3427 Highlander Dr
Jun, 8, 2011 2:44PM SELR ROOFING No.6530 P. 11
Use BLUE or BLACK Ink
,p C)ffice_:W
IJILY of Wa j Perrnn#: I
n
I Permit Fee: •
3830 Pilot Knob Road
Eagan MN 55122 1 Date Received: j
Phone, (651) 6755675 1 l
I Staff: I
Fax. (651) 675-5694 1 !
2011 RESIDENTIAL BUILDING PERMIT APPLICATION
l bate• Site Address l a ~ 01 f i
/
Name: L hone:.~c = 6~
RESIDENT 1/rte
OWNER Address /City !Zip: C.~'fr~ l
Applicant is: Owner Contractor
TYPE OF WORK Description of work:
Construction Cost: On) , Multi-Family Building: {Yes / No
Company: Sc LA E Drl A 6 Contact: 39 VA6 U u
CONTRACTOR Address:(M t ' ~10z' City: 7- Lzlil '
State: NJ Zip: Phone: &A- L~ f G _l.&_ •
License L CJ Lead Certificate r 7 `r l
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 anal supporkng:document§ that you submit at o considered4o be public information; portions of
the information may be classified as nonpublic~if you provide specific reasons thet,would permit.the Cl#y,to
conclude that the are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State one Gall at (651) 454.0002 for protection against underground utility damage.
Gall 48 hours before you intend to dig to receive locates of underground utilities. www.aopherstateonecalJ Qrn
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 parmit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval plans.
X (51444 VAAj Y 1kC /GL x l~
Applicant's Printed Name Applicant's Signature
Page 1 of 3
0 CASH RECEIPT .'`"
CITY 4F EAGAN
3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE
19
AMOUNT $ I
& DOLLARS
1 oo
E] CASH ? CHECK
POR I 'gA
FUND I tODE I AMOUNT
Q !
BY
?• . .
NUMERICAL FILE CaPY
CITY OF EAGAN
3795 Pilot Knob Road
- ? Eogon, Minneaofo 55122
Phona: 454-8100
_ PERMIT
Dote: June 27, 1977 Recelpt No.:
Single
Site Address: ''lanie.r i)rive Residential
. , ?.;
Lot Block ` Sub/Sec. '- ` Muiti Res., ?
Cost of Installation
? Name - t?. c?stafson S: Associates New/Alter./Repalr n(-w
Addreu '041 W. 78th St.
City r?1?m??on Phone:
V. Name Y'roject Pluanbing Co.
1 "•743 Humboldt Ave. So.
i Address
0
V
City? Phone:
This Permit is issued on the express condition that all work sholl be
, Minnesota Stotutes ond City of Eagan Ordinonces.
Permit Fee
No. /1_
20.00
Surchorge ' -
I? Toto I 2 0. 5 J
done in accordance with ali npplicAble State of
1 nnit
Building Official
CiTY OF EAGAN
3795 Pilot Knob Roud
- ` ? Eagan, Minnesota 55122
Phone: 454-8100
PERMIT
Date:
June 27, 1977
Site Address: ?i•
Lot Block 7 Sub/Sec.
NQme r'• i-• Gustafson & tlsSOCi.dtes
.
3
Address
-?003. W. 78th St.
O
City Rioaminqtan , Phone:
v
Nome PzO7ect Ficumlring Co.
?
?
Arlr{racc 4743 Humboldt Ave. S^.
-
No. _3
Receipt No.:
Single
Residential
Muiti Res., Comm./Ind: r;-' "- • I ,
New/Alter./Repoir. '
Cost of Installation
2J? I'
Permit Fee
Surcharge l
C
V
City --" Phone:
This Permit is issued on the express condition that all work sholl ba
Minnesota Statutes and City of Eagan Ordinances.
rocai za • _.,.
done in occordance with all applicable State of
Building Official
CITY OF EAGAN
3795 Pilot Knob Rood
.. ' ? Eagon, Minnesota 55122
Phone: 454-8100
PERMIT
Date:
une 27, 1977
Site Address: ` `33 Highlander Drive
Lot ? Block ' Sub/Sec
SH 4th
Nome ' H. Gustafson & Assaciates
3 Address -'0v7_ W. 78th : t.
O
?j
City ':?loomington
_ Phone;
i Nome '-;roject PZ,imbing Co.
?
Addr i:l[: t L'1Vn. ?O.
a
0 ess
City ?Phone:
This Permit is issued on rhe express condition thot oll work shall be
Minnesota Stotutes and City of Eogan Ordinances.
No. 91!
Receipt No.:
$ingle
Residential
Multi Res., Comm./In?.?'` 4"%u52 I 1 unit
New/Alter./Repair Cost of Installotion -
^+?
Permit Fee 2 n,
?
Surcharge • • 50
Tota I 20.50
done in accordance with oll applicable State ot
Building Official
CrITY OF EAGAN Remarks
,,,,,,;,,__ . SURREY HEIGH'TS 4TH ADDITION ,. 2 .... 6 ., , 10 73003 020 06
Owcer r?} i(I1ael?.61YSA6, PY 1bi,L Street GARAGE State
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK
SEWER LATERAL
WATERMAIN
WATER LATERAL
WATER AREA
STOfiM SEW TRK
STORM SEW LAT
CURB & GUTTER
51DEWALK
STREET LIGHT
WATER CONN,
BUILDiNG PER, Q. 5 Q 3-31-77
SAC
PARK
CITY OF EAGAN Remarks
Addition StiRRFY HFTf;NTS 4TH ADnN LotI Rllr( Parcel 10 73003 f11 fl [1fi
Owner /) '. ;' -,/ L_ ?` Screet GARAGE State
?u ? : 3 y3 t th o??a r
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK
SEWER LATERAL
WATERMAIN
WATER LATERAL
WATER AFiEA
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER. #4244 5560 3-31-77
SAC
PARK
I C,1TY OF EAGAN Remarks
Addition SURREY HEIGHTS 4TH ADDITION Lot Z Blk 8 Parcel 10 73003 020 08
Owner f'e Y hd, Street GARAGE State r
' Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
, STREET RESTOR,
GRADING
SAN SEW TRUNK
SEWER LATERAL
WATERMAIN
WATER LATERAI
WATER AREA
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
SUILDING PER. #4244 5560 3-31-77
SAC
PARK
CITY OF EAGAN Remarks
AdditionSURREY HEIGHTS 4th ADDN Lot3 elk 7 ParceI10 73003 030 07
oWner % ? - . . / Street 3431 Highlander Drive Sr?te Eagan, hN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF,
STREET RESTOR.
GRADING
SAN SEW TRUNK
SEWERLATERAL 1975 . 369.00 73$.02 A0040$3 5-19-77
WATERMAIN
* WATER LATERAL 1975
WATER AREA 1973 SS2SS@ i1T1 @Z' original parc 1
I* STORM SEW TAtC?,q* 1975
STORM 5EW LAT
CURB & GUTTER
SIDEWALK
' STREET LIGHT
WATER CONN,
220.00
#5560
3-31-77
SUILDING PER.
sa,c 475.00 5560 - -
PARK
CITY OF EAGAN Remarks
AdditJURREY HEIGHTS 4th addri. Lot 2 Rik 7 Parcel 10 73003 020 07
Owner Street 3433 HighlaIIdeY' Drive state Eagan, MN 55122
" l'. Y t. l?ln l l?AV/?cktn.I? 17: hi I"i :. ' i !i'
Improvement Date Amount Annual Years Payment Receipt date
STREET SURF,
STREET RESTOR.
GRADING
SAN SEW TRUNK
* SEWERLATERAL 1975 1845.02 369.00 5 738.0 A004083 5-19-77
WATERMAI N
* WATERLATERAL 1975
WATER AREA 1973 SS@SS6C1 uii der OT1 inal STC 1
* STORM SEW 'WW 1975
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. 220.00 5560 3-31-77
BUILDING PER. #4244
sac 415.00 5560 3-31-77
PARK -
CITY OF EAGAN Remarks
AdditionSURREY HEIGHTS 4th ADDN Lot 4 Rlk 7 Parcel IO 73003 040 07
owner?li 1 Ce ?Grr I?.r'_? -'r i; $tfeBL 3427 Highlander Drive state Eagan, NW 55122
? r! . , ?4Q,{pJ ? . f'-LfX ,T
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK
j* SEWER LATERAL 1975 Lci45. 02 369.00 $
WATERMAIN
* WATERLATERAL 1975
WATER AREA
* STORM SEW $K LsO" 1975
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. . 3-31-77
BUILDING PER.
sac 475.00 5560 3-31-77
PARK
CITY OF EAGAN Remarks
Addition SURREY HEIGHTS 4th Addn. Lot 1 eIk-_?Parcel'10 73003 010 0-7
owner? bo,,;(Fr street 3429 Highlander Drive stat Eagan, MN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK
SEWERLATERAL I9 S S.0 369.00 S 738.02 A004083 5-19-77
WATERMAIN
WATER LATERAL 1-975-
WATER AREA 1973 a ess d r ari 1113 ar B1
* STdRM 5EW MK4at 1975
STORM SEW LAT
CURB & GUTTER
51DEWALK
STREET LIGHT
WATERCONN. 220.00 5560 3-31-
13UILDIfVG PER.
sa,c
47500
5560
-31-77
PARK
Receipt MECHANICAL PERMIT
CITY OF EAGAN
Permit No.
Fee
FiII in numbered spaces S/C
Type or Print /egib/y Tot
1. Date 2. Installation Cost '
3. Job Address '- ? Lot Blk. Tract
4. Owner
5. Contractor
6. Address
7. City •
State
Zip
8. Building Type: Residential 0 Commercial ? Institutional ?
9. Work Description: New ? Add ? Alter ? Repair ?
10. Describe - - . Fuel Type
11.
No.
' Equi°ment 8TU - M. Ea.
Forced Air , No. Equipment CFM
Air Handlin
:
Mfg. g
??kJ r•'C
Boilers
d
Mfg. Z 3 ( Mech. Exhaust
Unit Heater a
40,\- ?(?C r
,
Mfg, Other
Air Cond.
Mfg.
Gas, Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed : for
Rough F'i9eI ?
Inspections: Date Insp. Data?y?/? Insp. ?
This is your permit when numbered and approved. T-
Approved CITY OF EAGAN 454-8100
Phone --
? 5 f ?? 1?- ? s??-
??
C
??/? ?
INSPECTIUN RECURD
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knab Road Permit Number:
Eagan, Minnesota 55123 Date Issued:
(612) 681-4675
SITE ADDRESS:
; I.' , ti; 1
%ilfeRf Y FlF' 1#iFl t', 4 1 H
PERMIT SUBTYPE:
Ca 1 .- ; 1 (;;rto- fitP.
r{ur,i tll nlr,
0 :O1Nb!:
0'3 /I I /9 3
APPLICANT:
1,:
TYPE OF WORK:
kEP arr
RF ti (!+) N(;
i?P '?1.I; [F' 1 1 I1N
f I'NAI
?
?
?
1 NI.IJD f: `. 14?'9 ( 1 0 1 I) :t4:3! ( I. Il i i ) 3 43.i ( t() l ?)
ff'f`S t"rl41f=1llfi tIN i'tt'M11 0:1040i. fi0 1 . HtM. 1. 1,1,11RRtY 141', 41H1
?
?
Permit No. Permft Holder Dete Telephone N
S/W
PLUMBING
HVAC
ELECTRIC
ELECTRIC
InBpectlon Date Insp. Commeats
Footings I
Foundatlon
Framing
Foofing
Rough Plbg.
Rough Htg.
Isul.
Freplacs
Flnal Htg.
Orsat Test
Final Pibg. Plbg. Inspec[or - Not'rfy Plumber
Const. Meter
Engr./Plan
Bldg. Final
'C
Deck Ftg.
Oeck Final
Well
Pr. Disp.
CITY OF EAGAN
? . ' 3795 Piloc Knob Road
Eogan, Minnesota 55122
Phone: 454-8100
-`LC'r'?P.ir-`' - PERMIT
Dote:
June 27, 1977
3d2? cr ive
Site Address:
Lot JBI«k 7 Sub/Sec. SH 4th
Name ?xa-*mzkD' f:. Gustafson & Associates
`
`00I W. 78th St.
; Address
O
'loomington
City phone:
n.roject Plumbing Co.
Name
`
9743 Htmboldt Ave. So.
? Address
S Nl.pls. 55431
Ctty _
Phone:
This Permif is issued on the express condition thot all work sholl be
Minnesoto S tatutes and City of Eagan Ordinances.
No. 4
Receipt No.: 0651 n,
Single
Residential
Multi Res.. Comm./Ind. Townhousel 1 uitit
New/Aiter./Repair. D P'Cost of Installation
Permit Fee 20.00 _
5urcharge
Tota I 20.50
done in accordance with oll applicuble Stote of
Building Official
, CITY OF EAGAN
? 3795 PFIot Knob Road Eagon, MN 55122
PHONE: 454-8100
BUILDING PERMIT
Site Address
L01' BlOCk ~ Sec/Sub. ?--urxey Hghtrr 4t1'1
Parce! .#?_
,
w Name
W
Z Address ?
O _ ?i?l?*rc_tOTk ??33-7262
w
o Ncme
,
N° 4244
Receipt # "
Erect x
?
Occupanty
Alter ? Zoning
Repair ? Fire Zone _
Enlorge ? Typ= of Const.
Move ? # Stories
Demolish ? Front ft.
Grade ? Depth ft.
Auorovals Fees
oa
V Address
- Assessment
? .._: Ls
.)ilI V1IOter & $2w. _
Cit Phone
Potice
.._ F
? Name
Fi
F W re
?? Address Eng.
<W Cit Phone Planner
Council
f hereby ocknawfedge that I have read th'rs Qppl+cQtion and state lhat 81dg. Off.
the information is correct and agree to cornply with oll applicable AP?
Stote of Minnesota Stotates and City of Eagan Ordinances.
Signature of Permittee -
Permit
5urcharge •'`?'
Alan chetk
SAC '
Water Conn.
Woter Meter
,f,
Totai
A Building Permit is issued to: ?'• ?? s' "- '`-???-• on the express condition thot
all work sholl be done in accordance with all applicoble State of Minnesoto 5tatutes and City of Eacan Ordinances.
$uilding Official -
Pemk # pets lared panniFlK
Pl umbing --7'?' ?-- 8 ? (q -`z 7- 7 7
Mechanicai°-"-s-!-?
INSPECTIONS DATE INSP. Rough-In Finol
Footings
-?? -F Date Insp. Date Irup.
Foundation Plumbing
Frome/ins. y Methanicol
Final
Remarks:
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
--------------
INSPECTION RECORD Control No. 1252
PERMIT TYPE: "to t t u i Ma
Permit Number. ?d > 17Z
Date Issued: 30 /92
SITE ADDRESS: t or i 2
1433 HTBNtANnER DR
St1RREY HEIAHt9 ATH
BLOCKi j APPLICANT:
8 A J MASONRY
a (612) 489--2086
z - - ?
fL ?
PERMIT SUBTYPE: TYPE OF WORK:
Ml11 r t _ (Mt5r_ . ? REPAIR ?F?.rttlpTION AAitAAL ALAr.K Uall
v«mn Ho. w?mn ?awer asce T.lopnom 0
sn+v
PLUMBIN(i
HVAC
ELECTRIC
ELECTRIC
Inspwtlon Deta Insp. Communs
Footings I
?
Foundation
Ftaming
Roofing
Rough Plhg.
Rough Htg•
Isul.
FlteplaCe
Rnal Htg-
Orsat Test
Flrrel Plbg. Pibg. Inspector - Notify Plumber
Consi. Meler
EngrJPlan
Bidg. Ffnal
Deck Ftg.
pedc Fnal
YVelt
Pr. Disp.
WATER SERVICE PERMIT
CITY OF EAGJ4N
3745 Pilof Knab Rood PERMIT NO.:
Eagon, MN 55122 DATE; - '
Zoning: - - - No. of Units:
Owner
.
Address:
Site Address: ' - -'' Y
Plumber:
Met
r No
: Connection Chorge:
.
e
Size: Account Deposit:
r No
R
:
d Permit Fee:
.
en
e
I ogree to eomply wiFh !he City o; Eagan Surchorge:
ances
O
di Misc
Charges: ' ',? `` `.,`'• ''
.
r
n .
Totol:
B Date Poid_
y
Date of Insp.: Insp.:
m
CITY OF EAGAN SEVIIER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.: -
Ecgan, MN 55122 DATE: 7/1
Zon°ng: _ No. of Units: ? 1 -
C .ner:
..ddress: -
. . . .,?,
Site Address:
Plumber:
1 agree to eompiy with t6e City of Eagan
Ord; ances.
BY --
Date of Insp.:
Connection Charge
Account Deposit: .
Permit Fee:
Surchor9e:
Misc. Charges:
Total:
Date Poid:
a' OF EA6AN WATER SERVICE PERMIT
3795 Pilot Knob Roed
E,,gan, 1vlN 55122
Zoning:
Owner:
Add ress:
Site ^ddress:
Plumber:
Meter No.:
Size:
Reader No.:
1 a4ree to comply wiH+ the City of Eagan
PERMIT NO.:
dATE:
_ No, of Units:
Connection Charge:
Account Deposit: _
Permit Fee:
Surcharge:
Misc. Charges: -
Total:
Date Paid:
in.
50
f,
CITY OF EAGAN SEWER SERVICE PERMIT
3745 Pilot Knob Road PERMIT NO.:
Eagon, MN 55122 DATE:
Zoning: No. of Units:
Owner: --- -
Address: _
Site Address• : '??' i??• •: • ... , _
Plumber: ;?,-• ,? r -, - -
1 agree M eomply wiH+ the C9ty of Eagan
Ordincnees.
By
Date of Insp.:
Insp.: _
CITY OF EAGAN
8795 Pilot Knob Road
Ecgan, MN 55122
Zoning:
Owner:
Address:
Site Address: _
Plumber:
Meter No.: ?
Size:
Reader No.: _
1 agree to eomply with the City of Eogan
Ordincnces.
By
Date of Insp.!
Connection Charge: -
.. _ . . _, Z x
Account Deposit:
Permit Fee:
Surcharge: „
Misc. Charges:
Total:
Dote Poid:
WATER SERVICE PERMIT
PERMIT NO.:
DATE:
_ ?..
No. of Units:
ConnectionCharge: - ?!"t.t
Account Deposit:
Permit Fee: t n. UG Jx'
Surcharge: rx]
Misc. Charges:
Tota I: Dote Paid:
CIT': OF EAGAN SEWER SERVICE PERMIT
3795 Pilot Knob Road
PERMIT NO.:
'
Eagan, MN 55122 DATE:
Zoning: No. of Units: '
Owner:
Addresc: _
Site Address: '? "•`- .
Plumber. 111?1.:-; ? .
ogree te eomply with the City of Eagan Connection Charge:
Ordinances.
Account Deposit:
Permit Fee:
B
y 5urcharge:
Date of Insp.: Misc. Charges:
Ins
: Total;
p, Dote Poid;
CITY OF EAGAN SEVIIER
3795 Pilot Knob Rood PERMIT NO.: I a z')
Eagan, MN 55122 DATE: _ ; .•z }
Zoning:
No. af Units:
Qwner.
Address: _ Site Address! -1A qn „s
PI umber: "r,? i r • „ , , , - --
?/7? -7•T ::,,r??,.-
1 ageee to tompty wifh the City of Fagon
Ordinonces.
By
Date of Insp.:
Inso.:-_
Connettion Charge: ?fl, t`
Account Deposit:
,Perm1Y Fee:
Surcharge:
lvlisc. Charges:
Totol:
Date Poid:
-'--L="''? =------?
CITY JF EAGAN WATER SERVICE PERMIT
3793 Pilof Knob Road PERMIT NO.:
? -.ogan, MN 55122 DATE:
Zoning: _ No, of Units:
Owner:
. '
? Address: -
Site Address? r7 1•1
; Plumber:
Meter No.: Connection Charge: -
Size: Account De
posir:
Reader No.: Permit Fee:
I agree to comply with the City of Eogon 5urchorge:
Ordinances. Misc. Charges: ? ," r - : •;`• ?-"T
Totol:
gY Date Paid:
Dote of Insp.:
Insp.:
//$/87 IEQUEST FOR ELECTRICAL INSPECTION !0 430001-04
5
, S. h¢v.tions la eowletinp th:s fum m baek of wllor copv.
a? "X" Be/ow Work Covered by This Request aaa xeo. Tvoe ot eu:ia:na awlimes wkw Ea.ic.me.t w:.ea
M Fee ServieeEntranceSiza 4 Fee Faeders/5ubfeeders M Fee Gircuits
0 to 200 Amps 0 to 30 A 0 to 30
Above 200 Amps 37 to 700 Anps 31 to 100 Atom
Switmning Pool Above 100- A6ove 100_A
Transiortners Irrigation B? Partial•`Other F
. Sicps Special Inspection 5o?? TOT/;L E ?
Ae?arks I
_?O /? J /0 a
Itough-in Date I. the EI
Irmpectw.hereby
cnn:M1 tlaa the anova
Final Dat
7 iRp?4m has beeo
r 1 ?
_ ? r d._
.hi.r0quia,,,oid,8n,affftfram
This request wie y76, j
B "' 79 ?s,cl,R7
Reques Date " - Fire Nu. ' lbugh-in I?pectfon
Heqv ?¢tl?
ady Now Q Will NofiiC InsOec-
_7'_ ? ? ?YCS ?NO lor W1en q¢ddY
[3'1-icets¢d Elecirical Contraclw I herepy raquest impeeKOn oT aEove
? Owner alechicsl work imtalled aY.
Str [ A
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o x or ute N. f
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/r?l I ? ?AM . k 'J. ?
ecLan No.
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hnD or o.
flange No.
Coury1
OccuDant (PRINTI Phnne No.
9
POr Svppiier ress
EI tri 1/ tractw rry Name) Cmv ctor's LiceMe No_
nq Addr untractor ar Owner MakiM Insbila[ion) .
Au or'¢ ed Si ?ture onlracto Ow - r I?king I?s Ilatianl
? . Munber ?
YINfdE50TA STq7E BOApD OF EIECTitIC17Y THIS INSPECTION BEQUEST MILL NOT
GNggs-Midwey Bldp. - Ibom N-781 BE ACCEPiED BY THE STA7E BOAND
1821 University Ava_. St. Peul. YN ?704 UNLESS P/10PEN INSPEGTON FEE 6
Plqne 1612) 2972711 ENClOSED.
This request void
t 8 mor',hs fr?n
9201
Lola?l3c?7 , --;Y4Q?
?{? ??o?oo
Raques't Uat
S ? Fire Nu. Rouqh-in insVer,tiun
FequireA?
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RcaAy Now ? Will Notify. Insnec-
1..
Wh
F
'
d
&5L ?Ves JJ
No
r
en
e
u
y
Q'C.enesed ElecVir.al Conlractnr 1 heraby reyuest inspecUOn ot ebove
? Owner elecVical work installed ac .
St ree[ AdArass,.BOa or Route Na G AM
?? ?!A
er.Uan o.
I Townshi0 Np r Nn.
qange No.
nw t
Occupan[ IPRIN_U??? Phona No.
Power $upplier Atldress
ElecVi 5.mhact r(COm N?mel? C?act??r'S l?icense No.
7T1U/ ?Fq°
Mailin Address (Contractor or Owner Making In tion)
?-sas C 12
o!? S?`, ?it.c.? ??L? Sa37-Z
AuMOrizeA S' ture (Con ra r/O n Aytaking Ins[allatfon) Phonc Number
a ^--,`00
MINNESOTA STpTE BOAflD OF ELECTRICITV V ' THIS INSPECTION qEQUEST WiLL NOT
Griges-Midway Bldg. - Noom N•191 BE ACCEPTEO BY THE STATE BOAHD
1821 Univarsity Ave., St. Peal, MN 55104 • VNLESS PHOPEX INSPECTION FEE IS
....__ ,e- - -- . ENCLOSED.
+ REQUEST FOR ELECTRICAL INSPECTION
T 9 2 3 01? Saa instrurtions lor completin his torm on hack of ynllaw copy.
"X" Below ii/ork Cnvered by This Request
?EB-00001-01
?qq?I
aw Atld Rep. Tyne o1 BuilAing Aoaliances Wired Equipment
WireA
Home Range Temporary Service
Duplex Water Heater Lightiny Fiztures
Apt. Building D er Electric Heatin
Commercial Bldg umace Silo Unluader
Industrial Bldy. Air Conditioner Bulk Milk T2nk
Farm oma, Soec, iv o"ner (specify)
tha.r Sper.ity Othcr 0
Othi.,,
Cnmpute lnsUer.tion Fee Below
tt Fee SarviceEnirance5iza k Fee Fextlers/5ubleeders k Fee Cirr.uits
0 to 100 qm s 0 to 30 qm?s 0 tn 30 Am s
101 to 200 qmps 31 to 100 qmps 31 to 100 Am s
Above 200 qim??s Above 100-Amps Above 100_<1mps
Trensmrmer% \\ Remote Control Circ. Partial%O r Fe
Sic_7ns
'
.',. Special Inspection
$
•?
ftenwrks O- ,!
?,. lV'? TOTAL F
Pough-in D:, 1e 1, the ElecVical
Inspectoq heraby
c
tit
th
t th
b
'
Final
? DF?,
?? er
a
y
a »
ove
:?I.
nrtion has baen
m de.
This repuest void
18 months fiom
<- ' CASH RECEIPT
` CITY OF EAGAN
3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
RECEIVEO
1 ay a, R Fr 'y
$vrre?l f'1T3 7'
r19
AMOUNT $ I
°-.556u
-1
BY
NUMERICAI FILE COPY ' i
E] CASH ? CHECK
_ ? s u
.?3 .?.d 7
??J
FOR -'?^Z? fCCAJCVi^?
- ,. J i "' ? ? _.... ... _ . . ??
I/
? . CITY OF EAGAN
" 3795 PiIM Kno6 Rood Eagan, MN 55122 N2 4244
PHONE: 454-8100
BUILDING PERMIT APPLICATION $140,000 ReceipY #
To 6e used for 1 BLdQ (4 Lri3Y5) TownhoUSe Date M3r 10 _ 19-Z7-
i5t4 A?d?dryeSs 3429p33?31? 27 H?hlander Dr_ Erect p OccuPancy
??- qt!-I- B'ock 7 Sec/Sub. SuITeY ?ht5( 4th? Alter ? Zoning R3
ar$??d a ? Repair ? Fire Zone
Enlorge ? Type of Const. V
z Name Gold Medallion Cnrg, Move ? # Stories
3 Address Demolish ? Front - _ ft.
o C,? Bloomington phone 835-7262 Grade ? Depth ft.
Q Name D, H, Gustafson bASSOC. ? ZIIC? Approvais Fees
o?u
AdIToom ngton, 835-7262
Name _
Address
I hereby acknowledge ihat I have read this application and stpte that
the informati is correct and agree to comply with all opplicable
State of Minneso a s and City..qf Eogan Ordinances.
Signature of PermiT?,
A Building Permit is i sued to:
all work sholl be do i accQ
Building Ofi4icial .
Assessment _
Water & Sew.
Police _
Fire _
Eng.
Planner -
Council _
Bldg. Off. _
APC
Permit "iz,vv
Surchorge iQ•00
Plan check
sAC 19ao.oo
WMer Conn. a$Q•QQ
Water Meter 240.00
roral 3,502.00
d ASSOC_ _ - on the express condition that
of Minnesota Statutes ond City of Eagon Ordinonces.
-,
• RESIDENTIAI. BUII.DING
,f,p Permit Application
(p; '-FDft) City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5674
New Construction Reauiremenis RemodeVReoair Reauirements
3 registered site surveys showing sq, ft of lot sq. N. of house; and all roofed areas 2 copies of plan
(20°k maximum lot coverage allowed) 1 set of Energy CalculaGons for heated addNOns
2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey for addi6ons & decks
i set of Energy Calculations Addition - indkate 'rf onsite septic system
3 copies of Tree Preservation Plan if lot platled eNer 711193
Rim Joist Detail Options selection sheet (bldgs with 3 or less units
Date k\_ / ?.? / 03
Site Address 'kU _
Construc[ion 6ost)
_41_06
5?0_1
Office Use OnN
Cert of Survey Recd
Tree Pres Plan Recd
Tree Pres Not Reqd
_ On-site Sep6c System
rw_,-O` ( Z-)f I ?
uniusce #
DescriptionofWor? KP??4L2
PropertyOwner ?Urf+Pv. TeleptioneAl)(1rja) qaA -557?
Contractor _ American Building Contractors, Inc.
Address _ 12247 Nicollet Ave South
state Bumsville, MN 55337
(952) 707-6959
City
Telephone # (
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(Jsubmissiontype) Submitted Submitted
• Energy Envelope Calculations Submitted
Licensed P{umber
Mechanical Contractor
Sewer/Water Contractor
? ? Telephone #(
03 Telephone # (
#(
I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a
perxnit; that the wark will be in accordance with the approved plan in the case of work which requires a review and
approval of plans.
C\GN CVJ'fG.r? boj? Lvl?
ApplicanYs Pliiinted Name Applic 's Signature
?
Sub Types
OFFICE USE ONLY
O 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pooi
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.)
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.)
? 04 02-plex ? 10 08-plex Fb 18 Deck ? 23 Porch (screenlgazebo)
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or_ N? 25 Miscellaneous
Work Types
? 31 New O
? 32 Addition ?
? 33 Alteration ?
?ff 34 Replacement
Valuation Z
Census Code
SAC Units
Nbr. of Units
Nbr. of Bldgs
Type of Const U V?
Footings (new bldg)
? Footings (deck)
_ Footings (addirion)
Foundation
Drain Tile
Roof Ice & Water Final
? Framing
_ Fireplace _ R.I. Air Test ^ Final
Insulation
ccupancy
Zoning
Stories
Sq. Ft.
Length
Width '
ys em
City Water
Booster Pump
PRV
Fire Sprinklered
REQUIRED INSPECTIONS
FinallC.O.
? FinallNo C.O.
_ Plumbing
HVAC
Other
_ Pool _ Ftgs _ Air/Gas Tests _ Final
_ Siding Stucco Stone
_ Windows (new/replacement)
_ Retaining Wall
Approved By '770;n , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Tota I
? 30 Accessory Bldg
? 31 Eut. Alt- MulS
? 33 Ext. Alt - SF
? 36 Multi Misc.
35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
37 Demolish (Bldg)' ? 43 Reroof ? 46 Windows/Doors
`Demolition (Entire 81dg) - Give PCA handout to applicant
O 1?7' 3 MC/ES S t
OR
tNllEM Ut1 `t
?".?122-1 309 ?
NER JUGY A
HIGN DEfi DR
N h9N 55122-1309
F-- A aA\ A?
REVIEWED rol
? t,tiaNG 9NSPE6TfiON"
DR
INSPECTION RECOR
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55123 Date Issued: c 3/ 1 ? r,
(612) 681-4675
SITE ADDRESS: APPLICANT:
.??.tif'i 11f?.??1?3. ?t?, ?"??? q•?' i ?'?f_
PERMIT SUBTYPE:
H l3rEi_Lr=,NEi,US
TYPE OF WORK:
li?.p?i,??j?!?7SIJVJ t?-?iT?]IiVla
?
REI1 hRKSa IN 1 Ij 1)?S 1?9 t,"I fJl 1) .,?,7 ? L.C37. 31 .. r LCIl? "}
FI`t .:: i:nL L C, i E:L OPi "c. Yr4IT ??1%0 l'il. i I(i'f" C;:, ftl Y.. 1.,? `ur;F'.E:'Y YITS STl?lj
? CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
SITE ADDRESS:
PERMIT G'D s-
?
PERMIT TYPE:
Permit Number: c; :- ry W,
Date Issued: 31. 'L / ?-3
?„..,.. _ ,
:..i., i ; s cr
r.zerd.e
DESCRIPTION:
;a i r1.10 r
, f37A k1Js'i ir. i 'y I"e 1'D C:LLi4i01,.15
B u i.lclingoi' •. 1y??e ftf..P411ft
1J?.5(;' (JC„Gll{1r7Yi`w'i/ i("..
REMARKS:
' Y T
'f?F° ( i I l'' . fl I"1)1 '^nl'trT ,-l (I fl?!' °i I? 1 ;IIIr!sPT'V 4T^: ATI;l
FEE SUMMARY:
CONTRACTOR: - ? ? P
MEIn(J ..:C6Lr1(:i 1.., ?'1:?[r"Ef ?'??,,7G94£??'7. S;UftS?. "l H?7'"S iCl,,?iV?liltlSF AS?,;(1i„
'L47_44 3?20 f.Vt ?J EI1'?;HLPr'D:"R 0(1
PLVi4UU7H ?1Pd 657?!J' SI1UflN iwih!
I hereby aeynowt.EeIGe that: T. haus rp;€; i'his app1ic.4tioti ar3r; S#:at. 1.'rtfii I'lin
infcsrmat:;tvn J.s Gorre(:U e,nzi Go E,c3mt,.ty wwCh a1t .appift,'Ibl?. STaic: oi 1411.
St:atutes, eartcl G,'tt,y C+F Eege,n Ordit7z3tties,
L I
d
r Y11,?Y
APPLICANT/PERMITEE SIGNATURE ISSUED V: IGNA UR .
REACTIYATE._
PERMIT # %to 4ti
arr oF EAcaN
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 & structural plans, l 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 whicfi request is made, 2) address is thanged or 3) lot thange is requested once permit
is issued.
Date /93 Valuation of work 5EE P?`?''r ?-3409
5ite Address: 342.7 4I6 t+ta4wDE12 DR.. (+uuU QGS 34291 3431, 3433)
STREET SU1TE /
Tenant Name: (commercial only)
IAT BIACK 7 SIISD. SUMtE-/ P4EtVI+Ts P.I.D. N 10 -73c?03 O'fo 07.
l 3 Z 4 M?
Descri tion of work: PS
The applicant is: ? Owner L% Contractor ? Other (Describe)
Name Sv ?? 170m,3 ar*ePhone
Property LAST FIRST
Owner
Address
STREET STE M
City State ZiR
Company meN rc? T? 1NG 1oC Phone 557'190F?.
?
V94 L
?ya
N
3"? 9
Contractor . Exp
C) License #
Address
qy C?
4 $
City State /sI/n/N Zip S.Syy2
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. (P 0
Signature of Applicant: ? ^-? ?
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation
? 02 SF Dwg.
? 03 Sf Addition
13 04 SF Porch
0 05 SF Misc.
? 06 Duplex
? 07 4-Piex
? 08 8-Plex
? 09 12-Plex
? 10 Multi. Add'1
WORK TYPE
? 31 New
? 32 Addition
? 33 Alterations
P?34 Repair
• ,4 * 411k
? 11 Apt./Lodgingju.? -%JJ 16 Bajpp0t Finish
JX 12 Multi. Misc. El 17 Swim Pool
? 13 Garage/Accessory ? 18 Comn./Ind.
? 14 Fireplace _ ? 19 Comn./Ind. Misc.
? 15 Deck ? 20 Public Facility
? 21 Miscellaneous
? 35 Tenant Finish
? 36 Move
? 37 Demolish
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC bccupancy
Zoning
d of Stories
length
Depth
APPROVALS
Planning
Engineering
REGtUIRED INSPECTIONS
O Site
? Wallboard
Basement sq. ft.
lst F1. sq. ft.
2nd F1. sq. ft.
Sq. Ft. total
Footprint Sq. ft.
On-site well
On-site sewage
Building
Yariance
? Footing
? Final
MWCC System
City Ylater
PRY Required
Booster Pump
Fire Sprinkler
Census Code
SAC Code
Assessments
? Framing ? Insulation
? Draintile ? Fireplace
Permit Fee
Surcharge
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:
v.lwcia,: $
?pl?? 340 q (-?r4NcaNa?l4
Pt?jzmfT
De.
?
SAC %
SAC Units
...,r. . . , . ,
BUILDIP rG PERPIST P.PPLICAiTON
Date : ID -2rf-7b
?
LOT ? BLG^,K / AUDITION J"??
{?ARCTrS, & SrCTSO'[l PASt18F.R IF U1,1PI,ATTED
FIDDRF.SB QF FARCEL a-U.T/ ? OUvBcE
70NITdG K- 3 OCG^J°Ah'CY USE 165S/0$NT/
E^uT7glATliD CO^uT
OF717ER bbtA:;' TELEPT3QNE NO. p 35-7262
PJDRESS &?brni.: b 7-6 ?? , ?J?nn. •
CODPfRACTOR ?usjf/FS,? ? f75s?C, TELEPHONE, NO. 7262
ADDRESS
Note: Inclvde site plan, building plans, and energy calculations ryith this
application
Signed ? 7??
.L2 At oC .
OFPICE USE
-05
VALUUF1TI0id ,r? ?z 62 -)
SAC
[aATE?t COi7iVECTIOP7
F7ATER h1ETER
SUII,DING PERESIT FEE
svRCxAxcE rEE
PLAN CFECK FEE
PARK DED2CATIO14 FEE
OTHER
TOTIiL*
-4=4-lt
40
60
l? .to
_ , .
?
APPROVl:LS:
ASSESSMEIirT CLERK1?.?. BUILDING DEPT. POLICE DEPT.
VA9TER & SE4tER DEPT. FIRE 4EPT. PARK DEPT.
1 <
•• • ,
?
' .
?• .. • , ?
' ' ' y , . .
/ • . •
•
, •
• •
? . . • ? . . . . . • '
_ _ _ . •
....
. ?w .
.
.' .? . ,.... STATEMENT .. ..: .
?g0
CITY OF E.4GAiV ;
3795 PILOT KNOB ROAD 10-7-76 ' .• i
• ' ? EAGAN, MINNESOTA 55122 ?
? Phone 454-8100
.
, g.
# .
• D.H. Gustafson & Assoc.
Suite.650, Southgate Office Plaza
_ 5001 w. 78tn st.
-• Mplsv M 55437
L J 6
?s
? '?" ' DETAdi AND MAIL WIiN YOUY CXECK YWR CANCEtIED p1ECK IS COUR QECEIPT. ,- '
.
'_._ . _ ., . . . .
.
? - , ytS%`:3:: s7J <??i°,1.??Y',..2z...,?-.:+s::e:F's&7S/'n`::"J.T3+Fi3.X_...w..a:-`9a.?^.fJC?>`t'-:3-?t-ti.G.:R:S:- , ;
• ? 19-7-76
„ 4/r
t ;,.. i
r
• ?"M y
.
-
. j
., .
.
? Park Donation:
. • ???'?r' ; ? r? . .
Surrey Heights Townhouse Addi_tpn -•??... ?-., .,
,
(new project - 44 units) r,. o. '
?
. . . ' 11,1 y
YY ?1?. Y$ ?f
2 units paid previously
. 12 units @ $100.00 - $1200,00
• i ? T ?_.: '
?
s. _ Total Due ---------------^---------- $1200.00
:
. • . 4 . ' :.? .
.
(l ,
'Y ?
? • I 1 ?
? .. Bedi?ms
' tS !64 }AIp eY qtFCK N0. ' -
' • ' .-. . - . -.. -. ?'.':-:: _ ' , .._..,.?....: • ....: ... .. : . .. `...., .... '?:.'., ... . . . .-. '
i
'. 10t1 OAR (Sp SFi57 CV804
. .. .
' '
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. . . . ,
.
• . . ??
'
. .. • ?g '
INSPECTION RECORD Control No. 1252
CITY OF EAGAN PERMIT TYPE: B u r. i_ 0 x Nca
3830 Pilot Knob Road Permit Number. 001722
Eagan, Minnesota 55123 Date Issued: 1@/ 3 0/ 9 2
(612) 681-4675
SITE ADDRESS: APPLICANT:
Lo r: z B L 0 C K: 7
3433 HIGHLANDER Uft B& J MASOIVF2Y
SURREY HEIGHTS 4TH (612) 4 89-2055
?
?
-1
I
PERMIT SUBTYPE: TYPE OF WORK:
MULTI, (MISC:.) REPATR
f7ESCRTPT70N GARAGE ftLOCK WALL.
PERMIT
C1TY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
PERMIT TYPE:
Permit Number:
Date Issued:
EsUT1.LlING
001722
:L0/38f92
SITE ADDRESS:
3433 FIIGhII_HPiD[R UR
I..OT: 2 BLOCK: 7
SURREY HE1:GH75 4TH
DESCRIPTION:
REMARKS
GARRGF BIOCK WALL
Buildin.g Permit l'ype MULTI. (MISC.)
Building`W,ork Type ftEPAIR
U8C OccupanCy M-1
\
b ? IX[T`6'
FEE SUMMARY:
Base Fee
Surcharge
Subtotal
r
VRLUATION $1,600
$37.00 COPY
$1.00 Total Fee
$38.0@
$38 .50
CONTRACTOR: - ApplS.canr. - OWNER:
B& J MflSONRY :14892056 E3AILEY ENTEftPRISES
434 MflTCH RVE 484 WABflSHfl
ST PAUL MN 55117 ST PAUL MN 551.17
(612) 489-2056 (612)224-5482
I hereby acknowledge that I have read this application and state that the
i.nformation is rrect and agree to comply wi.th all applicable State of Mn.
atutes and Ci of Eagan Ordinances.
? -
Tjtkta R ?;r,( I7n.1(
APPLICANT/PER E SIGNATURE ISSUED Y: I NAT fiE
Control No. 1252
PERMIT #
REACTIVATE _
CITY OF EAGAN s?^
1992 BUILDING PERMIT APPLICATION
681-4675
SINGLE 3 MULTI-FAMILY 2 sets of ptans, 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 /o / Jc3 Valuation of work
Site Address: ~?Y_11_7
STREET SUITE I
Tenant Name: (commercial only)
LOT ? HLOCK ? SUBD. P.I.D. *
Descri tion of work:
The applicant is: O Owner ? Contractor ? Other (Deeeribe)
i-
Name C., f. Phorse
Property LAsT F,RST .
Owner ?
??y ??4
Address
a-
17zr
STREET STE 0
City State ?Gc/ Zip
Company _ ?¢ J i?69SO?dti Phone
Contractor Address License # Exp.
City State ?41 '?? - Z i p S,Ti/7
Archltect/ Company Phone
Engtneer Name Registration #
Address
City State Zip
Sewer 8 water licensed plumber Processing time for
sewer & aater permits is two days once area has een approved.
I hereby acknowledge that I have read this application and state that the information is
correct and agree to comply w' pplicabl State of Minnesota Statutes and City of
Eagan Ordinances.
Signature of Applicant: vi J
v
OFFICE USE ONLY
BUILDING PERMIT TYPE
13 01 Foundation
? 02 SF Dwg.
? 03 SF Addition
O 04 Sf Porch
? 05 SF Misc.
? 06 Duplex
? 07 4-Plex
O 08 8-Plex
? 09 12-Plex
? 10 Multi. Add'1
WORK TYPE
? 31 New
? 32 Addition
? 33 Alterations
J;04 Repair
? ? ?,•• . - .
? 11 Apt./Lodging "?O 16 frasement Finish
l?l 12 Multi. Misc. ? 17 Swim Pool
Pr 13 Garage/Accessory ? 18 Comm./Ind.
? 14 Fireplace O 19 Comn./Ind. Misc.
? 15 Deck ? 20 Public Facility
O 21 Miscellaneous
? 35 Tenant Finish ? 37 Demolish
O 36 Move
GENERAL INFORMATION
Const. (Actual) Basement sq. ft. MWCC System
(Allowable) lst F1. sq. ft. City Water
UBC bccupancy M-I 2nd F1. sq. ft. PRV Required -
Zoning Sq. Ft. total Booster PumP -
# of Stories Footprint Sq. ft. Fire Sprinkler -
Length On-site well Census Code -
Depth On-site sewage SAC Code -
APPROVALS
Planning Building Assessments
Engineering _ Yariance
REGIUIRED INSPECTIONS 0-''kL3--
13 5ite WFooting ? Framing ? Insulation
? Mallboard 15 Final O Draintile ? Fireplace
Permit Fee 3'7,0o v,i,,,t;,,,, g l?od ?'
Surcharge I , a o
Plan Review
License
MWCC SAC
City SAC
Mater Conn.
Water Meter ,
Acct. Deposit
S/N Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Trails Ded.
Copies „yp
Other
Total:
SAC %
SAC Units
STATE RESIDENTIAL CONTRACTOR/REMODELER
LICENSING INFORMATION
PERMIT #
1. I have made application for license to We Department of Commerce.
Date of Application
_ Residential Building Contractor
_ Remodeler
Signature Date
2. I am exempt because I am a m specialty remodeler.
J/,?=, Jl? ?e c! 2--
Signature Date
3. I am exempt because my annual gross receipts are less than $15,000.
Signature Date
4. I am exempt because contracts on individual projects in aggregate do not
exceed $2,500.
Signature Date
Questions regazding the licensing law should be directed to the Department of
Commerce, 133 East Seventh Street, St. Paul, Minnesota 55101, (612) 296-6319
Licensing Information, (612) 296-2594 (Enforcement).
3_ 71 S,.?reI h4V5 , 4+h
BEA BLOMOUIST
MAYOP
THOMASEGAN
JAMES A. SMITH
JERRYTHOMAS
THEODOkE WACHTER
COUNCIL MEMBEPS
.?.
?'..
CITY::OF EAGAN
@?.?."" .._- l .
'.?`?;;?r w195 'PI LOT?K NO BROAD
„t?y v.o eoxanw f'
?`-EAGAN,?MINNESOTA
4s'i?z?
tp
PHONE 4
SO•EIOO
""5
`'?`r?+ -. ar-?. `?, ?' ?y?s+•, m?'., .
rs
TNOMASMEOGES
CITY AOMINISipAiOF
EUGENEVnN OVERBEKE
CITY CLENN
March 4, 1982
MICHAEL GAISBAUER ;
;3431 HIGHLANDER DR
EAGAN MN 55122
Dear Mr. Gaisbauer:
Your letter was received today and will be copied to the Mayor, members
of the City Council, Police and Fire Departments.
lt is extremely rewarding to all of us who are either employed or serve
your local government to have the type of input you provided in your letter.
Thank you for your time and appreciation. It is definitely motivational
to our Police and Fire Departments.
Sincerely,
?6 VA
Thomas L. Hedges ?
City Administrator
TLH/hnd
TNE LONE OAK TREE ... THE $YMBOL OF STRENGTM AND GROWTH IN OUR COMMUNITY.
MAR 4 1982
_-
-
--
- --
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MECHANICAL (RESIDENTIAL)
Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5694
Please complete for. Single Family Dwellings
Tovmhomes and Condos when permits aze required for each unit
430'SZ
nate -7 i l i 113
Site Address 3 Y L 7 f•?i'y?, ?,q r?D ER ??.+ Unit #
Property Owner M' I(9 t-A R.5 o n) (/rL IA ? A?- ? Telephone #(' G3 ) 277 - y y a 6
Contractor / '+?L.SN U fj ) d?y Aj.+D COrIb"tbNiivry &C
Street Address b Z Y8 LA /Co [ A1Jp Av-e. ?tl a City ? o'lf ?MA_
/_' r Zip SS 7 z U Telephone #( 763 )? 36? 04, 6 7
State
T6e Applieant is _ Owner ? Contractor _ Other
Add-on, modiCcation or alteration to existing dwelling unit $ 30.00
X furnace replacement
_ air exchanger
X air conditioner ?
other
L
y
?. r
$ .50
State Surcharge
Total
I hereby apply for a Residential Mectianical Pernut and acknowledge that the informarion is complete and accurate; that the work will
be in conformance with the ordinances and codes of the Ciry of Eagan and with the Mechanical Codes; that I understand tlus is not a
pemvt, 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. , n A ^
?25k ?
ApplicanYs Signature
ApplicanY Printed Name
MECHANICAL (COMMERCIAL)
Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone 10 651-675-5675 FAX # 651-675-5694
Plcase wmplete for. commercial/industrial buildings
multi-family buildings when separate permits are not required for each dwclling unit
Date
Site Address Unit #
Tenant Name (if applicable) Previous Tenant Name
Property Owner Telephone # ( )
Contractor
Street Address City
S[ate Zip Telephone # ( )
The Applicant is _ Owner _ Contrector _ Other
Work Type
Newconstruction UndergroundTank _Install _Remove
Interior Improvement Call for inspection during installation/removal of tank
Processed Piping
Nature of Work:
Permit Fee $50.50 Minimum ree (includcs State Surcharge)
Contract Value $ x 1% _$ Permit Fee
• If permit fee is $1,000 or less, add $.50 ? $ State Surcharge
If permit fee is over $1,000, add $50 per
$1,000 Permit Fee
$ Total Fee
I hereby apply for a Commercial Mechanical Permit and acknowledge that the information is complete and accurate; that the work
will be in conformance with the ordinances and codes of the City of Eagan and with the Mechanical Codes; tha[ 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 accordancc with
the approved plan in the case of work which requires a review and approval of plans.
Applicant's Printed Name
ApplicanPs Signature
Approved By: , Inspector Date:
HEATING TEST RECORD (?QRSAT)`
? SCF 6,1 2001 II'`J
ADDRESS: <3427 Hi hlander Dr? APT: I FLOOR: CITY:Ea an D ,I/ lO .
OCCUPANT: Mark Densm re OWNER:
HEAT LOSS: HEATING INSTALLED BY: Marsh Neatin & Air
ELECTRICAL WORK BY: S ark Electric ; GASLINEBY: Marsh Heatin & Air Conditionin
TYPE OF HEAT: GA FA ROOFfOP SPACE HTR UNIT HTR OTHER
GAS DESIGN
MANUFACTURER: LENNOX
MODEL: ? G26-Q2-504>
SERIAL: C) I
INPUT: 50.000 BTU
CONTROLS
THERMOSTAT: VENT SIZE: ?? d C
VALVE: w KIND OF LINER: SIZE NoNE_
LIMIT: CxG? vs'ta-?N I DRAFTHOOD: I REGULATOR:
LIMIT SETTING: 7 5 FILTERS - IgIZE: ';VI " J1' '
I
NUMBER: ?
J
FAN SETTING: I,
I
CHIMNEY - INSIDE
11
OUTSIDE
PILOT TYPE: ,$ U r ac-*- i CHIMNEY CONSTRUCTION:
PILOT MAKE:
PILOT MODEL: ! SMOKE BOMB: IWIRING:
PILOT TIMING a Sr co DRAFT: ITEST TAG:
L.W. CUT OFF: I DOOR PRESSURE: iLIGHTING INST:
PRESSURE: 3_ Sw C !10a COs 6- 3 90 !I DATE TESTED: 03
INPUT CFH: 10 OZ COMPANY TESTING:
STACK TEMP: ?J6 '% CO o---e I NAME OF TESTER: jc-q