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INSPECTION REC4RD ~ COntrol No. ~ ~ ; C~TY OF EAGAN PERMIT TYPE: Nl11 1 Mc: ' 3830 Pilot Knob Road Permit Number. • M 1~ T~ Eagan, Minnesota 55123 Date Issued: h~ w= (612)681-4675 SITE ADDRESS: ~ ofi , ~ k ; APPLICANT: ,B6• SAFART PASS QU7lER NaUStMB GQfiP ~AFAR i ~9iTAtf~S (617 ) ~!?12-Fi~/l~ PERM~T ~t~RBTYPE: TYPE OF WORK: NEW t~~~~ ~ i r~~~ ~ F~aN i Nc~ TNra1~~AT~nN FINAl. i 1FtEi'l AC.! ~r*MAkt:c: ~'s t~l ~'UNfRMC.~I'!1N IJk E 1~Fh ~ fil AYI ~JI'K PI.BB ~~<~~r- - c - ~~-;~y-R -n.s ~y,''Z~~~ ~ ~~~r-ry.t~~ s k . .-Y.{-'-~.-~~~.?`~t~.Y~ • -~~~,-.~t -r.~-~_-~_ - ~ . - _ ~ ~ _ , ? - 'r- _ ~ ~ , ~ ~ ; Psrmk tia wrmR Hoider Dats 7Mspnone s S/W ~ : PLUMBING 8 J~a~ ~~`~f 7J HVAC Q ~ ~~,~-/p 'j ELECTRIC 9/1( y' ~ ELECTRIC mfpaet~on D~os Insp. camnents Foatings I F~ ~.Zz 9Z s Rooflng Rough PIbO• Rai9h Ht9• 0 f I~I. ~ G - . ~~.p - ~ yz~~ ~~,a~ ~ ti $ , - ~ ~ ~ orsac Teet ~ S ~a~. cv~ ' ' ~ ~/-q t+ Final Plbg. ~r ~ Plbp. ir~spector - NofMy Pk~mber Canst. Mater ~8• ~ 5 /~.2 Deck Ftg. Deck Ftnel VVep Pr. Disp. ~ 0~ Q.II ~ ~ /S- ~y ~ ~ ~y ss 9 . .`~Yc~J?;. . _ _ . • . P ~ 1~ r! ~erti~icate n~ ~ccu~anc~ ~~t~ o~ ~agan _ - ~e~artment o~ ~uil~i~tg ~~c~~ccki~ This Certificate issued pursuant to the requirements of the Uniform Building Code certifying that at the time of issuance this structure was in compliance with the various ~ oiriinances of the City regulating building corrstructiorc or use. For the following: Use ClassificaGon: 81dg. Pemdt No. I~2 ~ Occupancy Type Zoning Disuict ~~~ry~ Cans~ Ownerof Building Ad~ 5i C~iA~ AVE, APPIE VAI~EY _ i I~aS j1A(,~ I . Bui ' Address ~ ~ ~ ~~~h, f f 7 ~ ~ - J~~ J Dale: ~ ~~25~q2 _ Building Official ~ " POST IN A C~NSPICUOUS PLACE _ , ~ ~ . . CITY OF EAGAN Remarks #10 65850 060 U2 Addition SAFARI ESTATES Lot ~ Blk 2 Parcel Owne~~J I~~ t . - Street 4860 Safari Pass srace Improvement Date Amount Annual Years Payment Receipt Date STREETSURF. ~ ~ ~82 ld3'].rj4 ]_~3.']~j 1~ STREETRESTOR. j~82 ~46.(3 3~~.33 GRADING (Q 1982 603.~3 6~. ~ ~ SAN SEW TRUNK Z I~ 6~4 O. ~ SEWER LATERAL , L WATERMAIN i! WATER LATERAL 2 WATER AREA (F ~jI STORM SEW TRK {t 3 1~ 866. 1 1 . 8 ~ STORM SEW LAT 1 82 5 CURB & GUTTER SIDEWALK STREET LIGHT WATER CdNN. ~UILDING PER. SAC PARK K~~~3 ~ Request ~ate F' ~NO~.- Ro in nspection ^ e uiretl? O Reetly Now 6 Will Nofity Inspeclor ~ j U L Yes ? No `~1hen Ready? I• 7icensed conVactor p owner hereby request inspedion of above electrical work at: Jo~ s[Slree[. Bor qoute No Qy Section No. Township Name or No. Range No. ~y anl ~PRINT~ Pho~ No. 1 Supp r r~ Htltl I rn - al Com actor o aqy Name) , ` Co ciw5 License No. - ~ C~i-i'~ Mailin dress (Conrcactm or wner Making Insta ip,n~ ~ 1 Y~ Au IC r or/ wnar aki7 Installatio Pho mbe MINNESOTA STATE BOI.H ELECTRICITV THIS INSPECTION REOl1EST WILL NOT Gtlggs-MiCwey Bltlg. - oom &1]3 BE ACCEPTEO 9V THE STATE BOAPD 1821 Univenity Av¢., SL Paul, MN 55104 UNLES$ PROPER INSPECTION FEE IS Plane (81]) BQR-0800 ENCLOSED. 9~5! 9~- REQUEST FOR ELECTRICAL INSPECTION EB-00001~08 14 3 8 See inslmdions lor compleling ihis form on Oeck oi yellow capy /O~lof~ K "X,. Below Wak Covered by This Request ~~a ~ ew Atltl Rep. TypeoFBuiltling AppliancesWired EquipmeniWired Home Range Temporary Service Duplez Water Heater Electric Heating Apt.BUilding Dryer Other-(Specity) Comm./lndusirial Furnace Farm Air Contlitioner Olher~syeciy7 ConVactorS Remarks'. Compute lnspection Fee Below: # Other Fee # ServiceEntranceSize Fee # Circuits/Feetlers Fee Swimming Pool 0 to 200 Amps I 0 to 100 Amps ~y.q'} TranSformers Above 200 _ AmpS Abova 100 _ Amps SignS Inspecmr5 Use Only: TOTAL Irrigalion Booms a. a Special Inspection Alarm/COmmunication THIS INSTALLATION MAY B DER L~ISC~NNECTED IF NOT Other Fee COMPLETED WITHIN 18 HS. I, the Elec~rical Inspector, hereby Rough~in ? ..GY : / certity that the above inspection has F~,,,ai been made. e OFFICE USE'JNLY T~is requesl voitl 18 mon~hs trom Address; Ggbp p~g Lot 6 Blk 2 Sec/Sub ~'p,g~ ESTATES These items ware/were not completa at the tlme of the final inspection. 11/25/92 Yas No (.C~~> Final grade (6" from siding) ~ Permanent stepa - garaga ~ Permanent steps - main entry Permanent driveway ~ Permanent gas Sod/seeded grass ? Trail/curb damage Porch ~ Basement finish ? Deck Pleasa verify with the bullder the removal of roof teat oaps from tha plumbing system and the shut-off of watar supply to the outside lavn faucat before fzeeze potantial ezists. ~ wrnESww~ White - City copy Yellow - Resident copy Pink - Contractor copy -#5~~ r,, Z~ RESIDENTIAL ~ ~J~ ' BUILDING PERMIT APPLICATION 5~ o~~ CITY OF EAGAN 3830 PILOT KNOB RD, EAGAN MN 55122 651-B81-4675 New Canetructlon Heoulrementa RemotleUHeoalr BeautremeMs • 3 ragislere0 site surveys ahowing sq. tl. of bt, sq. iL of tause; and ~jl roofeA areas • 2 copies ot plan ~ ~rj~ (20%ma~dmumbtcoveragealbwed) • isetofEne~gyCa~ulatbnsforheatedaddftlons \ ~ ~(,7 • 2 copies of plan showing beam 8 wmdow saes; pouretl foun0 tlesign, etc.) • 1~te survey tor exlerbr atltlttbns & decks ~ • ~ set ot Energy Cakulations • IndiCAtB H hOme SBrvBtl by &ep~IC SySt6m fW 8dditbnS • 3 copies of Tree Preservation Plan B bt plattetl after 7/1/~3 • Rim,blstDeteilOptlonsselactionsheetro~gswith3orlessuntts) VALUATION 1~ ~ DATE ~~I"I ~U~ ~ SITE ADDRESS V ~Cl MULTI-FAMILY BLDG _ Y _ N NPE OF WORK~CJ~,C ~LV FIREPLACE(S) _ 0_ 1_ 2 APPLICANT_S~q~VAll~ Ftcfarl~rc Inr STREET ADDRESS 9820 Zilla Straet ~TM y~q~ _ Z~p TELEPHONE #~j~1~ 7SS- ~~I CELL PHONE # FAX # ~~OJ "~'~"J~ ~ PROPERiYOWNER~~~ ~1 C~~ 9.~C_i'~J TELEPHONE# ~o?" ( ~J COMPLETE THIS SECTION FOR nNEW~ RESIDENTIAL BUILDINGS ONLY Energy Code Category _ MINNESOTA RULES 7670 CA1'EGORY 1 MINNESOTA RULES 7672 (J submission type) • Residential Ventilation Category 1 Worksheet Su6mitted • New Energy Code Worksheet Submitted • Energy Envelope Calculations Submitted Piumbing Conhactor: ~ „ tl ~ ~ Plumbing system includes: _ Water Softener _ La rix~2 ~ 200 e: $90.00 _ Water Heater _ No. o I. a s ~ No. of Baths n ~ - ~~1~~. Mechanical Conhactor: ~Phone q Mechanical system includes: _ A'v Conditioning Fee: $70.00 _ Heat Recovery System Sewer/Water Conhactor: Phone # I hereby acknowledge that I have read this application, state that Informatio is rrect, and agree to comply with all applicable State of Minnesota Statutes and Ctty of Eagan r inances. ~ Signafure of Applicant - OFFICE U5E ONLY Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _ Updated 4l02 OFFICE USE ONLY ? 01 Foundation ? 07 05-plex ? 13 1&plex ? 20 Pool O 30 Accessory Bldg ? 02 SF Dwelling ? 08 OGplex O 16 Fireplace ? 21 Porch (3-sea.) ? 31 EM. Alt - Multi ? 03 01 of _ plex ? 09 07-plex ? 17 Garege ? 22 PorchlAddn. (4sea.) O 33 Ext. Alt - SF ? 04 02-plex ? 10 08-plex O 18 Deck ? 23 Porch (screened) ? 36 Multi O 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Stortn Damage ? O6 04-plex ? 12 12-plex Plbg_Yor_N ? 25 Miscellaneous ? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding ? 32 Addition ? 36 Move Bidg. ? 42 Demolish (Foundation) ? 45 Fire Repair ? 33 Alteration ? 37 Demolish (Bldg)• ? 43 Reroof O 46 Windows/Doors ? 34 Replacement "Demolition (EMire Bldg only) - Give PCA handout to applicaM Valuation Occupancy MClES System Census Code Zoning Ciry 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) FinaUNo C.O. _ Footings (addition) _ Plumbing Foundation HVAC _ Drain Tile Other Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests _ Final _ Framing _ Siding Stucco Stone _ Fireplace _ R.I. _ Av Test _ Final _ Windows (new/replacement) _ Insulation _ Retaining Wall , Approved By , Building Inspector Base Fee Surcharge Plan Review - MC/ES SAC City SAC W ater Suppy & Storage S&W Permit & Surcharge Treatment Plant Plumbing Permit Mechanical Permit License Searoh Copies Other Total , HOUS~ HEATINb TEST RECORD ~ G~ ~a~ ADDR669 - ~~~Ap7. _.-F OpR CITY~~~~IJR6 , OCCUPANT OYMER ~ ~+r•4Y_ u~~IL'Sr~. MEA'C LOSS T8 H7 T SOLD BY IN57Al,LEG BY~~~~~...~~'~'~f'~'~ Ebthieol We.k 9y _ Get LIM 6y c~~.. ~ TYPE Of NBAT GA FA ~_HW STpAM _-.._SPA~ HTR. -UNIT HTR. -~TMBR GAS DESIGN ~ CORVER610N µAKE MAKF OF BURNER Med¦I ~ Mod.l E.~lol Gax. BZt7 RaN~p INPUT IMKE OF FURNACE Abdd S CONTROLS ~ THERM T ' H~at Plup Vrnf Slto Vel~~ r 1 KINp Of L~kER SIZE NQy Llmu Dwh Hood Rpulawr 0i4 L~mM S~Mlno FllfMS Sis wnb Fen S~Nlny OdmNy Leeatlon kisJ~ -.~-~~wdd~ Pllof irPo G~~.y Con.rwNio~ Y..~! Pllm Meb Pila Mado~ Sme4~ Bow6 W:rirq Pliw Tia~no Oreh t'~T~~t To0 L.W. C~r+ Wf poor Pna~w~ I.Iphflno huf. 'll Pr.~sur. •s ~P~rc~MCp? ' d GonT~st~d Inyw CFM PweNq 0= ' G+mpany T~atinp Snau T~~np. p.raM CA He~a ef T~~pr R R7s • ~ 8252303 ]1-25-92 03:lOPM POOI #10 PERMIT 0 9 s 2 ~ CITY OF' EAGAN = 3830PilotKnobRoad PERMITTYPE: Buz~orN~ Eagan, Minnesota 55123 Permit Number: 001278 (612) 681-4675 Date Issued: 08 J25/92 SITE ADDRESS: 4860 SAFARI PASS LOT: 6 BLOCK: 2 SAFARI ESTA7E3 DESCRIPTION: 'Building Permit Type 3F DW6 ' Building`Work Type NEW ~ UBC Occupanc~y R-3 M-1 ConstrucCion `T,ype V-N Zoning ' R-1 euilding Length ~ 65 Build'ing Width 54 ~ ` 'i `"~~1 it,. ..t~." ~i~ I; ~;{,7~~f/ ' ~~~~C, (~;J `s i ~ y; ~ ~3 L, L , ~ i _ ~ ; ~ u REMARKS: S& W CONTRACTOR - WELTER-BLAYLOCK PLBG FEE SUMMARY: VAI.UATION $136,000 Base Fee $765.50 MISCELLANEOUS $1.610.50 Plan Review $497.58 Total Fee $3,641.58 Surcharge $68.00 SAC $700.00 3AC ~ 100 SRC Units 1 Subtotal $2,031.08 CONTRACTOR: - Applicant - sT. ~I OWNER: BUTLER HOUSING CORP 14325885 00@171 BUTLER HOUSING CORP P 0 BOX 24597 P 0 BOX 24597 APPLE VALLEY MN 55124 APPLE VALLEY MN 55124 (612) 432-5885 (612)431-4132 I hereby acknowledge that I have read this application and state that the information 3s correct and agree to comply with all applicable State of Mn. Statutes and City of Eagan Ordinances. ~ - ~(urn ~ oi'!,~ ~ nl.~_ APPLICANTlPERMITEE SIGNATUPE I UE Y: I NAT RE INSPECTION RECORD Control No. o~~~ CITYOFEAGAN PERMITTYPE: Buz~orN~ 3830 Pilot Knob Road PermitNUmber: 001278 Eagan, Minnesota 55123 Date Issued: 08 /25 / 92 (612) 681-4675 SITE ADDRESS: ~ oT : 5 B L D C K: 2 APPLICANT: 4860 SpFARI PASS BU7lER HOUSING CORP SAFARI ESTATES (612} 432-5885 PERMIT SUBTYPE: TYPE OF WORK: SF OWG NEW . . FOOTING FRAMING INSULpTION FINAL FIREPLACE , REMARKS: S& W CONTRACTOR - WELTER-BLAYLOCK PLBG ~ I I- PERrtIT ~r CITY bF EAGAN -~~,~~-I.~ ~ ReACTIVA7E _ 1892 BUILDING PERMITAPPLICATION . v_~rt ~ 681-4675 AUG 1 3 RECo SINGLE & MULTI-FAMILY 2 ets of plans~registered site surveys~opy 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 8 / ~.3 / ~ yaluation of work ~ Site Address: `7r~(oYJ ~a~~?~! ~o~~aS STREEi ~11E ~ Tenant Name: (commercial only) N~ IAT BIACR ~ SUSD~ 1/, ~ReC P. I. D. N l~ ~'JGGf ~ Descri tion of work: The applicant is: ,~Owner ~Contractor ~ Other coeee~i~> Name f~l~ /.ES~ 0~,7`1g~ phane 3/-~/3Z Property ~~Si F T ~z - 588~' Owner Address _~~D. t~S DX Z~S ~7 STREET STE R City c~/` State /~~d+'~ Zip ~7 Company G~ 1-~Sr a~~~i Phone Z- C011tf8CtOY Address ~B~C z`~ /7 License ~~/7/5''Exp.3 ~ City ~ oZ~~2! State ~ 2ip ~ Company ~ ~/!2 ~C~/"/ Phone -~ZS ArchitecU ' Engineer Name _~/~~/~CCj ,~/~l C~I Registration 7~ Address _ C2ST ,(~~O / ~iy ~~e City ~lOO/N~7drI~ State /v`~~~~ Z p Sewer 6 water licensed plumber / . Processing time for sewer 5 water permits is twa days once area has been approve . 1 hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicab State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant: OFFICE USE ONLY ~ • BUILDING PERMIT TYPE !af ~ ' ~ O 01 Foundation ? 06 Duplex O 11 Apt./Lodging ? 1~Baseme~Finish ~02 SF Dwg. ? 07 4-Plex ? 12 Multi. Misc. ? I1 Swim Pool ? 03 SF Addition O 08 8-Plex ? 13 Garage/Accessory ? 18 Comm./Ind. O 04 SF Porch ? 09 12-Plex O 14 Fireplace ? 19 Comm./Ind. Misc. ~ 05 Sf Misc. ? 10 Multi. Add'1. 0 15 Deck ? 20 Public Facility ~ 21 Miscellaneous WORK TYPE ~ 31 New O 33 Alterations ? 35 Tenant finish ? 37 Demolish ? 32 Addition ? 34 Repair ? 36 Move GENERAL INFORMATION Const. (Actual) V- N Basement sq. ft. MWCC System YE 5 (Allowable) v- N lst F1. sq. ft. City Water es UBC Occupancy 2-3 M_~ 2nd F1. sq. ft. ~ PRY Required Zoning R-I Sq. Ft. total Booster Pump ~f of Stories Footprint 5q. ft. Fire Sprinkler Length ~T On-site well Census Code /D/ Depth SyT On-site sewage SAC Code ~ APPROVALS Planning Building Assessments Engineering Variance RE~UIRED INSPECTIONS ~ ? Site ? Footing - ? Framing O Insulation O Nallboard O Final O Oraintile ? Fireplace Permit Fee vei~c~oo: g ~ 3~, o00 Surcharge Plan Review -~2 X2`! _ ~76g License l2x z = (ay) MWCC SAC ( X 14 Cly~ City SAC I~ I. O Nater Conn. B~MT, ~3o x~~ a Mater Meter , ~~OX ~y = fo~U ~ Acct. Deposit I $ _ g S/W Permit fo32 x ~5= S/W Surcharge ~I U~6o Treatment Pl . 1 sT F'~°oR ; ' Road Unit gS,nT _ b~ Zwo ~~oyt; Park Ded. Trails Ded. 1~~°_ ln 29 ~ 3oc `720 Copies zXS= l~ 1 X iz~ l2 Other ax~v = .~e 3~~cs3= 3S,79G Total: 3o~,~.i= 7io Ih 9 -J ~ SAC Units IOD IyI7 X53= ~S~Ir~\ 135 OS 7 ~ ~ Sur~ver~or~s G'ert~f~cate SURVEY FOR: Iiutler Flousing Corp. ~ DESCRIBED AS: I.ot 6, Rlock 2, SFlP~RI E57'ATLS, City of F:agan, llakota County, htinnesota and~ erving easements oI record. i / ' 979.5 ~ . . / ~5 . / a7~.3 ~ ~ 9BO.8 i / ^~.g , o ~ `b ~ / ~ r. : .F. \ , a~b.e ~roy, Og / / \ af~ m ~ $ ~ , ~ ~ ~ 983.8 a / _ \ 9 ~`+i q88•$ ~~\6pb y~ \ ?C R 98fi`' ~ ~ . ~ °o\~ ~ ~Z~ 6~~~ ~ ~ ~ ~ r $ ~ ( i 1 . ~ r ~ ~'i t1~°~ a v~`' ~ + ~ ~ . ~ ~ ~ i ~4 ~ ,1 ~ O~~e<~n ~ \ ~ rasi ~ ~ ~ ~ / R ,p~ i/ ~ qy,~~7 Tf 1b w ~ C~ `a~ifli ~O•~ ~O (P \ ~ f~0 O ~ 2 ' .~O . 986 1 ~ \ ` 4 / ; . ~x.st m ,'s~ / ~ 999.3 ~'i'~ / / / / ~ 993.3 i 8. a y~ e ~~f~ ~ ~ ~p ~ ~ ' ~ ~ ~9~00 r . ~ / ~Q,` 4~ i / H . ~ r ~ ~ ~ ~ ~ , i ~•5' " ` ~ I, < ~ ~ t ~ ~ 5 ' S`! , - ,E',,,~~1/9,,._T~.. 99~,3 . ~d -T/- ~C~1~' I~IdGI%EERIIVG DEPT LQT SC1. FOOrAGE = 12, 349f ; ~ ~ i ~ PROPOSED ELEVATIONS BENCHMAHK, m,. La a~Z TopolFoundallons .qg~,~ ~ R~m•R~c„~ , Garaga Floo~ • 982,3 In~' qqq,q8 Basement Floor . q~q,p , f Approx. Sewer Servlca Elev. v NO MIN. SETBACK RE~UIREMENTS ~ Proposed Elavetbna Exieli~ Elevatbns . FroM - 3o House Side - ~o Q . Dralnage Direcllons w. Rear S Gerepe S~de - g m benolea ollsal Slaka ° ~ SCALE~ I' Inth = 30 F821 a ~ JOB NO.: . N IHEPEBVCERiIFY 741ATT111318ATflUEANDCOPAECTPEPRESENT11710N P I~~D~~~~ OF 7HE BOUNOAII~ES OF TNE ABOYE DESG~~BE~ PROPERIY AS SUR- ~IzR-34$ ~ VEVED BY ME OP UNUEp MY DIRECT SUPEfIVISIONANDDOE3 NOT PURPORT i0 SHOW IMPROYEI.ffNiS OH ENCR011CHMENT9, EXCEPT AS SHOWN. BOOK: PAGE: Plannrng Engrneering Surveying , 9701 Em Bbom~rplen Frnw~r. lloom1~p~pn. Nlnmwl~ 63~]0 pSN 9~ . TN~plron~plAq-0iM D L DOREN, IAND RVEYOR CADD FILE; DWf3. CHK. Mlf~lE TALICENSENUMBER14J76 Batk~92 Page 1 OF 6 ODINBR: BUTLER HOUSINO CORPORATION STTE ADDRE88: ~@¢Q P~SB. ~ ~ LSGAL: LOT 6, BGOCK 2, SAFART ESTAT~B FIRST AADITION CONTRACTaR: BUTLER HOQSING CORPORATION DATE: AOQUST 6, 1992 DBTERMINE WORAINQ SQOARE ~OOTAGE OF EACH: 1. TOTAL EXPOSED WALL AREA: 2350 SQ. FT. X.11 = 258.50 2. TOTAL ROOF/CEILING AR~A: 1387.66 $Q. FT. X.026 = 36.08 A. TOTAL WALL WINDOW AREA: 207.00 B. TOTAL DOOR AREA: 37.80 C. TOTAL SLIDINO OLASS DOOR AREA: 33.30 D. TOTAL FIREPLACE WALL AREA: 0.00 ZERO CLEARANCE 8. TOTAL WALL FRA!lING AREA (AVQ. 10~}; 235.00 F. TOTAL RIM JOIST ARBA: 156.00 G. TOTAL NET WALL ARBA ABOV~ FLOOR: 1,680.90 ' TOTAL EXPOSSD WALL AREA: 2,350.00 H. TOTAL FOONDATION WINDOW AREA: 0.00 I. TOTAL NET FOUNDATION AREA ABOVE ORADB: 85.00 J. TOTAL OVBRHANG AREA: 61.00 DETERMINE "U" VALIIS OF EACH WALL 3EOMENT: a. 207.00 X"U" 0.367 = 75.97 b. 37.80 % "D" 0.066 = 2.49 c. 33.30 % "U" 0.367 = 12.22 d. 0.00 S"U" 0.074 = 0.00 e. 235.00 X"U" 0.090 = 21.23 f. 156.00 X"U" U.041 = 6.35 g. 1,680.90 X"U" 0.043 = 72.64 h. 0.00 X"U" 0.367 = 0.00 i. 85.00 X"U" 0.140 = 11.92 j. 61.00 X"U" 0.024 = 1.47 3 TOTAL °U•' = 204.29 IF ITEH ~3 IS THE SAME A8, OR LESS THAN ITEM ~F1, YOU HAVE MET TAE INTENT OF SBC 6006 (c)2. Psge 2 OF 6 TOTAL EXPOSED ROOF/CEILINQ ARSA = 1,387.66 k. Total skylight area: 0.00 i. Total roof/ceiling framing area (avq 10$): 138.77 m. Total net insulated roof/ceiling area: 1,248.89 DBTERMINB "U" VALUE FOR EACH ROOF/CEILING SEC3M8NT: k. 0.00 X"U" 0.367 = 0.00 1. 138.77 X"U" 0.025 = 3.46 m. 1,248.89 X"O" 0.021 = 26.65 4 .......................TOTAL ~.U~.; _ ----30.10 IT TOTAL OF #4 IS THB SAME AS, OR LESS THAN #2, YOU HAVS MST TRB INTENT OF SSC 6006(c)1. ALTERNATE SUILDINO ENVELOPE D88ION: TO UTILIZB THE TOTAL EIiVLLOPE SYST~! METHOD, THE VALUES ESTABLISHSD BY THE SUM OF ITEliS #3 AND #4 SHALL NOT SE (3REATER THAN TIiS SUM OF ITSlIS ~1 AND ~2. '1. 258.50 '+2. 36.08 = 294.58 '3. 204.29 '+4. 30.10 = 234.40 I AEREBY CBRTIFY THAT I HAVS CALCULATSD THE "U" FACTORS AND "R" VALU88 SEREIN AND THAT THS BOILDINO HBRE DESCRIBED MEETS OR EXCEEDS THE STATE OF MINNESOTA 8N8RGY CON88RVATION ACT. BOTLER HOUSIN(3 CORPORATION - L,,.. _ , SIGNATURE:~DENNIS F. SUTLER, PRE8. DATS: AUC3UST 6, 1992 Page 3' OF 6 WINDOW AND DOOR SCHEDULE QUANTITY TYPE SIZE FACTOR WINDOW OPENING 0 SASEMENT 27 % 14 2.60 0.00 1 PATIO DR 5 X 6 33.30 33.30 0 CASF.!lENT 20 X 36 6.80 0.00 0 CASEMEHT 20 X 44 8.00 0.00 6 CASEMENT 20 X 56 9.70 58.20 4 CA88MENT 26 X 38 8.60 34.40 11 CASBMHNT 26 X 44 9.80 107.80 0 CASSl18NT 24 X 44 9.80 0.00 0 CA88MENT 24 X 56 12.00 0.00 0 CASEMENT 36 X 56 16.80 0.00 0 CA88M8NT 20 X 56 9.40 0.00 0 CASEMENT 0.00 0.00 0 CA88l~tENT 0.00 0.00 0 CASEMBMT 0.00 0.00 1 SIDE LTS. 1 X 1.3 6.60 6.60 23 TOTAL GLASS AREA: 240.30 DOOR BCHEDULE QUANTITY TYPE SIZE FACTOR DOOR OPENIN(3 1 THERMATRU 3'-0" X 6 20.00 20.00 1 TAERMATRU 2'-8" X 6 17.80 17.80 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 TOTAL DOOR ARBA: 37.80 TOTAL WALL WINDOW AREA: 207.00 U-VALUS 0.367 TOTAL PATIO DOOR AREA: 33.30 U-VALUE 0.367 TOTAL BA3EMENT WDW ARSA: 0.00 U-VALUE 0.367 240.30 TOTAL DOOR ARHA: 37.80 U-VALUE 0.066 Page 4~OF 6 THRU EXT~RIOR FRAM~ WALL: INTERIOR AIR - - - - - - - - - - - - - - - - - 0.68 S88ET ROCK - - - - - - - - - - - - - - - - - - 0.45 THSRMO-BRSAIC - - - - - - - - - - - - - - - - - 0 STUD - - - - - - - - - - - - - - - - - - - - - 6.93 SHBATHIN(i - - - - - - - - - - - - - - - - - - - 2.06 SIDING - - - - - - - - - - - - - - - - - - - - 0.78 EXTBRIOR AIR - - - - - - - - - - - - - - - - - 0.17 TOTAL "R" VALUE - - - - - - - - - - - - - - - - 11.07 1/R = "U" VALUB - - - - - - - - - - - - - - - - 0.090 TSRU INSULATION WITH SIDING & S.R. INTERIOR AIR - - - - - - - - - - - - - - - - 0.68 SH66T ROCK - - - - - - - - - - - - - - - - - 0.45 THSRMO-BREAR - - - - - - - - - - - - - - - - 0 INSULATION - - - - - - - - - - - - - - - - - 19 SHEATHING - - - - - - - - - - - - - - - - - - 2.06 SIDING - - - - - - - - - - - - - - - - - - - 0.78 EXTBRIOR AIR - - - - - - - - - - - - - - - - 0.17 TOTAL "R" VALUE - - - - - - - - - - - - - - - 23.14 1/R = "U" VALUE - - - - - - - - - - - - - - - 0.043 THRU CSILINO MEMBSR INTERIOR AIR - - - - - - - - - - - - - - - - 0.68 3SEET ROCK - - - - - - - - - - - - - - - - - 0.58 CEILING lIEMBER - - - - - - - - - - - - - - - 4.35 INSULATION - - - - - - - - - - - - - - - - - 33.92 STILL AIR - - - - - - - - - - - - - - - - - - 0.61 TOTAL "R" VALUE - - - - - - - - - - - - - - - 40.14 1/R = ."U" VALUB - - - - - - - - - - - - - - - 0.025 THRU CSILINO INSULATION INTERIOR AIR - - - - - - - - - - - - - - - - 0.68 3H8BT ROCK - - - - - - - - - - - - - - - - - 0.58 INSULATION - - - - - - - - - - - - - - - - - 45 STILL AIR - - - - - - - - - - - - - - - - - - 0.61 TOTAL "R" VALUE - - - - - - - - - - - - - - - 46.87 1/R = "U" VALUE - - - - - - - - - - - - - - - 0.021 Page S~OF 6 THRU CONCRETE BLOCK INTBRIOR AIR - - - - - - - - - - - - - - - - 0.68 CONC. BLft. - - - - - - - - - - - - - - - - - 1.28 INSULATION - - - - - - - - - - - - - - - - - 5 SHBST RR. (OPT. - - - - - - - - - - - - - - ' 0 BXTERIOR AIR- - - - - - - - - - - - - - - - - 0.1T TOTAL "R" VALOfi - - - - - - - - - - - - - - - 7.13 1/R = "II" VALOS - - - - - - - - - - - - - - - 0.140 THRU RIM JOIST INTERIOR AIR - - - - - - - - - - - - - - - - 0.68 IN$ULATION - - - - - - - - - - - - - - - - - 19 RIM JOIST - - - - - - - - - - - - - - - - - - 1.89 BHSATHING - - - - - - - - - - - - - - - - - - 2.06 SIDING- - - - - - - - - - - - - - - - - - - - 0.78 EXTERIOR AIR- - - - - - - - - - - - - - - - - 0.17 TOTAL "R" VALUS - - - - - - - - - - - - - - - ~24.58 1/R = "U" VALOS - - - - - - - - - - - - - - - 0.041 THRU CANT. @ MBMBER (SNCL038D) INTERIOR AIR- - - - - - - - - - - - - - - - - 0.68 FINISH FLOORING - - - - - - - - - - - - - - - 1.23 UNDERLAYMENT- - - - - - - - - - - - - - - - - 0.43 PLYWOOD - - - - - - - - - - - - - - - - - - - 0 JOIST - - - - - - - - - - - - - - - - - - - - 11.88 3HEET ROCR- - - - - - - - - - - - - - - - - - 0.58 STILL AIR - - - - - - - - - - - - - - - - - - 0.61 TOTAL "R" VALUE - - - - - - - - - - - - - - - 15.91 1/R = "O" VALUB - - - - - - - - - - - - - - - 0.063 THRU CANT. @ INSULATION (ENCLOSED) INTERIOR AIR- - - - - - - - - - - - - - - - - 0.68 I~INISH FLOORItYG - - - - - - - - - - - - - - - 1.23 UNDERLAYMENT- - - - - - - - - - - - - - - - - 0.93 PLYWOOD - - - - - - - - - - - - - - - - - - - 0 INSULATION- - - - - - - - - - - - - - - - - - 19 SHSET ROCK- - - - - - - - - - - - - - - - - - 0.58 STILL AIR - - - - - - - - - - - - - - - - - - 0.61 TOTAL "R" VALUE - - - - - - - - - - - - - - - 23.03 1/R = "O" VALIIE - - - - - - - - - - - - - - - 0.043 Paqe '6' OF 6 THRU CANT. @ MEMSER (SXPOSSD) INTERIOR AIR- - - - - - - - - - - - - - - - - 0.68 FINISH FLOORING - - - - - - - - - - - - - - - 1.23 UNDERLAYMENT- - - - - - - - - - - - - - - - - 0.93 PLYWOOD - - - - - - - - - - - - - - - - - - - 0 JOIST - - - - - - - - - - - - - - - - - - - - 11.88 SHEATHINO - - - - - - - - - - - - - - - - - - 0 S~FFIT- - - - - - - - - - - - - - - - - - - - 0.47 EXTERIOR AIR- - - - - - - - - - - - - - - - - 0.17 TOTAL "R" VALOE - - - - - - - - - - - - - - - 15.36 1/R = "U" VALUE - - - - - - - - - - - - - - - 0.065 THRU CANT. Q INSULATION {EXTERIOR) INTERIOR AIR- - - - - - - - - - - - - - - - - 0.68 E'IHISS FLOORING - - - - - - - - - - - - - - - 1.23 UNDERLAYMENT- - - - - - - - - - - - - - - - - 0.93 PLYWOOD - - - - - - - - - - - - - - - - - - - 0 INSULATION- - - - - - - - - - - - - - - - - - 38 SHEATHING - - - - - - - - - - - - - - - - - - 0 SOFFIT- - - - - - - - - - - - - - - - - - - - U.47 EXTSRIOR AIR- - - - - - - - - - - - - - - - - U.17 TOTAL "R" VALUB - - - - - - - - - - - - - - - ^41.48 1/R = "U" VALIIE - - - - - - - - - - - - - - - 0. ~24 FILE NAME: ENERGY.BHC ~ CITY OF EAGAN CITY USE ONLY ' PLUMBING PERMIT ;y~ SUBD. (612) 681-4675 RECEIPT ~ C~`~`'y ~~o DATE q~~ - 2_ RESIDSNTIAL PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLING5. ALSO, FOR TOWNHOMES AND CONDOS W1IEN PERMITS ARE REQUIRED FOR EACH UNIT. WORK DESCRIPTION COMPLETE THE FOLLOWING: N0. FIXTURES EA. T~TAL NEW CONST ~ REPAIR/ADD ON 15.00 ADD ON _ / SHOWER 3.00 REPAIR _ ~ WATER CIASET 3.00 ~ / s~.xr~ r[rs 3. o0 3= 3 IAVATORY 3.00 ~ OWNER NAME: L~~ I~~ N~~~~ N~ ~a~`?'~' ~ KITCHEN SINK 3.00 3~° l/r~7 / IAUNDRY TRAY 3.00 ? SITE ADDRESS :`l ~C- C% S~~~~ Y i" r~~.~ HOT TUB/SPA 3.00 / WATER HEATER 3.00 ? ~ ! FIAOR DRAIN 3.00 3 r GAS PIPING OUT. irrsTnLt~x: tNL~LTL= tZ a~C f} ~(L n~k //Y~. y (MINIMUM - 1) s.oo ~a ROUGH OPENINGS 1.50 ADDRESS: ~'I ~~5~" /nG* ~ S r _ OTHER WATER SOFTENER S.OD CITY: l.~iLeew~ ~~nk t~`~t ZIP: _ PRIVATE DISP. 15.00 , e U.G. SPRINKLER 3.00 PHONE ~i~ Q I` ~ I _ W. TURNAROUND 15.00 t .`i ` ~ ~ STATE SURCHAItGE .50 ~ .El~t ~,.u_. c SIGNAT[I~t OF~ RM EE TOTAL: S ~IR } COMMERCIAL PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDING$. ALSO FOR MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT. WORK DESCRIPTION: DWNER NAME: CONTRACT PRICE: SITE ADDRESS: 1X OF CONTRACT FEE. . STATE SURCHARGE - $.SO FOR TENANT NAME: 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 , ~ CITY OF EAGAN L B ~ , MECHANICAL PERMIT RECEIPT # ~~U ~ SUBD. (612) 681-4675 DATE /a/~// ~7.~- RESIDENTIAL PLEASE COMPLEI'E UPPER PORTTON ONLY FOR SINGLE FAMIIY DWIIJ.WGS. AI30, COMPLETE FOR TOWNHOMES/CONDOS R'HEN SEPARATE PERMITS ARE REQUIRED FOR EACH DWELIdNG UNIT. ~J OWNER: a' ~ f ADD-ON A/C ADD-ON FURNACE ? 31TE ADDRFSS: p ADD ON/REMODEL (FJiQSTING $ 15.00 ~ {2, J ~ CONSTRUCI'ION ONLl~ INSTALLER: HVAC: 0-100 M BTU 24.OQ PHONE ~i~ ADDITIONAL SO M BT[T 6.00 ADDRESS: ~ ~'~~i GAS OUTI.E1'S - hIII~TIMUM 1@ S:i E1. ~ CI11': S ZIP: ~j SURCHARGE $ .50 / SIGNATURE: ` TOTAL: $ , ~ NO PERMIT REQUIBED FOR DUCTWORK ONLY! COMMERC~IL PLEASE COMPLEfE THIS PORTION FOR ALL COMMERCIAUINDUSI'RIAL BUILDINGS. ALSO COMPI.El'E FOR APARTMENT BUILDINGS OR OTHER MULTI-FAMILY BUII,DINGS'WHEN SEPARATE PERMITS ARE NOT REQUIRID FOR EACH DR'ELLING UNTl'. WORK DFSCRIPTION: , CONTRACf PRICE: FEFS 1~Xo OF CONTRACf FEE. STATE SURCHARGE LS S:SO FOR EACH 51,000 OF PERMIT FEE. s PROCESSED PIPING • 525.00 $ MINIMiJM FEE - S7a.00 OWNER: TOTAL: $ SI1'E ADDRFSS: 1'ENANT: SUTfE INSTALLER: ADDRFSS: CT11': ZIP: PHONE CTPY SIGNATURE SIGNATURE: , - / HOUSE HEATING TEST RE ORD ~ ADDRESS / ~r~ / ~ ~ ~ ~J-~ ppT.-FLOOR CITY~SUBURB OCCUPANT OWNER Q •$~~_.~___P~,y{,[~T ~.a~ . v~ HEAT LOSS~~,D{~TE HTG. 1"Ii,~T._ c ~ SOLD BY rv • tN~u.-~~ ~ INSTALLED 8Y El~chicel Work By u Go~ Lin~ By TYPE OF HEAT GA _ FA HW _STEAM -SPACE HTR. -UNIT HTR. -OTHER GAS DESIGN CONVERSION MAKE MAKE OF BURNER <<< 4" - ~ ; =rr. Mod~l Mod.l F^"r ~.~r.a: :o:Y, i`.~:.. Sarial Ma:. BTU RaHny .i~ ~~~~~:.~:~v~ (:w'~N B.ii:f~T.!'7~~'•...'~ INPUT MAKE OF FURNACE ' Abd.l "~J°'~ni~F~ ~ ~ CONTROLS ~ ~ THERMOST T Hwt Plug V~nt Size ~ U Volva KIND OF LINER SIZE ~~NgONE Limit Drofr Fleod Rpulenr /.F^~~ Limit S~tting Filters Siz~~~.l~~umbsr Fon Setting d Chimn~y Locafion Insjdl~taida Pilot Type l ~ Q~imney Conserueffon S ~ Pilot Maka ~ Pilm Model 2 Smoka Bomb Wiring Pflot Timing S4-~ Draff " Test Toq L.W. Cut Off Dox Prssaure Liqhtinq In~f. ya / Prossun ~ y ~Parcent C02 ~ Du» T~~ted ~i ~ Cz- Input CFH-p~Pxcent O~ 'b D Company Testing ~/i1 Stock Tam Pxcent CO Nams of Tset~r Fwm Z35 ~ C; _ p ' ` C9~~ OF G~CiC~C1P1 3830 PILO~ KNOB ROAD, P.O. BOX 21199 BEA BLOM9UASf EAGAN. MINNESOTA 55121 n+wor PHONE: (612) 454-8100 ~ TMpµe~ E~qry ,V~MES A SMIM JANUARY 2, 1986 V~CEIIISON tHtooorze wncrrteR ' ' COW~[il Memben J BYRON SdATSCHKE n{onaasHEO~s FORTUNE REALITY c'~0~"'""""°` 4940 VIKING DRIVE ~ EUGENE VP.N OVERBE~ CiN Ciah MINNEAPOLIS MN 55435 Re: Safari Estates - Financial Guarantee Dear Mr. Watschke: I[ has recently been brought to my attention that the City of Eagan is not holding a Financial Guarantee for the Safari Estates Development. I would Like to refer you to Item 8, Page 4 of the Safari Esta[es Development Contract which requires the developer [o deposit an acceptable Financial Guarantee and states, "Such bond or collateral agreement shall be approved by the City Attorney and , shall continue to be in full force and effect until released by the City." Although a Letter of Credit was submitted to the City it no longer remains in effect since its expiration date. Therefore, I hereby request a new Irrevocable Letter of Credit in the amount of $8,108.00. Until this Let[er of Credit is submitted and accepted by the City of Eagan, the followi~ lots wi11 not be issued a building permi[: Lots 2, 3, 13, 14, 15, 18, and ~'7 of BLock 1; Lots 1, 2, 3, 4, 5, 6, 8, 10, 12, 13, 14, 20, 22, 23, and 24, of Block 2, Safari Estates. As of this date these lots show ownership of Fortune Realty, S. Byron and Sandra Watschke, or Darrel and Vivian Wa[schke. Listed below are the items and the amounts to be covered by the new Letter of Credit. i 1. Street lights _ 4 each @ $500.00 (DEA)_plus energy cost $240.00 $2,960.00 • 2. Erosion con[rol (estimated acreage yet [o be improved) 2.86 acres at $300.00/acre 858.00 3. Restoration (estimated acreage yet to be improved) 2.86 acres at $1,500.00/acre 4,290.00 Total Revised Financial Guarantee $8,108.00 ~ If you have any questions please contact me ac 454-8100. : 3 Si cerely,~~ J ~ ~ • raig E. Knudsen _ Engineering Technician cc: Tom Colbert, Public Works Director Ed Kirsch[, Engineering Technician Dale Peterson, Chief Building~ Official ~ CEK: 'eh 1HE LONE OAK TREE...THE SYMeOL OF STRENGTH AND GROWfH IN OUR COMMUNIiY , City of Eagan 3830 Pilot Knob Rd Eagan, MN 55122 (651) 675 -5675 www.ci.eagan.mn.us Site Address: 4860 Safari Pass Lot: 6 Block: 2 Addition: Safari Estates PID:10- 65850- 060 -02 Use: Description: Sub Type: Work Type: Description: Census Code: Zoning: Square Feet: 0 Comments: Fee Summary: Valuation: 3,000.00 Contractor: Pella Windows & Doors Turnkey Sales 15300 25th Ave N #100 Plymouth MN 55447 (763) 745 -1400 e- Windows/Doors Windows/Doors-New/Replacement House 434- PERMIT City of Eaan BL - Base Fee $3K Surcharge - Based on Valuation $3K Applicant/Permitee: Signature - Applicant - Construction Type: Occupancy: 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. Total: $90.00 Owner: John Newe 4860 Safari Pass Eagan MN 55122 $88.50 0801.4085 $1.50 9001.2195 Issued By: Signature Building EA086905 10/15/2008 ePermit 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 with all applicable State PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA146816 Date Issued:11/15/2017 Permit Category:ePermit Site Address: 4860 Safari Pass Lot:6 Block: 2 Addition: Safari Estates PID:10-65850-02-060 Use: Description: Sub Type:Residential Work Type:Replace Description:Water Heater Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection. Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener). Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087 Surcharge-Fixed $1.00 9001.2195 $60.00 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Francis Ambrose 4860 Safari Pass Eagan MN 55122 Benjamin Franklin Plumbing 5718 International Parkway New Hope MN 55428 (612) 238-9709 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA147591 Date Issued:01/19/2018 Permit Category:ePermit Site Address: 4860 Safari Pass Lot:6 Block: 2 Addition: Safari Estates PID:10-65850-02-060 Use: Description: Sub Type:Residential Work Type:Replace Description:Furnace & Air Conditioner Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952) 445-2840. Please call Building Inspections at (651) 675-5675 to schedule a final inspection. Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088 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 - Francis Ambrose 4860 Safari Pass Eagan MN 55122 (612) 718-5158 Blue Ox Heating & Air Llc 5720 International Pkwy New Hope MN 55428 (612) 238-9709 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA171961 Date Issued:09/09/2021 Permit Category:ePermit Site Address: 4860 Safari Pass Lot:6 Block: 2 Addition: Safari Estates PID:10-65850-02-060 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. If water damage is encountered, please call (651) 675-5675 to schedule a site visit to verify the extent of the damage. Any repairs must be inspected prior to covering. The inspector will determine if an additional permit will be required to repair the water damage. 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 - Francis Ambrose 4860 Safari Pass Eagan MN 55122 Supreme Contracting 1130 70th St W Inver Grove Heights MN 55077 (651) 353-4783 Applicant/Permitee: Signature Issued By: Signature