4136 Prairie Ridge Rdat,
City of Eap
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
dor Office'Use
Permit #:
Permit Fee: "" ?f/.Va
Date Received:
Staff:
2009 RESIDENTIAL Bit-atax
ILDING PERMIT APPLICA ION
Date: c/l /32 2/ ( Site Address: ittie. rtiz
Tenant:
Suite #:
RESIDENT / OWNER
Name: 1 e;w2Phone: {U /.2-,38t- ga
//.
Address / City / Zip: ` '74162 7 &wt/E tip' XZ
Applicant is: Owner Contractor
TYPE OF WORK
Description of work: &CC, ,-400/`
Construction Cost: 00 _ Multi -Family Building: (Yes / Ng)
CONTRACTOR
Name: L yacj^''8)Gyez/ $ 1), L License #: c:)0 G,3Oc ,3 y
Address: / 2 7/ SS 3'z, it
/3
City: /, Gr'/71O State: A Zip: S6-0441
Phone: %S_ 7745--6 7yr Contact Person: 27r Se-2)44-{,eC
COMPLETE
Energy Code
Category
(J submission type)
In the last 12 months, has
_Yes _No if yes,
THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Category 1 Minnesota Rules 7672
• Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
Submitted Submitted
• Energy Envelope Calculations Submitted
the City of Eagan issued a permit for a similar plan based on a master plan?
date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor:
Phone:
NOTE: Plans ndsupporting do uments at y ubmi r onsidered to be7,public information , Portions
the Inform ion may be classrfie ® n ude � h t he ovid e s e cfi cs hat wo %d permit, he Ci
cooty to
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; th- .derstand 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
accorda : with e approveplan in the case of work which requires a review and approval of plans.
x
nfs Printe • ame
x D#0110
Applicant's Signature
Page 1 of 3
INSPEC
CITY OF EAGAN
; 3830 Pilot Knob Road
? Eagan, Minnesota 55123
(612) 681-4675
? SITE ADDRESS:
? ? i?= f'1<<ti i it 1 l ?; ?????? r?i+1 t1111J I I;'i IlI11 1 Ilt,•J
PERMIT SUBTYPE:
[ON RECQRD
PERMIT TYPE:
Permit Number:
Date Issued:
APPLICANT:
(t,l.'! bt1J i'•-id'1
TYPE OF WORK:
iil .i. I' 1! { 1 i!W
f)ttl l UFNt,
0 4 sn?.
?•A ir:irr•
At. r[: f{ Ar r 0i4
t !•:; P h 114 ?-: b I A Nf? I r" i,)
INSPECTION DA • DA
Permit No. Permit Holder Date Telephone i
S/W
PLUMBING
HVAC
ELECTRIC
ELECTRIC
Inspectfon Dete Insp. Corr+ments
Footings I
Foundation
Framing
Roofing
Rough Plbg. I
Hough Htg.
isul.
Fireplace
Final Htg.
Orsat Test
Final Ptbg. Pibg. Inspector - Notify Ptumber
Const. Meter
EngrJPlan
Bldg. Final
Deck Ftg.
Deck Final ?
Well
Pr. Disp.
_ •'. . . - _ . . ,%r ..., f.- a _ _ . . / : .,?ti,- : . . - ->>'QM'?.' .. . . . : L..;:.;. . .
? ?t-A f CITY OF EAGAN ?Q 17599
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100
BUILDING PERMIT Receipt # -? ?
To be used tor SF L)WG/CAR Est. value ;141,000 Date MAR 13
Site Address 4136 PRAI6tIE &InGE RD
Lot g Block s Sec!Sub. COUnRY ?OLIM OFFICE USE ONLY
l1-1
!1-
PBrCeI NO. Occupancy R_ 3 FEFS
Zoning R- t
Name
Name 5AME
Phone
Address
City -
Phone
I hereby acknowlege that I have read this application and state that Ihe
information is correct and agree to comply with all applicable State of
Minnesota Statutes and City o( Eag3n Or na
Signature of Permitee
A Buiiding Permft is issued to: VAN-SMI EUILD$1t3
on the express condition that all work shall be done in accordance with all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building OffiCial ?
(A
l
t
C
t
Bld
P
it r.
783.?
ons
c
ua
)
(Allowable) ?
- erm
g.
Surcharge 70` ? ?
# of Srories
69'
Plan Review 509.00 '
Lenglh
Depth 45' SAC. City 100•00
S.F. Total - SAC. MCWCC 600'00
S.F. Footprints - 625.00
4n Site Sewage _ Water Conn
On Site Well water Meler 90.? ?
MWCC Syslem ?
- 30.00 ?
City Water n Acct. Deposit
?
PRV Required xx S/W Permit 30.00
Booster Pump - SiW Surcharge • 50
252.00
Treatment PI
APPROVALS Road Unit 355•00
Planner
Council - park Ded.
BIdg.O(f. _ Copies
3
445.00 '
VarQnce - TOTAL .
?
• ? Permit No. Permit Holder Date Telephone #
.WATER
SEWER
PLUMBING
? n, ?:
?u ' J'r 5 D $ ?t7
?p
H.V.A.C. V v
ELECTRIC
Inspection Date Ins . Comments
Footings I ?WI71?L) ui)S T'9/ u?'C 1 '
FounOation
Framing ? 3 0 ?S
Roofing Q
Rough Plbg. ?
Rough Filg.
Isul. 464
Fireplace
Final Htg. ?,? ? - ? •???? l? I
Final Plbg. ??-?? ,-? ? ?- ? •
Const. Meter Ibg. Inspector - Notify Plumber
Engr./Plan
Bidg. Final "-) n % .
DeckFtg. f-2Q.
Deck Final
Well
Pr. Disp.
Trx#t#iraft jaf
(titp of Cagart '
Erprbnntt a# wuitding jnpprtian
This Ceriifrcate iuued pursuanl to lhe requirements oJSertion 306 oJtJre Unijarm Building
Code cerlifl?in8 rhar at 1he tune of issuancr 1his"ucture x+as in compGance wilh the various
ordi?wnas ojthe City regulaAing bui7ding construction or use For lhe jo!lowing.
ux am;rm.uw Qr nr?r,aR e,at.,= r,o. 17sw
0ot013aa77'ype Zoain6 pisyiu n t TYOe Coca--kVlr
Owoet d bnddm8 AGdas
&ua(Un Add= -1}.? ? Loali?
WROW
mum ? Bwldmg O? /? Da? !
POST IN A CONSPICUOUS PI,ACE
CITY OF EAQAN
CONTRACT
PRICE
For
PERMIT #
3830 PILOT KNOB ROAD, EAGANo MN 55122 I RECEI
PHONE 4548100 DATE:
DESCRIPTION
1raina - -
1 Address
c City S??s?9 -?
? Add
$ cRy
FEES
COMM./IND. FEE - 1% OF CONTRACT FEE
APT. BLDGS. - COMM. RATE APPLIES
TOWNHOUSE & CONDO - RES. RATE APLLIES
MINIMUM - RESIDENTIAL FEE $12.00
MlNIMUM - COMM.IND.lFEE $20.00
STATE SURCHARGE PER PERMIT .50
(At)D $.56?/C__1PER EACH $1,000,,OF PERMIT FEE}
Mult. Add-on
Comm. Repair
Other
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
NO. FIXTU RES TOTAL
-3 Water Closet - $3.00 $
Bath Tubs - $3.00
? Lavatory - $3.00
? Shower - $3.00 jr v o
? Ktchen Sink - $3.00
UrinaUBidet - $3.00
? Laundry Tray - $3.00
? . C o
T Floor Drains - $1.50 /. 75- °
Water Heater - $1.50
? •-C
Whirlpool - $3.00 • j,
Z Gas Piping Outlets - $1.50
(MINIMUM -1 PER PERMIT)
Softener - $5.00
Well - $10.00
? Private Disp. - $10.00
? Rough Openings - $1.50 - S ?
U. G. Sprinkler System - $12.00
PERMIT FEE:
STATES SJC:
GRAND TOTAL: ?
For OHice Use Only:
' MECHANICAL PERMIT PERMIT #
. • CtTY OF EAaAN RECEIPT # ? 3a30 PILOT KNOB ROAD, EAGAN, MN 55122
NTRACT PRICE: 'Aa0 PHONE: 454-8100 DATE:
Site Address
I ,,.
m name ,
c Ciry
? Name -
3 Address _
O CitY
TYPE OF WORK
Forced Air
Bolier
Unit Heater
Air Cond.
Gas Piping Outlets #
Phone
Phone
11" nn sTu
M BTU
M BTU
M BTU
CFM
?
PERMIT FEE:
S/C:
TOT/0.L:
BI.DG. TYPE
Mult
Camm.
Other
WORK DESCRIP'TION
New •? ?
Add-on
Repair
FEES
RES. HVAC 0-100 M BTU
"? - '- ADDITIONAL 50 M BTU
.?..y..:4 (RES. HYAC INCLUDES A/C ON NEW
CONSTRUCTION)
GAS OUTLETS (MINIMUM -1 PER PERYIn
?? Or+ COMMAND FEE -1°k OF COMTRACT FEE
APT. BIDGS. - COMM. RATE APPLIES
TOWNHOUSE 8 CONDOS - RES. RATE APPLIES
MINIMUM RESIDENTIAL FEE - ALL ADaON 8
- $24.00
- 6.00
- 1.50 EA.
REMODELS - 12.00
MINIMUM COMMERCIAL FEE - 20.00
?b STATE SURCHARGE PER PERMIT - .50
(,4pD $50 S/C PER EACIi,$1000.00 OF PERMR FEE)
SIGNATURE OF PERMfTTEE
FOR: CITY OF EAGAN
? CASH RECEIPT ? .
CITY OF EAGAN. -- ?
3830 PILOT KNOB ROAD •
EAGAN, MINNESOTA 55122
oArE 'f- 1 :?? 19 qf)
a?cE?o
FF40.
AMOUNT
d OOLLARS
'oo
? CASH HECK Iq
FM ?f ll?- / is 99 40 1 n 1a--k5
04
BY .ce.17^.4'T
V ? w ? F' wn,ae-Par«a coor
C v'
v veaow-Postn,p copy
Pink-File Gopy
Thank You
-?
SEWER & WATER PERMIT OFFICE USE ONLY
CITYOF F-AGAN METER # PERMIT DATE 03/ 14; 9Ci
3830 Pilot Knob Rd. 11272
Eagan, MN 55122-1897 CHIP ? PERMIT #
METER SIZE B.P. RECEIPT # C 5755
ISSUE DATE B.P. RECEIPT DATE03 1319
DATE --t 3 13 9o 0
X PRV - BOOSTER PUMP
SITEADDhESS 4136 PRAIRl'".i RIUGI? ^D
LOT 5 BLOCK 5 SEC/SUB CUUN'['ItY HOLiAW
APPLICANT: J -- ADORESS:
CITY, STATE PRtOR LAKE. ZIP `- .??
PHONE: o ?
PLUMBER: STAR PLiMSING
ADDRESS: 101$ NIOUND 5PRINGS T1;ftk
CITY, STATE aI410114I151IM?, MN Zip 55420
PHONE; 884-4149
OWNER:
ADDRESS:
CITY, STATE ZIP
PHONE:
PERMIT REGIUESTED
--XSEWER -,,WATER - TAPS
- COMM/IND ? RESIDENTIAL
-4 NEW - EXISTING
Lawn Sprinkler Meters are to be Installed
Ahead of Domestic Meters on Water Line.
Credit WILL NOT be given for Deduct Meters.
I AGREE TO COMPLY WITH CITY OF
EAGAN ORDINANCES
SIGNATURE WHEN METER ISSUED
PLEASE ALLOW TWO WORKING DACYS FdR PROCESSING. CALL 454-5220 FOR INSPECTIONS. FOR STORM
SEWER PERMITS, CONTACT ENGINEERING DEPT.
SEWER & WATER PEF
CITY OF EAGAN
3830 Pilot Knob_Rd.
Eagan, MN 551 22-1 897
DATE 0+03/13,j90
USE ONLY
METER # ?37 /171.??
CHIP #a/6 31C
METER SIZE S
ISSUE DATE
PERMITDATE 03/24/90
PERMIT # 11272
B.P. RECEIPT # C 6755
B.P. RECEIPT DATE 03 13 90
X PRV _ 800STER PUMP
SITE ADDRESS 4136 PRAIRIE RIDGE RD
LOT -5 BLOCK 5 SECISUB
CUUNTKY HOLL4k'
APPUCANT:
ADDRESS: `? ? -7 s_- f r
CITY, STATE PRIOR LAKE Zip
PHONE:
PLUMBER: STAR PLUMBING
ADDRESS: 1018 Y,OUHD SPRINCS TEF;P,
CITY, STATE BLOOMI?:GTON. MN ZlP 55420
PHONE: 884-4149
OWNER: _
ADDRESS:_
CITY. STATE
ZIP
PERMIT REQUESTED
__dSEWER _-WATER -TAPS
_ COMM/IND ? RESIDENTIAL
-i NEW - EXISTING
Lawn Sprinkler Meters are to be Installed
Ahead of Domestic Meters an Water Line.
Credit WILL NOT be given for Deduct Meters.
I AGREE TO COMPIY WITH CITY OF
EAGAN OBDINANrMS -7
PHONE: !9IGMATU!?EN MfiM'ISSUED
v
PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. CALL 454?5220 FOR INSPECTIONS. FOR STORM
SEWER PERMITS, CONTACT ENGINEERING DEPT. .
??
CITY OF EAGAN ND 17599
? 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
?
BUILDING PEFMIT PHONE: 454-5100 Receipt # l J n 6 -7 ?zJ'
Tobeusedfor SF DWG/GAR Est.vaiue $141,000 Date MAR 13 , 79 90
Site Address 4136 PRAIRIE RIDGE RD
Lat 5 Block 5 Sec/Sub. COUNTRY HOLLOW
Parcel No.
w Name VAN-SMITH BUILDERS
o Address 5975 TIMSER TR
City PRIOR LAKE phone 440-2094
o Name SAME I
g¢ Address
? City Phone
Name _
Address
Clty -
Phone
I hereby acknowleqe ihat I have read this apphcation and stale that ihe
mtortnation is wrrect and agree to comply with all applicable S[ate of
Minnesota Statutes and Crty ol an Or ma e.
,
Signature ot PermRee
A Building Permn is issued to: VAN-SMIT BUILDERS
on ihe express condilion that all work shall be done in acwrdance with all
apphcable State ol Mmnesota Statutes and City of Eagan Ordinances.
Bmlding Official
OFFICE l1SE ONLV
Occupancy K-3 M1 FEF.S
Zornng R=1
(ACWaI) Consl V-N Bldg Permn 783.00
(Allowable) V-N
Surcharge 70.50
x of Siories - 509
00
Length 69 ' Plan Review .
Deplh 45' SAC, City 100.00
S.F.TOtal - SAC,MCWCC 600.00
S.F. FooWnnls -
OnSneSewage _ WaierConn 625.00
On Sile Well Waler Meter
0
90.0
MWCCSystem ? 30
00
XX Acct. Deposil .
Crty Water
PRVRaquire0 ? S/WPermit 3n-nn
Booster Pump - SiW Surcharga _ 50
Treatment PI
0
252.0
APPROVALS Road Unn
0
355.0
Planrrer - park Ded
Caunal
BIEg.Ofl. _ Copies
Variance _ TO7AL 3,445.00
Address: 4136 PRAI_RIE RIDGE PD9D Lot 5 Blk 5 Sec/SubC,pUNT_RY HOfdpW
These items were/were not complete at the time of the final Lnspection.
DATE; 1 Ry 2 1991 Yes No
s
INSPECIM:
Final grada (6" from siding) LI
Permanent steps - garage
Permanent ateps - main entry
Permanent driveway •
Permanent gas
Sod/seeded grass
Trail/curb damage
Porch
Basemant finish
Deck
Pleasa verify vith the builder tha removal of roof test caps from the plumbing
system and tha shut-off of water supply to the outside lavn faucet before
freeze potential exists.
White - City copy Yellow - Resident copy Pink - Contractor copy
P? . . . ? DATE: - -03/14/90
RE: 6136 PRNIRIE RIDGE RD
-
1
R Your Sewer & Water Permit for the above property has been completed. It will be held at the
Public Works Garage (3501 Coachman Road) until the meter is picked up. BE SURE TO
C:2LL PUBLIC WORKS (454-5220) FOR YOUR PERMANENT WATER TURN ON.
.
_ Your Sewer & Water Permit for the above property cannot be completed for the following
re8sons: I
- Your Sewer & Water Permit for the above property has been completed, but the meter cannot
1 be issued or occupancy allawed until further notice.
- COMMERCIAL PROJECTS ONLY: Please pay for meter at City Hall. Meter size must be
confirmed by Bill Adams or Dirk House (Plumbing Inspectors - 454-8100) before issuance
WARNING: BEFORE DIGGING, CALL LOCAL UTILITIES - TELEPHONE, ELECTRIC, GAS, ETC.
- REQUIREU BY LAW.
CONTACT COMMUNITY DEVEL.OPMENT DEPARTMENT FOR WATER TURN ON POLICY.
Secretary, Building Inspections Dept.
,S//?,/9D ?EQUES'?FOR EP ECTRI?CALtiNSPECTION
r
041579 "X" Be/ow Work Covered by This Request
,nf?^N•SgiQ` EB00001-0]
y ?`?s`x] C7?/ $
ew Ad ep TypeotBmlding App6ancesWired E WPmentWiretl
Home Range orary Service
Duplex Water Heater Electnc Heating
Apt Bwlding Dryer Other (Speciry)
Comm llndustrial Furnace
Farm Av Conditioner
Other (speafy) Conlractor5 Pemarks
Compute Inspecbon Fee Below
# Other Fee # ServiceEniranceS¢e Fee # Circwts/Feeders Fee
Swimming Pool 0 ?0 200 Amps 0 to 100 Amps
TranSformer5 A6ov8200_AmpS Aho Amps
SignS Inspector's Use Only i
\ TOTAL
Irngaaon Booms U
2,f ?5-
Special InspecLOn
Alarm/Communication THIS INSTALLATION MAY 8E ORDERED DISCONNECTED IF NOT
Other Fee ? COMPLETED WITHIN 18 MONTHS.
I, the Electncal Inspector, hereby
tif
t th
th
b
i
i Rough-in oaie
cer
y
a
e a
ove
nspect
on has
been made oat
• L
OFiIGE USE ONLY
This repuest wia lB monibs hom
1l/?s?/sa eWis
.
C? 4 1579 0,1,5
Request Date Fire No Ro -i InspecLOn
Re r?
atly Now ? Will Notiy Inspector
- ? v ? ?
? Ves ?'No When Reatly9
I icensed coniractor O owner hereby request inspechon of above electrical work at:
Job Atltlress (Slreet, Box or Route No ?
I
3G
K Cily
?
t
/
/
Section No Township Name or No Range No Counry
Occupant(PRINT) Phone No
G
Power Supolier ?/ qddre/ss ?/ .J
/U?7 il 17
EIectncal Conimctor (COmpany Name)
k
E?
4
, Con?raclor's Liwnse No
ot
r I,
" ?
"-
Mailmg Atltlress OOnVactor or Owner Makmg Irwlallalan)
?"7 / 2
LZ•?'c J?
y1re
Amh(COnVactorrOwner Making Ins[allanon l Phone Number
-1
MINNESOTA STATE BOARD OF ELECTRICITV THIS INSPECTION REOUEST WILL NOT
Grlpgs-MlOwey Bltlg. - Roam 5-173 BE ACCEPTEO BY THE STATE BOARO
1021 UniveraHy Ave, SL Paul. MN 551D0 UNLESS PROPEfl INSPECTION FEE IS
Plwna(612)662-0800 ENClOSEO
;E?QQUEST^FORoEP ECTRI?CALtiNSPECWTI?ON
?
041585 "X" Below Work Covered by This Request
?n?f?fR• EB-00001.07
ew A ep. ? TypeofBuiltlmg AppliancesWiretl EquipmentWired
Home Range Temporary Service
Duptex Water Heater Electnc Heating
Apt. 8wldmg r
D Other (Specity)
Comm./Industrial urnace
Farm Air Conditioner
Olher(specily) Conhaclor§ RemaMs
Campute fnspecbon Fee Below
# Other Fee # rviCeEntranceS2e Pee # Cucurts/Feeders Fee
Swimmmg Pool to 200 Amps ('J / to 100 Amps 4
Transbrmers Above 200 _ Amps Above Amps
Signs Inspecror§ Use Only TOTAL 66
Irrigahon 8ooms
Special Inspeclion
AlarmiCommunication THIS INSTALLATION MAY BE ORDERED DI ONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 M ?
I, the Eledncal Inspector, hereby
ce
t
f
th
t th
b
i
h RO09n""
?
r
i
y
a
e a
ove
nspection
as
been made. Final e ?
OFFICE USE ONLY
This requesl wi0 18 mon[hs Imm
a-
(rv 415 8 5 r ??,. ?t ?
Request Date
+
. Fire No. Rou i Inspection Notify
Wor
Will
Re eedY Now ?
`
` .. ?
? W
hen ReadYP
es ? No
It3'licensed comractor O owner hereby request inspeciion of above electrical work at:
Job Atltlress (Streel. Box or Roule No )
/
'
3 Gty
c
?% r2 M-
Section N. Townshrp Name or No Range No Gounty
a ?'a1?e, .
Occupa t(PPINT) Phone No
W G ?1
PowarSuppue, Aadress ,
l
leclncal Gonbecror (COmpany Neme) Conirnctar's Lmense No
?. ? ? ? ?
,
Marhng Adpress I?ontractor or Owner Making Ins?alla
oon)
4t C
Au[honzetl S naNre (ConlraclodOwner Makmg InstallaLOn) PM1One Number
-?IESOTA STATE BOAflD OF ELECTPICITY THIS INSPECTION REQUEST WILL NOT
Mltlwey Bltlg - Noom S-173 6E ACCEPTED BY THE STATE BOARD
rverslty Av¢. SL Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS
`2J662-0800 ENCLOSEO
2006 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX 4 651-675-5694
New Consimctian Reawrements
3 registered site surveys showing sq k of lot, sq ft of house, and all roofed areas
(20% maeimum lot coveraga allowed)
2 copies of plan showing beam 8 window sizes, poured found design, etc
1 set ot Energy Calcula6ons
3 copies of Tree Preservation Plan if lot plafled afler 711/93
Rim Joist Detail Ophons selechon sheet (bmldmgs wdh 3 or less umts)
Minnegasw mechanical ventilatron form
Remodel/Reoair Reamremenis
2 copies of plan showmg footmgs, beams, joists
1 set of Energy Calwla6ons for heated additions
1 sde survey for adddions & decks
Addition - indreate if oo-site septic system
7?;, cD
e6a_,?? 3 I aa
Oflxe Use Onlv
Certo'5urveuftecd _Y _N
TreePEesPianRecd ?Y - N
7ree Poesf2equited _Y _N
On.sileSephcSystem _Y _N
Date I / 2-0/00 Canstruction Cost 00(o
SiteAddress r',o- 12- J-J?_ ? UnitlSte #
Description of Work ? p C-L a. 1- I?0=4 ?1 -e- 9'??"7?
Multi-Family Bldg _ Y_ N ?
Fireplace(s) _ 0
_ 1 _ 2
Property Owner 13P v\ ? Telephone # ( (QS I ) ?
Contractor fDP-6,iL- c, J "br2n /-
Address H(p J7 4F- a AVL C--? City 1?Cr16roV-L tf? d-
State WI.?l/ Zip S, $-O ??- Telephone #(9yz )Li 3 2- -Z3 (
COMPLETE THIS AREA ONLY IF
Energy Code Category - Minnesota Rules 7670 Ca[eeorv 1
• Residential Ventilation Category i Worksheet
(Jsubmissiontype) Submitted
. Energy Envelope Calculations Submitted
A NEW BUILDING
Minnesota Rules 7672
. New Energy Code Worksheet
Submdted
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 Telephone #(
Mechanical Conhactor _ I Telephone #(
Sewer/Water Contractor 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 work which requires a review and
approval of plans.
Ad0. ?_\_ C ?v ?l-e`
Applicant's Printed Name
Applicant's Signature
DO NOT WRITE BELOW THIS LINE
Sub TVpes
? 01 Foundation
? 07
05-piex
? 13 16-plex
? 20 Pool
? 30 Accessory Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 EM. Alt - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garege ? 22 PorchlAddn. (4sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 70 08-plex X 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 ? 25 Miscellaneous
0)313 ? ??yLl-
WorkTvpes
? 37 New ? 35 Int Improvement ? 38 Demolish Interior O. 44 Siding
? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
[1 33 Alteration ? 37 Demofish Buifding` 0 43 Reroof ? 46 Windows/Doors
)9 34 Replacemen `Oemolition (Entire Bldg) - Give PCA handout to applicant
.? ' ?
.T. aJ ??'T???? i
`? ?\?:.?? . .?{ rY S s ?
. ` . t?t..'?)'??[.;\', i, ,??.?Y? !J• ._. "sj_•+?,",
DBSCriptlOfl: Water Damage_ Yes
Valuation okin Occupancy MCES System
Plan Review _ 100% or _ 25%
Census Code ,(// s Gf _ Zoning City Wafer
?
SAC Units
Stories
Booster PumP
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const Width REQUIRED INSPECTIONS
Footings(new bldg)
? Footings (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
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Piant
License Search
Copies
Other
Tofal
_ Sheetrock
FinallC.O.
# FinaUNo C.O.
HVAC
Other
Pool Ftgs Air/Gas Tests Final
_ Siding _ Stucco Lath _ Stone Lath _Brick
W indows
_ Retaining Wall
Building Inspector
06? ?2,, 4,9 G'n0
? RI-LAND C0.
SURVEYING
SERVICES
1875 PLA2A DRIVE
EAGAN, MINNESOTA 55126
CERTIFICATE OF SURVEY FOR:
VAN SMlTH BUILDERS
LEGAL DESCRIPTION: LOT-5- ,6 LOCK5., COUNTRY HOLLOW
ACCORDING TO THE RECORDED PLAT
r THEREOF D4KOTA COUNTY,MINNESOTA
I
i SCALE:I"=30'
?
?
?
I
6-,Og Fcmri
837. 98 ?
Lo-r 6 ?
o f-
?? N89°53'2?
< (n 95.Z8
O Iq 0
EC) 1 k. O
? OD
OD
? ? ? i ? 1 /Wrttt.RS I
Q) 2 l? E?6N
LOT 5
?N
^ I a, ) WAT&2 6lEV. '
?l1 ? ? ? 6t Z 24 N
?; u 3 •g . N
4T.58 -
? ?. 4s.28 $- I a ?.?es se?,?r iuty O
N89°38'31"W .e Z
Qu e3 ? $ .47.7-7 165.92
' ? .?
LOTr?_ ?
..-s
•n :.? ? r?..?
CITY C1F E:AGRN
GFlSHIER: lg TFRMINAI_ NC1: D01
DA'TE: 01l25/00 'i IME : 1 i e 46: 43
m:
NAMF r. EN(J5 ENTL:RF'RTSES
3210 9001 4136 F'ftFlRIE: RUG 97.25
2155 9001 4136 F'RAi2TE fiDG c?.l?Q
Tor,a:l. fier..Pypt, Amnunt : 99.25
CR J.2'c:S::) i
lJ5[R ID: JAN
3 GqQ(5 2000 BUILDiNC PERMIT APPLICATION (RESIDENTIAL)
! crrr or eacM 3830 PILOT KNOB RD - 55122 ??
651-881-4675 S90 aS
Naw CamhucMan Reauire manN
Y J replMered sHe surveyt showin9 s4 fG Ot bt W. ft ot houw 2 ooplas d Plan
and gH roofed arew (40°6 ma)imum bt covawae allowe? 1 set of eneryy calcWaHOrn fw heoled addtioru
D 2 ooplet ot dam (aNow beam d wlrKbw dzes: Poured fid desigm NC.) 1 fB9 wn'eY fOr 6xteAor atlc911om ! d6cks
D 1 wt d aneryy cmaYaHOni ' .
D 3 copiea ot hee ProsenaMOn plm M bt pIaMW adpr 711/93
DATE: /" zo "? CONSTRIJCTION COST:
DESCRIPfION OF WORK:
?
STREET ADDRESS: I r P,
LOT: 5 BLOCK: ? S180./P.I.D. t: U I ?)
Name: C> 0 6/ FiVI _i A Phone
PROPERTY Lctst ° Flof
OWNER
Sh
f
Address:_
ee
Clty Sfate: ? Zlp:
Company: ?liZ17 .^ti ??? Phone e: (/0/; .....
CONTRACTOR (area code)
?
?C? Q?'
Slreet Addreaa: a`-O Z?
,? C-2?- G-./?? ??'?cp•
licer?se
CHy eP`l K!-P?l? State: Zip:
ARCHITECT/
ENGINEER Company: Nqme:
Telephone i: ( )
Sheet Addresa: ReglshaHon C
CHy gfcte• Zlp:
Sewer/water licensed plumber (H Irotallina sewertwater): Ptane #: L?
I herobY acknowledpe Mwf I have read Mia appiMcallion, abfe fhaf the iNormalbn b ectl and apree b? cort?ry wilh a1 app8cable 9fate
of Minneaota Stalutea and City of Eapan Ordirwnces.
? Slprwiure ot AppBccnt??
OFFICE USE ONLY
Certificates of Survey Received _ Yes _ No
Tree Preservation Plan Received , ? Yes ? No ? Nof Required
OFFiCE USE ONLY
BUILDlNG PERMIT SUBTYPES
fl 01 Foundatlon O 07 05-plex
0 02 SF Dweliing p OS Og-plex
13 03 01 of _ plex 0 09 07-plex
E3 04 02-plex O 10 08-plex
Q 05 03-plex O 11 10-plex
13 06 04plex O 12 12-plex
woRK nrPe
O 31 New
O 32 Addition
C3 33 Aiteration
0 34 Repair
O 13 16-plex O 21 Porch (3-sea.) p 31 Ext Alt - Multl
O 17 Garage O 22 Porch/Addn. (Msea.) p 33 Ext. Alt - SF
0 18 Deck O 23 Porch (screened) p 36 Mufti
0 19 Lower Level O 24 Stortn Damage
Pwg _Ya_N O 25 MisCellaneou9
O 20 Pool p' 30 Accessory Bldg. 0 36 Move Bldg. p 43 Reroof
0 37 Demolish (Bldg)' O 44 Siding
0 38 Demalish (Interior) 0 45 Fire Repair
O 42 Demolish (Foundation) O 46 Windows/Doors
' Give PCA handout to applicant for demoiition permit
GENERAL INFORMATION
SAC Code
No. of Units
No. of Buildings
Const. (Actual)
(Ailowable)
UBC Occupancy
Zoning
# of Stories
Length
W idth
Basement sq. ft.
Main level sq. ft.
sq.ft.
sq.ft.
MISCELLANEOUS INSPECTIONS
0 Stucco/Stone
APPROVALS
Pianning Building
sq.ft.
sq.ft.
Footprint sq. ft.
Census Code
MC/ES System
City Water
Booster Pump
PRV
Fire Sprinklered
Engineering Variance
Permit Fee
Surcharge
Plan Review
License
MC/ES SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
Valuation: $
SAIC Units
% SAC
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55123 Date Issued:
(612) 681-4675
SITE ADDRESS: LQT e 5 g L 0 C K: 5 APPLICANT:
4136 PRAIRIE RIDGE Rp BUTLER
COUN7RY HOLLOW (612) 681-1530
PERMIT SUBTYPE:
DECK
TYPE OF WORK:
DESCRZPTION
6UILDIMG
024345
08(10/94
PATRICK
ALTERATIOM
(5TAIR5 & LANDING)
INSPECTION .. . ..
FOOTIN65 FINAL
r-
?
?
_. '_ ?
PERMIT
'X. CITY OF-EAGAN
3830 Pilot Knob Road PERMIT TYPE:
Eagan, Minnesota 55123 Permit Number:
(612) 681-4675 Date Issued:
Ix/ /4;v
Bl1ILDIN6
024345
08J10/94
SITE ADDRESS:
4136 PRAIRIE RIDGE RD
LOT: 5 BLOCK: 5
COUNTRY NQLLOW
P.I.N.: 10-18275-050-05
DESCRIPTION:
(STAIRS
Buil,ding'-.Permit Type
*ilding W4,rk 1'ype
L
?
.
f
?. '
v?
& LANpING)
DECK
flLTERATION
,,.... L? 's ?+
???? ?' ? z f ?: ??ji unni
REMARKS:
FEE SUMMARY;
Base Fee
5urcharge
Tntal Fee
$30.00
S.50
$90.50
CONTRACTOR: OWNER: - Applicant -
BUTLER PATRICK
4136 PRRIRIE RIDGE RD
EAGAN MN 55123
, (612)581-1530
I hereby acknowledge that T liave rRdd this
informatian is cnrriact and agree to camply
Statutes a ti y af Eagan nPdinances.
?--
APPLI NT/PE T SIGNATUfiE
appl3catinn amd state that the
with a31 applicable SYat'.e of Mn.
?
-JI)Dtl A_ & "! . 1
ISSUED ' SIG ATURE
14144
CITY OF EAGAN
1994 BUILDING PERMIT APPLICATION
681-4675
4'?15 ? •fiD
SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site ?f energy
calcs.,?
COMMERCIAL 2 sets of architectural & structu1 set of
specifications, 1 copy of energy --....,,
Penalty applies: 1) when permit is typed, but not picked up by last working day of month
in which request is made, 2) address is changed or 3) lot change is requested once permit
is issued.
Date Valuation of work
Site Address:
STREET 5UfTE N
Tenant Name: (commercial only)
LOT 6 BIACK ? SUBD. P.I.D. #
Descri tion of work: AJDITI.D C)Z-- -51AAR5 1C? .lJ?C
The applicant is: Owner ? Contractor ? Other (Describe)
Name I U.-TLe ?K Ti 2lCK Phone G71-153c)
Property LAST F1RST
Own@f pddress ??3?a -I'1?4I?L.t? fGlfX4? ?
STREET STE ti
city state '"U4 zip 5123
Company Phone
Contractor Address License # Exp.
City State Zip
Company Phone
Architect/
Engineer Name Registration #
Address '
City State Zip
Sewer & water licensed plumber . Processing time for
sewer & water permits is two days once area has been approved.
I hereby acknowledge that I have r ad this plication and state that the information is
correct and agree to comply ith a appli te of Minnesota Statutes and City of
Eagan Ordinances. .
Signature of Applicant:
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation
? 02 SF Dwg.
? 03 SF Addition
? 04 SF Porch
? 05 5F Misc.
WORK TYPE
? 31 New
? 32 Addition
0 06 Duplex
? 07 4-Plex
? 08 8-Plex
El 09 12-Plex
? 10 Multi. Add'1
SfQirS ? l?r?; ??
,0 33 Alterations
O 34 Repair
? 11 Apt./Lodging
? 12 Mult9. Misc.
? 13 Garage/Accessory
O 14 Fireplace
,13i 15 Deck
? 35 Tenant Finish
? 36 Move
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
Planning
Engineering
REQUIRED INSPECTIONS
? .Site
? Wallboard
Basement sq. ft.
lst F1. sq. ft.
2nd F1. sq. ft.
Sq. Ft. total
Footprint Sq. ft.
On-site well
On-site sewage
Building
Variance
? Footing
Final
? Framing
? Draintile
O Insulation
[3 Fireplace
Permit Fee
Surcharge
Plan Review
License
MWCC SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total:
?lun;a,: s I Z D0
?Y ?..
•? A
? 16 Basement Finish
? 17 Swim Pool
? 18 Comm./Ind.
? 19 Comm./Ind. Misc.
? 20 Public Facility
? 21 Miscellaneous
? 37 Demolish
MWCC System
City Water
PRV Required
Booster Pump
Fire Sprinkler
Census Code ci?v
SAC Code .9 ?
Census Bldg /
Census Unit o
Assessments
SAC %
SAC Units
.
?
T+1? ??..?._l..,,?. ?. ?
t?; tG
G3?, ` I
il
38 ?
+o's
Is
t4 ?
/ I
?V
,
. j
? .
J 1?'1?5
,I
11544
1990 BUILDING PERMIT APPLICATION
CITY OF EAGAN
SINGLE FAMILY DWELLINGS
MULTIPLE DWELLINGS
' `''I Z)o 3 ? Date: J O? D
2 SETS OF PLANS 2 SETS OF PLANS 2 SETS OF ARCHITECTURAL
3 REGISTERED SITE SURVEYS REGISTERED SITE SURVEYS - & STRUCTURAL PLANS
1 SET OF ENERGY CALCULATIONS (CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFICATIONS
1 SET OF ENERGY CALCULATIONS 1 SET OF ENERGY CALCS
# OF RENTAL UNITS
# OF FOR SALE UNITS
PENALTY APPLIES WHEN: TYPING OF PERMIT IS REQIIESTED, SUT NOT PICKED UP BY LAST WORKING DAY
OF MONTH IN WHICH REQUEST IS MADE.
LOT CHANGE IS REQUESTED ONCE YERMIT IS ISSUED.
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS
DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DAYS ONCE A PERMIT HAS BEEN COMPLETED.
PERMIT MUST SHOW A LICENSED PLUMBER.
To Be Used For
Site Address
Lot J
A 14quation:
4416('IV, Ili(,(l I
Block _'-2_
Parcel/Sub
Owner , 'qIll .5??1'l'
Address S S ° ? ^
,
City/Zip Code
Phone
Contractor
Address
City/Zip Code
Phone
Arch./Engr. _
Address
City/Zip Code
Phone #
OFFICE USE ONLY
Occupancy ?I
Zoning
Actual Const V-N
Allowable V-N
# of stories
Length ?
Depth
S.F. Total
Footprint S.F.
On site sewage_
On site well
MWCC System V,
City water ?
PRV _
Booster Pump _
COMMERCIAL
FEES
B1dg. Permit
Surcharge
Plan Review
SAC, City
SAC, MWCC
Water Conn
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
TYeatment P1.
Road Unit
Park Ded.
Copies
SUBTOTAL
Penalty
7 83,00
r/O,Sb
S?A, O
L
/C?.JD
6-pp,OD
" DO
30• vo
3O, 00
, Sa
3 Soa
TOTAL j , i(?
APPROVALS
Planner
Council
Bldg. Off.
Variance
. , ?
? ?4 Lv.?f? ?"l O • .
r ?
GA2n6E
ao xati
12X ?a= 1yy
r--
?zy x ?s = 93?0
ssm7--
'-I LI ?C 2 G
7 y-? =
?-
130? X?y? 1K??o
) S T' 17Lo 0/2-
2- 13 ? ? Xs?= G?z6?
N? FL, oon
/Lr
7x7r
?-
?d? x s? = ys?s?
7 y b?6J?
TRI-LAND C0.
SURVEYING
SERVICES
1875 PLAZA DRIVE
EAGAN, NI{NNESOTA 55126
CERTIFICATE OF SURVEY FOR:
VAN SMITH BUILDERS
LEGAL DESCRIPTIM. LOT-5- ,BLOCK5 , COUNTRY HOLtOW
ACCORDING TO THE RECORDED PLAT
THEREOF DAKOTA COUNTY,M{NNESOTA
SCALE; I"=30'
&AR FLOOR
631• 98
i 'w LOT 6
m ?
N89053'2IP"E 150.03
31. ae ? 9i. 28 N
CD
O ? ? ?24 ?2g85' ? Q
[,LS, ? ? ? ? I ?o
?i Op t6
co
co
? c)
n' ?? y9, w I L 0 T 5
? I o 0 0 ?
N W
? BI -
WA'TgiZ /L245LUY ?
S
N
'-. N
1`
? ?l Q _ ° 0 NAU6'r Ut1UY`J 0
N89038'31"W F6F.S E,Zv
165.92
,. ,7,
gy????
W?
LOTD I-T f ? o
EAGAN ENUIIVEERI?T?'-
D?px
LEGEND PROPOSED FILL BASEMENT - WALKOUT
INVERT ELEVATION AT SERVICE EXTENSION=
o DENOTES IRON MONUMENT PROPOSED GARAGE FLOOR ELEVATION= 636,°
o DENOTES WOOD HUB SET PROPOSED FIRST FLOOR ELEVATION
DENOTES EXISTING SPOT PROPOSED &4SEMENT FLOOR
ELEVATION ELEV?Iao?o b????p???
DENOTES PROPOSED SPOT ?
ELEVATION
? DENOTES DRAINAGE DIRECTION NOTE ' VERIFY ALL FLOOR HEIGHT3 WITH
FINAI HOUSE PLANS
I Aerety csrtify fhat ihis survey,plan or
rsport was prepared by me or undsr my
direct supervision and that I am o duly
Reqistered Land Surveyor under ths
Laws of the. Stote of Minnesota.
ley J. Swpq.EA„ Mn. Rep. No. 15235
Date -
DUNER
SITE ADORESS
CpNTRACTOR
Ctii[niUn LfI/LLUYL hfvtrutu[. u L? A ?1 ? /r .-. ? ??. J7 e
? I
DATE
PHONE
• Determine working square foota9e of each. r/
1. Total exposed wall area .:... 338o sq. ft. x? _
2. Total roof/ceiling area ..... / 3 d? sq. ft, x?
lO 26
1
Total exposed r+all area above floor = a% ?•BF3
a. Total wall windoN area........................... /?o
D. Tatal door area ................................. o
-
.. ,
c. Total sliding glass door area ................
d. Total.fireplace wall area ......................... .
e. Total wall framing erea (average101)........ ..... ?'7???. ."!?.
f. Total net wall area above floor ................. a?37 g. Total rinL joist aren ............................ 16,7 ? r?-
- ?u
? Total eicposed foundation area = 5-9z
h. Total foundation windorr area ....... :............. ii8
i. Toal net foundation area above grade ............ gZ¢,
Dete-mine "U" value of each Mall segment.
d. X uVu ?,?,Z ..
b. ?Q .. . A V hUM "O/7
/ C.i
C: ?X "U" 9 ? _ =?s. z? • .
d. -?
-- r "U" '
? _ -
.
. . e. ? 79 x "u° . i z = 33, 9Z
? •f. a?37 X "U" ' -04 ? 99.1,8
• g. ?e? '7 ' X foulo ?D4 ? _ ?. t`' ••.
• h. X "U"
1. 9-71 x & ?9
.
3 .....................................iotal -36
6
If item,l3 is tbe same as. or less than item 11. ou have met the inient
of S8C 6006(c)2. . . . . . '
„I } ,
. Total exposed roof/ceiling area
J. Total skylight area ............ ........... .. -
k. Total roof/celling framing area (average]OS)... i 3Z1.6
1. Total net insulated roof/ce111ng area........... iiA 3. g
Oetermine "U" value for each roaf/ceiling segment.
J. - x "U" C
k, X"U" •o? 0 3.9£3
1: 1193.1 X"u" o? . a387-
A ..................................Total s-
If total of f4 is the same as, or less than 12. you harc met the lntent of
SBC 6006(c)1. .
Alternate Building Envelope Oesign
To utiiize the total envelope system method, the values establlshed by the
sum of ltems #3 and #4 shall not be greater than the sum of items fl and #Z.
t. + 2. a
3. + 4. •- a -
\
.i,.
131.01q
2006 RESIDENTIAL MECHANICAL rExMiT nrrLicaTroN
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please complete for. single family dwellings & townhomes/condos when pertnits are required for each unit
*50.50
Date
Site Address_' 7?_? ?) 2 J y?? [",? Unit #
Prvoper[y Owner n y1-e Telephone #( (p la)
Contractor Lofgren Htg & A/C
5708 Upper 147th St W#!02 -
Street Ad Apple Valley, MN 55124 City
Sta[e Telephone # ( ) __
Elond #: Expires:
Thr. Applicant is _ Owner ? Contractor _ Other _
Add•on or alteration to existing dwelling unit
• $ 30.00
fumace _Additional _Replacement _ NeN
air exchanger
airconditioner-RS
, heat pump ?
, other
Staite Surcharge .50
Total
J 11 Bv--
?--^----___?
I hereby apply for a Residential Mechanical Permit and acknowledge that the information is complete and accurate; thal the work will
be in wnformance with the ordinances and codes of the City of Eagan and with Mechanical Codes; t I understsnd this is not a
perrnit, but only an application for a permit, and work is no[ to start without p it [ha[ the work wi be in accor4 lance wit the
appinved plan in the cas of work which requires a review and approval of pl s.
ApplicanYs Pri ed Name A hcanYs ign u
For Office Use P
Permit qce, 6'
City of Eaali .
E Permit Fee:
3830 Pilot Knob Road Eagan MN 55122 Date Received: I
Phone: (651) 675-5675 Fax: (651) 675-5694 Staff:
t..----------------J
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 7 Z1- c'9 Site Address: li'cdt e- 12.J .
Tenant: Suite
RESIDENT / OWNER Name: To I 6winer Phone: G S ! -'1 S2 - y zN
12 ~4 s~~J
Address/ City/ Zip: q / 3 ' Pr's ci" e- te' J ~tr_
Applicant is: Owner X- Contractor
TYPE OF WORK Description of work: I Gp/C [emcri i. )r ow
Construction Cost: Z °12 1.00 Multi-Family Building: (Yes No
CONTRACTOR Name: / / "?z ~r~r/ate ~ PThrS License 2.0 y `1 Z 'l Y
Address: fgc~/c dsc rT.eL
City: r- State: ,v zip: S soon-
Phone:. 6S1-q3r?-(7GO Contact Person:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Category 1 Minnesota Rules 7672
Energy Code • Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
Category Submitted Submitted
submission type) • 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?
_Yes No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that they are trade secrets.
f 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 11J¢,Ck Tb eiai ' o n x
Applicant's Printed Name A plicant's Signature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA168001
Date Issued:04/06/2021
Permit Category:ePermit
Site Address: 4136 Prairie Ridge Rd
Lot:5 Block: 5 Addition: Country Hollow
PID:10-18275-05-050
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:Does not include skylight(s)
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and leave on site. We encourage you to retain an electronic copy of
photos until the project passes a final inspection.
*Roof permits issued between December and March will be inspected in the spring or when weather warms up.
Valuation: 5,000.00
Fee Summary:BL - Base Fee $5K $118.00 0801.4085
Surcharge - Based on Valuation $5K $2.50 9001.2195
$120.50 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 -
Kevin J & Anne L Norris
4136 Prairie Ridge Rd
Eagan MN 55123
(651) 357-7879
Hoffman Weber Construction Inc
2155 Old Hwy 8 NW
St. Paul MN 55112
(866) 970-1133
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA175884
Date Issued:04/20/2022
Permit Category:ePermit
Site Address: 4136 Prairie Ridge Rd
Lot:5 Block: 5 Addition: Country Hollow
PID:10-18275-05-050
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:One Window/Door
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow
windows, call for framing inspection. Call for final inspection after installation.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Valuation: 1,500.00
Fee Summary:BL - Base Fee $1500 $62.50 0801.4085
Surcharge - Based on Valuation $1500 $0.75 9001.2195
$63.25 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 -
Kevin J & Anne L Norris
4136 Prairie Ridge Rd
Eagan MN 55123
(651) 357-7879
Builders & Remodelers Inc
5301 East River Road
Suite 110
Fridley MN 55421
(612) 827-5481
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