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941 Diffley RdEAGAN TOWNSHIP BUILDING PERMIT N° 2189 ¢................................................... Eagan Township Owner Address (present) ?'?-0'`"?=-•----'/'Q °?-'?_`?-='--' Town Hall Builder -'_ Address ...«:t.:?t:i'.e??.:,wg--?--?"L--I--...Y.-,??- DESCRIPTION Stories To Be Used For Front Depth Heigh! Est. Cost l Permit Fee Remarks /.17 0 [ 1 G..., .?? =?' - '? LOCATION Street, Road or other Description of Location I Lo! Block Addition or Tract 1 This permit does not authorize the use of streets, roads. alleys or sidewalks nor does it give the owner or his agent the right to create any situation which is a nuisance or which presents a hazard to the health, safety, convenience and general welfare to anyone in the community. THIS PERMIT MUST BE KEPT ON THE PREMISE WHILE THE WORK IS IN PROGRESS. upon This is to certify, that ..... &.:..___ .................................has permission to erect a.... upon the above described premise subject to the provisions of the Building Ordinance for Eegaii Township adopted April 11, 1955 (} r? 1 •x-c:d ?- c-C<??..4./......._°.- ...... . . ........9: .y ........................._? ....... y / ....._................_....... Per -------------- ._a u ... ?Chairmah of Tnwn Board Suildin Insp........actor........ 6 .6 CITY OF EAGAN N° 10 4 4 2 3630 Pilot Knob Road, P.O. Box 21.199, Eagan, MN 55121 ,f PHONE: 4546100 ?JC} ? 5 BUILDING PERMIT Receipt # To be m d for DECK Est Value $600 Date JUNE 24 IP 85 Site Address 941 DIFFLEY RD Erect ?X Occupancy Lot 1 Block 1 Sec/Sub. DEER ADD Remodel ? Zoning Repair ? Type of Const. Parcel No. Addition ? No. Stories Name HARRY DEER Move ? h ? D li Length SAME emo s Depth Address 28 Int. Impr. ? 454-4 Sq. Ft. City Phone Install ? Approvals Fees o Name SAME ;i1 - Acidness City Phone Name _ Address City _ Phone I hereby acknowledge that I hove read this application and state that the information is correct ynd og{eee to comply with all applicable State of Minnesota Statutes and F:ity of Eagan Ordinancas. Signature of Permitteel' 91444 A Building Pertmit Is issued to: HARF all work shall be done in accordance with Building Official Assessment Permit -?11 . a u • 50 Water a Sew. Surcharge Police Plan Review Fire SAC Eng. Water Conn. Planner Water Meter Council Road Unit Bldg.off. 6/20/85 Tr. PI. APC Parks Var. Date Copies $12 0$ . Total on the express condition that es and City o£ Eagan Ordinances. CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHONE: 4548100 BUILDING PERMIT Receipt To be wed fee Est. Value Dete Site Address ' Lot Block Sec/Sub. Parcel No. W Name ;. Address b City Phone 9 Name 10442 Erect Ll Occupancy Remodel 11 Zoning Repair 13 Type of Const. Addition ? No. Stories Move ? Length Demolish ? Depth Int Impr. 11 Sq. Ft. Install 1:1 Approvals Fees tF o Add Assessment Permit L i • 'v u1 ress City Phone Water & Sew. Surcharge • 5 U Police Plan Review toe Name Fire SAC n 13 Address Eng Water Conn . . ceW City Phone Planne? Water Meter Council Road Unit I hereby acknowledge that I have read this application and state that Bldg. Off. e:0/6 Tr. PI. the information is correct and agree to comply with all applicable APC P k State of Minnesota Statutes and City of Eagan Ordinances ar s f P itt Si t Var. Date Copies i gna ure o erm ee A Building Permit is issued to: Total on the express condition thw all work shall be dome in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Building Official Permit Ho. Permit Holder Data Telephone d Plumbing HNA.C. Electric Softener Impaction Date Insp. Other Footings I Footings II Foundation Framing Roofing Rough Plbg. Rough Htg. Insul. Fireplace Final Htg. Final Plbg. Final ft4IL Me Cervocc. Water Describe Location: Well Sewer Pr. Disp. CITY OF EAGAN 3795 Pilot Knob Road Eagan, Minnesota 35122 Phone: 454-8100 PERMIT Cost of Installatior Date: July 27 , 197 Receipt No.: f1fi2R 06247 q.11 CO. Pa. 'Single I X Site Address: y? Residential ` Lot Block Sub/Sec. AWN • Multi Res., Comm./Ind. i? -:fir=',- 2i. Ydfi'i0I'_ Name _ New/Alter./Repair c 0 Address ',4 3_ Co. IRcl. 30 Eagan City Phone: Nome Standarc Heating & A/C Co. Address Permit Fee No 953 5.00 50 Surcharge City t` Phone: Total This Permit is issued 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 3795 Pilot Knob Road Eagan, Minnesota 55122 Phone: 454-8100 CESSPOOL PERMIT No. 313 Date: J Site Address: 941 County Road 30 Lot Block Sub/Sec. A?XCh Qr??xJ Name Harry F. Deer Address 941 County Road O City Fagan 55123 Phone: Name Weierke Trenching t Address --jiff Road e City Phone: This Permit is issued on the express condition that all work shall be Minnesota Statutes and City of Eagan Ordinances. Receipt No.. ? cf r'. Single Residential ti Multi Res., Comm. /Ind. New/Alter./Repair. Cost of Installation '.00 Permit Fee Surcharge Total done in accordance with all applicable State of Official Dees /? , '0Y1 /D J98'50 Dlo of TOWN OF EAGAN 3795 Pilot Knob Road St. Paul, Minn. 55111 PFM9T NO.: 13 The Board of Supervisors hereby grants to Genz-Ryan Plumbing do Heating, Inc. of Rosemount Nirncsota 55068 a Plumbing- Permit for: (Owner) HarZ:y Deer at County !10. 30. 3t.Paul pursuant to application dated April 16.191 ._. Fee Paid: 20. 00 _ Dated this 20th day of April , 19 70. Building Inspector !?? __ INSPECTION RECORD CITY OF EAGAN PERMIT TYPE: { + i ++:• 3830 Pilot Knob Road Permit Number: {:'K y Eagan, Minnesota 55122-1897 Date Issued: (612) 681-4675 SITE ADDRESS: APPLICANT: { <<, i ICI {? iii t h tbl;'1 4141-.:4iNt PERMIT SUBTYPE: TYPE OF WORK: INSPECTION TYPE DATE INSPTR. INSPECTION TYPE .DATE INSPTR. r, i I i Permit Holder Date Telephone tl PLUMBING HVAC Inspection Date Insp. Comments FOOTINGS FOUND FRAMING Q,! ROOFING ROUGH PLUMBING f PLBG AIR TEST ROUGH HEATING GAS SVC TEST INSUL GYP BOARD FIREPLACE FIREPLACE AIR TEST FINAL PLBG FINAL HTG CJYSAT TEST BLDG FINAL DOMESTIC METER IRRIGATION METER FLUSH MAINS CONDUCTIVITY TEST HYDROSTATIC TEST BSMT R.I. BSMT FINAL DECK FTG DECK FINAL INSPECTION RECORD CITY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: Eagan, Minnesota 55122-1897 Date Issued: (612) 681-4675 1 vr;ri0 01 44 + SITE ADDRESS: 1: 1 11, 1 APPLICANT: PERMIT SUBTYPE: TYPE OF WORK: ; I, Y Iz INSPECTION TYPE DATE INSPTR. INSPECTION TYPE DATE INSPTR. L Permit Holder Date Telephone # PLUMBIN ft' HVAC 3= Inspection Date nsp. Comments FOOTINGS FOUND FRAMING 170 ? r ?t ss a ROOFING ROUGH PLUMBING Alt- PLBG AIR TEST ROUGH HEATING GAS SVC TEST INSUL GYP BOARD FIREPLACE FIREPLACE AIR TEST FINAL PLBG FINAL HTG ORSAT TEST BLDG FINAL f??y/p ld/ DOMESTIC METER f LyQ IRRIGATION METER FLUSH MAINS CONDUCTIVITY TEST HYDROSTATIC TEST BSMT R.I. BSMT FINAL DECK FTG DECK FINAL / ?- r CITY OF EAGAN Remarks Addition Deer Addn. Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. STREET RESTOR. GRADING SAN SEW TRUNK SEWER LATERAL WATERMAIN WATER LATERAL WATER AREA (0 1984 475,00 31.67 15 7 00 C008617 10-13-83 STORM SEW TRK STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. BUILDING PER. SAC PARK Lot ( Block / PID # / 4r d Wa Plat Sewer /water permit # 3 l a Date 9 9 Receipt # I CITY OF EAGAN 1999 SEWER AND WATER CONNECTION AND AVAILABILITY CHARGES EXISTING RESIDENTIAL PROPERTY Sewer Water Lateral charge @ $21.85/ff $ Lateral charge @ $22.10/ff $ Trunk @ $880/connection Trunk @ $920/connection SAC 1,1550 Water supply & storage 825.00 Date paid Date paid Receipt # Receipt # Account deposit 15.00 Treatment plant 468.00 Sewer permit & surcharge 50.50 Water meter "Inspections req'd prior 114.00 to issuing Subtotal $ Account deposit 15.00 Water permit & surcharge 50.50 Plumbing permit & surcharge 30.50 Subtotal $ Total $ - Plumbing permit & surcharge 30.50 Total $ Sewer and Water $ 117t, 9 Lateral charge @ $21.85 and/or t?2.'10ff 4-0 Trunk @ $880 and/or $920/connection A e d' D •' SAC I,W0.00 Date paid Receipt # 160 , 00 Water supply & storage w Co N t/ 825-00 Date paid ReceiPt # SPCg9 10354,0 SV?CO1 10."?U a.. ?LONO cs a" ? to Treatment plant w-, a .4yrr 468.00 Water meter "Inspections req'd prior to issuing w m MR 114.00 Account deposit p ec h0 30.00 Sewer and water permit & surcharge a Wt g` , 100.50 -?d4. f-n9 Subtotal $} 3 ..S` Plumbing permit & surcharge 30.50 Total $7//3.5a d,I a C) C) v Y (rJ Uj'a V, 1"'A? '-QJ 0. OFFICE USE ONLY Property owner ? •' Pd k1 Gb 6 Y> Address 9 y ?i Tir /0?/ ?a o d/ Phone numb l c IS C Plumber Y PRV required: R-O-W Permit: City Cty Unpaid $ Permit Fees: City financed: #Xt?t:k'n?ktYd?tXt?Xt?tXtgt?XM-9tHt>X>k>kSt? K?CNnk)Y.>%At%cMXokX<?.>k# CITY OF EAGAN CASHIER: JS TERMINAL N0: 769 PATE: 12131/99 TIME: 15:3002 ID: NAME: OPAL IN-NOME SERVICES INC. 381.i, 9378 941 DIFFLEY RD 0748.00 3811 9378 941 DIFFLEY RD 1yr68.00 380 9379 941 DIFFLEY RD 880.00 2275 9220 741 DIFFLEY RD 17039.50 3446 9001 941 DIFFLEY RD 10.50 3866 937':? 941 DIFFLEY RD 1.00.00 3865 9220 941 DIFFL..EY RD 825.00 3868 9220 941 DIFFLEY RD 460.00 3716 9220 941 DIFFLEY RD 114.00 2252 9220 90 DIFFLEY RD 30.00 CR121898 1s CONTINUE USER ID: JAN XW CONTINUE 8t???;??%%t??*Xt)Xm?i:>n.Fr k?%#X<?CBt#?F>k>X)X?%>#Hckt?t)X>X#?k?Xt >;c:N:;t%: t);t:;:X:KtW°r:•.,titikH:NFL':1<>X:?t ?'d'i,:?$iX?FX<W.Y,cMYF CONTINUE CITY OF EACAN CASH:f.R( ,Its TERMINAL NO: 769 WS: 12/3099 'TIME: 1.5:3004 v I1AME: ;PAL iAf-HOME: SERVICES INC. ?. \7 371-3 ?;r a) 941. DIFFL.FY D 50.00 r139£`2C) 90 DIFFLEY RD 50.00 3 VO 215.°"9001. 941 DIFFLEY RD 0.50 c 10124001441 DTFFL.E:Y p;ITi 30.00 TOW . Receipt Attll}W)t" C11,:3. v1 OR i 20 892 , ism, in: JAN i Lot 1 Block PID # V e ( L A-! Q ISeaver /water permit N Plat Lateral bene i $21.50/ff Tnink @ $895/co ection 1,100.00 Supply & storage C) Date :'d Recei# 15.00 Treatmel 50.50 Water m 807.00 CITY OF EAGAN 1998 SEWER AND WATER CONNECTION & AVAILABILITY CHARGES EXISTING RESIDENTIAL PROPERTY & Lateral bane @ 21.30/ff Tnw"k @ $860 action SAC Date paid Receipt # Account deposit Sewer permit charge permit & surcharge \ 20.50 Total $ Date permit & surcharge Plumbing permit & surcharge Total Sewer and Water Connection & Availabili Lateral Benefit @ $21.30 and/or $21.50/ff x SS (? Trunk @ $860 and/or $895/connection SAC Date paid Receipt # Supply & storage (WAC) Date paid Receipt # Treatment plant Water meter Account deposit Sewer and water permit & surcharge Subtotal Plumbing permit & surcharge Total 444.00 111.00 15.00 50.50 Char es ?-loy aC7 A? $ t-Iao.CC? rS\ n(. n UCH 1,100.00 807.00 444.00 111.00 30.00 100.50 Receipt # 20.50 $x-1.0 o Pis sa1v0.,"V\p_ Property owner \R C Y ?LCk-vCO Address q'A Phone number OFFICE USE ONLY PRV required Number of taps Availability $ Y? Plumber City financed Lot Block PID Plat Sewer /water permit Date Receipt CITY OF EAGAN 1998 SEWER AND WATER CONNECTION & AVAILABILITY CHARGES EXISTING COMMERCIAL PROPERTY & Lateral bene i 21.30/ff Trunk @ $1,790 SAC @ $1,100/unit Date paid Receipt # Sewer ue t & surcharge Plumbing permit & surcharge Total 50.50 25.50 permit & surcharge Sewer and Water Connection & Availabil Lateral Benefit @ $21.30 and/or $27.15/ff X go Trunk @ $1,790 and/or $1,875/acre SAC @ $1,100/unit Date paid Receipt .4 Supply & storage (WAC) @ $2,955/acre Treatment plant @ $444/SAC unit Sewer and water permit & surcharge Subtotal Plumbing permit & surcharge Total i??oy $ al?? 50.50 $ 25.50 Ixo f I 6?8. 3y 100.50 25.50 The number of &4C units is determined by the Metropolitan Council Wastewater Services (602-1000). OFFICE USE ONLY Property owner Address Phone number PRV required (U1T? Number of taps No 9/w yA»,7s rr?+ir -Jr?c Availability $ V9 /o S' ?7 1 d eat ,rs d Plumber City financed @ $27.15/ff Trunk @ $ , 75/acre Supply & sto (WA C) Treatment plant 444/; Water permit & sur ge CITY OF EAGAN SEWER & WATER CONNECTION CHARGES - 1989 EXISTING PROPERTIES SEWER CONNECTION CHARGES SAC Previously Pd. Receipt # ACCOUNT DEPOSIT SEWER PERMIT TOTAL: 4J?p TOTAL FOR SEWER & WATER ROOK-UP: WATER CONNECTION CHARGES $ 675.00 WATER CONNECTION $ 580.00 Previously Pd. Receipt # 15.00 WATER METER 10.50 TREATMENT SURCHARGE $ 700.50 ACCOUNT DEPOSIT ??????? WATER PERMIT PLUMBING PERMIT e0o, J v TOTAL: ,A),a r e 2 T? P $1; 63fs:?- OFFICE USE ONLY 90.00 228.00 15.00 10.50 12.50 $ 936.00 /Do.o0 1006.00 PROPERTY OWNER: f/ ADDRESSs L:? B: I ADD: c%?L T c??L?<z c?? ?-? .J ? - 7 y ?? ?ccJ r ?? L?o?sfeh y%c??„-tom 2 Ate- f v/ LT 0-6 / (073 8o r ?L 13.?S? /zf 75- f ?? s -7 7S 825 /4 G No 11vo ?r-u,4TF,)Z: La4P / /Z. .6 S',e:c,-c` Ga?trG ? /YSS.asI'rk>{? 2- 3 zS- etZF,.P 6AINsT f?SSesS,n? 3 r S43'°o -' ?0?? 54ecuer crcf +C?47"E/C rr L-rz?'e?-ems ? 4 3 T?V I vkI /Z,--" Time WH`I?Lr= YOU WE?(RE?O? U?T Phone / °?? - S lC I W Area Code Number E ensign TELEPHONED PLEASE CALL CALLEDTOSEEYOU WILL CALL AGAIN WANTS TO SEE YOU URGENT RETURNED YOUR CALL Message C: w a1u? ?€ v e e_'7 NERAL OFFICE PRODUCTS 612 COMPANY 925.7500 7M 3795 PILOT KNOB ROAD. P.O. BOX 21199 SEA BLOMQUIST EAGAN, MINNESOTA 55121 Mq PHONE: (612) 454$100 THOMAS EGAN JAMES A. SMITH JERRY THOMAS THECOORE WACHTER Court Mambas THOMAS HEDGES November 26, 1982 °iyAdVWkOW EUGENE VAN OVERBEKE ON Cbr. PAUL HAUGE CITY ATIUfUSE'Y FACAN MN Re: Project 365, Lot 1, Block 1, Deer Addition - Postponement of Assess- ments Dear Paul: Enclosed please find the original copy of a fully-executed agreement by the property owner of the above-referenced lot requesting that the la- teral benefit f= trunk water main assessment associated with the above- referenced project be postponed until some future date. Please insure that this agreement is recorded against the affected property for all future interested parties. Sincerely, Thomas A. Colbert, P.E. Director of Public Works TAC/jack enc. cc - Harry P & Phyllis C. Deer Lot 1, Block 1, Deer Addition Ann Goers, Special Assessment Clerk THE LONE OAK TREE ...THE SYMBOL AND GROWTH IN OUR COMMUNITY c CrTY OF EAGAN CDNSERr TO PQSTPCNFD ASSESSMENTS IN CONSIDERATICN of the postponement by the City of Fagan of the levy of assessments for lateral benefit from trunk water main (Project 365) serving the following property: Lot 1, Block 1, Deer Addition C ?= The undersigned, for themselves, their heirs, executors, administrators, suc- cessors and assigns, hereby coLsent to the levy of assessments cr the raking of a connection charge in lieu of assessment at the time said property is connected tc the trunk water main installed under Project 365 or at any earlier time at the option of the undersigned, so long as said assess- rent or connection charge is made at the prevailing rate at the time of oo wt-- tit or such earlier time. The undersigned, for emselves, their heirs, executors, administrators, suc- cessors, and assigns, further hehpby waive notice of any and all hearings neces- sary and waive objection to any technical defects in any proceedings related to any assessment or connection charges for City of Eagan project 365 or Contract No. 82-14 for said improvements, and furthez wazve the right to object to or appeal from any assessments or cm¢umectian charges made in the future pursuant to this agreement. Dated: . Z, 7, Harty P STATE OF 1"nOIES PA) ss. COMny CP DAKOTA ) Phyllis C. Deer C this day of ?a i9 FLbefore me a notary public within and for said county, personally appeared 14,91e cy r- "-J E161? and mil, ti L? , S C . (? r??2 to Me ly known to be the persons de going instrument and acknowledged that they and deed. This Document Drafted Bv- Hauge, Smith, Ride & Keller, P.A. 3908 Sibley Memorial Highway Ragan, Mn 55122 (612) 454-4224 0, &-1t/ fry act zp?t APPROVED- lic Works Director CITY OF EAGAN 1 Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. STREET RESTOR. - GRADING 'SAN SEW TRUNK SEWER LATERAL ? ' Il ` ' WATERMAIN WA 'Coo i t. I f ( [ i i WATER LATERAL - BOATER AREA 1984 475,Q0 31.67 15 475,00 C008617 10-13-83 s1 <STORM SEW TRK I 3 STORM SEW LAT -'! CURB & GUTTER - I r' SIDEWALK KI STREET LIGHT :i ` WATER CONN. `. ' . BUILDING PER. SAC y...°,. PARK s.., ,i I can Vit CA ?/??) ?i V J u It% r14 W/ ?'?, A4n © IWCW ww v • • • ®. ®0 0Qy U L) g U ) ^(j?GSrti j a w /"I ' ? J bwK V ll ?tA?? cur6l? rA r7, 17, ' Iii. \ y 16 (µy? r , V,? I r ?? `Y 4 r w ^ -?. ?1Y (.) • • ??A®??1? CITY USE ONLY Q ry q LOT BL RECEIPT (/ / c SUBD. RECEIPT DATE: 1998 MECHANICAL PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN MN 55122 Date: ??'' -1 1-(-) (612) 681-6675 r I 11 ``?) Complete this section only if you are installing HVAC in single family, townhomes or condos under construction and not owner /occupied • HVAC: 0-100 M B T U $ 24.00 ADDITIONAL 50 M BTU 6.00 • Gas outlets (minimum of one required @ $3.00 ea.) • State Surcharge: .50 • TOTAL: Complete this section only if you are remodeling, adding to, or repairing existing single family dwellings, townhomes, or condos. Note: Mechanical permit is not required for alteration/add-on to ductwork in existing residential units; but is required for the following: -hr ?1ox?? 3g5C{?V 01?{O?I? Install iumace Install air conditioning Install air exchanger, i.e. Vanee system, etc. Other Minimum fee applies to all remodel or add-ons of existing residences $ 20.00 State Surcharge .50 Total: $ 20.50 SITE ADDRESS: q41 OWNERNAME: PHONE#: ?j ,I INSTALLER NAME: I? G1 ,1? 1 Y? ?1 C PHONE #: Z??? 'T STREETADDRESS: 191,E ?J?J LU S?Il`? C "? \A STATE: M SIGNATURE OF PERMITTEE IS/FORMS BLD/MECH PERMIT (RES) - 1999 / VVV L BL CITY USE ONLY n p _L RECEIPT#: 70 ?? SUBD. RECEIPT DATE: w ?? p 1998 PLUMBING PERMIT (RESIDENTIAL,) CITY OF RAGAN 3830 PILOT KNOB RD EAGAN, MN 55122 (612) 681-4675 Please complete for: ? Ingle famil dw ' ? town omes and condos when permits are required for each unit ? backflow preventer for underground sprinkler system ----------------------------------------------------------- FIXTURES ----------------- EACH --------------------------------------------- # TOTAL Shower 3.00 x = Water Closet 3.00 x = Bath Tub 3.00 x = Lavatory 3.00 x = Kitchen Sink 3.00 x = Laundry Tray 3.00 x = Hot Tub/Spa 3.00 x = Water Heater 3.00 x = Floor Drain 3.00 x = Gas Piping Outlet ` minimum - 1 3.00 x = Rough Openings 1.50 x = Water Softener * for dwellings under construction 5.00 x = Water Softener * for existing dwelling 20.00 x = U.G. Sprinkler * for dwelling under const. 3.00 = U.G. Sprinkler * for existing dwelling 20.00 = Alterations * to existing residence 20.00 Water Turn Around 20.00 = Private Disposal System * MPC lic. 75.00 = (new and refurbished systems) Private Disposal Systems * Abandonment 20.00 = RPZ (new installation only) 20.00 = STATE SURCHARGE .50 TOTAL 20/ j O ------------------------------------------ -------- ----------------------- ---------- -- I hereby acknowledge that I have read this application, state that the information is correct, and agree to compty with all applicable City of Eagan ordinances. It is the applicant's responsibility to notify the property owner that the City of Eagan assumes no liability for any damages caused by the City during its normal operational and maintenance activities to the facilities constructed under this permit within City property/right-of-way/easement. SITE ADDRESS: OWNER NAME: prBh ope-f / p p INSTALLER NAME: ?///asy.y r! ?C?? O lL TELEPHONE #: ?O l? G y STREET ADDRESS: CITY: 1%Ia //-Pi s STATE: ApllH . ZIP: 5 ;> SIGNATURE OF PERMITTEE CD/PERMIT FORMS/RPLBG PERMIT (RES) - 1998 1998 BUILDING PERMIT APPLICATION (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD - 55122 681-4675 New Construction Requirements • 3 registered site surveys ? 2 copies of plans (include beam & window saes; poured intl. design; etc.) 4 1 energy calculations ? 3 copies of tree preservation plan if lot platted after 7/1193 required: _ Yes _ No DATE: f o Remodel/Repair Requirements ? 2 copies of plan ? 2 site surveys (exterior additions & decks) ? 1 energy calculations for heated additions CONSTRUCTION COST; R? J?NQw t/ S ?5 7, ?I o S) S ?)/??CLz'`S DESCRIPTION OF ORK: 1dl-,- P4 1'R /i oc \ ¢ CtIL 11v6 STREET ADDRESS: R ?l) O 1 S= V LOT: BLOCK: SUBD./P.I.D. Name:_ PROPERTY Last First ?- OWNER ?a y Street CONTRACTOR r YRL---A T 5) S O City - ? S "r. P A (U L- State: M ?V Zip: 5-5t/-F Company: W) L L L J J }? 7Vr/ 5 Phone #: 07-70 Street Phone #: `2 `P / 13'S -7 License # a o? K 7 R O City LyGSY 5T P-s UZ- State: M Zip: S3 1 ? g ARCHITECT/ ENGINEER Company: IV L (j N0+ iC?VAS Name: i N U 0 -e-Y YY\ i -i- I S C l-k-e cj w b \(V-- CO vV\V 1 e t-? ct- 5 Street Address: City State: Sewer & water licensed plumber (new construction only): and lot change is requested once permit is issued. Zip: Penalty applies when address chang I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicabl State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant: OFFICE USE ONLY Certificates of Survey Received - Yes No Phone #:. Registration It-?t- 8Tree Preservation Plan Received - Yes - No - Not Required PERMIT CITY OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55122-1897 (612)681-4675 PERMIT TYPE: BUILDING Permit Number: 0 3 3 3 7 9 Date Issued: 09/22/98 I SITE ADDRESS: P.I.N.: 10-19850-010-01 941 DIFFLEY RD LOT: 1 BLOCK: 1 DEER DESCRIPTION: MISC. REPAIRS Buli4d ng".,Permit Type 80ilding Work Type _?ensus Code` ` 434 STORM DAMAGE REPAIR ALT. RESIDENTIAL % L. REMARKS: FEE SUMMARY: ftRPTR T"ORhTIONS _ App 114351932 0002158 OWNEOL?L JIM P 0 BOX 240744 706 ROBERT ST S APPLE VALLEY MN 55124 ST. PAUL MN 55114 (612) 432-3444 (612)291-1557 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 Mn. Statutes and,,City of Eagan Ordina,nces.., APPLICANT/PERMITEE SIGNATURE ?IMUED BY: SIGNATURE 1998 BUILDING PERMIT APPLICATION (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB B RD RD - 55122 a G 0 681-4675 -9 2 Q New Construction Requirements RemodelfRepair Requirements • 3 registered site surveys • 2 copies of plans (include beam & window sizes; poured fnd, design; etc.) ? 1 energy calculations • 3 copies of tree preservation plan if lot platted after 7/1193 regui _ Yes _ No DATE: qu l I/ F hF OPA L T:ntc, T Name R I S C-0 L L ?1 l M Phone #: Last First 132 , 2-q DESCRIPTION OF WORK: ?y-a? ?/+^^t4rv F /?E Nr. r?`,5 STRE ADDRESS: 4 I }17 I F LFY LOT: BLOCK: _r 1 SUBD./P.I.D. PROPERTY OWNER Z,t ^ISJ f Street Address: ??O Ln S ?o R ? --r- City ? -pp-,L- State: ' -` t13 Zip: Company: Zo N EZ STa QA?7 o NS Phone #: 43 s ^ 1 9 3 Z CONTRACTOR p Street Address:?, 6, a b x Z? b 744 License # Z I S-O City APPCe- \A4 LU Y State: MtJ Zip: 5 12-4 ARCHITECT/ ` ENGINEER Company?E S (6N L/4SS 1 ?S Phone #: Registration #: Street City Sewer & water licensed plumber (new construction only): and lot change is requested once permit is issued. ? 2 copies of plan ? 2 site surveys (exterior additions & decks) ? 1 energy calculations for heated additions CONSTRUCTION COST; `fl 10 ? State: I hereby acknowledge that I have read this application and state that the information is correct State of Minnesota Statutes and City of Eagan Ordinances. ------ ) Signature OFFICE USE ONLY Certificates of Survey Received - Yes No Zip: Penalty applies when address chap; to comply with all applicat Tree Preservation Plan Received Yes - No - Not Required PERMIT CITY OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55122-1897 (612) 681-4675 PERMIT TYPE: BUILDING Permit Number: 032831 Date Issued: 08/07/98 SITE ADDRESS: 941 DIFFLEY RD LOT: 1 BLOCK: 1 DEER P.I.N.: 10-19850-010-01 DESCRIPTION: & GARAGE STORM DAMAGE REPAIR 434 ALT. RESIDENTIAL s _?_ ?v.. ... _. TRUSSES B.Mildin-g_Permit Type Fuil.di-ng',Jgrk Type (-'Census Code` C _r REMARKS: REPAIR TRUSSES,GARAGE DUE TO STORM DAMAGE. FEE SUMMARY- CONTRACTOR: CHRISTIANS INC 1480 PARK CHANHASSEN (612) 470-2001 - Applicant - ST. LIC. OWNER: 14702001 3712 OPAL IN HOUSE SERVICE RD 941 DIFFLEY RD MN 55317 EAGAN MN 55123 (612)291-1557 I- 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 Mn. Statutes and City of Eagan Ordinances. APPLICANT/PERMITEE SIGNATURE e" /:;u UED BY. SIGNATURE INJ 1998 BUILDING PERMIT APPLICATION (RESIDENTIAL) CITY OF RAGAN NO ?/ 3 3830 PMOT KNOB RD • 55122 - - 9 d New Construction Requirements # 3 registered site surveys # 2 copies of plan # 2 copies of plans (include beam & window sizes; poured find. design: etc.) # 2 site surveys (exterior additions & decks) # 1 energy calculations # 1 energy calculations for heated additions # 3 copies of tree preservation plan if lot platted after 7/1193 required: _Yes _ No DATE: <wJ,- $ CONSTRUCTION COST; (Dg ooa DESCRIP ON OF WORK: MEW 'TasassF.S,_R& -,ASer Aoeac Iku +SC_. 1. 1413 V4 auftg - o e-M ST RE T ADDRESS: 9q 1 1 F?db? RD LOT: ? BLOCK: I SUBD./P.I.D. #:?2 Y/ Remodel/Repair Requirements Name: Otj7M-- 10 klouse eVtr? Phone #: 2-91_ PROPERTY Last First OWNER Street Address: City State: Zip: 1? I -) Company: ?Hel$TtgNS tNC. Phone #-. t4 -1 0 ZC?DI CONTRACTOR 19 Street Address: 141210 QARIC RD. 3r3 License# 3-)12- city CNrnJ 'rgss&rq State: [AVj Zip: ARCHITECT/ ENGINEER Company: Phone Registration #: Street City State: Zip: Sewer & water licensed plumber (new construction only): Penalty applies when address chang and lot change is requested once permit is issued. I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicabl State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant: OFFICE USE ONLY Certificates of Survey Received _ Yes No Tree Preservation Plan Received Yes No Z) L/ 2,, 1985 BUILDING PERMIT APPLICATION - CITY OF EAGAN NOTE: ALL CONTRACTORS MUST BE LICENSED WITH THE CITY OF EAGAN INCLUDE 2 SETS OF PLANS 3 CERTIFICATES OF SURVEY 1 SET OF ENERGY CALCULATIONS To Be Used For: I1 k Valuation: 6v v ? Date: - -?Sl Site Address: q4( -n ? V OFFICE USE ONLY Lot: L Bloc Sect/Su ?ddlh E ct X Occupancy Remodel Zoning Parcel # Repair Type of Const ' I Enlarge # of Stories Owner kt4 rru ?lis ??r Move Length Demolish Depth Address 41 /?V 3Tj Grade Sq Ft City/Zip Code ?N `1'6)Z3 ----_-_-• Phone (464-(47 IF APPROVALS Contractor S¢ Address City/Zip Code Phone Arch./Engr. Address City/Zip Code Phone # 50 Assessments Permit Water/Sewer Surcharge Police Plan Review Fire SAC Engr Water Conn Planner Water Meter Council R d Unit Bldg Off G Parks APC Treatment P1 Variance TOTAL p ? ii GL. ?(.L111 , 1 i". ? .. fy?5o -vro , o ? LAI i L C? CITY OF EAGAN CONSENT TO POSTPCNED ASSESSMENTS IN CONSIDERATION of the postponement by the City of Eagan of the levy of assessments for lateral benefit fran trunk water main (Project 365) serving the followinq property: I.ot 1, Block 1, Deer Addition, Dakota County, Minnesota. . ,Harry F. Deer and Phyllis C. Deer, husband and wife, The undersigneddfor themselves, their heirs, executors, administrators, suc- cessors and assigns, hereby consent to the levy of assessments or the making of a connection charge in lieu of assessmant at the time said property is connected to the trunk water main installed under Project 365 or at my earlier time' at the option'of ttiivundersigned, so long as said assess- meat or connection charge is made at the prevailing rate at the time of connec- tion or such earlier time. The undersigned, for themselves, their heirs, executors, adninistrators, suc- cessors, and assigns, further hereby waive notice of any and all hearings neces- sary and waive objection to any technical defects in any proceedings related to any assessment or connection charges for City of Eagan Project 365 or Contract No. 82-14 for said inprovenents, and further waive the right to object to or appeal fran any assessments or connection charges made in the future pursuant to this agreement. j? Dated: November '2, 1982 ;, L'l EXEMPT FROM STATE DEED TAX STATE OF MEZW-MA) COUNTY CF DAKOTA ) ss. On this a.3 day of J o J Phyllis C. Deer 19 'F ; before me a notary public Hav22-v r- ?s _rea wiuu.n ana ror saia co , personally appeared a* Ph y L(. I C C _ husband & yi.. to me onally known to be the persons descril going instrument and acknowledged that they exe( and deed. This Docunent Drafted By; Hauge, Smith, Fide & Keller, P.A. 3908 Sibley Manorial Highway Eagan, Mn 55122 (612) 454-4224 Exempt f om Staie?Dt:ea ?r Dakota County Treasurer HarryFa cammb' iC` act APPROVED- lic Wo ks Director h 61-7791 d ST OF MINNESOTA ss Count of Dakota office of County Retarder This is certEfy that the within yas ed for recorij fil instru.• en v on th this Of :^c t 3?5/tl?f?t •+D. 1? dzy t• and that p lot N the same Was duly recorded in pa rata L'ounc1 ;ecards. JAMES N • DOLA_ N-_---- Cou ty Rc order 1 By) . Deputy ye, C. CITY OF EAGAN CONSENT TO POSTPONED IN CONSIDERATICNN of the postponernnt by the City of Eagan of the levy of assessments for lateral benefit fxan trunk water main {Project 365) serving the following property; Lot 1, Block 1, Deer Addition The undersigned, for themselves, their heirs, e-?oacutors, administrators, suc- cessors and assigns, hereby consent to the levy of assessments or the making of a connection charge in lieu of assessment at the time said property is connected to the trunk water main installed under Project 365 or at any earlier time at eye option'(Sf the undersigned, so long as said assess- ment or connection charge is made at the prevailing rate at the time of connec- tion or such earlier time. The undersigned, for themselves, their heirs, executors, administrators, suc- cessors, and assigns. further hereby waive notice of any and all hearings neces- sary and waive objection to any technical defects inany proceedings related to any assessment or connection charges for City of Eagan Project 365 or Contract No. 82-14 for said improvements, and further waive the right to object to or appeal fran any assessments or connection charges made in the future pursuant to this agreement. n' Dated: ' '7, Lz/ STATE OF MINNESOTA) cxwry OF DAKam ) ss. On this ;? 3 day of /Jd a l9 within and for said coty, Personally appeared and by C_ , to me per onally known to be the persons descr' going instrument and aclmowledged that they ere and deed. This Document Drafted Bv: Hauge, Smith, Eide & fCeller, P.A. 3908 Sibley Manorial Highway Eagan, Mn 55122 (612) 454-4224 0, A.e-.C-". Phyllis C'. Deer .e me a notary public F- -D r-161? riexecutedstie fore- K.% r free act APPROVED _ lic L4orks Director Harry P of 3795 PILOT KNOB ROAD, P.O. BOX 21199 BEA BLOMQUIST EAGAN. MINNESOTA 55121 MW PHONE: (612) 454-8100 THOMAS EGAN JAMES A. SMITH JERRY THOMAS THEODORE WACHTER County MemCbrs THOMAS HEDGES November 26, 1982 City Ackyorustralar EUGENE VAN OVERBEKE City Clerk PAUL HAUGE CITY ATTORNEY EAGAN MN Re: Project 365, Lot 1, Block 1, Deer Addition - Postponement of Assess- ments Dear Paul: Enclosed please find the original copy of a fully-e.-oacuted agreement by the property owner of the above-referenced lot requesting that the la- teral benefit from trunk water main assessment associated with the above- referenced project be postponed until some future date. Please insure that this agreement is recorded against the affected property for all future interested parties. Sincerely, g pi Thomas A. Colbert, P.E. Director of Public Works TAC/jack enc. cc - Harry-P_& Phyllis C. Deer (LOt 1, Block 1, Deer Addition Ann Goers, Special Assessment Clerk THE LONE OAK TREE... THE SYMBOL AND GROWTH IN OUR COMMUNITY /?4Xe DAKOTA COUNTY HIGHWAY DEPARTMENT APPLICATION FOR ACCESS DRIVEWAY OR ENTRANCE PERMIT (Applicant to be furnished with propel standard plate) Hwy. No. Route Per ;TV 7 Section- Print or type application. Fill our 4 copies, sign and mail to County Highway Department. Sketch property, present and proposed driveways and relation to County Highway an back of all four copies. Nomeof Applicant Dil, Illy DPe_r Address 9GTel. W - Name of n Property Owner any F.I ?I Address q(11 ee K? 30 &?rz7? Tel. V5y-U7? Locotion: f?_ 1 Co. Rd. 3U in r/[t kr -fo_ County I'L Miles N-S-Ei;W d15?lcuu? ?? +P 'Qch-'d Tin;I (Circle omn ( p ec lift oad- landmark, or road Intel aeet n) Legal Description of Property ?eCr _C_ ( as shown on your Tax Statement) Purpose of Driveway Residence Is a Building to be Constructed ® No Commercial (specify type) What F-1 Yes Kind ?t)r Cd check Will the Building be EJ Temporary or 56 Permanent proper Is the Property in ® Platted or 0 Unplotted Area (squares) Distance from center of highway to front of building, or front of pump island is feet. Is land higher? lower? or level? with highway. Show feet h Inches Show feet As inches Number of Present Driveways to Property Date Proposed Driveway will.be needed Give Exact Location of Proposed Driveway to Property Give Exact Location of Present Driveway to Property 1. We, the undersigned, herewith make application for permission to construct the access driveway at the above ]outlon, said driveway to be ...strutted to cordorm with the standards of the Highway Department and to any special provisions Included in the permit. b in agreed that all work will be done to the satisfaction of the Highway Department. It Is further agreed that no wmk In connection with this application will be started until the application Is approved and the permit issued. ` L - f0 Date Do Not Write Below This Line l" gnature of Applicant Not Valid Unle7ls ACCESS DRIVEWAY OR ENTRANCE PERMIT Signed and)\umbe:ed Permit Number Permission is hereby granted for the cinstruction of the driveway as described in the above application, said driveway to be constructed an accordance with the Minnesota Highway Departments Driveway Standard Plate No. and subject to the requirements on reverse side and the following special provisions: Permission granted for residential driveway to County State Aid Highway 30. Keep driveway as far east of the school/Dakota Electric easement as possible. Variance granted on the 60' spacing between driveways because of extenuating circumstances. Please deliver an 18" x 28" round pipe with end sections as soon as possible. It is expressly understood that this permit is conditioned upon replacement or restoration of the trunk highway to its original or to a satisfactory condition. It is further understood that this permit is issued subject to the approval of local city, village or borough authorities having joint supervision over said street or highway. AFTER PERMIT Is APPROVED: DAKOTA COUNTY HIGHWAY DEPARTMENT ? White to Applicant ? Buff to Central Office ig p 91 ? Pink to Area Maint- Office 15 tT.?.?.4 17 7 -- ? Green to Municipality or Sec. Crew Date County Traffic Engineer 10?'l, 131C 1, Deer Agn. MASTER CARD LOCATION af¢?A '?3 L9p f?eT d70 ?/r?,C4 /,/U7 OWNER STRUCTURE AND LAND USED AS r? l i E Permit No. Issued ssued To Contractor Owner BUILDING PLUMBING CESSPOOL - SEPTIC TANK V {1I- ?& Ill) WELL ELECTRICAL HEATING GAS INSTALLING ?3 67b L) ?TrGt- SANITARY SEWER OTHER OTHER f Items Approved (Initial) Date Remarks Distance From Well FOOTING SEPTIC FOUNDATION CESSPOOL FRAMING TILE FIELD FT. FINAL ELECTRICAL HEATING DEPTH OF WELL GAS INSTALLATION SEPTIC TANK D A CESSPOOL C7 ?? DRAINFIELD ^ PLUMBING WELL SANITARY SEWER q Violations Noted on Back COMMENTS: Sarah Thomas From: James Lanigan <jamie@lanigankolb.com> Sent: Monday, January 14, 2013 3:42 PM To: Sarah Thomas Subject: Opal Services, Inc. Hello Sarah, Thank you for your response to our call regarding the group home locations that Opal Services, Inc. is in the process of buying and licensing. As my colleague mentioned in the voicemail this morning, Opal Services is buying Opal In -Home Services, and applying for licensing of all existing group home locations. The county and state licensing process requires that we inform each municipality that we are applying for licensing. We are not requesting to be licensed within the city of Eagan. We simply needed to inform you that we are applying for county and state licenses for homes that are located in Eagan. Per Minnesota Department of Human Services form DHS -0250 -ENG, page 5: "Applicants for a residential program (adult foster care) license issued by the Department of Human Services under Minnesota Statues, Chapter 245A, The Human Services Licensing Act, are responsible for contacting the municipality where the program will be located to inquire about applicable local ordinance requirements." The form requires we list the contact name, phone number and date - of -contact for each city that we informed of our application. I will note on our license application that you are the person we informed for the city of Eagan. For your information, the four group home locations in Eagan are: Coachman, 3518 Coachman Rd, Eagan, MN 55122-1212 Diffley, 941 Diffley Rd, Eagan, MN 55123-1775 Gold Trail, 1868 Gold Tr, Eagan, MN 55122-1616 Slater, 4489 Slater Rd, Eagan, MN 55122-2382 Regards, James Lanigan Opal Services, Inc. Owner, President & Administrator 763-242-0212 Circular 230 Statement To ensure compliance with requirements imposed by the IRS, we inform you that, unless specifically indicated otherwise, any tax advice contained in this communication (including any attachments) was not intended or written to be used, and cannot be used, for the purpose of (1) avoiding tax -related penalties under the Internal Revenue Code, or (2) promoting, marketing, or recommending to another party any tax -related matter addressed herein. INFORMATION IN THIS MESSAGE, INCLUDING ANY ATTACHMENTS, IS INTENDED ONLY FOR THE PERSONAL AND CONFIDENTIAL USE OF THE RECIPIENT(S) NAMED ABOVE. If you are not an intended recipient of this message, or an agent responsible for delivering it to an intended recipient, you are hereby notified that you have received this message in error, and that any review, dissemination, distribution, or copying of this message is strictly prohibited. If you received this message in error, please notify the sender immediately, delete the message, and return any hard copy print-outs. 1 City of Eagan 3830 Pilot Knob Rd Eagan, MN 55122 (651) 675-5675 www.ci.eagan.mn.us PERMIT 101' City of Eaan Permit Type: Building Permit Number: EA108998 Date Issued: 01/30/2013 Site Address: 941 Diffley Rd Lot: 1 Block: 1 Addition: Deer PID: 10-19850-01-010 Use: Description: Sub Type: Single Fam Construction Type: Work Type: Day Care Inspection Description: Census Code: Occupancy: Zoning: Square Feet: 0 Comments: Opal Services - Kristi Filipiak 651-554-6160 Fee Summary: Day Care Inspection $50.00 1221.4216 Total: $50.00 Contractor: Owner: Merkan Corp 706 Robert St S St Paul MN 55107 - Applicant - I hereby acknowledge that I have read this application and state that the 'nformation is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Applicant/Permitee: Signature Issued By: Signature Sarah Thomas From: Sarah Thomas Sent: Tuesday, January 15, 2013 9:00 AM To: 'James Lanigan' Subject: RE: Opal Services, Inc. Thank you for the information. We will put a note in the parcel files. Regards, Sarah Sarah Thomas 1 Planner I City of Eagan City Hall 1 3830 Pilot Knob Road 1 Eagan, MN 551221651-675-56961651-675-5694 (Fax) 1 sthomas ancityofeagan.com THIS COMMUNICATION MAY CONTAIN CONFIDENTIAL AND/OR OTHERWISE PROPRIETARY MATERIAL and is thus for use only by the intended recipient. If you received this in error, please contact the sender and delete the e-mail and its attachments from all computers. From: James Lanigan [mailto:jamie@lanigankolb.com] Sent: Monday, January 14, 2013 3:42 PM To: Sarah Thomas Subject: Opal Services, Inc. Hello Sarah, Thank you for your response to our call regarding the group home locations that Opal Services, Inc. is in the process of buying and licensing. As my colleague mentioned in the voicemail this morning, Opal Services is buying Opal In -Home Services, and applying for licensing of all existing group home locations. The county and state licensing process requires that we inform each municipality that we are applying for licensing. We are not requesting to be licensed within the city of Eagan. We simply needed to inform you that we are applying for county and state licenses for homes that are located in Eagan. Per Minnesota Department of Human Services form DHS -0250 -ENG, page 5: "Applicants for a residential program (adult foster care) license issued by the Department of Human Services under Minnesota Statues, Chapter 245A, The Human Services Licensing Act, are responsible for contacting the municipality where the program will be located to inquire about applicable local ordinance requirements." The form requires we list the contact name, phone number and date - of -contact for each city that we informed of our application. I will note on our license application that you are the person we informed for the city of Eagan. For your information, the four group home locations in Eagan are: Coachman, 3518 Coachman Rd, Eagan, MN 55122-1212 Diffley, 941 Diffley Rd, Eagan, MN 55123-1775 Gold Trail, 1868 Gold Tr, Eagan, MN 55122-1616 Slater, 4489 Slater Rd, Eagan, MN 55122-2382 Regards, James Lanigan Opal Services, Inc. Owner, President & Administrator 1 PERMIT City of Eagan Permit Type:Building Permit Number:EA116906 Date Issued:10/14/2013 Permit Category:ePermit Site Address: 941 Diffley Rd Lot:1 Block: 1 Addition: Deer PID:10-19850-01-010 Use: Description: Sub Type:Reroof Work Type:Replace Description: Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Please print pictures of ice and water protection and leave on site. Carbon monoxide detectors are required by law in ALL single family homes . Brian Preuss 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 - Merkan Corp 706 Robert St S St Paul MN 55107 (763) 242-0212 Aspen Exteriors Inc 14245 St. Francis Blvd Suite 101 Anoka MN 55303 (763) 277-8869 Applicant/Permitee: Signature Issued By: Signature Use BLUE or BLACK Ink r For Office Use Permit#: I LID-el City of tagal. -"' ° Permit Fee: y_--' 3830 Pilot Knob Road Eagan MN 55122 Date Received: Phone: (651)675-5675 Fax: (651)675-5694 Staff: 2016 RESIDENTIAL/ BUILDING PERMIT APPLICATION Date: / 12/' Site Address: / // i," `t'Y Unit#: Name: .1;14./5 /fr C �L'ltl..i'L b , cn -i Phone: e.- -0 '/ 2 3-7 70 Z-- Resident/ Resident/ Owner F Address/City/Zip: 1 4:/L/ 5--- b. i Cr,Mei rv'44 rc.1.1-L.. se_t'vIOUTtf- l'LttL' 5 6 4 HI Applicant is: Owner Contractor Description of work: C-'L l�' Type of Work p Construction Cost: 6' 444 ' Multi-Family Building: (Yes /No k ) Company: 5 12 l<ki f e' 5 .. "� L. Contact: /i- S`�i 1v1 /T j Address: S ,'5L� 4/kle itie U('�,." City: P1/1 �4/ = 127/ti Contractor `� State: 11Zip: c7-5-37Z,. Phone:a7I--/f 57 "Email: .5C-11W11/� 1 Kt ey[ei. - t 1 License#: Lead Certificate#: If the project is exempt from lead certification, please explain why: I 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: Phone: I Mechanical Contractor: Phone: Sewer&Water Contractor: Phone: 1 Fire Suppression Contractor: Phone: NOTE:Plans and supporting documents that you submit are considered to be public information. Portions of the information may be classified as non-public',if you provide specific reasons that would permit the City to conclude that the are trade secrets. _ CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.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 Code must be completed within 180 days of permit issuance. x ., /.'-.--7 r't (,c-/ rt/ x l` Applicant's Printed Name A icant's Signature Page 1 of 3 Use BLUE or BLACK Ink r -i For Office Use - Permit#: / 02 Cityof Eaaall Permit Fee: lU 3830 Pilot Knob Road Eagan MN 55122 Date Received: Phone: (651)675-5675 Staff: Fax: (651)675-5694 2016 SEWER AND WATER REPAIR / DISCONNECT PERMIT IDate:/ 2f�'��' Fee: $65.00 ICity Sewer City Water Repair Disconnect I 1 Description Of Work: El 5 L'C'I/1 t=f" f[i e'u/e e- G.KI4:1-1ft--. Street Address for Proposed Work �/ 4 ! f �! "ry te- 51 /76 - Name: Phone: 1 Owner Information Address/City/Zip: I Applicant is: Owner Contractor s Licensed Pipelayer Master Plumber Property Owner Name: 1-- ev '. l'4' (4 G Gi: 1l 01— Phone: 9.---7—‘i4�7 3j 5 i Address/City/Zip: 7 5 77 ( 7 i v Lam' I Pipelayer Training Certification Card#: OtA / 2-'/ or Master Plumber License#. I acknowledge that the information is complete and accurate and 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. App ;;;---71 .. ./'1'„,(1„-v,..4-//./ _, —r,,,,"Z;//;--;--_ '—'7 _ scant(Print Name) Applicant's Signature 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