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4126 Pennsylvania AveBLDG. PERMIT NO. 01-3210.' Bldg. Permit 01-3422 *Plan Check 01-3446 Surch./Adm. 01-3446 SAC/Adm. 01-2155 Surcharge 75-3860 Road Unit 20-2275 SAC ?0-3865 Water Conn. 20-3868 Water Trmt. 20-3716 Water Meter 20-2252 Acct. Dep. 24-3713 Water Permit 20-3743 Sewer Permit 79-3866 Sewer Conn. 28-3855 Park Ded. 69 0 TOTAL I CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHON E: 454-81 QO J4 sf ?: .., BUILDING PERMIT Receipt? ?:-?-• `?' ? To be used for 3F DK/GeA Est Value $73,000 Date OCTOBER 14 ,19 `'- Site Address 4126 8lill118YLYAN"LA AVE Lot ZS Block i Sec/Sub. SZAFFdRD YLACg Parcel No. . Name ?UNTIL?lt MIDilEB? BMtB = Address 3902 CEUAiZYAI.B Dx ° City aAGAN Phone 454-0433 Q Name $AU o u 74ddress P Ir-ity Phone Name _ Address, City _ Phone .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 EaqantOrdinances. Sipnature of Permittee J irRGPiTIER :12DWE8? M0NES A Buildine Permit is issued to:- on the express condition that all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Building OFFICE USE ONLY 113 MI On Sfte Sewage Occupancy - MWCC System = Zoning ? On Site Well (Actual) Const - ? ,- City Water (Allowable) PRV Required # of Stories Booster Pump Length ?i 1 Depth 4` S.F. Total Footprint S.F. APPROVALS FEES ; ???? Engr./Assess. Permit Planner Surcharge 36.50 Council Plan Review 233.W Bidg. Off. _ SAG City 100.00 Variance SAC, MWCC 5%•90 Water Conn. 550.00 WaterMeter 67•90 RoadUnit 325_a((} Treatment P1 Parks TOTAL U.531.50 ? CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21•199, Eagan, MN 55121 ?55 7 1 BUILDING PERMIT PH ON E: 454-8100 Receipt? ti??'?''' ??'Y' •' To be used for ^ -)VG/CAf Est. Value 473p0W Date OCTQSP-R 18 ,19 ?& Site Address 1•'- ? PENi?::'i'e.\- t A AYE Lot elock 1 Sec/Sub. ? CA?T'4!D Y1J?CE Parcel No. 17RONr11iR .: smS c Name z Address 3902 •uA', .. "ft ° 54 ? ? ? City " i Phone w , o Name 5.i?;: ? ? s Address ? City Phone i- Q W V Name j y F W z Address u a Z City Phone t W I hereby acknowledge that I have read this applicatfon 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 Permittee r s?:;?.i7 i E tt rit ?w?sT eo?s A Building Permit is issued ta - on the express condition that all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Building Official__ OFFICE USE ONLY Ki ri 1 On Site Sewage Occupency ?- MWCC System x Zoning On Site Well IActual) Const ' n City Water (Allowable) `Tr PRV Required # of Stories Booster Pump Length Depth S.F. Total Footprint S.F. APPROVALS FEES Engr./Assess. Permit Planner Surcharge ja•50 Council Plan Review ? -3 3•00 Bldg. Off. SAC, City ?- LSL•W Variance SAC, M WCC WaterConn. 50•00 Water Meter 67. 0 Road Unit 3`[lA1? Treatment P1 --4Q4-,W Parks TOTAL `? a 3 : 0 Permit No. Permit Holdsr Date elephone ?t Plumbing H.V.A.C. Electric / / Softener Inspection Date insP. Comments Footings I ? Footings II Foundation Framing Roofing Rough Pibg. 2-13 Rough Htg. c ,f ,et ISUI. Fireplace Final Htg. Final Plbg. 1 Bldg. Final Cert Occ. ? Temp. LP Deck Ftg. Deck Final Well Pr. Disp. CONTRACT PRICE $1700. 00 Site Address 4126 - enn4y V? Lot 25 Block 1 ? Name WENZEL HFATINi m m Address 1955 Shawnee c City LaQan PERMIT # MECHANICAL PERMIT `• ?.' ._ i CITY OF EAGAN RECEIPT # 3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: 1 1 I2'I' 88 PHONE: 454-9100 -7 & Ave. BLDG. TYPE WORK DESCRIPTION Sec/Sub Staffor Res. xx New lxx y Aoig Mult Add-on Comm. Repair )ad _ Other ion - Name MuN rIr:[c wrM L c Address 3.908 Sibley-1 p City Lagan TYPE OF WORK Forced Air Boiler Unit Heater Air Cond. Vent Gas Piping OuUets # Other 80,006 M BTU M BTU M BTU M 8TU CFM FEES RES. HVAC 0-100 M BTU -$24.00 ADDITIONAL 50 M BTU - 6.00 (RES. HVAC INCLUDES A/C ON NEW CONSTRUCTION) GAS OUTLETS (MINIMUM - 1 PER PEkMin - 1.50 EA. COMM/IND FEE - 1% OF CONTRACT FEE APT. BLDGS. - COMM. RATE APPLIES TOWNHOUSE & CONDOS - RES. RATE APPLJES MINIMUM RESIDENTIAL FEE - ALL ADD-ON & REMODELS - 12.00 MINIMUM COMMERCIAL FEE - 20.00 STATE SURCHARGE PER PERMIT - .50 (ADD $.50 S/C IF PERMIT PRICE GOES BEYOND $1,000) FEE: 25.50 .} , S/C: SIGNATURE OF PERMITTEE TOTAL• $26•00 FOR: CITY OF EAGAN ? PERMIT li PLUM8ING PERMIT RECEIPT # CITY OF EAGAN . 3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: CONTRACT PRICE: PHONE: 454-8100 Site Address Lot Block SeciSub m Name ?c Address '? - c City Phone Name ? ? Address p City Phone FEES COMM/IND FEE - 1°rb OF CONTRACT FEE APT BLDGS - COMM RATE APPLIES TOWNHOUSE 8 CONDO - RES. RATE APPLIES MINIMUM - RESIOENTIAL FEE - $12.00 MINIMUM - COMMIIND FEE - $20.00 STATE SURCHARGE PER PERMIT - .50 (ADD $.50 S/C IF PERMIT PRICE GOES BEYOND $1,000.00) SIGNATURE OF PERMITTEE FOR: CITY OF EAGAN BIDG. TYPE WORK DESCRIPTION Res. New Mult. Add-on Comm. Repair Other RES. PLBG. ONLY - COMPLETE THE FOLLOWING: NQ. FIXTURES TOTAL ?-Water Closet - $3.00 $ ?Bath Tubs - $3.00 Lavatory - $3.00 ? Shower - $3.00 Kitchen Sink - $3.00 Urinal/Bidet - $3.00 - T Laundry Tray - $3 00 . 7-Floor Drains - $1.50 ? Water Heater - $1 50 Whirlpool - $3.00 = Gas Piping Outlets - $1.50 (MINIMUM - 1 PER PERMIT) Softener - $5.00 Well - $10.00 '_ Private Disp. - $10.00 ?_Rough Openings - $1.50 `? • -t FEE STATE S/C: GRAND TOTAL: - ? ? &t - -. i Terttfiratie nf (DrrupaMry tirp of eagan B,eirttrttttenY of luilbatg ineprrtinn This Cenificale issued pursuant to the requirements of Section 306 of the Uniform Building Code certifying that at the time of issuance rhis struc[ure was in compliance with tlre various ordinances oj the City regulating building construction or use. For the foRowing: u? Cbms;ficatio„ S F DWG / GAR &dg. Ft,a,;, No. 15737 o-„a„n, Tra R-3 M-1 zo,,;? ?,;a R-1 Type Cnmt v-N owmiorBufla;ng FRONTIER MIDWEST Ad,= 3902 CEDARVALE DR Buiiaing Addrm 4126 PFNNSYLVANIA AVE Local«y L25, Al, STAFFORD PLACE 7': L?fl ;;, l p,k. DECEMBER 30, 1988 Building Officiai POST IN A CONSPICUOUS PLACE CITY OF EAGAN Permit No: Date: 1R-?n?Q 3830 Pilot Knob Road g/P No: Date: 10' ? y-F < P.O. Box 21199 Eagan,MN 55121 'Owner. rl??l?la= i'llu?cp? SiteAddress: +??? tennsylvania Ave L25 r2 Staffor:l Plaec : Plumber. '?tat PlumbinR : MWCC: Zoning. ?'. Ci Ch i?=?'??'?? of Units: i No g: ry . ? ' ?? Acct. Dep: ? ?"' ??P`? I agree to comply wilh the City of Eagan Permit Fee: Ordinances. Surcharge: Misc.: „nl- By SEWER SERVICE PERMIT F _ CITY OF EAGAN ' Permit No: 10 0 2= Date: 10-204$ 3830 Pilot Knob Road Meter No: Si2e: P.O. Box 21'199 Reader No: Date: Eagan, MN 55121 Owner. 7-rontic.v Yjdvest - SiteAddfess: 411; Pdmng!1 g*?7a Ao& T75 R1 Staffnrrl Plarm -- _. . , - Conn. Chg: 55C. 0??d Zoning: kl Acct. Dep: ' No. of Units: ? Permit Fee: Surcharge: ? 1 agree to camply with ihe City of Eagan Tr. Plant ' F Ordinances. Meter. '- 7•2bd Misc.: Pr-,V PFQ F--'r, By WATER SERVICE PERMIT CItY nPEAGAN ` Permit No: Date: 3+20'"$8 3830 PilotiCnob Road Meter No: 4L:Z 7S3 35? Size: ^ °Cl? P.O. Box 21199 Reader No: ?D,? % 9? ?9 Date: Eaflan, MN 55121 Owner. -•-- „t ?p,- ??-?,_=a.:r _ SiteAddress: •r ,- ?+q bye 125 AI. Staffnrd Place Conn. Chg: 550. 0(1nd Zoning: Rl Acct Dep: ' s- 00nd No. ot Units: 1 Permit Fea 10, OOpd Surcharge: • S0pd I agree to comply wiih ity of Eagan _ Tr. Plant 204, OOpu _ Ordioanc . Meter. y??. Qgfkg 1 Misc.: gy ? f WATER SERVICE PERMIT . • CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21 -199, Eagan, MN 55121 N? 15737 PMON E: 454-8 100 BUILDING PERMIT Receipt# 0 -=. To be used for SF DWG/GAR Est. Value $73, 000 Date OCTOBER 18 ,1g 88 Site Address 4126 PENNSYLVANIA AVE OFFICE USE ONLY R3 Ml 25 1 STAFFORD PLACE Lot Block Sec/Su6. On Ske sewage - Occupancy -R-f- MWCC System X Zoning Parcel No. Vn On Site Well _ (Actual) Const a FRONTIER MIDWEST HOMES Name Gtywater X (Allowable) VD z Address 3902 CEDARVALE DR PRV qequired X u of Stories ? o City EAGAN phone 454-0433 BoosterPump _ Length 48 oepth o Name SAME S.F. Totai , ? a Address Footprint S.F. .¢- City Phone APPROVALS FEES 00 $ 466 . "w Name Engr./ASSess. Permit ?i i - Address Planner Surcharge 36.50 a W City Phone Council Plan Review _230 BIdg.Off. SAQ Ci[y ---IQQiOO I hereby acknowledge that I have reatl this application antl stale that the Variance SAC, MWCC -5.5D-.00 information is correct and agree lo comply with all a licable State of Water Conn. 5$0.00 nnesota Statutes and City of a an rdi nces. Mi Water Meter f] 00 Signature of Permitlee -- Road Unit - 325..00 FRONTIER MIDWEST HOMES A euilding Permil is issued to:_ Treatment P1 -?94' 00 on ihe express cond ition thal all work shall be done in accordance wiM all Parks applica6le State of Minnesota atutes and City agan Ordi ances. TOTAL $2.,a31 50 BuildingONicial_ ?-3- Th, requesl voitl / 18 mon[hs /mm o° O D _ 2 oI_ V 2 .C..?1? Req C51 D?? ? Fi,e NO////? HOUpp=?n insyr.cuon I? I ?i?i I R? rred? n^ Reatlv Nuw ?II NoIify InsPec- lo Whon Reatly 9.6-1-ensed Electrical ContracIor 1 hereby request inspection of abova n.....__. eleclricel work installed et: , ......?. Suaet Address. B or Noute City 5 rvmi` ec ?on o. Township Name or No. Range No. Co ?V Occupant IPRINTI ?4 Phone No. r - Power S. vI i 1 {? / 0 /4 Add ess IWIe/ Elecvic?l Cont?acto ?ompony'Nam ? /???' / L ? ri G Conttar.mr's Licen.e Nn. °Tj Mailinp Addygid (Coniract or Ojw 'er Making Ins Ud/1',5 ?' 6 I tionl 1 ? ? Authorized S' atw 1 ntraCtnr'Owner Making Installation) • 7hone Number Y,5?a IW3 T ON flEQUEST WILL NOT THISINSPEC I MINN SOTA STATE BOARD OF ELECTHICITY BE ACCEPTEO 9V THE STATE BOAHD Grigea-Midway Bldg. - Room N-791 UNLESS PROPER INSPECTION FEE IS 1821 Universitv Ave.. SL Paul, MN 55104 ENCLOSEO. Phone (612) 642-0800 ?? ?? REQUEST FOR ELECTRICAL INSPECTION ee-ooaoi-os 1 See inslrvctmns for completing this torm on back o1 Vellow copy. ?955,-) D-2'owf$ 2 "X" Below Work Covered by This Request Add Feo. TYVa of Builaing AoDliancea Wired-- Equipment WireA Home Range Temporary Service Duplex Water Heater Lightiny Ffxtures Apt. Bullding Dryer Electnc Heatin Commercial Bldy. 041 F inace Silo Unloader Industrial Bldy. Air Conditioner Bulk Milk Tank Farm iner ner.i v incrlSUCCityI t er pecily Ot c Oth,)r Compute Inspectlon fee Below p Fee ServiceEnirence5ize H Fae Feaders/Subieeders N Fee Cfrcmis ( U ta 200 Am s 0 to 30 qm s 0 tn 30 !?m s Above 200 qmps, 31 to 100 Amps 31 to 100 Am s Swinunfng Pool Above 100-Amps Above 700_Am s Transtormers Irrigation Boorcis Pdrtia6Other Fee $igns Special Inspection ? Aemarks ? ? f NouBh-in Onte , the ¢al insoa<<a.. ne.anv ? Findl nily thal the above r spection hes been ?l made. TMareaueatvoltll8mamhelrom '? /„ APFLICATION FOR PERMIT SEWER AND/OR WATER CONNECTIQN ; NOR'E: PA7¢Mf OF FEE AT TIME OF ? APPISCATZON DOFS NOT CVN- ? ,*y STI1iflE APPR('iJAL OF PIIthffT. • ? INSPFICl'ICN OF SFSd1i ISID/O2 WKTM f ? IPISPALIATIONS WIId. N07' BE SCfD(IISM : ? [TICIL PII7dQT HAS BE@] APPROVm. dtV ?fffx?xifrfaaf?tf??f?tttttf?4ee?Yrf#?t OF CC6cjtai9 (PLEASE PRINT 1) PROPIIt17 ADDRESS: -44,2& pENNSYLVANIA AVE LF7GAL DFSC[tIPTION;. LOT 25 BLOCK 1 STAFFORD PLACE LotJBlock/Subdivision or Tax Parcel ID IF EXISTINGG STRL'CTLTRE, DATE OF ORIGINAL BIJILDING PERMIT ISSOANCE: PRESENP ZONING/PROPOSID OSE: Q CONAEE2CIAL/RETAIL/OFFICE Q INDL'SIRIAL a INSTITOTIONAL/GOVERIZENT Mont Year IR7Cj R-1 SINGLE FAMILY E'] R-2 DLPLEX ('Pao C'nits) II R-3 TOWNHOUSE (Three + Units) ( Dnits) Q R-4 APARTMENT/COPIDOMINIUM ( Onits) 2) ? NAME: FRONTIER MIDWEST HOMES CORP ADDRESS: 3902 CEDARVALE DRIVE CITY, STATE, 2IP: EAGAN, MN. 55122 PHONE: 454-4333 3) NP.ME: STAR PLUhiBIMG ADDRESS: 1018 MOUND SPRINGS TERRACE CITY, STATE, ZIP: BLOOMINGTON, MN. 55420 PHONE: 884-4149 MASTER LICENSE # 3329 4) NAME: STEFANSKI, JOSEPH & OKERLICKI STEVEN ADDRESS: 4833 JEFFERSON AVE N E CITY, STATE, ZIP: COLUMBIA HIEGHTS, MN 55421 PHONE: 788-1557 (JOSEPH) Use I? Active E7cpired Not recordec Sta Initia 5) is a =94 • ao ??.e El CONNECTION TO CITY SEWER ED CONNECTION TO CITY WATEF2 F] OTHEI2 6) 1 *?,r**?*******,r****.**#******x+?*r*****:r:****+???:r**?*r*+*w****?******t****,r*.**?*«**********,r+??***? * 7M GOID COPY OF 1iIE PEF2NIIT WILL BE SIIPf DIRF)CIZ,Y 'PO PUffi,IC FARKS 10 FACILITATE METII2 PIQt-OP. ? ,*k PLEASE ALLrDW ZhU FARKING DAYS FOR PRO(?'SSING. SOMIDONE EROM TfM CITY WILL ODWALT YOU IF R4IERRE ; * ARE ANY PROBLFMS. i ,'?t*Y? * «***+*Yr* *?,t,t*?w*r+r*+t*,k******t*??*t++* *** *,t,t?**t* ?,t*r***+.***t*****t**??*+r+t+*? *+****,t+.,t**tat,t*?y FOR CITY USE ONLY PERMIT # ISSUED Pd w/Bldg. Permit FEES: $ /C) . S"-D $ $ /D_ SG $ $ ?7-U? $ $ $ $ $ $ $ $ $ $ C-D $ $ l S b - o-? $ $ $ $ $ $ $ $ $ $ $ SEWER PERMIT (INCLUDE SURCHARGE) WATER PERMIT (INCLDDE SL'RCHARGE) WATER METER/COPPERHORN/OC'TSIDE READER WATER TAP (INCLODE CORPORATION STOP) SEWER TAP ACCOU[VT DEPOSIT - SEWER ACCO(;NT DEPOSIT - WATER WAC SAC TRDNK WATER ASSESSMENT TRLNK SEWER ASSESSMENT LATERAL BENEFIT/TRUNK SEWER LATERAL BEN°FIT/TR(!NK WATER WATER TREATMENT PLANT SORCHARGE OTHER: $ I S-z Z ' &I -? $ TOTAL ?-r L/ / Z_ RECEIPT # RECEIPT DOES UTILITY CONNECTION REQLIRE EXCAVATION IN PUBLIC RIGHT OF WAY? ? Q YES IF YES, THEN A"PERMIT FOR WORK WITHIN PUBLIC Q ROADWAY" MUST BE ISSLED BY THE ENGI[VEERING NO DIVISION. LIST AS A CONDITION. SLBJECT TO THE FOLLOWING CONDITIONS: APPROVED BY: TITLE: DATE: RESIDENTIAL =1 - * ' BUILDING PERMIT APPLICATION CITY OF EACAN ?j ?0 2?> 3830 PILOT KNOB RD, EAGAN MN 55122 651-681-4675 NawConsWction Reauiremenla • 3 re9istered sRe surveys showing sq. ft. of lo}, sq. N. of house; and all roofed areas (20% maimum lot coverage allowed) • 2 copies of plan showing 6eam & wiridow sizes; poured found design, etc.) • 1 set of Energy Calculations • 3 copies of Tree Preservation Plan If lot platted afler 711/93 • Rim Joist DeUil Options selection sheet (61dgs with 3 or less units) DATE 6 ?Q a • Residential Ventilation Category t Worksheet Submitted • Energy Envelope Calculations Su6mitted SITE ADDRESS 4 1?(o RilnSV LIjamt4 CQ ?z. MULTI-FAMILY BLDG _Y _N TYPE OF WORK l7'cc-k FIREPLACE(S) _ 0_ 1 _ 2 APPLICANT 44'L0077' U -2, 24 DL IF- X STREET ADDRESS 41 aC ?rt n r v Lua ?„ A ,,-e CITY EA-GlfA/ STATE ?lJ ZIP Sscrd-3 TELEPHONE # 611-4Sa •9a3 6 CELL PHONE # `10 (-) 0 RemodeURaoair ReouiremeMa . 2 copies of plan • 1 set of Energy CalcWations for heeted addi6ons • 1 site survey tor exterbr additions & decks . Indicate if home served by septic system for additions VALUATION FAX # PROPERTY OWNER ?12 le'&LJ&A'L.. Ir ki JG r2 ..ToS.r p?TELEPHONE # 6 5/-4-Sr2 ? a- ?? COMPLETE FOR "NEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category _ MINNF.SO'CA RULES 7670 CA'I'EGORY 1 MINNESOTA Ri7LFS 7672 (J submission rype) Plumbing Contractor: Plumbing syslem includes: Mechanical Contractor: Mechanical system includes: Sewer/Water Contractor: _ Air Conditioning Heat Recovery System Phone # Phone # Fcc: $90.00 Fee: $70.00 I hereby acknowledge that I have read this application, state thot the information is correct, and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Signature of Applicant ----°°-----------°-------------°--___--_-----_____--_-----------------'----------°.._.....----___---------_--'----_......._ ._. OFFICE USE ONLY Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _ Updated 4/02 . New Energy Code Worksheet Submitted Phone # _ Water Softener Water Heater _ No. of Balhs Lawn Sprinkler No. of R.I. Baths OFFICE USE ONLY . j . k ? 07 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool 0 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 Porch/Addn. (4-sea.) ? 33 EM. Alt - SF ? 04 02-plex ? 10 OS-plex x 18 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 x 31 New ? 35 Int Impravement ? 38 Demolish (Interior) ? 44 Siding ? 32 Addition ? 38 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair ? 33 Alteration ? 37 Oemolish (Bidg)' ? 43 Reroof ? 46 Windows/Doors ? 34 Replacement *Demolitlon (Entlre Bldg only) - Give PCA handout to applicant Valuation Occupancy MC/ES System Census Code Zoning City Water SAC Units ? I Stories Booster Pump Nbr. of Units ? Sq. Ft. PRV Nbr. of Bldgs G Length Fire Sprinklered Type of Const Width REQUIRED INSPECTIONS ?C Footings (new bldg) FinaUC.O. _ Footings(deck) :X: Final/No C.O. _ Footings (addition) _ Plumbing Foundarion HVAC Drain Tile Other Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests _ Final ?C Framing _ Siding Stucco Stone _ Fireplace _ R.I. _ Air Test _ Final _ Windows (new/replacement) _ Insularion _ Retaining Wall Approved By L/F-kx? , Building Inspector Base Fee Surcharge Plan Review MGES SAC City SAC Water Supply & Storage S&W Permit & Surcharge Treatment Plant Plumbing Permit Mechanical Permit License Search Copies Other Total t I i 1988 SUILDING PERMIT APPLICATION - CITY OF EAGAN SINGLE FAMILY DWELLINGS t 1 INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENEAGY CALCULATIONS NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MQST DESIGNATE WIiICB ADDRES3 IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED. MULTIPLE DWELLINGS RENTAL ONITS FOA SALE UNITS # OF UNITS INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SURVEY - CHECK WITA HLDG. DEPT., 1 SET OF ENERGY CALCULATZONS COhAERCIAL INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS, 1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS ' - - UI 13 tsee To Be Used For: NEW CONST, Valuation: $6}".?'49- Date: 10/10/88 Site Address 4126 PENNSYLVANIA AVE Lot 25 Block 1 Parcel/Su6 STAFFFORD PLACE Owner S'I'EFANSKY, JOSEPH & OKERLICKI 'JILVr Address 4833 JEFFERSON ST. N E I City/Zip Code COLUMBIA HIEGHTS 55421 Phone 788-1557 rn(2Vnu Contraetor FRONTIER MIDWEST HOMES CORP Address 3902 CEDARVALE DRIVE City/21p Code EAGAN 55122 I Phone 454-0433 Arch./Engr. PHILLIPS PLAN SERVICE Address 14530 PENNOCK AVE City/Zip Code APPLE VALLEY 55124 ') 3, 000 - OFFICE USE ONLY On site sewage_ Occupancy R-3 M-I MWCC system _jg?f Zoning R-1 On site well Actual Const V-hi City water ? Allowable V_ PRV required ? # oF stories Booster Pump _ Length `fU' Depth 48' S.F. Total Footprint S.F. APPAOVALS FEES Engr/Assess Permit y?.oo Planner Surcharge ZZ110 Council Plan Review 0 Z33, 0 Bldg. Off SAC, City ? Varianee SAC, MWCC .55 Water Conn 5S0.00 Water Meter (09,00 Road Unit 325,00 Treatment Pl Zo4.na Parks Copies of TOTAL `? .i/ /'R/MRPIf)6G'? Mnhn 1? Z? Phone li 432-2044 EvATERFOR ENVE:O?E FtVERAGc °U" COMPUTATiON {CNMWm\ ZXlo1 . DYlNER SITE AQDRE55 . CONTRACTaR Cgr,., V,.?A DATE PHONE Deternine working square foatage of each. 1. Total exposed wa11 araa .... .? Z43 S.to4p sq. ft. x .11 s?j?S] 2. Total raaflcziling area .... ?US F3 sq. ft. x Total expased waIT area a6ove floar =?,2 fl g•(,(? a. Total wa11 window area .......................... A ar,.-; b. Total door area ................................. 3 9. L? c. Total slidino giass dcor area ................... ya d: Total fireplace wa11 area ........................ 418 e. Total wall framing area (averaget0"<)............. a a S.R(o f. Total ne_.wa'1 area above flaor ................. t te5G.88 g. Total r:m Joist area ........................... I,4B Total exposed foundation area = h. Total foundation window area ..................... . i. ToaI net fiaundatian area a6ove arade ............ 15,33 Det=rmina "U" vaiue of each wail segnsent. a. 1 GLs,'-J X31Upi ,35 = y?.85 b. 3q.('a X„U„ ..y5 = ? ?.83 c - 4a X „U„ . 4l5 _ ! g •9 d- `18 X .,U" e. x HU0 `• tto S(o.$?C x ????, O'J = ?4.? 5• I?-1 6 X"U" e o 3(O = S 3? h. X "V., _ ;. z s.33 X„U„ . ty _= b.5 s ...:....:.................:..........rotat If ite.m 13 is the same as, ar less than itln fl, you have met the intent af 58C 6006(c)2. Total exQosed raof/ceiling area = I O 8S Total gross rcof/ceiling area = ... j. Total skyliqht area ..................?s, k. Tota1 roof/ceilinq framing area .... lO,,- 1. Totat net insnTated rooflceiling area....... 4 -1a. Z Oeternine °U" value for each rnof/c_ilina segmeat_ J X "U" k. Ibg.Ss X itU,s 0 z1 = 2.Z5 X"U" .019 = I 8. & 4 ..................................7ota1 = 2 7371 If total af 714 is the same as, or less t5an 02, yau hava met the intent of 5BC G006(c}r. To utiiized the total envelope systo-:n method, the values-estabiishad 6y the sum of items s3 and 14 sha11 noi be gre=_ter than the sum of ite.?s 3i and a2. ?• ?.5 1,75 + 2. 2$.ZR 3. 1?t\.o5 + a. ZO???f = Z11.93 MAT°..3IdLS Merm. 3esistance "R" tl,Yt. 2= ?= Ai+ Sla]..^.gAat2ri31 ?. Sheathing 314" 5- Insula:iaa SO Sheetrock Y .58 Interiar Air .(e\ Studs 2N. .L 81 Ri1a i `R q Conc. Blks. ?? ' ' "=' = • -• a ? ? - . :_ `: a ' c=' S = C=r-=-- , _ ,_•v-:,._ ,:_ .:... - n.6a 26 ? .? U. 5. SIOit?! G •GZ . 6. ze': 2=:c= a_ -' : • : 0.1; . a_ ? . ' . . . U - .o-?.. 1. xata=ie- a?r `•'?a o.sa'. 2. ?y 41 ?3r3 . .4? 3.. co" ZN?u.1_ 1?•? 4.?1"[?'thEIZ?M?Y.._. _ `• `/ 5. ot DINCi •?2 0.i7 Tota1 1• Snt_==°= 3:= ejlm 0 fi.Si 2? 2. ?iS S U L n"? t?•? -IM 5. ?oIUG •G'Z. 6. Ex'.er_or ti= fi2= 0.17 . . To?. * a0.36 - ? . ? U= - • 1. xate:'_o= air fi? • o. 6s Z. 1 R1G1D { I Cfz? r 3 . - • • a. j,?' GoriC n?.ocfc l.Z 5. ? S. r':c:e'iar a?: :iLn • 0.17 'so ta1 • '7 , i3 , . , ' ? : : • ?c ;?c : GTf 'GSADE • ? • i ? . ?1'i?/If ? ?t •• ? • •?? • •?et ?? % ?? : ? ? . . ?' ?(( • . • , 1 /l! . . . . tr? - ; • ar. ? , ? r. ? ? ? ff . . • : • ?. I ? ` rr ? - . ..- ?, . . rxc. 14 !!I ¢ ? • ° ' = ?IG_ 13 • • . . • L! s+ 7 +? ? ? /I( = IC( 's l/t ? ' :.tdiC3:2 77-E• ww" Ydl"uGr dLzr? i^.C { ? ? ? ? , ? -?? ` I ? i.IIIC-C=.^.- C= ?:.3L•?3LC'. • ? . ? • ?„ -? ? ? _._ . • Wnt.t. ::r.r•?:;;;:.^. ' ?:r1St 01 t•l?nt nil7 v,111 nCVA fur , •(:.11Y: CGIsLITUCt lun ---? .. . ?? ? i . • ;t ' • ?? . FiC. A2 ? i / . ? ; L? f'L1 .. ? Sui S _, ? <f:'-_??•. ? .?ICiI :•: • A -y?. ? . ?`???•: ? ?? • ° 'o' !y? ? r i ? ? t . ? / \ . ' i - -- ---? ? -_"--? ^ fi .?L _? . ---- ? \. , •?------0 . ?•, _ .. ??y • _.?•r. ?10 OD-' t--l? t' Cauytrur? i:,., 1:.'r.itu•:. ,. ,ax'4'5 6. U.I7 ;?,?.?? v= 058 ----------nyGif 1. Intrrlt,c air 'ill?? 7. r_•'^r-"-"---- - ._?... a. ------_•- ... .•-----•?•-..r-. 5: _•-•••Y._ . . 6. Extcriur air lill.t Tu111-- 1. 3ntcriar oic_film ...---.__.-•_?,fi9 2. ----._.. ._.. _. ----- J. -'-------- •.__------_.?_..-' 4. -------•----...-- -•_-------- 5. 5, gxtcrinr air iilm ??_>> ' ?1'otal. ` L. tntieli•,c_,,Ir.[l.ln-•---•---•-•_.n.Gn 2. •'----'--- ' • •--._. _ . _...._.. _...•-•- • l. _.__..._...__. .. _ _. ... .-•.-----_?._ a. •-•--•--••-------....__?._?_...?? O.17 ,__._.__.__._..-- -••Ta-u?ti --+ . ,! STJU? lltl ?:ItnOt: • ' • ' ? ?t • . ? 4'? ? .?..? r? _ i . 7i?Zi !l?FIL. BA III ?• '? /: I! f i c• ia, - 1 . ? • !t[ /t?_ .?.-?'' ? i„ ? ? y •'? ? _ - , indi?:et,, ly' .. •q?• :e!ua, deuGh 6nti ? t , _?_ ? . L'n'Il: • . ? ' , F1'fGPY1t]4 OF PIG. bl . VuiL' HALI. ?.r, t . . , • , PL?A Q = ? Lt?,IS.4 L F i , WAL.L .4ZEA - e07 - ?uLL:.I ; t43 x g = ,r2l f :7 - ? i ?tH -146 x J ' (46 B LJG(? ; S z,c,c. -Ebo f- .cg = I So.`?w 4at74 -F i ? ?. ' ? ?--?•? PU L L I,4b ?r, , ? r . • V V 1ZtM: `:??v?S Z-?-??• = 14? WA! L, t3Lock `, f?, `? X, S = 7 5-3 3 x S \A = 83?• , t ,n , . ?.: ??: ,. : W DxiS ? 4149=4= :' 'Zfl(C?= ~s _ Z 9. 3 CEi Liu4 Z S. ? : : 2?3G = Z = ! o . ??f3ds ?' ZS ?l76? 3? I Z. 5 • '3 lwa8 4p z 1700?5 rn Z? ?--- z= Ii'I o _ DrzS . II ? ?. . .'? , ? „• , - ?-.._ . " , , • . ? . . :? ?Cad t , ? ; ??-O . ?'ssC fl.nv ? . . ??aL tlav up • • , . ' • , •• . . TC. dE.:. -_ . _ • . ri .S 1 ri ?l 1 . ' -. -, . ? t Gcee'o_ 1. ?Iats-t_- aj- 2. - 5?' /?(r 4_ E:2- r?D _ a-Vs1ttc 0.61 .cQ - ? :oc.L 2Z s?.g ' - ? - . - , . . •? t3= :otia . 1_ Intcrior air Fti.? ? 0.61 Z 3_ zzy ru?L ? ??s 4. Extc:ior ai: fil? (s::l oi . . . To ta1 2 - ?C, t . . ' • • .U = . ? 'vcri er? tox.?rr?c . . . ],_ Insidc air filtn . 0.61 2. • 3. ' 4 . S. Gtits:de air f?m 0.17 Tota1 Snsic'c air t'_lm 2 . 3. ' • , 4. 5? Lvtside air E=a= 0.1 Total . • ' . 1. 2nsicrc air tilm . 0.6? . . 2. ' 3_ . . , • a_ 5. G?tsidc air E3La a., . To?a7. . ' ' ? s.veatnd , ?. . . . . , , . . , - 1 0 • :9 ?,,,¢,:.?. . . • %% I •Z'?, p?y? . . , ... • .. • ? t--o .?-o ?-? ? - • . ? , ' - ' ?., . • •. ttotc Uaa additierul. s`+eats i: ra=i ?? . . • ? j{('?i.i-tiL :? • • , ? ? .S4L•c3LtI SC= t1eCS12+ S8L1 GS?C3_St- ?• ? ? .. . . . . • • ? . . - • 2iuL . • . . ?• 11.cv c-r, • .. • ? . - . . . • • ' -. . s' • ' • ' ?It,? t7 ' ? . . , • ? . ? ? . ? . ---•. -.?_? -- -- rk4a,a xL,- /ooa Ti,ea36c/oo ,4 a PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMES AND CONDOS WHEN PERMITS ARE REQUIltED FOR EACH UN1T. ATEW CONSTRUCTION r7 ADD-ON A/C ADL`-CLv FUR?tiACE FIltEPLACE INSERT DATE _/ 4*& FEES I-IVAC: 0-100 M BTU $ 24.00 ADDITIONAL 50 M BTU 6.00 GAS OUTLETS (MINIMUM 1@ S3.oo EACH) ADD-ON/REMODEL (Exis'i'tNG CoNSTRUCi'ioN) STATE SURCHARGE TOTAL Zd, s-0 a SITE ADDRESS: 5?/ 2 4 /.Z?i+?i?ayG?/?.?,,,?- ?t/,? OWIVER NAME: 1&4 COPF- TELEPHONE #: y.ry - 9Z? INSTALLER: 1410V?6,fG ,f?sfdrf.r?JG• ? ADDRESS: CTTY: ??-? STATE: /?J?? ZIP CODE: / 2-'Z ? TELEPHONE #: 2--tAer_r_ X/GNA?'A7?RE10F PERMITTEE?r 2_fr 1994 MECHANICAL PERMIT (RESIDENTIAL) #- 7,769 CITY OF EAGAN ?- 3830 PILOT KNOB RD EAGAN MN 55122 (612) 6814675 PLEASE COMPLETE FOR ALL COMbERCIALlINDUSTRIAL BUII,DINGS. ALSO COMPLETE FOR APARTMENT BUILDINGS OR OTHER MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT. DATE: NEW BUILDING INTERIOR IMPROVEMENT WORK DESCRIPTION: CONTRACT PRICE: $ FEES 1% OF g?t"M FEE $ PROCESSED PIPING: $25.00 MINIMUM FEE: $25.00 STATE SURCHARGE $.50 FOR EACH $1,000 OF E?RFEE. ,a,,... TOTAL $ SIT'E ADDRESS: OWNER NAME: TELEPHONE #: TENANT NAME: (IIvIPROVEMENTS oNLY) INST ADDRESS: Crry: STATE: ZIP CODE: TELEPHONE SIGNATURE OF PERMITTEE CITY INSPECTOR 1994 MECAANICAL PERMIT (COMMERCIAL) CITY OF EAGAN 3830 PII.OT KNOB RD EAGAN MN 55122 (612) 6814675 , . ? - - Smelorf ts 6(a?ficate SURVEY FOR: Pront icr Piidwcst Ilrnnes Corp. -??? DESGRIBED ASi s.?nrroan i?r?ncr , ` pENN,, QI?VANI A?v?. -{-- . City of Gagatt, Ilakota (;oimty i!a? 7 Piinnesotn and resciving ? ,p=21e?. c.'scmcnts of recorcL M .. ?ll ?•. i ?. , , ?•? / m Im ... ? ? .. -a.o I e Gar yn.3 a = 20000 ! _? . llz 9 rv, io ? So?n• lecah?.,? ?? '1 5 ? - ? __...- _. _30 ? 971.5 I tb_ T ' ` 1 f ? 5C_ M M ? ? M Prepased N Spl?{-E..i^•? N , 'o ao -o-- "° 1 i .?J? 1 2?9 , 0 91A.i m•n r -1?an ? N? 0 1 _ <o l N ? 1 ?-- 2 w ' ., CP N .?)."S?:•,,,,;;/9`;; l:l??t T 1 ? f ` s l P•R•V. RE IREO . ? ? PROPOSED EIEVATiON5 iop of foundafiOn .qZ1.5 Garopa Fionr .9t1. 1 Basamanf fioor .6918.3 Apprem. Sewer Ssrvics Elev.. 9o0.qt Propossd Elsvatiens ? O Exisl{nq Elsvollons Droinapa Direetlone ..,,.._. Deaotas Ofhsl SlaNe I O lifEaLuNo P/anninp Engirraering Surveying aei e..r nee?+M„„ n...", o.hw., aw».a. eS.oe n?N+,.?.??neserh ?; • 8 • \ ? BENCHMARK, ' ? ` Tep H.! Hyd, nc 1 MIN.SF.TBqCK REOIREMENiS . ? 1 Front - 30 House Slde - 16 Raar - %5 6oraqe Sld* -? SCAIE: t IneA e 30 Fest o.. i Mreby cerllly Ihol Ihp iurvoy. Plan « r9oorl res vnoerte ey rrH I JOB 110 : er undn my dlncl ruMrvblon mA IAOI 1 em a doly Rr0lslved e$(Z-5Z0 Lene surverw uneu tne iewI ef tM 91atr sf Mlnnesete. BOON: a , va ?. ?.t)'- ?FAGE: Je1 vY U . n n, coM• Nl1B 1- ?? D O m z 0 4D W A N sutrqorfs eertificate s SURVEY FOR: Frontier Alidwest Ilomes Corp. ----- '"? DESCRIBEO AS: t,ot zs, Biock 1, s'rnrroaoPlAce;" Ci.ty of Iiagan, Dakota County 9!?I? 7 0 Kinnesota ancl reserving ` ,8 =21 ep0. .. R=pp000 ? ' 91? 9 easements of record. ??g•2, e APP„'' a ?t--=- ? - Sum?a loc ?a?..nS? ? '? 5 . , .,. ?..?- ? '0 Gar l ? T ' 6 9121.5 ,?a . . w g „, M s c M ` M ? P??eS?d ? 1 !e 90 i? ' ? ? 9m. ' o j 9,.3 -av ?• r 1 ??• N O f - ao 1 ',4 1 1 .ow 1 '. oi ? ate ° ? • ^}??AN El`vG NEERIIlTG D? T jl 1 1 ? : p? ? M • O e.? 6 ?qX. R` IREb qS2 \ \ \ ? \ i ? ' s 89 s•SA \ ?. ;. PROPO5ED ELEVATIONS Top of foundation ¦qz1.5 Garoqe Floor 89zt, 1 6osemenf Ftoor .69 ig.3 Approx. Sewer Ssrvice Elev. • y00,9? Proposed Elevaliane EMisNnp Elevatfom Drainape Direcrlone r..,..._? Demotee Otfeet 31aMe . O "• ' ? ? , i2. SCAIE: 11'neh = 30 Feef 1 1 1 ? 6ENCHMARK, t \abuh+Md? ac } < =9to.?7 MIN. SETBACK REOIREMENT3 ? Front - 30 Hou11e 81de - \ Reoe - %5 L3orapa3lds-!5, I MroDy eorllty that IMs wrveY, plan er nPorl weN PrOPand Uy mg J08 NO.: /?'ED?L?'!ND or unAn mr dirael SuperrISlan enA Ihof ! am o duty R09I2IareA $$(Z-?j20 Lend 9urroya uneor Ihe lars of Me 9fate ef Mlnoesela. BOON: P/enning Englneenng Swveying IlOIWIlb'milnylaninvw OI?uplpn.Mlm?qbSHiO ? ?w.q?.xitawe? t0, 4 1 94 PAGE: JM r y . n so. Ucsm• 1 14lT8 Surve?or?s G'ert??'?cate SURVEY FOR: Frontier Alidwest Ilomes Corp -"4-- .saN.m:a,. DESCRIBED AS: ' lp?NI?(? Q VAN? A` A Lot 25 , uiock i, sTnrroao niAcE; ? r 3 City of Eagan, Iklkota County q±•°& ? Minunesota and reserving ?. ,p_ Z??pp• easements of record. 91 8.z, , p ? ? I i r ? I ? t9 1 ? 2i.o ? 4?. zo w IL' 1 ?Gar 1?t ? 'l I ,•. ? i-? ?.. ? `•1 ? 952 PROPOSED ELEVATIONS M M ? f 9n. O i' R=2ODd? ?\9-9 bca?'w+?? ?? '? 5 ?-55-,- 30 o-?o • .. ,4 : ,o 0 M 1 T m ?L M ? / ? ? P?epased N ? N ? 46 90 ` o-- .S ? 70.8 97?. h °o r 9?.3 -az.,? N 0 ao . N ? j r ? ? 1 ! i r s? . . ? \ ? . ? ? ? iop of Foundation .q'+-1,5 Qorape Floor .91t. 1 Baeemenf Floor i-9183 Approz. Sewer Service Elev.. 900.9} Propossd Elevalions 0 O ErieNnp Elevatlons ? Droinoqe Olrecllons ? ....Y. Oenotee Offyef SluMe . a iiEDL unro Planning EnglneeNng Sur?reyirtg M1l-0 l?Mbnliww?l. ?ynxq?an.MMiwM?99?f0 IN?qa?rplhpMlOtM ?- ? 3CAlE: 11neh = 30 Fesf 1 1 1 1 11 Z ' 1 A W ?-?? o , --, 1 '° ' f %J 1 l 1 ? 1 1 l 1 1 ? BENCHMARKI 1 \ 1 MIN. SETBACK REOIREMENTS ? Front ^ 3e Howa Slds -11 \; Rebs - 15 6araqeSlde-!41_ I henby qrfllY that IMs survq. Plon er reparl wes prepand by me JOB NO.; or under my dlNel superWslon ond Ihol i em e euly Rephtmd $BIZ• 15 20 land 8urroror Vndv IM lewa of tM 9taN of Mlnnuofa. BOOK: Oale: 10, 4 i 44 PA6E: Jef r y n on, Ucsns• 14378 PERMIT City of Eagan Permit Type:Building Permit Number:EA116692 Date Issued:10/10/2013 Permit Category:ePermit Site Address: 4126 Pennsylvania Ave Lot:25 Block: 1 Addition: Stafford Place PID:10-72500-01-250 Use: Description: Sub Type:Reroof & Windows/Doors 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. Windows/Doors: If altering the opening size, a framing inspection is required. Fee Summary:BL - Base Fee $8K $162.25 0801.4085 Surcharge - Based on Valuation $8K $4.00 9001.2195 $166.25 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 - Bryan Staerkel 4126 Pennsylvania Ave Eagan MN 55123 (612) 723-6345 Gates General Contractors, Inc 3500 Vicksburg Lane North, Suite 400-351 Plymouth MN 55447 (763) 550-0043 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA120509 Date Issued:02/18/2014 Permit Category:ePermit Site Address: 4126 Pennsylvania Ave Lot:25 Block: 1 Addition: Stafford Place PID:10-72500-01-250 Use: Description: Sub Type:Residential Work Type:Replace Description:Furnace Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952) 445-2840. Holly Flood 1408 Northland Dr #310 Fee Summary:ME - Permit Fee (Replacements)$55.00 0801.4088 Surcharge-Fixed $5.00 9001.2195 $60.00 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 - Bryan Staerkel 4126 Pennsylvania Ave Eagan MN 55123 Sedgwick Heating & Air Conditioning 1408 Northland Drive, Suite 310 Mendota Heights MN 55120 (952) 881-9000 Applicant/Permitee: Signature Issued By: Signature SEDGWICK HEATING & AIR CONDITIONING CO. HEATING JOB NO. 1408 NORTHLLAND DRIVE, SUITE 310 • MENDOTA HEIGHTS, MN 55120 • (952) 881-9000 TEST RECORD Av) ADDRESS ~ 4o a CITY OCCUPANT OWNER J ^1 r~~~-• SOLD BY INSTALLED BY MAKE MODEL S ~r SERIAL NO.~ INPUT L~ ~ A f/ THERMOST'A;T..D--L ► V im" , VENT SIZE VALVE `~f ~_l~d.SL!►~`:~ TYPE OF LINERS LIMIT LINER SIZE LIMIT SETTING FILTERS: SIZE t ILI NUMBER FAN SETTING WIRING PILOT TYPE TEST TAG IGNITION MODEL LIGHTING INST. PILOT TIMING 4 vi- / y DATE TESTED l ' ) PRESSURE PERCENT CO, ! L • r COMPANY TESTING INPUT CF PERCENT 02 'T O STACK TEMP. PERCENT CO 0 ~~dl^ NAME OF TESTER LVV' FORM 235 (REV. 10/10) FORM DISTRIBUTION: WHITE COPY - JOB FILE YELLOW COPY - CITY PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA129694 Date Issued:03/06/2015 Permit Category:ePermit Site Address: 4126 Pennsylvania Ave Lot:25 Block: 1 Addition: Stafford Place PID:10-72500-01-250 Use: Description: Sub Type:Residential Work Type:Replace Description:Water Heater Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection. Applicant: Troy Good 3670 Dodd Rd Eagan, MN 55123 Fee Summary:PL - Permit Fee (WS &/or WH)$55.00 0801.4087 Surcharge-Fixed $5.00 9001.2195 $60.00 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 - Bryan Staerkel 4126 Pennsylvania Ave Eagan MN 55123 (920) 205-6433 Champion Plumbing 3670 Dodd Rd., #100 Eagan MN 55123 (651) 365-1340 Applicant/Permitee: Signature Issued By: Signature