3225 Donald Ave
Use BLUE or BLACK Ink
in I Permit / I
Cit of Eajau
y I Permit Fee: I
3830 Pilot Knob Road I I
Eagan MN 55122 j Date Received: j
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 j Staff: j
2010 RESIDENTIAL BUILDING PERMIT APPLICATION}
Date: v"Site Address: -5325 yU1~1 pct Rue- 'P t CA fl A-N N 55
Tenant: P'111.1 OItC~~ Suite
RESIDENT / OWNER Name: Rao O & t ~ Phone: ~ 1oS 11331- 0314
Address/ city/ Zip: 33a 5 hol"'W Ryt ~c, 'P`IN 55111
Applicant is: X Owner Contractor
TYPE OF WORK Description of work: ~(It~OGIQIIQ~t~di~l0Y1
Construction Cost: "k 15I 00 Multi-Family Building: (Yes / No A-)
CONTRACTOR Name: License
Address: City:
State: Zip: Phone:
Contact: Email:
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:
NOTE. Plans and supporting documents that you submit are considered to be public i c~rmatfan.- PprWons of
the information may be classified as non-public if you provide specific reasons that wc+u/d p x# # i#y to
conclude that the are.-trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage.
Call 48 hours before you intend to dig to receive locates of underground utilities. www.clopherstateonecall.org
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 o k~iORe approval of plans.
x t7u.1 ®lto xP
Applicant's Printed Name Y 1 $ 2010 Applicant's Signatur
Page 1 of 2
DO NOT WRITE BELOW THIS LINE
SUB TYPES
_ Foundation _ Fireplace _ Porch (3-Season) _ Storm Damage
Single Family _ Garage _ Porch (4-Season) _ Exterior Alteration (Single Family)
Multi _ Deck _ Porch (Screen/Gazebo/Pergola) _ Exterior Alteration (Multi)
_ 01 of Plex _ Lower Level _ Pool Miscellaneous
Accessory Building
WORK TYPES
New _ Interior Improvement _ Siding _ Demolish Building*
_ Addition _ Move Building _ Reroof _ Demolish Interior
Alteration _ Fire Repair _ Windows _ Demolish Foundation
Replace _ Repair _ Egress Window _ Water Damage
Retaining Wall *Demolition of entire building - give PCA handout to applicant
DESCRIPTION
Valuation CoO Occupancy MCES System
Plan Review Code Edition SAC Units
(25% 100% Zoning I City Water
Census Code y3 y Stories Booster Pump
# of Units - Square Feet PRV 1
# of Buildings Length aJ Fire Sprinklers
Type of Construction Width
REQUIRED INSPECTIONS
Footings (New Building) Sheetrock
Footings (Deck) Final / C.O. Required
Footings (Addition) Final / No C.O. Required
Foundation HVAC
Drain Tile Other:
Roof: Ice & Water Final Pool: -Footings Air/Gas Tests -Final
Framing Siding: -Stucco Lath -Stone Lath -Brick
Fireplace: -Rough In Air Test -Final Windows
Insulation Retaining Wall: _ Footings _ Backfill _ Final
Meter Size: Radon Control
Erosion Control
Reviewed By: , Building Inspector
RESIDENTIAL FEES ~ 3 Y Nd*nli,,, 1 q 9g y
Base Fee ,3 i~'` cry
Surcharge
Plan Review 3501 3i 8 A0, 63G019'
MCES SAC
City SAC a k'Jk'iA ,~q~r >vsrngj hr{j a° ~o
Utility Connection Charge
S&W Permit & Surcharge 3?
Treatment Plant
Copies
TOTAL
Page 2 of 2
(0 00400 v3( S?
v
N2 3268
CITY of EAGAN
BUILDING PERMIT
Owner ....
/?....?.r .......................................
Address (present) .....Aip ^?-=?._ .., ..r..^..? ........................
Builder .................................................................................................
Address
DESCRIPTION
3795 Pilot Knob Road
Eagan, Minnesota 55122
454.6100
Date _...`.:3.0
..
Stories To Be Used For Front Depth Heigh! Est. Cos! Permit Fee Remarks
a LOCATION `7A-C-;
or
This permit does not authorise the use of streets, roads, alleys or sidewalks nor does it give the owner or his agent
the right to create any situation which is a nuisance or which presents a hazard to the health, safety, convenience and
general welfare to anyone in the community.
THIS PERMIT MUST BE KEPT ON THE PREMISE WHILE THE WORK IS IN PRO RESS.
This is to certify, that ....'a.:.`.'.`.: e::?...._?.°.?.'°.'-.........has permission !o erect
the above described premise subject to the provisions of all applicable Ordinances for the y of E gan.
...`.......a z : ........................
Mayor
R
Per ............................ ...............CJ??.............. j...........
Building Inspector
A
CITY OF EAGAN Remarks `c /=
Addition Section 9 Lot Blk Parcel 10 00900 031 50
Owner hyli???UL+. treet 3225 Donald AV.e State Eagan,MN 55121
i S ? ? j i,(? _? 1 I 1, ? '? I
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. 1 666.0 10 Paid
STREET RESTOR.
GRADING
SAN SEW TRUNK y D 1968 1 0.00 4.67 Paid
* SEWERLATERAL 1173.1 7 .21 1 Paid
Sewer Stub N 350.00 15 Paid
* WATERMAIN 1
WATER LATERAL
WATER AREA
# STORM SEW TRK 1975 15 1
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. 260 1 6 IL-30-74
PER.
SAC
Lon-oc
10506
-30-7)j-
PARK
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-189
(612) 681-4675
SITE ADDRESS:
IV
1 ? ??ta
I PERMIT SUBTYPE:
I I ; :01tal1-- 1
_/c) INSPECTION RECORD
PERMIT TYPE:
Permit Number:
Date Issued:
' ` `,
41 tit ttr M. APPLICANT:
TYPE OF WORK:
,( 1,,,;
I 114A1
Al IFRAIION
ttiA?; IN`.fR11
Perm" No. Perm" Holder Date Telephone e
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 6 (/
FIREPLACE
AIR TEST jl
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
RESIDENTIAL
,`ZSR 75
BUILDING PERMIT APPLICATION G
C) CITY OF EAGAN 3 0 `? 1-
3830 PILOT KNOB RD - 55122
651-681-4675
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 sizes: poured found design, etc.) . 1 site survey for exte6or additions & decks
. 1 set of Energy Calculations
. 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 ^" ! VALUATION (excwDlNC LAND/?j Igo.oD
JOB SITE ADDRESS57Z? 9fL6 54iFNUZ_
IF MULTI-FAMILY BUILDING, HOW MANY UNITS?
PROPERTY OWNER - 7M 8 " ,IONNCL ?.P? V taIM Z
TYPE OF WORK n'lD/Ar FIREPLACE(S) _ YES _ NO
APPLICANT
PAGER #
CELL PHONE #
PHONE # 4 721 4?6Z0F
_ FAX # VIEW RESIDENTIAL BUILDING ONLY - FILL OUT COMPLETELY
Energy Code Category
(check one)
Plumbing Contractor: _
Plumbing System Includes:
Mechanical Contractor: _
Mechanical System Includes:
Sewer/Water Contractor:
Phone #
Phone #
All above. information must be submitted prior to processing of application. . -
9 04
l Q?c?n a-gl2
I hereby acknowledge that I haveread this application, 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
.ertificates of Survey Received _ Tree Preservation Plan Received _ Not Required
_ MINNESOTA RULES 7670 CATEGORY I
- Residential Ventilation Category 1 Worksheet Submitted
- Energy Envelope Calculations Submitted
MINNESOTA RULES 7672
- New Energy Code Worksheet Submitted
Phone #:
Water Softener Lawn Sprinkler
_ Water Heater _ No. of R.I. Bade
No. of Badis
Air Conditioning
Hcat Recovery System
Pee: $90.00
Updated 1/01
PERMIT
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road B U I L D I N G
Eagan, Minnesota 55122-1897 Permit Number: 029271
(612) 681-4675 Date Issued: 11/22/96
SITE ADDRESS:
3225 DONALD AVE
LOT: 31 BLOCK: 50
SECTION 9
P.I.N.: 10-00900-031-50
DESCRIPTION:
(GAS INSERT)
635xldinc.Permit Type FIREPLACE
buil-ding Wl,rk Type ALTERATION
i?'Census Oods?;y
REMARKS:
434 ALT. RESIDENTIAL
.? ..u J 1 A' g`j ?x u.
L x? X
FEE SUMMARY:
Base Fee $25.00
Surcharge $.50
Total Fee $25.50
CONTRACTOR: - Applicant - ST. LIC OWNER:
FIRESIDE CORNER INC 16331042 0001068 GREEN TOM
2700 N FAIRVIEW AVE 3225 DONALD AVE
ROSEVILLE MN 55113 EAGAN MN 55121
(612) 633-1042 (612)452-6044
I, hereby.. acknowledge_,that -l .,have read ,this rapplication and state that;the -
>inFvrmation, is ogrrect a nd agree to comply ,with ?aJLL applicable Sta:xe- ofMn.
Statutes, and ,pity aF fia?an. Qx¢i a ge' K e s _
. ... ?....... .... ?. a. e........ Sr, ,. .... ?_ ?..a....m.._n .., .., atw. F ?I . L....... '. "v'.... _L.... .ems" .? _.?...« .... '....
APPLICANT/PERMITEE SIGNATURE
ITSSUED :sl A U E
l?
,µp e l ?'•k H , ..,ate
y t ? •1 ... :ice:,.
r::v 4 CCTV 3F V.k,AN
F f ASH1:L:h *ko "' TJ}:?f4INAL MG 3 4
Y'IATR?- ,T''MF 415: i'PvefJi
k r y k n t f' ;? J?
?1AME: F?L LIED„ FIRESI INL
t.
? $5, )C1Q1 32x 5 DrONAL + A4f? 1) +
32tf? L3?31 420Rk NTON,RI 7. 2`t.CYQ;,
ON 4& F _ a zit'
2a a;i 9G fI rr:L'i" ThF?';T
ex r - < + 7yY` r ?`i r
l.:i?i? tti ' Y a$y
[t i
Tota §oeP9r-t AnaYljirntt`, i,At3
L?i3LY'?3b10. - s
X *% SPiN $i?k #7 yF k?(kYtk t GYt k#sF # an, uAi-,
r
CITY OF EAGAN
55122
Miq 3830 PILOT KNOB RD -
1996 FIREPLACE PERMIT APPLICATION
`r
L 681-4675
DATE: Z
DESCRIPTION OF WORK: CONSTRUCT NEW FIREPLACE: WOOD BURNING GAS
INSTALL GAS INSERT ONLY IN EXISTING FIREPLACE
INSTALL GAS LINE ONLY IN EXISTING FIREPLACE
ROOM TO BE INSTALLED IN: -t so ADDRESS: 3 -z z ? -+-so ?A A?-O 1i V{
LOT 0, _ BLOCK -?Z SUBDIP.I.D. #: P-I
APPLICANT: (circle one only) OWNER CONTRACTOR
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.
PROPERTY
OWNER
OTHER:
Name: 6 141W? J q nl ?J (:!5L- Phone
Signature:
Street Address: 3 Z-ZE' ?ocJ ALA OYZ
City: ff-A tt{{?? State: 44 N Zip: 5-5- 12- .W
FIREPLACE
INSTALLER
GAS LINE
INSTALLER
Phone #:BYo:Q 633 7
Street ddress:369FD -U-) --ld License #: `D 8
City'bu 4Aa J I t.-L-? State: 'Lu
Company:
Name:
Signature:
Street Adc
City:
State:
zip:-53-37Z
Phone #:
(o 00900 v-;l 5b ::4
SOT., I' MINNESOTA VALLEY ,.cpTq? II ;,?++
SURVEYORS & ENGINEERS CORP.
N
f J?
C Jl +??}._ ? 120M F-I21N eVEH11e $OYiN e11RNevILLE, MINHf1a1.. 553n C }ka ?. ?W
'L .4 1 A
Certificate of Survey for: t
?_ G x
QQ L2 #;'
h .?
o
"06-1
c---io2.oa - y
O I f
m
1 y t.1
NW Cor, Lot. ?o ry/ ??v /?40
\ / Eosenieo ? Q a
Block 3 - O (/&•K/a .: /•':fi /!.f':'tih /if
/1/a7lh /ine of Lo}
B/ock 3 Lelendne 4a'' NQ, 2 o v ;i
- ?O 21
I
9'r
cjt
r:
Revised -Ii•ne 6 1974
I hereby ...li+y that this is o true and sane., representation Minnesota Valley Sarreyors
of . survey of the boundaries of the above described land, - Ea$1 era, C rp. - `=
and of the lorotion el all buildings, .here.., and ell visible ???-_'•?: R L 5
anvoo<hmems, if any, from Or on said hind. y 4
As surveyed by me thi,Z"`r day of tlu/ - A-0- +oZ-?1 1 - 9293 n`
Minn. Reg. No.
t
MASTER CARD
/6) 6C)¢oo 0 3l S?
LOCATI
OWNER
STRUCTURE AND
LAND USED AS
Permit
No.
Issued Issued To
Contractor Owner
BUILDING
PLUMBING -
CESSPOOL - SEPTIC TANK #?--
WELL
ELECTRICAL
HEATING
GAS INSTALLING
r ??
SANITARY SEWER
_1 [f G?
='
OTHER
OTHER --
--?--?- -
Items Approved
(Initial)
Date
Remarks
Distance From Well
FOOTING J/7/`JS
?
?
? SEPTIC
FOUNDATION -
-
- CESSPOOL
FRAMING Q z L
/ TILE FIELD FT.
FINAL
ELECTRICAL
HEATING
-07 DEPTH
OF WELL,
_
GAS INSTALLATION -
SEPTIC TANK
CESSPOOL
DRAINFIELD
PLUMBING PZ/ 9 6- 71
WELL
SANITARY SEWER
21
Violations Note
d
on Back
COMMENTS:
2004 RESIDENTIAL PLUMBING PERMIT APPLICATION
CITY OF EAGAN
?-I c 3830 PILOT KNOB ROAD, EAGAN MN 55122 c?
v 651-675-5675 I S
Please complete for modifications to existing residential dwellings.
Date l
-
Site Street Address
? 1e_ Unit #
a2a.5
'
-1f??
Property Owner Telephone
Contractor i29 P?
p V 1 /m Telephone #
_
AddressIi?/a Cityty / 15azz -- State Zip
The Applicant is: _ Owner Contractor -Other
Alterations to existing dwelling $ 50.00
-Add fixtures to rooms, excluding water softener and water heater
-Septic System Abandonment
-Water Turnaround (add $121.00 if a 518" meter is required)
Other:
Water Softener _ Water Heater $ 15.00
replacement _ additional
7?
Lawn Irrigation System RPZ_ new _ repair -rebuild $ 30.00
State Surcharge $ .50
Total $
I hereby apply for a Residential Plumbing Permit and acknowledge that the information is complete
and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan and the plumbing codes; that I understand this is not a permit, but only an application for a
permit, work is not to start without a permit and work will be in accordance with the approved plan in
the eveAt a plan is requirgd to be reviewed and approved. // n
Appricant's Printed Name Ap'plicant's Sigi)=re-
7
2004 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
?S? 33 Telephone # 651-675-5675 FAX # 651-675-5694
New Construction Recuirements RemodeVReoair Requirements (SfNce"rlll
3 registered site surveys showing sq. fl. of lot, sq. ft. of house; and all roofed areas 2 copies of plan Cep orSurvE }18at a ?'r if ? "N
(20% maximum lot coverage allowed) 1 set of Energy Calculations for heated additions Tree i diwiFod
Tiel'ras (Zeq°ueast `r?
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 if on-site septic system pnSepl?,,. pb,? F i r1,
3 copies of Tree Preservation Plan if lot plafted after 711193
Rim Joist Detail Options selection sheet (bldgs with 3 or less units
Date - / 02-2- / /
Site Address w ?? G Construction Cost $ 5i 570 r o-0
Jr??o2 Unit/Ste #
Description of Work
Multi-Family Bldg _ Y X. N Fireplace(s) _ 0 _ 1
Property Owner I If i Q n cLTw oe, I `\: / -J re?2() Telephone If (6.51) 7lso? - ?G ?7? y
/ (
Contractor 7D/
(?
Address %
State --??nn
City dt (Y?/
Telephone # 4:51) oZ [ 1 -5l/p
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
c
Telephone #(
Telephone #(
Telephone # (
I hereby apply for a Residential Building Permit an Vapication ge that the information is complete and accurate;
that the work will be in conformance with the ordodes of the City of Eagan and the State of MN
Statutes; I understand this is not a permit, but only 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
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 EM. 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_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 4&W Occupancy MCES System
Census Code 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.
X Footings (deck) _ Final/No C.O.
Footings (addition) _ Plumbing
_ Foundation _ HVAC
_ Drain Tile Other
Roof _ Ice & Water _ Final Pool Ftgs _ Air/Gas Tests -Final
Framing _
_ Siding _ Stucco - Stone - Brick
_ Fireplace _ R.T. -Air Test -Final _ Windows
Insulation Retaining Wall
Approved By: f (? Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
N
0s R
0.
N ,. h
O ? W
O ?I
M ?? ? w 3
2
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a
I aP 2 I W
y l° 4° OI o
\ `` I I ??? ? I ul ? V
;?\ gYis"? ??1j59`,•c 31'?Chcµ!wP? 0.2°?? ' ? I Q
L M 214 I ?`h
N , 1 \) ,,,? h o
`?'O O?,O ° I lyR j Nrs?°WpO,? p Z
? 4; ' W = h h ? '? a o C'.
L .
t9i
3 W\ W DECK 3„ a°?p p W JJJ ?Q '
`• V I L" N SE Vi I°1
\V 3 -
h I e4, rA _ ,??
:`I y.7 i $NEO 64 AGE
PO/HT OF BEC/NN/NC afT:
laglecEC ro 8E AEC. ?"'-' --- --- ' -L ' •.;.,.• 'r:
IS 41 ? ......, Kea^/z z? aoar /o/.ea rift) __ _• ?s'•; `^
NB9°08`01"y? NC/NE CO!/B[K3 ?y ?Y7,?. [ ,.? ? !S.
\. ;MO
4j.e •? NW COR. (OT dr "' -. ? ro r
OA ? BLOCKS FE``Ce" ). ...? Oej C
M r ?? I 4
of the
:t half of
I
that part I
Southwest
330 feet
Amab
city of eagan
C4lR1CLA E. AVADA
Mayor
PAULBAKKEN
PE.G(; ' CAU SON
May 2, 2001
CYNDEE FIELDS
MFG TILLEY
Coundl Mcrnbcrs
MR PHILLIP LARSON
3325 DONALD AVE
THOMAS HEDGES EAGAN MN 55121
Cin, Administrator i
Dear Mr. Larson:
On May 1st, I inspected a shed on the back of your home and found it to be an unsafe
Municipal Center: structure due to a collapsed roof, bowed walls, and partial detachment from the home
3530 Pilot Knob Road itself.
Eagan, MN 55122-1897 Sincerely,
Phone 6.Fax: (51.681.4612 TDD: 651.454.5535 ! William Bruestle
Building Inspector
Maintenance Facility:
. WB/]s
3501 Coachman Point
Eagan, MN 55122
Phone 651.651.4300
Fax: 651.68 1.4360
TDD: 651.454.5535 www.cityofeagan.mm
THE LONE OAK TREE
The m-mlwl of nrength
and grnVah in nor
annnumiq'
o
NOTE T
e
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NOTE.
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s4-
VILLAGE OF EAGAN WATER SERVICE PERMIT
PERMIT NO.:
3795 Pifot Knob Road
Ligon, MN 55122 DATE:
No. of Units:
Zoning:
Owner:
Address:
Site Address:
Plumber: Connection Charge:
Meter No.:
Account Deposit:
Size:
Permit Fee:
Reader No.:
I agree to comply with the Village of Eagan Surcharge:
Misc. Charges:
Ordinances.
Total:
By Date Paid:
-
Insp.:
Date of Insp.:
VILLAGE OF EAGAN SEWER SERVICE PERMIT
3795. Pilot Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning: No. of Units.
Owner:
Address:
Site Address:
Plumber:
I agree to comply with the Village of Eagan Connection Charge:
Ordinances. Account Deposit:
Permit Fee:
Surcharge:
By: Misc. Charges:
Date of In Total:
Insp.: Date paid
City of Eaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Use ��
Permit #:
Permit Fee: �6
Date Received:
Staff:
i1
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit #:
Resident/
Owner
Name: �- -- 6---trese.n Phone: 9S7-02(
_57,--
r-�
Address / City/ Zip -j -t') q f Of aJ -L EL: yt 1
,)--‘C
Applicant is: Owner --j' 6ontractor
Type of Work
,Description of work: ' 64 c
Construction Cost: 6W-5-!- ' Multi -Family Building: (Yes / No )
Contractor
�
Q it e )/ontact: VC -VV.\
Company: FI (-9-1—. (, /ir
Address: 2-0931.--y1.--y0 i .n Or City: ry, rU,(. z_4)'_.
State: '1 � 1� % Zip: - 3 2 Phone:_. / s -=,
lr
License #: k-3 I 7`'1 7.,f_____ Lead Certificate #:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
In the last 12 months,
Yes No If
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Eagan issued a permit for a similar plan based on a master plan?
yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that they are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.orq
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the MinnesotBuilding Code Oust be completed within 180
days of permit issuance.
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Applicant's Printed Name
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Ap
ant's Sign
Page 1 of 3
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA149084
Date Issued:05/07/2018
Permit Category:ePermit
Site Address: 3225 Donald Ave
Lot:000 Block: 000 Addition: Section 9
PID:10-00900-50-031
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.
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Timothy R Mudge
3225 Donald Ave
Eagan MN 55121
Uptown Heating & Cooling
3110 Washington Ave N, Suite 100
Minneapolis MN 55411
(612) 827-4674
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA149085
Date Issued:05/07/2018
Permit Category:ePermit
Site Address: 3225 Donald Ave
Lot:000 Block: 000 Addition: Section 9
PID:10-00900-50-031
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 -
Timothy R Mudge
3225 Donald Ave
Eagan MN 55121
Uptown Heating & Cooling
3110 Washington Ave N, Suite 100
Minneapolis MN 55411
(612) 827-4674
Applicant/Permitee: Signature Issued By: Signature