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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 — itIP - t { , Y" SIL '; i. .ice.. Ali �l i1 "�����' 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$'reatment Pl /SL APC Parks Varianee Copies xoTA[. Z24 .oc? NOTS: ADDRESSES FOR COAPER LOTS - COATHACTOR/HOMSOWAER HOST DFSIGHATE i/HICH 9DDRFSS IS DESIRED. HO CHANGES flILL BE ALLOiIED ONCS BQILDING PERMIT IS ISSOED. COMPANY • ICATE OF SURVEY FOR: ORRIN THOMPSON HOMES A Division of U.S. Home Corporation EENCHMARK: Top nut of hydrant at the south side and 150 ft. east of 1076 Hummingbird Lane. Elevation = 910.09 ft. (NGVD-1929) FRONT GARAGE SLAB: Propased elevation = 907.53 ft. DUCKWOOD 5 89° 21' 54" E m ? ? T I r W N 1 0' I LOT 14 N I N 0 Z 1 1 DRIVE 123.78 EAGAN REVI E BY DATE 3' I 4"bG 0 - -o - -I 0 - O V q i I Q - - = - ; c0 ? 26.5 I ? m? s ?0 `? IO o _ ; I 3 o ? I 30. 2' m w i3.e3 O ? ? O ^' n o 1'1.5 a 4 22.83 N 89 ° 13' OI" W 123.49 'E 1-t i ; A (kJ` rainaqe REVIE . BY DATE ? f U1//ity Edsement Lot 14, Block 2, LEXINGTON PLACE SOUTH Dakota County, Minnesota a a 0 P am a duly ///Rjjjegis[ered Land Surveyor under Che lavs o£ th0 S[ate oE Minneso[a. [Ml Reg. No.Da[e 71 • MINNEAPOLIS, hIIN • PHONE: 374-4740 I hereby certify tha[ this is a true and correct representation of a survey of the boundaries of the land above described and of the location o£ all buildin9s, if any, Chereon, and all visible encroachmen[s, if any, fran or on said land. I further cer[ify that [his survey vas pcepared by me or under my direct supervision and that I Scale: 1" = 30' a Iron monument found o Spike or wood stake set .900.0 Existing spot elevation I W' ZI ? ? ? m 0 ' Z ? - o ? P ?i a e a ? Proposed House.&_ As-BUilt House_ Drawn by Ev 'Project no.85104 *************************************** CITY OF EAGAN CASHIER: SS TERMINAL NO: 769 DATE: 08/24/00 TIME: 07:47:38 ID: NAME: MINNESOTA EXTERIORS 3210 9001 1090 HUNIIQGBD LN 181.25 2155 9001 1090 HUMNGBD LN 5.00 Total Receipt Amount: 186.25 CR136332 USER ID: JAN ,1???$ 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: . . ,.: ., -- , . . , .; - • .. :: 4 _ . . • . • .. .lra'Wm m ..ViL.nC''1J° .I]MV4 . . ... i - :. . V.r .. ... . 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