4785 Galaxie Ave
/330- Use BLUE or BLACK Ink
r I
I For Office Use
Per
mit#:
Eainan
&I City of l I
j Permit Fee: / ~ Jb I
3830 Pilot Knob Road I
Eagan MN 55122 ~ d 5a too
Date Received: 04 Ec( g D,K.
Phone: (651) 675-5675 j
Fax: (651) 675-5694 I Staff:
L -----------------I
2010 MECHANICAL PERMIT APPLICATION
Date: 7--7-/0 Site Address: 6.doLxi-- /-eve
Tenant: S C u Suite
RESIDENT / OWNER Name: ::ZA901A 15, Phone: 625-1 1223-- (f~(V
Address / City / Zip: q7,35 h i-e -
2-CONTRACTOR Name: (1,5V '7~/ /4,U' ,\AG License
Address:/ S S ; ly 1~4~ / City: ~Lt QicU vt
State: MpA) Zip: ~S(Z Z Phone: (D,e`/
Contact: ( Email:jc[a (I-At eLcZ-eAUDC ts-
TYPE OF WORK New Replacement Additional Alteration Demolition
Description of work:
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.
PERMIT TYPE RESIDENTIAL COMMERCIAL
Furnace 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:
$50.50 Minimum Add-on or alteration to an existing unit (includes State Surcharge)
$90.50 Fire repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) $ ~S SU TOTAL FEE
COMMERCIAL FEES:
$70.50 Underground tank installation/removal OR Contract Value $ x1%
$50.50 Minimum (includes State Surcharge)
= $ Permit Fee
- If Permit Fee is less than $1,000, surcharge is $.50.
- If Permit Fee is > $1,000, surcharge increases by $.50 for each = $ Surcharge
$1,000 Permit Fee (i.e. a $1,001-$2,000 Permit Fee requires a $1.00 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.org
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance
with the approved plan in the case of work which requires a review and approval of plans.
Applicant's Printed Name Applicant's Signature
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
a - - , ,
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number:
Eagan, MinnesQta 55122-1897 Date lssued: " I `' 11? `4`x ?
(651) 681-4675
SITE ADDRESS:
PERMIT SUBTYPE:
i <, Ici t I I ?
APPLICANT:
TYPE OF WORK:
INSPECTION .. . ..
, ,.
I ;%i{r s
F-
L
i MntVv; l I fii , M11°. t ttl I
1o +R f r 1 iNo t t11 i Nto
?
?
Permit Holder Date Teiephone #
SEWER/
WATE R
PLUMBING
Hvac
Inspection Date Insp. Comments
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYPBOARD
FIREPLACE
- ?-
FIREPLACE
AIR TEST
FINAL PIBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
DOMESTIC
METER
IRRIGATION
METER
FLUSH
MAINS
CONDUCTIVITY
TEST
HYOROSTATIC
TEST
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
CASH RECEIPT
'CITY OF EAGAN
P. 0. BOX 21-199
EAGAN, MINNESOTA 55121
!J v
DATE J ? 19
/ r
eEeeIveo
FROM ? ?
AMOUNT $
r
& DOLLARS
?oo
[-]CASH ?CHEGK
? ? • `
MOII FUND CODE At.tOUNT
- . y . .
Thank You ? .-
???-
Bir i
1Mhite-Payers CopV
Yellow-Posting CopY
Pink-File Copy
REACTIVATE FOR DECK- UNDER $500 VALUATION
Gj41j•LIAM ROSKE 452-5432(H) CITY OF EAGAN
456-2923 (W) 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
)V. P" PHONE:454-8100
r'^ 40967
BUILDING 'PERMIT Receipt
,.:, ?
T? v ...J Lw. ? ' .Ci: •.- FN Vnln? .' ?' , ? . ., .. M?e ? ... . . "i?.'?[i " _ to , :
Site Address Erect
Remodei
Lot Blxk Sec/Sub. '? ? •; G'' r.
Repair ? J
Parcel No. Addition ?
Move ?
?.
at Name
? , .. Demolish ?
Address Int Impr. ?
City Phone Install ? Occupancy _
Zoning
?
Type of Const.
No. Stories
Length .
Depth
Sq. Ft.
o
' Approvab Fees
Name
i =?
O Add Assessment Permit
ress
u? Cit Phone
Y
Woter & Sew.
Surcharge
Police PlanReview -"9 •. =?
?W Name Firo SAC . J?
s? Address Eny. Water Conn.
OCW City Phone Plonner Weter Meter
Council Road Unit "`? • C) 0
1 hereby ocknowled9e that 1 have read this opplicotion ond stote that Bldg. Off. • ` ' Tr. PL ?' •??'
the {niormation is correct ond ogree to tomply with oll applicoble AP?
$tote of Minncsota Stotutes ond Ciry of Eogan Ordinonces. PSrks
Var. Date Copies
Sipncturc of Pem+ittee
Total
/? Building Permit Is issued to: on the express tonditia? Ihot
all work sholl be done in otcordante with oll opplicoble Stote of Minnesota 5tatutes ond Ciry of Eoflan O?dinonces.
.
8uildinp Officiol
?
Y
i
Permit No. Psrmit HoWer Dats Telaphone #
binp /v ?. 11-
A.C.
HV ? 5
[
tric
endr
Inspeetion Date Other
Footinga I
Footings 11 _.?
?
Foundation
Framiny
qoofin9 j
Rouyh Plbg.
Rough Htg.
Insul. e,
Finplace
Final Htg. 7 ? .
Flnsl Plbg.
Final
cwvocc. ?
Watsr ??ibe Loeation:
Wsll
Sewer
Pr. Dlsp.
CITY UF EAGAN Remarks
Addition BERKSHIRE PONDS
Owner
Street 4789 Aa l axi e Aventte
10 13750 190 03
Improvement Date Amount Annual Years Payment Receipt Date
STREETSURF. '^`i 1982 239.09 23.91 10 0//,g(a '2/'Z?(e
STREET RESTOR. O C 60
GRADING
SAN SEW TRUNK 7 1982 176.04 11.74 15 7. 3 4j0 a 1,p
SEWER LATERAL t 1982 57.24 3.82 15 , 2 ?
* 88 ' 28
53 70 , cr ?/ ? -?
WATERMAIN rL?j 1982 .
46.09 -
,
3.07 15 p, 7 ?f m
?t WATER LATERAL
WATER AREA 19$2 176.04 11.74 15
STORM SEW TRK ? Cy0 /I oZ (P,F>
STORM SEW LAT
CURB & GUTTER '
SIpEWALK
STREET LIGHT
Road Unit .
WATER CONN. .
-
BUILDING PER.
10967-
SAC 525.00
PARK
Racaipt MECHANICAL PERMIT Pertnit No.
CITY OF EAGAN -,C, nr,
Fee R -
,
a Fill in numbered spaces SIC . ?C;?
Type or Prfni /egiblY L -?10• 50
T
o
1. Date 1v-18-e5 2. Instaliation Cost ?'?-}`'•?`l
3. Job Address471% v`Aot Blk. Tract
4. Owner
. m
5. Contractor Phone
6. Address 7 ? kL? r ?? °'? vt -.
7. City State ??`.. Zip
8. Building Type: Residential 0 Commercial ? tnstitutional ?
9. Work Description: New 0 Add ? Alter ? Repair ?
10. D6SCflbe Tn4`p11 pis faTOed nJ-r Fuel Type 'SL41' G:i°
? F-
11.
No.
I Eauioment 8TU - M. Ea.
ForcedAir No. EQUiament CFM
AirH
ndlin
:
Mfg. g
a
Boilers
Mfg. Mech. Exhaust
?
Unit Heater
Mfg, Other
Air Cond.
Mfg.
? Gas, Piping Qutlets
12. 1 hereby certify that the dbove information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed : for
?
Rough _ Final
Inspections: Date ! Insp. Date Insp.
This is your permit when numbered and approved.
Approved _ CITY OF EAGAN 454,6100
Rooeipt PLUMBING PERMIT Pennit No.
crnr oF EAGAw
?
F
w
Fill in numbered *sacea S/C
Type or Print /sp/bJy T
t r '
o
1. Date .? 2. Installation Cost
3. Job Address . •, ? Lot Blk. Tract
4. Owner ? ? f •> ^'?
5. Contractor - Phone .
6. Address
7. City Siate 2ip _
8. Building Type: Residential'0 Commercial ? Institutional ?
1 9. Work Description: New)C Add O Alter ? Repair ?
10. Describe
11.
No. Fixtures
Water Closgt No. Fixtures
Ce
o
l/D
i
field
Bath tubs ssp
o
ra
n
S
k
ti
T
Lavato?y ep
c
an
$oftner
• Shower Well
? Kitchen Sink
Urinal/Bidet Othe
i
Laundry Tray r
' Floor Drains
Drinkiny Ftn.
Slop Sink
Gas Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
oomply with all ordinances and codes governing this type of work.
Signed :
for
Rou9h F inal
InspeCtions: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 464-8100
Nlettr No.: 6.l S/?`'
Size: ?,
Reoder No.: 1'2F M217 7 Z,
omolp wia fiw Cihr ef Eelew
C1TY OF EAGAN
3830 Pilot Knob Road
P. O. Box 21439
Eagan, ?YIN 55121
Zoninp: _
OwnO?: t t?
Mdrcss:
Sita Addreas:
Plumber:
Meter Na,.
Stze:
Reader No.:
I MF" te eaaolr w" !IN Cihr of Eoyaw
Orriseeam
ey _i
Dote of Insp.;
CITY OF EAGAN
3830 Pilot Knob Road
, P. O. Box 24199
Eagan, lVIN 55121
Zoninp:
Owner,
/lddress:
S1te /Add?ess: ,
Plumber.
I MM ro aes* willi !w phr of fasaw
Or11senew
WATER SERVICE PERMIT
PERMIT NO.:
f1tTG. ,. 7.7 WATER SERVICE PERMIT
FERAAIT NO.:
DATE:
- No. of unrts:
Connection CharQe: -,!.?
Account Deposir: -
Pertnit Fee: "
Surchorpe;
Misc. Ct,orpes;
Totcl: -
bate Poid: '
Intp.:
SWER SERViCE PERMR
PERMIT NO.:
D111'E:
No. of Units:
By __
Dote of Inap,;
Insp.:___
Connectlon Chorpe;
AcOOCmt Mposit:
Parmit Far.
Surchorpa;
Misc. Chorpes:
Totcl;
Date Pald: -
CITY OF EAGAN N°_ 10 9 6 7
3830 Pilot Kno6 Road, P.O. Box 27-199, Eagan, MN 55121 '
PHONE: 454-8100
BUILDING PERMIT Receipt # 7 7
To M ased fer SF DWG/GAR Est.Value $62•000
_. Dete SEPTEMBER 13 1985
, _
SiteAddress 4785 GALAXIE AVE Erect gl Occupancy R3
c
Lot 19 Block 3 ec/5ub
.
BERKSHIRE PONDS
Remodei O_
Zoninp ul
Repeir ? Type of Const. v
Parcel No.
Adtlition ? No.Stories
RSM HOMES Move ? Length 36
a
? Name
14486 UPPER
GUTHRIE CT Demolish ? Depth 46
? Address Int Impc ? Sq. Ft.
City A.V. Phone 435-8868 Install ?
? Name
SAME
452-3499
Appravals
Fees
s? Address
?- City Phone
Name _
Address
Pnone
I hereby ackrwwledge thof 1 have read lhis application and stote tFwf
fhe informotion is corcect ond ogree fo comply with oll applicobla
Stofa of Minrusota Statu s a ity of Engan Ordiiwnces.
Siqnoture of PeaniM•
A Building Permit fs issued M: RSM HOWIRt
oll work shall be done in ocmrdante wifh oll plicoble_Stote of Mii
Assessment _
Water 8 Sew.
Police -
Fira
Erp.
Plonner
CAUncil
13ld9. Off. 9/12/85
APC
Var. Date
Permit
sumnarea 31 _ 00
Plan Revlew 1 S 9_ S Q
sac. 525.00
Watar Conn. 500.00
waee. Mete. 63 . 00
RoadUnit 280.?0
Tr. Pi. 132.00
ParkB
? Copfes
Total 'S 2 ,DOg.s0
on the exprcss cordiNOn Ihai
and City of Eoqon Ordinonces.
8uildlnq Officiol
..0 /S'Sb
t? r PLUMBING (RESIDENTIAL)
?yAa (0-7 Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5694
Please complete fot: Single Family Dwellings
Townhomes and Condos when permits aze required for each unit
Date?1
/
?
? .
Site Address ?.LJC.I L Unit #
Praperty Owner Telephone # (65() 1096-1010
contractor H
PIP€WARKG
R
.
.
?7d ?DD ROAD
address
hAN a?1
6AN
3 ci?
?
,
2
(?1) 365 1340
state
zip Telephone #( )
The Applicant is _ Owner Contractor Other
Septic System New Refurbished Su6mit 2 sets of plans and MPC license $ 100.00
InGutles County fee. Additional consultant fees may apply.
Altera[ions To Existing Dwelling Unit, Including $ 50.00
_ Adding fxtures to lower levels or room additions, excluding water softener and water heater
_ Abandonment of septic system
- Water turnaround (+ 5!8" meter if needed -$121.00)
Other:
_ RPZ _ new installation _ repair _ rebuild ? $ 30.00
_ Lawn irrigation system D
C ?
Water softener ? Wat
h
t
_
er
ea
er $ 15.00
? replacement _ additional
State Surchaege $ .50
Total $ 1
I hereby apply for a Residential Plumbing Permit and aclrnowledge that the information is complete and accurate; that the work will
be in confomiance with the ordinauces and codes of the City of Eagan and with the Plumbing Codes; that I understand tlns is not a
pemut, but only an application for a pernut, and work is not to start without a pernilt; that thelwork will be in accordance with the
approved plan in the cpse of work which requires a review and approval of plans.
Applicant's Printed Name ApplicanYs Signature
cIrv oF E.AcAN
CA&'N.T.ERe 5 1'E.RM.T.NAL. N0. 775
DA'iE. 01/1.9/93 1'IME: 15:02e1.3
ILl.,
NAME: HEARTH SF:RV1:Cf=.S INt;
3210 9001 4785 GAL.AX2E AU 60.00
2i.55 9001 4785 GALAXIF AV 0.50
,
?
Tot17, ReCeipt Amoslnt: 60.50
Cfi L0 i.3B9
USF:Ii TCis NANCY
? CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(651) Q81-4675
PERMIT
PERMITTYPE: El 11zLC,7.N r
Permit Number: Gi 3 4 4 n 8
Date Issued (6 1 i 19 19 3
SITE ADDRESS:
a78 5 rRt.tAzr_ t;'.'r-_
LQTa :1.9 U L.UCK: 3
BEF.KSHIRE PONOS
P . i.N. : 7.0-1s"150--:L9 0 -03
DESCRIPTION:
E?u'?.ldinis`.?ner?mic
uildtrrq 1,4. r?l_ Type
' ?en_us Code
t
1
i
k.
FTPiFF't,ACE
NE w
434 RL7. REaIIJEN'iZAI_
'l ( _ t
?_:%' •?? 4 `?J ;?`? } y4=
REMARKS:
CHI1+9N EYJP?1_UE I'q I1?, 1" ^F -1.IN3!?L=:1'- .11 w:Ur?? C(tY+1Ci'A!.Tiq fi.
FEE SUMMARY:
BaSe Fee $5U . 00
Si.ircharc7e ',.SVi
Tatal Fre 60 e50
CONTRACTOR: - n p u.l i r. a n r- OWNER:
j1E"AP,-fI-I SERVTCES„ SNC. 11078558 SCI-IIilI4MEt.F, OlkLI.EN
? hs13 sHn001A Lar;E u? E d 7 85 6ri_AxIE i,VE
LiNo LHxrs mr.! 5 5 0 14 rw6 aN 11 N 5 51>_'2
! 651.I 40I-8.558 I h3rebu acknowledoe that I haWe read t:ha„?, aPRlicatiarf and state that the
in.tormatiori is c.or-rgc'C. anx] aqree teaeomply wi.T.h a1L aapJ.3.cabt.e StaTp o'f Mi7.
Statutes and citv Uf Eaqan brdinances.
I
APPLICANT/PEPMITEE SIGNATURE
-i
"&
ISSUEO BV: SIG ATURE -
3 ?-l '--t acy
49
1999 FIREPLACE PERMIT APPLICAT(ON
CITY OF EAGAN
3830 PILOT KNOB RD - 55122
(651) 681-4675
l `
D /-( ?qz?
ate:
Description of Work: ? Construct nerv flreplace _ Alterationu to existing
_ Install yas iiesert onlv _ Install gas line nnlv
Other
a
G? ?c k -?.
7
b
dd ?)
?l -7 Av,
o
a
ress:
Lot: ? $lock: -'2) Subdivision/P.I.D. #: A 1 o n ?? ?? O?r?n?n
Applicant (circle one only): Owne ,Contracto PermitFee: $60.50
?661
#
Name: Phone
:
PROPERTY Last Firsy
OWNER
?
Street Address:
Ciry ? State: M? Zip:
C
? ?
??
?
°? # S q07^sSSg
Ph
(4t
Company: 17 ?Q-(
c???
1
C one
FIREPLACE
I3v`STALLER
Sheet Address: 6?0 % -? 4? ^ :5,?aoQ3 et, L
City ? " V,6 l-Q lLState: Zip:
Company: t-y p r)_A 5e_r 1/ Phone #:
GAS LINE
INSTALLER Sheet Address:
City State: Zip:
I hereby acknowledge that I have read this application and state that the information is correct
and agree ro comply with all applicable State of Minnesota Statutes and City of Eagan
Ordinances.
/ DA ? - -
Signature
J0,1NI 1 9 1cj°Q
1987 BOILDING PERMIT 9PPLICATION - CITY OF EAGAN
SINGLE FAMILY DWELLINGS
INCLDDE 2 SETS OF PLANS, 3 CERTIFICATFS OF SDROEY, 1 SfiT OF ENERGY CALCOLATZOAS
NOTE: ADD&ESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MIIST DESIGNATS WHICH ADDRESS
IS DESIRED. NO CHANGES WILL BE AI.LOWED ONCE BIIILDING PERMIT IS ISSQFD.
M[TLTIPLE DWELLINGS - RFSIDENTI9L RENTAL DPiITS FOR SALE QNITS
INCLUDE 2 SETS OF PLANS, CERTIFICAT6 OF SURVSY - CHECB iIITH BLDG. DEPT.,
1 SET OF ENERGY CALCULATIONS '
COP4IERCIAL
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: ?/,evK Valuation?t"j Date: 7NLV-
4,.4 ?effcl Footprint S.F.
Phone #
Site Address 47!i5 OFFICE IISE ONLY
Lot Iq Block ? On Site Sewage _ Occupancy
MWCC System Zoning
J
Parcel/Sub On Site Well Type of Const
t/
? City Water (Actual)
Owner
; (Allowable)
l? of Stories
Address y 7?S Length
City/Zip Code ESf2 2 Depth
S.F. Total
-
Phone y5
2'JEy7jZ . USY.-212 ? ApPR0Y9LS FEgS
Contractor Assessments Permit
Water/Sewer Sureharge
Address Police Plan Review
Fire SAC, City
City/Zip Code Engr SAC, MWCC
Planner Water Conn
Phone Council Water Meter
Bldg Off Road Unit
Arch./Engr. APC Treatment P1
Variance Parks
Address Copies
TOTAL
City/Zip Code
William H. Roske
4785 Galaxie Ave_
Eagan, MN 55122
Estmate for 11'A12' decH: on front of house:
Quantity Description
3 Posts 6x6x6i.:- Treated
1 Peam 2X1VX12' - Treated
13 Joists (12) and ledqer 2X8Y1,2' treated
20 Joist hangers for 2X97S
15 ibs 16d and lOd qalv_ nails
3 Concrete premix 10 - lb bags 288 5/4X6 Redwaod custom decking - lin ft.
Fr i ce (-1mount
?M.24 T-24.87
$o. 58 :VS. SS
16.79 £82_94
t.59 4: 11.8n
t.69 $10--;5
$1.55 $4.65
?r.39 :£112.32
Total = $255.51
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6x6 ?oos?s ??«?
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2/84
CITY Or EAGAN
APPL2CATION FOR PEPuMZT
SEWER AND/OR WATER CONNECTION
1) PROPE.Tt!'Y' ACD?,Z.SS:
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ACCRESS:
? CITY, STA'IE,', ZIP:
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,
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AUDRESS:
CITY, ST','I'r-, ZZP:
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UP..W.{ (T,ti? II?]ITS)
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Q L\STI'?LTIOVILL/GGV??2:?r,'?; ^
IPLEASE PHI,tiII
PR!
PWMBER LICENSE p_?'??jg'`,?n
retror
a i
5} II3pIG",''E :4[-1ICH P&?4•7IT ZS BEP:G REt?(.TF.STID:
? C):u1ECPZO?I 'R7 CITY SETr7ER
? CLD1'.QF,?PIG:I TO CITY ATATER
? ?'i'.ER (PLL'T,.,? OFSCRIBE)
6) IIQDIG,: C:E:
? PI=15E F?OID APPRWID pgt,+1IT FC1R PZCS?-UP BY ONE OF AFQVE
? PLEtiSE :''.\IL APP PIIZ?IIT TJ 1. 6. 3. 4 AEW£
(Circle one)
7) SIG.AT[.'RE: c , ?- , .• ,: . -
- - OATE:
(PCEASE PRINT)
3'r' S"T=? cE, Dcli : 0?' C_?clGi.AL =.+?ILDZ:r'
.? -" ST ISJ,.: ?\?:
;[•'w= -- - -
L'S: XR-1 SL:GL: :P^nSLY
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FOR CITY USEONLY
PLONBE ICEti ?c
Activ
i ed
f Reyord ?
? ??v?/
ar? inir„
M! WCl.+li?rl st !lgau f? ?t •.+'s? at?a ar s?r ?.ssa :? a?R `a/ki!??1lsJ? s w?? S?saa
FOR C I T Y U S E ON:,Y
PER`tIT °- ISSUED
. . Fcr. S : S /L) ? ?CJ
nERMT1 (I`Il'L'JL`. =C-.L'.A-RUL)
{'7ATEc2 PER141_:` (ILICiuD: SIIRCHARGE)
$ ? WATER METER/COPPERHORN/OUTSID: READER
$ WATER TAP (INCLUDE CORPORATION STOP)
$ SE:vER TAP
Oi._1T
ACCOUNT DEPOSIT - WATER
WAC
S.x S =o ? SPC
$ TBGNK WATER ASSESS?SE2IT
$ TRuiQK SELvER ySSE55:iEPiT
s LATEP.AL BENEFZT/TRU`]K SE:•ib'R
$ I.aTERrIL BENEFIT/TRWK WATER
$ WATER TREATMENT PLANT SURCHARGE
$
S
$
OTHER:
TOTaL
PutiI0LT:1T PAZD/R,r_,r-'-vI2T
DOES UTILITY CON.)ECTION REQUIP.E EXCaVATZON ZN PUBLZC RIGHT OF WAY? I
c--7 YES ZF YES, THEN H"PERh1IT FOR WORK WITHIN
PUEiLIC ROADWAY" MUST BE ISSUED BY THE
Q NO ENGZNEERING DIV:SION. LIST AS A CONDI-
TION.
SUBJECT TO TIiE FOLLOS9ING CONDITIONS:
APPROVED BY:
TI: LE: `
DAT°_:
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1985 BUILDINC PERMIT APPLICATION - CITY OF EAGAN
NO'fE: ALL CONTRACTORS MUST 8E LICENSED HI1'H THE CITY OF E6GAN
INCLUDE 2 SETS OF PLANS
3 CERTIFICATES OF SURVEY
1 SET OF ENERGY CALCULATIONS
To Be Used For; NC ?v <? f .t? `??
^?S • Valuation: ? Date: _ 1 U
Site Address: OFFICE USE ONLY
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Lot: 19-
Parcel U
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Remodel _
Repair
Enlarge _
Move _
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Occupancy
Zoning
Type of Const
U of Stories
Length
Depth
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pppROVALS _____-_ _-?
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Assessments Permit
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City/Zip Code Water/Sewer Surcharge
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Phone 1i !/
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Variance Treatment P1
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CONSUlTIN6 EHaiNEENS ENGINEEAING PIAHNEAS ond LAND fURVEYOCOMPANY, INC.
rAOSE N**466,
1000 EAST 1461A STREET, Bl1RN5VILlE, YIHNESO7A 5533? PN 432-3000
Cer?Zf Z ccc?` S'?Z?trYe t?
L¢Oat .I??crLp??osL: Lp-r 19 BLOCK 3 BERKSH1RE
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SCALE /"• 40'
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DAKOTA coUK?TYI MiNNESOrA ,
DENOTES EX/ST/NG ELEVATIOIU
(94e•0) DErt1oTE5 PROpo5E0 EGEVATION
I°OND5,0
/NDICATES piRECTioA! OF SURFAcE DRArN46E
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Ihereby certity that thia ie a truc and carrect representation ot a trtet ot
land as shawn' and deecribed hereon.. Ae prepared by tna on thi• ,3Am day ot
.S?BE'? s 19.8 .
o..iiinn. 1te6. No.
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/'79/-?-- STO 2006 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
NewConsNxtion
Reouirem k
3 regislered si? surveys shaviig sq. ry. oT bt. sq. ft. of house: arW A rookd areas
(20°6 mmimum lot caerege allorred}
2 oopies of plan shwving bmm & wimbve yizes; ppired (ourld daign, ek.
1 sei of Energy Cafcuiations
3 wpies of Tree Preseaation Plan if bt platkd afier 71193
Rim Jdst Defail Opfiais selecfion sheet (puildirigs with 3 or less units)
NGnoegasco mechazricai venlitation foan
RemodellReoair Reairemenm
2 coPres of plan shvwing Gmtings, beams, joisis
1 set af Energy Cakulations fw heaEed aclchans
7 siEe survey (pr adr16ais 8 decks
Add'Non - ind"xatg dorr-site septre system
Z?'C/' e0
Offae Use OnN
CertofSurveyRecd _Y _N
Tree Pres Plan Recd _Y _ N
TreePresRequited _Y _N
On-siteSepticSyslem _Y _N
Daft 9 ? y 1 0-7 ry °
Canstruction Coat DOc9 .
SiteAddresa y7r3?'S ?T/4'kh-;e- N.--' ??
-? ?
Unit/Ste #
DescripiionofWork _ 5o cf;1'-°f
Malti-Family Bldg y /?N Fireplace(s) 2
Property Owner % M Telephone # ( `Sl 7S - LY I
CoMractor
Address O'b 7 CCiL City S%`+'?tua?°r
S? A? ZiP S54'Z. Telepnooe#(4S/ ) y3q-176o
COMPLETE T!i!S AREA ONLY IF CONSTRUCTIM?fi A NEW BUILDING
Energy Code Category - MinnesM R»les 7670 Catr¢orv 1 _ Minnesota Rules 7672
(J submi?ion type) • Residetkial VeNiktion Category 1 Worksheet . New Enetgy Code Warkstieet
Su6mitted Submitted
• Energy Envebpe Calcuiations Submitted
In the lasf 12 monihs, has the City of Eagan issued a permit for a similar plan based on a master plan8
- Y _ N ff yes, date and address of master plan:
Licerned Plumber
Mechanicai Contractor
Sewer/Water Contractor
Telephone #?
Telephone #(
Telephone #(
I hereby apply for a Residentiai Building Perniit and acknowledge that the information is complete and accurate;
that the work will be in confomiance with the ordinances and codes of the City of Fagan and the State of MI3
Statutes; I understand this is not a permit, but only an applicatinn for a permit, and work is not to start without a
pennit; that the work will be in accordance with the approved plan in t6e case of work which requires a review and
approval of plans.
INC4?' 1!29WSo-A"/
Applicant's Printed Name Applicant's Signa6ure
/? \ REQUEST FOR ELECTRICAL INSPECTION Ee-uuuo,:ua
(Q "?C? ' See instruetions lor completin9 this form on back oi Vellow coov. (G. -/0 ?'y S
`p MORI '"X:' Below Wark Covered by 7his Aequest
AAd Rp,?1. _-,{ype of BuilCing . Applianma Wired Equiumenl Wired
Home Range Temporary Service
Duplex Water Heater Lighting Fixtmes
Apt. Building Dryer Electric Heatin
Commercial Bldg. Furnace Silo Unloader
Industrial BIAg. Air Conditioner Bulk Milk Tank
Farm ' otner peci y thmr (sper.ilv)
t er SVeci y Ot er Other
Compute Inspection Fee 8elow
M Fae Sarvice EntrenceSiza Faxdars/Subieaders N Fee Circuits
0 to200qms Oto30Ams Otn30Ams
Above 200 Amps 1 to 100 Amps 31 to 100 q y
Swimmin Pool n Above
100-Anips Above 100_P.m)s
Transtormers ,
rrigaton Booms Partial.Other
Signs pecial Inspection g
J TOTA
Nemarks 2
? L F E
Rough-in
Fi^al D te
1 1,the Elac
Inspectoq hweby
certify that the abave
inspeclion has been
maae.
tOlsreQUeatvoitll8monthsirom V ?' -/
?)qv Ci's
Street Atldress, Boz or Ryute Na . City
715- G?lqz-J? ? ?-.
ecUOn o. Township Name or No. Ranye No. County
Occupam (/pp INT)
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f/
i _
7Z
Paw t Supp/lJ er r
!{?o,K lr55 ???/?rLC._..
. AAtlress
Electrical ConNaclor (COmpanV Neme) ConVactor's license No.
Mailing Address (Conhaclor or Owner MakinA Installation)
•
Authorjpetl Sig re IGonvactor n" iny nstallationl Phone Number
U% _ -- - - ?? ? ?
? Licensed Elec[rical Con[rectm I hereby request inspection ot above .
)KOwne, electrical wo,k installed at
MINNfSOTA STATE BOAXD OGELECTHICITV iTHIS INSPECTION 0.EQUE5T WILI NOT
Griggs-Midway Bldg. - Room N•191 eE ACCEPTED BY THE STATE BOARD
1821 Universitv A.ve., St. Paul. MN 55104 UNLESS VPOPEH INSPECTION FEE IS
Phone (612) 287-2111 ENCLOSED.
1-s request voitl ?_ _(LG'` G?
8 months from J '?
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA154254
Date Issued:03/06/2019
Permit Category:ePermit
Site Address: 4785 Galaxie Ave
Lot:19 Block: 3 Addition: Berkshire Ponds
PID:10-13750-03-190
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Thomas J Mccauley
4785 Galaxie Ave
Eagan MN 55122
(612) 817-1770
Wenzel Heating & Air Conditioning
4145 Old Sibley Memorial Hwy
Eagan MN 55122
(651) 894-9898
Applicant/Permitee: Signature Issued By: Signature
fit 0
f For Office Use
° offi fr :::
47„ E AG N
: 10-` t4
3830 PILOT KNOB ROAD(EAGAN, MN 55122-1810 CEIVtj';D Date Received: i-/aa
(651)675-5675 TDD: (651)454-8535 I FAX:(651)675-5694 AAV 2 2 2 019 staff
tc)
buildinainspectionscitvofeaoan.com
2019 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: S-.a—I cl Site Address: 4 8 5 C0-0 q y;' A V
Tenant: /__ Suite#:
Resident( tiilftlBf •
Name' /'en c c /1 ' C C c w ) -e y Phone: (o 12 X 17 /7 90
Address/City/Zip: 8S Co )o Y,e Awe S-s /a
Name: e.S.0 i c n P) .i,-., b i S-e r v i Le S License#: PC Co lb It 3 S $
ContractorAddress: P O . car o1 r)1 a City: c:.8 o ,r\
State: y'Y\Ai Zip: S S / Phone: (o S ^ (a 8 )-- g 2 S 2--
Contact:
Contact: ' Email: I tie )
))
Type of Work New _Replacement Repair Rebuild _ ModifySpace _Work in R.O.W.
Description of work:
Water Heater
Lawn Irrigation(_RPZ/ PVB)
Water Softener
D@SCin Add Plumbing Fixtures( Main/_Lower Level)
Septic System
New Description:
Abandonment Connection to City Water from Well
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 New fixtures, adding or removing piping (includes State Surcharge)
$60.00 Septic System Abandonment
$100.00 New Residential(fee collected with Building Permit)
$115.00 New Septic System (includes County fee and State Surcharge)
$60.00 Connecting to City Water from Well*+$290 for Meter and$190 for Radio Read=$540
*Sewer&Water Permit also required for connection charges
TOTAL FEES$ (p 0 ' °Q
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.aooherstateonecall.org
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's
website at www.citvofeanan.com/subscribe.
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. J�
Applicant's Printed Name
plicant's Signature
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