4091 Vermont AvePERMIT
City of Eagan Permit Type:Building
Permit Number:EA127591
Date Issued:10/07/2014
Permit Category:ePermit
Site Address: 4091 Vermont Ave
Lot:21 Block: 4 Addition: Stafford Place
PID:10-72500-04-210
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:
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 by law in ALL single family homes .
William Krech
Valuation: 4,000.00
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Patrick R Gazich
4091 Vermont Ave
Eagan MN 55123
Krech Exteriors Inc
5866 Blackshire Path
Inver Grove Heights MN 55076
(651) 688-6368
Applicant/Permitee: Signature Issued By: Signature
CITY OF EAGAN Permit No: 97$ -5 3830 Ppot Knob Road Date: 7--I9-88
Meter No: y~ 7 -0 a aO ~i~ ?oc.~
P.O. Box 21199 Reade? No Size:
ri~B 3 a 3
Eagan, MN 55121 T~-~---,~- Date: _9- a~- r~
Owner.
Site Address:~poI
Plumber B4 gf for3 Flace
Conn. Chg:
Acct Dep:__ 1~Zoning; R1
Permit Fee: No. of Units: 1
Surcharge:
1 aqree to comply with the City a EAyan
Tr. Plant_ zn! nn.,,;
ea
Meter. Ordinanc
Misc.:
'
er
WATER SERVICE P IT
CITY OF EAGAN Permit No:
Date: 7 -14-88
3830 Ptlof Kqob _Qpsd g/ p No: t' 37 Date: 7- I 8-88 P,0.°Box'21199 ~
Eayan, MN 55121
Owner. Frantier p;idwest
SiteAddreas: 4o92 Vermont Aventze T2; R4 tAffnr'-7 r1s
Plumber. 5tar Plumbinfi
nnwce: 5 5c,. eapd Zoning• n 1
City Chg: ' No. of Units: •
Acct. Dep: ' n°
Permit Fee: a9ree to comply wlth the qty o( Eagan
Surcharge: ` O?dinancea.
Misc.: By
SEWER SERVICE PERMIT
BLDG. PERMIT NO.
. 1.!' C.~.c: C1; . o~I%' i(J
01-3210 dg. Permit ~
01-3422 Plan Check
f'
01-3445 Surch./Adm. '
01-3446 SAC/Adm.
01-2155 Surcharge ~75-3860 Road Unit
20-2275 SAC
20-3865 Water Conn.
20-3868 Water Trmt. A
20-3716 WaterMeter ~-C) ~
~
20-2252 Acct. Dep. 0 ~
20-3713 Water Permit
20-3743 Sewer Permit 79-3866 Sewer Conn. 28-3855 Park Ded.
TOTAL
~ CASH RECEIPT ~
CITY,OE EAGAN
3830 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE
FROM
~
AMOUNT
(!i
8 DOLLARS
100
• ? CASH CHECK ,
/ i
R1ND OBJECT AMOUNT
Thank You ~._..~BY ~
IMwls--PaYen Copy
g r ~•e~l L C * Q YNIOx~oeUn9 CoPY
Pink-Flle Capy
. , ~
~
. ~ .
fgertiftratt nf Mrrupaury
Citp of Cagan
~~~W of ilwlbwg jwpntm
T hls Certifrcate isrued pursuant to the requirements of Section 306 of the Unifonrt Building
C o de ce rri jying t h a t a t t h e t ime o f r s suanc e t h i s s t r u c t u r e uw ! n c o n t p l i a n c e w i t h t h e v a r i o u s
ardinances of ?he City regulating building construction or use. For tJre following:
um a.sffnooo iNIVC'1't1t f_~:353
mds. Rrmit Ho. ~
~-y ~'Pe 1 Zonina pis~r;a lt ~ 7yDe Co""'
Orvota ot Buildin= ;'m t' l~: • Addmm 3902 CffAWALE a.ay EAVAN
10~ 1 Vf''~'T AVI.~.V't.B I.? 1, B4, STAFM PL+Aa
~
• - n.te:
Mldit OfficW
POST IN A CONSPICUOUS PUCE
. . . . . . _ _ . 1
, ~ • t CITY OF EAGAN 16 3 5 { i
' 3830 Pllot Knob Road, P.O. Box 21-199, Esgan, MN 55121 ~
PHONE: 454-8100 . , ,
BUILDING PERMIT Receipt
To be used for Est Value Date JLLY ,19
Site Address OFFICE USE ONLY
lOn 3ite Sewe e ~ J.~
Lpt BIoCk Sec/Sub. ~tAt r~ k.r1 r?(,.~(;I: p Occupency
MWCC System r Zonfny
Parcel No. On Sfte Well
(Actuaq Conat
x ~
; 40I;t?5 cltywater (Allowable)
c Name '
W • PRV Required s of Stories
; Address
~ City Phone ~ter Pump Lenyth
Depth ~
a Neme S.F. Total
.O
~ ` Address Footprint S.F.
c
P City Phone APPROVALS FEES .
4'14 , •
W W Engr./Assess. Permit '
Name
~ o Address Planner Surcherge
Councll Plan Review r ~
{ W City Phone i~;
Bldg. Off. SAC, City
Variance SAC, MWCC
I hereby acknowledge that I have read this application pnd state that the
information is conect and agree to comply with all aiiplicable State of Water Conn.
Minnesota Statutes and City of Eagan Ordinances. "
Water Meter
Signature of Permittee _
R08d Unit
a 1l~ F?t' S
A Building Permit is isaued to: Treatment P1 on the ezpress eondition that all work shall be done in accordance with all -
appticable State of Minnesota Statutes and City of Eagan Ordinances. PBYks
Building Official TOTAL
Pe?mft No. Permit Molder Date TeNphone ~
Plumbin9
y
H.V.AC. O(~~ S/ J
Electric 9/& S
Softener
Inspectlon Date Insp. Commenb
Footings I ~
Footings 11
Foundetion s,
Framinq 3j 4
Roofing
Rough Plbg.
Rough Htg. I~
IsuL
Fireplace
Final Htg.
Final Plbg.
Bldg. Finel
Cert Occ.
Temp. LP
Deck Ftg.
Deck Final
Well
Pr. Disp.
, . PERMIT 11
PlUM81NG PERMIT RECEIPT #
CITY OF EAGAN . y
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE:
CONTRACT PRICE PHONE: 454-8100 • -x
Site Address ` I BLDG. TYPE WORK DESCRIPTION
Lot ' Block SeciSub Res. 11" New ?
' r-a< Mult. Add-On
y Name Comm. Repair
~ Address ~ ' ~ ~W ' Other
c Ciy Phone RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
Name 1 Water Closet - $3.00 Bath Tubs - $3.00 ~ Address. 5-, ,
;-Kitchen FIXTURES L
Lavatory - $3.00
p Ciry fr 1'e(:4j Phone
Shower - $3.00
Sink - $3.00 ~ (
FEES --t-Urinal/Bidet - 53.00
COMM/IND FEE - 1% OF CONTRACT FEE Laundry Tray -$3.00 n%
APT. BLDGS - COMM RATE APPLIES ~Floor Drains -$1.50
TOWNHOUSE & CONDO - RES. RATE APPL.IES Water Heater -$1.50 D
MINIMUM - RESIDENTIAI FEE - $12.00 Whirlpool - $3.00
MINIMUM - COMM/IND FEE - $20.00 ~Gas Piping Outlets - $1.50 ~
STATE SURCHARGE PER PERMIT - .50 (MINIMUM - 1 PER PERMIT)
(ADD $.50 S/C IF PERMIT PRICE GOES Softener -$5.00
BEYOND $1,000.00) Well - $10.00
r , Private Disp. - $10.00
h•, j ~ ; ~j~ Rough Openings - $1.50
SIGN TURE OF PERMITTEE FEE:
STATE S/C:
FOR: CITY OF EAGAN - GRAND TOTAL• U~-'
PERMIT # 2L--~--
- ' MECHANICAL PERMIT
' CITY OF EAGAN RECEIPT # 3530 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: CONTRACT PRICE PHONE: 451-8100
i Site Address ` E ^ 1"Q uT"
BLDG. TYPE WORK DESCRIPTION
( LotBlock Sec/Sub Res. ~ New 1\<1
~ Name, ` - ~ • E'~ r , - ~ , Mult Add-on
Address N~I h~ ~E p~l ~ Comm. Repair
c Ciry Phone 7Z 1-5 4- 5 Other
FEES
Name RES. HVAC 0-100 M BTU - $24.00
L
" + L tL"~ ADDITIONAL 50 M BTU - 6.00
c Addr63s
p Ciry % ~ r ? Phone ' ~ 3- (RES. HVAC INCLUDES A/C ON NEW
CONSTRUCTION)
GAS OUTLE7S {MINIMUM - 1 PER PEHMIT) - 1,50 EA.
TYPE OF WORK COMM/IND FEE - 1% OF CONTRACT FEE
ForCed Air M BTU APT. BLDGS. - COMM. RATE APPLIES
TOWNHOUSE 8 CONDOS - RES. RATE APPLIES
Boiler M BTU MINIMUM RESIDENTIAL FEE - ALL ADD-ON 8
Unit,Heater M BTU REMODELS - 12.00
MINIMUM GOMMERCIAL FEE - 20.00
Air Cond. M BTU STATE SURCHARGE PER PERMIT .50
----Vent ~ CFM - - ~ - ~ ' (ADD $.50 S/C IF PERfWIT PRICE GOES
Gas Piping Outlets # /5o BEYOND $1,000)
Other ~
FEE ~-~iK~sd- ' f ~
S/C: SIGNATURE OF PERMITTEE
TOTAL• ~`FOR: CITY OF EAGAN
PERMIT #
PLUMBING PERMIT RECEIPT #
CiTY OF EA<iAN
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: CONTRACT PRICE j!' PHONE: 454-8100
Site Ad~iress ' ' - ~ k ~ • ± BLDG. TY~_ WORK DESCRIPTION
Lot Block Sec/Sub Res. New `
• ~ ' ' ` ~ Mult. Add-on
m Name A Comm. Repair
~ Address , Other
c Ciry Rl AINF 11Alft`o554,a, RE3. PLBG. ONLY - COMPLETE THE FOLLOWING:
NO. FIXTURES TOTAL
Name - ~ ' • T > • Water Closet - $3.00 $
~ Bath Tubs - $3.00
3 Address Lavatory - $3.00
p City Phone Shower - $3.00
Kitchen Sink - $3.00
FEES Urinal/Bidet - $3.00
COMM/IND FEE - 1% OF CONTRACT FEE Laundry Tray -$3.00
APT. BLDGS - COMM RATE APPLIES Floor Drams -$1.50
TOWNHOUSE & CONDO - RES. RATE APPUES Water Heater -$i 50
MINIMUM - RESiDENTIAL FEE - $12.00 Whirlpool - $3.00
MINIMUM - COMM/IND FEE -$20.00 Gas Piping Outlets -$1.50
STATE SURCHARGE PER PERMIT - .50 (MINIMUM - 1 PER PERMIT)
(ADD $.50 S/C IF PERMIT PRICE GOES _~_SoRener -$5.00
BEYOND $1,000.00) Well - $10.00
Private Disp. - $10.00
, Rough Openings - $1.50
SIGNATURE OF PERMITTEE FEE
STATE S/C:
FOR CITY OF EAGAN GRAND TOTAL•
~ _ . . . - ~
CITY OF EAGAN : ~ ~ -I
3830 Pilot Knab Road, P.O. Box 21-188, Eagan, MN 55121
PHONE:454-8100 -
BUILDING PERMIT Receipt ~F ~ ~ I ~I
To be used for SP Di~G/GAR Est Velue ;~,00~ Date 3GLY lt3 ~ g A8 i
5ite Address ~1 1/~RHONT AVE OFFICE USE ONLY ~3J~~ i,
t l 4 STAFI'ORU PI.ACt On 8Re SeweQe Occupancy
Lot Block Sec/Sub. MWCC 3ystem X Zoning
Parcel No. On Site Well
(Actual) Conat
P~~)~T1ER MiD~lE6T !f0lfL•'S Ct~ywater x (Allowable)
a Name
Z Address 3~02 CEUAi±VALL~ Dx PRV Required ~ of Stories
o ~:AGAN 054-0433 Booster Pump Length
CitX Phone i
Depth
o Ng~e SAMF: S.F. Total
O v Address Footprfnt S.F.
~ City Phone APPROVALS FEES
~ a Engr./ASSese. Permit ~ 4~4• ~
y~ W Name y~
~ 2 Planner Surcharge
~ ~ Address • 2~J , p~
= City Phone Council Plan Review t~
W I
~ BIdg.Ott. SAC.City t~•"~
I herqpy acknowledge that I have read thls applfcation nd state that the Variance SAC, MWCC g~•~
informetion ia correct and agree to compy vyith all ~licable State of Water Conn. 5~~ ~
Mlnne9ota Statutes and City o1 ~agaA Ordin~~lce~ 87
i~ ~ ~ f Water Meter ~
Signat,re of Permittee Road Unit 32
A~ulidin Permit is issued to: f RpNrI6H MIDG'ES'i' HOt!$S 2~~~
9 Treatment P1
on the express conditlon that all work shal I be done In accordance with all
applicab~e State of Minnesota Statutes and City oi Eagan Ordinances. Parks Q
Building Official , ' i~ TOTAL i
- - - » J
This reques~ voitl
18 ~nths from ~ V
E 28 382L~//~~
I Re st Da~ O. F~re N. pP~up een~lns =1inn E]RCaAy Now ~y,i~-N[TifY InsUec-
s ~NO ~m WhP~~ ReadV
<ensed ElecUiwl ConVactnr I M1ereby raquast inspaction ot abova
? Owner eleclrical wofk insAalled et:
Stree ddress Box or Route N. GtV ~
~
ec ~on o. TownshiP Name or No. anpe No. Counly
OccuVa~ IPR T) Phon No.
o l E s ~
Power $up e Address
EI~~aI.Gnr~{iy~:~_~[~py~y~~e) C<inirar.tor's License No.
N~~HI K LL R p
Mailing T4b4Un1t`LE1NNMe1'KakLnANB atioN
Author¢e ~gna ure on rac od0 a a ation) Phone Number
MINNESOTA STATE BOARD OF ELECTRICITV THIS INSPECTION FEQUEST WILL NOT
Griggs-Mitlway Bldg. - Raom N-191 BE ACCEPTED 8Y THE STATE BOAflD
1821 Universitv Ava.. SL Peul. MN 55104 UNLESS PFOPEN INSPECTION FEE IS
en....., ici..aeo.nann ENCLOSED
REQUEST FOR ELECTRICAL INSPECTION ~ qEB~-0/0001-06
, See instructions br camoleting tMis larm on Eeck ol vellow coov.
E 2 8 3 82 "X'" Below Wark Covered by 7his Request
DI"S TYPe of 9ui ltl,og Appliancea Wired Equiumet Wired
Home Range Temporary Service
Duplex Water Heater ApL 8uildinq Dry Commercial 81dy. mace Silu Unlonder
Industial BIAy. Air CondiLOner Bulk Milk Tank
Farm otner oeci v n1n~F (si3or.,fyl
t nr $ueciW Other OIM1Ur
pectian Fee Below
tl Fae ServmeEnvaneeSiza H Fee Fenders/5oblaedens b Fee Cv uits
0 to 200 Am s 0 to 30 Amps to 30 Am)s
Above 200 qmps 31 to 100 Amps 31 to 100 Am s
Swm~ming Pool Above 100_Amps Ahove 100_Amps
Transiormers Irngation Boonis Partial-'0 e
Signs Speciai Inspection $ TOT FyE€~.p
Aem~rks `J
/
Rough-in Dn~en the Elactrical
rv~-bdl ~
i' ~ Inspectoq nerony
F.nal On~e ~hfl~ ~he above
~nsvection has Eeen
G •fT,' mada.
fMS repuast voitl 18montM Irom
CITY OF EAGAN N_' 1 5 3 5 3
• 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
~ PHONE:454-8100
BUILDING PERMIT Receiptit
To be used tor RF DWG/CAR Est. Value $80, 000 Date JliLY 18 ,19 88
Site Address 4091 VERMONT AVE OFFICE USE ONLY R3/Ml
21 4 STAFFORD PLACE On Site Sewage _ Occuvancy
Lot Block Sec/Sub. MWCCSystem X Zoning R1
ParCel No. On Site Well (AcluapConst VR
Ciry Water X (Allowable) Vn
e Name FRONTIER MIDWEST HOMES
W Address 3902 CEDARVALE DR PRV Require0 u of Srories
o EAGAN Phone 454-0433 BoosterPUmp _ Length 44
City 48
Depth
¢ Name SAME S.F.7otai
0
oa Address FootprintS.F.
U
~ City Phone pppROVALS FEES
W w Engc/ASSess. Permit $ 494.0(
Name 40.0(
~ i Planner Surcharge
x- Address
aw City Phone Council PlanReview 247.0(
Bldg. OH SAC, Ciry 100.0(
I hereby acknowledge Ihat I have read Ihis apphcation nd state that ihe Variance SAC, MWCC 550.0(
informahon is correct antl agree to compy w~ih a~l licable State of Water Conn. SSODO
Minnesota Statutes antl City qWf ~aga Ordin c
Signature of Permiitee ~+r ~ Wa1er Meter 67.0C
Road Unit _32a~0C
A Building Permit is issued to FRONTIER MIDWEST HOMES Treatment P1 204.0(
oniheexpresscondition[hatallworkshallbedoneina cordancewithall
applicable State of Mnnesot tatutes and Ci1y of n Ordin nces. Parks
BwldingOflicial TOTAL ~2 577•Q(
~
1988 BIIILDING PERMIT APPLICATION - CITY OF EAGAN
SINGLE FAMILY DWELLINGS / s 3 S a
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SUAVEY, 1 SET OF ENERGY CALCULATIONS
NOTE: ADDRESSES FOR CORNER LOTS - CONTHACTOA/HOMEOWNER MUST DESIGNATE Wfi2CH ADDRESS
ZS DESIAED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PEAMIT IS ISSUED.
MULTIPLE DWELLINGS RENTAL QNITS FOR SALE UNITS U OF UNITS
INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SURVEY - CHECK WITH BLDG. DEPT.,
1 SET OF ENEAGY CALCULATIONS
COh4fERCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & S'fHUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS
S/F"~ D
To Be Used For: ~~U) (pq/Sr2UCValuation: 9-09-"') Date: 07~a'~g2f
Site Address 409 1 VF2nnanrr A?E. p~o 0o OFFICE USE ONLY
Lot 91 Hlock Li On site sewage_ Occupancy
MWCC system ? Zoning
Parcel/Su6 2;MFF02A On site well Actual Const b&
~ City water ?Allowable f/ii/
Owner ~RI~S-p}~N ~V+TR6,e/N.E PRV required _ U of stories
Booster Pump _ Length
Address 75aa' C'rc-~aX AVF. n(oF-r)4 Depth
5>4y S.F. Total
City/Zip Code 2GCKLyN Po evT NUkI Footprint S.F.
Phone 5Lo l- lgy APPROVALS FEES
Contractor Frontier MIdwest Homes Corp. Engr/Assess Permit 11,95,
Planner Surcharge 90
Address 3902 Cedarvale Drive Council Plan Review Z~
Bldg. Off. e~=t'I/IZ- SAC, City /DO
City/Zip Code Eagan, Minnesota 55122 Variance SAC, MWCC Sr,'o
Water Conn SS'o
Phone ~ 45LI -0433 Water Meter
Road Unit 3 zS'
Arch./Engr. Phillips Plan Service Treatment P1 2 6 y
Parks
Address 14530 Pennock Avenue Copies
TOT9L
City/Zip Code Apple Vallev. MN 55124
Phone II 432-2044
~Qi~~ { . .
(~Gr 2U,{,zz
a.
~SMT lI23 1,7
_ /~~SSs
i
1'z ~,~•yg ; a' ~99L
g ,s s
Hedlund Engineering Services 9201 EasiBloominQtonFreeway
Bloaminpton, Minnasota 55420
LanC Surveyors Clvll EnQinaars LanG Planners Phone: 889-0289
~ survRor,s G'ert~,f "e
JAWIZ 800K _ PAGE JOB N0. 8SR3b~
SURVEY FOR: Frontier ?'idwest i'.omes Corn.
OESCRIBED AS: Lot 21, Rlock zl, STn.FFOFD PLF•.Ct, Ci-y of Eaz2n, Ta.'-ota Count,y,
Plinnesota ?nd reserving easements of recor.d.
TOP OF FOUNDATION
GARAGE FLOOR
BASEMENT FLOOR zl ' `9 I I
SEWER SERVICE ELEV.
PROPOSED ELEVATIONS C
EXISTING ELEVATIONS : 391 aTIB.A
DRAINAGE DIRECTIONS j'~
DENOTES LOT CORNERS : o
DENOTES OFFSET STAKE: 0
7, 132.55
I AV E •
I ~ CZ \ Q o
~
v\ 64t.o gv.,
s4. =
W sl ~ z \ ,sy_.s
Q M5 R G1 p
LC I ? a .5~ '~y.- ,S+ /
\ O b 2 a
I L~
.
E DD
ti
N
I1VG DEP'd'. _
/ 1'V ~~ti 3 y
~..fA 4a A N
-P EVIEWEO ,
~'p ~ ~ ~ i ?
s S
CERTIFICATE OF SURVEY
I hercby certify that this survey,plan or report was prepared by me or unQ"y ireci
supervision ond fh(it I om o duly Reqistered Land Surveror under tha laws of the
Sfate of Minnesota.
= Oate:' /==/.3 1 j~
Jeffrgy &)dqren, Lice se No. 14376
EXT°_3IOR ENVELOPE AVERAGE "U" COMPiITATiOP1
OwNER: P-iGGS JoNnl HND C~A-Tlf~~//~E nnrr:_~~g-87 -
SITE ADDRESS: i-IOqI V,Ee-MON7- AVFNLLE PHor,E: 45y-ol133 T,2oN77,Ele,
CONTRACTOR: F2DNTIsYL
Determine working square footage of each
1. Total exposed wall area..... ~26?Y9. s sq. ft. x.11 = a~
2. Total roof/ceiling area..... '5a. ft. X.026 = 3!•3
Total exposed wall area above floor=_ rg(aI
a. Total wall window area /44
b. Tota1 door area zz 7
c. Total sliding glass door area dp
d. Total fireplace wall area
e. TotaT wall framing area (average 10;:) 1 Q(o,l
f. Total rim joist area
g. net wall area a6ove floor /G53.
h. wall area a5ove floor
i. wall area a6ove floor
j. frame wall area ar foundation
Total exposed foundation area= % •s •
. . . .
k. Total foundation window area -
l. Total net foundation area above grade r7G, 5--
Determine "u" value of each wall segment
(e.g. window, door, each separate wail section)
a. 144 x "ull .4S = (a4.8
b. 3'7 x ,1 U,, .45, C. 40 x 'lu„ , 45 = r8
d. X "U" _
e. /~!o• 1 xIV. , 09 = ll0.7
f. ~sa X ,.ul. . o¢ = ~
9. 14-53.9 x~-v. odr = SS.I
h. X "U" _
i X "U., ,
j. X llul. _
If item I-Q is th
k. ~ X "U" = as, or less thangi
rl, you have met t
1. 76.<p X"U" Og = 6, ~ intent of SBC 600E
3 . .................................Total = ~o, 3
c w~L?c ttveraye u wmpucsUwn
Total exoosed roof/ceilinq a=ea
m. Tbtal skyliqht area
Total roo`/ce±2in, :ramir.q area (1VCLIIgC lOB)...
o. Tote1 net insulatcd roof/ccilinq area........... -
Determine "U" value for each roof/ceiling seqraent
M. X "U" _
n. Ja,0.4 x 'lull .0~' = 0~•8
o. X "U-- .az = Al• 6
4 Tbta1 'f to*_al c` ;4 is the sama as, or less than R2, you have met tne inteni o:
SAC;' 5005 ;rl 1. Alter.^.ate Buildina Envelone Desiga
1b etiliz2 the total eacelope system method, tne values established 5y tne s~^ o`
items U z.d ;;4 sha11 not be greater than the sum of items n1 a.d n2.
1. + 2.
3. 1 ~~•3 + 4. Al- 4 = a~o•'?
~
PLchQ iir WCOD2IDUr=
~ LwE4 L FT, ECpos~D WALL
$LOGft ; a~t~+as+~-+~+~ot~+zo= /53 ~
44 +a5+-14~- W _ Ia9
~:ULL ( ' ~~o.t44+a~t~4+f~tio+b~-ao =lsa.
~
TZ 1 M= ~ sa- ~ SGZ , ~T, S1tpO5ED WA LL. Ar-EA
t3Lock', i53 x , S = • ~
~.t1 EE /a9 x
W. 0.; X 8 = i~~ ~
~PuLL 1 X. 8
FuL.LZ% k S = , ~ _
sa x I = isa.
TotP~L
. :
EKpoSr,-D GEILIIJq
~a6 X44~ t{~ ~-~o) = 1144t
~ wDk&lS 11 0 DooQ.s ~
a, 43to -Tr+ i i l - 48 3°- I Z.o
ao 3~ -n+, - A4 ag- I «
,A448 - Tt+~-1 _ 24 . 3'1 1
~ ¦ Ii~cTlo. DRS , II
. 444 -q.o `
~ F35 M4 U L) i+5 ~1
E' U'n J St of (10110n +u11 nrca for
rcn~~~lic: i.,n r._11.11,,.:
~ fr:srr: cumstzuct lun r
. , . . - • , ::<r
~z i 1).: i k. . i ~
a. i4,C~Z.6flY.[z. - • - Z.o` , `,;'e
~
, x.- s. S~o.ia~........ : . ..~iZ
~ aiC G. F:r.lcri.:r a1i' (ilm ~ o.l7
~ ~ .:•:~:k:
4I.L - . . •.r~~i~~1 ~n ~O. 8$ :.`ta
. V z.
ric. 11 TG['VI61I OF
FIW1E IiAL 1. iutrrtnt•ai~' :{Ir.i q.f•i0
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,
APFLIC~ATION FOR PERMIT iNMT: pp'U12M OF FEE AT TIME OF
. : AeeLicraTTau ooes naT coN- ;
STI1Ll1E liPPA('iJAL OF PIIiFIIT.
SEWER AND/OR WATER CONNECTIQN ; INsPECTION oesEWER rND/oawaTea ~
r ; xtasrnc[.aiors wua, rxtr ae scEYl[.m ;
~ ' • y UNl'IL PE7iMT }Vt5 BEEN APPROVm. '
~
dty oF ecciocan
(PLEASE PRINT ,
1) PROPII2TY ADDRFSS: 4ORI yEeN101YT AV~NL(,E
T.FY:AT DFSCRIPTZON: (.GT (9,) -6L(7CK tI aS\TA-FFOkZ C.A-CF-
Lot Block S ivision or Tax Parcel ID )
IF EXISTING STRCCTURE, DATE OF ORIGINAL BUILDING PEPMT ISSLANCE:
Nont Year
PRESENT ZONING/PROPOSID LSE:
Q CONAIEE2CIAL/RETAIL/OFFICE ITi R-1 SINGLE FANLiLY
a INDLSTRIAL F----]R-2 DLPLEX (34ro [Jnits)
Q INSTI4VTIONAL/GOVEE2PIMENT Q R-3 TOWNHODSE (Three + Onits) ( Units)
Q R-4 APARTN]ENT/CONDOMINIOM ( Units)
z) ~ NAME: FP_oNrlr P_ (1t1i0l,L)ESr -fbMES CoP-P09,47-1014
ADnREss: 3qoa CEt)apvAL,F ~r~.lqr>
crTY, STATE, zrP: E ZAtJ ~ N\N 551a'a-
PxoNE: y5~1-QU33
For City Use
3) S'f Ap- kLmf-'I N G P1umUers License:
ADDRESS: ~~IS lV10tAND al21N63 TE.fk9RG,E Active
Expired
czTY, STATE, zrP: `_8LoOMuA~67DN, MN 55L1Qa Not recorded
PHONE: -d-I y9 MASTII2 LICENSE #~3aq St I~~
4) ~ ~
NrrE: GelGGs.; okN RND 0_AT7-l,5R1n1E
ADDRESS: '7508 COLFHX AVENUF 1\10277-1
CITY, STATE. 2IP: _ZfeCpK-~_~N P/QQ~~, N\N SStI
PHONE: ~-~`b/ - I ~S y 2-
5) s ~ •Z r .i URA
~ CONNECTION TO CITY SEWEF2 m CONNECTION TO CITY WATER D 0'PHII2
6) ~T~1 ~ p~ia/38"
titt#s#**k**:ti:t#frirk*s* *****;t*###:k:trtkki#*#rt*:tirir**f*t:Fk*i*tr***#*Y:Fir*#i*iiFirir*#:Frt#**:F***i**rtiF*yr****ir*k+i
* y
* THE GOID COPY OF 'I"E PII2MIT WILL BE SENI' DIRfX`PLY 'PO PUBL,IC WORKS 10 FACILITATE METER PICK-IIP.
*k PLEASE ALTAW 'IWO WORKING DAYS FOR PROCESSING. SOMEONE FROM TfM: CITY WILL CONi'ACP YOL IF TI-IEf2E ~
* ARE ANY PROBLEMS. *
~*.***~**~****++*+*****~~~+r*,r~+*~*+*~***+~****+~~~***********~~******~**+***:*~**~******+**w***:~*,
FOR CITY USE ONLY ~ PERMIT # ZSSUED •
Pd w/Bldg. Permit FEES:
$ 16 -,5-7) $ SEWER PERMIT (INCLUDE SLRCHARGE)
$ $ WATER PERMIT (INCLUDE SURCHARGE )
$ WATER METER/COPPERHORN/OC'TSIDE READER
$ $ WATER TAP (INCLCDE CORPORATION STOP)
$ $ SEWER TAP
$ l$ ACCOUNT DEPOSIT - SEWER
$ $ ACCOUNT DEPOSIT - WATER
$ D• Uz) $ wAc
$ (~50• 6r-D $ sac
$ $ TRUNK WATER ASSESSMENT
$ $ TRC'NK SEWER ASSESSMENT
$ $ LATERAL BENEFIT/TRUNK SEWER
$ $ LATERAL BENEFIT/TRUNK WATER
$ O $ WATER TREATMENT PLANT SURCHARGE
$ $ OTHER:
$ Z 2 U--D $ TOTAL
- 5' S-
RECEIPT RECEIPT
DOES CTILITY CONNECTION REQUSRE EXCAVATION IN PDBLIC RIGHT OF WAY?
r-I YES IF YES, THEN A"PERMIT FOR WORK WITHIN PUBLIC
ROADWAY" MUST BE ISSUED BY THE ENGINEERING
El NO DIVISION. LIST AS A CONDITION.
SUBJECT TO THE FOLLOWING CONDITIONS:
APPROVED BY:
TITLE:
DATE : y f ' /,P~p
`t7.~P 3I3!/~~' IAVho% House Worksheet
Cuetomai'sName r/~uh1-Ji~ r /11/,]~,uFCT qddreee J7Uctl Si~Lt~ /'I')SMaOP"LIC yGV~.
City F~511s~1 State ZiP SS/da TelephoneNumber VSy- Oy33
WINTEH:Inside DssipnTemp 7S °F-OutsideDasipnTSmp ~~aCU °F~HestinpTampDlffennce -FS °F
SUMMEfl: Ouuida Desipn Tamp F-Ineide Desipn Temp °F . Coolinp Tamp Differenca Ch.) °F
IiEATlNp COMMONDATASECTION~'-• COOLINO~--BTUN iOSB MEATINO . f : r'.' .'v~ • 'Y•i , •
F~CTOF 11C10N lTUNOAIN
GROSSWALL !7-
3S DOORS&W
INDOWSITableAorBl ~`~U NET WALL S(p 3
CEILING
FLAORS O -
INAw~on T~iW D
~lume Polume / C Inf4man
elwn_ % 10 X t.l/gp X
r~ x ~/eo x GTx r~w0od~ e im
I
3~S - I•c~ xo.iea33 X 301 3011 x o.oiss3 x~u x.~ = 3~SS
5 SUB-TOTAL BTUH LOSS (per 10°f)
x ADJUSTMENT FACTOR (Table C)
SFfC~ TOTAL BTUH LASS
PEOPL x300BTUHGAIN
pxae,oan~
APPLIANCES BTUH 7200
SUB-TOTAL BTUH GAIN (room sonsihle only) S 01
¦ DUCT, LASS/GAIN FACTOR ITabla FI x
SUO=lOTAL BTUH ISensibla Gninl
MOISTURE REMOVAI (suh total ¦ 1.3) x 1.3
S TOTAL BTUH LOSS/GAIN LIPO 0
TABL A- HEATING -DOORS& WOOU FHAME WINDOWS TABLE B- COOLING - DOORS 6 WINDOWS 70
IPER70°FI FaC[ore assume windowshaveinside shad~n
Pene9 Or venalian
Fur slidmy ylaas doors. use lactors br [he same t 8 b Y dra
ype window hlinds and sliding glass dooro ara vaated as windows.
Cons[ruction
Window6 wwuauaa eouwau46 nhwouu
Framea
DoorT es yy T~ jj xAroB eBtuhLoss rerroin TFMI.OIfE TlMI.DPf aA,.. .aruwo.1n
ingle Pana
Claar 9.90 10.46 11.65 o...,a„ n• m• m• w m~ m• ~N n• r
M ~q n
u ~a u n u u
Wnh Storm 4.7 15.251 6 a ~
DoublePane 'n .1 r fl"n x a n s ,
Cleai 5.51 5 0?•:.7.?G . O G i /
Wnh Storm ,41 3.65 4.90 SEbSW 1410 u a"u u a r x
Triple Pene -
Clear 3.80 4.39 5.48, s a n s a a n ia
Jalous~a - urwnv Iw im ire Ia W ia Ia Ios in
Sinple
MUa'I~: l~ IOY 10] l 101 ]l U 109113 S
$mglew/smrm - - 5.0' rrm•v o.~ ~.6 p~ 36 46 H 16 .6 6•
SkyliphtsSinyle 11.07 17.69 12.92 . QQ F«v.auaaeon.m TOTALS ~
VoIY~hTen~ co~~ melal tlooi~
DouUle
Door 6.65 7.35 8.75 U
Wood On1y 460 - - TABLE D- INFILTRATION MUITIPLIERS
Wood w/siorm 3.20 - - Wintar Air Changas Por Hour
UrethaneCore RFborAraa 900 ar yyc 900.7500 15ppy7pp a,~plipp
1.
Urelhane Core Bes[ 0.4 0.4 0.3 0.3
IR-51 w/slorm - - 1.70 Avnrege 1.2 ~ 1.0 0.8 OJ
, TOTALS 12y,9 /35 r P°or 2.2 7.6 1.2 1.0
Foreach flnpbceedd: Bpt qwnpe Ppur
0.1 02 0.6
Summer Air Chengaa Par Hour
TABLE C-ADJUSTMENT fACTORS - IHEATINGI F~AM ~01~ 16004100 owr2100
F. lemperaiu~e DiH. ~ qp 5p ~ 5p 70 8p y~ BBst 0.2 0.2 0.1 0.2
M;uament Factor 3 4 5 6 7 8 9 Average 0'5
_ _ 10.5 04 ftor I 0.8 - OJ 0.6 0.5
r Am~rw;ir. Si~nd'utd Inr 1986 Pub. No.22-8018-4 P 1 I0
. ' RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EACAN
3 Z 3830 PILOT KNOB RD, EAGAN MN 55122 /o.')~' S
651•681•4675
New Conetruction fteauiremenU RemodeVReoair Reuuirements
• 7 r?gisteren sile surveys showmg sq. 9. ol'ci. ;q 9. of house; and all roofetl areas . 2 xpies of plan
(20°o maximum lot wverage allowed) . I sel of Energy Calculatrons tor heated atl0itians
• 2 mcies of plan showmg heam 3 wmaow srz^s, poured (ound desgn, ztc I • I srte survey lor eztenor addilions 8 Oecks
• t szt of Energy Calculations . Indiwte d home served ay septic syslem for additions
• 3 copies of Tree Preservation Pian if lot platted aRer 7!1/93
• Rim Joat Oelad OpGOns selectwn sheet (Cldgs vnth 3 or less umfs)
DATE `"l-A4 'dZ VALUATION A
~
S~ITE~ ADD~~ S ~/J~~ 1~AT i/P MULTI-FAMILY BLDG XY N
TYPF WOR~f jllp FIREPLACE(5) A 0_ 1_ 2
APPLICANT rTl2G . I/L^
STREETADDRESS Zagl?-7 /~LY~1129~A//ze4>~ CITYBE(176 _p~_STATE." ZIP5~~
TELEPHONE #%TR 7DZ6949 CELL PHONE 1 FAX #
PROPERTY OWNER Pai ¢ZJ .fu l7a~C~ TELEPHONE
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ \(I\ Vt;ti(YI'A R[iLL•'S 7670 C:\"1'L?GORY f N(I\'\L•:SO"f:\ RCL1;5 7672
(d submission type) . Residential Ventilation Category 1`NOrksheet SubmitteC . New Energy Code Worksheet Submitted
• Energy Envelope Calculations Submittetl
Plumbing Contracfor: Phonc R
Plumbing sr'stem includes: _ Water SoRencr _ L.a«ri Sprinkler rSEP ~.00 ~Vater Hcater No. of R.I. }3aths - ~52002
No. of I3aUis ~
Mechanical Coniractor: Phone N
Mcclcinical ~c~tcnt includc:: Air Condiuuning BY-Fcc:
HcalL Rccoeciv S~:sicm
Sewer/Water Contractor: Phone #
I hereoy acknowledge that I have read fhis application, stafe thaf the information is correct, and agree to comply
with oll applicable State of Minnesota Statutes and City of Eagan Ordinance .
SlgnatureofAppUcanf
OFFICE USE ONI,Y
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Uptlated d102
OFFICE USE ONLY
? 01 Foundation ? 07 OS-plex ? 73 16-plex ? 20 Pool ? 30 Accessory 81dg
? 02 SF Dwelling ? 08 06-plex O 16 Fireplace ? 27 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 0 1 of _ plex 0 09 07-plex ? 17 Garage ? 22 Porch/Adtln. (4-sea.) ? 33 Ezt. Alt - SF
? Oa 02-plex ? 10 08-plex ? 78 Deck ? 23 Porch (screened) ? 36 Multi
? OS 03•plex ? 11 10-plex ? 19 lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plez Plbg_Y or _ N ? 25 Miscellaneous
? 31 New ? 35 Int Improvement ? 38 Demolish (Inlerior) ? 43 Siding
? 32 Addition 0 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)' ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement 'Demolition (Entire Bldg only) - Give PCA handout to applicant
Valuation Occupancy MC/ES System
Census Code Zoning Ciry Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footings (new, hldg) _ FinaUC.O.
_ Footin~s (deck) _ FinalNo C.O.
_ Foo[ings (addition) _ Plumbing
Foundation H V AC
Drain Tile Other
Roaf _ Ice & Narer _ Final _ Pool _ Ftes _?.iriGas Tasts _ Final
_ Framing _ Siding Smcco _ 5[one
_ Fireplace _ R.I. _ Air Test _ Final _ Windows (new/replacemznt)
_ lnsulation _ Retaining Wall
P,pproved By , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Wa[er Supply & Storage
S&W Permit 8 Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
RESIDENTIAL
BUILDING PERMIT APPLICATION
cp
~ I.
3830 PILOT K OB RD, EAGAN MN 55122
651-687-4675 i
New Conetructlon Reaulrements pemafeVNeoeh Reaulrementn
• 3 regislered sMe surveys showing sQ. ft ol bt, sq. fl. of house; and II roofed areas • 2 copies ot plan
(20%maximumbicoveragealbwed) • lselotEnergyCalculatbnslorheatedaUdAbns
• 2 copies of plan showing heam 8 win0ow sizes; poured found design, elc.) • 1 sAe survey lor exterior additbns & decks
. 1 set ot Energy Calculatbns • Indicate it home served by septic system bredd'Abns
• 3 copies of Tree Preservation Plan A lot platted alter 711193
. Rim,bi51 Detail Optqns seleClWn sh2Bt (bitlgs wrth 3 or IeSS unit5)
~
DATE _ I D' I'UZ VALUATION -~I G~~ Ov
SITE ADDRESS ~174I I-11fJP),j AUiQ_ MULTI-FAMILY BLDG _ Y N
NPE OF WORKd- Wi a'~ifnl5 FIREPLACE(S) X 0_ 1_ 2
APPLICANT
21P 5~33 7
STREET ADDRESS =17 CIN&"V~1~ STATE/ni"
TELEPHONE # 90 ~'07-T6959 CELL PHONE # FAX #126;~n 0~0k
PROPERTY OWNER vCC21 CV? TELEPHONE #k5I- 1!16 (L 0Su(
COMPLETE THIS SECTION FOR ••NEW- RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNESOTA RULES 7670 CATEGORY 1 MINNESOTA RULES 7672
submission type) . Residential Ventilation Catagory 1 WoAcsheet Submitted • New Energy Code Worksheet Submitted
• Energy Envalope Calculations Submitted
Plumbing Conhactor: Phone #
Plumbing system includes: _ Water Softener Lawn Sprinkler Fee: $90!00-
Water Heater No. of R.I. Baths
_ No. of Baths ~ ~~T : 2002 I L I
v
Mechanlcal Conhactor: Phone k
Mechanical system includes: _ Air Conditioning - Fee: $70:00 -
_ Heat Recovery System
Sewer/Water Conhactor: Phone #
I hereby acknowledge that I have read this application, state ihaT the fnformation is correct, and agree To comply
wlth all applicable State of Minnesota Statutes and City of Eagan O inances.
Signature of ApplicaM x"w'
OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4102
OFFICE USE ONLY
? 01 Foundation ? 07 OSplex ? 13 16plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3sea.) ? 31 Ext. Alt - Multi
? 03 01 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
? 05 03plex ? 11 10-plex ? 19 Lower Level ? 24 Stortn 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 (FOUndalion) ? 45 Fire Repair
? 33 Alleration ? 37 Demolish (Bldg)' ? 43 Reroof ? 46 Windows/DOOrs
? 34 Replacement `Demolition (EMire Bldg only) - Give PCA handout to applicaM
Valuation Occupancy MC/ES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const W idth
REQUIRED INSPECTIONS
_ Footings (new bldg) _ FinaUC.O.
_ Footings (deck) _ FinaVNo C.O.
_ Footings (addition) _ Plumbing
Foundation HVAC
Drain Tile Other
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ AidGas Tests _ Final
_ Framing _ Siding Stucco Stone
_ Fireplace _ R.I. _ Air Test _ Final _ Windows (new/replacement)
Insulation _ Retaining Wall Approved By , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Suppty & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
~ RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
J 3830 PILOT KNOB RD, EAGAN MN 55122 >
651-681-4675
New Construction Reauirementa RemodeVReoair Reauiremenla
• 1 registered sita surveys showing sq. ft. of IoL sq. ft. of house; and ail roofed areas • 2 copies of plan
(20°b maximum lol coverage allowed) . 1 set of Energy Calculatlons Mr heated addilions
• 2 copies of plan 5howing beam 8 window sizes, poured found desgn, etc.) . 1 site survey for eztenor additions & decks
• 1 set of Energy Calculatbns . Indicate if home served 6y sep[ic system for additions
• 3 copies of Tree Preservation Plan d lot platted aRer 7l1193
• Rim Joist Detail Options selection sheet (bidgs with 3 or less units)
DATE 1J~I~ Da' VALUATION
SITEADDRESS 1111-(/11plJf"~//2 MULTI-FAMILYBLDG _ Y /Z N
TYPE OF WORK~ ~XtS FIREPLACE(S) X 0_ 1_ 2
APPUCANT jZ/~
SiREETADDRESS/~n~VzIfOt CITY,kMtQ6k!iA- STATEJf~,/j~ZiPI-~;Z
TELEPHONE # 95~ 7f/7~L9Sz7 CELL PHONE # Fa,x -9' 9H6
PROPERTYOWNER T"LYf' raZl iELEPHONE#4V_499-,?
COMPLETE FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ yIIYNESO"fA RULF,S 7670 CATEGORY 1 MItiNI;SO"1';1 RULGS 7672
(d submission type) . Residential Venlilation Category 1 Worksheet Su6mitted . New Energy Code Worksheet Submitted
• Energy Envelope Calculations Submitted
Plumbing Contractor: Phonc
Plumbing systcm includes: Wa[er Softener I.awn Sprinklcr Fee: $90.00
Water Heater 1\ro. oF R.I. Baths
No. of Batlis
Mechanical Contractor: Phone #
Vlcchanical systcm includcs: _ Air Conditioning Pcc: $70.00
I-Ical Rccovcry Systcm
Sewer/Water Contractor. Phone D~ 2 f~
C l.D'- ~a
NOV 1 y 2~02
I hereby acknowledge that I have read this application, state that the information ~ rrect, and agree te_ i mply
with all applicable State of Minnesota Statutes and City of Eagan Ordinances. ( ~
Signafure of Applicanf ~t!i~~I ~v"-/ ~
'------------------f-
OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4I02
OFFICE USE ONLY ~
? Ot Foundatlon ? 07 05-plex ? 13 76-plex ? 20 Pool ? 30 Accessory Bldg
O 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) 0 31 Ext. Alt - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 PorchlAddn. (4-sea.) 0 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screened) ? 36 Multi
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex O 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
? 31 New ? 35 Int Improvement ? 38 Demotish (fnterior) ? 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (FOUndation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)" ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement `DemoliNon (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 Const Width
REQtIIRED INSPECTIONS
_ Footings (new bldg) _ FinaVC.O.
_ Footings (deck) FinaUNo C.O.
_ Fooangs (addition) _ Plumbing
Foundation HVAC
Drain Tile Other
Roof _ Ice & Warer _ Final _ Pool _ Ftgs _ Air/Gas Tests _ Final
_ Framing _ Siding Stucco Srone
_ Fireplace _ R.I. _ Air Test _ Final _ Windows (new/replacement)
_ [nsula[ion _ Retaming Wall
Approved By , Building Inspectar
Base Fee
Surcharge
Plan Review
MClES SAC
City SAC
Water Supply 8 Storage t•
S&W Permit & Surcharge'
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