1224 Wilderness Park Ctihromm en et( II in
City of Eaali
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 575-5675
Fax: (651) 675-5694 MAY 0 5 2011
Er,EiNf
Use BLUE or BLACK Ink
Permit Fee;
Date Received:
Staff;
2011 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 6 6— P 1 Site Address: ri; Gx L J 1! d e rtio s r* C+- Unit tt:
RESIDENT !
OWNER
Name: Er i k 477;71 ra I Phone: 7 ! 6i V
__6_,1
r'� fJ
Address / City / Zip: _J O W 110 e r'ri G S f a r i L. Ea 1.. r+.
Applicant is: Contractor
TYPE OF WORK
Owner
Description of work; -W� I i h 1:7-�-[�177 d Q - d,or t3 /1r I!7 -c
�^ d
Construction Cost: 1 3 'J, 0/�'} Multi -Family -Building: (Yes I No - )
CO
CONTRACTOR
111
Company: Li '11 L;1ljC.C..1 n a - COntact: Ala /`! et -
Address 10 t-.01'1-12'�i 0 % C4 I/'7`%jE't !''1/ {) iif�j
State: M Zip: 6-) f 1 a hens, /t ICity:
N I Phone, ✓ f t) o
_
license #:0( 0 I ('I0 3L/ A) 4 �` '
Lead Certificate* +
---Ar
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) CIWA
In the last 12 months,
Yes No If
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:
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone-
Phone:
Phone:
' NOTE;.Plans and supporting documents that you sb'mllt at consi iered to be public information. Portions of
the fnffrmation may be classified as npn+publfc if you provide specific reasons that Would permit the City to
I _ ' conclude that they are trade secrets. '
CALL BEFORE YOU DIG. Call Gopher State One Call at (651)454-0002 for protection against underground utility damage.
Call 48 hours before you intend to dig to receive locates of underground utilities. ww y.aottherstateonecall.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.
x Ala Act( 3c�tk•� e t3
Applicants Printed Name
?Ieae
x,
Applicant's Sig atura
review + can w; 441
T.ti:d 1769SSL9TS9:01
Page 1 of 3
price.
:Wald 20:20 tiT02-S-1,uW
•
1�1�q 117lc(QrrpSSCI-
DO NOT WRITE BELOW THIS LINE
SUB TYPES
Foundation
Single Family
Multi
01 of Plex
Accessory Building
Fireplace
Garage
Deck
Lower Level
_ Porch (3 -Season)
Porch (4 -Season)
Storm Damage
_ Exterior Alteration (Single Family)
_ Porch (Screen/Gazebo/Pergola) _ Exterior Alteration (Multi)
Pool Miscellaneous
WORK TYPES
New _ Interior Improvement
Addition _ Move Building
)( Alteration_ Fire Repair
Replace Repair
Retaining Wall
DESCRIPTION
Valuation 0
Plan Review
(25/0_ 100% )
Census Code
# of Units
# of Buildings
Type of Construction
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
Meter Size:
Reviewed By:
Siding
Reroof
Windows
Egress Window
Demolish Building*
Demolish Interior
Demolish Foundation
Water Damage
*Demolition of entire building - give PCA handout to applicant
MCES System
SAC Units
City Water
Booster Pump
PRV
Fire Sprinklers
Sheetrock
Final / C.O. Required
�[, Final / No C.O. Required
%' HVAC
Other:
Pool: _Footings _Air/Gas Tests _Final
Siding: _Stucco Lath _Stone Lath Brick
Windows
Retaining Wall: _ Footings _ Backfill _ Final
Radon Control
<1."
Erasion Control
, Building Inspector
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
Page 2 of 2
cIrr 'DF EAQ.*N SEWER SERVICE PERMIT
5745 Pilof Knob Rood PERMIT NO.:
Eogon, MN 55122 DATE:
Zoninfl: i No. of Units: ~
Owner: _ .1 r n ' ;,r,t t~' ;nz1
Address:
Site Address, 1 z24 !qijdQrnE3:4 r-rbrw. rr.L14 R3 WPk _
Plumber: -:,'~~•Ct Pa~~:;t:fn~~ :'r,_
100.00 pd
1 agne to complr with tha Ciryr of Eagan Connection Chorge' 75 -()(1 IXI- .
Ordinonop. Account Deposit:
Permit Fee: I (I - O'' t'eq
Surchorge:
gy _ Misc. Gwrfles:
, Date of Insp.: Total:
Insp.: Dote Paid:
CtTY.OF EAGAN WATER SERVICE PERMIT
9796 Pilot Knob Rood PERMIT NO.: "
Eagon, MN 33122 DATE:
Zoning: No. of Units:
Owner: ~+F~t2ri 12"='.0r.xo'e' -
Addre55:
SiL@ AddYCSS: 12,A 4-ti4J *4 fl~d~'i.l~li i?~ ~~Pyl;,yr ' '''t
Plumber.
Meter No.: Connadion Charge: ~ • `,7 ~ '
Slze: Aooount Deposit:
Reader No.. Permit Fee: 7- T>:
I agno M aompip wilh !he Citr ef Eagan Surcharge:
Ordinanas. Misc. Charges: '>n • 0 v'~'
Totol:
BY ' Dote Paid:
Date of Insp.: Insp.:
~
CITY OF EAGAN
3795 Pilot Knob Road Eagen, MN 55122 N2 4245
, PHONE: 454-6100
BUILDING PERMIT y')00• ReceiPt Te be ussd for ~ r .i:n i :att. Garg. Dute ar • 19 77
Site Address zIdeme ("t, _ ErecT 0 Occuponcy I
f!.c3ex~ness f'arlc ci~ ~i
Lot ~ Block $ec/Sub. /~1~~er ? Zoning
Parcel # Repair ~ Fire Zone _
Enlarye p Type of Const. y
cc Name S':'c-:1c1 Peter.sanConst. - Move
3 Address 47r)i i,, 110Lh ~ # Stories r
Demolish ? Front ft.
~ 1~ Phone `~~5~-'~ Grode ? Depth ft.
Ci
~ Name Svet1U :'e tc Approvals Fees
o~ Address 4701 i., Assessment Permit •t _
ul Ci ~1~ ~ 4 Ph~ gi~ 4'!5144 Water & Sew. Surcharge 2 4• 50
Polite - Plan check _
FW Name Fire SAC 475•56
'x~ Address Eng. Water Conn. 22U.Ot9
tuZ+ C~ p~~e Planner Water Meter 60. ~
Council r'srk Don 120.00
I hereby acknowledge that I have reod this applicotion and sLote that gld9 Off
the information is correct und ogree to comply with oll opplicab:e 1037.50 Stote of Minnesota Stotutes and City of Eogan Ordinonces. APC Totol
Signature of Permittee
A Building Permit is issued to: _"wEttt! :'p tPY seri :.ntts t. on the express condition thot
CII work sholl be done in occordance With oll opplitoble Stote of Minnesota Statutes ond City of Earon Ordinances.
Building Officiol
~~k # aN IMr~ hn~Ml~
Pltxnbinp
Mechonical d
INSPECTION6 DATE INSP. Raqlrle+ Find
Footings ~ Dots Irop. Dote Irop.
Foundotion Plumbing - 7
Frame/ins. Mechoniaol
Firtol
Rerrwrics: 7 ~ a /
CITY OF EAGAN ~
3795 Pilot Knob Road
, Eagdn, Minnesota 55122
~ Phone: 454-8100
ri ~ATIrrG 901
PERMIT No.
Date: ~"~Y 24, 1~ Receipt No.: 06101
Single I
Site Address: 1224 Wilderness Park Circle Residential -
~I
Lot ' Block 3 Sub/Sec. WPk Muiti Res., Comm./Ind.
Name New/Alter./Repair
~ Address 4701 '•'<~st 1_1C'~th S±. Cost of Installution _
Ciiy ~ loomington Phone: Permit Fee _ 2~~
` Nome Genz-Ryan Plunbing & Heating Inc. Surcharge
Address 14745 So. Robert Trai1
~
e
~ City Foser:o;ant 55068 Phone: Totol 20' 50
This Permit is issued on the express condition thot oll work sholl be done in occordance with all applicable Stnte of
Minnesota Statutes ond City of Eegon Ordinances.
8uilding Officiol
I
~ CASH RECEIPT ~
~ - CITY OF EAGAN 3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE 19
rescnv=o
PROM
AMOUNT ~ I
Ce D04LAR¦ '
~oe
? CASH ~ CHBCK
FOR
~I
RVND COD[ AMOUNT
I
. BY ,
U D55 8
NUMERICAL FILE COPY
z-~ ~ ~ , P • 1 - ~
clrr oF "cwN
3795 Pilot Knob Raea
Ea9an, Minnesota 55112 I NSPECTO R NOTI F I CATION
No. Phoee: 454-8100
REQUIRED BY LAW
PERMIT FOR ALL INSPECTIONS
Dote: Receipt No.:
Single I
5ite Address: ' Residential
Lot Block Sub/5ec. Multi Res., Comm./Ind.
Name New /111ter./ Repof r ^
; Address Cost of Inst(illotion
O
City Phone: Permit Fee '
Name 'lf:lt,i -1:•
Surcfarge
~ Address -)30
, -
City Phone: Total
This Permit is issued on the express wndition thot ail work shall be done in accordonu with all appliwble Stote of ~
Minnesota Statutes ond City af Eogon Ordinonces.
Building Officiol
CITY OF EAGAN Remarks '
Additi Wj.ldex7lees Park Loc 14 Bik 3 Parcel 10 811250 140 03
owne` /IA4.Il.` AWliLl11IhfLctreet 122 State Ewa1,.MN .5.5123 I
Improvement Date Amount Annusl Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK im.. 176.o5 8.80 2 A003896 132.05 -20-77
SEWER LATERAL
WATERMAIN
WATER LATERAL
WATER AREA / 149.34 A003896 -20-77
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. 00
BUILDING PER.
SAC
PARK
I
CITY OF EAGAN
~ 3795 Pilof Keob Road Eogen, MN 55122 N2 4245
a PHONE: 454-8100 S ~
BUILDING PERMIT APPLICATION $49t004. Receipt # ~3~ °
To be und for Sing. Fam Dwlg, d Att. Garg, pate Mar• Zgr 19 L7
1 Wilderness Park Ct. I
Site Address Erect Occuponcy
~ot 14 e~ock Sec/Sub. Wilderness Park AdAp~,. 0 Zoning
Parcel # Repair ? Fire Zone _
Enlarge ? Type of Const. y
ce NaTe Svend PetersanConst. Move p # Stories
3 Address 4701 W. 110th $t. Demolish ? Front ft.
0 Ci Mpls. Phone RA4- 514LL Grode ? Depth ft.
~ Svend Petersen Const. APVrovals Fees
Name
Address 4701 W. 110th St, Assessment Permit • O
~ Ci Phone 88~5144 Water 8~ Sew. Surcharge '
Police Picn check _
F ~W Nome Fire SAC 475.00
.00
x~ Address Eng. Water Conn. 220-
<W Ci Phone Plonner Water Meter 60•
Counc;i Park Uon 120.00-
I hereby acknowledge thot I have read th' a icotion ond state thnt gld9, p{{.
the informotion is correct and agree mply-with~pll gKplicable 1037.50
State of Minnesota Stntutes and C' of Ea n O di 4 Ces. APC Total
Signoture ot Perm
A Building Permit is issued t: on tne express condition that
oll work shall be done in rdonce ith a licoble State of Mi esota 5tatutes and City of Eagon Ordinances.
Building Officiol
' IILil:':OT'tdG Pi&'4IT APFL.',.C?:2'J:1
;.rT Pr.cc11JDITI00 ll//Z/~tRd:~& ss 2N~.1c
z:RI:CnL Fi ..',.7^^IOZI `?:ii'.GisR,il' Ui;"'r1kiTED
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C~~7;F.ie~Y~ USF'
~
]'Sr'i:!'ii°0.l'uU CCSi L
TuiaLt'uCLif NO. 6 gL7~_ ~ ILI
0
CO?:T`.lii;L'T•OR ~fTt/iSc-'i? C7o/?S~ L'O TELEPHGfIP: fdp.
A11U.-:tR3^u
Y?otec Iucivat,~ ci.te plan, hui!.din3 plans, and energy calcula±ions %:itl: inzs ?
$P'rc Fc /.ZCtiicJ 6~s /~NkK ~~(i7
a?:plir.4tirn 3 S
~-L-~
. / .
Signed~-'/~rh-,~~~~~~^-t-~- _
~/CyoQQ OPI'ICE USE
~
VIfLUililOi.
S21C r-
F?i1.-C~,?2 CO:ai:^,:C^TO'tl
~
b1A7ER iSI:TE:R
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r~JY?.DID:G FEitid='.;' P:::: Z3C~
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JL?P.°.07:.•'..5:
115SESwd:NT CLFth BUILDING DEFT. POLICE DE+T.
f7T.iZR E°u!:L.P. DEPT. FI?L DP:PT. PF1R4K D.^s!'T.
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" ' . )J`.i4 ),i.L, e - '~7 " ' ' .-:.~rL" ' ~DELMAR H. SCHWANZ
LANOSURVEYpp
RlpoiterGG UOOlr Ldwf oi The Sbte ot MinneWla
14575 SOUTM ROBERT TRAII P.O. BOX M HOSEMOUNT, MINNESOTA 55088 PMONE 612 429-1769
~ /SURVEYOR'SCERTiFICATE
~ `a, 39g f5'
~a N64 0
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ullility cuaemcnt
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SCAT.E: 1 1-i^ki 'i
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L `54.34 /
4 331~,- . R=6o.00
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T hcrcb;/ ccrtAfy that thia ie a true and correct rcUrc:aum..,~1)n ,i
LoY. 14, ulack 3, ::'I?,nF?S~ESS PARIt ADDITI31', accordln; to tt:., n
plgt thcrcoi', Aakota County, 1•:.Lnnr~cota.
Alao ahowin"- thc lication ot.' a propoaiDci noucc st ik--(• thcrc ri.
Ac jUr"!~yoii by ;nc tFi13 23ra dZy oP Yarch, 1:377,
, ; J • .
- - - 7_
~WruNESOrn aEwsrHnT,I)n No ebls
RESIDENTIAL
BUILDING PERMIT APPLICATION
3830 PILOT KNOB RDE EAGAN MN 55122
651-681-4675
New ConsVUetbn BeaulremeMe BemodeNleoah Neaulrementa
• 3 registered stte surveys stwwing sq. fl. of bt, sq. N. of house; and all rooted areas • 2 copies of plan
(20Y mazimum bt coverage albweC) • ~ set of Energy Cakulatbns lor heateA adtlAbns
• 2 coDies of Dlan showing beam 8 wintlow sizes; pourea lound design, etc.) • 1 sRe suNey for exlerbr adAtlions 8 decks
• 1 set of Energy Cakulatbns • I'ntlicate it home served by septic syslem lor add'Abns
• 3 mpies of Tree Preservatbn Plan X bt platled attar 7/1/93
• Rlm Joisl Detall Options selectbn sheet (bldgs wAh 3 or less unAS)
DATE VALUAT ON 7
SITE ADDRESS MULTI-FAMILY BLDG _ Y _ N
TYPE OF WORK r'P ~ u~ FIREPLACE(S) _ 0_ 1_ 2
APPLICANT &A4 LeJh f~UGu e ~/~'t l~
~
STREETADDRESS Gr- CIN /Ll9 STATE14'L ZIP~~~337
TELEPHONE #7~~'~/1 ~-li2-ZZ CELL PHONE # FAX #
PROPERTYOWNER 25~~' /tTELEPHONE#
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINVESOTA RliLFS 7670 CA1'ECORY 1 MINNESOTA RULES 7672
(4 submission type) . Residential Ventilation Category 1 Worksheet Submitted • New Energy Code Worksheet Submitted
• Energy Envelope CalculaGons Submitted
Plumbing Conhactor: Phone #
Plumbing sys[em includes: _ Wa[er Sofrener _ Lawn Sprinkler Fee: $90.00
_ Wa[er Hea[er _ No. of R.I. Badis
No. of Baths
Mechanlcal Conhactor: Phone #
Vlechanical sys[em includes: Air Conditioning Fee: $70.00
Heat Recovery System
Sewer/Wafer Conhactor: Phone N
I hereby acknowledge that I have read This application, sTate that the informaTion is e, d agree to comply
with all applicable State of Minnesota StaTUtes and City of Eagan Ordi s.
Signafure of Applicanf
--°-------°-------~..._..._•_.___._...-°---~.~..._..._..r._----
OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4102
OFFICE USE ONLY
? 01 Foundation ? 07 OSplex ? 13 16plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling O 08 06plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 01 of _ plex ? 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
? OS 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04plex ? 12 12-plex Plbg_Yor_N ? 25 Miscellaneous
0 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addilion ? 36 Move Bldg. ? 42 Demolish (FOUndation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)' ? 43 Reroof ? 46 WindowslDoors
? 34 Replacement 'Demolltion (Entire Bldg only) - Give PCA handout to applicaM
Valuation Occupancy MC/ES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Canst Width
REQUIRED INSPECTIONS
_ Footings (new bldg) _ FinaUC.O.
_ Footings (deck) _ Final/No C.O.
_ Footings (addition) _ Plumbing
Foundation HVAC
Drain Tile Other
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ AidGas Tests _ Final
_ Framing _ Siding Stucco Stone
_ Fireplace _ R.I. _ Air Test _ Final _ Windows (new/replacemcnt)
_ Insulation _ Retaining Wall
Approved By , Building Inspector
- - - - - - - - - - - - - - - - - -
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S8W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
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