3862 Dolomite DrCITY OF EAGAN WATER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.
Eagan, MN 55122 DATE.
Zoning: No. of Units.
Owner:
Address.
Site Address.
Plumber:
Meter No.: — Connection Charge -
Size: Account Deposit.
Reader No.: Permit Fee.
1 agree to comply with the City of Eagan Surcharge.
Ordinances. Misc. Charges.
Total.
By P/1 Date Paid.
Date of Insp.: Insp :
4
CITY,OF EAGAN SEWER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning:
No. of Units:
Owner:
Address:
Site Address:
Plumber:
agree to comply with the City of Eagan Connection Charge:
Ordinances. Account Deposit:
Permit Fee:
B Surcharge:
Y Misc. Charges:
Date of Insp.:
Total:
Insp.: Date Paid:
*City oisaaau
3630 Pitot Knob Road
Eagan MN 59122
Phone; (651) 675.6675
Fax: (651) 675.11684
Use BLUE or BLACK Ink
R
For OMee Use p
Permit a 1 19 o
Permit Fee: e' 3 65
Date Received: I /Eh
/
Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: - - J y Site Address: 3 e(00, 3$x.2, 3!?69‘ Inca Qotc w , rz A a . unit If:
Name: A C r P2.4 AJ 4 4 � / N � U : �� C Phone: 74 5 - "
Address/ City / Zip: 'SO 6 e- a r -o g 4v A.\ z p (',ci d E.•1 ii*L1t
ArA.t $Th'2.
Owner
Applicant is: Owner Contractor
Ty,I , . Description of work: 7 E.+2 Or a• QE -
i_:.C button Cost / 90 0 Multi -Family Building: (Yes %�' / No
•
Company: CIE 1 Esc rr.raioi2/Yids r . contact ISrAtii ZR S
Address: 90S 61,'3 . city: m PL S .
St,3te: Aix) Zp; .Sr4» 9 Phone: ‘11 - r6,-- AI/3
License*: C Z Y1 / s / Lead Certificate #:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
Q4IDS L.iL12E. R 47- Po.s. J 97
COMPLETE THIS AREA ONLY IF CONSTRUCTING A JEW BUILDING
In the last 12 months, has the City of Eagan issued a permit fora similar plan based on a master pan?
_Yes No If yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
08:00000,-
1 .
Phone:
Phone:
Phone
r ftR' J" 1, .,: J. 7'77: `at
rK '
CALL aEFORe YQU DIG. Call Gophsrstase one Call at (651) 464.0002 for protection against underground utility damage. Cali 48 hours
before you Intend to dig to receives locants of underground Wilke. saAv.doohetatateonecakorq
Ihereby ad I understand this inowledge that this snforrnation is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eaganan� with d+e not a permit, but only an application Tor a permit, and work is not to start without a perms that the work win be in
approved plan In the case *Nave Mien requires a revrew and approval of plans.
Exterior work authorized by a building permit lamed In accordance with the Minnesota State Bonding Code must be completed within 180
days or permit issuance.
ApPllcars Printed Nam®
80/80 39 d
1NItiW 1x3 I3$
`77$7
Applicant's Signature
Page 1 of 3
L9Z9I98ZI9 LOOT PTOZ/80/T0
dily of Eaaall
3830 Pilot Knob Road
Eagan MN 56122
Phone: (661) 675-5675
Fax: (651) 676.6684
RECEIVED
MAR 2 8 2O1b
Use BLUE or BLACK ink
1
For Mee Use
Pernik a: 1''
Permit Fee:
Dote Received: 3 / a
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Data; 3 -II- `/ Site Address: 'IA D 3704, 3 - Md-rE DL- units:
Reeiidentl
Owner
Name: eh. 4e /1i41...S 4 bZ14 L.41 -A-%
c.
Address / City / Zip: :so 1st C icru Q til✓, sJ ,
Applicant is: Owner Contractor
J
Phone: 763 - s ,' 1-- 9 7 740
Type •ot:WOric
Contractor
Description of work: £d...0 a` 1 Pt..f-c.L. S 6
a i-4-40 a /Yl &, 4 l -
Construction Cost: / y< V tr0 Multi -Family Building: (Yes c / No
Company: a E ? 0 2 Mlit7 1-1-r . Cn aA contact _DA '1' t3 Q1,' S
Address: 4/P -S, 100 /:6' 1. city: /7/ pL S
State: /410 Zip: SS's,// rj Phone: lv/ A • g to /- eo 21/3
License #: L 2 Y/ / 3 / Lead Certificate #:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
1�t•l,los- QuIL," Pos 11-71r
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BOLDING
In the last 12 months. has the City of Eagan issued a permit fora similar plan based on a matter plan?
_Yes No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor. Phone:
NOTE;Plans and , 'rOrta%d',iF
_ . > class**, tan r�a lrhw at 0010!
CAIS BEFORE YOU DIG. Call Gopher Stats One Call at (661) 454-0002 for protection against underground utility damage. CaU 48 hours
before you Intend to dig to receive bcatee of underground utilities. www_aoohetstateonecall.onI
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 1 umdarsaand this is not permit, but only an application for a permit. and work is net to start without a permit: Mat the Mark be in
accordance with the approved plan In the rase of work which requiros a review and approval of plans.
Exterior work authorized by a bullding permit issued in actiordance with the Minnesota State Building Code must be completed within 180
daysofpermit ieauanca.
x 4"
Applicant's Printed Name
VO/TO 39vd
Applicant's Signature
Page 1 of 3
1NIVW 1X3 I3S L9Z9T98ZT9 00:60 t'TOZ/8Z/E0
City of Eaali Rs.cs,\ED
3830 Pilot Knob Road �t
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
r
Use BLUE or BLACK Ink
For Office Use (�
Permit #: / ? / 70 �4t / �,�1
Permit Fee: /c?< '&4
Date Received: f �{'
ii`—/
Staff:
2016 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: / / /10 Site Address: 3 g6'3 Oaf I i7ah . -k I
Unit #:
R ®en
O mer
Name: S ker j 11'6 .N..0\. -e--••7 Phone:
Address / City / Zip: 3c- 6 O 01 c,,,n, k ---c pf c("1 -.?/4 A) 5 1
Applicant is: Owner ✓ Contractor
1itis fiA/t
Description of work: VC„,, t AJ (1)- r ij e.o (,v cJc 1 !IAnil 4--) , (o1 " (Yld \ir a c t/ 1-1 -e fi-s CAN
y
Construction Cost: ` 000 Multi -Family Building: (Yes / No )
aac# �.�
Company: ) r) w ti 1,-. w r R (_, � 10, 1 r Contact: 3,9e( r`0. 7 f 7 7cg.1
Address: 3 L/'a 1<4 e i �, <o, r �F City: /740/i•---EtcF //c,
State: A) Zip:A Li 6n1' (.14en^
c53 g Phone: 61 Di 1 7 7S �-I Email: towN�i �c ? u c l c9e_ 1 5
License #: Fe, 66 / L-jp2 Lead Certificate #: N//9 -
If the project is exempt
131/, if
from lead certification, please explain why:
(A 1c1 �(f , I,r }-crud, w6,1 ,,,,t, b
In the last 12months,
/
Yes �( No
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Eagan issued a permit for a similar plan based on a master plan?
If yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Fire Suppression Contractor:
C e Ai ✓'pet et,, -,1- e i um C-0-5 Phone: 7� 3 51f 3 3 i -r /
j ,,,,A gial`y wON1` `
I-4 '4 j`-,,, (
iv") o a I - A 1v e e r) Phone: 7‘ 31'1 2 r6 3 ;77
nit / F7 Phone:
1'/ / Phone:
» e nd supporta ®ado r, ons i ® e� rmattt n s r
the inform tion may be ifie @ on pub of you • ®, pe ons that l s i't the City to
onclude that'the
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 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 .J Gcl 5 0e �I�s
Applicant's Printed Name
can s Signature
Page 1 of 3
• OBD- D010,44 ti
DO NOT WRITE BELOW THIS LINE
SUB TYPES
Foundation
Single Family
Multi
01 of _ Plex
WORK TYPES
New
Addition
Alteration
Replace
Retaining Wall
Fireplace Porch (3 -Season)
Garage Porch (4 -Season)
Deck
_X, Lower Level
DESCRIPTION
Valuation
Plan Review
(25%_ 100% )
Census Code
# of Units
# of Buildings
Type of Construction
1
fri it lin Ito
nterior Improvement
Move Building
Fire Repair
Repair
REQUIRED INSPECTIONS
Footings (New Building)
Footings (Deck)
Footings (Addition)
Foundation
Roof: _Ice & Water _Final
?C Framing
Fireplace: _Rough In Air Test
Insulation
Sheathing
Sheetrock
Fire Walls
Braced Walls
Porch (Screen/Gazebo/Pergola)
Pool
Occupancy
Code Edition
Zoning
Stories
Square Feet
Length
Width
Final
Siding
Reroof
Windows
Egress Window
Exterior Alteration (Single Family)
Exterior Alteration (Multi)
Miscellaneous
Accessory Building
Demolish Building*
Demolish Interior
Demolish Foundation
_ Water Damage
*Demolition of entire building — give PCA handout to applicant
Meter Size:
MCES System
SAC Units
City Water
Booster Pump
PRV
Fire Suppression Required
Final / C.O. Required
si Final / No C.O. Required
HVAC _ Gas Service Test Gas Line Air Test
Pool: _Footings _Air/Gas Tests _Final
Drain Tile
Siding: _Stucco Lath Stone Lath _Brick
Windows
Retaining Wall: Footings _ Backfill _ Final
Radon Control
Fire Suppression: _Rough In _Final
Erosion Control
Other:
Reviewed By: j L-'" , Building Inspector
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
til h
Page 2 of 3