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3497 St Charles Pl3830 Pilot Knob Road, P.O. Box 1-1 9, Eagan, MN 55121 NA 12202 PHONE: 454-8100 BUILDING PERMIT Receipt # To be used for SF DWG/GAR Est. Value $64.000 Date JUNE 27 19 $6 Site Address 3497 ST. CHARLES PLACE Erect EIC Occupancy R3 HA 4PTON HE IGHT Lot Block2 Sec/Sub SIemodel ? Zoning aI , . Parcel No Repair ? Type of Const. IM . Addition ? No. Stories FRONTIER MIDWEST Move ? Length 4n W Name 3908 S I BLEY 141EPr1 HWY Z Demolish ? Depth 47 3 Address o ..??.. .. . r. A• 9'f Int. Impr. ? Sq. Ft = o Name SMN tj ¢ Address ~ City Phone ULW W ~z U? ¢w Assessment Water & Sew. Police Name RICHAil2D CHART-TER Fire Address Eng. Planner I hereby acknowledge that I have read this application and state that the Bldg. Off 6/27/8 information is correct and agree to comply with all appligable Sta Minnesota Statutes and City of Eagan Ordin_aanpes. ' APC ' j Var. Date Signature of Permittee- A Building Permit is issued to: r ?wr all work shall be done in accordance with all Building Official Fees Permit 325.0( Surcharge 32.0( Plan Review 62.51 SAC 575.01 Water Conn. 00.01 Water Meter 63.51 Road Unit 290.01 Tr. Pl. 156.01 Parks Copies $2,104.01 Total on the express condition that City of Eagan Ordinances. I Permit NO. Permit Holder Date Telephone M Plumbing IHNA.C. / f Electric w - - - Softener Inspection Date Insp. Comments FootingsI rl 6 u! IFootings It IFoundation ?W& I Framing I Roofing I Rough Plbg. Rough Htg. Insul. j Fkeplace I Final Htg- j 6 Final Plbg. I I Bldg. Final Iced. 000. I Deck Fig. ID*ck Frmg. Well Describe Location: IPL Dlap. PERMIT #_ MECHANICAL PERMIT RECEIPT # CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE: b $1 oti0. UU PHONE: 454-8100 Site Address . Lot o Block Name _ Address c City - Name rroiitiier uo c Address 3908 Sibiey O? City Eagan TYPE OF WORK Forced Air Boiler Unit Heater Air Cond. Vent Gas Piping Outlets # Other 80,000 M BTU M BTU M BTU M BTU CFM FEE: S/C: TOTAL e TYPE WORK DESCRIPTION BLDG . New R es. Add- M l on u t air Re C 2-2565 p omm. O h t er FEES Hwy. RES. HVAC 0-100 M BTU -$24.00 -0433 ADDITIONAL 50 M BTU - 6.00 ADD-ON AIR COND. 0-24 BTU - 12.00 24.00 ADDITIONAL 6 M BTU GAS OUTLETS COMM/IND FEE - 1% OF CONTRACT FEE - 6.00 - 1.50 EA. MINIMUM - RESIDENTIAL FEE - 10.00 MINIMUM - COMM/IND FEE - 20.00 STATE SURCHARGE PER PERMIT - .50 (ADD $.50 S/C IF PERMIT PRICE GOES !.!0 BEYOND $1,000.00) 25.50 • SIGNATURE OF PERMITTEE $26.70 FOR: CITY OF EAGAN PERMIT # 7yT_ * PLUMBING PERMIT y? CITY OF EAGAN RECEIPT # 60 Li 3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE: DunUV- IRA-21M Site Addr ss ,zZ/ Lot Block $ Name _ mu Address c City 3 Name 1 ' Address O City COMM/IND FEE - 1% OF CONTRACT FEE MINIMUM - RESIDENTIAL FEE _$10.00 MINIMUM - COMM/IND FEE - 20.00 STATE SURCHARGE PER PERMIT - .50 (ADD $.50 S/C IF PERMIT PRICE GOES BEYOND $1,000.00) / ,. PERMITTEE I 1 FOR- CITY OF EAGAN TYPE Res. A Mult Comm. _ Other NO. FIXTURES Water Closet - $3.00 / Bath Tubs - $3.00 Z_Lavatory - $3.00 Shower - $3.00 / Kitchen Sink - $3.00 Urinal/Bidet - $3.00 Laundry Tray - $3.00 Floor Drains - $1.50 =Water Heater - $1.50 Whirlpool - $3.00 WORK DESCRIPTION New X Add-on Repair TOTAL ?L .3. c. ,.3. Q u . Gv A f" avRvl w1 - -"-Vv Well - $10.00 Private Disp. - $10.00 -3 Rough Openin js - $1.50 's FEE STATE S/C: rc 1 GRAND TOTAL- CASH RECEIPT CITY OF EAGAN ?-? 3795 PILOT KNOB ROAD EAGAN, MINNF-30TA 55122 DATE 19 RECEIVED , PROM AMOUNT f DOLLARS loo ? CASH Q-dHECK Pope C ?j/ I ! r. 1 j ?/ r BY (. 6 A0 n .r White-Payers Copy Yellow-Posting Copy Pink-File Copy Thank You BLDG. PERMIT NO. ?Z Z O 01-3210 Bldg. Permit ZS (? G 01-3422 Plan Check / ?Cp z 01-3445 Surch./Adm. G 01-3446 SAC/Adm. (7/ . 76- 01-2155 Surcharge 3 Z 3 17-3860 Road Unit 20-2275 SAC 20-3865 Water Conn. ?() U () 20-3868 Water Trmt. 20-3716 Water Meter 20-2252 Acct. Dep. 20-3713 Water Permit U D U Sewer Permit J 00 20-3743 79-3866 11-3855 Sewer Conn. v Park Ded. i i I I i TOTAL 2 / S4 ?U O CITY OF EAGAN WATER SERVICE PERMIT 3830 Pllot"Knob Road T P.Q, Box 21199 PERMIT NO.: Eagan, MN 55121 DATE: R1 No. of Units: 1 Zoning: . Owner Address: Site Addess: Plumber qtgr snn flf]fld qOArge: Meter No.: nlG- 15 nna Size: ? d f)n Reader No.;? Be M5R Fee: I agree to comply with the ga9,'?u?rg ?, Ordinances. REQ isc. Charge . Total: r ?- Date Paid: Bate of Insp.: Insp.: CITY OF EAGAN SEWER SIIRVIO PERMIT 3830 Pilot Knob Road PERMIT NO.: P. O. Box 21199 Eagan, MN 55121 DATE: Zonng: No. of Units: ;Owner. _ Sit* AA IrOSC Plumber TO. 1 agree to own* wmh "M CRY of Ilea Connection Charge: . 0"Nuenew Account Deposit. Permit Fee: Surcharge: BY Daft of Insp.: Insp.: CITY OF EAGAN 3830 Pilot Knob Read P.O. Box 21199 Eagan, MN 55121 Miec. C howc Total: - Daft Pall: - WATER SERVICE PERMIT PERMIT NO.: DATE: 30 2044 No of Units: 1 Zoning: Pront ier Yidwe t Owner. Address: 3497 St Charles 7 t P Site Adoass: Plumber Star P1 Connection Charge: Meter No.: Account Deposit: 12 Size: . QQ---- Permit Fee: Reader No.: I agree to comply with the City of Eagan Surcharge: ?-- Misc. Charges: Ordinances. Total: 6'1 CA-A ,oar pT Date Paid:- Date of Insp.: Insp.: This to n CS - E(".) Scree ddr s o' Rau o. City L / o 4-A) action No. Township ame or No. Range No. Count Occup' t (PRINT) E i?1 ? ? ? Phone No. 5 - U 33 Power plier Address Electrical Contractor (Company Name) KENDRICK ELECTRIC C ntractor's License No. lo z Ma i I i)ngt/l9?§w5 {Gppyfgq?gp.g1?9M.9aryMicp}RSta lajion 1 `Y 'A?Fl / 1?LrPlPl l / li,lL J+(1jT1 Er Z ' ig y tallation) Phone Number MINNESOTA STATE BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT Griggs-Midway Bldg. - Room N•191 - BE ACCEPTED BY THE STATE BOARD UNLESS PROPER INSPECTION FEE IS 1821 University Ave., St. Paul. MN 55104 P6nn. 18121 497.21 t 1 ENCLOSED. ??ra,enaeu ueuuicai wnamc w' I hereby request inspection of above ? Owner electrical work installed at: REQUEST FOR ELECTRICAL INSPECTION - ! r-?(1? See instructions for complelinq this form on beck of yellow copy. "X" Be/ow Work Covered by This Request In9 Appliances Wired V ES-00001.04 SSiC; I i I I `" ;ciuioi mug. 1 t/(rurnace I I Silo Unlearn, I Industrial Bldg. J Air Conditioner T Bulk Milk Tank N Fee Service Entrance Size H Fee FeedersrSubleedere H Fee Circuits U to 200 Amps Above 200 Amps 0 to 30 Amps 31 to 100 Amps 0 0 to 30 Am s 31 to tU0 qm s %Ol Swimming Pool Above 100_Am s Q Above 10U_Am s Transtormers S' Irrigation Booms Partin L•Other Fee igns Special Inspection emerks TOTA EE 1 (L(/?vC 2 i. the Ef.ca eSr Y- "e Inspector, hereby Final rye certify that the above r ?/eZ inspection has been l made. request void 18 65`7cY/ 2004 RESIDENTIAL PLUMBING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN MN 55122 651-675-5675 Please complete for modifications to existing residential dwellings. 15's-0 Date rS I -5 1 6 r h p 3j/9? Unit # Site Street Address Property Owner Telephone #V, 9l?1 Contractor W ('0 `9"n,?o Telephone # (,?661)?365 -/,3 r!) Address 36 7o 0;"6 it waQ City state 1)14. Zip, _1_3 The Applicant is: _ Owner Y Contractor -Other Alterations to existing dwelling $ 50.00 -Add fixtures to rooms, excluding water softener and water heater -Septic System Abandonment -Water Turnaround (add $121.00 if a 518" meter is required) Other: _ Water Softener _?Water Heater $ 15.00 replacement _ additional Lawn Irrigation System RPZ_ new _ repair -rebuild $ 30.00 State Surcharge $ .50 Total $ J?-`mod I hereby apply for a Residential Plumbing Permit and acknowledge that the information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan and the plumbing codes; that I understand this is not a permit, but only an application for a permit, work is not to start without a permit and work will be in accordance with the approved plan in the event a plan is required to be reviewed and approved. Applicant's P Applicant's ignature 4 CLAIM VOUCHER - REFUND REQUEST CITY OF EAGAN MAKE CHECK PAYABLE TO: ELDER-JONES BUILDING PERMIT SERVICE ADDRESS: 1120 E 80TH ST BLOOMINGTON MN 55420 LOCATION: 3497 ST CHARLES PL Y RECEIPT #/DATE; 29035 6/19/02 / REASON FOR REFUND: NOT DOING JOB PERMIT #: 51861 TYPE OF REFUND: Plumbing Permit 9001 .4087 $ Mechanical Permit 9001. 4088 $ Building Permit Fee 9001 .4085 $ 139.25 Plan Review Fee 9001. 4222 $ SAC (MC/WS) 9220 .2275 $ SAC (City) 9379. 4681 $ SAC (Admin) 9001. 4246 $ Water Connection 9220. 3865 $ Sewer Permit 9220. 4532 $ Water Permit 9220. 4507 $ Account Deposit 9220. 2252 $ Water Meter 9220. 4509 $ Water Treatment 9220. 4685 $ Surcharge 9001. 2195 $ Overpayment 9001. 2250 $ Curb Box Deposit Refund 9220. 2253 $ Construction Meter Dep Refund 9220. 2254 $ Other $ TOTAL $ 139.25 I declare under the penalties of law that this account, claim, or demand is j ust and that no part of it has been paid. SIGNATURE 7/22/02 DATE city of eagan PAFRiCIA E. AWADA Mayor PAUL BAKKF.N I PEGGY CARLSON July 22, 2002 CYNDEE FIELDS MEGTILLEY Council Members KARA BENSON ELDER-JONES THOMAS HEDGES 1120 E 80TH ST BLOOMINGTON MN 55420 City Administrator RE: REFUND OF BUILDING PERMIT 51861 Dear Ms. Benson: Municipal Center. 3830 Plot Knob Road On June 19, 2002, a permit to replace windows at 3497 St Charles Place was issued to Sears Eagan, MN 55122-1897 Home Improvement (Elder-Jones Building Permit Service Inc). As you are requesting in your letter dated July 12, 2002, we are refunding $139.25 to you under separate cover. We are unable Phone: 651.681.4600 i to refund the $3.50 state surcharge that was collected. Fax: 651.681.4612 This letter is also meant to advise you that effective January 1, 2001, the City of Eagan's Fee TDD: 651.454.8535 Schedule assesses a $50.00 fee to refund permits that have been processed and receipted. As a courtesy, we are informing contractors of this policy and issuing a full refund, minus the state surcharge, for a cancelled permit on a "one time only" basis. Maintenance Facility: 3501 Coachman Point If you have any questions, please feel free to give me a call at 651-681-4695. Eagan, MN 55122 Phone: 651.681.4300 erel y, licrt__tai r Fax: 651.681.436 l TDD:651.454.8535 ,rjrfm Severson I Office Supervisor www.ciryofeagan.wm cc: Dale Schoeppner, Chief Building Official THE LONE OAK TREE The symbol of strength :md growth in our community RESIDENTIAL - - BUILDING PERMIT APPLICATION CITY OF EAGAN l? l 3830 PILOT KNOB RD, EAGAN MN 55122 1 a- 651.881.4875 New Construction Reguiremenh Remodel/Repair Requirements _ • 3 registered site surveys slowing sq. R of lot, sq. R. of house; and all roofed areas 2 copies of plan 2 copies of ing beam 6 window sixes', poured found design, etc.) ore:tenor additions 8 decks • 1 set of ergy culatWns e served by septic system for additions (20% m um lot coverage albwed) //-MULTI-FAMILY y Calons or heated additions • 3 copies of Tree Nation Plan if lot platted after 711193 • Rim Joist Detail Opti selection sheet (bldgs with 3 or less units) DATE SITE ADDRESS BLDG _Y NV TYPE OF WORK - FIREPLACE(S) -0-1 -2 APPLICANT c ^r STREET ADDRESS uJ1 =V-sN CITY A4, STATEI ZIPS= TELEPHONE FAX # PROPERTYOWNER RIP TELEPHONE# 1611- 0 qT7? COMPLETE THIS SECTIO Energy F R "NEW" RESIDENTIAL BUILDINGS ONLY Code Category _ MINNESOT RULES 767 CATEGORY I _ MINNESOTA RULES 7672 (J submission type) • Residential entilation Catego 1 Worksheet Submitted • New Energy Code Worksheet Submitted • Enemv E elope Calculations Su milted Plumbing Contractor: Phone # __ 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 inclu es: _ Air Conditioning "' Heat Recovery System 7 ? l 7 2002 JUR N Sewer/Water Contract Phone # ----- ------------ ----__--.r ---------------- --------------------------------------- ------------- I hereby acknowled that I have read this application, state that the info ation is correct, and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordina?cess. Signature of Applicant OFFICE USE ONLY Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _ Updated 4102 OFFICE USE ONLY ? 01 Foundation ? 07 05-plex ? 13 16-plex ? 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 New ? 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 ? 46 Windows/Doors ? 34 Replacement -Demolition (Entire 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 Width REQUIRED INSPECTIONS Footings (new bldg) _ Final/C.0- - Footings (deck) _ Final/No C.O. - Footings (addition) _ Plumbing _ Foundation _ HVAC _ Drain Tile Other Roof - Ice & W ater _ Final _ Pool _ Figs _ Air/Gas Tests -Final - Framing _ Siding _ Stucco _ Stone - Fireplace _ R.I. - Air 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 S&W Permit & Surcharge Treatment Plant Plumbing Permit Mechanical Permit License Search Copies Other Total July 12, 2002 City of Eagan Building Department 3830 Pilot Knob Road Eagan, MN 55122 To whom it may concern: Elder-Jones Building Permit Service, Inc. I am requesting a refund for building permit #EA051861, issued 06/19/02. The permit was for replacing nine windows at the residence of: Mary Ann Wilson 3497 St. Charles Place Eagan, MN 55122 Enclosed is the original permit. Please make the check payable to Elder-Jones Building Permit Service, Inc. If you have any questions or need more information, please call me at 952-345-6047. Thank you, Kara Benson Permit Service Elder-Jones Building Permit Service, Inc. 1120 East 80th Street • Bloomington, Minnesota 5542071498 952-854-2854 0 FAX: 952-854-4909 RESIDENTIAL j C7 7? BUILDING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB RD, EAGAN MN 55122 651-681-4675 New Constructon Reaulromenta . 3 registered site surveys showing sq. ft of lot. sq. fl. of house; and ILI roofed areas (20% maximum bfbovemgs allowed) . 2 copies of plan showing beam & window Was; poured found design, eta) . i set of Energy Calculations . 3 copies of Tree Preservation Plan d lot platted after 7/1M Rim Joist Detail Options selection sheet (bidgs with 3 or less units) DATE 's/a- / r O - RemodegReoalr Requirements . 2 copies of plan . 1 set of Energy Calculations for heated additions . 1 site survey for exterior additions & decks . Indicate if home served by septic system for additions VALUATION Do(D SITE ADDRESS q9 S Ck? ?? I MULTI-FAMILY BLDG _ Y _ N TYPE OF WORK -t-e i P - a ? /Ze x orJ FIREPLACE(S) _ 0 _ 1 _ 2 APPLICANT 41 d? "!1 STREET ADDRESS o y ??g s? CITY 14)y0 STATE _ ZIP TELEPHONE # qr 77 1?'__000CELLPHONE # ?C? Z '? 3 Sf FAX # Yea 2-- `32>2 ? PROPERTY OWNER 0/764-L/ TELEPHONE# g 7a ------------------------ ----------------------------------------- --------------------- -------- COMPLETE THIS SECTION FOR -NEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category _ MINNESOTA RULES 7670 CATEGORY 1 1$SbT)4' yj ES 7672 (J submission type) . Residential ventilation Category 1 Worksheet Submitted D l?ev? E 1eJ?Cd ?1i orksheet Submitted (, 1 LU I,IJI Energy Envelope Calculations Submitted n MAY Plumbing Contractor: Plumbing system includes: Mechanical Contractor. Mechanical system includes: Sewer/Water Contractor. Water Softener _ Water Heater No. of Baths Air Conditioning Heat Recovery System Lawn Sprinkler No. of R.I. Baths Phone # Phone # Fee: $90.00 Fee: $70.00 I hereby acknowledge that I have read this application, state that the infiorrqation is correct, and agree to comply with all applicable State of Minnesota Statutes and City of Eagan OrdinI Signature of Applicant Yro _ ................................................. OFFICE USE ONLY Certificates of Survey Received _ Tree Preservation Plan Received - Not Required , Updated aro2 OFFICE USE ONLY ? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg ? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. All- 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 New ? 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 ? 46 Windows/Doors . ? 34 Replacement 'Demolition (Entire 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 Width REQUIRED INSPECTIONS _ Footings (new bldg) _ Final/C,O. _ Footings (deck) _ Final/No 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. -Air Test -Final _ Windows (new/replacement) Insulation _ Retaining Wall Approved By Base Fee Surcharge Plan Review MC/ES SAC City SAC Water Supply & Storage S&W Permit & Surcharge Treatment Plant Plumbing Permit Mechanical Permit License Search Copies Other Total Building Inspector 4 RESIDENTIAL q?? I BUILDING PERMIT APPLICATION. 1 I CITY OF EAGAN 3830 PILOT KNOB RD - 55122 651-681-4675 New construction Reauiremens RowdeVReoair Requirements . 3 registered site surveys showing sq. ft. of lot sq. ft. of house; and all roofed areas . 2 copies of plan (20% maximum lot coverage allowed) . 1 set of Energy Calculations for heated additions . 2 copies of plan showing beam & window sizes; poured found design, etc.) . 1 site survey for exterior additions & decks . 1 set of Energy Calculations . indicate ff home served by septic system for additions . 3 copies of Tree Preservation Plan ff lot platted after 711/93 Rim Joist Detail Options selection sheet (bldgs with 3 or less units) DATE 'A. Strt.a-0Q VALUATION S16061 JOB SITE ADDRESS 349.'x- `JaanN C?.t1rtJ? ?! 1to,C A. IF MULTI-FAMILY BUILDING, HOW MANY UNITS? PROPERTY OWNER Cfk?.t1? Ahr` TYPE OF WORK%4&.co 4 , -4A, ?' n! FIREPLACE(S) _ 0 _ 1 _ 2 APPLICANT A (1A '?CKha?omk Trt??n\kc? SASS , UPHONE# }t,3.SYO •$Sa?(O ADDRESS 6,206 Wnh 90N <' ?It,..u WhAcu t6CZA ZIP CODE 10334 PAGER # CELL PHONE # FAX # NEW RESIDENTIAL BUILDING ONLY - FILL OUT COMPLETELY Energy Code Category _ MINNESOTA RULES 7670 CATEGORY 1 (check one) - Residential Ventilation Category 1 Worksheet Submitted - Energy Envelope Calculations Submitted MINNESOTA RULES 7672 - New Energy Code Worksheet Submitted Plumbing Contractor. Phone #: Plumbing System Includes: _ Water Softener Lawn Sprinkler Fee: $90.00 Water Heater No. of R.I. Baths No. of Baths Mechanical Contractor: Mechanical System Includes: Sewer/Water Contractor: - Air Conditioning - Heat Recovery System Phone # Phone # Fee: $70.00 All above information must be submitted prior to processing of application. 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 Ordinances. Signature of Appllcar ? ':Lm[ti,(Z; Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required Updated 2002 f N OFFICE USE ONLY ? 01 Foundation ? 07 05-plex ? 13 16-plex ? 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 New ? 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 ? 46 Windows/Doors ? 34 Replacement 'Demolition (Entire 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.pf Bldgs",- Length Fire SprinkJered Type of Const Width REQUIRED INSPECTIONS _ Footings (new bldg) _ Final/C.O. Footings (deck) _ Final/No 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. - Air Test - Final - Windows (new/replacement) _ Insulation - Retaining Wall Approved By Base Fee Surcharge Plan Review MC/ES SAC City SAC Water Supply & Storage S&W Permit & Surcharge Treatment Plant Plumbing Permit Mechanical Permit License Search Copies Other Total Building Inspector Installed Siding and'OsPOWER OF ATTORNEY OF COBB STATE OF GEORGIA KNOW ALL PEOPLE BY THESE PRESENTS: THAT I, David N. Katz, a resident of Montgomery County, Pennsylvania ("Principal"), and a licensed contractor of RMA Home Services, Inc., DBA Home Depot Installed Sales located at 660 Mendelssohn Avenue North, Golden Valley, MN 55427, having a license.number of BC- 20268257, do hereby appoint, name and constitute Elder-Jones Building Permit Service, Inc. ("Agent") as my true and lawful attorney-in-fact and do authorize and grant said attorney-in-fact for me and in my name, place and stead the power to execute, acknowledge, sign and deliver (in such form as may be required by the municipality) a permit application, or any other instrument(s) which may be necessary and appropriate, in order to obtain the proper permit(s) from the City of Eagan, Minnesota for the installation, maintenance and repair of windows and siding (the "Work"). The powers conveyed to the Agent by this Limited Power of Attorney are limited solely to the express powers delineated herein and apply solely to the Work. This Limited Power of Attorney shall expire and automatically be revoked on the 30th day of May, 2003, which date is one year from the execution hereof. Further, the powers conveyed by this Limited Power of Attorney may be revoked by Principal at any time by express revocation and shall also be revoked by the Principal's death, disability, incapacity or incompetence. IN WITNESS WHEREOF this Limited Power of Attorney is executed this 3o"' day of MA--j 2002. David z SWORN TO AND SUBSCRIBED BEFORE ME by David N. Katz on this 30`h day of May, Notary blic in for the Stat of eorgia My Commission Expires: January 21, 2006 396816.0 Proudly sold, furnished and installed by RMA Home Services, Inc., a Home Depot authorized contractor. 3200 Cobb Galleria Parkway, Suite 200 • Atlanta, GA 30339 • Phone (770) 779-1300 • Fax (770) 984-0709 • Toll free (800) 79-DEPOT Cash Receipt Receipt Date 101-VOI Time Printed 15;31:28 Receipt Hunber 1121 DAN WOHLER^= SylUTHSIDE 9001.2195 .50 HP 43118 9001.4088 30.00 HP 43118 9001.2195 .50 HP 43117 9001.4088 30.00 HP 43117 9001.2195 ,50 HP 43119 9001.4088 30.08 HP 43119 Total Receipt Amount 91.50 User HHCGRAH h CITY USE ONLY LOT, v BL SUBD. ?IIAIS 2000 Date: 0 q /,I (o [C 0 PERMIT #: RECEIPT #: CC.AL PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD KAGAN MN 55122 651-681-4675 Complete this section only if you are installing HVAC in a single family dwelling, townhome or condo under construction and not owner/occupied. • HVAC: 0-100 M B T U ADDITIONAL 50 M BTU • Gas outlets (minimum of one required @ $3.00 ea.) X Alteration/ Rj'ptctcc? Complete this section only if you are remodeling, adding to, or repairing an existing single-family dwelling, townhome, or condo. Please indicate if it is a new item, alteration, or repair. New Furnace Air exchanger 5 1 State Surcharge .50 Total $ - Repair X 411 1 I. Fee $ 30.00 State Surcharge Total 30.50 Reminder: Call for inspections SITE ADDRESS: 3q 9 7 SF • C h ' r I-e S p I a c OWNER NAME: Mary ion r-1 W, S O /? PHONE #: /O5 (nScF -q q ?a (AREA CODE) INSTALLER NAME: Wohlers Southside Mg. & A/C, Inc. PHONE #: 6950 W. 146th St. Suite 106 j (AREA CODE) STREET ADDRESS: CITY: Apple Valley, MN 55124 0) 59, q3) -,.o ?0 STATE: ZIP: $ 30.00 6.00 RECEIPT DATE: Other Air conditioning Other OF PERMITTEE :x{ L BL SUBD. APPROVED BY: INSPECTOR PERMIT* RECEIPT#: RECEIPT DATE: 2000 MECHANICAL PERMIT (COMMERCIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55122 651-681-4675 Please complete for: all commerciaUndustrial buildings multi-family buildings when separate permits are not required for each dwelling unit DATE: WORK TYPE: New construction Install U.G. Tank - Interior Improvement Remove U.G. Tank - Processed Piping When installing/removing underground tank, call 651-681-4675 for inspection by fire marshal and plumbing inspector. Description of work: Fees: 1% of contract price OR $30.00 minimum fee, whichever is greater. Underground tank removal/installation = minimum fee Contract price: $ x l% = $ (Base Fee) State surcharge calculate at $.50 for each $1,000 Base Fee TOTAL $ SITE ADDRESS: OWNER NAME: PHONE #: (AREA CODE) TENANT NAME (IMPROVEMENTS ONLY): WAS THERE A PREVIOUS TENANT IN THIS SPACE? Y N. NAME: INSTALLER: ADDRESS: CITY: PHONE#: (AREA CODE) STATE: ZIP: CITY USE ONLY SIGNATURE OF PERMITTEE 1999 BUILDING PERMIT APPLICATION (RESIDENTIAL) C ? CITY OF FAGAN l 3830 PILOT KNOB RD - 55122 651-681-4675 n G?? New Construction Reduirements Remodel/Reoair Reouirements ? 3 registered site surveys showing sq. ft. allot, sq. h of house ? 2 copies of plan and all roofed areas (2096 maximum lot coverage allowedl ? 1 set of energy calculations for heated additions ? 2 copies of plans (show beam & window sizes; poured fnd. design; etc.) ? 1 site survey for exterior additions & decks ? 1 set of energy calculations ? 3 copies of bee preservation plan it lot platted after 7/1/93 /CONSTRUCTION COST: 70 DATE: 3-32-1;f DESCRIPTION OF WORK: STREET ADDRESS: 0 4115? -7 57 GG?`t??e g 0 ??v? LOT: BLOCK: D- SUBD./P.I.D. #: w0 n ?S P i f ` Name: W+ Phone #: 6 S 6 ??'ss 7 Z PROPERTY twt Fmt OWNER Street Address: -5 ? ?-? City i°l °? ?• State: Zip: s^s?? Z "Cz Company: c.-ma Zi^- Phone #: e/ Z - CONTRACTOR Street Address: SUV / License # Exp. Stater zip: lS/YC City ARCHITECT/ /j ENGINEER Company. Phone #: Registration #: Street City State: Zip: Sewer & water licensed plumber (required for new construction onivl: Penalty applies when address change and lot change is requested once permit is issued. 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 Ordinances. Signature of Applicant: OFFICE USE ONLY Certificates of Survey Received , Yes No Tree Preservation Plan Received - Yes - No - Not Required OFFICE USE ONLY BUILDING PERMIT TYPE ? 1 Foundation ? 06 4-plex ? 2 SF Dwelling ? 07 5-plex ? ? 03 1 of_ plex ? 08 6-plex ? ? 04 2-plex ? 09 7-plex ? ? 05 3-plex ? 10 8-plex ? WORK TYPE 11 10-plex ? 16 Fireplace ? 21 Porch (3-sea.) 12 12-plex ? 17 Garage ? 22 PordVAddn. (4-sea.) 13 16-plex ? 18 Deck ? 23 Porch (screened) 14 Apartments ? 19 Lower Level ? 24 Storm Damage 15 Lodging ? 20 Pool ? 25 Miscellaneous ? 31 New ? 35 Tenant Impr ? 39 Gas Line Only K32 Addition ? 36 Move Bldg. ? 40 Gas Insert ? 33 Alteration ? 37 Demolish Bldg. ? 41 Wood Stove ? 34 Repair ? 38 Demolish (Interior) ? 42 Reroof GENERAL INFORMATION Const. (Actual) (Allowable) UBC Occupancy Zoning # of Stories Length Width APPROVALS Planning Permit Fee Surcharge Plan Review License MC/ES SAC City SAC Water Conn. Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment PI. Park Ded. Trails Ded. Other Copies Total: SAC Units Basement sq. ft. Main level sq. ft. sq. ft. sq, ft. sq. ft. sq. ft. Footprint sq. ft. Building , •.c7? r GGl9 ?s .0?? w??H w?,v?DccJ ? 43 Siding/Soffits/Fascia ? 44 Windows/Doors ? 45 Fire Repair Census Code !f 3 y SAC Code No. of Units e2l No. of Bldgs _4 MC/ES System City Water Booster Pump PRV Fire Sprinklered t"(-4 -- Engineering Variance Valuation: $? % SAC CITY OF EAGAN ;Ml) Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 N - PHONE: 454-8100 BUILDING PERMIT Receiptp k`'I "N Tobeusedfor SF DWG/GAR Estyalue $64,000 Date JUNE 27 ,19_86 Site Address 3497 ST. CHARLES PLACE Erect LX Occupancy R3 Lot 6 Block2 Sec/Sub. HAMPTON HEIGHTSRemodel ? Zoning R1 Repair ? Type of Const. Vn Parcel No. Addition ? No. Stories c Name FRONTIER MIDWEST Move D molish El ? Length 4() De th 47 = o Address 3908 SIBLEY MEM HWY e Intlmpr. ? p Sq. Ft Airy EAGAN Phone 454-0433 Install ? o Name SAME Approvals 00 u a Address Assessment City Phone Water & Sew. Police 0, Name RTr.HARD ('HART.TRR Fire ' .T ua Address 14101 (:ART)F..NVTF.W ( Eng. 56 City A-V- Phone 432-5492 Planner Council I hereby acknowledge that l have read this application and state that the Bld Oft 6/27/8f information is correct and agree to comply with all ap able S g Minnesota Statutes and of Eag in es. APC Var. Date Signature of Perm ill A Building Permit is issued to: r nmLl x xu. 1?11? all work shall be done in accordance with all applicabl Late of Building Official L Permit $ 325.0( Surcharge 32.0( Plan Review 162.5( SAC 575.0( Water Conn. 500.0( Water Meter 63.5( Road Unit 290.01 Tr. PI. 156.01 Parks Copies Total $2,104.01 on the express condition that City of Eagan Ordinances. 20e 1985 BUILDING PERMIT APPLICATION - CITY OF EAGAN NOTE: ALL CONTRACTORS MUST BE LICENSED WITH THE CITY OF EAGAN COMMERCIAL SINGLE FAMILY DWELLINGS INCLUDE 2 SETS OF ARCHITECTURAL INCLUDE 2 SETS OF PLANS & STRUCTURAL PLANS, 1 SET OF 3 CERTIFICATES OF SURVEY SPECIFICATIONS AND 1 SET OF -11 SET OF ENERGY CALCULATIONS ENERGY CALCULATIONS $2,000 LANDSCAPE BOND To Be Used For: ce Single Family Valuation: vvs?-- Date: ty W '(JEp Site Address j Lot 6 Block 2 ?SCaGZ! Parcel/Sub Hampton Heights Owner Roy & Patricia Peltier Address 1362 Wynne Ave City/Zip Code St. Paul, MN 55108 Phone 647-0887 Contractor Frontier Midwest Homes Address 3908 Sibley Memorial Hwy. City/Zip Code Eagan, MN 55122 Phone 454-0433 Arch./Engr. Richard Charlier Address 14103 Gardenview Ct. City/Zip Code Apple Valley, MN 55124 ErectC Remodel Repair Addition Move Demolish '- Int.Impr. Install APPROVALS Occupancy Zoning Type of Const S of Stories Length Depth Sq Ft FEES Assessments Permit 3 ZS- Water/Sewer Surcharge 3z Police Plan Review 16Z. S Fire SAC 575- Engr Water Conn Sro Planner Water Meter L;31S Council Road Unit Bldg Off 6Treatment P1 /5-6 APC Parks Variance Copies TOTAL - / 6 Phone # 432-5492 SIGMA SURVEYING SERVICES 3908 Sibley Memorial Highway Eagan. Minnesota 55122 Phone: (612) 452.3077 gCALr,-: 1":40' ?y9 xf r 0 ,p Z 1 OT l0 i 11- ; 5 HoMO+€B5L?6rificate Pot: O LANDOEVELOPEN5 AEAL1oNs ER COMPANIES .; STAFFaflp .tt Z5 14o, Oo N ?A0 35? ZIV 9 _- io.o-a----' 12AIWA4E ??f ya :A5 M T, :? oa ar9, LOT GO i V-X lot_- vA h? >Ie.O,? ?G _ 30.01 / I Iv J o ? cc m p n ; d1 k_ _30.0 ..ryl: x 862.0 i WAYNE D. CORDES - 14675 - -LEGEND - o Denotes Iran Afaxoent a Denotes Wood Hub Set x 861.0 Denotes Existing Spot Elevation (ASNOWN Denotes Proposed Spot Elevation ',-Denotes Drainage Direction -PROPERLY DESCRIPrIDN- LOT (V ,BLO=K 2 µAMpToN_. ?EIGNT15 according to the recorded plat thereof, county, Minnesota PROPOSED GARAGE FLOOR ELEVATION= 5(04.0 PROPOSED Top of Block ELEVATION- D",3 PROPOSED BASEMENT FLOOR ELEVATION° 861.3 NOTE: Verify all floor heights with Final House Plans. -s uafEVO_rt_S Cr RT1FICATIDN- I hereby certify that this survey, Plan or report was prepared by me or under my direct supervision and that 1 am a duly Registered Land Surveyor under. the laws of the State of Minnesota. 1144'r.L. Date: '-/9156 waynee D. Cordes, Minn. Reg. No. 14575 1 C , ? 2/84 ._ CITY OF EAGAN APPLICATION FOR PERMIT SEWER AND/OR WATER CONNECTION (PLEASE PRINT) 1) PROPERTY ADDRESS: L Z ? ?? ? /` LEC1L DESC-tIPTICN: L (-o 8Z ?i1 -PTA j u L ECC WS (Lot/BloCk/Sti:C11V1s1Cn or Tax Parcel I.D. Nu=er) ' IF W IS =;0 STRE;C'=E, DATE OF =TTGMIAL `UILDL`:G ='-:IT. ISJ e: C: PFLES= CC TS Y /P?OPOS= USE: X R-1 SZ;GLE FA .ILY ? R-2 CUP= (7-00 L^?I':S) ? R-3 TCfvNHCUSE (T-F-11= + LZTITS) ( T.P.TITS) ? R-4 APART UNITS) ? C Ci ME-,C L:%L/RETAII?OFP'ICE ? \ T ? LSI ZLIL ? INSTITUTICNAL/Gu=-I ' T \'r 2) APPLI(Z:.`.,ir (PLEASE PRINT) NAME: Frontier Midwest Homes Corporation ADDRESS: 3908 Sibley Memorial Hwy. Bldg. E. CITY, STATE, ZIP: Eagan, MN. 55122 PHONE: 454-0433 3) PLunBE? (PLEASE PRINT) FOR CITY USE ONLY NPIME: ' Star Plumbing ADDRESS: 1018 Mound Springs Ter. PLUMBERS LICENSE: Active CITY, STATE, ZIP: Bloomington, MN. 55420 Expired PHONE: XAJiLn 884-4149 PLUMBER LICENSE # 3329 Q Not of Record Ma". 15173T 4) OCCUPANT/CS+ZTER IYLLASt PRINT) ADDRESS: CITY, STATE, ZIP: PHONE:7? 5) INDICATE WtIICH PER-LIT IS BEING REQUESTED: CONNECTION TO CITY sa ER Please mail gold copy to CONNECTION TO CITY WATER Wenzel Mechanical 3600 Kennebec Dr. Q 0711ER (PLEASE DESCRIBE) Eagan. MN. 55122 6) ra*DIC=,z O.+c: PLEASE HOLD APPROVED PERMIT FOR PICK-UP BY ONE OF ABOVE PLEASE M*U APPROVED PM%IIT TO 1, 2 3, 4 AsovE (Circle one) 7) SIG:?TL'2rE: DATE: A Ma as ASM?.aO! Man lMgMtM as i ? O Spa i as i ii ?? :a a ! It fJF.llyi f? f? rt l ii:?i F O R C I T Y U S E O N L Y PERMIT R ISSUED FEES: $ S S S S S $ S $ S S S $ SEi'rLR PERMIT (nICL:DE SURCHARGE) WATER PERMIT (INCLUDE SURCHARGE) WATER METER/COPPERHORN/OUTSIDE READER WATER TAP (INCLUDE CORPORATION STOP) SEWER TAP ACCOUNT DEPOSIT - STATER WAC SAC TRUNK WATER ASSESS"ENT TRUNK SEWER ASSESS: ENT LATERAL BENEFIT/TRUNK SEWER LATERAL BENEFIT/TRUNK WATER WATER TREATMENT PLANT SURCHARGE OTHER: TOTAL AMOUNT PAID/RECEIPT R DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY? L YES IF YES, THEN A "PERMIT FOR WORK WITHIN PUBLIC ROADWAY" MUST BE ISSUED BY THE Q NO ENGINEERING DIVISION. LIST AS A CONDI- TION. SUBJECT TO THE FOLLOWING CONDITIONS: APPROVED BY: TITLE: DATE: me assn aau Mon AN onm W&M a! M sobw w m w !=" Name a!w e"M R w:pq aim vi M ut sa a•?pa iar saw se ijm on _ _ __.., *RYTE: PAYMENT OF FEE AT TINnOF APPLICATION DOES NOT CONSTITUTE APPROVAL OF PERMIT. INSPECTION OF SEWER AND/CR WATER ; TfQQI' ai.amQNB WILL NOT BE Sa m- ULED UNTIL PERMIT HAS BEEN ; APPROVED. ' °_-___°_° --- -------- P ease Print 1) PROPERTY ADDRESS: LEGAL DESCRIPTION: (Lot/Block/Subdivision or Tax Parcel ID ) IF EXISTING STRUCTURE, DATE OF ORIGINAL BUILDING PERMIT ISSUANCE: Mon Year PRESENT ZONING/PROPOSED USE: ? aX44ERCIAL/REPAIL/OFFICE r7 INDUSTRIAL n INSTITUTIONAL/GOVERISDJENT CITY OF EAGAN APPLICATION FOR PERMIT SEWER AND/OR WATER CONNECTION 2) NAME: ADDRESS: CITY, STATE, ZIP: PHONE: R-1 SINGLE FAMILY R-2 DUPLEX (Two Units) R-3 TOWNHOUSE (Three + Units) ( Units) R-4 APARTMENT/CONDOMINIUM ( Units) 3) u c: NAME: ADDRESS: CITY, STATE, ZIP: PHONE: MASTER LICENSE# Plumbers License: a Active I?Hlt Expired Not recorded Staff initl7al 4) ti as • _"?•„!'?sr? NAME: ADDRESS: CITY, STATE, ZIP: PHONE: n CONNECTION TO CITY SEWER C] CONNECTION TO CITY WATER OTHER 6) " • E] PLEASE HOLD APPROVED PERMIT FOR PICK-UP BY ONE OF ABOVE C3 PLEASE MAIL APPROVED PERMIT TO 1, 2, 3, 4, ABOVE (Circle one) FOR CITY USE ONLY PERMIT # ISSUED Pd w/Bldg. Permit FEES: $ $ SEWER PERMIT (INCLUDE SURCHARGE) $ ID- 5? $ WATER PERMIT (INCLUDE SURCHARGE) $ ( ?J SU $ WATER METER/COPPERHORN/OUTSIDE READER $ $ WATER TAP (INCLUDE CORPORATION STOP) $ $ SEWER TAP $ J 5?00 $ ACCOUNT DEPOSIT - SEWER $ ?J ?ZD $ AC OU DE C NT POSIT - WATER $ J ?• 0-0 $ WAC $ S Js. O'Q $ SAC $ $ TRUNK WATER ASSESSMENT $ $ TRUNK SEWER ASSESSMENT $ $ LATERAL BENEFIT/TRUNK SEWER $ $ LATERAL BENEFIT/TRUNK WATER $ $ WATER TREATMENT PLANT SURCHARGE $ $ OTHER: $ $ TOTAL RECEIPT RECEIPT DOES UTILITY CONNEC TION REQUIRE EXCA VATION IN PUBLIC RIGHT OF WAY? YES IF YES, THEN A " PERMIT FOR WORK WITHIN PUBLIC NO Q ROADWAY" MUST BE DIVISION LIST ISSUED BY THE ENGINEERING . AS A CONDITION. SUBJECT TO THE FOLL OWING CONDITIONS: APPROVED BY: v TITLE: DATE: ?kX??kc96%??XM%c>f:?X?k?ck?k?>k%??u??«k?kX?* t?m?k?X???k?kX??K?XrkX??c?k CITY OF F_AGAN CASHI.I_R., S TERMINAL NO. 671. DATE. 03/30/99 TIMEn 11..:1.0.25 Iiu NAME. AM HOME.:: IMP PROD INC 32:1.0 9001 3457 ST CHAS PI._ £13.2 5 215:15 9001. 3491' ST CHAS PL 1..50 v Tonal Receipt Amount-. 84.75 CR:1.05464 USER ID. NANCY m???m??k%?rFmm>X?kB??k%k?X?kX?>:;rk?km?%?k?k?k?%n,k?%cX??k ?K?k?XXcX?1c PERMIT City of Eagan 3830 PILOT KNOB RD EAGAN, MN 55122 (651) 681-4675 Permit Type: Building Permit Number: EA034988 Date Issued: 03/31/1999 Site Address: 3497 St Charles PI Lot: 6 Block: 2 Addition: HAMPTON HEIGHTS Description: Sub Type: Single Family " UBC Occupancy: Construction Type: Work Type: Windows/doors 41 Description: c ' Zoning: Census Code: 434 Square Feet gg Remarks: Plan reviewed by Wayne Miller. Fee Summary: Valuation: $3,000.00 State Surcharge Base Fee 1.50 83.25 S84.75 Contractor: - Applicant - Owner: American Home Improvements St. Lic.: Mary Wilson 9001 Rico Rd Bldg 9 3497 St Charles PI Monroeville, PA 15146 612-315-4516 Fagan. MN 55122 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. Applicant/Permitee: Signature Issued By: Signature uLf l,n I r1K I For Office Use I I l I City of Permit q I / , u, I Permit Fee: (.C 0' I 3830 Pilot Knob Road I I Eagan MN 55122 Date Received: C 7 a✓~ Phone: (651) 675-5675 I Fax: (651) 675-5694 I staff: _ 201,3 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: ! Site Address: "1 7 ~l• C J~ ~~C Tenant: Suite F-- Resident/Owner Name: ~ a91V1` Phone: Address / City / Zip: Name: ~A~y 11'f Ec..f}p,~„ } L License PC-6H3 3b,6-- Contractor Address: Z-7313 1 Z4sTJ'- S% . OVv✓ City: - t rlr7F lZ~`~lr4~y State: I`iIN Zip: 639 b Phone: ZZ L QlZ Contact: 5W7.7 S~jj*cZ Email: -New z Replacement Repair -Rebuild Modi S ace Type of Work - - fY P Work m R.O.W. Description ofwork: 6owrZ ~/f}LVl= RESIDENTIAL Water Heater Water Softener Lawn Irrigation L_ RPZ / PVB) I Permit Type - Septic System Add Plumbing Fixtures C_ Main Lower Level) Water Turnaround New I Abandonment RESIDENTIAL FEES: $60.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge) I $60.00 Lawn Irrigation (includes $5.00 State Surcharge) $60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge) ( *Water Turnaround (add $189.00 if a 5/8" meter is required) $105.00 Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge) TOTAL FEES $ 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.gopherstateonecall.org 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 X. Applicant's Printed Name Applicant's Signature FOR OFFICE USE Reviewed By: Date: Required Inspections:--- _Under Ground _ -Rough-In_ =Air Test _GasTest- Final = -