3763 Linden Lane 7
Use BLUE or BLACK Ink
r - - - - - - - - - - - - - - - -
For Office Use I
77 y of Ea Cit Ol (tn I Permit
b I Permit Fee: O ` C) I
3830 Pilot Knob Road I
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff: I
I
2010 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 1 10 Site Address: AI
Tenant: Suite
RESIDENT/ OWNER Name: iI aR Phone: l~
Address/ City/ Zip: mt
Applicant is: K Owner Contractor
TYPE OF WORK Description of work:
R&P
a.
Construction Cost: l 0 Multi-Family Building: (Yes / No )
CONTRACTOR Name: License
Address: City:
State: Zip: Phone:
Contact: Email:
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 supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City 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.gopherstateonecall.org
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start withou a permit; that the work will be in
accordance with the approve ,plan in the case of work which requires a review and approval of plan .
X P( 1 , A- o~ S'S x
Applicant's Printed Na a Applicant's Si re
Page 1 of 2
CASH RECEIPT '
CITY OF EAGA`N r
3830 PILOT KNOB ROAD '
EAGAN, MINNESOTA 55122
DATE :.. ? I ?- 19 1 1
nECerveo ;
s?
----•- `? -=i .
AMOUNT $ - I ' " -
?. l"L1
8 DOLLARS
im
? CASH qI /CHECK
,.J / L( - % k 1 . 'ri : '( _C , , 1 ..\ /"j
C 12895 ?l?-Paym copy
Yelbw--PoSWV Copy
?,:._. ? ...._..:_.... .r?-a. . . ; Pink-F lle Copy . , .,
Thank You
sv ? `
?
,
BI
To
?
. , CITY OF EAGAN fi
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 48886
. PHONE:454-8100
LDIft PERMIT Receipt #
a used for sr M/"R Est. vawe :1 S? 9004 Date APR i l ? 99I
Site Address '
Lot 1? Block
Parcel No.
w Name --'--'"T
? Addre T
CItY A
V M-JY
o Name
ik¢ Address
? Citv Phone
Address
City -
Phone
t hereby acknowlege that I have read this application and slate Ihat Ihe
information is correct and agree to comply with all applicable State ot
Building Official ? SeGSub.
Mmnesota Statutes and Cit -,01 fi,?gan Ordinances.
:?'.? i . , _.,.-,? c.'y,.-.,-..rc,,.•
Signature of Permitee
LIPSSTYL6 KiAlES
A 8uilding Permit is issued to:
on the express condilion that all work shall be done in acco,rdance with all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
OFFICE USE ONLY
R?s M-1
Occupancy FEES
zoning 836.00
(Actual) Const ? Bldg. Permit
(,viowable) -
Surcharge T8.00
,r or stories 543.00
Length Plan Review
1???
Depth SAG Ciry S.F.Tolal - 6???
SAC,MCWCC
S.F. Footprints - 660.00
On Site Sewage _ Waler Conn
95.00
on sne wen
-? Water Meler
MWCCSystem 30.?
? Acc1. Daposil
City Water 30•?
PRV Required - S/W Permit ?
.50 ?
Booster Pump - S/W Surcharge
276.OU ?
Treatment PI p
?7O•? ?
APPROVALS Road Unit
Planner - park Ded.
Council --
ies
Co 1.00
Bidg. OfL _ p 3,669.50
Variance - TOTAL
' Psrmk NO. Permil Nolder Date Tebphone k
WATER
SEWER
PLUMBING ?DZ[Q ? '?l
H.VA.C. ?dVII I , . S A
ELECTRIC ?(p `S ?
Inspection Data Insp. Comments
Fomobng5 1
Founaetion s" / 9 s
Frarrru?ns 6.? q liJ % y 9??,JB,
Roofing
Rai9h Plbg. 6
Ro,sh"tg- - d 4 ?s' 9/ ?i?•
lsn. O !/
Fveplace
Final Ht9. • Q
Final Plbg.
Cpnst. 6Aeter Plbg. Inspactor - Notity Plumbar
ErgrJPlan
Bk1g. Fnal ,, Ow.
Deck F19. k ?
Deck Final
Well
Pr. Disp.
g?;a I
RE:
DATE
APR 16m 1991
3763 LINDEN LN (LIPESTYi.E HOMES)
X ?
Kour Sewer & Water Permit for the above property has been completed. It will be held at the
Pub4?. Works Garage (3501 Coachman Road) until the lneter is picked up. BE SURE TO
?-1;AtL PUBLIC WORKS (454-5220) FOR YOUR PERMANENT WATER TURN ON.
Your Sewer & Water Permit ior the above property cannot be completed for the following
reasons:
Your Sewer & Water Permit for the above property has been completed, but the meter cannot
be issued or occupancy atlowed untii further notice.
- COMMERCIAL PROJECTS ONLY: Please pay for meter at City Hall. Meter size must be
confirmed by Bill Adams or Dirk House (Plumbing Inspectors - 454-8100) before issuance.
WARNING: BEFORE DIGGING, CALL LOCAL UTILITIES - TELEPHONE, ELECTRIC, GAS, ETC.
- REQUIRED BY LAW.
CONTACT COMMUNITY DEVELOPMENT DEPARTMENT FOR WATER TURN ON POLICY.
Secretary, Building Inspections Depi.
? INSPECTION RECORD
+ CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Mumber:
- Eagan, Minnesota 55123 Date Issued:
Control No. 0652
ftil l t01 q(i
A8A133 i
0r,)1N19a
1 (612) 681-4675
? SITE ADDRESS: t or, 19 N 1Or Kt i APPLICANT:
l.IlfCiEN t.AME tiCN?,IFIC.H CAN3T. DAVIp
F f1lE WOOCII,AIfUS 3RL1 (Gia) 447-8806
PERMIT SUBTYPE:
k;AtiPh1PNi f tNISH
TYPE OF WORK:
AITEttATIOW
• t? = a ?? t ?? ?
6
`?.Mtr?T
? ? . .. . ? .. . . ..
p ?
Mtf MARF:g: REL;EIF'T • SifPAHYI`IE REWNiTS REQUZftECI FOR Rl.EC Ei {'! ta[i
Permtt No. Permft Holder Date Telephorre 1f
S/W
PLUMBING
HVAC
ELECTRI ?
ELECTRIC
Inspection Date Imp. CommerHs
Footings I
Foundation
Freming ( 2 O/,)
ry
Roofing
Rough Pibg.
Rough Htg.
2
Isul. C
Fireplace
Flnal Htg.
Orsat Test
Final Pibg. Pibg. Inspector - Notity Plumber
Const. Meter
EngrJPlan
Bldg. Finel
Deck Ftg.
Deck Final
wau
Pr. Disp.
319?F ?? - ?
?_M=n'
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued:
(612) 681-4675
SITE ADDRESS: ' T $
? I N1?t. M ! HN{.
APPLICANT:
ra??r+ t) rrrr.;
y}.?9erf.7
04fe4/a7
PERMIT SUBTYPE: TYPE OF WORK:
INSPECTION D• . D•
1???!lr;ll i??.±
r _I ..r)
Permit No.
ELECTRIC
PLUMBING
HVAC
Inspection Dete li
FOOTINGS
FOUND
FRAMING y_ 7?y?
7
h
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING -
GAS SVC
TEST
INSUL
GYP BOAflD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
HOUSE HEATING TEST RECORD
AP T. _
OWNER
AT LOSS DATE HTG. INST.
.lLD BY INSTALLED BY /
Eleclrical Work BY Gas Line By ` TYPE OF HEAT GA FA w"' HW STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN
MAKE MAKE
....
Model "?r r .?
Model
Sxial Max. E
INPUT MAKE
Model
OF BURNER
FLOOR G TY" SUBURB
CONVERSION
STU Rating -'?
OFFURNACE
CONTROLS
THERMOSTAT 7 Heat Plug . ? Vsnt Size '-
Valve ?KIND OF LINER SIZE NONE
Limit
- % Drah Hood Regulator
Limit Seftiog ?Filters Size r Numbsr
Fan $etting -r r•, Chimney Location Insids
Pilot Type Chimney ConstrucYion
Pilot Make
Pilot Model $moke Bomb _
Pilot Timin9 Draft
L.W. CuT Off -'Dow Pressure
Prossure Percent C02
Input CFH Percent 0 2 ,/
Stack Temp. 'w?! Pereent C0
Form 235 F?--
Outside
Wiring
Test Tag
Lighting Inst `
DaTe Tested
Company Testing
Name of Tester '+ ?°-
SEWER & WATER PERMIT
CITY OF EACAN
3830 Pilot Knob Rd.
Eagan, MN 55122-1897
DATE AYI: 11, 19'^. l.
METER #
CHIP #
METER SIZE
ISSUE DATE
SITEADDRESS 376? LltduEt? Lv
LOT 1`' BLOCK ISEC/SUB THE WOOnLANDS 3Rt!
APPLICANT:
ADDRESS:
CITY, STATE 21P
PHONE:
PLUMBER:'
ADDRESS: 10 N COUNTY ROAD I
CITY, STATE S"OREVIEtiJ MN ZIp 55126
PHONE:
ZIP
Y
PERMITDATE ` '•/16/91
^"'
PERMIT # 11 921
B.P.RECEIPT# C 12395
B.P. RECEIPT DATE04 15 /92
PERMIT REQUESTED
'-SEWER x WATER -TAPS
- COMMJIND -X RESIDENTIAL
NEW - EXISTING
Lawn Sprinkler Meters are to be Installed
Ahead of Domestic Meters on Water Line.
Credit WILL NOT be given for Deduct Meters.
I AGREE TO COMPLY WITH CITY OF
EAGAN ORDINANCES
SIGNATURE WHEN METER ISSUED
PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. CALL 4545220 FOR INSPECTIONS. FOR STORM
SEWER PERMITS, CONTACT ENGINEERING DEPT. !
SEWER & WATER PERMIT
CITY OF EAGAN
3830 Pilot Knob Rd.
Eagan, MN 55122-1897
DATE %?'K 11. 1491
OFFICE USE ONLY
METER# a 7°? PERMITDATE 04/i5/91
CHIP # c a a l c 3 SE pEAMIT # 1 l 911
METER SIZE B.P. RECEIPT # C 12825
1
ISSUE DATE B.P. RECEIPT DATE -0/4 115,19
` PRV - BOOSTER PUMP
SITEADDRESS 3?6; !_'N??VN L"1
LOT 19 BLOCK 1 SEC/SUB T11E WOGDLAr7DS 3+:,:?
fiESS:
, STATE ZIP
NE:
MBER:?.`_
RESS: 101 4 Gi COUNTy ROAD I
, STATE SHCREVIEW 14+? Zip 55126
NE:
IER: LIFESTYLE AOPfES
RESS: `)87 STF:r1"."F0.'iI) RD
, STATE 4r hDaTA NEIGIiTS L•"? Zip 55050
PERMIT REQUESTED
X SEWER X WATER _ TAPS
COMM/IND
X NEW
2L RESIDENTIAL
EXISTING
Lawn Sprinkler Meters are to be Installed
Ahead of Domestic Meters on Water Line.
Credit WILL NOT be given for Deduct Meters.
, ? -- ,
- --'?? ? 1 AGREE TO COMPLY WITH CITY OF
EAGAN ORDINANOES _
SIGNATURE WHEN METER ISSUED
WO WORKING DAYS FOR PROCESSING. CALL 454-5220 FOR INSPECTIONS. FOR STORM
CONTACT ENGINEERING DEPT.
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 NA i888 Fj
' PHONE:454-8100
BUILDING PERMIT Receipt #
:
To be used for SF DWG/GAR Est. Value $156, 000 Date APR 11
Site Address 3763 LINDEN LN
Lat 19 Block 1 SeGSub.THE WOODLANDS 3R]
Parcel No.
W IName LIFESTYLE HOMES
? Address 987 STRATFORD RD
City MENDOTA HEIGHTPhone 454-7866
o Name SAME
;il-
Address
City Phone
1-
W W¢ Name
? ; Address
a W City Phone
I hereby acknowlege that I have read Ihis application and slate that the
information is correct and agree to comply with all applicable Slate ol
Minnesota Statutes and CitfYA.€agan Ordinances. _
Signature of Permitee 'l?' j,-Le-eo? '
A euilding Permit is issued to: LIFESTYLE HOMES
on the express condition that all work shail be done in accordance with all
applicable State of Minnesota Statutes and City ot Eagan Ordinances.
Building Official
OFFICE USE ONLY
Occupancy R-3 .P'?-1 FEES
Zoning R=1
(Actual) Const V-N Bldg. Permit
D
836.0
(Allowable) V=N
Surcharge
78.00
# of Stories -
Lenglh $$ ' Plan Review 543 . 00
Depih 32' SAG City i nn _ nn
S.F. Total - SAC, MCWCC 650.00
S.F. Foolprinis -
Water Conn
0
660.0
On Site Sewage _
On Site Well - Wyter Meler 95.0
0
MWCC System
Acct Deposit 30.00
Cdy Water ?
PRVRequired _ S/WPermit 30.00
8ooster Pump - S/W Surcharge .5
0
Trealmenl PI 276.00
APPHOVALS RoadUnit 370.00
Planner - pyrk Ded.
Council
Copies
1.00
BIdg.Oft. _
Variance - TOTAL 3,669.50
p 02 y9Z/9 I? 600-t? -
Request Date Fire No. Rough-in InSpection
qeQ?
i
?
? Ready Now N_A4k<otify Inspector
I ?
?
G No When Fieady?
I' ensed contractor =7 owner hereby request inspection of above electrical work at
Job Atltlres5(Street. Box Or Route No„ City
J Ll Y18 QIT., ?
Section No. 7ownship Name or No. Range No. County
-?1-- - )U" /?
OccupanlfPRINT) phone No.
L??- -18 6 6
Power SuDPlier Address
???'?_ 43b° ?'' . ?L.1 • ?t
Elecbicai Conhactor ICompany NameJ Contracior§ License No.
e=- --- 6`-6 C l
Maihng Address (Contractor or Owner Making InStallation)
Author¢e Wr ICOntr ctodOwner ~ I allation) Phone Number
--- - "1'79-9201
MINNESOTA S7ATE BOAFD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT
Griggs-Midway BIOg. - Room 5-173 BE ACCEPTED Bv THE STATE BOARD
1821 Univergiry Ave., 51. Paul. MN 55104 UNLESS PFOPER INSPEGTION FEE IS
Phone J612) 642-0800 ENCLOSED.
REQUEST FOR ELECTRICAL lNSPECTION
? See instmctions for completinq this form on back oi yellow copy.
?ngRgq "X" Below Work Covered by This Requesf
N
EB-00001-D8
?-
4?1_
ew Add Rep. TypeofBUilding AppliancesWired EquipmentWired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Other (Specify)
Comm./industrial Fumace
Farm Air Conditioner
Other(spemFy) ConfracrorSRemarks. tv ?T ?J flO'?,z ?
Compute Inspection Fee Below:
# Other Fee # Service EntranceSize Fee # Circuits/Feeders Fee
Swimming Pool 0 to 200 Amps 2.00 0 to 100 Amps 40,
Transformers Above 200 Amps 00 Amps
Signs Inspedor's Use Only, p ' TO l
Irrigation Booms
?O ??
?' g ?
Special Inspection ' -
AlarmlCommunication THIS INSTALLATION MAY 6E O R C Nf4ECTED IF NOT
Other Fee COMPLETED WITHIN 18 MO Z
I, the Electrical Inspector, hereby Rou9n-in
certify that the above inspection has
been made. F;nai oace
OFFICE USE ONLV
This request void 18 months Irom
?.? ?I-- yVs7
°10
7 6 5
Request Date ` rii2 No.
/ ` ? (dy Rough-in Inspection
Required?
? Ready Nowill Notily Inspector
N1hen Ready?
b ? es ? No
I licensed contractor p owner hereby request inspection of above electrical work at:
Job Atldress (Street, Box or Route No.? i
L..,?a?e,? ,v?
3763 City
E'4 ,?
Section No. Township Name or No. Range No. County
q
Occupant(PRINT) ?
P*u Phone No.
szsY -??
Power Suppliar / Atldres5 ?^ . /
i•• 7`dA/
Electrical Comractor tCompany Name)
111'F' ? EcT ?G Contracbr5 License No.
G'"¢ Oa S?
Mailing Atltlres5lCOnir tor or Ownec Making InStallafion) ,
Me r.,41 YeFW P.-? •?'?. F.? ,0./ A41 ss-.
Authorizetl Signature I r torlOwner Making Inslallati Phone(Numbeii"
?; L! '?? Cf- 7 - oOLZ
MINNESOTA ST0.?yB0ARO OF ELECTRICITV / THIS INSPECTION REOUEST WILL NOT
Grig9s-Mitlway d(tlg. - Room 5-173 BE ACCEPTED BY THE STATE BOARD
7821 Universily Ave.. St. Peul. MN 55104 UNLESS PROPER INSPECTION FEE IS
Phone (612) 642-0800 ENCLOSED-
(y//8'/9? REQUEST FOR ELECTRICAL INSPECTION
\ Cnn :n :I?n - Ae, 1 11 - 1- 1 Rs{ow Work Covered by This Request
?
?
/
ew Ad9 Rep. Type of Building AppliancesWired EquipmentWired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Other (Specity)
CommJlndustrial Furnace
Farm Air Conditioner
Other (specity) Contractor'S Remarks-
?'/i?
Compute Inspection Fee Below: /
# . Other Fee # Service Entrance Size Fee # Circuds/Feeders Fee
Swimming Pool 0 to 200 Amps 0 to 100 Amps
Transformers Above 200 Amps Above 100 Amps
Signs Inspecror's Use Onty: TOTAL ?
Irrigation Booms
?
Speclal Inspection
Alarm/Communication THIS INSTALLATION MAY BE ORDERED ISCONNECTED IF NOT
O[her Fee COMPLETED WITHIN 78.1MbNTHS. ?
I, the Electrical Inspector, hereby Rough-in /??,.f are 3??
certify that the above inspection has
been made. Final ( Date?
-1. ?
?
05 CI
?l
OiFICE USE ONLY ' ` . This request voitl 18 months Irom
?s; ?
Address: 3763 LINDIIV TANF. Lot 19 Blk ] Sec/Sub THE WOODLAMS 31RD
These items were/were not complete at the time of the final inspection.
' 9/6/91 Yes No ?
Final grade (6" from siding) ?
Permanent steps - garage
Permanent steps - main entry ?
Permanent driveway
Permanent gas
Sod/seeded grass 6Ay ?
Trail/curb damage ?
Porch
Basement finish ?
Deck
PLease verify with the builder the ramoval of zoof test caps from the plumbing
system and the shut-off of water supply to the outside lawn faucet before
freeze potential exists. ,?y
?%
nECniEOnxa
White - City copy Yellow - Resident copy Pink - Contractor copy
? _ - - - - - _ _ - _ _ - -- - - ?
I ?ur4- "sO I
? Pertnit #
I C I
? Permit Fee:
I I
? Date Received: ?
I ?
? Staff: I
I I
------------------
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: -l -7'09 SiteAddress: 3 763 ,,i S"5123
Tenant:
suite #:
RESIDENT! OWNER
3 ?
Name:,MA? ? 0)5;0 5 Phone: 6 5-1 -21 5-5_9
Address ! City / Zip: Sfr*%?E- AS
? C
A
li
t i
O
pp
s: _
wner
ontractor
can
TYPE OF WORK t
Description ofwork: *??rOD
o?
Construction Cost: Multi-Family Building: (Yes _/ No ?
CONTRACTOR Name: 10 &; ,, -?-, rr TjJ(- License #: 2 O26 0$ 7
Address:
City: ?? a[ cS State: M t4 Zip:S5, yZ I
Phone: ]b 3-5-61a"r b )`L1 Contact Person: ZTLv?,-1 /tr''?rj_
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Cateqorv 1 Minnesota Rules 7672
Energy Code . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
Category Submitted Submitted
(4 subrtiission type) • Energy Envelope Calculations Submitted
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:-PIans and supporting alocriments that ?you submit are cvnsid?rer/ tQ be ?rui?lic information ? ?;?or`tfons of :
the informatiQ6may°be classifietl as non-public if you providespecific ieasons fhat Hrould pe`rmrt, fhe?Cify fo.
? <<:' i ? v < <
conc/Ude thaf fhe ; are tratle secrefs. _ - ? --
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 woric 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 Fen
x ?/!?? r? x
ApplicanYs Printed Name App Kant's Signature
1 of 3
;
y
?orfNt#ce_Use
City o1 Eapn I Permit #: I Permit Fee: ? U I
3830 Pilot Knob Road '
Eagan fiAN 55122 i Date aeceived:
Phone: (651) 675-5675 I Staff: 52vYu0
Fax:(651)675-5694 i ? 1
L - ----------------?
2008 RESIDENTIAL BUILDING PERMIT APPLICATION 61&cL .?2 -9c;1"
Date: ? ^ ?s ? D Site Address: 7/VJJ L? ??"??Jt?J? lL,?-
Tenant: Suite #•
RESIDENT! OWNER Name: T ? Phone: (?i 'rJ ?? q_I l" ??
Address/City /Zip:
Applicant is: _)LOwner _ Contractor
TYPE OF WORK Description of work: SFLG T)tAm ?
?
Construction Cost Multi-Family Building: (Yes _ J No ?
CONTRACTUR Name: lLV"mrz, License #: I3(,' aa3"03 <
3.1" w/ly-_ ik P
1#' Address: t:5 ?.
h t h M
- -?`-? l
Ph?(? ?cN -
p26S`?.Allq Do City: State: Zip:
SaRJ1?. t?-zv- A5
? ` ?L ?????'??P
Phone: ?,
?7 ? "35' Lt Contact Person:
COMPLETE THIS AREA ONLY IF CONSTRUCTIPIG A NEW BUILDING
Minnesota Rules 7670 Cateporv 1 Minnesota Rules 7672
Energy Code . Resideritial Ventilation Category t Worksheet • New Energy Code Worksheet
CBtBgOfy Submitted Submitted
(4 SUbmiSS{On type) • Energy Envelope Calculations Submitted
In the last 12 monfhs, has the City of Eagan issued a permit for a simiiar plan based on 8 master plan?
_Yes _No 11 yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and supportfng docUments thaf you submit are constdered to be public lnformetfon. - Partfons af ;
the informatfon may be classiiied as non-publfc ff you provide speclfic reasons that would permif the Cfty fo
canclude that the" are trade secrets. "
I hereby acknowtedge that this information is complete and accurate; that fhe work will be in conformance with the ordinances and codes of the City of
Eagan; that i understand ihis is not a perrnit, 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 ihe case of work whkh requires a review and approval of plans. ,
X tj E. 40664; X Applicant's inted Name Applicani's ur
Page 1 of 3
` ' DO NOT WRITE BELOW THIS LINE
SUB TYPES
? Foundation ? 05-plex ? 16-plex ? Accessory Building ? Pool
71- Single Family ? 06-plex ? Fireplace El Porch (3-season) ? Ext. Alt. - Multi
? 01 of _ Plex ? 07-plex ? Garage ? Porch (4season) ? Ext. Alt. - SF
? 02-Plex ? 08-plex ? DeCk ? Porch (screen/gazebo/pergola) ? Multi Misc.
? 03-Plex ? 70-plex ? Lower Level ? Storm Damage
? 04-Plex ? 12-plex ? Miscellaneous
WORK TYPES
? New ? Interior Improvement ? Siding ? Demolish Building*
? Addition ? Move Bu ilding ? Reroof ? Demolish Interior
-? Alteration ? Fire Repair ? Windows ? Demolish Foundation
? Replacement ? Egress Window AT Water Damage
' Demolition (entire building) - give PCA handout to applicant
DESCRIPTION•
V
l
ti
t
MCES S
a
ua
on Occupancy ys
em
Plan Review Code Edition '•(? ''?7 SAC Units
(25%_ 100% Zoning City Water
Census Code L/ ?4
?7T Stories Booster Pump
# of Units Square Feet PRV
# of Buildings Length Fire Sprinklers
Type of Const.
-rp?- Width
REQUIRED INSPECTIONS
Footings (new bldg) Sheetrock
Footings (deck) Final/C. O. ?
_ Footings (addition) ? FinallNo C.O.
Foundation ? HVAC
Drain Tile Other:
Roof: _Ice & Water _Final Pool: _Footings _Air/Gas Tests _Final
? Framing Siding: _Stucco Lath _Stone Lath _Brick
Fireplace:_R.I. _A irTest _ Final Windows
X Insulation Retaining Wall
Reviewed By: Building Inspector
RESIDENTIAL FEES:
Base Fee
Surcharge
Plan Review
MCIES SAC
City SAC
Utility Connection Charge
S8W Permit & Surcharge
? Treatment Plant
? Copies
Total
?K, (IAti
? ?06,
ri -7
1 ?5j 000
Page 2 of 3
Clty of Eaian
3830 Pilot Knob Road
Eagart MN 55122
Phone:(651)675-56i5
Fax:(651) 675-5694
- -----------
j For CNEice Use j
? Pertnit
j PermitFee:
? Date Aeceived:,=)?? ?
? StaH: (!_:ee I
008 RESIDENTIAL PLUMBING PERMIT APPLICATION
Dete:
Site Address: LlJ Lw
Tenant: Suite #:
RESIDENT / OWNER Name: Phone:
Address / City/ Zip: U 4412
CONTRACTOR Name: License #:
Address:
CitY: State: Zip:
Phone: Contact Person:
TYPE OF WORK -New _ Replacement )?,,. Repair _ Rebuild _ Modify Space _ Work in R.O.W.
Descri tion of work:
PERMIT TYPE RESIDENTlAL
Water Heater ` Water Softener
_ Lawn Irrigation Add Plumbing Fixtures
L_ RPZ /_ PVB) Main _ Lower Level)
_ Septic System ? Water Turnaround
=New Cor,
Abandonment
RESIDENTIAL FEES:
$50.50 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $.50 State Surcharge)
$30.50 Lawn Irrigation (inciudes $.50 State Surcharge)
$50.50 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround" (includes $.50 State Surcharge)
'Water Turnaround (add $136.00 ii a 518" meter is required)
$100.50 Septic System New ($10.00 per as built) (includes County fee and $.50 State Surcharge)
$90.50 Fife Repair (replace bumed out appliances, ductwork, etc.) (includes $.50 State Surcharge)
TOTAL FEES $
1 hereby acknowiedge that this information is complete and accurate; ihat ihe work will be in conformance with the ordinances and codas of the City ot
Eagan; that I understarxl ihis is rrot a permit, but only an application for a permit, and work is not [o sta with ut a permi[; that ihe work will be in
accordance with the apprggved pian in the case oi work which requires a review and approval lans
x
AppUcanYs Printed Name ApplicanYs Signature
FOR OFFICE'USE. Reviewed By:
Required Inspections: ?Under Ground _Rough-ln ?Air Test iGasTest Final
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CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS:
PERMIT
PERMITTYPE: ' BulLDzNG
Permit Number. 029651
Date Issued: 04/04/97
3763 LTNDEN LANE
LOTs 19 BLOCKD 1
THE WOODLANDS 3RD
P.I,N.e 10-75878-190-01
DESCRIPTION:
REMARKS:
rHRnoM)
Type BASEMEN7 FTNISH
pe ALTERA7TON
434 flLT. RESIDENTIAL
?i
Q MV
FEE SUMMARY:
Base Fee $50.00
Surcharge $.50
Tota1 Fee $50.50
C0NTRACTOR: -- Appiicant - sT. OWNER:
;00 PE7ERS6N CONST, CARL 15886564 000 275 TENO BEN
' 1574 LAKEVIEW CUftVE 3763 LINDEN LN
ERGAN MN 55122 EAGAN MN 55129
(612) 688-6564 (612)452-6115
w? 4% '.? ?
APPLICANT/PERMITEE SIGNATURE ISSUED B: SIGNP
1997 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
(46 3830 PILOT KNOB RD - 55122
681-4675
RamodeUReoair Reauiroments
?
? 3 registered site surveys ? 2 copies of plan
• 2 copfes of Afans (indude beam 8 window saes; pnured fid. design; eta) ? 2 site surveys (exterior additions 8 dedcs)
• 1 energy calculations ? 1 energy ealwlaHons for heated addiUona
• 3 copiss of tree preservation plan if lot platted after 7/1193
required: _ Yes _ No '
DATE: 3 'o? s- 4I7 CONSTRUCTION COST:
DESCRIPTION OF WORK: -?bn? f'^'S4
STREETADDRESS: 3?(v 3 L?;,, olP„ Ly?
LOT 9 BLOCK _L SUBD./P.I.D. #: w??&A-LJJAk
PROPERTY Name: 7?n o &,01 Phone #:
OWNER L,,.. ?.
Street Address: ? -7 6 ? 1-'?°??^
City: State: Z;p: Ss?a 3
CONTRACTOR Company; Cae-? ? fersd., ?o`.,j ??? ?? s? y
?.W?>4e phone#:
Street Address: 15711 ?r?- License ??
City: State: m? Zip: ssfa?
ARCHITECT! Company: Phone #:
ENGINEER
Name: Registration
Street Address:
City: State: Zip:
Sewer & water licensed plumber (new construction only): . Penalty applies when address change
and Iot change are requested once permit is issued.
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:
OFFICE USE ONLY RECEI ED
Certificates of Survey Received _ Yes _ No MlE?1,4 " ?"497
Tree Preservation Plan Received _ Yes _ No _ Not Required BY=
- _, OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Duplex
? 02 SF Dwelling ? 07 4-plex
? 03 SF Addition o 08 8-plex
? 04 SF Porch o 09 12-plex
n 05 SF Misc. 0 10 _-plex
WORK TYPE
0 31 New A 33 Alterations
? 32 Addition ? 34 Repair
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stcrtes
Length
Depth
APPROVALS
Planning
, rt • ?-
r,
A
0 11 Apt./Lodging o 16 Basement Finish
0 12 Multi Repair/Rem. 0 17 Swim Poot
? 13 Garage/Accessory o 20 Public Facility 0 14 Fireplace ? 21 Miscellaneous
0 15 Deck
a 36 Move
0 37 Demolition
_ Basement sq. ft. MCNVS System
_ Main level sq. ft. City Water
_ sq, ft. Fire Sprinklered
_ sq. ft. PRV
_ sq. ft.
_ sq. ft. ? Booster Pump
Census Code. d'a9
_ Footprint sq. ft. SAC Code 1
Census Bldg
Census Unit ?
Buifding Engineering Variance
Permit Fee
Surcharge
Plan Review
License
MCNVS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI.
Raad Unit
Park Ded.
Trails Ded.
Other
Copies
Total:
Valuation: $
% SAC
SAC Units
?
CITY IISE ONLY
L gL RECEIPT#:
SUBD. RECEIPT DATE: _
1997 PLUMBING 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,requiredfor each wnit
? backflow p'reventer#or underground sprinkler system
FIXTURES EACH b,Q, TOTAL
Shower 3.00 x =
Water Closet 3.00 x =
Bath Tub 3.00 x =
Lavatory 3.00 x =
Kitchen Sink 3.00 x =
Laundry Tray 3.00 x =
Hot Tub/Spa 3.00 x =
Water Heater 3.00 x =
Floor Dtain 3.00 x -
Gas Piping Outlet ` minimum -1 • 3:00 x =
Rough Openings 1.50 x =
Water Softener ' for dwellings under construdion 5.00 X =
WaterSORCnEr '`for existing dwelling 20.00 X
U.G. Sprlnkl2r ' fordwelling underconst. 3.00 =
U.G. Sprinkler ' for existiog dwelling 20.00 = .
Alterations ' to existing residence
20.00
= ?
WaterTum Around 20:00 =
Private Disposal 8ystem ' oak Cty lic: 75.00
=
(new and refurbished systems)
Private Disposal Systems `Abandonmenc 20.00 =
STATE SURCHARGE .50
TOTAL 0110
I hereby adcnowledge that I have read this applicadon, state that the information is correct, and agree to comply'with all.applicable City
of Eagan ordinances. It is the applicanYs responsibiiity to notify the propertyawner that the City of Eagan assumes no liability forany
damages caused by the City during its normal operaHonal and maintenance aGivities to the faalities constructed under this pertnit within
City property/rigM-of-way/easement.
SITE ADDRESS: -1r/ 6 .1 L?;, d en L"?,•,-Q-
OWNERNAME: Z?-t.-? 7? h o
INSTALLERNAME: TELEPNONE#: a/P- (a?a-,3e3 -7
_
STREET ADDRESS: )4e- 7V ao X 770
CITY: 144C-kln .(r,JC STATE: m4/ ZIP:
Rla6&01.' Q). Q ,?
SIGNATURE OF PERMITTEE
?
1991 BUIi LDI PERM?SIT 4APLICATION
CITY OF EAGAN
e
SINGLE FAMILY DWELLINGS
MULTIPLE DiTELLINGS
? .. i
C0MaSERCIAL
2 SETS OF PLANS 2 SETS OF PLANS 2 SETS OF ARCHITECTURAL
3 REGISTERED SITE SURVEYS REGISTERED SITE SURVEYS - & STRUCTURAL PLANS
1 SET OF ENERGY CALCULATIO (CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFICATIONS
i SET OF ENERGY CALCULATIONS 1 SET OF ENERGY CALCS
# OF RENTAL UNITS
\ # OF FOR SALE UNITS
PENALTY APPLIES WHEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY LAST WORKING DAY
OF MONTH IN WHICH REQUEST IS MADE.
IAT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED.
NOTE: ADDRESSES FOR CORNER LDTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS I5
DESIRED. NO CHANGES WILL SE ALIAWED ONCE BUILDING PERMIT IS ISSUED.
PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DAYS ONCE A PERMIT HAS BEEN COMPLETED.
PERMIT MUST SHOW A LICENSED PLUMBER.
To Be Used For: Valuation: ..S 000Date
Site Address ,?763 U(n(jQn L(Q iie,
Lot L? Block ?
Parcel/Sub I?r u)n()(t lQ Vl(k i ('(J
?
Owner La ?VYI? S
Address qL31 ni?fZ°t {C?(X
City/Zip Code LIM6 f+j 4??
( I r_ ?
Phone
Contractor Sa.'(n,Q
Address
City/Zip Code
Phone
Arch. /Engr . Ll ?. akj? `c,. lV??meS
i
Address
City/Zip Code
y-s-°II
OFFICE USE ONLY
FEES
Occupancy Bldg. Permit 836.017
Zoning k' -! Surcharge 78-oU
Actual Const V-N Plan Review S'?3.c70
Allowable Y?N SAC, City ? p(?, UO
# of stories SAC, MWCC 100
Length 9 Water Conn. b o,DO
Depth Water Meter 55,00
S.F. Total Acct, Deposit 3t7.t70
Footprint S.F. S/w Permit O 0
S/W Surcharge , O
On site sewage_ Treatment Pl .a1l ,0
On site well Road Unit 3rjp,p0
MWCC System Park Ded.
City water ? Trail Ded.
PRV Copies l,Oo
Sooster Pwnp _
APPROVALS
Planner
Council
Bldg. Off. Q =g/
Variance
SUBTOTAL
Penalty
Iat Change
TOTAL
Phone #
q Q'e 4?ernf?
-P??7 agrees that all work shall be done in accordance with
(Signature of Contractor) rz!S,
all applicable State of Minnesota Statutes and City of Eagan Ordinances.
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50 IkSSEMBLIES !?S REqUIREO SO L?NE 43 DDES IYOT
..... ......... ........_ ..... ..._....._.._......_....... ....... .....__.._.___........._......... .......... .
51 EXCE.......E....U ... LiME 46_ lF LIHE 43 IS LESS THAP............ _............II.IPIE
.... .................. _...................................................... .... ........
52 46. PROPOSED ?ISSEMBLlES MEET CODE
......... ................. ................ ............ ..... _......._........................... _............. _..__._............
53 REQUIREMEtITS_
_ ..................___.._...... .....---,_.__._.__.___.._...._____.______._?.._.....___...
sa lllll.ll]]]ll))]]lllll]1111111J111111111]]7)l])1l1]_
55 FIGURE 1
............. ........
__._.....____......____.._.._.._._..__._.____.__
56 INTERlOR A!R FILM
.............._......._........._............._..._.._..._._._._...__._..___.._._....__....w.,...__.......__.........
57 INSUL ?T IUN
58 CONTINUnUS VApOR BARRIER-._._..._.._.-__.____..._._._.__.?__..
..._.....__............_..___...___._.____..._..____.._?__..___.___._._.__.___.__
59 INTERIOR FINISH
.............._.......__............-•------._...._......._._........__......_._..._.__._........_._...___-__....
60 .............._....... INTER{OR ... ...?L.I............._..R FILlW
..... ........................ ._......_..__....__......__.._....___.... _.
61 TQTaL A;SEMBL . ...Y _ ... R-UaLUE
.................._...._......._.......__.............__.Y._......_._.__...____......._---......_.__.
62 aS5Eh1BLY U-V ALUE (1 iR)
...._......_...._...._..._..__._...__....__......__
63
......_........_. ................ _.____.__....__.___...._...._......._......._..... __.._.._................ _.... _.
64 CIG.IR00F INSULkTED AREA:(lv'I................ H.ATTIC.,aRE?I)_,.,_..._
............. _............. ._.. ........................ __...... _...... _ _....._............--
65 1111]1)]1111]lIl]1]lllll111111,111]]]1I11]]]11]]]1 M..... ___?
66 .. F...16......U...R.E 2
.
........_..__.___...._____...___...._..._....._.._?.____..__.__.__._.
67 ?PITERI...
.GR AIR FILM
........................._......_._....... ..._......._..._..._.._.__.._....._........_.._._..._...._...........__._..
6s ir?u?a.rior?
................................._._..._......__..._._..._.._.__._................._...__...__.__.........____......
69 1,1JOQD MEMBER
70 INTER1uR FIWISN
................._._.__._............__--_•--..._..._.___......__..___._.__......_._..?......_.__.
71 INTERIUR aIR FILM
................ . . ........ .................. ...............
.
. .. .
72 TuTAL ASSEMEIti' R-UALUE
............ ... . ................... . ......... __. . . ...... ......_..._. ._..__........................._.....
. .
73 K...?;?EN1BLY la-UqLUE (1.?R)
.................................. .. ............................................................. .......... __.__ ............. _.....
_..
? 74
].?1?1111.11.11]]ll]]l,lJl.l.l)11l]],1,111111_1lJl]?llll)11.._. _.___. __. _
.. ... ...
? ?? C}SUI?iTED k(?EA:(15?ITFl ATTIC AREA)
............................... .. ............... ................ ............ _..._.......................... ................. _._...........
?6 .1.11J.j]]].17.111.11;111,11)]llll.l.lllJ]]111111.311111)lll......._......_.._ ..............
?7 F'IGURE 3
.................................. _............ ___...___.......__._..._._._____.__.___.__.._._..___...._
78 iNTERIIiR KIR FILNI
..................................3o .
.
.
LbNT,I,N-Uo,UF9 JTERiCIk FIMISH
. RRt.
S. VAPOR..BiL.
.ER _ ..... ........
........
_ ............................................... ........ ...... _......... ..,........ ........,.......... ......... ...........................
31 IN?'.ULaT IQP!
..... _._ ................. ................ _................_...___...__..?......_. _......
._..._.._.
82 SNEATHih1G
. ............._....._...._...............__..____.__...__.._.._._.___..._....._._.._--___........_.._._
33 E;?TER1iDR FINISH
........ .. ......... ..............................................__....................._._..........._.........._._....._........._.
84 E%7ERIUR_AiR FiLM
. . ..
a5 ..........lV ..... R...-......».-.-..VALL?E.... ................................................?....«..................
Tf?T?,L u'?SEtHE'.
................................._......_..........................._..._........_..__..._....__......__........----..
86 a55EM11RLY U-4'ALUE (11R)
....................................... _............................... .._---- .._.._............. _____...___.............._.....
s7 ,l.liJl.l]].1.1.111I,Illl.l.llllll]].1.ll.lllllll.lll.l]ll.l]]]]] ...................................
88 E"oOSE'D 1?fkLL I(V£UTATED APE?1 ?
.................. ... ............ ....... .................... ..................... .............. _............................. _................
.
a4 1_]I].1.11111.11]]ll] ]l.lllllll ll,l] ]]]ll)] l.? 11711]] lll ]_.___.._..._.....::.___.
?0 0 F IGURE 4 .
0.61
...................
44.012
?._• ?].00
? 0.56
.................
0.61
45.70
o:oz
.... _ ................
11J111)111,
1002.00
0 ?.1: ] 1]llll]],lI l lll
? l)]1]]l: ]_)1I.1111_
.5?:1111]]11711:11]]]lJ]]ll:lllll]]1
0.61
? 2[?6; ] 11111.
......;. . .............
° a.? ?:llllll:
......q .........................................
' 22.??? l lllll:
___:___. _. . .......? ..............
:?............. .............. ................
: 4736.0O:SU.FT
......• _4?86.25`StJ.fT
,....
P.yge 2
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?. ?
uEArLoC;s caLcG.
(
(
(
(
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l
(
l
(
t
l
A B C D E
136 ? 28.00 ? 2.14:
GCP3642
__...___.:.-__............._._.__.___..._._....-
. 0.47:
- --------- _---- 13.05
.... ......
137 ......_..._..---_._.__. _._...__._.._. _.
........_.___._....
Di:3624 _____._....
.
: _SO,00 . ;__..._._2_1'?:..?__a_47: _ 57_28
138 ............... . .._................ -.......... ...... ...._......____...___.... _...... ----
DC3224 ••------___...._.._--•--.....
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1 `4:
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?
:
:
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6_824
139 I ._
.•.._...
.
...._..__..
.
.
._..
....
.
.. ......................-•---...._._...._._._..-----............-----.......__......._...._.__..__.___.....___. _.__.•.
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_..... -•-...._..._._.
_.___....._..._._.--__.._.?_
.
........... _......
6.524
..._..__.
140 .............................._._...._....__..._....__............______..._............__
CCAtii3 _
.
_.__._..
: 1$.00 ? 2.14€ U.47: 8.388
.
_..
_
141 ..
........ """......"'._?_?__..__......_...?.....__.."'...._.._._. ??_.
ac2024 ........?.....__._...,......__a...._ ._._._...?__?_._..........a..__?__'....?._
: .oo ? 2.00: 0.501
_........_...._........_..:........._.................._._...............
.... _....
.
_
4.5
......._.......
142 .. _. . ..... _. _.. __.
.. .. .... . . .. .............._....._....................... _..._.._.._..._......__
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............ _
. ; 2.14:
....... _...............,_ 0.47;
_w....._._..:... a
...
.............
143 ...
........................... ..... --------_................... .............. ..._........... _.... ............. ................ <_.....
394.75
SQFT
:-
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?1111]1l1]I1;_ TOTAL U.s._ _181:1
144 .
_
_
.. ............. ;.l.l]]]lll]ll:llllll.ll)]l;l,]]I11,11]]l?)lllllll..
145
.. AREA R VkLUE UxA
....................... .__.._ ...................
146 ....... ................................____...._.....__ ... ___._ .
3-0 x6-$ EN7RAPJCE 1.00
-----........_.._ ,
€ 37.00€
..._............. .... ,... 14.O0:
____...... .......... 2.643
.................
147 _
. .... ... . .. ... .. . . . .. .. . . ....._..._........._..._..____..........
2-8 ti6-SSERY!CE .____..___.._._._.............. .._
1.00 ? 19.00 : 14.00: 1.256
148 ...... .................................................................«._....._.............._.?.?.....
2-9 x6,-9 SERIiICE ........._.................?..... .. .?.....?..................:..«.???.«........._M...?......_........ ?..»...«..........
0.00 ? 0.010: 14.00: ?l
:
149 .
................. __......... ........__..___.__._....______..____..._.._.____......_.__........._.______...._. . ...........
:TUTaL kk 55.00: TOTaL U: 3.923
.a.
r..
r'_a?3e v
PERMIT
Y CIT* OFNEAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
SITE ADDRESS:
DESCRIPTION:
PEFiMIT TYPE:
Permit Number:
Date Issued:
,
BASEMENT FINISH
ALTERATION
,?:?
,.? ?
e?r g i? 4 -??.. ta 5
.?
01 V
suxLoxNe
000831
86/18/92
REMARKS:
RECEIPT # C O */IT SEPARATE PERPlTTS REQUIREO FOR ELEC & PL86
FEE SUMMARY:
8ase Fee $85.00 COPY 5.50
Suraharge $.50 Total Fee $36.00
5ubtotal $35.50
CONTRACTOR: - Applicant - ST. L CpN/NER:
SGHWEICH GQNST, DAVID 14478808 0003607 RIZZO PAUL
17160 HAMILTON DR 3763 LINDEN LANE
LAKEVILLE Mid 55044 EAGaro PIN
(612) 447-8606 (612)454-8297
?
_ T ttereby acien
information i:
StsCittes and
SIGNATURE
3763 LINDEN LANE
LOT: 19 BLOCK: 1
THE W40DlANDS 3RD
Control No. OvG 52
INSPECTION RECORD Control No. 0 6 C L
CITY OF EAGAN PERMIT TYPE: BuxLoiNG
3830 Pilot Knob Road Permit Number: 000831
Eagan, Minnesota 55123 Date Issued: 06 / 18 / 92
(612) 681-4675
SITEADDRESS: LOT: 19
3763 LINDEN LANE
THE WOODLANDS 3RD
PERMIT SUBTYPE:
BASEMENT FINISH
sLocK: 1 APPLICANT:
SCHWEICH CONST, DAVID
(612) 447-8808
TYPE OF WORK:
ALTERATIOIV
?
't `• ` .. ? ! i'? N t "f ! i; i'I I
?
.?
r.?} i ? ?? I ?•1:?
.._,..REMARKS: RECEIPT # SEPARATE PERMITS REQUIRED FOR EIEC .&_.PL66.,.::
PERMIT #
REACTIVAT? t
CITY OF EAGAN y¢ 0-6
1992 BUILDING PERMIT APPLICATION ,? ?eIZ
681-4675 ,? 1? ?t i v RECo
SINGLE & MULT1-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, l 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 Valuation of work -
Site Address: 37 ? 3 04
STREET SU1TE f
Tenant Name: (commercial only) MI? ? ?
T? BLOCK SUBD.? ?,?Jnir-ly?v -3 ? P.I.D. # .
Descri tion of work: &A6?-Me""T FtNi54-(
The applicant is: ? Owner O Contractar D Other (Describe)
Name vL Phone
Property LAST fIRST
Owner Address ?,2:2 LirJ??=? L?
? "57?ET STE #
City St
!'y
goggE
t
2 Zi
y
a
e
p -
Company _dAv1 e S'c,dl vJ?l(,?1 Gor?3 T Phone
Contractor Address l7l&O• ?jtLfi') it) License #0od3La, Exp. .33 53
c;ty Z4 ,?C'rj > c.c.F state /? 6 p 49?'-s"6
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,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:
? ?
oaw=
OFFICE USE ONi.Y
BUILDING PERMIT TYPE
? 01 Foundation O 06 Duplex 0 11 Apt./Lodging
? 02 SF Dwg. ? 07 4-Plex O 12 Multi. Misc.
? 03 5F Addition ? 08 8-Plex ? 13 Garage/Accessory
O 04 SF Porch ? 09 12-Plex ? 14 Fireplace
? 05 Sf Misc. ? 10 Multi. Add'1. ? 15 Deck
WORK TYPE
31 New
? 32 Addition
? `33 Alterations
? 34 Repair
GENERAL INFORMATIDN
? 35 Tenant Finish
? 36 Move
Const. (Actual) Basement sq. ft.
(Allowable) lst F1. sq. ft.
UBC Occupancy 2nd F1. sq. ft.
Zoning Sq. Ft. total
# of Stories Footprin t Sq. ft.
Length On-site well
,
Depth On-site sewage
APPROVALS -
Planning ? Building
Engineering Yariance
REGIUIRED INSPECTIONS
0 Site ? footing PFraming
? Wallboard Final ? Uraintile
R-
O Insulation
? Fireplace
Permi t Fee 3.5"1U o v,t,at;«,: g
Surcharge
Plan Review
License
MWCC SAC
City SAC
Water Conn.
Water Meter ,
SAC Units r.
Acct. Deposit
5/W Permit --
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total:
SAC %
P?16 Basement Finish
0 17 Swim Pool
? 18 Comm.JInd.
? 19 Comm./Ind. Misc.
? 20 Public Facility
a 21 Miscellaneous
? 37 Demolish
MWCC 5ystem
City Water
PRV Required
Booster Pump
Fire Sprinkler
Census Code
SAC Code
Assessments
Q CITY USE ONLY
L I/ BL RECEIPT T7
SUBD. ,1f (K2 Lt)4?y" RECEIPT DATE: /?1 7
1997 PLUM$INfi P£RMIT (RESID£NTIAL)
crrY oF EaeAx
sgso PI.or xxos Rn
EAsAr?, Mx ssi$$
(61E)6$1-4675
Please complete for: ? single family dweliings
? townhomes and condos when permits are required for each unit
D backflaw preventer for underground sprinkler system
FIXTURES EACH # TOTAL
Shower 3.00 x =
Water Closet 3.00 x =
Bath Tub 3.00 x =
Lavatory 3.00 x =
Kitchen Sink 3.00 x =
Laundry Tray 3.00 x =
Hot Tub/Spa 3.00 x =
Water Heater 3.00 x =
Floor Drain 3.00 x =
Gas Piping Outlet * minimum -1 3.00 x =
Rough Openings 1.50 x =
Water Softener ' for dwellings under construction 5.00 X =
Water Softener ' for existing dwelling 20.00 x =
U rinkler
elling under const 3.00 '
a
U.G. Sprinkler atina dw ellina
?for 20.00 = ?
?kefatlOnS ' to existing residence
20.00
=
Water Tum Around 20.00 =
Private Disposal System " Dak Cty lic. 75.00 =
(new and refurbished systems)
Private Disposal Systems "abandonmenc 20.00 =
STATE SURCHARGE .50
TOTAL ? •?S^?
•-------------------------------------------------------------------------- ------------------------------------------------------
I hereby acknowledge that t have read this application, state that the infortnation is corred, and agree to compy with all applicable City of Eagen ordinances.
tt is the applicant's responsibility to notify the property owner that the City of Eagan essumes no liability for any damages caused by the City during its
nortnal operational and maintenance activities to the faalities construded under this pertnit Mrithin City property/right-of-way/easement.
SITE ADDRESS: (0, rj C) e-+^j ? „Z>W0?P
OWNER NAME:
INSTALLER NAME: M? ?? L oc?,Sllg o&. ) ?(,AjA-,? TELEPHONE #:
STREET ADDRESS:
cin: ?,.n ?rs ??c
/'vo
STATE:
'7,/4-/ /,0vV SIGNATURE OF PERMITTEE
CD/FORMS/PLBG PERMIT (RESIDENTIAL) 1997 ? J?
??/
ZIP: 4 ei; Sy2 Co
CITY OF EAGAN
3830 PILOT KNOB ROAD
EAGAN, MN 55122
PHONE: (612) 454-8100
:???:???
a:<:?::<::::.:.....,..................... ....
FOR CITY USE ONLY
PERMIT # ?&;
RECEIPT # I 7
DATE: . 1;? -3- ?J
> PLEASE COMPLETE UPPER PORTION
It??;???: ONLY FOR SINGLE FAMILY DWELLFNGS &
.:... ?:,.:<.. K<
.:.?,,.:. .... _
TOWNHOMES/CONDOS WHEN PERMITS ARE
REQUIRED FOR
EACH UNIT.
=
--
----
------------------------ --------------------
WORK DESCRIPTION ---------- ----
--------------
COMPLETE THE FOLLOWING: --
N0. FIXTURES EA. TOTAL
NEW CONST ADD-ON MINIMUM 15.00
ADD ON ? SHOWER 3.00 3.0 0
REPAIR k WATER CLOSET 3.00 G?d
A BATH TUB 3.00
LAVATORY 3.00 0,00
OWNER NAME: KITCHEN SINK 3.00 ??Pf
LAUNDRY TRAY 3.00 3.o0
SITE ADDRESS: 37(? HOT T[TB/SPA 3.00
WATER HEATER 3.00 3"?'
LOT:? BLOCK I SUSD. FLOOR DRAIN 3.00 g•DG'
GAS PIPING OUT.
INSTALLER: (MINIMiTM - 1) 3.00
? ROUGH OPENINGS 1.50 ySW
ADDRESS: lGl?4 OTHER
R
S`?ro
ZIP:
CITY: PRIVATE DISPE 15.00
U.G. SP$INKLER 3.00
,Lp !
PHONE
?/,
J
So
SUBTOTAL S R
.
? ST. SURCHARGE .50
SIG ATURE OF ERMITTEE ?
TOTAL:
?OMMER?TIAL??7DUSTRIAL, PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS AND
..,..:<.. ,.,,.,. ».,... ......,
MULTI-FAMILY BUILDINGS WHEN
SEPARATE PERMITS ARE NOT REQUIRED FOR EACH
DWELLING UNIT.
------
---?__
-_____
-------------------------------------___-__-
CONTRACT PRICE: --------__ __-____--
FEES
OWNER NAME:
SITE ADDRESS:
LOT: BLOCK SUBD.
INSTALLER:
ADDRESS:
CITY: ZIP:
PHONE
1$ 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)
FOR:
CITY OF EAGAN
CITY OF EAGAN
3830 PILOT KNOB ROAD
EAGAN, MN 55122
PHONE: (612) 454-8100
DWELLINGS &
,
am PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY
TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH ONIT.
------------------- ------------------------------------------
WORK DESCRIPTION FEES
NEW CONST
ADD ON
REPAIR
OWNER NAME: L/
SITE ADDRESS : 3) C' LOT:,L9 BLOCK SUBD.
INSTALLER: ' ?'? . ?
ADDRESS: AND AIR CON TIONING
cITY: MINNEAPOLI?IVN 55432
PHONE #: Z?v Z_4?2
ADD-ON MINIMUM $15.00
HVAC 0-100 M BTU 24.00
ADDITIONAL 50 M BTU 6.00
GAS OUTLETS - MINIMUM 3.00
OF 1 PER PERMIT
t'>
SUBTOTAL: $,.2ZG
STATE SURCHARGE: .50
rJ ?/
`3 ? TOTAL: S_,i1?`S7
?
S GNATURE OF P TTEE
FOR CITY USE ONLY
PERMIT #
RECEIPT #
DATE :
??. m4gfiC... ?PLEASE COMPLETE THIS PORTZON FOR ALL COMMERCTAL/INDUSTRIAL BUILDINGS,
::...
APARTMENT BUILDINGS, AND MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE
NOT REQUIRED FOR EACH DWELLING UNIT.
------_____------------------____----________--_______----_-___--_-_____-_--____-
CONTRACT PRICE:
OWNER NAME:
SITE ADDRESS:
LOT: BLOCK SUBD.
INSTALLER:
ADDRESS:
CITY: ZIP:
PHONE #:
FOR:
FEES
1% OF CONTRACT FEE.
STATE SURCHARGE _ $.50 FOR
EACH $1,000 OF PERMIT FEE.
PRQ{)F$SF.[1 Pip?NG = $25.00
$25.00 MINIMUM FEE.
CONTRACT PRICE x 1$
STATE SURCHARGE
TOTAL:
$
(SIGNATURE)
CITY OF EAGAN
, FlPR-64-191 THJ 11:95 ID:JAMES R NILL INC
SURVEY4R'S CERTIFICATE
LO, T
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TOP O M
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ig9y
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` DENOTES PRQPOSED SURFACE DRAINAQE
O DENO'TES IpON MONUMENT 5ET
• DFtVOTES IRON MONUMENT FOUND
x000•0 aC'NOTES FJ(ISTINO ELEVAl10N
(000.0) DENOTES pRpppSED ELEVATION
?
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23
NOTE: BUl.DN0 OIMIMipN3 3H qqg Rq ?
LOCATMI, A1101IT?Cf!lAt. pllJif FOR lV1LpMq? F"M1'!QJ
DIMENSIONS.
SCALE: 1 INCH - 3p pEET
PROPOSED f3ARAOE FLOOR - 9o6,1 FEET
PROPOSED LOWEST FLOOR - $4L.3 pEET
PROPOSED TOP OF BLOCK - qe I. ) FEET TIFY
LIFE
ST-YLE
THAT THIS 15 A TRUE AND CORRECT
HCMES R"ESEEN?TA( pN QF A SURVEY pF THE BOUNDARIES OF-
Lot 19, Blodt I, THE WOODLANDS THIRD ADDtT10N, oocording to the recorded
plo t f heteoi, Oakofa County, M1 nnewfa
IT DQES NOT PUpppqT TO SHOW IMPROVEMENTS OR ENCROACHMENTS, EXCEPT AS SHOWN. AS
SURVEyEp gY Iu1E pq UNpEq MY DIRECT SUPERVISION THI.S 3Rp . nav OF nPRi L . ,?
. ?09l.
NOTg: MO ?m go" ??aK ?. R. HILL, INC.
_._. ,.. ,.,, ?
LO'f 7'1??
?K i?llC?ibU 89 PROF'0? B • ?
T??[ lu?rcrcn.
??????'?Y ? JOHN C. LAR50N, LqND SURVEYOR
MlNNESOTA LICENSE NUMBER 19828
James R. Hill, inc.
PLANNERS / ENGINEERS ! SURVEYORS
2.ri00 W. CTY. RD. 42 *BURN3VILlE, MN. 55337 • 812-890.8044
TEL N0:612 890-6244 0232 P01
3Q6 -2
LIFE STYLE HOMES
Lki I %c
0)
?
PERMIT
City of Eagan Permit Type: Mechanical
3830 Pilot Knob Rd Permit Number: EA083253
Eagan, MN 55122 . Date Issued: 05/28/2008
(651) 675-5675~~~ EPermit Category: ePermit
www.ci.eagan.mn.us lflflUl tflflLLL
Site Address: 3763 Linden Lane
Lot: 19 Block: 1 Addition: The Woodlands 3rd
PID 10-75878-190-01
Use
Description:
Sub Type: e - Furnace
Work Type: New
Description: Furnace
Comments: Quesetions regarding electrical permit requirements should be directed to Mark Anderson, State Electrical Inspector,
952-445-2840
bob boldt
4310 trenton it
Fee Summary: ME - Permit Fee (Replacements) $50.00 0801.4088
Surcharge-Fixed $0.50 9001.2195
Total: $50.50
Contractor: -Applicant - Owner:
Boldt, Bob Matthew Hobbs
4310 Trenton Tr 3763 Linden Lane
Eagan MN 55123 Eagan MN 55123
(651) 454-7760
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.
Applicant/Permitee: Signature Issued By: Signature
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.AGAN
For Office Use
ch II
�`�°
}, Permit#: i'50 /
Permit Fee: "/ ��" 7� `
.
Date Received:-� —1 d�/
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 RECIEVF ., T
(651)675-5675 I TDD: (651)454-8535 I FAX:(651)675-5694 Staff:
buildinginspections cr cityofeagan.com '
MAY 1 1 ?018
2018 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: 3 7 4 "3 l—//]ci 7.'v L�S"/ Unit#:
` �, Name: i✓t, 'T7- fri , t?-,J Phone: V: / Gf 9 Y Yg 5
{ Woe!` Address/City/Zip: 12 3 c.-•„-74,)/4/- 1---,4/4, i „� ' r Ai ,j f7 2 9
�`���,, ` ' Applicant is: Owner / Contractor i?--
TypeotWori
Description of work: X eMl o,-e / I')t ,,i G 4 f T/ // -2_I c_4 J 6,ii, /'/411
Construction Cost: 3 I 1 '0 , lid Multi-Family Building: (Yes /No )
e����� j .Company: / /1i ':ri, 1 LA2 4 4,),•9,,,/ Contact: 17/77 4,,'0(
o' ,a1,,� Address: J /et) c,✓ / 61 '/ City: ,/''V a hie/e
��`� ;� State:�AL Zip:�JI1 f 2 t" Phone:L°/Z Cf 0 27 Z/mail: '7Le.'t.?L/' Lf(2i(114-17711 ie,1 ,, Ce,,,,
�� '. License#:j (r 7 7 i ��7 Z Lead Certificate#: /t'4 � c O'i 8 i'
If the project is exempt from lead certification, please explain why:
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:
Fire Suppression Contractor: Phone:
NOTE Plans'and**ming(# uments t4 you submit are considered to a public inf rmation. ons of*in ` 'ion maybe' W
classified ast,,o -•:X if „" •e = ±otic...,reasons that , "'ul t theCW ,,; tude that the are tiii4seeretilak
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's
website at www.cityofeagan.com/subscribe.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage. Call 48 hours before you
intend to dig to receive locates of underground utilities. www.gopherstateonecall.orq
I hereby acknowledge that this information is complete and accurate;that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approv- : - .
x 7 /'riO t<n>, C.,,, c 04._ x _ ,.,. -__ars-.....111.11111111•--.
Applicant's Printed Name ' s,•" nt's Signature
7 ZI/4dc- 67. /....„„..-- ,�
DO NOT WRITE BELOW THIS LINE
'.SUB TYPES
Foundation _ Fireplace = Porch(3-Season) _ Exterior Alteration(Single Family)
Single Family _ Garage _ Porch(4-Season) _ Exterior Alteration(Multi)
_ Multi _ Deck _ Porch(Screen/Gazebo/Pergola) _ Miscellaneous
01 of_Plex Lower Level Pool Accessory Building
WORK TYPES
_ New _ Interior Improvement _ Siding _ Demolish Building*
`.* Addition _ Move Building _ Reroof _ Demolish Interior
"�` Alteration Fire Repair Windows Demolish Foundation
Replace _ Repair Egress Window Water Damage
Retaining Wall *Demolition of entire building-give PCA handout to applicant
DESCRIPTION
Valuation P! 040 Occupancy 202„6 '/ MCES System
Plan Review / Code Edition 14 If' SAC Units
(25%_100% Zoning A- City Water
Census Code 4 3 Y Stories / Booster Pump
#of Units / Square Feet D 1 PRV '--
#of Buildings / Length /,Z„ Fire Suppression Required
Type of Construction Width Aa
REQUIRED INSPECTIONS
Footings(New Building) Meter Size:
Footings(Deck) Final/C.O. Required
Footings (Addition) Final/No C.O. Required
Foundation Foundation Before Backfill HVAC_Gas Service Test Gas Line Air Test
54.- Roof: Ice 8yWater 4LFinal Pool:_Footings Air/Gas Tests _Final
vy Framing 30 Minutes 1 Hour Drain Tile
Fireplace: Rough In Air Test _Final Siding:_Stucco Lath _Stone Lath _Brick_EFIS
Insulation Windows
Sheathing Retaining Wall:_Footings_Backfill_Final
Sheetrock Radon Control
Fire Walls Fire Suppression:_Rough In_Final
Braced Walls Erosion Control
Shower Pan Other:
Reviewed By: , Building Inspector
RESIDENTIAL FEES V /` ,,{, I d G 0
Base Fee :Lev 3 SZ/14.94.1g Y V A
Surcharge /� �..t / G se rd.Plan Review / ‘.Z /1 3. lk 1O't&I /J
MCES SAC
City SAC / 3 7'yv .441,
Utility Connection Charge
S&W Permit&Surcharge
Treatment Plant
Copies 106- ly
TOTAL
Page 2 of 3
�� 9y APR-04-'91 TMJ 11:56 tD:JAMES R HILA INC TEL NO:612 090-6244 14232 P01 L� •7�
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DENOTES PROPOSED SURFACE DRAINAGE Dtl►eEN3glw1•AscHnscruAtKANE Fat ��� s T1prl
/ 116,0131
O DENOTES IRON MONUMENT SET
• DENOTES IRQN MONUMENT FOUND �Y�filNCh1 " � FEET
XOOp.D DENOTEEXISTING ELEVATION PROPOSED
GARAGE FLOOR — 9'00./ FEET
(U00.4) DENOTES PROPOSED ELEVATION LOWEST FLOOR -- $9L.3 FEET
PROPOSED TOP OF BLOCK— 9014 FEET
WE HEREBY CERTIFY TO LIFE STYLE HOMES
REPRESENTATION OF A SURVEY OF THE BOUNDARIES OF THAT THIS IS A TRUE AND CORRECT
Lot 19, Block II, THE WOODLANDS THIRD ADDITION, oocording to the recorded
plot thereof, Dakota County , Minnesota.
IT DOES NOT PURPORT TO SHOW IMPROVEMENTS OR ENCROACHMENTS, EXCEPT AS SHOWN. AS
' SURVEYED BY Pa OR UNDER MY DIRECT.SUPERVISION TI-11S 3R.1') . RAY
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PERMIT
City of Eagan Permit Type:Building
Permit Number:EA169759
Date Issued:06/08/2021
Permit Category:ePermit
Site Address: 3763 Linden Lane
Lot:19 Block: 1 Addition: The Woodlands 3rd
PID:10-75878-01-190
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. We encourage you to retain an electronic copy of
photos until the project passes a final inspection.
If water damage is encountered, please call (651) 675-5675 to schedule a site visit to verify the extent of the damage. Any
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 -
Matthew & Sarah Hobbs
3763 Linden Ln
Eagan MN 55123
(651) 295-5838
Walker Roofing Company
2270 Capp Rd
St Paul MN 55114
(651) 251-0910
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA174689
Date Issued:02/14/2022
Permit Category:ePermit
Site Address: 3763 Linden Lane
Lot:19 Block: 1 Addition: The Woodlands 3rd
PID:10-75878-01-190
Use:
Description:
Sub Type:Water Softener
Work Type:Replace
Description:
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Matthew & Sarah Hobbs
3763 Linden Ln
Eagan MN 55123
(651) 247-3424
Milbert Company (culligan)
1801 50th St E
Inver Grove Heights MN 55077
(651) 451-2241
Applicant/Permitee: Signature Issued By: Signature