4653 Pello CirCiTY UF EAGAM Remarks
Addition,, Ridgecl i ff First Adcin. Lot 21 81k 2 parCel #10 63980 210 02
Owner +!?.)fl- Lj - street 4653 Pello Circle State EagaI1, MAI 55122 _
Improvement Date Amount Annual Years Payment Receipt date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK 19$ 184.49 12.30 25 147.62 coo7661 2-18-82
SEWERLATERAL ?
WATERMAIN
WATER LATERAL
WATER AREA lI} .62 CQQ 66], 2-18-$2
STORM SEW TRK 1982 638.24 -
STOFM SEW LAT 1982 955.45 5 955.45 12-23-81
Seryices 19 12-23-81
CURB & GUTTER
SIDEWALK
STREET LIGHT
Road Unit 185.00 27057 9--29-82
WATfR CONN. 335.40 " "
BUILDING PER. 6907 '
s,ac 525.00 "
PARK
Raceipt' i' MECHANICAL PERMIT Permit No.
CITY OF EAGAN
' Fee
Fill in numbered spaces S/C
Type or Print legibly T
t
-?
i
- o
J J l_:
.
1.
Date J
i
2. Installation Cost
3. Job Address "-Lot -r ? Blk. - "Tract
4. Owner 5q 4 1,
5. Contractor Phone ?'? : , - •? --
6. Address
7. City - State , y V Zip ' ' --? - -
8. Building Type: Residential )? Commercial ? Institutional ?
9. Work Description: New 0 Add X Alter 0 Repair ?
10. Describe
11.
Type
No. Eouopment 8TU - M. Ea.
Forced Air No. Equipment CFM
Ai
H
dli
Mfg. r
an
ng:
Boilers
Mfg. Mech, Exhaust
Unit Heater
? Mfg.
Air Cond. Other
Mfg.
Gas, Piping Outlets
12. I hereby certify that the above information is true and correct, and 1 agree to
comply with all ordinances and codes governing this type of work.
/
Signed : " -' for
Rough Pin I
Inspections: Date Insp. Date ?Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
CASH RECEIPT
CITY OF EAGAN
3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE 19
RECEI V EO
FROM
AMOUNT $ 17
DOLLARS
1eo
? CASH ? CHECK
FOR
White-Payers Copy
Yellow-Poeting Copy
Pink-Fila Copy
Thank You `. ?
??- BY
Receipt °2 MECHANICAL PERMIT Permit No.
t lt M CITY pF EAGAN F?
?
FiII in numbered spaces S/C '
Type or Print legibly Tot.
1. Date 2. Installation Cost 1.. .
I ? f
3. Job Address =- Lot Blk. Tract ? C t l
4. Owner '''P0,011 IVM[--n p IM:.
5. Contractor Phone -
6. Address
7. City State Zip ;
8. Building Type: Residential l? Commercial ? Institutional ?
9. Work Description: New ? Add ? Alter ? Repair ?
10. Describe ??t 1-1 -' ar'C?O`i ;'iT' '•1? ' i :' Fuel Type ? -
11,
No,
? Eouioment BTU - M. Ea.
Forced Air No. Equipment CFM
Air Handlin
:
Mfg. g
Boilers
Mfg. Mech. Exhaust
Unit Heater
Mfg. Other
Air Cond.
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 Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 464,8100
Receipt l?? PLUMBING PERMIT Permit Na
CITY OF EAGAN
Fee
Frll in numbered spaces S/C '
Type or Print legibly Tot. •
,
1. Date ? ?{ ?,?'J ? 2. Installation Cost
,
3. Job Address'_ ?? `? J rr Lot Blk. Tract
4. Owner
5. Contractor ;, I? - l ?1• '/ Phone
6. Address
_ l
7. City ? State Zip ? / -
8. Building Type: Residential E3 Commercial ? Institutional ?
9. Work Description: New CI Add D Alter ? Repair ?
10. Describe
11.
No.
? Fixtures
Water Closet No. Fixtures
Ce
l/D
i
fi
ld
Bath tubs sspoo
ra
n
e
S
ti
k
T
Lavatory ep
c
an
Softner
Shower W
ll
Kitchen Sink e
Urinal/Bidet Oth
Laundry Tray er
Floor Drains
Drinking Ftn.
Slop Sink
Gas Piping Outlets
I 12. 1 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 454-5700
cirY oF EA"N
3795 ?qof Kaob Resd Ee9an, MN as122
e PHOIJt:4S4-A100
BUILDING PERMIT Reuipt #
To be Med For . Est_ Value . Detn
Site Address Lot Biock Sec/Sub. ? - ' ' - -
Parcel #
W Name y
')?
; Address
b
$` Name _
?? Address
F- r:...
Name _
Address
I hereby ocknowiedge that I hove read this opplicotion ond stofe thot
the information is correct cnd agree to comply with oll upplicable
Stote of Minnesota Statures and City of Eoqan Ordinonces.
Signoturc of Permittee
l1 Building Permit is issued to:
otl work sholl be done in occordonce with all
6ufldleq Offieiol
E?ect Q Occuponcy
Alter ? Zoninp
Repolr Q Fire Zone
Enlurya ? Type of Const.
Move ? # Stories
Demolish ? Lengih
Grode ? Depth Sq. Ft.
Approrals Fees
Assessment Permit '
Water & Sew. Surchor9e
Poliu Plon check
Fire SAC
Erq. Water Conn.
Planner Water Metar
Countil Road Unit
Bldy. Off.
APC Totul
on the expresS COnditiOn Ihat
Statutes and City ot Eopon Ordinances.
Permit No. Permit Holder Misc. Psrmit No. Holder
Plumbing ?5 <0,, -D l? ?135-8-11
H.V.A.C. 7-7 COE t4,'C_ (I'ZA-g
won
w.n.
Disp.
Sewer
Eieetric ? -7 7 y5`5
Inspection Date Insp. Other
Footings ?
Foundptfon
Framiny ?!
Rouph Plbq.
Rouph HVAC
Insulation
Final Plbg.
Final HVAC f
Final
Water Dessribe Locatian:
Wel I
Sewer
Pr. D'ap.
cIn oE IK?GAN SE1fVER SERVICE PERMIT
3795 Mlw Kneb Road PERMIT NO.:
Eogee, MN 55122 DATE:
Zoninp: ' " .
No. of Unlts:
Owner: _ Urrir i•, ? a _
/lddress:
Site Address: - L_?i'? pal 1? i'trclc 1`1 32 Ri4-•acl-' c"
Plurr?ber. _ _ "••'i'.nza1
()0
I egrae to osmPh wtlb !M Ciry of Eayen Connectlon Charye: _ ''I _(!' •, ;
Ordinaeea.
By
Dote of I nsp.:
Account Deposit:
PeRnit Fee: -
Surcharge:
Mtsc. Cha?ges:
Totai:
Insp.: Dute Pold:
cIn oF IEAa,N WATER SERVICE PERMIT
3795 Piloc Knob Road PERMIT NO.:
Eapae, MN 55I22 D11TE:
Zoning: No. of Units: '
Owner. T'iG: 1*°s•?'- 3c?n ,
Addross:
Site Address: Circlc
Piumber:
Meter No.: Connection Chorge:
Size:
Reader No.:
1 aoree M aaaplr wi1h f6e City oi Eayan
Ordinaaas.
By
Acwunt Deposlt:
Permit Fee: 1 ?l • `' ? -'
Surcharge:
Misc. Choryes:
Total: -
Dute Paid:
^J( /? REQUEST FOR ELECTRICAL INSPECTION
? 7}( & See instructions for completin9 this form on back of Yellow copy.
'T 1 ???
"X" Below Wnrk Covered by This Request
EB-00001-03
.2 -7S-?
N Add Rep. Type of Building Appliancas Wiretl Equinment Wiretl
Home Range Temporary Service
Duplex
Apt.Building
Commercial Bidg.
qt Water Heater
Dryer
Furnace Lighting Fixtures
EleclricHeatin
Silo Unloader
Industrial 81dg. _ Air Conditioner Bulk Milk Tank
Ferm Other Spenfy thor ISVer.ifyl
l,er peclfy OIhO! Other
CamPUte Msper,tion Fee Belnw
k Fee Sarvice Entrance Siza Fee Feeders/5uhfeeders N Fee Circui[s
0 to 100 4fn 30 Am s 0 0 tn 30 Am us
2
w 100 qmps 3to 100 Am s
q??? Z__
a E L e 100-Amps o ve 100_.4mps
A
7 stor rs teControl Circ. ,!
tial-Ot
Si s ial Inspection g? ,1 5C T
d
Q
Remarks J ?/ •
OTALP E
Rough-in ? Daic? ? I, tha Elxcvical
?/ InsVector, herany
? /i.rCl
final . . , ( n???inspection hes been I
This ruquest void
q..N
?-
tn momns trom
CITY OF EAGAN N? 6907
9795 PIIM Kno6 ;toad Eogan, MN 55122
PHONG 434b100 ?7VJ?
BUILDIN?i PERMIT Receipr #
Site Address 407J reiio %,ircle krlan iuy/
Lor 21 BI«k _2 See/Sub. Ridgecliffe lst
oa,cel # 10 63980 210 02
C Nama Vi+?+a aaniu+yovaa iav+uco
?
Address 1712 HOpkins Crossroad
11i1- CC7/ 9 C/ 1 "?
p I Nome ??'I'
?? Addreu
Nome _
Addresa
I hereby ackrowledge thot I hava read this applicotion ond stote that
the inlormofion is wrrecf und ogree to comply with oll opplicoble
State of Minnesoto Stotutes ond Ciry of Eoqon Ordinonces.
SiBnuture of Permittee
A Building Pertnif Is iuued fo: OIrIn
oll work sholl be done in xcordorxe with all
Bulldirg Officiol d
Erecr ? Occupnncy R-3
Alter ? Zoning PD
Repotr ? Fire Zone Np+
Eniaroe ? Type of Corut. V
Move ? # Srories
Demollsh p Lengih 44
Grode ? Depth 26 Sq. Ft.-
Aonrorab Fees
Asuument
Woter & Sew.
Police Pertnir x+i•vv
Su.charqe 28•00
Plon check 150.50
Fire SAC 525.00
Enp.
Plonner
Councll Water Conn. 335900
Wcfer Meter 60.00
Rood Unit 185.00
Bidg
Off
.
.
APC
Totol S1584.50.
on t he express conditlon thnl
Liop Statutes ond Ciry of EaOOn Ordinances.
,i, ma?est ?11d I( Z3 L z 1, t 3 0 1 100
?8 ?, 77n8'$ 6 -2--7 "3
RenuPSt Uate
' Fire No. HouPh-
i i Inspaction
Ha4?i red?
Reatly Now'?VJfll Nntity.lnzpec-
?
?e4 ?N?? ior VJhen Rc:ady
DI-L icensed Electncal ConVac[or I hereby request insoection oi above
Owner eleclrical work inslalled at
t Address, doa o Roule No. City
C
53
IN
tcut Qw?
,
.:.
ecuon o. TownvhiV Name or No. Fange No. Cot
%1f ?
OccuPan[IPHINT_II D ?y` l{.,?_1?5.(tV
?1 n`1?1? 1'?1?15V" t,-,"' Phone No.
Puwer Supplier Atltlres?spn?,,?
Ele ical Convacm ICOmpany Namel
' Cnnvacmr's Lir.ense No.
-z
9s
b '
?- 1.._ -
u
v
Maiti
? g AdJresscIConV/a`ctor ?oCr.Owner Making Instailation!
1
?
?
Author' ed S?B ure onhactoJOwner Making Installation)
` Phone NumAer
&IlJ"5?50S-
MINNESOTA STATE BOAFD OF ELECTRICITV ' THIS INSPECTION flEQUEST WILL NO7
Griggs-Midwey Blda• - poom N-191 ' gE ACCEPTED BY TME STqTE BOAND
1821 Universilv Ave., St. Paul, MN 56704 UNLESS PROPER INSPECTION FEE IS
on....e irstll 147_2111 ENCLOSED.
'f_?CITY OF-?. Include 2 sets of plans,
?? v ? 1 site plan w/elevations 6
BUILDING PERMTT AF'PLICATION 1 set of energy calculations.
u!
Tb se osea For val?Von Date 9-aLk-81
c?re-
Site Address: y(e.S3 PELLO Cl. PIRH IOq) OFFICE USE ONLY
Lot, _. ,/BIOC?C?_-Z ..S?C.?.SUb: R\VFEGL.?FF? ?•IY.'C'ti !? _ OCCl1p3I1C.'y
Parcel #: (o (o3`j$o zro C)i??----f3 altei zoning ?-
Repair Fire Zone
Owner. Enlarge _ Type of Cnnst. ?-Yr
Nbve # Stories
a Division of U, S. Home Connn"finn DPIiiollSh Front yy ft.
PddresS:
KINS CROSSROAD GiddO D2pth ft.
afy
C1ty/ZlP ODd2: MINNETONKA. MINN S5343
Phore #: 5'k4-1333 APPRDVATS FEES
Contractor:
Pddr05S: a Division of U. S. Home Corporation
- MM
C1L'y/ZlP COCl2: MINNFTONKA. MINN. 55343
Phone #:
Arch./Eng.:
Address:
City/Zip Code:
Phone #:
Assessments
Water/Sewer
Polioe
Fire
En4-
Planner
Council
Bldg. Off.
APC
Pe.nnit 301
Surcharge 4Z8 ?
Plan Check /SD
SAC l5-?S °
Water Conn. 3 3 a- zu
Water Meter 60 "
Road Unit / ff S "
??
'IL7TAL !s'S ?4
(grr#ifirtttr of (Orrupttnry
Citp`of (eagan
13rpttrttnrtti uf 3guilding 3nsprriiom
Tbit Cntifirate irJxtd purta4nt to the stquiyrnuntt of Srrtion 306 0( the Unilorm Building
Codc certifyiag that at the time of ittHarut tbit nnututt wat iu complianrt witb the variout
ordinanrer of the Citr rrgulating 6uilding cannsartran ar utt. For the following:
i1MCl..fioum SF DM/GAR Bld4hmtl[NO. 6907
OomP^n''hN R3 'hPC?tlao V FinZon M Zmi^8Di'Wn Pn
o„.am,uaj,,, Orrin Thomnson Aac..n 1712 f!opkins (Ysrd., Mtir.a.
md,,,a#? 4553 Pello !`iTCle .,rLot 71,Rlock 2,Rid4ecliffe
? By:
Jd7ri1d1y R, 1982
?`--
HEATING TEST RECORD
aDDRESS ?G Sl 1?@ I?D? LAY l MUNICIPAL.ITY ?•- /1lPG?'l. '
JCCUPWNT . OWNER y' /3-PM6i A1I
z /l
7YPE OF HEAT: ROOF FA -? STEAM__UNITHTR._OTHERINFRA-RED
MAKE P1 L4-1'fL4Ill7/Il[
Mee.i
s«ioi E /'1T O 5
INPIJT FUEL ?
THERMOSTAT CONTROLS
Valra e c ?
Limit l-P C?d<T
Limit Settiny
Fan $eMin9 _ Pilee Trp. ' S.?
Pilof A4oke Pilor A{ad.l -?? -
PilofTiminq ?SPG
L.W. C.t Off es • /? /?S? Pre::u.e __o(roa Parc.nt C0? ?1 •
Inpui CFH ??'`f Porcenl o? y, 7
Sbck T.mP. ' ?01_/ Percent?CO
v.,,, s„ e
3"
KIND OF LINER Rz4.5'tiC SIZE
Orofr CAy"tr'!1 Teat Tay/6_
IAAK E
Model
kAKE A
s«?vi ?4 ?" ? /3
INPU7 10Q4 26'O FUEL r
l
???li-t CONTROLS THERMOSTAT "-
Ya1ra NaN N L!/P /I
Limit ? AOW ?1 ,/l'e ttlil
Limit Set}inp 2,C S
Fan Serflnq 7%h[if'G(l Pifai Typ.
Pilot Liak, " .
P il ot lAodel ..
Pllot Timinp ? ' .
L.W. Cut Off p
Pn:sun J/ 7 Peteene COZ
Irput CFH ?'Me Q"d& Percent 0 1 11
' .
StcckTamp. - _ . ?OO? P?rcanT CO ?
v.,,, s;:.
KIND OF LINER P/GfPt`( SIZE? .
Drvff _ T.al Top
IAAK E
Model
Swiol
INPLJT FL1F1
THERMOSTAT
Vetvo
Limit
Limit SoMin9'
Fan $?ttin9 -
Filo} Tyq _
Pilcr Akaks -
Pilot FbdQl _
Pilo! 7lminq _
L.W. Cuf Off _
PreasuraT ? Pateent C
InpW CFH?P.reen} 03v
Stnck Tamp, ? Pweont CO
Ven7 Sixa ? . .
KIND OF ILINER SIZE
0.aft
Teae Top
0.off
CONTROLS
Tvit Top
e
63f
Date Tested ?/ _ -3 ` 0 5
Name of Tester mr!
Jo b No.
KIND OF LINER SIZE
air flow report
CFM A/C fan /vent
kitchen 120 64
ent 58 45
dining room 65 50
243 159
livin room
no. 112 60
w 115 55
so. 143 62
370 177
i
office 81 57
storage 76 44
laund 77 50
238 151
small bed 50 0
bath room 50 0
100 0
master bed
no 120 30
so 91 30
bath 56 15
closet 60 17
327 92
579
L 1-?
PERMIT #. s 1--l o -13
RECEIPT DATE:
2002 RESIAENTIAL PLUMBINfi PERM11' Ai'PL1CA'4ION
CITII OF EkBAN
S$SO P1LOT KNOS RD
EAfiAN, MN 55122
651-681-4675
Please complete foc single family dwellings, townhomes and condos when permits are required for each unit,
backflow preventer for irrigation system
SITE ADDRESS: "T V3 f&16
OWNER NAME: :
INSTALLER NAME:
STREET ADDRESS:
TELEPHONE#:? i ID21,nLSLI (AREA CQDE)
TELEPHONE #:
(AREA CODE)
CITY: L-3Q an STATE: MK) ZIP: S S1 `3 ?
_ SEPTIC SYSTEM, new/refurbished (requires two sets of plans and MPC license) $ 100.00
includes $40.00 County fee
Note: Additional consultant fees may apply
. MODIFICATION/ALTERATION TO EXISTING DWELLING UNIT, INCLUDING:
x Adding fixtures to lower levels or room additions, excluding water softeners and: water heaters. $ 50.00
_ Abandonment of septic system.
r if needed -$118)
dwelling unit (+
_ Water turnaround - ex
ist
ing
WS"
me
te
?
`
?
?
j
?
`
Other v, -k--
_ RPZ: new installation/repaiNrebuild $ 30.00
_ lawn irrigation system
ReplacemenUadditional: _ water softener _ water heater $ 15.00
State Surcharge D} ?? I r_ ??
1 ? 1 ?? I
l $ 50
' b a0
U I
$
Total
I hereby acknowledge that I have read this appliwtion, state lhaUhe information is correct, and ag P?eoorrp ywi le Ciry of Eagan ordmances: it
is the applicanPs responsibility to noti(y the property owner that the C@y of Eagan assumes no liability for any damages caused bytheCity dunng dsnormal
oPerational and maintenance activ@ies to the §cilities constructed under this pe_. rtniAvithin iproP:3+"'Se'?,???{-of-wayleasement.
SIGNATURE OF PERMITTEE 1l02
RESIDENTIAL
? BUILDINC PERMIT APPLICATION
! i CITY OF EAGAN
j 3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675 ? I F? 121I
New Conatmaion Reauirements
• 3 registered site surveys showing sq. R. of lot, sq. ft, ot house; and all roofed areas
(20% maximum lol coverage allawed)
• 2 copies ot plan showing beam & window s¢es; poured found design, etc.)
• 1 set of Energy Calculations
• 3 copies of Tree Preservation Plan ii lot platted after 711193
. Rim Joist Detail Oplions selectlan sheet (bldgs wAh 3 or less unils)
DATE
2-S
RemodellReoairReauirements c C:--xL`-0
. 2 copies of plan
• t set of Eneyy Calculations for heated additbns
• i site survey Por extenor additions & decks
• Indicate if fwme served by seplic system for additions
VALUATION 1,9, 0,210
SITE ADDRESS '?53 MULTI-FAMILY BLDG 0"1' ZN
TYPE OF WORK FIREPLACE(S) _ 0_ 1_ 2
APPLICANT ?5L?e4 6eY75471 ,
STREETADDRESS ?&53 Pe.llo Crrc.Qp CITYfD4a4 STATE/Lfk) ZIPSSlaa
TELEPHONE #6,5-1 6?1&0(oSq CELL PHONE #(OW 61a 9&S 3SSl FAX #(051 ?oS-.0337
PROPERTYOWNER j-e-( &-flSlln TELEPHONE#/05??Y(- 0la$Y
COMPLETE THIS SECTION FOR "NEW°" RE5IDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNESOTA RUI.ES 7670 CA'I,CGORY 1 MINNESOTA RLJLES 7672
(J submission type) • Residential Ventilation Category 1 Worksheet Su6mitted • New Energy Code Worksheet Submitted
• Energy Envelope Calculations Submitted I
Plumbing Conhactor: ____
Plumbing system includes:
Mechanical Contractor:
Mechanical system includes:
Sewer/Water Contractor:
Air Conditioning
I-Ieat Recovery System
Phone #
-" ----' . --' --' "' "' """ _' " _' _ -""' " -""""' . -"" -' """" -""""" -"' -' -"' -"""""""' """
I hereby acknowledge that I have read this application, state that the information is
with all applicable State of Minnesota Statutes and City of Eagan Ordinances.,,,'?
Signature of Applicant
OFFiCE USE ONLY
Water Softener
Watcr Heater _
No. of Baths
_ Phone #
Lawn Sprinkler
No. of R.I. Baths
Phone #
Fee: $90.00
Fee: $70.00
rs r?
??f?v???-lvo? IU
dc
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4102
OFFICE USE ONLY
? 01 Foundation
? 02 SF Dwelling
? 03 01 of _ plex
? 04 02-plex
? 05 03-plex
? 06 04-plex
? 07 05-plex ? 13 16-plex
? 08 06-plex ? 16 Fireplace
? 09 07-plex ? 17 Garage
? 10 OS-plex ? 18 Deck
? 11 10-plex ? 19 Lower Level
? 12 12-plex Plbg_Y or _ N
? 20 Pool
? 21 Porch (3-sea.)
?X 22 Porch/Addn.(4-sea.)
? 23 Porch (screened)
? 24 Storm Damage
? 25 Miscellaneous
? 30 Accessory!Sldr
,. . i
? 31 Ext. Alt - Multi
? 33 Ext. Alt - SF
? 36 Multi
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
x 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)* ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement *Demolition (Entire B ldg only) - Give PCA handout to applicant
Valuation D B? Occupancy MC/ES System
Census Code LI ,341 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
Footings (new bldg) FinallC.O.
_
Footings (deck) ? Final/No C.O.
Footings (addition) Plumbing
?i Foundafiun ? HVAC
Drain Tile Other
Roof _ Ice & Water Final Pool _ Ftgs _ Air/Gas Tests _ Final
_
X Framing _
_ Siding 9tucco Stone
Fiteplace _ R.I.
Air Test Final Windows (new/replacement)
_
a{ Insularion _
_
_ Retaining Wall
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
Approved By
a3
Building Inspector
Total
r
Addition at 4653 Pello Circle
Eagan, MN 55122
Updated page for load ananlysis
14 x 4 Addition to front of house
Area BTUH BTUH
Sq Ft Loss Gain
Now R13+ 1/2" Gysum R5 112 753 158
Single Paint w/storm 24 1309 686
2062 844
New R19+112"Gypsum R5 112 565 119
R13 + 1!2" Gypsum R5 32 215 45
Double Pain Low E 24 732 841
1512 1005
Decrease in heat loss 550
-161
y?_i
Lennox Objective Guide to Installation Comparison
#*###iiltx*tRf1Rt*?##*#R#?#**??t?t***?#****?#??i#*#***#/*#t#?t*##?it???tRt#i#?st
LOGIC Software Group
Lennox Industries Inc.
Dallas, TX
1-800-527-3506
?*t?#t**?#*itttt#R#!Y*k#*;*i?#*t****#*f}**##**?**t*****?*K#R*#?f#ttt#lt?E??*f?*k
07/22/99 LOGIC 1000 RESIAENTIAL LOADS ANALYSIS PAGE 1
ADDITION AT 4653 PELLQ CIRCLE
EAGAN, MN 55122
PREPARED FOR: CITY OF EAGAN
PREPARED BY: JAY AND MARGARET BENSON
FILE TITLE: ADAITION
DESIGN TEMPERATURES (DEGREES F)
WINTER INSIDE 72 WINTER QUTSIDE -12
SUMMER INSIDE 75 SUMMER OUTSIDE 89
DAILY TEMPERATURE RANGE INDICATOR M
DESIGN GRAINS RELATIVE HUMIDITY 32
DEGREES NQRTH LATITUDE 44
SUh4fER AIR CHANGES PER HOUR 1.2
WINTER AFR CHANGES PER HOUR 0.5
AREA BTUH BTUH
SQ FT LOSS GAih
ROOM - 1 BASEMENT A IlV ZONE 1 25 X 24
WALL 15B 8 OR 12 IN BLOCK + R-5 2-5 FT BELOW 200 1,243 Q
WALL 12A NO INSUL+ 1/2 INCH GYPSUM HOARA R-.5 192 9,371 916
WALL 15B 8 OR 12 IN BLOCK + R-5 2-5 FT BBLOW 200 1,243 0
WALL 15B 8 OR 12 IN 9IACK + R-5 2-5 FT BELOW 192 1,193 0
WALL 12H3 R-19 + 1/2 INCA GYPSUM BOARD R-.5 160 $06 169
WALL 12H3 R-19 + 1/2 INCH GYPSUM BpARD R-.5 165 832 174
WINDOW 3D DOUBLE PANE LOW E WOOD FRAME FACING-NW 27 819 940
TINT-PLAIN SHADING-DRAP§kCff8JJ$EVggWgg(Bg?tery ppergted p,k,)
SHAD I NG COEFF I C I ENT = 1 pRg gp;AUTM ON && LEVEI.S UF THE HOUSE.
WALL 12H3 R-19 + 1/2 INCH GXPSUM BOARD ?,5?N&&SLEF.PING RQIA-MS. 0N9eVELS 20
DOOR 11E L72ETHANE CORE Cp??pIpG g?EYfN? ?EAS. ?:B?q'SRALLY 70
WALL 15B 8 OR 12 IN BLOCK + R-5 2-5 F&*KW%MaXEpETE(rW-g 1,y cW,a,q7py$, 0
FLOOR 21A BASEME'VT FLOORS 0 0 0
WARNING!!! ZERO TEMPERATURE DIFFERENCE ENCOUNTERED !
WINTER INFILTRATIOTv 32 CFM 2;952
SUMMER INFILT RATION 77 CFM SENSI$LE GAIN EAGAN 11181
LATENT ? ? 1,66
PEOPLE ?
1 SENSIBL?•??.' 300
LATENr( GAIN 230 L
?
L.:.. ?e)`
ZJ! G INSPECT
-----
I.
Prepared by:
Margaret M. Benson, CPA
651/405-8337
12/20/2001
07/22/99 LOGTC 1000 RESIDENTIAL LOADS ANALYSTS PAGE 2
ADDITION AT 4653 PELLO CIRCLE
EAGAN, MN 55122
AREA BTUH BTUH
SQ FT LOSS GAIN
TOTAL FOR ROOM 1 4,800 CU FT 600
SENSIBLE 14,636 3,770
LATENT 1,898 L
ROOM - 2 FIRST FLOOR IN 7.ONE 2
45 X 29
WALL 12D3 R-13 + 1/2 INCH GYPSUM BOARD R-0.5 191 1,284 269
WINDOW 2C SNGLE PN W/STRM CLR MBTAL FRM FACING-S 9 491 257
TINT-PLAIN SHADING-DRAPES HALF DRAWN
SHADTNG COEFFICIENT = 1
WALL 12H3 R-19 + 1/2 INCH GYPSUM BOARD R-.5 200 1,008 211
WALL 12H3 R-19 + 1/2 INCH GYPSUM BOARD R-.5 157 793 166
WINDOW 3D DOUBLE PANE LOW E WOOD FRAME FACING-NW 21 641 736
TINT-PLAfN SHADING-DRAPES HALF DRAWN
SHADING COEFFICIENT = 1
WINDOW 3D DOUBLE PANE LOW E WOOD FRAME k'ACING-NW 14 409 470
TINT-PLAIN SHADING-DRAPES HALF DRAWN
SHADING COEFFICIENT = 1
WALL 12H3 R-19 + 1/2 INCH GYPSUM BOARD R-.5 106 533 112
DOOR 8M SLDNG DR, 2 PN CI.6AR GLASS WD F FACING-N 41 1,888 718
TINT-PLAIN SHADING-DRAPES HALF DRAWN
SHADING COEFFICIENT = 1
WINDOW 3D DOUBLE PANE LOW E WOOD FRAME FACING-N 14 409 200
TI:VT-PLAIN SHADING-DRAPES HALF DRAWN
SHADING COEFFICIENT = 1
WALL 12C R-11 + 1/2 INCH GYPSLJM R-.S 179 1,353 284
DOOR 11E URETHANE CORE 21 335 70
WALL 12C R-li + 1/2 INCH GYPSUM R-.5 164 1,240 260
WINDOW 2C SNGLE PN W/STRM CLR METAL FRM FACING-S 24 1,310 686
TINT-PLAIN SHADING-DRAPES HALF DRAWN
SNADING COSFk'ICIENT = 1
WINDOW 3A DOUBLE PA1'dE CLR GLA55 WOOD FRM FACING-E 4 185 226
TINT-FLAIN SHADING-DRAPES HALF DRAWN
SHADING COEFFICIEN'T = 1
WINTER INFILT RATION 98 CFM 9,037
SUMMER TNFILTRATION 235 CFM SENSIBLE GAIN 3,615
LATENT GAIN 5,108 L
PEOPLE 2 SENSIBLE GAIN 600
LATENT GAIN 460 L
APPLIANCES 2200
TOTAL FQR RQOM 2 8,640 CU FT
1,080 ----- -----
SENSIBLE 20,918 10,080
LATENT 5,558 L
Prepared by:
Margaret M. Benson, CPA
651/405-8337
12/20/2001
07/22/99 LQGIC 1000 RESIDENTIAL LOADS ANAI,YSIS
ADDITION AT 4653 PELLO CIRCLE
EAGAN, MN 55122
ROOM - 3 SECQND FLOOR IN ZONE 3 48 X 29
WAI,L 12C R-Il + 1/2 INCH GYPSUM R-.5
OVERHANG = 1.0
WALL 12H3 R-19 + 1/2 INCH GYPSUM BOARD R-, 5
OVERHANG = 2.0
WINDOW 3D DOUBLE PANE LQW E WOOD FRAME FACING-5
TINT-PLAIN SHADING-DRAPES HALF DRP,WN
SHAOING COEFFICIENT = 1
WALL 12H3 R-19 + 1/2 INCH GYPSUM BOARD R-.5
WINDOW 3D DOliBLE PANE LOW E WOOD FRAME FACING-NW
TINT-PLAIN SHADING-DRAPES HALF DRAWN
SHADING COEFFTCIENT = 1
WINDOW 3D DOUBLE PANS LOW E WOOD FRAME FACING-NW
TINT-PLAIN SHADING-DRAPES HALF DRAWN
SHADING CQEFFICIENT = 1
WALL 12H3 R-19 + 1/2 INCH GYPSUM BOARD R-. 5
OVERHANG = 1.0
WINDOW 3D DOL'BLE PANE LOW E WOOD FRAME FACING-N
TINT-PLAIN SHADING-DRP,PfiS HALF DRAWN
SHADING COEFFICIENT = 1
WALL 12C R-11 + 1/2 INCH GYPSUM R-.5
OVERHANG = 1.0
WINDQW 2C SNGLE PN W/STRM CLR METAL FRM FACING-E
TINT-PLAIN SHADING-DRAPES HALF DRAWN
SHADING COEFFICIENT = 1
WTNDOW 2C SNGLE PN W/STNM CLR METAL F'RM FACING-E
TINT-PLAIN SHAAING-URAPES HALF DRAWN
SHADING COEFFICIENT = 1
CEILING 16H DARK R-38 INSULATION
WINTER TNFILTRATION 59 CFM
SUMMER INFILTRATTON 143 CFM SENSIB LE GAIN
LATFNT GAIN
PEOPLE 3 SEN51BLE GAIN
LATENT GAIN
TOTAL FOR ROOM 3 9,216 CU FT
SENSIBLE
LAT'ENT
PAGE 3
AREA BTUH BTUH
SQ FT LOSS GAIN
208 1,572 329
155 779 163
14 409 212
155 782 164
6 182 203
31 939 1,072
162 816 171
6 182 89
175 1,323 277
24 1,310 1,171
9 491 416
11152 2,516 1,138
5,492
2.297
3,104 L
900
690 L
1,152
16,789 8,508
3,794 L
Prepared by:
Margaret M Benson LLC
651/405-8337
07/22/99 LOGIC 1000 RESIDENTIAL LOADS ANALYSIS PAGE 4
ADDITION AT 4653 PELLO CIRCLE
EAGAN, MN 55122
_________________________________°________=______ _ - -
_ _____________________________
STRUCTURE TOTALS 22,656 CU FT
SENSIBLE
LATENT
MINIMUM Cooling Capacity needed is 33,617 btu
at 89 degrees outside and 75 degrees inside
Maximum Desired Cooling Capacity is 38,660 btu
(115% of Total Load)
52.343 22,357
11,260 L
*****srrr***??xa*srs::?*:z:ss?** Version 92.12 *******r*****s*stssstss??xxsts*?
? This Heating and Cooling Load Computation was produced using the procedures •
* and tables of the Air Conditioning Contractors of America's Manual J, *
* Seventh Edition. The accuracy of the calculated loads depends upon the *
* accuracy of the data used and the accuracy of the Manual J load calculation ?
= procedures for the given conditions, No warranty, either expressed or *
* implied, is given by Lennox Industries Inc. with respect to the accuracy *
? and/or sufficiency of the information provided by this report. ¦
?t?*tit#tf#*tR?ttlt**###??*#*$*#?*k?f&#???i#&??tttxitt##tK#t!##t*/t*iti?t?tt#fi
2,832
Prepared by:
Margaret M Benson LLC
651/405-8337
07/22/99 LOGIC 1000 RESIDENTIAL LOADS ANALYSIS PAGH 5
ADDITION AT 4653 PELLO CIRCLE
MULTI-ZONE/MULTI-FAMILY CALCULATIONS
ZONE 1
BASEMEN'I' A
TOTAL LOADS
ZONE 2
FIRST FLOOR
TOTAL LOADS
ZONE 3
SECOND FLOOR
TpTAL LOADS
ONLY ONE ZONE CONDITIONED ALL ZONES CONDITIONED
WITH ZdNE PA,RTITION LOAD NO ZONE PARTITEON LOAD
------------------------- ------------------------
PRIMARY BTU LOSS HTU GAIN BTU LOSS BTU GAIN
EXPOSURE 5ENS LAT SENS LAT
N 14,636 3,770 1,898
------- ------- -------
14,636 3,790 1,898
14,636 3,770 1,898
-- - ------- -------
14,636 3,770 11898
N 20,918 10,080 5,568
------- ------- -------
20,918 10,080 5,568
N 16,789 8,508 3,794
------- ----- - -------
16,789 8,508 3,794
20,918 10.080 5,568
------- ------- -------
20,918 10,080 5.568
16,789 8,508 3,794
------- ------- -------
16,789 $,508 3.794
Prepared by:
Margaret M Benson LLC
651/405-8337
.+f
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S. HOAtE CORPORATION
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60UN04[:ES Of TME UMD A?OYE DESCR16ED AhA 6F iHE iO:;f;fOn OF kU EUIIDlNGS. !f ANY,
IqEREON, A.Yp ALL y1516lE £NCYOACMMENIS. If ANY, fROM i'P GN SAtp tAND.
Do??d ?A:.2?n ea? p+ SRAD 'qg/ C. p- WiN(:,':H g nS50CUTk5, INC.
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Sur.aror. btinn0.u4o Rryirl.miion No?/fCF ----
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Prepared by:
t' v",arg3r;t M. Benson LLC
' 651r405-8337
6/14/2002
9653
eir" "; ??Q• C. R. WINDEN 3 ASSOCIATES, INC.
v??C?L V IAND SURVEYORS Tsl. 645•3646
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t- FOR: 1381 EUSTIS ST., ST. PAUL# MINN. 55108
U. S. HOME CORPORATION
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Addition, Dakota County, Minnesota. (U
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N'E MERFBY CERTIFY THAT iHiS IS A TRUE AND CORRECT REPRESENTATiUN Of A SURVEY OF THE
60UNDARIES Of THE lANO ABOVE DFSCRI6ED AND OF TME IOCATION OF All 6UILDINGS, IF ANY,
THEREON, AND All V15161E ENCROACHMENTS, IF ANY, FROM OR ON SAID IAND.
Dorod thii??n day of ,ST_A.D. 1900/ C. R. WINOEN 8 ASSOCIATES, INC.
by
Sur.aror. Minnewta Roqisfrotion No.M6
Nn519
CTTY L1F' .F..AGAN
CA5S-17:CRc JS TI_.RM.T.NAL.. td0. 699
DFliE. 08/13/199 '1'IMli:c 13.25402
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NAME,: MAf'GFthL-:7 M BEN50N
321.0 9001 4653 P'EI...lO GIR 422.05
34i?? 9001, 4653 PE.I._LO CTR 274.33
2155 JC)fli 4653 F'FI._l.CI C:f.;i 14.D0
To1:al Fiece:ip1; Amounl,e il.fla38
CR:I.1:14C i
l.1Sl:R .T.Iis JAN
CYTY QF ERGRM PE1tti%T
3830 P°LOT KNDB RD
EREs:d, t°iid 55122
551-681-4617
&1RYi. 823
S-A-L-f-S Dit-p-F-T
757M
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lA P(Fc: VISA
TR T4rF: iUJSE
BU; 309
CATE: Rl'S 13, 99 I1:34:C3
T4TRL ?;710.38
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9J/0 SOICES Ita THE 0.;(GT OF iH
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1999 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD - 55122 c?
651•681-4675
New Consfrucfion Reauhemenfs ' RemodeVRepair Reauiremen}s
? S regisfered sBe surveys showing aq. B. of 101, sq. fl. of house
and gll roofed areas (20% maxtmum lot eoveraae allowed)
D 2 copfes of plans (show beam S window slaea; poured fnd. design; etc.)
? 1 set ot energy cuiculafions .
? 3 coples of kee preservafion plan If lot plafFed aHer 7/1/93
DATE: I 'L3I99
2 copies ol plan
1 set of energy calculolions lor heWed addilions
1 sHe survey for exlerior addBlons 3 dec W
CONSTRUCTIONCOST: 4 15aODD
DESCRIPTION OF WORK: Rddulirion -Jo horne - 3 xckAwX,o
STREETADDRESS: 4601 Pallr)_CirrIP
LOT: 21 BUJCK: 2- SUBD./P.I.D. #: RickyCiX?e FWs? i+dc1 J7an
PROPERTY
OW N ER
Name: P)enSnn -lal + I?'?a?are:1' Phone#: ?51- hHlo-OIpS?-I
lasT irsl
Street Address: yl 53 PP lV) rarr-l P
City Er4 a an State: IA ? Zip: S 5l'a a.
Company: -?J Gk- KYl 'e-_ Phone #:
(area code)
CONTRACTOR
Sheet
• City
ARCHITECT/
ENGINEER Comm
Telephone #: area code ( )
Sfreel Address: Registration #:
Ciiy
Lieense # bcp.
State: Zip:
_ Name:
State:
Smwer 8 water licensed plumber (reauired for new eonshuctlon onivl:
PenaHy appiies when addcess eFange and lot change is requesfed once permR is issued.
i, .. ,.
Zip:
?
I hereby acknowl . ge\fhct I;have re ,d this appllcaHon, state that fhe information is cortect, and agree fo comply with atl appiicabl
State of \(ota Stetufes and Cily?of\agan Ordinances.
Signature of Applicant: ?? ??? XXiX/.1 wh
?,
? OFFICE USE ONLY
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. (4-sea.
? 03 1 of _ plex ? 08 6-plex O 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 ? 15 Lodging ? 20 Pool ? 25 Miscelianeous
WORK TYPE
13 31 New ? 35 Tenant Impr ? 39 Gas Line Only ? 43 Siding/Soffits/Fascia
X 32 Addition ? 36 Move Bidg. ? 40 Gas Insert ? 44 WindowslDoors
? 33 Alteration ? 37 Demolish Bldg.' ? 41 Wood Stove ? 45 Fire Repair
? 34 Repair 0 38 Demolish (Interior) ? 42 Reroof
* Give PCA handout to applicant for demolition permit
GENERAL INFORMATION
Const. (Actual) Basement sq. ft. Census Code ?
(Allowable) Main level sq. ft. SAC Code
UBC Occupancy sq. ft. No. of Units ?
Zoning sq. ft. No. of Bidgs
# of Stories sq. ft. MC/ES System
Length sq. ft. City Water _
Width Footprint sq. ft. Booster Pump _
PRV
Fire Sprinklered
APPROVALS
Planning
Permit Fae
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:
Building
? ? • ? 3
--? lU.3R?
A Engineering Variance
Valuation:
?
SAC Units
% SAC
, . .
..,..? .. _ _ ... -- .-- -...-- `:•R:-tv?nv[rv an?oVtlnl W,' IIV .
IAND SURVEYORS Tal. 645•3646
FOR: 1381 EUSTIS Si., ST. PAUL, MINN. 55108
U. S. HOME CORPORATION ^
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Lot 21, Block 2, Ridgecliffe First 1?j I
Addition, Dakota County, Minnesota. \ (v ?--
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WE HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECt REPRESE N ATI(:)N Of A SURVEY OF TH:
60UNDARIES OF iME IAND ABOVE Df5CR16ED AND OF THE IOCATION OF Itll lUIIDINGS, IF ANY,
THEREON, AND ALl V15161E ENCROACMMENTS, IF ANY, FROM OR ON SA10 IAND.
Oo1ud this?Pn C. R. WINDEN 6 ASSOCIATES, INC.
day ol ? - A. D. 19?f? f
Ai,?.?..?,,? '
br 6 '
Survaror. Minno.olo Ropianation No.?72 '.
***********************#***************
CITY OF EAGAN
CASHIER: JS TERMINAL NO: 779
DATE: 03/24/00 TIME: 13:04:55
ID:
NAME: JAY OR MARGARET BENSON
3212 9001 4653 PELLO CIR 30.00
2155 9001 4653 PELLO CIR 0.50
3213 9001 4653 PELLO CIR 30.00
2155 9001 4653 PELLO CIR 0.50
Total Receipt Amount: 61.00
CR125028
USER ID: JAN
**?******?*+*****???***************?*?*
******?***?***************?****?*******
CITY OF EAGAN
CASHIER: JS TERMINAL NO: 779
DATE: 03/24/00 TIME: 13:04:41
ID:
NAME: JAY OR MARGARET BENSON
3212 9001 4653 PELLO CIR 30.00
2155 9001 4653 PELLO CIR 0.50
3213 9001 4653 PELLO CIR 30.00
2155 9001 4653 PELLO CIR 0.50
Total Receipt Amount: 61.00
CR125028
USER ID: JAN
******?******?*********?****?**********
CITY USE ONLY
LOT d I BL ? PERMIT #:
SUBD. RECEIPT
ia5 oa?
?
RECEIPT DATE: _2 " ?J' O
2000 MECHANICAL PERMIT (RESIDENTIAL)
Dste: * Z-VI I oo
Complete this section onlv if you are installing HVAC in a single family dwelling, townhome or coudo under
construction and not ownedoccupied.
• HVAC: 0.100 M B T U
ADDITiONAL 50 M BTU
• Gas outlets (minimum of one requued @$3.00 ea.)
State Surcharge
Total
$ 30.00
6.00
.50
$
Complete this section onlv if you are remo elin addin¢ to. or reosirine an existing single-family dwelling,
townhome, or condo. Please indicate if it is a new item, alteration, or repair.
New _ Alteration ? Repair _ Other
? Furnace
_ Air exchanger
CITY OF EAGl1N
3830 PIIAT IQ70B RD
EAGAN !•IIt 55122
651-681-6675
A'v conditioning
Other
Fee
State Surchazge
Total
Reminder: Call for inspections
$ 30.00
.50
$ 30.50
SITEADDRESS: LAIoSZ N-k?h C\rG12,
OWNERNAME: -eV\SO`Tl PHONE#: (oSl - ?$lnOlaSy
(AREA CODE)
INSTALLER NAME: PHONE #:
(AREA CODE)
STREET ADDRESS:
CITY:
STATE: ZIP:
SIGNATURE OF PERMI'ITEE
cirr usE oNLv
L BL
SUBD.
APPROVED BY: , INSPECTOR
PERMIT #:
RECEIPT#:
RECEIPT DATE:
2000 MECHANICAL PERMIT (COtMRCIAL)
CITY OF EAGAN
3830 PILOT lINOB RD
EAGAN, MN 55122
651-681-4675
Please complete for: all commerciaUndustrial 6uildings
multi-family buildings when separate permits are not required for each dwelling unit
DATE:
WORK 11'PE: New construction Install U.G. Tank
_ lnterior Improvement _ Remove U.G. Tank
_ Processed Piping
When installing/removing underground tank, call 651-681-4675 jor inspection by frre marshal and
p[umbing inspector.
Description of work:
Fees: 1% af contract price OR $30.00 minimum fee, whichever is greater.
Underground tank removaVinstallation = minimum fee
Contract price: $ x 1%= $ (Base Fee)
State surchazge calculaze at $.50 for each $1,000 Base Fee
TOTAL S
SIT'E ADDRESS:
OWNER NAME: PHONE #:
(AREA CODE)
TENANT NAME (IlNPROVEMENTS ONL1):
WAS TI-IERE A PREVIOUS TENANT IN THIS SPACE? Y N. NAME:
INSTALLER
ADDRESS: PHONE #: - ,
(AREA CODE)
CITY: STATE: ZIP:
SIGNATURE OF PERMITTEE
L BL CITY USE ONLY
a ?
SUBO.
RECEIPT #: za ? U ?? Av?
RECEIPT DATE: aV .
PERMIT# ?or) / C)
2000 PLLMIDING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT IINOB RD
EAGAN, bPI 55122
651-681-4675
Please complete for: ? single family dwellings
? townhomes and condos when permits are required for each unit
? backflow preventerforunderground sprinklersystem
FIXTURES
EACH #
TOTAL
Atterations to existing dwelling - minimum fee
Describe: Ac?r?.A-i n Cl $ 30.00
Bath tub $ 3.00 x = $
Floor drain 3.00 x = $
Gas pi ing outlet " minimum -1 3.00 x = $
Hot tub/spa 3.00 x = $
Kitchen sink 3.00 x = $
Laundry tray 3.00 x = $
Lavatory 3.00 x = $
Septic System new/refurbished ` requires MPC lic. 75.00 x = $
Septic S stem abandonment 30.00 x = $
RPZ new installation/repairlrebuild 30.00 x = $
Rough opening 1.50 x = $
Shower 3.00 x = $
Under round sprinkler Hdwelling is under construction 3.00 x = $
Under round sprinkler if existing dwelling 30.00 x = $
Water closet 3.00 x = $
Water heater 3.00 x = $
Water softener if aweutng under eonsvuceion 5.00 X. _ $
Water softener if exisdng dwelling 30.00 x = $
Water tumaround 30.00 x $
State Surcharge .50 -> -> -> $ 50
rotal $ 3 .ro
Reminder. Catl for inspections of alterations, i.e. water heaters, water softeners, etc.
------------------------------------------------------------------------------------------------------------------------------------------
I hereby acknowledge that I heve read- this applicatlon, state that the iMortnation is cortect, and agrea W compty wfth all appliwble City of Eagan ordinances.
k is the appliwnYS responsibility to notify the property owner that the City of Eagan assumes no Iia6ility kr any damages caused by tha City dunng ifs
normal operational and maintenance adivdies to the facildies constructed under this partnk within City property/rightof-wayleasement.
' SITEADDRESS: I-4lo_4IId C\YGv2
OWNERNAME::-Jia;iu 62nSOn TELEPHONE#:(051 (O$faOfoSy
(naen cooe)
INSTALLER NAME: Se
TELEPHONE #:
(AREA CODE)
STREET ADDRESS:
CITY: , STATE: ZIP:
11-?. ?i,v?.?
SIGNATURE OF PERMITTEE.
Use BLUE or BLACK Ink
j For Office UseI
I ,
City of Eajan I Permit
I
I Permit Fee: q- a, 6ro 1 3830 Pilot Knob Road I I
Eagan MN 55122 I Date Re ived:
j
Phone: (651) 675-5675 i Staff: I
Fax: (651) 675-5694 _ _ _ _
INFLOW INFILTRATION PERMIT APPLICATION
Plumbing / Sewer & Water
Date: Site Address: i4LO P-eflo
NCR-
Tenant: Suite
Name: Phone:
RESIDENT / OWNER
Address / City / Zip:
Name: License
CONTRACTOR Address: City:
State: Zip: Phone:
Contact: Email:
7LPU B /NG (Within the building envelope) SEWER & WATER (Outside the building envelope)
TYPE OF WORK mp Pump Repair Repair
Other: Other:
DESCRIPTION Description of work:
FEES
$55.00 /Each (includes $5.00 State Surcharge) (Rev. 6-30-10) TOTAL FEE $
*Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submit 1/1 repair costs for
reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors
can be found by visiting www.citvofeagan.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.4ogherstateonecall.orra
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 fora permit, and work is not to start without a
permit; that the ork will be in accordance with the approved plan in the cas of work whic requires a review and approval of plans.
i
xf` -A )~j
x
Applicant's Printed Name Applicant's Signature
FOR OFFICE USE Reviewed By: Date:
Required Inspections: -Under Ground -Rough-In -Final