576 Michigan CtCITY OF EAGAN Remarks
rler
li ,
2 Parcel 10 44300 270 02
State Eagan,MN 55123
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. IRIP. 1981 1690.16 84.51 20
STREETRESTOR. 1981 1409.71 70.49 20
GRADING
SAN SEW TRUNK ..
* SEWER LATERAL ?
WATERMAIN
* WATER LATERAL iggi
WATER AREA
STORM SEW TRK 0
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN, 250.00 17516 1 15 80
BUILOING PER. 3923 1 . Q 2
SAC 450-00 zoiy -7
PARK
Receipt ?) ;? / !.• MECHANICAL PERMIT Permit No.
CITY OF EAGAN
, Fee
•.? `( ? ? ? Fill i» numberedspaces S/C
Type or Prinf legibly
Tot.
-1;
1. Date 2. Installation Cost
/ fii,( G.,t,<r- < T ;
3. Job Address 5- 7 C? Lot Blk. Tract
?
4. Owner
5. Contractor Phone 6. Address
7. City State _ !' Pp, Zip
8. Building Type: Residential l14 Commercial ? Institutional ?
9. Work Description: New ? Add f7 Alter ? Repair O
10. Describe Fuel Type
11.
No.
X Equipment BTU - M. Ea.
Forced Air e '` ') No. Equipmeni CFM
i
i
Mfg. ; u A
r Handl
ng:
i
Boilers
Mfg. Mech. Exhaust
Unit Heater
Mfg. Other
Air Cond.
? o
Mfg. ? .?, • ??/
Gas, Piping Outlets
12. I hereby certify tjwtfie above information is true and correct, and I agree to
comply with all ford?nances and codes governing this type of work.
?
Signed :
? for
Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
WATER SERVICE PERMIT
CITY OF EAGAN
3795 Pilot Knob Rood PERMIT NO.:
5agan
MN 55122 DATE;
,
Zoning: No. of Units:
Owner: -
Address: -
Site Address:
Plumber:
Meter No
: Connection Charge:
.
Size: Account Deposit:
--
Reader No.: Permit Fee: -
I agree to aomply witb the Citq of Eogan Surcharge:
Ordinanees. Misc. Charges: -
7otol:
By _ Date Paid:
Dote of Insp
CITY OF EAGAN
3795 Pilot Knob Road
Eugan, MN 55122 ,
Zoning:
Owner;
Address:
Site Address:
PI umber:
1 agree to con+ply wieh the Citq of Eagan
Ordinanees. ?
R..
SEWER SERYICE PERMiT
PERMIT NO.:
DATE:
- No. of Units:
Dote of Insp.:
Insp.:
Connection Charge:
Account Deposit: _
Permit Fee:
Surcharge:
Misc. Chorges: -
Tota1:
Date Poid:
-
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PI-68O
46 5- 55122
651
New Construction Reauiremenls
• 3 registered site surveys showing sq. ft. of lot, sq. R. al house; anll roofed areas
(20°k mazimum lo(mverage albwed)
• 2 copies of plan showing beam & window sizes; poured found desgn, etc.)
• 1 set of Energy Cakulafions
• 3 copies of Tree Preservation Plan if lot platted aker 711193
. Rim Joisl Detail Options seleclion sheet (bldgs Wrfh 3 or less units)
DATE ZU - °/ - ZUU l
JOB SITE ADDRESS ? 7? A?'i %C- 94 A/ v7'-
IF MULTI-fAMILY BUILDING, HOW MANY UNITS? _
PROPERTY OWNER MA- 9i cd012c? f/,t i
TYPE OF WORK 4e-a; c? C FIREPLACE(S) _ O_ 1_ 2
APPLICANT (J?s?,./ ?:J t ?G11l9?ow?s? ??C- PHONE# 952- 89E /?/
,
ADDRESS 2 / <;J G'i e, ?v,I? Gira,. ZIPCODE SS3? `
PAGER # CELL PHONE #
PAX #
NEW RESIDENTIAL BUILDING ONLY- FILL OUT COMPLETELY
Energy Code Category _ VIINNESOTA RUI.I:.S 7670 CATEGORY 1
(check one) - Residential Ventilation Category 1 Worksheet Submitted
- Energy Envelope Calculations Submitted
MINNF.SOTA RULL.S 7672
- New Energy Code Worksheet Submitted
Plumbing Contractor: _
P1umUinK System Includes:
Mechanical Contractor:
Mcchanicil Sys[cin Includcs:
Sewer/Water Contractor:
_ .1ir Condi[ioninn
_ Hcat Recovery System
Phone #
Phone #
Fee: $90.00
Tee: $70.00
All above 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 comply
with ali applicable State of Minnesota Statutes and City of Eagan Ordina ces./ ?
Stgnature of Applicant
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 1/01
\Vacer Softener
Water Heater
No. of Baths
RemodeVReoairReauirements ? O ? . ci ?
. 2 copies of plan
• 1 set of Energy Calculations for heated additions
. 1 site survey for exterior addilions 8 decks
. Indiwte if home served 6y sepfic system for additions
vaLucrioN 4:?- a`' -
Phone #:
Iawn Sprinkler
No. of R.I. Baths
OFFICE USE ONI.Y
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? OS 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Aft - Multi
? 03 Ot of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext Alt - SF
? 04 02-plex ? 10 OS-plex ? 18 Deck ? 23 Porch (screened) ? 36 Multi
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
? 31 New ? 35 Int Improvement ? 38 Demolish (Interiar) ? 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)• ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement 'Demolition (Entire Bldg only) - Give PCA handout to applicant
2
'
0
9
Valuation f
7?- Occupancy MC/ES System
Census Code 2oning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const ? W idth
A LOD(e- /}T' OLo REQUIRED INSPECTIONS
_ Footings (new bldg) FinaVC.O.
_ Footings (deck) ? FinaUNo C.O.
_ Footings (addition) _ Plumbing
Foundation HVAC
Drain Tile
Roof Ice & Water Final Other
_ Framing _ Pool _ Ftgs _ Air/Gas Tests _ Final
_ Fireplace _ R.I. _ Au Test _ Final _ Siding Stucco Srone
_ Insulation _ Windows (new/replacement)
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
Approved By ? C, , Building Inspector
L?l 2"-0
? ? PERMIT NO. .??__._._.
Eagan Township
Dakote Couniy, Minnesola Date ._..{.V.1,G:..?3....LQ 7.7to
Applecation for Building Permit ?
Tppe of building or work coalemplafed. Circle coxxeei descriplions.
idenlial Commercial Induslzial Othex.............................................. -'--........---......--........---......_.......--°--_"'--..........
Euil Enlarge Alfer Aepair Insfall Move Wreck Oihes ........................................................................
DeYails or remarks..... '......................... ................................ ............
Locafion
Number SYreeY Belween whal cross sfreeSS Siso Esf. Valualion
f?J ?Cl1/?of?v Grou r T
Lo! Bloclc Addifion Rearzangemen2 or Trac2
C?cS T-c. C
Owner .?j.?..??.N?e ......_..c.R.LI? ......
Coniracior .X).V.'..V.!lJt -`-'--1 --°°---'--
il?l
Address _ff!.-f--'I........---..........
Addreas ....-'---......."--.._-'-"'--•_------.......--•_"--"'•'-_""_-----._-'--`-"'
The underaigned hereby makes apnliea2ion for a permiY !o
$ do work as herein specif?ed, sgreeing Yo do all worlc in siricf
Toial fee eolleoted. accordanee wiih !he buildiag ordinanee adopled April 11, 1955
by !he Eaqan ownehip Soaed of Supesvisoxr.
Permif fees are no2 ?
refundable.
...... --. ._ .- -- - "-'- .'-•--------- .-' - ----°- -- _ ........ ....."""-'-_
5igned_
?-Vlelisr
? 65778 ` ? ; ' ?5°°
Request Date Fire No. Rough-in Inspection
Requiretl?
X-Reatly Now ? WII Notiy Inspectw
2 ^ 2 ? ?/ ? Yes fiT-No Whan Reatly?
1r*censed contractor O owner hereby request inspection of above electrical work at:
Job Ftltlress (Streat, Boz
o
r Rome NoJ t cM '
?
/
( G , 5,4 ?-h
Section No. Township Name or No. Range No. Couny
Occupant(PRINT) Plwna No.
tc<r I-Xill
Power Suppli Atldress
/ /A/h 7';itN
Eiecvicai Contrector (COmpany Neme) CoeNacrorS License No.
ALOIS FEIDT
Mailing AE h A'A I?t m -
i`?
?M UM
nutnoriea0 Sign%;,?re Cyom.raa?orlOwner M?y?/- instanarbn)
C:???c.?0 c. s? ?one Number
NINNESOTA $TATE BOAND Of EIECiflICITY
Gripps-NlOway 010p. - Room 5173
1821 Universtty Ave., 5l. Poul, MN 55104
PhOne (612) 692-0800
THIS INSPECTION REOUEST WILL NOT
BE ACCEPTED BV THE STATE BOAFD
UNLESS PROPEF INSPECTION FEE IS
ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION
/ pw See instructions for compkting this form on beck 0f yellow copy.
H65778 X" Below Work Covered by This Request
y6 ?'xY, EB-00001-Otl
•;,?°? 6603?.?7
e Add Rep. TypeofBuilding ApplianceSWiretl EquipmeniWired
- Home Range Temporary Service
Duplez Water Heater Electric Heating
Apt Building Oryer Other (Specity)
Comm./lndusirial ' Furnace
Farm Air Conditioner
qher (specifyn ConVactar5 Remarks:!7 ?/"
Compute Inspection Fee Below: V F F ° ?? `
# Other Fee # ServiceEntranceSize Fee # Cirouits/Feeders Fce
Swimming Pool 0 to 200 Amps 0 to 100 Amps
Transformers Above200_Amps ve 100_Amps
SiJnS Inspector5 Use Only: ? TAL [
Irrigation Booms /
Special Inspection
Aiarm/Communication THIS INSTALIATION MAY BE ORDERE DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONTHS.
I, the Electrical Inspector, hereby Rougn-in oa?e
certity that the above inspection has
6een made. F;,,ai ? oate .
OFfIGE USE ONLY
Tnis requast voitl 18 mon(hs Irom
CITY of EAGAN
UILDING PERMIT
Owae: •Y...!:..?.... L.°--.?-°-.y. . _ •
Addsess (Preeen!) ...... F?1 ..... -G?'L-?B-9........ t..i+c....
Huildez ...................... oror!t?.9e---?--............................................
Addreu
DESCRIPTION
?
. .
N4 3923
3785 PiloY Knob Aoad
Eagan, Minaesala 55122
654-8100
Da:.
Siosiea To Ba ed For Froni Dapfh Heigh! Eel. Cost ermi! Fea Ramasks
or
2 71 ?2-
This permif does not aviho7rsa the use oi sireels, roads. alieys or eidewalks aoz does it give the ownar or 6is agent
the xighf Yo erea4e any siluaiion which is a auisance or whieh presenta a haaard !0 2ha healfh, safelp, coavw3encro aed
general welfare !o anpona in the communily.
THIS PEAMIT MOST SE PT ON ?(E 7??tEMISE WHILE THE WORK IS SN PROW::
?i...Gr.?t.- ....................hes permission r
......_upoa
This is !o eerlifY. ihal.---- ...:?3L
ihe above Ryor eubjec! !o ihe provisions of all applicab.............?...._"'_'_"'-"'--'_'-...... Per --"'_ ' --......... .._............................
BuildinQ Iwpac lor
Jnf.1 7 f-3k :L?
.L a..i< c s.i a. '- E slare.1'
C?iY CP EitGAN
3795 Pilot Knob P.oad
Eagan, Ptir.nescta 55122
PERNfIT NO.: 849
The City of Eagan hereby grants to Genz-.,ryan Veatinq & Plumbing
of P.osemount
- Ken Peters
a HAatinrt Permit £or: (Owner) t+T. Rlilie
rA48ffY?ra?r ?Pep
at ?7fo t±ichiRan Ct??_ ? pursuant to applica'tion dated 516/76 •
Fee Paid: S1410•00 dated this 22 day of June _, 19 7f:?
1.90 s/c ?
Building Inspeetor
PiecL•anical Permits:
2id Total:
.t a r, s a
CI`i'Y CF EiaGAN
3795 Pilot Knob r^•oad
Eagan, Mir,n2eota 55122
PERNiIT NO.: 692
The City of Eagan hereby grants to Genz-Ryan Plumbinq & Heating
of RDSemount
a Plumbing Permit for: (Owner) W. Blilie
at 576 Michigan Gburt , pursuant to application dated 6/16/76
Fee Paid: $20.00 dated this
.50 s c
22 day of Sune 2 19 76 .
Building Inspector
Aiechanical Permits:
Bid Total:
2 CITY USE ONLY
L 21 BL
SUeo. ?,akt6dei
RECEIPT #:
RECEIPT DATE:
PERMIT# 3 -I(/? ?
E000 PLUM$INfi PERMTf (RSIDwN1'1AI.)
crrYograflaiv p b
8930 PII.OT KROB RD
Ftentv, auv 55122
651-68t-4675 -
Please complete for: ? single family dwellings
? townhomes and condos when permits are required for each unit
? backflow preventer for underground sprinkler system
cIvTHocc
FA[:H
?
?
TOTAL
Alterations to existing dweiling - minimum fee
Describe:
$ 30.00
Bath tub $ 3.00 x = $
Floor drain 3.00 x = $
Gas i in outlet ' minimum -1 3.00 x = $
Hot tub/s a 3.00 x = $
Kitchen sink 3.00 x = $
Laund tra 3.00 x = $
Lavato 3.00 x = $
S8 fIC S St8ff1 newlrafurbished 'requires MPC Ilc. 75.00 % _ $
Se tiC S Stem abandonment 30.00 X = $
RPZ new installatloNrepair/rebuild 30.00 X = $
Rou h o enin 1.50 x = $
Shower 3.00 x = $
Under rounds rinkler ifdwellfngisunderconsWCtion
Under round s rinkler if existing dwellin 3.00
30.00 x
x =
= $
$
Watercloset 3.00 x = $
Water heater 3.00 x = $
Water softener If dwelling under constructlon 5.00 x = $
W ater softener if existing dwelling
Waterturnaround 30.00
30.00 x
x
---- =
_ $
$ ' -?
State Surchar e
Total .50 --> ---> ----> $ .50
$ y't7
Reminder: Call for inspections of alterations, i.e. water heaters, water softeners, etc.
---------------------•---------------------------------------------------------•---- --------------•----------••-----------------------
I hereby acknowledge that I have read this appliration, state that Ne information is carect, and agree lo comply with ali applirable Ciry of Eagan ordinances.
It is the applicanPs responsibility to notlfy the property owner that the City of Eagan assumes no liability for any damages caused by the Ciry during its nortnal
? operatlonal and maintenance acGviUes to the facilities consVUCted under this permit within Ciry properry/riqh[-of-way/easement.
I SITE ADDRESS:
OWNER NAME: :
TELEPHONE #:
-5
INSTALLER NAME: TELEPHONE #:
(AREA CODE)
STREET ADDRESS:
ciTV:
S E: ZIP;
?SIGNATU OFPERMITTEE
Lot T1 Block _-)-
Plat
PID #
Receipt #.
CITY OF EAGAN
2000 SEWER AND WATER CONNECTION AND AVAILABILITY CHARGES
EXISTIPIG RESIDEIdTIAL PROPERTY
Sewer
Trunk $900/connection
City SAC
Base SAC
Date paid
Receipt #
Account deposiY
Septic abandonment
Sewer permit & surcharge
Subtotal
Total
?
100.00
1,100.00
Date
'q9
Water 3iu
Lateral charge @ $22.55lff $Pd w, i'4+p.t3*sl^'k,
Trunk @ $940/connection f Qd .,"jklJm"`f
Water supply & storage -849?99??
Date paid
Receipt # ?
Treatrnentplant
15.00 Water meter "Inspections req'd prior
30.00 to issuing
50.50 Account deposit
Water permit & surcharge
? Subtotal
Plumbing permit & surcharge
Total
Sewer and Water
Sewer later harge @ $22.30Jff
Water lateral c e @ $22.55/ff
Sewer trunk @ $9 connection
Water trink @ $940/c ection
City SAC 100.00
Base SAC 1,100.00
Date paid Receipt
Water supply & storage 840.00
Date paid Receipt #
Treatment plant 492.00
Water meter "Inspections req'd prior to issuin I 14.00
Account deposit 30.00
Septic abandonment 30.00
Sewer and water permit &, surchazge 100.50
Subtotal S
Plumbing peimit & surcharge 50
Total $?
15:00
$ 't s: C--) c--
30EM, ga 5?
$
?
i
\ 1X ?
?II" o
OFFICE USE ONLY
Property owber-? i C_" V Cy ?.f
Address r,-?l La v 1'? 1 C,? i 0.C'i 1n ?U
Phone number
Plumber cr-ra.?yv?-?-?
ES ?er /wa[er permit #_
PRV required:
R-O-W Permit:
Unpaid
Permit Fees:
City financed:
1-, 5
City .,?County r/JA
cc: Carolyn Krech, Finance Deparhnent
MASTER CARD
LOCATION
I •
-
OWNER (",
STRUCTURE AND
Permit
No.
Issued Issued To
Conirattor Owner
BUILDING 3 9 t3 a-P *-249 ;"
PLUMBING
CESSPOOL - SEPTIC TANK G9?, G.aQ`'.?
?---;i.?- 7fo 'tt
?? Jo?? „'I&
WELL /?.Sjf?i/
Ri ? __ ?i ?
/
ELECTRICAL J ?
HEATING
GAS INSTALLING
SANITARY SEWER
OTHER I
OTHER I
Items Approved
(Initial) Date Remarks Disiance From Well
FOOTING SEPTIC
FOUNDATION CESSPOOL
FRAMING a -e TILE FIELD FT.
FINAL
ELECTRICAL
HEATING
'30' JL DEPTH
OF WELL
GAS INSTALLATION
SEPTIC TANK ?
CESSPOOL 76
DRAINFIELD .
PIUMBING
WELL .
SANITARY SEWER
Lp?
Violations Noted
on Back
COMMENTS:
COMPLIANCE INSPECTION REPORTS
TO BE USED ONLY IN EVENT OF OBSERVED VIOLATIONS
PERMIT NO.
CONDITIONS OF CONSTRUCTION AT THIS INSPECTION
? NO EVIDENCE Of NON-COMPLIANCE
OBSERVED.
a ACCEPTABLE SUBSTITUTIONS OR
DEVIATIONS.
DATE OF INSPECTION
? NON-COMPLIANCE. BUILDER WILL COMPLY
WITHOUT DELAY.
ITEMIZED AND DESCRIBED
? NON-COMPLIANCE. BUILDER DOES NOT
INTEND TO COMPLY.
? COMPLETION OF CERTAIN IMPROVEMENTS
WILL BE DELAYED BY CONDITIONS BEYOND
CONTROL.
? REINSPECTION REQUIRED DATE OF REINSPECTION
REINSPECTION REVEALED
CERTI FICATION - I certify that I have carefully inspected the above in which I have no interest present or prospective, and that I have reported herein
all significant conditions oLserved to be at variance with ordinances of the Town of Eagan, approved plans and specifications, and any specific require-
ments for off-site improvements relating to the property inspected.
? ALl IMPROVEMENTS ACCEPTABLY COMPLETED
INSPECTOR
Aoy" .?7
,61r//(/ 2
0
1/bti " = i'
.
?
?
?
?
?
,?
cC qPL3
. , •-+.
DATL' : ?71'_
BUTLD.;?C P?TI:[T tuj:7IM1m;r,2,T CHEQK
Lot_1& 4 B:LcokAci-3::'ti_;;a
Parcel P-z3 secticn nar.'oer
?
Stre--t?????'
OUm;:r "4L5InP ?Li / I& Address
Develcper AZcL ass
Zone-Orclin2x.ce #52 ?
Lot Size X ? Total area
Fla'tted _ ?Unp].atted ?
?. , /y
Build:;.rg Size X To;al area_ _
Or cepar.::y
. z
?
Typ2 oi ecnstrnotion &Qd/ rA?
Setbacks: Strn-,at s3dc:s _??i??? lsc Rear
I
SlU'C.'S /
Parr,ar.g: Tota.1 area
Parl;ir.g area set,bac:l:s:
Street :,ide Ftear
Landscapa agprcval
Spe4ial Assess:nents:
S'C chaxge_
Water araa;
P.ssessed
Q$4K0. 00 =11i
rJ
?-
f z??
To?al sgaces
Sides
Bond required s ?
- ??
!
Ur.ass es s ed
If asse3eed: Connsotion char;e
If unasses::e8: Con:nection
Lot 3i;?.sion:
Adc:itioaal assessments needed
Latera].s e
Not nssde3 +/
Assessed Not assessed ,i
Tlai•rer of he2rin;:
Needed Not naeded J?
Assessm:nt clk_?) Y Water & Sewe: Dept, Auilding Dept
Te.:1 o
Police Bept Fi-re Dept (Co:m & T.nd cnly)
06/29/2016 16:04 7635311801 DEANS TANK INC
41i' Citjofaaii
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675.5676
Fax: (651) 675.5694
PAGE 01
Use BLUE or BLACK Ink
For office Use
Perm:
Permit Fee: —75. D v
Date Received:
Staff:.,
2016 MECHANICAL PERMIT APPLICATION
0 Please submit two (2) sets of plans with all commercial applications.
Site Address: 576 Michigan Ct
Data: 6/29/16
Tenant Suite #:
Resident/OwnerNeme:
Brian Jensen Phone: 612-889-5716
_
Address / City / Zip: 576 Michigan Ct, Eagan, MN, 55123
Contractor
Name: Dean's Tank, Inc. License #: 0475
Address: PO Box 22515 City: Robbinsdale
State: MN Zip: 55422 Phone: 763-535-0194
Contact Doug Nething Email: deanstank@gmail.com
Type of Work
New Replacement Additional Alteration Demolition
Description of work: remove underground heating oil storage tank
NOTE: Roof mounted and ground mounded mechanical equipment le required to be screened by City
Code. Please contact the Mechanical Inspector for Information on permitted screening methods,
Permit Type
RESIDENTIAL
Furnace
COMMERCIAL
New Constnrction Interior Improvement
— Air Conditioner
— _
Install Piping _ Processed
Arc Exchanger
—
Gas Exterior HVAC Unit
Heat Pump
_
Under/Above ground Tank (... Install / Remove)
x Other tank removal
_ , —
RESIDENTIAL FEES
$60.00 mgt Add or alteration to an existing unit, includes State Surcharge
$100.00 Residential New, includes State Surcharge = $ TOTAL. FEE
COMMERCIAL FEES
$60.00 permit Fee Minimum
Contract Value $ x .01
= $ Permit Fee
$75.00 Underground tank installation/removal, includes State Surcharge
Surcharge = Contract Value x $0.0005
If the project valuation is over $1 million, please call for Surcharge
= $ Surcharge
= $ TOTAL FEE
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.
Douglas L Nething
Applicant's Printed Name
x . Dia re J!%
Apgllcarrt' ignaWre
FOR OFFICE USE
Required inspections: Reviewed By: Date:
Underground Rough In Air Test Gas Service Test In -floor Heat Final HVAC Screening
• Use BLUE or BLACK Ink
r
, For Office Use /�
Permit#: S '" dD
City of �aa� ..Permit Fee: at-
3830 Pilot Knob Road
Eagan MN 55122 c' Date Received: r ' 7
Phone: (651)675-5675 °
(ri�/,
buildinginspections(a cityofeanan.com Staff:
AUG 15 2017 ,
2017 RESIDENTIAL BUILDING PERMIT APPLICATION C `t2-4
-
Date: 8 )' )l11 c
Site Address: _J�ID \G UaA C-g0KT Unit#: '7 i (1
Name: ?)*(41 RAD t sE IJ Phone: &I- >-18539-,511(0
Resident/ Si6 m�c�\cAt. co ucic
Owner Address/City/Zip.. +A AN , mt..) 6. 1a,3
i\2— / ,
I I [Applicant is: OwnerW., Contractor .,,
-F W
i r Description of work: ) ?o c\N l NcC\L dN3?AG\& of \b\ '
Type of Work �v�
1 Construction c6st: rb0u0 Multi Family Building: (Yes /No )
Company:
....Contact: ...._
i I
` Address: City:
Contractor
State: Zip: Phone: Email:
License#: Lead Certificate#:
If the project is exempt from lead certification, please explain why:
3
s ..r._ ..v.. .. COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
I 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:
I Licensed Plumber: Phone: I
' Mechanical Contractor: Phone:
Sewer&Water Contractor: Phone:
I Fire Suppression 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.
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on
the City's website at www.citvofeaoan.com/subscribe.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage. Call 48 hours before
you intend to dig to receive locates of underground utilities. www.qopherstateonecall.orq
\ I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to tart without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and appy. -1 of plans.
x123*Ll1'i"J .NSEI -) x i'
Applicant's Printed Name Applicant's Sign•f e
Page 1 of 3
DO NOT WRITE BELOW THIS LINE ( COX
SUBTYPES "SI(c, 0(•f1_1,' " r
Foundation Fireplace ,Porch (3-Season Exterior Alteration (Single Family)
Single Family Garage Porch (4-Season) Exterior Alteration (Multi)
Multi Deck Porch (Screen/Gazebo/Pergola) Miscellaneous
01 of_Plex Lower Level Pool Accessory Building
WORK TYPES j� 44. �.7 v(
New f` Interior Improvement Siding Demolish Building*
_r\
Addition o Move Building Reroof Demolish Interior
Alteration Fire Repair Windows Demolish Foundation
Replace Repair Egress Window Water Damage
Retaining Wall *Demolition of entire building-give PCA handout to applicant
DESCRIPTION 7e
Valuation w Occupancy MCES System _
Plan Review Code Edition 4/14444,it SAC Units
(25%_ 100% ); Zoning > City Water
Census Code Stories Booster Pump
#of Units Square Feet PRV
#of Buildings Length Fire Suppression Required
Type of Construction /' Width
REQUIRED INSPECTIONSi�
Footings (New Building) Meter Size:
Footings (Deck) Final /C.O. Required
Footings (Addition) Final/ No C.O. Required
Foundation yFoundation Before Backfill HVAC_Gas Service Test Gas Line Air Test
Roof: _Ice &Water Final Pool: _Footings _Air/Gas Tests _Final
Framing ,t 30 Minutes 1 Hour Drain Tile
Fireplace: _Rough In Air Test _Final Siding: Stucco Lath Stone Lath Brick EFIS
,c
Insulation Windows
`
" Sheathing Retaining Wall: _ Footings_ Backfill_Final
" Sheetrock Radon Control
Fire Walls Fire Suppression: _Rough In_Final
Braced Walls Erosion Control
Shower Pan Other:
Reviewed By: 1 t , Building Inspector
RESIDENTIAL FEES
Base Fee644014
Surcharge s
Id
4109 6
i 6
Plan Review ° � .,.0 5-`
c elo
MCES SAC
City SAC
Utility Connection Charge
S&W Permit& Surcharge dr
-Li . i ,
Treatment Plant «' ' 7 Le 41Y f
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TOTAL
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PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA165754
Date Issued:11/18/2020
Permit Category:ePermit
Site Address: 576 Michigan Ct
Lot:27 Block: 2 Addition: Lakeside Estates
PID:10-44300-02-270
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Softener
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 -
Alexander Hernandez-siegel
576 Michigan Ct
Eagan MN 55123
Champion Plumbing
3670 Dodd Rd., #100
Eagan MN 55123
(651) 365-1340
Applicant/Permitee: Signature Issued By: Signature