4140 Raptor Rd04/21/2014 12:19 Les Jones Roofing, Inc.
440111°City atEap
3830 Pilot Knob Road
Eagan MN 55122
Phone: (661) 676-6876
Fax: (661) 676-5694
SAX)9528817009 P.010/011
Use BLUE or BLACK Ink
1 -
For Office Use�� u
Permit*: 1 Cs/ � 'L% q U
Permit Fee: 3� -1*r
Date Received:
Staff:
2014 RESIDENTIAL BUILDING PERMIT APPLICATION 5a2/9
Date: 474/t41/,‘ Site Address: 4ii 90 - L/,1j ' . Y/98 -111J2 -4'f Unit #:
•
> '�eI Name: o AR -O06 7 Y 4,4 /Na-. Phone: 475f - CPI- `%4 519
Address / City / Zip: Po £k Z / Z S /4Ib -12- ydLrirs /11i✓ 5'52170
Applicant Is: Owner Contractor
Description of work: /2,4001/ o 4WD L4e t 45;441/7
Construction Cost: $.g1O• 73 Multi -Family Building: (Yes X .1 No
Company:. LAS ra `5 1Ccr2FN..) 1 NIG Contact: Ct14t.S .NI3 SoN1
Address: 1 L 1 W. WI* sZy -f- City: ��t,tsiolu t.ni CT"fo lv
State: M,IJ Zip: .5-S-47-0 Phone: 9S2 -ggt Z7/ •
License #: CaS ,O Lead Certificate#: NN=;— 41;037Z- /
If the protect Is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a pemtlt 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: y 4 q y n Phone:
Ab' �y� ,`,'a�r�.r�.1'S !�i%,1 yi��go° o�,yRµt��" °%�7°h� YI�T•q„�`J�L1.��+�)�a��d a�,. i��il�r: ` °.�Pf`� °A-�x"�`!l,°�: "YrO�-yl:l�� "]'�Ai 1��^.•.. % :S ?�q,(°�F� �.;
r:;lei%1'%1'il'lni'.r'nT=Yin^�i�'1�7%1��:�7:Wt'i"i.tC,iy.'v'. d��i��=J`.1.;1Q!_�J/�ll�`S:_`wFv7 �l`!t'7:.3.J �_:•�a��. �1.,. ,''��:_ �,rrs'r ��v��p'�'�f (���4�j r._ _..
CALL I3g ORE YOU DIG. Call Gopher State One Call at (861) 454.0002 for protection against underground utility damage. Cali 48 hours
before you Intend to dig to receive locales of underground utilities. www.aooherstaleonecall.org
I hereby acknowledge that this Information le 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 en application for a permlt, and work la not to sten without a permit: that the work will be In
accordance with the approved pian In the case of work which requires a review and approval of plane.
Exterior work authorized by a building permlt Issued In accordance with the Minnesota State Building Code must be completed within 180
days of permit Issuance.
x ei(1-4-iS 4 /•D L -S Cr
Applicant's Printed Name
Applicant's Signature
Page 1 of 3
-2-
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RESIDENTIAL BUILDING
Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5694
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6 ! LP,7
4LJ u S - 7G
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New Construction Requirements Remodel/Reoair Requirements Office Use Oniv
3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and all roofed areas 2 copies of plan %W-Cert of Survey Recd
(20% maximum lot coverage allowed) 1 set of Energy Calculations for heated additions Tree Pres Plan Recd
2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey for additions & decks J&-7ree Pres Not Reqd
1 set of Energy Calculations Add'rtion - indicate if on-sife septic system _ On-site Septic System
3 copies of Tree Preservation Plan if lot platted after 711193
Rim Joist Detail Options selection sheet (bldgs with 3 or less units
Date 12- / 0 > Construction Cost ? "`C0
Site Address 41 ? ??Y k m Unit/Ste #
Description of Work 1k'w
Multi-Family Bldg 1? Y_ N Fireplace(s) _ 0 2
Property Owner VA-Mi. Telephone #qSp1) Sqp7 -/ I Z0
Contractor .N. IhUSOY7
Address l7(y`ts- City LGCIC.QI/'llj'e-,
State ?J1 y Telephone # (?5d_) 5GIdj7pC
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
?
Energy Code Category
(? submission type)
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Minnesota Rules 7670 Categgry 1 _ Minnesota Ru1es 7672
• Residential Ventilation Category 1 Worksheet . New Energy Code Worksheet
Submitted Submitted
• Energy Envelope Calculations Submitted
elephone #(q5-) $GI3 "CpL17g
? A!G 12 2003 ?elephone #((?t/?, )
3103 - N?3
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yelephone # ((,qS/ ) 'qJrd'jNCS
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I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate;
that the work will be in conformance with the ardinances and codes of the City of Eagan and the State of MN
Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a
permit; that the work will be in accordance with the approved plan in the case of work which requires a review and
approval of plans.
rn eL
Applicar4js Printed ame Applic ' Signatu e
OFFICE USE ONLY
Sub Types
? 01 Foundation ? 07 05-piex ? 13 16-plex ? 20 Pool
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.)
>- 03 01 of-Eplex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.)
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo)
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
0 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
Work Types
,A_,
? 30 Accessory 81dg
? 31 Ext. Alt - Nlulti
? 33 Ext. Alt - SF
?? 36 Multi Misc.
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addition ? 36 Move Bldg. 0 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)* ? 43 Reroof ? 46 Windows/Doors
? 34 ReplaCement "Demolition (Entire Bldg) - Give PCA handout to applicant
Valuation O Occupancy MC/ES System --
Census Code /UA Zoning City Water -
SAC Units e-21 Stories Booster Pump
Nbr, of Units Sq. Ft. PRV ,----
Nbr. of Bldgs Length Fire Sprinklered `-
Type of Const Width
Foorings (new bldg)
_ Footings (deck)
Footings (addifion)
Foundation
Drain Tile
Roof --
_ ' Ice & Water 4 Final
Framing
Fireplace _ R.I. Air Test Final
? Insulation
REQUIRED INSPECTIONS
FinaUC.O.
FinaUNo C.O.
_ Plumbing
HVAC
Other
_ Pool _ Ftgs _ Air/Gas Tests
_ Siding Stucco Stone
_ Windows (new/replacement)
_ Retaining Wall
Approved By
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
?
.l
Final
Building Inspector
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?q -2 \5 -41
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G rey ha W K 3
MNcheck COMPLIANCE REPORT
Minnesota Energy Code
MNcheck Software Version 3.0
Permit #
I
Checked by/Date I
COUNTY: Dakota
STATE: Minnesota
ZONE: 2
CONSTRUCTION TYPE: Single Family
DATE: 8-21-2003
DATE OF PLANS: 01/02/03
PROJECT INFORMATION:
Greyhawk End Units Slab On Grade '
Eagan, MN .7
>?/ yU ?A,, pr4A /2 1)
COMPANY INFORMATION:
MW Johnson Construction Inc.
17645 Juniper Path #100
Lakeville, MN 55044
COMPLIANCE: PASSES
Required UA = 498
Your Home = 354
29.0% Better Than Code
Area or Cavity Cont. Glazing/Door
Perimeter R-Value R-Value U-Value UA
CEILINGS 980 44.0 0.0 26
WALLS: Wood Frame, 16" O.C. 2322 19.0 2.0 130
BSMT: Conc. 4.0' ht/4.0' bg/4.0' insul 464 10.0 0.0 32
GLAZING: Windows or poors, Above Grade 132 0.480 63
DOORS 38 0.350 13
FLOORS: Over Unconditioned Space 290 30.0 0.0 10
SLAB FLOORS: Unheated, 42.0" insul. 116 10.0 80
HVAC EQUIPMENT: Furnace, 90.0 AFUE
--------------------------
COMPLIANCE STATEMENT: The
consistent with the buildi;
submitted with the pe
designed to meet t requi.
Builder/Designer 6 ?
-----------------------------------------------------
proposed building design described here is
ng plans, specifications, and other calculations
application. The proposed building.has been
?eme s o the Minnesota Energy Code.
Date c?k C
/
LOT SURVEY CHECKLIST FOR RESIDENTIAL
BUILDING PERMIT APPUCATION
PROPERTY LEGAL: S/cg C? Zi?e,-r /q'We17a--i
DATE OF SURVEY: 8- Z l -- O 3
LATEST REVISION:
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DOCUMENT STANDARDS
? ? • Registered Land Surveyor signature and company
? ? ? • Buiiding Permit Applicant
? 0 -W • Legal description
? 0 0 • Address
? ? • North arrow and scale
'a ? ? • House type (rambler, walkout, split w/o, split entry, lookout, etc.)
x'?
°S-? ?l?
? 0
0 A-;
-J •
• P
Directional drainage arrows with slope/gradient ?o?Go?necf P
sewer and water services & invert elevation ("o sy?6O
osed/existin
Pro ?? ?EG?cN? 1
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p
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o 0
?- •
• Street name
Driveway C9r'ac?? ??
A ? ? • Lot Square Footage
? 2K ? • Lot Coverage
ELEVATIONS
Existin
? ? ? • Sewer service (or Proposed)
,? ?
>??-? ?
-Ats •
• Property comers
Top of curb at the driveway and property line extensions ->K
x CI ? • Elevations of any existing adjacent homes
10 0 ? • Adequate footing depth of structures due to adjacent u6lity trenches
? • Waterways (pond, stream, ete.)
Proposed
,K ? ? • Garage floor
x ? -40L • Basement floor
? ? ? • Lowest exposed elevation (walkout/window)
? • Property comers.
? ?
. ? • Front and rear of home at the foundation
2
PONDING AREA (if appiicable)
? ix 0 • Easement line
? R ? • NWL
? .BI' ? • HWL ?
? 9 ? • Pond # designation
x v 4A- • Emergency Overflow Elevation
? 9 ? • Pond/Wetland buffer delineation
DIMENSIONS
? O ? • Lot Iines/Bearings 8 dimensions '
? ? 40'. • Right-of-way and streetwidth baek of curb) ?
? 0 Cl • Proposed home dimensions inclu ing any p posed decks, overhangs greater than 2', porches, etc.
(i.e. ail structures requiring permanent footings)
)K 0-Wr- + Show all easements of record and any Ci utilities within those easements>?,-
X ?-?? • Setbacks of proposed structure and sideyar setback of adjacent existing structures ?i++?ss?ns -?oy,f ? r'Pa r)
• Retaining wall requirements, if any 2 3: r ?.-
Reviewed:
Name Date
GJFORMS/Building Permit Application
CER TIFICA TE OF SUR VEY M. W. JOHNSON CONSTRUCTION
o GV DRAWAGE & UTILITY EASEMENT CATCH
OVER ALL OP OUTLOT A BASIN
M ?HNO RAPTOR ROAD 30.0 8- 8 M
S 89035' 18" E 150.80 ?
110„ fSo 11e„ 1qo_ "C!o. . ?_ CATCH
yL/'J v-?' 36'ao V? - he928x6 -he929x2 2&00 36 EmriuR
he916xT. he92 x2 DR AG & UTILITY SE NT he9 x6
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? N; DRIVEWAY
N °o DRIVEWAY N DRIVEWAY a°x° DRIVEWAY DRIVEWAY
N ' 7.1% N 7.S°Ie N 3.8? o n 63? 429
x
W N m
M M
M x 20.33
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20.33
X 20,33 u
20.34 ?; M
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m M 4156 n
4152 M X
? n 4148 M
N
°f M 4144
m ?M
4140 ? m;n I,
927x9 W ?o m
27x5 GARAGE ?
? GARAGE 00
? GARAGE ?
GARAGE 00
GARAGE '
(V 11.0 5.50 W 5.67 W 5.67 W 5.67 W 5.50 "
Id, ro PROPOSED ? N PRO
POSED? 0 PROPOSED pROPOSED + pROPOSED
G
2 V 7 W
0
4 HOME
O ? N
' TWO STORY
? N N
? o Q e
$
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Q SLAB TWO STORY
SLAB TWO STORY
SLAB TWO STORY `
SLAB TWO STORY
SLAB
Z 25,83 26.00 26.00 26.00 25.83
928x3 11.1 .929XB 9291 930x3 f93Ux-51 Dx 930x8 931x8 ix8 ?x 932x
°o; ? o 0 0 0 o? ?
o? 929x2 0
N? ° 9300 °
O N
- 930x8 °
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DRAINAGE & U ILITY EASEMENT _
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1"=30'
x6 S z,i 936x0 936x1
S 89°35' 30" E 150.80
PROPERTY DESCRIPTION:
LOTS 5 THRU 9, BLOCK 2, GREYHAWK 2ND ADDITION,
CITY OF EAGAN, DAKOTA CO„ MINNESOTA
LOT 5
PRQPOSED GARAGE FLOOR ELEV.=930 0
PROPOSED TOP OF BLOCK ELEV.=930.3
LOT AREA.= 3798 SQ,FT.
BUILDWG AREA = 1218 SQ.FT.
SEWER SVC INV: 918.0
-'°- "-
i LOT 6
"6
t`
9 X PROPOSED GARAGE FLOOR ELEV=930.7
j PROPOSED TOP OF BLOCK ELEV =931.0
SiLT LOT AREA.= 2683 SQ.FT.
Atoooo? BUILDWG AREA: 1218 SQ.FT.
? N?? SEWER SVC =918.0
W Z LOT 7
°°O PROPOSED GARAGE FLOOR ELEV.=930.7
a
o
PROPOSED TOP OF BLOCK ELEV. 931.0
N LOT AREA: 2683 SQ. FT.
BUILDWG AREA: 1218 SQ.FT.
N SEWER SVC =919.7
p
= 10
m LOTS 8 & 9
PROPOSED GARAGE FLOOR ELEV: 932.0
?
p PROPOSED TOP OF BLOCK ELEV.=932.3
W SEWER SVC.-919.0
N
O BUILDING AREA: 1218 SQ.FT.
?
932x0
?
LOT AREA LOT 8= 2683 SQ.FT.
931x8 LOT AREA LOT 9: 3715 SQ.FT.
3:1 Maximum Slopes
or Ra °ning Wall INi81
Be Required
NOTE:
ALL DIMENSIONS ARE TO
OUTSIDE FOUNDATION
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? DENOTES SERVICE LOCATION ?
OO?xO DENOTES PROPOSEQ ELEVATIQN
--? DENOTES PROPOSED DRAINAGE DIRECTION
OOOxO QENOTES EXISTING ELEVATION .?
? DENOTES WOOD HUB
? DENOTES FOUND IRON PIPE MONUMENT
I HEREBY CERTIFY THAT THIS SURVEY WAS PREPARED BY ME OR UNDER
Bohlen MY DIRECT SUPERVISION AND THAT I AM A DULY REGISITERED LAND
Surveyiag & Engineering SURVEYOR INJDER THE LAWS OF THE STATE OF MINNESOTA.
31462 FoNage Avenue 4735 12o3rd Street W. Q Z
Northfeid,MN 55057 S?age?MlN 55378 DATE- 08-04-03 PFoxe(50764557799aB PFaze?(A52))B9559259Z REVISED 8-21-03 LEROY H. HLEN, LAND SURVEYOR
REVISED 9-16-03 MINNESOTA LICENSE N0. 10795
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*M9-1047-03 Fn.ENAME: i0tsD-yniKzcert.z3yu
01/26/04 12:00 FAX 6128927900
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ID' ? Minnesota . .
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Subjec t:- ' 4120; 4124, 4128, 4132, .
.?. .. ?, 14 41?44: 414$: 4152; 4156RaPtor Road, ? Minnesota
Ref: 2000 Intemativnal Rcsidentill Code . :
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incbes ? ravided
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?tem # Fioor truas--24 iaehe?t oa center ?vith bearin ? ?rer. . ? . . • . .
h 1-1 /2 inches is called leugt .. . ?d construction•ai?d itnd the 1-3I8 inch b??gnch?s on.
. .. t have revievved the design and fiel ....??s -COneCted with 1-inch staP1e this case-
additian of 112 by •2 inch bearin? , cr?teria (loads) .
ar?d th:
? is acceptable in meeting the pto_ 3ect ldesign each side minimum No fuxther
center maximum .. , iate with (7)8d naiIs
() Trusse s to be -secured to toptsill p . ?. ..
. , ? ?o?3if c:??tions are necessar??- ? ' -
. . . .. ., nter bearin wall bottom late bears 1 inch off the
2: The xxG 16 ink b? o? ee e? artitfon waUs.
. ? . . - ma:s, oi .N bloek f undatian wall at th .? ? . .
i? -and field constrixction and find tbat ?. e third) aftl?e 2x6 '-. p) ?1 r'",
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?.?beaeiu ? o=? the 17r ?asoruy block fa?mdatio? ?ilowu?? ? the(r h? dd watl fotces to be correed
midctiE • plate is located fully over
. course bf th ? ? •.t'?YaSfE 1T?t? i0 t'1e•found1ation bar ?1 end th The ood fr??ed wall shall be anchored to the t 2
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eam ? with minimum { ,? diameter anchor boltby b inches embedment ?
.. lliTn fc?undi tivn wall re thar16 fee ?
?- , len?,?tla ar?d not ?stions or
tt' is adequate for your use in die evaluat?on wall.? 1f you ave ?? ,. .
betie ie this repo .
conirn• :nts, please call me. f-
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01/28/04 12:36 FAX 6128927900 MW JOHNSON CONSTRLTCTION Q002/002
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Address: 4140 Raptor Road Zip: 55122
Lot: 9 Block: 2 Subdivision: Greyhawk 2nd
THE FOLLOWING ITEMS WERE/WERE NOT COMPLETE AT FINAL INSPECTION ON I
Yes No Comments
Final grade - 6" from siding i7 r s L
Permanent steps - garage 44
Permanent steps - main entr"Iy
Permanent driveway
Pennanent gas
Sod/Seeded lawn '
Trail/curb damage S'?,? • ??irl?.. ?jI
Porch x,
Lower level finish 12,1
Deck
Fireplace
• V erify with your builder that roof test caps from the plumbing system have been removed.
• T urn off water supply to the outside lawn faucets before freeze potential exists.
• C all the City's Engineering Department at 651-675-5646 prior to working in right-of-way ar installing
irrigation system.
V BUILDING INSPECTOR: ?
1,,+?;.,•.'"'--°? '`,
ar ?
CONTRACTOR:
Johnson Construction, MW
17645 Juniper Path #100
Lakeville MN 55044
01/2$/04 12:36 FAX 6128927900 MW JOHNSON CONSTRLTC'TION
28. 2004" 1), 20AW4r- IVI1LaUME INDUSTRIES-p????. ???2e??$eNO. 6647
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02/19/2004 13:10 6124704870 LYMAN LUMBER C0. PAGE 01
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BC CALCO 2003 DESIC3N REPQRT - US
Thursday, February 19, 2004 12:09
Double 1 3i4" x 18" VERSA-LABAK) 3100 SP
Job Name: Fife Name: BC CALC Prajec! : FB01
Address; Description.
City, State, Zip: , speatiar;
Customer: De6igner; Sarah Schmefinq
Code repprts; lCBO 5512, NER g29 Company: Lyman Lumber
MisC:
,1.,.
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2
, ?...... ._.._a. • - • -..„ ??i...... ? :
. . ,.. ...____...
, . . ,.., , . , ,..?...-r,;-?:-,•rw.?." "
i??'ryTTy66pp{II?1?11777
a ,..., .
.?iul:!l1au4??i ME
3963 Ibs LL
2075 Ibs DL
General Data
Version; US Imperial
Member Type; Ffppr B@am
Number of Spans: 1
Left Cantilever; No
Right Cantilever: No
Slope: 0/12
Tributary: 02-00-00
Live Load: 40 psf
Dead Load: 10 psf
f'artition Load: 0 psf
Duration: 100
Disclosure
The completeness and accuraey of
the input must be verified by gnyone
who would rely on tfie output as
evidence of suitability for a
particular applieatioh. 7he output '
above is based upon builqing
code-accepted design prQpertie
and anafysis methods. instailati
af 601SE engineered wood
produCts must be in accordance
with the current Irlstalletion Cuide
ancf the appficable building COde6.
To obiain an lnstallation Guide or if
you have any questiona, please call
(800)232-0788 befors beginning
Product installatian.
BC CALCO, BC FRAMERM, BCI(S),
BC RIM BOARbT"', BC OSB RIM
BOARDTM B015E GLIJI.AMr",
VERSA-LAMQ), VERSA-RIMO,
VERSA-RIM PLUSO,
VERSA-STRAN DTm,
VERSA-STUD(g), ALLJ015TQD and
AJST" are trademark6 af
Boise Cascede Corporation.
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.....__.,... ...... .........................,.... ........." - -
02-00?0? '. . . l .'? . ._.. ? . _... ?, . ..,......_. r ,._.... ..? l
?d.Laad - 40 P0I 10 pSf Trfbutery
. .. . , ...._ _. .._. .._ ..
7rtsr??m.s.??-n•„un,,..,??.?,-,??:,n„wM?,.,,?,.,,,,,,,w.,,:?.-?_. -... .. ._. __ ...._._.
61
1587 !b$ LL
756 16$ DL
Total Horizantal Length - 19-06-00
Load Summary
lb Dsscription Load Type Ref. Sfert End Type Value Trib. Dur
S Standard Load Unf. Are9
Left oo-aaoa 19-08-04 Live
40 paf .
02-80-00 100%
I Conc, Pt. Dead
Left 05-00-00 05-09-00 Live 10 psf
2170 Ibs 02-00-00 90%
n/a 115%
2 Dead 9301bs nla 90%
Unf. Lin. Left 00-00-00 05-00-00 LIVe 0 plf n/a 100%
3 Dead 80 plf n/a 94%
Unfi, Area Left 00-00-00 05-00-00 Live 40 paf 09-00-00 115%
I Dead 17 psf 09-00-00 9o°rb
Controfs Summary
Control Type Vafue % Afiowable Duratlon Losd Case Span Location
Moment 21304 ft-Ibs 39.7% 115% 3 1- Internal
Neg. llAoment D ft-Ibs n/a 700%
End Shear 4972 16s 35,5% 115°!0 3 1- Left
Total Load Defl. U829 (0,372") 38.190 3 1
Live Lo$d Defl. U936 (0.25") 38.5% 3 1
Max Defl, 0.372" 37.20/a 3 1
Not6s
Design meet5 Cod9 minimum (LJ24 0) Tpta) fGad defleotion criteria.
Qeeign meets Code minimum (U360) Live load deflection critarla.
wA m.Wsddeflectien crlterlg_
Minimum bearing tength far BO Ig 211,
Minimum bearing length for 81 ie 1-
pan Length(S) = Cleer Spen + 1/2 min. end bedring + 112 intermediate bearing
Cannection Dlagram
Member has na aide loeds.
Cancentrated ioads ara npt considered in side load analysls.
Connedors are, 16d Sinker Nails
e _ 2"
b=3"
c _ 7„ ... .....
d = 12" a
t
e?
? ......
7"t'-V'l
,S ' ???d11D
2006 RESIDENTIAL MECHANICAL rERMIT arrLicATioN
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please complete for: single family dwellings & townhomes/condos when permits are required for each unit
'3D -6)
Date ! / ac) / CC-.
Site Address LA ? 4_40 Unit #
Property Owner ?Cs._, CL60'1CI-rk-° Telephone #
Contractor Wohlers Southside Htg. & Air, Inc.
6950 W. 146th St., #106
Street Address Apple Valley, MN 55124 City
(952) 431-7099
State Telephone # ( )
Bond #: KLM054??8,-/ Expires: 08r 25?240
The Applicant is Owner )< Contractor Other
Add-on or alteration to existing dwelling unit $ 30.00
furnace _Additional _Replacement ? New
air exchanger
?- air conditioner
_ heat pump
other
State Surcharge $ .50
0!
,
ZOLc
Total
? -
I hereby apply for a Residential Mechanical Permit and acknowledge that the information is complete and accurate; that the work witl
be in conformance with the ordinances and codes of the City of Eagan and with the Mechanical Codes; that I understand this is not a
permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of work which requires a review and approval of plans.
c?-
Applicant's Printed Name Applicant's Signature.
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA160184
Date Issued:02/20/2020
Permit Category:ePermit
Site Address: 4140 Raptor Rd
Lot:9 Block: 02 Addition: Greyhawk 2nd
PID:10-30976-02-090
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Standard Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener).
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Farhana Ahmad
1852 Red Fox Rd
Eagan MN 55122
(651) 336-6527
Champion Plumbing
3670 Dodd Rd., #100
Eagan MN 55123
(651) 365-1340
Applicant/Permitee: Signature Issued By: Signature