3716 Blackhawk Lake CtINSPECTIDN RECORD
CIT1( OF EAGAN PERMIT TYPE: W111 01MO
3830 Pilot Knob Road Perrnir Number: 4
Eagan, Minnesota 55123 Date Issued: rt+? /I fs i`) 4
(612) 681-4675
SITE ADDRESS: ?( J) .? N ti I 11l. ?: .? APPLICANT:
f,r ! F: M t A fti fi A ld k'. I p w. t t? l w' I F. it 1 t. V. V i Ft E' f' t, q C. E t N E,
11 f. A 1 P, I 1!t 1.,f h F !! 1 Fi t
PERMIT SUBTYPE: TYPE 4F WURK: .
auw
a01J611 t w f i rrrat
I I Prnslt Mo. Psnn! #lc?Aw oets 'li?e?Fnane #
,'?AM
?
MAC '
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knomofta Deis Mep. Coa?manb
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RuNdadan
Roabv
Rougb PIlrcj. ?? ?•
Romm
Fn?l M?p.
\
OFaii lim
Final P6g. Prig. #nspaaior - IUc+!'iiq PMMer
Const. Me6w
EnWA4an
BIdy. Finel
Docic Ftg.
aeCk Flr?al
1AIeN
W. Disp.
)'t `. . 7 -s'1,^,
SE?.AfER WATER PERMiT "
CItY'&. EAGAN
;DATE ? LfAR 24, 19A2 .. x ` , 7'! _ • , f: OFFICE USE ONLY . .
3830 Pilot Knob Rd
Eagan,.MN 55122-1897
, ?.'. . .
METER # ' PERMIT DATE 03/25I9Z
'CHIP PERMIT. # 12632
METER SIZE B.P. REGEIPT # ' C.61792$
, ISSUE DATE B'.P. RECEIPT DATE 03 34B0a
. X_ PRV - BOOSTER PUMP
SITE ADDRESS 3716 Bi.ACKiAWK 1.AU CT
LOT 20 BLOCK 2 SEC/SUB ??CKHAWK RIDGE
APPUCANT: ADDRESS: CITY, STATE ZIP
PHONE:
PLUMBER:
ADDRESS: 1521 94TH LN
CITY, STATE BLAIPIE MAl' ZIP 55434
PHONE: ' 7$6-4007 '
OWNER: F S 8 CONST INC '
ADDRESS: 25oo w GO[JNTY ROALa 42
CITY, STATE BitEtNSVILLE NN ZIP 55337
PHONE: $90-$OOA
PERMIT REQUE$TED
X SEWER X WATER - TAPS'
- COMM/IND X RESIDENTIAL "
x NEW ? EXISTING
Lawn Sprinkler Meters are to be Instatled '.
Ahead of Domestic Meters on Water Line. `
Credit WILL NOT be given for Deduct Meters.
I AGREE TO COMPLY WITH CITY OF .
EAGAN ORDINANCES
SIGNATURE WHEN METER ISSUED
PLEASE ALLOW TWO WORKING DAYS FOR PROCES$ING. CALL. 454-5220 FOR INSPECTIONS. FOR STORM .
SEWER PERMITS, CONTACT.ENGINEERING`DEPT:
. .
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. . ..,; . . . ._..?. . . :_ . ... _. ,.._ ? ?:.,. . . .?_ ' .. .. . ... . .. 1 . ._ ..? ._ _ ?, w _. _ _. . . . .. . :... .
i
CASH RECEIPT ^
CITY OF EAGAN
3830 PILOT KNOB ROAD • ?
EAGAN, MINNESOTA 55122
? .
UATE 19
FECEMW
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8 DOLIARS
O CASH ? CHECK
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Addreqs : 3716 BLAa(RAHRZ LAKE CT Lot 20 B1k2 Sec/Sub gj,Aaa4K gIDGE
These itews were/were not complete at the time of the final inspection.
D Yes No
Final grade (6" from siding) ?
Permanent steps - garage ?
Permanent steps - main entry
Permanent driveway ?
Permanent gas
Sod/seeded grass
Trail/curb damage
Porch f
Basement finish ?
Deck ?
Please varify with the builder the removal of roof test caps from the plumbing
system and the shut-off of water supply to the outside lawn faucet before
freeze potential exists. &
ucrciEOVUtx
White - City copy Yellow - Resident copy Pink - Contractor copy
A
r e ?
?
(Ux#i#ira#r of (Orrupartxg
Citp of eagan
lorpttftmt n# "diag 3prrtwn
Tfiis CerVfwate IkSUed pursuant to the requiraemenls of Section 306 of the Uniform Bulfding
Code cerdfytng tliat at tlre tlme of Issuance this sducture wm in aompltaace wllk the warious
ordinances ojthe Cft}' negulaan8 building construction or use. For the following:
vn c2usiaw600 SF TJWG/CAR ma&eamitxo. 94
O-W-7 Ta ? J Zmdn DkWd R I TYa co- VN
owoad • FSB OOTST. Add= 2500 WCfY RD 42, B'VII1E
3716
MANFAW LAt? CI' . L-ity L20, B2, M.AQANK RT.DCE
??.
;-T
DI. 6/24/q2
?
mus oerKa
POST IN A CONSPICUOUS PLACE
I1??SPEC'TII?N ` CORW
.... _?... / `/? ¦.
' r •,,'. \}F Y/1\71At, ?? ? . . r •.:,_ -?'s?' . _
3$30 Pilot Knob Road Pemit N~:
Eagan, Minnesota 55123 Eea% 1mmxt (612) 681-4675 `
SITE ADORESS: ry ' APPLIC?I?T:
?.ov : 2• 4?.ac?cR ?.
3?'16 101.AC111~ LAIKE C't
, . ALACKMAWIC a2'00t PERMiT SUBTYPE: TYRE OF'wUOROQ .?r nwt3 " ? .
v
s?TIE' ?nar?w? ; fR?NIN? ?Nf?itl?41T?+?N ;
' mAi.I.?GAAD FIM#L
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_ y
:
? PKmp Ho. hnnk MO"w DatY 1i?ph?s #
P9108M ?.g r$? . ?lpp
K"G
ELf at.R ?. . °°
Ei[L?iW
FoodW 1
FoUr4RUM .
P"4h • °ri1'
• ""'i/" •'4 .: 6'/d '?`? lV `li, ,'?/ . • ? . i*
W.
FwMiswM
OISSI Teet
Rn91 Pbg. ? ?+OC1D?-?
Conet. Mlew
EnWA%n
Oft F'Aal V.2?C tlJ
Deck Rp.
Oeck Fkial
Well
Pr. Oisp.
DATE: MAR 25, 1992
RE:
3716 BLACKHAWK LAKE CT (F S B CONST INC)
X Your Sewer & Water Permit for the above property has been completed. It wiil be hetd at the
P;?blic Works Garage (3501 Coachman Road) until the meter is picked up. BE SURE TO
CALL PUBUC WORKS (454-5220) FOR YOUR PERMANENT WATER TURN ON.
Your Sewer & Water Permit for the above property cannot be completed for the following
reasons:
Your Sewer & Water Permit for the above property has been completed, but the meter cannot
be issued or occupancy allowed until further notice.
COMMERCIAL PROJECTS ONLY: Please pay for meter at City Hall. Meter size must be
confirmed by Bill Adams or Dirk House (Plumbing Inspectors - 454-8100) before issuance.
WARNING: BEFORE DIGGING, CALL LOCAL UTILITIES - TELEPHONE, ELECTRIC, GAS, ETC.
- REQUIRED BY LAW.
CONTACT COMMUNITY DEVELOPMENT DEPARTMENT FOR WATER TURN ON POUCY.
Secretary, Building inspections Dept.
SITE ADDRESS 3916 BLACKHAWK LAKE CT PERMIT REQl.FE5TED
LOT 20 BLOCK 2 SEC/SUB BLAeKHAWK RYDGS '
x SEWER R WATER
APPLICANT:
ADDRESS:_
CITY, STATE
PHONE: _
PLUMBER: SCHULTiES PLBG
ADDRESS: ' 1521 94TEI LN
CITY, STATE BLAINE MAT ZIP 55434
PHONE: 786-4007
TAPS
COMM/IND A__ RESIDENT{AL ,
X NEW .^ EXISTING '
4awn Sprinkler Meters are to be Insfalled `
Ahead of Domestic Meters on Water Line: Credit WILL NOT be given for Deduct Meters. .
. I AGREE TO, MPLY WI CITY OF
OWNER: F S B CONST INC EAGAN O ???
ADDRESS: 2500 W COUNTY AOAD 42
CITY, STATE B3lgNSYILLE MN ZIP 55337
PHO : $?-3 SIGNATURE WHEM METER ISSUED
PLE???E I4LL 4' 0" RK?(NQ DAYS f& PRQCESSING. CALL 454-5220 fOR IN$PECTIONS, FOR STORM
SEWER PERMITS, CONTACT ENGINEERtNG D&7.
. . ,.: ,.. .; .
ZIP
4?8 2 5
Request Date Fire No. Rough-in Inspection
Requiretl?
?l Ready Now X1 Will Noti(y Inspector
L?-22-92 , ygs v ryp When Ready?
1EX licensed contractor O owner hereby request inspection of above electrical work at:
Job Address (Street. 8ox a Route No.) City
3716 Black Hawk Lake Court Eagan
Section No. Township Name or No Range No. County
Occuparn (PRtNT) Phone No.
FSB
Power Supplier Address
Dakota Electric
Electncai Contractor (Company Name) Contractor§ License No.
Laz rElectric, Inc. CA 01110
Mading Address (CoMrector or Owner Making Installabon)
8383 Sunset Road N.E., Minneapolis, [`M1 55432
------- ---
Authorized Signature IContractonOwner Making Installation) h.- Number
---?L
4G)?----------- r
- 784-3729 ---
MINNESOTA STATE BOARD OF ELECTRlCITV THIS INSPECTION REOUEST WILL NOT
Griggs-Midway Bitlg. - Room 5-173 BE ACCEP7ED BY THE S7ATE BOARD
1821 University Ave., St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS
Phone (612) 642•0600 ENCLOSED.
??t? RE(]UEST FOR ELECTRICAL INSPECTION
?
? 47825 See instrudions for completing this form on back oi yellow copy.
X" Below Work Covered try This Request
dw--..
?'A? EB-00001-08
ew Add Rep. TypeofBuilding AppliancesWired EquipmentWired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Other (Specity)
Comm.tlndustrial Furnace
Farm Air Conditioner
IOther (specify) CoMrector's Remarks
Compute Inspection Fee Below:
# Other Fee # Service Entrence 5ize Fee # Circuits/Feeders Fee
Swimming Pool 0 to 200 Amps 0_ ta=.P,mps
Transformers Above 200 Amps A6ove 40p Amps
S19nS Inspectors Use Only: 7'QTpL
Irrigation Booms $$6.50
Special Inspection
AlarmlCommunication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONTHS
I, the Electrical Inspector, hereby
tif
h
h Rough-in ;-` • Dat
cer
y t
at t
e above inspection has
been made. Final _ Date
:j ?,1 r> -?
OFFlCE USE ONLY
This request void 18 months trom
. ,
GITY 6F EAGAN
3830 Pilot Knob Road
Eagan, Minnes4ta 55123
(612) 6$1-4675
PERMIT
PERMIT TYPE:
Permit Number:
Qate Issued:
c u" a iff
jo Iiq 144
BUILDIN6
024737
10 /7.8 /94
? SITE AD?RESS:
p . I. N . : 10-14406-200-02
9716 BLACKhiAWK LAKE CT
L(l7"S 20 BLdGK: 2
BLACKHAWK RIDGE
DESCRIPTION:
?
W" I ' h gk?'
?
; na ? n
. _ ...... ?'??
REMARKS:
FEE SUMMARIF
Base Fee $25.60
Surcharge .60
To'tal Fee $25.50
CITY G1F EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
SITE ADDRESS: LpT :
3716 BLACKHAWK
BLACKHAWK RIDGE
PERMIT SUBTYPE:
FZREPLACE
INSPECTIUN REC4RD
PERMIT TYPE:
Permit Number:
Date Issued:
20 eLo c x: 2 APPLICANT:
LAKE CT VTERECK FIREPLaCE INC
(612) 445-5620
TYPE OF WORK:
NEW
BUILDING
024737
10/18J94
INSPECTION . . .
RQUGH-IN FINAL
F
L
?
~ CITY r?F SAGAN
"! 994 BUt1.DING PERM1T ApPLJGATION
681-4675 ?
SINGLE & MUI.TI-FAMILY 2 seCs of plans, 3 registered site surveys, 1copg of er?ergy
calcs.
C4MMERCIAL 2sets of architectural & structural p]ans, i set of
speciftcations, 1copy af energy calcs.
Penalty aAplies: 1) when permit fs typed, but not pfcked up by list wttrking d? ?f ?th
in which request is made, 2) address is changed or 3} iot chamge is requested or" ?erm#t .
is issued,
Qate Ualuation of work
Sit$ Address:
STMT
r
Tenant Narne: (carrmercial vnly)
_
LVi iTL1/VA L? - s{Ji'iD• n_ l. .i.Ye ? . ..
Descri tion af work:
The appl i cant is: 0 Owner Contractor E3 Other c"scrtbr
04 Ptton- e
Nlame 1-4 A 44W
Property
OW11Br ,
A
, sT
'
Add
&I
re5s
Ad
sra$Er
City State
Company. ?W6lir-GK- E.la;-:Pi.rACE SAL18 . ?? Phone
Contractor Address 3465 1407N ST. N.W. Licifnse f Exp.
???
city 49-5,62Q ._.? state
Company Ptrone
J4rCh1teCt/
Et1glC1?er ?ame Reqistration f
Address .
City State
Sewer & water 1icensed plumber Proces?ing tirne ?'t?r
sewer & water permits 1s twa days ance area iaas 6een appro've .
I hereby acknQwledge that I v read is a plication dstate ti?at tho info'?tioh #s
correct and agree to compl it all lic State nnreta atutes ?and City of
Eagan Ordinances.
ture of Appl icant:
=
L
4FFICE USE ONLY
BUILQING PERIVIIT T1fRE
? 01 Foundatian 13 46 Dupiex ? 11 Apt.JLocJging
E3 02 SF Drvg. ? Qi 441ex ? 12 Multi, Misc.
? 03 SF Additfan D 08 8-Plex CI 13 Garage/Acciessory
? 04 5F Poreh ? 09 12-Rlex 14 Fireplace
? 05 SF Misc. D l0 Multi. Add'1. C7 I tleck
WC?RK TYRE
?31 New CI 33 Alterations E7 35 Teaant Finish
? "" Add-10411--mon a 34 Repa3r. .^.? 3.6'?..awc
GENERAL INFt3RMATIUN
?
?
? 11166 a??et?ent Finish
? 17 Swim pool
Q 18 Gamm. Jlnd.
L7 19 Camm./Ind. Misc.
Q 20 Rubiic Faci73ty
C 21 Mixcellane4us
E3 37 Demvlish
Cnnst. (Actual) 8asomt sq. ft. MKC Systern
A1lowablej
S 1st F1. sq. ft. ? City 'Water ?
U
B C ccupancy 2nd Fl. sq. ft. PRi1 Requlred
Zoning Sq. Ft. total Baaster Pum?
# of Starf es ? Fuotpri nt Sq. ft. ? Fi re Spri nk.l er
Length On-site we11 Census Cvde
Qepth On-site sewage ? SAC Code ?
APPRQYALS Ge?su? Un??
Rlanning Building ? Assessments
Engineering Varfarnce
REQUlRED 1NSPECTIC3NS
C] Site ? Footing CI Framirtg C] insulation
D Wal l baard O Fi nal ? Drai nt! l e Ll Fi repl ace
Permi t Fee vatuafon: ?
Surcharge
P1 an Review
ticense
MWCG SAC
CZty SAC
Water Cann.
' Water Meter
Acct. Deposit
5/W Permit
5/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Traits Ded.
Copies
Other
i'ota1:
SAC 96
5AC Units
CITY fJF EAGAN
3830 Ftilot Kfidb Road
Eagan, Minnesota 55123
(612) 681-4675
Building Perrnit Type
Building Work Type
UBC Occupancy
Construction Type
Zoning
Building Length
Building Width
'PEhMIT TYPE:
Permit Number:
Date Issued:
Cantrol No. 0 0 CJ 13"
BUILDING
000094
03/24/92
SITE ADDRESS:
3716 BLACKHAWK LAKE CT
1.0T: 20 BLOCK: 2
BLACKHAWK RIDGE
DESCRIPTION:
REMARKS:
FEE SUMMARY:
Base Fee
Plan F2ev3ew
Surcharge
SAC
SAC %
SAC Units
Subtotal
PERMIT
VAI.UATION
$758.50
$493.03
$67.00
$700.0@
188
1
$2,018.53
SF DWG
NEW
R-8 M-1
VN
R-1.
$134,090
52
38
hfISC F'EES 11,610.50
7nta1 Fee $3.629.03
CONTRACTOR: - Appliaant - ST. DWNER:
F58 CONST TNC 18903000 8003 85 FS8 CONST INC
2500 W COUNTY RD 42 9 2500 W CQUNTY FiD 42 9
BURNSVILLE MN 55337 BURNSVILLE MN 65337
(612) 890-3000 (612)890-3000
I hereby acknnwledge that I have read this application and state that the
information is carrect and agree to comply with all applicable State af Mn.
Statutes and City of Eagan qrdinances.
? -
APPLICANT/PERMITEE SIGNATURE ISSUE BY: SIGNATURE
Confral INSFECTION RE?C(?RD ?o.
CITY C}F EAGAI"rl PERMIT TYPE: surLnrNG
3830 Pilot Knob Road Permit Number: 8 0 0 0 9 4
Eagan, Minnesota 55123 Date fssued: 03 /24 /92
(612) 881-4675 .
SITE ADDRESS: LOr : 20 B La cK: z APPLICANT:
3715 BLAGKHAWK LAKE CT FS6 CONST ING
BLfiGKWAWK RraGE (612) 890-3000
PERMIT SUBTYPE:
sF owG
TYPE OF WVQRK:
NEw
INSPECTION
SITE D. .
FOOTIIUQ .,
FtiAMIMG INStJLRTION
WRLLBOARD FINRL
FIREPi.ACE
?
? `
C ` -
BUILDING PERMIT TYPE
D Ol foundation
Ul 02 Single Family
D 03 Two-farnily
0 04 Multi-fam. T.H.
? 05 Apt. Bldg.
WORK TYPE
03 90 New
0 91 Add9tion
O 92 Alterations
OFFICE USE ONLY.
? 06 Garage/Accessory
D 07 fireplace
? 08 Oeck
? 09 Basement Finish
O IO Swim Pool
D 93 Remodel
? 94 Repair
O 95 Tenant Finish
GENERAL INFORMATtON
O 11 Res. Add./Porch
O 12 Comm.JInd. New
O 13 Comm./Ind. Add
? 14 Comm./Ind. Rem.
O 15 Public Fac.
O 96 Move
O 97 Demolish
? 99 Undefined
- '?
?? ?!
. '
? 16 Agrlcultural
? 17 Building Move
C] 18 Demolition
? 20 Miscellaneous
Occupancy R-3 -/ Basement sq. ft. !`0.? MWCC System
Zoning lst F1. sq. ft. 1?69s ? City Water
Const. ?Actual) 2nd F1. sq. ft. ? PRY Required
(A1 owable} Sq. Ft. total Booster Pump
# of Stories Z footprint Sq. ft. F9re Sprinkler
Length 71,7__ On-site well Census Code
Oepth 3 On-site sewage SAC Code
APPROVALS
Planning Building Assessments
Engineering Yariance .
REQUIRED INSPECTIONS
1X Site
01 Wallboard
13 Footing
VD Final
CO Framing
O Draintile
?-
?
0/
,0 Insulat9on
Ll Fireplace
Permit Fee
Surcharge
P1an Review
license
MWCC SAC City SAC
Water Conn.
Nater Meter
Acct. Oeposit
S/W Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Oed.
Trails Ded.
Coples
Other
Total:
sac %
SAC Units
2S,e so
&7
y93.03
60
1C2._a
30
3a
Oos
3$D
? `! ?
3 ,S .1- /%
.,?.
10 Z.?.?Z-k -?C3 =
2
?
S- ?33
_?.L._
96, , . . .
vetuBtia,: s ? 3 coc??
?.° d/
? ? ?7L ^
--
P;
?0r
2, 1 3 0
z l, G ?.?- /y.S
' d .
s ?
l
REQUIREMENTS:
SINGLE FAMILY
1992 BUILDING PERMIT APPLICATION
CITY OF EAGAN
iAR 1 g REtO
2 SETS OF PLANS, 3 REGISTERED StTE SURVEYS, 1 SET ENERGY CALCS.
MULTIPLE DWELLINGS 2 SETS OF PLANS, 3 REGISTERED SITE SURVEYS, 1 SET OF ENERGY CALCS.
# OF UNITS RENTAL FOR SALE
COMMERCIAL 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS, 1 SET OF
SPECIFICATIONS, 1 SET OF ENERGY CALCS.
PENALTY APPLIES WHEN TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY LAST WORKING
DAY OF MONTH IN WHICH REQUEST !S MADE -OB LOT CHANGE !S REQUESTED ONCE PERMIT IS
ISSUED.
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH
ADDRESS IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
To Used For: Valuati? ,? " Date: .?? Site Address lc) R&bv?A4' " tt . ???°'y`J , l? ? •
Lot ,Q Block ? T EE
h Occupancy
? Bidg Permit
r
h
r
e
S
Parcel/Sub 1 Zoning g
c
u
a
?
Owner Actual Const
Allowable Plan Review
License Fee
# of stories SAC, City
Address Length SAC, MWCC
Depth Water Conn.
City/Zip S.F. Total Water Meter
Footprint S.F. Acct. Deposit
Phone S/W Permit
On-site sewage S/W Surcharge
Contractor Qn-site weil Treatment PI.
MWCC System Road Unit
Address City water Park Ded.
? PRV Trai) Ded.
City/Zip oi? ?J 55 Booster Pump Copies
Phone Ucense APPROVALS SUBTOTAL
Penalty
Planner Lot Change
Council
? TOTAL
Arch./Engr. ?5 ? ?;,?r?S?1l,? 1
_ Bldg. Off. .
Variance
Address
City/Zip Code
Phone #
?
Sewer/Wat Licens ;d Contr. ?
Processingtime
.
for sewer/ ater p its is two ays ce area as been ap ove .
- agrees that all work shall be done in accordance with
?n.?+ rn n rrnHnn . •
all apolicable State of Minnesota Statutes and City of Eagan Ordinances.
f ?
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all - I
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Q stw?
y
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4
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'r'oP BI.aGK E?t.. 839,3
Q c?S? ME NT E L. 8'? ?, t
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N
133.00 _ _ • h _
m ?o
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? ,??``t 133..00 ?
ekc? N 84'y8'5y"w ?
'?O i? + ? • , . '? t?' a_ 1
t'?
D?SCR IrTION ___., ... .. .-.-..°...."".?.
. ...._.. ,
l.oT ao, RtocK
BIACKNAWK RIDGEj "? f r ?? NoRtw
? DAKO TA t ourv T Yl
MJIVNS O'TA ALt 61FAR1Ar4s ASfWMgv
? e p? ?ypT? ? 1?ON M 0 Ni/ M?NT
?`
? , . ( _ L. ? ._._ ._
7 herph,y eprt9.?y thai: this survcY wae prepared by me or
ur,c?Ar rny direc't yUpcrvision and that I t?m a duly Registerec
Larid Suz•veyor undcr 1:he ]-aws of t;Yic Stfite •of Minnesota,
1)r_bIZs? L o•._ 1JoKlen_ '."'_'?-......._
Re:giy•Ccred Land Surve,yor No. 10795
r . . ? , .
, -..
F. _.0111
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ITE ?11:']_ r_;?"_. i.T.`" !I'T;i('Tv I,yY,-., t7 . FHCJ N'..? 6 9 0
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CITY OF EAGAN FOR CITY USE ONLY
3830 PILOT KNOB ROAD
EAGAN, MN 55122 PERMIT #
PHdNE: (612) 454-8100 RECEIPT # ?
DATE :
?- ---
PLEASE CQMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS &
rxwu.•.s•a..o.,l:...xaa..ww.;ar::.,
TOWNHOMES/COND05 WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
__---------...------------ ----------------------------------------------------------
WQRK DESCRIPTIQN COMPLETE THE FOLLOWING:
N0. FIXTURES EA. TOTAL
NEW CONST ADD-ON MINTMUM 15.00
ADD ON ? SHOWER 3.00
REFAIR ` WATER CLOSET 3.00
BATH TUB 3.00
LAVATORY 3.00
aWNER NAME: /22 KITCHEN SINK 3.00
J LAUNDRY TFtAY 3.00
SITE ABDRESS: ? ?zj? HOT TIJBJSFA 3.00
WATER HEATER 3.00
LOT: BLOCK ? SUBD. F'L04R DRAIN 3,00
ff ?^ GAS PIPING OUT.
INSTALLER: (MINIMUM - 1) 3.00
ROUGH OPENINGS 1.50
ADDRE S S:_ OTHER
WATER SQFTENER 5.00
CITY: ZIP: PRIVATE DISP. 15.00
U.G. SPRINKLER 3.00
PHONE #: v t?Z`?o ;? `'/`
SUBTOTAL
ST. SURCHARGE
SICNATTJRE SAP-PERMITTEE
TOTAL:
.50
? ??
? '
.....
PLEASE COMPLETE THIS PORTION FOR ALL CpMMERCIAL/INDUSTRIAL BUILDINGS A D
MULTI-FAMILX BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH
DWELLING UNIT.
CflNTRACT PRTCE: FEES
dWNER NAME: _
SITE ADDRESS:
LOT: BLOCK SUBD.
INSTALLER:
ADDRESS:
CITy: ZIP:
PHONE #:
FOR:
GITY Ok' EAGAN
I$ pF CONTRACT FEE.
STATE SURCHARGE _ $.50 FOR
EACH $1,000 OF PERMIT FEE.
$25.00 MINIMUM FEE.
CONTRACT PRICE x 1% $
STATE SURCHARGE $
TOTAL:
(SIGNATURE)
$
! i
CTTY OF EAGAN
LB?-- MECHANICAL PERMIT RECEIPT # /DS ?5S
SUBD. (612) 6814675 DATE fZ?, 9 ,=?--
RESIDENTIAL
PLEA.SE COMPI.ETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS. ALSO, COMPLETE FOR
TOWNHOMFS/CONDOS WHEN SEPARATE PERMTl'S ARE REQUIRED FOR EACH DWELLING UNTf.
f::
owivER: =
-Q;
FEEs
SITE ADDRFSS:
~ ' ADD ON/REMODEL (EXISTING
CONSTRUCTION ONLI) $ 15.00
INSTALLER: - -,-1 J y. HVAC: 0.100 M BT[J 24.00
PHONE #: ' ADDTiTONAL SO M BTU 6.00
ESS: GAS OUTI.ETS -1V?TIII?IUM 1 Q $3 EA. G?
[I ZIP: SURCHARGE $ .50
SEGNATURE: ,-._
ik& TOTAL: $ `
, .?
COMMERCIAL PLEASE COMPLETE THIS PORTION FOR ALL COMMF.RCIAI,/INDUSTRIAL BUILDINGS. AISO COMPLETE FOR
APART'MENT BUILDIlVGS OR OTHER MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR
FACH DVVELLING UNIT.
I WORK DESCRIPIION:
CONTRACT PRICE:
1% OF CUNTRAGT FEE.
STATE SURCAARGE IS $.54 FOR EACH
$1,000 OF PERMTT FEE.
PROCESSED PIPING - $25.00
MINIMUM FEE - $25.00
$
?
• v
CITY OF EAGAN
3830 PILOT KNOB ROAD
EAGAN, MN 55122
PHONE: (612) 454-8100
1$ OF CONTRACT FEE.
STATE SURCHARGE - $.SO FOR
EACH $1,000 OF PERMIT FEE.
PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS &
TOWNIiOMES/CONDOS WHEN PERMITS ARE REQIIIRED FOR EACH UNIT.
--
------------------------
WORK DESCRIPTION -------------------------- ---- -
-------------------
COMPLETE THE FOLLOWING:
N0. FIXTURES EA.
NEW CONST ADD-ON MINIMUM 15.00
ADD ON f SHOWER 3.00
REPAIR ? WATER CLOSET 3.00
BATH TUB 3.00
LAVATORY 3.00
OWNER NAME: KITCHEN SINK 3.00
IAUNDRY TRAY 3.00
SITE ADDRESS : HOT TUB/SPA 3.00
0 WATER HEATER 3.00
BLOCK ? SUBD,
LOT: C-4 FLOOR DRAIN 3.00
GAS PIPING OUT.
4
INSTALLER:_
(MINIMUM - 1)
3.00
ROUGH OPENINGS 1.50
ADDRESS: OTHER
WATER SOFTENER 5.00
L2Ip;
C I TY :
PRIVATE DISP.
15.00
---1 - _ U.G. SPRINKLER 3.00
PHONE
SUBTOTAL
ST. SURCHARGE
IGNATURE OF PERMITTEE
$25.00 MINIMUM FEE.
TOTAL
rmw
---$ 4z
?
?? ?? ??
G., , C7?
17; ICIYJ
?-??
.50
PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS AND
MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH
DWELLING UNIT.
---------------------------------------------------------------------------------
CONTRACT PRICE: FEES
OWNER NAME:
SITE ADDRESS:
LOT: BLOCK SUBD.
INSTALLER:
ADDRESS:_
CITY: ZIP:
PHONE
FOR:
CITY OF EAGAN
CONTRACT PRICE x 1$ $.
STATE SURCHARGE $
TOTAL:
FOR CITY USE ONLY
PERMIT #
RECEIPT # ?O S 7
DATE: I
TOTAL:
$
(SIGNATURE)