4371 Woodgate Lane N
CITY OF EAGAN Remarks
Addition ..114811arr1 Park Thi rd Adcli ti nn Lot 11 e1k 1 Parcel
owner street 4371 North Woodgate Lane State Ea an MIlV 55122
LG_v
Improvement Date Amount Annual Years . Payment Receipt Date
STREETSURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK
* SEWER LATERAL
WATERMAIN
* WATER LATERAL 1981
WATER AREA ~
STORM SEW TRK
* STORM SEW LAT 1981
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
9UILDING PER.
SAC
PARK
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE:
3830 Pilat Knob Road Permit Number.
Eagan, Minnesota 55122-1897 Date Issued:
(612) 681-4675
SITE ADDRESS: APPLICANT:
i I f:~rili~~ : i' I e•rii r: . ~~.;i~ I.'.
~ PERMIT SUBTYPE: TYPE OF WORK:
. .
.
(
Mr,E:V F i aN I{IVl<<.jt i) r.•r M t~ r i,,:f ~ r
F
L
. _ _ - - - - -
~
Permit No. PKmR Ho1dK DaM Telephone s
ELECTRIC
' PLUMBiNG
HVAC
Impmtlan Wb Insp. Conrmnfs
I FOOTIN(3S
FOUNO
FRAMIN(3
ROOFiNO
HOUGH
PLUMBINO
PLBG
AIR TEST
' ROIJ('H
, HEATINCi
CiAS SV'C
TEST
INSUL
GYPBOARD
FIREPLACE
FlREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FlNAL BSMT R.I.
BSMT FINAL I
DECK FTG
w
DECK FlNAL ls^
I
- - - - - - - - -J
INSPECTIUN RECORD
. CItY UF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued:
(612) 681-4675
I SITE ADDRESS: APPLICANT:
, Si;ri,;tll; r i IAm4 r4 t II I: ! fi,il { lt) E 1 ;li,s I
l~illl 1 F1f=1~ 1 7~i I •i I~ ~ 1 ' I'1 I .
PERMIT SUBTYPE: TYPE OF WORK:
tJl ~1
INSPECTION • I
1 1 1•,I'i l Ca'.
i fJ'~11) !'1 1 1 ~tli i 1 ; I li~ F I
I
:rltt,~t ; N { f ! i~tli,l! 11•1 1{!
I ni,1,t , I•I V lJ 1'1 Ici+ WI N.'! i t't I;ii
I
F
-
, PermR No. Parmft Holder Date Telephone M
ELECTRIC 8'?(0 9 S ~
PLUMBIN(3 ~~~q qs
•,y ?ivnc ~ i IA919 -0
o?GG5
Insp~etla~ Dsb Mup. Comma+b
FOOTINGS -Y
FoUNd D 7 14
FRAMING
ROOFINI(3
P~LUUMBING 12. ft :a i
PLBG
AIR TEST _ ~ .
, ROUGN
HEATING -Ap
S SVC
' INSUL
OYPBOARD
FlREPLACE " /
' ~ L C4
FIREPLACE O h e.9, ~
AIR TEST
FlNAL PLBG '(J ~
FINAL HTG
ORSAT
' TEST
BLDG FINAL
~
BSMT R.I.
BSAAT FlNAL
DECK FTG
DEdC FlNAL
' ~ • - .
~ ~ .
W-ei.~licate nf cccupanc~
Mrij of ftgau
Tx*Wtmtut .f la,rniy 384tedim
77iis Certificate issued pursuant ro tlte requirements of the Uniform Building Codt
certifying that at the timt of issuance tleis strucrur+t ?vas in compliance with the variolrs
onlinances of the City rrgalating building constnrction or use. For the following:
ut clus;rcafim: SEIM swg. wamit rro. ?bSIl--
OOMP-y 7Yvn S3~U 1 zonioa nba;d ~ rra const. ~
o.ner orewlding MrCtAFJ. 1irtt+LM . H2¢$_ Awamss 46 19 wreM ra aer~.,r
~
~ amawg Aaamn 6371 u7fY'.e,TF T.At~ NMU Localny I,J 1- nir.MAT.3JITiD 30-
nre:J" K~,Z.L!
Building Official,
POST IN A CXKWIClIOUS PLACE
2 0 8- 3 6 8 0 OFPIC Th4 reqvest void 18 monlhs iram volidabon dma pnnmd mthis sbo:.a~
i~y~~5USE NLY
• v
: d ~
PLEASE PRINT OR TYPE II~
Requesf Dok Rouph-m vispxvon reqoired ~d Yes ? No Inspecnon Other Thon Roogh-ln: 0 Ready Now Will Cvll
y
` 1' l (You mos~ m~l ~he impenor when reody) Date Ready
I, 9 licensed confrador ? owner hereby request inspecfion of ihe above elecirical wark at:
lob Pddrms (SVeet, 80:, or Rouh No.) G Lp ~
Seaion No. Towmhip Name or N. Range Nn Fin No. Co~~
Q~
~ Phone No.
1~ 8 - I I
Power Su plier Addres
a. ec. ,
E ' I Conhadar (Compon, Name. Conlranor licen v Mmtr lic No. (Plant Elaa.Only)
O
iO
Maili Addnss (Conlrvaor r er Pedorming Insbllaeon ,
Au nzed Signalun (Conimtlor or Owncr PeAorming Insmllarvon) ho e No
r
EB- I -10 6/95 ATEBOAROCOPY-SEEINSTRUCTIONSONBACKOFYELLOWCOPY
I~~I~I~~`~ I I I II REOUEST FOR ELECTRICAL INSPECTION
~ Minnesota State Board of Electricity ~
i 11I 1827 University Ave., Rm S- 28, St Paul, MN 55104 ~<3
* 0 2 0 8 3- 6• i~ 1* Phone (612) 642-0800 a 9
Home Duplea Apt.8ldg. Other. New Addn
Commercial Industrial Farm Remod Re air
Air Cond. Hfg. Equip. Wafer Hlr. Load Mgmt Other
D er Ran e Elec. Heaf Tem . Service
"X' above /he woAc covered by this requesf Enter remarks m fhu spoce and on the back of fhe whde mpy only.
Calculafe Inspectwn Fee - ihis Inspechon Requesf will noi be accepted wiihout the correct fee:
Olher Fee # Serrice EMrance Size Fee # Cirai~ts/Feeders Fee
Mobile Home Park $fall 0 to 200 Amps 0 fo 100 Amps
$treet Lig./TraHic $ig. Above 200 Amps Above 100 Amps
Transformer/Generator INSPEC70N'SUSEONLV TOTAL
Sign/Outline L}g Xfmr 7 7 ~
Alarm/Remote Control ~
Swimming Pool i ne26 ~em Iha~ i ~m «+~d ~ei i 4~bad here the dme: im~~d
Irrigafion Boom Rough-In
Special lnspedion
Finol
Inves}igalive Fee 0,
THIS INSTALLATION MAY BE ORDERED OISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This roquest wid 18 manths kom wlidotion daie prinbd in ~his box.
* 0 4 L 6 1 3 4 5 X pLEASE PRINT OR TYPE
Requmt Dma Ro;rgMn inspxtion reqvired3 Yes Na Inxpecoon O~her ihon RoogMn eody ryo~u Will Coll
(Yau mus~ca0lhe inspeciorwhenraody~ Dore Ready
I, 0 licensed contmctor owner hereby request inspection of the above electriml work oC
Job Address (Srceei, Bor, or Ria No ) Ci Zi
~ ou w6d w,~ ~ ~ sS-l z2--
Sernon N. Township N. or N. Rra,e N. fim No. Cwny m~}
Occuponi Phorie No.
Pw.er Sopplier hddresa
7 ~ l,?o~ ~~`e
Elecnicol Csakxror lCampony Namel Contrumr lioense No. Maskr W. No. FMm EIM. Only)
MaiLng Addrev (Connacbr « P.ner Perlarmug ImmAonm)
AutMri i e (Conkoeor or erlorming Wwllmwn) Phore.No. ~
I
EBO0001 I/96 ernrc e...oo I 1.1-..-.....x.
e.....
REQUEST FOR ELECTRICAL INSPECTION 6~`~-°'-
416 -13 4 ~ B121eUniversary n earRm. S1e128,'SL Paul, MN 55104
Phane (612) 642-0800
Home Du lex A t. 81d . Other: New Addn
Commercial Indushiol Farm Remad Re ir
Air Cond. Htg. E ui . Wofer Htr. load Mgmf Other.
D er Range Elec. Heat Temp. Senice
"X" obove the work covered by fhis iequesf. Enter remorks in fhis space and on the back of the white copy only.
~
Calculafe Inspetfion Fee - This Inspection Request will nof be accepted withoul fhe correcf fre:
Other Fee R Service Enirance Size Fee N Circuits/Feeders Fee
Mobile Home Park Stall 0 l0 200 Amps 0 to 100 Amps
Streef Ltg./TmHic Sig. Above 200_Am s Above 100_Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Oudine Lig. Xfmr.
Alarm/Remote Conhol
$wimming Poal i here cani iha md the '.talloeon dexribed herein on [he daros swred
Irri alion Boom Ra,yh4n pme
$peciallnspection
Filwl
Investigotive Fee pa
THIS INSTALLATON MAV RF n nFRF11 MCCf1NNFCTFII IF Nl1T C(1MPI FTFfI WITHIN tA Ml1NTHS
Address 4371 [,i)oDQUe uW NoRltt Zip 5512 2
Lot I I' Blk I Sub MALIA.RD PARK 3?tD
THESE ITEMS WERE / WERE NOT COMPLLTE AT THE TIME OF THE FINAL INSPGCI'ION.
Date: S o"1q Yes No Inspector. 1-147
Final grade (6" from siding)
Permanent steps (garage)
Permanent steps (main entry)
Permanent driveway i/
Permanent gas
Sod/Seeded grass V
TraiUcurb damage
Porch L~
Basement finish
Deck
Please verify wilh the builder the removal of roof test caps from the plumbing system and the shut-off of waler supply to
ihe outside lawn faucet before freeze potential exists.
Contact engineering division at 681-4645 before working in rightof-way or installing underground sprinkler system.
Whi[e - City Copy Yellow - Resident Copy Pink - Contractor Copy ~
RESIDENTIAL
BUILDING PERMIT APPLICATION
3~$a y CITY OF EAGAN
3830 PILOT KNOB RD, EACAN MN 55122
651-681-4675
New Conatruction Reauirements RemodellReoair Requirementa
• 3 registered site surveys stwwing sq. fl. of lot, sq. ft. of howe; and all mofed areas • 2 copies of plan
(20% maYimum lot coverage allowed) . 1 set of Energy Calculations (or heated additions
• 2 copies of plan showing beam 8 vnndow sizes; poured found design, etc.) . 1 site survey tor exlerior additions & decks
• 1 set o( Energy Calculatbns . Indicate if home served hy seplic system for additions
• 3 copies of Tree Preservation Plan'rf lot platted after 111193
. Rim Joist Detail Options selection sheet (bldgs with 3 or less units)
p S 7
DATE VALUATION ~l ~3~
SITE ADDRESS `z -~w LcljY\'~
M'ULT I-FAMILY BLDG Y 41 N
TYPE Of WORK I C) FIREPLACE(S) _ 0_ 1_ 2
APPLICANT LkSfW'h
STREET ADDRESS I-7-3C`'~~~ /.~~/~.e° ~ CITY At STATE i~21P
TELEPHONE # CELL PHONE # 6122~O-o2 '~'/a~ FAX #
PROPERTY OWNER TELEPHONE# CrS-'-49
COMPLETE FOR "NEW° RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ M[NNI;SOTA RiJLLS 7670 CA'CCGORY I MINNESOTA RULL,S 7672
(4 submission type) . Residential Ventilation Category 1 Worksheet Submitted • New Energy Code Worksheet Submitted
• Energy Envelope Calculations Submitted
Plumbing Contraetor: Phone #
Plumbing syslem includes: Watcr Softcner _ Lawn Sprinklcr Pee $90.00
Water Heater No. of R.I. 13aths
No. of 13atlis
Mechanical Contractor: Phone #
Mechanical system includes: _ Air Conditioning Tee: $70.00
Heal Recovery Systcin F
Sewer/Water Contwctor: Phone #
LI hereby acknowledge that I have read this application, state that the information to ~comply
with all applicable State of Minnesota Statutes and City of Eagan Ordinances.
SignafureofApplicant
OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4/02
OFFICE USE ONLY
? Ot Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling O OS 06-plex ? 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
O 04 02-plex ? 10 OS-plex ? 18 Deck ? 23 Porch (screened) ? 36 Multi
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
0 33 Alteration ? 37 Demolish (Bidg)` ? 43 Reroof ? 46 WindowslDoors
d 34 Replacement 'Demolition (Entire Bldg only) - Give PCA handout to applicant
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) _ FinaVC.O.
_ Footings (deck) _ FinaUNo C.O.
_ Footings (addition) _ Plumbing
Foundation HVAC
Drain Tile O[her
Roof _ Ice & Wa[er _ Final _ Poo] _ Ftgs _ AidGas Tes[s _ Final
_ Framing _ Siding Stucco Stone
_ Fireplace _ R.I. _ Air Test _ Final _ Windows (new/replacement)
Insula[ion _ Retaining Wall
Approved By , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S8W Permit & Surcharge
Treatment Plant
Plum6ing Permit
Mechanical Permit
License Search
Copies
Other
Total
CITY OF EAGAN
CASHTER: JS TF_RM]:PJAI_ NOc 760
L1ATEr. 05/01/98 T'IMEr 00000
:f. %
NAME- DFl!"iI..FNE A h:ASSI.lLiE
3210 9001 4371 WUOf!GA7E I_ 50.00
205 900i 4371 IxIOC1AGATh L 0.50
Q
To;.a'. ftecei.p+, Amoun':-
C909q6FS_1
LSCR Lr; JAM1!
, ~d)e n . :~t'iS.n . ,:a.^. .;:°,U':Y,:.".a.:J;::.CW~Y.. .>41:o;;RiY.c°,N,•nci. ;a;r
~
CIl'Y OF EAGAN PERMIT
3830 Pilot Knob Road PERMIT TYPE: B U I L D I N G
Eagan, Minnesota 55122-1897 Permit Number: 031875
(612) 681-4675 Date Issued: 0 5/ 01 J 9 8
SITE ADDRESS:
4371 WOODGATE LANE N
LOT: 11 BLOCK: 1
MALLARD PARK 3RD
P.I.N.: 10-47252-110-01
DESCRIPTION:
Building-Permit Type DECK
Building Wbrk Type NEW
Census Code 434 ALT. RESIDENTIAL
~
\\\j-;`r /l/ ~i/I
J ~/~-/~~~r'~t~~` •
7-'j L- 1
r
~ ~ ~ 1 ...J ( / ' ~J ~~i ~4'~. J { l 1
REMARKS:
PLAN REVIEWED BY MIKE BARCK
FEE SUMMARY:
Base Fee $50.00
Surcharge $.50
Total Fee $50.50
CONTRACTOR: OWNER: - ppplicant -
KASSUBE GARRY
4371 WOODGATE LANE N
EAGAN MN 55122
' (612)726-6762
I hereby acknowledge that I have read this application and state that the
infiormation is correct and agree to comply with all applicable State of Mn.
u Statutes and City of Eagan Ordinances. ~
~ l
~ APPUCANT/~ER T E SIGNA~~ ISSUED : SIGNAT
97 B UILDING PERMITAPPLICATION (RESIDENTIAL) $-~JO•O
st-6159 CITY OF EAGAN
3830 PILOT KNOB RD - 55122
681-4675
New Construdion Reauirements RamodeUReoair Reauimments .
? 3 registered site surveys ? 2 copies of plan
? 2 copies of plans (InUuda beam 8 win0ow sizas; pourad fnd. Oeaign; etc.) ? 2 site aurveys (exterior atlOicions 8 tledcs)
? 7 energy ealculations ? 1 enetgy talalatlons Mr heated adtlitions
? 3 copies of trae preservatlon plan H lol platteA eRar 7/1J93
repuired: _ Yes _ No DATE: APRIL 64" CONSTRUCTION COST:
DESCRIPTION OF WORK: DEC K
STREETADDRESS: N3-II NOI wipbO Oa,4t &RA,14, q&,V M'IJNiV
LOT BLOCK ~ SUBD./P.I.D.
OAY ~2~'-~7C1
PROPER7Y Name: KaSSiII GavW Phone#E~~~ ~Os-~~8
OWNER .n
Street Address: 4371 Nev th W0Oe1aft1+ A,,0~
Ciry: 4wI • State: M: SIw/ Zip. .S'S/2 1 ^
CONTRACTOR Company: S Q 14 Phone
Street Address: License
City: State: Zip:
ARCHRECT! Company: Phone
ENGINEER
Name: Registration
Street Address:
City: State: Zip;
Sewer & water licer.aed plumber (new construction only): . Penalty applies when address change
and lot change are tequested once permit is issued.
I hereby acknowledge that I have read this appliption and state that the infortnation is correct and agree to comply with all applicable
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant:
OFFICE USE ONLY D
Certificates of Survey Received _ Yes _ No
Tree Preservation Plan Received _ Yes _ No _ Not Required
OFFICE USE ONLY
BUILDING PERMIT TYPE
0 01 Foundation ? 06 Duplex ? 11 Apt./Lodging ? 16 Basement Finish
? 02 SF Dwelling o 07 4-plex o 12 Multi RepaidRem. ? 17 Swim Pool
? 03 SF Addition o 08 8-plex ? 13 Garage/Accessory ? 20 Public Facility
? 04 SF Porch ? 09 12-plex ? 14 Fireplace ? 21 Miscellaneous
? 05 SF Misc. ? 10 = plex .e' 15 Deck
WORK TYPE F~0-1 ~~i s s~z cD F;oe F:;jrtj2C ~r&-+
,pr'~31 New ? 33 Alterations o 36 Move
? 32 Addition ? 34 Repair ? 37 Demolition
GENERAL INFORMATION
Const. (Actual) Basement sq. ft. MC/WS System ~
(Allowabie) Main level sq. ft. City Water
UBC Occupancy sq. ft. Fire Sprinkiered
Zoning sq. ft. PRV
SF of Stories sq. ft. Booster Pump
Length sq. ft. Census Code. y 3
Depth Footprint sq. ft. SAC Code o 1
Census Bldg I
Census Unit t7
APPROVALS
Planning Building M'g Engineering Variance
Permit Fee Valuation: $
Surcharge
Plan Review
License
MC/WS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit S/W Surcharge
Treatment PI.
Road Unit
Park Ded.
Trails Ded.
Other
Copies
.'y ~~'••i~y~~~ la~'1
Total: '
% SAC
SAC Units
i • .
f ~ ~~•v . . `
396.00- - -
_ .
. %
- /~f~ rs.~~.,...~.~r • • ^1C'+.~-- •,rw ~
i
'•OJ` \ 333.00
• ~ ~ y5, I
\ . ~ ~ ~j
ILO
~ ~s Ga?r~`9~ ?30~ ~ M
~ ~ \ .
~
~ ~6~\• 1`\ \ t ; ~ ~
. ~ 12 •
Vr _
9•48
.
. ~
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•
i
PERMIT c~,4qo1l
~ CITYOF EAGAN
3830 Pilot Knob Road PERMITTYPE: euzLorrvc
Eagan, Minnesota 55122-1897 PermitNumber 026511
(612) 681-4675 Date Issued: 10 / 10 / 9 5
SITE ADDRESS:
4371 WOOD6ATE LANE N
LOT: 11 BLOCK: 1
MALLARD PARK 3RD
P.I.N.: 10-47252-110-01
DESCRIPTION:
Building Permit Type SF UWG
Building Wark Type NEW
UBC Occupancy R-3 U-1
Construction Type V-N
Zoning . R-1
BuildSng Length 64
Building Width ' 56
Building stories 2
&guare Feet ~ 2,455
REMARKS:
PRV S& W PlBR - WENZEI PLBG
FEE SUMMARY:
VALUATSON $154,000
Base Fee $1,157.25 MISCELLANEOUS $1,892.50
Plan Review $405.09 Total Fee $4,366.79
Surcharge $77.00
SAC $850.00
SAC 96 100
SAC Units 1
Lic. Search Fee $5.00
Subtotal $2,494.29
CONTRACTOR: - Applicant - 57. LIC. OWNER:
i'UTEWOHL MSCHAEL 16879141 0001670 TUTEWOHL HOMES MTCHAEL
4612 MANOR DR 4612 MANOR DR
EAGAN MN 55123 EAGAN MN 55123
(612) 687-9141 (612)687-9141
I hereby acknowl.edge that T have read this application and state that the
infiormation is correct and agree to comply with all applicable State of Mn.
Statutes and City of Eaqan Ordinances.
6J ~11n f1.DA~I ~ mJ+
APPLICANT/PERMITEE SIGNATURE ISSUED B SIC~NATURIE
Y `
CITY USE ONLY
L / BL I RECEIPT jo
SSBD- ~-~Q~ D.sclQ, DATE:
1995 MECHANICAL PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
(612) 681-4675
Please complete for: ? single family dwellings -
? townhomes and condos when permits are required for each unit
„G New construction Add-on furnace
Add-on air conditioning Add-on air exchanger, i.e. Vanee system, etc.
Date:
~
FEES
4p
? Minimum Fee: Add-on/Remodel (existing residence only) $ 20.00
? HVAC: 0-100 M BTU 4.0
Additional 50 M BTU 6.00
? Gas Outlets (minimum of 1 required @$3.00 each) ~pO
? State Surcharge .50
TOTAL
SITE ADDRESS:
OWNER NAME: PHONE /q
INSTALLER NAME:
WENZELFfiEATING
STREET ADDRESS: 19568MAWNEE RatiD
RQ.G C[`LFJ
CITY: STATE: ZIP:
PHONE ( )
S I UN AT U R E'O t- HERNf 1lT
. ±
cirr use oNLv
L _ BL _ RECEIPT
SUBD. DATE:
1995 MECHANICAL PERMIT (COMMERCIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
(612) 681-4675
Please complete for: ? all commercial/industrial buildings.
? multi-family buildings when separate permits are ~ required
for each dwelling unit.
DATE: CONTRACT PRICE:
WORK TYPE: NEW CONSTRUCTION INTERIOR IMPROVEMENT
DESCRIPTION OF WORK:
FEES: $25.00 minimum fee gl 1% of contract price, whichever is greater.
Processed piping - $25.00
State surcharge of $.50 per $1,000 of pertnit fee due on all permits. ~
CONTRACT PRICE x 1%
PROCESSED PIPING
STATE SURCHARGE
TOTAL
JI I t NL7UFCtJJ:
OWNER NAME: TELEPHONE
TENANT NAME: (innPROVeMeNrs oNLv)
INSTALLER:
ADDRESS:
CITY: STATE: ZIP•
PHONE
SIGNATURE:
SIGNATURE OF PERMITTEE CITY INSPECTOR
CITY USE ONLY
L~ BL ~ RECEIPT O O
SUBB-r'' /a~ca' ~c~c~.~ i' DATE: a~ ~
1995 PLUMBING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
(612) 681-4675
Piease complete for: ? single family dwellings
? townhomes and condos when permits are required for each unit
FIXTURES - EACH NO. TOTAL
Shower 3A0 x 3• 00
Water Closet 3.00 x = , O
Bath Tub 3.00 x 3,66
Lavatory 3.00 x 6,1)
D
Kitchen Sink 3.00 x / - 3,00
Laundry Tray 3.00 x 700
Hot Tub/Spa 3.00 x =
Water Heater 3.00 x Z = ~ UO
Floor Drain 3.00 x .00
Gas Piping Outlet ' minimum - 1 3.00 x
Rough Openings 1.50 x S =~O
Water Softener 5.00 x =
Private Disposal ' akota ccy. iicense 20.00 =
U.G. Sprinkler " ho e under const. 3.00 =
Alterations ' to exisci y 20.00 _
Water Turn Around 20.00
0. 50
STATE SURCHARGE .50
?OTAL 10,00
SITE ADDRESS: `/9 71 N
OWNER NAME:-
INSTALLER NAME: ~0AII -1"1q/Yl,/.C~pc Q
STREET ADDRESS:
CITY: STATE: /f'l lll Zip: sS/a c;2--.
PHONE ( /~oZj ~?~c? -~S(o5
Q/lP/I2
. .51U T
OFFICE USE ONLY
L _ BL _ RECEIPT Jl:
SUBD. DATE:
1995 PLUMBING PERMIT (COMMERCIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
(612) 681-4675
Please complete for: . all commerciallindusVial buildings.
P multi-family buildings when separate permits are = required for each dwelling
unit.
DATE: CONTRACT PRICE:
WnRK TyPF; _ NFk4J !QNSTP.l.ICT!ON _ ACO ON AI :
DESCRIPTION OF WORK:
IS WATER METER REQUIRED? _ YES _ NO. IF SO, PLEASE PROVIDE THE FOLLOWING:
WATER FLOW: GPM. ARE FLUSHOMETERS TO BE INSTALLED? YES NO.
FAILURE TO PROVIDE THIS INFORMATION WILL RESULT IN A DELAY OF METER ISSUANCE.
WILL YOU BE INSTALLING A METER FOR A FUTURE U.G. SPRINKLER SYSTEM? _ YES _ NO.
IF SO, YOU MUST APPLY FOR A SEPARATE U.G. SPRINKLER PERMIT.
FEE: $25.00 minimum fee or 1% of contract price, whichever is greater. State surcharge of $.50 per
$1,000 of permit fee due on all permits.
CONTRACT PRICE x 7%
STATE SURCHARGE
TOTAL
SiT'c i1GuRc55:
TENANT NAME: STE. #
OWNER NAME:
INSTALLER:
ADDRESS:
CITY: STATE: ZIP:
PHONE SIGNATURE:
APPLICANT
OFFICE USE ONLY
METER SIZE: " DATE: INSPECTOR:
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA135537
Date Issued:03/22/2016
Permit Category:ePermit
Site Address: 4371 Woodgate Lane N
Lot:11 Block: 1 Addition: Mallard Park 3rd
PID:10-47252-01-110
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace & Air Conditioner
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Joel M Adams
4371 Woodgate Lane N
Eagan MN 55122--228
Golden Valley Heating & Air
5182 West Broadway
Crystal MN 55429
(763) 535-2000
Applicant/Permitee: Signature Issued By: Signature