3859 Mersey Way,CIT-Y'OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
INSPECT'IUN RECORD fControl No. 033-4
PERMIT TYPE; N111 L U 1 Nfe
Permit Number: 0l010:1
Date Issued: 8 4 I9` f
SITE ADDRESS: LOT, 11
.3059 MkRStY WAY
[:OVENiRY PASS 3RQ
PERMITPUBTYPE:
APPLICANT:
I Hu RCf T ilUNO CO [llt;
(61z) 671-1i304
TYPE OF WORK:
KEu
INSPECTION
FUOi'INii .
F14A#11NCi INSUlAFi011
.?
f1NAI FIREPLACE
+tfMARi:hr R1:CE IP7 N 5h41 PI.HR. - VAII.EY PL1l04HxN6
Pt?mH No. Permlt Holdw Data TebphoM #
SNV
PLUM8ING P4•. 2/0
NVAC ?P???• ? ?/Y??
ELECTR ?
ELECTRIC
hnpoation Dabs Inap. Commenta
Footings I s?L !
Foundetion s c
1
Fran,mg Co - G
Roofing
Rough Plbg.
RotiBh Ht9-
w'' G z.
FirWiace ` -
Final Htg. I 9 9 -U
Orsat Teat
Flnal Ptbg. 7al Plbg. Inepector- Notify Plumber
Const. AAeter
EnerJPlan
Bldg. Firtal
Dedc Ftg.
peck Ffnal
weli
Pr. Diap.
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
SITE ADDRESS:
'. I'lI t- .i 1 WA'f
? ii'vl tJ I 1:'. 1'A .'. ,itii
PERMIT SUBTYPE:
t,, . I
APPLICANT:
TYPE OF WORK:
Idlf ) 1 11 I N ts
dr .tttt.!,
Nb/t'?l1+4
i rIa tiii i i n:
_. _._ ?- _ _ . .. ..
? J
INSPECTIUN RECORD
PERMIT TYPE:
Permit Number:
Date Issued:
Permit No. Permft Holder Date 7elephone M
S1VN
PLUM6ING
HVAC
ELECTRIC
ELECTRIC
tnspection Date Insp. CommeMs
Footings I
Foundation
Framing
Roofing
Rough Plbg.
Rough Htg.
Isui.
Freplace
Final Hlg.
Oraat Test
Rnal Pi6g. Plbg. Inspectw - Noti(y Plumber
Const. Meter
Engr./Plan
Bldg. Final
Do.* Fis.
DeCk Final 7 / Q
'
Weil AAV
Pr. Disp.
J? , '4F '?
(gertifirate uf (Orrupaury
Citp of (Cagatt
19"Mrtmraz n# Twamg inwrtwu
7his Centfrnate bSUed pursuant ta the requlrrnrents of Section 306 ojthe Unrform Building
Cede certifying Ihat at the dnre of issuance this structure wns in coniplianoe wflh the r+atous
azlinwtc+GS of the Gyty rrSukdn% building construction or m For the foUowing.
tbe a.ffecuica SF DGG/GAR ef& namu t+& 382
? I Rl VN
o•ncr T1ve ?J?rIT?ID 00 ? ? ..,--- 520 I E FZIV R ItD, FRIMEY
Daw 7/24/q2
POST IN A COHSPICUOUS PLACE
.???*V'jW
CITY 4F EAGAN
454-8100 "
DEPT. OF BUILDING INSPECTIONS
Correction Notice
Located at 3is y.??;Z s C ? I have this day inspected fhis structure and
these premises and have found the following
violations of city codes governing same:
c?e /_?? ?j c?`,T r;r,dT ,-f,i,z =5 j--;"L:- / ?L-/ -
': _,-?iL??vG „i .?.-L?? 1??/}Tc` ??/c?i?
?
?•: ; ?'1 r l?'%,`, y,v C.?J v-,,/ r 1
When corrections have been made, please
call 454-8100 for inspection.
,
Date
Inspector City of Eagan
DO NOT REMOVE THIS TAG
15Z- ?/S
?
???
J 43? ii ? d ?v6sv?
Requesl Oate Fire No. g in Inspection
' gtl?
;ReaOy Now ? WIlI
Nmity Inspector
s-) Z'q Z r. Ves ? N. When Reatly?
I?' censed contractor p owner hereby request inspection of above electrical work at:
Job Adtlress (Sheep BoM ar qoule Na.) Ciry
? ss h ?1
Section Nor' TownS?ip Nama or Range No. Counry
?
OccupeM fPRINT7 Phone No.
'1k
Pawe Supplier n
/V/r ? / Address
Eiech¢
pan Name) Conlroctor§ lirense No.
=
? ??I-do3g
Matling Atltlress ICOnlracmr or Owner Making InslallaGan,
Amhorrzed S-gnaWre iComr or/Owner king Inslallation Phane Number
' ?v
MINNESOTA STATE 60ARD OF ELIECTHICITY THIS INSPEGTION FEQUEST WILL NOT
Griggs-Mitlway BIAg. - Room S-173 BE AGCEPTEO BY THE STATE BOAFD
1821 Oniversity Ave., SL Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS
Phone(614) 602-0800 ' ENCLOSED.
n 12.lCjZ- REQUESTFOR ELECTRICAL INSPECTION
? See InsVUCtions br completing Ihls form on back ol yellow copy.
`??` (?
J U O IJ l? "X" Be/ow ItYOrk Cwered by This Request
ew Atltl Rep. -''-TypeofBuilding AppliancesWired EquipmentWired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt Building Dryer Other (Speciy)
- Comm./Industrial Furnace
Farm Air Contlitioner
Other (syecily) Comrector's Remarks:
Compute Inspection Fee Below:
# • ' Other Fee # ServiceEntranceSize Fee # Circuits/Feetlers Fee
Swimming Pool 0 to 200 Amps 0 to 100 Amps
Transformers Above 200 _ Amps Ab 700 _ Amps
SIgnS Inspector's Use Only: TOTAL
Irrigation Booms /J 6-D 5-8
Special Inspection
Alarm/Communication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF N07
Ofher Fee COMPLETED WITHIN 18 MONTHS.
I, the Electrical Inspector, hereby
tif
th
t th
b
i
i Rouyn;n Date
cer
y
a
e a
ove
nspect
on has
6een made. F;,,ai c Dater^
OFFICE USE DNLY
Tnis fequest voitl 18 monlhs irom
?' 1?
J 4306
Pequest Dat9 Fre ugh-in Inspec[ion
p uiredP ? Reatly Now f2'Nill Notity Inspettor
y Yes L No Whan fleady?
IFzlicensed contractor ? owner hereby request inspection of above elecirical work at:
Job Atltlres9($trael. Box or RoWe No.)
0 City
3 SS9 dt?
Section No. Towns?ip Name or No. Range No. Counry
• L
?^KFw?
Occupam RINT) Phone No.
Power Su Atltlress
?
? - KJlt?
Electncal
mpany Name) CqnVactor5lb¢nse No.
?
Val C oa 38I
Mailin9 AtltlrB551C00VaMOr Or oWne! Mdkin9 In9tallatlon)
Rulnorized SignaWre ?COnVactor wner M n non) Phone
Number
= I
V
MINNESOTA STATE BOARD OF ELFJGTPICITY THIS INSPEGTION FEpUEST WILL NOT
Grigga-Midway 81tlg. - Room S173 BE ACGEPTED 9Y THE STATE BOARD
1821 Univenity Ave.. 51. Peul, MN 5510e UNLESS PPOPER MSPECTION FEE IS
Vhone (612) 642-0800 ENCLOSED.
REDUEST FOR ELECTRICAL INSPECTION ee.ooom-oe
j43068 See instrudmns Iq; complEJap Ihis brm on back of yellOw copy
X" Be/ow Work Covered by This Request
e Add Rep. ? Typeoteuilding AppliancesWired EquipmentWiretl
Home Range Temporery Service
upl ex Water Heater tin
A pc Building Dryer Other (Speciy)
omm./Intlustrial
C Furnace
arm Air Conditioner
Other (syecity) Contractor's Remarks:
Compute lnspection Fee Below:
k Other Fee # ServiceEntranceSize Fee # CircuitslFeeders Fee
Swrimming Pool 0 to 200 Amps 0 to 100 Amps $
Transformers Above200_Amps ve 0_Amps
Signs Inspecmr3 Use Only:
? TOTAL
Irrigation Booms
73 ( SO
7 3
Special Inspection
Aiarm/Communication THIS INSTALLATION. MAYBE O DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MO S.
I, the Electrical Inspector, hereby
tit
th
h
b
i Rouyn-in o e_)
cer
y
at t
e a
ove
nspection has
been made. Ftnal f e ?
?
OFFICE USE ONLY ?
This requast vaitl 18 months imm
Address: 3859 MERSEy WAy Lot I I Blk 2 Sec/Sub COVENTr_tY PASS 3RD
These items wexe/were not complete at the time of the final inspection.
Date: 7 24 92 Yes No
Fina1 grade (6" from siding) d/
Permanent steps - garage ?
Pexmanent steps - main entry
Permanent driveway
Permanent gas ?
Sod/seeded grass ?
Trail/curb damage
Pozch i?
Basement finish
Deck
Please verify vith tha bullder the removal of roof tast caps from the plumbing
system and the shut•off of watar supply to the outside Lawn faucet beFora
freeze potential exists. ?
u.eowex
White - City copy Yellow - Resident copy Pink. - Contractor copy
,., ..
* * * * 2422 Enlerprise Dilve
* PIONEER uumwRvcroio.crvan.ainccIrl, MendotaNeights,MN55120
011g nAQ1' flg ,.. LANa nArmeM. uNOSCAre AwcroiccTe
* * (siz) 681-1914
. Certi(icete ot Survey ior: ! HE K0TTC(/ND COMPqNY_ LNC.
Hoose addwess - M<<sey
Noose Medel - f1 pPI<?e.. NURTH
' /'Tlna.?tM
a ?. e s T4A °L1`12f
?
0SO
? ° ??• / \
o /
S/ II
/A; \
o?
OD \
\
\
? .,
S9B? 86
0? V,?s???? a4
r?
pA4f?.?
co
(bhn?\ /
60
IZNGINEERIAIG D
• 900.o Denofes Exislin Elevofion Prx?POSeo HousE f[.Ev
? oo.o Uudes Prvjvo?Erl Elew/ia0 Lowes /oor Elrva ion 8 ai, 9 z
-------- Ueno%sDmino eiUlr'li.ly £vsement ToporBloekElevolion eg a,o3
-•---- Denadrs Drtiri?p' Flor?'Direelion GarrleSlab Elevation sa9,1
0 lJpn?ei Monuh3enl Bmrings shown are vssumxed o[k,os q e f,fib
LOTLL, BL OCA! 2, COVENTaY f'Q95 3IM ADDI TION
D<7KoTl? CbUNrY? MINNESOrA
1 hnebY mrtlh thet thtf gurrey, plen or report M?f,p,r1e?pe?.M bY ?m under my dlroel fupervlsioa end thpt I nm duly Repiqned Lend Smvayor
under tAe I?n ol fhe Sute of Mlnnewta. Daled ehls?der oI AP r:t A.D. 19 ,
11 ?I,IC S?aIC . l?t ? ??-` RON.IIfP.. CI Il. EO.N0.1211
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s8.
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32\.110 0
30
0
Il5
PERMIT
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(672) 681-4675
PERMIT TYPE
Permit Num6er:
Date Issued:
BUILDING
000382
04/29/92
SlTE ADDRESS:
DESCRIPTION:
3859 MERSEY WAY
LDT: li BLOCK: 2
COVEN7RY PASS 3RD
e.w`iSdintg_Permit 7ype
Building i+tprk Type
, 4J8t Occupa-nc5"?,.
Canstruction 7y.pe
Zoning
Building Le°ngCh i
8uilding Width 5
SF DWG
NEW
R-3 M-1
VN
R-1
54
32
( 7
. _. ?_. ..?:/
REMARKS:
RECEIPT 11 L ? 13'?S&,<7)
S&W PLBR. = VALLEY PLUPIBIN6
FEE SUMMARY:
Base Fee
Plan Review
Surcharge
SAC
SAC $
SAC Units
5ubtotal
VALUATION
$688.50
$447.53
s5T.00
$700.00
100
$1,893.03
;lsa,0e0
MISC FEES $1.610.50
Total Fee $3,503.53
CONTRACTOR: - Applicent - 5T. LIC. OWNER:
THE RQTTLUND CO ItiC 15710304 0001335 ROTTLUND CO THE
5201 E RIVER RD 5201 E RIVER RD
FRIDLEY MN 55421 FRZOLEY MN 55421
(612) 571-0304 (612)571-8304
I hereby acknow2edge that I have read Chis application and state that Che
information 1s carrect an8 agree to eomply witk all applicable State ot M.n.
Statutes aniS City of Eagan Ordinances.
? E' ,C,!
APPLICANT( RMITEE SIGNATURE ISSUED BY: SIGNATURE
Control No. 0334
?
INSPECTION RECORD Control No. ri v3 4
CITYOF EAGAN PERMITTYPE: suzLoiNG
3830 Pilot Knob Road Permit Number: 000382
Eagan, Minnesota 55123 Date Issued: 0 4/ 2 9/ 92
(612) 681-4675
SITEADDRESS: LoT: 11
3859 PIERSEY WAY
COVEIV7RY PASS 3R0
PERMIT SUBTYPE:
SF OWG
aLocK: 2 APPLICANT:
THE ROTTLUNp CO INC
(612) 571-0304
TYPE OF WORK:
NEW
INSPECTtON ., . ..
SITE FOOTING
FRAMTNfi INSULATION
FINAL FIREPLACE
REPIARKS: RECEIPT N
?
L
S&W PLBR. = VALLEY P WMBING
, ,r ; i.,i.? i1?''.• r?
•ii?i i; i n.. ?.,in i
? 0,1
I /' ?
1 I'.? I 1? il, h: ' !,
? I? ?. ?• i:t 'i: ?,
1
'A : (4
r !
"1 d
?
?
PEer+r.r, r
? ?2_?
cinr oF EAc,aN
1992 BUILDING PERMIT APPLICATIQN
681-4675
-r*pfa?, f-,3-5_63 s 3
?l i
LRPR 2 7 fireo
SINGLE 8 MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy
calcs.
COMMERCIAL 2 sets of architectural 8 structural plans, 1 set of.
specifications, 1 copy of energy calcs.
Penalty applies when typing of permit is requested,,but not picked up by last working day
month in which re uest is made ar lot chan e is re uested once ermit is issued.
Date
91-- Valuation of work 133006 .
r
te Address: Na?
STREET . STE /
Tenant Name_.,__TrAP %Qwutj. C"'f-,?'. 1?'---trtC-?
LOT it BLOCK Z- SUBD. P.I.D. Y
G'6U2'r?
Descri tion of work:
The appiicant is: Owner ? Cantractor ? Other (oes«;ns)
Name ebwQvf4 (ro• C, Phone f-L-67°
Property LAST FIRST
Owner Address ??-? ? L•?? v-?
-
,
STREET STE N .
City 1==1'A.?r? /?vl State 2ip ?
Company Phone _
Contractor Address License # Exp._
City 5tate Zip
Company Phone
-
Architect/
Eng(neer Name Registration N
Address
City State Zip
Sewer & water licensed plumber ? b'H . Processing time for
sewer & water permits is two days once ea as been ap •oved.
I hereby acknowledge that I have read this application and state that the information is
correct and aqree to comply with all applicable State of Minnesota Statutes and City of
Eagan Ordinances.
?
Signature of Applicant:
• • •vr ?v v• r•
BUILDING PERMIT TYPE ,
? 01 Foundation ? 05 Apt. Bldg ? 09 Basement finish 0 13 Public Fac.
*r02 SF Dwg. ? 06 Garage/Accessory ? 10 Swim Pool ? 14 Agricultural
? 03 Two family ? 07 Fireplace ? 11 Res. Add./Porch ? 15 Miscellaneous
O 04 Multi-fam. T.H. ? 08 Deck O 12 Comn./Ind.
WOR K TYPE
pr 31 New ? 34 Repair ? 37 Demolish
0 32 Addition ? 35 Tenant Finish ? 99 Undefined ,
? 33 Alterations ? 36 Move -
GENERAL INFORMATION
Const. (Actual
? Basement sq. ft. ?f'z MWCC System ?
(A1Towable lst fl. sq._ft. Z City Water
UBC Occupancy 2nd fl. sq. ft. PRY Required
Zoning ? Sq. Ft. total Booster Pump
# of Stories Footprint Sq. ft . Fire 5prinkler
Length On-site well Census Code 707?
Depth 37,33 On-site sewage SAC Code ?
APPROVALS
Planning Building Assessments
Engineering Variance
"'11RED IM SPFrTIONS
P 5ite C? Footing Framiog ? Insulation
kg? Wtillbaard ? Final ? Draintile ? Fireplace
Perniit Fee (??keSD vew.t;a„_ s 006
Surcharge
Plan Rev9ew 59
(L -
Z?k 3% 1
License
MI?CC SAC
?mp 33k J,S: ZG, z5
'
CiYy SAC 106
Mater Conn.
Water Meter rL_
93-
-0sr- =
?1112,Z5? 68
Acct. Deposit 30
S/W Permit 30
S/W Surcharge -?
Treatment P1. 3oa 21,;Q
Road Unit
Park Ded.
3R?
-zqX3y
?. f3 - 48
Trails Ded.
Copies
Other
Total: F), Z?_
?ar
ZD.r zo,r /6
?: ----??
? 1l 3? ??I t
SAC %
SAC Units
0'.!'iY cR
? . ? . . ..
S?PE .SDDSESS
COYTR?.CTOR P-07-7?-UNL7 GO. DATF. Pi{ONc
Dete=.in woraing, square footai;e of cach.
1, lotal exposed vr11 area sR. ft. x 0'
_ e 0?6
• 2. Total roof/ceiling area .. 3?• 8 sq. ft. x ? 2G Y`
Total exposed vell area nbovc floor = Z zgl? .
a. Total uall windov a.-ea . ........................
b. Totel door a:es ................................... -:- , -JJ
c. Totzl sliding gla-ss door area ..................... '34"?7
d. Total fireplece va?1 e:ea .......................... 2 4
e. Total vall fro--ning a=ea (average lOP) ...... ...... /a- (,?
P. Total net vell area above f2oor ................... /(?3 .7 '
. B. Total rim Joist aren .:.............. ........... .2 Or?
Totsl exposed frn:ndation arca = C7? tf `
h. Total foundetion vindcv.a:ea ....................... -7 7
i. Total net foundation a-ea above grade ............. q?.G 47-
. Deter.r.ine "U" calc:e o; eech va21 ,eF;ment.
8. x„U" Q, ¢rL, = G S. b 2
? a. 43.7( X„U,. O,(38 = G•o?.
C. 35, 97 X „u„ o.?z = ?z.7y
d. Z`T X ,.?„ . CJ. f = Z. ? -
e.
J81.-7 5? X .,VI Of 02n:j = ?(P,l%
,
r. G 35.-75 X „U,. .70.3 3
. g. 7,06 X .,l1„ 0,041
h. r.5 7 5? X ,.U„
X ",,,, l4- z5
3. ............................. .. . ro r.rti = Zo 1,7?" oi?
..
If ite-m 13 is the same as, or less
!.h:Ln ite:z dl,
you nave met the intent
or ssc 6006(c)2.
f,
Totnl exposed roof/ceilinG Rren
" `l , „r?. .. . . . . -? -
Totai gross roof/ceilinn areri =
,]. Total skylieht area .......................... _
k. Total roof/ce?ling framing area . ..............
l. Total net insulated roof/ceiling area ........ A 4 ar9 ?_ '
Dete-mine "U" value for clch roof/cci I int' segment.
J,?- X liUlf --?-
•
,
q3.$8 X „u„ o.azy = 2,53 .
k:
„U„ o,?22-
. . ... .. .. . .. . . . .. ....... .. .. .: . Total _ " 21 • l f
o ;?-
If total oP N4 is the sa-ne as, or less than N2, you have met the intent of
s$c 6oo6(c)i. . .
To utilize the total envelope system method, the values establi:hed by the
sum af items H3 end 14 shall not be 6reater. thxn the sum of iten:s N1 and ,Y2-
1,
+ 4. .
, r,
o ? .
_ . ... O °
.? -Vf?I.U? GAI.Gl.Il.?'?IOI? ?GaNT).
rFAMr- WP?1-?- ? ?IN?I.ILAT1oN
, LoMPoH?r+j?,
?
12
I F-t'
;U
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a.t("['EAM AIF- Fi M
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GYP, ZD
tw- FIL?M,
- _ F - VALU E.
'
19.0
o, 45 -
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u=Rr?? ?_°43
-FFAMV wAu. ? ?TI!P
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o_uT'-!21oE AiP Rt,A.
-?Z??hl?lhl(.. .
iNhi? P?2? RLM. .
- F--VALU5
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2 ,OLr _
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?,a 3
CITY OF EAGAN FOR CITY USE ONLY
3830 PILOT KNOB ROAD
? EAGAN MN 55122 PERMIT #
PHONE: (612) 454 8100 RECEIPT # D(o=?
: :: S'i': DATE:
PLEASE COMPLETE UPPER PORTZON ONLY FOR SINGLE FAMILY DWELLINGS &
TOWNFIOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH IINIT.
WORK DESCRIPTION
NEW CONST ? Y
ADD ON _
REPAIR
OWNER NAME:
SITE ADDRESS: ?? /'/?GefE" ???'YI
LOT:BIACK oZ. SUBD. I-d
INSTALLER:
v
nnnRes s: 9303 PlynlOUtM Ave.Atn_ ?
en Vailey, MN. 55427
CITY: ZIP:
PHONE #: S7? -?/-?_ (I
FEES
ADD-ON MINIMUM C $
HVAC 0-100 M BTU ?24.00 ADDITIDNAL 50 M BTU ?T-
GAS OUTLETS - MINIMUM 3.00 '
OF 1 PER PERMIT
SUBTOTAL: $CL2 7-_Qa
STATE SURCHARGE: .50
TOTAL: $ cZ 7•s6
S NATURE OF PERMITTEE
PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTAIAL BUILDINGS,
APARTMENT BUILDINGS, AND MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE
NOT REQUIRED FOR EACH DWELLING IINIT.
CONTRACT PRICE:
OWNER NAME:
SI:E ADDP.ESS:
LOT: BLOCK _ 5UBD.
INSTALLER:
ADDRESS
CITY:
PHONE #:
FOR:
ZIP:
FEES
18 OF CONTRACT FEE.
STATE SURCHARGE _ $.50 FOR
E.;:," y1,000 Os PERN:I; FEE.
PROCESSED PIPING = $25.00
$25.00 MINIMUM FEE.
CONTRACT PRICE x 18 $
STATE SURCHARGE
TOTAL:
a
(SIGNATURE)
CITY OF EAGAN
L? 8L _ L CITY OF EAGAN
) PLUMBING PERMIT
SUBD. Q84? L3 (612) 681-4675
PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS
WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
CITY USE ONLY
RECEIPT /OS 3
DATE /a 4
ALSO, FOR TOWNHOMES AND CONDOS
WORK DESCRIPTION
NEW CONST X
ADD ON
REPAIR
OWNER NAME: :?
SITE ADDRESS:_'?
INSTALLER: V '<
ADDRESS:_ ?a 1c?1 C 12« ? L-
CITY: ) -• ? A- ZIP: C i) ?_ '
PHONE #: y? 7 - a 1 1 I
C lh \
SIGNATURE OF PERMITTEE
STATE SURCHARGE .50
v Qu
TOTAL: S U ?_?
COMMERCIAL
PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS. ALSO FOR MULTI-FAMILY
BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT.
WORK DESCRIPTION:
OWNER NAME:
SITE ADDRESS:
TENANT NAME:
SUITE #:
INSTALLER:
ADDRESS:
CITY:
PHONE #:
FOR:
CITY OF EAGAN
CONTRACT PRICE:
1% OF CONTRACT FEE.
STATE SURCHARGE _ $.50 FOR
EACH $1,000 OF PERMIT FEE.
$25.00 MINIMUM FEE.
CONTRACT PRICE x 1%
STATE SURCHARGE
TOTAL:
$
$
(SIGNATURE)
COMPLETE THE FOLLOWING:
N0. FIXTURES EA. TOTAL
? REPAIR/ADD ON 15.00
SHOWER 3.00 ?
_S WATER CIASET 3.00 a -
l BATH TUB 3.00 7'
? IAVATORY 3.00 y'
? KITCHEN SINK 3.00 ?-
1 IAUNDRY 1RAY 3.00 ?
HOT TUB/SPA 3.00
7- WATER HEATER 3.00 ?
7- FLOOR ORAIN 3.00 ? GAS PIPING OUT.
? (MINIMUM - 1) 3.00 ?
? ROUGH OPENINGS 1.50 'A -
OTHER
WATER SOFfENER 5.00
_ PRIVATE DISP. 15.00
U.C. SPRINKLER 3.00
_ W. TURNAROUND 15.00
? ClTY,.OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
SITE ADDRESS:
PERMfT
3859 MERSEY WAY
LOT: 11 BLOCK: 2
COVENTRY PA55 3R0
P.S.N.: 10-18402-110-02
PERMIT TYPE:
Permii Number:
Date Issued:
G
B U I L D I
023855
06/15/94
DESCRIPTION:
?
REMARKS:
Building-P_ermit Type DECK
rBuilding Work 7ype NEW
?
,
?
??-
\
f
.. . :, f?...... -_..
?J ? ? \?;_. '?::."=1 ?:? ti-._.i. ? V t i tl
[ ?,r
FEE SUMMARY:
Base Fee $30.00
Surcharge $.50
Total Fee $30.50
CONTRACTOR: - p,pplicant - ST. I.IC. OWNER:
PETERSON M A DESIGN BUILD 19259455 0006704 PETERSpN DESIGN BUILD
5100 EDEN AVE 1086 5100 EOEN AVE
EDINA MN 55436 EDINA MN 55436
(612) 925-9455 (612)925-9455
Y hereby acknowledge that I have read this application and state that the
information is correct and agree to comply with all applicable State af Mn.
? Statutes and City of Eagan Ordinances. J
YUr?? 4. Lmn 44m-g
? APPLICANTIPERMITEE SIGNATURE MSUED B .SIG ATURE
INSPECTION RECORD
CITYOFEAGAN PERMITTYPE: auzLorNs
3830 Pilot Knob Road Permit Number: 023855
Eagan, Minnesota 55123 Date Issued: 0 6/ 15 / 94
(612) 681-4675
SITE ADDRESS: APPLICANT:
LOT: 11 BLOCK: 2
3859 MERSEY WAY PETERSON M A DESIGN BUILD
COVENTRY PASS 3RD (612) 925-9455
PERMIT SUBTYPE: TYPE OF WORK:
DECK NEW
INSPECTION .. . ..
FOOTINGS FSNAL
F
L ?
i . , • ,
,i . - ; .
f
.. ? . i.?,
•.i. .
1
? CITY OF EAGAN
1994 BUILDING PERMIT APPLICATtON
681-4675
r-m:-_ -.?
X3(9 S D
64A-'? 1°6
SINGLE & MULTI-FAMILY sets of plans, 3 registered sit
u rveys, o y of energy
J?j
0 6 1994
COMMERCIAL 2 sets of architectural & str E?ura]_p],ans_ 1 s of
specifications, 1 copy of energy ca . '--
Penalty applies: 1) when permit is typed, but not picked up by last working day of month
in which request is made, 2) address is changed or 3) lot change is requested once permit
is issued.
Date Q A(JQ? Valuation of work
site address: 300151
STREET ?-SUITE #
Tenant Name: (commercial only)
LDT ? BLOCK o1-- SUBD. P.I.D. #
Descri tion of work:
The applicant is: ? Owner Contractor ? Other (Oescribe)
Name z " Phone
Property LAST FIRST
Owner qddress ??
STREET STE #
City 5tate Zip SS,o?l3
Company Phone 4?46- e,916:5'
COntraCtOP Address ?26/? EyJ422License #Exp.?
City State V_n Zip ?;?yb
Company Phone
Architect/
Engineer Name Registration #
Address
City State Zip
Sewer & water licensed plumber Processing time for
sewer & water permits is two days once area has been approved.
I hereby acknowledge that I h ve read this application and state that the information is
correct and agree to comply wi h all applicable State of Minnesota Statutes and City of
Eagan Ordinances. ?
,
Signature of Applicant: ,?'?-
?
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Uuplex ? 11 Apt./Lodging
? 02 SF Owg. ? 07 4-Plex ? 12 Multi. Misc.
O 03 SF Addition ? 08 8-Plex ? 13 Garage/Accessory
El 04 SF Porch ? 09 12-Plex ? 14 Fireplace
? 05 SF Misc. ? 10 Multi. Add'1. 0" 15 Deck
WORK TYPE
ID 31 New ? 33 Alterations ? 35 Tenant Finish
? 32 Addition ? 34 Repair ? 36 Move
GENERAL INFORMATION
? 16 Basement Finish
? 17 Swim Pool
? 18 Comm./Ind.
? 19 Comm./Ind. Misc.
O 20 Public Facility
? 21 Miscellaneous
? 37 Demolish
Const. (Actual) Basement sq. ft. MWCC System
(Allowable) lst fl. sq. ft. City Water
UBC Occupancy 2nd Fl. sq. ft. PRY Required
Zoning Sq. ft. total Booster Pump
# of Stories Footprint Sq. ft. Fire Sprinkler
Length On-site well Census Code Y3 i
Depth On-site sewage SAC Code oi
e
Uni
APPROVALS ensus
t ?-
Planning Building Assessments
Engineering Variance
REGIUIRED INSPECTIONS
?.5ite
? Wallboard
U Faoting
13 Final
? Framing
? Draintile
? Insulation
? Fireplace
Permit Fee
5urcharge
Plan Review
License
M4lCC SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total:
vatuecia,: g
SAC %
SAC Units
S4153 RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675
New Conatruction Reauiraments
• 3 registered site surveys stwwing sq. ft. of iot, sq. R. of house; antl ail mofed areas
(20°k maximum lot coverage allowed)
• 2 wpies of plan showing 6eam 8 window sizes; paured fowM tlesign, etc.)
• 1 sel of Eneryy Calculafions
• 3 copies of Tree Preservation Plan if lot platted after 7I1193
• Rim Joat Detail Opliona selection sheef (bidgs wilh 3 or less units)
DATE IQ - (?--02
S1TE ADDRESS
TYPE OF WOR
APPLICANT
IULTI-FAMILY BLDG _Y ZlN
FIREPLACE(S) _ 0 _ 1 _ 2
STREETADDRESS qqs Ift0colw. j4Ve'SC CITY *STATE1"N ZIP.is'/N
TELEPHONE# 6iZ33!-IY5-'5' CELLPHONE# 6i1'jIoq-(a323 FAX#
PROPERTYOWNER . 16rh DeIS6? TELEPHONE# ?aSI'?I4S'qS(oS`
COMPLETE FOR KNEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ N[IVNESOT:i R(.'Li:S 7670 CA"fEGORI' 1 _
(v submission type) • Residentlal Venfila6on Category 1 Worksheet Submitted
• Energy Envelope Calculations Submitted
Plumbing Contractor: ____
Plumbing system includes:
Mechanical Contractor:
blccli:unc:il svstcm includes:
Sewer/Water Conhactor:
Air Conditioning
I-[cat Rccovcry• Systcm
Phone #
Phone #
',l=(?Faf
MINVESO"C:? RCLES'1672
• NeiEngrgy?Co?eyWOrkspget i ,Jtimitted
" ? LLU[ ,
IEL-
Fee: 590.00
Pcc: 570.00
i hereby acknowledge that I have read this application, state that the information is correct, and agree to comply
with all applicable State of Minnesota Stptutes and City of Eagan Ordirig nces.
Signature of Appllcant ;
OFFICE USE ONLY
_ Wa[er SoEtener
? 4Vater Hea[er
_ No. of Baths
_ Phonc #
L.awn Sprinkler
No. of R.I. Baths
RemodeUReoair Reauirements
• 2 copies of plan
• 1 set af Eneryy Caiculatiore for heated adtlitbns
. 1 site survey for extenor aCdifions & decks
• Indicate iF home served by septic 5ystem for additions
VALUATION I I01S00
Certificates of Survey Received Tree Preservation Plan Received _ Not Required _
Updated 4102
OFFICE USE ONLY
11 01 Foundation ? 07 OS-plex ? 13 18-plex O 20 Poal 0 30 Accessory Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace O 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 Ot of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 78 Deck ? 23 Porch (screened) ? 36 Mutti
? 05 03-plex ? 11 10.plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plez Plbg_Y 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
? 33 Alteration O 37 Demolish (Bldg)• ? 43 Reroof ? 46 WindowslDoors
? 34 Replacement `Oemolition (Entire Bldg only) • Give PCA handout to applicant
Vatuation Occupancy MC/ES System
Census Code Zoning Ciry Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footings (new bldg) _ FinaUC.O.
_ Footings (deck) _ FinaUNo C.O.
_ Footings (addidon) _ Plumhing
Foundation HVAC
Drain Tile Offier
Roof _ Ice & Water _ Final _ Pool _ Figs _ AirlGas Tests _ Final
_ Framing _ Siding SNCCO Stone
_ Fireplace _ R.I. _ Air Test _ Final _ Windows (new/replacement)
_ Insulation _ Retaining Wall
Approved By , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
W ater Supply & Storage
S8W Permit & Surcharqe
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
2006 RESIDENTIAL BUILDING rExMIT arri.icaTiorr
City Qf Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Consirudion Reouiremenis
3 registered sAe surveys showing sq. R of IoC sq. ft of house; and all roofed areas
(20%maximumlotcoverageallowed) .
2 copies of pian shaxing beam $ window sizes; poured found design, eic. 1 sei of Energy Calcuhtions
3 copies of Tree Preservation Plan if lot platted after 771193
Rim Joist Defail Options selection sheet (buldings with 3 or less units)
Minnegasco mechanipl ventilafion form
RemodeVReoair Reauirements
2 wpies of plan showing footings, beams, joisis
1 set of Energy Gakulafions forheated addNOns
1 site survey for addiGons 8 tlecks
Add'dion - indicafe if ar-sde sepfic sysfem
??? pc?)
tilfice`Use Onlv
Ce?tofSiivey.Rectl"?Y ?[J
7reePresP3aii;lYe? ? °Y 3N.
TreePresR?9?it2d ? ?'._?' "N
Oo-sde:?eP6c,,,Syste? , ° _Y ,?N
Date ila_
Site Address
69-LusF a
r z. Construction Cost
Unit/5te #
Description of Work l?W? C) F? A}.t10 P-C S/YLy4 L-E ?.60F
Multi-Family Bldg _ YX-N Fireplace(s) _ 0 h 1 _ 2
Property Owner ?-
r /n S N 4- Y F??
= , Telephone #(lO.S1
Contractor
Address
State City
Zip Telephone # ( )
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv I Minnesota Rules 7672
Energy Code Category . Residentiai Ventllation Category 1 Worksheet • New Energy Code Worksheet
(J submission type) Submitted Submitted
• 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?
_ Y _ N If yes, date and address of master pian:
Licensed P(umber
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 pemut, 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 ofplans. " -
As$ DEL-Sv/.J
ApplicanYs Printed Name icanYs Signature
DO NOT WRITE BELOW THIS LINE
Sub Tvoes
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 AccessoryBldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) O 31 Ext. 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 (screenlgazebo) ? 36 Multi Misc.
? OS 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex ? 25 Miscellaneous
Work Tvpes
? 31 New ? 35 Int Impravement ? 38 Demolish Interior ? 44 Siding
? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
0 33 Alteration ? 37 pemolish Building* ? 43 Reroof ? 46 Windows/Doors
? 34 ReplaCement •Demolitfon (Entire BIdg) - Give PCA handout to appliwnt
DBSCription: Water Damage _ Yes
Valuation Occupancy MCES System
Pian Review 100% or 25%
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)
_ Foundarion
_ Drain Tile
Roof Ice & Water Final
_ Framing -
_ Fireplace _ R.I. _ Air Test _ Final
Insulation
Approved By:
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Piant
License Search
Copies
Other
Total
REQUIRED INSPECTIONS
_ Sheetrock
FinaUC.O.
FinaUNo C.O.
HVAC
Other
_ Pool Ftgs Air/Gas Tests Final
_ Siding _ Stucco Lath _ Stone Lath _Brick
_ Windows
_ Retaining Wall
Building Inspector
?
2444 Enlorprise Orlva
* PIONEEpt LN.oW"v.ro".crvIL 2jw1Nee1R11 Mendou Iletgble, MN 55140
uMOfteMPMEM•LwqvIIeAnewtrat[era (g1Z) 881-1914
eng neer ng
* * **
. Certilicate oi Survey tor: TyE aQTTCUND COitjPANY? L/VC. ?
Noos• Addvess - Ml,- sey W4y 1 Eo,9a.r ? rn?,,,,
Novse m°aei - Rrr14 +°^ NaRTH
CO t+m?t+ ' / Ttiav,er
4 q?,'° s TA a?12('
? s8 1 ?
K8F
b
N, 'g
OD
?
\
\
?k. ?.?
SpB.386
?
? N 1"
m?
o wC?a?•o.
QPti t,?6j '°?
? w
:`Q' 3 ao
."'
?J\ V• 0 N/ d
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t- A G A sJ 4-
F
?RpylF 1°VF' ;?
? /? ... .....,
ny _...-"'-_`J...l, ,. -. .
? -2 Y?y?
3O
0
60
V
0:;
t:
Np:a:?trnt.3 Dr;
*.9oO.o Denofes fxislin? flevalion P?aioAOSEv Hovs6 ELEV rioa
• oa. o U&roles Prupo Ed £/evalion LOWPS /oor EI[Va ion B 6 i, 9 z-
- -- D?errvfes broirto¢er Ufili?ly £asemer?f Top or''BlockElPVOlion a?o, 03
-----w- Dena?rs D+rnind?4e' F/or?"Direclian Gar?or SIaG Elevafion ae9,i
o Aenavii Monuffienf Bwrings sliown ar-e tyssurmo+ n Dpne es q hLb
LOTJL-,BLOCI! Z, COVENT,QY PASS 3k'D ADDITION
OqKoTn CU!/NtY, M/NN£SOTA , - -
1 h"e6Y eNtlty Ihat Ihli lurveY. plen or raporl w.?U?P.r1e?psreel 6Y me m voder my dlreH fapIrvylen end Ihat I Im duly Repqlerad lorwl Emvhra
umMr thr bm al the Slne ol Mlnrofau. DatM o1 A1P r: I A.D. 19 .
i'1qq,,5 Yca/e IL"cb, 'TV f t Rflfl_?f p.. q I1. EO.NO.Irl11
Date:
City of Eaau
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
RECEIVED
FEB 1 9 2016
Use BLUE or BLACK Ink
For Office Use
Permit #: _
Permit Fee:
Date Received:
Staff:
2016 MECHANICAL PERMIT APPLICATION
❑ Please submit two (2) sets of plans with all commercial applications.
Z-` Z:�r LP Site Address:
35(1 V/1°z,z.yL.y y
Tenant: ee, 1 L O Suite #:
kr }
23i etlt��M/IC1E#r
c
Name: C,..(4.11:-- (:� :-)1: \,`, �.Q� Phone: 612- - -1..!,..)0- i',43(0'-10
Address / City / Zip: .-Si.SC\ hoc( -g.`;; 1 l:�wL,. 4Z..A[7)\1.': at,. ,. 37.)\` .3
Conttlr ctor
<
Name: Vi--1-V4q. t4,4' ASIC, 1-k C . License #: M 6` `y*_t "I
Address: q3 .\ Q�`1'CO i:1 1 I-\ 2cc, ti City: 17)3Lc ai \J - ..ccy
c-
State: Maj Zip: 559-1-- Phone:1.vc 5 •`t1-` ‘\tv
Contact: 1)C-,3 ,S N i+,1Q53i') Email: tir1c, `1<'7,'t'-
P 7
"� to i✓iib
}
New J Replacement Additional Alteration Demolition
Description of work:
} _
Perm t'
f yj}y(/ij y{ �'j�j
A"wRoo}]ypmoun �{$ r
RESIDENTIAL
Fumace
�ug5 K
COMMERCIAL
New Construction Interior Improvement
C R
Air Conditioner
Install Piping Processed
Air Exchanger 9
Gas Exterior HVAC Unit
Heat Pump
Under/Above ground Tank (_ Install / Remove)
Other
RESIDENTIAL FEES
$60.00 Minimum Add or alteration
to an existing unit, includes State Surcharge <,
includes State Surcharge = $ TOTAL FEE
$100.00 Residential New,
COMMERCIAL FEES
$60.00 Permit Fee Minimum
Contract Value $ x .01
= $ Permit
Fee
FEE
$70.00 Underground tank installation/removal
Surcharge = Contract Value x $0.0005
If the project valuation is over $1 million, please call for Surcharge
= $ Surcharge
= $ TOTAL
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.
tJ
x l�
x IH1)51p63'
Applicant's Printed Name
FBF 'OFFICE USE
Required Inspections.
App
Signature
Underground Rou
Test
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA146482
Date Issued:10/27/2017
Permit Category:ePermit
Site Address: 3859 Mersey Way
Lot:11 Block: 2 Addition: Coventry Pass 3rd
PID:10-18402-02-110
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:Two or More Windows/Doors
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow
windows, call for framing inspection. Call for final inspection after installation.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
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 -
Eric H Sagvold
3859 Mersey Way
Eagan MN 55123
(612) 237-5938
Beissel Window & Siding Co
1635 Oakdale Ave
W St Paul MN 55118
(651) 451-6835
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA165024
Date Issued:10/14/2020
Permit Category:ePermit
Site Address: 3859 Mersey Way
Lot:11 Block: 2 Addition: Coventry Pass 3rd
PID:10-18402-02-110
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 -
Eric H & Beth A Sagvold
3859 Mersey Way
Eagan MN 55123
(612) 237-5938
Three Rivers Contracting Llc
2676 47th St East
Inver Grove Heights MN 55076
(651) 214-6640
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA176055
Date Issued:04/28/2022
Permit Category:ePermit
Site Address: 3859 Mersey Way
Lot:11 Block: 2 Addition: Coventry Pass 3rd
PID:10-18402-02-110
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 -
Nicholas Michael Barnes
3859 Mersey Way
Eagan MN 55123
Champion Plumbing Llc
3670 Dodd Rd., #100
Eagan MN 55123
(651) 365-1340
Applicant/Permitee: Signature Issued By: Signature