4921 Pine LaneCity of Eaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Use
Permit #: /()/
Permit Fee:
Date Received:
Staff:
2012 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit #:
RESIDENT /
OWNER
TYPE OF WORK
Name: 7;4119 4/9 y/ til / Phone: 677 —7/‘ -3 777
17/9.2444e
Address / City / Zip: ! 9Z/ ' (40r4e CA 'iv 4
Applicant is: Owner `Contractor
Description of work: 6e(9/4,-‘7-
Construction Cost: l ai &d. Multi -Family Building: (Yes / No
CONTRACTOR
Company: 0e/7a Co'st/- 'Ct/d/1 Contact: 77' , £ti'i'Z.
Address:o�•7Z ,/6W se. -X/#2,20
City: ntekt""A'T;01/7`ail
State: V/fJ4 Zip: 1514.2 Phone: 6j X7—.2/6 -
License #: � ‘.3 .5-ag/ 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:
Phone:
Sewer & Water Contractor: Phone:
Mechanical Contractor:
NOTE: Plans and supporting documents that you submit are considered to be public informationPortions 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 Beets.
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.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 State Building Code must be completed within 180
days of permit issuance.
x ,% , &' Z
Applicant's Printed Name
x
Apn sSi•''atur
Page 1 of 3
CITY OF EAGAN
383QPilot Knob RQad
(/?an, Minnesota 55122-189
(651) 681-4675
, 1
SITE ADDRESS: '
t li. :';NI
' t ??I t i, 1 1 Stl-! . I
PERMIT SUBTYPE:
TYPE OF WORK:
INSPECTION D. . DA
?ni
; i??;;,?i ? i,i t i ?:;; ???i?,?? i rJ a; ?•
I i3l11 i'I {;?, t! rli,l
RF MAftK S z PI AIV RF V L E4JE?13 ttY WAYNF M 1! t 1 I+
r, 6. L.i NI IIMiiFR iy F,/lII1N MEI HAMII J
INSPECTI01`? RECORD
PERMIT TYPE:
Permit Number:
? Date Issued:
a t+f tor k. APPLICANT:
1hl.'1 iFil.? ?wi?s
? ?
i ,
Permit Holder
Date
Tslephone #
SE ER/
WATER
PLUMBING
HVAC
Inspection Date Insp. Comments
FOOTINGS ?aoeO
l
FOUND
7
FRAMING
ROOFING
ROUGH
PIUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
DOMESTIC
METER
IRRIGATION
METER
FLUSH
MAINS
CONDUCTIVITV
TE5T
HVDROSTATIC
TEST
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
. KCL`ttfiCQ.t¢ df cCC"liliC?
Y 6i" of *agaic
Tle* a?rtweut oF ZKilbing aaBoectian
This Certificate issued pursuant to tke requirements of the U?ciform Buifding Code
certifying tiwt at the time of issuance this srructure was in compliance with the various
qrdinances of tlre City regu[atrng bui(drng constructian or use. For the followiRg:
ux c,?ircaci: SF M ebg. rem,i, Nw.34416 ?
0--v-r Trve 93 1 zonins aarkt fl? Type const. VN
owner oreuiiaina 'Y MCIfWS Addms 3338 FR@M AVM 90[ZIH
Building AdNess 021 PIlNE LANE LT 4, BL ! PIlETfzEE EUM
B,i,bng «r=W .
POST IN A CONSPICUOUS PLACE
Address 4agi rTrF TxE Zip 55122
Lot 4 Blk t Sub PIWTREE ED?M
THESE ITEMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECTION.
Date: (eh? 9 Yes No Inspector:
Final grade (6" from siding)
Permanent steps (garage)
Permanent steps (main entry)
Permanent driveway
Permanent gas
Sod/Seeded gass
TraiVcurb damage
Porch
Basement finish
Deck
Please ve ' with the builder t6e removal of roof test caps from the plumbing system and the shutoff of water supply fn
the outside awn faucet before freeze potential exisis.
Contad engineering division et 6814645 before working in righbof-way or installing underground sptinkler system. ?
White - City Copy Yellow - Resident Copy Pink - Contracror Copy
PERMIT
C?kTY OF EAGAN
?3830 Nilot Knob Road
Eagan, Minnesota 55122-1897
(651)681-4675
PERMIT TYPE: 8 u r i_ n I iv r
Permit Number. 03 4 4 7. 5
Date Issued: 01127 /99
SITE ADDRESS:
4521 PS14c LAhJE
L4Ts 4 BI.OCK: 1
PTNETREE F4HrST
P.T..N.: 10-57850-040-01.
DESCRIPTION:
{r I.
L`'3?^RYld:cQ'-„P81"ffllt TV'l7E
!ilu.; intnn Obrk Tyoe
leiHC Occuoaracl
; Constr uction Tit'3e
j Zonina '-1
/ F3uS ldanq LenoCM `
?8u9, lding Width j
S
?:. By,ildinq si:qrige
FceL'
Ct??,l:Y
sF owr
NIc 6J
R-i /U--:1.
U IV
(2-1
70
64
L2,40 4
101 1 - I=1iM. JE'PAI'.H
REMARKS:
f-'UHiV ftEVIFl.lEU i'tY UIF."NF MLLI I,CR..
S & W PI.UMPER SS 50UYH MECHNNICAL Pfif)NC#(641).42c3-3733.
FEE SUMMARY:
vALurarroN $219.,000
Hase Pee $ 1„660 .15 hll^C. FEES 11,637.50
f>.1nY1 fteV1EW $1,E79e1.0 l'ot31 FC?e 05.536_25
Surcharqe $109.50
5AC $5„050.00
SAC % 1G5@
yAC lJnitg :L
Subto'tal $35
83Se75
CONTRACTOR: - Noolicanr_ - sT. L7c. OWNER:
i+7ANLEY 8R0S CONST INC 13863815 20054327 MANLGY eROI'HEkS
20E35 JUPIl'ER AVE 3338 FFiEI"IOiV1' AVE ..',
LgKEVILLE MN 56041 MINNEflPOL1S MN 66408
(117) 386-3815 ( 6].?_) 3Sfi-387.5
?
L herobv acknow.tectqe that I have read this app.Licotion and stiaL8 tihat tiie
in#nrmaYion is cGri-sct at?d darep tio compl.v wi_Ch a? i applicnblc Stzite c1 Mn.
Statutes and C,itv oY Eaqan Oi-d;riances.
/
?
APPLICANT/PERMITEE SIGNATURE
.l ,l ? /o
--? ISSUED BY: SIGNATURIPq
-1
CITY pF EAI:,AN
CASNSFF: 5 f'EFMINAi.. N0: 774
DATEe. 0:1128/39 1'.7.ME:r, 15:1.9;1.8
111,
NAMF: MANL.EY Bfi(7'1'HEFS CONS'(F'l1C:l'ZQN
i.'.2`;F 9001. 4921 F'INf- LANE Sr`i36.?S
Tn+,a]. fieceipt Amount. 5y5:36.25
CRi0P.256
t.ISF.F. ILi: NANCY
?
:
?
i
1998 BUILDING PERMIT APPLICATION (RESIDENTIAL)
, • CITY OF EAGAN
` 3830 PILOT KNOB RD - 65122
681-4675 ?
New Construetion Reauirements RemodeVReoair Reauirements
? 3 registered sde surveya
? 2 copies of plans (inGude beam 3 window s¢es; paured fid. design; etc.)
? 1 energy alcuWtlons • 3 copias of tree preservation plan N bt plaGed aRar 7/7193
reQUired: _Yes ? No
DATE:
1 0 •a3•q?8
Name: m ta.4 L-" bR-o-rN %A-s CauSZ-V-u''oRkone #: (v' a? 3 L?L- 3`6 ? 5
Last First
IZe...s?DE_..tr?raL- Ne-.-?C??+s-rx??c--noa
DESCRIPTION OF WORK:
STREET ADDRESS: `-I 9o1 I
LOT: LA_ BLOCK: SUBD.lP.I.D.
PROPERTY
OWNER
CONTRACTOR
ARCHITECT/
ENGINEER
StreetAddress: 33'.SS vsJE. So.
ciry rn?t?j "E4aFk, " s srace: mbj . zip: 55 140$
Company: 5 rar.nr- AS Phone #:
Street
City
• 2 wpies of plan
? 2 site surveys (exReAor adtldions S decks)
? 1 energy alalatlona for heated additions
CONSTRUCTION COST; a38i °O°• cmc:?
State:
Company:
2zp:
Phone #: C` '-Z
Name: TtD r"'N Registration
StreetAddress:.3`I3-'M)
cicy E.•?a..? srate:
rv,\"
Zip:
Sewer & water licensed plumber (new construction only): MEc-*A ?....?.+? . Penalty appiies when address chang
and lot change is requested once permit is issued.
q a3-3-7 ?)3
I hereby acknowledge that I have read this appliqtion and state that thQ infortnation is correct and agree to wmply with atl applicabl
State of Minnesota Statutes and Ciry of Eagan Ordinances.
Signature of
OFFICE USE ONLY
Certificates of Survey Received Ll?yes
No
License #
DEC 2 31992
Tree Preservation Plan Received _ Yes ? No - Not
OFFICE USE ONLY
BUILDING PERMIT TYPE
r
? 01 Foundation ? 06 Duplex p 11 Apt./Lodging ? 16 Basement Finish
)", 02 SF Dwelling ? 07 4-plex ? 12 Multi Repair/Rem. ? 17 Swim Pool
? 03 SF Addition ? OS 8-plex ? 13 Garage/Accessory ? 20 Public Facility
? 04 5F Porch ? 09 12-plex ? 14 Firepiace ? 21 Miscellaneous
? 05 SF Misc. ? 10 _ plex ? 15 Deck
WORK TYPE
7?1131 New ? 33 Alterations ? 36 Move
?O 32 Addition ? 34 Repair ? 37 Demolition
GENERAL INFORMATION
Const. (Actual) \//j Basement sq. ft. /5'7;? MC/WS System ?
(Allowable) IIA) Main level sq. ft. ir7?Z- City Water
UBC Uccupancy 3 U1 uPA sq. ft. i?y `1 Fire Sprinklered
Zoning ? G sq. ft. PRV
# of Stories y sq. ft. Booster Pump
Length _70 sq. ft. Census Code.
Depth 5'1 Footprint sq. ft. ?c-i ° SAC Code p?
Census Bldg a?
Census Unit
APPRC)VALS -
Planning Building Engineering Variance
Permit Fee I(o (o C) - I15- Valuation: $ /,904f)
Surcharge I oOt. "
Plan Review f C) ?I 9. I ?? X 33 =?p 5 6
License x 3
MC/WSSAC tU?
City 5AC r? N X $= y 71
Water Conn. ?o ° a4 `L
Water Meter
---
? x ? a= $.nt-
Acct. Deposit ?y 7a .?? = a 5I 4 z
S/W Permit
S/W Surcharge r?1n
sa.,Gas 1??= is 7a X 5y
= S? t?,5,or
Treatmertt PI.
5 c- S?
Park Ded. ?yAER
?°'e ? l ?7?
Trails Ded. ?,•,?°?
$y
7 x ra
- =
Other aSA
+i6 x 16 °
'
Copies ?a6 x 6 ; J
??sk? 5?f = 9v y?6
Total:
3 f, x 30 = ?sr?
% SAC x ;k-
SAC Units 8' ?r 66 76,
?G =
f 3 a,x
/33J2
?iCl IT. 33;-1V
,, .
* * *
'k PIONEEFt
* eng neer
* * 7? *
Certificate of Survey for:
2422 Enterprise Drive
Mendota Heights, MN 55120
LAND SUpVEYORS .aIAL aQNEERS (612) 681-1914 FAX:681-9488
uxo rLMr+ves. unoswe uRaui[tn 625 Highwoy 10 N.E.
Bloine, MN 55434
(612) 783-1880 FAX:783-1883
MANLEY BROS. CONST.
4921 PINE LANE
BENCH MARK
TOP OF PIPE
ELEV.=973.11
3
(VACANT) -?
? Z.
I ? ?60? 13 I
N89041'52"E 137.40 o ?
6.7 9.9 46.33 30.00 4.0 972.7 I
o ,O
ni 971.8 28.33 ° 3.5
10 r /? -----4
?
p i°o a?.00 vv ? ? O
JJ ??/ o? PROPO?D 973.2 I
970.3 n.7 p.O? p? DRIVEW Y
?
? .ya x .00.^ 1?0 I W
? ?Z /? oot .00? 974.3 I I Z
?
'_ ? Zw T O N I 0 ?w3.000 i SERVIkE 3 J
? ? ?a 0^ ^ 1 / ao?.00 r ? ELG ? _ ?
M ? ow o/ax o A q'i '?l64•g i ? I?
/?o a ? r I
o
Z ?? L - - - - 97'?'-- 33.33 " 97?---? Z
oi971.1 io 1
^ oi ?o ?n 10
STM H. iLO C.B.
0 967.2 970.8 . 3 0.00 974.4
sse.o N89'41'S2"E 137.53 7-:
°
?
?e? 5f7'o r ,n-l
'{?,°? I
I 5-0 w.? n 13
(VACANT) '7TOPCOFM
?,ELEV.- 7
NOTE: PROPOSED CRAOES SHONN PER CRADING PLAN BY: E.G. RUD
NOTE: BUIIDING DINENSIONS SMONN ARE FOR HORIZONTAL AND VfRTICAL LOCATOM
Oi STRUCTURES ONLY. SEE ARCHIIECNAL PLANS FOR BUILDING AND
FOUNDRTON DIMENSIONS.
NOIE: NO SPEpFlC SOILS INVESTIGATIIXJ MAS BEEN CONPLETED ON THIS LOT BY THE
SURVEYOR. THE SUIiABILITY OF SqLS TO SUPPORT THE SPECIFlC XWSE
PROPOSED IS NOT THE RESPONSIBIUTY OF THE SURVEYOR.
..-
PROPOSED HOUSE ELEVATION
LOWEST FLOOR ELEVATION: 9711Z
TOP OF BLOCK ELEVATION: 9%0'0
GARAGE SlAB ELEVATION: 77
NOTE: T715 CERTFlCATE DOES NOT PUFPORT TO SHOW EASEMENTS OTHER THAN X 000.00 OENO7E5 EXISnNG ELEVA710N
THOSE SHOWN ON THE RECORDED PLAT. ( 000.00 ) DENOTES PROPOSED ELEVATION
NOIE: CONtttACTOR MUST VERIFY DRIVEWAY DESIGN. --- DENOTES DRAINAGE ANp UTILITY EASEMENT
' DEN07E5 DRAINAGE FLOW DIRECTION
NOTE: BEARINCS 5l10WN ARE BASED ON AN ASSUMED DATUM 0- DENOTE$ MONUMENT
$ DENOlES OFfSET HUB
WE HEREBY CERTIFY TO MANLEY BROS. CONST. THAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A
SURVEY OF THE BOUNDARIES OF:
LOT 4. BLOCK 1. PINETREE FOREST
DAKOTA COUNTY, MINNESOTA
IT DOES NOT PURPORT TO SHOW IMPROVEMENTS OR ENCHROACHMENTS, EXCEPT AS SHOWN, AS SURVEYED BY ME OR
UNDER MY DIRECT SUPERVISION THIS 10TH DAY OF NOVEMBER, 1998.
S
SCALE : 1 INCH 30 FEET B. I NED: tPIONEER ENGIN RING P.A.
= ?
?8? 98275.13 SN7C John C. Larson, L.S. Reg. No. 19828
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LOT SURVEY CHECKLIST FOR RESIDENTIAL
BUILDING PERMI.T APPLICATION _
PROPERTY LEGAL:
DATE OF SURVEY:
LATEST REVISION:
DOCUMENT STANDARDS
1? lyl46/g?
• Registered Land Surveyor signature and company
• Building PermitApplicant
• Legaldescription
• Address
• North arrow and scale
• House type (rambler, walkout, split w/o, split entry, lookout, etc.)
• Directional drainage arrows with slope/gradient %
• Proposed/ebsting sewer and water services & invert elevation
• SVeet name
• Driveway
ELEVATIONS
Existina
er' ? ? • Sewer service (or Propased)
6?-- ? ? 0 Propertycorners
[T- ? ? • Top of curb at the driveway
cr' ? ? • Elevations of any existing adjacent homes
Prooosed
cr' ? ? • Garage floor
E5, ? ? • First floor
[a" ? ? • Lowest exposed elevation (waikouUwindow)
GY ? ? • Property corners
[3-,? ? • Front and rear of home at the foundation
PONDING AREA (if apolicable)
? 4!r' ? • Easement line
? ra-' o • NWL
? [3'- ? • HWL
? c' ? • Pand # designation
? [a,, ? • Emergency Overflow Elevation
DIMENSIONS
J2- ? ? • Lot IineslBearings 8 dimensions
Er ? ? • Right-of-way and street width (to back of curb)
? ? • Proposed home dimensions including any proposed decks, overhangs greater than 2',
porches, etc. Q.e. ali structures requiring permanent footings)
er ? ? • Show all easements of record and any Cily utilities within those easements
El, ? ? • Setbacks of proposed sVucture and sideyard setback of adjacent ebsting structures
? C3-"o • Retaining wall requirements, i ny
z ,3G
Reviewed:.
me / Date
a
January 1998
GRAIGI BW/BI.OGPRAIT.FM
4: • '
FLL F Co PY
(SEE ATTACHMENTS)
Development
f 11 v.c l rce
Lot Number 4
Address
Builder
Y
Bloek Number I
Tree Protection Reauirements-
X Tree Fencing
Oak Tree Pruning (Seal wounds during April 15 to July 1)
Therapeutlc Pruning
Retaining Wall
Other.
Replacement Trees•
Attachmants:
T
Additional Notes•
?N.i {t rt
?Lc ilw?l ?
Not Required u
asFalows: }?•??-? ??-.., ? `?ce, /?{:?dcu P- IZ'
_t^;?s.111.4',z?rt ?l ?x! V?vW- .,?a??L
l
Yes
No
(br?-ESf-`t3w?6v-ej wLZw
FEASM FORFMY DtvasIoN
ROOEMB
?
?
6128234689
011105/1999 19:05 6128234669 MANLEY BROS CONSTRUC
. a1Z08i99 15:01 EfM'?fIN MTGE FAG e 6126234669
a.n ts1«rm alw
? t ?? w?u He+ghu m sat7a
(452) W-11114 fAA Ni'???
677 M1?MrSNY ,0S?34M.i,.
* . ?. * Mein?. W (612) 7.3..,..o FAx: 7.s-,..s
Certiticote of Survey tor: MANLEY BROS. CONST.
+u+ .s+c wrc
3
(rAcAwq (
I13 ?
? Nai'41'62"E 137.40 ip
.. s .a • 4.0 01:.1 `
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PAGE 91
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? ENEI2GY CODE WORKSHEET FOR 1& 2 FAMILY DWELLINGS
- ? SYT6 ADDRESS S PK- Q I . . ;.'i''Y
COMPLC.TBDHY, L-E BOILDIN6CLA33IFICATZON: ? cate o1y 1
9 (etaadard) 'or.* cat?
. . HIt7ZHUM CRITHRIA '
FoundaCion IneulaGion-R10 . Walle r. Windowo - IS , lab onGrade Zneulation-R10 foreallowable rercentagese
P 9 1`:
Floor'overunheated epacee-.R29
[Foufidation Windowe 1/2"
neUlatedGlase.Hood orvinyl Frame - eTHpl Wiadow 4 Door Area -- A. Total. Window t< poar Area in 3q. Feet
' . : WINDOWS (Including Foundation Windowe)t ,
. WINDOW MAN[7FACTURB NAMHt
WZNDOWMA1T[iFACT[7R6 TYPHs GSM
Y7INDOW HAtiDPACTURE U FACTORt • /?f
R.-O. Quantity eq.fC.AYea
Dimeneione
0-0 A X 31 N l? 14
7,!-c,"x4co' !!if IJII' /DI
ZLu"x 9r-o" 1? Zo
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Atea oE n_ Q Et
Windowe 4 Doore
B. Total Wall Area in Sq, Ft. .
Wall Total Height- Area
Perimeter
al Area oE Walle
ft
DATE
t
Roof Att1a Iaaulatiattt
R94-With Attic No F[eel
R38-With Attic Raieed lieel
R38 & RS-Solid Rafte're
STBP 4 Calculate area ae a pezcent o£ wall
C. From 5[ep 1 divide box A(Window & Door
Area) by box B(total wall area) l-imeo 100
equale the window and door area as a
percent of wall area (box C).
OR A
Box 8 X 300 ° F i ? ,
ST2p 3 Ueeign Featureo
ASSGMBLY
FRAMING TYPES -
STANDRRD FRAMINO >? etude 16" o.c.
ADVANCED FRAMZNd ntude 24" o,c," •
CAVITY INSULATION RLi_
8fl6ATBIMG TYPSt
LESS TNNJ c R-5 ? R-5 > OR MOR6 U-FACTOR p
From the table, (teveree side) determine the
maximum percent window & door area for thedeeign optione eelected and enter the t valuu
in Box D below baeQd on the window mfg. U-
factor: _
Lk =-?
The t value from tlic Lable in Box O s11all bo
equal to or greatur than the } 1n Box C
--
......_. '!..._. __!'.?._?._i.."??[---? -•-
' -
.
ONE- &I'Wp,pq*QLy RESIDF.NTIAL p[R(,pING pRESCRHpWE (COOK-800K)
APPROAC}i
MAXIMUM WINpOW q(.ID DOOR AREA AS A PERqENT OF OVERALL WALt,
AREA
77
Fremi Cavit 8xtertor Window U-Fattot
n lnaulation 5heathin 0.49 0.36 0.31 0.27
STANDARD
STANDARD R-13 2 R- 7 13.49'. 17.89'. 21.3% 24.3%
S1'ANDARD R-13
R-15 R- 5 12.4%- 16.4°a 19.7% 22.5%
STANDARD
R-18-19 R- 5
< R- 5 12.996
I2.19'e 17.1%
16
096 20.19'0
18
87 23.4%
STANDARD
R-18_19
R- 5
14.096 .
16.65'0 .
0
21.8% 22,0%
25
3'Y
ADVANCED
R-18-19
c R- 5
12,996
17.1%
20.15'0 .
e
23
4"0
ADVANCED R-18-19 Z R- 5 14.5% 19.29'a 22.5% .
26
1%
STANDARD
STANDARD R-21
R-21 < R- 5 12.8°/. 17.019 19.9% .
23,1%
ADVANCE > R- 5 14.5°e 39.3% 22.596 26.1%
Q
ADVANCED R-21
R-21 < R- 5 13.6% 18.1% 21.29'o Z4io
R- 5 15.OYe 19.9% 23.29'0 ' Notee:
• Window area equais rough opening minus Installatlon cleerancea.
Window U-factor masl be determined by either the Nationa! Fenestratton Rating
Couneil standard 100-91, or ASHRAE 1993 Hendbook oE Fundammtals, Chapter 27,
Table 5.
POMII• Fax Note 787t ?om
n
n
Aslditlonal ealculaked vak•a,
' CITY USE ONLY
L BL I RECEIPT #: C-Vl
SUBD. RECEIPT DATE:
1999 PLUMBuvs PERMrT (REstnEv'rtAL)
CffY OF £ItfiAN
S$SO Pll.OT KNOB RD
gAfiAN, MN 5518E
(651) 6$1-4675
Please complete for: D single family dwellings
? townhomes and condos when perm its are required for each unit
? backflow preventer for underground sprinkler system
- _- - _- _- - ------------------ ---------'--------------
FIXTURES -"------?
EACH ?.?- --- ---- -----------
# - - -
TOTAL
Shcwar 3.00 x a = G.•to
Water Closet 3.00 x 3 = 9• ?o
Bath Tub 3.00 x
Lavatory 3.00 x 3 = g. ? t>
Kitchen Sink 3.00 x ? _ ?• OD
Laundry Tray 3.00 x ?_ = 3• q?
Hot TublSpa 3.00 x ! _ -?. aD
Water Heater 3.00 x 00
Ftoor Drain 3.00 x 3-L'V
Gas Piping Outlet " minimum -1 3.00 x
Rough Openings 1.50 x =
Water Softener ' for dwellings under conSWCtion 5.00 x =
Water Softener ` for existlng dwelling 30.00 x =
U.G. Sprinklet ` for dwelling under const. 3.00 =
U.G. Sprinkler ` for existing dwelling 30.00 =
Alterations ` to existing residence 30.00 =
Water Tum Around 30.00 =
Private Disposal System ' MPC iic. 75.00 =
(new and refurbished systems)
Private Disposal Systems ' Abandonment 30.00 =
RPZ (new installation/repair) 30.00 =
STATE SURCHARGE .50
Reminder. Call 881-4675 for inspectfons of water heaters,
water softeners, alteraUOns, etc.
, ? ,.?`e
TCTAL ?J
--•-----•---------•---• -------------------------•-------...----------•--• •---------------••-•-------------.......--------°---•----------..
I hereby acknowledge that I have read this appliption, state that the information is cnrrect, and agree to comply with all applipble City of Eagan ordinances.
It is the applicanPS responsi6iliry to notiry the property owner tthat the City of Eagan assumes no liabiliry for any damages caused by the City during its normal
apereGOnal and mainlenance activities to the faali6es constructed under fhis permit within City property/right-of-way/easement.
SITE ADDRESS: ?zl g.Z? ? ? ? L? K-.?--'
OWNER NAME: ?7 k-??L LSr'D4 .(e 11--S
INSTALLER NAME: ?dGt VA TELEPHONE #: e/S257
STREETADDRESS: 11-"31g, SE
ctrY: /?r. o r L aA:?e
STATE:
ZIP: ss?7?
SIGNATURE OF PERM
CD/PERMIT FORMSlRPLBG PERMIT (RES) - 1999
??? C) 3 `7
CITY USE ONLY
LOT LI Q L ? RECEIPT #: C0-
SUDD. l??'M.V.\? I v('e RECEIPT DATE: LI• ?-??
1999 MECHANICAL PEMIT (ftESIDENTIAL)
CCI'Y OE EAfiRN
3850 P1LOT KNQB RD
£AfiAN ,MN 55 ] 22
3- 3D - 9,9 (651) 681-4675
Date:
Complete this section onl if you are installing HVAC in single family, townhomes or condos under
canstruction and not owner /occupied
• HVAC: 0-100 M B T U $ 30.00
ADDITIONAL 50 M BTU 6.00
. Gas outlets (minimum of one required @$3.00 ea.) -3106
• State Surcharge: .50
. ToTar.:
Complete this section onlv if you are remodeling, addina, to, or repairing existing single family dwellinas,
townhomes, or condos. Please indicate if it is a new item, replacement item, or repair.
_ New _ Replacement _ Repair
_ Furnace _
Air exchanger, i.e. Vanee system, etc.
Reminder: Cal[ 681-4675 for inspections.
Other
Air conditioning
Other
$ 30.00
State Surcharge: .50
Total: $30.50
? K--,e_
SITE ADDRESS:
OWNER NAME: Q. PHONE #: ?
INSTALLER NAME: PHOVE ,?:
STREETADDRESS: /s
C[TY: STATE: ZIP: Ss3 7?
SIGNATURE OF PE ITTEE
JSlPORMS BLD/ML•CH P[RMIT(RES)- 1990
L BL
SUBD.
APPROVED BY:
INSPECTOR
1999 MECHANiCAL PERMIT (COMMEfZCIAL)
CITY OP E4fiA1V
3$30 P1LOT KNOS }iD
EAsA1v.1K1v 55 i 22
(651)681-4675
Please complete for: all commercial/industrial buildings
multi-family buildings when separate permits are not required for each dwelling unit
DATE: CONTRACT PRICE:
WORK TYPE: NEW CONSTRUCTION INTERIOA IMPROVEMENT
DESCRIPTION OF WORK:
FEES: 1% of contract price OR $30.00 minimum fee, whichever is greater.
Processed piping - $30.00
CONTRACT PRICE x 1%
PROCESSED PIPING
PERMIT FEE
STATESURCHARGE
TOTAL
SITE ADDRESS:
OWNER NAME:
($.50 per $1,000 of oemvt fee due on all pemuts.)
PHONE #:
TENANT NAME (IMPROVEMENTS ONLY):
INSTALLER:
ADDRESS:
CITY:
CITY USE ONLY
RECEIPT #:
RECEIPT DATE:
PHONE #:
STATE:
ZIP:
SIGNATURE OF PERMITTEE
'7? 13
2006 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Constntction Reoui2men4s
3 registered site surveys shaxing sq. fl. of lot, sq. R of house; and all roofed areas
(20% maximum lot coverage allaxed)
1 Soils Report if proposed huilding is to be placed on disturbed soil
2 copies of plan showing beam & window sizes; poured found design, etc.
1 set o( Energy Calculatbns
3 copies ol T2e Preservation Plan if iot platted after 711/93
Rim Joist Detail Oplions selection sheel (buildings with 3 or less unils)
Minnegasco mechanical ventilation fortn
RemodellReoair Reauirements
2 copies of plan showing fooings, beams, joists
1 set o( Energy Calculations for heated addilions
1 si(e survey for additions & decks Add'N'on - indicate i(on-site septic syslem
?V. 4M
Office Use Onlv
'CertofSurveyReal _Y _N
SoilsReport _Y _N
TreePresPlanRerd _Y - _N,
Tree Pres Reqaired _ Y _ N
On-sdeSepUcSyslem - _Y _N
Date ?/ _ / 0
Site Address /V-/ (d,4
2?
,*Tz i Construction Cost ?Roob, 00
Al UniUSte #
Description of Work a(?' Le? s?'T"1 %
A r p
Multi-Family Bldg _ Y_ NO .
Fireplace(s) _ 0 _ 1 _ 2
Property Owner A u 44 6(9 h? ! f??'7? Telephone #( )
Contractor C (!,L44y ?.c,o L?4G
Address N?'?
Statem/v
?h
t}"1?e'IJ ?
?? ..S
Zip!S05q t 7 ' J
City/????[?GS
Telephone#(6tz)Q7A _ v_oq
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670Cateeorv 1 Minnesota Rules 7672
Energy Code Category , Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(J submission rype) Submitted Submitted . Energy Envelope Calculations Submitted
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_ Y _ N If yes, date and address of master plan:
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
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 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 wark which requires a review and
approval of plans.
GR,AI(!?- 13 QAAy
ApplicanYs Printed Name
Applican's ign re
DO NOT WRITE BELOW THIS LINE
Sub Tvpes
? 01 Foundation ? 07 05-plex ? 13 16-plex
O 02 SF Dwelling ? 08 06-plex 0 16 Fireplace
? 03 01 of_plex ? 09 07-plex ? 17 Garage
? 04 02-plex ? 10 08-plex ? 18 Deck
? OS 03-plex ? 11 10-plex ? 19 LowerLevel
? 06 04-plex ? 12 12-plex
Work Tvpes
? 31 New
? 32 Addition
? 33 Alteration
? 34 Replacement
? 20 Pool ? 30 Accessory Bidg
? 21 Porch (3-sea.) ? 31 EM. Alt - Multi
? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt- SF
? 23 Porch (screen/gazebo/perola) ? 36 Multi Misc.
? 24 Storm Damage
? 25 Miscellaneous
? 35 Int Improvement ? 36 Demolish Interior ? 44 Siding
O,. 36, Move Building ? 42 Demolish Foundation ?, 45 Fire Repair
? 37 Demolish Building* ? 43 Reroof ? 46.. 1(Vindows/DOars `Demolitfon (Entire Bidg) - Give PCA handout to applicant - • D25CflptlOtl: Water Damage _ Yes > .
v
Valuation Occupancy
Plan Review 100% or 25%
Census Code Zoning
SAC Units Stories
# of Units Sq. Ft.
# of Bldgs Length
, . ?
Type of Const Width
_ Footings (new bidg)
_ Foorings(deck)
_ Footings (addition)
Foundation
Drain Tile
Roof Ice & Water Final
_ Framing?
_ Fireplace _ R.I. _ Air Test _ Final
_ Insulation
Approved By:
Base Fee
Surcharge
Plan Review
MC/ES SAC
Cify SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
MCES System
f'ity WaYer,
`
Booster Pump
PRV
Fire Sprinklered . ?
-. . . ` '
REQUIRED INSPECTIONS
_ Sheetrock
FinallC.O.
FinaVNo C.O.
HVAC
Other
Pool Ftgs Air/Gas Tests Final
_ Siding _ Smcco Lath _ Stone Lath _Brick
Windows
_ Retaining Wall
Building Inspector
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA147852
Date Issued:02/12/2018
Permit Category:ePermit
Site Address: 4921 Pine Lane
Lot:4 Block: 1 Addition: Pinetree Forest
PID:10-57650-01-040
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener).
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Thang Nguyen
4921 Pine Lane
Eagan MN 55123
(612) 986-3978
Champion Plumbing
3670 Dodd Rd., #100
Eagan MN 55123
(651) 365-1340
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA165863
Date Issued:11/24/2020
Permit Category:ePermit
Site Address: 4921 Pine Lane
Lot:4 Block: 1 Addition: Pinetree Forest
PID:10-57650-01-040
Use:
Description:
Sub Type:Reroof & Siding
Work Type:Replace
Description:
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and house wrap and leave on site.
When installing ventilated soffit material, remove existing material (i.e. debris that could block vents) and take steps to
ensure maximum ventilation to attic. Call for final inspection after installation.
Valuation: 10,000.00
Fee Summary:BL - Base Fee $10K $191.75 0801.4085
Surcharge - Based on Valuation $10K $5.00 9001.2195
$196.75 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 -
Thang Nguyen
4921 Pine Ln
Eagan MN 55123
(612) 986-3978
Elite Restoration Pro
1120 E 80th St, Suite 201
Bloomington MN 55420
(952) 322-7773
Applicant/Permitee: Signature Issued By: Signature