1086 Northview Park Rd
Use BLUE or BLACK Ink
er': F For Office Use I
, I I
U o n I Permit
I
City I Permit Fee: 965 S I
3830 Pilot Knob Road i I
Eagan MN 55122 1 Date Received:
Phone: (651) 675-5675 I Staff:
Fax: (651) 675-5694
2011 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: Q - 30 - t 0 Site Address: LO86 M r V ^ view (OAA u
Tenant: .7 C-04 I Ct0ka"T' Suite
RESIDENT / OWNER Name: Phone:
Address / City / Zip:
CONTRACTOR Name:AQpnliooce .l_oSL(1Pa~S of tAA IPC License #:SVV2TSL:-j?L1i
Address: t~l0s RAmami A City: pow IaLC_
State: )n Le, Phone: i-2-464-S39/
Contact: l'1'1 iGLe,Q Email:
TYPE OF WORK - New ~!r Replacement - Repair Rebuild - Modify Space -Work in R.O.W.
Description of work:
PERMIT TYPE RESIDENTIAL
Water Softener
Water Heater
Lawn Irrigation RPZ PV13) Add Plumbing Fixtures Main Lower Level)
_ Septic System Water Turnaround
_ New
Abandonment
RESIDENTIAL FEES:
$55.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge)
$35.00 Lawn Irrigation (includes $5.00 State Surcharge)
$55.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround" (includes $5.00 State Surcharge)
'Water Turnaround (add $166.00 if a 5/8" meter is required)
$105.00 Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge)
$95.00 Fire Repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge)
TOTAL FEES $ SS
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 464-0002 for protection against underground utility damage.
Call 48 hours before you intend to dig to receive locates of underground utilities. www.oopherstateonecall.oro
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.
Applican Printed Name Applica Signature
FOR OFFICE USE Reviewed By: Date:
Required Inspections: Under Ground Rough-In Air Test Gas Test Final
CASH RECEIPT
• .i ?
CITY OF EAGAN
3836 PILOT KNOB ROAD
'EAGAN, MINNESOTA 55122
DATE 19
qECE1VED
FRGM
4
AMOUNT $
& oo DOLLARS
? CASH O CHECK
FUND 06JECT ? AMOUNT
C-' ? • ? c-`
Thank You
BY
White-Payers Copy
N9 Yellow-PosOn9 CoPY
Pink-File Copy
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PH O N E: 454-$1 QO
BUILDING PERMIT Receipt #
To be used for SF DWG/CsAF: Est. Value 3105,0(,;) Date ?
t r_'e) +) A
19
Site Address 1(?86 Nt?RTHVT'`sFd FAR1C RD
Lot " Block l Sec/Sub. LEAIt+iGGTOH P,ARKVIt;
Parcel No,
cc Name Jor MlldXbt COIiSTROG"PXf);.;
3 Address xF4 11' "t;'%AFt AV7'. S
° City °A1tMi , Phone 431-20."i
a Name _
,o
z r-
? ?
? a- Address
C i tij _
?¢
? w Name
?w
Addre
U
i W Ci?ty -
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.
Signature of Permittee
A Building Permit is issued to:_. cr::'i:,T
on Ihe express condilion that all work shall be done in accordancewith all
applicable State of Minnesota Statutes and Cify of Eagan Orqinances.
Building Official _
OFFICE USE ONLY
On Sita Sewage OCCUpancy
MWCC System Zoning ?+' A-1
On Site Weil (Actual) Const V-°1.1
City Water ? (Allowable) v-i;
PRV Required # of Stories
Booster Pump Length 41.'
Depth 42 '
S.F. Total
Faotprint S.F.
APPROVALS FEES
Engr./Assess._ Permit W0•00
Planner Surcharge 51•50
Council Plan Review 29 J• X
Bidg. Off. SAC, City 100•0c
Variance SAC, MwCC 550 • 00
WaterConn. 5511•00
Water Meter 67.%
Road Unit 3?5•oo
Treatment Pi 2 o4•00
Parks
TOTAL 2s733.5-,
BLDG. PERMIT NO. / c>I ?
r? t?
01-3210 Bidg. Permit
01-3422 Plan Check
01-3445 Surch./Adm.
61-3446 SAC/Adm.
01-2155 Surcharge
75-3860 Road Unit
20-2275 SAC
20-3865 Water Conn.
?
20-3868 Water Trmt.
20-3716 Water Meter
20-2252 Acct. Dep.
?
20-3713 Water Permit
20-3743 Sewer Permit
79-3866 Sewer Conn.
28-3855 Park Ded.
TOTAL
CASH RECEIPT
'.?
CITY O.F EAGAN
3830 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
19
RECE OM
F .i; ?l/.I,-.?/??'•"?f' ??,I .!_?'.? - _..
nMOUrrr
? -
8 DOLLARS
,oo
' ? CASH Q CHECK
I . L 44?6?
BY
White-Peyers Copy
Yelbw-Postirg CaPY
Pink-FHe Copy
Thank You
'
?77 7 77
a
MECHAI
cIrr
- 3830 PILOT KNOB
Site
m Name _
?o Address
c City -
L Name _
c Address
o City
-
TYPE OF WORK
Forced Air
Boiler
Unit Heater
Air Cond.
Vent
Gas Piping OuUets #
Other
PERMIT #
. PERMIT RECEIPT #
T
AGAN ?
17 '
' ?-' ? y
, EAGAN, MN 55122
DATE:
4-8100 For Office Use Only:
ILDG. TYPE WORK DESCRIP170N
les. New
Ault Add-on
:omm. Repair
)ther
FEES
IES. HVAC 0-100 M BTU -$24.00
DDITIONAL 50 M BTU - 6.00
!RES. HVAC INCLUDES A!C ON NEW
GAS OUTLETS (MINIMUM - 1 PER PERMIT)
COMM/IND FEE - 19'o OF CONTRACT FEE
M BTU APT. BLDGS. - COMM. RATE APPLIES
TOWNHOUSE 8 CONDOS - RES. RATE APPLIES
M BTU MINIMUM RESIDENTIAI FEE - ALL ADD-ON 8
M BTU REMODELS
M BTU $ MINIMUM COMMERCIAL FEE
STATE SURCHARGE PER PERMIT
CFM (ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND $1,000)
- 1.50 EA.
- 12.00
- 20.00
- .50
FEE
S/C: SIGN P IyOTEE
TOTAL: FOR: CITY OF EAGAN
??a o?g9 ?irJ?"??
. ... T?? ? .. . .. -w^+---•. ?.t _
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Esgan, MN 55121 ?l?
PHONE: 454-8100 _, -
BUILDING PERMIT Receipt
To be used for ?y DW44(4" Est. Value $1C'Sr00U Date ??`?%? ? ,19 "'
SiteAddres$? lv<so ?,?fc;:iti•l??w :`AUlI ?
?
Lot Block 1 Sec/Sub.Lf:XIKG'!'r3N PARKYILn
-? Parcel No.
m Name Jt'?4 M1;L:.ER Cu14aZTtUCZION
x Address 10133 C!!;,.:"; AVE S
° City 'rARF:1Ni,iON Phone 431-2401
'c Name ?'• '?
.o
? Q Address
? City Phone
OFFICE USE ONLY
on srte sewage occupency 1-3 M-1
MWCCSystem
Zoning a?
•} "
On Site Well (ACtuaq Const
Ciry Wafer ? (Allowable)
PRV Required # of 5tories
Booster Pump Length ?4u 9
Depth y 1 ~
S.F. Total
Footprint S.F.
APPROVALS FEES a
5t10•100
Engr./Assess. Permit
Planner Surcharge
71 ' .00
Council Plan Review
BIdg.Off. _ 5AG City 'i..J0•01i
Variance SAC, MWCC ??G•??
_ ? 50' LIO
Water Conn. -
Water Meter 67 • 00
Road Unit -'? s+ ?
Treatment P1 204•0C
Parks
TOTAL
?Q
? W Name
W yU
_ g Addre
U
`yZj CltY-
I hereby acknowledge that I have read this application and state that the
information is correct and agree to comply with all applicable State ol
Minnesota Statutes and City of Eagan Ordinances.
Signature of Permittee A Building Permit is issued to:MA"!'ER CQ!;:'1
on the express condition that all work shall be done in accordance with all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building Official---- - ------------------- -
Psrmit No. Permit Holder Date Telephone if
Plumbfig ? i
G ??^ .
? ? `' ,??A-!a?.?
? y ?' "
H.V.A£.
Electric • ?C"??'?/ ? ? r, 2?? ^_ ?`; /°'? 7/?' ?'? °?
Softener
Inapectfon Date Insp. COmmentS
Footings I
Footings II
Foundation p
Framing Q
Roofing
Rough Plbg. /s F? d/) -,3-2r G A" ?
Rough Htg.
isul. - G - z -J6
Fireplace
Final Htg. ? ,-
Final Plbg. d'
Bldg. Final
Cert Occ.
r
Temp. LP
Deck Ftg.
Deck Final
Well
Pr. Disp.
d ` 0 LA
(Itr#ifira#e uf (?rrupttnry
Citp of (Eagan
10rVarWrnf of llutlbing JnWpriian
This Certif:cate issued pursuanr to the requirements of 5ection 306 of the Uniform Buildi+tg
Code certifying that at the time of issuance this structure was in compliance with the various
ordinances of the City regulating building construction or use. For rhe following.•
Use cta?6naon S'F RdG/GAR - Wg. Rrmit No. 15fi?_4
oa„P.ncy Type R3/41 zw,;ng o;suict PWR I Tya Comt. VN
owoer at MiiiwM rffL1ER MMICTIQV neerat 18133 (EDAR AVL S. FARMN:fl'N
a?wa;? Aaa? 1086 NQEIRVMl PARK ROAD L?.,,;ty I3. B I - IEXINGItK PAHICVM
i
,? ? n.?- JANOASY 27, 1989
'"--?-mag ?
POST IN A CONSPICUOUS PLACE
PERMIT #
MECHANICAL PERMIT ? " ?,
CITY OF EAGAN RECEIPT #
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE:
CONTRACT PRICE: PHONE: 454-8100
Site Address -?
Lot Block ? P
Sec/Sub gLDG. TYPE WORK DESCR ION
° x , ,
c' K'J; 2 4j Res. New
Y
I
?
'
° Name ' Muft Add-on
4
?
- Add Comm.
Re p air
; co
i c ress -
Ciry Phone `QC
r <_ (
Other
-
Name 17
t- FEES
RES. HVAC , 0-100 M BTU - $24.00
c Address ADOITIONAL 50 M BTU - 6.00
Cit
' Ph (RES. HVAC INCWDES A/C ON NEW
p y one CONSTRUCTION)
GAS OUTLETS
MINIMUM
1 PER PEHMIT
50 EA
-
(
) - 1. .
TYPE OF WORK COMM/IND FEE - 1% OF CONTRACT FEE
Forced Air M BTU G? APT. BLDGS. - COMM. RATE APPLIES
Boiler
M BTU TOWNHOUSE 8 CONOOS - RES. RATE APPLIES
MINIMUM RESIDENTIAL FEE - ALL ADD-ON 8
Unit Heater M BTU REMODELS - 12.00
` Air Cond. M BTU R MINIMUM COMMERCIAL FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
Vent CFM
- (ADD $.50 S/C IF PERMIT PRICE GOES ?
Gas Piping Outlets # ? 1"- BEYOND $1,000) ?
Other
FEE:
S/C: SIGNATURE OF PERMITTEE
TOTAL•
FOR: CITY OF EAGAN
?
s, PERMIT #
PWMBING PERMIT RECEIPT # ?
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: "
CONTRACT PRICE: PHONE:154-8100
m Name
m Addre
c Cily _
Name
? AddresS
p City Phone'.
FEES
COMM/INQ FEE - 1% OF CONTRACT FEE
APT. BLDGS - COMM RATE APPLIES
TOWNHOUSE & CONDO - RES. RATE APPLIES
MINIMUM - RESIDENTIAL FEE - $12.00
MINIMUM - COMM/IND FEE - $20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
BLDG. TYPE WORK DESCRIPTION
Res. New
Mult. Add-on
Comm. Repair
Other
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
NO?. FIXTURES TOTA4;
'JWater Closet - $3.00 $
Bath Tubs - $3.00
?Lavatory - $3.00
Shower - $3.00
Kitchen Sink - $3.00
Urinal/Bidet - $3.00
Laundry Tray - $3.00
' Floor Drains - $1.50
% Water Heater - $1.50
Whirlpool - $3.00
! Gas Piping Outlets - $1.50
(MINIMUM - 1 PER PERMIn
Softener - $5.00
Well - $10.00
Private Disp. - $10.00
?
Rough Openings - $1.50
OF
CITY OF EAGAN
FEE
STATE S/C:
:J
GRAND TOTAL•
CITY OF EAGAN Permit No: b Date: '.l ', ????? q? Sfze:
3830 PPat Knob Rosd Meter o: ?
P.O. Box 21189 der No: Date: _
Eagan, MN 55121 N e"?
Owner. Jot ?,jller Const.
1 T ;
SiteAddresx r in?tnn P?r]:
11?? ?Or?.t1ViP. W °a 1. n, ir,.,
Plumber. p1?m uth Plumbin^ -Conn. Chg: I; 5o ')O^rl - Zoning: '- ?
_ No. of Units: '
ACCL DBp: 1 `i _ tlRnr? -
Permit Fee:
Surcharge: -I a9ree to eomply with the City of Eagan
Tr. Plant Ordlnances.
Meter.
' s By ?
Misc.: ?
o Q WATER SERVICE PERMIT
Date: • ? _6 _ , a
CITaF OF EAGAN Permit No:
Date: _!?_•'•-
3850 Pilot Knab Road B/P No:
P.O. Bax 21199
Eagan, MN 55121 , ?Owner.
1 ? r ro i zw , I? .-k -,,; z •, r ; a - Y_nrLT':x-t3G-.
Site Address:
vi a4+
MWCC: `?• `. O()pd Zoning' `
City Chg: _oC". t;C; ? No. of Units:
Acct. Dep: I ? . OCp'
I agree to comply
with the City of Eagan
Permit Fee: Ordlnances.
,_l'T? .
?
Surcharge:
Misc : By
SEWE R SERVICE PERMIT
CITY OF EAGAN
3830 Pilot Kncb Road
P.O. Box 21199
Eagan, MN 55121
Permit No:
Meter No: _
Reader No:
Datec
Size:
Date:
Ownec Joe Miller Cou$t
SiteAddress: 1035 'doxthview °ark Rd Lz rl Teainatnn ?Rrk-Conn. Chg: 55i3 (1apii
Acct. Dep: 1 5 tl{1^r?
Permit Fee:
Surcharge: A?'•
Tr. Plant
Meter.
2oning: -
No. of Units:
I agree !o comply wlih fhe City of Eagan
Ordinances.
WATER SERVICE PERMIT
>.? .?
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21 •199, Eagan, MN 55121 N? 15824
" PHON E: 454•8100 ry ry? ?
BUILDING PERMIT Receipt # _ b 0
To be used for SF DWG/GAR Est. Value $105, 000 Date NOV 3 ,1 g$$_
Site Address. 1086 NORTHVIEW PARK RD OFFICE USE ONLY
Lot 3 elock 1 Sec/Sub.LEXINGTON PARKVIE OnSiteSewage _ Occupancy R-3 M-1
MWCC System X Zoning PD R-1
Parcel No. V-N
On Site Well _ (ActuapConst
a Name_JOE MILLER CONSTRUCTION CiryWater X (nllowabie) V=I?_
W PRV Required
- # of Stories
= Address 18133 CEDAR AVE S BoosterPUmp _ Length ??!
° City Fp M?N(=TON Phone 431-9007
Depth 41'
p Name SAME S.F.Total
,
oQ Address Footprint S.F.
? City Phone ppppOVALS FEES
Engr./Assess. Permi[ 590.00
W w Name $0
$2
?= Planner Surcharge .
x? Address
Council _
Pian aeview 295.00
a w City Phone
BIdg.Off.
SAC, City 100.00
I hereby acknowletlge that I have read this application and state that the Variance SAC, MWCC 550.00
information is correct an agree to compty wit -,all appliwble State of Water Cona 550.00
Minnesota Statutes an y of Eag'dn Or est"
Water Meter
67.00
SignaWreof Permitte Roatl Unit 72-1_00
A Building Permit is issued to:_ E_MILLER_ COT]$T__. Treatment Pt ?,Q}-QQ_
on the express condition that all ork shall be done in accordance with all
Parks
applicable State of Minnesota Statutes and City of Eagan Ortlinances.
Building Official
? r?r? TOTAL 2 ,733.50
_
? 9,30 ? 9
3 4 9 3 ' -
P I k7 ?,?.. '? . ? ?°-0
Reque t Date Fire a. h-in InspecGOn
• ui2E?
. ? Reatly Now ? W0 Notily IMpeciw
01 O Ves ? No When Feady.+
I licensed contractor p owner hereby request inspection of above electrical work at :
Jo A re I ireet, x Rou N.)
` qry ?
Section No. Townshlp Name w No. Raige No. Co i i&
O t (PRIPJT) Pha
4
- ?O
Power Supplier pddress
Elecv"ical Convactor (Company Name) C .
K ? ?
??ing ??`40 ?P?,NNOCe on)
K I.ANE ?
A u k?ulliEfiO?? y G 7 ry fl
1rilF y.,. Phone N Der
MINNESOTA STATE BOAFD OF ELEGTPICT' THIS INSPECTION REQt1EST WILL NOT
Grigga-Mldway BNIg. - Room StT! BE ACCEPTED 6Y TNE STATE BOAFD
1821 UniveniryAve., SL Paul, MN 55104 UNLESS PHOPER INSPECTION FEE IS
Plro. (612) 6424l800 ENCL0.SE0.
rf?C/g'g _REQUEST FOR ELECTRICAL INSPECTION
? See insvuciions (or completing this torm on back of yellow copy.
3 4 9 6 3 `7C' Below Work Covered by This Request
EB-00001-0]
9,30 s 9
ew Adtl Rep. 7ypeofBUilding AppliancesWired EquipmentWired
Home Range Temporary Service
Duplez Water Heater Eledric Heating
Apt. Building Dryer Olher (Speciy)
Comm./Industrial Furnace
Farm Air Conditioner
Other (specity) nt ctarS Remarks:
Campute Inspection Fee Below:
# Other Fee # ServiceEntranceSize Fee # CircuilslFeetlere Fee
Swimming Pool 0 to 200 Amps 0 to 100 Amps
Transformers Above 200 _ Amps Above 700 _ Amps
Signs lnspectorSUseony:
Irrigation Booms
Special Inspection J ?
Alarm/Communication
Olher Fee
I, the Electrical Inspector, here6y Rough-in . Date
certify thaY the above inspection has
been made. F;,,ai ? oei
OFFlCE IISE ONLY
1T15 requesl wid 18 monffis hom
71REQUEST FOR ELECTRICAL INSPECTION
f? ? See Insimclions for completirg Mis tortn on back ot yellow copy.
L, 7U709 X" Below Work Covered 6y This Request
EB-00001-07
„ ,y,9'2n9
co`lD351
ew Add Rep. TypeofBuilding AppliancesWired EquipmeniWired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Other (Specity)
Comm./Industrial Furnace
Farm ? Air Conditioner
ONer (epaciy) Conhecbr5 Remarka:
Compute Inspection Fee Below:
# Othar Fee # ServiceEnirance5ize Fee # Circuits/Feetlers Fee
Swimming Pool 0 to 200 Amps 0 to 100 Amps
Transformers Above 200 _ Amps Above 700 _ Amps
SignS Inspector§ Uee Only: TOTAL
Irrigation Booms
Special Inspecti0n ??
Alarm/Communication oG
Olher Free :576) 42
I, the Elec[rical Inspector, hereby R°°9n-m oa?
certify Mat the above inspection has
been made. F?nai oet
OFFICE USE ONLV
This reque9t witl 18 monMS fiom
7070 9,(..3 ?? '
RequestDate Df Fre No u h?in Inspeciron
uiretl?
? ReaM Now .?{7
ctor
?
12-1-$8 Xj Yes ? No W
hen Ready?e
IX] licensed contractor ? owner hereby request inspection of above electrical work at:
Jab Ad7raxs (Sireet, Box or Roule No.) City
1086 Northview Park Road Eagan
Section No. Township Narne or No. Range No. CwMy
Dakota
?? Phon
Joe
Pliller Construction CO. 431-2001
PowerSUpplier
Dakota Electric Atltlress
Farmington, MN
Elecirical Contracror (Compairy Nama) CoMraUOrS License No.
Midland Electric Inc. 041610
Melling Atltlress (COnVactor or Owner Making Instellalion)
14055 Grand Avenue So Suite E Burns i
Authoeae ' nature (Comrector/OHner Meking Installafion) Phone Number
892-6688
MINNESOTA STATE BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT
GrlgghMWway BICg. - poom S173 BE ACCEPTED BYTHE STATE BOARD
1821 Universlty Ave., SL Pau4 MN 55106 UNLESS PPOPEH INSPECTION FEE IS
Phone (612) 802-0800 ENCLOSEO.
AlbL
-?y;{-y?-g?-?--------, ;
? City Ol Laia11 1 Parmit #:
I ?
Permil Fee:
3830 Pilot Knob Road
i
Eagan MN 55122 ? Date Received:
Phone: (651) 675-5675
Fax: (651) 675-5694 I stae:
----- -----------
2009 RESIDENTIAL PLUMBING PERMIT APPLICATION
L?y ;
: 1U'D`? No?-I?-,V,,?.w
?,
Date: -V `,61 Sit
Addr
e
ess
f
Tenant: Suite #: '
RESIDENT! OWNER Name: Phone:
? 2S
Address ! City / Zip:
0 ?
CONTRACTOR Name: License
Address: n - -
City: 3671100tURd O100 Stat Zip:
,
5
I
Phone: ContaclPerson:
TYPE OF WORK _ New V? Repla ment _ Repair _ Febuiid Mod' y Space _ Work in Fi.O.W. ;
/ i .'
-
!?
Descri tion ot work: W
PERMIT TYPE RESI!)ENTIAL
?Wa[er Heater Water Softener '
i
_ Lawn Irrigation _Add Plumbing Fixtures
(_ RPZ /_ PVB) Main _ Lower Level)
Septic System _ Water Tumaround .
New
Abandonment .
RESIDENTlAL FEES:
$50.50 Minimum Water Heater, Water Soitener, or Water Heater and Softener (incWdes $.50 Siate Surcharge)
$30.50 Lawn Irrigation (includes $.50 State Surcharge) '
$50.50 Add Plumbing Fixtures, Septic SystemAbardcnmsn?, N/atsr Tumaround* (includes $.50 State Surcharge)
'Water Tumaround (add $165.00 if a 5/8" meter is required) I
$100.50 Septic System New ($70.00 per as built) (indudes County tee and $.50 State Surcharge)
$90.50 Fire Repair (replace bumed out appliances, ductwork, etc.) (includes $.50 Siate Surcharge) ?.? TOTAL FEES $ ?X)
,i
i nereoy acknowiedge mat tnis imormatron is compiete ano accurate; matme worK vnn oe m coruot„lalILe w1111 kilo ul????a?„?? a........o...., ... .,-.
Eagan; that I underetand this is not a permil, but only an appiicalion tor a permit, and work is nol to staA vrithout a permit; that the work will be in
acwrdance with the approved plan in lhe case of work which requires a review and approval oi.plans. ' i
-?5C-2- x
. .
Appl? nCs Printed Name ApplicaM's S?? ature
3
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3530 PILOT KNOB RD, EAGAN MN 55122
651-681-4675
New Canshuction Reauiromand
• 3 registered site surveys slrowirg sq. ft of lot, sq. R. of house; and all mofed areas
(20°h maximum lot coverage allowed)
• 2 copies of plan shawing 6eam 8 windax saes; poured found Ceagn, etc.)
• 7 sel of Energy Calculations
• 3 copies of Tree PreservaGon Plan if lot platted aRer 711193
• Rim Jaist DeWd Opfions selection shcet (Eldgs with 9 or less unds)
DATE 3 I6 Z
1
RemodaURewir Reauiremenb I As 7 .
. 2 coPies of plan
• 1 set ol Eneryy CakulaUons far heatetl addNons
• i sAe survey far extenor addidons 8 decks
• Indicate if hortre served 6y septic system for additions
n BG
VALUATION
SITE ADDRESS L0 Sfv ry2o1._6? Va4-L i`°' MULTI-FAMILY BLDG _ Y Y? N
TYPE OF WORK I A-ccn cg 4 FIREPIACE(S) _ 0 Y?.1 _ 2
APPLICANT Gl.l'-e-o-- n
STREETADDRESS I755 ? CITY aSTATE M-R ZIP
TELEPHONE#Co57'G9v-3"j57o CELLPH NE# 651'7,-oE-5_1S5 FAX# -32
PROPERTY OWNER -i" TELEPHONE# 6S!-'FS? ? g(3a
--------------------------------------------------- ----------------------------------- --------
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ NIINNESOTI. RULES 7670 CAT'EGORY l MINNESOT:1 RUI.ES 7672
(J submission rype) • Residential VenGlatlon Category 1 Worksheet Submitted • New Energy Code Worksheet Submitted
• Energy Envelape CalculaGOns Submitted
Plumbing Contractor: _
Plumbing system includes:
Mechanieal Conhactor.
Mechanical system includes:
Sewer/Water Conhactor:
_ Water Softener
_ Water Heater
_ No. of Baths
_ Air Conditioning
Heat Recovery System
Phone #
Iawn Sprinkler Fee: $90.00
No. of R.I. Baths
Phone #
MAY CO6io
Phone # pt,.
-------------°-° °------- °-----°------. _... --------•------------°°-°
I hereby acknowledge that I have read this application, state that the
with all applicabie Siate of Minnesota Statutes ond City of Eagan On
Signafure ot Applicant
OFFICE USE ONLY
----------•----------
id agree to comply
Certificates of Survey Received - Tree Preservation Plan Received _ Not Required _
Upda[ed 4102
OFFICE USE ONLY
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? OB 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 Ot of _ plex ? 09 07-plex O 17 Garage ? 22 PorchlAddn. (4-sea.), ? 33 EM. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck 0 23 Porch (screened) ? 36 MuIU
? 05 03-plex ? 11 10-plex ? 19 LowerLevel ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscelianeous
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ?44 Siding
? 32 Addition ? 38 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alterafion ? 37 Demolish (Bldg)` ? 43 Reroof ? 46 WindowslDoors
0 34 Replacement 'Demolition (Entlre Bidg only) - Give PCA handout to applicant
Valuation Occupancy MC/ES System
Census Code Zoning City 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) _ FinaVC.O.
_ Footings(deck) _ FinallNo C.O.
_ Footings (addirion) _ Plumbing
Foundation HVAC
Drain Tile Othec
Roof _ Ice & W ater _ Final _ Pool _ Ftgs _ Air/Gas Tescs _ Final
_ Framing _ Siding Stucw Stone
_ Fireplace _ R.I. _ Air Test _ Final _ W indows (new/replacement)
_ Insulation _ Retauring Wall
Approved By , Building Inspector
Base Fee
Surcharge
Plan Review
MClES SAC
City SAC
Water Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
***********************?***************
CITY OF EAGAN
CASHIER: JS TERMINAL NO: 767
DATE: 08/18/00 TIME: 11:04:47
ID:
NAME: SCOTT OR GERI MERCHANT
3210 9001 1086 NRTHVW PK 167.25
2155 9007 1086 NRTHVW PK 4.50
Total Receipt Amount: 171.75
CR136078
USER ID: JAN
2000 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EACAN
3830 PILOT KNOB RD - 55122
651-881-4875
New CorofiucMon Reaulrements ReffxXlol
> 3 reyistereA fife wrveYS tfwwiny sq. B. ol bt. aq. R. 01 houee
and 20 roo(ed areat (TOX maximum lol covemae albweN
> 2 coples of plans (show beam & window shes; poured fntl. deflgn: etcJ
> 1 sef OI energy ca4culaHOn6
> 3 coples of hae pretervaHOn plan B lot plafled aHer 7/t/93
DATE: g11610U ,
2 copies of piw
1 set of energy ealcWaHOns lor heated adtlleons
1 aite wrvey fa exterlw addlllona 3 tlecks
CONSTRUCTION COST: A?? S171cioV
DESCRIPTION OF WORK: 6242? N h'"!?AL} to?
STREET ADDRESS: 108(0 Na r-tti• v(,uW A2 K K o?"-? ?R? V9-rv +M ti
LOT: 3 BLOCK: ? SUBDJP.I.D. #: L? x' 1 nq ?'o ? Pq rK V I C'v/
Name: ?A e Rc-? ?Se-? Phone 0: # b S-I -y5 6--qf 3U
PROPERTY Wst Flrst W blz - l2-OZC?O
OWNER
Ske6t Addresa: t C) $ 6 Nd 12.`? U t'L) P`? r KI-
cny t R?l ?N state: ??'??'L' np; SS! Z3
5??? ?rivPwa? Ca.
Cancve.+e co `r ?Phones: bS 624 . . \ ...... .....?e? l-
CONTRACTOR ? see/Q,.,?
. Sheet Adtfress•
C?y State:
S? L -C-
ARCHIiECi/ Name:
ENGINEER Company:
TelephOne f: ( )
Street Address: Regisiratlon #:
Ciy
Stafe:
Y
Zlp:
Zip:
Sewer/water licemsed plumber Qf insWllina sewarlwater): Phone #: (,
I hereby ackrawledge that I have read ihls applicaHon, atafe thal lhe IMortnaHon is rteet, and agree to complY wiTh aq aPPffcable Sfafe
of Minneaoia°Stahites and Cily of Eagan Ordinances.
Signature of ApplkanY.
?
OFFICE USE ONLY
Certfficates of Survey Received _ Yes _ No
AUG 17 2000
Tree Preservation Pian Received - Yes - No - Not Required
OFFICE USE•ONLY
BUILDING PERMIT SUBTYPES
? 01 Foundation ? 07 05-plex
? 02 SF Dwelling ? 08 06-plex
? 03 01 of _ plex ? 09 07-plex
? 04 02-plex ? 10 OS-plex
? OS 03-plex ? 11 10-plex
? 06 04-plex ? 12 12-plex
WORK TYPE
? 31 New
0 32 Addition
? 33 Alteration
? 34 Repair
? 13 16-plex
of 17 Garage
? 18 Deck
? 19 Lower Level
Plbg _V or _ N
? 20 Pool
? 21 Porch (3-seaJ
? 22 Porch/Addn. (4-sea.)
? 23 Porch (screened) ,
? 24 Storm Damage '
? 25 Miscellaneous
? 30 Accessory Bldg.
? 36 Move Bldg. 0 43 Reroof
? 37 Demolish (Bldg)' ? 44 Siding
? 38 Demolish (Interior) ? 45 Fire Repair
? 42 Demolish (Foundation) ? 46 WindowslDoors
* Give PCA handout to appllcant for demolition permit
GENERAL INFORMATION
SAC Code c9 r
No. of Units i
No. of Buildings /
Const. (Actual) ?
(Allowable)
UBC Occupancy -3
Zoning - ?
# of Stories
Length
W idth
Basement sq. ft.
Main level sq. ft.
sq.ft.
sq.ft.
MISCELLANEOUS INSPECT'IONS
? Stucco/Stone
APPROVALS ?
Planning Building
sq. ft.
sq.ft.
Footprint sq. ft.
Census Code
MC/ES System
City Water
Booster Pump
PRV
Fire Sprinklered
Engineering Variance
O 31 Ext Alt - Multi
0 33 Ext. Aft • SF
? 36 Muw
Permit Fee
Surcharge
Plan Review
License
MClES SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
5/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total: ? i
r7 J
valuation: $ g I r?/? -
36
SAC Units
% SAC
88-188
TRI-LAND C0. SITE PLAN FOR:
SURVEYING
SERVICES JOSEPH MILLER CONST.
1260 YANKEE DOODLE ROAD
EAGAN, MINNESOTA 55122
LEGAL DESCRIPTION: LOT_3_,BLOCKI, t FxiN GTON PARKViEW
ACCORDING TO THE RECORQED PLAT
THEREOF DAKOTA COUNTY,MINNESOTA
- t NORTHVIEW PARK ROAD
°.
SCALE: t"=30
897,9
17.15 s0
EX. HOUSE
897w55
S 89°43'03" E
0
s w.v.
r - - -
I
?
698 65
-'(- - - -
r 20'
.?
GRG. FL.= 900.6
0
C;
Lr)
17.0'Qs ? 898
. . 5.
%
GAR.
897? 35
I?
a ?I
89fl3 ?.85s0
ly' J HUB 899.35
M
PROPOSED -I- I
HOUSE
44' ? 898 I 24.0d s
??' ?j??? ? - ' _ `? -i
'?F I
899r.! 899u3
(V I ?
O
, .
O ` I
O
Z 3
L - - ?_ -
0796 N 89°43'03" W 85,0C
?
r? 'r r
LEGEND PROPOSED FULL BASEMENT NO W/0
INVERT ELEVATION AT SERVICE EXTENSION=
o.DENOTES IRON MONUMENT PROPOSED GARAGE FLOOR ELEVATION= 9003
o DENOTES WOOD HUB SET PROPOSED FIRST FLOOR ELEVATION = 900.e
900.0 DENOTES EXISTING SPOT PROPOSED BASEMENT FLOOR ° 891.9
ELEVATION ELEVATION
DENOTES PROPO5ED SPOT
ELEVATION
? DENOTES DRAINAGE DIRECTION NOTE ' VERIFY ALL FLOOR HEIGHTS WITH
FINAL HOUSE PLANS
t hersby certify that this survay, pian or
ro ?t?
port was proparsd by me or under my
direct supervision and that i pm a duly Bradley J spnMp. Rep. No..15235
Repisteced Land Surveyor under the I I- ?
Laws of the State of Mirtnesota, Date.
; ?.
. , J
_ . . .' .. 4 .
'd?kW.*71nkK*?k ?k:k7a3k?Rck%C?C?7kk:{<71?7K?k'k*7k?RASy:..+a>GYok?'k>pk ;'
. I:ITY (]r-' Fiit:AN '
?;;ASu.:CER;. Jfi -rC?frHINAL kOc Gf3:d '
?OY2c`lJ93 .TiMr. ?.4tie7i?:,..'
Wfi1E: (=?TiESIT'E. GRi)I.tiR
9Ctt3.': 10.26 NC iFiV:' F'K 6(].,Od
2gys x1a':; .?.nwa Na:;7Hvt; P!: c.sn
w ,
, t
? ? .. ..
7cit,??l: fir?c?ipt
Cri u3:8Ftk5 :
J$i:ft. I.T..Ie ?ON.'
.:?
.?:}U?H(A(Y,<M?(*?:t*** it *iK7ko
, 4 . . , . . .
???1qg
1999 FIREPLACE PERMIT APPLICATION
C1TY OF EAGAN
3830 P(LOT KNOB RD - 55122
(65]) 681-4675
Date:
Description of Work: ? Construct new fireplace
_ Install eas insert oi:lv
_ Other
Job address:
Lot: Block: 1 S sion/P.I.D. #:
Applicant (circle one only): Owne ' Contractor
PROPERTY
OWNER
FIREPLACE
INSTALLER
GAS LINE
INSTALLER
?
_ Alteratioiis to existing
_ Install gas lii:e a:lv
1! I &W
Permit Fee: $60.50
Name:rno K l Y I - l?,_S6? l/1 Phone4:i- lS? "T`y u
Last First
Stteet Address:'
City ?a S[a[e: Vh Aj Zip:
Company. r V"`/I A , ?,, p /L/ Ph?Q dn?
?CJ+ C?'1Q^?7Sj?
_ . .n ,^ U
City ??y 1 v ? Y Stale: hlk?_ Zip:
Company: ? ?,oLlr y Lic- Phone #:
Street Address:
City
I hereby acknowledge that I have read this application ?
and aggree to comply with all ap 'cable State of N
Ordinances.
RECEIVED L ?
OCT 2 21999 ign ture
BY:
State:
Zip:
information is correct
a(id City of Eagan
OFFICE USE ONLY
BUIGDING PERMIT TYPE
? 14 Fireplace
WORK TYPE
? 3 1 New
? 32 Addition
? 33 Alterations
? 34 Repair
GENERAL INFORNIATION
Census Code. 434
SAC Code 01
REMARKS
Chimney/flue must be inspected before concealing.
590•00+
52•50+
295•00+
1?796•00+
2>733•50*
?
19$$ BUILDING PERMIT APPLICATION - CITY OF EAGAN
SINGLE FAMILY DWELLINGS
161 iq
I
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS
IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
MULTIPLE DWE[.LINGS RENTAL UNITS FOR SALE UNITS # OF UNITS
INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SURVEY - CHECK WITH HLDG. DEPT.,
1 SET OF ENERGY CALCULATIONS
COMMERCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & STRQCTURAL PLANS' NOi/
1 SET OE SPECIFICATIONS AND 1 Sr^.T OF ENERGY CALCULATIONS -W 0 11968
_-Z
To Be Used For:Muj Valuation: Date:
Site Address
Lot ? Block ? ???
. ?
Parcel/Sub
Owner
Address
City/Zip Code
Phone
Contractor. „
Address City/Zip Code
Phone 1/3 /
Arch./Engr.
Address
City/Zip Code
Phone !k
On/9 te'gewabg _ Oceupancy R-3 M-I I
M41CC system ? 2oning P a '?2-I
.?n site well Actual Const ?
City water Allowable
PRV required _ Ik of stories
Booster Pump _ Length
Depth UI
S.F. Total
Footprint S.F.
APPROVALS FEES
Engr/Asses
Planner
Council
Bldg. Off.
Variance
fOO0e?o
73 3
s Permit
Sureharge
Plan Review
G?II?2 SAC, City
SAC, MWCC
Water Conn
Water Meter
Road Unit
Treatment P1
Parks
Copies
TOTAL
0
vALuN-c-i o?J
.a
G??
5
@
? ?! 2 X l?1 ?'7 I 6 g
Z?
?`?
X
6 ? ??12
x 13 ? ?o
..??Z^
-(b?l(e o
23??2XV/2_ X4Cj? ? ? 15
o2 y x ZY ? 4 9 2
I'/L X I y= z I
x'4`_
41
Ia'Ll 62f
88-188
TRI'LAND CO. SITE PLAN FOR:
SURVEYING
SERVICES JOSEPH MILLER CONST.
1260 YANKEE DOODLE ROAD
EAGAN, MINNESOTA 55122
LEGAL DESCRIPTION- LOT_3.,BLOCKI, LFXINGTON PARKVIEW
ACCORDING 70 THE RECORDED PLAT
THEREOF DAKOTA COUNTY,MINNESOTA
. ? NORTHVIEW PARK ROAD
&.
897x9
BNY '
c
v
SCALE: I"=30'
17.15' sQ
EX. HOUSE
GRG. FL.= 900.6
<
?
(
17.0'(D
L
i
C
r?
:
897+55
89°43'03" E
g W
r - - -
I
?
ese ss
--?- --
.i
GAR.
D
7 N
I PROPOSED
HOUSE
44'
89S 7 i
5.
899„I
I
I
L_
897r35
0
c
t9&3 `I
-- ?-I
? o
a
899x3 '
I
3 I
N 89°43'03" W
i_ ?? ? r? "r '.=
)
LEGEND
o DENOTES IRON MONUMENT
o DENOTES WOOD HUB SET
soo.o DENOTES EXISTING SPOT
ELEVATION
OENOTES PROPOSED SPOT
ELEVATION
? DENOTES DRAINAGE DIRECTION
1 harsby certify tAat this survey,plan or
rsport was prepared by me or under my
direct supervision and that I pm a duly
Reqistered Land Survtyor undsr ths
Laws of the State of Minnesota.
5
23.85'0
HUB 898.35
24.0010
y
: ?? ' 1
/'r?,.
PROPOSED FULL BASEMENT NO W/0
INVERT ELEVATION AT SERVICE EXTENSION=
PROPOSED GARAGE FLOOR ELEVATION = 900 3
PROPOSED FIRST FLOOR ELEVATION = 900.8
PROPOSED BASEMENT FLOOR = 8919
ELEVATION
NOTE * VERIFY ALL FLOOR HEIGHTS WITH
FINAL HOUSE PLANS
Bradisy
Date - -
Rey. No. 15235
_ k:X'PEI2IUIt EIIVF:LOYFJ AUEIiAaG-
• . ? ('Po be, eubmitted witli building
, -
one or Two Family pwe11 iig
All otlier ? ?
Coutraotor
...a..a ur?rnau17U1 1 - !/(--
"ull COPIPUTATI011
permit applioaEion) fr-V15c:v 512'61gg?
owner
Bf te Addrees
__ l-?(-X.Ihc.??f")ln \\ FA/??T!/ P?..?
11&t0 v
Fltone
LIItEAL EEET OF
EXPO5ED VIALL ft. above LJ??II'"I
grade ?
'POT/lL EXPOSEU IYALL AIIEA 8q--Fm
oPAQUE WALL COtIS7'RUCTI01l
Deteil
relerenae
Irom
attachad
siLeeto
WI11 UO WS I
lialEe
It
I U Value x Area
nun
a`
X
Bq.-FT. U.
. CO ()(A)
U
r
%. Y1ti npii ld X 8R. FT. le3,,eFF
_--???) in)
x sq. Fm.
X sa. ,eT. - (u) (n)
Ilull X sq. (U)(e)
? x Sq. FT. - (U)(A)
"U" Vnlue x Area
? Type 166frvir liull- i3(o
?? X sq' F?: ? lacv,qzcu?cn?
Ilull • „
It ------- ?Ilull Q
x a . Fi. (n)
- (?)(n)
np n -
x sR. F?r. ? (U)(n)
W049t "U" Value x Area
Idalte. & TYpe ?IU I Iq,
u If x 84j. FT. ??O ??)?A)
u n .`-x Sq. FT, ?_?c? •= 1 ?11)??)
?????n x nR. F'r. ? I?)(?)
- x sq. F?r. - (u) (n)
Tomu.s 7SQ. i-m.? 99 cu) ca)
To?rnL (u)(n) VALUE,q AVER UE ifull
? °
UIVIUEU DY TOTA[O7/LL AAEA??d?? /05
AVERAC3E
•115 or lees for 1&2 iamily dwellinge
RoOF/CEIliIliat?
TO'PAL AREAt
lletail refereitiae flUll_ I?7iI q
from '
IIUII
-------x SQ. Fr.( ?(?1 (U) (A)
attaclied slieete, ifull ? (U)(A)
Ueacrlbe openitige X 9Q. FT. _ (A) in root. x BQ. F'P. n (Il)(A)
ap u
--------.? x 3Q. Evr.--------- .,_ (U) (A)
ToTnc, (u)(n) vnr,uES nzvzncv ax > TOTAL ROOF/CEILIti1?[tEA
AVEItADE !?U! :02$0r va»tilqtea roorH. ?D?? '
?
.
.111
?
?]??9X???a?-•Fz9?5 ??q,5)=I?'???3?
81?3x(
z34?? i?
I ,cjO-7X 197 = yPAI
ioX 14-7 = ?2zia1
I 7-0A8 = ?to XI' a
7 z- 2- 0 X,15 = 181 0 K I=10
I Z'I(aX3w - ) o,S>CI =10,5
1 3-zwx?oa -Z1 ? 1-Z-1.0 .
S`r1., 7, 8t 0
?? u?ows I&?5
?
,1 Z? 7 / o4-
PEUISC.-io 512,51967
04Vl9L5
Z3q?? IQ
60',o
/951?1?
l?'±lleEelmining uUu valueu nt Itoott Wall? llim? and Uono. 8loalc
.. . .
. .
'
IIUVF/
dEll,IltU
_ , Il V1lLU
1.1 Interior Air k'i.im 0.61
2.) 5i0', nrr. ea. ,56
3• ) It?auleEion ¢?
?.1 ?
•
5.) Exterior Air Film .61
. I?TSLL) .
up° tl 1/!l? r02.1 lOTN,
--
g
? i• .
Yru'L li VALU
6.) Ynterior Air p'ilm 0.68
7.)
0.) lll'ayp, $d.
znsulation
H:oo
9. )
10.) J'?ult:('-rI1F:
Itpeotiite 81di?t z ?.
.) g
Exterior Air Film .67
417 •
???n 4 llliy r O'+•7j TOTAL (!1)a z7 O f
11111 . SIl) YAI,U
12.) Interior Air Y'ilio 0,60
130 Ineulabioa ?q.ov '
14. ) z" Fir ilim Joiab • 1.88
15.) J'wir.-r-Pffc . .
20
16.) Nsovuite.sidinr , 67
, ,
170 Exteriar Air Film ?17
I??U ea 1?Iln ?M.p TOTAL (I1)n
. 2vvn-
FOUl1UAT,I01(
10.).interior Air Film'
19.) •' ? Il VIWUq
0,68
'
20: )
21.)
22.)
P-rl y rR1P1eD •
121, Uoaoreke Bloolt .
11.co
I,2g
23.) Exterior Air Film ,17
npii -070? TomAL (ti)e
^ ? .
.
APFLICATION 1=0R PERMIT
SEWER AND/OR WATER CONNECTION
} ?.?.......?.?.........??......?._.?
? NC71'E: PAYMNf OF FEE AT TIME OF
? APPLICATZON DpFS NpT CON-
? STi7[7f'E APPRGJN. OF PIIIFIIT.
e
f
? INSPECfION OF SFAdER INID/OR WATE[t ;
; iNsta[.v,Tiotas wu.[, ta5r se scmvi.m ;
? [RdfIL PII+MIT HAS E@] ApPROVID. ;
ltYSf fik*tiiyk4f fYY/e44f?fe1(**i?e*fkf fii•
oF LcocjRcn
(PLEASE PRINT
1) PROPII2TY ADDRESS: Ib?? UUwA UctW ?twxGG.
T•FY;AT• DESQ2IPTION:
or
IF EXISTING STRCCT['RE, DATE OF ORIGINAL BtiILDING PEtMiT ISSLANCE:
PRESEiNT ZONING/PROPOSID CSE:
Q COMMERCIAL/RETAIL/OFFICE
Q INDCSTRIAL
Q INSTITCTIO[VAL/G0VERAIINENT
Nbnt Year
j,-,-R-1 SINGLE FAMILY
? R-2 DUPLEX (3WO L'nits)
? R-3 TOWNHOOSE (Three + []nits) ( Cnits)
Q R-4 APARTMENT/CODIDOMINIL'M ( C'nits)
z) ? NANE: 'Zfuc m r l l? &,- Cott f-
aDDREss: ?a? a 3 Gc?Oti.a K},,? S
CITY, STATE, ZIP:
PHONE: `/3
3) ? ?: ?• NarE:
% ?e w
N
?h ?/c r
..r..
aoDxESS: 4SSO -z4,tin!3 L". ?
CITY. STATE, ZIP: HGf,pgl .(a.. (;?u?? IY1rJ
PHONE: yr? ?,? y7i f MASTER LICENSE #^?4(,s'
4)
NAME:
ADDRFSS:
CITY, STATE, ZIP:
PHONE:
P1 erumicense:
I? Active
btpired
Not recarde(f
Sta Initial
5) ?i? ? :?Y ' . a ??y i •ao ..?x?o
Eg-GONNECTION TO CITY SEWER Q-CONNECTION 'Ib CITY WATEE2 O OTHETt
6) ? Gt?li?s•-aLl1? mdu.d?
r*****iek*********iF*********!k******4k****ir*****?F*:F:F*********rt***i?**#**?k*****k************aF*#ik*****:F*r
*
*'I73E GOID COPY OF ZYIE PEf2NIIT WILL BE SENP DIRFx'I'LY TD PUSI,IC WORKS ?U FACILITATE METER PICK-OP.
PLEASE l1LIOW 'I4O FARKING DAYS FOR PROCFSSING. SOMIDONE EROM TEIE CITY WILL CONTACP YOD IF THERE
* ARE ANY PROSI04S. '
??***,e*******??*r,x**,r*******,+**?:*****r*****?***++***********?****x***r.**+??:*+x*+******:r++******??;
FOR C0l"Y USE ONLY
PERMIT # ISSL'ED
Pd w/Bldq. Permit
$
S
$ ? -7, [j-D
FEES:
S 16 •S ? SEWER PERMIT (INCLCDE SC'RCHARGE)
S /D 7 _ WATER PERMIT (INCLLDE SCRCHARGE)
$ WATER METER/COPPERHORN/OCTSIDE READER
$ $ WATER TAP (INCLCDE CORPORATION STOP)
$ $ SEWER TAP ?
$ $ ?S OTJ ACCOCNT DEPOSIT - SEWER '
$ ACCOUNT DEPOSIT - WATER '
$ WAC
$ (? S f•? • ?? $ SAC i
$ $ TRUNK WATER ASSESSMENT
$ $ TRCNK SEWER ASSESSDIENT
$ $ LATERAL BENEFIT/TRUNK SEWER
$ $ LATERAL BEN°FIT/TRCNK WATER
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$ $ WATER TREATMENT PLANT SL'RCHARGE
_
$ $ OTHER: I
$ 71' Ue) $ TOTAL
7 '
RECEIPT RECEIPT
DOES L'TILITY CONNEC TION REQLIRE EXCAVATION IN PL'BLIC RIGHT OF WAY?
Q YES IF YES, THEN A"PERMIT I'OR WORK WITHIN PCBLIC
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NO ROADWAY" MUST BE ISSLED EY THE ENGINEERING ?
DIVISION
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SCBJECT TO THE FOLL OL9ING CONDITIONS:
APPROVED BY: 41ty? /a-z??
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TITLE:
DATE :
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Use BLUE or BLACK Ink
I For Office Use
I I
I Permit I
City of Eanofl
I Permit Fee: 6di I
I I
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3830 Pilot Knob Road I
Eagan MN 55122 I Date Received:
Phone: (651) 675-5675 j Staff:
Fax: (651) 675-5694 L -----------------I
INFLOW FILTRATION PERMIT APPLICATION
Plumbing / Sewer & Water
Site Address: /06C Ize-d
Date:
Tenant: C~ Suite
Name: Phone: 33
RESIDENT / OWNER v Ada
Address /City /Zip:
Name: License
CONTRACTOR Address: City:
State: Zip: Phone:
Contact: Email:
PLUMBING (Within the building envelope) SEWER & WATER (Outside the building envelope)
TYPE OF WORKSump Pump Repair Repair
Other: Other:
~f e ,l
Description of work: ►`'"i ` S ` ``2 ``si`r
DESCRIPTION
FEES
$60.00 / 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.cityofeaaan.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. www.gopherstateonecall.org
I hereby acknowledge that this information is complete and accurate; that the work will conformance with the ordinances and
codes of the City of Eagan; that I understand this is not a permit, but only an application or 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 w i requires a revi w a approval of plans.
X_ 45;,-t- ov~ x
Applicant's Printed Name -Ifip Signature
FOR OFFICE USE Reviewed By: Date:
Required Inspections: -Under Ground -Rough-In -Final
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PERMIT
City of Eagan Permit Type:Building
Permit Number:EA152694
Date Issued:10/26/2018
Permit Category:ePermit
Site Address: 1086 Northview Park Rd
Lot:3 Block: 1 Addition: Lexington Parkview
PID:10-45035-01-030
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:Includes Skylight
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: 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 -
Scott A Merchant
1086 Northview Park Rd
Eagan MN 55123
(651) 261-9601
T. Dunham Construction
831 Ventnor Ave
Eagan MN 55123
(612) 819-0480
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA163020
Date Issued:08/11/2020
Permit Category:ePermit
Site Address: 1086 Northview Park Rd
Lot:3 Block: 1 Addition: Lexington Parkview
PID:10-45035-01-030
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 -
Scott A Merchant
1086 Northview Park Rd
Eagan MN 55123
(651) 261-6633
Champion Plumbing
3670 Dodd Rd., #100
Eagan MN 55123
(651) 365-1340
Applicant/Permitee: Signature Issued By: Signature