1065 Keefe StCities Digi
itv Control
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CASH RECEIPT
CITY OF EAGAN '
3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE
19
Rtcrivao
FROM
AMOUNT ? I
/D 7/ 7J IL O/ !l D/ & DOLLARS
too
? CASH ? CHECK
rort
White-Payers Copy
Yellow-Posting Copy
Pink-File Copy
Thaak You
B Y
?
Me
Id ??
I U 7 3-
/470 -
/aG9-
? ?..??
INSPECTION RECORD
CITY OF EAGAN ' PERMIT TYPE:
3830 Pilot Knob RoBd Permit Number: 4'
Eagan, Minnesota 55122-1897 Date issued:
(612) 681-4675
SITE ADDRESS: 14 14' 0 `" 0 1 APPLICANT:
t c • r f , ! . t t t h f •; I iI?rn ??r, i??PI il???qt .
r,? McI.E 3t?1? (fil.,,) >491-37 73
PERMIT SUBTYPE:
, , r:i l , I
TYPE OF WORK:
1tf ti,i: R I 1' 1" i'v M
FRAH i Nii
f 1 NAl
i? I I f rtnrrnM
Mlt + `;IIlIhID AViA 1! Mf N f
p1lillitl 1 N N 1 fi
-------------------------
?
J
Permit No. Permk Holder Date Telephone If
ELECTRIC
PLUMBING
HVAC
Inspectlon Dete Insp. Comments
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS 5VC
TEST
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG _-
ORSAT
TEST
?
BLDG FINAL -
- -
7,Z ?_9rrl f?
BSMT R.I. f
?
'
-
BSMT FINAL
DECK FTG
DECK FINAL
CITY pF EAGAN
3795 ''..at Knob Rood
f,..yun, MN 55122
Zoning: _
Owner:
Address
Site Address:
Plumber:
Meter No.:
Size: _
Reader No.:
1 ogree !o complr with the City of Eugcn
Qrdinoeoes.
By
Dote of Insp.:
Connection Chorge: 00 4%.
Account Deposit: '
Permit Fee:
Surcharge:
Misc Ch
. arges.
. Total:
Dote Paid:
Insp.:
CITY OF EAGAN
3795 ?-ilot Knob Road
Eagan, MN 55122
7nninn•
Owner:
Address: - ?° _!E ys-
Site Address:
Plumber:
1 agree to comply wiN+ the City of Eagon
Ordinancea.
By
Date of Insp.;
I nsp.:
SEWER SERVICE PERMIT
PERMIT NO.:
DATE:
- No. of Units:
Connection Charge
Account Deposit: .
Permit Fee:
Surcharge:
Misc. Charges:
7ota I:
Date Paid:
m
WATER SERVICE PERMIT
PERMIT NO.:
DATE:
- No. of Unirs:
CITY OF EAGAN Remarks r
Addition Lot 7 Blk 1 Parcel lo 47752 070 01
Owner , v street 1065 Keefe St_ State Fagan , MN ?,?191
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. 1 ,
STREET RESTOR.
GRADING
SAN SEW TRUNK y0
* SEWER LATERAL
WATERMAIN
?t WATER LATERAL 1968 000 6 0 20
WATER AREA
STORM SEW TRK 1
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
Road Unit Char e
WATER CONN. • 12255 ' 10-27-7$.-
BUILDING PER.
SAC 12 2 -5
^
PARK
EAGAN TOWNSHIP
BUILDING PERMIT
No 2251
Eegan Townahip
Town Hall
ne:. .-. 6--=.. ...?.Z...° ....................
6lories To Be Uced For Fron! Deyth Heigh! Est. Coa! ' Pesmi! Fee Aemaske
LOCATION
Thls permlt doee nof aulhartse the use oi streels, roads, alleys or eidawalks aor does !t give !ha oanes or hSs agen!
the zlgh!!o oreale eap aiiua!!oa whieh le a nuteanaa or whlch prasents a heaard !o t6a healfh, eafely, conveafenee and
geaesal welfare !o anpoae isi the communitp.
THIS PERMIT MUST BEPT ON THE PAEMISE WHILE THE WOAK IS IN PAOGAESB.
This is !o aerlify. !hal .......... :.. .?.'?...^...`.'? ..........has permisalon !o ereat a........... ................................. _upoa
the above deseribed pzemiae suhJee! !o the provlaiona of the Building Ord4nanes !or E an To nshiy adopled April 11,
1955. ?2o
..................................?4...?............,.?......... Yer -'-.....................:U`.`.`..`..`:.`...../?..............................
?/CSafrman oYTnwn Board 8uildin Ins eetor
EAGALv1 °f0WNSH!P Nc 136
B9.J B LD 1 BV G P E Rfvi i'r
Ownex ?'---- ?-- r.QQr--??-l?y?- -.-.-f..!??_. - - --- - -- -- .-- . // Ea9an Township
Address (Present) Town Hall
Builder . ..___•Nc-?T----------....-------------?------------
Dale
Address ..._ ._- - ,-------------- .
DESCRIPTION
5tories To Se Used For Fron! ? Depih HeighY I£si. Cos! Permii Fee Remarks
LOCATION
I?91Norw,a
or
This permit does xAi auihoxise the u=.e of sireefs, roafts, alleys or sidewalks nor does it give the ownex or his agenY
the right fo creale any sifuation which is a nuisance or which presenis a hazard io the healfh, sately, convenience and
general welfare fo anyane in the communify.
THI5 PEAMIT MUST BE KEPT N TH PREMISE WHILE THE WORK IS IN PFFOGA SS. ?
This is So ceriify, fhai_?._.... .. .... .. ..'-___haspermissioa io erect a_ ..... ............t!r.Lq._.--__....'-_----._.-----upon
the above described premise subjeci t ihe provisions of the Building Ordinance for Eagan Toy?e?snip adopSed April 11,
1955. ?J
.......---....__.--? ?;---------..... Per ...... -----__-__----'-----------------------------._'__...-----..._.---
Chairnan of T Soard Building Inspecior
This request void 18 months from
R 11410
Date o this Request
I, asLicensed Electrical ontractor Owner, do hereby request inspection of the above electri-
cat a?i?g installed at:
S[reet Address ot Route No.
Section Township
Range County
Which is occupied by
' - - - (Name of Occupanq
Is a roughin inspection required on this job? No ? Yes ? Ready Now ? Will Call ?
Power Supplier ?? Address
paul stafford electric, inc.
'
Electrical Contractor Contractor
s Licen se o. _
oM(w es .
Mailing Address minnea olis mn 55419
( Iectrica l Contractor ar Own« Making This Installatlan)
Authorized Signature Phone No. o - q
,F?.,...?..? ,..,........ ....,.. ti,??.... T??. ?.,..,??,.?,,.,,
?`?f\ ?? 00 n?D ?0?? This inspec6an requestwill not be accepted by the
u(,? ?,? ? State Baard unless proper inspection ke is enclosed.
_ • A Minnesota State Board of Electricity
,A54 University Ave., St. Paul, Minn. 55104-Phone 645-7703
REQUEST FOR ELECTRICAL INSPECTION
CHECK BELOW WORK COVERED BY THIS REQLIEST
/.aq %6-xAr-M
`R 11410
Type of Building New Add. Rep. Check Appliances Wired Foc Check Equipment W'ved For
Hume ? ? ? Range ? 7emporary Wiring ?
Duplex 0 ? ? WaterHeater ? LightingFintures ?
Apf. Bldg. ? ? (D Dryer ? Electric Heating ?
Commemial Bldg. ? ? ? Purnace ? Silo UnloadeF ?
Industrial Bldg. ? ? ? Air Conditioner 9 Bulk Milk Tank ?
Fatm ? ? ? Lvs[ List
Other ? ? ? Rehers?
) Oe1Qrs?
FI 7
0[0 100 Am s. 0 to e U' 11 0 to 30 Am eres e2 -
101 to 200 Amvs. 31 to I Am es 31 to 100 Amoeres
Si ns ? Special lnspection Minimum fee E5.00
Remazks
TOTAL FEE ,StJ
I, the Electrical Inspector, hereby certify that the above inspection has been no'de. •Od
(Final)
This request
18 months from
Date
Lku ( - P- 7
PERMIT# -55 4 / U
RECEIPT DATE:
2002 RESIDENTIA?L F'LUMSINC PEitMIT AFPL1CATION
ciTY oF E,as,aiv
SASO PILOT 1{NOB {iD
Ewenrr, auu ssr sE
651-691-4675
Please complete for: single family dwellings, townhomes and condos when permits are required for each unit,
backflow preventer for irrigation system
SITE ADDRESS: ( 065 e{C 5Y, &srAVi SS/oZ I
OWNERNAME:: Lis ?141016 S/?yjCr TELEPHONE#: 6SI -YS-15S
(AREA CODE)
INSTALLER NAME:4 TELEPHONE #: ???? T71 Z3Sg
(AREACODE)
STREET ADDRESS:
CIn: ,,, st Aetw/
s?--
STATE:
ZIP: ssit?
_ SEPTIC SYSTEM, newlrefurbished (requires two sets of plans and MPC license) $ 100.00
includes $40.00 County fee
Note: Additional consultant fees may apply
• MODIFICATION/ALTERATION TO EXISTING DWELLING UNIT, INCLUDING:
x Adding fixtures to lower levels or room additions, excluding water softeners and wate r heaters. $ 5D.00
_ Abandonment of septic system.
_ Water turnaround - existing dwelling unit (+ 5/8" meter if needed -$118)
Other:
RPZ: new installatioNrePaiNrebuild
?., $ 30.00
_ lawn irrigation system
? S E
P 1 0 2002
ReplacemenUadditional: _ water softener _ water h`??r $ 15.00
State Surcharge $ 50
$
Total
I hereby acknowledge that I have read this application, state thatthe information is conect, and agree to complywith all applicable Ciryof Eagan ordinances. It
is the applicant's responsibility to notify the property owner that the City of Eagan assumes no liability for any damages caused by the City during its normal
operational and maintenance activities to the §cilities constructed under this permit wthin City property/right-of- IL?.??
SIGNATURE OF PERMITTEE 1/02
`?-D"1-4- D
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EACAN MN 55122 ? ?0 c)
651-681-4675 ?
Naw ConsWelion Reauirements
• 3 registered sfte surveys showing sq. ft. ot lot, sq. ft. of house; and all roofed areas
(20°k mauimum lot coverage allowed)
. 2 copies of plan showing beam & window s¢es; poured found design, etc.)
• 1 set of Energy Calculations
• 3 copies of Tree Praservation Plan if lot plafled aRer 7/1193
. Rim Joist Detail Oplions seleclian sheet (bldgs wNh 3 or less units)
DATE D'a /- O:)N
SITE ADC
TYPE OF
ULTI-FAMILY BLDG _Y _N
FIREPLACE(S) _ 0 _ 1 _ 2
APPLICANT ( / '? Csd % d?J
STREETADDRESS aP!!? ?S ?c?/'fLI L,y?/!F' CITY STATE??ZIP?
TELEPHONE CELL PHONE # FAX #
PROPERTYOWNER l'It}0ICy- GiSA ?11 Y11?r TELEPHONE#
COMPLETE FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNESO'CA RiJLES 7670 CATEGORY 1 MINNES07'A RULL:S 7672
(d submission type) • Residential Ventilation Category 1 Worksheet Submitted • New Energy Code Worksheet Submitted
• Energy Envelope Calculations Submitted
Plumbing Contractor. Phone # JL? L
Plumbing system includes: Waler Softener I.awn Sprinkler ec:---? 00_ --
Water Hcater No. of R.I. Baths IN ?No. of Baths SEP 0 5 2002 ?
Mechanical Confractor:
Mcctiaucal system includes:
Sewer/Water Contractor.
_ Air Conditioning
Heat Recovery Syslem
I hereby acknowledge that I have read this application, state that the
with all applicable State of Minnesota Statutes and City of Eagan On
S(gnature of Applicant
Phone #
Phone #
OFFICE USE ONLY
RamodellReoairReauiremenb
• 2 copies of plan
• 1 selofEnergyCalculationaforheatedadditions q _ I C)
. 1 site survey for exlerior additions d decks
. Indicate H home urved by septic syslem far addillons
VALUATION
Fee:
is correct, and agree to comply
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4102
OFFICE USE ONLY
? 01 Foundation ? 07 OS-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) . 0 31 Ext. Alt - Multi
? 03 01 of _ plex ? 09
07-plex
? 17 Garage J
? 22 Porch/Addn. (4-sda.) ?
33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex 0 18 Deck ? 23 Porch (screened) ? 36 Multi
? 05 03-plex ? 11 10-plex ?69 Lower vel ? 24 Storm Damage
? 06 04-plex O 12 12-plex Plbg?or_ N ? 25 Miscellaneous
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
V/ 33 Alteration ? 37 Demolish (Bldg)* ? 43 Reroof ? 48 Windows/Daars
? 34 Replacement •Demolition (Entire 81dg only) - Give PCA handout to applicant
Valuation k 0 1, t) Occupancy fl- 3 MC/ES System
Census Code Zoning P-(_ City Water
SAC Units ? Stories Booster Pump
Nbr. of Units O Sq. Ft. PRV
Nbr. of Bldgs ? Length Fire Sprinklered
Type of Const ? W idth
REQUIRED INSPECTIONS
_ Footings (new bldg) FinaUC.O. .
_ Footings (deck) ? FinaUNo C.O.
_ Footings (addition) ? Plumbing
_ Foundarion ? HVAC
_ Drain Tile Other
Roof Ice & Water Final Pool Ftgs Air/Gas Tests _ Final
d Fianuug Siding Stucco Stone
_ Fireplace _ R.I. _ Air Test _ _
Final _ Windows (new/replacement)
? Insulation _ Retaining Wall
Approved By
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S&W Permit 8 Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
Building Inspector
v
RESIDENTIAL
5 1 ?JZ ? BUILDING PERMIT APPLICATION ?
? CITY OF EAGAN '3
3830 PILOT KNOB RD - 55122
651-681-4675
New Construction ReouirameMs RemodellReoair Reouiremanb
• 3 registered sNe surveys showirg sq, R. of lot, sq. R o1 house; and all raofed arees • 2 copies of plan
(20% maximum lot coverege allowed) • 1 set of Energy Calculations for heated additions
• 2 copies of pWn showing beam & window saes, poured (ound design, etc.) • 1 site survey for eMerior addihons & decks
. 1 set of Energy Calculations . Iridnxte if home served by septic system for additions
• 3 copies of Tree Preservatlan Plan K lot platted afler 7l1/93
• Rim Joist DeWil Oplions selection sheet (61dgs wilh 3 ar less units)
DATE 4'_5UX,2'02ll VALUATION
JOB SITE ADDRESS IUoS *-e94e S-%C2-e>>k.
IP MULTI-FAMILY BUILDING, HOW MANY UNITS?
PROPERTY OWNER L-Sq S"a-e..?
TYPE OF WORK ' ' FIREPLACE(S) _ 0_ 1"_ 2
APPLICANT t`ZC{?A•4brtpa7ato?D'4'T???.???td?\tS ? PHONE# 3{sa?•?la •?Sellc
ADDRESS
PAGER # CELL PHONE #
FAX #
CODE 363,S`(
NEW RESIDENTIAL BUILDING ONLY - FILL OUT COMPLETELY
Energy Code Category _ MINNESOTA RULES 7670 CATEGORY 1
(check one) - Residential Ventilation Category 1 Worksheet Submitted
- Energy Envelope Calculations Submitted
_ MIlVNESOTA RULFS 7672
New Energy Code Warksheet Submitted
Plumbing Contractor: _
Plumbing System Includes:
Mechanical Contractor: _
Mechanical System Includes:
Sewer/Water Contractor:
Phone #
Phone #
Fee: $90.00
Fcc: $70.00
All a6ove information must be submitted prior to processing of application.
I hereby acknowledge that I have read this application, state that the information is correct, and agree to compiy
with all applicable State of Minnesota Statutes and City of Eagan Ordinances.
Stgnature of Applfca?LWl.C7???.?NAM"rN
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 2002
_ Water Softener
_ Water Heater
No. of B:uhs
Phone #:
Lawn Sprinkler
No. of R.I. Baths
Air Conditioning
Heat Recovery Systcm
s 4
OFFICE USE ONLY
0 01 Foundation
? 02 SF Dwelling
? 03 01 of _ plex
? 04 02-plex
O 05 03-plex
? 06 04-plex
? 07 OSplex ? 13 16-plex
? 08 06-plex ? 16 Fireplace
? 09 07-plex ? 17 Garage
? 10 OS-plex ? 18 Deck
? 11 10-plex ? 19 Lower Level
? 12 12-plex Plbg_Y or _ N
? 20 Pool
? 21 Porch (3-sea.)
? 22 Porch/Addn. (4sea.)
? 23 Porch (screened)
O 24 Storm Damage
? 25 Miscellaneous
? 30 Accessory Bldg
O 31 EM. Alt - Multi
? 33 EM. Alt - SF
? 36 Multi
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
O 32 AddiGon , 0 36 Move Bldg. ? 42 Demolish (Foundation) O 45 Fire Repair
? 33 Alteration . ,, ? 37 Demolish (Bldg)` ? 43 Reroof '? 46 Windows/Doors
? 34 Replacement "Demolition (Entire Bldg only) - Glve PCA handout to applicant
Valuation Occupancy MC/ES System
Census Code Zoning City VVater
SAC Units = Stories - ' ' • Booster Pump'
Nbr. of Units Sq. Ft. . , PRV •
Nbr. qf Bldgs ' Length ,. • Fire Sprinklered
Type of Const ,
W idth .
REQUIRED INSPECTIONS
_ Footings (new bldg) FinaUC.O.
_ Foo6ngs(deck) FinaUNo C.O.
_ Footings(addition) _ plumbing
_ FoundaHon HVAC
_ Drain Tile Other
Roof _ Ice & Water _ Final Pool
Ftgs Air/Gas Tests Final
_ Framing _
_ _
Siding Stucco Stone
_ Fireplace _ R.I. _ Air Test _ Final _ Windows (new/replacement)
_ Insulation _ Rehining Wall
Approved ey
Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
r
Installed
Siding andIMU&PspOWER OF ATTORNEY
OF COBB
STATE OF GEORGIA
KNOW ALL PEOPLE BY THESE PRESENTS:
THAT I, David N. Katz, a resident of Montgomery County, Pennsylvania
("Principal"), and a licensed contractor of ItMA Home Services, Inc., DBA Home
Depot Installed Sales located at 660 Mendelssohn Avenue North, Golden Valley, MN
55427, having a license number of BC- 20268257, do hereby appoint, name and
constitute Elder-Jones Building Permit 3ervice, Inc. ("AgenY') as my true and lawful
attorney-in-fact and do authorize and grant said attorney-in-fact for me and in my
name, place and stead the power to execute, acknowledge, sign and deliver (in such
form as may be required by the municipality) a permit application, or any other
instrument(s) which may be necessary and appropriate, in order to obtain the proper
permit(s) from the City of Eagan, Minnesota for the installation, maintenance and
repair of windows and siding (the "Work").
The powers conveyed to the Agent by this Limited Power of Attorney are
limited solely to the express powers delineated herein and apply solely to the Work.
This Limited Power of Attorney shall expire and automatically be revoked on the 30t'
day of May, 2003, which date is one year from the execution hereof. Further, the
powers conveyed by this Limited Power of Attomey may be revoked by Principal at
any time by express revocation and shall also be revoked by the Principal's death,
disability, incapacity or incompetence.
IN WI"TNESS WHEREOF this Limited Power of Attorney is executed this
30rA
day of M/41 , 2002.
David . z
SWORN TO AND SUBSCRIBED BEFORE ME by David N. Katz on this
30'h day of May, H@?
Notary blic in for the Stat o eorgia
My Commission Expires: January 21, 2006
396816.v3
Proudly sold, furnished and installed by RMA Home Services, Inc., a Home Depot authorized contractor.
3200 Cobb Galleria Parkway, Suite 200 • Atlanta, GA 30339 • Phone (770) 779-1300 • Fax (770) 984-0709 • Toll free (800) 79-DEPOT
v
IPCITY ? OF EAGAN
3830 Pilot Knob Fioad
Eagan, Minnesota 55122-1897
(612) 681-4675
PERMIT
PERMIT TYPE:
Permit Number:
Date Issued:
Cxos78'39
BUILpIN6
027550
06/03/46
SITE ADDRESS:
1065 KEEFE ST
LOT: 7 BLOCK: 1
MCKEE 3RD
P.I.N.: 10-47752-070-01
DESCRIPTION:
MAC 50UND ABATEMENT
ermit 7ype SF (MISC.)
k Type ALTERA7ION
:. 434 ALT. RESIDEN7IAL
If ??
've?
REMARKS:
FEE SUMMARY:
VALUATION
Base Fee
plan Review
Surcharge
Total Fee
$174.75
$87.38
5.50
$267.63
$11,000
CONTRACTOR: - ,qpplicant - sT. Lzc.OWNER:
BLOM CU570M HOMES 18913773 0001110 SNYDER JON
8675 135TH 57 W 1065 KEEFE 57
APPLE VALLEY MN 55124 EAGAN MN 55121
(612) 891-3773 (612)655-9585
° Z rs8
° anfca'rinaCi,on Mrr ?
` Statut?s ?r?dCx.??yr. ssi? ?a?? t1r?lfr+??€ces?:t `:, rt °;
i
._ __..,,,.m..e.... __v, '.. _..d..., :._m ?..?........_ .., .._.x, .. .. ? ,.... , r
APPLICANT/PEFiMITEE SIGNATURE
, ?,o,9.
ISSUE?loD .?SI&RA U
_ CITY OF EAGAN
q3830 :?? PILOT KNOB RD - 55122 '? ?9 ?r1 ? q
1996 BUILDING PEFZMIT APPLICATION (RESIDENTIAL) E??? •1
681-4675 MW-14
Naw ConsWClion Reauirementa_ RemodeVRep?ir Reauirements
? 3 registered aite surveys ? 2 copies of plan
? 2 copies of plans (include beam & window sizes; poured fnd. design; etc.) ? 2 site surveys (exterior additions & decks)
? 7 anergy calculaNons ? i energy ealculations Tor heated additians
? 3 wpies of tree presarvation plan if lot platted after 711193
required: _ Yea _ No
DATE: -5-' R'. CONSTRUCTION COST: I/)
DESCRIPTION OF WORK: 0 SOl&,D IMA TEAIFNT
STREET ADDRESS: _,??1 S 'ee ?G ST
LOT ? BLOCK SUBD./P.I.D. #: ?Ir}( na '?j
?
PROPERTY Name: S/V yD,? TINI Phone #: I9,? - 9S?S
OWNER '"" ""°T
Street Address-?
City: State: Zip:
' coNTRAC7oR_ Company: /YI?7/645S Phone #: ?l-3773
Street Address: 195- 'of STAl License #:
City:Aw l?f?g4?y State: r"?-- Zip,-"2iL-_
ARCHITECT! Company: Phone #:
ENGINEER
Name: Registration #-
Street Address-
City: State: Zip:
Sewer & water licensed piumber:
cfiange are requested once permit is issued.
PenaKy applies when address change ar -,
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply wit?
applicable State of Minnesota Statutes and City of Eagan Ordinances.
i
Signature of Applicant:
OFFICE USE ONLY
Certificates of Survey Received
_ Yes No
Tree Preservation Plan Received - Yes - No
RL CCNED
MAv 0 8 49s
------- -------
OFFICE USE ONLY ? ?
.
4
BUILDtNG PERMIT TYPE ? > ., .?..
0 01 Foundation ? 06 Duplex ? 11 Apt./Lodging ? 16 Basement Finish
? 02 5F Dweliing ? 07 4-plex ? 12 Multi Repair/Rem. ? 17 Swim Pool
? 03 SF Addition ? 08 8-plex ? 13 Garage/Accessory ? 20 Public Facility
? 04 SF Porch ? 09 12-plex ? 14 Fireplace ? 21 Miscellaneous
?05 SF Misc. ? 10 = plex ? 15 Deck
WORK TYPE
? 31 New Alterations ? 36 Move
? 32 Addition ? 34 Repair ? 37 Demolition
GENERAL INFORMATION
Const. (Actual) Basement sq. R. MC/W5 System
(AAowable) Main level sq. ft. City Water
UBC Occupancy sq. ft. Fire Sprinklered
Zoning sq. ft. PRV
# of Stories sq. ft. Booster Pump
Length sq. ft. Census Code. y3y
Depth ? Footprint sq. ft. SAC Cade o/
Census Bldg
? Census Unit ?
APPROVALS
Planning Building Engineering Variance
Permit Fee
Valuation: ?
?
$
Surcharge
Plan Review
License
MCNVS SAC
Cify SAC
Water Conn.
Water Meter
Acct. Deposit
5NV Permit
S1W Surcharge
Treatment PI.
Road Unit
Park Ded.
Trails Ded.
Other '
Copies
Total:
% SAC
SAC Units
(::.TS' _..' CArHN
::iAS!;:f.;_i:, i=t ?-??Ni?,,.?-J. P?:.I
E?7r.^
lWs
rArt_„ ; t., A,•99 Ir.M[::,, _>> W_9
T,'.i :,
?c ,
n;A_ ??`p 1l:s:sI' ,?:.t. i1l'? ,...,i TEi1Ki,Lr r-?• N
i I. ).
J ef
. l:,li
M;.n 9Ct;! :i.,,,,t MrLi nRD nP }.E5„25
P:.S`. 9t..10'1. l.r,-r'i f1F:t'_I_:'i:iPi 1)''n' ::,Gi)
P:.?'..:I.I .:;rt.l; :L(.n M(:I.I.i?lill AIIJ. \`IR..'J
-ir;Jl Vrf]e].p4 A..Om1.
Ct:t2C_Y ,
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CASHIUR: is F(..FiMiNAL i!io 7019
i1Q I;:. : I. I./?ki9=? 1 TIa':: iW:i:33
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IAMi ,: IzDPr..Sr i::EDMR rzrt r:•Vr;xacr c:n
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;'t.`_i.`.t 9001. 259.3 (:1.1...MStJ1\ f` T ^l .. p'.)
32i.Q 900i tnr,e; Fr:_r:rrE sr °=,ap
2f55 9031 i0E5 Kicl°.F": S(' 4.01)
300 9()01 4250 BEAVl:-F? P;?ti 139.15
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:i:7k$t.",! rf 9Fi# `?%$'sF?Y?X'?:Y,??'?'$:'t ?f Y:.%n?n'%n'ikYr:n;;XrXzi 1XsKWM?:t$s#Y,e7?';M
I
1999 BUILDING PERMIT APPLICATION (RESIDENTIAL)
J?? ?] 1
New Conshuctlon Reaulremenh
CITY OF EAGAN
3830 PILOT KNOB RD - 55122
651-681•4675 ?r?yy h? Dv
? 3 registered sRe surveys showing sq. H. d lot, sq. H. of house
and gll roofed areas (20% maximum lof coveraae allowed)
> 2 copies ol plans (show beam 3 window slxes: poured Ind. deslgn; efc.)
> 1 set of energy calculation:
> 3 copfea of hee presenatlon plan IF loi plaMed after 7/1/93
DATE: dzk
. _ ?_ .
DESCRIPTION OF WORK:
STREEf ADDRESS:
LOT: '-I BLOCK: SUBD./P.I.D. #:
Name:,,L ` oy-?C¢4 Phone #: GS/-L
PROPERTY LOSf Fi"t
OWNER i / „ /
Sheet
Remodel/Reoah ReaulremenH /S"?
2 eoples of plan I k -?
1 set of energy calculations lor heWed addlNons
1 sNe survey tor extedor add8lons a decks
CONSTRUCTION COST: 2,2 ?,
City Stafe: Zip:
Company`-??? Phone #:
(area code)
CONTRACTOR
Street Addresszwe License #?o/27.?.?? Exp.? "
CitY 62ZC411? State'?? Zip: Ss?a z
ARCHITECT/
ENGINEER
Telephone #: area code (
Streei
City
t.
. Sewer & water Ilcensed plumber (reauired for new construeflon onlv):
Name:
RegisfraHon #: _
State: Zip:
6 Penaliy applles when address change and lot change Is requested once permH Is Issued.
I hereby acknowledge Ihaf 1 have read ihis applicatbn, state that ihe Intormatlon is cortect, and agree to com ly wMh all applicabl
State of Mlnnesota Stotufes and Cify of Eagan Ordinances. n n
Certificates of Survey Received _ Yes
Slgnature of Appllcani:AL?
OFFICE USE ONLY
No
Tree Preservation Plan Received - Yes - No - Not Required
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 4-plex ? 11 10-plex ? 16 Fireplace ? 21 Porch (3-sea.)
? 02 SF Dwelling ? 07 5-plex ? 12 12-plex ? 17 Garage ? 22 Porch/Addn. (4sea.
? 03 1 of _ plex ? 08 6-plex ? 13 16-plex ? 18 Deck ? 23 Porch (screened)
? 04 2-plex ? 09 7-plex ? 14 Apartments ? 19 Lower Level ? 24 Storm Damage
? 05 3-plex ? 10 8-plex ? 15 Lodging ? 20 Pool ? 25 Miscellaneous
WORK TYPE
? 31 New ? 35 Tenant Impr ? 39 Gas Line Only ? 43 Siding/Soffits/Fascia
? 32 Addition ? 36 Move Bldg. ? 40 Gas Insert ? 44 Windows/Doors
? 33 Alteration ? 37 Demolish Bidg.* 0 41 Wood Stove ? 45 Fire Repair
? 34 Repair O 38 Demolish (Interior) ? 42 Reroof
" Give PCA handout to applicant for demolition permit
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Width
APPROVALS
Planning
_ Basement sq. ft. Census Code
_ Main level sq. ft. SAC Code
_ sq. ft. No. of Units
_ sq. ft. No. of Bldgs
_ sq. ft. MC/ES System
_ sq. ft. City Water
_ Foatprint sq. ft. Boaster Pump
PRV
Fire Sprinklered
Buiiding Engineering Variance
Permit Fee !? ?-
Surcharge U L
Plan Review
License
MC/ES SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI,
Park Ded.
Trails Ded.
Other
Copies
Total: I s ? - -4 (?,
Valuation: $
i
I
SAC Units
% SAC
MASTER CARD
0
OWNER
/
STRUCTURE AND
LAND USED AS
Permit
No. ?
Issued Issued To
Coniractor Owner
BUILDING
PLUM8ING za-sL _?-?'-zd
CESSPOOL - SEPTIC TANK
WELL
ELECTRICAL
HEATING
GAS INSTALLING i
SANITARY SEWER I
OTHER I
OTHER I
0
r
Items Approved
(Initial)
Date
Remarks
Disfante From Well
FOOTING b SEPTIC
fOUNDATION CESSPOOL
FRAMING r ? P TILE FIELD FT.
FINAL
ELECTRICAL
HE,4TING I DEPTH
OF WELL
-i
GAS INSTALLATION _
SEPTIC TANK
CESSPOOL
DRAINFIELD
PLUM8ING
WELL
SANITARY SEWER
Violations Noted
on Back
COMMENTS.
COMPLIANCE INSPECTION R,EPORTS
TO BE USED ONLY IN EVENT OF OBSERVED VIOLATIONS
r 1
?
PERMIT NO. DATE OF INSPECTION
CONDITIONS OF CONSTRUCTION AT THIS INSPECTION
? NO EVIDENCE OF NON-COMPLIANCE
OBSERVED.
1:1 ACCEPTABLE SUBSTITUTIONS OR
DEVIATIONS.
? NON-COMPLIANCE. BUILDER WILL COMPLY
WITHOUT DELAY.
ITEMIZFD AND DESCRIBED AS FOlLOWS:
11 NON-COMPLIANCE. BUILDER DOES NOT
INTEND TO COMPIY.
? COMPLETION OF CERTAIN IMPROVEMENTS
WILL BE DEIAYED BY CONDITIONS BEYOND
CONTROL.
2 'J X ti
24 =
:
5?8x:
1 2 -
a'37 6 T
? REINSPECTION REQUIRED DATE OF REINSPECfION
REINSPEGTION REVEALED
CERTI fICATION -1 cenify that I have carefully inspected the abwe in which I have no interest present or prospective, and that I have reported herein
all significant conditions otserved to be at variance with ordinances of the Town of Eagan, approved plans and specifications, and any specific require-
meMS for off-si[e improvements relating 2o the property inspected.
? ALL IMPROVEMENTS ACCEPTABLY COMPLETED
Bt11LDING INSPECTOR DATE
NTS
LJ
OgLFtP 2
?
?
?
?
?
?
?
?
?
?
?
?
?
?
?
?
?
i
i ? oT 1
?e?r? eD 4 Q/?i? a?v
. ??
? ?.
?
?
?
? ? 'eae/ t? N C),? 21 rC Ca ..'S / -1
?*************k************k****k******
CITY OF EAGAN
CASHIER: JS TRRMINAL NO: 794
DATE: 09/28/00 TIME: 13:50:05
ID:
NAME: DOUG CARLSON INC
3210 9001 1065 KEEFE ST 125.25
2155 9001 1065 KEEFE ST 3.00
Total Receipt Amount: 128.25
CR137971
USER ID: JAN
2000 BUILDING PERMIT APPLICATION (RESIDENTIAL)
430)-N 3830 PILIOT KN B RD - 35122 l?9. ?
? 651-681-4675
New CauhucXOn Reaulrernenh
D 3 replstered iite wneys Ywwiny p. M, of lot, aq. rt. ol houae
antl gff rooted areaa (7A% mczlmum bt covemae ailowedl
D 2 capiea of plans (show beam R wlndow alzea: poured Ind. design; etc.)
? 1 ief of eneryy CdCUlCtlonS
a J coples ot hea prefervaHOn Plan H Ipt plotled afler 711/93
DATE: `I - :;;+ J` - O v
DESCRIPTION OF WORK:
STREET ADDRESS:
LOT: /
0
Remodel/Reoair Reaulremenh
2 copies W plan
1 set ot eneryy cdcWOtlons for healed addiMOns
1 sNe wrvey lor exledor addinona & decks
CONSTRUCTION COST:
x S LYI. e c?
BLOCK: ? SUBD./P.I.D. /:
PROPERTY
OWNER
Name: ?SrL `f ?E r ?c> il Phone 0: ?os ? - ?n ?ro ? ?? a S
la Firsi
Sheet Address: 1 U6S T?E, E -ce- ST e e-' l
dy state: N2 /1l zip:
. Company: S J0 c.c 6 cuGt,r 1SOn Z2C. Phone#: 75I;z, ?Idf z4zc?"
(area code)
COMRACTOR
SheeT Address: --) 45 -/.3.q ? f r?e ucense a?3?a Exp. Z91
cny ?,/?iPe ?e l??il? y stare: up:
ARCHITECT/
ENGINEER Company: Name:
Telephone M: ( )
Sheef Address: , Regkha8on p:
I IP: SEP 2 8 2000
cny state: z
,
3`-'?-- - - -
Sewedwater licensed plumber fH installina sewer/waterPhone #: (
I hereby acknowledge Ihat 1 have read lhis applicafbn, afate that Ihe InfomnaHon fe ortect. and ? fo compy wNh atl apPliwble Stafe
of Minneaota Slaiutea and Cily of Eagan Ordirwncea
Sigrwture of Applicant
OFFICE USE ONLY
Certificates of Survey Received _ Yes _ No Tree Preservation Plan Received _ Yes _ No _ Not Required
OFFICE USE ONLY
BUILDING PERMIT SUBTYPES
? 01 Foundation O 07 05-plex
O 02 SF Dwelling O OS 06-plex
O 03 01 of _ plex ? 09 07-plex
O 04 02-plex O 10 08-plex
? 05 03plex p 11 10.plex
? OB 04-piex ? 12 12-plex
O 13 16-plex
13 17 Garage
O 18 Deck
O 19 Lower Level
Plbg Y or _ N
? 20 Pool
O 21 Porch (3-sea.) O 31 Ext. Alt - Multi
O 22 Porch/Addn. (4-sea.) O 33 Ext. Alt - SF
? 23 Porch (screened) O 36 MuRi
? 24 Storm Damage
O 25 Miscellaneous
O 30 Accessory Bldg.
WORK TYPE
? 31 New ? 36 Move Bldg. ? 43 Reroof
O 32 Addition ? 37 Demolish (Bldg)• ? 44 Siding
0 33 Alteration ? 38 Demolish (Interior) O 45 Fire Repair
? 34 Repair ? 42 Demalish (Foundation) ? 46 Windows/Doors
• Give PCA handout to appl icant for demolition permit
GENERAL INFORMATION
SAC Code
No. of Units
No. of Buildings
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
W idth
Basement sq. ft.
Main Ievei sq. ft.
sq. ft.
sq.ft.
MISCELLANEOUS INSPECTIONS
? Stucco/Stone
sq. ft.
sq.ft.
Footprint sq. ft.
Census Code
MC/ES System
City Water
Booster Pump
PRV
Fire Sprinklered
APPROVALS
Planning Buiiding Engineering Variance
?ermit Fee Valuation: $ _
Surcharge
Plan Review
License ?
MC/E5 SAC
City SAC
Water Conn. '
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
SAC Units
% SAC
09/11 '95 10:57 ID:DqCGTA COUNTY PF{YSICAL D FAlf:612-891-7031
PAGE
Municipai Notice of Well Permit Application
Dakota County Environmeetal Management bepartment
Weter and Land Management Section
14955 Cialaxie Avenua West
Apple Valley, MN 55124
Tci (612) B91-90] 1 Fax (612) 891-7031
DATE; Septam6er 11, 1995
'P0: Tom Colbert/Wayne 5chwanz Fax #: (612) 681-4612
FROM; Water and Land Management
RE: Well Permit #: 95•9233
Municipality: Eagsn
5 e6, ?'
Well Type: _Demestte- °J
6nvironmental Speeialist: Rutten
The Weter and Land Management Section of the Dakaa County Environmental Management
Dopardnent has reaeived tha following partnil appliostion for tha wall dasoribad. ]f you require further
roview nf the appiication ar if you have any questlons or concerns about it, contact the Environmental
Specialist listed above or ottr office at (612) 891-701 t. 1f Ihere is no rs,sponsa from yaut affica wilhin 24
HOURS (eacluding weekends and holidays), we will assume that you heve no abjections to the issuanr.e of
the permit. Please note that permit issuance is always canditioned on the permit applicant's observancc of
and compHance wlth al1 appBcabtc stato, caunty, and municipat taws and codos.
Well Contracwr: F.H. Renner & Sona
Date application receivCd: Septem6er 8, 1995
Anticipated Drilling Date: Time; '?"*•""
Anticipated Grouting Date: J I_ Time: "••'+'+
Property Owner: Kurt Blair
Well Ovmer: Kurt $lau
R'ELL LOCATION:
PLS Coordinates: nwl/4 swl/4 swl/4 Sec 2, Town 27, Range 23
Street addross: ] O65 Keefe St 'n
PINNumber:
WELL INFORMATIONs
Diameter: 3
Casing depth: •6+«tsrr
Total depth: 100
Static Water Level: 40
Aquifer: uneonsolldated sediments
COMMENTS:
R-95% 612 891 7031 09-11-95 10:52AM POOI 442
r-
2005 RESIDENTIAL BUII.,DING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New ConstNdion Reauirements RemadellReoair Renuiremenb Office Use OnN
3 registe2d sile suneys showing sq. ft of lot, sq. fl. of house; and all roafed areas 2 copies of plan Cart of Survey Recd _ Y_ N
(20°h maximum kt coverage allowed) 1 set o( Energy Calculatlons for heated additians Tree Pres Plan Real _Y _ N,
2 wpies of plan showing beam & windaw sizes; poured tound design, etc. 1 site survey for addNons & decks Tree Pras Requlred -_Y _ N
lsetofEnergyCalculations Addftion-indiceteNonsdeseptlcsystem OnaileSepUcSystem _Y _N
3 copies of Tree Presenafion Plan rf lot plaped after 711193
Rim Joist Delall Optbns selec6on sheet (buildirgs wtth 3 arless untls)
Date (_0 14epl/ oS Construction Cost
Site Address 10?OCJ K- P{ 5? . UnitlSte #
Description of Work 0or? 1 JIDfati 1K Jof- ""W1n
_
Z
1
0
Multi-Family Bldg _ Y_ N Fireplace(s) _ _
_
O
C'l ?h Telephooe # kQn (O W0 ^ !Za?? J
wner
Property
PELLA WINDOWS & DOORS
Contractor 15300-25TH AVE. N. STE. 9100
Address PLYMOUTH, MN 55447 _ City
State 763-745-1400 1'elephone # ( )
LICENSE # 20165884
cl7 .
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Categorv 1 Minnesota Rules 7692
Energy Code Category , Residential Vantilalion Category 1 Worksheet • New Energy Code WoAcsheet
(Jsubmissiontype) Submitted Submitted
. Energy Envelope Calculations Submitted
Have you previously constructed a building in Eagan with a similar plan? _ Y _ N If so, 25% plan review
fee applies.
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone # (
Telephone # (
Telephone #(
I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a
permit; that the work will be in accordance with the approved plan in the case of work which requires a review and
approval f plans.
?C,?'o?
pA icl anYs Printed Name Applicant's Signature ,
bFFICIE USE ONLY
Sub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? OS OB-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 EM. Alt - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex ? 19 LowerLevel ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Yor_ N O 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteretion ? 37 Demolish Building' ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement ' 'DemollGon (Entire Bldg) - Give PCA handout to applfcant
Valuation Occupancy MCES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const Width
_ Footings (new bldg)
_ Footings (deck)
_ Footings (addition)
Foundation
Drain Tile
Roof Ice & Water Final
_ Framing
_ Fireplace _ R.I. _ Air Test _ Final
Insula[ion
Approved By:
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
REQUIRED INSPECTIONS
_ FinaVC.O.
_ FinaVNo C.O.
_ Plumbing
HVAC
Other
_ Pool _ Ftgs _ Air/Gas Tests Final
_ Siding _ Stucco _ Stone _ Brick
_ Windows
_ Retaining Wall
Building Inspector
° Wd9N •g 'uor amil paniaaay
Pet1a Windaws &Doors - Twin Cities, Inc, 15300 25TI3 AVE. N. STE_ #100
PLYMOVFfL ?vIId 55447
763Y745-1400
3une 8, 2001
City of Sagan
3836 Pilot Knob Road
Eagan, MiV 55122
Dear Jan:
WATS 1-500-062-5359
FAY763/745-1401
Elder 7ones Corparation is authorized to pull building permits for Pella Windows &
Doors -'Itvin Ciries, Inc. Please allow their representstive to provide that service for us
in Eagan. This authorization shall be valid vntil su6h time as the division manager
expressly revokes it, in writing to the City.
I request that this auttwrization be accepted expeditiously, so as to not delay the
processing of our bnilding permits any further. Please catl me if there are any questions,
I can be contacted at 763-745-1432.
Yow- iirunediate attention to this matter is appreciated.
' cerely,
?-:? W.
SANIM
Bryan . May ? l?omiYRmeo
Replacement Sales Manager w ? gt,qq?
cc: Kaza - Eldcr Jones ??i'LQ.?'R- ?-??? ?" ?'" ?
Denna Krafly - ReplacemenY Sales Process Coordinator
Windows, Doars,
& Skylights
7nn ifi
C'STTTn I.TTAT T1lS
bIST Cb/ 9T6 VS7S /T:CT TAd rnionion
For Office Use
Permit
city of EaftaIl
Permit Fee:
3330 Pilot Knob Road
Eagan MN 55122 Date Received:
Phone: (651) 675-5675
Fax: (651) 675-5694 Staff-----------------
2009 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: Site Address:
- - -
Tenant: Suite
5~
RESIDENT ! OWNER Name: Phone: _1 L 5
Address / City / Zip: `*y~^'~~ !S1 --1--1-.E- J ? -
f 1
CONTRACTOR Narne: License
rr J
Address: b Ai G.f (q
City: , Gt f _ _ State: }4 N Zip:
Phone: J 31j_() Contact Person:
TYPE OF WORK New yReplacement Repair Rebuild _ Modify Space _ Work in R.O.W.
Description of work:
PERMIT TYPE RESIDENTIAL
Water Heater -Water Softener
Lawn Irrigation Add Plumbing Fixtures
L__ RPZ / PVB) Main - Lower Level)
Septic System Water Turnaround
New
ent
RESIDENTIAL FEES:
$50.50 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $.50 State Surcharge)
$30.50 Lawn Irrigation (includes $.50 State Surcharge)
$50.50 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround` (includes $.50 State Surcharge)
*Water Turnaround (add $165.00 if a 5/8" meter is required)
$100.50 Septic System New ($10.00 per as built) (includes County fee and $.50 State Surcharge)
$90.50 Fire Repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge)
TOTAL FEES $ •
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.
X_ x
Applicant's Printed Name Applicant's iature
FOR OFFICE USE Reviewed By: Date:
Required Inspections: Under Ground Rough In Air Test -Gas Test -Final
j
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA130292
Date Issued:04/15/2015
Permit Category:ePermit
Site Address: 1065 Keefe St
Lot:7 Block: 1 Addition: Mckee 3rd
PID:10-47752-01-070
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:
Census Code:434 -
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 by law in ALL single family homes .
Description:re roof main roof and garage
Valuation: 4,000.00
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 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 -
Jon M Snyder
1065 Keefe St
Eagan MN 55121--141
Polar Builders Inc
1103 West Burnsville Parkway
Suite 110
Burnsville MN 55337
(763) 370-0074
Applicant/Permitee: Signature Issued By: Signature