4742 Ridge Wind TrDate:
City of Eaaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Use
Permit #:
/G/
Permit Fee: oU
Date Received:
Staff:
INFLOW & INFILTRATION PERMIT APPLICATION
Plumbing / Sewer & Water
;v' 78.1/
Site Address:
9792 Zic19-e. 7-/atl
Tenant: Suite #:
RESIDENT I OWNER
Name: i /6 t 6tin. %7 6,,r l
l
Phone: ((' l " 324— 5.'
Address / City / Zip: -'4 Z g -,
W((1() 7/-6-4.1 41( ira II[LAJ 5-sat
11
CONTRACTOR
License #:
Address:
City:
State: Zip:
Phone:
Contact: Email:
TYPE OF WORK
PLUMBING (Within the building envelope)
Sump Pump Repair
SEWER & WATER (Outside the building envelope)
Repair
/X
Other:
Other:
DESCRIPTION
Description of work:
FEES
$55.00 / Each (includes $5.00 State Surcharge)
TOTAL FEE $
*Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submit I/I repair costs for
reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors
can be found by visiting www.cityofeagan.com/inflow, or City Hall at 3830 Pilot Knob Rd.
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.qopherstateonecall.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.
x
Applicant's''ri ed Name
Applicant's Signa re
FOR OFFICE USE
Reviewed By: Date:
Required Inspections: _Under Ground __Rough -In Final
, _ . . , .
r . _ CITY OF EAGAN . ~~rJC~~
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100
BUILDING PERMIT Receipt #
To be used for D~CK Est. Value ~Q~ Date J~E Z , 19 ~4
Site Address 474Z RID~G~ idIIND Tk
Lot b Block 4 SeciSub. r~RK ~IDCB 2NA OFFICE USE ONLY
Parcel No. + OCCUpancy - FEES
Zoning
W Name ~ ~B ~ ~NNIE ]~Ai~B'n' (Actual) Const Bidg. Permil ~6 • ~
~ Address ~?7a2 RIACE iII1~fD ?R (Allowable) -
Surcharge ~ ~
Clty Phone 688--2042 # of Stories ~Q~ p~an Review
Length
Name aw~ Depth ~ SAC, City
Address S.F. Total - SAC, MCWCC
~ City Phone S.F. Footprints -
On Site Sewage _ Water Conn
~
W w Name On Site Well - Water Meter
~ ; Address MWCC System -
Q= Acct. Deposit
<W City PhOne City Water -
PRV Required - SrW Permit
I hereby aCknowlege that I have read this application and state that Ihe BoosterPump - S~W Surcharge
intormation is correct and agree to comply with all applicable State of
Minnesata Statutes and City of Eagan Ordinances. Treatment PI
Signature ot Permitee ~ i APPROVALS Road Unit
]~a Oj{ CQrjl~x~ ~A~RE~ Pfanner - park Ded.
A Building Permit is issued to:
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. g~d9. pff. _ Copies
Building Official variance - TOTAL 2b' ~
I
~ Permft No. Permit Holder Date Telephone #
WATER
SEWER
PLUM8ING
H.V.A.C.
EIECTRIC
Inspettlon Date Insp. Comments
Foolings I
Foundation
Framing
Roofing
Rough Pibg.
Rough Hlg.
Isul.
Fireplace
Final Htg.
Final Plbg.
Const. Meter Plbg. Inspector - Notiiy Piumber
Engr.IPlan
Bldg. Fnal
Deck Ftg. G ~
Deck Final / ~s
Well
o~.
R~aipt - ! MECHANICAL PERMIT P~rmit No.
~ CITY OF EAGAN '
• FN
~ # .
Fill in numbered ~ S/C
~ - ( 1 _ ~ ryps or Print /egibly To~ -
1. Date ~ 2. Instaliation Cost ~
• ~r'_ _ , . ~f,.
r r'
3, Job Address Lot Blk. ~ Tract
4. Owner
.
~
5. Contracto~ ~ • ~ - Phone _ ~ -
8. Addross `
7. City ' State Zip .
8. Buiiding Type: Residential O Commercial ? Institutional O
9. Work Descriptio~': New ~ Add O Alter O Repair ?
10. Desaibe Fuel TYpe
11. No. Epuip~lt BTU - M. Es. No. EQUipment CFM
Forced Air Air Handling:
Mfg. ~ T~ .
Boilers ;t Mech. Exhaust - -
Mfg. ~
Unit He~ter
Mfg. Other
Air Con~.
Mfg.
Gas, Pi ' g Outlets
;
12. I hereby certify that the above information is true and correct, and I agree to
comply with all prdinances and codes governing this type of work.
Signed : for
Rough Fi~al
Inspections: Dat~ Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
ClT1f OF EAGAN , ~ 8
3830 Piiot Knob Road, P.O. Box 21•199, Eagsn, MN 55121
" PHONE: 4548100
~ BUILDING ~ERMIT R~~+~ ~
T~ M w~d Me t1 it~G/ :::~1 Est. Vaiue 3 r Q Q t! Date i' „ 19}~~
Sits Addreet ~ :Z i:](;~: Li I ~+lD 'I'~~ Erect ~ Occupancy , 3
/Sub. Remodel Zoning
~ot 4~Block ~ c°'' ~~~,~,i`. t~.~~~~ tc~
Repair ? Type of Con~t. , ~
Paroel No. Addition ? No. Stories
~ Name JCJ HOMES INC Move ? Length 4~
w ` Demolish ? Depth ~ 5
~ Address 1~~ ~.l ~1 PEt1NOCR Ajjr' ~nt ~mpr. ? Sq. Ft.
City : Phone ~ ~ ~ ' ~ 3 3 Instau ?
Ap~eorab FN~
Name
uu~ A~~ Assessrrront Permit y } S L- ~ L~
~ City Phone Woter b Sew. Surcharge 2 6- 5 G
~ Polfu Plan Review 1 d F- flQ
~W Name ~'!J`~Rzt ;aA~~L~PROBE L,I~.':=k Fi?. 5AC 52S_0Q
~W
Addross S 3~` t' E~; 'v K z1V!~ E~, Water Conn ~ n n_ n p
t W City V• Phone ~ 3 2-~ 0 4 4 p~~~r Weter Meter F~~
_(1 Q
Cour+cil Road Unit ~ k~~ - f~ Q
I hereby ocknowl~dye thot I have read it~is applicotion ond stare thot Bldg. Off. 7,~ 1 7.~' ~~i Tr, PL ! 31 . 0(}
the inlormotion is wrrect and ogree to tomply wirh all opplicobl~ A~
Stah of Minnewto Stotutes and City of Eogon Ordinonce:.
Var. Date Copies
5ipnotun of Permitte~ p, r~~
Total r '
A Buildiny Pennit Is isswd to: . on tFN ~xpreas co~dltbn tha~
dl work sholl b~ dorw in occo?donce with oll applioobl• Stote of Minnesota Statutes and City ot Eopan Ordinanc~s.
Buildinp Officid
- P~rmit No. P~rmk Ho1dK Dar TNsohon~ #
Plumbfnp 5 1 e. r 2. S ~ 7
H.vr?.c 9-I1- ~
E~~ y L ' 3 a s 3a .
Sotcamr
imp~ction Dat~ Insp. Oth~r
Footinpa I
FooUnysll
Found~tlon
Framiny ~ `1`
RooHnp
Rough Plbp. _ 3~
Rouyh Htg.
Insul. ~
Firtplsce
Finai Hty.
Final Plby. /C fy
Ffnal ~
Cer,yOcc. ) __t (U
Wffisr Dhc?ib~ Loution:
Well
Sewer
Pr. Disp.
~
l, ~ PLUMBING PERMIT P~rmit No. C~r
Receipt
CITY OF EAGAN '
FM
~ ' Ji
Fill in numbered spac~s S/C
Type or Print legiWy Tot •
~
1. Date ~S 2. Installation Cost , S d~ "
- . ;
3. Job Address 7 7 7~- ~~.-~~=~ot ~~-.Blk. TracY
~
4. Owner ~ U S L~ i~ tM
5. Contractor S~~~ c/~ ~ t` n Phone ~~~j f r
6. Address J ~ :a, k~ ~~1~ ~-c
7. City ~ ; Stete „ Zip ~ .5 ~
8. Building Type: Residential ~J Commercial ? Institutional ?
9. Work Description: New l~ Add ? Alter ? Repair ?
10. Describe
11. No. Fixtures No. Fixtures
Water Closet Cesspool/Drainfield
r Bath tubs Septic Ta~k
l.avatory 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
oomply with all ordinances and codes governing this type of work.
Signed : for
fiough Final
Inspections: ~ate Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8700
CITY OF EAGAN Remarks G/ ~ /~~8 ~
Addition PARK RIDGE 2nd ~ot 6 Rik 4 Parcei 10 56751 060 04
Owner 5treet.l~?~~~
~ ~ TT~$~~;~~~ State oan~ ~ 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. ~ ~
STREET RESTOR. ~ , ?
GRADING
SAN SEW TRUNK ~'7 ~ f// 3 O-a~'~s
SEWER LATERAL a, (R,
WATERMAIN G~J 642 . 1F 5. 25 1~ . O /U'oZ ~~`S
WATER LATERAL ~
WATER AREA , a] - / ~
STORM SEW TRK 1 O 9 2. ~3 1 - IU' 8-~~
STORM SEW LAT
CURB & GUT7ER '
SIDEWALK
STREET LIGHT
WATER CONN. n
~UILDING PER.
SAC ir tr
PARK
INSPECTION RECORD I Control No. L
ClTY OF EAGAN PERMIT TYPE: ~aux ~ t~ ~ N~+
3830 Pilot Knob Road Permit Number: r~ b
Eagan, Minnesota 55123 Date Issued: 1!~? 9 J 9 a
(fi12) 68i-4675
SITE ADDRESS: s~ K= ~ APPLICANT:
47~? RIDAE L~IINd TR BARRETT 60B
PARK RJbtdF 2MfI (612} 9~12-9~2~
PERMIT SU6TYPE: TYPE OF WORK:
w~~~~: wr: w r~~ ~~+rsM AItERAtION
. .
~HA1lIM1~ f'INJIL
~
~ _,F-' _,y..'~~~~~~ ~ ' ~ F ~ ~
. - . - ~ ~ 3~. ,
- , ~ -~vfi ~~~3~~-,~. _ ,,sx .
. , - _ . _ ~ - • • ; , ,
. . .
. ~ . ~ ~ _ - . . . . . . ~ _ a _ T.. ~ , ' . ` - . Y
L~ _ ~ ~ _ ~ _ _ _ ~ ~ ~ ~
i's?tnR No. Permft Holdsr Date Tal~phono /
SIVY
PLUMBilV(i ~
HVAC
ELECTRlC ,S/ ,3 ,
~ v2 ~
ELECTRIC
M~etlvo D~te Map. Commenb
Foaiings I
Fourdetlan
Framing ~l ~ .1 ~ ~
Rooflny
RoWh PIb9•
Rough Htp.
) z - ~ cu.¢-r,K v -
F~~ L~~L ~/N~f 1
Final Htg.
Orset Teai
Flnel Pltip. Plbg. Inspector - Notify Plumber
Conet. Meter
Engr.lPlan
Bkip. Rnal
Deck F~.
I
Deck Flnel I
w~i ~
~
Pr. Dfsp. I
~ a I
, ~1iti~lOtr~r
° CITY OF EAGAN WATER SERVICE P~l1AIT
I 3830 Pilot Knob Road
P. O. Box 27199 PERMIT NO.:.. _
Eagan, MN 55121 D/~TE: ~
Zaninp: No. of UMrs: 1
Owner: - ~ ' it3:~~ •
Addross: -
~ Site Addr•~ rr ~ -
I. Plumber. ~ ' ~ '
Meter No.. ~b6~:
=
~ ~(0l3 E nnection ~Charpe: .
~ 1`.>.
~ ~g , /~4"t', , ~ _ ~ Aooourit De t:
Size: Po?~ -
' Reode? NO.. O gI~7 ~9g.~~r ~ i a< ~~~+er~t~`Fsl:`y ~ n n~`
! . `i;; ,
1 y~w eo aowot~r wfK ew C~ ef E~rw Sur~arge: '
prii Mfsc. Chor~ees: i ._i'~~x~i ~
Totol: ~ ' . , ~ .
~ By - Dote Poid:
~ o Irup.: In~p.:
~4r18~g`~ ,
CITY OF EAGAN SEINER S~tVlCE PERMR
3830 Pilot K~nab Road
P. O. Box 21199 PERMIT NO.:
~ Eagan, MN 55127 DATE; -
Zoninp: No. of Units:
Owner. :
Addrcss: ,
, ~
Site /lddress: ~ • - ~ ~ s _ ; _ ~
' Plumber. ~ ~ ;~.-?j:~;l ^
7'-'~-~ - , r~{11~~± .
1 y~w M ee~a~l~r wiN~ !M Cihr ~f l~p~ Conrnction C~a~:
OrdiM~e~s. /laount Depodh
Pem+it F~s:
Su~dwrpet
BY Misc. Chorpes:
Date of inap.: Totol:
I n~p.: Doh Poid:
f
¢~o~~ yo~ - ~ n,t~;~ /OG o~ 7
,1. 452 8 _ ~ ~ ~ -
Fequest Date Flr . Rouqh~in Inspection
J~ ~ Required~ Featly Now ? Will Notify InspecWr
7 ? Vgs a Wlten R
~ I~licensed contractor ? owner here6y request inspection ot above eleclrical work at: .
Job Atldress Street. Box ar Foule Na. Ci
~ ~7ya ~if e w~.,a( T ry en
Section Na TownsM1ip Name or No. qg Np, Counry ~ [
A oTA
Occupa ~PRI~yT) PhoneNO.~~' ~
C.l% A
Pawer uD -er / Atltlress
A .o ~..f..n. ~j'3rx~ ' ?o'~ c~~ ~n, /p.~
Elec~nc Conhaclor~9 ompany~j
e~ , Contractor§ License No.
~9n.nd ~/t~.~i~ CAoo~ 33
Matling Adtlress (Connactor or Owne~ Making I slallation~
~o?~nc+~oz.o ~..e Jon~A,a /7'1N SJ~3Sa
Aulhorizea SI I e oMrsGtor/Owner aki Installationl PhOne NulMlar
y9~ - ~
MINNESOTA STATE BOARO OF ELECTFICITY THIS INSPECTIDN REOLIEST WILL NOT
Griggs~Midway Bltlg. - ROam 5-1]3 BE ACCEPTEO BY THE STAtE 90AR~
tBPI Univereity Ave., SL Paul, MN 55106 UNLESS PROPER INSPECTION FEE IS
Phone~61t~602~0800 ENCLOSED.
• ~ CITY OF EAGAN N~ 16563
3830 Pilot Knob Road, P.O. Box 21•199, Eagan, MN 55121
PHONE: 454-8100 ~ ~
BUILDING PERMIT Receipt # ~
To be used for DECK Est. Value $1, 000 Date J1JNE 2 ~ g 89
Site Address 4742 RI?GE WIND TR OFFICE USE ONLY
Lot 6 Block 4 SeGSub. P~K RIDGE 2ND
Parcel No. occupancy - FEes
Zoning
w Name BOB & CONNIE BARRETT ~qctual)Const - B~dg.Permit 26.00
i Address 4742 RIDGE WIND TR (Allowable) - Surcharge - SQ
0
City EAGAN PhOne 688-2042 # of Srories -
Lengih ~ P~an Review
o Name S~ oepm ~ snC, c~ry
Address S.F.rotai SnC,MCwCc
U<
~ City Phone S.F. Footprints -
On Site Sewage _ ~Nater Conn
~
W W Name On Sile Well - Waler Meter
MWCCS stem
~o Address Y - AccL Deposil
aw City PhOne Cirywater -
PRV Required - SNJ Permil
I hereby acknowlege that I have read this application and stale ihat the Booster Pump - SrW Surcharga
iniormation i5 correct and agree to Comply with all applicable S~ate of
Minnesota Statutes and City of Eagan Ordina~,n7ces'~-~}- Treatmenl PI
Signature of Permilee __~el~'~~~u ~ A7PROVALS Road Unil
A 8uilding Permil is i5sued to: BOB OR CONNIE BARRETT Planner - park Ded.
on the express condition that all work shall be done in accordance with all Council
applicable State of.M~1innesota, !S1tatutes andy
~Ciry~o1f Eagan Ordinances. g~dy. pry, _ Copies
8uiltlinqOflicial I'~~ II.pA! I11?J Variance - TOTAL Z6.$0
. , CITY OF EAGAN N~ 10 6 3 8
3630 Pilat Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100 ~ 6L .
BUILDING PERMIT Receipt
Ts M wd !a SF DWG/GAR Esr. Value 553~ 000 pa~e JULY 22 ~q85
SiteAddrea 4742 RIDGE WIND TR Erect C~ Ottupancy R3
4 PARK RTnGF. ~Np Remodel ? Zoning ul
Lot Blaek Sec/Sub. Repalr ? Type of Const. ~
Parcel No. Addition ? No. Storiea
RUSCON HOMES INC r.tove ? Lengtn 48
~ Nari+e Demolish ? Depth jS
Address 14530 PENNOCK AVE Intlmpc ? Sa.Ft.
cn~ A• V• Phone 432-1433 inscan ?
SAME Apo~ovol~ F~es
~ Name
Asseument Permit 292.00
Addrest
City Phone Water 3$ew. Surc~erge 2 6. S ~
Police PlanReview 146.00
~'Z Neme M11RK NAGEL/PROBE ENGR Firo snC 525.00
p~~f 14530 PENNOCK AVE ~q, WaterCOnn. ~Q2~~0
~b ci<v A•V• phone 432-2044 pi,,,,,er waterrne~er ~3.~00
CounNl Road Unit 280 _ OO
I herebY ackrqw~eAps thot I haw reod this appliwtion and ata~e that Bidg. Off. ~~~-7I H S Tr. PL 13 2. ~ ~
fha Informafion is cortect and ugree to comply with oll npplicobla A~ parks
Stnte of Minnewta Statuta: and Ciry of Eaqon Ordina c.
/p C~c~ ~ ~~3lc~ Var. Date Copies
$iprroturo of PermiMaa ~ ~ iota~ $1 ~ 964 . 50
A Buildlnp Permlt Is issued ro: RUS ON HOMES INC on tha azpress eordition ~hoi
all work shalt be done in uecordm~ce with ol li State of MI ta tot and Ciry of Eoppn Ordinancef.
BWlditq Ofiidol ~ ~~~~L'`'f
REQUEST fOR ELECTRICAL l CTION es-ooooi.oa
w:
O o 3~ ~ ~See instructions for completino~ ~ beck o/ ~ Ilaw capy.
5 "'1{"" Below Work Covered b This Re uest q 3~ $
Add Reo. Type oi euilaine APO~iances Ylired Equipment Wired
Home Range Temporary Service
~ Duplex Water Heater Lightiny Fixtures
Apt. Building Dryer Electric Heatin
Commercial 81dg. Fumace Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tank
farm ome, ne~:~ v ~ne~ lsue.:~fv)
t er Suocify Ot er Oth~;r
ampute lnspection fee Below
'p Fae ServiceEntranceSize N Fee 'Faeders~SUbteeders~ M Fee Circuits
! ~to200qms - Oto30Ams 2 Oto30Ams
Above 200 qm~s 37 to 100 qmps 31 to 100 A s
Swimmin Pool Above 100_Amps Above 100_Amps
Transiormers ~rngation Booms ' Pertial~'Other Fee
. Signs Suecial inspection S22O0
Pem+rks TOTAL F D
JJ J
flouqh-in O~^eI~// ~he Eie -
~ In%pactor, Mereby
~ ' t the above
Final f nsoeetion has been
erode.
~~ie request voltl 18 monlM1a irom
~ ~ o~~
Ko a9 9 5 !o, c.~ c~~
Request ~ate Fire No. Raugh~in Ins ion
Requ ? ? Reatly Now ill No~ify Inapector
j,7i 9'L gs ryp When ReaW~
1 ~ licensed contrador ~owner hereby request inspection of above electrical work at:
J Atltlress (Slreet. BOoa or Route No.~ Ciry
~/7YL I~~ c. GJ.%~ 7/
SacM1On No. Towns ' Name or N0. Rarge No. Cou~y
OccuOan~ IPRINT~ Pfiaie No. w p 9yZ ~ 9y~E
o H • - Zyyz
Power SupPlier / Atltlress
~p /~~GKric.
ElecVical ConVac~or ~COmpany Name~ CoMradork Licensa No.
Maifing A~ress ICOnhactor or Owner Making Installation~
y~yZ w.~ ~
~ ~r,. s ~Z-L
Aulhorizetl SignaWre i IractorvOwner Making Ins~alla4onl ~ Phone NumOer w~ 9~/Z' yZ~
~ ~ZoYL
MINNESOTA STATE 60AH0 OF ELECTpICITY TNIS INSPECTION REOl1EST WILL NOT
Grigga-Mltlway 81Eg. - Roam S1]3 BE ACCEPTEO 9Y TNE STATE BOARD
1821 Univarsity Ave.. St. Peul. MN SS10C UNLESS PFOPER INSPECTION FEE IS
Phone(61])661-0800 ENCLOSED.
/o g 9~ RE~UEST POR ELECTRICAL INSPECTION ee-oaom-
ry C ? SeB inslrutlions fot mmpleting ihis form on Ceck oi yellow wpy. ~Dq7f~i~~
~ ~ ~ ~ ~'7C" ge/ow Work Covered by This Request
ewA~.J Rep. 7ypeoBuilding AppliancesWired EquipmaniWired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt Building Dryer O[her-(Specify)
Comm./Industrial Furnace
Farm Air Conditioner
O~her (speci(yl ConVanor's Remarks:
Compute 7nspection Fee Below:
# Other Fee # ServiceEnirance5ize Fee # Circuifs/Feeders Fee
Swimming Pool 0 to 200 Amps 0 to 100 Amps
Transformers Above 200 _ Amps Above i00 _ Amps
Signs Inspectork Use Only. TO2TA~L
~ Irrigation BoomS 1~~ ~.~C,/
Special Inspection
Alarm/Communication THIS INSTALLATION MAY BE ORDERE~ DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN NTH / f
I, the Electrical Inspector, hereby Rough~in oa~ ~
certiry that the above inspection has Final oa~
been made. ~ '7 -
OfFICE USE ~NW
Tliis repuesl voitl 18 monlhs imm
This reques[ void ~ ~ y
v
05453~ ~ Lc~ ~ ~f P~~c~ ~ 5~
RequPat Date Fire No. HnoBh-i InsVeciion ~
I _ ~ fleqw ? ~Reatly Now ill Noti~y, InsOec-
es ? No ~or When Headv
icensetl Electrical Contractor . 1 hereby reQUest insoection ot abova '
? Ownar ~ elecVical work inslelled at:
SUeeYAdd~ess, 6ox or Rou e No. . City
l
ecuon o. Town.hio Name or o. fianye o. Counly
OccuOant I INTI Phone No.
~ ' 3~-~ / 33
P r S~nDlier Address
~ ~~7.(. / ~ .
Elecvical on[ractorlCOmOanY Name) ontrar,mr's Li~ense No.
~a ~ ~
MailinB A~tl~ess 1 ontracto~ or Owner MakinB ~~sWlla~i nl }~j
yy
/ O ~~/J~J / V
Authorized Si namre trac~ r/Own akiny Insta la~i • 1 Phone Numbe.r
~
MINNESOTp STATE B~ ND OF ELECTflICITV TMIS INSPECTION PEQUEST WILL NOT
Griggs•Midway Bldg. - Noom N-791 BE ACCEPTED BY THE STATE BOARD
LINLESS PPOVER INSPECTION FEE IS
7827 UniversiiY Ave., St. Paul, MN 55104
Phone (612~ 297-2177 ENCLOSED.
~//c~G~/g~ REQUEST FOR ELECTRICAL INSPECTION esaoaoi-0e
~ 4 5 2 9~ See inrruotio- 1or wmp-eting ihls lortn on Dack of yellow cropy L~'
~~~~A ~~lpJr~~'/
~ g~ _
"X" Be/ow Work Covered by This Request
ew tl Rep.. TypeofBuiltling AppliancesWired EquipmentWired
Home Range Temporary Service
Duplex Wa}er Heater Electric Heating
Apt 8uilding Dryer Olher (SpeCify)
Comm./Industrial Furnace
Farm Air Conditioner
Other~syeciry~ Contramors Remarks:
Compute Inspection Fee Below:
# . Other Fee # ServiceEntranceSize Fee # Circuits/Feeders Fee
Swimming Pool 0 ~0 200 Amps O to 100 Amps
Ttansformers Above 200 _ Amps 100 _ Amps
Signs ~~w~or5 use only: ~ ~ TOTA Q
Irrigation Booms ~
Special Inspec[ion
Alarm/Communication THIS INSTALLATION MAY BE ORD DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONTHS.
I, the Electrical Inspector, hereby Rouq~~in oa~e
certify ihat the above inspection has F;,,ai Dare
been made.
OFFICE USE ONW ~ ~
This request voitl t8 moniM1S Irom
1989 H[1ILDING PfiRMIT APPLICATION - CITY OF EAGAN . ,
3IRGLE FAMILY DWELLING3 f ~ ~ ~ ~
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS
NOTEt ADDaFSSFS FOR CORNER LOT3 - CDNTRACTOA/HOMEOHNER MUST DESIGNATE HHICH ADDRESS
I3 DESIRED. AO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS I330ED.
NULTIPLE DWELLINGS EENT9L OZIITS FOH SALS QiiITS ~ OF 08IT3
INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SIIRVEY - CHECg iiITH BLDG. DEPT.~ 1 SET OF ENERGY
CALCULATIONS
COPAIERCIAL
INCLUDE 2 SETS CF nRCHITEC?:;R<.L g STDrirT~Tp~~ Pi!!A?Ss
1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS
To Be Used For: Valuation: ~ Date: t~J%
Site Address y7y~ LJ,,,,[ ~ OFFICE OSfi ONi.Y
Lot (o Block Occupancy FEES
Zoning
Parcel/Sub 2.~..( /-}a~,~~~' Aetual Const Bldg. Permit ~
Allowable Sureharge ~~Q
Owner „(j,,,,;~ # of stories Plan Review
Length O-~ SAC, City
Address `1~vz ~Q,q~ W,;,~! j.,,% Depth /z~ SAC~ MWCC
S.F. Total Water Conn
City/Zip Code SsjzL Footprint S.F. Water Meter
Aeet. Deposit I
Phone ~~d~-1~YZ On site sewage S/W Permit
On site well S/W Surcharge ~
Contraetor N/f4 MWCC System _ Treatment P1.
City water _ Road Unit
Address PRV required _ Park Ded.
~ Sooster Yump ` ~opies
City/21p Code TOTAL ~l..f~~
APPROVAI.S
Phone ~ - Planuer _
Couneil
Areh./Engr. ~V/,4 Sldg. Off.
Varianee
Address Council
City/Zip Code
Phone 0
NOTEs Sewer & Water Permit fees and account depoait fees will be ineluded in the building
permit fee. Processing time for aerrer and saater permits is two days once a lioenaed
plumber has applied for a permit at Citiy Hall.
,A O B E 3 EN4INEEAS . '
ENGiNEEAiNG `P~ANNEAS and li1ND ~URVEYOIIS
I COMPANY, INC.
1000 EAST 146M STREET, BURNSVILLE, IdINNESOTA SS337 PH ~32'3000
cer~i}'i cac~~~ Su~-y-e y
~¢OQt .I~G.lCr'~p~~OSL• ~pT 6, BLOCK 4, PARK RlD~E 2ND ADDITIUIV,
~ DAKOTA COUNTY, MINNESOTA
~~yo_o% DENOTES EXISTItJG ELEVATION
(9'{°• pENQTES PROPOSED ELEVATIO~I
INDICATES DIRECTION OF r
SURFACE ~RAINAGE ~ 33 ~a~
J
FIN~SHED GARA6E F~.oOR r^5 S
~tE,/artotil = 94z.3~y ~ - -i' % ~ ~a
/ ~ ~ ~
Q R-
O
~ / \ 0 S
o-.
10 : ~
o ah oo LoT E \5
GQ a~~ 9
~ ~ ~ s ~3s D¢~( .
~ ° '-y~°J ¢ s'
. ~ .y / 9333c
,a ~ I"t ~ L . i / J,
1~ l ~
$ a~~''~rv (f~ 11~~ "nF _ i ~
,j ~ ~ .
~ ` $ ? ~ ~ 9~
ti~ \ ~<J ~ 33 t~ 9`''~
~o ~ ,1,''~ ~O~Pp~~'~' , rv
; \ ~~2~`i ~ ~T' c~:,ti ~
'S / °1 q, 3 . \ A~ ~ ' ~
~'l ~iaG ~
O ~z 1° aq L_~_, ; ,
i O ~9fr vo1 ~ !1
F
R ~ ~a
~~?i So_ \o \ /V, Z--30~ FRCN? BUILDI/VG-
NORTH F " SET'PACK LIIJE-
SCALE = 30• ~O
4j< s
~o DRAINAC-E AND
~o\~ UTILIT`( EASE??1ENT
9 ~
~
~ 's •
I her~by certity that thia ie a true and corract repreeantation of a tract ot
land as shown'and deecribed hereon.. Ae prepared by me on thi~ i~"~ day ot
.Tv~y , 1985 .
~
, T ?linn. l~~s. No. /6~Sf
~ ~ B~ y CITY OF EAGAN CITY USE ONLY
PLUMBING PERMIT
SUBD. p~,~~G S~ (612) 681-4675 RECEIPT ~ _GZI~~~
O DATE /D dl
RESIDENTIAL
PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMES AND CONDOS
WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
WORK DESCRIPTION COMPLETE THE FOLLOWING:
N0. 1~?}tTURES EA. TOTAL
AEW CONST ~ REYAIR/ADD ON 15.00 /S~
ADD ON ~ ~ SHOWER 3.00 ~
REPAIR _ _ WATER CIASET 3.00
BATH TUB 3.00
IAVATORY 3.00 '~.6
OW:7ER NAME: ~ /~~ri~ _ KITCHEN SINK 3.00
/~~n ~ e IAUNARY TRAY 3.00
SITE ADDRESS: y7YZ /(.c~';c /?i.(,~( T/ _ HOT TUB/SPA 3.00
_ WATER HEATER 3.00
_ FIAOR DRAIN 3.00
GAS PIPING OUT.
INSTALLER: fe/~
_ (MINIMUM - lj 3.00
_ ROUGH OPENINGS 1.50
ADDRESS: OTHER
_ WATER SOFTENER 5.00
~~~y~ ZIP: _ PRIVATE DISP. 15.00
U.G. SPRZNKLER 3.00
PHONE ' _ W. TURNAROUND 15.00
STATE SURCHARGE .50
SIGNATURE OF PERMITTEE TOTAL: S~/S.S
O
COMMERCIAL
PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS. ALSO FOR MULTI=FAMILY
SUZLDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT.
WORK DESCRIPTION:
OWNER NAME:
CONTRACT PRICE:
SITE ADDRESS: 1X OF CONTRACT FEE. .
STATE SURCHARGE - $.50 FOR
T~~T N~~ EACH $1,000 OF PERMIT FEE.
SUITE $25.00 MINIMUM FEE.
INSTALLER: CONTRACT PRICE x 1X $
ADDRESS: STATE SURCHARGE $
CITY: ZIP: .
TOTAL: $
PHONE :
FOR: (SIGNATURE)
CITY OF EAGAN
INSPECTION RECORD Control No. ~ 2~~
CITY OF EAGAN PERMIT TYPE: R u z ~ o z N s
3830 Pilot Knob Road Permit Number: 0 0 7. 7 0 5
Eagan, Minnesota 55123 Date Issued: 1. t~ / 2 9/ g 2
(612)681-4675
SITE ADDRESS: ~ ~ T: 6 B L 0 C K c q APPLICANT:
4742 RIDGE WIND TR BFlRRETT B08
PARK RTDGE 2ND (612) 942-9428
PERMIT SUBTYPE: TYPE OF WORK:
8ASEMENT FINISH flLTERATlON
. .
FftAM,T.NG FINRL
~
~ -
, PERMIT ~ontrol No. 9~7 /I H
1G~~
~ITY OF EAGAN
3830 Pilot Knob Road PERMIT TYPE: s~~ z~. p x r~ ~
Eagan, Minnesota 55123 Permit Number: 0 rp 7, a q,
(612) 681-4675 Date Issued: 10 ! 2 9/ 9 2
SITE ADDRESS:
4742 RIL7~F, WTNC] Tft
LO7~~ 6 BI.OCK; 4
PRRK RIDGE 2NfJ
DESCRIPTION:
' Bu.;il~f,i~~n..g r~ermit Type BASEMENT FINISH
Bui~~{,i.ns'~W_ork Type ALTERATTQN
UBC DcCU~~rtic~y ft-3
`
L
t,'~f,
~,4~ i.
5d,
1 ~ 7
t '.i ~ 7=~~~[`~+ r1~1~~~ ~~i~t~~'~'
}
4
s r ~ ~ ~ L ( ~ ~ I ~ c t_
~ . z.~ r_ x
,
REMARKS:
~c~Zf~~~
FEE SUMMARY:
6ase Fes $35,~~i
5urcharge ,~,50,
Total Fae $35,50
CQNTRACTOR; OWNER: - Flpplicant
BflRRETT (30B
474?_ RSDGE WSND TR
EA6AN MN 55122
(612)992-+~428
I her~by acknawledge that I have re~rd thi~ applic~Cian and state kh~t ths
irrl`ormatibr~ is ccrrrect ~nd aqree to comply with all ~ppl3caksle State a'f tCn,
~ statutes and City of Eagan ordinan~es. J
` L~~-+~..e~ ~ QC~G~~ Q,c~__ ~n:.e~ fts~,rl 1~~_
APPLICANT/ ERMITEE SIGNATUFE ISSUED BY: IGNA~'TIR
PERMIT ~i CITY OF EAGAN 'r~-~
REacrI~aTF _ 1992 BUILDING PERMIT APPLICATION
~ 681-4675
1 3 ~ .
SINGLE 8 MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy
calcs.
COMMERCIAL 2 sets of architectural 8 structural plans, 1 set of
specifications, 1 copy of energy calcs.
Renalty applies when typing of permit is requested, but not picked up by last working day
oF month in which re uest is made or lot chan e 1s re uested once ermit is issued.
Date _ /D / 9 / yz- Valuation of work
~
Site Address:_ Y77'Z j~q j
57REET SUITE f
Tenant Name: (commercial only)
LOT ~ BLOCR ~ SUBD. PQlIL QICIc,e P.I.D. *
O
Descri tion of work: / . ~.,e~.,~,,~-
The applicant is: ~ Owner Contractor ? Other (Oeserlbe>
Name /3ar~~Z~ ti Phm~~e, ~ 2~yz F~-
Property ~~51 F,RST a _ ~
Owner Address y~yz. ,Q,~14~1,J, ~ T.. % ~y~~y~ Conn~e.
STREET ~
STE A
City /
~ State /1'~n. Zip .5.-S'/'Z-Z
Company Phone
Contractor Address License N Exp.
City State Zip
Company Phone
Architect/
Englneer Name Registration ~
Address
City State Zip
Sewer 3 water licensed plumber Processing time for
sewer 8 water permits is two days once area has been approved.
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 Ninnesota Statutes and City of
Eagan Ordinances.
Signature of Applicant: L~,/
O ~
OFFICE USE ONLY .
BUILDING PERMIT TYPE ~ '
~u q
V? r ~
? O1 Foundation O 06 Duplex ~ 11 Apt./Lodging ~-lb Basement Finish
? 02 SF Dwg. ? 07 4-Plex O 12 Multi. Misc. ? 17 Swim Pool
O 03 SF Addition ? 08 8-Plex ~ 13 6arage/Accessory O 18 Comm./Ind.
? 04 SF Porch ? 09 12-Plex ? 14 Fireplace O 19 Comm./Ind. Misc.
? 05 5f Misc. ? 10 Multi. Add'1. ? 15 Deck ? 20 Public Facility
? 21 Miscellaneous
WORK TYPE
~31 New O 33 Alterations ~ 35 Tenant finish ? 31 Demolish
O 32 Addition ? 34 Repair ? 36 Move
GENERAL INFORMATION
Const. (Actual) Basement sq. ft. MWCC 5ystem Z'r-,~
(Allowable) ~ lst F1. sq. ft. City Water
ii6C Occupancy Q-3 2nd F1. sq. ft. PRV Required
Zoning Sq. Ft. total Booster Pump
/ of Stories Footprint Sq. ft. Fire Sprinkler
Length On-site well Census Cade ~~,~t~
Depth On-site sewage SAC Code ~
APPROVALS ,
Planning Building Assessments.
Engineering Variance
RE~UIRED INSPECTIONS
? Site ? Footing ? Framing ? Insulation
? Wallboard ? Final ? Draintile ? Fireplace
Permi t Fee vei~~;~: g
Surcharge
Plan Review
License
MWCC SAC
City SAC
Mater Conn.
Water Meter .
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total:
SAC % ~
SAC Units ~
~
, ~ .
. ~ ~
1~
1985 BUILDING PERNIT APPLICATION - CITY OF EAGAN
NaTE: ALL CONTRACTORS MUST BE LICENSED WITH THE CITY OF EAGAN
INCLUDE 2 SETS OF PLANS
3 CERTIFICATES OF SURVEY
1 SET OF ENERGY CALCULATIONS
53,oca~.
To Be Used For: SinQle I'amil~ Valuatian; ;~ate:
Site Address: -~~~Z ~~~~}j~ OFFICE USE ONLY
Lot: ~ Block ~ Sect/Sub P~['~ Erect Occupancy (Z-3
a N~} Remodel Zoning
Parcel - Repair ~ Type of Const S=
Addition ~I of Stories
Owner ~I lf ~~~(f~ Move ~ Length ~
,j ~ Demolish Depth 35
Address ~
jU7 ~f~_~ Int.Impr. _ Sq Ft
Install
City/Zip Code ~DF3.1 ~1~2~,,
Phone ~7^~~~,~~ APPROVALS FEES
Contractor _RUSCON HOMES,y INC. Assessments Permit 2°12."-'
IJater/Sewer Surcharge Z(o.3-°
Address 14530 Pennock Avenue Police Plan Review 14~.°°
Fire SAC 525,
City/Zip Code Apple Valley L hIIV 55124 Engr Water Conn ~Q~
w
Planner Water Meter 3.
Phone 432-1433 Council Road Unit 2So, =
Mark Nage1 Bldg Off 7 - Treatment P1 {3 2_`=
Arch./Engr. Proobe EnQineerine APC Parks
14530 Pennock Ave Variance Copies
Address 1Q00 E. 146th St. TOTAL ~
Apple Valley, hIIV 55124
City/Zip Code Burnsvillei hQV 55337
Phone I/ 432-3ppQ
2¢ ~c 3C~ _~,cP 4 x 54-= 4-(~~s~ , , .
, ,
• ~ S2. ~ ~ ( ~`~OS . ' v :
2q K'
`~Z 4~4
a08E CONSULTIN6 EHOINEERS
ENGiNEEttING PLRNNE85 ond LAN~ 3URVEYORS
COM(~ANY, INC.
L ~00 EAST 146M STREET, BUANSVILLE, LI~NNESO7A 33337 PH ~32'3000
ce~-~Z}`Z ~a~ su.~-z.-e y
~~t ~~~''~~p~~~n~ LOT 6, BLOCK 4, PARK RIDGE 2ND ADDITION,
~ DAKOTA COUNTY, MINNE54TA
~'~~`o_s% DENOTES EXISTIt~IG- ELEVATION
(9~• pENOTES PROPOSED ELEVATION ~
INDICATES DIRECTION OF r93 `
SURFACE DRAINAGE - ?
~o`
FINISHED 6ARA~E FwoR ~ i, s
Et~?a-rtc,J = 94z.3'~ : s' s~
- ! o
/ \ ,O 'R ~
~ ~ \
O S
o / . °
1 • F
D a5 ° / ~ LoT 6
kq ~p ~ 5
d
~ \ ^ s \9 '
3
i ,a ,Y~ ' ~ y >
.y 93 : <
"e yti~ ~ . i-,~; ;,,J.
. ` i_ ' j ` i '~C
s~ .i ~
a~~ ~
8 k '3 i~Q7 /
g ~33ja13~~~/ r39,
~ J
~~'~,~,~D'~ f.` , ~i
O
\ ~2`i~ ~ Y' h>> o ~e
0
~ ~S J g ~ .r A~' ~
R~~G ~,O ~ ~z ° aQ ; ;
F R
o ~9y~~-o~ ~ !1
~~TjC So, ~S 30~ FRONT gL'ILDING-
I~10 RTH c<` " SETBA~ K L I 1.1E-
SCALt ` 30~ ~j~< ~
c DRAINAGE AND
°`J UTIl.1TY EASE~?1EN~
9~
~ s -
I her~by certify that thia is a true and carrect representation ot a trac! ot
land a• •ho+m'and deecribed hereon.. As prepared by me on thi~ day ot
Tv~y , 1985 .
_ 1linn. ltes. No. /~085
• v
. . . ~ ~v~s~..,
~ .r . • ~
~ - EXTERIOR ENVELOPE RYERAGE "U" COMPUTATION ~ r; ~ ~
, y .
. . . • • . .
~ , OWNER . ' . - . ,
~ ~ - : . - - ' - , r ~.:.~1 : • : _ ' . . r ~ r . i - •.-~,M. .
, ; SITEf A~DRESS`
. t e:r , ~ . . . . _ .n,~ .
.r... ~ ~ . . • ~ ~
CONTRACTOR CZ-u~~o~i tla,~.~s' OATE ~ . . -PHDNE~~q3Z ~l~?~3_
. , , _ . , . • .
Determine working square faotage of each. .
,
1. Total exposed wall area l~~oZ ~ sq. ft. x sl I .
2. Total roof/ceiling area sq. ft.~x o' Z6
7ota1 exposed wall area above floor = 16~'07:7
a, Total wall window area /29,Z
b. Total door area . ~R ' • '
.
. c. Total sliding glass door area . f~g
' d: Total fireplace wall area - . '
e. Total wall framing area (average 1Ub)...:........ ~
. f. Total net wall area above floor ~ 271~,f~ . '
• g. 7ota1 rim joist area 49.~f,_ .
Total exposed foundation area = 95, Z ,
h. Total foundatian window area -
1. Toal net foundation area above grade 9-
5~~
Deterrsine "U" value of ea~h wall segr_nt. •
a. /29 Z ~ ~~U~~ = 2.~
~ 3R x „U„ .13 = q,44
- c. Q$ x "u" ,33 = Z9.d4
d. - X s -
~ e. /41, Z _ x . ?o , 4• 12
f. / 27~, Q~ X . nA3 = ` ~ .
9• ~ X . 04 . ° ~.9$
h. - X „u~~ ~ ~ ^ ~
, i. q~_ X . o~ _ ~Ce~
3 . f:. ~-:-.....Total = / D '
If item n3 is the same as. or less than item ~1, you have met the intent
of SBC o0C5(c)2.
,
. ~
. : r t ~ . . . . . . .
'~r, , 'y ~ ir rl' ~ ~ ' ' ~ . ~
Y
~b . : 4 1 ~ ~ ' ; ` ~ ' ~ i '
~ . • . . •'~1~ ~ • I". . ~ f.~.,,~. . , ~ .
~ Total exposed roof/ceiling area
~ ~ • Total gross roof/ceiling area = . •
Total skylight area . ~ ~ .
k. 7ota1 roaf/ceiling framing~area ~
1. Total net insulated roof/ceiling area....... __1''~~ - .
Determine "U" value for each roof/ceiling segment.
~ . . . . ~ II I IY s~ i ' .
V 4
~ k. .Qf~'`-i' X IIUII r OLA ~ Z. / ZJJ1GNeea~~Z~$Z~~IUSULOVER.
[ /v/ L ~i
~7~' V X nUn D7i . _ a l~5~. 'f2.~~56 ~l.~~e 3.1~.
~
+ 4.................... ~ ° ~ '
...............Total / Z .
If total of ~4 is the same as, or less than fl2, you have met the intent of ~
SBC G006(c)T. . . . •
N
To uti7fized the total envelope system method, the values.established by the
sum of items #3 and B4 shall not be greater than the sum,of itens B1 and ~2. .
. _ . } 2. a .
3. + 4. _
MATERIALS Therm. Resistance "R"
Exterior Air - Lp~
5lding Material . ~5 ~~u
Sheathing Z•°i,
Insulation ~g_ s'~+-^
Sh9e~oCk .95 !'i
Interiox Air ~ 17
5tuda s.s e; i Pu .
Rim 1.5 „
Conc. 81ks. 1.28 +~i, ~s.zt
,
' _ . . . ~ .
~ , -
~ , i al~~+
i
~ ~ /j CITY OF EAGAN
L-.~'Jr APPLICATION FOR PERMIT
~ ' SE~VER AND/OR WATGR CONNECTIODT
I (PLEASE PRINT)
1) PF,OPIIiI1' A[~DRESS: _ d7d~ tzi Ago ~.>i nr3 m ' 1
iFrai. DFSC.RIafIC:7: L6-B4 Park Ridae
(Lot/Block/Subdivision or Tax Parcel Z.D. N~r)
u EtIS:= :G `..'T.~F;CI'~,:2E. Dr1T' 0_' ORIGIidAL riiILDL'IG P~_~.ZT ISS~?NG°.:
~Y
P:t:S~~ ~:.^,~Ii~l:/P.-.~)°OS~ i53: ~ R-1 S~7GL~ rP~SLY •--V.--° •
? R-2 CUPL,E.'C ('ITnO Wi ITS)
~ R-3 TG~1[~30USE ('I'HRF." + 1.P.dITS) ( Wi
ITS)
? R-4 ApAR'IP~..''T/C~DIDC~~1Ti1IU.~1 ( Wi
ZTSi
? ca~c~r./~r~r~or~zcE ,
? ~USTRIr~L
Q INSTITUTIONAL/Gp~'IIL~pr
z) AP°LIC~~T (PLEASE PRINT) - _
NAhSE: Ruscon Homes, Inc.
ADDRESS: 1453U Pennock Ave.
CITY, STATE, ZIP: _Apple Vallev MN 55224
PHO~: 432-143'i
3) Pj,j,^•igg~ PLEASE PR1N1) .
NF4~tE: Star Plumbirlg ' FOR CITY USE OvLY
ADDRESS: 1018 MOUrid $ 21 PLUHBEA ,LICENSE:
P 'ngs Ter.
. Active
CITY~ STATE, ZIP: Bloomington~ MN 5~}+20 E:pire
P$0~: ~ Nok Record
884-4i49 PLUMBER LICENSE N 3329M ~)4 ~
1 n ia
4) 0[CIJPpl'~'f/('J,~r1Eg ' (PLEASE PRINI)
NF1ME: MILLS, David
ADDRESS: 14327 Vallev View Rd
CIT^l, STATE, ZIP: Eden Prairie, Nia..55344
P~~~~ 937-1561
5) INDZCATG L+1!-IICIi PEP,FIiT IS BEI[~,'G REQUFSTED;
~ CC:W"VECi'ION 'il~ CITY SEY]ER
~ C0:]DIE~TIOy 'i1~ CITY P7ATf.T2 ,
? CJI'F~2 (PI,I'ASE DFSCFtIBE)
6) ~dpIG,.:; 0:~:
? PI4?SE F'.OID APPRWEp PER~IIT FOR PICFC-UP BY ONE OF A60VE
°IF.aSE b'AIL PRWm PER~LIT TU 1, 2,O 4 AHOVE
(Circle one)
7) SI~v'aTL.~E: DATE:
~e ~e a'w:a+~:wi~ n~ aa ~e~~:~ ri r r~sa:a:~ ~ sr sr:sa:~ ia a a.R rt~r..~:r~tar~ r a~f rssssaao-w
F O R C I T Y U S E O N L Y
PERtit2T ISSU~D ,
~
prr. g; $ Si> SET•:Eo nc,v,ur i( I:;C:.:iD: SUP.CH~r~.Gc)
$ /o-S~c~ . WATER PERP4IT (INCLUDE SURCHARGE)
$ ~ ~i~r, WATER METER/COPPERHORN/OUTSIDE READER
$ W?~TEP. TAP (I.ICi,UDE CORPORATION S:OP)
$ SE;aER TA?
$ /5-~~ ACCOUNT CEPOSIT - SEPIER
S lS.v~, ACCOUNT DEPOSIT - WATER
$ S"~• ~ WAC
$ ~aS:~c~ SAC
$ TRUNK ?VATER ASSFSSP4E:IT
$ TRUNK SE[4ER ASSESSMENT
$ LATERAL BENEFIT/TRUNK SEWER
$ LATERAI, BENEFIT/TRUNK WATER
S ~.~,i ~~v ' OTHER
$ TOTAL
$ ~~lS- 5 U AMOUNT PAZD/RECEIPT # ~f~~
DOES UTILITY CONNECTION REQUIRE EXCAVATION ZN PUBLIC RIGcIT OF WAY?
~ YES IF YES, THEN A"PERMIT FOR WORK WITHIN
PUBLIC ROADWAY" MUST BE ISSUED BY THE
C.] N0~ ENGZN~ERING DZVISION. LIST AS A CONDI-
TION.
SUBJECT TO TEIE FOLLO!~7ING CONDITIONS:
APPROVED BY: ~
TITLE:
DATE :
.a s~ ws ~~~~w nc~ ~a s~ ~e ~ ia ww R+~ rt~ w~~ ws'~ Ra rE ~ ~a ti+ nt+ ~c~ ia ~r
$ 2 °I is s ~
zoos RESIDENTIAL PLUMBWG PeRnnirAPPUCC,TioN
CITY OF EAGAN
~ 3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please complete for modifications to existing residential dwellings.
' Date / d(~ ( U b
Site Street Address `~7~~ I 1~ I~
~1.~ Unit #
1,!~/_~~ ry I
PropertyOwner vYl~~(C~,/~1 /-?(,(A"),Sb{rl Telephone# Qyj~ ) pqE,'~ l~/~ ~
Contractor Telephone # ~j~ ) 3 ~ ~{'O
' Address City G°Y'+ State~~ Zip~~~3
The Applicant is: _ Owner Contrector _Other
Septic System _ New _ Refurbished Submit 2 sets of plans and MPC license Includes County fee
$ 100.00
Per as-built $ 10.00
Alterations to existing dweliing $ 50.00
_ Add plumbing fixtures. This fee includes installation of a water softener andlor water
heater at the same time. If you a~e installing onlv a water softener and/or water
heafer, do not complete this section; move to the next section and check the
appliance(s) you are installing.
_Septic System Abandonment
_Water Turnaround (add $130.00 if a 5/8" meter is required) ~ 3
Other: -
I '
_ Water Softener , Water Heater $ 15.00
_ new Vreplacement
Lawn Irrigation _RPZ _PVB _new _repair _rebuild $ 30.00
I State Surcharge $ 50
' Total $ ~~~V
I hereby appiy 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, wo c is not to start without a.perrnit and work wi!! be in
accordan.c/e with the approved plan in the event a plan is required to r vi~ed an pprov~d. ~
~lll~()I~h
Appli~Printed Name Applic nt's ignature
~I~
2006 RESIDENTIAL BUILDING PERMIT APPLICATiON ~JD.b ~
City Of Eagan ~
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Conshuction ReoWreme~ ftertrodeVRena~ Reauiremen5 ~ O~ice Use OnN
3 registered site surveys showing sq. R. W lot, sq. ft af hase; aiM a0 roofed areas 2 copies M plan showing fooGngs, beams, joisls CeR MSurvcy Recd _ Y_ N
(20Y maximum lat coverage allvxcd) 1 set of Energy Calculations for heated atltlltio~ Tree Pres Plan Recd _ Y_ N,
2 copies of plan showing beam 8 window sizes; poured }ound Oesgn, etc. 1 site survey for additions 8 decks Tree Pres Required _ Y_ N
lsetofE~gyCakulatiqs Addidon-indicateilw'sifesep6'csyslem Omsi[eSeptlcSystem _Y _N
3 copies of Tree Preservation Plan if bt platted afler 7M/93
Rim Joist Deteil Optlons selecfion sheet (buildings wilh 3 or less unils)
~ Minnegasco mechanical ventilation form
Date ~ / CoostruMion Cost l.ll v ~ o=
SihAddress 4~4Z ~~;i,t~ln~`C'~.~.~Q uo~usre n
Description of Work ~ 1''\C{
Multi-Family Bldg _ Y~N Fireplace(s) _ 0 _ 1 _ 2
PropertyOwoer ~~~~~~Q ~ L~~ ~~'jS~')') Te~epbonea(~S/) (OSCO-O~`~~I
Cootractor ]y~~,~~ t Q
Aadress ~~tp~~ (s--~ o vt ~Ci` .~i City r-'1TplQ \)Q~ 0
State M t~ Zip SS a- Telephone #(~(Sa-) ~~j Q(`) ~
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Categorv 1 Minnesota Rules 7672
Energy Code Category . Residentlal Ventllation Calegory 1 Worksheet . New Energy Code Worksheet
submission type) Submitted Submitted
. Energy Envelope Calculatlons Submitted
In the last 12 months, has ihe City of Eagan issued a permit for a similar plan based on a master plan8
_ Y _ N If yes, date and address of masTer plan:
Licensed Plumber Telephone ~
Mechanical Contractor Telephone # ( )
Sewer/WoterConiractor Telephone#( )
I hereby apply for a Residential Building Permit and acknowledge that the informaGon is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a
permit; that the work will be in accordance with the approved plan in the case of ork which requires a review and
approval of plans.
~-/SSCa ;L ,.~~I~- ,
ApplicanYs Printed Name ~ Ap can s ature
RESIDENT OWNER
Name: Phone:
Address City Zip:
CONTRACTOR
Name: SUr) e_ (,J4.1 t°,( License 0 8 7' (JG
Address: 17201 pri/)1Jl *2rl'i4t 1tiJat
City: al ii'l Ve P f •t State: Yl Zip: t 3a
1 'l
Phone: `S2- t G 3g- i iv Contact Person: Pack
t
TYPE OF WORK
Atm Space in R.O.W.
_Replacement _Repair _Rebuild _Modify _Work
Description of work: I W a €K
PERMIT TYPE
RESIDENTIAL
Water Heater X Water Softener
Lawn Irrigation Add Plumbing Fixtures
RPZ PVB) Main Lower Level)
Septic System Water Turnaround
New
Abandonment
RESIDENTIAL FEES:
$50.50 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $.50 State Surcharge)
$30.50 Lawn Irrigation
$50.50 Add Plumbing
*Water Turnaround
$100.50 Septic System
$90.50 Fire Repair (replace
(includes $.50 State Surcharge)
Fixtures, Septic System Abandonment, Water Turnaround* (includes $.50 State Surcharge)
(add $165.00 if a 5/8" meter is required)
New ($10.00 per as built) (includes County fee and $.50 State Surcharge)
burned out appliances, ductwork, etc.) (includes $.50 State Surcharge)
TOTAL FEES 50. 50
City otBaQan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
x Qa(I �li JOfn'\
Applicant's Printed Name
n GCGPIG
Ul] OCT 2 8 2009
Applican
s Signature
Use BLUE or BLACK Ink
r //��jj �j 14
Permit P Dd -o i
Permit Fee:
Date Received: �b 421
Staff:
2009 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: 10 Z4 Site Address: 1 17 4 1 �d j L✓.i I)f)
Tenant: Suite
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.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.
FOR OFFICE USE
Reviewed By: Da
Required inspections: Under Ground Rough -1n Air Test ,_Gas T
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City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 4742 Ridge Wind Tr
Lot: 006 Block: 004 Addition: Park Ridge 2nd
PID:10- 56751- 060 -04
Use:
Description:
Sub Type: e- Reroof
Work Type: Replace
Description: House & Garage
Census Code: 434 -
Zoning:
Square Feet: 0
Fee Summary:
Valuation: 2,000.00
Contractor:
Home Depot at Home Services, The
5169 Winnetka Avenue North
New Hope MN 55428
(763) 367 -9740
PERMIT
City of Eaan
BL - Base Fee $2K
Surcharge - Based on Valuation $2K
Total:
Applicant/Permitee: Signature
- Applicant -
Construction Type:
Occupancy:
Comments: Pictures are not acceptable in lieu of inspections. Kara Benson 11 20 East 80th Street, Ste. #21 1 Bloomington, MN 5542
952- 345 -6047 tims @el derjones.com
Owner:
Elizabeth E Martinson
4742 Ridge Wind Tr
Eagan MN 55122
Permit Type:
Permit Number:
Date Issued:
Permit Category:
$69.00 0801.4085
$1.00 9001.2195
$70.00
I hereby acknowledge that I have read this application and state that the informa
of Minnesota Statutes and City of Eagan Ordinances.
on is correct and agree to comply
h all applicable State
Issued By: Signature
Building
EA073167
05/01/2006
ePermit
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 4742 Ridge Wind Tr
Lot: 6 Block: 4 Addition: Park Ridge 2nd
PID:10- 56751- 060 -04
Use:
Description:
Sub Type: e- Windows/Doors
Work Type: Windows/Doors - New/Replacement
Description: House
Census Code: 434 -
Zoning:
Square Feet: 0
Comments:
Fee Summary:
Valuation: 3,000.00
Contractor:
Crew2 Inc
2650 Minnehaha Ave
Minneapolis MN 55406
(612) 276 -1680
Applicant/Permitee: Signature
PERMIT
City of Eaan
BL - Base Fee $3K
Surcharge - Based on Valuation $3K
Total: $90.00
- Applicant -
Construction Type:
Occupancy:
Owner:
Elizabeth E Martinson
4742 Ridge Wind Tr
Eagan MN 55122
Permit Type:
Permit Number:
Date Issued:
Permit Category:
A framing inspection is required when installing a Bay or Bow window or if the opening is altered. Smoke detectors are
required in all sleeping rooms prior to final
inspection. When wall studs or ceiling joists are exposed, hard -wired detectors are required. Battery operated types are
acceptable if the wall/ceiling finish (i.e. sheetrock) has to be removed to install a smoke detector.
$88.50 0801.4085
$1.50 9001.2195
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.
Issued By: Signature
Building
EA082705
04/24/2008
ePermit
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PERMIT
City of Eagan Permit Type:Building
Permit Number:EA124370
Date Issued:06/30/2014
Permit Category:ePermit
Site Address: 4742 Ridge Wind Tr
Lot:6 Block: 4 Addition: Park Ridge 2nd
PID:10-56751-04-060
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:Two or More Windows/Doors
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow
windows, call for framing inspection. Call for final inspection after installation.
Carbon monoxide detectors are required by law in ALL single family homes .
Valuation: 4,000.00
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Elizabeth E Hanson
4742 Ridge Wind Tr
Eagan MN 55122
Renewal Andersen
1920 County Road C West
Roseville MN 55113
(130) 651-2644 X777
Applicant/Permitee: Signature Issued By: Signature
.
For Office Use �c
..--/-Ogc 4(
; „ ::::eo
Date Received: L. "-
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651)675-5675 I TDD: (651)454-8535 I FAX: (651)675-5694 Staff: .
buildinginspections c(Dcityofeaclan.com L
2018 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit#:
Name: ,�.,I d L.c.)i Lc-- A (-.f o AO Phone: 5//3 Z-7 5.Z P
Resident/
Owner Address/City/Zip: 4/7 417 ''Z P bv.,Ai p `%& c/Ls
Applicant is: Owner A Contractor
Type ofWo k ' Description of work: 60. .1 r'Z,L �i G /4/ ',t ZY � Vo ,&
Construction Cost: I /51. Multi-Family Building: (Yes /No )
Company: / .0,-sv /i✓6,- eto,V5.7AGr,CT/O.+L ontact: s<✓.v -jP'R/.-)
Contractor ; Address: 5 '"73,x' JI/Z/s1 V City: CA/„4 5'K�
I
State/>/oil Zip: 5J/ ii( Phone: ‘/Z-1617J 7 2I n " ':S'aviv`/, 1RO.-)R1 rL ,
PO
License#: be-, ,"7 1 Z776 Lead Certificate#:
If the project is exempt from lead certification, please explain why:
13viG.r /:r �'s �,a`
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: Phone:
Sewer&Water Contractor: Phone:
Fire Suppression Contractor: Phone:
NOTE:Plans and supporting documents that you submit are considered to be public information. Portions of the information may be
classified as non-•ublic if ou •rovide s•ecific reasons that would •ermit the C' to conclude that the are trade secrets.
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's
website at www.citvofeaqan.com/subscribe.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
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.00pherstateonecall.orq
I hereby acknowledge that this information is complete and accurate;that the work will be in conformance with the •4,inances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work i not to start with/a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approv- • • -ns.
x ,/.9,,,.),,a /' -s''.-J .---) x le'✓ v ` �/
Applic nt's Primed�Name Applicant's Si•'"r ''!
el
7qv K/2
1 'C Di i cl . / �5`
DO NOT WRITE BELOW THIS LINE t
SUB TYPES
Foundation _ Fireplace — Porch(3-Season) _ Exterior Alteration(Single Family)
— Single Family _ Garage _ Porch(4-Season) _ Exterior Alteration(Multi)
Multi .e Deck _ Porch(Screen/Gazebo/Pergola) _ Miscellaneous
01 of Plex Lower Level Pool Accessory Building
WORK TYPES
New Interior ImprovementSiding Demolish Building*
_ _
Addition Move Building Reroof Demolish Interior
Alteration _ Fire Repair _ Windows Demolish Foundation
_
Replace _ Repair Egress Window _ Water Damage
Retaining Wall *Demolition of entire building—give PCA handout to applicant
DESCRIPTION
Valuation 36 N' Occupancy IAc; – I MCES System
Plan Review / Code Edition 7.rJ/ SAC Units
(25%_100%v) Zoning ,2 I City Water
Census Code 113 Si Stories Booster Pump
#of Units / Square Feet 3 2,i' PRV
#of Buildings / Length )4 Fire Suppression Required
Type of Construction E Width Xi'!
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
_i Footings (Deck) Final/C.O. Required
Footings (Addition) 4e., Final/No C.O. Required
Foundation Foundation Before Backfill HVAC_Gas Service Test Gas Line Air Test Hood
Roof: _Ice &Water _Final Pool:_Footings Air/Gas Tests _Final
Framing 30 Minutes 1 Hour Drain Tile
Fireplace: _Rough In _Air Test _Final Siding:_Stucco Lath _Stone Lath _Brick_EFIS
Insulation Windows
Sheathing Retaining Wall: _Footings_Backfill_Final
Sheetrock Radon Control
Fire Walls Fire Suppression: _Rough In_Final
Braced WallsErosion Control
Shower Pan Other:
Reviewed By: , Building Inspector /�
RESIDENTIAL FEES l 3 Ag ,�R�� n /J /rte 90Z0ar
Base Fee /1
Surcharge
Plan Review 7 7
MCES SAC
City SAC
Utility Connection Charge
SSW Permit&Surcharge
Treatment Plant
Copies
TOTAL
Page 2 of 3
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i ' EAGAN
REViE.WED - ■
BY: W/.
D.?!,,TE:___________7322: \/
BUILDING IIS`- EC IONS DIVISION
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PERMIT
City of Eagan Permit Type:Building
Permit Number:EA164323
Date Issued:09/24/2020
Permit Category:ePermit
Site Address: 4742 Ridge Wind Tr
Lot:6 Block: 4 Addition: Park Ridge 2nd
PID:10-56751-04-060
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:Does not include skylight(s)
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and leave on site.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Valuation: 5,000.00
Fee Summary:BL - Base Fee $5K $118.00 0801.4085
Surcharge - Based on Valuation $5K $2.50 9001.2195
$120.50 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Elizabeth E Hanson
4742 Ridge Wind Tr
Eagan MN 55122
(651) 210-9947
Legacy Restoration Llc
15350 25th Ave N, Suite 114
Plymouth MN 55447
(763) 354-7660
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA168792
Date Issued:05/04/2021
Permit Category:ePermit
Site Address: 4742 Ridge Wind Tr
Lot:6 Block: 4 Addition: Park Ridge 2nd
PID:10-56751-04-060
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:One Window/Door
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow
windows, call for framing inspection. Call for final inspection after installation.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Valuation: 1,500.00
Fee Summary:BL - Base Fee $1500 $62.50 0801.4085
Surcharge - Based on Valuation $1500 $0.75 9001.2195
$63.25 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Elizabeth E Hanson
4742 Ridge Wind Trl
Eagan MN 55122
(651) 324-5295
Mad City Home Improvement
5020 Voges Road
Madison WI 53718
(651) 500-0514
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA168933
Date Issued:05/10/2021
Permit Category:ePermit
Site Address: 4742 Ridge Wind Tr
Lot:6 Block: 4 Addition: Park Ridge 2nd
PID:10-56751-04-060
Use:
Description:
Sub Type:Residential
Work Type:Alteration
Description:Fixtures
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.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Fee Summary:PL - Permit Fee (miscellaneous)$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 -
Elizabeth E Hanson
4742 Ridge Wind Trl
Eagan MN 55122
(651) 324-5295
Mad City Home Improvement
5020 Voges Road
Madison WI 53718
(651) 500-0514
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA177012
Date Issued:06/13/2022
Permit Category:ePermit
Site Address: 4742 Ridge Wind Tr
Lot:6 Block: 4 Addition: Park Ridge 2nd
PID:10-56751-04-060
Use:
Description:
Sub Type:Water Softener
Work Type:Replace
Description:
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
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 -
Elizabeth E Hanson
4742 Ridge Wind Trl
Eagan MN 55122
(651) 210-9947
Tri County Water Conditioning Inc
325 Third Ave NW
P O Box 65
Huchinson MN 55350
(320) 587-2950
Applicant/Permitee: Signature Issued By: Signature