1090 Hummingbird LaneCity otEapn
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
RECEIVED
APR 21 �n�4
Use BLUE or BLACK Ink
For Office Use
Permit #:
Permit Fee:
Date Received:
Staff:
(al
4i,D+1,y'
2014 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: '`4 Site Address:'
Tenant: .GLJ r
Suite #
•
1
J
v+ Sri
eel ent/Ow ne Name: 4 _ . , t 4. ',
Address / Cit / Z'
y p:,
'
Phone: r, i
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itIP
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t { , Y"
SIL '; i. .ice..
Ali
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"�����' Milbert Company Inc dba C gn Water f
Name: ucense #: WC643176
Address: 1801 50th Street East City: Inver Grove Hgts.
State: MN Zip: 55077 Phone: 651-451-2241
Contact: William R Milbert Email:
Type • O — New Replacement Repair Rebuild Modify Space Work
in R.O.W.
OF _ _ _ _
4.�� Description o work:
RESIDENTIAL
t ,
Water Heater
Water Softener
Level)
Lawn Irrigation (_ RPZ / PVB)
Add Plumbing Fixtures ( Main /
_
It p_
Septic System
_Lower
Water Turnaround
_New
ti 4 Abandonment
RESIDENTIAL FEES:
$60.00 Water Heater, Water Softener, or Water Heater and Softener
(includes $5.00 State Surcharge)
Turnaround* (includes $5.00 State Surcharge)
and $5.00 State Surcharge)
TOTAL FEES $ –"--
$60.00 Lawn Irrigation (includes $5.00 minimum State Surcharge)
$60.00 Add Plumbing Fixtures, Septic System Abandonment, Water
'Water Turnaround (add $200.00 if a 5/8" meter is required)
$115.00 Septic System New ($10.00 per as built) (includes County fee
CALL BEFORE .YOU DIG. Call Gopher State One CaII 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.ora
I hereby acknowledge that this informa:ion 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 wit ` the approved plan in the case of work which requires a review and approval of plans.
xwl(An,i�Af2/'
k--
Applicantsrinted Nam
e
x
Applicant's " ignature
CITY OF EAGAN Remarks
Addition Lexington Place South Lot 14 81k 2 Parcel 10 45060 140 02
Owner Street 1090 Htimmi najy,?d Lane State Eag an, MN
Improvement Date Amount Annual Years Payment Receipt Date
STREET SUR F.
STREET RESTOR.
GRADING
c+rt !' •?ifif d i
SAN SEW TRUNK 1985 247.64 16.51 15
SEWER IATERAL 101 1986 163 1. 0 3 2 b . 2 0 S •J
Services 101 1986 729.39 ' 145.87 5
WATERMAIN 1985 65.81 13.16 5 ?
WATER LATERAL 10151 1986 8 7 3.43 1"7 4. 6 8 5 ?
WATERAREA 1014 1986 243.73 48.74 5
WAT LAT BEN 101 1986 111.98 .22.39 5
STORMSEWTRK lOln 1986 426.54 85,.30 5
STQRM SEW LAT 101 1986 8 0 3.34 ,1 b 0. 66 5
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER. ?
SAC
PAR K
' •' CITY OF EAGAN 11642
3830 Pilot Knob Road
P.O. Box 21-199
MN 55121 ? y•-
Eagan
?-- ,
,
,
. PHONE: 454-8100
BUILDING PERMIT 1'
Receipt #
To be used tor Sr'• DWG/GAR Est. Value $93 ,UOU Date MARCH 17 , 1g t16
` Site Address 1090 HUM2?:INGSIRD LN
Erect ? k3
Occupancy
Lot 14 Block 2 Sec/Sub. LEXILJGTON PL SfRemodel ? Zoning R1
? Parcel No Aepair ? Type of Const ;;
. Addition ? No. Stories
¢ Name
OFtT'c IN THnMPSON HONIES Move ?
?
Length a4e_
= Demolish Depth
o Address - Int. Impr. ? Sq. Ft
City hone 544- 7 3 3 3 Install ?
o Name Approvals Fess
$ i
~ Address
Ci Assessment
t
r 8
Sew
W Permit 2'? ?
e 46.5U
Surchar
ty ?
.
a
e
Pnone
P
li g
206.00
Pl
R
i
? Q N o
ce an
ev
ew
00
575
? W ame Fire .
SAC
??
< W Address
ciry Eng.
Pn Water Conn. 50U. 0 U
63 . 50
one Planner Water Meter
I hereby acknowledge that I have read this application and state thatthe
information is correct and agree to comply with all applicable State oi
Minnesota Statutes and City of Eagan Ordinances.
Signature a( Permittee ? ' " ' ? e;;, ,?' j' , - '
A Building Permit is issued to: URR IN THOA1PSON :
all work shall be done in accordance with all applicable State of Minnesota
Council Road Unit 290.00
Bldg. Off. Tr. PI. 156.00
Var. Date I Copies
Total , 249 . 00
iC)MES on the express condition that
Stajutes and City oi Eagan Ordinances.
i
:
?
?
;
' PERMIT #
. MECHANICAL PERMIT RECEIPT #
CITY OF EAGAN
CONTRACT PRICE 3830 PILO T KNOB ROAD, EAGAN, MN 55121 DATE
PHONE: 454-8100
Site Address N1*1,77'
? ?M BLDG. TYPE WORK DESCRIPTION
Lot/Z-y Block Sec/Sub ??` ??• '
, w ?
? N
R
_? e
es.
? Name , Mult Add-on
Address R
i
C
y r
omm.
epa
c City Phone pm
er
Name fl ir(, , l f'? yc I'?l ? FEES
c Address RES. HVAC 0-100 M BTU -$24.00
p City ? Phone i/ '1373 ADDITIONAL 50 M BTU - 6.00
ADD-ON AlR COND. 0-24 BTU - 12.00
ADDITIONAL 6 M BTU - 6.00
TYPE OF WORK
*or
d Ai
?(V)M BTU
ev ?
i)' GAS OUTLETS - 1.50 EA.
ce
r _O
_ COMM/IND FEE - 196 OF CONTRACT FEE
Boiler M BTU MINIMUM - RESIDENTIAL FEE - 10.00
Unit Heater M BTU MINIMUM - COMM/IND FEE - 20.00
i
C
d M BTU STATE SURCHARGE PER PERMIT - .50
r
on
. (ADD $.50 51C IF PERMIT PRICE GOES
Vent
Gas Piping Outlets # ? CFM ?. BEYONO $1,000.00)
Other
FEE
S/C: ? SIGNATURE OFPERMITTEE
• ??
?
TOTAL •
FOR CIN OF EAGAN
,
CONTRACT PRICE
Site Addres
Lot Block
? Name ompson
?a A d d r K a •
c CityC c3
PLUMBING PERMIT
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55121
PERMIT #
RECEIPT #
DATE: ?laO ? 6
BLDG. T1fPE WORK DESCRIPTION
-vrn.i.?uu?- v
Res.
um ng o. Mun.
V Comm.
Phone 933-2521 Other
Name urrin i nompson humes
c Address 1^ 0 S S 1"
p City a ' , Phone -
FEES
COMM/IND FEE - 1% OF CONTRACT FEE
MINIMJM - RESIDENTIAL FEE - $10.00
MINIMUM - COMM/IND FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S%C IF PERMIT PRICE GOES
BEYOND $1,000.00)
OF PERMITTEE
FOR CITY OF EAGAN
New ?
Add-on
Repair
FIXTURES TOTAL
?' •
Water Closet - $3.00
7- $
?
Bath Tubs - $3.00
-7-- -
Lavatory - $3.00
? ?
-
Shower - $3.00
? Kitchen 5ink - $3.00 -
Urinal/Bidet - $3.00
/ Laundry Tray - $3.00
- =
7
Floor Drains - $1.50
? Water Heater - $1.50 ?
Whiripool - $3.00
?
Gas Piping Outlets - $1.50
Softener - $5.00
Well - $t 0.00
?Private Disp. - $10.00
?
-
Rough Openings - $1.50
FEE
STATE S/C:
GRAND TOTAL: ? S '
O. Box 21199 PERMIT NO.:
gan, MN 55121 pATE:
ninp: - No. of Units:
nwr: - :
/lddrcss:
No..
eader No.:
yne to aomplp wi1h tIN Cihr ef byen
of I nsp.:
TY OF EAGAN
30 Pilot Knob aosd
0. Box 21199
gan, MN 55121
Address:
te eow/Ip wllr tb Cw of [.w•
of Irnp.:
_ Connaction Chorpe:
. /lccount Deposlt:
_ Permit Fee: .
Surcharfle:
Misc. CFnroes:
Totcl:
. Date Pa1d:
_ Insp.:
SEINER SERVlCE PERMR
PERMIT NO.:
DATE:
No. of Units:
Corr»ctian Cwrpa:
llcoou++t beposit: Prmdt Fw:
Surctwrpe:
Mlm Uarpst:
Totol:
Diob Poid:
WATER SERVICE PERMI'L '?
PERMIT NO.:
DATE: '
No. of Units: ?
tmm?sn- .. 7_,F:?
--aara Poia:
CITY OF EAGAN N 0
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
BUILDING PERMIT PHONE: 454-8100
Receipt #
11642
?V 6a'?'
7a be used ror SF• DWG/GAR Est. Value $ 93, 000 Date MARCH 17 , 1986
SiteAddress 1090 HUMMINGBIRD LN Erect I7 Occupancy R3
Lot 14 Block 2 Sac/Sub. LEXINGTON PL SORemodel ? Zoning R1
Parcel No Repair ? Type of Const IT
. Addition ? No. Stories
ORRIN THOMPSON HOMES Move ? Length 4?0
Q
W Name
i CROSSROAD Demolish ? Depth40-
Address ?
o Int. Impr. Sq. Ft.
Ciry Pnone 544-7333 _ Install ?
a
Name SAME
o
Approvals
Fees
,°? ¢ Address Assessment Permit
? Ciry Phone
Water & Sew.
Surcharge 50
? Pofice Plan Review 206.00
?? Name Fire SAC 575.00
?i Address Eng. WaterCOnn. 500.00
a W Ciry Phone Planner Water Meter 63 . 50
Council Foad Unit 290.00
Iherebyacknowledqethatlhavereadthisapplicationandstatethatthe gldg.OTf. 3/14/$ Tr. PI. 156.00
information is correct and agree to comply with all applicable State of
Minnesota Statutes and City of Eagan Ordinances. APC Parks
9 Var.Date Copies
tc-?e-
SignatureofPermittee 6 Z 249
00
Total ' .
A Building Permit is issued to: ORRIN THOMPSO MES on the express condition that
all work shall be done in accordance with aJ4a lica I,' State of Minn sota S u..t ?s and City of Eagan Ordinances.
Building Oflicial t ?? ? OA / -
REQUEST FOR ELECTRICAL INSPECTION ea.00001.04
0 See instructions lor completing this twm on beck o/ yellow copy. V'
?,-3-7 `L 3 "X" Be/ow Work Covered by This Request ?
AddTBeo. Tvoe oi euilei ..--Y- 4oolinnun Mfud Eouiumenl Wired
tlll0 F
I I I I Industrial Blda. 1 I Air Conditioner I I Bulk Milk Tenk I
N Fee Sarvjce En[renea5ixe A Fee Feaders/5ubfentlers N Fee Circuits
0 to 200 qm s 0 to 30 Am s 0 to 30 Am s
Above 200_Am>s 31 to 100 Amps 31 to 100 Am s
Swinxning Pool Above. 100_Amps Above 100_Am s
Transiormers Irrigation Boort?s Partial-'Other F e
ial Inspection S?iS-e) ?
TOTAL
I, tha Elechical
Inspector, heraby
certify thxt the above
insoection hes baen
TNsrepueslvalAlBmonthafrom - 6 A?7K
This request voitl -? 5^?,G
18 months from O ?
C ?23
I Request ??
,/ / - ?n?
`_
? Fire No. No Ph-in spection
Fe
quire?f?
'
?Aeady Now OWill Nntily, Insper
lor Wh
n q
d
?
?f ?
?
1
es N. e
eo
y
Licensed ElecVical ContreCtor 1 herabv request inspection of ebove
? Owner electrical work installad aY
Street Atldress, Box of Route No. Ciry
/? ? ? :
ectwn o. Township Na or No. Hange o. unt
1
Occuu.?? IPNINTI Phone N
o.
J
ower Supplier A Address
l ri? ConIractor ICompany Namel
T/?E> , Cnnhaclor' ' ice)nse No. -
Mafling AdJ ss lComr ctor or Owner Making InstallatioN
U
A=ure IConrtactor Owner aking Installation) Pho umb¢r) ?-^y
? J/! J ?-
AAINNESOTA STATE BOAflD?LECTRICITY THIS INSPECTION BEQUEST WLLL NOT
Grigga-Midwav Aldg. - Room N-191 BE ACCEPTED 9Y THE STqtE BOARD
1827 UnivarsitY Ave., St. Paul, MN 55709 . UNLESS PNOPEfl INSPEGTION FEE IS
Pnnnw f6721297.211 1 ENCLOSED.
1986 BIIILDING PERlIIT 9PPLICATIOA - CITY OF EAGAA
NOTS: ALL CANTRACTpRS MI1ST BE LICBNSED iiITH THE CI1R OF EAGAN
COMMCI6L SINGLE FAMIILY DWSt.LINGS
INCLIIDE 2 SETS OF 9RCHITECTURAL INCLIIDE 2 SETS OF PLANS
& STRUCTURAL PLANS, 1 SET OF 3 CERTIFICATES OF SURVEY
SPECIFICATIONS AND 1 SET OF 1 SET OF ENERGY CALCULATIONS
ENERGY CALCULATIONSJ ?`? Z?
$2,000 LANDSCAPE BOND
To Be Used For: Z(55,1-7&-rdCIE Valuation: q3.60() Date: (2
Site Address 1070 ????u4i3i2r? OFFICE OSE ONLY
Lot 14 Block Z ? Ereet X Oecupaney :V-7 3
Parcel/Sub L-c.x1N4"f1U Q(AZE SJVfN
Owner
Address
City/Zip Code
Phone
Contractor i?17?1/?$V1J
Address 1717 hWK.I1JS )(4fAt4Pj>
City/Zip Code Mh1 -1-Q ,ss&43
Phone 5 -" - '7 333
Areh./Engr.
Address
City/Zip Code
Phone #
Remodel
Repair
Addition
Move
Demolish
Int.Impr.
Install
Zoning (c-(
Type of Const _V-
# of Stories
Length 40
Depth 40
Sq Ft
APPROVALS FEES
Assessments Permit -qlZ
Water/Sewer Sureharge TS?
Police Plan Review Z
Fire SAC 575
Engr Water Conn SDu
Planner Water Meter LTSv
Council Road Unit 790
Bldg O£f 3. s6`s$'reatment Pl /SL
APC Parks
Varianee Copies
xoTA[. Z24 .oc?
NOTS: ADDRESSES FOR COAPER LOTS - COATHACTOR/HOMSOWAER HOST DFSIGHATE i/HICH
9DDRFSS IS DESIRED. HO CHANGES flILL BE ALLOiIED ONCS BQILDING PERMIT
IS ISSOED.
COMPANY •
ICATE OF SURVEY FOR:
ORRIN THOMPSON HOMES
A Division of U.S. Home Corporation
EENCHMARK: Top nut of hydrant at the
south side and 150 ft. east of 1076
Hummingbird Lane.
Elevation = 910.09 ft. (NGVD-1929)
FRONT GARAGE SLAB:
Propased elevation = 907.53 ft.
DUCKWOOD
5 89° 21' 54" E
m ?
?
T I
r
W
N 1 0' I LOT 14
N I
N
0
Z 1 1
DRIVE
123.78
EAGAN
REVI E
BY
DATE 3' I 4"bG
0
- -o - -I 0
- O
V q i I Q
-
- =
-
; c0
?
26.5 I
?
m?
s ?0 `? IO
o _ ; I 3
o ? I 30. 2'
m w i3.e3 O
?
?
O
^' n o
1'1.5 a
4 22.83
N 89 ° 13' OI" W 123.49
'E 1-t i ; A (kJ` rainaqe
REVIE
. BY
DATE
?
f U1//ity Edsement
Lot 14, Block 2,
LEXINGTON PLACE SOUTH
Dakota County, Minnesota
a
a
0
P
am a duly ///Rjjjegis[ered Land Surveyor under Che lavs o£ th0 S[ate oE Minneso[a. [Ml Reg. No.Da[e 71 • MINNEAPOLIS, hIIN • PHONE: 374-4740
I hereby certify tha[ this is a true and correct representation of a survey of the
boundaries of the land above described and of the location o£ all buildin9s, if any,
Chereon, and all visible encroachmen[s, if any, fran or on said land. I further
cer[ify that [his survey vas pcepared by me or under my direct supervision and that I
Scale: 1" = 30'
a Iron monument found
o Spike or wood stake set
.900.0 Existing spot elevation
I
W'
ZI
?
?
?
m
0 '
Z ?
- o
? P
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e
a
?
Proposed House.&_ As-BUilt House_ Drawn by Ev 'Project no.85104
***************************************
CITY OF EAGAN
CASHIER: SS TERMINAL NO: 769
DATE: 08/24/00 TIME: 07:47:38
ID:
NAME: MINNESOTA EXTERIORS
3210 9001 1090 HUNIIQGBD LN 181.25
2155 9001 1090 HUMNGBD LN 5.00
Total Receipt Amount: 186.25
CR136332
USER ID: JAN
,1???$ 2000 BUILDING PERMIT APPLICATION (RESIDENTIAL)
"I cirr oF EAcani
3830 PILOT KNOB RD - 55122
651•681•4875
D J reglalered tlte wrveys ahowlnp aq. R o( bf, sq. f1. of houae
and gQ rooled areas (20% mmdmum lof covamae a0owe?
> 2 copies ol plans fshow beam & wlrMow sixes: poured tnd. daalgn: efcJ
> 1 set of eneryy cW IaHons .. . > J coples ol hee ppervaMO?plan If lot platted afler 7/1/93
DATE: ?
DESCRIPiION O WORK:
STREET ADDRESS: 9,4e111111111 7
LOT: -- BLOCK: %?- SUBD./P.I.D. #:
2 copies W Pian
1 fet of energy cplcWaNons la heated addXOns
1 sire wrvey ror exfeAw adoais A decW ,
CONSfRUCTION C05i:
VIA
P,ona:: /
PROPERN
OWNER
CONTRACTOR
ARCHITECT/
ENGINEER
Sheet Addreas: U ? / l
Cify State: 21p:
Company: ? Phone M: -?5/
1-6 ? ???6 (area code) ?
Sheet Address: Llcense Y ??u?ExP•
CNy state. Z? /v Zip:
Company:.
Telephone If: (
Name:
Sfreet Addreas: Re9lstraHOn u:
City
State:
SewerAvater licensed plumber (if inslallina seweNwaterl: Phone #:
Lp:
I hereby ackrawledge Miof I have read fhis application, sfate thaf Ihe infortnaNon ia corteMagree to comply wNh afl applicable State
of Minnesofa Slalutes and Ciy of Eagan Ordirwncea
Signalure of Appllcant
OFFICE USE ONLY
Certificates of Survey Recefved = Yes = No AUG z-" r
Tree Preservation Plan Received Yes No _ Not Required 113y- 3?000
OFFICE USE ONLY
BUILDING PERMIT SUBTYPES
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 21 Poroh (3-sea.)
? 02 SF Dwelling ? 08 06-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.)
? 03 01 of _ plex ? 09 07-plex ? 18 Deck ? 23 Poroh (screened)
? 04 02-plex ? 10 08-plex ? 19 Lower Level ? 24 Storm Damage
? 05 03-piex ? 11 10-ptex Plbg _Yor_N ? 25 Miscellaneous
? 06 04-plex ? 12 12-plex ? 20 Pool ? 30 Accessory Bldg.
WORK TYPE
? 31 Exc a,n - nnuni
? 33 Ext. Att - SF
? 36 MuRi
? 31 New ? 36 Move Bldg. ? 43 Reroof
? 32 Addition ? 37 Demolish (Bldg)' ? 44 Siding
? 33 Alteration ? 38 Demolish (Interior) ? 45 Fire Repair
? 34 Repair ? 42 Demolish (Foundation) ? 46 Windows/Doors
' Give PCA handout to appi icant for demolition permit
GENERAL INFORMATION
SAC Code
No. of Units
No. of Buildings
Const. (Actual)
(Allowable)
UBC Occupancy
Zaning
# of Stories
Length
W idth
Basement sq. ft.
Main level sq. ft.
sq. ft.
sq.ft.
sq.ft.
sq.ft.
Footprint sq.ft.
Census Code
MC/ES System
City Water
Booster Pump
PRV
Fire Sprinklered
MISCELLANEOUS INSPECTIONS
? Stucco/Stone
APPROVALS
Planning Building Engineering
Permit Fee Valuation:
Surcharge
Plan Review
License
MC/ES SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
SMI Surcharge
Treatment PI.
Park Oed.
Trails Ded.
Other
Copies
Total:
Variance
SAC Units
% SAC
r
??/ILI1_1.'1?4UY .7LB ?iY.1?$Nf1Y .! •:? ? ? •?I ??i?)a??)?.7?I:?Id: :?1? /e Y71: •71:u
' ?1' f ? • ? ? • • • ?? ! i 1 01 ? • ?11
.? ? ' . : .
'.ITY OF EAGAN .? .
1)
2)
APPLICATION FX)R PERMIT SEWEFt ADID/OR WATER CONDIDCPION
PROPERTY ADDRFSS:
Ty=nT• DESCRIP7.'IONz
IF EXISTING STRL'CTIIRE, DATE OF ORIGINAL HL?ILDIM PERMIT ISSL?AIVCE:?? '
PRESEPII' ZONINS/PROPOSID USE: : -1 SIN?Z.E FAMILY Mon ear) ,._.
R-2 DUPLEX (4tao Dnits)
R-3 7?OW[?h10L?SE (Three + Lfiits) ( Onits)
- R-4 APARTMENTyCONIDOMIPIILR+I ( Units) ,
:: CONF?ERCIAL/RETAIL/OFFICE
. . , ' . - i . ' IINDL?STR3AL : . ;; .
INSTI4LTTONF.L/00Vg2IZ1ENT . ..
NAM:
+ ADDRESS:
' CITY, STATE. ZIP:.
PHONE:
x
3). • c?•
- - - NAME:
_ ADDRESS:
CITY, STATE, ZIP:
-- - - PHONE:
722n PLUMBIFJG f,nwl
1 ANr
, MfNN?-p ??ONkA BLVp?_
3=- MASTER LI2ENSE #
?.
For City Lse
Plumbers License:
Cf Active
Cr Espired
O Not Recorde
SEOF ?Initaal
4) [i"a?i •_u ?a.???7
. NAME:
- AMRESS: Q,Q p?J
QTY. STATE, ZIP:
PHONE:
5) ' ?• : - • ??
.
CONNECMW TO CITY SE,'hEF2 ?'ION TD CITY S+9TII2
(Please Descri.be)
6) u • • i
PT FA.SF. fIOLD APPROVFD PERhII'f E'OR PICK- Y OI? DF ABOVE
Pt?EASE MAIL APPROVID PERMIT 7n 1. 2 3 4, ABJVE
(cir?c eone)
7) a?v" . r ?• ?
W!i
T? "-FOR CITY USE x?ON„Y
... . ._ ... . tr ' PERMIT ° ISSUED
yj • ?, ? ?
y:?:- /Q'??''`?•:".?/??'??? ?_inY.? `? . . . ; "`" ??.J.-? A` +ip ,?
? - ..3 ?rA? ? . G { y
?Jy?.(
?' . . y+T :u^F ir. . ! - - "'C' rti?+ e.": 4 "y'a?? ? l• ?
F S $ SETrrER ?=M _TT (221CL:,D .. SUPCh?.RGc) R
,WATER PERPIIT (INCLJDE SL'RCFIARGa)
„?.f ;.-4^.1• v. 4v!:' n`?. '.[.Y
.>M4. WATER METER/COPPERHORN/OUTSIDE READER
- -• ? WATER TAP (INCLUDE CORPORATION STOP)
< <.-?.- . _._ 5 -_ - ?c? ??.??M _.:?..:. :,.,a; t.y, . . ?e?-';? _+•=;?.?ia? ?:?:?;
. . . $ ???0-?J ..r?C?l::i•T_ ^^7r^c1_ _ ...? r v
?ACCOUNT DEPOSIT WAT£R
D O-? " .WAC
$ it7Y- SP.C
... ' . . ? . . . . - .... _ .o-.. .....' - A?s" d.1?..,
TRU'NK 64ATER ASSESSi•SEPIT ,
$ TRli:IK SEWER ASSESS1IE:iT "
?..
?- +S LATERAL BEDIEFIT/TRUNK SE::TF.lR . ?
` _ - - $ LATERP,L BENEFIT/TRU:IK SQATER
- - $ / -7 O-?WATER TREATMENT PLANT SURCHARGE ... ,_
. - -- -- $ -- OTHER: " s
- - $ - TOTAL
$ _ ??? %• ?CJ P.AlO[::VT PAID/RECEIPT v G (? GO'? -
.?
?a4 . S_0 k.777
DDES UTZLITY CONNECTION REQUIRE_£XCAVATION iN Pt3BL2C RIGHT 9F WA=
_ ? -. i°` • °? ,=
YES IF YES, THEN A"PERMIT FOR WORK WITHIN'
PUBLIC ROADWAY" MUST BE ISSUED BY TY.E
L? NO ENGINEERING DIVISZON. LIST AS A CONDI-
TION
- .'. . . , . ... _ :?. , . _. =
'_SUBJECT TO THE FOLLOWING CONDITIONS: .
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APPROVED BY:
TI.LE:
DAT°:
Use BLUE or BLACK Ink
I For Office Us/e~ I
j Permit I VZ ~Z7 j
City of Ear I ~d . oa
Permit Fee:
3830 Pilot Knob Road
Eagan MN 55122 I Date Received: I j
Phone: (651) 675-5675 I ? I
Fax: (651) 675-5694 1 Staff:
2011 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: I Unit
Name: f ` J t 7 Phone:
RESIDENT / +
OWNER Address/City/Zip:
Applicant is: Owner Contractor
Description of work:
TYPE OF WORK Q?
Construction Cost: /J O Multi-Family Building: (Yes No }
Company:. ic.Gs.1 d7GGr ! (2141-i.11 w ~t Contact: C_GC1 i1
Address: ~Y® 7 City: N~,JG4 y~r~f
CONTRACTOR
State: Zip: ~ _7 Phone: f- 2 f t~ 5~
License K 31- 6 Lead Certificate
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:
l
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 they 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.gooherstateonecall.org
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
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.
x x
Applicant's Printed Name Appli ant's Sign ture
Page 1 of 3
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA164212
Date Issued:09/22/2020
Permit Category:ePermit
Site Address: 1090 Hummingbird Lane
Lot:14 Block: 2 Addition: Lexington Place South
PID:10-45060-02-140
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:Does not include skylight(s)
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and leave on site.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Valuation: 5,000.00
Fee Summary:BL - Base Fee $5K $118.00 0801.4085
Surcharge - Based on Valuation $5K $2.50 9001.2195
$120.50 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Mark J Rolfzen
1090 Hummingbird Lane
Eagan MN 55123
(612) 719-5025
Grussing Roofing
6921 Raven Ct
Eden Prairie MN 55346
(952) 935-0557
Applicant/Permitee: Signature Issued By: Signature