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1612 Sherwood WayCity of Eagan Eagan, PERMIT City of Eaan Permit Type: Mechanical Permit Number: EA098510 Date Issued: 04/07/2011 Permit Category: ePermit Site Address: 1612 Sherwood Way Lot: 4 Block: 1 Addition: Brittany 03rd PID: 10-15002-040-01 Use: Description: Sub Type: e - Air Conditioner Work Type: New Description: Air Conditioner Comments: Questions regarding electrical permit requirements should be directed to Mark Anderson, State Electrical Inspector, (952) 445-2840 Renae Freinwald 2200 Hwy 13 W Fee Summary: ME - Permit Fee (Replacements) $50.00 Surcharge -Fixed $5.00 0801.4088 9001.2195 Total: $55.00 Contractor: Genz Ryan Plumbing & Heating 2200 West Highway 13 Burnsville MN 55337 (952) 767-1000 - Applicant - Owner: Joseph Kurcinka 1612 Sherwood Way Eagan 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 Date: City of Eagan 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 /rho RECF1'1FD DEC 15 2010 Use BLUE or BLACK Ink I<o Of Permit #: / 5-gc /% Permit Fee: 570 Op Date Received: Staff: INFLOW & INFILTRATION PERMIT APPLICATION Plumbing / Sewer & Water Site Address: J Tenant: Suite #: RESIDENT / OWNER Name: -ere 4..vc_t*Adi(c.._ Phone: 0-7-41-1- --rt C (2 1 j Address / City / Zip: /1,.,'S1.t rw �4. ti) 1W Sri .2 / CONTRACTOR Name: License #: Address: City: State: Zip: Phone: Contact: Email: TYPE OF WORK PLUMBING (Within the building envelope) SEWER & WATER (Outside the building envelope) X Sump Pump Repair Repair Other: Other: DESCRIPTION Description of work: Jt tmou e_ - f f I( L ko rt •t- i UNN e ff�— v it WC-- .t ILL 0cA r L Lr acteA c �/ K v& -ie f FEES $55.00 / Each (includes $5.00 State Surcharge) TOTAL FEE $ *Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submit I/1 repair costs for reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors can be found by visiting www.citvofeagan.com/inflow, or City Hall at 3830 Pilot Knob Rd. CALL BEFORE YOU DIG. Call Gopher State One CaII 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.orq I hereby acknowledge that, this information is complete and accurate; that the work will be in conform- ith the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, �f, • rk is not to start without a permit; that the work will be in accordance with the approved plan in the case of work requires, - -w and approval of plans. x V UQ ��tr/Gt ti Applicant's Printed Name FOR OFFICE USE Required Inspection: LGA Appla is Signature Under Ground Rough -In Final CITY OF EAGAN SEWER SERVICE PERMIT 3'f95 Pilot Knob Roes PERMIT NO.: Eagan, MN 55122 DATE: Zoning: No. of Units: Owner: i Address: Site Address: " T agree to comply with the City of Eagan of Insp.. Connection Charge: Account Deposit: _ Permit Fee: Surcharge: Misc. Charges: - Total: 100.00 CITY W 3795 Pi Eaga^. M _ Zoning: r, Z Owner. Address: . Site address: Charg ; e: Plumber: Connection Account Deposit: Meter No.. permit Fee Size: -, Reader No.: City of Eego^ Misc. Charge' the Mir, Ch 1 egg to comply w" O*dimomews. Date Date Paid: By Insp Dote of Insp.: WATER SERVICE PERMIT EAGAN PERMIT NO" Knob Rood DATE: i N s5122 No. of Units: Tntifiratr of (Orrupaury Citp of (Eagan loppartmM of Nuilbttto inspertinn Tbis Cent ficate issued pursuant to the nquirea mi of Section 306 of the Uniform Building Code certifying that at tit time of isttutnce this structure war in coal pliance witb the various ardawacea of Ae City replataag hold-mg contraction or xue. For the follomg: by: Dew: November 19, 1982 "I CITY OF EAGAN 3795 Pilot Knob Reed Eo9an, MN S5122 PHONE: 454-6100 BUILDING PERMIT Receipt # To be reed for Est. Value Date 19 Site Address Erect ? Occupancy Lot Block Sec/Sub. Alter p Zoning Parcel # Repair ? Fire Zone m Name - :.on Rui?,lers W z Address "Or.aonc' -rive 9 _ ^ , _ -- A Name Z? uL) Address F rt... oL..-- Name _ Address I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all opplicoble State of Minnesota Statutes and City of Eagan Ordinances. Signature of Permittee Enlarge ? Type of Const. Move ? * Stories Demolish p Length Grade p Depth Sq. Ft. Approvals Fees Assessment Water & Sew. Police Fire Eng. Planner Council Bldg. Off. _ APC Permit Surcharge Plan check SAC Water Conn. Water Meter Road Unit Total A Building Permit is issued to: on the express condition that all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Building Official Permit No. Permit Holder Misc. Permit No. Holder Plumbing 2q? - 9-z- H.V.A.C. Well Water Disp. Sewer Electric bi 3 557?o Fa ?ti< ?. S-zS-FtZ -{E wt Inspection Date Insp. Other Footings bf Foundation Framing Rough Plbg. LA) AX Rough HVAC Insulation Final Plbg. g Final HVAC Final ?_ L Water Describe Location: Well Sewer Pr. Disp. r Receipt MECHANICAL PERMIT Permit No. CITY OF EAGAN Fee Fill in numbered spaces S/C Type or Print legibly Tot. 1. Date 2. Installation Cost n 3. Job Address C Lot-Blk. Tract 4. Owner 5. Contractor _ ?.. - Phone 6. Address { 7. City State Zip 8. Building Type: Residential ? Commercial ? Institutional ? 9. Work Description: New ? Add ? Alter ? Repair ? 10. Describe Fuel Type 11. No. Equipment BTU - M. Ea. Forced Air No. Equipment CFM Air Handlin : Mfg. g Boilers Mfg. Mech. Exhaust Unit Heater Mfg. Other Air Cond. Mfg. Gas, Piping Outlets 12. 1 hereby certify that the above information is true and correct, and I agree to comply with all ordinances and codes governing this type of work. Signed : for Rough Final Inspections: Date Insp. Date Insp. This is your permit when numbered and approved. Approved CITY OF EAGAN 454-8100 Receipt PLUMBING PERMIT Permit No. 1 CITY OF EAGAN Fee Fill in numbered spaces S/C Type or Print legibly Tot 1. DateL 2. Installation Cost "/C/;-'C.. >r_?' ?-lid ?':/-.iT%/?;'•'t 3. Job Address J ?ot_ Blk. Tract 4. Owner ?, f' / C. •i i ?« 5. Contractor Phone 6. Address I f" . "mac 1)E • / T 7/ c '- ? I 7. City State /)//l/ Zip - U B. Building Type: Residential ? Commercial ? Institutional ? 9. Work Description: New ? Add ? Alter ? Repair ? 10. Describe 11. No. Fixtures Water Closet No. Fixtures fi C l/D i l Bath tubs esspoo ra n e d i S T k - Lavatory ept c an f S - - Shower tner o W ll , Kitchen Sink e Urinal/Bidet Oth Laundry Tray er Floor Drains Drinking Ftn. Slop Sink Gas Piping Outlets 12. 1 hereby certify that the above information is true and correct, and I agree to comply with all ordinances and codes governing this type of work. Signed tea" for -•i /. ii.•T Rough Final Inspections: Date Insp. Date Insp. This is your permit when numbered and approved. Approved CITY OF EAGAN 454$100 INSPECTION RECORD CITY OF EAGAN PERMIT TYPE: tI I'l I Nis 3830 Pilot Knob Road Permit Number: Eagan, Minnesota 55122-1897 Date Issued: (612) 681-4675 SITE ADDRESS: ' ' APPLICANT: ? f 1: 11 it l1Ur1U WAY i.?, ? r l tiro i ckir c i . ) 4169 PERMIT SUBTYPE: TYPE OF WORK: ALTFRATION (Lit HtIOLJ) Permit No. Permit Holder Date Telephone k ELECTRIC PLUMBING HVAC Inspection Date Insp. Comments FOOTINGS FOUND FRAMING ROOFING ROUGH PLUMBING PLBG AIR TEST ROUGH HEATING GAS SVC TEST INSUL GYP BOARD FIREPLACE FIREPLACE AIR TEST FINAL PLBG FINAL HTG ORSAT TEST BLDG FINAL BSMT R.I. BSMT FINAL DECK FTG DECK FINAL LviN o ?? INSPECTION RECORD CITY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: Eagan, Minnesota 55122-1897 Date Issued: (612) 681-4675 SITE ADDRESS: ` 1 rj t u i111: 1 I i1?I(tJOOl1 14A` ltl(i 115ANY IRD PERMIT SUBTYPE: . , Fj I I U11 ! 1 III Nil H.'?. 1 •1n '00;1-040 411 APPLICANT: 4 lit u1-I t TYPE OF WORK: I f 11; A l l ON ,t r. It t t„N , i. t IC I I I N) INSPECTION • TYPE DATE INSPTR. RFMARKS - A %UPARATIF Pt- RMI 1 15 I7f.gU1RED fOR ANY Pt.11M1l1N6 1115( V1 t 1.IRII At W1111 -we L? ------------- Permit No. Permit Holder Date Telephone s ELECTRIC 1? Jr v PLUMBING 64 C y ll ft 7701 HVAC Inspectlon Date Insp. Comments FOOTINGS FOUND FRAMING w lG Y ?1 ROOFING ROUGH PLUMBING PLBG AIR TEST ROUGH HEATING GAS SVC TEST INSUL GYPSOARD FIREPLACE FIREPLACE AIR TEST FINAL PLBG FINAL HTG ORSAT TEST BLDG FINAL G BSMT R.I. BSMT FINAL DECK FTG DECK FINAL tit CASH RECEIPT CITY OF EAGAN 3795 PILOT KNOB ROAD EAGAN, MINNESOTA 55122 DATE RECEIVED 19 AMOUNT $ 8 DOLLARS ioo ? CASH ? CHECK Thank You ??-- BY White-Payers Copy Yellow-Posting Co Pink-File Copy CITY OF EAGAN Addition Brittany 3rd Addition Lot 4 elk 1 Parcel #10 15002 040 01 Owner }}I r ! :-` Street 1612 Sherwood Way State Eagan, MN 55122 1. Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. 1982 2013.03 402.61 5 1207.83 A011788 1-3-83 STREET RESTOR. GRADING &Ob 1982 596.22 119.24 5 357.74 A011788 1-3-83 SAN SEW TRUNK p ?f 1976 143.11 54 15 66.79 A011788 1-3-83 *SEWER LATERAL (0 1982 383o. 10 66.02 5 2298.06 11 1' - WATERMAIN * WATER LATERAL 1982 5 WATER AREA 1982 296.92 59.38 5 178.16 A011788 1-3-83 * Services 1982 5 STORM SEW TRK 6? 1982 628.22 125.64 5 376.94 A011788 1-3-83 * STORM SEW LAT 1982 5 CURB & GUTTER SIDEWALK STREET LIGHT ROAD UNIT 240.00 31581 8-25-82 WATER CONN. 420.00 of n BUILDING PER. 740;7 1 SAC 525 - 00 f1 11 PARK CITY OF EAGAN .t 3795 Pilot Knob Read Eagan, MN 55122 NO 7467 PHONE: 454-8100 - BUILDING PERMIT Receipt cs # To be used for SF DWG/GAR Est. value $112,000 Dote Auaust 25 , 19-a2- Site Address 1612 Sherwood Way Erect ® Occupancy R-3 Lot 4 Block 1 Sec/Sub. Brittany 3rd Alter ? Zoning R-1 Parcel # 10 15002 040 Ol Repair ? Fire Zone NA g Nome Tollefson Builders z Address 1655 Norwood Drive - o Name _ ?? Address t 1.._. Name _ Address Phone I hereby acknowledge that I hove 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. Signature of Pennittee Enlarge p Type of Const, V Move ? # Stories Demolish ? Length 53 Grode ? Depth 44 Sq. Ft.- Approvals , Fees Assessment _ Water 8 Sew. Police Fire Eng. Planner Council _ Bldg. Off. - APC Permit ao?.vv Surcharge 56.00 Plan check 231.50 SAC 525.00 Water Conn.42O.00 Water Meter 60.00 Road Unit 240.00 Total $1995?50_ A Building Permit is issued to: Toliefson Builders on the express condition thin all work shall be done in accord arx(q'-?dh all oppli;blq State of Minnesota Statutes and City of Eagan Ordinances. Building Official OFFICE USE ONLY This request wid 18 months from validation dote prinbd in 1,ia box. Ll d C/ i'7 / ?L? ?f/ III11ll111111ll 11 11 l 1111111111 II II «,6, PRINT TYPE L X00 Ra?ye ?o!o 5 (C(JJ Rough in inspection required? ? Yes No IYou must call ,he inspector when ready) InspecF:on Odser Th.. Roughln: ? Reody Now Will Call Dale Reody: I, [licensed contractor ? owner hereby request inspection of the above electrical work at: Job Addmss IStrom, Box, or Route No.) Ciy N Zip Code No. Township Name or No. Runge NV. Fire No. County Occupant I Ph. No. Power Supplier Address E iwl Cwmador ICompa,ry Namel l?I? Cookactor Ucense No. Mosier Uc. No. (Plant Elect. Only) essnkoctor or Owner Perfamirg Installation) Moiling Addr j?oa ?(•j/? Aulhorired Signature (Contr for or Owner P ingsfnstalloem) i. Phone No. _ ? 66 (5j3oj9 45-9 X75 ® REQUEST FOR ELECTRICAL INSPECTION 7 Minnesota State Board of Electricity 1821 FlniverSiry Ave., Rm. S-128, St. Paul, 1 MN 55104 Phone (612) 642-0800 1:TeI" I Lo- ?L Home Duplex Apt. Bldg. Other: New Addn Commercial Industrial Form Remod Repair Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other: D er Range Elec. Heat Temp. Service eXe above the work covered by this reques . Enter remarks in this space and on the back of the white copy only. lns 2_?`{S Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee: Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee Mobile Home Park Stall 0 to 200 Amps 0 to 1 ps Street Ug./Traffic Sig. e 200 A Above 100 Amps Transformer/Generator USE O uLf INSPSCTOR'S d?p TOTAI.?,,,,? Sign/Outline Ltg. Xfmr. ?(? v1 Alarm/Remote Control Swimming Pool F i I ins a ioetalla described hash on the rimes slmd Irrigation Boom Dale S ecial Ins ection p p Investigative Fee Da THIS INSTALLATION MAY BE ORDE D DISCONNECTED IF NOT COMPLETED WITHI - 1 MONTHS. 0 070 514 5f?Gdl ? 3 ?d ? ?0 Request Data Fie No. Rough-In Insp an Required gh-In F? Inspection other Th? IVou u Spector when ready) ?Q ?u ? Read Now y"iii Notify Inspector I 1s E] No Date Read I licensed contractor ?owner hereby request inspection of above electrical work at: Job Address (Street Box or Route No.) City n V SeCion N Township Name or No. Range No. O I W Occupant (PRINT) Phone No. Power Supplier Address Electrical Contractor (Company Name) tractor's License No. O Harrison Electric, I nc. CA00808 T Mailing Address (Contractor or Owner Making Installation) 2525 Neva a Ave. N., Iden Val ley, MN 55427 Autho d S' nature (Co t caner k' In aliation) Phone Number 544-3300 MINNESOTA5rATE BOARD OFY[EC IGITY THIS INSPECTION REQUEST WILL NOT Griggs-Midway Bldg. - Room 5128 BE ACCEPTED BY THE STATE BOARD 1821 University Ave., St. Paul, MN 651 I UNLESS PROPER INSPECTION FEE IS Phone (612) 6420800 ENCLOSED. GS REQUEST FOR ELECTRICAL INSPECTION ° 8-00001-09 000 , See instructions for compleling this form on back of yellow copy. ' g. (wi 7917 0 070 514 "X" Below Work Covered by This Request Ne Add p Type of Building Appli9rtnirs Wired Equipment Wired Home Range Temporary Service Duplex Water Heater Electric Heating Apt. Building Dryer Load Management Comm./Industrial Furnace Other (Specify) Farm Air Conditioner Other (specify) Contractor's Remarks Compute Inspection Fee Below: # Other Fee # Service trance Size Fee # Circuits/Feeders Fe Swimming Pool 0 to 200 Amps 0 to 100 Amps l Transformers Above 200 Amps bove 100 -Amps Signs Inspectors Use only: TO AL Irrigation Booms ill °V oSV Special Inspection Alarm/Communication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT Other Fee COMPLETED WITHIN 18 M S.- 1, the Electrical Inspector, hereby if Rough-in Da cert y that the above inspection has been made. Final Date OFFICE USE ONLY This request void 18 months from _ void !b L.q ?I I months from ./ ?? 3.riF?3 ?- ,j-ri 3zzo S 3S r ap nequesr vale rRe No. Hovg P-?n Inspection -(}'( eq ved? ?Ready Now ill Notify Inspec- ,. - D?_ yes ?No r When Ready Licensed Electrical Contractor I hereby request inspection of above ? Owner electrical work installed at: Street Address, Be. or Route No. 1 City W 1 Section No. Township Name or No. +n Kongo No. County pao (PRINT) Occu Phone No. `` P-W& Supplier Address Electrical Contractor (Company Name Contractor's License No. Mailing A r ss (Con.Lt?ractor or Owner Making last`ailation) Authorized Signature (Contractor Owner Making Installation) Phone N er k31?-'n °C MINNESOTA STATE BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT Griggs-Midway Bldg. - Room N-191 - BE ACCEPTED BY THE STATE BOARD 1821 University Ave.. St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS tt?--- 19111'971111 - ENCLOSED. •2 3 REQUEST FOR ELECTRICAL INSPECTION ^ ES-00001-03 5 6 If See instructions for completing this form on back of yellow copy. L' "X" Below Work Covered by This Request ?Z ZO 5 ew Add Rep. Type of Building Appliances Wired Equipment Wired Home Range Temporary Service Duplex Water Heater Lighting Fixtures Apt. Building Dryer Electric Heating Commercial Bldg. Furnace Silo Unloader Industrial Bldg. Air Conditioner Bulk Milk Tank Farm Othe c Other lSpeonfvl t er Suemfy t e Other Compute Inspection Fee Below - N Fee Service Entrance Size k Fee Feeders /Subfeaders N Fee circuits 0 to 100 Amos 0 to 30 Amos 0 to 30 Amos' 101 to 200 Amos1 31 to 100 Amps 31 to 100 Amps Above 209 Amts 1 Above 100-Amps Above 100-AMPS ,Trads-tololers\ i Remote Control Circ. Partial/Other Fee Slgnsv Special Inspection ? $ T Remarks 36 AL F E ?, t D v- Rough-in Date VV the Electrical Inspector. hereby V 1 certify that the above final Dane inspection has bean This request void 18 mnmh< finm This request void g z Ly t 31 ? ID r ( `?Q11y/ _ 3 r`1` 3157q 18p months from 5 1 !V{1/ 0 11FF7F- ?oroa R'nyos' ?No ?Reaov tJOw Will Non Ready ec- for When Licensed Electrical Contractor . 1 hereby request inspection of above Owner electrical work installed at: Street Address, Box or Route No. City action No. Township Name or No. Range No. County Occupant (PRINT) r ( ? Phone No. E rS ?Y? Power Supplier Address Electrical Contractor ICOmpany Name), Contractor's License No. I ? t?3=`F A•d ss (Contractor or Owner Making Installrinoril Mailing gA Author' ed Signature ICOntractor Owner Making Installation, Phone Number q ('??f ?- I \ ". O MINNESOTA STATE BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT Griggs-Midway Bldg. - Room N-191 BE ACCEPTED BY THE STATE BOARD 1821 University Ave., St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS Ph,...e 1612129].2111 ENCLOSED. N?? 3 5 5 7 6 REQUEST FOR ELECTRICAL INSPECTION See instructions for completing this form on back of yellow copy. "X" BeI v-Wxjj Covered by This Request j ' ?. EB-00001.03 Ne? Add Rep. Type of Building Appliances Wired 140ipmerit Wired Home Range Temporary Service Duplex Water Heater Lighting Fixtures Apt. Building Dryer Electric Heatin Commercial Bldg. Furnace Silo Unloader Industrial Bldg. Air Conditioner Bulk Milk Tank Farm Other (Specify) ther(Specify) t er Specify Other Other Comput8 Inspection Fee Below k Fee Service Entrance Size d Fee Feeders/Subfeedere 7/ Fee Circuits ------------------ - 0 to 100 Amps 0 to 30 Amps 0 to 30 Am s 101 to 200 Amps 31 to 100 Amps 31 to 700 Am s Above 200 Amps Above 100-Am s Above 100-Amps Transformers Remote Control Circ. Partial%Other Fee Signs Special Inspection S ?? TOT L FE Remarks ? 1 / E 1 0j LLLddd i Rough-in Date I, the rice) Inspactor- hereby certify that the above Final ?acJ tion hes been /? made. This repueat void 18 months from RESIDENTIAL j BUILDING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB RD - 55122 651-681-4675 LO ll Now Construction Requirements RemodellReoair Requirements • 3 registered site surveys slowing sq. ft. of lot, sq. R of house; and as roofed areas • 2 copies of plan I Cp 1 ° (20% maximum lot coverage allowed) . 1 set of Energy Calculations for heated add 1' itions q • 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 it home served by septic system for additions • 3 copies of Tree Preservation Plan If lot platted after 711193 • Rim Joist Detail options selection sheet (bWgs with 3 or less units) 5_) 3,Q 1 I fm DATE `r O-O/ VALUATION 2 S ? 0 JOB SITE ADDRESS 1617-- S e/-rn rodef IF MULTI-FAMILY BUILDING, HOW MANY UNITS? PROPERTY OWNER Obe -f lnll2y 1L'"1ec1 fX,1 TYPE OF WORK A La f-ee e' h!r Sc e ?k FIREPLACE(S) _ 0 - 1 _ 2 APPLICANT g/A--k- st PHONE# Gr/Z Y/?/ Sd'G? ADDRESS 2- SFFig4PL ZIPCODE5-5-/67 PAGER # CELL PH NE # 1 Z "01 "S?GY FAx # ddb 119D VIEW RESIDENTIAL BUILDING ONLY - FILL OUT COMPLETELY Energy Code Category _ MINNESOTA RULES 7670 CATEGOI (check one) - Residential Ventilation Category 1 WorksheE - Energy Envelope Calculations Submitted MINNESOTA RULES 7672 - New Energy Code Worksheet Submitted Plumbing Contractor: Plumbing System Includes: Mechanical Contractor. _ Mechanical System Includes: Sewer/Water Contractor: Air Conditioning Heat Recovery System Phone # Fee: $70.00 Phone # All above information must be submitted prior to processing of application. I hereby acknowledge that I have read this application, state that the informaf is correct, and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Clrdin Signature of Applicant Water Softener _ _ Water Heater No. of Baths _ Phone #: Lawn Sprinkler No. of R.I. Baths Certificates of Survey Received - Tree Preservation Plan Received - Not Required _ Updated 1101 Fee: $90.00 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. AR- SF ? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screened) ? 36 Multi ? 05 03-plex ? 11 10-plex 35 9 Lower Level ? 24 Storm Damage ? 06 04-plex ? 12 12-plex Plbg_Y or XN ? 25 Miscellaneous ? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding ? Addition 3 ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair Alteration 33 V ? 37 Demolish (Bldg)* ? 43 Reroof ? 46 Windows/Doors ? 34 Replacement *Demolition (Entire Bldg only) - Give PCA handout to applicant Valuation a0 Occupancy -3 MC/ES System Census Code ti Z c( Zoning City Water SAC Units 01 Stories Booster Pump Nbr. of Units 0 Sq. Ft. PRV Nbr, of Btdgs i Length Fire Sprinklered Type of Const_ Width REQUIRED INSPECTIONS Footings (new bldg) Final/C.O. - Footings (deck) - Footings (addition) Plumbing Foundation HVAC _ Drain Tile Roof _ Ice & Water _ Final _ Other X Framing _ Pool _ Ftgs _ Air/Gas Tests _ Final _ Fireplace - R.I. -Air Test -Final _ Siding _ Stucco _ Stone Insulation _ Windows (new/replacement) 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 >C Final/No C.O. ? 4 RESIDENTIAL BUILDING PERMIT APPLICATION CITY OF EAGAN ,{? ysaa, I 3830 PILOT 651-681-4675 7- 55122 Qr 7/) MO New Construction Requirements RemodellReoalr Requirements /cabled V-01 . 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 I, . 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 if home served by septic system for additions . 3 copies of Tree Preservation Plan if lot platted after 7/1/93 . Run Joist Detail Options selection sheet (bldgs with 3 or less units) DATE ° r 1 (SCI( I VALUATION (EXCLUDING LAND) y I . `y G? JOB SITE ADDRESS-Le L_), S he- rr c ood R219 IF MULTI-FAMILY BUILDING, HOW MANY UNITS? PROPERTY OWNER )De cJ' K,I,i r't ;I 'VA Ir A TYPE OF WORK 2 C2 'C vl L FIREPLACE(S) _0 _1 _2 _-3y APPLICANT l? 4t G1 Pn?iL '1wi A r>rrc_I' ty'1 PHONE # ?ld?`K(D % ADDRESS Loo 3 c__rf/ SGT' QOaA at,40 ZIP CODE SS/oo1. PAGER # CELL PHONE # FAX # NIEW 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: Plumbing System Includes: Mechanical Contractor: _ Mechanical System Includes: Sewer/Water Contractor: All above information must be submitted prior to processing of application. Phone # Phone # Fee: $90.00 Fee: $70.00 I hereby acknowledge that I have read this application, state that the information is correct all applicable State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant Certificates of Survey Received _ Tree Preservation Plan Received - Not Water Softener Water Heater _ No. of Baths _ Phone #: Lawn Sprinkler No. of R.I. Baths Air Conditioning Heat Recovery System (1L,,,.9 13, aqree to con Updated 1101 J 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 2018 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 'V 34 Replacement *Demolition (Entire Bldg only) - Give PCA handout to applicant Valuation U (Z Occupancy k- 3 MC/ES System Census Code y3 % Zoning Q? City Water SAC Units f'! Stories Booster Pump Nbr. of Units ( Sq. Ft. PRV Nbr. of Bldgs ( Length Fire Sprinklered Type of Const _j Width _ Footings (new bldg) Footings (deck) Footings (addition) _ Foundation _ Drain Tile Roof _ Ice & Water Final Framing Fireplace _ R.I. -Air Test -Final Insulation REQUIRED INSPECTIONS _ Final/C.O. Final/No C.O. Plumbing HVAC Other Pool _ Ftgs _ Air/Gas Tests - Final - Siding _ Stucco _ Stone - Windows (new/replacement) Approved By ?zC1 , 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 ti 1 TO Be Used For L CITY OF EAGAN Include 2 sets of plans, 1 site plan w/elevations 6 BUIIDIbE PENCr APPLICATION 1 set of energy calculations. ®. n-Valuation //,I /Taa Date Site Address C? Lot Block Sec./Sub. 3' Parcel jo (50 GqO o? Owner: . CYty/Zip Code: Phone #: Address: City/Zip Code: Phone #: Address: City/Zip Codee Phone #: ® CEFICE USE ONLY bl/? Occupancy 3 Alter Zoning Pepair Fire Zone Enlarge _ Type of Const. Move # Stories Demolish _ Front 3 ft. Grade Depth y ft. Water/Sewer surcharge Police Plan Check Fire SAC Eng. Water Cann. Planner Water Meter Council Road Unit Bldg. Off. - - APC 7MAL I I C('Z $o f 3 a .. N Tollefson Builders Inc. Or. 11332 183-65A I? JACKSON - SURVEYORS REGISTERED UNDER LAWS OF STATE OF MINNESOTA 3476 EAST 55th STREET, MINNEAPOLIS, MN 55017 727-3484 Sbucbrportg lCrrtifiratr D R A I N A G E EASEMENT 0 ?S 'A 1 ?y w -41a-0- ?01 1 1 ? h? I HERESY CERTIFY THAT THE ABOVE 1199 A TRUE AND CORRECT PLAT OF A SURVI" OF Scale: 1H 301 0 Iron °000=Existing Elev. -+ %Drainage `D.& U. Easawnt Lot 4,Block 1,Brittany 3rd. Addition, Dakota County,Ninnesota, Proposed Garage Floor Slav. 102.5 Proposed First Floor Slav.. 103.3 Proposed Basement Floor Elsv. 94.3 AS SURVEYED SY ME THIS 27th_ DAY of--July A.D. 1982 SIGNED= F. C. JACKSON. 4 , 2 G' ?? ' I Is l A •' N ?>,!. t?'( L i ?c„1 ^ i l' 3 tv" es _ ? 3 :'E3 h 72 Cfinrimin*??n,-1. Eden ??l31 h? f ( f?hcrz®© ?! 118 r ? K b t 1 < Csf' C ,a, PL ntt t.Uttr•F*t n ' . ItI'T nrn?r^, I`?9PTiIF:ECR CT•' Ii'0 , 3h:r'^ Loa M! DER ' ?DIJ:ii ECrS ftTII '. i -I L'?A" n,^r!ic? ?v=? cotrer?n^Ies f L I^'JL rte? or L'.2PCg1 • -' TOTAL t?•'?e F7.o C?' I"34'M tt_ °T )l )(l•? ; /?\? . .. . •. . : ` . .. ._ .. 'c'.ne ,l j. C ) a? . • - «. .. ... 7.1 CaSF ry,a J)-r. Clfit Ir,sna mr r-il I g r9^u TOTAL .S,Oo Z VI C'a I'OCP9 ? S G G 4 ? . z i'M CP I MATI( Er tiAKj:S G', h. [ r7 TFICK ;?'ti C? It.U[4wCU IB C^rPr_ -', T?Lcl,.., ?.?.. IC)" Q Tikca . - nPn C3P•i7^ _ 2's r .- ? ...., ann r rxr; r. nr?,nc? ^ttW t'exS o-? rzP.^sr= !:n?t? nnovt o>'jr^ pzz ?:t e? S ?? .:i. r roe tl!' -? 7 C? ?z2 L'o:2 A17, C7 'r_ ? Li,S£i;,,;e ) YOU; t , 1 t 'ry , ro 2 t ,. f 1 i + ? i i z a ? ( ? f (s r i g r .4 ? f - ? ti f 2 a , _ Y _ l.{ ?f + k µY ?' ' ' ? r r, ?{ I%5 i? t ? ' t 3 K.)• 1 ? ' ? 4 ? F 4 i S ) ,i'4? ? ) - L ' It f L J? i Cf ;? 4 S ~ r Tr` {f 1 y y ` t?11 ? • F 3 Y ? 4 ? y ? • ? • ? , f N^ 'Y ?? {t ?f ' ' L ?? ? ? _ ? Jf , 4• ? ??? } M1 r ! .3z lq K T {L .n . r.. t V ?,1 ]1?Y , 1 ?S :'r S 3i Ta {? ) 7. f...,? .F .l in 4. ?.YI e4 3 - Y L 4 .qe ;4 9Ec Tfo..a n _ 30Z 'q Q Srrr,oJ t? 39 &L $ i 8? nti o?/ r S Fr ?An"I._ ?. Yk --t I t {l <j. S ?•t ?C? (i . A .. . ? ? n e? : 5 ? ? ? tS yf . ._ . .?. . .?.. . .? . . _ ? "" 9 ? t Ir+ :G ' ? S 7 r Sa rnA._? ! _ !<!A imp. ?,- - M?<LSJ?)__?,?( .?. ' ) Z I OTA L3 . ;?,t pp r N r;7 -I s s 41. 13i1URo, TOTALS, 5 $ V ?? .5. CE I1It'C., T,?TA IS _f? 4 _ iYZ. C " T,ITAL U [A' VAII)fs " ' ' DIVID1rll I3Y '1`?i1AI +11 LL ArtrA tt . A r? 'x ,s.`? et (i '1 a ° v r- z'. .J f x?tie A ?1`P^'L { t ? , i 7 -'.a a^C .,1 i •hal r_c t Sl.?. ?'cr ir3. L?L'Py4 v ,+?,. s?^?a ??U•J ate`<? v...u \^r MK F? 3 x },s^._':r X?-r°h y_. .,}s''' l ??„?r__....:..?., '..t n?bA ?yv.r-.-?rnn,.:ttr;.. n Ynt p ii ? . . r 44ru i r ??. LAP, ff s ?. r ?r??t F ?? d"/a a rry; ` C"es?e rFT :. ....r it w? f. ? 4 CITY OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55122-1897 (612) 681-4675 SITE ADDRESS: P.I.N.: 10-15002-040-01 DESCRIPTION: BUILDING 026196 08/08/95 I ? 5 PERMIT 1612 SHERWOOD WAY LOT: 4 BLOCK: 1 BRITTANY 3RD PERMIT TYPE: Permit Number: Date Issued: (KITCHEN) Building-Permit Type SF (MISC.) Building Work Type ALTERATION i r i REMARKS: A SEPARATE PERMIT IS REQUIRED FOR ANY PLUMBING OR ELECTRICAL WORK FEE SUMMARY: VALUATION Base Fee Plan Review Surcharge Lie. Search Total Fee $174.75 $61.16 $5.50 Fee $5.00 $246.41 $11,000 CONTRACTOR: - Applicant - ST. LIC. OWNER: KIRK CONST CO 12274769 0005839 KURCINKA JOE 423 E WYOMING ST 1612 SHERWOOD WAY ST PAUL MN 55107 EAGAN MN (612) 227-4769 (612)452-5144 I hereby acknowledge that I have read this information is correct and agree to comply Statutes nd City of Eagan Ordinances. APPLICANT/PERM_IT/ EE/E1? /SI NATURE application and state that the with all applicable State of Mn. r ISSUED B A SIG E INSPECTION RECORD CITY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: Eagan, Minnesota 55122-1897 Date Issued: (612) 681-4675 BUILDING 026196 08/08/95 SITE ADDRESS: P• I. N .: 10-15002-040-01 LOT: 4 BLOCK: 1612 SHERWOOD WAY BRITTANY 3RD PERMIT SUBTYPE: SF (M.ISC.) 1 APPLICANT: KIRK CONST CO (612) 227-4769 TYPE OF WORK: ALTERATION DESCRIPTION (KITCHEN) INSPECTION TYPE FRAMING .DATE INSPTR. INSPECTION ROUGH IN PLBG DATE INSPTR. ROUGH IN HTG FINAL REMARKS: A SEPARATE PERMIT IS REQUIRED FOR ANY PLUMBING OR ELECTRICAL WORK F 7 CITY OF EAGAN ,II 3830 PILOT KNOB RD - 551222` 4 1995 BUILDING PERMIT APPLICATION (RESIDENTIAL) c? 681-4675 CD ?i New Construction Reouirements RemodeVReoair Requirements ? 3 registered site surveys ? 2 copies of plan ? 2 copies of plans (include beam & window sizes; poured Md. design; etc.) ? 2 site surveys (exterior additions & decks) ? 1 energy calculations ? 1 energy calculations for treated additions ? 3 copies of bee preservation plan if lot platted after 711193 required: _ Yes No 41 DATE: ef- 3 ` 5'. CONSTRUCTION COST: DESCRIPTION OF WORK: ??ooFL ?/ Tc.ffE? STREET ADDRESS: ?? ?? s}fEIZGUIdI? ?ilr? y LOT BLOCK SUBD./P.I.D.#: hr ?•slptl c PROPERTY Name: Phone #: 45 S/164V OWNER Street Address City: /FefGA.f/ State: 171AI. Zip: CONTRACTOR Company: ,Ki,e,- C®oysT Co. Phone #: EaZ 47L Street Address: 4Z3 F lr??cm ?r Sf License #- •52632 City: -S7' ?tea State: /may Zip- ARCHITECT/ Company: Phone #• ENGINEER Name: Registration M Street Address, City: State: Zip: Sewer & water licensed plumber: Plpy4E f J14W?6 /?J6 y 11.r '. Penalty applies when address change and lot change are requested once permit is issued. I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant: _G 1IP cO V57- G10 OFFICE USE ONLY ^ ^ /C, # -5-,6 3 9 Certificates of Survey Received _ Yes _ No AUG 0 3 1995 Tree Preservation Plan Received Yes No OFFICE USE ONLY BUILDING PERMIT TYPE ? 01 Foundation ? 06 Duplex ? 02 SF Dwelling ? 07 4-plex ? 03 SF Addition ? 08 8-plex ? 04 SF Porch ? 09 12-plex 05 SF Misc. ? 10 = plex WORK TYPE ? 31 New X33 Alterations ? 32 Addition ? 34 Repair GENERAL INFORMATION Const. (Actual) (Allowable) UBC Occupancy Zoning # of Stories Length Depth APPROVALS Planning Permit Fee Surcharge Plan Review License MCNVS SAC City SAC Water Conn. Water Meter Acct. Deposit SNV Permit SNV Surcharge Treatment PI. Road Unit Park Ded. Trails Ded. Other Copies Total: ? 11 Apt./Lodging ? ? 12 Mufti Repair/Rem. ? ? 13 Garage/Accessory ? ? 14 Fireplace ? ? 15 Deck ? 36 Move ? 37 Demolition 16 Basement Finish 17 Swim Pool 20 Public Facility 21 Miscellaneous _ Basement sq. ft. MCNVS System _ Main level sq. ft. City Water _ sq. ft. Fire Sprinklered _ sq. ft. PRV _ sq. ft. Booster Pump _ sq. ft. Census Code. Y?Y _ Footprint sq. ft. SAC Code -L Census Bldg _L Census Unit O Building Engineering Variance Valuation: $ ?? o do % SAC SAC Units CITY OF EAGAN CASHIER: JS TERMINAL_ NO. 45 DATE. 05/09/97 TIME: 11:54:28 NSAME: KIRK CONST CO 3210 9001 1612 SHERWOOD W 43.00 2155 9001 1612 SHERWOOD W 0.65 Total. Receipt Amount: 43.65 CRO73418 USER If. JAN ??XC?%cX: %r %c ??k?Xc?c?#?C kc ? ?kY?%cXc?#??%?#sXXcXcXc?C%?%? k?#?k? .? PERMIT CITY OF EAGAN 3830 Pilot Knob Road PERMIT TYPE: B U I L D I N G Eagan, Minnesota 55122-1897 Permit Number: 0 2 9 9 5 4 (612) 681-4675 Date Issued: 05/12/97 SITE ADDRESS: 1612 - SHERWOOD WAY LOT: 4 BLOCK: 1 BRITTANY 3RD P.I.N.: 10-15002-040-01 DESCRIPTION: (WINDOW) Buldin{ Permit Type z"Buildi.ng Wbrk Type Census code ?. e 1 ? I SF (MISC.) ALTERATION 434 ALT. RESIDENTIAL a? ,r r ?._ 1J -t i r , L _ ?! 3 a _ ... REMARKS FEE SUMMARY: /d Base Fee Surcharge Total Fee $1,300 VALUATION $43.00 $.65 $43.65 CONTRACTOR: - Applicant - ST. LIC.OWNER: KIRK CONST CO 12274769 0005839 KURCINKA JOE 423 E WYOMING ST 1612 SHERWOOD WAY ST PAUL MN 55107 EAGAN MN (612) 227-4769 (612)452-4771 I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with 411 applicable State of Mn. Statutes and City of Eagan Ordinances. APPLICANT/PERMITEE SIGNATURE f0flll D/P . I D Y:SI'NAU E 1997 BUILDING PERMIT APPLICATION (RESIDENTIAL)3, CITY OF EAGAN 3830 PILOT KNOB B RD RD - -55122 681-4675 ? 3 registered site surveys e 2 copies of plan e 2 copies of plans (Include beam & window sizes; poured fnd. design: etc.) e 2 site surveys (exterior additions & decks) e 1 energy calcutations e 1 energy calculations for heated additions ? 3 copies of tree preservation plan if lot platted after 7/1/93 required: _ Yes _ No ^? _ DATE: / CONSTRUCTION CO ST: /2s9 DESCRIPTION OF WORK: STREET ADDRESS: LOT BLOCK Z.h57? win?6w (3`kS- ate- ??J (rsvm. 4 N SUBD./P.I.D. A G?i.?-avw w.15 S.ovt'O -20m 2Em ,PEZ1A/C nd PROPERTY Name: )L-1k101-1N)e4 TLLW"?'e ' Phone #: 41' 1/77/ OWNER / Street Address ?? o? SLi rhwacG l/Ua City: 9 State: Zip: CONTRACTOR Company: LULL- r'10/1$7- fO Phone #: 227 274 Street Address: /may D- 3 % Avon ihs License #: -5?3,C_ City: J V Gr u? State: Zip: ?S/d 7 ARCHITECT/ Company: Phone #: ENGINEER Name: Registration #: Street Address: City: State: Zip: Sewer & water licensed plumber (new construction only): and lot change are requested once permit is issued. Penalty applies when address change 1 hereby acknowledge that I have read this application and state that the information is correct a agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. i Signature of Applicant OFFICE USE ONLY Certificates of Survey Received _ Yes _ No Tree Preservation Plan Received - Yes _ No _ Not Required BUILDING PERMIT TYPE OFFICE USE ONLY ? 01 Foundation ? 06 Duplex ? 11 Apt./Lodging ? 16 Basement Finish ? 02 SF Dwelling ? 07 4-plex ? 12 Multi Repair/Rem. ? 17 Swim Pool ? 03 SF Addition ? 08 8-plex ? 13 Garage/Accessory ? 20 Public Facility ? 04 SF Porch ? 09 12-plex ? 14 Fireplace ? 21 Miscellaneous ? 05 SF Misc. ? 10 = plex ? 15 Deck WORK TYPE ? 31 New ? 33 Alterations ? 36 Move ? 32 Addition ? 34 Repair ? 37 Demolition GENERAL INFORMATION Const. (Actual) (Allowable) UBC Occupancy Zoning # of Stories Length Depth APPROVALS Planning Basement sq. ft. Main level sq. ft. sq. ft. sq. ft. sq. ft. sq. ft. Footprint sq. ft. Building MCNVS System City Water Fire Sprinklered PRV Booster Pump Census Code. SAC Code Census Bldg Census Unit Engineering Variance Permit Fee Surcharge Plan Review License MC/WS SAC City SAC Water Conn. Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment PI. Road Unit Park Ded. Trails Ded. Other Copies Total: Valuation: $ % SAC SAC Units CITY OF EAGAN CASHIEI 1S TERMINAL NO: 693 DATE: 07/29./99 TIME: 11:35.00 ID; NAME: SEL.A ROOFING G REMODELING 3210 9001 1612 SHERWOOD W 209.25 2155 9001 1612 SHERWOOD 14 6.00 Total. Receipt Amount. 21.5.25 CR113969 USER ID,. :SAN 1999 BUILDING PERMIT APPLICATION (RESIDENTIAL) CITY OF EAGAN 3 r ?y OI I 3830 PILOT KNOB RD - 55122 ?o O 651-681.4675 ew Construction Requirements 3 registered site surveys showing sq. k. of lot, sq. ff. of house and all roofed areas (20%, maximum lot coverage allowed) > 2 copies of plans (show beam & window sizes; poured fnd. design; etc.) I set of energy calculations > 3 copies of tree preservation plan R lot platted after 7/1/93 DATE: 7 a'° -q a city DESCRIPTION OF WORK: Rr20DF7 /fV'5e . STREET ADDRESS: jGl? Sh e 1NOO? Wcy LOT: - J?- BLOCK: _I SUBD./P.I.D. #: 3 Name: J o a Phone #: PROPERTY Last First OWNER Street CONTRACTOR ARCHITECT/ ENGINEER State: Zip; Company: S i n u0- ORINr a RED40Du r IN INTO. Phone #: rd.49- &2-3 - 909 4100 EXCELSIOR BLVD. (area code) ST. LOUIS PARK, MN 55416 Street Address:_ In ann., nxn License # 10 s Exp. City Remodel/Repair Requirement-i- ` 2 copies of plan I set of energy calculations for heated additions I site survey for exterior additions 8 decks CONSTRUCTION COST: ) I I C 0 a State: Company: Name: Telephone #: area code ( ) Street City Sewer K water licensed plumber (required for new construction only): State: Penc-hy applies when address change and lot change is requested once permit is Issued. Zip: Zip: 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 PL-t e Registration #: Gs-/ -I- S'g- -K-771 OFFICE USE ONLY BUILDING PERMIT TYPE ? 01 Foundation ? 06 4-plex ? 11 10-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 02 SF Dwelling ? 07 5-plex ? 12 12-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 03 1 of plex ? 08 6-plex ? 13 16-plex ? 18 Deck ? 23 Porch (screened) ? 04 _ 2-plex ? 09 7-plex ? 14 Apartments ? 19 Lower Level ? 24 Storm Damage ? 05 3-plex ? 10 8-plex ? 15 Lodging ? 20 Pool ? 25 Miscellaneous WORK TYPE ? 31 New ? 35 Tenant Impr ? 39 Gas Line Only ? 43 Siding/Soffits/Fascia ? 32 Addition ? 36 Move Bldg. ? 40 Gas Insert ? 44 Windows/Doors ? 33 Alteration ? 37 Demolish Bldg. ? 41 Wood Stove ? 45 Fire Repair ? 34 Repair ? 38 Demolish (Interior) ? 42 Reroof GENERAL INFORMATION Const. (Actual) (Allowable) UBC Occupancy Zoning # of Stories Length Width APPROVALS Planning Basement sq. ft. Main level sq. ft. sq. ft. sq. ft. sq. ft. sq. ft. Footprint sq. ft. Building Engineering Census Code SAC Code No. of Units No. of Bldgs MC/ES System City Water Booster Pump PRV Fire Sprinklered Variance Permit Fee a?R a 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: a (? a SAC Units Valuation: $ % SAC CITY USE ONLY '/ l L ? BL ? RECEIPT#:'?71?`"?' SUED. r? DATE: °2? IS 1995 PLUMBING PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55122 (612) 681-4675 Please complete for: single family dwellings ? townhomes and condos when permits are required for each unit FIXTURES - EACH NO. TOTAL Shower 3.00 x = Water Closet 3.00 x = Bath Tub 3.00 x = Lavatory 3.00 x = Kitchen Sink 3.00 x = Laundry Tray 3.00 x = Hot Tub/Spa 3.00 x = Water Heater 3.00 x = Floor Drain 3.00 x = Gas Piping Outlet * minimum -1 3.00 x = Rough Openings 1.50 x = Water Softener 5.00 x = Private Disposal * Dakota Cty. license 20.00 = U.G. Sprinkler * home under const. 3.00 = Alterations * to existing 20.00 = a?? Water Turn Around 20.00 STATE SURCHARGE .50 S° TOTAL O SITE OWNER NAME: J0Fd /'11?2Y iNXf INSTALLER NAME: G ?DrY t, P/?GI>7??/?t/C STREET ADDRESS: X753 /V - 4 57?. CITY: ST• Adze / STATE: ZIP: ?S?O3 PHONE #: ( b t Z ?fy '779 1 OFFICE USE ONLY L BL RECEIPT M SUBD. DATE' 1995 PLUMBING PERMIT (COMMERCIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55122 (612) 681-4675 Please complete for: ? all commercial/industrial buildings. P multi-family buildings when separate permits are Dgi required for each dwelling unit. DATE: - CONTRACT PRICE: WORK TYPE: NEW CONSTRUCTION ADD ON REPAIR DESCRIPTION OF WORK: IS WATER METER REQUIRED? _ YES _ NO. IF SO, PLEASE PROVIDE THE FOLLOWING: WATER FLOW: GPM. ARE FLUSHOMETERS TO BE INSTALLED7 _ YES _ NO. FAILURE TO PROVIDE THIS INFORMATION WILL RESULT IN A DELAY OF METER ISSUANCE. WILL YOU BE INSTALLING A METER FOR A FUTURE U.G. SPRINKLER SYSTEM? _ YES _ NO. IF SO, YOU MUST APPLY FOR A SEPARATE U.G. SPRINKLER PERMIT. FEE: $25.00 minimum fee or 1% of contract price, whichever is greater. State surcharge of $.50 per $1,000 of permit fee due on all permits. CONTRACT PRICE x 1% STATE SURCHARGE TOTAL SITE ADDRESS: TENANT NAME: STE. # OWNER NAME: INSTALLER: ADDRESS:, CITY: PHONE* ZIP: SIGNATURE: APPLICANT OFFICE USE ONLY STATE: METER SIZE: DATE: INSPECTOR: City of Eaali 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BLUE or BLACK Ink Permit #: '2613,2— Permit 2li3-- Permit Fee: 6-0 Date Received: / — Staff: J 2010 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: 7-1:5-70 Site Address: /6 /.2.t/ , -,al &aj t Tenant: / Suite #: RESIDENT I OWNER Name: /�i'c�f'G`iy 44. Phone: bS/—'{SP-" /4/4f V Address / City / Zip: /dot"?.- - Tj LIAAcy CONTRACTOR •i7 ..cJa, ! License #: ,608,,;18/414 Name: A/041./1_/l/u i's2 Address: 6087 4/4,...-4.„5-7,-- Q City: a0.0)&640 4, State: /114.../ Zip: ...<SIZ6 Phone: 4S /— 777-75 Contact: 1.1 Email: TYPE OF WORK PERMIT TYPE New Replacement Repair Rebuild Modify Space _ Work in R.O.W. _ ^ , , Description of work:__Zeit* /t .4l p RESIDENTIAL / Water Heater Water Softener Lawn Irrigation Add Plumbing Fixtures ( RPZ I PVB) ( Main Lower Level) _ Septic System Water Turnaround New _ Abandonment RESIDENTIAL FEES: $50.50 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $.50 State Surcharge) $30.50 Lawn Irrigation $50.50 Add Plumbing *Water Turnaround $100.50 Septic System $90.50 Fire Repair (replace (includes $.50 State Surcharge) Fixtures, Septic System Abandonment, Water Turnaround* (includes $.50 State Surcharge) (add $166.00 if a 5/8" meter is required) New ($10.00 per as built) (includes County fee and $.50 State Surcharge) burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) TOTAL FEES $ SU.ScO 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.gopherstateonecaii.orq I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of pl rdaps) ^ Applicant's Printed Name Use BLUE or.-BLACK Ink r - - - - - - - For Office Use I n I City Permitof Ea Permit Fee: I 3830 Pilot Knob Road I C I Eagan MN 55122 Date Received: Phone: (651) 675-5675 I I Fax: (651) 675-5694 I Staff: I ~ I 2012 RESIDENTIAL BUILDING PERMIT APPLICATION Date: I 1 Site Address: f~~ ~u~JVZ~ ~f Unit Name: Lje t~_ Il yi' G%Nl llc_ Phone: lr~J~2 Y/ 04- RESIDENT / OWNER Address / City / Zip: %oZ SlrlL 7~dUlr CC/Ctc? Applicant is: Owner -1->10 Contractor TYPE OF WORK Description of work: &m Eh el-A&_ J;y&a'✓ Construction Cost: Multi-Family Building: (Yes / No/-<) Company: 7b i0V ~ffild/~ !!/tC Contact: Pkl-u C b*4&V_ CONTRACTOR Address: 364-3 l.~✓ Lnl City:, State: 'fin Zip: ,J_c'J 2. 3 Phone: ra Z S75' ~ 30,3 License Ae a 3S 91Y Lead Certificate If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? _Yes _No If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer & Water Contractor: Phone: NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of the information maybe classified as non-public if you provide specific reasons that would permit the City to conclude that they are trade secrets. 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. Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 dayyss of permit issuance. x X r~l9"tJ'~ in D r- Applicant's Printed Name Applicant's Signature Page 1 of 3 PERMIT City of Eagan Permit Type:Building Permit Number:EA137662 Date Issued:07/14/2016 Permit Category:ePermit Site Address: 1612 Sherwood Way Lot:4 Block: 1 Addition: Brittany 3rd PID:10-15002-01-040 Use: Description: Sub Type:Reroof Work Type:Replace Description: Census Code:434 - 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: 4,000.00 Fee Summary:BL - Base Fee $4K $103.25 0801.4085 Surcharge - Based on Valuation $4K $2.00 9001.2195 $105.25 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Brian P Trussell 1612 Sherwood Way Eagan MN 55122 Polar Builders Inc 1103 West Burnsville Parkway Suite 110 Burnsville MN 55337 (763) 370-0074 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA138529 Date Issued:09/01/2016 Permit Category:ePermit Site Address: 1612 Sherwood Way Lot:4 Block: 1 Addition: Brittany 3rd PID:10-15002-01-040 Use: Description: Sub Type:Windows/Doors Work Type:Replace Description:One Window/Door Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow windows, call for framing inspection. Call for final inspection after installation. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Valuation: 500.00 Fee Summary:BL - Base Fee $500 $40.00 0801.4085 Surcharge - Based on Valuation $500 $0.50 9001.2195 $40.50 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 - Brian P Trussell 1612 Sherwood Way Eagan MN 55122 (651) 208-2477 Pella Northland 15300 25th Ave N #100 Plymouth MN 55447 (763) 355-1300 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA146538 Date Issued:10/31/2017 Permit Category:ePermit Site Address: 1612 Sherwood Way Lot:4 Block: 1 Addition: Brittany 3rd PID:10-15002-01-040 Use: Description: Sub Type:Residential Work Type:Replace Description:Water Softener 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 - Brian P Trussell 1612 Sherwood Way Eagan MN 55122 (651) 208-3477 Dean's Professional Plumbing 7400 Kirkwood Court N Maple Grove MN 55369 (763) 428-1321 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA147885 Date Issued:02/14/2018 Permit Category:ePermit Site Address: 1612 Sherwood Way Lot:4 Block: 1 Addition: Brittany 3rd PID:10-15002-01-040 Use: Description: Sub Type:Residential Work Type:Replace Description:Furnace 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 - Brian P Trussell 1612 Sherwood Way Eagan MN 55122 Dean's Professional Plumbing 7400 Kirkwood Court N Maple Grove MN 55369 (763) 428-1321 Applicant/Permitee: Signature Issued By: Signature Atli) For Officer OfCi I et i ; i is Permit#: .,. I EAGAN •`' Permit Fee: Date Received: !_l/7 3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 F (651)675-5675 I TDD: (651)454-8535 I FAX: (651)675-5694 Staff: buildinginspectionsc cityofeagan.com SEP i / 2013 2018 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: Unit#: Name: /' G/J✓Cr��/ Phone: �' t'S1d1�rt#1 Pf. Owner //t5?. Address/City/Zip: //t5? r J f'dac e c/ 6A--' -• x.. • Applicant is: Owner x Contractor Description of work: v' C o /v '-- ' i ®i4 •. . . Construction Cost: dale J Multi-Family Building: (Yes /No A) . Lj Company: -„e✓ c /�- fie-✓z" ✓✓ Contact: •, Address: J9 i--" "3'46— e-1*--' ,/a,7 City: .4„."7,,,,// C€?t't'Ir�;l�Qlr;. � .... State:, ^'Zip: ,s,//t/ Phone: ,,de Email: �?Yige7/.�, /3'`- License#: i3 G /P/e3.2- 3 Lead Certificate#: If the project is exempt from lead certification, please explain why: dl d/.' c--7// .r- 0 7/ COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? Yes No If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer&Water Contractor: Phone: Fire Suppression Contractor: Phone: NOTE':•Plans su rrl�`40Atit tO*t you sut fare co Eder to*:p' blic inform on i its of the r anon classified as nr - iic if.'you o sj�fic;. or s..tirat Fiat•. t.the Cjtkelude that the ... ,•. . You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's website at www.citvofeastan.com/subscribe. Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 days of permit issuance. CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gooherstateonecall.orq I hereby acknowledge that this information is complete and accurate;that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. r x Applicant's Printed Name Applicant's Signature DO NOT WRITE BELOW THIS LINE /6/2 5ti Low Wig4-1 / -/q SUB TYPES Foundation _ Fireplace _ Porch(3-Season) _ Exterior Alteration(Single Family) Single Family Garage Porch(4-Season) _ Exterior Alteration(Multi) Multi .)/Deck _ Porch(Screen/Gazebo/Pergola) Miscellaneous 01 of_Plex _ Lower Level _ Pool _ Accessory Building WORK TYPES _ New _ Interior Improvement _ Siding _ Demolish Building* Addition _ Move Building _ Reroof _ Demolish Interior Alteration _ Fire Repair _ Windows _ Demolish Foundation XReplace _ Repair Egress Window Water Damage Retaining Wall *Demolition of entire building—give PCA handout to applicant DESCRIPTION / Valuation ( ( V 1/0 Occupancy MCES System Plan Review Code Edition SAC Units (25%_100%y) Zoning City Water Census Code Stories Booster Pump #of Units Square Feet PRV #of Buildings Length Fire Suppression Required Type of Construction6 Width REQUIRED INSPECTIONS Footings(New Building) Meter Size: Xj_ Footings (Deck) Final I C.O. Required Footings (Addition) 1/ Final I No C.O. Required Foundation Foundation Before Backfill 1'' HVAC_Gas Service Test Gas Line Air Test Hood Roof: _Ice &Water _Final Pool: _Footings Air/Gas Tests _Final Framing 30 Minutes 1 Hour Drain Tile Fireplace: _Rough In _Air Test _Final Siding: _Stucco Lath _Stone Lath _Brick_EFIS Insulation Windows Sheathing Retaining Wall:_Footings_Backfill_Final Sheetrock Radon Control Fire Walls Fire Suppression: _Rough In_Final Braced Walls Erosion Control Shower Pan Other: Reviewed By: 17,- , Building Inspector RESIDENTIAL FEES Base Fee i '"" / % :. 5 Surcharge # �i'5 Plan Review MCES SAC City SAC 7 Utility Connection Charge 3 Y- ((5.---- 0 v S&W Permit&Surcharge Treatment Plant Copies TOTAL Page 2 of 3 To11efson Euilders Inc. L �/ Or.11332 ' ��� // (,i�SCF / /9. •••• 183-65A I be l JACKSON - SURVEYORSr • REGISTERED UNDER LAWS OF STATE OF MINNESOTA ^ , .1 3616 EAST 55th STREET,MINNEAPOLIS,MN 55417 7273484 0 urbtpor'S Ccrtifi att �2'�l DRAINAGE * • 1 4/ „ y 1 EASEMENT 1' 1.1 lY `� , /f Q ,� • \ � , . 9`,g' -',� b , i RC1 __.�' ...-r4 . 44 I ,- , 4. \ 74 D 1'� � -� r Z� N s' kt - ..- 4114* *14'ski. v., ‘k \ , o - l'it .,......„ �� o , . , , �' ; alb �� 1 . t ‘i15. 2 1 � 1�r �_r 10 .,.,,,// '1!).' k- \k,)40'd %`0( I HERESY CERTIFY THAT THE ABOVE 18 A TRUE AND CORRECT PLAT OF A soarer O!r Scala: 1" 301 o Iron aqaer, = Existing Elsv. %Drainage • _.,..,O.61 U. Easement Lot 4,5lack 11Arittany 3rd. Addition, Dakota County,Minnesota. Proposed Garage Floor Elev. 102.5.- Proposed First Floor Elev.. 103. 3 Proposed Basement Flows E1ev. 94.3 As SURVEYED SY ME.THIS 27th.--DAY OF_+1111y A.D. 1982 J ' SIGNED _ f.:. - ft t • ..iii F. C. JACKSON. MINWE .R Rto1sTRATION. No. 3600 • / PERMIT City of Eagan Permit Type:Building Permit Number:EA152168 Date Issued:10/02/2018 Permit Category:ePermit Site Address: 1612 Sherwood Way Lot:4 Block: 1 Addition: Brittany 3rd PID:10-15002-01-040 Use: Description: Sub Type:Windows/Doors Work Type:Replace Description:Two or More Windows/Doors Census Code:434 - Residential Additions, Alterations Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow windows, call for framing inspection. Call for final inspection after installation. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Valuation: 4,000.00 Fee Summary:BL - Base Fee $4K $103.25 0801.4085 Surcharge - Based on Valuation $4K $2.00 9001.2195 $105.25 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Brian P Trussell 1612 Sherwood Way Eagan MN 55122 (651) 208-3477 Apex Energy Solutions 9655 Newton Ave S Bloomington MN 55431 (651) 688-2739 Applicant/Permitee: Signature Issued By: Signature EA 15 1) (0 ‘ Trussell Residence 1612 Sherwood Way Eagan, MN 55122 I Christian R. Erickson, a liceed Minnesota electrician, validate that the electrical wiring that I inspected in the hardwired smoke detectors boxes (upstairs hallway, downstairs hallway, downstairs bedroom #1 and downstairs bedroom #2) is in proper condition, correctly installed and properly terminated per the 2017 NEC electrical code. Sincerely, Christian R. Erickson Si. Tt OF MINNESOTA ESOTA 4c! r�—, ctte A ELECTRICIAN - - / _ # License# AJ016849 w �` Expiration Data 05/16/2020 Effective Date 05/17/2018 / / Original Issue Dale 05/17/2006 1 CHRISTIAN R ERICKSON ' ( / 5 - `� - 2134 NEBRESKA AVE E .. ST PAUL MN 55119 Christian K.Erickson Licensed Electrician March 3rd 2019