3622 Blue Jay Way CITY OF EAGAN IF
r 3830, Pilot Knob Road, P.O. Box 21-199, Eagan, M N 55121 117N
s- PHONE: 454-8100
BUILDING RRII Rece ipt #
To be used for SF BBC/GAR Est. Value $57,000 Date kIMCH 27
, 19
Site Address 3622 BLUE JAY WAY $ Erect I Occupancy R3
Lot 19 Block 2 Sec/Sub. LEXINGTON P = 5 ,odel ? Zoning
Parcel No Repair ? Type of Const.
. Addition ? No. Stories
Name ORRIN THOI PSON ilO S Move ? Length
m
c
Address 1712 HOPKINS CROSSROAD Demolish
1712 ?
? Depth
F
S 9
-
lmpr.
City MT Phone 544-7333 Install
? t
q.
SAME
o Name
a Address
City Phone
F W Name
x a Address
a w City _ Phone
Assessment
Water & Sew.
Police
Fire
Eng.
Planner
Council
Permit ` 00
Surcharge 25.50
Plan Review 00
SAC 575.00
Water Conn. 500.00
Water Meter 63.50
Road Unit 290.00
I hereby acknowledge that! have read this application and state that the Bldg. Off. 3/27/8 Tr. PL 156.00
information is correct and agree to comply with all applicable State of
Minnesota Statutes and City of Eagan Ordinances. APC Parks
Var. Date Copies $2,069.00
Signature of Permittee -, -' =r J
ORRIN Ti OMPSON I t}i?a ;S Total A Building Permit is issued to: 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 g ._ -
Permit No. Permit Holder Date Telephone #
Plumbing ?- a
H.V.A.C. c;
Electr' 3 (D S d (p
Softener
inspection Date Insp. Comments
Footings l
Footings 11
Foundation
Framing
Roofing
Rough Plbg.
Rough Mtg.
Insul.
Fireplace
Final Htg.
Final Plbg.
Bldg. Final /+ t
i)tr4 r1j ed?
Cert. occ. I
Deck Fig.
Deck Frmg.
Well
Pr. Disp.
}
CONTRACT PRICE:
Site Address
Lot Block
G)
c?
Name -
Address
City
Name
a?
c
0
7 S
.
PERMIT #
MECHANICAL PERMIT
l0?
RECEIPT #
CITY OF EAGAN -
3830 PILO T KNOB ROAD, EAGAN, MN 55121 DATE:
PHONE: 454-8100
TYPE
BLDG WORK D
RIPTION
S
Sec/Sub . E
C
- W_
I Res. New
I/Js O 411 Mult Add-on
Comm. Repair
Phone Other
City 114"J. Phone
TYPE OF WORK ?y
Forced Air y
--l M- BTU
Boiler M BTU
Unit Heater M BTU
Air Cond. M BTU
Vent
G ? CFM
as Piping Outlets #
Other
FEE:
S/C:
TOTAL:
FEES
RES. HVAC 0-100 M BTU - $24.00
ADDITIONAL 50 M BTU - 6.00
ADD-ON AIR COND. 0-24 BTU - 12.00
ADDITIONAL 6 M BTU
GAS OUTLETS
COMM/IND FEE-1% OF CONTRACT FEE - 6.00
- 1.50 EA.
MINIMUM - RESIDENTIAL FEE - 10.00
MINIMUM - COMM/IND FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND $1,000.00)
A ' j SIGNATURE.OF PERMITTEE
FOR: CITY OF EAGAN
CONTRACT PRICE:
(? L
Site Address
Lot 17 Block
PERMIT #
PLUMBING PERMIT RECEIPT #
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55121 rl?IE t y?-- '•?'
PHONE: 454-8100 {
Name 1 1 1 A". I-) F-1 f )<
Addrei??LG f? 1?1
C city '`'H k G'? Phone'
Name A' i r?I I L?i L
C Address 1 J Ivy { ', r _? r ', ?`
p City '' k k Phone
FEES
COMM/IND FEE - 1% OF CONTRACT FEE
MINIMUM - RESIDENTIAL FEE - $10.00
MINIMUM - COMM/IND FEE - 20.00
STATE SURCHARGE PER PERMIT .50
(ADD $:50 S/C IF PERMIT PRICE GOES
BEYOND $1,000.00)
SIGNATURE OF PERMITTEE
FOR: CITY OF EAGAN
DG. TYPE WORK DESCRIPTION
Res. New
Mult Add-on
Comm. Repair
Other
NO. FIXTURES TO AL
Water Closet - $3.00 hs
Bath Tubs - $3.00
Lavatory - $3.00
Shower - $3.00
Kitchen Sink - $3.00
Urinal/Bidet - $3.00
Laundry Tray - $3.00 tJ ._
Floor Drains - $1.50
Water Heater - $1.50 <
Whirlpool - $3.00
Gas Piping Outlets - $1.50
Softener - $5.00
Well- $10.00
Private Disp. - $10.00
Rough Openings - $1.50
FEE:
STATE S/C:
50
GRAND TOTAL _
CONTRACT PRICE
Site Address
Lot Block i
Name it u?rc
° Add
City
Name 4
Addre 4
O City 1 ? Ct, r
PERMIT #
PLUMBING PERMIT RECEIPT #
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE:
PHONE: 454-8100
BLDG. TYPE WORK DESC#IrIPTIC
ec Sub
Res. New
* ° $ Mult Add-on
Comm. Repair
one 6 3 O I' Other
FEES
COMM/IND FEE - 1% OF CONTRACT FEE
MINIMUM - RESIDENTIAL FEE - $10.00
MINIMUM - COMM/IND FEE 20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND $1,000.00
/k._
SIGNATURE OF ERMITTEE
FOR: CITY OF EAGAN
NO. FIXTURES TOTAL
Water Closet - $3.00
Bath Tubs - $3.00
Lavatory - $3.00
Shower - $3.00
Kitchen Sink - $3.00
Urinal/Bidet - $3.00 - --
Laundry Tray - $3.00
Floor Drains - $1.50
Water Heater - $1.50
Whirlpool - $3.00
Gas Piping Outlets - $1.50
Softener - $5.00
Well - $10.00
Private Disp. - $10.00
Rough Openings - $1.50
FEE
STATE S/C:
GRAND TOTAL.
5?J
CITY OF EAGAN 1ATER SERVICE PERMIT
3830 P* nob Road 7275
P. 8? fox 21199 ' y-i CL PERMIT NO.: Eagan, MN 55121 DATE:
4-3-86
Zoning Rl No. of Units: 1
Owner: Thompson Homes
u 4dress
Site Address: 3622 Blue Jay Way L-19 B2 Lexington PI So
Plumber: Thompson Plumbing
Meter No.: -.0 16 IRM ction Charge: ) V U . uupG
Size: t: l5.OO d
Reads Nf o !ii g call ; l0.00pd
I ayes to comply with &LECTfilt ri t r .sopd
oniiaeee s. 156. Oapd Ti'
UIRED ' i• B%W 6 3 5 pd meter
By Date Paid:
Date of Insp.- Insp.: __?,
This request void
18 months from
C .3685
Request Date Fire No. Rough-in Ins ction
Re a red? J
[] Ready Now WiII Notify Inspec
o
Wh
R
d
yes ? N. r
en
ea
y
Licensed Electrical Contractor I hereby request inspection of above
? Owner electrical work instal led at:
Street Address, B r Route
5
T? A2 Ci
.
ecteon No. Township N o No. Range No. C rity
Occupant (PRINT) Phone No.
C<,G/ ??.
Po Supplier Address
aU ICJ` /
1 V
AZO
EI trical Contractor (Company Name) Contractor's License P6.
//??(Jl.»K c= 73 CJ
Mails g ddre (Co ractor or Owner Making stailation)
o
4?? 41?
Authoriz d Signature (Contractor/Owner Making Installation) Phone Number
MJM4ESOTA STATE BOARD OF E RICITY THIS INSPECTION REQUEST WILL NOT
Griggs-Midway Bldg.- Room 1 BE ACCEPTED BY THE STATE BOARD
1821 University Ave., St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS
Phone (612) 297-2111 ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION Oft Es.e0001-0e
Ii, See instructions for completing this form on back of yellow copy.
£ 1? [; R F) "X"' Below Work Covered by This Request
lVeo Ad -Rep. .,Type of Building Appliances Wired Equipment Wired
Home Range Temporary Service
Duplex Water Heater Lighting Fixtures
Apt. Building Dryer Electric Heatlnc
Commercial Bldg. Furnace Silo Unloader,
Industrial Bldg. Air Conditioner Bulk Milk Tank
Farm Other pacify Othe I (Spec ify)
Other Spocify Other 01hur
("mmnirto Incnort,nn Foo R Ines
# Fee Service Entrance Size N Fee Feeders/Subfeeders # Fee Circuits
0to 41 '0 to 30
Amps
Above200_Amps 00 •31 to 100 Amps 31 to 100 A s
Swimming Pool Above 100-Amps Above 100-AMPS
Transformers Irrigation BOOrris Partial-`Other F
Signs Special Inspection TOTAL FE
U
Remarks
AF /n . _ _ l / ?` tf {,
I Y I
ough-in 6j inal
C
his request voi 1 hs from ' /ltXec w
Date
I, the lectrle
Inspector, hereby
I certify that the above
Dee 11 nspection has been
CIl7_ de.
AA10
CITY OF EAGAN N ° 11704
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100 013
BUILDING PERMIT Receipt # W
To be used for SF DWG/GAR Est.Value $57,000 Date MARCH 27 1J36
Site Address 3622 BLUE JAY WAY Erect Occupancy R3
Lot 19 Block 2 Sec/Sub. LEXINGTON PLr' SlQmodel ? Zoning R?
Parcel No Repair ? Type of Const.
. Addition ? No. Stories
ORRIN THOMPSON HOMES Move El Length 38
W
z Name
Address 1712 HOPKINS CROSSROAD Demolish El
El Depth 39
F
S
c
City MTKA Phone 544-7333 Int. Impr.
?
Install t
q.
SAME Approvals Fees
i
Q Address
City Phone
F I Name
x a Address
z
a m o Name
City Phone
I hereby acknowledge that I have read this application and state thatthe
information is correct and agree to comply with all applicable State of
Minnesota Statutes and City o agan Orddiinances.
Signature of Permittee ? • 7 f Z
ORRIN THOMPSON HOMES
Assessment
Water & Sew.
Police
Fire
Eng.
Planner
Council
Bldg. Off- 3/27/8'
APC
Var. Date
. 00
Permit
?5 0
Surcharge
152.00
Plan Review
SAC 575.00
Water Conn. 500.00
Water Meter 63.50
Road Unit 990.00
Tr. PI. 156.00
Parks
Copies
Total $2,069.00
A Building Permit is issued to: on the express condition that
all work shall be done in accordance with all a lic le State of M ' nesota Statutes and City of Eagan Ordinances.
Building Official
CITY OF EAGAN Rema
Lexington Place South
Addition
Owner Street °
Parcel 10 45060 190 7
fi ? h Eagan, MN
."R
Improvement Date Payment Rece ipt Date
STREET SURF.
STREET RESTOR. r ?. '. .
GRADING -. !7-
SAN SEW TRUNK 1985 47.64 16_51 5
SEWER LATERAL 101 ° 198 1631 .0 3,2'6.,2-0 5
Services 101 198 729.39 1.45.87 5
WATERMAIN 1985 65.81 13.16 5
WATER LATERAL 101 1986 873.43 17.-4-68 5
WATER AREA 101 198 243.73 48.74 5
WAT LAT BEN 1013 1986 111.98 22.39 5
STORMSEWTRK 141'l 1986 426.54 85,:30 5
STORM SEW LAT 1016 1986 803.34 160;.,66 5
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER.
SAC
PARK
CITY OF EAGAM WATER SERVICE PERM
3830 Pilot Knob Road
P. O. Box 21199 ,
PERMIT NO.:
EagaP, Ifi N 55121 DATE: 8 6
Zoning: F,.-1 No. of Units:
9
Owner: 'fir o Sot Fn ,:,r,
Address:
S i t e Address. 36.22 Bl*j.e J Wa r .z,'_ P2 La In toa PI-80,
Plumber: ThO "?p.SOf P1a~X .' g
Meter No.: Connection Charge..}
Size: Account Deposit:
Reader No.: Permit Fee: ' `Z a ' _
I arm to comply with the City of so"" Surcharge:
'
OrAiaone.s. `Pe ^xs
Misc. Charges a+
Total: '; . 1 „. r
{ By Dote Paid
Dote of Insp.: Insp.:
CITY OF EAC AtN.
3930 Pipit Knob Road SEWERS VICE PERMIT
P. O. Boat X1199 94-36
PERMIT NO.:
Eagan, MN 55121 DATE: 4-3-86
Zoning: Rl No. of Units:
Owner tpBOU
Address:
Site Addmm.3622 Blue JRY Way L1912 Leaingtoa P1 So
Plurr?her Tbawpwn Plumbing
3-28-86 61911 100. 06pi!
e1roe fo 4010* with !!wr Cit!' of loom C:rwmectior? Chow: 4 l5.00ptl
• "Menem Account Deposit: 15.0004
Permit Fee: l0 • 0-0,
Sur hharge: t' l
By Misc. Oharpes:
Date of Insp.' Total:
lnsp.t Dote Paid:
0?1
RESIDENTIAL
5
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD,EAGAN MN 55122
651-681-4675 / / 3 , 7
New Construction Requirements Renmdel/Reoair Requirements
• 3 registered site surveys showing sq. ft of lot, sq. ft. of house; and all roofed areas • 2 copies of plan
(20% maximum lot coverage allowed) 1 set of Energy Calculations for heated additions
• 2 copies of plan showing beam & window sizes; poured found design, etc.) • 1 site survey for exterior additions & decks
• 1 set of Energy calculations indicate if home served by septic system for addOrs
• 3 copies of Tree Preservation Plan if lot platted after 7/1/93
• Rim Joist Detail Options selection sheet (bldgs with 3 or less units)
DATE , I VALUATION 7 _S_1V SITE ADDRESS (kQ_. MULTI-FAMILY BLDG Y N
TYPE OF WORK__ _ FIREPLACE(S) - 0 1 2
APPLICANT -CLAC.
STREET ADDRESS '7CJ1 (q /12. _ ). CITY STATE ZIP
TELEPHONE # CELL PHONE# FAX #
PROPERTY OWNER 617f-44, A04 4 ICL/ TELEPHONE #
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category MINNESOTA RULES 7670 CATEGORY 1 MINNESOTA RULES 7672
(d submission type) • Residential Ventilation Category I Worksheet Submitted • New Energy Code Worksheet Submitted
• Energy Envelope Calculations Submitted
Plumbing Contractor: Phone #
Plumbing system includes: Water Softener _ Lawn Sprnl .00
Water Heater No. of R.I. s
No. aths JUL 0 51?002
Mechanical Contractor. Ph e #
Mechanical system includes: - Air Conditioning y 0.00
Heat very System
Sewer/Water Contractor. Phone #
I hereby acknowledge that I have read this application, state that th ation is corre and agree to comply
with all applicable State of Minnesota Statutes and City of an Ordinances.
Signature of Ap
OFFICE USE ONLY
Certificates of Survey Received Tree Preservation Plan Received _ Not Required
Updated 4/02
OFFICE USE ONLY
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
Q 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
?' 03 '01 of _ plex ? 09 07-plex 0 17 Garage ? 22 Porch/Addn. (4-sea.) 0 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex 0 18 Deck 0 23 Porch (screened) ? 36 Multi
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_,Y or N ? 25 Miscellaneous
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addition 0 36 Move Bldg. ? 42 Demolish (Foundation) 0 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)* 0 43 Reroof ? 46 Windows/Doors
? 34 Replacement *Demolition (Entire Bldg only) - 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 r 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 cps-
Surcharge -- ?? -L?-
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total (Q 13 . /
PERMIT # RECEIPT DATE: ® ,1 i v I
RESIDENTIAL 'PLUMBING PE AT APPLICATION
crrY OF EAS$SOPILOT KNOB RD
i AG AN, MN 55122
651-681-4695
Please complete for: ? single family dwellings
? townhomes and condos when permits are required for each unit
> backflow preventer for irrigation system
SITE ADDRESS: hj'lLW Vv
OWNER NAME:: TELEPHONE #:
(AREA CODE)
INSTALLER NAME: TELEPHONE #: 02A - 35J"`/-nn
r (AREA CODE)
STREET ADDRESS:
CITY: lib STATE: ktg-__ ZIP:G L
Reminder. Be sure to schedule inspections of alterations, i.e. water heaters, water
I hereby 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 perty/ri ht-of-way/easement.
SIGNATURE OF PERMITTEE
Updated 1/01
New residential dwelling unit under construction and not owner/occupied $ 90.00
Add-on, modification or alteration to existing dwelling unit, including: $ 50.00
• abandonment of septic system
• new installation/repair/rebuild of RPZ
• lawn irrigation system
• water turnaround
Nature of work:
Septic System, new/refurbished - $ 225.00
includes County & Consulting Inspector fees
requires MPC license
State Surcharge $ .50
Total
ters etc.
R
Date: 10/31/2001
Installer ...
Install Date: 11/01/2001
Time ........ -
M
Client ..... : SEARS
Order Number: 011321429317
Department..: 50
Customer....: BRADLEY, GRETA
Address ..... : 3622 BLUE JAY WAY
City ........ : EAGAN, MN 55123-
Phone ....... : (651)456-0493 .. r:k !;,.orze
Item:
WATER TREATMENT Standard Replacement - Softener
WATER TREATMENT Permits
Special Instructions:
OUST HAS UNIT
Amount Received
Comments .......
Pick up at:
CUST HAS UNIT
NOTICE TO CUSTOMER:
Do not sign this statement until the installation is satisfactorily completed.
The installation of the above has been completed satisfactorily.
011321429317
SALES CHECK NUMBER
CUSTOMER SIGNATURE
INSTALLER NOTE: Return this form with your invoice.
•.%e i n . r. e d mr, ha..:cIre ari .i .o .da:r. _qe, =..
.h'ave
_i.r .... ..1
m`y h... me ash C aXn:a.
no .a _a c?e
ar.
ix,
ha ."e the :ked a ll Lines and r-oarid eaks.
t
t )
Appliance Installers of MN
CusLoylter
V
CITY OF EAGAN
C
DATE: ASHIER: 3S TERMINAL NO: 026
t2/27/99 TIME„ 15:04:35
ID-
NAME: 14ARiTMAN EXTERIORS
300 9001 362P BLUE JAY k
2i. `; 9001 3622 BLUE JAY N t25.25
Tot!;l. :f Receipt Amount d
CR:12:1716 08.25
USER II?e JAN
?R>kSK** ::?k:?K*}{C*** *** C?k'Jj?%1C7tt +J?C ? ?C} 7? C?k ?C 7k
1999 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OP EACAN
j i 3830 PILOT KNOB RD - 55122
J 65'1-661-4675
D S mgmww sm sxweys showing s4 a of lot, st t of hou* 2 Capin of ptaft
and roofed a t20% m tot as?arereae SHowed) I
set ofer epat
> 2 copies of p s (agar beam & w4ndow sizes; poured hat. dsalg etc.) I site "my for wdwtr add le
f sat of energy calculations
) Icoples efts prumadon plan Y lot pt ted after 7103
a9
DATi : CONSTRUCTION C)
DESCRJnON OF WORK'
n 1
b 2 z 1
STREET ADDRESS:
LOT: BLOCK: -2- SUBt JPID,
Name: CJvY` r r Pty #: . ..... . ... k PROPERTY Lad First
O
City (51C state: 1X17 ,. Zip:
Canparl t: ?- '@?" t o y y 10 ?? Phone #: % `
s
co*
CZONTRACTOR. { Street 7 u b?, o e#I.)4I
City I coo , f i y State: :
ARCHITECTI
INGINEER Company:________________________________________________ Nn::
City State: Zip:
9WAW & water rypnstruetion onIv1: T+efe Maine t.
Nmft appiles and lot dmge is requested once permit Is issued.
t ackn I have need t!I aye _ s6de litatthe Information Is correct, and agree to a embda ad t
chb9in OOrdMw4m
Signature of Applicant:
OFFICE USE ONLY
C icates of Survey Received Yes No f 1FC 27 9
Tree Preservation Pbnt R Yes -;,_ No Not Required
OFFICE USE ONLY
BUILDING PERMIT TYPE
0 01 Foundation ? 06 4-plex 0 11 10-plex ? 16 Fireplace ? 21 Porch (3-sea.)
Cl 02 SF Dwelling 0 07 5-plex ? 12 12-plex 0 17 Garage ? 22 PorchfAddn. (4-sea.
Ct 03 1 of - ptex 13 08 6-plex ? 13 16-plex ? 18 Deck ? 23 Porch (screened)
0 04 2-plex ? 09 7-plex ? 14 Apartments ? 19 Lower Level ? 24 Storm Damage
0 05 3-plex 0 10 8-plex ? 15 Lodging ? 20 Pool ? 25 Miscellaneous
WORK TYPE
0 31 New 0 35 Tenant impr ? 39 Gas Line On ly ? 43 Siding/SoffitslFascia
? 32 Addition 0 36 Move Bldg. 0 40 Gas Insert 0 44 Windows/Doors
13 33 Alteration ' D 37 Demolish Bldg.* 0 41 Wood Stove ? 45 Fire Repair
0 34 Repair ? 38 Demolish (Interior) ? 42 Reroof
"Give PCA handout to applicant for demolition permit
GENERAL INFORMATION
Const. (Actual) Basement sq. ft. Census Code
(Allowable) Main level sq. ft. SAC Code
UBC Occupancy sq. ft. No. of Units
Zoning sq. ft. No. of Bldgs
# of Stories sq. ft. MC/ES System
Length sq. ft. City Water
Width Footprint sq. ft. Booster Pump
PRV
Fire Sprinklered
APPROVALS
Planning Building Engineering Variance
Permit Fee Valuation: $
Surcharge
Plan Review
License
MC/ES SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
SAC Units
% SAC
*1 big Into
CITY OF EAGAN
Z ,°?
APPLICATION FOR PERMIT SEWER AND/OR WATER CONNECTION
- = -(Lot A_A/ uxuvisicui car i rc+ic.e? L.,J. ivU LL J.. f
CF- EXISTIDIG SZRL'CZL?RE,.: DATE OF ORIGINAL BUILDING PERMIT ISSUANCE: xvrrLcl z H i n :
.BzAL DESCRII ION.
?RESENT' ZONING/PROPOSED USE:
Units)
R-1' SIM3LE FAMILY
R-2 DUPLEX (Two Units)
R-3 TOWNS USE.(Three + Units)
42 In- SER VER 14 11
5
r '. --..:, ?3Y n r ' ... NAME • _-: i'.?^ij.i.:S?FT['? Y '4. Fr.
'+rtG f {^?
• ADDRESS:
-
-? CITY
STAT E
ZIP
, ,
PHONE:
?;? . ?...,
'?`
'
`
•
-?".+? _. .
???
.?. ?-
•`:=."?` . -
3) x ?: a?• For City Use
NAME: Pl
Li
mb
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u
cens
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s
:
- ADDRESS:
C17
A
A
ti
- c
ve
Y? s -?? •
CITY, S? ??E
A, ZIP:
jean\1 C? E)Tired
PHONE ?j?j • MF R LIC3MM
# Not- Recort
a !§Mf
Initial
l -
- Y+" v; K4'W 'b-Y°' _ IYCYL'J •_ ` ..?.v iTmss `?.Ccrw RY??(1
r, fxe a r ??".c'
f?N
QTY STATE, ZIP: r¢ Y t? R V _
PH=
CONNECTION TO CITY SEWER - CONNECTION TO CITY WATER . T
p OTHER (Please Describe) -- -
6) ?? • :.
PLEASE HOLD APPROVED PERMIT FOR PICK-11 BY ONE OF ABOVE
PLEASE MAIL APPROVED PERMIT TO 1, 2,..3, 4, ABOVE
(Ciro
1 one) 7). 1MCeQ1t-'h*jz4=
. , "gam
M +
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ODES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF..;WATp
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YES IF ..YES r THEN W ?ER!?1?TT FOFt? WORK WITHIN
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PUBLICIROADWAY" MUST BE ±SSUED BY THE ,
NO ENGINEERING DIVISION ,LIST AS A CONDI-
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SUBJECT TO THE FOLLOWING CONDITIONS:
IM
APPROVED BY:
TI:
LE .
DATE
:
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1986 BUILDING PERMIT APPLICATION - CITY OF EAGAN
NOTE: ALL CONTRACTORS MUST BE LICENSED WITH THE CITY OF EAGAN
7-0'
COMMERCIAL
INCLUDE 2 SETS OF ARCHITECTURAL
& STRUCTURAL PLANS, 1 SET OF
SPECIFICATIONS AND 1 SET OF
ENERGY CALCULATIONS
$2,000 LANDSCAPE BOND
SINGLE FAMILY DWELLINGS
INCLUDE 2 SETS OF PLANS
3 CERTIFICATES OF SURVEY
1 SET OF ENERGY CALCULATIONS
To Be Used For: Valuation: 4D? Date: -Zo -
Site Address S(,22 Ahju_ OFFICE USE ONLY
Lot J Block
Parcel/Sub
Owner
Address
City/Zip Code
Phone
Erect Occupancy
Remodel Zoning ?•J
Repair Type of Const
Addition # of Stories
Move Length 38
Demolish Depth
Int.Impr. Sq Ft
Install
APPROVALS FEES
Contractor Assessments Permit pp
Water/Sewer Surcharge
Address ?-lIZ12 ; h e co r Police Plan Review co
Fire SAC 4ihi
City/Zip Code `_? n?? Engr Water Conn
Planner Water Meter
Phone 1 Council ?r . Road Unit Zj
Bldg Off L2Z Treatment Pl
Arch. /Engr . APC I 7"
Parks
Variance Copies
Address TOTAL 7s v?rri ivy
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.
LLM \ tNl-1Nbb (1NCi UUMPANY • 2815 WAYZATA BOULEVARD • MINNEAPOLIS, MN • PHONE: 374-4740
CERTIFICATE OF SURVEY FOR:
ORRIN THOMPSON HOMES
A Division of U.S. Home Corporation Scale: 1" = 30'
BENCHMARK: Top nut of hydrant at • Iron monument found
3649 Blue Jay Way a Spike or wood stake set
Elevation = 905.46 ft. x900.0 Existing spot elevation
(NGVD-1929) Q& Proposed spot elevation
Drainage direction
FRONT ,:GARAGE SLAB:
Proposed elevation = 902.83 ft.
?aSe
age 7 X33' ,O ?9 Sc'
o Q O /
L13
0G
ICI ?? e,?a o ? ?? ? / \?`•
o \ d \? 5 /B
61
Lot 19, 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.
MN Reg. No. '4?Z, Date 3 31
1) REV. 3-24-86''' CNAHJ E GARAGE TO
Proposed House.1L As-Built House- Drawn by P Al 'Prn-imt- nn 85104
CTW
EFT
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA145562
Date Issued:09/14/2017
Permit Category:ePermit
Site Address: 3622 Blue Jay Way
Lot:19 Block: 2 Addition: Lexington Place South
PID:10-45060-02-190
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace & Air Conditioner
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
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.
Contractor:Owner:- Applicant -
Karey Bradley
3622 Blue Jay Way
Eagan MN 55123
(651) 399-4629
Joel Smith Heating & Ac
13915 Lincoln Street NE
Suite E
Ham Lake MN 55304
(763) 792-1066
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA160789
Date Issued:04/14/2020
Permit Category:ePermit
Site Address: 3622 Blue Jay Way
Lot:19 Block: 2 Addition: Lexington Place South
PID:10-45060-02-190
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:Two or More Windows/Doors
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow
windows, call for framing inspection. Call for final inspection after installation.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Valuation: 5,000.00
Fee Summary:BL - Base Fee $5K $118.00 0801.4085
Surcharge - Based on Valuation $5K $2.50 9001.2195
$120.50 Total:
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.
Contractor:Owner:- Applicant -
Karey Bradley
3622 Blue Jay Way
Eagan MN 55123
Renewal Andersen
1920 County Road C West
Roseville MN 55113
(651) 264-4777
Applicant/Permitee: Signature Issued By: Signature