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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