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3614 Blue Jay Way ALAN WATER SERVICE PiRMT 7274 Box 21199 PERMIT No.: Eagan, MN 5512'F DATE: 4-3-86 Zoni R1 I Erg: No, of Units Owner. _ Thompson Homes Address: Site Address: 3614 Blue Jay, ~Ta LIS B2 Lexington Pl So Plumber: Whompson 81u G Meter No.:.3 70 / 90 12 7 500.00pd size: 4/8 Rec14 Before digging t 15.00 dd Reoder No.: NE- 'j 10.00pd 1 egres to esrnoh► w*h the W 50pd Ors" rocs. RE Mrsc ~ 156 . QQPd TP Tatoi 63 . S nd meter BY Dote Paid: Dote of Insp.: Insp.: z F t CITY OF EAGAN F. 11712 c 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHONE: 454-8100 r BUILDING PERMIT Receipt # f, To be used for SP DWG /GAR Est. Value $68,000 Date APRI1. 1 19 3614 BLUE JAY WAS Erect ❑iti. Occupancy R3 Site Address Lot16 Black 2 Sec/Sub. LEXINGTON PL SoRemodel ❑ zoning R1 Parcel No. Repair ❑ Type of Const Addition ❑ No. Stories i ORR I N THOMP SON HOMES Move ❑ Length 42 4 z Name Demolish ❑ Depth 4-6 II o Address 1712 HOPKINS CROSSROAD Int. Impr. El Sq. Ft t City ATKA Phone 544--7333 Install ❑ i o Name SA+' Approvals Fees I.- 00 Address Assessment Permit 337.00 City Phone Water & Sew. Surcharge 344.00 Police Plan Review 6S - 50 E FZ Name Fire SAC 575.00 0 °z Address Eng. Water Conn.00 a W City Phone Planner Water Meters:50 Council Road Unit 290.00 l hereby acknowledge that l have read this application arfd state that the Bldg. Off. 3J311~3 Tr. PL 156.00 information is correct and agree to comply with all applicable State of Minnesota Statutes and City of agan Ordinances. APC Parks Signature of Permittee- Var. Date Copies Total $2,1244.00 A Building Permit is issued to: ORRIN HOMFSON ROVIES on the express condition that all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. ' Building Official fr ; t Permit NO. Permit Holder Date Telephone # Plumbing a (o H.* A.C. Electric ? Softener Inspection Date Insp. Comments Footings 1 Footings II Foundation Framing t Ph t . a7 y Bldg. Final - i ~iQ~`fLtJ~v/ 6fsl Cert. Occ. Deck Fig. Deck Frmg. Well Pr. Disp. PERMIT # c PLUMI3NNG PERMIT RECEIPT'#i CITY OF EAGAN r 3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE. ~ ' CONTRACT PRICE: PH :454-8100 moo} Site Address BLDG. TYPE WORK DESCRWTION Lot Block ec/Su es._ New Name Mult Add-on a Addre s Comm. Repair S City Phone Other I) f j i J NQ. FIXTURES TOTAL L Name f Water Closet - $3.00 c Addre (i- L"' ` LX Bath Tubs - $3.00 L)U p City l Phone ~-Lavatory _ $3.00 Shower - $3.00 FEES-Kitchen Sink - $3.00 COMMAND FEE - 1% OF CONTRACT FEE --T-Urinal/Bidet - $3.00 Laundry Tray - $3.00 L) MINIMUM - RESIDENTIAL FEE _$10.00 Floor Drains - $1.50 MINIMUM - COMMAND FEE - 20.00 -Water Heater - $1.50 STATE SURCHARGE PER PERMIT - .50 Whirlpool - $3.00 (ADD $50 SIC IF PERMIT PRICE GOES -Gas Piping Outlets - $1.50 BEYOND $1,000.00) Softener - $5.00 Well - $10.00 Private Disp. - $10.00 =Rough Openings - $1.50 SIGNATURE OF PERMITTEE FEE ' STATE S/C: FOR: CITY OF EAGAN GRAND TOTAL- PERMIT # MECHANICAL PERMIT RECEIPT CITY OF EAGAN p/ 3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE: 40 CONTRACT PRICE: f PHONE: 454-8100 Site Adss lwae &"-f BLDG. TYPE W DESCRIPTION Lot _ Block Sec/Su eC 1, Res. No i✓ Name i Mult A -on Addr 1 Gs Comm. R it c City Phone f Other Name Tlidllaow FEES c Address '041k) RES. HVAC 0-100 M BTU $24.00 p City Phone ADDITIONAL 50 M BTU - 6.00 ADD-ON AIR COND. 0-24 BTU - 12.00 TYPE OF WORK ADDITIONAL 6 M BTU GAS OUTLETS - 1.50 EA. Forced Air 4 BTU COMM/IND FEE - 1% OF CONT ACT FEE Boiler M BTU MINIMUM RESIDENTIAL FEE - 10.00 Unit Heater M BTU MINIMUM - COMMAND FEE - 20.00 Air Cond. M BTU STATE SURCHARGE PER PERMI - .50 Vent.! CFM (ADD $50 S/C IF PERMIT PRICE ES Gas Piping Outlets # BEYOND $1,000.00) Other FEE: S/C: SIGNATURE OF PERMITTEE TOTAL: r FOR: CITY OF EAGAN CITY Of EAGAN Remarks r` Addition xin 't P ce Outh Lot Is Blk 2 Parcel 10 45060 180 02 Owner street 3611 Blue jay Way State Eagan, MN Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. STREET RESTOR. GRADING SAN SEW TRUNK 1495 247.64 _ SEWER LATERAL 3 1. 03 2 6 'r " 0 1986 729.39 145.87 5 ervices WATERMAIN 1985 _13.16 5 WATER LATERAL 10 9 8.6- 8 7 . 43 174.68 5 WATER AREA 10 19 8 2 7 4 48.74 5 WAT LAT BEN 1011- 1986 111.98 22_39 5 STORM SEW TRK 10 111 1986 426.54 85Q0 5 STORM SEW LAT 1016 1986- 803.34 160':66 5 CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. BUILDING PER. SAC PARK CITY OF EAGAN WATER SERVICE PERM 31130 Pilot Knob Road 274 P.70. Box 2YI99 PERMIT NO.: Eager, MN 55121 DATE: 4-_ Zoning:' No. of Units: Owner. Tbompbon Votes Address: Site Address: 3614- Blue Tay ! Bay 11;3 X32 L, jx4gtwi. T1 So Plumber: Thompson Lq.g Mater No.: Connection Charge: Size: Account Deposit: S . CSfJpc? Reader No.: Permit Fee.' i 0 « bsd i 49M to eess* with the city of sawn Surcharge: * `3 Ondiwenoes. Misc. Charges: ?frd TIP, Total: By Date Paid: Date of Insp.: Insp.: CITY QF EAGA►N SEINER SERVICE PERM 3830 PilotRnob Road ,21199 PERMIT NO.: 4--~ P. 0. Box Eagab, MN 55121 DATE. Zoning: No. of Uriiia: Owner. T*m"poo22 HoLles _r- Site Address:3614 $111e Sap Way 1..1.8 B2 Lazington PI So~ Plumber: Tbo1±BC~z1 Plctial~ittg 6106 4-l 3 Ifl .0 )pd R 1 yree to ""OF, wuh the CRY of B"m C.mnection Chorpe: 475, ordinefteft Actount Depot: Permit Fee: - 10.0024 Surdwarge: + By Mist. Qlorgm Dote of Irk.: Towl: Insp.: Dote Paid: This request void a 18 months from C~19 4 ' `C 3717 d, , Request pate 'Fore No. Rough-in Inspection R c nredl OReady Now 11 Notify. Inspec- ✓,~,1' s Ej No Tor When Ready censed.Electrical Contractor I hereby request inspection of above ❑ Owner electrical work installed at: Street Address,, Bo or Route N ec ron o. Township N e or o. Range No. out t Occupant (PRINT) Phone No. Po r Supplier Address U pp 1 a~ V"/ EIe f ontractor (Company Name) Contractor's License No c.J Mailing Addres ICo tracto or Owner Makil j Autho zed>Signature (Contract r/Owner Making Installation) Phone Number s NNESOTA'STATE BOARD OF CTRICITY THIS INSPECTION REQUEST WILL NOT Griggs-Midway Bldg. -Room .19Y BE ACCEPTED BY THE STATE BOARD 1821 University Ave , St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS Phone (612).287-2111 ENCLOSED. • 'j REOLIEST FOR ELECTRICAL INSPECTION p E13-00001-04 ` See instructions for completing this form on back of yellow copy. 3717 ""X Below Work Covered by This Request Nwp Add Rep. Type of Building, Appliances Wired Equipment Wired Home Range Temporary Service Duplex Water Heater Lighting Fixtures Apt. Building` Dryer Electric Heating Commercial Bldg. Furnace Silo Unloader. Industrial Bldg. Air Conditioner Bulk Milk Tank Farm Other (Specify) Other (Spo, fy) t er Specify Other Other Compute Inspection Fee Below k - Fee Service Entrance Size # Fee Feeders /Subfeeders.. # Fee Circuits -fa O to 200 Amps , a •0--to 30 Amps O to 30 Am )s Above 200_Amps ~ij 31 to 100 Amps 31 to 100 Amps Swimming Pool Above 100-Am s Above 100_AmPs Transformers` Irrigation Booms Partial-'Othe ee Signs Special Iris pection $ TOTAL FE 4/ Remarks ~ Rough-in Date- r" the Electri f 0 inspector. hereby i Final • - Date certify that the above inspection has been made. This request void 18 months from r CITY OF EAGAN N a 11712 ` 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHONE: 454-8100 1/b 6 BUILDING PERMIT Receipt # To be used for SF DWG/GAR Est. Value $68,000 Date APRIL 1 '19 86 3614 BLUE JAY WAY R3 Site Address Erect ~ Occupancy Lot 18 Block 2 Sec/Sub. LEXINGTON PL SORemodel ❑ Zoning V Parcel No. Repair ❑ Type of Const. Addition ❑ No. Stories Name ORRIN THOMPSON HOMES Move ❑ Length 42 W 1712 HOPKINS CROSSROAD Demolish 11 Depth 4 o Address Int. Impr. ❑ Sq. Ft. City YiTKA Phone 544-7333 Install ❑ o Name SATE E Approvals Fees 0 Q Address Assessment Permit 3 3 7. 0 0 I" City Phone Water & Sew. Surcharge 34.00 8 ¢ Police Plan Review 168.50 W W Name Fire SAC 575.00 0Z Address 500.00 Eng. Water Conn. a W City Phone Planner Water Meter 63.50 Council Road Unit 290.00 1 hereby acknowledge that I have read this application and state that the Bldg. Off. 3/31/8 Tr. Pl. 156.00 information is correct and agree to comply with all applicable State of Minnesota Statutes and City agan Ordinances. APC Parks Var. Date Copies Signature of Permittee Total $2,124.00 ORRIN HOM ON HOMES A Building Permit is issued to: on the express condition that all work shall be done in accordance with ppli ble e of ' sota S tes and City of Eagan Ordinances. Building Official CASH RECEIPT • CITY OF EAGAN P. O. BOX 21-199 EAGAN, MINNESOTA 55121 DATE 19~ RECEIVED FROM AMOUNT Is ~d G7 QI & _ DOLLARS 3 Z , ~U 6 j S H / K F44 L AM FU C SIP c) a G T ~i Al- a~ - .sue Thank You - N_ 611 C~ c, ~La ite-Payers Copy 4_ L E Yel o Posting Copy szv Pink-File Copy ' RESIDENTIAL BUILDING l c;2 Permit Application City Of Eagan 3830 Pilot Knob Road, Eagan Mn 55122 Telephone # 651-675-5675 FAX # 651-675-5674 New Construction Reauirements RemodeVReoair Reauirements Office Use Only 3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and all roofed areas 2 copies of plan `Cert of Surrey Recd (20% maximum lot coverage abed) t set of Energy calculations for heated additions -Tree Pres Plan Recd 2 copies of plan showing beam & window sizes; poured found design, etc. t site survey for addifiDns & decks _ Tree Pres Not Reqd 1 set of Energy Calculations Addition - indicate if on-site septic system _ On-site Septic System 3 copies of Tree Preservation Plan if lot platted after 711/93 Rim Joist Detail Options selection sheet (bkigs with 3 or less units Date Construction Cost J Jr, _req~ Site Address {fy ~~c cy Unit/Ste # Description of Work Multi-Family Bldg _ Y X N Fireplace(' 0 1 _ 2 Property Owner pTP/ l t"~ Telephone # ( eaV) 6 13/ - 7~ 4 t Contractor (t~ Address a ~3 of, - State Zip elephone # COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Minnesota Rules 7670 Category 1 _ Minnesota Rules 7672 Energy Code Category Residential Ventilation Category 1 Worksheet New Energy Code Worksheet 0 submission type) Submitted - Submitted • Energy Envelope Calcul itt~d Licensed Plumber Telephone ) J Mechanical Contractor 1 Telephone # ( ) Sewer/Water Contractor Telephone # ( ) I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN Statutes; I understand this is not a permit, but only an application for 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 a review and approval of plans. Applicant's Printed Name Applicant,'&Signature OFFICE USE ONLY Sub Types ❑ 01 Foundation ❑ 07 05-plex ❑ 13 16-plex ❑ 20 Pool ❑ 30 Accessory Bldg ❑ 02 SF Dwelling ❑ 08 06-plex ❑ 16 Fireplace ❑ 21 Porch (3-sea.) ❑ 31 Ext. Alt - Multi ❑ 03 01 of _ plex ❑ 09 07-plex ❑ 17 Garage ❑ 22 Porch/Addn. (4-sea.) D 33 Ext. Alt - SF ❑ 04 02-plex ❑ 10 08-plex ❑ 18 Deck ❑ 23 Porch (screen/gazebo) ❑ 36 Multi Misc. ❑ 05 03-plex ❑ 11 10-plex ❑ 19 Lower Level ❑ 24 Storm Damage ❑ 06 04-plex ❑ 12 12-plex Pibg_Y or _ N ❑ 25 Miscellaneous Work Types ❑ 31 New ❑ 35 Int Improvement o 38 Demolish (Interior) ❑ 44 Siding ❑ 32 Addition ❑ 36 Move Bldg. ❑ 42 Demolish (Foundation) ❑ 45 Fire Repair ❑ 33 Alteration ❑ 37 Demolish (Bldg)* ❑ 43 Reroof ❑ 46 Windows/Doors ❑ 34 Replacement *Demolition (Entire Bldg) - Give PCA handout to applicant Valuation Occupancy MC/ES System Census Code Zoning City Water SAC Units Stories Booster Pump Nbr. of Units Sq. Ft. PRV Nbr. of Bldgs Length Fire Sprinklered Type of Const Width REQUIRED INSPECTIONS - Footings (new bldg) _ Final/C.O. - Footings (deck) _ Final/No C.O. Footings (addition) _ Plumbing Foundation _ HVAC _ Drain Tile Other Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests Final - Framing _ Siding _ Stucco _ Stone Fireplace _ R.I. -Air Test -Final _ Windows (new/replacement) Insulation _ Retaining Wall Approved By , Building Inspector - - - Base Fee Surcharge Plan Review MC/ES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant License Search Copies Other Total CITY USE ONLY PERMIT ^t RECEIPT DATE: - RESIDENTIAL 9FOGRANNAL P HOWIT APPLICATION crrY OF Ecsv 3$80 PILOT KNOB RD EAGAN MN 55122 651-6$1-4E675 Please complete for: ➢ single family dwellings JA ( A townhomes and condos when permits are required for each unit Date: / SITE ADDRESS: lul OWNER NAME: -.1 on'e C TELEPHONE -1 (AREA CODE) INSTALLER NAME: „ Rooter TELEPHONE 2800 Campus Dr., StC# 40 (AREA CODE) STREET ADDRESS: Plymouth, MN 55441 51 CITY: STATEN ZIP: Place a check mark next to the permit work type New residential dwelling unit under constructionand not owner/occupied $ 70.00 _ Add-on, modification or alteration to existing dwelling unit $ 50.00 • furnace replacement • air exchanger • air conditioner • other V" Nature of work: 111414.0111~0' State Surcharge $ .50 Total $ Reminder: Call for inspections. I 'jAV NATURE OF PE(lD ZnIOU iot J CITY USE ONLY PERMIT RECEIPT DATE: APPROVED BY: , INSPECTOR COIVIMKIAL MECRAMCAL PFAM T APPLICATION CITY OF CT 3$30 PILOT KNOB RD EEGAN, MN 55122 651-6$1-4675 Please complete for: all commercial/industrial buildings multi-family buildings when separate permits are not required for each dwelling unit DATE: i SITE ADDRESS: OWNER NAME: PHONE (AREA COLE) TENANT NAME (IMPROVEMENTS ONLY): WAS THERE A PREVIOUS TENANT IN THIS SPACE? Y N. NAME: INSTALLER: ADDRESS: PHONE (AREA CODE) CITY: STATE: ZIP: WORK TYPE: New construction Install U.G. Tank Interior Improvement Remove U.G. Tank Processed Piping Specify Nature of Work: When installing1removing underground tank, call 651=681-4675 for inspection by Fire Marshal and Plumbing Iinspector. Fees: 1% of contract price OR $50.00 minimum fee, whichever is greater. Underground tank removal/installation =minimum fee Contract price: $ x 1%= $ (Base Fee) State surcharge calculate at $.50 for each $1,000 Base Fee TOTAL $ SIGNATURE OF PERMITTEE f Updated 1/01 1986 BUILDING PERMIT APPLICATION CITY OF'EAGAN NOTE: ALL CONTRACTORS MUST BE LICENSED WITH THE CITY OF EAGAN 653 COMMERCIAI. SINGLE FAMILY DWELLINGS INCLUDE 2 SETS OF ARCHITECTURAL INCLUDE 2 SETS OF PLANS & STRUCTURAL PLANS, 1 SET OF 3 CERTIFICATES OF SURVEY SPECIFICATIONS AND 1 SET OF 1 SET OF ENERGY CALCULATIONS ENERGY CALCULATIONS $2,000 LANDSCAPE BOND To Be Used For: 46-Jeaf'-14- Valuation: Date: Site Address -964, OFFICE USE ONLY Lot Block Erect X Occupancy Remodel° Zoning Parcel/Sub Repair Type of Const Addition # of Stories Owner Move Length Demolish Depth Address Int.Impr. Sq Ft Install City/Zip Code Phone APPROVALS FEES A., A Contractor Assessments Permit Water/Sewer Surcharge p~ Address ObiQL ~~O<Ky Police Plan Review' Fire SAC City/Zip Code a 46k thki Engr Water Conn ft, Planner Water Meter Phone Council Road Unit , Bldg Of Treatment Pl Arch./Engr. APC Parks Variance Copies' Address TOTAL ,212 ~ OD City/Zip Code Phone # NOTE: ADDRESSES FOR CORNER LOTS CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED. e OCL ENGINEERING COMPANY • 2815 WAYZATA BOULEVARD • MINNEAPOLIS, MN * PHONE: 374-4740 CERTIFICATE OF SURVEY FOR: ORRIN THOMPSON HOMES A Division of U.S. Home Corporation Scaler 1" = 30' BENCH MARK: Top nut of hydrant at the 0 Iron monument found northwest corner of Blue Jay Way and C Spike or wood stake set Duckwood Drive. Elevation = 907.46 ft. (NGVD 1929) x-900.0 Existing spot elevation oo. Proposed spot elevation Drainage direction FRONT GARAGE SLAB: Proposed el. = 903.53 ft. \/)rai~a9e L/fi/ity EaSC177Pn1 o N \ ~ o a% 9 5 89°21'54"E 124.00 9O q P . 3 rn O 40 130.7 46.33 0 rn O m z l0' rob 2 { T r" N 6.8 tr O C m N I S M ro 1-7.0 w b Z.o ~9S 6, °4.03 Lu t0 ~~o r I '~a 24.5 ;t.f~VNOP / a O , b b 38 ° -10 . o •s~ o O o O •J Lot 18, Block 2, LEXINGTON PLACE SOUTH Dakota County, Minnesota I hereby certify that this is a true and correct representation of a survey of the boundaries of the land above described and of the location of all buildings, if any, thereon, and all visible encroachments, if any, from or on said land. I further certify that this survey was prepared by me or under my direct supervision and that I am a duly Registered Land Surveyor under the laws of the state of Minnesota. Ic'...0,._c? MN Reg. No. ,i,, Date -;~7 -7i1 Proposed Housed As-Built House- Drawn by Eu 'Project no. 85104 li CITY USE ONLY 0 / L BL 02, RECEIPT O Z~r SUBD.<~. (2 izo. RECEIPT DATE: 1998 PLUMBING PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, NN 55122 (612) 681-4675 Please complete for: ➢ single family dwellings townhomes and condos when permits are required for each unit backflow preventer for underground sprinkler system FIXTURES EACH # TOTAL Shower 3.00 x Water Closet 3.00 x - Bath Tub 3.00 x = Lavatory 3.00 x Kitchen Sink 3.00 x Laundry Tray 3.00 x = Hot Tub/Spa 3.00 - x = Water Heater 3.00 x = Floor Drain 3.00 x = Gas Piping Outlet * minimum -1 3.00 x = Rough Openings 1<.50 x Wate r * for dwellings under construction 5.00 X = VFjftrSoRgFe-r-`~*~rexisft dwelling 20.00 x _ U.G. p er * for dwelling under const. 3.00 - U.G Sprinkler * for existing dwelling 20.00 = Alterations ` to existing residence 20.00 = Water Turn Around 20.00 = Private Disposal System * MPC iic. 75.00 = (new and refurbished systems) Private Disposal Systems * Abandonment 20.00 = STATE SURCHARGE .50 TOTAL 59 - - ihereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable City of Eagan ordinances. It is the applicant's responsibility to notify the property owner that the City of Eagan assumes no liability for any damages caused by the City during its normal operational and maintenance activities to the facilities constructed under this permit within City property/right-of-way/easement. SITE ADDRESS: KO, MALLORY 3614 BLUE JAY WAY OWNER` NAME: EAGAN, MN 55123 (612) 686-7241 INSTALLER NAME: NORBLOM PLUMBING CO. TELEPHONE _V8A . STREET ADDRESS: ae0112~> a ena,ar1a MINNEAPOLIS, Mee 5508 CITY: STATE: ZIP: i (;~Z/ A la~l~ SI F PERMITTEE JS/FORMS BLDG/PLBG PERMIT (RESIDENTIAL) 1998 • s • s n • • saw - ~+a t t t a1 000 O • 2 1; 0 Ivy* 1144"t zff!kf~ CITY OF EAGAN _ APPLICATION FOR PERMIT SEWER AND/OR K,TER CONNECTION S_ :z 4 Please Pr k _ PROPg2T'Y`ADDRESS: 1,EGAL DESCRIPTION .o: ate...., Lot lock S visa n or_ Tax-parcelI D M4Nunber), _ - ~ ..,,.-.rr. `k.:.,... y rat; ,'~'.°_'a,,~";~"`~'!x s. • ~5~ _ -•.,y,.iti, _ +fgo..fr.~, ,i,~•r `"~1 IF EXISTING`STRL.TRE, DATE OF ORIGINAL BUILDING PERMIT ISSUANCE ay. 13M r? .rc `A:C t.C~. ✓~y~ -~C "i4 h,..i(y Nbn eQi ZONIrIG/PROPOSID USE: -1'- S AMILY R-2: DUPE TWO L 'ts) r, ' + t'nits) _ Units) Y R-3 TOWNHOL NM a R-4 ,-APAR'IVTf CONDOMIIU CCZAL/RETAIL/OFFICE ~ ~~~'K' NAME ;ter ADDRESS: -lli .71tLiJ.:i,& ' `y -z-- - •PHONL'• sir For City Use ; • All^ 'NAME. Pliers License ADDRESS: Z 1. =f k A -o" C= Expired ZIP= ~ ~ a • G7 Not Recor(k PHONE . ~?J, ► Z~Z I MA.sMR LICENSE # Y r~ PEA S L -:JILL 6J.C.4 .Yi a i„w. x4 b'' i.-, ~ ~.,~~",~`~?~"~-°'~i: x''~, rmz"i~ ~ _~::.:-..+„d-~. ar:..:.c.,iF.,.,` : =NAME ' ~Qr/l~f ! l - ~ - ~ .,.s ~ ~ ~ ,t. -A ZL. re-M 33"1 ~ 'Q"`-"`~`i,~ys .C Y2Te ,r•~ J' ^ k~ r a.r. _ -r.-.:arm ~s _ ~.r,5ry,.., - c•.~ ~ _ fir' T%Z' ~ J CONNECTION TO CITY ~ CONNDCTION TO CITY SEWER E3 OTHER (Please Describe) - ❑ PLEASE HOLD APPROVED PER= FOR PICK-L BY ONE OF ABOVE PLEASE MAIL APPROVED PERMIT TO 1, 2, 3, 4, ABOVE 1 w y„5 . Circle one) =mot r ''r~, .gym. - ~'--;w P' _Lr. t. ~ ,Jy'~yracuY tl t S. ` kS'ri C o--3: i.? - _ ter, _ -^^:re~R~'•a -G3,.-~' "kI~O~MVIiSiyll~~,[e.cPr sue.'~,~•'~+.' `tr"" - u rjs.,-.'4. ,X"^a, -4:.::',.., .'7•y6'.r, z ~ u W~%FOR C~ITY U'SON LY is .ia+. { `.'m.- to.r ,,z, - ...S++.ra- y•?t-',. _y S. ,-r-y ,,.off'-- - - s f-~ka."''S ,r.e. ~^S~r•c~^ rt~...,.a,.: PER-MIT a ISSUED MAI-sfiK+ciy ~ -•s .f ~'y„ _'h - ~y'- ,'Y,'.l_?..is'~...,~ 4.=. a ~tr .72~,~~rt,se; c', tr ~~„t,~~ "i•'~'" SErrED `P RMIT I`IC SURC. WATER PERZlIT (INCI UDE ~u'RCfiARGE) t ~ 3 ate, wit, " * WATER METER/COPFERHORN/OUTSIDE READER d y - .u 'i ~+F.:A..•1N' `+-t 'a stn .j'+''.7 tWv sn $ M WATER TAP C INCLUDE CORPORATION STOP)-- S E TAP, ~ i ~ T' ~ s:=`,.,~ ~z•"~.~ ` ter 1 ~ sz. j V V~ ♦ J^~. V V 1~ - S N -~3Q.r•-.~~b ~ 1 ~r~~ ~~~~'I~S' w~~ l'"~l.. a;sn~ a 'T "~!~+y~ "'~"n.~ua:'ne ~ - ~ ACCOUNT DEPOSIT WATER_ WAC } a:}P..,`' clrL , r C k • ~`'4`.'r.-F..-~=.. t>..~s-,x ^~`,Y tea..-~ 1 v;t~y.~'G.'~ "'".,~`'.aLfi'~':+~ 74, fTRUNK WATER ,AiSSESS,'EtiT r~ - $ 7 +wp qa 41; - ti V2GK.SEW$R ASSES SMEN $ U*RAL'BFNEFIT/TRUNK SE::'E:~ } $ LATERAL. -BENEZ;Ir /TRUNK WA WATER TREATMENT PLANT SURCHARGE OTHER ...r'! - TAI j T 1 - ~ ~ ~ ~ r E ~ ~ ~ - r4 fi f E~'~ r AMOUNT FAIL/RECyz'. PT _.L z IDES UTILITY CONNECTION _REQUIRE EXCAVATION iN PUBLIC RIGHT -OF WAS X µ YES IF YES, THEN - $ERM T OFD "WORK WITHZN az z --PUBLIC. ROADWAY" MUST BE ISSUED BY THE Q NO a ENGINEERING DIVISION LIST AS A CONDL Y, ~ .yrr-: -~~^`t ~ arm ....,y; .;;i _ s~'+- ~r s "may . ..,.1''SS7~'~~~b y-1~•4 SUBJECT TO THE FOLLO~~TING CONDITIONS: a.rr1 _ ..-iTi •"?Y- tar. x:`Ld,", r APPROVED BY:(,iJ 4"zCJ7~-o TITLE: + s r x DATE: L~ - ~ - _ - - -.,w _ rr-myfla YL,,.v 4y.a iF+.++w ~~'~1...i~es...r'f~._ Use BLUE or BLACK Ink r For Office Use Permit I City of Ea 01 V Permit Fee: I I 3830 Pilot Knob Road 1 Eagan MN 55122 Date Received: o- 3- Phone: (651) 675-5675 I I Fax: (651) 675-5694 I Staff: L-------------- --I INFLOW & INFILTRATION PERMIT APPLICATION Plumbing / Sewer & Water Date: Site Address: Tenant: Suite RESIDENT OWNER Name: WSCA 110m l0m Phone: ^~53'`"Ia0 Address/ City/Zip: w W a/ , v M a h c WJ 5503 Name: License CONTRACTOR Address: City: State: Zip: Phone: Contact: Email: PLUMBING (Within the building envelope) SEWER & WATER (Outside the building envelope) TYPE OF WORK Sump Pump Repair Repair Other: Other: Description of work: ?/Vows. Su yT~ ~ ~ DESCRIPTION FEES $60.00 / Each (includes $5.00 State Surcharge) TOTAL FEE $ *Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submit 1/1 repair costs for reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors can be found by visiting www.cityofeagan.com/inflow, or City Hall at 3830 Pilot Knob Rd. CALL BEFORE YOU DIG. Call 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. www.gopherstateonecall.orq 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 I understand this is not a permit, but only an application for 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 a review and approval of plans. X .)V\am- ~ x I Auy_~,_ Applicant's Printed Name Applicant's Signature FOR OFFICE USE Reviewed By: Date: Required Inspections: -Under Ground -Rough-In Final