653 Witham LaneCity of Eaall
3830 Pitot Knob Road
Eagan MN 55122 RECEIVED
Phone: (651) 675-5675
Fax: (651) 675-5694 DEC 1 7 2010
Use BLUE or BLACK Ink
Permit #: ('7 711 7
Permit Fee: J S - Q(")
Date Received:
Staff:
2010 MECHANICAL PERMIT APPLICATION
Date: L Site Address; t.
Tenant: lf l))l,l t'i,C%ki'LS--l(
Suite #:
-J
RESIDENT / OWNER
Name:
Address / City / Zip: ( C-)") LL
Phone: 1,(� fl
CONTRACTOR
Name: BURNSVILLE HEATING & A/C, INC. License #: L1 h3S`3 f (l 1 3
3451 W. fiumsvilie Parkway
Address: Suite 120 City:
State: ZipBurnsvlIIe, MN 55337 Phone: (V;2 ccCmcoo-5
TYPE OF WORK
Contact: l j Email:
New x Replacement
Additional
Alteration
Description of work: t 1 {ai 1 t 1 l -
Demolition
PERMIT TYPE
RESIDENTIAL
Furnace
Air Conditioner
Air Exchanger
Heat Pump
Other iltd, \ l
_ New Construction
install Piping
Gas
RESIDENTIAL FEES:
$50.50 Minimum Add-on or alteration to an existing unit (includes $.50 State Surcharge)
$90.50 Fire repair (replace bumed out appliances, ductwork, etc.) (includes $.50 State Surcharge)
COMMERCIAL
Interior Improvement
Processed
Exterior HVAC Unit
Under / Above ground Tank ( Install / _ Remove)
**When installing/removing tank(s), call for inspection by Fire
Marshal and Plumbi_129 Inspector
TOTAL FEE
COMMERCIAL FEES:
$70.50 Underground tank installation/removal OR
$50.50 Minimum (includes State Surcharge)
- If Permit Fee is less than $1,000, surcharge is $.50.
- If Permit Fee is > $1,000, surcharge increases by $.50 for each
$1,000 Permit Fee (i.e. a $1,001-$2,000 Permit Fee requires a $1.00 surcharge).
Contract Value $ x 1%
= $ Permit Fee
= $ Surcharge
= $ TOTAL FEE
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. www.Aopherstateonecafl.org
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 plan
X 1� t 1 CC 9'lc V a (l . -i i0j:
Applicant's Printed Name Applicant's Signature
, ~ . . . ,
r
. ~
, - ~ (g.er#i#tra#t of (orxupanry
, Citp of (tagan
~rpabum pf luitdiag 3wrrtinn
T bis Cernj'+oate 1uue~d pursuant to die nqufraxents ojSacAfon 306 of 11re [IniJorm Building
Code oa~i~1'?R8 thc[ at Jlte time of Lsutancc lhissdudurie Krrs iit caspJiance wf11c 1Ge various ~
adinap-cer of 11u GYtY ngulaang bufldiV cwubuaion or use. Fur 11re foflowing:
lA~e QiudGaso~ - c'~ •'~.y ~••n H~e~.1lsR PIo. to= ~I
ppq~~,77~ u0 M 1 7aaief ~ AI ~ C ~
OMOV d ieidiag wddio
BuMnAdd= ~v L12, II'3, i~~tIIt7i vsN 2nm
1A, /
o~
POST N A COPISPICUOUS PLACE
i . .
CITY OF EAGAN ~~0 ~ 3830 Pilot Knob Road, P.O. Box 21-199, Eegan, MN 55121
PHONE: 454-8100 1 ( ~ ~
BUILDING ~RMIT Receipt # ~ ' ~
To be used for sY Est_ value $i07,~ oate ~7 1g 91
Site Ailess 653 Wt LN
Lot BloCk SeC/Sub. OFFICE USE ONLY
P1fC@I NO. Occupancy ~3 i
zoni
W Name FEES
D/1N3.Z Sit0lHEtiS INC (Actuai) ng const Bldg. Permit 6~.~ '
Address (~lowabie) ~ suuenarge 53.50
Cit)/ Phone # ol Stories ~ plan Review 432'00
Length
t~ Name sAME oecu, ~ snc. ciry 100.00
Addf@SS S.F. Total = SAC. MCWCC 650~00
~ cIty Ph0118 S.F. Footprints 6W. 00
On Sile Sewage _ Water Conn
~a Name on siie wen ~ Wafer Meter 90'00
Address Mwcc system AW . 30.OQ
g W City Phone city wa~ ~.oo
PiiV Required _T SAN Nnnit
I hereby acknowlege that I have read this application and stafa that the Booster Pump _ c,,M Surq,arge •30
information is CorreCt and agres to comply with all applicable State ot 276.00
Minnesota Statutes and City of Vagan 6rdlnances. . Treatment PI
Signature of Pertnitee ~L-'? '.~•^--r' APPHOVALS qoad Unit 370•00
A Building Permit is issued lo: MHLZ BROTHM INC Pl&'ner - Park Ded.
on Ma express condition that all work shall be done in accordance with all Co+ncil
applicable State of Minnesota Statutes and Cify of Eagan Ordinances. gldg. pry. - CoP1eS'-~ 3~ ~~.00
Building OHiCial + ~ Variance - TOTAL
" PKnMt No. PMw~it FbkNr Mb TMbphont M
WATER I 3/
SEVAfl
PlU1dBING ^f / ~ - ~Qw
H.VJIC. 1 0~7 a pa -
ELECTRIC / ~
Yu*crion DoN Yt$p. CanrWKs
WoenDs I ,l~ fl LCJ
w.~
F&Mc Y 4 ~
Rookg
Ptg. - -1~
F-pi- -ZQ (~S ~ G~e•.r•*e~ e vi,reeQ
Fnd fn9. ~V L - ~ 2
Fnal Pbg.
Caw. Msler Plbg. Inspecoa - Nodfy Plurtger
Ergr.IPlan
&dp. Fnal Z
Oedc Ftg.
Oedc Final
VNe1
Pr. pisp.
• - -9r sE~ v~cr r
slo*
-
. . , r ' . , _ f . .F~: . . . •
SEWER & WATER PERMIT -.O ICE USE ONLY ' CITY OF EAGAN f METER # ~9 y 7 PERMIT DATE 03 / 11 / f` 1
3830 Pilot Knob Rd.
Eagan, MN 55122-1897 CHIP ~ p PERMIT ~
METER SIZE S s°~~u S B.P. RECEIPT #
DATE '2ISSUE DATE B.P. RECEIPT DATE 03 7 91
~ 7' 1~~91
-1- PRV - BOOSTER PUMP
~
SITE ADDRESS 653 Tr'TTf(AM i.N PERMIT REQUESTED
LOT 12_BLOCK _2-SEC/SUB C NT)aX PASS 2ND Y
. r- . . ~ SEWER Jr WAT'ER _ TAPS
-`APPUCANT:
ADDRESS: - COMM/IND _X_ RESIDENTIAL
ClW, STATE ZIP .XL NEW - EXISTING
PHONE:
Lawn Sprink+er Meters are to be installed
PLUMBER: Ahead of Do*stic ter on Water Line. 'i
ADDRESS: Credit WILL be_ --e210e~ M~er§. i
CITY, STATE $I,00MIxGTON MH ZIP 55420 /
PHONE: 984--4149 - 'OF
I; GREE TO COM LY ITH CITY
OWNER: liAHLTs BRO"PHEKS iNC EAGAN ORDINANC
ADDRESS: 9304 LYNUALE AdE S I
CITY, STATE Ai-f)0MIb'GTON irN ZIP 5542q
PHONE: ~~~~-hFFh SIGNATURE WHEN METER ISSUED '
PLtASE ALIOW TW0 WORKING DAYS FOR PROCtSSING. CALL 4545220 FOR INSPEC710NS. FOR STORM
' SEWER PERMfTS, CONTACT ENGINEERING DEPT.
, .
SEVYER & WATER PERMIT OFFICE USE ONLY
CITY OF EAGAN METER # PERMIT DATE 03/ 1 Z/91
3830 Pilot Knob Rd.
Eagan, MN 55122-1897 CHIp # PERMIT # uA~q
METER SIZE B.P. RECEIPT # s -
op " ISSUE DATE B.P. RECEIPT DATE 03 07 91
D~TEt . 1991
W ~ X pRV - BOOSTER PUMP
SITE ADDRESS 53 Wj'fKAM I-N PERMIT REQUESTED
LOT _1_2BLQCK -~$EC/SUB ~ COYL~NITRY ,~ASS 2HD I
, • , . . , r . SEWER `r ~ WATER - T~lP3""
A PPUCANT: I
ADDRESS: - COMM/IND I RESIDENTIAL ~
Cl*, STATE ZIP ~L NEW ~ EXISTING
PHONE:
Lawn Sprinkter Meters are to be Installed
PLUMBER: 1~ - Ahead of Dorliestic M ter on Water Line.
ADDRESS: 018 MOUND SPRINC rit. Credit WILL,I+~dt be e~or dedtrctMeters.
CITY, STATE BLOOMIi4GTON .ZIP `?5420
•-.-7~-~'. ~.1'< _
PHONE: 884--414c
I AGREE TO COMPLY ITH CITY OF
OWNER: DAHLE BRQTH,;~:S INC EAGAN URDINANCEt
ADDRESS: 4304 LYt?DALE tiVE 5
CITY, STATE B1DmI ?3A! ZIP 55'+20
PHOME: 888-6866 SIGNATURE WHEN ME7ER ISSUED
PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. CALL 454-5220 FOR INSPECTIONS. FOR STORM
SEWER PERMITS, CONTACT ENGINEERING DEPT.
. . ...;Y'- . ,
. .
S. . .
CASH RECEIPT
CiTY OF EAGdN ~
p'3830 PILOT KNOB ROAD ~
EAGAN, MINNESOTA 55122
- onre
A,,oUNT
s - 8 DOLLARS
O CASH XCHECK
1,95 3
~
FUNO OBJECT AMOl1NT
I
i
Thank You
BY ~
Y,'~`,~
12432 „
~
Pk-iFN~ Oopy,
..:.n - - - -
~ INSPECTI4N RECORD
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number: 4
Eagan, Minnesota 55123 Date Issued:
(612) 681-4675
SITE ADDRESS: APPLICANT:
• ~ I +I i tlnN 1 tyfJt
PERMIT SUBTYPE: TYPE OF WORK:
t~i„;
INSPECTION .
~r~ .l~l ri1 (i~M t tNN~
~ J
~
PN1RR M0. PMmit No1dM Do1e TNWIwns •
S/MI
PLUMBIN(i
HVAC
ELEcTRic y G43' 3 ~!J
EIECTRIC I
htpoetlon Dma Ywp. Commmm
~
Foo*q. I y.-4_-13 tv,
~
Foundabon ~I
Fmn,g
Al/
, p4AV
1`10"0 P°°.
R«+9h ?~D•
~ ~ II
P"PWM
~I
Final Htg. ~
Orset Tesl I
Finel PD9• Plbp. InepecEor - Noo'ilyy PMxnber i
I
Qonst. Me1a I
EnWJPlmn
&d9- FMd Z
Dedc Fq. ~
Dsck Final I
VVeY I'I
Pc Dksp. II
I
• DATE: MARCH 12. 1991
RE: 653 WITt1AM I4W (DAHLE BROTHERS INC)
X Nour Sewer 8 Water Permit for ihe above property has been completed. It will be held at ihe
Publi6-Works Garage (3501 Coachman Road) until the meter is picked up. BE SURE TO
_ CAiL PUBLIC WORKS (454-5220) FOR YOUR PERMANENT WATER TURN ON.
.R'
- Your Sewer & Water Permit for the above property cannot be completed for ihe following
reasons:
- Your Sewer 8 Water Permit tor the above property has been completed, but the meter cannot
be issued or occupancy allowed until further notice.
- COMMERCIAL PROJECTS ONLY: Please pay for meter at City Hall. Meter size must be
confirmed by Bill Adams or Dirk House (Plumbing Inspectors - 454-8100) before issuance.
WARNING: BEFORE DIGGING, CALL LOCAL UTILITIES - TELEPHONE, ELECTRIC, GAS, ETC.
- REQUIRED BY LAW.
CONTACT COMMUNITY DEVELOPMENT DEPARTMENT FOR WATER TURN ON POLICY.
Secretary. Building Inspections Dept.
a 59830 ' . ~ "J (/~~5
~
a.
Repuest Oaie ire No Ro in InspecUOn ~2•
Re i ? ? Reatly Now ~'~(~Ihen Reetlypector
J es No
?
I~jcensed contractor ? owner hereby request inspection ol above electncal work at:
Jo0 AtlOress (Street. Box or Rome No / A ~ dry
6 ~ho- f-`i 4~
Secvon N. Townsh0 Name or No, Range No. Counly J
Occupa a
ntlP TI Phone No
Y " J/r/c
POsd,pie~ e~~i+r Address e?~'o'`~S'~
Eleclnc I ConVactor (COmpany Name)
ConVactorS L¢ensa No.
'C-i« -e co,
Mdiling AOOr255 (COnVdttOr or ner Ma g instailaaon)
s/S~7 0 . ~ k S tla e
Autnonzetl nat e(ConVaclovOwner Makmg Ins~ i n Pbone Number
Q. O
MINNESOTA STATE BOl RD OF ELECTRICITY THIS WSPECTION REOUEST WRL NOT
Gdgqs-MlEwey BIEq - Poom S173 6E ACGEPTED BV THE STATE 60APD
1821 Univenlty Ave, SL Paul, MN 55106 UNLESS PROPER INSPECTION FEE TS
FMne(612) 6124B00 ENCLOSED
REQUEST F09 ELECTRICAL INSPECTION Eeaooot oe
4 ~ ~
P, M See inslNCUOns lor compleLng thi5lorm On hac4 0l yallow tOpy
JC" Below Work Covered by This Requesf
w
59830 `
ew Adi Rep' ` Typeol8uildmg AppliancesWired EquipmentWiretl
Home Range Temporary Serwce
Duplez Water Heater Electnc Heating
Apt. Building Dryer Other (Speaty)
CommJlndushial Fumace
Farm Air Contlihoner
Other (specily) Convamor's Remarks.
Compute Mspechon Fee Below' r5'6
# ONer Fee # ServweEntranceSize Fee I # Cucmts/Feeders Fee
Swimming Pool 0 to 200 Amps i,$; 0 to 700 Amps
Transtormers Above 200 _ Amps _ Amps
Si(Jn5 Inspectar5 Usa Onty. ~~~777 UI TO/TA~L
Irrigation Booms
Speaal Inspection
AlarmlCommunication THIS INSTALLATION MAV BE O DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MQNY.FQ
I, the Electrical Inspector, hereby R°°9n-'" oaia .
certify ihat the above inspection has F,,,ai Date
been made.
OFFICE USE JNLY
Thrs reQUest vpitl 18 months Iram
K83 /a .Qa. ~
Reque 0 Fire Na Raugh+n ns aclion
Pepuvatl ~ReaEy No-x ? Win Nouy Inspector
XYas ? No Whan RBatly4
f licensed contracror ? owner hereby request inspection of above electiical work at
Joo a0tlre ~SVe r Rome C~
$B[tion tlr TOwn5hit0 Hdmp Or NO. Renga NO. CAu
OCCUOant(P i, e Ona No
S
Power Supplier 1.1 Atltlress
ElecvK o act pa a b Con,~ctorE Lice N ~
<116
Naning ss I actor or r Making Insullturon)
AuOt ptl igndlur ontracta er 91n51d11d1 ' Pbo
MIN TA STATE BOARO OF ElE TRICITY THIS INSPECiION REOUEST WILL NOT
Gr ,MlEway BIEg. - Hoom S1)3 O~ BE ACCEPTED BY iHE STATE BOARD
1 Univ¢relly Ave. St. Peul. MN 55104 UNLESS PROPER INSPELTION FEE IS
VMna (612) 61341800 ENClO5E0
pC~REQUEST FOR ELECTRICAL INSPecnun i~
O pC ? See mstmcLOns lor com0laung this brm on Oack oi yellow copy
4-6.a J `X'_5elow Work Covered by This Requesf
A IiancesWued EquipmentWireO
ew Add Rep.Typeof Builtlmg PP Temporary Service
Home Range
Duplex Water Heater Electric Heating
Apt Bwltling Oryer Other (Specity)
Comm llndustnal Furnace
Farm Air Conditioner
Omer Isuek,dyl Convaclor5 Remarks.
Compute Inspechon Fee Below.
p Other Fee # Service EnVanceSize Fea 8 Circwls/Feedere Fee
Swimming Pool 0 to 200 Amps 0 to ~0a P.mps
Transformers Above 200 - AmPS Above 100 _ Amps
Signs insvecmr5 use Oniy. OTAL ~
~ •
Irrigation Booms '
Speaal InsOection
AlarmlCommunicahon THIS INSTALLATION MAV BE ORDj5HfD DIS~CONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONTHS.'..~ ;
Rougi
I, the Electrical Inspector, hereby
certiry that the above inspeciion has Flnal
been made.
OFFICE USE ONLY
This reQUest vai0 18 moNhs iram
CITY OF EAGAN N0 18 771
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
BUILDING PERMIT PHONE: 454-8100 Receipt # ~ '
~ , ~
To be used for SF DWG/GAR Est. value $107, 000 Date AR 7 192
Site Address 653 WITHAM LN
Lot 12 Block z SeGSub.COVENTRY PASS 2N oFFICE USE ONLY
PefCBI NO. Occupancy R-3 11-1 FEeS
Zaning R_1
m Name DAHLE BROTHERS INC (qctual)Consl V=I1 eldg.aermu 664.00
~ Address 9304 LYNDALE AVE S (nuowabie) V-N
0
Surcharge 53.5
° Cit BLOOMINGTON phone 588-6866 u of stones -
y Len9Ih _}l a! Plan Rewew 432.00
, o Name SAMF. Depth 52 ~ snc, cny 100.00
0a Address S.F.TOtal - SAC,MCWCC 650.00
a
- City Phone S F. Footpnnis -
On See Sewage, _ 'Nater Conn 660.00
Name On Sile Wall - Water Me1er 90.00
Address rnwcc system X
Acd Deposit 30•00
0,1 City PhOnO CnyWater x
~
PRV Requiretl SIW Permtl 30.0
I hereby acknowlege that I have read ihis apphcation and state Ihat ihe Booster Pump - SnN Sumharge .50
mformauon is correct and agree to comply with all app6cable Stale ol
Minnesota Stamtes antl Ci a ~ 7reatment Pi 276.00
SignaWreotPermitee ~,Y~/1n a~'~f a9~ s- APPROVALS qoadUmt 370.00
A Bwldmg PermR is issued to: DAHLE BROTHERS INC Planner - park Dad.
on Ihe express condition ihat all work shall be done in acwrdance wdh all Council
appl¢a61e State of Minnesota StatutesI and City of Eagan Ordinances gld9 pp_ _ Copies
BmldingOfficial~ ~'11lA 14 Variance - TOTAL -j.356.0~
Address Lot ( 2 Blk Z Sec/Sub CB V.e:. fp qS.' z
These items wexe/were not complete at the time of the final inspection.
's " 2 9 g / - 0& Yes No
FLnal grade (6" from siding) v'
Permanent steps - garage tl~
Permanent steps - main entry
Permanent driveway ~
Permanent gas ~
Sod/seeded grass L_~
Trail/curb damage
Porch •
Basement finish f ar
Deck ~
Please vari£y vith the builder tha removal of roof test caps from the plumbing
system and tha shut-off of water supply to the outside lavn faucet before
freeze potential exists.
White - City copy Yellow - Resident copy Pink - Contractor copy
1991 BUII:DING PERMIT~PPLICATION
CITY OF EAGAN NjAR o
SINGLE FAMILY DWELLINGS MULTIPLE DWELLINGS COMMERCIAL
2 SETS OF PIANS 2 SETS OF PLANS 2 SETS OF ARCHITECTURAL
3 REGISTERED SITE SURVEYS REGISTERED SITE SURVEYS - & STRUCTURAL PLANS
1 SET OF ENERGY CALCUI.ATIONS (CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFICATIONS
1 SET OF ENERGY CALCULATIONS 1 SET OF ENERGY CALCS
OF RENTAL UNITS
OF FOR SALE UNITS
PENALTY APPLIES WHEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY IAST WORKING DAY
OF MONTH IN WHICH REQUEST IS MADE.
IAT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED.
NOTE: ADDRESSES FOR CORNER IATS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS
DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DAYS ONCE A PERMIT HAS BEEN COMPLETED.
PERMIT MUST SHOW A LICENSED PLUMBER.
To Be Used For:
Valuation: Date: 'L-
Site Address OFFICE USE ONLY
1
~OC7
Lot k2 Block Z FEES
O
Occupancy 9-3 M-I Bldg. Permit (0&9,0
Zoning R-f Surcharge S3,SJ
Parcel/Sub cv~..htl S Actual Const V- Plan Review 32.o D
Allowable V-N SAC, City OQ,Oo
Owner # of stories SAC, MWCC •00
Length '-j8 Water Conn. D.00
Address Depth 52 Water Meter 0,00
S.F. Total Acct. Deposit 0,00
City/Zip Code Footprint S.F. S/w Permit 00
S/W Surcharge ,5io
Phone On site sewage_ Treatment P1. (v,o O
` On site well Road Unit 37D, Do
Contractor ~t~~+-- ~-•-nS MWCC System ~ Park Ded.
City water Trail Ded.
AddrESS C\-'~QA PRV ~ Copies
- \ Booster Pump _
City/Zip Code SUBTOTAL
APPROVALS Penalty
Phone rfi€~f=~-~-~ Planner Lot Change
Council TOTAL
Arch./Engr. Bldg. Off. G]-3-.}-91
Variance
Address
City/Zip Code
Pho
' ~ agrees that all work shall be done in accordance with
(Signat e o Contractor
all applicable tate of Minnesota Statutes and City of Eagan Ordinances.
! • •
V AV L l-l
2y~c~6 = 624 ,
6%z k 5 = ~ss)
5 S = FS ~l9 0
~
&SMT, o•*
X"2C~? 664•00+
53•50+
IZ 432 • 00 F
y~ ts= 3Z 2,206•50+
3>356•OU*
S~~ xry= I2bLlO 664•001-
}-I p I,~SE s s• s o*
- 432•00+
2Y206•50+
~'/Zk4~,= 1~5Z 3356•00*
3 ~ = Cbo~
z x
1 X 12= li
I'4 x Z4 = 3G
t~o~'~
166 012 /071
. CERTIFICATE OF SURVEY
L'avey R. eoa&m. ;Dw.
ApLWw ~ 8773 DUPONT AVENUE SOUTH
BLOOMINGTON, MINN. 65440
r esa-soaa
LAND SURVEYORS
Survey for: DAHLE BROS., INC.
N~ fi
yo
59 E DESCRIPTION:
j zy F~ lot 12, Block 2, COVENTRY.
\ I ! ~ PASS 2ND ADDITION
~~ry
s1
k
-
~ 9372
~S 36 ~.3~ ~ ~ .
~ `yl. I ~ i
:W ~ ~Qvl~, 8388 ev+ ~ ` N .
ll j_v
0 N ~ a= e
z4 y I
~ B39 ~
gy~_ fiB39L ~ r z~~ I 837: Scale: 1"=30'
! y
I~
I ~ Sarriic~ ~ N ~ - I ~
~ N
y~
60'
? ~urb '~~~,,i~` ~ Proposed Grades:
~
15~
s~. Top af Blocks B~D-
( pI Garage floor, 84'O °
1 ~ Basement floor 637
°
til 0 ~ i
7---,~ ~ , .,v~ L. ~ ,~~~r~ ii
~ ; ~ ; ~ . ~ .
_ . ~
NOTE: Circled elevations are proposed, others are exist'~~
Arrows denote direction of drainage. ate
XAt~'aAW ENGTi'JEEi-IIsaC ~1i;~rJG
an
G~ Ravo , L
We hereby certify that this is a true and correct representation of'a survey of he
boundaries of the land above described and of the location of all buildings, if any, thereon
and all visible encroachments, if any, from or on said land. Dated this 28th day
of february , 1991
' by
Min sota Registration No. 9018
270-5B
~
' EXTERIOR EhVELOPE AVERAGE "U" CO~FUTATI04 _
04NER: D^hla Rrnc Tnr
SITE ADDRESS: ~oS3 30L- •
CONTRACTOR: Dah1e Bros. Inc. DATE: pHONE: 888-6866
DETERMINE uORKRlf, SOUARE F007AGE OF EACH:
1. TOTAL EXPOSED uALL A.REA,,,,,,,, 1878 sq ft x"U" .11 . 206.58
1. TOTAL ROOF/CEIIING AREA,,,,,,,, 1280 sq ft x"U" ' ,026 ~ 33.28
3. TOTAL EXPOSED uALL ARE.4 CALCULATIONS:
Total exposed wall
area above floor,,,,,,,, 1604 sq ft
a) Total wall window area:
Double qlazed...... 148 , sq ft x"U" .56 . 82.88
qlazed...... s4 ft x "U'' ~
b) Total door area 38 sq ft x"U" .13 e 4.94
c) Total sliding qlass door area:
Double glazed...... 40 sq ft x"U" •56 ~ 22.40
qlazed....:. sq ft x "U" ~
d) Total fireplace wall area sq ft x"U" ~
e) Total wall franing area
(Averaae 109)........... 160 sq ft x"U" •09 ~ 14.40
f) Total net wall area above
floor (insulated)....... 1218 sq ft x"ll" •04 a 48.72
g)_ Total rim Joist aree,,,,,, 164 sq ft x-"U" .04 . 6.56
Total foundation
area (Exposed).......... 110 sq ft
h) Total founda[Ton '
wTndow area............. sq ft x"U" "
1) Toial net foundation
area above grade........ 110 sq ft x"U" .14 ~ ~_15 40
3. TOTAL a) th ru 1) 195.30 ~
If Item sj Is the sane as, or less than item f1, you fiave met the intent of
2 MCAR 1.16008 A and 0.
_ Page 1
4. TOTAL EXPOSED -RODF/CEllltif, CALCULATIONS:
Total cxPnsed
roof/ceilinq area........ 1128 sq ft
(Trip1e) ft x "U" '
Total fkyllahc are2....... sq ,
k) TotaS roof/celllnq framTng
area (Averaoe in9,)...... sp ft x"U" ~
1) 'Total oet insula[ed
roof/ceilinq area....... 1015.20 sq ft x"U" .02 ~ _20.3 .
~ TOTAL j) thru 1) 22.56
If totai of !4 is the sane 25, or iess than 92, you have met the intent of
2'!C 1't 1.16008 A and 0.
~
ALTERNATE BUILDING ENVELOPE DESIGN
To utilize Lhe total envelope system.method, the values established hy the sum
of ltems 13 and !4 shall no[ be greater than the sum of items P1 and ff2.
- 1. + 2. ~
j, + 4. -
ceaT iF~.caT t aN.._
1 hereby certtfy =hat I fiave calculated the "U" factors and "R"
values hereln and that the buildinci here descrl n+eets or exceeds the S[ate
of Hfnnesota Eneray Lonservation Act. ~
Slqna[ure
, Lw
Print name
(Da[e)
Page 2
~ • ~
• CD45TRUCTION R VA WE
VAIL FRAMfNG SECTIOH:
1 lnterfor afr ftlm 0,6$
2 ~ GYP Board .45
j 5; fnc es sofc wood 6,88
~ 4 5/32 Sheathine 2,06 ,
S Hardboard Sidi~ ,67
6 Fxterlor afr fl(m 0,17
TdTAL fl ~ 10,91
U - 1/R ~ .09 ,
uALL SECTION (lNSULATED)
--(1 tnterlor air film D-68
2 z oar
; i rg ass
~ b ea ing
5 Hardboard SidinL .67
F Ext,erlor afr film 0,17
TDTAL R - 23-II3
U = 1/R - .04
RIM JOIST SEC7IDN:
, 1 Interlor aTr fflm 0,6$
erglass Batt 19.00
~ 3 Softrock 1.88
4 5/32 Sheathine 2.06
5 Harclhnarcl Siclino .67
6 Exterior air fiTm 0.17
TOTAL R - 24.46
fOUNDATION INSULATION RE4UIRED: -
Min. R-5.on entire wall OR tl~ 1/R - .04
Q p.:•,e• Min. R-10 down to frost depth .
:
- p: FOUNDAiiDN SECTI6N:
~ 1 Interlor alr fiim 0.68
'P • ' ' ' Z 1" Stvrofoam 5.00
a : 3 oncrete oc .
Extertor a r'f i In 0.17
a.
- •-a•
G (5
1,71
~~:c•. . v,,./!: ' (fi
a• ,;J a TOTAL A - 77
U - IJR ' .14
SLAR ON GRADE
Q•-Q~.n;f
A•~,~.~,',;4
.'.O.Q.;,~• ~ . .~d1
~.4:c~:,°_ a.>'''d '•.d' •
II ~ ~ • ' • . . a- :4'
~ . . 4rL
Heated 51abs_ ' • • .
Minimum R 8.5 '.Q~ ~ a• ai
• ' 7 9.
Unheated Slabs: : Q'4. ,•.,':^Q ; ~
Minimum R 6.2 'Q. . ..iq.' '
CONSTRUCTION R VAcUC •
CEILINf, SECTIDN (INSULATED): ~
I lnterlor air f11m 0.61
~ Big 2 8 Board .56
C&L'IE 3 CLG Ins. (Blow 44,00
3 4 b Exterlor air film, still) 0.61
TOTAL R - 45.78
U ~ 1/R - .02
CEILING FRAriING SECTION:
I 2 5 1 Interlor air fllm 0.61
Z Gvp Board .36
qIR VENTED 3 CLG Ins. (Blow) u9.20
4 Interior air film still 0. I
FtOW 5~inches soft woorl 6.88
' TOTAI R ~ 57.66
U ~ i/R ~ •02
r,
CEILING SECTION (ItlSULATED):
1 ' I n t e r i o r a i r f i 1 m 0• 61
Z 5/7 7 } oar .-')b
- - 3 CLG Ins. (°low 44.00
4 Ex[erior air film still 0. 1
TOTAL R = 45_78
~
U ~ 1/R ~ .02
I 2 3 4 5 .
tEIUHf, FRAHING`.SELTION: -
1 interiar air ft':m 0.61
VENTED 2 5/8 Gyp Board .56
3 CLG Ins. (Blow) 44.00 _
. k Er.!erio~ alm still 0. 1
5 ~ dnches soft woo& '3.89
T07AL R =
„U = 1/R .02 ~
3 4 ~ . .
1 'Inside aTr film 0•fi1
2
. ~
Outside air film 0.17
~ TOTAL =R = sz
, <; J. ~ . . . . .
U.°'.1/Rs~.
~i~'M` ` _ J ~ • N''~
. ` .
, . ~
dg0
. . ~ ~ . - . .
- . . ,
x
PEIiMfIT
~ CITY"OF'EAGAN . ,
3830 Pilot'Knob Foad PERMIT TYPE: ~.1%
_
Eagan, Minnesota 55123 - Permit Numb`er:'- 0 z e i i n
(612) 681-4675 Date Issued: 04/ 21 J 9 3
SITE ADDRESS:
' 653 WITHAM LANE ,
LOl': 12 BLO;CK: 2
COVENTRY PAS,S 2N0 '
P.I.N_: 10-18901-120-02
DESCRIPTION:
ALSO D,ECK & FP
ildin PermiL Type SF PORCH
.
u1,1 di'ng ` rk Type ADD'T'I'ION
Building L.eh 'h 12
=Eiil,d.T n4 Wicith- 8
-1 .
. - • N ' . ' _ ~ u . s
j . ' r '
~
9 .
QRV, Umgnn
REMARKS: - " - - - ' ' ~ .
FEE SUMMARY: ~
VA-LUAI'ION $:11 , y0O
Base Fee $126.00 COPIES $2.00
PLan Review $81.90 7ota:1 f=ee $220. n0
Surcharge ~ $5.50
Lic. Search Fee I ~"5.00
SubtoCal / $218.40
CONTRACTOR: Flppl.lcant - ST. L IC. OWNER:
LARSON CONSTC1 A- 14519293 41,,008706 NELSON GREG843 19TH AVE N 653 WITNAM LAIVE
S ST PRUL MN 55075 EAGAPI MN
(612) 451=9293 (67.2)683-9598
. . . I
I heheby' ~
_ckno~t.~1,eTlre.'tho t> hat~aarR~z3 't~~35.'app-];Ac;a'Cian iarid'st~i-l:a Yisih thr-~,[rr~f,prmat~arr.x5w~~.r,r4r.t And agr~e,-ta"C6jup*l ,y ~t3~tr„al,l bp~liaable Star..s „f i~in.
( . StatuCas and CiCY o'F,Ea46n ardiriI"nc os'.
L
APPLICANT/PERMITE SIGNATURE ISSUED ):SIGNATURE - i
/
INSPECTION IaECOIZD
CITYOFEAGAN PERMITTYPE: euzLnrHc
3830 Pilot Knob Road Permit Number. 01,10 7 11
Eagan, Minnesota 55123 Date Issued: 01 j 21 / 9 3
(612) 681-4675
SITE ADDRESS: LoT : 12 a i_ o c K: 2 APPLICANT: ,
653 W;I:THAhI LANE LARSON CONS1" D A
i
" CUVt'IVTRY PASS 2NU (612) 451-9293
PERMIT SUBTYPE: -TYPE OF WORK:
SF PORCH FlppITION
' ?ESCRIPTZON AI.SO DEC,K & fP
INSPECTION .
FOOTYN6 FRAMJ:hIG ,
Ii11SUlA1"ION FYNAL
FfRFPLACt_ ,
~ • . , ' , _ . , , • ~ ~
REALI1YAIt to~2~N20pp2~ VI I T Vr CH%.INIY
PERM,IT. 1~ ~ ~~~"9L~ v~~ 1993 BUILDING PERMIT APPLICATION
~b~ APR 19 1993 681-4675
T
SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy
calcs.
COMMERCIAL 2 sets of architectural & structural plans, 1 set of
specifications, 1 copy af energy calcs.
Pena,lty applies: 1) when permit is typed, but not picked up by last working day of month-
in wh`ich request is made, 2) address is changed or 3) lot thange is requested once permit
is issued.
Date Valuation of work
Site Address: ~S~ ~/%/aAln /9/7f
NSTREET AIITE Y
`
Tenant Name: (commercial only)
IAT BIACK SUBD.(LC' P.I.D. N
Descri tion of work: S~9~Gn orui ADDJT~U~7 Yk/-~ G,~
The applicant is: ? Owner ? Contractor ? Other coe4«ix>
Name /J.F/JU" Phone 6z-?- 9s98
Property LAST FIRST
Owner Address 9Y-3 e?JJ/>B/I~
STREET STE ! ,
City 1-44mh State A/9 Zip
Company 0. 4. //;XS07 lDigl • Phone ~S~ ~ r9 Z~l 3
Contractor Address //~l~ Ai.r License NcnoB)OC Exp.3--?i•9i
City -Sv -~T. O~ILC State /;?79 Zip SsU~-S
Company Phone
Architect/
Engfneer Name Registration M
Address
City State Zip
Sewer & water licensed plumber . Processing time for
sewer & water permits is two days once area has been approved.
I hereby acknowledge that I have re d this application and state that the information is
correct and agree to comply with a applicable State of Minnesota Statutes and City of
Eagan Ordinances. ~
Signature of Applicant: ~
OFFICE USE ONLY .
. , , .
BUILDING PERMIT TYPE
? OI Foundation ? 06 Duplex O 11 Apt./Lodging ? 16 Basement Finish
? 02 SF Dwg. ? 07 4-Plex O 12 Multi. Misc. ? 17 Swim Pool
? 03 SF Addition O 08 B-Plex ? 13 Garage/Accessory ? 18 Comm./Ind.
t 04 SF Porch ? 09 12-Plex O 14 Fireplace ? 19 Comm./Ind. Misc.
05 SF Misc. ? 10 Multi. Add'1. ? 15 Deck ? 20 Public Facility
? 21 Miscellaneous
WORK TYPE
? 31 New O 33 Alterations ? 35 Tenant Finish ? 37 Demolish
1& 32 Addition ? 34 Repair ? 36 Move
GENERAL INFORMATION
Const. (Actual) Basement sq. ft. MWCC System
(Allowable) lst F1. sq. ft. City Mater
UBC Occupancy 2nd F1. sq. ft. PRV Required
Zoning Sq. Ft. total Booster Pump
1~ of Stories Footprint Sq. ft. Fire Sprinkler
Length 12~ On-site well Census'Code ~
Depth ~ On-site sewage SA~Code
APPROVALS
Dlanning Building Assessments
Engineering Variance
REQUIRED INSPECTIONS ACSo IN jc~g~ D~z,r C scaEe)J ~v y SE4So9J CZax/t.4W.S1~
t G ~4s ~ i ~ z-pt*e.e
? Site Footing C~Framing 19 Insulation
• Wallboard ~Final ? Draintile JkFireplace
Permit Fee 126,00 v.imt;m: S~~ D~v
Surcharge
Plan Review
License S~Q~N ~~GH .M y gEqSpY.) C0111 f~!?S!~
cWty sac I~.Sxl2 = ?,~~~x 29 - ~1ooZ
Water Conn. ~
uater Meter Acct. Deposit -
S/W Permit
S/w Surcharge 8' 3C I2~
Treatment P1. x 7 ~
Road Unit
Park Ded.
Trails Ded. M
ies
er ~
Total:
sAC%
SAC Units
lr 0~~'
, • • CERTIFICATE Of SURVEY '
':ipF ~ 8773 OUPONT AVENUE 80UTM
~ I~ BLOOMINOTON, MINN. 60420
V • 888•1084
r
LANDSURVEYORS
Survey for: '
DAHLE BROS., INC.
~hIP s,eoo ,
DESCRIPTION:
r F~~~ - lot 12, Block 2. COVENTRY
S I • ~
ppSS 2ND ADDITION
~
W I ~ .f op ~ I
X ~1 ~1~
~ 5 36~_ j~)_ 1~ .
7=,o.Z t~ P
;W i v I x~B N; -
;
0 N ~ N a:
i
z4
839
z
e
g~o ' ~839L ~ =4,_-~ 837~ Scale: 1"=301
Ct?3
I ~ Sc=riicc ~ N
RO' :~'1 l9
/ ~ I N
i r
pn 9
D Proposed f,rades :
Top of Blocks
Garage floor 94W'-°
Basement,floor B37=
W? 7-H~9M
NOTE: Circled elevations are proposed, oLhers are existing.
Arrows denote direction of drainage.
We hereby certify that this is a true and correct representation of a survey of the
bowzdaries of the land above descriUed and of the lucation of all Uuildings, if any, thereon ~
and all visible encroachments, if any, fi•oro o,• on said land. Dated this 28tti day
of Februarv , 1991 J ~
. by
4
l,- Mui~ sota Registration No. 9018
- ~
; CITY OF EAGAN
EXTERIOR ENVELOPE AYERAGE 'U' CO![PUTATION
' . OWNER: y ( /IF/~jh
SITE ADDRESS• _ ~J3 4jJ1~0/J?
CONTRACTOR: h .9• ji9rM'YJ e"61VJ_ DATE: PHONE:
Determine working square footage of each:
ff/CGI~ ,7~ sq. ft. x .11 - 3~
1. Total exposed wall area ~"d10
2. Total roof/~cYeiling area a~rg sq. ft, x.026
Total ezposed xall area above floor
a. Total wall window area -//,2 u(f
b. Total rioor area - J U
c. Total sliding glass area -~1
d. Total fireplace wall area
.
e. Total Wall framing area (average 10%) :
f. Total net wall area above floor S
g. Total rim joist area ~pES p
Total exposed foundation area
f/~~r D
h. Total PaUln window area ~
i, Total net foundation area above grade
Determine `U' value of each wall segment:
a. x ' U' ~ = o? .
b. X 'U'
c. 3( x 'U'
d. sy x' U'
e. x gU' .09 =
f. S~ xgpt . Dy = ~32 ~~.84
f/oo? g• ,2yv xgU' a
h. x 'UI -
i, x 'U' -
3 . Total
If item 03 is the same as or less than item 1i1, you have met the intent of SBC
6006(c)2.
Total exposed roof/ceiling area = a~ ~J 8
j. Total skylight area 0
k, Total roof/ceiling framing area (average 10%) ...473-9-
1. Total net insulated roof/ceiling area............
OVER
~ i
Determine 'U' value for each roof/ce3ling segment: '
J. Q x 'ut
k. ~ x ' U'
1. ~s9 x 'U' QP~
4 .
Total
If total of p4 is the same as or less than 02, you have met the intent of SBC
6006(c)t.
Alternate Building Envelope Design
To utilize the total envelope system method, the values established by the sum
of Items I13 and 04 shall not be greater than the sum of Items 01 and 02.
1. + 2.
3. 16/ B% + u. 9% 78
2
1984 ENER Y~ CODE QUIREMENTS
On or about March 1, 1984, the following energy code requirements
should be calculated and included with a building permit application.
1. Roof - ceiling assemblies - R-38 U= 0.025 Average
2. Exterior walls & rim joists - R-20 U= 0.11 Average
3. Floors over unheated spaces - R-20 U= 0.05 Average
4. Exterior overhangs will be considered as exterior wall.
5. Foundations (all exterior walls) - Minimum of R-5 insulation.
6. All insulated areas must be separated from the heated space
by a well-lapped or sealed vapor barrier with a minimum perm
rating of 0.1. A 4 mil. polyethlene sheet or equivalent meets
this requirement.
A Kra£t face R-19 type insulation will be accepted in the rim joist
areas. Air chute baffles are to be placed in every rafter space.
emcctu+[ to (a) rnnuas remm r,ajrs;,r nieIuAL
. or Trriuur usEo rr.oeueTS
IR) IR1 .
In[erior /,lr Film (valls) O.EB GyDSUm or Ol+s[er Ooard 318" 0.31 ' r
Citerior Fir film (ualls) 0.17 Cypsum or ylas[er 4oare I/2" 0.45
fgICrior l,fr film (Ycnted Ceilinp) 0.61 Cypsvn or 01..ster boarE 5/8" 0.56
E. t~ri,r Air Fllm (Ventrd Ccilinq) 0.61 ilywooA )/B"
Intc.lor alr iiln Qtcn Ventee) 0.61 P7 ~~47
yvood 1/1" 0.62
f.oerior Air illm hton Ym[eal 0.17 Ply..vod 7/4" 0.97
' ~ Shea[hinp. re9. densiry I/1" 1.32
6ion~inun Sidinc 0.61 Sne.tninn, reo. eensiiy 25/32" 2.06
. Al~ninvm .,i[A Backer I.82 N:il•M1ase sne:.[hinq I/2" 1.14
Aloninun ..itn Bac4cr 6 Folled 1.96 . '
117 a B tco Sidinn (11ooe) 0.81 Built-up koofs 0.7]
7/16 . 12 uarCOOartl Sidinq 0.67 Rsbes[os-ce,nt s~inalis 0.21
/•sLestos Slninm 1/4 La0oc4 0.21 Asph,,lt roll roofing 0.15
'Stucco (Oro.~n ind finisn Coa[) - hsv>nlt Sninqles 0.44
},'e" vooa s.e n oo. or Sheathing 0.?4 Inselation: 2-2 J/L" Iiberplass 7.00
I/i" Gly.ooa Jo~tninq 0.63 Insula[ian: 7 112" flEerpluf II.aO -
' 1/:" Particle tlwrd 0.66 Insulation: 6" fiberglass 19.00
190DS: BLOUItIt 400LS . ,
Gir. pine t slmitsr soft lloods I I/2" 1.89 Approx. l" • . 9.n0 . . 2 I/I" 3.12 ApDroa. 4 1/2" 13.00 . '
I 1/3" 4.35 Approx. 6 I/L•' 19.00 .
S 1/1" 6.87 Approx. 7 1/4" 74.00 . .
Approx. 14" 30.00 . . .
Avorox. IB" 40.00
' . AII other insulation materials nuit Ce
vinee .«ir,ea (a rouor) , (a) v«m;cvlicc .
8° Conuct< Block (5 L C ReO.) 1.11 1.93 . . .
12^ Cencre[e Block (5 G L Reg.) 1.18 3.15
. '
8^ t;5hn uelsnt 7.18 5.07
12" LiSht Weignt 2.48 5.87 .
•esen>e..e+.aesac.•.:.:.ea_ner>en . .
NDTF: (U) a Area Spusre Iec[
. . , .
AII VlnEOVS - . . . . . ' - (../Stcros I" to 4" Spacc) .SG
Rero.nl Dauole Llaxing (RDL) .55
Tnercp or wcldcd 3/16" air spacc .69 I/4" •ir coacc .65 -
1/2" air SDOCe .58 . .
, (Otner wlndo.+s s?ecifically testea un ose Eetter ratin9s) '
1 314 Solld core eoor .46 '
v/storn, wnoE .jl v/starn, metal .36 ,
Pesse SmelDoor Insl/i:/GL 7.45rt .13 ' Slidinq Glass Uoor, Vood .65 . ,
MCUI .)IS , '
. CITY OF FAGAN •
r;t7~ ruriMvM "U" ~'ALUE A,\D R-FACTOR AT ROOF, LdALL, RIPt !u\D CO::CRETE BLOCI:
Provide insulation baffles in every' RQOF. I (.~.ILf NC,
• rafte: s~ace.
- ' (D W-[EXlo~ FtR F?~~ 1
~l Q 1?`SULAj1oN •
v > ~ .
~ EX~ER1oi Al"r Fl~f'1
j C~-
• ~ ~ W_ ~ fiz = oZs TojA` (R)_ . .
. ; InALL (17-) IIAC
R1R f1LM
• ~ 9 G) CaYP. ' 8D. ' : . '
- ,
(D e~ 11"sULATtoN 9Q ZS/3zit p~IL7, ~1Tc .
. . I ~ I . ~o ~l!1~UNf7c SiD~r'(a -
; ' to u EX;_716,'. F+r. FILr1 ~
ToTqL (g) _
-
,t (I1TEPlor. q~r. F~U1
' . "OG S f/Z!" 1FSULA7lc;a . . . . . .
i F7 2' Fliz- SZWlj .1O1s"[
~s 15 u~sZ 50",
• ~ u- c~orlfTE sio}rG .
O t*TE1z1DF- A1F- flLM
. . . . . -o ° 11. Ulf . ToTP.F (rc) _
ria • , '-:r.
.
. o - op . . fC1J[CDATI00
Cn) vAtu:
D 10 1Ei7017 AItt FIUl -
uj S~~ . •
~ e n ?J ~I ~")l~x (~f IG. $Lh,
. • • O I ,f ~ ~ YP-~c~~"t 9.5
, . . r; EX~c.P•{~iz AIR EICM
e
ll U21 _
• , . I/IZ= 'j , TO~P.L ~CC~=
. . i
Floor, oVe; unhez[ed spaces mus[ have mininum R-fac[or of R-ZO (tuck-under garaoes).
FSoors ov,= outdoor air (ovcrhangs) aust liave a nininam P.-factor of R-33.
CITY OF EAGAN FOR CITY USE ONLY
3830 PILOT KNOB ROAD
EAGAN, MN 55122 PERMZT # PHONE: (612) 454-8100 RECEIPT # ~z-
3S1~G1aaN~CAI. YY~ItMx`S DATE:
RESIDENTIAT;:; PLEASE COMPLETE IIPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS &
. . .
TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
WORK DESCRIPTION FEES
NEW CONST ADD-ON MINIMUM $15.00
ADD ON _ HVAC 0-100 M BTU 24.00
REPAIR _ ADDITIONAL 50 M BTU 6.00
GAS OUTLETS - MINIMUM 3.00
OWNER NAME: OF 1 PER PERMIT
SUBTOTAL: $
SITE ADDRESS: C9 l~ STATE SURCHARGE: .50
LOT:1 BLOCK o~ SUBD. !c'2Y TOTAL: $4R'7"
INSTALLER: •
ADDRESS: SIGNATURE OF PERMITT E
CITY: ZIP:
PHONE
COMPIERCSWIND'qSTRZALi. PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS,
APARTMENT BUZLDINGS, AND MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE
NOT REQUIRED FOR EACH DWELLING UNIT.
°
CONTRACT PRICE: FEES
OWNER NAME: 18 OF CONTRACT FEE.
STATE SURCHARGE _ $.50 FOR
SITE ADDRESS: EACH $1,000 OF PERMIT FEE.
PROCESSED PIPING = $25.00
IAT: BLOCK _ SUBD. $25.00 MINIMUM FEE.
INSTALLER: CONTRACT PRICE x 18 $
ADDRESS: STATE SURCHARGE $
CITY: ZiP;
TOTAL: $
PHONE
( S I GNATIJRE )
FOR:
CITY OF EAGAN
CITY OF EAGAN FOR CITY USE ONLY
3830 PILOT KNOB ROAD
EAGAN, MN 55122 PERMZT # /4~7/
PHONE: (612) 454-8100 RECEIPT # ~`I
PL#1~TBING 1'$itldT~' DATE:
R~SIC?F,3i~'IAx.:, YLEASE COMPI.ETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS &
TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
WORK DESCRIPTION COMPLETE THE FOLLOWING:
' N0. FIXTURES EA. TOTAL
NEW CONST ~ ADD-ON MINIMUM 15.00
ADD ON SHOWER 3.00 3,00
REPAIR WATER CLOSET 3.00 L,,Vl
BATH TUB 3.00 3, do
LAVATORY 3.00 OWNER NAME; KITCHEN SINK 3.00
LAUNDRY 3.00
~7~ OTTUB/SPAY 3.00
SITE ADDRESS:
WATER HEATER 3.00 3,42
v
LOT: 12 BLOCK ~ SUBD. FLOOR DRAIN 3.00 3, c:,,>
/ GAS PIPING OUT.
INSTALLER: (MINIMl7M - 1) 3.00
ROUGH OPENINGS 1.50 ~5_0
ADDRESS: OTHER
/ WATER SOFTENER 5.00
CITY: 2IP: PRIVATE DISP. 15.00
~pv U.G. SPRINKLER 3.00
PHONE tk:__ ~O p - lo C~
SUBTOTAL $ 3 y' S v
ST. SURCHARGE .50
SIGNATURE OF PERMITTEE ~ S
TOTAL: $
bOMMERCIAI:jiNDUSTRIAL: PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS AND
M[7LTI-FAMILY BUILDINGS WHEN SEPARATE YERMITS ARE NOT REQUIRED FOR EACH
DWELLING UNIT.
° ° -
CONTRACT PRZCE: FEES
OWNER NAME: 18 OF CONTRACT FEE.
STATE SURCHARGE _ $.50 FuR
SITE ADDRESS: EACH $1,000 OF PERMIT FEE.
LOT: BLOCK _ SUBD. $25.00 MINIMiIM FEE.
INSTALLER: CONTRACT PRICE x 18 $
ADDRESS: STATE SURCHARGE $
CITY: ZIP:
TOTAL: $
PHONE
(SIGNATURE)
FOR:
CITY OF EAGAN
I Fo%Office Use
CiLy Of La~~11 j Permit#:
I
I Permit Fee, f
3830 Pilot Knob Road
Eagan MN 55122 ~ Date Received:
I ~
Phone: (651) 675-5675
Fax: (651) 675-5694 i staff: ~E/ I
2008 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: _~~L?~LL_ Site Address: b93
Tenant: Suite
RESIDENTlOWNER Name: `~2, Ou4nLK Phone:051 -L0Z--m~~7
Address / City / Zip: C C ,J
CONTRACTOR Name: License#: Y~~~-la"I" ?V1
Address: 651-365-13~i 0
u
City: Eegan, MN 55123•1339 State: Zip:
Phone: Contact Person: 4ZL5 6e V1
TYPE OF WORK _ New -,Z/Replacement _ Repair _ Rebuild _ Modify Space _ Work in R.O.W.
Description of work:
PERMITTYPE RESlDENTIAL
-i/- Water Heater Water Softener Lawn Irrigafion Add Piumbing Fiutures
~ RPZ 1_ PVB) I Main _ Lower Level)
Septic System _ Water Turnaround
New
Abandonment
RES/DENTIAL FEES:
$50.50 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $.50 State Surcharge)
$30.50 Lawn Irrigation (includes $.50 State Surcharge)
$50.50 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround" (includes $.50 State Surcharge)
'Water Turnaround (add $136.00 if a 5/8" meter is required)
$100.50 Septic System New ($10.00 per as built) (includes County fee and $.50 State Surcharge)
$90.50 Fire Repair (replace burned out appliances, duchvork, etc.) (includes $.50 State Surcharge)
TOTAL FEES $ '~O
I hereby acknowletlge that this information is complete and accurate; thal the work will be in confortnance wrth the ordina ~d d o it D
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a p ri ; a e xrorkvA b
accordance with the approved plan in the case of work which requires a review and apProval of plans.
X~e,s C. .~Ie.t,,cr MaR 1 o Zoos
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ApplicanYs Printed Nam Applicant' gnature '
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FOR OPF.ICE USE. ' . - .4~a,. _~..i.,., r qe;.iS~".s~r~:,. zN~.x~~zy.::. • sra,,.., - t:
y;: Date•,.
•t~9 Reviewed6
.ty '4rfi:'w\.:h.a~''..i?,r'La'.i:~~1n'3a.4' ''dp~.•:..~_
,t.,~.j.`'c.E, y,c..~,:`q,., ..i.;rc+~j•>!`;',`' .?;;:f~'.r,Y*` ~'~t''
Required'r,lnspections:, "Under:Grourid:sj,?~~;~~`
„ =Rough;ln`.'' r.„TestIn`aGas„Test~~ia°'a-;Final=':-;'
HIJ
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA143210
Date Issued:06/07/2017
Permit Category:ePermit
Site Address: 653 Witham Lane
Lot:12 Block: 2 Addition: Coventry Pass 2nd
PID:10-18401-02-120
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:Does not include skylight(s)
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 within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
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 -
Michael Bulnaek
653 Witham Ln
Eagan MN 55123
(612) 210-9690
T. Dunham Construction
831 Ventnor Ave
Eagan MN 55123
(612) 189-0480
Applicant/Permitee: Signature Issued By: Signature