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1233 Wilderness Park Cir 5/C/ REDUEST FOR ELECTRICAL INSPECTION EBOOOOb08 I j ? See msimcLOns lor completing ihis forrn'on back Ot yellow ropy 101y.1 I "X" Below Work Covered by This Request e~mA_ Re"p.I TypeolBwitling Applianceswiretl EquipmemWired Home Range Temporary Service Dupiex Water Heater Elednc Heating Apl Builtlmg Dryer Other (Specdy) Commllndusirial Fumace ~ Farm Au Conditioner Other IsVecilyl Gomremors Remer:s, i I ~ Compute lnspection Fee Below: I d Other Fee ServiceEniranceSae Fee # CucunslFeeders Fee Swimming Pool 0 to 200 Amps ~ / 0 ta 100 Amps Transformers Above 200 _ Amps A P 700 _ Amps SigOS inspenor's Use oniy , TOTAL Irngaeon Booms ,;0(" il ~ Special Inspection AlarmlCommunicaLOn THIS INSTALLATIO BE CONNECTED IF NOT Other Fee COMPLETED WIT O I, the Electrical Inspector, hereby Rougmin ~ oa; ceNfy that the above mspection has F,,,ai oa been made. --OFFICE USE ONLV This reQUest voia 18 momns Irom . _ _ _ . -..r..,... YILUGE OF EAGAN WATER SERVICE PERMIT . 3795 iibt Kwob Rood PERMIT NO.: 2052 Eoyan, MN 35122 DATE: 9/ 2 0/ 7 fi Zoning: RI No. of Units: 1 Owner: Sm$nn Pn ersen Addreas• s c ress: 1233_ldilderne~s Park Cir le L12 B1 WPk P um r: .~ro ject PlumbinQ Co. Meter :A-.Sr 'A 3,140 Connection Charge: 220.00 pd Size: ~ Account Deposit: Reader No.: ys / Permit Fee: 10. 00 pd I eyno to eowqlr with tIN Villov of Eayoe Surcharge: • 50 pd O?Iin74-~ ~ Misc. Charges: 60.00 pd Total: By Date Paid: Date of Insp.: lnsp.: YILLAOE OF EAOAN SEWER SERVICE PERMIT 3799 Mlot Kweb Roe/ PERMIT NO.: 2802 Ee4ee, MN 55122 DATE: 9/ 2 0/ 7 6 Zoning: _ - No, of Units: 3- Owner: SV nn Petersen Addreas: Site Address: 1233 Wilderness Park Circle I.12 R1 WP Plumber: proiect Plumbinq Co 9/15/76 #4116 100.00 pd I a9rN to eomPly with tlw ViUep ei Eopw Connection Charge: 350.00 p d 0741memcm Account Deposit: Permft Fee: 10 . 0 0 p d Surcherge: •50 pd gy; Misc. Charges: Date of Insp.: Total: Insp.: Date PaW: CITY OF EAGAN Remarks Additfon LAt 12 Bik ~ Parcel 10 8 2 0 120 1 II o,,,,,, r?'L 7~-`~1 str~t 1233 Wilderness Park Cr. stete Ea.gan,MN 55123 TJ Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. STREET RESTOR. GRADING SAN SEW TRUNK a( 176,05,. 8,080 20 SEWER LATERAL WATERMAIN WATER LATERAL WATEFi AREA _ rfinjw STORM SEW TRK STORM SEW LAT CURB & GUTTER 51DEWALK STREET LIGHT WATEH CONN. 9UILDING PER, SAC Co PARK 1111.7 Roaeipt MECHANICAL PERMIT Permit No. CITY OF EAGAN Fm FfIJ in numbered spaces 5/C Type or Print !eglbJy Tot 1. Date 2. Installation Cost 3S ~'k C~' ro L°. 3. Jvb Addresa / <~`nL.ot r~ ~ Blk. % Tract 4. Owner 5. Contractor Phone 6. Address 7, City State Zip 8. Building Type: Residentiai D Commercial ? Institutional ? 9. Work Description: New ? Add ? Alier ? Repair O 10. Oescribe Fuel TYpe 11. No. Eauioment BTU - M. Ea. No. Equiament CFM Forced Air Air Handling: Mfg. • Boilers Mech. Exhaust Mfg. Unit Heater Mfg. Other Air Cond. Mfg. Gaa, Piping Outlets 12. I hereby certify that the above information is true and correct, and I agree to oomply with all ordinances and codes governing this tYpe of work. Signad : for Rough Final ~ Inspections: Date Insp. Date 7~~~,, /G _InsP• ~ T'Z This is your permit when numbered and approved. ARproved CITY OF EAGAN 464-6100 I SPECTIUN REC4R9 CITY OF EAGAN PERMIT TYPE: ' " ' 3830 Pilot Knob Road Permit Number. i4 110 ~ Ea9an, Minnesota 55122-1897 Date Issued: (612) 681-4675 • ~ SITE ADDRESS: E~? r-. t:, 11.1 111 F ~ APPLICANT: ' ir1 ;CPARI( t: (lt P~r1~ i I f! ;'i',~.t,~ f r1 I F• ri! . . i r4 I,t ; i . ~ . PEqM1T Su~qTYQE: TYPE OF WORK: INSPECTION TYPE DA • D• ~ ~ ~ ~ Permit Hoider Date Telephone M PLUMBING HVAC Inapeetion Dste Insp. Commants FOOTINGS FOUND FRAMING ROOFING yz ~ ~ ROUGH PLUM8ING PLBG AIR TEST RQUGH HEATING GAS SVC TEST INSUL GYP BOARD FIREPLACE FIREPLACE AIR TEST FINAL PLBG FINAL HTG ORSAT TEST BLDG FINAL DOMESTIC METER IRRIGATION METER RUSH MAINS conioucTwiTr TEST HYDFIOSTATIC TEST Q BSMT R.I. BSMT FINAL DECK FfG DECK FlNAL ~ I - - RESIDENTIAL BUILDING PERMIT APPLICATION CITY OF EAGAN ~ 3830 PILOT KNOB RD - 55122 651-681-4675 New Construclion Rwuirements RemodeVReoairReauiraments • 3 registereA site surveys showing sq. ft. of l04 sq. ft of house, an~ll roofed a2as • 2 co0ies of plan (20% maximum bt caverage albwed) . t set of Eneigy CakriWtbns for heated addilbns • 2 copies of plan showug beam 8 windax srzes; poured found desgn, elc ) . 1 site survey for extenor additans & decks • 1 Set of Energy CalCUlalions • IndxatC rf home SCrvCd by Septlc system for 2ddibons • 3 copies of Tree PreservaGOn PWn i( bt platted afler 7/1193 • Rim Joist Detail Options selechon sheet (bldgs wiN 3 or less unils) DATE 10 - L-I -n I YALUAION JOBSITEADDRESS la~~~dWAer?iP55 }7Grk Gi~~IP IF MULTI-FAMIIY BUILDING, HOW MANY UNITS? PROPERTY OWNER C>fe~ TYPE OF WORK I~,orc. FIREPLACE(S) ?O _ 1_ 2 APPUCANT F ` ?t - PHONE# 9SuLy~J'r-_373~ ADDRESS I6~Sn OfbS+er C+• 11or jCe ~ Yl• ZIPCODE .SS_?~ PAGER # CEII PHONE # FAX # NEW RESIDENTIAL BUILDING ONLY- FILL OUT COMPLETELY Energy Code Categary _ MINNESOTA RUI.LS 7670 CATEGORY 1 (check one) - Residential Ventilation Category 1 Worksheet Submitted - Energy Envelope Calculations Submitted MINNESOTA RULES 7672 - New Energy Code Worksheet Submitted Plumbing Contractor: Phone N: Plumbing System Includes: Water Softener Lawn Sprinkler Pee: $90.00 NVatcr Heater No. of R.I. Baths No. of Baths Mechanical Contractor: Phone k Mecf~znical Systcm Includcs: Air Conditioning Pee: $70.00 _ Heat Recovery System - - Sewer/Water Contractor: Phondli" i i ~ • , All above information must be submitted prior to processing of application. f I hereby acknowledge that I have read this appiication, state that the information is correct, and agre-eto comply with afl applicable State of Minnesota Statutes and City of Eagan Ordinances. Signature of AppUcanf Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _ Updated 1101 OFFICE USE ONLY ? 01 Foundation ? 07 OS•plex 0 13 76-plex ? 20 Pool 0 30 Accessory ~ldga ? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace X 21 Porch (3-sea.) ? 31 Ext. Alt - Multi ? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 E#. Alt - SF ? 04 02-plex ? 10 OS-plex ? 18 Deck ? 23 Porch (screened) ? 36 Multl ? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Starm Damage O 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous ? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding 32 Addition ? 36 Move Bldg. ? 42 Dertalish (Foundatlon) ? 45 Fire Repair ? 33 Alteration ? 37 Demolish (Bldg)• O 43 Reroof ? 46 Windows/Doors ? 34 Replacement 'Demolilion (Entire Bldg only) - Give PCA handout to applieant Valuation 41 ; a00 Occupancy (l ; _ L/'L MC/ES System Census Code 4 3~ Zoning City Water SAC Units Stories Booster Pump Nbr. of Units Sq. Ft. I -Lj PRV Nbr. of Bldgs _L Length Fire Sprinklered Type of Const Width REQUIRED INSPECTIONS _ Footings(new bldg) FinaUC.O. Footings (deck) _y FiuaVNo C.O. Footings (addirion) _ Plumbing Foundation HVAC Drain Tile Roof Ice & Water Final Other ~ Framing _ Pool _ Ftgs _ A'u/Gas Tests _ Final F'veplace _ R.I. _ Air Test _ Final _ Siding Stucco Stone Insulariou _ Windows (new/replacertwnt) Approved By T2- , Building Inspector Base Fee 3- 5~" NSt*J Surcharge Plan Review MCIES SAC City SAC Water Supply & Storage S&W Permit 8 Surcharge Treatment Plant Plumbing Permit Mechanical Permit License Search Copies Other Total ~~~~~s /ao~~! Fequest Date, Fire No. Rouph-in Inspettion NOTICE: You Must Call Electncal Inspeclor Reqmretl'+ II A PougM1-In Inspedron /I ?Yas ~~41fto IsPeQwretl. I ~I licensed contractor ? owner hereby request mspeCtion of above electrical work at i Job Atldress (Snee6 Bax or Route No ) ~I City- ~2 Section No Tavnship Name or N. Range No, C ut~ (i (PRINT) one No. Power Supplier ` Atldress IC Etecvical Contrecmr ~C ~ma) ~ I ConlraMorS L~cense No. me?~c~ ~e ~c , cr Ao atling Address (COntroctor or Orvner Making Inslallatmn) ~ \ 1 Auih z ignaW~ (Contracton glnstallation) PhoneNUmber NESOTFO OF ELECT TY THIS INSPECTION REOUEST WILI NOT Grlggs-MlRoom 5-19 8E ACCEPTED BV THE STATE BOARD 1821 UnivPeul, M 106 UNLESS PROPER INSPECTION FEE IS Vhone(6 Ba1-0B00 I ENCLOSED. - neWUesi run nLtGIFi1, INSPEGTION ` ~EB-00001-/ i S e i sl qio lor comple~ing Ihis lorm~on back ol yellow copy, pS ~ 'Be/ow Work Covered by This Request M 20268 ~9 ~ ~ ° i Add"f!p. T ofBdtlin AppliancesWuad EquipmentWiretl Home Range Temporary Service Duplex Water Heater Electric HeaM1ng Apt. Building Dryer Load Mana ement Comm./Industrial Fumace i Other (Specdy) Farm Air Condrtioner OtM1er (spenty) Conlrador§ Pemarks:l I lyC Compute Inspection Fee Below: Ccpa...i, r" Ma4il # Other Fee # ServiceEniranceSrze Fee # CircuRS/Featlere Fee Swimming Pool 0[0 200 Amps 0 to 700 Amps Transformers Above 200 _ Amps Above 100 _ Amps SigflS Inspectorb U. Ony TOTAL Irriga6on Booms ~Q • 'S`~ Special Inspection Alarm/Communication THIS INSTALLI TION MAY BE ORDERED DISCONNECTED IF NOT Other Fee COMPLETED WITHIN 18 MONTHS. I, the ElecUical InspecloC hereby Rouqn,n I Date certify that the above inspection has F~~ai i ome• been made. „ OFFICE USE ONLY This reduest voitl 18 monihs imm i ~ CITY of EAGAN 4067 BUILDING PERMIT ....5:.....~G4..~f"S.AN......r.ePAr..S.7.~.....1l.c...... 3795 Pilo! Knob Road Ownei ~ Eagan, Minneaola 55124 Addsea (Presenf) ~!.7~L.....~I.lf7..~:~.I.•`....f..t'f../..~,~.~$.......5..-.5.~/3 ~J 454-8100 Bulldar .......................s a7./.Yl.K................................................... > / ~ Addreai ~ Deto l..~..2.~(l ~ DEBCAIPTION Btoriec To Be Uaed For Fron! Deplh Heigh! Eai. Cos! Permi! Fee Aomarlcs /6 gc ~ 8 ~5~ ~oa • 333 LOCATION Sireal, Aoad or oiher Daseripfion oI Locelfon I I Lo1 Bloek Addillon or Trsc! This permii does not aulhorize the use oi elreefs, roads, ellaps or cidewallu nor does if give the oanor or his agen! the riqht to ereale any sifuation which is a nuisence or which presents e hasard !o the heallh, safelp, eoaveaienp and general welfare !o anyone in the communily. . ~ THIS PERMIT MUST BE KEPT ON THE PREMISE WHILE THE WOAK IS IN PROGRESS. i ihis is !o eerlify. haepermiaston !o erec! a..~~,~ . ....._upoa the above described premise subjeci Yo the provisions af all applicable Ordinanees for !he Ci2~Eagan. ..,1.`!.!.....L......~...~.1..z2 Pr ..~~.l........~~................... . Mayor Suildinp Iaspxlo r- , CS`i'Y CF E9GAN 37.05 Pilot Kno3 P.oad Eagan, Nlinnescta 55122 PERi~'fIT N0. : 805 The City of Eagan hereby grants'Ito Genz-RVan Plumbinv & Heatinq Znc. o£ ~ Rosemount, MN 55068 a HEATING Permit for: (Owner) Svend Petersen ' at 123,8 Wilderness Par1S pirsuant to application dated _ 9/16/76 Fee Paid: $20.00 dated this 24 day of September , 19_ 76 .50 s/c ~ i Building Insp°ctor Nechanic[Ll Permits: , Bid Total: ' / o ~s~a So iC)o II ~ 727 I Project Plumbing Co. ~ 9743 Hur.ibold tAve. So. I PLUMBING $venn Petersen Const. Frk Cizcle 123 & 1235 4lilderness 76 $40.00 20 September 76 1.00 s/c I I ~ ,irr.10 2d Carlson I Wildernesa Run Road ~ ~ '-ag<' L, Mi nn . Bk : 2 9/153 . DELMAR H. SCHWANZ lANDSUWVEYUA Feps\m~C UnG.r L.~t of Tne ISi.:. of Mmneeob 11515 SOUTM ROBENT TRAII P.O. BO% M ROSEMOUNT, MINNESOTA 55088 PMONE 012 423-1789 I , SURVEYOR'S CERT,IFICATE . ~ r ~ 7500 ' N 88 ° 30'44 " W h o 'o . 1~ a LOT 12 + ~ . "T z o So iou anovo leo,; a r- I 7 R~ I 10 i ~ HOVS,E 1 incn = 47 !'eet <o.. o Denc*.es irori mor.. o / O . .GGR%. If \I~ Q 30.0 ` 1-t:,~-.Drainage LY m u tillty ~ R-j68;~5 ` ~S`~~• - , 0 ~ I :tereby cert,lfy that thits is a true and correct representation of a survey oP the boundari~:s ..nf : " Lot 12, II1ock 1, WILDrRNESS ?ARK ADDZTION, accurding to the recorded plat thereoF, Dakota County, Minnesota. It also shops the location of a proposed ou11d1nF. As surveyed by me ~ this 19th day oP Auguat, 197t,. I ~ O ~ ~ I , I •d,wrvFSOTA REG[S RATIO4 N0.8675 / I I I ~ f PERMIT CITY OF EAGAN 83C4 WifotKnobRoad PERMITTYPE: aurLorNe ~ agan, Minnesota 55122-1897 Permit Number: 0 3 3 3 6 0 (612) 681-4675 Date Issued: 0 9~ 2 2/ 9 8 SITEADDRESS: 1233 WILDERNESS PARK CIR LOT: 12 BLOCK: 1 WILDERNESS PARK P.I.N.: 10-84250-120-01 DESCRIPTION: R E R O O F Building Permit Type STORM DAMAGE Building Work Type REPAIR .Census Code 434 ALT. RESIDENTIRL ~ , . ' . . . _ . , ' . . i ` REMARKS: i I FEE SUMMARY: I NrA`fIN~TAq~56CIATES _ pPP 114691212 0009228 OJONES WNER: GREG 26386 HIGHVIEW AVE 1233 WILDERNESS PARK CIR FARMINGTON MN 55024 EAGAN MN 55122 (612) 892-0454 (651) I hereby acknowledge that I have read 'this application and state that the information is correct and agree to co'mply with all applicable State of Mn. SCatutes and City of Eagan Ordinances. L J APPLICAN7/PERMITEE SIGNATURE UED BV: SIGNAT E 1998 BUILDING PERMIT APPLICATION (RESIDENTIAL) CITY OF EAGAN ~ 3830 PIT.OT KNOB RD - 55122 3 c) e81-4675 Naw Construetion Re uirements RemodeUReoair Reauirements ? 3 registered site surveys • 2 copies af plan • 2 copies of plans (incluCe beam 8 window saes; poure0 fnd. design; etc.) ? 2 site surveys (exteriar additians 8 decks) ? 1 energy wiculationa ? 7 energy calculations for heated additinns ? 3 copies of !ree preservation plan d lot platted after 777193 reqwred _ Yes _ No 00 DATE: - CONSTRUCTION COST; DESCRIP N OF WORK: ~ D7/YI ~ S EET ADDRESS: ! L _ LOT: BLOCK: SUBD./P.I.D. n'v~a AJ-) ~ Name: Phone PROPERTY Laz irst OWNER p y ~ \ Street Address: aJ/ ~ ~lijL~/ Ciry State: f~I/ V/ Zip: Company:&/! Ar-) lt-/Lcl:/ e • 1c~1~v~iwjl CONTRACTOR / / Street Ass: ~~Dla License # City ddrg ~ State: ~V Zip: ARCHITECT/ ENGINEER Company: Phone Name: Registration Street Address: C iry State: Zip: Sewer 8 water licensed plumber (new construction only): Penalty applies when address chanc and lot change is requested once permit is issued. I hereby acknowledge that I have read this application and state that the info ation is ce and agree to compty with all appiicat Siate of Minnesota Statutes and City of Eagan Ordinances. Signature of Applica : OFFICE USE ONLY Certificates of Survey Received _ Yes _ No Tree Preservation Plan Received _ Yes _ No _ Not Required OFFICE USE ONLY . BUlLD1NG PERMIT TYPE ? 01 Foundation ? 06 Duplex ? 11 Apt./Lodging 0 16 Basement Finish O 02 SF Dweliing ? 07 4-piex ? 12 Multi Repair/Rem. ? 17 Swim Pool ? 03 SF Addition ? 08 8-plex ? 13 Garage/Accessory ? 20 Public Facility ? 04 SF Porch ? 09 12-plex ? 14 Fireplace ? 21 Miscellaneous ? 05 SF Misc. ? 10 = plex ? 15 Deck WORK TYPE ? 31 New ? 33 Alterations ? 36 Move ? 32 Addition ? 34 Repair ? 37 Demolition GENERAL INFORMATION Const. (Actual) Basement sq. ft. MC/WS System (Allowable) 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. SAC 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 Pertnit S/W Surcharge Treatment PI. Park Ded. Trails Ded. Other Copies Total: % SAC SAC Units 1:2 3.,7 ,eA... MASTER CARD LOCATION OWNER STRUCTURE AND LAND USED AS Issued To Permit No. Issued Coniractor Owner BUILDING PLUMBING 1? 0/ -2U-'~ CESSPOOL - SEPTIC TANK WELL ELECTRICAL HEATING , GAS INSTALLING SANITARY SEWER • OTHER OTHER Approved Items (Initial) Date Remarks Distance From Well FOOTING SEPTIC FOUNDATION CESSPOOL FRAMING TILE FIELD FT. FINAL ELECTRICAL DEPTH HEATING OF WELL GAS INSTALLATION SEPTIC TANK CESSPOOL DRAINFIELD . PLUMBING WELL I SANITARY SEWER ~ Violations Noted on Back COMMENTS: COMPLIANCE INSPECTION REPORTS TO BE USED ONIY IN EVENT OF OBSERVED VIOlATI0N5 PERMIT NO. DATE OF INSPECTION CONDITIONS OF CONSTRUCTION AT THIS INSPECTION ? NO EVIDENCE OF NON-COMPLIANCE ? NON-COMPLIANCE. BUILDER DOES NOT OBSERVED. INTEND TO COMPLY. ~ ACCEPTABLE SUBSTITUTIONS OR ~ DEVIATIONS. COMPLETION OF CERTAIN IMPROVEMENTS WILL BE DELAYED BY CONDITIONS BEYOND CONTROL. NON-COMPLIANCE. BUILDER WILL COMPLY WITHOUT DELAY. ITEMIZED AND DESCRIBED AS FOLLOWS: ? REINSPECTION REQUIRED DATE OF REINSPERION REINSPECTION REVEALED CERTI FICATI ON - I cettify that I heve carefully inspected the abwe in which I have no interest present or prospective, and thet I have raported herein all significant conditions oLServed to 6e at variance with ordinances of the Town of Eagan, apprwed plans and specifications, and any specific require- ments for off-site imprwements relating to the property inspected. F-I ALL IMPROVEMENTS AGCEPTABLY COMPLETED BUILDING INSPECiOR DATE COMMENTS: 23 Attn: ~ • Arnold Carlson 1255 Wilderness Run Road F-1gt*%, t+li. nn . Bk : 19/153 _ DELMAR H. SCHWANZ LAND SUR V EYOF ReqUlcreO Vnoar Lawt ol Tne Stale of Mmnesota 14515 SOUTH ROBERT TRAII P.O. BOX M ROSEMOUNT, MINNESOTA 55088 PMONE 812 423-1788 , SURVEYOF'S CERTIFICATE . ~ \ L I~.) 7s. oo ' I N 88 °30'44 "W h O' io lb - O yp° / LOT 12 I L 0--. .~;7o 30 VROPOSID/ o r- a = r-~ 10 o HOUS~E n i I ~ 1 inch = 40 f'eet 0 ~ o Denotes irvn mon. : a -~w N I I o I a ~ GAR / 1 / oo : J, z<.o . 1-7- llrainage ~ - ~ m utility ~ l11 0'o' esmt. ~ oa3~Q0 u~ ,o - L ,6 . o ~ ~L R' L_10~a3 ` ~~r,• i ° k I ~f,1` jC)1 , 1 ~ I _T hereUy cer•tify that thta .Ls a true and correct representation oP a survey of the Uoundarles of: I - Lot 12, B2ock 1, WILDF.RMESS PARK ADDITTON, according to the recorded plat thereof, Dakota Coyinty, Minnesota. It also ahows the locatlon of a proposed buildlnF. As surveyed by me ~ thls 79th day ot August, 197c,. O , '1 nNFSrITa qEG15'YRA7I(1~1 NO 8625 ~ • \ Date: BUILDII7G PERMIT P.PPLICATIOI4 LOT __Zg BIACIC ADDITI ~ PARCEL & SiCTIODI PNtdBER IF UB]PLATTED - ADDRF.SS OL' PP.RCEL I.~ /./~~-~~•r.n.~',%Li /~iti/-~ P/2~'~[v , AOi1TIdG_~--aCCUPIiPJCY W 'e;~t5~ E;TILIATED COS^1 Ow.dER S PF7-Eh' Sf`A/ C9 U/f/S't- (?O TELEPHONE v0. zunxESS -//70 / u/ /'1 PG s• 5 S 4~ 3~ CONTRACTOR 5.. (fc7 ?'~LEPxorE rto. AnoREss ~ 7 o i Gv o T= 5-~- /Ll f'L s_ f'y i•vr~. y 5~f 3 7 iiotes Include site plan, building plans, and elergy calcul ' ns vJith this application ~ S' ed OPFICE iTSE VALUATIOII SAC ~ ys~ Da ATER co.~vEcTxoea ~ ra kJATER !4ETER ~ I..~ • 0c) BUILDING PER1,1IT FEE ~ SURCHA.RGE FEE 3 -PLAtI CfiECK FEE PAFtiC DEDICATIOId FEE OTHER - TOTAL* ~ / I V ' APPROVALS: ~ ASSESSMEiVT CLERK_4~~BUILDING DEPT. POLICE DEPT. WATER & SETJER DEPT. FIItE DEPT. PARR DEPT. ~ MECHANICAL (RESIDENTIAL) 12p ~ Permit Application City Of Eagan 3830 Pilot Knob Road, Eagan Mn 55122 Telephone # 651-675-5675 FAX 4 651-675-5694 Please complete for. Smgle Family Dwellings Townhomes and Condos when permi[s are required for each unit Date Site Address ~rlr.`js pQY c-;-r- Unit # Property Owner VTL[~ ~ V LJ..~.i..~, U~'CS Telephone ) u Contractor Wohlers Southside Htg. & Air, Inc. I 6950 W. 146' St., #106 Street Address _ Apple Valley, MN 55124 Cjty (952) 431-7099 State Telephone # ( ) The Applicant is _ Owner ~ Contractor Other Add-on, modification or alteration to existing dwelling unit $ 30.00 furnace replacement air exchanger ~ air conditioner other State Surcharge $ .50 C,I ~ ` ~II11 Total SCP 0 8 i I herehy apply for a Residen[ial Mechanical Permit and acknowledge that the iafol tion-is-complete=and•accu~'rate; that the work will be in conformance with the ordinances and codes of the City of Eagan and with the Mechanical Codes; that I understand this is not a pemut, but only an application for a permit, and work is not to start without a pernvt that the work will be in accordance with [he approved plan in the case of work wtrich requires a review and approval of plans. UD~1@5 QCAr~,t.v (.jj_~,,~ Applicant's Printed Name Applicant's Signature MECHANICAL (COMMERCIAL) Permit Application City OfEagan 3830 Pilot Knob Road, Eagan Mn 55122 Telephone # 651-675-5675 FAX # 651-675-5694 Plcasc complete 1'or commercial/industrial buildings multi-family buildings when separate permits are not required Por each dwciling unit Date Site Address Uni[ # Tenant Name (if applicable) Previous Tenant Name Proper[y Owner Telephone # ( ) Contractor Street Address City S[ate Zip Telephone # ( ) The Applicant is _ Owner _ Contractor _ Other Work Type New construction Underground Tank _Install _Remove Interior Improvement Call for inspection during installationlremoval of tank Processed Piping Nature of Work: Permit Fee 550.50 Dlinimum Pec (includes Stntc Surcharge) Contract Value $ x I% Permit Fee • If permit fee is $1,000 or less, add $.50 ~ $ State Surcharge If permit fee is over $1,000, add $.50 per $1,000 Permit Fee $ Total Fee 1 hereby apply for a Commercial Mechanical Permit and acknowledge that the information is compie[e and accurate; [hat the work will be in conformance with the ordinances and codes of the City of Eagan and with the Mechanical Codes: that I understand ihis is not a permi[, but only an applica[ion for a permi[, and work is not to start withou[ a permi[; that the work will be in accordance wuh the approved plan in [he case of work which requires a review and approval of plans. Applicant's Printed Name Applican['s Signa[ure Approved By: , Inspec[or Date: VJL,LAGL OF EAGAN WATER SERVICE PERMIT 3495 Pilot -Knob Rood PERMIT NO.: 2052 liglim,M14 55122 DATE: 9/20/7G Zon g: RI No. of Units: 1 Owner: Rvmnn Petersen Address: Site Address: 1233 Wilderness Park Circle L12 B1 Wn'k Plumber: If r o j e c t 1 u b i n g Cc. Meter No.: Connection Charge: 220 P d Size: Account Deposit: Reader No.: Permit Fee: 10 . 00 pd 1 agree to comply with the Village of Eagan Surcharge: .50 Pd Ordinances. Misc. Charges: 60.00 p d Total: By � Date Paid: Date of Insp.: o > Insp.: VILLAGE BF EAGAN SEWER SERVICE PERMIT 3795 Pilot Knob Road PERMIT NO.: 2: „" Eagan, MN 55122 DATE: / ' r , I Zoning: & T No. of Units: 1 Owner: Sv ?rin n Petersen . Address: Site Address: 1233 Wilderness Park Circle L12 131 WP Plumber: r r k ct, ',)1 dm I,, in g r t., . 9115/76 (4116 1nO.0O pd I agree to comply with the Village of Eagan Connection Charge: 351 P Ordinances. Account Deposit: Permit Fee: Surcharge: B Misc. Charges: Date of Insp.: i Total: R' Insp. _ f i Date Paid: PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA124165 Date Issued:06/24/2014 Permit Category:ePermit Site Address: 1233 Wilderness Park Cir Lot:012 Block: 001 Addition: Wilderness Park PID:10-84250-01-120 Use: Description: Sub Type:Residential Work Type:Replace Description:Furnace & Air Conditioner Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952) 445-2840. Scott Lofgren 5708 Upper 147th St W #102 Fee Summary:ME - Permit Fee (Replacements)$55.00 0801.4088 Surcharge-Fixed $5.00 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 - Gregory L Jones 1233 Wilderness Park Cir Eagan MN 55123 Lofgren Heating & Air 5708 Upper 147th St W Suite 102 Apple Valley MN 55124 (952) 431-5811 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA124392 Date Issued:06/30/2014 Permit Category:ePermit Site Address: 1233 Wilderness Park Cir Lot:012 Block: 001 Addition: Wilderness Park PID:10-84250-01-120 Use: Description: Sub Type:Reroof Work Type:Replace Description: Census Code:434 - 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 by law in ALL single family homes . Michael Schrader 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 - Gregory L Jones 1233 Wilderness Park Cir Eagan MN 55123 (763) 444-1373 All Season Remodeling & Exteriors LLC 17344 Puma Street NW Anoka MN 55303 (763) 444-1373 Applicant/Permitee: Signature Issued By: Signature