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3868 Dolomite DrUse BLUE or BLACK Ink For Office Use Gily j Porn* MC 1 3 nig- City I l permit Fael C22 5 3830 Pilot Knob Road Eagan MN 68122 Phone: (651) 675.6675 Fax: (651) 6784 Dale Remixed: 4-019'111— start -j19'111- Staft: 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Li' 9- it/ Site Address: g (0 Ns'LoMI J 7"E DR.. Unit 8: Resident/ Owner Name: % 46 /ii4,3 46i:I ( £ 4 T ...74 c. Phone- 763 - S71— 9770 Address / City / bp: RSO J� t Cao -r u R 4v, .J , 14 604 ttigi 1/144.45 Y /5•J Applicant is: _ Owner 2fContractor Type: dfiMor.'k, Description of work li; t -Pi -.4 et- Ala t ?", 1: fl a-5 Construction Cost - Multi -Family Building: (Yes / No C Company: E I eAr r tat/ o 2 Plity 27 £ alt Contact DA ✓ r Address: y° -S" c4 (ooh ¢. City: m P� 5 state /VAS Zip: 55'4/i 9 Phone: 6' •Z - X16. - Co z v3 License #: 4 v/// / 3 / Lead Certificate If the protect is exempt from lead certification, please explain why: (see Page 3 for additbnal information) Q, Is, IRS. t �/4 7- Pos:' . 771 COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the Inst 12 months, has the City of Eagan Issued a permit for a similar plan basted on a master plan? Yes No If yes, dobe and address of master plan: licensed Plumber: Phone: Mechanical Contractor. Phone: Sewer & Water Contractor: Phone: NOTE. MOS v1rn,0 the! ini*Ialkal-,704 CAU. BEFORE YOU DIG. cell Gopher stem One 414111 at (651) 454.0002 for prote:eon against underground Witty damage. Call 48 hours before you intend to dig to receive locates of underground utilities. wwW.aobhersbteonarau.euq 1 by acknowledge that this information is complete and accurate; that the work will be in conformance v►lth the ordinances and codes of the City of ea Eagan: that 1 w trio dnd fetris is not a confit, but only an application far a pomiir. and worn is not to start withal a permit that the work all ba n approves Wan In the case of wort which requires a review and approvalExterior or purls. daysof work aUthotiaad by a betiding permit issued In accordance with the Minnesota Stats Buudirq�Code must be completed within 180 pennit 0 /'gjp . s Applicant's Printed Name ET/80 39vd Applicant's Signature Page 1of3 1NItiW 1X3 I3S L9Z9T98Z19 9T:bT bTOZ/TT/b0 CITY OF EAGAN 3745 Pilot Knob Road Eagan, MH 55122 PHONE: 454-8100 BUILDING PERMIT Receipt # N2 6731 To be and for I Est. Value Dote 19 Site Address Erect ? Occupancy j 1ur)d1i Lot Block Sec/Sub. Alter ? Zoning Parcel # Repair ? Fire Zone Enlarge ? Type of Const. W Name s. 1t . S Move ? # Stories Z Address .-loke !Ane Demolish ? Front ft. s 0 zu Vg City Phone Grade ? Depth ft. Name Approvals Fees Address Name _ Address 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. Assessment _ Water & Sew. Police Fire Eng. Planner Council Bldg. Off. - APC Permit Surcharge Plan check SAC Water Conn. Water Meter Road Unit Total 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 Permit # Dole herd Perwkfee Plumbing Mechanical 02 ? $ Q - z- 7 -$ F c-e r t sv t i (ooo /0 - zo- 2- /V(0 ?r l?C INSPECTIONS DATE INSP. Rough-In Final Footings - Date Insp. Dote Insp. Foundation Plumbing /f Frame/ins. Mechanical Final 2 y?-tsl Rema?r/ks: r lm4?--4 CITY OF EAGAN 3795 Pilot Knob Road Eagan, MN 55122 N2 6732 PHONE: 454.8100 BUILDING PERMIT Site Address Lot Block Sec/Sub. Parcel # a Name W 3 Address city Phone Name 0 ?? Address Pknna Address 1 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. Assessment F! & Sew. W4 Po re e Eng. Planner Council Bldg. Off. APC Permit - Surcharge _ Plan check SAC Water Conn Road Unit Total Signature of Permittee A Building Permit is issued to: on the express condition that ail work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Receipt .## Date _ 19 Erect C3 Occupancy Alter ? Zoning Repair ? Fire Zone Enlarge ? Type of Const. Move ? # Stories Demolish ? Front ft. Grade ? Depth ft. Approvals Fees . 45, 000 Building Official I~ * Dato [mod Panakha Plumbing 2 z - g- F_ nZ - Y-6,11 , , Mechanical - zq r t r-K V-0 r\? I L' ?c_?Y^?'C_ DoZ( o -zc? &? 1U1as'?? r- C_ INSPECTIONS I DATE INSP. Rough-in Final Footings 6 ( Date Insp. Dote Insp. Foundation _ Plumbing Z •I?•Sf ?T? Frame/ins. Mechanical _ a Final Remarks: / i- CITY OF EAGAN "- 3795 Pilot Knob Road Eogon, MN 55123 N4 6 7 3 3 PHONE: 454-8100 BUILDING PERMIT Ta La used for F Tai'. Site Address ve Lot Block Sec/Sub. riarhill 3rd Parcel # ' o Name W z Address 13816 114 9 Valley ac z V?g Name rM Receipt # Erect ? Occupancy Alter ? Zoning Repair ? Fire Zone Enlarge ? Type of Const. Move ? # Stories Demolish ? Front ft. Grade ? Depth ft. Approvals Fees Address Name _ Address 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. Assessment - Water & Sew. Pol ice Fire Eng. Planner Council Bldg. Off. APC Permit Surcharge Plan check SAC - Water Conn. Water Meter Road Unit Total - Signature of Permittee I 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 w ? Pone* Daft hawed Penafttee Plumbing 2S-I a ?'.:.I ? - g. EK?--- Mechanical (`l 4\ t ?- &c c-.'c_ T(co0`r ( a-zo-B ?GtS Fr Fc. INSPECTIONS DATE INSP. Rough4n final Footings Dote Insp. Date Insp. Foundation Plumbing i-y.4r ,ff ?L1 Frame/ins. 6°) Mechanical -r' t- Final /.e55 Remarks: ?LJTT7+? CITY OF EAGAN 3795 Pilot Knob Road Eagan, MN 55122 PHONE: 454-8100 BUILDING PERMIT Receipt # Site Address 04 r r-11,4 Lot Block Sec/Sub. Parcel # 0: Nome z Address 1 p City o Name Zr uu Address - F' City WW Name ?W z _?? Address - 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. N2 6734 Erect p Occupancy Alter p Zoning Repair ? Fire Zone Enlarge ? Type of Const. Move p # Stories Demolish ? Front Grade E] Depth ft. Approvals Fees Assessment Water & Sew. Police Fire Eng. Planner Council Bldg. Off. _ APC Permit Surcharge Plan check SAC Water Conn. Water Meter Road Unit Total 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 rem* # Dab Issasd rom"taa Plumbing A S( -Z -&- EPI - atr\ Mechanical ,-?-(Q 9- -7 - r-C r 'C- /t ?c rcc__ T (c OG'i ? Lo -moo ?- / ?tts r ? ? C ? INSPECTIOM DATE INSP. Rough-in Final Footings ' -? Date Insp. Date Insp. Foundation Frame / ins. _ Plumbing Mechanica Final i ` PLL /? c",, _ Remarks: lyf .tom ap" INSPECTION RECORD CITY OF EAGAN PERMIT TYPE: 1 , 3830 Pilot Knob Road Permit Number: Eagan, Minnesota 55122-1897 Date Issued: (612) 681-4675. SITE ADDRESS: APPLICANT: PERMIT SUBTYPE: TYPE OF WORK: ?1 f FJt; ?, '.Fflf f f F h' I:ii 1,?u 1"t? raS4" u J - -- - - - -- - --- - - - - - - - - - - - - - - --- - - --- -- ---- Permit No. Permit Holder Date Telephone K ELECTRIC PLUMBING HVAC Inspection Date Insp. Comments FOOTINGS FOUND FRAMING ROOFING ROUGH PLUMBING PLBG AIR TEST ROUGH HEATING GAS SVC TEST INSUL GYP BOARD FIREPLACE FIREPLACE AIR TEST FINAL PLBG FINAL HTG ORSAT TEST BLDG FINAL BSMT R.I. BSMT FINAL DECK FTG DECK FINAL CITY OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55122-1897 (612) 681-4675 ! M 10 SITE ADDRESS: 1411 I410 (IM k k I. w, I I;I? 11st; it ! I I 1?13 PE?"TI§UBTIYP y ROOT` I NG I t. , MARI, .y : l N) 1 1.1111- <, It IF PA IN F F k"O r ON RECORD k. t! 1 1 4s 114s, PERMIT TYPE: ct.'t3H + r, Permit Number: Date Issued: zi +?+ i.lt:l APPLICANT: ,)W,TRI!If' r I (IN CO ?? 1 ,) ? . i I 1 437 I :'i1 1 .•1) TYPE OF WORK: ii; '.' ( ;I I I (;I) ANN :3619 !41 I I )]1:1 WAY 1 '40 Permit No. Permit Holder Date Telephone aw ELECTRIC PLUMBING HVAC Inspection Date Insp. Comments FOOTINGS FOUND FRAMING ROOFING ROUGH PLUMBING PLBG AIR TEST ROUGH HEATING GAS SVC TEST INSUL GYPBOARD FIREPLACE FIREPLACE AIR TEST FINAL PLBG FINAL HTG ORSAT TEST BLDG FINAL BSMT R.I. Q??? BSMT FINAL DECK FTG DECK FINAL -, r r uF EAGAN Addition' BRIAR HILL 3RD ADD] Owner )N Lot 27 BIk Street 3868 Dolomite Drive 10-14992-270-01 Improvement Date Amount Annual Years Payment Receipt Date STREET SURF, - 1971 Paid nde 12arcel 10 -25 STREET RESTOR. 1975 80.27 8.03 1 16.11 A010818 1-18-82 GRADING 1982 123.04 24.61 5 8.44 AO 08 8 1-18-82 Street Surf. 1982 600.76 120.15 5 48o.61 - =•82 SAN SEW TRUNK ?- 1968 33.61 1,12 30 16.81 SEWER LATERAL WATERMAIN * WATER LATERAL U7 1971 36.81 1.84 20 14.13 AQ1 0818 1-1A-8p WATER AREA ?7 ?x 1977 67.21 48 15 40.33 -- A010878 -I FI-R 9 ** S /W Lat Stm L -> 1982 1431.44 286.29 5 1145.16 . - _ STORM SEW TRK 4: : 7 1982 402.73 80.55 5 322.19 Aolo-878 1-18-82 * STORM SEW LAT 1971 20 CURB & GUTTER SIDEWALK STREET LIGHT Road Unit 19-1; - 00 25368 6-22-81 WATER CONN. _us. 00 2-1;36R 6-22-Rl BUILDING PER. 6731 _ SAC 525.00 25368 6-22-81 PARK _ ... rm:iAN Addition ERD Owner_T ?, ,l15 `i TION Lot 28 Blk 1 Parcel-],0-14992-+280-01 Street 3870 Dolomite Drive State Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. 10Z 19T1 Paid unde parcel 10-C 2000- 0110-25 STREET RESTOR. Z-1 l 1975 0.27 .0 1 8.09 Ao l68 12-1-82 GRADING 1982 123.04 24.61 5 73.84 " to Street Surf 1982 600.76 120.15 5 60.46 tt SAN SEW TRUNK 1968 33. 1 1.12 30 15.69 ?r ?' SEWER LATERAL WATERMAIN L WATER LATERAL i 1971 36. 1 1.84 -- 20 12.8 A01168 12-1_82 WATER AREA 53 1977 .21 4.48 15 35.85 to tv ** S/W Lat Stm L r 1982 1431.44 286.29 5 858.88 tt to STORM SEW TRK 1982 402.73 80.55 5 241.65 " t. STORM SEW LAT 1971 20 CURB & GUTTER SIDEWALK i STREET LIGHT Road Unit 185.00 25368 6-22-81 WATER CONN. 335.00 25368 6-22-81 BUILDING PER. 6732 SAC 525.00 25368 6-22-81 PARK t L .y ....caAN Remarks fJf t ±i Addition* BRIAR HILL 3rd ADDITION Lot 29 Blk 1 Parcel 10-1499'2-+290-01 Owner Je'; Street 36T2 Dolomite Drive State Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. ?L 12T1 Paid undo parcel 10-( 2000- 010-25 STREET RESTOR. Z-11 1975 80.2 8.03 10 16.11 A010823 12-30-81 GRADING ^5c 1982 123.04 24.61 5 98.44 A010823 12-30-81 Street Surf U 1982 600.76 120.15 5 480.61 12-1171-Al SAN SEW TRUNK 1968 33.61 1.12 30 16.81 A010823 SEWER LATERAL WATERMAIN WATER LATERAL 1971 36.81 1.81 20 14.73 A010823 WATER AREA 19TT 6T.21 4.48 15 1 40.33 A010823 12-30-81 ** S/W Lat Stm L 5s 1982 1431.44 286.29 5 1145.16 .-AG10823-- 12-30-81 STORM SEW TRK 1982 402.73 80.55 5 322.19 A010823 12-30-81 STORM SEW LAT 1971 20 i CURB & GUTTER SIDEWALK STREET LIGHT Road Unit 1R5-00 25.368 _ WATER CONN. BUILDING PER. 6733 SAC 525.00 25368 6-22-81 PARK CITY Addition. BRIAR HILL 3rd ADDITIOX Lot 30 Blk 1 Parcel Owner?LJ2 Street 3874 Dolomite Drive State Improvement Date Amount Annual Years Payment Receipt Date STREETSURF. 104 19T1 Paid under Parcel 10- Wooo? bio-25 STREET RESTOR. Z ,-f1 80.2 8.03 10 16.11 A016839 1-5-82 GRADING &563 1982 123.04 24.61 5 98.44 A010839 1-5-82 Street Surf L1 C? 1982 600.76 120.15 5 48o.61 A010839 1-5-82 SAN SEW TRUNK 1968 33.61 1.12 30 16.81 A010839 1-5-82 SEWER LATERAL WATERMAIN WATER LATERAL 0 19T1 36.81 1.84 20 14-T3 A01083 1-5-82 WATER AREA ' 197T 1 61.21 4.48 15 1 40.33 A010839 15-82 ** " 19821 1431.44 286.29 5 1145.16 A01083 1-5-82 STORM SEW TRK 5 I 1982 402.73 80.55 5 322.19 A01083 1-5-82 * STORM SEW LAT 1971 20 CURB & GUTTER SIDEWALK STREET LIGHT Road Unit 185-00 WATER CONN. BUILDING PER. 6734 SAC 525.00 25368 6-22-81 PARK 1 WATER SERVICE PERMIT CITY C AGAN 3795 Pilot Knob Road PERMIT NO. Eagan, MN 55122 DATE: Zoning: T No. of Units: ' r l Owner: Address: Site Address: i it _ " L27 B1 B Ur f?111 " 1? Plumber: Meter No.: Connection Charge: 335 Size: Account Deposit: R d N Permit Fee: ea er o.: 1 agree to comply with the City of Eagan Surcharge: - Ordinances. Misc. Charges: Total: By Date Paid: Date of Insp : Insp.: . CI"Y Ol 'AGAN SEWER SERVICE PERMIT 3795 Pilot Knob Read PERMIT NO.: Eagan, MN 55122 DATE: Zoning: - " No. of Units: Owner: Tollefson pu.ai_ Address: Site Address: ^nl - it r: ° T '' Plumber: I some to comply with the City of Eagan Ordinances. By Date of Insp.: I nsp.: Connection Charge: Account Deposit: Permit Fee: Surcharge: Misc. Charges: Total: Dote Paid: - CITY OF EAGAN WATER SERVICE PERMIT 3795 Pilot Knob Read PERMIT NO.: Eagan, MN 55122 DATE: d Zoning: No. of Units: ' Owner: Toll.efson Bull:- Address: Site Address ?' 7!? 'n1 { X e 128 R I 'lriar Hil_ 1 IT" Plumber: Meter No.: Connection Charge: Size: Account Deposit: Reader No.: Permit Fee- I some to comply with the City of Eagan Surcharge: Ordinances. Misc. Charges: Total: By Date Paid: Date of Insp.: Insp.: CITY OF 5AGAN SEWER SERVICE PERMIT 3798 Pilot Knob Read PERMIT NO.: Eagan, MN 55122 DATE: Zoning: No. of Units: 1ef?s•?r. - ,, Owner: - Address: Site Address: 7, 1 agree to comply with the City Ordinances. By Date of Insp.: Insp.: Account Deposit: Permit Fee: Surcharge: Misc. Charges: Total: Date Paid: CITY OF EAGAN WATER SERVICE PERMIT 3795 Pubs Knob Rood PERMIT NO.: Eagan, MN $5122 DATE: Zoning: No. of Units! Owner: Address: l Site Address: b1 Pr1ji - Plumber: Meter No.: Connection Charge: Plumber: l PC Connection Charge: of Eagan Size: Peader No.: I agree to comply with the City of Eagan Ordinancm By Date of Insp.. Account Deposit: Permit Fee: Surcharge: Misc. Charges: Total: Date Paid: I nsa.: SEWER GERVICE PERMIT CITY OF EAGAN 3795 Pilaf kwob Road PERMIT NO.: MN 55122 E DATE: agan, Zoning: No. of Units: {* tm;4: • _ Owner. Address: Address: 3-74 nod.omite Sit l "i?_1. ll e Plumb r . e 1 agree to comply with the City of Eagan Connection Charge: Ordinances. Account Deposit: By - Date of Insp.: Permit Fee: - Surcharge: Misc. Charges: Total: I nsp.: Date Paid: CITY OF EAGAN 3795 Pilot Knob Road Eagan, MN 55122 Zoning: WATER SERVICE PERMIT PERMIT NO.: DATE: .. No. of Units: 1. t r, Owner: f r4 n.+ I? ; Address: Site Address: '" t L't '.?4 III Rx1tLC rill TT- Plumber: -r Meter No.: Connection Charge: Size: Reader No.: I agree to comply with the City of Eagan Ordinances. Account Deposit: Permit Fee: Surcharge: Misc. Charges: Total: By Date Paid: Date of Insp.: Insp.: CITY OF EAGAN SEWER SERVICE PERMIT 3795 Pilot Knob Road PERMIT NO.: Eagan, MN 55122 DATE: Zoning: No. of Units: Address: Site Address: ; 3 or. i *_ e " i Plumber: 1 agree to comply with the City of Eagan Connection Charge: Ordinances. Account Deposit: Permit Fee: By Date of Insp.: Surcharge: _ Misc. Charges: Total: CITY OF EAGAN 3795 Pilot Knob Rood Eagan, MN. 55121 N? 6731 PHONE: 454-8100 BUILDING PERMIT APPLICATION Receipt To be used for 1 Of 4 PI,E)C Est. Value $45.000 Date ime 22 , Igm- 3868 Dolomite Drive R3 Site Address Erect (N Occupancy Lot 27 Block 1 Sec/Sub. Briarhill 3rd Alter ? Zoning R3 Parcel # 10 14990 270 01 Repair ? Fire Zone NA Enlarge ? Type of Const. V w Name Tollef8on Builders Move ? # Stories z 9 Address 13816 Holyoke Lane Demolish ? Front 44 ft. city A pple Valley Phone 454-6873 Grade ? Depth 22 ft. W No Owner Approvals Fees o me _ Address F- fin. Name Address 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. Signature of Permittee - A Building Permit is issued to: all work sholi be done in acco Building Official Assessment Water & Sew. Police Fire Eng. Planner Council Permit 128.00 Surcharge 22.50 Plan check 64.00 SAC 525.00 Water Conn. 335.00 Water Metero•00 Road Unit185.00 Off Bldg . . APC Total era on the express condition that of Minnesota Statutes and City of Eagan Ordinances. BUILDING PERMIT APPLICATION Site Address -20 ( Lot 30 Block. Parcel # 10 Sec/Sub._ 300 01 Name Toll f eon Builders w z Address 13816 Holyoke Lane o ..... , - . p Name Owner OU Address H l`:r. aL Name _ Address 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. Signature of Perrnittee - A Building Permit is Issued all work shall be done in Building Official CITY OF EAGAN 3794 Pilot Knob Raod Eagan, MN 55122 N! 6734 PHONE: 454-8100 oC?S? Receipt # Is - Erect 0fi Occupancy R3 Alter ? Zoning R3 Repair ? Fire Zone _ NA Enlarge ? Type of Const. n Move ? # Stories Demolish ? Front _-44 ft. Grode ? Depth 22, ft. Approvals Fees Assessment Permit 1LtS. W Water & Sew. Surcharge 22.50 64.00 Police Plan check Fire SAC 525.00 E 335.00 r C nn t W ng. . a e o t t M r W Planner Council a er e e Road Unit 185.00 Off Bld . g. APC Total $1319.50 Buildere on the express condition that State of Minnesota Statutes and City of Eagan Ordinances. CITY OF EAGAN 3795 Pilot Knob Road Eagan, MN 55122 PHONE: 454-8100 BUILDING PERMIT APPLICATION Receipt # Value $45,000 Site Address >O rv wiVa w L Vu Lot 28 Block 1 Sec/Sub. &`iarhill 3rd Parcel # 10 14990 280 01 a Z 9 Name Tollefson Address 13816 Holyoke Lane o Name _ 0? Address F- City- uW Name _ 1-z Address 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. N2 6732 Jame 22 Erect Occupancy R3 Alter ? Zoning R3 Repair ? Fire Zone IA Enlarge ? Type of Const. V Move ? # Stories Demolish ? Front 44 ft. Grode ? Depth 22 ft. Approvals Few Assessment Water & Sew Police Fire Eng. Planner Council Bldg. Off. - APC Permit ----- Surcharge 22.50 Plan check 64.00 SAC 525.00 Water Conn. 135.00 Water Meter60.00 Road Unit185.00 Total $1319.50 Signature of Permittee - - I A Building Permit is issued to: T 1 90II Bui d r9 on the express condition that all work shall be done in ac rdancewd h' I pplicable State of Minnesota Statutes and City of Eagan Ordinances. Building Official ?/cam OF EAGAN IIDI2M PET1II'T APPLICATION To Be Used For Valuation Include 2 sets of plans, 1 site plan w/elevaticns 6 1 set of energy calcillations. Date e/ Site Address 9"_7U DICE USE ONLY IDt.' Block Sec./Sub Erect Occupancy Parcel #: i` (D 1W?9n 2fPO-Alter Zoning Repair Fire Zone Owner: Enlarge ^ Type of Const. r Address, Move # Stories Damlish Front </ ft. City/Up Oode: _ Grade Depth = ? ft. Phone #: oontractc Address.- City/Zip Phone #: Arch./Eng.: City/Zip Code: Phone #: APPROVALS F EES Assessments Perntit Water/Sewer Surcharge Police Plan O?ecdc % Fire SAC Eng. Water Conn. ;->> Planner Water Meter ??, Council Road Unit 1 SAS Bldg. Off. APC '!OPAL )31 ' ?Ci CITY OF EAGAN ? 3795 Pilot Knob Road Eagan, MN 55124 N2 67 PHONE- 454-8100) BUILDING PERMIT APPLICATION Receipt # To be used for 1 of 4 FLEX Est. Value $45,000 Date June 22 1961 Site Address 3872 Dolomite Drive - Erect X Occupancy- R3 Lot 29 Block 1 SeciSub. Briarhill 3rd Alter ? Zoning R3 Parcel # 10 14990 290 Ol Repair ? Fire Zone NA Enlarge ? Type of Const. V __ W Name Tolle son Builders Move ? # Stories 3 Address 13816 Holyoke Lane Demolish ? Front 44 - ft. ° city Apple Valley phone 454-6873 Grade E3 Depth 22 n. Name Owner Approvals Fees 0 05 Address Assessment _ Water & Sew. Cit Phone t Police - °w Name f = ire r uE5 Address Eng. < City Phone Planner - Council _ i hereby acknowledge that I have read this application and state•thot Bldg. Off. _ the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. APC Permit 1.40.VU Surcharge 22.50 Pion check 64.00 SAC 525.00 Water Conn. 33Lr 00 Water Meter60. 00 Road Unit185.00 Total $1319-50 Signature of Permittee A Building Permit is issued to: Tollefson Builders on the express condition that all work shall be done in accor a with all cable ate of Minnesota Statutes and City of Eagan Ordinances. Building Official cm OF EAGAN BUILDING PEMIT APPLE Tb Be Used Site Address 38-7,;", ? YyU Lotial Block / Sec./Sub rQp i Parcel t: ° a r Owner: i d LMO :zqo {> '1 Address: City/Zip Code: Phone #: omtractor. 411 Address: City/Zip Phone Arch./Eng.: _ Address: • City/Zip Code: Phan !: Valuation include 2 sets of plane, 1 site plan w/elevations & f set of energy calculations. _ Date en ? - o I _C/_' . OFFICE USE ONLY Erect Y, Occupancy Alter Zoning Pepair Fire Zone /111- Enlazge _ Type of Cont. y Move # Stories Demolish _ Front </ ft. Grade Depth 5z- ft. APPROVALS FEES Assessments Permit Water/Sewer Surcharge J >3 Police Plan Cheok_ Fire SAC 7 Eng. Water Conn. ? 3S - Planner Water Meter 50 Council Road Unit 1 kS Bldg, Off. APC TOTAL /3l ?' C3_? C =Y OF EAGAN To Be Used Valuation Site Address 391 c Ind 1 Block / Sec./Sub rip Parcel „ _ _ Owner: [O ,qq,?o 3cc cv Address: City/Zip Code: Phone #: Contracts i Address- City/Zip Code: Phone #: Arch./trg. . Address: City/Zip Code: _ Phahe #: Include 2 sets of plans, 1 site plan w/elevations s 1 set of energy calculations. . Date t5 J lJ - 6F/ y v - C FFICE USE ONLY (arect Occupancy Alter Zoning Repair Fire Zone /%;C-- E}h? _ Type of Const. Move # Stories Demolish Front <r?i ft. _ Grade Depth ft. APPROVALS FEE S Assessments Permit /' 8 Water/sewer surcharge Police Plan Check v Fire SAC 5 ,fir Eng. Water Conn. 3S -° Planner Water Meter !,u -=' Council Road Unit ) T =j Bldg. Off. APC 7amL To Be Used For- Site-Address :53- 10A; Block A- ? Ja tip 3 '? ?? CITY OF EAGAN include 2 sets of plans, 1 site plan w/elevations & BUILDING PERCT APPLICATION 1 set of energy calculations. s 7 Valuation Date e;l ".jP `(5F/ OFFICE USE ONLY Parcel vl Owner: Address: City/Zip Code: Phone A: Cmtractc Address: City/zip code: Phone t: Address: . . City/Zip Code: Phone #: 'Erect ?c Occ%w1CY 3 .Alter Zoning Repair Fire Zone_ Enlarge _ Type of Const. ±z Move M Stories DeMll Front </ ft. Grade Depth ft. APPROVALS FEES Assessments Permit ?2 K Water/Sewer Surcharge Police Plan Check yy ? Fire , SAC 19 R= Erg. Water Conn. 33S- Planner Water Meter (ou Council I:oad Unit Bldg. Off." APO 65S159 2004 RESIDENTIAL BUILDING PERMIT APPLICATION City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 7D oo u. New Construction Requirements RemodetRieoair Requirements OtFlci='t'Jse?OhTv 3 registered site surveys showing sq. fL of lot, sq. ft of house; and all roofed areas 2 copies of plan Carrot` Survey Recd " Yom` `N (20% maximum lot coverage allowed) 1 set of Energy Calculations for heated additions TreepresPlbnRecd `s °-jyY_N 2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey for additions & decks Tme f rs&Raggired? = v -Y _.N I set of Energy Calculations Addition- indicate if on-site septic system %4te SepAc.1? ems r_:_.: ' .;Ct 3 copies of Tree Preservation Plan if lot platted after 7/1/93 - Rim Joist Detail options selection sheet (bldgs with 3 or less units Date-9-142-1 OU Construction Cost L? [?J d Site Addr ss ??.AJ Unit/Ste # Z Description of Work (i) / 'YO Pv? l ) Multi-Family Bldg - Y N Fireplace(s) - 0 - 1 - 2 Property Owner ( o a ???>a Telephone # Contractor Address - City ?,)s z? State /0?7/,t- Zip 6757/ Telephone # ( 6573 '-1?7 G f?3,-S- COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Minnesota Rules 7670 Cateeorv 1 _ Minnesota Rules 7672 Energy Code Category • Residential Ventilation Category 1 Worksheet New Energy Code Worksheet (4 submission type) Submitted Submitted • Energy Envelope Calculations Submitted Have you previously constructed a building in Eagan with a similar plan? _ Y fee applies. Licensed Plumber Mechanical Contractor Sewer/Water Contractor Telephone #( Telephone # Telephone # l u 9 ? ? I hereby apply for a Residential Building Permit and acknowledge that the info ation is complete and ccurate; that the work will be in conformance with the ordinances and codes of the Cit - d the Stat of MN Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. (\_-? ? L NTY JJ I CC N1 Q? \ Applicant's Printed Name Applicant's N If so, 25% plan review 2004 RESIDENTIAL BUILDING PERMIT APPLICATION City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 (o a q I Telephone # 651-675-5675 FAX # 651-675-5694 New Construction Requirements Remodel/Repair Requirements 3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and all roofed areas 2 copies of plan (20% maximum lot coverage allowed) 1 set of Energy Calculations for heated additions 2 copies of plan showing beam & window saes; poured found design, etc. 1 site survey for additions & decks 1 set of Energy Calculations Addition - indicate Nonlife septic system 3 copies of Tree Preservation Plan if lot platted after 7/1193 Rim Joist Detail Options selection sheet (bldgs with 3 or less units ?-X-+ O Use Oy n v? Cad of Survey Reed _Y _N Tree Pres Plan: Recd- _Y _N. Tree Pres Required _Y _N On-site Septic System _Y _N q 9.P Date f / ? / Zc'c i Construction Cost 2/ 0? ° Site Address ?8 ?O GLC tM 17 2,e Unit/Ste # Description of Work If fiPLAct 10l0U DECK flDD1Tbo) Multi-Family Bldg k y- N Fireplace(s) - 0 - 1 - 2 Property Owner k OGGe ?? r ?? Teep one#(-]C3 y2?-4GZ? Contractor l?? ( E KIEK IoK M A iW1I.N ANC6 - Address yG4 State l? W Co t,-' S1-City hpliN€AfoL1 Zip ?SLJ 1-1 Telephone#(C9)?Z? ?c16?1 EXT 13 COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Minnesota Rules 7670 Category 1 _ Minnesota Rules 7672 Energy Code Category • Residential Ventilation Category 1 Worksheet New Energy Code Worksheet (J submission type) Submitted Submitted • Energy Envelope Calculations Submitted Have you previously constructed a building in Eagan with a similar plan? _ Y _ N If so, 25% plan review fee applies. Licensed Plumber Mechanical Contractor Sewer /Water Contractor Telephone #( Telephone # ( Telephone # ( I hereby apply for a Residential Building Permit and acknowledge that the informatio s comp a de; that the work will be in conformance with the ordinances and codes of the City of Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. I 0 3 2004 U L) r ii and occur A I Kr- evv4 ,40 ?1 Applicant's Printed Name Applicant's Signature OFFICE USE ONLY Sub Types ? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg ? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi ? 03 01 of_plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF ? 04 02-plex ? 10 08-plex 7% 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc. ? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage ? 06 04-plex ? 12 12-plex Plbg_Y or_N ? 25 Miscellaneous Work Types ? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding ? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair ? 33 Alteration ? 37 Demolish Building' ? 43 Reroof ? 46 Windows/Doors 34 Replacement "Demolition (Entire Bldg ) -Give PCA handout to applicant Valuation Occupancy MCES System Census Code _y s q ?T Zoning City Water SAC Units Stories Booster Pump # of Units Sq. Ft. PRV # of Bldgs Length Fire Sprinklered Type of Const Width REQUIRED INSPECTIONS - Footings (new bldg) Final/C.O. Footings (deck) _ Final/No C.O. Footings (addition) _ Plumbing _ Foundation HVAC _ Drain Tile _ Other Roof - Ice & Water _ Final - Pool _ Figs _ Air/Gas Tests _ Final _ Framing - Siding _ Stucco _ Stone - Bri ck _ Fireplace _ RI. -Air Test - Final Windows Insulation _ _ Retaining Wall Approved By: 1 2- Building Inspector Base Fee Surcharge 0r?le- Plan Review MC/ES SAC ill?1 w City SAC Utility Connection Charge S0 An &W Permit & Surcharge Treatment Plant License Search Copies Other Total Its7-J1 F. C. JACKSON LAND SURVEYOR REGISTERED UNDER LAWS OF RATE OF MINNESOTA 1JCENSED RY ORDINANCE OF CITY W MINNEAPOL" SGIS EAST SETH STREET55417 727-3484 *urbtpot's Caditcstt t i ;I a" I L j ? yy I Sn /?. Y ? ,y 1 f ?. v c 1 HERESY CERTIFY THAT THE AVOYE IS A TRUE AND CORRECT PLAT OF A SURVEY OF Propsred Garage f1Dar Elev. 99.0 / kto"sed Baseaent floor Eiev. 99,37 Prapnred First floor Elev. 108.37 1 i • a , `7`7 I f I P. 1` 4s ? • 9 2004 RESIDENTIAL BUILDING PERMIT APPLICATION City Of Eagan ?1 U a*?;-- 3830 Pilot Knob Road, Eagan MN 55122 (y (a >,L Telephone # 651-675-5675 FAX # 651-675-5694 _ M?a A New Construction Requirements Remodel/Repair Reouirements Office Use Only "a ( -d 3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and 011 roofed areas 2 copies of plan Ceu of Survey Recd _ Y _ N _ (20% maximum lot coverage allowed) 1 set of Energy Calculations for healed additions Tree Pres Plan Recd _Y _N 2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey for additions & decks Tree Pres Required _Y N l set of Energy Calculations Addition - indicate ifonsile septic system On-sits Septic System _Y _N 3 copies of Tree Preservation Plan d lot platted after 711193 Rim Joist Detail Options selection sheet (bldgs with 3 or less units 17 tI 2? ' ? ? Q? Date / 1 / Construction Cost Site Address 1 ' 36 7y DOLUA+ Ili: !)!I Unit/Ste # Description of Work Pf4AcL 16)0o PLck Awapo i ?/ Multi-Family Bldg /? y - N Fireplace(s) - 0 - 1 _ 2 Property Owner J #1Vj0 Qp 6G E Telephone # (`]fob) 1-42S- 46A- Contractor EXILfby M/ itANANO Address qo? N. G61" Sf. ,e City kjJ0AP6Llr State _ M N zip Wglci Telephone#(Go )) 322-4%9 b)T-k1>_ COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Minnesota Rules 7670 Category 1 _ Minnesota Rules 7672 Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet (J submission type) Submitted Submitted • Energy Envelope Calculations Submitted Have you previously constructed a building in Eagan with a similar plan? fee applies. Licensed Plumber Mechanical Contractor Sewer/Water Contractor Telephone #( Telephone #( Telephone # ( N If so, 25% plan review I hereby apply for a Residential Building-Permit and acknowledge that the information iryom^!^°'`~'^^ -` that the work will be in conformance with the ordinances and codes of the City of Eagan an the S of MN Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. fNlkt tupN // l Applicant's Printed Name Applicant's Signature OFFICE USE ONLY Sub Types ? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg ? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi ? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF ? 04 02-plex ? 10 08-plex 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc. ? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage ? 06 04-plex ? 12 12-plex Plbg_Yor_ N ? 25 Miscellaneous Work Types ? 31 New ? 32 Addition ? 33 Alteration )*_ 34 Replacement Valuation Census Code SAC Units # of Units # of Bldgs Type of Const ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair ? 37 Demolish Building' ? 43 Reroof ? 46 Windows/Doors 'Demolition (Entire Bldg) - Give PCA handout to applicant V,0 Occupancy Zoning Stories Sq. Ft. Length Width Footings (new bldg) Footings (deck) Footings (addition) _ Foundation _ Drain Tile Roof _ Ice & Water _ Final Framing Fireplace - RI. - Air Test - Final Insulation MCES System City Water Booster Pump PRV Fire Sprinklered REQUERED INSPECTIONS _ Final/C.O. Final/No C.O. Plumbing _ RVAC Other Pool _ Ftgs _ Air/Gas Tests _ Final Siding _ Stucco -Stone - Brick _ Windows Retaining Wall Approved By: , Building Inspector Base Fee Surcharge Plan Review MC/ES SAC City SAC Utility Connection Charge & S P i h urc arge erm t S&W Treatment Plant ?CSTL? v License Search Copies Other Total F. C. JACKSON LAND SURVEYOR ROISTERED UNDER LAWS OI STATS DT MINNESOTA .. ,? LICENSSD MY ORDINANCE OF CITY M MINNE4POUS .{? 3616 EAST 55TH STREET3rt1417 727-3484 ,..... -rC :q Ic: / ` SO gitl[bepo[?g ?LTfftttAft T ?? o t m of A SURVEY OF ?•-? ? N '+` \` '• 1 HERESY CERTIFY THAT THE ASOYE IS A TRUE AND CORRECT PLAT A Prepopaed Garage floor Elev. 99.0 mss, PrapDRed Basem:nt floor Elev. 99.37 d ..; yam Propot<ed First floor Elev. 108.37 \\ Lots 27628,29 and 30,Block 1, Briar Hill 3rd. Addition, Dakota County,Minnssota: \ J As SURYEYED aY ME THM 10th, DAY or May x.D. 1981 :sign 7 _77 F :?.ZUI's=.aa..ra.._E.:,•s.a+?cew:..aa-.t...!A?^>s:.?ia...ab>3f:s2:.e?s.., +.-.F- Tolletson Suliaers inc. - Ur.1144D 183-71 , fff F. C. JACKSON LAND SURVEYOR RMOTERED UNDER LAWS D/ RATE OF MINNESOTA :y .. UCEM RD NY ORDINANCE OF CITY O? MINMEAPOLU 8616 EAST 55TH STREET55417 727-3484 *Srbrpor'o Crdth ate 1 - r=.Zf off ?-re e v. 71 o. ` r fir, ?> f Yr l? / \ Sl z 1 HEREBY CERTIFY THAT THE ABOVE IS A TRUE AND OORRECT PLAT OF A SURVEY Or Proposed Garage floor Elev. 99.0 - Yom. Proposed Basement floor Elev. 99.37 Proposed First floor Elev. 108.37 Lots 27,28,29 and 30,81ock 1, ` 10 Briar Hill 3rd. Addition, Dakota County,Minnesita I 20th. slay 1981 w AS SURVEYED aY rE TMIS DAY or- .D. - ` V i . F I ? r• IGKRD? ?' ? ?. y?citwav t? w waRa?roM.? ?t?boD '' p , ••.I y II??? rM? S ? 4 JL +IL .rGti X t'• .r R ? .k+T r ?$?. T i v y _ ? y J I r d x4' 3 'L .: C C-'.y r +? % •` ..?_.r tt i r ? i 'i. 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Lr., n?:. ?_ /U.f.o E[?G6. .. [ :.. A _ _ ! f}??,- ,r! f ?rt`t C? 9 II ?S CG1Lc. erJ C:4R 4GE j Pl7t' Is(?1_???(t" ?' ? y-°"• tst??--?w....n?? J.1.1 ?!? ' ' ' 1 Al (.-- r ? ? i j 1 i ` `' -? ??l 1 !! r F?'C Tit. C ?- 1_L?l ? "-----?? Il?.?s.?. 1?"' 11 C,:1.r 1I 1 uf_ 17 it d , ??a-?:..,.w?.?.?.y? !?'r ci F1 ir?? $ I? -.-? --?..f 1/'l r'•?i?C1R f.??iti?i`' ?.A? ?`Z? Y. ' ToTeA t I?;J 40w,-R Wln ?r_ tw n4 i f 1 il?r - f/ 1j y ?- L _`ZIOAr-Lr IC r l,?.S 31 1 ............ j_-------? ??r...-•_?- ._? ._?.l! ? c ? l j l i ' j_ ? -i ..__J:f_4it_LLL(5_Lf n ? L? ?-? 1 f 1 - - I I .1 -. - ---- -tgTnL ,04? +,? f B OI.J t'R Wla, t_t_W/rNCOL'T? p ?7 C', nl(! i_.1 c???rR Ii n..>C. I.j F'Rowr-r .- cIr ?_10115E_ j Sll,-`.'-??!.lrl??._F!v.`.!._..._M{----I•--- ? El N ,4 ^j'i 1 `_ +1 71 L lam. F q __ _t AIS.L?_:?? 1 1 ! I tl !ri/ •1?._,....._...«._,_-,•,.,Y,.+ I S n I ?.s-..._ is r ?...._, I. ?..-j _ 1 ?;1, n r R 1?..Lp,!- F 1. v ? u _. r.:k + a .. i.: it MY ,: in:'? )".?Yik" >F J'?.?(i. {, .?•.iY;..f &TV Of- WAS TERWYK NO: t:l.. TWEv 150503 01. P155 000i 3970 DOLOMITE f; 9.30 201 `; 9001 2839 DOLOMKIE ... 9.00 . VO 901 96CI LIII.JOM V... ,. WEAK I i' w I. 045 0001 3860 DOLUMVE D V.00 Fi 01 : }1 )I ;! :" "? ! ' ., r: . .. r F:. 1 r -? 9901 3801 1'11 OM IX n D17 NY\-??V i ..I ;i 4!I (., ;i! !,n 1 li. .' ,1•,i of , ILYA CITY OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55122-1897 (612) 681-4675 SITE ADDRESS: P.I.N.: 10-14992-270-01 PERMIT ' PERMIT TYPE: BUILDING Permit Number: 031942 Date Issued: 05/20/98 3868 DOLOMITE DR' LOT: 27 BLOCK: 1 BRIAR HILL 3RD DESCRIPTION: SIDING & SHUTTERS Bu3'1`d1ng Permit Type MULTI. (MISC. ) B'uilding'Work Type REPAIR 'Census Code -? 434 ALT. RESIDENTIAL ?? 3ti11?1 i(t ?W1{5 ??LI S!. I??.??fli ?ti ?t 1 REMAM.LSUDES; 3870, 3872, 3874 DOLOMITE DRIVE L28 L29 L30 FEE SUMMARY: VALUATION $18,000 7--5- Base Fee $262 21S- Surcharge $9,00 Total Fee $271.25 9VIT WI NIVS & SIDING INC 12816363 0008077 BRIA:R11ILL ASSOCIATION P 0 BOX 5937 3800 HEATHER DR ROCHESTER MN 55903 EAGAN MN 55122 (612) 281-6363 (612)683-9659 I hereby acknowledge that I have read-thls- application acrd State that the, information is correct and agree to comply with all applicable State of IMn. Statutes and City `of Eagan Ordinances:. O APPLICANT/PERMITEE SIGNATURE ISSUED BY:S ATURE 1998 BUILDING PERMIT APPLICATION (RESIDENTIAL) CITY OF EAOAN 3830 P9.OT KNOB RD - 66122 681-4678 New Construction Requirements RemodeVReoair Reauiremerds ? 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 H lot platted after 7/1193 required: _ Yes _ No DATE: VW 2t a ?= a? ? 2 copies of plan ? 2 site surveys (exterior additions & decks) ? 1 energy calculations for heated additions CONSTRUCTION COST; */7, 732 ,? DESCRIPTION OF WORK: 9%4,04 -4 iL/_ /i's STREET ADDRESS: 3F10- 3,F)O - <a8 L;? 9 1,50 -2,D LOT: -Z BLOCK: / SUBD.IP.I.D. #: Name: E?(c [?? d Ct 9rfsSd a?/?/?' Phone #: to/L -/al",3-T^ s-,! PROPERTY Last First OWNER 3cPO? ??Air,- A Street Address: City fa en State: A;? Zip: SSlz 2- Company: ?1 /n?edr '? d ? . yt Phone #: sy7 --)Ifl --,6 "3 CONTRACTOR U Street Address: -0 ?Ok S ?1? 7 License # .-r D -# F6 7 ?! City ?_0 CA e s-,,te State: m ARCHITECT/ ENGINEER Company: Phone #: Name: Registration #: Street City State: Sewer & water licensed plumber (new construtfion only): and lot change is requested once penult is issued. Zip: 5sf'as 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 Tree Preservation Plan Received Yes No Not Required PERMIT CITY OF EAGAN B U I L D I N G 3830 Pilot Knob Road PERMIT TYPE: Eagan, Minnesota 55122-1897 Permit Number: 0 2 8 016 (612) 681-4675 Date Issued: 06/20/96 SITE ADDRESS: 3868 DOLOMITE DR LOT: 27 BLOCK: 1 BRIAR HILL 3RD P.I.N.: 10-14992-270-01 DESCRIPTION: REROOF Oild"ng Permit Type ,building-t4prk Type MULTI. (MISC.) REPAIR 434 ALT. RESIDENTIAL Census Code` REMA(li?PL UDES: 3870, 3872, AND 3874 WILLOW WAY L28 L29 L30 FEE SUMMARY: VALUATION Base Fee $137.25 Surcharge $4.00 Total Fee $141.25 $8,000 CONTRACTOR: - Applicant - ST. LIC.OWN: MIKE MOHS CONSTRUCTION CO 17211107 5456 BR-T HILLS ASSOCIATION 3414 SNELLING AVE S WILLOW WAY MINNEAPOLIS MN 55406 EAGAN MN (612) 721-1107 I hereby acknowledge=that I'have ree,ad' this application and state that the information is correct and agr,ee to comply;,w,ith all applicable State of Mn. Statutes and City 'of Eagan Ordinances. APPLICANT/PERMITEE SIGNATURE ISSUE Y: S GNATURE ?gor? CITY OF EAGAN 3830 PILOT KNOB RD - 55122 1996 BUILDING PERMIT APPLICATION (RESIDENTIAL) 681-4675 Remodel/Repair Reouirements ? 3 registered site surveys ? 2 copies of plans (Include beam & window sizes; poured fnd. design; etc.) ? 7 energy calculations ? 3 copies of tree preservation plan if lot platted after 7/1193 required: _Yes _ No DATE: DESCRIPTION OF WORK: STREET ADDRESS: LOT BLOCK SUBD./P.I.D. #: y/.f 2iuS/?f? Phone PROPERTY Name: OWNER ? 2 copies of plan ? 2 site surveys (exterior additions & decks) ? 1 energy calculations for heated additions i ? 1, ;' S- Cw, COST: 19 S Z/Q - .??S' 74/- 38 7?/ Ad to G?-?e 4e Street Address- City: State: - Zip: N 8d 6 # 272 -?? D2 CONTRACTOR Company: Y /l?GIJ`I S IV1 Phone : n ' ??? ??? ` / Y # Li .f75'C/' Street Address: )n/Pi t i 5 cense : city: *< State: AN Zip: ?d6 ARCHITECT/ Company: Phone #: ENGINEER Name: Registratio n #: Street Address City: State: Zip: Sewer & water licensed plumber: change are requested once permit is issued. Penalty applies when address change and lot I hereby acknowledge that I have read this application and state that the infor ation is correct and agree to comply with all applicable 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 Permit # q -7 -? l J Receipt Date: 9' I I CITY OF EAGAN SEWER/WATER REPAIR OR DISCONNECT PERMIT 2001 Date Sewer Water Fee: $50.50 Address/area to be repaired ?:200 Description Kip C©v-,P,v`,_mv-, V- AVv Owner: Telephone: ( - C1.j_1 G Street Address: Zip Code: t?S I-cak f,5 (' n mz4 _ a4-7-370L9, Installer: Telephone: f?51 ?3$-`7?iS (area code) ss4.3s?'- Address: A-) City {/,/MaA Zip Code: SSV Signature of Permittee Date: CityofEaafl 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 /oo O6 ?2 Use BLUE or BLACK Ink Permit #: q'. In Permit Fee: 6- 7, 75 Date Received: Staff: 2010 RESIDENTIAL BUILDING PERMIT APPLICATION /20110 Site Address: 380- .389O - 3g7.2 -38'7 471 Otoi.%/TE- ! /-'b J Tenant: Suite #: RESIDENT / OWNER Name: %' /?$SOC. r",vA/V d4L /1,1&MT Phone: 263 -4/9'/- 39,77 Address / City / Zip: ?O 22 £ l H LAKE RP. RARE &06175- , 3// Applicant is: Owner X Contractor TYPE OF WORK Description of work: gELi WVt. RrvOf 7 fl'CE joF Construction Cost: -13i !' dt Multi -Family Building: (Yes ??--/ No ) CONTRACTOR Name: gE r T fOj ,t1R/1/T. CDP7 License #: Kd.7 y/'3/ Address: 1/6 S- G� 40m ST -tee -e% City: ktA/91-E Fo vb State: MA/ Zip: 56- '/ 9 Phone: ! 2 - 86 /- 2�3 Contact: ;0.-v r 1D Email: ! e het X T • cam COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? Yes _No If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer & Water Contractor: Phone: 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.aopherstateonecall.oro 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 cape of work which requires a review and approv, x Cp'2l5-/v0L"j --S-0 Applicants Printed Name Applicants Signature Page 1 of 2 City of Eaiau 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BLUE or BLACK Ink For Office Use Permit #: G� 'e2 '`� 1i Permit Fee: � d - ()L Date Received: Staff: 2011 MECHANICAL PERMIT APPLICATION Date: ' ti /i Site Address: 54p-722- Tenant: )pj.p , Tenant: Suite #: J Name:'L.' t14/ Address / City / Zip: S Name: '>i Phone: 1.11.4--/ L 9:sl F License #: Address://x �j����.y�=�cG:js,�' City: State: . Zip:;3l.,si5— Phone: kms/ ."Ss*-- , ;. /' Contact: lL 'rf- ./ Email: New ,Replacement Additional Alteration Demolition Description of work: ' ; 'pfrk_ p..,-,ra,• s --< %, - r�'S"`%�a RESIDENTIAL Furnace Air Conditioner _ Air Exchanger Heat Pump Other COMMERCIAL New Construction Interior Improvement Install Piping Processed Gas Exterior HVAC Unit Under / Above ground Tank ( Install / _ Remove) RESIDENTIAL FEES: $55.00 Minimum Add-on or alteration to an existing unit (includes $5.00 State Surcharge) $95.00 Fire repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge) 5..-, 1;4 TOTAL FEE COMMERCIAL FEES: $75.00 Underground tank installation/removal $55.00 Minimum (includes State Surcharge) - If the Permit Fee is less than $10,010, surcharge is $ 5.00 - If the Permit Fee is > $10,010, surcharge increases by $.50 for each $1,000 Permit Fee (i.e. a $10,010-$11,010 Permit Fee requires a $ 5.50 surcharge) OR Contract Value $ x 1% = $ Permit Fee = $ Surcharge =$ TOTAL FEE 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.aopherstateonecall.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. Applicant's Printed Name City of kap 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 RCEt\1Eq 2012 Use BLUE or BLACK Ink For Office Use Permit /03171 Permit Fee: Date Received: 3— ' 1 Staff: 1'J 2012 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: 2,477 Site Address: Tenant: Suite #: Name: Phone: R (/ Address / City / Zip: .3,6-64' Name: 71 0J.Aa License #: PeaWirol Address: /f �` &ij afek.t ,;%S"- 1 GAS— City: SS�c State/N Zip: SXJ ?s Phone: /,7 ' a-7) / Contact: /tide- Email: acement _ Repair _ Rebuild _ Modify Space _ Work in R.O.W. Description of work: RESIDENTIAL Water Heater Lawn Irrigation (_ RPZ / PVB) Septic System New Abandonment Water Softener Add Plumbing Fixtures ( Main / _ Lower Level) Water Turnaround RESIDENTIAL FEES: $60.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge) $60.00 Lawn Irrigation (includes $5.00 State Surcharge) $60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge) "Water Turnaround (add $189.00 if a 5/8" meter is required) $105.00 Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge) TOTAL FEES $ CALL BEFORE YOU DIG. Call Gopher State One CaII 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.gopherstateonecail.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 ,? ett vin iaeyit 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 pl Printed Name At1 Iicant's Signature FOR OF Requi 410'City otEke 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 678.4676 Fax: (651) 67566$4 Date; • Use BLUE or BLACK Ink imr For Office Use / Permit* l! ; / o0' hermit Fee: ;7. 4)55 Data Received: 11 /I 543 3 Staff: 4,! 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Site Address: 3nJ 3$70, le72,3?79 tSo4.ow,rz Aa. Unit#: Choler Name::/ u9 C 7- "4 A 4. Al t v i .x+) C Phony 743 - tS 3- 9 7 70 Address / City / zip: 7S-0 zr e A 7-v Q Av A) 'a` ,2 A aaoi b E.J i//K mss S3'ylr7 Applicant is: Owner Contractor Description of wont: • r.412 or -F2 a 1 L - Construction Cost 1/ 9 00, Gr° Multi -Family Building: (Yes )C / No Company i&! P Contest knew, Is TS. (J ' S address: 4/0 s tc) 64).6. S7 . City: m PG S . State:/Y%c 1 zip: .3T 9i 9 License #:.!0C .*Y!/3/ Phone: 4'11- r6' -G x Y3 Lead Certificate #: If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) QtLi,I,S L L2( QuldY Porti' 197 S COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months, has Me City of Eagan Issued a pemnit for a similar plan based on a master plan? Yes No If yes, date and address of master plan: Licensed Plumber. Phone: Mechanical Contractor. Phone: Sewer & Water Contractor Phone: 1 CALL. BEFORE YQU DIG. Call Gopher State one Cali at (651) 454-0002 for prot cl on aga A$t underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.goaherstateonerau.org I hereby adcnowledge that this information is complete and accurate; that the work wit be In confom ante 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 to Mart without a permit that the woi t iota be in Beeordenne with the approved Wan In the case of work reach requires a review and approval of Exterior work dots of peckwitholted by a building permit Issued in accordance with the Minnesota State autldin Code must be computed within 180 x VAviN u a.i3 Applicant's pn Name Z0 / TO 39tid INIVW 1X3 I3a x Applicant. Signature 777 Page 1 of 3 L9Z9T98ZT9 OZ:ZT ETOZ/tT/TT 411INF City Date: 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 6755675 Fax: (651) 675-5694 FA 3--? _ Use BLUE or BLACK Ink For Office Use Permit #: )1, W Permit Fee: Date Received: Staff: 2013 RESIDENTIAL BUILDING PERMIT APPLICATION 7 4./ site Address: Mag, 3sg70 3771, 3¥ )4f 62. Unit 6: Resident/ Owner Type'of.Work, Name: eh) 4e, Aff,3 46t N<iA.3 + r Address / City iZip: :SO b1C34-r-u2 Av, , lA Applicant is: Owner KContractor Phone: 7k3 - si3- 97 7 oLD£:J V L Y /QA) spy. 7 Description of work: R£KO E a' 4.4 P °Kf - J,'' ',) /o 6 F Multi -Family Building: (Yes 2C / No Construction Cost / 4 Y • CN Contractor Company. g £ 1 E,r ER/ c 2 /Aft kr-r . &2� Contact Da✓, Address: YDS. w tDo# S- City: h'/ Pi 5 State: /VAS Zip: SS -y/ C/ Phone: 1pi ,Z ' b' (r' / - Lo 2 S/ 3 License It: 4 �- ZIP / 3 / Lead Certificate #: J If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) (11-4/0s. Pos,- /77r 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 pian? Yes _No If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor. Sewer & Water Contractor: Phone: Phone: CALL BEFORE YOU DIG. Cap Gopher State One Cali at (651) 4540002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.000herstateonecap.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 1 understand this is not a pormit. 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 Build n Code must be completed within 180 days of permit issuance. x I./ Applicant's Printed Name x Applicant's Signature / 4',x77 �) Page 1 of 3