510 Rolling Hills Cir
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~ . INSPECTI4N REC~RD Control No. ;J J~_
~ CITY OF EAGAN PERMIT TYPE: i t' ~ M"
3830 Pilot Knob Road Permit IVumber: ~
Eagan, Minnesota 55123 Date Issued: o~~~ 6~ g?
(612) 681-4675
SITE ADDRESS: ~ ot' ~ ~ z p~ uc E. . APPLICANT:
fi~~ RC1{.?.IMI~ NILt9 CTR RtDER90N FlOMES IMC
Bl1~t OAK HIl.t ~ ?Np f612) ~23--3~86
,
PERIV~I~T ~~~TYPE: TYPE OF WORK: Mt w
.
f~~Ct 1 1 NE~ ~RAN Y Nti
[NSULAf IElN FINAL
F ittf.l'1 ACF.
FI~MARk~ 5 r ~ Z 4~I CbMTRA6TOR - pEINE pf.NA -
. _ ' _ .
wnnn No. Ps~mn Hoid.. w6e re~.phon. s
. SI1N
PLUMBING S~~$'~~-- ,}'L,~rf-
HVAC ~ l~ 7- ~
ELECTRtC ~
EIFCTRIC
Insp~etion ~aie Insp. Commenb
~ l~a ~
FrBming -~92, D.S ~C.s Ll,I ~h l.j hA r miiT ~j
/
Roofing ~ ~
~gh ~ G~
~ ~%z
p 2a9z ~s
~ 2~9= D s aa
Rnal Htq. ~ _ p
Orsai Tesi
Ffnal Plbp. ~ U . Ir~spetxor - NoQifY PI ber '
~7
Const. Meter
EngrJPla^
Bidg. Final _~`g2 eO~rGGF' - G ~ Z Q
Dedc Ftg.
Deck Final
Well
Pr. Disp.
~-25?Z ~
f . • y,~F
~ ~
~e~ti~ica#e u~ ~ccu~anc~
~~t~ o~ c~~~
1 ~~~t ~f
This Certificate issued pursuant to the requirements of rhe Unifor?n Building Code
cerlifyiag that a1 the time of issuance this structure was in camplrance with the various
ordinances of the City regulating building construction or use. For the foUowing:
SF U,iG ~147
IJse Qaasification: Bldg. Panut No.
Oocu~ocy 7~pe Zoning District 7ype Coaa-
OwraafBuildin ~~+S Add~tss 351 ~~t1~ w~ ~
/ V ~ ~
i A~Il.$$ ~OCB~~ty
~ _
~ Q/24~42
sw~a~~ ar~
POST IN A CONSPICUOUS PLACE
~03462 ,B~ ~ Z~ ,~°~5~~
Request ~ale ~ ~ Fir¢ Na. Pough~in InspMian
7,~ ReQUiretl9 ? Reatly Now ~LAGin Notity Inspector
d ~Ves G No ~YVhen FeaOy?
~ licensed contractor p owner hereby request inspection of above electrical work at:
Job Atlaress ~Street. Box ar Route N~ / Giry
~ D~~~ i/lj' ~'iiCVe ~i~'~)'9~~
$eclion No. Townshi0 Name or No. Range No. County
~
OCCUpd IPRINTI PhOnO N0.
ed~.c.r~h Z3 -3086
Power Suppligr Atltlres~~ ~
a7 v ~
Elxmcal C mracmr ICOmpany Name~ ~r/ ConV/acl~o/r5 ~1icense No.
~ cl ~ G(L!/~`~I~C.. ~.c Yi 0 0 I~~
Matling A es ICOnVa<lor or Owner M king Inslallali n~
1.2 ~.f' .~~a, y tv9 Y.~~s e~~:~ ~Jv6v
Aumorrzetl SlgnaIDre IConhatlori0 ner Maki g 1 aLOn PM1One N Oer
~I ` .~Z~ `~~3 - ~l3 ~
MINNESOTA STPiE BOAHD OF EL FICITY THIS INSPECTION REOUEST WILL NOT
G~Iggs-Mitlway Bldg. - Poom 54]3 BE AGCEPTE~ BV THE STATE BOARp
1821 University Ave., SL Paul. MN 5510A UNLESS PROPER INSPECTION FEE IS
Vhone (613) fi40-0WO ENCLOSED.
, y~ REQUF i FOR ELECTRICAL INSPECTION ,''"`-d??~ es/.o~ooo, oe
~ / ~ See in5 ns (or compieting this forrn on back ol yel~ow coOX t /o~p S~/
,,C.a6~,~'
x
~ 0 3 4~2 i~Below Work Covered by Thrs Request u~
r°
ew Add Rep. TypeofBUiltling AppliancesWired EquipmentWired
Home Range Temporary Service
Duplex Water Heate~ Eleclric Heating
Apt. Building Dryer Other (Speci~y)
Comm./IndusVial Furnace
Farm Air Conditioner
Ot~er ~sV~~YI Conlrector5 Remarks:
Compufe lnspec(ion Fee Belowr
# Qther Fee # ServiceEniranceSize Fee # Cirouiis/Feeders Fee
Swimming Pool 0 to 200 AmpS db 0[0 100 Amps ao
Transbrmers Above 200 _ Amps Above 100 _ Amps
Signs ~~specmr's Use ONy: TOTAL `
Irriga[ion Boams d~
~ r-
Special Inspection
AiarmlCommunication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONTHS.
1, the Elect~ical Inspector, hereby Rough~in oa~e ~
certify that the above inspection has Finai - ~
been made. y
OFi1CE USE DNLY
T~is r¢quest voi~ 18 monNS Irom •
Addres5: 510 RLIId,ING HILi,S CLR.,rLE L°t 42 Slk 2 Sac/Sub g~ ~
These items were/were not complate at the time of the final inspection.
D 9~24/92 Yes No
Final grade (6" from siding)
Permanent staps - garage
Permanent steps --main entry
Permanent driveway
Permanent gas
Sod/seeded grass
Trail/curb damage
Porch
Basement finish o
Deck
Please verify vith the builder the ramoval of roof test caps from tha plumbing
system and the shut-off of water supply to tha outside lavn faucet before
freeza potential exiata. ~
acraeoruu
White - City copy Yellow - Resident copy Pink.- Contractor copy
~~i9 96; ~
zoo~ RESIDENTIAL BUILDING rEiuvtiT nrrLrcaTiorr
City Of Eagan
_ 3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
NewConsWCtionReauremenis ~ Remodel7ReoairReouiremPnis 9lficeUseOnlv
3 reqistered site surveys shovnng sq. ft. of lot, sq. tt. of house; and all rooted areas 2 copies of plan showing footings, beams, joisfs Cert of Survey Recd,;. Y'_ N .
(20%mmcimumlotcoverageallowed) lsetofEneryyCaiculations(orheatedadditions SoiLdRepod _Y_N
1 Sa1s Report if propased buildirig is lo be pWced on dBWNed sdl 7 site survey kr atldfions 8 detks Tree Pres Plan Recd _Y _ N,
1 copies of plan showing beam & windav sizes; poured found design, etc. Adddion - irMicafe if oo-s~7e sepfic sysfem Tree Pres Required Y_ N
1 set ol Energy Calculatbns On-ate Septic Syslem _Y N
3 copies oiTree Pregerva6on PWn H lot platted after 711/93
Rim Joat Detail Optlons selection sheet (buildings with 3 or less units)
Alinnegasco mechanical venNa6an fortn .
Plans are considered ublic information unless ou state the are trade secret and the reason.
Date.~/~/ ~ ( ConstructionCost ~
Site Address lJ//77 Unit/Ste #
n~
Description of Work e O O ~ J~~
Multi-Family Bldg _ Y_ N Fireplace(s) _ 0 _ 1 _ 2
PropertyOwcer ./~"Il9l~L~ F l7/7~ /p ~G~-d~') Telephone#(~)~~-/~Or~-
Contractor ~ ~Clf~ GLGtG ~/IC. ~
~ Address .~~c~~ / f City /~rlC.~Os!
State ~ Zip ~Telephone # ~~~JQ/
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy Code Category .,Residenlial Ventilation Category 7 Worksheet • New Energy Code Worksheet
submission lype) Submitted ~ ~ Submitted
. Energy Envelope Calculafions Submitted -
In ihe last 12 monihs, has the City of Eagan issued a permit for a similar plan based on a master plan2
_ Y _ N If yes, date and address of master p~an:
Licensed Plumber Telephone )
Mechanical Contractor Telephone )
Sewer/WaterContractor Telephone#( )
I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate;
that the work will be in conformance with the 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
peanit; that the work will be in accordance with the approved plan in the case of work which requires a review and
approval of plans.
~~p -
/l~~J~~Y~~
Applicant's Printed Name % gnatur
~ PERMIT Control No. O 7 5 4
CtiTY OF EAGQN
3830 Pilot Knob Road PERMIT TYPE: aui~oiNe
Eagan, Minnesota 55123 Permit Number: 0 0 0 9 4 7
Date lssued: 0 7/ 0 6/ 9 2
(612) 681-4675
SITE ADDRESS:
510 ROLLIN6 HILLS CIR
LOT: q2 BLOCK: 2
8UR OAK NILLS 2N0
DESCRIPTION:
-Buildi,ng Permit Type 3F DW6
Buildint~.Work Type NEW
UBC Occupancy R-3 M-i
' Construction`7ype V-N
Zoning R-1
Building length 64
Building Width . 37
~ ~
/
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~
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~a
~
L7 ~
` ~~sl~~ /'~`~~C~ j~"~~
V~~~;Aa 1~ ~''/t_~ . I'~. G~
; - 2 t_ J ~ ~
REMARKS: ~ d ` G\ ~ ~V
S& W CONTRACTOR - PEINE PL9G
FEE SUMMARY:
VAIUATION $142,000
Base Fee $786.50 MISCELLANEOU9 - ~1.610.50
Plan Review $511.23 Total Fee $3,679.23
Surcharge i71.00
3AC $700.00
SAC 8 109
SAC Units 1
Subtotal Sz,068.73
CONTRACTOR: - APPlicant - ST. ~IC~yyNER:
PEDER30N HOMES INC 14233086 0B01466 PEDERSON HOMES IMC
3511 143RD ST W 3511 143RD 5T W
ROSEMOUNT MN 55068 ROSEMOUN7 MN 56068
(612) 423-3086 (612)923-3066
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 Mn.
' Statates and City of Eagan Ordinances.
, ~ -
AP LICA ~ITEE GNATURE ISSUE : S NATURE
f .
DERMIT. # CITY OF EAGAN
ftEACT'I~fATE 1992 BUILDING PERMIT APPLICATION
~ 681-4675
SIN6LE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy
calcs.
COMMERCIAL 2 sets of architectural & structural plans, 1 set of
specifications, 1 copy of energy calcs.
Penalty 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 is re uested once ermit is issued.
Date 6 / 24 y 92 Yaluation of work 115,000
Site Address:_ 51o Ro11inA Hills Circie
. STREET SUfTE M ~
Tenant Name: (commercial only)
IAT ~!2 SIACR 2 SUBDBur Oak Hills P.I.D. #
2nd Additi n
Descri tion of work: sin ie Famii
The applicant is: ? Owner Contractor ? Other (Oescrlbe>
Name Charles Thorkildson Phone687-9o5z
Property LAST FIR57
Owner pddress 4657~;Pello Cir~le
STREET ~ STE ~ .
City Eagan State MN Zip 55122
Company _Peaerson Homea. Inc. Phone 423-~086
Contractor Address ~511 143rd St West License #o0oi466 Exp.3-31-94
C9ty Roaemount $tate MN Zip qSo6A
Company _ Pederson Homes. Inc. Phone
Archttect/
Engineer Name Registration #
Address
City State Zip
Sewer & water licensed plumber Peine Plumbin . Processing time for
sewer 5 water permits is two days once area as been approved.
I hereby acknowledge that I have read th9s application and state that the information is
correct and agree to comply with all applic ble State of Mi esota Statutes and City of
Eagan Ordinances.
Signature of Applicant: _ ~ ~
, 1
OFFICE USE ONLY ~ ~ ~ ~ . ;
e„
BUILDING PERMIT TYPE ' .
? O1 Foundation ? 06 Duplex ? I1 Apt./Lodging ~ ? 16 Basement Finish
~02 SF Dwg. ? 07 4-Plex ? 12 Multi. Misc. ? 17 Swim Pool
? 03 SF Addition ? 08 8-Plex ? 13 Garage/Accessory ? 18 Comm./Ind.
? 04 SF Porch ? 09 12-Plex ? 14 Fireplace ? 19 Comm./Ind. Misc.
? 05 SF Misc. ? 10 Multi. Add'1. ? 15 Deck ? 20 Public Facility
~ 21 Miscellaneous
WORK TYPE
~ 31 New ? 33 Alterations ? 35 Tenant Finish ? 31 Uemalish
? 32 Addition ? 34 Repair ? 36 Move
GENERAL INFORMATION
Const. (Actual) V- N Basement sq. ft. MWCC System YES
(Allowable) y-,y Ist Fl. sq. ft. City Water ~'-S
UBC Occupancy I 2nd F1. sq. ft. PRV Required
Zoning ~ Sq. Ft. total Booster Pump
S of Stories Footprint Sq. ft. Fire Sprinkler
Length ~y~ On-site well Census Code ~
Depth ~ On-site sewage SAC Code O{
APPROVALS
Planning Building Assessments
Engineering Yariance
REC~UIRED INSPECTIONS
? Site ? Footing ? Framing ? Insulation
? Wallboard ? Final O Draintile O Fireplace
Permit Fee v.i~c~~: g 14Z.,OOp'
Surcharge
Plan Review
License CiAQA6.6! 32 k2~ = 'TA4 ~
C i~ty 5AC x~ z=~
Water Conn. , G G g X!(. = l0~ 689
Water Meter ~J"~T~
Acct. Deposit ~zx3a /oZ~~
S/W Permit 12x 3 r ~4,
S/W Surcharge ~o%S'
Treatment P1.
ParkDedt ~II~XJS= ~G~~~
Trail s Ded. ~ST FwoR
Copies ~X= Illo
Other Zx2%bc Zy
Total :
113~! ~C53% G~ JoZ
$AC % 100 ZMp FLOC(~
SAC Un i t s_L
3zx~~~ /ezax53= 542ry~z.
~ ~1~~~~2.
IV3-33
C6RTIp'ICATS OF SURVEY FOR; ~
PEDERSON HOMES INC. . . '
~ l
z DELMAR H. SCHWANZ
ScALS: 1^ = 30' i aw~.e.na una~
~iu..pi~rrn~lul~
w Minewa~~
14150 SOUTH ROBEliT TRAIL R08EMOUNT, MINNE90TA 6605! !72/42~-1789
SUiiVEVOfi~ CERTIFICATE SOD-/~-SZE Le
/i2.59 q9
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M ~ ~ p II
u q9 _ ~ /
~ wl ~ - -
, 5
° ~
i~ I ~
~ o= Iion Monument ~ I 4qy,q~~
= Set Wood Hub f~r
= Existing Spot Elevation ~ I ~~~t5~ ~ ( V~
~ ~ B°~'4 ~ tA
= Proposed Elevation . p \
. I ~ 1 q'Sq ~Y a I~ ~ I m a J
~n a : ~ fa Mw~
0` I Nf I I Z v
~ z ~D ~ Q 1
z e , ~ ~
y___~-
PROPOSED GARAGE FI,OOR BLEV. B9S.~ 1 O' I ~
PROPOSED TOP OF BLOCK ELEV. B4S.33 1 d ~ ~ V
PROPOSEU I.OWEST LE{lEL ELEV. 88'~ • 3 3 ~ 11 ~ 6 M I ~ ~
~ `
3 ~ ~ I ~
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O I
a ~ ~t~r~° 5 I~
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~'-.r~ib le8.39
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LEGAL DESCRIPTION - ~
ly~f~-~- . - .7rq~
LOT 42, B7ACK 2, BtlRR OAR HILLS 2ND. ADDITION~: In'l"~~ i•~.
accordinq to the recorded plat thereof, ~
Dakota County, Minnesota. 2oc.~~NC> c;s ~r~
~cl 0 ~pyy~~ps~~~p}~~4~~~~}~~i
, ~d-619~'~`~ YSdV~ddVt9~hS'ld~~:) ~viJ~
~~aaaoa~~ ~~'~rxr~i~;uJi .
. o•~"~a~Q?...........~y~4,.
1 hereDy eertlly thel thla eurvey, p~en. or report wae VP,:'
preperod by me or under my dlrect eupsrvlelon end ' i
thtl I am e duly Reqleterod Lend 3urvsyOr undsr FL R y' ,;~.1 ~
tne iewe of tM 3tns ol MinMeote. q i ` ` /
Delmer H. c tens._. 8625 y
oated 6-23-92 Mlnna~M~ ~ lon No. lMl6;
~
g O
. d
~~y~~~„~ s U R~~
nn+umim+m~ .
Energy Conservation 5upple~ent to Building Permit Application
- BOILDING AND SAFETY DEPARTnEHT
TAIe aupple~ent ie providcd to aaeiet the eppliant !n eo~puting the ELiERIOR EII9EI,OPE APERAGE 'U' FAC7'OR
IBFOAIlATI01l. Tdle infor~ation la requlred eo tAe BUII~IpG OFFICIIL an detenlee thet tfie sns~ltted pl~ne co~pl~
ritA the ~IfRGi fAILSERYATIOA DESIQI C9IiERI~ of t6e .~R17E BUILDIIICi CDDE lSecticn 60011. It !e t4e ~PPLICAIR'S
reepoaei6111t~ to aeeuratelT and a~pletel~ co~pnte the data; refleet the proper DE:SIGA CRITERIA !a t6e plam; .
au6~it product epeciflatioo, ae needed to eupport the 'B' ~ed 'U' facton wed; aad to assure lhat anetroetion
le a~o~pliehed per tAe appro~ed plaas.
JOH LOGATION ~ ~LU ` ~!L-f- !
' ~~/L L~ T~~~'T L E„ I~ L~ 5 6'^1 PAOAE i~c .-J" ~
OYXERSi ' " ' i~
i ? ~ ~C
CONTBACTOR , ~~~F'1~ ~`SY~.I ~r'JI ~ v ~ PHOIIE ~ ~ ~ ' ' ~ , ~
_ ~
A. Deteniae !he Total E:poeed Yall Arna ae follo~e:
1. Total rall ~indor area ~f
2. Total doar area ~ ~ ~ ~
3. Total alidiag glaee door area
4. Total tireplaee ~all area
5. Total nll fta~ing erea leverege 10I1 Z- S Z. ~
6. Total net ~all area above flaor I~ I 6~
7. Total ri~ joiet arna •
Subtotal: Total ezpoeed eell area above floor Z S Z ~ ~
'
8. Total Saundatian rindar area
9. iotal net foundation area above grede I~~' '
Subtotal: iotal e:poeed foundation erea ~
GRAND 707AL Ef(POSID IIALL lREh Z~ 6'i ~ CI'~
Z~/3,0¢~
E. Multipl7 tEe GRAHD 7DiAL EYPQSEU YALL AREA X.11 = I7EC I
L. Deter~ine the iotal Expoeed Roof/Ce111ng Area ae follars:
10. iotal ekrlight area ~ ~
11. iotal roof/ceiling fndng erea laverage SS1 i J
~
12. Tatal net insulated roof/ceiling area ~
GRAND TOTAL EXPOSED ROOF/LEILIRG AREA I I I J
D. Ilultiply tAe GRAND TOtAL EXPOSED ROOF/CEILING AAEA X.026 - ITEIf II ~
1~
~ o
. ~
Getenine the 'U' nlue of eacd aeg~cnt 11-91 and ~ultipl~ b~ the ve ae follore:
1. 7. o~. O~J x~~' 1~' Zi - ~ i 7~~' i
z. ~9,~ x.~. ~ - ; ; ~-,~7
,
3. _
~
4. x s
s. Z- S Z, ~ z~u• , O~( - Z Z, ~l 3
6. I q !9. ~~.x~~• .ca-3 - az.~'~
z (~4 - a x~u• , v 4- ( - 5, 9~
,
a. z ~u~
9. 1~r~, d t~~~ , l c ~ - / S. ~d
,
6DD 1-9 FOR iOtAL Y6W. SEGl1EATS - ITE![ III Z S' •
Deter~ine the 'I1' value af each aeg~ent (10-12) aod ~ultiply b~ the erea aa follare:
lO. ~ ~ / ( . ~ ~ , i; I 'U• I 1- ? . .5 ~
~ '
r-n s s, ~ x . ~ _ . ~ ~
is. c ci~i~~~ ;
~ ~ 3~; ~ x ~o• 1 ~-I , ?~o
A~D 10-12 FOR TQiAL ROOF/CEILIAG 5EGRFRSS - ITFd I9 ~ ~ Z~'
G~ If item No. IZI is the same as, or less than Item No. I, you have met the tntent of State
Building Gode 6006(c12.
H. If item Xo. IV is ihe aame as, ar leas than Item Ho. II, you have met the inten! of State
Building Code 6006(cll.
I. Add Item No. I • Item No. II Z D• ' 3~~~~ ~
J. Add Item No. III Z~~'~'k'~ • Item Ha. IV ?~~.c - 7i 6
F:. If the sum of Itema III and IY are leas than Items I and II, you have met the intent of
tne code tor tota2 envelope system.
In addition to the ebove iteme you may heve to add for auch ite~ee ae floare over
unheated spaces, euch ae cantilevered arees, etc.
To arrive at •U' value divide the total ai the R veluee for each aegment (ee abavel
into 1,000. Anever you heve ie the 'U' velve ior that segment.
Example: A total •R' of 35.08 divided into 1.000 =.028 'U•
Use BLUE or BLACK Ink
r-----------------
I For Office Use �
� �3� �
Clty of Ea��� � Permit#: �
I ci �
3830 Pilot Knob Road � Permit Fee: Q i
I �
Eagan MN 55122 Date Received: �
Phone: (651) 675-5675 j I
Fax: (651)675-5694 I �
� Staff: I
�-----------------I
2014 MECHANICAL PERMIT APPLICATION
❑ Please submit two (2) sets of plans with all commercial applications.
Date: ��' ����`r Site Address: �(D �.���lu(1 f'f 1���S � i/`-
Tenant: � �� �t— r�-f�}y� i� L-b S O '^�- Suite#:
Resident/Owner Name: C`Nv�K fi�a•-�� G.� S a � � Phone: �O�<� �$7 s-�f OJ 2—��
Address/City/Zip:_ �(U ����r'� p }-J ll��1 C r r�
Name:�j%l�L� � � � � K C _ License#: ����Q�U p�
Contractor Address:_�6 �5 6 � � City: U EY�at r������
State: ,c Zip: �T d 8 J Phone: � fi ('" �4 7--�S�
Contact �{}�l�� Email: � /�l � ��t ="' �t C , <�r
New �lacement Additional Alteration Demolition
Type of Work Description of work: �1�i/ �vvn�-�Gr
NOTE: Roof mounted and ground mounted mechanical equipment is required to be screened by City
Code, Please contactthe Mechanical Inspector for information on permitted screening methods.
RESIDENTIAL COMMERCIAL
(/ Furnace New Construction _Interior Improvement
t P@Cllllt Type —Air Conditioner _Install Piping _Processed
_Air Exchanger Gas Exterior HVAC Unit �
_Heat Pump Under/Above ground Tank �Instalf/_Remove) �
_Other �
�...�..�.�. _...a.�....�, _.,. �._.._. _,
� RESIDENT/AL FEES � �
$60.00 Minimum Add or alteration to an existing unit(includes$5.00 State Surcharge)
$100.00 Residential New(includes$5.00 State Surcharge) _ $ TOTAL FEE
� COMMERCIAL FEES Contract Value$ x.01��
$55.00 Permit Fee Minimum �
$70.00 Underground tank installation(removal =$ Permit Fee �
� *If contract value is LESS than$10,010, Surcharge=$5.00 = $ Surcharge* �
�"If contract value is GREATER than$10,010, Surcharge=Contract Value x$0.0005 �
� ""`If the project valuation is over$1 million, please call for Surcharge =$ TOTAL FEE ;
�� ,_ _�_�..�,�
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 �( � E � �ll� E- X �,.'-__�-.._...__��_
ApplicanYs Printed ame ApplicanYs Signature
FOR OFFICE USE
__ Required Jnspections: Reviewed By: Date:
•°-�-- Undergr�und Rough lp AirTest Gas Service Test In-floor-Meat =�ir�al-• HVAC Screening
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA163316
Date Issued:08/26/2020
Permit Category:ePermit
Site Address: 510 Rolling Hills Cir
Lot:42 Block: 2 Addition: Bur Oak Hills 2nd
PID:10-15501-02-420
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:Includes Skylight
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 -
Charles E Thorkildson
510 Rolling Hills Cir
Eagan MN 55121
(651) 587-1746
Capital Construction Llc
416 Gateway Blvd
Burnsville MN 55337
(952) 222-4004
Applicant/Permitee: Signature Issued By: Signature