4611 Parkcliff DrCASH RECEIPT
T F E ?
CI Y rQ AGAN
„. .
P. 0 BOX 21-199
EAGAN, MINNESOTA 55121
/
DATE- - f9
RecsIven
FROM
AMOUNT $ 1 J?
1 00
? CASH fl CHECK _-•
FOR
. . , 1
FUND COOE pMpIJMT
j _
Thank You
s Y
White-Payers Copy
Yellow-Posting Copy
Pink-Fife Copy
? CASH RECEIPT ?
CITY OF EAGAN
P. O. BOX 21-199
EAGAN, MINNESOTA 55121
DATE 19 (
RCCEIVGD
PROM
AMOUNT
10 - S00 - ?30 ALL & DOLLARS
,oe
? CASH CHECK
?, .? • ^a ! _''? _
FOR
? 1 t ,. t I t'c ,_ ?.? C_? L ? ? ? ?
1_ `? ,? d ???,,? ?<(i ?_ ? r- ?_ ?
FUND CODE AfAOUNT
7
°' =1 7 ?/a2 0 7s
i Ple?o /OC? U
? 7 3?' . ? ?o 0
Tha u
. BY ? -
VYhite-Payers Copy
Yellovv-Posting Copy
Pink-File Cop
CITY OF EAGAN ?T
3830 Pilot Krab Road, P.O. Box 21-199, Eagan, MN 55121 jr ? 9?n
1'J 1
PHONE: 454-8100
BUILDING PERMIT Reteipf # 4?? S':;? D----
Site Addreu
Lot 3
Parcel No. _
eWc Name
Z Addre
? City _
Name
?? Addre
Citv .
Nsme _
Address
City _
Phone
? I hereby acknowledye thot I have reod
the information is correcf and ogree
Stote of Minnesoto Stctutetland/City
Sipnaturo of Permittee ? _* ?'?',` '•
A Building Permit is issued to: -?
ell work sholl be done in accordance w
Bufldlnp Officfol
? -- --- -
and
oll ?
t
$ 7 7,0 0 0 D MAY 25
19 84
a e ,
Erect ? Occuponcy R3
ST qlter ? Zoninp R
/ Repatr ? Fire Zone N A
V
Enlarye p TYPe of Const.
Move ? #k Storie
1 Demolish
[] 4 7
Length
-AF9-
6rode n Deoth
Sa. Ft.
Assessment
Woter & Sew.
? Polite
- Fire
- Eny.
- Picnner
Council
thOt
cble Bldfl. Off.
APC
Fees
Permit
- . G U
3 64
Surchorge 38.50
Plun check 1$ Z. C U
5AC 525.OU
Woter Conn. 470.01)
Water Meter `' ?_ n ' '
Rood Unit
rotol ? - 50
on the exprcss Condition thnt
and City of Eayon Ordinonces.
1
Psrmit Na Permit Holder Misc. Permit No. oldsr
Plumbing (.(lI
H.V.A.C. ?I I-' P ?OII ?
W?tl
Water
Dlsp.
S?wer
Eleetric
SyYo? , ilv ?-zZ-sq 4z.5-a
Irqpaetion Date Insp. Other
Footings
r r. 'r-
-?,'
oun ation
Framinp
Rouyh Pibp.
Rouph HVAC
Inaulstion 1
Final Plbp. - ? a
Final HVAC
Final ?
water Dascribs Location: .
YYell
Sew9r '
Pr. D'ap.
Receipt MECHANICAL PERMIT Permit No.
CITY OF EAGAN
Fee
fill in numbered spaces S/C '
Type or Print /egiWy
Tot.
1. Date 2. Installation Cost -
3. Job Address Lot Blk. Tract
T"-
?
4. Owner •
5. Contractor "Z
6. Address ev 'j ? ' -..
7. City State
8. Building Type: Residential ?
Phone
? Institutional ?
9. Work Description: New 0 Add O Alter O Repair 0
10. Describe Fuel Type
11.
No. Equ'ioment BTU - M. Ea.
Forced Air No. Eauiament CFM
Mfg. Air Handling:
Boilers
Mfg. Mech. Exhaust
Unit Heater
Mfg. Oth
Air Cond. er
Mfg.
Gas, Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed :
for
Rough Finel
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
Receipt PLUMBING PERMIT Permit No.
C17Y OF EAGAN
Fee
Fill in numbered spaces S/C
Type or Print legibly Tot. .??
1. Date 2. Instaliation Cost
/
3 J
b Add
/o
J Blk
-?
? ' ? T
ct1 ?"C
. ress
.
t
.
o
? ra
Y
4. Owner
5. Contractor Phone •- ? ' '- ?.? ? :?-
6. "
Address
7. ,
City 5tate % -
- - Zip
8. Building Type: Residential d/ Commercial ? Institutional ?
9. Work Description: New ? Add ? Alter O Repair O
10. Descrihe
I 11.
No. Fixtures
Water Closet Na. Fixtures
Cesspool/Drainfield
Bath tubs Septic Tank
Lavatory Softner
Shower Well
Kitchen Sink
Urinal/Bidet Other
Laundry Tray
Floor Drains
Drinking Ftn.
Slop Sink
Gas Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
comply with all ordinances.and codes governing this type of work.
Signed : for
Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
CITY OF EAGAN Remarks
Addition PARK CLIFF ADDN. Lot 3 Blk 2 Parcel
owner Street 4611 Park Cliff Drive State Eagan, MN 55123
Improvement Datt! Amount Annual Years Payment Receipt Date
STREET SURF.!' 1
STREET RESTOR.
GRADING
SAN SEW TRUNK ;? 19H1 2
*SEWERLATERAL 2.778.79
WATERMAIN
* WATER LATERAL 1981
WATER AREA
STORM SEW TRK 1981 502.04 368.20
* STORM SEW LAT 1951
CURB & GUTTER
SIDEWALK
STREET LIGHT
ROAD UNIT $260.00 #43582 5-25-84
WATER CONN. 470.00 11
BUILDING PER. #9107 11
sAC $525.00
PAR K
CITY OF EAGAN WATER SERVICE PER
I
3830 P;;ot Knob Road M
T
P. O. Bax 21199 PERMIT Na.:
Eagan, MN 55121 DATE:
Zoning: " I No, of Units:
Owner, O^-'„1il r'Pdf r8011
llddrcss:
4611 Par.kcliff Drite 1,3
Site /lddross;
sl'
Plumber: T'?,?_t;?•. ^?.???
Meter No.:
Connection Charge: . ),.; :-)r
Size: Account Deposit: 15.00 pci
Reoder No.: Permit Fee: 10. 00 -c;
I egrm M oomplq wilk Hn Cify ef Eagoe Surcharge: . 5:
Ordlnancas. Misc. Chorges:
Total:
BY Dote Pctid:
.,_-- .
OF EAGAN SEWER SERVICE PERMIT
Pi<ot Knob Road
Box 21199 PERMIT NO.:
r ?
i, MN 55121 DATE: '
A? " F No. of Units:
Ozmun Psclerson
Add,
to eomplr wkh !he Cky of Easos
of {nsp.:
TY OF EAGAN
30 Pilot Knob Road
0. Box 21199
gRn, MN 55121
Ozmun Pedereon
... ? ........ .........?.
Atcount Deposit: 15. 0"0 pci
?r f9Permit Fee: 10.00 pd
+[o eomp wieb the City ef Eagew Surchorge: .50 d
sneas.Misc. Charfles: 63• pd net,
? Total:
Date Pafd:
of Insp.: Insp.;
Gonnection Choroe: - 425.00 Rsj
Account Deposit: 15. QQ pd
Permit Fee: - 10.00 pd
SurtF?orpe:
Misc. Chorges:
Total:
Dote Poid:
WATER SERVICE PERMIT
PERMIT NO.:
DATE: 6 - 4 -
No. of Units:
CITY OF EAGAN O?
3830 Pilot Kno6 Road, P.O. Box 27-19 9, Eagan, MN 55121
- ` PHONE:454-8100
BUILDING PERMIT eeceipt
Te M uwd for SF DWG/GAR Est. Volue $77,000 paSe MAY 25 , 19-34
SiteAddress 4611 PARKCLIFF DR Erect u Occupancy R3
Lot 3 Block 2 Sec/Sub. PARKCLIFF 1ST Alter ? Zoniny Rl
Parcel No. 10-56700-030-02 Repolr ? Fire 2one N/A
Enlarga ? Type of Const. V
rc Name WILLIAM & JUDITH TAIT Move ? # Srories
Z Address 5459 E 79TH ST Demolish ? Length 47
? CitV INDIANAP0I4g,e 317/349-4251 Grade ? Depth 49 Sq. Ft.-
OZM[IN-PEDERSON INC ADDrovala Feea
o Name
15136 GALAXIE AVE
oU
d
Assessmenl
Permit +S 364.00
res
Ad
431-5000
X E VAL
u? Water&Sew. Surciwrge 3$.50
City
Phone
Police Plan check 182.00
F. Name Fire SAC 525-00
?? Address Enp. Water Conn. -?.Q.. 00
<W City Phone Plnnner WaterMeter_6i.3--00
Council Road Unit 7F+n 00
I hereby acknowledge thot I hove read this applicotion ond state that gldg. Off.
flle information is correct ond agree to comply with oll opplicable
Stote nf Minnemto Starut9ffan ?E?ty ogan Ordinances.
/
APC $1?902.50
Totol
Sipnoture of PermiMee
"?-
- A Building'Permit Is issued ro: - OZMU PEDERSON
on the lxpreu conddion ihm
?joll work shall be done in occordarxe wit oll pIlcable Sfale?of innesoto Sfatufes and Ciry ot Eogon Ordmances.
Builnp Offlciot ?
.., ? ?
?
? ?1 / ? ? CITY OF EAGAN Include 7. sets of plans,
? ? 1 Gertificate of Survey &
SIF DWCa. ?GAR BUILDING PERMTT APPLICATION 1 set cf energy cal,r-.u1z.;:;-ons.
. l ?OA:7. ?'
7b Be Used Fbr ^,! Valuation Date ??2D?
Site Ptldress ?O ( 1 kv C
D c •
Lot 0 Block -
2` Sec./Sub. _
?
Y OFFICE USE ONLY
Erect
IO^SIo7D0-O?'? QccupancS'
?#:
? !`l1 Alter Zoning fZ- I
Ranair Fire Zone N p.
ONmer: Enlarge _ Type of Const. ?
Address: ?
c
(11 C ??
?. # Stories
_ .
Derolish
Front
ft.
City/Zip Code: DePth 41 ft.
Phane #: ?3l 7-?9-d 1
APPROVALS FFFS
Contractor: -[?y_ Assessnents Permit
Prldress: ' !^7ater/Seaer Surcharge
Police Plan Check
City/Zip Code: d-, ;? Fire SAC 525•°°
Phone #: ?• Water Conn. 47U. °
Planner Water Meter
Arch./Eng.: Council Road Unit 2L4>.=°
Bldg. Off. z
Address: APC
City/Zip Code:
Phone # : TOTpy ? ?/ 6 a . S-p
_, A
-P
On
?
1?
P li
N .?
• x X ?
,- ?
J S l5? ? ?,
G ?
N ?
REQUEST FOR HECENCAL INSPECTION I E?Bf'°°°°»°
, See :.wtr?tiars for comp4ting?his fam mlitick of rallo? cwv- b( LZ ?Pj Y
A n??? n 7 -?x-. &,? wQ,k `--weied by Thrs Request
?Add Rao. Tvoe nf BuiEdim Aaolia. wireA Equipimmont Bired
N Fee ServicaEn4scee5irse k Feo FeedersZSubleede?s 0 Fea Circuits
1.00 om? 7ps omao AArros 1 27.50 omso Anys
Above 200 A - 31 to 100 A?s -nn 31 to 100 Affps
Swimming Pool A6ove 100- Above 1Q0_ArryPs
Tra?form?,vs Irtigation Bodrs Partial.'OYhec €?
' 1 I S'gis iSpecial Inspec[ioe? 3. 00 I T FEE
Ne?rks `I .? `?
floupMin Datc ? El .
?
Irc.Oec I?e?B4Y
rtih Mat the abova
Final ? ?t rmpeetim has bee.
TIIY Ipuest raid 78 maMls 4am
This reyuest Void ?' /?(?
78 months frqn t It
A, 05 4 4 0 7 L g ' -P-4 d.;" I
fleguest Da1e
1 ire No.
1 Rouph-in ion
Nepmred?
QReatly Now 13WilI Nolity 7a?sMn:-
6-21-84 Yes ?No tm When Iie.-Wy
? Licemed Eleclriwl Contrector
1 IwahY mVeast iaspectim of ebovo
? Owner eleclriepl ?rmk irmTalNd at_
SVee[ Address, Boz w flout¢ No. Giry
4611 PARKCLIFF DRIVE EAGAN
ecuon No. Township Name m No. nge o. County
I I DAKOTA
Occupxnt IRi1NT) Phone No.
02'MUN - PEUERSON, INC. 431-5000
Fbwer Supulia AAtlress
DAKOTA ELECTRIC FARMINGTON, MN
Electtiol Contrdctw (Cmnpanry Name) Cantracmr s Licensc !lo_
LAKEVILLE ELECTRIC INC. A041802-9
Mailin0 Address Montracta m Owmer Yakinp Inspila[fon!
AuMoriz ignutum Co c!m r 1lakinp IrealWtianl Rwme Mintb¢r
YINNESOTq Sfp7E gpARD Oi ElEC7iiiC1T'TN? INSPECTION BEQUEST 911LL N0T
Grigps.Yidwey Bldp. - Mun M-197 r BE ACCEPrED By 7HE STAIE BpApp
1827 Univorsiry Ave_, St. Pavl, YN 55104 UNLESS YROPER 1NSPECTION FEE 75
Phore 16721 297.2177 ENGIOSEU.
4;jj Y 0 REQUEST FOR ELECTRICAL INSPECTION r ee-ooaot-cu
? ' Sea inshuctians tor comoleting this torm on back ol yellow copy.
A 41441 "X" Below Work Covered by Thrs Request
Niiiii AAd R.P. Type ol Bwldmg AoPliancns Wired Equipment Wired
X Home Range X Temporery Service
Duplex Water Heater Lighting Fixtures
Apt. BwlAing Dryer Electnc Hea(in
Commercial Bldg. Fumace Silo UnbeAer
Industrial 81dg. Air Conditioner Bulk Milk Tank
P2rm Otne? oecity Oth, 6pe<.ifvl
t er ISUOeify Othce 01hcr
Compute lnspectron fee Below
p Fe?e ServiceEntrenceSize 4 Fee Feeders/SWtneders # Foa Cucwts
U ro 0 Am s 0 to 30 Am s 0 m 30 Am s
Above 200 qmps 37 to 100 Amps 31 to 100 q S
Swimming Pool Above 100-Amps Above 100_Anips
Trensiormers IrrigaLOn Booms Partial-'Other Fee
Signs SpeciallnspecLOn $ 1
TOT
--
Rem?rks 10 .50 ?/
AL lPE?
.r1
Rough-in Date 1, Ihe sl
Inspectar, heraby
certdy thet the above
Final Onte pecLOn has been
r ? mede.
Thla reouest void 18 montha From
This requesl voitl 43--?'-(0
mon?hs iwm
1 18 A 41441 t-i g a Pa,,.k
o-O
??_??T1YJ
RequestDate Fire No. Rough-in nsper.UOn
Required?
?ReatlyNOwOWiIlNobivlnspec-
5-29-84 t
Wh
R
e QVes ?NO or
en
oatly
rA Licensed Electncal Contractor I hereby requast mspacUOn of above
? Owner electncel work installed at.
Street AAdress, 9ax or Raute No. Cilv
4611 PARKCLIFF DRIVE EAGAN
ecU on o.
I
Township Nxmc or No.
RanAe No.
I
Caunty
DAKOTA
Occupanl IPqINT) Phone No,
'OZMUN - PEDERSON INC. 431-5000
Power SapVl,er Atldress
DAKOTA ELECTRIC FARMINGTON MN
Electncal Contracror (COmpany Name) Contracmr's Lwense No.
Mailmg ress onrac[oror wnar a mg nslailationl
20480 JAC UARD AVE. W. , LAKEVILLE, MN 55044
Authonzed ignature Convactor/Owner Mmg Installatian) Phone Number
469-4939
MINNESOTq STqTE BOAPD OF ELECTNICITY THIS INSPECTION flEQVEST WILL NOT
Griees-Midway Bldg• - floom N-191 gE ACCEPTED 6Y TME STATE BOAHD
1821 UNLESS PROPEfl INSPECTION FEE IS
UnivarsitV Ave., St. Pqal, MN 66104
Phone (812) 297.2711 ENCLOSED.
U .*
:6 4 ?c+
3a
?s2.0 r;,.
s2s
a7o+
63•:]Gy
260=L(+
1? O 2•` 0 M
???-? ?
PLUMBING (RESIDEN'TIAL)
Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5674
Please complete for: Single Family Dwellings
Townhomes and Condos when permits are required for each unit
44 25D .sa
Date ? / ?6
Site Address Uni [ #
Property Owner TelepLone # (6"?jt ) `"F-Sa " `jq1j(2l
Contractor R??NC\A.('hc'f\ ¢}?
Address City
State Zip ? Telephoue # (.Dl) %,rl " "YUs?
e \ - lM - '5
The Applicant is _ Owner ? Contractor _ Other
Septic System New RefurbiSlted Submit 2 sets of plans and MPC license $ 100.00
Inclvdes County fee. Addltional consultant fees may apply.
Alte tions To Existing Dwelling Unit, Including
?
00
$ 50
Adding fxtures to lower levels or room additions, excluding water soften er and water heater .
_ Abandonment of septic system
_ Water turnaround (+ 5/8" meter if needed -$121.00)
_ Other. e--)FtAs vv?. "?5r ? ,n "
_ RPZ _ new installation _ repair _ rebuild $ 30.00
_ Lawn irrigetion system
_ Water softener _ Water heater $ 15.00
_ replacement _ additional
State Surcharge
N
$ .so
'rotat In $ f?b •?
i nereoy appry tor a xesiaenhal Ylumbing Permit and acknowledge that the infor#Mion-iscamgleFe--Md=.-4Vmkte; that the work will
be in conformance with the ordinunces and codes of the City of Eagan and with the Plumbing Codes; that I understand this is not a
permit, but oxily an application for a permit, and work is not to start without a pernut; that the workAill be,yn accordance with tl?e
approved plan in Ihe case of work wliich requires a review and approval of plans. ? ?
C ` \
ApplicanYs Printe Nam Applicant's Signatur
RESIDENTIAL BUILDING
Permit Application
City Of Eagan ? rj
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5694 C?-y-q? `rs_03
New Construction Reaui2menfs RemodeVReoair Reauirements Office Use Onlv
3 registered site surveys showing sq. ft of lot sq. ft ot house; and all roofed areas 2 copias of pWn Cert of Survey Recd
(20%maximum lotcove2ge allowed) 1 set of Eneyy Calculations forheated additions Tree Pres PWn Recd
2 copies of plan showiig beam 8 wiiMow saes; poured tound design, etc. 1 site survey for additions 8 decks Tree Pres Not Reqd
1 set o( Energy Cakulatlons Add'rtion - indicete ilar-srte sep5c syaiem _ On-site Septic System
3 copies of Trce P2servation Plan if bt platted afler 7/t/93
Rim Joist Delail Optlons selecUon sheet (bldgs with 3 or less units
Date ?
Coustruction Cost ?,S'ts0
Site Address _ y? // ?A r kc.? ?'F r? UnitlSte #
'Em -s- 3
9
Description of Work /n+1Shr Nc 6?1 ' Za?Lc?wN
Multi-Family Bldg _ YX N Fireplace(s) _ 0 _ 1 _ 2
PropertyOwner W, 1. 1,\q? G. rAi -r Telephone#(GS/) ?/S2- ?I97I
Contractor
Address 14 4. 1 9 u< kr,brF V! City
State ? o„ G 2 'y yL? Zip ,S"J /-2 3 Telephone #(6S/ )VS a- 1I9 7 9
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Energy Code Category - Minnesota Rules 7670 Cateeorv 1
• Residential Ventilatlon Category 1 Worksheet
(J submission type) Submitted
• Energy Envetop Calculatlons Submitted
?I . --'--- _
Licensed Plumber
?-' ? 1 1 ?7f!? ,
Mechanical Contractor
? .
Sewer/Water Contractor
Minnesota Rules 7672
• New Energy Code Worksheet
Submitted
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 ordinances 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
pernut; that the work will be in accordance with the approved plan in the case of work which requires a review and
approval ofplans.
t,), rI,Q, cz ?/ -A, r r,<,
ApplicanYs Printed Name ApplicanYs Signature
OFFICE USE ONLY
Sub Types
? 01 Foundation
? 02 SF Dwelling
? 03 01 of _ plex
? 04 02-plex
? 05 03-plex
? 06 04-plex
Work Types
? 31 New
? 32 Addition
x- 33 Alteration
? 34 Replacement
?
?
?
? 30 Accessory 81dg
? 31 Ext. Alt - Multi
? 33 EM. AIt • SF
? 36 Multi Misc.
35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
36 Move Bldg. ? 42 Demolish (FOUndation) ? 45 Fire Repair
37 Demolish (Bldg)' ? 43 Reroof ? 46 Windows/Doors
'Demolition (Entire Bldg) • Give PCA handout to applicant
Occupancy MC/ES System
Zoning City Water
Stories Booster Pump
Sq. Ft. PRV
Length Fire Sprinklered
W idth
Valuation ?r/v U
Census Code
SAC Units
Nbr. of Units
Nbr, of Bldgs
Type of Const ? -LJ
_ Footings (new bldg)
_ Footings (deck)
_ Footings (addition)
_ Foundarion
Drain TIle
Roof Ice & Water Final
? Framing
Fireplace _ R.I. _ Air Test _ Final
Y Insulation
REQUIRED INSPECTIONS
FinaUC.O.
_X FinaUNo C.O.
Plumbmg
HVAC
Other
_ Pool _ Ftgs _ Au/Gas Tests _ Final
_ Siding Smcco Stone
_ Wmdows (new/replacement)
_ Retaining Wall
r^
Approved By Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit 8 Surcharge
Treatment Plant
License Search
Copies
Other
Total
? 07 05-plex ? 13 16-plex ?" 20 Pool
0 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.)
? 09 07-plex ? 17 Garage ? 22 Porch/Addn.(4-sea.)
? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo)
? 11 10-plex ? 19 Lower Level Gy17#p 24 Storm Damage
? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
L"G 13141`h1
pZ,9a
PO ?
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RU, EAGAN MN 55122
651•681-4675
New Consuuctfon Renuiremente
• 3 registereG sAe surveys showing sq. fl. of bt, sq. fl. of trouse; arai ?_II roofed areas
(20% maximum Iot coverage allowed)
. 2 COples of pl8n Shpwing heam & wintlOW SizeS; p0ured f0und tlesign, elc.)
. isetatEnergyCakwlatbns
• 3 cOpies ot Tree Preservatlon Plan tl lot plattetl afler 7/1/93
. Rim Jolst Detail Optbns selectbn sheet (bklgs wNh 3 or less unMS)
DATE ? ?.? -O eL
SITE ADDRESS
NPE OF
_ Water Softener _
_ Water Heater _
_ No. of Baths
?N
_ 2
APPLICANT ; f41LA,,m I-x?s?itra2 S
STREET ADDRESS ?/? ?a ll..c?rnn?r?n .?uP CITY Cai?rza ik? STAiE.?IP ?a'S3ys?
TELEPHONE #9V-SFl/-$la.Q? CELL PHONE # FAX # 9_q?F'8"/-2611
PROPERTY
1EIEPHONE# P A?,W2 -Y97F
VALUATION
------------------------------------------------- ------- ------------- ----- ---------------------
COMPLETE THIS SECTION FOR %NEW- RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNESOTA RULES 7670 CATEGORY 1 MINNESOTA RULES 7672
(d submission type) • ResideMial VeMilation Category 1 Worksheet Submitted • New Errergy Cod9 Workaheet Su6mitted
• Energy Envelope Calculations Submitted
Plumbing Contractor.
Plumbing system includes:
Mechanlcat Conhactor. _
Mechanical system includes:
Sewer/Water Contractor:
_ Air Conditioning
_ Heat Recovery System
e-i $1S
Fee: $90.00
Fee: $70.00
Phone k
I hereby acknowledge that I have read this application, state that the information Is corrI#,siod (
with all appticable State of Minnesota Statutes and Ciiy of Eagan OrdZA"' es.
Signature of Applico ?
OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required `
Rmixide6'Reoelr Reauiremertte
• 2 Cppies ol plan
• 1 set of Eneigy Calculatbns for heated edtlitbns
• 1 site survey for extenor additioris 8 decks
• IiMkate'rfhomeservedbysep[icsyslemforadtlifions
MULTI-FAMILY BLDG Y
FIREPLACE(S) ?0__ 1
Phone #
Lawn Sprinkler
No. of R.I. Baths
Phone #
Updatetl 4102
OFFICE USE ONLY
O 01 Foundation ? 07 OSplex O 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? OB D&plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt- Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garege ? 22 PorchlAddn. (4sea.) ? 33 Ext. Aft - SF
? 04 02-plex O 10 08-plex ? 18 Deck ? 23 Porch(screened) ? 36 Mufti
? 05 03-plex ? 17 10-plex 0 19 Lower Level ? 24 Storm Damage
? 06 04-plex O 12 12-plex Plhg_Yor_ N [1 25 Miscellaneous
? 31 New ? 35 Int Improvement ? 38 Demolish (interior) ? 44 Siding
O 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
0 33 Alteration O 37 Demolish (Bidg)' O 43 Reroof O 46 WindowslDoore
? 34 Replacement •Demolition (Entire Bldg onty) - Give PCA handout to applicant
Valuation Occupancy MC/ES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const W idth
REQIJIRED INSPECTIONS
_ Footings (new bldg) _ FinallC.O.
_ Footings (deck) _ FinaUNo C.O.
_ Footings (addition) _ Plumbmg
Foundation HVAC
Drain Tile Other
Roof _ Ice & Water _ Final _ Pool , Ftgs _ AidGas Tests _ Final
_ Framing _ Siding Smcco Stone
F'veplace .: RI, Test
Final Windows (new/replacement)
_
_
_ Ineulationt ` • ? _
Retaining Wall
_
A#.
?
.
,
• :,-;' 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
7,50
-Ci1lL16
?513 433 RESIDENTIAL ?'
BUILDING PERMIT APPLICATION
New Construction Reauirements RemodellRepair Reuuirements
• 3 registered sde surveys showing sq R. of lot. sq. ft, of house, and all roofed areas • 2 copies ot plan
(20% maximum lot coverage allowed) . 7 set of Ener9y Calculahons for heated additions
• 2 copies ol plan showmg beam 8 window szes; poured (ound design, etc.) . 1 stte survey for extenor addihom & decks
• 1 set of Energy CalculaGons . Indicate if home served by sephc system for additions
• 3 copies of Tree Preservahon Plan if lot platted after 711/93
• Rim Joist Detail Options selection sheet (61dgs vnth 3 or less units)
DATE VALUATION /220_O ,C_)C:)
SITE ADDRESS MULTI-FAMILY BLDG _ Y ?N
TYPE OF WORK- !`c? 12C3 FIREPLACE(S) ? 1
2
_
_
APPLICANT SLJUPbM .PJc`.Cn
STREETADDRESS ,7f//l GJ.?<?ika? ftu? S CITYAik inwPSTATEQ'1iLZIP'!?_53yy
TELEPHONE # GI?` '&a/".%9&2CELL PHONE # FAX # 2<2•F's$I-SS??
PROPERTYOWNER TELEPHONE# - ?W9
--------------------------------------------------------------------------------------°-------
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ JIINNI•:SU'f.\ RULGS 7670 G\"1 GGORY l Mli ??(?
(d submission type) . Residential Venttlation Category 1 Worksheet Su6mitted • e8r y o e o h e
• Energy Envelope Calculafions Submitted n,IUL 2 5 2002
Plumbing Contractor: --------- ____----- __---- ------ Phonc #
Plumbing systcm incWdcs: 4Vatcr SolLencr _ I.aim Sprinklcr
Watcr Hcatcr No. of R.I. Baths
No. of Baths
Mechanical Contractor:
Ytcchanical st:cicru includcs:
Sewer/Water Contractor:
Phone #
Phone #
rcc: $70.00
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply
with all applicable State of Minnesota Statvtes and City of Eagan Ordin ces.
Signature of Applicanc Ql.( R"-A
--- ----- ------------------ ----------- ------------ -------- ---°-'----------
OFFICE liSE OVLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4/02
:1ir Conditiouin;
Hcat Rccovcny Systcm
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651•681-4675
OFFICE USE ONLY
? Ot Foundation ? 07 OS-piex ? 13 16-plex ? 20 Pool ? 30 Accessory Bidg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 E#. Alt - Multi
? 03 01 of _ piex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 OS-plex ? 16 Deck ? 23 Porch (screened) ? 36 Multi
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (81dg)• ? 43 Reroof ? 46 Windows/DOOrs
? 34 Replacement 'Demolition (Entire Bldg only) - Give PCA handout to applicant
Valuation Occupancy MC/ES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bidgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footmgs (new bldg) _ FinaUC.O.
_ Footings (deck) _ FinabNo C.O.
_ Foorings (addition) _ Plumbing
Foundation HVAC
Drain Tile Othet
Roof _ Ice & W ater _ Final _ Pool _ Ftgs _ Air/Gas Tests _ Final
_ Framing _ Siding Stucco _ Stone
_ Fireplace _ R.I. _ Air Test _ Final _ W indows (new/replacemenq
_ Insulation _ Re[aining Wall
Approved By , Building Inspector
------------------------ ---------- ---------- -- ---- -----°-----°
----------------------------------------------°---- ------- --------------------
Base Fee
Surcharge sc? d U
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 -z1?.(os2.Z
1999 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EACAN
3830 PILOT KNOB RD - 55122
651-6814675
New Constructlon Reauirements
? 3 registered sMe iurveys showing sq. M. of lot, sq. fl. of house
and gjl roo(ed areas (207 maxim?eraae allowed)
? 2 copies ot plans (show beam 6 window alzes; poured (nd. design; etc.)
? 1 sef of energy calculafions
D 3 copiez ot kee preservoilon plan H lot platted affer 7/7/93
DATE:
DESCRIPTION OF WORK: /100 f -ro?/1I
STREET ADDRESS y6 l? G?* G/" ?f
LOT: -3 BLOCK: a SUBD./P.I.D. #:
Remodel/Reuair Reaulremenh
2 copies af pian
t sM of energy calculations for heafed addiNons
1 sRe suney (or exterior addHbns R decks
cosr: 59ff-?e 'i?ld
Name: ? /§-t t Phone #:
PROPERTY tast Ftr:t
OWNER Street Address: k? c6.1? Q /I C!?
/ /?
?? 1/ i-
City r-a? akc State: Zip:
Company: Phone#: ?7y
(area code)
CONTRACTOR SheetAddress:__l???i?c?'e?? a?e ? License# ?"[ ?5l
7?Ex?.
City Hu AoV State: 49'iZ Zip:
ARCHITECT/
ENGINEER
Telephone #: area code ( )
Name:
Streel Address: Regishation #:
City
Sewer 3 water Iicensed plumber (reaulred for new conshucflon onlvl:
State:
Penalty applies when address change and lot change is requesfed once permR is issued.
Zip:
Sy41 "?'
I hereby acknowledge that I have read thls opplication, atate thaf the informaflon is cortecf, and agree to comply wRh all applicabl
State of Mtnnesota Sfatutes and CMy of Eagan Ordinances.
Signature of Applicant:
OFFICE USE ONLY ? 7?1
Certificates of Survey Received _ Yes _ No
Tree Preservation Plan Received _ Yes _ No _ Not Required
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 4-plex ? 11 10-plex ? 16 Fireplace ? 21 Porch (3-sea.)
? 02 SF Dwelling ? 07 5-plex ? 12 12-plex ? 17 Garage ? 22 Porch/Addn. (4sea.
? 03 1 of _ plex ? OS 6-plex ? 13 16-plex ? 18 Deck ? 23 Porch (screened)
? 04 2-plex ? 09 7-plex ? 14 Apartments ? 19 Lower Level ? 24 Storm Damage
? 05 3-plex ? 10 8-plex O 15 Lodging ? 20 Pool ? 25 Miscellaneous
WORK TYPE
0 31 New ? 35 Tenant Impr ? 39 Gas Line Only ? 43 Siding/Soffits/Fascia
0 32 Addition ? 36 Move Bldg. ? 40 Gas Insert ? 44 Windows/Doors
? 33 Alteration ? 37 Demolish Bidg.' ? 41 Wood Stove ? 45 Fire Repair
? 34 Repair ? 38 Demolish (Interior) ? 42 Reroof
* Give PCA handout to applicant for demolition permit
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Width
APPROVALS
Planning
Basement sq. ft.
Main level sq. ft.
sq.ft.
sq.ft.
sq.ft.
sq. ft.
Footprint sq. ft.
Buitding
Engineering
Census Code
SAC Code
No. of Units
No. of Bldgs
MC/E5 System
City Water
Booster Pump
PRV
Fire Sprinklered
Variance
Permit Fee
Surcharge
Plan Review
License
MC/ES SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W 5urcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
Valuation: $
5AC Units
% SAC
2/84
% CITY OF EAGAN,
APPLICATZON FOR PERMIT '
-" SEWER AND/OR WATER CONNECTION
(PLEASE PRINij
1) PROPERTY ADDRL•SS: D/^-
-.}_
Lf]C3AL DF'SCE2IPTION: Lo Ii L? :?.f/
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(Lot,/Bl Subdivision ar Tax Parcel I.D.. Nurber)
IF EXTS:7`<', S'i'R[JCNRE, DATE 0° ORIGINAi.. B[JIIDING PE'..tiSIT :SSJANCE:
PRESE.*TP ::^?lli3^./PROPOSkJ LTSE: R-1 SIIVQE FALMIILY
(3 R-2 DUPLE{ ('IWO tJDlITS)
O R-3 '(op$1'7USf' (^,'!o?Fs ? !,*,:T^5t l -+r?nt:
C7 R-4 APARTMNf/CazCMINIUM I ? [k+1I15)
? Ca41WCIAL/RE7AI1?OF7ICE
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p INSPI'ISTPICNAL/GGVIIddMffST I-, .
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ADDREss_ 41y?? 7!?4 P"-/%
crrr, srr,TE, zIP:
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? I
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'
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,
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5) INpIC11TE Wf{ICH P£HI4IT IS EEINC; RE7QUFS'IFD:
ON 20 CITY SFk7ER
` CC3N.JFX.TION 'IC) CITY WATER
EIC7I'!{fl2 (PLEASF. DESCItIBS)
6) :N^,:C....
? YI: ,lSE kIOTD APPROM ) P:.F117IT IOR PI4h-UP BY OrIE OF r'1HOJf:
? ? PI.F.?SE r . 'LD PIIi??LLT `It? 1, 2, Q 4 }1BCFT
(Circle one)
t
7) JICvY,iLRF.. _ 'DATE.
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2/84
, CITY OF EAGAN
APPLZCATICN FOP, PEFLtiIIT
-` - SESJER AND/OR WATER CONNECTZODi
(PLEASE PRINT)
1) PP.OP =- ACDRFaS:
rFryi. DESC'?I°T'C:I:
(Lot/Bioc:</Sundivislcn or Tax Farcel I.D. Ninr?er;
5 L1`,=- G_° CRIGi.?,mL BiiSi.,^,S.`:G F=_.sm ISS:????:
-?•G'.E ^ ,.p
. ? R-1 Su??%til,Y •------ -__ , .
? R-2 DLTP={ (7•:0 CNITS )
? R-3 'IC;%'i1HCUSE (TI-n2? + uV=S) ( U,ti'I^_S)
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ADDRESS:
CTT: , SI:A'?';.', ZI? : .
PHOVE:
j) pj,j„M=-, NAi?SE: (NLcASE pRIHi) FOR CITY USE O4LY
ADDF2ESS: PLUNBERS LICENSE:
Active
CIT:, STATE, ZIP: ? Ezpired
PHOiNE:
PLUflBEp LICENSE ti Nat oi Record
3f? lni[1?
y? c..??ur?i?l/V.VC1?.K t•?cH?c rnini?
NAhIE :
ADDRE55:
CITY, STATE, ZIP:
PHO NE:
5) INDIG=.TE WEIICIi PEP?LIT IS BEItiG REQUEST=:
? Q,'`.`LLIECP?ON 'I17 CZTY SE?"]m
? CCNtiEY.`TZGJ1 'IC7 CI'I^i WATER
? dI'E'x,.'4 (PLFASE DESC:2IHE)
b)
. ? PZ=`SE ::OID APPRWEJ PER;•LiT FOR PICi:-UP BY O:IE OF e'1BG'vE
' ?°T--F-aSc ?7LIL APPRMc"TJ pEER7-1IT TU 1, 2, 3, 4 AEO,lE
? (Circle one)
7) SIG!,ATL:c£: D.ITE:
. 4 .
? ?( A_?Y I!_)O J? ii /.!?_? ?1? ? f{ ?! ?i.i ? r O f ?:ii:a :? S ? ! f_A !i'?l? ! ? !!l??giC• t
? • .='\ •
1
F O R C I T Y U 5 E O N L Y R
pE`•tMIm °- 755UED
F_ -1
F°ES: $ SE:'i?'r: nro?trm (_T'iCL:::?: SUlCE?c%
$ /p, WATE'.'. PERf1IT (Ii7CLtiDE SURC:?ARGE)
$ WATER METER/COPPERHORN/OUTSZDE RE.`.GER
+S WATi.°. T.1P ( INCiiiD ; CORPORAT:C'iN 5^_^P )
$ SEi1E:? .:'_P
$ 9 ?`-? • ?`'? ACCOUNT DEPOSIT - SE,:EP.
$ /_E7- °-? ACCOUNT DEPOSI': - L4AT°_??
$ WAC
$ SaC
$ TRU;dF: WATER aSSFSS.-:??:T
$ TRli.IK SE:vER ASSES5MENT
$ LATE°.AL SE*IEFIT/TRL'NK SESdER
$ LATERAL BENEFIT/TRU:Ih WATER
$ OT?iER
$ TOTAL
$ ?
A
?PAID/RECEIPT
I\
\
DOES UTILITY CQNDIECiION REQUIRE EXCAVATION IN PUBLZC RIGiiT OF SvAY?
YES IF YES, THEN A"PERMIT FOR WORK SJITHIN
PUBLIC ROADF]AY" MUST BE ISSUED BY THE
NO ENGZNEERING DIVISIGN. LIST AS A CONDI-
TION.
SUIIJECT TO THL FOLiOWING CONDITIONS:
APPROVEO flY:
DATr : _ ?O ? ? // .?? •
c f? ?
! ?-/? ?Ff/ I?F ? }? !f+ ! 1? ?! ?Ff? !? 1! m 14 ""f m on lF.i m!m /e so J1 as A W# Mi m 7! FJM Ri RM Ol MA m m
? z/8a
? ? .
CITY OF EAGA13 ?
APPLICATIO:] FOR PERMI`P
SEWER AND/OR WATER CONNECTZODi
, (PLEAaE PNINi) , . .
1) PROPER71' ADDRESS: 3 6)?,
LFX3AL DFSCFtIPTZON: Za I'/"7
(Lot/Slock/Subciivision or Tax Pazce I.D. Ntarber) ?
IF EXZS=X; STRIJCIS]RL, DATE dx' ORIGINAL SCiI:DING P=-,?ST ISSJANCr: ?
, 1h!or,L`1; Lecl.Yl
PRESE.*lT 7,"IPY:/P20F'OSED USE: Ct)\R-1 SLNXLE FAM.SLY
? R-2 DUPIEX ('IWO UNI'15) ?
C7 R-'i ?CX*knU.??'' t?`1Pf;,' E te•T?^,r,
? R-4 APAI2'IINhN`l'/CCNbKt4INIUM UNITS) ? .
p CONT7E[tCiAL OFk'ICE
a ??
?j
Q INSTIZSTfI / ? ..,?
2) AppI.ICANr
LEASE?RINi)
I ?
=r
. NAME: C; 4
4A 0
'
AWRESS:
?
CITY. STATE, ZIP• V, /44
?M rl St" ?
p
?
3) PLU4RIM iLEA ? P T FOR CITY USE 6NlY
?% '7,
ADD • 1
' ? PLUM RS tICENSE:
r?? i
u Attive ?
CITY. TE. P: r?ar. ???• Q E:pired . i
PI??' - 3L? PLIIXBEli LICE Jy . 0
Mot o kecor
?
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4) OCQlPANT/0f^7C7LT2
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'
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r% fe .j!V r G n ?.S
STATE, Z P :
? p 'Vs --A
5) INDICATE WtI ICH PE1ht1IT IS BEINC; ,
' Q COhTIf=ON 'M CITY SDJFS2
LYONNECTZON 'Ib CITY WATEIt ?
? (7I'[IER (PI.EP.SE DFiCRIBE)
6)
? PL':'1SE fiOLD zjpPRrJVLI] PLRtiIIT FOR PICF:-UP SY ONE OF ASCNE
t?PL.r1,SE ;+1ASL .SPPRC7l17) PFM%1171 T`J 1. ?.. 3, ','AHGJE
(Circle cne)
7) SI??'?TC?: ? .
??? ? DATE
:
i
- ?
' 2/84
?
a t
CITY OF EAGAN
APPL2CATI0N FOR PERMIT
l` SEWER AND/OR WATSR CONNECTIODT
(PLEASE PRIHT)
1) PROPERTY ADDRESS:
r.Frat DES(RIP'I'IC:I:
(ir?t/Block/Subclivision or Tax Parcel I.D. Nisnber)
iECIS':'_ :G S"T.4CCi?^:2E, DAT-2 G^ ORIGs^.dAL EuiLDLI;G P=,-_.+ST ?S?:?NCE,:
t "cr--- -_- ,
? R-1 SiNIGLE r^a-%IILY
? R-2 DLTPI.EX (7`'0 UNITS)
? R-3 i'C7+V'I?IIILYJSE (TN.RF^ + TNITS) ( TNITS)
? R-4 Z2AR'IP=:T/CONL0',=IU.%I ( L.IITSI
p CQMrIIItCIAL/RESAII,/OFFICE
? LNDL'STRTAL
? INSTSTUTIOA:P.L/GOVEFZNKIIV':
2) jippl,ICpNT
NAME: (PLEASE PRINT)
ADDRESS:
CITY, STATE, ZIP:
PHOiNE:
3) pu?MEP, PLEASE PRINi) FDR CITY USE OHIY
N?ME•
ADDRESS: PLUHBERS LICENSE:
% Q Active
CITY, STATE, ZIP: ? Expired
PHOiNE: ?iLK Q Not of Record
PLUMBER LICENSE !}
arr nitia
4) OCCTJpp,:/pr,'zTM ' NPME: (PLkASE PPINT)
ADDRESS:
CITY, STATE, ZIP;
PHO^IG:
5) INDICl,TE WIIICH PF_FiMIT IS SEII`G RFQUESTID:
? CO:?.^?1ECI'ION TO CITY SEYIER
? CCN.IFS,TICN TO CITY LdATER
? CI'F.E'.R (PLZASE DF,SCFtiSE)
? PLFASE F?OZD APPRUVEp PER.^?LTT FOR PICi:-UP BY OLVE OF A6WE
' ?°I.EA5E %TAIL APPRONIID PER"lIT 'SO 1, 2, 3, 4 11EWE
(Circle one)
7) siG!Z?zt'RE: DaTE:
qa'iC se
7f , F O R C I T Y U S E O N L Y
PERMIT " ISSUED
F°ES: $
$
$
$
$
$
$
$
$
S
., $ .
$
S
$ .
=^;= nEoMrT (r`IC=DE Sli°CH?_T?GE)
WATER PERMIT (INCLU?E SURCHARGE)
WATER METER/COPPERHORN/OUTSIDE READER
WATER TAP (INCLUDE CORPORATIC;I STCP}
SE?4En mao
ACCOUNT DEPOSIT - SETr:ER
ACCOUNT DEPOSIT - WATER
WAC
SAC
TRUNK WATER ASSESSi?E:IT
TRliNK SEWER ASSESSMENT
LATERAL BENEFIT/TRUNK SEL9ER
LATERAL BENEFIT/TRUNK WATER
OTHER
S TOTAL
$ AMOUNT PAID/RECEIPT
DOES UTILITY CONNECTZON REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
YES IF YES, THEN A"PERMIT FOR WORK WITHIN
PUBLIC ROADWAY" MtTST BE ISSUED BY THE
? NO ENGINEERING DIVISION. LIST AS A CONDI-
TION.
SUIIJECT TO TFIE FOLLO:^IING CONDITIONS:
APPROVED BY:
TITLE:
DaTE:
<
:
?
¦! sw ms at M! am--A* !aw tn.}?ql /Rfe R+? K? l4 4 i? ?i? "la rt =i4 fJW R+W P4O! rt r Ig Mr
? /I
RESIDENTIAL BUILDIPTG
(0' I Z ?j Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5694
/
0.35
New Constructlon Reauiremenb RemodeUReoair Reauirffnents Office Use OnN
3 registered site surveys showing sq ft of lot sq. ft. of house; and all roofed areas 2 wpies oF plan Cert of Survey Recd
(20% mazimum bt coverage allowed) 1 set of Energy Calwlalans for heated additions Tree Pres Plan Reod
2 copies of plan showing beam & window sizes; poured found desgn, etc. t sile survey for additions & dedcs Trae P2s Not Reqd
7 set o! Emrgy Calcumtions AddRion - irMicate flonsifa septic system _ On-site Septic System
3 copies of Tree Preservation Plan 'rf lot platted after 711193
Rim Joist Detail Options selection sheet (bidgs with 3 or less units
Date 8"_ / Canstruc6on Cost
Site Address ?[? /jg y-?? ?? 9 /)j/^ UniUSte #
Description of Work 3"- /t O L(Ji L 0( D U.1S i S LRGLf F S l Z•P
Muiti-Family Bldg _ Y? N i
Fireplace(s) _ 0_ 1 _ 2
Property Owner _ 13, ff Telephone # (6S ? ) ?/S..Z y?f J9
? /
'
i
Contractor
AWj2e, 17T ?N
S
Ll !
Address /
City Sr? Pa tA? ,
State n?
_ / "/ Yt
Zip Telephone # (?y'"r ) g6175
i
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy COde Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(J submission rype) Submitted Submitted
• Energy Envelope Calculations Submitted
Licensed Piumber
Mechanicai Contractor
Sewer/Water Contractor
Telephone #(
Telephone #(
I hereby apply for a Residential Building Permit and aclrnowledge that the i.
that the work will be in conformance with the ordinances and codes of the
1
?
r ??ljj
?
ation is complete anaccurate;
of Eaean and"the State of MiN
Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a
pernut; that the work will be in accordance with the approved plan in the case of work which requires a review and
approva] ofplans.
5 I,2 tl'e 4?fA tr (S 0 ?l
ApplicanC's Printed Name
azky 4??
ApplicanYs Signature
?T 35
OFFICE USE ONLY
Sub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 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 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screenlgazebo) O 36 Multi Misc.
? OS 03-plex C] 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex O 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repatr
? 33 Alteration ? 37 Demolish (Bldg)• ? 43 Remof ? 46 Windows/Doors
? 34 Replacement •Oemolition (Entire Bldg) - Give PCA handout to applicant
Valuation Occupancy MC/ES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIItED INSPECTIONS
_ Footings (new bldg) _ FinallC.O.
_ Footings(deck) _ FinallNo C.O.
_ Footings (addirion) _ Plumbing
Foundation HVAC
Drain Tile Other
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests _ Final
_ Framing _ Siding Stucco Stone
_ Fireplace _ R.I. _ Air Test _ Final _ Windows (new/replacement)
_ Insulation _ Retaining Wall
Approved By
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
5&W Permit & Surcharge
Trea4nent Plant
License Search
Copies
Other
Total
Building Inspector
?-2
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?_gal Description of Froper[y: Lot ??_BlockAddition?y? -?'??-.._nate?
ite Address__
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'
AVERAGE LINEAL FEET OF
EXPOSED WALL AREA ABOVE r.RADE
ain level
Lineal ft. of
framed wall above grade?l, x height of wall
im oiat area
f
f
x height of rim
i
t. o
Lineal m
r
.ower level
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framed wall above grade_?I x height of wall
`
ht above grade?
hei
d
b
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?a A
Lineal ft. of g
ove gra
e
?x
masonry wall a
TOTAL wall area above grade including windows and doors
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x "U° value ,
„U„ _ (U)(A)
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x
sq. ft.
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(U)
sq. ft. X (U)(A)
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x
sq. ft. "U" (li) (A)
sq. ft. x _ (U)(A)
"U"
sq. ft. x (U).(A)
It x
sq. ft.
sq. ft. X
x
'
"U" (U) 0)
sq. ft.
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gn ? ?. ??-
OPAOUE WALL CO NSTRUCTION; Area x"U" valu? „ull _ (l;) (A)
x
sq. ft.
X
ft
s
Ln?
n (U)(A)
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q.
ft
s
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ence from x
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ti? ur- sq, ft.
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i
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ll
ff _ (U) Cp;
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, TOTAL Wall Area Including ?/?j
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Wi TOTAL (U)(A) ?
n
\ ?-y
°
°
TG1'AL (U)(A) VALUF.S AVG.
I1
UIVIDED BY 1'O TAL WALL AREA
AVERA(;E "U" Minimum .?`or less for 1& 2 family dwellings
- +? o- +_?? fnr ai1 nther buildings
- -
the
: ?f avr
?:()Tf rage "U" values as calculated above do not meet Che Energv Code requirements,
.
"nlern ate Envelope Design";as indicated on Page 5 may be u sed.
2o?i 4 r ? i I= Z?c?. 34
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wail vres
y.v4 ?
f ram:n=+
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FRAMING MEMBERS IN WAL.LS
Exterior _ air_film_ __ ,_
?..
.
R-Value
.17 Siding
Sheathing M'`y1+'
a
?soft wood
Y" (?zy wall I
Inte?rior air filro
?--- ??'-?? -
-• - ?---
.45
.68
TOTAL R = II?,JL_?
U= 1/R U= . O?C? 1
_ FRAMED WALL _
Exterior air film
Siding
Sheathing
?n
4VW batt insulation
'?" drv wall - - -
Interior air film
+ Q2?
2.o'I
,C? r--> .
45
68
TOTAT R
U = 1/R U = +C7A '2.....
--
1 a'
'
,?---?--^- ?--
?r--- -"
-- - - ' -- - -- - '
?L)
_ RIM JOIST ARM__
Exterior_air fi, lm
?
Siding ?-
Sheathing 2.?7-----
1.68
1`?" soft wood _-
????
Insuiat-ina ;;
.68
Interior ai fj?m ------?-
'1'OTAL u
U = 1/R U '
MASONRY WALL
Exterior aix film ?__.__. __... . ----=17 --
1Ly_C4i?I.i?_
Insulation jN
Interior air film
TOTAL R Jn^]
V = I/F
?Il ?/
ROOF CEILING
• --._. _
---
?
-----
__- _ ----- ?.
' ? --? -
- --??-
Buil_t_up-srmfinr -.-
_ Outside_air film .61
Insulation
- - ---- - -? - ----- - ? ?-?'?
V Drywall
45
Interior air film _61
TOTAL R = u a 1/x u
Outside air film __.61
Insulation
31" Drywall .45
Interior air film
.61
TOTAL R =
u=
U = 1/R
Outside air film
Insulation
.17
- ? --- - ---s33 -- .
_---- _ ?_
Wood deckIn8--- - -
y!!-1?•L" ?.`
Interior air film
, ?
? \ `_- - ---- --- ---
U = 1/R
.61
_ TOTAi. R
U =
ROOF/CEILING:
1'GTAL AREA: sq. ft.
netail reference x sq. ft: (U)(A)
-,---x
from above. ?.U
sq.
ft.
c"t?._ ? i. (L')(A)
s
Descri6e openiny. x sq. fL ?_ (LI) (A)
,
in roof ??--- •?U?? x sq. ft. _ (U) (A)
. , nUn x sq. ft. _ (t') (A)
------ ,,Ulv x sq. ft. ' (l') (A)
, -
------- -nUn x sq. ft. (L) (A)
TOTALS "C:sa. ft. ?(ll)(A
'1'OTAL (U) (A) VALUES
-n?.linca -9•, Ijf?(:r/ i.^?
.. --. _
. =
• /'?'l?? AVC.. ntin
*
: t _
CtiILIt:C ARF.A ??•{
?.,,: - 1333 x .oZ? = 34,Cvo
AVERAt:E °L'" .05 for ventilated roofs
.10 for all other construction
,40'fF.: ]f average """ values as cal culated above do not meet the EnRerpy Code requirements, the,
"Altcrnate F:nvelope Design" as indicated on Page 5 may be used.
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Date:
City of Eaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Use
Permit #: / D 0 3 I J
Permit Fee: °-O
Date Received: I ' / 3
Staff: h�Yl
INFLOW & INFILTRATION PERMIT APPLICATION
Plumbing / Sewer & Water
Site Address:
S 1a./
Tenant: f/i)�(14 �.
y,/
Suite #:
RESIDENTTIOW ER
Name:
Phone: - P
V�I,�
g_ r..� /%/U SS/2-3
ess/City /Zip.• LCo/i i/ _.4 jai'
CONTRACTOR
Name: ,4Y 1 7 itzi.A_ r -
License #:
Address: (P3 Yq au -'`"
City: u 7)ciet6
State: tleJ Zip: /-55Y7-5 Phone:
"7 - - 37 ` 9SS a--
Contact:f L Email:
TYPE OF WORK
PLUMBING (Within the building envelope)
✓ Sump Pump Repair
SEWER & WATER (Outside
Repair
the building envelope)
Other:
Other:
DESIP ION
CR
Description of work: 61.1\ 61 p (r✓✓)
""
ttIV -
J r �l
_Li. 042. k � )
FEES
$60.00 I Each (includes $5.00 State Surcharge)
TOTAL FEE $ *
*Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submit Ill repair costs for
reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors
can be found by visiting www.cityofeagan.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.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 whi h requires a review and approval of plans.
x�J
Applicant's%%�(�!�
P.rriinted9Vame
FOR OFFICE U
Required Inspections:
Under Ground
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA116201
Date Issued:10/04/2013
Permit Category:ePermit
Site Address: 4611 Parkcliff Dr
Lot:3 Block: 2 Addition: Park Cliff
PID:10-56700-02-030
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 .
Ian Jacobsen
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 -
Mary M Sharkey
4611 Parkcliff Dr
Eagan MN 55123
Amek Construction
9555 James Ave S
#228
Bloomington MN 55431
(952) 888-1200
Applicant/Permitee: Signature Issued By: Signature