3871 Dolomite DrCITY' OF EAGAN WATER SERVICE PERMIT
3795 Pilot Knob Rood 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•
agree to comply with the City of Eagan Surcharge•
Ordinances. Misc. Charges•
Total •
By ./� Dote Paid:
Date of Insp.: Insp •
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
1 agree to comply with the City of Eagan Connection Charge:
Ordinances. Account Deposit•
Permit Fee.
Surchorge•
By Misc. Charges.
Date of Insp.: Total.
1 Insp.: Date Paid.
All' City ol8atau
Date:
3830 Pilot Knob Road
Eagan MN 56122
Phone: (651) 67545675
Fax: (651) 6764684
Use BLUE or BLACK Ink
For Office rise
Permit V
Permit Fee:
Date Received:
Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Site Address• 38L9, 3 r71, 6 8 7 3, 3 75" ppl. o M' T' 2. Unit #:
Reildetttl
Owner
Name:
e4 46 `~ /1'1».3 4 6 t Nt E N ..•� •�: C. , Phone: 76 3-S-71— 97743
�
Address / City / zip: :SO Q C Ce4 ry 2 Av, j , 1 A aoaD £.s 14 L _y 7
Applicant is: Owner ,Contractor
Type oMork,
Contractor
Deacription of work: { i o ' €- aw RE PS. 6/ J 6 a P.4'4 Al z 7-4 I. -
Construction Cost / 9,00o• CIL_ Multi -Family Building: (Yes / No
Company: a £ I £,r r a 2 /%7ih.JT . Cv cep Contact: DA ✓ r 9 a�2ai S
Address: 5/0 �' W (a 1 /1- J7 -
State: /''? SS'y//
City MPLS
Phone: lo/z- S'6/-1. 2y'3
License#: '4 C- 4' / 3 / Lead Certificate #:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional inf enation)
FLSIvS- g�Il'r PoS:' JS7r
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit fora 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:
NOM; �y'` �� •,iiiowsedio
tftaistonit
CALL BFrPORE YOU 019, Cat Gopher State Ono Catl of (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.aoaherstateontacaLtpt
I hereby acknowledge that this Intonnation Is complete and aoxtrate; that the work will be corifomtance with the ordinances and coda of dhe City of
Bacon: tat I undeatand this is nota permit. but only en application for a pent, and work is not to start without a permit: that Mie wont WII$ be in
accordance with the approved plan in the case or work which requires a review and approval of plane.
Exterior work authorized by a building permit issued In accordance with the Minnesota Stam Build nflCode must be completed v/811111180
days of permit issuance.
xI ',2...Q_'
Applicant's Printed Name
ZO/Z0 3Jbd
Applicant's Signature
Page 1of3
1NIVW 1X3 ISS L9Z9t98Z19 LO:ZZ bTOZ/9Z/Z0
CllyofEagall
3830 Pilot Knob Road
Eagan MN 36122
Phone: (661) 676-6675
Fax: (661) 675-6684
Use BLUE or BLACK Ink
For Office Use
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: • I— S — /I/ Site Address: 384 y, 3 7 '7 /, 3V73, 3 87? Qo La 141r rE A iL . Unit #:
Name:
-J
1@r, , Address / City / Zip: VS—c. C. a r4 ry Q Air rt.) 'a` Z A oL E•.J L4KL£lr'
-sr4.th
Applicant is: Owner ,K Contractor
Description of work: 7— EA -2 0%1-1 a• I2 E - Paor-
, Cost 13 7 o'O- Cr° Multi -Family Building: (Yes � / No )
Company. 41E I Sic 'r'c a'ode 0/47.417. emeP Contact J Avrd fld� RR S
Address: 4/0 s tt.) 6 , City: _ m PG $ .
State: /X1oci Zip: Sri,✓ 5' Phone: !o'Z r6/^ 6 z ya
License ft. 4 C z N 1/ 3/ Lead Certificate #:
If the project is exempt from lead certification, please explain why: (see Page 3 for addition& information)
tos Eta L. 14arLr Pos; 197
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 _Io If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor. Phone:
Phone:
Sewer & Water Contractor:
CALL BEFORE YpU DI(. CaU 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. 1yww.000heratateonerall.orq
I hereby acknowedge 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 1s not a permit, but only an application for a permit, and work is not to start without a permit; that the work %dU be In
accordance with the approve° plan In the one of %writ which requires 8 review and approval of plans.
Exterior work authorized by a building permit Issued In accordance with the Minnesota State Buflth Code must be completed within 180
days of permit isauance.
x btiivra Qui RAlS
Applicants Printed Name
80/TO 39Vd 1NIt7W 1X3 I3fi
x
Applicant's Signature
Page 1 of 3
L9Z9T98Z19 LO:OT tTOZ/80/I0
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA158170
Date Issued:09/30/2019
Permit Category:ePermit
Site Address: 3871 Dolomite Dr
Lot:18 Block: 01 Addition: Briar Hill 3rd
PID:10-14992-01-180
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Standard Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener).
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
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 -
Geraldine A Dodge
3871 Dolomite Dr
Eagan MN 55122
(651) 274-6943
Champion Plumbing
3670 Dodd Rd., #100
Eagan MN 55123
(651) 365-1340
Applicant/Permitee: Signature Issued By: Signature