1660 Riverton PtCITY OF EAGAN Remarks
Addition Blackhawk Lake Addition LUt
Owner
10 14385 040
Street 1660 Riverton Point Stace Eagan, MN
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF,
STREET RESTOR.
GRADING
SAN SEW TRUNK C P;
SEWER LATERAL
WATERMAI N
WATER LATERAL
WATERAREA
STORM SEW TRK ??-19-83 1295-91 96-39 ,s , ' ? ?,t;j (l?s f ![ d c J •
S70RM SEW LA7
CURB & GUTTER '
SIDEWALK
S7REET LIGHT
WATER CONN.
BUILDING PER.
SAC
PARK
.?
.t
t ? (gtr#i#iratt of (Ocrupttnry
titp of (tagan
1hp8x''httPttf Df g11gbi'itg lWPItiDIt
This Certifcate issued pursuant to the requirements of Section 306 of the Uniform Building
Code cerli, fying thal at the 1ime of issuance thir structure was in coMpliance with the r+arious
ordinances of the City regulating buildrng construction or use. For the following.•
use chadicaaoo Sk IJWG/Gc'1:: awe. ftrm;t rro.
D Oocupancy Type Zaoing District TYPe ConM.
? , • _ - i ;
Owner of Huildmg Addtess
Loalitp -rr?+
ate: XTICUR 22, 1987
POST IN A CONSPICUOUS PLACE
CITY OF EAGAN -
' 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
BUILDING PERMIT PHONE: 454-8100 ReceiPt #
Tobe used for Est. Value - - Date ,19 I
Site Address PO 1 N l OFFICE USE ONLY
A . ? C : "A . , . '
Lot Btock Sec/Sub On Site Sewage Occupancy
. MwCC System Zoning
Parcel Na On Site wetl _ Type of Const
City Water (Actuaq
,
- ?
(Allowable)
a Name
= Address 4 • • ` ? ? - 5 ik of Stories
Len
th
;
° City Phone g
Depth
S
F
Total
O Name .
.
FootprintS.F.
0 ` Address APPROVALS FEES
? City PhOne Assessments _ Permit
?. Q
F W ,
Name Water/Sewer
Police _ Surcharge
Plan Revlew _
z
v.
Address Fire SAC. Cit
cc Z
City Phone Engr. SAC, MWCC
W Planner WaterConn.
Council _ Water Meter
I hereby acknowledge that I have read this application and state Bldg. OH. _ Road Unit
that the Information is correct and agree to comply with all applicable APC - Treatment P1
State of Minnesota Statutes and City of Eagan Ordinances. Variance _ Parks
Signature of Permittee Copies
70TAL
A Building Permit is issued to: ' on the express condition that
all work shall be done in accordance with all applicable 5tate of M innesota Statutes end City of Eagan Ordinancea
Building Official
« permit No. Permit Holder Dste Telephone
Piumbing
?
H.V.A.C.
Electric
Softener `1 t
.., 7 E ,,.??" --l
Inapectlon Date Insp. Comments
Footings I
Footings II
Foundation ? .
Framing
Roofing
Rough Plbg. 7 /7' 5' ' -
Rough Htg.
Isul.
Fireplace
Final Htg. e
Final Plbg. Q x.
Bldg. Final
Cert. Occ. ?
Temp. LP `
Deck Ftg. •
Deck Frmg.
Well
Pr. Disp. ,? - J?
PERMIT #
, PLUIfI161MG PERMIT RECEIPT ti
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE
? Name
? Address t'
?
c City Phone ` I• Z L
Name
c Address ? ` =1
p City Phone-1?
FEES
COMM/IND FEE - 1% OF CONTRACT FEE
MINIMUM - RESIDENTIAL FEE - $12.00
MINIMUM - COMM/IND FEE - $20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
?
BLDG.TYPE
Res.
Mult.
Comm.
WORK DESCRIPTION
New
Add-on
Repair '
Other
RES. PLBG. ONLY - COMPLETE THE FOLLOWING
NO. FIXTURES TOTAL
Water Closet - $3.00 $
Bath Tubs - $100
?Lavatory - $3.00
? Shower - $3.00 --
! Kitchen Sink - $3.00 Urinal/Bidet - $3.00
I Laundry Tray - $3.00
- ! Water Heater = $1.50 -
Whiripool - $3-00
? Gas Piping Outlets - $1.50
(MINIMUM - 1 PER PERMin
Softener - $5.00
Well - $10.00
Private Disp. - $10.00
• Rough Openings - $1.50
FEE:
II STATE S/C: FOR: CITY OF EAGAN GRAND TOTAL:
' MECHANICAL PERMIT
' CITY OF EAGAN
. 3830 PILOT KNOB ROAD, EAGAN, MN 55122
Site
m Name
? Address ?.L1=
c Gity T--? t;t `
? Name
3 Address
p City Phone
TYPE OF WORK
ForcedAir !_ ?r??•c? _ ? MBTU
Boiler M BTU
Unit Heater M BTU
Air Cond. z- / ?? •? ? M BTU
Vent CFM
Gas Piping Outlets #
Other
BLDG. TYPE WORK DESCRIPTION
Res. ? New
Mult Add-on
Comm. Repair
Other
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 PERMIT) - 1.50 EA.
COMM/IND FEE - 1% OF CONTRACT FEE
APT. BIDGS. - COMM. RATE APPLIES
TOWNHOUSE & CQNDOS - RES. RATE APPLJES
MINIMUM RESIDENTIAL FEE - ALL ADD-ON &
REMODELS - 12.00
MINIMUM COMMERCIAL FEE - 20.00
STATE SURCHARGE PER PERMIT - _50
(ADO $.50 S/C IF PERMIT PRICE GOES
BEYOND $1.0001
FEE -? 1??
-6 /
S/C: J SIGNATURE OF PERMITTE
TOTAL•
FOR: CITY OF EAGAN
RECEIPT # -7 • J
DATE: _
PERMIT #
Site
PLUMBING PERMIT RECEIPT # ? rJ ? O?cj
CITY OF EAGAN ?
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: 31
PHONE: 454-8100
SeclSub
BLDCa. TYPE WORK DESCRIPTION
Res. New
Mult. Add-on
Comm. Repair
Other
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
NO. FIXTURES TOTAL
Water Closet - $3.00 $
Bath Tubs - $3.00
Lavatory - $3.00
Shower - $3.00
Kitchen Sink - $3.00
Urinal/Bidet - $3.00
Laundry Tray - $3.00
Floor Drains - $1.50
Water Heater - $1.50
Whirlpool - $3.00
Gas Piping Outlets - $1.50
(MINIMUM - 1 PER PERMIn
Softener - $5.00
Well - $10.00 _.?
Private Disp. - $10.00
Rough Openings - $1.50 '
FEE:
? Name
? Addre
c City
?
Name ,- , , , .
3 Address
O City LC-Z-4 Phone
COMM/IND FEE - 1% OF CONTRACT FEE
APT. BLDGS - COMM RATE APPLIES
TOWNHOUSE 8 CONDO - RES. RATE APPLIES
MINIMUM - RESIDENTIAL FEE - $12.00
MINIMUM - COMM/IND FEE - $20.Oa
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
OF
STATE S/C:
FOR: CITY OF EAGAN - GRAND TOTAI: ?? `? ? ?
: .,.,ti; ... 7-7-7-
PERMIT #
MECHANICAL PERMIT RECEIPT #
CIn OF EAGAN Y
` 3630 PILOT KNOB ROAD, EAGAN, MN 55122 DATE _
iCONTRACTPRICE: PHONE:45a-81oa
? Name
(D , R
I Address L
c Ciry
Name
Address
p City
TYPE OF WORK
Forced Air _
' Boiler _
Unit Heater _
Air Cond. _
Vent _
' Gas Piping Outlets # _
M BTU $-
M BTU $`_
M BTU $-
M BTU $-L
CFM .1-
FEE: _
S/C: -
TOTAL•
rt.. ?' ! T gLpG
TyPE WORK DESCRIPTION
S,pc/.Sub .
Res. New
Mult Add-on
Comm. Repair
_ , ; s _ ..,, .•? Other
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 PEf1M11) - 1.50 EA.
COMM/IND FEE - 1% OF CONTRACT FEE
APT. BLDGS. - COMM. RATE APPLIES
TOWNHOUSE 8 CONDOS - RES. RATE APPUES
MINIMUM RESIDENTIAL FEE - ALL ADD-ON &
REMODELS - 12.00 :
MINIMUM COMMERCIAL FEE - 20.00 •
STATE SURCHARGE PER PERMIT - .50 ,j
(ADD $.50 S/C IF PERMIT PRICE GOES .?
FOR: CITY OF EAGAN
BUILDING PERMIT
To be used for AQD
• ?
CITY OF EAGAN
^_**} ,, ?,??+
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100
Receipt # ? J' ' ?•c?
Site Address ib6O AIVBR'r0N P?
Lot b Block I- Sec/Sub. BLACICUWK LAJM
^----.,_
Name _ GREG 6 LSIC.H NA I80l1
Address 1660 RIVEx'PaN PT
City SAGAti Phone 452-937Y
Address 4921 NEii't't
City - - MP1B
ILOULtul Name
? ; Address
<W City Phone
that I have read this application and state that the
and agree to comply with all applicable State of
Signature of
Ge done in accordance with all
City ot Eagan Ordinances.
Building pHicial
Occupancy
Zoning
(Actual) Const
(Allowable)
# os stoT;es
Length
Dep1h
S.F. Total
S.F. Footprints
On Sile Sewage
on sice weu
MWCC System
City Water
PRV Required
Booster Pump
APPROYALS
Planner
Councit
Bidg. Off.
Variance
OFFICE USE ONLY
FEES
Bldg. Permit
Stisrcharge
P1an Review
SAC, City
SAC,MCWCC
Water Conn
Water Meter
Acc1. deposit
S/W Permit
SrVJ Surcharge
Treatmenl PI
Road Unit
Park Ded.
Copies
TOTAL
437.00 1
27,,50
?
Z84.00 ?
74R_RA
Rermk No. Permit Hoider oate 7elepnone #
WATEii
SENIE5i
PLUM8ING 5 s
?+.v.a.c. rOXj_A ' ?
E?CTRIC A190,2 9 ;VD?
Inspeetion Date Insp. Comments
Faotings I
Foundation
Framing
Roofing
Rough Plbg.
Rough Htg.
Isul.
Fireplace
Fnal Htg.
Orstat Test
Finai Plbg. Plbg.lnspector - NotifyPlumber
Const. Meter
Engr./Pian
Bldg. Final
Deck Ftg. '
Dedc Final
Well
Pr. Disp.
.. f V?. . . . . . 1T_?T.
• • • CITY OF EAGAN
• • 3830 Pilot Knob Road, P.O. Box 21-1 99
Eagan
MN 55121
,
,
BUILDING PERMIT PHONE: 454-8100
?
Receipt #
To be used for POOL Est. Value =10,000 Date AW 34 ,1g-9L--
Site Address - 1660 RIYERT0N P'f
Lot ?? Block _I Sec/Sub. S1.ACKIiAMK LAU
OFFICE USE ONLY
PdfC@I N0. Occupancy _ FE ES
Zoning _
W Name OEGM ?t ?Z a? ?'lA?taai (Actuai)Canst _ BIdg.Permit 117-[1(1
I
0 AddresS 1660 RIVERM11 PT (Allowable) _
Surcharge
S_Ad
Cit FAGA?1
y Phone 452-9372 _
# or scodes
Plan Revie
Length _ w
o? Ndi11@ V?Y pWl.$ Z?i Deplh - SAC, City
U Address 651 CLI!! aD S.F. Total _
¢
~ Cltyl WAHSVZLLZ Phone $94-140 S.F. Footprints _ SAC, MCWCC
F On Si1e Sawage _ Water Conn
uW
w Name on Site weu
Water Meter
Address Mwcc system _
`W City Phone acy water _ ??. DePOS1t
PRV Required _ S/W Permit
I hereby acknowlege ihat I have read this application and state that Ihe
i
f
i Booster Pump - g/W% Surcharge
n
ormaUOn
s correct and pgrea to comply with all applicablqr State of
Minnesote Statutes and Cio of Eagan Qrdinances. Treatment PI
'
Signature of Permitee APPROVALS Road Unit
A Building Permil is issued to: vALUY ?WLS INC Planner - Park Ded
on the express condition that all work shall be done in accordance with all
Council .
applicable State of Minnesota Statutes and City of Eagan Ordinances. gldg, pry, _ Copies
Building Official ` ' ???nce - TOTAL 122•00
. parmit No. Permit Holder Date Telephona #
WATER
SEVYE:i
PLUMBING
H.V.A.C.
ELEC,??? 9-00
???? ?? ?nsp. Co„rne,ts
Footings I /l
FoundaGon
Framing
Rooling
Rough Plbg. r*
Rough Htg.
?
6 -2 - 22
Isul. ?
Fireplace
Final Htg.
Orstat Test
Final Plbg. - .?j Z " Plbg. Inspector - Notify Plumber
Const. Meler
Engr.lPlan
Bldg. Final
Deck Ftg.
Dedc Final
Weli
Pr. Disp.
41 ?x
7* J,4
--?--
? CASH RECEIPT ?
-• CITY OF EAGAN
:\ t 3830 PILOT KNOB ROAD
fAGAN, MINNESOTA 55122
• DATE " ?.-- 19
'
RlCRIV[D PROM
AMOUN"t • $ - • I -
?oo
? CASH CHECK
e 1__ '.1
ROR '
BY
White-Payers CopV
Yellow-Posting Copy
Pink-File Copy
Thank You
BLDG.
01-3210 Bld g. Permi
01-3422 Plan Check
01-3445 •Surch./Adm.
01-3446 SAC/Adm.
01-2155 Surcharge
17-3860 Road Unit
20-2275 SAC
20-3865 Water Conn.
20-386$ Water Trmt.
20-3716 Water Meter
20-2252 Acct. Dep.
20-3713 Water Permi
20-3743 Sewer Permi
79-3866 Sewer Conn.
11-3855 Park Ded.
TOTAL
., ? ,
CASH RECEIPT
CITY QF EAGAN
. 3830 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
r,
DATE `
t9
RHC81 V ED
FR0117
aMOUNr $
& DOLLARS
+oo
? CASH ? CHECK
POR
FUND CODE AMOUNT
r' ??V
.
i
. i
Thank You
BY " : I
. , r. t•--- • White-Payers Copy
Yellow-Posting Copy
Pink-F's4e Copy
CITY OF EAGAN Permit No: 878E
3830 PNot Knob Road Meter No:
P.O. Box 21199 Reader No: _Eagan, MN 55121
*!ulrenin-n Const. `
.,....,.,_
Date: 6 3-F7
Size:
Date:
Plumber Pl 1n$
Conn. Chg: 525.0Opd Z?.,-
A D 15• 0Pd
Ri
tep
. o. . -
O. ? a
Permi t Fee:
Surcharge: •?
18 I agree fo comply with tha Cfhr of Eagan
0. 0pd
Tr. Plant •
Ordinances.
M eter.
Misc.: gy
WATER SERVICE PERMIT
,? CASH RECEIPT •
. CITY OF EAGAN
. ' .
3830 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122.
DATE •. , c. _ 19 '
RCCEIVED . . '
FROM
AMO UNT $ I
?
& OOLLARS
ioo
? CASH n CHECK
rort / FUND CODE AMOUNT
..? L ?
j •
?
- ? _
r
Thank You
BY
White-Payers Copy
Yellow-Posting Copy
Pink-File Copy
CITY CF EAGAN Permit No: Date: '24"87
3630 Pilot Knob Rcad Meter No: Size:
P.O. Box 21199 Reader No: Date:
Eagan, MN 55121
Ownec '-'u1re-ai.aa ^onst.
Site Address: 1660 R ivertoa Po i nt L4 El " 1 ac!L-'Lz.wi: T-? :-:e
Plumber. "nickmueller
Conn. Chg: 525. t?Opd Zoning: -'1
Acct. Dep: 15 .OOpd No. of Units: 1 ?
Permit Fee: 10.00Dd.
Surcharge: '• SCD?d I agree to comply with Ihe City of Eagan ?
Tr, Plant 130• fl 0pd Ordinances.
Meter. `-7..0OP4
Misc
: By
.
WATER SERVI CE PERMIT
CITY OF EAGAN Permit Noc_
3830 Pilo't Knob Road Meter No: _
P:d. Box 21198 Reader No:
Eagan, MN 55121
Owner. _ - tJrennan Const.
Site Address: 1660 Riverton Point I4
Plumber. ThOmPJQn Pli1-abinR
' Conn. Chg: 525• 00",!3 I,N Acct Dep; -LPermit Fee:
0'? d
Surcharge; • 3??pd Tr. Plant '?
•0 cn' Meter.
_ Date: c- .: .. .
_ Size:
- Date:-
comply with Ihe City ol Eagan
? WATER SERVICE PERMIT
CITY OF EAGAN Permit No:
3830 Pilot Knob Road Meter No:
P.O. Box 21199 Reader No:
Eagan, MiV 55121 N
rz?lre??nan c':,:?st.
Owner.
Site Address: ?:iv%rton Poii:
r,.._..,._ ' n1d7irbiiln.
Conn. Chg: 5^ 71
Acct Dep: 15
Permit Fee: s0'
Surcharge:
Tr. Plant 18 0
Meter.
M i sc.:
_ Date: "
_ Size:
_ Date: _
II
BI.aCl"13Wk La::.e
?Kti4' w•-
e?wly with the City of Eagan
ances.
z
IAfATER SERVICE PERMIT ?
878u
PF
CITY
Owne
Site A
OF EqOqN permit No:
3830
Pilot Knob Road qq?ef No: ??(A a0
P.O. Box 21199
Eagan, MN 55121 Reader No;
Conn. Chg: 525, pi) (i
Acct. Dep: ?- ` . ??+J?pi(nra r4iaol??
Permit Fee: 10, Oi,, ?pLnu? r
Surcharge: 7't?? ? I?T.?+rrT !
Tr. Plant- 1 . ,
-
Meter. ,
.
:'tulrennan Const,
Date:
Size:
Date:
with the Cify of Eagan
WATER SERVICE PERMIT ?
p 490211.V
,?/
Reyuest Oale
.?
-' g "9) Fre No Rough+n Inspection
R'e3wred9 y
? Reatly Now .qWill NoLly Inspector
wnen Featly?
J?.Yes L Na
I>;-licensed contractor D owner hereby request inspection of above eleclrical work aC
Job AtlOress (SVaet Box ar Route No )
o , u f?? n Po, ri-? City
,E.? ,a,?
SecLOn NO Township Name 0r NO Rdnge NO Coun(y
? ry
Occupant(PRMT)
Gi Rhone No
?.?7.z
PowerSupFlrer Adtlress
)
? R o*n e 2?c. /?n.n,n ??
Ele<v¢al Convactor ICOmpany Namel GonVactors L¢ense No
MdiLng Atltlress IConlfdOtOr Or OWner MOking In5[911dLOn,
1a305 Gnoi s4 , Nw, C? RbQ,?. MN SStiy?
Aumi Sgnamre iCO nOwner Making Inslanatro. Phone Number
? -755-075 q
MINNESOTA STATE BOAPD OF ELECTRICITY THIS INSPWTION REOUEST WILL NOT
Griggs-Mitlway Bltlg. - Room 5-173 BE ACGEPTEO BV THE STATE BOAFD
1821 Universiry Ave. St Paul. MN SSIOd UNLESS PROPER INSPECTION FEE IS
Ppone(612) 6024800 ENCLOSED-
lQ/??/S? ;EQUESToFOR EP ECTRI?CALtiNSPECTION
49021 "X" Befow Work Covered by This Request
ee-ooooi-oe -?I
?
: `°?"? /p3 3lob'
ew "Atld Rep TypeofBwlding ApphancesWuetl EqmpmentWired
Home Range Temporary Service
Duplex Water Heater Electnc Heating
? I Apt 8udding Dryer Other (Specdy)
I ?COmm./Intlushial Fumace
? Farm Air Condillonef
I OtM1eNSyeoityl
I
Compufe lnspection Fee Below
Con?rectorSRemerks W?R? ? 1
02 AUi??P.J A? fON
# Other Fee # ServiceEntrenceSze Fee # Circmts/Feedere Fee
Swimming Pool 0 to 200 Amps 0 to 100 Amps
Transformers Above 200 _ Amps /+mps
SIgnS Inspeciors Use Only TOTAL
.Irrigahon Booms ?
? 30r50
SpeGallnspec6on
Aiarm/Communica6on THIS INSTALLATION MAY BE ORDERED DISCONNEQTED IF NOT
Other Fee ? 50 COMPLETED WITHIN 1 THS
I, the Electrical Inspector, hereby Ri ? o ie
certify ihat the above inspection has
been made p,nai ? Date
OPPICE USE DNIY
This requesl voitl 18 monlhs from • _
`
s
C ??
?f
?
°
-°
p
4905 ? /
J?w
RaqueS Date
?{ Fre Na Rough-in Inspection
Reqmretl?
eatly Naw ? Wdl Notdy Inspeqor
k(R
R
d
?
' W
u ?a - ? / '?Yes 7 No M1en
ea
y
I)41icensed contractor ] owner hereby request inspection of above electrical work at.
Job Atldress (SVeet Bax or Roule No ?
PoI'A+ Cily
Eb A:.I
Seaion No Townsmp Name or No Range No Co nry ?
Occupan:(PRINTi
M l
o
JS Phone NO ^ ' ?? ? ?
ys
, i
r
R _?
Pow'er{ ?Suopior + Atltlress
/?r0/2M" inr)OMI ?
EiecmcaiConrtaaorlCOmpany Name, Convacror5 4
e No
e ec1?n ? c. +tic? 5
d `1 ! "
Moiling Address iConvector or Owner Meking Instellatian?
1-2305 G? s? , rvr,J G'oN tt?ds rv ssq 33
Aothorrzetl SiSn? re ICOn!raVprOwner Man?nq Installavon) - Pho?e Number
7$S- 67$
MINNESOTA STATE 60AHD OF ELECTRIQTY THIS INSPEGTION REQUEST WILL NOT
Griggs-Mitlway Bldg - Poom S-173 BE AGGEPTED 8V THE STATE BOARD
1021 University Ave_ St Paul. MN 55104 ' UNLESS PROPER INSPECTION FEE IS
Phone(613)6<2-OB00 ENCLOSED
?/f 7 O REQUEST FOR ELECTRICAL fNSPECTION
(Nw /'/ No See mstmclions for roniplating this lorm on back ol yellow capy
0 4 9025 ' "X" Below Work Covered by This Request
EB-00001-68
ew P4dL Rel Typeof0wlding ApplianwsWVed EqmpmentWiretl
Home Ranqe Temporary Service
Duplex Water Heater Electric Heating
ApL Bmiding Dryer Other (Speaty)
Comm.llndusirial Furnace
i Farm Av Conditioner
I Otber ispenlyi Contractor's Remarks
ComputelnspechonFeeBelow. $W+Mr..rn PVO?.
a Other Fee # Service EMrance S¢e Fee # Qrcmts/Feeders Fee
l
S
P A
wimmmg
oo 40,00 0 to 200
mps
Transformers Above 200 _ Amps o e 100 _ Amps
Sgns mspecmrs Use Onry
O TOTAL _
Irngaho2
Booms '
A, ?
1
Special nspechon O
Alarm/COmmunicatwn THIS INSTALLATION MAY B OH DISCONNECTED IF NOT
Other Fee O COMPLETED WITHIN 18 THS.
I, the Electncal InspectoC hereby Rou9n-m
a
cerhfy Ihat Ihe above inspechon has
been made. i
F,,,ai o
f
OFiICE USE ONLY A
Thc ?amicc? vn?n tA mnm6e Imm - .
/_
This requesl vmd G////* 2
18 mon[hs (rom
/4 0773-2,iL-4
7?-;l`/ y
neuues[ vaie ? ' rire rvo. Houpn-in InSpecUOn
6?? ?J Resqwpiretl? ? fleaAy Nuw Q Will Notitv. los0ec-
/ yaYes No tor When Neady
Licensed EIecVical CwiVactor I hemby raqvest msoectiun oi abova
? Owner eleclricel work tmtelled ar
S[reet AAdress, Box fl
or o No.
6 ( ? ve? ?-
Ci1y
ecllon o Township ame or No. RanBe o. Coun
?
Dccupanl FINT ` JJ Phone No.
r WsT
Power Supp 'er Address
I tncal Coy hdctor (yompany f^p Con[rar,toi s License No.
?/ '/t T, c y
nilinB AdJress ICOnt ctor or Owner Makmg tnstaila[? n
"?
?
53? Y
-
r ? L
s
eo,r 4
3
!03
x/ . <
Autho Sipnature (
ner MaWng Installalion) Phone N er
2q7
0 7S'5-'t ,57Z f
? THIS INSPECTION REQUEST WIIL NOT
MINNESOTA E BOARD OF EIECTflIC V BE ACCEPTED BY THE STA7E BOARD
Griggs•Mid Bldg. - Aoom N•191
7827 University Ave., S[. Paul, UNLESS PROPER INSVECTION FEE IS
MN 65
Phane (6121 297-2111 ENCLOSEO.
'
REQUEST FOR ELECTRICAL INSPECTION ryEB-00001-04
' See instructions for comoleting this iorm on beck of vellow copy.
A V I 7 3 2?-"'1(" Below Work Covered by This Request
NW4 Addj Rep. Type of Bwlding Appliances Wired Equipmenl Wired '
Home Range Temporary Service
Duplex Water Heater Lightin,y Fixtures
Apt. Bwldmq Oryer Electric Heahn
Commercial Bldg. Fumace Silo Unloader
Industrial Hldg. Air Conditioner Bulk Milk Tank
Farm ot er oea.? y tner Ispeciryl
t nr SuecTy Other Other
Compute lnspection Fee Below
k Fee Service Entrenee5ize d 'Fee Feeders/Subteeders b Fea Circuitn
U to 200 qm s 0 to 30 qm s 0 to 30 Am
Above 200 qmpsi 31 to 100 qmps 31 to 700 A MPS
Swimming Pool Above 100_Amps Above 100_--4m '
Transformers Irrigation Booms Partial,'Other Fee
Signs Speciallnspection 5 '
T
?
Aemarks S OTAyr
/ nl 1
! AL "'.i ,
Bough-?n Date
1
??SPlctp, hgreby
cerlify that the ahpve
F?nal inspeetion has been
TMa request vo1E 18 monUe irom
REQUEST FOR ELECTRICAL INSPECTIOPI ?Fse'00001'04
? Soe Inslruetiene far eompleiinp thle 7nm on beak of Vellow eopv.
"X" Be/ow Work Covered hy 7his Request
>
W?i Add Rae. Tvoe el Bulldina AooliaMSe WIraA EQUivonent W3red
p Fae 8aIVleoEnlronee8lsa p tye FaaAera/BUbfaeden M (ae CircWb
U W 200 qm & 0 to 30 A 0 to 30 Amlis
Above 2 Am • 37 to 1 AmpS ,?.g4 31 to 100 A
Swimmin Paol Above 100_ Abo i(10 A
Transformers ni tion Booms Parfial'04her f
I , I Sig^s ]special mspecuon 18 (9/yy.yITO7Al ?
amerke /' - . ? b
Rough.in ?a? I. IM Elxhlaal
7 ?? 1mPSOtor. Mlaby
w?tlW thN ens ebovo
Flnel ? D 1e impeetion hea besn
s '?? de.
TlWroqunlvo1018monHmlrom w
„o a 7??WS-7
e fram
- 0 7350l..?l,
75 :s 8 "al-
-3
Npquaet C/ot- Firo No. kupMm Inspection
0uireE7
tlY Now QWIII NotifY.
Pat"
? %yes ?ND dor Whan PeaGy
iceoeed ElscVlcel CoMrnctor I ?repy mp?t ytip?ty? ofabovs
Dwnor elaetrieal wark IneLilad au
Sireet Addrese, Box or q No. Ciry
nc on o. owne iv omo ar o. ngo o. oun
Oec n
IPBINTI Phnnw Na.
?
/ C 7;D.L
L-At, ive A
49 AJ j
owef SupDlief AAdraea
le icel Con rectar (Compeny Neme Conlraetoi n Liconse No.
• 0 Ll 2
- e ?
ilinp Ad reee Conlrec r or Owiror Mekinp lirefail8tionl
L L - L j
r
.- ?
Autborfze ipneture (COntrector Owner kmp Imtallation)
J Phone N
MINNE6 TO BT?RO OF EIECTIIICITY ?? ? TNIS INSPECTiON flEQUE6T WILL NOT
Orippe•Midwey? Room N4B7 ACCEPTED B INTHE 6PECTA1N FEE p6
1827 Unlvarelt Ave., St. Paul, MN 58704 NLE6 ROPE
Plwlro 18121387-41H ENCLOSED.
This request voidF/,5 /POI ?/ 5??
18 ?nths from Q? ?U
E.40416Lq ,(? ?t/o°°
Req est Da[ Fre No. Rouph-in Insuer.UOn
u Lfy Inspea-
? /?7 Repuired? Ready Now Q WiII No
0 b ?Yes Nn n tor When Reatly
O?"ensed Electncal ConVactor 1 hereby requasi mspecUOn of above
wner electricai work msteiled er
Svee[ AAdre>s, 6ox or floute No. Ciry
XiOo RiLlekM„J Pe,N r 66/7?v
ecuon o.
I
Townshrn Name, or No.
RanBa No.
I
County
.R ?^
?'"'l./ `Y
Occupant (PflINT)
?J& 0? r44TH14Q^? Phone No.
Pawer Supplier Aadress
Elecuncal ConVactor (Comuany Name) Cnntractor's License No.
(.Gf+C.rA eCe? EI?eL?`Ce?C. ItiC. ??`-taol 1
Mailmg AtlJress ICOnVar.tor or Owner M ing Ins?ailaUOnl
L(3 Ru7(,lc w,•kiv,c) 'rlLi, L,;?ri?J
Authon2 " S, atur (Co trac9f/ ner Making Installaunnl Phone N
umbFr
M
MINNESOTA STATE BOAND OF ELECTflICITY THIS INSPECTION REQUEST WlLl ryOT
Gr?p9s-Mitlwey Bltlg. - flaom N•191 BE ACCEPTED BY THE STqTE BOAND
1821 Universitv Ave.. St. Paul, MN 56104 UNLESS PHOPEN INSPECTION FEE IS
?nnnnlet9lea>.nano ENCIOSED.
REQUEST FOR ELECTRICAL INSPECTION ea-ooooi-os
00 , See instruc4ons for completin9 this lorm on back ol Vellow copY 0%5f,2?
E? ?F OT,211 6- "1(" Below Work Covered by 7his Request
sv4 Addj nen. rvoa ol euiiaine noat ...... mraa EquiVment Wve]
Home Ranye Temporary Service
Duplex Water Heater LighLny Rxtures
Apl Bwiding Dryei Bec[nc Heatin
Commercial Bldy. Fumace Silo Unbader
Indusinal 81dg. Av Conditioner Bulk Milk Tank
Farm oine, oeciN -iner Isi,ac,fv?
ilwr SucaFy Olher 01ncr
omnute lnspection Fee Below
# Fee SarvmeEnvanee5rse y Fee Feaders/Subfeeders b Fee Cncwts
U to 200 Am 5 0[0 30 Am 5 0 tn 30 Am Os
Above 200 qm??y 37 to 100 Amps 31 to 100 Am s
Swimming Pool Above 100_Am s Ahove 100_AmEs
Transtormers ?vigation Booms Partial Other ee
I I _ I Signs f I ISpeCial InSpeCtion? 1 slO•5-Q ITOTALFEpIO(?/
Pertwrks
??
I, the Elec17115.-l
iosoa«o., na,aey
certify [M1at the abova
insuacLOn nas eeen
made.
llUe repuest voltl 18
CITY OF EAGAN N° 13 6 81
?- 3830 Pilot Knob Road, P.O. Bax 21 •199, Eagan, MN 55127
BUILUING PERMIT PHONE:454-8100 Receipt# --1 11 00 `4
Ta 6e usedfor SF DWG/GAR Est. Value $203.000 Date MAY 28 ,198.7
SiteAddress 1660 RIVERTON POINT
Lot 4 Block 1 Sec/Su6. BLACKHAWK LAKE
Parcet No.
a Name MULRENNAN CONST LTD
; Address 4010 E 52ND ST.,#205
° City MPLS Phone 7ZZ-4029
o Name SAME
? a Address
- City Phone
ww Name RUSSELL HOME DESIGN
?
z z- Address
aw City EDINA phone
I here6y acknowledge that 1 have read this applicatlon and state
thattheinfofmationisCOrreCtende fd tOCOmplywithallappliCable
State of Minnesota Stat es and ity of Eag n rdinances.
Signature of Permittee
A Building Permit is issued to: MULRE VNAN CONST INC
all work shall be done in accordance with all licable S[ of I
Building Official ?
OFFICE USE ONLY
On Site Sewage k Occupancy R
?
MWCC System ' ?
Zoning
On Site Well Type of Const V
City Water __Y_- (ACtuap _v
(Allowable)
# of Stories
Length
Depth 46
S.F. Tot91
Footprint S.F.
APPROVALS FEES
? $12.50
Assessments Permit
WatedSewer _ Surcharge 101.50
Police _ Plan Review A_tno.o? 25
Fire SAC,City l
Engr
SAC, MWCC N
ti
Planner
WaterCOnn. ?
?
Councll Water Meter ?in,
Bidg. Oft _ Road Unit ??Dn?c n0
APC _ Treatment Pt i8e.00
VafianCe _ Perks
Copies
70TAL $2,397.25
on the express condition tAat
innesota Statutes and City of Eagan Ordinances.
BUILDING PERMIT
To be used for POOL
Site Address 1660 RIVERTON PT
Lal 4 Block 1 Sec/Sub. BLACKHAWK LAKE
Parcel No.
w Name GREGORY & LEIGH MATHISON
; Address 1660 RIVERTON PT
° City EAGAN Phone 452-9372
o Name VALLEY POOLS INC
?? Address 651 CLIFF RD
• City BURNSVILLE Phone 894-1480
Nz Name
Address
City Phone
I hereby acknowlaqe hat have read this apphcation and stata that the
mlormation is correcl nd agree lo comply with all applicabl State of
Minnesola StaWtes an Ci ?r ol Eagan rdi ances.
SiqnaWre of Permitee /
A Buildinq Permit is issued to. VALLEY POOLS INC
on the express condition that all work shall be tlone in accordance with all
apphcable State ot Minnesota Statutes and Cny of Eagan Ordinances.
Building OPoaal
CITY OF EAGAN N2 19620
3830 Pilot Knob Road, P.0 Box 21-199, Eagan, MN 55121
PHONE; 454-8100 ? I S t G?
? ° Receipt # - (
Est Value $10,000 Date AUG 30 19 91
OFFICE USE ONLY
Occupancy _ FEES
Zoning _
(ACtual) Const - 81dg. Permit t i 7_ nn
(Allowable)
f1
- Surcharge 9_0
M olStones _
Length _ Plan Review
Dapth - SAQ Ciry
S.F. Tolal -
SAC, MCWCC
S F FOOlprinis -
On Site Sewage _ Warer Conn
On Sile Well - Water Meler
MWCCSystem _
CAy Water _ Acct Deposit
PRV Required _ S/W Permrt
eooster Pump - SNJ Surcharge
Treatmenl PI
APPROVALS Road Uml
Planner - park Ded.
Council
BIdg.011. _ CoOies
Variance - TO7AL 122.OU
CITY40LF EAGAN Np ? 9626
3830 Pilot Knob Road, P.O. Box 21•199, Eagan, MN 55121
, PHOTE:454-8100
BUILDING
PERMIT Receiptd
To be used for ADDITION Est. Value $55, 000 Date AUG 30 ,19 91
Site Address 1660 RIVERTON PT
Lot 4 BIOCk 1 SeGSub. BLACKHAWK LAKE OFFICE USE ONLY
Parcel No. omupancy R=3 FE ES
Zoning -
w Name GREG & LEIGH MATHISON (ACWaI) COnst BIdg
PermR 437_00
? Address 1660 RIVERTON PT (Albwable) _
.
_ 27.50
0 City EAGAN PhOne 452-9372 Nof Stories _ Surcharge
Plan Review 2$4.00
Length _
o Name MULRENNAN CONSTRUCTION pepth SAQ Cn
U< Address 4921 NEWTON AVE S S.F. rotai _
-
SAC
? City MPLS Phone 927-6889 S F. Foolprinis , MCWCC
_
F On Site Sewage _ Water Conn
?z Name On Sne Wen
- water Meter
AddfBSS MWCCSyslem
aw Gify Phone City Water _ Acel. Deposit
PRVRequired _ S/WPermit
I here6y acknowlege that I h v rea
hiplication and state that the BoosterPump - SyySurcharge
iniormanon is wrred d a r o rth all applicable State ol
t
Mmnesota Statules and t? f Ea es. Treatmem PI
SgnaWre of Permitee APPROvALS Roatl Unrt
A Buiidin9 Permn is issued to- MULRENNAN CONST Planner - park Ded.
on the ezpress condrtion that all work shall be done in accordance with all Courxil _
apphcable State ol Mmnesota S
tatutes
and City
o
f Eagan Ordinances. BIdg.Ofl. Copies
ppp
I
.
S,(?
Buildmg Oflicial L?? 11Q, 1 ?1?
t ? Vanance _ 7O7qL 748.50
.?:y.. . . . . "_ . - , ..?.z.. . _..
t
bui Iolibq .
tmvwk-oo
4u? ?,ia$
W
I- .
15. ?
?
%WpAhl IY1 4toa
uo rivmr,214.. WA
.
i o, oax
`?(An V PI
q? •25z1
eA- lqZ.
Tr. Pla
Meter.
iav.u a??fiancea. '_
ey .
WATER SERVICE PERMIT
cny'm Eegan :
i
.?
CITY OF EAGAN
APPLICATtON FaR PERMIT
SEWER AND/OR WATER CONNECTIUN
? . __,-_ _ -- niraxiZlY'
**10'1'5: PAYMFRP OF FEE AT TIME OF
; nrrLIcAZZON nos Nom aMsriWM
; aPrxovlw OF PERruT.
•
s INSPDCfION OF SFWEt AUD/CF2 WA3E2
i II1S'TAI.IATIODS UTI.IZ @AT BP. 5(70>-
* MID O[JirB, PFTiNIIT HAS BM
• APPi2L7M.
1) PROPERTY ADDRESS:
LEGAL DESCRIPTIONz
_ Lot B ock Subdivision or Tax Parce ID
IF EXISTING STROCIL'R£. DATE OF ORIGINAL BLILDING.PERMIT ISSC'11NCE: PRESENr Za=/PROPOSID esL: ltNon ear
? CM49WIAL/RETAII?0FE7C:E
Q ILcC'S`lStIAL
? INSTI2S.'TIONAL/G0VEWg,TTP
? R-1 SIIN"TE FANILY
R-2 DC'PIEC (TWo Lfiits)
[j R-3 1D4dCMSE (Three + Units) ( ifiits)
R-4 APARTrII3+Tr/CONIDOML[dIC?M I Units )
2) 2?C],
- AonREss:!?{ ( -l
crrsr, sraM, zrp:,f?1?Y? Uhi -=?--/-I I-7
rxcW: -12-2- .A:tircl
3) • ?: a• N?1ME. ? ty Use .
Plimbers License:
14MRFSS: ACtive
. crrsr, sTnA mm, z1 p: Expired
r?
PHOW: ? JZ)
MA
S'1ER riot recordea
? .
LICE[YiE#
?al
4) •• ?• ??-
?: ? all
rDDREss :? 2
.
crrY, srp :
aE, zxP:
PHONE:
.
5l ? ?• ? ?• • ?• :» • ?. :. ??
Q COIa=I'ION 1D CITY SESAFT2 ? COM,4EX.TION TO CITY YATIIt
,, C] prrIM '- .-
6)
?
?
PLF.ASE $OID APPROVID PERMIT FCR PICK-C?P BY ONE OF ABOVE
--- --- (a PLFASE 1yAIL APP3tCNfD PERNIIT 10 1, 2, (D 9. ABOVE
(Ciscle ane)
.? ? ?.
1
FOR CITY USE ONLY
PERMIT `{ 'ISSLED
Pd w/Bldg. Permit
$
$
$ C7 •o -z'
FEES:
?4r-kb
S /D SEWER PERMIT (INCLL'DE SL'RCHARGE)
S &' WATER :PERMIT_jINCLCDE SDRCBARGE)
s
$
WATER METER/COPPERHORN/OL'TSIDE READER
WATER TAP (INCLL'DE CORPORATION STOP)
$ $ SAP
$ COUNT DEPOSIT -$RWF.R
S $ ACCOONT DEPOSIT - WATER
$ ?I?S `0-D $ • WAC SAC
-- TRC*K ,WATER ASS83SmENT--
5 $ TBLNK SEWER ASSESSMENT
S $ LATERAL BENEFIT/TI2LNK SEWER
> ?kD. v`U
? ?j G-Z C,L
RECEIPT
$
S
$
RECIPT
LATERAL BENEFIT/TRUNK WATER
WATER TREATMENT PLANT SLRCHARGE
OTBER:
TOTAL
)OES PTILITY CONNECTION REQ(!3RE EXCAVATION IN PDBLIC RIGHT OF WAY?
Q YES IF YES, THEN A"PERMIT FOR WORK WITHIN P[!BLIC
Q ROADWAY" MDST BE ISSi:ED $Y THE ENGINEERING
NO DIVZSION. LIST AS A CONDITION.
SL'BJECT TO THE FOLLOWING CpNDITIONS:
iPPROVED SY:
TITLE : -- -- -- ---- - - - - - - -----
DATE: ?/3 /f 1
- ? ?
CITY OF EAGAN
APPLICATION FOR PERMIT
SEWER AND/OR WATER CONNECTION
:*TOW: PAYMEN'P OF FEE AT TIME OF
: ArrLIcaMoN DOES Nom CONsizTM
: APPRovat oF PEF44rT.
: TuSPECTIox oF sBM AND/tR MMM
; TNSI`AT.T.ATTODIS WII.L NCYP BE SQED-
: ULED [7N7.ZL PII2[+iIT HAS BE@I
: APPROVID.
- ? - /- ----1) PROPERTY ADDRESS: '-
LEGAL DESCRIPTION: ? C- -? '1&C W r Gy.
Lot Block Subdivision or Tax Parce ID )
•
IF EXISTING STRC(,ZS7RE, DATE OF ORIGINAL BL'ILDING PERMIT ISSCANCE: "
PRESENf 7ANING/PROPOSID C'SE: (Nbn Par
q coNIMcxAL/xErrIzroFFicE
Q IbIDL'STRIAL
M INSTITUTIONAL/GpVIItAIIyN,'D7T
2)
?R-1 SINGLE FAMILY
Q R-2 DI?PLEX (Tt.o L?nits)
? R-3 TOWNFIOC?SE (Three + Units) ( Units)
R-4 APARTMENT/COAIDOMINIL?M ( Units)
NAME:
ADDRESS:
CITY. STATE. 2IP:?f?NS,
PHONE:
3) ' ?: ?• NAME: /}? f For City Use
/?"6 /i?'/9s,41 Plumbers License:
ADDRESS:? y 7. !J 1Ym10ll /f lC?y P o.ni- FSActive
y
cpired
CITSC, STATE. ZIP: -- ?j 5'? z 2 Not recorded
PxorE: MASTER LICENSE# t?=tial
4)
lue-0.4kUYd?IVW II9i'
NAME:
AODRESS:
CITY. STATE, 2IP:
PHONE:
5) is w• • o, • : a • ?? --
? CONNECTION 1b CITY SEWIIt ? CONDIDCTION TO CITY WATII2 Q OTHER '- ..
6) n • • r Q PLF.ASE HOLp APPROVID PERMT FY)R PICR-C?P $Y ONE OF ABOVE --- -- --
[}? PLFASE MAIL APPROVID PERMIT TO 1, 2. 3? 4. AHOVE
(Circle one)
» ? ?. • ?"?? _ ?-??.?? ? "7-
/? a /? ?
FOR :ClTY USE ONLY
PERMIT # TSSUED '
Pd w/Bldg. Permit FEES:
$ $ SEWER PERMIT (INCLUDE SURCHARQE)
$ S ?d 5? WATER PERMIT (INCLUDE SURCHARGE)
$ WATER METER/COPPERHORN/OUTSIDE READER
$ S WATER TAP, (INCLLDE CORPORATION STOP)
$ S SEWER TAP
$ $ ACCOUNT DEPOSIT - SEWER
$ $ ?S «? ACCOCNT DEPOSIT - WATER
$ $ wAc
$ $ SAC
$ $ TRDNK WATER ASSESSMENT
$ $ TRUNK SEWER ASSESSMENT
$ $ LATERAL BENEFIT/TRUNK SEWER
$ $ LATERAL BENEFIT/TRUNK WATER
$ /
?-D 'O D $ WATER TREATMENT PLANT SORCHARGE
,
$ $ OTHER:
$ 77°z ' 06 $ 2 TOTAL
-2 V?, o ? - 7s?z y
RECEIPT RECEIPT
DOES LTILITY CONNEC TION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
? YES 'IF YES, THEN A" PERMIT FOR WORK WITHIN PUBLIC
Q
NO ROADWAY" MUST BE
DIVISION
LIST ISSUED BY THE ENGINEERING
AS A CONDI
IO
. T
N.
SUBJECT TO THE FOLL OWING CONDITIONS:
APPROVED BY: la(._a?l
TITLE:
DATE:
e
CITY OF EAGAN
3830 PZIAT &NOB ROAD
EAGAN, ?IN 55122
PAONE: (612) 454-8100
1?CHAh1ICAI:; PEB.MIT
FOR CITY IISE ONLY
PERMIT #
RECEIPT
DATE: a7 9/
SiDBNSTAI.i" PLEASE CDMPLETE IIPPER YORTZON ONLY FOR SINGLE FAMILY DWELLINGS &
?.... .:_.......
TOWNHOMES/CONDOS STHEN PERMITS pRE REQUIRED FOR EACH IINIT.
--__-___---------------- ___---------__------__-__--------___-----___------____-
WORK DESCRIPTION FEES
NEW CONST
ADD ON
REPAIB _
OWNER NAME:
SITE ADDRESS: IC.@ (P(7
IAT: 'Y BIACK ? SUBD, c D I r?
INSTALLER:
ADDRESS: lq b
? zir: h3 3a3
PHONE #: -fz-Z- S-6 SS
ADD-DN MINIMUM
HVAC 0-100 M BTU
ADDITIONAL 50 M BTU
GAS OUTLETS - MINIMUM
OF 1 PER PERMIT
SUBTOTAL:
STATE SURCHARGE:
$15.00
24.00
6.00
3.00
$.?.5
.50
TOTAL:
C OF PERMITTEE ?
$b3AIERCiALJiND45TRIAL: PLEASE COI?IPLETE THIS PORTION FOR ALL COI?IIiERCIAL/INDUSTRIAL BUILDINGS,
W ....... .. ... . . ........ ... .. ..
APARTMENT BUILDINGS, AND MULTI-FAMZLY BUILDINGS ilHEN SEPARATE PER?fITS ARE
NOT REQIIIRED FOR EACH DWELLING UNIT.
--------------------------- __------- ___------ __---------- _______-_-
CONTRACT PRICE:
OWNER NAME:
SITE ADDRESS:
IAT: BIACK , SUBD.
INSTALLER:
ADDRESS:
CITY:
PHONE #:
FDR:
CITY OF EAGAN
ZIP:
FEES
18 OF CONTRACT FEE.
STATE SURCHARGE - $.50 FOR
EACH $1,000 OF PERMIT FEE.
PROCESSED PIPING - $25.00
$25.00 MINIMUM FEE.
CONTRACT PRICE x 18 $
STATE SURCHARGE $
TOTAL:
$
(SIGNATURE)
It?TDEl?'xlF?Si7<
H?_.:<,;_.:,.,>:.„ .... ..........._..
--------------- ---
WORK DESCRIPTIDN
NEW CONST
ADD Y 0
O
REPAR
OWNER NAME:
SITE ADDRESS: IuLE'U P(
LOT: BIACK ? SUBD.
INSTALLER: QcJuk I?7?1 CWi?
ADDRESS: 4-40 r-), £eCC
CITY:? K-? ZIP: SS ??
PHONE -4 2 Z - ?;-Cn SS
FEES
TOTAL: S 15.50
;c0l4?SERGXALj?1DLISTRZALi; PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS AND
MULTI-FAMILY BUILDZNGS WHEN SEPARATE YERMITS ARE NOT REQUIRED FOR EACH
DWELLING UNIT.
CONTRACT PRICE:
OWNER NAME:
SITE ADDRESS:
LOT: BIACK _ SUBD.
INSTALLER:
ADDRESS:
CITY: ZIP:
PHONE #:
FOR:
CITY OF EAGAN
3830 PILOT KNOB ROAD
EAGAN, 14N 55122
PHONE: (612) 454-8100
PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY
TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
--------------------------------°-------°°-----
18 OF CONTRACT FEE.
STATE SURCHARGE - $.50 FOR
EACH $1,000 OF PERMIT FEE.
$25.00 MINIMiJM FEE.
CONTRACT PRICE x 1% $
STATE SURCHARGE S
TOTAL:
FOR CITY USE ONLY
PERMIT #
RECEIPT #?
DATE:
DWELLINGS &
COMPLETE THE FOLLOWING:
N0. FIXTURES EA. TOTAL
ADD-DN MINIMUM 15.00
r SHOWER 3.00
_ WATER CIASET 3.00
BATH TUB 3.00
LAVATORY 3.00
KITCHEN SINK 3.00
LAUNDRY TRAY 3.00
_ HOT TUB/SPA 3.00
_ WATER HEATER 3.00
_ FIAOR DRAIN 3.00
GAS PIPING OUT.
_ (MINIMCTM - 1) 3.00
_ ROUGH OPENINGS 1.50
_ OTHER
WATER SDFTENER 5.00
_ PRIVATE DISP. 15.00
U.G. SPRINKLER 3.00
SUBTOTAL S 16
ST. SURCHARGE .50
$
( S IGNAT[TRE )
CITY OF EAGAN
K ?.9X&
? `? ? 96z? . a?,aeKw
i • I ,4
EXTERIOR ElIVELOPE AVERAGE "U" CnMPUTA7A0N? L ti, ?l "-
. otniEit: 64-n. ENERbw c,4Lcuc,ATiCNs FoR Paoc. i2oaM
1 A?D ?•T101y
51TE AOORE55: e ,., ?o;n
t,ONTRACTOR: 9 ? - ? ? ('??,?•d„? 6„ ?Q pATE : PHONE : 1:'f.t r/ -
--7 ?-
DETERMI?IE UORKItIG SOUARE FOOTAGE OF EACH:
1. TOTAL EXPOSED UALL AREA/7%Sq ft x"U"
2. TOTAL ROOF/CE I L I HG AREA........ 5141 sq Pt x"U" Qa
3• TOTAL EXPOSEO t,IALL AREA CALCULATfOtIS:
Total exposed wall
area above ftoor,,,,,,,. ,c17(a sq ft
a) Total wall window area: `
e2 kU.e 1-ow -E QldZCd..?? ??
•••• sq ft x U mtL • ?.G,
glazed,,,,,, sq ft x"U" • o ???
b) Totai door area ,,,,,,,,. ?j sq ft x"U" f? ? O
t) Total sliding glass door area: .
d Aw l.ew -T? , .
9lazed...... /.m7sq ft x"U" •a1/ ? o?S..z
glazed......
. sq ft x "U"
d) Total ffreplace wall area sq ft x"U"
? .?.gy.
e) Total wall framing area ?
(Average 1v).......... sq ft x"U" .09
n
f) Total net wali area above •
• floor (Insulated) ,,,,,,,sq ft x"U" 4!/
g) Total rim joist area......
sq ft x "U" -
Total foundation
arca (Exposed).......... /.2 sq.ft
h) Total foundatton
windav area............. .?--= sq ft x"U"
I) Total net foundaiion
arca a6ove grade:....... sq ft x"U"
3.
a
W
a ^
o9 a ,/ D&
TOTAL a) thru i} _ ?
If (tcm #j is thc sane as, or less [han iten N1, you have met thc Intcnt of
S.D.C. 5ec[Ion 600(. (c) 2,
TGTAL EXFOSeD rDG:/CeIL11:G CfiICULATI0N5:
" 7ota1 exposed -
, roof/ccilinq area......... sq ft
j) To;al skyl ich? area....... 25 sq ft x"U" , 35 ° y.,? ?
k) Total roo`/ceiiir.q fra^ing / ,
area (l,v<•ace 10.`?)...... '
. 7g• s s4 ft x??U"
1) Total net insolated
roof/ceiling area...... Y(?j Sq ft x"U" p]-. ? ?.3
4. , TOTAL J) thru 1) ?
If total of °b is the sare as, or less than 92, you have net the intent of
S.B.C. Section 6006 (c) 1,
- - ' ' : , • • ;;r•;? . • • • ', ,: :'"'?
y1CTERrIATE BUILDItIG EtIVEIOPE DESIGN .
7o utilize the total envelope system method, the values estabifshed by the sum
of items r3 and'i4 s:iall not be greater than the sun of items B1 and #2.
1. 53.6? + 2.
s. 5a. r? a +-4. ??.75 - 3 •
' l° Alee?- "f1f e y e.ac?e r eqv: t e m e,u-l?s 7 itP
? P(a.us EtCAs .
bCc.v? tic.c?'u.c I
• . C E R T 1 F 1 C A T I Q iJ
-- - - - - - - - - - - - -
t hereby certiPy that I have calculaterl the "U" factors and "R"
values herein and that the huildinn here descrihed meets or exceeds the State
of Minnesota Encroy Conscrvation Act.
Slqnaturc
(Da c)
'. •
CITY OF EAGAN
EXTERIOR ENVELOPE AVERAGE 'U' COMPUTATION
t7GINER: a-vl ?era ? ?.? A; Sen
SIYE ADDRES3 • // / n /2' ?e r-?.j &,",
4-
CONTRACTOR: DATE: 5/a PHONE:
Determ3ne vorking square footage of each:
1. Total exposed wall area .. y 3 ?/ sq. ft. x.11
2. Total roof/ceiling area ... ? q3L, sq. ft. .x .026 = 50.3 3
Total exposed wall area above floor --3
a, Total wall window area ............................ .ysa
b. Total door area ................................... jio
c. Total sliding glass area .......................... i
d. Total fireplace wall area .........................
e. Total wall framing area (average 10;U) ............. 4f3o
f. Total net wall area above floor ................... Jsv/
g. Total rim joist area .............................. 3A,5?
Total exposed foundation area = [ JS
h. Total foundation window area ....................... D
i. Total net foundation area above grade ..............
Determine 'U' value of each wall sesnent:
a. ysa x
b. fin X
c. x
a, igy X
e. 38? x
f. x
9. A A L x
h. D x
i. 425 x
'U'
' U' j-?cf5
'UI , aN5
rut y? f
' U'
fu' • ? $.?2
IU' , n5/05
'U' p
IUI
_ ??• 7
= 3? . r`
= Q
= a7
3 . ................................................... Total = yy7. a
If item U3 is the same as or less than item #1, you have met the intent of SBC
6006(c)2.
Total eaposed roof/ceiling area = /Q3A
j. Total skylight area ............................... ?
k. Total roof/ceiling framing area (average 10%) ..... / 93.A
1. Total net insulated roof/ceiling area ..............
OVER
. ?
Determine 'U' value for each rqof/ceiling sepent:
x' U' c9 - O
k. /y-3,(a x 'U'
1 . ' l d . `l x + u t
, ? ??, = 38. 33
q . ...................................................... Total = h/3. 3
If total of #4 is the same as or less than #2, you have met the intent of SBC
6006(c) 1.
Alternate Building Envelope Design
To utilize the total envelope system method, the values established by the sum
of Items #3 and (14 shall not be greater than the sum of Items 111 and 112.
1. '{(? .?f6 + 2.
3. + 4.
2
' FORCEO A1R
HEATING & COOLING
SYSTEf1 SIZ1N6
E-VALUATION"
?--s
FOR: 4aeftEr HT6
DATE:APRIL 23 1987
BACKGROUND
HEAi1NG TEMP 70
MIN QUT TEMP -3Y
DESIGN GRAIN 28
COOLING TEMP 75
MAX OUT TFMP 95
CFM UENTILTN 100
RDOM BY ROOM
ANALYSIS
FAMILY
-W- -L- -H-
20 22 17
EXPOSEn RREA 607
3i 19.0i 0.0
4.9/ 2978
l.li 699
PARTITN AREA 0
WINDOWS
lz 3i 3 lbi 1
68.0/ 2040
42.21 143]
4/ 31 2 17i 1
65.0/ 2275
62.6i 2193
DOORS
21 li 42iY
52.01 2394
9.1i 384
CEILING
40.0i 440
2.3i 1055
0.8i 388
FLOCR-
CONJ FLCJR
DUCT LOSS
pUCT GAIN
PEOPLE GAIN
S'Jf1MER 1 NF ] L
0
H
308
548
TOTAL LOSS 10743
6AINS
LATENT 764
SENSIBLE 5y38
TOTAL 6642
KITCHtN
-W- -L- -H-
14 lfi 9
cXPOSED F7REA 147
3i 19. 0i 0.0
4.9i 721
].li 169
PARr1TN AREA 8
WINDOWS
1/ 3i 3 5/ 2
67.9i - 1820
28.6i 429
DOORS-NONE
CEILSNG
44.0/ 0
FLCPR-
CPlID FLOOR
7UCT LPSS 0
DU'_k GAIN 8
PEOPLE GAIN 368
KITCHEN ADDS 1200
SUf1MER INFIL 147
T07AL LOSS 1741
GA1NS
LATENT 357
SENSIBLE 2246
TOiAL 2684
DINETTE
-W- -L- -H-
]2 i4 9
EXPDSED AREA 202
3i 19.Hi 0.0
4.3i 957
1.1i 232
PARTITN AREA 8
WINDOWS
li 3i 8 Si 3
fiS.Oi 3400
47.7i 2386
DCDF.S-NONE
CEILING
I 44.0i 0
FLOOR-
' COND FLOOR
DUCT LOSS 0
DUC7 GAIN 0
PEOPLE GAIN 308
SUf1f1ER INFiL 110
I
TOTAL LOSS 4391
6A]NS
LATENT 325
SENSIBLE 3829
TOTAL 3355
DINING
-W- -L- -H-
14 14 9
EXPOSED RREA 92
3i 19.0/ 0.0
4.9i 454
l.li 106
PARiITN AREA 8
WINDOWS
li 3i 4 8/ 4
68,0i 2266
S5.]i 1839
DOORS-NONE
LDRY+BATN
. CEILING
44.0i 0 TOTAL LOSS 5186
FLDOR- GAINS -W- -L- -H-
CDND FLOCR LATENT 185 ;4 .6 S
SENSIBLE 2521
DUCT LDSS 0 TOTAL 2706 EXPOSED AREA 250
DUCT GA1N 0 3/ 19.0/ 0.0
4.9i 1228
PEOPLE GAIN e FOYER l.li 288
SUMMER INFIL 129 PARTITN RRtA b
-W- "L- -H 'AINOOWS
20 13 17 li 3,, 2 Si b
TOTAL LOSS 2721 68.0i 1133
EXPOSEO AREA 211 37,71 629
GAINS 3i 19.0i 0.0
LATENT 111 4.9i 1035
SENSIBLE 2075 1.1/ 243 p00R5
TOTAL 2187 j Si li 211Y
i PRRTITN AREA 8 59.0i 1239
I 2.21 152
i WINDOWS
LIUING 4i 31 2 18/ 7 CEILING
65.0i 2340 40.0i 0
42.21 1717
-W- -L- -H- FLOOR-
18 18 9 COND FLOOR
OOORS
EXPOSEO PRER 364 Si 21 21iN DUCT LOSS b
3i 19.0i 0.0 71.01 2982 OUCT GAIN 8
4.9i 178fi 18.8i. 454
l.li 419 PEOPLE GAIN H
CEILING
PARTITN AREA 0 40.0/ 260 SUMMER INFIL 147
2.3i 623
WINDOWS 8.8/ 224
1/ 3i 5 lei 3
68.0i 3408 FLOOR- TOTAL LOSS 3800
37.7i 1888 ' COND FLOOR
GAINS
I DUCT LOSS 8 LATENT 127
DOORS-NONE DUCT 6AIN 8 SENSIBLE 1218
TUTAL 1345
CEILING ? PEOPLE GAIN 0
44.0i 0
SUMMER INFIL 329 '
ppSTER+BATHR00M
-
FLOOR
CONO FLOOR -
DUCT LOSS 0 I 70TAL LOSS 6961
-lJ- -L- -H-
DUCT GAIN 8 ? 28 22 11
I GAINS
PEOPLE GAIN b LA7EN7 280 EXPOSED ARfR 458
SENSIBLE 2963 I 3i 19.0i 8.0
SUMf^ER INFiL 213 TOTAL 3244 4.9i 2250
l.li 526
PARTITN AREA H
/!
W T'vDCwS
..'1/ 3i 8 Bi 6
+ • 68.Bi 453 3
44.4i 2960
' li 3i 4 6/ 6
68.0i 1813
SS.li i471
DOORS
21 ]i 42/N
9H.Bi 378H
14.Si 611
CEILING
40.Bi 784
2.31 1861
b.8i 677
FLODR-
CONO FLOOR
DUC7 LOSS 0
DUCT GAIN 0
PEOPLE GAIN 600
SUMf1ER I NF I L 496
TOTAL LOSS 14258
GRINS
LATENT 890
SENSIBLE 7346
TOTAL 8236
.r7,D+BATH
-W- -L- -H-
18 18 11
EXPOSED AREA 474
3i 19.0i 0.0
4.9i 2325
l.li 546
PRRTITN AREA 8
WINDOWS
li 31 4 Si 3
68.0i 2176
32.21 1208
DOORS-NONE
CEILING
40.0i 324
2.3/ 777
9.8i 229
FLOOR-
COND rL00R
DbCT LOSS 0
DUCT GAIN 0
PEOPLE GAIN 300
SUf1f1Ck 1NFIL 261
TOTAL LOSS 5275
GAINS
LATENT 456
SENSIBLE 2596
TOTAL 3052
LOFT
-W- -L- -H-
14 16 B
EXPOSED ARER 226
3i 19.0/ 0.0
4.9i 1112
l.li 26]
PRRTITN ARER 0
WINDOWS li 31 2 8i 1
68.0i 906
37.7i 503
4i 3i 2 8i 5
65.0i 1040
146.1i 2337
DOORS-NONE
CEILING
40.0/ 224
2.31 537
8,8i 193
FLDOR-
COND FLOOR
DUCT LOSS 0
DUCT GAIN 0
? PEOPLE GAIN 306
I SUMMER INFIL 131
TOTAL LOSS 3596
GR7NS
LRTENT 343
SENSIBLE 3727
TOTAL 40l]
BASEMENT
I BSf1T PERIMTR 177
BSi?T DCPTH 8
HEIGHT EXP 3
INSUL R-URL 18.0
INSUL DEPTH S
WINDOWS
1/ 3i 5 6i 9
68.0/ 2266
? 37.7i 1258
DOORS
zi li 42iN
90.0i 3780
14.5i 61]
BSMT LOSS 1673fi
BSMT GRIN 4G68
STRUCT'JRE TQTAL
HEAT LDAD 86235
COOL LOAA 43658
L
'N? X1-I --fi-
?,
?J
\ \
1
f
,t
.
:
??r
?? 1 I ,82
Gl? k/?!
?
-.-7I-1 --?-
.,
•, ?
?
?
?a
?
?
tasa a' ??
f
i•
? LoKs of Soil BorinR; ?"cO-
Location or Project
Borings made by _L/7'-/ Sc?, y.,Date
Classification Sys[em: ?U1SHO ; USDA-SCS Unified ; other
AuRer used (check two): Hand v, or Power _; Flight I-< or Bucket ; other
Depth, Borinq number
Ln
feet Surface elevation
o
\
1 -
2 _ I BN.. saKO????ay?il'nk
3 -
AV..? sa.«/- F.•., e?w/c%j'
G -
?,.
5 - sa.<11t;rd sedky
5 -
7 -
8 -
End of boring at 4:?' feet.
Standing water table:
F-cesent a[ feet of depth,
hours after boring.
Noc present in boring hole tl-?.
Mottled soil:
06served a[ feet of dep[h.
Not present in boring hole ?/
ObsQrvations and comnents:
Depth, Boring number it,
in
feet Surface elevation
-
0
1 -
12
I"7Fa? ??.. saxfl??ay
1 3 -
L f. fd r w
I 4 -
s-
b 7i'` f/a?cl C'?a y- S, y!f
7 -
8 -
End of boring at l feet.
Standing water table: •
Present at feet of depth,
hours after borinR.
Not presen[ in boring hole 1/
Mottled soil:
Observed at ? feet of depth.
Not present in boring hole
Observations and comments:
} •
Loca[Son or PLOj2CC ? ??? // L
/
- d!/[ /7 .) c? K
., Bozings caude by _ Tf- S?l,,?,,iz
Date t/
Classification Systec?: AAS]i0 ; USDA-SCS L; UnlEled
; othcr
Auger used (check tvo): Hand //, or Power P1:ghC !? or Bucket ; uther
Dep[h, ? BnrinR number __,Z
in
feet f Surface elevatinn
DePth, I3orinF nvmber ?
in
fee[ Surface alevation
0
2 -
3 -
Sa K?/ ?sw? ? t / f?acK
4 -
S -
6 -
7 -
8-
End of boring at (o feet.
Standing water table:
Rresen[ at fcet of depth,
hours af[er borlnq.
hot presen[ in boring hole (/ ,
`fot[led soil:
Observed a[ feet of depth.
Not pcesent in boring ho!e (i
06scrvations and comments:
0 -
2 -
...,<f _ A5? S i(
i"/Pdl .9.K .raKI/c45--
2 -
7.? N
3 VZ
I-e
I 4 -
s- I ra
6 _.
7 - v
8 -
End uf boring at A'P" feet. '
Standinfi c;a:er ta61e: • ?
Present at feet of de.pth, ;i
t
hours after horirtp..
Not present i;c borin,v, hole !/ ?
Mot[led soil: - j
Obscrved at ____ fee[ of dep-h. j
Not present in ?3orinF hole !/ ?
Observa[ions :ttci com,men[s: ' I
.
+ PERCOLATION TEST DATA SHEET
Tesc hole location 26/ Hole number_,e
L_
Dace tes[ hole vas prepared D 6? , Depth of hole bottom,? inches.
Dlameter of hole, inches.
Soil data from [es[ hole;
Depth, inches Soil texture
Q - 91 p.? ?? /a
Method of scratchinq sidewall C i- fZ' .-?'Z C l
Dep[h of pea-sized g:avel ir. bottom of hole, inches.
Date and hour of initial vater filling lD 1'/g? 30
?
Depch of initial vater filling, 4J inches above hole bottom.
Method used to maintain at leas[ 12 inches of water depth in hole for at least
4 tiours
Percolacion test readings made by
starting at ?00
(date) •m•
during [est, .? inches.
on
Maximum water depth above hole bottom
Time Time
Incerval,
Minutes
Measurement,
inches
Drop in wa[er
level, inches Percolation
rate,
minutes per
inch
Remarks
? PD
-- 5
5 .s
Percolacion rate = 9•9 minutes per inch.
, . .
, PERCOI.ATION TEST DATA SHEET • Test hole location Fd-'/ y Af/c7c llh i„ ?&? Hole number??_
Da[e CesC hole vas pcepared O A, , Depth of hole bo[tom,? Snches.
Dlamecer of hole, c inches.
Soil data from test hole:
Depth, inches Soil texture
C X7 ?o a w -
?-
-
Method oE scratchinq sidewall Sn b'3 /14,
De?th of pea-si>_ed gr3v_1 ?n bottom of hole, ? incnes.
Date and h-r of initial water filling 1Q7;00 -
Depth oF initial water filling, U_ inches above hole bottom.
Mechod used to maintain at least 12 inches of water depth in hole for at least
4 hours 4/1 it,
Percolacion Eest readings made by ?A Sc`rhrv, -c-lloN on
lD Z /.'? f/ startin at a'10'
8 m . Maximum water depth above hole bottom
da[e)
-- during test, inches. -
Time Time
Zn[erval,
Minutes
Measurement,
inches
Drop in vater
level, inches Percolation
rate,
ininutes per
inch
Remarks
i
'Y17
- - U. . -
'r 6
o ?• ?-5 .>-
.
Percola[ion rate = 12.? '7 - minutes per inch.
,c y Q /? 664&?4 1?71egk.
OF
3830 PILOT KNOB ROAD TMOMFS EGAN
EAGAN, MINNESOTA 551221897 Wyor
PHONE (614) 454-8100 DAVID K GUSTAFSON
FAX (612) 454-8363 P/MEV+Mc«1+
TIM PAWLENTY
THEODORE WACFRER
Council Members
THQ+MS HEDGES
Cm/ Admmistrator
Se
tember 11
1991 EU6ENE VAN OVERBEKE
p
, Gry CkrK
MULRENNAN CONSTRUCI'ION LTD
4921 NEWTON AVENUE SO
MINNEAPOLIS MN 55409
RE: 1660 RIVERTON POINT
Dear Mr. Mulrennan:
We have reviewed your proposal of September 4 regarding the attic access location for the
swimming pool addition. Pursuant to Section 106 of the Building Code, it is our
determination that in this individual case the attic location, as proposed, is acceptable.
Sincerely,
?
? Joe Merchak, Construction Analyst
Protective Inspections
JM/js
Enc.
CC: Doug Reid, Chief Building Official
Greg & Leigh Mathison, Uwners
THE LONE OAK TREE...THE SYMBOL OF STRENGTH AND 6ROWfH IN OUR COMMUNIlY
Equal Opportunity/Affirmative Acflon Employer
0
0
0121191
c:? ef Ea1a,,
8uAA-.?I bep+.
9.5. ArT;c- acCC•.55 40r- Yoo' 0-d44:Dl\ C? /(0(00 Pit?GrJo? J?b:n+-
0
MEN
MEN
mmmo
MULRENNAN
CONSTRUCTION
LTD.
via re'vQ-s4- o? alf-et-naAe leca-.-?.o'. -4r- fl.? a?{:c a«Pss +o
6e place.d eX+40-Ra(i y a„ Ae- 9able e,#d ef fCc add:{-:on. TI.Q
reyu:?eme.?{- So,- ftie aec?sS may (lresa,n.? a probr?, w:?
I
Mo:s4+?r-e ?ro-.tis?er- :f?' plac.eJ' on 'P-he ;ns:c(e o? tke ?1d;ld:n
?laese md?;??t ?s o?+k,y acc eja4-a6:1;? oC th:s p?opasa/ a-
any ae{c?:.?:o,?a( r- eine,w'ES,
1\ ?
w- \
4921 Newton Ave. So.
Minneapolis, MN 55409
927-6889
, 1991 BIISLDING PERlI?4ICATION
` I CITY OF EAGAN
SINGLE FAMILY DWELLINGS
2 SETS OF PLANS
3 REGISTERED SITE SURVEYS
1 SET OF ENERGY CALCUTATIONS
li[[TLTIPLE DWELLINGS
JL
...,?
?
COMMERCIAL
2 SETS OF PLANS 2 SETS OF ARCHITECTURAL
REGISTERED SITE SURVEYS - 6 STRUCTURAL PLANS
(CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFICATIONS
1 SET OF ENERGY CALCUTATIONS 1 SET OF ENERGY CALCS
_# OF RENTAL UNITS
_# OF FOR SALE UNITS
PENALTY APPLIES WKEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY LAST WORKING DAY
OF MONTH IN WHICH REQUEST IS MADE.
IAT CHANGE IS REQUESTED ONCE PERHIT IS ISSUED.
NOTE: ADDRESSES FOR CORNER IATS - CONTRACTOR/HOMEOWNER tiUST DESIGNATE WHICH ADDRESS IS
DESIRED. NO CHANGES W2LL 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.
14dd''?fiO VI ' GP-
?Iy1? ao
To Be Used For: Valuation: Date:
?+.nT
Site Address 1660
Lot ? Block ?
Parcel/Sub O{???K&wk_
Owner
Address
City/Zip Code
Phone lLrj4 -
Contractor
Address !Jqij Aa.", ?.Q ::;.n
City/Zip Code
a
OFFICE IISE ONLY
Occupancy IC''?J
Zoning
Actual Const
Allowable
# of stories
Length
Depth
S.F. Total
Footprint S.F.
On site sewage_
An site well =
*CC System
City water _
PRV _
Booster Pump _
FEES
Bldg. Permit 4f3700
Surcharge a17.55
Ylan Review Z044,00
SAC, City
SAC, MWCC
Water Conn.
Water Meter
Acct. Deposit
S/w Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Trail Ded.
Copies
SDBTOTAL
Penalty
Lot Change
TOTAL ?
APPROVALS
Phone Planner _
1 Council
Arch./Engr. :Roe-f(( Bldg. Off. ?'t9 9/DS
? Variance
Address
City/Zip Code cC j;,tu
Phone it V:;1'x< -
?f R?IDAAiN4 ? AUAY77e?.,1
S er/Water i nsed Contr. /!//?
-T
y agreas that all aoik shall be done in accordance with
ignature of Contractor)
/ ?
?
all applicable State of Minnesota Statutes and City of Eagan Ordinances.
l3 ?Og
1987 BIIILDING PERMIT APPLICATION - CITY OF SAGAN
SINGLE FAMILY DWELLINGS
IPCLUDS 2 SEPS OF PL9NS, 3 CERTIFICAiSS-OF SQR9EY, 1 SST OF ENERGY CALCOLATIOHS
HOTE: ADDRESSES FOR CORNfiR LOTS - CONTR9CTOR/HOMEOWNfiR MIIST DESIGAATE AHICH ADDRESS
IS DESIRED. NO CH9NGES WILL BE ALLOWED ONCfi BQILDING PERMIT IS ISSIIfiD.
HOLTIPLE DLiEI.LINGS - RFSIDENTIAL RENTAL IIAITS FOR SALE DHISS
INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SQR9EY - CHBCK WITH HLDG. DEPT.,
1 SET OF ENERGY CALCULATIONS
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF
ENERGY CALCULATIONS,
$2,000 LANDSCAPE BOND
J
2oJ,o0o
To Be Used For: S; Valuation: 6&4ede_elo Date:
Site Address ,?,? Jz:,,?er•(a.. pE; ?+.-? OFFICE IISB
Lot 4/_ Block ?
Pareel/Sub RIa,Fha,.ile l.akQ
Owner
Ma-Fk; s ? a
Address ?,{ Ce..QAn
' A..e So ,
City/Zip Code
Phone Q,lk J_ yqph ? 9PPROVALS
Contractor
Address '1161n Sf Oaa5
City/Zip Code A/.S. 5-5zll -7
Phone 7aa - ?/OA-9
Areh./Engr.
Address ?.tr,l A .'jo
City/Zip Code ??; ?o l rl fv
On Site Sewage ? Occupancy
MWCC System _ Zoning
On Site Well Type of Const
City Water ? (Aetual) ?
(Allowable) ?
# of Stories
Length gj3
Depth ¢(o
S.F. Total
Footprint S.F.
FSES
Assessments
Water/Sewer
Police
Fire
Engr
Planner
Council
Bldg Off
APC
Variance
Phone ll
Permit
Surcharge
Plan Review
SAC, City
SAC, MWCC
Water Conn
Water Meter
Road Unit
Treatment Pl
Parks
Copies
TOT9L
8iz.??2
? zs
N P-
,4-
S2 5,
?7.
:1
L ?
i
q0a)
( ? ? ?? = ?2? x 44 = 3? ? 3 Z
24 4
.
J
202 9 2q-
1991 BOIINC (?J0LICATION
G,ITY OF EAGAN
SINGLE FAMILY DWELLINGS lii1LTIPLE DWELLINGS C024fERCIAL \
2 SETS OF PLANS 2 SETS OF PIANS 2 SETS OF ARCNITECTURAL
3 REGISTERED SITE SURVEYS REGISTERED SITE SURVEYS - & STRUCTURAL PIANS
1 SET OF ENERGY CALCiIIATIONS (CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFICATIONS
1 SET OF ENERGY CAI.CUII+TIONS 1 SET OF ENERGY CALCS
OF RENTAL UNITS
_# OF FOR SALE UNITS
PENALTY APPLIES WHEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY IAST WORKING DAY
OF MONTH IN WHICH REQUEST IS MADE.
IAT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED.
NOTE: ADDRESSES FOR CORNER IATS - CONTRACTOR/HOMEOWNER HUST DESIGNATE WHICH ADDRESS IS
DESIRED. NO CHANGES WILL BE ALIAWED 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.
TF.7QODR.
To Be Used For: ?m Valuation: ?D., OnCZ_ Date:
Site Address ?(G(o 0 IJT, OFFICE USE ONLY
Lot ? Bloc k PEES
00
Occupancy Bldg. Permit '
i Zoning Surcharge 5.00
Parcel/Sub b ha?k' Ay l Actual Const Plan Review
Allowable SAC, City
Owner&apQ(a, il,??g??? # of stories SAC, MWCC
?
Q (?. Length Water Conn.
Address
b(o b wA2,TUV1 ?? 1- Depth Water Meter
(' S.F. Total Acct. Deposit
City/Zip Code fAGAo Mt t1 S SQ), Footprint S.F. S/w Permit
S/W Surcharge
Phone On site sewage_ Treatment P1.
(?
J On site well Road Unit
Contractor y?O I
so S Tiv MWCC System _ Park Ded.
City water Trail Ded.
Address IS I r ? Q ? _ PRV _ Copies
Booster Pump
City/Zip Code _
SIIBTOTAL
APPROVALS Penalty
Phone Q ti - 1 y? O Planner Lot Change
_
Council TOTAL J? a . (JQ
Arch./Engr. Bldg. Off. ta9 9/DS
Variance
Address
City/Zip Code
Phone #
Sewe /Wat r Licensed Contr.
? agrees that all work shall be done in accordance with
(Signature of Contractor)
all applicable State of Minnesota Statutes and City of Eagan Ordinances.
C:[TY UF f,FlGAN
CASHIER: 1; TE-1'thf.[NAI_ hOs 015
DAfE: 02/0W0 '1SMF_e 11:28:16
T4.
NAME- TNF_ CAfiF'[NT("kS CONTRACI"SNG ]:NC
3210 9001 1660 F:IVE.F.TON F' 391.c'.S
3422 9001 060 I;IVFF;TfIN P 254.31.
'r''_1 ;,; 9001 1660 RIVEkT'GN F' Q.50
.
A
1
7ot;a:l. Fieceapt Amotrrtii,e r,.`.';;:1a0b
Cfi12r`3M
I.JSiT..R TDc JAN
2000 BUILDINC PERMIT APPLICATION (RESIDENTIAL)
CITY OF EACAN
?? ?-I 3830 PILOT KNOB RD - 55122
851-681-4875
?-?-er? ?-a Y, v d
New ConsfiucMon RarndremeMs
> a ropisrered fire suneys fAoMny sy. n. a W. ta n. a nouse s eopies a pan
antl Sff roofed areas (M mmcimum taf covemae Ulowet) 1 tet ol enerpy cdcWaHOnt for hetAed odtllMOns
D 2 eopiea of plaru (tliow beam 8 wlntlow sizes: Poured fid. desipn: atc.) 1 qte wrveY tor exfeAa admtlons 8 decka
? 1 tat ol enerpy calculallone
D 3 CoPies of hee Pmsenatlon plan H IO} plaMgd aHer 7/1/93
DATE: I- t t-l- a.gp ?
DESCRIPTION OF WORK: Z r
SiREET ADDRESS: Wae? 110bI[Ota ?m CONSTRUCTION COSi: ?,$ poo42
(1
_
LOT: J'1 BLOCK: I_ SUBD./P.I.D.11: O]X c1.-IG(:t 1,??c
Name: 4WRT-FTuTr L6 To o Phone C
PROPERIY tost Flrst
OWNER I & (° (D
Sheet Address: 4as$ `iZ l vGTCt o N?- ,
cny ?N-krg stare: vn rJ np:
Company: tNr, GN46tJTM,S Q0QTStw`i`r,a6 IQ(, phone u:
(area
COMRACTOR code)
streefnddress:( i oS cISJ VZ? 1?t ucenseg 36_?a Exp. I_A-L"
cly 0000t.uA state: r'VIvJ Zlp: SS?6y
4RCHRECT/ Tcw5Sb5 N"inv>? vr?6 , ft_&6?.-iVtUJb w""
ENGINEER Company: THa CAdk,NTQRS Co+vTAwcllNb lro?? Name: ?;JLbD ?CqLb
Telephone #: ( (0(Z, ) S'j l(?_
streetAddress: N\K 1? Regishatlon Y:
aN ow*z state: M u 21p: S3 bq
eweNwater licensed plumber (H installina sewerlwatarl: Phone #: (
iereby acknowledpe ihaf I have read ihia aPWtcaHon, dafe thal ihe Inlomwiion b cortect, and aWee b comply wilh aA appAcable State
? MI nnesota Stalutes and CNy o} Eayan Ordinancea
i
Siyrwlure of Appacant
?
OFFICE USE ONLY
)rtificates of Survey Received _ Yes _ No L? '/??A A 14 r-
c,_,
ee PreservaUon Plan Received _ Yes _ No X Not Required
OFFICE USE ONLY
BUILDING PERMIT SUBTYPES
? 01 Foundation ? 07 05-plex
0 02 SF Dwelling p 08 06-plex
? 03 01 of _ plex O 09 07-plex
O 04 02-plex O 10 OB-plex
0 05 03-plex 0 11 1 aPlaX
O 06 04-plex O 12 12-plex
WORK TYPE
O 31 New
? 32
J<'33 Addition
Alteretion
? 34 Repair
? 13 16-plex ? 21
O 17 Garage O 22
? 18 Deck O 23
O 19 Lower Level p,24
Piog _Y w _ N X_ 25
0 20 Pool O 30
Poroh (3-seaJ
PorGh/Addn. (4sea.)
Poroh (screened)
Stortn Damage
Miscellaneous
Accessory Bldg.
? 36 Move Bldg. ? 43 Reroof
? 37 Demolish (Bidg)' ? 44 Siding
O 38 Demolish (Interior) ? 45 Fire Repair
O 42 Demolish (Foundation) ? 46 Windows/Doors
' Give PCA handout to applicant for demolition permit
GENERAL INFORMATION
SAC Code 01
No. of Units I
No. of Buildings C)_
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
W idth
Basement sq. ft.
Main level sq. ft.
sq.ft.
sq. ft.
MISCELLANEOUS INSPECTIONS
O Stucco/Stone NR
APPROVALS
Planning _
Permit Fee
Surrh3rge
Plan Review
License
MC/ES SAC
City SAC
W ater Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total
SAC Units
% SAC
Building
?-SU - 3 I
(, g .0 ?-
sq.ft.
sq.ft.
Footprint sq. ft.
Census Code
MC/ES System
City Water
Booster Pump
PRV
Fire Sprinkiered
??G Engineering Variance
Valuation: $ ay , 6T ?/
`/ S6 sv„, t+ /S" = a.u2y
O 31 Ext Alt - Muiti
0 33 Ext. Alt - SF
O 36 Multi
H
(o 5?ac)
2004 RESIDENTIAL BUII.DING PERMiT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Constructlon Reaui2mems RemadeVReoair Reauiremenis
3 ragiste2d ske wrveys showing sq. ft of lot sq. ft of house; end afl roofed areas 2 copies of plan
(20% maximum lot coverage albwed) 1 set of Enertgy Calwlations for heated additions
2 copies of plan shaxing beam & window sizes; poured found deslgn, etc. 1 site survey for additions & decks
1 set of Energy Calcula8rns Adddion - indrcate S ar-site septicsystem
3oDpies of Tree PreservaUon Plan if Iot platted after 711/93
Rim Joisl Defail Options selection sheet (bldgs witlh 3 or less unBs
S 'l-7 0 . SZJ
Date e; Construction Cost
Site Address lG/ o pt 61-?!2 G^ 0° u/^7 UniUSte #
Description of Work jt?cglA /(1,E' "`ra v v
4"'-
Multi-Family Bldg _ Y
N NSreplace(s) _ 0 _ 1 _ 2
Property Owner A2 .&?Z? ? ?6AS( o ? f? Telephone # ( ?ij,1) ?lU ^ ?r„ S J
Contractor 14l2 ?7261` ?0 45S o c j CG
Address l7,f/ 7 A,?qtiS,!^-- elcy City ?Hdvv c K
State ? A- Zip 5 -V0 Telephone # ( 7G,3) 17oo? ?
_ e)
COMPLETE THIS AREA ONLY IF GONSTRUCTING A NEW BUILDING
- Minnesob Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category 1 Warksheet • New Energy Code Worksheet
(Jsubmissiontype) Submit[ed Submitted
• Energy Envelope Calculatlons Submitted
Have you previously constructed a building in Eagan with a similar plan2 _ Y _ N If so, 25% plan review
fee applies.
Licensed Plumber
Mechanical Contractor
Sewer/Water Confractor
Telephone #(
Telephone #(
Telephone #( j
I hereby apply for a Residential Building Permit and aclmow?edge that the informarion 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 pernut, but only an application for a permit, and work is not to start without a
pernut; that the work will be in accordance with the approved plan in the case of work which requires a review and
approval of plans.
GvA l1 •?
ApplicanYs Printed Name Applicant's Signature
OFFICE USE ONLY
Sub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.)
? 03 01 of_ plex ? 09 07-plex ? 17 Garage ? 22 PorchlAddn. (4-sea.)
? 04 02-plex ? 10 08-plex ?( 18 Deck ? 23 Porch (screen/gazebo)
? 05 03-plex ? 11 10-plex ? 19 LowerLevel ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
Work Types
? 31 New
? 32 Addition
? 33 Alteration
)"k- 34 Replacement
Valuation co 0
Census Code
SAC Units
# of Units
# of Bldgs
Type of Const ?
Footings (new bldg)
? Footings (deck)
_ Footings (addition)
Foundation
Drain Tile
Roof Ice & Water Final
_ Framing
_ Fireplace _ R.I. _ Air Test _ Final
_ Insulation
Width
REQUIRED INSPECTIONS
Final/C.O.
Final/No C.O.
_ Plumbing
HVAC
Other
_ Pool Ftgs _ Air/Gas Tests Final
_ Siding _ Stucco _ Stone _ Brick
_ Windows
_ Retaining Wall
Approved By: , Building Inspector
Base Fee
Surcharge
Plan Review
MCIE5 SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
,s° ,
• • a
? 30 Accessory Bidg
? 31 Ext. Alt - Multi
? 33 Ext. Alt - SF
? 36 Multi Misc.
O 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 36 Move Building ? 42 Demolish Foundation O 45 Fire Repair
? 37 Demolish Building' ? 43 Reroof ? 46 WindowslDoors
'Demolition (Entire Bidg) - Give PCA handout to applicant
Occupancy MCES System
Zoning City Water
Stories Booster Pump
Sq. Ft. PRV
Length Fire Sprinklered
.?
0??C ?, v IAL)
? ?v-?.
, 1 HERFBV CER1
N6 EN6INEEAS - ? ?' P¦er.neo e
;BS and IflND gUBVE40AS suocnws??
. • . xEGISifUMOEP
' • ? OF
iFY 1N4T iH15 VIAN Wa9
A
EGT
N
N
OER
M
Y
DI
' ME
O
Y ?? . . . a
+ '
.
. . .. . -•.;+._ -
•.
p
-
[
.
q
p
?
LL
p
ry
EO`NC/1RJlJT?VKY?OKtv A, r c /
?
A
AI
'
I
R
TNE LAMS Of TNE STATE ' ..\/4w
¦
V
T
MIN Tl.
-
•:
't
? P
W@R ,Ci1Gc' F2NR E<6v/?;In
. C
?kr
\ OAi[ .? 87qE¢ Np ?+ NO D E BY pENAHNS
REVISIONS _
2004 RESIDENTIAL PLUMBING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55122 ?
651-675-5675
Please complete for modifications to existing residential dwellings.
Date ?_ I --? o I p p"?.?
Site Street Address ?la O 11 l, ???D k, (? Unit #
Property Owner fir"L•f,jn eDli, sf? Telephone # ( )
Contractor 1" rtf.,rr N w?L ee- elephone #(,?Fl)4Ta--?7L9'
Address QXD A/ C'19wrrovd <?r CitySo?? ? State MZip ?JrO )
The Applicant is: _ Owner _ Contractor _Other
Alterat?ions to existing dwelling ??
?Add plumbing fixtures. $ 50.00
If you are only installing a water softener andlor water heater, the fee is $15.00 plus the
state surcharge - see next section.
_Septic System Abandonment
_Water Turnaround (add $121.00 if a 8" meter is required)
_Other. ??nn?. ? nn on ?Jl Ax Q
Water Softener Water Heater $ 15.00
_ replacement _ additional
Lawn Irrigation System _RP2 _PVB _new _repair _rebuild $ 30.00
State Surcharge $ 50
Total $ ? •?.J
I hereby apply for a Residential Plumbing 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 plumbing codes; that I understand this is not a permit, but only an application for a
permit, work is not to start without a permit and work will be in accordance with the approved plan in
the even a plan is req_uired to be reviewed and approved. _ D m??0 i, r
/ ?' v?_ 004 I
App icant, `? s Printed Name Applicant's Signature JAUU . 0 2 ?
,5?ef/G mtt ?k
2004 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3?f 3830 Pilot Knob Road, Eagan MN 55122
? Telephone 4 651-675-5675 FAX # 651-675-5694
Sf z9
New Consiruclion Reauiremenfs RemodellReoair Reauiremenis F:1lfiae'llse?n
3 registered site suneys showing sq. tt. of lot, sq. ft of house; and II roofed ar?s 2 copies of plan Now 4'? ??" , i (20 %maximumbtcoveragealbwed) lsetofEnert?yCalculaGonsforheatedaddi6ons a :??2 caPies of Plan showin9 beam & window sizes; poured found desi9n, etc. 1 stte surveY a_ ,? ae :;+,..oK for additio? & decks s.1 set ot Energy Calculations Addrt'ron - indicate if on-sife sepUc system &;?y, '
3 Copias of Tree Pmservation Plan if ht platted aifer 711193
Rim Joist Delail Options selecfnn sheet (Mdgs wiHi 3 or less uniLs
Date G y Construction Cost ?S G? p G d?
SiteAddress UnitlSte #
Llescription of Work cloeh -rca C <6 &Ii4?
0 2
Multi-Family BJd g _ Y N Fireplace(s) _
ProperTy Owner ?z Telephone #((t i) YS/"? 7G J
Contractar (-d
address IzIF!'7 AlW-Sati el&y Cicy ???vvc--7
State lh' ti- Zip g5';lrG Telephone #(76j ) Y?3 / 7I ?
/?li? T ???? Gl.t - d'I G -,?G 5 ?
7(e 3
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 _ Minnesota Rules 7672
Energy Code CategOry . Residential Ventilation Category 1 Worksheet • New Energy Cotle Worksheet
(4 submissian rype) Submitted Submitted
• Energy Envelope Calculatlons Submitted
Have you previously constructed a building in Eagan with a similar plan? _ Y
fee applies.
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone # (
N If so, 25% plan review
Telephone
Telephone # ( •1, )_
?
I hereby apply for a Residential Building Pemut and acknowledge that the infomiat)on i"9mglete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Bagan 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.
1/.¢//>- /tr , 1? " A
"
Applicant's Printed Name
Gc 7
ApplicanYs Signature
OFFICE USE ONLY
5ub Types
? 01 Foundation ? 07 OS-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
)c 02 SF Dwelling ? 08 OB-plex ? 16 Firepiace ? 21 Porch (3-sea.) ? 31 Ext. Alt- Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Eut. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (sueen/gazebo) ? 36 Multi Misc.
? OS 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? OB 04-plex ? 12 72-plex Plbg_Y or_ N ? 25 Miscellaneous
WorkTypes A 47"C' , 6 fn-0,6-1 /¢01, /a?L 1I 62"m OLjPlaL
r?
? 31 New I ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 32 Addition ? ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33 AlteraGon/ O 37 Demolish Building' ? 43 Reroof ? 46 Windows/Doors
'
O' 34' Repl2cement '" 'Demolition (Entire Bldg) - Give PGA handout to applicant
' .
Valuation I -. Occupancy TI(,7-"11- MCES System
Census Code Zoning City Water
SAC Units Stories eooster Pump
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const Width
,%A
REQUIRED INSPECTIONS
_ Footings (new bldg) . , FinallC.O.
_ Footings (deck) ? FinaUNo C.Q.
_ Footings (addition) _ Plumbing
Foundation HVAC
Drain Tile
Roof ? Ice & Water Other
Au/Gas Tests
?C. Final _
Ftgs
Final
?
Frauung =
jid?i =
? Stucco Stone Brick
Fireplace
k R.I. XAu Test X Final mdows
-
? Insula6on Retaining Wall
?
Approved By: , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatrnent Plant
License Search
Copies
Other
Total
I 3-I 3 . -t 5-
?
a-I'-I.(-.C l
P(71J}i
V ? ? f
sr2-rx,
(?lU ( A?t' J? lZ.l9clvvt 1?-n???/W1L
LTy.?° Nf?
R
Peak Industriul Services
11531 95th Avenue North • Maple Grove, MN 55369
Phone: (763) 315-4730 • Fax: (763) 494-9017 • wvrw.peakindustrialservices.com
April 20, 2005
Wally Arntzen
17817 Hanson Blvd.
Andover, MN 55304
RE: Mold Survey Results
Project number: PK05.092.01
Dear Mr. Amtzen:
?
On March 17`h and April 4'h 2005, Peak Industrial Services, LLC (Peak) conducted a
Mold Survey at your residence located at 1660 Riverton Point, Eagan, MN. The work
scope for the survey included the use of olfactory observations and the collection and
analysis of two sets of air samples inside the house.
Sample Locations and Results
The survey was requested to determine if the remedial action that took place, at the
residence, adequately addressed a prior fungal contamination/growth issue. Two sets of
air samples were collected in the main house. The first set of air samples were taken to
determine what kind of mold, if any, was present in the house using a spore trap. The
second air sample was taken to determine what culturable amount of mold was present
due to spores present at the residence. The First set of air samples were collected on an
Air-o-Cell cartridge by passing a known amount of air through the caRridge using a
calibrated air pump. Because the analysis of the Air-o-Cell cartridge is by microscopic
examination and does not include culturing the sample, identification of the fungus is
typically to the genus level and occasionally to the species leveL The second set of
samples were collected using an Andersen N6 samplec The Andersen sampler impacts a
known volume of air into a growth media. This media is cultured to promote fungal
erownh. This growth is then examined microscopically to determine the viable number of
fungal spores that are present in the environment.
Three Air-o-Cell samples were taken in the following areas: Lower Level, Main Level,
and Upper Level. The resul[s from the spore trap air samples indicated that the total
amount of fungal spores present in the house were low, however the results from the
lower level did not rule out that an active colony was present. It was thought that low
levels of fungal spores from the remodeling remained in the house.
Mr. Wally Am[zen
Project number. PK05.092.01
Page 2
The house was resampled using the Andersen sampler to determine if the fungal spores
were viable. Viable spores are a better indication whether an active or growing fungal
colony exists.
The second se[ of samples using the Andersen sampler were taken in the following areas:
Guest Bedroom, Former Pool Area, Lower Level Bathroom, Main Level, and Upstairs.
The results from this culturable sample indicated that there were very low levels of viable
fungal spores ?present in the sampled areas of the residence. A viable fungal spore level
of 1000 cfu/m is typically referenced as the threshold for acceptable indoor air quality.
The levels measured inside the residence were between 24 cfu/m3 and 36 cfu/m3.
Conclusions
It is in our opinion that fungal contamination at your residence is very low. The two sets
of air samples indicate that the remedial action that took place was adequate and there are
no significant populations of mold growth at the sampled locations.
We appreciate the opporiunity to assist you with this survey and look forward to working
with you in the future. If you have any questions, please feel free to reach me at (763)
315-4730.
Respectfully,
Peak Industrial Services
John Landwehr
General Manager
rrmcipal
? ENVIRONMENTAL
SCIENCE CORP.
12065 Lebanon Rd.
ppR 1 8 2005 ' Mt. JuliEC, TN 3'1122
(615) 758-5858
?I 1-800-967-5859
Pax (615) 458-5859
Tax I.D. 62-0814289
E9C. 1990
Viable(Culturable)MOld Spore Report
ESC SOP# 350307
1oM Ldndwehr EMLAP/AINA N 100789
April 12, 2005
Peak Induscrial Services
11531 95th Ave N
Maple Grove, fMl 55369
ESC Sample #: L193906-01 L193906-02 L193906-03 L193906-09
Client Sdmp12 Id: GVEST BDR CONTROL SAMPLE FORMEA POOL AREA LOWER LEVEL HATH
Locatioh: Guest Bdr Control Sample Former Pool Area Lower level ba[h
Project q: PKOS-09201- AIR SAMPLPK05-09201-AIR SAMPLPKOS-09201-AIR SAMPLPX05-09201-AIR SAMPL
Collect OaCe: 04/04/05 09/09/05 04/04/05 09/04/0$
Recelve Date: 04/05/05 04/05/05 09/05/05 09/05/05
Analyz2d Date: 09/12/05 04/12/05 09/12/05 04/12/05
Parametez 2aw Lbunts cfu/m3 kaw Counts Cfu/m3 Raw Cbunts cEU/m3 Raw Counta cfu/m3
Volume (liCers) 84 Not appliC 84 84
PRCC 400 400 400 400
Medium Used MEA MEA MBA MEA
L1m1C of OeCectlon (colonaes) Q <1 4 a1
R1CELndlld
Aspergillus canditlus
Aspergillus flavus
Aspergillus fumiga[us
Aspergillus glaucus
Asperg_llus nidulans
Aspergillus mger
Aspergillus echraceus
Aspergillus sydowni
Aspergillus versicolor 1 12
Aureobasidium
0asadiomyceCea
Bipolans/nrechsiera
Bo[ryCis
Chaetomium
Cladosporium 1 12
Epuoccum
Mucoz
Nor.-sporulatang Eungi 1 12
Paecllomyces
Peniciilium
Phoma/coeiomycetea 1 12
Rhizopvs
S[achybotrys CharCarum
Vlocladium
YeaSCe
Total cfu/m3 29 24
9 ? AV
C1a ia G. Zimmer?m ESC Represee[a[ive
Pazcicle hole correction chart uaetl foz all calculations, cable and/or formula available upon requeet
Unless ocnerwise indica[ed samplee were received in good condition.
Blank correc[ions have noC been applied.
Thia report shall not be repzoduced, excep[ in full, without [he wtiteen approval from ESC
Page 1 oE 2
4* ENVIRONMENTAL
SCIENCE CORP.
12065 Lebanon Rd.
M[. Juliet, TN 37122
(615) 758-5858
1-800-767-5859
Fax (615) 758-5859
Tax I.D. 62-OB19289
Es[. 1970
John iandwehr
Peak Indus[rial Servicee
11531 95[h Ave N
Maple Grove, t41 55769
ESC Sample # :
Client Sample Id:
Location:
Pro7ect k :
Co11ecC Date:
Receive DaCe:
Analyzed OaCe:
Viable(CUlcurable)MOld Spore Report
ESC SOPp 350307
EMLAP/AIHA p 100789
L193906-05 L193906-06
MAIN LEVEL UPSTAIRS
Main level Vpstaire
PKOS-09201-AIR SAMPLPR05-09201-AIR SAMPL
04/04/05 09/04/05
04/05/05 09/05/05
04/12/05 09/12/05
April 12, 2005
Paramecet Raw Count9 cfu/m3 Raw Counta cfu/m3
vo:ume(liters) 84 94
PHCC 400 400
Medium Used MEA MEA
Limi[ of DeCection (colonies) <1 <1
Altemaria
Aspergillus candndus
Aspergillus flavus "
Aspergallus fumiga[us
Aspergillus glaucue
Asper9illus mdulane
Asper9illus ni9er
Aspergillua ochraceus
Aspergillus eydowii
Aspergillus versuolor
aureobaeidium 1 12
Basidiomycetea
Bipolazis/Drechsleza
Ho[ry[is
ChaeCOmium
Cladosporium 1 12
EpicocCUm
Mucor
Non-sporula[ing fungi 1 12
PdeCllomyC¢s
Pen1C1il1um
Phoma/coelomycetea
Rh_zopue
Scachybotrye char[arum
Ulaclddium
Yeascs
Total cfu/m3 36
' ^ n
Clau ia G. Zimmerman, SC Represencative
Particle hole correcCion chart ueed for all calculations, table and/or formula available upon reques[
Unless otherwiee indicated samplee were received in 9ootl condi[ion.
Blank correctior.s have not been applied.
T.hie report shall noe be reproduced, excep[ in full, wi[hout the writeen appzoval from ESC.
Page 2 of 2
Company Name/Atldress Alternate Oilhng mformation Anal y5is Chain ol Custody
of
Page
r'iQl ?
c
x d??lGp'S i _
Preparedby
i
o .
t rs3 r 9 5f ?' /? ?'e y o .
ENVIRONMENTAL
/???IP Ga'oV2 ??N ,5",?36
SCIENCE CORP.
12065 Lebanon Road
Report m Eman io ?i r?io ' c MtJuliet. TN 37122
pro e?
s
I i u
' Phone (615) 758-5858
uipeon ? s
oe ; Q ? i?
i phone (800) 767-5859
Phone Client Projact #
¢!(7
LU W
I V
I
FAX (615) 758-5859
FAX
Collecletl by
(print) ` P O#
. r
CollecteC Doy (sgnature). /f Rush1 ( Lab MUST Be Notifed )
2 X
5ame Da Date R esuhs NccdeJ:
Q
I
I
N
?I
m
u
I
' CaCada (lab uu only)
=
Y
Next Day . 175 % -
Emai11
No?Yes w Q
?' ¢ I I ?
U Template/Prelogm
( .
Two DaY ..
.. . 1.5 %
FA%? _
4o_Yes
U
?
z I F.,
z
hioPed via:
[4 i
SamplelD SampleDescription TyPe• Volume
o?Area Daie Time ? ? ; a;u ,a ?V i?V 41 ftemarke/COntaminan[ ?
Sa bC {aOwlY)
?
ro( 0
I
O-
x G
y
,
'Type= Tape-Tapelifi, Bulk -BUIk.Swab - Swab. CP-ContactPlale.55-SOd,W-Waler,ST-SporeTrap Allerqenco.Zeton,Art-O-Cell, AF-AnderSenFungal, AB-Andersen8actenal
Comments: ??qQ5?gqRd Ii JR? 147
i ' ed by ature Date Time Recervetl Dy (Signature) SamDles re[umed via. ? FedEx ? Courier ? UPS
- Conditio pab uu only)
ehnqmshed by (Si9naNre) Date Time' Recerved by (Signature) Temp ?rt0
'f
6A, Botlle eceived.
Relinquisned by (Sgnature) Dace Time, Recerved for la ?b ignaNre)
I Time DH Checked NCP
l?J
_ ?
? ENVIRONMENTAL
SCIENCE CORP.
Alez mcLean
Peak Induscnal Setvires
11531 95th Ave N
Maple Grove, hW 55369
ESC Sample k .
Client Sample Id.
Location:
Pro)ec[ p .
Collec[ Oa[e
Analyzed oate?
Receave Date
t??.R 2 8 2C?? ;;??
12065 Lebanon Rd.
MC. JulieC, TN 37122
(615) 758-5858
1-800-769-5859
Fax (615) 758-5859
Tax I.D. 62-0819289
Eee. 1990
Non-Viable(Spore Tsap)MOld Spore Report
ESC SOPp 350306
eMLAP/AIHA q 100789
Macch 25, 2005
L192126-01
9250902
Lowei
PK05-092-01 WALLYS
03/17/OS
03/18/05
0]/73/OS
L192126-02
9250958
Control
PK05-092-01 WALLYS
03/ll/OS
03/18/OS
OJ/23/OS
L192126-03
9250500
Main
PR05-092-01 WALLYS
03/1'1/OS
03/18/OS
03/23/OS
L192126-09
9250487
Upper
PROS-092-01 WALLYS
03/1//OS
03/18/OS
03/23/OS
Parame[ez Raw Courtts Spores/m3 Raw Counts Spores/m3 Raw CounCS SpOLes/m3 Raw Counta Spores/ml
Volume Licers; 150 150 150 15a
Back9round Debn s• Heavy moderace Heavy Heavy
L1mi[ of Deeeccian (spores) Q <1 Q <1
A1[ernaria 9 27
Ascospores 30 67
Aureobasatlcum
7
47
Basidiosco[es 6 40 2 13 1 7
Hipolaris/Drechslera
Bocrye:s
Chaeco:nium
7 6
40
;':atloscor:uR. 2 13 3 20 1
_,.:vd;a-ca 1 7
Epuoccum 1 '1
FLL9dY1LLm
niqrospoca
Gcner Colcrless
7
0[her Brown 8 53 2 13 1
PeniC111ium/ASperg111us 16 107 9 27 2 13 2 13
RusCs
SmuCS,MyxOmyceCes,Peximnia 1 0 1 7
SGfichybocrys chazCarum
5[empnylinm
Torula
UloclaCium
aygomycecee
Total Spores/m3
179
19"/
114
107
!
Claudia G. 2immexm#n, ESC Represencat.ve
•eackground debris ie an indica[non of amoun[ of non-fungal biologi<al particulace matter preaw[ on [he sample and is
chazac[erized ae very lighe, light, Modera[e, heavy or very heavy. Heavy backgrowd debne may reduce zeadabiliry so
chae spore cwnCS should be considered minamal.
Unless o[herwise indicated samples were receaved in 9ootl condi[non.
Blank correc[ions have noc been applied.
Thie meport sha11 not be reproducetl, excep[ in full, wiChouc che written approval ftom ESC
Page 1 of 1
pany Name/Address Alternate oilhnq mformation Anal sis Ghain ot Cuslody
Page
of
Peak _
_
r 1 5 S/ t S=^ ?e N
A
Preaareo oy
?oPk G-e?c, Mr/ Ss34C 9
?
ENVIRONMENTAL
SCIENCE CORP.
z 13065 Lebanon Road
eeponto A Emanm
7
?
?
C
'
?
G
S
?1
, 6.' Mt. Juliet.l'N 37122
lo [q
AMC i.
ouJ i
I
al . . V
Pro]ect / '] n
I$a n
?C ?? (f 1 , Y S
/? I
' 0
. ?z
,
I¢ Phone (615) 758-5858
?
n?
DescnPtion `
? 4
Q
Phune (800) 767-5859
Phone ChenlPmject# '
. 6?(D w
l W ,
i W
I
F ; y aj
: o i
FAX (615) 755-5859
Fnx
692
iu
' ,
;¢
'
i a
.?
H
.
'
¢ m
' l @
Collecled bY (Dnnt) Jo?h ??
A WC h r' I P O# cL i o
h ? !al
Q I uJ Q ? ? ?
Collectetl 6y (signa
re):
W Rush7 ( Lab MUST Be Notdled ) Date Resu l?s ly,a}edeJ: ? ?
> L7 > ?[tl CoCode. (lab use only)
JJ
ff
^
Same Da
2% n onv? ...( ? X F ? m F ?
U
?
? , .
- Y
Nea Day . 175X
Emad? _NO
IKVes LL) Q ` G TemPlate/Prelogin
Two DaY .. . . 1.5 X
-
FA%? ,ZC No_ves y,7
?. V
w z' ?
I¢I j z
¢
SMpced Ya
O ? _ ? , ?
, =
I U ?
SaTp101D Sample Descripbon Typ2' Volume DdI2 Tn1tC N ? I dU a U 'I w w RemarkslGOnlaTinant Sample P(lab only)
or Ar¢a
Lo er ST 150 3-)3 1301 "[
qz5052 co„+f or s r ? so 3_1-4 I37,0 x
925050o Mq;r? ST 150 3- 1323 X
q25°y L4 ? ? 5° _?? 135? x
r 3
-
?
•Type = Tapa - Tapelitl. Bulk - Bulk.SwaC - Swab CP-ContaciPlate.SS-SoiI,W-Warer,ST-SporeTrap.Allergenco.Zefon.Air-O-Cell. AF - AntlersenFUngal, AB - AntlersenBactenal
CUI111l1CIlU.
???
? Relin msh )
I q (Si Nre
Date
3_??,?5
Time
D9oQ Rece?ved by (Signature) , Sam01e5 reWmetl via ? UPS
-,/-
?/?fetlEx ?Couner ?
,? Condition b use onl )
Y
RelinquisheG by ( ignature) Date Lme RecerveC by (SignaNre) T¢mp Boitles R cerved
Reiinquohed by (SignaWre) Date Time Recervetl for lab by alure) al Time ?
? pH Cbeck¢d NCF '
C1. y
?
2004 RESIDENTIAL MECHANICAL PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Tlelephone # 651-675-5675 -
Please wmplete for: single family dwellings & townhomes/condos when pettnits are required for each unit
Date '6
Site Address 1LOLo[e ?%A3wiUtn ?h l ?1 Unit #
Property Owner Telephone # (763) ow)
Contractor
? tLI S Cit
fG e
Street Address ?/ VIvQ
1 ?/
? W, v y
ly
?? Te?e
hone # (763 )
Zi [
/ ?' / `'
l
State p
p
Bond #: Expires:
The Applicant is _ i
Owner
Contractor Othec
Add-oo or alteration to existing dwelling unit $ 30.00
? furnace _Additional ?Replacement
air exchanger
di
i
?
?R
N
nt
l
aircon
t
oner ew
_ aceme
ep
other
State Surcharge D`' ? 6-LQp4 $ 50
Total $ ?
0y
I hereby apply for a Residential Mechanical Pemilt and aclmowledge that the information is complete and accurate; that the work will
be in conformance with the ordinances and codes of the City of Eagan and with tha Mechanical Codes; that I understand this is not a
permit, but only an application for a permit, and work is not to start without a ; that the ill bolm'-a-cco'hknce with the
approved plan in the case of work which requires a review and approval of pla .
mow! `Ad`
Apphcant s Pnnted ame Applicant's Signatur
9527586278
'Y0/11/2008 23:38 9527586278
313 Lyndale Ave,
New Prague, MIV. 56071
Phone: (952) 461-2356
Fax: (952) 758-6278
Fc4gpw
ADVANCED ONSITE INC
PAGE 01
A d vartc ed OnSite
lnc
,l
.
To: Ciry of Eagan pffice of Inspections From: Tom KlanChnik
Fax: (651) 675-5694 Date: June 12. 2008
Pi+one: (651) 5676 Pages: 7
Re: MPCA ComplianCe Data CC:
0 Urgent 0 For Revlsw ? Pleasp Commen,t ? PJease Reply 0 Ptease Racycle
•Comments:
Hi Mike,
This is Ltie MPGA Gompllance form for Scoit & Nancy Yager at 1660 Riverton
Point Eagan , Mn. 55122. The system is a Passina or Compliant system.
Please call if you have any questions. Thanks!
;/11/2008 23:38 9527586278 ADVANCED ONSITE INC PAGE 02
313 Lyndale Ave
New PraguP, MiV 56071
Phone(952)469-2356
Fax (952) 758-6278
Memo
To: GMAC Real Estate Atkn: Kevin Me11/Scott & Nancy Yager
From: Tam Klanchnik
Date: rri 1-08
Re: Septic Comp. Insp; 1660 Fiverton Point Eayan, MN. 55122
Hi,
Please find the enclosed M.P.C.A. compliance inspection information. The
septic system cOmplianoe inspection for the above mentioned location was complated
on June 11, 2008. No discharge issues were found.
Probing verified the tank as precast with a solld bottom.
The existing drain freld was fleld located. ProbinQ nf the drain field verfied the
bottom of the drain field to be at an estimated depth of 24 inChes below the surface
grade. Soil borings were completed in the drain field area. The borings reveaied a lack
ot ihe Condition noted as mott(ecf soils to 62 Inches below surface grade. Regulations
for your site require three feet of separation from the bottom af drain field to any
evidenc:e of rnvttled soils or bedrock. It Is evident that the separation does exist
Based upon my sitP evaluation of June 11, 2008 the septic system has been
Gassified as a passing or camplying system. Please note that no determinatian of
future hydraulic perFormance has been nor Can be made due to unknown conditions
during system construction, abuse of the system, inadequate maintenance, or future
water usage.
If you have any questions please cantact me at (952) 461-2356. Thanks!
0.V11/2008 23:36 9527586278
Nlinnesata ?oilution
Con2rnl Agenty
520 Lafayette Road Norrh
St_ Paut, MN 55755-4794.
ADVANCED ONSITE INC
PAGE 03
Compliance Inspection For-m
Existing Subsurface Sewage Treatmont Systems (SS7S)
Instruttions on paag 7
Parcel number:
System status. Compliant ? Noncomptianf
(based an all co pli nce requrremen}s)
5ummary Form
For LocBtTracking Purposes:
Property information ,/? / 1 +
Prnparty nwnor nart?B(s): ?GOV!_?,V..19!???'(??
Propertyaddress-?(?_b?--??_??--.l-D1?/ _.y?-Q/?i?? ir/?, ?SI?Z '-_ ?
PrOpGrty Ownr.PC Oddr08g (if diHe,iq. ? ? -
COUniY: n? /_O7jg PfoP2nY O
El?C wner phone: Permitting authority
natasystemconstructed: ,?,acc_ Rwrsuntqrlnspection:
SysCem Description r -
erief system descr,ption: SI+1,?it?7"4„ C
I--?,?-T
Locat pertnit number: Number ot YJedrooms: _liwe` Design flow rate: ?(?'Q _
Is the System: -
In Shoreiantl area?
>?Yes ? No
An U.5- Environmental Fnotectiuu ?
Agency (EPA) Class V lnjection Wellg 0 Yes No
In Wellhead ProtocUOn ArEa? F? Yes A?'fVo
System serving a Minnesota DepBrtment ?
of Heath (MDH) licensed faciUty9 ? Ye5 No
COmplianCe Stdtus (Based on state requirements - addihonaf locil requiremenLs may also apply.)
Based on the informatipn gathpred and rQported On attached forms, the compliartce status of this system is (check one);
XCertiF;r.aie u! Compllance -vaud until (3 ye3rs from datc ol repori):
? fVoEice of Noncompliance - For Noncompliant systems:
Tlie reason tor nDncompliarece is:
This noncpmpfiant system is classf£ed as (check one below)• ?
? Imminent threat to public health & safety El F2iling to protact ground water ? Not in compiiance with operoting permit
C2rt1f1CdttOfl (Completed form must be Submitted tn the local unit of govemment within 15 days.)
! hcrcby cc:rti{y ihet all ihe necea"ry irrlormarlon 17AS b2en gathelLd fo dP.trrmine !he compllance status of tbls Systeln. No
determination of fvture system perlormance has been nor can be made due to unknown eondifions during system construction,
pDSSibfe abuse o/the system. inadequate maFnfenence, or (u}urF water usage. Name
Certification number,
Business license name and numb _ _ ??/i?y ?'? ???f?G???•{ / 'f?j1.y
---?.?[aSfq??p or
Name of local unit
Signature:
Date:
Required Attachments 1nspEctar comp+ete. This Inspection Report is paqes long.
Gneck compli ee farms attached; t6Myd[aubc PerfOrritanc@ ?`j rank Integriry ,?Soii separetian ? operating aer*nrt Form (i?
2ppli ble) ,Systam drawingfAg-built drawing.? An assessment of any local requirement?c ihat are different frqm wAat is required on this
form Soil BOring Log& ? AbanConmen( fprrrl {if appropnate} d Other informatinn {li=ty ..
iUpgrede Reqvir¢mCnts (tlrr)?'r,d A41 nn Stet, g 7?t¢?5J qn Imminpn? ?ivo»f t0 ponuc n?ellh an0 xn%n(y pTFe:SJ must bc pp9leded, r6pllCed, o,
w-c diacvnpnurd wlH.in tpR months ol receipf o'rhfs neUCp etwlfhln.3 Sharter pC.nod!(requvcd 6v la?pl ardlnan<e Nffio 9yifom fp i?aMB ?? Aroksf dJwN
-aler, !he oypfonr muor Lr. vpqreded, n,obleJ. u. rts use dlsenrt-nyetl wdhin fhe 1lmC repu+retl Uy 7pca7 ordinance. lf vn 6xisflrrg system is nol /efling as deRnyy (n
Inw, and hes af l?ac; lwo feet ol design :a? soperenm?, lbc+rt Ne sysf(+m nee?no( be upgratlqd, repoirCtl, mF?ecetl. or Its uae discon6quey rwr..ilhstrntlir.p any
/oce) ordnan?s !he!!s meip smct 771,F prowsron ppas r,of oppfy fo sysicros rn shmnOnd arees. WeRheed fiiotec8on argas, orfhpvv u&eer m Cannecyian K.ryry rood
Deu.>ryp5, antlloNgrqg estaAlisryrryenfs es tlnFnetllnlaw
W(T-WWi5t54-31
411108
rnmpliancc ln6pecti0rt Fortrl for CxiSfirry SSTS
.
01?/11/2008 23:38 9527566276 ADVANCED ONSITE INC PAGE 04
Parrol niimber: $YStem StatuS: kComp11ani
? Noncompiiant
A (as determrned by if7is form)
Hydraulic performance and Other Complianoe
Compliance fssue #1 of 4
D8(2 Of ObS2rvet1011: RPacnn for observa4iqn; _2??
Thlg tOrm expires upon next inspection or in ihree years, whichEVer occurs frst:
Compliance questionslcriteria: {Required}
. CCh ,eck the approrrate box
Doca the eyatem diSGhaiye atlwitge t0 5110 ? Y85 ND
_ground surface?
Does the sYSiem diSCharge RPwaUa to dr2in i[] Vo.r, ? No
Ne ar surtacc waters?
_. .. . _... _ . -T, ` ?.
Ooes the system cause sewage backup I? Yc^, ? No
.i.. .n.,en?.... ..? .........-`---. .
Po oth2r situations exist that have the I[J Yes w No
pntPn4ial ip ,mmwdlately and adveraely
impact or threaicn pu6lic heaith or safery
_(electrical, unsafe covers,_etc. ?
-- -?- --
Any "yes ° answer lRtliCa[es that the SyStBm iS 2tl immiqgpt
ehreat io public healill and safety.
dces the system pose a threat to ground ? Q Yes ,V No
water forany eonditions deemed non-
_.,pfOtBrtive as Aatarmined bylha iriepcctor? ?
"Yes" indicates thai the sysfem is fa7fing to prolect
ground Water. !f `yes'; describe the condltion no(ed:
Verification Method": (Optional)
(Check the apprOprisfQ box)
Searched for surface outlet
?I Perforrned hydraufic test
? Searched for seeping in yard
? Checked for har.ki,p in home
? Gxcessive ponding in soit system/D•boxes
? Hnmoownyr testimony
[] F_xamined for surging in tank
[] "81ack soiP" abovy ?;uil dlsper5al System
? System requires "Emergancy" pumping
? Portormetl qye test
x other: _C/Aruc 0
--
' No standard protocof exiyts. rHis lisl is not exhaustive,
in sequentiaf order, nor does it indlcale whrch
combinaiione are nececsa ,ry fo rrrekm fMs detarm7n9tion.
Certification
Thisform is to be complnted and attached to the Summary Form of the Minnesota Polfution Controt Agency's (MPCA) Compliance
incportlen Korm for Exieting Subaurfcee Sewage 7realInenl 3ystem5. Gbservanons, interprc3t2tiOns, and conGlusiqns must be
completed by an inspector. Completed form must be submitted to the local unit of govemm6nt within 15 davs.
PrapoRy owncr nemC(s): <;[}qW e.
Property address
Pruperty owners ao0re5 (If dif`erent):
COIfRry: ?
-- - ? ?f?---
??
PhOnC:
I hereby ceriity that 7 personally,nade the observations, interpretsrions. and conclus;ons repnRed on ihis fomr and that they are
carreCt.
Name: ?lTJ?QS'?C _ ._i`?
l7 Cortification number:
RiisinPae license name and nu "
?
Nema of locnl vnit of O a or
. -
-
Sion2iure: .-•- -'L'"?_? __`.-. _.. Uace:
wq•wwisi34-37
41 r[ue
rnmpfionce lnspection Form for Lafstb,y 55T5
06I11/2008 23:38
.
f-'arrel number:
9527586278
Tank Integrity and Safety Compliance
ComplianCe Issue #2 of 4
ADVANCED ONSITE INC
_ System siatus: NCompiiant
!ac delermined bytnis formJ
PAGE 05
? Nonr,pmpliant
Date of observation: Reason for obecrvetion: 7his fOrm expirgc on {three years}:
GompUance questions/criteria: (Required)
_(Chack tfte_ap?ropriate box)
Doc? the 3ystem concistuf a aeepage piC, Ej Y6S ?Tlp
_ceapoo?f_drywelf,orleachin d?
DO 0ny sewage tank(.c) Feak 6¢iaw thoir yes ?VNo ?
designed operating de t?h7_ __ i
If yES, id2ntify whiCh sewape ?
tank IeaXS_
Any ' yes" answer indrea(es that [fle sysrem (s failing fo protect
ground wafer.
" Seepage pits rneetirtg 7080.2550 may be oompliant if afiowed
in nrdinance by IOCaI permitting euihoriLy_
5afety Check
Verification Method'•: (Ophonat)
(Check the eppropriate box)
4 Probed tank bottom
? 06served fow liquid tavol
[] EXdRTined COnStfUGYion fECOR15
F-I Examinrrf cmpty (pumped) tank
El Probgd oufsitle tank for "biack soil"
Q PressureAIOcuum check
Fr Other:
c??
" No slBndard protoc0/ exist, . This fict i5 rtot EXhauStive, in
5equenfia! DNer, nor does rf indf?ato whith co+n6inetians
are necessary ,o make this detertrrinatron.
i, are any maintenance hale wvers ciamaged, cracked, nr appeared lo Ge srructur2lly unsound?
? Yes' ,?(No
2. Wcre 2A maintenance hole ccrvers rxaplaced in a secured manner (e.g., all screws replaced)?
wYE3 ? No'
3_ Was secondary access restraint present (safety Aan, secand cover, or safety neitlng) - highty recommertcfeC. D Ye5 VNo
4. Was any ofher safa=yMeaith assue present?
? Yes^ ,'No
EXplain;
$yStCm 1S an immfpent (li/eaf f0 pubj(C h2alfH and sa{ety_ ^ Y ?
Certification
This form i5 to be compfeted and attaChed to thp Summary Form of the Minnesota PalWfion Control AgEncy's (MPCA)Compliance
Inspaction Form for Hxisting 5ubsurface Sewage 7reatment Systems. Obseraatinns, irramrefacions, and conoluaions must bw
compteteJ by an inspector, mamtamGr, or service provider. Completed form must be Submilted to the locai unit Of govemmentwithin
15 days_
aroperty owner name(s): --- f , .? ?
L
Propertv address: -- 66p _?ilL°?•?D,J_,?O r?? ---- -
Property owner'S addrESS (iftl(ffp.ent),
County: ///.?
-JL 4054-._ Pf1n1lP.'
I hereby cedify that 1 perspnalJy made the
correci observ2tions, ;nterprelaUons, and co?lusiong reporfed on this torm and lhat they are
.
Namc: s?n
- I ???-_ G9rtrflcatlon oumner•
71CZ.-
.?.i1CiIIP.CC [I[nn5@ l12t11B 3nd ItU ?? ^ ?J/? /f. OI'
?_
.. v
Name of local unit of gov ? t: _ • •
Signakuro! ? --- --. ?
oate:
w9-wrvi5ts9-31 ,?? p?? fpmptiance lnspection Form far ExiaLiriy S57'S
06/11/2008 23:38
Parco( numbor:
9527586278
ADVANCED ONSITE INC
PAGE 06
System sFatus: KCvmptfant ? Noncomplianf
(as defermined by this form}
Soil Separation Compliance mnd Other Compliance
Campliance issue #3 of 4
DOtE Of ObSeN2tiOf1: ?1 ? pe0E0n for ob:aErvation.
?-
Thrs irrformatron on thrs fprm does nof expire. '-'
CampEiance questlon5lCfiteYia: (Required)
,_(Check 1he ap??ropriare box) --?- .?
Fnr systems built pnor to Aprif 1, 1706, and not i
located in Shoretand or Weffhead Protection Area or not serving a tood, beverage or I
Indging estab(ishment- f
poes the syslem have at least a hxa-foot
vertical Separation dictance from periodscally
saturated soil or bedrock7 Yes
For non-perfOrmance systems built April 1, i
1995. or Ipter or for non-pr^,rf?Fmancc? Sy5t0m5
located in Shoreland or WeAhead Protection I
Arcas or sarving a food, beverage or lodging
catab?ishmcn[; I
Does the system have a three-foot verfical I
sr+nar2tion dictance from nFriod,caFly saturated I
soil or 6edrack?` _ Yes [] No `
For reduced separation disFence systems (i.e.. fI
"pertormance" sysiems undera3d 7080_0179 or i
Type N or V system under new 7080. 2350 or
7080.2400): I
DOes the sy5tem meet the tlesigned vekical ?
separation distance from periodicalfy Saturated I
_EOiI or bcdrock?•_ _ _ I_ED YEL-0 Np _
Any "no"answer fnditates tbai the syslem is faili»g to protect
ground water.
Certification
Verification Method`": (Optional)
(Check the appropnate box)
IK Conducted soil observation(s) (attach 6oring logs)
? Two previous verifications (attach boring ioqs)
? Other; ?rjy??j?g/???• Soif o6servation does not expire. Previous observatians
by two independertt parties are suificfent unless sitP
conainons nave been altered.
" May ba reduced by up £o 15 percent rf allowed !n loca/
ordinaroce.
No standard profoco! exisls This llst is not exheuStive,
in sequenfiat order, nor does it indicafe which
cont4in2tions are necessary to make this
OBfE(T1A8IlOfI.
This form is to be completed and attached to Ehe Summary Forrn of the Minnesota Pollutiort Control Agency's (MPCA) CampiianCe
(nsp9Ction FOfM fOY Exlstitlg Slibstilface Sewage Treaiment SySt9ms. ObGAn+ations, inWrpretationf•, and conrlusions mupt ptl
compleietl oy an mspector or designer. Gompletrd form must be submitted to the local unit of government within 15 days.
Property owner name(s): _gai7j
't.5??['?/
Prop
crtYaddress: -- -.?1?i?__/csl?!t??a.?A?
PropPrly nwnar'c -dreSF (jf diffcrent)
Gounty:
--
f'hone
1 hciedy certify iha! f persor+aAy rnade the observatrons. interpretations, and conclusfons reporfed on ihis form and th3t they are
cor??ct
Name: Cercification number:
BusinesS Iicense name and number- ?-
Name of loc2l unit of govc l
Signature: ? ~---• • -- ?`-
- '- -. - ' -- 02te' --•?-p-??:?? _ __
wq-wwists4•31
9/71[J8 COYnpliatt[c lrtspG[tion !'a nr /'ur Exlsting 55T5
06/11/2008 23:38 9527586278 ADVANCED ONSITE INC
Site 5ketch:
.. ... ?S?
?
?? I od
W-,
c dy r.*tc
PAGE 07
Pleue indiea:? the letatlaa ef: We1L we& uS?ek m s?s?em, d lfin= r oR'te' esnbYSh?e? . ?z.:.k; s? <o? r ut:.Y :c? i s. s e-.
'exer?eC uil zrea<mpw area, eunain df-Sim ptepory tinte, u•u?-?ay u+d ri•e1 leret (edu?u \?]T ?^r?a?ied ?d:?r1
i.xlude si:?s zyd fe,?gthand epprattmste dlataneef fron fiRednfe. _ pe: u such u tre-es :nd ou, idt -;s, P?ezee a:i?, :s-
buiita?wings,mspe_:ionn?oru.Cerefie??ti)efCompSs?:ai?d?:oeeeir)of?one?7?uunc? ir'al•?i?:'e
Saii•Bnrings (HR ;): Locace aach boring on she mag above, ind.icaca on che ;:she ^.` cnc coi;nn the soil
eexrure, suvccur&, cclor, deocFi of each di.fferant soil n,he. e.•idelic- qf aa'LLin ;. bedr!w'i.' 2nd scandirg -watar.
:?SO xndtcate if the m-tetzl is fi11.
BK? HR? ?R=
., I 7!2 sa?1
,
.
., 6fotc
?
Id YC ? d?t? 'ftd
. kw`4?
I?
r? Ii
4
aFre2b DEPTMCF\tQ'f7LL1rG. S6ASDNA.G HIG)i WA7EAON BWRdCKQ'+n-30"T ?LNES
• ?. ?„ ?i
I
?
_ lb12002 15:25
9524612336
From: Tom 4Clanchnik
Questions? Call 612 232-9737
Fax 952 758-6278
To: Mike Lence
Company: City of Eagen
Address: City Hall 3830 Pilot Knob Rd.
Eagen, Mn. 55122
Date: July 15, 2002
Time: 13:41 PM
GARY STABER
Advanced On-Site, Inc.
313 Lyndale Ave.
New Prague, Minn., 56071
(651) 681-4676
Pages: 5 (including this one)
PAGE 02
Message: Hi Mike, this is the M.P.C.A Compliance Inspection Form for Peggy Tuttle at
•. ue bl,?rP?? The inspection revealed a passing o?in-comatia" ni?
Vn? ? system. Please call if you have any questions.
Thanks!
!P?^902 15:25 9524612336 GAP,Y STASER PAGE 03
25275 Vergus Ave.
New Prague, MN. 56071
Phone(612) 232-9737
Fax (952) 758-6278
I? Advanced On-Site
I
Memo
Ta Peggy Tuttle
prom: Tom Klanchnik
Dae: iiiDruc
Re: Septic Compliance Inspection: 1660 Riverton Point Eagen, Mn. 55122
Hi Peggy,
7he septic system compliance inspection for the above mentioned loca6on was
campleted on July 15, 2402. A copy of the inspection document is enclosed for your
use. The resuits of the inspection reveafed a status of passing or in-compliance.
Please understand this evaluation is not a guarantee of future performance for this
septic system. This evaluation only documents that the septic system is in
compliance with today's inspection standards at the time of the mspection.
ff you have any ques6ons please feel free to contact me at 952-481 -2356.
_?lb;'2002 15:25 9524612336 GARY STASER PAGE 04
1/29102 Water/Waste+rater-I5T54.31
Compliance Inspectiort Form for Existing
? Individual Sewage Treatment Systems Minnesota Pdlution
Cantrol Agency
-,p/eGOn of fhis (orm fulfHs Ihe minimal requiremenfs of Minn Stat. § 715_55 (2009) and Minnesofa R. Cb- 7080 (1999)_ Please
_ _ _ . .. _ _ __- _ .,,.....r.. s . weHmmm nr7r4if'vn.c
General;
bate of InspeCtion: _7-15-02_ Reason for inspection:_Property Transfer
Pro?nrty Owner(s)__peggy Tutt7e 7elephnne {952)_472-1240
Persan requesling inspection _
Telephone (
Site Address ,1660 Rfverton Point (5tY _Eagen Zip Code _55122
fire No./ Parcel No. CowN.y _Dakota Township _Gty of Eagen
Legal Description see address
Local itegu{atory Authority _Cty Of
OaYe system constructed _1986 Sysbem in Shoreland Area:? no Syrstem in WeUhead
Protection Area: yes (fp System serving a MDH licensed fadiity: yes Cp Local Permit #(f any}
--
= ystems built prior to Apri1 1, 1996 and not located in
°. ?ore#and ar Wellhead Proteciion Area or Serving e Fvod,
Beverage or Lodging Establishment
a (a yes answer is an 1TPHSsystem)
p.s.; rge of sewage to the ground surface?
.:tihar af sewage to draintile or sUrface waters?
??, wage 6 kup inW dwelling?
":ation wi the poroential to immediately and
r?dversely imp or threaten public heafth
?apety?
less than 7W0 feet of t
,ystem bottom and saY
a !;eepage pit, cesspool,
? - ? = tne system
?
i av:eiafing peml
1 ifyes,
Nz3s the reqw(l
H; »o, the ste
1 he p(onitorin
/,
y-tmns located in SFwreland w' Weilhead ProtectiOn
Areas or Serving a Food, Beverage or Lodging
EStablishmert, ar sySEems Built afCer
? jg }?n cvc*am an imminerrt thf29t 60 publiC tlB?1
or ?(a y?s answer is an 1'7'PHS syst?rnJ
- Distfiarge oF sewage to the ground surface? 1`ES ?
O - Dischar9e of sewa9e to draintile or wrface waters? YES ?
YES NO - Sewage backup into dwelling? YES ?
- Situatian with the potendal to immedlately and
adversely impatt or threaten pubic health or
YES NO Safety? YES ?
yes an.syver is a failingsysYevn)
wfation between
Or bedrock7 YES NO
, leaching pit? YES NO
ifed under a moh
no, go to page 2)
I monitoring taken place?
is non-complyingJ
i indicate that the system meets
expectations?
no, thB System is non-cOmptying)
YES NO lf yes,
Has the required monitoring taken place? YES No
ti (N rta, the system rs non-comply'mg)
Page 1 of 2
Is tfie svstem fa"1? ina? (a yes answOrLs a faflirlg
sy51m)
- Less than 7F#REE feet of vertiCal separation behNeen
system bot6om and satu2ted soil or tedrock? YES
- qsmpage pit, cessp001, drywell, or IOaGhing pit? Y6
plan or I Is tl?e svstem nnn-rnrop?iarrt?
YES NO - Is the system regulated urxler a monitoring plan
operating permit? (fino, go to page 2) YFS I
- The monitoring indicate that the system meets
pOffIX171elRCC 6xpEC[citiOflS? YES NO
wq-wwists4.31
1Ei2002 15:25 9524612336 GARY STASER
. n.
5ite Sketch: ?
Nv a.tl?
v
?
?a ?o-
? 00.
wei?
PAGE 06
N
Please indicatc the locatioo oi: Well, well setback fu rystcm, dwelling ot vthu csta6L5bmenr, tank(5). so1 vcatmrnt rysicm,
reservcd soi] teatment ama, curtain dtain, property linbs, waterways, and buried ]in.s (thosc NOF installed by tfie unliry).
Include si2es and Icngth and approzimatc distanccs from fixed refercxe poinu such a5 saee[s and buildings. Pltase aztach as-
bu:le drawings, mspection rcports, Ccraflcat(s) of Comp4ancc and No¢ce(5) of Noncompliantq if alvailable.
Sc3d Borings (BR #): Locate each boriag on the map above, indicate on the right of the column the soil
structure, colar, depth of each different soil type, evidence of moUling> bedroclc and standing water.
-".; .o indicate if the material is fill.
BR # / BR # Z
laYlf I-40 .SiwO ..,.I /° r.<I Z/z s.a.•D
/oY?t I Z//'/ S.w4 1 /av 1 ?I/y 59?0
,o re ? ??Y sa?o
BR *
RECORD DfiPTH OF MO'tTLING. SE4501VAL HIGH R'A?'b8 OR B6DI2OCKON A60VE LIN£S
eI ,I ,/ ..
-
?.?:Ymeuts: ES`f'i»RrLD pj/JfH e `/?R nes/ ?s ?tlA 20
111141) -/x] ledn"
-`-- ?S'?.ma'f6D Cre,..e T'oOL! i36'r
,.. •?a ? ? i , , .. . ., . . . . . _, ,
IVlemo
To: Greg & Leigh Mathison
From. Gary Staber
Date: October26,.-1998 - -
RE: Compliance lnspection; 9660 Riverton Point
Hi Greg & Leicfh,
The septic system compliance inspection for the above mentioned location was
completed an October 24, 1998. A copy of the inspection document is enclosed for
your use. The results of the inspection revealed wpassing or in compliance status.
Please understand this evaluation is not a guarantee of future pertormance for fhis
septic system The evaluation only documents that the septic system is in compliance
with today's inspection standards at the time of the inspection.
If you have Gny questions please feel free to contact me at 461-2356.
'i c?cvr?orve 461 -2356
25275 VERGU>Avt F„y 461_2336
NEw Prm.cue, MN 56071 pM,eR 560-7336
Gary Staber
Pento?.cnor+ 1esTwc,. Comvuu+cE wscEC'riorvs, Secnc SvseM DEVCN
5,w BoHiHGs, SFUnc SvsreM Tnoue1E-Sr+oc»?v+c
L iLENSER INS"ftFIJ PtiU BCNDEf)
Cim'iFU o gv NlwrvESUra PnLi unon CoH7HOL AceNw ? 400
. . , ,. - .._. _ . . . . .. ..
- , .w»" , " . _ ' `
. _ " . k.... .. :1.
Existing Septic Systems guggested (2l98)
Recommend¢d Inspection Form :?` 1Vlinneso'ta Pollution Control Agency
;.+ Laca( s(andards may 6e more or fess reslriciive than this jorm. These dfferences mast be made available by the Loca! Unrt qJ'G'iovernment'
bAT)E,OIFINSPEMON: 1o-z.4-`? ??q?
Property Owner(s_,e.? + Lu ,,?1? /1,??.-t L? = oN Telephone ( Person requesting inspe? (if different than owner) Telephone ( )! ?Z?
??},?teasan;,for inspection: ?2.. c
V%i,te Address I? 1,, 0 2?:' City L::.A-.n.?a s:
ky, !ip Code z'z. Unit of Government Regulnting this property L?-, F -Z,_,
, ?Fire No. Township Name
'.'Township Range Scction Quarur
SYSTEM ,
DATE OF ISTS CONSTRTJCTION / ?i 3'1 ;.Location of TSTS
Well Setback from tank'' l? fi{ Shoreland ~`?^
Well Setback fram soil hmatmen: system ,-.4 \,C?' ft _ Wellhead Protection A*ea
Serving a Food, Beverage or Lodging Establishment
(Chnck apprnpriate sewer system component and indicate location on site sketch on bacA of form).
Tan : Sail 'rreatment System: pther (hriel7y describe): Wiiter Meter
tSeptic tank -? Rock tmnch _ Altemative system
_ Aerobic [ank _ Gravelless pipe trench Experimental system Y05 ??
Pump tank Chamber trench _ War:uitied syscem If yes, Flow Measurement
Holding tank Seepage bed Exp. Date:
Other Mound Other
_ At-grade
System kiuilt 1'rior to April 1, 1996 und not Located in
Shoreland or Wellhead Protection Area or Serving a Pood,
Beverage or Lodging Establishment
m 5horelanQ or
Area or Serving a Food, Beverage or Lodging
Nighment and all systems Built after April l, 1;
1s the sys(gm an imminent nublic health threat (iP[iT)? . U rad
1. Discharge of sewage w ihe ground surface7 YBS ? 10 mo
; 2. Dischazge of sewage to draintile or surface waters? YES O 10 mo
3. Cesspool? YGS 10 mo
4. Sewage backup into dwelling? YES 0 IO mo
i. Situation with the potential [o immediately and
, adversety impact or threaten public heullh or safety? YGS p 10 mo
. (s the svs[em failing?
6. Less than TWO fee[ oF venical separation 6etwezn
' system bottom and saturated soil or bedrock?
` YES O I.UG'
7. A seepage pit, drywell, or taaching pit? YESO LUG•
' LUG = Locpl Unit of Covemment must specify an upgrade period
1. Discharge of sewa o the ground surface? $ NO 10 ma
to tile or surface w
2. Discharge of sew s? YES NO !0 mo
3. Cesspool? YES NO 10 mo
4. Sewage backup g? YES NO 10 mo
;
5. SiNation wi[h Ihact or lh ten
public health or YES NO 10 mo
Is the s stem fa'
6. Less than ' EE feet of venical separation 6etween
sysce ttom and saWrated soil or bedrock? YES N UGr-
7. A seepage pit, drywefl, or leaching pit? Y6S NO LUG•
, Based on the compliance criteria above the system status is r!`? therefore, .
(Choose: in ompliance OR failing OR imminent threat) ; •
i-yhisdocument is a k'
, f . (Choose: Czrtificate of Compliance OR Notice of Noncom il ance 1 . .. ' ' - : . .
1 herehy certify tltat all the information I have provided regarding !he individoal sewage treatment system is aceurate.,
Properry Owner ' Dace
' 1 hereby certify as a stale of Minnesota licensed Inspector, or Qualified Employee that my observations rewrded are accurale as of this dace for the Site sr `. ,
'above.I hereby cenify that all inspection work was completed according m applicable requiremen[s. No determination of fumre hydraulie performance
?=''?'bo made due to unknown conditions during system construction, future water usage over the life of the system, abuse of the system, and/or inadequam
?,lir?'; :. , . :
??;j f mamtenance all of which will edversely aFfect the life of the syscem.
I „
?i?':., ?
,.i?pacar's name(print) K ? ?oE.S ?p,RY?AB$ I?) ?'?,j ?',Tiicense anNor Registrati n Number o Address
???ed ??/?NV?
??,`;':,?falid Until; (pr tmti Tf2D , which ve comes first) .?°-? ?? - ? (? Signam`ro '' _ _-? - • -' J615ate e
, ' . ? .?... ?... ?.... : ?. ?: ' .?.:...
o a tozo• . - - , , . Wellloo
_ 0
SuggesteA items for site sketch: Well, well setback to systzm, dwelling or oihtr estnblishment, tank(s), soil treatment system,
resarved soil tmutment :vea, curtain drain, property lines, waterways, mid buried linzs (ihose NOT installed by the utiliry).
Include sizes and length and appmximate dist;unces fmm Hxed reference points such as streets and buiidings. Please attach
previous as-built drawings, inspection reports, Czrtificate(s) of Compliance and Notice(s) of Noncompliance.
Soil I3urings (S13 N): Locate each boring on the map above, indicate on the right of the columns
low the textiue, structure, color, depth of each different soil type, evidence of mottling, bedrock and
.,ianding water. Also indicate if the material is lill.
a-
SB # SB # SB # L
S ?.. ?
24
! o ? i z?l ?1
3
/ 2?1'
? o
L1v'
; ti"
' .°-v? -az'1'Z
C ?
?? ??
r • „
i ' Comments: 'c-??-?'i'.?-,?rl'?.:._
YI . -
p:\Is1s\prog_devlezinp.dac-12/30/97
? ' ._._.?_,-... .
? __ _-__ _... ..___...,....... . .
c?e&d
?----------------;
i
r
j Permit u: ?j G'•`J? i
? Permit Fee: ?q-/'
? Date Fleceived: j
I ?
I StaH: ?
rax: tw i) oto-ao7y I I
2008 RESIDENTIAL BUILDING PERMIT APPLICATION ?k?l ';)5?
Date: ' D ? SiteAddress: %f?k COPT
Tenant: Suite#:
RESIDENT / OWNER Name: IyiiG? x? Phone:
Address / City / Zip: /? a ?Gt°i.?m ?i.a t?
Applicant is: _ Owner _ Contractor
TYPE OF WORK Description of work: ZF
?
Cons[ruc[ion Cost: ??:3Dd. Multi-Family Building: (Yes_
CONTRACTOR Name: License#: .Zl??,=iS?CrU
Address:
City: State: Zip:
Phone:
_? 5 6U` di?5? Contact Person: L?i - <cd? ?
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Cateaorv 1 Minnesota Rules 7672
Energy Code . Residen[ial Ventilation Category 1 Worksheet • New Energy Code Worksheet
CBtEgOry Submitted Submitted
(4 5u6mission 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 Plum6er: Phone:
Mechanical Contrector: Phone:
Sewer & Water Contractor: Phone:
NOTE='Plans and'supporting iio`cuments that you su6mit,are aons'idereil to be,pubJic`informatwn =. PorEions bil
thg rniormation m`ay
be c/ass6red as:non publicIt yoa prowde speafrc ieasons that rvould permrt the CIty fo
,
conclude?that:the aie lrade secrets
I hereby acknowledge that this iniormation is complete and accurate; that the work will be in con
Eagan; that I undersiand this is not a permit, but only an application for a permit, and work is
accordance with the approved plan in the case of work which requires a review and approval of pli
X C? f'//7J z?/1'ri'lL- X_. ?-
ApplicanYs Printeme ' s
iinances and codes of the Ciry of
a permit; that the work will be in
Page 1 of 3
DO NOT WRITE BELOW THIS LINE
SUB TYPES
? Foundation
O_ Single Famfly
? 01 of _ Plex
? 02-Plex
? 03-Plex
? 04-Plex
WORK TYPES
? New
? Addition
`3ZL Alteration
? Replacement
? OS•plex ? 16-plex ? Accessory Building ? Pool
? 06-plex ? Fireplace ? Porch (3-season) ? Ext. Alt. - Multi
? 07-plex ? Garage ? Porch (4season) ? Ext. Alt. - SF
? OS-plex ? Deck ? Porch (screen/gazebo/pergola) ? Multl Misc.
? 10-plex ? Lower Level ? Stortn Damage
? 12-plex ? Miscellaneous
/?20N Gt3 naaCiA !?`?1/LGY,Z tiI
? Interior Improvement ? Siding ? Demolish Building'
? Move Buildi ng ? Reroof ? Demolish Interior
? Fire Repair ? Windows ? Demolish Foundation
? Egress Window ? WaterDamage
' DemolRion (eMire 6uilding) - give PCA handout to applicant
Valuatlon ?Mp?
Plan Review
(25%_ 100 % ?
Census Code
#of Units
ii of Buildings
7ype of Const
wt
Occupancy 4 MCES System
Code Edition 1117d, SAC Units
Zoning City Water
Stories Booster Pump
Square Feet PRV
Length Fire Sprinklers
Width
REQUIRED INSPECTIONS
Footings (new bldg)
Footings(deck)
Footings (addition)
Foundation
Drain Tile
Roof: _ICe & Water _Final
? Framing
Fireplace:_R.I. _Air Test _Final
Sheetrock
Final/C.O.
? FinallNO C.O.
HVAC
?Y Other:
Pool: _Footings _Air/Gas Tests _Final
Siding: _Stucco Lath _Stone Lath _Brick
Windows
? Insulation _ Retaining Wall
Reviewed By: in- i , Building Inspector
RESIDENTIAL FEES:
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connectlon Charge
S&W Permit & Surcharge
Treatment Plant
Copies
Total
????
???? m
4' ,q
?(?/Urf lGoom-
/? 0L9D
v??
Page 2 of 3
Jul 08 08 10:44a 763-213-0699
Minnesota Pollution
Control Agency
520 Lafayette Road North
St. Paul, MN 55155-4194
Parcel number: / 660
System status: IA Compliant 0 Noncompliant
(based on all compliance requirements)
Summary Form
Property Information
Property owner name(s): 77Z,-
/6,6o r �
Property o ner' address (if different): O
County: Property owner phone: 9' —0S7 6d 4-i'
Date system constructed:
System Description
Brief system description:
Local permit number:
Is the system:
In Shoreland area?
An U.S. Environmental Protection
Agency (EPA) Class V Injection Well? ❑ Yes 54 No
763-213+0695 p.2
C3mptiance Inspection Form
Existing Subsurface Sewage Treatment Systems (SSTS)
# i /003 -Instructions on page 7
844..azia, 9"er-
t; '
For Local Tracking Purposes:
Property address:
g7
itting authority:et 446'
Reason for inspection: V (J
MI Yes
Number of bedrooms:Design flow rate: �jOF7
0 No
in Wellhead Protection Area?
System serving a Minnesota Department
of Heath (MDH) licensed facility?
I:SkNo
No
Compliance Status (Based on state requirements — additional local requirements may also apply.)
Based on the information gathered and reported on attached forms, the compliance status of this system is (check one):
iX Certificate of Compliance - valid until (3 years from date of report): 7_6-r/
❑ Notice of Noncompliance - For Noncompliant systems:
The reason for noncompliance is:
This noncompliant system is classified as (check one below):
0 Imminent threat to public health & safety 0 Failing to protect ground water ❑ Not in compliance with operating permit
Certification (Completed form must be submitted to the local unit of government within 15 days.)
1 hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No
determination of future system performance has been nor can be made due to unknown conditions during system construction,
possible abuse of the .system, inadequate maintenance, or future water usage.
Name: I/ , 1i[_ /. ,�' Certification number/0 D 41 it
Business Iicen : name and number:
Name of local unit of government:
or
Signature: AP a #1 i_ / 4.,i...5
/
Required Attachments Inspector Complete: This Inspection Report is _- pages long.
Check compliance forms attached: KHyd.raulic Performance jzILTank Integrity [Soil Separation ❑ Operating Permit Form (if
applicable) 0 System drawing/As-built drawing ' ❑ Ar. assessment of any local requirements that are different from what is required on this
form {[Soil Boring Logs 0 Abandonment form (if appropriate) 0 Other information (list):
Upgrade Requirements (derived from Minn. Stat. § 115.55) An imminent threat to public health and safety (iTPHS) must be upgraded, replaced, or
its use discontinued within ten months of receipt of this notice or within a shorter period if required by local ordinance. 1f the system is failing to protect ground
water, the system must be upgraded, replaced, or ifs use discontinued within the lime required by local ordinance. ll an existing system is not failing as defined in
law, and has at least two feel of design soil separation, then the system need not be upgraded, repaired, replaced. or its use discontinued. notwithstanding any
local ordinance that is more strict. This provision does not apply to systems in shoreland areas, Wellhead Protection Areas, or those used in connection with food,
beverage, and lodging establishments as defined in law.
Date: 7-6 - 0
wq-wwists4-31
4/1108
Compliance Inspection Form for Existing SSTS
Jul 08 08 10:44a 763-213-0699
Parcel number:
)6‘
763-213+0695 p.3
System status: la Compliant ❑ Noncompliant
(as determined by this form)
Hydraulic Performance and Other Compliance
Compliance Issue #1 of 4
7-b-0$
Date of observation:
Reason for observation:
This form expires upon next inspection or in three years, whichever occurs first
Compliance questions/criteria: (Required)
(Check the appropriate box)
Does the system discharge sewage to the
ground surface?
Does the system discharge sewage to drain
tile or surface waters?
Does the system cause sewage backup
into dwelling or establishment?
Do other situations exist that have the
potential to immediately and adversely
impact or threaten public health or safety
(electrical, unsafe covers, etc.)?
❑ Yes
❑ Yes
❑ Yes
❑ Yes
No
j$j No
NI No
IV No
Any "yes" answer indicates that the system is an imminent
threat to public health and safety.
Does the system pose a threat to ground
water for any conditions deemed non -
prolective as determined by the inspector?
"Yes" indicates that the system is failing to protect
ground water. If "yes", describe the condition noted:
❑Yes 14No
.52
Verification Method*: (Optional)
(Check the appropriate box)
Searched for surface outlet
❑ Performed hydraulic test
154 Searched for seeping in yard
fa Checked for backup in home
�$) Excessive ponding in soir systemiD-boxes
0 Homeowner testimony
❑ Examined for surging in tank
❑ "Black soil" above soil dispersal system
❑ System requires "emergency" pumping
❑ Performed dye test
04. Other:
No standard protocol exists. This list is not exhaustive,
in sequential order, nor does it indicate which
combinations are necessary to make this determination.
Certification
This form is to be completed and attached to the Summary Form of the Minnesota Pollution Control Agency's (MPGA) Compliance
Inspection Form for Existing Subsurface Sewage Treatment Systems. Observations, interpretations„and conclusions must be
completed by an inspector. Completed form must be submitted to the local unit of government within 15 days.
Properly owner name(s): A. .
Property address:
4.
/660
Property owner's address (if different): o� f
County: P„oa�z Phone: %�d-�' -g 7 ”'
1 hereby certify that 1 personally made the observations, interpretations, and conclusions reported on thfs form and that they are
correct.
Name: Y/lxl
Business ense name and number.
Name of local unit of government:
Signature:
Certification number:
wq-wwists4-3 1
411/08
Date: 2-4 —45 $
or
Compliance inspection Form for Existing SSTS
Jul 08 08 10:44a 763-213-0699
Parcel number:
/666 Y
763-213+0695
System status: ( Compliant 0 Noncompliant
(as determined by this form)
Tank Integrity and Safety Compliances_0./ /003 L.
Compliance Issue #2 of 4 `��
Date of observation:
This form expires on (three years):
Reason for observation:
csoiLLI
p.4
Compliance questions/criteria: (Required)
(Check the appropriate box)
Does the system consist of a seepage pit*, 0 Yes 94 No
cesspool, drywell, or leaching pit?
Do any sewage lank(s) leak below their 0 Yes IAN°
designed operating depth?
If yes, identify which sewage
tank leaks.
Any "yes" answer indicates that the system is failing to protect
ground water.
" Seepage pits meeting 7080.2550 may be compliant if allowed
in ordinance by local permitting authority.
Verification Method**: (Optional)
(Check the appropriate box)
igt Probed tank bottom
k Observed low liquid level
( Examined construction records
❑ Examined empty (pumped) tank
❑ Probed outside lank for "black soil"
❑ Pressure/vacuum check
❑ Other:
*" No standard protocol exists. This list is not exhaustive, in
sequential order, nor does it indicate which combinations
are necessary to make this determination.
Safety Check
1. Are any maintenance hole covers damaged, cracked, or appeared to be structurally unsound?
2. Were all maintenance hole covers replaced in a secured manner (e.g., all screws replaced)?
3. Was secondary access restraint present (safety pan, second cover, or safety netting) - highly recommended.
4. Was any other safety/health issue present?
Explain:
*System is an imminent threat to public health and safety.
❑ Yes* Cif No
Yes ❑No`
0 Yes ad No
❑ Yes` [4 No
Certification
This form is to be completed and attached to the Summary Form of the Minnesota Pollution Control Agency's (MPGA) Compliance
Inspection Form for Existing Subsurface Sewage Treatment Systems. Observations, interpretations, and conclusions must be
completed by an inspector, maintainer, or service provider. Completed form must be submitted to the local unit of government within
15 days.
Property owner name(s):
Property address: / 6 6 O
Property owner's address (if different):
County Phone: �- — 3'57 O
T1'
I hereby certify that 1 personally made the observations, interpretations, and conclusions reported on this form and that they are
correct.
Name:
Business licerfse name and number:
Name of local unit of government:
Signature:
Certification number: ) O / 7
c . 3 73
wq-wwists4-31
4/1/08
or
Compt ionce Inspection Form for Existing SSTS
Jul 08 08 10:44a 763-213-0699
Parcel number:
/ 660
763-213+0695 p.5
System status: iRt Compliant 0 Noncompliant
(as determined by this form)
# I K2 03.
Soil Separation Compliance and Other Compliance
Compliance Issue #3 of 4
-7-c -O3
Date of observation:
This information on this form does not expire.
Reason for observation:
Compliance questions/criteria: (Required)
(Check the appropriate box)
For systems built prior to April 1, 1996, and not
located in Shoreland or Wellhead Protection
Area or not serving a food, beverage or
lodging establishment:
Does the system have at least a two -fool
vertical separation distance from periodically
saturated soil or bedrock?
For non-performance systems built April 1,
1996, or later or for non-performance systems
located in Shoreland or Wellhead Protection
Areas or serving a food, beverage or lodging
establishment:
Does the system have a three-foot vertical
separation distance from periodically saturated
soil or bedrock?*
Yes ❑ N
For reduced separation distance systems (i.e.,
"performance" systems under old 7080.0179 or
Type IV or V system under new 7080. 2350 or
7080.2400):
Does the system meet the designed vertical
separation distance from periodically saturated
soil or bedrock?*
Yes ❑ No
Any "no" answer indicates that the system is fa ling to protect
ground water.
Verification Method": (Optional)
(Check the appropriate box)
(gf Conducted soil observation(s) (attach boring Togs)
0 Two previous verifications (attach boring logs)
FA Other:
Soil observation does not expire. Previous observations
by two independent parties are sufficient, unless site
conditions have been altered.
" May be reduced by up to 15 percent if allowed in local
ordinance.
No standard protocol exists. This list is not exhaustive,
in sequential order, nor does it indicate which
combinations are necessary to make this
determination.
Certification
This form is to be completed and attached to the Summary Form of the Minnesota Pollution Control Agency's (MPCA) Compliance
Inspection Form for Existing Subsurface Sewage Treatment Systems. Observations, interpretations, and conclusions must be
completed by an inspector or designer. Completed form must be submitted to the local unit of government within 15 days.
Property owner name(s):
Property address:
/4,40
Property owner's ddres ,�(if different): "
County:Phone:
1 hereby certify that / personally made the observations, interpretations, and conclusions reported on this form and that they are
correct.
Name:
Business liceyfse name and number: - 7y,
Name of local unit of government:
Signature: _
wq-wwists4-31
4/1/08
Certification number: %C7 V 7
6ILM.�' 3 ?3 or
Date: 7- --0_5
Compliance Inspection Form for Existing SSTS
Jul 08 08 10:44a 63-213-0699
Site Sketch:
763-213+0695 p.6
K7o33-
i
•
•
•
•
100'
20'
WeU
0
100'
Suggested items for site sketch: Well, well setback to system, dwelling or other establishment, tank(s), soil treatment system,
reserved soil treatrnent area, curtain drain, property lines, waterways, and buried lines (those NOT installed by the utility).
Include sizes and length and approximate distances from fixed reference points such as streets and buildings. tPlease attach
previous as -built drawings, inspection repors, Certificate(s) of Compliance and Notice(s) of Noncompliance.
Soil Borings (SB #): Locate each boring on the map above, indicate on the right of the columns
-low the texture, structure, color, depth of eachdifferent soil type, evidence of mottling, bedrock and
snding water. Also indicate if the material is fill.
SB# SB#
SB
p:lists\prog_devlexinp_doc - 12/30/97
s,
6
a'
/, ;
-/
31
` 1- , ,/
/
/Y
'J,36
p:lists\prog_devlexinp_doc - 12/30/97
C!ty of Evan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5685
Email: planningAcityofeagan.com
RECEIVED Noy 0
4411
For Office Use
Permit #: /d 3 )i'
Date Received:
2011 ZONING PERMIT APPLICATION
V Please submit a set of scaled drawings with the application.
Site Address: i& 67 0 R) V [ f `) r 71 s as
Name:
Address:
3-64A) SON( Phone:
22140 85f4da2c(Ur
City/State/Zip:
(o/23( /aD6J
Applicant Signature:
❑ Retaining Wall <4 feet 0 Driveway
❑ Patio Sport Court
❑ Sidewalk 0 Fence
Date:
0 Other:
Description of work: S OS X St 13 SSL. C 6,A to o o J t r
A[ S.S5?J
J
PLAN NI
Approved:
etbacks,hard surface coverage; shoreland zoning, b uffzone/setbacks, eta .
Date of Approval: 00,9/49
Staff: LCi,. ) d r t
Notes: E\ro - orti
Co vL-o-o \ -€) toy V-, r� U-ee.g d/1-1/1- _ � �' i�C�i Ov, L Ohl Ytn.us-i- be
prix tit ivt�ie�ltetQ Foot i pec. -e . ?vior +0 ditUrbica'1-kotr S6tts on cz,1'i-e
-,-me- -Pre sevor, Wo--) r ee velli — e6r t C gS 1-b eoSi-to?5 - 531G :A) r Io ,d&s&piin
S p1a ►n ira2 ; w tt.edt Hca t� si ve_ole_uo
Revised Plans
Approved: Yes / No Date of Approval: Staff:
ENGINEERING.
Gradtng, drainage, utility easements, wetlands, erosion control, improvements in the Right -of -Way, etc
Approved:
Notes:
Yes)/ No
Date of Approval: Z /;2,O /2_ Staff:
Revised Plans
Approved:
Yes / No Date of Approval:
Staff:
COMMENTS
1W�(�e✓J IauS Sots
- 5 i 1 s ct—$ \at . of
a 5 1. 1 S V'Yic+,-)f vn c 614 ok. t I o cs.s. cQ ori
G:\Building Inspections\PERMIT APPLICATIONS \2011\2011 Permit Applications
V014.1,09
N
'3'101 i?it
IVO
•Yl0`$SDI NM AO
31Y1��Sjjpp1J$HIAOS*YjJyyQNI )H1 tl3ONO
3,1
.e.467 94 7��,,''1'�N1'YONO1SIA83dfS•
1731(10 1}t 4130Nfl HO an AS O3HYd3Nd
SY/A NY1d SIN/ -LINA A4I.L AA 3M3H 1
SUOFI AUAS GN}U1 'Pup S
• - lU33Ntflt43 4?
M „80 , ,S 069 N
00'02/
•
•
1
. '3
•
• ,
•
�b3. .S11L/7/1.11
•
•
•
•
•
•..
•
L, Y .
, • . •
0)
n
0
0
0
r•
0
. 0
0)
0
O
t I'A? • Yom_ _
•
I•
0
(D
a
0
11
5•
O
0
F-'
01
r.
r•
0
h-•
(D
N
rt
W
r-
1
n
a
is
0
0)
r-
1—•
(D
0)
rt
(D
5
•
•
i s
•
•
VI
.
i
SNOISIA3a
smimpot!
AA
31,111OH
feat,: da 219
7s'✓Jli .?9etztre zfarn, 7
•1'.0/1/9
.
1
]
N
'3'101 i?it
IVO
•Yl0`$SDI NM AO
31Y1��Sjjpp1J$HIAOS*YjJyyQNI )H1 tl3ONO
3,1
.e.467 94 7��,,''1'�N1'YONO1SIA83dfS•
1731(10 1}t 4130Nfl HO an AS O3HYd3Nd
SY/A NY1d SIN/ -LINA A4I.L AA 3M3H 1
SUOFI AUAS GN}U1 'Pup S
• - lU33Ntflt43 4?
M „80 , ,S 069 N
00'02/
•
•
1
. '3
•
• ,
•
�b3. .S11L/7/1.11
•
•
•
•
•
•..
•
L, Y .
, • . •
0)
n
0
0
0
r•
0
. 0
0)
0
O
t I'A? • Yom_ _
•
I•
0
(D
a
0
11
5•
O
0
F-'
01
r.
r•
0
h-•
(D
N
rt
W
r-
1
n
a
is
0
0)
r-
1—•
(D
0)
rt
(D
5
•
•
i s
•
•
VI
r •
1ZLL
3
9999.49E1
a
sNO►s►A311
;
A9
3
ON
• _
: . trac ✓A»3
x ty'
o ztf5 2r3muri
(
•a/r/5\
•
A 14V
9311L6 G7•
'Y10'SBNNIN X10
31Yi33*41��iO $*V11 3N1 u30Nn
A9i1 074944 .1 01gN�aNOt51AK3tlfS •
1031110 A}I 1130Nfl *10 3rl A8 0311vdOUd
SWM NY1d SIN/ 1VNL Adt1N31 AA3N3N 1
00-02/
SH0143AUfS (Mtn P
• - 3U339TON
rIZaito
t
•
•
•
•
•
•
•
rn
1
•
110. e •
0
DJ
0 (D Di 0 0
72,
•
('l14 Geo,v4b
LIUETorJ /
•
•
d •
Ihkofvere
1.12. 154(0• 6 .6
Witibcopab Plus
.1*.c0eVV tom:
COA 6:ILA do.
/o/L/r
‘.c,0\15)
0s,2,10,
Lot = 44,428.34 sq. ft.
',House & Garage = 3,096.77 sq. ft.
1481.49 sq. ft.
526.25 sq. ft.
210.00 sq. ft.
1581.00 sq. ft
175.87 sq. ft.
962.89 sq. ft.
22.44 sq. ft.
-896 /-?f t--'•
Impervious Surface =' -
Fence = 226 Ft. /,. 9 .+4,
£95ittD'riveway =
tr,Addition =
3 .1, 4, arch =
import Court =
,Fire Pit =
pD runt oncrete =
quipment Pad =
Total =
1
•
• „
.
,(•.:••''.
"•;• •
}
•, , . • ' 7 .��
t• •
•
•
•,t ••;4.1.iy.
• 1 •• "
.. • •
�'
• ,•
,1'. • '
•
. • , •
i •
t V' a• L. •
'•.`., , (•
; • ,•' •
''M :`.. ,'i ',1, t, ,. t�•l+i.-1 .. .•
r• 'i t.. ; w 'i . •''i:....,...,... 4 ! u.. sr�ry y ti iii..m...-�,; -
r�'
t� •,' ,7, {I. '• 1.
L:>
41,11
C!tyofEa�all
Mike Maguire
Mayor
Paul Bakken
Cyndee Fields
Gary Hansen
Meg Tilley
Council Members
Thomas Hedges
City Administrator
Municipal Center
3830 Pilot Knob Road
Eagan, MN 551 22-1 81 0
651.675.5000 phone
651.675.5012 fax
651.454.8535 TDD
Maintenance Facility
3501 Coachman Point
Eagan, MN 55122
651.675.5300 phone
651.675.5360 fax
651.454.8535 TDD
www.cityofeagan.com
The Lone Oak Tree
The symbol of
strength and growth
in our community.
November 16, 2011
Warren Johnson
22140 Beaumont Way
Farmington MN 55024-9795
Re: Building/Zoning Permits for 1660 Riverton Point
Dear Warren,
/D3/
City staff has been working on reviewing both the building and zoning permits
that you have submitted for the subject property for a swimming pool, retaining
walls and sport court. As you're aware, this is a riparian lot and has topographical
concerns. City staff has used topographical data from Dakota County and
determined that the property has steep • slopes that exceed 12%. Because of this,
additional City Code standards apply to the site and any proposed alterations. The
building and zoning permits cannot be approved until verification that these
standards are being adhered to. A copy of this City Code section is attached for
your use.
Clearing of vegetation is not allowed on steep slopes. You had previously
informed me that no trees will be removed for these projects. Please stake out the
exact location of the proposed improvements. Once this has been done, please
contact me so that I can arrange a site visit for verification.
An erosion control plan will be necessary. The erosion control plan should be
drafted by you, the applicant, and adhere to performance standards such as
keeping erosion/sediment out of Blackhawk Lake and restoring ground cover on
disturbed soils within 24 hours of completion of grading activities next to a water
of the state (Blackhawk Lake). Methods to meet these standards are generally
listed in Section 4.32 of City Code (attached), and include perimeter control such
as silt fence and/or bioroll installation and seeding and mulching with fiber
blanket installation on steep slopes.
Please note that due to the time of year, weather conditions will not allow for
permanent vegetation cover for several months. Because of this, if the permits are
approved, construction cannot occur until spring 2012, when bare ground is
exposed for the shortest time possible and permanent vegetation cover can be
established as soon as weather conditions allow.
Regarding the sport court, it appears some type of retaining walls will be needed.
Please verify this as the plan does not identify such walls.
//e 3 p/ie
Lastly, an updated survey with spot elevations including the Ordinary High Water
Level (OHWL) and the location of the proposed improvements is needed to verify
slope conditions and that setbacks are met. The OWHL of Blackhawk Lake is
792.2 per the Department of Natural Resources.
In summary, the following items are needed to move forward with the project(s):
1. 12 standards — City Code is attached
2. Stake location of improvement — no clearing allowed
3. Erosion Control Plan — City Code is attached
4. Retaining walls for Sport Court — identify and show on site plan
5. Survey of property identifying spot elevations, OHWL and setbacks
I realize this is a lot of additional information, but as noted, this is a sensitive
parcel. If you have any questions feel free to call me directly at 651-675-5696.
Sincerely,
Sarah Thomas
Planner
Enclosures: City Code Section 11.65, Subd. 9. I. 2. (d)
City Code Section 4.32
CC: Daniel and Mary Garry, Property Owner
Eric Macbeth, Water Resource Coordinator
John Gorder, Assistant City Engineer
Dave Westermayer, Engineering Technician
Jeff Wheeler, Building Inspector
City of Evan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
-WED
211
Use BLUE or BLACK Ink
Permit #:
Permit Fee:
Date Recei
Staff:
1032,12�
112x'3,��
2009 RESIDENTIAL BUILDING�PERMIT APPLICATION
Date: l0^12' X44 Site Address: //060 Xtyer70A:r.
Tenant: D a.f\ f r 4 r( r'/
C9
Suite #:
RESIDENT / OWNER
r �n
Name: 'J 0x (1A, '..(o yr _ y^ Phone: c2/y' yd 6 (o 194
Address / City / Zip: 6160 gi Uf/�%h ?nit; /' Ea an SS 1 27-
Applicant
Z
Applicant is: Owner g. Contractor
TYPE OF WORK
Description of work: 8t4., Id `.,n5 -/l fob/
Construction Cost: ZS no Multi -Family Building: (Yes / No yC )
CONTRACTOR
Name: Va /'1 y P66 /S aA c) S S License #: /t///�
Address: pian. C I GS T (, Jj 1 Ilba. �l
city: 50 i�� State: Ih%nl Zip: 55-73
(�%'7
Phone: /52-a�7''" I 20 )C l yo Contact Person: %��cly 4.01 a 4e,+�
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: Vc,, /ekt 061$ c2# -Spa
Phone: y,10,1-effri-/ ®X/yo
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to bn public information. ° Porn
e information may be classified as, non-public if you provide speci€ic reasons that would permit the City
conclude that they are trade secs+
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 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.
izr,(IL Mc.rvv,,Ln
Applicant's Pi(inted Name
DO NOT WRITE BELOW THIS LINE
1o3z9v
SUB TYPES
Foundation
Single Family
Multi
01 of _ Plex
Accessory Building
Fireplace
Garage
Deck
Lower Level
Porch (3 -Season)
Porch (4 -Season)
Porch (Screen/Gazebo/Pergola)
Pool
WORK TYPES
New _ Interior Improvement
y- Addition_ Move Building
Alteration Fire Repair
Replace _ Repair
Retaining Wall
DESCRIPTION
Valuation
Plan Review
(25%_ 100%
Census Cod
# of Units
# of Buildings
Type of Construction
W
y 3�
REQUIRED INSPECTIONS
Footings (New Building)
Footings (Deck)
Occupancy
Code Edition
Zoning
Stories
Square Feet
Length
Width
Footings (Addition)
Foundation
Drain Tile
Roof: _Ice & Water _Final
Framing
Fireplace: _Rough In Air Test _Final
Insulation
Meter Size:
Reviewed By:
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
Siding
Reroof
Windows
Egress Window
Storm Damage
_ Exterior Alteration (Single Family)
Exterior Alteration (Multi)
Miscellaneous
Demolish Building*
Demolish Interior
Demolish Foundation
Water Damage
*Demolition of entire building - give PCA handout to applicant
J,c - yc
Ace?
R-1
MCES System
SAC Units
City Water
Booster Pump
PRV
Fire Sprinklers
Sheetrock
Final / C.O. Required
Final / No C.O. Required
HVAC
Other:
Pool: tit. Footings ,Air/Gas Tests y'Final
Siding: _Stucco Lath _Stone Lath _Brick
Windows
Retaining Wall: _ Footings Backfill _ Final
Radon Control
Erosion Control
, Building Inspector
Page 2 of 3
VI 0
a=
•
0)x
tm
•
LOU
m
0
•
IIA
N 4p )0 52" 5
55• AD
.RECEIVED
MAR 1.2 ?412
.Sy
t.
ZbaCPr •r25o 2Bj3g, .TC •c ..::9000
C.-P‘T*14E2.,cce. zq" $-N.TL Teftlz.: Atobbo
•
-/
e•
X
0
•
.
•
ti•
Lot = 44,428.34 sq. ft.
}louse & Garage =
(;40
' y f Driveway =
trAddition =
3 9;,. orch =
-Sport Court =
;.Fire Pit =
pc,c i ic[ oncrete =
vEquipment Pad =
Total =
ads
\5' Impervious Surface
Fence = 226 Ft.
r
x
0
3,096.77 sq. ft.
1481.49 sq. ft.
526.25 sq. ft.
210.00 sq. ft.
1581.00 sq. ft •
175.87 sq. ft. /,&O
962.89 sq. ft.
22.44 sq. ft.
�-SOo6' 7+st-t4t.
ill?
h;
•
Ci0e 161
•
EAGAN
REVI 1/Y ED
•
14-47-
•
•
t
•
•
• 1 h• .
•
, • i ,
•
•
«•t•
•4 ;
•
•+�
rT •
• • •
r
•1
z.••
1 1 I
V). ,.. �•..1../'•Y«. �,,, ,fir: ^•
•
•'e
•
•
• •
•
•.•G
•
1
•s•
�'. i•'.• P. r t4
• t
• Y"Sa
•
I ..
�.✓ -.;i• t.
a ; 1
r�• '
•
• :r. 1••
• •
•
a� T•.
,r
•
•
« t • •1 .,•. t, ��
(*"
City of Eaaafl
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
r
Use BLUE or BLACK Ink
For Office Use
Permit #: f
Permit Fee: '31 1,i 119
Date Received:/', 7/.. vl
Staff:
2011 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 10 261 tt Site Address: Me- O RNAC S � ® �
Unit #:
RESIDENT /
OWNER . �; ,
Name: bi 1V 6 ac2. Phone:
Address /City /Zip: 16 YC V R i i_- V o "� te 55
Applicant is: Owner 'Contractor
TYPE OF WORK
Description of work: UY� l W1y1� \/%41-/' [L.- ij 41-5 f 0 �i
Construction Cost: /2, 000 Multi -Family Building: (Yes / No)
CONTRACTOR
Company: L4/45C4PCS f L ✓S Contact: V " ecA J-64' Aso 0
Address: 2Z) -0 8f/1✓/f0iv1- viii City: lfili1E )� /nom
State: M Zip: 5 57)2 '1 Phone: (0/2 -366
3 6 Y+ - Co 0 (� .
License #: �_ Lead Certificate #: '�
If the project is exempt
from lead certification, please explain why: (see Page 3 for additional information)
In the last 12 months,
Yes ><oIf
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Eagan issued a permit for a similar plan based on a master plan?
yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
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.
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 uilding Code ust be completed within 180
days of permit issuance.
x Jou pIS a rJ
Applicant's Printed Name
0 IL, ✓e►-fA')
DO NOT WRITE BELOW THIS LINE
SUB TYPES
Foundation
Single Family
Multi
01 of _ Plex
Accessory Building
WORK TYPES
New
Addition
Alteration
Replace
Retaining Wall
DESCRIPTION
Valuation
Plan Review
(25% 100%
Census Code
# of Units
# of Buildings
Type of Construction
6
Fireplace
Garage
Deck
Lower Level
Porch (3 -Season)
Porch (4 -Season)
_ Porch (Screen/Gazebo/Pergola)
Pool
Interior Improvement
Move Building
Fire Repair
Repair
1131/
Occupancy
Code Edition
Zoning
Stories
Square Feet
Length
Width
REQUIRED INSPECTIONS
Footings (New Building)
Footings (Deck)
Footings (Addition)
Foundation
Drain Tile
Roof: Ice & Water Final
Framing
Fireplace: _Rough In Air Test _Final
Insulation
Sheathing
Sheetrock
Reviewed By:
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
Siding
Reroof
Windows
Egress Window
Storm Damage
Exterior Alteration (Single Family)
Exterior Alteration (Multi)
Miscellaneous
Demolish Building*
Demolish Interior
Demolish Foundation
Water Damage
*Demolition of entire building - give PCA handout to applicant
MCES System
SAC Units
City Water
Booster Pump
PRV
Fire Sprinklers
Meter Size:
Final / C.O. Required
Final / No C.O. Required
HVAC Gas Service Test Gas Line Air Test
Other:
Pool: _Footings _Air/Gas Tests _Final
Siding: _Stucco Lath Stone Lath _Brick
Windows
Retaining Wall: 41 ---Footings Backfill J- Final
Radon Control
Erosion Control
, Building Inspector
Page 2 of 3
City of Eagan
PERMIT
City of Eaan
Permit Type: Building
Permit Number: EA115717
Date Issued: 09/30/2013
Permit Category: ePermit
Site Address: 3660 Robin Lane
Lot: 11 Block: 2 Addition. Blackhawk Forest
PID: 10-14325-02-110
Use:
Description:
Sub Type: Reroof & Siding Construction Type:
Work Type: Replace
Description:
Census Code: 434 - Occupancy:
Zoning:
Square Feet: 0
Comments:
If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar.
Pictures are not acceptable in lieu of inspections.
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.
Fee Summary:
Valuation: 8,000.00
BL - Base Fee $8K
$162.25
Surcharge - Based on Valuation $8K $4.00
0801.4085
9001.2195
Total: $166.25
Contractor:
Corbin Exteriors Llc
1115 Southview Blvd
South St Paul MN 55075
(651) 760-3116
- Applicant -
Owner:
Anothy P Kubalak
3660 Robin Lane
Eagan MN 55122
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.
Applicant/Permitee: Signature
Issued By: Signature
4
.o
'o
//727,47,7-Vr
(.0
,7"
d ti~
` t.
><<
0
~
DRAi>~lAa~
E
~ r
- 2.3 Nw~ ~
791.3
1 NN1 ` SCAL I" = 30' E
i`
'f:`
, N ~ II",
~LE~A DE L SCR. PTI N I 0 ~ I[ . < ~ LoT 4 Lo
r, \ ,r ~ , B CK 1, ~~,ACI~{HAfNK LAKE_ AD~lT10rV
- DAKOTA CuuN7Y, Mt1~,tN~507r~, A91 TIOA1,
~
~ ~ r, ~ , r\ V.
\ yam,, ,
~r_ - /
_ - -
~ ~ }
4' ~ S.. ~
\ ~
~ ~,kA1~~/gn~ A ~ I
. ~ ~ ,~I ~~1, ~ ~ r ~ r i'r
'F` ~ 1` - ~
~~3a,~~ DENoT~., i~XIST'[~6 7'~,~ i~-• 3
/ ~ k4 ~e~' ~ (837.x) D~NO"~~~ F'ROPr~~:-~f~?"~ ~1.~~'~'i,"i~~
...4 ~g~9,~~ ~
wq.3,o~ r..t-'',"' 1(\JDfL~7E~5 (~!F'.~.~r~lf~t~..j OF SUR~~C~"~ 1::AVI ~ DRA I NAGS
iP ;g3?~~ n° ~S - 32' w
s ' 843~~~ = FINISNEp 6AP.~";~ FLDOR ELE!/QkTION n 6 ,4T/OA/
O r~ d ~ /
~$57,~'~ ~ lh ~ q,4,~~ ~
~ a (Q ~I, ~
S , S' ~ ~ ~ ~
~ -C , / ~ ~l ~ ~
~ / . _ ~ ~ > =g:~ 3 g ~
~ in ~ N' r ~ .off Zoo ~ ~ , s~S
~w. ~ ~.~i ~~33,5j ~ f
` ~ t ~ I ~ ~ ~I i ; Rq. ~ - ~ i , t ~ ' `o o ~
~ ~ ~ ~ ,
~f~k', t tl;'~ i' o ~ - - ~ "
o X843: a~ I ~
'0 m
s' Z s'
- - z.
~'i /20.00 hr~
N 8°3° 59 OQ'
'Y
. . ~~~~cL' 1%01)6 T Na 146. DI
I HEREBY CERTIFY THAT THIS PLAN WAS tHECKEO DESIGNED CONSULTING ENGINEERS, PREPAAEO BY ME OR UNDER MY DIRE T SHEET REV
PREPARED FOR: PIRNNERS and LRND SURIlE40R ~A~ S r SUPERVISION AN T~ T~J D REGISTERED .{I~ ..~C/KV~'~ UY DRAWN DATE 'OR: y' E:
NGI UNDER THE LAWS OF THE STATE .~y 2 " ` N RING A/' R~~++ J'
OF MIN TA. .SCALE IYi~~I'i'.1..~~~. ~ , IENNJAN
~ N~ iNC. - j,- CONSTR ~ •29 87 (ao N0. DATE BY JOB N0. p. UC~'L ; A REMA AKS ( 0 TE REG. NO 'RUCTION
1000 EAST 1461h STREET, BURNSVILLE, MINNESOTA 55337 PH 432-3000 REwsIONs ~ inc.
IN C. 1
VVV vrVi�V• ✓�f�y�\�����
� ForOlficeUse---------�
` �1, j Permit#: ���> " � �
� ���� �� L� �� I • �/� '%f�� 1
� Permrt Fee: t�`r
3830 Pilot Knob Road � �
Eagan MN 55122 � Date Received: �
Phone:(651)675-5675 I I
Fax:(651)675-5694 I Staff: I
I I
�����������������J
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: �1 �Z►� /�� Site Address: (��� ,J C�+u►� ��' Unit#:
�
x` � �� Name: � �� �"�?2�C"1 Phone: 21�! -"1,c92 - S�b 7 c'!
���� � n
�' �� ;. Address/City/Zip: ��o�i(� K.�J-e��U�''' P�t" �'aS a•�• $;S/ 22...
� ,,� �� Applicant is: Ovmer �,Contractor
t t
� �
' Descriptionofwork: �N) ��+.�S�i•�+b / ��trS � �•'d��� K�apat�S
������
� �
� �
_ _ �,,; � Construction Cost: Multi-Family Building: (Yes /No�
�
x ' � ,� /� /�
'� ` ; Company: t-�'�'��d�1 �IJ Ke.n�vd+�''+�'� Contact: �'�^'�-�•
�����, ; Address: ��� �3�} G't" c;�y: La Gsvl�-~
�
X State: ��Zip: SS4V�"�� Phone: � � �i��mail: .��� ��►..a,�c..h,�lp• �
,,; ` License#: ��. ��7�u1-- 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 Clty 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:
K��n�RF'i ' ��*w^�����W��rd����FF�f � +�1��R`9���� � �"�� g � ; �
�����f��fi[��,�����-����������� �� �.� s� � .� ��, ���a
2 S
:. .. y�, € ; J �. L-} , +.. k �� �� ���,� t �k � �;y�-�� f���� ������ti
,. . .:. .�, ,...., .., wr::. '.N, ,. n� n.i k,�'v.v... c. ..E<�. ... ,.. ., .r .- � ... ., � 2�@. . �C�r..
�€
k y
�S= �
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.qaaherstateonecall.ora
I hereby acknowledge that this information is complete and accurate;that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a bullding permit Issued in accordance wkh the Mlnnesota State BulMing Code must be completed wlthin 180
days of permit issuance.
X �-•_ ��u� '�3�_ x
Appl�canYs Printed Name Applicant's Signature
Page 1 of 3