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3673 Blue Jay Way
se BLUE or BLACK Ir For Office UseG~ City Permit of Eajan I Permit Fee: ~ 3830 Pilot Knob Road I _ Eagan MN 55122 j Date Received: _7 Phone: (651) 675-5675 I~ Fax: (651) 675-5694 Staff: / 2010 MECHANICAL PERMIT APP (CATION Date: Site Address: Isell4eg Tenant: Suite L ~ zy RESIDENT/ OWNER Name: - - Phone:- Address /City/Zip: 73_~~L~~ _ CONTRACTOR Name: License - Address: "AE 111W Sak.iw - City:6 s State: Zip: Phone: Contact: _1 _ L Email: TYPE OF WORK New _ 1/ lacement _ Ad itional _ Alter D lor/(v ~J c~ lit, Description of work: ~ _~7 NOTE: Roof mounted and ground mounted mechanical equipment is required to be screened by City Code. Please contact the Mechanical Inspector for information on permitted screening methods. / RESIDENTIAL COMMERCIAL PERMIT TYPE ✓ mace New Construction Interior Improvement Air Conditioner Install Piping Processed Air Exchanger Gas _ Exterior HVAC Unit Heat Pump Under / Above ground Tank Install / _ Remove) When installing/removing tank(s), call for inspection by Fire Other _ Marshal and Plumbing Inspector RESIDENTIAL FEES: $50.50 Minimum Add-on or alteration to an existing unit (includes $.50 State Surcharge) $90.50 Fire repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) TOTAL FEE COMMERCIAL FEES: $70.50 Underground tank installation/removal OR Contract Value x1% $50.50 Minimum (includes State Surcharge) _ Permit Fee - If Permit Fee is less than $1,000, surcharge is $.50. - If Permit Fee is > $1,000, surcharge increases by $.50 for each Surcharge $1,000 Permit Fee (i.e. a $1,00142,000 Permit Fee requires a $1.00 surcharge). TOTAL FEE 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.org I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordin ces and codes of the City 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; thiM the work will be in accordan( with We approved plan in the case of work which requires a review and approval of plans. Applic nt's Printed Natfie Applican 's gnature FOR OFFICE USE Reviewed By: _ _Date: Required Inspections: --Under Ground Rough In ___Air Test ___Gas Service Test In-floor Heat `-Final FAGAN ff WATER SERVICE PERMIT . v Knob Road liI ~V 7278 ~w•esr-B`ox 21199 PERMIT NO.: Eagan, MN 5121 DATE: s Zoning: No. of Units: Owner: Thompson Homes Address: Site Address: 3673 Blue Jay "'74 xi gton P.l 0 Plumber. Thompson Plumbztg Meter No.:.3 7A 91!9 e, nrrv* Size: rr !Ok Cbtlnt 15. 00per Reader No.: Q`3 Al440 g l C . 00pd g~~ eel some to omnollr wiNr the Ci NSA= + t rchorge: iJjsr"t Ordinance& Misc. Charges: 1 3.5{}d_ d meter Total: By Date Paid: Date of Insp.: Insp.: _ , B~ .:~i'~ ~t~~~ CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 `d 11-T 113 BUILDING PERMIT PHONE: 454-8100 Receipt # Cfp To be used for SF DWG/GAR Est. Value $68,000 Date APRIL 1 19$6 3673 BLUE JAY WAY R3 Site Address Erect ~ Occupancy Lot 10 Block 4 Sec/Sub. LEXINGTON PL SQ3emodel 13 Zoning R1 Parcel No. Repair ❑ Type of Const. V Addition ❑ No. Stories ORRIN THOMPSON HOMES Move ❑ Length 42 i Name 1 HOPKINS CROSSROAD Demolish ❑ Depth 3o Address 544333 Int. Impr. El Sq. Ft. City MTKA Phone _7 Install ❑ z o Name SAME Approvals Fees u Address Assessment Permit 00 ~ City Phone Water & Sew. Surcharge 34.00 Police Plan Review 1650 F W Name Fire SAC 575.00 Address Eng. Water Conn. 500.00 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. 3/31/86 Tr. PI. 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 Signature of Permittee Total $2,124.00 A Building Permit is issued to: ORRIN THO PSON HOMES 9 on the express condition that all work shall be done in accordance with all applicable State Minnesota tat to d ity of Eagan Ordinances. Building Official CITY OF EAGAN 11%3 ~k 3830 Pilot Knob Road, P.O. Box 21-199, Eagano MN 55121 , " PHONE: 454-8100 G BUILDING PERMIT' Receipt # $8 Td 'b,6 used for SP DWG/GAR Est. Value $68,000 Date "RIL 2 19 315"73 BLUE JAY WAY R3 Site Address Erect ~ Occupancy YB Block --!d-sec/Sub. LEXINGTON PL SGemodel ❑ Zoning Lot R~ Parcel No, ' Repair ❑ Type of Const. Addition ❑ No. Stories Name ORRIN THO"SON HOMES Move ❑ Length 42 HOPKINS CROSSROAD Demolish ❑ Depth 48 3 Address Int. Impr. ❑ Sq. Ft o iH City Phone 54 4 -1.3.3.3 Install ❑ o Name SAME Approvals Fees Address Assessment Permit ' 00 City Phone Water & Sew. Surcharge 34 ' B D Police Plan Review ~ 57500 Name ' Fire SAC 5000 d • ' Address Eng. Water Conn. 5 City Phone Planner Water Meter 63 `0 Council Road Unit 290.00 I hereby acknowledge that l have read this application and state that the 156.00 information is correct and agree to comply with all applicable State of Bldg. Off. Tr. PI. Minnesota Statutes and City of Eagan Ordinances. APC Parks ` Var. Date Copies Signature of Permittee 1~A~46A, ^y -~T1Et SON HOMES S Total A Building Permit is issued to ORRIN t on the express condition that all work shall be done in accordance with all applicable State : innesota Slaatutes a,9d City of Eagan Ordinances. Building Official }a g P * \Dow *go* OWP. G G1 P~ PNW G. ~1. i *•w. tiw I uir ' PERMIT # 2 PLUMBING PERMIT RECEIPT # CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 551,21 DATE CONTRACT PRICE: PHONE: 454-8100 Site Ad r s 'c~ B G. TYPE WORK DESCRIPTION Lot Block Sec/Su Res. New 4) Name k~ i , Mult Add-on Addre s~It_«o! tom{ Comm. Repair c City " { c Phone L "L Other O. FIXTURES 10. T1,L Name ' T Vl 1 Water Closet - $3.00 C Addr I - 1 { ( ) r c z~;' -7-Bath Tubs - $3.00 J Q p City . Phone -Lavatory - $3.00 Shower - $3.00 1 Kitchen Sink - $3.00 FEES Urinal/Bidet - $3.00 COMM/IND FEE - 1% OF CONTRACT FEE MINIMUM - RESIDENTIAL FEE - $10.00-Laundry Tray - $3.00 MINIMUM - COMMAND FEE - 20.00 Floor Drains - $1.50 -Water Heater - $1.50 STATE SURCHARGE PER PERMIT - .50 Whirlpool - $3.00 (ADD $59 S/C IF PERMIT PRICE GOES _7-Gas Piping Outlets - $1.50 BEYOND' $1,000.00) Softener - $5.00 Well $10.00 r Private Disp. $10.00 =Rough Rough Openings - $1.50 SIGNATURE OF PERMITTEE FEE: STATE S/C: FOR: CITY OF EAGAN GRAND TOTAL: PERMIT # MECHANICAL PERMIT RECEIPT # ' 20 CITY OF EAGAN~ ~e 3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE: CONTRACT PRICE: PHONE: 454-8100 Site A djess Y BLDG. TYPE WORK DESCRIPTION Lot Block Sec/Sub 1, Res. , New - Name L To Address ,l L> Mult Add-on y c city _ Comm. Repair Phone Other Name G A.) 3 Addr 1 'v' /A)f __55t1~ FEES RES. HVAC 0-100 MBTU -$24.00 O City Phone 34141 7,171 ADDITIONAL 50 M BTU - 6.00 ADD-ON AIR COND. 0-24 BTU - 12.00 TYPE OF WORK ADDITIONAL 6 M BTU - 6.00 fjj ~ GAS OUTLETS - 1.50 EA. $ 171 COMM/IND FEE - 1% OF CONTRACT FEE Forced Air M BTU Boiler M BTU MINIMUM - RESIDENTIAL FEE 10.00 Unit Heater y9 M BTU MINIMUM - COMM/IND FEE - 20.00 Air Cond. 4LZ1 ~/!1 M BTU $ STATE SURCHARGE PER PERMIT - .1% Vent. CFM (ADD $.50 S/C IF PERMIT PRICE GOES BEYOND $1,000.00) Gas Piping Outlets # 7- Other FEE: S/C: } SIGNATURE OF PERMITTEE >A` TOTAL FOR: CITY OF EAGAN CITY OF EAGAN Remarks Addition Lexington Place South Lot 10 Blk 4 Parcel 10 45060 100-04 Owner Street 3673 Blue Jay Way State-Eagan° MN - - Improvement Date Amount Annual Years Payment ' Receipt ' Date STREET SURF.. ll - - - 1 I STREET RESTOR. GRADING - - SAN SEW TRUNK 4 1985 247.64 16.51 15 - SEWER LATERAL 1011 , 2 0 5 01 1986 1631 ~ 326 Services 101 1986 729.39 145.87 5 WATERMAIN 1985 65.81 13.15 5 WATER LATERAL 10 1986 873 .43 f-74 . 6 8 5 WATER AREA 101 1986 243.73 4.8 74 5 . WAT LAT -BF. 9 Z2 3 9 5- -STORM SEW TRK -101 1986 426.54 &5'.30 5 STORM SEW LAT 101 1986 803.34 160, 66 5 - - 1 CURB &GUTTER T SIDEWALK - STREETLIGHT - - - - I WATER CONN. BUILDING PER. - SAC PARK - - - This request void t, 78 months from `7 W YYY~~~ C"1716 4.t o B q Request Date Fire No. Rough.-in Inspection Re wired? Ready Now ilI Notify Inspec y es O No [or When Ready KLicensed. Electrical Contractor I hereby request inspection of above.- ❑ Owner electrical work installed at: Stage; Address, B or Route N C_ ect+on No. Township Na a or o. Range No. Cou Oc pant (PRINT) Phone No. o Sup her Address El trical Contractor (Company Name) 1/9, 3,2 Contractor's License No, 7_3b~ Mailing Addr s ICo tract r or caner Making 1 stailation) Authori ed Signature (Contractor/Owner aking Installation) Phone Number NESOTA STATE BOARD OF C ITY THIS INSPECTION REQUEST WILL NOT _ Griggs-Midway Bldg. -Room BE ACCEPTED BY THE STATE BOARD 1821 University Ave., St. Pe , MN 55104 UNLESS PROPER INSPECTION FEE IS Phone (612) 297_2111' ENCLOSED. g(p REQUEST FOR ELECTRICAL INSPECTION t7 EB-00001-04 Ill, See instructions for completing this form on back of yellow copy. 3716 "X" Below Work Covered by This Request WA43 iil~iw Add Rep. Type of Building Appliances. Wired Equipment Wired 01 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 (Sper.ify) t ef. Specify -Other Other - Compute Inspection Fee Below # Fee Service Entrance Size MA bfeeders # Fee' circuits O 'to 200 Amps s 0 to 30 Amps Above 200_Ampsrnps 31 to 100 Am Swimming Pool _Amps :Above 100_Ar11ps Transformers Oms Partial-!Other F Signs ection S TOTAL FEE Remarks 1710 Rough-in Date L, the Electrica 0^ inspector, hereby 0ex certify that the above Final Date inspection has been made. JI/13 RESIDENTIAL BUILDING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB RD, EAGAN MN 55122 651-681-4675 New Construction Requirements Remodel/Repair Requirements • 3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and 011 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 additions • 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 VALUATION SITE ADDRESS VIA MULTI-FAMILY BLDG _Y N TYPE OF WORK IN 610S FIREPLACE(S) _ 0 1 2 APPLICANT 1~'t..ll IpP STREET ADDRESS S /Ill? r,1 J~Vrz CIT1TAT/' ZIP 6-13772~ L_ TELEPHONE # CELL PHONE # FAX PROPERTY OWNER - (rVY TELEPHONE # COMPLETE FOR KNEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category _ MINNESOTA RULES 7670 CATEGORY I _ MINN RULES 7672 F~nergy(~po F (4 submission type) • Residential Ventilation Category 1 Worksheet Submitted New Wprl stw t Submift • Energy Envelope Calculations Submitted J J Plumbing Contractor: Phone # - Plumbing system includes: Water Softener Lawn Sprinkler Fee $90.00 Water Heater No. of R.I. Baths No. of Baths Mechanical Contractor: Phone # Mechanical system includes: Air Conditioning Fee: $70.00 Heat Recovery System Sewer/Water Contractor: Phone # I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinancrs. Signature of Applicant l 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 AccessoryBldg ❑ 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.) ❑ 33 Ext. Alt - SF ❑ 04 02-plex ❑ 10 08-plex 0 18 Deck ❑ 23 Porch (screened) ❑ 36 Multi 05 03-plex ❑ 11 10-plex ❑ 19 Lower Level ❑ 24 Storm Damage O 06 04-plex ❑ 12 12-plex Plbg_Y or _ N ❑ 25 Miscellaneous ❑ 31 New ❑ 35 Int Improvement ❑ 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 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 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 Water Supply & Storage S&W Permit & Surcharge Treatment Plant Plumbing Permit Mechanical Permit License Search Copies Other Total ► a 1986 BUILDING PERMIT APPLICATION - CITY OF EAGAN NOTE: ALL CONTRACTORS MUST BE LICENSED WITH THE CITY OF EAGAN COMMERCIAL 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: ► 1 ~~O Valuation: Date: ~-2~- 000 Site Address UA. OFFICE USE ONLY Lot _IQ Block Erect X Occupancy I~Z 3 Remodel Zoning L Parcel/Sub Repair Type of Const : Addition # of Stories Owner Move Length Demolish Depth 4{0 Address Int.Impr. Sq Ft Install City/Zip Code Phone APPROVALS FEES Contractors S Assessments Permit Water/Sewer Surcharge kf, 0 Address Z n Police Plan Review Fire SAC C ity/Zip Code yam, ~4 ylh ~ Engr Water Conn Am 1co Planner Water Meter Phone Council Road Unit -co Bldg Offs Ljjlfi_ Treatment Pled Arch./Engr. APC Parks Variance Copies Address TOTAL 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. CLARK ENGINEERING COMPANY ! 2815 WAYZATA BOULEVARD s MINNEAPOLIS, MN • PHONE: 374-4740 CERTIFICATE OF SURVEY FOR: ORRIN THOMPSON HOMES A Division of U.S. Home Corporation Scale: 1" = 30' BENCH MARK: Top nut of hydrant at 0 Iron monument found Blue Jay Way and Falcon Way. o spike or wood stake set Elevation = 904.02 ft. (NGVD-1929) x900.0 Existing spot elevation oa• Proposed spot elevation FRONT GARAGE SLAB: = Drainage direction Proposed E1. = 907.93 ft. BLUE JAY MAY 905.22 903. Z i CURB 5 89° I7'.51"F 63,00 905. ez 903, 2/ '.t •Q d O d t` U V) m N Uri w ~ M LU d 13.67 d 2 10.8 HOUSE #3673 10.2 V %J 11, - - 42.0 0 Q U7 N Q Q 56~0~o ~/v6 ~2 /6 32 Lot 10, Block 4, 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. o MN Reg. No. JJ~TZ46 Date Proposed House , As-Built House- Drawn by Project no. 85104 . CITY OF EAGAN WATER SERVICE PERMIT 3830 Pilot Knob Road j P. 0. Box 2'X#99 PERMIT NO.: Eagan, MN 55121 DATE: 4-3-$' Zoning: P No. of Units: I Owner: _ -__Thompson 770mes Address: Site Address: 3673 Blue Jey Way LI0 B4 Lexlnet D Pt So Plumber. 'IhOMpson Plumbing Meter No.. Connection Charge: 500 -()()Rd Size: Account Deposit: 15.0OPd Reader No.: Permit Fee: 10-22R4 e9wee to conk* wuh the City of Began Surcharge: . 5PA 014111""M m Misc.'Charon: 156.0i3Id TP Total: 63 , 50pd meter BY Date Paid: Dote of Insp.: Insp.: CITY OF EAGAN SEWER SERVICE PERMIT 3830 Pilot Knob Road 84210 P. O. Box 2T499 PERMIT NO.: 4-3-86 Eagan, MN 55121 DATE: No. of Units: 1 Zomittg: Owner. Thompson: Rome Address: Site Address:3673 blue Jay Way L10 B4 `Lexington F1 So Pkunber. nLomson plug inn 4-1-86 61066 100.001-4 i *on* to em npfr with dw Cky of Bogen Connecticr% Chorpe: 4 7 5.00pd t eee. Account Deposit: 15.00p Permit ' Fee: 0 • ,f 2 Surdmrge: Pd By Misc. Chorges: Date of Insp.: Totoh Insp.: Date Paid: > , s • _ i • • r • - s~: • - etc• ~ t ~ • • i p M • CITY OF EAGAN Y . APPLICATION FOR PERMIT SEWER AND/OR WATER CONNECTION r - 4 r , _r : y~ . w (Please Print) - a ti- - s.Yt icr:, ars Y -x'.~5a,•d-✓c.Z.ys- I T PROPERTY ADDRESS: _ vc s TEAL DEMON: - ~ras ..v Lot ock Subdivision or Tax Parcel I.D. Number) 44, - IF EXISTING STRT_)M11RE1DATE OF ORIGINAL ILDING_ PERMIT ISSUANCE: ' , ~ . • t-.~.. ~ ~ a~ ~bbn ear N PRESENT zoNING/PROPOSED USE: -1 SINGLE FANBLY" `R-2 DUPLEX (Ztao- Units) R-3 TOWNHOUSE (Three + Units) Units) } IK R-4 APARTCONDOMN Z_ I CMg4m tF,i;%RETAIL/OFFICE ' r~ - NAME- ADDRESS <n..+H J'f' DDRESS r X11 i 4Fa1. 4'Y.<y!t f^~ `-.T7 ~ ffl:7 CITY STATE ZIP. 44 - 40 M, (~f xa PHONE: 3Y - is - s : - 'For City Use - 11 "1 . r Plumbers fc~. ~ = _ umbers _ License- L.F1 VIE 4 Active ?i ADDRESS: Azza, QTY, :STATE, ZIP: /kw . Expired PHONG:t. r-. - . ,..1•JClr71TrLt Llt.C+l.W7t+ Tf - lVlJtr i~GL.W.~. _13 L.I..1Qi NAME:LV1 _ a ~ ADDRESS- V.- 4 r 3i QTY; STATE, ZIP : _ _ • - - PHONE Moore CONNECTION To CITY SEWER CONNECTION TO CITY WATER E OTHER (Please Describe) - - _ Q PLEASE HOLD APPROVED PER= FOR PICK i. BY ONE OF ADOVE _ PF~ASF MAII~ APPROVED PERMIT TO 1, 2, 3, 4, ABOVE (Circl one) +.~.3 ~'•zy~_'"...o.`~`~~, ~Y s tia~-;, cr 9 Mwy7 -r ~,~,tt'c a yr.. ".*~;`~~G., -:.'.cr P F _ _ 7 ~1r-k i:'ArT c`+rr t,.... J~• a,R.~.e,•s. *r>a- . >~'-~`4 ~ `F 0 R CITY , _ : - ~ }3 ~ 7~.-,.• . S EaO N L Y z .f- V"z ys 9 - ice. ._:2;~ ~''",~>a.•; ~ `t Tr,~~•' Z ate' s~S..~E~~~x~ z„ at-"C ~"r '~TT`''.7' m PERMIT a ISSUED 7o, 7_ # . 4' f'' _ .#x a 4 'I ~,~fi: i 2 T ; 'i a..n-9.•..,..+a- ....,,y.""sS-.k.. `~~Y t~a x`~ y,,. _..y. r >••tiv-w ay.~~.'~~ ''rU ~ s rx m~ f _ r ~ w'r. i?~a a§ a f t~ E } " ,,y v~+~7q-'i i~-- -C~ nv U.. ~ ..y.~ ~ v y.._~~ „ : j,•~ 'v7~2~' ~a~+ ~~•.r~_'4~ t.~~+ +f, c ~ ~ . ~l"~„~ ~ _~,~.'~~~'.-''9•r~5c~ ~ i .i5. .'a'= ~^j;~~.r~ „a ` SEw~E EMIIT (I`1CLU SURCHARGE) _ ,a ASTER:PE L'- _ PJIIT (II`JCuDE u'RCHARGF) s WATER METER SID /COPPERHORN/OUT ~a-„ E READER,-` - WATER. TAP INCLUDE `CORPORATION STOP BF „f,'~y'Y~~~~P rk-`- z _.aK . :i-.~-~" ~,r1~ r~`,~~'~"~~,a;~.~.` 'Y.i.~~'Y~.., s. 1~.a•ar _ ) .:sT~t~.{"'~.,,-.,~F SEWER <TAP b, MYAM ACCOUNT Dk POSIT WATER ~ " s~. a 'wr S ~ "a;~.~,+v 4. -•1 y~.wS x'~"Ls•„ ~ y'"~• ~ 'k n x,. x''F ttr, s.-:' T - rr-,WAC t x.r 1>a`„ k..~~"C )1'°' s, ^f-- rt h'-_> TRUNK WATER .Ai.SSZ8SMENT r - ~1 Jt. i , E t . Sties i f i'' f t ? + S $ . TRI' NK 1SEWER ASSESSMENT T $ - LT RAL %BF-NEFIVTRUNK SE IN ER C T t `r K i~ATER rI,.$E I£ ' `'RUti'K WATER WATER TREATMENT PLANT SURCHARGE S f , Z 0Txmt _ _ _ .a a ~i , r ~ • I . T©Tpil, , 'ArIOU:IT, "TAI VRE,9#PT 4J.K-'w i 'Y~.. -..~%E! A.--1_ . _-CV~.'•' #T.v . E .L' ~'w- iF-_ fem.. -1.-.i%b' , - _ -stf~:p~`.tY P ® J"4 :1. IDES UTILITY CONNECTION REQUIRE EXCAVATION i N PUBLIC RIGHT 1OF fiWA'n~.:_ YES IF YES THEN h "$ERIIT F09°iWORK WITHIN . PUBLIC ROADWAY" MUST 'BE'35SUED BY THE .r _ ~T NO ENGINEERING DIVISION LIST AS A CONDI- sr ~-t~~ -...,rte .s- T--, ~ t p _ ...v ~,'~~p~'~,+~,.• ~ e~. y~1 _ ~".._S;'~.t"£f'L• ~'.6+i -W..:yv~s L~}t 4W..i .~C ~ -~-+.w~"T _~~47'~. ~'SR+'Y ~ ~y~~ rp. ~ yG. f teis.4".t v "+"Maxr•[ { M Y SUBJECT TO THE FOLLOWING CONDITIONS yr -„7.`"'.. - - z _i _ h.. e 3..-. -fit ,y .cz+r ~ •s rt ~,r~i~~~`~+~2~{sx~+~,.- i'~?: .•e,.iro3n - _ - l `7 ab l4S^'s ^543 ajK -e APPROVED BY: n*j y _ t - DATE : ,l t 2 kn ' F c 1 _ ~ ~ • ~ - ~ ~ A( v~ ~ y~-+.'i' ICY For Office llscj~ ~y ity j Permit t ` (C C of Eap I Permit Fee. 3830 Pilot Knob Road Eagan MN 55122 j Date Received: j Phone: (651) 675-5675 I I Fax: (651) 675-5694 1 Staff: 2008 RESIDENTIAL BUILDING PERMIT APPLICATION Date: O Site Address: tWv Tenant: / Suite RESIDENT / OWNER Name: Phone: Address / City / Zip: 7 Applicant is: Owner Contractor TYPE OF WORK Description of work: Construction Cost: ys Multi-Family Building: (Yes / No T CONTRACTOR Name: License T Address: 67_3 ~ n ~~d G , Cr _ y2(^ City: State: IV~__ Zip: Phone: Contact Person: ° ' COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Minnesota Rules 7670 Category 1 _ Minnesota Rules 7672 Energy Code • Residential Ventilation Category 1 Worksheet New Energy Code Worksheet Category Submitted Submitted submission type) • Energy Envelope Calculations Submitted In the last 12 months, has 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: NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that the are trade secrets. 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 with t p rmit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval , p s. 1 ~ y X ~1 Jai fT' X Applica is Printed Name Applic 's Sig atu e Page 1 of 3 Use BLUE or BLACK Ink r - - - - - - - - - - - - - - - For Office Use I Permit City b I Permit Fee:ti fl' I 3830 Pilot Knob Road I Eagan MN 55122 $02~~~ Date Received: Phone: (651) 675-5675 I I Fax: (651) 675-5694 I Staff: I I 2010 RESIDENTIAL BUILDING PERMIT APPLICATION Cr '-b Date: L,2 Ll C Site Address: 3 73 R I-UIE J,qy e~,IAV Tenant: E, C'L.S C 1\J Suite RESIDENT / OWNER Name: 5C Cr T ~ L-S r' Phone: Address / City / Zip: 3~-7) L i?F- <)A'/ CIVAV, FAC 4i`, N/V Applicant is: _3zwner Contractor TYPE OF WORK Description of work: /Qr:r'LA:: KC77,Q DgCk ;,q D S fL4fAlfA16 Construction Cost: Multi-Family Building: (Yes / No v") CONTRACTOR Name: License Address: City: State: Zip: Phone: Contact: Email: COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months, has 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: NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that the are trade secrets. 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.orcl 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 P Applicant's Printed Name Applicant's Signature Page 1 of 2 DO NOT WRITE BELOW THIS LINE SUB TYPES - Foundation - Fireplace - Porch (3-Season) - Storm Damage - Single Family _ Garage _ Porch (4-Season) _ Exterior Alteration (Single Family) - Multi Deck Porch (Screen/Gazebo/Pergola) - Exterior Alteration (Multi) 01 of _ Plex Lower Level Pool Miscellaneous Accessory Building WORK TYPES New - Interior Improvement _ Siding - Demolish Building* _ Addition - Move Building _ Reroof - Demolish Interior Alteration - Fire Repair _ Windows - Demolish Foundation - Replace - Repair _ Egress Window - Water Damage Retaining Wall *Demolition of entire building - give PCA handout to applicant DESCRIPTION Valuation C.~ ( Occupancy( MCES System Plan Review Code Edition SAC Units (25%_ 100%_X.) Zoning City Water Census Code Stories Booster Pump # of Units Square Feet PRV # of Buildings Length Fire Sprinklers Type of Construction Width REQUIRED INSPECTIONS Footings (New Building) Sheetrock Footings (Deck) Final / C.O. Required Footings (Addition) Final / No C.O. Required Foundation HVAC Drain Tile Other: Roof: -Ice & Water -Final Pool: -Footings -Air/Gas Tests -Final Framing Siding: -Stucco Lath -Stone Lath -Brick Fireplace: -Rough In -Air Test -Final Windows Insulation Retaining Wall: _ Footings _ Backfill _ Final Meter Size: Radon Control Erosion Control Reviewed By: L , Building Inspector RESIDENTIAL FEES Base Fee Surcharge Plan Review / MCES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant Copies TOTAL Page 2 of 2 Tt Q --I M r Z c Z rn - z T G 0 7. O z o c � rr - -t 11 C c c C Ti e 1 A C3 p= G I 7.1 CSO c, cra rn - c — 0 r.z � rn W 00 -� <7 _I-14 V 0,2 4- j--(1 evag IBM 11. 1 r•L • • • • 11 • • • • • • • • y rri f's *-N 4 • • if 1411141 03 • 4 4 1 •• \ Li\ 1/44 11 N LJ City of Eagan PERMIT City of Eaan Permit Type: Plumbing Permit Number: EA136144 Date Issued: 04/27/2016 Permit Category: ePermit Site Address: 3673 Blue Jay Way Lot: 10 Block: 4 Addition: Lexington Place South PID: 10-45060-04-100 Use: Description: Sub Type: Residential Work Type: Replace Description: Water Heater Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments: Please call Building Inspections at (651) 675-5675 to schedule a final inspection. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Building Code). Fee Summary: PL - Permit Fee (WS &/or WH) $59.00 Surcharge -Fixed $1.00 0801.4087 9001.2195 Total: $60.00 Contractor: Champion Plumbing 3670 Dodd Rd., #100 Eagan MN 55123 (651) 365-1340 - Applicant - Owner: Jeffrey W Tipple 3673 Blue Jay Way Eagan MN 55123 (757) 768-9152 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