1261 Wilderness Run RdCityofEaau
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
2011 RESIDENTIAL
Date: 3 Irx" 11201 ( Site Address: i (o1
Tenant: 1 Cr -fl 1 1 l h
r=IV/ED
APR EJ u. 701;
Use BLUE or BLACK Ink
For @fttUse(� �7
Permit #: / / e % /
Permit Fee:
Date Received:
Staff:
PLUMBING PERMIT APPLICATION
idOiktexoPsC 4?“,/,-) i C Mil —6-51-3
RESIDENT / OWNER
CONTRACTOR
Suite #:
Name:
Address:
State:
Contact:
Ai:;'° 0ny t Cs3`7.,'"t Ilc License#:
Ootris4' C; r- City:
z ; `z .:ko f7 !e. M\'4 7'q
TYPE OF WORK
_ New Replacement Repair _ Rebuild _ Modify Space _ Work in R.O.W.
Description of work:
PERMIT TYPE
RESIDENTIAL
\k. Water Heater
Lawn Irrigation (_ RPZ / PVB)
Septic System
New
Abandonment
Water Softener
Add Plumbing Fixtures ( Main / _ Lower Level)
Water Turnaround
RESIDENTIAL FEES:
$55.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge)
$35.00 Lawn Irrigation (includes $5.00 State Surcharge)
$55.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge)
*Water Turnaround (add $166.00 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)
$95.00 Fire Repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge)
TOTAL FEES $
V0j
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,gopherstateonecail.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,.
colic) IP
Applicant's Printed Nae
i
Applicant's Signa ure
FOR OFFICE USE Reviewed By: Date:
Required Inspections: Under Ground Rough -In Air Test Gas Test Final
urr oF Er?oAN SEWER SERVICE PERMIT
97',5 W1at Knob Road PERMIT NO.: '
Eayon. MN 55122 DATE:
Zoning: _ No. of Units: ~
Owner .
Address: -
Sita Address: ; 3 19; 1 • J l ~ WR 4 t: "
Plumber. ;:'d
1 a9ros to empir with the City of Eoqan Connection Charge:
Ordinanw. Account Deposit:
Permit Fee:
Surcharge: ~ -
gy Misc. Chorges:
Dote of I nsp.: Total:
Insp.: - Date Poid:
cinr oF IEAa?N WATER SERVICE PERMIT
3799 '.`ilot Knob Road PERMIT NO.: .
Eoyon, MN 55122 DATE:
Z~ing; No. of Units:
Owner:
Address: • t.,.
Sita Address:
Plumber:
Meter No.: Connection Chcrge:
Size: - AocourK Devosit: _
Recder No.: Permit Fee:
1 agnae to eomply wfth tha Cify of Eayan Surcharge:
Ordinanesa. Misc. Chorqes:
Totof :
By Date Paid:
Dote of Insp.: Insp.:
cinr oF EAGAN
3795 Piler Knob Road Eagan, MN 55122 N2 4 6 8 0
' PHONEs 464-8100
9265
BUILDING PERMIT . ~ 41, wo. Receipt #
To ba used for '"'~1g• Ga~t' Value Dote #i$r.. 8, 19 78
~ Site /Wdress 1261 tvilderness Run kd. Erecr Occupancy I
Lot 1 8lock3 Sec/Sub. 1{R G Lh Alter p Zoning R1
pa~l # lt) 84353 241 03 Repair ? Fire Zone 3
Enicrpe ? Type of Const. y
3-~iciiard :~tunson
~ Nome Move ? # Stories
z Address 14409 C;v. W. 11 pemolish ? Front f,ft.
,.uY-nc:v e
Ci Phone Grode p Depth - ft.
ApPraralt Fess
o Name rI*Sc
Z~ .
~ Assessment Permit
_ jr.,:, :\ve.
aU Address - f=?"_ 7 So. Sr.• 1 t
u~ Ci ~'e~ai2 Phone 698-5501 Woter & Sew. Surchorge Z~~•
Police Plan check
uce ~W Name Fire SAC 7lif).00
Y~ Address Eng. Water Conn. 250•0
<W Ci Pho~e Pfanner WoterMeter U~~•'•~ ~
Council
I hereby acknowledge thot I have reod this application and state that Bldg. Off.
the informotion is rnrrect ond agree to comply with oll applicable APC Totol 948.5u
State of Minnesota Statutes and City of Eagan Ordinances.
Slgnature of Permittee ~
; ~ E:FTt
- + Inc. on the express condition thut
A Buifding Permit is issued to: ttD[7es
oll work sholl be done in accord'once With oll applicnble State of Minnesota $tatutes nnd City of Eagnn Ordinances.
Building Offkial .
~
~
i ,
P~k ~j OMs Iwwd ~rwNh~
Plumbing / e 8~' p 7 p ~
Mechanicol
INSPECTIONS DATE INSP. RagFfln Find
Footings •~!21 -?b Date Irqp. Oo% Inup.
Foundation Plumbiny LC4 ) fi CZ. !~:L7
Frome/ins. Mechonital
Finnl .
I
Rsmarks:
CITY OF EAGAN
3795 Piloe Kso& Read
' Eoyaa. Miwresam 55122
Mhonr 454-8100
zNC
_ PERMIT No.
~ ~ n`~~~~
pate: :1}']Yll 1 8 19 R
eceipt No.:
Sinple
1~... l'i 1 Z r~ n r•, r; S5; ;1 _r, ,.'?a C: ResidenYiul -
Site Address:
Lot Block ' Sub/Sec. Multi Res., Comm./Ind. I
Name '~'l1SeS'2 F~oI~eS 111C. Now/AIter./Repoir. ~
~ 1lddress Cost of Instollotion _
Pau]. ?~.~n
City Phone: Pertnit Fee
Nome , P 11:-1, t},_tSurchorpe 0
.
Address - ~ - - . -
Ciy Phone: Toral P '
This ermit is issued on the express condition that all work shell be done in accordence with all applicoble State of
newto Stotutea and City of Eayon Ordinonces.
Buildirg Official
. ~ CITY 4f EAGAN
" 3795 Pilot Knob RoaW
_ Eagon, IYUnMsoN 55122
rhmw: 454-8100
HEATING _ pERMtT No. 1135
~Iarch 20, 1978 Re«ipr No.: (}9391
Do+e:
Sinple I
Site Address: 1261 ~.11C'.r'T21eSS RUt? Road Residential Y
Lot 2 " Block 3 Sub/Sec. _ T•~~ th MulH Res., Comm./Ind. I
Narr,eTil:~-n F:omes Inc. New/Alrer./Repalr new
~ Mdress G 27 Sne11inQ Ave. So. Con of Installotion _
Ciry St. Pau I 55116 Phone: Permlt Fee 2n. 00
Nome 11 r der&ZaIl _ Surcfwrye S n
g~
y
~ /lddress
City, yg' Phone: Total 20•-)r'
This P rmit is issued on the express cadition thot all work shall be dorre in accordance wifh oll uppUcoble Stote of
Min ta Statutes and City of Eapan Ordimnces.
Buildinp Official
~
~
~ CASH RECEIPT ~ I
.
CITY OF EAGAN
3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122 I~
DATE 19 i
R<C6IV6D
RROM
AMOUNT $ I I
~
6 DOLLARS
ioo
? CASH ? CHECK ~
POR ~
I
FUNO C006 AMOUNT ~i
BY
NUMERICAL FILE COPY '
CITY OF EAGAN Remarks Addition Wilderness Run 4th Addition Lot 24 Rik 3 Parcel 10 84353 241 03
Owner ~ Street 1261 Wild _rnPSC Rim Rnad State Eagan, MN 55123
Improvement Date Amount Annual Years Payment Receipt Date
STREETSURF. 197 1177.72 117.77 10 1177.72 C002369 10-4-76
STREET RESTOR.
GRADING
PISAN SEW TRUNK 1973 $163. 26 $8.16 20 i
SEWER LATERAL
WATERMAIN
wATERtATERAL 1972 $584.91 $38.99 15 311.98 2$ 9-11-78
WATER AREA 341 1977 1610.66 15
STORM SEW TRK 1981 340.00 22.67 15
STORM SEW LAT
CURB & GUTTER '
SIDEWALK
STREET LIGHT
WATERCONN. ' 00 926$ 3-8-78
BUILDING PER, #4680
SAC
PAfi K
~s u s 3 f~b Y
tu request voi 18 months from D 9Gi
, .
~
Date Sf this Request 4-13-1978 P 69911
I, as YaLicensed Elec[rical Con[ractor O Owner, do herehy request inspection of the above elec[ri-
cal wiring installed at:
~a y, 0 3 t,d2 y~
Street Address or Route No. 1261 49i1dorno4s Run Road CitY Pagan
Section Township Range County Dakota
Which is occupied by 'Piltron $omoa
(Name ot Occupant)
Is a roughin inspection required on this job? No ? Yes :a Ready Now ? Will Call Ei3c
Power Supplier Dakota Cty. Address Farmington
Electncal Contrac[or O.B. 'Phompcon Eloetsie Co. Contractor's License No 33735
(Company Name)
Mailing Address 12201 I12tka Blvd. f Mtke. ;5343
(Ele rr~ica~l6~ontracto,~i Ownaf'Making This Installatlon)
Authorized Signature ~YT~? ~ Phone No. 933-2521
(Electrical CoMrlft`or or Ownar Making This Installatlon)
This inspectian request will not 6e accepted by the
State Board unless proper inspection fee is enclosed.
Minnesota State Board of Electricity
.7954 UniversiivAve., St. Paul, Minn. 55104-Phone 645-7703
~ ~EiE"QUEST FOR ELECTRICAL INSPECTION P 69911
CHECK'3ELOW WOAK COVERED BY THIS REQUEST
iype of Building New Add. Rep. Check Appliances W'ved For Check Equipmen[ Wired For
Home U ? 0 Rangc 30 Temporary Wiring ?
Duplex 0 ? ? Wat eater ? LightingFixwres 70
Apt. dldg. ? ? ? Dry Electric Heating ?
Commercial Bldg. ? ? ? Fur Silo Unloader ?
Industrial Bldg. ? Aic ndit' 'Q Bulk M~k Tank ?
Farm ? ? ? pList List
Other 0 ? ? Hehe~sl Heh~ers~
1
COMPUTE INSPECTION FEE BELOW
Service Entranre Size: u Fee Feedersfl Sub(eeders: # Fee Citcuits: # Fce
0 to 100 Am s. 0 to 30 Am eres 0 to 30 Am eres
101 to 200 Am s. 31 to 100 Amperes 31 to 100 Am eres
Above 200 Amps. Above 100 Amps. Above 100 Amps.
Transformers Remote Control Circ. Partialoiotherfee •
Signs Special Ins ection Minimum fee $5.00
Remarks Ha11 TOTAL FEE 5
I, the Electrical Inspector, here ertify a h¢above inspection has been made. O•6
(Rough-in) Date 'Y-1--
(Final) ~Date
This request void 18 mont i
CITY OF EAGAN
3795 Pilot Knob Road Eagan, MN 551I2 N2 4680
PHONE: 4548100
BUILDING PERMIT APPLICATION $41,000, Receipt # 9265
To be used for SF Dwlg, b Ga% Value Dote Mgr' 8, , 19 78
Site Address 1261 W1ldeineSS Run Rd. Erect n Occupancy I
Lot 24 Block3 Sec/Sub. WR 4th Alter ? Zoning Rl
Parcel # 10 84353 241 03 Repair ? Flre Zone 3
Enlorge ? Type of Const. V
rc Name RiChBid MUnSOII Move ? .{k Stories
i 14409 Co. Rd. 11
AddrCSs Demolish ? Front 65 ft.
o HUTtISV 2 Grode ? Depih 30 ft.
Cit Phone
o Name I son yotnes,_..=6 AOVrovab Fees
~U Address 627 Sn_ Snelling Ave_ E+ssessment Permit-118_00 _
~ rAddre~ Ea{{an phone 698-5501 `Nater & Sew. Surcharge -2Q-r20
Police Plan check
Ww Fire SAC 500.00
rZ
Eng. Water Conn. 250_0aw Phone Planner WoterMeter 60_n0
Council
1 hereby acknowledge that I hove reod this apPlication and stote thot Bldg. Off.
the information is correct ond agree to comply with all appiicable APC Toto
Stnte of Minnesota Statutes and City of Eagan Ordinances.
Signature of Permittee
A Building Permit is issued to: Tilsen Homes Inc, on the express condition that
all work shall be dane in accor nce all a limble $tate of Minnesota Statutes and City of Eogan Ordinances.
Buildirg Offictal -
5 o S `A -7 RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651•681-4675
New Conetruedon Heaulremente RemodeVNeoalr Reauhemanta
• 3 regisleretl site surveys shawing sq. fl. of bt, sq. tt. ol house; anE gp rootetl arees • 2 copies ol plan
(20% ma)dmumbtwveregealbwed) • lsetofEnergyCalculatbnsforheatetlaedabns
• 2 copies ol plan shaxing heam 8 window sizes; poureA found tlesi9n, etc.) • t sAe survey br ezterbr atld'aions 8 tlecks
t set of Energy Cakulatbns • InCicate rt home served by septic system toradditqns >
• 3 coples o17ree Presenatbn Plan tt bt platted afler 711193 a~ 3 a 5
. Rrcn Joist Defail Optbns seleclion sheet (bltlgs wiN 3 or less unrts)
DATE _~S - Zo' d Z VALUATION ~/:S-f S(nC)
SITE ADDRESS I Z(oi MULTI-FAMILY BLDG _Y _ N
TYPE OF WORK FIREPLACE(S) _ 0_ 1_ 2
APPLICANT C0-e.c { c~jr s m.Aj
STREETADDRESS Z40 6neS°cr Si- CIN S* 3c-u) STATEYA.VZIP 5 1
TELEPHONE fi Co ~z -si K-93 13 CELL PHONE # 5-.,,.c_ FAX #
L« ~ao~)' 9-7 o°,~
PROPERTYOWNERL Glv_ TELEPHONE# ~5l-G86- 6 Zo7
COMPLETE THIS SECTION FOR ^NEW,• RESIDENTIAL BUILDINGS ONLY 0
Energy Code Category _ MINNESOTA RULES 7670 CATEGORY 1 MINN
d
(J submission type) . Residential Ventilation Category 1 Worksheet Submitled • New nFeF
• Energy Envelope Calculations Submitted Plumbing Conhacfor: Phone #
oll
Plumbing system includes: Water Softener Lawn Sprinkler _ Water Heater _ No. of R.I. Baths
_ No. of Baths
Mechanical Confracfor: Phone #
Mechanical system includes: _ Air Conditioning Fee: $70.00
_ Heat Recovery System
Sewer/Water Contracfor. Phone #
I hereby acknowledge ihaT I have read this application, state that the information is correct, and agree to compiy
with all c7pplicable StaTe of Minnesota StatuTes and City of Eagan Ordi nces.
Signature of Applicant r~-!k
OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4/02
OFFICE USE ONLY
? 01 Foundalion ? 07 OSplex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 06plex ? 16 Fireplace ? 21 Porch (3sea.) ? 31 Ext. Alt - Multi
? 03 Ot of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4sea.) ? 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 O 24 Slorm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) D 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (FOUndation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)' ? 43 Reroot ? 46 Windows/Doors
? 34 Replacement 'DemoliNon (Errtire Bldg only) - Give PCA handout to applicant
Valuation Occupancy MClES 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 W idth
REQUIRED INSPECTIONS
_ Footings (new bldg) _ FinaVC.O.
_ Footings (deck) _ FinaVNo C.O.
_ Footings (addition) _ Plumbing
Foundation HVAC
Drain Tile Other
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tesa _ Final
_ Framing _ Siding Stucco Stonc
_ Fireplace _ R.I. _ Air Test _ Final _ Windows (new/replacement)
Insulation _ Retaining Wall
Approved By , Building Inspector
Base Fee
Surcharge
Plan Review
MCIES SAC
City SAC
Water Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
_ , . ~ e~Ylo O v
Dl1TE 42z22. Lt~Z IG '7p
BUILDII4G PERMIT APPLICATION
Include 2 sets of plans, 1 site plan w/elevations and 1 set of energy calculations.
//ff •O
To be used foz Valuation
Site Addzess;
la~/ Az(A
Lot Block Sec. Sub. Parcel Number ~.y/ D~
~R 3 - v
Owner V%?~l;?V Telephone
Address /y~JO O LL
~ 2n-~ . 55,33'7 f~Contractor ~07'YtQ,O Telephone
Address
(ffo-qpm ?pY!/1-0. SS/2 7
Arch./Eng. Telephone
Address
OFF2CE USE
Erect ? Occupancy I
Alter Zoning iq
Fepair Fire Zone
Enlarqe Sype of Const.
Move H of Stories
]lemolish Front JS 'lr
Grade Depth 2 n
OFFICE USE
Date of Approval & Initial FFES
Assessment Permit
3~~~78~
Ftater/Sewer _ Surcharge
Police Plan Check
Fire SAC SOO
Eng. t9ater Conn. =SO~~_
Planner G7ater PReter 6 0~
Council _
Rldg. Off.
A.P.C. TOTIaJ.
qLf
Cities Di i~ ta1 Quality Control
The following image represents the best
available image from the original page.
Every effort was made to capture the content
from the original page.
r I,I~O ~ . • - M1'•.;' • • ' wcii .ai"•._' ~-t - I " rr-_':y~,~:)t"~
' . , • "dtrcia[oR ahvsi.on spAca "ir" coKFm?=
(io M suEoi[Cod with building pe ruit app1lCatloe) .+ii~•;}
OIM or tvo fasily dnetling__[_ Ovner
All other ~ .
Site Addrass. '
. .y,.
Coo[raetor ZIL:rnEW V,aME.S 1?dc. Dace fo- 3-'-1 -3 Phoae
.L=11L T!. OI' • , ~ ' .
Ql06M WALL ft. •brnre Qnda- lPi-7-2
~ - . ' . TOTAL ECCPOSED WAI.L AREA SQ. 1T. •
0ftQOE qAiL CONSTRUCTION: "U" value X,srea
x.eq. ft.
' P„aSIC r-QannF. i.tni i "U" .0-7 _ sq. ft. 1 S
atall"rofetance ''lJ" z eq. ft, ~ (q
frao "U" x sq, ft. .
attached sheete c ~~?c p EtC, P61 nr.y "U" .4'7 x nq,
'lull : eq. ft. sq, ft. vnmoWS: 'ro^ VAI.UE X•ttea W I N OU W,~) @ F'A-r i o ~R : (.v EA'r~1 E2 SN ~ EI..D
S4•44, •
l ' @_c?;i - agXrn- ~e..o .a.fc.
2 @ 'C -,;IL 1 - -14 x4n' aq.ft. .
I @ c -2,1 - -,~t 4K Qv..m. 1~-a Aq.ft, , .
@ 0 2 i - -14 r~Slo~ sq. ft, Z @ n. ~-l. - '19Z x ~om iq.ft. •
1 @ t1, N • - ?,n x ~cT * sq. ft. '
ca 0 iQ. 2 sq:ft. . .
']a x t(o .816 °4•,q^• , I
!Lw a c7Pe .q.. ft. 41 3. (rL-- 6; 1- M
"U" 2r :•9. fc
n n ~ . S?j. C; a Z4. 4 (
A..~~. "U" . 55 : sq. ft. '7. o n w *_4 m' (
n Sir~EL1E,N^r "U" . SS x eq, ft. -7 ,-7 ~ 4,2
lOO18t "0" value I •rea . oo2St PE.ASE ' . ,
typ~ op ¢ e "U" z eq. fti Ze. o ~ (n, Z
° Ic~ 21- Xb 3 x eq. ft. 171 7 ~ M.(
w w "U" = tq. ft. ~ (9) , (
« . ~ SN-In "Uot x sq. ft. 40•O
TOZ1L (I) (A) VALUBS 2ba1, ` 3 TOTALS 1a-7~2 @q. ft.~a~
p1~ID~ ET 'POTAL WALL ARSA . "
AtiRACE "0" .17 or less for 1 6 2 failly dtellings
.22 or lees for al'1 other buildinge
FooF/ceu,nac:
TO?l1L ARFA: •q. ft.
Deqil refesence 0.4': a mq. Et, ~ 1 7 O ' Sol 3 (h (
from "L" : sQ, ft.
- ({A (
•trAo6ed sheate ' "U" z sq, ft. Deseribe opanings 'b" x sq. ft.
la roof "U" : sq. ft.
DIYID~ EY(TOTAL uRpOF -ri0~ TOTALS ~ I70 ~q. ft. D• ~ M(
0[II.I11G AREA / I 1-7 0-0
e4-
. .
rs~ca~~r» .os cor .enci.i.c.a roor.
, .10 for e11 ocher eonstruetioa
R- value
1. bc.rrS u=•c I 2 . ('7 1NSUl.AT \C1w1 _2~- ~o '
3: Ti-.-'~ 6YP~,~M .A~ ' _
4. I~~~~b A ~SZ . hl ( '
S.
b. ~3 .-~3 ' • ~ 3
Z32
MTMTIE0N FRAMM: R- talue . .
1. n„-rS a%~ «
• 2. g. c~ , w~E~ .4, \ w.~•.
j, '~-S/~,z' SNE1.~t!-\Itlr_ -!1,C1fn .
4. '~S'~" Iw~~UI o"r~~N 11•Oo
S.
6. I1.~4~tc~F A~Q lQ,Z7---7
~L If rerage "V" values as ealeulated abata do not ret the awrgy Cod• reqnirersts, .
tM "Alternat• EVV*lopO Design" a• outliaed !u SDC 6006 (g) r7 be uted. MdltloMl
shoots r7 be used co shar calaulatiaas.
~
• ~
' , . .
1
~:i
7 CITY USE ONLY
L02'ZZ BL RECEIPT 1 r `7"
SUBD. RECEIPT DATE:
1998 PLLJLMING PERMIT (RESIDENTIAL)
CZTY OF EAGAN
3830 PILOT IINOB RD
EAGAN, MN 55122
(612) 661-4675
Please complete for: ? single family dwellings
? townhomes and condos when permits are required for each unit
? backflow preventer for underground sprinkler system
FIXTURES EACH # TOTAL
Shower 3.00 x =
Water Closet 3.00 x =
Bath Tub 3.00 x =
Lavatory 3.00 x =
Kitchen Sink 3.00 x =
Laundry Tray 3.00 x =
Hot TublSpa 3.00 x =
;Water Heater 3.00 x _ ~ •~n
Floor Drain 3.00 x =
Gas Piping Outlet ` minimum - t 3.00 x =
Rough Openings 1.50 x =
Water Softener * for dwellings under construdion 5.00 X =
Water Softener ` for existing dwelling 20.00 ' x
U.G.Sprinklef 'tordwellingunderconst. 3.00 =
U.G. Sprinkler ' for existing dwelling 20.00 =
Altelation5 " to existing residence 20.00 =
Water Tum Around 20.00 =
Private Disposal System ' MPC itc. 75.00 =
(new and refurbished systems) _
Private Disposal Systems * Abandonment 20.00 -
RPZ (new installation only) 20.00 =
STATE S:IRCHARGE .50
TOTAL
I hereby acknowledge that I have read this application, state that the infortnation is correct, and agree to comply wRh all applicable City of Eagan o inances.
It is the applicanYS respc- --',Eagan assumes no liability tor any damages wused Gy the City during its
normal operational and rti u+M, DIMH er this pertnit within City propertylright-of-wayleasement.
i 1261 WILDERNESS RUN ROAD I
SITE ADDRESS: I EAGAN, MN 55123 i
~ (651) 686-6207 I
OWNER NAME ~
INSTALLER NAME: Oiz_FiI~NA~I"L-lA~"'~ P~~~GL TELEPHONEg7' 33
STREETADDRESS: ZJI 0 5
CITY: mwtiknl~-POUS STATE: ZIP: 65YO8.
SIGN T OF PERMITTEE
CDlPERMIT FORMS/RPLBG PERMIT (RES) - 1998
LL
,~b:o?
APoOEA TY LwE ~ -
I
~
I \
5 uNt
~~.?-I
,
-2o
I
~ 0\ - 0
~ I
~
,
I \ ~
i
0 3~'
~
o i ~
~
IJ I
O2,1Wl. 55/2-3
LoT 3Lack I
ze.OaJ
i
~ o.n~r_~ao?F~rY
1~- LOT -PL A N
FROM : WALTER MECHANICAL MN GAS GRILL PHONE NO. : 9528951888
City of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone- (651) 675-5675
Fax: (651) 675-5694
Jun. 05 2012 01:37PM P2
Use BLUE or BLACK Ink
For Office Use l�
Permit #: U F-1
Permit Fee:
Date Received:
Staff:
2012 MECHANICAL PERMIT APPLICATION
0 Please submit two (2) sets of plans with all commercial applications. ,n�J`
Date: lU ',d� Site Address: \ �o �` \ \, C fi( ne, c� C� 1`�\ v
Tenant:
y\\te\ t.sf\\G� }-O \
Suite*:
A6S.:vbl�:'�°, 4 •�V' N,t E.;.�ft
Name: \vY` Phone: t 7`—' (...5)-/t -11 4l
Address 1 City / Zi %WON.)A \...-\--e.„
NTRAcTO ;:
Name: U V k1 License#:
_eAk
Address: 1 b 1 - G\c- R I k City: n \11\,‘Q)
State: Zip: Phone:
Contact: r Z�Q.J Y ` Email: hvl/�lj tJAV 5/ eftQ
PE•'OF ORK ":
r i
• 1 ... !
New X Replacement Additional Alteration Demolition
Description of work:
� � s' Ir a
N .. ... ��pf4� �!{�4C�1 ���I�d�� �l�:li�� 111 t ll `Ifiv.elr�9p1 1 1n@n�;RssiR@�llyl ' W. ; �t:R�81 C Y"','�►`1
Code:'P'PA'`T•V, �t th �!ai cY�.1n `f et �nfo m 0 AP..lp t• !£ .**'ciee , T Vp
' , �/; r� e r�:,, r ��0� !'S���,�,�ri� S�=Q1! ���!i,� ,,,,"/Ar �1fr•
' '
X =PERMJT TYPE'
RESIDENTIAL
Fumace
Air Conditioner
COMMERCIAL
New Construction Interior Improvement
Install Piping Processed
Air Exchanger
Gas Exterior HVAC Unit
Pump ump
/ Above ground Tank (`Install / Remove)
Other
_Under _
RESIDENTIAL FEES:
$60.00 Minimum Add-on or
alteration to an existing unit (indudes $5.00 State
turned out appliances, ductwork etc.) (indudes
Surcharge)
$5.00 State Surcharge) = $ TOTAL FEE
$100.00 Fire repair (replace
COMMERCIAL FEES:
$75.00 Underground tank installation/removal
$60.00 Minimum (includes State
(indudes $5.00 State Surcharge)
Surcharge)
810,010. surcharge is $ 5.00
surcharge increases by $.50 for each $1,000 Permit
Fee requires a $ 5.50 surcharge)
OR Contract Value $ x 1%
_ $ Permit Fee
- If the Permit Fee is Tess than
_ $ Surcharge
- If the Permit Fee is > $10,010,
Fee
= $ TOTAL FEE
(i.e. a $10,010-$11,010 Permit
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 4544002 for protection against underground utility damage. Call 48 hours before
you intend to dig to receive locates of underground utilities. www.acoherstaieooecall.ora
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 fora permit, and work is not t• start without aper nit; that the work will be In accordance
with the approved plan in the case of work which requires a review and approval of plans.
Applicant's Prints Name
X i (1/!1fJdVL'..
Applicant's Signatu
r :);.� �, r r;y,a.�A�,•c�r��e t.( I r � <:�,4��F tila t `''r['S': dkN r.E �L��r �r1.Juer ®o '�e7 iva^,r�:r>Y�6+'�Xy n- Y•a 1... r Z
eek fotl .� ;, Ro oto ljt'r'c �„c;Alcs,'e � "'"�' k �i& -`d` <i y1190r s ,.:.'"`_4, tak6 y4 �4 ycA 441.111,
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA119555
Date Issued:12/05/2013
Permit Category:ePermit
Site Address: 1261 Wilderness Run Rd
Lot:000 Block: 003 Addition: Wilderness Run 4th
PID:10-84353-03-241
Use:
Description:
Sub Type:Reroof & Siding
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and house wrap and leave on site.
When installing ventilated soffit material, remove existing material (i.e. debris that could block vents) and take steps to
ensure maximum ventilation to attic. Call for final inspection after installation.
Valuation: 8,000.00
Fee Summary:BL - Base Fee $8K $162.25 0801.4085
Surcharge - Based on Valuation $8K $4.00 9001.2195
$166.25 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 -
Dinh Lam
1261 Wilderness Run Rd
Eagan MN 55123
Nmc Exteriors & Remodeling
15 - 1st Avenue South
Buffalo MN 55313
(763) 684-1662
Applicant/Permitee: Signature Issued By: Signature