3409 Highlander Dr
Jun. S. 2011 2;42 PM SELA ROOFING No. 6530 P. 2
Use BLUE or BLACK Ink
For,:„:Offlcti U I
I -
tCI I
; Permit ~ ,
non
City of Ea 36 s l
0 I(;'_.~ Permit Fee: _,.i/s
3830 Pilot Knob Road v'
Eagan MN 55122 Date Received: j
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 1 Staff:
2079 RESIDENTIAL BUILDING PERMIT APPLICATIO
Date: Y L Site Address: ni 0:
Name: ` QIJG~~ 1~.~nec~yy~Jl~
.kZ&L4it? RESIDENT 1 340
I &0 1 / E'C]
OWNER Address 1 City/ Zip:
Applicant is: _Owner Contractor
TYPE OF WORK Description of work4
Construction Cost k/ 1, 96d .4 6 0 Multi-Family Building: {Yeg / No_)
Company: ` R49~r11V i Contact: 64tiog
CONTRACTOR Address: 1 i6 J _O it City: L • 1' 1
State: C.9~ . Zip: Phone: -
65q-16:P
License #f: l o 60 Lead Certificate P CJ
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
-Yes _,No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone;
Sewer & Water Contractor: Phone:
NOTE., Plans and suppor#ing.docur»ents that you. submit are considered to. be public inforniation. Portions of
the informateon may be. classified as non-public if you provide specific reasons that would perrrrlt the Caty.to
conclude that the are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State one call at (651) 454-0002 for protection against underground utility damage.
Call 48 hours before you intend to dig to receive locates of underground utilities. www.aopherstateope-gal-I24
I hereby acknowledge that this information is complete and acourate; that the work will be in conformance 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 ' hoot a per that the work will be in
accordance with the approved plan in the case of work which requires a review and approv plans. x 'i , __11
x Vk-AA1I mo.
Applicants Printed Name plicant's Signature
Page 1 of 3
NUMER!CAL FILE
CITY OF EAGAN
3795 PILOT KiVOB ROAD
EAGAN, MINNESOTA 55122
GASH RECElPT
DATE 19
ItECEIVED
FROM
AMOUNT $ I
DOLLARS
ioo
[] CASH ? CHECK
FOR
J
.t
-rviv
..' a :j • ,(;' :,(?' f _ ?:.1 j ; ;, ,: /? r ?; ?.-rj `? `? ?{"?+ a'? / ` j ?t
.?
4th
Owner
5treet -- ?409 Hi,g'yLanrlar j)rlYe
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK
SEWER LATERAI
WATERMAIN
WATER LATERA
WATER AREA
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
Remarks
5 Blk 1 Parcel 10 73003 050 01
dition SURREY HGTS. 4th Lot 8-eIk 1 Parcel 10 73003 080 01
. _ .,
iner/,%-?- screet-3411_Highlander DTive StateEagarl? NIN
provement
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK
SEWER LATERAL
WATERMAIN
WATER LATERAL
WATER AREA
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER.
Date I Amount
HGTS. 4th
Lot 4 sik 1 Parcel 10 73003 040 01
3413 Highlander Drive stete Eagan
GARAGE
Improvement I Date I Amount I Annual I Years .1 Payment I Receipt I Date ?
STREET R
GRADING
SAN SEW TRUNK
SEWER LATERAL
WATERMAIN
WATER LATERAL
WATER AREA
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STFiEET LIGHT
WATER CONN.
-Bik 1 Parcel 10 73003 070 01
Drive
Improvement I Date I Amount I Annual I Years I Payment I Receipt I Date
SAN SEW TRUNK
SEWER LATERAL
WATERMAIN
WATER LATERAL
WATER AREA
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
_ .,r cAGAN Remarks
Addition SURREY HEIGHTS ?/
th Lot"IIlt) Bik 1 parcel 10 73003 030 01
Owner i'I i•. Street • state_Eagan, MN 55122
3409 Highlander Drive
Improvement Date Amount Annual Years Payment Receipt Date
STREET 5UR F.
STREET RESTOR.
GRADING
SAN SEW TRUNK
SEWERLATERAL 73$.02 A004083 5-I9-77
WATERMAIN ?
WATER LATERAL
WATER AREA 1973 1SS@SS@ d@T the OT1 inal parcel '
STORM 5EW Yi'r/.,?t" 1975 I
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. 220.00 4613 11- -76
BUILDING PER. 11-7-76
sa,c 450.00 4613 11-7-76
1 1-14-77
'YD • cc
..I r vF EAGAN Remarks 10.73003 060 01
Addition SURREY HEIGHTS ?th Lot Fi .(iin?r) Rik 1 Parcel
Owner f?l%! ,?. •'_ - _ Street - • 5tate Eagan, MN 55122
3411 Hi-ghlander -Drive
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN 5EW TRUNK
* SEWERLATERAL 1975 1845.02 369.00 5 738.02 A004083 5-19-77
WATERMAIN
* WATER LATERAL I9
WATER AREA
* STORM SEW m? 1975
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. 220.00 1 11-7-76
,
BUILDING PER. . - -
sac 450.00 4613 11-7-76
PARK 5081 1-1 -77 ?
3?0?
. .ir cAGAN Remarks
I Addition SUR EY Fr HTS 4/th -Loc? (U.n.it) Rik-1 Parcel 10 73003 020 01
I Owner ? ? - ?.•__ ,\
? Street ' ??..-s&- a 1?-' scate. Eagan, NIlV 55122
-,41;:2sso-FF` n1n, i,-r ; i;',:, r;? . 3413 Hiahlander Drive
Improvement Date Amount Annual Years Payment Receipt Oate
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK
SEWERLATERAL 73$.02 A004083 5-19-77
WATERMAIN
WATER LATERAL 1975
WATEFiAREA 1973 SSS@SS@ er origin par @1
* STORM 5EW 76M/ejf? 1975
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
I
WATER CONN. 220.00 4613 11-7-76
I
BUILOING PER. 41 S 1613
- - I
sac 450.00 4613 11-7-76-
PARK _ 7
?/o• o0
CITY OF EAGAN Remarks
Addition SURREY HEIGHTS 4/th Lot Blk I Parcei 10 7snn3 nl (1 01 '
Owner J 1- -2 :, ?:': :;irStreet-? scate Eagan, MN 55122
' • I'?41 5 Hi ah 1 anr?pr llri vc
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK
* SEWERLATERAL 1975 1845.02 369.00 5
WATERMAIN
* WATER LATERAL 1975
WATER AREA
* STORM S E W TIM_Jjr,-- 197S
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATERCONN. 220.00 4613 I1-7-76
BUILOING PER. #4135 461-7, 11-7-76
sa,c 450.00 4613 11-7-76
PAR K -14 -']']
V'd. 00
I/ 5' ot. C?orv?raa?-
- ?-
T
J 3 ?o:?, al
Request Date Fire No. u ?-inl Inspecti
oiretl
XReatly Naw ? WIII Noliry Inspector
( < < rVes . . No When Rea0y4
IXlicensed contractor ? owner hereby requesf inspection of above electrical work aY.
Jo0 Atltlress (Sireel. Box ar Foule No.I ' City
3y13 14-1Gµ1 44 •JdcR? p EA Gfln/
Sec;ion No. Towns?ip Name or No. Range No. Counry
,9 Il o
Occupan[(PqINT)
bE T C No Phone No.
Cv83 - a?3.?
Power Supplier
DAKoT? Atltlress
iaami v ?r ? r SC'Z
Electrical Convactor ICompany Name) ^
'
T(
'?
l G?nVactor5license Nro7. 6
2J
e' °'
/rh//
G
Mailing Atlyess ?ont aclor or Owner Making Installa[ionl
? ? 3
? we;l l
Au?honzetl Nre ?COnhacmr?Ow aking Ph
p
n
e N
u
mber
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MINNESOTA STATE BOAHD OF ELECTqICItY v THIS INSPECTION RWUEST WILL NOT
Griggs-Midway BIEg. - Poom S173 BE ACCEPTED BY THE STATE 90ARD
1821 pniversity Ave.. SI. Paul. MN 55106 UNLE55 PROPEq INSPECTION FEE IS
PMne (612) 662-0800 ENCLOSED.
r y?.. REDUEST FOR ELECTRICAL INSPECTION ?° ? ee-oaoa,-0a
jl? ??j0? . ee instmclions for completing tpis lorm on Dack ol yellow copy ; ??????qqq
J 73I ?D??3 ?
"X" Below Work Covered by This Requesf ??'
e A8d Rep. Typeof8uiiding AppliancesWired EquipmentWired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apl Building Dryer Olher (Specily)
Comm./Indusirial Fumace
Farm Air Conditioner
OUer (sVecily) ConhactorS Remarks' /
Compute Inspec[ion Fee Below: ov jc Pea`
# Other Fae # ServiceEniranceSize Fee # Circuits/Feeders Fee
Swimming Pool 0 to 200 Amps 0 to 100 Amps
Trensformers Above 200 _ Amps A6ove 100 _ Amps
SiJnS Inspector5 Use Only: 7 pl_?
Irrigation sooms
Specia( lnspection - ?
AIarMCommunication THIS INSTALLATION MAY BE OR D DISCONNEC'fE?IF NO
Other Fee COMPLETED WITHIN 18 MONTHS.
I, the Electrical Inspecmr, hereby
i Rough-in Date
cert
ty that the above inspection has
been made. F;,,a?
? J)a?
Y.7
OFfICE USE DNLV a
This repvest void 18 montbs (rom
YILLIIOE OF EAOAN SEWER SERVICE PERMIT
J795Pi17lKnobRoad PERMITNO.: 101" 2835
11/18
Eag,%, MN 55124 DATE:
Zoning: RI I No. of Units: 1
Ovrner: G
i>1a "" A AIl{
-
Address:
SiteAddresa: 3.415_ pigh landar nr rI01 B1 SH Sth
?l
Plumber: PDi * ± nih; ^
4 ro
._
11/17/76 .
p4613 100.00 pd
1 oqrae fo comply wifh eM Vilkq• of Eagen Connection Chaag5A 00 Ad
Ordinoncn. Account Deposit:
, Permit Fee: 10,00 pd
Sumharge: 50 Dd
gy; Misc Chazges:
Date of Insp
: Totat:
.
Inap.: Date Paid:
YILLAGE OF EAGAN
1195 Viidt Knob Road
EagaA, MN 55122
'Loning: RII _
Oivner: Go1d
Address: -
fiite AddresO. 415
Plumber: PrOje
WATER SERVICE PERMIT
PERMIT NO.: 2-e85_ -
DATE: - 11/18/76
No. oF Units: 1
Connection Chazge:220.00 pd
Accuunl lleposit
Permi[ Fee: 10.00 pd
Surcharge: - - 50 pd _ _
Misc Charges:60. 00 pd meter
REade No.: `?---
1 gr co DI Y ?'?th fhe Villoge of Eogon
Or p di
----?
ey ?
Uate of Insp.:
•rotai: -_
Date Paid:
lnsp.:
YGeAQs_ pF EAGAN SEWER SERVICE PERMIT
3795 iibt Knob Road PERMIT NO.: -Z06& 2 9 3 6
Eogan, MN $5112 DATE: 11 / 18/ 7 6
Zoning: RI I No. o£ Units: 1
Owner. Gold Mg?dllion
Address:
Sicenddmss: 3413 Hig_hlander Dr. L101 BT SH Sth
P1um6e:: Proiect Plumbina Co.
11/18/76 #4613 1?0r0.00 pd
1 aqroa to comply wifb ths Villoga e4 Eogan Connection ChargeD.00 pd
Ordinanca,.
By:
Uate of Insp.:
Insp.: -
Account Deposi4Permit Fee: 10.00 pd
SurcharAe: • 50 pd -
Misc. Charges:
Total: --
Date Paid: -
VILLAGE OF EAGAN
7795 Viiut Knob Road
EogoA, MN 55127
ZoninR:
Qavner:
Address
Site Adc
Plumber.
1 99b to plr with the Villoge of Eagon
OrdifiG ' . 1 .
By
DareoClnsp.:-
? V
WATER SERVICE PERMIT
PEHMIT NO.: 2885
Dn7'E: - 11118/76
No. of Units: 1
Connection Charge:220.00 pd
Account DeposiL _
Permit Fee: 10.00 pd
Surchargc: .50 pd
Misc Charges 60.00 pd meter
Total;
Date Paid:
Insp.: -
3 IT
-4ILL%3E OF EAOAN SEWER SERVICE PERM
3795 Pilot Knob Road PERMITNO.: 2Eqg3 28 11/18/76
Eagan, MN 55112 DATE: 1
Zoning: RI I No. of Units:
Owner: Gold Med811ion
Address:
Sitenddress: 3411 Highlander Dr. L608 B1 SH Sth
Plumber: Project Plumhing 11/17/76 N4613 100.00 pd
?0.00 pd
1 ag.ae eo co?nply wfN? t6e Village eF Eayan Connection Ch?g :
Ordi1ancH. Account Depositl0. 00 pd
Permit Fee: 0 P
Surcharge:
BY; Misc. Chazges:
Date of Insp.: Total:
Insp.: Date Paid:
YILLARE.OF EAOAN
3795 Pilot Knob Road
Eagan. M41 55122
Zoning: RII _
owner. Gold Medal
Address:
Sire Address: 3411 H1g
Plumber: Pro eCt P1
WATER SERVICE PERMIT
PERMIT NO.: 2083
DATE: _
No. oC Units: 1 Merer No.: Connection Charge: 220.00 pd
Size'.` Account Deposit:
Re No.: Permit Fee: 10.00 pd
? 50 pd
I o9r o eo Ir with tbe Village o4 Eagan Surcharge:
60.00 pd meter
Ordinan 7 '7 Misa Charges:
Total:
By Date Paid:
Date of Insp.: Insp.:
nuace oF ¢acaN WATER SERVICE PERMIT
3795-R!ot kSto.¢ Road PERMITNO.: 2084
Eagon,MN 55744 DATE: 11/18/76
Zoning: RI I No. of Units: 1
Owner: ?
Address: _
Site Address:
Plumber. p
Meter Na?
Reader No.
BY A ?..
Date of Insp.:
Connection Charge:220.00 pd
Account Deposit
Permit Fee: 10.00 pd
ly with the V{Ilaga of Eaqon Surcharge: • 50 pd _
_-:;, _ ,., Misc Charges:60.00 pd metC='
Total: -
Date Paid:
Insp.:
YILLROE OF EAOAN SEWER SERVICE PERMIT
3795 CylrgKnop.Roud PERMIT NO.: XalIEa 2834
Eagan, MN 55132 DATE: 11 /18/7 6
Zoning: RII No. of Units: ?
Owner: Gold Medallion
Address:
siteAddress: 3409 Hiahlander Dr. L305 B1 SH t
Plum6er: Pro'ect Plumhing Co. 11/17/76 #4613 100.00 p
I aqrao ro eomply wifh the Villoga of Eagon Connection Cha?ge0.00 pd .
Ordinaacaa.
Hy:
Date of Insp.:
Insp.: -
Account Depositi?.? P?-
Permit Fee: P
Surcharge:
Misc. Chazges:
Total:
Date Paid:
czmr or EAcav
, 3795 Pil.ot Irxob Road ? ? •
Eagan, Minnesota 55122 ?
PERvffT NO.: 743
The City of Ea,gan hereby grants to Proiect Plumhinv Co,
I
of Mn l a
a PLUMBING - Permit for:(Owner) Guetafaon & Assoc{atee _
at 1 - xvland,erun3aant to application.dated. 11/s/76 _
Pce Paid: S80.00 dated this 8 day of November e 19 76 •
2.00 s/c . .
Building Inspector I
P.eehanical Permits:
IIi3 Total:
?
?
s?-
CITY OF Er1GAN
3795'Pilot Knob Road
Faaan, Minnesota 55122
PERMIT NO.: 839
ihe City of Eagan hereby granta to A. einder & Son
of 120 E. Hutler
a HEATING Permit for: (Owner) Gustafson`GOld Medallion Aomea
3425-23-21-1?-15-13 1? and
at 1409 Hiahlander Dr. , pursuant to application dated 12/17/76
Fee Paid: $160.00 __ dated.this 3 day of Januarv ? 19 77.
4.00 s/c
Building Inspector
P4echa^_cal Permits:
Eiu Tutai:
. ?7
CITY of EAGAN
BUILDING PERMIT
Ownes ?LD MEDALI,ION COP.P.
.............. ................................................
Address (psesenf) Bloomington, MN
............................................................ °-...-'--°-....
D. H. Gustafson & Assoc. Inc. .
Builder ...................................................:.................--.---.....................
Addreas Bloomington, MN
............... ...............................................................................
DESCRIPTION
w;ja r
N4 4135
3795 Pilo! Knob Road
Eagan, Minnesoia 55122
454•8100
Dele .....1.......................
Slories To He Used Foz Fron! Daplh Haigh! Esl. Cos! arm ! Fae Asmsrks
4-Unit & 6ar?.50'
Townhouse
66'
139.000
?470.00
/c ?.??} ?rw
3411 Highlander Lots 6 & 2, 3409 Highlander Lets 3& U 1
3413 Hig&lander Lotsn2 & 4, 3415 xighlander i.otsM & 7 0 5urrey Ats. h
Thia permi2 does noi aulhoriae the use of sfreeis, roade, alleya or sidewalks nor doea it glve the owner oi hU ngea!
the righ! !o creaie any situation which is a nuisance or whieh presenls a hazard !o the healffi, eatefy, coevenieaea aad
general welfare !o anpone in the communiip.
THIS PERM2T MUST SE KEPT ON THE PREMISE WHILE THE WORR IS IN PROGAESS.
Th1s 1s fo certifp• • , fhaf.... .R_....H.....GAS.?dfS9.17.__...."-"'_".... has permuuon -!a aseet a_" 4""-_t1."""nit "'_ ................... 7bwnhouse......&......Ga....ra..?p?a
the a6ove desaribed p mise subjeef !o the provisions of all applicableC'_' 6e Cii9 ? g
yF-! . Z' ...................... Per _..----?/(??-..........................
..-°---- °---------- - -'ya= Buildiay Impeclo:
- PERMIT #
M
ECHANICAL PERMIT RECEIPT #
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE:
CONTRACT PRICE: PHONE: 454-8100 For Office Use Only:
Site Address ' gLpG. TYPE WORK DESCRIPTION '
? Lot Block Sec/Sub , Res. New >
Mult Add-on
Name .
t ? Address Comm. Repair
? c
City
Phone
' Other
.
F
? FEES
Name ` RES
HVAC 0-100 M BTU -$24
00
. .
c
? Address
` ADDITIONAL 50 M BTU - 6.00
O
ty
??
Phone (RES. HYAC INCLUDES A/C ON NEW
CONSTRUCTION)
GAS OUTLETS (MINIMUM - 1 PER PERMI7) - 1
50 EA
.
.
'TYPE OF WORK COMM/IND FEE - 146 OF CONTRACT FEE
Forced Air M BTU APT. BLDGS. - COMM. RATE APPUES
TOWNHOUSE & CONDOS - RES. RATE APPLIES
Boiler M BTU MINIMUM RESIDENTIAL FEE - ALL AOD-ON 8
Unit Heater M BTU REMODELS - 12.00
Air Cond. M BTU MINIMUM COMMERCIAL FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
Vent CFM {ADD $.50 S/C IF PERMIT PRICE GOES
Gas Piping OuUets # BEYOND $1,000}
Other
FEE
-
51GNATURE OF PERMITTEE
? S/C:
TOTAL• ' ? FOR: CITY OF EAGAN
__ I
J
\
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M
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
SITE ADDRESS: , k, l
:, 1 11111 ANcl? i
??t t„ •Fil ?,it t•, 4 114
PERMIT SUBTYPE:
TYPE OF WORK:
8+F1 1 t?rat+
HN4i, I
N:i i l 1 !o :
kFpAiH
ti v -S i!1 fi M ti
{1 f'-;1: P !!' f i f IN
PERMIT TYPE:
Permit Number:
Date Issued:
APPUCANT:
afi 0 H
i3#'fMAPk?;. 1N1U(lp1, tA111 il11T r.1 34 1 t(11ii 3 iA.iti (!0 1 1 )
Permft No. Permit Holder Date Teleplfone #
S/W
PLUMBING
HVAC
ELECTRIC
ELECTRIC
Inspection Date Insp. Comments
Footings I
Foundation
Framing
Roofin9
Rough Plbg.
Rough Htg.
Isul.
Fireplace
Final Htg.
Orsat Test
Final Plbg. Plbg. Inspector - Notify Plumber
Const. Meter
Engr./Plan
Bldg. Final
wCJ
Deck Ftg. .
Deck Final
Wa1V
Pr. Disp.
? CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
SITE ADDRESS:
?I . .t . na . . ? ? ? ?) ' ? , :? ?? 0 1
DESCRIPTION:
PERMIT CA?o C;? ?
PERMIT TYPE:
Permit Number:
Date Issued:
arI?;t:?c
fl r. :< : i.
?
R t-s 1 n11 % , c
. 8,.i i .t d ? ta.?:. ?m
8L1i1 d7'tty JIUY'4< "I"qpiy
iJ13C 0 0 0 lt(ra7n rv
LI_Ai LiJ'?
i' f '' A i: I?
REMARKS:
l 1`! 1_ iJ n f .,. ti 5 1 j t- (? 1i) 33 1'<; r I_ {J
FEE SUMMARY: ??
f?,
_ QI 'V? v.! ??? I? ?
f
0
ll ..}lil'rl?? . . l ( i),f1 / (j`
CONTRACTOR: - a w p.t xc?, n r.:OWNER:
MEl RO "'1L7lnir.3 7. ,., T_;s?'2 ?'ici?4° t? 1 _.'UR...t? Y ,1T5 ?? 04Ji.I?fi?U?3C" ??t 31?C
142 !? 4 ' (11 'JE I11_r4N lt[C
P L'r H S] I J T N hl i? r° t ? L f? ?3 f; !d m P•!
n q'- 1, til rrt .`l
i h€r'eby ac!,encawle:dgp thdt 7 ha<,ep +-pa%'I thiis a;r;a?icat. aun arts} st?slrs ti:i'tat thn
in.forrebt±.ur: is correet anxf ag.rry,,? E;u c r.anra3.y u,tth: A1.1 appli.ceble S3;'?tt' crt Nr;.
Si:u,h:tst.QS ar„ r,ity c+f kh,]an OrdinaxnceaG ,
? ?
? ? if ?l ?? , n} ?
APPLICANTlPERMITEESIGNATURE ISSUED NIGNATURE?
REACTIVATE _
PERMIT:#? ?
CITY OF EAGAN
1993 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 8 structural plans, 1 set of
specifications, 1 copy of energy calcs.
Penalty applies: 1) when permit is typed, but not picked up by last working day of month
in which request is made, 2) address is changed or 3) lot change is requested once permit
is issued.
Date 0 3.. / r? / C1 ? Valuation of work 600
iNC?u?S 34?1,
3??
Site Address:
- STREET SUITE Y ° '
Tenant Name: (commercial only)
IAT 3 SLOCK ? 5Lr2eC`I FFE14tfT5
FsuBD
P.I.D. N/O 73?3
1
(o Z I .
4 ?
,
Descri tion of work: 2 e '
The applicant is: ? Owner ?Contractor ? Other coeacr;be>
Name Svrrc t?ssec, Phone
Property ?AST FIRST
Owner
Address
STREEi SiE N
City State Zip
eompany M ev<d S'?a +w Sj Te.L Phone 5 5?' I S a`b
Contractor Address Iya+Jy Avp N` Q License # gM Exp. 4 1Q
City State M ?N N Zip S,'5
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. °
baa-?yo? -D i ??A21
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Signature of Applicant: ?.?..?_ ?.1I
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OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation
? 02 SF Dwg.
? 03 SF Addition
? 04 SF Porch
?5 SF Misc.
? 06 Duplex
0 07 4-Plex
O 08 8-Plex
? 09 12-Plex
<jZ30 Multi. Add'1.
WORK TYPE
? 31 New
O 32 Addition
? 33 Alterations
?Z 34 Repair
GENERAL INFORMATION
O 11 Apt./Lodging j'%_`'nY' BaseKW Finish
? 12 Multi. Misc. ? 17 Swim Pool
O 13 Garage/Accessory ? 18 Comm./Ind.
? 14 Fireplace ? 19 Comm./Ind. Misc.
? 15 Deck ? 20 Public facility
13 21 Miscellaneous
? 35 Tenant Finish O 31 Demolish
? 36 Move
Const. (Actual) Basement sq. ft.
(Allowable) lst F1. sq. ft.
UBC Occupancy ? 2nd F1. sq. ft.
Zoning Sq. Ft. total
# of Stories Footprint Sq. ft.
Length On-site well
Depth On-site sewage
APPROVALS
Planning Building
Engineering Yariance
REGIUIRED INSPECTIONS RT-s
0 Site ? Footing
O Wallboard P( Final
? Framing
? Draintile
MWCC System
City Water
PRV Required
Booster Pump
Fire 5prinkler
Census Code
SAC Code
a
?
Assessments
? Insulation
? Fireplace
Permit Fee 6-1 L. =
Surcharge g&, a?
Plan Review
License
MWCC SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total : q 718 , ao
vatuacip,:
SAC X
SAC Units
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SURREY HEIGHTS TowNHOMES
?n AGAN, MINNESOTA .
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SUBD. _
CITY USE ONLY
RECEI
7
DATE:?
7995 MECHANICAL PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
(612) 681-4675
Please complete for: ? single family dwellings
? townhomes and condos when permits are required for each unit
New construction ? Add-on furnaceoeei,?C6:-_ -7
Add-on air conditioning Add-on air exchanger, i.e. Vanee system, etc.
Date:
FEES
,J
? Minimum Fee: Add-on/Remodel (existing residence only) $ 2.00
? HVAC: 0-100 M BTU 24.00
Additional 50 M BTU 6.00
0??? ? Gas Outlets (minimum of 1 required @$3.00 each)
/ ? State Surcharge .50
TOTAL
D. 50
SITE ADDRESS:-5W
OWNER NAME: ,1 PHONE #: ??a-S' ?
INSTALLER NAME:/''??U?
STREET ADDRESS: ??
CITY: ?° STATE:,4w ZIP:
PHONE #:
CITY USE ONLY
L _ BL _
SUBD.
RECEIPT #:
DATE:
1995 MECHANICAL PERMIT (COMMERCIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55722
(612) 681-4675
Please complete for: ? ali commerciaUindustriai buildings.
? multi-family buildings when separate permits are II4S required
for each dwelling unit.
DATE:
CONTRACT PRICE:
WORK TYPE: _ NEW CONSTRUCTION INTERIOR IMPROVEMENT
DESCRIPTION OF WORK:
FEES: o $25.00 minimum fee p[ 1% of contract price, whichever is greater.
• Processed piping - $25.00
• State surcharge of $.50 per $1,000 of permit fee due on all permits.
ls•?/1•VIVm1 R?ril.. i -r e+?/?r X 1%0
I?RIIrC n?
PROCESSED PIPING
SYATE SURCHARGE
TOTAL
SITE ADDRESS:
OWNER NAME:
TENANT NAME: (IMPROVEMENTS ONLY)
INSTALLER:
ADDRESS: _
an:
PHONE #:
TELEPHONE #:
STATE: ZIP:
SIGNATURE:
SIGNATURE OF PERMITTEE CITY INSPECTOR
Date: /D- 2q-7?0
BUILDIYdG PERt•SIT P.PPLICAiTOLd
ypT BI.C:,K ? ADDITIOPI S_Wn"T-vIT? T?'? YtG7
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PARCPL & SECTION PNPSDnR IF UYIPLATTED
ADDRF,SS QF FIIRCEL_ 3141S f41 IvF3Lf?n)04? U/Z. fg-
ZOI12tdG 4 'Z? OCC'JPPrCY U5E i`Yt -
EuTIMAiGD COS^1
0?717ER c„F9 ??Ji92udnJ ?,el°. TELEPHONE NO. ?3S" 72 (v'Z
ADDP.ESS 9LOo.7,.
PSo- ?//.?. TELEPHOtM' PaO. 2?.S.i `72?2
CONTRACTOR [o 05Tif
ADDRESS- A"Qr-1/.uv,rhti i'hin-
-7
Note: Inclufte site plan, bui2ding plans, and energy calculations vJith this
application
Signed??'
?.tot. /.c/<'•
OI'I'ICE USE
??jj e?°
VALi71fTI0ii E ??'f Qa.r - CGnr.t
sAC
Y7AiE?t CCPe3YECTIOTS
F7ATER b7ETER
BUILDING PF•R[•9IT FEE
SURCRAItGE FEE
PLAN CF=K FEE
PARK DEDICATI014 FEE
OTRER
TOTAL*
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APPROVP.LS :
ASSESSME-,.'T CLERKA?2._Zy BOILDING DEPT. POLICE DEPT.
67ATER & SEV7ER DEPT. FIRE UrPT. PARK DEPT._
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? Date: fp -?A, -7(0
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TLDTYdG PrPP2ST P.I'PLZCAiYON
LOT BLC:,K ADDSTIOP7 .4cwi.eE-1g
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PARCPL SLCTIOP] PNYSBnR IF U2IP D ??c--
ADARF.SS QF
70IJITdG K- 3 OC(--J°At.CY_&2?w' uar,
EwTThIRi'GD COST ?D X Ip ?IJ
0?fiIER 601r? +-7"lEYJi9LCia.J eO?P TELEPHoNE N0.
ADDP.ESS C?L[?dh. i.! ?v h-+.n.+. •
COIdTP.ACTOR D. N. 6vs7-f/FS0ti1 E49406. /-1-)C. TELEFSOM PTO. 8?- 72?02
ADDRESS A(-00.+?
Note: Inclnde Eite plan, building plans, and energy calculati.ons Ylith th's
application
Signed Q?n? ?
pLI lous7"/t1-a o'.j?oc.
OPFICE USE
?.?
VALUIfiIOidO
r.
S?.C
emlE-1 co.•r.vEcTiUM
FJATER t4ETER
BUILDING PERGIIT FEE
SURCHARGE L'EE
PLhN CFiECK FEE
PARK DEDICATI011 FEE
OTRF:R
TOT71L*
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APPROVAT,S :
ASSESSME:Ti CLERK , BUILDING DEPT. POLICE DEPT
47AiER & SI47Et2 DEPT. FI12E DP.'PT. P21RIC DEPT
, . . ,
c?o? (6, 8 Lc? ? I
" ?1' 6? a z i
, IOCATiON , 3409, 3413, & 3415
9aC.4e'r g' .5 7
OWNER G°ld Medallion Cbrp.
Ile / k Z
r Surrey
I K
MASTER CARD
STRUCTURE AND 4-Unit mownhouse and Garages
LAND USED AS
Permii
No.
Issued Issued To
Coniracior Owner
BUItDING 4135 11/10/76 I D. H. Gustaf.son & Asl
I soc.
PLUMBING -2413 //-p'-74 ?
CESSPOOL - SEPTIC TANK
WELL
ELEQRICAL
HEATING
GAS INSTALLING
SANITARY SEWER
OTHER
OTHER i
I
Items Approved
(Initial)
Dare
Remarks
Distance From Well
FOOTING ? SEPTIC
FOUNDATION CESSPOOL
FRAMING _ Ot X „..•ay-? TILE FIEID FT.
FINAL
ELECTRICAL
HE.4TING DEPTH
OF WELL
6A5 I NSTALLAT I ON
SEPTIC TANK
CESSPOOL
DRAINFIELD
PLUMBING
WEIL
SANITARY SEWER
26- 7
Violations Noted
on Back
COMMENTS:
COMPLIANCE INSPECTION REPOftTS
TO BE USED ONIY IN EVENT OF OBSERVFD VIOLATIONS
PERMIT NO. DATE OF INSPECTION
CONDITIONS Of CONSTRUCTION AT THIS INSPECTION
? NO EVIDENCE Of NON-COMPLIANCE
OBSERVED.
? ACCEPTABLE SUBSTITUTIONS OR
DEVIATIONS.
? NON-COMPLIANCE. BUIIDER WILL COMPLY
WITHOUT DELAY.
NON-COMPLIANCE. BUILDER DOES NOT
INTEND TO COMPLY.
? COMPLETION OF CERTAIN IMPROVEMENTS
WILL BE DELAYED BY CONDITIONS BEYOND
CONTROL.
.
D DESCRIBED AS FOLLOWS:
? REIHSPECTION REQUIRED
DATE OF REINSPECTION
CERTI FICATION - I certify that I have carefully inspected the above in which 1 have no interest present or prospective, end that I have reported herein
all significant conditions o4served to be at variance with ordinances of the Town of Eagan, approved plans and specifications, and any specific repuire-
ments for off-site imprwements relating to the property inspected.
F-I ALL IMPROVEMENTS ACCEPTABLY COMPLETED
BUILDING INSPECTOR
COMMENTS:
DATE
.?* ..