4634 Summit Pass ~ s9~f //~l ~s
" 2004 RFSIDENTIAL BUILDING PERNIIT APPLICATION / v
. City Of Eagan L+~Q,~~
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694 ~~c
f
New Coirsirucfion Reouirements RemodeVReoair Rewirements Q£fice ~sg~ohlv .
3 registered site surveys showing sq. fl. of lot, sq fl of house; and all roofed areas 2 capies of plan Ge~~~vc9~~d
(20% maximum lot coverage allowed) 1 sel of Energy Calculalions for hea~ed addiUons TrCB-PYe"s f Istl Read-~ t_ Y_ t~
2 copies of plan showing beam & wmdow srzes, poured found design, elc. 1 site survey for a~tions & decks I[e¢-P~es Retjuited;~~ ~~,;;;Y`"~,,;,,N
lsetofEnergyCalculatwns Adddion-indicatei(on-s8esepticsystem FAi=si1e38p1icSyaMem`~='~._Y~ ~_N
3 cc~pies of Tree Preservation Plan rf lot planed afler 7M193
Rim Jast Detail Opfions selecfion sheet (bidgs wdh 3 w less units
Date ~ / / / ~ Construction Cost _
Site Address ~/~i ~ ~t /2q vy[ / ~ SS UniUSte #
6 tv ~7,~1~ l a~
Description of Work 1lPL~/L
Multi-Family Bldg _ Y~N Fireplace(s) _ 0_ 1 _ 2
Property Owner f~tY,H ~~la !t~ ~~~2 E r _ Telephone # ((p5~1 ) '~I ',~g ~ ~
Contractor /JCZd( ~/~e-Ye1'~ - ~~~e/~ %E~F
Address City
State Zip Telephone # ( )
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cate¢orv 1 Minneso[a Rules 7672
Energy Code Category , Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(Jsubmissiontype) Submitted SubmiNed
. Energy Envelope Ca~ula6ons Submitted
Have you previously constructed a building in Eagan with a similar plan? _ Y _ N If so, 25% plan review
fee applies.
Licensed Plumber Telephone J
Mechanical Contractor Telephone )
Sewer/WaterContractor Telephone#( J
By ~
I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; I understand this is not a pernut, but only an application for a pemut, 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.
~~i~~. ~ue~~~ ~ ,~~~a
Applicant's Printed Name Ap l~cant's Signature
OFFICE USE ONLY
Sub Types ~ .
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? OS 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 01 of_plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt-SF
? 04 02-plex ? 10 08-plex ~ 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc.
? OS 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04plex ? 12 12-plex Plbg_Yor_N ? 25 Miscellaneous
Work Types
~C3 31 New ? 35 Int Improvement ? 38 Demolish interior ? 44 Siding
~ 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteration ? 37 Demolish Building' ? 43 Reroof ? 46 WindowsJDoors
? 34 Replacement 'Dwnolitton (Entire 61dg) -Give PCA handout to applicant
Valuation Occupancy MCES System
Census Code ~ Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const r(QL Width
REQUIRED INSPECTIONS
Footings(new bldg) FinallC.O.
~ Footings (deck) ~ Final/No C.O.
_ Footings (addition) _ Plumbing
Foundation HVAC
Dtain Tile
Roof Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests Final
_ Framing _ Siding _ Stucco _ Stone _ Brick
_ Fireplace _ R.I. _ AirTes[ _ Final _ Windows
Insulation _ Retaining Wall
Approved By: L , Buiiding inspector
Base Fee
Surcharge n~~ ~ ~ ~
~
Plan Review
MC/ES SAC ~ ~
City SAC
Utility Connection Charge
S8W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
ff.~n. z .
~ ~~;.m-,
` 3 ~ REVISIONS
s"_'~iFaf 1' ,'ll'I - REV HSE IYPE
.
- ` l$ Q 1$ 6~ 0324/03R5
- REMV EG WELL
- 0312]/03R5
ry_
SCALEIN FEET
~,r~ _ LEGEND i
~ QS ~ENOTES SANITARY MANHOLE
' ~ DENOTES ITYDRANT
I I I ~ DENOTES CATCH BASIN o
$ DENOTES SANITARY SEWER Z+ e
3:1 Nlaxianum Slopes F ~ a
6 or ~~~~~r,«~ w~n wou W DENOTES WATERMAIN 2 q
~ 5 ST ~ENOTES STORM SEWER
, S89°19~Z7~~W ~7~.~~J ~p ~ENOTESSTORMMANHOLE
~ (955.2) (9558) (9~0.3) 5 N
~ ~ y~!;fi' ,3 , x 4'~e ~ 46•98 '~~'+fi" y ~ DENOTES STORM APRON ~
f. > ~ 5.00° - - ' Ch
°~=5s N Zo.s DRAINAGE&U11UTY~5 SETBACKS a~
G~ 10 ~ E ~ o ~ EASEMEN' ~ W<
~ ° ~ \ ;
p G s ns c~i ° °i '~x 2' x ~ n~ ~ MIN. FRONT YARD SETBACK = 30' ~ r
I p~
j~ t , Z FPLC. 5. SS3 G~9 55~ ~ MIN. SIDE YARD SETBACK = 5' (GAR4GE), 10' (HOUSE) ~ i
~ ' ~ 5~I
8 6R, ¢ V H N / ~ MIN. REAR YARD SETBACK = 15' W~
r~-~~ o 0 78.98 ~ o
~ `a5* t i. ~ e m G ~ W ~ ~
x `::i3„ a~~~ i;"..- ^ ~ 3 t'" ~ 0~ S U ~i
g~t ge ,
3 ¢ 1.03 6'p ~ ' PROPOSED TOP OF FOUNDATION ELEVATION= 957.0 °
7 ~ ~ 6 a~+~~ in \ I ~ pROPOSED GARAGE FLOOR ELEVATION= 956.0 ~ o
M I I ~.98 0~ I% ri ~ pROPOSED LOWEST FLOOR ELEVATION= 948.33 ~
I ~ ~ I ~ m
~ ~70.98a oy I rY >~'a~s ~
~ g;~s_S? o a a ~ o .x 7 ~ $ 4
~ ~ ~ ~ TOO ~ p n N ~ (p a » t
~ a ~ y,gg a v $ I O ALL OFFSET IRONS ARE MEASURED TO HUNDREDTHS N
v~ ~ a 95I.5 Z~ OF A FOOT AND CAN BE USED AS BENCHMARKS. ~
~ V.~ 27.96 o-~ ~ s51 69 SSt 7 g5"< 47 I ~
~ p DENOTESIRON
- ~ ~ ~ ~ 3n: a~ 951.5 r~~~.~~ J 5 vt
~ - ~~S- MONUMENT
x 7~ DENOTES EXISTING
x ty & ~ ~9c9a6 (9W.9) X Di,.7.~
3z864 ELEVATION
V (9s9.0) 30.00 5~6~~k os DENOTES PROPOSED
~ EH~OUSE S89 19,27 W, O 07 ~OOO.O~ ELEVATION W
a I / f- DENOTES ~IRECTION ~ ~ a
N ° 1 TFDN-950.6 S~ L J~ OF SURFACE ~RAINAGE ~ ~ U ~
° ~~NL~ O DENOTESSANITARY ~ O~1 ~y w
944.0 SEWER SERVICE ELEVATION ~ o ~ Fd Z
S ~ ~ w ~
~ A TITLE OPINION WAS NOT FURNISHED TO THE SURVEYOR ~ i,°~ F~ _i Z
' NOR WAS A SPECIFIC TITLE SEARCH FOR THE EXISTENCE OR w Q W~ ~
NON-EXISTENCE OF RECORDED OR UNRECORDED H a Py E~ a
T
i I . / \ EASEMENTS CONDUCTED BY THE SURVEYOR AS PART OF Q~ C7 V~ w
a ~AA~AV~I z ~ ~ ~ ~ . ; ~ rHissuRVev. v a o
~ ~~VO~YM~D , .,._w . ~ . ~ V >
~
o T. I hereby certify that this is a true and correct representation w a ~
' BY ' > of a survey of the boundaries of: U
Y DA _ ~ , ~y~~ ~
m ~~3 ~ LOT 6, BLOCK 2, PINETREE PASS 7TH ADDITION
/r~ , a,1 ' i_~-~'~ :.t'..-u.~~j.l)ln l~
° ~~I~~ING INS~b1IOI~S DEPT. " ~ ~ DAKOTA COUNTY, MINNESOTA
N And the location of all buildings, if any, thereon, and all visible DRAWN
< HARDCOVER encroachments, if any, from or on said land. As surveyed by RS
p LOTAREA= 14,077 S.F. fl'1@ YhIS 41h d8y Of MBfCh, 2003.
l~2EE SUMMARY CHECKED
w HOUSE AREA,=~ ~.562 S F. GRG
h COVERAGE = 18.34 °/a n~~ N~ EXISTING TREES IN BUILDABLE AREA DATE
~ ~ ~ i ~,~i, ~ ~ ~ E~ ~ ~G1.
~ 03/05/03
~li
_ ~a s Gary R. Germond AS SHOwN
~ " Licensed Land Surveyor, Minn. Lic. No. 24764 JOB NO.
3 5402-707
~ x
_
~ ~
_r. . -
~ .~C " ~ _
p aE~~g~o~
`n w is o ~s w so
~ ~ EW EGWELL
SCALEIN FEET
l+~ = LEGEND
~ g ~ ~SOv DENOTESSANITARYMANHOIE
j ' y~p DENOTESITYDRPM
~ I ~ ' ~ oervOTESCATCHBA5IN
6 S OENOTESSANITAfiVSEWER U~
~
5 W DENOTES WPTERM4IN ~
ST OENOTESSTORM SEWER i
$89~~9~2~"N/ ~
6~ igs a ossn 46.98 s s. ~.uu ~ oeNO~ssrowanwnro~
~ 9lse~ n DENOTESSTOPMAPRON
N 95J.55 20.5
~a ~t. + n pRAINAGE h UTI~ITY~s SETBACKS ~ ~
~ .N I EASEMENT ~ Pi ~
I O;i',tl~Y 95`~"a' 2'~ ~ w / s5J09 5x~' S1W n~ ~ MIN.FRONTYAflO5ET9AIX=JO' {q ~
~ ~fi'{:!~ .~j r ~ ` MIN.SIDEYM~SETBACK=S(GNUGEAIPMWSE) ~ r
~ N F~1~'S"~~;~ a""' 1898 ±o ~ ~ M~N.REMYMDSETBACK=15 ~
N :~F~:~p::s,t{y' n m Oh
6
~ ~ ~M ••~•95t B[ n ~6 105 f W £
„ ~ VROPOSEOTOPOFFOUNDATIONEIEVAiION=B5i.0
7 I ~ I I g~ Iri1aP I p PNOPOSEUG~RI~GEFLOORELEVAT~ON= 958.0 ~i~
O qqq ~ PitOPOSE~LOWESTFLOORELEVAl10N= BGB33 ~R
~IOa9o p~ ~ m
d 4
O I I951Y] 7~ ax I Q.os~i ~ ~
~ a ~ 0 0 g~ 9 I O PLlOFiSEfIRONSAREMEA5UPE0TOHUNOREDTNS ~ ~
: (W~.S)x Z OiAFOOTPNDCRNBEU5E0A58ENCHM1WiKS. y
'O ' 2J.90 95169 95~81 95]f] pY
~ IL~ ~ 9~986 ~1~ ~ _ _ _ \ p DENOtESIRON K
~n ~~523-°P~CTI.VL' MONUMENT
Y 9~e np n a~q ~y h ° X W 0 0 DENOTES E%1511NG
~ IMf.el 30.~~ v- i~_'{?SOJ6 EIEVATqN
3 nsoiil _n~ $$9~~9 Z~~W ~60. ~ ~000.0~ ~ENEVniiONOPOSED }
I li0N~950.6 I r DENOTES OIRECTION ~ T/J F
q OF SURFALE OMINAGE ~
' ~ ~ DENOTES SANITAAY ~ O U ~
fi 1 p ~ `4{.0 gEryFRSERVICE ELEVNTON ~ o~~ i
• ~
ATTtEOPINIONWASNOTFURNISHEDTOTHESURVEYDR ~c ~y
~ ~ ~
a NORWASASPEQFICTIRESEARCHFORTHEEXISTErvCEOR ¢ Fi] ~
I I / ~ T x NON~EXISTENCEOFRECORpE00RUNRECORDEO I~''~-a (~~y <
~ ~ EASEMENTSCONDUGTEOBYTHESU0.VEYORASPMTOF aw
~ THIS SU2v~', V y~ z ~
C~ ~ Q F
~ U
~ ~ I ~ereby certiy ihet Ihis is a true and cortect represenWUon w ~ ~
~ d ~ ~ o(asurveyoflhabountlariesot: U
- ~ ~ LOT 6, BLOCK 2, PINETREE PA55 7TH ADOITION
' .1 ` 1 DAKOTA COUNTV, MINNESOTA
a ~ Antl the loqtion of all bWtlirgs, if any, thereon, antl all Nsible
HARDCOVER Ci encroachmenis, Itany, from or on said land. As surveyetl by ~ R~
= ~orwaea•u.ons.c. TREESUMMARY ~ melhls4NdayolMarch,2003. CHECNED
HCUOVERAGE=10.31% NOEXISTINGTREESINBURUA9lEMFA ~ ~ /P%A GRG
~ ~ ~qy ^ /QM /C ~~/~I%!~^~`s-X 09105/03
~ _e r Gary R. Gem~ond ' n5 SHOWN
~ ~~~~°.~"e ~ j)cR+ ~ln ~ S a' 4~I C) ~~1°. ` Licensetl Lantl Surveyor. Minn. Lk. No.2d784 JOB NO.
~
LOT SURVEY CHECKLIST FOR RESIOENTIAL
' ~ ~ BUILDING PERMff APPLICATION
PROPERTY LEGAL: L n~ L ~C ~ fr.~~> Q/,~ 'f-f(.~
DATE OF SURVEY: 3~ `f - n~
LATEST REVISION: 3 ~7~ D3 ,
m
a
e
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9
Q
O; Q DOCUMENTSTANDARDS
? • Registered Land Surveyor signature and compa~y
? ? • Building Permit Applicant
~ ? ? • Legaldescriptlon
fd~ ? ? • Address
~ ? ? • North arrow and scale
fi?~ • House type (rambler, walkout, split wlo, splk eMry, lookout, etc.)
? • Directlonal drainage arrows with slopelgradient %
d? ? • Proposedlexisting sewer and water services $ imert elevation
0~ ? ? • Streetname
~ ? ? • Driveway
? ? • Lot Square Footage
~ ? ? • Lot Coverage
ELEVATIONS
Existina
L~ ? ? • Sewer service (or Proposed)
~ ~ ? • Properry comers
? . Top of curb at the driveway and property line extensions
l~ • Elevations of any exisdng adjacent homes
? C~ ? • Adequate footing depth of structures due to adjacent utility trenches
~ t~ 0 • Waterways (pond, stream, etc.)
Prooosed
C~ ? ? • Garage floor
? ? • Basement floor
~ ? ? • Lowest exposed elevation (walkouUwindow)
~ ? ? . Property comers
6a' • Front and rear of home at the foundation
PONDING AREA (if a~plicable)
? ~ ? • Easement line
? f,d~ ? • NWL
? ? • HWL
? ~ ? • Pond # designadon
? ~ ? • Emergency Overflow Elevation
O • Pond/WeUandbufferdelineation
OIMENSIONS
rd' • Lot Iines/Bearings 8 dimensions
E~ • Right-of-way and sheet width (to back of curb)
• Proposed home dimensions including any proposed decks, overhangs greater than 2', porches, etc.
(i.e. all sWclures requiring pertnanent footirn~s)
? • Show all easements of record and any City utllities wifhin those easements
IB~~/ . Setbacks of proposed sWcture and sideyard setback of adjacent existing sWctures
19' ? ? • Retaining wall requirements,'rfany
Reviewed: ~ 3
Nam Date
G:/FORMS/Building Pertnit Appliption
l
REVISIONS
~ REV HSE NPE
03124/03
C~o 30 1$ U 1S $0 6~ REMV.EG.WELL
APR 0 2 i Lla~~ oamro as
SCALEIN FEET
LEGEND
QS DENOTES SANITARY MANHOLE
~ DENOTES ITYDRANT
~ I I ~ DENOTES CATCH BASIN V~
3:9 ~Aazirtsam S~ S DENOTES SANITARY SEWER F
6 or F~ataining 1~/all Will W ~ENOTES WATERMAIN o ~
B9F{@t~Ulf9fJ , gggo19'27~~W 171.17 ST DENOTESSTORMSEWER 2
- (sss.x) (sss.e) (sws) ~ DENOTES STORM MANHOLE
n ~ s,s5.~s s a 46.9$ 953 6a x 9_=~ A7 n pENOTES STORM APRON
~ ~ N i
a
P r s ~ ~ ~ ~ ~ ~
~.w 'O ~ 453,55~ 20.5 a DRAI E SE EN TILITY~S SETBACKS Ri y
ki : n O I T- W 6
~ ~ 1 P0 ;
Q i) ' ~~5`s~a5 ~ ~ a O1 gs~~~ ~ MIN.FRONTYARDSETBACK=30'
~ ~ =2 ~ 2 a ~o FPLC. X x ^ ~ ~'a
~ 8 6X: " 5. e53 09 55.ca MIN. SIDE YARD SETBACK = 5' (GARAGE), 10' (HOUSE) o
~ ~ 4(xI~` 1{~~ ' o 18.98 o a ~ ~ ~ MIN. REAR YARD SETBACK - 15' ~ o
00 ~ " a ad ~j ~
,s e s 6 a
I 45t 4< vc'i Y a 1.03 ~ 6'y I W PROPOSED TOP OF FOUNDATION ELEVATION= 957.0 ~
7 ~ M a o rn~ y V
7 ~ P R O P O S E D G A R A G E F L O O R E L E V
A
T I O N= 9 5 6. 0 ~ o
~ I m.98 0~ I i.i ti0 ~ ~ pROPOSED LOWEST FLOOR ELEVATION= 948.33
~ ~ I I o~ ~ I ~
~ ~ 10.98 N N ~ ~ ~pas ~
~ ~ ~ 9 5 i. s z T00 ° an o x953'7 ~
i: o ~ ~ w (p ~
~ a J e 4.98 ~a+ g I O ALL OFFSET IRONS ARE MEASURED TO HUN~REDTHS yyy
( n ~ I v Q a( 9 5 i. 5) ~ Z OF A FOOT AND CAN BE USED AS BENCHMARKS. ~ ~,Q
r~ ~ V ~ 27.98 ary 9 5t b 9 45i 1 9 5 2.« 1 f~ WS~
- N~ 10 ~ k- -ga~.gs t' ~ - - - - IS \ O DENOTES IRON
i
~ - y~py}-- MONUMENT
; - 95~'~ ~r ~ENOTESEXISTING
9<8.88 30.00 ` a.a-' s~s.as (97P9) X()C„~ 0
(9~9.0) s5o..is ELEVATION
p I ExisnNC S89°19~27~~W ~ 0.~7 ~00p.0~ DENOTESPROPOSED
EIEVATION W •
~ ~ . r
` ° q I 7PDNW
0.8 DENOTES DIRECTION
~ I `S~ f-T OF SURFACE DRAINAGE ~ O(~ O
° O DENOTES SANITARY ~ ~1 w
g 944.0 SEWER SERVICE ELEVATION ~ o Z
~ / \ L.~ ~ ~
•
o ~ ~ A TITLE OPINION WAS NOT FURNISHED TO THE SURVEYOR Q W ~ ~ yw Z
= ~ NOR WAS A SPECIFIC TITLE SEARCH FOR THE EXISTENCE OR ~ n ¢
W
~ NON-EXISTENCE OF RECORDED OR UNRECORDED ~ a C~ Q
~ ~p pp~ ~ i I F -`s ~ ` EASEMENTS CONDUCTED 8Y THE SURVEYOR AS PART OF Q~ C~Ii~ W
a L,cpy~eylVl ~ i„ - ~ ? THIS SURVEY U a ~ ~cy o
~ ~ h~, 4, I hereby certify that this is a true and correct representation ~ a V ~
~S~ ~/I~ <
x ; of a survey of the boundaries of. U
D,4 ~f ~~3-e~ ' `f 3-03
~ - ~^,T `~'1;1'~i~~~•+~-~ ~F~! ; LOT 6, BLOCK 2, PINETREE PASS 7TH ADDITION
° ~UI~~IN~ 1~1~~6~I~~S DEPT. ' . " ~ ~ DAKOTA COUNTY, MINNESOTA
~
~ And the location of all buildings, if any, thereon, and all visible
N DRAWN
a HARDCOVER ~ encroachments, if any, from or on said land. As surveyed by RS
~ ~oTnRen= ~a,o~~ s.F. ~lREE SUMMARY me this 4th day of March, 2003. CHECKED
z HOUSE AREA„g,2,582 S.F. GRG
a COVERAGE=F 18.34 0~ NO EXISTING TREES IN BUILDABLE AREA ~A C~ DATE
osroeios
° li o °-~o~lo ri~~ ~ ~I1G~ ~~,~7'
% SCALE
~ r ~ Gary R. Germond AS SHOWN
a 9 Licensed Land Surveyor, Minn. Lic. No. 24764 J08 N0.
5402-707
3
~ ,
Permit Number
MECcheck Compliance Report
1999 Minnesota Energy Code
MECcl~eck Software Version 32 Release 1 Checked By/Date
TITLC: Dan and Diana Kueter
%~G3k fa~oit"r~~$1
COUNTY: Dakota
STATE: Minnesota
lONE: 2
CONSTRUCTION TYPC: Single Family
DATE: 03/27/03
DAT6 OP PLANS: March 21, 2003
PROJECT INFORMATION:
#5407026
46i4 Summit Pass
Stonecliffe
COMPANY iNFORMATION:
Lungren Bros. Construction
NOTES:
Kcnton "B" Base Plan
COMPLIANCE: Passes
Maximum UA = 696
Your Home = 652
63% Bcttcr Than Code
Gross Glazing
Area or Cavity Con[. or poor
Perimeter R-Value R-Value U-Factor UA
Cciliog L Flat Ceiling or Scissor Truss 1956 44.0 0.0 53
Wall I: Wood Frame, 16" o.c. 217 19.0 2.0 10
Window I: Ahove Grade, Wood Frame, Double Pane with Low-E 41 0.270 11
Wall 2: Wood Fnme, 16" o.a 1899 19.0 2.0 83
W indow 2: Above Grade, Wood Frame, Double Pane with Low-E 372 0330 123
Door I: Solid 38 0350 13
Wall 3: Wood Frame, 16" o.c. 173 12.0 2.0 8
W indow 3: Above Grade, Wood Frame, Double Pane with Low-E 70 0330 23
Wall 4: Wood Frame, 16" o.c. 1526 19A 2.0 75
Window 4: Above Grade, Wood Frame, Double Pane with Low-6 179 0330 59
Wall 5: Wood frame, 16" o.c. 119 12.0 2.0 5
W indow 5: Above Grade, Wood Frame, Double Pane with Low-E 59 0330 19
Wall 6: Wood Frame, 16" o.c. 413 11.0 2.0 33
Basement Wall 1:
Solid Concrete or Masonry, 9.0' hU8.5' bg/9.0' insul 1668 5.0 0.0 130
Floor 1: All-Wood JoisUTruss, Over Unconditioned Space 193 30.0 0.0 6
Floor 2: All-Wood JoisUTruss, Over Outside Air 43 30.0 0.0 1
I'urnace L Forced Hot Air, 90 AFUE
Proposed and Maximum U-Factor Averages
Proposed Maximum
Average U-Factor Allowed U-Factor
Abovc-Grade Windows and Glass Doors 0327 0.370
Includes Poundation Windows> 5.6 ft2
Floors Over Unconditioned Space OA33 0.033
COMPLIANCB S"fATEMENT: The proposed building design described here is consistent with the building plans,
specifications, and other calculations submitted with the permit application. The proposed building has been
desi~ned to meet the 1999 Minnesota Energy Code requirements in MECcheck Version 3.2 Release l.
Builder/Designcr_~~ `W Date ~ 7"a
2004 RESIDENTIAL PLUMBING PERMIT APPLICATION
CITY OF EAGAN ~ 3v- ~
o~~ I 3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please complete for modifications to existing residential dwellings.
Date r / / ~ KUETER, DAN
4634 SUMMIT PqSS
Site Street Address EAGqN, MN 55122 U~I~ #
~ (651)994-8871
Property Owner _ ~~elephone # ( )
Contractor Norbl~m p~u,rn~~n~ Telephone# ((yl2)S~LII"Nd33
Address /~Q~ ~i~ ~ S City _ State_i~TN_ Zip
The Applicant is: _ Owner _ Contrector _Other
Alterations to existing dwelling $ 50.00
_Add fixtures to rooms, excluding water softener and water heater
_Septic System Abandonment
_ Water Turnaround (add $121.00 if a 5/8" meter is required)
Other:
Water Softener _ Water Heater $ 15.00
_ replacement _ additional
~Lawn Irrigation System RPZ_ new _ repair _rebuild $ 30.00
State Surcharge $ .50
~ 5a
Total $
I hereby apply for a Residential Plumbing Permit and acknowledge that the information is complete
and accurate; that the work will b' onformance with the ordinances and codes of the City of
Eagan and the plumbing codes~ ~ derstand this is not a permit, but only an application for a
permit, work is not to start '~a pe and work will be in accordance with the approved plan in
the event a plan is requ' re~ve d approved.
~ .y`.L6
ApplicanYs Printed Name° A nYs Signature
~u~
Address: 4634 Suminit Pass Zip: 55122
Lot: 6 Block: 2 Subdivision: Pinetree Pass 7th
~
TFIE FOLLOWING ITEMS WERF,M'ERE NOT COM!'LEl'E AT FINAL INSPECTION ON
Yes No Comments
Final grade - 6" from siding
Permanent ste s - arage
Permanent ste s- main entry
Permanent driveway
Permanent gas
Sod/Seeded lawn
Trail/curb damage
Porch
Lower level finish
Deck
Fireplace
• Verify with your builder that roof test caps from the plumbing system have been removed.
• Tum off water supply to the outside lawn faucets before freeze potential exists.
• Call the City's Engineering Department at 651-675-5646 prior to working in right-of-way or installing
irrigation system.
~ BuiLnrvc ~~srec'ros: I l/
CONTRACTOR:
Lundgren Brothers
935 Wayzata Blvd E
Wayzata, MN 55391
r~
Site address: ~~Jyt~G~y
m~ Lot l~ Block ~ Subtl. ~kJc TQ ~ Y~}SS ~ r y'
On April 15, 2000 the Minnesota Energy Code, Category I Building Aequirements for insulation protection, air
tightness, and ventilation, was atlopted. As a result, the City of Eagan is requiring that the following information be
submittetl prior to issuance of a Certificate of Occupancy.
This struct~re: ls consiructed to meet minimum requirements of the Mn Energy Code, Chapier 7&70
~ OR
This sUucture: wiil be constructed to meet more restrictive requiremenis of Chapters 7672 or 7674
APPLIANCE GAS ELEC MANUFACTURER MObEL BTU'S VENTING TYPE
Water Heater
Furnace S ~G D6~ '
Dryer M VCG(r~~ 2 12CJOv VC~
VENTEO
EXHAUSTSYSTEM LOCATION TYPE MO~EL CFM's ves na
Kitchen kitchen
Bathroom 1
~w~~ r~°~tti _,CF 5~ 5~t,
Bathroom2 T 2 ~RO N GrM ~j~i `Z
Bathroom 3
TE/'c, 1 IJ ~J ~
Bathroom 4
Other
VENTING
FIREPLQCE' S LOCATtON GAS W000 MANUFAC7URER MdDEL BTU'S DIRECT arMOs
L ~ 1" I ~ ' ~j ` ~
MAKE-UP AIR MODEL TYPE CFM's
f~1='~ s r 0 . ~ c~
I hereby acknowledge that the a6ove information is correct and agree to comply with the Minnesota Energy Code and Ciry of Eagan
requirements.
.
~ ii
9f~: la 4d' L/--~ `Q`~
Si na ire , ~ Date
ha~
CompanyName
' This form is the responsibiliry of the General Contractor.
l~~- ~lc~c~ ~.w ~S~'~U !3~' "-S$~~~ ~59b~7aSl
S'
`~,~`;,v~ r.~~.tx. t'~'~a-~ RESIDENTIAL BUIl,DING ~P :7~ lD`~ 3 c~ `1~.5Z)
~ t ~ Permit Application
City Of Eagan ~ ~ ~ ~ ~0°S~
3830 Pilat Knob Road, Eagan Mn 55122 ~~b-~ O. J~
Telephone # 651-675-5675 FAX # 651-675-5674 y
NewCOnshucCronReauiremenGS RemodelfReoairReauirements UseOnl ^^'D~'~'°O~
3 reg~lered site surveys showing sq. fL of lot, sq. ft. of house; and all roofed areas 2 apies o( plan rt of Survey Reod
(20% mazimum bt coverage allowed) 7 set of Ene~gy Calculations ~or heeted addihons ~ Tree Pres Plan Recd
2 copies of plan showing beam & window srzes; poured found desgn, etc. 7 site survey for addNOns & decks ~ Trae Pres Not Reqd
1 set of Energy Calculations Addilion - indicete it onsite sep~s~t¢~? ~ On-sile Sep6c System
3 cop~es of Tree Preservation Plan if lot pWtled afler 7/1l93 `-(-~1 f
Rim Joist Dehail Optlans selectiai sheet (bldgs wilh 3 ar less units Lf.+-~ ~ L~ _ YJ S~b~ ~ y`Q~ ~
~
Date `-F l~° _ l Construction Cost ~ Q 7.3
Site Address ~(n J~ ~.Y.a/Y1lI7/ T~S S UniUSte #
Descriptiono[Work S~Tj
Multi-Famity Bldg _ Y X N Fireplace(s) _ 0~' 1 _ 2
Property Owner Telephone # ( )
Contractor ~,~~~)DG-2~/'J ~f1D5 ~~St"62Uc~7'JD~v
Address ~S %/~JDIfF~ I~0(rfAJ'~ ~ Ciry ~~9 `/Z~
j
State Zip ,-rj~~
~l / Telephone # ( ~SjZ ~ "7 G1 Gi ~
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Ca[eeorv 1 Minnesota Rules 7672
Energy Code Category . Residendal VentilaGon Category 1 WorkSheet • New Ene~gy Code Worksheet
submission type) Submitted Submitted
• Energy Envelope CalculaUons Submitted ~
Licensed Plumber _ ~LA-tiDE2 /"lEC~//},c~~C~4'L Telephone ~j¢.' ~~S"~~~-2
Mechanical Contractor ~LA-NDE/C. ,lE~fff},tJJC.A~ Telephone #~52) ~ ~S - ~~O`~Z
Sewer/WaterContractor ~~}~pGUmR/NG- Telephone# ~l~--~-~.~:',
n ~ i; ~i5 ~I 1',~ ~ ;
~ ~
( APF 0 2 ~nn~
I hereby apply for a Residential Building Permit and acknowledge that the inforcri ~ ion is comp and a curate;
that the work will be in conformance with the ordinances and codes of the City~ ~Eagan and the SSate of MN
Statutes; I understand this is not a permit, but only an application for a permit, an s no to start without a
permit; that the work wili be in accordance with the approved plan in the case of work which requires a review and
approval of plans. ~k~
~i'~v9fl/h ~if'rGLE~~20 ~h~~~ v,~ P JaJ
Applicant's Printed Name A~plicant's Signature
OFFICE USE ONLY
. r:4
Sub Types '
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
~ 02 SF Dwelling ? 08 06-plex ? 16 Fireplace O 21 Porch (3-sea.) ? 31 6ct. Alt - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 PorchlAddn. (4-sea.) ? 33 Ex[. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc.
? OS 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Stortn Damage
? 08 04-plex ? 12 12-piex PI6g_Y ar ~ N ? 25 Miscellaneous
Work Types
~ 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alteratlon ? 37 Demolish (Bldg)• ? 43 Reroof ? 46 Windows/Ooors
? 34 ReplaCerrlent ~ '~Demolition (Entire Bldg) • Give PCA handout to appllcant
Valuation Occupancy ~ -3 MC/ES System ~
Census Code O/ Zoning IZ'/ City Water -
SAC Units p~ Stories o~ Booster Pump ~
Nbr. of Units d i Sq. Ft. ~ PRV ,e '
Nbr. of Bldgs Gj Length Fire Sprinklered ~
Type of Const Width CF5
REQUIRED INSPECTIONS
~ Fuotiags (new bldg) ~ FinallC.O.
_ Footings (deck) FinaUNo C.O.
Footings (addition) Plumbing
~ Foundation _ HVAC
Drain Tile Other
Roof % Ice & Water Final Pool Ftgs Air/Gas Tests _ Final
~ Framing Siding Stucco Stone
~ Fireplace ~ R.I. ~ Air Test ~ Final = Windows (new/replacement)
Insulation Retaining Wall
_ Approved By ~ , Building Inspector
-
'
ease Fee ~~r 7r~f o----------vlv /~~lv 1331h /75J~ (5"°= ~G.~7G
Surcharge sr /7 ~ LfC
Plan Review ~ ? r~ ~
MC/ESSAC ~'=o66n. ~5co ~ ~
City SAC ~H/i ~lJ/G ~a ~702- /G' l1 U
Utility Connection Charge
S&W Permit & Surcharge ~
Treatment Plant
License Search
Copies
Other
Total
~ c~{~ C~ ~lL~ Cvl~l
_
~ _ ~ TREE PRESE~VATION ~PLAN SUM~VI~4R~Y, ~
~ ~CITYOF-EAGANFORESTRYDIVISION"~.~ ' ~ ~,N~~
~651.-8755300 ~ ~,r., ~ - ,
(SEE ATTACHMENTS)
Development ~l~l~~ ~~SS ~ ~ i~'~~ ~S ~UNE~U~~
Lot Number , Block Number ~
Address -1~~~ S~.1,4N4 VVL ( T l'?a S~
Buiider ~.1.~N~C;1~4V L3i20$ ('ONSY. .1.~~
Tree Protection Requirements:
~ Tree Fencing 1~~~ N~ ~~~'~'"E S l LT ~iN ~
Oak Tree P~uning (Immediately seal.wounds during Aprl11 to July
31)
Therapeutic Pruning
Retaining Wall
Other:
Replacement Trees:
NotRequired
As Follows:
Attachments: ~ ~
~
Nos G~L~MPf~P~~
t~~?
Additional Notes: @~~
~
.r__
H:\ghove~2002fi1e1treepres\Tree Preservation Plan Summary-2002
~ ~
~ ~ ~
~ --f , . ,
, .
A a~~s~o~s
XS IYPE
°~P `A ao t5 a ts '~Q so
EMV EG WFty
~ ~ Y[> ]P
SCHLE IN FEET
fe~ t-. LEGEND
~ ~ ~ OO OENOTESSANITqRYMqNHOLE
~ ~ OENOTESITYORANT
I I ' ~ ~ ~ ~ENOTES GATCH BASM U$
6 S DENOTES SANITARYSEWER ~ ~J X
5 W OENOTES WATERMNN y F~ _
SS9~~9~Z7~•W ~ ~ ~7 ST OENOTESSTORMSEWER Z (yET
- a~~ ws.m 46.98 ssac, ~sw,a ~ o~wor&ssiowneUwHO~E
9 5 N 93° B~ ~ENOTES STORM NPRON
i~ ~
N s5n5g' •205 pRAINAGE & UTILITY 5
~ ~ I EASEMENT ~ ~ SETBACKS a ~
~ O~ sv~s 1f ~ a fv~ 95xD ` MIN.FRONTYARDSEf9ACK=30' IO;
~ '~'8
~fis~+ m 19.90 0. 9~~ ~ 5}w ~ MIN.SIDE MINaREMYpROSEG~KE1.5a'IHOUSEf ~g
~ 07 ~'~~rv v"% 6 ~ ~ p°~
95~se ~S h ~iG 103 S~ W ~ l~Ix~
~ ~ GROPOSEOIOPOFFWNDAiIONELEVATON=85]0 r~~~
7 ~ M I I 90 ~m O PROPOSEOGARAGEFLOORELEVATION= 9560 ~i
~ z M1 v PROPOSE~LOWESTFLOORELEVATiON= 9C833
a ~ ' 1098 ~'v3 ~ m ~
~ N I~ 'B5191 [Ti OY . I - W[
J N $tl I o %95Jt ~ ~F ~
m~98 6 I O ALLOGGSETIRONSAREMEASUR£~TpHUNOREDTHS
a ~ 'h (95~5) x Z OFAFOOTAN~GPNBEUSEOASOENCHMARKS. pp
- ~ 10 I y V ~ ~J.98 95=69 55~P~=5Rai - \ A ~
L ~r~.~S(2~T°° ~~1.~ - i s ~ DMONUMENOTN ~b
gaE85 N ay 9tS~ N (hy~5 g ppp~ OENOTE$EXI$TING
„ ~wam 30.00 ~~ke5o3s E~evqnON
c 9~~' EpSPNGSSg~~9~L7 W ~BD. 7 ~0~~.~~ DENOTESPROPOSED }
e ~ 1 MWSf I ELEVATION
I1tON~95p6 ~ OENOTESDI1iECTION ~ ~ Q
~ ~ OFSURFACEORAINHGE ~ O V O
~ OEHOTESSANITARY ~
~ I o ~ ~ 944'~ SEWERSERVICEELEVATON Z
~ ~ ~ o ~ ~
ATI1tEOPINIONWASNOTFURNISHEOTOTHESURVEVOR ~a
~ ~~1p. NOR WAS A SPECIFIC TITLE SFARCH FOR THE EXISTENCE OR ¢ ~j Q
I I ~ ~ T NON-IXISTENCEOFRECOROEOORUNRECAROE~ ~ a [y w
~ ~ EASEMENTSCONDUCTEOBYTHESURVEYORASPMTOF Q w fA
_ ~ THI5 SURVEV U p~ z o
3 ~ F ~ V ~
9 ~ $ I hereby certify Nat this is a Uue aM corteq represenbtion w ~ a
- Q ~ W a survey of ihe bountlaries oE U
- ~ ~ ~ L07 6, BLOCK 2, PMETREE PASS 7TH AD~ITION
_ ~ ~ DAKOTACOUNN,MINNESOTA
Md the location otall builtlings, if any, the~eon, and all Wsible
HARDCOVER ~ encroachments, if any, from or on said land. As surveyed by ~ q~
_ ~oiakEn=u,mzs.F. TREESUMMARY ~ ' meNi54~hdayofMarCh,2003. CHECKE~
i HOIISEAREA=2,5025.F. ~ ~ Q
` COVERaGE~ 1834% NOEX~STiNGTREE5INBUILDABLEARE4 ~ ~ GRG
R DATE
~ ~ ~ ~b WI051Ri
p ~ SCALE
£ ~ GaryR.GermOnd ' ASSHOWN
~ ~~t~a\y~ n`,f, ~ S a, y.~ > ~ Licensed Lantl SurveyDr, Minn. Lic. No 24764 ~OB NO.
l
?
~ Eo~b_ffice,Use I
Clty of E~~a~ i Permit# e ~ 1 ~ I
~ PertnR Fe ' ~
3830 Pilot Knob Road
Eagan MN 55122 j Date Received: j
Phone:(651)675-5675 ~ ~
Fax: (651) 675-5694 ~ Staff: ~
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: ~ ~ ~ ZO~~ Site Address: ~T ~ ~ 5~ M ~ ~S S
/ ~
Tenant: Suite
~d ~s-r-Gs~ ~z~~
RESIDENT/OWNER Name: ~ v J~-~- Phone:
Address / City / Zip: 3~ VG'ry'~"O% - ~s ~
Applicant is: ~ Owner _ Contractor
TYPE OF WORK Description of work: ~rad~
Construction Cost: ~0~ QO6 Multi-Family Building: (Yes _ 1 No ~
CONTRACTOR Name: ~ ~ 7 License ~O~gD~ 6~
Address: S6~U ~r ~<J~'
City: s( State: L~v, Zip: ~S6
Phone: V~~o~'3ZU~ ~O Z,3 J~ Contact Person: J'"'
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Cateaorv 1 Minnesota Rules 7672
Energy Code . Residential Ventilation Category 7 Worksheet • New Energy Code Worksheet
Category submined submined
5ubmission Type) • Energy Envelope Calculations Su6mitted
In the last 12 months, has the City ot Eagan issued a permit ior 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 supporling documents that you submit are considered to be public information. Portions of
,the information may be' classi8ed as non-public ii you prov,ide specific`rea§ons that would permit the City to~~
' conclade that the are trade secrets. " ' ` ' ` ` " ° "
I herehy acknowledge that this information is complete and accurate; that the work will 6e in conform nce 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 o start without a pertnd; that the work will 6e in
accordance with the approved plan in the case of work which requires a review and approval of p s.
X c}~Gve~ S~ ~lec'yvs~
ApplicanYs Printed Name Applicant' Sig> ure
l Page 1 of 3
For Office Use 0-1
ro
`.% :::ef6
E A AN : 6
Date Received: jg-A
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 RECIEVED J
(651)675-5675 I TDD: (651)454-8535 I FAX:(651)675-5694 Staff: mann -
buildinpinspectionsCa eityofeagan.com - L.
JUN � 3 201R
.111
2018 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: C."-' —/7 Site Address: 3 y �✓''°''"` c.-.Cr Unit#:
Name: 62 J/c Phone:
Resident/
@F Address/City/Zip: (3/ l v m" ;' 74 //'`-/✓'
Applicant is: Owner 1 Contractor
T Gf Work Description of work: j—t'- / f �'%^e✓I sem'eP"
Construction Cost: /0.,„it2.0 , s.- "F�/f ` Multi-Family Building: (Yes /No )
Company: 7cs�_c/ � � c�f�` ' Contact: ✓ ,r✓" . c �^�
CQfttr tQt Address: f l�--a /,yam."4 - - — /a v City: 4-7777
742
State:/j""'-Zip: ,/.//may Phone: ' l/-/G 7 v Email: 4.4-- c` e
License#: A G ,� /U - Lead Certificate#: :��A -- �J a
If the project is exempt from lead certification, please explain why:
, v 1/ /'//- /' 'if
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::,, ons -or/i
NOTE Plans d o ng-documents thatlyou`su ' cones dered to be Ric'info a n..Portim 3 ',kcilielipo
c sed as nor-public if,you provide sped reams that would permi€ a City to conclude drat theya ,trade ,..=, .,..
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.citvofeaaan.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.nopherstateonecall.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.
x
Applicant's Printed Name Applicant's Signature
q6 -34.1 u 1rlf\j- i15-5 / c7
s
DO NOT WRITE BELOW THIS LINE
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
r Alteration Fire Repair Windows Demolish Foundation
Replace _ Repair _ Egress Window Water Damage
Retaining Wall *Demolition of entire building-give PCA handout to applicant
DESCRIPTION
Valuation di 2.3,,a c o.-- Occupancy I1?4- -1 MCES System
Plan Review Code Edition IAA-z o rS SAC Units
(25% 100% )) Zoning 12-i City Water
Census Code Stories Booster Pump
#of Units Square Feet PRV
#of Buildings Length Fire Suppression Required
Type of Construction 13 Width
REQUIRED INSPECTIONS
Footings(New Building) Meter Size:
Footings(Deck) Final I C.O. Required
Footings(Addition) 6) Final I No C.O. Required
Foundation Foundation Before Backfill HVAC_Gas Service Test Gas Line Air Test
Roof: Ice&Water _Final Pool:_Footings _Air/Gas Tests Final
\ep 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: / f I/ k/ � , Building Inspector
RESIDENTIAL FEES // / � d
Base Fee 4 f� ��S� Sq • IC I®w � ,vo j�. 1 �
Surcharge Lf 112 Al Qo°
Plan Review /3 edttown.
MCES SAC //TM/Z."
City SAC
Utility Connection Charge
S&W Permit&Surcharge
Treatment Plant
Copies
TOTAL
Page 2 of 3
1
For Office Use �j
> e3 D
t G A N
:::e:
Date Received:
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651)675-5675 I TDD: (651)454-8535 I FAX: (651)675-5694 Staff:
buildinginspections(a�citvofeagan.com L
2018 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: 7/25/18 Site Address: 4634 Summit Pass
Tenant: Ostergaard
Suite#:
Resident/Owner
Name: James Barton Design Build Phone: 952-431-1670
Address/city/zip: 5920 148th St W, Apple Valley, MN 55124
Name: Diversified Plumbing License#: PM064624
Contractor
Address: 125 E. Railroad Street city: Norwood Young America
State: MN Zip: 55368 Phone: 952-448-0756
Contact: Jacob Sams Email: jacob@diversifiedph.com
Type of Work —New Replacement —Repair —Rebuild / Modify Space Work in R.O.W.
Description of work: Install shower, sink, faucet, and toilet to lower level bathroom
RESIDENTIAL
Water Heater
Water Softener
Lawn Irrigation( RPZ/_PVB)
: Permit Type X
Septic System Add Plumbing Fixtures( Main/ Lower Level)
New Water Turnaround
Abandonment
............
RESIDENTIAL FEES:
• $60.00 Water Heater, Water Softener, or Water Heater and Softener(includes State Surcharge)
$60.00 Lawn Irrigation (includes State Surcharge)
£ $60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround*(includes State Surcharge)
*Water Turnaround (add$280.00 if a 3/4"meter is required)
$115.00 Septic System New(includes County fee and State Surcharge) TOTAL FEES $60.00
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
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.citvofeagan.com/subscribe.
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. Digitally signed by:Jacob Sams
Jacob Jacob Sams me DN:CN=Jacob Sams email=
a m S jatob@diversitledph.com C=AD
)(Jacob
X :Date:2018.07.25 11:35:38-06'00'
Applicant's Printed Name Applicant's Signature
FOR OFFICE USE Reviewed By: Date:
Required Inspections: Under Ground Rough-In Air Test Gas Test Final
Meter Related Items: Meter Size Radio Read Manometer Staff: