3632 Ashbury RdCITY OF EAGAN
3830 PllOt Krtob Road, P.O. Box 21 •199, Eagan, MN 55121
PH O N E: 454-8100
BUILDING PERMIT Receipt #
s Y i?' I? l•. ?' 2 5
To be used for Est. Value ??' •'?' ' Date
5ite Address '
Lot Block ' Sec/Sub. . `??', ?• '.. .
Parcel No.
ae Name
3 Address
0 Clty Phor?e
°C
,o
Name
? a Address
? City
U?
w W
Name
F W
Address
UZ
?
Clty
W
e
I hereby acknowledge that I have read this application and state that the
information i5 correct and agree to comply with all applicable State of
Minnesota Statutes and City of Eagan Ordinances.
Signature of Permittee
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_ _
#4219
OFFICE USE ONLY
On Ske 58wage Occupancy
MWCC System Zoning T_
On Site Well .i
(Actuaq Const T_
T
Ciry Water (AilowaWe)
PRV Required # of Stories T
?
Booster Pump Length
Depth
S.F. Total
Footprint S.F.
APPROVALS FEES
,
` j'' S'
Engr./Assess. Permit 34' ? 1
Planner Surcharge
Council Plan Review 1147.51.
BIdg.Off. SAC,Ciry ???t?'
?'? ? '
Variance SAC, MWCC
?"? '
Water Conn.
Water Meter
Road Unit
Treatment P1 +
Parks
TOTAL
Psrmit No. Permit Holder Date Tslaphoas it
Plumbing s?;? ?' ? ? --? ?• ? ,?,
?
H.V.A.C. 10
Electric
Softener
Inspectlon Date Insp
.
Comments
Footingsl °??2 u>? ?30 ?d' x ?les-c 26
Footings II
Foundation
?f?
Framing ?
?-?'
Roofing I
` ?;'?
Rough Plbg. ,-
th?
Rough Htg.
Isul. o AZ
Fireplace ?j
Final Htg. ?e
Final Pibg.
Bldg. Final
Cert Occ. l !
Temp. LP
Deck Ftg.
Deck Final
Well
Pr. Disp.
-60
PERMIT #
? ,.
RECEIPT #
DATE
CITY OF EAGAN
MECHANICAL PERMIT
454-8100
MINIMUM RESIDENTIAL FEE - $10.00 + $•SO
MINIMUM COMMERCIAL FEE - $20.00 + $.50
%
FEE
S/C zs
TOTAL 2?R' f2S3
1. Bldg. Type: Res v Comm Inst 2. New ? Add Alter Repair
• ?' UL-?'J ? ? ?-' t.. 1?? ?^'?? ? ? ?
3. Total Bid Price 4. Job.Address ?- -?
Lot ? Block ' Sec ?%?-?`'?"z'?`'?'? .? ? 5. Owner
6. Contractor ?•?'`,??-? ???'o- J.??C...• ???? i..l.? ??????? ?JXi,Q ???,??G
(Name) (SVeeO (CitY) (ZiP)
7. Contractor Phone #
-RESIDENTIAL HEATING - 01-100,000 BTU's -$24.00. Each additional 50,000 BTU's or fraction -$6.00
RESIDENTIAL COOLING - 01-24,000 BTU's -$12.00. Each additional 6,000 BTU's or fraction -$6.00
MODIFICATIONS/ALTERATIONS -$10.00 minimum fee
HEATING VENTILATING HOT WATER' STEAM AIR COND.
? ?.(? iR PIPING PROCESSED PIPING AIR HAND. EQUIP. RtFRIG.
.?!?L RES. GAS PIPWG OUTLETS -$1.50 TANKS: L.P. ! UNDERGROUND OTHER
COMM./IND. RATE -,1% OF TOTAL ID PRICE PLUS $.50 STATE SURCHARGE FOR EACH $1,000 OF FEE.
Signed: `'---?'.,^ ?- . for C?:j A C.. •
Approved Inspections: Date Rough Insp. Date Final Insp.
PLUMBING PERMIT
CITY OF EAGAN
3830 PILOT KNOB tiOAD, EAGAN, MN 55122
? Name =?'?•` - W?.?•"?,
? Address ? 4'
c Ciry ?? ?? ..? 1 ?? • ? Phone ' " __' ?
? Name _
3 Address
p CitY -
FEES
COMM/IND FEE - 1% OF CONTRACT FEE
APT. BLDGS - COMM RATE APPLIES
TOWNHOUSE & CONDO - RES. RATE APPLIES
MINIMUM - RESIDENTIAL FEE - $12.00
MINIMUM - COMM/IND FEE - $20_00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
PERMIT # X `? ?/ :w--
RECEIPT ti ?-
DATE:
BLDG. TYPE, WORK DESC PTION
Res. New
Mult. Add-on
Comm. Repair
Other
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
NO. FIXTURES TOTAL
_.2::Water Closet - $3.00 $ r
?-Bath Tubs - $3.00
Lavatory - S3.00 `
? Shower - $3.00 ?
? Ki!chen Sink - $3.00 ?
Urin21/Bidet - $3.00
--x_Laundry Tray - $3.00 '
-x-Floor Drains - $1.50
-Y-Water Heater - $1,50
? • ?
Whiripool - $3.00
_:z:Gas Piping Outlets - $1.50
(MINIMUM - 1 PER PERMIT)
Softener - $5.00
Well - $10.00
Private Disp. - $10.00
Rough Openings - $1.50
.-?
SIGI7ATURE OF PERMI'TTEE ?j v FEE: STATE S/C: • = L)
FOR: CITY OF EAGAN GRAND TOTAL: -
CITY OF EAGAN
3830 PIIotjGnob Road
P.a, dox 21199
Eagan, MN 55121
Owner.
?
Site Address: 3632
?
Permit No: ' Date:
Bl P No: Date: ? - ?
tson :onst.
t?ier
MWCC: 525. QQ»,?- -L Zoning• y'
Ciry Chg: 110•06F-= No. of Units: ?
Acct Dep: 15. 00":.
Permit Fee: I agroe fo compiy with the City of Eagan
Ordinances.
Surcharge: '
Misc.: gy
SEWER SERVICE PERMIT
CITY OF EAGAN
3830,Pilot Knob Road
P.O. Brnc 21199
Eagan, MN 55121
Site
Permit No: Date:
Meter No: Size:
Reader No: Date:
Conn. Chg: _
Acct. Dep: 525. OOpd - •
IS. COpu
Permit Fee:
Surcharge: _
Tr. Plant_ I9.00Ad
• 5 aR4
130, OOpc:
Meter. 67 ,?Q
d
V
Zoning: _
No. of Units:
II
I agree to comply wfth the City of Eagan
Ordinances.
By
WATER SERVICE PERMIT
?t
(gtrtifiratt uf (Orruvarir;
Citp of (tagan
aPpirtmPtt1 Qd 1lt?M 3wPlfiDt'I
Thi.s Certificate issued pursuant to the requirenrents of Section 306 of the Uniforrrr Building
Code cernJ'ying that at the time of issuance this structure was in compliance with the r+arious
ordinances of the City regulating building construction or use. For the jollowrng.•
LJx Clasti6nuon ?/GAR Blds. Rrmil No. ?', i9
Oocupeocy 7ype R3 Zoning Diwict Type Const.
OWOC(OfB111"dI T?3.. .T+i?' ,A:rkn8 ---
7 1;r`
a?;tai? nad? ??-12 ??, ?:? a %C..?'a ,•J?: ,.. _
Dera 2 I:C;
Mildin8 Officid
POST IN A CONSPICUOUS PLACE
CASH RECEIPT f ?
CITY OF EAGAN
3830 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
D74TE
19
RLCL?IYEO ` I }
RROA1 I I; f I ??
AMOUNT $
a noLLwas
oo
E]CASH Q CHECK
j
FOR -i . . . .
FUND COOE AMOUNT
? UJ
_y
? V
i
J ?
Thank You
BY
White-Payers CoPY
Yellow-POSting Copy
Pink-File Copy
CASH RECEIPT
CITY OF EAGAN
3830'PtLOT. KNOB ROAD
? EAGAN, MINNESOTA 55122
DATE
f
REGEI V GD
19
AMOUNT $ I
& DOLLARS
+oe
? CASH E] CHECK
B Y ' i,,,?v
? . ..
- ,? White-Payers Copy
Yellow-Posting Copy
Pink-File Copy
Thank You
BLDG.
?
i1--3210
01-3422
01-3445
01-3446
01-2155
17-3860
20-2275
PERMIT N0.
p ?.. ti: i-;.' `•, ?, .i_,?,, ? ?c ?,
Bldg. Permi
Plan Check
Surch./Adm,
SAC/Ad:n.
Surcharge
Road Unit
SAC
20-3865 Water Conn.
20-3868 Water Trmt.
20-3716 Water Meter
20-2252 Acct. Dep.
20-3713 Water Permi
20-3743 Sewer Permi
79-3866 Sewer Conn.
11-3855 Park Ded.
TOTAL
e-*A
CITY OF EAGAN
3830 Pflot Knob Road, P.O. Box 21 -199, Eagan, MN 5 5121
PHONE: 454•8 100
BUILDING PERMIT Receipt#
To be used for `; ? ': ?' ! •A ° Est. Value ?- ' • • ? ' Dete
Site Address 3032 rt::,.:'1"'Y ?:D OFFICE USE ONLY
Lot BIoCk ' Sec/Sub. ? On Site Sewage ` Occupancy 4t'
MWCC System ' Zoning
-
Parcel No. ?
On Site Well (Actual) Const
;i LbEkTSV:+ CDN5'1
' City Water ; (Allowable) v?
a -
Name
W
3
Address i rk 4 R1YEkllAL:: i:x PRV Re uired
4 # of Stories
-507-
0 City 8 • P'`? PhOne Booster Pump Length _.T ?____
Depth
, o Name • `?E?` ?'- S.F. Total
z ?-
o Q
Address
Footprint S.F.
U? City ? Phone APPROVALS FEES
yVj W Name • Engr./Assess. Permit +395.00
50
34
l z ' Planner Surcharge '
Address
m W Clty PhOl1e
Council
Plan Review
? ??
? Bldg. Off. SAC, City i
I hereby acknowledge that I have read this application and state that the
Variance
SAC, MWCC
515.UO
intormation is correct and ggree to comply with all applicable State of Water Conn. 525.00
Minnesota Statutes and City ot Eagan Ordinances. 00
67
Signature of Permittee Water Meter •
305
00
Road Unit .
A 8uilding Permit is issued to:_;- .'- 1I?= !' ??_!_'< <•- :•5i ,;?,! '_+ Treatment P1 f
on the express condition that all work shall be done in accordance with all
applichble State of Minnesota Statutes and City of Eagan Ordinances. Parks
Building Official_ TOTAL
? . 3Z?r. Ufl
CITY OF EAGAN
3830 Pflot Knpb Road
P.O. ffox 21199
Eagan, MN 35121
Owner`. Gilbi
Site Address: 3632
Plumber. ?':Utl
Conn. Chg: 525.(
Acct Dep: 15• ?
Permit Fee: 10 , {
Surcharge Tr. Plant- '-
Permit No: 2 2 C 6 Date: 11 - -"
Meter No: Siza S/9"/Poc-*
Reader 37 Date: 1/-f0 41 Z_
^tson Const.
lshburv P.oad L4 B1 Blackhawk r.l.en II
ar P hing Barnes Plwnbizj;Z
) ?1 R 9; Rl
diga'pg
JH1?2? 1
with the City oi Eagan
Meter. A2 ???? WATER SERVICE PERMIT
CITY OF EAGAN Permit No: ' Date: ?',_•, '7
3830 PIIot.Knob Road nneter No: 292 0 9 6 siZe: S 8'` oc
P.O. BoiF 21 199 Reader No: Date: ?- „2 (p
' Eagan,IAN*35121
Own&
Site Address:
Brus. Gonst*
hL n7 Eoa c. L4 3? i
m
Conn. Chg: Hl-tav "Zonin:g?ii?i?S
Acct Dep: Ur-t?F
t,; s
Permit Fee: f.11??.?
Surcharge: ? ly witb the Clty ot Eayan
Tr. Plant ? ?n.
Meter.
Misc.: ' g??.
WATER SERVICE PERMIT
This reqvest void
18 momhs (rom
D 21 3q1
... .. .... ......_.
Sveet Atldress, Bok or
3Co3Z
?
? ..
City
ectmn
m
I Township Name or No. Range No.
Count
Y
OccJpant(PplNT) Phone No.
Pawer$uPplier
(L
?
d/' ? dress
, P
,,
6/.
Elect lcal Contrar.tnr ICompany Name.)
A s??n ?? ? .
Coniractur s License No.
MalM1ne .4?Jress IConnactor or O
w
ner Makine Installationl
,
/
'
Author
ed SiBnature Conua tor/Own . aking Installationl
ne Numbor
MINNESOT
A STATE BOARD OF ELECTNICITV THIS INSPEGTION NEQUEST WILL NOT
Griggs-Midway Bldg. - qoom N-191 BE ACCEPTED BV THE STATE BOAND
1821 Univarsitv Ave.. St. Ppal. MN 55104 UNLESS PqOPEN INSPECTION FEE IS
Phone (612) 642-0800 ENCLOSED.
Licensed Elec[ricul Contracmr
Owner I harabv reQUeat insoectian oi above
elaeb{ e? .
REQUEST FOR ELECTRICAL INSPECTION ee-ooaoi-os
1 See instructions for complating this lorm on beck of vellow copy.
D 211 J"C.' 1 'J(" Be/ow Work Covered by 7his Request
Atld Hep. Type of BuiltlinB Ap0liuntxe Wired Equ?V??ant Wired
Home Ranye Temporary SErvice
Duplex Wa[er Heale.r Liyhtiny Fixtures
Apt. Building Oryer Electric Heatm
Cominercial Bidy. Fumace Silo Unluader
InAustrial BIAg. Air Conditioner Bulk Milk Tenk
Farm iner (Sprci v omer Isne?ii?1
t .r Snecity Orher 01hur
Compute Inspection Fee Below
M Fea Sarvice EnVancaSize h Fee Fexders/Subteeders k Fee Circuits
/Z.[A 0 to 200 Am 5 0 to 30 qm s /' 36, CYl 0 tn 30 Am s
e 200 qmpy. 31 to 100 Amps 31 to 700 A s
a
ming Pool Above 100_Amps anove ino_amv,
Transiormers Irrigation dooms _,5r6 Partial.`Other Fee
Signs Special inspection S C'?y-?
?v T
Mem9rks
yp OT FEE?
' Noueh-in Da?e I, t Elechi
- /? ? ? 7 ?Isaa a,abv
?a.ufv ?nax ma atova
Final
// J/?o< ) /? ^ P •_ %?j?e- spection has bean
?? nC aa.
Thle reUUesl volC t8 montM iro.
CITY OF EAGAN N2 142 1g
3830 Pilot Knob Road, P.O. Box 27 -199, Eagan, MN 55121
PHONE: 454-8 100 0
---} ---7 --?
)
BUILDING PERMIT Receipt
# - \- ?
To be used for SF DWG/GAR Est. Value $69,000 Date SEPTEMBER 25 1987
Site Address 3632 ASHBliRY RD OFFICE USE ONLY
R3
4 1 BLACKHAWK GLEN 2
Lot BloCk Sec/Sub. On Site Sewaga Occupancy
X
R?
MWCCSyatem Zoning
ParcelNo. Vn
onSiteWell (ACtual)Const
a Name GILBERTSON CONST cirywater X (Allowa6le) Vn
Address 7704 RIVERDALE DR PRVRequired _ xofStories
3
°
City B. PARK Phone 560-6943
BoosterPUmp
_ Length 50
39
Depth
¢
.o Name SAME S.F.7otal
oa Addre55 Faotprint S.F
: City Phone APPROVALS FEES
?a
w w
Name Engr./ASSess. Permit $ 395.00
tz
z
Address Planner Surcharge 34.50
.,
aw
City phone Council Plan Review 197.50
Bldg.Ofl. SAGCity 100.00
I here6yacknowledge that I have reatl this application and state that the Variance SAC, MWCC $25.00
information is correct and agree to comply with all applicable State of Water Conn. 525_00
Minnesota Statutes and City of E n Ordinanc 6
Water Meter 7.00
-
Signatureof Permittee
? Road Unit 0
$.00
3
A Building Permit is issued to:GIL$E$TSflN-QQN.STRi1CTLQN Treatment P1 ?
n
1.00
on the express condition that all work shall be done in accordance with all
applicable State ot Minneso Statutes and Cit of Eagan Ortlinances. parks
?
f
TOTAL 2329.00
$.
Builtling Official___ _T?? L
'
_?
?
1987 BDILDING PEAMIT APPLICATIOH - CITY OF EAGAN
SINGLE FAMILY DWELLINGS
INCLIIDE 2 SEfS OF PLANS, 3 CERTIFICATES OF SDRVfiY, 1 SST OE ENfiRGY
NOTE: ADDRESSES FOR COfiNER LOTS - CONTRACTOR/fi0ME0ANER MQST DESIGAATE WHICH ADDRESS
IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BQILDING PERMIT ZS ISSIIED.
MOLTIPLE DWELLINGS - RESIDENTIAL
INCLUDE 2 SETS OF PLANS, CEA
1 SET OF ENEBGY CALCULATIONS
COl'RMERCIAL
RENTAL UFIIT3 FOR SALE IINTRS
OF S[JRVEY - CHECB iiITH BLDG. DEPT.,
INCLU?E 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SpECIFICATIONS AND 1 SET OF
ENERGY CALCULATIONS,
$2,000 LANDSCAPE BOND
?o Be Used For: Valuation: ? Date:
Site Address
Lot ? Block ?
Parcel/Sub R/y"/{,p,,, /i el/" 2 =414c4d
Owner _'W&te-J ?.?Abr9T
Address'?/p pz?lg?-s, ?/36
City/Zip Code ? t?44e%(
SSy23
Phone g?69_ 30 99
Contraetor 4;/6.ra,) ?ncST.
Address 770zl zou?C" b-zl;lp
City/Zip Code p,/Sk /z?/yj,,/ ,55y'yel
Phone ,.?& U -(o J t/3
Arch./Engr.
Address
City/Zip Code
?
Phone #
0
G 9aoo °° vrr j
On Site Sewage`
MWCC System
On Site Well
City Water ?
APPROYALS
Assessments
Water/Sewer
Police
Fire
Engr
Planner
Council
Bldg Off / ZI
APC
Variance
Occupancy R- 3
Zoning K- 1
Type of Const
(Actual) Y- N
(Allowable) y-N
# of Stories
Length So,On
Depth
S.F. Tota2
Footprint S.F.
FE&S
Permit 39S•oo
Sureharge 3?•50
Plan Review 191.50
SAC, City 100.00
SAC, MWCC 526,00
Water Conn 5Z ,Oo
Water Meter 6 ,00
Road Unit 0 ,00
Treatment P1 ? gp.00
Parks
Copies
TOTAL ?
??946-F
Zy X22= SaaXIa= 633G
?sr FLp-
Z'Z X 39 = 10 9 2 x yy= y 8oyg
?m T
l042??s? = lo?2x/v= ly/6`6
f
4 0 552
Sb'O-
SlJnVEYOR'S CERTIFICATE siErvrva coRPORariorv
3
- M?
- NO
N -
S 70 ° 16'29" E 80.80 o N
---- ?
N
' o I o VI
I __ 'I
5 r ?ORAINAGE d fJTltlN 1?
?5S,?,T??T ?
p ? LOT 4
n U ??..
f% o
?.?._
I 4? , n I
( y:L? J i
.,,.
,
(^? -
?- i -
_J p
m
0)
i ?
r
5?------I-
2 a X , H
I? IW
M to
e Z
r
) a? N ?
I
It ? W
7
ti
4m Q
?
zs
3
I ?0)
I lO J
- ? ? Q
? ? m
? N 70016' 29" W 100.68 -? ?
p
ASHBURY\.,fiROAD
? ., . . ?.. ;i `'S.:PT.
?- DENOTES PROPOSEQ SURFACE ORArNAGE
,O DENOTES iRON MONUMENT SET SCALE; 1 INCIi n30 FEET
ep DENOTES IRON MONUMENT FOUND PROPOSEO GARAGE FLOOR - ??k9 FEET
%D00.0 DENOTES EXISTINC, ELEVATION PROPOSED LOWEST FLOOR - 20-1.9 FEET
(000.0) DEtI0TE5 PROPOSEII ELEVATlON PROPOSED TOP OF aLOCK - 121,9 FEET
VIE HEAEBY CERTIFY TO SIENNA CORPORATION TIiAT TIIJS 1S A TRUE AND CORRECT
REPRESENTATION OF A SURVEY OF TIIE OOUNDARIES OF:
Lot y Block / BLACKHAWK GLEN 2ND ADDITION, according to the recorded plat
thereof, Dakota County, Mtnnesota.
IT OOES NOT PURPORT 'TO SIIOId 114PROVE1IENTS OR ENCROACNMENTS, IF ANY. AS SURVEYED DY .
FIE 0(i UNDER MY DIRECT SUPERVISION 7HIS 30TH pAY OF DECEMBER , 19 86.
?AMts ti. HiLL,
THE LE6AL DESCRIPTIdN USED ON 5IGt1ED: INC.
THIS SURVEY WILL BECOME VALID (
UPON FILING THE PLAT OF BLACK-
IIAWK GLEN 2ND ADDITION. • , pY; Gi ?
HAROLD C. PETERSON, LAIID SURVEYOR
41INNE507A LICENSE NUI•iAER 12294
PROJECT N0. aoo,c ? PAGE JAMCS R. H(LL, (NC,.
85618 '
Planners / Engineers / Surveyors
FILE NO. 8200 Humbcidt Avanum South
FOLDER Bloominplon, Mn, 65431 612-ee4-3029
Cities DiOtal
i Control
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- APFLICATION FOR PERMIT
SEWER AND/OR WATER CONNECTION
itV Of GC1gaP1
1) PROPERTSC ADDRESS:
.,> ................... x...............
? NOTG: PAYMENf OF £EE AT TIME OF .*?.
? APPI,ICA120TI OOFS NOT CCf]- ?
? STI7[flE APHAiJAi. OF PPRFIIT. ?
:
; iNsrecrraN oF sDM nra/aR vmnn •
;.
; irsTuanTioNs waa. Nor ee amnED ;
?[Rd1ZL PIItMIT H115 HE@I APPAOVID. ?
?xee?w?t++f?i?ia?++i»i+:t??et,t:?+tir?
LE7GAL DESCRIPTIONS . . . . . . L?N q dL./,? /. . / . . . .
IF EXISTING STRLMtTRE, DATE OF ORIGINAL BiJILDING PERMIT ISSUANCE:
Mont Year
PRESENT ZONZNG/PROPOSID USE:
Q CONA9ECtCIAL/RETAIL/OFFICE
Q INDOSTRIAL
a INSTITUTIONAI;/GOVEFUZIENT
1J R-1 SINGLE FAMILY
? R-2 DUPLEX (Rb.o Cjnits)
Q R-3 TOWPIIIOUSE (Three +; Ur?its) ( Units)
Q R-4 APARZT9EDTf/CONIDOMINIUM ( . Dnits)
z) ? NAME: sn>>
ADDRESS: ~J7CJ'? /j , u? K J?2- /,F ?•P
CITY, STATE, ZIP: r
PHONE: ?.
3) ? NAME:
15V l S For City Use
P reum License:
ADDRESS • -Gz . ? Active
, ExPired
CITY, STATE, ZIP: Not recorded
PHONE: ? MASTER LICENSE #
...... ... ..
- I Sta?Initla?
/
4) e? '.?a •.i.?'?il •/
rAME: i?2??'_ V?
ADDRESS:
CITY, STATE, ZIP: p
PHONE: 7?1 7 7
5) ? a a?• u ?e
? CONNECTION TO CITY SEWER ? CONNECTIOIV TO CITY WATII2 O 0'iBM
6) ?
****?*******+******?*? ****,?************?*****+**************************?***?******?*,r************?
* THE GOLD ODPY OF TFIE PII2MIT WIIS. BE SENf DIRECTLY TO PUBLIC WORKS 10 FACILITATE ME1M PICR-UP. *
? PLEASE AISAW 'iVA WORKING DAYS FOR PROCFSSING. SOME'ANE FROM Tm CITY WILL CONfAGT YOU IF T4ERE *
*iARE ANY PROBLEPIS. w
rt**?ryrFir*Irie*klr*ie *ir**kir***ir***ikkiririr#?eiiiiii++a++a+a++a.+aaaaa+a++a?aaaa+++,4+ii+aa++.t++i+,i.+a.aa+++++if+i
FOR -CITY USE ONLY
PERMIT # ISSUED
Pd w/Bldg. Permit FEES:
$ S (O' S-2) SEWER PERMIT (INCLUDE SURCHARGE)
$ $ ?d51) WATER PERMIT (INCLUDE SORCHARGE)
$ (s? 7 $ WATER METER/COPPERHORN/OL'TSIDE READER
$ $ WATER TAP (INCLL'DE CORPORATION STOP)
$ $ SEWER TAP
$ $ f?(t-r;) ACCOUNT DEPOSIT - SEWER
$ $ ?cS ?lJ? ACCOUNT DEPOSIT - WATER
$ $ WAC
5_ U?
? z
?
$ $ SAC
$ $ TRDNK WATER ASSESSMENT
$ $ TRONK SEWER ASSESSMENT
$ $ LATERAL BENEFIT/TRC'NK SEWER
$ $ LATERAL BENEFIT/TRUNK WATER
$ $ WATER TREATMENT PLANT SORCHARGE
$ $ OTHER:
$ 0`0 S ?5 Q-"D TOTAL
_._.7_7.763 7Jf 23
RECEIPT RECEIPT
DOES UTILITY CONNEC TION REQUIRE_ EXCAVATION IN PUBLIC RIGHT OF WAY?
[__j YES IF YES, THEN A"PERMIT FOR WORK WITHIN PLBLIC
_
Q
NO ROADWAY" MUST BE ISSLED BY THE ENGINEERING
DIVISIOLV
LIST
.
AS A CONDITION.
SUBJECT TO THE FOLLOWING CONDZTIONS:
APPROVED BY:
TITLE:
DATE:
2004 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.
-1?, x S SZ)
Date ALQ I J L I fJ `{
?//
3? ??- 1 7CCril. Unit #
Site Street Address (?.o.ti.r?
Property Owner Telephone # (k6j)?f5d
Contractor `4LY `P ALrD4?4-? Telephone # (6,1 ) 345
-
?
Address 34o 90 City State /7, Zip /a
The Applicant is: _ Owner ontractor _Other
Alterations to existing dwelling $ 50.00
_Add fxtures to rooms, excluding water softener and water heater
_Septic System Abandonment
_Water Turnaround (add $121.00 if a 5/8" meter is required)
Other:
Water Softener ?Water Heater $ 15.00
V__?replacement _ additional
Lawn Irrigation System RP2_ new _ repair rebuild $ 30.00
State Surcharge $ .50
0
Tatal $ 15.5 d
I hereby apply for a Residential Plumbing Permit a ckno dge that the information is complete
and accurate; that the work will be in conformance ?q e ordinances and codes of the City of
Eagan and the plumbing codes; that I understand this 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.
4j eVe,nS
Applicant's Printed Name
% vL 't 1?,t.t,?d?N-?-?
ApplicanYs ignature
f5/515a
2004 RESIDENTIAL PLUMBING PERMIT APPLICATION
CITY OF EAGAN 'A
??,? ?.? 3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please complete for modifications to existing residential dwellings.
Date _5 I J`l I ?
Site Street Address ? 1? Unit #
Property Owner ? Telephone # (/,?"jJ )4&
Contractor Telephone # (4,51) 3(05 -160
-?
Address,`?? U, WA City State h'1A. Zip Sf-543
The Applicant is: _ Owner /Contractor _Other
Alteretions to existing dwelling
_Add fixtures to rooms, excluding water softener and water heater
_Septic System Abandonment
_WaterTurnaround (add $121.00 if a 5/8" meter is required)
Other: $ 50.00
V-11Water Softener Water Heater
replacement _ additional
Vol, $ 15.00
Lawn Irrigation System RPZ_ new _ repair _rebuild $ 30.00
State Surcharge $ .50
Total $ /5 ,5B
I 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.
n'JlR4 O"e.Ve?h.s
ApplicanYs rinted Name ApplicanYs ignature
pE (? L? U dL??
? Mar 14 2004
? D
C IO cc)
City of EaQali
Date:
Tenant:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
Site Address: 36k =-C 1451' j
5T L
Use BLUE or BLACK Ink
Date Received:
Staff:
2009 RESIDENTIAL BUILDING PERMIT APPLICATION
J
A 5 5
Suite
RESIDENT OWNER
TYPE OF WORK
CONTRACTOR
iA n j E S T r fr /C i Phone:
Address City Zip: 3 fp 3 f j /(I y
Applicant is: Owner 'x Contractor
Name:
Description of work:
Construction Cost:
Multi Family Building: (Yes No
Name: I `7c. tt �Gt l
HOC ST
City: �fiM ti t'f�
Phone: tf k� a J 17F'
Address:
Contact Person:
License
State: Zip:. 5
two i
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:
o+fyoupr`ovide�frc
hat th> are t rade se
ng docume
you submit a
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
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 app It~of plans.
t:E. E.. ka,1%-k
Applicant's Printed Name Applicant's
Page 1 of 3
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA115601
Date Issued:09/27/2013
Permit Category:ePermit
Site Address: 3632 Ashbury Rd
Lot:4 Block: 1 Addition: Blackhawk Glen 2nd
PID:10-14351-01-040
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar.
Pictures are not acceptable in lieu of inspections.
Carbon monoxide detectors are required by law in ALL single family homes .
Michael Bischel
Valuation: 4,000.00
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 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 -
Justin K Kane
3632 Ashbury Rd
Eagan MN 55122
(901) 355-4535
Bischel Building Contractor Services Llc
100 8th Street
Farmington MN 55024
(651) 463-8762
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA149577
Date Issued:05/30/2018
Permit Category:ePermit
Site Address: 3632 Ashbury Rd
Lot:4 Block: 1 Addition: Blackhawk Glen 2nd
PID:10-14351-01-040
Use:
Description:
Sub Type:Residential
Work Type:Underground Sprinkler System
Description:PVB
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 - RPZ/PVB/Lawn Irrigation $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 -
Gregory Then
3632 Ashbury Rd
Eagan MN 55122
Jay's Plumbing
25 South Sutton Lake Blvd.
Jordan MN 55352
(612) 868-4102
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA166975
Date Issued:02/17/2021
Permit Category:ePermit
Site Address: 3632 Ashbury Rd
Lot:4 Block: 1 Addition: Blackhawk Glen 2nd
PID:10-14351-01-040
Use:
Description:
Sub Type:Fireplace
Work Type:Gas Insert
Description:
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home may require smoke detectors in all bedrooms. Chimney / flue must be inspected prior to
concealing.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Valuation: 3,000.00
Fee Summary:BL - Base Fee $3K $88.50 0801.4085
Surcharge - Based on Valuation $3K $1.50 9001.2195
$90.00 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 -
Jason & Erica Colvin
3632 Ashbury Rd
Eagan MN 55122
Fireside Hearth & Home
2700 Fairview Ave N
Roseville MN 55113
(651) 633-2561
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA169013
Date Issued:05/12/2021
Permit Category:ePermit
Site Address: 3632 Ashbury Rd
Lot:4 Block: 1 Addition: Blackhawk Glen 2nd
PID:10-14351-01-040
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace & Air Conditioner
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Pete DeGrood at (507)
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 -
Jason & Erica Colvin
3632 Ashbury Rd
Eagan MN 55122
Genz Ryan Plumbing & Heating
2200 West Highway 13
Burnsville MN 55337
(952) 767-1000
Applicant/Permitee: Signature Issued By: Signature