584 Atlantic Hill DrCITY OF EAGAN Permit Na Date:
3830 PllS&%Iob Rgad Meter No: -S Size:
P.O. Box 2?99' Reader No: O&p 27 / f pate:
Eagan, lY1N 55121
Owner.
,.
SiteAddrBSS: 'iills 'r. ivi
Plumber_ c-Ke.s,d.? ?}•
Conn. Chg: itQ?? ' -
Acct Dep:
Permit Fee: ., 'e digglllg ? T?IC • fsM EIt.
Surcharge: EpHONE . Fagree twith the Clty ot Eagan
Tr. Piant ' ?`?' '' ?•>>' ?n
Meter.
Misc.: gy
WATER SERVICE PER
CITY OF EAGAN
3830 Pilot Knob Road
P.O. BoX 21198
Eagan, MN 55121
Site
Permit No:_
Meter No: _
Reader No:
Conn. Chg: 52 S. %?gd.
Acct Dep: IS.Oore
Permit Fee: . !?Ond
Surcharge: _ .50p"
Tr. Plant_
Meter.
Zoning: _
No. of Units:
Datec
Size:
Date:
I agree io comply wHh the Ctty of Eagan
Ordinances.
Br
WATER SERVICE PERMIT
9126
CITY OF EAGAN Permit No: 107 7A Date: 1'• 7-ti7
3830 Pilot Kgbb Road B/ P No: 1;= Date:
P.O. Bbx 2'1199
Eagan,,MN 55121
Owner.
Site Address: ' t r T3 i 7 1 R t;ri va 1 o
Plumber: -
MWCC: ?? Zoning• ".
City Chg No. 01 Units: ?
Acct. Dep: 3
I agree to comply wNh the City of Eagan
Permit Fee: ???
' 'l
Ordinances.
Surcharge:
Misc.: By
SEWER SERVICE PERMIT
CASH RECEIPT
. ?
• • CITY OF EAGAN y
3830 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE
19
RECGVLD /ROM
AMOUNT $ I
r
.? at DOLLARi
?oo
E]CASH []CHECK
FOR
?-
? . , L ' .
BY
- White-Payers Copy
Yellow-Postinp Copy
Pink-File Copy
Thank You
BLDG. PERMIT N0.
01-3210 Bldg. Permi
01-3422 Plan Check
01-3445 - Surch./Adm.
01-3446 5AC/Adm.
01-2155 Surcharge
17-3860 Road Unit
20-2275 SAC
20-3865 Water Conn.
20-3868 Water Trmt.
20-3716 b:ater Meter
20-2252 Acct. Dep.
20-3713 Water Permi
20-3743 Sewer Permi
79-3866 Sewer Conn.
11-3855 Park Ded.
TOTAL
CASH RECEIPT
CITY OF EAGAN
• 3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
OATE
RECEIVED
19
qMOUNT $ I
& DOLLARS
?oo
? CASH FlCHECK
FOR a
? • BY
? . ?
NUMERICAL FILE COPY
,
UILDING PERMIT
To be used for CITY OF EAGAN
3795 Pilot Knob Road Eagae, MN 55122
PHONE: 454-8100
ReceiPt #
pote '.""
?
N? 4 5 6 8
19
-
$ite Address - Erect Occupancy
Lot Block ? Sec/Sub. Alter ? Zoning
Parcei # Repair ? Fire Zone _
Enlarge ? Typa of Const.
w Nome
W ' ^ § m 8ul1 ders Itii. Move ? # Stories t
3 Address ?:;,y.?an! ? ? ¢ ?"??'_
--?? Demolish ? Front ft.
City Phone Grode ? Depth ft.
?
? Nome
Approvols
Fees
0
Address
?
Assessment
_ Permit _
?
- Water & Sew. Surcharge
Ci Phone
F Police Plon check
FW Name Fire SAC
Y? Address Eng. Water Conn. " -
<W Ci Phone Planner Weter Meter `
Council
I hereby acknowledge that I hove read this application and state that Bidg. Off.
the informotion is correct ond agree to comply with ail applicable
State of Minnesota Statutes o nd City of Eosan Ordirwrxes. APC Totai -
Signature of Permittee
A Building Permit is issued to: i QTS. ` on the express condition that
all work shall be done in accordance with all applicable Stote of Minnesota $tatutes and City of Eagan Ordinances.
Building Official
Permit # car. issu.a v.?.n+.. ,
Piumbing
Mechanical
.-
I SPECTIONS DATE INSR Rouph-In Final
Footings //-/?=77 Dote Insp. Date trup.
Foundation Plumbing $?-
Frame/ins. ,z. 1-.7r Mechnnical
Final
Z4W
Remorks:
.a..tiZ? .?- A-;4
w???
7r.
-? . _ro. . . _ .., . „ , ri
PERMIT # ff'9 ? L^
PLUMBING PERMIT
CITY CF EAGAN RECEIPT k
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: ???
PHONE: 454-8100
m Name
? Address
c Ciry Phone
- Name u ?,'--
3 Address ? ? S T
O City dc_a?4 A Phone VS .? " 3.
FEES
COMM/IND FEE - 1% OF CONTRACT FEE
APT. BLDGS - COMM RATE APPLIES
TOWNHOUSE 8 CONDO - RES. RATE APPLIE
MINIMUM - RESIDENTIAL FEE - 12. 00
MINIMUM - COMM/IND FEE - $20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYONO $1,000.00)
SIGNATURE OF PERMITT
FOR: CITY OF EAGAN
BLDG. TYPE WORK DESCRIPTION
Res. ?- Mew ?.
Mult. Add-on
Comm. Repair
Other
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
NO. FIXTURES TOTAL
Water Closet - $3.00 R
Bath Tubs - $3.00
Lavatory - $3.00
Shower - $3.00
Ki!chen 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
(MINIMUM - 1 PER PERMIn
Softener - $5.00
Well - $10.00
Private Disp. - $10.00
Rough Openings - $1.50
FEE:
STATE S/C:
GRAND TOTAL:
CITY OF EAGAN
3795 Pilot Knob Road
Eagan, Minnesota 55122
Phone: 454-8100
f: 'PERMIT
No
Date: ' f --,?
Receipt No.:
Single I
Site Address: Residential
? I
LoY Block
Sub/Sec. MulYf Res., Comm./Ind.
Ncme New/Alter
oir
/Re
.
p
.
.
;
Addreu
Cost of Installation
O
City Phone: Permit Fee
Name Surchorge
.
?
? Address
e
0
V "
City Phone: Total
This Permit is issued on the express condition that oll work shall be done in occordance with all opplicable State of
Minnesota $tatutes and City of Eagon Ordinances.
?
Building Official
CITY OF EAGAN
- 8795 Pilot Knob Road
Eagan, Minnesota 55122
Phene: 454-8100
- - PERMIT No.
Dare: .73miary 11, 1978 Receipt No.•
5II4 A!-lant1C Single I
Site Address: ?ili- ? Residential '
Lot Block 5ub/Set. "'-J ?j '- iL?F' ?L2?-''- Multf Res., Comm./Ind.
Ncwm New/Alter./Repair '
? Add'ess Cost ot Instailafion
City ^t' JPhone: Parmlt Fee
Nome 1:,enz-F?,vdn Flumubi^a -,ieatir.^ -r.,.. Surchorge ?
? Address 1-4 745 So. F.o'. : - - -
City Phone: Total
This Permit is issued on the express condition thot oll work shall be done in occordance wlth all applicable State of
Minnesota Stotutes and City of Eagan Ordinances.
Building Offitiol
CITY OP EAGAN
• 8795 Pitof Knob Road
Eogon, Minnesoto 55122
Phone: 4544100
? PERMIT
Date:
Site Address: DrivF
Lot Block ----- 1?-Sub/Sec.
Nome
?
; Address
O
City Phone:
Name i= -
.
0
° Address '1747, So. '`r<_
e
?
City ='?-'se?no?l: Phone:
7his Permit is issued on the express condition thot nll work shall be
Minnesota Statutes and City of Eagon Ordinances.
v '
No.
Receipt No.:
Single I
Residential
Multi Res., Comm./Ind. I
NewfAlter./Repair
Cost of Installation
Permit Fee
Surcharge
rorar
done in acoordance with all applicnble State of
Building Officiol
I
r
CITY Of EAGAN
• 3795 Pilat Knob Reed
Fagon, Minnesofo 55122
Phone: 454-8100
n?,iINBZN('; _ PERMIT No. 103
Dote: ,-y Receipt No.:
Single I
Site Address: Residential
Lot ' Block 1?-Sub/Sec. Multi Res., Comm./Ind. I
Name /Re
New/Alter
air
.
p
?
;
Address
Cost of Insiollation
D
City Phone: Permit Fee
Nnme 5urchorge
`
? -
P Address 's : . . •
e
0
v
e'
c
.
City
. Phone: Total
This Permi s issued on the express condition that oll work shall be done in accordonte with oll applicable State of
Min eso Statutes and City of Engan Ordinances.
Building Officiai
- ' CITY OF EAGAN
3795 Pilot Kaob Roed
Eagan, AAinnataM 55122
Phone: 454-8104
, - _ - _ - , - --- PERMIT
Date: 6/ 2` Site Address:
5$4 Atlantic Drive
Lot 441 Block &:;;3_ Sub/Sec.
Name -?rdon R. Thompsor,
` -r
Address iitla(1t1C :ii'o
?
City ' gan Phone:
Name lbort (:o. - Clii?.i'jc :
.
g Address
e
0
V "
City Phone:
This Permit is issued on the express wndition that all work sholl be
Minnesota Statutes ond City of Eagon Ordinances.
No. •'J_7
Receipt No.:
Single I
Residentia l
Multl Res., Comm./Ind. I
' `.oration
New /Alter./ Repair
Cost of Installotion
Permit Fee
Surcharge Totul
done in accordance with all applicable State of
Building Official
CITYOFEAGAN Remarks l?.?u???-?-?'?1?9/,?/G' ?d.???
Addition Lakeside Estates Lot • r 2 Bik 2 Parcel 1044300 241 02
Owner Street 584 A lantic Hj.].I.S Dr. State F''-'agaa?M 55123
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. Tmp-ol 1352.16
STREET RESTOR. 1981 1409.71 70.49 20 1127.79 C0087
GRADING
SAN SEW TRUNK S- 1981 280.00 14.00 20 224 . 00 C008785 7-9-84
'tEWERLATERAL 1981 4281.24 214.06 20 3425.00
WATERMAIN
A(/VATER LATERAL 1981
WATERAREA 1981 280.00 14.00 ZO 224.00 C0087$5 7-9-
STORM SEW TRK a3 198 711
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILOING PER. 4568 8095 11-14-77
sAC 475.00 8095 11-14-77
PARK
RESIDENTIAL
BUILDING PERMIT APPLlCATION
CITY OF EAGAN
3830 PILOT KNOB RD - 55122
` 651-681-4675
?-'LJl dJ1
-Y
v Constmetion Ranuirements RemodellReoair Reauirements I ?
3 registered sde surveys showing sq. ft of lot, sq. ft of house; and all roofed areas + 2 capies of plan Q
(20% maximum lot cwerage allowed) . 1 set of Energy Calculations for heated addPo'ons
2 copies of plan showing 6eam 8 window s¢es; poured found design, etc.) . 1 site survey for exWor additions & decks
1 set of Energy Calculatiore . Iridicate if home served by septic system for aUdilions
3 copies of Trce Preservatbn Plan if lot platled after 711193
Rim Joist Detail Options selection sheet (61dgs with 3 or less uniLs)
aTE S -/S a /
)B SITE
8
MULTI-FAMILY BUILDING, HOW MANY UNITS?
IOPERTY OWI
PE OF WORK
'PLICANT
)DRESS '
1GER #
ZIP CODE
NE1V RESIDENTIAL BUILDING ONLY - FILL OUT COMPLETELY
'_nergy Code Category MINNESOTA RULES 7670 CATEGORY 1
(check one) - Residential Ventilation Category 1 Worksheet Su6mitte
- Energy Envelope Calculations Submitted
_ MINNESOTA RULES 7672
- New Energy Code Worksheet Submitted BY
Plumbing Contractor. Phone #:
Plumbing System Includes: ? Water Softener _ Lawn Sprinlcler Fee: $90.00
Water Heater No. of R.I. Badis
No. of Baths
Mechanical Controctoc Phone #
Vlechanical System Includes Air Conditioning Tee: $70.00
Heat Recovery Systecn
Sewer/Water Contractor: Phone #
above information must be submitted prior to processing of application.
ereby acknowiedge that I have read this applicption, state that the information is correct, and agree to comply with
applicable State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant
:rtificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
r.
vaLuarioN
FIREPLACE(S) _0 _1 _2 _3
PHONE# CP 5_/ - y.sa 36J 3
Updated 1/01
CELL PHONE # FAX #
OFFICE USE ONLY
01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool
02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.)
03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.)
04 02-plex ? 10 08-plex X 18 Deck ? 23 Porch (screened)
05 03-plex ? 11 10-plex ? 79 Lower Level ? 24 Storm Damage
06 04-plex q 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
31 New
32 Addition
x33 Alteration
r?
34 Replacement
iluation ,ggy
;nsus Code
kC Units
x. of Units
)r. of Bidgs
pe of Const
4?1,
-i-
? 35 Int Improvement ? 38 Demolish (Interiar) ? 44 Siding
? 36 Move Bldg. ? 42 Oemolish (Foundation) ? 45 Fire Repair
? 37 Demolish (Bldg)* ? 43 Reroof ? 46 Windows/Doors
*Demolitfon (Entire Bldg onl» - Give PCA handout to applicant
Occupancy
Zoning
Stories
Sq. Ft.
Length
Width
MC/ES System
City Water
Booster Pump
PRV
Fire Sprinklered
REQUIRED INSPECTIONS
_ Footings (new bldg) FinaVC.O.
_ Footings (deck) X FinaUNo C.O.
_ Footings (addirion) _ Plumbing
Foundation HVAC
Drain Tile
Roof Ice & Water Final Other
_ Framing _ Pool _ Ftgs _ Air/Gas Tests _ Final
_ Fireplace _ R.I. _ Air Test _ Final _ Siding SNcco Stone
_ Insulation _ Windows(new/replacement)
Approved By
ise Fee
ircharge
an Review
:/ES SAC
ty SAC
ater Supply & Storage
.W Permit & Surcharge
eatment Plant
imbing Permit
;chanical Permit
:ense Search
>pies
her
(11, 6 C)
1,00
? 30 Accessory Bldg
? 31 Ext. Alt - Multi
? 33 Ext. Alt - SF
? 36 MuRi
Building Inspector
?,IZ ?GI.?Lfo 4Z-.c T".?l'?li'
f 70, o0
ital `IU _p0
T'his request void 18 months from
.Date of this Request /v `
I, as C9'icensed Electrical
cal wiring installed at: /
Z? a y /- a.kA_,d-?
Street Address or Route No.
Section Township
Which is occupied by
P 31813
electri-
Range County /?UZ'29*1
Is a roughin inspection required on this job? No ? Yes ? Ready Now ? Will Call qY
Power Supplier _A&46 40 , 1110 Address t
ElectricalContract'o?NDR1CK ELEC IC Contractor'sLicenseNo. ?
MailingAddress ,13813 HIG?HmTMTe' 6UR?;SVILLE
Authorized Signature GARY (r`ti"v`v?`L'?`? of Ownef Making ThIS?0II0 NO. 432 - 503b
(Eiectrlcal Cantractor or Owner Makin9 ThIS Installatlon)
????? ?OARD CoPY
Minnesota State Board of Electricity
1954 University Ave., St. Paul, Minn. 55104-Phone 645•7703
.REQUEST FOR ELECTRICAL INSPECTION
CHECR BELOW WORK COVERED BY THIS REQllEST
U9 / y -i'c
31813
7'ype ot Building New Add. Rep. Check Appliances Wired Foc Checlc Equipment Waed For
Home ? ? ? Range ? Temporafy Wiring 91
Duplex 0 ? ? Watec Heater ? Lighting Fixtures ?
Apt. Bldg. ? ? ? Dryet ? Electric Heating ?
Commemial Btdg. ? ? ? Fumace ? Stlo Unloader ?
Industrial Bldg. ? ? ? A'v Conditioner ? Bu?1p k ?
Farm List .: Lt#1
Other ? ? ? p
Hera?s?
-- - -- - = L?'
COMPUTE INSPECTION FEE BELOW , f IJ
Service Entrance Size: # Fce Fcedeis&Subfeeders: u Fee C'vcuita: ? Fce
0 to 100 Am s. 0 t
Am ces 0 to 30 Am eres
101 to 200 Amps. O 31 ta 0 Ampetes 31 to 1 00 Am eces
Above 200 Amp j
Abo00 Amps. Above 1mps
Transformers RemControl Cira Partialot othei fee
S' ns Specns tion
. 0
Minimum fee $5
Remazks /?-/ -
TOTAL FEE
Q
I, the Electncal Ins?ector, h44eby certify that the above inspection has been made.
(Rough-in) Date
(Final)_ Date
This request void 18 months from ??'
This request void 18 months from U??? O-D
Date oF,this Reques a-?L 1 76? P 31866
92
I, as GXLicensed Electncal Contractor 0 Owner, do hereb request inspection of the above electri-
cal wiring installed at: 6 il F;?_t7t??p,?J
o?
Street Address or Route No. ?31-"? City
lgw?-
Section Township Range Countyx&he?
Which is occupied by 0 ? ? ?
(Name oi Occupant)
Is a roughin inspection required on this job? No ? Yes [l"' Ready Now ? Will Call 07?
Power Supplier i iQe.cYl Address ?l3hw'n l.aan?a-+ti
ElectricalContracto????D p R???? El F?T`?'C
Cont` ractor'sLicengUR2
(COmpany Name)
MailingAddress 138 13 HIGH DRI'1E
Authorized Signature -GAR TjEiKEN DY???kr or owoe. makio9 rni:?one No ?`13Z - 5036.
(Electrical Contractor or Owner Makiny Tnls Installatlon)
?UME BOARD COPY
Minnesota State Board of Electricity 19§4 University Ave., St. Paul, Minn. 55104-Phone 645-7703
. REQUEST FOR ELECTRICAL INSPECTION
CHEGK`BELOW WORK COVERED BY TH1S REQUEST
????3,3
p 31866
•'Type of Building New Add. Rep. Cbmk Appliances Wired Foi Check Equipment Wired For
Home ? ? ? Range ? Temporary W'ving ?
Duplex ? ? ? WateiHeater ? LightingFixtures ?
Apt. Bldg. ? ? ? Dryu ? Elec[ric Heating ?
Commercial Bldg. ? ? ? Fumace ED Silo Unloader ?
lndustrial Bldg. ? ? ? A'v Conditioner ? Bulk Milk Tank 0
Fazm ? [] ? List List
Othei
?
0
? p
HeietgI p
Heiers?
COMPUTE INSPECTION FEE BELOW?1v
Service Enhance Size: # Fee F b s: # Fee C'vcuits: # Fee
0 to lOD Am s. 0 1404130 Ar 0 to 30 Am eres
101 to 200 Amps. 31 to 10 " 31 to 100 Am eres
Ahove 200 Amps. Above 100 A Above 100 Amps.
Transfoimers 1 1 Remote Contrd Circ. Partial ot other fee
S' ns 1 1 Special Inspection Minimum fee $5.00
Remazks
TOTAL
I, the Electrical lnspector, hereby th abcsve ins ection has beer?.
(Rough-in) Date
(Final) Date ,-?
This request void 18 months from
crrr oF E,e,caN
9795 PiIM Kno6 Rood Eagun, MN 55722 N° 4566
PHONE: 454-8700
BUILDING PERMIT APPLICATION Receip+ .{p 8095
$51,000
To 6e umd for Sin¢_ FAm ik.*1 B R pnr? Date NOV. 14, 19 77
Site Address 584 At18ntiC H1115 Di. Erxt J] Occupancy j
Lot24 & Block Sec/Sub. L8ke51de EStBtes Alter ? Zoning Ri
Parcel Repoir ? Fire ZOne - 3 _
Enlarge ? Type of Const. V
W NeTe S d K Heim Builders Inc Move ? # Srories 1
Z
O Address 45$-1E.,__6rreeriEea-f-Dz. Demolish ? Front ft.
Ci Ea gan Phone 454-3477 Grade ? Depth 48 ft.
? „_ APProvals Fces
o Name _
???
Address
r ?:...
Name
1 hereby acknowledge that I have read this applicotion ond state that
the information is correct andpugree to fomply with all upplicable
Srote of Minnesota Statutes qnd $itv of' Eagan Ordirippfes.
e???Z1f
Signoture of Permitt
,?
A Buildinq Permit is issued :
all work shall be done in accor
8uilding Official -
Assessment _
Water & Sew.
Police
Fire _-
Eng.
Planner `
Council _
Bldg. Off. _
APC
Pertnit 14L.VV
Surcharge 25.50
Plan check
SAC 475.Ou
Water Conn.- NA
Water Meter ryA
Total 642.50
Heim BLdTS, on the express condition that
le SMte of Minnesota Statutes ond City of Eagan Ordinnnces.
9999 BUILDINC RERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD - 55122
? 651-681-4675
lLew Conshuciton Reauiremenh Remodel/Reoatr Reauirements
D 3 regisleretl sfle aurveys showing sq. H. of bt, sq. ff. of house
and all roofed areas (20°7 maximum lof coveraae allowed)
? 2 coples of plans (show beam & window slxes; poured fnd. design; efc.)
? 1 sM of energy calculaNons
D 3 copiea of hee preservaNon plan M lof plafted aMer 7/1/93
DATE:
.: ,
DESCRIPTION OF WORK:
STREEf ADDRESS: <
LOT: ?14 \ BLOCK:
? Ofl?
Name: Phone #: (F?S? ? ?,S Z - 3EZ3
T
PROPERTY Last Ftrst ?
OWNER --??-,7 /
Sheet Address: td (I i l
City i5l, Qt:.... State: ?? . Zip; 2-3
Company:- T4?__ Phone#: 2) ?6F?
(area code)
CONTRACTOR ?/??, / T-
License#'zD16G3Sr'3 Exp. 3-z0-'0
StreetAddress: (,fi
city ???,C?,1•Pi state: iY,? Zip: SZ-337
ARCHITECTJ
ENGiNEER Company: Name:
Telephone #: area code ( )
Streefi Address: Regisfration #:
City State: Zip:
Sewer 8 water Ilcensed plumber (reaulred fw new constructton onlv):
Penalfy applles when address change and lot change Is requested once permff Is issued.
I hereby acknowledge that I have read this applicatlon, state that the information is correct, and agree to comply wMh all applicabl
-Siate of Minnesota Stafutes and CMy of Eagan Ordinances. ? jA
y Signature of ApplicanY.
OFFICE USE ONLY
2 coples of plan
1 set ot energy calculalions for heated addlNons
7 sNe suney for exFerfor addMions i deeW
CONSTRUCTION COST:
Certificates of Survey Received _ Yes _ No
Tree Preservation Plan Received _ Yes _ No _ Not Required
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 4-plex ? 11 10-plex ? 16 Fireplace ? 21 Porch (3-sea.)
? 02 SF Dwelling ? 07 5-plex ? 12 12-plex ? 17 Garage ? 22 Porch/Addn. (4sea.
? 03 1 of _ plex ? 08 6-plex 0 13 16-plex ? 18 Deck ? 23 Porch (screened)
? 04 2-piex ? 09 7-plex ? 14 ApaRments ? 19 Lower Level ? 24 Storm Damage
? 05 3-plex ? 10 8-plex ? 15 Lodging ? 20 Pool ? 25 Miscellaneous
WORK TYPE
? 31 New ? 35 Tenant lmpr ? 39 Gas Line Only ? 43 Siding/Soffits/Fascia
? 32 Addition ? 36 Move Bldg. ? 40 Gas Insert ? 44 Windows/Doors
? 33 Alteration ? 37 Demolish Bldg.* ? 41 Wood Stove ? 45 Fire Repair
? 34 Repair ? 38 Demolish (Interior) ? 42 Reroof
* Give PCA handout to appiicant for demolition permit
GENERAL INFORMATION
Const. (Actuai)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Width
APPROVALS
Planning
Permit Fee
Surcharge
Plan Review
License
MC/ES SAC ;
City SAC
Water Conn.
Water Meter
Acct. Deposit
S!W Permit
5/W Surcharge
Treatment PI.
Park Ded.
Traiis Ded.
Other
Copies
rotal:
Basement sq. ft.
Main level sq. ft.
sq. ft,
sq. ft.
sq. ft.
sq. ft.
Footprint sq. ft.
Building
13?.as
..3 `?
14a.--? Z?--
Census Code
5AC Code
No. of Units
No. of Bldgs
MC/ES System
City Water
Booster Pump
PRV
Fire Sprinklered
_ Engineering Variance
Valuation: $
.
SAC Units
% SAC
?(„:Y?:Xt 'b(hiritA;?F:i+?k'l,t?,(X,:};JXMk?;hkX('M'?7iM.?'SM?;t:kYnW:i(71( 'Mh"???'C 'N.M'?i(
C7:T'`l OF' GAGFlN
f.:A';N]:L.Fi: t; fli:f:M:[NAL NOe 761
UAl'E_;, 08I25!99 '1':[t1l::r 08:02r:i.i:'
II; e
NA'1F.a ASC-F'EFiMIi'S
.:SRiU 9001 WG CM.LSON L.f: 0305
205 9001 9.222 Cfil'iL'iiO;! I_.I! 4. (:1C1
:32W 9001 5E:34 AT'1...AN'P'Il' Hi... 09.25
205 9001 584 /-11LflN'1:i(: HL 3.50
,.
'r'4'i:a:l. fte.,cn.::ipi: ninraurvr,:, 300„00
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U:iEI? :i:i1° JAN
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?±l BL D
CITY USE ONLY
SUBD.
RECEIPT #: 1 I "1 b L -1
RECEIPT DATE: I I- a -9 ?
PERMIT # 7 CS 5 ?S D
1999 PLtTM81N6 P£iiMiT (mIDENTIAL)
Cl1'Y OF f AfikA
S$SO PILOT KNOB itD
fr4HAN, MN 55122
(651) 6$1-4675
Please complete for: ? single family dwellings
? townhomes and condos when permits are required for each unit
? backFlow preventer for underground sprinkler system
FIXTIlRES
EACH #
TOTAL
9
Bath tub $ 3.00 x = $
Floor drain 3.00 x = $
Gas i in outlet ' minimum - i 3.00 x = $
Hot tub/s a 3.00 x = $
Kitchen sink 3.00 x = $
Laund tra 3.00 x = $
Lavato 3.00 x = $
Minimum fee alterations to existin dwellin 30.00 x = $
Private Dis osal S stem new/refurbished ' re uires MPC iic. 75.00 x = $
Private Dis osal S stem abandonment 30.00 x = $
RPZ new installation/re air 30.00 x = $
Rou h a enin 1.50 x = $
Shower 3.00 x - $
Under round s rinkler if dwellin is under construction 3.00 x = $
Under round s rinkler if existin dwellin 30.00 x ' $
Water closet 3.00 x = $
Water heater 3.00 x - $
Water softener if dwelling under construction 5.00 x = $
Water softener if existin dwellin 30.00 x ' $
Water turnaround 30.00 x ---- _ $
State Surchar e .50 --> ---> ----> $ .50
Total --> --? ----> ---> $ -
Reminder: Call for inspections of alteretions, i.e. water heaters, water softeners, etc.
-----------------------------------------------,-------------------------------, ------------------------------------------------------
1 hereby acknowledge that I have read this appliption state Mat the infortnatlon is corred and agree to mmply with all applicable City of Eagan ordinances.
It is the applicant's resp--:"- •^-^"', ? -? r x,at.thw CiN_of Eagan assumes no liability for any damages caused by Me City tluring its
normal ope2fional and OXBOROUGI I, W ILLIAM der this permit within City pmperty/nght-of-way/easement.
? 584 ATLANTIC HILLTiljbRIVE
SITE ADDRESS: _ EAGAN, MN 55123
OWNER NAME:: (651) 452-3623
INSTALLER NAME:
(612) 827-4033
STREET ADDRESS: nnn? i+w rsr1r1 i
TELEPHONE #:
(AREA CODE)
TELEPHONE #:
(AREA CODE)
cin.: MINNEAPOUS, MN 55I0$ . STATE: ZIP:
SIG A I F PERMITTEE
CITY OF EAGAN
APPLICATION FOR PERMIT
SEWER AND/OR WATER CONNECTION
.......
*1fYJ'G': PAYMhTfP OF kEE AT TIME OF
r,PrLscAzoN ooFS rDr aONSMTM
APPxovai, oF rMOUT.
irrsreMorr oF sENx ArID/ox M'aM
rrLC+rzr.ramrpNS wrr,r• NDr gE ?M-
f7LID [7Ni'II. PERMIT HAS Bffid
APPROVFFD.
- ****x?****?*?**,r*r*?**?**+**#?**,?*,r*
P P.?4CP DMl P1? .
1) PROPERTY ADDRESS:
LEGAL DESCRIPTION
'E'' EXISTING S1RCCRE, DATE OF ORIGINAI, Bi7ILD2NG PERMIT ISSUANCE: '
PRFGENT ZONING/PROPOSFD CSE: - (hbtl ear .
q ca44Eaciai./xErAIL/oFFicE
Q IbIDL'STRIAL
[I INSTI'IUTIONAL/GOVERTAg,'NT
2) 9?
ADDRESS:
CITY. STpTE, ZIP:
PHONE:
? R-1 SINGLE FAhffLY
? R-2 DL'PLEX (Zt,a Onits)
R-3 TMMOIISE (Three + Units) ( Units)
R-4 APARTMEN'p/CONIDOMINILTI ( Units )
3) ?J .Nu1:71:
NAMFi:
ADDRESS:
CITY. STATE, ZIP:,
PHONE:
MASTII2 LI(ENSE#
4) •• • ia•
NAME:
ADDRFSS:
CITP. STATE, ZIP:
PHONE;
-57
? CONNEC.TION T0 CITY SEWER ? CON6IIX.TION ZO CITY WATER
Active
E)cpired
Not recorded
St Irutial
Q (mim
PLEASE HOLD APPRpVID Pg2MIT FOR PICK-OP BY ONE OF ABOVE
PLEASE MAIL APPROVEp PERMIT TO 1, 2, 3, ¢, ABOVE
/I / (Circle one)
6)
n • • r ?,?.
Q
FOR CITY USE ONLY
PERMIT # 2SSUED -
Z ?O
Pd w/Bldg. Permit FEES:
$ $ /U? ' S-D SEWER PERMIT (INCLUDE SURCHARGE)
$ $ IO•.S? WATER PERMIT (INCLLDE SLRCHARGE)
$ $ (!'IWATER METER/COPPERHORN/OCTSIDE READER
$ $ WASER TAP (INCLUDE CORPORATION STOP)
$ $ SEWER TAP
$ $ ACCOUNT DEPOSIT - SEWER
$ $ACCOUNT DEPOSIT - WATER
$ $ WAC
$ $ SAC
$ $ TRDNK WATER ASSESSMENT
$ $ TRUNK SEWER ASSESSMENT
$ $ LATERAL BENEFIT/TRUNK SEWER
$ $ LATERAL BENEFIT/TRONK WATER
$ $ WATER TREATMENT PLANT SURCHARGE
$ S 49, S d OTHER:
$ TOTAL
C; 3
RECEIPT RECEIPT
DOES UTILITY CONNECTION REQUIRE EXCAVATION IN POBLIC RIGHT OF WAY?
Q' YES IF YES, THEN A"PERMIT FOR WORK WITHIN PUBLIC
Q ROADWAY" MUST BE ISSLED BY THE ENGINEERING
NO DIVISION. LIST AS A CONDITION.
SDBJECT TO THE FOLLOWING CONDITIONS:
APPROVED BY: -7 ",
TITLE:
?
DATE : `Y,
, ?
GOLD COPY PERMIT RELEASE FORM
PERMIT ll I IC;2 Y-J
ADDRESS A+I Q?W}41 C I( lS
PICKED UP BY
/ 0 q V 3o0 zV/ "o?
... . ., ... ..,..... nema
Addition Lakeside Estat2s
Owner c 61h;4 Street
4 Ik 2 Parce?_. 10 44300 241 02
Hills Dr, state_ Eagan,rmr 55123
ImOrovement Date Amount Annual Vears Payment Receipt Date
STREETSUFF.
STREETRESTQfl[ F? r
GRADING .1981 .1409.71 ']0.49 ZO 1127.79 C00878
7-2-84
SAN SEW TRUNK ,5-„
'SEWERLATERAL 1981
1981 280,00
Q2$1,24 14.00
214.06 20
20 Z24.00
3425,00 508785 7-9-84
WATERMAIN
'YNATER LATERA?
19$1
WATERAREA r?1 1981 1$0.00 14,00 20
224.00
C0087
W-9
STOR
M SEW TRK 'a3
1$
]1 O
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT -
WATER CONN,
BUILDINGPER. 4$68 909$ I1-14-77
SAC
PARK
475.00
8095
11-14-77
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nATE 1l/%o I7_
?
BUILDIAIG PERMIT APPLICATION
?
Include 2 sets oE plans. 1 site plan w/elevations and 1 set of energy calculations.
m?.
To be used foY '5f,W?& F=}NIrLv v Aj,r?+clre? uation ?7o a? u
???Q ? A rC????rtiai`( Site Address: s,s J 7- 3
Lot BloCk SeC./Sub. Parcel Nwnber
#.R-el V H'4r.F ?J Gf&t,' 5ibr-, .
&Srr+res
oH,ner S rk ???•i» /?'u:?nr'?s• S'ac,
Address g-4!;,r, 6'rePc&4f' 3>r
EA6A1y
Telephone uS?- 3`{77
Contractor 51rA- e,irl
Addrese kSri/ E,?zT &*'reu[
Arch./En4• P1,S;har9 AjecLc'
Address
Telephone s/S$e' 1177
Teleghone
OFFICE USE
Erect
Alter
Repair
IIi7.arge
Nbve
Mmolish
Grade
Occupancy ?
Zoning
Fire Zone
Type of Const.
# of Staries ?
Pront
Depth ^ ?5F-
OFFICE USE
Date of Approval & Initial
Assessment /,',,M?- " %/ /?'77
Water/Sewer
Police
Fire
Eng.
Planner
Oouncil
eldg. Off. /7-/-4- 7J
A.P.C.
FEES
- ?
Peratit ?-
Surcharge
Plan Check
SAC '`/% °
Water Cbnn.
t7ater Meter .f/ A
TOTAL
?. /
?A
3
S
?
Cl)
Q
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. ?
-3-75 x Ploi K?oto ?a4.
0?-
v?c??r'
wELL REcoRD
Well er and Address I VILLAGE OF EAGAN
edA2A uc?
Well Location Seetion Lot Block
&L'Y"i icence ?No. Perrait No. Date
?
g Com pany Address Telephorie
Size of We11 v/- Inches ? Water Level Feet
Well Depth?? d CJ _Feet ? Draw Down r? Feet at 3U GPM.
Casin De th ;
B P Feet Capacity Gallons IK? Per/HIR..
Thiekness Started Enaea ? of I
Kind o£ r^ormation ? Color Depth Depth Formation Remarks
---T e
j " 1,978
F,xtericl• space-A7,01nd Casing Sealed With: y]Cement Grout
Q Other
Disinfectant Used /7. ? 147L •
Hours I.ePt in Well_
Clay
riller's Signature
RET[7ftN THIS RECORD AFTER COi•II'LETIQN .
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Use BLUE or BLACK Ink
r
For Office Use
I I
~ Permit j
City of Ea I osa
Permit Fee: 1
3830 Pilot Knob Road
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 i Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit
Name: Phone: ` 5 Z
Resident/
Owner Address I City / Zip:
Applicant is: Owner Contractor
1
Type of Work Description of work: &4 .4
DD
Construction Cost: TODD • Multi-Family Building: (Yes / No
Company: Contact:
( contractor ~ Address: (:5* City: c
State:4,/Zip: 6-5 -0,7 L Phone:
License Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
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:
. e. .
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
i conclude that they are trade secrets
_ e~.
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.oopherstateonecall.org
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.
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.
Applicant's Printed Name Applicant's Signature
Page 1 of 3
r
City of kali
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Use '7
Permit #: 1 Z 3
Permit Fee: /09
Date Received:
Staff:
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: II I if
Site Address: 5-13V A -7-714,v77 C- aGC,-
P2
Unit #:
est en
Owner
Name: X� g/A.). Q x7o rZo V61/
Address / City / Zip:
Applicant is: Owner ,/ Contractor
Type of Work
Description of work: - $ / 0
Construction Cost:
Multi -Family Building: (Yes / No )
Cont ado
Company: /EAT -Y.2(.4 o 174 -
Address: .905" ,f(AbJ 4-` ` 5
Contact: 7-(--11"-
City: kr ''` `'`''E
State: Zip: 5-5-0e< Phone: e95[ 7 1426 Email:
License #: /766.7;,-; 7;3 3 Lead Certificate #:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
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:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
Phone:
NOTE: Plans and supporting documents _that -you submit are considered to be public information. Portions v
the information may be classified as ri on.p lrc if you provide specific reasons that would permit the City to
conclude that they 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.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.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building
days of permit issuance.
Do& ( se •-)
Applicant's Printed Name
x
Applicant's Si • ure
t be completed within 180
Page 1 of 3