2835 Burnside Ave
<f 1 For Office Use j
( Permit
City of Ea~dIl
RECEIVED I Permit Fee: 06 l
3830 Pilot Knob Road I I
Eagan MN 55122 NO 10 2010 l Date Received:
Phone: (651) 675-5675
Fax: (651) 675-5694 ; Staff:
-----------------J
2008 MECHANICAL PERMIT APPLICATION
Date: Site Address: .
Tenant: Suite
RESIDENT / OWNER Name: D"j4 j- -4' Kell lA .~Y) Phone: 661--;14014`7N
Address /City /Zip: 5 r~a~
CONTRACTOR Name: ' w-. ?9 License
Address: ,
City: C2~CZ~ Qlri~ State: Zip: 641i2k
Phone 0494a l Contact Person:
TYPE OF WORK New V/' Replacement Additional Alteration Demolition
Description of work:
-Rz4laeu~ .LX
i NOTE: Both roof mounted and ground mounted mechanical equipment is required to
be screened by City Code. Please contact the Mechanical Inspector or one of the
Planners for information on permitted screening methods.
PERMIT TYPE RESIDENTIAL COMMERCIAL
Furnace _ New Construction _ Interior Improvement
✓Air Conditioner Install Piping Processed
Air Exchanger Gas _ Exterior HVAC Unit
* HVAC units must be screened
_ Heat Pump Under/ Above ground Tank (_Install /-Remove)
_ Other When installing/removing tank(s), call for inspection by Fire
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 State Surcharge
$1,000 Permit Fee (i.e, a $1,001-$2,000 Permit Fee requires a $1.00 surcharge).
$ TOTAL FEE
1 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 M Agwy X A P ?
Applicant's Printed Name Applican% Signature
FOR OFFICE USE Reviewed By: Date:
Required Inspections: Under Ground - Rough In _Air Test -Gas Service Test In-floor Heat Final
CITY OF EAGAN Remarks
Addition Country Home Heights Lot 10 Rlk 7 Parcel 10 18300 100 07
Owner-&I-',/ } l 4-2 / -o s-o_-' Street 2835 Burnside Ave. State Eagan, MN 55121
Imwovement Date Amount Annual Years Payment Receipt Date
REETSURF. 1972 MOO $84.00 10 1
STREET RESTOR.
GRADING
SEW TRUNK 1968 100.00 $3.33 30
SEWER LATERAL 1970 15
WATERMAIN
%o WATER LATERAL 1970 2022.00 134.80 15
WATER AREA
* STORM SEW 1970 15
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. $230.00 1530 7-1-69
BUILDING PER.
SAC 200.00 1530 7-1- 9
PARK
EAGAN TOWNSHIP No 506
~~~"~~J~T~~ ~ ILDING PERMIT'
Owner ,~+_,GfL~S... ....i~^C_<..... r- Eagan Township
Address (present) - Town Hall
Builder . rQl----- _ 'p
- - - Date
Address DESCRIPTION
Stories To Be Used For Front Depth Heigh! Est. Cost Permit Fee Remarks
E9 ~ ~ I
LOCATION
Street, Road t r Description of Location Lo! Block Addition or Tract
This permit does not authorise the use of streets, roads, alleys or sidewalks nor does it v the owner or is agent
the right to create any situation which is a nuisance or which presents a hazard to the heal safely, conve fence and
general welfare to anyone in the community.
THIS PERMIT MUST B E... Q}~ - MISE-WHILE per WORK
tISeIN aOG SS.
This is to certify, that- - - ..'-------------...........-'---upon
the above described premise subject to the provisions of the Building Or finance Eaga hip adopke April 11,
1955.
Per
Chairman of Town Board Build' g ctor
I
Cit of Dian j Permit# gS~ I
I I Permit Fee: qV . K I
C)
V I
3830 Pilot Knob Road I
Eagan MN 55122 Date Received:
Phone: (651) 675-5675
Fax: (651) 675-5694 Staff: -
2008 RESIDENTIAL BUILDING PERMIT APPLICA HUG 1 2 2008 D
Date: W I I I OX Site Address: YYl
t~ t 1, ey
Tenant: 45e11U ~UYt~ Suite :
RESIDENT i OWNER Name: y AT-N C11 S' Phone:
Address/ City / Zip: a 8gS 5U irvw l2 AUQ lU-k-
Applicant is: _Owner Contractor
TYPE OF WORK Description of work:
Construction Cost: . 0 It roily Building: (Yes No
CONTRACTOR Name: ftL eM,' tCE 5" License# aol9aoloa
Address: i) a M t Yle AA/J- S.
-fa.0
City: M m a~ State: ~ n Zip: SSu
Phone: lpia-m, l-Saa Contact Person: bow i-P lidam'%
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
_ Minnesota Rules 7670 Category 1 _ Minnesota Rules 7672
Energy Code . Residential Ventilation Category I 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 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 ]Swal-y Aktm.S x & ,VI /I r 1 Dj~~a
App iccant's Printed Name Applicants Signature
Page 1 of 3
1006 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Construction Requirements Remodel/Repair Requirements Office Use Only
3 registered site surveys showing sq. ft. of lot. sq, ft. of house; and all roofed areas 2 copies of plan showing footings. beams, joists Cen of Survey Recd _ Y _ N
'(213% maximum lot coverage allowed) I set of Energy Calwlations for heated additions Tree Pres Plan Recd Y N
2 copies of plan shoving beam & window sizes; poured found design, etc. - 1 site survey for additions & decks Tree Pres Required _ Y _ N
l set of Energy Calculations Addition - indicate if on-site septic system On-site Septic System _Y _N
3 copies of Trans Preservation Plan if lot platted after 711/93
Rim Joist Detail Options selection sheet (buildings with 3 or less units)
Minnegasco mechanical ventilation form
Date /O? / Construction Cost //~Q
Site Address 13((y7s&e 4w17u& Unit/Ste #
Description of Work Q~eSliife d17LC 61)1Ybt ~l~ / l dlili
VIV
Multi-Family Bldg - V X N 1 Fireplace(s) _ 0 - 1 - 2
Property Owner D2WIV KE 1(y ! Elm S4,0-tA.) Telephone,#/( (,S/)
~itJ//( GtS S!~/L~//Li b~u/F~6ld1/f~S Ll~GNd i~ 0~3~110~"
Contractor
Address 4;,(Aq i+lliLd .~BGrO/ SG49/L ~?p City
State Zip Telephone # (&51) ~Y
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Category I _ Minnesota Rules 7672 .
Energy Code Category • Residential Ventilation Category 1 Worksheet New Energy Code Worksheet
(,i submission type) Submitted Submitted
• 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?
Y _ N If yes, date and address of master plan:
Licensed Plumber G( L Telephone
Mechanical Contractor DEC 1hUIJ J 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 Ap licant Signature U
EAGAN TOWNSHIP
3795 Pilot Knob Road
St. Paul, Minnesota 55111
Telephone 454-5242
PERMIT FOR WATER SERVICE CONNECTION
Date: July 1, 1969 Number: 299 C'-,q ~
Billing Name: Paul D. Pahos Site Address: 2535 Burnside Avenue
Owner: Paul D. Pahos Billing Addres9835 Burnside Avenue
Plumber: All-State Plumbing
Location of Connection Meter Size`s,A Connection Chg. 211 Pd-
Acct. dep. 15.00 pd.
Picked up xnd meter on
July , 1969. Meter No ✓d /LsaC 3 Permit Fee 7.50 Pd.
Meter Reading 4;:-o Meter Dep.
Meter Sealed: Yes Add'l Chg.
NO Total Chg.
Inspected by
Date
Building is a: Remarks:
Residence X
Multiple No. Units
Commercial
Industrial By:
Other Chief Inspector
In consideration of the issue and delivery to me of the above permit, I
hereby agree to do the proposed work in accordance with the rules and
regulations of Eagan Township, Dakota County, Minnesota.
All-State Plumbing
e ar Ave. So.
Richfield, Minn
Please notify the above office when ready for inspection and connection.
E
EAGAN TOWNSHIP
3795 Pilot Knob Road
St. Paul, Minnesota 55111
Telephone 454-5242
PERMIT FOR SEWER SERVICE CONNECTION
DATE: July 1. 1969 NUMBER 429
1 a 7 G.NNOWNER:Paul D. Pahos Address 2835 Burnside Avenue, St. Paul 55118
PLUMBER All-State Plumbing TYPE OF PIPE Heavy cast iron
DESCRIPTION OF BUILDING
Industrial Commercial Residential Multiple Dwelling No. of units
Location of Connections: Connection Charge 200.00 pd.
Acct. dep. 15.50 pfd.
Permit Fee 7
Street Repairs
Total
Inspected by:
Date
Remarks:
By
Chief Inspector
In consideration of the issue and delivery to me of the above permit, I
hereby agree to do the proposed work in accordance with the rules and
regulations of Eagan Township, Dakota County, Minnesota
All-State Plumbing Co.
6539 Cedar Ave. So.
Mcf1fielul .
Please notify when ready for inspection and connection and before any portion
of the work is covered.
~iva/~/ r
ordin No. nos
WELL AND WATER SUPPLY MANAGEMENT
Permit No.
WELL PERMIT
94-9025
DAKOTA COUNTY ENVIRONMENTAL MANAGEMENT DEPARTMENT Unique
WATER AND LAND MANAGEMENT SECTION H45184
14955 CsI k Mu*, Appk Vdley, NN 55124
Tdephooe (612) 891.7011
0r
WHEREAS, the NON-TRANSFERABLE
PERMITTEE/DBA: Hartmann Well Company ISSUED TO: 40174
ADDRESS: 308 E. Main St. REVIEWED BY:Luehrs
New Prague, MN 56071
has submitted a permit application, has paid the sum of $111.00
dollars to the County of Dakota as required by ordinance Number 114 and
has complied with all of the requirements of said Ordinance necessary
for obtaining this permit to seal the Well described herein:
An abandoned well with a casing diameter of 4 inches, depth of 240 feet,
and completed in Unconsolidated Sediments, will be permanently sealed.
The well shall be cleaned of equipment and debris, disinfected, neat
cement pressure grouted and terminated at least two feet below grade.
THE WELL IS LOCATED IN THE MUNICIPALITY OF EAGAN AS FOLLOWS:
WELL LOCATION PROPERTY OWNER & ADDRESS WELL OWNER & ADDRESS
2835 Burnside Avenue Paul Pahos Paul Pahos
2835 Burnside Avenue 2835 Burnside Avenue
Eagan, MN Eagan, MN
NOW, THEREFORE, Hartmann Well Company is hereby permitted and
authorized to seal the well described and located above for a period
of one year from the date of this permit. Sealing of this well is
subject to all provisions of Dakota County Ordinance 114, the Minnesota
Wells and Borings Code and any conditions attached on the reverse
side of this permit.
Given under my hand Tuesday, March 1, 1994
ATTEST
ENVTRO ENTAL SUPERVISOR ENVIR ENTA AGEMENT DIRECTOR
03/01 194 14:58 ID:DAMTA CD-WSC FAK:6128917031 PAGE 1
MUNICIPAL NOTICE OF WELL PERMIT APPLICATION
DAKOTA COUNTY ENVIRONMENTAL MANAGEMENT DEPARTMENT
WATER AND LAND MANAGEMENT SECTION
14955 Galaxie Avenue West, Apple Valley, MN 55124
Tel (612) 691-7011 Fax (612) 891-7031
Tom Colbert/Wayne Schwan8 Fax ♦i (612) 661-4612
FREs Harsh 01, 94
Water and Land Management
Well Permit 0: 94-9028 Well Type: Sealing
Municipality : Eagan Reviewer : Luehrs
;i NOTICE:
The Water and Land Management Section of the Dakota County Environmental
Management Department has received the following permit application for
havedescribed.
ifeyouwell
questionsoorrequire
concerns review of
contact® application or
Specialist listed above or our office at (612) 891-7011, If there is no
P.1 response from your office within 24 HOURS (excluding weekends and
j holidays), we will assume that you have no objections to the issuance of
the permit. Please note that permit issuance is always conditioned on
„i the permit applicant's observance of and compliance with all applicable
laws and codes. A copy of the well permit will be forwarded to your
office when completed.
F WELL CONTRACTOR INFORMATION:
Hartmann,Well Company
Application Receivedt 02/17/94
Anticipated Drilling/Sealing Date if knownr 02/17/94 Time: 13:00
LOCATION OF WELL:
'i PLS Coordinates L
Well Location " NE :s NW SW Sec 3 , Town~a7 , Range 23
Property Owner P2835 aul Pahoslde Avenue
Well Owner Paul Pahos
.PID Number
WELL INFORMATION:
Diameter 4
Casing depth 233
Total depth 240
SWL 153
Aquifer Unconsolidated Sediments
COMMyBNTS:7Yu6 t.d(
x/•11 ~c~-r =O/1 (}O ~(1SrpJ ,~^lvr f'y cyPrp, y%( c.r Yh~.aF P/k.~r.
4LAO
}
I
~R=95% 6128919031 03-01-94 01!50PM P001 #22
t'r
Log gd s 2004 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone 4 651-675-5675 FAX # 651-675-5694
New Construction Reouirements RemodeVReoair Requirements Ofke' A"'Ise OnN
3 registered site surveys showing sq. fL of lot sq. ft. of house; and all roofed areas 2 copies of plan Cert of Survey Recd '',Y -N
(20%maximum lot coverage allowed) l set of Energy calculations for heated additions Tree Pras P(artRecd Y _.N'.
2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey for additions & decks Traa`s RegO`odd `°u" YN
I set of Energy Calculations Addition- indicate ifonsde septic system OrtsTe'•Sep6c &gsteY
3 copies of Tree Preservation Plan if lot platted after 711/93
Rim Joist Detail Options selection sheet (bidgs with 3 or less units
m
Date i 04, o4 Construction Cost 2.-7, q D
Site Address -2- 15 (tj f 0S, t)t, lC t £a5°.v yk P 55 / 2 ) Unit/Ste #
Description of Work r'bl;-5c ~t 1~ ir4~ or) - 5a, ,Jk Co,lra) - MAC twl 150
Multi-Family Bldg - Y X N Fireplace(s) _ 0 "If 1 - 2
Property Owner pa rI ? Kx1 3 IL l`/S~~ U Telephone #(b51) 7q q-(o1b L~
Contractor C ro 5sr e c4
Address ('7 1 3 Oo L` v`c o l N S City 140 Lta k L
State M Zip S S 30 Telephone #(y~3)'t3V-6Z ° z
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv I _ Minnesota Rules 7672
Energy Code Category • Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(4 submission type) Submitted Submitted
• Energy Envelope calculations Submitted
Have you previously constructed a building in Eagan with a similar plan? _ Y _ N If so, 25% plan review
fee applies. - - 1
Licensed Plumber (i Telephone )
JAN " d
Mechanical Contractor I Telephone # ( )
Sewer/Water Contractor I - 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's 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.) ❑ 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 Plbg_Y or_ N 25 Miscellaneous
Work Types ~y 1✓%r1De,✓5 d /9~r ('E/l dlcSC /Y7T•'L L~S;Iw^„'ov
❑ 31 New ❑ 35 Int Improvement ❑ 38 Demolish Interior ❑ 44 Siding
❑ 32 Addition ❑ 36 Move Building ❑ 42 Demolish Foundation ❑ 45 Fire Repair
❑ 33 Alteration ❑ 37 Demolish Building" ❑ 43 Reroof A 46 Windows/Doors
❑ 34 Replacement 'Demolition (Entire Bldg) - Give PCA handout to applicant
Valuation 7 -7 Dv Occupancy P, `5 MCES System
Census Code L 3 g Zoning (Z- l City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const R 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 -Brick
Fireplace _ R.I. - Air Test _ Final ~C Windows
.o 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
2005 RESIDENTIAL PLUMBING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please complete for modifications to existing residential dwellings.
Date) L / 2-9 l 05-
Site op n
Street Address ~3S ~~✓nSJf~Y. AV,- Unit #
Property Owner )Woo Telephone # ( 65-1) 2,6-F- 7 DD
Contractor Telephone #
( )
Address City State Zip
The Applicant is: _ Owner _ Contractor -Other
Septic System - New Refurbished Submit 2 sets of plans and MPC license Includes County fee
$ 100.00
Per as-built $ 10.00
Alterations to existing dwelling $ 50.00
Add plumbing fixtures. This fee includes putting in a water softener and/or water
heater at the same time. If vou are installing only a water softener ana'/or water
heater, do not complete this section. Move to the next section and check the
appliance(s) you are installing.
-Septic System Abandonment
-Water Turnaround (add $125.00 if a 5/8" meter is required)
Other: Y
_ Water Softener / Water Heater $ 15.00
new replacement
-Lawn Irrigation _RPZ _PVB -new -repair -rebuild $ 30.00
State Surcharge $ .50
Total $
1 hereby apply for a Residential Plumbing 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 plumbing codes; that I
understand this is not a permit, but only an application for a permit, work is not to start without a permit and work will be in
accordance with the approved plan in the event a plan is required to be reviewed and approved.
pplica s Printed Name Applicant's Siu ature
PERMIT
City of Eagan Permit Type: Plumbing
Permit Number: EA106971
Date Issued: 09/19/2012
of 3 a R Permit Category: ePermit
Site Address: 2835 Burnside Ave
Lot: 10 Block: 7 Addition: Country Home Heights
PID: 10-18300-07-100
Use:
Description:
Sub Type: e - Water Heater
Work Type: New
Description: Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments: David Elgstuen
2835 Burnside Ave
Eagan, MN 55121
651-269-7400
Fee Summary: PL - Permit Fee (WS &/or WH) $55.00 0801.4087
Surcharge-Fixed $5.00 9001.2195
Total: $60.00
Contractor: Owner: - Applicant -
David R Elgstuen
2835 Burnside Ave
Eagan MN 55121
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
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA128469
Date Issued:11/14/2014
Permit Category:ePermit
Site Address: 2835 Burnside Ave
Lot:10 Block: 7 Addition: Country Home Heights
PID:10-18300-07-100
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Holly Flood
1408 Northland Dr #310
Fee Summary:ME - Permit Fee (Replacements)$55.00 0801.4088
Surcharge-Fixed $5.00 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 -
David R Elgstuen
2835 Burnside Ave
Eagan MN 55121
Sedgwick Heating & Air Conditioning
1408 Northland Drive, Suite 310
Mendota Heights MN 55120
(952) 881-9000
Applicant/Permitee: Signature Issued By: Signature
SEDGWICK HEATING & AIR CONDITIONING CO. HEATING �oe No.�°Z� �` �
1408 NORTHLAND DRIVE,SUITE 310 • MENDOTA HEIGHTS,MN 55120 • (952)881-9000 TEST RECORD
ADDRESS��� °'��J������ CITY �
OCCUPANT OWNER ��� ��c.-"��La:��`� , ' � ��;
�s,'r�X'�"R-
SOLD BY � � WSTALLED BY `� �-�;,;�
MAKE_ �O�Z/����� MODEL �����'�4����'D ����
SERIAL NO._ S�l 7' [d" ����-� INPUT ���
�-��1��� �"
THERMOSTAT VENT SIZE
VALVE �"'"` F � �'�'�-� TYPE OF LINER ,Q U"''(
LIMIT J�P ��So LINERSIZE � ��
LIMIT SETTING ��v FILTERS: SIZE �� ,"�'�� NUMBER
FAN SETTING- � `/`�I WIRING I/�-� ���
PILOT TYPE �S� TEST TAG
IGNITION MODEL ,�S� LIGHTING INST. �-
PI�OT TIMING � � I' � DATE TESTED �� v� � �/�
PRESSURE `S PERCENT COZ � ��� r
INPUT CFH ���' PERCENT 02 ��� COMPANY TESTING z-�'
STACK TEMP. �4'�� PERCENT CO � NAME OF TESTER ��
FORM 235(REV.10/10) FORM DISTRIBUTION: WHITE COPY•JOB FILE YELLOW COPY-CITY
JY-1
F . For Office Use 7
Permit#:
MAR 13 2020 Lb D.�(
Permit Fee:
Date Received:
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651)675-5675 I TDD:(651)454-8535 I FAX:(651)675-5694 Staff:
buildinginsoectionsc cityofeagan.com L
2020 RESIDENTIAL BUILDING PERMIT APPLICATION
Dater I 20 Site Address: i 41.fi Aye ' Unit#:
Name: Kei 1� C '%r1s Phone:(si)
Owner Address/City/Zip:AM UVf es t(;. Ave Edx1, � M W S51 a,
I Applicant is: Owner Contractor
—
Description of work: IN Mtni VJCk,,` xt
Type of Work /
• Construction Cost: 7_' �4� Multi-Family Building:(Yes /No V )
Company:1'6e .kft06 Contact: (( 5J) 278.q t sq
Contractor Address:I�qq �Q /r •,ANN 44e, std City: .1 __ `_
State: Mu Zip: �I'1 Phone:(),t;' ?1 Email: �d1�'WcYt n
License#: t Lead Certificate#: ,awn� S �O
If the project is exempt from lead certification, please explain why:
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:
Fire Suppression Contractor: Phone:
NOTE.Plans and supporting documents that you submit are considered to be public information. Portions of the information may be
r classlNed as Hart p :A
ublic f you provide specilk reasons that would permit the City to conclude that#hey are trade secrets.
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's
website at www.cltyofeaaan.comisubscribe.
Exterior work authorized by a building permit issued In accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
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.gopherstateonecali.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
�j „a
wiith ttheapproved plan in the case of work which requires a review and appro of ns.
Applicant's Printed Name App n s Signature
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.. cg3s eatzegst d6 A s , / o .
DO NOT WRITE BELOW THIS LINE
SUB TYPES
_ Foundation _ Fireplace Porch(3-Season) _ Exterior Alteration(Single Family)
>C Single Family _ Garage _ Porch(4-Season) _ Exterior Alteration(Multi)
— Multi _ Deck _ Porch(Screen/Gazebo/Pergola) _ Miscellaneous
01 of_Plex — Lower Level — Pool _ Accessory Building
WORK TYPES
New ^ Interior Improvement _ Siding _ Demolish Building*
Addition _ Move Building Reroof T 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 4 71,000 Occupancy MCES System
Plan Review Code Edition SAC Units
(25%_100% ) Zoning City Water
Census Code Stories Booster Pump
#of Units Square Feet PRV
#of Buildings Length Fire Suppression Required
Type of Construction Width
REQUIRED INSPECTIONS
Footings(New Building) Meter Size:
Footings(Deck) Final/C.O. Required
—
Footings(Addition) Final/No C.O. Required
Foundation Foundation Before Backfill HVAC_Service Test Gas Line Air Test_Hood
Roof:_Ice&Water _Final Pool:_Footings _Air/Gas Tests _Final
Framing 30 Minutes 1 Hour Drain Tile
Fireplace:_Rough In Air Test _Final Siding:_Stucco Lath _Stone Lath _Brick_EFIS
Insulation Windows
Sheathing JC Retaining Wall: Footings )X' Backfill tie Final
Sheetrock Radon Control
Fire Wails Fire Suppression:_Rough In_Final
Braced Walls Erosion Control
Shower Pan Other:
Reviewed By:_t ig , Building Inspector
RESIDENTIAL FEES
Base Fee 0 53 .Z c
Surcharge $ 35: 5-D
Plan Review O '/5. 5/
MCES SAC
City SAC
Utility Connection Charge
S&W Permit&Surcharge
Treatment Plant
Radio Meter Read
Copies
TOTAL # // £,70, Z(
Page 2 of 3
LOT SURVEY CHECKLIST FOR RETAINING WALL
BUILDING PERMIT APPLICATION
ADDRESS: 2835 Burnside Ave.
APPLICANT NAME: Kelly Chris
DATE OF SURVEY: 3/12/2020
LATEST REVISION:
co
**Permits required for Retaining Walls 4 feet high or greater.
cos
(.)
z a DOCUMENT STANDARDS
E l 0 0 Registered Engineer signature and company
9 0 0 Building Permit Applicant
O 0 0 Address
❑ 0 0 Legal description
❑ 0 0 Lot lines/Bearings&dimensions
O 0 0 North arrow and scale
❑ 9 0 Street name
❑ 0 0 Show all easements of record and any City utilities within those easements
O 0 0 Setbacks of proposed structure and side yard setback of adjacent existing structures
ELEVATIONS
❑ 0 0 Property corners
❑ 0 0 Top of curb at the driveway and property line extensions (only if wall is within 30 ft. of curb)
❑ 0 0 Elevations of any existing adjacent homes
O 0 0 Adequate footing depth of structures due to adjacent utility trenches
❑ 0 0 Waterways (pond, stream, etc.)
❑ 0 ❑ At the foundation of the building and/or nearest structure
PONDING AREA(if applicable)
❑ 0 0 Easement line
❑ 0 ❑ NWL
❑ 0 ❑ HWL
O 0 0 Pond#designation
❑ 0 0 Emergency Overflow Elevation
❑ 0 0 Pond/Wetland buffer delineation
No Shoreland Zoning Overlay District
RC= Conservation Easements
RETAINING WALL INFORMATION
El 0 0 Location of Retaining Wall on property
O 0 0 Top&bottom elevation at each end of wall and any change in elevation in between
O 0 0 Type of material (i.e. modular block, boulder, etc.)
O 0 0 Directional drainage arrows with slope/gradient%
Reviewed By: Dave Westermayer Date 3-31-2020
G:/1 Engineering/Forms/Building Permit Application-Retaining Walls Rev. 10-16-19
3/12/2020 Dakota County-GIS n
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Disclaimer:Map and parcel data are believed to be accurate,but accuracy is not guaranteed. Map Scale
is is not a legal document and should not be substituted fora title search,appraisal,survey,or 1 inch=50 feet
03/12or :sin_ ' ai I.
/2020
'` WED ��_..�. Die
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EAGAN ENGINEERING 1'EM,. �4_LAe ..
Date:V. r
gis.co.dakota.mn.us/DCGIS/ Eagan Building Inspections Division 1
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA166617
Date Issued:01/25/2021
Permit Category:ePermit
Site Address: 2835 Burnside Ave
Lot:10 Block: 7 Addition: Country Home Heights
PID:10-18300-07-100
Use:
Description:
Sub Type:Residential
Work Type:Alteration
Description:Basement Fixtures
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 (miscellaneous)$59.00 0801.4087
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 -
David R Elgstuen
2835 Burnside Ave
Eagan MN 55121--130
(651) 269-7400
Peterson Plumbing
4209 Diamond Dr
Eagan MN 55122
(612) 655-4022
Applicant/Permitee: Signature Issued By: Signature