4693 Penkwe WayCITY OF EAGAN Remarks
Addition J0Hb= r.aKt? RrnGE ADDTTTON Lot 6 Qik 3 p?t 10 3980Q_Q?Q 03
Owner ??? , .? ? (+? , -,! " ? -'^ str?t 4693 Penkwe Way ?`agan-55zz
- 1 " stete
Improvemeni Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN 5EW TRUNK
* SEWER LATERAL --
WATERMAIN
• WATER LATERAL igRi
WATER AREA a
STORM SEW TRK
* STORM SEW LAT
CURB 8i GUTTER
SIDEWALK
STREET LIGHT
Road Unit 185.00 18461 4 8 80
WATER CONiV. 305.00 of
BUILOING PER. i? t+
SAC
PARK
. • cirr oF EAwrr
3795 Pilof Knob Roed
No. Ea9en, Minnesota 55122
Phone: 454-e100
PERMIT
Dcte: hy 2
Site Address: ?': .'-,`33 '•'P.nkwe i??sy
Lot Block Sub/Sec.
Trsy. Cake :1idge
INSPECTOR NOTIFICATION
REQUIRED BY LAW
FOR ALL INSPECTIONS
Receipt No.:
Sing(e
Residentiol .
Nome Orrin ThwapsoI'- H0T:?eS New/Alter./Repai?
? Address
" Cost of Instollation
City Phone: •
Permit Fee
Nome ?aY N. V1a1tST :-:e3t1.. $' ?
? Surcharge
? Address ? " ?',?,,? -•?? ": ,
.?., r. ? . ?r . . ,
City 'phone: ' ITotal '
This Permit is issued on the express condition rhat oll work sholl be done in cccordance with oll applicable Stcte of
Minnesoto Stotutes ond City of Eogon Ordinances.
Building Official
No.
PERMIT
Date:
Site /lddress:
/
Lot '?' Block .? Sub/Sec.
I Name • ? .. ,. ??: ??.
.
; Address "
O
city
_ Phone:
454-53;z1
INSPECTOR NOTIFICATION
REQUIRED BY LAW
FOR ALL INSPECTIONS
Receipt No.:
Single I
Residential
I
Multi Res., Comm./Ind. I
New / Alter. / Repoi r
Cost of Instollotion
Permif Fee
Name ?onrr.?ers :),OI L .'ra%er . surcha?9e
.
? Address , . , _ `'? . .-. .. '...:
City ' Phone: Total
This Permit is issued on rhe express condition that oll work shall be done in atcordonce with all appHcable State of
Minnesoto Stotutes ond City of Eagan Ordinonces.
CITY OF EAGAN
3795 Pilot Knob Road
Eogon, Minnesoto 55122
Phene: 454-8100
Building Official
CASH RECEiPT
CITY OF EAGAN
3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE
19
REClI V ED
FROM
AMOUNT $ I
6 L
0
? CASH ? C H E C ?
J
White-PeYers CoPY
Yellow-Posting Copy
Pink-File Copy
Thank You f
C>??-J' B" f
CITY 09 EAGAN
3795 Pilot Knob Rood
Eagan, MN 55122
Zoning:
Owner.
Address:
Site Address:
Plumber:
ogree to comply wlth H+e City of Eogan
dinances.
By
Date of Insp.:
CITY
3795 P
Eagan,
Zoning:
Owner:
Address:
5ite Address:
PI umber:
Meter No.:
ci-
Reader No.:
1 agrae M eomply with the City of Eogon
?... Oedinanees.
By
Dote of Insp.:
SEVIIER SERVICE PERMIT
PERMIT NO.:
n eTe.
No. of Units:
Connection Charge:
Account Deposit: _
Permit Fee:
Surcharge:
Misc. CFarges: -
Total:
Connection Charge:
Account Deposit:
Permit Fee:
Surchurge:
Misc. Charges:
Total;
Dcte Paid:
I nsp.:
AF EAGAN WATER SERVICE PERMIT
ilot Knob Road PERMIT NO.:
MN 5512.2 DATE:
No. of Units:
crnr oF EAcAN
' 3795 Ptbr 1cnob Roaa Eaga¦, MN 55122
; PHONE: 454-8100
BUILDING PERMIT
Receipt #
N2 5685
To be usad for Est. Volue Date 19
SIM /lddress Erect 0 Otcuponcy
Lot Block Sec/Sub. Alter ? Zoning
parcel # Repair ? Fire Zone
E
l T
e of Const
n
orge ? yp
.
oWe Name Move ? # Stories
3 Address YOS:?rCa?.
. , Demolish ? Front ft.
b
_ ' ,r:•.?,-_
Ci
?,._ __
Phone Grnde ? Depth ? ft.
lx Approvo Is Fees
p Name _
ou Address
Name _
Address
I hereby acknowledge thot I have read this opplication ond stote that
the infortnation is correct ond ogree to comply with oll appliccble
Sfate of Minnesota Stotutes and City of Eagan Ordinonces.
Assessment ` -' s = !
Wuter 8 Sew.
Pol ice
Fire
Eng.
Planner
Council
Bldg. Off.
APC
Permit -
Surcharge
Plon check
SAC
Water Conn.
Woter Meter
Total
Signoture of Permittee I
A Building Permit is issued to: ?- on the express condition that
ull work sholl be done in eccordance with all opplicable State of- Minnesoto Statutes ond Ciry of Eogan Ordinonces.
Building Official
PensM # peh IMU pwwl!!N
Plumbing 70v ?
Mechanical Q
INSPECTIONS DATE INSP.
Rouph-In
Finol
Footings -?7v Date Inap. Date Irnp.
Foundation Plumbing ? ? ?
Frame/ins. (p-/,3` ?d Mechonical
. Finnl
Remarks:
cirr oF EAGAN
3795 Pilot Knob Read
Eagen, Minnesota 55122
No. Phone: 454.8100
` . PERMIT
Date: '
Site Address: 4693 Penkwe 'NsY
Lot Block Sub/Sec.
JhTy•C8k8 Ridf"e
Name Orrin Tliompson
g Address 171` H°pkins Crossmad
? '?,?innetonlr?.
'
City Phone:
Wenaikl 1Ae chac:i c a i
Name
3600
? Address
45E2..-156r.
City Phone:
This Permit is issued on the express condition that all work sholl be
Minnesoto Stotutes and City of Eogan Ordinances.
INSPECTOR NOTIFICATION
REQUIRED BY LAW
FOR ALL INSPECTIONS
Receipt No.:
Single I
Residentiol
Multi Res., Comm./Ind. I
New/AIter. / Repair
Cost of Installotion
?0. '?u
Permit Fee
.50
Surchorge
Totol done in accordance with all opplioable Stcte of
Building Official
L
uuce??aeu uecinca? ?oinra?wr I hereby reauest inspection of above
? Owner elec[rical work inslalled et
Sveel Atldress, Box or oute No. Cit,,vpp
ecUan o. Township ame ot No.
- 1 »ne. o• CoiCunw
d?
Occupant (PqINT) Phon No.
Pawer Supplier Adtlress
ElecVi al Convactor IComOany Namel
? ? Conhar.mr s License No.
0399 ?-
Mailing Atldress ICOnvactor or Owner Making I tailaY
? C1? s? M 1s _ ??C?7
Auffior' d Sipnatme (CoMrac[or Ow Mak- Instsllation) Phone Number
MINNESOTA STATE BOAND OF ELECTIIICITV THIS INSPECTION PEQl/EST WILL NOT
Gri99s•Midwey Blde. - Room N-191 BE ACGEPTED BY TME STATE BOAHD
1821 University Ave.. St. Paul. MN 55704 UNLESS PROPER INSPECTION FEE IS
mw"ov»l• ENCLOSED.
This request vold '7- a0 L?' 3-730 1
18 rtpn[hs Irom 0? ?
REQUEST FOR ELECTRICAL INSPECTION
^une inalructions for completimi this form on back ol yellow copV.
'X " Bep9pt95opered by This Request
. EB-00001-04
..;
3-7309
ANtl F? p. Tvae of Building AoPliences Wired Equipmen[ Wired
Home Range Temporary Service
Duplex Water Heater Lightiny Fixtmes
Apt. Building Dryer Electric Heatin
Commercial Bld,y. Furnace Silo Unloade(
Industrial Bldg. ir Conditioner Bulk Milk Tank
Farm ther aeci y dher ISnr.r.i?vl
? .r SVeafy OtFer Oiher
Compute Inspection Fee Below
p Fee ServiceEn2mnceSiza b Fee Feedars/5ubteeders 4 fee Circuits
0 to200Ams 0 to30qms 0 to30Ams
Above 200 qinps 31 to 100 Amps 31 to 100 Am s
Swinvning Pool Above 100-Amps Above 100_Am{n
Transiormers Irrigation 8ooms Partial'Other Fee
Signs S4>ecial Inspection
S
"
T TAL FEE
Bemarks/s, - TL- 1 ?
O,
Rough-in Date
I, the Elecvical
I
r
Inspectoq horeby
certify that the ebove
fi^al D
% ! insoection hes been
made.
This re0ueat voia 18 monlhs from
This request void ? eiz
18 mo;:ttis f-rom
Date o this Request S I 7 I?J Fire No. S 64354
I, 2s.Licensed Electrical Contractor ? Q, er, d9-?ereby ryqyest irssP?f,tion of the above electri-
cal wiring installed at: ?(p 3 L,j?tr? - C-. C. ???%1 .
?t et Address or Route No. `emcwe v"RN ?l Ci(?ty y. ?
ion Township Range County 1,r-47?5
1Vhich is occupied by
Is a roughin inspection required on this job? No ? Yesdg-- Ready Now ? Will Calkgl
Power Supplier ReC3 Address R44-%IN,7?
Electrical Contractor Ba? ?L?C??I G Contractor's License Nofi?''?11
(COmpanyName) ?D.
Mailing Address
(E?e rlcal ontractar or Owner Making Tnls Iastallation) O ',?y? ?
Authorized Signature Phone No. ?? ? ?`?
(Eleclrical Contrattor or Ownar Making This Installation)
?5f i? }'?f? ?? /a ?? f{'??@? This inspection request will not 6e accepted hy the
tJ ?i C? d;l ? ?f State Board unleu proper inspeetion fee is endosad.
mmnnsota aune nuarv or uecancny
Griggs Midway Bldg. - Room N191
7821 University Ave.. St. Paul, Minn. 55104 - Ptrone 297•2771
? : FiEQUEST FOR ELECTRICAL INSPECTION
CHECK BELOW WOAK COVERED BY THIS REQUEST
EB-00001-02
1? z
S ,s f 41.9 lt
Type of Building New Add. Rep. Check Appliances Wired For Check Equ'ryment Wired Foi
Home
? ? ? Range ? Temporary Wving ?
Duplex ? ? Water Heatec ? Lighting F'ucmres dU
[. Bldg.
O ? ? ? Dryer;, Electtic Hcating ?
mmercial Bldg. ? ? ? Fum $ilo UNoade[ ?
Industrial Bldg. ? ? ? A'v C" ?tio ' Buik Milk Tank ?
Fazm ? ? ? List '? List )
Other
?
?
? p
Hehel$ p
y
Heiersl
COMPUTE INSPECTION FEE BELOW
Seivice Entrance Size: u Fee Feeders&Sub(eedeis: # Fee C¢cuits: # Fee
0 ta 100 Am s. 0 to 30 Am res 0 to 30 Am res ,00
101 to 200 Amps. 31 to 100 Am eres 31 to 100 Am eres ,f9
Above 200 Amps. Above 100 Amps. Above 100 Am s.
Transformers RemoteCantrolCirc. Partialorothetfee . S?
S" ns Special lns ection Minimum f
Remarks TOTAL E,12. 7-1.06
I,the Electricallnspector,hereby
(Final)
This request void
18 months from
has been made.
Date P6
Rate.4,- V - sv
CITY OF EAGAN
.-?
h? BUIIDING PUMIIT APPLICATZON
y4, o o0
7b Be Us Fbr Res%oemce Valuation -
?(oq3 {`??K,,,,E 6.1Av
Site Address:
Lot Block 3 Sec./Sub. =oaNNy cnY-e
\D ?
Pazcel.#:
Qaner:
Address:
City/Zip Code:
Pnone #: e?# q - 7 3 3Y
T
Contractor: (1RRIN TI-inMPRflN I-IAMRc
Address: a Divi;ion of U. S. Home Corporation
}7}?:2-HQFVHfI6 fiRASSRBfk9
City/Zip Code: MINNETONKA, MINN. 55343
Phone #: Syq-1333
Arch./Eng.:
Address:
City/Zip Code:
Phone #:
Fsect. ?
Alt2Y
RePau' .
Enlarge -
Nbve
Detolish
Grade
Assessments
Water/Sec.er
PO11CE
Fire
Eng.
Planner
Council
Bldg. Off.
APC
Perniit
Surcharge a3
-
Plan Check '
SAC Slj ?
Water Conn. z a
Water Meter ?
Road Unit 1 XS
? l z 93 ?_
Include 2 sets of plans,
1 site plan w/elevations &
1 set of eneLC3Y calculations-
Date 3 -as-S' l7
OFFI(E USE OAII.Y
Ocm4kincY
Z0711i1C3
Fire Zone ?
'Iype of Const.
# Stories
Front ( S?' ft.
Depth ft.
cirr oF EA"N
3795 Pilet Rneb Road , Eagon, MN 55122
PFIONE: 454-8100
BUILDING PERMIT APPLICATION
Sre /wdress 4693 Penkwe Wav
Lot_?- Block3_ Sec/Sub. LTnhnny r,akP
Porcei # R1d42
c iName Orrin Thnmi cnn Hnmec
z Addre.1712 Hopkins Crossroad
?
Nome
Address 5 aICl2
Name _
Addresg
I hereby acknowledge thot I hove read this application and state that
the information is correct and agree to mmply with all applicable
State of Minnewta Statutes and City of Eagan Ordirances.
Signature of Permittee
A Building Pertnit Is issued M: OY lIl Th g
oll xrork shall be done in occordance ' I oto-ebMii
Building Official
Receipt #
N4 5685
Erect X] Occupancy R 'A
Alrer ? Zoning R 1
Repair ? FIre Zone 2
Enlorge ? Type of Conat. v
Move ? # Stories
Demolish ? Front F+a ff.
Gmde [I Depth 24' 'A" fr.
Approvals Fen
Assessment i/ i. 1 .%_14 1
Water & Sew.
Police
Fire
Eng.
Planner
Council
Bldg. Off. 4/ 4/ 8 0
APC
Permit ]3171_ 5n
Surchurge 2 3- n n /
Plan check F, S A.K
yqC 525 _ 00
Waer Conn. '10 S_ n p
Hr,?r Mete, ti n n n
lnaA ITnit 185 -0(
Total 3
on the express mndition that
Statutes and Ciry ot Eagon Ordinances.
SEDGWICK HEATING & AIR CONDITIONING CO. HEATING JOBNO. SSI S/
8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) 881-9000 TEST RECORD
ADDRESS
OCCUPANT
SOLD BY
MAKE
SERIAI NO. ?-
i? U L
2 0 2004
LIMIT 1? S±
LIMI7SETfING SS
FAN SETTING
`
PILOT NPE
IGNITION MOD EL
PILOTTIMING
C_
PRESSURE PERCENT CAz
INPUTCFH &b PERCENTOz
cv ey?
-o
STACK TEMP. PERCENT CO tL' •?ti
-72 4;
FORM 235(RE¢ 11/89)
•
cirv
OWNFR I. ? } Z `
INSTALLED BY
MODEL 0-2 V
INPIJT
L
VENT SIZE
TYPE OF LINFa °? _ V 4
LINER SIZE 0v
FILTERS: SIZE ? I?? NUMBER
WIRING
r?
TEST TAG
?
LIGHTING INS7.
DATE TESTED I 1 ~u `)
COMPANV7ESTING
,
NAME OF TESTER
FORMDISTRIBUTION: WHITECOPY -JOBFILE YELLOWCOPY - CITY
P--Z:f? .
2005 RESIDENTIAL MECHAIVICAL PERMIT APPLICATION 3 Q So
?? r? City Of Eagan
?? j
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please complete for: single famity dwellings & townhomes/condos when permits are required for each uni[
Date7 Q,J
Site Address Unit #
n
P
t
O Tele
hone # (/OY/
ropcr
er
y
w p
Contractor
Street Address $910 Wentworth Ave. So City
inneapo is,
State (952) 881-9000Zip Te?ephone te ( )
Bond #: Expirea:
The Applicantis _ Owner _ Contractor _ Other
Add-on or alteration to existing dwelling unit $ 30.00
furnace _Additional _Replacement
air exchanger
?
4/
airconditioner _New ? Replaceme
)'Y f7Gt?L
other
State Surcharge $ 50
T
l So
$ J6
ota ,
I hereby apply for a Residential Mechanical Pemut and aclmowledge that the information is complete and accurate; that the work will
be in confonnance with the ordivances and codes of the City of Eagan and with the Mechanical Codes; that I uuderstand this is not a
permit, but only an application for a pennit, and work is not to start without a peanit; tktat the work will be ' accordance with ihe
approved plan in the case of work which requires a review and approval of plans.
WOM 14TG R, AIR "0: Cf` c ?_/" !/l', 1 A
Applicant's Printed Name
JUL 2 1 2005
2005 COMMERCIAL MECHAIVICAL PERMIT APPLICATION
City Of Eagah
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please complete for: commerciaUindus[nal buildings
multi-family buildings when separate peanits are not required for each dwelling unit
Date
Site Street Address Unit #
Tenant Name (if applicable) Previous Tenant Nawe
Property Owner Telephone # ( )
Contractor
Street Address City
State Zip Telephone # ( )
Bond #• Expires:
The Applicant is , Owner _ Contractor _ Other
Work Type
New Construction _ Underground Tank _ Install _Remove **see below
Interiorlmprovemeni _ InstallPiping _ Processed _Gas
Nature of Work:
"When installing/removing underground tank, ca!! for inspection by Fire Marshal and Plumbing lnspector
P01'Illit FfC3: $70.50 Underground tank ins[allation/removal
$50.50 Minimum (includes State Surcharge)
or
Conhact Vaiue $ x 1% _ $ Permit Fee
• If permit fee is $1,000 or less, add $50 => $ State Surcharge
If nernut fee is over $1,000, add $.50 for
every $1,000 permit fee $ Total Fee
I hereby apply for a Commercial Mechanical Pemtit and acknowledge that the informafion is complete and accurate; ihat the work
will be in conformance with the ordinances and codes of the Ciry of Eagan and with the Mechanical Codes; that I understand this is
not a permit, but only an application for a permit, and work is not to start without a permit; tha[ the work will be in accordance with
the approved plan in the case of work which requires a review aud approval of plans.
Applicant's Prin[ed Name
Applicant's Signature
Approved By: , Inspector Date:
,D_ ,i?isy
A
2004 RESIDENTIAL MECHANICAL PERNIIT APPLICATION
U? City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please complete for. single family dwellings & townhomesJcondos when pemvts aze required for each unit
5a-!M
Date 6 Y
Site Address ^f(p4ol Unit #
Property Owner Telephone #
Contractor
. _..7: 1 ? _ CiQXr).-..,•..-.
Street Address C? ?0 Wentworth Avy. E13, City
. ..nneapo is, J
State (952) 881-9000 Zip Telephone # ( )
Bond #: Expires:
The Applicant is _ Owner V" Contractor _ Other
Add-on or alteration to esisting dwelling unit
Z
? $ 30.00
? furnace R
_Additional cement
air exchanger
air conditioner _New _Replacement
other
?
? ? ? ? u ? $ .50
State Surcharg
SEP 16 2004
T
r
l $ ?
o
a B
Y
I hereby apply for a Residential Mechanical Pemvt and aclmowledge 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 with the Mechanical Codes; that I understand tlns is not a
pemut, but only an application for a permit, and work is not to start without a permit that the work wilybe in accordance with the
approved plan in the case of work which requires a review and approval of plans. ?
SMgM F1'FG. & ??Fd ?• ? ? ?
Applicant's Printed Name ApplicanYs Signature ?
A . . .
2004 COMMERCIAL MECHAIVICAL PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please complete for: commercial/industrial buildings
multi-family buildings when separate permits are not required for each dwelling unit
Date / /
Site S[reet Address Unit #
Tenant Name (ifapplicable) Previous Tenant Name
Property Owner Telephone # ( )
Contractor
Street Address City
State Zip Telephone # ( )
Bond #: Expires:
The Applicant is _ Owner _ Contractor _ Other
Work Type
New Construction _ Underground Tank _ Install _Remove *`see below
Interior Improvement _ Install Piping _ Processed _Gas
Nature of Work:
`*When installing/removing underground tank, call for inspection by Fire Marshal and Plumbing lnspector
P¢rml[ F¢¢S: 570.50 Underground tank installation/removai
$50.50 Miximum (includes 5[ate Surcharge)
or
Contract Value $ x 1% _ $ Permit Fee
• If ep rmit Fee is $1,000 ar less, add $.50 ? $ State Surcharge
If ep rmit fee is over $7,000, add $.50 for
every $1,000 ue rmit fee $ Total Fee
1 hereby apply for a Commercial Mechanical 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 with the Mechanical Codes; 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 oFwork which requires a review and approval of plans.
ApplicanPs Printed Name
Applicant's Signature
Approved By: , Inspector
4693
ce • • C/
For:
U. S. HOME CORPORATION
C. R. WiNDEN 3
IAND SURVEYORS
1361 EUSTIS SL, ST
O
9F
.?
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4_ \
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a
?
C' ? \
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A \
t'io
j \
-.,
i
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_bA Sed
ProP e
Ho"s
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PENyw'?
J/ O
ASSOCIATES, INC.
Ttl 645- 3646
PAUIP MINN. 55108
/
y?Ay
Lot 6, Block 3, Johnny Cake Ridge
Addition, Dakota County, Minnesota
'A/
Scale: 1" = 30'
O Denotes Iron
wE HEREBY CERTIfY TMAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY OF TNE
lOUNDARIES OF THE tAND ABOVE DFSCRIlED AND OF TME IOCATION OF ALl 6UIlDINGS, IF ANY,
TMEREON, AND All VISIBIE ENCROACNMENIS, IF ANY, fROM OR ON SAID IAND.
Detad tAis17rH dav oF n'1.4R A.D. iVBO
C. R. WINDEN d ASSOCIATES, INC.
Surv?yor, Minn?wlo R?pia?ro?ion No.1?L?
.
CITY OF EAGAN
EARLY UTILITY CONNECTION PERMIT
4693 Penkwe Way L6 B3 Johnny Cake Ridge
Address Subdivision/Parcel
I hereby request permission fxom the City of Eagan to connect to the
sanitary sewer and water lateral line in the public right-of-way. I
understand that the City has not yet completed, inspected and/or accepted
the sewer and/or water lateral. I agree not to use, test, or connect these
individual services to any interior plumbing and understand the require-
ment to cap the sewer service to prevent any unauthoiized use.
In accepting this permit, it is agreed that I will hold the City and its
agents harmless from any damage that may occur due to this early connection.
It is understood that no Occupancy Permit will be issued or.water allowed
to be tumed on until the City utility system has been declared operational
by the City Engineer.
, Signed by - Plnmber: j"1ENZEL MECHANICAL
Owner: d?n-
V?
Developer•
Builder:
Dated: 5/27/80
*****??*****?*?*?**?*******************
CITY OF EAGAN
CASHIER: JS TERMINAL NO: 699
DATE: 08/25/00 TIME: 07:10:17
ID:
NAME: WESTURN CEDAR SUPPLY, LLP
3210 9001 4693 PENKWE WAY 111.25
2155 9001 4693 PENKWE WAY 2.50
Total Receipt Amount: 113.75
CR136481
USER ID: JAN
2000 BUILDING PERMIT APPLICATION (RESIDENTIAL)
?zlw
CITY OF EAGAN
3830 PILOT KNOB RD - 55122
851•681-4875
113-15
n 3 reglafered flro wrveys ahowlny s4 t! of lof, sq. fl. W houae 2 copies ot plpn :
ond 20 roofetl areai (2096 ma*imum l01 coveman allowadl 1 sef ol energy calculafions tor healed adcUtlau
> 2 coples of plana (ahow hecm 8 window slzes; poured tnd deflgn; etc.) 1 aNe wrvey for exfeAOr addiNana & decka
a 1 aet W eneryy colcWaHOna
> 3 coples of hee presenallon plan 11 bt plalted a1Fer 7/I/93 "
DATE: 2 ^ a 3CONSTRUCTION COST: V i
DESCRIPTION OF WORK: rdF????n C) `
STREET ADDRESS:
LOT: ?
BLOCK: V SUBD./P.LD.M: ,???ly\I ? Ca
Name: Phone u: 6s1- YS% 58-2 l
PROPERTY tast Flrst
OWNER
Sheet Address:
City State: , ZiP:
Company. ?Je-ST[ATn 6;,L/' 5i,p,o/?/ Phone#: 763
" ' ?T (area code)
COMRACTOR Sfreet Address: I92P ff/ , License #??ExP•''3/'?I
Cfty TX Y State: As) Zip:
ARCHIiECT/
ENGINEER Comparry: Name:
Telephone #: ( )
Streef Addresa: Regisfrafion C
Cryy Stafe: Zip:
Sewerfwaler ticensed Plumber (H IrntalNna sawerhraterl: Phone #: U
I herebY acknowledye Ihat I have read lhis applkoHon, state Nxat Ihe InfortnaMon is correc?. cnd agree to compy wMh an oppUcable Sfate
of Minnesola Sfalutes and CNy of Eagan Ordinances.
Signature of Applicanh
OFFICE USE ONLY
CertifiCates of Survey Received _ Yes _ No
Tree Preservatlon Plan Received _ Yes _ No Not Required `??`
OFFICE USE ONLY
BUILDING PERMIT SUBTYPES
? 01 Foundatlon ? 07 05-piex ? 13 16-plex ? 21 Porch (3-sea.)
? 02 SF Dwefling ? 08 06-pfex ? 17 Garage ? 22 Porch/Addn. (4-sea.)
0 03 01 of _ plex ? 09 07-piex 0 -18 DEn:k ? 23 Poroh (screened?
O 04 02-plex ? 10 08-plex ? 19 Lower Level ? 24 Stortn Damage
? 05 03-plex ? 11 10-plex Plhg -Y or_ N ? 25 Miscellaneous
? 06 04-plex ? 12 12-plex ? 20 Pool ? 30 Accessory Bklg.
WORK TYPE
? 31 New ? 36 Move Bldg. ? 43 Reroof
? 32 Addition O 37 Demolish (Bldg)' ? 44 Siding
? 33 Aiteretion ? 38 Demolish (Interior) ? 45 Fire Repair
? 34 Repair ? 42 Demolish (Foundation) ? 46 Windows/Doors
' Give PCA handout to applicant for demolition permit
GENERAL INFORMA710N
SAC Code # of Stories sq. ft.
No. of Units Length sq. ft.
No. of Buildings ? Width Footprint sq. ft.
Const. (Actual) Basement sq. ft. Census Code
(Allowable) Main level sq. ft. MC/ES System
UBC Occupancy sq. ft. City Water
Zoning sq. ft. Booster Pump
PRV
Fire Sprinklered
MISCELLANEOUS INSPECTIONS
? Stucco/5tone
APPROVALS
Planning Building Engineering Variance
Permit Fee Valuation: $
Surcharge
Plan Review
License
MC/ES SAC
City 5AC
Water Conn.
Water Meter
Acct. Deposit
S!W Permit
S/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
? 31 Ext. Alt - Multi
? 33 Ext. Att - SF
? 36 Muki
SAC Units
% SAC
410'Qq of Eal
3830 Plot Krrob Road
Eagan IAN 55722
Phone: (651) 675-5675
Fam (651} 675-5694
Date- srs
, aU G 2 S 2008
?
?
BUILDING PERMIT
3 Pen kw-e
?________'_______ ; .
' ... , '"
t ??..,.?-70
1 Pertnit Fee: 7
+ I
I Date Received: ?
i
1
? Statu I
? -------?
APPLICATION
wav &
e CC
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1
REsIDErrriowtaER y
k.r0
Name:- Prone:
ncarow r Cks f Zip:
„pp-mM ir: _Owne. x contractior
TYPE OF WORK Desaip6on of work: t?epl ac IY)
To Ta 1
Consvuction Cost: ?O ?OC'7C?
Muni-Famity Building: (Yes _/ Na -?
CONTRACTOR Name: ticerae ft:
nddress: 11825 Poiet Donglay Drive Soalh
w Hastiogs,MIlV 55033 State: Z,p.
P,,o,ie-l k 51 y9 80344 come Perso„_ )er??iah °r M'? KerR
COMPLETE TMIS AREA ONLY IF CONSTRUCl1NG A NEW BUILDING
Minnesota Rules 7670 Cateaorv 1 Minnesota Rules 7672
Ener9Y Code • Resdendal Vermlaaon categay 1 Wonsneet • Mew Energy cade worleheat
Cdmpfy Sutnnided Submitted
(J submission type) • Energy Errvelope Calauiatias SuMniRed
In the last 72 moNhs, has the IXity at Eagan issued a permft tor asimilaz plan based on a master pNn?
_Yes _No lf yes, date and address of master plan:
Ucensed Plumber• Phane:
Mechanical Comractor: Phorks:
Sewer & Water CoMrac[or: Phone-
.
, '.NOT?
Slt
1t1?2R13 th8t
SU4l?f?? ?R bL' Int4il?RHtf4
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?y n`P?Tdl i?'?qS. ??
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Co"iJCltide ttiat ,?aftad?" ' .. >
I here6y acknowledge that this informffiion is complete and accurate; tha[ ttie work vrill be in
?a9a?: drat I urMerstand iMs is irot a permi[, 6ut only an app6cation for a permR, and wa
accordance with the approved plan in the case of wmk which raquires a review arxl a{proval ?
x (??????J
Applicant'S Pritlted Nam Appl i
prtnance with the ordinances and codes of the City of
irot to slart without a pannit; ihat tFie work wiN be in
Signeture
F'aqe 1 of 3
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