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4143 Pennsylvania Ave
Use BLUE or BLACK Ink 1 or Office Use Permit City of EaEd I b 3830 Pilot Knob Road Flea i Permit Fee: Eagan MN 55122 I Date Received: Phone: (651) 675-5675 j Fax: (651) 675-5694 I Staff: 1 L-----------------1 2010 MECHANICAL PERMIT APPLICATION Date: Site Address: 7/q3 /'4K5~1Ij/Cctii 0e In 5~5-1 Z3 Tenant: ~,!-P~~/ ✓ 'e, V Suite M RESIDENT I OWNER Name: S~hv ~1 0 e ~-2►r- Phone: &0 (o ~G~ - ~9oZ Address / City / Zip: P-~kt1g Ucv~t i c. A-o e -n S/`z 3 CONTRACTOR Name: (_,Ca_-t l 7JC Pu,~-: Nq License M Address: llf 5~ s%~~E'y M-a-w tl vc City: CC.oicvr~ State: M A) Zip: ~`j 5 / Z°L Phone: &,51 Contact: I apll t- c Email: 144(l Lr Lf a, W_e e4Z C/At Vae_ ,CD-", TYPE OF WORK New Replacement Additional Alteration Demolition Description of work: NOTE: Roof mounted and ground mounted mechanical equipment is required to be screened by City Code. Please contact the Mechanical Inspector for information on permitted screening methods. RESIDENTIAL COMMERCIAL PERMIT TYPE ✓ Furnace New Construction Interior Improvement V1 Air Conditioner Install Piping Processed Air Exchanger Gas Exterior HVAC Unit Heat Pump Under / Above ground Tank Install / _ Remove) When installing/removing tank(s), call for inspection by Fire Other Marshal and Plumbing Inspector RESIDENTIAL FEES: 4 ; o© $50.50 Minimum Add-on or alteration to an existing unit (includes $,5ntate Surcharge) $90.50 Fire repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) $ 55! TOTAL FEE COMMERCIAL FEES: $70.50 Underground tank installation/removal OR Contract Value $ x1% $50.50 Minimum (includes State Surcharge) Permit Fee - If Permit Fee is less than $1,000, surcharge is $.50. - If Permit Fee is > $1,000, surcharge increases by $.50 for each Surcharge $1,000 Permit Fee (i.e. a $1,001-$2,000 Permit Fee requires a $1.00 surcharge). TOTAL FEE 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.ora 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. x --X->i-:A h A~ 1, f U_ . ( x - Applicant's Printed Name Ap icant's Signature FOR OFFICE USE Reviewed By: Date: Required Inspections: -Under Ground - Rough In -Air Test -Gas Service Test -In-floor Heat -Final Exterior HVAC Screening Inspection CASH RECEIPT t , CITY OF EAGAN 3830 PILOT KNOB ROAD EAGAN, MINNESOTA 55122 DATE RECEIVED FlOM f k !.!k, ! 4 L." "1'4. % ' ? . - • AMOUNT - & DOLLAFS Soo El CASH q CHECK -f r,.. Fa+ ? •,:1 ? 2:?- (/ ? ?; : , l:'' !: ,. % Thank You BY wnae--Perers Cqyr t., vellow-Fostln9 Covr Pir*---file Copy BLDG. PERMIT NO. 01-3210 Bldg. Permit 01-3422 Plan Check ? `-- , ? 01-3445 Surch./Adm. i ? 01-3446 SAC/Adm. 01-2155 Surcharge , 75-3860 Road Unit 6-2275 SAC X- k20-3865 Water Conn. - `~ o 20-3868 Water Trmt. 20-3716 Water Meter ; 20-2252 Acct. Dep. -_: 20-3713 Water Permit ? ?- 20-3743 Sewer Permit C ? 79-3866 Sewer Conn. 28-3855 Park Ded. TOTAL I , / 1 CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PH ON E: 454-8100 , , - BUILDING PERMIT Receipt* To be used for ::F D?iG/GAA Est. Value 9`+.??? Date DZ ?g?R Site Address 4143 FStIlqSYLI'AtiIA AV:. Lot 1r, Block 3 Sec/Sub. S7Al?lCYRUU PLACE Parcel No. a Name FR(''4T!.FR 4ID?'T'Si !ttl;'f:S COPIP. = Address '. :.: ° Phone 454-0433 City 9AGAN o Name SAMI! , ? q Address ? City Phone u °C Uy W W Name F Address ¢ = City Phone W 9 I tvesebyacknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State oi Minnesota Statutes and City of Eagan Ordinances. 4 ignature of Permittee f?tt)'t'!'Z?i' tj1.JL?'ES? t?nl?S A Building Permit is issued ta_- on thV express condition that all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Buitding Official OFFICE USE ONLY On Stte Sewage Occupancy k-3 `m.• l MWCC System ^ Zoning R-1 On Site Well (Actual) Const W-A1 City Water x (Allowable) Y-N PRV Required x # of Stories Booster Pump Length 55 Depth 3A S.F. Total Footprint S.F. APPROVALS FEES Engr.lAssess. Permit .1 S•00 Planner Surcharge 47.00 Council PlanReview 275•00 Bldg. Off. SAG City 101.00 Variance S,4C, MWCC 350! Water Conn. 550.00 Water Meter 00 67, Road Unit -17 4.? Treatment P 1 '?'?_ • ? Parks TOTAL ?'2Gb8 .00 +r,+?R?.. , -?'?",?,? .?, .. .. .,,r .??„o?e?'.T+a..qw-.?+ -.-...? T -?.... .,? : .?, . ,- . . .-r.f?.--,.--?..-..?,?„?.?s WORK 0114i,i,'?D BIIMRE P?'1IT lJt'?S 'W-6 EAGAN 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 ? 0 19 Ir, PH ON E: 661-4675 BUILDING PERMIT Receipt # ' To he used for USEMM FINISH Est. value Date M" S 1992 Site Address 4143 PENDiSYLVAtiIA AVE Lot 15 Block 3 Sec/Sub. STAFFQRD P1,ACB Parcel No. ' Nat118 M 1 W.lAR 11! Vlrl A w q?ress 4143 PElRISYLVAIaIA AVE ? Cit, EAGAl1M Zp 55123 cr Na(T1@ SAME 0-, Address ?.r ? city ZIP Pharie 8 uoerise # I hereby acknowlege that I have read this application and state that the informalion is correct and agree to comply %iith all applicable State ol Minnesota Statutes and City? Eagan Ord?" ?a.npaw '? Signature of Permitee? A Building Permit is issued to: WILLIAM iIFOR'fC on Ihe express condition that all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Building Oflicial ? Oocupancy Zoning (Actual) Const (Allowable) k ol stories Lenglh Depth S.F. Total S.F. Footprints On Site Sewage on site weu Mwcc system CAy Water PRV Required Booster Pump APPROVALS Planner Council Bldg. Olf. Variance OFFICE USE ONLY R-3 Bag. Perrrn Sumharge Plen Review FEES 35.00 .50 SAC, City SAC, MCWCC Water Conn water nnecer acG. Deposa 5Ml Permit S!W Surcharge Treatment PI Road Unit Park Ded. Copies TOTAL J79 71,J Permit No. Permit Holder Date TeWphone N SI1N P.unnBinG .?' q?- Hva,c ELEcrRIc °- eLECTRic Inspecti«+ oaM inap. comments Foodrxgs I Foundalion Framing Rooling Rough Plbg. - p- Rough Htg. Isui. Freplace 7 Final Htg. Orsat Test C*_ Final Plbg. Inspeclor - otify P Const. Meter ? EngrJPlan C'O /,.e 'Nege Bldg. Final Dedc Ftg. DeCk Fnal e C Weil , Pr. Oisp. . CITY OF EAGAN ''''•'' 3830 Pilot Knob Road, P.O. Hox 21-199, Eagan, MN 55121 PHONE: 454-8100 BUILDING PERMIT Receipt # To be used for SG A a Est Value 9' •Date 1Y- ='IT 36 ,19 SiteAddreSS ?'1'•?.; 9r.4"ti?7'i?.V€101A AYd• + ? S?/lg??1? ????inr Lot Block Sec/Sub. Parcel No. ac Name _,.'. ..?r ,?ti. ....?...,. ..-,•?- - _ 3 Address 1'b-n7 ?')APdA;-E ??lYf ?• 4 ;4_0 _ 3 0 City • Phone _ o Name i Address _ Phone I hereby acknowledge that 1 have read this application and state that the information is correct and agree to comply with ail applicable State of Minnesota Statutes and City of Eagan OrdinanCes. Signature of Permittee _ : Nn*'i?S A Building Permit is issued to:______.__ on the express condition that ali work shall be done in accordance wit h all applicable State of Minnesota Statutes and City of Eagan Ordinances. Building Of(icial OFFICE USE ONLY On S+te Sewage OccupanCy MWCCSystem X Zoning 1z_ t On Site Well (Actual) Const tf -''t City Water X (Allowable) PRV Required z # of Stories Booster Pump Length ?.? depth ? S.F. Total Footprint S.F. APPROVALS FEES Engr./Assess. Permit * 550400 Planner Surcharge 4`7• 00 Council Plan Review 275•00 BIdg.Off. SAC,City 1M_ •w Variance SAC, MWCC S? 00 Water Conn. s_iol_00 Water Meter ?57 .(IO Road Unit Treatment P1 ??J4•00 Parks TOTAI . Permlt No. Permlt Hoider Date Telephone # Plumbing - n ? -- ??. OYL, H.V.A.C. ? 'tt ta? 13 Electric U?J?alOw 9 I Softener Inspection Date Insp. Comments Footings I Footings II Foundation Framing 2 S O Roofing Rough Pibg. , r ? RoughHtg. ?lj ? p ye?o[• ? ..f! /-i'C-. ? ?" - IsuL 2G ? Fireplace Final Htg. Final Plbg_ Bldg. Final Cert Oca Temp. LP Deck Ftg. Deck Ffnal Well Pr. Disp. CONTRACT PRICE: $18O11. 00 Site Address L .'.!4 -' ''nrisq Lot l ' Block j ? Name - m Address _ c Ciry - Name -.a?.i?.?. ...;. c Address 0 C;ty .,aean TYPE OF WORK Forced Air Boiler Unit Heater Air Cond. Vent Gas Piping Outlets # Other MECHANICAL PERMIT CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55122 PHONE: 454-8100 PERMIT # RECEIPT # ' DATE: ? 14-91/; U ..?.L<Y nv ? • BLDG. TYPE SeC/Sub .?t?r;" >i'd' Res. Mult Comm. ,...,. 56? Other 0 ` M BTU M BTU M BTU M BTU CFM fEE S/C: TOTAL: WQRK DESCRIPTION New Add-on Repair FEES RES HVAC 0-100 M 8TU -$24 00 :! . . ADDITIONAL 50 M BTU . - 6.00 4-0433 (RES. HVAC IMCLUDES A/C ON NEW CONSTRUCTION) GAS OUTLETS (MINIMUM -1 PER PEkMIn - 1 50 EA 24.00 COMM/IND FEE - 1% OF CONTRACT FEE APT. BLDGS. - COMM. RATE APPLIES . . TOWNHOUSE 8 CONDOS - FiES. RATE APPLIES MINIMUM RESIDENTIAL FEE - ALL ADD-ON 8 REMODELS - 12.00 MINIMUM COMMERCIAL FEE - 20.00 STATE SUfiCHARGE PfR PERMIT ADD $ 50 S/C IF PERMIT PRICE GOES - .50 1.50 . ( BEYOND $1,000) 23.50 SIGNATURE OF PERMITTEE $26.00 FOR: CITY OF EAGAN ' PLUMBING PERMIT ' CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55122 CONTRACT PRICE: PHONE: 45+-8100 Site Address `y " `" '1 LLP, LS,X / //i, Lot Block Sec/Sub ? Name _ ? Address c Ciry ? ? Name 1-6 fU 1 i Cf-- 3 Address 3?1 p c;H 1-=6 4AN FEES COMM/IND FEE - 146 OF CONTRACT FEE APT. BLDGS - COMM RATE APPLIES TOWNHOUSE & CONDO - RES. RATE APPLIES MINIMUM - RESIDENTIAL FEE - $12.00 MINIMUM - COMM/IND FEE - $20.00 STATE SURCHARGE PER PERMIT - .50 (ADD $.50 S/C IF PERMIT PRICE GOES OF FOR CITY OF EAGAN PEFiMIT # l D ? a ? RECEIPT # ???'•, j DATE: ) -?-/ ?-?d / Y BIDG. TYP? WORK DESCRIPTION Res. Y New _A?- Mult. Add-on Comm. Repair Other RES. PLBG. ONLY - COMPLETE THE FOLLOWING: NO. FIXTURES , OTAL Water Closet - $3.00 Bath Tubs - $3.00 -Lavatory - $3.00 Shower - $3.00 :?__Kitchen Sink - $3.00 Urinal/ Bidet - $3.00 I_-Laundry Tray - $3.00 3.• r`r= Floor Drains - $1.50 ? • ? ?' Water Heater - $1.50 ? Kc, Whirlpool - $3.00 =Gas Piping Outlets - $1.50 (MINIMUM - 1 PER PERMIT) Softener - $5.00 Welt - $10.00 Private Oisp. - $10.00 :3--Rough Openings - $1.50 FEE: STATE S/C: ' ??GRAND TOTAL• `'? ? ? 5C INSPECTION RECORD CITY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: Eagan, Minnesota 55122-1897 Date Issued: (612) 681-4675 SITE ADDRESS: APPLICANT• . idrl •YI VAiV1A nVF ;;I/hFi-111,'Ii +I.A1.l 0.1,'1 PERMIT SUBTYPE: TYPE OF WORK: HC'•( 1. [f'T 1014 @,? & . ., ._ . ._ .. ... , ......', ... .. . .. ... ... .:....i .. . . ? . . ...? ' .. . I .: :. £ ? .._.I ? t_ . ? .. ... . ..... V., n: ...? i; #?11? N K ?i : Ft F{3 l) f, t I' 001 lE I i t A N1 Ft r? E. '.- •>? tiN-3 倉牥業⁴潈摬牥䐉瑡॥敔敬桰湯ണ倊啌䉍义ेउ噈䍁उഉ䤊獮数瑣潩慄整䤉獮䌉浡敭瑮൳䘊住䥔䝎॓उ但乕ॄउ剆䵁义ेउ佒䙏义ेउ佒䝕ൈ倊啌䉍义ेउ䱐䝂䥁⁒䕔呓उഉ刊問䡇䕈呁义ेउ䅇⁓噓ൃ吊卅॔उ义啓ौउ奇⁐佂剁ॄउ䥆䕒䱐䍁ॅउ䥆䕒䱐䍁䄊剉吠卅॔उ䥆䅎⁌䱐䝂उഉ䘊义䱁䠠䝔उഉ伊卒呁䕔呓उഉ䈊䑌⁇䥆䅎ौउ佄䕍呓䍉䕍䕔॒उ剉䥒䅇䥔乏䕍䕔॒उ䱆单ൈ䴊䥁华उഉ䌊乏啄呃噉䥉൙吊卅॔उ奈剄协䅔䥔ൃ吊卅॔उ卂呍删䤮मउ卂呍䘠义䱁उഉ䐊䍅⁋呆ेउ䕄䭃䘠义䱁उ ? ,: • (gerfif iratp of (IDrrupttnry titp of (f agan ErpwWtrtd af WuMing JWrrfinn This Certiftcate issued pursuant to the requiremenls of Section 306 of the Unifonrt Building Code cenifying that at the tinie of rssuance this structure was in compliance with the various ordiirances of the City regulating brulding construction or use. For rhe folTowing.- Use Ctamfinoao ???/GAR Bldg. Permit No. -1600 1 o,,.„r,,,y Tya R3/M 1 Zoning DWM R I Tra co„L VN owwf ot e"osnQN= MIMST EriM ODR16_ 3902 MAARVATR DR, FiY'?AN B,a,d;,,e Aadr,. 4143 PMISYLVADIIA AVIIM L 15, B3. STAFM PLlCE ? a,te: FEBOJM ZT, 1989 Building ind POST IN A CONSPICUOUS PLACE T CITY OF EAGAN Permit No: 3830 Pilot KnBb Road g/ p No: tsy y y 7 P.O. Box 21199 ' Eagan, MN 55121- ' FRONRIER MDtiJES7 ROHES 12/30/88 ? Date: Date: 12128/88 Site Address: 4143 PEN!!S'iLVRi'IlA AVE., Ll S, 143, &TAFFORD PL Plumber. SIA? PLDG MWCC: 5550.00 City Chg: lOCr.Op pd No. of Units: A t D • ? .00 Rl cc . ep. I ag?ee to cumply wfth the City of Eagan Permit Fee: 14.04 Dd .30 Qa Ordinances. Surcharge: "p .C}L 1FE^ Misc.: By SEWER SERVICE PERMIT . . ... s . _- . , CITY OF EAGAN Permit No: Date: 3830 Pilot Kr¢ob Road• Meter No: Size: P O' B°'x 21199 Reader No: Date: Eagan, MN 55121 • Owner. Site Address: 4143 PEiaNS i'E,i?Ati 'LA kVE., 3, 153, S . ? -? ? Plumber. '?TAl2 PLBG Conn. Chg: ¢ 550.00 pd Acct Dep: - 15.00 n(! Permit Fee: 1 J. Oa a,t Surcharge: 50 pd Tr. Plant 704.00 ;)d Meter. = 7 : ^' nd Misc.: P'!V Zoning: _ No. of Units: I agree to comply with the City o! Eagan Ordinances. By CITY OF EAGAN Permit No: ?l' Date: 12 / 30/ 8S 3830 Pilo4 Knob Road Meter No: Size: P w P.O. Box 21199 Ck; PPAmeW No: ? Date: ?2 `1 `7 -kl Eayan, MN 55121 I Owner FRONTIER MIDWEST HOMES $ite Address: ?`i? r'T'"'''`Sy-LVAN1A AVF,., Ll 5, A3 , STAFFORD PL. Plumber • ?? Conn. Chg: f= ,sn _ nn PA 2oning: ?$1 Acct Dep: 15 ?o ?d No. of Units: Z Permit Fee: l(L nn pa Surcharge: 51] wi I agre fo c0mp4y Tr. P1ant2g4?g0. ?.? Or ina es. Meter. A7 nn pd i MISC.: ,-P-E% R'r'.t!tfIRFD gY WATER ? ???11? RESIDEN7IAL BUILDING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB RD - 55122 657-6874675 New ConaWCtion Reauiremanb • 3 registared sAe surveys showirtg sq. %. of lot, sq. ft of fwuse; and all roofed areas (20%marimum lot cwerage allowed) • 2 copies of plan showirg beam & window s¢es; poured lound design, etc.) • 1 set of Energy Calculalions • 3 copies of Tree Preszrvation Plan i( lol platted after 7/1l93 • Rim Joist Delad OpGons selection sheet (Wdgs wiN 3 or less unils) RemodaVRaoair Reauiremenls • 2 copies af plan • 1 sel of Energy CalculaGons for heated additians • 1 sile survey kr exterior add'Nons & decks • Indicate if home served by sepUc system for additions DATE 11-13-07 VALUATION $6,300.00 #117 ? \Sv JOB SITE ADDRESS 4143 PennslYVania Avenue Eagan, MN 55123 IF MULTI-FAMILY BUILDING, HOW MANY UNITS? PROPERTY OWNER Jerry & Bette Wheeler TYPE OF WORK (5) wrNnnw RFPI'Af.FMFNTS FIREPLACE(S) _ 0_ 1_ 2 APPLICANT Mon-Rav, Inc. John Bower PHONE# 763-546-9625 ADDRESS 801 Boone Avenue North Golden Vallev. MN ZIPCODE 55427 PAGER # CELL PHONE # A19_3Rfi_(,95q FAX # 763-546-8977 NEW RESIDENTIAL BUILDING ONLY - FILL OUT COMPLETELY EnergyCode Category MINNESOTA=RULES 7670 CA'TEGORY 1 (check one) - Residential VentilatiortCategory 1 Worksheet Submitted - Energy Envelope Calculations Submitted MINNFSOTA RULES 7672 - New Energy Code Worksheet Submitted Plumbing Contractor: Phone #: Plumbing System Includes: Water Softener Lawn Sprinkler Fee: Water Heater No. of R.I. Baths No. of Baths Mechanical Contractor. _ Mechanical System Includes: Sewer/Water Conhactor: _ Air Conditioning _ Heat Recovery System Phone # Phone # $90.00 Fee: $70.00 All above information must be submitted prior to processing of applicaUon. I hereb`y acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicanf Certificates of Survey Received _ Tree Preservation Plan Received ? p? 4re0V I II h 11 D Updated 1/01 OFFICE USE ONLY I ? 01 Foundation ? 02 SF Dwelling ? 03 01 of _ plex ? 04 02-plex ? 05 03-plex ? 06 04-plex O 31 New ? 32 Addition ? 33 Altera6on 0 34 Replacement Valuation _ Census Code _ SAC Ur.its . : Nbr. of Units _ Nbr. of Bldgs _ Type of Const _ ? 20 Pool ? 21 Porch (3-sea.) ? 22 Porch/Addn. (4-sea.) ? 23 Porch (screened) ? 24 Storm Damage ? 25 Miscellaneous ? 30 Accessory Bldg ? 31 Ext. Alt - Multi ? 33 EM. Alt - SF ? 36 Multi ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding ? 36 Move Bldg. ? 42 Demolish (FOUndation) ? 45 Fire Repair ? 37 Demolish (Bldg)• ? 43 Reroof ? 46 Windows/Doors 'Demolition (Entire Bldg oMy) • Give PCA handout to appiicant Occupancy MC/ES System Zoning City Water -- ? Stories $ooster Pump Sq. Ft. PRV Length Fire Sprinklered W idth REQUIRED INSPECTIONS Footings (new bldg) Footings (deck) _ Footings (addirion) _ Foundation Drain Tile -' Roof Ice & Water Final Other Framing _ Pool _ Ftgs _ Air/Gas Tesu _ Final Fireplace _ R.I. _ Air Test _ Final _ Siding SNCCO Stone Insulation _ Windows (new/replacement) Approved By Base Fee Surcharge Plan Review MC/ES SAC City SAC Water Suppiy & Storage S&W Permit & Surcharge Treatment Plant Plumbing Permit Mechanical Permit License Search Copies Other ' Total ? 07 OS-plex O 13 16-plex ? OS 06-plex ? 16 Fireplace ? 09 07-plex ? 17 Garage ? 10 08-plex ? 18 Deck ? 11 10-plex ? 19 LowerLevel ? 12 12-plex Plbg_Y or_ N FinaUC.O. _ FinaUNo C.O. Plumbing HVAC Building Inspector CITY OF EAGAN ic 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHONE:454-8700 1 y BUILDING PERMIT Receipt#_ To be used for SF DWG/GAR Est. Value $94, 000 Date DECEMBER 28 1988 SiteAddress 4143 PENNSYLVANIA AVE. Lot 15 Block 3 Sac/Sub. STAFFORD PLACE Parcel No. a Name FRONTIER MIDWEST HOMES CORP. zAddress_3902 CEDARVALE DRIVE - - - o City EAGAN phone 454-0433 o Name_ 0a Address ? City_ ?a "W Name_ wW i? Address U Q W Clty_ I hereby acknowledge that I have read ihis application and state that the information is correct and a9[ee to compl wi II applica6le State of Minnesota Sfatutes anC City?o7??Ea n r a Signature ot Permittee ( . ___ _ A Building Permit is issued to: FRONTIE DWEST HOMES ontheexpressconditio ihalallworkshallbedoneinaccordancewithall applicable State of Mi n ota Stalu and City ol Eagan Ortlinances. Building ONicial_ OFFICE USE ONLY On Site Sewage _ Occupancy R_3 /M_1 MWCC System X Zoning R-1 OnSiteWell (ACWapConst V_N Ciry Water X (Allowable) Q.-N PRV Required X # of Stories Booster Pump _ Length 5,5 Depth ?G S.F. Total Footprint S.F. APPROVALS FEES Engr./Assess. Permit 550.00 Planner Surcharge 47.00 Council Plan Review 275.00 Bldg. OfL SAC, City __iQO iQO Variance SAC, MWCC 550.00 WaterConn. 550-00 Water Meter 67 _ OD Road Unit -32$?0 Q Trea[ment P1 204.00 Parks TOTAL $2668.00 kOBK CCMPI.ETED BEFORE PLR?ffT WAS APPLIID FOR CITY OF EAGAN ??01 95 3830 Pilot Kno6 Road, P.O. Box 21-199, Eagan, MN 55121 - BUILDING PERMIT . PHONE: 681•4675. /? p, ?J ? 1? ?? ?J il Receipt # (, To be used for BASEMENT FINISH Esc Vatue Date MAR 5 , i s 9? Site Address 4143 PENNSYLVANIA AVE Lat 15 Block 3 SeGSu6. STAFFORD PLACE P8fC81 N0. Occupancy zoning Name WILLIAM SIFONTE (ACluai)Const W AddfESS 4143 PENNSYLVANIA AVE (Allowable) ? City EAGAN MN Zjp 55123 o htories L O e 9 Phone 688-6065 oepcn S.F. Total Q N9me SAMF 0 S.F. Foolpdnts ? Address Sile Sewa e O j n g atY ZIp On Site Well ? Phone MWCC System Q Cily water v Vcef1Se # PRV Required I hereby acknowlege that I have read Ihi calion and state that the ' Booster Pump informafion is correct and agree to com applicable State o! t h alf a ?j Minnesota Statutes and City o agan r SignatureofPermitae APPHOVAL5 LLIAM SIFONTE A Building Permit is issued to: Planner on ihe express condilion that all work shall be done in accordance with all Couuil it applitable Sta1e ol Minnasota Statutes an d y ot Eagan Ordinances. C Bldg. Olf. ? -y / h BuildingOHicial* ?J1,tl( I?I?Lf variance OFFICE USE ONLY R-3 _ Bldg. Permit Surcnarge PWn Revien Licerse snc. cicy SAC,MCWCC W ater Conn Water Meter Acct. Deposit SIVJ Permil 5/VJ Surchatge Treatmanl PI Aoad Unit Park Ded. Copies TOTAL FEES 35.00 .50 35.-J0 t Request Da11?¢ " e ? 1? -` ? Fire No. Pough-'m InsOeclion Requirea? ves - No ? Reatly Now 'C(Will No?ity Inspector ? W?en Reatly? I -`licensed contractor -r(owner hereby request inspection of above electrical work at: JoD Ad s ?SVeeL Bor floule No.j ?I or?f3 (?1„ac? ?L L Ja,?.fi Ciry AcrA Mn1 Seclion No. Towns?ip Name or No. Ranqe No. Counry Occupant(PRINT) 1 i Q • ^ r 0 Phone No. - Power SuOPlier Atltlress Elec ncal Comraclor ICOmpany Neme? omto wn c1^ Canirac?ors License No. MaiLng q.eress ( ConVacror or Owner Makmg inslallaliont Pf Pr-.r s?.? _ _ A u?COalraclo•ioe? k? YI Inslaliation? Phone Number 6gg bo ' MINNESO?TA STqTE BOARD OF/EfECTRICITV THIS INSPECTION iiEQUEST WILL NOT Griggn-Midwey BIEg. - RoomfS.173 - BE ACCEPTEO BY THE STATE BOARO 1831 Universiry Ave_ SL Paul: MN 55104 • UNLE55 PROPEF WSPECTION FEE IS Phane1813)6dY-0000 ENCLOSEO. RF?UEST FOR ELECTRICAL INSPECTION ee-aoom-oe ? SBB,`5lrucfio0s fol cOmpl2ling tM1'i510frn an bOCk ol yBllOw copy- "X" Below Work Covered by This Request ew TypeofBUilding AppliancesWiratl EquipmeniWiretl y Home Range Temporary Service Duplex Water Heater Elect6c Healing Apt. 8uilding Dryer Olher (Specity) Comm.Rntlustrial Fumace Farm Air Conditioner ONer (sVecity) Condraclors Pemarks'. ? ?AS?,n?1T hJN? uHCUV?cED Compute lnspecfion Fee eelow OU.&Eg I ?QE C?NCE+q?'? ?1Z't l71A ILWE7nF3? # Other Fee # ServiceEntranceSize Fee # Circuits/Feeders Fee Swimming Pool O 10200 Amps 0 m 100 Amps Transformers Above 200 _ Amps Above 100 _ Amps SIg05 Inspectar's Use Only: TOTAL irrigation Booms Special Inspection Aiarm/Communication THIS WSTALLATION MAY BE ORDERED DISCONNECTED IF NOT Other Fee COMPLETED WITHIN 18 MONTHS. I, the Electrical Inspector, hereby certify that ihe above inspection has been made. Rouqn*,o oaca Fnal Date ?O OFfICE USE JNLY This repuest voiC 18 monIDS trom Th's repuest void 18 mpn(hs tmm Hequ¢st Dale Fire No. Rouph-in Insper,[inn A ired? oFeady Now Will Notify Inspec- Ycs ONo Ior When Feady icensetl ElecVical Contractor I hereby raqueat inapeetion of above ? Owner elechicel wark inslalled et Sheet Addfess, Box or flou o. City N ! ectron o, ? 7ownshi0 Name ur o* flanee No. Co nty Occuu t(PP} NT) Phone No. /Df 1 / '4?iuLD Power Su0 ie Atl dress ? R e? ? y ?f" v r1 Electrical Co,n[r?ctor ICO?n?ame i /) Ai j /l / t Cont( tor's Licpnse No, t'/ (7 Mailinp Atl ess (COmractor or Owner Makiny Ins ationl rJ Authorize S ignature ICOnhacmd0 ner Maki stallaGonl ` Phonn Number yYa ?YS?3 MINNESOTq STATE BOARD OF ELECTqICITY TMIS INSPECTION REQUEST WILL NOT Griggs.Midwey Bldg. - Room N•191 BE ACCEPTED BV THE STATE BOARD 1821 University Ave.. St. Paul. MN 55106 UNIESS PPOPER INSPECTION FEE IS Phone(612)642OBW ENCLOSED. REQUEST FOR ELECTRICAL INSPECTION . ea-ooooi-os , Sea nseruc[ions for comOleYng this fnrm on back ol vellow caPy. u "X" Below Work Covered by 7his Request Now, Add ReD. Tvon of Builtling Appliuncea Wired Equiument Wired Home Range Temporary Service Duple.x Water Heater LiGhtiny Fiztures Apt. Buildmg Dryer Electric HeaUn Commercial Bldy. Fumace Silo Unlonder Industrial BIAg. Air Conditioner Bulk Milk Tank Farm om?, pr,, y oin.:, isucnivl , ur Snecity Ot er Other Compole lnspection Fee Below M Fea ServiceEnhencaSize H Fee FAnders/5ubteeders N Fne Circults 0 to 200 Am s 0 to 30 qm s 0 tn 30 Am A6ove 200 qmps 31 to 700 Amps 31 to 100 A s Swinvning Pool Above 700_Am s nnove 100_Amps Transiormers Irngation Eiooms Partial.'Other Fee Signs Suecial Inspection pemarks ? TOTAL FEE Roueh-in Da??? . fhe ElecVical ? Insoacloq heraby certity tha> >he above Final ( D;?e ? 4ingpection has been ??°?l ?? n J made. fltla repueat voiC 18 monthe irom 1988 BUILDING PERMIT APPLICATION - CITY OF EAGAN SINGLE FAMILY DWELLINGS 1?bD 1 INCLUDE 2 SETS OF PLANSt 3 CERTIFICATES OF SUAVEYO 1 SET OF ENERGY CALCULATIONS NOTEa ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WFiICH ADDRESS IS DESIRED. NO CHANGE3 WILL BE ALLOWED ONCE BtlILD2NG PERMIT IS ISSUED. MULTIPLE DWELLINGS RENTAL QNITS FOR SALE UNITS 6 OF ONITS INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SURVEY - CHECR WITH BLDG. DEPT.v 1 SET OF ENEAGY CALCULATIONS CONAfERCIAL INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS, 1 SET OF SPECIFICATIONS AND 1 SET OE ENERGY CALCULATIONS ? To Be Used For: ??rnN1raucrTnN Valuation: ? Date: 17/f1Q/RR Site Address 41Ql pFNNGYIVANTA AUF Lot jr,_ Block -1_ Parcel/Sub ?pFFnvn pi nrF Owner OIFOWTE, 1.I.I.1 jGM Address 3575 I_FXTNGTON AVF SO_ #918 City/Zip Code EAGAN 55193_ Phone ' fiRfi-6(1fi5 Contraetor FRf1NTiFR MTf]WFST Hf1MFS f'ORP_ Address 3909 CFf1ARVAI F DRIVF City/Zip CodeEpf,AN 55197 Phone aFa_naql Arch./Engr. pHTI I iPC PI ON CFRVif.F Address 14Fl(1 PFNNf1f.K AVF City/Zip Codepppl F 1IAI IF( FF124 Phone # - 439_2044 ciqI600_ or'r-icE usE oNLz On site sewage_ Oceupancy p. 3 A?_I MWCC system L?- Zoning On site well Actual Const V- N City water ? Allowable V- N PHV required ? # of stories Hooster Pump _ Length 55 ? Depth 3y 1 S.F. Total Footprint S.F. APPROOALS FEES EngrlAssess Permit 5?,b Planner Surcharge y Ob Couneil / Plan Review , Bldg. Off."Jj??3 SAC, City 0, Variance SAC, MWCC Water Conn ?D Water Meter ? Road Unit , pD Treatment Pl d4 ?O Parks Copies , TOTN. ?n e.x......'s. ........ i ?. . 1 ?! , 041NER _ SITE AD EXTERIOR EYVELaPE AYERAGE "U" COMPiJTATION !.. I.QR???; ?t?! Zx? CONTRACTOR DATE PNONE Oeternine wor{cing square footage of each. i. Total exposed wall area ...... a- 5-77 __ sq. ft. x •II =? 2. Tatal roaf/ceiling area ...... sq. ft. x •Ou= 3. q Total exposed wall area ahove fSoor = SL C) d$ a. Total walt window area ..................:........ 1.-7 5 b. Total door area ................................. s9 ' c. Total sliding giass door area ................... -10 d: Total fireplace wall area ........................ - g. Tots7 rim joist area ............................ 951 e. Total wa11 framing area (average 1Qa)...:......:: =? f. Tatai ne:.;va'fl area above f7aar ............... Total exposed foundation at-ea = ?g . h. Total foundation window area..................... G/ i. Taal net foundation area a6ove arade ............ loq- Detenairse "U" value o` each wali segment. a. 1-75 X 3lull 5(v b. ?,9 X "U" . ?s = f T55 c. ?Ib golUet .31 = ? 3.a d. X "U" _ e.gflues D73 = I 3.oS f. 15-I5.?-,z X "Ulg ?D% = 59,8s 9. ?S I X „u„ h. G x„u,l . ?/? = y? 3 Z i. [09 gilu'. .?_ = I S, 2(0 3 ..........................:..........Total If item #3 is the same as, or tess than item #1, you have met the intent of SBC 6006(c)2. , Total exposed roof/ceilina area =' q 11 Total gross rnof/ceiling area = J. Total skyiight area ....................... k. Total roof/ceiling framing area ............. ?rf - -7 7. Tota1 net insutated roof/ceiling area....... 4'ca S.3 _ 4eternine "ll" value for e=ch roof/c=iling segment. 3• X "U" k. q\.Jl X"U" 9 1.1?'ja5.7> X 'lull .D19 4 ..................................Tota1 = 7.4 If totaT of R4 is the same as, or less than #2, you have me# tfie intent of 5BC 6006(c)T. To utiTized the total envelope system method, the values.esta6lished by the sum of items a3 and 14 shall not be greater than the svm af iteRS 11 and n2. .ti-7 + 2. 3. I.2b + 4. Zo&.23 MATE82ALS Exteriar 9ir Siding Materia1 Sheathing Insulatian Sheetrock Interiar 3ir Studs Ri.m Conc. Blks. T.kerm. Eesistance "R" .IZ .(ol S. o 1 50 Cab zx(? /.a1 2,10 1 F4 IR ,. /• a g .•.. L4?D tFFj i._rv,o C=r.=_? 2. 3 D ii- ? a _ _ c ? 3. wr.cd z -•? -- ' ?D • g? a. 3(y" TN-`c?Ry 5i? g. S IOIN G •GZ 6. Exte icr a? ?`la • 0.17 = Toesl ? 3-.Z 1 • , . U ? , oZ3 1. Inte=lo= a; -_s_2= • 0. 68 . 2.. ?? 4'tP3p • •45 3.. (P" ??lq ?i?5?1 14.0 4. 3/4" T 61?(Z`M?? 5.0 5. ot iwi? .?Z. 6. Ex:er:o= a= =i1M 0.17 Total 2 ' 1. Znterio- ai- film O.68 Z? 2. .O 3. ZX?O _)OIST a. 7a?An?91( s. o?r?c' •?Z 6. Ex'?erioz zr fi? 0.17 . . Total a-7 ; 3b U= • ],. Znter=cr a:.. gt lm ' 0. 68 2. 1 R1C?ID t I •?° . 3. • 4. ' GONC WG 5. • ? • b. Ex?erior air filas ? 0.17 Toe? • • ? . 1 'G?ADE • ? ???'?/1t ? 1( /? . • ? ? .'? ? r, ? • . • !rr " ? ' 6.• •. ' ?i, = ' .. • . ?!?^. F26. #4 ` ? ? 1fI ? T ? ?/ ' I. ?Ci ? ,•? • ? • ??? C fCC y (fl ? . . cte?`4 a^.L ? Q ` • ? : ?? . . b ? . STAN ?:A'r-L - i • ...?-• ?;g: ?3 C? =i"?C'_? v:.? ?"3 "' ?' . `? ?\ • ???.?«1???(,?,t1?111`1? ? -- ..r 1-%cad i pea[ flncr _ up • , •. Fsc. C5? , ' . . , : , .. COR3? . R?v1ZltC I. Intc-?c: a'_r f:la 0.6Z . ?. R ? ? ?n • ?,? 3. IAJSU . &S n ?.ln W A. ESctc:ior air Ei2ra tseill) 0 T • ' ' • . . • ' V= .?lg 1. Interior air lilm 0.61 2. G-? F3 D 3. !?.l 2xy SUL ' 4. _ Extcrio_ air fiLn (sc;t ai ? , --, . TocaL 2 _ -/0- i: , ; . ? ' • .U = . i [o.l.SrrR?CT/ e>` • 2, Insldc air film 0.61 2 . 3. ' . . 4 ? . . $, Outs?de air filsa 0.17 To wl ?X ??•-r ? . . . . . y Znsidc air ti2m 0'6: 2 . 3 ' • . . d - g? osstsidc air film o.l ToGal. ? . ],. . ... • Ias£de air film ' 2. ' 3. ' 4- 5, Gtit?idc ?ir Eilm o.l Sota1 , ? ..• . . . ? • . • . Notc: Usa adc'itfnasl ^•he=er i . marSC? ..aecde3 Sar detaiL,' ssd ca , . . . . ? t. ? '2.zat llov ap • • ? ? =•venttd . •• f, • • • . , . . rl S 1 .`1 J ?? J . ? ?. . ?? ? • `? ?(' , 3 , ?• •? ? $eaC ? . • . `• flcv ag ' ',• . •: ' . . ? . _+ pSC;- . •. .• L 'ktisRL Ft. ExPOSO-o UJq-L-L ?toc? . ??s lt? . C? • ?- ?,1\ ??It Z '. 105 F ? ?ze,p \?-z = a5-1 S q c?RaZe 1 ktack KNee w_o • Fo?` 1 ?--o i l 2 F;a.ef lA ce. ?t vl-?, ; l05 ^?xpose70 c+.9Ao1 A;e.2,4 X g = ? i(as g ?to ? g - ` L6, 1 x 1 -? r- rj ci t1 Ape ToTF?L R3`1-7 u,);?N po w 5 5 YQ ? l`l5 pclop-s s? 35 Pa+?o P«?5,15. </o ? z?o CITY OF EAGAN 1992 BUILDING PERMIT APPLICATION 681-4675 SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy calcs. COMMERCIAL 2 sets of architectural & structural plans, 1 set of specificatians, 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 3 / 9 Valuation of work Site Location: 414 3 ??,.r? S.?L??N,??1,. ?'??• STREET SiE tl W 1 N-C) Tenant Name: LOT 16 BLOCK SUBD.?, r? x.u P.I.D. # Descri tion of work: The applicant is: A`Owner ? Contractor ? Other coescrsbe> Name Sr -1-o?32j (.l) t? ?I l+rn Phone?Vf< 6a6S _ Property LAST ' FIRST Owner Address 4I 1?3 P<--j r?.c L N?, ? STREET STE # City iA--j State Mt?J Zip Company Phone Contractor Address License # 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 hi,? application and state that the information is correct and agree to comply with all p) cable 5tate of Minnesota Statutes and City of Eagan Ordinances. ^? I , / ! r ? inu rA Signature of Applicant: CJYV" BUILDING PERMIT TYPE ? 01 Foundation 0 02 Single Family ? 03 Two-family ? 04 Multi-fam. T.H. ? 05 Apt. Bldg. WORK TYPE ? 90 New O 91 Addition ? 92 Alterations OFFICE USE ONLY ? 06 Garage/Accessory ? 07 Fireplace ? 08 Deck O 09 Basement Finish ? 10 Swim Pool ? 93 Remodel ? 94 Repair ? 95 Tenant Finish ? 11 Res. Add./Porch ? 12 Comn./Ind. New ? 13 Comm./Ind. Add ? 14 Comm./Ind. Rem 0 15 Public Fac. 11 56 Move ? 97 Demolish ? 99 Undefined GENERAL INFORMATION Occupancy Zoning Const. Actual) (A1 owable) # of Staries Length Depth APPROVALS Planning Engineering REQUIRED INSPECTIONS ? Site ? Wallboard Basement sq. ft. lst Fl. sq. ft. 2nd F1. sq. ft. Sq. Ft. total Footprint Sq. ft. On-site well On-site sewage Building Variance ? Footing ? Final ? Framing ? Draintile ? Insulation ? Fireplace Permit Fee Surcharge Plan Review License MWCC SAC City SAC Water Conn. Water Meter Road Unit Treatment P1. Road Unit Park Ded. Trails Ded. Copies Other Tatal vawac;m: $ r ? t? ? 16 Agricultural ? 17 Building Move ? 18 Demolition ? 20 Miscellaneous MWCC System City Water PRV ReQuired Booster Pump Fire Sprinkler Census Code SAC Code Assessments SAC % SAC Units L BL SUBD. CITY OF EAGAN PLiIMBING PERMIT (612) 681-4675 RESIDENTIAL PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAHILY DWELLING5 WHEN PERMITS ARE REQIIIRED FOR EACH UNIT. ----- --°------------- ------------------------- NO WORK DESCRIPTION NEW CONST _ ADD ON _ REPAIR _ OWNER NAME : LO i I? I Ar'n SL to IS (-e- SITE ADDRESS: ?? 7 3 v p?jajSv?l V AJ INSTALLER: ob f+_? y3 A-do J CITY USE ONLY RECEIPT # ALSO, FOR TOWNHOMES AND CONDOS COMPLETE THE FOLIAWING: FIXTURES EA. TOTAL REPAIR/ADD ON 15.00 SHOWER 3.00 _ WATER CIASET 3.00 SATH TUB 3.00 IAVATORY 3.00 KITCHEN SINK 3.00 IAUNDRY TRAY 3.00 HOT TUB/SPA 3.00 WATER HEATER 3.00 FLOOR DRAIN 3.00 GAS PIPING OUT. (MINIMUM - 1) 3.00 ROUGH OPENINGS 1.50 OTHER WATER SOFfENER 5.00 PRIVATE DISP. 15.00 U.G. SPRINKLER 3.00 W. TURNAROUND 15.00 STATE SURCHARGE .50 TOTAL: s COMMERCIAL PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS. ALSO FOR MUI.TI-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 jj: FOR: CITY OF EAGAN CONTRACT PRICE: 1% OF CONTRACT FEE. STATE SURCHARGE - $.50 FOR EACH $1,000 OF PERMIT FEE. $25.00 MINIM[7M FEE. CONTRACT PRICE x 1% $ STATE SURCHARGE TOTAL: (SIGNATURE) ADDRESS: CITY: C QC7A_r3 ZIP: ?SI1.3 ? CITY OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55122-1897 (612) 681-4675 SITE ADDRESS: P.T.N.: 10-72500-150-03 PERMIT PERMITTYPE: aurLntNG Permit Number; 032811 Date Issued: 0$/ 0 7/ 9 S 4143 PENNSYLVANIA AVE LOT: 15 BLOCK: 3 STAFFORD PLACE DESCRIPTION: RERpQF ermit 7ype STORM OAMAGE brk Type REPAIft 434 ALT. RESIDENTIAL F avag. c ft v B REMARKS: REROOF DUE TO STQRM DAMflGE. FEE SUMMARY: ? ? CONTRACTOR: - appitcant - sr. Lzc. OWNER: TOP GUN ROOFING 14284559 0003388 WHEELER JERRY 5014 PARRISM AVE NE 4143 PENNSYLVANIA ROGERS MN 55374-9009 EAGAN MN 55122 (612) 428-4559 APPLIGANT/PERMITEE SIGNATURE . 1998 BUILDING PERMIT APPLICATION (RESIDENTIAL) CITY OF EAGAN ? - ? _ ? ? 6 3830 PII.OT KNOB RD - 55122 fi81-4675 New Construdion Reauirements RemodeVRaoair Reauirements . ? 3 registered sde surveys ? 2 copies of plans (inGutle beam 8 window sizes; pouretl fnE. design; etc.) ? 1 energy caleulations ? 3 copies of Vee preservation plan A lot platted after 7f1193 required: _ Yes _ No DATE: 4y/ 4 / C?? T ?/} n DESCRIPTION OF WORK: _ 115 ? .-a"I1o'Y ?i STREET ADDRESS: ? 2 cnpies of plan ? 2 site surveys (exterior addkiana 8 decks) ? 7 eneigy wlculations tor heated aCdRions CONSTRUCTION COST; !Z000 )Q Q, S+r) r V1'? n Cljyv,,? Q LOT: I 'S- BLOCK: ? cUt3D./P.I.D. #: Name: Phone #: PROPERTY Last First OWNER .. . 1, - r, er CA- StreetAddress: / fJ L° City /` 9-4 !e: Y? State: _?? Zip: Company: 12 Phone #: CONTRACTOR Street Address: rr 1'S ?Ay License # ?Z? City R" ??w VS ? State: Zip: L?37!1?rp&2? T ARCHITECT/ ENGINEER Company: Phone #: *•'ame: Regist*ation #: Street Address: City State: Zip: Sewer 8 water licensed plumber (new construcGon only): . Penalty applies when address chang and lot change is requested once permit is issued. I hereby acknowledge that I have read this application and state that the information is correCt and agree to comply with all applicabl State of Minnesota Statutes and City of Eagan Ordinances. // , OFFICE USE ONLY Certificates of Survey Received _ Yes Tree Preservation Plan Received Yes Signature of Applicant: ? r _ No ' _ No _ Not Req ir BUILDING PERMIT TYPE ? 01 Foundation ? 06 Duplex ? 02 SF Dwelling ? 07 4-plex ? 03 SF Addition ? 08 8-plex ? 04 SF Porch 0 09 12-plex ? 05 5F Misc. ? 10 = plex WORK TYPE ? 31 New ? 33 Alterations C] 32 Addition L'1 34 Repair GENERAL INFORMATION Const. (Actual) (Allowable) UBC Occupancy Zoning # of Stories Length Depth APPROVALS Planning OFFICE USE ONLY ? 11 Apt./Lodging ? ? 12 Multi RepaidRem. ? ? 13 Garage/Accessory ? ? 14 Fireplace ? ? 15 Deck ? 36 Move ? 37 Demolition Basement sq. ft. Main level sq. ft. sq. ft, sq. ft. sq. ft. sq. ft. Footprint sq. ft. Building Engineering Variance Permit Fee Surcharge Plan Review License ? MCNVS SAC City 5AC Water Conn. Water Meter Acct. Deposit SNV Permit S/W Surcharge Treatment PI. Park Ded. Trails Ded. Other Copies Total: Valuation: $ 16 Basement Finish 17 Swim Pool 20 Public Facility 21 Miscellaneous MC/WS 5ystem City Water Fire Sprinkiered PRV Booster Pump Census Code. SAC Code Census Bldg Census Unit % SAC SAC Units APFLICATION f=OR PERMIT SEWER ANDJOR WATER CONNECTION , , .. .. , ,. . hUTE: PAM= OF M AT TIME OP .. f APPLICATION WFS Ndf CON- y*, w SPI7(T1E ]1PPAVJAL OF PFFNIIT. ? r i INSPECl'SON OF SETW32 ADD/Oi 4U,'fIIt M ?*. ? II1ST'ALIATIO[1S WII.L NOT BE S=31M ? LTIlIL PII2PIIT F1Au HEQd APPRWID. ? lu?W f++++??riffteerxfa?f+?+r?rWeiyt?+fsr?? ity oF eagan (P E PRINT 1) PROPII2TY ADDRESS: 4141 pFNNSYIVANIA AVF TFGAi DE.SCRIPTION:. ? Lot B ock 5 ivision or Tax Parce ID IF EXISTIWG STRL'CT[JRE, DATE OF ORIGINAL HUILDING PII2MiT ISSUANCE: N/A Mont Year PRESENT ZONING/PROPOSID USE: Q COMPCEtCIAL/RETAIL/OFFICE Q IDIDCSTRIAL ? INSTITUTIONAL/GOVERDIIMENT Iu R-1 SINGLE FAMILY ? R-2 DLPLEX ('i4,o 'nits) ? R-3 'POWNHOOSE (Three + L'nits) ( Units) Q R-4 APARTMENT/CODIDOMINIUM ( L'nits) z) ss ?A' NAME: FRf1NTTFR MiDWF$JJiOMFS CORPORATiON ADDRESS: 3902 CEDARVALE DRIVE CITY, STATE, ziP: EAGAN MN. 55122 PHONE: 454-0433 3) rAME= STAR PLUMBINC ADDRESS: 1018 MOUND SpRINGS TERRACE CITY, STATE, z2P: BLOOMINGTON_ MN 55420 PHONE: 884-4149 MASTER LICENSE # 3329 4) NAME: SIFONTE. WILLIAM ADD1xES5: 3575 LEXIN6TON AUE SO_#218 CITY, STATE, ZIP: FAGAN_ MN_ 55123 PHOIVE: 688-6065 elumpers Lacense: ij P,ctive Expired Not recordec St Ia niaT- 5) s ?, w ?•??? ? ae Ea C1ONNECTION TO CITY SEWER [jD CONNECTION TO CITY WATER O QTHER 6) ? 12/09/88 +?*,r?*xr?**rq,r******r?*,?4**?**********,t,t?t*,t:t**,tt+?****,t,t*****t**t* W *+*?:t**t*,tx*??ie*??***,t**??*w??*?,ty * * THE GOLII COPY OF THE PII2NIIT WILL BE SENP DIRDCIZY TO PU&LIC Wl7RKS TO FACILITATE MEPII? PICK-IIP. ? * PLEASE ALI.OW 'IWO ititIRKING DAYS FOR PROCESSING. 50P'IDONE FROM TM CZTY WIIS, CONPACT YOU IF TfIEE2E * * ARE ANY PROBLEMS. i ??******** r* *+r * *?+* **?x*?*,+*+r+?+**?**?*****,r*+** *,r** ?***?***,r**,e,r*****?*** *****,r+r********?,?+*?****; . FOR CITY USE ONLY PERMIT # ISSCED Pd w/Bldg. Permit FEES: .. $ $ SEWER PERMIT (INCLLDE SDRCHARGE) $ $ WATER PERMIT (INCLUDE SURCHARGE) $ $ WATER METER/COPPERHORN/OL'TSIDE READER $ $ WATER TAP (INCLDDE CORPORATION STOP) $ $ SEWER TAP $ $ ACCOUNT DEPOSIT - SEWER $ $ ACCOLNT DEPOSIT - WATER $ $ WAC $ $ SAC $ $ TRUNK WATER ASSESSMENT $ $ TRUNI{ SEWER ASSESSMENT $ $ LATERAL BENEFIT/TRONK SEWER $ $ LATERAL BE[VEFIT/TRUNK WATER $ $ WATER TREATMENT PLANT SLRCHARGE $ $ OTHER: $ $ TOTAL RECEIPT RECEIPT DOES LTILZTY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY? Q YES IF YES, THEN A"PERMIT FOR WORK WITHIN POBLIC Q ROADWAY" MOST BE ISSLED BY THE ENGINEERING NO DIVISION. LIST AS A CONDITION. SUBJECT TO THE FOLLOWING CONDITIO[VS; APPROVED BY: TITLE: DATE: December 30, 1988 STAR PLUMBING \ ^ ? [1 1018 MOUND SPRINGS TER BLOOMINGTON, MN 55420 REe 4143 PENNSYLVANIA AVE., L15, B3, ST9FFORD PLACE WARNING: BEFORE DIGGING, CALL LOCAL DTILITIES - TELEPHONE, ELECTRIC9 6A9t ETC. - REQDIRED BY LAW XX Your Sewer and Water Permit for the above property has been completed. ? It will be held at the Publie Works Garage (3501 Coachman Road) until the meter is picked up. BE SDRE TO CALL POBLIC WORKS (454-5220) FOR YOIIR PERMANENT WATER TURN ON. i Your Sewer and Water Permit for the above property cannot be completed for the following reason: _ Your Sewer and Water Permit for the above property has been completed, however, the meter cannot be issued or occupaney allowed until further notice. Sineerely, 1 ? Jan Severson Seeretary JS .--.. , , Awk Rets?de.,rhd UI/ho% Hoyse V{lorksizeet Cusamer's Name f1_z'Cmi £'e LS uJt. S i ,qddress ' . City State 2ip Talephone Num6ar WINTER:Inside DesipnTemp _ f ?q? °F-Outaide DeslpnTemp `ao °F ? NsatingTemp Dlffennee ? °F SUMMER: putaida Desipn Temp ?rL? °F-Insids Design Tsmp 7?' °F ? Cooling Temp Diffaranca c2d °F HEAT . ING .., . , . .... . .. ... ,.....,... .. ..,... ? r NE0.TING. r ??.:. . ••?•.•«•.; ? •.e ? .. . . -•.. ? ?j?, LOOl1NOirw.? ?( . ?? ? eTUNl055 fACTOfl ..y4.. FACTOR N6 IN+:.. $ ., GROSS WALL p /a US c1? .. /.3 DOpRS B WINDOWS (TableA or B)? S .G NETWALI ? Y f a o - __??? (o CEILING ? FIAORS ?- In???n?wn Hw?mp T o Wlun? Wlum? X I O X ,.,/m x x ? 1.1/eo x L'?T x Co o4n InlM?iw %0.78333 x I? ??,1t?1 ?? ' X 0.01833 xk7 % - ? ? SUB-TO7AL BTUH LA'S (per 70°FI x AOJUSTMENT FAC70R (Sa61e C) .. ` TOTAL BTUH LOSS - .. ` .f?. PEOPI x 30p BTUH GAIN w?c.oraortd APPLIANCES BTUH 1200 IjdN'„ SUB-TOTALBTUHGAIN(roomsensibleonly) - 1 a 1-4 X DUCT IASS/GAIN FACTOR (Tabie F) x ?? . a?i4?' • .?;'?;?i?;?t' SUB-TOTAL BTUH (Sensibie GaiN ? ? MOI5TUREREMOVqL(subto[al x 1.3) x 1.3 TOTAL BTUH LOSS/GAIN TABLeA-NEA7ING-DOORS 6 WOOD FRAME W{NDOWS (PER 10°fl Por allAing glass tloors - use Fuctors for 2he same type window consttuCliGO. Window B - Preme B Door 7 pea Wa d 71M Metul x Area . Btuh Lnss Singla Psne Clcar . 9.90 10.45 'y '?11:55 WilhStorm 75 525 `6. DouulePam Cledr 5.51 6.09 - ?25? SL} Wich S[orm ,qf :gp?, riplePane Clear 3.80 4.39 :.,-r.:.. '6;4¢y - '7alous?? singla . - .. --- ingle w storm -„y.0 ?; Sinr?le 11.07 11.69 !'?2y5T Double. 6.65 7.35 ?8W oo, WuutlOnly 4•60 ' Woodw/storm 3.20 UreihaneCore R- %7•;gps Ureihane Com IR.51w/scorm TOTALS TABLE 8- COOLING - DOORS @ WINUOWS ' Factora asaume windows have inside ahadinp by drAperies or venePBn blinda and sliding gless doon are troated as windows. . YxOLLOLY! DpY?I[ONY lIN'Y4NY wswn ' M rewr. onA ?bZ a?' 71 Ii a * Tu.?n wrr. ?Y :7?! s' W • Tun? onc '14:? a' ? 5? et 'ti. x? L .11xu14ou" Ni6MM 11 a?y 11 . i T • . \BW ?04: N 'q: M "tl r a' s :n: c[6sw a '; 10 :?i; a ?M N :a? 6 L. II atwixa ia at k% i$ w Iy " womO ? IDl ti? 0.1 1" 10.1 L? 10.1 L QQ Fo.hocadow.uw TOTALS r+i..nw. wm ?rm een? ? FaruntluncwsmsqlEOw? . . . TABLE 0 - INFILTRATION MULTIPUERS Winter Alr Chanpet Por Xour • ' FloorArm. BOOwIus 1100.1600 76M4100 s..r7700 Broi 0.4 bA 0.3 . 0.9 AvBrp6 . 1.2 1.0 0.6 0.7 Pow 2.2 1.8 1.2 1.0 foraNh faeplauaGtl: ' Bw Arra"' poor 0.1 0.2 D•6 TABIE C- ADJUS7MENT FACTORS - IHEATINGI •F. Tempora[uro Oi 50 5p 7p gp gp A,djus,mant Facmr 3 4 5? 6 7 _ B g Summar Afr Changes Por Hour FloorAna BOOorlm 900.7600 15m2100 ewItm emt 0.2 0.2 03 ?01 Awn+Be 0.6 0.5 . 0.1 0.1 Poor 09 0.7 0.8 QS E American SlanOard, Inc. 1986 Pub? No. 22-8DIS4 g,I ?Q 2004 RESIDENTIAL BUII.DING PERMIT APPLICATION . -+ City Of Eagan q? 3830 Pilot Knob Road, Eagan NIN 55122 D? Telephone # 651-675-5675 FAX # 651-675-5694 C?? -7 -1?-UI NewCoreWdionReaulremenLS 3 registe2d site surveys showing sq. R of bt, sq. ft of house; and all roofed areas RemodeliReoairReauirements 2 copies of plan ? 0 . e allowed) 20% mazimum bt covera 1 sel of Energy CalculaUons for healed addNOns g ( 2 copies of plan showing beam & window sizes; Poured found design, etc. 7 site survey for additions & decks i set of Energy Calculations Addibon - indkate Jf on-sde septic sysfem 3 copies of Tree Pmservation Plen H IM platted atter 711193 Rim Joist Dehil Options selection sheet (61dgs with 3 or less units Date C II` l? Construction Cost q Q0O • SiteAddress q «; L"";G UnitlSte # Description of Work &7w Multi-Family Bldg _ Y? N Fireplac s) 0 ? 1 _ 2 qzil? X dl Property Owner 7L'-/ /' WktL W Telephone D Contractor Address City State Zip Telephone # ( ) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING - TvIinnesota Rules 7670 Cateeorv 1 Minnesob Rules 7672 Energy Code Category , Residen6al Ven6laGon Category 7 Worksheet • New Energy Code Wwksheet (4 submission type) Submitted Submitted • Energy Envelope Calculafions Submitted Have you previously constructed a building in Eagan with a similar plan? _ Y _ N If so, 25% plan review fee applies. Licensed Plumber Mechanical Contr Sewer/Water Con' Telephone #( Telephone #( Telephone #( I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN Statutes; I understand this is not a pemrit, 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 wluch requires a review and approval of plans. We" VWI*,? " UG" Applicant's Printed Name ApplicanYs Signature OFFICE USE ONLY Sub Types ... . ? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg ? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi ? 03 01 of_ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) O 33 Ext. Alt - SF ? 04 02-plex ? 10 08-plex ip 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc. ? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage ? 06 04-plex ? 12 12-plex Pibg_v or_ N ? 25 Miscellaneous Work Types `P 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding ? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair ? 33 Alteration ? 37 Demolish Building` ? 43 Reroof ? 46 Windows/Doors ? 34 Replacement •Demolition (Entire Bldg) - Give PCA handout to applicant Valuation -0 Occupancy ? -3 MCES System Census Code ? Zoning City Water SAC Units Stories Booster Pump # of Units Sq. Ft. PRV # of Bldgs Length Fire Sprinklered Type of Const Width REQUIRED INSPECTIONS Footings (new hldg) FinaUC.O. ? Footings (deck) ? FinaVNo C.O. _ Footings (addition) _ Plumbing Foundafion HVAC Drain Tile Other Roof _ Ice & Water _ Final _ Pool Ftgs _ AidGas Tests Final _ Framing Siding _ Stucco _ Stone _ Brick _ Fireplace _ R.I. _ Air Test _ _ Final _ Windows _ Insulation Retaining Wall n 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 Totai . .. Jerry and Bette Wheeler 4143 Pennsylvania Ave Cell : (651) 4 85-3qy5g Uome ?C651)686-`bSy6 ? ? i ? / I tlk 7 ?°•q-a.t?-L ? ?uRiC 4Mp+{y? ? ? -?... / ? / N ? ? f I ' ? ?• ' i ? 1 2007 RESIDENTIAL BUILDING PERMIT APPLICATION City Of Eagan S.XLLt1 Qj 3830 Pilot Knob Road, Eagao MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 ? lz 90._ New ConsWCtian Reauiremenls 3 reqistered ste mrrvqs shwring sq. ft. of lot, sq. R of hwse; aid all rooled areas (20%maximiun lat covertge allowed) 1 Soils Repat'rf propased buikrirg is lo be placed an d6Wrbed mil 2 cropies af plan shawing beem 8 window sizes; poured found design, etc. i sM of Energy Cakulations 3 capies d Tree Preservadan Plan rf lat plalted after 711193 R'on Joist Delail Op6ans selection slmt (buildirgs wiM 3 or less unils) Mnnegasco mechanical ventilation faim A NEW BUILDING RemadeVReoair Reouirements 2 capies M plan shpxing faotlngs, heams, joals 1 sef of Enefgy CalculatiMS for heated additians 1 site survey for additions & detla Addltian -irMiceta i/on-site sep&sysfem Plans are considered ublic infiarmatioro unless ou state the are #€ade secret and the reason. Date / /? Site Address ??_??h C? Cons h ' Q (? ction Cost ??(? . og / ?h UniUSte # Description of Work ? W + ? 1 Multl-Family Bldg _ Y_ N Fireplace(s) _ 0 _ 1 _ 2 Property Owner ?!' ____? e(?-V- Telephone # (?51 ) ?' 86 ' ? ? ? ? Contractor Mon-Ray Inc i, nadress 801 Boone North State MN ? Zip 55427 city Golden Valley Telephone #(763 ) 544-3646 COMPLETE THIS AREA ONtY !F Energy Code Category - Minnesota Rules 7670 Cateeorv 1 submission fype) • Residential Ventilatlon Category 1 Worksheet Su6miited • Energy Envelope Calcula6ons SuEmttled Minnesota Rules 9672 • New Energy Code Worksheet SubmHled In ihe last 12 monihs, has the Ciry of Eagan issued a permit for a similar plan based on a master plan2 _ Y - N If yes, date and address of master plan: Licensed Plumber Mechanical Contractor Sewer/Waier Contractor I hereby apply for a Res Telephone # ( Telephone # ( Telephone'# ( Ofte Almonty CeROtSurvey$aA:: _Y _N Sa15 RepaE-, . _ V - _ N TreePtas plao'Retd : ?l' _N, TreePmsReqWrecl. _Y.: _?N On=sdeSepm.,rysfem _Y? _N that the information is cornplete and accurat that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approvat ofplans. ?14H?o 16/ e- (C Applicant's Printed Name p ?cant's Signature DO NOT WRITF, BELOW THIS LINE Sub Tvoes ? 01 Foundatlon ? 02 SF Dwelling ? 03 01 of _ plex 0 04 02-plex ? 05 03-plex ? 06 OMplex Work Tvpes ? 31 New ? 32 Addition ? 33 Alieration ? 34 Replacement ? 13 16-plex ? 16 Fireplace ? 17 Garage ? 18 Deck ? 19 LowerLevel ? 20 Pool ? 30 Accessory Bidg ? 21 Poroh (3-sea.) ? 31 Ext. Alt- Multi ? 22 Porch/Addn.(4-sea.) ? 33 ExtAlt - SF ? 23 Porch (screen/gazebo/pergola) ? 36 Multi Misc. ? 24 Storm Damage ? 25 Miscellaneous ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding ? 36 Move 8uilding ? 42 Demolish Foundation ? 45 Fire Repair ? 37 Demoiisn 8uiiding` ? 43 nerooT ? 46 Windows/Doors 'DemolWon (Entire 81dg) - Give PCA handaut to applicant D@SCrIptl011: Water Damage _ Yes ValuaUon Occupancy MCES System Plan Review. 100% or 25% Census Code Zoning City Water SAC Units Stories 8ooster Pump # of Units Sq. Ft. PRV # of Bldgs length Fire Sprinklered Type of Const Width REQLTI2ED INSPECTdflNS _ Footings (new bldg) _ Sheetrock _ Footings (deck) FinaUC.O. Footings (addiuon) _ FinaVNo C.O. FoundaIion HVAC Drain Tile Other Roof ice & Water _ Final Pool Ftgs Air/Gas Tests Einal _ _ Framing _ _ Siding _ Stucw Lath _ Stone Lath _Brick _ Fireplace _ R.I. _ Air Test _ Final Windows _ insulation _ Retaining Wall Approved By: Base Fee Surcharge Plan Review MClES SAC City SAC i.itility Connection Charge S8W Permit & Surcharge Treatment Plant License Search Copies Ofher Total ? 07 OSplex ? OS 06-plex ? 09 07-plex ? 10 08-p1ex ? 11 1D-plex ? 12 12-plex Building Inspector Atralors, Ccrtificatc SURVEY FOR: Frontier Plidwest Ilomes CorP. DESCRIBED AS: Lot li, 131oCk 3, S'I'AFrOrI? °I,P.CF,, City DC liag8tt, llaltotti County, h1innesota and reserving easectents o` record. ? ? ? 9,/J?N76-13'gOrN ?Sy ?A \ // / \ PROPOSED ELEVAiIONS Tap ol foundation ¦ 931,rj 6araqs Floor . q 3 i, I Baeemsnf floor 169z3.4 Apprax. $ewer Sarvles EHv.. y/T.S} Propossd Elarotlonf 0 <Z) Erratlnq Elavatione ? Orolnaps Oireeflone ? ...?r Danoles Ofisef Stake ? p lifEDLUND Plenning Englrreering Survsyhig mi un sie?w? ?m.w. rwwa. eH?e , -_ i ? i i i i i i i i ?Ole . ?9.? 39 ? 3 p Q ?l'^`j?en 4v /o v 2 / o cti . o>O ? 40 ?'"'c ? FP ' Gy? ` /o io , ? .. ,. ? / °9 , ' ?0j 1?? 6 ? 4 ? 73 yFN? ? N SCALE: i Inch • 30 Fset BENCHMARKI T.N. . ut4.wes4 Lor. Lof 25 !0leck 1 Pennr luawiq Ave. FiCv. - y?a. G?i I MIN. SE'fBACK REQIREMENTS Front - ? Hause Side - /D Raor - /5 6araqe Slde - S I Mrtbr Nrllfy flqt IMe wrw?. Plan a reperl was ynOOrN bp rm JOB NO.' er unAer my dheel suMrrblon anA Ihof 7 am e Aulp ReqbtoveA ggR-609 Lene sw..r« undv Me lors sf Me 8fa1e sf Minnessta. BOOK: 12, s,$s D. ?' PnoE: rVr in M, LIOMH aa3n c 0 m 2 0 cc UC ? ? v J PERMIT City of Eagan Permit Type:Building Permit Number:EA116843 Date Issued:10/11/2013 Permit Category:ePermit Site Address: 4143 Pennsylvania Ave Lot:15 Block: 3 Addition: Stafford Place PID:10-72500-03-150 Use: Description: Sub Type:Reroof Work Type:Replace Description: Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Please print pictures of ice and water protection and leave on site. Carbon monoxide detectors are required by law in ALL single family homes . Heather Connell Valuation: 4,000.00 Fee Summary:BL - Base Fee $4K $103.25 0801.4085 Surcharge - Based on Valuation $4K $2.00 9001.2195 $105.25 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Jerry L Wheeler 4143 Pennsylvania Ave Eagan MN 55123 Connells Custom Exteriors Inc 1125 S Frontage Rd, Suite B Hastings MN 55033 (651) 438-2973 Applicant/Permitee: Signature Issued By: Signature Use BLUE or BLACK Ink r -. For Office Use City Permit#:of Permit Fee: l 3830 Pilot Knob Road Eagan MN 55122 Date Received: . /U ! 7 Phone: (651)675-5675 Fax: (651)675-5694 Staff: `moi✓ 2017 RESIDENTIAL BUILDING PERMIT APPLICATION Date: -- ) Site Address I 'I 3 I e \►'1 � V'2 v." / V P S �� a Unit#• �.....� Name: R,,,- c 1 tJ Z 1<, k 1 �'1 S Phone: C 1/ Z(17-- C 3 C 3 Resident/ > ) Owner Address/City/Zip: Applicant is: Owner Contractor Description of work: IQ a°Y. -O(�.,_� _._.�.Y_s�C� Type of Work t'T y Construction Cost: •I �` Multi-Family Building: (Yes /Nom, ) Company. ��c cc I �k�-.�h��........... .. .N�. ...,,._.. .,Contact:.���,,��. .,_,.w .,..,.�..��.,��.�,_ Address: l-J3O (V Sr �ad City: l ?) kJ°/G> Contr actor n M State:" Zip:S's ) a� Phone: G'1 9Qi--9909 Email: d l-v0I'1 (ifroc4?o . License#: 13 CG'S 007-7 Lead Certificate#: If the project is exempt from lead certification, please explain why: 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: 1 Mechanical Contractor: Phone: Sewer&Water Contractor: Phone: "t 9 Fire Suppression Contractor: Phone: ukNOTE:Plans and supporting documents that you submit are considered to a be public information. Portions of the information may be classified as non-public if you provide specific reasons that would permit the City to 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.qopherstateonecall.orq I hereby acknowledge that this information is complete and accurate;that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. Exterior work authorized by a building permit issued in accordance with the Minnesota S to Building Code must be completed within 180 days of permit issuance. x h G To/L hs Applicant's Printed Name Ap icant's Signature Page 1 of 3