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4170 Countryside DrC ITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21 -199, Eagan, MN 55121 PHONE: 454 -8100 BUILDING'PERMIT To be used for SF /CAR Signature of Permitee Building Official Est. Value $110,000 Site Address 4 Lot 1 Block 1 Sec /Sub COUNTRY ZO W Parcel No cc z 0 cc 0 cc WW r- W ¢ a W z rD cowman) 1? It RS, INC 1 Phone 461 -3381 Name Address City Name Address City Phone ° `'• Name Address City Phone I hereby acknowlege 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 Chip e(Eagan Ordinances. A Building Permit is issued to: INC on the express condition that all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Occupancy Zoning (Actual) Const (Allowable) # of Stories Length Depth S.F. Total S.F. Footprints On Site Sewage On Site Well MWCC System City Water PRV Required Booster Pump APPROVALS Planner Council Bldg. Off. Variance Receipt # C Date SEP 12 OFFICE USE ONLY 14-1 R--1 V.41 V-4 64 Y x X Bldg. Permit Surcharge Plan Review SAC, City SAC, MCWCC Water Conn Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment PI Road Unit Park Ded. Copies TOTAL FEES 675.00 I Pr. Disp. I Well Deck Final I [Deck Ftg. I 1 Bldg. Final Engr. /Plan I [Const. Meter I Final Plbg. I Final Htg. I Fireplace I I Isul. I Rough Htg. I Rough Plbg. I Roofing I Framing I [Foundation 1 I Footings I I Inspection Date ( Insp. m = C -13 Cl) < E m > WI . .- c , -I -4 0 m m m . c) 0 k //a .b\ , -N •••.., • . /r -z7p� /T /, 9 i2 1 ci \ I/ , y K 1k /9s - I //9 C...Ky I Permit No. 'N „ . Permit Holder Plbg. Inspector — Notify Plumber 1 s- y0 feo prrb /.) Awe/ e/P../ /` 1 / (4,4/ I"CY el,npc° Comments PC. �� CiLC i c:). /0 /z15'l>e' Date .17/2(''' r3a/ Telephone # J URE OF PERMITTEE CONTRACT PRICE Site Address Lot / Name City t 4' , V,1 D ->tpi Name Address City L Ake 7 FOR: CITY OF EAGAN PLUMBING PERMIT CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55122 PHONE 45481100 0 Sec /Sub r') Od R ,U c1� %�i y3 t `[rc i C..ctre- Phone ne 4-333/ FEES COMMJIND. FEE - 1% OF CONTRACT FEE APT. BLDGS. - COMM. RATE APPLIES TOWNHOUSE & CO NDO - RES. ,RATE APLLIES MINIMUM - RESIDENTEAL" FEE $12.00 MINIMUM - COMM.IND. /FEE $20.00 STATE SURCHARGE PER PERMIT .50 (ADD $.50 S/C PER EACH $1,000 OF PERMIT FEE) BLDG. TYPE Res. X Multi Comm. Other RES. PLBG. ONLY - COMPLETE THE FOLD FIXTUR Water Closet - $3.00 $ / Bath Tubs - $3.00 Lavatory - $3.00 Shower - $3.00 / Kitchen Sink - $3.00 Urinal/Bidet - $3.00 / Laundry Tray - $3.00 Floor Drains - $1.50 / Water Heater - $1.50 Whirlpool - $3.00 Gas Piping Outlets 41.50 (MINIMUM -1 PER PERMIT) Softener - $5.00 Well - $10.00 Private Disp. - $10.00 Rough Openings - $1.50 U. G. Sprinkler System - $12.00 PERMIT FEE: STAT S S/C: For Office Use Only PERMIT# / 585 9 RECEIPT # / 99' 2 / DATE: /9// //1 C� WORK DESCRIPTION New > Add -on Repair TQTAL: I NG: OTAL c 0 • SIGNATURE OF PERMITTEE - $24.00 6.00 CONTRACT PRICE: Site Address y/ � % Lot ` / / BIo k cr I L`Ck -t` • Name f � , "c tc1 as Address, / t(C; • r /.j City /11 /2 -4/14 MECHANICAL PERMIT CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55122 PHONE 454 -8100 TYPE OF WORK Forced Air / ,O( M BTU Boiler M BTU Unit Heater M BTU Air Cond. M BTU Vent. CFM Gas Piping Outlets # Other /e BLDG. TYPE Res. Mutt. Comm. Other PERMIT* / RECEIPT # DATE: / .,/ l For Office Use Only: WOR New Add -o Repair FEES RES. HVAC 0 -100 M BTU ADDITIONAL 50 M BTU (RES. HVAC INCLUDES A/C ON NEW CONSTRUCTION) GAS OUTLETS (MINIMUM -1 PER PERMIT) 1.50 EA. COMM /IND FEE - 1% OF CONTRACT FEE APT. BLDGS. — COMM. RATE APPLIES TOWNHOUSE & C,` QOS - RES_RATE APPLIES MINIMUM RESIDENTIAL FEE — ALL ADD -ON & REMODELS MINIMUM COMMERCIAL FEE STATE SURCHARGE PER PERMIT (ADD $.50 S/C IF PERMIT PRICE GOES 9E'Y ND *1,000) RE: DATE: OCT 18, 1990 410 COUNTRYSIDE DR (PIETSCH BUILDERS, INC) Your S, wer & Water Permit for the above property has been completed. It will be held at the Public Works Garage (3501 Coachman Road) until the meter is picked up. BE SURE TO CALL PUBLIC WORKS (454 -5220) FOR YOUR PERMANENT WATER TURN ON. Your Sewer & Water Permit for the above property cannot be completed for the following reasons: COMMERCIAL PROJECTS ONLY: Please pay for meter at City Hall. Meter size must be confirmed by Bill Adams or Dirk House (Plumbing' Inspectors — 454 -8100) before issuance. WARNING: BEFORE DIGGING, CALL LOCAL UTILITIES — TELEPHONE, ELECTRIC, GAS, ETC. REQUIRED BY LAW. CONTACT COMMUNITY DEVELOPMENT DEPARTMENT FOR WATER TURN ON POLICY. Secretary, Building, Inspections Dept. Your Sewer & Water Permit for the above property has been completed, but the meter cannot be issued or occupancy allowed until further notice. BUILDING PERMIT To be used for SF DWG /GAR CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21 -199, Eagan, MN 55121 PHONE: 454 -8100 Est. Value $110,000 SEP 12 N2 18363 Receipt # C 9907 Date 1990 Site Address 4170 COUNTRYSIDE DR Lot 1 Block 1 Sec /Sub COUNTRY HOLLOW Parcel No 2ND cc w z 0 0 Cc 0 U1- U� W F W W ¢z a Name Address City PIETSCH BUILDERS, INC 9543 BIRCH LN LAKEVILLE Phone 461 -3381 SAME Name Address City Phone Name Address City Phone I hereby acknowlege 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-�f Eagan Or ' ances,- --- . Signature of PermiteeL —"-� .1 / -% .�g [.d°!" A Building Permit is issued to PIETSCH BUITLDERS, INC on the express condition that all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Building Official rum 1\ ii j +II• Occupancy R -3 Zoning (Actual) Const (Allowable) # of Stories Length Depth S.F. Total S.F. Footprints On Site Sewage On Site Well MWCC System City Water PRV Required Booster Pump APPROVALS Planner Council Bldg. Off. Variance OFFICE USE ONLY M -1 R.L V —N V —N 64' 48' X X FEES Bldg. Permit 675.00 Surcharge 55 OD Plan Review 438.00 SAC, City 100.00 SAC, MCWCC 600.00 Water Conn 695.00 Water Meter 90.00 Acct. Deposit 30.00 S/W Permit 30.00 S/W Surcharge . 50 Treatment PI 252.00 Road Unit 355.00 Park Ded. Copies TOTAL 3,250.50 SEWER & WATER PERMIT CITY OF EAGAN 3830 Pilot Knob Rd. Eagan, MN 55122 -1897 DATE SITE ADDRESS LOT BLOCK SEC /SUB APPLICANT ADDRESS CITY, STATE ZIP PHONE: PLUMBER ADDRESS CITY, STATE ZIP PHONE OWNER: ADDRESS CITY, STATE ZIP PHONE OFFICE USE ONLY METER # / 4 .1a7 c7 CHIP # �! 7a 5b p / 2 PERMIT # / METER SIZE 1, /< B.P. RECEIPT # ISSUE DATE 1' 7 — y/ B.P. RECEIPT DATE PERMIT DATE PRV BOOSTER PUMP SEWER COMM IND NEW Lawn Sprinkler Meters are to be Installed Ahead of Domestic Meters on Water Line. Credit WILL NOT be given for Deduct Meters. I AGREE TO COMPLY WITH CITY OF EAGAN ORDIN NCES PERMIT REQUESTED WATER ___._ TAPS RESIDENTIAL EXISTING SIGNATURE WHEN METER ISSUED PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. CALL 454 -5220 FOR INSPECTIONS. FOR STORM SEWER PERMITS, CONTACT ENGINEERING DEPT. QIi rtif irar of ®rrupaurg (itp of Cagan Dryathi pttt of Bathing Juwrirtinu This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building Code certifying that at the time of issuance this structure was in compliance with the various ordinances of the City regulating building construction or use. For the following. Use Classification' rwc/CAR Bldg. Permit No. 18363 Occupancy TYPe Rix 41 Zoning Distin R1 Type Cono VN Owner of Buildin TSO1 BURS., 1. F-3 i - a,aa'° Address 4170 CflJP1IRXbfl E DRIVE J L 1, 13 r'l11]N1 ' rant? al 2ND Buodin Otfjcw e� POST IN A CONSPICUOUS PLACE Dates W _JJI/1 R 3(1, 1 • 'I SINGLE FAMILY DWELLINGS 2 SETS OF PLANS 3 REGISTERED SITE SURVEYS 1 SET OF ENERGY CALCULATIONS PENALTY APPLIES WHEN: Site Address Lot Parcel /Sub Owner Address City /Zip Code Phone Address Block Arch. /Engr. Address City /Zip Code Phone # LeVf Contractor / /2/,4 City /Zip Code /(/6J,/% Phone ft, V' X4343 1990 BUILDING PERMIT APPLICATION CITY OF EAGAN MULTIPLE DWELLINGS 2 SETS OF PLANS REGISTERED SITE SURVEYS - (CHECK WITH BLDG. DEPT.) 1 SET OF ENERGY CALCULATIONS # OF RENTAL UNITS # OF FOR SALE UNITS COMMERCIAL 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS 1 SET OF SPECIFICATIONS 1 SET OF ENERGY CALCS TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY LAST WORKING DAY OF MONTH IN WHICH REQUEST IS MADE. LOT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED. NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR /HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED. PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DAYS ONCE A PERMIT HAS BEEN COMPLETED. PERMIT MUST SHOW A LICENSED PLUMBER. To Be Used For:- Valuation: M),;l Date: Occupancy Zoning Actual Const Allowable # of stories Length Depth S.F. Total Footprint S.F. On site sewage On site well MWCC System City water PRV Booster Pump APPROVALS Planner Council Bldg. Off. Variance OFFICE USE ONLY R -3 M -1 R -1 V -N 6 ti8 118 3 . 0 RECO FEES Bldg. Permit Surcharge Plan Review SAC, City SAC, MWCC Water Conn Water Meter �r75, caa .55,00 4t38,00 6,00,00 425 goo 9o,00 Acct. Deposit 30,00 S/W Permit 3(),00 S/W Surcharge ,SZ Treatment P1. 22o0 Road Unit 355,0 0 Park Ded. Copies SUBTOTAL Penalty TOTAL te.AC 1Zx7�: Zyo ZZ y8y Z x 15= 10,e ,o -2-51 4-)( L= fo7 i t i x 19 244 J `3 x I 7342 1 -1o1-c5c 35►47 =° I(/j •'L ) w -\ . 15��X►_ 715776:5 PERMIT # 4731b Please complete for: RESIDENTIAL PLUMBING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55188 651 - 4675 ➢ single family dwellings ➢ townhomes and condos when permits are required for each unit ➢ backflow preventer for irrigation system SITE ADDRESS: I1D Cx ie ve OWNER NAME:: hr(!i ini( SO1 INSTALLER NAME: Oman Pict) ? (urnhi n STREET ADDRESS: 3L1J1 � chvl�w nV ta CITY: lteAr I �' Place a check mark next to the permit work type TELEPHONE #: TELEPHONE #: STATE: nil V RECEIPT DATE: ( 1-?5 - 01 (AREA CODE) qc - L t.e9 (AREA CODE) ZIP: Reminder: Be sure to schedule inspections of alterations, i.e. water heaters, water softeners, etc. 5O1-/L-1 I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable City of Eagan ordinances. It is the applicant's responsibility to notify the property owner that the City of Eagan assumes no liability for any damages caused by the City d w ing its normal operational and maintenance activities to the facilities constructed under this permit within City property /right -of- way /easement. SIGN TURE OF ' ER TTEE Updated 1/01 New residential dwelling unit under construction and not owner /occupied $ 90.00 Add -on, modification or alteration to existing dwelling unit, including: $ 50.00 • abandonment of septic system • new installation /repair /rebuild of RPZ • lawn irrigation system • water turnaround Nature of work: 1. fai f /o ht _ Septic System, new /refurbished - • includes County & Consulting Inspector fees • requires MPC license $ 225,00 State Surcharge $ .50 Total $ D 5-CD PERMIT # 4731b Please complete for: RESIDENTIAL PLUMBING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55188 651 - 4675 ➢ single family dwellings ➢ townhomes and condos when permits are required for each unit ➢ backflow preventer for irrigation system SITE ADDRESS: I1D Cx ie ve OWNER NAME:: hr(!i ini( SO1 INSTALLER NAME: Oman Pict) ? (urnhi n STREET ADDRESS: 3L1J1 � chvl�w nV ta CITY: lteAr I �' Place a check mark next to the permit work type TELEPHONE #: TELEPHONE #: STATE: nil V RECEIPT DATE: ( 1-?5 - 01 (AREA CODE) qc - L t.e9 (AREA CODE) ZIP: Reminder: Be sure to schedule inspections of alterations, i.e. water heaters, water softeners, etc. 5O1-/L-1 I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable City of Eagan ordinances. It is the applicant's responsibility to notify the property owner that the City of Eagan assumes no liability for any damages caused by the City d w ing its normal operational and maintenance activities to the facilities constructed under this permit within City property /right -of- way /easement. SIGN TURE OF ' ER TTEE Updated 1/01 Date 1 O / 1 5 / 200 "4 Construction Cost �' Site Address y 176 Co v tvr RY S I DE l' R I VC Unit /Ste # Description of Work D &Ck \bDRIC) Multi - Family Bldg _ Y Y N Fireplace(s) _ 0 _ 1 _ 2 Property Owner Det w 9 Nilo M T � w Telephone # ( CS 1 ) I4S IF 9 7 X Contractor E bECk 9- DYZ Coi rAMK Address \\C2 A kt?oty Pc V G t , City I u V U to taVE HE (Gi State M Zip c30 77 Telephone # (G)) 22-4509 va la New Construction Requirements 3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and all roofed areas (20% maximum lot coverage allowed) 2 copies of plan showing beam & window sizes; poured found design, etc. 1 set of Energy Calculations 3 copies of Tree Preservation Plan if lot platted after 7/1/93 Rim Joist Detail Options selection sheet (bldgs with 3 or less units 2004 RESIDENTIAL BUILDING PERMIT APPLICATION City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651- 675 -5675 FAX # 651- 675 -5694 Remodel /Repair Requirements 2 copies of plan 1 set of Energy Calculations for heated additions Recd 1 site survey for additions & decks Tree#�resRegmeed : _.._ Addition - indicate if on -site septic system 0a -uite Septic Sy tern COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Energy Code Category (-1 submission type) Minnesota Rules 7670 Category 1 • Residential Ventilation Category 1 Worksheet Submitted • Energy Envelope Calculations Submitted Have you previously constructed a building in Eagan with a similar plan? Y fee applies. Licensed Plumber Telephone #( Mechanical Contractor Telephone # Sewer /Water Contractor Telephone # bft-rci lA tai &lu 00#0 urvey Recd:: _ Y h Tree PresP[an Minnesota Rules 7672 • New Energy Code Worksheet Submitted cup N If so, 25% plan review 2004 J _JI I hereby apply for a Residential Building Permit and acknowledge that the information is c e and acc>rate; that the work will be in conformance with the ordinances and codes of the City of lagan -awe Staris 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. M Oct OP-1 Applicant's Printed Name Applicant's Signature Sub Types ❑ 01 Foundation ❑ 07 05 -piex ❑ 13 16 -piex ❑ 20 Pool ❑ 30 Accessory Bldg ❑ 02 SF Dwelling ❑ 08 06 -piex ❑ 16 Fireplace ❑ 21 Porch (3 -sea.) ❑ 31 Ext. Alt- Multi ❑ 03 01 of _ plex ❑ 09 07 -piex ❑ 17 Garage ❑ 22 Porch /Addn. (4 -sea.) ❑ 33 Ext. Alt - SF ❑ 04 02 -piex ❑ 10 08 -plex X 18 Deck ❑ 23 Porch (screen /gazebo) ❑ 36 Multi Misc. ❑ 05 03 -piex ❑ 11 10 -piex ❑ 19 Lower Level ❑ 24 Storm Damage ❑ 06 04 -piex ❑ 12 12 -piex Plbg_Y or _ N ❑ 25 Miscellaneous Work Types ❑ 31 New ❑ 32 Addition 0. 33 Alteration ❑ 34 Replacement *Demolition (Entire Bldg) - Give PCA handout to applicant Valuation f %` 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) _ Final/C 0 Footings (deck) ( Final/No C.O. Footings (addition) _ Plumbing Foundation _ HVAC Drain Tile Other Roof _ Ice & Water Final Pool Ftgs _ Air /Gas Tests _ Final Framing Siding Stucco Stone — Brick Fireplace _ R.I. _ Air Test _ Final Windows Insulation Retaining Wall Approved By: f , 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 OFFICE USE ONLY ❑ 35 Int Improvement ❑ 38 Demolish Interior ❑ 44 Siding ❑ 36 Move Building ❑ 42 Demolish Foundation ❑ 45 Fire Repair ❑ 37 Demolish Building* ❑ 43 Reroof ❑ 46 Windows /Doors SINGLE FAMILY DWELLINGS 2 SETS OF PLANS 3 REGISTERED SITE SURVEYS 1 SET OF ENERGY CALCULATIONS 91 G PERMIT APPLICATION CITY OF EAGAN MULTIPLE DWELLINGS COMMERCIAL 2 SETS OF PLANS 2 SETS OF ARCHITECTURAL REGISTERED SITE SURVEYS & STRUCTURAL PLANS (CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFICATIONS 1 SET OF ENERGY CALCULATIONS 1 SET OF ENERGY CALCS # OF RENTAL UNITS # OF FOR SALE UNITS PENALTY APPLIES WHEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY LAST WORKING DAY OF MONTH IN WHICH REQUEST IS MADE. LOT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED: NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED. PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DAYS ONCE A PERMIT HAS BEEN COMPLETED. PERMIT' MUST SHOW A LICENSED PLUMBER. To Be Used For: DEC-K, Site Address 4 4 ) COUi.tnejSIDE D/?IUE Lot I Block Parcel /Sub (a 'r{ 1(o - ) 2 *., - t, M ary Owner t )VNIA) M A Address City /Zip Code Phone Contractor Address City /Zip Code Phone Arch. /Engr. Address City /Zip Code Phone Sewer/Water Licensed Contr. Valuation: '� Date: f 7'. 3 () FEES Occupancy Bldg, Permit Zoning Surcharge ,Actual Const Plan Review Allowable SAC, City # of stories SAC, MWCC Length Water Conn. Depth Water Meter S.F. Total Acct. Deposit Footprint S.F. S/w Permit S/W Surcharge On site sewage Treatment P1. On site well Road Unit MWCC System _ Park Ded. City water Trail Ded. PRV Copies . fD Booster Pump APPROVALS Planner Council Bldg. Off. QS Variance SUBTOTAL Penalty Lot Change TOTAL agrees that all work shall be done in accordance with (Signature of Contractor) all applicable State of Minnesota Statutes and City of Eagan Ordinances. New Construction Reauirements • 3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and aII roofed areas (20% maximum lot coverage allowed) • 2 copies of plan showing beam & window sizes; poured found design, etc.) • 1 set of Energy Calculations • 3 copies of Tree Preservation Plan if lot platted atter 7/1/93 • Rim Joist Detail Options selection sheet (bldgs with 3 or less units) DATE 3v u -72- VALUATION SITE ADDRESS i f( 70 C4-)c," 't- , .‘di itiA TYPE OF WORK Re APPLICANT AN co Q- !`crOC .¢ 5 \cl - 5 STREET ADDRESS G5 IZdee c-` e. 8( vc. CITY STATE/NN ZIP TELEPHONE # 9sa 19'1 S03( CELL PHONE # FAX # PROPERTY OWNER De \0 f ekc svt--) Energy Code Category (� submission type) Plumbing Contractor: Plumbing system includes: Mechanical Contractor: Mechanical system includes: Sewer/Water Contractor: RESIDENTIAL BUILDING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB RD, EAGAN MN 55122 651 -681 -4675 COMPLETE THIS SECTION FOR ••NEW RESIDENTIAL BUILDINGS ONLY MINNESOTA RULES 7670 CATEGORY 1 • Residential Ventilation Category 1 Worksheet Submitted • Energy Envelope Calculations Submitted Phone # Water Softener _ Lawn Sprinkler _ Water Heater _ No. of R.I. Baths No. of Baths Air Conditioning Heat Recovery System OFFICE USE ONLY Remodel/Repair Requirements • 2 copies of plan • 1 set of Energy Calculations for heated additions • 1 site survey for exterior additions & decks • Indicate if home served by septic system for additions MULTI - FAMILY BLDG _ Y _ N FIREPLACE(S) — 0 — 1 — 2 TELEPHONE # /Yd 75 MINNESOTA RULES 7672 • New Energy Code Worksheet Submitted Phone # Phone # Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required Fee: $90.00 Fee: $70.00 I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. / 9 Signature of Applicant 9 Pp � Si Updated 4/02 OWNER: •EXTERIOR ENVELOPE AVERAGE "U" COMPUTATION SITE ADDRESS: CONTRACTOR: j-- DETERMINE WORKING SQUARE FOOTAGE OF EACH: 1. TOTAL EXPOSED WAI:,I:, AREA i SQ. FT. X 2. TOTAL ROOF /CEILING AREA /56 SQ. FT. X 3. TOTAL EXPOSED WAI:, AREA CALCULATIONS: Total exposed wall area above floor DATE: i) Total net foundation area above grade Total foundation area (exposed) h) Total foundation window area a) Total wall window area 195k3 SQ.FT. X "U" v? = 30t/ b) Total door area x, 7 SQ.FT. X "U" :,O7 c& c) Total sliding glass door area . t ) ,0 SQ.FT. X „U" _ 3f,Z d) '.[ otal fireplace wall area SQ . F`.0 . X , 'U" _ 0 e) Total wall framing area Z7c4, SQ.FT. X "U" r07 = 21-.3 (average 10 %) f) Total net wall area above ,_ eo4: SQ.FT. X "U" X 3 _ ibil'r I floor (insulated) g) Total rim joist area If item #3 is the same as, or less than item #1, you have met the intent of 2 MCAR 1.16008 A and 0. 264 < 3`53 PAGE 1 r / ,11 PHONE: 1 ( � / -�� _ I 7 i7:1 Z ?`r .; SQ.FT. X „U„ Lf = 1 ?P j SQ.FT. SQ.FT. X " = 10.6 SQ.FT. X "U" wt = TOTAL a) through i _ 1 Z64 1e 4 : TOTAL EXPOSED ROOF /CEILING CALCULATIONS: Total exposed roof/ l0 SQ.FT. ceiling area rr\\ j) Total skylight area SQ.FT. X "U" k) Total roof /ceiling framing area (average 10 %) 1) Total net insulated roof/ceiling area 4. TOTAL j) through 1) _I !,,%T,I i If total of #4 is the sane as, or less than #2, you have ,met the intent of 2 MCAR 1.16008 A and 0. ALTERNATE BUILDING ENVELOPE DESIGN To utilize the total envelope system method, the values established by the sum of #3 and *4 shall not be greater than the sum of items #1 and #2. 1. +2. +4. CERTIFICATION (Signature (Date) PAGE 2 fC3, SQ.FT. X "U" r6 = F39) , `"I j _ SQ.FT: X " � >? = «J %/ ) I hereby certify that I have calculated the "U" factors and "R" values herein and that the building here described meets or exceeds the State of Minnesota Energy Conservation Act. 4, t) This agreement, COUNTRY HOLLOW SECOND ADDITION PRESSURE REDUCING VALVE AGREEMENT 954870 made and entered into the _ day of 1990, by and between the CITY OF EAGAN, a municipa'•ity of the State of Minnesota, (hereinafter called the City), and the Owner and Developer identified herein. The terms "Developer" and "Owner" as used herein refer to: PROGRESS LAND COMPANY, INC. whose address is 14300 Nicollet Court, Suite 235, Burnsville, Minnesota 55337. WHEREAS, the Developer has applied to the city for approval of the plat or subdivision known as COUNTRY HOLLOW SECOND ADDITION, located within the City; and WHEREAS, the Owner and Developer agree to notify the proposed potential buyers of all lots within COUNTRY HOLLOW SECOND ADDITION that Lots 1 -4, Block 1, Lots 1 -17, Block 2 and Lots 1 -10, Block 3 are in a high water pressure zone and a pressure reducing valve shall be installed in each home below the elevation of 875 feet. All costs shall be the responsibility of the Buyer and shall be installed to prevent damage due to high water pressure. NOW, THEREFORE, the City, Owner and Developer agree as follows: 1. Recording. This agreement shall be recorded with the Dakota County Recorder so as to provide notice to the owners of Lots 1 -4, Block 1, Lots 1 -17, Block 2, and Lots 1 -10, Block 3. The Owner shall provide and execute any and all documents necessary to implement the recording of this agreement. New Add Rep. Request D / - -5 > / - Fire No. Rough -in Inspection Required? ,,,e Yes ❑ No .. ❑ Ready Now„�CI Will Notify Inspector When Ready? ,P Iiicensed contractor Di owner hereby request inspection of above electrical work at: Job Address (Street, Box or Route o.) i Home City Section No.. Township Name or No. Range No. l County / L & i i E y Occupant ($FyNT ��-` -_ & ,< — ) Phone No. Power tier ter` c --G " C €ie- Address . ^• . /yI��.� �_ Dryer Electrical ntractor (Company Name) Contr - 's License No. Mailing Address ( ntractor or Owner Making Installation) . -- ° -- < Authorized t gnature (Contractor/Own alon Installation) y Phone Number lG+,V New Add Rep. Type of Building Appliances Wired Range X Equipment Wired Temporary Service Home Duplex Water Heater Electric Heating Apt. Building Dryer Other (Specify) Comm. /Industrial Furnace Farm Air Conditioner Other (specify) Contractor's Remarks: Compute Inspection Fee Below: Other Fee # Service Entrance Size Fee # Circuits /Feeders Fee Swimming Pool 0 to 200 Amps "` 0 to 100 Amps Transformers Above 200 Amps Above 100 Amps Signs Inspe ctor's Use Only: THIS INSTALLATION MAY BE ORDERED DISCONNECTED COMPLETED WITHIN 18 MONTHS. TOTAL ( K Irrigation Booms Special Inspection IF NOT Alarm /Communication Other Fee /, -(/ I, the Electrical Inspector, hereby certify that the above inspection has been made. Rough - in / Date Final �� Date - OFFICE USE ONLY .. - This request void 18 months from MINNESOTA STATE BOARD OF ELECTRICITY Griggs- Midway Bldg. — Room S -173 1821 University Ave., St. Paul, MN 55104 Phone (612) 642 -0800 REQUEST FOR ELECTRICAL INSPECTION See instructions for completing this form on back of yellow copy. X" Below Work Covered by This Request THIS INSPECTION REQUEST WILL NOT BE ACCEPTED BY THE STATE BOARD UNLESS PROPER INSPECTION FEE IS ENCLOSED. 2. Notice. The recording of this document shall constitute notice to all owners and future owners of property in the COUNTRY HOLLOW SECOND ADDITION subdivision that Lots 1 -4, Block 1, Lots 1 -17, Block 2, and Lots 1 -10, Block 3 are in a high water pressure zone and that a pressure reducing valve shall be installed in each home below the elevation of 875 feet. All costs shall be the responsibility of the Buyer and shall be installed to prevent the damage due to high water pressure. 3. Validity. If any portion, section, subsection, sentence, clause, paragraph or phrase of this agreement is for any reason held to be invalid, such decision shall not affect the validity of the remaining portion of this Contract. 4. Binding Agreement. The parties mutually recognize and agree that all terms and conditions of this recordable agreement shall run with the land herein described and shall be binding upon the heirs, successors, administrators and assigns of the owners and developers referenced in this Contract. IN WITNESS WHEREOF, we have hereunto set our hands. CITY OF E (Date: By: -Or00 % .rstel CG.1 ) Its: Mayor Its: PPCS/ / T11 mas A. Attest: . J. VanOverbeke Its: erk OWNER AND DEVELOPER: PROGRESS LAND COMPANY, INC. By: Its_ _ Request Date ,0/ I censed contractor 0 owner hereby request inspection of above electrical work at: Job Address (Street, Box or Rob No.) Section No. 76 C _.c)Ct Township Name or No. Range No Occupant (TT Power Electri Contractor (Company Name) Mailing Addres (Contractor or Owner Making Installation) ' 75 Aut,0 Signature (Contractor /O ner Making Installation) Fire No. Rough -in Inspection Required? s 0 N f ❑ Ready Now r ill Notify Inspector When Ready? Phone No. Address i' Contractor's License No. 0 Phone Number MINNESOTA STATE BOARD OF ELECTRICITY Griggs- Midway Bldg. — Room S -173 1821 University Ave., St. Paul, MN 55104 Phone (612) 642 -0800 Compute Inspection Fee Below: Other Swimming Pool Transformers Signs Irrigation Booms Special Inspection Alarm /Communication Other Fee Fee I, the Electrical Inspector, hereby certify that the above inspection has been made. Appliances Wired e Heater i ce onditioner Remarks: Service Entrance Size 0 to 200 Amps Above 200 Amps Inspector's Use Only: Fee EquipmentWired Temporary Service Electric Heating Other (Specify) Circuits /Feeders 0 to 100 Amps Above 100 Amps TOTAL 5 - (,) 6 THIS INSTALLATION MAY BE ORDERED DISCONNECTED W NOT COMPLETED WITHIN 18 MONTHS. Final Rough -in Fee Date / OFFICE USE ONLY This request void 18 months from REQUEST FOR ELECTRICAL INSPECTION lok See instructions for completing this form on back of yellow copy. "X" Below Work Covered by This Request THIS INSPECTION REQUEST WILL NOT BE ACCEPTED BY THE STATE BOARD UNLESS PROPER INSPECTION FEE IS ENCLOSED. New Add Rep. Type of Building Rang Home Wate Duplex Apt. Building Dryei Furni Comm. /Industrial Air C Farm Other (specify) Contractors Request Date ,0/ I censed contractor 0 owner hereby request inspection of above electrical work at: Job Address (Street, Box or Rob No.) Section No. 76 C _.c)Ct Township Name or No. Range No Occupant (TT Power Electri Contractor (Company Name) Mailing Addres (Contractor or Owner Making Installation) ' 75 Aut,0 Signature (Contractor /O ner Making Installation) Fire No. Rough -in Inspection Required? s 0 N f ❑ Ready Now r ill Notify Inspector When Ready? Phone No. Address i' Contractor's License No. 0 Phone Number MINNESOTA STATE BOARD OF ELECTRICITY Griggs- Midway Bldg. — Room S -173 1821 University Ave., St. Paul, MN 55104 Phone (612) 642 -0800 Compute Inspection Fee Below: Other Swimming Pool Transformers Signs Irrigation Booms Special Inspection Alarm /Communication Other Fee Fee I, the Electrical Inspector, hereby certify that the above inspection has been made. Appliances Wired e Heater i ce onditioner Remarks: Service Entrance Size 0 to 200 Amps Above 200 Amps Inspector's Use Only: Fee EquipmentWired Temporary Service Electric Heating Other (Specify) Circuits /Feeders 0 to 100 Amps Above 100 Amps TOTAL 5 - (,) 6 THIS INSTALLATION MAY BE ORDERED DISCONNECTED W NOT COMPLETED WITHIN 18 MONTHS. Final Rough -in Fee Date / OFFICE USE ONLY This request void 18 months from REQUEST FOR ELECTRICAL INSPECTION lok See instructions for completing this form on back of yellow copy. "X" Below Work Covered by This Request THIS INSPECTION REQUEST WILL NOT BE ACCEPTED BY THE STATE BOARD UNLESS PROPER INSPECTION FEE IS ENCLOSED. STATE OF MINNESOTA ) ss. COUNTY OF DAKOTA ) On this a S% day of a , 1990, before me a Notary Public within and for said County /f personally appeared THOMAS A. EGAN and E. J. VanOVERBEKE to me personally known, who being each by me duly sworn, each did say that they are respectively the Mayor and Clerk of the City of Eagan, the municipality named in the foregoing instrument, and that the seal affixed on behalf of said municipality by authority of its City Council and said Mayor and Clerk acknowledged said instrument to be the free act and deed of said municipality. 'HD' sc: *t PSNi+lti ad: tst M , c ^,TA STATE OF MINNESOTA ) ss. COUNTY OF 1`.r_� On this Public within appeared personally , k they ai'e - and- foregoing instrument, No't�ary �P blic day of , 1990, before me a Notary and for said County, personally - r j -s4 (r (( r , -end-- to me who being - wach..by me duly sworn, each- did say that respcctivcly. the E t ';t (1 l _ of the corporation named , and that said instrument was signed __ &1 c on behalf of said corporation by authority of its Board of Directors and said �r 5 ; Cttl - acknowledged said instrument to be the free act and deed of the corporation. Notary Pu in the Address: 4170 COUNTRYSIDE DRIVE Lot 1 Elk 1 Sec /Sub COMM HOLLOW 2ND These items were /were not complete at the time of the final inspection. DATE: NOVFMRRR 30, 1990 Yes No INSPECTOR: i .,. Final grade (6" from siding) y7 Permanent steps - garage ' � Permanent steps - main entry V' Permanent driveway p� Permanent gas Sod /seeded grass Trail /curb damage j' e1, Porch Basement finish is m r ` Deck V Please verify with the builder the removal of roof test caps from the plumbing system and the shut -off of water supply to the outside lawn faucet before freeze potential exists. White - City copy Yellow - Resident copy Pink - Contractor copy APPROVED AS TO FORM: f City Atto ,Dated: APPROVED AS TO CONTENT: 04-4-6A1 Public Wo Department Dated: l h, /9F0 THIS INSTRUMENT WAS DRAFTED BY: SEVERSON, WILCOX & SHELDON, P.A. 600 Midway National Bank Bldg. 7300 West 147th Street Apple Valley, MN 55124 (612) 432 -3136 MGD o t' /F. HILTS' H E:LIILDERS INL.. EL i 110 plftiN�IFOx an14F1ti wN�►I�tG��N� COMPnNY ttvC. IUt1U CAST 14 onh STREET, nURFUEVILLf:, MINNESOTA WS! rvey ( 3 -;a) DENOTES EXISTING ELEVATION (535,0) DENOTES prtOPOSED ELEVATION Ate INDICATES 011150110N OW sunrAcE D!1AiN """Ni"." va FINISHED OATIAGE noon sr.EVAT1914 SZ-7 2.tz BASEMENT FLOOR ELEVATION 0 , :k. TOP OF BLOCK ELEVATION sca.LE 1 is 6ge 30' ©' F,ev/V r tirL p // SE7 L./AO OR4 /A446e' AND 417/1./Ty 8 0 1 3 .7 56 ,.! 3'6?() 11-5:0‘,7 1:16APAII; p of Hot -' (&�t�` /fin T03.0,0 i*i I 1 1 bb 85 and described hsrearr. As prepared by err ibis' 3o stay nt r-- _.. hj� yr,f"p 9 -r� -9d F4, IMP t/D ' E 11 J 1+.147 Hi! .�J�_!1 1 • r ef PH 4DZ•ttt)ta I" W Mtnn , I1a. 1 (ers, 1 13 0 N t �1 (8zs" , C3z}.I7) 1 hereby certify Innt this 1• a title nod aanreal tepteeetttatintt of a+ trent ui inrrr! ern +Ircrwn ,19.. SaAU?tt'd 301 ifdL. EL - rnati£ ENGLIGCRLG CoMpfltlV INC. t lu�tlaevl1,>+1� , µlFlNEBata t ae T I �4 a m Stray, Gertlflca e ,� , o��n p[�lT!n'� t i tt : o 1, etocx 1 CovA/ rgY` �WLLOW 5R:6 :Dm) 9c t -�- alveo 4 couN7Y, M+► d ag ) DENOTES EXISTING ELEVATION ( P5?�5, G`) DENOTES PROPOSED ELEVATION INDICATES O111ECTION OIL 9%JE sACE DDA%NAGV 01 FINISHED OAfA(E noon ELEVATION SZ-7.(o BASEMENT FLOOR ELEVATION P35.fiLeval TOP OP BLOCK ELEVATION .5i)9 6F4 ap K � R�Ar� p wC (A3o. 6� D' FRUN7r gv /Lb // 5E 7 RAae, PR.I. RE ..J;]..;,(-,.71AII ENtGINEERJNG DEPT OR/1 /A/A ANC> n 911'411111V an lA 'tikl11V6Vans ,r+ a -, rir 4•i-4 II . _ 1 / 40.1)/14 1.147. 56351 rvey 32/4-, PI{ ADZ. %0 --- Wm, new I le, 0 (,) hl 21,0 O N 85' ° 8' 31 85,0 ($z (; ) I hereby oettlly the% ibis 1s n true and correct tehtee tttntlntt of at %Tont of Intid no shown And described hst•ot►. P paeratetl byme en 11►10' play of __44(.£ RE'vi 94/ -90 Ft- ' PAID N Gt . '�6 / pRvivr ,g30//..p/A/6, eg„ Ahs Y;+:;AGAIN EN GIN EERING DEpT A 1.1 t I EL I_ //frione l? : EtioitiGenitio COMPIIf NY INC. ' 140Th elliEET, tiUnFIRVILLE • tAINHEG , Gertifica e 0 rvey kegaLagitcd_riatisqui tor 1, 01._0c,/e / ) CoVArTRY i.I 0 LLO W gg.C.:AJD APP/7/ Oki, (2,411<`07-11 CouNITY ) tvi 11,105507A . DENOTES EXISTING ELEVATION (55,0) DENOTES PrIOPOSED ELEVATION —4---- INDICATES D11150TION Oil StinrAce DtiAINAGI _,3.5.3.104 FINISHED 0 AnpmE rl_0011 ELEVATI914 f3Z-7,6,10:1 BASEMENT FLOOR ELEVATION P35.4_12_60 TOP Or BLOCK ELEVATION MALE t I' at ZIO' .5ott 6pAr-g .54 6PAPe Cit 30, 6) OR4 bv,el 6g A NO 6./71 t. / 7" Y A 5& r— P R.V. R F r"--) t • 1 hereby oerilty Ilint thin end desavlbad hewn, Isol 9-// -9 /c4 trap : • 1 4 • 1 . ,52/4 56 clz•Vacto N 69° 8 3i" W 85 , 00 o 0 0.4 moo 1 81 21,1 lz.ob - 34: Q3,3 filri 1 APAGe PRomr,e-G) sso Hot."‘ Iv z Lfc 0 N _,E 1,) a) (t3z5, noi). Ito, hpf35 632.5.0 ls n Wu* mid aortnot teptneettInlInt1 of n %Toot of Int nt rtItoWn plinpatnti by 'me on %Ills ó þ ò ÿþ ÿÿ þýý üþþÿÿûò ÿþ ãü ù ëì ÿù ýüûúùø ã üúùø à õàðøñ øü ã ü ãååâüøù Þÿ ýÝü ÷ ñø äñ ñ Ýü ñ û ñ éò ÿøÿ þò ò ñÿ ÿ øéãò ò øò é ã ûñö Ýü ûù ÿòñù ñ é ÷æåÜæéíëéåëí øü ýü ÿ êüæåÜæéîéîí êüþé ÷ö ùõô øø ñùñ ãô åãü ù ôø ôõííå ÿôõíí èìçå ûùÿ ä øø ò ñ ÿ ñøù øøûý òô ýü ãùò ÿâ é øøà ñýÿü üùýÿü PERMIT City of Eagan Permit Type:Building Permit Number:EA150057 Date Issued:06/19/2018 Permit Category:ePermit Site Address: 4170 Countryside Dr Lot:1 Block: 1 Addition: Country Hollow 2nd PID:10-18276-01-010 Use: Description: Sub Type:Reroof Work Type:Replace Description:Does not include skylight(s) Census Code:434 - Residential Additions, Alterations Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Please print pictures of ice and water protection and leave on site. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Building Code). Valuation: 4,000.00 Fee Summary:BL - Base Fee $4K $103.25 0801.4085 Surcharge - Based on Valuation $4K $2.00 9001.2195 $105.25 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Debra K Mattson 4170 Countryside Dr Eagan MN 55123 Minnesota Exteriors 8600 Jefferson Hwy Osseo MN 55369 (763) 391-5514 Applicant/Permitee: Signature Issued By: Signature