4201 Thomas Lake Rd
~ - INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road ~ ~
Permit Number:
Eagan, Minnesota 55122-1897 Date Issued:
(612) 681-4675 ~
SITE ADDRESS: - , ~ . APPUCANT:
, . - , :i,'.~; , I AVr• Rn
PERMIT SUBTYPE: TYPE OF WORK:
1~ f~1!',1;? . . t~~'! i~ti t, I•~'I tSl:
~ 7771
~ Permlt Na Permit Holder Date Teiephone Ik
T ELECTRIC 3 //3 9-7
r ,
PLUMBI 01-J-7-0
s
HVAC ' / ~ ~1' `7to~ -(o~
Inspectlon Date Insp. Comments
FOOTINGS
G~V
FOUND
FRAMING I
ROOFING
ROUGH
PLUMBING
PLBG J~
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
T
INSUL p QA/ GYPBOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
p~7r ~
FINAI HTG
ORSAT
TEST
BLDG FINAL
BSMT R.I.
BSMT FINAL
DECK FfG
DECK FINAL
' f .~--74' - ~ ~.Y 4 ' . . .
1 w~r9
i . ? q
C`ttfiCQte df cCC1ivQ1io
eit~ af Cfagatt
#~eya~rtmeut of 13qilbing anoection
77eis Certiftcate issutd pursuant to the mquirements of the Unrform Buildrng Code
certifying that at the time of issuance t/iis strtecture was in compliance wirh the various
ordinances of the Ciry regulating building construcrron or use. For the jollowing:
Use Clusificatioti 81dg. Pcmn, No. 2()233
ca-F'-cy ryv~ R3A71 zoning Disn;n R 1 Tyae consi. VN
Oaner of Buildi~ HEW MW OWNSMIM Add,cse~ ~~ajMj, ~
BuiWing Address420lMO" IAT ROAD I.nolityl.._l. B 1. WDDTM
Date. s
Buildin6 Official
POST IN A COPtSPICUOUS PLACE i
OFFlCE USE ONLY This requeslvoid 78 monPos Fam wlidation dale prinled in Ihis 6ox.
IVID
~ 13 4 3 7 3 9 9- 9* PLEASE PRINT OR TYPE
R0a1qa10$ /9 7 euyh4n io:prnou ,ey„i,ad? re, ? N. Inspecnon Oiher Ynan RagMn: ? 2eody Now ~i cou
(l'au musl mll the inzpecmr when reody~ ole Reody: - l~ I,~FLI licensed conhaclar ? owner hereby requesf inspection oPlhe a o5e el ical work oI" ~Job Address (Srceet, Bo., or R.W. No.) Ciy
4201 17zomas -Ot.ILa1< aR01 Eagan
Secnan No. iownsMp Name or No. I I Ranga No- Fire No. Couny
DakoCa
Occupom Phwie No.
Rxkm8ax3t31&Irkx$sx2SxNew Home Counciling 456-0674
Powrr Supplier Address
Dakota Electric
Elechical Conkocta (Cempony Name) Comrocror License No. Mosler Lk. No. (PIan1 Elect DnM
Joos Electric Co. CA 00961
Nwiling Addmss (Conhoclor or Owner Performing Inslollotion)
3980 eau D' Rue Drive Ea NIN 55122
Autharized SignaNre (Comractar w Owner Performing InsMllalio Phone Na .
688-6180
EBO0001 A-71 8/96 Up"rE BOARD COVY - SEE I R 3 ON BACK OF YELLOW COPY
7 . REUUEST FOR ELECTRICAL INSPECTION 62 9O
~F 3'7 I- 3 9 99 Mg21 Uniyr sity Ave.Rm. 9-~1t
28, St. Paul, MN 55104 -
Phon~42-0800
Home Duplex Apl. Bldg. Other: g New Addn
Commercial Indushiol Farm Remod Re oir
Air Cond. H. E ui . Water Hh. Load Mgml. I Ofher:
Dryer Range Elec. Heaf Tem . Senice
°X" above the work corered by this requesl. Enler remarks in Ihis space ond on rhe back of ihe whife copy only.
ZZ --!x-, e(O z-~
do 7 ZcD
Cakulole Inspeclion Fee - This Inspeclion Requesf will not be accepfed wil{iout fhe coirecY fee:
Other Pee # Servire Entrance Size Pee A Circuits/Feedere Fee
Mobile Home Park Stall 0 to 200 Amps 0 10 100 Amps
Skeef Ltg./TmHic Sig. Above 200_Am s Above 100_Amps
Transformer/Generator INSPECTOP'S USE ONLY ~ ITOTAL
Sign/OWline Lfg. Xfmr. $92.50
Alarm/Remote Confrol
~
$wimming Pool
I here6 cem that I ins el ml i m0aiion daxribed he.ein on the dmes smred
Irrigotion Boom eoigMo Da~ ( ~ /~,7
Speciol Inspection ~
Finol Dole-IC ~
Invesligotive Fee i
THIS INSTALLATION MAV BE ORDERED DISC . ED WITHIN 1.
MONTHS.
M 0 7 9 3~~ ~~~g
Request Date Fire N. Rough-in Inspection NDTICE: Vou Musl Cell Eleclrical Inspactor
Requiretl9 II A Raugh-ln Inspection
? Ves o Is flequiretl.
I icensed contractor ? owner hereby request inspection of above electrical work at:
D Addresse~~r PoNe No.) Ciry EA .~.J
Section No. Townshlp Neme or No. Range Na. Counry
Dtko r,4
Oca;upan!(PRINT) PhonB No.
PowerSUp lier ^ Address
o / ,
Elecincal CoMractor (COmpanY Name) ConVedor, License No.
14~ QGi C Cl, 0
Mailin tl s Comrador orOwnerMakinglnstalleion)
r ?e- ~/1S SS 07
Authar¢e a(Cont ttar/ r M g Ins~ n) Phone Number
/ Aa v
MINNESOTA STATE 90ARD OF ELECTflICITY THIS INSPECTION REQUEST WiLL NpT
GrlggsMitlwey Bltlg. - Hoom ^r113 <•~M'/r~,'~,~~~~~ I BE ACCEPfED BV THE STATE BOARD
1821 Univereity Ave., SI. Paul, MN 55104 UNLES$ PFOPER INSPECTION FEE IS
Phone (612) 692A800 ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION es-ooam-oe
1 op. See instmctions for cempleting ihis Porm on back al yellow copy
M0 7 913 tX" Be/ow Work Covered by This Request
ew Add Rep. TypeoBuilding AppliancesWired EquipmemWired
Home Range Temporary Service
DupleX Water Heater Electric Heating
Apt. Building Dryer Load Management
Comm./Industrial Furnace other (Specity)
Farm Air Conddioner
Other(speclly) ConvaotoPaRemarks: ii),snp "7")Q"~~.
~ d rv
Compute Inspection Fee Below: ~ ~/E'~/1t~. C T4
# Other Fee # ServiceEnirance5ize Fee # Circuits/Feeders Fee
Swimming Pool 0 to 200 Amps o to 10o Amps
Transtormers A6ove 200 _ Amps Above 100 _ Amps
Sigf15 Inspecbr5 Use Only: 'fOTAL S-
Irrigation Booms / f , U
Special Inspection (
Alarm/Communication THIS INSTALLATION MAY BE OR DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONTHS.
oate
I, the Electrical Inspector, here6y Rough-in ~ 11
certity that the above inspection has
been made. , S
OFFlCE USE ONLY
This request voitl 18 monihs fmm
Address - 4201 n~ ~ xono Zip 5512 2
~ .
I.ot I Blk i Sub wEMRn
THESE ITEMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECI'ION.
Date: 5097 Yes No Inspector:
Final grade (6" from siding)
Permanent steps (garage) ~
Permanent steps (main entry) V
Permanent driveway ?
Permanent gas LIZ
Sod/Seeded gtass ~
TraiUwrb damage ~
Porch
Basement finish r,'/
Deck 1--
Please verify wi[h the builder the removal of coof test caps from the plumbing system and the shut-off of water supply to
the outside lawn faucet before freeze potential exists.
Contact eugineering division at 681-4645 before working in rightof-way or installing underground sprinklcr system. ~
White - Ciry Copy Yellow - Resident Copy Pink - Contraclor Copy
ItESIDENTIAL
~oU BUILDING PERMIT APPLICATION
CITY OF EAGAN --l
3830 PILOT KNOB RD, EAGAN MN 55122 '-n O
~
S_ 651-681-4675
New ConaVUCtlon NaoulremeMS RemotlallReueh Reoulremems
• 3 repl5t9fBtl Site SWV6y3 ShOwhig Sq, ft. 0f 10t, Sq. ft 0f hoUSB; and $If ro019d efBBS • 2 WpIB3Of DWn
(20% mexdmum lot coverage ellowed) . 1 set of Energy Calculatbns for heated adOAbns
• 2 copies ot plsn stwwing beam & window saes; poured foun0 design, etc.) • 1 ste survey for exteriar add'dbns & tlecks
• 1 set ol Energy Cakulafbris . Indkate %Frome served by septk system br adtlAbns
• 3 copies ol Tree Preservation Plan il bt plebetl atter 7A/93
. Rim Joist Deteil Optbns selectlon sheet (bldgs wAA 3 or less unRs)
DATE VALUATION ~I ~ f 1VV
SITE ADDRESSUO I I f L MULTI-FAMILY BLDG _ Y 'N
TYPE OF WOR V I FIREPLACE(5) _ 0_ 1_ 2
APPLICANT ~ OL R ~ f
STREET ADDRESS n CI STATE ~MIP~y-7
TELEPHONE # - ELL PHONE # FAX # 6211`~
PROPERNOWNER 1JjLh IU 16" ` TELEPHONE#Lb,'4"5Of ' 64D
COMPLETE THIS SECTION FOR -NEW° RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNESOTA RULES 7670 CATEGORY 1 MI
(4 submission type) • Residantial Ventilation Category 1 Worksheet Submittad • N & itted
• Energy Envelope Calculations Submitted JUN 0 4 2002
Plumbing Conhactor: Phone #
.
Plumbing system includes: _ Water Softener _ Lawn Sprinkler ee: byt
Water Heater No. of R.I. Baths
No. of Baths
Mechanlcal Conhactor: Phone ri
Mechanical system includes: _ Air Conditioning Fee: $70.00
_ Heat Recovery System
Sewer/Water Conhactor. Phone #f
I hereby acknowledge that I have read this application, state that the information is correct, andc99 ree to comply
with all applicable State of Minnesota Statutes and Ciiy of Eaga r inances.
Signaiure of Applican
Y OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4102
OFFICE USE ONLY
? 01 Foundation ? 07 05-plex O 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 06-plex O 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - MuRi
? 03 01 of _ plex ? 09 07-plex O 17 Garage ? 22 PorohlAddn. (4sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex O 18 Deck ? 23 Porch (screened) ? 36 Multi
? 05 03-plex ? 11 10-plex O 19 Lower Level ? 24 Storm Damage
? 08 04plex ? 12 12-plex Plbg_YOr_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 WindowslDOOrs
? 34 Replacement •Demolition (Entire Bldg only) - Give PCA harufout to applicaM
Valuation Occupancy MC/ES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footings (new bldg) _ FinaUC.O.
_ Footings (deck) _ FinaUNo C.O.
_ Footings (addition) _ Plumbing
Foundation HVAC
Drain Tile Other
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests _ Final
_ Framing _ Siding SNcco Stone
_ Fireplace _ R.I. _ Air Test _ Final _ Windows (new/replacement)
_ Insulation _ Retaining Wall
' Approved By , Building InspeCtor
- -
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storege
S8W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
PEI2MIT
~ ~CITY OF EAGAN
3830 Pilot Knob Road PERMITTYPE: euzLozwG
Eagan, Minnesota 55122-1897 Permit Number: 0 2 9 2 3 3
(612) 681-4675 Date Issued: 11 / 15 / 9 6
SITE ADDRESS:
4201 TNOMAS IAKE - ~
' LOT: 1 BLOCK: 1
WEXFORp
DESCRIPTION:
• mi,. CJ7`r' OFI
Bo1-dln#,,Permit Type S
,~ux~Lx#3nc~ Dl`%rakType N ~ (I.~M.t.!~
~Ug(: ~t",~1F~Yd-Kf'G+~.,f F ilr.., .::;,.r.ri.,iif;
a ;
'Y.
F
~I77 L.e-i'1gft7
RU4I,Q~
- Widt°h
Buildz.t34
00:1.
~~wt-,` 101
m
~
~
%
REMARKS:
;
PRV S& W PLBR - MA77HEW D.NNIELS PLBG .
; ~ .
~....jC:.. .
f).)" d.n,;•1~'•.~
FEE SUMMARY: o-
VALUHTIQN
6ase Fee $1,152.25 MISCEL
Plan RevSew $576.13 Total Fee . .
5urcharge $76.50
SAC $900.00
SAC ~ 100
r SAC Units 1
Subtotal $2,704.88
CONTRACTOR: - Applicant - 5T. LzC OWNER:
NEW HOME COUNSELING TNC 14560674 2006044 NEW HOME CqUNSELING
1566 WEXFORD CT 1566 WEXFORD CT
EAGAN MN 55122 EAGAN MIN 55122 ~
(612) 455-0674 (612)456-0674
i he'reCiy' ao-fsnowledge ~h~Ch ~ hav.~ rea,d hl,s a,N?plic~at3 an. and &~ate that the
' znfo'Pirrat~vn°~s ,~brh~~t antl`,a~r~~ Css cqasp~lyG'wi~th°'aij iP~l13,cable State _o# Mn,
Statwtee'atidC, ity` of
,
~l~
IC NT/ ERMITEE SIGNATURE'ISSUED B : SI ATUfi
~
CITY OF EAGAN I(
3830 PILOT KNOB RD - 55122 -~~i'~ ~ z~• 3~
~ 1996 BUILDING PERMIT APPLICATION (RESIDENTIAL)
681-4675
Zlew Constnxfion ReauMementa Remed Lm eair Rea ui m rM•
? 3 rsqfslercd site surreya i 1 eoPies M plan
? Y copks of planf (induda bsam d wiMOw sitea; pourod tntl. desipn; eteJ ? 2 sfte wneys (erierior sdd8ions S dedcs)
4 1 e"er9Y ca~~~~tions ? 1 energy qlalationa (or heated additions .
copke at tree prosenMion pbn H bl ploCed aRar 711193
requUed: _ YM 2-~Na
nATE: ' - l' CONSTRUCTION COST: L,
DESCRIPTION OF WORK: _
STREET ADDRESS:
LOT BLOCK SUBDJP.I.D.
14
PROPERTY Nam • hone
OWNER • - ~
Street Address
City: State.V,z Zipi~~2~
CONTRACTOR Company~ Phone
~
Street Address: ~ License # ' ~
City State: ZipiLG.LZ,
ARCHITECT! Company~ Phone
ENGINEER
Na _ Registration
Street Address•
City: State: Zip:
Sewer 8 water pcensed plumber:~ OllVl(f LPenaly applies when address change and lot
change are roquested once permit is issued. ` •
i hereby acknowledge that 1 have read this sppiiea8on and atate Uhat the informaHon is correct end agrea to compy ith ail
applicable SWte of Minnesota 5tatutea and Cily of Eagan Ordinances. j .
Signature of Appiicant: ~
OFFICE USE ONLY REcEI~D
NO 0 8 1996
Certificates of Survey Received &I --efes No
Tree Preservation Plan Received _ Yes No
B
~
~p
OFFICE USE ONLY • .
BU[LDING PERMIT TYPE
? 01 Foundation ? 06 Dupiex ? 11 Apt./Lodging ? 16 Basement Finish
Z' 02 SF Dwelling ? 07 4-plex ? 12 Multi RepaidRem. ? 17 Swim Pool
0 03 SF Addition ? 08 8-plex o 13 Garage/Accessory o 20 Pubiic Facility
0 04 SF Porch ? 09 12-piex ? 14 Fireplace ? 21 Miscellaneous
0 05 SF Misc. ? 10 = plex ? 15 Deck
WORK TYPE
~i 31 New o 33 Alterations ? 36 Move
? 32 Addition o 34 Repair o 37 Demolition
GENERAL INFORMATION
Const (Actual) vr1 Basement sq. ft. i10a MC/WS System ~
(Aliowable) ,i n) Main levei sq, ft. 111S City Water ~
UBC Occupancy 2-3 J -r 2" sq. ft. 1158 Fire 5prinkiered
Zoning sz-i 4~40 sq. ft. -rbo PRV
# of Stories z sq. ft. Booster Pump
Length a4' sq. ft. Census Code.
Oepth 3g' Footpnnt sq. ft. '-7S SAC Code o~
Census Bldg ~
Census Unit ~
APPROVALS
Pianning Building an6 Engineering Variance
Permit Fee Valuation: $ 000
Surcharge
Plan Review
License v u L~- `d
MC/W5 SAC 3y x t ,
City SAC 28 Y iy
Water Conn. ~QY 2 3~
Water Meter ° 3 1-7, ~ w P ~
Acct. Deposit 154-
S/W Pertnit s~ a~tis
5NH Suroharge ~Z y
Treatment Pi. islb 9 194 z 'o,
Road Unit Park Ded. Z"a -
Trails Ded. s y,c 3y 'q 3 F. 3!.
Other s x zs 3 i. zs
Copies zo„q. s i qo
Total: ~s7.C, ~b~ sy = cx~s~a -
% SAC 3ou zs. sd
SAC Units ~
~sa 5-z8.
66# IOOd Nd6E:50 96-ZI-II %96=x
' 2422 EnTarpriBp Drive
uxo anverans • are v~r,r~crns Mendoto Heiphfs. MN 65120
* PIONEEFt (612) 681-1914 FAX:681-9488
*o RAe ryggr. ~ L~ L`r'o~"K A~1=~ 625 Highway 10 N.E.
BloinB, MN 55434
4c *'k (812) 783-1880 FAX:783-1883
Certificate of 5urvey for: NEW HQME COUN5ELING, INC.
42(l1 iNOMa5 IAKC ROAD '
Nb~r: {o• fa thwr~I,.
rj~? 61++Ji J 9c'tRl.l `'.a4~ ~
yib~ 1 ~ C'd'N71`•
~
tL.s,
BY t~y
,
S£E DETAIL EAGAIV EIVGIlVEERING l]EPT. ,rdT
al $
`~Q&A.H. ND. 30 (DIFFLEY ROAD) I
° LO
N89°43'31"4% 44187
FRAN
.ess.-e - - - - --7-~
~ ~ ~ 9 9s9.it\96X$t • k960.2 "~~~Z~ ~ ~
~ ~ s~sae °~x~ ' x =°S~icy'~.a 1 y~z,
~ 4~U5°I6'OB`
~ ~~0' 9esa~ x~ k ~ . •n~a .~~uaa 1tmr5$0.93
~y ~esx.x '~~`~',,ge.a Q- ~.88
• ~ 7 ~5~- . ~ ~ ^'931.7
NA~fl1~AIN-~ -937,7 1 1,~ 40 `'SMI. MH.
xrD x w x 9 1.61 x936.2 a 1,\ `V
951.6-~"' 44. .q 9a20 3' / 9 y, 8qp.8 ~~`Spry, 6 ~m 7.
79y i N BM.-p d y~.y
9(C7~8~ 94~.0"912 84 6"c Y 8 g ~
7-
$AN. SEWER LINE ON PppP. `untsk'~ 0~.~ i~ 940
942.9-<..yQ,s~ '`E%ISTING BI7. DRIYEWAv
7v a
HO
r ~
NOT£r SE4kA 5ERYICE INV. ELEV.=97&6
r
~ +'~60•06~~\ (LP~, ~ '
~
ggNCH MARK
958.B TDP OF PIPE
* ~ Rpe ~ p /~pi
ELEV.=851.27
pNp ~ .EP9G~0E~
~ ° ~ R E Y 16W E D
.
BENCH MARK
70P OF PIPE ,I~@
ELEV.=949.28 ~pply t f q'~ q 3Y ~~'7- -,.M USE ELEVA.TJS,~~L
DETAIL UTE Y
~r~r{LEVATION: x U
- ; ' TOP OF BLOCK ELEVAl10N: ~ y
GARAGE SLAB ELEVATION: ~
NOTE: OPOPOSEO 6RAPE8 SHOWN PER GRAIIINC PLAN @Y:
NOSE BURAING OINENSIONS SHOWN ARE FOR 14ORRON7nL ANO 4ERTICAI. LACnTION X 000.W OEN01E5 EqSTNG ELEVAYIarv
d' SSAUCTRtE9 aNIY. SEE MCMi1'ECNAL PLA1is t"OR BURDMG R40 ( 000,00) OFMOTES ARIXPOSFD ELEVAlION
FOUNDAlION OiMEN510NS OENOIES DRAINAGE MD uS1uiY EASEMENT
NOTE: NO SPEqFlC SVILS IMVES11GAnOM HA5 BEEN WMPLElEO ON 1Hi5 l0T BY iN[ OEMOT[S IXNiNAGE FLOW OIRECnpN
&JROE7'OR, THE SV11A61L111' OF SOiLS TO SUPPPi7 'ME SPE.7FIC :+OUSE OCN01'ES MONUMEtJi
PRWOSED 15 NOT 1HC RESPONSl60.1rY OF THE SVRVEYOR. -~-g-~ r~(ENOTE:iIOFiSET HV6
NOn: 1F1I5 CERTFlCATE DdE3 NOT PURPORT TD 5HOW EASEMENiS O1HER 7HAN
1HOSE SHO@N 9N THE RECORpED PLAt,
NO7E; CONTRACTOR MUSC YFRIFY ORIVCwAY DE9CN.
NOTE: BEARINGS SHOWN ARE 0ASfl aN AN ASSUMEO DANM
p1E HEftEBY CERTIFT 70 NEW HOME COUNSELING, INC. THAT TH45 IS A TRUE ANp CORRECY REPRESENTATION OF A
SURVEY OF THE 60UNOARIES OF:
LaT 1, BLOGK 1. MIExFORD
pAKOTA COUNTY, NINNESOTA
IT POES NO7 PURPORT TO SHOW IMPROYfMENTS OR ENCHROACFiMENTS, EXCEPT ZlohnC, AS SURVEYEY_14 ON
F SEPT.. 1996. 51GMEER ENGIN RING, P.A.
UNDER MY OIRECT SUPERNSION THIS ~7H~ ~ p~
fCSGALE : 1 INCH = 100 FEET IC-? ~Lo«. ev: r9on, l.S. Rsg. No. 19 28
872 96107.01 SWK
i0'd
LOT SURVEY CHECKLIST FOR RESIDENTIAL
• BUILDING PERMIT APPLICATION
• PROPERTYLEGAL:
DATE OF 364VEY:
> LATEST REVISION:
~ m
DOCUMEIVT STANDARDS
< s ~
?~1 ~ Registered Land Surveyor signature and company
~ • Building Permit ApplicaM
fa' 13 O • legal description
@~-'O ? • Address
G"~13 13 • North arrow and scale
0~"O 0 • House type (tambler, walkout, split w/o, split entry, lookout, etc.)
5a~o El • Directional drainage arrows with slope/gradient %
Z"~o ? • Proposed/existing sewer and water services 8 irnert elevation
Y7' ? ? • Streetname
0"~? ? • Driveway
ELEVATIONS
Existina
@' ? ? • Sewer service (or Proposed)
(L 0 12~ • Property comers
2"'0 o • Top of curb at the driveway
C,K 13 El • Elevatlons of any exassGng adjacent homes
Prooosed
[~S1 ? • Garage floor
d ? • FiISt flOOf .
o 13 • Lowest exposed elevation (walkouUwindow)
? ? • Property comers
9' O ? • Front and rear of home at the foundaUon
PONDING AREA Cf aoolicable)
? ~o • Easement line
o 1~~.7 • NWL
O B~ C3- • HWL
? ~~q • Pond # designation
C3 o • Emergency OveAlow ElevaGon
/ DIMENSIONS
o0ia? • Lot IineslBearings & dimensions
0 • Right-oi way and street width (to back of curb)
? • Proposed home dimensions including any proposed decks, overhangs greater than 2',
/ porches, etc. (.e. all structures requiring permanent footings)
? ? ~7' • Show all easemeMs of record and any C' uf3litle~w~Fin ose ease
? • Setbacks of proposed structure and skieyardse k~adjawnte~d ng s ructures
? 2--o • Retaining wall requireme, ff an
Reviewed:
Nam ate
.lanuary t988
CRAIGIGBBABI.OGPRAR.FM
'y ~
CONNECT TO E%. 12'OIP
• • , . ~ . ~ WITH WET TAP. s.wrT~rsY sw[n srnnc'~5 s~nu. ^r. ~
~ - SAKCUT BITUMINOUS AND
• NARMIN91l RESTOFE STREET SECTION ,
, PGThpkFUy 4d4p44i5 . Y1YLL1PESI.i ID GVIGINAL CONDITtON.(WITNIN ONE WEEK) M*m ~n~+s aw:. Ae P mv.`m "rcrt 'R•. •
FYCdvdll Lpd/ .•c UO [1 n MH M~~"•!OC.61CIIv
fn'cee ulmut wrltt.e n ' FBQM RL maum ut sm111ea 15• urto M trns.
FrILY nfllb,. 0.1pLt ort w y
I'.OD 39tp Ave e
A{acLC Offlcn >etk, Snita
Y.:nncapolle. MlnnYZnta 51431 j ll,•. . \ ~
fnlzls»-us:
MM lDC 25' FHOM PROP. COfl. E%
5 FROM R/W OPEN CU7 ACRO55 THOw/+5 LARE-~ ~
% 1 9 ~l . 23.5~.. \y.~ A, ROAD. CONNEGTION TO EX. STVB. . 7 (
7rN~' •y.~ Z AND RESTORATION TO BE DONE II ~ ~
MH ft STA.0-37 WEKFORO WAY BY CITY. .
GQ , ~y ~ • ~ 1. \ - ~ 4 20 PL H LOC.IO~FROM R/W
~ r
i a
t_
Q ` ~ ~ •~f• ! ~l Z
i ~
PRIVaTE \~9.. a.
DNIVEWPY THOMAS / LAKE z ROAD I
~fi'w w ,.os 4~,,4ro. Si~i r ~
\Q~ ! ~S- 1'=7
INV 938.5
CS-94B.5 7 T
EES25'/
IP 251/~ UTILITY
Z,~e
~ ~ EASEMEMi . ' ~ZS• ,f~ ` ~ } a "10' ~ _ ~ \ 10
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EY THE dTY OF EAGAN) WITH MANHOIf.. i
~-100 ' " ~ n + • _ YERIFY ELEV. Q LOCATION IN FIELO.
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9M TNH FIR POWT 6 SUMAC UFIVE ~ ~ . ELEV - 934.90 ~
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,4KE ROAU BM-TNH ' THOMASIANEfl
THOMAS L
\ 926 55
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. 75'MM.
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~::TERIOF. EN,IELOYL• AVERAGE "L" COMPUTATION
OWI4E1, ~C~_`-' h~ h , 'St~ZI~ AN N0.
C'nti'I'F.i~C:TU!<: IJFin' }{t)ME' C:7UN. y:1~1iv,~ i,,nTE /8796 ~P OP7E 5-0674
i)F'1'F.Rt+I1ME WUkKINC 5QUAR£ FUOTAGE
3564.349
1, 'IrJto: exp:;:.ed aren3617.221 hq,ft. r: .11 397.2343
2. 'Iot.ai area 1068 sq.ft x.('iL5 43.368
3. To*a2 iloor can*, area 0 sq.ft. x 0.05 0
(over unheare;9 eticlosed areas)
4. ,'ota: fi.-)or cint. area 12 sq.ft. x 0.025 0.3
(over ur:heate.l expcsed .9reas)
•;;:;;1 area abo~;e the floor. 3256.549
u. 7'cr.a: w2windau area . . . . . . . . . . . . . . 266.97.
D. ':OLSi dooz ares 37.8169
c. :ora; s.'.idi.nq giass door area 80.04
d. `IctaI f]ier:iace area 0
r:~ . ^'ot.a'_ wall framina area tave. 10%)........ 325.b549
f. ?'~-,tn; ;ie* aal] area aLove the floor....... 2546.125
g. ':ota] rim joist area 306
'1'OTAL iXF':1;:Eli FOLNDA'1'ION ARFA 46.6722
h. 7^r.a1 s fcur.datic•r, wir.dcw area . . . . . . . . . . . . 0
i. Tota:l aat four;dati:n area 46.6722
~et•~~ni.na vblue of each wali segnent.
a. z56.y1 x"u" 4.41 - 109.4331
b. 37.8:89 x'1U" 0.06 = 2.269134
c. 80.04 x"U" 0.41 = 32.8169
d. U X°Un p> 0
e. 325.6549 x°U" i;.0 9i) 334 = 29.91778
~:4~.12~ x "C•' 0.04:1215 ~ 110.0313
y. 306 x"l"' 0 .0 40683 = 12.53051
i~. 0 x11U„ 0.41 = 0
i, 46.67 2 2 r. °U" 0.076161 = 3.554623
! .........Total. 300.0529
s:: o: lpsE the:: irer.l a; yo,: have mot the current
MCAh 1.16v08 A RtaL` U.
TO;'hL Ek'r'oi;E" hOGF/CE.II.ING AREA 1668
; Tuthl k:kyliyht araa 0
k. Tvta:L f:iat roofjceiling fz•aming area...... 166.8
1. Total net fle,t roaf./ceiling area.......... 1501.2
Detarmine "U" value for each roof/c1g. segment
j. 0 H"U" 0= 0
k. 166.8 x"U" 0.025549 = 4.261625
1. 1501.2 x"U" 0.021801 = 32•72727
' .
/ ...................................7'atai 36.9889
7f ,kc,~,,, a'? is che same as or less than iteri #2 you have met the
L I,1CAR 1.16008 A AND 0.
TO'1A7. F! Oca;; CANI'. AkEA (er.closed) • Q
o. 74~t.al f'_our cart. £r.&ning area .;ave. 0
t. Tota] r,et i.nsuiated floar/cant.. area..•.•• 0
Detvrmine "Jp, value for eac}, floor/can:. segmant.
0. 0 s "U" 0.069I44 = 0
0 x "L'l 0.029386 = 0
a ................................TOtal 0
11, x8 i:: t.Ge :_nme as or iess than iteu: #3 yuu have met the
e:1`10t'yy ::Ode:. 2:dCnR 3.16008 A AND 0.
TVI'A3. F7.pt>N/CAN`i. kREA !exposed3 12
Q. Tc±~; f~oor/car,c. fiarning area (avE:. 70%)• 1•2
i: . 'Pota] r,et insuiGt~d f 7 ocr/ _ _..r . Hrea...... 20.8
ceteri:!;~;e `'I)" valuc for each floor/cant. segment.
q. 1.2 x"U" 0.048333 = 0.057999
I-. 10.8 x"U° 0.022805 = 0.246294
9 Tntal 0.304293
:+.c.er: P9 ic t.h~- zi^ -,r iess than itern 04 yo-u have met the
cr.,-t'yy t^.CkR J. 16J~i8 A AND 0.
I'Hh.'r 1 Hh',~F_ CP.LCUI.ATED THE "U" FACTORS AND "R°
N.i'.kEIN' I.;i.; i'HAI 7Hc: BiJI!.DIdG HP'RE I2ESCRIBED I45'F.'TS OR F~)QLTEDS
1'F? : SI'A ! E E?~E R.iiY 1:0~'TSPdRVA''I6P~ Af: T. ~ i ~
, siynatuFel
J 1
• DETERt4If;E °1J" VALUESII
Air.... , . 0.66
Tharnw-Rre~k...... 0
Stud.....,........ 6.53
S Yfea :1:: na . . . . . . . . . 2.06
SS.diny........... . C.7e
0.17 1:,07
Totai "Rn Vatue............
1/R = "1,1", Value..... ..0.090334
7'HRU ;NSULkTiOIS -~:liii Sii)'i7'v & S.R.
InYeric,r Hi:...•,• 0.68
C)
lu[;alaticn...... :4
^•,heathir.q ;%.06
1-!idSr,c5, . . . , . . . . . . . L.79
EXte r i u c liiY...... 0.17
~.Oi.ai lip„ va;ue............ 23.14
a12 _ :~t:~ .........,.C~.p45z:.5
CL: ; 1..1;i'v MEr913ER
Al....... 0.68
Shcet. F:3Cf. • • • • • . • J • 56
Ceiii.^., Tde:nt.er.... 4,3'
Ii,sulaticn....•.•. 32 , 92
Sci?1 Air.......,. 0.61
^c,taJ 01.01 Value............ 39.14
,,/R
J'H12U : P;ILII'v~i ? 17'i'J:.ATIi)?d
lrlte:Air. O.6 3
SheeC RucK..,,.,.. 0.58
lneulr~ticaiy, . 44
SLi.li Air.,....... U.61
Totai uRn Vaiue.,.......... 45.87
jiR - "Iiu V31UC?....,....... 0.021801
THRU co!ackeTE h;.,Ocx
llltF-.Y.iO:" Alr.-.... 0.E8
conc:. nik...... 1.26
Incuiat.ion........ 11
~ZhpE>t Rt;. (cI:t.). 0
F.xteri.ai' A.r'... 0.17
i'otai "hu Valuc
7/R = "ii`t ..................D.0?F1C+1
1'HRC tiFf4 JOlai'
intt,7'i.o1 iii.C...... U.f:B
1 :i6U." a(:lii(:........ i9
Rllil JOSEt,........ :.by
2.0F+
0 .78
.~X1:P.Z707' R]r......
;z,tal "R" ;!a:ue....... 24.08
i/q = pu".......... 0.040683
vta)ue: Lc;r o:i:idow 0.41
L'" va; •.ie :ot iicors......... 0,06
,
'v~~ ~~dluc. 4t., Pdt.ip Drs.... . (,.G1
Tyr;t; ^h1:T. ";CISHLF ( e:;ci.csefl )
?nt.e~r.au: ai: 0.68
1:;nisr Flooring.. . 1.23
i:.*i c?ei la yment. . . . . . 0
Pay4700d 0,93
JoSB*............. 11.56
Sheot Kuc'r....... 0.58
St1:~1 hir......,.. 0.61
'iCT.al Pxu vd1UF'............ 15.59
'jlt = °U" .................0.4ti4144
~
,
~
TF;RU CArr:. i~ '!;su:_IT.oN ienclosei;
int.c;ri:;. ?ti:...... ::.66
Finlsh F'7o"r5ny,.. 1.23
Undaa-ltiymer,r, , . . . . , it
Plycaood........... 0,93
Irtsulat.Scn........ - 0
Shr•ec Ruck....,... 0. 58
T,ir......... 0 .51
iot?.: Va'_un............ 3403
!;'1t = "1;................... 0.i72938t)
]'Y,Set~ CP.::'P. ~ P;;:.Y~Bf.;Ft (er:po~ed)
rior Mt.. . . , . 0.66
ri1'_i>71 F:oC:'_'':ly 1.23
OP.C1E3Y1t1)'1lE:lf-...... 0
P1ywOpd . . ...93
lO1St I4.84
Sh2Ar:hinr......... 2.06
scffic............ e.79
Value............ 20.69
"U" . . . . . . . . . . . . . . . . . .0, D48333
THhU CA;vP. l ;rlSt;:.F.TI!;N ;exposed?
Irteric:r Air....., 0•Ee
F'ini-,h F1ooLir.g... 1.23
Ur, dez'ia}'rarnt....... J
P1}'wocd........... Li193
Zi1su?ation........ 38
Sheathiny......... 2.65
Soff.i.t.......... o.78
Exterior AJr...... 0•17
Tc;tal HK" Vai'ae.......... 4305
1/R - "t1H ............0.022805
CITY USE ONLY
L ~ BL ~ RECEIPT
SUBD. DATE: 'j •3 9
1996 MECHANICAL 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
New construction Add-on furnace
~ Add-on air conditioning Add-on air exchanger, i.e. Vanee system, etc.
- - - - - -
Date: 5=11P- 97
FEES
• Minimum Fee: Add-on/Remodel (existing residence only) $ 20.00
? HVAC: 0-100 M BTU 24.00
Additional 50 M BTU 6.00
? Gas Outlets (minimum of 1 required @$3.00 each)
? State Surcharge .50
TOTAL o~~SO
SITE ADDRESS: y~ f 113orn'?5
OWNER NAME: PHONE ~`L~=7~7tJ
INSTALLER NAME:~~~ i ?l~
STREET ADDRESS:7~2~ aUaShjhQzvn 14zlel
CITY: STATE: /L11U ZIP:
PHONE ((p~~ ) 9N)-{D''~~ 117
.
~
y~~E ,^yi ~ srl
~ ~y
~~i~ f04k~l
~~~„~7
CITY USE ONLY
L ~ BL _ RECEIP7
SUBD. DATE:
1996 MECHANICAL PERMIT (COMMERCIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
(612) 681-4675
Please complete for: ? all commercial/industrial buildings.
? multi-family buildings when separate permits are ~t required
for each dwelling unit.
DATE: CONTRACT PRICE:
WORK TYPE: NEW CONSTRUCTION INTERIOFt IMPROVEMENT
DESCRIPTION OF WORK:
FEES: $25.00 minimum fee Qr 1% of contract price, whichever is greater.
Processed piping - $25.00
State surcharge of $.50 per $1,000 of pffn2 fee due on all permits.
COMTRACT PRICE x 1%
PROCESSED PIPING
STA7E SURCHARGE
TOTAL
GlTE ADnRFSS:
OWNER NAME: TELEPHONE
TENANT NAME: (irwPROVeMENTS oNLv)
INSTALLER:
ADDRESS:
C1TY: STATE: ZIP:
PHONE
SfGNATURE:
SIGNATURE OF PERMITTEE CITY INSPECTOR
L) BL ~ CITY USE ONLY RECEIPT 69/10
SUBD. DATE:
1996 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 whcn permits are required for each unit
FIXTURES F~qCJj N~ TOTAL
Shower 3.00 x .3 a?
Water Closet 3.00 x 3
&iii ~iJ~ i.^~s :L
.-i
Lavatory 3.00 x ~ = ia.oo
Kitchen Sink 3.00 :c 3.00
Laundry Tray 3.00 x a.oo
Hot Tub/Spa 3.00 :c =
Water Heater 3.00 x
Floor Drain 3.00 x
Gas Piping Outlet ' minimum -1 3.00 x
Rough Openings 1.50 \3_ = i! o
Water Softener 5.00 x =
Private Disposal ' Dakota Cty. license 65.00 =
(new and refurbished systems)
U.G. Sprinklef ` home under const. 3.00 =
Afterations ' to exisnng 20.00 =
Water Turn Around 20.00
STATE SURCHARGE .50
TOTAL ~a - OD
SITE ADDRESS: 4201 Ttianas Lalce Road
OWNER NAME: Ne^' ~ ~~~ling
INSTALLER NAME: Matthew Daniels, Inc.
STREET ADDRESS: 15230 Carrousel wav
CI7Y: Rosemount STATE: m ZIP: 55068
PHONE ( 612 ) 423-3730 .
~J • O u
OFFICE USE ONLY
L BL RECEIPT
SUBD. ` DATE:
1986 PLUMBING PERMIT (COMMERCIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
(612) 681-4675
Please complete tor: * all commerciairndustriai buitdings.
• mulN-family buildings when separate permits are a2( required for each dwelling
unR.
OATE: CONTRACT PRICE:
WORK TYPE: NEW CONSTRUCTION ADD ON REPAIR
DESCRIPTION OF WORK:
IS WATER METER REQUIRED7 _ YES _ NO. IF SO, PLEASE PROVIDE THE FOLLOWING:
WATER FLOW: GPM. ARE FLUSHOMETERa 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. SPRINY(LER PERMIT.
FEE: $25.00 minimum fee or 1% of contract price, whichever is greater. State surcharge of $.50 per
$1,000 of ponn3 fee due on all permfts.
CONTRACT PRICE x t%
STATE SURCHARGE
TOTAL
SITE ADDRESS:
TENANT NAME: STE. #
OWNER NAME:
INSTALLER:
ADDRESS:
CITY: STATE: ZIP:
PHONE SIGNATURE:
APPLICANT
OFFICE USE ONLY
METER SIZE: DATE: INSPECTOR:
CITY USE ONLY
L~ BL I RECEIPT
SUBD. DATE:~94'7
1996 MECHANICAL 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
_54- New construction Add-on fumace
Add-on air conditioning Add-on air exchanger, i.e. Vanee system, etc.
Date:
PEES
? Minimum Fee: Add-on/Remodel (existing residence only) $26-66
? HVAC: 0-100 M BTU 24.00
Additional 50 M BTU -6:99
? Gas Outlets (minimum of 1 required @$3.00 each) z _oo
? State Surcharge .50
TOTAL ~.30,Sa
SITE ADDRESS:
OWNER NAME: /flel,/ A.wes PHONE
INSTALLER NAME: ~ "4ll d
STREET ADDRESS: F~/;L
CITY: STATE: ZIP:
PHONE
~
SIGNATUR
CITY USE ONLY
L • BL RECEIPT
SUBD. DATE:
1996 MECHANICAL PERMIT (COMMERCIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
(612)681-4675
Please complete for: ? all commercial/industrial buildings.
? multi-family buildings when separate permits are ~ required
for each dwelling unit.
DATE: CONTRACT PRICE:
WORK TYPE: NEW CONSTRUCTION INTERIOR IMPROVEMENT
DESCRIPTION OF WORK:
FEES: $25.00 minimum fee gl 1% of contract price, whichever is greater.
Processed piping - $25.00
State surcharge of $.50 per $1,000 of p~r j= fee due on all permits.
CONTRACT PRICE x 1%
PROCESSED PIPING
STATE SURCHARGE
TOTAL
SITE ADDRESS:
OWNER NAME: TELEPHONE
TENANT NAME: (InnaROVeMeNrs oNLv)
INSTALLER:
ADDRESS:
CITY: STATE: ZIP:
PHONE
SIGNATURE:
SIGNATURE OF PERMITTEE CITY INSPECTOR
L B~
SUBD
NEW BECEIPT {i 7/8//
RECEIPT DATE
DATE ~
TO C v`-~'~ti Y l l./
.705 n
OWNER
PLEASE BE ADVISED THAT THEBE IS A FEE SHOBTAGE ON THE ABOVE
ELECTRICAL INSTALLATION IN THE AMOUNT OF $
SHORTAGE MOST BE PAID WITHIN 14 DAYS.
REMARKS
G~0 - 30 AMP CIRCUZTS
31 - 100 AMP CIRCUZTS =
0 - 100 MiP SERVICE _
r 101 - 200 AMP SERVICE _
TOTAL FEE DUE
LESS FEE RECEIVED
_ TOTAL FEE SHORTAGE DU°
PERMIT It~~ S
/
ORIG RECEIPT ll(~07,3
RECEIPT DA2E___1~L~S~~f~/ % -
PLEASE RETURN A!'OPY OF THIS FORM WITH YOUR BEMITTANCE.
THANK YOU! .
i~
2007 RESIDENTIAL PLUMBING PeRnniT aPPUCarIoN
CITY OF EAGAN c
3830 PIIOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please com lete for modifications to existin residential dwellin s.
Datel30 / 01-~
Site Street Address ~ l V6~YU~ aS ~Gy' UlA Unit #
Property Owner l ~ 6 6S byl Telephone ?
Contrector_ _ J6ds _~{U,VVI~~ Vlp1 Telephone# ,61a Aa'Mloa
Address as S.Suhm vta Clty C5Tta-kx State_"1 _ Zip 5535"~
The Applicant Is: _ Owner & Occupant Licansed Plumbing Contractor
SepUc System _ New ` Refurbished Submit 2 sets of plans and MPC license Includes County fee
$ 100.00
Per as-built $ 10.00
Fire Repair (replace burned out flxtures, etc.) $ 90.00
This fee a lies when extensive umbin reairs are made to a buildin .
AlteraUons to existlng dwelling $ 50.00
_ Add plumbing fixtures to main level lower level. This fee includes
instailation of a water softener and/or water heater at the same time. lf you are
installfng only a water softener anaVor water heater, do not complete this secfion;
move to the next sedion and place a checkmark next to the appliance(s) you are
installing.
_Septic System Abandonment
_ Water Tumaround (add $136.00 'rf a 5/8" meter is required)
Other:
Water Softener _ Water Heater $ 75.00
_ new _ replacemern
~ Lawn Inigation _RPZ PV ~ _new _repair _rebuild $ 30.00
State Surcharge $ .50
Total $
I hereby apply for a Residential Piumbing Pertnit and acknowledge that the information is compiete and accurate; that the
woric will be in conformance with the orclinances and codes of the City of Eagan and Me plumbing codes; that I
understand this is not a permit, but only an application for a permit, work i ot to start without a permit and work will be in
accordance with the approved plan in the event a plan is required to b ev'ewed an pproved.
~~~1l~?1 /~Ct/fi'.--. ibA- Gv~~ ~
ApplicanYs Printed Name Appli s Si ature \
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 4201 Thomas Lake Rd
Lot: 001 Block: 001 Addition: Wexford
PID:10- 83850- 010 -01
Use:
Description:
Sub Type: e - Air Conditioner
Work Type: New
Description: Air Conditioner
Comments:
Fee Summary:
Contractor:
Haley Comfort Systems
122 West 3rd St
Hastings MN 55033
(651) 437 -0338
Quesetions regarding electrical permit
445 -2840
Larry Leacock
15966 Fennel Ct.
ME - Permit Fee (Replacements)
Surcharge -Fixed
Total:
Applicant/Permitee: Signature
PERMIT
City of Eaan
- Applicant -
Permit Type:
Permit Number:
Date Issued:
Permit Category:
equirements should be directed to Mark Anderson, State Elec
Owner:
Donald M Johnson
4201 Thomas Lake Rd
Eagan MN 55122
$50.00 0801.4088
$0.50 9001.2195
$50.50
Issued By: Signature
Mechanical
EA089353
05/27/2009
ePermit
cal Inspector, (952)
I hereby acknowledge that I have read this application and state that the informa
of Minnesota Statutes and City of Eagan Ordinances.
on is correct and agree to comply
h all applicable State
Use BLUE or BLACK Ink
I For Office Use
A&6-
City O1 Ea o Permit#
of nall I Ip
I Permit Fee:
3830 Pilot Knob Road I
Eagan MN 55122 Date Received:
Phone: (651) 675-5675
Fax: (651) 675-5694 I Staff:
I
I
-72014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: ~ //q - Z0 I4 Site Address: ~ 2O ~ Tlr~,-SAS kO- F-C~ ONi0 Unit
Name: 4J01-i Nf-o K kw9 Kam-`~.~•e._ Jo~\ vISQNPhone: t 9SZ^0 RIY0
Resident/
Owner Address / City / Zip: 20 1 Th o it-NR S tic.` (Z c q,7
Applicant is: Owner -k- Contractor
i
Type of Work Description of work:- `Za of
Construction Cost:W ly, c~0 0 Multi-Family Building: (Yes / No
Company: _ A "jar CA ~J'C'Q-I~L~ r, OF Contact: S 2 y.Q Woc, ^3.q-
Contractor Address: E-( 223 \4e,/,Fo n tam, City: L&L~n~ a
State: v-) Zip: S,51 Z'Z Phone: _
License#: Lead Certificate
I If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
~ ~ rs p rl t
y --I
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING I
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
I
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor:
Phone:
Sewer & Water Contractor: Phone:
5 ~
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
I_ 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.qopherstateonecall.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
days of permit issuance.
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