994 Ticonderoga Tr ' • ~ ~ ' CITY OF EAGAN ~ z ~ 7 ~ ~
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHON E: 454-8100
BUILDING PERMIT Receipt#
To be used for ' Est Value ~ Date ~ ,19 ~
Site Address ~ OFFICE USE ONLY
Lot Bloc~C` Sqc/Sub. L~XlAiG'TON :~(!CA~ OnSiteSewage _ Occupancy
y MWCC 5ystem _ Zoning
PefCBI NO. , On Site Well Type of Const ti
City Water _ (Actuai~ _.y_
a Name (Allowa6le)
W # of Stories
3 Address ' Length `
° City Phone 1`' j~'~ Depth
S.F. Total
, p Name Footprint S.F.
~ i Address APPROVALS FEES
~ City Phone Assessments _ Permit
F Q WateUSewer _ Surcharge
F W IVame Police _ Plan Review
= o Address Fire _ SAC, City
Engr. _ SAC, MWCC
~W City Phone Pianner _ Wate~Conn.
Council _ Water Meter
I hereby acknowledge that I have read this application and state Bldg. Off. _ Road Unit
thattheinformationiscorreCtBndagreetocomplywithallapplicable APC _ TreatmentPl
State of Minnesota Statutes and City of Eagan Ordinances. Variance _ Parks
Copies
Signature of Permittee TO7A~
1 [ .,i" . •1C,c':-, Y
A Building Permit is issued to: vn the express condition that
all work shall be done in accordance with all applicable Sta ~ql ~linnesota Statutes and City of Eagan Ordinancea
Building Official ~
P~rmit No. Psrmit Molder Dats Telsphon~ ~k
Plumbing ~r1 L~ ~5` 6 Gt..(:''; r Lli~ 7
~ ? ~
H.V.A.C. ~ 7~jLC `~~'a~ G'/9 8
Electric ~ /Cr ~ ~
Softener ~ ~ ~ 8 ~ ~ ~
Inspection Date Insp. Commsnts
Footings I
Footings II
Foundation ~ ~ - ~
Framing 7 ~
Roofing
Rough Plbg. i~~
Rough Htg. ` 7 L 7
ISUI. ~ /I~o~' I~Ga.c~ 7/~ f k-~-
Fireplace
Final Htg.
Final Pibg. ~ f
Bldg. Final ~ ~
Cert.OCa --d~ ~'•fl• Nacc~s s an~e G~~ ~
Temp. LP i(jGcc...a~ ce.,~e,. w~ Il -sk -~'w c..
Deck Ftg. ~ ~P d 4~
Deck Frmg.
Well
Pr. Disp.
~ T 'r r..T . . . , - r- . ; . . . . s... _ . _
~ ' , , ' PERMIT # ~ ~ ^~~~0~~
PLUMBING PERMIT RECEIPT # ~'S`-~ ~
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE ~r
CONTRACT PRICE: PHaNE: 454-8100
Site Address << . BLDG. TYPE WORK DESCRIPTION
Lot Block ~ Sec~Sub Res. New
r
• ~ Mult. Add-on
~ Name Comm. Repair
~ Address Other
c City ) Phone RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
NO. FIXTURES TOTAL
Name ' Water Closet - $3.00 S
~ Address ~~th Tubs - $3.~0
~ Lavalory - $3.00
p City Phone : ~ Shower - $3.00
~ Ki?chen Sink - $3.00
FEES Urinal/Bidet - 53.00
COMM/IND FEE - 1°rb OF CONTRACT FEE ~ Laundry Tray -~3.00
APT. BLDGS - C~MM RATE APPLIES ~ Floor Drains -$1.50
TOWNHOUSE 8~ CONDO - RES. RATE APPLIES ~ Water Heater -~t.50
MINIMUM - RESIDENTIAL FEE - $12.00 Wh~rtpool - $3.00 -
MINIMUM - COMM/IND FEE -$20.00 ~ Gas Piping Outlets $1.50
STATE SURCHARGE PER PERMIT - .50 (MINIMUM - 1 PER PERMIn
(ADD $.50 S/C IF PERMIT PRICE GOES Softener -$5.00
BEYOND $1,000.00} Well - St0.0~
Private Disp. - $10.00
Rough Openings - $1.5Q
~ . s-'~, : .-i t'- ~
SIGNATURE OFPERMITTEE FEE: '
STATE S/C:
FOR: CITY OF EAGAN GRAND TOTAL:
" , .~~:.w~ w . .W~.S.
` ' r^ ' _ ~ ' . ~ . . . - . , ~ . ' . .
• , PERMIT # ~ 7 ~O
' • ' MECHANICAL PERMIT RECEIPT # ~
CITY OF EAGAN p ~
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE 7`'
CONTRACT PRICE: ~ PHONE: 454-8100
Site Address ~ BLDG. TYPE WORK DESCRIPTION
Lot ~"f Block Se~%Sub R~ ~ NeW ~
~ Name ~ <i ; MuR Add-on
Comm. Repair
~o Address
c Ciry ~ ~ hone Other
Name ~ ' r' ; FEES
~ RES. HVAC 0-100 M BTU -$24.00
c Address ADDITIONAL 50 M BTU - 6.00
p City % Phone ~ (RES. HVAC INCW DES A/C ON NEW ~
CONSTRUCTION)
_ - _ - _ GAS OUTLETS (MINIMUM - 1 PER PERMI'n - _.1.50 EA.
TYPE OF WORK COMM/IND FEE - 1°ib OF CONTRACT FEE
Forced Air 1~?.' ~'M BTU ~ APT. BLDGS. - COMM. RATE APPLIES
TOWNHOUSE 8 CONDOS - RES. RATE APPLIES
6oiler M BTU MINIMUM RESIDENTIAL FEE - ALL ADD-ON ~
Unit Heater M BTU REMODELS - 12.00
Air Cond. ; M BTU ~ MINIMUM COMMERCIAL FEE - 20.00
Vent. CFM ~ STATE SURCHARGE PER PERMIT - .50
Gas Piping Outlets # ' ' BEY ND $1,Opp) PERMIT PRICE GOES
Other R
FEE: ~ ~
•j-
S/C: ' SIGNATURE OF PERMITTEE
TOTAL• ~ `
FOR: CITY OF EAGAN ~
~ ~ ~ ~ ~ ~ ^ . ~,-T
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE: ~ ~ ~ ~ ~
3830 Pilot Knob Road Permit Number: ~~?',+1
Eagan, Minnesota 55122-1897 Date Issued: '
(612) 681-4675
SITE ADQRESS: ~ ' ' 9 ~ ~ ~ ` ~ APPLICANT:
s ! ~:I h? r~~~r. :
1 I f1~ai~F 1 i- i. :)r.. I:. ,
I i'x iMr,T+~~ '";+i1~lifii i~ 1!I . ~ , y
PERMIT SUBTYPE: TYPE OF WORK:
~ , ~ .
, ~ ,
. .
~ ~
~ ~
Permit No. Pertnit Holder Date Telephone N
ELECTRIC
PLUMBING
HVAC
Inapactlon Date Inap. Comments
FOOTiNGS
FOUND
FRAM~NG
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
R~UGH
HEATING
GAS SVC
TEST
INSUL
GYPBOARD
- FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FiNAL
BSM7 R.I.
BSMT FINAL
DECK FTG
DECK FINAL
, ~~<~~7~
~ . 'R,`~"_° _ . - . . : -\tr , . .
~ . _ _ . , .
f~~r#ifir~tP ~f (~rru~~tnr~
. • ~Citp of ~agan
' ~p~iBYhriPltf Af ~1t~I~ ~tiS~Ptt~Dtt
T7ris CertiJtcate rssued pursuaat to the requirements of Seclion ~06 of the Unijorni Building
Code certijying that at the ti~ne of issuance this structure i?sas in complirrnce with the various
ordirrances of the City regulating building construction or use. For the following.•
use c~ficauon ~i' ~.'IJC; ~"r;l: ew6. Ptm,n No. ~ i?=
p~p~p~y Type ~~.5 Zonio~ piwict • 7ypn Const ~
Owner of Buildi~ ~ Address t' , i
i ~3 ~(~Q
s~,aa;~naa~ _~?C~`r~,~'~~ IY.r~Tf. ~~~4, i;~, i~7{L,FG1Cltd 9C~L'~~?~ r3~1
o,~: nilGilST 20. 198~
e~e;~g o~,~ -
POST IN A CONSPICUOUS PLACE
- -~g'TM-
Dat~ 6--1 ! 7
CITY OF EAGAN Permit No: ~ ~ oe
B~s Size:
3g30 pllot L:notf Road Meter No: p ~ y as~ pate: ' y
p,p, gcx 21199 Reader No:
. Eagan, MN 55121
Owner. Rottlund ~ • ~
i?~ T~ ~ T c [ tl tQ`~ , n U~11
.Site Address: 49 ~ ~i~~n ~ ~ r~
'Plumber Vaile P1 bin~~
P1 -
' sz~ no a ~ ~ i
~Conn. Chg: t5. c)0 d ~ 11~8C~ ~
Acci Dep: ~ , ~e ~gg1
Permit Fee: lt ~ r1 gr~~
c~'~y ,Nith the Cihr o1 Eayan
Surcharge: ~~0~ ~ ~
1 ~ ~e
Tr. Plant
Meter. ` r By
Misc.:
WATER SERVICE PER
_ ~ _ _ _ , . . _ ~,:;~s~- --r~°
_ - ~ 8a2~ Date: ~+_tt-87
CITY OF EAGAN Permit No: Size:
3830 Pi~t K~o~--R°ed Meter No: Date:
. P.O. Box Zt199 Reader No:
Eaga~, ~N 55121
Owner. `-cttiund Co~: ~n
~94 TicondexQ4~~ Tra '
Site Address: Vall Plumbin^
Plumber. r. ~
5~ 5 OOpd Zoning: ~
Conn. Chg: 1S No. of Units:
Acct Dep:
1`)-~~ wRh the C•tll? ot Eagan
Permit Fee: ~ egree to comply
5urcharge: 1~ ,y ' ~n Ordfnances.
Tr. Plant 1
Meter. ~ By ~
Misc.: '
WATER SERVICE PERMIT
l
~ CITY OF EAGAN SEWER SERVICE PERMIT_
g~?7-C '
~ p~~ Road pERMIT NO.: _ ,
~ P.O. Bwt 21199 ~ - -
~ DATE: 1
Eagsn, MN ..~121i No. of Units:
I'~ ZOrlit'vg:r itUt und Company .
' Owner. ton S ~'rh
Address: con ero~a Trai L2 R2 I.exins
~ Site Address: a eq in~; 10~ . OOpd
E Plumber. _ S~S n~?nd
~ I~g~ to compM w~ Connection Charge: i~ n~~~
~ Accou~t Dep~~t~ l~ ~~4d _
; Ordlnances. , • ' Permit Fee: ~n~
~ Surcharge:~-
Misc. Charges:
BY Totsl:
~ Date of tnsP•~ D~ p~id:
I Inap.: -~--r.~
;
This roduest voitl "7'/ C U
/8 mon[hs fmm ~ ~ T7
D~7 4,~0~5` a° ~ ;~/7
Reqvest ate ire No. uPh-in Idsp~cUon
fi qwretl? ~ReaAV Now~Will Nutify, Insoec-
- Yes ~NO ~or When qeady
? Licensed ElecVical Con~ractor I hereby request inspection ol abova
? Owner electrical work installed at:
Str ei dress Box or te No. Cit
liC J/ 1
ecllo~+ o. ownship Name or No. Rai g o. Cow~ry
Occ nt IPRI T) Phoue No.
1/ .
Power SupDlier Atltlress
1
Elac cal Convactor ICompafiy Name) ~ Co ;r's Licen~No,
~j-u'- 1 i
r,
M iline A Iress (ConVactor or, wner kinP ~~stailatioN
I v~ ~
f
Aut ized Si9nature onvactodOwner Makin Installationl one r~--
~ CJ
MINNESOTA STA e ND Oi ELECTPICITY THIS INSPECTION PEQUEST WILL NOT
Gripes•Midwey BIAg. - Room N-791 BE ACCEPTE~ BY THE STATE BOAND
1821 Universitv Ave.. St. Peul, MN 5570C UNLE55 PflOPEP INSPECTION FEE IS
P~one(6121642-0800 ENCLOSED.
jp/~~/8~ REQUEST FOR ELECTRICAL INSPECTION ea-ooooi-o
1 See inslructions lor completine ~his form on beck o~ Yellow copy. .~i
L 7$~7
`~7 4-'4 '"X" Below Work Covered by lhis Request
Add PeD~ ivpe oi 9uilEinB AoP~~~~~ee Wired Equiument WireA
Home Range Temporery Service
Duplex Water Heater Lightfny Fixtures
Apt. Building Dryer Electric Heaun
Commercial Bldy. Fumace Silo Unloader
Industrial Bldg. Air Conditioner Buik Milk Tenk
Farm O~hei uec~ v iherlSner.ilvl
i er uccity ther pthur
ompu[e Inspection fee Below
N Fee Servica Entrance$ize H Fee Fexders~5v~lewders N Frte Circuits
U to 200 Amps 0 to 30 qm s 0 m 30 Am s
Above 200 qm~~y, 31 to 100 qmps 31 to 700 qm s
Swinming Pool Above 100_Am s Above 100_A~n s
Transiormers Irrigation Boort~s Pdrtial.~Other Fee
Signs Special Inspection S)
TOTA FEE~A~
flemerks ~
Hough~in D:rte I, the E
r Inspector, heraby
cerUfy thnt the ebove
Final e/~ i~spec~ion hes been
• a 7 ,,,aaa.
t
(hle repueat void 18 monthe Irom
ihis repuest void q/~/p~ - ~
78 mon~s from` ~ ~
D 14227,c~~ = y~. , , .r~
R quest Date ' Fire No. uph-in Ins ction
quiretl? ~Reatly Now W~II Nmity Inspec-
- Yes ?Nu tor When Ready
? Licens~Electncal Contractor 1 hereby requast insoec<ion of above
~ pµ~~a~ eleclrical work instelled et:
S[r e~ Address, Box or Routa No. ~'~v
~ D ~ ~
ecuon o. Township Name or No. Range No. Cou ty
Oc enl IP NT) Phune No.
P r Supplier ~+dtlress
Ele rical Cnnlrector (Coh~pany Nam I Comrar.lor's Licensa o.
r~ -
Maf mB d ress (C=nba or or Owper Ma ~ Ins~aila~ionl
%lLC ~
Author' ed ~BRalure lConVa d wner Making Installatinnl Phone Number
f
MINNESOTA STATE APD OF ELECTPICITY THIS INSPECTION NEQUEST WILL NOT
Griggs-Midwey Bldg. - Room N-791 BE ACCEPTE~ BY THE STqTE BOARD
1821 Universitv Ave.. St. Paul. MN 55t00 UNLESS PXOPEN INSPECTION FEE IS
Phone (612) 642-0800 ENCLOSED.
~~~/,y j` REQUEST FOR ELECTRICAL INSPECTION ~esy-xooono/i-o/s-
f 1 Seo inshuc~ions for compleGng this form on back ot vellow copy. /.lG~ tOl(/
D 7 "'X" 8elow Work Covered by lhis Request
AAd Rep. Tyoa oi eulltling Applinncae Wired EpuiVmeN WireA
Home Range Temporary Service
~uplr.x Water Heater Liqh[iny Fixtuies
Apt. Building Dryer Electric NBaUn
Commercial Bidy. Furnace Silo UnloaJer
Industrial BIAg. Air Conditioner Bulk Milk Tank
Farm Otner pvc~ v ~nee lsn)nltyl
~ l:f SUCCIIy ~M1f~! n~~1L`!
ompute Inspection fee Be/ow
p Fe ServfceEnhanceSiza n Fee Faxders~5ubleeders % Circuits
U to 200 Am s 0 to 30 Am s 0 tn 30 {~in s
Above 200 qmps 31 to 100 qmps 31 to 100 Am s
Swinxning Pool Above 700_Am s Abave 100_Amps
Transiormers Irrigation &wrris Pertial.'Other Fee
Signs Special Inspecti~n .
Xertwrks TOTAL E
' ~ 7i00
Nough-in' D~ r the E ql
~~~0 ~ InsOactor, hereby
cer~ily that tha above
Final '~1e ~ ingpection has bean
? l
made.
mla request void 18 moniha from
- CITY OF EAGAN nJ~ 13 7 3 3
3830 Pilot Knob Road, P.O. Box 27-199, Eagan, MN 55121
PHONE:454-8700
BUILDING PERMIT Receipt# "f'~"d
Tobeusedfor SF DWG/GAR Est.Value ~93,000 Date .1UNE 8 t987
SiteAddress 994 TICONDEROGA TRAIL OFFICE USE ONLY
Lot 24 Block ~ Sec/Sub. LEXINGTON SQUAR OnSitesewage Occupancy R3
6TR ADD Mwcc syscem X zonin9 Rl
Parcel N0. On Site Well Typa of Cons[ ~7
City Water X (ACtua~
a Name ROTTLIiND COMPANY (Allowable)
w tc of Stories
= Address P•0. BOX 383 Length -T+~
o ~ity OSSEO Phone 571-0304 oePm ~
S.F. Total
a Neme SAME Footprint SF.
.o
~Q Address APPROVALS FEE5
~ City Phone Assessments _ Permit $ 479.00
weter/Sewer Surcharge ~6._50
~w Name Police _ PlanReview 239 50
t= Fif¢ _ SAC, Ciry lOO.OO
x - Address
~a Engr. _ SAC,MWCC 525.00
aw City Phone Plenner _ WaterCOnn. 595-f1p
Council _ WaterMeter ~7 np
I hereby acknowled9e that I have ~ead this application and state BIdg.Off. _ Road Unit ~rn~
thatiheinformationiscorre nda9~eetocomptywithallapplicable APC _ TreatmentPt i_zReT,n
n0
State of Minnesota Statute nd Cit{ of Eaga O dinence Variance _ Parks
Copies
Signature of Permittee TOTAL $2_, 467.00
A Building Permit is issued to: ROTTLUND COMPANY on the expiess condition that
all work shall be done in accordance all applicabl tate of Minnesota Statutes and City of Eagan Ordinancea
Building Official
s
RESIDENTIAL
f • ~S S(r,3 BUILDINC PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EACAN MN 55122
651-681-4675 Q~ ~
New Construction Raouiremenfa RemadaUReoair Reauirements
• 3 registered site surveys showing sq. ft, of lat, sq. ft. of house; and all roofed areaz • 2 copies of plan
(20% mazimum lot coverage allowed) . 1 set ot Energy Calculations for heated additions
• 2 copies of plan showing beam & window sizes: poured found design, etc.) . 1 site survey kr e~enor addNons 8 decks
• 1 sat al Eneryy C~culations . I~icate if hwne served by sepUc system for addilions
• 3 wpies of Tree Preservation Plan if lol platted after 711/93
• Rim Joist Detail Options selec6on sheel (bldgs with 3 or less unMs)
DATE ~ ~ t l ~UZ' 'f~r-rQ ~
VALUATION~ '~`(!G7JC~~
51TE ADDRESS ~7 y/ l~~nd`'e ra~a4 Tra.~ ( NIULTI-FAMILY BLDG _ Y _ N
TYPE OF WORK SCd~'Y{A FIREPLACE(S) _ 0_ 1_ 1
APPLICANT ~ ~ e-
STREETADDRESS Iaa t/~ Nc:co/~e.~' !`tr~c S~ CITY Rurngv.l (e.STATE1QLZIP SS33~
TELEPHONE # CR5 yj ~o ~ -69S~ELL PHONE # FAX <95.~! ~JE~s ~ ~3v~
PROPERTYOWNER (~~V'I~ ~~2-u.I5ov~- TELEPHONE# C~~~~688-b364
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ ,ylIYNESOTA RULFS 7670 CA'C~GORY 1 MINNF,SOTA RULES 767`l
(J submission type) • Residential Ventilation Category t Worksheet Submitted • New Energy Code Worksheet Submitted
• Energy Envelope Caiculafions Submitted
Plumbing Contractor: _ _ Phone # _
Plumbing system includes: _ Water Softener _ Lawn Sprinkler Fce: ~90.00
_ Water Heater _ No. of R.I. Baths
_ No. of Baths
Mechanical Contractor: Phone # ---""i
Mechanical system includes: Air Conditioning I~~(j? ~Iti~e`:4~ ~Z ~
_ Heat Recovery System `
I~ SLP 1 8 2002 U
Sewer/Water Conhactor. . _ -..-Phone #~L
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 Stptutes and City of Eagan inan~ 5./ Q~ C'~ ~J
SlgnatureofApplicanf ° n ' ~
OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4102
OFFICE USE ONLY ,
? Ot Foundation ? 07 O5-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ex[. Alt - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 OS-plex ? 18 Deck ? 23 Porch (screened) ? 36 Multi
? OS 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? O6 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
? 31 New ? 35 Int Improvement ? 38 Demolish (Interiar) ? 44 Siding
? 32 Addition ? 36 Move Bidg. ? 42 ~emolish (Foundation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)` ? 43 Reroof ? 46 WindowslDoors
? 34 Replacement "Demolition (Entire Bldg only) - Give PCA handout to applicant
Valuation Occupancy MC/ES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of 81dgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footings (new bldg) FinaUC.O.
_ Footings (deck) FinaVNo C.O.
_ Footings (addition) Plutnbing
_ Foundarion AVAC
_ Drain Tile Other
Roof _ Ice & Water _ Final Pool Ftgs AirlGas Tests Final
_ Framing Siding Stucco Stone
_ Fireplace _ R.I. _ Air Test _ Final Windows (new/replacement)
_ Insulation _ Retaining Wall
Approved By , Building Inspector
-
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
~ ~
~ ~
~
.3
1987 BQILDING PERN~i' ~PPLICAYIOH - CITY OF EAG9N
SINGLE FAMILY DWELLINGS
IHCLIIDE 2 SETS OF PLANS~ 3 CERTIFZCATES OF S08VSY~ 1 SST OF ENERGY CALCQLATIOHS
HOTE: ADDRESSES FOR CORNEE LOTS - CONTRACTOB/HOMEOSiNEH MQST DESIGHAifi WHICH 9DDEESS
IS DFSIRED. NO CH9NGES AILL BS ALLOWED ONCE BIIILDZNG PERMIT IS ISSOED.
MQLTIPLfi DSiELLINGS - RFSIDSNTIAL RENTAL DBITS FOR S9LS O~ITS
INCLUDE 2 SETS OF PLANS~ CERTIFICAYE OF,SORVSY - CH6CB iiTTH BLDG. DfiPT.,
1 SET OF ENERGY CALCULATIONS
COP4~BRCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
t SET OF SPECIFICATIONS AND 1 SET OF
ENERGY CALCULATIONS,
$2,000 LANDSCAPE BOND ~
°l3.~0
To Be Used For: `s~ FAM! L7
~w r+ i~vG Valuation:`'~~ Date: S
Site Address qq~T1CnNDtrz6 Gq OFFICE OSE ONLY
7KA I(.
Lot ~ Block On Site Sewage_ Occupancy F~ 3
MWCC System ,i Zoning (~'~I
Pareel/Sub On Site Well Type of Const
City Water ? (Actual) Q
Owner ~.,~y/~/~' (Allowable) Y
0 of Stories
Address Po.L~nX.2k3 Length 4
Depth 4-O
City/Zip Code nuE~ MN ,5'S36q S.F. Total
Footprint S.F.
Phone ,$'~/-~z6-4 APPROV9LS FSBS
Contractor ~ MC Assessments Permit
Water/Sewer Surcharge 4l0•-
Address Police Plan Review 3R so
Fire SAC, City ioo.
City/Zip Code - Engr SAC, MWCC S 2 S.
Planner Water Conn $LS.
Phone Council Water Meter (o-l
Bldg Off , Road Unit 3~5,
Arch./Engr. ~y/h,s APC Treatment P1 ~gp.
Variance Parks
Address Copies ~
TOT6L
City/Zip Code -
Phone 41 ~
~~O ~ 4r-~ ( 3 ZO r~ S~ = l7 ~ c~ ' . ` ~ `
, ~
y "~3 ~ ,
~K ~O- Cqo x ~8 .i,
~ Z- X l O ~ f 2_~ = ~ ~ ~O
22,~ 20 =~~~,0 ( 2 = S 28~
~22~0
- I
,
,
QL~ LQ17lJI~7lIIBS . ~ 6R75 Highwny 65 KE. P.O. 6ox 32308 Min~eapolis, F1N 55~32 (6 121 571-6~66
SU~URIIAM ERfGlNEERIlUG. IN~C. ,2zosN~«ue~a~e.so. u~.~,~+ne,Mr+sss3~ raiz~evnosin
Clu~( Mumalyul d Enuronma~ml Enybwn~ny ~ LonJ ~nruev~^y ~ lanJ PMnnwg ~ Soil Tesu~g
Certificate o! 6urvey tor 4fI ~ Q GOmpan
~ ~
Bearings Shoun Are Assumed '
o Deno[es Iron Honument - .
~ Denotes Foundetion Corner Offset Stuke. PROPOSED II.EVAT~ONS ~ ~
z Deno[es Esis[ing Eleva[ion ,
O Denotes Proposed Eleration . Top oE B18ck 9 o Z.~
Deno[es ?irec[lon of $urface Drainage Lovest Fioor ~•8
Dena[es Dratnage and OCility Eesemen[ Garage Floor a/.7 ~
- Tra~l
~condero a _
~ Scate: 1 Inch =SD. I¢et
w a°~9•`° ,5'89°43'~a3:°~E " 9a~,s
?S.- o
~ ~ 99~0
~~q a - 5 ~°-s ~
, ~
~ 5 x v ~
~9 "I ~ i M
mJ oL7 cy0o.67
~joo.(el li5o 9ooR293~ /6.D ~ ,
I ~ ~'D91 ~
I o~z. 5 ~
V 933 ~ o
m I `?c
ti~D h ~ oy~ p, ^ v~~
~ ~ I " ~~o~~o~.h ~ ~ ~
~ ~ ` ~ ~9 ~ ~
q~ U~
~ a4.o _ L6 ~ 8 9S SS "
89~.85
I '
I I
r,
_ I -
i 1 I I / r
- - ,o ~ D,a~d~ ,.,,d Cl~,l;~y ~ _ _ :
93 ~3 5 Easemenf _ f o~'~' Z,q
•3 s. - h 84
04
s
~¢30~',~
Lot z~ , Block z
LEXINGTON SC~'~.DA~~ 6th ~4DL~iT10iV
Subject to easemen[s of record ~/Vo> ~EGORDE~ Dakota County, Minnesoia
I herebr certify tha[ this survey, Dlan or reyort wus"prepared by me or under my dSrec[ .
supervision and [ha[ I am a duly licenseJ Land Surveyor under el~e lnws of t6e Stute of
Minnesota. p1~ ~ -
Signed [his ~0 dey af ~ h•D.~ 19~/.
~.r_ Cnmpa~tles
. SU6UROAN ENGINfER7NG. INC.
~
NoC pv611shed: All right~.reserved .
CopprlBht 1987 $E Componles, Su6urban EnglneerlnQ, 1nc. Aoberf E Stransk . Ninrt.:tiicense No.
587300 ~~n3
,..„~,,..,_„.e,._...y.,.~~,.__.~..:,~,.~....W~,.._.~. . . . _ . _
, ' ~ AY s.~ p.~ • .
EXTERIOR ENVELOPE AVCRA6E~"U" COMPUTATION
owNER '~'kj F ~d"CTLU N~Y O
SITE ADDRESS ~qg Trcorv~~r~2~~~ (
RAIL
CaNTRACTOR SARh~ DAT~ . PHONE S7f-~3oS~
Determine working square footage of each.
~-I / 1 / _ , ~ 4, co°i
1. Total exposed wall area ~'~5 sq. ft. x .
2. Total roof/ceiling area ~ b'~y sq. ft. x r~z~ _`t2i `f~
Total exposed wall area above floor =)S U 2
, 2~`l.`tO
a. Total wall window area 3~
b. Total door area
c. Total sliding glass door area 7-`i~(n
d. Total fireplace wall area -
e. Total wall framing area (average 10%). ~~"1
f. Total net wall area above floor (U4 ~.`i
g. Total rim joist area F?~
Total exposed foundation area =
h. Total foundation window area
i. Total net foundation area above grade
Determine "U" value of each wall segment.
3'l,~K~y 2 1Y,~~i"2
a. b'/,9'X,S'Y ~ii,.l YX ~U~~ = 1'02 .~3
1gX~6~~ ^
b, •z a u, z ~ X~~U~~ = 5~ Y l~
c. ? i i~ g~~U,~ 0 5~~ = I 3~6Z
d. g nUn _ ° ~
e. 1 I-7 x"U" e o~,7 = 1 b 1 S
f. /U4G/,~ X.~~U~~ ,UYZ = y4,U
g ~ 6 B X ~.U„ ~~yp = ~,yZ
x nUn v
h.
i. x„U,~ , o~1G 3 u
3 ............................:.........Tota1 ° ~'~,5'~
If item II 3 is the same as, or less than item lll, you have met the intent
of SSC 6006(c)2.
Total exposed roof/ceiling area = 3~(
Total gross roof/ceiling area = / 6~~ ~
j. Total skylight area -
k. Total roof/ceiling framing area ~t~ ~
1. Total net insulated roof/ceiling area / S 3.~
Determine "U" va2ue for each roof/ceiling segment.
] Y. nUn _ .
k. ~i c°~ X~~U~~ ob2`r = 2 ~ G5'
1. 05"3(~ X ~~p,~ ,~25- _ ~8.`tU
4 Total =
If total of !l4 is the same as, or less than ~f2, you have met the intent of
SBC 6006(c)1. ,
To utilize t[~e total envelope system method, the values established by the
sum of items 1/3 and 114 shall not be greater than the sum of items #1 and ~i2.
i. ~~U,6i + z. y2,~E~ - 217i7
s. (~i8.37 + a. y/, U~" - 2'24,6 z
.
. , _ . . .
. ROOr/CEILTNG ~ ~
: Lr(j ~ . ConsLruclion ! R-Vril~ie
r 3 (i . 1. InLerior air £ilm , O.G1 '
~ 2. S/pi'~ C~YT~ f3 k.C~ S43
~ 3. f}LC1c....t/ /NSvt ~
A ~~14~n~
~ i`; (..{II
j}~ • ~ 4. £xterior air film (SROL•al o
• Vi.fT ~ til ° 3 ro~o.
. ` i_.( 1 ~ ~ ~ . . , V = ,O~S
• / ~ ..,,j, . . ~
~
, . • ~ .I~ , . • ,
Ven~ed HeaC flow ' • ' •
uP ~ , 1 . . ,
~ , . , ; , ,
~ , ~ , , ' ~ . , .
~ . ~
~zc. ~is , '
. ~ ~ r-,~....~ •
• : ' .
. . .
' ~ ~ 7.. Interior air film 0.61
+~~r~;•_~v-~.ui•n._tir.>-nc~t-...o.?nc..en~,ea - 2. y
L+. /rS. C?Yl~ I'~~=D 5S
- --=--r---i-rJ•----y-. 3. .,~5v~ ovc,z T.~uss 3~1 ~
i 4. Eaterior aiL film sti 1~ . I"
~ n Total 3 (e ~ ~ Y
~ I I I~ I1~,~~ _ I~~ V- .02~
~il l < < ,
,
`~J ~ ; 3 . : : , . ~ , . . ~ .
~
Y.eat flos~ up ~ ~ , . venCed. , . ~ ! ~ •
, . ,
I . ,
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• FIG. R6 ~ 9. • ,
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• - . . . ~ . ' ' . . ~ • . .
3 5 ~v 1. Insi.de ai.r f3.lm 0.G1
. e .nruf~a~ .
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S:
• r~ 1 9n1 .9.S~J=„~a • • .j. ' ' • • •
9~ •.o-1v~-~~ ;~;r.~:.~i:::':'-°'~
;~...••r~'~.-.~~.
' S. Outside air. fiLm 0.17
~
• To tal
•r . ~ ~ . .
~ , . .
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. . / . .
• NOi7-VII3TP.D ' Not•c: Use addi.tioi~al sheets •if more upace i~
• needed Eor deL•ails and calculatians.
~ . $eriC . , • , .
• , , flov ~p ~ •
.
. ~ . ~ Section T-C Page S
' iteplaces
~ Ftay 1, 1982 ' Diarch 18, 1983
~ ~ GNGINECRE~'GARAGE HEADCR'~~ ~ ~ ~`-~fi, ~
. _
','t,
' 1G'6 % 22 in Stock ,
NOTE: ~1AXI~IUP! ALLOWABLE TIE-IN SPAN 24'0" ROOF TRUSSES
(G50 LflS TOTAL PER LINEAI. FOOT :
. _ - ~=1~.
_ ~ ~ , , .
:
.
~ 1G'G x 22"
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AUTOMATED BUILDING COMPONENTS, INC. •
r~ ' ~ Component Plants ~a Kftchen Divislon .
Millwork Di~~sio~ 9 Excelsior, MN ~
Chanhassen,MN ~ Lon LBke,MN Chetek,Wl 1~ s~yJ4744111 ~
6121937-'JO60 . 612/477~7376 715/924-086~
~~~~~~~~~~~~~~~~~~~~~~~*~~~~~~m~*~~m~~~
CI7Y OF EFlGAN
CASHIEk: JS TERMINAL N0~ 33
DATE: 11/03/9i TIMF°a ~J:~~:Jl
l
ID:
NAME~ FLI~ER-IONCS
~
3210 9001 934 TICONI~EROGA ~~.fJ
2155 3001 974 TICQNDEhOGA 2.50
?n*.a1 ReceiF+, Amo~an+.: i.02.?5
CR0826iE1
USEfi IU: JAN
~kX~%c~?k~X~k~k%~~k~kX~~ %~#~~X~~X~X~X~k%~~X#~X#~~k %~~~k~kk~~k ~k~k~c~F
PERMIT
~ G~T'~'-~F EAGAN
3830 Pilot Knob Road P~RMIT TYPE: B U I L D I N G
Eagan, Minnesota 55122-1897 Permit Number: 0 31 @ 5 8
(612) 681-4675 Date Issued: 11 / 0 3/ 9 7
SITE ADDRESS:
99q TICONDEROGA TR
LO7: 24 BLDCK: 2
LEXINGTON SQUARE 6TH
P.I.N.s 10-45080-240-02
DESCRIPTION:
~~~r,~ (PATIO DOOR/WINDOWS) ~
~uil~#a~s~ ermit Type SF (MISC.)
~~11~in~ ~~lc Type REPAIR
~ ~~~nsi~~ t;saCfe. q34 ALT. RESI~ENTIpL
_
~
~~r4~
~
~
~ ~ ~ ~
' b~~~~ n. ~
y ' `~~a~a
e ~ ~
~ ~ ~ ~
ma
~ ~
~
a~ ~
~ ~
~
~
~ ~ ~ ~ .a ~
¢ ~~s~ ~
REMARKS:
FEE SUMMARY:
VALUATION $5,000
Base Fee $99.75
Surcharqe $2.50
Total Fee $102.25
.
~
CONTRACTOR: _ Applicant - ST. ~IC OWNER:
RENEWAL BY AN~ERSEN 15024777 200R063 PAUISON WERB
35~ 73RD AVE NE 99Q1 7ICONDEROGA Tft
FRIDLEY MN 55432 EAGAN. MN 55123
(612) 502-4777 (612)688-6369
i g' ~ e i P G~ x~ t C S FI iS ~ '1 $ xn F*b fl D
9 n - 1$
` `s . s . , . p ' v n
~ Yse~^~Ya;~z ~eEtrtow~~dg"s ttt~~ ~ ~~~x.Ne~sf 't~~~ a~~~~aa~~~~xrr ~"i~'d` r~~~~e ~~Z~,~ ~h~ '
~ir~'~ts~ana~~,oa~ .~s ctzrre~t arizl= ~~c~r~s,^ et~rti~~~ ~u~:'~~~~~ :~P~,~~#~.~ c~:~,1~~,=
~ , ~ - „
~~~a~ut~~sE~~nd c~t~! .o'~ ~aga~r~ ctr~da~a~~s~ c ~ ~ ~ ~
~ F e ~ , k r . ~ _ _ ~ .x..__ ..~a~
~.,n R~; ) ~
APPLICANTJPEqMITEE SIGNATURE ~ ISSUED B: 51 ATU
97 BUILDING PERMITAPPLICATION (RESIDENTIAL) .~~~z, ~
~ CITY OF EAGAN
3830 PILOT KNOB RD - 55122
681-4675
New Constructian Reouirements RamodeUReoair Reauirements
? 3 registered ske surveys ? 2 copies of plan
? 2 copies of plans (indude beam 8 window sizes; pourod fnd. design; etc.) ? 2 sda surveys (ezterior addkions 8 Cedcs)
? 1 energy calculations ? 1 energy plculatio~s Por heated atlditions
? 3 copies of tree preservation plan 'rf lot pfatted after 717Ig3
required: _ Yes No ~
DATE: I~ 2'"l CONSTRUCTION COST:
OESCRIPTION OF WORK: ~~A~-~ t P~T~O a~ A~1~ 2 w~~oaw5 /r~I I
J~IYI
STREET AppRESS: aQ`i 2~6/~ • T~ .
a
LOT ~ BLOCK SUBD./P.I.D. ~ ~
PROPERTY N8m2: _ P/.~~I.SGr~( ri-~(~ Phone#: _~~g' fi~~~ ~
OWNER
Street Address: Q~" ' T~ ~-~FlN p~ ~06,z1 . '~"'2 A t
City: ~~~~1 State: ~1 N Zip: ~s 1~
CONTRACTOR Company:~EY~I-C~J/1~. 6`~ Phone#: ~2"4~~7
Street Address:3S~ ~3 ~~JE ~E License 6~~
City: F2~oL~,'"~ State: ~'`r zip:S3~f3Z
ARCHITECT/ Company~ ~l ~r- Phone#:
ENGINEER
Name: Registration
Street Address:
City: State: 2ip:
Szwer & water licer.~ed plumber (new construction only): penaity applies when address change
and lot change arc ~ equested once permit is issued.
I hereby acknowledge that I have read this application and state that the information is correct and agree t comply with all applicable
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant: ~
OFFICE USE ONLY
Certificates of Survey Received _ Yes _ No
Tree Preservation Plan Received _ Yes _ No _ Not Required
OFFICE USE ONLY ~ ~
. ~ ,4c~
f ~
BUILDING PERMIT TYPE ~j~
? 01 Foundation ? D6 Duplex ? 11 Apt./Lodging ? 16 Basement Finish
? 02 SF Dwelling ? 07 4-plex ? 12 Multi RepairlRem. ? 17 Swim Pooi
? 03 SF Addition ? 08 8-plex ? 13 Garage/Accessory ? 20 Public Facility
? 04 SF Porch ? 09 12-piex ? 14 Fireplace ? 21 Miscellaneous
? 05 SF Misc. ? 10 _-plex ? 15 Deck
WORK TYPE
? 31 New ? 33 Alterations o 36 Move
? 32 Addition ? 34 Repair ? 37 Demolition
GENERAL INFORMATION
Canst. (Actual) Basement sq. ft. MC/WS System
(Aliowable) Main level sq. ft. City Water
UBC Occupancy sq. ft. Fire Sprinklered
Zoning sq. ft. PRV
# of Stories sq. ft. Booster Pump
Length sq. ft. Census Code.
Depth Footprint sq. ft. 5AC Code
Census Bldg
Census Unit
APPROVALS
Planning Building Engineering Variance
Permit Fee Valuation: $
Surcharge
Plan Review
License
MCNVS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
5/W Surcharge
Treatment PI.
Road Unit
Park Ded.
Trails Ded.
Other
Copies
Total:
SAC
SAC Units
UNDERGROUND SPAINKLER SYSTEM
PLUMBIIVG PERMTT
Date: Permit #
Date '~/~7~9/
,
Receipt # ~0/ 9 ~~f
_ Commercial: $25.50 + water tap if rr..~uired. (City installs all taps up to 1"). If
adding new service, a water permit will be required, as well.
~E~ostin~ residentiai: $15.50 (Plumbing permit not required if bacldlow preventor was
previously installed).
_ Residential developments: Fee to be determined by building inspections depamnent.
May require payment of water permit, plumbing permit, WAC, and water treatment
plant fees. Qa ~ ~ r,
i i ,
(Address to sprinklered)
Homeowner/Plumber: ~ / ~uiv~, ~~ccL,.,~ ~
Phone ~{Jr.r-~p~~
Street Address; ( 7 [ _~.~.e.Co L ~ ~
City, State, Zip: ~~,~7~~~~ ~ o__~~
Owner Name:
Street Address: _ `~Q ~ ,
Phone
7rrigation Contractor: _ irff,~,~o,. ~ ~
Phone
3~ ~z ~.~a - ~v,c~
I hereby aclrnowledge that I have read this application and state that the information is ~/U`
conect and gree to comply with ail applicable City of Eagan Ordinances
6!z,>~- -
cc: Engineering Department
. *******#*~******i~**#*if*4***#*****ty.
CITY OF EAGAi~ m~ *
~ * ~PROVnL oF P~r-uT. *
APPLICATION FOR PERMIT * *
* ~DCriorr oF sF.~ ~~rro/oR vu~zQt *
* TISSTAT.TA'i7ONS WII.Ti PX71' BE SC~IFD~ *
SEWER AND/OR WATER CONNECTION P~T ;
. ~ - ~ * APPRCNID. •
* ~t
r ~
* ~
•
. +*,r,t***t:*+**,r*rr t** **t**k*,r***:,ta+,t*
P ease Print
~~1) PROPERTY ADDRESS: qqy T--~_~~~ ~a . i
LEGAL DESCRIPTION: a4 a LcY sy « ~
(Lot/Block Subdivisi'on or Tax Parce~ ZD )
IF E7QSTING SIRL'CiORE, DATE OF ORIGINAL BL~ILDING PERMIT ISSCANCE: -
(Mon ear)
PRFSENT ZONING/PROPOSID L'SE:
~ CA^R~I2CIAL/RETAIL/OFFICE ~ R-1 SINGLE FAMILY .
Q II~ID[.'STRIAL Q R-2 DLPLEX (1ko Lnits)
[I INSTIZS.~TIONAL/GOV~]T ~ R-3 TDW[~iOC~SE (Three + Units) ( Units)
. Q R-4 APARTME~PP/COI~IDUMINiL~hi ( ' Units )
2 )
r~,r~'~;
'.«~°-'~"~~IN~a 6~ ING..
~~~s: 810 CREEK L~4NE ~
ci~. - sraz~, ziP: JORDAN. MN 55352
PHOI~: 4y3- al a i
3) ~ ~ c~• Fbr City C~se
- VA ~ F1/ PL M$ING CO. INC. P1~mibers i,icense:
a~t~ss: 810 CREEK IANE Q~~
ciTr, srax~, z~: ~ LJ
~ • - ~ Not recoraea
PHOt~: 4 y a-~~~ ~ MASTER LICENSE# a~,; ~ gt~
tlal
4) ~ i~•
N7Y~7E: Ro N l'.._d c~
_ ADDRESS: 3~ Y 3 a~ . :
CITY. STATE, ZIP: O sse.,
PHONE:~7{-uau~c
~5) i n - ~ r. : a • a~ • a~
~ cnr~r~crioN ~ crrr s~x ~ wrsmcriorr zu ci~r wP.z~ p omf~a .
6~ " ' Q P7~EFISE HOLD APPROVID PERMIT FC)R PICK-OP BY ONE OF ABOVE
~ PLEASE MAZI, ApPROVE9 PETtMIT TO 1~ 3, 4, ABOVE ~
~ (Circle one) ' '
7) r. n u• - ~ b~
' • Y" • Y' 1' ~ ' • 1 • I' ' ~ I7i• P Y91' • ~I• • • D~ • ~ ~
• r. • ~ ~ : o- «•r. •,e+ai ~ ~ ~ ~ a• • ~ r
. ~OR CITY USE ONLY '
PERMIT # ISSDED
Z Z ~
Pd w/Bldg. Permit FEES:
~ S ~C SEWER PERMIT (INCLUDE SURCHARGE)
$ $ /G'' S~ WATER PERMIT (INCLCDE SC~RCHARGE)
S (r'7` CJ O $ WATER METER/COPPERHORN/OL'TSIDE READER
S S WATER TAP (INCLL~DE CORPORATION STOP)
S $ SEWER TAP
S $ • U G ACCOUNT DEPOSIT - SEWER
S $ /,~j C~ ACCO~NT DEPOSIT - WATER
$ S z S- U" Z~ $ WAC
$ (i: Z S• Cf 27 $ SAC
S S ~ TRLNR.WATER,ASSESSMENT
' .
S - $ TRUNK ,$E~~; ASSESSMENT
S $ LATERAL BENEFIT/TRLNK SEWER
$ $ LATERAL BENEFIT/TRUNK WATER ~
$ I~ U' d[~ $ WATER TRF~ATMENT PLANT SL~RCHARGE
$ $ OTHER:
$ / / / ~ C~~ O $ J~~' ~ v TOTAL
- 74~5 3 3 7y s
~ S ,
RECEIPT RECEIPT
DOES UTILITY CONNECTION REQLIRE EXCAVATION IN PIIBLIC RIGHT OF WAY?
~ YES IF YES, THEN A"PERMIT FOR WORK WITHIN POBLIC
Q ROADWAY" MLST BE ISSLED BY THE ENGINEERING
NO DIVISION. LIST AS A CONDITION.
SUBJECT TO THE FOLLOWING CONDITIONS:
APPROVED BY: ~/~C~.~L~' [;-r.[~7L-o
TITLE:
DATE: ~ _ ~
4 CASH RECEIPT
~ :
• ~
. CITY OF EAGAN
- ~ 3830 PIL~T KNOB ROAD
EAGAN, MINNESOTA 55122
DATE ~ ' ~g
RECEIVEO ~ ~
FNOM ~ ~ ~ .f . '
AMQUN7 $ . I ,
& DOLLARS
+oo
? CASH Q CHECK
FoR ~r~ ~ r"~, i_ ~ ~ ~ ~ C__, '
,
. , r~,~~4 " ,
, ~ f ` / ? i _
~ FUNO C DE AMOUNT
Thank You
BY L-~ / L. liL t_
White-Payers Copy
Yellow-Posting Copy
Pink-File Copy
, ~
BLDG. PERMIT;NO. .
c ~ ' ~ ~
c_ , _ . '
~~y,. `~~,,~f `f'~,~„ ~,J .
01-3210 Bldg. Permi't_____ a U
01-3422 P~an Check U
. ~
01-3445 5urch./Adm.
_ ~
01-3446 SAC/Adm. ,S
01-2155 Surcharge S r~
17-3860 Road Unit ~~'S~ ' ~
20-2275 SAC 5'!y 7 ~
20-3865 Water Conn. ~o? ~
~ 20-3868 k'ater Trmt. ~ ~
20-3716 Water Meter ~ ~ ~ ~
~
20-2252 Acct. Dep.
20-3713 Water Permit
20-3743 Sewer Permit
79-3866 Sewer Conn.
1]-3855 Park Ded.
TOTAL ~ ~ ~
CASH RECEIPT
~
CITY ~F EAGAN
3830 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE ~ / 19
~CenEO . ( . ~
FROM ~ ~
l' ~c_: L- L t~ ~ r ~?``'t
~ i:t
AMOUNT $ jl ~ i V
/ ei L
8 DOLU?RS
~oo
? CASH I].CHECK
_ J
, ; r ,
'y .
ron ~;j Ll / i ) . - /
• ~ . . ~ y
~ ~y~~Gu ~ ~
,
;
,
~ ~ ~
FUND ECT ~ AMOUNT
Thank You
BY - _ i il~~~
wn~~e-~aye~s cov?~
r. •
~ ~ ~ ~ ~ velow--Fosnns ~Pv
} ~ ~ ~ - . ' ' RNc~Ne Copy
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