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 ~
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-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
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t. ~ ,Jy'~yracuY tl t S. ` kS'ri C o--3: i.?
- _ ter, _ -^^:re~R~'•a -G3,.-~' "kI~O~MVIiSiyll~~,[e.cPr
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`tr"" - u rjs.,-.'4. ,X"^a, -4:.::',.., .'7•y6'.r,
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APPROVED BY:(,iJ 4"zCJ7~-o
TITLE:
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DATE:
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Use BLUE or BLACK Ink
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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