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580 Worchester Cir
City of Evan 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 JUN2 3 RECD Use BLUE or BLACK Ink Staff:cl� 2010 MECHANICAL PERMIT APPLICATION Date: (o ` \D Site Address: 3g C /# Ck f\t;Q Tenant: , �CYCA 5 \ Suite #: J RESIDENT / OWNER Name: c � ' Ju it )-11 Phone:,Ui j 9 — q &?5 5 Address / City / Zip: C WU?. Kj/ak_ CONTRACTOR Name: BURNSVILLE HEATING & A/C, INC. License #: t4e..2,Y1( 3451 W. Burnsville Parkway Address: Sults 120 City: State: zip:Burnsville, MN 55337 Phone: q,S Z -n (4 - + ..y..) Contact: Email: TYPE OF WORK New X' Replacement Description of work: Additional 4_� Alteration Demolition PERMIT TYPE RESIDENTIAL Furnace )‹ Air Conditioner Air Exchanger Heat Pum X Other COMMERCIAL New Construction Interior Improvement Install Piping Processed Gas Exterior HVAC Unit Under / Above ground Tank ( Install / Remove) ** When installing/removing tank(s), call for inspection by Fire Marshal and Plumbing Inspector RESIDENTIAL FEES: $50.50 Minimum Add-on or alteration to an existing unit (includes $.50 State Surcharge) $90.50 Fire repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) TOTAL FEE COMMERCIAL FEES: $70.50 Underground tank installation/removal OR $50.50 Minimum (includes State Surcharge) - If Permit Fee is less than $1,000, surcharge is $.50. - If Permit Fee is > $1,000, surcharge increases by $.50 for each $1,000 Permit Fee (i.e. a $1,001-$2,000 Permit Fee requires a $1.00 surcharge). Contract Value $ x 1% = $ Permit Fee = $ Surcharge = $ TOTAL FEE 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.copherstateonecall.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 lan in the case of work which requires a review and approval of plans. efieDnitil Applicant's Printed Name Applicant's Signature , . Ter#tf trate uf (Orr~panr~ . Citp af Cagan ~r~rarbnrtd Jof ~ iag jawrtinn This Cerdfxale ~SUed pursrwxt to the nqtdnmeatr of Serxion 306 of llu Unljorrn Building Codt Mrnf}Iitg ttiat a11he tlmt of istumwe rhlsstrucwr Kns In cnnrpfianoe wdtJt the various , orffirarrers of the Cit}' regulaQinB buUdinB c+onslruction or usa For tlre foUoxdng: ~ uK a.WT~ ~~/GkR mk nw" K,. 18426 0-4-T Type ' oi+ PD/R VN nia cann Ownrt d B~e~dq ~a ~ ~ 'k, L12, B 1, RELS CF SDONMUDCE NMM 21, 1990 , &acrlag Offidd aw^r iro A ooNswcuous ruce ,•CiTY OF EAGAN tB~Zs ` 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHONE: 454-8100 BUILQiNG kERMIT Receipt # ~ To beused for yF DWG/GAR EsL Value =91.000 Date- OC'r a , l9-9D_ Site Address SW WORCNES?ER CIR LOt iZ BIOCk 1 SeC/Sub. _~IL~~ OFFICE USE ONLY Parcel No. avna~ pccupancy R~ ~i FEES MITTELSTAEDT ~RO'THERS zoning i1 W Name (nctuaq const V- 81dg. Permit 599.00 I AddreSS 785 sUNBET DR (Allowable) V-N Surchar e 45.50 r Phone 456-9125 r or storieg 9 Cit EA" y Plan Review 389•00 Length o Name S~ Deplh SAC, City 100• 00 fl Address S.F. rotai - snc, Mcwcc 60o•oo City Phone S.F. Footprints - 625.00 r. On Sile Sewage _ Water Conn uName t= On Site Well Water Meter Address ti+wcc system x 3000 i W Ciry Phone cay water X ~t. oePos~i • PRV Required _ S/W Permil 30• ~ I hereby acknowlege that I have read this application and state that the Booster Pump - gryy Surcharge '50 inlortnation is correct and agree to comply with all applicable State ol 252.00 Minnesota Statutes and City of Eagan Ordinances. Trealment PI Signature of Permilee APPROVALS Road Unlt 955,00 A Building Permit is issued to: MIITELSTAEDT ERQ'jHgn$ ptanner _ Park Ded. on the express Condition that all work shall be done in accordance with all Councii applicable State o( Minnesota Statutes and City of Eagan Ordinances. g~ Off. _ Copies Building pfficial Variance - TOTAL 3,116.00 permN No. Permit Holder Date Tslephone # WATER • A~ S S 0 SEWER PLUMBING F!/~eOO44 H.V.A.C. ELECTRIC W IntpectFon Oate Insp. Comments Fcwtings 1 Faxbalion Framing ~G %d (J S RoohN R.* PYs. O /7- Houugh Hlg. 0/6 90 LLS CC:,?l f • t t0 6 F co Is~d. J~ i H+ 4, N FL/M IFL ( Fireplace FwW Hy. / zG-96 Fnai Pwg. 2 p_ Const. Meter P1bg. Inspector - Notity Plumber Engr.lPtan Bldg. Fuial Dedc Flg. Deqi Final Well Pr. Disp. ir~. ~ ts.. . . . : . , . . Fo? oni~ use onir:~ • • ~ ~ MECHANICAL PERMIT PERMIT # ~ rl ~ . CITY OF EAGIAN RECEIPT # ' 300 PILOT KNOO ROAD, EIIGAN, MN 55122 ' CONTRACT PRICE PNONE 4S44100 DATE: 3ite Address ; ~+1G k GIi : S"L' FEi2 R C WpRK DESOIUPTION Lot Biock - Sec/Sub Res. x New ~ Ii11JLS OF :JTO':VELRlTD~;T m Name I3t1RNSVTLLr ;-iZATIt1'.~ Mult Add-on ' A~~ 124$1 RHnDF ISLA'dD AVE . CO~"m. Repek ~ City S11v AGE Phone e'14-000'~ FEES Neme T' 7 ' TB T: RES. HVAC 0-100 M BTU - $24.00 . c Addresa ADDITIONAL 50 M BTU - 8.00 , O City Phone `4'G-q'' (RES. HVAC INCLUDES AJC ON NEW CONSTRUCTION) GAS OUTLETS (MIMI1AUi1-1 PER PERMIT) - 1.50 EA. TYPE OF WORK COMMAND FEE -17L OF CONTRACT FEE Forced Ah M BTU f APT. BLOGS. - COMM. RATE APPLIES Boile? M BTU TOWNHOUSE 8 CONDOS - RES. RATE APPLIES UnR Heater M BTU MIMMUY RESIDENTIAL FEE - ALL ADaON 8 /Ur Cond. M 8TU REIiAODEL3 - 12.00 MINIMUM COMMERCIAL FEE - 20,pp Vent CFM STATE SURCHARGE PER PERMIT - .50 Gas PiPin9 0udeft # (ADD $.50 S1C PER EACH $1000.00 OF PERMIT FEE) Other PERMIT FEE: SIGNATURE OF PERMITTEE S/C: ' MTU: ~ FOR CtTY OF EAGAN . k; . _ _ , PLUMBING PERMIT For Cit Use Only CITY OF EAGAN PERMIT #t ~ CONTRACT 3830 PILOT KNOB ROAD, EAGAN, MN 55122 RECEIPT # PRICE PHONE 4548100 DATE: Site Addres BLDG. TYPE WORK DESCRIPTION Lot Blodc Res, ~ New Const. v Mult. Add-on Name Comm. Repair _ Address aher ~ RES. PLBG. ONLY • COIIAPLETE THE FOLLOWING: c CityLcAt+~l.G 5'SaklZ Phoned • NO FIXTURES TOTAL ~ Water Closet - $3.00 $ ~ Name beAjs Bath Tubs - S3.00 ~ Address LLavatory - $3.00 ~~~g ~ City ~o Phon~ - ~ ~~r - $3.oo _L lGtchen Sink - $3.00 _T UrinaVBidet - $3.00 FEES / Laundry Tray - $3.00 _~jQ COMM./IND. FEE -19G OF CONTRACT FEE / Floor Drains - $1.50 APT. BLDGS. - COMM. RATE APPLIES Water Heater-S1•50 I.Sn TOWNHOUSE & CONDO - RES. RATE APPLIES Whidpool - $3.00 MINIMUM - RESIDENTIAL FEE $12.00 ~ Gas Piping Outlets -$1.50 - togO MINIMUM - COMM.IND./FEE $20.00 (MINIMUIiA -1 PER PERMIT•NEW CONST.) STATE SURCHARGE PER PERMIT .50 Softener -$5.00 (ADO $.50 SJC PER EACH $1,000 OF PERMIT FEE) WeA - $10.00 Private Disp. - $10.00 ~ Rough Openings - $1.50 41 ' SIG R OF PERM U. G. Sprinkler Syslem -$12.00 PERMIT FEE: STATES S/C: _SQ ; FOR: CITY OF EAGAN GRAND TOTAL: - - ~ SEWER & WATER PERMIT OFFICE USE ONLY CITY OF EAGAN - METER # Y3 7 41 11 ffl3 PERMIT DATE lU f O i/90 3830 Pilot Knob Rd. 116~ti , Eagan, MN 55122-1897 cHiP# a~s 9~'-3 a~ PERMIT # METER SIZE - 6 '-B.P. RECEIPT # C 10561 DATE LCT 4, 1990 15SUE OATE J1' /y ~fD B_P. RECEIPT DATE 101041 90 _ PRV - BOOSTER PUMP ' SITE ADDRESS "o WOFCIiESTLR CIR PERMIT REQUESTED LOT 1213LOCK 1 SEClSUB FtILLS QF STONEBRIllGE t. ' x SEWER X WATER - TAPS APPLICANT: ADDRESS: COMMIIND --X- RESIDENTIAL ~ CITY, STATE ~ ZIP X NEW - EXISTING PHONE: riCDONALD PLUMBING Lawn Sprinkler Meters are to be Installed PLUMBER: ' Ahead of Domestic Metors on Water Line. ADdRESS: 13271 KENWOOD TR ' Credit WILL NOT be given for Deduct Meters. CITY, STATE I.AKEVIGLE, M2J Zip 57044 PHONE: 43.5-3334 I AGREE TO COMPLY WITH CITY OF OWNER: ttlT"`ELSTAEDT BRF1''HERB CONST " EAGAN ORDINA CES ADDRESS: 785 SUNSET DR ~ CITY, STATE kAGAN, MY ZIp 53123 PHONEr 1+56-9125 SIGNATUR WHEN METER I SUED +.L~',l',~u .-c~~ ~I. G.?T / /a~ U PLEASE_AIILOW TWO MIORKING QAYS .c.FOR ~OC~SSING. CALL 454-5220 FOR INSPECTIONS. FOR STORM SEWER PERMITS, CONTACT ENGINEERING DEPT. j ~ . . . . . . . . _ . . . . . . . . -q--.~ ..---rr.c I SEWgR *°WATER PERMIT ~ OFFICE USE ONLY CITY OF ~AGAN ~ k~ ?M METER # PERMIT DATE 10105/92 3830 Pilot Knob Rd. 11666 Eagan, MN 55122-1897 CHIP # PERMIT # L 10561 METER SIZE B.P. RECEIPT # DATE OCT 4, 1990 ISSUE DATE B.P. RECEIPT OATE 10104L90 PRV - BOOSTER PUMP .it SITE ADDPjf'SS 580 WORCHESTL4d CIB PERMIT REDUESTED LOT 1' ~LOCK 1 SEC/SUB HILLS 0F STONSBBII)GE X SEWER X WATER - TAPS APPLICANT: ADDRESS: - COMM/IND X RESIDENTIAL CITY, STATE ZIP X NEW - EXISTING PHONE: ?~CUONALD PLUHBIi1G Lawn Sprinkier Meters are to be Installed PLUMBER: Ahead oi Domestic Meters on Water Line. ADDRESS: 18271 KENWWQ TR Credit WILL NOT be given for Deduct Meters. CITY, STATE LAKEVILLE, MN ZIp 55044 PHONE: 433-3334 ( l - I AGREE TO COMPLY WITH CITY OF OWNER: MI'rTSLSTAEDT $ROTEIExs OOiiST EAGAN ORDINANCES li ADDRESS: 783 $UNSET DR CiTY, STATE EAGAH, MN ZlP 55123 PHONE: 456-9125 SIGNATURE WHEN METER ISSUED PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. CALL 454-5220 FOR INSPECTIONS. FOR STORM SEWER PERMITS, CONTACT ENGINEERING DEPT. •~--'~'-'F~-.~n'+~5..--r.~---~•- ~ CASH RECEIPT ' CITY OF E,AGAN ; 3830 PILOT KNQB ROAD EAGAN, MINNESOTA 55122 , oAre C - ,a FlEaNED f~~! ~ ~Ji1~c~ +i~4 ~ J • AMOUNT t 92 & DOUARS 100 ? CASH ~ CHECK r FM ; L.. FUND OBJECT AMOUNT Thank You ; BY C 10561 P~~~ft Copy f ~ DATE: OCT 5. 1990 flE; 580 ii08CHESTER CIR (MITTELSTAEDT BROTRERS CONST) x' Your Sewer & Water Permit for the above property has been completed. It will be held at the Public Works Garage (3501 Coachman Road) until the meter is picked up. BE SURE TO CALL PUBLIC WORKS (454-5220) FOR YOUR PERMANENT WATER TURN ON. ~ur Sewer & Water Permit for the above property cannot be completed for the following sons: ti i' Your Sewer & Water Permit for the above property has been completed, but the meter cannot be issued or occupancy allowed until further notice. COMMERCIAL PROJECTS ONLY: Please pay for meter at City Hall. Meter size must be confirmed by Bill Adams or Dirk House (Plumbing Inspectors - 454-8100) before issuance. , WARNING: BEFORE DIGGING, CALL LOCAL UTILITIES - TELEPHONE, ELECTRIC, GAS, ETC. . - REOUIRED BY LAW. CONTACT COMMUNITY DEVELOPMENT DEPARTMENT FOR WATER TURN ON POLICY. ~ Secretary, Building InspectionS Dept. 4 ~ CITY OF EAGAN NO 15426 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHONE: 454-8100 BUILDING PERMIT Receipt # v ~ 7obeustdfor SF DWG/GAR Est value $91,000 Date OCT 4 ,1990- Site Address 580 WORCHESTER C R LOt lZ BIOCk 1 Sec/Sub. HILLS OF OFFICE USE ONLY Parcel No. STONEBRIDGE occupancy R-3 M=1 FEFS Zoning PD R=1 w Name_ MITTELSTAEDT RROTHFRS (ncwaqconst V=N em9 aermii 599.00 o AddreSS 785 SUNSET DR (Allowable) V-N Surcharge 45_ 50 City EAGAN Phone 456_91 9 S # of stones Lengih 44' PlanReview 389-n0 ~F Name SAME Depih 46' snc, cny 100.00 g< Address s F. roiai - snc, Mcwcc 600. 00 City ~ Phone s F Fooiprincs - OnSiteSewage _ `NalerConn FZS.O~ F¢ ~w Name OnSilewell - WaterMeter 9n-00 ~z AddfBSS MWCCSystem _x_ aw City PhOn2 QtyWaler ~ Acct Depos~l 30_00 PRVReqwred - SiWPermit 10•110 I hereby acknowlege that I have reatl this application and state ihat the Booster Pump - SrW Sumharga • 50 intormalion is correct antl agree to comply wilh all applicable Slate of Minnesota Statules and Cit of Eagan Ordinances Treaiment PI 252.00 SignaWrO of Permitee~-! ' APPROVALS Road Umt 355.0 0 A Building Permit is issued to: MITTELSTAEDT BROTHERS Planner - park Ded, on the express condition that all work shall be done in accordance wnh all CouncJ apphcable State of Minnesota Statutes antl City of Eagan Ortlinances Bldg OiC Copies n 1(i R OA I n~J variance - 70fAt 3,116.00 Building OHicial Address: 580 WOkCHESTEB CIRLII.ot 12 Blk 1 Sec/Sub HII;[S OF SIONEBRIDGE The'se items were/were not complete at the time of the final inspection. naTF: ISJVEMBE3 21, 1990 Yes No INSPECIOR: W Final grade (6" from siding) Permanent steps - garage - Permanent steps - main entry ~ Permanent driveway Permanent gas Sod/seeded grass i~ Trail/curb damage Porch ~ Basement finish y Deck Please veri£y with the builder the removal of roof test caps from the plumbing system and the shut-off of water supply to the outside lawn faucet before freeze potential exists. White - City copy Yellow - Resident copy Pink - Contractor copy i/ia/sv y yio y ~ 8 41_ 9 Fei Date Fre No Pough+n Inspection V viretl'+ ? Reaey Now ~j~,Will Nonty Inspector Yes ? No /'~'~an Ready9 I licensed contractor El owner hereby request inspection of above electncal work at: Jao Aotlress fSneec Bw or Route No.) Ciry $acuon No Townsmp Name or No Range No County O~ccupanjt(PqINT) Phane No Power SupOLer Atlaress , c 7,e/ °c., Electncal Conttactm COmpany Nema) ('qnVector's Lrcense No. EG,---Z-T Matlmg Aptlress (Cantractor or Owner Makmg Installervon) AuNonieO nduura IConlracm,/Own¢r Mdkmp In5laildti0n) Pnone Number MINNESOTq STATE BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT Grigge-MiJwaY Blag - Roam &193 BE ACCEPTED BV THE STATE BOARD 1821 Unlvenity Ave., SL Vaul, MN 55104 UNLESS PROPEF INSPECTION FEE IS Vhone(6iY)6at-0B00 ENCLOSED. ~ 1011,2190 REQUEST FOR ELECTRICAL INSPECTION eeo0001-07 ? See ire[ructions ior comdewg tms form on Oack of yeliow copy ,584-19 X'=Be/ow Work Covered by Thrs Request ew Add Rep. " TypeofBwlding AppliancesWired EqmpmentWved Home Range Temporary Service Duplex Water Heater ' Electric Heatinq Apt Bwltling Dryer Other (Specify) Comm /indushial Furnace Farm Air Condrtioner Otner(spealy) Convaclor5 Pemnrks Compute Inspecnon Fee Below: # Other Fee # ServiceEniranceSrze Fee # Cvcuits/Feeders Fee Swimming Poal 0 to 200 Amps 0 to 700 Amps Transtormers Above 200 _ Amps _ Amps Si 9n5 Inspecror§ Use Only: / A T07q~~ ~ Irn ation Booms WV (D Special Inspec6on Alarm/Communication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT Olher Fee COMPLETED WITHIN 18 MONT I, (he Electrical Inspectoc hereby RougM1-in Date certify ihat the above inspection has ~ Final Da a been made. OFFICE USE ONLY This reQvest voitl 18 monins Imm 2005 RESIDENTIAL PLUMBING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN MN 55122 651-675-5675 Please complete for modifications to existing residential dwellings. Date lII" O O5/ souR, JoeL 580 WORCHESTER CIRCLE Site Street Address EAGAN, MN 55123 Ulllt # (651) 6864664 Property Owner ` - - - _ i Telephone # ( ? contractor . NORBLOM PLUMBING CO. Telephone ) Address , City State Zip MINNEAPOUS, M~N~5540~ _ The Applicant is: Owner ontrac or Other Alterations to existing dwelling ~ $ 50.00 _ Add plumbing fixtures (excludes water softener and/or water heater--complete next section if installing these appliances). _Septic System Abandonment _ Water Turnaround (add $125.00 if a 5/8" meter is required) Other: Water Softener Water Heater $ 15.00 _ new replacement LaWn Inigation _RPZ _PVB ' _new _repair _rebuifd $ 30.00 State Surcharge $ 50 Total $ I S. 50 I hereby apply for a Residential Plumbing Permit and acknowledge that the information is complete and accurate; that the work will be_ in conformance with the ordinances and codes of the City of Eagan and the plumbing codes; that I understand this is not a permit, but only an application for a permit, work is not to start without a permit and work will be in acc dance with the approved plan in the event a plan is required to be reviewed and approved. ~I~~FF N~rbl~ 5 ~ Applicant's Printed Name ApplicanY ignature . ~ RESIDENTIAL BUILDING PERMIT APPLICATION ( GTY OF EAGAN 4.14 3830 PILOT KNOB RD • 55122 ~ 651-681•4675 New Constmction Renuirements RemodellReoair Reauiremenls 6D, • 3 registered site suneys showing sq ft. of lot, sq. fl. of house, and all roofed areas • 2 copies of plan (20%maximum bl coverage aliowed) . 1 set of Energy Calculations for heated addi6ons . 2 copies of pian showing beam & window sizes; poured lound design, etc ) . 1 sAe survey for ezterior additions 8 decks • 1 set of Energy Calculalions . Indicate if home served by seplic system for additions • 3 copies of Tree Preservation Plan if lot platted aker 711193 . Rim Joist Detail Options selection sheet (61dgs with 3 or, less umts) DATE AAr,~ 0~00~ VALUATION JOB SIiE ADDRESS Se 0 1.1J6rcl~esf.a,- C;rcl ~ IF MULTI-fAMILY BUILDING, HOW MANY UNITS? ~ PROPERTY OWNER ~'c~e I &or TYPE OF WORK C-o-~ c V;„ui S,'drNO e.,nr~ lkw FIREPLACE(S) _ 0_ 1_ 2 W~ndowg APPLICANT HG PHONE# Q86-4~64- ADDRESS ZIP CODE PAGER # CELL PHONE #~~a1~~759- 98~5 FAX # NEW RESIDENTIAL BUILDING ONLY - FILL OUT COMP r-Li C 0 T Energy Cotle Category MINNESOTA RULES 7670 CATEGORY pR 0 2 2002 (check one) - Residential Ventilation Category 1 Worksheet Su - Energy Envelope Calculations Submitted By MINNESOTA RULES 7672 ~ - New Energy Code Worksheet Submitted Plumbing Contractor: Phone PlumUing Systcm Iiicludes: Water So(tcncr _ L.awn Sprinkler Fcc: $90.00 W1LCC HC1lCr NO. Of R.I. B1l}IS ~ No. of IIaQis Mechanical Contractor: Phone # Mcchanical SysLem Indudcs: _ Air Conditioning Fcc: $70.00 - Hcat Rccovery Systcm Sewer/Water Contractor: Phone # All above information must be submitted prior to processing of application. I hereby acknowledge that I have read this application, state that the information is correct, and agree to camply with all applicable State of Minnesota Statutes and City of Eqgan Ordinances. Stgnature of Applicant Certificates of Survey Received _ Tree Preservation Plan Received ~ Not Required _ Updated 2002 OFFIGE USE ONLY I , ? Ot 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 ? 43 01 of _ ptex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF ? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screened) ? 36 Multi ? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage ? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous ? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) O 44 Siding ? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair ? 33 Alteration ? 37 Demolish (Bldg)' ? 43 Reroof ? 46 Windows/Doors ? 34 RePfacem ent 'Damolition (EnHre Bldg anly) • Give PCA handout to applicant Jb-fprp°-° wtllx~sJ- Sin~Mr Valuation 6 000 6/3aiFc£ "~71 m-/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 V- N W idth REQUIRED INSPECTIONS _ Footings(new bldg) FinaUC.O. Footings (deck) x FinaUNo C.O. ~ Footings (addition) = Plumbing Founda[ion HVAC Drain Tile Other Roof Ice & Water Final Pool _ F[gs _ Air/Gas Tests _ Final ~ Framing - - ~ Siding _ Smcco _ Srone Fireplace R.I. Air Test _ Final Windows (newlreplacement) ~ Insulation _ Retaining Wall ~ Approved By , Building Inspector - Base Fee Surcharge PlanReview GAn-~-~ MC(ES SAC C~ ciry sAC Water Supply & Storage S&W Permit & Surcharge ( j 0Ip '7_~-Ir4-t LC,7- Treatment Plant Plumbing Permit Mechanical Permit ~ L/F/s~ti License Search Copies Nt/ir~-~irc. coS r Lf Geec' ~ Z Z o00 Other N(.- ~ G o00 3aoo XZ , Total ~ 3 GeS T~ f~ ~ ~ 060 IVEYOR'S CEFtTIFICATE MITTELSTAEDT I BROS. CONST. I ~ ^ 6 ~ . . • _ . ~ O ~ 0 0 lo ~ Z Q (1 ai ~ ~ ,a,• o e~°`e f 'B09 0 ~ I 0 y / Q + 2 • A~ ~ I V L6 ~ F4 fy B~Hq. I j/ W I ~ 9JO' ? ~I I ~ I~ I- I u M .eso 1 Q ir J (1 8924 0g2y . ~ Y--- 36.33 ° ~ dl a \o ~q21 ~ I ^ I .c 50 A . i ~ 11 1 ~ m Ow o0 ty) n lT~ 1 ~692.5 c~ ro - V' ~ n 0)0o N 30 1e.0 \ ~m oW-P. bu? n ° Q N Q •~;A O N I~ _ J p I1 I O O . ` e9t.Q ~ v mm b q BBg9f~ ~Pf 4 ` ~ a=•° '°et.a n.~.~ I I ~ Q, ti \ I~ y; i ti ~ J ~ 1~ gy, i wl 0 4~. oI /`eqti o . ECE F~"""' ~33 3 \ I Q~ ' 32 `SS c J °a.AS o , i S _1 egB3\ 10 ~ O T0o 01;~~`, t-~,- rs:," i~ i;A a;.," ~ c{ 4 i:~ ` ~ DENOTES PROPOSED SURFACE DRAINAGE ; iy~ _~d. ~ ^ O DENOTES IRON MONUMENT SET j, ;e G ~S~ALE~,.~;I~,` 0FEEf- • DEN91ES IRON MONUMENT FOUND PROPOSED GARAGE X000.0 DENOTES EXISTING ELEVATION PROPOSED LOWEST FLOOR - 887, Z/ FEEf (000.0) DENOTES PROPOSED ELEVATION PROPOSED TOP OF BLOCK- 89y $ FEET WE HEREBY CERTIFY TO M ITTELSTAEOT BROS. CONST. THAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY OF THE 80UNDARIES OF: Lot 12, Block I, HILLS OF STONEBRIDGE, according to the recorded plat thereof, [bkota County,' Mlnnesota. IT DOES NOT PURPORT TO SHOW IMPROVEMENTS OR ENCROACHMENTS, EXCEPT AS SHOWN. AS SURVEYED BY ME OR UNDER MY DIRECT SUPERVISION THIS I ST DAY OF OCTDBER , 1990 SIGNED• JAM S R. NILL, INC. - - - - - PROPO ED GRADES SFiOWN WERE - TAKEN FHOM THE DEVELOPMENT ~ PLAN FOR lIILLS OF STONEBRIDGE BY. PREPARED BV PIONEER ENGINEERING LAST oaTID 11-5-e7. JOHN C. LARSON, LAND SURVEYOR MINNESOTA LICENSE NUMBER 19828 ~ m ~o D _ o TI ~p O ~ 0 v James R. o F ` o ~ o o D Hil I, inc. 00 - o m o~ Z p~ Z~ m`~' m PLANNERS / ENGINEERS / SURVEYORS ~ O~ m> ~O < ' 9401 JAMES AVE. S. • BLOOMINGTON, MN. 55431 • 612-884-3029 ; n 0 F . ;.A . - ~ 1990 BUILDING PERMIT APPLICATION CITY OF EAGAN SZNGLE FAMILY DWELLINGS MULTIPLE DWELLINGS COMMERCIAL 2 SETS OF PLANS 2 SETS OF PLANS 2 SETS OF ARCHITECTU[2AL 3 REGISTERED SITE SURVEYS REGISTERED SITE SURVEYS - & STRUCTURAL PLANS 1 SET OF ENERGY CALCULATIONS (CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFIGATIONS 1 SET OF ENERGY CALCULATIONS 1 SET OF ENERGY CALCS # OF RENTAL UNITS OF FOR SALE UNITS PENALTY APPLIES WHEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PIGKED UP BY LAST WORKING DAY OF MONTH IN WHICH REQUEST IS MADE. LOT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED. NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED. PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DAYS ONCE A PERMIT HAS BEEN COMPLETED. PERMIT MUST SHOW A LICENSED PLUMBER. firT i ' RECb To Be Used For: It"M~Y Valuation: -4t-R~2~- Date: /fJI')_ It~PJ . ~ Site Address 15~90 I,q,e~LNF'SrF"2 Gi2 1 , OFFICE USE ONLY aov Lot /2 Block / FEES occupancy R=3 M -I / Zoning ~ Parcel/Sub OF ~'+CJ.r~E/~lL.A6F Actual Const Bldg. Permit ~q J+9,OD Allowable Surcharge ~0 Ocaner # of stories Plan Review 905100 Length SAC, City lb01 0d Address Depth SAC, MWCC &00,00 S.F. Total Water Conn (p'2, i00 City/Zip Code Footprint S.F. Water Meter 100 Acct. Deposit 30,CD Phone On site sewage_ S/W Permit '.3 OooD ~ On site well S/W Surcharge . SO Contractor MiTi"E,-5T,9F4T (/hlLOei, MWCC System -jz Treatment Pl. 2SZ.,lb A City water V Road Unit' ,355,00 Address ~/j{,fj ~,v~„c7- /)/1„ PRV Park Ded. Booster Pump _ Copies City/Zip Code SUBTOTAL APPROVALS Penalty Phone Lr(a Cl/:~ ~5 Planner _ TOTAL g, ~I l,•UO Council Arch./Engr. Sldg. Off. Variance s Address City/Zip Code Phone # VA_ Zox22= yNaX , ~ Sz`~ k 4~ ~ r os~ 127< /U'/Z= I~4 Lf 12G2 XlLi= I'~~52 FI o us~ f 2A ~ x 5!= C~~~n 1o ry Z- SURVEYOR'S CEATIFICATE MITTELSTAEDT eROS. cor,sr. I - ~1"r NM N~ Q ~32~ 10 1 °z a , o e , o~ w ~sF eyo / P g V~ s~' 5h i p + ~66y ya, ~ ~A"~., ~ ,ag•' ~ t•C~e~, ~~~4qK j wy 11 ~ p~ j tD \?~J ~ ~g g~ i / / II~ O ~ 90% I I.0g2g ~ ~ 8924 -j ~ O \ I L 5.0 \0 \ 3 r oo i~ ea6 tir) co I - p(T(T ~egc? cB ro ' e? CF ~ A ~0 N 30 IB.O ' m m iD I ~ ~ Q G) N p N~ I f~ ~ ~ {p - ~ N. r4 ~ p itl B~e* g6q9 1i \'v ~ m m =z.Q~ ee?., h.~ ~ iz. /~A~~ 3g53 ~ ~ ~ ~II / `ry e p flfV B~~g ~33•32 545s \•I~~ / cD J , S eee. io ~ O ~ U ~jT0033,/S~~ 1$~7~} E~ L . ~ nv ~ DENOTES PROPOSED SURFACE DRAINAGE ~ r ~ O DENOTES IRON MONUMENT SET F~,SCrALE;1,:IP~1CH vOFEET- ,nr ' ~ ~~o • DENOTES IRON MONUMENT FOUND PROPOSEDGN, aIr~. GARAGEFL'OO?y rFEETT X000.0 DENOTES EXISTING ELEVATION PROPOSED LOWEST FLOOR - 8874 FEEf (000.0) DENOTES PROPOSED ELEVATION PROPOSED TOP OF BLOCK - 89z/ $ FEET WE HEREBY CERTIFY TO M ITTELSTAEDT BROS. CONST. THAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY OF THE BOUNDARIES OF: Lot 12, Block I, HILLS OF STONEBRIDGE, according to the recorded plat ihereof, Dokota County, Mlnnesota. IT DOES NOT PURPORT TO SHOW IMPROVEMENTS OR ENCROACHMENTS, EXCEPT AS SHOWN. AS SURVEYED BY ME OR UNDER MY DIRECT SUPERVISION THIS I ST DAY OF OCTOBER , 1990 SIGNEDJAM S R. HILL, INC. PROPOSED GRADES SFIOWN WERE ~ TAKEN FROM THE DEVELOPMENT PLAN FOR FIILLS OF STONEBRIDGE BY. ~ PREPARED 9Y PIONEER ENGINEERING LAS7 ontID 11-5-e7. JOHN C. LARSON, LAND SURVEYOR MINNESOTA LICENSE NUMBER 19828 ~ m o ~W o ~ o o D)ames R. Hi , inc. ~ -rmA~~~ 'N>m~ o m o~ Z~, ~ Z~"' ~ PLANNERS / ENGINEERS / SURVEYORS _ A p(3) m U)O < 9401 JAMES AVE. S. • BLOOMINGTON, MN. 55431 • 612-884-3029 : m ~ N DATE EXTERIOR ENVELOPE AVERAGE "U" COMPUTATION OWNER TIMAE/ZLIIJ6 ~1- SITE ADDRESS ~-oT N ) LL-S a F CONTRACTOR MIT7r_-' L S-Tn6ar 8 12014 Ea s Cp,v yT-rt W -7-1a~ 1.2 t- . ADDRESS r7$5 tirin.~SFr 7)(2. d A~AJ YHONE q .'~'Co Q1 -2 5 DETERMINE WORRIftG SQUARE FOOTAGE OF EACH. 1. Total exposed wall area ~ r$e-~, sq: ft, x•11 a~ 3q~ 2. Total roof/ceiling area I 2. $'7 sq, ft. x•026 Total exposed wall area above floot - 2'1 $m a. Total wall window area 1230,S b. Total door area L/D c. Total sliding glass door area y Z d. Total fireplace wall azea -e. Total wall framing area (average lOx) / g(o f. Total net wall area above floor / 3 eL 5 g. Total rim joist area 1!a O Total exposed founda[ion area a IloO h. Total foundation wiadow area - i. Total aet foundation area above grade /(,40 Determine "U" value of each wall segment. a. 23015 RIfUlt . 35 .Z ° 9111 b. L/o x „U„ , 0 7 ~ /G ~7 a ' /,G C. ,lz x 11»fI 7 ~ tlJ. x 11}YT1t - e - e. x rtUn ~ J/ ° ,2oi7 f. / 30.5 xf4ull ,v 4311 s 59.1 g. /Go x "ol' ,oy+,/ '`7.0 h. - x flv„ i. 1 Go x'Tu" , O K Z - I 3. / 3 . ...............................Total ol C If item lf3 is the same as, or less than item O1, you have met the ineent of SBC 6006 (02. -i- Page 2 ;of 2 . . Total exposed roof/ceiling area y /2 $7 J. Total skylight area - k. Total roof/celling framing area (average 107.).. 1. Total net insulated roof/ceiling area / 2 oL. G Determine "U" value for each roof/ceiling segment.. j - R flUet k. ,q ifUlr . O z.~i g ~ . 07 1. / 2 0l,,,la x"u" , 0 2r R 2G.3_ 4 ..........................................Tota1 i/ 17 If total of 04 is the same as, or less than 02, you have met [he in[ent of SBC 6006(01. Alternate Building Envelope ?esign To utilize the total envelope system method, the values established 6y the sum of i[ems 03 and 04 shall not be greater than the sum of items O1 and 62. 1. + 2. \ a 3. + 4. . . . . v -2- CITY USE ONLY PERMIT 14 1 (p q RECEIPT DATE: I D I(~V ~ iiES1DENTIAL M£CEANICAL iERMIT APPLICAT10N crrY og snsM 3830 Paor icivoa ftn RF18AN MA 55122 651-6$1-4695 Please complete for: ? single family dwellings townhomes and condos when permits are required for each unit Date: 10 -9 •v l SITE ADDRESS: ('A Q~ OWNERNAME: Joc..ii, Fi~y)f TELEPHONE#: CvSI rQ$(~i1.~(p(py (AREA CODE) INSTALLERNAME: ?k)1(6?o`LL ~kQ[f1G TELEPHONE#: gs-;A (AREA CODE) STREETADDRESS: Iv2~(Sll J~6dF 15)linrl /4J- S • CITY: J[,C,c) C'a Ci 2 STATE: k4N ZIP: Place a check mark next to the ermit work t e . New residential dwelling unit under constructionand not owner/occupied $ 70.00 ~C Add-on, modification or alteration to existinq dwelling unit $ 50.00 • furnace replacement • air exchanger . air conditioner . other Nature of work: State Surchar e $ 50 Total ~ $ sn.rn ,i r Reminder: Call jor inspections. SIGKfTftE OF PE Updated 1/01 CITY USE ONLY PERMIT RECEIPT DATE: APPROVED BY: , INSPECTOR COMMEEtCIAL MECHANIC14i. PERMIT APPIICATION CTfY OF EA6f4N 3830 Pu.or xxoa Ru £A6AN, MN 55122 651-681-4675 Please complete for: all commercial/industrial buildings multi-family buildings when separate permits are not required for each dwelling unit DATE: SITE ADDRESS: O WNER NAME: PHONE (AREA CODE) TENANT NAME (IMPROVEMENTS ONLY): WAS THERE A PREVIOUS TENANT IN THIS SPACE? Y N. NAME: INSTALLER: ADDRESS: PHONE - (AREA CODE) CITY: STATE: ZIP: , WORK TYPE: New construchon [nstall U.G. Tank _ [nterior Improvement _ Remove U.G. Tank _ Processed Piping Specify Nature of Work: When insta!ling/removing uiederground tank, cal! 651-681-4675 for inspection by Fire Marshal and Plumbing linspector. Fees: 1% of contract price OR $50.00 minimum fee, whichever is greater. Underground tank removaUinstallation = minimum fee Contract price: $ x 1% (Base Fee) State surcharge calculate at $.50 for each $1,000 Base Fee TOTAL $ S[GNATURE OF PERMITTEE Updated 1/O1 1999 BUILDING PERMIT APPLICATION (RESIDENTIAL) CITY OF EAGAN ~--t -1 ~ 3830 PILOT KNOB RD - 55122 U • 651•681-4675 C~ 9 ~cr New ConsfrucHOn Reaulremenh Remodel/Reoalr ReaulremeMs ? 3 reglsfered sHe surveys thowlnp sq. tt. of lot, sq. R. of house 2 coples ol plan and gll roofed areas (20% mazimum lof coveraae allowed) 1 sef ol eneryy calcukMons tor heafed addMions ? 2 coples of plans (show beam i window :Izes; poured fnd. design; etc.) 1 iRe survey Iw exterior addRions i decb ? 1 set W energy colculations ? 3 coples of hee presenaNon plan i bt platted afler 7/1/93 DATE: Sontemb.r 70 191n CONSTRUCTION COST: J I2,00. 00 DESCRIPTION OF WORK: d•a-k neck4-o exi-st N4 korx` STREEf ADDRESS: 8 0 lAlnnc t« C irc Ir LOT: BLOCK: SUBD./P.I.D. #k: LI: I I< f6YEa, br;.~- slf~ lD i 1q%o i 1 rz~ ! Name: gnr r sOc.I PhoneM: ~~&`66-4tc,64 PROPERTY Last FIM (0«/7S9-0IV`65 pays OWNER StreetAddress: LinrcKast~r G"'c(e- - city fa.k k\ store: /11N ziP: SSr~3 Company: Phone k: (area code) CONTRACTOR Sheet Address: Llcense * Exp• City State: Zip: ARCHITECT/ ENGINEER Company: Name: Telephone lk: area code ( ) Stree4 Address: Registration N: Clty State: Ztp: Sewer 3 wafer Ilcensed plumber (reaulred for new consirucflon onlvl: r PsMatly applies when address change and lot change Is requested once permN Is Issued. II VQreby acknowledge thaf I hwe read this applicafion, state thaf the informatlon Is cortecf, and agree to compty wNh all applicabl Sfafe 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 BUILDING PERMIT TYPE ? 01 Foundation O 06 4-plex ? 11 10-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 02 SF Dwelling ? 07 5-plex ? 12 12-plex ? 17 Garage ? 22 Porch/Addn. (4sea. ? 03 1 of _ plex ? 08 6-plex 0 13 16-plex ? 18 Deck ? 23 Porch (screened) ? 04 2-plex O 09 7-plex ? 14 Apartments ? 19 Lower Level ? 24 Storm Damage ? OS 3-plex ? 10 8-plex ? 15 Lodging ? 20 Pool ? 25 Miscellaneous WORK TYPE ? 31 New ? 35 Tenant Impr ? 39 Gas Line Only ? 43 Siding/Soffits/Fascia ? 32 Addition ? 36 Move Bldg. ? 40 Gas Insert ? 44 Windows/Doors ? 33 Alteration ? 37 Demolish Bldg.' ? 41 Wood Stove ? 45 Fire Repair ? 34 Repair ? 38 Demolish (Interior) ? 42 Reroof ' Give PCA handout to applicant for demolition permit GENERAL INFORMATION Const. (Actual) Basement sq. ft. Census Code 4~ y (Allowable) Main level sq. ft. SAC Code o~ UBC Occupancy sq. ft. No. of Units o Zoning sq. ft. No. of Bidgs f # of Stories sq. ft. MC/ES System Length sq. ft. City Water Width Footprint sq. ft. Booster Pump PRV Fire Sprinklered APPROVALS Planning Building Engineering Variance Permit Fee Valuation: $ 1 2('6 Surcharge ~ Plan Review License MC/ES SAC City SAC Water Conn. Water Meter Acct. Deposit S/W Permit S!W Surcharge ~ Treatment PI. i Park Ded. ~ Trails Ded. ' Other Copies Total: SAC Units % SAC '~~/~kC'M'MY(i MY;SX(%nYFMYFYF'M'M'My(•'n':YRft>KX~Y,(X(>kYF'M'KYn"MM~XCYn".F~l"M C2'1Y OF E:AGAN CASH:I:k"f?e J; 7F.:'kt1INAl_ N0: 764 DA'TF;, 09/09/99 'f'IM4=: 14:i'_4:58 ID:. NAME: :iDEL_ W. EtOl.lf? :i32.'.1.4 `_3U01 :iS:;O W0RCh{F'FilEi'< 60.00 2155.3001 580 µIORCHI2:STEFi CJ.'r.',0 Tnta:l. hor.eipfi Amnuni:: 60.50 crQc:,84n U;c.r, SD;; 7AN CITY OF EAGAN FOR C7TY USE ONLY 3Z~ ~ 3830 PILOT KNOB ROAD EAGAN, ?IN 55122 PERMIT # PHONE: (612) 454-8100 RECEIPT # 14~CNANICAT.,,PERMI'~ DATE: 'I S RESICIENTTAL:PI.EASE COMPLETE IIPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS & TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT. WORK DESCRIPTION FEES NEW CONST ADD-ON MINIMUM ADD ON Z Ht7AC 0-100 M BTU 24.00 REPAIR _ ADDITIONAL 50 M BTU 6.00 GAS OUTLETS - MINZMUM 3.00 OF 1 PER PERMIT OWNER NAME: SUBTOTAL: SI1c HuGRESS: ~5a - 4~clZ c~rESTE' C ST.A.E SURCu4.°.GE: .Sn 5-~c LOT:_Z2 BLOCK ~ SUBD. TOTAL: $I~ ' INSTALLER: ADDRESS: SIGNATURE OF PERMITTE 12481 Rhode Isg A/C' Inc. ~ -qn CITY: ) ~~78.11 2 MIN PHONE 894•0005 I COtRMERCIALjTNDASTRTA2.; PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS, APARTMENT BUILDINGS, AND MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT. CONTRACT PRIGE: FEES OWNER NAME: 1% OF CONTRACT FEE. STATE SURCHARGE _ $.50 FOR SITE ADDRESS: EACH $1,000 OF PERMIT FEE. PRDCESSED PIPING = $25.00 LOT: BLOCK _ SUBD. $25.00 MINIMUM FEE. INSTALLER: CONTRACT PRZCE x 19 $ ADDRESS: STATE SURCHARGE $ CITY: ZIP: TOTAL: $ PHONE (SIGNATURE) FOR: CITY OF EAGAN 4,1111) City of Eaali 3830 Pilot Knob Road Eagan MN 55122 RECEIVED Phone: (651) 675-5675 Fax: (651) 675-5694 JAN 3 0 2012 Use BLUE or BLACK Ink For Office Use/ (76 -/ Permit #:/// �✓ k / J� Permit Fee: t 0 ( l Date Receiv .. _s-6) /J -- Staff: J -_ Staff: 2012 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: � ►rte!/ J 4- Site Address: gBO W o rc.•he.ti ter c. r4dl - Tenant: Suite #: RESIDENT / OWNER TYPE OF WORK Name: BOta- ((j1� Cell phone: (as ') CSC "" 9-444'f' Address / City / Zip: S t5C) (A) Ur[� rr C f c-11- 0. CCK 551 D_ 3 Name: License #: Address: City: State: Zip: Phone: Contact: Email: New Replacement Repair Rebuild )( Modify Space Work in R.O.W. Description of work: it i }die.v�. re_NokV re,j©C;o±e ink. -6 D j Sk Wct cr- RESIDENTIAL Water Heater Lawn Irrigation ( RPZ / PVB) _ Septic System New — Abandonment Water Softener X Add Plumbing Fixtures 0( Main / Lower Level) Water Tumaround RESIDENTIAL FEES: $60.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge) $60.00 Lawn Irrigation (includes $5.00 State Surcharge) $60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Tumaround* (includes $5.00 State Surcharge) *Water Tumaround (add $189.00 if a 5/8" meter is required) $105.00 Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge) TOTAL FEES $ CALL BEFORE YOU DIG. Call Gopher State One CaII at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.orq I hereby acknowledge that this information is complete and accurate; that the work will be in 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 , ans. X/ e -i C i.t„r Applicant's Printed Name APor is Signature FOR OFFICE USE Required Inspections: Under Ground __R it Test Gas Ti 4401 City of Eap 3830 Pilot Knob Road 71117 U E Ndr Eagan MN 55122 RECEIVED Phone: (651) 675-5675 03/113038 Fax: (651) 675-5694 JAN 3 0 2012 r7- 2046 RESIDENTIAL BUILDING PERMIT APPLICATION Use BLUE or BLACK Ink For Office Use 7 /P44 (. Permit Fee: /Q7' r C) Date Receiv al6 I Permit #: Staff: Date:-ff-s2=►J Site Address: S %C-) RESIDENT / OWNER i 75`1-`1 `6445` - Get I Name: -37.5 Go to Pone: (6 5-0 `Sc, " el -C6 If Address / City / Zip: 6-150 „c; Si -4 - Cf-g ( 551,3 ,'_-‘14.A. Applicant is: /1 Owner Contractor TYPE OF WORK Description of work: ii. i -thee ($4, IOLA./ ..et , 6 C oit4-1-,u-- .. Construction Cost: ,.k 15"/ 6 Xi . Cu Multi -Family Building: (Yes / N > I ) CONTRACTOR Company: Contact: Address: City: State: Zip: Phone: License #: Lead Certificate #: If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) CUOStru f`l. cx4 -et /17r (/1To) In the last 12 months, Yes No If Licensed Plumber: COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING has the City of Eagan issued a permit for a similar plan based on a master plan? yes, date and address of master plan: Phone: Mechanical Contractor: Sewer & Water Contractor: Phone: Phone: NOTE: Plans and supporting documents that you submit are considered to be i ubiic information. sof the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that they are trade secrets. CALL BEFORE YOU DIG. CaII 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.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. 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. x ;c 1.7D'4i!" Applicant's Printed Name Vs Signature Page 1 of 3 LipQiLL' kesf SUB TYPES Foundation 1- Single Family Multi 01 of _ Piex Accessory Building WORK TYPES New Addition Alteration Replace Retaining Wall DESCRIPTION Valuation Plan Review (25%_ 100%_//1 Census Code #of Units # of Buildings Type of Construction Fireplace Garage Deck Lower Level 0 NOT WRITE BELOW THIS LINE _ Porch (3 -Season) _ _ Porch (4 -Season) _ Porch (Screen/Gazebo/Pergola) Pool Interior Improvement Move Building Fire Repair _ Repair Ja;o 1131.1 — Siding Reroof Windows _ Egress Window Storm Damage Exterior Alteration (Single Family) Exterior Alteration (Multi) Miscellaneous _ Demolish Building* Demolish Interior Demolish Foundation Water Damage *Demolition of entire building - give PCA handout to applicant Occupancy Code Edition Zoning Stories Square Feet Length Width REQUIRED INSPECTIONS Footings (New Building) Footings (Deck) Footings (Addition) Foundation Drain Tile Roof: ___Ice & Water ___Final Framing Fireplace: _Rough In _Air Test ^Final Insulation Sheathing Sheetrock Reviewed By: RESIDENTIAL FEES Base Fee Surcharge Pian Review MCES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant Copies TOTAL //S 76 �o / /-/ MCES System SAC Units City Water Booster Pump PRV Fire Sprinklers Meter Size: Final / C.O. Required Final / No C.O. Required HVAC ___ Gas Service Test Gas Line Air Test Other: Pool: _Footings __Air/Gas Tests _Final Siding: __Stucco Lath Stone Lath __Brick Windows Retaining Wall: __ Footings Backfill ___ Final Radon Control Erosion Control , Building Inspector A/G 0 f /2C14a2 pQ' /-7'3OmA Page 2 of 3 PERMIT City of Eagan Permit Type:Building Permit Number:EA165330 Date Issued:10/28/2020 Permit Category:ePermit Site Address: 580 Worchester Cir Lot:12 Block: 1 Addition: Hills Of Stonebridge PID:10-32990-01-120 Use: Description: Sub Type:Reroof Work Type:Replace Description:Does not include skylight(s) Census Code:434 - Residential Additions, Alterations Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Please print pictures of ice and water protection and leave on site. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Building Code). Valuation: 5,000.00 Fee Summary:BL - Base Fee $5K $118.00 0801.4085 Surcharge - Based on Valuation $5K $2.50 9001.2195 $120.50 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Joel & Cynthia Bour 580 Worchester Cir Saint Paul MN 55123--165 Bilco Enterprises Inc 6884 Beaver Pond Way Hugo MN 55038 (612) 718-5893 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA179161 Date Issued:09/21/2022 Permit Category:ePermit Site Address: 580 Worchester Cir Lot:12 Block: 1 Addition: Hills Of Stonebridge PID:10-32990-01-120 Use: Description: Sub Type:Furnace Work Type:Replace Description: Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Building Code). Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Pete DeGrood at (507) Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088 Surcharge-Fixed $1.00 9001.2195 $60.00 Total: This permit shall be null and void if work does not start within 180 days of issuance, or if work is suspended for 180 days or more after started. I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Joel & Cynthia Bour 580 Worchester Cir Saint Paul MN 55123--165 Burnsville Heating & Air Conditioning 3451 West Burnsville Parkway, Ste. 120 Burnsville MN 55337 (952) 894-0005 Applicant/Permitee: Signature Issued By: Signature