelve locates of underground utilities, www.aooherstatepnecall.org
I hereby ecknowledge that this ir�ormatbn Is complete and accurate;that the work wlll be In cont�ormance with the ordinances and codes of the City of
Eagen; Ihac I underatand thls Is not a permit but only an application for e pennit,and work►s not to efaR without a permit;that the work wlll 6e in
accordence with the approved plan in the ease of work which requlres e review and approval of plans.
. ��rr
x i�r� �lo�i r �,•. ,z-°i7���
X
Applicant's Printed Name ApplicanC's Slghature �
Y� t
e I �. �.
I : •
....... .......... ��' .. a� � . , .
� " ___Use BLUE or BLACK I���
� For Office Use � �
� f j��I �
C�bOl �� �11 i Permit#: / � `A � � '� I
� � � Permit Fee: /���(� � � ,
3830 Pilot Knob Road � �. �--a_�� �
Eagan MN 55122 � Date Received: c/ .� � �
Phone:(651)675-5675 I � I
Fax:(651)675-5694 I Staff: I
I I
� .. . . .. V����������������J I
2015 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit#:
� �j' /� • �` /� N ��,,J� J /� A
t � ,� C�`l�[.�I��- 1\.(/(il.Cl LY����hone: Z. .
' Name:
���� �
��, �; ��g� = Address/City/Zip:
��,,a; ' t ';t,� Applicant is: Owner Contractor
�� �.; '�1.� ► 1�' �
Description of work:
„'����►f��r� ;
' a, , ;;,,. Construction Cost�5��'°� Multi-Family Building: (Yes /No�)
, i = �i' .
a A '
� , = Company: (��l �,�'�`�KS Contact:
� Address: � � � �f�/�City:
����'�H��� - : •
�` ;� State�Zip::� 31� Phone: ' •C�
`�� ' _ ` License#:�Jll�Z /� Lead Certificate#:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months,has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes _No If yes,date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer&Water Contractor: Phone:
��j � ������s'�� ��� �� �����r����� ���q� � I � °
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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.qopherstateonecall.orq
I hereby acknowledge that this information is complete and accurate;that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 780
days of permit issuance.
X�,��,+ �t.�ll� � �
Applicant's Printed Name ApplicanYs Signature
Page 1 of 3
`7 ��-�< �1�3���� � ���( �: . r.
. ` DO NOT WRITE�ELOW THIS LINE �7���
SUB TYPES
Foundation Fireplace Porch(3-Season) _ Exterior Alteration(Single Family)
� Single Family _ Garage _ Porch(4-Season) _ Exterior Alteration(Multi)
_ Multi _ Deck _ Porch(Screen/Gazebo/Pergola) _ Miscellaneous
01 of Plex Lower Level Pool Accessory Building
WORK TYPES ��'� �Orn �-�u� W� h�w SY�iu-�f•
_ New _ Interior Improvement _ Siding _ Demolish Building*
Addition _ Move Building _ Reroof _ Demolish Interior
� Alteration _ Fire Repair _ Windows _ Demolish Foundation
_ Replace _ Repair _ Egress Window _ Water Damage
Retaining Wall *Demolition of entire building-give PCA handout to applicant
DESCRIPTION �—
Valuation �°—'� Occupancy �(,� MCES System
Plan Review Code Edition 2��S�g3�- SAC Units
(25%_100%� Zoning �� City Water
Census Code Stories Booster Pump
#of Units Square Feet PRV
#of Buildings Length Fire Suppression Required
Type of Construction � Width
REQUIRED INSPECTIONS
Footings(New Building) Meter Size:
Footings(Deck) Final/C.O. Required
Footings(Addition) '� Final/No C.O. Required
Foundation � HVAC_Gas Service Test Gas Line Air Test
Roof:_Ice&Water _Final Pool:_Footings _Air/Gas Tests _Final
� Framing Drain Tile
Fireplace: _Rough In Air Test _Final Siding:_Stucco Lath _Stone Lath _Brick
�C Insulation Windows
Sheathing Retaining Wall:_Footings_Backfill_Final
Sheetrock Radon Control
Fire Walls Fire Suppression:_Rough In_Final
Braced Walls Erosion Control
Other:
Reviewed By: �U J , Building Inspector
RESIDENTIAL FEES
Base Fee � � ,� �_ �U � � � ���
Surcharge
Plan Review , \ r
MCES SAC C�1� �J��VL�' �'
c�ty sac Z� � � �
Utility Connection Charge r
S�W Permit&Surcharge
Treatment Plant
Copies
TOTAL
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