4100 Nicols Rd2 9 9- 4 4 7 ? OFFIC USE NLY This request void 10 monMs from validatian date ynnled in this bw.
9?,9 ?r ' -?, ?
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PLEASE PRINT OR TYPE kc9,,eOc
Requesl Da7y
? d Rough-in inspetllon required2 ? Ves ? N.
d InspMion 01her Than Ra?gh-In: 0 Revdy Now 0 Will Coll
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I, jrlicensed contractor ? owner hareby request inspedion o{ ihe above eledrical work at:
lob Pddr s ?SmN, Bor, or Roore No.?
0o Nrcolj p Cip
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Setlion No. Township Name or No. Ronge No. Fire No. Coun1%7?,, ?
Occvpom
Q J?? Phone No.
Po.r5upplier Address
EI<cviml Conlm?y ?Compony Name)
D G? Conlntlor Limnse Na.
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19 Mmkr Lic Nn (Planl Elen. Only)
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EB-00001A-10 61pSI / STACABORRUPY-SEEINSTRUCiIONSONBACKOFVELLOWCOPY
REQUEST FOR ELECTRICALINSPE 10 ION ??
III) I III II II I II I II i I I I I II II I I? 1n Stat;
B21 U Paul MN 55104 ??. --??- ?
Avear Rmf I1 B,C?
* 0 2 9 9 4 4 7 3?K ? Pho?(612) 642-0800 ?'jS??? '+?`
Jj Aome Duplez Apf.8ldg. Other: New Addn
ommercial Indushinl Farm Remod Re air
Air Cond. Hig. Equip. Wafer Hic Load Mgm}. Other:
- D er Range Elec. Heat Tem $ervice
"X' obove the work cwered by this reques[ Enter remarks in this spa<e ond on }he bock af ffie whife copy only.
T-?- \ /D 5 `-' ( a, ?/?_?^pJ
Calculate Inspecfion Fee - This Inspecfion Req?st will noed wit?ut t" he corre ee:
OHrer Fee $ $ervice EMrance $ae Fee # Grcuils/Feeders Fee
Mo6ile Hame Park Stall 0 to 200 Amps 0 to 100 Amps
5}reef Ltg./Tmffic Sig.
TransfarmedGenemtor A6ove 200 Amps Above 100 Amps
EONL
Sign/Ou}line L}g. Xfmr.
Alarm/Remote Canfrol
$wimming Pool herein ihedabn ekkd
Lh??b,
Irrigotion Boom
$pecial Inspedion
Inves}igative Fee
THIS INSTALLATION MAY BE ORDERED D IF NOT COMPLETED WITHIN 8 M THS.
TOWNSHIP No so5
ING PERMIT
Owner !
Addrees
Buiider .-----.....--
Address .............
Eagan Township
Town Hall
? . DaSe7? J..._
. .. L ......... ...........
_...-.
DESCAIPTION
5fories To Be Used Fos - Froni Depih Heighi Esl. Coaf Permi! Fee Remerks
.?y('??? - I ?DDDD ? -
LOCATION
--r-•-•? ..o, L.ocx .iaainon or zrau -
o?
This permit does aoY auSkiorise the use of sireefs, roads, alleys r sidewalks nor doea it give the owner or . his ageni
the :igfiS So ereale any situation which is a nuisance or which preseals a haaard !o the heallh; . safeiy, convenience and
general welfare !o anyone in the eommunifp.
THIS PERMIT MUST PO?N T PS??yW?H,ILE THE WORK IS IN PROcG,Lg E[/S$!,'?
This is 1o cerfifp, iha?[??T"+r.?G.. 1:lY._has permissi to erec! ac_/--.-.!4z?? ._._..•.. ._?..... .. -
ihe above descrffiedremise sub"eci fo the . - -- .-?-upon
p 7 provisione of -!he Suildia Qsdieau or . ga Tow " adopied Apail 11.
1955. . ......... ? .... .. ....__.
...... .. ....... --------------------------------- .. ...... Per . _ ..__._ . ' /?. '. .
._. ?... . .. . . .........
Cheirman of Towa Board ? $u' ' g Inspecfor
PERMIT
CITY OF EAGAN aUILDING
3830 Pilot Knob Road PERMIT TYPE: 028297
Eagan, Minnesota 55122-1897 Permit Number: 0 7(19 / 96
(612) 681-4675 Date Issued:
SITE ADDRESS:
4100 NTCOLS RD
LOT: 2 BLOCK: 2
CEDAR GROVE 1S7
P.I.N.: 10-16700-020-02
DESCRIPTION:
puyl'd3ng Permit Type
Buiiding'`Wark Type
Census Code ?
6ARAGEJPORCH/ROOF/SIDING
.?
', s'' a_t
REMARKS:
REPAIRS INCLUDE:
FEE SUMMARY:
CONTRACTOR:
QSI
9LAINE
(612) 425-9576
- Applicant -
14259576
p 0 BOX 49116 110302
MN 55449
STDRM OAMAGE
REPRIR
434 ALT. RESIDENTIAL
OGYEK2"S aoa
4100 NICOLS RD
EAGAN MN
(612)456-0548
I here,by acknowledge tha`CI hatrs read this a'pplica'tion ahd stete ChatGhe infiormation is correct and agres to comply with a11 applicable State of Mn.
Statutes and City af Eagan Ordi;nances.
„
APPLICANT/PERMITEE SIGNATURE
•? 0'"""?
ISSUED : SIGNATURE
New Canslrudion Reau6ement5
?
?
?
CITY OF EAGAN
3830 PILOT KNOB RD - 55122
1996 BUILDING PERMIT APPLICATION (RESIDENTIAL)
681-4675
3 registered sRe surveys
2 oopies of plans (Mdude 6eam 8 window sizes; poured fid. design; etcJ
7 energy ce1CUIB1bn9
3 eopin W Vce pivaenation plao % bt pleded after 7l7/93
required: _ Yea _ No
DATE:
DESCRIPTION OF
STREET ADDRESS:
RemodeVRepafr Reovirementa
? 2 copiea of plan
? 2 site avrveys (eztertor additions & decks)
? i energy ealculations for heated additions
CONSTRUCTION C05T: I 7 ?IC) oc-
LOT ? BLOCK ? SUBD./P.I.D. #: SCOar 902;I4 1 ±
PROPERTY Name: ?,. /?,V?o _ Phone #A-516
OwNER rwar
Street Address•U??UL(??? Ni
- City: ? dpdh State: 1W Zip -;?.
CONTRAC70R Company: Phone #:
5treet Address: License #: aC?'D?la3
City: f Cnr?nn State: f?W Zip - :syy?
AFtCHITECT! Company: Phone #-
ENGINEER
Name: Registration #:
Street Address*
Ciry: State: Zip•
Sewer 8 water licensed plumber:
change ere requested once pertnit is Issued.
Penaity applies when address change and lot
I hereby acknowtedge that 1 have read this application and state that the information is correct and agree to comply with ali
appiicable State of Minnesota Statutes and City of Eagan Ordinances. 7;LiIG=??
Signature of Applicant:
OFFICE USE ONLY "" " ?? <
.lrii 9 9 9yyti ` L??C
Certifiptes of Survey Received _ Yes No
Tree Preservation Plan Received Yes No r '- ? I! i
2007 RESIDENTIAL PLUMBING PeRMir aPPUCarioN
? CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please complete for modifications to existing residential dwellings. Do noP combine inside and outside
olumbina nn the same aoolication senarate annlications and oermits are reouired.
Date I ?l? N t
Site Street Address Unit #
PropertyOwner ??Rl? `??t fl S Telephone#
AppRance Coinnecticns inc
Contractor 734$ nanita Cr Telephone# ( )
Address SF18IC0pee 5537$ity State Zip
952445-4803
The Applicant is: _ Owner & Occupant " Licensed Plumbing Contractor
5eptic System _ New _ Refurbished Submit 2 sets of plans and MPC license Includes County fee
$ 100.00
Per as-built $ 10.00
Fire Repair (replace bumed out fixtures, etc.) $ 90.00
This fee a lies when extensive lumbin re irs are made to a buildin .
Alterations to existing dwelling $ 50.00
_ Add plumbing fixtures to main level lower level. This fee includes
installation of a water softener and/or water heater at the same time. If you are
instaNing onlv a water softener and/or water heater, do not complete this section;
move to the next section and place a checkmark next to the appliance(s) you are
installing.
_ Septic 8ystem Abandonment
_Water Tumaround (add $136.00 if a 5/8" meter is required)
Other:
Water Softener _ Water Heater $ 15.00
_ new _ replacement
Lawn Irrigation _RPZ _PVB _new _repair _rebuild $ 30.00
State Surcharge $ 50
Total $ t 113°?0
I hereby apply for a Residential Plumbing Pertnit and adcnowledge 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 plumbing codes; that I understand this is not a permit, but
only an appliption for a permit, work is not to staR without a permit and woric will be in acxordance with the approved plan in the event
a plan is required to be reviewed and approved.
771S&- 2007 RESIDENTIAL PLUMBWG peRMiT aPPLicaTioM
CITY OF EAGAN '?.
3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please complete for modifications to existing residential dwellings.
Date
Site Street Address ? i vv ?cOS (Z-Qo-6 Unit #
Property Owner ?Cl 1 y_:15 Telephone
Contractor? Telephone#
Address laLdD Y City Q State MN ZipSEj4M
The AppFicantis: _ Owner ? Contractor _Qther
Septic System _ New _ Refurbished Submit 2 sets of plans and MPC license Includes County fee
$. _9 0[1.OS1
Per as-built $ 10.00
Fire Repair (replace hurned out fixtures, etc.) $ 90.00
Alterations to ezisting dwelling $ 50.00
_ Add plumbing fixtures. This fee inaludes installation of a water softener and/or water
heater at the same time. !f you are installing onl a water softener and/or wafer
heafer, do not complete this section; move to the next secYion and check the
appiiance(s) you are installing:
-Septic System Abandonment .
L? ???
L?'
??? G
"
}
meter is required)
?
Water Tumaround (add $136.00 if a 5!8
? U
? ? n n o n onm
Othef: - I I _
?? V LVVI
_ Water Softener ? Water Heater $ 15.00
_ new ? replacement
Lawn Irrigation _RPZ _PVB _new _repair -rebuiid $ 30.00
State Surcharge $ 50
. $?'?
Total
I hereby apply for a Residential Plumbing Permit and acknowledge that the information is compiete ana accurace; cnac me
work will be in conformance with the ordinances and codes of the City of Eagan and the plumbing codes; that I
understand this is not a permit, but only an application for a permit, work is not to start without a permit and work will be in
accordance with the approved plan in the event a plan is require o e reviewed and approved.
-,b ;d ? ci21vv1rLn Y1 ?? ?.
ApplicanYs Printed Name ApplicanYs Signature
CITY OF EAGAN Remarks * CedaY' Grove Acquisition
Addition eEDAR GROVE #1 Lot 2 elk 2 Parcel 10 16700 020 02
Owner f)e 1CY"L, fi- Cn. ;i::,;1 ? Street 4100 C'eeler Amens State EaqBn, MN 55122
Ai"C,r,o s `RoRd
Improvement Date Amount Annual Years Payment Receipt Date
STREETSURF. 19$5 1266.9 84.46 15
STREET RESTOR.
GRADING
SAN SEW TRUNK
* SEWER LATERAL 1972 1,304.00 52.16 25
WATEFMAIN
* WATER LATERAL 1972
WATER AREA
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. LI N
BUILDING PER.
SAC
PARK
Pr' -- .
INSPECTIDN RECORD
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued:
(612) 681-4675 ?
SITE ADDRESS: APPLICANT:
? 1 I?r?I: ?•t;??'.'1 {'.,? 1 _ ( C, 1. ? +l.'!.. 4!-?/n
PERMIT SUBTYPE:
, 4i ;, ,.
TYPE OF WORK: ,rr P+a, i
INSPECTION .• . .A
1PI'.11i ft! 1i?PJ f,?1???
I;+i?al I ri??
RFMAkK`.: Iit- t'Al12''f fHf:l tllft hA1tANC /F'01<l M?rti??)F /.`-:101r0y
?
-1
J
I -
Permit No. Permit Holder Deta Telephone N
ELECTRIC 99 y gi3 ? p?'
PLUMBING
HVAC
Inspection Dete Inap. Commertta
F007lNGS ?
! •
FOUNO
FRAMING /ai Q6 /j
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
BSMT R.I.
BSMT FINAL I
I
DECK F?'
DECK f "'• E
Use BLUE or BLACK Ink
r
For . I Office Use
11
, a
Permit#: (J
I I
W of Eun
Permit Fee ' 0(0
I
3830 Pilot Knob Road
Eagan MN 55122 1 V I Date yev 1(/' 1
Phone: (651) 675-5675 I I
I Staff: I
Fax: (651) 675-5694 L ---INFLOW & INFILTRATION PERMIT APPLICATPlumbing / Sewer & Water
Date: - 10--LT-11 Site Address:
Tenant: BU 6 6V8 /<1'5 Suite
RESIDENT ( OWNER Name: Bob 6 yc-KtS Phone: (o ~l' ~ ' Z(7 x
Address / City / Zip: t( f oo yr`cas k(. N/V
Name: Re C II&A pl!uy"lA1"1q 4e4 `iKA (Kell License
Address: q(?-q Akgcrz4&7-,~e City: ~°t'o Mdc~ X Ralt
CONTRACTOR
State: 419 Zip: 5T396 Phone: 76 3 - 419 7- W U
Contact: i' r Email
PLUMBING (Within the building envelope) SEWER & WATER (Outside the building envelope)
TYPE OF WORK Sump Pump Repair Repair
Other: Other:
Description of work: AOta2 6~ "4",t f%le- t6l'I 5 Tied i~To S4rfr2,-
DESCRIPTION pp
FEES
$55.00 / Each (includes $5.00 State Surcharge) TOTAL FEE $
*Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submit 1/1 repair costs for
reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors
can be found by visiting www.cityofeagan.com/inflow, or City Hall at 3830 Pilot Knob Rd.
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. mvw.gopherstateonecall.org
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and
codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a
permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans.
X. ili~if ael 7n/~ -ex. x
Applicant's Printed N me Applica 's ignature
FOR OFFICE USE Reviewed By: Date:
Required Inspections: -Under Ground -Rough-In -Final
Use BLUE or BLACK Ink
r - - - - - - - - - - - - - - - - -
k I For Office Use
City of ~a Permit I I
Permit Fee: ~n `Q
3830 Pilot Knob Road g~l l3
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff: I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit
t ~
Name: Ro e^t f,~ VICAC Phone:
Resident/
Owner Address/ City /Zip:
! ~~jC ~iLS 1~
Applicant is: Owner Contractor
Type of Work Description of work: ,ge - pu'15i d e
Construction Cos S_ 10 Multi-Family Building: (Yes / No t--)
Company: ymcd A t_vftContact: its 71o j3°
Contractor Address: 61 W/A C,V 4 City: :74!7
State: Zip: 03 Phone: A2,>-Y,2 7" J
License bc.636 (4Y/ Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
i conclude that they are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.aopherstateonecall.ora
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
Applicant's Printed Name Applicant's Signature
Page 1 of 3