1668 Norwood Dr
-
Use BLUE or BLACK Ink
-For--Offi-ce--Use-
I I
City o Eajan Permit#:
I Permit Fee: I
3830 Pilot Knob Road I
Eagan MN 55122 Date Received:
Phone: (651) 675-5675
Fax: (651) 675-5694 I Staff
INFLOW & INFILTRATION PERMIT APPLICATION
Plumbing I Sewer & Water
Date: rx Site Address: 16 ~ Xv,, ff WG~C 1/ ( n~'1 42," -,2;2 2
Tenant: Z-"~rl- Suite
RESIDENT /OWNER Name: Phone:
Address/ City/ Zip: Z66 S N 2
Name: A6144e /J l~ L~YLIZy' License
CONTRACTOR Address: City:
State: Zip: Phone:
Contact: Email:
PLUMBING (Within the building envelope) SEWER & WATER (Outside the building envelope)
TYPE OF WORK Sump Pump Repair Repair
Other: Other:
Description of work:
5%l~// ✓)iGJ~ ~i ✓~,r°11~1 J'3/i'1
DESCRIPTION
41
FEES
$56.00 /Each (includes $5.00 State Surcharge) (Rev. 6-30-10) 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.citvofeagan.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
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 ao V, v lt~r X J~~'
Applicant's Printed Name Applicant's Signature
FOR OFFICE USE Reviewed By: Date:
Required Inspections: Under Ground -Rough-In -Final
?
CASH RECEIPT
CITY OF EAGAN
P. O. BOX 21-199
EAGAN, MINNESOTA 55121
DATE 19
ncceiveo
FROM
AMOUNT $ ?
Ae DOLLARS
too
E]CASH ? CHECK
FOR
FV ND CODfi AIAOUNT
Tha k ou
?' ' ? BY
yGC.
White-Payers CopY
Yellow-Posting Copy
Pink-File CopY
CITY OF EAGAN ?T
, 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 1? ? 8903
PH ON E: 454-8100
BUILDING PERMIT
To be u"d for
Site Address 1668 PdOR?irQOn DR
Lot I) Block 3 sec/sub. nR T
Parcei No. 10-15000--030-03
Name TOLLEFSnr7 BLDR
; Address 1655 NO 1;1?T('i0I} D
b City T'lCI-,?'d Phone 4
o Name
?? Address
F- City Phone
H
F W Name
Address
s- W Citv Phone
I hereby ocknowledge thot I hove
the informotion is correCt ond a
Stote of Minnesoto Statutes and
Slpnature of Permittea
A Building Permit ia issued to:
atl work sholl be done in o i
Buildirg Officiol
?.i
Receipf # i ,
~?il ? ?0(1 Dare :?Li}'.CII zl
`: 1t3
Erect Occupcncy
Alter 0 Zoning
Repoir ? Fire Zone N/A
Enlarge ? Type of Const. 'J
Move p # Stories
Demolish ? Length ?
Water & Sew.
P
li
o
ce
Fi
re
E
ny.
Pl
anner
:ation and stote thot Council
gldg. Off.
with oll appiiccble
Ordinances. APC
Permit ' 00
surcha.ge 40.50
Plon check 18 el• () 0
snc 525.00
Wcter Conn. 470.00
Water Meter 63.00
Road Unit 260.00
Totol 51 , 9 ?. 2 . `. ? ^
on the express condition thar
ond City of Eoqan Ordirwnces.
Permit No. Permit Holder Misc. Permit No. Holder
002
W
Disp.
Sewar
Electric
pection date
Ins
Insp.
Other
Footingt af
Foundation
Framing ?
Rouph Plb9.
I
Rough HVAC ",'
Insulation ?
Final Plby.
Final HVAC
?
Final c?
Water Dsscri6e Location: _
Well
Sewer -
Pr. Ditp.
MECHANICAL PERMIT
CITY OF EAGAN
3830 PILOT KN08 ROAD, EAGAN, MN 55122
PRICE: PHONE: 454-8100
Site Address
Lot V
? Name _ ["?as, dir H1
? Address LG t1
c City 1r L,? ff •r
? Name
3 Address iLc. , NL U1
p C;ty
TYPE OF WORK
Forced Air
Boiler
Unit Heater
Air Cond.
Vent
Gas Piping Outlets #
Other
? BLDG. TYPE WORK DESCRIPTION
Sec/Sub Res. V New
Mult Add-on ?
Comm. Repair
? ?- i_-, i ci fa O1hBf
M BTU
M BTU
M BTU
?M BTU
CFM
FEE:
S/C:
TOTAL:
?y.., . . .. _ ?r ? _,.... ;
PERMIT #
RECEIPT #
DATE:
FEES
RES. HVAC 0-100 M BTU -$24.00
ADDITIONAL 50 M BTU - 6.00
(RES. HVAC INCLUDES A/C ON NEW
CONSTRUCTION)
GAS OUTLETS (MINIMUM - 1 PER PERMIn - 1.50 EA.
COMM/IND FEE - 14b OF CONTRACT FEE
APT. BLDGS. - COMM. RATE APPUES
TOWNHOUSE & CONDOS - RES. RATE APPLIES
MINIMUM RESIDENTIAL FEE - ALL ADD-ON &
REMODELS - 12.00
MINIMUM COMMERCiAL FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND $1,000)
.. ?
i ,
•
?
c.
,w
SIGNATUR OF PERMITTEE
711s87
FOR: CITY OF EAGAN
Receipt MECHANICAL PERMIT
CITY OF EAGAN
.,,.,_.. ?,.w..
FiII in numbered speces S/C _
Type or Print /egibly
Tot.
1. Date 2. Installation Cost
i
3. Job Address Lot "- Blk. Tract ?
4. Owner
5. Contractor Phone
6. Address
7. City " State Zip
8. Building Type: Residential O Commercial ? Institutional ?
9. Work Description: New 2" Add O Alter O Repair ?
I 10. Describe Fuel Type
I 11.
No. Equinment BTU - M. Ea.
Forced Air No. EQUiament CFM
Ai
H
dli
Mfg. r
an
ng:
Boilers
Mfg. Mech. Exhaust
Unit Heater
Mfg. Other
Air Cond.
Mfg.
Gas, Piping Outlets
?
12. I hereby certify that the above information is true and correct, and I agree to
comply with all ordinances 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 464-6100
Receiot C, PLUMBING PERMIT
?_ . , r_ . CITY OF EAGAN
Permit No, f
Fee
Fill in numbered spaces S/C Type or Princ legibly
Tot.
1. Date 2. Installation Cost -
3. Job Address Lot Bik. i-l Tract
_ r - •?--' / „ -
4. Owner --
5. Contractor
4?'VL -/C
6. Address ?
7. City ? State
8. Building Type: Residential L
i ;
9. Work Description: New A
10. Describe
11.
Zip
Commercial ? Institutionai ?
Add ? Alter ? Repair O
No. Fixtures
Water Closet No. Fixtures
Cesspool/Drainfield
Bath tubs Septic Tank
Lavatory Softner
Shower Well
Kitchen Sink
Urinal/Bidet Other
Laundry Tray
Floor Drains
Drinking Ftn.
Slop Sink
+ Gas Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
comply with all ordinances 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
Phone
?
CITY OF EAGAN Remarks
Addition BkITTAlvY Loc 3 sik 3 Parcel 1?? ?gnn nzn nz
Owner Street 1668 Norwood Drive State
Vlli UEl.! L4.
Improvement Date Amount Annual Years Payment Receipt Date
STREETSURF. ?,L 1127.96 A014041 6-2-84
STREET RESTOR.
GRADING ?G 198 428.73 28.58 ? 384.41 't
SAN SEW TRUNK Jc ? 1976 156.51 1 62.64
"
"
• SEWERLATERAL 336.06 3696.67 "
WATERMAIN
* WATER LATERAL 1991
WATER AREA -5/ 1$0.00 14014041 6-2-84
STORM SEW TRK s rY 1981
492.50
j2 .$3
351 , 1$
A014041
6-2-84
* STQRM SEW LAT 1981
CURB & GUTTER
SIDEWALK
STREET LIGHT
ROAD UNIT 260.00 3-21-84
WATER CONN.
470.00
't
BUILDING PER. 890
sac 525.00 "
PARK
3830 Pilot K;;ab Road r55U
P: O. Box 21199 PERMIT NO.:
Eagan, MN 551,21 DATE:
Zoning: ` No. of Units:
Owner: 8 'SOn ?' _?KS
Address:
Site Addreu: 1 6 . oraroo . r ve ?,_ ..r. tt?ny s
Plumber: f?Fn2 RV an
- - 0 14 1 . p
425.00 pd
1 egrea to eemply wieh /ie Ciyr of Eayon Connection Charqe:
Ordinencas. Accourit Deposit:
'sc
r
• }
Pertnit Fee: ?
•.?1L?:
Surchorge: `
By Misc. Chorges:
Date of Insp.: Total:
CITY OF EAGAN WATER SERVICE PERMIT
3830 Pilot f' nab Road
P. .O. 6ox 21199 PERMIT NO.:
Eagan, MN 55121 DATE:
Zoninp: No. of Units:
Owner: ' ;,.letson Bldrs
/4ddress:
Site Address: 1668 *iorwood Drive L3 B.y ::xtetar. y lst
Plumber: f -.er-,'r. :^.vgn
Meter No.: Connedion Chorge: t' 7?J `00 v`?
:t S. 0[ ; n?_;
5ixe: Accourff aeposit:
10.9 0 -?d
Reader No.: Permit Fee:
1sgros to oomply witb lIM Gry of Es4en Surcharge: 'T) d
63.00 ?7d meti
Ordinosua. Mlsc. Ghorpes: _
Totol:
gy Dote Paid:
Date of Insp.: Insp.:
CITY OF EAGAM WATER SERVICE PERMIT
3830 Nif ot r' nob Road
P. O. Box 21199
PERMIT NO.: ,,
Eagan, MN 55121
DATE: _++.{
"
Zoning: No, of Units: 1 ?
Owner -`0l efsou Bldrs f
Address: , 7, '_
Stte Address: 5$. ??orwo ve :3 B3 Brj.ttanv 'st
iomber:
-
'
:
? ? ( ?
ter No.: `
?l l ? - ' f1V t nettion Chorge: 470.90 p' -
'
Stx. 4 ?urrt Deposit: 15. 00 pc ?
Reader No.: o Permit Fee; 10.00 pd
f-f 1 a9re* to hr wlek ity of a Surcharqe: . 5(l n?
O?dina . Misc. Gwrges: r j. 00
Total:
By Date Paid:
Oate of I nsp.: ? ? I nsp,;
CITY OF EAGAN '?j Q
3830 Pilot Kno6 Road, P.O. Box 21-799, Eagan, MN 55121 i` • 8903
PHONE: 454-8100
BUILDING PERMIT Reteipt # ???L(/1 ?-
To ba uwd fer SF DWG/GAR Est,yalue $81,000 pate MARCH 21 1y84
SiteAddress 1668 NORWOOD DR_ Erect 2SX Occupancy R3
Lot3-81ock 3 Sec/Sub.BRTTTANV qlter ? Zoning RI
Parcel No. 1 0-1 5000-030-03 Repoir ? Flre Zone N/A
Enlarg0 ? Type of Const. V
W Name TOT.T.F.FSnN RT.nRR_ Move ? # Srories
Z Address 1 6 55 NnRWOOn T]R _ --- Demolish ? Length7(L_
? City F.A(]AN Phone 454-6873 Gmde ? Depth._3D-Sq. Ft.-
Approrala Feea
o Name S?E
?
?? Address
r City Phone
?w Name
_? Address
u
?W City Phone
1 hereby acknowledge thot I have read this oppiication ond store that
the inlormation is wrrect ond agrea fo comply with all opplicable
Sfate of Minnesola Stafutes ond Cify of Eogan Ordinancet.
Signoture of Permittee -
A 8ullding Dermif is issued to:
oll work sholl be done in acw
Assessment -
Water & Sew.
Police -
Fire
Eng.
Plonner _
Council _
Bldg. Off. _
APC
Pe.,l,ct $ 376.00
Surchorge 40.50
Plan check 18$.00
SAC 525.00
Water Conn. 470 _ 00
Woter Meter 63 - 00
Rood Unit 7Cn 00
Totol '<_?2., rj0
TOLLEFSON BLDR. on the ezpress condition thnt
e wilh al aDCliw e Sfate of Minnewto,5tafutes and City of Eapon Ordinances.
Building Officiol
SEDGWICK HEATING & AIR CONDITIONIN
8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) 887
AODRESS t 6???D??' Ok -
OCCUPAN7
SOLD BV 'S O-?? ?\
MAKE ?k
SERIALNO, ,q ? -?j? ?'?
THERMDSTAT b
?1' 6vvv
VALVE
LIMIT
LIMIT SETTING ?00_-0"F
FAN SETTING A-
PILOTTYPE ?
IGNITION MODEL
PILOTTIMING ?
PRESSUR i ! '
PEFCENT COz
INPU7 CFH ` ? /? PERCENT Oz
STACKTEMP. I_1PERCENTCO
FORM 235 (REV.11I09)
GopCpO?
qTY HEATING S `&OO
TEST RECORD JOB NO.
Cb ?p
?
-
OWNER -
A"'"("
INSTALLED BV -
01
MODEL "-' "oU.oo(`G i`
INPUT 7???-n/
VENT SIZE
TVPE OF LINER
/? r ?
LINER SIZE L?
FILTERS: SIZE
WIRING
TEST TAG
LIGHTING INST,
DATETESTED / 112714?1
?
COMPANV TESTING
NAME OF TESTEfi
FORMDiSTRIBl1T10N: WHITECOPY-J09FILE YELLOWCOPV - CITY
/?/,?y r
ti?i^?-
Rb 8e [laed Fbr 40
Site Addree6 U--)W,
Lct ? 81odc ?
Poiml 1: / J
Sec./Sub.
clTSr cr• F1AGAN Ir,cluae 2 sers of p?iansp ??03
1 site plan w/elevatians i I
HUIIDING PEEihII'P APPLICATZCIN 1 set c,f etecgy Calt,ylatlang. j
?-valuatiai Date dLI,!/(,i/1
CFF'ICE? USE RNI.Y
Erect ? oocwPancY
; 47J d- 03 0- C7_ nlter zonir?q
Owtlers ?,- {jE'Q(}ll) ?e Fire 2one
_ 'lype o£ oonst.
??? Move M Stories
Derolish Fxont 7p f{,
CLtS'/Z1P Cade; Grade Dq->tli .3o ft.
Ptnna # :
aaare$: 1 ? c
ah+/xiP Qade:
ptwne o: _ 45
]1idi./FS'iq. s
Addieae: •
citx/zip ooae:
rhom t:
APPIiWALS FEES .
Assessmnt8 Permtt 37
Water/5ewer Surcharge yh Sn_
Police Plan C1erk ?
Fire SAC .?-a,g-
g.
? water Conn,
P1any1C Water Met1's /03 2?
Ocx.tncil Road Unit
Bldg. Off.' ?
APC
3-??1??l pp?
z+arnL I ; ?l a a ?5 ?
„
,
?a.9
. .
RESIDENTIAL BUILDING
PermitApplication
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone 4 651-675-5675 FAX # 651-675-5694
New ConsW cibn ReauiremenCS RemodeVReoair ReauiremenCs
3 registe2d site surveys shovring sq. ft. of lot, sq. ft. of house; and II roofed areas 2 copies of plan
(20°h maximum lot coverage albwed) 1 set of Energy Calculations for heated additions
2 copies oi plan showing beam & window sizes; poured tound design, etc. 1 site survey tar addifions & decks
1 set o( Energy Calalations AddiG'on - irMicate Hon-site sepfic system
3 copies of Tree Preservalion Plan if lot platted atter 711193
Rim Jaist Detail Options seledion sheet (bldgs with 3 orless units
? ?C) oe
`Ue g 1 ?'
Office Use Onlv
Cert ofSurveyRecd _Y _N
Tree Pres Plan Recd _ Y_ N
TreePresNotReqd _Y _N
On-sde Sepbc System _ Y_ N
Date Q?
Site Address ? n{ Lko' Construction Cost ?i 6?C?CJ
Unit/Ste #
Description of Work ?C?y?l?iPP*wvt f ei ('?p,.sAqq (Vf'r it/
Multi-Family Bldg _ Y? N ? Fireplace(s) ? 0 _ 1 _ 2
Property Owner ?, ?Y ?e,IKICI? Telep6one #
Contractor ?i0 (-LaEt Lf (-Tfiv 4
Address
State
Zip City Pt.?) ! r
Telephone #((?js') ) -Sf
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Catesorv 1 Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(Jsubmissiontype) Submitted Submitted
• Energy Envelope Calculations Submitted
Have you previously constructed a
fee applies.
?1`G 11'1 Iti -
? ?? pUG 12 2103
plan2 _ Y
N If so, 25% plan review
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone #(
Telephone #(
Telephone #(
I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a
,V(n the case of work which requires a review and
permit; that the work will be in accordance with the approved pla
approval of plans.
?crc ????sh;Ff /, ,-
Applic t's Printed Name p ca 's signaturii/
OFFICE USE ONLY
Sub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex O 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace 0 21 Porch (3-sea.) ? 31 Ext. Alt - Multl
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF
O 04 02-plex ? 10 OS-plex )e 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex ? 19 LowerLevel ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Pibg_vor_N ? 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alteratlon ? 37 Demolish (Bldg)• ? 43 Reroof ? 46 Windows/Doors
X 34 Replacement `Demolltlon (Entire 81dg) - Gfve PCA handout to applicant
Valuation ,Lpew Occupancy R_-? MC/ES System --
Census Code j/ 3 Zoning /7`/ City Water
SAC Units Stories Booster Pump -
Nbr. of Units ? Sq. Ft. PRV ?
Nbr. of Bidgs Length i? Fire Sprinklered
Type of Const Width ?
REQUIREDINSPECTIONS
Footings (new bldg) FinaVC.O.
? Footings (deck) ?- FinaUNo C.O.
_ Footings (addition) _ Plumbing
_ Foundation HVAC
_ Drain Tile Other
Roof Ice & Water Final Pool Ftgs Au/Gas Tests Final
? Framing _ Siding Stucco Stone
_ Fireplace _ R.I. _ Air Test _ Final _ Windows (new/replacement)
_ Insularion _ Retaining Wall
Approved By
Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S8W Permit & Surcharge
Treatrnent Plant
License Search
Copies
Other
Total
/
0
?
i
C)?
0
a
?
J V .
t 4??
I M[R6tT Cl
Or.11495 ,
? tee-7
JACKSON - SURVEYORS
R[61/T[R[O VND?R LAWS O/ KATt M YIMNtpTA
3616EAST55thSTREET,MINNEAPOLIS,MN55417 727348q Snchtpor'Ii dccNtuat
,
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/
1 Or,,; e ry
N
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e• ??0/? ;,
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N
i Tf` ` •
116 , ? j,? ?-~ ?i
Scale: 1".30'
•=Iran
? --?= Draioage
OOO.04xistiag Elev.
=Draiaage 6 Utility Easement
?'.
\ s.
22 ;
' \ D
?
.,
s o
' {7
M1
rNAT TX[ ABOVt 18 A TRU[ ANC CORR[GT rLAT W A SUIIY[Y OF 3 1
Proposed Carage Floor Blev,
I.ot 3,Block 3;Srir?Cany, ?opoeed Firet lloor Elov.
Dakota Caunty,Minneeats. propoaed Basement Ploor Elev.
. . ? RESIDENTIAL
BUILDINC PERMIT APPLICATION
CITY OF EAGAN
(Y f 3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675
New Constructlon RenulremaMe
. 3 registered sile surveys showing sq. R. of lot, sq. tl. ol house; and all roofed areas
(20Yo maximum lut coverage allowed)
• 2 copies ol plan showing beam & windax sizes; poured found design, etc.)
• 1 set of Eneyy Calalations
. 3 copies ot Tree Preservation Plan'rf lot plaHed after 711193
. Rim Jaist DeWtl Optwns selection sheet (Mdgs with 3 or less units)
DATE 9)' 'A ` 02
_ Water 5oftener
_ Water Heater
No. of Baths
SITE ADDRESS IllOLp t? wbRv.?f4i7'O D R MULTI-FAMILY BLDG _ Y kN
TYPE OF WOR&R06V 'MACZ (DFF L SbbtNL?tiV,, FIREPLACE(S) X 0_ 1_ 2
APPLICANT QµF 2lci_" Q? ?oi+.t C? C.DNiRA GT? dZ.S
STREETADDRESS WC0% Ncctwavr DdL CITY GAG,l•1a STATE N0 ZIP 55_1, 27-
__ --- - /?
--------
TELEPHONE # ORRMLI&CELL PHONE 4 ' FAX #
4152-1u'1-loei54
?
PROPERTYOWNER n?Q.GvLoQI B%,Lt-csG.IC TELEPHONE#aS2-(o*8'7•1202--
.
------------------------------------------°--------°------------°---------------------------
COMPLETE THIS SECTION fOR "NEW" RE5IDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNlSO'PA RULI'S 7670 CATEGORY 1 MINNFSOTA RULF,S 7672
(J submission type) • Residenfial Ventilation Category 1 Worksheet Submitted • New Ener9y Code Worksheet Submitted
• Energy Envelope Caiculafions Submitted
Plumbing Contractor:
Plumbing system includes:
Mechanical Contractor:
Mcchanical system uicludes:
Sewer/Water Contractor:
Phone #
Phone #
? ??,F?k: u $'?
nl AUG 2 12002
---------°----------------------------------°---°--°---°-°--°-°---------°--°----------°-° °---------° --°----
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 Statutes and City of Eagan Ordinances
Signature of Applicant D1?? Z'r_OL?
OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Upda[ed 4102
1 7 j. /s
RemodellReoair Reauiremenls
. 2 wpies of plan
. 1 set of Energy Calculatbns for healed additlons
• 1 site survey for extedor additions & decks
. Indicate if home served by sepfic system for additions
VALUATION
Phone #
_ Iawn Sprinkler
_ No. of R.I. Batt
Air Conditioning
_ Heat Recovery Sys[em
? 01 Foundation
? 02 SF Dwelling
? 03 01 of _ plex
? 04 02-plex
? 05 03-plex
? 06 04-plex
? 31 New
? 32 Addition
? 33 Alteration
? 34 Replacement
Valuation
Census Code
SAC Units
Nbr. of Units
Nbr. of Bidgs
Type of Const
,
OFFICE USE ONLY '
?I
? 07 DS-plex ? 13 16-plex ? 20 Pool 13 30 Accessory Bltlg
O 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea J ? 31 Ext. Alt - Multi
? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea; ) ? 33 Ext. Alt - SF
? 10 08-plex ? 18 Deck ? 23 Porch (screened) II ? 36 MuRi
? 11 10-plex ? 19 Lower Level ? 24 Storm Oamage
? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous ;
P
? 35
Int Improvement
? 38 il
Demolish (Interior) ?
44
Siding
? 36 Move 81dg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 37 Demolish (Bidg)* ? 43 Reraof ?I? 46 Windows/Doors
?
'Demolition (Entire Bldg only) • Give PCA handout to appBcant
Occupancy MC/ES System _
Zoning City Water _
II
Stories Booster Pump _
Sq. Ft. PRV
Length Fire Sprinklered _
W idth
?I
REQUIRED INSPECTIONS il
_ Footings (new bldg) FinaUC.O.
_ Footings (deck) -
FinaVNo C.O. 'i
_ Footings (addition) _ Plumbing
Foundation HVAC
_ Drain Tile Other ?i
Roof _ Ice & Water _ Final Pool _ Ftgs
Air/Ga's Tests
Final
_ Framing _
_
_
_ Siding Stucco Stone,
_ Fireplace _ R.I. _ Air Test Final Windows (newheplacement) '
_ Insulation _ Re[aining Wall
Approved By
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
Building Inspector
•9'ollefson Buildere Inc.
., r . r-•
Or.11495
? 188-7 .
JACKSON - SURVEYORS
Ri61iT[N[D UMD[R LAWf OI RAT[ OI YINNifOTA
3616 EAST 55th STREET, MINNEAPOLIS, MN 55417 727-3484
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1 X[REBY GRRTIrI'` TXAT TN[ ABOY[ It 11 TRUt AND CORR[CT PLAT OF A SURY[T OF .
I.ot 3,Block 3;SriKtany,
Dekota County,Mlnneeota.
As el1RV[`/[D BY M[ TNIf 6Ch. l4rch ? p 1"4
Proposad Garage Floor Hlev.
Proposed Firet Floor Eiev.
Prupoeed Saeement Floor Slev.
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F. C. JACKYON. MIMws T RmHTMT1oM, NO. 3000
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ELD
C
ITY OF EAG?'?N
APPLICA'PION FOR PER'?IIT
SELVER AND/OR WATER CONNECTZOAT
(PLEASE PPIHi)
1) PF.OP??T`! AGDRESS:
r Fr.,L, DESCR?i'TIC:1:
(Lot/Block/Subdivision or Tax Parcel T.D. Ntmr'.er1
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? R-2 GUPLE{ ('IWp UNITS )
Q R-3 ZCiv-1\IItC(JSE (Tf-r-,r:; + U?IITS) ( INZTS)
? R-? Aon.R?*rcnt/C?:L+?Cx`??II'i.'.i ( L`Li I:Sj
? COvTMSE_?CLaI,/'tr ETAII,/OFFICE
_ ? LmUS'i'Ry L
_ Q INSTI'IL'I'ICN'1L/GOVM?,MQvT
2? APDi_T= (PLEASE PRI4i)
? nkIE: ?rar..i_c--Fso,j Ovri-Dew's
- ADoREss :
crrY, sTaTE, zIP:
PHOtNE:
3) PLomER LE
rySE FOR CITY 11SE OHIY
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l r7?I?C2 V1? N +'TT?
ADDRESS: PIUNBERS UCE4SE:
Active
- CIT1', STATE, ZIP: 1,4NW Expired
•-
PHO?= ?l?/? MKSit:t
_ ?f PLt1MBER LICENSE i/ Hat af Recard
- - arr initia
4) OCCL*PpNT/uy?? kYLtAy??b YNINTJ
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ADDRESS: .G-S
CITY, STATE, ZIP: Reo
PFK}:IE:
S) LNDIG=+TE S+iHZCH PEPMIT IS BEING RFQUESTfl7:
.12t Cb u^VEC'fION 'Ip CITY SEL'IER
' 0C0'NDCPIGN TO CITY SVATER
? CI=(PLFASE DESCF2IBE)
6) L:IJ1G?i:.i O::t::
? P=E F?OID APPE2dVID PER.+IIT FOR PIC?:-UP BY ONE OF ABOVE
? PLEr1SE N*AIL APPROVID PIIRLLT M 1, 2, 3, 4 1aEWE
(Circle one)
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F 0 R C I T Y
PERNtIT = ISSUED
F°ES: $ zd ?
$
$
$
S
$
$
S
$ •
S
U S E O N L Y
.... T IJ?..?D? ." li..,.._t.:..J .
WATE2 PER"1IT (INCLL'DE SURCHARGE)
WATER METE.°./COPPERHORN/OUTSIDE REnCER
WaT^R TAP (I.iCL'JDE CORPORATICV S:CP)
SEWEo mAn
ACCOUVT GEPOSIT - SEi•IER
ACCOUNT DEPOSIT - WATEB
WAC
sac
TRUNR ?dAT°R ASSFSSME:IT
TRliVK SE[dER ASSESSMENT
LATE°,AL BENEFIT/TRUNK SERTER
LATERAL BENEFIT/TRUNK WATER
OTHER
TOTAL
AMOUNT PAID/RECEIPT #_L,L?/
DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGriT OF WAY?
? YES IF YES, THEN A"PERMIT FOR WORK WITHIN
PUBLIC ROADWAY" MUST BE ISSUED BY THE
[VO EIVGINEERING DIVISION. LIST AS A CONDI-
TION.
SUIIJECT TO TFIE FOLLOSdING CONDITIONS:
APPROVED BY: C? ,&? f--g
TITLE:
DATE:p?-
? ?"? w'? •? ?• s? ?ci+ ?c? ia W.w mtm w W w wjg w" Ra wt+ w w ?n Wsm w_a MWsft W_j+ 94-50 0c00MW" r =
PERMIT
City of Eagan Permit Type: Mechanical
3830 Pilot Knob Rd Permit Number: EA079997
Eagan, MN 55122 . Date Issued: 09/25/2007
(651) 675-5675~~~ EPermit Category: ePermit
www.ci.eagan.mn.us lflflUl tflflLLL
Site Address: 1668 Norwood Dr
Lot: 3 Block: 3 Addition: Brittany
PID 10-15000-030-03
Use
Description:
Sub Type: e - Furnace & Air Conditioner
Work Type: Replacement
Description: Furnace & Air Conditioner
Comments: Questions regarding electrical permit requirements should be directed to Mark Anderson, State Electrical Inspector,
952-445-2840.
Fee Summary: ME - Permit Fee (Replacements) $50.00 0801.4088
Surcharge-Fixed $0.50 9001.2195
Total: $50.50
Contractor: -Applicant - Owner:
Sedgwick Heating & Air David W Bullock
8910 Wentworth Ave S 1668 Norwood Dr
Minneapolis MN 55420 Eagan MN 55122
(952) 881-7739
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.
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type: Plumbing
3830 Pilot Knob Rd Permit Number: EA080054
Eagan, MN 55122 . Date Issued: 09/27/2007
(651) 675-5675~~~ EPermit Category: ePermit
www.ci.eagan.mn.us lflflUl tflflLLL
Site Address: 1668 Norwood Dr
Lot: 3 Block: 3 Addition: Brittany
PID 10-15000-030-03
Use
Description:
Sub Type: e - Fixtures
Work Type: Replacement
Description: Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:
LILLY OLBY
3260 GORHAM AVE
ST LOUIS PARK MN 55426
Fee Summary: PL - Permit Fee (miscellaneous) $50.00 0801.4087
Surcharge-Fixed $0.50 9001.2195
Total: $50.50
Contractor: - Applicant - Owner:
Vogt Heating & Air Conditioning David W Bullock
3260 Gorham Ave 1668 Norwood Dr
St Louis Park MN 55426 Eagan MN 55122
(952) 929-6767
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.
Applicant/Permitee: Signature Issued By: Signature
*City otEapn
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
RECEIVED
JUN 242013
Use BLUE or BLACK Ink
For Office Use / L L
Permit#: 1 I i"ld 1
Permit Fee: ':) 1 • I
Date Received: 1>k- 113
Staff:
,jam 20132RESIDENTIAL BUILDING PERMITpAPPLICATION
Date: f 'f" d U /3 Site Address: L & 8 /1/0-41/00 +'nf —, U,5
Unit #:
Resident/
Owner
Name: £2 V 5 4 11ff f/VG1v.ac-- Phone: (-6,,) ben — -F zei
Address / City / Zip:_ IIIOfl ved0 ,PAiv6 b,9$4A Mi / 55/2L
,
//Owner Contractor
Applicant is: i.""..
Type of Work
Description of work: f?Z # /40,0ea/Y6
Construction Cost: (r15'.4616i) Multi -Family Building: (Yes / No 1/ )
Contractor
Company: &ib /14#4512-- Contact:
Address: City:
State: Zip: Phone:
License #: Lead Certificate #:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) 6..i,1\ -
WO 412e. Ndr ac6EU 6N7M f-5 2- I 1rf
In the last 12 months,
_Yes No If
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Eagan issued a permit for a similar plan based on a master plan?
yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
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 reasonsthat would permit the City to ,! .
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.gogherstateonecall.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 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
X 6-''t A g
Applicant's Signature
Page 1 of 3
1? -'v
SUB TYPES
Foundation Fireplace
it Single Family _ Garage
Multi _ Deck
01 of _ Plex Lower Level
DO NOT WRITE BELOW THIS LINE
(0(s IJo vv°" V.
Accessory Building
WORK TYPES
New — Interior Improvement
Addition _ Move Building
J/ Alteratione Fire Repair
Replace — Repair
Retaining Wall
DESCRIPTION
Valuation
Plan Review
(25% 100%�
Census Code
# of Units
# of Buildings
Type of Construction
ti311
Porch (3 -Season)
Porch (4 -Season)
Porch (Screen/Gazebo/Pergola)
Pool
Occupancy
Code Edition
Zoning
Stories
Square Feet
Length
Width
REQUIRED INSPECTIONS
Footings (New Building)
Footings (Deck)
Footings (Addition)
Foundation
Drain Tile
Roof: _Ice & Water _Final
At Framing
X Fireplace: 14- Rough In Air Test A4 Final
Insulation
Sheathing
Sheetrock
Reviewed By:
Siding
Reroof
Windows
Egress Window
Storm Damage
Exterior Alteration (Single Family)
Exterior Alteration (Multi)
Miscellaneous
Demolish Building*
Demolish Interior
Demolish Foundation
_ Water Damage
*Demolition of entire building - give PCA handout to applicant
1-FZG
MCES System
SAC Units
City Water
Booster Pump
PRV
Fire Sprinklers
Meter Size:
Final / C.O. Required
Final / No C.O. Required
HVAC _ Gas Service Test Gas Line Air Test
Other:
Air/Gas Tests _Final
Stone Lath Brick
Pool: _Footings
Siding: _Stucco Lath
Windows
Retaining Wall: a Footings _ Backfill
Radon Control
Erosion Control
, Building Inspector
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
Final
/d too
Page 2 of 3
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA112053
Date Issued:07/25/2013
Permit Category:ePermit
Site Address: 1668 Norwood Dr
Lot:3 Block: 3 Addition: Brittany
PID:10-15000-03-030
Use:
Description:
Sub Type:Fireplace
Work Type:Gas Fireplace (new)
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home may require smoke detectors in all bedrooms. Chimney / flue must be inspected prior to
concealing.
Carbon monoxide detectors are required by law in ALL single family homes .
Tim Shimek
Valuation: 3,000.00
Fee Summary:BL - Base Fee $3K $88.50 0801.4085
Surcharge - Based on Valuation $3K $1.50 9001.2195
$90.00 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 -
David W Bullock
1668 Norwood Dr
Eagan MN 55122
(651) 282-8645
Glowing Hearth and Home LLC
100 Eldorado Dr.
Jordan MN 55352
(952) 492-9276
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA139239
Date Issued:10/14/2016
Permit Category:ePermit
Site Address: 1668 Norwood Dr
Lot:3 Block: 3 Addition: Brittany
PID:10-15000-03-030
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
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 -
David W Bullock
1668 Norwood Dr
Eagan MN 55122
(651) 341-3502
Jake The Plumber
255 Roselawn Ave E, #43
St Paul MN 55117
(651) 212-5253
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA152958
Date Issued:11/13/2018
Permit Category:ePermit
Site Address: 1668 Norwood Dr
Lot:3 Block: 3 Addition: Brittany
PID:10-15000-03-030
Use:
Description:
Sub Type:Siding
Work Type:Replace
Description:
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please leave printed pictures of house wrap on site for the final inspection.
When installing ventilated soffit material, remove existing material (i.e. debris that could block vents) and take steps to
ensure maximum ventilation to attic. Call for final inspection after installation.
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 -
David W Bullock
1668 Norwood Dr
Eagan MN 55122
Craftsmans Choice Inc
5680 Quam Ave NE, Suite A
St. Michael MN 55376
(763) 276-7465
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA169828
Date Issued:06/10/2021
Permit Category:ePermit
Site Address: 1668 Norwood Dr
Lot:3 Block: 3 Addition: Brittany
PID:10-15000-03-030
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. We encourage you to retain an electronic copy of
photos until the project passes a final inspection.
If water damage is encountered, please call (651) 675-5675 to schedule a site visit to verify the extent of the damage. Any
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 -
David W & Lori L Bullock
1668 Norwood Dr
Saint Paul MN 55122--277
(651) 702-1300
Built Strong Exteriors Llc
2215 Quebec Ave S
Lakeland MN 55043
(651) 702-1300
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA171445
Date Issued:08/16/2021
Permit Category:ePermit
Site Address: 1668 Norwood Dr
Lot:3 Block: 3 Addition: Brittany
PID:10-15000-03-030
Use:
Description:
Sub Type:Residential
Work Type:Alteration
Description:Fixtures
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Fee Summary:PL - Permit Fee (miscellaneous)$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 -
David W & Lori L Bullock
1668 Norwood Dr
Saint Paul MN 55122--277
Roelson Plumbing Services Inc
10924 Pioneer Drive
Burnsville MN 55337
(952) 288-1486
Applicant/Permitee: Signature Issued By: Signature