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3608 Falcon Way ' - CITY 4F EAGAN 0' 70`4 MN 3830 Pil K O E . nob Road, P. . Box 2 ot 1-199, agan, 55121 PHONE:681-4675 ' j BUILDING PERMIT Receipt # To be used for BASEMENT FiNISH Est. Value Date MAR 3 , 1992 Site Address 36oa lw1.CON WAY Lot 3 Biock s Sec/Sub.LEXINCTON PLACE O?F 3CE USE ONLY FEES Parcel No. Occ "Pa"`y ? 35 00 i Z Bldg. PermR . on ng s J0?'[N Si?00!lQUI ST ? (nctual) Const - s?rcharge •?0 9608 lA1.CON iJAY (Allowable) • W ?d?S - Plan Revfew ? E?. N ? C?Y ZP M of Slories th Len - ?? 5.00 ? p g - phone Depin - snc, city ? D/IVID SC?iNEICH CONS? N? S.F. rotal - sac, nnCwcc 17160 IIAMIT '['(3N DR S.F. Footprints ? . AddfPSS Sit Se a e O Water Conn Cfty 1.AKEVII.L£ MH ZP 55044 w g n e On Site Well _ Water Meter ? T-a808 Phone 44 MWCC Syslem = necc DePosic 8 u 0W3??r cirywater _ . ?? # PRV Required _ SNV Permit I hereby acknowlege that I have re d Ihis application and state that the Booster Pump - SrW Surcharge information is correct and agree f?comply with all apoNicable Slate of Minnesota Statutes and City of Eag OrdinMces. t ? / Treatment PI iA/1- Signature of Permitee ? APPROVALS Road Unit A Building Permit is issued to: DAVID VCMrEICi! COHST Pianner - Park Ded. ; on the express condition that ali work shall be done in accordance with all Council applicable State of Minnesota Statutes and City of Eagan Ordinances. g?j, pff. _ ?P1eS ? Building Official - e Variance - TOTAL 41 • Q? ? ? Permk No. Permit Holder DNe Telephone # S/W PLUMBING FMAC El_ECTRIC EL.ECT'RIC Inspeetion Date Insp. Commenffi Foolings I Foundation Framing Roofing Rough Plbg. Rough Htg. !L lgul. 3-?.sz s Freplace Final Htg. Orsat Test Final Plbg• Plbg. Inspedor - Notily Plumber Const. Meter Engr?Plan Bldg. Final Oedc Ftg. Dedc Final Pr. Disp. CITY OF EAGAN 11705 3830 Pflot Knob Road, P.O. Box 21-199, Eagan, MN 55121 ?- PHONE• 454-8100 BUILDtNG PERMIT . Receipt # SF DWG/GAR $57,000 Site Address 3608 FAi,CON WAY Erect K? ls' Occupancy Lot 3 elock 5 Sec/Sub. LE?f ING`1'UN r'L SOiemodei ? Zoning R1 Parcel No. Repair ? Type of Consk V Addition ? No. Stories Name ui?.;Z j iv T:i0MPSON HOME$ Move ? Length z 1712 iiUYK21?1$ CROSSROAD Demolish ? Depth 3y o Address Int Impr. ? Sq. Ft ICity- I'`TKi9 Phone 544-7333 fnstall O - = o Name ? ¢ Address r,?--- Phone 1 hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicabte State oi Minnesota Statutes and City of Eagan Ordinances. ?-... Signature ot Permittee O.fZRIN THOMPSON NOME A Building Permit is issued to: all work shall be done in accordance with all appliofible State oi Minnesc Assessment Water & Sew. Police Fire Eng. Planner Bldg. Permit -'"'' • vv Surcharge 28•50 Plan Review 1-52- 0 0 SAC 575.00 Water Conn. 50U . OU Water Meter 63.50 Road Unit 2904 Tr. PI. 156,00 Var. Date I Copies Total ? . 0 0 on the express conditlon that City of Eagan Ordinances. -2 a 31 l ? - 6 la 12 L Ps?mft Na Permit HAdw Date TN*pharo M Plumbiny . L 3 • H.V.A.C. Eleetric A-d SoMsner ImpecHon Dats Insp. Commenh Footinys I FooUnqsil Foundatbn Framiny • ? ?? RooNnq Rouyh Plbq. ? fiouph Hly. Ingul. Fireplaee Flnai Hty. Flnal Plbp. Bldy. Flnal D. .S..t c d p^ "?6 Cerl. Oec. Deck Fty. Deek Frmy. Well ' Pr. Dlsp. PERMIT # CITY OF EAGAN ? r. ? MECHANICAL PERMIT RECEIPT ? 454-81 00 ? z MINIMUM RE8IDENTIAL FEE - $10.00 +5.50 DATE MINIMUM COMMERCIAL FEE - $20. $•50 1. Bldg. Type: Res Comm Inst 2. New Add _ 3. Total Bid Price 4. Job Address Lot ? Block 5- l?s 5. 6. Contractor (Mame) lStreeq 7. Contractor Phone # FEE &2 V" `-;D S/C .o TOTAC;Z' 5 b Alter RESIDENTIAL HEATING - 01-100,000 BTU's -$24.00. Each additional 50,000 BTU's or fraction -$6.00 RESIDEN AL COOLING - 01-24,000 BTU's -$12.00. Each additional 6,000 BTU's or fraction -$6.00 MODIF ATIONS/ALTERATIONS -$10.00 minimum fee " HEATING VENTILATING HOT WATER STEAM AIR COND. eIR PIPING PROCESSED PIPING AIR NANO. EQUIP. RtFRIG. RES. GAS PIPING OUTLETS -$1.50 TANKS: L.P. UNDERGROUND OTHER COMM./IND. R - BIQ PRICE PLUS $.50 STATE S? HARGE j0 ?ACH $7,000 OF FEE. Signed: for Approved Inspections: Date Rough Insp. ate Final Insp. PLUMBING PERMIT RECEIPT # ' CITY OF EAGAN u 3?30 PILOT KNOB ROAD, EAGAN, IIAN 55121 DATE: CONTRACT PRICE PHONE: 454-8100 SiteAddress BLDG.TYPE WORK DESCRIPTIQM L ot --= Block Sec/Su b V / ? Gl?i- y Name Mult Add-on ?a Address Comm. Repair c J/ ?l City ?'-? Phone 1 ' ? jL Other . i? ?-'i; ? - ..>>. .. ? Name >fc, ? ? Nq. FIXTURES T07AL . ? Address O Ciiy Phone ?- ?J LLavatory - $3.00 T FEES Kitchen Sink - $3.00 Urinal/8idet - $3.00 COMM/IND FEE - 1°a OF CONTRACT FEE MINIMUM - RESIDENTIAL FEE - $1D.00 ? MINIMUM - COMM/IND FEE - 20.00 STATE SURCHARGE PER PERMIT - .50 (ADD $.50 S/C IF PERMIT PRICE GOES ? Gas Piping Outlets - $1.50 BEYOND $1,000.00) " Softener - $5.00 1 / ; Well $1 0 00 . FOR: CITY OF EAGAN PERMIT# Res. ? New Water Closet - $3.00 ? -?Bath Tubs - $3.00 Shower - $3.00 Laundry Tray - $3.00 Floor Drains - $7.50 T_Water Heater - $1.50 ? Whirlpool - $3.00 - _,_Private Disp. - $10.00 ? Rough Openings - $1.50 FEE STATE S/C: - Z GRAND TOTAL• ?' ?' ? Control No. 0379 INSPECTION REC4RD I CITY OF EAGAN PERMIT TYPE: btlik. Q 1mfl ' 3830 Pilot Knob Road Permit Number: 0004f'6 -Eagan, Minnesota 55123 Date Issued: (612) 681-4675 SITE ADDRESS: L O T t 3 "LOCK ;b APPLICANT: 3606 rALcaN wnv sc:HwErcH CawSr. anvxu ? LExraGTO+a E-t_ncE s (?;t2) 447-e908 i PERMIT SUBTYPE: TYPE OF WORK: ? I+t i t NCW i INSPECTION .. . .A rnoi, lNa FtNAL I 1 ? ?•?Y`*L?+4y_? -. • ? ' • f ?.."? ? 31I ? .; ? ITM+ :. 1S I I I I ?? . .. . ? ? I ,_..._. .-. .. ? . . .-. . . . . . - . ? ? . ? .. . .. . ? ? - -. . -. . i ? ,_,.. . . .. . . . - ? : ... . , ; . ? M - - - - - - - - - - - - - - - - - - - - - - - - - - - - Peemk No. Permlt Holder Date Telephone #k S/VH PWMSING HVAC ELECTRIC ELECTRIC InsQsctlon Date Insp. Comments Fooiings I Foundation Framing Rooting Rough Plbg. Rough Htg. Isul. F(replace Fnal Htg. Orsat Test Final Plhg. Plbg. Inspector - Notify Plumber Const. Metcr Engc/Pisn Bldg. Flnal Deck Ftg. Declc Final WeII Pr. Disp_ 'OFEAGAN ? Pilot Knob Road wATER SERVICF PERMIT ? ,,,, Bux 11199 PERMIT NO.: i, MN 55121 DATE: - o: No, of Units: 1 ;`omes llddrcss: 3+'?Je `'alcon W8y I3 B5 No.. te ee.oy wi16 !M Tocoi: _ Dote Paid: 5 Date of Insp.: InSP6: ?y (o CITY OF EAGAN $MR MVlCE PERMR 3830 Pilot Knab Rwd P. O. Rox 21199 PERMIT NO.: Eagan, MN 55121 pATE; ZO^i^0: - No. of Units: Owrnrnr. Addrcss: Sits Address: ' 08 FSl eor. , '- Plumber: `'eT2z-Rpan 3--28-36 61: ' :;. ? . I "M ho Mf woh !M CIly af so"w CorrNetlon Chorpt: Aotounf DEpOqt: _ PermR Fee: Surctw?p: By Misc. Chorqes: - DcM of Insp.: Total: Iresp.: Dah Prold: CITY OF EAGAN WpTpt SERVICE PERMIT 3830 Pilot Knob Rosd P. O. Box 21199 PERMIT NO.: Eagan, MN 'a5121 ? DATE: Zonir*: _ No. of Owner; Addross: - Sih Addrcm . ? Plumber: ::'r,?;•-sn - %i tE AAeter No.: Slze: Reoder No.: 1 qm to ason/1? M11h Ne Ci1p of OnAweaoM. Deposit: IRiCflu.t???• Pertnit Fee: rz? SurcFwrOa: Misc. -?r Total: By po" Patd: Date of Inap.: Irnp.: CITY OF EAGAN SEWER SERVlCE PERMIT 3830 Pilot Knob Rosd P. O. Box 21199 PERMIT NO.: Eagsn, M11! 55121 DATE: Zoninp: No. of Units: OwrNr. Addrcss: - Site Address: Plurribar. - - ,? I qrM te poopfy wIM !w Ci1p oi iqp¦ Connoetion Choepe: . araimmas. /lcoount Depodt: Permit Fee: Surdwrpe: By Misc. Cho?wsc Dote of Irnp.: Inap.: Totoi: Dah Poid: CITY OF EAGAN Remarks Addition Ltxington Place South Lot 3 Owner Street 3608 Falcon 10 45060 030 OS an, MN Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. STREET RESTOR. GRADING x??i. aZ SAN SEW TRUNK 041 24764 - SEWER LATERAL 101. 1986 1 631.. 0 0 3 Z t-. Z 0 ? ? - Services 101 1986 729.39 145.87 5 WATERMAIN WATER LATERAL 1012, 19 8 6 8 7 3. 43 .174.68 5 WATERAREA 10111- 1986 243.73 ' 48.74 5 WAT LAT BEN 10 13 1986 111.98 22.39 5 STORMSEWTRK 101rI 1986 426.54 85.30 5 STORMSEW LAT 101 t 1986 803.34 160 . 66 5 CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. BUILDING PER. ' SAC PARK N ' CITY OF EAGAN No20176 3830 Pilot.Knob Road, P.O. Box 21-199. Eagan, MN 55121 PHONE: 681 -4675 ? 17& (2 BUILDING PERMIT Receipt # - L To be used for BASEMENT FINISH Est. Value Dale MAR 3 1991- Site Address 3608 FALCON WAY Lot 3 Black 5 SeGSub. LEXINGTON PLACE oFFICE uSE oNLr FEES PBrcel NO. R-3 Occupancy i Z 35.00 Bldg. Permit ng _ on N2file JOHN BLOOMQUIST (nctuapConst - Surcharge .50 w p,ddrp,ss 3608 FALCON WAY (Allowable) - Plan Review Cj(?r EAGAN MN Zp en9 h?aries = ?? 5.00 0 Phone Deplh - SAQ City ¢ Nyme DAVID SCHWEICH CONST S.F.7otal - Snc, rnCwCC ? qddresS 17160 HAMILTON DR S.F. Footprints Sit O S water Conn ewage _ n e Cky LAKEVILLE MN jjp 55044 OnSitewell Waterr?neier ? Phone 4?+7-$$OS = MWCC System qmt Oeposit cg 0003607 V l1S6 # caywater - . ce PRV Required _ SM Permit I hereby acknowlege ihat I have re d this application and state that ihe Baoster PumO - SPN Surcharge information is correct antl a ee U omply with all ap icable State of Minnesota Slatules and City rdin ces ? ag 7realmanl PI Signature ol Permitee APPR04AL5 Road Unil A Building Permit is issued to: DAVID SCHWEICH CONST Planner - park0ed. on the express condition thai all work shall be done in accordance with all Ca+mil -- .50 applicable State of Minnesota Statutes and City of Eagan Ordinances. Bldg. OII. _ Copies ?/ Building Oflicial 1kl/1 ,?11?: j ??,U Variance - TOTAL 41.00 BUILDING PERMIT Receipt# Wi n 11705 7obeusedfor SF DWG/GAR Est.Value $57,000 pat, MARCH 27 1g86 3608 FALCON WAY R3 SiteAddress Erect LS Occupancy Lat 3 eloc k 5 Sec/Sub. LEXINGTON PL SORemodel ? R1 Zoning Parcel No. Repair ? Type of Const. V Addition ? No.Stories ORRIN THOMPSON HOMES Move ? Length 38 W Name 1712 HOPKINS CROSSROAD Demolish ? Depth 39 3 ° Address MTKA 544-7333 Intlmpr. ? Sq.Ft. Ciry Phone Insiall ? o SAME i Name ? ¢ Address ? Ciry Phone Wo W Name Address z i w City Phone 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 Ordina?ncies. Signature of Perminee ?w O? y-/? ORRIN THO"rIPSON HOME: A Building Permit is issued to: all work shall be done in accordance with aU-epp " ble State of imestl CITY OF EAGAN 13830 Pilot Knob Road, P.O. Box 21-799, Eagan, MN 55721 Np - PHONE: 454-8100 , , i Assessment Permit 304.00 Water & Sew. Surcharg?30 Police Plan Review 152. 00 Fire SAC 575.00 Eng. WaterConn. 500.00 Planner water Meter 63. SO Council Road Unit 290. Q0 BIdg.Off. 3/27/8 Tr. PI. 156. 00 APC Parks Var. Date Copie rotal 2.069.00 on the express conditlon that §tafdtes and Ciry of Eagan Ordinances. Building (trx#ifirtt#r of (Orrupttnry Citp of (tagart Ep{tFlTfritPI1T IIf BLtIIDtItQ 3ItS}iPtfilttt Thi.r Certijcate i.rsued pursuanr to the requiremenu of Section 306 oJthe Uniform Build(ng Code cerrrjying that at the fime ojissuance this structure was in comp(iance with the various ardin¢nces oJthe City regu(aNng building construc[ron or use. Foi the jollowing: usscinvdia,nm SF DWC:/(:AR BWg.FtnWiNa 11705 o=wm rype R 3 zon;,,g Dw,;a R 1 rya c.nna V o.aeWWiqXORRIN THOMPSON Add? 1712 HOPKINS CROSSROA eww;h An• 366/8 ?• FALCON WAY Local;ty L 3 B 5 LEXINGTON PL. 1;[/ 0.k: d??? 24r1986 Budding OBioalg,?' POST IN A CONSPICUOUS PLACE 5 1 3 p 4 3 4 111 Request Dat Fire No. Q? " RougM1-in Inspection RequireC? C, Ready Now I?Jill Notity Inspector ??W?en Reatly? ? es C No Alicensed contraaor ] owner hereby request inspection of above electrical work ai: Job Atltlress (Sheet BoH or Rawe No.) ? d? ot ?Cr.? ?'i/ Ciry LC.? /j.v' Sedion No. Townsnip Name or Na. Range No. Counry / , ?ylr A- f? . Ocwpant • 6?oc.? .sf ? Phone No. u h o Power Sunvher . D4 ko& E/o_v .-« qedress f Elecmcal Coniractm (COmpany Namel I C E/ Contracu r5 License No. SS ?? ? E T???G a Z Mailing qetlres/s ??GOn? aor orOw?ne? aNln installaiion) 4'/E7? N ? 0?" /C ? Ov d . GI a.?. Auaonzetl SiS^anre ICO) I vOwner yaking Insl " n? Phon umber 6e -- ao yz--- MINNESOTA STATE B RD OF ELECTRICITY 1HI5 INSPEGTiON fiE0UE5T WILL NOT Griggs-MiEwey Bltlg. - Room S473 BE ACCEPTEO BY THE STPTE 80ABD 1821 University Ave.. SL Paul. MN 55104 UNLE55 PROPER INSPECTION FEE IS Phone (612) 642-0B00 ENGIOSED. REQUEST FOR ELECTRICAL INSPECTION J? See mscructons for complating this lorm on baok ol yellow oopy. "X" Below Work Covered by This Request ; 4t'A N?•-? .a.. ew Atltl kep. Typeof8uilding ? AppliancesWired EquipmentWired Home Range Temporary Service Duplex Water Heater Eleclric Heating Apt. Building Dryer Other (Specily) Comm./Intlustrial Fumace Farm Air Conditioner Olher (sypcify) Conlractors RemaBS' ' // a ,5??+-/ re yv. ? / Compufe Inspection Fee Below: ?s?7?/ s O?her Fee # ServiceEniran eSize Fee '# Gircuits/F eders Pee Swimming Pool 0 to 200 Amps 0 to 100 Amps Transtormers Above 200 _ Amps Above 100 _ Amps Siqns Inspectars Use Only: TOTAL Irrigation Booms p • b30 tp Special Inspection niarm/COmmunication THIS INSTALLATION MAV BE ORDERED DISCONNECTED IF NOT Other Fee COMPLETED WITHIN 18 MONTHS. I, the Electrical Inspector, hereby Ro°gn-'° oaie? , Z certify that the above inspection has been made. F;oai , oaie? , Y OFFICE USE ONLY This recuesl voitl 18 monPS Irom This requesl void U (,//1 ` ` 18 mpn[hs from -C ' 3718 L3, B 5, eX??rcTOA/??.So ,??,ly = Reque t Uate `? ? • Fire No. qo??he?? lnspection Ies ?NO ?Ready Nuw?Will NotitY Insoec- ? mr When PeaAY [41-icensed Electrical Convacmr I hereby raquest iasoection of ebove ? Owner electrical work installad et Street Atldress. Box or Route No. Ci[ O eciwn o. TOwnshi0 Nam¢ or N. RanOe No. C rt OccuVeM IPRINT) Phone No. --73.?;? ._ . o r Sup liar . ?? ? EI nical Conuacto? ICompany Neme) Cnmractor's License No Mailinp Addr ss ICoM ctor al Owner Making Ins[ailation l i??'V• Authori ed Signature ICOnvactor Owner MakfnB Installation) Phane Number 2 - zrN NESOTA STATE BOAflD OF TRICITV THIS INSPECTION 0.EQUEST WILL NOT BE ACGEPTED BY THE STATE BOARO rig g s -Midway Bldg. - Roo •191 1821 Universitv Ave., St. aul, MN 55704 UNLESS PqOPER INSPECTION FEE IS on- 16121 29].2111 ENCLOSED. VsjI /?1d REQUEST FOR ELECTRICAL INSPECTION , ee•ooooi-a ` It See insimctions br comoletirq tbis torm on beck oI Yellow copy. f- R71A "X" Below Work Covered by This Request F."HAdI peD.I TYOe of Boileing I ApDliancea Wiretl I EquiUment Wired I ee M Fee Service EntrenceSize tt Fae Feaders/3ubieeders N Fxp Circuits 40-406 0 to 200 qm s . 0 to 30 Am s 0 tn 30 Am Above 200 Am 1 51 to 100 qmps 31 to 100 Am s Swimming Pool Above 100_Am s Abave 100_Am s Transiorme?s Irngation Boorris Pdrtial."Oth Special Inspection iO7AL ..__e. ... / U • the Elec ilLc sPecbq hereb? cartily thet the bove Final te c inspaction hes Ceen ? ?/ ? 'matle. mb rpuaat witl 18 moniha from \ / ? CITY'OF tAGAN 3830 Pilot Knob Road Eagan, Minnesota 55123 (612) 681-4675 PERMIT PERMIT TYPE: Permit Number: Date Issued: 9UILDINO 00@456 05/04/92 SITE ADDRESS: 3608 FALCON WAY LOT: 3 BLOCK: 5 LEXINGTON PLACE 5 DESCRIPTION: Building Permit 7ype ? OECK Building lJork Type NEW ? Ll REMARKS: FEE SUMMARY: Base Fee Surcharge Subtotal $25.00 $.50 $25.50 COPIE3 $1.00 Total Fee ;26.50 CONTRACTOR: - Applicant - S7. LIC. OWNER: 3CHWEICH CONST, DAVID 14478808 0009607 BLOOMQUIST JOHN 17160 HAqILTON DR 3608 FALCOPI WAY LAKEVILLE MN 55044 EAGAN MN (612) 447-8808 (612)681-0153 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 Pln. Statutes and City ofi Eagan Ordinances. ? Li -os? APPL CANT/PE ITEE SIGNATURE I 'nuo Rri-,r f Nt1 ISSUEDBY: SI NAT RE Control No. 0379 INSPECTION RECORD Control No. 0379 CITY OF EAGAN PERMITTYPE: auiLoiNG 3830 Pilot Knob Road Permit Number: 000456 Eagan, Minnesota 55123 Date Issued: 05 /04 /92 (612) 681-4675 SITEADDRESS: LoT: 3 3608 FALCON WAY LEXINOTON PLACE S PERMIT SUBTYPE: DECK IFOOTIN(i F L t,r L?.n. eLoCK: s APPLICANT: SCHWEICH CONST, DAVID (612) 447-8808 TYPE OF WORK: NEW , , .. I w4 : : , 0 u 1. t i ' , i•i n? :. In? ri i. .,i? i ? ?? i ?•i ? FINAL ? ? PE?'cMI7 #" qf4 CITY OF EAGAN 1992 BUILDING PERMIT APPLICATION 681-4675 SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy calcs. COMMERCIAL 2 sets of architectural & structural plans, 1 set of specifications, 1 copy of energy calcs. Penalty applies when typing of permit is requested,"but not picked up by last working day of month in which re uest is made or lot chan e is re uested once ermit is issued. Date !z / ) 9 / 92- Valuation of work 44 5c-9- Site Address: ??3 ? ofI /Qc,,,., a,,..L? STREET STE i' Tenant Name:?lof/•?/ RLoo yh C?oist' oT _? eLaK Descri tion of work: The applicant is: ? Owner ? Cantractor ? Other (oescribe) Name A Loar3q r:,>i rl' -fo id/W Phone Property «5T FIRST Owner Address ;?G o? ? 'ec STREET STE / City r?/> A+? State ?,?-.? Zip Company Phone 441r7- PF-&8 Contractor 4- Address _ l1,t66 MAA,147,arV y?A License M 00D36C17 Exp. 3) 9? City b9/C-A 1/??L E7 State Al/ Zip Lr3'0 '/y Company Phone Architect/ Engineer Name Registration # Address City State Zip Sewer & water licensed plumber . Processing time for sewer & water permits is two days once area as been approve . 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. Signature of Applicant: f???/ vrrwc uac vnLT BUILDING PERMIT TYPE ? 01 Foundation ? 05 Apt. Bldg ? 09 Basement Finish ? 02 SF Dwg. ? 06 Garage/Accessory ? 10 Swim Pool ? 03 Two family ? 07 Fireplace ? 11 Res. Add./Porch ? 04 Multi-fam. T.H. =OS Deck 13 12 Comn./Ind. woRK rYPe 0'31 New ? 32 Addition ? 33 Alterations ? 34 Repair ? 35 Tenant Finish 0 36 Move GENERAL INFORMATION Const. (Actual) (A1Towable) UBC Occupancy Zoning # of Stories Length Depth APPROVALS Planning Engineering REQUIRED INSPECTIONS E3 37 Demolish ? 99 Undefined Basement sq. ft. lst F1. sq. ft. 2nd fl. sq. ft. Sq. Ft. total Footprint Sq. ft. On-site well On-site sewage Building Variance ? Site ,1?"Footing ? Wallboard Pr Final ? Framing ? Draintile _73-2 0 Insulation ? Fireplace Permi t Fee 2 s v.tu.cion: s Surcharge s? Plan Review License MWCC SAC City SAL Yater Conn. Mater Meter Acct. Deposit 5/W Permit S/W Surcharge Treatment P1. Road Unit Park Ded. Trails Ded. Co pies Ot her ? Total : 2d, I , t.. l? 46PG611c Fac. ? 14 Agricultural ? :5 Miscellaneous MWCC System City Water PRV Required Booster Pump Fire 5prinkler Census Code SAC Code Assessments SAC 9G SAC Units ?Wvarr GIVUl[VL'CI<1N(a cAxWnNY 0 2815 Y7AYZATA C6RTIFICATE OF SURVEY FOR: ORRIN THOMPSON HOMES A Division of U.S. Home Corporation . BENCHMARK: Top nut of hydcant at ' southwest corner of Hummingbird Lane and Falcon Way. Elevation = 904.54 ft. (NGUD-1929) fRONT GARAGE SLAB: Proposed El. = 905.05 ft. • MINNEAPOLIS, FA1 • PHONG: 379-4740 Scale: 1" = 30' • Iron monument found ° Wood stake set , yon.o F,xisting elevation ? ?---draina?e 6 UJi'/.ity Easemenf a ;o . ! ' " ° 21 5 89 S4 E 126.54 Q 0 3 ? 2o.e3 Q ? ? 30.i r OD 18.5 . I `D ? µf 6.O7: a N 0 z -.D ? M m 7 83 n O ? 3 10 8 . m ? LO T 3 O ? .i W .e h ^ IS ? ? U J m l!) b O.o ? 3 O ? 2 I . O d U ' z I N ? ss.s I o I U- 1 1 ??? 11 I ? ' _ ?'^; • / N 0 a N 96 21'54" W 127.17 I N O a ? ?EGilis d'w/ aE . cANTa 1 vP00 a? ? F TNA? i s Lot 3, Block 5, LEXINGTON PLACE SOUTH, Dakota County, Minnesota I hereby certify Uiat Gliis is a true and correct representation of a survey of [he boundaries of the land above described and of the location o£ all buildin95, if any, [hereon, and all visible encroachments, i£ any, from or on said land. I fureher cer[ity [hat thls sucvey vns prepareA by me or under my direcG supervisLon and ChaC I am a duly Registered Land Surveyor under the lavs of the State o£ MinnesoCa. . \?,i ?{ /?'y f?Y aI MIIJ Reg. No. /?7y,CJDa[e _r `?U Proposed House x As-Built House _, Drawn by 5^i 'Proiect no_851on 7986 HOII.DING PEHlQT ApPLICATIOH - CITY OF EAG9N NOTE: ALL CONTRACTORS MQST BE LICENSED 1iITH THE CITY OF EAGAN 201 COMRERCIAL 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: L5(RS?,v???? SINGLE F9MILY DfiSl.LINGS INCLUDE 2 SETS OF PLANS 3 CERTIFICATES OF SURVEY 1 SET OF ENERGY CALCULATIONS Valuation: Date: ?j- ici -? Site Address F0.L-Qn "? OFFICE BSE ONLY Lot ? Hlock ?j Parcel/Sub G?? Owner Address City/Zip Code Phone Erect X Oceupaney _ R Remodel Zoning ? Repair _ Type of Const $? Addition # of Stories Move Length Demolish Depth 39 Int.Impr. Sq Ft Install APPROVALS FSES Contractor QKy, n "o- Assessments _ Permit 15p. c I.., Add W Water/Sewer _ Sureharge p ress J 1 I2 -npk; poliee Plan Review po Fire SAC -?t,, po City/Zip Code ?: Yl? ?( L/? + VIA „-3q3 Engr Water Conn r-pp. pp Planner Water Meter Phone Couneil Road Unit 2?10. G? Bldg Off L2X Treatment Pl P<4.,, p0 Areh./Engr. APC Parks Varianee Copies Address TOTAL ? co City/Zip Code Phone # NOTE: ADDAESSES FOR COBHSR IATS - CONTBACTOE/HOMEOiiNLE M[JST DSSIGNATE i1HICH ADDRESS IS DSSIRED. N0 CH9NGES {iILL BE ALLOHEp ONCE BIIILDING PERMIT IS ISSIIED. C[.ARK ENGIIdGERING COI4pANY o 2815 WAYZATA F300LEVARD • MINNEAPOGIS, hQ1 • PHONE: 374-4740 CERTIFICA2E OF SURVEY FOR: , ORR1N THOMPSON HOMES A Division of U.S. Home Corporation Scale: 1" = 30' BENCHMARK: Top nut of hydrant at ' a Iron monument found southwest corner of Hurtvningbird ° Wood stake set ? Lane and Falcon Way. „ 500.0 Existing elevation Elevation = 904.54 ft. (NGVD-1929) • FRONT GARAGE SLAB: Proposed El. = 905.05 ft. ' ?---draina?¢ d U/i/.ity Easeme?t ? P . ' ? 589°21 S4"E 126.54 ?r 4 -? ? 3 0 :o.s3 Q , o 30.1 ? lyJ 6.0 °/. a N 0 . -Z 7.83 k O LOT 3 O 10 a? m Q 3 O . w ? 15 ) u V ? I ? e.o I , m ? . J = O Q ? Z I ?N 35.5 I ? O . 4. ? ioJ N m 89°21' 54"W 127.17 R v 0 A Lot 3, Block 5, LEXING717N PLACE SOUTH, Dakota County, Minnesota I hereby ccr[iCy tha[ Ulis is a true and correct represenW[ion of a survey of the boundaries of Lhc ]and above described and of Cfie lotation oE all buildings, if any, [hereon and ail i i , v s ble encroachments, if any, from or on said land. I Eucther cereify tha[ thls survey vas prepared by me o7 undeC my direet supervision and tha[ I an a duly Rcgis[eced [.and Sucveyor unclerthe lavs of Che StaCe of Minnesota. S;" io hW Reg. No.r/Cj,7,7,QDa[e !/ • ???? Proposed House X As-Suilt House _ Drawn by Ev 'proiect no_ 8510a lolic CITY OF EAGAN 1992 BUILDING PERMIT APPLICATION 681-0675 SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy calcs. COMMERCIAL 2 sets of architectural & structural plans, 1 set of cff- tions, 1 copy of energy calcs. n Penalty appli hen typing of p t is requested, but not picked up by last working day of month in r e i adel lot chan e is re uested once ermit is issued. Date Valuation of work Site Locatio • i,??? rv STREET STE # Tenant Name:_ IT-orlN /K'Loo P7 ? rJ IST? LOT 3 I BLOCK f SUBD. ?-n,rl P.I.D. # Descri tion of work: 5+»{- '; s?l The appl i cant i s: ? Owner f;? Contractor ? Other coesor;ne> Name & oa r;q dVt 5r G-a,M/? Phone 6cF'?)- 6/.S3 Property LAST FIRST OWner Address 36 z$ R eX1,Car? tAI-IV Y STREET STE # City r6_>1 il/ State /?""? Zip Company 1?4VIO /'owsT Phone y?-??'4'? Contractor Address _ 1714,K0 /?,4.'yll7-0-1 ,t7/? License #. tc>et?34o 7 l1K City State Z;p Company Phone Architect/ Engineer Name Registration # Address City State Zip Sewer & water licensed plumber . Processing time for sewer & water permits is two days once area has been approved. 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. Signature of Applicant: ?? BUILDING PERMIT TYPE ? 01 Foundation ? 02 Single Family ? 03 Two-family ? 04 Multi-fam. T.H. ? 05 Apt. Bldg. WORK TYPE '9.90 New ? 91 Addition ? 92 Alterations OFFICE USE ONLY ? 06 Garage/Accessory ? 11 Res. Add./Porch ? 07 Fireplace 0 12 Comm./Ind. New ? eck ? 13 Comm./Ind. Add 09 Basement Finish 0 14 Comm./Ind. Rem ? 10 Swim Pool ? 15 Public Fac. 9 93 Remodel ? 96 Move ? 94 Repair ? 97 Demolish ? 95 Tenant Finish ? 99 Undefined GENERAL INFORMATION Occupancy Zoning Const. (Actual) (Allowable) # of Stories Length Depth APPROVALS Basement sq. ft. s.s'R-Ae lst F1. sq. ft. 2nd F1. sq. ft. Sq. Ft. total Footprint Sq. ft. On-site well On-site sewage Planning Building DS 'i-3-92 Engineering Variance REQU1RED INSPECTIONS ? Site ? Footing 15 Framing ? Wallboard ? Final ? Draintile ? Insulation ? Fireplace vatuas;m: ?----- Permit Fee 35,00 Surcharge Plan Review License ? MWCC SAC City SAC Water Conn. Water Meter Road Unit Treatment P1. Road Unit Park Ded. Trails Ded. Copies ? Other Total: r r , ? 16 Agricultural ? 17 Building Move O 18 Demolition ? 20 Miscellaneous MWCC System City Water PRV Required Booster Pump Fire Sprinkler Census Code SAC Cade Assessments SAC % 3AC Units ._ i'i Y i1 I" l= !-`c l:;i A N F,PPLICATION FOR PERMIT SEWER AND/OR WATER CONNECTION 1) PROPERTY ADDRESS: ? LEGAL DESCRIPTION: tLOt/ttlocK/SUbdivision or Tax Parce r 3-Z.8-Xh •_ IF EXZSTING STRL'CLiTRE, DATE OF ORIGINAL BL'ILDING PERMIT ISSL'ANCE: " - (Nbn YearJ PRESENr ZONING/PROPOSFD'L?SE: C] C'011MEE2CIAL/RETAII,/OFFICE Q, IDIDf.'STRZAL n INSTI1i1PI0NAL/GOVEUZg,'NT IK R-1 SINGLE FAMILY : ? R-2 DCPLEX (Zt,o Cfiits) ? R-3 'IO[tiT][-tODSE (Three + Units) ( Dnits) ? R-4 APART:IENP/CO:IDOMINIUM Units) '?J1'.,. .. ..• . _ :. .\ i.. ?_.. . . tiI'PLS(117'IGN IYJT'.S UJP CYi.'.?.;,'I'iiPtE : r APPROVAL OF PgihffT. * * INSPF]C.TZON OF SES+]ER AND/OR YFiTET2 INSTAT.T.ATTONS WIIS, NU'P BE SQ1ED- * UL,ID UNITL PII2t+IIT HAS BEEJ APPF20VFD. • ' ,*? w w r *:*+***:**?**?***?**t*****f?*t:*t* 2) ? NAt,1E ADDRESS ? czTY, srATE, ZZP:./Ni???7Z.1.tJ/?CA? PHONE: !`7'si/fI- 3) ? NAME: ADDRESS: CITY, SI'ATE, ZIP: PHONE: l. LicENsE# 1 t3f?9?t Active bcpired Not recorded Staff initiat 4) oeo • • i?+• _ - NAME: , . ADDRFSS: ' . CZTY, SPA'PE, ZZP: PHONE: . 5) IM, a• ?• ?cr .?. -ii -?y-yua? - ? CONNEC.'TION 'IO CITY SEWER ? CpNNECrION 'Ib CITY WATER ? OTfEIt 6) PI,EA,gE HOLD APPROVID PEE2MIT FOR PICK-UP BY ONE OF ABJVE PLEASE MAIL APPROVED PERMIT 70 1, 2,(g 4, AMVE (Circle one) ' 7) ,?'?:3"?"_7 e57'?'?=`??:i??'auiul?t?n__r_a°hf!'-53a'?'ao.???e,;..,?,. T?. r ?.??.? ..i ?u?.??'•? -o . Ml:71I:.AO::Jli7,'II FUII CITY USE ONLY . •-, PERMIT # ISSL'ED ??7 = 31, 6 6 Pd w/Bldg. Permit < S $ $ s $ $ ? "O D U-v $ ?7Sv (3 $ $ $ $ S FEES: $ ro- s-a $ $ ,. $ $ S $ S S $ $ $ ' $ $ S SEWER PERMIT (INCLODE SURCHARGE) WATER PERMIT (INCLL'DE SURCHARGE) WATER METER/COPPERHORN/OC'I`SIDE READER WATER TAP (INCLL'DE CORPORATION STOP) SEWER TAP ACCOUNT DEPOSIT - SEWER ACCOC'NT DEPOSIT - WATER WAC SAC TRUNK WATER ASSESSMENT TRCNK SEWER ASSESSMENT LATERAL BENEFIT/TRL'NK SEWER LATERAL BENEFIT/TRCNK WATER WATER TREATMENT PLANT SCRCHARGE OTHER: SZ $ d / • Q ? TOTAL 2- RECEIPT RECEIPT DOES UTILITY CONNECTZON REQLIRE EXCAVATION IN PUBLZC RIGHT OF WAY? ? YES IF YES, THEN A"PERMIT FOR WORK WITHIN PUBLIC Q ROADWAY" MUST BE ISSL'ED BY THE ENGINEERING NO DIVISION. LIST AS A CONDITION. SUI3JECT TO THE FOLLOWIDIG CpNDITIONS: APPROVED BY: TITLE: Di1TE: ?13 /f g, .?? s • w •?? • r. ?. r.••na? • ? ?i a? • ? : 6) t, u ? ? ? , .. . ;;., _ '; _ .., .. _?. - - : •a ?.,a = _ ? . . ? PLEASE HOLD APPROVID PF?2bffT FOR PIQC-BY OI? OF ABOVE PLEASE I?IL APPROVID PERPffT TO 1. 2. 3. 4, ABOVE W. 6` ne) (Circl o 71„:: r ,• . ` ? , R? . ' ",? ? ` ?i ' L rr 'Ar 4 ?M3' . q 1 ? - 4 C .e OR C _ _?... . _Tr..?--r..Pb:.:VY.':t-??T'?°_.:::'- ? , ... ._. _ . w.w 4ff_ :'4 r _. ,. ?,... -??.. . . +. . . :'. ? __ .. .... J;:.=y o i}/. ?;y?t- _u i 1??1 c ? :... ? .i? Y.?.J ? ?? T1u.x Es??x asstssrE?,?r .. {?'^ f +5 .; LAT?RAL?B?TEFI,T/TRUNK SET•:z." $ .' . ` '?' T I;ATERr1L.$EiV£? I tTRU`K WATE: ? - _ .., ?. -•1 _ i?57 d`O r 6 • .:,.. WATER TREATMLNT PLANT S URCHARGE ?- $ lOTIIElt:* ? -•^? , y^° : b r Y' ? _ .• ? 1 " j 1? L v` ^" '. t ? 1 " - } " T ? < ,( 4 . ", 7.+? N( r ? _ q. t { - [ - • --uii+i+i ivwurc.t.i'lutv_xttluixt_EXCAVATION.IN PUBLiC.RIGHT 1 - _ . . ' - "^? : ._aa?..•?. . J j.'. 6M ?'S;: `i`T{ „> ?? ? YES + , l IF YES ri THEN A' ".$ERP2ZT - f?OF?i WORK WITHIP j - _- ^? ?*;?cPUBLIC°ROADWAY"--MUST ?E ?SSUED BY THE -' Q NO ENGINEERING DIVZSION LIST AS A CQND7 ??T TION :+' ? "" ?- . ? 3JECT. T¢ THE FOLL?WING CoN?iTIONS - ,.-.-_. _... - - ? , . - - f . - , . _Y. . . -i. . ... . . APP ROVED SY. ? TIT LE. DAT° R +,? . . I l Y t} .1 ? ? ...TS ! .: . __? i ?? ? ? { p r 5.. S - c. . \ / L 3 S 1 h ? ??v ? CITY OF EAGAN 3830 PILOT RNOB ROAD EAGAN, MN 55122 PHONE: (612) 454-8100 FOR CITY USE ONLY PERMIT # RECEIPT DATE: PLEASE COMPLETE IIPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS & TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT. WORK DESCRIPTION N0. NEW CONST ADD ON REPAIR OWNER NAME: ?\c' SITE ADDRESS: ?--CkAC'- v__.j `? C:_`? IAT: ?? BIACK ? SUBD. INSTALLER: ? ADDRESS: CITY: ZIP: PHONE #: SIGNATURE OF ?--G-? COMPLETE THE FOLLOWING: FIXTURES EA. ADD-ON MINIMUM 15.00 SHOWER 3.00 WATER CIASET 3.00 BATH TUB 3.00 IAVATORY 3.00 KITCHEN SINK 3.00 LAUNDRY TRAY 3.00 HOT TUS/SYA 3.00 WATER HEATER 3.00 FLOOR DRAIN 3.00 GAS PIPING OUT. (MINIMUh1 - 1) 3.00 ROUGH OPENINGS 1.50 OTHER WATER SOFTENER 5.00 PRIVATE DISP. 15.00 U.G. SPRINKLER 3.00 SUBTOTAL ST. SURCHARGE lU1HL TOTAL 3 - ?- ? S IS• ? .50 PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL SUILDINGS AND MULTI-rAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT. CONTRACT PRICE: FEES OWNER NAME: SITE ADDRESS: LOT: BIACK SUBD. INSTALLER: ADDRESS: CITY: ZIP: PHONE FOR: 18 OF CONTRACT FEE. STATE SURCHARGE - $.50 FOR EACH $1,000 OF PERMIT FEE. $25.00 MINIMUM FEE. CONTRACT PRICE x 18 $ STATE SURCHARGE $ TOTAL: $ (SIGNATURE) CITY OF EAGAN ??,?? ? 3? I ? RESIDENTIAL BUILDING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB RD, EAGAN MN 55122 651•681-4675 New Construction Reauiraments RemodellReoair Reauirements • 3 registered site surveys showing sq. ft. of lot, sq. tt. ol house; and all roofed areas . 2 copies of plan (20%maximum lot coverage allowed) . 1 se[ of Energy Calculations for heated additions "? ? s • 2 copies of plan showing beam 8 wintlow sizes; poured found desgn, etc.) . 1 site survey tor exterior additions & decks • 1 set of Energy Calculations . Indicate if home served by sepGc system foradditions . 3 wpies ot Tree Preservation Plan if lot platted aker 711193 • Rim Joist Detail Options selection sheet (bldgs with 3 or less units) DATE 7- Z- b Z- I ?? VALUATION j?. ?. SITE ADDRESS,j° ???co ???? MULTI-FAMILY BLDG _ Y ? TYPE OF WORK •/ ? FIREPLACE(S) _ 0(0_ 2 c.> ? J-(ti .F APPLICANT STREETADDRESS IZZy-7 /jii'co/%,,A?ci 5 CITY rirns '/ STATE /,ZIPS5--337 TELEPHONE #95-Z_ ;h-7.. 69s9 CELL PHONE # FAX # PROPERTY OWNER Jaa..l 41 TELEPNONE # loS/- Z7(o -//ZL ""---------------------------------------°"_"----""_".'---?--"'__"'----'_"""'----- COMPLETE THIS SECTION FOR KNEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category _ MINN1:50'l':A RULI:S 7670 Cxl'I:GOI2Y 1 NIIVN (J su6mission type) • Residential Ventilation Category 1 Worksheel Submitted • New • Energy Envelope Calculations Submitted Plumbing Contractor: ____ Plwubing syslem includcs: Mechanical Contractor: Vlcchanic.d svstcm inclu(Ics: Sewer/Water Contractor: _ Wa[cr Sottcncr Watcr Hcatcr -- \'o.ol'Baths -- Air Conditioning I-Icat Rccovcry Systcm Phone # Phone # .)tlI 1 5 2002 Fcc: $70.00 ---------------------------°-°----°----------------°°------------...-------°-------------°-----------°------------ 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 Eagan Ordinances.r? Signafure of Applicant ---------------------------------------------------------- ---------- '----------------- __------ ----- ------------------------------------------------------ ------ OFFICE USE ONLY Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _ Updated 4102 _ Phonc # I.awii Sprinkler No. of R.I. Baths jOa?ie_S j A-F4_e_c gflWConatructbn HeaulremeMs • 3 regislered site surveys slwwetg sq. tt. of lot, sq. N. of house; and 4II roofed areas (20% meximum bt ooverege allowed) • 2 copies of plan showkig beam & wlndow sizes; poured lound design, etc.) • lsetofEnergyCetuletions • 3 copies of 7ree Preservatbn Plen If bt platted after 7/7J93 • Rim Joist Dateil Oplions seleclbn sheet (bMgs wNh 3 or less unns) DATE 7 2 -o Z SITE ADDRESS Zag TYPE OF WORKZe wi APPUCANT.J? ? STREET ADDRESS / Z z " /bi ?, TELEPHONE #9S? 7o?/,9s9CELL PHONE # '"//e STATE/Ar`k' ZIPS FAx # 95z.?i(Z??? PROPERN OWNER ??: Q-k DcQ TELEPHONE #GS /r 2-7&- //Z/ COMPLETE THIS SECTION FOR uNEWff RESIDENTIAL BUILDINGS ONLY Energy Code Category _ MINNESOTA RULES 7670 CATEGORY 1 r (4 submission lype) . ResideMial VeMlletion Category 1 Worksheet Submitted • • Energy Envelopa Calr.ulations Submined Plumbing Conhacfor: Plumbing system includes: Mechanlcal Conhactor: Mechanical system includes: Sewer/Water Contracror. RESIDENTIAL BUILDING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB RD, EAGAN MN 55722 651-681-4675 _ Water Softener _ _ Water Heater _ No. of Baths Air Conditioning Heat Recovery System Phone # Lawn Sprinkler No. of R.I. Baths Phone # Phone # .IUI 1 5 2002 Fee: $70.00 I hereby acknowledge that I have read this application, state that ihe information is correct, and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Signnlure of Applicanf OFFICE USE ONLY 15 7. Z,$ RemoEeUReoelr ReaufremeiHs • 2 copies of plen • 1 set of Energy Cakulations lor heated additbns . 1 sife sunrey Por exladar atltlttans & decks • Indicata H home served by septic system for atlAifbns VALUATION MULTI-PAMILY BLDG _ Y ?? fIREPLACE(S) _ 0 2 ?4(i.Q I O Certificates of Survey Received _ Tree Preservation Pian Received _ Not Required _ uPaetaa aroa PERMIT City of Eagan Permit Type:Building Permit Number:EA163377 Date Issued:08/28/2020 Permit Category:ePermit Site Address: 3608 Falcon Way Lot:3 Block: 5 Addition: Lexington Place South PID:10-45060-05-030 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. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Building Code). 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 - Dawn L Hoffner 3608 Falcon Way Eagan MN 55123 (701) 371-9758 Estate Claim Services Llc 6701 Penn Ave S, Suite 201B Richfield MN 55423 (651) 309-1114 Applicant/Permitee: Signature Issued By: Signature