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4884 Pilot Knob Rd Use BLUE or BLACK Ink r I I For Office Use , I I Permit I I , City of Eagan I Permit Fee: - CJ 3830 Pilot Knob Road I Eagan MN 55122 I Date Received: Phone: (651) 675-5675 I I Staff: Fax: (651) 675-5694 L -----I 2010 RESIDENTIAL vPLUMBING (PERMIT APPLICATION 2~r~ l! f~/ d~~nJch r<.t a c-~ Date. ~ Site Address: c -eTenant: A,. t VL Suite RESIDENT/OWNER Name: /h t Phone: ~~-Yr tP1~o~ x cry Address / City / Zip: i c f4 e v(" CONTRACTOR Name: License 3f7 rC Address: [ 0. City: ~nJI~T State: /-7~v 5-C Z y Phone: - c-5-/27 Y'5--- s-3 Ik e Contact: pert Email: ~o...~.,~.e.- TYPE OF WORK _ New eplacem1ent _Repair -Rebuild - Modify Space - Work in R.O.W. Description of work: PERMIT TYPE RESIDENTIAL Water Softener Water Heater Lawn Irrigation RPZ PVB) Add Plumbing Fixtures Main Lower Level) tic System Water Turnaround New Abandonment RESIDENTIAL FEES: $50.50 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $.50 State Surcharge) $30.50 Lawn Irrigation (includes $.50 State Surcharge) $50.50 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $.50 State Surcharge) *Water Turnaround (add $166.00 if a 5/8" meter is required) 100.50 ptic System New ( 10.00 as built) (includes County fee and $.50 State Surcharge) $90.50 Fire Repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) TOTAL FEES $ 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 is not to with t a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and app al plans. x rly.~~ x Applicant's Printed Name plican Signature FOR OFFICE USE Reviewed By: Date: Required Inspections: Under Ground -Rough-In Air Test Gas Test Final CITY OF EAGAN Remarks Addition Sec'•t1 31, Lot Rlk Parcel 10 03400 OtO 51 owner111[LI1 Li I.IUhc:?reet 1?88l? Pilot Knob Rd. State Eagan,MN 55122 Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. STREET RESTOR. GRADING SAN SEW TRUNK SEWER LATERAL WATERMAIN WATER LATERAL WATER AREA STORM SEW TRK STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. BUILDING PER. SAC cirir oF E?GaN 3795 Pilot Knob Rood Eagan, MN 55122 N! 5843 PHONE: 454-87 00 BUILDING PERMIT Receipt ?k Te be ussd for ' Est. Value Dote 19 Site Address ? Erect ? Occupancy Lot Blotk Sec/Sub. Alter ? Zoning P Repair ? Fire Zone - ' arcel # Enlarge ? Type of Const. ? ?a?-? cr4?: Name Mwe ? .# Stories _ ` Z Address Demalish 0 Front ft. ? Ci . Phone Grode ? Depth ft. gx Appwvols Fees Name 0 ? ?? Address Assessment Woter & Sew. Cj phone Police ? Nome F W Fire ?? Addreu Eng. <'Z" Ci Phone Pipnner Council ?.? I hereby acknowledge thot I have reod this opplication and state thot gldg. Off. the information is mrrect and agree to comply with all upplicuble Stote of Minnesota Statutes and City of Eagon Ordinonces. APC Permit Surcharge ? Plon check SAC Water C.onn. Water Meter Road Unit Totol Siqnoture of Permittee I A Building Permit is issued to: on the express condition that all work shall be done in accordonce with cll applicable Stote of Minnesoto Statutes cnd City of Eagon Ordinances. Building Officiol PennM # poft laaed PornlMw Plumbing Mechonical INSPECTIONS DATE INSP. Rough-I n Fi nol Footings Dute Insp. Date Irup. Foundotion Plumbing Frome / ins. Mechanicol Finol !YJ Remnrks: y/s/r6 CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHON E: 454-8100 BUILDING PERMIT Receipt# To be used for Est. Value Date -" br' ,19 r Site Address "' iF 4 N I GUT '=Xo$ Zf?1?D Lot 'Block 'Y Sec/Sub. St:CT. 34 Parcel No. a Name -.,..... .,. = Address ''A p -+ - • `• U City Phone , o Name : A'."r: ? ? Address ? City Phone a W Name _ = Address ? W CitY - that I have appiication and state that the y with all applicable State of Signature ot Permittee -'-''A Building Permit is issued to: 1 lt?? with all OFFICE USE ONLY On Site Sewape Occupancy MWCC Syatem Zoning On Site Well (Actual) Const City Water (Allowable) PRV Required # of 5tories Boaster Pump Length Depth S.F. Total Footprint S.F. APPROVALS FEES Engr.lAssess. Permit Planner Surcharge Council Plan Review Bldg. Off. SAC, City Variance SAC, MWCC Water Conn. Water Meter Road Unit Treatment P1 Parks TOTAL ? f ' ?,? Permlt No. Permit Holder Dats Telephone # Plumbing H.V.AC. Electric Softener Inspoctfon Dat* Insp. Comment6 Footings I Footings II Foundation Framing Roofing Rough Pibg. Rough Htg. Isul. Fireplace PO Wa6D S?.?ce? C r Final Htg. p ? Final Plbg. Bldg. Final Cert_Occ. Temp. LP Deck Ftg. Deck Final Well Pr. Diap. ek . PERMIT # MECHANICAL PERMIT RECEIPT # ?- •-}? CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: Site Address Lot Block ? '•` m Name ?c Address c Ciry BLDG. TYPE WORK Sec/Sub ? Res. New _ Mult Add-on Comm. Repair . . Other ....., n . ? Name Address .p City Phoneu ?,1fPE OF WORK ?orced Air M BTU Boiler M BTU Unit Heater M BTU Air Cond. M BTU Vent. CFM Gas Piping Outlets # Other DESCRIPTION FEES RES HVAC 0-100 M BTU -$24 00 . . ADDITIONAL 50 M BTU - 6.00 (RES. HVAC INCLUDES A/C ON NEW CONSTRUCTION) GAS OUTLETS (MINIMUM - 1 PER PEFirAIT) - 1 50 EA . . COMM/IND FEE - 196 OF CONTRACT FEE APT. BLDGS. - COMM. RATE APPLIES TOWNHOUSE 8 CONDOS - RES. RRTE APPLIES MINIMUM RESIDENTIAL FEE - ALL ADD-ON & REMODELS - 12.00 MINIMUM COMMERCIAL FEE - 20.00 STATE SURCHARGE PER PERMIT - .50 ADD $ 50 S/C IF PERMIT PRICE GOES ( . BEYOND $1,000) FEE S/C: 51GNATUR F PERMI EE TOTAL• s-. FOR: CITY OF EAGAN IN CITY OF EAGAN 3 ' ot Knob Road Eagan, Minnesota 55122-1897 (612) 681-4675 SITE ADDRESS: L" PERMIT SUBTYPE: 5PECTION RECORD PERMIT TYPE: Permit Number: Date Issued: 41 S: IYtJ'+i so 0 10 -5' APPUCANT: I tf t t, r: ti: TYPE OF WORK: . . , i.IfN11I1kJ f{f F'i.Af:f- 14Ul41 1 P ? -?.c ? Permit No. Permit Holder Date Telephone # ELECTRIC PLUMBING HVAC Inspection Date Insp. Comments FOOTINGS FOUND FRAMING ROOFING ROUGH PLUMBING PLBG AIR TEST ROUGH HEATING GAS SVC TEST INSUL GYPBOARD FIREPLACE FIREPLACE AIR TEST FINAL PLBG FINAL HTG ORSAT TEST BLDG FINAL BSMT R.I. BSMT FINAL DECK F?G DECK FINAL 16 6.3?/OD 61D S7 TOb7N OF EAGAN 3795 Pilot ;Znob P.oad St, Paul, Afinn. 55111 PERrIIT N0. 36_ The Board of Supervisors hereby granta to cart [:e.,.,. MlIIdoCB We11 ('.Or Of a*+do n?Mim as[f%n ' a WELL DRILLYNG Permit for: (Owner) wa...in O nn 8t 4884 Pilot Kne6 R..ad pursuant to application dated 4/12/il Fee Paid: $10.00 Dated this_12_tb_day of AV,at , 197,_1_. Building Inspector io 03y6o a'?v S zowN oF Eacaca 3795 Pilot I:nob P.oad St. Paul, riinn. 55111 PEPMT IdO. 115 The Baard of Supervisors hereby grants to riarvin Ohmsnn of 4884 Pilot Kuob Road a Permit for: (Owner) aaate $t aame , pursuant to application dated Max 12/1971 Fee Paid: 20.00 Dated this ly day of t•1nu , 197_L. Buiiding Inspector /a o3yod TOG7N OF EAGAN 3795 Pilot I:nob i.oad St, Paul, Minn. 55111 PEPSfIT N0. 104 aiv ?S/ The Board of Supervisors hereby grants to PEINE°S PLG`NSING Q HEATINC of Vasmillion# iKitutseota a HF.ATiNG Permit for: (Oc,mer) Martin Ohmams at 4884 Pilot Rnob Roadt Eagan S5123 ? pursuant to application dated .r 4/2?? ? Fee Paid: $20.00 Dated thia Z9th day of Apzil , 197_1. Building Inspector E 5 614 3 e, . J171 Repuest Dete /?I ` ?`J 7- ? Flre No. Raughin Inspection FepuiretlT L;Aeedy Now ? Wili Notify Inspector Wh R ? ? Ves en eedy I'%ficensed contractor ? owner hereby request inspection of above electrical work at: ,bG Address(Streei,/ ?Box or Houte No.) ? f j ?) 0 9 ( Ciry LT?'4 /?') ?,M1 ? ( . • / Section No. Township Neme or No. Renge No. Counry Occupent (PRIM) / Phorre No. DO z- 1 t`% Power Supplier qddreas Electrical Contraclor (Company Nama) ` ? C(ntrapoI§ License No. 3 ? ( C, (c,- y Mailirg Pddrass (COnlrattor w Owner Making Installalion) / Z-7 Auth ' ure (COnVadod Meicln Ilation) ? Ph7u?r? GY 7 L/ MINNESOTA S BOAND Of ELECTPoCITY iHIS INSPECTION REOUEST WILI NOT Griggs-M Bltlg. - PoOm S.7]3 BE ACCEPTED BY THE STATE BOARD 7821 Universlty Ave„ St. Paul, MN 55106 UNLESS PROPER INSPECTIDN FEE IS Plwlre (872) 662-0800 ENCLOSED. g'/x/,?g REQUEST FOR ELECTRICAL INSPECTION eaaoom-o7 ? See Instrucnons for mmpleting ihis lorm on beck of yeliow copy. E ""5 614 3- `X" Below Work Covered by This Request e Add Rep. TypeofBuilding AppliencesWired EquipmentWiretl Home - Range Temporary Service Duplex Water Heater Electnc HeaGng Apt. Builtling Dryer Other (Specity) Comm./lndustrial Furnace Farm ' Air Conditioner OMer fspeciry) Cqnvactor9 qemarks: Compufe Inspection Fee Below: # Other Fee # ServiceEMranceSize Fee # Circuits/Feeders Fee Swimming Pool 0 to 200 Amps o to io0 Amps Transformers Above 200 _ Amps A6ove 100 _ Amps Si9f15 Inspevi0r5 Use Only: TOTAL Irriga[ion eooms Special Inspection Alarm/Communication rIo Olher Fee ' I, the Electrical Inspector, hereby it h h Rough-in oe yt att cert eaboveinspectionhas been made. Fnal OFFIGE IISE ONLV This repuesl voitl 18 rtanths irom CITY OF EAGAN 3795 Pilot Knob Road Eagan, MN 55122 PHONE: 454-8100. ." . .? BUILDING PERMIT APPLICATION Site Address Lot Block Sec/Sub. Parcei # 10 03400 010 51 w Name MarVlri D71IR2Illl Z 4984 i o 0 oa Address O F.van 55i 99 . L5L_l77/. p Name S2Lle f ?? Addrea P- ri.., vti.,.,P Name_ Addres; N4 5843 Receipt .jk ? ??/.eq Erect }M Occupanty Dd Alter ? Zoning A RepCir ? Fire Zone TTT Enlarge ? Type of Const. ?T Move ? # Srories 1 Demolish C] Front 40 ft. Grade ? Depth 24 ft. Aoorovuls Fees Assessment Water & Sew. Police Fire Eng. Planner Council I hereby ucknowledga thut I hove read this opplication and stote that gld9, pff. 5/26/du_ the information is eorrect and u ee ro comply with all plicable AP? Stota of Minnesota Statut 9 rty of Eagan din + s. Signature of Permittee ?? Marvin Ohmann A Building Permit is issued to: oli work shali be done in acmrdonce with all eppli State of Mjoeso Building Official % ? Pertnit y"•`"' $urchorg? Plan check SAC Water Cann. Woter Meter Road Unit Total 70-.5T-- on the express condition that Statutes and City of Eagan Ordinances. CIZy pF. EFIGAN Include 2 sets of plans, 1 site plan w/elevations & BUILDING PE1MT APPLICATION 1 set of energy calculations. 'Ib Be Used For Valuation Date sire ndare55 -9B?34 ' i I?+ k,.? 'J OFFICE USE O+II,Y Iot Block Sec./Sub. Erect ? Occupancy --? Parcei #: /O o 0 C) 1 O ? ? Alter zonin9 ? Repair _ Owner: K Enlarge . AddreSS: ?roi?sn City/Zip Code: Grade _ Phone Contractor: ?-- Address: City/Zip Code: Phone #: Arch./FS-ig.. _ Address: city/zip Cocle: Phone #: Fire Zone 7ype of Const. # Stories I Front Q ft. pepth ft. P,PPROVAI6 FEES Assessnents Pesmit ? Water/Sevrer Surcharqe d? ?- Police Plan Check Fire SAC Eng, Water Conn. Planner Water Meter Council Road Unit Bldg. Off. APC - .>ra DDTAL ?&Q r- ? ----? ob h,?° CITY OF EAGAN N_ 14 5 2 8 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 LDING PERMIT PHONE:454-8100 p BUI ^ ?- y _1 Receipt # s )`-' I Cjl 19 To6eusedfor FIREPLACE Est.Vllue $1,000 Date DECEMBER 29 87 Site Address 4884 PILOT KNOB ROAD OFFICE USE ONLY Lot 1 Block 51 Sec/Sub. SECT. 34 On Site Sewage _ Occupancy MWCCSystem _ Zoning Parcel No. On Site Well _ (Actuap Conat a Name ARNOLD G. DOERING City Water _ (qllowa6le) z Address SAME PRV Required _ # o} Stories 0 City phOne 454-8601 BoosterPump _ Length Depth , o Name SAME S.F.7otal 0 a Address Footprint S.F. ? City phone pppROVALS FEES w W Name Engr./ASSess. Permit $20.50 5 t z Address Planner Surcharge 0 • x., aw City Phone Council PlanReview Bidg Oft SAQ Ciry . . I here6y acknowledge that I have reatl ihis application and state that the Varience SAC. MWCC information is correct and agree to comply with all applicable State of Water Conn. Minnesota Stetutes and ry f Eagan Or nances. X 1 Water Meter ? Signature of Permittee xl Road Unit A 8uilding Permit is issued to: ARNOLD IIOERING Trealment P7 on the express contlition that all work shall be done in accordance with all applicable State of Minnesota tutes and City/qf Ea gan O dinances. Parks ? i ?21.00 _ BuildingONicial TOTAL ? EdGAN TOWNSHIP BUILDING PERMIT J-a?- 3 `/ 0 /0- 3( 11T° 2403 Eagan Townahip Town Hall Dale .. ................ :.... DESCRIPTION Stosia To Be Uaed For Froa! Dapth Heighf Esf. Cosi ' Permit Fee Aemarks 1 4L? , ; .? a'y .'te'G? ?a'} aa..-d A7. I _;?;o f?,.,Tov LOCATION S ra , Aoad or ofhe Dasorip!!oa ot LocaSion I Lo! Block Addilioa or Trae! I I Thls permit does aot aufhoxize the use of streets, zoeda, elleys or stdewalke the sigh!!o ereale anp situafion which is a nuisanca or which presents a hasard general welfare !o aapone ia the eammuniiy. THIS P£RMIT MUST BE KEPT 07J THE PRE ISE WHILE THE WOAK IS IN Thia is to carliip, lha2._712_t ..... ".`..`."' .................. haspermission 3o eree the ebove described psemisa subjeei !o the provisions of the Building Ordinenee 1955 nor does it give the owner or Lis agenS !0 the heelffi, eafelp, eonvealeaee and PROG ESS. q?. ! a. ---- .........---•-. ?•.?1i......... upon for Ea n Top adopled April 11, ................._?!5ct'?.__.?.:....l..`..:`.'c??.....-.----.---......... Per ......-.---?........."._.....:?,....P................................. Chairman of Tnwn Board ?LS BuSldin Ins ecloz ?6 Pemut #: Receipt Date: CITY OF EAGAN 2007 SEWER AND WATER CONNECTION AND AVAILABILITY CHARGES EXISTING RESIDENTIAL PROPERTY Address Ll ?'t? y7: ?p f Y lnj h L R ?Y Property Owner /'7Y'Nd /j `Jo e N lN ? Telephone# lpS (- yJ^- Fr6c) I Plumber Date of Inquiry Contact Name Sewer lateral charge @ $24--MTff Sewer trunk @ $1,150/connection City SAC MCES SAC R'eceipt # Date _ Septic abandonment Pernut Fee State Surcharge Total Sewer and Water -'aLb- 07 Sewer Asscssrnti,{- ,Ap?ne..nNa? t OFFICE USE ONLY fiO PRV required ? City /Jo County R-O-W Permit Water -H4?^'96' ce 3. oeo, °-' Water lateral charge.4?? ? ?Fo°° Watertrunk@$1,200/connecrion /2c??.? 100.00 Water supply & storage 1,070.00 1.675.00 Receipt # , Date Treahnent plant 50.00 Pemrit Fee 50.00 State Surcharge .50 Plumbing perxnit required - water meter to be acquired with plbg pernut g 6, 025 6-? Total 4" Sewer Service $ 6 .00 1" Watei`Service 72.00 Sewer lateral charge @ $28.30/ff Water lateral chazge @ $28.60/ff Sewer trunk @ $1,150/connection Water trunk @ $1,?200/connection City SAC 100.00 MCES SAC ? 1.675.00 Receipt IIate Water supply & storage 1.070.00 Receipt Date ? Treatment plant 660.00 Septic abandonment ?. 50.00 Permit Fee 100.00 State Surcharge ? ,. .SQ Total / \ $ rmit required to be acquired with plbg pernut 660.00 50.00 .50 $ 5 qBo, 5D ? cc: Cazolyn Krech, Finance Department ?R `?IY?y ?IO? ?`I)J?•`[A ASSESSMENT AGREEMENT This Assessment Agreement ("Agreement") is made this 27 day of ?4ip?-• t , 2001, by and between ARNOLD GEORGE DOERING, a single person, (hereinafter "Landowner"), and the CITY OF EAGAN, a Minnesota municipal corporation (hereina$er "City") (hereinafter collectively referred to as the "Parties"). WHEREAS, Landowner is the fee owner of property located in the City of Eagan, County of Dakota, 9tate of Minnesota and legally described as: Commencing at the Southwest corner of the Northwest Quarter of Section 34, Township 27 North, Range 23 W, thence East along the South line of said Northwest Quarter a distance of eight (8) rods to point of beginning; thence Easterly along said South line of said Northwest Quarter a distance of 363 feet; thence South 300 feet; thence West 363 feet; thence North 300 feet to point of beginning. (hereinafter the "Property"). WHEREAS, as part of Public Improvement Project No. 787 (hereinafter the "Project"), the Property was proposed to be assessed for certain water lateral charges ($3,000.00) and sanitary sewer lateral chazges ($3,000.00) associated with the Project; WHEREAS, Landowner has requested that the City eliminate these charges from the assessment and collect the same as a connection charges upon subdivision or development of the Property; and WHEREAS, the City is willing to not immediately assess the water ]ateral charge and sanitary sewer lateral charges and defer collection of the same all upon the terms and conditions contained herein. NOW, THEREFORE, in consideration of ihe mutual promises contained herein and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the Parties do hereby a.-ree as follows: ? ? Treatment as Connection Char2es. The City agrees the Property shal] not be immediately assessed for water lateral and sanitary sewer lateral charges. These charges will be collected and paid when the Property is subdivided, platted, and/or connects to city sewer and/or water services, whichever occurs first. Then these amounts shall be treated as connection charges and paid at the rate then in effect. 2. Waiver. Landowner hereby waives his right to object or appeal any connection charges pursuant to MtNN. S'rn'r. §429.081 and further waive notice of hearing from this agreement. 3. Bindine Effect. This Agreement shall be binding upon and inure to the benefit of the Parties' heirs, successors and assigns and shall run with the land. Amold George Doreing CITY OF EAGAN: atricia E. Awada Its: Mayor By: Mira McGarvey Its: Deputy Clerk ? STATE OF MINNESOTA) )ss. COUNTY OF DAKOTA ) The foregoing instrument was acknowledged before me this ??day of 2001, by Amold George Doering, a single person. gk (f Notary Public l(e MATTHEW W. LARKINS NOTAFV PUBLIC • MINNESOTA MyCOmmissonExpiresJan.31,2005 ! STATE OF MINNESOTA) )ss. COUNTY OF DAKOTA ) The foregoing instrument was acknowledged before me this aI` ' day of , 2001, by Pah-icia E. Awada and Mira McGarvey, the Mayor and Deputy Cle K of the City of Eagan, a Minnesota municipal corporation, on behalf of the municipal corporation. . APPROVED AS TO FORM: City Attomey's Office Dated: APPROVED AS TO CONTENT: & Public orks Department Dated: 1•J- ;t0 -0/ THIS INSTRUMENT WAS DRAFTED BY: SO MARYSVVENSON NOTAHYPUBUFMINNESOTA ?Mp Canrtission EVIms Jan. 31.2DO5 o SEVERSON, SHELDON, DOUGHERTY & MOLENDA, P.A. 7300 West 147th Street, Suite 600 Apple Valley, MN 55124 (952) 432-3136 (RBB: #206-17428) Q ? FamADp?'b '- pA8 Na. ? VETENANS ADMINISTNATIONIU.S. DEPAqTMENT OF MOUSINO AND URBAN DEVEIOPMENT , .. NEALTM AUTXOqITY APPROVAL HUD/FMA OR VA CASE NO. INDIYIOIIAL WATER-SUPPLY AND SEWAOEDISP054L SYSTEM HUOlFHA OR VA OFFICE IMPORTANT-TM1is farm should be wmplcicd and fded as rcquved by exiving law 38 U.SC. 1604 anE 1810. PAHT 1-TO BE COMPLETED BV HUD/FHA OR VA MORTGAGEE NAME ANO ADDRE55 (Inc7ude ZIP CWe) • • MOPTGAGOR OR SPONSOR PflOPERTVApDPES ? , i?. . SU6OIVISION/LOTNO. v -a3?f oo- o/D ?S l TOTAL NUMBER ISTHERE A BASE- MENT7 ISTHIS A NEW INSTHLLATION? CAN TNE ATTIC OR OTHER wREA BE MADE INTO ADOITIONALBEDROOMSi(!f"Yef,"hawmerty?) LIVINGUNITS BEDqOOMS BATHS El VES ?NO O1'ES ?NO ?VES ?NO WATER3UPPLY BV; ,..J . SYSTEM DESIGNEO FOR ?PUBLICSYSTEM ?COMMUNITYSVSTEM VI INDIVIpUAL NO. OF BEDROOMS GARBAGEDISi0.SAL SEWAGE-0ISPOSAL BY: ?PUBLICSYSTEM ?COMMUNITYSYSTEM INDIVIOUAL ?YES ?NO PART II-TO BE COMPLETED BV NEALTH DEPARTMENT OR COMPLIANCE INSPECTOR INSPECTOR'S SKETCH (TO REPoRTASBUILT DEVIATIONS FROMAPPROV£D PLAN) It is ffie opinion of the Q State ? Counry MLOCaI Department of Healih that this individual watersupply system ?QieaMFUtis(actory, u a domestic watcrsupply for the subject property. II is the opinion of ffie Q Stxte ? County 0 Local Department of Health thTt tltis individual sewagedisposal system with pmper maimenance 03 Can be expecled lo func[ion satisfactorily, and is mt likety to create unsanitary cunditions ? Cannot be expected [o fune[ion satisfactorily. Dv`AT/E' O AD- SIGNATUR TIT ? ' NOTE: The health authority should comple[e the appropriare opinion statemenl above and a1Yx dale, agnamre end title in the speces provided. NOTE: Uxe of the rEVerse oC t[tis folm is at the option of the health authonTy. PART 111-FOR USE OF FIELD OFFICE I have reviewed [he foregoing and [he pertinen[ Compliance Inspection Report and recommend [ha[ the individual water-supply system be considered ?acceptable ? not acceptable and Yhat the sewage-disposal be considered El accep[able ? no[ accep[able DATE SIGNATURE TITI.E E] HUD AHCHITECTUflAL SECTION CHIEF OR DEFUTV CHIEi ? VA CHIEF FPPflAISHL SECTION OR OESIGNEE VA FOPM 26?6395, AaF 1981 SUPEfl5EDE5 VA FORM 06b395, OCT 1976, HUD FORM 92573 WHICM WILL NOT BE USED. Permit #: _ <?)-A lC) Receipt Date: CITY OF EAGAN 2001 SEWER AND WATER CONNECTION AND AVAILABILITY CHARGES exisriNC RE5IDENTIAL PROPeRnr Address viy 0, ? (j?- ? V?- b rroperty owner _ '4v ,n, -0- v\, A Tetepbone # Co S 1- ?-{ S?k- 8 lo c) ? Plumber OFFICE USE ONLY 4L PRV required /J?yi City I?A County R-O-W Permit Sewer Water Lateral chazge @ $22.85/ff $ Lateral charge @ $23.05lff Trunk @ $925/connecrion Trunk @ $965/connection City SAC 100.00 Water supply & storage 860.00 Base SAC 1,150.00 Date paid Date paid Receipt # Receipt # Treaanent plant 516.00 Account deposit 15.00 Water meter "'"I pections req'd prior 115.00 Septic abandonment 50.50 to issuing Sewer permit & surcharge 50.50 Account osit 15.00 Water rmit & surcharge 50.50 Plu ng permit required Total "I'll oial $ ? Sewer and Water Sewer lateral charge @$22.85/ff iLv "' P Water lateral charge @$23.05/ff ioo '?-P. 4 Ss.vo oo1 Sewer trunk @ $925/connecrion dla I Water trunk @ $965/connection City SAC 100.00 Base SAC 1,150.00 Date paid Receipt # Water supply & storage 860.00 Date paid Receipt # ? C} h b Treabnent plant 516.00 p Qtiyh,? _.Wah=xnetcr-*,k[nspections req'd prior to issuing ? 1-33s80-- Accounfdeposit 30.00 Septic abandonment 50.50 Sewer and water permit & surcharge 100.50 Plumbing pcrmit requircd Q? Total g 4?? ? cc: Carolyn Krech, Finance Department -9 o-- vv,-?? 2--30 - G c r 4 ' t0 --? - - -- - ? D?rNA^K ---- --- AA ? .- -- - - ----- -- - -- --- - - - -- - -- Ql?' ? ----- - YY/??7 ??C !i O?l ?•' p ;?v? - - - - - - - ? i' -----?Q -- , t ? q - o5;.- ?r -- - _? ° ?t? - ? - -- - - - ldrtr? - - -- - - - -- -- - -- - ' - - ?p?,C?- -(?'? ? '?.-?,?. -?<g • -- . - MASTER CARD ? Olo -S ? • LoCATIoN 1iLor KNot, yr$y f&c 3 y G,Fo DHMA?? ? n! STRUCTURE AND LAND LISED AS Permit No. Issued Issued To Confractor Owner BUILDING 240 3 3-2t- PLUMBING CESSPOOL - SEPTIC TANK 57-1j WELL ELECTRICAL HEATING GAS INSTALLING I I SANITARY SEWER ? OTHER ( I OTHER I • 9 Items Approved (Initial) Date Remarks Distance From Well ?:GOTING SEPTIC _ FOUNDATION FRAMING ? ? ? 1? ? 1I ?1?•1? fi ? ?7 CESSPOOL TIIE FIELD FT. FINAL ELECTRICAL + HEATING DEPTH nrJ OF WELL ?C /O GAS INSTALLATION SEPTIC TANK Jp?qM,. S'?/KL.?• CESSPOOL DRAINFIELD PLUMBING WELL SANITARY SEWER ? ? ? ? Violations Noted on Back COMMENTS: COMPLIANCE INSPECTION REPORTS ; TO BE USED ONIY IN EVEN7 OF DBSERVED VIOLATIONS ? PERMIT NO. CONDITIONS OF CONSTRUCTION AT THIS INSPECTION ? NO EVIDENCE OF NON-COMPLIANCE OBSERVED. 1:1 ACCEPTABLE SUBSTITUTIONS OR DEVIATIONS. DATE OF INSPECTION NON-COMPUANCE. BUILDER WILL COMPLY WITHOUT DELAY. NON-COMPLIANCE. BUILDER DOES NOT INTEND TO COMPLY. ? COMPLETION OF CERTAIN IMPROVEMENTS WILL BE OELAYED BY CONDITIONS BEYOND CDNTROL. AND DESCRIBED AS FOlLOWS: ? REINSPECTION REQl11RED DATE OF REINSPECTION - ? REINSPECTION REVEALED CERTI FICATION -I certify that I have carefuliy inspected the a6we in which I have no interest present or prospective, and that I have reponed herein all significanC conditions oLserved to he at variance with ordinances of the Town of Eagan, approved plans and specifications, and any specific require- ments for off-site imprrnements relating to the praperty inspected. ? ALL IMPROVEMENTS ACCEPTABIY COMPIETED 6UILDING INSPEGTOR DATE 0 L'I7Y OF :r:.Ac,AN r.,AsN:r.Fr, s rrF;Mzr,r?? NOt 699 UATF^ 0308/98 T]:Nf.::u 0:1404 IUc NFlMC; AMERICAN HOME Prnnur,TS INC 32:i.4 9001 4884 PII_O'1 1(NOTi 74„75 205 9001 4884 F'7L..Ol" YNUk3 1.,50 t ? I(J'h ].i. RPCE!.LI.Y'F, YtmoI.nntt 76.25 CF'C187276 L)°F_'R ID: N1NCY -? CIT1( OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55122-1897 (612) 681-4675 SITE ADDRESS: PERMIT PERMITTYPE: BurLozrvG Permit Number: 031615 Date Issued: 0 3/ 18 J 9 8 4$84 PILOT KNOB RD L07: 1 BLOCK: 51 SECTIqN 34 P.I.N_: 10-03400-019-51 DESCRIPTION: ?p?•. Y.:Ra?.:l: GY'M Y j ? y\? ¢?' s ?. REMARKS: ' gc. FEE SUMMARY: Base Fee Surcharge Total Fee (WSNDOW REPLRCEMENT) ermit Type SF (MISC.) Vq Type REPATR 494 A17. RESIDEMTIAL VALUATION $3,000 $74.75 $76.25 CONTRACTOR: _ Applicant - s-r. LIC.OWNER: AMER HOME IMPROVEMENT PROD 13154516 20090017 DOERING ARNOLD 1 823 ZEALAND AVE N 4884 PI40T KNOB RO RQOKLYN PARK MN 55445 EAGAN MN 55122 (612) 315-4516 (612)454-8601 ci?e ?s c?r?-'erp't ;* ?rad'G£ty 6f,???o'n LI ANT/PERMITEE SIGNATURE Nia Rj.,? I mV ISSUED Y: GNATURE, - ?'?? 1998 BUILDING PERMIT APPLICATION (RESIDENTIAL) i?G??J crrY oF Raanx 3830 PII.OT KNOB RD - 66122 fi81-4675 New Constmdion ReaWremants ? 3 registered ske surveys ? 2 copies of plans (inGude beam 8 window saes; poured fid. design; etc.) • 1 energy ealeulations ? 3 copies of tree preservatian plan H lot plaked after 7I7193 re? ired: _ Yes _ No oATE: ?r, DESCRIPTION OF WORK: STREET ADDRESS: LOT: J_ BLOCK: 61 SUBD./P.I.D. #: 9? PROPERTY OWNER CONTRACTOR ARCHIT'ECT/ ENGINEER Name: /JOC ?'!hd 11 1KlA/ Phone#: 61IR 'ZS % ?6CJ/ Lsst F'vit 5treet Address: /t j, City /? & Q a.1 State: 10ivi Zip: Company: Phone Su'eet AddressAf,23 --Z t -clr, .. G vc & Licensa # City State: Zip: -S.S kS-S ?j0. t?r ?t-nc t?l Company: Phone #: Registration #: Street Address: City Sewer & water licensed plumber (new construction only): and lot change is requested once permit is issued. Zip: Penalty applies when address chang I hereby acknowledge that I have read this application and state that the information is correct and agree to compy with all applicabl State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant: OFFICE USE ONLY Certficates of Survey Received _ Yes _ No RemodeUReoair Reauirements ? 2 eopies of plan ? 2 stte surveys (exteriar edditlons 8 tlecks) ? 1 energy calwletions for heffied edditions CONSTRUCTION COST; 2 t/7 Srate: Tree Preservation Plan Received - Yes - No - Not Required OFFICE USE ONLY BUILDING PERMIT TYPE 0 01 Foundation ? 06 Duplex 0 02 SF Dweiling ? 07 4-plex ? 03 SF Addition ? 08 8-plex 0 04 SF Porch ? 09 12-plex ? 05 5F Misc. ? 10 _-piex WORK TYPE ? 31 New ? 33 Alterations ? 32 Addition ? 34 Repair GENERAL INFORMATION ? 11 Apt./Lodging ? ? 12 Multi RepaidRem. ? ? 13 Garage/Accessory ? ? 14 Fireplace ? ? 15 Deck ? 36 Move ? 37 Demolition Const. (Actual) Basement sq. ft. (Allowable) Main level sq. ft. UBC Occupancy sq. ft. Zoning sq. ft. # of Stories sq. ft. Length sq.ft. Depth Footprint sq. ft. APPROVALS Planning Building Engineering Permit Fee Valuation: $ 5urcharge Plan Review License MC/WS SAC City SAC Water Conn. Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment PI. Park Ded. Trails Ded. Othpf COpI@5 Total: 16 Basement Finish 17 Swim Pool 20 Public Facility 21 Miscellaneous MC/WS 5ystem City Water Fire Sprinklered PRV Booster Pump Census Code. SAC Code Census Bldg Census Unit Variance % SAC 5AC Units Cities ity Control The following image represents the best available image from the original page. Every effort was made to capture the content from the original page. _--sL4.- ' p q c?t --- - -- - --- ? ?r ? - ---- -- ?r¢ ? = ? P5 ? se? 34 p?Q ? D 2. I- i l?_ ?T? ? --- '. ?V ----- ??! -----;?ov.ts •.- (Y?a?rcPfla f?'? eldec ker ? r ----- - e 5 4=00 ? SCREEN5 2692'3&3p REAL ESTATE INQUIRY - NAME/RDDRESS/LEGRL XINPN003 PRRCEL ID: it) 03460 010 51 PLAT NAME: SEC7ION 34 TWN 27 RRNGE c^3 SRECIAL HOMESTEAD CF1RD ENTERED: 02 OS 1991 FIRST DIVISION: LRST DIVISION: FEE CURRENT OWNER: RRNOLD G DDERING 4884 PILOT KNOB RD LEGAL: F'T OF NW 1/4 OF SW 1/4 COM NW COR E 8 RDS TO BEG E 363 FT 5 300 FT W 363 FT N 300 FT TO HEG 34 2723 EAGRN MN 55122-2739 TRpNSFER TO SCREEN NUMBER: PF8-SCROLL FORWRRD 4A?-ol hwy esmlvT .??Qe?C I( or? GT Y ObJ JOO ,3-/s-9/ / L/ ?Sar i_. 7987 BQILDING PERFiIR APPLICATION - CITY OF EAG6N SINGLE FAMILY DWELLINGS INC[.[IDE 2 SETS OF PLANS, 3 OF S[IROEY, 1 SST OF ENERGY CALCQLATIONS NOTE: ADDRESSES FOR CORNfiE LOTS - COHTRACTOR/HOMEOiiNEH MQST DESIGHATS iIHICH ADDRESS IS DFSIRED. NO CBANGBS WILL BE ALLOWED ONCE BQILDZNG PERHIT IS ISSIIED. MULTIPLE DSiSLLINGS - RSSIDENTIAL RENTAL QAITS FOft SALE ONITS INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SIJHVEY - CHECB WITH BLDG. DEPT., 1 SET OF ENERGY CALCULATIONS COPRSERCIAL INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS, 1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS, $2,000 LANDSCAPE BOND To Be Used For: Site Address 57eiv? ? ? u? Valuation: -?? q5ly-y h'ue6 Ri OFFII Lot ' Block s ? Parcel/Sub Owner /tYNO Y G -I)oe, in1Q Address `f "-q P'?? T Kva? ?j City/Zip Code C.a?p,.r SSlaa- ? Phone Contraetor Address City/Zip Code Phone Arch./Engr. Address City/Zip Code Phone # Date: On Site Sewage_ Occupancy MWCC System Zoning On Site Well _ Type of Const City Water (Actual) (Allowable) Of of Stories Length Depth S.F. Total Footprint S.F. APPROYALS FBBS Assessments Permit °?D • '?T' Water/Sewer Surcharge •S b Police Plan Review Fire SAC, City Engr SAC, MWCC Planner Water Conn Council Water Meter Bldg Off Road Unit APC Treatment P1 Variance Parks Copies TOTAL ? -?- ?,. ? , ? ? a?x 3 C? a a x '?-- - , n ; ' Za a ? °z O ? ?a 6 f No °` Io ZU Q ZLL ` ID? ? _H0 N N ( w ? "' =z ?o 0 0 ??t?' ? F ? cl ? lOr }'? '}y1??1 LL ¢ 1 _ ? ? ¢ N [? ° 3 dm Zr V W 0 0 ASSESSMENT AGREEMENT ? N U ? w W 0 > 2 O U ? W ? ? f. W?°C Z 3 Lu O Q ¢ ? x U 1'786005 ? ? ? This Assessment Agreement ("Agreement") is made this 31 S day of M0, ?/ otd0 2001, by and between ARNOLD GEORGE DOERING, a single person, (hereinafter "Landowner"), and the CITY OF EAGAN, a Minnesota municipal corporation (hereinafter "City") (hereinafter collectively referred to as the "Parties"). WHEREAS, Landowner is the fee owner of property located in the City of Eagan, ? County of Dakota, State of Minnesota and legally described as: Commencing at the Southwest comer of the Northwest Quarter of Section 34, ? Township 27 North, Range 23 W, thence East along the South line of said Northwest Quarter a distance of eight (8) rods to point of beginning; thence , Easterly along said South line of said Northwest Quarter a distance of 363 feet; thence South 300 feet; thence West 363 feet; thence North 300 feet to point of beginning. (hereinafter the "Property"). WHEREAS, as part of Public Improvement Project No. 787 (hereinafter the "Project"), the Property was proposed to be assessed for certain water lateral chazges ($3,000.00) and sanitary sewer lateral charges ($3,000.00) associated with the Project; WHEREAS, Landowner has requested that the City eliminate these charges from the assessment and collect the same as a connection charges upon subdivision or development of the Property; and WHEREAS, the City is willing to not immediately assess the water lateral charge and sanitary sewer lateral chazges and defer collection of the same all upon the terms and conditions contained herein. S ?? W V W ? Y N w ,-nU NOW, THEREFORE, in consideration of the mutual promises contained herein and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the Parties do hereby agree as follows: f * , n. ` Treatment as Connection Chaz2es. The City agrees the Property shall not be immediately assessed for water lateral and sanitary sewer lateral charges. These charges will be collected and paid when the Property is subdivided, platted, and/or connects to city sewer and/or water services, whichever occurs first. Then these amounts shall be treated as connection chazges and paid at the rate then in effect. 2. Waiver. Landowner hereby waives his right to object ar appeal any connection charges pursuant to MiNN. S'rnT. §429.081 and further waive notice of hearing from this agreement. 3. Bindin Effect. This Agreement shall be binding upon and inure to the benefit of the Parties' heirs, successors and assigns and shall run with the land. OA";_00 A Arnold George Doering --7 CITY OF EAGAN: By:, Patricia E. Awada STATE OF MINNESOTA) )ss. COUNTY OF DAKOTA ) Its: Mayor ,,•.???:.;.'?,,,,, By: Mira McGarvey Its: Deputy Clerk r The foregoing instnunent was acknowledged before me this day of M? , 2001, by Amold George Doering, a single person. / ---- MATTHEW W. LARKINS NOt3T,y PllU11C NOTARV PUBLIC •MINNESOTA , MyCOmmiasionEHpirmJen.31,ZW5 arY STATE OF MINNESOTA) )ss. COUNTY OF DAKOTA ) The foregoing instrument was acknowledged before me this ,?.F.?C, day of odkfs? , 2001, by Patricia E. Awada and Mira McGarvey, the Mayor and Deputy C,rA of the City of Eagan, a Minnesota municipal corporation, on behalf of the municipal 66rporation. '= JUDY M. JENKINS ? ?' NO7AHYPUBLIC-MINNESOTA '_'," ? A1?' Cortunission Expires Jan. 31, 2005 '? n. ? Z?? blic APPROVED AS TO FORM: IG?/? /? • /? City Attorney's Office Dated: b/t y/o/ APPROVED AS TO CONTENT: u ic arks Department Dated: Sl = 3/- U/ THIS INSTRUMENT WAS DRAFTED BY SEVERSON, SHELDON, DOUGHERTY & MOLENDA, P.A. 7300 West 147th Street, Suite 600 Apple Valley, MN 55124 (952) 432-3136 (RBB: #206-17428) SEVERSON,SHELDON, DOUGHERTY & MOLENDA, P.A. SUTCE 600 7300 WEST 147TH 57REET APPLE VALLEY, MINNESOTA 55124-7580 (952) 432-3136 TELEFAX NUMBER (952) 4323780 E-MAIL bauem@sevmomheldon.com TO: Jerry Wobschall, Consultant FROM: Robert B. Bauer, Assistant City Attorney DATE: August 14, 2001 RE: Amold George Doering/City of Eagan Project No. 787 Our File No. 206-17428 Jerry, Enclosed foa the City's records regarding the above-referenced matter, please find the original Assessment Agreement dated May 31, 2001 and recorded with the Dakota County Recorder's Office on June 26, 2001 as Document No. 1786005. cc: Thomas A. Colbert, Director of Public Works Clty 0f EapIl 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 ?----------------- I ??y'??.Use OJ ?? ? Pertnit#: ? Permd Fee: ` b• ? j I ? ? Date Received: ? j C I I Staff. i 2008 RESIDENTIAL BUILDING PERMIT APPLICATION Date: i?- `_0 UI SiteAddress: ?(1 V7 ??I???Nab I?o?d Tenant: !?`-'?`Rdd C) Q eo ' '%0I Suite #: RESIDENT / OWNER Name: A?"--?Io OQ f~ ;N!? Phone: /SI ' ySy" lSY60I Address/CitylZip: y SSq /- I'll 0? X--i0 b Applicant is: _ Owner ? Contrac[or TYPE OF WORK Description ofwork: C4, ?^^? l\t b ? i ?? M a p,?r ?n? w,?? I yl6?( n ( Construction Cost: 6q60- 0 O Multi-Famity Building: (Yes NoA_, CONTRACTOR Name: ' J ts+ cko? (?e oklvn u.vSe License Address: /vQr /'4'^ e µ ? t Ciry: 5vNNSv"11-r State: /I ?? Zip: s? 30 6' Phone: 6S?- 2/6' .%Z)Ly0 ContadPerson: 4P"e T?'v.." COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Minnesota Rules 7670 Cateqorv 1 Minnesota Rules 7672 Energy Code . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet CBtegory SubmiHed Submitted (4 submission type) • Energy Envelope Calculations Submitted In the last 12 months, has the City of Eagan issued a pertnit for a similar plan based on a master plan7 _Yes _No If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer & Water Contractor: Phone: NOTE: Pians and supporting documents that you submit are considered to be public information. Portions of the aqformafion maybe cfassirted as non-pubfic if you provide speciric'reasons thaf would permit the Cify to ' conclude that the are trede secrets. I hereby acknowledge that this infortnation 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 pertnit, 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 qf7°(x°, GJk--- x Applicant's Printed Name ApplicanYs Signature Page 1 of 3 /eel( r Use BLUE or BLACK Ink r - - - - - - - - - - - - - - - - - I For Office Use I City Ol lrJnniU1RdPermit#: I Permit Fee: L10. CJ~ 3830 Pilot Knob Road Eagan MN 55122 Date Received: Z I Phone: (651) 675-5675 I %P1 Fax: (651) 675-5694 1 Staff: 2011 RESIDENTIAL BUILDING PERMIT APPLICATION Date: 191911t Site Address: Unit Name: eyo t?ee bt l uc Phone: ~ Z f - 51J`'~- e~tJ~ ' RESIDENT / OWNER Address / City / Zip: ks-1 P) for I /wdU ;~v of Applicant is: V Owner Contractor TYPE OF WORK Description of work: QoeC, Cj~ `~01 ~ ~u ra'~" c510V4 J Construction Cost# t Multi-Family Building: (Yes / No ) Company: Contact: CONTRACTOR Address: City: State: Zip: Phone: License 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 L 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. I 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.popherstateonecall.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 be completed within 180 days of permit issuance. x+Jd x OA4,A Applicant's Printed Name Applicant's Signature Page 1 of 3 DO NOT WRITE BELOW THIS LINE SUB TYPES _ Foundation _ Fireplace _ Porch (3-Season) _ Storm Damage Single Family _ Garage _ Porch (4-Season) _ Exterior Alteration (Single Family) Multi _ Deck _ Porch (Screen/Gazebo/Pergola) _ Exterior Alteration (Multi) _ 01 of Plex _ Lower Level _ Pool Miscellaneous Accessory Building WORK TYPES _ New _ Interior Improvement _ Siding _ Demolish Building" Addition _ Move Building _ Reroof _ Demolish Interior Alteration _ Fire Repair _ Windows _ Demolish Foundation Replace _ Repair _ Egress Window _ Water Damage Retaining Wall *Demolition of entire building - give PCA handout to applicant DESCRIPTION Valuation 41 Occupancy 2 AG MCES System 1 Plan Review ..~/e Code Edition z aa, SAC Units (25%100% Zoning # City Water Census Code Stories Booster Pump # of Units ( Square Feet _ PRV # of Buildings Length Fire Sprinklers 4 Type of Construction Width REQUIRED INSPECTIONS Footings (New Building) Meter Size: Footings (Deck) Final / C.O. Required Footings (Addition) Final / No C.O. Required Foundation HVAC _ Gas Service Test Gas Line Air Test Drain Tile Other: Roof: -Ice & Water -Final Pool: -Footings -Air/Gas Tests -Final Framing Siding: -Stucco Lath -Stone Lath -Brick C Fireplace: Rough In Air Test Final Windows Insulation Retaining Wall: _ Footings _ Backfill _ Final Sheathing Radon Control Sheetrock Erosion Control Reviewed By: , Building Inspector RESIDENTIAL FEE Base Fee ~Q Surcharge Plan Review MCES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant Copies TOTAL Page 2 of 3 -1, ,i ~~g ~d-~- ~ ~ ~~v ~,~I ~