3878 Dolomite Dr'III` City of liaiall
3830 Pilot Knob Road
Eagan MN 66122
Phone: (661) 6764675
Fax: (651) 6784684
Use BLUE or BLACK Ink
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Permit Fee: � 05:3' r
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Staff
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: q- 5 --/ Lf sit. Address: 3117 l>e4.0/4I / rE
ReaidenU
Owner
Units:
J
Name: e% /le /y144 4 6L lac L a , .s: c., Phone: 763 • S-77, - 9'7 7
Address / City / Zip: PSO S s4 7 L, 2 4 v, A) , ,14
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Applicant is: Owner ,CContractor
Type. ouVliork,
Contractor
Description of work Q 4=P4 4 C Z /11O LT", P1, L. (.,)i.)
Construction Cost . _ Multi -Family Building: (Yea / No _„„)
Company: CIE I ex' r €.e/ 2 )Z.ifi N r. Co 2P. Contact bay, rJ 4.4 /t.d.i S
Address: YDS. t.J loD/1' '.
City: /77
State: /VAS Zip: Sr 4// 9 Phone: !o/ 1' S (o / -1 2 4/3
License x: 4.3 t 2 `// / 3 / Lead Certificate #.
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
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COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 menthe, has the City of Fagan Issued a permit for a similar plan bawd on a master plan?
_Yes No If yes, date and address of master plan:
Ucensed Plumber: Phone:
Mechanical Contactor: Phone:
Sewer & Water Contractor: Phi:
1407---—Pkiiis and
CALL BFtFORE you DIG. Can Gopher Spats 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. murimooneretateonecaltong
I hereby ac kno Ledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codas of the City of
Engen s w1 tpiu approved
this is not a permit but only an aDDaoatien fora tomtit and work is not to start without a permit: that the work wall be in
plan In the cased wont much requires a review and approval of prens.
days of pen,* issuance.
Warier
Woik authorirad by a building permit Issued In accordance with the Minnesota Stat. BulldirtgCode must be completed within 160
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Applicant's Printed Name
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Applicant's Signature
Page 1 of 3
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City of Eagan
PERMIT
City of Eaan
Permit Type: Building
Permit Number: EA108009
Date Issued: 11/09/2012
Permit Category: ePermit
Site Address: 3878 Dolomite Dr
Lot: 32 Block: 01 Addition: Briar Hill 3rd
PID: 10-14992-01-320
Use:
Description:
Sub Type: e-Windows/Doors
Work Type: Windows/Doors
Description: House
Census Code: 434 -
Zoning:
Square Feet: 0
Construction Type:
Occupancy:
Comments:
Improvements to the home require smoke detectors in all bedrooms. If altering window openings, call for framing
inspection. Call for final inspection after installation.
Carbon monoxide detectors are required by law in ALL single family homes.
Fee Summary:
Valuation: 4,000.00
BL - Base Fee $4K
$103.25
Surcharge - Based on Valuation $4K $2.00
0801.4085
9001.2195
Total: $105.25
Contractor:
Window World AKA Probuilt America
2211 11th Ave E, #130
N St. Paul MN 55109
(651) 770-5570
- Applicant -
Owner:
Scott C Miller
616 McFaddens Trl
Eagan MN 55123
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
41'City atEke
3630 Pitot Knob Road
Eagan MN 55122
Phone: (661) 675.6675
Fax: (651)676.5694
Use BLUE or BLACK Ink
r For Qlhce dee
Perm* 6 l CI()-
Permit Fee: .. -1.-a5"
Data Received: 1
Staff:
2013 RESIDENTIAL BUILDING PERMIT APPucATION
Date: • SIN Address: 3174,, 3 7'S, 3 eS.0, 81F,1j tZtooLork er i AQ. Unit ft:
Name: c A C 7 not; ti) r4 rb 1 E a..r i -.710 C Phone: 7401 - .s'4 3 -19 7 7o
Address / City I Zip: �St> a Z: t 4 7--u,2 ,�1.J N p 604E.-1 V+Ki *'
Ar -SrilA
Applicant is: Owner 2, Contractor
Description of work: '7"£'A,2 OFF. e• O.E - QvoF
Construction Cost 9 VO CTO Multi -Family Building: (Yes / No
Company: E J /DRlb.a , R Contact tow 12•,F. r S
Address: 90 s- 6DtiS? .
state: / i -1 zip: .5rv/ 9
City: /'h PG 5
Phone: LD'z
License #: .t y J 3 / Lead Certificate #:
If the project Is exempt from Wad certification, please explain why: (see Page 3 for additional information)
fit. 4.5 LE C- ,tr Pas;
i,,r
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW UJLDING
In the Fast 12 months, hes 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. Phone:
Mechanical Contractor. Phone:
Sewer & Water Contractor: Phone:
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CALL BEF E Y DJG Call Gopher Stats One Call at (651) 4640002 for protection against underground utility damage. Call 48 hours
before you Intend to dig to receive locates of underground utilities. vnwr.00pherstateonmall.oro
I hereby acknowledge that this information is complete and accurate; that the work vriil be in conformance with the ordinances and codes of the City of
Eagan:
understand this la not a permit. but only an application for a pemlit, and work is not to start without a permit that the work vrill be In
approved plan In MG case orwork which requires a revlew and approval of plana.
days Exterior work authorixad
of permit Issuance. by a building permit issued in accordance with the Minnesota Stara Sultan Code must be completed within 180
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Applicant's Pri_nted Name
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Applicant's Signature
Page 1 of 3
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