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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 }: j ? 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