3810 Country Creek Way
f ~
Use BLUE or BLACK Ink
I-- - -
1 ,
Permit
fit " -3--
of Bap
i
3830 Pilot Knob Road Permit Fee:
! !
Eagan MN 65122 1 Date Received: I
Phone: (651 675-5675 I I
Fax: (651) 673.6694 I Staff: I
_ !
INFLOW & INFILTRATION PERMIT APPLICATION
Plumbing / -Sewer & Water
Date: 1 / J Site Address: 91jo r!
Tenant:
Suite a.
r i
Name: Tc~P~a b~r-~ phone. 6e61-q!5;?-&X76
REsIioENT/OwNER
Address / City / Zip: i v coul *OfLrlg~k aku - Lazy? >U Jl Jr5
Name: !~r ~1
nU e.~ t,G7r~ ~I '►fi uoense J(,01 i?6/ _ ply
399a ~ennsy/ ~r
CONTRACTOR Address: aA ----ter ~e- city:
State: M3 _Zip: Jr'~a Phone: G JAI " & St,- /a 44p
Contact 45-1 re or I!.l h e- Email: IIe
Coy
PLUMBING (within the building envelope) SEWER & WATER (Outside the building envelope) `
TYPE OF WORK Sump Pump Repair Repair
Other:
Other:
DESCRIPTION Desc Iption of work: 1' e
FEES , i ~~C p/l<2 E~
$55.00 !Each (includes $5.00 State Surcharge) C/g f ~~~~il TOTAL FEE $ . Q b
'Permit flees will NOT be reimbursed by the City of Eagan. If you plan to submit M repair costs for
reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors
can be found by visiting www.citvofeatian comlinflow, or City Hall at 3830 Pilot Knob Rd.
CALL BEFORE YOU DIG Call Gopher State One C811 at (651) 454.0002 for protection against underground utility damage. Call
46 hours before you intend to dig to receive locates of underground utilities. o to I.
v+vw gophers t9Qnecal cxo
! 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 tD 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,
~ulr~ 1-1 uck~mue.Irer
Appilcent's Printed Name `
Ap cant's Signature
Ft~!Y' 9 ' z b° _ a
s 8 m J is , I 4 a,
' ~ FZe`v181~e(1, I~ia#es
pAti 3 rQ
S.
F
ailed 09 T ZBB9 T S9 '73nwAonmaxb3 13rN3Sd1 dH Wd0 T : T T T T OZ 91 `;qad
PERMIT
City of Eagan Permit Type: Building
Eaaan. Permit Number: EA094238
Date Issued: 06/02/2010
OR Permit Category: ePermit
41 it~ of E3
E
Site Address: 3810 Country Creek Way
Lot: 3 Block: 1 Addition: Cedar Grove 11th
PID:10-16711-030-01
Use:
Description:
Sub Type: e-Reroof Construction Type:
Work Type: Replace
Description: House
Census Code: 434- Occupancy :
Zonin,:
Square Feet: 0
Comments: If there is no ice protection inspection prior to final, the contractor must meet the inspector Nva ladder and flat bar.
Pictures are not acceptable in lieu of inspections.
Carbon monoxide detectors are required by law in ALL single family homes.
Fee Summary: BL - Base Fee S3K $88.50 0801.4085
Valuation: 3.000.00 Surcharge - Based on Valuation S3K $1.50 9001.2195
Total: $90.00
Contractor: - Applicant - Owner:
Bradach Roofing, Siding & Seamless Gutters Inc Teresa Y Hebert
18267 Ital Ave 3810 Country Creek Wad
Lakeville NIN 55044 Eagan NIN 55122
(952) 892-601
I hereby aeknowledae that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and Cite of Eaaan Ordinances.
ApplicantiPermitee: Signature Issued Bv: Signature
CITY OF EAGAN
3795 Pilot Knob Rood Eagan, MN 55124
PHONE: 464-8100
BUILDING PERMIT RQCeiRt #
To 6e used for . ` Date
5ite Address
Lot Bfock ? Sec/Sub. "-
Parcel ?}.`
? Name
W
a Address -
0
? Name
0
o? Address ' i` •
V?
? r:... . %??.' o?.,,..,. `•54-6873
Name
I hereby acknowledge that I have read this application and state thot
the information is correct and agree to comply with all opplicable
State of Minnesata Stvtutes and City of Eagan Ordinances.
Signdture of Permittee
A Building Permit is issued to:
all work shall be done in occordance with all oppli
8uilding Official '
N4 4473
tember 7, ,a 77
Erect Q. Occupancy
Alter ? Zoning
Repair ? Fire Zone _
Enlorge ? Type of Const.
Move ? # Stories
Demolish ? Front ft.
Grade ? Depth ft.
ADD?OYGIS FCC$
Assessment -
Water & Sew.
Pol ice
Fire
Eng.
Pfanner
Council
Bldg. Off. ,
APC
TIIG•
Permit
$urcharge Plan check
SAC '_; s °:7{1
Water Conn.
I Water Meter
Total '?`?• 40
on the express condition thot
and City of Eacan Ordinancas.
Permit # Da% Iswed Penuiffer
Plumbing 77
Mechanical 7 7
INSPECTIOMS ? DATE INSP. RoupMln Final
Footings Date fnap. Date Irqp.
FoundoYion Plumbing 77
Frame/ins. l'/?' Mechaniwl p.?/-)) 77
Final ?
3 ' 77
I
Remarks: !
(?
(y'yt??,?-?0 /D •-a Y - >?
4,tz?-w CLQ.4 ,
? CITY OF EAGAN Remarks
Addition CEDAR GROVE #11 Lot- 3 eik 1 Parcel 10 16711 030 Ol
Owner?, ?? -??o street _3810 Country Creek 47ay state Blu,mt 1"IN 55122
Improvement Date Amount Annual Years g Payment Receipt Date
STREET SURF. 1971 261 - 65 26 - 16 52.37
STREET RESTOR. ?y 12
75
124.31
12.43
10
74.59
A005485
1 20 78
GRADING
= _ jqff
Str
,Oat
1978
1035.45
103.55
10
207.05
C0104
5-29--65
5AN SEW TRUNK t4 b 1968 60.09 2.00 U 38.09 A005485 1 20 78
if SEWERLATERAL } 1975 1 6 298.79 29$.$0 A 5485 2 78
* Water lat. & stubs 1975
WATERMAIN
WATERLATERAL & area 1 200.45 13.36 1 120.29 A 5485 1 2 8
WATER AREA I
* Stc,rrr Sewer Trunk 1976 268.;, 68 107.38 AO 5485 1/20/78
?
STORMSEW TRK " 1971 33.56 1.6 20 20.20 A005485 1 20 78
STORMSEWLAT kb 1971 222-37 1.11 20 13.49 A005485 1 20 78
CURB & GUTTER
SIDEWALK 197$ M 1$.75 10
STREET UGHT
WATER CONN. 230.00 07301 9-7-77
PER. #4473 07301 9-7-77
sAC 475.00 07301 9-7-77
PARK
-t7
7?7
?
! --?ITY OF EAGAN. .
I 3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS: Hl , it r
r:•.k I n I-JA?
PERNIIT SUBTYPE:
ON
;CORD
PERMIT TYPE:
Permit Number:
Date Issued:
APPLIGANT:
{ P. ( . } ?!.'?• i;`hi
TYPE OF WORK:
Wl t I If t H?
0:4N4NN
1N/iC1/4 Y
rrr PAr.R
(nooFl111i )
ROOF 1 Nf,
Permit No. Permit Holder Date Telephene # i
ELECTRIC
PLUMBING
HvAC
Inspection Date Insp. Commenta
FOOTINGS
FOUND '
FRAMINp
ROOFING
ROUGN
PLUMBING
PLBG
AIR 7EST
ROUGN
HEATING
GAS SVC
TES7
INSUL '
GYPBOARD
FIREPLACE
FIREPLACE
AIR TEST I
I
FINAk. PLBG
F!NAL HTG
ORSAT
TEST
BLDG FINAL
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
,---GI-TY OF EAGAN °
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS:
? • :tii ?,;::i_ ? ?! 1
PERMIT SUBTYPE:
ON RECORD ^--
,,+? r ? ?? ? ?ci
PERMIT TYPE:
Permit Number: ? ?g ?'
Date Issued:
.
IAl i FIRcl.TFR
7 7 1? 5 1f, i
TYPE OF WORK: ;, FpA t N
r i nr n i
FT 4
,..
. ?... ,. _. -.._, .. ? ?. . . :'
?
.t, • : , , . ?' ?.. . _ . .
V
Parmk No. Pernit Holdsr Date Ta{ephone M
ELECTRIC
PLUMBING
HVAC
Inspecdon Date Inap. Comments
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST
FlNAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
85MT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
?
INSPECTION RECORD
?f CITY OF EAGAN PERMIT TYPE: r I ' j' j 0 ',
` 3830 Pilot Knob Road Permit Number: °"t
? Eagan, Minnesota 55122-1897 Date Issued:
(612) 681-4675
I SITE ADDRESS: APPLICANT:
coIlPd l Ei Y(:Rt t t' t)A .?It 114 ? j'ri t't11 f+ 'at l?V I
E DAt7 .r,ROVE 1 t"i kl i?`, t J.,) 33] --•Rf,A 1 I,
PERMIT SUBTYPE:
i" f} 0 i' I Rf (i ??
TYPE OF WORK:
pgiR ?
1-.(=PLAC1` Exrt!:7IN(3
k'iNAi
r
Permit No. Pemd. Holder Date Telephone M
ELECTRIC
PLUMBING
HVAC
Inapectlon Date Insp. Comments
FpOTINGS
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
8SM'f R.I.
BSMT FINAL
DECK FfG
DECKFINAL
?vez?
to wmply with the City of Eagon
SEWER SERVICE PERMIT
Connection Charge: -
Account Deposit: -
Permit Fee:
Surcharge:
Misc. Charges:
Total:
Dote Paid:
CITY OF EAGAN WATER SERVICE PERMIT
3795 oidot Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning: No. of Units:
O
ner
.
w -
Address:
Site Address
Plumber
.
Meter No.: Connection Charge:
Size• Account Deposit:
Reader No.: Permit Fee:
1 ogree fa wmply with the City of Eagan Surchttrge:
Ordinanees. Misc. Chorges:
Total:
gy Date Paid:
kDote of I nsp.: I nsp.:
0
?
I'FATI?;? ?
Date• 17, ].'-?7":
CITY OF EAGAN
3795 Pilot Knob Rood
Eagan, Minnesota 55122
Phene: 454-8100
PERMIT
Site Address: 3810 CAUntz'y Creek Way
Lot Block ? Sub/Sec
I Ncme Lj,t.:L i ?.. :.?" .
Ciry r:aga? Phone:
F;(.,atinf7 Inc.
Narr?e
eaab..
Receipt No.:
Single
Residential
<-i•"`. _ :1" . . r' . . - _
r < _ r
?r)10
No
.
77 ._
I y
New/Alter./Repatr. Cost of Installotion
20.00
Permit Fee
.SO
e(3 ,r•,r,. . . S"
City ,:,'-- -- - , Phone: Total
This Permit is issued on the express condition thot all work sholl be done in accordonce with all opplicable State of
Minnesota Statutes and City of Eagan Ordinances.
?? -
.
4
,
+. h? •
PLU MBING
Building Officiol
CITY OF EAGAN
3795 Pilot Knob Road
Eogan, Minnesota 55122
Phone: 454-8100
PERMIT
Date: October 17, 197 i`
$ite Address: L'` ''v
Lot -" Block - Sub/Sec. `?r 11
Name ?' ` `?"=! Bttil• ,E?,rs
.
; Address
O
? City ` aqar. Phone:
Name C.-n?-Ryan Plm.bing & Heating
? Address 14745 So. Robert Traii
e
Cityv.??r-?tlri? Phone:
This Permit is issued on the express condition that oll work shull be
Minnesota Statutes and City of Eagan Ordinances.
No. ?
Receipt No.: ?) -f 7' {
$ingle
Residentiol
Multi Res., Comm./Ind.
New/Alter. / Repai r
Cost of Installation -
Permit Fee 20•00
Surcharge
Tota I "
done in accordance with oll applicable State of
Officiol
Tollefson Buildars Ioc.
Or.l0oU3-1
181-6d
F. C. JACKSON
LAND BURVHYOR
N6fi18THF60 UND[R 4Wg OR BTATC O/ MINNLfOTA
LICtNi[D SY.ORGINANC[ p/ CIIY OF YfMf[A/OLfE
727-3484
? 9818 EAST 687H STREETS541]
- . . _?_ - ?_-
?atbcpor'g QCertiticatc
• _ ?I"o r! -
fcj eq
7
-
? '
'
--?
30-
N I ?- ?-I
? .24 ? ? •?,
\ ?9
\
?
?'h?: s"
\?
I HE REBY CERTIFT TIAT TN6 AROV6 I B A TRYNS AMD OORREGT PLAT OF A SURV[Y \
Lot 3,Block 1,Cadar Grovn No. 11,
Dakota County,Minneeota.
AS SURVEYEp BY N8 TH1??SLII. pAY ? Feb• A
RevLaed July 20th. 1977
f•_
?
?
gi
q)
V
1141\
s
V
? .
CITY OF EAGAN PERMIT
3830 Piiot Knob Road O'ERMIT TYPE: B u z Lo i N G
Eagan, Minnesota 55122-1897 Permit Number: 030812
(612) 681-4675 Date Issued: 0 9/ 19 / 9 7
SITE ADDRESS:
3810 COUNTRY CREEK WAY
LOT: 3 BLOCK: 1
CEDAR GROVE 11TH
P.I.N.: 10-16711-030-01
DESCRIPTION:
REPLACE EXTSTSNG
E'eLSl°.q3ri?-,,Permit Type DECK
a 6,14, 4TYPe RepAIR
;CeneNS CQCl?r ' 434 A'LT. RESIDENTINL
Gt • •• +ii ?+aii
R?
r ?i?y. i+ p ` RBS?
F
?g Y a?o
s??
REMARKS:
FEE SUMMARY:
Base Fee $5e.00
Surcherge $.50
Total Fee $50.50
CONTRACTOF{: - Applicant - ST. LIC OWNER:
Li*F2RY'S HOME REPRSR SERV 13318641 5032 HEBERT 7ERRY
317 QUINCY ST NE 3810 COUNTRY CREEK WAY
MI.NNEAPOLIS MN 55413 EAGAN MN
(612) 331-8641 (612)452-8275
(
1997 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD - 55122
681-4675
New Construction Recuirements
RemodeUReoair Reauirements
Isd ?,So
? 3 registered sde surveys ? 2 copies of plan
? 2 copies of plans (inclutle beam & window sizes; poured fnd. design; etc.) ? 2 site surveys (eMerior aCddions 8 tlecks)
? 1 energy calcuiatians ? 1 energy ealculations for heated additions
? 3 copies of tree presarvation plan if lot platted aRer 711/93
required: _Yes _ N ?
DATE: ?5_A? CONSTRUCTION COST:
DESCRIPTION OF WORK: f219J_lmeM
STREET ADDRESS: ??? ? ???" 4 k_4Ze4IC '-?/'"j"'-'A
L T V BLOCK 1 SUBD./P.I.D. f11t
PROPERTY Name: /f4ol Phone &a7r
owNeR ?,,,
StreetAddress: -
City: rc? 6-?? State: Zip: SS 1 a?
CONTRACTOR company: L4Ma4,, ' C A--M,?7 &?-iv?' phone #:
Street Address: License #: ?a 3.2
City: ? State: i)1,A_J Zip: -S y/
ARCHITECTI Company: Phone
ENGINEER
Name: Registration #:
5treet Address:
City:
Sewer & water licer.r?ed plumber (new construction only):
and lot change are, equested once permit is issued.
Zip:
Penalry applies when address damp
I hereby acknowledge that I have read this appiication and state that the information is corr and agree to ly wi htable
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
State:
?I
i
f?
?I
. •,.Y'?,a
..,_ .} ?:,, . .? .
?
•'I
1 MER[BY C[RTIrY T11ATTM9 ACOyt ItA
.
4 .
. .. . z ? ; ?- . . ' . . '. r??' Ea ?"., [.. 1•? ? t?
w ? ??
z? n ;::y•'3 , . _ 1 F 3?'
_
?' . . . .,... . ': . . ' ' . ;,. .y , . '
LoE 3,Block 1.Cedar`Cnove No, il;
.
.
?
, :..
Dakota
County;Mianesot<<
a.
, . ..
, .- ... ,, , - ? •
' ' ';- • ? <?.-. ;;
T
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 6814675
PERMIT
PERMIT TYPE:
Permit Numher:
Date Issued:
BUILDING
030960
10/13/97
SITE ADDRESS:
P.S.N.: 10-16711-030-01
DESCRIPTION:
3816 COUNTRY CREEK WAY
LOT: 3 BIOCK; 1
CEDAR 6ROVE #11
(szoiNG)
ermit Type SF (MI5C.)
bnrk Type REPAIR
434 RLT. RESIDENTIAL
ss
a'?
?',???? a4:sn ?w. g? ? ?z??M 9' d?
?M.?. ?s ?7
REMARKS:
FEE SUMMARY:
Base Fee
Surcharge
Tota1 Fee
CONTRACTOR:
WALJ-MASTER
1197 PAYNE AVE
ST `PAUI. MN
(622) 771-5151
? ckriowl
•3?n, arma'?i`an 3s c
°Sta'C#?t`?a antl ;Cit
VALUflTION
$124.75
$3.50
$128.25
- Applicant -
17715151
55101
APPLICANT/PERMITEE SIGNATl1RE
$7,000
OWNER:
HEBERT 7ERESA
3810 COUtdTRY CREEK WAY
EAGAN MN 55122
(612)452-8275
.,.r1 I
ISSUED B : I A
? 1997 BUILDING PERMIT APPLICATION (RESIDENTIAL)
-?I??• ?J?
CITY aF EAGAN
5830 PILOT KNOB RD - 55122
687-4675
I:[3'? • - h • ? ' _ .?'?f?
1n1hlCr- 0^7' -12.rc5?DC-?CC
? 8 registered site surveys ? 2 copies of plen ? 2 copies of plans (inWutle beam 8 window aizes; pourod fid. desgn; etcJ ? 2 aRe aurveys (exterior adCRiona 8 dedcs)
? 7 energy plculations ? 1 On8
rgy calaletlana for heated additlons
• 3 copies W tree preservstion plan H lot piatted aRer 7!1l93
required: _Yes _ No "OQ
DATE: IOII3IR CONSTRUCTION COST: ?6 ` 33
DESCRIPTION OF WORK:
STREET ADDRESS:
LOT 5 _ BLOCK
PROPERTY
OWNER
CONTRACTOR
ARCHITECTI
ENGINEER
--L_ SUBD./P.I.D. #:
#
Name: IJ666riT zIR-5Q Phone #: 45 a- 'Fr h-75-
?
RemodeVReoair Raeuirements
r?
Street Address: SY1 C+ cac-)h?
City: E7AC?-Ahl State: M IV Zip: :S-a- I Z Z
Company: WALLW»5Tc-fZ phone #: '7 71 51 S/
Street Address: 11 q'7 LA?YIVC 8VC License #:
City: n7-4'r1 cA L State: _}'?l PJ Zip: ??? f
Company: Phone #:
Name: Registration
Street Address:
City: State: Zip:
Sewer 8 water licer.sed plumber (new construction only): . Penalty applies when address change
and lot change arc , equested once permit is issued.
1 hereby acknowledge tfiat 1 have read this application and state that the infortnation is
State of Minnesota Statutes and City of Eagan Ordinances. ?
Signature of Applicant:
OFFICE U5E ONLY
all applicable
Certificates of Survey Received _ Yes _ No
Tree Preservation Plan Received _ Yes _ No _ Nat Required
PERMIT CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
PERMIT TYPE:
Permit Number:
Date Issued:
BUZLDING
030955
10/10/97
SITE ADDRESS:
3810 COUNTRY CREEK WAY
LOT: 3 BLOCK: 1
CEDAR GROVE #1L
P.I.N.: 10-16711-030-01
DESCRIPTION:
- (ROOFSNG)
BDsldin?,Permit 7ype SF (MISC.)
Building Wqrk Type REPAIR
Cerrsu`s Cbde ?'? 434 ALT. RESIDEN7IAL
?
T.
L }:
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S? . . . . :144'IM.
° @ .
Yg S'xf? '? -,.?`
v'
! ri.
v}` '
1
a s rc a +v
?? ?????
M
REMARKS:
FEE SUMMARY:
VALUATION $3,000
Bese Fee $74.75
Surcharge $1.50
Total Fee $76.25
,
?
CONTRACTOR: - Applicant - sT. Lzc OWNER:
J J EXTERIDR CONCEPTS 14253636 0809389 HEBERT TERRY
12579 957H AVE N 3610 COUNTRY CREEK WAY
MAPLE GROVE MN 55369 EAGAN MN
(612) 425-3638 (612)733-7701
I hereky, acknowled9e , thatZ•° hams ,rear?1-th1s lipplS,cat3an arod 9,tatv tbst th? °
in-Formation is correct and `agree to comply wi.th all applicatile 5tate o# Mh.
StaCtites aad City :qf-Eagan l1rdl-nar+ceg;.
APPLICANTlPERMITEE SIGNATURE ISSUED B SIG ATURE
------- ------------
5 O BUILDING
Naw Constructlon Reauirements
RemodeVRenair ReauiromeMs
? 3 registered site surveys t 2 cpPjes p{ plan
• 2 copies of plans (indude beam 8 window s¢es; poured fid. design; etc.) ? 2 slle suneys (exteriw atltlRiona 8 decks)
• t energy calculetions ? t energy caiculetions tor heated additlans
? 3 wpiea of tree preservation plan if lot platted after 7H183
required: _Yes No '
DATE: , fO //O ! P 7 CONSTRUCTION COST: 2?`S C
DESCRIPTION OF WORK: PL?%! 0/"/1^-? H
STREET ADDRESS:
LOT _,.?L_ BLOCK SUBD./P.I.D. #: _ C,OJ'6, .?,JfB19Z ?I
PROPERTY
OWNER
CONTRACTOR
Name: _ f-P/i
u.,
Street Address:_
City:
Company:
PERMIT APPLICATION (RESIDENTIAL) 4?G , z
CITY OF EAGAN
3830 PILOT KNOB RD - 55122
681-d675
Phone #: '7? 3 '7101
wc
State:
/ioY LKZone # :
Street Address: ?.Sr<` License #:
City: State: ZipS'Sc?
ARCHRECT! Company:
ENGINEER
Phone #:
Name: Registration #:
Street Address:
City:
State:
Zip:
Sewer & water licer.ned plumber (new construction only): . Penalry applies when address change
and Iot change are , equested once permit is issued.
I hereby acknowledge that I have read this appiication and state that fhe informatio? is c?ect and a ,?6 comply with all applicable
Shate of Minnesota Statutes and City of Eagan Ordinances. \/ //
Signature of Applicant:
OFFICE USE ONLY
Certificates of Survey Received _ Yas _ No
Tree Preservation Plan Received _ Yes _ No _ Not Required
. CITY OF EAGAN
3795 Pilot Kno6 Road Eagan, MN 55122 NO. 4473
PHONE: 454-8700
BUILDING PERMIT APPLICATION $31t000. Receipt # _73g]-
To be used For Sing. Fam Dwlg, d Ggrg. Date September 7, 1 9 77
Site Addrew 3810 Country Creek Wav Erect [k Occupancy I
Lof 3 Block 1 Sec/Sub. C13 11 ? Alter ? Zaning Rl
Porcel # Repair ? Fire Zone _
Enlarge ? Type of Const. V
w Name SUSeAIIE J Forster Move ? # Stories
Z Address Demolish ? Front 42 ft.
? Cit Phone Gmde ? Depth 24 ft.
e...........?? Fee.
p Name T&ikef6^?°1dE5., iR@.
?? Address 14916 HelyokP I.n
Auole ValleY o6,,..e 454-6873
Nome _
Address
I hereby acknowledge that I hove read this application and state that
the information is correct ond a9ree to comply with oll opplicable
$tate of Minnesota Statut??$nd,City of?E gan QTdinan es.
J
Signature of Permittee -a ? (,! k
A Building Permit is issued to: To118£5oII BZdIS. I
oll work shail 6e done in accordo ce with all?cpplicabile tate of Mir
Building Official
Assessment Permit `1S.VU
Water 8 Sew. Surcharge 15.50
Police Plan check
Fim snc 475.00
Eng. Water Conn. 230.90-
Planner Water Meter 60.00
Co,,,,c;l Park Don 75.00
Bldg
Off
.
.
APC
rorai 948.50
C. on ihe express condition that
sota Slatutes and City of Eagan Ordinences
CITY USE ONLY
PERMIT #: 4J P RECEIPT DATE:
RUIDEPTIAL MECHANiCAI. PE$MIT APPLICATION
CfCYOii £Afil4R
3930 Paor Kxoa Rn
EA6AA E1ft 55122
651-6$1-4675
Please complete for. ? single family dweliings
townhomes and condos when permits are required for each unit
Date: 0F) I G ('p ( Cl ?
SITE ADDRESS:
OWNER NAME: 1
INSTALLER NAME:
STREET ADDRESS: 1.1n l0 ) /4+5"
cITV: 4 lr"k--
STATE: '(Y-)/\,j ZIP:
Plaee a check mark neYt te the nnrmit werk 4vne
New residential dwelling unit under constructionand not owner/occupied $ 70.00
n( Add-on, modification or alteration to existina dwelling unit $ 50.00
T, • fumace replacement
• air exchanger
• air conditioner
• other /J
Nature of work: // /L
State Surchar e $ .50
Total $
Reminder: Call for inspections.
7ELEPHONE #:
S-l ?,. - , f ?. G •
SIGNAtUAE OF PERMI
Updated VOl
Use BLUE or BLACK Ink
r - - - - - - - - - - - - - - - - -
I For Office Use I
Ea Permit I
City of 1 I 0~.
Permit Fee.
3830 Pilot Knob Road
Eagan MN 55122 I Date Received:
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff:
I I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit !J
Name: T Phone:
Resident/
Owner Address / City / Zip:
Applicant is: Owner Contractor
Description of work: C' S l YJ IT O ✓S~
Type of Work
Construction Cost: Multi-Family Building: (Yes / No
Company: t jel Ge S C1~ %?7r~ SJ ' Co act: J l /VL
Contractor Address: ~02 v tiw City:
State: ~4)`b Zip: Phone: 3 l~ d
License Lead Certificate M
If the project is exempt from lead certification, pleas explain why: (see Page 3 for additional information)
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 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.ong
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance. ,j
x ?5i~L
x
Applicant's Printed Name Applic nature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA175467
Date Issued:04/05/2022
Permit Category:ePermit
Site Address: 3810 Country Creek Way
Lot:3 Block: 1 Addition: Cedar Grove 11th
PID:10-16711-01-030
Use:
Description:
Sub Type:Furnace & Air Conditioner
Work Type:Replace
Description:
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Pete DeGrood at (507)
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 -
Teresa Y Hebert
3810 Country Creek Way
Saint Paul MN 55122--165
(651) 452-8275
Apollo Heating & Air
6510 Hwy 36 Blvd N
Oakdale MN 55128
(651) 770-0603
Applicant/Permitee: Signature Issued By: Signature