3866 Dolomite Dr*City of btu
3830 pilot Knob Road
Eagan MN 85122
Phone: (681) 675-5675
Fax: (651) 6754694
Use BLUE or BLACK Ink
For Moe Use
Porn* St (n3
Permit Fee: k)5- 3 5
Date ted: 1 L (LF(1 -
Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: L/ . _I 4/ site A(1*w a: 3 g (4'1." N Lo isi, E DR . ,Unit #:
Resident/
Owner
Name: % AC A 6E IN .471_ -7;a C, _ Phone: 76 3 - S7 3 - 9 7 7 °
Address 1City /Zp: SISO QtCr47'uQ 4v, . ,2A 6046 E 1/414,4,S Y /QA)
sV47
Applicant is: _ Owner SCContractor
'n►0. af:+Yifpnc mon of work R E.P.4 G P- Mc.,4 r. P6 t- iso'3_
Construction Cost - Multi -Family Building: (Yes / No
c
Company CI £ 1 ,r r 0 2 Ali • PT . Cv al Contact 14 ✓r 0 a../2-2.1-1
Addross: yes L (#b' Jfr: City: _ m P -
State: /"/ zip: S.5-4/1 9' Phone: (o/ z - g (o / - Crr 2 V3
Licensee: CS - 2 Y/ / 3 I Lead Certificate #:
If the project is exempt from lead certff ca(on, please explain why: (see Page 3 for addklonal information)
L4G.S_ Qu/LY Posr /S7ai
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW GUUIIQING
In the last 12 months, has the City of Eagan issued a penult for a similar plan based on a master plan?
_Yes No If yes, date and address of master plan:
Licensed Plumber: _ Phone:
Mechanical Contractor. Phi:
Phone:
Sewer & Water Contractor:
NOTE; Raw atm w;
thltinfolinfition
CALL BEFORE YOU Dlit tall Gopher spite One Call at (661)454-0002 for protection against undetpround uday damage. Call 48 hours
before you Intend to dig to receive locates of underground Midss. mwvw,stopharatateoMall.ont
I hereby admwwedpe that thk intimation k complete and asomata; that the worts will be in conbmwnoe with the ordinances and codes of the City of
Eagan: that I understand athis is net s tont but only an op tion fora permit. and work to not to star lathout a permit: that the work WO be in
approved plan in the cue of work which requirve a review and approval of plam
Wen**. en**. werk authorized bye building permit issued in accordance with tete MInneaoa State Build ne Code must be completed within 180
days of permit issuance.
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Applltautfa Printed Name
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x
Applicant's Signature
Page 1 of
1NIvW .LX3 I3S L9Z9I98ZI9 9I:bI btOZ/tI/t,0
CITY OF EAGAN
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.
y
Total.
By Ofr ✓� I / — Date Paid•
Date of Insp.: Insp •
WATER SERVICE PERMIT
CITY OF EAGAN
3795 Pilon Knob Road PERMIT NO:
Eagan, MN 55122 DATE -
Zoning: No. of Units -
Owner:
Address•
Site Address:
Plumber•
SEWER SERVICE PERMIT
agree to comply with the City of Eagan Connection Charge:
Ordinances. Account Deposit•
Permit Fee•
Surcharge -
By Misc. Charges•
Date of Insp.: Total•
Insp.: Dote Paid•
City of Eagan
PERMIT
City of Eaan
Permit Type: Plumbing
Permit Number: EA108779
Date Issued: 01/10/2013
Permit Category: ePermit
Site Address: 3866 Dolomite Dr
Lot: 26 Block: 01 Addition: Briar Hill 3rd
PID: 10-14992-01-260
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:
Tony Boerner
2090 County Road 42 W
Burnsville, MN 55337
952-435-2442
Fee Summary:
PL - Permit Fee (WS 8/or WH) $55.00
Surcharge -Fixed $5.00
0801.4087
9001.2195
Total: $60.00
Contractor:
Tony's Appliance
2090 County Road 42 West
Burnsville MN 55337
(952) 435-2442
- Applicant -
Owner:
James B Andert
1660 Blackhawk Cove
Eagan MN 55122
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Applicant/Permitee: Signature
Issued By: Signature
*City oisaaau
3630 Pitot Knob Road
Eagan MN 59122
Phone; (651) 675.6675
Fax: (651) 675.11684
Use BLUE or BLACK Ink
R
For OMee Use p
Permit a 1 19 o
Permit Fee: e' 3 65
Date Received: I /Eh
/
Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: - - J y Site Address: 3 e(00, 3$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 Eagan
PERMIT
City of Eaan
Permit Type: Mechanical
Permit Number: EA123460
Date Issued: 06/09/2014
Permit Category: ePermit
Site Address: 3866 Dolomite Dr
Lot: 26 Block: 01 Addition: Briar Hill 3rd
PID: 10-14992-01-260
Use:
Description:
Sub Type: Residential
Work Type: Replace
Description: Air Conditioner
Comments:
Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Janel Behrends
122 West 3rd S
Fee Summary:
ME - Permit Fee (Replacements) $55.00
Surcharge -Fixed $5.00
0801.4088
9001.2195
Total: $60.00
Contractor:
Haley Comfort Systems
122 West 3rd St
Hastings MN 55033
(651) 437-0338
- Applicant -
Owner:
James B Andert
1660 Blackhawk Cove
Eagan MN 55122
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.
Applicant/Permitee: Signature
Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA157172
Date Issued:08/07/2019
Permit Category:ePermit
Site Address: 3866 Dolomite Dr
Lot:26 Block: 01 Addition: Briar Hill 3rd
PID:10-14992-01-260
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Air Conditioner
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
Surcharge-Fixed $1.00 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 -
James B Andert
1660 Blackhawk Cove
Eagan MN 55122
Haley Comfort Systems
4320 Hwy 52 N
West Frontage Rd
Rochester MN 55901
(507) 281-0138
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA157443
Date Issued:08/20/2019
Permit Category:ePermit
Site Address: 3866 Dolomite Dr
Lot:26 Block: 01 Addition: Briar Hill 3rd
PID:10-14992-01-260
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
Surcharge-Fixed $1.00 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 -
James B Andert
1660 Blackhawk Cove
Eagan MN 55122
Haley Comfort Systems
4320 Hwy 52 N
West Frontage Rd
Rochester MN 55901
(507) 281-0138
Applicant/Permitee: Signature Issued By: Signature