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4282 Wexford WayGsf- 05- se9.y 4`1:* City of Eaau 3$30 Pilot Knob Road Eagan MN 55122 Phone: (661) 6754675 Fax: (661) 676-6694 2010 RESIDENT' Date: 7 —12--10 Site Address: LT Tenant ►1 -et. Use BLUE or BLACK Ink For .0 'pe Use%�j (�_// �/� Permit #: " 1 1 "! lJ / Permit Fee: 36 CO Date Received: Staff: L PLUMBING PERMIT APPLICATION Z I. /tx Prwt .11 Sults #: RESIDENT I OWNER Name: Et if -t -t- Li .exh-1,-- Phone: 6 $I --u5 2.-3Y 7(1 Address / City / Zip: 411:024. Z... %ti,e., C gird L.er CONTRACTOR Name: acrrio7 A 9 9-lrt , License #: `- eel_ craeteryl Address: 9O fo V - _52 S7Xe er 5 City: 14,4"-c- P / ..- .- ,1. State: .rte i 4 ,Zip: 3 7 Phone: 3C.i - 2-5' t-1.- 5-g' 5— Contact: Cha/ TT,e'1 Email: TYPE OF WORK New placement Repair , Rebuild Modify Space _ Work in R.U.W. — Description of work: _ PERMIT TYPE FtLetENTIAL Ater Heater Lawn irrigation Water Softener Add Plumbing Fixtures ( RPZ / PYS) (_, Main Lower Level) — Septic System New Water Turnaround Abandonment _ RESIDENTIAL FEES: $50.50 Minlinin Water Heater, Water Soften (includes 5,50 State Sur Fixtures, Septic System (add $166.00 If a 5/8" ($10.00 per as bul r, or Water Heater Aml Softener (includes 6,50 State Surcharge) arge) Abandonment, Water Tumaround" (includes 5.50 State Surcharge) $30.50 Lawn Irrigation $50.50 Add Plumbing "Water Turnaround $100.50 Septic System $90.50 Fire Repair (replace etar is required) (includes County fee and $.50 State Surcharge) ductwork, etc.) (includes $.50 State Surcharge)�-- TOTAL FEES $ J - C1} burned out appliano:s, CALL BEFORE YOU DIG. Call Gopher S Call 48 hours before you intend to dig to receive Ie I hereby acknowledge that this information Is complete a Eagan; that I understand this is not a permit. but only accordance with the approved plan in the case of work one can at (651) 454-0002 for protection against underground utility damage, tes of underground utilities. www.gopherstaterinecall,orO accurate; that the work will be in conformance with the ordinances and codes of the City of application for a permit, ono work is not to Stan without a permit; that the work will be in ch requires a review and approval of pians. Applicant's Printed Name FOR OFFICE USE Required Inspections; _Under Ground x Applican s Signature Reviewed By: I te; „Rough -In Air Test Gas Test ✓,;,,_Finan ~ . +A , . • ";emficate of cccoanc~ ~itv of cFagan 2*04rrucxt of ISS"hig 3*4eCri.x This Ceriifrcate issued parsuant to the rcquirements oJ rhe Unifor»+ Building Code certifying that at tlu time of issuanee this structurr was in compliance with the various orrlinonces af the City negulating building constnuction or use. For the following: uw Clauiticatkm: SF DWG/GAR eWs. Pem;,,,b. 27582 OC-P-y Tyl, R-3 U-1 y,,;oa Dima R-1 T~Pe con5t ' o,,,,,,Qa( B,,;a;,,g KEY 1.AND HOMES Addma 17021 F1SH INT Rd. PR10R LAKE a; 4282- RFORD iiAY L..;q, L19 B1 W FO&D 2ND MN U B-Idimg offieW i ~ POST iN A CONSPK.'110US PItICE f ~ INSPECTION RECORD C4TY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number. 4' '7 H." Eagan, Minnesota 55122-1897 Date Issued: • ' " (612) 681-4675 SITE ADDRESS: r ! 0 Yi 5W31 I fiN AppLICANT• I. t, r: .1~~~ ts l c,i. ~ ? • . m rfinF?n 1!A'V i. . ; I~i'I~ ..ili (1.~.. •l~~E.) -r.~(1't7 PERMIT SUBTYPE: TYPE OF WORK: i:, it, INSPECTION . D• ,,u• ; ~ ~~i; ,'i11Nl~ i i eIM . i~tA { 1.~, N1, tPd'. IIIAI)1i/q . rar,! I! ~ei, I ~ r~r,t ~•i . , ~ ~ . ~ . I ~ ! ' , ~ ~ ~ IL ParmR No. Permk Holder Date elephone M + ELECTRIC ' PLUMBING HVAC InspectEon bab Insp. Commentt / f : FOOTIMGS 3 f/ ~ / / FOUND ! FRAMING ROOFING ` ROUGH ~ PLUMBING -16- G PLBG oj AlR TEST ROUGH HEATING GAS SVC TEST INSUL dYP BOARD FIREPLACE ? wl N' FIREPLACE AIR TEST O ! FINAL PLBG 7 I FINAI HTG R Y I ORSAT I TEST I BLDG FINAL ~ :f 14G I~ ~ . - - l BSMT R.I. BSMT FINAL , DECK FTG DECK FINAL . I ~ - - - 2 V V~ 5 6 7 ~ OFFIC USE O LY This reqaest void 18 manths irom vohdahon dale pnnted in thrs b~ Yd ~~~s~ Mr ab PLEASE PRINT OR TYPE l, ~v 4+ Requesy Dare Rough-in inspea~on reqmred2 e 0 N. Inspedion Other Thon Roughln. ~ Reody Now '~^I 1@0ll g- 9 (Yao m.n call Ihe inspedor when r od Da Ready ~ licensed conirodor ? owner hereby requesf mspedion o{ ihe ove eledri<al work at: Jab Pddress' (S/Vee1, eQot, or Route ~Na) ] Gp ip od 7 O L , $echon No Township Name or No Range Na re No unp ~ Occvp m Phone N. Power lier Addmss ' Eledn nlmtlor (Compa Nome) 1 Con,mtlor L<ense Maskr Lc No IPlam Elect Only~ "i / MaiLng Addmss ommnor or Owner Pedomnng insiollmion~ (O 7S Authonzed Si awre (Cammdor or O»ner PeAarming InsMllo6o Ph EB-WOOIA-106195 STATEBOAflDCOiY EEINSTRUCTIONSONBACKOFYELLOWCOPY REOUEST FOR ELECTRICAL INSPECTION I III II II P88 IMinnesota State Board of ElecVicity 1827 University Ave., Rm. S aul, MN 55104 2 S 6 1* Phone (612) 642-0800 Home Dup e: Apt. Bldg. Oler:•~~ New Addn Commerciol Indushial Farm Remod Re air Air Cond. Htg. Equip Wafer Htr. Load Mgmt. Olher D er Ran e Elec. Heot Tem Sernce 09 "X" above fhe work covered by fhis requesf Enfer remarks in this space and on fhe back of the whde copy only. ~ y 1~ u Colculate Inspection Fee - This Inspecfion Request will not be aaepted wdhout Ihe mrrecf fee: Olher Fee # Service EMranoe Size Fee At Circuils/Feeders Fee Mobile Home Park Stoll 0 to 200 Amps ~ 0 to mps $freef L}g./TraNic $ig. Above 200 Amps 0 Amps Tmnsformer/Genernfor INSPECTOR' SEON Sign/Oufline Lfg. X(mr. Alarm/Remole Confrol $wimming Pooi I hen cenl iha~ i ~he el«iriwl insm hem on Me dobe zia Irrigation Boom Rouq -in ~ Daie Speciallnspechan fiiwl Dale Invesfigative Fee I THIS INSTALLATION MAY BE ORDER DISCON CTED I OT COMPLETED WITHIN 18 MONTHS. Address 4282 WERFORD WAY ZjP 5512_ LOt 19 B1k 1 Sub WEXFORD 2ND THESE ITEMS WERE / WERE NOT COMPLETE AT THG TIME OF THE FINAL INSPGCI'ION. Date: /S n, Yes No Inspector: L1 Final grade (6" from siding) ~ Permanent steps (garage) ? Permanent steps (main entry) Permanent driveway Permanent gas ~ Sod/Seeded grass ? , TraiUcurb damage e/ Porch ~ Basement finish ~ Deck ~ Please verify with the builder the removal of roof test caps from the plumbing system and the shut-off of water supply to Ihe outside lawn faucet before freeze potential exists. Contact engineering division at 681-4645 before working in righbof-way or installing underground sprinkler system. ~ White - City Copy Yellow - Resident Copy Pink - Contractor Copy PERMIT e~o5~~57 CITY OF EAGAN 3830 Pilot Knob Road PERMIT TYPE: B U I L O I N G Eagan, Minnesota 55122-1897 Permit Number: 0 2 7 5 8 2 (612) 681-4675 Date Issued: 0 5/ 2 0/ 9 6 SITE ADDRESS: 4282 WEXFORD WAY LOT: 19 BLOCK: 1 • WEXFORD 2ND P.I.N.: 10-83851-190-01 DESCRIPTION: Ouilding__Permit Type SF DWG ~Building W'ar.k Type NEW ~ UBC Occupancy", R-3 U-1 J Construction Type V-N / Zoning ~ R-1 J euilding Length 56 ~ Building Width j 42 , B,uilding stories 2 ~ -Square Feet 1,823 C'en`sus_,Code~ 101 1- FAM. DETACH i,.. ,:~.:~~V • REMARKS: S& W PLBR - D C MECH FEE SUMMARY: VALUATION $146,000 Base Fee $1,117.25 MISCELLANEOUS $1,923.50 Plan Review $558.63 Total Fee $4,572.38 Surcharge $73.00 SAC $900.00 SAC % 100 SAC Units 1 Subtotal $2,648.88 CONTRACTOR: - Applicant - sT. LIc.OWNER: KEY LAND HOMES 14409400 0001553 KEYLAND HOMES 17021 FISH POINT RD 17021 . FISH POINT RD PRIOR LAKE MN 55372 . PRZOR LAKE MN 55372 (612) 440-9400 (612)440-9400 I hereby acknowledge that I have read this application and state that the infiormation is correct and agree to comply with all applicable State ofi Mn. Statutes and City of Eagan Ordinances. - J .~nft R.a ~ rn24 APPLICANT/P A~ EE SIGNA7URE ISSUED BY: IGN URE -I- CITY OF EAGAN 7,~ 3830 PILOT KNOB RD - 55122 r-j ti• i% 1996 BUILDING PERMIT APPLICATION (RESIDENTIAL) 681-4675 coi0.rP.UIJA Mew Construdion Reauirements RemodeUReoair Reavirements ? 3 registered eke swveys ? 2 eopies ol plan ? 2 copies of plane (indude beam 6 window sizes; Doured fnd. design; elc ) ? 2 slle surveys (exterior additions 8 decks) ? 1 energy alculat{ons ? 1 energy ealwlaHons tor heated eddilions ? 3 eopias of tree preservatlon plan H lot plaNeO after 711193 required: _ Yee _ No DATE: IAxY Iqq C"a, CONSTRUCTION COST: DESCRIPTION OF WORK: t~E~J Si+AC,:TLT-_ STREET ADDRESS: ~Z`aZ W F XFo2.~ W(~~ LOT 1`( BLOCK SUBD./P.I.D.#: ~~-XrD~.D 2~ h~DPITtC71~ PROPERTY Name: Phone OWNER Street Address- City: State: Zip: CONTRACTOR Company: V)Fq(,At~o Phone#: ~40-~4flv Street Address: I1p21 J:~sA PoifiT RD License lSS~ City: PRiolz- L.AI-~ State: Mk4• Zip: SS3-72- ARCHITECT! Company: Phone ENGINEER Name: Registration Street Address• City: State: Zip: Sewer & waier licensed plumber: v?- L, Penalty applies when address change and lot change are requested once permit is issued. I hereby acknowledge that I have read this application and state that the infor ~ation is ,orr ct and agree to comply with all applicable State of Minnesota Statutes and Ciry of Eagan Ordinances. b Signature of Applicant: OFFICE USE ONLY _ZT_ J°- Certificates of Survey Received _ Yes _ N Tree Preservation Plan Received Yes ? No d OFFICE USE ONLY BUILDING PERMIT TYPE 0 01 Foundation ? 06 Duplex ? 11 Apt./Lodging ? 16 Basement Finish 114~102 SF Dwelling ? 07 4-plex ? 12 Multi Repair/Rem. 0 17 Swim Pool ? 03 SF Addition ? 08 8-plex ? 13 Garage/Accessory ? 20 Public Facility 0 04 SF Porch ? 09 12-plex o 14 Fireplace ? 21 Miscellaneous ? 05 SF Misc. ? 10 = plex o 15 Deck WORK TYPE 31 New o 33 Alterations ? 36 Move a 32 Addition ? 34 Repair o 37 Demolition GENERAL INFORMATION Const. (Actual) Basement sq. ft. / MCIWS System (Allowable) ~ Main level sq. ft. ogS City Water o~ UBC Occupancy sq. ft. oz Fire Sprinklered _ Zoning sq. ft. PRV # of Stories ABsM~ sq. ft. Booster Pump Length 5~O sq. ft. Census Code. /O/ Depth ~ Footprint sq. ft. 82-SAC Code C Census Bldg 1 S ~ Census Unit APPROVALS ( Planning Building Engineering Variance ' Permit Fee Valuation: $ Surcharge Plan Review /o License ~,,,f l 2s f~~ - MC/WS SAC F y~ ~o9s City SAC 6 x /r. v-= 93 ~~.=r~e•Z~ °~,o~ Water Conn. ~ZX z y = 730 ~ xf 7. (iz~ Water Meter 7 Acct. Deposit S/W Permit S/W Surcharge Treatment PI. ~30 Road Unit ~ ~j - Park Ded. Z Trails Ded. Other Il3s /o ~ = 3 /-z1 X ,33x , Copies f16 = Co W G~lZ. b x~'-s ` 8( 22,~ Z8 S TOtal: ~ z K Z~ ~ 3 3 6 33 K/co % s,ac zx ,3.s ~v9sxi~ _ SAC Units S ~ - ~ 2422 Enterprise Drive 'K Mendoto Heights, MN 55120 * PIONEEFt W10 SUPVE10N5 • QNL FNGiMFCNS (612) 681-1914 FAX:681-9488 eng neer ng ur+o eLuaeas. unosc.ve ArtcniTecis F62I Highw ay 70 N.E. ine, MN 55434 z) 783-1e80 FNx:783--1e53 Certiticate of Survey for: KEYLAND HOMES 4282 WE7CFORD WAT 3662-IV-E tAGAN h7 Y'IAGA~y ylVC'hiBi~l LNuDEPT. ' ~~BENC MARK # Q / TOP OF PIPE 1 U ~ ELEV.=950.38 ~ / EG I D69• I N89020r56wW HOYSE 96 t82.09 951.4 950.2 42,33 950.5 5.0 ~ 950.7 61 24 949.0 956.8 ~n o, o i . 30 r-----------~rrr------arr-------7 . . J 948,1/ v~ 10 ~ k ~ i 957. 9SZ5 50.9 ~ i 952.0 26.33 ----y ~ 0 p a A vwiw/n Z i / ~ I Ta o/ap n~ i SERVICE-y + o~= h i INV.=9380 ~ W 951.9 cO / . O i~a 19 W16 W~ ~ U ~ O~ N~ I M ~ aZ 13.66 I /O~ ai a~'i Q - p ~ a~ 95319 x 952.9 i o u/~ ao 949.8 / O O ~ Ow ~ ° E---- z~ L.~.~.~'z - -_.i_=c----'-1--J tn In 952.1 950.6 S 961.5 955.8 955.3 t7.3-c.33 1 27.15 q.~ Jo.B. / yc r-5 N$9920,56pW 48'QO 13 ~ a Sv 6 3 ExIsnNC 956.2 I HOUSE 20 BENCH MARK TOP OF PIPE ELEV.=95199 N07E: PAOPOSED CRADES SHOWN PER GRAOiNC PIAN BY: PIONEER PROPOSED HOUSE ELEVATION N01E: BUIl01NC DIuEN90N5 SHOWN AHE FOR HORRONTAL ANO YERfiC/LL IOCATON LOWEST FLOOR ELEVATION: ~7-6 OF STRUG7URES ONIY. SEE ARCNITECTUAL PLANS FOR BUILDING AND fOUNDATION DIMENSIONS. TOP OF BLOCK EIEVATiON: NOTE: NO SPEGFiC 5045 INVESTIGATON nA5 BEEN COMPI,ETED ON na5 LOT BY THE SURVEYOR, THE SVITA84ITY OF SOIL$ TO SUPPORT THE SPEtlFIC NOUSE CARAGE SLAB ELEVATION: PROPOSED i5 N07 THE RESPON519N7Y OF THE SuRVEYOR. NOTE: 1NI5 CEpTIFICATE DOES NOT RIRPORT 10 $HOW EASEMENlS 07HER 1HRN k 000,00 OENOIES EXISTINC ELEVATION 1HOSC SHONN ON THE RECORDED PIAT. ( 000.00 ) DENOTES PROPOSEO ELEVATION OENOTES ORwINACE 4N0 UTl17Y EaSEMENT NOTE: CONTRRCTOR MUST VER6C DRIVEWAV OE9CN. UQJOTCS ORAINAGE FLOw DiRECTIoN NOTE: BEFRINGS $HOWN ARE BASEO ON AN ASSUMEO OATUM OENOTES MONUMENT - --g- DENOTES OfFSET NUB WE HEREBY CERTiFY TO KEYLAND HOMES THAT THIS IS A TRUE ANO CORRECT REPRESENTATION OF A SURVEY OF THE BOUNOARiES OF; LOT 19, BLOCK 1, WEXFORD 2ND ADDITION DAKOTA COUN7Y, MINNESOTA iT DOES NOT PURPORT TO SHOW IMPROVEMENTS OR ENCHROACHMENTS, EXCEPT AS SHOWN, AS SURVEYED BY ME OR UNDER MY DIRECT SUPERVISION 1HiS 1ST DAY OF APR14 1996. PYO~1GrvED: PIONEER EN `EERI . P.A. SCALE : 1 INCH = 30 FEET John C. Larson, L.S. Reg. No. 19826 907 96089.00 SWK ze-d 4 , LOT SURVEY CHECKLIST FOR RESIDENTIAL BUILDING PERMITAPPLICATION PROPERTY LEGAL: DATE OF SU . LATEST REVISION: Z z ~ m DOCUMENTSTANDARDS ? • Registered Land Surveyor signature and company M-~ o ? • Building PermRApplicant M-'o o • LegaldescripUon 0-1 ? • Address ? • North arrow and scale [3~~ ? • House type (rembler, walkout, spiit w/o, split entry, lookout, etc.) • 3"~o o • Directional dreinage arrows with slope/gradient % ? • Proposed/exissting sewer and water services & invert elevation 0 ? • Street name L9' ? O • Driveway ELEVATIONS Existlng C~' ? ? • Sewer service (or Proposed) Gr'10 ? • Property comers or--? ? • Tap of curb at ihe driveway CK'C3 ? • Elevatlons of any eristing adjacent homes Prooosed CY'0 ? • Garege floor q~'13 ? • Frst floor u"o ? • Lowest exposed elevation (walkouUwindow) [~0 O • Property comers 21'~ 0 ? • Front and rear of home at the foundation PONDING AREA (if aoolfcable) ? o' ? • Easement fine ? R' ? • NWL ? ? • HWL ? ? • Pand # designation ? • Emergency Overflow Elevation DIMENSIONS o' ? ? • Lot IinesBearings & dimensions 0-1~-C] ? • Right-of-way and street width (to back of curb) ff --O 0 • Proposed home dimensions including any proposed decks, overhangs greater than 2', porches, etc. p.e. all structures requiring permanent faotings) C---O ? • Show all easements of record and any Cily util'fies within those easements q~~ ? • Setbacks of proposed structure and sideyard setback of adjacent ebsting shuctures ? ~o • Retaining wall requirements ' ny Reviewed: ame / ate January 1996 CRAqt DGfliBIOGVRMf.FM N~ S7A i5.O5,HS ul' Sin. na79J5_ 1 il ~o'; s_;. , b: . 23 22 21 z,: e.~'~t i/ pp l SEE SHEET , S=G.~S IC f SEE LEF7 SEE LEFT I .~r'~ ~i 21 I 5_0~8~ I i ~W ~ ~ ~~''A/ry ( UIP.C~ 52 MH.STA.3~7J • -6' \ L• C5=9555 \V=9t2.S6 5=i+12 19 C5=953 6 t ~nV=9a0 76 ~ ti.6'tEE 1 p Eq~E''uCHT ~ v 7' i W 4 95 ~0 L,2 CS=9Sl.n ~ r GuD EI 9a i]J U iNN 6 E6660.30 TNN 0.54 ~.STAI. 9Q C.~ a50 MH 45in, 18~6.S.01 ~iA_~ 5-0~ 0 IDiI~L 17 % TNHEL.997.0~ ' t~D & P , 2 GL J, CS.~9a91 ~ . ~C 4ee' ~_c. 4S > " 4 5'. ~el,-' T ~ ~lD~'f .~,i' \ 1 iA! I''iV_93 5, a F1E' I ~NVn93b.55 ~ ' ~ 4 1 ~5:9a1.5 ~ MH.STA.5-90 M ' 7 .YV-yaS.o9 p~ % i ~ CS-945.9 e.. . ` \ i:`. uS+rl 4Y ` ~ i . ~y. : Mn YSln 21+24.14 ~ MH.STA.2.82 ~ ~ ~'2.~FO~O Ot5 ;~3ik (M:'~~C S'n 1•^,,p79a ~ ~ r" r n.5' MN.57w. 0139 ~ ~ ~ R< 5=0+15 ~ S l9'N , w g- S-'attl 1r4V=93625 y Im nv.939,5' v ~ ~•i=9a6.u N.4fA.2-20 . j :;.5!: L~2 ~ i.``~ : R e It•f I% " iiA 2:•U63 N ~ si ~0 . oa'.:S -<,{-'p• i tl.07k -$J aEVJVE . o ~ i " V' \ - MM.STA4-69 m / VF.Ahf. W;.:~t. SC~SHEET 2402U MH.5T4:9120 ~MN , ' • / EPS"iG 4 sIn. rs•G',ut, "r ~ ~ / sz!'<. S~ 7.zu r ~ D Ox ~E~J:E ex s' 1 ' a . qOP D r, b- : b \ 6 . / h ~ \ ~ ..NMSTAOPSO y l~.oS=U+Sb 1 S 5 ~ °~'~V..~.. W 2i'.. ~ ytp•.. ~ 5 1~R5 ~ r1~ . vI.,T. S; nv-935.'0 ~9, JS1G: ab W . 't . ; 956.Sa 2!6 ; C5=$46. : MM`STA..3170 IC 8 s'..C cor-[N , nE"r. N ~ s aa SERv.CE h,CUR6 p~~ I ~ d.•:-95a.tl1 14 J 1 S10F i0 SIPND ` ~ ~ [$-5+55 . . . \ S=a+65 22 i~Y ~ as~.4' . ~ " ~ . 5...::.... 9 I.r-:954.G4 i \ i 'Et:US~ _ ' - . , ~ - . \ CS=95e ,r05 " . . < iJ=91 Z ` IIIG=, ` • ~ C5'A~€o9 - 1 \ MH.STA 2r70 2 1N• M~~ SIA. JIh69_63. ~ s.. . 0 T CU ~3Afi ; s_~-: :..:s VD0ES~0 ~ ? ? MM.STA.2.62C5=9a3 q51ALL -4, vq:ED dAGAf ti~ _ . . ~ . . , y~/ LOCATIO ~OR \ ~M-\I Sin 20,8994 %~i~.e~`.,•~ ~ 1 GV. ld'-ti' D~V.0. 5~ T'i'11 ' ' 5=G~06 ~'d"x6" 7EE sz ~e.a• ~ `,U1^cA`C'Y OF THS DAi/'. SI ~ ez`~ 5=0+~}]s9I1~\EF:N ,S=94aal.~TNMEL9470/ ,:1~G4;I`T10~5• p,vp 211 10 t~LY ~ T h~~ WEXFOR~J WAY NE`.Li .:Y=93760 \ E"~`R'0.i _~o<.~3 f PURPOSES O , cs=§aao ~/ao,w 93T.67 ~ IT SHOULD VE~","Y ~If~G ITE. ~ t,9_-~ ,<<.,~~•~ NTHES 960 iz.es 954 .89 95IAI 99].6] v. ~ 55, -z ~ N : ~ i:: >+-5tr ~J • _ ~-y-^=^z-rt ' 9 N."_`=-v ~ 945.64 ._-i 12.90~ RE.~}v 955 I 94636 Y . M„ RE-~-~ _ 9 RE -+N336 El n o~o~~ 950 1320, y~. YE=.}yFly l i ' ~ ~ ~ • FE~+rc6_ ' I i i oo~ S:4 - _SE: JdJ..'.L !.v ~ 945 ei' ~ ~a-=~ ~i'^_\ , e•>: :.e ~ 1 z 940 <r , . ~ I • , / r5~'""9:vr.3T8 ~ ~ SDR 3S W ~J . kv ~ . 6 \ 935 wo e-P:cscR ss n 1.32 jI SCR 35 O_'";' , 61 ~i I 5DG SS P. ExiSTIr.G lI ~ ~ I ~ 7N,y- SA`.. SM . 930 srM - c:H 'I ~ . : 54N ' u,;.c . i - s a~'>ri , 8 , . i I ~.r 2?o yl . . . ~ .iFy A :i.:n /y RD 1~] • • -,1 _ , _ J~ ~ :~/I . , °~:I~~ Hf( ~T . . . f i- Wf! . . . EXTERI02 ENVELOPE AVERAG[ "U" COh1PUTA7I0N OWNER: DnTF: S-I-ciCo SITE ADDRESS: 4Z'bZ NWEXI"o&ZD YVArl PFIO^IE: 44"c)"cS400 . CONTRACTOR: ~EqLAI-a17 ~~ES PLAN # ?JCoLoL.-- Determine working square footage of each 1. Total exposed wall area..... 2.1 3 sq. ft. x.11 2. Total roof/ceiling area..... sq. ft. x.026 = 2 v~ Total zxposed wall area above.floor= Z~j~(e a. Total wall window area 2.3b•C.o b. Total door zrea c. Total sliding glass door area 3Q~•~1 d. Total fiireplace wall area - e. Total wall framing area (average 101) f. Total rim joist area 231~.~ g. net wall area a6ove floor ~~}O•1' h. wall area a6ove rloor . i. wall area a6ove floor j. frzme wall area at SOL`^.Qat_O.T'i Total exposed foundation area= Ip..~(o k. Total foundation window zrea ~ 1. Total net foundation area above orade Determine "u" value of each Mrall segment - (e.g. rrindow, door, each separate wail section) z. xu~~ ~ 4~0 = l oio, I b. °t`b•~ X 'lull •31 = 14,`I C. x 'lu„ ~ 4l0 a . r, „u„ - _ , e. 23°I • ~ x u~~ . ~t5 = 22~-I r. Z3~, $ x 'lull , oq.l 9 ia4o, 1 x„u„ h. X llull _ ~ X 1.ull _ . j.- x 'lull _ If item >3 is the sz k x 'lull = as, or less than ite JI, U , intentOfaS8Cm6006 h x ~u~ ( 3 . .................................Total TAT•%.L EXPOS:D RQOF/CcILffIG CALCULATIONS: . . • To;al exposed roof/ceiling area........ ~D8¢j sq ft To[al sl:yliaht area....... sq ft x"U'- ° 1:) To[al roof/ceilinq framin, zrea (Averaae 1(17,)...... _C)&.Qj sq ft x"U" •~~1{- = Z,(p 1) To[al ne[ insulated roof/ceilinq zrea.....,. sq fi x"U" _~~•s L. TOTAL j) t h ru 1) 23. ~ I: total or =b is the same zs, or less than 1'2, ycu have net the intent or . 2 lf.r.: Z 1.16008 _i c.T.d 0. • ALTERt;ATE BUILDItIG ENVEIOPE DESIGN io u:ilize the :otzl enyelope systen methcd, che vzlues estzblished by the sun of iten; -3 znd :=4 shall not he nreater than the sum of i[ems Nl and -2. 30l l + 2. Za.z = 3z9 3 + a. -31 = 2.`c~3• co 2 L Iq BL CITY USE ONLY RECEIPT#: ~j' (J ~ 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 whfsn permits are required for each unit FIXTURES EACH tLQ, TOTAL Shower 3.00 x 2 = (,•bb Water Closet 3.00 x -3 _ 17,06 Baiii Tuu 3.00 ;c Z = -oo Lavatory 3.00 x 3 = . <C~o Kitchen Sink 3.00 x -491- _ aQ Laundry Tray 3.00 :c I = 3-66 Hot TublSpa 3.00 :c = Water Heater 3.00 ;c f = 3.66 Floor Drain 3.00 :t J_ _ 3-06 Gas Piping Outlet " minimum -1 3.00 :c I = -6G Rough Openings 1.50 :c 3 _ 19-60 Water Softener 5.00 x = Private Disposal ' Dekota Cty. license 65.00 = (new and refurbished systems) U.G. Sprinkler ' home under const. 3.00 = Alterations " to existing 20.00 = Water Turn Around 20.00 STATE SURCHARGE .50 TOTAL oa SITE ADDRESS: ya ?,a OWNER NAME: INSTALLER NAME: c- STREET ADDRESS: 7/ 1,-)6~ ~ CIn': STATE: ZIP: SS3~dL~ PHONE Fc;~ ~ OFFICE USE ONLY - ' L BL RECEIPT SUBD. DATE: 1996 PLUMBING PERMIT (CQMMERCIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55122 (612) 681-4675 Please complete for: * all commerciallindustrial buildings. • multi-famity buildings when separate permits are nW required for each dwelling unit. DATE: CONTRACT PRICE: WORK TYPE: _ NEW CONSTRUCTION ' ADD ON _ REPAIR DESCRIPTION OF WORK: IS WATER METER REQUIRED? _ YES _ NO. IF SO, PLEASE PROVIDE THE FOLLOWING: WATER FLOW: GPM. ARE FLUSHOMETER:i TO BE INSTALLED? YES NO. FAILURE TO PROVIDE THIS INFORMATION WIIL RESULI' 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. SPRINf:LER PERMIT. FEE: $25.00 minimum fee or 1% of contract price, whichever is greater. State surcharge of $ 50 per $1,000 of rmi fee due on all permits. CONTRACT PRICE x 1% STA7E 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 ~ B - RECEIPT ~ G 39G SUBD. ~ DATE: 1996 MECHANICAL PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55122 (612) 687-4675 Please complete for: ~ single family dwellings ? townhomes and condos when pertnits are required for each unit New construction Add-on fumace Add-nn air conditioning Add-on air exchanger, i.e. Vanee system, etc. Date: EEF~S • Minimum Fee: Add-oNRemodel (existing residence only) $ 20.00 ? HVAC: 0-100 M BTU 4.00 Additional 50 M BTU 6.00 ? Gas Outlets (minimum of 1 required @$3.00 each) ~ ~ State Surcharge .50 TOTAL 3a S~ SITE ADDRESS- OWNER NAME: PHONE INSTALLER NAME' Q~ ~ ~ Tn STREET ADDRESS: ( Avi CITY: STATE: ~ V V ZIP: J ST1 r~ PHONE b`TGAATQRE-6FF 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 commerciaUndustrial buildings. ? multi-family buildings when separate permits are ~ required for each dwelling unit. DATE: CONTRACT PRICE: WORK TYPE: NEW CONSTRUCTION INT'ERIOR IMPROVEMENT DESCRIPTION OF WORK: FEES: w $25.00 minfmum fee QC 1% of conVact price, whichever is greater. . Processed piping - $25.00 . State surcharge of $.50 per $1,000 of Reand fee due on ali permits. CONTRACT PRICE x 1% PROCESSED PIPING STATE SURCHARGE TOTAL SITE ADDRESS: OWNER NAME: TELEPHONE TENANT NAME: (IMPROVEMENTS ONLI) INSTALLER: ADDRESS: CIiY: STATE: ZIP. ~ PHONE SIGNATURE: SIGNATURE OF PERMITTEE CITY INSPECTOR 2000 BUILDING PERMIT APPLICATION (RESIDENTIAL) -7~ q~~ U 3830 PIL'OT KN B RD - 55122 ~-o V 851-881-4875 -1 r01 _O~ •N9w Consfiucflal Reaulremenls RemoUellReoair Reauiremenn D 3 roylsferod sIte wrveys showlnp sq. M. of bf, aq. ft. of house 2 copiea of plan anG ya roofatl areas (20'16 maxlmum lot coveraae albwedl 1 se10( eneryy cdculoilons for heated adtllXOna D 2 capies of plans (ahow beam d wlndow sizea; poured fnd. tletlyn; elc.) 1 slle wivey for axfarbr addiflona & decks i 1 fYf OI G1Wfyy O01CWatbnt D S copiea o! hee preservallon plan 11 lot plaMed aNer 7/1/93 DATE: 7Z- q -On CONSfRUCTION COST: D00 DESCRIPf10N Of WORK: Y>t! ,;°YJ)CrIi' f~"~Yll S~~ STREEf ADDRESS: LOT: \9 BLOCK: SUBD./P.I.D.B: Name: LeUer I l/l ~ elW Pnoneu: LvSI PROPERTY taat Flrat OWNER W P/X~1~~ NI~\I Sheet Address: qASo2 CNy State: M/ V Zip: 5S4a"~ Company: N ~ Phone N: (area code) CONiRACTOR Sfreet Address: lJcense N Exp. CHy State: 21p: ARCHfiECT/ ENGINEER Company: NA Name: Telephone ( ) Sheef Address: RegistraHon i: City Sfate:....,~ 7iP: Sewedwater licensed plumber (H irmtallina sewarhAraterj: Phone ( 1 heteby aeknowledye Ihat 1 have read this c~,plkaSion, slate Mwt the IMortnarion fs cortect, ond apree fo Comply wHh ati app6eable State of Minneaota Stafiifea and Cify of Eapan C3Fd(nances. , Slyrwfure of Applfcant 1 OFFICE USE ONLY Certificates of Survey Received _ Yes x No FEg _ g : Tree Preservation Plan Received _ Yes _ No ~ Not Required OFFICE USE dNLY BUILDING PERMIT SUBTYPES ? 01 Foundation ? 07 OS-plex ? 13 16-plex ? 21 Porch(3-sea.) ? 31 ExtAit-Mutti O 02 SF Dwelling ? 08 06-plex ? 17 Garage ? 22 Poroh/Addn. (4-sea.) ? 33 Ext. Alt - SF ? 03 01 of _ plex ? 09 07-plex ? 18 Deck ? 23 Porch (screened) O 36 Mutti ? 04 02-plax ? 10 08-plex ~-19 Lower l,evel ? 24 Stortn Damage ? 05 03plex ? 11 10-plex VIbg,~CYCr_N n 25 Miscellaneous ? 06 04-plex ? 12 12-plex O 20 Pool ? 30 'Accessory Bldg. WORK TYPE ? 31 New ? 36 Move Bldg. ? 43 Reroof ? 32 Addition ? 37 Demolish (Bldg)' 0 44 Siding ,W'33 Alteration ? 38 Demolish (Interior) ? 45 Fire Repair s ? 34 Repair ? 42 Demolish (Foundation) ? 46 Windows/Doors • Give PCA handout to applicant for demolition pertnit - GENERAL INFORMATION SAC Code 0 1 # of Stories sq. ft. No. of Units i Length sq. ft. No. of Buildings CJ Width Footprint sq. R. Const. (Actual) Basement sq. ft. Census Code 4 3 y (Allowable) Main level sq. ft. MC/ES System UBC Occupancy sq. ft. City Water Zoning sq. ft. Booster Pump PRV Fire Sprinklered MISCELLANEOUSINSPECTIONS ? Stucco/Stone APPROVALS Planning Building 6 Engineering Variance Permit Fee 6 O, S 0 Valuation: $/U ,o oG , UO Surcharge CITY oF EAran Plan Review License CASHIEfi: iS TEfiMINAL N0: 016 MC/ES SAC DATE: 02/03/00 TIME: 13:54:24 City SAC Water Conn. IU: Water Meter NAMEa ftENEE LIELER Acct. Deposit S!W Permit 3210 9001 4262 WEXhORI, WA 60.00 S/W SurChBfge 3430 300:1. 4282 WEXFORLi WA 0.50 Treatment PI. 2155 9001 4262 kIEXF01iU WA 0.50 ' PBfk DEd. 3430 900i. 4282 WEXFOFD WA 1.00 Traiis Ded. , Other . Copies S O Total: 61,90 SAC Uf1itS Total fieceil"'f Antoilnt : 62.00 % SAC CR12;34 (3b IJSIe:Fi :CDe JAi+! PERMIT # Ll o 9 RECEIPT DATE: L4 - `e->" v I MIDENTIAL PLUM$1Nfi PEfiMiT APPLICATIOft crrYoF EAsm 3$30 PILOT KNOB RD SAHAN. MN 55122 651-681-4675 Please complete for: ? single family dwellings ? townhomes and condos when permits are required for each unit ? backflow preventer for irrigation system SITE ADDRESS: m kard lIJQIl OWNER NAME: : I I 'Y ZVI ~iI i LTELEPHONE (AREA CODE) INSTALLER NAME: TELEPHONE (AREA GODE) STREET ADDRESS: CITY: STATE: ZIP: Place a check mark next to the ermit work t e New residential dwelling unit under construction and not owner/occupied $ 90.00 ~ Add-on, modification or alteration to existinq dwelling unit, including: $ 50.00 • abandonment of septic system • new installation/repair/rebuild of RPZ • lawn irrigation system • waterturnaround Nature of work: ~~d ~jY 1 Septic System, new/refurbished - $ 225.00 • includes County & Consulting Inspector fees • requires MPC license State Surcharge $ .50 Tota I Reminder. Be sure to schedule inspections of alterations, i.e. water heaters, water softeners, etc. I hereby acknowledge lhat I have read this application, s[ate that the information is correct, and a9ree to comply with all applicable Qtyof Eagan ordinances. It is the applicanPS responsibiliry to nohfy the property owner that the City of Eagan assumes no liabilityfor any damages caused by the Ciry during its normal operational and maintenance activi6es to the facilities constmcted under lhis permR X~= op leasem o ~ n n n ~ ~ I~, I~ ~I T~y v U SIGNATURE OF PERMITTEE I r~l APR 0 6 2 "u Updated 1/01 By Q-k-a- "7 J RESIDENTIAL BUILDING Permit Application City Of Eagan 3830 Pilot Knob Road, Eagan Mn 55122 Telephone # 651-675-5675 FAX # 651-675-5674 New Construchon Reauiremenfs RemodeVReoair Reowremenis Ofrice Use Onlv 3 registered sile surveys showing sq. ft of lot sq. N. of house, and all roofed areas 2 copies of plan Cert of Survey Recd (20%maximum lot coverage allowed) 1 set of Energy Calculations for heated additions Trce Pres Plan Recd 2 copies of plan showmg beam & window sizes; poured found design, etc. 1 site survey for additions 8 decks Tree Pres Not Reqd lsetofEnergyCaiculations Add'rtion - indicafeAon-sdesepficsystem _Oo-sAeSepticSystem 3 copies of Tree PreservaUon Pian d lot plaried afler 71153 Rim Joist Detail Op4ons selec6on sheet (bidgs with 3 or less unRs Date 3 / / 0~J ~ Coustruction Cost SiteAddress 14ja( Unit/Ste # = 01 mN s~ Descrip[ion of Work ' Wd Multi-Family Bldg _ Y~ N Firepiace(s) _ 0 _ 1 _ 2 Property Owner J j I~ '1~' y) L~~~ i (~~c r- Telephone ) e~ -7 Contractor Address City State Zip Telephone # ( ) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING - Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672 Energy Code Category , Residential Ventilation Category 1 Worksheet . New Energy Code Worksheet (J submission rype) Submitted Submitted • Energy Envelope Calculations Submitted Licensed Plumber Telephone ) Mechanical Contractor 7elephone # ( J Sewer/Water Contractor Telephone Ul I!. , j IDi f , viAR 0 3 2003 I hereby apply for a Residential Building °ermit and acknowledge that the informa - on is complete and acc rate; that the work will be in conformance with the ordinances and codes of the City oEagan and the State o~ MN Statutes; I understand this is not a permit, but only an application for a permit, and ` o lc=is-~Y=te=sta~E-wittlout a permit; that the work will be in accordance with the approved plan in tt~e case of work which requires a review and approval of plans. G-I dei' ApplicanYs Printed Name Applicant's Si ature OFFICE USE ONLY Sub Types ? 01 Foundation 0 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg 13 02 SF Dwelling ? OS 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 EM. Alt - Multi ? 03 01 of _ ptex ? 09 07-plex O 17 Garage ? 22 PorchlAddn. (4-sea.) ? 33 E#. Alt - SF ? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc. ? 05 03-plex ? 11 10-plex ~ 19 Lower Level ? 24 Storm Damage ? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous Wark Types ? 31 New ? 35 Int Impravement ? 38 Demolish (Interior) ? 44 Siding ? 32 Addilion ? 36 Move Bidg. ? 42 Demolish (Foundation) ? 45 Fire Repair 33 Alteration ? 37 Demolish (Bldg)• ? 43 Reroof ? 46 Windows/Doors ? 34 ReplaCement 'Demolition (Entire Bldg) - 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 Bldgs Length Fire Sprinklered Type of Const Width REQUIRED INSPECTIONS _ Footings (new bldg) FinaUC.O. _ Footings (deck) Final/No C.O. Footings (addition) T~ Plumbing _ Foundation ~ HVAC ~tI//yj, Drain Tile Other Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests _ Final _ Framing _ Siding Stucco Srone _ Fireplace _ R.I. _ Air Test _ Final _ Windows (new/replacemen[) _ Insula[ion _ Retaining Wall Approved By , Building Inspector Base Fee Surcharge Plan Review MClES SAC 01)0 N~ City SAC n`~m` Utility Connection Charge vjJ(Q/ S&W Permit 8 Surcharge ~ Treatment Plant License Search Copies Other Total i , C I For Offce Use l ~ ~ _ ~ - - - I ~ Permit#: ~ Clty of Ea~an ' 3& ' ~7 ~ ' I Permit Fee: ~ 3830 Pilot Knob Road Eagan MN 55122 ~ Date Received Phone: (651) 675-5675 Fax: (651) 675-5694 i Staff i 2008 RESIDENTIAL BUILDING PERMIT APPLICATION Date: 1 ~D l~ Site Address: lL- Tenant: ! -15, Suite#: RESIDENT/OWNER Name. Phone: 6~l -y,S-2 3y77 Address / City / Zip: i~ Applicant is: XOwner _ Contreclor TYPE OF WORK Description of work: Construction Cost. Multi-Family Building. (Yes No ~ CONTRACTOR Name: 91,1an rc-i-oS~ r License 2-O 3?JLI 75// Address: 031 C-, h5' City: klt~ 10 9 State: M~j Zip: SS /0 7 Phone: Lr5I"LI 7f"'3I 73 Contact Person: KX4 r/\roSQ T COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Minnesota Rules 7670 Cateqorv 1 Minnesota Rules 7672 Energy Code . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet Category Su6mitted Submitted (4 5ubmission type) • Energy Envelope Calculations Submitted In the last 12 months, has the City of Eagan issued a pertnit for a similar plan based on a master plan? _Yes _No If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer & Water Contrector: Phone: NOTE: Plans and suppoRing documents that you submit are considered to be public information. Porfions of the information may be classified as non-public if you provide specific reasons that wou/d permit the City to conclude that the are trade secrets. 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 permR, but only an application for a permit, and work is not to stad wdhout a permik that the work wdl 6e in accordance with the approved plan in the case of work which requires a review and approval of plan x L0.n k0S1i ApplicanYs Printed Name I canYs Signature Page 1 of 3 PERMIT City of Eagan Permit Type:Building Permit Number:EA115106 Date Issued:09/23/2013 Permit Category:ePermit Site Address: 4282 Wexford Way Lot:019 Block: 001 Addition: Wexford 2nd PID:10-83851-01-190 Use: Description: Sub Type:Reroof Work Type:Replace Description: Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar. Pictures are not acceptable in lieu of inspections. Carbon monoxide detectors are required by law in ALL single family homes . Angie Olson Valuation: 4,000.00 Fee Summary:BL - Base Fee $4K $103.25 0801.4085 Surcharge - Based on Valuation $4K $2.00 9001.2195 $105.25 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - William Lieder 4282 Wexford Way Eagan MN 55122 (651) 452-3474 Reroof America 10740 Lyndale Ave S Suite 10W Bloomington MN 55420 (952) 888-8440 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA168521 Date Issued:04/23/2021 Permit Category:ePermit Site Address: 4282 Wexford Way Lot:019 Block: 001 Addition: Wexford 2nd PID:10-83851-01-190 Use: Description: Sub Type:Residential Work Type:Replace Description:Furnace & Air Conditioner 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: 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 - Joseph & Hillary Sass 4282 Wexford Way Eagan MN 55122 Homeworks Services Co Dba Homeworks Plumbing Htg 1230 Eagan Industrial Rd, Suite 117 Eagan MN 55121 (612) 400-9020 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA178426 Date Issued:08/16/2022 Permit Category:ePermit Site Address: 4282 Wexford Way Lot:019 Block: 001 Addition: Wexford 2nd PID:10-83851-01-190 Use: Description: Sub Type:Water Heater Work Type:Replace Description:Standard Water Heater Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Building Code). Please call Building Inspections at (651) 675-5675 to schedule a final inspection. Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087 Surcharge-Fixed $1.00 9001.2195 $60.00 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 - Joseph & Hillary Sass 4282 Wexford Way Eagan MN 55122 Champion Plumbing Llc 3670 Dodd Rd., #100 Eagan MN 55123 (651) 365-1340 Applicant/Permitee: Signature Issued By: Signature