696 Hay Lake Rd N
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' Use BLUE or BLACK Ink
�-----------------
� For Office Use ���
I / ---7'/
Cltof E� �Il ; Permit#: � � /`�� M/� l,C
� � � Permit Fee: � / �Q' " '
3830 Pilot Knob Road � � ``_ /� �
Eagan MN 55122 � Date Received: �
Phone:(651)675-5675 I I
Fax:(651)675-5694 I Staff: I
I I
� . .. �����������������J
2015 RESIDENTIAL BUILDING PERMIIT APPLICATION
Date: �J � Site Address: v�� �o�� � � \ `'�� Unit#:
_ �� � �
M�� �; :.; Name: _� �`7 �� Phone: �`�{J, '��� / ��� �
t R@S� /� � /
�������yitgr �'� Address/City/Zip: � V�3/r��"i � _�-L �/�-� /��
������ ; . � �
~����� ' Applicant is: Owner �Contractor
� ��. j� �,,(; tC�.. � /�
'' Description of work: i�(�/►'� I -1��G It�r�� ✓�.J� �"C��� 1 '� �� �� `��
Type,of Wo�k ;
Construction Cost: l C.�U Multi-Family Building:(Yes /No )
����� � ��:. �
��.. ����
r �
�"�� Com an U A
���� p y: � � �c � _Contact: � L�. �V�U
��� `� f Address:��`'°fi(G' 1 ��' � �.19���X City: ���'� �U=��
Cor�#ractor f; ��
' State:�"'Zip: ���O Phone: �I�� ` ! E ail:+ .Sj�J� ���✓�'�1/U°Y�- �-c�
� License#:C�CrJ�J� �� Lead Certificate#: �S
If the project is exempt from lead certification, please explain why:
^
COMPLETE THIS AREA ONLY IF CONSTRUCTI�JG A NEW BUILDING
In the last 12 months,has the City of Eagan issued a permit for a similar plan b;ased on a master plan?
Yes No If yes,date and address of master plan:
Licensed Plumber: Phone:
�
Mechanical Contractor: Phone:
Sewer&Water Contractor: Phone:
Fire Suppression Contractor: Phone:
NOT;E `Plans� �r�p�� �g d x��nts th,� ���� arr��dn��r�ret�.#o u1b#ic��# �tic�r� �o l�� n �`
� �� :. �� �
the mforniation tr��,y be��` � a r� z �iii��f ��vro��1������ci�i� r �hat o` 1 �r�it th�
� .; �� .��: v� ��ude���, . }t a�'��atle secnets. i` � � � �
�i$. � ,�.. TM � ��x. t :��. .•:
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.qopherstateonecall.orq
I hereby acknowledge that this information is complete and accurate;that the work will be in conformance with the ordi ances 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 with it; 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 St�ate Build' g C be completed w' 'n 180
days of permit issuance.
X ��� � X I
Applicanfs Printed Name A ' ant':s S' e
Page 1 of 3
f��� ��-� �-��c- �c�l� til� f ,�
�
DO NOT WRITE BELOW THIS LINE ����`���C� '
SUB TYPES
_ Foundation _ Fireplace Porch(3-Season) _ Exterior Alteration(Single Family)
_ Single Family _ Garage �Porch(4-Season) _ Exterior Alteration(Multi)
_ Multi _ Deck _ Porch(Screen/Gazebo/Pergola) _ Miscellaneous
01 of Plex Lower Level Pool Accessory Building
WORK TYPES
New _ Interior Improvement _ Siding _ Demolish Building*
� Addition _ Move Building _ Reroof _ Demolish Interior
Alteration Fire Repair Windows _ Demolish Foundation
— — , � — .. , �
Replace R�pair " Egress Window Water Damage
Retaining Wall *Demolition of entire building-give PCA handout to applicant
DESCRIPTION f
Valuation ��� Occupancy ,�i��'"�°' MCES System
Plan Review Code Edition � SAC Units
(25%_100%�) Zoning City Water
Census Code Stories Booster Pump
#of Units Square Feet PRV
#of Buildings Length FireSuppression Required
Type of Construction Width `
REQUIRED fNSPECTIONS
Footings (New Building) Meter Size:
� Footings (Deck) Final/C.O. Required
�Footings(Addition) � Finai f No C.O. Required
� Foundation HVAC_Gas Service Test Gas Line Air Test
Roof: _Ice&Water _Final Pool:_Footings _Air/Gas Tests _Final
� Framing Drain Tile
� Fireplace:�,Rough In"�Air Test �Final Siding:_Stucco Lath _Stone Lath _Brick
Insulation Windows
Sheathing Retaining Wall:_Footings_Backfill_Final
Sheetrock Radon Control
Fire Walls Fire Suppression:_Rough In_Final
Braced Walls Erosion Control
�',.
Other:
Reviewed By: , Building Inspector
RESIDENTIAL FEES �� �f , �
Base Fee �"� ��'
Surcharge ���'� '�y���
Plan Review �°'�,�
�������
MCES SAC
City SAC � �� /"
Utility Connection Charge � � � k � � '' �� �
S8�W Permit& Surcharge
� �
Treatment Plant ,���"!
Copies �}'��k� ���.�'���.• ��°`
TOTAL � �t�9,.�'
��!�! 7vldt �age 2 of 3
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- � � HAY LAKF ��OAD �� .
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SHEET 2 QF 2 SHEETS -
PROJECT NO. _ BOOK ! PAGE �AMES R. HjLL! INC.
87298
� a . Planners ,/ Eng�n�ers J Surveyors
F1LE NQ. � . - �
. • 8200 Humbotdt Avenue Sauth
FO L.D E R . 8lootningta�n. Mn. 55439 6'l2-884-3�29
. 0 CASH RECEIPT •
CITY OF EAGAN •
3830 PILOT KNOB ROAD .
.
EAGAN, MINNESOTA 55122
.DATJE 19
RECEtV RD
FROM
AMOUNT ?
ti? 1
Ac DpLLARi
?oo
[]CASH Q CHECK
FoR
? . , , . ,-
BY
White-Peyers CopY
Yellow-Posting Copy
Pink-File Copy
Thank You
BLDG./ ; PERMIT N0.
?/ ,. _
01-321C1 Bldg. Permit L'
01-3422 Plan Check G
01-3445 Surch./Adm. -22
01-3446 SAC/Adm.
01-2155 Surcharge
17-3860 Road Unit
20-2275 SAC S /
20-3865 Water Conn.S))",nv
20-3868 Water Trmt.
(
20-3716 Water Meter o 7 Q U
20-2252 Acct. Dep. p =- c?
20-3713 k'ater Permit
20-3743 Sewer Permit
79-3866 Sewer Conn.
11-3855 Park Ded.
TOTAL
CITY OF EA(
. W0 Pilot Knob Road, P.O. Box 21
, r PHON E: 454-8
To be used for Est Value Eagan, MN 55121 33607
BUILDING PERMIT
Receipt #
Date
Site Address OFFICE USE ONLY
lot - - BIOCk Sec/Sub. On Site Sewage _ Occupancy
MWCC System _ Zoning
PerCel No. On Ske Well _ Type of Const
City Water _ (Actuah
¢ Name (Allowable)
W
3
Address # of Stories
Lengtn
? City Phone Deptn ,.,.
F
Total
S
, p Name .
.
FoOtprint S.F.
? ` Address APPROVALS FEES
i- City PhOne Assessments _ Permit
a Water/5ewer _ Surcharge
?
?y W Nem@ Police _ Plan Review
W
=n Address Fire _ SAC,City
Engc _ SAC, MWCC
i W City Phone Planner _ Water Conn.
Council _ Water Meter
I hereby acknowledge that I have read this application end state Bldg. Off. _ Road Unit
thattheintormationiscorrectandagreetocomplywithellapplicable APC - TreatmentPl
State M Minnesota Statutes and City of Eagan Ordinancea Variance _ Parks
Signature of Permittee Copies
TOTAL
A Building Permit is issued to: on the express condition that
all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinancea
Building Official
Permlt No. Psrmit Holder Date Talephone ?t
Plumbing
H.V.AC.
Electric
Softener
Inspectlon Date Insp. Commants
Footings !
Footings II
Foundation
Framing ,y_y9 ? ?.
Roofing
Rough Plbg.
Rough Htg.
Isul.
Fireplace
Final Htg.
Final Plbg.
Bldg. Final o• f-? ? ; ?.?'.
Cert.Occ.
Temp. LP
Deck Ftg.
Deck Frmg.
Well
Pr. pisp.
• MECHANICAL PERMIT '-
CITY OF EAGAN RECEIPT #
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE:
Site Address
Lot - Block
? Name
? Addre
c City _
Name
3 Addre
p CitY -
TYPE OF WQRK
Forced Air
Boiler
Unit Heater
Air Cond.
Vent
Gas Piping Oudets #
Other
BLDG. TYPE WORK DESCRIPTION
`4*ult `.:
New -
Add-on
Comm.
Other Repair
FEES
RES
HVAC 0-100 M BTU -$24
00
. .
ADDITIONAL 50 M BTU - 6.00
% Phone (RES. HVAC INCLUDES A/C ON NEW
CONSTRUCTION)
GAS OUTLETS (MINIMUM - 1 PER PERMI - 1
50 EA
n .
.
COMM/IND FEE - ig'o QF CONTRACT FEE
M BTU APT. BLDGS. - COMM. RATE APPLIES
TOWNHOUSE 8 CONDOS - RES. RATE APPLIES
M BTU MINIMUM RESIDENTIAL FEE - ALL ADD-ON &
M BTU REMODELS - 12.00
M BTU MINIMUM COMMERCIAL FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
CFM g (ADD $.50 S/C IF PERMIT PRICE GOES
r BEYOND $1,000)
R
FEE
•
.?
S/C: - SIGNATURE OF PERMITTEE
TOTAL•
FOR: CITY OF EAGAN
• PERMIT # d = u4Z
' PLUMBING PERMIT ?f7 7C?
CITY OF EAGAN RECEIPT 4i
• 3830 PILOT KN08 ROAD, EAGAN, MN 55122 DATE:
CONTRACT PRICE:
Site Address
Lot i eloe
? Name tl-
? Address L-",
c City ?? .•?
? Name ?..
3 Address _0h:
? p City
BLDG.TYPE
Res. ?
Mult.
WORK DESCRIPTION
New k
Add-on
Repair
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
NO. FIXTURES TOTAL
Water Closet - $3 00 $ ?-Bath Tubs - $3.00 ?
--D._Lavatory - $3.00 ?
I Shower - $3.00
I Kitchen Sink - $3.00
Urinal/Bidet - $3.00
COMM/IND FEE - 1°rb OF CONTRACT FEE
f APT. BLDGS - CQMM RATE APPLIES =
TOWNHOUSE 8 CONDO - RES. RATE APPLIES
MINIMUM - RESIDENTIAL FEE - $12.OU
MINIMUM - COMM/IND FEE - $2fl.00
' STATE SURCHARGE PER PERMIT - .50
(ADD $50 S/C IF PERMIT PRICE GOES
12
CITY OF EAGAN
I_Launtlry I ray - ?:i.UU -,
1 Floor Drains - $1.50 -
i Water He2ter - $1 50
Whirlpool - $3.00
___?_Gas Piping Outlets - $1.50 (MINIMUM - 1 PER PERMIT)
Softener - $5.00
Well - $10.00
Private Disp. - $10.00
Rough Openings - $1.50
FEE:
STATE S/C:
GRAND TOTAL: ? ? ?
* _ ,. .
?-'
,
.
(Urtifiratt u# COrrupanry
Citp of (eagan
Etpwrintrt[Y nf 11utId'mg JWprtinn
This Cenificate issued pursuaat tn the reqairerrrents nf Section 306 of the Unifornr Building
Code certifying that at the time of issuance this structure mas in contpliance with the various
ordinances of the City regubting building construction or use. For the foJlowrng.•
u? c?a? ,?,' DWG/C?t:- - mag. Wnic No. 1360'i
'
?uw-r ? ? ?s ? ?' Trm C'ma. V
owmcrauaaig CAM C?',?S ?;r? Aaa?,<:521 9U i?.Y ?':_ c.?A,?i
BIIOdIDgAddIl84 I.OCaI1Sy ???, B31 C.,lt.l
Dau: "X.IUM ZS 1987
Building O(6cia1
POST IN A CONSPICUOUS PLACE
CITY OF EAGAN
3830 Plbt Knoff Road
P.O. Box 21199
Eagan, MN 55121
?-:rr:nd i+?;its
Qwner.
Site Address: `jg 5 `ia . ;:`•.a v J-ike Plumber "iltner P]j 1
Conn. Chg: ' =5 • C?0 Pu ?r-2
Ir. ct D: 15 .0?AOYe , r i
rmit Fee: 11, , 0 `'? ??
rcharge: • }0'P_(
Plant 1 B0. O0
eter. 67,l,ln..4
WATER SERV
Date: 5?-13--87 ?
siZe: sl ?'., Date: _ ' ?g
ill rarra II
i
}
r.
w-
}tiw•vi a,on
?
? a?ee to comply with the City of Eagan
Ordinances. _ I
By c? ` 'v''
ICE PER66
cinr oF ea%Xe]u SEWER SERVICE P?MIT
3830 PY3l+Knob Road gP.O. Box 21199 PERMIT NO: °
Eagan, MN 55121 DATE: ' `
Zoning: ?'1 No. of Units: `. ?
Owner r-rand Oa€:s
Addr---
Site Address:
Plun
I ayroe to comply with the City of Eagan Connectfon Charge: ?? S•?Opd
Ordinances. Account Deposit: 1 ? ' oope
Iu . 0QPd ?
Permit Fee: ' S0Pd
Surcharge:
gy MisC. Charges: '
?
Date of Insp.: Total: -
Inap.: Date Paid: ?
J
.? _. _.,,. _. . .....
, ._ ?...
CITY OF EAGAid Permit No: 8729 Date: 5` 33-87
3830 PFfot Knob Road Meter Na S12e,
P.O. Box 21189 Reader No: , Date:
Eagan, MN 55121 -
Oaks •
Owner. Y ,,j„ q„ IAlcP rtnp?l 1,13 R3 (hrerh13.I Farm II 5?5' 0Jp`' 2onin F.1
nn. Chg: 9?
;t. Dep:
` ' 7? ?' x
No. of Units:
•mit Fee: `f ' ??
charge: agree to comply with the City ot Eagan
Plant ' `??? r
Ordinances.
?ter. F) 7.Ot111d
INATER SERVICE PERMIT
CITY OF EAGAN N° 13 6 0 7
, 3,$30 Pilot Knob Road, P.O. Box 21 •199, Eagaa, MN 55127
BUILDING PERMIT PHONE: 454-8100 Receipt # ?3?3
Tobeusedfor SF DWG/GAR Est.Value $75,000 Date MAY 12 ,1g87
SiteAddress 696 NO HAY LAKE RD
Lot 13 Block 3 Sec/Sub. OVERHILL FARM 2N]
Parcel No
a Name GRAND OAKS DEVEL CO
z Address 4521 SO HAY LAKE RD
a City EAGAN Phone 452-8 34
Name SAME
d Address
c
i-
City Phone
tw
W W
w Name
F
xn Address
aw City Phone
I hereby acknowledge that I have read this application and state
that the information is correct and agree to comply with all aDPlicable
State of Minnesota Statytes and Ciyy;qi Eagan qrdinances.
Signature of
A Building Permit is issued
all work shall be done in ac
Building Official
with all
CO
ot
OFFICE USE ONLY
On Site Sewage Occupancy R3
MWCCSystem X Zoning _Rl
On Site Well Type of Const y
Ciry Water X (ACtuaQ
(Allowable)
# of Stories
Length 48
Depth 4[-
SF. Total
Footprint S.F.
APPROVALS FEES
?
416.00
Assessments Permit
Water/Sewer _ Surcharga
Police _ Plan Review 90R _ (1(1
Fire _ SAQ City 1 (lfl _ (1f1
Engr. _ SAC, MWCC ;
Planner _ WaterConn. 595_00
Councd _ WaterMeter
n
67_0
BIdg.Off. Road Unit 305.00
APC Treatment P7 1 RO _ 00
Varience _ Parks
CoPies
J TOTAL
on the express coniiition that
S4atutes and City of Eagan Ordinancea
-j
n
!r/.2ld'7 REQUEST FOR ELECTRICAL INSPECTION es-ooooi-os
, See insM1UCtions for completvg Uis torm on back of yellow copY.
D"i '' 8 O "X" Below Work Covered by This Request
AAd ftep. TypO al BmlEing APp1unnCee WveC Epu.Vment WireA
Home Fange Temporary Service
Duplez Water Neater Liyhnny Fixtwes
Apt Bufldinc7 Dryer Etectric Heatni
Commeraal Bldy. Fumace Silo Unloader
Industrial BIAq. Av Condieoner Bulk Milk Tenk
Farm oin«r oec.irv eine,isuecifv1
t 7w SuomfY Other Oth.e
Compute lnspecuon Fee 8e/ow
p Fee Service EntranceSiza H Fea Faaders/Subfeedws N Fee Circwts
!z. aV 0 to 200 qm s 0 to 30 qm s 73 0 tn 30 Am s
Above 200 qmps 37 to 100 Amps " 31 to 100 Am
Swimming Pool Above 100_Amps Above 1n0_Amps
Transtormers Irrigation Booms $L Partia6"Other Fee
Signs Specialinspection ?
8?
TOT
emarks AL ?E/?p
?GO
Nouoh-in
Fllldl
?
r
/ ?I?^e)?
?? ( 7
!!!---
M1 J. the Ele cel
Inspector, heraby
carbiy that tha above
lISpBCIIOn hB3 bB811
Ida.
rre
Thle repuest voltl 18 montha irom
inis request voitl
?8 moqnth?s (wm
D eJ.?L 4 8 0 t /a' ,1?,3
Reques? Dale Fire No.
Rouph-in Inspecbon
,.y{
S' I R ireA? OReady Nuw ?/? Wil1 Npufy InsDec.-
Wh
? 1
1
? ?os ?No r
¢n Ready
1
lroensetl Electncal Con[rac[or 1 hereby repuest inspacUOn ot ebova
? Owner electricel work mstalied et:
Street AdAress, eax or Boute No.
Cgi`i'69 /V. ?L- _ - W. City
?
I ecuon o. Township Name, o o. Range No. County
Occupant IPRINTI
C'o /rc?d(?.?; Phun, Nn.
vS :? - cS?i 3
Power $up0lier Adtlress
Electncal Conbacmr IComDany Namel Conirar.mr's Lir.ense No.
Mailing A dress ICOnVacior or Owner Making Instailauonl
? T?- w. m .
Authonz)etl Signa[vre IContractor wner Makiny Installation)
/ Phone Numbe.r
P ,
U- ?3 el
MINNESOTA STqTE fiOApD OF ELECTRICITY TMIS INSPECTION flEQUEST WILL NOT
Griggs-Midwey Bltlg. - Noom N•191 BE qCCEPTEO BY THE STATE BOAND
1827 4niveraity Ave.. St. Gaul. MN 65104 UNlESS PNOPEfl INSPECTION FEE IS
Phone (672) 642-0800 ENCLOSED,
RESIDENTIAL
BUILDINC PERMIT APPLICATION
CITY OF EACAN
3830 PILOT KNOB RD EACAN MN 55122
651-6814675
/
New Consiruclion Raauiremente
• 3 regislered site surveys slwwing sq. ft. oF lot, sq. R of house; and ail roofetl areas
(20% maximum bt coverage allowM)
• 2 coDies of plan shovnng beam 8 wmdow s¢es, poured found desgn, elc )
• 1 sel of Eneryy CakWa6ans
• 3 wpies of Tree Preservation Plan d lot platted aker 7I1/93
• Rim Joat OHail Op6ons selection sAeet (61dgs wi(h 3 or less units)
DATE ? Is J/O oL
SITE ADDRESS
TYPE OF WORI
APPLICANT Cedar
ULT6FAMILY BLDG _Y \CqJ
FIREPLACE(S)?0 _ 1 _ 2
STREET ADDRESS -- - -?""'- CITY
TELEPHONE # :?(03 4sS CELL PHONE #
STATE ZIP
FAX# ???T9S- •S3(i O
PROPERTYOWNER TELEPHONE#(v?`?cSCb?J?J
'-"-----'---------------- -'-'---------. ----------"'--'-------'----------------'--°'---------
COMPLETE THIS SECTION fOR NNEW" RESIDENTIAL BUILDINGS ONLY
.
Energy Code Category _ NIINNESOTA RliI.ES 7670 G\'fF,CORI' I NfINVESOT:1 RULES 7672.
(J submission type) . Residendal VenhlaGOn Category 1 Worksheet Submitted • New-&?erg?Cpde W.nrksheeSubmitted
• Energy Envelope Calwla6ons Su6mitled ' D ?
Plumbing Confractor:
Plumbing sys[em includes:
Mechanicai Conhactor:
Mechanic.il svstem includes:
Sewer/Water Contractor.
Phone #
Phone #
? .
Fee: S0.00J-
Fee: 370.00
-°----°----------------------------------------^------° ^-----------...------------------------°-----------°°----°
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply
with all applicable State of'Minnesota Statutes and City of Eogan Ordinances. q /J
Signature of Applicant (X" •-GL?u?rcT"
----- _.--------- ------- ___------------------ --------- - --------- __------------- -___..._.------ --------------------
OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Receroed _ Not Required _
Updated 4102
Water Softener
_ Water Heater
No. of Baths
RemadePReoairRaavirements /
. 2 copies of plan
• 7 set of Energy Calculatrons for heated aCdiGons
• 1 srte survey Mr extenoraddNons & decks
. indicate i( home served by septic system for additions
P ? e7
VALUATION l!2 (g c)(D• ?
Phone #
_ Lawn Sprinkler
_ No. oF R.I. Baths
TJ
.-lir Conditioniiig
Nea[ Rccovcry Systcm
OFFICE USE ONLY
? 07 Foundation ? 07 OS-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Ait - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Ait • SF
? 04 02-piex ? 10 08-plex ? 18 Deck ? 23 Porch (screened) ? 36 Multi
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscelianeous
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)' ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement *Demalition (Entire Bldg only) - Give PCA handout to applicant
Valuation Occupancy MC/ES System
Census Code 2oning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED IN SPECTIONS
_ Foonngs(new bldg) FinaUC.O.
_ Footings (deck) FinaUNo C.O.
_ Footings (addirion) _ plumbing
_ Foundation HVAC
_ Drain Tile Other
Roof - Ice & Water _ F inal _ pool _ Ftgs _ Air/Gas Tests _ Final
_ Fraaung _ Siding Stucco Srone
_ Fireplace _ R.I. _ Air Test _ Final _ Windows (new!replacement)
_ Insulauon _ Retaining W'all
Approved By
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
W ater Supply & Storage
S8W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Building Inspector
Total
' CITY USE ONLY /? ?-???
/
L r t BL Si RECEIPT p: ( .j
SUBD. RECEIPTDATE:
PERMIT #
8000 PLUM$INfi PEiiMiT (fiESIDENTIlkL)
CfPYOF gkfir4A
S$SO flD.OT KNOB itD
8!1&AP, S!N 551 E8
651-681-4675
Please complete for: ? single family dwellings
? townhomes and condos when permits are required for each unit
? backflow preventer for underground sprinkler system
nvrHocc
Fnr.N
#
TOTAL
Aiterations to existing dwelling - minimum fee
Describe: $ 30.00 !
Bath tub $ 3.00 x = $
Floor drain 3.00 x = $
GeS i if1 OUtIEt ' minimum -1 3.00 x = $
Hot tubls a 3.00 x = $
Kitchen sink 3.00 x = $
Laund tra 3.00 x = $
Lavato 3.00 x = $
Se tic S stem newlrefurbished • re uires MPC tlc. 75.00 x = $
Se tiC S stem abandonment 30.00 x = $
RPZ new InslallatloNrepair/rebuild 30.00 x = $ ?
Rou h o enin 1.50 x = S
Shower 3.00 x = $
Under round s rinkier if dwellin is under mnstruaon 3.00 x = $
Under round s rinkler if exisan dwellin 30.00 x = $
W ater doset 3.00 x = S ?
Water heater 3.00 x $ ?•?
W ater sokener If dwelling under construcLOn 5.00 x = $
W ater sokener H existin dwemn 30.00 x = $
Watertumaround 30.00 x $
State Surchar e .50 --> --> ---> $ .50
Total --> --> ----> -'_> $ .50
Reminder: Call for inspections of alterations, i.e. water heaters, water softeners, etc.
----------- - -------
----•-... •------•-----
.
.
- cortect. end agree Ic comply with ali applicable Cityof Eagan ordinances.
. I.have_ reaC this applintlan, state ihat the infortnaGon - is .
I hereby acknowledge that.
It is fhe appliwnt's responsibility to notify the property owner that the City of Eagan assumes no liability for any damages caused 6y the Ciry during ifs nortnal
operational and maintenance achvities lo the faciliUes constructed under this permit wimin City propertylright-of•way/easement.
COFFEY, WILLIAM
SITE ADDRESS: 696 HAY LAKE ROAD NORTH,
EAGAN, MN 55123 I TELEPHONE
OWNER NAME: : (ssi) ass-sass
? (AREA CODE)
INSTALLER NAME: .
STREET ADDRESS:
CITY:
TELEPHONE #:
(AREA COOE)
STATE: _ ZIP:
SI URE OF PERMITTEE
,
?
3
198T BQILDING PERNIIT APPLICATION - CZTY OF EAG9N
?
SINGLE FAMILY DWELLINGS
i
INCLIIDE 2 SETS OF PLANS, 3 CERTIFIC9TES OF S[TRVEY, 1 SET OF ENERGY CALCQLATIOHS
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOiiNER MIIST DESIGiNATE WHICH ADDRESS
IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSIIED.
MULTIPLE DiiELLINGS - RFSIDENTIAL • RENTAL U2IITS FOA SALE IJIDDITS
INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SQRVEY - CHECK LiITH BLDG. DEPT.,
1 SET OF ENERGY CALCULATIONS
COMMERCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF
ENERGY CALCULATIONS, ?
$2,000 LANDSCAPE BOND '
To Be Used For: g,'S . Valuation: 15,00c) Date: ?J-' // -0 7
Site Address ?9 G N. I-14...,Lk IZQ OFFI
Lot 3 Block 3_ On Site Sewage_
MWCC System ?
Parcel/Sub On Site Well
City Llater ?
Owner
Address
City/Zip Code
Phone 9PPROVALS
Contractor G12aNa OFFO Assessments
Water/Sewer
,?n
Address ?!t ?( LK`? police
Fi-re
City/Zip Code Engr
Planner
Phone Council
Bldg Off
Arch./Engr. APC
Variance
Address _
City/Zip Code
Phone l1
Occupancy i?'3
Zoning 12 I
Type of Const rt-
(Actual) .sL
(Allowable)
# of Stories
Length 48
Depth 44
S.F. Total
Footprint S.F.
FEFS
Permit
Surcharge 37,
Plan Review 0 ?
SAC, City /
SAC, MWCC Sa S'
Water Conn ??s--
Water Meter
Road Unit
Treatment P1 25L)
Parks
Copies ?
TOT9L
f? x 3 z = K Z-7 Z
24 ? 23 = S") zY,- (&
ZQ n2? `
fl K?( = 121 ?- ??= (?,?5
,
.? .
14-0 5s-
U l..tJ1'II'UIHISL1Dl
t:i(;;AND C]t=1't,:.S I7F"_'VELOF'IvlEN'f COrIF'FyNY
I`1f_lt.>E:.t_ I°iA1=iT'7NIOU nr.:ra U VAl._UE U X Af:[:A
MAX I1`Illl`f At..l_OWET) BV caDE
1-plAl._ WALL FlFtEA 1696 .J.l 186.56
fD7A1.. F1OiJf- F1REA 1:_3OC0 .026 33. f3
TCi"fFtt.. AI_L.L7WE.L) 220.36
ACti I E_VC.D
WF1LL AREA
WIDII.iOWS :'G.: .5 10J.5
I)OC1RS 40 .077 3.08
'.ii;1_:[LiL GLAB'3 36 .49 17.28
1= IRI:F'1_.i-\CEi ;_Ci .25 7.5
WAl_L FRAME,: AREA 169.6 ,041 6.4536
f<fln ,70I5T' 144 „U4 ;'6 6.27t34
1=iJllp.lD F'aF?OVE: GRADE 95 .0749 7_500.i
i'•It:T UdAI_L. AFtF::A 976.4 .037EJ 36.99352
7-L]TAL.. WAL L 186.0910
ROIJf ARL'A
Sk::YL_ J fE: E3 .5 4
((f]Or f=Ftfll'1E J.30 . 032 4, :tr.'.?
IVET Rtl7JF' 1170 .0200 24,076
('0 7 t-ll_ IzULIF 32.496
'COIFIL. Af:'H:I:E_'•1Lli 219.377u
f'IARG1N IIV I:ACl=55 CIF I:l'7DE. „982"03
"/. I•16iFiEi]:hl IN r;C[-;Ef3S' .44ho:/':3:4
/,s -?
GOLD COPY PERMIT RELEASE FORM D141 -?2Q-Ai!'Y ?.
?
PERMIT If
ADDRESS ? / f? ? • ?!???,g,t?iQJ
r--
PICKED UP BY
?
CITY OF EAGAiV
APPLICATION FOR PERMIT
SEWER AND/OR WATER CONNECTION
*i0T6: PAYMEKr'OF £EE AT TIME pF
APPLscaMoN ooFS Nom CONSTITUTE
AerPxovar. oF PEPrmr.
nvsPncrzorr oF sEWM ram/ox M=
INSrnr.raTrpNS p7R7• Mr gE SCHED-
OLID UNTIL PFItMIT HAS BM
APPRUVID.
- ?.
***+****#** *?w *x:*,tsr**+rr**t*,r*,r***,r*
P ease Print
1) PROPERTY ADDRESS:
LEGAL DESCRIPTION:
IF EXISTING STRC'CIL'RE, DATE OF ORIGINAI, BC!ILDING PERMIT ISSCANCE: . ?
i
PRFSENf ZONING/PROPOSID L'SE: tMon Year
[? COn4ERCIAL/REI'AIL/OFFICE ?- R-1 SINGLE FAhIILY
rl IND?TSTRIAL Q R-2 DCPLEX (1wo Pnits)
? INSTITUTIONAL/GOV?ENT ? R-3 40WNiOIISE (Three + Units) ( C?nits)
. ? R-4 APAR'ITENT/C06IDOMINILM ( Units)
2) ?
NAME: ?21?ND 6F1-{L? • ADDRESS:
CITY, STATE, 2IP:
PHONE:
• 3) For City Use
. .
NF?hE: ?ufh(31/J ? Plwnhers License:
ADnxFSS: / O/,L4 AtXW MCi9Dc LA-NL - Active
ciTr, srAZE, zIP: _EDf,u ?Rx-r,? r LI Expirea
? ?--1 Not recoraea
PHONE: T'FU T/ J? MASTER ISCQNSE# 356 OA?
ta In1t1d1
4) ?a« • • i i?•
NAPE;
_ ADDRFSS: .
CITX, STATE. ZIP:
PHONE: .
5) n ?n t r• • ?• : a • a• • ?? -
nCON[gCPION 'N CITY SEWFI2 La-epNNECTION M CITY WATII2
6)
'? • ??- .?- PLEASE HOLD APPROVID PII2IV'IIT FC)R PICK-[!P BY ONE OF ABC7VE
? PLEASE MAIL ApPROVID PERMIT 1U 1. 2, 34 4. ABOyg
_ ?? /? I'l (Circle one)
FOR CITY USE ONLY
/ I
?
PERMIT # ISSUED '
Pd w/Bldg. Permit FEES:
$ I,4'$ SEWER PERMIT (INCLLDE SCRCHARGE)
$ lG $ WATER PERMIT (INCLLDE SORCHARGE)
$ ? 7 ' o-f $ WATER METER/COPPERHORN/OL'TSIDE READER
$ $ WATER TAP (INCLUDE CORPORATION STOP)
$ $ SEWER TAP
$ $ ACCOUNT DEPOSIT - SEWER
$ c-D $ ACCOLNT DEPOSIT - WATER
$ -e4- Z $ WAC
$ ?0 $ SAC
$ $ TRUNK WATER ASSESSMENT
$ $ TRL'NK SEWER ASSESSMENT
$ $ LATERAL BENEFIT/TRLNK SEWER
$ $ LATERAL BENEFIT/TRCNK WATER
$ $ WATER TREATMENT PLANT SORCHARGE
$ $ OTHER:
$ I Ll C? c?' c? $ TOTAL
-7
RECEIPT RECEIPT
DOES UTILITY CONNECTION REQUIRE EXCAVATION IN.,PIIBLIC RIGHT OF WAY?
Q YES IF YES,,THEN A"PERMIT FOR,WORK WITHIN PLBLIC
Q ROADWAY" MLST,cBE ISSL4ED BY.THE ENGINEERZNG
NO DIVISION. LIST AS A CONDITION.
SUBJECT TO THE FOLLOWZNG CZINDITIONS: •
APPROVED BY:
TITLE:
DATE : 1-?j 3 Zf 7
SURVEYOR'S CERTIFICATE GRAND OAKS DEVELOPMENT C0.
NOTE: GRADES SHOWN WERE TAKEN FROM
THE GRADING PLAN FOR OVERHILL FARM SECOND ADDITION, PREPARED BY MINNESOTA
VALLEY SURVEYORS ItJC., LAST DATED
MARCH 28, 1966. '
? DENOTES PROPOSED SURFACE DRAINAGE
O DENOTES IRON MONUMENT SET SCALE: 1 INCH = 30 FEET
• DENOTES IRON MONUMENT FOUND PROPOSED GARAGE FLOOR = 9v41.0 FEET
.X000.0 DENOTES EXISTING ELEVATION PROPOSED LOWEST FLOOR = q3?•n FEET
(000.0) DENOTES PROP05ED ELEVATION PROPOSED TOP OF BLOCK = 9,iY.q FEET
I HEREBY CERTIFY TO GRAND OAKS DEVELOPMENT C0. THAT THIS IS A TRUE AND CORRECT
REPRESENTATION OF A SURVEY OF TNE BOUNDARIES OF:
Lot 13, Block 3, OVERHILL FARF1 SECOND ADDITION, according to the
recorded plat thereof, Dakota County, Minnesota.
AND OF THE LOCATION OF A PROP05ED BUILDING. IT DOES NOT PURPORT TO SI10W IMPROVEMENTS
OR ENCROACHMENTS, IF ANY, THEREON. AS SURVEYED BY ME, OR UNDER h4Y DIRECT SUPERVISION,
THIS 11't1t DAY OF T^p,j , 198'1.
SIGNED: JAMES R. ILL, INC.
/ /
? ?
BY:
AROLD C. PETERSON, LAND SURVEYOR
SHEET 1 OF 2 SHEETS P1INNESOTA LICENSE N0. 12294
PROJECT N0. 800K / PAGE JpMES R. HILL, INC.
87298
Planners / Engineers / Surveyors
FILE NO. 8200 Humboldt Avonue South
FOLDER Bbomington, Mn. 55431 812-884-3029
SUR"VEYOR'S CERTIFICATE
N
GRAND OAKS DEVELOPPIENT C0.
M HAY LAKE ROAD R
(q44•5)_ 84.98 N89058'37"E--, ) (q39.0) -
-
0 1
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o
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(9`i3.?)
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2?. 1849
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F
24.
POSED
OUSE N /f
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1
18.49-
1SB31
3
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---?=---
a
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? LOT 3
i-
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- N
I
.J O 13 r-
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Z Z -J
i I
-?ORAINAGF d.UTfLlTY EASEMENf
?5
PER PLAT',? 5 I
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85.00 N88053'09"W -'(q? z• o?
I
L_ l% f J
r
L_ ?i ? I 1'
I
SHEET 2 OF 2 SIiEETS
PHOJECT NO. BOOK / PAGE
87298
F1LE NO,
FOLDER
JAMES R. HILL, INC.
Planners / Engineers / Surveyors
8200 Humboldt Avenue South
Blootnington, Mrt. 55431 812-884-3029
Use BLUE or BLACK Ink
. � r————————————————�
I For Office Use �
I I �
' � Permit#: ��! �� I
Clty of ����� � �
� ; , �
� Permit Fee: % ` �
3830 Pilot Knob Road i i
Eagan MN 55122 � Date Received: �
Phone: (651) 675-5675 � �
� Staff: �
Fax: (651) 675-5694 �_________________I
2015 RESIDENTIAL PLU I G PE MIT APPLICATI
Date: — '"- Site Address: � �V � ���'"
Tenant: Suite#:
a
au �., �:. �' . r� .
�� ~' � � x Name: -e Phone:
,si �uvra�
��� * $.�; Address/City/Zip: �7�t,V'Vl,�
�w �t r /� S
�� �� Name: � C-�.� V'� /1 � License#: C�6 l � � ��
��w
�}� � �� ` Address Q `' /�� � City: IJ�.l�Y1s1� le !�Q
T1C�OC �� ,. l.
�;��� State:�Zip: J ��� � Phone: ��� � � (� �� '( -( C�
`�� ��� ����;
���� „ � ��` �� t` Contact: Email:
�`
£� � _New _Replacement _Repair _Rebuild �Modify Space _Work in R.O.W.
�� � .;YP� � ��c
�: ,, (�-
� � � x Descri tion of work: ► � }�Wl.. � �
n��',. �-;.; �.� �.�� P
��`' RESIDENTIAL
�,n ���- -�r:
�
�k;..
� ��" ` Water Heater
� �� �� � Water Softener �
� *� �, Lawn Irrigation(_RPZ/_PVB)
It Ty�B � ,
� �� Septic System Add Plumbing Fixtures�Main/_Lower Level)
� �t� ��
����� �� < _NeN, Water Tumaround
� ���m�
�t;�. Abandonment
RESIDENTIAL FEES:
$60.00 Water Heater, Water Softener, or Water Heater and Softener(includes State Surcharge)
$60.00 Lawn Irrigation(includes State Surcharge)
$60.00 Add Plumbing Fixtures, Septic Svstem Abandonment, Water Turnaround''(includes State Surcharge)
"Water Tumaround(add$210.00 if a 5/8"meter is required)
$115.00 Seqtic Svstem New(includes Counry fee and State Surcharge)
TOTAL FEES $
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 ofunderground utilities. www.aopherstateonecall.orq
I hereby acknowledge that this information is complete and accurate;that the work 'll be in conforman with t ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit a d work is not to rt w'h ut a per it; that the work will be in
accordance with the approved plan in the cas of work which requires a review and a pr val of plans.
X �.�J--��� l�v�.� �
Applicant's Printed Name ppli nYs Signature
� �Ty ��� � � �� : ¥�.
F�QR fJFF���� SE �. �� � � � �¥ � � � �� t
# � �d�� ���� ;� �: ��t� �::
�� r�, � � ��'�� ���r �,� ����r � � � . ��
��j,uirec� I�a� �� ���ns Ur� ��� � , � � y � � �
q � ��� � ���h in��. ��r���' � �as T ��al� �� �
x. ��� ��� �� � � � n �� ,� �.:: � ,�; �,�� � � � ���
�
�: -
� ��,s = r 7. , � �� `
�l�t,�r���lated Iter�?� tul�te� � � �����"1�eatl Ma�ome#er Staff: �
n.�.:�
t,.,..�. .. � . v .,�r ,
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA132356
Date Issued:08/10/2015
Permit Category:ePermit
Site Address: 696 Hay Lake Rd N
Lot:13 Block: 3 Addition: Overhill Farm 2nd
PID:10-56151-03-130
Use:
Description:
Sub Type:Fireplace
Work Type:Gas Fireplace (new)
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home may require smoke detectors in all bedrooms. Chimney / flue must be inspected prior to
concealing.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Valuation: 3,000.00
Fee Summary:BL - Base Fee $3K $88.50 0801.4085
Surcharge - Based on Valuation $3K $1.50 9001.2195
$90.00 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 -
Sheila A Coffey
696 Hay Lake Rd N
Eagan MN 55123
Hearth and Home Technologies
2700 N. Fairview Ave
Roseville MN 55113
(651) 638-3309
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA132761
Date Issued:09/02/2015
Permit Category:ePermit
Site Address: 696 Hay Lake Rd N
Lot:13 Block: 3 Addition: Overhill Farm 2nd
PID:10-56151-03-130
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.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
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 -
Sheila A Coffey
696 Hay Lake Rd N
Eagan MN 55123
Lofgren Heating & Air
5708 Upper 147th St W
Suite 102
Apple Valley MN 55124
(952) 431-5811
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA151825
Date Issued:09/14/2018
Permit Category:ePermit
Site Address: 696 Hay Lake Rd N
Lot:13 Block: 3 Addition: Overhill Farm 2nd
PID:10-56151-03-130
Use:
Description:
Sub Type:Fireplace
Work Type:Gas Insert
Description:
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home may require smoke detectors in all bedrooms. Chimney / flue must be inspected prior to
concealing.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Valuation: 3,000.00
Fee Summary:BL - Base Fee $3K $88.50 0801.4085
Surcharge - Based on Valuation $3K $1.50 9001.2195
$90.00 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 -
Sheila A Coffey
696 Hay Lake Rd N
Eagan MN 55123
Fireside Hearth & Home
2700 Fairview Ave N
Roseville MN 55113
(651) 633-2561
Applicant/Permitee: Signature Issued By: Signature