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3825 Riverton Ave1111/11 CityofEa�all 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BLUE or BLACK Ink For Office Us �,-777 IC Permit #: f Permit Feer 00 Date Received: Staff: 2010 MECHANICAL PERMIT APPLICATION Date: Site Address:`388 5 . e,e/z 77 Ale. I I Tenant: Suite #: J RESIDENT 1 OWNER Name: ,9C/4 7-' 7t 5 Phone: /— 5'/,97 l Address / City / Zip: ,,c'17, 7/7 A ri .571 " 0 1/.././ _, _5131/ 3 CONTRACTOR Name6772/;,/J/€,4, S /9,..4/ i License #: P 7 �..5---:::5-.6 Address;o2/ / ` ,S/ wed //'?� City: QSSE't� 3 --.2 �r ( . State: .724" Zlp55536 9 Phone:: 76(3- ,S-65- 2/c?-/ . Email: itAue & 4:20,7214•"1. rJ%u/j VilLe,G'1i'Y1 Contact: 6pe ll / ' TYPE OF WORK New 1 1� ieplacement Additional Alteration Demolition Description of work: NOTE: Roof mounted and ground mounted mechanical equipment is required to be screened by City Code. Please contact the Mechanical Inspector for information on permitted screening methods. PERMIT TYPE RESIDENTIAL �X , Fumace Air Conditioner i I COMMERCIAL New Construction Interior Improvement — Install Piping Processed T Air Exchanger _ Gas Exterior HVAC Unit Heat Pump____ _ Under /Above ground Tank C_ Install 1 Remove) Other _ **When instating/removing tank(s), call for inspection by Fine Marshal and Plumbirvilns2ector RESIDENTIAL FEES: $55.00 Minimum Add-on 53-, 0 0 or alteration to an existing unit (includes $5.00 State Surcharge) burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge) $ TOTAL FEE $95.00 Fire repair (replace • _-, 575.00 Underground tank 555.00 Minimum (includes I installatio - _ - OR State Surcharge) $10,010, surcharge is $ 5.00 surcharge increases by $J50 for each 51,000 Permit Fee requires a $ 5.50 surf harge) Contract Value $ x 1% = $ Permit Fee - If the Permit Fee is less than Fee = $ Surcharge - If the Permit Fee is > $10,010, (i.e. a $10,010-$11,010 Permit =$ TO • E CALL BEFORE YOU DIG. CaII 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.eopherstateonecall.oro 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 wor is t to star] vomit a permit; that the work will be in accordance with the approved plan in thethcase of work which requires a review and approval of plans x ,Dawe -1� a/i/ Applicant's Printed Name x Appticant's Signature FOR OFFICE USE Reviewed By: Date: Required Inspections: Under GroundRough In ,Air Test Gas Service Test In -floor Heat Fine Exterior HVAC Screening Inspection Z•d 1.6££-999-£9L uosuel)slayo euer eZ£: 6 b Ol.ZOInr ~ . ~ CITY OF EAGAN ~ 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 f" PHONE: 454-8100 1461 BUILDING PERMIT Receipt # To be used for ~ECK Est. Value $1+000 Date VARCH 16 , 1 g; 9 Site Address 3825 RIVEE.TCN AVE LOt 9 BlOCk 2 SeC/Sub. ~~~CMAWK QAV`n OFFICE U5E ONLY Parcel No. occupancy - FEes Zoning W Name ~'-~N'~ ~AY (Actual) Const - Bldg. Permit 2 6 . CG o Address 3825 RIVEx~ivrt AtiE (Aliowable) Surcharge •5'Q City ~A~?-'a Phone # of Stories - Length _ Plan Review o Name AM Depth - SAC, City 2i09 Address 38Q4 YICK3EilRG i.hi S.F. Total - SAC, MCWCC ~ City 1'LYYOUTN Phone 553-9371< S.F. Footprints - On Site Sewage _ Water Conn ~ F W Name On Site Well Water Meter a? Cddress Phone C MWCC ry Wa e~stem = Acct. Deposit y PRV Required - S!W Permit I hereby acknowlege that I have read this application and state that the Booster Pump - SiW Surcharge information is correct and agree to comply with all appiicable State of Minnesota Statutes and City of Eagan Ordinances. Treatrnent PI Signature of Permitee APPROVALS Road Unit A Buiiding Permit is issued to: AMkE Planner - park Ded. on the express condition that all work shall be done in accordance with atl Councii appiicabie State of Minnesota Statutes and City of Eagan Ordinances. g{dg, pff. _ Copies Building Off icial Variance - TOTAL a~'~~`~ , Permit No. PermR Holder Date Telephone # WATER ~ SEWER PLUMBING H.V.A.C. ELECTRIC Inspectfon Date insp. Comments Footings I Founda6on Framing Roofing Rough Plbg. Rough Htg. Isul. Freplace Fnal Htg. Final Pibg. Const. Meter Plbg. Inspector - Notify Piumber Engr.IPlan Bldg. Final Deck Ftg. y ~ Deck Final Y,L Well Pr. Disp. a ~ R 1 • . . . ? ~ ~ fgtx#tfira#t uf (~rrupanry titp ot (tagan Erpttrtmm# of lttild'mg lWrrfinn This Cer7ifcate issued pursuant ro the requiremexzs of Section 306 of ihe Uniform Building Code ceriifying that at the d'me of rssuance this structure was irr compliance wilh the varrous ordinances af the City regulatrng building cnnstruclion or use- Far the following. use classirxioom sias. KmQ No. Oocupancy 7ype Zoning District Type Const. ~r Owoer of Buildiog - Addreu - BmldingAddres - L,oratity Dats: BuRdiag 09icirl POST IN A CONSPICUOU6 PLACE CITY OF EAGAN 1268? . . 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121N2 PHONE: 454-8100 BUILDIAIG PERMIT Receipt # To be used io? Sr^ uWG/GF,}2 Est Value $130,000 Date Si:P'ri;AFiEF2 26 19ti ci SiteAddress -RFVERTON AVE Erect oecupancy Lot-r•' Block 2 Sec/Sub• BLACKHAWK OAKS Remodel ? Zoning bZ1 Parcel No. Repair ? Type of Const.~~- Addition ? No. Stories W EAddreSS' 'I'It•~UTFiY i)F;NNIS Move ? Length 7`~ Z -.1U29$ ~:DINBi)R GE CIR Int Impr. oemolish ? ? Sq. Ft Depth . ~0 o 1~FN ~RIE 941-0489 Install ? o Name ^ TiOMP Approvals Fees ~ c Address p- U. BOX 158 -~c.~v Assessment Permit ~ 508.00 ~ city Wrr.r.S Phone 507/553-3103 water & Sew. Surcharge 65.00 Police Plan Review 254.00 L8U W Name 1-340/722-0543 Fire SAC 575.00 Address Eng. Water Conn. 5 0 0. 0 0 i W city Pr,one Planner Water Meter 63. SO Council Road Unit 290.00 I hereby acknowledge that 1 have read this application and state that the gldg. Off. 9 1 7/8 Tr. PI. 156.00 information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. APC Parks - Var. Date Copies Signature ot Permittee - Total r L,41 I. 5 0 A Building Permit is issued to: A }IUNI." OF YOUIR OWN on the express condition that all work shall be done in accordance with all appliceble State of Minnesota Statutes and City of Eagan Ordinances. Building Official L Pemfl No. Pennl! No1dN DNe TeNphone M Pluvw6in9 H.V.A.G`. Electrlc i SOIIMlf Inspectloe Dab Irop. Commnnb Footlnqsl Footlnysll Foundatbn Y7 4q Fnminq Roaln9 J y ? Rouqh Plbq. Houyh H19• ~i. G1J Fheplsee FMM Hty. 1 / • Flnal Plbp. 7174? - ! ~1~-7 ' ~t &dy. FN1aI y 3-9^ y7 .!/r d Cort. Occ. y , A Deck Ftg. Deck Frny. Wall Pr. Disp. CITY OF EAGAN Remarks !%U I Addition BLACKHAWK QAKS ADDITION Lot 9 Blk 2 Parcel 10 14387 090 02 Owner Street 3E325 Riverton Auenue State Fa.gan, MN 55122 Improvement Date Amount Annual Years Payment Receipt Date STREET SUR F. STREET RESTOR. GRADING SAN 5EW TRUNK r 1970 3.84 25 SEWER LATERAL WATERMAIN WATER LATERAL WATER AREA 19]] 141.$* 9.45 15 STORM SEW TRK 7 ~ 1983 458.7 30.58 15 STORM SEW LAT CURB & GUTTER SIDEWALK STREET I.iGHT WATER CONN. BUILDING PER. SAC PAFK SEDGWICK HEATING & AIR CONDITIONING CO. HOUSE HEATING TEST RECORD ADDRESS CITY OCCUPANT OWNER HEAT LOSS DATE HTG. INST. . SOLD BY INSTALLED BY Electrical Work By , J; Gas Line By -TYPE OF HEAT GA_ FA_ HW_ STEAM SPACE HTR. UNIT HTR. OTHER GAS DESIGN CONVERSIOIV , MAKE MAKEOFBURNER Model Model Serial Max. BTU Rating INPUT ~ MAKE OF FURNACE Model CONTROLS THERMOSTAT Heat Plug Vent Size ` Valve " KIND OF LINER SIZE NONE Limit - Draft Hood j Regulator Limit Setting rC Filters Size Number Fan Setting Chimney Location Inside Outside Pilot Type Chimney Constructian ` Pilot Make Pilot Model Smoke Bomb Wiring Pilot Timing Draft Test Tag L.W. Cut Off Door Pressure Lighting Inst. Pressure Percent C02 ~ Date Tested Input CFH Percent 02 y Company Testing Stack Temp. ~ Percent CO Name of Tester ~ r- Form 235 INSPECTIQN RECORD C1TY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: • Eagan, Minnesota 55122-1897 Date Issued: (612) 681-4675 SITE ADDRESS:' ' ' ` , " APPLICANT: ~.'F I? I+IN rl"JE PERMIT SUBTYPE: TYPE OF WORK: , ! i; r <'~t i„ft INSPECTION . ~l:ii :i • f , I ft i 1 i i~l~ I I { Ir ~:ii ~:II'~ ~~wii' I fi{~ i:j ~ 1 1 t I I 11 rsl I ~~5; 1 . . , . , i . ~ , . . . . , , . . ~ . . , , . . , . „ . . : : . _ ' . . y t ~ . _ - . , , Permit No. Permit Holder Date Tmlephone # ELECTRIC o~ ~ ys O 4v PLUMBIN 0 HVAC Inapaetlon Data Insp. Comments FOOTiNGS FOUND FRAMING ~ ROOFING HOUGH ~ !1 PLUMBING ..72/tT PLBG AIR TEST ROUGH HEATING GAS SVC TEST iNSUL ~ GYP BOAHD FlREPl.ACE FIREPIACE ~ AIR TEST FINAL PLBG / CV ~r- FtNAL HTG ORSAT TEST , BLDG FINAL BSMT R.I. BSMT FINAL (v DECK FTR DECK FINAL I CITY OF EAGAN NQ 16206 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 ~ PHONE:454-8100 ~ A BUILDING PERMIT Receipt # To be used for DECK Est. Value $1, 000 Date MARCH 16 , yg39-- Site Address 3825 RIVERTON AVE Lot 9 81ock 2 Sec/Sub. BI.~ICKHAWK OAKS OFFICE USE ONLY Parcel No. occupancy - Fees Zoning - w Name BRENT GRAY (nctual) coost - sldq. Permit 26.00 o AddBSS 3825 RIVERTON AVfi (Allowable) - Surcharge .50 City EAGAN Phone a of Siones _ Len9th _ Plan Review , o Name /+~E oepm - snc, ciry ~a Address 2804 V7CKSRIIRC: i.N S.F.TOIaI - SAC,MCWCC ~ Cily PT.VhiOIiTH PhOne 554_9774 S.F.Footprims - On Site Sewage _ Water Conn • ww Name OnSiteWell - WaterMeler z MWCC S stem Address y - Acct. Deposit aw Ciry Phone ciywaier - PRVRequired _ S/W Permit I hereby acknowlege ihat I have read this application and state that the Booster Pump - SnN Surcharge infortnation is correct and agree to comply wi[h all applicable State oi Minnesota Statutes an~dryof gan Ordinan.,c~es/. f\-~, ~a Treatment PI Signalure of Permitee 1`YU y/~/L APPROVALS Road Unit A Buildinq Permii is issued to: AI1RE Planner - park Ded. on the express condition that all work shall be tlone in accordance with all Council 50 applicable Siate of Minnesota Statutes and City of Eagan Ordinances. gld9. pff_ _ Copies Variance _ 70TAL Z~'~C Buildirg OfFicial J~f- ' f1 N'M5 9 Request ~ate re No. Rough-In Inspection ReQUiretl Inspection O[her Than Rough-~n ~ (YOU t call inspedm when reatly) ~ Reaay Now ~Wiil Noliy Mspector Yes ? No pale Reatly I$~licensed contractor ? owner here6y request inspection of above electrical work at: Job Atltlress (SVeeC Bax or Route No.) Ciry 38zS ?Z,ve~( 6 V. L) R, - - Section No. Township Name or No. Range No. County v vg "T v4 Occu t'reK (PRIN~ r a., Phone No 4 Power Supplier Address , O A Y-o'C P, k~c~-.r Eleclrical ConVactor (COmpany^~ame) ConVactor's License No. \ d 2 S Mtilirg~d ress ( onV or Owner Making I Ilation) > Put ~ize i aWre (COnhacrodOw a Install io ) Phone Number ~ J ~ MINNESOTA STATE BOAHD OF ELEC TV THIS INSPEGTION REQUEST WILL NOT Griggs-Midway Bldg. - Haom 5-126 BE ACGEPTEO BY THE STATE BDARD 1821 UnivemRy Ave., SL PeW, MN 55104 UNLESS PROPEF INSPEGTION FEE IS Phone(612)64&0800 ENCLOSEO. .,S Q5 - . REQUEST FOR ELECTRICAL INSPECTION 0 2559 10- See insvudions for complating Ihis form on b.ick ol yelbw copy "X" Below Work Covered by This Request . • N6' Add Rep. Type of Building Appliances Wired . Equipment Wired Home Range Temporary Service Duplex Water Healer Electric Heating Apl. Building Dryer Load Management Comm./Induslrial Furnace Other (Speci ) Farm Air Conditioner (Aher (syecity) ConVacroGS ftemarks, ~ Compute Inspection Fee Below: ~ ol~ i G 0We/ / # Other Fee N Service Enirance Size Fee # Circuits/Feeders Fee Swimming Pool 0 to 200 Amps 0 to 700 Amps d ~ Transtormers Above 200 Amps Above 100 -Am s Signs Inspecmr's Use Only: ~ TO'T/A~L Irrigation Booms t1o Av y{~' .0 Special Inspection ~ Alarm/Communication THIS INSTALLATION MAY BE RED DISCONNECTED IF NOT Other Fee COMPLETED WITHIN 18 MO I, the Electrical Inspector, hereby certity that the above inspection has IV2 been made. r OFFICE lISE ONLY ~ This request voitl 18 monihs hom CITY OF EAGAN • 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 ~p - UcH~ BUILDING PERMIT PHONE: 454-8700 Receipt p Tobeusedfor SF DWG/GAR Est.value $130,000 paSe SEPTEMBER 26 ,,g86 SiteAddress 3825 RIVERTON AVE Erect ~l Occupancy R3 lot 9 Black 2 Sec/Sub. BLACKHAWK OAKS Remodel ? Zonin9 Rl Parcel No. Repair ? Type of ConstIvEl Addition ? No. Stories w Name TIMOTHY DENNIS Move ? Length 79 10298 EDINBURGE CIR Demolish ? Depth ~n a Address Int. Impr. ? Sq. Ft Ciry EDEN PAWIE 941-0489 install ? o rvame A HOME OF YOUR OWN APProvals Fees G~ Address P.O. BOX 158 Assessment Permit $ 508.00 ~ Ciry WFL.LS phone_ 507/553-3103 Water&Sew. Surcharge 65.00 Police PlanReview 254.00 ~W Name 1-800/722-0593 Fire SAC 575.00 = Address 5~0.~~ ~ o , Eng. Water Conn. <W city phone Planner Water Meter 63 . 50 Council Road Unit 290. 00 Iherebyacknowledgethatlhavereadthisapplicationandstatethatihe BIdg.Off. 9/17/$ Tr.PI. 156.00 iniormation is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eag n rdinances. APC Parks a~I7v Var. Date Copies Signature of Peimittee_ Total $2,411.50 A euilding Permit is issued to: A HO OF YOUR OWN on the ezpress condition that all work shall be done in accordance with all applicable S},gtQ of Minne ota tutes and City of Eaqan Ordinances. Building Oflicial , uYsq L4 RESIDENTIAL + BUILDING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB RD, EAGAN MN 55122 651-681-4675 Now ConMrudion Reauirements RemodeVRepair Reauiremenls • 3 regislered sAe surveys shmving sq. ft. of lot, sq. fl. of house; and sll roofed areas • 2 copies of plan (20%mazimum Intcoverage allowed) . 1 sel of Energy Calculationt for heated addftions • 2 cropies of plan showing beam & window saes; poured found desgn, etc.) • 1 site survey for arleriar additions & decks • 1 set of Energy Cakulallons . Indicate if home served by seplic system for additions • 3 copies of Tree Preservffiion Flan if lot platted after 711/93 • Rim Joist Oetail Optbns selecGon sheet (bldgs with 3 or less units) DATE VALUATION 41r 410O.O O S ~5 aS T11~er~m-, MULTI-FAMILY BLDG _Y N TY E OF re- -(~Z)a-~ hD~`' nPi 'CaS~S' FIREPLACE(S) _ 0_ 1_ 2 APPLICANT 2,--,Cf-n c41~~v~ Gl 54e.inef STREETADDRESS OkCA24 A+re D. CITYJ3Urn.SJ+IIt STATEMIJZIP 5-S3~J TELEPHONE #92• 9DQ-(qR S7_ CELL PHONE # FAX # 15D -9619"~04-e PROPERTYOWNER P)re-f\+ k~.V TELEPHONE# (9SI-~S~-~SD~/~ COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category _ MINNFSOTA RULES 7670 CATEGORY 1 MINNESOTA RULES 7672 submission type) . Residential Ventilation Category 7 Worksheet Submitted • New Energy Code Worksheet Submitted . Energy Envelope Calculations Submitted Plumbing Contractor: Phonc # Plumbing system includes: Water Softener _ Lawn Sprinkler Fee: $90.00 Water Heater _ No. of R.I. Baths _ No. of Baths Mechanical Contractor: Phone # Mechanical system includes: Air Conditioning Fee: $70.00 _ Heat Recovery System Sewer/Water Contractor. Phone # I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinanc s. SignaFureofApplknnt CJI~(n+L~VL~{,~.~J~ OFFICE USE ONLY Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _ Updated 4/D2 OFFICE USE ONLY ~ i ? 01 Foundation ? 07 OS-plex ? 13 16-plex O 20 Pool ? 30 Accessory Bldg ? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt- Multi ? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF ? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screened) ? 36 Multi ? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage ? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous ? 31 Naw ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding ? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair ? 33 Alteration ? 37 Demolish (Bldg)* ? 43 Reroof 0 46 WindowslDoors O 34 Replacement "Uemolition (EnYire Bldg only) - Give PCA handout to applicant Valuation Occupancy MC/ES System Census Code Zoning City Water SAC Units Stories Booster Pump Nbr. of Units Sq. Ft. PRV Nbr. of Bldgs Length Fire Sprinklered Type of Const W idth REQUIRED INSPECTIONS _ Footings (new bldg) FinaUC.O. _ Footings (deck) Final/No C.O. _ Footings (addition) _ Plumbing Foundation HVAC _ Drain Tile Other Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Au/Gas Tests _ Final _ Fr~S _ Siding Stucco Stone _ Fueplace _ R.I. _ Au Test _ Final _ Windows (new/replacement) _ Insulation _ Retaining Wall Approved By , Building Inspector - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ° - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Base Fee Surcharge Plan Review MC/ES SAC City SAC Water Supply & Storage 5&W Permit & Surcharge Treatment Plant Plumbing Permit Mechanical Permit License Search Copies Other Total PERMIT CR.~10 ~i ~ CITY OF EAGAN 3830 Pilot Knob Road PERMIT TYPE: Permit Number: B U I L D I N G Eagan, Minnesota 55122-1897 0 2 5 5 9 0 (612) 681-4675 Date Issued: 0 5/ 16 / 9 5 SITE ADDRESS: 3825 RIVERTON AVE LOT: 9 BLOCK: 2 BLACKHAWK OAKS P.I.N.: 10-14387-090-02 DESCRIPTION: Btpilding Permit Type BASEMENT FINISH Buildxng Lda`r.k Type AL7ERATION a. , t . i . . REMARKS: A SEPARATE PERMT7 IS REQUIRED FOR ANY PLUMBING OR ELECTRICAL WORK FEE SUMMARY: Base Fee $35.00 Surcharge $.50 lic. Search Fee $5.00 Total Fee $40.50 CONTRACTOR: - Applicant - s7. I.IC. OWNER: BUDGET INSTALL & REMODEL 18944131 0005145 GRAY BRENT 5340 EGAN DR 3825 RIVERTON AVE BURNSVILLE MN 55337 EAGAN MN (612) 894-4131 (612)688-8048 I hereby acknowkedge, that I have read this application and state that the information is correct and agree to comply with a11 appSicabie 5tate of Mn. ~ Sta s artd 'ty of Eagan Ordinances. J 1 APP ICANT/P RM E SIGNATURE ISSUED BYISIGNAT ¢ URE 14r,90 CITY OF EAGAN , ~ 3830 PILOT KNOB RD - 55122 %1995 BUILDING PERMIT APPLICATION (RESIDENTIAL) 681-4675 New Canswelion Reauirements . RemodeVReoair RaquiremeMs ? 3 registered cke surveys ? 2 copios ot plan ? 2 copiea of plans (inWude beam & window sizes; poured fid. deaign; etc.) ? 2 site surveys (ex[erior edditions & decks) ? 7 energy celculatrons ? 1 energy celcutations for Mated add'Riona ? 3 copies of hee proservation plan if bt platted after 7!1193 requirs~ Yes _ No - DATE: CONSTRUCTION COST: p~- DESCRIPTION OF WORK: EA/+Sw C*/- STREET ADDRESS: p1 v'e"' I-O'^ s' LOT _Q_ BLOCK SUBD.1P.I.D.#:1 NPAL0~• PROPER7Y Name: ~ erLr. Phone (9 OWNER " n mu Street Address ~ City: State: Zip: ko<<gn (usT.V4-5- ~`f-yl31 coN7wac7oR Company: c3.~.n. Ph~ ne Street Address: P, ~ • ~ s~'~ License yS^ Ciry: State: A N~_ Zip:2 337 ARCHITECTI Company: Phone ENGINEER Name: Registration Street Address• City: State: Zip: Sewer 8 water licensed plumber: Penaity applies when address change and lot change are requested once permit is issued. I hereby acknowledge that I have read this application and state that the ' rm ti is w ct and agree to compry with all applicable 5tate of Minnesota Statutes and City of Eagan OMinances. Signature of Applicant: OFFICE USE ONLY Certificates of Survey Received _ Yes ~ No MAY 0 8 1994 Tree Preservation Plan Received Yes Na , . OFFICE USE ONLY . . m Y•y BUILDING PERMIT TYPE 0 01 Foundation ? 06 Duplex ? 11 Apt./Lodging ci'` 16 Basement Finish 0 02 SF Dwelling o 07 4-plex o 12 Multi RepaidRem. ? 17 Swim Pool 0 03 SF Addition o 08 8-plex ? 13 Garage/Accessory o 20 Public Facility 0 04 SF Porch ? 09 12-plex o 14 Fireplace ? 21 Miscellaneous ? 05 SF Misc. 0 10 = plex r 15 Deck WORK TYPE a 31 New o~ 33 Alterations ? 36 Move ? 32 Addition o 34 Repair o 37 Demolition GENERAL INFORMATION ~ Const. (Actual) Basement sq. ft. MClWS System (Allowable) Main level sq. ft. City Water UBC Occupancy sq. ft. Fire Sprinklered Zoning sq. ft. PRV # of Stories _ sq. ft. Booster Pump Length sq. ft. Census Code. 5`3 f' Depth Footprint sq. ft. SAC Code ` Census Bldg i Census Unit p APPROVALS Planning Building Engineering Variance ~ Permit Fee Valuation: $ Surcharge Plan Review License MCNVS SAC City 5AC Water Conn. Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment PI. Road Unit Park Ded. Trails Ded. Other Copies Total: % SAC SAC Units 1989 BUILDING PERMIT APPCICATIdN - CITY OF 6AGAN SINGLE EAMILY DWELLING3 I ~ z O ~ INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS NOTEt ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOSiNBR MU3T DESIGNATE ftHICA ADDRfiSS I3 DESIBED. NO CAANGFS NILL BE ALLOWfiD OACE BUILDING PERMIT I3 I33IlED. MULTIPLE DWELLINGS RENTAL ONIT3 FOR SALE ONIT3 • OF UPIT3 INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SUHVEY - CHECK WITH BLD(3. DEP'f.t 1 SET OF ENERGY CALCULATIONS COMMERCIAL INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS, 7 SET OF SPECIFZCATIONS AND 1 SET OF ENERGY CALCULATIONS - j~l, ? ; ~ 1989 mo q To He Used For: Valuation: _l7 Date: Site Address i'V'ex~ / b012 OFFICE OSE ONLY Lot -17 Block z Occupancy FSE3 / Zoning Parcel/Sub ~ij/4GJK 0WeCs Aetual Const Bldg. Permit UD Allowable Sureharge Owner 1f of stories Plan Review ~J / 4u, Length SAC, City Address 3(2r ~/%/eks'~+' Depth SAC, MWCC C S.F. Total Water Conn City/Zip Code G/Q~w Footprint S.F. Water Meter Aeet. Deposit Phone On site sewage_ S/W Permit On site well S/W Surcharge Contraetor f-{i'+'bQ,cr MWCC System _ Treatment Pl. City water Road Unit Address zl~~ Ul~KSDt?L4 G. PRV required _ Park Ded. Booster Pump _ Copies ISD City/Zip Code Plv/Mer'11 TOTAL 00 APPROYALS Phone Planner _ Couneil Arch./Engr. Bldg. Off. ~~/S Variance Address City/Zip Code Phone !l NOTE: Sewer & Water PermiL fees and aecount deposit Pees rrill be included in the building permit fee. Processing time for sexer and Water permits is two days once a lioensed plumber has applied for a permit at Citq Hall. - ~ _ AOBE T.no-n+y L, Deu~~S CONSUL11Hd !NO NfElls PIFENGINCERING pkaNI+Eas ond ~AHd iURYEYOIIS COMPANY, INC. ~ 1000 UST 1461h STREET, oURNSVILLEO IIINNESOTA 53337 PH 4432--33 000 CeriF xVz ccz~ Gsx~~y jLggal .Iae,tcr~pZiast: LOT 9, BLOCK 2, .Bl11CKNAWK DAKS ADD17-ION, DAI<OTA CouN7Y, MINNESOTq 0) o1 o¢' R/U6IZ7-0N /1 VENU~ ~ ~ _ _ _ ~a~ ~,Y15ED !o•IS• 8~ 0 0 0 89° 59' 9&"~- . io5.0o FRoNT BU I LDIn16, A SETSACK LlAIE I t2.33 ~ CB9i;~~ ~ARaL~E=~ 9 i~o I N I 5~.48i Cs_vz.-sD UENbTES EXI r3"1-ING I _ ~ P~°PosEt~ r Nv~ 7r. a I ELEVA770N r`"u'r 2b3Z I ~ (e93.s ) DENOTF_S PROPOSED I ~ .o.o 79.83 E LE VATI O N I(gyz,z) '~'~3C~ jry (e9t•z~ I s--~" INDICATES DIRECTION OF SUFZFACE PRfI I IJA6E I ~891.so) yI I g9z.6 -FIAl15NED GA246E FLOOR ELEVqTIDhI Q", iv I Cg9~X o% . ~9~-- I ~ N± 7 a ~ l M I \ I cr~ . J ~ I i LoT 9 i ~ I I ~ . I SCFILE 30' I 5I \ ~I5 DRAMA6E AND UTILI7Y EASEMENT [896.a~ 88. oo CB9O-o~ 89° 56' 37„ W L89`O:"D I hereby cartify that this ie a true and correct repraegntaTion of a ttraet pf land a¦ sho++n'and deacribad hereon.. Ae prepared by fie on th3s 1z,71~ daY of 56wrr?w 2 198e- , . ?to. ~E?, /n/~S /84 L..M....~~ l~.+e.t 7('~ ~ o•a 508•00+ 65•00+ 254•00+ 575•00+ 500•00+ 63•5U* 290•00+ 156•00+ 2, 411•5D* ~ IC7 198~ BDILDING PERHIT APPLICATION - CITY OF EAGAN ~ NOTE: ALL CANTRACIOES MOST BS LICENSSD llITH THE CITY OF EAGAN Vel][NGLE FAMIILY DWELLINGS INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS M[fLTIPLfi DWELLINGS - EESIDBNT79L RENTAL DBITS FOB SALS OIdITS INCLUDE 2 SETS OF YLANS, CERTIEIC9TE OF SORVEY - CHECg HITH BLDG. DEPT.t 1 SET OF SNERGY CALCULATIONS C0144ERCIAI: INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS, 1 SET OF SPECIFICATZONS AND 1 SET OF ENERGY CALCULATIONS, 11-i $2,000 LANDSCAPE BOND oa 0 To Be Used For: 511JG,~ FH1hValuat n: te: Site Address '38aS 17;vtcro~ PQe, OPFICE IISE ONLY Lot 9 Block ~ Erect ~ Occupancy Remodel Zoning 1 Pareel/Sub [~I.ACK41F~w~ tA~S '(3DDlTionl Repair _ Type of Const Addition # of Stories Owners I mofff'ItBPR3ii" QEaaLS Move _ Length -74 Demolish Depth 30 Address 10a9 8 Ed;Nbw2G1• Cc,zclE Int.Impr. Sq Ft Install C1ty/Zip COdB 15dE0 P2RIR1E , J"lN 5531(y Phone 9 W ti- oti S9 APPROVALS FEES Contractor A h1el,vE o? /~~~k cwiJ Assessments Permit Water/Sewer Surcharge ~e5 Address Police Plan Review_ ~ F City/Zip Code wEtL mf+. 56e)97 Engr Water Conn _50-=- j- 80 0 -7,1 a- 0S93 vn Planner Water Meter 6.b'0 Phone Sa-7 -~S3° 31 e3 Council Aoad Unit 'Zqo Bldg Offqj7•S(, Treatment Pl Areh./Engr. µc~~.F C'1 ,i0 APC Parks ' Variance Copies Address h5 i-l 6OU E TOT9L City/Zip Code Phone # NOTE: ADDSESSSS F0R CORNER I.BTS - C6NTRACTOR/HOfiEOiiNE@ MIIST DESIGNATE AHICH ADDRESS IS DESIRED. HO CHANGES iiILL BE ALL@iIED ONCB BQILDING PERMIY IS ISSIIED. -Z-L,,~zS= J~Sc~ 'x IZ = ~~c~~ ~ ~~Zp , ~ ~ Z 1'7~ox ~j , Z2 z ~4 k5'~ ~ Z1(~Z ~ 1ZqZ~Z ' CITY OF EAGAN , EXTERIOR ENVELOPE AY£RAGE 'Ut COHPUTATION i OtiNER: L, /Jr>hr~,L:l SITE ADDRESS• CONTRACTOH: ~5 -qyoQr!~Wh,Jn,--. DATE: J- Tv PHONE: Determine working square footage of each: 1. Total exposed Nall area 2)jLq sq, ft. x.11 = U~ ~ 2. Total roof/ceiling area otI1~f sq. ft. x.026 Total exposed t+all area above floor = ~~~a~<o5 a. Total wall windou area b. Total door area c. T<sto-1w~~\~•-~w:t..c W~.*~Ct4~Sl~'~'h.":~.-'C.14~:... d. ~T~,+~:_1 v\rtw~tC w/ ~v-................ l36.46 e. Total waii framing area (average 10%) 1,?Ma6 f. Total net wall area above floor a i7. ~U g. Total rim joist area 2:i`fI x~ -41. Total exposed foundation area h. Total foundation windoN area 17,9? 1. Tota1 net foundation area above grade R.ry 3 , Determine IU' value of each wall segment: a. 172.77 x: U~ .a`f7 b. s.68 x ful ,or3f = 14, l17 c. i,.i6 x +uI ilff = 1~F~c3 d. 13 ,.Y6 x 'U' e. ,1.3.5,?-4. x 'Ul .c~rlV = 1.;?.771 f. fa! 7, 30 xfU' 53.:?,6 - g. ~Z`f,cJ7~ x' U' i J=f~ c 9. `-f i h. x 'U' ~:a7ti = fu75 i. x'UI , iqU a , S a.'V, , 141 . 3 . Total = _ If item 03 is the same as or less than item 01, you have met the intent of SBC 60o6(c)2. Total exposed roof/ceiling area - 09 r T K. Total. roof/ceiling framing area (average 10$) 1. Total net insulated roof/ceiling area 1'7 0 ZZ,61-) ~ (OVER) I ~ • . Y~ . . Determine 'UI value for each roof/ceiling segioent: - k. X gut I. 19ua~o x out Ioa5 4 . Total - If total of 114 is the same as or less than f12, you have met the intent of SBC 6006(c)1. Alternate Building Envelope Design To utilize the total envelope system method, the values established by the sum of Items #3 and 1!4 shall not be greater than the sum of Items !ii and U2. 1. 09 + 2,-- 3. 1 7~~50 + 4. 'J.-a. . ' ~ hr•' f.' " U. S. DEiAR/YENT OF NqISiNG AN0 UPBAN OEVELOPYENi FfDER1L1qlISINGMMINIfTNATIp! e}SA Parm 2005 Pot ~'cume regiseer of car6oa copia. /orro Form APProved VAForm 26-1052 my be sepamed Jons above (old. Snple OA111 No. 63-R0055 , Rev. 2/r74 camplet<d sAcsu ro`ethirin ori6inJ mder. o ProPo:ed con:rruction DESC6tIPTION OF MATERIALS ?rO• iT, 6e imerted by FHA v VAI 'p Under Consfrudion Properfyaddreu ~n.o'k~v L.. 0ehn;~ Cify E~A~ Pca%r~~~ Sfafe M~, x... Morlgagor or Sponsor . y. . . . . (NiIM) (Ad14tl\) . Conhodor,or 8uilder A Now.e o~~?~urC)~r, ~ l~-,c., W~ll.S ~ YYI+n, INSTRUCTIONS -3. Foraddltionel infomietion m how thie fomi is to be suhmitfed, unlese requirecl, thm the minimuun eccepteble a[Il ba easmned Work "'.•men6m of copioe, etc., eea. the inswclione epplice6le to Ihe FHA ' axceeding min4num ietryiremente cemio[ ba conaldered unless epecipcelly 'ApplicaUm for Morlgega Inuurence or VA R708 r DetemJnetlan of deacribed I. ~,Reosaneble Value, as ihe cese mey be. A. Include no dtemetes, "or equel" phreaes, or cronwdictory itema ",s 2' Deecrihe e11 metaiels end ec~uipnenbe used, whether ar not (CoreidereUon o[ a requeal for ecceplence of aubstltule meteriab or nlawn on lhe drpwin e, by ma~king en Y in eecl~ appro{siela check-box equipmen[ is nut Iherekry precluded.) eid mteting ihe imatian called (or each spece. If spxce la S. Indude siynetures required et the end of t}Ja form. ~ iiudequale,' enter' "See miau" end describe under item 77 or on en 6: ~[}~e rnnuGUCtion ahell be completed in camplience wfth the related eltached sheet Ti~: USE OF PA1NT OONTAINING MORE 71{RN FIVG drewings anA epecifica6ona, ae emended dudng pmcesainp 1he specifice- . 1ENTHS OF ONE PERCIIiT IEAD 6Y WEICIIT 1S PROI03311ED. tions include thia DescriDUan of Materiels end eppliceble Minimiun Ro- . 3. Wodc not speciGenlly described or rshown wlll rrot be considered peAy Standards 1. Exu?vanorH T:q ~ _ ~ • I . Bcaring wil, tYPe Clt~ T~'~000 O~ ~Q1~OWane.G ~ox-~~nn " ~ ir-OkYL IQn -mjak?Q. 2, FOUNDATIONS: y„~7 '.Foolingr.wncreae mix ' strength psi as(y0.-o Reinforcing. .'Foundatioawall: material i:~o hr• C5 IQ<--k ,1 Oh o~~ pReinforcing Imcrior foundation wall: material oZY6 5-Fu.Qwo..ll Iii ~g~~ .clovk~G, Q" C{~~~ So r Co~uml6Piera: malcrial and minfurcing 2 4%k ka4 X12.'*Cov~C, -.Columm: matcrial and aizcs u P-po ~o~ CirJm: maierial and aiza X~~ X a0~ kohqsE'eP~ t a-y°jli~-material Baumrnt emrance a~eaway Window areaways - ~ Watttproofing ~c-E( n 10.S'~' e~-- Fooling drai~u T1: ( LO - , Ttrmite pmteclion . Baumendaa space: ground cover ; ioxulaiion ; loundaiion venls SpeCI]l fOUOd]lbM Additiomlinfarmalion: Styro-fGti.M 01~ X\~hU`~~!'d'~~~OG~ 3. CHIMNEYS: ` htaiuial ~1 Ta-.'^1PSS'1't P-C( Prefabricaled(makrandiite) ~"'w'..._,. f1"-J-pl WQ`k a~'A~~+~ Ileater flue size tV° Fireplau flue iiu Flue lining: maleiial ~ Vrnu (ma/snal and tiir): gas or oil hwter ; water healer - J - ' AJdilional infortnalion: c4: NREPIACB: Prc af Su~l°r L ner#;~ ~h dump md clunow 'i Type: ~ wlid fuel~;~ ga~.-I.{w_rn~i~ng~;~q?^j circulator (maAr and srte) Pircplau: tfuing'..d13G.eL!'~L.4Z)' lining 4 i r~ lo ps`e~L ; heanh maniel .^Addiuonalintormaiion: Zew C`~E6/~QhLJ (/h`2~' 13Y A ~°'~''r- c vU~~~"'K•_ 1~'Y UwKOi- . S. EXiERIOR WALLS: -fita~ a{1-. Wt... WR~ WdS ~C.P• ' Wuod Game: wood graJe, and slxcies ? Corner Lracing. Buiiding papcr or &Il ~ rptt - ShniAing FExt.C lueP~y_W9thiclcneas 22" ; wiJth ~j,wlid• Qspacecl „ o. c.: 0 diagonal: Siding 8ll ~ee-~ ; gnde rypekQj3!__; aize P eapwum 9 fvirning -A•G~ V) ` Shingla i Hrade ; IYpe ; size ; exNosure Gsicning _ $cucco ; thickneta ; Lath . ; wcight Ib. Mannry vmac Silh Linieb - 111ese flaihing- /~y +ifacing lhic4neu q fiting material Masonry: ? wlid (~,6eed ? sluccoed: /otal wall thic4nae 1S1 8ac4up muerial ihickneu bonding Uoor silb Window iillalinle6 Bsae flaihing . Inar'wt wrfacec damppraofing, cwU lis of ; furri g Addilional informalim: L'~' i c ~a~n cr~n rcrciw~' ~ ~LCN,-G1n~V ~ . Exter'wr peinling: rtuterial ; num6er of wau Gabk wall conftraction: ?same af main wallr-*ther construction 6. FLOQR FRAMING: 4t .7 m' W{''. Wtki~, 1~ ,Joitla: woal,grade, aud apecies ~Ftv~-F~x` ~NOlher oZXfUS 161~ O.Cf,bridging anchon 1 , Conutle dab:~basrment fluor; ~ fim floor; ~,8mund supponed: Q~e1GsuPporung; mia iihr~~+ . reinforcing ; insulstion : membrans ' Fill under ilab: material +v~o-~°~~ ; Ihicknnfya i-". AdJitional informalim: . 7: SUBFLOORING (Desvibe underflooring for s ial floori uRder ifem 2 1.) yr8 Dfalerial: grade and ipecicc ~X~" lu pp~V WC]OdZ ; ~iu : 1Ype . IAid: 0 fint floor, 0second Ilmr, C] atia q. fl.; Q diagoml; Kright anglu. Additiond information: 8. FlNISH FLOORING: (Wood only. Desntbe other flnish flooring under ilem 21•) ' {,oe~rqM " Roo~u GRAM Srcciu TNtutmw Wim B1m. PwnR Pmu~i Fint ftoor , Sewud floor Anic flwr u . II. Addiuonal information: OAF- FHa Fonn soos DESCRIPTION OF MATERIALS VA Fonn 26-1852 ' ' ~ • • DESCRIPTION OF AAATERIALS 29. VARTRqON FRAMING: , Studr wood, grade, and specin siu end Bpacing °7 x Y IS " O•G~ O~her Addiuonal in(ormalion: 10. CEILJNG FRAMING: ~`a,48'rr,Wth, w~.-t.w~KP• ,S G Joisu: wood, grade, and spxin Other, ~ g^d H, Additianalinformation: (Q') 11. ROOF FR/1MINCi: sC aGt EK~. WfzWht• l'i S. V, A, . Rallen: wood, grade, and spaia Roorf7 w(we detal): grade and specia Additioiul infortnalion:~i~-.o ~~O~G ~ . _ 12. ROOFING: v Shrathing: waod, 6rade, and specia y~• - L uK~ E~ 'CkL ' r n~l ~npc~ •~'alid: I] spaced_" oe. Aoofing ~ S S , r1 Brade size ~ 7er' : type Underlay Pc~l* R n o.[- ; weight or ihicknnii.a~!; size ; faitrning . Builbup roofmg ; num6er of plim ;suduing materidl Flashing: maleriai i Bage or weight gravel nop: Qsrow Suude AJJiiwnal information: _~c~ 13. GUTTERS AND DOWNSPOUTS: ~'V BY ~-t,UW~, o~ ~nvr bW.nAh,C, Cunen: material : Bage or weighl ; size ; shape Duwmpowa: maierial : 6age or wcighl : size ; shape ; number Downapouu connated w: ? Slorm wwer, 0 aanitary aewer; 0 dry•well. ? Splamhblockr material and size Addilional informalion: 14. wnH nNn rwsrER laih Q walls, ceilings: material ; weight or ihickneu Pla~ur. coeu fini,h ~y. Dry'wall~walb.~,ceilings: mp ~ierial s~+eoc~ ; ihicl~nas_I finish 5~y~.~~l'_kxF~~` l FPC~. C' ~ ~~nq. Jointtreatmem ~aoAhl ~ 15. DFCORATING: (Painf, wallpaper, ek.) a Roow Wnu. FInux AGruuL Ano NrucnrwH Crnino PIwux MATYIW. ANd ARIIGiWN Kitcben 8ath Oaher ~ Addilional infarmaiio : Ib. INTERIOR DOORS ANa.+D TRI~l: 4N l ~ Pr e. • k ~ ~ ; ~ 9. - , Doon: type maierul pr thkknen Door Irim: type J rd he-e te.~. ; mrlnul Ba k ~ uu ' Pr'"e~"fav~ ; malerial 44 ~ Ba~e: tpxJ '-...r_. _ . _ - . • . _ ' Finish: doon Y~.~ '~h~ShS•°-~ ; trim Other lrim (ifrm, type ane r"arpn) Additional informaiwn: 17. WINDOWS: .1,( Cla.& 3 n WinJowa: type ^ a ; make P4`'1':ZL h ; material Pi nX.1 wh thic4neu . Clae: grade H i M~er.rnw1'-[] wsh weighut Khalanca, type P6115P y-: head fluhing Trim: type.AN.+~~~'o~-. ; maierial_bb-9& Paint : number coau Wtaihrmrippng: typeZY' S . ° ; materfel \.JvNv~ pSiorm wh, number Scrcrni:~ full; ?halQ t~yp-e ` ~y ; number n Il~ .~uk-; screen cloth tilUVr, t - Basement windowr. type1JS111..L~: materil~t h ~ ;~cram, numberStorm u+h, number , Special windaw~ ~ Addiiional informatim: 18. EMRANCES AND EXTERIOI, DETAIL: l ~ -r• Fnme: materfal thicknea Main entrante door: material Fi vro~^~St ~hSt~~ ; widih 3' V p•~ lhicknws / e~. ~ Other emnMe doon: material ~f~° width~`Ythickneu~". Frame: material , IhicknnaL~" , . Ilcad fluhing Weathenlrippng: rype~'MOSLOti m~'7 , dYe~ Streen doort: thicknas numbet ; W:reen cloth material ' Slorm doon: thicknm number Combinatiai ftorm and screen doon: ihickness numbers2--; wr«n cloth material Shuueri: ? hingul; El fiacd. Railings , Attic buven Extcrior millwwlc: grade and specics - Paint ; num6er coaU ' Additional information: 19: CABINETS AND INTERIOR DETAIL• 'l ~qh ; Kitchen cabineu, wall uniu: malerial a4R ~ Tl0.+~O.l1~oOCX ~ • lineal f et of 'helvet : thdf widlh uniu top ~JCing Bax-unics: maierial 6ak m .~~Back and end tplnh Finish of wbineu number coats Meditine nbineu:maYe _ ; model . Oihcr w6inets and buihdn furniwre a ' Yi e 5 .Sa+f~ v Q r i eA ~n G4 I'iIaeT~! ' Additional information: kpr-tj Wa j CQ -'~AE T~~C/ut, f', 20. STAIRS: - - - - - - - - - - . - T~e~w RIiLRf ' SL0.1NG/ HAYUMIL ' BAWSTfMi $TMII . ' - Maarial 7TicYMss Afaurial 71.icknm Material Sixe Malerul Sia Movid 5ire Bafcmenl .Main Mtic Diuppearing: makp and modrl numhcr Addiiional information: 2 . ~ °.~21. SPEdAI FLOORS'AND WAINSCOT: a~ a c,4~ yovt` O.ra c.. . Tuv'sua.o Ww. Bua Unoeanooa , Lorwnoh Mnnuu. C01n0. BoROU. Sau. CMa, BTC. AMwwu MnnaML MA rcwt . ~ Kitchen ' . $ Bath w Locnnox MnTUUti Coi.oa, Bowu, Cnr. 9ixq, GAoe, Em. Ilucur 1{uaut Huoxr ih SMOwuu p.ea Tus (Faor Fwop) Bath ~ 3 , Bathroom acceswrier. IR Recessed;' material G)VrO0a~ ; number eVL; ?Atuchdi; msterial ; numbo Additioml informatian: , . _ . 22.' PWhABING: PizTURa Nuuma [.acJenan Aluc6 MiR'd FI%NR6 IOLITfICAT10H No. Sua Caaa $Ink~ (G JIt A/` X~~1e6% . S. Lvebry !eJ t` •G.. Watcr cloul ' Bnhmb~~ Showerover m0 SWllhowu0,' . Irundry 4ay,-. .k. i kv a: 3 an . 3Y wL~` c i l'f'R. ~tuc• S ~i~e u~' a l/. ~•~e 5 . A? 4inain rod 'A[j Daor ? Shower pan: matcrial , ' Watet mpply: Q public; ]a wmmuniry ryatem; inclividual (prlvate) system.* F Sewage d'upotal: Q public; )Reommunity oyolem; [I individual (privele) syitem.* . *Shau arod dnmbt iadim'dm( ryslem in rompkfs Asfail in xpnraly draroiryi md aperifica(iau ocrorAin` fo rsqvinmmtt. Houae drain (inaide): 0 es.e iron; ? iile;~57' other RV G Houte newer (ouuide)t [3 cut' iron; kiile; ather , Wata piping: ? galvanized u«I;)?4aPper w6ing; [D ,aher o Sill caclu, number -a. Dortwdc water'hnter:,rype aWS. ; meke and modelhndng upaciry~, . . ' gph. 100' riae. Sange unlc: material upacitY~Billau. Cu mrvice:g utitirycompanY; ? liq. peL gar, Q other Cu piping: [3 oooking; Q1ouae heAdng. Foaing draina.comocted w: 0sarmsewer; Q uniury sewer; [3 dry well. Swnp PumP: malce and model twpatity : diechatga inm 23. ?unro: ` 1' . , ? Ho[ wuer:l Q Steam.' Q VRpor. ? One'PiPe q'nem. Two-pipe oystem. , . h ? Rad'uton. [3Cmvecwn. ? Bautasrd. radialion. Make and madel 7 Radiant pancl: Q floor: Q wall; O ttiling.. Pand coil: mslerlel . ? Circulawr.. ? Aeturn pump. Malca and model ; qpacity 6Pm, " Boilei: mslm andmodel . . Owput Biuh.: net nting Bmh. ~ `.Mditional informatiaa::.-.. . . . Wum air: ? Cnviry. Forced. Type oC synem Cc)-n . . Duct maiuial: iuppy G~\U ; niurn cw±l ~3 Imulation , thickneu . $a,Ouuide air. inWce. Furruce:make and modd Ly°_.lCa,~nX ~ . Input Btuh.; ouiput B[uh, ` • Additiwul infortnaiion: ~'YS °7n ? Space heaiu; Q Boor furnace; Q wall heater. Input Btuh.; owput Btuh.; number uniu Make, model - qdditional inlormatian: . Camerols: rruke and /ypes ' Additbml inkrmation:Fue4 Q Coal: ? oil"gar 0 Gq. pee. gai: 0 elecwic; Q other ; norage capaciry Additional informaGm: ' Firing equipment fumishcd wpantely: Q Cu bumer, convenion lype. E] SwYer: hopper. feed bin ked ? Oil burner: 0 prenure atomizing; 0 vaporizing . Make and model ' . . Cuntml Addiiioml informarion: Eleclric hfating iynem: rype [nput wallr @ vahs; outpm Btuh. Addidonal information: Veniilating equipment: auic fan, make and modci ; capecily rbn. kiichm ea6aurt fan, make an(l malel - n Oiher heating, ventilating, or caoling cquipmrnt 'tA dkY~. ' hr7t.1A';a~n6t0~ 24. EIECTRIC WIRINQ: 5 ~ Srrvice: ? overhead;A underground. Panel; Q fuse fwz; ~ circuil•brcaker, make.~5" e~AMP'# QU No. eircuit& p Wiring: ? tonduit: d armored ca61e;V nonmetallic cablq Q knab and Iube; Q olher 'Special owleu: 0 range; ? water heamr, ? oihet _ 0 Door6ell. ? Chimq. Push-6uuon locationf Additional information: 25. LIGHTING flX7URE5: ~.Sb-~ ~y, ~~~ytie~~ovwQwv~.,,k.c• , Toul number of fixtura- Taml allowance for fiztura, rypical in+tallaiion, S . Nontypieal imtallation Additional informstion: 3 DESCRIPTION OF MATERIAIS . DESCRIPTION OF MATERIALS 26. INSUTATION• ' 11,~Tqw 'IN~ntnm Mwnuny Trre, nno Maniuo <ir Inarnuw*wM V+rot BARaieR Rwl' . Griling ~ z~e ~ Wall Floor - HARDWARE: (moke, malerial, and flniih.) \213 ~ r-`~ SPECIAL EGUIPMENT: (SfaM mahrial or moka, model and qvonNfy. lnclude only eqVipmsnl ond opplivnce: which ore accepR oble by local law, custom and opplicable FHA standards. Do not include ifsmi which, by esfa6lished cusfom, ore sapplied by octupanf and removed whan he vacahr promiiss or chaHles prohibifed by law from bacoming realFy.J 27. MISCEIlANE0U5: (Dsscribs any main dwslling maferiolr, equipmenl, or conshvclion ifems nof thown elsewhere; or use fo provide odcritional informnfion whsrs fhe spate providad wai inadaquois. Alwoy: reference by ilem nvmber fo correspond to numbering ussd on fhis form.) p'A 1, ~;.Y. c - PORGk45: TBIRACES: OARAGfS: O K U" hR~ 1iwct~ c~2X4 F,7{.Uc~~ IG~~a~C ~ cAro,<> > rt[~.S r~n i a4 " o.G~ F=loor w~ C12lr~ WALKS AND DRIVEWAYS: „ Driveway: width base malerial { thicknceo sudxcing malcrial _._,,ihitknes+_ Fmnl wdk; width't ~D" : material ; thicknefa~". Service wnik: widds ; mqlerial { thickneee Stepe malerial L'Ov.c_. ; lrcad, IX-rixn8~.-°. Cheek walla OTHER ONSITE IMPROVEMENTS• . .~)vN. C~ I (Sfrrifj alf tx(nier ertiilt inaPtaurmrn(i rtaf dnaibtA rBftrwhoe, mrfudins iItnrr turh ae ummml qrrtdms, Aroinagt sfrudnrtf, rr(airring wn!(t, fma, railinRt, and atnirdry alruduret, J LANDSCAMNG. PLANTINfi, AND FINISH ORADINO: k5-6-rG .eyr pf{c'V-r,F' 6W, t Ihc~, Topoil ° lhiek: ?(mnt yard; ? tide yards; 0 rmr ysrtl to fttl behind maia building. Lawns (xnfrd; mddrJ, wiprrgrd): Q front yard ; 0 side yarda rcer yartl Planting: [3 aa ipecificd and ahown on Jrawings: ? ns followe: Slude irea, deciduous. " celipca Evvgrcrn trtts. ' to D& B. Low flowering Irem, dtaiduous, ' to_' Evergran shrubs. ' to B & B. High-growing shrubs, deciduaus. ' io_.._' Viner, 2ryrar Mcdium-growing shruM, dcciduous, ' to_ Low•growing sLruba, dcciduom, ~ [o_, IosrmnenTloN.-'lhis exhibi[ shell be idendfled by the dgmture of the buildeq or eponsor, and/or the proposcd mvrtgagor if lhe lauer• u kmwn .t ehe time of apPlindon. e- Gq `YQVy.,. C) o.te 5,gn.luR fZ Wog'a w R"a Signalurt FHA Fertn 2005 VA Form 26-1832 4 • U.S. GPO: 7974-544-478/7341 .uS L. DEUn AOBE N7MA07H ENGINEEAING ~oNSUU~?+o ENO1NEERf PLANHEAS ond IAHD '~URCOMPANY, INC. ~ 1000 EAS7 1461A STREET, BURNSVILLE$ MINNESOTA 55337 PH 432-3000 Cer~i}'i ca~ Surzre y jdaat ..Qe.$cr40e2fon: LOT 9, BcacK 2, .B[ACKNAWK OAKS AoDI7loN, DAKO7A cou~v7"Y, MINAIESOTA 9/v,5R7-0N AVENUE 41 g a N 890 59' 4$" io5.oo o $ Q ~l 30' FRoNT BUILDIIJC~ 5 5~ ~»a?.-9 S6TP~ICK CINE 9i~ z2.33 ~ ; -~g93 5~ I I hAKnL~ E=~_ ~ d.4 ~ d . I N ~ S~•58' I P9AP056o r C $pz .-sD DENOTES EXI9TING rrov~1 o I ELEU,QTIOAI ytau -02637- M . ~I I (893.5) DENO-fES PROPOSED in.ab 79.E3. m.o . , ELEVATION Io 1. -5-5)__ C693•~> 3=~ I INDICATES DIRECTION OF SURFACE DRAINJA6E 6?3.e3 = F!NISN5D 6AR466 FLODR ELE?ATION !u I C~9~K , o a $ ~ LoT 9 i i ~ u L_ 1 Y~~ I ~ I I I ~ I SCALE : 1° ~ 30' I ~ I 5I ~ I5 II :~-DRAIMAcE AND UTILI7Y EASEMENT ~ 88.~ C$9o.o Cs96 ~ S 89° 56' 37" W I hareby cartity that this ie a true and corract repreeantation o[ a traetot land as sho+m'And described heraon.• As praparad by ma on this _IzrW day of s 6wrew.aCe ~ 19ge- . . ' " %4`;at,,~ Hinn. l~e~. No. /Gof1s , E T.no-n+y L. De ti~~S AOB ENGINEEIIING `pIRHNEAS ond6lAHp 3URVEY6IIS COMPflNY, INC. . ~ 1000 EAST 1461A STREFT, BURNSYILLE, YINNESOTA 53337 PH 432-5000 Cer-~i}'i cu~ Su.r-Ye y ~g441 IJ~e.:cr4p2ion:, LaT 9, BLOCK 2, . B[17CKNAWK OAKS ADD17/oN, DAKOTA CouN7Y, MINNESOTA ~ K/U~R TOti! AVENUE i3iy - ~ - ~a~ ~YI'SED jo'IS• Sb 0 890 59" 4B" io5. 00 30' FRONT BUILDIN& J pA &Z--Z) I. 9E7B4CK LlAIE 9t. 9z. 9.t . zz'S3 o gqa.z I hA ¢nC.lE=L____-- 8 .9 ~2 . N ~ 5~.58 I PR-oPasEV r CB130 DENOTES EXISTIMG i - ~ rwvl~r- ~ I ELEUqTION .I F`"u ~ ~3~ I ~ (895.5) DENOTES PROPOSED 79.83o.o . ELEVATION INDICATES DIRECTION OF SURFACE DRfI l tJA6E I ~891.So~ ~ I . 891.rb s FlNI5N5D GARA6E FLOOR - I ELEVqT/OAl M N I ~ ~ I ~ LO-T 9 II I I ~ I SCAIE I ~ I I 5I ~ II5 DRAliJA6E AND _---J UTILITY EASEMENT -N - -,n 88. o0 ~896.0) C89o.o~ 89° 6-6' 37„ w ~69o.a> . I hereby cartify that th3a ie a true and corract repreeentation of a tract ot ~ land as shown'And deecribed hereon.. As prapared by fia on lhii /Zn/ day of 12E?/o/~S ~Sl~ L.n..ere.e~ lwet /~"`7~`~ /t~-?( Hinn. ~f6• NO~ /&dE'S 3826`Rrv'ii T 4) A•dr"_ Date: 12/30/2009 Revision Date: 12/30/2009 Site information Address 1:38 25 Address 2: A City: l=AS �Gounty: Application Information -, c •A 7 Business Name: Comfort Solutions Heating & Cooling Contact Person: Dave Kolby Office Ph: 763-565-2121 Fax: Cell Ph: 763-238-7722 Address 1: 7829 Palmgren Ave N.E. City: Otsego State: MN Zip Code: 55330 House Details Square Feet: 4000 sq. ft. Avg. Ceiling Ht: 8.5 ft. Ventilation : Exhaust Total Ventilation Capacity : leocfm. Minimum Continuous Ventilation :90cfrn. Continuous Ventilation Provided: Exhaust: 90 cfm Intermittent ventilation satisfied by OTHER exhuast appliance. Combustion Appliance Water Heater: Power Vent Input BTUs: 76,000 Independently Vented New Construction Project #: Lot: Block: Subdivision: MN Contractor License #: p.2 Number of Bedrooms: 5 PI ec Coots - r ri 'rx QrrrX Q r ( Fumace/Boiler: Direct Vent/Sealed Combustion Other Combustion Appliances Gas Fired Direct Vent Fireplace(s): Yes Gas Fired Natural Draft Fireplace(s): No Exhaust Equipment Exhaust Ventilation Capacity (cfm): 90 Exhaust Fan Rating (cfm): 75 Make -Up Air No Make -Up Air Required by Code Input BTUs: 80,000 Independently Vented Gas Fired Power Vent Fireplace(s): No Solid Fuel Appliances): No Clothes Dryer (cfm): 135 Combustion Air Round Rigid Required: 6 inches or Insulated Rex: 7 inches Applicant Name (print):' LIFE, L iIs Signature/Date: J Code Official (print): U`f Signature/Date: © 2004 CenterPoint Energy Minnegasco. 2004 Mechanical Code Guidelines_ Page 1 ------------------ For Office Use Permit #: / V o`c.i f j Permit Fee: _sG Date Rec ' /6 v Q Staff: ? I ---------------- 2009 RESIDENTIAL BUILDING PERMIT APPLICATION G- ' Date: I Site Address: Tenant: Suite #: V-11e . /1:J RESIDENT / OWNER Name: -4 4 a IN y'./9 Phone: 6 ??/ Y +' 's?`? 7 Address / City / Zip: X37 l' ' e 5f „ Applicant is: Owner Contractor TYPE OF WORK Description of work: rn Construction Cos ' Multi-Family Building: (Yes / No CONTRACTOR Name: License #: t Z)d 7 Z- / d-oi? z- P 7 Address: 7 L° ? S dm j City: 75 C' o-l -Ile )--77, State: r Zip: Phone: ° a F9 Contact Person: ! a Gf / e e4G COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Minnesota Rules 7672 _ Minnesota Rules 7670 Category 1 _ Energy Code • Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet Category Submitted Submitted submission type) • Energy Envelope Calculations Submitted In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? _Yes No If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer & Water Contractor: Phone: NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that they are trade secrets. 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 to s vpllTt a peynit; that the work will be in accordance with the apprM/50 plan n th case of work which requires a review and approval ans: x Gt0 6`'7 x Applicant's Printed Name Ap icant's Signature Page 1 of 3 Auc- DO NOT WRITE BELOW THIS LINE %DOI SUB TYPES _ Foundation Fireplace Single Family _ Garage Multi Deck _ 01 of Plex _ Lower Level Accessory Building WORK TYPES New Addition Alteration Replace Retaining Wall Porch (3-Season) _ Storm Damage Porch (4-Season) _ Exterior Alteration (Single Family) Porch (Screen/Gazebo/Pergola) _ Exterior Alteration (Multi) Pool Miscellaneous Interior Improvement Siding _ Demolish Building* Move Building _ Reroof _ Demolish Interior Fire Repair Windows Demolish Foundation _ Repair Egress Window _ Water Damage .Demolition of entire building - give PCA handout to applicant DESCRIPTION 04 Valuation Occupancy Plan Review Code Edition (25%_ 100%z Zoning Census Code Stories # of Units Square Feet # of Buildings Length Type of Construction j3 Width REQUIRED INSPECTIONS Footings (New Building) Footings (Deck) Footings (Addition) Foundation Drain Tile Roof: _Ice & Water -Final 4 Framing Fireplace: _Rough In -Air Test -Final Insulation Meter Size: Reviewed By: _ Base Fee Surcharge Plan Review MCES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant Copies -4G-- MCES System a;, ? SAC Units ft City Water "- -?-- Booster Pump --, PRV Fire Sprinklers Sheetrock Final / C.O. Required Final / No C.O. Required HVAC Other: Pool: -Footings -Air/Gas Tests -Final Siding: -Stucco Lath -Stone Lath -Brick Windows Retaining Wall Erosion Control Building Inspector TOTAL Page 2 of 3 Receipt#: 51939 2666069 ABSTRACT FEE $46.00 ATT COPY $2.00 111111111111111111 Recorded on: 6/23/2009 11:26:54AM By: STG, Deputy COPY DEL D Return to: CITY OF EAGAN COMMUNITY DEVELOPMENT DEPARTMENT 3830 PILOT KNOB RD EAGAN, MN 55122 Joel T. Beckman County Recorder Dakota County, MN CERTIFICATION OF PURPOSE OF SECONDARY KITCHEN FACILITIES WITHIN SINGLE FAMILY DWELLING I, :T, oAt s A . !y , duly sworn and under oath, certify that I am the Owner of the one-family detached dwelling as defined in Section 11.03 of the Eagan City Code located at 3825 Riverton Avenue and legally described as Lot 9, Block 2, Blackhawk Oaks, PID #10-14387-090-02. A building permit application has been submitted on my behalf to the City to enlarge, alter, improve, remodel, and/or finish the above-referenced dwelling, or a portion thereof, to include the installation of facilities for a secondary kitchen within the dwelling. The secondary kitchen facilities to be installed under the building permit are for the sole purpose of providing cooking and food service facilities for private entertainment of guests by the property owner at the dwelling. I acknowledge that the Eagan Zoning Code prohibits the existence of a second kitchen facility within a dwelling unit to serve a complete, independent and secondary living or housekeeping use within the dwelling. I certify that the installation of the secondary kitchen facilities under the building mit is not for the purpose o providing a second complete, independent and separate living and/or housekeeping nit ithin the dwellipg. Dated: 2009 Subscribed and sworn to before me this .23 day of Signature 2009. ---------------------------------- KRISTIN M PITCHFORD Notary Public - NOTARY PUBLIC - MINNESOTA MY COMMISSION EXPIRES 1$1.2010 rr I hereby verify that the above said Certification of Purpose of Secondary Kitchen Facilities Dwelling was recorded at the County Recorder's Office on THIS INSTRUMENT WAS DRAFTED BY: City of Eagan Community Development Department 3830 Pilot Knob Road Eagan, MN 55122 By: Its: Within Single Family , 2009. G:\Building Inspections\FORMS\Certification of Kitchen City of Eagan Cash Receipt Receipt Date 7/16/2009 Receipt Number 151608 ACR HOMES/DAYCARE INSPECTION 3825 RIVERTON AVE 1221.4216 50.00 DAYCARE INSPECTION Total Receipt Amount 50.00 121197 6:24:34 City of Eaaau 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 ----? For Office Use - - - - - - - - - - I ®???/ Permit #; Q, ?O Permit Fee: r Date Received: Staff: ---------------- 2009 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: 7-1 ®?? Site Address: ,'Z. r? vci Tenant: ?,' Suite #: RESIDENT / OWNER Name:, 'G, , !0? 5 Phone: Z3 7 S ?.t'J?// "??/. Address/ city/ Zip: Z , CONTRACTOR Name:'/7 License #: as- Address:/). Zip:,5 /- / / City: ?2ell State:/ ?? Phone:6i / 7773 Contact Person: 5 ? Jae -, TYPE OF WORK _ New Replacement _Repair -Rebuild _ Modify Space _Work in R.O.W. Description of work: PERMIT TYPE RESIDENTIAL C h,q fl C PIplc vim ' o ?C S ?? z ?C' Water Heater Water Softener Lawn Irrigation Add Plumbing Fixtures L- RPZ / _ PVB) Main i Lower Level) Septic System Water Turnaround New 0 / 1091, 1 ;0 `Abandonment l ?j ? e2O RESIDENTIAL FEES: $50.50 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $.50 State Surcharge) $30.50 Lawn Irrigation (includes $.50 State Surcharge) $50.50 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $.50 State Surcharge) *Water Turnaround (add $165.00 if a 5/8" meter is required) $100.50 Septic System New ($10.00 per as built) (includes County fee and $.50 State Surcharge) $90.50 Fire Repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) TOTAL FEES $ i nereoy acknowledge that mis Information is complete and accurate; trial the wont win oe in conformance witn the O inances ana cones or me ?.ay or Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to wit a permit; that the work will be in accordance with the approved plan in tthh case of work which requires a review and approval of plans. oa__: Applicant's Printed Name Applicant's, Signature FOR OFFICE USE Reviewed By: Date: Required Inspections: Under Ground Rough-ln Air Test Gas Test Final City of Eagan Cash Receipt Receipt Date 7/21/2009 Receipt Number 151747 METER 4?RIVERTON 6101.4509 219.00 PERMIT # 90039, SUN RAY PL Total Receipt Amount 219.00 110249 9:00:15 For Office Use-_- 411110, PCity of Eaaau -6t 3830 Pil ot Knob Road Eagan MN 55122 Date Received: Phone: (651) 675-5675 Fax: (651) 675-5694 Staff: 7v -----------------J 2009 MECHANICAL PERMIT APPLICATION Deft: Site Address: Tenant: Suite Name: t me 5 Phone: RESIDENT /OWNER Address / City / Zip- ~i~l Di-J~ f~ l! C 9 / ~ 1) 3l 9 l t CONTRACTOR Name License cl6c& ry7S~ GU ~t'ct..~sn~~ C T -I Address: P'' 2 9 City: State. ZIP; Phone: c - Contact Person: S TYPE OF WORK New Replacement Additional Alteration Demolition Description of work: zlz °~~JD2 c f~7f- Yc ~/r ~c j!' r NOTE: Both roof mounted and ground mounted mechanical equipment Is required to be screened by City Code. Please contact the Mechanical Inspector or one of the Planners for information on perjWW screening methods. PERMIT TYPE RESIDENTIAL COMMERCIAL Furnace New Construction Interior Improvement Air Conditioner Install Piping Processed Air Exchanger Gas Exterior HVAC Unit Heat Pump - Under /Above ground Tank L_ Install 1_ Remove) " When installing/removing tank(s), call for inspection by Fire Other Marshal and Plumbing Inspector RESIDENTIAL FEES: $50.50 Minimum Add-on or alteration to an existing unit (includes $.50 State Surcharge) $90.50 Fire repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) $ r~ TOTAL FEE COMMERCIAL FEES: $70.50 Underground tank installation/removal OR Contract Value $ X1% $50.50 Minimum (includes State Surcharge) - if Pennit Fee is less than $1,000, surcharge is $.50. $ Permit Fee - If Permit Fee is > $1,000, surcharge increases by $.50 for each = $ State Surcharge $1,000 Permit Fee (i.e. a $1,001-$2,000 Permit Fee requires a $1.00 surcharge). $ TOTAL FEE I hereby acknowledge that this information is complete and accurate; thatthe work will be in conformance with the ordinances and codes of the City of Eagan: that I understand this is not a pennrt, but only an application for a perrnit, 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 "W Z-6z/ Applicant's Printed Name f Applicant's Signature FOR OFFICE USE Reviewed By: Date- Required Inspections: -Under Ground - Rough In Air Test Gas Service Test _In-floor Heat -Final Exterior HVAC Screening Inspection Z,d 61.0E-599 (09L) icgloyl enea d09:60 PO 0S deS t > u s ��as az - ..� cm ®' N • 4 W ATE R `SEI V10E 3 8 Road z r _ Ea ' a N551 . . DA-- `' _ ti Zoniflg: $ . ` - • x I o sot Units � Owner.. 't `ftri I._ glenn i is f ' A ddress • , • * y t .Site Adders S R # Aar t �# l`+�lix� wk Oaks [ Plumber T A- - Plp lv fn r Meter No corm ection _Char ge: - � ©pd _ Size z r ? , . -7-1' � Account Deposit: 15 - OOj+d .- Reader No Per Fee 1Q -0dpd ` ' 1 agree to with `the Cit of E Sur char g e: - 5i�pd �Ordlnan misc. Charges 156 - - Total: 63 _ S�Pd 'metier „in _ � BY� Date P ai d: - Date of Insp. a. _ Insp.: CITY OF EA- • S E ER SER CCE' PERMIT 383(2°1$11'13-6-; otKnob Ro r ` F3 �' - f PERMI N0 Ea 61721 r1 M�, 9 DAT Zons . r No f ..lJn i ts : �.,_„���_ i •.. Owner: T r " BlackIla Address - - - Site Address' ,e Ptdmber. 62 plumb `" 9 - a .,39 \ 1 1 g r a b to co mp ly ... with the cit of Ea9 % C onnect ion Charge: 1 Ord SAScooun D eposi t . t i Pe fee i ! 1 1 surcharge . *` By t /d Chorger € Dote of �• A • Total: t Insp.: i 1 Dated: Use BLUE or BLACK Ink r----------------� � I For Office Use � • � Permit#: / ��/��� j C�6y Ol ����11 I Permit Fee: ��`��I 3830 Pilot Knob Road � � Eagan MN 55122 � Date Received: � Phone: (651)675-5675 I � Fax: (651)675-5694 I Staff: i � I 2015 RESIDENTIAL BUILDING PERMIT APPLICATION Date: � 2 �S <l �Site Address: ���� ��������DG`� ��G' Unit#: ��,�,�. �.,�,..,�.,�,��,,��, .��._..�� � ,.��.�,,.�.,�.,� ,�..a,m..�.,.���,�..� �s � Name: � ��` ���5 Phone: � l�esid�n#I � / � �1111FI�E�� Address/City/Zi��3��<�� �- �Grg�rS t �(� ���(� � � / Applicant is: Owner � Contractor ' ' Description of work: � �G�� �y��a Qf`I�rk ' ' Construction Cost:�, �C��� Muiti-Family Building: (Yes /No� � ,..� Company: //T_��� �ca j4 S �< Contact: %��L� " �l2 `�/� ^ �G? � Address: ���S�j ��� ��i�4-� City: /��5� �`�� Contractor � State:��Zip:�� Phone: Email: License#���z���l� Lead Certificate#: If the project is exempt from lead certification, please explain why: 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: N{JT�'»Pf��s.a�,�1'��r�par�ir��+cF����en��s that;�ew"�w#rr���a��o�sld�tir'ed�bs�a��zt�c�i�#'�rr��f�u�: �'ortior��Qf the�n�fort�a�on m��t be classi�ed a�n�n���li�Ff yau pro���le�p��i�c,r�a��ns tha#wo�ld perr��t�#te �`y#y to concl�rd'e�hat#�e . are t�a��.�cre#s. CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.�opherstateonecall.orq I hereby acknowledge that this information is complete and accurate;that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. Exterior work authori by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 days of ermit issu �,r`" r � 'x X /�'�i��.�-°�7 ��Gt'���u��"_ plicant's rin d Na e Applicant's Signature Page 1 of 3