4723 Ridge Wind Tr cir~r oF ~?c~?N
379! Pllef Kwo~ Rood Esgen, MN SS122 ~'~f 1`
~ PHONL~ 454-8100
BUILDING PERMIT Receipt #
Ts b~ Yad fa Est. Voiue ~ t;~~O Date Octob4r 24 19 33
S~te Addrou ~ ~ f~e n ra R-3
3 G Park F.idge Erect Occupancy P^
Lot Blxk Sat/Sub. - Alte? p Zoning
Pa~~ # 10-5G7~0-030-04 ~ - Repair Q Fire Zone
Enlar{ye O TYpe of Const. V
W NaTe n y & c ie e or ~ # Srorie~
~ 1~016 lst Ave. So.
Addreas Demoliah Q Length
Bloominqton 884-3636 Grade p Depth ~ Sq. Ft.
~ Na~ RusCOn Home6 Approvols Fees
Addrea t t• Assessment Permit '
F' Cit ~urnsville phone 432-1433 Woter a Sew. . Surcharga
Police Plon check~~
C~ Name
~W F~re SAC 45J.00
llddreu Enp. Woter Conn.
<W Ci Phone Plonner Woter Meter
Council Rood Unit
I hereby acknowledge that I hove read this opplicotion and state that Bldg. Off.
fhe info~ma~ion Is torret! a~d ogree tn oomply with all appliceble
State of Minnesoto Stotutes and City of Eagon Ordinances. APC Totol
Sipnature oF Permittea
uscon r_or~es
A Building Permit Is iuued to: on th~ express condttbn thni
oll work sholl be done in occordante with oll opplicable Stote of Minnesota Statutes and City of Eoflon Ordinances.
Buildinq Officiol
Parmit No. Pe?mit Hold~r Misc. Permit No. Holdsr
Plumbina l-r'j Z- 1
H.v.ac. OQ ~ ~ 61zg-~. ll-y
w.n
Water
Disp.
S~vwr
Eleetric ~-oc~ l LS' 6 i- C.. ~(5$3
Irapeetion Dtt~ insp. Other
Footinpt G
Found~tlon
Fnmin~ ~
Rouyh Plbp.
Rou¢~ HVA
Inwlstion
Final Plb~ ~C
Final HVAC
F~~.i / ~ - ` G
Wat~r Location:
VUell
Sewer
Pr, Difp.
Reoeipt 4 L~L pLUMBING P MIT Permit No.
~ CITY OF EA~AN % J
, + _ ~ ~ Fee
Fill rn numbered spaces S/C J
Type or Print legibly ~y_U v
Tot.
1. Date r ~ ' 2. Installation Cost ~
i 1 _ cwe~~ ~ c , , ,
3. Job Address ; ~ ~ ;~-i~ ~ f -Lot ~ Blk. ~ Tract / . :
4. Owner ? .
~
5. Contractor ~-/u ~ i ~/i 1) iv' Phone ~ - ~ ~
6. Address i c> , . , ~ •-i ~ ~ j,~ -a . 1
T -
7. City ~ ~ < , ; . i: ,l , i ( Stdte i 1~7 Zip ~ '
: ~
8. Building Type: Residential C$°~ Commercial ? Institutional ?
9. Work Description: New LT Add ? Alter ? Repair ?
10. Describe
11. No. Fixtures No. Fixtures
Water Closet Gesspoal/~rainfield
Bath tubs Septic Tank
Lavatory Softner
Shower Well
Kitchen Sink
Urinal/Bidet Other
Laundry Tray
Floor Drains
Drinking Ftn.
Slop Sink
~ Gas Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
5igned : ' 1 for ~ -
i .
Rough Final ` ~
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved ~ CITY OF EAGAN 454-8100
Receipt f 7- i"1` MECHANICAL PERMIT Permit No. ~T
~ t_ ~ CITY OF EAGAN F~ .
~ ~ fill in numbered spaces S/C t'
1'"" f r~ ~ ~ Type or Prinr legib/y Tot
i~
1. Date ~ ~ 2. tnstallation Cost
, T~- ; ~
3. Job Address y~;~ ~=+~c.t c,~~~ Lot Blk. ~ Tract ~U
4. Owner s t~•; h-~.-s-%
~
5. Contractor ~ ~ ~„w,~`t k ';T r It_ . Phone ~ ' ~ J
1
6. Address ` ~ r ~ , 1. ~
7. City State ~ 1 _ Zip _
8. Building Type: Res~dential C~, Commercial ? Institutional ?
1
9. Work Description: ~New ~ Add ? Alter ? Repair ?
1D. Describe • "r ~ , - Fuel Type - ~ ~~J
}
11. No. E~s~ip~IIf~ 8TU - M. Ea. No. Enuipment CFM
1 Forced Ai~ Q ~ Air Handling:
Mfg.
Boilers ; Mech. Exhaust
Mfg.
Unit Heater
Mfg. Other
Air Cond. _
Mfg.
Gas, Piping Outlets
12. I hereby certify that the above information is true and correct, and 1 agree to
comply with all ordinances and codes gqverning this type of work.
` ,
Signed : ^ for
Rough ~ Final
Inspections: Date Insp. Date Insp.
~ This is your permit when numbered and approved.
~ Approved CITY OF EAGAN 464-8100
CITY OF EAGAN Femarks
Addition P~K RIDGE 1ST ADDN ~ot 3 61k 4 Pa~ce~ 10-56750-030-04
owner street 4723 RIDGE WIND TRAIL state EAGAN 14IIV 55122
Improvement Date Amount Annual Years Payment Recaipt ~ate
STREETSURF. 7 1982 14.91 10 104.40 A013552 2-15-84
STREET RESTOR. 19HS i~g~ 32.80 15 102.91 C009864 10-23-84
- 8 .~8 25.94
SAN SEW TRUNK 1982 9.81 15 117.78 A013552 2-15-84
*SEWERLATERAL {0 1985 626.1( Qj.]4 15
WATERMAIN
WATER LATERAL 1985
WATER AREA 19$2 9.$1 ],5 1].].]8 A013552 2-is-8~i
STORMSEW TRK 1985 370.93 24.73 15
STORM SEW LAT 1985
CURB & GUTTER
SIDEWAIK
STREET LIGHT
ROAD UNIT 250.00 39493 10-24-83
WATER CONN. 4SO.OO
~UILOING PEFi. 8603
SAC 525.00 " "
PARK
~ Ji0U5E -HEA7ING TEST RECORD /a -5 ~-~;30-~~
ADDRE55 ~ ~ APT. FLOOR CITY SUBUR I~.,
OCCUPANT ` OWNER
HEAT LOSS DATE HTG. INST.
SOLD BY INSTALLED BY
Electrical Work By Gas Line By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER
~ GAS DESIGN CONVERSION
MAKE ~ MAKE OF BURNER
Modsl Model
Serial ~ Max. BTU Rating
INPUT ~ ~i MAKE OF FURNACE
Model
CONTROLS
THERM?OSTAT Heot Plug Vent Siza
Valvell ~Qy~_ K~C$ KIND OF LINER SIZE NONE
Limit ~ Draft Hood Regulawr
Limit Setting . Filters Sizs Number
Fan Setting QS ~ ~~o ' Chimney Location Insida Outsids
Pilot Type Chimney Construction
Pilot Make ~
Pilot Modet t Smoke Bomb Wiring
Pilot Timing Draft Tast Tap
L.W. Cvt Off Door Pressure Lighting (nst.
d
Pressure 3•~ Percent C02 Date Testsd r ~
I~put CFH Pereent OZ ~ Company Testing ~
Staek Temp. Percent CO ~ V Name of Tester r
Form 235
; CITY OF EAGAN WATER SERVICE PERMIT
3~30 Pilpt Knob Road
P. O. Box 21199 PERMIT NO.: S 10 2
E agan, MN 55121 DATE: 1~? ;
Zontng: 1 No, of Unirs: I
Owner: '.~uSCOn. i:t?~ta5
Address:
S~te Address: '~7: i Ri~.~e ?:ir~ci ~Frai2 L3 tid i~ar~. ~id^e
Plumber: _ ~tar F 1 ~•r L-Xc
Mete~ No.: Conriection Charge: 4~0. ;,;i
Size: Acoount ~eposit:
Recder No.: Permit Fee: 1~).! i. ~i
1 p~ to oompl~r with !h~ Cit~r of Eayan Surchnrge: -
OrdiNanea. Misc. Chorper. 0~;,~d m et t~ r
Totnl:
8Y Dote Paid:
[?ote of Insp.:
CITY QF EAGAN ~yy~ ~y~CE PERMIT
38'.i0 Pilot Knob Road
P. O. Box 2i 199 PERMIT NO.: .
Eagan, MN 55121. DA~: 's - . . ,
~ ~
No. of Units:
OWner: ~.ISCQ!'i ,i.7I7(:$
P1ddrC55:
S~te ~ddress: 4723 Ridze ?~inc~ 'l~rail L~ ~'ar}~ ~'i~(c-~
Plumber: ~ ~ -ar F ! c~ - , ~:C
1;~~-.: ~ - ~ nc;. , ~„t
~.~h. to oanap w~l~ f6e c.N,, ef Eal~¦ co??.~scHa, c],arpe: _ L~;~~.
Or~inewea. Acwurrt Dep4ait:
P+ermk Fee: - 1 • `
Surchorps: '
By Misc. Chorpe:;
~ate of Ir~p.: Total:
Dot~ Poid:
_
1000 GF-SP
' " CITY pF EAGAN Include 2 sets of plans,
p~ p ~ ' 1 site plan w/elevations &
BUILDING PER~ffT APPLICATION 1 set of energy calculations;
~ D-~
7b Be Used For Single Familx 7 Valuation ~ ' Date 10/17/83
Site Pddress 4723~Ridgg Wind Trail OFFICE USE ONLY- '
Lot Block Sec./Sub. Park I?~ e Erect ~ Occupancy _ 3
Parcel l~ ~=50 -D>O -O Alter T Zoning ~
, Repair Fire Zone
Owner: Randy & Michelle Bork ~az9e _ 2~Pe of Const. _i,
Address: 10016 1 . z~v _ So_ ~ Stories • ft.
D~lish Fxont /~O
City/Zip Code: 731nnm~nqj-~n 5547(1 Grade Depth v7 ft.
Phone 884-3636
APPRDVALS F~
Contsactor: R,~ -on H~ma~ Ass~ssnents Peznut ~by
?4ater/Seaer Surcharge a %
Address: 7 ppp F_ 7 4Fi+h _ sr _ Police Plan Check ~
S
a ~
Clty/Zlp COdO: Rt~rngvillp 55337 F1Se SAC R S °n
y ~g. Water Conn. So ~
Phone n: 43 ~-1 4~ ~ Planner , Water ?~ter (yo ~
Council Road Unit ~,s-n
Arch./Eng.: Phillips Plan/Probe En~irieerin~ gldg. Off. -
Address: 1000 E. 146th St.. Burnsville. MN. ~
City/zio Code: 55337
D'none n: ~+3~-204~+ / 432-3000 ~r~ ~`1 ~9 `~O
CITY OF EA6AN N~ S6O3
9793 Pilef Knob Rood lagan, MN 5513! ~
PHONE: 434-8100
BUILDING PERMIT Recelpt # 3~yy3
Te 6a u~ad fe~ SF DWG/GAR Esr. Value $57>000 Dare October 24 , ~q~_
Sira Addreu 4723 Ridge Wind Trail Erea gg Occuponcy R-3
Lor 3 BI«k 4 Sec/Sub. Park Ridge qlter ? Zoning R-1
pa~~ # 10-56750-030-04 Repo~r ? Fire Zone NA
Enlarqe ? Type oF Const. V
~ Name ~ndy & Michelle Bork Move ? # Stories
~ Address 10016 lst Ave. So. pe,,,o~~~, p Length 40
Bloomington p~,o,~ 884-3636 Grode p Depth 47 Sq. Ft.-
g Name Ruscon Homes Avo~o.al~ Fees
o~ Addren 1000 E. 146th St. Assessment Permit 304.00
u~ ~~t BuYRSVllle p~~e 432-1433 Water 8 5ew. Surchorge Z8 • 50
Police Plan check 152.00
p Name
~Z Pire SAC 525.00
Mdress Enp. Waler Conn. 4S_Q..~
<W Ci Phone Planner Woter Meter 60.00
Councll Road Unil Z5~.~0
I hereby ackrrowledge that 1 hove read this opolicarion and store thot g~dg. Off.
the informotion is wrrect ond ogree to mmDly with all applicnble APC Total $1769.50
State of Minnewto Statutes and City of Eagan Ordirances.
Signature of Permittea
A Building Permit is issued M: RuSCOII HOII}ES ~ on the express condition thnt
oll work sholl be done in accordonce with oll applim e tote ot~~~
^r~r-~esota
Statutes ond City of Eagan Ordinonces.
Building Official _
REQUEST FOR ELECTRICAL INSPECTION ee-ooooi.oa
' See inslructions tor completing this torm on back o1 Yellow copY•
""X'" Be/ow Work Covered by This Request ,7j~ q~~
~ ReO~ Type ot euiltlin9 Apaliunces Wired Epuipment Wired
Home Range Temporary Service
Duplex Water Heater Lightiny Fixtures
Apt. Buildinq Dryer Etectric Heatin
Commercial 81dg. Furnace Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tank
Parm the~ oeo v O~herlSUecl~vl
l~er $pemfy Othcr Other
ompute Inspection fee Below
p Fee ServiroEnlranceSize p Fae Feaders~Subfeaders d Fere Gircuits
U to 200 qm s 0 to 30 Am s 0 tn 30 Am s
Above 20D qmps 31 to 100 Amps 31 to 100 qm s
Swimming Pool ~ Above 100_Amps Abave 100_Am s
Transiormer5 Irrigation Booms Partia - Fee
Signs Special 6ispection 5~~ F~'
Hertarks . ~T~' T~
flouBh-in Date
/ / / I, e ectricel
• y o 1^spectoq ~areby
certity that the abova
Final ~~~e ' pection ~as been
~.?!F ~ ea.
.
T~la repueat voie 18 montlre irom
~..~as ~~d ~~-IS L3~ 8y ~~~nl'l~ ~~ac~(~ 394~( ~
1e rtwnms iwm
~ 3a~so
Reques Date Fire No. qouph-in InsOec[ion
Raquired~ ~ReaAy Now ~il NotiW, InsOec-
/L ` ~ ~,µE.. ?No toS.When ReedY
icensad Elec[rical Con[rac[or I herab re
y quest insPection o1 above
? Owner elechical work instailed ar.
Street Address, Bon or Fou[e No. Citv
y? 3 ~'~p~~ -r~e ~'~~h
ecUOn o. Township Name or No. Range No. Coun^ty
f--~K
OccuoanllPRINT) Phone No.
' 1
Power Supplier Address~JaJe
~~l / 1~1~CI/`~
ElecV cal Convactor (Company Namel Conhaaor~s License No.
~ r L ~ I~L-
Mailing Address ICOnVactor or Owner Makinp Instailalionl
~ .-~a-v~~~
Authorized atur Cmha md0 er Maki nstallaun 1 Phone Numbor
~ ~ S
MINNESOTA STATE BO OF ELECTf11CITY THIS INSPECTION flEQUEST WILL NOT
Gri09s-Midwey Bldg. - Noom N-181 BE ACCEPTE~ BY THE STATE BOAND
UNLESS PAOPEN INSPECTION FEE i5
182t University Ave.. SL Paul. MN 66104
Phone (e121297.21t1 ENCLOSED.
AOBE coHsutTlHa tH01H~1flS
ENGINEE~AING P~RH?+ens and IAN~ ~URV(YOf1S
COMPANY, INC: ~
L .~1040 GST 141~ STRCCT, DUrtH~ViLIC, 1[IHHCSOTA SSSS7 rH 172-3000
Cc rt'~ c c~c ~~~`t,t~- zr'~ y
~di~_~~T ~t'~,~~jor-Z ' L D i 3 (3LDGX 9~ PARk Q/DGE ~
DAK07A GD. MINtit~'S07,q ,
~k RiDG~' WlNA _7RA1L _
(931.21 5•86~ C935.3)
~
N 3~ (y~5 , y
C 32.1) N B ° D I~~W {7135.s) NoRTH
-a 7c.oa ~o I 30 '
r---------` ~
Soo DEND7F5 EX/ST/NG ELEI/• 1
30.~ A~NoTES PRoPoSEp ~~.~N. S~i 1 I~
(997.0)
~ lNDIGAT~S DiREGT1op( oF i 2O~ ~~FRONT SFTBRLk
SyRF,4cE ARA~NAGE ~ ~ :'i L1NE .
1 N c~ N a.
~ ~ ~ ~1) ~
I~ _
'N N i 19. In o
N ~ ~ PROP~E9 ~ ~
¢ ~ ~ I{OUSE c~ ~
l 40' b'
p~ ~ ~ 1 (933.5~ (933,:)~ Z .
;933.5~ (934.2'1
s1 3~- ,
s
F1N~SHE~ ~ARA~E Fl.poR ~tE~ = 9~7•0 ' DRAlN~1GE A1JlD
~ , ; ur~,~lrr
~ u~ 55.-00 - - .-+r~ ~ FASEMENT
(926.5 N 89°4~'41"W .
(930.2)
~
`
I hereby certify that tliis is a true and correct repre~entation of a tract oF land as shourn and
described hereon, As prepared by me on this 12 day of oG70R~F1 , 19 .
Minnr,sota Ilegistration No. //,Q~~j
~
rnu.Lira ru?tv ~~xv i~.c
- . ~ ~ . . _ - .
- . _ . -
:
- - ~ EXTERIOR ENVELOPE AVERH~SE-~1" CdMPUTATION
-
' tO~ 6F _
.
` OWNER
;
t. .
: . ,
, w
.
. . < _ , ~
' SITE ADDRESS - ~ ~
CON7RACTOR _~uSCo~J DATE 5- 17- 83 PHONE ~ -
• Oetermine working square footage of each.
f . . . - . .
1. Tata) exposed wa11 area ~ 8~9. S ~ sq. ft. x .18 '~~$.•3~
. _ _ _
2. Total roof/ceiling area IDOO sq. ft. x .04 °
Total exposed wa11 area above floor = ILntp~l
a. 7ota1 watt window area ~oZ
b. Total door area 3 8 .
c. Total sliding glass~door area Y 4
- d: Total fireptace wall area -
e. Total wall framing area (average 10%)...:........ !N 2,~
` f. Total net wail area above fioor !Z 7 S - ~
g. Total rim joist area 13 D
Total exposed foundation area = 8'~• 8
h. Total foundation window area ~
i. Toal net foundation area abpve grade
_ Determine "U" value of each wa11 segment.
a. CoZ x~~U~, , 55 = 89• 1
b. 38 x"u" . I~ = 5. 2 8
c. g ~~U„ , 5 = ZZ
d. - X _ ~
e. I y2 X~~U" , Iz = I"1 ~o
f. 12'18 x~~~„ , O~q = 75•
y. I 3o X e 5 = S
h. X .r _ -
i.-~~8 X ~`}fo = ~.Z
3 ~~q.~.~.....Total -
If item ~3 is the same as, or less than item #1, you have met the intent
of SBC 6006(c)2.
n i h i
~b~ Ol L~~~~ j Permit M: ~~V
3830 Pilot Knob Road I Perma Fee: ~6~ ~
I
Eagan MN 55122 ~ Date Rerzivetl: ~
Phone:(651)675-5675 ~ 1 ic mn /~M ~
Fax: (651) 6753694 ~ Siaff: dQ19 6 V~uu, I
2009 RESiDENT1AL PLUMBING PERnnt7 aPPUCanoN
}
oe~: / ~ Add.~: a , ~ ~ ~f~e.. L
Tenant: g;
RESIDENTI OWNEH Name: ~~I7/Uy ~ P~: ~'/~2 - 9~a ~"dru2/7~
Address / Cily ! Zip: ~~S (
G~~UI~I J/ e 1" 1 1(~WL NI ~ SJ.,7 ~y
CONTRACTQR Name: L~errse
Address:
City: State: Zp:
Phone: Comad Person:
TYPE OF WORK _ New _ Re~acement _ Repair _ Rebu7d _ Modify Space _ Work in R.O.W.
Descrf on oi work:
PERMIT TYPE RES/DENT/AL
_ Water Fleater _ Water Solterter
Lawn trriga§on A~ Plumbirg FixWres
~ RPZ i_ PVB) Main _ Lower Level)
I _ Septic System ~ Water Tumaround
New
AbandonmeM
RESIDENTIAL FEES:
$50.50 Minimum Water Heater, Water Softener, or W ater Heater an Softener (inctudes $.50 State Surcharge)
$30.50 Lawn Irrigation (ir~ciudes 5.50 Sta[e Surcharge)
$50.50 Add Plumbing Fatures, Septic System /~ndonmerrt. W ater Tumaround` (indudes E.50 State Surcharge)
"W ater Tumarau~ (add E165. W if a 5/8' meter ~ required}
$100.50 Septic System New ($70.00 per as buiit) (indudes County lee and $.50 Siate Surcharge)
$90.50 Fire Repair (replace bumed out appliances, ductwork, etc.} (includes $.50 5tate SurCharge)
TOTAL FEES ~
I he2by acknowledge tha[ this informaqon is mmplete arid aocura[e: th# tlie amk wi0 be in conformanw witl~ the ard~rces a~ cotles ot the City of
Eagan; that t urMerslaM Uus 's ~rot a permi[, Wrt adY an app6calion for a peimiy a~q wo~lc is mt m start lMu[ a permrt: tlea[ me xwrk will be in
accordance wim me a{~roved qan w the case at wor~c whECh rpu'ves a review a~N aPWovaF of pla^s- ~
X -~/!'1/VI-I ~C.J~'V x ~
AppllcanYs Printed e AppllwnYs Sig
~~FP€ C1FF~G~ ti5~ ; ` ~ R `~.w~ ~ ~ ' t~e ;
~
; ; ~ ~ ~ ;h"'~."`s'~
~ ~ ? ~-fe~ '~ktf'~~ ~`a~~~, z
Ft _
~f~Bf~.ill~l~fS 6'#~O~t&, c ~s ~btdBC~tlkt~ x,f,._.._ ' { - t ~l ~
` .
x . X. ~ , ,
-----------------i
~ ~oroirce Use i
Clty of Ea~a~ I PBrtnitp /7 b C~J ~P
~q~ I
~ Permi! Fee: I~ O. w Q/
3830 Pilot Knob Road ~ Date Receive
Eagan MN 55122 i
Phone: (651) 6755675 i s~a,,: JAN ~ 0 2009~
Fax: (651) 675-5694 i I
2009 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: ~ ' Site Address: ~ ~ ~~''V i "~7_TY~pL ~ ~
~N
Tenant: Sult tl:
RESIDENT/OWNER Name: ~f?~7~Vb/ ~~VL7 Phone: oc-A °2y'
Address / City / zp: ~il ~~?~UI
Applicant is: ~ Owner _ ContraCtor s~~
TYPE OF WORK Description of work:
Construc[ion Cost: Multi-Family Building: (Yes No ~
CONTRACTOR Name: License
Address:
Ciry: State: 2ip:
Phone: ContactPerson:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Cateaorv 1 Minnesota Rules 7672
Energy Code . Residential Ventilffiion Category 1 Worksheet • New Energy Code Worksheet
Category Su~rnined Subm~tted
Submisslon type) • Energy Errvelope Calculations Submitted
In the last 12 months, has the City of Eagan issued a permit for a simllar pian based on a master plan?
_Yes _No If yes, dale and address of master plan:
Licensed Plumber; Phone:
Mechanical CoMractor: Phone:
Sewer 8 Water Contractor: Phone:
NOTE: Plansand supporting docpments that you submif are considered to be public inlormation: Porteons ol
the informafiort may be classified as non-publia if you p~ov7de specefic reasons tf~at would permit the Ciry to
' conclude thatthe are trade secrets. "
I hereby acknowle0g8 that this intormation is complete and accurate; that the work will be in conformarice with the ordinances and codes oi the City of
Eagan; that I understaM this is nol a permit, but only an application for a permit, and work is not io start without a pertnit; that the work vrill be in
accordance with the approvetl plan in the rase of work which requires a review and approval of plans.
x ~~~i/%~ ~ ~lf ~1
X
ApplicanYs Printed Name AppllcanYs S a
Page 1 of 3
DO NOT WRITE BELOW THIS LINE
SUB TYPES
_ Faundation _ Fireplace _ Porch (3-Season) _ Storm Damage
_ Singie Family _ Garage _ Porch (4-Season) _ Exterior Alteratlon (Single Family)
_ Multi Deck _ Porch (ScreeNGazebo/Pergola) _ Exterio~ Alteratlon (MuIH)
_ Ot of _ Plex ~ Lower Level _ Pool _ Miscellaneous
_ Accessory Building
WORK TYPES
_ New _ Interlor Improvement _ Siding _ Oemolish Bullding'
Addition _ Move Building _ Reroof _ Demolish Interlor
L( Alteretion _ Fire Repair _ Windows _ Demolish Foundation
_ Replace _ Repair _ Egress Window _ Water Damage
'DemWlUon of entire bWlding -give PCA handout to epplicant
DESCRIPTION
Valuation 3AG0 Occupancy G~ MCES System
Plan Review ~ Code Edition ,2.Oa 7 SAC Units r
(25°/a_ 100%~ Zoning City Water r'
Census Code Stories Booster Pump -
# of Units ~ Square Feet PRV
# of Buildings - Leng[h Fire Sprinklers
Type of Construction ~ W idth ~
REQUIRED INSPECTIONS
_ Footings (New Building) _ Sheetrock
Footings (Deck) Final ! C.O. Required
- Footings (Addition) ~ Final / No C.O. Required
Foundation HVAC
Drain Tile Other:
Roof: _Ice & Water _Final Pool: _FOOtings _Air/Gas Tests _Final
~ Framing _ Siding: _Stucco La[h _Stone Lath _Brick
Fireplace: _Rough In Air Tes[ _Final Windows
Insulation _ Retaining Wall
Meter Size•
Reviewed By: Building Inspector
RESIDENTIAL EES ~
Base Fee
Surcharge =J7-
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
410``City ofban
Date:
Tenant:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
e-Ia
RECF N E-\
MAK 16 0.
Use BLUE or BLACK Ink
1
For Office Use �t
Permit #: G c 3 3 L t
Permit Fee:
Date Received: K12—
Staff: 12
Staff:
2012 MECHANICAL PERMIT APPLICATION �'t
Site Address: 1 �3 UJL/101
Suite #:
I` I Phone: (..JQ 1 a -8 O--tL03
RURNSVII I F HEATING & A/C, INC.
3451 W. Burnsville Parkway
Site 120 City:
irnsville, MN 55337 Phone: Z a ®O
J
RESIDENTIAL
Fumace
Air Conditioner
Air Exchanger
Heat Pump
Other
New Construction
Install Piping
Gas
COMMERCIAL
Interior Improvement
Processed
Exterior HVAC Unit
Under / Above ground Tank ( Install / _ Remove)
RESIDENTIAL FEES:
$60.00 Minimum Add-on or alteration to an existing unit (includes $5.00 State Surcharge)
$100.00 Fire repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge)
_ $ OCA• J _ TOTAL FEE
COMMERCIAL FEES:
$75.00 Underground tank installation/removal (includes $5.00 State Surcharge)
$60.00 Minimum (includes State Surcharge)
- lithe Permit Fee is Tess than $10,010, surcharge is $ 5.00
- If the Permit Fee is > $10,010, surcharge increases by $.50 for each $1,000 Permit Fee
(i.e. a $10,010-$11,010 Permit Fee requires a $ 5.50 surcharge)
OR
Contract Value $ x 1%
= $ Permit Fee
$ Surcharge
= $ TOTAL FEE
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage.
you intend to dig to receive locates of underground utilities. www.aooherstateonecall.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.
k C xC
Applicant's Printed Name Applicant's Signature
Call 48 hours before
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