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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