4190 Countryside DrParcel Files Cover Sheet
Unique ID: 4034
4190 Countryside Dr
101827503001
EXTE IOR Et ELOPE AVERAGE "U" COMPUTATION
•
OWNER: 411. l if s _ ..,
SITE ADDRESS:
CONTRACTOR: � �� • - �_ DATE: 3 ic7 PHONE: 4
1. TOTAL EXPOSED WALL AREA
2. TOTAL ROOF /CEILING AREA
3. TOTAL EXPOSED WALL AREA CALCULATIONS:
Total exposed wall
area above fioor
a) Total wall window area:
glazed
glazed
Total foundation
window area
1) Total net foundation
area above grade
DETERMINE WORKING SQUARE FOOTAGE OF EACH:
//6a
sg ftx "U"
q
sq ft
ftx "U"
sg ftx "U"
sq ft x "U"
b) Total door area 37. 77$ sq ft x "U" / 3 a ' i1.9//
c) Total sliding glass door area:
/1 •
/V glazed a' G4`' sq ft x
glazed sq ft x
d) Total fireplace wall area e _7 4 7 / sq ft x
e) Total wall framing area
(Average 10)
Total foundation
area (Exposed) ����
1►us,
1101*
a/.76/ sq ft x "U"
sq ft
sq ft x "U" ,y<"
sq ft x "U"
„gam 4 =5 1 )
--t.(2.2kL .( =v
Je c
4/1
f) Total net wall area above
6 „ floor (Insulated) . (// sq ft x . "U" .093 a ' - 7Q y3
q) Total rim Joist area ?//.667 sq ft x "U" , per/ g S
802
TOTAL a) thru 1)
�'�' • ‘l r/‘
If item N3 is the same as, or less than item fl, you have met the intent of
S.B.C. Section 6006 (c) 2.
5.94/0
OD
New
Add
Rep.
, Type of Building
Appliances Wired
Equipment Wired
Y Home
s
Occupant (PRINT)
da5-7 i m 'e<�. (
t
Date
I �'
Range
Addre
Temporary Service
Electrical Contractor (Company Name)
s�frr� ii
12.
Contractor's License No.
r7cfsS
Duplex
Autthcjiizye(Cut/actor/Owner J e (Cttr�acc�tor /Owner Making Installation)
(71.1 s r
Water Heater
Above 200 A
Lighting Fixtures
31 to 100 Amps
Apt. Building
31 to 100 Amps
Dryer
Electric Heating
Above 100 Amps
Commercial Bldg.
Furnace
Silo lirtloader
Transformers
Industrial Bldg.
Air Conditioner
Partial- Othe
Bulk Milk Tank
Signs
Farm
S ction
Other (Specify)
T OTAL
/ E
Other (Specify)
Other (Specify)
Other
Other
Rough -in
., /
.
_,
r .
-10
^
Date
s a S
[ - m 7
I, the El tri
Inspector, hereby
certify that the above
nspection has been
made.
Final
s
Occupant (PRINT)
da5-7 i m 'e<�. (
t
Date
I �'
Request Date
/.
., /
.
Fire No.
etpugh -in Inspection Yees s
FMequi O No
Township Name or
Ready Now owil Notify InsPec-
for When Ready
Street Address, Box or Route No.
I MO e6c1n ide Qr
r Fee
City
Ore n
Section No.
Township Name or
Range No.
#
County
Occupant (PRINT)
da5-7 i m 'e<�. (
t
Phone No.
U3/ 5
Power Supplier
j /4/<, q ZkeYrie ASV)
Addre
Electrical Contractor (Company Name)
s�frr� ii
12.
Contractor's License No.
r7cfsS
Mailing Address (Contractor or Owner Making Instailation)
7L7 S` J. / 3 ° L5,9l/A6 e 7
/
Autthcjiizye(Cut/actor/Owner J e (Cttr�acc�tor /Owner Making Installation)
(71.1 s r
Above 200 A
Phone Number /
. ``�' 6 3 62
#
r Fee
I ServiceEntranceSize
#
Fee
Feeders /Subfeeders
#
Fee
Circuits
t
/Zoc
0 to 20 Amps
0 to 30 Am s
12.
� . .:.a.
0 to 30 Amps
Above 200 A
31 to 100 Amps
31 to 100 Amps
Swimming Pool
Above 100 Amps
Above 100_Amps
Transformers
Irrigation Booms
,57:::.
Partial- Othe
Signs
S ction
(f
7 a �
�'
T OTAL
/ E
Remarks p
This request void 7 , "/
18 months ths from ,
D 2137 �
18 t 1'3 1, ')?"-
Licensed Electrical Contractor
Owner
MINNESOTA STATE BOARD OF ELECTRICITY
Griggs- Midway Bldg. — Room N -191
1821 University Ave.. St. Paul, MN 55104
Phone (612) 642 -0800
This request void 18 months from
I hereby request inspection of above
electrical work installed at:
42-5fS7 REQUEST FOR ELECTRICAL INSPECTION
See instructions for completing this form on back of yellow copy.
"X"' Below Work Covered by This Request
77
THIS INSPECTION REQUEST WILL NOT
BE ACCEPTED BY THE STATE BOARD
UNLESS PROPER INSPECTION FEE IS
ENCLOSED.
EB - 06
rf ; 5'7
TOTAL EXPOSED ROOF/CEILING CALCULATIONS:
Total exposed
roof/ceiling area //6 sq ft
j) Total skylight area
k) Total roof /ceiling framing 1/6
area (Average 109;) sq ft x "U" .•v X7 /32
1 ) Total net insulated
roof /ceiling area sq ft x "U" .6)2c1..
If total of #4 is the same as, or less than 112, you have met the intent of
S.B.C. Section 6006 (c) 1.
ALTERNATE BUILDING ENVELOPE DESIGN
To utilize the total envelope system method, the values established by the sum
of items P3 and 114 shall not be greater than the sum of items P1 and 112.
1. + 2.
3. + 4.
C E R T I F I C A T I O N
q ft x "U"
is
TOTAL J) thru 11
i hereby certify that 1 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.
(Signature)
1.2c.s-.;4
&/ ...7.---
63476 6 _
_. ,,.
Fire No.
i
/.00///
g .,1/.. °/5
Request Date
6 � / `�°�f
J /!
r ou g -in Inspection
"equired?
G. Yes L J eY
eady Now I] Will Notify Inspector
When Ready?
1 sec contractor L owner hereby request inspection of above electrical work at:
Job Address (Street, Box or Route No.)
ll
City
Section No.
Township Name or No.
Range No.
County
Occupant (P T)
Phone No.
/
Power Supplier
Address
Electrical Contractor ompan ame)
Contractor's License No
4/j 2/
Mailing AdContractor or Makin tallation) ,
Authorized Sign (Contr .or /Own r Making Installation)
Electric Heating
Phone Num r, 357
New
A '
k ,i.
' " Type of Building
Appliances Wired
Equipment Wired
Home
Range
Temporary Service
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
1
0 to 100 Amps
Transformers
Above 200 Amps
Above 100 Amps
Signs
I nspector's Use Only:
THIS INSTALLATION MAY BE ORD
COMPLETED WITHIN 18 MONTHS.
"
�� U�
- I • CONNECTED
TOT - �t�
J
Irrigation Booms
Special Inspection
IF NOT
Alarm /Communication
Other Fee
I, he 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
MINNESOT7( STATE BOARD OF ELECTRICITY
Griggs- Midway Bldg. — Room S -173
1821 University Ave., St. Paul, MN 55104
Phone (612) 642 -0800
,5*/9P -_ REQUEST FOR ELECTRICAL INSPECTION
P. See instructions for completing this form on back of yellow copy.
X" Below Work Covered by This Request
J 63476
THIS INSPECTION REQUEST WILL NOT
BE ACCEPTED BY THE STATE BOARD
UNLESS PROPER INSPECTION FEE IS
ENCLOSED
06.//1
CntISTRUCT I t1N R VALUE
WALL FRAMING SECTION:
(1 interior air film
'-42 2J sIr
3 & inch. s soft wood
4 lc, t z i
(5 'V Rs L.' L O
A Exterior a i r f i l m
• WALL SECTION (INSULATED)
( 1 Interior a i r f i l m 0•611
(2
(3 a .J✓S /r�.Oo,,/
R
5 ` y es ,eOu
Exterior air film
RIM JOIST SECTION:
(1 Interior a r film n,6R
(2 .'/
i3 /a ,?1/t /• Rcl
(4 'Wy RiW'R, 2- 0
5 72e" ct, 00 SAGI •
fi Exterior air fi 0.17
TOTAL R 9 cS'O
U•1 /R.,O`//
FOUNDATION SECTION:
1 Interior air film
2 Ccu fvr
4 Exterior air film
(5
(6
SLAB ON GRADE
0.6n
.2/
0.17
TOTAL R • /COP
U• 1 /R• ,•r19 /
n 7
TOTAL R - ; 3, /C
U • 1/R • &Pya
TOTAL R • /,9 ' 1''
U • 1/R • .l)8a
♦ - •• I . • • • Q • s � � is • t' c ` d '
t
'
.d
. , , 4 d I . ••. ` • ' , , • • ,
Ag
• ,40.5(1.
�
•:.. x
. 4 4,. .
i
A Q. .•. ,Q . '• • ,�
,• 4 , • ...
• 1 • /
/.7v/ / .
F 66406,;.) / ( ._
Fire , `
No.
>
/
i'/ u,—.
ugh -in Inspection
equired?
f8. 173 No
i -C' 5
��//�
El Ready Now CWCAW Notify Inspector
When Ready?
Request Date I .
t &G / 3 / O G+ '7
I 0 licensed contractor Downer hereby request inspection of above electrical work at:
Job Address (Street, Box or Route No.)
1/49c) ,,,: /z „4: AZ.
City
64
Section No.
Township Name or No.
Range No.
County
DA' ItO 7
Occupant (PRINT)
jtr)klui = ; 36. 2 j C
Phone No.
68'x— 7831
Power Supplier
L ' *horn & t'°]z.1 G
Address s f
riepfz.,,,, /V C, Tv”
Electrical Contractor (Company Name)
— 6-Z T
Contractor's License No.
Mailing Address (Contractor or Owner Making Installation)
0 (7d o c.• A,/Ti+2 y S' l D�
O iL < Er -c -s.-)
tallation)
Phone Number
6f8 k 283/
Authorize ig ture (Contractor /Owrfer Making 1
'° C o
New
Add
Rep.
Type of Building
Appliances Wired
Equipment Wired
Home
Range
Temporary Service
Duplex
Water Heater
Electric Heating
Apt. Building
Dryer
Other (Specify)
Comm. /Industrial
Furnace
Farm
Air Conditioner
Other (specify)
Cont actor's Remarks:
i3. am iE NT 'F 15 ti
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
Inspector
Use Only:
TOTAL
0 5
Irrigation Booms
Special Inspection
Alarm /Communication
Other Fee
I, the Electrical Inspector, hereby
certify made. that the above inspection has
been
Rough - in / '
Det+E /s r
Final
ifoi�
'
TN
Datt-
- .- 2g -slO
OFFICE USE ONLY
This request void 18 months from
MINN 9A STATE BOARD OF ELECTRICITY
Gri idway 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.
EB- 00001 -07
/ o
l■h, 10
o 0 0
AIR VENTED
FLOW
�j,/ `.•1� Y. WY1r�)�ti.� • �� Z7�L^:ti.�.'s� ✓ixL`t ^�1�'��r
Al Ail
0
VENTED
CENSTRUCTIntl
CEILING SCCTiOtl ( INSULATED):
1 Interior air film n.Al
2 S /k' , CY
3 t 4 i 6' o ° t•''
4 Exterior air film (still) n.h1
TOTAL R • y 'Z.16D
CEILING FRAMING SECTION:
1 Interior air film
2 5
3 n-`Pt
4 Interior air film
5
n.61
3/.170
(still) - n.m
inches soft wood •y. 3(
CEILING SECTION (INSULATED): 0.61
1' Interior air film
2
3
4 Exterior air film (still) 0.61
TOTAL R •
1 , Inside air film
2
3
4
S Outside air film
U 1 /R•
TOTAL R • 37. &°
u . 1 /Rtl7
U• 1 /Rd
CEILING FRAMING SECTION:
1• Interior air film 0.
2
3 Exterior air film (still) 0.61
5 inches soft wood
TOTAL R •
U= 1 /R
n.17
TOTAL R
U• 1 /R•
R VALUC.
n.61
1) PROPERTY ADDRESS:
2)
3)
4) IM
5)
6)
LEGAL DESCRIPTION
IF EXISTING STRUCTURE, DATE OF ORIGINAL BUILDING PERMIT ISSUANCE:
PRESENT ZONING /PROPOSED USE:
1 COMMERCIAL/RETAIL /OFFICE
1 INDUSTRIAL
1 INSTITUTIONAL /GOVERNMENT
I LiCANTI
CITY, STATE, ZIP: BURNSVILLE, MINNESOTA 55337
*PILL
NAME:
ADDRESS:
CITY, STATE, ZIP:
PHONE:
V ' ,OWNERI
NAME:
ADD ESS:
CITY, STATE, ZIP:
PHONE:
INDI4 1r
l` = = SIGNA
SEWER AND /OR WATER CONNECTION
city of eagan
PHONE: 890 -4868
c o CONNECTION TO CITY SEWER
APPLICATION FOR PERMIT
(PLEASE PRINT)
4190 COUNTRY SIDE DRIVE, EAGAN
(Lot /Block /Subdivision or Tax Parcel ID #)
11
NAME: KLAMM MECHANICAL CONTRACTORS, INC.
ADDRESS: 12409 COUNTY ROAD #11
KLAMM MECHANICAL CONTRACTORS, INC.
12409 COUNTY ROAD 4,11
BURNSVILLE, MINNESOTA 55337
890 -4868 MASTER LICENSE # 00599M -5
14133 SHADY BEACH TRAIL N.E.
PRIOR LAKE, MN. 55372
431 -5205
I !WHICH! PERMITftIS+k BE NC t
'ls
Pil
:NOTE: PAYMENT OF ILE AT TIME OF *
* APPLICATION DOES NOT CON- *
,* STITUTE APPROVAL OF PERMIT.
* *
: INSPECTION OF SEWER AND /OR WATER :.
: INSTALLATIONS WILL NOT BE SCEDULED :
: UNTIL PERMIT HAS BEEN APPROVED. :
******* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
(Month /Year)
R -1 SINGLE FAMILY
El R -2 DUPLEX (Two Units)
! R -3 TOWNHOUSE (Three + Units) ( Units)
R -4 APARTMENT /CONDOMINIUM ( Units)
For City Use
Plumbers License:
Active
Expired
Not recorded
Staff Initial
CONNECTION TO CITY WATER n OTHER
12 -01 -87
ED KLAMM JR. - OPERATIONS MANAGER
* *
* THE GOLD COPY OF THE PERMIT WILL BE SENT DIRECTLY TO PUBLIC WORKS TO FACILITATE METER PICK -UP.
* PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. SOMEONE FROM THE CITY WILL CONTACT YOU IF THERE
* ARE ANY PROBLEMS.
* * * * * * * * * * * * * * * * * * * * * * * ** ** , t**************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *4
PERMIT # ISSUED
FOR CITY USE ONLY
Pd w /Bldg. Permit // FEES:
$ �C $ 10.0 SEWER PERMIT (INCLUDE SURCHARGE)
$ )C $ /���" WATER PERMIT (INCLUDE SURCHARGE)
$ (O - 7(4D X $ WATER METER /COPPERHORN /OUTSIDE READER
$ $ WATER TAP (INCLUDE CORPORATION STOP)
$ $ SEWER TAP
0 ACCOUNT DEPOSIT - SEWER
ACCOUNT DEPOSIT - WATER
$ � ZS ' v ) $ WAC
$ � � 2- S efi $ SAC
$ $ TRUNK WATER ASSESSMENT
$ $ TRUNK SEWER ASSESSMENT
$ $ LATERAL BENEFIT /TRUNK SEWER
$ LATERAL BENEFIT /TRUNK WATER
$ WATER TREATMENT PLANT SURCHARGE
OTHER:
TOTAL
$/.- :7)&46/
RECEIPT #
I l
I 1 NO
$:15).ao
7 5 2
RECEIPT #
DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
YES IF YES, THEN A "PERMIT FOR WORK WITHIN PUBLIC
ROADWAY" MUST BE ISSUED BY THE ENGINEERING
DIVISION. LIST AS A CONDITION.
SUBJECT TO THE FOLLOWING CONDITIONS:
APPROVED BY: C ,11- 7 , Q)
C €
TITLE: /
DATE: /2/ f /47
WORK DESCRIPTION
NEW CONST \�
ADD ON X
REPAIR
CITY OF EAGAN
3830 PILOT KNOB ROAD
EAGAN, MN 55122
PHONE: (612) 454 -8100
OWNER NAME: N.:(9//k Ar 'e'ci<'
SITE ADDRESS: 4i/ F10 ‘ Q T4 / (f..
LOT:_ BLOCK / SUBD.
INSTALLER: . A' a;ete .e./ Er�/3.TJ % �2 .�/�/'�►
ADDRESS: ;342" ' 7 'ft)
CITY: CA/ Cie 4 ZIP: S1-
PHONE #: 174
PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS &
TOWNHOMES /CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
CONTRACT PRICE:
OWNER NAME:
SITE ADDRESS:
LOT: BLOCK SUBD.
INSTALLER•
ADDRESS:
° CITY: ZIP:
PHONE #:
FOR:
CITY OF EAGAN
TOTAL:
FOR CITY USE ONLY
PERMIT #
RECEIPT # 10/5
DATE: e/9,71
FEES
ADD -ON MINIMUM $15.00
HVAC 0 -100 M BTU 24.00
ADDITIONAL 50 M BTU 6.00
GAS OUTLETS - MINIMUM 3.00
OF 1 PER PERMIT
SUBTOTAL:
STATE SURCHARGE:
TOTAL:
4 , 1 #124 4
ITT
SIGNATURE OF PE EE
095- 9-w 9i
; PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL /INDUSTRIAL BUILDINGS,
APARTMENT BUILDINGS, AND MULTI- FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE
NOT REQUIRED FOR EACH DWELLING UNIT.
FEES
1% OF CONTRACT FEE.
STATE SURCHARGE — $.50 FOR
EACH $1,000 OF PERMIT FEE.
PROCESSED PIPING — $25.00
$25.00 MINIMUM FEE.
CONTRACT PRICE x 1%
STATE SURCHARGE
(SIGNATURE)
SINGLE FAMILY DWELLINGS
2 SETS OF PLANS
3 REGISTERED SITE SURVEYS
1 SET OF ENERGY CALCS.
. TIPLE DWELLINGS RENTAL UNITS
1989 BUILDING PERMIT APPLICATION
CITT OF EAGAN
1
TIPLE DWELLINGS 1 .4) /
2 SETS OF PLANS
REGISTERED SITE SURVEYS -
(CZECH, WITH BLDG DIV.)
1 SET C CALCS.
NOTE ADD8ESSE3 Fee CORNER LOTS - CONTRACTCM/BOMEOWNER MUST DESIGNATE REICH ADDRESS
IS DESIRED. H0 ORANGES WILL > SE ALLOWED ONCE BUILDING PERMIT IS ISStJ1DD..
SEWER & WATER PERMIT FRES AND ACCOUNT DEPOSIT FEES WILL BE INCLUDED KITH THE BUILDING
PERMIT FEE. PROCESSING TIME FOR SEWER AND WATER PERMITS I3 TWO DAIS ONCE A PERMIT HAS
BEEN COMPLETED INDICATING A LICENSED PLUMBER.
PENALTY APPLIES WHEN: PERMIT IS NOT PAID FOR IN SAME MONTH IT IS REQUESTED.
LOT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED.
To Be Used For: JS 1E n fJ t-) Valuation:
Site Address y I MO Counlr►2ys;+c;= bP
Lot 3 Block
Parcel /Sub Gouwr1Z. ��c.�}
Owner J ff- 0-5 7 (Z. 4
Address 0, Cov.Q sins DJ
City /Zip Code e4-6;A / Z3
Phone ? - 7f / (ij) 7.25 --5 .247/
Contractor
Address
City /Zip Code
Phone
Areh./Engr.
Address
City /Zip Code
Phone di
FOR SALE UNITS
Coil
Bldg. Off.
Variance
# OF ITS .,_,_,.1••.....
OFFICE USE ONLY
Occupancy FEES
Zoning
Actual Const Bldg. Permit
Allowable Surcharge
# of stories Plan Review
Length SAC, City
Depth SAC, MWCC
S.F. Total Water Conn
Footprint S.F. Water Meter
Acct. Deposit
On site sewage S/W Permit
On site well S/W Surcharge
MWCC System Treatment P1.
City eater Road Unit
PRY required Park Ded.
Booster Pump Copies
SUBTOTAL
APPROVALS Penalty
Planner TOTAL
Date: DEceM5eg, . 13, 1 159
t (S�
R u -V
COMMERCIAL
2 SETS OF ARCHITECTURAL
& STRUCTURAL PLANS
1 SET OF SPECIFICATIONS
1 SET OF ENERGI CALCS.
DATE: d 7 _ 9j
COMPLAINT TAKEN BY: Z,Jr 4g,tw_o_4.67
NAME:
ADDRESS: 1
COMPLAINT:
a
SIGNED:
ACTION TAKEN:
COMMENTS:
TYPE OF BUILDING:
RECORD OF COMPLAINT
/L1Q-e--
PHONE NO.: L t ) 7,3 ' 6 Fe- 2 3 f
LEGAL DESCRIPTION:
t 'l - k—o—c- 12 -- 66"--X--- )1e)
Q
r
Site
Lot
Parc
cc
. o
0a
cc
W W
W
Z
_
c
¢ Z
aW
BUILDING PERMIT
To be used for
aC /C pc( tyttn,ty vb.
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21 -199, Eagan, MN 55121
PHONE: 454 -8100
Receipt #
Address 4190
Block
Sec /Sub.
el No.
Name
Address
City Phone
Name X1 — /1.5 - 3.7
Address JjjE1(-
City Phone
Name
Address
City Phone
cc
W
z
O
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.
Signature of Permittee
Date
On Site Sewage
MWCC System
On Site Well
City Water
APPROVAL'S
Assessments
Water /Sewer
Police
Fire
Engr.
Planner
Council
Bldg. Off.
APC
Variance
OFFICE USE ONLY
Occupancy
Zoning
Type of Const it
(Actual)
(Allowable)
# of Stories
Length
Depth
S.F. Total
Footprint S F.
FEES
Permit
Surcharge
Plan Review
SAC, City
SAC, MWCC
Water Conn
Water Meter
Road Unit
Treatment P1
Parks
Copies
TOTAL
A Building Permit is issued to 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
Permit No.
Permit Holder
Date
Telephone*
Plumbing
g /
"=- C�.t,,,rct�vt
cXs7
i i
//4//
dam, ,�, 2',
/,--1-//3/8V
X
H.V.A.C•
'6' '7
/ 1
) t-,LL`C e_t,
(// 7
_
Electric
,9 / 7 /
_ .J-
/a� / ?'l
eY
$3C>
Svfmnd,
/C(G
c
/
o t - ,7',;1Zc'ur
/4 / " 9
Inspection Date
Insp.
- Comments
Footings I
96
Footings II
Foundation
7_y_
.= A
Framing
A9, �..,i
/
v4j
J/
Roofin
0?0,9 '°
Rough Plbg.
J(:' . g-y'
4
4.. - - 6
" f) /r,d
Rough Htg.
I3o�V
A,
p �7
/O - 9 $ Ail. . ,+.I.. txti ai%- alai
1'
Isul.
/G ' q/07
ef)
Fireplace
,v,_.57
. {.
Final Htg.
Final Plbg.
a494?
Liz
PRV REQUIRED
Bldg. Final
X /ri.
D.
i3 ` O szczego
Cert. Occ.
,/ e
,Qs; —
C,,raec, ,- /O-2 c CG 1)-S
Temp. LP
�'��• �li� r i/ `,' ✓e _ /
Deck Ftg.
Deck Frmg.
Well
Pr. Disp.
ATURE OF PERMITTEE
WORK DESCRIPTION
ite Address *S!,/ 9n
of Block
r .r.� 1/re*
Name leer! 1,8
Address e
City
ONTRACT PRICE:
Name
Address
City
TYPE OF WORK
Forced Air
Boiler M BTU
Unit Heater M BTU
Air Cond. M BTU
Vent CFM
Gas Piping Outlets #
Other
va t S'O D
Sec /Sub
Phone
1 ' 7.7 - FIf his
,et MECHANICAL PERMIT
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55122
PHONE: 454 -8100
0
BLDG. TYPE
Res.
Mult.
Comm.
Other
FOR: CITY OF EAGAN
* PERMIT# '
RECEIPT # 7 7
DATE: '' /, 7/�$
New
Add -on
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) .:.
COMM /IND FEE - 1% OF CONTRACT FEE
APT;BLDGS: £ M RMTE A 'LIE y _ _
TOWNHOU ESOS --R
MINIMUM RESIDENTIAL FEE — ALL ADD -ON &
REMODELS
MINIMUM COMMERCIAL FEE
STATE SURCHARGE PER PERMIT
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND $1,000)
- $24.00
6.00
12.00
20.00
.50
1.50 EA.
Site Address h i 19 Gc. 4 RySIDE
Lot 3 Block 1 Sec /Sub
COunrt Ho4.w44.)
Name ...‘oN R0576E-26
Address X1 110 GouNToy sip
City EA GA N Phone & - 746
12.5-
CON7faiT
PRICE
c
0
Name
Address
City
FOR: CITY OF EAGAN
t PLUMBING PERMIT
i.174/i.;%8 CITY OF EAGAN
830 PILOT KNOB ROAD, EAGAN, MN 55122
PHONE 454 -8100
SAME
Phone
DE,
FEES
COMMJIND. FEE - 1% OF CONTRACT FEE
APT. BLDGS. - COMM. RATE APPLIES
TOWNHOUSE & CONDO - RES. RATE APLLIES
MINIMUM - RESIDENTIAL 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)
1
361
BLDG. TYPE
Res. X
Mult.
Comm
Other
For Office Use Only
PERMIT # //s45�nn
RECEIPT #�)U c�•
DATE:
` /.
WORK DESCRIPTION
New
Add -on
Repair
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
NO. FIXTURES TOTAL
Water Closet - $3.00 $
Bath Tubs - $3.00
I Lavatory - $3.00
_I_ 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 - $1.50
(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:
STATES S /C:
GRAND TOTAL:
WORK DESCRIPTION
New X
Add -on
Repair
CONTRACT PRICE:
Site Address 4190 CO
Lot
as
c
1)
c
0
Name
Address
FOR: CITY OF EAGAN
Block /
chain
PLUMBING PERMIT
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55122
PHONE: 454 -8100
d4 Dr.
Sec /Sub
Con to
2409 County Road #11
City Burnsville Phone 890-4868
STATE S /C:
GRAND TOTAL:
Name
Address
City Prior LAk Phone 431 - 5205
FEES
COMM /IND FEE - 1% OF CONTRACT FEE
APT. BLDGS - COMM RATE APPLIES
TOWNHOUSE & CONDO — RES. RATE APPLIES
MINIMUM - RESIDENTIAL FEE - $12.00
MINIMUM - COMM /IND FEE , "- $20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND $1,000.00)
BLDG. TYPE
X
Mult.
Comm.
Other
RES. PLBG. ONLY COMPLETE THE FOLLOWING:
TURES TOTAL
Water Closet FIX $3.00 $ 4 r` f:3
1 Bath Tubs - $3.00 3. czci
Lavatory - $3.00
4 . Shower - $3.00
1 Kitchen Sink - $3.00
1 Urinal /Bidet - $3.00
Laundry Tray $3.00
1 Floor Drains - $1.50
1 Water Heater- $1.50
Whirlpool - $3.00
Gas Piping-Outlets T $1.50. g 2
(MINIMUM -`1 PER PERMI
Softener - $5.00
Well - $10.00
Private Disp. - $10.00
3_Rough Openings - $1.50
FEE:
d K
l / -zold
; f- ':.k -nN S ;'Z �' i.�. .': y"yr:."
CITY OF EAGAN f
454 -8100
DEPT. OF BUILDING INSPECTIONS
Correction Notice
Located at /
I have this day inspected this structure and
these premises and have found the followin g
violations of city codes governing same:
/ )
7 / /c 2 PS'S
I II f' clo //
'
a h 11; e — ca,
Inspector City of Eagan
DO NOT REMOVE THIS TAG
When corrections have been made, please
call 454 -8100 for inspection.
Date
2 --8-S7
8.21$7
gT1f Q
gAGAN , p r r c 4 n
34130 Knob Road B/P No: 76661
P.O. Box 21 99 t
Eagan, 55121
Owne
Site Address: 41+4
Plumber 1G iG81
MWCC:
City Chg: 100. t?i�lpd
Acct Dep: 15
Permit Fee: 10. 00pd
Surcharge: ' ¢Pti
Misc
Zoning
No. of Units
1 agree to comply 1
Ordinances.
By
SEWER PERMIT
`.
interior Air film
Exterior Air Film
Interior Air Filar
Exterior Air Film
Interior Air Film
Exterior Air Film
GUIGCLIIIC TO (R) FACTORS rr'.o: I .,In;F itt,:zUAL
Of T YP I CAL.LY USL t) - i'I:c)i'UCTS
(tl,,lls)
(Wails)
(Vented C e i l i n g )
(Vented C e i l i n g )
(item Vented)
(lion Vented)
Aluminum Siding
Aluminum with Backer
Aluminum with Backer 6 Foiled
1/2 x 8 Lap Siding (Wood)
7/16 x 12 Hardboard Siding
Asbestos Sidings 1/4 Lapped
Stucco (Broom and Finish Coat)
3/4 Wood Subfloor or Sheathing
1/2" Plywood Sheathing
1/2" Particle Board
All Windows
(w /Storms 1" to 4" Space)
Removal Double Glazing (RDG)
Thermo or welded 3/16" air space
1/4 air space
1/2" air space
(other windows specifically tested
8" Concrete Block (S 6 G Reg.)
12" Concrete Block (S L G Reg.)
8" Light Weight
12" Light Weight
WOODS:
Fir, pine 6 similar soft floods 1
2 1�2" 1.89
3 1/2" 4.35
5 1/2" 6.87
1 3/4 Solid core door
w /storm, wood
w /storm, metal
Pease StcclDoor Inst /N /GL 7.458
Sliding Glass Door, Wood
Metal
(R)
u Gt
0.17
0.61
0.61
0.61
0.17
0.61
1 .82
2.96
0.81
0.67
0.21
0.94
0.62
0.66
Filled
(R) Vermiculite
1.11 1.93
1.28 3.15
2.18 5.03
2.48 5.82
Insulation:
Insulation:
Insulation:
NOTE:• (U) x Area Square Feet •
• 440u
.56
.55
.69
.65
.58
can use better ratings)
.46
.31
. 26
. 13
.65
.715
Gypsum or plaster hoard
Gypsum or plaster hoard
Gypsum or plaster board
Plywood 3/8"
Plywood ywood 1 /2"
Plywood 3/4"
Built-up Roofs
Asbestos-cement shingles
Asphalt roll roofing
Asphalt Shingles
BLOtl1 NG WOOLS
Approx. 3"
Approx. t+ 1/2"
Approx. 6 1/4"
Approx. 7 1/4"
Approx. 14"
Approx. 18"
All other insulation
verified (R Factor)
3/8"
1/2"
5 /8"
Q <,a
Sheathing, rcg. dcnslty 1/2" /.3A
Sheathing, rcg. density 25/32";"
Nail -base sheathing 1/2"
2 -2 3/4" Fiberglass
3 1/2" Fiberglass
6" Fiberglass
0:,
0.A
0.5
0.1
0.4
0,1
1.?
2.0
1.1
0.
0.;
0.,
0.
9.
13.
19.
24.
30.
40.
materials must be
Date 1 7 / lP / 0 S
-k-r
e!.
Construction
'Lc
Cost
Site Address LI I g a Co
Unit/Ste #
Description of Work N e. & c - 0
F-
- C 00
Multi- Family Bldg _ Y . j.--N
Fireplace(s) 1
# 1 2
Property Owner o n e54
Telephone # (65) ) 64
- 7 g 3
Contractor pi e c 4-
00
S
-r c> cA k. o ✓'\
Address 9 ttc omo<c1,,...3,
4"
1-4 E
Cit MpLS .
State M nl
Zip 5 (3
Telephone # V7Z.- 7 8 '/ ` 03 O
New Construction Reouirements
3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and gljroofed 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 (buildings with 3 or less units)
2005 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651 -675 -5675 FAX # 651-675-5694
A cant's gnature
Remodel/Repair Requirements
2 copies of plan
1 set of Energy Calculations for heated additions
1 site survey for additions &decks
Addition - indicate if on-site septic system
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
— Energy Code Category Minnesota Rules 7670 Category 1
• Residential Ventilation Category 1 Worksheet
(J submission type) Submitted
• Energy Envelope Calculations Submitted
Have you previously constructed a building in Eagan with a similar plan?
fee applies.
Licensed Plumber Telephone #(
Mechanical Contractor Telephone #( )
Sewer /Water Contractor Telephone #(
Minnesota Rules 7672
New Energy code Worksheet
Submitted
N If so, 25% plan review
I hereby apply for a Residential Building 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 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 pl • ns.
Sub Types
❑ 01 Foundation
❑ 02 SF Dwelling
❑ 03 01 of _ plex
❑ 04 02 -plex
❑ 05 03 -plex
❑ 06 04 -piex
Work Types
❑ 31 New
❑ 32 Addition
❑ 33 Alteration
❑ 34 Replacement
Valuation
Census Code
SAC Units
# of Units
# of Bldgs
Type of Const
_ Footings (new bldg)
_ Footings (deck)
Footings (addition)
Foundation
Drain Tile
Roof _ Ice & Water _ Final
Framing
Fireplace _ R.I. _ Air Test _ Final
Insulation
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
❑ 07 05 -piex ❑ 13 16 -piex ❑ 20
❑ 08 06 -plex ❑ 16 Fireplace ❑ 21
❑ 09 07 -piex ❑ 17 Garage ❑ 22
❑ 10 08 -plex ❑ 18 Deck ❑ 23
❑ 11 10 -piex ❑ 19 Lower Level ❑ 24
❑ 12 12 -piex Plbg_Y or _ N ❑ 25
❑ 35
❑ 36
❑ 37
Int Improvement
Move Building
Demolish Building*
Approved By: , Building Inspector
Pool
Porch (3 -sea.)
Porch /Addn. (4 -sea.)
Porch (screen /gazebo)
Storm Damage
Miscellaneous
❑ 38 Demolish Interior
❑ 42 Demolish Foundation
❑ 43 Reroof
*Demolition (Entire Bldg) - Give PCA handout to applicant
Occupancy
Zoning
Stories
Sq. Ft.
Length
Width
REQUIRED INSPECTIONS
Final/C.O.
Final/No C.O.
Plumbing
HVAC
MCES System
City Water
Booster Pump
PRV
Fire Sprinklered
❑ 44
❑ 45
❑ 46
Other
Pool _ Ftgs _ Air /Gas Tests _ Final
Siding _ Stucco — Stone _ Brick
Windows
Retaining Wall
❑ 30 Accessory Bldg
❑ 31 Ext. Alt - Multi
❑ 33 Ext. Alt - SF
❑ 36 Multi Misc.
Siding
Fire Repair
Windows /Doors
SINGLE FAMILY DWELLINGS
INCLUDE 2 SETS OF PLANS) 3 CERTIFICATES OF SURVEY, 1 SET
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR /HOMEOWNER MUST DESIGNATE WHICH ADDRESS
IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
MULTIPLE DWELLINGS - RESIDENTIAL RENTAL UNITS FOR SALE UNITS
INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SURVEY - CHECK WITH BLDG. DEPT.,
1 SET OF ENERGY CALCULATIONS
COMMERCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTTRAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF
ENERGY CALCULATIONS,
$2,000 LANDSCAPE BOND
To Be Used For:
Site Address q ‘
Lot 3 Block I
Parcel /Sub 6'f,6/YL4/' WO-0
Owner
Address
City /Zip Code
Phone
L ae /I /.'J /J
Address / Zia/ z� f
Cit /Zip Code £/'7 Ale ,..<11a
-
Phone 445/5 � ,Ql s-
Arch. /En r.
Contractor
Address
City /Zip Code
Phone #
ill/5 -6376
1987 UILDI PERMIT APPLICATION CITY OF EAGAN
7
On Site Sewage
MWCC System
On Site Well
City Water
APPROVALS
ssessments
Water /Sewer
Police
Fire
Engr
Planner
Council
Bldg Off
APC
Variance
CALCULATIMS
Occupancy
Zoning 1
Type of Const
(Actual)
# of Stories
Length
Depth
S.F. Total
Footprint S.F.
FEES
Permit
Surcharge
Plan Review
SAC, City
SAC, MWCC
Water Conn
Water Meter
Road Unit
Treatment P1
Parks
Copies
TOTAL as 5
s3.
ioo.00
szs. oo
525.00
1 7.00
506.00
!Moo
2
MODEL HOME — NO Q.0. UNTIL CITY OF EAGAN
PLANNING Oils. �- 14073
3830 Pilot Knob Road, P.O. Box 21 -199, Eagan, MN 55121
PRV REQUIRED PHONE:454 -8100
BUILDING PERMIT Receipt* /L Lai
To be used for SF DWG /GAR Est. Value $110,000 Date AUGUST 21 , 19 87
Address 4190 COUNTRYSIDE DR
3 Block 1 Sec /Sub. COUNTRY HOLLOW
el No.
Name CUSTOM HOME REALTY
Address 14133 SHADY BEACH TR NE
City PRIOR LK Phone 445 -6376
SAME
Name
Address
City Phone
Name
Address
City Phone
gnature of Permittee
ad this application and state
• etocom•Iywith'al1:pplicable
Al. samui
I Cy of E: r n Ordina ces.
Site
Lot
Parc
cc
w
z
0
cc
. 0
z l-
t
1-
ow
W
F W
z
U
,
a
1 hereby acknowledge that I ha e
that the information is corre
State of Minnesota Statut
Use Classification
SL`s
Occupancy Type Zoning District
Owner of Building
Building Address
Building Official - -°
POST IN A CONSPICUOUS PLACE
On Site Sewage
MWCC System
On Site Well
City Water
APPROVALS
Assessments
Water /Sewer
Police
Fire
Engr.
Planner
Council
Bldg. Off.
APC
Variance
Trrttftratr of (rrupanrj
(Citp of (tartan
Bldg. Permit No.
Type Const
Date (1)OV¢rvlOC[
OFFICE USE ONLY
Occupancy
Zoning
Type of Const
(Actual)
(Allowable)
# of Stories
Length 51.5
Depth
S.F. Total
Footprint S.F.
X
Erportmrnt of Butthing 3nsprrtton
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;
E
FEES
Permit
Surcharge
Plan Review
SAC, City
SAC, MWCC
Water Conn.
Water Meter
Road Unit
Treatment P1
Parks
Copies
TOTAL
R3
Rl
d
V
/18.0
Si $225
A Building Permit is issued to: OME REALTY 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
$ 533.50
55.00
266.75
100.00
525.00
525.00
67.00
305.00
180.00
For Office Use
.'iii ,,® Permit#:
s. '® .„ ,ted
E AG A N
,,, 0
Permit Fee: C%
Date Received:
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651)675-5675 I TDD:(651)454-8535 I FAX:(651)675-5694 Staff:
buildinginspectionscityofeagan.com L
2018 RESIDENTIAL PLUMBING PERMIT APPLICATION 1
Date: 2.1ZS /i B Site Address: /0 �V /2 /p �� g, C'��6 4-�j /�'"
Tenant: Suite#:
Name:�-� Ti� f>,S f� E Phone: (o j�_ "- i 7 37
Re�tdent/Owr. ` /\ T
Address/City/Zip: 4//90 CoV �"lz�.s/D E �, -,t/,
� �-Cr/2--3
Name: */� License#:
'.ContractorAddress: City:
, State: Zip: Phone:
! Contact: Email:
New Replacement Repair —Rebuild —Modify Space Work in R.O.W.
Description of work: I °12--k/ je,Q G/�/� 1.z. �i2/v4��/n/1f, Wd6 4' iz L& (
RESIDENTIAL
v Water Heater
Water Softener
Lawn Irrigation(—RPZ/—PVB)
' Permit`Type f Add Plumbing Fixtures(—Main/—Lower Level)
‘11. Septic System
r
, New
.
Water Turnaround
r,. Abandonment
RESIDENTIAL FEES:
$60.00 Water Heater, Water Softener, or Water Heater and Softener(includes State Surcharge)
$60.00 Lawn Irrigation(includes State Surcharge)
$60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround*(includes State Surcharge)
*Water Turnaround(add$280.00 if a 3/4"meter is required)
$115.00 Septic System New(includes County fee and State Surcharge) TOTAL FEES $
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.gooherstateonecall.orq
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's
website at www.citvofeagan.com/subscribe.
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 oif
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to startwithout a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval tans.
x hI-d -S T fie R
App icant's Printed Name Applic is Signature
FOR OFFICE:USE Reviewed Dz
4
41:4
Required Inspections: ` dein Ground Rough In Air Test Gas Test ri 11,,,':17 nal �,
Meter Related Iterms: :M , 'ize t � Rada ad Man t '° %`
- Ail6ffr
f For Office Use �i }�
r i (�Q�// ")1/
1
®,a.,,„4i i,0%
i Permit#: / O l `�
,0 E AGA N
Permit Fee: //4k-' / 4
CIEVED Date Received: ���
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 1
(651)675-5675 I TDD:(651)454-8535 I FAX:(651)675-5694 FEB 2 7 2018 Staff:
buildinqinspectionscitvofeaqan.com L
2018 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit#:
Name:
Res JO H I�{ �oS l E'z6 Phone:4lob 1"9999:39// pi G
Owner'r` Address/City/Zip: 11/ /19 cJ Ci De. C 17 C.A6 Nail SC/2,,3
4 . Applicant is: X. Owner Contractor
V . I
v
P .." Description of work: Ii! A_ v •GIC AI _' a r
Construction Cost: Multi-Family Building:(Yes /No )
,.r t ' : Company: ‘ce-L.— Contact:
Contractor r Address: City:
State: Zip: Phone: Email:
License#: Lead Certificate#:
If the project is exempt from lead certification, please explain why:
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:
Fire Suppression Contractor: Phone:
NOTE Plans andsuppo Documents t/hi�u submi 3 r dot/to bepublic.is «A .`1' P it i ns" f t 1;:,-..-: r
classified as non-public f ou„p t fe specific rea. ®y* -'-'' *Quid permit the City to,-...x . r .-,...1, . t °.a .,: :tom 3 . * _ s
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's
website at www.citvofeagan.com/subscribe.
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.
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 o start without a permit; that thee work will be in
accordance with the approved plan in the case`of work which requires a review and ap- .va •f plan
-
x �H/i RDS%Q efta .fi fr_________
Applicant's Printed Name App i.= is Signature
DO NOT WRITE BELOW THIS LINEi41 ‘)0 (11 N2- Nel/b . y
SUB TYPES
Foundation _ Fireplace _ Porch(3-Season) _ Exterior Alteration(Single Family)
Single Family _ Garage _ Porch(4-Season) _ Exterior Alteration(Multi)
Multi _ Deck _ Porch(Screen/Gazebo/Pergola) _ Miscellaneous
01 of_Plex 'r4 Lower Level Pool Accessory Building
— — j .4 te
S ' — —
WORK TYPES
New
— Interior Improvement _ Siding _ Demolish Building*
Addition _ Move Building _ Reroof _ Demolish Interior
Alteration _ Fire Repair _ Windows _ Demolish Foundation
Replace _ Repair _ Egress Window .4 Water Damage
Retaining Wall *Demolition of entire building—give PCA handout to applicant
DESCRIPTION _
Valuation 0 5? 7 b SS Occupancy `-/ MCES System
Plan Review Code Edition ;70/f- SAC Units
(25%_100% )()) Zoning /—/ City Water
Census Code Stories Booster Pump
#of Units Square Feet PRV
#of Buildings Length Fire Suppression Required
Type of Construction V Width
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
Footings (Deck) Final I C.O. Required
Footings (Addition) 74 Final I No C.O. Required
Foundation Foundation Before Backfill i a„o HVAC_Gas Service Test Gas Line Air Test
Roof: Ice &Water _Final Pool: _Footings _Air/Gas Tests Final
Framing 30 Minutes 1 Hour Drain Tile
Fireplace: Rough In Air Test _Final Siding: _Stucco Lath _Stone Lath Brick EFIS
14 Insulation Windows
Sheathing Retaining Wall: _Footings_Backfill_Final
Sheetrock Radon Control
Fire Walls Fire Suppression: Rough In Final
Braced Walls Erosion Control
Shower Pan Other:
�,r
Reviewed By: .----
LIhilar liff , Building Inspector
RESIDENTIAL FEES 0.';''14"'e" 2.4-747/ "` c.- , yam/ q en • ‘-.5'..
Base Fee 3 5-41i on*:n 1- frp F 1®e 12,
Surcharge
L-
Plan Review o wc1Z le ve I ;.
MCES SAC A_3 eet 2.19,6-1, 0ic- . / f-
City
fCity SAC /_72.0 oh Cs 7,sx.t) D . 9 0
Utility Connection Charge -i5..4tTloi.kr.—
S&W Permit&Surcharge .f —x-12/4 5 a& ' -
Treatment Plant � �" 7
Copies 1
S
TOTAL Ti/5,elf '
Page 2 of 3