4888 Storland CtPERMIT
City of Eagan Permit Type:Building
Permit Number:EA127776
Date Issued:10/15/2014
Permit Category:ePermit
Site Address: 4888 Storland Ct
Lot:013 Block: 001 Addition: Whispering Woods 2nd
PID:10-83951-01-130
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:Two or More Windows/Doors
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 by law in ALL single family homes .
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 -
Debra A Wilken
4888 Storland Ct
Eagan MN 55122
(651) 882-1244
Pella Northland
15300 25th Ave N #100
Plymouth MN 55447
(763) 355-1300
Applicant/Permitee: Signature Issued By: Signature
ty of Eaaau
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
AUG 02I
Use BLUE or BLACK Ink
l
Permitil: (/ c 7 -7
Permit Fee:
Date Received:
Staff:
2010 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 0404 2 o(o Site Address: 14 S Tfl L. �►� 1i CO-cs2T
Tenant: Suite #:
CCR -
RESIDENT
&
RESIDENT / OWNER
Name: DEB U) t L Kelq Phone::
-1 r
1
Address / City / Zip: I+8 p $ Si-oz/0D ccs-Alz- �
Applicant is: Owner x Contractor
TYPE OF WORK
Description of work: wFYTE.?. Ditkpiptcle •gG?k1145
O^ is leo .Ute 0(5 Multi -Family Building: (Yes / No )V
Construction Cost I
/ifs
CONTRACTOR
Name: V �& 11-0 Pt &'s /IV L License #:
- t
Address: 1 1 � / U NGOL� St- 1100 City: ['r %MY1 i-tk (144N
i
State: ON 14 Zip: 55330-1- Phone: 7-(0.33 - 4571sL
- 804-
Contact: 3Y Email: C Ino rne-S 1 !aG i r CO Ni.
COMPLETE
In the last 12 months, has
If yes,
THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
the City of Eagan issued a permit for a similar plan based on a master plan?
date and address of master plan:
_Yes _No
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor:
Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. PortleAsof
the information may be classified as nonpublic if you provide specific masons that would the y to
conclude that they are trade
CALL BEFORE YOU DIG. CaII Gopher State One Call at (651) 454-0002 for protection against underground utility damage.
CaII 48 hours before you intend to dig to receive locates of underground utilities. www.dopherstateonecall.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.
P046-9 1\1
Applicants Printed Name
Applicanrs Signature
Page 1 of 2
tIC.1< -CA-016414d
DO NOT WRITE BELOW THIS LINE
SUB TYPES
Foundation
T Single Family
Multi
01 of _ Plex
Accessory Building
WORK TYPES
New
Addition
Alteration
_ Replace
Retaining Wall
DESCRIPTION
Valuation
Plan Review
(25%_ 100% )
Census Code
# of Units
# of Buildings
Type of Construction
_ Fireplace
T Garage
Deck
Lower Level
_ Porch (3 -Season)
Porch (4 -Season) _
Porch (Screen/Gazebo/Pergola) _
Interior Improvement
Move Building
Fire Repair
Repair
REQUIRED INSPECTIONS
Footings (New Building)
Footings (Deck)
Footings (Addition)
Foundation
Drain Tile
Roof: _Ice & Water _Final
Framing
Fireplace: _Rough In Air Test Final
Insulation
Meter Size:
Pool
Occupancy
Code Edition
Zoning
Stories
Square Feet
Length
Width
Reviewed By:
Siding
Reroof
Windows
Egress Window
p14114-04)•it,
Storm Damage
Exterior Alteration (Single Family)
Exterior Alteration (Multi)
Miscellaneous
_ Demolish Building*
_ Demolish Interior
Demolish Foundation
Water Damage
*Demolition of entire buildsn give PCA handout
MCES System
SAC Units
City Water
Booster Pump
PRV
Fire Sprinklers
to applicant
Sheetrock
Final / C.O. Required
/ Final / No C.O. Required
HVAC
Other:
Pool: _Footings Air/Gas Tests Final
Siding: _Stucco Lath _Stone Lath _Brick
Windows
Retaining Wall: _ Footings _ Backfill _ Final
Radon Control
Erosion Control
, Building Inspector
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
Page 2 of 2
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• -r ~.~-~r^~
• CITY OF EAGAN .~vf - , 1~2~
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 '
PHONE: 454-8100 ~
BUILDING PERMIT Receipt #
To be used for "1 Est. Value ~'4 s~~~', Date , 19
SiteAddress ~'~'~'^~t'~ ~
i.~ 1 ~'fil S~l;Y.I.t~G i~Ct~:. OFFICE USE ONLY
Lot Block Sec/Sub. ~
Parcel No. u occupancy x~~ FEES
Zoning ~-1
¢ Name ' ~ c'r`~„[~~ ~~`1 ~~w ~ (Actual) Const V'~~ Bldg. Permit ~ °
~ Address 1~~~~ Tf"~~~'"`I ~`~'L (Allowable) V`r" Surcharge s~•~
° City "~.:k5'JTI.W? phone ~?~.+-~~1~ #orscor~es ,
Lengih a J° Plan Review • 0~
p NSRIB - Depth g"+
~ SAG City 1~•'~
ZU
o Address S.F. Total - 575,(~
o~ SAC. MCWCC
r City Phone S.F. Footprints - x~~~ W
On Site Sewage Water Conn
w
W~ Narne On Site Well - Water Meter '''n • r~0
W -
Address MWCC System Ac~c. oe~os~t ~
~14 .00
a W Cit Phone C~ty Water
y PRV Required SNV Permit 1 C•
I hereby acknowlege that I have read this application and state that the Booster Pump - SrW Surcharge t'~
information is correct and agree to comply with all applicable State of ~ I g~~y~
Minnesota Statutes and City of Eagan Ordinances. Treatment PI
Signature of Permitee APPROVALS Road Unit Q'
~ii:4; :.E:~.:iGTi~ Li'I1.flF.:{;; Planner
A Buildmg Permit is issued to: - Park Ded.
on the express condition that all work shall be done in accordance with all -
applicahle State of Minnesota Statutes and City of Eagan Ordinances. Bldg. Otf. _ Copies
Building Official . Varia~ce - TOTAL ~ ~ ~~'~?'~',4
~ Permit No. Permit Holder Date Telephone #
C,
WqTER ~C~_~C' rf ? -E~ e' `~/.3
SEWER
PLUMBING ~ ~ ~ /8 ~
H.V.A.C. ~ i~ ' ~
ELECTRIC l.~ ~ Q ~ ~
Inspsetion Date Insp. Comments
Footings I ~ (~f
Foundation
Frami~g ~.Z L~i~
Roafing
Rough Plbg. .~i/-~l~ , .
Rough Htg.
IsuL </.r--
Freplace ~ ~i!
Final Htg. ~
Fnal Plbg.
Const. Meter Plbg. Inspector- Notity Plumber
Engr./Plan
Bldg. Final ~
Deck Ftg.
Deck Final
wau
Pr. Disp.
/ i
. L ~
~
~
i . ~ ~
f~~r#i#ir~t.e ~f (~rru~~nr~
~itp of ~agan
~r~r#mrnt ~rf ~uil~ing ,~n~~rriiun
. Thu Certificate issued pursuan[ to the requirements of Section 306 of the Uniform Building
Code cerlifying lkar at the time of issuance Jhis struclure was in compliance with the various
ordinances of 1he City regmlating building cotlstruction or ase. For the fallowrng.•
u: c~~ao~' Ix~JG/GAR mae. ~e~~ No. 16122
Oocuptncy Type 2oniog District R~ Type Conu. ~
o~~ts~ua~~F~OIIR SEA.9Q~tS B[l~E.RS ,~1?A06 l2IH AVE., EURNSSIIILE
BuildingAddress 4888 SIC~.Ai~ID 00[J4iT ~.~~~.13, B1, t~Il~ F10C~6 ZDID
: ~
' % ~ - ~ o~u: ~ 16, 1989
s~aa~~ arrir~"
POST IN A CONSPICUOUS PLACE
' _ . =-n"
. PERMIT # ~/.c C~
~ ' ' PLUMBING PERMIT RECEIPT #
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: ~ J'~ ~
CONTRACT PRICE: PHONE: 454-8100
Site Address f'" k~ ` ~ BLDG. TYPE WORK DESCRIPTION
Lot Block % SeciSub ' Res. ~ New V
_
Mult. Add-on
~ Name Y-- Comm. Repair
~ Address ~ ` ~1 " ~-5'` ' ~ ' Other
c City ~ ia- Phone ~ RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
~ • NO. FIXTUFiES TOTAL
Name ' ' ~ ~Water Closet - $3.00 S
_
` ~Bath Tubs - $3.00 ~
3 Address ~ ' ' 3 Lavatory - $3.00 ~
p City ~ , : . ~ ~ Phone ,~S fC, -~KS Shower - $3.00 ~
_LKitchen Sink - $3.00
FEES Urinal/Bidet - $3.00
COMM/IND FEE - 1°h, OF CONTRACT FEE ~Laundry Tray -$3.00
APT. BLDGS - COMM RATE APPLIES -~Floor Drains -$1.50 "
TOWNHOUSE & CONDO - RES. RATE APPLIES ~ Water Heater -$~.50
MINIMUM - RESIQENTIAL FEE - $12.00 ~_Whlripool - S3.Od
MINIMUM - COMM/IND FEE - $20.00 -
~ Gas Piping Outlets - $1.50 / `
STATE SURCHARGE PER PERMIT - .50 (MINIMUM - 1 PER PERMI'n
(AOD $.50 S/C IF PERMIT PRICE GOES Softener -$5.00
BEYOND $1,000.00) Well - 510.00
Private Disp. - $10.00
) ; Rough Openings - $1.50
~ ~ - < _ - ,~c - , ::4L~~ ~ ~ i -
SIGNATURE OF PERMITTEE FEE:
STATE S/C:
FOR: CITY OF EAGAN GRAND TOTAL:
~ ; r,
• . . • PERMIT #
~ MECHANICAL PERMIT RECEIPT # `
CITY OF EAGAN DATE: l' r~
3830 PILOT KNOB ROAD, EACAN, MN 55122
CONTRACT PRICE: PHONE: 454-8100 For Office Use Only:
Site Address_ u~ l~~' , BLDG. TYPE WORK DESCRiPT10N
Lot ~ Block SeC/Sub Res v'~ New ?
.7:'~~ ' r.1'
• > Mult Add-on
m Name J~~r:' ~ Comm. Re ir
'
~ Address ' ` r n Pa
c City iti ~^:~f Phone ; Other
r. ~ FEES
~ Name RES. HVAC 0-100 M BTU -$24.00
c Address t~ y ADDITI~NAL 50 M BTU - 6.00
p City ; ~'rl~ uI ± Phone (RES. HVAC INCLUDES A/C ON NEW
CONSTRUCTION)
GAS OUTLETS (MINIMUM - 1 PER PERMI~ - 1.50 EA.
TYPE OF W~RK COMM/IND FEE - 146 OF CONTRACT FEE
APT. BLDGS. - COMM. RATE APPLIES
Forced Air M BTU ~ TOWNHOUSE & C~NDOS - RES. RATE APPLIES
Boiler M BTU MINIMUM RESIDENTIAL FEE - ALL ADD-ON 8~
Unit Heater M BTU REMODELS - 12.00
Air Cond. M BTU MINIMUM COMMERCIAL FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
Vent CFM (ADD $.50 S/C IF PERMIT PRICE GOES
Gas Piping Outlets # BEYOND,$1,000)
Other ~
!
FEE: " % ,:f _ _
SI¢NATUFIE OF PERMITT~E
S/C:
~ TOTAL• V FOR: CITY OF EAGAN
CASH RECEIPT
r
c~TV oF ~a~Aru - ~
3830 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE 19
7
RECEIVED . ~
FFlOM~ i _ _ _ - - ~ .
~ AMOUNT $ ~
& DOLLARS
,oo
? CASH ~ CHECK
coa ' ' F
. ~ ; i .
FlJND OBJECT AMOUNT
Thank You
BY
wnna--Paye~s copy
- ; r v~~--~~ ~vr
, a~-~~e cooy
CITY OF EAGAN ,
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100
BUILDING PERMIT Receipt #
To be used for s~' E'~~~~ Est. Value ~ 114 , C CC~ Date , 19
SiteAddress SfiORI.+~ttD CT
Lot ° j Block 1 Sec/Sub.~ISPGRTidG ~:Ceji~S OFFlCE USE ONLY
Parcel No. ti~ o~~~aa~cv °'t~3 1'?"1 FEES
Zoning R-1
~'Oi'i. `;L'ASC,i~~,I37LI)zKS V-R e~ Fermit ~~08.(;0
¢ Name ~acn,ary c«,si dy.
~ address ! 2t)G6 T`dELF't'ki AVF (Allowable) y'~ Surcharge S~
~ City '~~~Sl`I LLE phone 89f3-~2813 ~ ot sro~es
~e~in 65 ~ Plan Review 344. Q0
, n fVame ~p~n 54' snc, c~~y 100. 00
Address S.F.Total - SAC,MCwcc 575.OU
City Phone S.F. Footprints - r,~~
On Site Sewage _ Water Conn
r Q
W W Name On Site Well - Water Meter I O~""
Address Mwcc sysiem ~ 30 . 40
e W Ci Phone Gry water XX Acct. Deposi?
~ PRV Required ~ SNV Permit ~
I hereby acknowlege that I have read lhis application and state that the Booster Pump - ~ytr Surcharge i•~
information is correct and agree to comply with all applicable 5tate of ~2$•~
Minnesota Statutes and City ot Eagan Ordinances. Treatment PI
Signature of Parmitee APPROVALS Road Unit 34Q.40
1'Oi;~. ~~A~I:;~•:> $Uli.:.~~.~ Planner - ParkDed.
A Building Permit is issued to:
on the express condition that all work shall be do~e in accordance with all -
applicable State of Minnesota Statutes and Ciry ol Eagan Ordinances. B~y, ary, _ ~OP'~s
Building OtfiCial Variance - TOTAL J ~ Q S~ •(1C
~
DATE: 2 ~ 13 / 89
~E: 4888 STORI.AZID CT.. Ll3, Bl, ~ili1SPERING i~lOOD$ 2ND
~ Your Sewer & Water Permit for the above property has been oompleted. It will be held at the
Public Works Garage (3501 Coachman Road) until the meter is picked up. BE SURE TO
CALL PUBLIC WORKS (4545220) FQR YOUR PERMANENT WATER TURN ON.
i Your Sewer & Wate~ Permit for the abo~e property cannot be completed for the following
reasons:
'~r~
~ Your Sewer & Water Permit for the above property has been completed, but the meter cannot
~ be issued or occupancy allowed until further notice.
COMMERCIAL PROJECTS ONLY: Please pay for meter at City Hall. Meter size must be
confirmed by Bill Adams or Dirk House (Plumbing Inspectors - 454-8100) before issuance.
WARNING: BEFORE DIGGING, CALL LOCAL UTILITIES - TELEPHONE, ELECTRIC, GAS, ETC.
- REDUIRED BY LAW.
CONTACT COMMUNITY DEVELOPMENT DEPARTMENT FOR WATER TURN ~N POLICY.
Secretary, Building Inspections Dept.
DATE: 2113/89
RE• 4888 STORI.AND CT.. L13. B:~ WHISPBRING WOODS 2ND
xx
Your Sewer & Water Permit for the above property has been completed. It will be held at the
Public Works Garage (3501 Coachman Road) until the meter is picked up. BE SURE TO
CALL PUBLIC WORKS (454-5220) FOR YOUR PERMANENT WATER TURN ON.
Your Sewer & Water Permit for the above property cannot be completed for the tollowing
~easons: `
r ~
Your Sewer 8~ Water Permit for the above property has been completed, but the meter cannot
~ be issued or occupancy allowed until further notice.
-ti
COMMERCIAL PROJECTS ONLY: Please pay for meter at City Hall. Meter size must be
confirmed by Bill Adams or Diric House (Plumbing Inspectors - 454-8100) before issuance.
WARNING: BEFORE DIGGING, CALL LOCAL UTILITIES - TELEPHONE, ELECTRIC, GAS, ETC.
- RE~UIRED BY LAW.
CONTACT COMMUNITY DEVELOPMENT DEPARTMENT FOR WATER TURN ON POLICY.
Secretary, Building Inspections Dept.
SEWER $ WATER PERMIT OFFICE U5E NLY
CITY OF EAGAN N u
PERMIT DAT -
3830 PIIOt Kf10b Rd. WATER PERMIT # ` j" SEWER PERMIT #
P. BOX 211 9 9 METER ~-3 B.P. RECEIPT # 910 7 5
Eagan, MN 55121 ~~R p 72 n ~~,y g~p. RECEIPT DATE 2 10 89
METER SIZE ~-'L ~
ISSUE DATE - ~ ~ XX PRV - BOOSTER PUMP
l
SITE ADDRESS ~ ~ ? ~ PERMIT REGIUESTED
LOT i
j BLOCK ~ SEC/SUB ~HISPERING i~00DS 2ND ~ )
" ~ f - SEWER WATER - TAPS
APPLICANT: ~~~o ~±'-'c+~(-,'~~ 7~v~ 1G~ F? I
' nc~~+~~
i~DDRESS: _ COMM/IND J RESIDENTIAL
CITY, STATE v~ h~~ E' ZIP=--' ~ 7
PHOCIE: ~ ^ ~ ~ ~ ~ vNEW - EXISTING
PLUMBER: ~ i ld G~ ~7 ~ tJs-+~ ti .
ADDRESS: 7731 TH AVE SQ I AGREE TO COMPLY WITH CtTY OF
CITY, STATE ~ ~ ~ Z~p 5~42 3 EAGAN ~ DINANCES:
PHONE: 869-7531 e'~~~ Cr,~~'c_..
~ , /
OWNER: ~C~~,~~}~ ~~~c. ~G•~'7 (C! P.~- ?
ADDRESS: SIC~1 URE ETER ISSUED
CITY, STATE ZIP C/
PHONE: 890-2813
PLEASE ALLOW TWO WORKING DAYS FOR PROCESSfNG. FOR STORM SEWER PER~AITS, CONTACT
ENGINEERING DEPT. -
~ -I , - . . _ - - -
SEWER & WATER PERMIT OFFICE USE ONLY
CITY OF EAGAN PERMIT DAT~ ' '
3830 PIIOt Kfiab Rd. WATER PERMIT # SEWER PERMIT #
P.O. Box 21199 METER ~ B.P. RECEIPT # ~
Eagan, MN 55121 READER # B.P. RECEIPT DATE ~ j'~}~
METER SIZE
ISSUE DATE xX PRV _ BOOSTER PUMP
SITE ADDRESS D~{ Y~ ' ~ l'~ ~ `J^ ~ PERMIT REOUESTED
' `3 1 `•':'1I.5'PER1NCa WC~DS Li:l)
LOT - BLOCK SEC/SUB
4 ° ' l,,~F - SEWER _ WATER _ TAPS
APPLICANT: _ ~ - x'- _
ADDF~SS: ' " ' ~ z ~ r, _ _ COMM/IND ` RESIDENTIAL
CITY, STATE ~ , , ` ' ZIP _ ,
PHONE: ' ~ - ' _ NEW _ EXISTING
.
i ~
PLUMBER: <
ADORESS: ~~33 'TH AVI~ I AGREE TO COMPLY WITH CITY OF
CITY, STATE ~ r 1 ZIP = EAGAN ORDINANCES:
PHONE: t~69-7531 f '
. ~ , .
OWNER: r ~ . .
AQDRESS: SIGNATURE WHEN METER ISSUED
CITY, STATE ZIP
PHONE: ~~`-~-2~'i'
PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. FOR STORM SEWER PERMRS, CONTACT
ENGINEERING DEPT.
BLDG. PERMIT NO. ~ ~ ~ ~ ~
1,.~-~ I~ C'~foG42 hrs ~~~~r lC.%a~
013210 Bldg. Permit ~
'01-3422 Pian Check ~
01-3445 Surch./Adm. ~
~ 01-3446 SAC/Adm. ~ ~'1
~ Ot-2155 Surcharge S~+
~ 75-3860 Road UnR O 00
~ 20-2275 SAC 5~~
` 20-3865 Water Conn. ~
~ 20-3868 Water Trmt. a~ g n~-'
20-3716 Water Meter ~ b
~ 20-2252 Acct. Dep. 3~ oU
~ 20-3713 Water Permit I U UO
~ 20-3743 Sewer Permit ~ ~
79-3866 Sewer Conn. 1 D C~ ~
28-3855 Park Ded.
TOTA~
G~ /14 4
4 8 ~ h~. ~ U~s~s_ ~nr~ h/°~'/
Request Date Fire No. ~ Roug~-in Ins n
Requiretl7 O RaaCy Now Will Notiy Inspector
~ z~~-~ s en Ready7
I licensed contractor ~p owner hereby request inspedion of above electrical work at
Job Atlaress (StreeS Box or RoNe No.) ~ Ciry
~ /'tN.O
Section No. Tormship Name or No. Farge No. Counry
Occupant (P PMire No.
- S ' ~s
Power SuppGer Adtlress
Electrical Comra C pa~ry Name) Canirector§ License No.
~
Mailin qm' or ar Oxirer iig Installalion)
l~ ~ e~
AuMorizeA Siqnat onva r/O.mer Making In allation) Phore Num er
- MINNESOTA ATE BOAHO OF ELEC7flICffV THIS INSPECTION REQUEST W ILL NOT
GAgge#1ltlway Bltlg. - floom &1l3 BE ACCEPTED BY THE ST.4lE BOARD
18Y1 UnNersl~y Ave., SL Vaul, MN %10! UNLESS PROPER INSPEClION FEE IS
Pl~mre (812) 662-0800 ENCLOSED.
u~j/~ g' ~ REpU : ELECTRICAL INSPECTION . Eeooamu~
? '.lor complelifg Mis lorm on bxk o~ yelbw copy. 9~~~~
~ y14 4 4 8 'X" Below Work Covered by This Request
Add Rep:'" 7ypeofBUilding AppliancesWired EquipmentWred
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Other (Specify)
Comm./Industrial Furnace
Farm Air Conditioner
Ottiar (speciy) Coniracror5 Remarks:
Compute Inspection Fee Selow:
# Other Fee # ServiceEnVanceSize F # ClrcuitsiFeetlers Fee
Swimming Pool 0 to 200 Amps 0 to to0 Amps
Transformers Above 200 _ Amps Abo Amps
Slgns InspecwrSUSeOnty: . ~ OTpL S-~
Irrigation Booms v`~ ~
Special Inspection
Alarm/Communication
Olher Fee (
I, the Electrical Inspector, hereby Rough-in oa~e ^ J.~~
cert'rfy that the above inspection has F;,,~ { oa~e ~
been made.
OFFlCE USE ONLY
T~is request voi0 18 monNa from
I
CITY OF EAGAN N~ 1612?+
' 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
b " s PHONE: 454-8100 ~ ~ ~ ~ ~
BUILDING PERMIT Receipt #
Tobeusedtor SF DWG/GAR Est.Value $114~000 Date , t9~2
Site Address 4888 STORLAND CT OFFICE USE ONLY
Lot 13 81ock 1 SeclSub.~ISPERING WOODS
Parcel No. ZND occupancy R-3 P~-1 FEES
Zoning R-1
w Name FOUR SEASOFS BUILDERS (Adual) Const V-N e~dg. Permit 688.00
o AddreSS 12006 TWELFTH AVE (Allowable) V-N
Surcharge 57.00
City BURNSVILLE Phone 890-2813 ;r oi s~o~es -
Leng~h 65' PlanReview 344.00
~F Name S~ Depth 54' snc, ary 100.00
ga Address S.F.Total - SAC,MCWCC 575.00
~ City Phone S.F. Foo~prin~s -
On Site Sewage - Water Conn 580.00
~w Name OnSileWell - WaterMeter 90.00
Address Mwccsys~em ~ p~ci.oeposi~ 30.00
aw Clty PhOf1B Ciry Water ~
PRVRequired ~ ~Permit 2~.0~
1 hareby acknowlege that I have read this application antl state tha[ the Booster Pump - ~yy Surcharge 1. 00
informalion is conect antl agree to comply with all applicable State of
MinneSota Stalute5 and City ol E an (dinances. Treatmem PI ZZ 00
Signature oi Permitee APPROVALS Road Unit 340.00
A euilding Permd is issu o: FOUR SEASONS RIIIL.DERS Planner - park Ded.
on the ezpress condi~ion that all work shall be dona in accordance with all Council -
applicable State of nMinnesota Stam}es and Ciry of Eagan Ordinances. g~dg_ pry, _ ~P'es
BuildingOtticial-,' I.N~L R.Dir,L~rn variance - ToTA~ 3,053.00
~T~-'-1
~ ~ `
2005 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.
Date S I I A~ c/~
Site Street Address 'Y88~ ~TO/'~LLh~ C.OU.r Unit #
Property Owner (C~ ~.J[ ~~P~l, Telephone # ( )
Contractor (N ~/~L Q,ntt -~7hS rlGl.irtbtll~n Telephone #(](3 )~SS~(o~~~
Address a~ ~ City ['i]nn ,~aD~T_ State /~iU. ZipS~
The Applicant is: _ Owner ?Contractor _Other
Alterations to existing dwelling $ 50.00
_ Add plumbing fixtures (excludes water softener and/or water heater--complete next
section if installing these appliances).
_Septic System Abandonment
_Water Turnaround (add $125.00 if a 5/8" meter is required)
Other:
Water Softener ~ ?Water Heater $ 15.00
_ new ? replacement
Lawn Irrigation _RPZ _PVB _new _repair _rebuild $ 30.OD
State Surcharge $ 50
Total $ SO ,
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 plar in
the event a plan is required to be reviewed and approved.
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ApplicanYs Printed Name ApplicanYs Signature -
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, ' 1989 BIIILDING PEF~IIT 9PPLICATZON - CITY OF EAGAN
SINGLE FAMILY DiiELLINGS ~ ~
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INCLUDE 2 SETS OF PLANS, 3 CERTIF CATES OF SURVEY~ 1 SET OF ENERGY CALCULATIONS
NOTEt ADDRESSES FOR CORNER I.OTS - CONTRACTOR/HOMEOWNER M03T DESIGNATE NHICH ADDRESS
IS DESIRED. NO CHANGES WILL BE ALLOiiED ONCE HUII.DING PERMIT I3 I33t1ED.
MULTIPLE DWELLINGS RENT9L IINITS FOR SAL6 IINITS i OF ONITS
INCLUDE 2 SETS OF PLANS~ CERTIFICATE OF SURVEY - CHECg WITH BLDG. DEPT.~ 1 SET OF ENERGY
CALCULATIONS
COP4~RCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
t SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS
To Be Used For: .S Valuation: 4', 0°° Date: '-g'~
Site Addreas '~Q$g s?u/teN.~ G~i OFFICE OSE ONLY
Lot L Block Occupaney -3 /j°/-/ FE6S
f.voo0 Zoning R_ /
Parcel/Sub f100 /,~,J~/ir~f.~ ~~G Actual Const Bldg. Permit 6d~~'
Allowable _ Surcharge S'7
Owner s~6C . ~ of stories Plan Review 3yy
Length ~ ~ SAC, City lU0
Address Depth S~_ SAC, MWCC S~S
S.F. Total Water Conn SZD
City/Zip Code Footprint S.F. Water Meter
Acet. Deposit 30
Phone On site sewage_ S/W Permit Zo
On site well S/W Surcharge 1
Contractor ~.,2 SFFlsy..~ /,~r~4oF~ / MWCC System ? Treatment Pl. 2z8
City water ? Road Unit 3 y4
Address /,zoor i~ ff?~ PRV required ~ Park Ded.
, Booster Pump ` Copies
City/Zip Code .~vi~~L- 55337 TOTAL ,.'~(1hq,00
9PPROVAlS
Phone ~ y0 o?g/3 Planner
Couneil
Areh./Engr. ~d,/~- ~}i«N- Bldg. Off. "Y7a Z~g ~
Var iance ~~S ~
Address _ I ;QUneil ~ ~ V~ ~
City/Zip Code ,Si; ~~u~ SS/D /
Phone I! 0~9/- D~ O 8 ~JiS~! il~•r,h~
NOTE: Sewer & Water Permit fees and account deposit fees will be ineluded in the building
permit fee. Processing time for sewer aad xater permits is two days onae a lioenaed
plumber 6as applied for a permit at City Hall.
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" ~ FSB CONS7FlUCTION, INC.
, a 1,~,:,-. - .
- - ~ ~ - ` 617 CHICAGO DRIVE
' fP r 6 gURNSVILLE, MN 55337
. (612) 435-5374
EXTERIOR ENVELOPE AVERAGE "U" COMPUTATION
Plan If /5gh~ Date _~x7[~7-
. Owaer: ~j,O~G ;
Contractor: ~~ti. Sf//Sd.-v ~ E
.~v~<o.E.r r d. ~
Site Address: y/~Pj ~i STU~~n/O ~°v~T
1. TOTAL EXPOSED WALL t}~EA ~53~ sq.ft. x°u~~ = a79.ig
2. TOTAL EXPOSHD ROOF/CEILING JS~J~ sq.ft. x"U" ,va6 =~~~/,Ny
AREA WALL AREA CALCULATIONS:
Total Window Area „2jp sq.ft. x"U" .y~ = 56,~~
~dv/teE Giazed
Tota1 Door Area ~ 3 sq.ft. x"U" , Orf = t./,~
Total Glass Door Area ~ sq.ft. x"U" • N/ = g~
or~L~ Glazed
Total Fireplace Wall Area 3 g sq.ft. x"u" _ 3 6 = ~ 3.~ g
Total Wall Framing Area o? U'/ sq.ft. x"U" " Og = ~6 3~
Net Insulated Wall Area .'6S/ sq.ft. x"U" ,0%3 =/p.~,d~
Tcetal Rim Joist Area /q{` sq.ft. x"U" ._1z = $E
Total Foundation Area /~J~ sq.ft. x"U" ./6 = e?~f.$~o2
Areaxposed) ,on Window ~ sq.ft. x"U" ~ = r~/f)
. Total Foundati
_ 3. TOTAL a C~'-I • ~~I
' If item 3 is the same as, or less than item 1, you have
met the intent of 2 MCAR 1.16008 A and 0.
4. ROOF/CEILING CALULATIONS
Total Skylight Area N/~ sq.ft. x"U"
Total Roof/Ceiling sq.ft. x"U" , Oo2
Framing Area
~ ~ ~ ~ Net Insulated Roof Ceil- sq.fC. x "U" ~ ° j/ /9
ing Area
To7n~ - 3S7C~
Z hereby certify that the building here described meets or exc eds the
State of Minnesota Energy Conservation Act. /f~//~%
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CONSTRUCTION
WALL FRAMING SECTION
Interior air film .068_
R ~a ~ ~ S. R. .'/_5'
3~/~~ inches of,~~~ wood k'%
, ~ ~.<7itilf O ~
~5 ~,~~.~r .8/
6 Exterior air film .017
TDTAL R O .
U = I/R . p$
~ WALL SECTION (INSULATED)
~ ' . . ~ TntPrinr air fi~m .068
2 ~ -
" 3 ss s ..~.r. /9• O
~ 4 ~i~ o~.s6 a~
5 s~ p..~U - d /
.--r-~6Exterior air film .017
TOTAL R ~ 3.~ 7
' ~ ~ U = I /R ^ . qy'>
RIM JOIST SECTION
I Interior air film .068
. ~ 2 S5P ~J~TIS i~-~ . /`J.
. i1 % N/ oo ~J ~i i .
. • ~ ~i/t'l~iT~ ~~2 -,~,06
s SiOir~ . ~ ~
6Exterior air film .017
' TOTAL R o~~~ 6~
U = I/R O~
FOUNDATION SECTION
' . I 7nterior air film .068
. ~ 2 / ' .f »Y'o - ~O
• r . 3 ~ " /~,~aGiG i•a B
~ ' , qExtPr~or air film .017
. (5
• ~ , . TOTAL R 6. ~3
• f#IApE . U = I/R ~
- • ~ l. •
CONSTRUCTION
. , • ' CEILING S~CTION (INSULATEll)
' ~1 Inte or i m
~ ~Z 'fS S./~ .5~
( 3 ,ro~v~v ~.,,s . ~U. O
3 ~4 Exterior air film .61
TOTAL R J~
~ II = IIR . o.~~
~J CEILING FRAMING SECTION
• ~ ~1 Inte ior air film .61
FLOW 2 (2 ~ s.f3. .3h
I VEHTED (3 /~.(ew~v ~.~.j• 330
~4 Interior air film .61
(5 3/ i..i Wi>v s/. ~S
~ TOTAL R 3g / 3
U = I/R .0.2~
C~ILING SECTION (INSULATED)
~1 Interior air film .61
- (2
( 3
~4 e io i i .)~61
TOTAL R
U = I/R
, ` CEILING FRAMING SECTION
2 3 , t.~ rj (1 nte or a i 61
~z
VENTED (3 ~
, ~4 Inte~ior fil 1
~5 ~ es of soi't wood
TOTAL R
• U = I/R
5
4 '
~ EXPOSED BEAM CEIL NG SECTION
• ~1 Inte ior ir ' m 6
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~5 E e io ir il
' ' TOTAL R
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- ~ hereby certif,y that this survey was prepared by me or
under my direct supervision and that I am a duly Registered
_ Land Surveyor under the laws of the State of Minnesota.
. . D at e e A._.., ra s o' e ~~~rC-Q
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~ Registered Land 5urveyor No. 10~95
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~ c] ~ RESIDENTIAL ~
~j1 BUILDINC PERMIT APPLICATION a
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675
New ConaWedoa ReauiremeMe RemodellReoafr Reauiremanb
• 3 registered site surveys showing sq. ft. M lot, sq. ft. of Muse; and ~II roofed areas • 2 capies af plan
(20% mmimum bt coverage allowed) • 1 sel of Energy CalcWatlore lor healed addRiom
• 2 copies of plan showing beam & windax saes; poured found design, etc.) . 1 sRe wney for ezteriar addAions 8 decks
• 1 set of Eneigy Calculations • IrMipte H home served hy septic system tor additions
• 3 copies M Trea Preservatbn Plan'rf lat platted aRer 7/tl93
• Rim Jaist DeW~ Options seleclion sheet (bldgs wXh 3 or less units)
DATE I- v~- d~ VALUATION I~~, C~
SITE ADDRESS y~~ b S~0 ! G ~ C F~ MULTI-FAMILY BLDG _ Y _ N
TYPE OF WORK ~i°~~ o~-I" 'C~P U66 FIREPLACE(S) _ 0_ 1_ 2
APPUCANT „ ^ ~~OFiN(3 & RFnRnnFr na~ nar
4100EXGEL$IORBLVD. C~ STqTE_ZIP
STREET ADDRESS
TELEPHONE # ID ~~L46PHONE # FAX #
PROPERTY OWNER ~ r/Y'~ ~/l I
a(I I~ P v7 TELEPHONE # Co ~y 7
,
COMPLETE FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNFSOTA RUI.ES 7670 CATEGORY 1 MINNESOTA RULES 7672
(J su6mission type) • ResidenUal Ventllation Category 1 Worksheet Submitted • New Energy Code Worksheet Submitted
• Energy Envelope Calculations Submitted
Plumbing Contraetor. _ Phone # _ _ --i
Plumbing syscem includes: _ Water Softener _ Iawn Sprinkler r' '''Fee: ~i~90.00~'
Water Heater _ No. of R.I. Baths ' `
No. of Baths 1 , ~ ~
I_.1 ~I
Mechanical Contractor. Phone # I ~
Mechanical system includes: Air Conditioning ~`r_--Eee =~$7-0:0D=~
_ Heat Recovery Systcm
Sewer/Water Conhactor: Phone #
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply
with all applicable State of Minnesota Statutes and City of Eagan Ordinances -
Signature of Appllcant ) ~ ~
_......r..._....._.._.._._.._....r..Y_----_____---..._____~.._...._ _
OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4I02
OFFICE USE ONLY
? 01 Foundatian ? 07 DS-plex ? 13 1&plex ? 20 Pool O 30 Accessory Bidg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 E~ct. 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) ? 38 Multi
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
O O6 04-plex O 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
? 31 New ? 35 Int lmprovement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ~ 45 Fire Repair
~ 33 Alteration O 37 ~emolish (Bldg)" ? 43 Reroof O 46 WindowslDoors
? 34 Replacement •Demolition (Entire Bldg only) - Glve 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 bidg) FinaUC.O.
_ Footiugs (deck) FinaUNo C.O.
_ Foo[ings (addition) _ Plumbing
_ Foundation HVAC
_ Drain Tile Other
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests _ Final
_ Framing _ Siding Stucco Stone
_ Fireplace _ RI. _ Air Test _ Final _ Windows (new/replacement)
_ Insulation _ Retaining Wall
Approved By , Building Inspector
W ~-------~~M
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S&W Permit & Surcharge
Treatment Piant
Plumbing Perrnit
Mechanical Permit
License Search
Copies
Other
ToWI
4,111.
tyofEaffaR
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Use
Permit #: /9:/e
Permit Fes: ' - Or)
Date Received:
Staff:
INFLOW & INFILTRATION PERMIT APPLICATION
X Plumbing / Sewer & Water
Date: o` - f S2-- 1 Site Address: ( g g g S +-0 f)
Tenant: Suite #:
Name: k 2S s r c r Pi L,, ►^� h: n S e r 4,1 5 17 License #: PC (U LI LI 3 S g
Address: P. 0 13c �} a ai ) 7 a City: `� �4 �•
State: 11,1 at Zip: S S/ a Phone: to S 1 (o % I- g 2 5
PLUMBING Within the building envelope) SEWER & WATER (Outside the building envelope)
Sump Pump Repair Repair
Other. Other.
FEES eperg A-gs hw 'fru
$60.00 / Each (includes $5.00 State Surcharge) ! F
*Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submit I/I 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 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.aooherstateonecalI.orR
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 nota 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 i 1 Ke_ -c) / )+2.
Applicant's Printed Name
Applicant's Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA132583
Date Issued:08/24/2015
Permit Category:ePermit
Site Address: 4888 Storland Ct
Lot:013 Block: 001 Addition: Whispering Woods 2nd
PID:10-83951-01-130
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:Two or More Windows/Doors
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: 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 -
Debra A Wilken
4888 Storland Ct
Eagan MN 55122
(651) 882-1244
Pella Northland
15300 25th Ave N #100
Plymouth MN 55447
(763) 355-1300
Applicant/Permitee: Signature Issued By: Signature
Jan. 3. 2019 11 : 53AM No. 2902 P. 2
h \lc
•
For Office Use
; • i Permit#:
EAGAN
Permit Fee: -s"
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 ECEI VE Date Received:
(651)675-5675 I TDD:(651)454-8535 I FAX:(651)675-56 1 Staff:
buildinoinspectionsaecityofeaoan.com JAN 0 3 2019 L
2018 RESIDENTIAL BUtFRM_IAPPLICATION
Date: I 1 / Site Address: 1{ gr 13'o r/a d Unita:
Name: eicot winesvh, Phone:
Resident/ �+�,��I
--Downer ;Address 1,CityiZip: TOf7d JJC1'!cuid
Applicant is: _Owner ' Contractor c P Pio/ Y/// `��(�!/l
Type of Work Description of work: 6� !�TGr/�Y
Construction Cost JSSO Multi-Family Building: (Yes /No
Companywie1Yx.� 1 cZel, opt tact
Contractor �
Address:/0633.5 !A.S hay /s City: ie. �p� )
IState/ Zip:55355 Phone: s 07/�/Em21L• ?D0 ra srh,�Ccr
Licenselit (� / a�9
,O 7 /,pp�f TO J Lead Certificate arAhfr/66a
If the project is exempt from lead certification,please explain why:
•
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUI r z-
In the last 1 • - t - the City of Eagan issued a permit fora similar plan bas • • master plan?
_Yes _No If yes,date and a•• -- - - er plan:
•
Licensed Plumber: Phone:
•
•
Mechanical Contractor Phone:
Sewer&Water Con 4, •r Phone:
Fire ••pression Contractor. Phone:
NOTE Plans and supporting documents that yon suborn are considered to be public information. Portions of the information may•
i classified as non-public if you provide specific reasons that would permit the City to conclude that they are trade secrets.
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.cmrofeaosn.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)456.0002 for protection against underground utility damage. Call 48 hours before you
intend to dig to receive locates of underground utilities. wywv.000nerstateonecall.oro
I,hereby acknowledge that this information is complete and accurate:that the work will be in conformance with the ordinances and codes of the City of
Eagan;that I understand this is not a permit but only an application for a permit.and work is not to start without a permit that the work win be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
z `irish:�•e Seri
Applicants Printed Name Applicant's Signature
DO NOT WRITE BELOW THIS LINE yeekL-0e, /,(44 ( 1 . / -=.-5---6 / /
SUB TYPES
Foundation _ Fireplace _ Porch(3-Season) _ Exterior Alteration(Single Family)
Single Family _ _ _ Exterior Alteration(Multi)
.__ C
Garage Porch(4-Season)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
iAlteration _ Fire Repair _ Windows _ Demolish Foundation
Replace _ Repair Egress Window _ Water Damage
Retaining Wall *Demolition of entire building—give PCA handout to applicant
DESCRIPTION
Valuation __Y_÷ :t Occupancy MCES System
Plan Review Code Edition 5' SAC Units
(25%_ 100% ) Zoning � City Water
Census Code Stories Booster Pump
#of Units Square Feet PRV
#of Buildings Length Fire Suppression Required
Type of Construction— Width
REQUIRED INSPECTIONS �•J
Footings(New Building) Meter Size:
Footings(Deck) Final/C.O. Required
Footings(Addition) }�' Final/No C.O. Required
Foundation Foundation Before Backfill J' HVAC_Service Test Gas Line Air Test_Hood
Roof:_Ice&Water _Final Pool:_Footings Air/Gas Tests _Final
Framing 30 Minutes 1 Hour X Drain Tile yl
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: , Building Inspector
RESIDENTIAL FEES ,-
Base Fee ,.T ` /ir,�
SurchargeD‘A. "
Plan Review !r �
MCES SAC i -1 /I '
City SAC , if, +-"
UtilityConnection Charge1
S&W Permit&Surcharge
Treatment Plant
Copies 11 V al' 1 l 0 m
TOTAL
Page 2 of 3