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4444 Slater RdCity of Eaall 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BLUE or BLACK Ink r For Office Use -2,1t20 Permit #: 1 Permit Fee: 1 b` Date Received: Staff: 2014 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Lt -1---V (L( Site Address: 1 C% Unit #: Resident/ Owner Type of Work Contractor Name: Address / City / Zip: Applicant is: Owner Description of work: RA -C., Construction Cost: Phone:CS [ 7q6 -1)1-7 Contractor Multi -Family Building: (Yes / No ) Company: , C C\ C (r jontact: Y v G• -in ` �� J City 6� �5 Address: �,,Q l � I �1 �,�N� S � State] J Zip: 5S c, Cr? Phone: �r `-- J 5 License #: a�� �L Lead Certificate #: Z -1S` (1j - %T1 If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? Yes _No If yes, date and address of master plan: Licensed Plumber: Mechanical Contractor: Sewer & Water Contractor: Phone: Phone: Phone: NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that they are trade secrets. 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.gopherstateonecall.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. Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 days of permit issuance. Applicant's Printed pamVt-tACkt-(.1 x Applica ignature Page 1 of 3 cmr c^ EA<iAN SEWER SERVICE PERMIT J79'~ 'Ntot K*ob Roea PERMIT NO.: Eadon, MN 55122 DATE: Zaninp• No. of Units. • .1ex Ownur: 7F.CsI`-vn ti0uie9 I.ic /lddress: $itt AddlESS: 4li4fl ,71a.~'i@2' 1.6 ) C !1i1.~.rC,; ii' Plumber. 100.00 i~.. 1 ym M eeniply wkb 11w Ciryr of Ee"s Connettion Chorye: 425 O?alnenea. Accaunt Deposif: Permit Fee: Surrharpe: By Mtsc. Chorom Dote of Insp.: Total: I nsp.: Qoir Paid: CITY OF EAGAN 3830 Ailot Knob Road MrATER SERVICE PER1MlIT j P. O. Box 21199 PERMIT NO.: 4883 ~ Fagan, MN 55121 DI~TE: 7 13 83 ' ~ 2onirg' R2 No. of uP ex ~ i QNr~r; ZBC~II Hq1LGi Units: I ~ IIIC Address: ! ~ Sica Address: 444 Slater Road, B3 Cinnemaa Rtdge 3 ~ Plumber. 7 ; hheter No.: Connection Charfle: S. 0 pd : 51ze: Account DePosft: j i Reader No.: Permit Fee: Z4 -QQ ~d I ~on'" to oemPFp wille 11e Ci1y of Eagon Surcharge: . 50 d ~ I ~ o.dis.no«. Mtac. Charges: U. DO pd meter i i ' By Toful: ~ Dote of lnsp.: Doft Poid: Infp.: - - - I SEVUER SERVICE PERMIT ~ CITIf pF UdAN : PERMIT NO.: 3795 PY•of Kneb Rea ieoes, DATE: MN 55122 No. of Units: Zoninp: Owner: 7 Addrcss: 4 1+ Jl~ ° s. ~ 2 Site /?ddress: ~ , _ 0.00 pci Plumber. 5 . ~ton Charpe• OQ 1e/rN h oom't~? wteh ~~°f ~O~°a Accour~t DePoet: . pedleenan. permit Fee: Surchar0e: ` Miac. CharOes: gy Totol: Dote of Insp.: ~e Pab: Insp.: aTY or encAN VYATER SERVICE PERMIT ~ 383u'oot Knob Road P. C.ux 21199 PERMIT NQ: Eagun, MN 55121 DATE: aupiez 2~ing; No. of Units: Owner: 'l.fl.Chm8n HC7tei ZIIC Addrcss: 5ita Addross: 444 slater Road, L B3 Cianamon Ridge 3rd. Plumber: WestoIIkB I Meter No.: Connection Charye: 450.00 pd i S{ze: Acoount Oeposit: ~ Reader No.: Pertnit Fee: t0. Qa Dd ~ 1 yree fo aorsply wilh !Iw Citp d Eeoaw Surthorfle: 60.00 pd mEtCT ~ p„alMnces, Misc. Choroes: I Totol: + gy Dnte Poid: i Dote of Insp.: InaR: II I ~ - - _ , CI1Y Of EAGAN , 3793 PIIM Kwey Rood Easen, MN S5122 IF;~ ' PHONEs 434-8100 dU1LDING PERMIT Reujpt ~ Tio wed fa ]/2 DUPLE% & W Est. Vclue $34.000 Date T,n 1 Stte llddrcss 4444 Slater i2oad (Unit B) Erw ~ pccupancy _ R-3 Lot __6Biock _3^ Sac/Sub,Cinnaaon RidQe 3rd AIter ? Zontny (Pll) R-2 Porcel # 10 17402 060 03 Repair ? Fire Zone IdA Enlarya p Typa of Const. V W Na,,,, 7.ac1_unan.Iiomes, Inc. MovQ ~ /~ddress 7760 "S1tChe11 RoBd pemli~ Q ~n~hte24 Ci Eden Pr.airie pha,e 937-9520 Grode ? Depth-A6L-Sq, Ft. ac Naffie `,)Wner ApProrols ftes v Addross ' Assessment Permit _ 211.00 C~ Water 3 Sew. Surcherflt 17 .Ot! Police Plon check 105.5G ~Z Nome Firo SAC ?25.00 u~ ~ress En0• Water ConnL 5n nn <W Ci p{~pe Plonner Water Meter ~Q , Qt} CcunNf Road Unit 2,50.00 I hercby ocknowledge thot I hove rood this opplicotion ond stote that g~~ Off, rhe information is cor?ect ond Qyree to comply with oll applicoble Stete of Minnespto Stotutes and Ciry of Eogon Ordinances. APC Totol T1 1 8.SQ Siynoture of Psrmittee Zachman liomea; Inc . /1 Buildinp PeRnit is issued to: on tM express conditlon that oll work zholl be dons in ocaordonce wlth oppiiwbly'$tate of i.~we~ote Stotutes ond City of E~on Ordinonces. Buiidirq Official ' - ~;"r Prrmit No. PKmit Holder Misc. Pe?mit No. HoMer PwmUn, 3u 31 6fhZ -7- -v-$3 H.v.aa o~. s.w.? ebeftk e 4 ro&E ~LLC~ ~-3-$3 inw.ceion ww insp. oen.. Foutlnyt Foundrtia+ Frominp Rou~h Plba r I RougAh HVA IMUlttian Firnl Plbs -7 Final HVAC Final w Wabr Dheri6o Loation: - 7/1, P?. Disp. ~ Reoaipt MECHANICAL PERMIT Parmit No. CITY OF EAGAN ; Fse ~ Fill !n numaered spaces S/C Type or Pr)nt Jeglbly Tot. ~ - 1. Date 2. Installation Cost 3. Job Address 4y'yy J~11~-•~+~Lot Blk. ~ Tract r 4. Owner RAY N. WELTER HEATING CO. 5. Contractor &one s. Address Minneapolis, MN 55407-3592 7. City State Zip 8. Building Type: Residential 2-- Commercial ? Institutional ? 9. Work Description: New a" Add ? Alter O Repair ? ~ r•j~ / ~ l ; , 10. Describe t~'S C lGac•~ !J /~n[ FueI Type 11. No. E_quipmenc BTU - M. Ea. No. Eauiament CFM Forced Air )1~~ Air Handling: Mfg. Boilers Mech. Exhaust Mfg. Unit Heater Mfg, Other Air Cond. Mfg, Gas, P'iping Outlets 12. I hereby oenify that tpe above information is true and correct, and I agree to comply with all or ances a s verniryg this type of work. Signed: ` ` ~ . : • for ~ Rough , Finel Inspections: Date Insp. Date Insp. This is you? permit when numbered and approved. Approved CITY OF EAGAN 464-8100 Repeipt PLUMGING PERMIT Permit No.,' I „ CITY OF EAGAN ~ Fee ~ Fill in numbered s,vaces S/C ; Type or Print legiblY Tot. _ i I 1. Date 2. installation Cost • ; _ ~ Cti ; 3. Job Address Lot ~J Blk. 3 Tract 1 r c1 ~ 4. Owner ~ ~ •_;.a-~/ ~ , 5. Contractor Phone _ 6. Address 1 7. City , 1 /'K .•v ' - State Zip ~t. i 8. Building Type: Residential~ Commercial O Institutional 11 ~i 9. Work Description: Ne*Cl Add 0 Alter ? Repair ? ~ 10. Describe ~ 11. No. Fixtures No. Fixtures ~ ~ Water Closet Cesspool/Drainfield ~ Bath tubs ~ f Septic Tank I i -7_ Lavatory Softner ~ Shower Wel l i Kitchen Sink ~ Urinal/Bidet pther ~ ~ LaundrY Tray ~ ~ Floor Drains i Drinking Ftn. ' 51op Sink ~ Gas Piping Outlets 12. I hereby certify that the above in rmation is true and correct, and I agree to ~ comply with all ordinanM anddes governing this type of work. Signed : -11 for ~ -~Rough final i Inspections: Date Insp. Date Insp. j This is your permit when numbered and approved. ? Approved CITY OF EAGAN 454$700 ~ ' cirr aF Z?owN (s asss rae~ K~ R«a 1090P, Mr+ 551u c~ ~j' ~ • 1 ?HOrus 454-8100 SUILDING PERMfT _ aeuio 2(( _ To Mwed h. 1/2 DUPLEX b GAR Est. Volue $47,000 Date June 1 19-al- Sit. Addrcu 4446 Slater Road (Unit A) E~ ~ ~~pancy R-3 :'Lot 6- Bicck _3 „ Sac/Sub.Cicnamoa Ridge 3rd Alter ? Zaning (PD) R-2 parcel # ln 17402 060 03 Repolr ? Fire Zone NA Enlorqe ? Type of Const. V W Nary,e Zachman Fiomes, Inc. Mow ? aqt 5rories ~ Addron 7760 *iitchell Road pemolish ? Length24._ Ci Eden Prairie pF„e 937-9520 Grode O Depth--42_.Sq. Ft. ~ Name Owner AVVrovols F•es ~t Addreu Assessment Permit 269.50 Water 3 Sew. SurcFwrga 23.50 PhOtQ 134.75 Police Plon check GW Name Fln SAC 525.00 /1ddrom Erp. Water Conn 450. OQ ~ W ci phor,e Plonnsr Water Meter 60. 00 Courxll Road Unit 250s00 I hereby ackrawiedpa thot 1 how rcad this applicotion ond stote that Bldp. Off. tibe intormotion is Correct ond agree to tomply with oll opplicable A~ T~a~ $1712.75 Stote of Minnesata Statutes and City of Eoqan Ordinonces. ~ $ipnofun of Pertnlttae A Bullding Permit Is issued to: ZaChman on the exprcss condition tlx» oll work sholl be done in accordanu with oll oppl ble Stote of iJn± c?.+?Lfts ond Gty of Eoqan Ordinonces. 8uilding Offidal 1~-! Permit No. Permit Holdar Mise. Psrmit No. Holdsr Piumbirq 3a CE112 n 7-27 13 Kvi?.r- 3~ ~ 7-4-g3 W.ll wac.. Disp. S~w~r Ehctric 1~J0(p~~02 PoolE lt(E<• -3-$3 Inspeetion Oah Inup. Othtr Footinyt J Foundatioti Fnminq fir, Rouoh PIb4 0'I , , rr ( • Rough HVA Insubtion ~ I Find PIb4 Final HVAC Finat Wa"r Dacribe Location: " YIINI " Sowmr • . Pr. Dhp. 1 Receipt i r MECHANICAL PERMIT Permit No. -7 ; CITY OF EAGAN Fim a~ • fill rn numbened waces S/C i Type or Prlnt JegiWy Tot. 1. Date 71er A"3 2. InstallatiQn Cost / I I a ( L f 1 3. Job Address 4i'`ir': .~•~i 1,~~- ~~1Lot ' l uf B Ik. ~ Tract oj'' L! 4. Owner ~AY N.'. WEL'T~ER HEATING CO. 4637 Chicago Ave. So. 5. Contractor Minneapolis, MN 55407 6. Addreu 825-6867 7. City State Zip 8. Building Type: Residential t~ Commercial ? Institutional O 9. Work Description: New L7 Add ? Alter O Repair ? ~ ~ 10. Describe Z/tll iiAt 4)IA '/L,/juel TYPe /o i6~lj 11. No. Equipment 8TU - M. Ea. No. Eauiament CFM Forced Air Air Handling: ~ Mfg. ~ Boilers Mech. Exhaust Mfg. Unit Heater Mfg, Other Air Cond. Mfg. Gas, Piping Outlets I L 12. I hereby certify that #he above information is Vue and correct, and I ayree to ~ wmply with all oydinances,end oodes gokernjhg this type of work. Signed: fie !i.f/ , ~ 7= for ~ Rough / 1. Finel Inspections: Date • Insp. Date Insp. This is your permit when numbered and approved. Approved C+TY OF EAGAN 464,8100 Receipt 7{i Cl ~ PLUMIWNG PERMIT Psrmit No. CITY OF EAGAN ' Fse 2 ~ - - ' . Fill in numbered speces S/C I Type a Prini /egibJy Tot, I 1. Date 2. Installation Cost I 3. Job Address Lot (0 Blk. ~ Tract ~ 4. Owner t`/ A I I 5. Contractor Phone i ' ~ B. Address 7. City - State ' - L Zip ~ 8. Bullding Type: Residentia~,' Commercial O Institutionel ? 9. Work Description: New Add O Alter O Repair O 10. Describe ` 11, No• Fixturea No. Fixtures Water Closet Couppp1/prainfield Bath tubs Septic Tank LavatorY Sohner ' Shower Well l Kitchen Sink Urinal/Bidet Other %Laundry Tray Floor Drains Drinking Ftn. Slop Sink Gas Piping Outleu 12. I hereby certify that the above i~formation is true and oorrect, and I apree to comply with all ordinances and codes governing this type of work. Signed : for Rouyh Final Inspections: Date Insp. Date Insp. This is your permit when numbered and approved. Approved _ CITY OF EAGAN 464-8100 ~ CASH RECEIPT ~ CITY OF EAGAN 3795 PILOT KNOB ROAD EAGAN, MINNIESOTA 55122 aa rs ~ s weccIven , PROM AMOUNT $ ~ 6 DOLLARS ~eo ? CASH ? CHECK FOR. 1 FUND CODE AMOUNT Thank You BY p F • White-Payers CoPY Yellow-Posting Copy Pink-Fife Copy CITY OF EAGAN Remarks ~.I U. I S t 2 D Addition,,, CIr]N?MDN AIDGE 3RD ADDN Lo= Dt Of 6 Rlk 3 Parcel owner lir~ ~ k~~,_ street 4444 SIATBR ROAD state EA6AN MK 55122 Improvement Date Amount Annual Years Payment Receipt Date STREET SUFiF. STREET RESTOR. GRADING SAN SEW TRUNK SEWERLATERAL 621.03 C009468 9-7-84 WATERMAIN WATERIATERAL lr 529.12 C009468 9-7-84 WATER AREA 1073 PAJA lindn, X 337.60 C449468 9-7-84 STORM SEW TRK STORM SEW LAT X 941.86 C009468 9-7-84 CURB & GUTTER ' SIDEWALK STREET LIGHT WATER CONN. .450.00 of it BUILDING PER. 8091 SAC 525-00 PARK CITY UF EAGAN Remarks- p1' 0 - 152- 2 U ~i P'-~ Addition, CINMMN RIDGE 3RD ADDN Lot pt Of 6 Rlk 3 Pa? owner screet 4446 SI.ATER ROAD stace EAGAN MN 5512 . Improvement Date Amount Annuai Years Payment Receipt Date STREETSURF. Q $67.60 C009912 11-15-84 STREET RESTOR. GRADING 5AN SEW TRUNK I 127.3 P SEWER LATERAL , 621.03 C009912 11-15-84 WATERMAIN WATER LATERAL X 529.12 C009912 11-15-84 WATER AREA 337.60 C009912 11-15-84 STORM SEW TRK STORM SEW LAT 941.86 188.37 5 941.86 C009912 11-15-84 CURB & GUTTER ' SIDEWALK STREET LIGHT 250,00 36096 6-1-83 WATER CONN. 4SO.00 " " 9UILDING PER. SAC PARK Y OF EAGAN Remarks . Additio CINNAMON RIDGE 3RD ADDN Lot 6 Qik 3 Pefcei 10-17402-060-03 Owner Screet 4444 & 4446 SLATER ROAD STate EAGAN MN 55122 Improvement Date Amount Annual Years Payment ReceDate STREET SURF. Q -03 STREET RESTOR. IN, GRADING SAN SEW TRUNK 197.3 1 . 22 6.81 15 .31 A012714 9-7-83 SEWER LATERAL WATERMAIN WATER LATERAL WATER AREA ZDI 173 131.44 8 1$ 3 STORM SEW TRK 1979 381.69 19. 08 286.29 A012714 9-7-83 STORM SEW LAT CURB & GUTTEfi SIDEWALK STREET LIGHT 6183 - - ROAD UNIT 500.00 3609 WATER CONN. 900.00 9UILDIN R. $090 & gl u SAC 1050.00 K 2004 RESIDENTIAL BUILDING PERMIT APPLICATION ' City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX 9 651-675-5694 New Construdion Reauirements RemodeVReoair Reowrements O(fioe Use OnN _ 3 regislered site surveys shaxing sq. R of lot, sq. ft of house; and ali roofed areas 2 copies of plan Cert oi Survey Recd.;; _Y'-- N (20%maaimum lot coverage allowed) 1 sel of Energy Calculations for heated add"Aions Tree P2sPmn Recd';` N, 2 copies of plan showing 6eam 8 window s'izes; poured found design, etc. 1 site survey for addNons & decks Tree Pres Require,d : i Y _ N isetotEnergyCalculaGons Addition - indicatei(on-sifesepticsysfem On-siiOSepticSystem~~;,,,Y._N 3 copies of Tree Pmservafion Plan if lol platted after 711/93 ` Rim Joist Detail Options selecfion sheet (bldgs with 3 or less units J ~ Date y l/G / O Y Constructi(o~n Cost Sa~ ° Site Address UniUSte # Description ot Work ~ .4e--z2~x Multi-Family Bldg ~ Y_ N Fireplace(s) _ 0 _ 1 _ 2 Property Owner~ Telephone # (6, s'l) yli ? - jv 3 3 Contractar Address 9~,4, Su City State Zip ~Y ~)U Telephone #(9f-) `+j +O COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING - Minnesota Rules 7670 Cateeorv I _ Minnesota Rules 7672 Energy Code Category . Residential Venhlafion Category 7 Worksheet • New Energy Code Worksheet (4 submission type) Submitted Submitted . Energy Envelope Calculations Submitted Have you previously constructed a building in Eagan with a similar plan? _ Y _ N If so, 25% plan review fee applies. Licensed Plumber Telephone # Mechanical Contractor Telephone # ( ) ]!31"; Sewer/Water Coniractor Telephone # I hereby apply for a Residential Building Permit and aclrnowledge that the information that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN Statutes; 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. ~ G? L? ' M AG pplicanYs Printed Name ApplicanYs Signature OFFICE USE ONLY Sub Types ~ ? 01 Foundation ? 07 OS-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg 0 02 SF Dwelling ? OS 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Exl. Alt - Multi ? 03 07 ot _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Eut. Alt - SF ? 04 02-plex ? 10 OB-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc. ? OS 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage ? 06 04-pleX ? 12 12-plex Plbg_Y or _ N ? 25 MiSCellaneOUS Work Types ? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding ? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair ? 33 Alteration ? 37 Demolish Building` ? 43 Reroof ? 46 Windows/Doors ? 34 Replacement 'Demolition (Entire Bldg) - Give PCA handout to applicant Valuation Occupancy MCES System Census Code Zoning City Water SAC Units Stories Booster Pump # of Units Sq. Ft. PRV # of Bldgs Length Fire Sprinklered Type of Const Width REQUIRED INSPECTIONS _ Footings (new bldg) _ FinaUC.O. _ Footings (deck) _ FinaVNo C.O. _ Footings (addirion) _ Plumbing Founda[ion _ HVAC Drain Tile Other Roof _ Tce & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests Final _ Framing _ Siding _ Stucco _ Stone _ Brick _ Fireplace _ R.I. _ AirTes[ _ Final _ Windows Insularion Retaining Wall Approved By: , Building Inspector - Base Fee Surcharge Plan Review MC/ES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant License Search Copies Other Total W-i q U L ' 9 CLAIM VOUCIIER - REFUND REQUEST CITY OF EAGAN MAKE CHECK PAYABLE TO: WREN BUILDERS ADDRESS: 9218 llTH AVE S BLOOMINGTON MN 55420 PERMIT #'S 63892 RECEIPT #/DATE: 65419 4-20-04 VALUATION: $4,000 REASON FOR REFLTND: Over charged TYPE OF REFUND: Accaunt De osi[ 92202252 $ Buildin Permit Base Fee 0801.4085 $ 40.75 Construcrion Meter De Refund 92202254 $ Curb Box De osit Refund 9220.2253 $ Fire Su ression Permit 0801.4096 $ Ove a ent 9001.2250 $ Plan Review Fee 0720.4222 $ Plumbin Permit 0801.4087 $ SAC MC/WS 9220.2275 $ ' SAC (City) 9379.4681 $ SAC Admin 0801.4246 $ Sewer Pemut 6201.4532 $ Surchu e 9001.2195 $ TreatrnentPlant 6101.4685 $ Water Pernrit 6101.4507 $ Water Meter 6101.4509 $ Water Su 1& Stora e 6101.4680 $ Other (Copy) 9001.4230 $ Total $ 40.75 I declaze under the penalries of law that this account, claim, or demand is just and that no part of it has been paid. ~ "k, April 20 2004 SIGNATURE DATE ~ ; - . PERMIT Clty Of EagaII Permit Type: Building 3830 PILOT KNOB RD Permit Number: EA063892 EAGAN, MN 55122 - - - . (651) 675-5675 „ Date Issued: 04/20/2004 Site Address: 4444 Slater Rd Lot: 062 Block: 03 Addition: Cinnamon Ridge 3rd PID: 10-17402-062-03 Use: Description: Sub Type: Exterior-Multiple Dwelling Occupancy: Work Type: ReroOf Construction Type: Description: Duplex - Includes 4446 Zoning: Census Code: 434 Square FeeC Remarks' Two inspections are required: Ice & water and a fnal inspection. Qd) ~ Over charged by $40.75 sent in for refund. 4-19-04 (Id) Fee Summary: Valuation: $4,000.00 Surcharge - Based on Valuation 2 00 9001.2195 BL - Base Fee 4075 0801.4085 BL - Base Fee 97.25 0801.4085 Total Fees: S140.00 Contractor: _ ApPl;caz,i _ Owner: Wren Builders NLIA A WRYCZA 9218 l lth Ave S SC Lic.: 4360 4444 SLATER RD Bloommgton, MN 55420 (952) 888-4952 EAGAN, MN 55122 I hereby acknowledge that I have read this application and state that the information is conect and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Applicant/Permitee: Signature Issued By: Signature EALVIN H. HEDLUND 7726 MORGAN AVE. 50. MINNEAPOLIS, MINN. 55423 lona Surroyor Civli Enyfneer PHONE NO. 866-2523 ert~te srrrr~er~org~ G'~j q- 49g JOB N0. B- 49 9 - SURVEY FOR: ZACNMAQ IiOME~- _7-NC, DESCRIBED AS~Lot 6, Block 3, CINNAMON RIDGE 3RD ADDITION, City of Eagan, Dakota County, Minnesota, and reserving eaeementa of record. ~ Nor}hern Nalura/ Gas Co P,pel:ne 80.00 N48°32'35"e 117.0} l~0 - - \ I-'-- - 3 ~I 4o I N~ 3 Top oF Founidaf7on = 915.33 ' cp i ~ rn N Basernent Fioor• 918.33 °C4 Ir 917.y~WIo `W/D qtT-_ 00N Garaye Floor= 918,0 VNIT \ ~ ~ a Proposed E/evdtions O ~ 2 Exis4in9 E/evat:ons _ N\ loQS STaitES ~15.92 ~1 \ ~N fs.92 Drainaye Direcfton 4 AsS. \ FEC ~ ~ Denoies Loh Cornei O \ I p-R \_1R. I IO~O STPKES / -7 I~---• N~\ 24\I. C) % - 9111 j I j- A , ^ ° J 914.2, - - - - - ~ 916.9 1 $6.0p N 48° 32' S"E ~ T4 M ' .T 4 0 M 9)3.9 SLATEFZ ROAD 916.6 CERTIFICATE OF SURVEY I hereDy certify fhot on 5- I6-83 Isurvoyed the property descriped opov• and fhot the aDovt plot i• o correct represenloti0n of sold wrvey. 7o5a4.' W. W_4vw"~ Colrln H. Nedlun0, Minn. Req. No. 5942 CITY USE ONLY PERMIT fl: RECEIPT DATE: SOOE RUIDENTIAL MECtIAftICAI. ~EUIT APPLIClETION crrY oF gwsAN S$SO PILOT KNOB RD f.AHAA EtN 55122 851-691-4675 AL'YYYkI'TERl2?10/OE 651$75-5675 Please complete for: ? single family dwellings townhomes and condos when permits are required for each unit Date: SITEADDRESS: OWNERNAME: 0,40QoN ~/~•/Qr~~ TELEPHONE#: INSTALLER NAME: ~'"a c L- ~r Sys-tP~ S TELEPHONE 9S~ - 93 3'~~~ ~ STREETADDRESS: QG CITY: Arf.n S STATE: ZIP: -Sf3 I73 Place a check mark next to the permit work type _ Add-on, mo ificat oton r alteration to existin dwelling unit $ 30.00 • furnace replacement • air exc anger • air conditioner • other Nature of work: n 1 I II I' ~ ~ ~ 11 ~ lP I E,',r, 2C?2 I~ ~ State Surchar e $ .50 TOtal $ S19hA'I'T.JR PERMITTEE L/ CITY USE ONLY PERMIT RECEIPT DATE: APPROVED BY: , INSPECTOR 8008 COMMEtCIi4L MECHANICAI. PEfiMIT i4PPLICATION C[TY OF EAfiAN 3850 P1LOT KNOB RD fAfiAN, MN 55] EE 651-6$1-4675 Please complete for: all commercial/industrial buildings multi-family buildings when separate permits are not required for each dwelling unit DATE: SITE ADDRESS: OWNER NAME: PHONE TENANT NAME (IMPROVEMENTS ONLY): WAS THERE A PREVIOUS TENANT IN THIS SPACE? Y N. NAME: INSTALLER: STREET ADDRESS: CITY: STATE: Zip; TELEPHONE WORK TYPE: _ New construction Install U.G. Tank _ Interior Improvement Remove U.G. Tank _ Processed Pipmg Specify Nature of Work: Wlien isstalling/reinoving u»dergrouied tank, cal! 651-681-4675 for inspectian by Fire Marshal and Plumbing inspector. Fees: 1%ofcontract price OR $50.00 minimum fee, whichever is grea[er, Underground [ank removaVms[alla[ion = minimum fee Conhact price: $ x 1%= $ (Base Fee) State sumharge calcula[e a[ $.50 for each $1,000 Base Fee TOTAL $ SIGNATURE OF PERMITTEE Updated 1/02 SUBTERRANEAN ENGINEERING INC. 7415 WAYZATA BLVD. Phons 548-8938 • •:~•i.. MINNEAPOLIS, MINNESOTA 55428 DATE EARTH WORK OBSERVATION REPORT p? OBSERVED Job Nams / Job No. EXCAVATION: Job Locatlon 41, LOt 7 //Pst Block Earthwork Plat Contractor + ~~'J Cllent ~ WAI Arrlva Job ~d Mlleage Y'4~1 . Total 777???FILL PLACEMENT: Decart Job YS Travel Tlme ~ Fhargeable ~ Lot 3~ S lab. Time ~ f, Hours Block Total Fiours Eng'r Plat On Job r• Report TImeCl~. Review Time Summary o} Tachnlcel and /or Engineering Services performed including Fleld Test Data, Locatfons, Elevattons, and Deothe are estlmated. THE LIMITATI9N OF LIABILITY STATEMENTS ON 7HE REVERSE SIDE OF YHE COMPACTION QUALITY CONTROL TEST REPORT CONSTITUTE AN INTEGRAL PART HEREOF. feet deep at feet deep 1. Excavation le Elevatlon end , grading to Elevatlon at end 2. Sids Slopea ara approx.: vert. ? 1/2 horiz.: 7vert. ? 1 horiz.: 1 vert. ? 2 horiz: 1 vert. /tlatter than 2:5 ? other E 3. Conetructlon Staking Is: adequate C~ not available ? Incomplete ? X 4. Excavation la oversized feet outalde ot building Iines. c 5. Excavation le: dry p wet ? A 5a. Water Is aeeping }rom v 5b. Depth of water In axcavatlon approx. A Sc. Dewatering Is: nacessary ? not required ? T S. Excavation le with : draglina ? backhoe ? acraper ? dozer ? 1 7. All unsultable solls have been excevated. YES ? NO ? 0 7a, feet of soll remalns to be removed. N S. Soll at azcavatlon base Is: Sllty Clay ? Sandy Clay ? Clayey Sllt ? Sllty Sand ? Clayey Sand ? Clean Sand ? Other 9• feet of flll reaulred to reach desian suharnds. 10. Excavation Is: Approved ? Not Approved ? tor flll placement. 11. FIII la , S r (type oi soil) . 17a. Imported On-slte borrow p! 11b. Compactlon la with sheepsfoot roller [3-'~ manual tamper O vlbratory ~ f smooth drum roller ? selt-propelled M/ non-vibratory ? I 12. Performed 15 fleld denslty teats, See Compactlon Ouallty Control L ~ Teat Report No. ~ L 13• 7D fest ot }III remalna to be plaeed. 14, enslty teets mest compactlon apeclflcatlons. YES NO ? 14a. Test No's. dld not meet comp on speclfications. 1S.Addltlonal obaervatlons ntl/o tests are re ulred. /YES NO ? FROST pDJACENT / ~ DEWATERiNG: PROTECTION: STRUCTURES: WEATHER CONDITIONS: P N well polnts ? straw blankets [3 Hot ? Dry Q~ ~ ~-deaD wells? loose soll p Warm ?/F3eln ? I T opsn dlteh ? troat rlpping ? wlthin 20 feet ? Cool L~Y Snow ? ~ N sump pump ? temp. heat ? 20-40 feet ? > 32'F ? S othsr ? otfier f] 40 ar r+!ore }pot ? S,4-+soezing ? RECOMMENDATIONS/SUM~ RY/Ws RK PROGRESS: K ~ Q'7'i ~~o~ _S^a.,~ T f'PS DISTRIBUTION:' ~ cc: ~v7 ah m 7 cc: cc: ~ G!! 6y P / cc: S ERRANEAN ENGINEERING INC. L cc: THESE LIMITATION OF LIABILITY STATEMENTS SHOULD BE CONSIDERED TO BE AN INTEGRAL PART OF THIS REPORT: 1. In performing our professional services wiih regard io earthwork inspecfion end queG4y wrrtrol, our findings will be obfeined end our recommendetions mede, in eccordance wi+h generelly eccapfad engineering principles end prec4ices. We will observe, monrtor end +es4 fhis work, end mey edvise or meke recommerdations, bu4 we ere nof guarenfon. This werrenfy is in Geu of ell other werrenfies either erpressed or implied. 2. $ubferrenean Enginaering inc. does not pracfice in the field o4 lend surveying, end is no4 rosponsible for the eccurary of grede sfekes end/or building locefion siakx at fhis jobsite. There musf be edsqua+e consfruction sfekes, cleerly merked, to eneble our wil impec4or to proparly euess the exceve#ion. We will not be ro:ponsible for arry herm- ful wnsequences resuking from impropar or ineorreef wns#nxiion s#eking. 3. The field densify fed de+a presented wifh 4his report represenfs the velues a4 per- ticler locel'ized poin4s wifhin the eerfhwork. Alhough this is believed to be feirfy repre- tentatire of the eondifion of iha fiill pkoed and eompected on 4his de4e, wnditioru e} other locetions erd elevetions in fhe fill mey very, and we do no4 wertant or guerentes uniform fill deruitiex. 4. We cennof eer+ify, eifhsr expressly or by implicefion, the queGfy of arry work on fhis project which we did nof heve fhe opportunify fo observe at fin} hend. InspeeFion of this eerfhwork projeef e+ inegular irrtervels does no4 permi} the inspecFor }o essess }he full urope of the con+recfor's ectivifies. 5. If the drudura is redesiqned in sixe end shape, or if if is otherwise movsd wbsequerrt to our inspection, we should be notified w ihet we un euen if eddifionel intpec+ion work is required, or suggasf wund enginearing ekernefives. We ere rro# respornible for eny soil•founde+ion sy:fem where the s+ruciure hes been reloceted wifh respeeF fo e:eevefion and fill eree, sub:equen+ to our impedion. SUBTERRANEAN ENGINEERING INC. MINNEAPOLIS, MINNESOTA PHONE 546-6938 COMPACTION QUALITY CONTROL TESTS Project cinnamon Ridqe Report No. 39 C'aAar Ave. So. & Cliff Road, Ea4an, Minn. Job No. S-8 134 Sand Cone Method 0 Indicoted Percent Compaction: ASTM Nuclear ? Cg % Max. Modified Proctor Dry Density D-1557 Other ? Max. Standard Proctor Dry Density D-698 ELEV. ANDJOR DEPTH BELOW Wel Denslt Y Ory Density MaRimum D018 T8S1 FOO1f2Of Tolal MOISTURE Laborofo % Floor Grade ( Corrected ry RECOMMENDATIONS REMARKS NO. Desi n Grode 'Sample CONTENT FOr Stone ) D`Y Density Compaction Fill Surfacs IrKludingStore) % prt ;ept.28, 0.5' 1982 182 924.5' 144.2 5.6 127.4 129.5 98.3 Meets Specs 183 -3.0' 922.0' 136.9 5.0 126.0 129.5 97.3 Meets Specs „ -0.5' 184 924.5' 143.4 8.9 129.0 129.5 99.6 Meets Specs " 185 -3.0' 922.0' 144.1 8.4 127.3 129.5 98.3 Meets Specs -0.5' " 186 924.5' 141.0 5.5 126.5 129.5 97.7 Meets Specs NOTES- I.) ALL TESTS CORRECTED FOR STONE CONTENT, WHERE APPLICABLE. 2.) APPROXIMATE DENSITY TEST LOCATIONS ARE SHOWN BELOW. ~ S .4 o ~ Z" IS`f 85 • ~ t-3 183 ~ ~8~ • 4 r,+.tvik e APPLICATION AND AU71lORIZATION FOR DELAYED PAYMENT OF TAX ' ON SPECIAL ASSESSA4ENTS FOR SENIOR CITI S' HOM TEAD ~ ~ LAWS 1974, G'HAPT'ER 206 V' STATE OF MINNESO'fA) a C@ ~i ~ COUNTY OF DAKOTA ) ' T0: County Auditor, Dakota County, Minnesota .DATE. - • I, the undersigned declare er pe ies of perju That I reside at <i-~-\j ~ - A ~ N ~ ? `7~ That I am not less tZ n'6~yeyrs ~ age an that t date of my birth is That I am th~ owner of the property legall describ/~ed as; _ .p \ ci "t.- C' q V ~ ) l ~ ~~Px`o~er~y~~Ii'e~i~ii' That my anterest in the ownership of the above property was aquired on - and is as follows: • 1. Sole ownership (Enter Yes, if applicable) if Cj 2. Joint tenancy, held with . 3. OTHER undivided interest (Specify) That on January 2, June 1, I owned and occupied the above vroperty as my homestead and such occupancy began on I(,~~ 1, /Q[~ 1 That the installments for improvements on the SPECIAL ASSESSMENTS duly adopted in ordin- ance by thef:~_„ r?'{~ ~'G96:! OF AS OFpC'1~" IY - j G0.~`~ which have been/allocated a ainst the subject property would create undue personal hard- ship on my behalf and I respectfuliy request that payment be delayed and that such in- stallment be so deferred for the years to SIGNED: ~ r ~ r a . - - - ~ - -k7vER - - - - SPOUSE - - - - - - - - - - - - - - - - - - - - - I. Clerlc of the OF ~a<p„yl IN County, State of Mirinesota, do hereb certiFy'that t application of ' i~,,•~ , , : u` above named,. has been duly reviewed an-9 that in ac:erdance with .e minutes of official record in said chambers was duly : APPROVEDJa- DS -0 rj or 9ENF£B es e€ „ That in accordance with approval granted, the SPECIAL.ASSESSMENTS listed below on the affiants subject property levied for annual collection in the amounts and for the years shown be so deferred with interest at the annual rate shown tmtil such time as it is deemed the applicant no longer qualifies or the property loses its eligibility. ASSESSMENT' D/P N0. ' TO'fAL AMOUNT YEARS INTEREST RATE e- ~ I ~03&,91-0 a88~s-v s y,s DATED ~ a- os - a oos Clerk . (over) ~ DAKOTA COUNlY pUDITORS OFFICE posting check list Record Posted by Date Defened taxes/assessment book 1Yansfer card (red dot) Local improvement assessment card Data processing notified . 7'ERMINATION ORDER Date terminated Reason (s) : By: Authorized Signature m 1040 mentofthe7reasu r ry-Internal Revenue Servi~ U.S. Individual Income Tax 200 ForNeyearJan 1_0~ 31,2004,aoihertax Return year begimm~g (99) IRS Use Only-DO not wnta or slaple in tMS spaoe La bel L Your first name an0 mtlial 2004, endmg 20 A JULIA Lastname OMBNo 7545-007a (See B A WRYCZA ' ~ Yoursocialsecuritynumber instruCtionS ) E It a )omt reNm, spouse's firsl name antl inltial L Last name ~ 475-BO-8839 Use the IRS ' SDouse's social securiry num6er Otherwise18be1. , E Home atldress (number and streeq If you have a P,p_ box, see instructions. q 9944 SLATER RD please print E Apt no. c~ 0rtype N. ~own or post oKCe, state, and ZIP ~otle. I/you have a foreign adaress, see mSVUCtionS ~ ImPortant! . Presieentiai EAGAN You must enter Election Campaign Mbl 55122 YoUr SSN(5) above. (SBe i05tNCtionS.)' po~. Checking "Yes" wtll nat 1hange your fax or reduce your refuntl. you, or your spouse d(Iing a ,oint retum, want 83 to go to this funtl' YOU $POU50 Filing Status ~M Single Yes E No ?Yes ONp q? Head of householtl (with qualifying person). (See mstr.) 2? Marned filing jointly (even if only one had income) if qualifying person is a child but not your tlependent, enter 3? Marned filing separately Enter spouse's SSN above this child's name here. ? °p and full name here. ? ~ °~uawa~elS Kel' pue a6e ~ liouaialay aa 6a yaurself. If someone can claim 5?' Quahfying widow(er) with dependent child (see instmctions) ons b Spouse . . . . . . you as a dependent, do not check box 6a . . . eo,os ;r . . cneckaa on 1 6a antl 6b y~e7f,1=0,/, c Dependents: . . . . ' ' No. of chiiaren (i) Frst nama Lasl name (2 DepentlenYS (3) p¢pentlanCS f Iv Op 6C WhO: x~ef0U! .0secunrynumber relalionshipto th)IC(wU~jQjy~ 'm asee oa aeEit (sga mslr ) ~ IiveC with you - • tlitl not Iive wi[h ' you tlua to Civorce l orseparatlon Z` (88lI11gWl _ Q~ DePentlente on Bc d Totalnumberofexemptionsclaimed . noee„terea,pove Atldnumben ? diZ °-e --P 7 Wages, salaries, tips, etc Attach For(s) W-Z ~ aeov. 'w` 1 Attach Schedule B d required . . . . . 7 9, 786 1~Woobv ms c~ 8a Taxable interest m ,ZL s b Tax-exempt in}erest. Do not include on line 8a , 8a p 21 9a Ordinary dividends. qttach Schedule B if required 8b 0 ~s u :1SO b Qualified drwdends (see instmchons) . . 9a ~~5) 70 Taxahle refunds, cretlits, or offsets of state gy 30 and local income tazes (see mstruchons) . 9 3 aa o~ I 1 Alimony received e x 12 Business income or poss). Attach Schedule C or C-EZ 'O 0 d . m~.~iaW3 a •~a~ 13 CapRal gain or (toss). Anarn scnel o drequlree If nol reqwree, ci ry~ne ' " " 14 Other gains or (losses). Attach Form 4797 , 12 0 pieg ; ? ~ 13 -3, 000 15a IRA distributions . " ' . . . . 16a Pensions antl annuities 14 LL6EE ~ns 16a b Taxable amouM (see inswctions) 15b dtl NM011do 17 Rental real estate, royalhes, partneiship b Taxable amount ONI 1 18 Farm income or (loss). Attach Schedule F. (see instrucnons) 16b s, S corporations, trusts, etc . Attach Schedule E , 0 o*dRP~~'a~y 19 Unemploymentcompensahon . . ' ' ' ' ' " ' +P 18 p tl OOSI ' . . . . . . . . . . . . . . . . . ZOa Social security beriefits . . . . . I20 ' 19 ~w ~'~O V• Other income. list type antl amount (see - I instrucb Taxable amount (see msvucnons) 20b p 00 ZZ hons) _ :no,r,~ww 5 Add the amounts in the far ri ht column for hnes 7 throu h 27 This is ourtotal income . 21 OU z3 Educator expenses (see instructions) °'""9 ~°"OS ~ 24 Certain business ezpenses of reservists, peAorminq artists, and ZZ a fee-basis government officials. Attach Form 2706 or 21p6-EZ , 23 wwui ~mopai a ' 25 IRq tleduction (see instructions) . ' 424 26 Student loan interest deduction (see instruchons) . . . 25 27 Tuition and fees deduction (see instructions) . . . . ' 26 2$ Health savings account deduction Attach Form 8889 . 27 0 29 Moving ezpenses. Attach Form 3903 28 ~ 30 One-hal( of sel!-employment tax. Attach Schedule SE 29 0 31 Self-employed health insurance deduction (see instructions) , 30 0 32 Self-employed SEP, SIMPLE, and qualified plans . 31 0 33 Penalty on early withdrawal of savings . . ' " 32 0 34a Alimony paid b Recipient's SSN ~ . . . ' 33 35 Atld lines 23 through 34a 34a 36 Subtract line 35 from line 22 This is your adj Noustetlice, gross i see ncome 35 0 For Disclosure, Privacy p ? KIA ~~antl Paperwork Reduction Act t. ' 36 1.829 . instructions Form 0(2004) m 1040 Department of the Treasury-intemal Revenue Sernce U.S. Individual Income Tax Return 20 04 For ihe yqar Jan Dec 31, 2004, pr other lax ye& Eeginnmg (99) IR$ Use Oniy-0o nol wrrte or staple m this space, La bel L Your first name and inNal 2004, erwing 20 OMB No. 1545-0074 Last name A (See JULIA p WR YCZr^, i Yoursocialsecuri[ynumber e ~ inStfUChonS.) E a Jom[ return, spouse's first name antl imtial Last name 475-80-8839 Use the IRS L ~ Spouse's social securiry number IabeL E Home address (number and streeq If you have a P 0 box, see ins[mctions. Otherwise, R 9494 SLATER RD APt.no. please print e . ' Important! . 0r typE. City, town pr post oKCe, state, antl ZIP cotle. If ypu have a tpreign address, see mSVUCtions. YOU AiuSt BntBr Presitlential EAGFN MN 55122 YourSSN(s)above. Election Campaign (See instructi0ns Note. Checking "Yes" will not change your tax or reduce your reluna. YoU Do you, or your spouse dfling a tomt retum, want $3 to go to this Pond7 , nSpOUSB ~ n Single . ~ ? Yes E No L.I Yes 11 No Filing Status q? Heatl of householG (with qualiTymg person). (See instr.) 2? Married filing jointly (even if only one had income) If 9ualifying person is a child but not your dependent, enter ---=-'--'v 3? Mavied filing separately, Enter spouse's SSN above this child's name here. ? and full name here. ? Iuawa)elS icey pue a6e' 5 Quahfying widow(er) with dependent child (see instructions) Lfi fouajajay aa 6a X Yourself. If someone can claim you as a dependent, do no[ check box 6a ~.ea ;ie~OflS b ' . . . . . . . . . . . . . 1 ? Spouse checkadon - Ba antl 6b G D¢5n., : ' No. of chiltlren OL' 6! (1) Las; name IZI D epentlenpa (3) DapenEY ( S y1%rtqua on 6C wh0: ldving soaal secunty numCer relatians~ipenlo Uila /or chilQlaz • livetl wiM you x ~am~ 81 f011f ou creEil (see insV ) ~ m a~e~S 9l 01 5¢e • tlitl not liva wiN yov tlue m tlWorce ' or aeparatlon ~ Isee mstructlona) Oepentlan[e on 6c QF notenleretlabova d Totalnumberofezemptionsclaimed . aaa,,,,meero . . on linos 1 aPo- dR P-e 's"P 7 Wages, salaries, tips, etc. Attach Form(s) W-2 . a~y' ~ b Tax_exemp . . . . . . . . 8a nSea-u.p..d.GoL 8a Taxable mterest. Attach Schedule 8 if reqwred . . . . f 4 8 6 t interest Do not include on line 8a 0 5 9a Ordinary dividentls. Attach Schedule B if reqwred Bb 0 so b Qualifed drvidends (see mstrudions) . 9a 4 3 ~ 5) 'IO Taxable refunds, credits, or offsets of state antl local mcome taxes see instru c ons) 30 11 Alimony received ' 0 0 72 Business mcome or (loss). Attach Schedule C or C-EZ CapltBl g2in Of (IOSS). Aitacn Scheauie o i/ reqmred II not reqwrea, ch¢ck hera . . . . 12 0 10389 Other gains or (losses). Attach Form 4797 . ~ ~ ~ 13 -3, 000 ~ 15a IR4 distributions 74 16a Pensions and annuities ~ Sa b Taxable amount (see instructions) 15b 0 LLb£E ~~5 oi~do aa Nnn 17 Rental real estate, royalties, partnerships, S corporations, trusts etc Attach Schedole E nsvucnons) 1'~ ONI 1 18 Farm income or (loss). Attach Schedule F e9no d¢puv'sa1y 19 Unemploymentcompensation 18 0 tl o~~ 20a Social security benefits . . 19 . ' I Zoa- b Taxable amount (see insirunions) 20b 0 ~ 'd1° K• 21 Other income List type and amount (see mstrucBOns) .na,~!wrv s ~ 22 Atld the amounts in the far ri ht column for lines 7 throu h 21. This is ourtotal income _ _ 21 OU z3 Educator expenses (see instructions) ? 22 ~!'"'°`i"'°S ~ 24 Certain business expenses o( reservists, pedorming artists, and 23 fee-basis government officials. Attach Form 2106 or 2106-EZ . 0 w~~i i°'wi x ' 25 IRA deduction (see instrucUOns) . . ' 24 26 Student loan interest deduction (5ee instruCtions) 25 27 Tuition antl fees deduction (see mstruchons) Zs 2$ Health savings account deduction. Attach Form gggg . 27 0 29 Moving expenses. Attach Form 3903 . Z$ 0 30 One-half of self-employment taz Attach Schedule SE . 29 o 31 Self-employed health 32 insurance deduction (see instructions) 3~ Q Self-employed SEP, SIMPLE, and qualifed plans . 33 Penalty on early withdrewal of savings 32 034a Alimony paid b RecipienYs SSN ~ . . 33 35 Add lines 23 through 34a . 34a 36 Subtract line 35 from line 22. This is youradjusted gross income KIA For Disclosure, Privacy qct, and Paperwork Retluction Act Natice, see instructions. ? 36 1, 829 . Form 4 (Zppq) • Property I~ ~ E Properiy ID House# Sireet Name Unit Today's date. 12t6l2005 Release: 1 02.07 Logged on user JWOBSCHALL J 1 0-1 74 02-062-03 J Address: 44qq Slater Rd SingIePID parcel5eerch qeer Print VewPhotos ParcelAdministration C-~N SpecielAssessments ~ ~ \SQ°rch &AssessmeniSenrch E'Summary Master Information ~ Comments Mass Add pIp: 7 6-1 74 02-06 2-03 Address: 4444Slater Rd , . ~ Mess Comments Update Lot 000 Block 003 AddiLOn: Cinneman Ridge 3rd Mass PnyoH Number Comrersion S/A Flags: D'ndsionmg parcel Status: Adive P 81 Year 2005 - ~ -~Rollover P81Cert: f0.00 ~ CounyTrensters (FTFy) Reports and Inquines Database U61i6es 7 Assessment Detail Records, Total Payof( _$286.50 !:itl SecurityAdminisUation S/A4 DescripUOn YearTer InterestReTOtalAssessm PrinapelAmoPayoNAmouStatus ? 100008 WATERL4T 0 1 0.0000 % $529.12 50.00 $0.00 qosed 100011 STORM SEW LAT 0 1 0.0000 % $941 86 $0 00 50.00 Closed 100012 SERVICES 0 1 0 0000 % E337 60 $0.00 $0.00 qosed 100889 SVJSS357 196 5 10.5000 % $621.03 $000 $0.00 qosed 100890 ST357 198 5 10.5000 % E867.60 E0.00 $0.00 qosed 101585 DELIN UTIL 196 1 9 0000 % $22.50 $0.00 $0.00 qosed 103600 ST 878-GN RIDGE 200 5 4 5000 % $288 50 $0 00 8286.50 Levied . _ . . _ a ' r " ' . m . . . . _ System Property ID House# Street Name Unit Today's date: 1 1 11 612 00 5 Release: 1.02 05 Logged on user. JWOBSCFIALL J 10-17402-062-03 ~ Address 4444 Slnter Rd SingIePID parcelSearch Clear Pnnt YewPhotos IF E ~I ParcelP,dminisva4an Pnrcel Information ~ ~ - - ~ • \AssessorComments USave ~IClear ?Delete "Owners j_MulliAddr ~9Permits ~Photos/Sketches ~ Parcel Divisioning -~Temporary PlDUpdate pflrcellnfo Legals/Divisians I 2. 4N SpedalAssessments Seelch ~ Master IntormaLon LOt 000 _ Blodc' 003 Addition: Cinnamon Ridge 3rd _ ~ Commenis Mass P,dd Metes end Bounds-~MassCammenfsUpdate pTOFLOT6BLK3LYINGNEOFLINEDRAWNFROMAPTONSELINE40FT5WOFMOSTECORTOAPTONNWLINE40FTSWOFMOSTNCOR Mass PayoH 6 3 Num6er Comrersion ~ Divisioning A Rollover CouMyTransfers (FTP) .,-J Reparts and Inquiries Database Utilities SecurityAdministration 7,000 character meximum lenglh Division InformaGon PereMPID ~ D'nrisonPrvcessDate: 11n/7983 ~i Diwsion Number 075220 Yeer Spli[ ~ ~ % Micr... F13 D B tIJ. p . ' \ \ Agenda Information Memo December 5, 2005 Eagan City Council Meeting F. APPROVE SENIOR CITIZEN SPECIAL ASSESSMENT DEFERMENT APPLICATION - PARCEL 10-17402-062-03 (PROJECT 878 CINNAMON RIDGE STREET REHABILITATION) ACTION TO BE CONSIDERED: To approve an application for a senior citizen deferment of special assessments. FACTS: • Section 2.75 of the Eagan City Code allows for the deferment of special assessments for senior citizens, if certain conditions are met. . The City has received a request for a defermenf from a property owner in the Cinnamon Ridge 3rd Addition. ' • The assessment was levied for street rehabilitation improvements related to project 878. • Staff has reviewed the application and determined that the eligibility , requirements are met. ATTACHMENTS: • Enclosed without page number is a copy of the application for deferment. • 30 ~.2Ss~ ~~s.so 2006 RESIDENTIAL PLUMBING PeRnniTaPPUCarioN CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN MN 55122 651-675-5675 Please complete for modifications to existing residential dwellings. Date3/7 / 1J(0 n Sya~~'~C QaA Unit# Site Street Address 1` Property Owner ~.1 ll`~ 0, ujd~L Z6,_ Telephone 6~) `6`rO- 71157 Contractor 1 0.~`~ 0 1 1 l uvAb i~ L'~L. Telephone #((°SI ) y63 "76I I Address G, D Sn - ~.l ~.~"h S~. W. city 1 As vv\i 1, 91'0 r state MkJ zip SSOd The Applicant is: _ Owner _~Contractor _ Other Septic System _ New _ Refurbished Submit 2 sets of plans and MPC license Includes County fee $ 100.00 Per as-built $ 10.00 Alterations to existing dwelling $ 50.00 _ Add plumbing fixtures. This fee includes installation of a water softener and/or water heater at the same time. If you are installing onlv a water softener and/or water heater, do not complete this section; move to the next section and check the appliance(s) you are installing. _ ~ . _Septic System Abandonment =WaterTurnaround (add $130.00 if a 5/8" meter is required) uu I Other. - Water Softener ~ Water Heater $ 15.00 _ new ~ replacement Lawn Irrigation _RPZ _PVB _new _repair _rebuild ' 30.00 State Surcharge $ 50 Total $ ~SSD I hereby apply for a Residential Plumbing Permit and acknowledge that the information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan and the plumbing codes; that I understand this is not a permit, but only an application for a permit, work is not to start without a permit and work will be in accordance with the approved plan in the event a plan is require.dn to ~be reviewed and approved. N~ark ; wA ~ e,', 7~ ` ~ ApplicanYs Printed Name ApplicanYs Signature Thisrenuest void p-~ L(~~ B31 C('nh J7~~~ ,s ~,w„ms f.om Q W 064862 $b'o o Renuest Date Fire No. Roueh-in Insuecuon Feqwrodl ea~y Now ? Will Nnuty Inspec- •~l~Llf IZ 3 ;RVus ?No tor Whan Ready ~Licensed Elactncal Contracror I hereby request inaoechon of abova Owner electrical work ingtelled el: S[reet Atldress, Box or Route No. CItV Sl St -9 '9 S~A " EAGAAJ ecuon o. Township Name or No. Range No. Coumy 0 O upant (PqINT) Phone No. G .l 14 Power Supoliar AOdr D 1<0 ~E , Aswc~ ~ n Elec ncal Comeoctor ICompany Nemel Conhuctor's Li .n~5e o. AON -Q e Mailina AdJress (COntrnctor or Owner Mnkine tn Ila[ion) 4.30 ,.i OGL l c~ GY Aut zetl $ipnflture nu ace wner Making Ins[allatio I Ph n Numbar ~ ~ "~8C°2 / MINNESOTA S TE BOAND OF ELECTqICITY THIS INSPECTION REQUEST WILL NOT Grigge-Midwey Bldg. - Noam N-791 6E qCCEPTEO BY THE STATE BOAPD 1821 Univarsity Ave., St. Paul, MN 55100 UNLESS PHOPEfl INSPECTION FEE IS ENC LOSED. REQUEST FOR ELECTRICAL INSPECTION r E8-00001-04 See inehuctions fer comoletin this torm on bock of ~ ~ g yellaw coDY• W"X~ Berow 6York CoVered by This Request 3 7?~ f Ada Rao. 7vae o1 e.umn.o AppIiO11CB5 WuBd Enuion,ani wi.ed Home Range Temporary Service Duple.x Water Heater LiGhtiny Fixtures Apt. Building Dryer Electric Heaun Commercial 81dy. Fumace Silo Unloader Industrial Bldy. Air Conditioner Bulk Miik Tunk Farm th«n oeci v 0he1 (Snec~ivl t er uec7v t er Othiv Compute Inspection Fee Below a Fee ServiceEntrenceSixe k Fee Fexdars/SUbineders P Foo Cvcuits U to 200 Am s 0 to 30 Am s 0 in 30 ;.n+ o ItAs Above 200 qmps 31 to 100 qmps 31 to 100 Am s Swimming Pool Above 100-Am s Above 100_Amps Trenstormers Irrigation Booms Partial-'Oth Signs Special Inspection 5 TOTAL F Remarks V r /~,An(„~ k, Or~ L.nY Rovgh-in Ihe Elecvicxl soector, hefoby certdy thxt the nbove Final 0teinspection hes been ? mede. Thlv ronuovl vnltl 1 R mnnf Rs from CITY OF EAGAN . ' 7795 Pllot Knob Rmd Eogan, MN 55122 T7 lr O 8091 PHONEs 4348100 i BUILDING PERMIT Receipt # , t"v T. M wed hr 1/2 DUPLEX & GAR Est. Volue $47,000 Dare June 1 1 q 83 Site Addreu 4446 Slater Road (Unit A) Erecr gF{ OccuPOncy R-3 Loe 6 BI«k 3 Sec/Sub.Cinnamon Ridge 3rd qirer ? Zonin9 (PD) R-2 parcel # 10 17402 060 03 Repair ? Fire Zone NA Enlarge ? Typc of Const. V oc Nar„e Zachman Homes, Inc. µo„e ? # Srories ~ Addrass 7760 Mitchell Road Demolish Q Length 24 Ci Eden Prairie pho„e 937-9520 Groee ? Depth 42Sq. Ft.- ~ Nome OwneT ApOrorals Fees 0 or' Address Assessment Permit • u~ Cit Phone Water 8 Sew. Surchorge 23.50 Police Plon check 134.7$ Gw Nome Fire $AC 525.00 Address Eng. Woter Conn.450.00 iW Ci Phone Plonner WaterMeter 60.00 Council Road Unit 250.00 I hereby acknowledga thot I hove reod this apDlicotion ond sfate thaf Bldg. Off. the inlormotion is corrett ond ogree 1o tomply with oll opDlicoble APC Totol $1712.~$ Stote of Minnewto Statutes and City of Eogon Ordirances. $Ipnoture of Pertniffea A Buildir,q Perrr,ir is issued ro: Zachman Hc,,, onr r nn the exprea conditlon 1hm oll work sholl be done in accordanct with all op/~{I ~dble~/ 5tat~e of in tutqs ond City of Eopon Ordinances. Buildin0 OfHclol /I J~\ J i ;LG~~. CITf OF ~Ca,'V Inciude 2 sets o£ plzns, , n 1 site plan w/elevations s U O~ BUILDI\G P£&RIT APPLICATION 1 set oi energy calculations. r ~ flu~~~;~ ?b Be (,s For _~Elle fmlril, Valuation %j6pqe& Date 5/13/83 Site Address: 4446 Slater Road OFFICE USE OPII,Y Lot 6 A BlOCk 3 Sec./Sub. Cinnamon RidggL2ct 4_ pccupancy Parcel f 0 ( 7,q0 Z p(Qa o 3ra Aaa. Alter Zoning Repair Fire Zone / Rwrer: Zachman xomes, 3nc. Enlar9e _'iYPe of Const. Pddress: 7760 Mitchell Roaa Nb ve r Stories peirplish Front ft. Clty/Zip Cor?z- Eden Prairie, Mn 55344 Grade Depth ft. Phone 917-952n p,pPROUp,T; E•'EES Contractor: Game as above ~ AssessTents PeTmit 10 Pddress: Water/Sew-er Surcnarge 3 -6-0 Police Plan Check- 5a5 , City/Zio Code: Fire SAC Phone Or. ~.hg.- Water Conn. 60 Planr.er S4ater Rleter ~D AzC'ii_/Eng,: same as above Council ad Unit a- FL'dress: A.°Bldg. Off. ~ - C I ciry/zio ccti'e: . CITY OF EAGAN TT 3793 Pild Knob Road Eagon, MN SSils lr O $090 BUILDING PERMIT VHONF: 454-8100 ReceiPt # To ba uwd fer 1/2 DUPLEX & GAR Est. Value $34,000 Dore June 1 1983 5ite address 4444 Slater Road (Unit B) R-3 Erect ~ Occuponcy Lor 6 ei«k 3 Sec/Sub.Cinnamon Ridge 3rd Airer ? Zonin9 (PD) R-2 Parcel # 10 17402 060 03 Repair ? Flre Zone NA Enlarge ? Type of Const. V ~ Nome Zachman Homes, Inc. Move ? # Stones z Addrcu 7760 Mitchell Road pemoiish ? Length 24 C; Eden Prairie phom 937-9520 Grode ? Depth 44 Sq. Ft.- o Nome Owcier ApDrovab Fees ou Address Assessment Permit 211.00 u~ Cit Phone V?ater 8 Sew. Surchorge 17.00 Police Plon check 105.50 ~w Name Fire SAC 52$.00 ~Z Addrem En9• WaterConn450.00 Ci Phone Planner Woter Meter 60.00 Council Rood Unit 250.00 I hereby ocknowledge that I hava read this applicotion ond state that gldg. Off. the informotion is wrrect and ogree to comply with all applicoble APC Totol $1618.50 Sfote of Minnewta Starutes and City of Eogon Ordirances. Signature of Permittee , nc. A Building Permit Is issued to: ac man ome on tha express condiMon 1hnt atf, pli b fate ta Statutes ond City of Eaqon Ordinonces. oll work sholl be done in accordance Buildinp Offitinl 1 CITY OF E?G?,N 7nciude 2 sets of plans, ~1 site plan w/elevaticns & ' BUILDIVG PER'KIT PPPLICATION 1 set oi energy calcula:ions. ~ e~q1E K1-~oc~ r- (f 3 y e-o-o _ Tb Be Used For F Valuation 49q4*9=:Rp' Date 5/13/83 r Slt2 PL'c'sEEss: 4444 Slater Road OFFICE US~' ONLY Lot 66J Block 3 Sec./Sub. Cinnmon aidge Erect _ C Occupancy 3 Parcel Id (7~~(~z G~26 0 3 3rd ~ter Zoning. Repair Fire Zor.e p,me~r• 7arhman Hnmac Tnr Enlarge _ 'I}rpe of Const_ N~,e r Stories Pddress: 7760 Mitchell xd pefrolish Front Cit /Zin Code: Grade Depth Et. Y Eden Prairie. Mn. 55344 Phone 937-9520 p,pPROVALS - FTS CAntractor: same as above ASSessaents Pesmit ~L Pddress: Water/Sec.eer Surcnarge 17 ,PS'Z Police Plan Checx . / 0 :T'.S~r1Z City/Zip Coc'e: Fire SAC Phone Ir. -13 • Water Corn. Sp Planner ater ~~ter (op ArCh_/Enq.: same as above Council ~ROad Un1t 4v Bldg. Off j g Pddress: ppC Citv/Zio C'rr?p. o - ~ ~ ~9~ ~ ~ ~y o a a ~ 3 3 ~ ~ a~ o ~      ò  ÿ     þýüýû  ÿ þüþü     ûÿÿ úúúúû ÿ êýñðüÿ  áê  ÿ  ø  úùø ÷ÿÿö   ø ÷ÿ ö ø ÷ÿðÿ÷ýÿ ÿ  ÷ ÿ  ÿááÞ÷ý  Ûü úëý ÿçÿÿ ú ÿ    íêõÿý ßÿè ýÿßÿûôõáá êáá ý ÿçÿÿââáèèá ÷û  ú îý üÿý ÿéýýââèíèí éýýè  öúõ ø ôó ÷÷ý îýñ÷ö Üýö óý  öØêíõû×ááááúýÿ ð õÿ þýüýôõ æêãáá îÿ ÿù ý ÿüÿîýîýßÿ ÿýî ý÷÷ýý ýÿîýîÿò ñý  ÿýýü ÿÿñ÷  îýý÷÷ýùÿúýÿ òôÿ ýúýÿ ý òþýüýÞ ýÿ è ÷÷ýä ÿ ñÿÿúüý ÿ ÿ úüý ÿ      ïý    øø  ÿ ÿþþý  üðü     ûýýþþ úúúúûý áöñ  á   á   ÿþ   þýüûúù ö ýûúù  õ ûúù þ  ãý ö ýö áäýùú Ú  þðý ø  õï  æ  ååñ ÿ ñæ  ç ñ íè è ü ïýüæ ë  ù  þ ý ñçñýñæ èöå åù å è ö üñç      ðý üúó  åñúïñ è  ø éêêèêèê õû  þý ï  éèìèì Ùýáÿè  ô ó  òñ ùù öïñùõóöñùúåîùÜýõ úÞ ãõÛìôÿâþ   ô óãù  îô íáë ï üúó  ï ïæ  ïùù ïï å ñ  ñùúóïùùü þ  åî þý öúå  ä  è ùùà ñ þ ý ý úþ ý PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA108057 Date Issued:11/14/2012 Permit Category:ePermit Site Address: 4444 Slater Rd Lot:062 Block: 03 Addition: Cinnamon Ridge 3rd PID:10-17402-03-062 Use: Description: Sub Type:e - Water Heater Work Type:Replace Description:Water Heater Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments:Brian Nerison 430 E. County Road D Little Canada, MN 55117 651-481-9155 Fee Summary:PL - Permit Fee (WS &/or WH)$55.00 0801.4087 Surcharge-Fixed $5.00 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 - Julia A Wrycza 4444 Slater Rd Eagan MN 55122 KB Service Company 430 E. County Rd. D Little Canada MN 55117 (651) 748-4933 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA108058 Date Issued:11/14/2012 Permit Category:ePermit Site Address: 4444 Slater Rd Lot:062 Block: 03 Addition: Cinnamon Ridge 3rd PID:10-17402-03-062 Use: Description: Sub Type:e - Furnace Work Type:Replace Description:Furnace Comments:Questions regarding electrical permit requirements should be directed to Mark Anderson , State Electrical Inspector, 952-445-2840 Brian Nerison 430 E. County Road D Fee Summary:ME - Permit Fee (Replacements)$55.00 0801.4088 Surcharge-Fixed $5.00 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 - Julia A Wrycza 4444 Slater Rd Eagan MN 55122 KB Service Company 430 E. County Rd. D Little Canada MN 55117 (651) 748-4933 Applicant/Permitee: Signature Issued By: Signature Date: C!ty of Eaaan 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BLUE or BLACK Ink For Office Use Permit #: 1 121 Permit Fee: 311. t:1 C 1 Date Received: 1 19 ,1-3 Staff: 2013 RESIDENTIAL BUILDING PERMIT APPLICATION 1 1 I ) Site Address: 1/ IN `j sI4e-7 /4 ki SSi LZ Unit #: Resident/ Owner Name: v .t C+{ �,.i r y C7^ Address / City / Zip: 51,04/ e-6 Applicant is: Owner contractor Phone: € $ f 'Z/0 r Description of work: ' [/J1r , - reivh1n. ` t tIs 4-&J I� �l w v✓�dc Dut Z- Construction Cost: 11 / 410, ^4 Multi -Family Building: (Yes C.No _) .{-v„i, Company: Auer fib(!weeContact:h tt9 J Address: 1/di CIA 14l/ti S City: SW-'< T17t F>atiL State: MW Zip: 5.51111—Phone: (tS/ off -/Y / ? Z. 3 License #: 6 e 6, L6 S-13. 5 Lead Certificate #: /Va f - I Ya 3a - ) If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? _Yes _No If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer & Water Contractor: Phone: OTE: Plans and supporting documents that you submit are considered to be pudic information. Portions he information may, be classified as non-public if you provide specific reasons that would permit the City conclude that the are trade secrets. CALL. BEFORE YOU DIG. Call Gopher State One Call at (651) 464-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities, www.gopherstateonecall 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. Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 days of permit issuance. x /41 //* ';:mbrS g-6, Applicant's Printed Name x Applicant's Signature Page 1 of 3 44'-fqtccto DO NOT WRITE BELOW THIS LINE I 118 7a -- SUB TYPES Foundation Single Family Multi 01 of Plex Accessory Building WORK TYPES New Addition Alteration Replace _ Retaining Wall DESCRIPTION Valuation Plan Review (25% 100% Census Code # of Units # of Buildings Type of Construction Fireplace Garage Deck Lower Level _ Interior Improvement Move Building Fire Repair Repair REQUIRED INSPECTIONS Footings (New Building) Footings (Deck) Footings (Addition) Foundation Drain Tile Roof: _Ice & Water Final y. Framing Fireplace: Rough In Air Test Insulation Sheathing Sheetrock Reviewed By: Porch (3 -Season) Porch (4 -Season) Porch (Screen/Gazebo/Pergola) Pool Occupancy Code Edition Zoning Stories Square Feet Length Width Final 1 Siding Reroof Windows Egress Window Storm Damage Exterior Alteration (Single Family) Exterior Alteration (Multi) Miscellaneous Demolish Building` Demolish Interior Demolish Foundation Water Damage 'Demolition of entire building - give PCA handout to applicant 41,13 MCES System SAC Units City Water Booster Pump PRV Fire Sprinklers Meter Size: Final / C.O. Required y Final / No C.O. Required HVAC Gas Service Test Gas Line Air Test Other: Pool: _Footings Air/Gas Tests Final Siding: _Stucco Lath _Stone Lath _Brick Windows Retaining Wall: Footings _ Backfill Final Radon Control Erosion Control Building Inspector RESIDENTIAL FEES Base Fee Surcharge Plan Review MCES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant Copies TOTAL roily 1 Page 2 of 3 411!0/ City of Ea�all 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 r 1. Use BLUE or BLACK Ink For Office Use Permit #: 1 'a 11 Permit Fee: (I) Date Received:'1 (3( ( L Staff: 2013 RESIDENTIAL PLUMBING L//PLUMBING PERQMIT APPLICATION Date: 7" �/ /?' `� �3 Site Address: (Nes 7 "s(4 Tenant: Suite #: Restdent/Owlner Name: l� fit / v'C( f/'�f�' �/6CI Phone: //// f .Sl/ � Address / City / Zip: 4/e/` Y" /6 C(.,���,) / "") CC -42; Contractor Name: 4,vl ek,,,,'l,k% N. �1� License #: (!)&20fa7—'/(1. (,) city: 2,�G''I%'�'�' Address: 27V 7 6 Dq A. I ���' State: 1/1/11`11/1/11`1Zip: 3� Phone: 7�DSR-'.67W Contact: .7;641 Email: Th/1144,0S/C'e/ ® //49' 01'`7 art' Type of Work New Replacement Repair Rebuild Modify Space Work in R.O.W. _ Description of work: Permit Type RESIDENTIAL Water Heater Water Softener217 C -2 Lawn Irrigation (_ RPZ / PVB) %yd 41 Add Plumbing Fixtures (_ Main / Lower Level) _ Septic System Water Turnaround New Abandonment RESIDENTIAL FEES: $60.00 Water Heater, $60.00 Lawn Irrigation $60.00 Add Plumbing *Water Turnaround $105.00 Septic System Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge) Turnaround* (includes $5.00 State Surcharge) and $5.00 State Surcharge) TOTAL FEES $ (includes $5.00 minimum State Surcharge) Fixtures, Septic System Abandonment, Water (add $200.00 if a 5/8" meter is required) New ($10.00 per as built) (includes County 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.gopherstateonecall.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 wit;, t 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 pl• s. 4)i7, oNy /yl sF,2lf Applicant's Rtinted Name x Applicant's Sign •! Mil 9i49slcri-cr frALLS AND INTERIOR PARTITIONS, WOOD FRAMED GA FILE NO. WP 3005 PROPRIETARY" GYPSUM WALLBOARD, WOOD STUDS One layer 54" proprietary type X gypsum wallboard or gypsum veneer base applied parapet or at right angles to each side of 2 x 4 wood studs 16" o.c. with 15,4" Type S drywall screws 12" o.c, Vertical joints centered over studs and staggered one stud cavity on opposite sides. Horizontal joints need not be staggered or backed: (LOAD-BEARING) Sound tested with resilient channels on one side, 314 glass fiberinsulation and a double layer of 54 propnetary type X gypsum wallboardapplied with screws spaced 12 o,c. PROPRIETARY GYPSUM BOARD United States Gypsum Company 54" SHEETROCOi Brand iJltraLlght Panels FIRECODE* 30 50 to 54 STC SOUND Thickness: 434" tFire) " 614" tSound) Approx. WeIght: 7 psi Fire Test' UL R1319. 11NK03873, 4-15-11 UL Design U407 Sound Test RAL TL11-132, 5-23-11 GA FILE NO. WP 3010 GENERIC GYPSUM WALLBOARD, RESILIENT CHANNELS, GLASS FIBER INSULATION, W000 STUDS Resilient channels 24" ox. attached at right angles to ONE SIDE of 2 x 4 wood studs 16" 0,c. with 1" Type 5 drywall screws. Base layer 5111" type X gypsum wallboard or gypsum veneer base applied at right angles to channets with 1" Type S drywall screws 12" 0,e Face layer 54- type X gypsum wallboard or gypsum veneer base applied at right angles to channels with 34" daubs of adhesive 12' o,e. vertically and horizontally. OPPOSITE SIDE: Base layer 54" type X gypsum wallboard or gypsum veneer base applied parallel to studs with 50 coated nails, 154long, 0,086" shank, 1544" heads, 32 Second ae 2 type X gypsum wallboard or gypsum veneer base applied parallel to studs with 8d coated nails, 234" long, 0.113" shanic, 542" heads. 17 o c. Face layer 3/8" regular gypsum wallboard applied parallel to studs with 31( daubs of adhesive 12" de vertically and horizontally, 2' glass fiber insulation. 0,90 pef, stapled to three layer side in stud space, Joints staggered 16" each tayer and side. (LOAD-8EARING) 60 to 64 STC SOUND Thickness: 674' Approx. Weight: 12 psf Fire Test. UL R3660-2, 12-3-68, UL Design U313 Sound Test: RAI. TL69-117, 12-16-68 W6 -rt 91-14Z( t +e r ?-a Plastic Penetrating Item and Diameter 1-1/2", 2", 3" or 4" sched. 40 PVC pipe 4" sched, 40 PVC or ABS pipe Floor, Roof or Wall :. Type CW, CF CW, CF = + ' Minimum Depth Wrap, Type A or Type IA' Wrap, Type A or Type IA' Forming Material — — Minimum Varies 1/4" Maximum Varies Varies Rating F 2 2 T 1 2 UL System Number C -AJ -2301 C -AJ -2304 Reference ARL SA727 SA727 Index 79 80 1-1/2" or 2" sched. 40 PVC pipe CW, CF 1/2" Type IA Foam Backer 3/8" 3/4" 2 1-1/2 C -AJ -2295 SA727 81 or SDR17 CPVC pipe 1" Type 1A Foam Backer 1/4" 3/8" 2 1-1/2 3/4" PEX tube or 1" ENT CW, CF 1/2" Type A Foam Backer 1/4" 7/16" 2 1-1/2- C -AJ -2296 SA727 82 1-3/4 1" sched. 40 PVC pipe FSD 1"Type IA Foam Backer 1/4" 7/16" 3 1-1/2 F -A-2062 SA727 83 4" sched. 40 PVC pipe or CW, CF 1/2" Type IA Foam Backer 0" 1-1/2" 1 1 F -A-2063 SA727 84 4" SDR17 CPVC pipe or 4" sched. 40 PVC conduit 6" sched. 40 PVC or CF Wrap, Type A or Type IA' — Varies Varies 2-3 1-1/2- F -A-2064 SA727 85 6" SDR135 CPVC pipe 2-1/2 3" sched. 40 PVC or ABS plse bW Wrim,1/2"TypeIA : Foam Backer /2" ,1, . 1-1/2" sched. 40 PVC or ABS pipe WF 1/2" Type IA Foam Backer 0" 1" 1 1 F -C-2180 87 1-1/2" sched. 40 PVC or ABS pipe WF 1/2" Type IA Foam Backer' 0" 1" 1 1 F -C-2181 SA727 88 3" sched. 40 PVC pipe or WF 1/2" Type IA Foam Backer 0" 1/2" 1 1 F -C-2182 SA727 89 3" SDR17 CPVC pipe or 3" sched. 40 PVC conduit 4" sched. 40 PVC or sched. WF 1/2" Type IA Foam Backer 0" 1/2" 1 3/4 F -C-2183 SA727 90 40 ABS or SDR17 CPVC pipe 2" SDR13.5 CPVC pipe CW 1/2" Type IA Foam Backer 1/4" 1-3/8" 2 0 W -J-2068 SA727 91 2", 3" or 4" sched. 40 PVC pipe GW Wrap, Type A or Type IA' Vanes Varies 2 1 W -L-2220 SA727 92 Up to 4" sched. 40 PVC or GW Wrap, Type A or Type IA' — Varies Varies 1 0-1 W -L-2221 SA727 93 1-1/4" SDR135 CPVC pipe 6" sched. 40 PVC pipe GW Wrap, 1/4" Type A or — 0" 3/8" 2 1-1/2 W -L-2222 SA727 94 Type IA 2" SDR13.5 CPVC pipe GW 1/2"Type IA Foam Backer 1/4" 1-3/8" 1-2 1-2 W -L-2223 SA727 95 3/4" PEX tube or 1" EMT GW 1/2" Type IA Foam Backer 1/4" 3/8" 1-2 3M4 W -L-22224 " SA72? .# 1-1/2- • 1-3/4 • 1-1/2" sched. 40 PVC pipe GW 1"Type IA Foam Backer 1/4" 5/8" 2 2 W -L-2225 SA727 97 2" sched. 40 PVC pipe GW 1/2"Type IA Foam Backer 0" 7/8" 1 0 W -L-2226 SA727 98 (a) Pipe covering material (b) Minimum depth dependent upon annular space dimensions (c) Optional (d) Ceramic Liber (e) 2 -hr. wall (n 2 -hr. (two layers 718" backer rod); 1 -hr. (bond breaker tape) (g) Two layers 7/8" backer rod (h) Formerly Type A -SP 13 USG Fire Stop Systems Performance Selector Copper Penetrating Item and Floor, Roof or Wall Firestopping Material Forming Annular Space Rating UL System Reference Diameter Type Minimum Depth Material Minimum Maximum F T Number ARL Index Pipe up to 6" CW, CF 1" Type FC or RFC 3", min. 4 pcf 1/4" 4" 3 0 C -AJ -1081 SA727 45 Tubing and pipe up to 4" CW, CF 1" Type FC or RFC 3", min. 4 pcf 1/4" 4" 3 0 C -AJ -1081 SA727 46 Tubing and pipe up to 4" CW, CF 1/2" Type A 3", min. 6 pcf° 0" 7/8" 2 0 C -AJ -1347 SA727 47 Tubing and pipe up to 4" CW, CF 1" Type IA 4", min. 4 pcf 1/2" 1-3/8" 2 0 C -AJ -1348 SA727 48 Insulated tubing and pipe up to 4" CW, CF 1/2" Type A 4", min. 4 pcf 3/8" 1-1/2" 1-1/2-2 1/2-1 C -AJ -5146 SA727 49 Insulated tubing and pipe up to 2" CW, CF 1"Type IA Foam Backer 1/8" 1/4" 2 1 C -AJ -5147 SA727 50 Insulated tubing and pipe up to 4" CW, CF 1"Type IA 3-1/2", min. 4 pcf 1/2" 1-1/2" 2 1/2-1 C -AJ -5149 SA727 51 Tubing and pipe up to 4" FSD 1/2" Type A 4", min. 4 pcf 1/4" 1-5/8" 3 0 F -A-1020 SA727 52 Insulated tubing and pipe up to 4" FSD 1/2" Type A 4", min. 4 pcf 1/4" 5/8" 3 1 F -A-5014 SA727 53 Tubing and pipe up to 4" WF 1/2" Type IA Foam Backer 0" 7/8" 1 1/4 F -C-1069 SA727 54 Insulated tubing and pipe up to 4" WF 1/2" Type IA Foam Backer 0" 7/8" 1 3/4-1 F -C-5042 SA727 55 Tubing and pipe up to 4" CW 1/2" Type IA Foam Backer 0" 1" 2 0 W -J-1091 SA727 56 Pipe up to 6" GW 1"Type FC 2-1/2", min. 4 pcf 1" 1-5/8" 2 0 W -L-1027 SA727 57 Pipe up to 4" GW 1/2"Type FC or RFC 2-1/2", min, 4 pcf 1/4" 1-5/8" 1 0 W -L-1039 SA727 58 Tubing up to 4" GW 1" Type FC or RFC — 1/4" 1-5/8" 2 0 W -L-1063 SA727 59 to 4" GW 1" Type FCS ROC = 1/4" 1 ll4.a t , G. ' ` ._ v Insulated tubing up to 4" GW 1/4" Type FC or RFC 2", min. 4 pcf 1/4" 1/2" 2 1 W -L-5043 SA727 61 Insulated pipe or tubing up to 4" GW 1" Type FC or RFC 1", min. 4 pcf' 1/2" 5/8" 2 3/4 W -L-5044 SA727 62 Insulated tubing and pipe up to 4" GW 1"Type IA Foam Backer 0" 3/8" 2 1/2 W -L-5114 SA727 63 Insulated tubing and pipe up to 3" GW 1/2" Type IA Foam Backer 1/4" 1-1/8" 1-2 1/2-1 W -L-5115 SA727 64 Cables Cables CW, CF 1"Type FC or RFC 3", min. 4 pcf 1/4" 4" 3 0 C -AJ -3045 SA727 65 Cables CW, CF 1/2" Type IA 4", min. 4 pcf Varies Varies 2 0-1/2-1 C -AJ -3174 SA727 66 Cables CW, CF 1/2"Type IA 4", min. 4 pcf 3/4" 3-3/16" 2 1/2 C -AJ -3175 SA727 67 Cables WF 1/2" Type IA Foam Backer Varies Varies 1 3/4 F -C-3054 SA727 68 Cables GW 1"Type FC or RFC 3", min. 4 pcf 1/4" 4-1/2" 2 0 W -L-3023 SA727 69 Cables GW 1/2" Type FC or RFC 3-7/8", min. 4 pcf 1/2" 3-7/8" 1 0-1 W -L-3034 SA727 70 Cables GW 1/2"Type IA Foam Backer 1/2" 1-1/2" 1-2 1/4-1/2 W -L-3162 SA727 71 Cables GW 1/2"Type IA Foam Backer 1/4" 1" 1-2 1/4-1/2 W -L-3163 SA727 72 Air Ducts Steel duct, Nom. 18" x 6" CW, CF 1" Type IA 1", min. 4 pcf Varies 1" 3 0 C -AJ -7062 SA727 73 Steel duct, Nom. 4" CW, CF 1/2" Type IA 4", min. 4 pcf 1/2" 1-3/8" 2 0 C -AJ -7063 SA727 74 Steel duct, 24-ga., up to 3" x 10" GW 1/2" Type FC or RFC 2-1/2", min. 4 pcf 7/16" 1-5/8" 1 0 W -L-7001 SA727 75 Steel duct, 28-ga. galv., nom. 4" x 6" GW 1"Type FC or RFC 2-1/2", min. 4 pcf 1/2" 1-5/8" 2 1/2 W -L-7002 SA727 76 4", 26-ga., galv. steel vent duct GW 1/2"Type IA Foam Backer 0" 1" 1-2 0 W -L-7057 SA727 77 Glass Pipe Glass pipe, nom. N GW 1/2" Type IA Foam Backer 1/2" 1-1/8" 1 0 W -L-2227 SA727 78 (a) Pipe covering material (b) Minimum depth dependent upon annular space dimensions (c) Optional (d) Ceramic fiber (e) 2 -hr. wall (f) 2 -hr. (two layers 7/8" backer rod); 1 -hr. (bond breaker tape) (g) Two layers 7/8" backer rod (h) Formerly Type A -SP 12 USG Fire Stop Systems