4142 Pennsylvania AveINSPECTION REC4RD
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date lssued:
(612) 661-4675
SITE ADDRESS: NhiSYI:VARi]
STFIFPOFtii PI.ACf
21 HlOCK
AIfF
, APPLICANT:
(hl,z) bftEi
PERMIT SUBTYPE:
TYPE OF WORK:
INSPECTION D. . ..
?
?
Permit No. PermR Holder Date Telephone #
ELECTRIC
PLUMBING
HVAC
loapection Date Inap. Comments
FOOTINGS
FOUND
FRAMING
flOOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
'
GAS SVC
TEST
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST
FiNAL PLBG
FlNAL HTG
ORSAT
TEST
BLDG FINAL
BSMT R.I. ?
Ge7
/?
BSMTFINAL 17
QECK FTG
DECK FINAL
'- INSPECTI4N RECORD
CITY OF EAGAN PERMIT TYPE:
3830 Pi1ot Knob Road Permit Number
Eagan, Minnesota 55122-1897 Date Issued:
(651) 681-4675 `
SITE ADDRESS:
Iti1 : ,'l itl.111;p ;
. . ? . i + i? ? . . . I '`I f1 P4 1 /1 fl'./ t.
PERMIT SUBTYPE:
F?F.MARK':#: P l.ilht RF1J11 t-0"1'1
! . , . I ; t" f M ItY ? PAT1;
i t I . ,iii 1 , . t+ItO
1, VACTYI
, ???• •,?
F- . ;
APPLICANT:
TYPE OF WORK:
t ?' 1' !?, i!' f( r114
A 1. ir i,A t a
tlA I tliri?tild
?
?? ?r ?
??
xt?}'x+ .. ? n
-1?
Permit Haider Date Telephone #
SEWER/
WATER
PLUMDING
HVAC
fnspectlon Date Irrsp. Comments
FOO7INGS
FOUND
FRAMING
AOOFING
ROUGH
PLUM8ING
??• ZTA?Pj
PLBG
AIR 7EST
HEOATING ?I'Z7•?
GAS SVC
TEST
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
DdMESTIC
METER
IRRIGATION
ME7ER
FLUSH
MAINS
CONDUCTIVITY
TEST
HY6ROSTATIC
TEST
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
? .- , . INSPECTIaN RECURD ?
CIV OF EAGAN REAcnVAiED FbR DEGIC 05/04/93 PERMIT TYPE:
3830 Pilot Knob Road FiTtvRE BIDG Sr51IIM 934-0756 Permit Number:
Eagan, Minnesota 55123 Date Issued:
(812) 681-4675
SITE ADDRESS: LOr, 21 "i n11.4;1 APPLICANT:
4142 PENN9YLVANTA At/E tiEAOUNAL 8LC1RS ING
sTAUF(}Rtl ntACF (s1.') 464-6971
PERMIT SUBTYPE:
. r u??tTYPE OF WORK:
Control No.
?
m
RPMARK%: R?Ct? li•t # REiiEMCY pLBO. ..
.
Permft No. PermR Holder pota Tslephons A
SNV
PLUMBING f 8 _
HVAC
ELECTRIC
ELECTRIC
Mupwtion DaUe hisp. Commsrdt
Footlngsl
Foundation
Framing
Roolin9
Roug?, Plbg.
Rough Htg- ?y 9; ft? sloo, 9-?
Mul.
`
?replace
Final Hbp.
Orsat Teat
Flnal Plbg. Pfbg. Irqpector - Notity Plumb6r
Carrst. Meter
EngrJPien
eidg. Final z? ? ?• ? O?g? ??S corru???as
°ec* Fig.
Deck Flnal
YVell
Pr. Oisp.
V
a. ,. • ?
(Ur#if trate of (Orrupanry
titp of (tagan
lorpcrbmd of sdIdiag jwprtimt
T hts CertiJrcate issued pursuant to the requinenrents ojSeclion 306 of !he Unlfonre Brdlding
Cnde certifying tlrat at the tbme of issuance this straclure wrrs in rnmpliaxce w*h the Harious
orduwnces ojthe City regulating building conshuction or use- For the following.
ux cwewmo•oa SF DWG?GAR aug. n,a;e 14M 127
0="m' T)M - /N41 Zoming nbb;a R 1 'lyp camr VN
ow-wa e..c RA90[Mi, E1iTIL?S ING' Add= 4580 9001T TRAIL, EAC,EIN
?r v? _ :?._ 5/20/92
i
POST IN A CONSPICUOUS PLACE
- ? ..
.,0 8117?.?i??
r, rlequest Date -
I 'Z Fire flough-in Inspepqn
Hepuire0?
1'?ieatly Now ? Will Notify Inspector
R
d
?
W?
G Yes - No en
ee
Y
Ity licensed contractor ? owner hereby request inspection of above electrical work at:
Job Atltlress ISlreel. 8oK or Route No.) Ciy
I`l a- pcn.e s? Van. + e-sr ii,0
Section No. Township Name or No. Range No. Cn?uny-• L /
OccuOant(PRINT) - Phone No.
?
c N
C
Power Supp08r Aaaress
Elech al ConVactor (COmpany Name) Corihadw5 License No.
/•! l? ? - L c1-+'r c
Maiiing qoaress (Convactor or Owner Makin Installation?
Au?Ywri ignaWre ICO? actorlOwner Making Inslallation) PM1ane Number
MINNESOTA STATE BOARD OF ELECTHIQTV ? THIS INSPECTION REQUEST WILL NOT
Griggs-Mltlway 810g. - Room 5193 BE ACGEPTED BYTHE STATE BOAflD
1821 University Ave., 51. Paul. MN 551pC UNLESS PROPER INSPEGTION FEE I$
Phone(61P) 64I4800 ENCLOSEO.
REQUEST FOR ELECTRICAL INSPECTION ?01"•`?°??"?.R_.ee 00001 -0e
_ ? See Insimc0ons lor com0letinA fiis torm on back 01 yellow copy. 7-?,96,2-50
J 0 81 1 Y "X" Be/ow Work Covered 6y This Request 'EF IVVI
ew Add Fiep: TypeoiBuilding AppliancesWired EquipmentWired
x Home Range Temporary Service
Duplex Water Heater Electnc Heating
Apl Building Dryer Other (Speciy)
Comm./lndustrial Fumace
Farm Air Conditioner
Otner (spxiy) nvaaor§ Ramarksi
Compute Mspection Fee Be/ow:
# . Olher Fee # ServiceEntranceSize Fee # Circuits/Feeders Fee
Swimming Pool 0 to 200 Amps / 0 to 100 A s
Transformers Ahove 200 _ Amps Ahove 100 Amps
Signs Inspemor5 Use Only: ' 7pTAL
Irrigation Booms /? S. ?
Special Inspection ?
Alarm/COmmunication THIS INSTALLATION MAY BE ORD ISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONTHS.
I, the Electrical Inspector, hereby Rough-in { Dete
certify that the above inspection has
been made. Final oe?e-
OFFICE USE ONLV
This repuest witl IB months Irom
J 331 91 !?(I s ?,B ? ?.? ?? ?3 yZ
Request Da e ?
Q
?I Fire No.
• Rougy-in Ins i
qea etl?
? Yes G No
? Reatly NOw 5411 Nafily Inspector
When Reedy?
I? licensed contractor ? owner hereby request inspection of above electrical work at:
Job Addre (St t. x or RpWe Noj ?
N City
Seclion No. TownsM1ip Name or No. T R,,ge No. Counry
OCCUPant INTI f 6J . Phono.
Power 5 'ern
I ? .. ? : Atltlra
EI t- ai Conva or (COmp y Nama?
ee Co tra ? §'c
ma in dtlr s( on acmr r Owner Making Insla alionj
Aulh nze0 Sign Wre IGOnV ctor;
0 ner Making Insl l 'on) I
P o
j?u r_ /
V J
MINNEAOTA STATE BOARD OF ELECTNOIV THIS INSPECTION REOUEST WILL NOT
Grigga-Mitlway 61tlg. - Foom 5-193 BE ACCEPTEO BY THE STPTE BOAflD
1821 ONVersity Ave., 51. Peul, MN 55106 UNLESS PROPER INSPECTION PEE IS
Phone(81I)6CY-0800 ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION
tl? See instmMions lor complating th15 brm on back oi yellow copy.
"X" Below Work Cover?d by This Request
esooooi-os
?° ?3i sS3
0
e dtl Rep. Typeofeuilding AppliancresWired EquipmeniWired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apc Building ryer Other (Specify)
Comm./Industrial FumaCe
Farm Air Conditloner
amer (syeciy) Convecmrg Remerks:
Compute Inspecfian Fee Below:
# - Other Fee # ServiceEnlrance5ize F e # Circuits/Feetlers Pee
Swimming Pool 0 to 200 Amps 14 0 ta 100 Amps
Transformers Ahove 200 _ Amps Above 700 _ Amps
SignS Inspector5 Use Omy: 7Q qIL
Irrigation Booms
Special Inspection
Alarm/Communication TNIS INSTALLATION MAY BF, D CQNNECTED IF NOT
Other Fee COMPLETED WITHIN 18 ONEHS.
I, the Electrical InspeCtor, hereby Rouqmm
r?
certiry that the above inspection has
been made. F,,,ai ( Date ?
OFFICE USE ONLY
This request voitl 18 moMM1S 1mm
Addresa: 4'142 PE[3ISYLVAPIIA AVEN[TE Lot 21 Blk I Sec/Sub gTAFFpRp pLArE
These items were/were not completa at the time of the final inspection.
Date: 5 q Yes No
Final grada (6" from siding) ?
Permanent steps - garage ?
Permanent steps - main entry ?
Permanent driveway ?
Permanent gas /
Sod/seeded grass /
Trail/curb damage
Porch (
Basement finish
Deck
Pleasa verify vith the buildax the removal of roo£ test caps fcom tha plumbing
system and the shut-off of water supply to the outsida lawn £aucet before
freeze potential exists. ?
ncmEOwu
White - City copy Yellow - Resident copy Pink.- Contractor copy
ccoU?t
2007 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan NIN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New ConsW ction Reauirements
3 regislered sife surveys shaxing sq. ft of lot, sq. ft d hause; and all roofed areas
(20%maximum lot coverage ellowed)
1 Soils Rpport'rf proposed buildmg is to be placed on tlisWrbed sal
2 copes of plan shmving beam 6 vrindovr sizes; poured found design, etc.
1 ut of Energy Calwlations
3 copies of Tree Presarvafion Plan if IM platted after 71153
Rim Joisf DeWil Optlons selecdon sheet (6uAdings wAh 3 or legs unils)
Mmnegasco mediamcal veftUlation tortn
Remodd7Reoair Reawrements
2 capies of pWn showinq foofings, beams, joists
1 set of Energy Calcula6ons fa heated addi6ons
1 site survey hr adtli6ons 8 tlecks
Adtlitlon-indicate if on-sife septlc system
A NEW BUILDING
Planc arr± rnnsidPred nuhlic infnrmation unless vou state thev are trade secret and the reason.
Date 10 l zZ
Site Address A/ l 07
Z PG N A1$ Construction Cost 660 000 C?
y4 V'u n'A tq a.e UniUSte #
Description of Work 4 e/L?C
Multi-Family Bldg _ Y?d N Fireplace(s) _ 0 _ 1 _ 2
Property Owner M R L F A I U s ^ Telephone # ( &S/
Contracror
Address 77
State ?}1hqn D3 zQ l-s iod
J ?JV? City
ZiP !5S/23 Tetephonek(6/2_) 36e!?_.4??
COMPLETE THIS AREA ONLY IF
Energy Code Category - Minnesota Rules 7670 Cateeorv 1
• Resitlential Ventilation Category 1 Worksheet
(4 submission type) Submitled
• Energy Envebpe Calculations SuCmitled
Minnesota Rules 7672
. New Energy Code Warksheet
Submitted
In the last 12 months, has ihe CiTy of Eagan issued a permiT for a similar plan based on a master plan?
_ Y _ N If yes, date and address of master plan:
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
I herebv annlv for a Residential Buildine
Telephone # (
Telephone # (
Telephone # (
co
C?
INfice Use Onlv
CeiiofSurveyRecd' _Y _N
SoilSReport , _Y _N
TreB Pres Plan Recd. _ Y _ N.
TreePres Required-" Y 'N
On-site5ephc5ystem _Y rrN
that the information is
that the work will be in conformance with the ordinances and codes of the City of Eagan
Statutes; I understand this is not a permit, but only an application for a permit, and work '
permit; that the work will be in accordance with the approved plan in the case of work wh ch
approval of plans. F?
[ete ana accurate;
the State of MN
to start without a
iires a review and
?GI4 (J E/?'YhiOr??
Applicant's Printed Name
DO NOT WRITE BELOW THIS LINE
Sub Tvqes
? 01 Foundation ? 07 OS-plex ? 13 16-plex ? 20 Pool ?
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ?
? 03 01 of_plex ? 09 07-plex ? 17 Garage ? 22 PorchlAddn. (4-sea.) ?
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo/pergola) ?
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
O 06 04-plex ? 12 12-plex ? 25 Miscellaneous
Work TYPes
? 31 New
? 32 Addition
? 33 Alteration
? 34 Replacement
D0SC1'IDtlOt1: WaterDamage
Valuation
Plan Review
Census Code
SAC Units
# of Units
# of Bldgs
Type of Const
100% or
_ Footings (new bldg)
_ Footings (deck)
_ Footings (addition)
Founda[ion
Drain Tile
Roof Ice & Water Final
_ Framing
_ Fireplace _ R.I. _ Air Test _ Final
_ Insulation
Occupancy MCES System
Zoning City Water
Stories Booster Pump
Sq. Ft. PFtV
Length Fire Sprinklered
Width
REQUIRED INSPECTIONS
_ Sheetrock
FinaVC.O.
Final/No C.O.
HVAC
Other
Pool Ftgs Air/Gas Tests Final
- _ Siding _ Stucco Lath _ Stone Lath _Bcick
Windows
_ Retaining Wall
Approved By: . Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Tatal
30 Accessory Bldg
31 Ext. Alt - Multi
33 Ext. Alf - SF
36 Multi Misc. ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 36 Move Building ? 42 Demolish Foundation ? AS Fire Repair
? 37 Demolish Building` ? 43 Reroof ? 46 WindowslDoors
-pemolition (Entlre Bidg) - Give PCA handout to applicant -
Yes
25%
PERMIT# ';?D Fs- '
RECEIPT DATE:
EOOE WISID$NT1AL PLUM$INF PERM1T APPLIClETIOft
crrY oF F-AsM
3$30 P1LOT KAOB iiD
F-ASAN, SfA 55122
651-6$7-4695
Please complete for: single family dwellings, townhomes and condos when permits are required for each unit,
backflow preventer for irrigation system
SITEADDRESS: I/ l?
OWNER NAME: :
INSTALLER NAME: ?
STREET ADDRESS:
CITY:
STATE:
ZIP:
_ SEPTIC SYSTEM, newlrefurbished (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:
_ Adding fixtures to lower levels or room additions, excluding water softeners and water heaters. $ 50.00
_ Abandonment of septic system.
_ Water turnaround - existing dwelling unit (+ 5/8" meter if needed -$118)
Other:
RPZ: new installation/repair/rebuild $ 30.00
? lawn irrigation system
ReplacemenUadditional: _ water softener _ water heater $ 15.00
State Surcharge $ .50
Y 9 2002
Total
I hereby acknowledge that I have read this application, state that the information is correct, and agree to?inply wi a p ica e` i o agan ordinances. tt
is the applicanPs responsibility to notify the propeRy owner that the City of Eagan assume o li ility r any d ag caused b he City during its normal
operational and maintenance activities to tha hacilities consUucted under this permit ? ght- ay/easement
SIGNA URE OF PERMITTEE 1/02
TELEPHONE#: 6 -Y I Gw 6 9 SS
(AREA CODE) TELEPHONE #:
(AREA CODE)
'( .• RESIDENTIAL
BUILDING PERMIT APPLICATION
? CITY OF EAGAN
?a 3830 PILOT KNOB RD, EACAN MN 55122
651•681•9675
Naw Constructlan Reauirements
• 3 registered site surveys showing sq. ft. of lot sq. fl. of house; and all roofed areas
(20°k maximum lot coverage allowed)
. 2 copies of plan showirng 6eam 8 window sizes; poured found design, etc.)
• 1 set ot Energy Calculations
• 3 copies otTree Preservation Plan if lot platted after 7/1/93
• Rim Joist Detail Options sHection sheet (bidgs with 3 or less units)
DATE
SITE ADDRESS ?
TYPE OF WORK-4
APPLICANT 2-A
STREET ADDRE55'?
TELEPHONE ?
PROPERTY OWNER
JSV41%TATE4 ZIP?
F A X # 9S -c)- '"'±- ',7 l /
TELEPHONE# 6.5`/-
COMPLETE THIS SECTION FOR KNEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ ]IIN,\LSU'PA RI1Lh:S 7670 CA'CEGURY 1 MIVNL:SOT:\ RLiI.I:S 7672
(J submission type) . Residential Ventilation Category 1 Worksheet Submitted • New Energy Code Worksheet Submitted
• Energy Envelope Calculalions Submitted
Plumbing Contractor:
Plwnbing systcm includcs:
Mechanical Contractor:
Ylcch.mical syslciu includcs:
Sewer/Water Contractor:
Watcr Sottcncr
_ Watcr Hcater
_ No, of Badis
Air Conditioning
I-[cat Rccovcry S}s(cm
Pcc: $70.00
Phone #
------------°-------° ----- °----° ° -----------°- ° °----------------° °-°---°-------° ---° ---- °-----------°-----
I hereby acknowtedge that I have read this application, staTe that the information is correct, and agree to comply
with oll applicable State of Minnesota Statutes and City of Eagan Ordiqanc?es.
Slgnature of Applicant
OFFICE USE ONLY
Certificates of Survey Received _
Tree Preservation Plan Received _ Not Required _
as
RemodellRenair Reauirements
• 2 copies of plan
• 1 set of Energy CalculaGons forheated additions
• 1 site survey forextenor ad0itions 8 decks
. Indicate if home served by septic system for atlditions
VALUATION2 ??- tj
_ Phonc #
I.1rhi Sprinkler
No. of R.I. 13aths
Phone #
Fce: $90.00
Updated 4/02
OFFICE USE ONLY ?
? 01 Foundation ? 07 OS-plex ? 73 16-piex ? 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 (screened) ? 36 Multi
? OS 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 (Bidg)' ? 43 Reroof ? 46 WindowslDoors
? 34 Replacement *Demolition (Entire Bldg only) - Give PCA handout to applicant
Valuation Occupancy MClES System
Census Code Zcning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr, of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footings (new bldg) _ FinaVC.O.
_ Footings (deck) _ FinaVNo C.O.
_ Foo[ings (addition) _ Plumbing
Foundation HVAC
Drain Tile Other
Roof Ice & Water Final Pool _ Ftgs _ AidGas Tests _ Final
_ Framing _ Siding Stucco Stone
R.I.
Fireplace Air Test _ Final _ Windows (new/replacement)
_
_
_
Insulation _ Retaining Wall
Approved By
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S&W Permit & Surcharge
Treatment Ptant
Plumbing Permit
Mechanical Permit
License Search
Capies
Other
Total
Building Inspector
INSPECTION RECORD I C°n °"° 0229
CITY OF EAGAN PERMITTYPE: euiLoiNG
3830 Pilot Knob Road Permit Number: 000127
Eagan, Minnesota 55123 Date Issued: 03/30/92
(612) 681-4675
SITEADDRESS: Lor: zi aLoCK: i APPLICANT:
4102 PENNSYLVANIA AVE SEASONAL BLDRS INC
STAFFORD PLACE (612) 464-5971
PERMIT SUBTYPE:
SF OWG
TYPE OF WORK:
NEW
INSPECTION ., . „
SITE F'OOTING
FRAMING INSULATION
WALLBOARD FINAL
FIREPLACE
REMARKS: RECEIPT N
?
?
REOENCY PLBG.
7
r - -"
- ?
PERMIT
CITY OF EAGAN
3830 Pilot Kraob Road
Eagan, Minnesota 55123
(612) 681-4675
Control No. 0129
PERMITTYPE: BuiLoiNe
Permit Number: 000127
Date Issued: 0 3/ 3 0/ 9 2
SITE ADDRESS:
,. 9142 PENNSYLVANIA AVE
IOT: 21 BLOCK: 1
STAFFORD PLACE
DESCRIPTION:
Buildi'h:g Permit Type SF OWG
,8uilding Work 7ype NEW
-' U8G Uccuparic`y,, R-3 M-1
' Construction Type VN
Zo•ning R-i
Bailding teng,th ` 43
Build3ng Wid'th 46
f,.
.: .-, , ? ?•-? F f
F
?Y :^`., l J `v7 i?r ? _ a ..... i _ . r
.
.
l _ .....,. '.?. _ _ .
REMARKS:
RECEIPT # CQ I ? 03 1
FEE SUMMARY:
Base Fee
Plan Review
Surcharqe
SAC
sac %
5AC Units
Subtotal
REGENCY PLBG.
VALUATION $69,006
$500.00 MISC FEES
$325:00 Total Fee
$34.50
$700.00
100
1
$1,559.58
CONTRACTOR: -
SEASONAL BLDRS IMC
4580 SCQTT TR
EAGAN MN
(612) 454-5971
$1.610.50
$3,170.00
Applicant - 37. LIG OWNER:
14545971 0001652 SEASONAL BUILDERS
212 4580 SCOTT TRAIL
55122 EAGAN MN 65122
(612)454-5971
I hereby acknowladge that 2 have read Chis
informaCiort is correct and agree to comply
L
7izLICANTIPERMITEE a City of Eagan Urdinartces.
SIGNATUFE
application and state thet Che
with all applicable State of Mn.
?
ISSUE Y: SIGNATUFE
.. } - .. 1992 BUILDING PERMIT APPLICATION
CITY OF EAGAN
REQUIREMENTS: ? 3(4 ? ?
f ?f-l.J
SINGLE FAMILY 2 SETS OF PLANS, 3 REGISTERED SITE SURVEYS, 1 SET ENERGY CALCS.
MULTIPLE DWELUNGS 2 SETS OF PLANS, 3 REGISTERED SfTE SURVEYS, 1 SET OF ENERGY CALCS.
# OF UNITS RENTAL FOR SALE
COMMERCIAL 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS, 1 SEf OF
SPECIFICATIONS, 1 SET OF ENERGY CALCS.
PENALTY APPLIES WHEN TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY LAST WORKING
DAY OF MONTH IN WHICH REQUEST IS MADE DB LOT CHANGE IS REQUESTED ONCE PERMIT IS
ISSUED.
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOI
ADDRESS IS DESIRED. NO CHANGES WILL BE ALLOWED
JG PERMIT IS
MAR 2 5 1992
WHICH
To?e Used For:
L Valuation:
COn'Date: ?
l S Address ?J4Z P?n/1 hVa/'l??Q py??e -?
Lot 21 slock 1 FFI U:
Parcel/Sub ;i u- ?-E?l'G? l I QCE Zo?ni???
9
Ovmer ?ual Const
Allowable
Address # of stories
Length
CilY/ZP Depth ?
S.F. Total
Phone Footprint S.F.
Contractor n4 i BOt'/dff- On-site sewage
On-site well
Address MWCC System
City water
cftY/ZP?? mkj 120 PRV
Booster Pump
Phone 45?`5?7 License 0001&52
Planner
Arch./Engr. rQd (?mPlj'/)Cj Councif
Bldg. Off.
Address Variance
City/7rp Code
Phone #
Btdg Permit
Surcharge
Plan Review
License Fee
SAC, City
SAC, MWCC '
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI.
Road Unit
Park Ded.
Trail Ded. .
Copies
SUBTOTAL
Penalty
Lot Change
TOTAL
`• FEES
wer aterLicensedContr. Processingtime
for se r/wat ermits is two ays once area as en approv ..
agrees that all work shall be done in accordance with
i n ure erm ee
al?applicable State of Minnesota Statutes and City of Eagan Ordinances. AMI&
PERMir 4 . CITY OF EAGAN ' 1992 BUlLDlNG PERMIT APPLICATION ?
681-4675
SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy
calcs.
COMMERCIAL 2 sets of architectural & structural plans, 1 set of
specifications, 1 copy of energy calcs.
Penalty applies when typing of permit is requested, but not picked up by last working day
of month in which re uest is made or lot chan e is re uested once ermit is issued.
Date Yaluation of rark
Site Location:
STREET STE 1f
Tenant Name:
Lar z I sLocK ? weo. r.?_n_ ?
STAF'FOR'D PLLICE
Descri tian of work:
The applicant is: ? Owner ? Contractor ? Other (Describe)
Name Phone
Property LAST FIRST
Owner
pddress
STREET STE #
City State Zip
Company Phone
Contractor Address License # Exp.
City State Zip
Company Phone
Architect/
Engineer Name Registration #
Address
City State Zip
Sewer & water licensed plumber . Processing time for
sewer & water permits is two days once area has been approved.
I hereby acknowledge that I have read this application and state that the information is
correct and agree to comply with all applicable State of Minnesota Statutes and City of
Eagan Ordinances.
Signature of Applicant:
Y
OFFICE l1SE ONLY
BUILDING PERMIT TYPE
? 01 Foundation
% 02 SF Dwg.
? 03 Two family
0 04 Multi-fam. T.H.
? 05 Apt. Bldg.
? 06 Garage/Accessory
? 07 fireplace
? 08 Deck
? 09 Basement Finish
? 10 Swim Pool
WORK TYPE
? 31 New
? 32 Addition
? 33 Alterations
? 34 Remodel
? 35 Repair
? 36 Tenant Finish
GENERAL INFORMATION
? 11 Res. Add./Porch
? 12 Comm./Ind. New
? 13 Comm./Ind. Add
? 14 Comn./Ind. Rem
? 15 Public Fac.
? 16 Agricultural
O 17 Building Move
? 18 Demolition
? 20 Miscellaneous
? 37 Move
? 38 Demolish
O 99 Undefined
Occupancy R-3 M-1 Basement sq. ft. 29 Z MWCC System YE5
_
Zoning Q.i ist F1. sq. ft. 777T City Water _TE
5?
Const. (Actual) V"N 2nd F1. sq. ft. PRV Required
(Allowable) Sq. Ft. total Booster Pump
# of Stories
- Footprint Sq. ft. Fire Sprinkler
Length ?? On-site well Census Code lot
Depth yb? On-site sewage SAC Code 01
APPROVALS
Planning Building Assessments
Engineering Variance
REQUIRED INSPECTIONS
,J"Site ,?Footing ?" Framing ?nsulation
?,H'Wallboard I,?'Final ? Oraintile ? Fireplace
Permit Fee $DO•°-° vetuatio,: :69,oaa-
Surcharge •$O k?; z2x
2Z <<lXcl X16 =`174 H
Plan Review 325.00
L i cense t3sraT:
MWCC SAC 700, oo a y x 36 = 86 y
City SAC /oo.oo yK7_ 7
Water Conn. 6jS,oo
Water Meter 95.00 x t5- ?3 35so
? y 1
Acct. Deposit 30.00 lsrfLOo¢
S/W Permit 30, ao
S/W Surcharge .50 8g 2 x s3 = y'?,27 -
1---
Treatment Pl. 3011, o a
Road Unit 380.00 6?L` v o
Park Ded. ?
Trails Ded.
Copies
Other
Total: ?
SAC % ? D a ,
SAC Units t
? ? ?. ?o . . .. . .. -----...
P.1i2 I
1110,
: SITc AOD2,cS5: ! I ? ,
Ctiid.1CT0?t Z/ ?j[?/ 579FOATZ:
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REACTIVATE ?
PFRMIT4
r. -
r
2-q
Lt (1?0 Lt u v L V) CITY OF EAGAN
APR 3 0 1993 1993 BUILDING PERMIT APPLICATION
681-4675
--------------
SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy
calcs.
COMMERLIAL 2 sets of architectural 8 structural plans, 1 set of
specifications, 1 copy of energy calcs.
Penalty applies: 1) when permit is typed, but not picked up by last working day of month
in which request is made, 2) address is changed or 3) lot change is requested once permit
is issued.
Date 3 Yaluation of work
Site Address: 4 ? QZ- FtNXI_(_i?i?14N;/S Av,
STREET SUITE
Tenant Name: (commercial only)
LOT BIACK ? SUBD. ???,Wj P.I.D. Vk
Descri tion of work: G
The applicant is: ? Owner Contractor ? Other (Describe)
Name S Av u i\, /a-P_ Phone "
Property CAST nFIRST
Owner /
pddress Nru ?/vv??? ap-e-_
STREET STE M
City cfrt State Zip
Company I IaLPhone 934-07SI
Contractor Address 1&7?C ?il? v?1 ?3?YLttK IJ?- License #Q'.?D?? Exp. 3?' -
Ci ty Cfe-'l&kJ PYLA 1/L! S? State Zi p M 43
Company Phone
Architect/
Engineer Name Registration #
Address
City State Zip
Sewer 8 water licensed plumber . Processing time for
sewer & water permits is two days once area has been approved.
I hereby acknowledge that I have read this application and state that the information is
correct and agree to comply with all applic ble State of Minnesota Statutes and City of
Eagan Ordinances.
Signature of Applicant:
OFFICE USE ONLY
BUILDING PERMIT TYPE ` '
O 01 Foundation ? 06 Duplex ? 11 Apt./Lodging ? 16 Basement Finish
0 02 SF Dwg. O 07 4-Plex ? 12 Multi. Misc. ? 17 Swim Pool
? 03 SF Addition ? 08 8-Plex ? 13 Garage/Accessory ? 18 Comm./Ind.
? 04 SF Porch ? 09 12-Plex ? 14 Fireplace ? 19 Comm./Ind. Misc.
? 05 SF Misc. ? 10 Multi. Add'1. 015 Deck ? 20 Public Facility
? 21 Miscellaneous
WORK TYPE
X31 New ? 33 Alterations ? 35 Tenant Finish ? 37 Demolish
? 32 Addition ? 34 Repair ? 36 Move
GENERAL INFORMATION
Const. (Actual) Basement sq. ft. MWCC System
(Allowable) lst F1. sq. ft. City Mater
UBC Occupancy Kf;? 2nd F1. sq. ft. PRY Required
,
Zoning Sq. Ft. total Booster Pump
li of Stories Footprint Sq. ft. Fire Sprinkler
Length ? On-site well Census Code
Depth 15 On-site sewage SAC Cod
?
APPROVALS ?
?
?? tSu.S
Planning Building Assessments
Engineering Variance
REGIUIRED INSPECTIONS
? Site
? Wallboard
? Footing
? Final
? Framing
? Draintile
-?
?
0
? Insulation
? Fireplace
'??,
Permit Fee
Surcharge
Plan Review
License
MWCC SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total:
??4 I valuccon:
ti
SAC %
SAC Units '
C:[7V (,1F F:AGat:
OAS:-I]:G:Rr 5 ii'RMIMAL. NIiJc 7:38
I,.h..'rS=: 11/27/99 '7"I:Mti. 14c002J.
ID :
iZAI`fl=;: itARi; F RO!3F.N(:l!IS7
321.0 9001 4:1.42 I°'FidN AVF ECI.LlO
aM 9001 4a.42 reNN aVr o„Sa
's
'Y"ot:il. REr_ei,nl: Fliflrut,'`.; '-iQ.Sn
CR099815
U4i:::( W•t NANC`/
?;;•`8YF_m>k",;;k::;iX;;,w;dY??-: ,.;:ik?ck:..?.,-.'c:..,,_... .. ? ., , .PCi;
PERMIT
CIT?Y OF EAGAN
% 3830 ilot Knob Road
Eagan, Minnesota 55122-1897
(657) 681-4675
SITE ADDRESS:
4142
LQl': 21
STRFFORD
P. S. N. : 10--72500-210--01
PERMIT TYPE:
Permit Number: B U I L D I N G
Date Issued: 0341 04
11/27/98
PEIVNSYLVANIA RVE
BLOCK: 1
PLACE
DESCRIPTION:
j ?--? BA7NROOM
3ldinq R-krmit TVPe
Bf,Slclinq Wor`,k-\ype
ff'ansus Code
f ?
t ?
BASEMENT FINISH
ALTERHTIOIV
434 ALT. RESIDENTSAL
REMARKS:
PIAN REVIEWEO BY CRATG NOVFlCZYK.
SEpARATE PERMIT REQUIRED FOR ANY PLUMBING WORK. Cl11 i nar _2anrn aFroonrnir cF6TR-=-Ef k P-ERMIT?1IdB ItlSFEETi-8i
FEE SUMMARY:
Base 1=ee $50.00
Surchar9e
Total Fee $50.50
GVNIHAGTUR:
OWNER: __ Hpplicant -
;OSENfJUTST mARK
7142 PtNPISYLVANIA AVE
_RGAN MN 55123
{651}6$8-6985
T. hereby acknowledqe that I havs read this
intormation is correcC and aaree to comply
L Statu es and ity ofi Eaqan Ordinances.
APPLICA T/PERMI7 G ATURE
appl.iration and staCe that the
with all aoplicable State ot Mn.
-1
h?
IFSUED B- Y: SURE
CITY OF EAGAN
3830 PILOT KNOB RD - 55122
-499d'BUILDING PERMIT APPLICATION (RESIDENTIAL)
2)`1 I 0 y19W 681-4675 s ](_) ?
New Canstrudion Reauirements RemodeVReoair Reaulrements
? 3 registered s8e aurvays ? 2 copies of plan
? 2 cropies of plans (Indude beam 8 windav sizes; poured (nd. design; etc.) ? 2 sfle surveys (ezterior add8fons & decks)
? 1 energy calculations ? 1 energy celculations lor heated addHions
? 3 copiee of hee preservatbn plen H tot plattad after 7N/93
required: _ Yea _ No .
DATE: 11- Z 3-? ?_ CONSTRUCTION COST:
DESCRIPTION OF WORK: ? 04OO "1 - 50Q mea.fi
STREET ADDRESS: 11ydL Fe,v".S? LV,4mA A L,, t
LOT BLOCK I SUBDJP.I.D. eKa 0 o
PROPERTY Name: tCuSPniQvisT I'?AR?L Phone #: 696
OWNER
StreetAddress S y?vAN;A A?e
City: State: Zip: 3
CONTRACTOR Company: Phone #:
Street Address: License #:
City; State: Zip:
ARCHITECT/ Company: Phone #:
ENGINEER
RECEIVED
NOV 2 3 1998
B
Name:
State:
Street Address-
City:
Sewer & water licensed plumber:
change are requested once pertnit is issued.
Registration #•
Zip:
Penalty applies when address change and lot
I hereby acknowledge that I have read this application and state that the infoRnation is correct and agree to comply with all
applipble Sfate oi Minnesota Statutes and City of Eagan Ordinances. AAA I ? I
Signature of Applicant:
OFFICE USE ONLY
Certificates of Survey Received _ Yes
Tree Preservation Plan Received Yes
No
No
OFFICE USE ONLY
?-
BUILDING PERMIT TYPE
13 01 Foundation a 06 Duplex ? 11 Apt./Lodging x 16 Basement Finish
? 02 SF Dwelling ? 07 4-plex ? 12 Multi Repair/Rem. 0 17 Swim Pool
0 03 SF Addition o 08 8-plex ? 13 Garage/Accessory ? 20 Public Facility
0 04 SF Porch ? 09 12-plex ? 14 Fireplace ? 21 Miscellaneous
? 05 SF Misc. ? 10 = plex o 15 Deck
WORK TYPE
0 31 New ? 33 Alterations ? 36 Move
? 32 Addition ? 34 Repair o 37 Demolition
GENERAL. INFORMATION
Const. (Actual) S- /j
Ail
S-
-J- Basement sq. ft. MC/WS System
(
owabie)
I Main level sq. ft. City Water
UBC Occupancy ?-3 sq. ft. Fire Sprinkiered
Zoning sq. ft. PRV
# of Stories
Length sq. ft.
ft Booster Pump
sq.
. Census Code.
Depth Footprint sq. ft. SAC Code a
Census Bidg ?
Census Unit o
APPROVALS ?
Planning Building l? Engineering Variance
Permit Fee
Surcharge
Plan Review
License
MCNVS 5AC
Ciry SAC _A
Vlrater Conn.
Water Meter
Acct. Deposit
S/W Pertnit
SIW Surcharge
Treatment PI.
Road Uriit
Park Ded.
Trails Ded.
Other
Copies
Total:
Valuation: $ 12-L30 °-'0
-
°k SAC
SAC Units
/? / BL ? CITY USE ONLY RECEIPT #:
I/ tLL
SUBD. Y ? RECEIPTDATE:
1998 PLLINBING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGPN, MN 55122
(612) 681-4675
Please complete for: D single family dwellings
? townhomes and condos when permks are required for each unit
? backflow preventer for underground sprinkler system
----- ---------------- - - - ---
FIXTURES -----------
EACH ---------------------------------
# TOTAL
Shower 3.00 x =
Water Closet 3.00 x =
Bath Tub 3.00 x =
Lavatory 3.00 x =
Kitchen Sink 3.00 x =
Laundry Tray 3.00 x =
Hot Tub/Spa 3.00 x =
Water Heater 3.00 x =
Floor Drain 3.00 x =
Gas Piping Outlet • minimum - t 3.00 x =
Rough Openings 1.50 x =
Water Softener ' for dwellings under construdion 5.00 x =
Water Softener ' for existing tlwelling 20.00 x =
U.G. Sprinklef " for dwelling under const. 3.00 =
U.G. Sprinkler ' for existing dwelling 20.00
Alteraii0n5 " ro existing residence 20.00
Water Turn Around 20.00 =
Private Disposal System ' MPC iic. 75.00 =
(new and refurbished systems)
Private Disposal Systems'Abandonmenc 20.00 =
RPZ (new installation only) 20.00 =
STATE SURCHARGE 50
0
TOTAL co?? S1
. -------------------------ave ------------------------------------ --- ------is------------dag2----e---to--- comp----lyw---ith- al--l- ---applicable------City ----of--- ---Eagan---ordinan--- --ce--s-.-
I hereby acknowladge that I h 2ad this application, state that the infortnation cortect, an
It is the applicant's responsibility to notify the property owner that the City of Eagan assumes no liability for any damages causetl by the Ciry during its
normal operetional and maintenance activities to the facilkies constructed under this pertnit within City property/right-of-way/easement.
SITE ADDRESS:
OWNER NAME:
INSTALLER NAME:
STREETADDRESS:
CIn:
CD/PERMIT FORMS/RPLBG PERMIT (RES) - 1998
TELEPHONE #: c g SI 4 M?
5S I a)
>X;kkcYCk?1,a?X'k.Xtk:V,4 %kMXi*** g: ?, `kk%KQ,t:x?KNc*Yr.i;;`YiX*
cIrv OF r_.r:GAaa
r.,nSHir::R: ss rERM.;NAi._ No? 7C.,
BA"1"E;: fl.'•:/iBf`..',i iSMI"; 007;;0
:De
rarnE;; r??r??t; E: !t(:)SF'??CaU':S7
3210 9001. 4:I.A2 i'EPJiJSYL.VAiJ 50„00
205 ql?tl:l. 4 t.4 c^: F'ENN'.3YI.. VA.&I O. SO
34::30 9001 41.k2 Pf:NN8Y!_V1N L„0!]
,
i
Wal P'tfzr_.-.o1: A;noun',,. 5050
:Bi.:1 i [)9"; i
0!:i;-;;r II : hlF:MrV
yFk;!^YW'1'u:;?;8;15 ;::?lY„Y,?;, ;;;F:z.:?k?X:?k'.'d%kh;rdin?;?Fr:•Io?iS,;?Y,c'J,?;'Sn.;?
PERMIT
? CITY OF EAGAN
3830 Pilot Knob Road PERMIT TYPE: a u z Ln r N s
Eagan, Minnesota 55122-1897 Permit Number: 030551
(612) 681-4675 Date Issued: 0 8/ 18 / 9 7
SITE ADDRESS:
4142 PENNSYLVANIA AVE
LOT: 21 BLOCK: 1
3TAFFORD PLACE
P.I.N.: 10-72500-210-01
DESCRIPTION:
i `
Bu2.lding -Permiti Type
;Bu3lding Work Type
, Gensus Code ,?
?.
.?
?
ti.
i
BASEMENT FINISH
ALTERATION
434 ALT. RESIDENTIAL
? n
?,`??\z
J1 l? 1j, t4?
?"'a
REMARKS:
FEE SUMMARY:
Base Fee $50.00
Surcherge $.50
Total Fee $50.50
CONTRACTOR: OWNER: - qpplicant -
? ROSENQUIST MARK
, 4142 PENNSYLVANIA AVE
EAGAN MN
(612)688-6985
T hereby acknowledge that I Msv2 wesd this app],a,oation snd stata that the
inParmation is correct and agree to comply with all applica6ie state of Mn.
? Statiite an Ci crfi Eag`an Uhdiriance,s. - ?
AP IICANT/PE ITEE 51? UR ISSUED EV. S A7 E
1997 BUILDIPVG PERMIT APPLICATION (RESIDENTIAL) CITY OP EAGAN
?? 5 S/ 5880 PILOT KNOB RD - $6122 687-"75
New Construetion ReaviremeMs BemodeVReoair Reauircmenh ??? 1
? 3 repistered site surveys ? 2 eopiea of plan
• 2 copbs of plans (indude baem & window sizes; ppurad fnd. design; etc.) ? 2 site suneys (exterior additlons 8 Cetlcs)
? 1 energy calculations ? 1 eneigy eslwlatlons for heated addkions
? 3 mpies W tree preaervation plan if lot plattetl aRer 7J1/93
required: _ Yea _ No -
DATE:
DESCRIPTION OF WORK:
STREET ADDRESS:
LOT ? L BLOCK
'eti,.j SaL
CONSTRUCTION COST:
>epRoorN+
I/
' SUBD./P.I.D. #:
PROPERTY Name: 106C'NQuj3j Mp!\ f, Phone #:
OWNER
i fP
'y? q m„
L
i
? U
'
Street Address:
N Ns$
v.A.v
A
j /
P
City: E A 4 R n/ State: N1 n. Zip;
^
coNrw?CroR Company: Phone #:
Street Address: License #:
City: State: Zip:
ARCHITECT/ Company: Phone #:
ENGINEER
Name: Registration #:
Street P.ddress:
City:
Sewer 8 water licensed plumber (new construction only):
and lot change are requested onee permit is issued.
State:
I hereby acknowledge that t have read this application and shdte that the inTortnation is correct
State of Minnesota Statutes and City of Eagan Ordinances. /, ), ,,
Signature of Applicant:
OFFICE USE ONLY
Certificates of Survey Received
_ Yes _ No
Tree Preservation Plan Received - Yes - No _ Not Required
Zip:
Penalry applies when address change
to comply with all applicable
t /
JUL 31 1997
. 61'I
?
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Duplex o 11 Apt./Lodging x
0 02 SF Dwelling o 07 4-plex o 12 Multi RepaidRem. ?
0 03 SF Addition _o .08 8-plex n 13 Garage/Accessory o
0 04 SF Porch niA Q-plex ? 14 Fireplace ?
? 05 SF Misc. 0 10 = plex o 15 Deck
WORK TYPE
o 31 New x 33 Alterations o 36 Move
a 32 Addition o 34 Repair o 37 Demolition
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
Basement sq. ft.
Main levef sq. ft.
sq. ft.
sq. ft.
sq.ft.
sq. ft.
Footprint sq. ft.
APPROVALS
Planning
Permit Fee
Surcharge
Plan Review
License
MCNVS SAC
Citv SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI.
Road Unk
Park Ded.
Trails Ded.
Other
Copies
Building 'YYI ,
Total:
16 Basement Finish
17 Swim Pool
20 Public Facility
21 Miscellaneous
MC/WS System
City Water
Fire Sprinklered
PRV
Booster Pump
Census Code.
SAC Code
Census Bldg
Census Unit
Engineering Variance
Valuation: $
?
ol_
/
O
% SAC
SAC Units
L'? ? fL ;4? CITY OF EAGAN
PLUMBING PERMIT
SUBD._ (612) 681-4675
RFSIDBNTIAL
PLEASE COMYLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS
WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
CITY USE ONLY
RECEIPT # L 13
DATE elz -j '-/ - Z
ALSO, FOR TOWNHOMES AND CONDOS
WORK DESCRIPTION
NEW CONST ?
ADD ON
REPAIR
OWNER NAME :
SITE ADDRESS: 7 /7d
INSTALLER: L?f (,Iic.2b//"-4
ADDRESS:
CITY:, V,gJ /1?Al 2IP:
PHONE #: 70 ? -Z?Y7
OF PERMITTEE
STATE SURCHARGE .50
TOTAL:
a?
$
PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS. ALSO FOR MULTI-FAMILY
BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT.
WORK DESCRIPTION:
OWNER NAME:
SITE ADDRESS:
TENANT NAME:
SUITE #:
INSTALLER:
ADDRESS:
CITY:
PHONE
FOR:
2IP:
CONTRACT PRICE:
1% OF CONTRACT FEE. .
STATE SURCHARGE - $.50 FOR
EACH $1,000 OF PERMIT FEE.
$25.00 MINIMUM FEE.
CONTRACT PRICE x 1%
STATE SURCHARGE
TOTAL:
$
$
(SIGNATURE)
COMPLETE THE FOLIAWING:
N0. FIXTURES EA. TOTAL
REPAIR/ADD ON 15.00
SHOWER 3.00
/ WATER CIASET 3.00 3 '
? BATH TUB 3.00 3 ?
? IAVATORY 3.00 3 ?
? KITCHEN SINK 3.00 3 -
? IAUNDRY TRAY 3.00 3
_ HOT TUS/SPA 3.00
1 WATER HEATER 3.00 3-
? FLOOR DRAIN 3.00 3 '
GAS PIPING OUT.
? (MINIMUM - 1) 3.00 3
? ROUGH OPENINGS 1.50 z/s%
OTHER
_ WATER SOFTENER 5.00
_ PRIVATE DISP. 15.00
_ U.G. SPRINKI.ER 3.00
_ W. TURNAROUND 15.00
CITY OF EAGAN
J
CTI'Y OF EAGAN I
2I B
L MECHANICAL PERMTT RECEIPT #
,
SUBD ? (612) 681-4675 DATE ? 8 9?-
.
RESIDENTIAL
PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS. ALSO, COMPLEI'E FOR
TOR'NHOMES/CONDOS WfiEN SEPARATE PERMIIS ARE REQUIRED FOR EACft DR'ELLING UNIT.
ORNER: ? 'f jEGL? . FEFS
SI1'E ADD/R,E/SS:
/tI?z ADD ON/REMODEL (EXISTIIVG
CONSTRUCI'ION ONLl) $ 15.00
HVAC: 0-100 M BTU 24•00
INSTALLE . ? Ly 4-0;t °1 ath (,lIM lI'I C ADDITIONAL SO M BTU 6.00
ADDRESS: /SS GAS OUTLETS - MINIMUM 1@ $3 ? S. 0-D
CITY: zIP:55CYo ? SURCIIARGE $ .SO
SIGNATU : TOTAL: S !J'
COMMERCIAL
PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS. ALSO COMPLETE FOR
APARTMENT BUILDINGS OR OTHER MULTI-FAMII Y BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR
EACH DWELLING UNTT.
i WORK DFSCRIPTION: II CONTRACl' PRIC& I FEES
1% OF CONTRACT FEE. ?
STATE SURCIiARGE LS $.50 FOR EACH
$1,000 OF PERMIT FEE. s
PROCESSED P?PING - S25.00 I S
MINIMiTM FEE - $25.00
x
CITY OF EAGAN
LAL B MECHANICAL PERMIT
SUBD. (612) 681-4675
RESIDENTIAL
RECEIPT # 4O062( rl
DATE ? ?
PLEAISE COMPLE!'E UPPER PC)RTION ONLY FOR SIIVGLE FAMILY DWP:LLINGS. ALSO, COMPLEfE FOR
TOR'NHOMES/CONDOS WHEN STPARATE PERM115 ARE REQUIRID FOR EACH. DOVELLLING UNTf.
owxER: o s e(j FEEs
SITE ADDRFSS: ADD ON/REMODII. ;EICISTING
CONSTRUCI70N ONLI) $ 15.00
INSTALLER: )pyJ HVAC: 0.100 M BTU 24.00
PAONE #t: qj `6 S- / 5? I ADDITIONAL SO M BTU 6.00
AUlUltESS: ?(1(? r} S U 2 S S 2 GAS OUTLM - MIPiDbiUM 1@ $3 EA.
crrY: o?-, ?,i J AIPI- S?y3 } sirxcanxcE: $ so
SIGNATURE: TOTAL: $
coMMERCrai. . '7111 g
PLEASE COMPLEI'E TIiIS PORTION FOR ALL COMMERCIAL/INDUS7RIAL BUILDINGS. ALSO COMPLEI'E FOR
APARTMENT BUILDINGS OR OTHER MULTT-FAMII Y BUII,DWGS R'HEN SEPARATE PERMITS ARE NOT REQUIRED FOR
EACH DWELLING UNTT.
WORK DFSCRIPTION:
OR'NER:
SITE ADDRESS:
1'ENANT:
SUI1'E #:
INSTALLER:
ADDRFSS:
CIT'Y:
PHONE #:
SIGNATURE:
CONTRACT PRICE
196 OF CONTRACf FRE.
STATE SURCAARGE IS $.50 FOR EACH
$1,000 OF PERMTI' FEE
PROCFSSID PIPING - $25.00
MIIHIMUM FEE - S25.00
TOTAL•
CITY SIGNATUR&
$
c
S
7.IP..
CAST METRO 2112 SHALE LANE
SURVEYORS EAGAN, MN 55122
?s?2? 452-oia4
INC. Certificate of Survey for:
SEASONAL BUILDERS
LEGAL DESCRIPTION; LOT 21,BLOCK I, STAFFORD PLACE
ACCORDING TO THE RECORDEO PLAT
THEREOF DAKOTA COUNTY,MINNESOTA
COUNTY ROAD NO. 30
N 89° 58' 12" E
93.65
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LEGEND 4 11F
o OENOTES IRON MONUMENT
? DENOTES WOOD HUB SET .
?g DENOTES E%ISTING SPOT
ELEVATION
UENOTES PROPOSED SPOT
ELEVATION
? DENOTES DRAINAGE DIRECTION
I hareby cerfify that this survey,plan or
raport was prsparsd by ms or under my
direct supxvision anG ihat 1 am a duly
Repistered Land Su?vtyor undar ihe
lows of the Stoto of Minnesoto.
Dat. 1 ?nAPA 1-7, ?q92
qpoPopro SPGir FoY7F?- - /iP
INVERT ELEVATION AT SERVICE EXTENSION=
PROPOSED GARAGE FLOOR ELEVATION • `?z•'-
PROPOSED FIRST FLOOR ELEVATION= ?
PROPOSED BASEMENT FLOOR ' ?$z
ELEVATION
NOTE' VERIFY ALL FLOOR FIEIGHTS WITH
FINAL HOUSE PLANS
?? :
? ? .
,rlt TRO 2112 SHALE LANE
JuRyFyORS EAGAN, MN 55122
452-0134
(612)
/NC. Certificate of Survey for; SEASONAL BUILDERS
I STAFFORD PLACE
RECOROED PLAT
LEGAL DESCRIPTION: ACCORONG TO THE,
THEREOF DAKOTA COUNTY,MINNESOTA
COUNT N ?ROAD. 12,4E 30
93.65
,-----
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S 800 36' 34'E
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LEGEND 4 ?F
o DENOTES IRON MONUMENT
o DENOTES WOOD HUB SET
,ab- DENOTES EELEV?ATION?T
OENOTES PELEVA7? P0T
ON
? DENOTES DRAINAGE DIREGTION
I hereby certify tAat tAis awveY.Dian or
report wos prsparsd by ms or under my
direct •upavision and thot I om a duly
^ Rapisterad Land Survtyor undar ih•
Lows of the State of Minnssota.
:_?1 ? [? ? •
?---
ALE
r'?ZO?oPE.9 SPC?T FeY? ' ?JD '4j'4"'GOa.7f
INVERT EI..EVATION AT SERVICE EXTENSION= ?Z z
PROPOSED GARAGE FLOOR ELEVATION? 3z-
PROPOSEU FIitST FlOOR ELEVATION
PAOPOSED BASEMENT FLOOR
ELEVATION
NOTE • VERIFY ALL FLOOR MEIGH7S WITH
FINAL HOUSE PIANS
oar•. MALr' 2'? vq92 _
Use BLUE or BLACK Ink
I For Office Use
I
Permit
City of Ea _
Ed.0)
Permit Fee. 1 I
3830 Pilot Knob Road I q /q I
Eagan MN 55122 Date Received: 1
I
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 i Staff: cry
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit
Name: MA21t 92L4 Phone: <P51 ^ 3~S- is
Resident/
Owner Address / City / Zip: 41! K2
Applicant is: Owner >a- Contractor
Type of Work Description of work: '
Construction Cost: Multi-Family Building: (Yes / No )
Company: 60 r 1D ermnl Z V-wk_, Contact:
Contractor Address: A?D3 City: 1,'Ae A4,,'
_ Zip: _51^tZS Phone: (1(Z - 3~"7 - 1 y2Z
State:A&AZ
License ~G- 1 gL 1 1 Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A .NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE; Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
L conclude that they are trade secrets.
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.org
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must omplet within 180
days of permit issuance.
x ' +c~ a
x
Applicant's Printed Name Applicant's Sign
Page 1 of 3