3569 Baltic AveCITY OF EAGAN
3830 Pilot Knob Raad
P. O, Box 21199
Eagan, MN 55121
Zoning:
OwMr: ?'ront j.e
Addrosa:
Slta Addros.: 357>9 ^a
I Plumbar. S t s r:' l
? Mabr No.: 7!/.?
Size: ?`??"/?a cK
Rsader No.: 0 7° 6 9;
1 NeN ta eswolIr whb IIN
r :4.idwest
ltic Avenue
WATER SERVICE PERMR
PERMIT NO.:
DATE: No. of Units:
±a:nnton tte
Connection C]?arQe:
u.
BY
of I nsp..
ii- a y-8(-
Infp.:
CITY OF EAGAN
3830 Pllot: nob Road
P. O. Box 21199
Esgan, MN 55121 .
Zoning;
' pwrwr; ; tCntiei
' Md?ess:
Sia /lddreu: Relt ic / .
Plumber. StaT Fliizo;.nt .
Meter No..
Size:
Reodsr No.:
1olrN !o oewolp wMU fV Cihr of 4ve
Oalwgsow.
BY
Date of Insp.:
WATER SERVICE PERMR
PERMIT NO.:
" D/1TE: • No. of Units: ?
Connectian CFwrye:
/laou??t Deposit:
Permit Fee:
Surcha?gs:
Miat. Chorpes: -
Total:
DaM Paid:
CITY OF EAGAN
3830 Pilotv<nob Road
P. O. Box 21199
Esgan, MN 55121 -
Zoninp: '
Owner, j;li ier -
Add?rss:
Slte /lddress: ?;v?•n..1E
Plurnber. - - '- - -
. .. - . .. 1 .
I?/IN !O M?y 1tlft 10 Cft of Si"m
O/JIMwOM.
By
Dote of Irup.:
Insp.: _
SEWER SERYECE PERMR
PERMIT NO.:
DATE:
No. of Units:
;,,..
i
COfIMCflOf1 a1GfgQ: ? .
ACCOUflf Dlposit:
Wnnk Fes:
Surcharpe:
Misc. U+oryes:
Totol:
Do» Paid:
BLDG. PERV IT 90.
?
j
'
•
? t
l
Lf ? , . ' I
r?,•t ( f
01-32I0 Bldg. Permit
-
-
01-3422 Plan Check ,
; ?? ? .!
01-3445 Surch. /Adm. ?-
01-3446 SAC/Adm.
01-2155 Surcharge
17-3860 Road Unit -
20-2275 SAC ?
20-3865 Water Conn.
20-3868 Water Trmt.
20-3716 Water Meter
20-2252 Acct. Dep.
20-3713 Water Permit
20-3743 Sewer Permit --
79-3866 Sewer Conn.
11-3$55 Park Ded.
:,
TOTAL
BUILDING PERMIT
' To be used for ?F
l?5?8
Site Address 3 S 69 ??ILTIC AVS Erect ? Occupancy R3
HA1?iPTON
Lot f Block 3 secisub HT$ Remodel ? Zoning p?.
Parcel No . Repair ? Type of Const y?
_ Addition ? No. Stories
W Name r??r7Tir:R Ct]IKPAIdIES
M HWY
9
Y Move ?
HLDG E Demo?ish ? Length
Depth 47
; Address 08 SIBLE
ME
,
3 Int. impr. ? Sq. Ft.
° E
City A??AN 454-0433
Phone Install ?
o Name ??ti? Approv als Fees
° a 32 S•?
,
? ¢ Address Assessment Permit
~ City Phone Water 8? Sew. Surcharge 3 2•(
?? Police PlanReview IGZ•:
W W Name Fire SAC 575 . i
?? Address Eng. Water Conn. ??? •?
i W City Phone Planner Water Meter `a3 ,?
I hereby acknowledgethat I have read this application and statethatthe Bldg.
information is correct and agree to comply with all applicable State ot
Minnesota Statutes and City of Eagan Ordinances. APC_
Signature of
Road Unit "" • "" '
Tr. PI. 15 6. 0 Q ?
Parks
Copie . ?0
Ti.b?l ?
A Building Permit is issued to: FR?I?`P?ER COMPAIVIES 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 ,,?,t x _
PNmN Na PKmlt Holdw Date TNephone k
wu^brw 7' /b
H.Y.A.C.
EWctft (?l, oyto o .?r/ ??/7•c?`
SOM11K
ImpeeUon Dab Irap. Comm"nb
Footinya I
FooWpe II
Foundsllon
Frwainp
RoWiny
Ramo 04bg.
R? ?. ?0 6 kJ
lnsul.
FNoplaq
Find Nty. Q
Finsl Plbp. ? `Q
&dy. Flnal
CNL Oce.
DeckFtp.
tfw
Dadc Fnnp. ?? ssa,e Q.n [Lui (? v?? b C tv ?-
WON I"L4Ct% f;I i.e ?'est ,f??
Pr. DNp.
PLUMBING PERMIT
' CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55121
Site
m Name i c
.q Address 3 ?i? C?t' `•; ? /t !: ?
c City j? !+ Phone
Name f U T j c P?, rt c Address
p City ?_,' Vf A Phone
FEES
COMM/IND FEE - 196 OF CONTRACT FEE
MINIMUM - RESIDENTIAL FEE - $10.00
MINIMUM - COMM/IND FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND $1,000.00)
FOR CITY OF EAGAN
PERMIT #
RECEIPT #
DATE: _
BLDG. TYPE WORK DESCRIPTION
h/
X
Res.
New
Mult Add-on
Comm. Repair
Other
Ng. FlXTURES
Water Closet - $3.00
_7-Bath Tubs - $3.00
T -
Lavatory - $3.00 -? `
Shower - $3.00
-
Kitchen Sink - $3.00
7
Urinal/Bidet - $3.00
?Laundry Tray - $3.00
,
Floor Drains - $1.50
=Water Heater - $1.50
Whirlpool - $3.00
=Gas Piping OuUets - $1.50
Softener - $5.00
Well - $10.00
Private Disp. - $10.00
$1
=
?
.50
Rough Openings - -
FEE
STATE S/C: S O
GRAND T,OTAL: ?
` PERMIT #
• ' , . MECHANICAL PERMIT RECEIPT #
. GTY OF EAGAN 10 % l y? i( .
3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE:
CONTRACT PRICE -i :.5 . CO PHONE: 454-8100
Site Address sau y Dul C 1 C TYPE WORK DESCRIPTION
BLDG
Lot 6 Block J Sec/Sub .
: • --
?
' Res. New
- Name WEN
LLL M}3C
ANICAL A
B
Address
3600 Ifennebec Drive Mult
dd-on
i
C
R
c
Ciry
Ean11' Phone 452-1565 r
omm.
epa
Other
Name Fr.ontier Cumpar.ies FEES
c Address UF? Sibley .ie;norial RES. HVAC 0-100 M BTU - $24.00
p City FagaR phone -0``33 ADDITIONAL 50 M BTU - 6.00
ADD-ON AIR COND. 0-24 BTU - 12.00
ADDITIONAL 6 M BTU - 6.40
TYPE OF WORK
UUO '? 4
;?U
:; 0 GAS OUTLETS - 1.50 EA.
Forced Air .
,
M BTU COMMIIND FEE - 1% OF CONTRACT FEE
Boiler M BTU MINIMUM - RESIDENTIAL FEE - 10.00
Unit Heater M BTU MINIMUM - COMM/IND FEE - 20.00
Air Cond. M BTU STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
Vent CFM
u
1 BEYOND $1,000.00)
.
Gas Piping Outlets #
Other
FEE 25.50
. SG SIGNATURE OF PERMITTEE
S/C:
TOTAL•
FOR: CITY OF EAGAN
p?'I?___ . , . . --- v .,. _ f r--va .mniv+ -'?o !'?„n"-P'4'"'R-WI.•-7iC7CO: 1- '•-w ?. . ., . . .fq?l?'??
• _ CITY OF EAGAN 18455
?
? 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100 0 ?v +
BUILDING PERMIT Receipt #
To be used for FIREPLACE Est. Value $1+00V Date OCT 15 1 9 40
Site Address 3569 BALTIC AVE
Lot 6 Block 3 SeciSubFiAMPTON HEIGNTS
. OFFICE USE ONLY
Parcel No. occuPancy - FeFs
DAVID 6 SU5A?i FRENCH Zonin9 25.00
? Name (Actual) Const - Bldg. Permit
o Address TI A? (AUowable) - . St3
S
EAGAN ? urcharge
City Phone # of stories -
Plan Review
Length _
o Name S`?E oePtn - SaC
ciiy
=
O
Ot Address S.F. Total - ,
U SAC, nncwcc
? City Phone S.F. Footprints -
Water Conn
On Site Sewage _
? W Name On Site Weu - Water Meter
Address MWCC System -
vZ
i W
Ciry Phone
ciry waier - Acct. Deposit
S1W Permit
PRV Required _
I hereby acknowlege ihat I have read this application and state that the
' Booster Pump - grw Surcharge
information is correct and
agree to comply with all applicable State of
Minnesota Statutes and City of Eagan Qr cen Treatment PI
!
Signature of Permitee APPROVALS Road Unit
` DAVID FRENCH
A Buiiding Permit is issued to: Planner
-
Park Ded.
on the express condition thal all work shail be done in accordance with all Councii
applicable State ol Mmnesota Statutes and City of Eagan Ordinances. gOd9. plf. _ Copies
2 g??
Building OtliCial ' - Variance - TOTAL
Permit No. Permit Holder Date Tefephone #
WATER
SEWER
PLUMBING
H.V.A.C.
ELECTRIC
Inspection Date Insp. Commenta
Footings I
Foundation
Framing
Rootirg
Rough Plbg.
Rough Fltg.
Isul.
Fireplace
Final Htg.
Fnal Plbg.
Const. Meter Plbg. Inspeclor - Notify Plumber
Engr./P1an
Bldg. Final
Deck Ftg.
Deck Final
weli
Pr. Disp.
n
?qm"..•'•?'.7.h ....b ..
. . . . ... . ?. ',:.
`
- S:'.., r.y.. . _?L..e.,..
s
.. -; ..
e. .. r .
. . .. ' .
.. . . -- .
.
t
CITY
OF EAGAN -42 17737 ?
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE:454-8100
BUILDING PERMIT Receipt #
To be used for DaCK Est. Value $1,0M. Date AIPR 19 ,ip0 ?
Site Address 3569 sALT'IC AVB
bt 6 Block 3 5ec/Sub. ?N ?
L. OFFICE USE ONLY
?
Parcel No. occuPancy - Fees
W
Name ?YID C FREI?iCH
Zoning
(ACtual) Const -
-
Bldg. Permit
23•?
? Address 3369 WLTi? AVE (Allowable) - • 50
0
City RAG" Phone 296-5547
# or stories Surchar9e
25iR Plan Review ?
Length
o Name 8AM Depth ? SAG City ?
?
O ? Addf@SS S.F. Total -
L SAC, MCWCC
? City Phone S.F. Foolprints -
Water Conn
On Site Sewage _
r
? W
Name
On Site Well
-
Wat
M
t
er
er
e
_ ; Address MWCC System -
. ¢ =
< W
City PhOne
Ciry Water
- Acct. Deposit
S/W P
i
PFV Required _ erm
t
I hereby acknowlege that I have read this application and state that the Booster Pump - Sryy S,rcharge
inlormation is correct and agree to comply wrth all applicable State of ?
Minnesota Statutes and City oP Eagan Ordinances. Treatmenl PI
Signalure of Permitee J` •^ APPROVALS Road Unit ?
DsAVID (3 ER8HCt1
A B u i l d i n g P e r m i t i s i s s u e d t o: Planner
-
P a r k D e d.
on the express condition that all work shall be done in accordance with all
Council 2•? ?
applicable 51ate of Minnesota Statutes and City ol Eagan Ordinances. Bld . Off. Copies
?
27.50
Building OffiCial Varance - TOTAL
Permit No. Permit Holder Date Telephone #
WATER
SEWER
PLUMBING
H.V.A.C.
ELECTRIC
Inspsction Date Insp. Comments
footings I
FoundaGon
Framing
Roofirg
Rough Plbg.
Rou9h Ht9•
Isul.
Freplace
Finai Htg.
Finai Plbg.
Const. Meter Plbg. Inspector - Notify Plumber
Engr.IPlan
Bldg. Final
oeck Ftg. z J ?
oeak Finai
weli
Pr. Disp.
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN ?
3830 PILOT KNOB RD - 55122 ?
I' ? ??" 1 v 651-681-4675
NewConsWCtMn Reaulremenfa RemodeURenair Reauirements
• 3 registered site surveys showing sq. d. W lot, sq. fl. of house; and all roofed areas • 2 copies of plan
(20%maumum lot coverage allowed) . 1 set of Energy Calculalions for heated addilions
• 2 copies of plan showing beam 8 window sizes; poured found design, etc.) . 7 si[e survey (or ezlerior additioris & decks
• 7 set of Energy CalcNations • Indicate If home served by seplic system for addiEons
. 3 copies of Tree Preservation Plen if bl plafted afler 711193
• Pom Jalsl Defail Options seleclion sheet (61dgs with 3 or less unils)
{ ? ?
DATE ? - dS =0 I VALUATION --I
JOB SITE ADDRESS 3 564 QAl._`71C 14llE Ef1 G?9nJ, M#jl 6-5-/2'Z-
IF MULTI-FAMILY BUILDING, HOW MANY UMliS?
PROPERTY OWNER "N £ cT1.? W dl? Y"
TYPE OF WORK SI'nlnJl.' /fnlln/DJr..lS PIREPLACE(S) _ 0_ 1_ 2
APPLICANT Aj 5 cn,JS7-- aF M..VhlN. PHONE# 4,Sh68'fs-0031
ADDRESS 3s 64 Qr9LT1-L AL)6. c-,4 & 4nJ? lK.IV- ZIPCODE !?_S147-
PAGER #
CELL PHONE # LSl-q7D-?OQ Z FAX #'?-GS?-68'S(-00? ?
NFW RESIDENTIAL BUILDING ONLY - FILL OUT COMPLETELY
Energy Code Category
(check one)
Plumbing Contractor: _
Plumbing Systcm Includes:
Mechanical Conhactor,
Mechanical System Includes:
Sewer/Water Contractor:
All above information must be submitted prior to processing of application.
Fec: $90.00
Fee: $70.00
1TsI
I hereby acknowledge that I have read this application, state that the information is ect, and ac7ree? ply
with all applicable State of Minnesota Sfatutes and City of Eagan Ordinances.
SlgnatureofAppllcanf
Certificates of Survey Received _ Tree Preservation Plan Recdived _ Not Required _
_ MINNESOTA RULES 7670 CATEGORY 1
- Residential Ventilation Category 1 Worksheet Submitted
- Energy Envelope Calculations 5ubmitted
_ MINNESOTA RULES 7672
- New Energy Code Worksheet Submitted
Phone #:
_ Water Softener _ Iawn Spi•inkler
Water Heater _ No. of R.I. Baths
No. of Baths
Air Condiaonuig
Heat Recovery System
Phone #
Phone #
Updated 1101
, RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD - 55122
651-681-4675
lew Canatruction Reaufremants
3 registered site surveys showing sq. N. of lol, sq. ft. of house; and all roofed areas
(20% macimum lat coverage allowed)
2 copies of plan showing beam & window s¢es; poured found design, etc.)
1 set of Energy Calculations
3 copies W Tree Presenatlon Plan if lot platted aRer 7!1193
Rim Joist Defail Options seleclion sheet (bldgs wAh 3 or less units)
)ATE _ I 1-3 -O
10B SITE ADDRESS_ -65 (rr`i k5044-i L
F MULTI-FAMILY BUILDING, HOW MANY UNITS?
'ROPERTYOWNER WUid.vICL
410-
'YPEOF WORK LriS;Wt CLQS rIGco oYl?v ? ?lV?iV?+/ FIREPLACE(S) _0 i1 _2 _3
kPPUCANT LaS L nu ItiS PHONE # 9S JL-- -_)46 •-b ai)-C1
%DDRESS 061? Kcdfer:6 s"t" Pr i a r iIP CODE 553 7?--
'AGER # CELL PHONE # FAX #
NE1V RESIDENTIAL BUILDING ONLY - FILL OUT COMPLETELY
Energy Code Category
(check ane)
Plumbing Conhactor: _
Plumbing System Includes:
Mechanical Contractor:
Mechanical System Includes:
Sewer/Water Contractor:
RemodeUReoair Reaulrements
. 2 copies of plan
• isetofEnergyCalculationstorhealedadditlons
• 1sNesurveyfurextenoradditions&decks
• Indiwfe'rfhomeservedbysepticsystemforadditions
VALUATION 4 ( .s-C7D -
Phone #
Phone #
-3 --?0 .b o
ree: $90,00
Fee: $70.00
111 a6ove information must be submitted prior to processing of application.
hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with
iII applicable State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant Q4?,C " Lf PAW,
;ertificates of Survey Received
MINNESOTA RULES 7670 CATEGORY 1
- Residential Ventilation Category 1 Worksheet Submitted
- Energy Envelope Calculations Submiked
MINNESOTA RULES 7672
- New Energy Code Worksheet Submitted
Phone #:
Water Softener Lawn Sprinkler
Water Heater No. of R.I. Baths
No. of I3aths
_ Air Condiuoning
_ Heat Recovery System
Tree Preservation Plan Received _ Not Required _
Updated 1101
This rnqueSl void 7? 2 C.
18 rronths fram V J 6
C62046 ?f-ao
Request Date
D
? O ` Fire No. flouBh-in Insper,lion
Re?QU
i/retl?
?Fleady Nuw []14?91 Notitv ln
sper
Wh
'
` ,,
?es ? No lor
en Peatly
censed Electrical Contracror 1 haraby request insDection ot ebove
? Owner . elacfrical wark insialled at Street Address, eoz or te No. _ C itv
^
? L? 6A
ecbon o. •TOwnship Name or No. Hanee No. Counry
Occuoant (P INT) •
?mm)
E Phone No.
'f 5 -d
Powe SuDOlier Address
Electrical Contractor (Campany Name) Conlracfor's License No.
C
LlEC?RI
?
? O ?
i inT
dress I
Convactor or
ki? ng lnstailationl
14540 PENAtOG'K LANE
Au n C n e or 1 r 1,24a Phone Number
i
MINNESOTA STATE BOARD OF ELECTRICITY TMIS INSPECTION PEQUEST WILL NDT
Gripqa-Midwey Blde• - Moom N•197 BE ACGEP7ED BY THE STATE BOANO
1827 Universitv Ave.. St. Paul. MN 66104 UNLESS PNOPER INSPECTION FEE IS
Phoneffi121642-0800 ENCLOSED.
HEQUEST FOR ELECTRICAi INSPECTION ee-ooooi-os
Ir See inatreetions for completim this lorm o. Oeek ot yel low copV.
,(.?` gnflA "X" Below Work Covered by This Request
p..aaaal eav.l Tvoa oi euiiaina I pPVlianees WireE I Equiumeno Wired ?
I I I I Industrial Bldo. 1 I Air Eonditioner 1 I Bulk Mflk Tank I
M Fee ServieeEntrgneaSiie fl Fae Fexders/Suhteeders N Fee Circuits
0 to 200 qm s 0 to 30 Am s 0 to 30 Am s
Above 200 qmpy 31 to 100 qinps 3112 100 A s
Swimming Pool Above 100_Amps Above 100_Am ?
Transtormer5 Irri tion Booms Pertfal.'Other-Eee
Signs Special Inspection 15 TO7,RL \
errarks ? /fE
Final
I, the Elect7ical
InsOector, hereby
$? ti/y Ihet the above
K?aoection hea been
t01e repueel
7
°
18
?6 °
?`ao
?
,
ReQUest Dete
? Fi No. ougRln Inpse bn Requ' tl
(YOU must cali inspector when ready) In ?bn Other Than Rough-In
'-qeaay Now ? wu No`ny inspecm.
W.? f ': 1 ? Ves Na Dete ReeGy
licensed contractor '-J owner herebyrequesC inspedion of above electrvcal?`?'..., . .
Job Atldress (SIreBI Box;orROUte
Na)
4: /? ?
- yg?-
'
?
\
11. J2 ?>
SediomNo. TuwnS?'?p Name or No. Range No. CnuMy
OccuP PRINTI
- .. TaneNO.
' '-?52 Z2.4S
Power $uppber ' . AOOress
Elecvical Cont acronlComOany Name) .?
NoR1-?.Qt?i? P-ir(L CDgo, Coet ai License No.
i? floZ3 Z?
Mailing Atltl ess ICOnireetoi v Owner Makinq Installation,
75 6
Aulhorize naNre IConhactor+Owner Ivq allationl
? PAonB Humper
L b-Q?6f
MINNESOTA STATE 60APD OF ELECTRICITY THIS INSPECTIDN REQUEST WILL NOT
Griggs-MlOwey Bltlg. - floom 5-173 BE HCCEPTEO BV THE STATE BOARD
1821 University Ave.. SI. Paul. MN 55106 UNLESS PROPER INSPECTION FEE IS
Phone(612)Bd]-0800 ENCLOSEp.
REQUEST FOR ELECTRICAL INSPECTION
? See InstrvMions lor rompleting ihis form an back of yellow copy
N 18 526 -X" Be/ow Work Covered by This Request
EB-00001-OBy^/
4
JyQ?? •
ew i(tltl ;p? ,'p;; Typeof8uildinq AppliancesWiretl EquipmentWired ?
,';?t Home Ran9e _ Temporary Service "
qplez Water Heater Etectric Heating
Building Dryer _ Load ManagemeM .
llntlustrial Fumace ? .Other(SpeciTy)
;` Farcn Air Conditioner
? Olhar'(sVanfy) ConVaciors Remyks:
? i,'eroY?''ee?°+`
Compute.InS&tion Fee-8elow:
# '.qDiher Fee # ServiceEntranceSize Fee N -? Gircuits/Feetlers Fee
SwimmiligfPOO1 - 1 010200 Amps - ,-c: 0 to 100 Amps
7rans{orrners Above 200 _ Amps Above 700 _ Amps
SigbS _. . Inspector's Use Only: TOTAL
Irriganon Booms ?
Spec?al Inspection ?
Alarm/Corrimunication THIS INSTALLATION MAY BE RpERED?D ONNECTED IF NOT
OltierFee;:,? COMPLETED WITHIN 18 MONT .
I, the--ElectraCal-lnspector, hereby
certifyJhat th@,above inspection has
beer m
4ade Ro°9h-'"
F;nai oi
oa U
OFFICE'USE ONLY','+ -? - This reque6t va tl 18months irom ??
CITY OF EAGAN p
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 12528
PHONE: 454-8100 ?
BUILDING PERMIT " ' Receipt#_-?
7obeusedior SF DWG/GAR Est.Value $64,000 Date AUGUST 27 19 86
SiteAddiess 3569 BALTIC AVE Erect 17 Occupancy R3
Lot 6 eiock 3 secisub. HAMPTON HTS Remodel ? zonin9 pD
Parcel No. Repair ? Type oi Const. 14R
Addition ? No. Stories 40
? Name FRONTIER COMPANIES Move ? Length
z
3908 SIBLEY MEM HWY, BLDG E oemolish ? Depth 47
o Address Int. Impr. ? Sq. Ft.
city EAGAN phone 454-0433 Install ?
o Name SAME
a
, Address
:
City Phone
F w Name
x ? Address
o
a W City Phone
Assessment
Water & Sew.
Police
Fire _
Eng.
Planner
Council
Iherebyacknowledgethatlhavereadthisapplicationandstatethatthe Bld9
information is correct and agree to comply with all applicable State of
Minnesota Statutes and City of'Ea9?
an rdinanc ? APC_
Signature oi Permitlee Vac [
y
Permit '? a4?•vv
Surcharge 32.00
Plan Review 162.50
SAC S7S.00
Water Conn. 500. 00
Water Meter 63 . 50
Road Unit 290.00
Tr. PI. 156.00
Parks
Copie? O
T.....I /
A Building Permit is issued to: ?FAONTIER COMPANIES on the expiess condition that
all work shall be done in accortlance with all plicable Slate Min ota Statutes and City of Eagan Ordinances.
Building Oflicial .C.?L-/
e
/ 1986 BQILDIHG PER!!IT $PPLICATIDH - CITY OF SAGAN
NOTE: ALL CONTRACTORS MOST BB LICENSED WITH TH6 CITY OF EAC,6N
CONIMERCIAL
INCLUDE 2 SETS OF ARCHITECTURAL
& STRUCTURAL PLANS, 1 SET OF
SPECIFICATIONS AND 1 SET OF
ENERGY CALCULATIONSJ
$2,000 LANDSCAPE BOND
SINGLE FAMIILY DWSLLINGS
INCLUDE 2 SETS OF PLANS
3 CERTIFICATES OF SURVEY
1 SET OF ENERGY CALCULATIONS
To Be Used For• ????%?iValuation Date: ___?
? ?
Site 9ddress OFFICB IISE ONLY
Lot ? Block ?
Parcel/Sub /?YdhAY6?
Address(
?
City/Zip Cod?
Phone Z -1z? /
Contractor FRON7IFR Pn?p?Nt€S
3908 Sibley Memorial Highway -$Idg, E
Address _ Eaagin, MN 553,22--
City/Zip Code
Phone _45?1- 04?3 ?Z
Arch./En
Address
City/Zip
Phone #
Erect Z; Oceupaney _ -70?
Remodel
? Zoning
Repair Type of Const M/
Addition # of Stories
Move Length A74?7
Demolish Depth ?
Int.Impr. ? Sq Ft
Install
APPROVALS FSFS
Assessments Permit •=E
WaterlSewer Surcharge 3Z
PoZice Plan Rev3ex /6Z, C7
Fire SAC 5 7
Engr Water Conn ?
Planner Water Meter
Couneil
Bldg Off ? Road Unit 970
Treatment P1 /SZ'
APC Parks
Varianee Capies
TOT9L 7
NOTS: ADDRESSES FOR CORPER IATS - CONTEACTOR/HOMEOIiA6R MUST DSSIGHATE WHICS
ADDRFSS IS DESIRffi, N0 CHANGES iti[.L BE ALLOiTSD ONCB BQILDING PERIiIR
IS ISSIIED.
.. , ` EXTERIOR EttV[L6PC
-'?.,,;ry E o .
/ SITE AOORE$S: ?
CONTRACTOR:
.r?.?r.
?:nrsrur,rr?av
S7?FF?dCA No wfo.
rnTr:???LS -i ?
f'IiONi :
Oetermine working square FooCage cf each
1. Total expased wall area..... sq. ft, x,j; = Q C?
2. Tatal roof/ceiling area..... td1 ? sc;. Pt. x.G26
Total exposed wall arca abovc flr,or=_
1G,
a. Tot3i wall taindaw area ............................
...............
b. Total door area .......................................
.........
.... ..
c. Total sliding glass daor ar:a .........................
.
d. Total fireplace wall area.. . . . . . .
.........................
.............
e. Totai wall framinq area (average 10,"-.) ..................
..........
f. Total rim joist area ..................
g. net watl area above fioor...Z`.?G?.?l.='T?:A............
...
• wail area above floor .....................................
i. wall ar=a above 'loor .....................................
'
7. rzme wali area at ?oundarion .............................
Total expased Taundation area=
? ?
4 7_
-,
,
4 5
k. Totti foundation wfndow area.......................
l. TotaT net toundation area above grade .............
Oetermine "u" value of each vrail 5_,rmCnt
(e.g. windoar, door, each separate-rrail se,:tion)
? a. I ZS x
? b. GI ?_ x
C. . d. X
.? Li„
,.ull
4:5 _ I o
d? I
, as
,.U,.
e. f qCo,4S x "U"
f. I-2
?O X„u„ p 3 = .:: `1
, , L:) = I -7 % ,
, Ut3 = ES• 7,1
?
a•
h. ,Y NU° a
i. Y 1. U., ?
' J • X "U"
:
- ? x ,.u,. _
?
• 1. C? S R"U" ? S = 1• 75
................................. racal
If item 33 is Che
as, or iess than,i
#1, yau have met_.t
inCent of SBC._66QE
'f RI.A
'Sl r?:
?:cpcior "r.vclcnc Avcraqc "L"" Camputacion
To'L•al cxtia:sed rooE/ccilinq arca - I OI (O
Pnga 2 0. q
ia. Totul skyliqht atea ............................ _
n. Total :ooP/cci:in, f:aminq arca (avcragc 10t)... l Of?Co
a. Total nec insulated rooF/ccilinq area........... :??q,L} •
. Determine "V" valuc for each rooP/cc:ling seyment
M. _ X "U" _ -?
n. 1 O(• CiJ x?•v" .?'J z = Z, ?} L}
o. 14, k„Tv
n ........................... 2b:a1
I: total of ?4 is the same as, or iess t:han I12,.you h<ive meC the inl•ent og
SBr 6006 (c) 1.
R2tNrA3tC BuiZdina Znvelooe Qesian
'LtO ut:lize the co;.al enveloee'systln method, the values established by tile s-:m of
items n3 and r4 shail not be greater than the sum oi items 471 znd $2.
?. ZI(?.o9 +2. Z(O. ^rl a • , S .
3. kv;T, 4. Z0-73 a ?4p
' • 11A1.I. •.C.'19',^•u.^. ??
.U^r i?z,.•?'?•??>>???in u.?il neca I?r Q??r
V:l lu.•
} _._.,.._ ?`_._?1?:-----{?l ?; <<•? .. AtcA?m: . ..... . o.G:B .
7. ev
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7fWL: IiAI.L
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= • ??.L?S?-?. ..3. V4?L
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f).fi.'t
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4.
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?-
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t••. . ,c c '. j ? ? 1 • .. M???._.?LlS.3G 8?.?._ a?t?. . .?,' `?
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1::<!^rit?? q.17
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f-A = . 145
s;.»l ori r,tu+ne
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; gec: £Iav vp • j•vented
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'?7
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conse cn . a-vaiuc
1. Zntcricr ai: :12z . 0.67, '
2. s3 ?? ? r31? , . ?cR
.i. Extcri.o: ai= :i'_r+ (still) O.ul
- Total rz c}58a
: ' '• ? ' U= .OZ •
FR.?+`? ? ' • . .
I. Interior air f.il-m 0.61
z_ 372?rG=r t3?
3. ?-f-4 4 I?.(5uL. 38. 3S
4, rxtr.clol ?i?Clln (sr..IL l.o:
matat 2 - qo.?s
. , , . . U = OZ4
C oA. sr?L v c ri m p`
1_ Ir.sidc ai: f1l:n 0.61
2.
3. . ,
4_
5. Gtittsidc zir _ E:l:n 0•:7
To taL
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I_ Tnsidc air Lilsn 0:51
?. . .
3_ . ,
4_
$. Outsidc air Fzl:n 0.17
• , TO tai , . .
]._ rnsidc aiz' filn • ? • 6?-
'
Z. .
3_ - •
a_
' S.
CuG?idc air £itin
0.17
. _ • .?.TO?1- .
. lratc: Use add3t:.ians1 sheets iP asore sraec
.
' necded Eor det:iL asd
' • . calcc3a=ians
-
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? ''Si,U:.p,lyt'oi t•L'a??ur, u.?:: n?en Ior ..
' ::acn: coit:;truct.l?n Can• i<<:_:? i?,.? u_v.i;??,:
I? .. '??^?.11'???? ? i. 1 - .':•?.?;I.?..t;?u: .. - --.•_ ._l1 (? . -
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z.'ZS ,.
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' FIG.'.9? ''IY?PVSET?7 CF _
Frln;t: tifiL1.: 1. InCr?inr air i 1In
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e .^ . .?i i? ?v 2' --........._..._.??? ?...?:.
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BLOC_ S? ; G S ?
dm t 3 0
,
?:ULL 1 130 F-t7 t= f= -24
o,c M......+?
rZ t M=??' i'?o s
WA LL AZEA
3Lac.K:'4 C=c K , S = 3 Z. 5
3- ,K. S= ?'? a
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?u?Ll ', ??? x. 8
c , , ..
?. _
4cb
??u ?? ? c ?? K 1 = t3o
. : s
? W DxlS
24/3G jL? to y
? r
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Ex.PoSS-D GEI LtUC{ I v i(o
Ll D oo ?.5
3` .
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D?s . ?r q .
tZS? ?
To I-A L = . I 4co9. 5
BUILDING PERMIT
To be used for DECK
CITY OF EAGAN NO 17737
3830 Pilot Kno6 Road, P.O. Box 21-199, Eagan, MN 55121
? PHONE: 454-8100
• Receipt #
$1,000
i s44__
Site Address 3569 BALTIC AVE
Lot 6 81ock 3 Sec/Sub. HAMPTON HTS OFFICE USE ONLY
PBfCBI NO. Occupancy _ PEES
2oning -
w Name DAVID G FRENCH (AClual) Const _ Bldg. Permit 25.00
o Address 3569 BALTIC AVE (Allowabie) - . SO
Surcharge
City EAGAN Phone 296-5547 +r oi stories
25X14 Plan Review
683 0693 Length
F Name SAME Depth 10 SAC
City
i Address S.F.TOtai ,
-
SAC,MCWCC
CItY Phone S.F. Footprin[s -
Water Conn
On Sire Sewage _
?w Name OnSiteWell - W
terM
t
e
er
a
5 8 Address MwCCSystem _
'
Qi
<W
City PhOf10
CityWatet Acct. Deposit
-
PRV Required _ S/W Permit
I hereby acknowlege that I have read this applicalion and state that the Booster Pump - SiW Surcharge
iniormation is correct an?-a ree lo compty wilh all applicable State of
Minnesota Statutes and Cfry aganyr, ce .
A Treatment PI
?J
.
p/
-
?
? _
(/I/Y ?.
SignaWre 0f Permifee 1 APPROVALS Road Unit
A Buiidinq Permit is issued to: DAVID G FRENCH PlannOr - park Oed.
on the ezpress condition that all work shall he tlone in accordance with all Cou^c'l 2
00
applicable Sta[e of Minnesota Statutes
and City of Eagan Ortlinances. Bldg. OIL _ Copies .
a
Building OHicial
A Ikll DI/X.1 TD?
Variance
_ TOTAL
27.$0
BIOMA
9URVEYINO
SERVICES
3908 Sibley Memorial Highway
` Eagan, Minnesota 55122
Phone: (612) 452•3077
SGA?-E; I"=bo ?
L-r
,.
L:.??r r]
0
a. _
?
D4'eAtWAy E
I ? tl1 l
EPhM'7.
/
Ll7T CD ?
/
?
4, J1,OL. I
CERTIFICATE FOR;
MOMEPURDEpS
? LAHnorveLnrIas
? AEAtiUaS
?
?i COMPANIES
MODEL : 5T'APR0Rb
BS?S
-T
P
a .e,?ase ?
» ? I
--?°-n
ni
0
i?
85IX
WAYNE U.
coRnEs
-14Gi5 -
_LEGENp "
O Denotes lron Morn/+ent
p Denotes N'oa1 Hub Set
x803•OQenotes Ezisfirg Spot Elevation
(,,=?..) Dprafes Proposed Spot Elevation
,,-----(knotes Orainage Directron
-PADPEItTY DE,9CRIPfIpV-
LOT 6 . BLGti'K t'
HAMPTON IiEIGHTS
accordirg to the recerded plat thereot,
Dakota Coun;y, ?in-iesota
PROPOSED GARAGf FLOOR ELEVAifON= E;7:.7
PAI7POSE0. Top of Btock ELEYATION` 85$,0
PROPOSED BASEYENT FLOOR ELEYATION- 855?A
lVtlTE: Verify all flaor heights with Firel House Pfaris.
_aiaMm [FRTIFICATIpV-
! hereby certify that this survey, plan ar repa't
wes prepnred 6y ire or under my direcf supervision
ard fhef ! am a Euly Reqisfered Lard Surveyor
er the /aws of the State of Yinnesota.
?aa- ca, oa te: $/1v/m
Wayne D. Corrles, 11inn. Reg. No. 14575
- ?+
14134
1990 BUILDING PERMIT APPLICATION
CITY OF EAGAN
SINGLE FAMILY DWELLINGS MULTIPLE DWELLINGS COMMERCIAL
2 SETS OF PLANS 2 SETS OF PLANS 2 SETS OF ARCHITECTURAL
3 REGISTERED SITE SURVEYS REGISTERED SITE SURVEYS - & STRUCTURAL PLANS
1 SET OF ENERGY CALCULATIONS (CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFICATIONS
1 SET OF ENERGY CALCULATIONS 1 SET OF ENERGY CALCS
_# OF RENTAL UNITS
_# OF FOR SALE UNITS
PENALTY APPLIES WHEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP SY LAST WORKING DAY
OF MONTH IN WHICH REQUEST IS MADE.
LOT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED.
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS
DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DAYS ONCE A PERMIT HAS BEEN COMPLETED.
PERMIT MUST SHOW A LICENSED PLUMBER. To Be Used For: G Valuation:
Site Address ? '?-6 r &1A`C AV2, I
Lot ? Block -7
Parcel/Sub
Owner b)GVi ? (m. ?/¢.?-?•?`
Address
Address"'?N
City/Zip Cc
Phone _
Arch./Engr.
Address
City/Zip fl'c
YAR 16 Reca
/ 04
/ d ??. Date: 9,0
?-
OFFICE USE ONLY
Occupancy .
Zoning
Actual Const
Allowable
# of stories
Length dJ`KIy
Depth
S.F. Total
Footprint S.F.
On site sewage_
On site well
MWCC System _
City water _
PRV _
Booster Pump _
pPPROVALS
Flanner
Council
Bldg. Off.
Variance
FEES
Bldg. Permit
Surcharge
Plan Review
SAC, City
SAC, MWCC
Water Conn
Water Meter
Acct. Deposi
S/W Permit
S/W Surchar€
Treatment P]
Road Unit
Park Ded.
Copies
SUSTOTAL
Penalty
TOTAL
City/Zip Code E4 gc?h , /"I A/ ' ,rJ oZ ?-
Phone #
lv 6?- ??n r? W a9G -?`ry
?
. ?
MODEL : ST'AFFoRI
i
?
I
11? O
.
.Q
?N
Z?
,? d ?
,
. -i-
?,..! ?
, c
1
Dt?IWA ? - _ a?.e -.
1C.o i.
UT i LIP
1?[/ 1 lV j ? r? ?s/
' I'
? ? --?° -a
.
i ? --r •?
;
25 ?
\0I
? i
? t(v? ,
0 ;
?
4
?i
N E
,.?\?????`????ti ? S ?.?`' •'..........
CITY OF EAGAN NO ? g455
3830 Pilot Kn9b Roael, P.O. Box 21-199, Eagan, MN 55127
BUILDING PERMIT PHONE:454-8100 Receipi # I?10-?O (
To be used for FIREPLACE Est. Value $1,000 Date OCT 15 , 1990
Site Address 3569 BALTIC AVE
Lot 6 Block 3 Sec/Sub. HAMPTON HEIGHTS
Parcel No. _
w Name DAVID & SUSAN FRENCH
3 Address 3569 BALTIC AVE
° City EAGAN Phone 683-0693
o Name S?
?? Address
? City Phone
?w Name
?30 Address
aW City Phone
I hereby acknowleqe Ihat I have read Ihis application and state that the
information is correct an ree to compl4 with all applicable State ot
Minnesola StaWtes and City EaganlQ ?? nc .
Si9nature of Permitee / _
A Building Permit is issued to: DAVID FRENCH
on Ihe express condition ihat all work shall be done in accordance with all
appliwble State of Minnesota StaWtes antl City of Eagan Ortlinances.
Building Oflicial
OFFICE USE ONLV
OccupanCy - FEFS
Zoning -
(ACtual)Cons1 _ BIdg.Permit 25.00
(Allowable) - Surcharge • $0
F ol Srories _
length _ Plan Review
Depih - SAQ City
$.F. Tolal - SAC, MCWCC
S.F. Footprinls -
On Site Sewage _ Nlater Conn
On Sile Well - Water Meler
MWCCSystem -
AccL Oeposit
City Water -
PRV Required - S/W Permil
Booster Pump - SiW Surcharge
Treafinent PI
APVROVALS Road Unit
Planner - park Ded.
Council
81dg.Ofl. _ Copies
Variance - TOTAL 25.50
- 4 it c165
1990 BUILDING PERMIT APPLICATION
CITY OF EAGAN
SINGLE FAMILY DWELLINGS MULTIPLE DWELLINGS COMMERCIAL
2 SETS OF PLANS 2 SETS OF PLANS 2 SETS OF ARCHITECTURAL
3 REGISTERED SITE SURVEYS REGISTERED SITE SURVEYS - & STRUCTURAL PLANS
1 SET OF ENERGY CALCULATIONS (CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFICATIONS
1 SET OF ENERGY CALCULATZONS 1 SET OF ENERGY CALCS
# OF RENTAL UNITS
?# OF FOR SALE UNITS
PENALTY APPLIES WHEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY LAST WORKING DAY
OF MONTH IN WHICH REQUEST IS MADE.
LOT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED.
NOTE: ADDRESSES FOR CORNER LOTS. - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRE55 IS
DESIRED. NO CHANGES WILL BE ALLOWE? ONCE BUILDING PERMIT IS ISSUED.
PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DAYS ONCE A PEAMIT HAS BEEN COMPLETED.
PERMIT MUST SHOW A LICENSED PLUMBER.
To Be Used For: C e- Valuation: ?7r 1?? d Date:
Site Address 356 F .6ti/t, c /?i/e.
Lot L Block 3_
Parcel/Sub
Owner Iliufc? ? JwJort ?/f-G?c ?'1
Address ?-
City/Zip Code Gy'Li G? ?-
Phone
Contractor .?)(hi/2
Address
City/Zip Code
Phone
Arch./Engr. _
Address
City/Zip Code
Phone #
OFFICE USE ONLY
FEES
Occupancy
Zoning'
Actual Const Bldg. Permit _M.00
Allowable Surcharge .60
'# of stnries Plan Review
Length SAC, City
Depth SAC, MWCC
S.F. Total Water Conn
Footprint S.F. Water Meter
Acct. Deposit
On site sewage_ . S/W Permit
On site well _ S/W Surcharge
MWCC System _ Treatment P1.
City water _ Road Unit
PRV _ Park Ded.
Booster Pump _ Copies
SUSTOTAL
APPROVALS Penalty
Planner _ TOTAL
Council
Bldg. Off.
Variance
1988 BUILDING PERMIT APPLICATION - CITY OF EAGAN
SINGLE FAMILY DWELLINGS
INCLUDE 2 SETS OF PLANS, 3 C RTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS
NOTE: ADDRESSES FOR CO ER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WFIICH ADDRESS
IS DESIRED. NO C NGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
M[JLTIPLE DWELLINGS
INCLUDE 2 SETS OF '.
1 SET OF ENERGY C'
COMMERCIAL
IINITS FOR SALE UNITS
# OF UNITS
, CERTIFICATE OF SURVEY - CHECK WITH BLDG. DEPT.,
INCLUDE SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET F SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS
i
To Be Used For: Valuatfon: Date:
Site Address 3S64 1.?(tLc
Lot IP Block ?
Parcel/Sub
9
Owner 70qe.
Address 3-361. -&-IktLc NQt
City/Zip Code
Phone
Contraetor _
Address
City/Zip Code
Phone
Arch./Engr.
Address
City/Zip Cod5
Phone #
ONLY
On site sewage` Occupancy
MWCC system Zoning '
On site well _ Aetual Const
City water ` Allowable
PRV required ll of stories i
Booster Pump ` Length '
Depth
S.F. Total
Footprint S.F.
APPROVALS FEES
Engr/Assess Permit
Planner Surcharge
Council Plan Review
Bldg. Off. 'j7 V? SAC, City
Variance SAC, MWCC
Water Conn
Water Meter
Road Unit
Treatment P1
Parks
Copies
TOTAL
FEEeM1-rs
'I lF APPL I r.a.B(.E I
i
_ J
G?? - q2`V3
C1TY OF EAGAN
? .
APPLICATiON FOR PERMIT
, ..
SEWER AIVD/OR WATER CONNECTION
1) PROPERTY ADDRESS:
LEGAL DESCRIpTION:
eas
?xxxxx?s:xxxxx.xxxz::::x
*107.W?: PA)MN?ir QF FEE AT TIME OF
??? ? ? ?=
APPRovar. oF PERrsr.
INsencizotv oF sEWM ram/cR MIER
T11STAiiATTCN.S WI,I.L NYI' BE.' $(',H$}-
UI,ID UNiZL PERNIIT AAS BFF.QV
APPROVID.
IE EXISPING STRt'CITJRE, DATE OF ORIGINAL BIIILDING PERMIT ISSi:ANCE: "
7
(Mon YearY
PRFSFSS ZONING/PROPOSID L'SE:
[] COAPERCIAL/RE,TAIL/OFFICE ? R-2 521+]GLE FAHffLY '
IDIDCSTRIAL Q R-2 DL'PLEX (T4.o L'nits)
? INSTITU1TIDNAL/GOVE1:PM]T ? R-3 MWNiOLSE (Three + Units) ( C?tlits)
. Q R-4 APARTMEDPP/CObIDOMI1VIDM ( Units)
2) NAME: FRONTIER MIDWEST HOMES CORPORATION
• ? ADDRFSS: 3908 Sibley Memorial Highway Bldg. E
CITY. STATE, ZIP: Eagan, MN. 55122
PHONE: 454-0433 • 3) • u ?: ?• For City Use ..
NAME: STAR PLUMBING Plumbers License:
ADDRFSS: 1018 Mound Springs Terrace ?Act1Ve
Expired _
? CITX. STATE. ZIP: Bloomington, MN. 55420 Not recprded ;
. _. ,
PHONE: 884-4149 MA.STER I,I(E(VgE# 3329 Staff ETt-lal
4) 1 W6r431l?r?• ia• . . . . . .
-%TAME.
_ aDoxsss: I5 ; -A ?
csrY, srAxE, zrn: .?S
PxorE: y?-? -/Z/ 3 -5) ? u «• w • ?• :o • ? - ?. _ _
_ CX COIZX.TION S0 CITY SEhM ? CONNDLTZON ZO CITY WATER C( OiPHER
6) '? ' •• ? PI.FIUE HOLD APPROV'ID PERNIIT F(R PIQS-C?P BY ONE OF AEOVE
[3 PLEASE MAII, APPROVID PII2MIT TO 1, 2. 3. 4. ABOVE
FOR :CITY USE ONLY
PERMIT # I55LED
?d o
Pd w/Bldg. Permit FEES:
$ $
$ /?•5v $
$ $
$ $
$ $
$ /S.fi7J $
$ $
S 60,9,60 $
$ J75.?? $
$ S
$ $ _
$ $
$ $
s /5? . na s
$ $
SEWER PERMIT (INCLUDE SURCHARGE)
WATER PERMIT (INCLLTDE SIIRCHARGE)
WATER METER/COPPERHORN/ODTSIDE READER
WATER TAP (INCLLTDE CORPORATION STOP)
SEWER TAP
ACCOUNT DEPOSIT - SEWER
ACCOONT DEPOSIT - WATER
WAC
SAC
TRLNK WATER ASSESSMENT
TRLNK SEWER ASSESSMENT
LATERAL BENEFIT/TRUNK SEWER
LATERAL BENEFIT/TRLNK WATER
WATER TREATMENT PLANT SURCHARGE
OTHER:
..,
$ 13`VS •' 56 $ . :_... :>. - TOTAL
RECEZPT RECEIPT
DOES IITILITY CONNECTION REQLIRE EXCAVATION IN PUBLIC RIGHT OE WAY?
? YES IF YES, THEN A"PERMIT FOR WORK WITHIN PIJBLIC
! ROADWAY" MUST BE ISSUED BY TAE ENGINEERING
u NO DIVI5ION. LIST AS A CONDITION.
SUBJECT TO THE FOLLOWING CONDITIONS:
APPROVED BY:
TITLE:
DATE:
?
; .
1