3869 Dolomite Dr
6128616267
05/22/2009 11:05 6128616267 BEI EXTERIOR MAINT PAGE 01
- -
o..
C1tY of EaQall Permit Permit Fee:.
3830 Pilot Knob Road
Eagan MN 55122 Date Received:'
Phone: (651) 6755675 1
Fax: (661) 675-5694 l start: _ . - . _ - - - - -
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
3 $ 73 3875 ~~O~u.' E /~lZ ! L'
Date: Z// 9 /0 9 Site Address: 3S6 q 3,3 ZI
Tenant: Suite
RESIDENT I OWNER Name: Ib /4ss01:.977aW ~~.v~v v~* 4- Zc7 Phone:
Address/ City /Zip: 7022 0,4_S_ F[Sf/ GA~+c~ ,P.0.#) m~/'Cf i r6 5S T//
Applicant is: Owner Contractor
TYPE OF WORK Description of work' Ark' .o lye ^,vO 46WZ4.7-~ . ea
_j
Construction Cost: 1/3 Iva ~ 34'25 _,,J Multi-Family Building: (Yes _ /No
CONTRACTOR Name: 8C Cx T&7Z« k , 7,4i,V7 6,~,e License eqo J /3? 8
Address: 7US 4'. CU •S
City: [~itr 71~c~1*r - State: - Zip: "::y
Phone: 6 1, 2(P' • 611f3 Contact Person: 1),4 01,,0
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Category 1 Minnesota 12ules 7872
Energy Code • Residential Ventilation Category 1 Worksheet • Now Energy Code Worksheet
Category Submitted Submitted
(4 submission type) • Energy Envelope Calculations Submitted
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:
NOTE; Plans and su drtin docurn-softyr Su-submit a f7;i Psld lro f;to be pt bl t Information Portfons.'of.:..
the information me be cl ssfffed 'as non publifc r#" yd+t ,pmv,d pe~~fiC asdri;s that, would permit the City to
canc7ude th f he .,•`arm: fret e• ret5i;
I hcrcby acknowledge that this information is complete and accurate: that the work will be in conformance with the ordinances 2nd 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.
X t:/-1r>'rs it1x+1'r?SdA
Applicant's Printed Name r Applicant's Signature
r page 1of3
CITY OF EAGAN
3795 Pilot Knob Road Eagan, MN 55133
PHONE: 454-8100
BUILDING PERMIT
,eoCS
Site Address 3875 Dolomite Drive
Lot 16 Block 1 See/Sub. Briarhill 3rd
Parcel # 10 14992 160 01
W I Name ivil.Ci.?uu nu.>_tuGiS
Address 1655-Abrtood Drive ^__
o Name OMPr
U? Address
I- rl«. a:.....e
Name _
Address
I hereby acknowledge that I hove 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 Permittes
A Building Permit Is issued to: Tot
all work shall be done in accordance with all
N9 7106
Receipt #
Erect Occupancy
Alter ? Zoning PD (R-31
Repair ? Fire Zone DA
Enlarge ? Type of Const. V
Move ? # Stories
Demolish ? Length 44
Grade ? Depth 22 Sq. Ft.-
Approvals Fees
Assessment _
Water & Sew.
Police -
Fire
Eng.
Planner
Council _
Bldg. Off. _
APC
Plan cfiecl' -inn
SAC 525.00
Water Conn. 115-0
Water Meter 60 0
Road Unit 189-
Total r,
1', l 3 ' SV
- on the express condition thm
and City of Eagan Ordinances.
Building Official
CITY OF EAGAN
2795 Pilot Knob Road Eagan, MN 55122
PHONE: 454-8100
BUILDING PERMIT 4' 3`1 . llXfb Receipt #
Site Address 3873 Dolomite Drive
Lot _ 15 Black I Sec/Sub. Briarhill 3rd
Parcel # 10 14992 150 01
rc I Name ioiieisOtt muiaers
Address 1655 Norwood Drive
W... SC177 ArS/._r;A71
o Name _
0? Address
t r....
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 Permittes
A Building Permit is issued to: Z
all work shall be done in accordance with
Building Official
N? 7105
R-3
Erect XT Occupancy
Alter ? zoning -
Repair
?
Fire Zone t
Enlarge ? Type of Cansi.
Move ? # Storie
Demolish
? s
Length
-
Grade ? Depth
72 Sq. Ft._
Approvals Fees
Assessment -
Water & Sew.
Police
Fire
Erg.
Planner -
Council
Bldg. Off. -
APC
Plan'check-
SAC 529.00
Water Conn. Q.Q.Q.
Water Meter _64_.411
Road Unit 189 _ (N)
Total ??-
x143?'SL?
_ an the express condition thnr
and City of Eagan Ordinances.
CITY OF EAGAN
3795 Pilot Knob Road Eegan, MN 55122
PHONE: 454-6100
BUILDING PERMIT
To be used tar 1 Of
Ni? 7104
*3y 1000 Receipt
PLEX
Site Address Dori wiLat ?L. ViiVe
Lot 18 Block 1 Sec/Sub. Briarhill 3rd
Parcel *
W Name Tril l pfgon Rtti 1 r1PrS
z Address 1655 Norwood Drive
$ o__- ccsnn 111 cn,n
p Name
Address
f• fin.
Name _
Address
I hereby acknowledge that I hove read this application and state that
the inlormation is correct and agree to comply with oil applicable
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Permittee
A Building Permit Is issued to: Th1
all work shall be done in accordance with all
Building Official
Erect Occupancy
Alter ? Zoning
Repair ? Fire Zone
-
Enlarge ? Type of Con
Move ? * Storie
Demolish
? s
Length
-
Grade ? Depth
72 Sq. Ft.-
Approvals Fees
Dote
Assessment
Water 8 Sew. P",n.t2LCO
Surchp?
Police Plan check'1-
Fire SAC 525.00
Eng. Water Conn. 335.00
Planner Water Meter 60.00
Council Road Unit 1 19.5,.0.0_
Off
Bldg
.
.
APC Total
` 11 38'sD
on the express condition Ihm
and City of Eagan Ordinances.
CITY OF EAGAN Np 7103
3795 Pilot Knob Rood Eason, MN 53122
PHONE: 454-8100
BUILDING PERMIT .IT3y10a6 Receipt # ,3 u J
To be wed for 1 Of 4 FI X Est. VOIue'V4-,QQ - Date A'I3 rrh 1 _, 19.82...._
Site Address 3869 Dolomite Drive Erect NY Occupancy R-3
Lot 17 Black 1 Sec/Sub. Briartull 3rd Alter ? Zoning PD (R-3)
Parcel # 10 14992 170 OL Repair E] Fire Zone NA
Enlarge []
E Type of Const. V
9 Name Tollefson Builders Move ? # Stories
Address 1655 N rwood Drive Demcdish E] Length 44
City E3 an 55122 phone 454-6873
6
Grade ? -22--
Depth Sq.
Ft.-
n..Y-,... Asorovols Fees
a Name _
ooiu Address
h r:w.
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: Toll efsort 11
all work shall be done in accordance with all pl' ble 5 of Mh
Building Official
Assessment -
Water & Sew.
Police
Fire
Eng.
Planner
Council -
Bldg. Off. _
APC -
Plan cFe'ck" +-%erz?
SAC 525.00
Water Conn. 3350_
Water Meter 60 DO
Road Unit 195 On
Total
V iq 3'i -5-0
on the express condition that
and City of Eagan Ordinances.
1b Be Used for 4
Site Addraea-.?f , ?SY7=
. ?10 OF EAGAN Include 2 sets of plans,
1 site plan w/elevations t
BUILDING PERMIT APPLICATION 1 set of energy calculations.
?3?, acv
Valuation Date o2?/d
Lot/S,i6,12. Block / Sec./Sub. e &A.
Parcel T' ID I`? t Z (D D I
Owner:
Address: 11.5 S Wo..!
City/Zip code:
Phone isSS?-
Contractor: ae
Address:
City/Zip Code:
Phase #:
Arch. /Eng.:
Address:
City/Zip code:
Phone t:
OFFICE USE ONLY
Erect Oom pancy
Alter Zoning A0 1e?3>
Repair Fire Zone AJA
Enlarge _ Type of Const. -ri
Move i Stories
Demolish _ Front q ft.
Grade Depth 1 ?2 ft.
Water/Sewer Surcharge ?7?oo a
Police Plan Check0sb
Fire SAC Sa3 D
Eng. Water Conn.
Planner Water Meter 6,0
Council Load Unit
Bldg. Off.
AFC
(37-0
TOTAL ¢ ',??
114:o'c! - 15T 771V CITY CF EAOAN Include 2 sets of plans,
- 1 site plan w/elevations i
1o Be Used Pbr 4
Site
BUIIDIM PEIMT APPLICATION 1 set of energy calculations.
Valuation , Date o2/ id ?
a A v. Z,,Z .
-07/
10t6017011?. Block / Sec./Sub. 3Rd
Parcel # rp iu`t`CZ. fGo ?/
Owner:
Addrese: L!1 _ 5 ?O?ftuaa?< Z91,1-
city/Zip Dose:
Photos t:
OFFICE USE ONLY
Erect K_ 0a.,4wcy d2
Alter zoning f ? wo
Repair Fire Zone A/A
Enlarge _ Type of Cont. TJ
Move N Stories
Demol? Front S ft.
Grade Depth q ?? ft.
Ontractor: Assessments Permit AN 4
Address: Water/Sewer Surcharge t7,oo
Police Plan Check/as --JA
City/Zip Cbde: Fire SAC 3?s
Phone Eng. Water Conn. ??
Planner
"r
Water Meter 60
Arct./Png.: council Road Unit
Off.
mums: • AFC
City/Zip Code:
Ptrone 2
._
':.
•'
_
I
l? 00.1 ( .
-A ...env `i
T
s
CI
Y OF EAGAtJ Include 2 sets of plane
,
'
i 1 site plan w/elevations i
DLLIIDIN6 PERMIT APPLICATION
1
f
...
set o
energy calculations
ab Be Used For y -lT Valuation 3yccb Date 02/i???a
Site Address-Vl9,__ 9/, ?73? 7S' ., (QcJ
Block / Sec./Sub
A-" ue re 3.a{ OFFICE USE ONLY
.
P
l
k' Z Erect
--?'- Occupancy
arce
1d I
a j
150 Alter Mning
Owner- P
cLL/
O Repair Fire Zone
eJ?
? Enlarge _ Wpe of 06nst. r/
Address: ?G, ?p«( ??• A Stories
'
'
City/zip code: De oust
Front
ft-
G
d
"-
t
ra
e
Depth - f
:
Phot
. APPROVALS g
erntrae6or: 4 st- Q? n Oct ?r Assessments Peanit ! as
Address: w
Sewer Surcharge 1-7<00
City/Zip Oode: olice
Police
Plan Checks
Fire SAC j
??
Phone #: Water Conn. a
E:?
?
g
-r Wa
ter meter 6,0
Arch./&q.: Council road unit i
'
Bldg, Off.
Address: • APC
city/zip code. --- } 3 Sn
1- Z s-
00 ??
s1\ u,) rLk Zb Be Used
S? era . o Site Addree
b;? : -7(v-3
q `(V-
?ZJ3 /
CITY OF FAGAN Include 2 sets of plans,
1 site plan w/elevations 6
BUIWING PE1a41T APPLICATICN I set of energy calculations.
3yaDc5
_ Valuation Date off/?//?a
IDts?6.n Blcije Sec./Sub. Axa,& &A-.
parcel- to r g( R a Z i -o 0 t
Owner:
iLGGc
Addresa: ?O c G?c e!
City/Up Oode:
Out actor: a S° i . ® Q p 11
Address-
City/zip Oode:
Phone #:
Arch./&W.:
Address: •
OFFICE USE ONLY
Erect __2_._ occupancy 4113
Alter Zoning 70 "-3
Repair Fire
Zone A/?0`
Enlarge_ Type of Cbnst.
Move if stories
Demolrsh _ Front ft.
Grade Depth y ?v ft.
Water/sewer Surcharge 17co 5-
Police Plan Checd[(drr'. n
Fire SACS'
Eng. Water Conn. ?•??
Planner Water Meter
Council Road Unit e
Bldg. Off.
APC
City/Zip Code: l" 3 3''0
Phone ?: s 2 Sf TOTAL`S--
/
CASH RECEIPT
CITY OF EAGAN
3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE
RECEIVED
FROM
19
AMOUNT $ I
CASH F] CHECP
1
6OLLARS
tol 1
I ? ' J
volt
3
C / . ?- BY
White-Payers Copy
Yellow-Posting Copy
Pink-File Copy
Thank You
CITY OF EAGAN
ti 2795 POW Knob Road Eagan, MN 55122
t PHONE: 454-8100
BUILDING PERMIT ,moo Receipt
To be used for Est. Value Date 710 5
9
Site Address Erect Occupancy
-r I
Lot Block Sec/Sub. - Alter p
Zoning
Parcel # Repair ? Fire Zone
Enlarge ?
Name
au Move ? Type of Const.
# Stories
Address Demolish ? Length
city Phone Grade [I Depth Sq. Ft.
a Name Approvals
0 Fees
6U Address Assessment
I- city Phone Water 8 Sew. Permit 1'?
Surchorg?.??
O
ll
1a Name Police
FZ Fire Plan c
eck
h
SAC
y Address Eng. Water Conn.
?
<W city Phone Planner Water Meter
Council Road Unit
I hereby acknowledge that I have read this application and state that Bldg. Off.
the information is correct and agree to comply with all applicable APC
State of Minnesota Statutes and City of Eagan Ordinances. Total "?-
3 7, 570
Signature of Permittee
A Building Permit is issued to: l? on the express condition that
all work sholl be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building Official
Permit No. Permit Holder Misc. Permit No. Holder
Plumbing C) Ly€?_I' (f????Z
H.V.A.C. 2gg'J? ?r`??rllC S ?2
Well
Water
Disp.
Sewer
Electri c ?E E(F,Ct -17IrZ
Inspection Date Insp. Other
Footings
Foundation
Framing
F
Rough Plbg. /Sf
Rough HVAC
Insulation
Final Plbg. L f
Final HVAC 4
Final 2 2
Water Describe Location:
Well
Sewer
Pr. DMp.
CITY OF EAGAN
P 3795 PllW Knob Rood Eagan, MN 55125
PHONEt 454-8100
BUILDING PERMIT !*of 6v0' Receipt #
To he wed kr F.. V..1... n...e
.0?
?i
Site Address T1 17P Erect 'p Occupancy
Lot Block Sec/Sub. Y Alter p Zoning
Parcel # Repair p Fire Zone
Enlarge p Type of Const.
Ge Name Move p # Stories
Address Demolish p Length
Grade ? Depth So. Ft.
R Noma
?? Address
Name _
Address
1 hereby acknowledge that I hove read this application and state that
the information is correct and agree to comply with oil applicable
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Permittee
A Building Permit Is issued to:
all work shall be done in accordance with all applicable
Building Official
Assessment
Water & Sew.
Police
Fire
Eng.
Planner
Council
Bldg. Off.
APC
Plan check
SAC
Water Conn.
Water Meter
Rood Unit
Total
on the express condition thou
of Minnesota Statutes and City of Eagan Ordinances.
Permit No. Permit Holder Misc. Permit No. Holder
Plumbing .Z„ Gt n t (2 n -? `$'?
H.V.A.C. $ r6A Pt??9d
Well
Water
Disp.
Sewer
Electric 7'$S 3$S ?q l? ???G S-(7-$Z
Inspection Date Insp. Other
Footings $Z
Foundation
Framing
Rough Plbg.
Rough HVA
Insulation
Final Plbg.
Final HVAC - (J
Final
Describe Location:
E
DWp. ar
h
CITY OF EAGAN
37" PlIk* Knob Rood Eogen, MN 55122
PHONEt 454-8100
BUILDING PERMIT j'3Y160C' Receipt #
Site Address
Lot Block Sec/Sub.
Parcel #
W Name
Address
G phone Erect
?
Alter p
Repair ?
Enlarge Q
Move ?
Demolish Q
Grade p
Occupancy
Zoning
Fire Zone
Type of Const.
# Stories
Length
Depth Sq. Ft.
Name
uU Address
Approve Is
Assessment
Fees
Permit.21„7( -06
00
???
city Phone Water & Sew. Surchar
SO
HZ Nome Police
Fire Plan ch
SAC
GO Address Eng. Water Conn.
iW city Phone Planner Water Meter
Council Road Unit
1 hereby acknowledge that I have read this application and state that Bldg Off.
the information is correct and agree to comply with all applicable APC Total
State of Minnesota Statutes and City of Eagan Ordinances. ?/
i' 3 of ? Q
Signature of Permittee t G
A Building Permit Is issued to: on the express condition thni
all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building Official
Permit No. Permit Holder Misc. Permit No. Holder
Plumbing +
H.V.A.C. 6 t!! ?ScdTl C ?? `
Water well
Diw.
Sewer
Electric
?? g3 II ff?"
2,t34 C l,?C , o
5--(7 `0 Z..
Inspection Date Insp. Other
Footings $ D^?
Foundation
Framing
Rough Pibg. .?
Rough HVA
Insulation
Final Plbg. ??.
Final HVAC
Final
Water Describe Location:
Well
Sewer '
Pr. Disp.
BUILDING PERMIT
3795 Pill Knob Road Eagan, MN 55122
PHONEt 4544100
'it 3(b pe' 2') Receipt #
Site Address
Lot Block Sec/Sub.
Parcel #
cc Name _
Z Address
o Name _
uu Address
rity
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 shall be done in accordance with
Building Official
Erect D
Alter ?
Repair ?
Enlarge ?
Move ?
Demolish ?
Grade ?
Occupancy
Zoning
Fire Zone
Type of Const.
* Stories
Length
Depth Sq. Ft.
Fees
Assessment
Water & Sew.
Police
Fire
Eng.
Planner
Council
Bldg. Off.
APC
Plan cFieck
SAC
Water Conn.
Water Meter
Road Unit
Total
*143? -So
on the express condition that
i of Minnesota Statutes and City of Eagan Ordinances.
Permit No. Permit Holder Misc. Permit No. Holder
Z77 3 6f v,Z n q-4
V 24$ 3
"rgs 3g ?Q l? ?l6C S-(7Z
Inspection Date Insp. Other
Footings
Foundation
Framing
Rough Plbg ya_ 4d
Rough HVA
Insulation
Final Plbg. .?
Final HVAC
Final .y J7 (,J
Syr Describe Location:
WWII
Sewer
Pr. Disp.
Receipt MECHANICAL PERMIT Permit No.
CITY OF EAGAN
Foe
-J
Fill in numbered spaces S/C
Type or Print legibly Tot.
1. Date F ' 7 -may 2. Installation Cost
3. Job Address _
4. Owner
5.
I Tract
Phone `
6. Address
7. City State Zip -
r'
8. Building Type: Residential ? Commercial ? Institutional ?
9. Work Description: New ? Add ? Alter ? Repair ?
1 10. Describe
1 11.
Type
No. Equipment BTU - M. Ea.
Forced Air No. Equipment CFM
dli
Ai
H
Mfg. r
an
ng:
Boilers
Mfg. Mech. Exhaust
Unit Heater
Mfg. Other
Air Cond.
Mfg.
Gas, Piping Outlets
12. 1 hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed : for
Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
oe..e:... NICI%UANIPAI PCRUIT Permit Nn
CITY OF EAGAN
Fee .
Fill in numbered spaces S/C
Type or Print legibly Tot.
1. Date . - 2. Installation Cost
3. Job Address Lot 115 Blk, i Tract
4. Owner
i
5. Contractor Phone
6. Address
7. City State 1 " Zip
8. Building Type: Residential ET Commercial ? Institutional ?
9. Work Description: New 12 Add ? Alter ? Repair ?
10. Describe
11
Type
No. Equipment BTU - M. Ea.
Forced Air No. Equipment CFM
Air Handlin
:
Mfg. g
Boilers
Mfg. Mech. Exhaust
Unit Heater
Mfg. Other
Air Cond.
Mfg.
Gas, Piping Outlets
12. 1 hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed: for
Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
Receipt
MECHANICAL PERMIT
CITY OF EAGAN
Fill in numbered spaces
Type or Print legibly
Permit No.
Fee
S/C
Tot. -
1. Date - 2. Installation Cost
3. Job Address 'Lot Blk. / Tract
f.
4. Owner
5.
6. Address
9. Work Description: New ? Add ? Alter ? Repair ?
1 10. Describe
1 11.
Fuel Type
No. Equipment BTU - M. Ea.
Forced Air No. Eguipment CFM
Ai
H
dli
Mfg. r
an
ng:
Boilers
Mfg. Mech. Exhaust
Unit Heater
Mfg. Other
_ Air Cond.
Mfg.
Gas, Piping Outlets
12. 1 hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed : for
Rough Final
Inspections: Date Insp. ` Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
7. City State Zip
8. Building Type: Residential ? Commercial ? Institutional ?
Receipt PLUMBING PERMIT I
Permit No.
CITY OF EAGAN
Fee
Fill in numbered spaces S/C
Type or Print legibly T
ot.
1. Date - 2. Installation Cost
3. Job Address 6f?, [ o i s Lot B lk. Tract
4. Owner r?. ! / e-lt--1i? L
5. Contractors h < . Phone 'i%
6. Address
7. City I rLr cr State Zip
8. Building Type: Residential ? Commercial ? Institutional ?
9. Work Description: New ? Add ? Alter ? Repair ?
10. Describe
11.
No. Fixtures
Water Closet No. Fixtures
Cesspool /Drainfield
Bath tubs Septic Tank
Lavatory Softner
_ Shower Well
_
i Kitchen Sink
Urinal/Bidet Other
/ .UUr4&y-T4:.W .. ., i,OM( 14
Floor Drains
f
Drinking Ftn. -
Slop Sink
Gas Piping Outlets
12. 1 hereby certify that the above information is true and correct, and 1 agree to
comply with all ordinances and codes governing this type of work.
Signed
for - '?
Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454.8100
Receipt PLUMBING PERMIT Permit No.
CITY OF EAGAN Fee
Fill in numbered spac es S/C
Type or Print legibly
Tot. •
Date l/ UAL 2. Installation Cost i
Job Address =fJ?? 144cmri. 7 (-Lot Blk. Tract
Owner %/f {-sc ?J LL ?i??
Contractor A :Z/A/ Z r <. t,
Phone
Address M/ I, F . ` 1 p
City State i". i ,V Zip
3.
4.
5.
6.
8. Building Type: Residential L9' Commercial ? Institutional ?
9. Work Description: New ? Add ? Alter ? Repair ?
10. Describe
11.
No. Fixtures
Water Closet No. Fixtures
Cesspool/Drainfield
Bath tubs Septic Tank
Lavatory Softner
Shower Well
Kitchen Sink
Urinal/Bidet Other
c
Floor Drains
Drinking Ftn. -, --
Slop Sink
Gas Piping Outlets
12. 1 hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed : for
Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
Receipt PLUMBING PERMIT Permit No.
CITY OF EAGAN
Fee
Fill in numbered spaces S/C
Type or Print legibly Tot.
1. Date 2. Installation Cost
3. Job Address L6/a• Tr Lot Blk. Tract
4. Owner - //r T?r?? ? L 1= F .;
5. Contractor Phone `f 2-
6. Address
7. City I r i i State Zip
8. Building Type: Residential Er Commercial ? Institutional ?
9. Work Description: New ? Add ? Alter ? Repair ?
10. Describe
11.
No. Fixtures
Water Closet No. Fixtures
Cess
ool/Drainfield
Bath tubs p
Se
tic Tank
Lavatory p
Softner
2JML Shower Well
_I Kitchen Sink
Urinal/Bidet "
Other i c C
Laundry-T y nl0 .
,r ;'? .
Floor Drains -- -
Drinking Ftn.
Slop Sink
Gas Piping Outlets
12. 1 hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed : c
for
Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
iJ
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS:
PERMIT SUBTYPE: )
S { U 37
E; ? „c k
PERMIT TYPE:
Permit Number:
Date Issued:
FIt11 I to I N6
0`4 1 4:A
APPLICANT:
TYPE OF WORK:
x ,: StslN, it1Fq(?? 3HN
N
P PATR
{I?IkI? F. ?:FlCtli'Fk';
Permit No. Permit Holder Date Telephone #
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.
BSMT FINAL
DECK FTG
DECK FINAL
IN
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS:
1 X11 I r tit 1{I t
P
. •. IIUI Ilp? 1 1 i I!k
?%` fik 1 A(: li l 1 1 :iFiU
PERMIT SUBTYPE:
RECORD
PERMIT TYPE:
Permit Number:
Date Issued:
[stl! 1 111 NC
02 lift 11
06/20/96
APPLICANT:
ar.i:?I i•'I
rI1N"IR111,YION (0
ito/
TYPE OF WORK:
it h <:1 1' 1 1' 1 1 ON
I'C1)oFTN1,
` VC MAHk 1 Ni I M11
isi ! R tli:'0 , AND 1.111 1 1141 1AAY
1 !,4 1 f, 1 1 h2
RV PA IR
Vfrko()h
Permit No. Permit Holder Date Telephone #
ELECTRIC
PLUMBING
HVAC
Inspection Date Inap. 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
v1
BSMT R.I. -
BSMT FINAL
DECK FTG
DECK FINAL
CITY OF EMAN
Addition El
Z
Lot 1T Rik 1 Parcel
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
to2 19T1 Paid vnde parcel 10- 000 10-25
STREET RESTOR. 19T5 0.27 .03 10 16.11 A011362 8-18-82
GRADING 1982 123.04 24.61 5 1145.16
0 1982 600.76 120.15 5 98.44 "
SAN SEW TRUNK Vj) 11966 33-61 1. 16.81
SEWER LATERAL
WATERMAIN
WATER LATERAL /D 14.73 A011362 8-18-82
AREA 39 6T.21 4-45 --15- 40.33 tr 11
** S L 1982 1431.44 286.29 5 1145.16 " 11.'
STORM SEW TRK 626 1982 402.73 80.55 5 322.19 " "
STORM SEW LAT 20
CURB & GUTTER
SIDEWALK
STREET LIGHT
Road Unit 185.00 #29030 3-1-82
WATER CONN. 335.00 11 11
BUILDING PER,
SAC tr t?
PARK
CITY OF E'AGAN Remarks
Addition BRIAR HILL 3rd ADDITION Lot 18 Blk 1 Parcel 10-1$992-180-01
Owner : Uc-=,nn Street 3871 Dolomite Drive State
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. 10L 1971 Paid undell ' parcel 10 000 10-25
STREET RESTOR. / 19T5 80.2T
1 8.03 10 16.11 A011345 8-11-82
GRADING C-6`7 1982 123.04 24.61 5 98.44 it 11
Strimpt Surf 6' G%0 1982 600.76 120.15 5 480.61 It to
SAN SEW TRUNK tjo 1968 33.1 1.12 30 16.81 It It
SEWER LATERAL
WATERMAIN
WATER LATERAL 0 1971 36.81 1.84 20 14.73 A011345 8-11-82
WATER AREA 1977 7.21 4.48 15 40.33 it it
** (%' 1962 4 286.29 1145.16 it "
STORM SEW TRK <c ' 1982 402.73 80.55 5 322.19 It
t'
* STORM SEW LAT 1971 20
CURB & GUTTER
SIDEWALK
STREET LIGHT
Road Unit 185.00 #29030 3-1-92
WATER CONN. 335.00
BUILDING PER. 7106
SAC 1;21;- 00 It
et
PARK
CITY OF EAGAN Rema
Addition BRIAR HIM 3rd ADDITION
Owner ! Street
-? Rlk
Dolomite Drive
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF, C)2 19T1 Paid undez parC -
STREET RESTOR. - -1 19T5 80-27 S. 03 11 A011313 8-4-82
GRADING (95G 1982 123.04 24.61 98,44 11 11
Street Sur 1982 600.76 120.15 5 480.61 " "
SAN SEW TRUNK 1968 33.71 1. 32 30 16.81
SEWER LATERAL
WATERMAIN
• WATER LATERAL IV 19 1 36-81 1.84 14.73 A011313 8-4-82
WATER AREA ; 1977 T•21 4.48 15 40.33 t' "
** S /W Lat Stm L 5" 1982 1431.44. 286.29 5 1145.16 " "
STORM SEW TRK (p 1982 402.73 80.55 5 322.19
• STORM SEW LAT 1971 20
CURB & GUTTER
SIDEWALK
STREET LIGHT
Road
WATER CONN.
135 00 91 t?
BUILDING PER. 7103
SAC
525.00
PARK
CITY OF EAGAN Remarks-
Addition ffitIAR HUL 3rd AMITION Lot 16 Rlk 1 Parcel lo-1$992-160-O1
Owner Street 3875 Dolomite Drive State
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. "02- 1971 Paid and parcel 10-0 2000- )10-25
STREET RESTOR. 2 -11 1975 80.27 8.03 10 16,11 A011374 8-24-82
GRADING 605e'i 1982 123.04 24.61 5 98.44 " It
Street Surf WO 1982 600.76 120.15 5 480.61
SAN SEW TRUNK Q 1968 33.1 1.72 30 16.81
SEWER LATERAL
WATERMAIN
e WATER LATERAL 101 1971 36-81 1.84 20 14,73 A011374 8-24-82
WATER AREA i ;A! 1977 7.21 It. h8 15 40.33
** S a Stm L (058 1982 1431.44 286.29 5 1145.16 "
STORM SEW TRK (? < 7 1982 402.73 80.55 5 322.19
• STORM SEW LAT 1971 20
CURB & GUTTER
SIDEWALK
STREET LIGHT
Road Unit 185,00 #29030 3-1-82
WATER CONN. 335.00
rr
rr
9UILDING PER, 7104
SAC rr rr
PARK
This request void 5 L16-, % ., months from
$53-85
30 ? 4 ?
? Sz (SC::)
re quest Date Fire No. Rough-ht Inspertion
u o
In
Ready Now)ZWill
/
>? No
ld
y
When R
for When Ready
Licensed Electrical Contractor ap- I hereby request inspection of above
Owner S+ electrical work installed at:
Street Address, Box or Route No. Cat
L Polo M ?
ec ion No. Township Na a or No. ange No. Co r?ty
Occupant (PRINT) Phone No.
L
I )c- l
Power Supplier Address
El total Contractor (Co any Name) Contracto r's License No.
Mailing Idress (Contractor or Owner Making Instailationl
57
-<I-
5
W 6+'}-
Authoriz
ture (Coot tor /Owner Maki ng Installation) Phone mber
Zsn
'E BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT
d9. - Room N-191 BE ACCEPTED BY THE STATE BOARD
.. sr P ,t YM 915104 UNLESS PROPER INSPECTION FEE IS
OF EAGAN .."' ft .
Pilot Knob Road PERMIT NO.:
MN $5122 DATE:
No. of Units:
ite Address: i l? 1 nr
lumber:
agree to comply with the City of Eagan
By
of Insp.:
CI-Y OF EAGAN
3795 Pilot Knob Road
Eagan, MN 55122
Zoning:
Owner: "
Address:
Site Address: ' t
Plumber:
Meter No.:
Size:
Reader No.:
1 agree to comply with the City of Eagan
k Ordinances.
By -
Date of
CITY OF EAGAN
3795 Pilot Knob Road
Eagan, MN 55122
Zoning:
Owner:
Address:
Site Address: 3?'
T',ra
Plumber:
I agree to comply with the City of Eagan
Ordinances.
By
Date of Insp.:
Connection Charge:
Account Deposit: _
Permit Fee:
Surcharge:
Misc. Charges: -
Total:
Dote Paid:
100.00 Pd
WATER SERVICE PERMIT
PERMIT NO.:
DATE:
No. of Units: F u7
Account Deposit:
Permit Fee:
Surcharge:
Misc. Charges:
Total:
Date Paid:
SEWER SERVICE PERMIT
PERMIT NO..
DATE:
No. of Units:
Connection Charge:
Connection Charge:
Account Deposit: _
Permit Fee:
Surcharge:
Misc. Charges: -
Total:
100.00 1
CITY O° tAGAN WATER SERVICE PERMIT
374'5 Pilot Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning: No. of Units:
Address:
Site Address: ; r ' 117 i' $1
Plumber:
Meter No.: Connection Charge:
Size: Account Deposit: _
Reader No.: Permit Fee:
I agree to comply with the City of Eagan Surcharge:
Ordinances. Misc. Charges:
Total:
CIT. OF EAGAN SEWER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
No. of Units: i
Zoning:
Owner:
Address:
Site Address: yr 1 17 `31 i
Plumber:
Connection Charge:
Account Deposit:
Permit Fee:
Surcharge:
Misc. Charges:
1 agree to comply whh the City of Eagan
Ordinances.
By _
Dote
of Insp.-
CITY 0. EAGAN WATER SERVICE PERMIT
3745 ,'°ilot Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning: No. of Units:
Owner:
Address:
Site Address:
Plumber:
Meter No.: Connection Charge:
Size: Account Deposit:
Reader No.: Permit Fee:
1 agree to comply with the City of Eagan Surcharge:
Ordinances. Misc. Charges:
Total,
By
Date Paid:
,F EAGAN WATER SERVICE PERMIT
Pilot Knob Road PERMIT NO.:
.n, MN 55122 DATE:
Zoning: No. of Units:
Owner:
Address:
=? ;,, :? <i tc
Site Address: '
L1:: R 11ri
ar :iii
Plumber:
Meter No.: Connection Charge:
Size: Account Deposit:
Reader No.: Permit Fee:
1 agree to Comply With the City of Eagan Surcharge:
Ordinances. Misc. Charges:
Total:
By Date Paid:
Date of Insp.: Insp
:
.
. _ OF EAGAN
+4795 Pilot Knob Read
.ago::, MN 55122
Zoning:
Owner: =
Address:
Site Address: r
Plumber:
SEWER SERVICE PERMIT
PERMIT NO.:
DATE:
- No. of Units:
100.00 pd
I agree to comply wlth the City of Eagan Connection Charge:
Ordinances. Account Deposit: _
Permit Fee:
Surcharge:
BY Misc. Charges: -
Date of I nsp.: Total:
I nsp.: Daft Paid:
2004 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Constructim Raoul rements Remodel/Repair Requirements am
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 sizes; poured found design, etc. 1 site survey for additions & decks
1 set of Energy Calculations Addition - indicate ifon-sife 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
Date l 7
Site Address
06 16 ,MI -- - Construction Cost / 35d -fir
l7? Cu S c ?? e ?qy ?4? Unit/Ste #
Description of Work W(n AoL) I -e 7(o r¢ i, t, ,t
` ? -
Multi-Family Bldg _ Y N Fireplace(s) - 0 _ 1 - 2
Property Owner ?je ? /e(; ? ? n?cS? Telephone # (657 X 87 - `(:ZR 7
Contractor IBS' ?CfS
Address ?i b
State / 7 /
?) . z J 3 City 3u /7n sLjk l(?
Zip 5V-3--31 Telephone # (?j y'}) j r/-36cY1
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Category I _ 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
N If so, 25% plan review
P kLT T
I hereby apply for a Residential Building Permit and acknowledge that the information is complet and accurate;
that the work will be in conformance with the ordinances and codes of th 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; that the work will be in accordance with the approved plan in the case of work which requires a review and
approval of plans.
Xpplicant's Printed Name App 'c 's
Telephone # (
jefeoa *Aldere Inc.
g?
R
F
F. C. JACKSON
LAND SURVEYOR
ID UNDER LAWS-Of STATE OF MINNESOTA
Sy ORDINANCE OF 61TY Or MINNEAPOLIS
16 EAST 66TH STREET 55417
727-3484
Surbtpor'IS eel
G_
' Q « 4 i
C ` 9 rr- e 9 k? .
06. A 11;?Ip '4
a\ 1c ?c.
2
\ Aft ?i
Proposed Garage Floor Slav. 103.0 c `
Proposed iasomeet Floor Slav. 103.37
Proposed First Floor Elov. 110.37
s'cV/e: / .ro'
• = rJ'07
.GrrF/if ; ye
f.
-- : p, rt y Ewse,Pvt eH1.r
?Ik
u /
x
??. 1K6
J1 -`W.e3
1 HERESY CERTIFY THAT THE ABOVE IS A TRUE AND CORRECT PLAT OF' SURVEY or
lots 15,161 and 18,Block 1,
Briar Hill 3rd. Addition,
Dakota County,Minnesota.
As SURVEYED BY YE THIS-Uth,_DAY OF_L-Yi_A. D. 1982
F. C. JACKSON.
or. 11292-/
193 71A
3600
'i Y .'' S'?-A
c?a 9.?,.cna?; -
Tr,TEI py PAS .,
TOTAL ?o F=.'? Cp F`OOrg S, t, 6
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i ..
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
PERMIT
PERMIT TYPE:
Permit Number:
Date Issued:
BUILDING
028013
06/20/96
SITE ADDRESS:
3869 DOLOMITE DR
LOT: 17 BLOCK: 1
BRIAR HILL 3RD
P.I.N.: 10-14992-170-01
DESCRIPTION:
REROOF
ermit Type MULTI. (MISC.)
k Type REPAIR
434 ALT. RESIDENTIAL
, s
ON . a"'tVVa 'w, $ r u ai ? uil§ 39 ne"pi 4., H REMARKS: 3$91 13
.38'15a?omi}e .fir.
INCLUDES: $.81$, 38^ ,
8822 W16606j WAY
-66-4 -6-6-4; - 662
FEE SUMMARY:
VALUATION $8,000
Base Fee $137.25
Surcharge $4.00
Total Fee $141.25
CONTRACTOR: - Applicant - ST. LIC.OWNER:
MIKE MOHS CONSTRUCTION CO 17211107 5456 BRIAR HILLS ASSOCIATION
3414 SNELLING AVE S WILLOW WAY
MINNEAPOLIS MN 55406 EAGAN MN
(612) 721-1107
n
I hereby ackncwlegde that S have read this applicationandt.state that`'the
ixsfflrmatian.ss cor.rect.arts1, a.gr to esieply'°w3•th aI appl'% able` tate of Kin 1 11 Sta ut s -andtV of ap prdin nces.?
e
APPLICANT/PERMITEE SIGNATURE
CITY OF EAGAN 1
3830 PILOT KNOB RD - 55122 01
1996 BUILDING PERMIT APPLICATION (RESIDENTIAL)
681-4675
New Construction Requirements Remodel/Repair Requirements
? 3 registered site surveys ? 2 copies of plan
? 2 copies of plans (include beam & window sizes; poured fnd. design; etc.) ? 2 site surveys (exterior additions & decks)
? 1 energy calculations ? 1 energy calculations for heated additions
? 3 copies of tree preservation plan N lot platted after 711/93
required: _ Yes _ No n / !/
DATE: ?0 ?7 9 ID l /? CON'/STRUCTION COST: `
DESCRIPTION OF WORK:2 "?° T
STREET ADDRESS: 3g to 7 ?23
L j8' X50 CI 3
617 . 40
LOT S r ?? BLOCK I SUBD./P.I.D. #:
PROPERTY Name: &(C 4-A /1 i (?S SL Phone
OWNER FMV
Street Address*
City: l_ State: Zip:
CONTRACTOR Company: IM' ?`,P/ ,)d? f/?`t 5 C_ Phone #: Z- /? - U 7
Street Address: C ?7 ' iya /?9 ?il,15 License #:
City: ' Y'o S State: A) Zip, o?
ARCHITECT/ Company: Phone #:
ENGINEER
Name: Registration #:
Street Address,
City: State: Zip:
Sewer & water licensed plumber: Penalty applies when address change and lot
change are 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
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
72 70
2007 RESIDENTIAL PLUMBING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please corfiplete for modifications to existing residential dwellings.
/S, 6
Date. 1 1
_2214, Unit #
Site Street Address ? "7s ,`_&1 0
_
Property Owner h e " leAl xe Telephone # (&Sl)
n
? =74'yO
Pw 'Ilce _,;;"I
h
# (?? ?
ep
o
e
.
Contractor
Address ° "f K///f??? i Xe Le City State /YJA/ Zip S ?'7
The Applicant is: _ Owner Contractor -Other
Septic System - New _ Refurbished Submit 2 sets of plans and MPC license Includes County fee
$ 100.00
Per as- built $ 10.00
Fire Repair (replace burned out fixtures, etc.) $ 90.00
Alterations to existing dwelling $ 50.00
Add plumbing fixtures. This fee includes installation of a water softener and/or water
heater at the same time. If you are installing oniv a water softener and/or water
heater, do not complete this section; move to the next section and check the
appliance(s) you are installing.
-Septic System Abandonment
-Water Turnaround (add $136.00 if a 5/8" meter is required
UU u ?
Other:
Water Softener Water Heater $ 15.00
_
new replacement
Lawn Irrigation _RPZ _PVB -new -repair -rebuild $ 30.00
State Surcharge $ .50
Total $
I hereby apply for a Residential Plumbing Permit and acknowledge that the information is complete ano accurate; that the
work will be in conformance with the ordinances and codes of the City of Eagan and the plumbing codes; that I
understand this is not a permit, but only an application for a permit, work is not to start without a permit and work will be in
accordance with the app/"d plan in the event a plan is required to be reviewed and a proved.
JJ?
Ap is nt's Printed Name Applicai is Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA110503
Date Issued:05/14/2013
Permit Category:ePermit
Site Address: 3869 Dolomite Dr
Lot:17 Block: 01 Addition: Briar Hill 3rd
PID:10-14992-01-170
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace & Air Conditioner
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Andrea Preusse
4145 Sibley Memorial Hwy
Fee Summary:ME - Permit Fee (Replacements)$55.00 0801.4088
Surcharge-Fixed $5.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Christophe R Jennings
3869 Dolomite Dr
Eagan MN 55122
(952) 460-0006
Wenzel Heating & Air Conditioning
4145 Sibley Memorial Hwy
Eagan MN 55122
(651) 894-9898
Applicant/Permitee: Signature Issued By: Signature
All' City ol8atau
Date:
3830 Pilot Knob Road
Eagan MN 56122
Phone: (651) 67545675
Fax: (651) 6764684
Use BLUE or BLACK Ink
For Office rise
Permit V
Permit Fee:
Date Received:
Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Site Address• 38L9, 3 r71, 6 8 7 3, 3 75" ppl. o M' T' 2. Unit #:
Reildetttl
Owner
Name:
e4 46 `~ /1'1».3 4 6 t Nt E N ..•� •�: C. , Phone: 76 3-S-71— 97743
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Address / City / zip: :SO Q C Ce4 ry 2 Av, j , 1 A aoaD £.s 14 L _y 7
Applicant is: Owner ,Contractor
Type oMork,
Contractor
Deacription of work: { i o ' €- aw RE PS. 6/ J 6 a P.4'4 Al z 7-4 I. -
Construction Cost / 9,00o• CIL_ Multi -Family Building: (Yes / No
Company: a £ I £,r r a 2 /%7ih.JT . Cv cep Contact: DA ✓ r 9 a�2ai S
Address: 5/0 �' W (a 1 /1- J7 -
State: /''? SS'y//
City MPLS
Phone: lo/z- S'6/-1. 2y'3
License#: '4 C- 4' / 3 / Lead Certificate #:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional inf enation)
FLSIvS- g�Il'r PoS:' JS7r
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit fora 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:
NOM; �y'` �� •,iiiowsedio
tftaistonit
CALL BFrPORE YOU 019, Cat Gopher State Ono Catl of (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.aoaherstateontacaLtpt
I hereby acknowledge that this Intonnation Is complete and aoxtrate; that the work will be corifomtance with the ordinances and coda of dhe City of
Bacon: tat I undeatand this is nota permit. but only en application for a pent, and work is not to start without a permit: that Mie wont WII$ be in
accordance with the approved plan in the case or work which requires a review and approval of plane.
Exterior work authorized by a building permit issued In accordance with the Minnesota Stam Build nflCode must be completed v/811111180
days of permit issuance.
xI ',2...Q_'
Applicant's Printed Name
ZO/Z0 3Jbd
Applicant's Signature
Page 1of3
1NIVW 1X3 ISS L9Z9t98Z19 LO:ZZ bTOZ/9Z/Z0
CllyofEagall
3830 Pilot Knob Road
Eagan MN 56122
Phone: (661) 675-6675
Fax: (661) 675 -5664
Use BLUE or BLACK Ink
For Office Use
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: "/"- S — /I/ Site Address: 384 y, 3 7 '7 /, 3V73, 3 87? yO L.e+,1 r YE A iL . Unit #:
J
_ Phone: 743 -.•s'y 3 - 9 7 70
/4 attiziod
Description of work: 7- ret.2 O%% a• at- Pao r-
Constriction Cost 130.7 C t . - el° Multi- Family Building: (Yes � / No )
Company. GCE I Sic 'r'c a,oie Pfd, r . emeP Contact Uvrd Id.i RR S
Address: 4/0 g e D1 ,
City:
State: ',IA] Zip: srv✓ g Phone: !o'z ° r6 /- 6 z ya
License s: 4e. z41) /3 /
Lead Certificate #:
If the project is exempt from lead certification, please explain why: (see Page 3 for addition& information)
&as t, c L. 14au Lr Pos; 197
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:
NO $ :. .- 719.'"
ale{(.� y ,�y K, 1
l o p r . -4474413.- lT�'JYA4
••'aip'r , , r„�.,u :. !!g FA a r *� `,�� ,,.�cyyyr[[ 7rµ, y •> u
CALL BEFORE 'VU DI(. CaU Gopher State One Calf at (691) 454.0002 for protection against underground utility damage. Call 48 hours
before you Intend to dig to receive locates of underground utilities. mow.000herstateoneeall.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 1s not a permit, but only an application for a permit, and work is not to start without a permit; that the work vae be In
accordance with the approve° plan In the carte of worts which requires 8 review and approval of plans.
Exterior work authorized by a building permit Issued In accordance with the Minnesota State MIMI Code must be completed within 180
days of walk issuance.
x bJiv1h EeoR.teS
Applicants Printer! Name
80/10 39Vd 1NIt7N 1X3 I3fi
x
Applicant's Signature
Page 1 of 3
L9Z9t98Z19 LO :13T tTOZ /80/I0
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA147420
Date Issued:01/08/2018
Permit Category:ePermit
Site Address: 3869 Dolomite Dr
Lot:17 Block: 01 Addition: Briar Hill 3rd
PID:10-14992-01-170
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener).
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Christophe R Jennings
3869 Dolomite Dr
Eagan MN 55122
(612) 478-8557
Champion Plumbing
3670 Dodd Rd., #100
Eagan MN 55123
(651) 365-1340
Applicant/Permitee: Signature Issued By: Signature