3887 Dolomite DrCITY OF EAGAN
3795 Pitst 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•
agree to comply with the City of Eagan Surcharge•
Ordinances. / Misc. Chorges•
By / Total
Date Paid:
Date of Insp.: 7-i 9 — Z/ Insp •
WATER SERVICE PERMIT
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 �c
`YI 4 )
agree to comply with the City of Eagan Connection Charge:
Ordinances. Account Deposit.
Permit Fee -
Surcharge.
By /JIjC/� Misc. Charges.
Date of Insp.:t j / 1 Total.
Insp.: Date Paid•
City of kali
3630 Pilot Knob Road
Eagan MN55122
Phone: (551) 8755875
Fax: (651) 875.5614
Use BLUE or BLACK Ink
For Office Use
j
Permitit
IX13°
Permit Fee: .°
Date Received: 1/62 (0113
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Daps: 7' le— /3 Site Address: 3 8 8J, '3 I". 3 S 79,1V 9 / I l b G o'- r rt b t. . Unit 8:
J
Name: 4_/9SSoc,4.rio.J cZ. M,t.,A..64,011_47 phony 763- 5 -37A7
Address / City /Zip: i 02 2 £. .t",ss, 1,474e. Ah 01,404E 626./4', Ss 3 s/
Applicant is: — Owner iC Contractor
'44 WOlc
Description of work: 7-14A- o FA' .a Q d - Agro F
Construction Cost: /i/s :46°,00 Multi -Family Building: (Yes )0 / No )
Company: t E/ ExrtR'0 m*rv:. �0.2P. Contact: b Li4 4..2/t/�
Address: 1/c.5- t 6 c r• Sr City: /19,0G S
State: /17A) Zip: - 3 41 !C
Phone:
GTR -b '4/-4.zy3
License #: G y // 3 / Lead Certificate #'
If the project is exempt from lead certU9Cation, please explain why. (see Page 3 for additional information)
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:
Mechanical Contractor,
Sewer & Water Contractor
Phone:
Phone:
• Phone;
NOW snr ' e:
: Phos
'lr'1,+�l►tigr Pas'
CALL BEFORE YQU DIG, Call Gopher Stsle One CMI at (651)484-0002 for protection against underground utak( dameye. Cal 48 hours
before you intend to dig to receive Incites of underground utilities
. me,stagiscobsweoliGut
I hereby acknowledge that this adonmatkun is complete and accurate; that the work will be In conformance with the ordinances and codes of the City of
Eagan: drat I understand this is not a permit, but only an appkation for a permit, and work is not to start without aPerm b I that the work WIbe In
aCCOrdance with the apptovetl pion in the case of worst which requires a review and apprrnJ cf pram•
Dander work authorized by a bulidbng permit Issued in accordance with the Minnesota b Bullring be completed within 180
days of permit Issuance.
Applicant's Printed Name
TO/T0 39 d
Applicant's Signature
Page 1 of 3
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41'
CityofEaaall
3830 Pilot Knob Road
Eagan MN 66122
Phone: (661) 675,5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Use
Permit #:
Song
Permit Foe:
Date Received; 1,0 / 11) 3
Staff.
111
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: A0 Slte Address: 3 7S; 3$1.7, 33 3S' 9 / .10 to 441 rt • Unit if;
`" . •
O ei >•:
Name: '`o /v G Y /y1 +1 Ai 4 G Z. 41 Z L 'T �"� C Phone: 743 - -s-93 - S' 7 7 a
Address / City / Zip: '5D 1b E. C r4 "—Li N ,2 AV "c`2 p god..bE,J L4 .Lt
Ar•a ..1-3-41,
Applicant is: Owner Contractor
7
Type,1?F' YQ C•
Description of work: -7" E +iZ Of- a 2 c - Geral=
Construction Cost /'f x LC - 60 Multi -Family Building: (Yes X / No
:: ..,
• Cant a r '
Company: 4E 1 A.; *7-e.2•0!1 frith• -P C PContact tAv,a. %' 1 r S
ress: VDS k 6o City: n'l PLS .
Add s? _
State: /Yl cj Zip: SS'S'/9 Phone: 6Iz-'6/- 6A4/3
License#: 8 e 1 9 / / 3 / Lead Certificate #:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
Vic-b,t,,L 1r2E. ri,,i,r Pos7 l97 ?
In the last 12 months,
If
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?
yes, date and address of master plan:
_Yes __No
Licensed Plumber.
Phone:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
/ .
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�.ri�� a�ruiw YVU DIG. Call Gopher State One Call at (651) 434.0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.aoo,erstateonecall,org
1 hereby acknowledge that this information is complete and accurate; that the work well 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 worts is not to start without 8 permit; that the work will be in
accordance with the approved plan In the case Of work which requires a review and approval of plaits.
Exterior work authorized by a building permit Issued In accordance with the Minnesota state Buildin Code must be completed within 180
days of permit issuance.
x bAv, N ( a-a'_c x
•
Applicant's Printed Name Applicant's Signature
£0/TO 397d 1NItiW 1X3 I3a
Page 1 of 3
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411' CityofEaaii
3830 Pilot Knob Road
Eagan MN 56122
Phone: (651) 8754675
Fax: (651) 675.5694
Use BLUE or BLACK Ink
For Office Use
Permit .1`b9/3
Permit Fee:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: -7-/y site Addrt;,ss:309s", 3 F ]eS9, 3v9/ iot,.OMoT 62. unit p:
Resldenv
Owner
Name: eJC 4t' ,e,s 46£Is£A;"i .�•J C. Phone: 74 -S"!3- 977
Address / City / Zip: :SO D C t4 ru Q 4v, , , 2 A Gol. E.4..1 i4 r /x7.0
Ssin7
Applicant is: Owner 2f Contractor
TYPe of.Work,
Description of worle f.•K e C a• {C E AL A -c- f- 1/ D / P.6's / a AIL 7-4 L -
Construction Cost /14 gar), G1D
Multi -Family Building: (Yes /No
Contractor
Company: a E I £,r - a 2 ii%i ex -r- . CaAP. Contact Nur 0 av/iu/ S
Address: VP -3- (.) tc)01.1 ¢•
City: /h PL
State: /'7^S Zip: 5-3-4// g Phone: Col z ' 8 to / - Co 24/3
License d: 4.3 C- 2 %' / / 3 J _ Lead Certificate #:
If the project is exempt from Toad cert1f cation, please explain why: (see Page 3 for additional information)
lnpLl,(pSPas7Y'
COMPLETE THIS AREA ONLY IF CONSTRUCTING A MENfilUILDING
In the iaet 12 menthe, has the City of began issued a permit for a similar plan based on a master plan?
___,Yes _No If yes, date and address of master plan:
Ucensed Plumber: Phone:
Mechanical Contractor Phone:
Sewer & Water Contractor: Phone:
CAI,, BEFORE (OU DIG. Call Gopher Stater One CaII at (651)4544002 for protection against underground utility damage. CaII 48 hours
before you intend to dlp to receive locates of underground utttdies. www.00pharstafAonecaii.ona
I hereby acknowledge that this Information is complete and aowrate, that the work will be in conformance with the ordinances and codes of the City of
Eagan: that 1 understand this is not a permit but ordy an application far 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 e review and approval of plans.
Exterior work authorised by a building permit issued In accordance with the Minnesota State BuildingCode must be computed within 180
days of permit Issuance.
x 4 ✓' 4 %24,2-2,
Applicant's Printed Name
E0/Z0 39td
Applicant's Signature
30.e.,7 7'3
Page 1 of 3
1NI 1 1X3 I3S L9Z9I98ZI9 ZI:Oi t?tOZ/L0/E0
City of Eagan
PERMIT
City of Eaan
Permit Type: Plumbing
Permit Number: EA127478
Date Issued: 10/02/2014
Permit Category: ePermit
Site Address: 3887 Dolomite Dr
Lot: 10 Block: 01 Addition: Briar Hill 3rd
PID: 10-14992-01-100
Use:
Description:
Sub Type: Residential
Work Type: Replace
Description: 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.
Jennie Wood
1424 3rd St N
Minneapolis, MN 55411
Fee Summary:
PL - Permit Fee (WS &/or WH) $55.00
Surcharge -Fixed $5.00
0801.4087
9001.2195
Total: $60.00
Contractor:
Benjamin Franklin Plumbing
1424 N 3rd St.
Minneapolis MN 55411
(612) 604-4285 X61
- Applicant -
Owner:
Judith A Spillman
3887 Dolomite Dr
Eagan MN 55122
(651) 452-4638
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