1958 Covington Lane
Use BLUE or BLACK Ink
For Office Use 400
pity of Eap I Permit#:
I
~ Permit Fee: I
3830 Pilot Knob Road
Eagan MN 55122 j Date Received:
Phone: (651) 675-5675 I
Fax: (651) 675-5694 I Staff:
2011 MECHANICAL PERMIT APPLICATION
Date: Site Address:
Tenant: ,~~•~1 SbW_Suite
r~ CS ? c! Phone:
RESIDENT /OWNER Name: bc,
Address / City / Zip:
CONTRACTOR Name: ,^t t e S I:.-ii- License
Address: i ~ I ~ ~ A7 { S} - -tc ? City:
State: i Zip: -,S _ 3 .1 Phone: 9 S
Contact: Email:
TYPE OF WORK New Replacement Additional Alteration Demolition
Description of work: ~ -71 r
NOTE: Roof mounted and ground mounted mechanical equipment is required to be screened by City
Code. Please contact the Mechanical Inspector for information on permitted screening methods.
/ RESIDENTIAL COMMERCIAL
PERMIT TYPE %Z Fumace New Construction Interior Improvement
Air Conditioner Install Piping Processed
Air Exchanger Gas Exterior HVAC Unit
Heat Pump Under / Above ground Tank Install / _ Remove)
When installing/removing tank(s), call for inspection by Fire
Other Marshal and Plumbing Inspector
RESIDENTIAL FEES:
$55.00 Minimum Add-on or alteration to an existing unit (includes $5.00 State Surcharge)
$95.00 Fire repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge) $ TOTAL FEE
COMMERCIAL FEES:
$75.00 Underground tank installation/removal OR Contract Value $ x1%
$55.00 Minimum (includes State Surcharge)
Permit Fee
- If the Permit Fee is less than $10,010, surcharge is $ 5.00
If the Permit Fee is > $10,010, surcharge increases by $.50 for each $1,000 Permit Fee Surcharge
(i.e. a $10,010-$11,010 Permit Fee requires a $ 5.50 surcharge)
TOTAL FEE
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.om
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.
x 1J, x
Applicant's Printed Name Applicant's Sig tur
FOR OFFICE USE Reviewed By: Date:
Required Inspections: -Under Ground Rough In -Air Test -Gas Service Test -In-floor Heat -Final
Exterior HVAC Screening Inspection
. - • CITY OF EAGAN
N2
12669
3630 Pilot Knob Road, P.O. Box 21-199, Eagan, M N 55121
PHONE: 454-8100 /
BUILDING PERM IT Receiptp
7abeusedtor SF DWG/GAR Est
Value $760000 Date SEPTEMBER 23 ?y 86
.
SiteAddress-1958 COVINGTON LN Erect QC Occupancy R3
Lot 4 Block 3 Sec/Sub. BERKSHIRE PONDSRemodel ? 2oning pD
Parcel No Repair ? Type of Const. VnI
. Addition ? No. Stories
RMC DEVELOPMENT CO Move ? Length 40
W
3 Name
3209 W 76TH ST Demolish ? Depth dR
° Address Int. ImPr? Sq. F[
city EDINA phone $35-3773 Install ?
a SAME Approvals Fees
i o Name
$ ¢ Address ASS6ssment _
? Ciry Phone Water & Sew.
W W
MINNETONKA DESIGN
Name
Police
Fir
i
Address 337 WATER ST e
En
a W
ciry EXCELSIAgne 474-5991 g.
Planner-
Council
Ihere6yacknowledgethatlhavereadthisapplicationandstatethatthe BIdg.Off. 9/2 2 /86
information is correct and agree to comply with all applicable State of
Minnesota Statutes and City o)'eagen QrdinariG6s. _ APC
Signatwe of Permi Azw-Aff 4deA11s?-GI"
A euilding Permit is i ued to: RMC DEVELOPMENT CO
all work shall be do e in accordance with all applicable SD(te of Minne.
Building
Var.
Permit $ 361.00
Surcharge 38.00
Plan Review 180.50
snc 575.00
Water Conn. 500 . 00
Water Meter 63.50
Road Unit 290. 00
rr. Pi. 156 . 00
Parks
Copies
Total $2,164.00
on the express condition that
Ciry of Eagan Ordinances.
O
r- ?.•..?, 3830 Plbt Knob R d? P o. Box?2G-Ai9s, Eagan, MN 55121 N2 12669
PHONE: 454-8100
BUILDING PERMIT Receipt #
Tobeusedlor SF DWG/GAR Estvalue S76,000 pate SEPTEMBEK 23 19 86
SiteAddress 1958 COVIYGTON LN Erect DK Occupancy R3
Lot-4 Block 3_Sec/Sub. BEI2KSHIRE PONDSAemodel ? 2oning PD
Parcel No. Repair ? Type of Const V,q
Addition ? No. Stories
Name RMC DEVELOPMENT CO Move ? Length 40
? 3209 W 76TH ST Demolish O Depth a?
?3 Address Int Impr. ? Sq. Ft.
?ity EDINA phone 835-3773 Install ?
_ ? Na? s? aPa?vars Fe
? ¢ Address Assessment Permit _
'' ?it" oh- Water & Sew.
Police
Fire
Surcharge
Plan Revie
?? Aaaress ?-- •••??- ?- Eng. Water Conn. 2vv. vv
c.E W C;ty EXCELS7"e 474-5991 planner Water Meter 63.50
Council Road Unit 290.00
I hereby acknowledge that I have read this application and state that the gldg. Off. 92 2 $ 6 Tr. Pi. 156.00
information is correct and agree to comply with all applicable State of
Minnesota Statutes and City of Eagan Qrdinances. APC ParkS
Var. Date Copie
Signature of Permittee TOt81 , ' 00
A euilding Permit is issued to: RMC DLVELOPME:N'I' CU on the express conditlon that
all work shall be done in accordance with all applicable State of Minnesota Statuies and City of Eagan Ordinances.
Building
?? ? X t a e? y! ?? n n??? e a? 3 3 s ?3
s ? n n y ? ? e cf g r
y n T Q ? V x a
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z
s
-1
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i
PERMIT #
• '' - + , MECHANICAL PERMIT RECEIPT #
CITY OF EAGAN
.? 3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE /?"??
CONTRACT PRICE;???? ? PHONE: 454-8100
Site Address BLDG. TYPE WORK DESCRIPTION
Lot Block Sec/Sub
Res. New ?
? Name fj'y WL4 Mult Add-on
Addr - ? , Comm. Repair
c City S. . ?._ Phone pther
Neme FEES
? d ?
3 Address RES. HVAC 0-100 M BTU -$24.00
p City ? Phone ADDITIONAL 50 M BTU - 6.00
ADD-ON AIR COND. 0-24 BTU - 12.00
TYPE OF WORK
`J ADDITIONAL 6 M BTU - 8.00
L GAS OUTLETS - 1.50 EA.
Forced Air Lsls??"`_ M BTU COMM/IND FEE - 196 OF CONTRACT FEE
8oiler M BTU MINIMUM - RESIDENTIAL FEE - 10.00
Unit Heater M BTU MINIMUM - COMM/IND FEE - 20.00
Air Cond. M BTU STATE SURCHARCaE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
Vent CFM BEYOND $1,000.00)
Gas Piping Outlets #
Other
FEE
? SIGNATURE OF PERMITTEE
S/C:
tw
TOTAL•
FOR: CIN OF EAGAN
' ' • ' ' PLUMBING PEHMR RECEIPT #
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE:
Site
? Name
.q Addre
c City ?
L Name
c Addre
o citv -'
FEES
COMM/IND FEE - 1% OF CONTRACT FEE
MINIMUM - RESIDENTIAL FEE - $1U.00
MINIMUM - COMM/INd FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND $1,000.00)
FOR: CITY OF EAGAN
BLDG. TYPE WORK DESCRIPTION
?
?
New
Res.
Mult Add-on
Gomm. Repair
Other
N . FIXTURES ?TgTAL
Water Closet - $3.00
Bath Tubs - $3•00
L.aVStOt'y - $3.00 ' ?` . . .
Shower - $3.00
-
Kitchen Sink - $3.00
? -
Urinal/Bidet - $3.00
Laundry Tray - $3.00
Floor Drains - $1.50 • ?
Water Heater - $1.50 --' -
Whirlpool - $3.00
?Gas Piping Outlets - $1.50
?
Softener - $5.00
Well - $10.00
Private Disp. - $10.00
?Rough Openings - $1.50 •?
FEE '
STATE S/C: -
GRAND TOTAL• ' ? • !? ?
PERMIT # i = fi` -?' /
PLUMBING
CITY 0 EAG N'T RECEIPT #7-3 1.? 0 7S' 0 7
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: ? 7. ?'12Z& 7
f Site
Lot.
m Name _
w Address
c Ciy _
? Name _
3 Address
o Citl+ -?
` FEES
COMIVP/IND FEE - 1% OF CONTRACT FEE
APT. BLDGS - COMM RATE APPUES
TOWNHOUSE & CONDO - RES. RATE APPLIES
MINIMUM - RESIDENTIAL FEE - $12.00
MINIMUM - COMM/IND FEE - $20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
SIGNATURE OF PERMITTEE
FOR: CITY OF EAGAN
BLOG. TYPE WORK DESCRIPTION
Res. New
Mult. Add-on ?
Comm. Repair
Other
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
NO. FIXTURES TOTAL
Water Closet - $3.00 $
,,-Bath Tubs - $3.00
Lavatory - $3.00
Shower - $100
Kitchen Sink - $3.00
UrinaliBidet - $3.00
Laundry Tray - $3.00
Floor Drains - $1.50
Water Heater - 51.50
Whirlpool - $3.00
Gas Piping Outlets - $1.50
(MINIMUM - 1 PER PERMIn _ Softener - $5.00
Well - $10.00
Private Disp. - S10.00
Rough Openings - $1.50
FEE:
STATE S/C:
GRAND TOTAL•
CITY OF EAGAN Remarks
Addition BERKSHIRE PONDS Lot 4 81k 3 pa,,,I 10 13750 040 03
Owner Street 1958 Covington Lane State
Improvement Date Amount Annuai Years Payment Receipt Date
STREETSURF. rl, 1$2 239.09 23.91 10
STREET RESTOR. 12 1985 123.80 8.25 15
GRADING
SAN SEW TRUNK 471 1982 176.04 11.74 15
SEWERLATERAL 1982 57.24 3.82 15
* Sewer Lateral 1985 427.88 28,53' 1
WATERMAIN j 1982 46.09 3.07 15
* WATER LATERAL 1985
WATER AREA LAS 2
- 176.04
11-74
STORM SEW TRK -] 1985 385.03 25.67 15
STORM SEW LAT
CURB & GUTTER '
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER.
SAC
PARK
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
` Eagan, Minnesota 55122-1897 Date Issued:
(612) 681-4675 i
SITE ADDRESS: APPLICANT: I
?
I Nio 1 uN t AMt"
?
PERMIT SUBTYPE: TYPE OF WORK:
INSPECTION .• • .A
? ?
Permit Holder Date Telephone #
PLUMBING
HVAC
Inspection Date Insp. Comments
FOOTINGS
FOUND
FRAMING
ROOFING /?, •?•?D
7
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYPBOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
DDMESTIC
METER
IRRIGATION
METER
FLUSH
MAINS
CONDUCTIVITY
TEST
HYDROSTATIC
TEST
BSMT F.I.
BSMT FINAL
DECK FfG
DECK FINAL
CITY OF EAGAN
3830 Pilot Knob Road
P. O. Bex 21199
Eagan, MN 55121
Zoninp: _
Owner: ( :
, Addron:
Site /lddress:
umber.
?Meter No.:
ze: °
.Reod? No.. 0 70 6
91 .-w- h ooavhr ao th.
' OerMwwaa.
WATER SERVICE PERMtT
PERMIT NO.:
D/1TE:
. No. of Unlts:
Q+ar9e: ..
BY 011} (N RLti`? - Doro Paid:
Dnte of Insp.: Irnp.:
CITY OF EAGAN SEW1ER $R{/KE PERMR
3830 Pilot Knob Road
P. 0. Box 21199 PERMIT NO.:
Eagsn, MN 55121 DATE:
Zoninp: j-? No. of Units: ?
Owrnr: Dev
ross: --
t??
tAddress: 1458 Cc,t-i2^'
' 21 ^er A 1 re i'c>>ctr
':
mber: Va11ev i" f°r?ai•1?
.'iC?.OVnd
?w b eewIr wMb Ni. C?r ef fop¦ Conrnction Ow?ye: bI S nn? '.
Acoount Depo?it:
Permit Fee:
Surdwr0?:
Misc. !]?arpe?
of Irsp.: Total:
trnp.: Oaft Pald:
This request void 7/ 94, lJ %- '?-o J
18 months trom
r ?9 n7? 1 L, r? ?, a_?-4., `-?? ??!>-oo
Req ate • ? Fire No. J i-in,lns ction
Roughred
Requ ?Ready Now Notitv InsPec-
?No tor Whe
n Readv
[&Jelcensed Electrical Contrector I hereby request inspection ot above
f'1 n....,e, electrical work instelled at:
Street Addrass, x or Route No. City
ection o- Township Name or N ange o. County
O?pn^t (PRINT) ? ? .
C Phone N
?
Power 5 ?ier Address
Electrical Contractor lCompany Na Con ractor' license No.
DRIC? ELF.G?'RIC ,?
Mailin9 AdjL} e?t4q?,?qQ?'?Q[ i ionl
LI t La•
Authori vfn a ing Installationl Phone Number
MINNESOTA STATE BOARD OF ELECTRICITY
Oriqps-MidwaY BId9. - Room N-181
1821 Univaraitv Avs.. St. P-ul, MN 55104
Phone (612) 642-0800
BE ACCEPTED•BY THE STATE BOARO .
UNLESS PROPEH INSPECTION FEE IS
ENCLOSED.
j' 17 ??? REQUEST FOR ELECTRICAL INSPECTION EB-00001-05
/ 0 See instructiona for completinp this torm on back ot yellow coPV- ??_ '? C?
?` [` ? n? C "X'" 8elow Work Covered by This Requesr
dRea•
t4rA
' r
Tvps of Buildinq
Home
Duplex
ApPliancee 1Mirsd
Range
Water Heater
Equipment Wired
Te rary Service
Lightin,y Fixtures
Apt. Building Dr r Electrie Heatin
Commercial Bldg. urnace Silo Unloader
Industrial Bldg.
Farm Air Conditioner
O[hr.r Deci y Butk Milk Tank
ther (SDOr.ify)
t .r Suecify ther Other
CITY OF EAGAN
3830 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
f
DATE 19
eeceivec
FROM '
AMpUNT $ I
FOR BLDG. PERMIT N0.
8o DOLLARf
?oo
E]CASH ? CHECK
01-3210 Bldg. Permit
01-3422 Plan Check
01-3445 Surch./Adm.
01-3446 SAC/Adm.
01-2155 Surcharge
17-3860 Road Unit
20-2275 SAC
20-3865 Water Conn.
20-3868 Water Trmt.
20-3716 Water Meter
20-2252 Acct. Dep.
20-3713 Water Permit
20-3743 Sewer Permit
79-3866 Sewer Conn.
11-3855 Park Ded.
TOTAL
---- ---?------_ _._?
? ? 77r
`? j ' )
White-Peyers Copy
Yellow-Posting Copy
Pink-File Copy
Thank You
BY
?
7986 BQILDING PERMIR APPLICATION - CITY OF &AG98
HOYS: AI.L COPTRACTOHS MOST BE LICENSBD iiITH THE CI1R OF EAGAN
SIAGLE FANIII.Y DWELLINGS
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS
MQLTIPLE DNSLLINGS - RESIDfiNTIAL RENT9L ONiTS FOB SALE OAlITS v
INCLUDE 2 SETS OF PLANS, CSETIFICATE OF 3QR9EY - CHSCS i1ITH HLDG. DEPT.j
1 SET OF SNERGY CALCULATIONS
COPMRCI6t
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS9
1 SET OF SPECIFICATIONS AND 1 SET OF
ENERGY CALCULATIONS,
$2,000 LANDSCAPE BOND
-76C-;oa4&
To Be Used For: Valuatiori: i? Date: ? /
/ T
Site Address /?? U/Xq?? ??.rl/S ? OFFICE IISE ODTLY
Lot Y Bloek 3
Parcel/Sub
Owner
-,
Address
Erect ? Occupancy W5
Remodel Zoning
_
Repair Type of Const 'YN
Addition # of Stories ?
Move Length 21t-)
_
Demolish _ Depth
Int.Impr. _ Sq Ft _
C1ty/Zip Code
Phone R,5?'3773
Contraetor ,g-- ?'?UF_
Address
City/Zip Code
Phone
Areh./Engr. L }v?.4?
Address 1!K37 (?g.? fp/^4?
City/Zip Code
Phone # 4121AI Sv 9L
Install
APPROVALS FEES
Assessments Permit 244_
Water/Sewer Surcharge ?
Poliee Plan Review 1
Fire SAC
Engr Water Conn
Planner Water Meter 6r.5D
Couneil Road Unit Z O
Bldg Off Treatment P1 ?
APC Parks
Variance Copies
TOTAL 6?.
NOTE: ADDRESSES FOR CORNSB LOTS - CONTRACTOR/HOAlEOii9E6 MDST DESIGN9TE AHICH ADDRESS
IS D&SIRSD. NO CHAAIGES WILL BE ALLOSiSD ONCE BQILDING PERMIT IS ISSOED.
2ZA
15 x 12 = ??
CD ?. lo = 60
5 yt r,, > - ?
zZ? Z'Z.= AEA
ZZ = 4 A
?p x iZ = 1Z0
?5?= •51°z-tz
R53= ?d?4o
=
X56
x ? ? = 1?jZo
x ?? = 19?co
.;
-§"
,
? -75ZICo.Oo
w . . ? Y"
FOR: R.M.C. DEVELOPMENT
C. R. 1N3NDEN 3 ASSOCIATES, INC.
IAND SURVEYORS fol 645•3646
1381 EUSTIS ST., ST. PAUIi MINN. 55106
__ COV I N GTQ ?t L. RN E
-" ToP of Curb=935.47 Top•!L.+r6=939.s { -"-
K X
_ ('435.47) C? 5:COO. " C939,84?
?--
9
? o ?o
? I
?l
5 ?
,°?
I Scale: 1" = 30'
? 1 o Denotes Zron Monur,ient
?1 (9<0,'? ?
f?---
F
j2
` NOTE:
h ? 37, Denotes idooden Stake
4
L---- ??
a -
? Proposed Garave Floor E1.°940.?
(940,5) Denotes Pronosed
? 0
N
Q a ProPosed I? p rinished Ground E1.
j
'S
?°
ti
?
Q Denotes Direction O•`
D
i
£
_ ?955 ( ? nace
ra
Sur
ace
k I _ Q Vertic:al Datum-N.G.V.D. 1929
3
----
? I P' Overhony
(9?0, 5) (
? 3
q
1$
-
65.?0
t4 89035' 34"w
Swomp = 928 4
Lot 4, Block 3,BERKSHI?.E °ONDS,
Dakota County, Minnesota.
WE MERE6Y CERTIFY TMAT fMIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEI' OF THE
60UNDARIfS OF THE IAND A60VE OESCRI6ED AND OF THE LOCATlON Of Atl 6UIlDIwGS, {F ANY,
THFREON, AND AlL VISI6lE ENCIiOACHMENTS, iF ANY, FROM OR ON SAID IAND.
Derod t6is z^' day ef ?ecamGe'?A.O. I11185 C. R. WINDEN d'ASSOCIATES, INC.
?9ause Reviaeil?=?5-8G . _- ??
b4'b'A'
Sur+tror, Minneselo Ropitlratien No. 77Z
;
MhOIY
u !R-i.l'l,lf<!. V .i_i!? i, . '!"
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t?. iotai d?c??? area ................................................. .f -
' - '?--
C. Total :i'`di7u ulasc -.?rea ............. -"? •
. . . . . . . . . . . . . . . . . . . . . . ?=?-r? ?vZ _
. ., -- --?=---•-
d. Tutai firtiplace >::i1 ,-trea ........................................
e. o':a wall 1-raming ,:re,t
.................. .........
--?----
f. Total rin ,foist area...................... ............. r?--?
a. ?net w?tl', aree abrve i!irar ..................... ...............
h. wali area abav; Flcr .. .......... .......................
i. wall area aieve i?r ................. ................ --------?----
, ...
-------
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FVCITrOF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
PERMIT
PERMITTYPE: euzLorNG
Permit Number: 033031
Date Issued: 0 8( 2 7( 9 8
SITE ADDRESS:
P.I.N.: 10-13750-040-03
1958 COVINGTON LANE
LOT: 4 BLOCK: 3
BERKSHIRE PONDS
DESCRIPTION:
C-.-., T.O. & REROOF/STORM
Bu531di.n-g-•,,Permit Type STORM pAMAGE
BtiYlding W6rk 7ype REPAIR
,-G'ensus Code434 ALT. RESIDENTIAL
.i g ? i y>,a f c ' c;T a' x? ,• i?;..
.
r? 1 f i? i a,t e
REMffM:
DAMAGE.
FEE SUMMARY:
CONTRACTOR: - applicant - sT. Lzc. OWNER:
RIGHT WAY ROOFING 15578678 0003999 JOHNSON FAYE
16475 45TH AVE N 1958 COVINGTtlN I.ANE
PLYMOUTH MN 55446 EAGAN MN 55121
(612) 557-8678 (651)452-0379
I . _. . .. .. .. _. . . ..... .... . ... ... .
I hereby aeknowledge that S have read this application and state that the
information is carreet artd agree to camply with all appl3cabfe SCate kfi Mn:.
Statutes and City of Eagan Ordinances.- .
APPLICANT/PERMITEE SIGNATURE IS D BY: SIGNA7URE
I
1998 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EA(}AN
3830 PII.OT KNOB RD - 55122
681-4675
New Construdion Reouirements
? 3 registered sde surveys
? 2 copies of plans (inGUOe beam 8 window sizes; poured fnd. Eesign; etc.)
? 1 energy raleula6ons
• 3 copies of tree presenation plan iF lot platted after 7/1/93
required: _ Yes _ No
DATE:
DESCRIP ION OF WORK: ??f'M ?GNY?OI,GD.
STRE T ADDRESS: Icn?? co U?-?? ? LX1
RemodeVRecair Reauirements
• 2 eopies of plan
? 2 ske surveys (exterior addkions 8 decks)
• 1 energy wlwlations tor heated adddions
CONSTRUCTION COST; U (oUq CO
LOT: 'A BLOCK: ? SUBD./P.I.D. #:
Name: <XJ 1 LI'150 n `7"CA,l.1.Q, Phone #: (-4SZ- CB-iQ
PROPERTY Last Fi t
owxEx Street Address: 1AOS cwjl9'L??i'1 '1,i1.
-
City State: M'n Zip:
Company:? ? 2S Phone tt: Z?c?.c`{?0?Q
CONTRACTOR
StreetAddress: 1100 L.-IE'.Ith License# wO:?Vqq
Ciry (6IY)/) State: YY? n Zip: "7-r-?qlzs
ARCHITECT/
ENGINEER Company: Phone
Name: Registration #:
Street Address:
Ciry State: Zip:
Sewer 8 water licensed plumber (new conshuction ony): . Penaily applies when address chang
and lot change is requested once permit is issued.
1 hereby acknowledge that i have read this application and state that the iniortnation is conect and agree to wmply with all applicabl
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant:
OFFICE USE ONLY
Certificates of Survey Received _ Yes _ No
Tree Preservation Plan Received Yes No
CITY OF EAGAN
APPLICATION FOR PERMIT
SEWER AND/OR WATER CONNECTION
F_ xx xxxxxxxx-:_x_._._x:__xxx_
F^KYI.'S: PAYNIF?M OF FEE AT TIME OF
F APPrscATIorr noFS Nom coNS-riTUTE
F APPROVAI. oF PII2MrT.
M
F INSPE7GTION oF SESM APID/OR WATFR
F rnSrar.ramrpNS WII,L MT gE SCHED-
F ULID U@7rII. PII2NffT AAS BEQd
F APPROVID. '
. xxxx=xxxxxxx,.x- x,.xxw-,.xwwxwxx=-
, Please Print
l) PROPERTY ADDRESS:
LEGAL DESCRIPTION:
IF EXISTING STR[.'C1S7RE, DATE OF ORIGINAL Bi1ILDING PERMIT ISSL'11NCE: - i
PRESENf ZONING/PROPOSID LTSE: - (I`bn YearJ
Q COMAffTtCIAL/REPAIL/OFFICE
1-7 IDIDL'STRIAL
n INSTI'IL!TIONAL/GOVE2bA'ENT
6
2) TTT?RG'.
UR R-1 SINGLE FAhffLY "
? R-2 DL'PLEX (no LTnits)
Q R-3 70WNiOL?SE (Three + Units) ( Lnits}
C3 R-4 APARTMEPPr/CONIDOMINILTI ( Units)
ADDRESS:
CITY, STATE, ZIP:
PxorE: F( 3?' - 3 7 -73
3) ?-
NANIE:
ADDRFSS:
CITY, STATE, ZIP:
PHONE:_`/"{?, a/o`1L MASTER LICENSE#
0,5'
Active
Expired
Not recorded
St?a f-Initial
4) •?• • • i?-
NAME: _ ADDRFSS: .
CITY. STATE, 2IP:
PHONE: •
5) ? n v•i r?• i • an •?..,-
. ' RF'EONNEGTION T0 CITY SEWIIt ? COIaIF?7C.TI0N TO CITY WATER Q OTfM '. .
6) ? • r • r M_PLEASE HOLD APPROVED PERF'IIT FY)R PICK-CP BY ONE OF ABC7VE .---° ---
? rE MAIL APPR ERMIT TO 1, 2, 3, 4, ABpVE ?
• /? ircle one)
7) C??-
?
FOR CITY USE ONLY
PERMiT # ZSSL'ED
7i7el-`-?
Pd w/Bldg. Permit
$
S
s ? 3 - 5`a
$
$
$
$
$ .?j?J?G7J
$ $
$
S
$
$ in D
$
_!
$
- /o/,q -7 7b
RECEZPT
,
FEES:
$ SEWER PERMIT (INCLUDE SC'RCHARGE)
$ lOS? WATER PERMIT (INCLUDE SC'RCHARGE) ..
$ WATER METER/COPPERHORN/OL'TSIDE READER
$ WATER TAP (INCLL'DE CORPORATION STOP)
$ SEWER TAP
$ ACCODNT DEPOSIT - SEWER
$ ? ??(7 O ACCOONT DEPOSIT - WATER
$ WAC
$ SAC
$ TRC'NK WATER ASSESSMENT y
r
$ TRL'NK SEWER ASSESSMENT ?
$ LATERAL BENEFIT/TRL'NK SEWER
$ LATERAL BEN°FIT/TRL'NK WATER
$ WATER TREATMENT PLANT SURCHARGE
$ '
$
RECEIPT
OTHER:
TOTAL
DOES UTILITY CONNECTION REQUIRE EXCAVATION ZN PUBLIC RIGHT OF WAY?
Q YES IF YES, THEN A"PERMIT FOR WORK WITHIN PUBLIC
Q ROADWAY" MUST BE ISSUED BY THE ENGINEERING
NO DIVISION. LIST AS A CONDITION.
SUBJECT TO THE FOLLOWZNG CbNDITIONS:
APPROVED BY:
TITLE:
DATE :
0
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA171038
Date Issued:07/28/2021
Permit Category:ePermit
Site Address: 1958 Covington Lane
Lot:4 Block: 3 Addition: Berkshire Ponds
PID:10-13750-03-040
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:Does not include skylight(s)
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and leave on site.
If water damage is encountered, please call (651) 675-5675 to schedule a site visit to verify the extent of the damage. Any
repairs must be inspected prior to covering. The inspector will determine if an additional permit will be required to repair the
water damage.
Valuation: 5,000.00
Fee Summary:BL - Base Fee $5K $118.00 0801.4085
Surcharge - Based on Valuation $5K $2.50 9001.2195
$120.50 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 -
Daniel Shepard
1958 Covington Ln
Saint Paul MN 55122--361
Estate Claim Services Llc
6701 Penn Ave S, Suite 201B
Richfield MN 55423
(651) 309-1114
Applicant/Permitee: Signature Issued By: Signature