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3958 Palisade Way Use BLUE or BLACK Ink I For Office Use ~ I 1 ~ I Permit#: Imo/ City of Evan I t 0 6 I Permit Fee: I 3830 Pilot Knob Road j I Eagan MN 55122 I Date Received: Phone: (651) 675-5675 I 1 Staff: Fax: (651) 675-5694 L - - - - - - - - - - -----I INFLOW &,'INFILTRATION PERMIT APPLICATION Plumbing / Sewer & Water Date: Site Address: Tenant: /Suite /M (~L 2 Name: Phone: (f1 S 1 / ~~`-~s~ RESIDENT / OWNER Address/ City/ Zip: 3 i b 1 ~C~c~ JrS I aa' Name: 1 License M 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 Description of work: A00 C1Jyf ~/~lL~~ l9~lDt1 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.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.goi)herstateonecall.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 Ci Eagan; that understan s is not a permit, but only an application for a permit, and work is not to start without a permit; th ork will be in corda ith a approved plan in the case of work which requires a review and approval of plans. x x Applicant's Printed Nam Applicant's Signature FOR OFFICE USE Reviewed By: Date: Required Inspections: ,Under Ground -Rough-In -Final CITY OF EAGAN Addition C+ed3T Owner /123,o/I/i sveec 3958 Palisade State Eagan,MN 55122 Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. STREET RESTOR, GRADING SAN SEW TRUNK i z.T "1970 .O ,00 2 P37.d SEWER LATERAL gZ ? 1 1 TO P2.1C1 WATERMAIN .y? WATER LATERAL 1 WATER AREA -J? STORM SEW TRK y= STOiiM SEW LAT 1 CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN, 300.00 6436 9-13-72 BUILDING PER. sac 2 0.00 6436 -1 -72 PARK =SEDGWICK HEATWG & AIR CONDITIONI 8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) ADDRESS /?" OCCUPANT-/?-?t C ONS SOLO BV 6? MAKE L`e-? ? d IC SERIAL NO. t THERMOSTAT??6 Q VALVE w LIMIT P. LIMIT SETTING FAN SE7TING PILOTTYPE ?/ ? - ) IGNITION MODEL [J?"I U 4J NG CO. HEATING JOB NO. aei-sooo TEST RECDRD CITV A) OWNEF INSTALLED BY J( MODEL v2?Z?-3-75 INPUT / ? ocQ % VENT SIZE { TVPEOFLINER sj-<z+? i LINER SIZE FILTERS: SIZE NUMBER WIRING "-- TEST TAG LIGNTING INST. PILOTTIMING 9G' s-7,ih r Z DATETESTED PRES5IJRE? PERCENTCOz ?/(((\\\??? `? ? / COMPANVTESTING INPUTCFH ° '? PERGENTOa `? ? - STACK TEMP. ? d PERCEN7 CO ? NAME OF TESTER FORM235(REV.1V89) FORMOISTRIBl1TI0N: WHRECOPY - JOBFILE YELLOWCOPY - CITY ?? ?? 1 1 F EB 112002 ? )-Y-? Cs C9 - TO'.'id 0? EAGAN °795 F9.lot Kuob ;:oad Ea,an, P4inne::ota 55121 PEPsNIIT N0. 251 The Board of Scpervisors hereby g:anec to L'etdcs' Grove Oe:lstruCtion Co. of 731,3 „aacord 31vQ. :.. 3outh St. Paul 55075 P2rniC tor: (Owner) ?;;:.?.(ie 1709 Deei'wood, 1771 Tacamite Trail. 395$ Paliaade Way, 4062 Mag'ietite Point, ?t 2_1n?. 12--,_7. 7-8-80 17-5-7 , pursuant to application dated Fee Paid: $80, nn Dated this 1Elth day of 3OAe19M , 19-M. _-- 2.00 B/C , • . . ' Building Inspector CE?h72 CJ'O ?? TOI:N OF EAGAN 3795 P•Ilot &iob i:oad Eagan, Niinnesota 55171 PERMIT N0. gF, The Board of Supervisors hereby grante to Cedar t3rove Conatruation 00, of 73L3 Casmotd B1v8:? :&.. Sbuth 8t.4'aul 55075 • a PIUSpIAIb Pezmit for: (Owner) szpne 1 , 99 Palleaata Waw, & 4e62 at 2 A? q..g..8 It & 1'T504 , pursuaat to applicatioa 9fe/za " Fee Paid: 00 Dated this 15th day of 3eDte78b9t 2000 0 . . ).. ._. . . +. .1? , ', i .;, ? ? ? • ' ding Iaepector • ? C , , - EAGAN TOWNSHIP BUILDING PERMIT own.: y--- ..----° .- .....................• -'----°'---°-...._-- - - - ------- "°- Address (Present) ..................... Builder ................... Addxeas ................. DESCAIPTION ? N° 2845 Eagan Township Town Hall De,..... y..-.?.g..-.7.? ............... .....---- Sfosies . To Se Used For Fron! Depih Heigh! Esf. Cos! Permi! Fee Remaska a-73.oo 3,1 oz LOCATION t-3/t ? -7 ?e s? •? ?, ?' . 9 I ;7 1'his permit does aot sulhorise the use of slreels, roada, alleps or sidewelks aor does it glve the owner or his agan! the righ!!o ereale any siiualion which is a nuisance or which presenfs a hesard !o the heallh, safelp, convenienee and general welfare !o anyone ia the commuaifp. THIS PERMIT MUST BE KEPT ON THE PREMIJJE WHILE THE WORK IS IN PROGAES . This is !o eerYifp, iha!_ ?° .....- ....... -.- - ..._.`:................. permusion 3o ereet a.... ?_---..._? ... . . . ... . .... upon .. .....___ the above deseribed psemise subjeet fo the provisions of the Building Ordinanee fos Eagan ownship adopled ApTil 11. 1955. /J-?..,.. .. man of Tnwn Soazd Je Pex ' .......................... A..".`..`.":?'....._0..........................""-........""'.... Huilding Inapectoz OS CITY USE ONLY PERMIT #: L/ v "' ? ? ' • REG`EIPT DATE: ? ?_?&S7 2002 RESIDENTIihL M£CHANICA1. PEiiMIT lEPPLICATIOR crrYoF E?sax 3830 Pnor xROa gu ` $nsax Mu ssi 2s e51-681-4675 .? ? ? Please complete for. ? single family dwellings townhomes and condos when pertnits are required for each unit Date: l - I`t -d°i- SITEADDRESS: Vd2??1? OWNER NAME: TELEPHONE #: INSTALLER NAME: 5....,?,.?? - 4iNG & AIRrnINDITIONING GO. TELEPHONE #: N10 Wentworth Avenue South STREET ADDRESS: WIIII@8polis, MN 55420 (952) 88 -.; CITY: • STATE: ZIP: ' Place a check mark next to the permit work type Add-on, modification or alteration t existina dwelling u it $ 30.00 • fumace replacement • air exchanger . aircondition // as??,,,? ?p/?) • other Nature of work: -- State Surchar e - -' -$ -.50- - Total g M.?? 26 vj?? SIGNATURE OF PERMITT57? voz CITY U3E ONLY PERMIT #: RECEIPT DATE: APPROVED BY: , INSPECTOR 2002 COMMUCIi4L M£CHlkft1ClFI. PFItM1T Ai'PLICATION . CITY OF F.A&AN 3830 PILOT KNOB ftD EAsAlv, b1N 55122 651-691-4675 Please complete for: all commerciaVindustrial buildings multi-family buildings when separate permits are not required for each dwelling unit DATE: SITE ADDRESS: OWNER NAME: PHONE #: - TENANT NAME (IMPROVEMENTS ONLY): WAS THERE A PREVIOUS TENANT IN TFIIS SPACE? Y N. NAME: INSTALLER: p .M 9 STREET ADDRESS: CIT'Y: STATE: ZIP: TELEPHONE #: WORK T'YPE: New conshucrion Install U.G. Tank _ Interior Improvement _ Remove U.G. Tank _ Processed Piping SpecifyNature When installing/removing underground tank, call 651-681-4675 far inspection by Fire Marsdal and Plumbing inspector. Fees: 1% of contract price OR $50.00 minimum fee, whichever is greater. Underground tank removaViastallation = minimum fee Contractprice: $ xl%=$ State surcharge TOTAL $ (Base Fee) calculate at $.50 for each $1,000 Base Fee SIGNATURE OF PERMITTEE Updated I/02 MASTER CARD Gi OWNE STRUCTURE AND LAND USED AS Permit No. issued _- Issued To Contrador Owner BUILDING - ? PLUM8ING CESSPOOL - SEPTIC TANK WEtI ELECTRICAL HEATING 2S/ GAS INSTALlING SANITARY SEWER q6 OTHER gg "J_ 07HER Items Approved (Initial) Date Remarks Distance From Well FOOTING • ?J ? ? SEPTIC FOUNDATION /2• ? .JfI CESSPOOL FRAMING TILE FIELD FT. FINAL ELECTRICAL H64TING 1, . ?. DEPTH OP WELL GAS INSTALLATION SEPTIC TANK CESSPOOL DRAINFlELD PLUM8ING / r Q WELL ' - - - SANI7ARY SEWER ? '? '? y Violations Noted on Back COMMENTS: COMPLIANCE INSPECTION R,EPORTS TO BE USED ONIY IN EVENT OF 085ERVED VIOLATIONS PERMIT NO. CONDITIONS OF GONSTRUCTION AT THIS INSPECTION ? NO EVIDENCE OF NON-COMPIIANCE OBSERVED. 1:1 ACCEPTABLE SUBSTITUTIONS OR DEVIATIONS. DATE OF INSPECTION ? NON-COMPLIANCE. BUILDER WILL COMPLY WITHOUT DELAY. ? NON-COMPLIANCE. BUILDER DOES NOT INTEND TO COMPLY. ? COMPLETION OF CERTAIN IMPROVEMENTS WILL BE DELAYED BY CONDITIONS BEYOND CONTROL. I7EMIZED AND DESCRIBED AS FOLLOWS: ? RElIQSPECTION 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. 11 ALL IMPROVEMENTS ACCEPTABLY COMPLETED BUILOING INSPECTOR COMAhENTS: DATE _ 9 ?-8-? ? . EAGF.N TOWNSHIP 3795 Pilot Knob Road St. Paul, Minnesota 55111 Telephone 454-5242 PERMLT FOR WATER SERVICE CONNECTION . . ?? Date• ? Number• 82 Billing Name: Site Addresa:? ` Owner: Billing Addreas ? ? Plumber; ,nA tion of Connection Meter Size Coanection Chg.300.0o nd 9/13/72 Meter No, IPermit Fee 10,00 nd 9/13/72 Meter ReadinpL Meter Dep. .50 Pd 9/13/72 Meter Sealed: Yea_ lAdd'1 Chg. NO ' Total Chg. Building is a: Resi.deace XX biultiple fio, Units Commercial Iudustrial Other Inspected by Date Remarka: 4325,06 RE•INSPEC7!ON FEE FGR IMPROPERLY INSTALLED METERS. By: Chief Inspector In consideraLion of the iasue and delivery to me of the above permit, I hereby agree to do tte proposed work in accordance with the rules and regulatioas of 8agan Townahip, Dakota County, Minnesot . Please notify the above office when ready for inspection and,connection. 1`0 -0 EAGL3N TOWNSHIP 3795 Pilot Knob Road St. Paul, Minnesota 55111 Telephone 454-5242 PERMIT FOR SEWER SERVICE CONNECTiQN DATE: NI1MgER 1140 OWNER• ?-y Address,??? W -1 PLUMBER r TYPE OF PIPE ?X-A- N A -?\ ck--, DESCRIPTION OF BUI7A ING Industriall Commerciall Residential I Multiple Dwelling I No, ot units Location of Connectfons: Connection Charge 260.00 pd 9/13/72 Permit Fee 10.00 pd 9/13/72 .50 pd 9/73/72 Street Repairs Total Inspected by: DaCe Remarks• By Chief Inspector In consideration of the issue and delivery to me of the above pexmit, I hereby agree Yo do the proposed work in accordance with the rules and regulations of Eagan Toc•mship, Dakota County, Minaes ta By Pleaae aotify when ready for inspection and coanection and before any portion of the work is covered. CTTV pl= ::AGAN Cf'i`iti:!:1-fi e:'t i C I::F:i iEP5M_ Ni? I; i C,9 Drllr.^ 09/09%99 (:CME^ 103039 rii, NAMrS: JFI=FRLY A. I-IfI:E S2"_O 9001 :355B PA_.CJPIIIL; A LL505 2155 9001 3959 PFdl...lS(anL' N 3.00 o'> ?r Tol:.]l FieC'r:?1(11; fiimDi.l(i1'..". . .?.c..t.r..c_,? C`r'11i:.:34 2 l.':iER 1:(1;: OAN ? i 1999 BUILDING PERMIT APPLICATION (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD - 55122 651•687-4675 New Construcflon ReautremeMs ? 3 regislered s@e surveys showing fq. N. of lot, sq. H. of house and ?II rooted areaa (207, maximum bf eoveraae allowed) ? 2 coples of plans (show beam E wlndow skea; poured fnd. design; etc.) ? 1 set of energy calculaNons D 3 coplea of hee preienalion plan iF bf plalted aker 7/1 /93 9/a / Remodel/Recair Reauhements 2 coptes ol pian 1 set of energy calculaHons for heafed atldXlona i aMe aurvey for exterlor addMions R decks ?576a ... DATE: ?l CI CONSTRUCTION COST: DESCRIPTION OF WORK: ?°07 e'e '"?'4 l00A';`4 STREET ADDRESS: s 7 S a / wt - ? ?°, "" LOT: ? BLOCK: ? SUBD./P.I.D. #: iox PROPERTY OWNER CONTRACTOR ARCHRE % ENGINE u.....,.. 1JGnnw dUr-'4'1S Lati Firsf ;?reet Address: tL City F",sc" State: / 1 n / / Cemeanv? h?? l ah'T??- c?p?rS ? li Q Sheet Address: / S / City Telephone #: area code ( Streei Ci1y Sewer 3 wafer Ilcensed plumber (reaulred for new eonsfructlon onlvl: State: PenalF,u applies when oddreas change and lof change is requesfed once permN is issued. Zip: I hereby acknowledge thot I have read ihis appltcaffon, sta}e that ttfe informaFion is conecf, and agree to comply wRh all applleabl State af Minnesota Stctutes and Cify of Eugan Ordinanees. Signafure W Applicant OFFICE USE O i, Certificates of Survey Received _ Yes _ No SEP S Phone #: l'Lln G S/- `f-s V- G 3 l?- Zip: S.S"/ Z 2 Phone #: ?/ S/ 6 9 7 9Ys? (area code) y License # Stafe: Zip: Name: ) RegistraHon #: Tree PreservaHon Plan Received i Yes _ No _ Not Required i ?10! OFFIGE USE ONLY BUILDING PERMIT TYPE ? 01 Foundation ? 06 4-plex ? 11 10-plex ? 16 Fireplace ? 02 SF Dwelling ? 07 5-plex ? 12 12-plex ? 17 Garage ? 03 1 of _ plex ? OS 6-plex ? 13 16-plex ? 18 Deck ? 04 2-plex ? 09 7-plex ? 14 Apartments 0 19 Lower Level ? 05 3-plex ? 10 8-plex ? 15 Lodging 0 20 Pool WORK TYPE ? 31 New ? 35 Tenant Impr 0 38 Gas Line Only ? 43 ? 32 Addition ? 36 Move Bldg. ? 40 Gas Insert ? 44 ? 33 Alteration ? 37 Demolish Bldg.' ? 41 Wood Stove ? 45 ? 34 Repair ? 38 Demolish (Interior) ? 42 Reroof * Give PCA handout to applicant for demolition permit GENERAL INFORMATION Const. (Actual) (Allowable) UBG Occupancy Zoning # of Stories Length Width APPROVALS Planning Basement sq. ft. Census Cod Main level sq: ft. SAC Code sq. ft. No. of Units sq. ft. No. of Bldgs sq. ft. MC/ES SysU sq. ft. City Water Footprint sq. ft. Booster Purt PRV Fire Sorinkle Building Engineering , - - ? 21 Porch (3-sea.) ? 22 Poroh/Addn. (4sea. ? 23 Porch (screened) ? 24 Storm Damage ? 25 Miscellaneous Repair Permit Fee Surcharge Plan Review License MC/ES SAC ;. City SAC Water Conn. Water Meter Acct. Deposit S/W Permit SNV Surcharge Treatment PI. Park Ded. Trails Ded. Other Copies Total: Valuation: $ t ? SAC Units % SAC PERMIT City of Eagan Permit Type: Building 3830 Pilot Knob Rd Permit Number: EA079509 Eagan, MN 55122 . Date Issued: 08/29/2007 (651) 675-5675~~~ EPermit Category: ePermit www.ci.eagan.mn.us lflflUl tflflLLL Site Address: 3958 Palisade Way Lot: 7 Block: 8 Addition: Cedar Grove 8th PID 10-16707-070-08 Use Description: Sub Type: e-Windows/Doors Construction Type: Work Type: Windows/Doors-New/Replacement Description: House Census Code: 434- Occupancy: Zoning: Square Feet: 0 Comments: 4130/08 Notification letter sent regarding expired permit pf A framing inspection is required when installing a Bay or Bow window or if the opening is altered. Smoke detectors are required in all sleeping rooms prior to final Fee Summary: BL - Base Fee $3K $88.50 0801.4085 Surcharge - Based on Valuation $3K $1.50 9001.2195 Valuation: 3,000.00 Total: $90.00 Contractor: -Applicant - Owner: Renewal Andersen Christophe R Bell 1920 County Road C West 3958 Palisade Way Roseville MN 55113 Eagan MN 55122 (651) 264-4777 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 Use BLUE or BLACK Ink, r 0F Office Use ( I I Permit ~It of Ea-* aIl I b s I Permit Fee: A -f6-' c I 3830 Pilot Knob Road 1 ! ° i I ptl( Eagan MN 55122 r6 I Date Rece ved: Phone: 651 675-5675 ! t/ 1 I i ~ I I Fax: (651) 675-5694 Staff: I----- 2010 RESIDENTIAL PLUMBING PEIMIT APPLICA ION Date: Site Address: f Tenant: Suite©it- RESIDENT / OWNER Name: 1 t om`- ~ Phone: )l L 1 Ut~ Address/ City/ Zip: t l~ ~-et L CONTRACTOR Name: 1 nse 0 i } Address: "t "l~ City: V 1 State Zip: 1 ~U Phone ?~b yLO J6~ Contact: l 1 Email: ` TYPE. OF WORK _ New Replacement _ Repair _ Rebuild _ Modify Space -Work in R.O.W. Description of work: PERMIT TYPE ESIDENTIAL WaterHeater Water Softener ' Lawn" Irrigation ( RPZ PVB) Add Plumbing Fixtures Main Lower Level) Septic System Water Turnaround New Abandonment I 1 I RESIDENTIAL FEES: $55.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge) 1 $35.00 Lawn Irrigation (includes $5.00 State Surcharge) $55.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnar und* (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 $5.01 State Surcharge) i $95.00 Fire Repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge) TOTAL FEES $-5 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. W"..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 ;t 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 I accordance with the`approved .plan irrthe case of work which requires a review and approval o I ns. X Applicant's Printed Name Ap cant's Signature ,pff i FOR OFFICE USE Reviewed By: Date: Required ingections: Under Ground Rough-In -Air Test Gas Test -Final j 1. 1, Use BLUE or BLACK Ink r - - - - - - - - - - - - - - - - - I I For Office Use f Permit City of EaWin ,Ilk I Permit Fee: l6 3830 Pilot Knob Road 1 Eagan MN 55122 Date Received: Phone: (651) 675-5675 I I Fax: (651) 675-5694 I Staff: 1 I 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: Unit Name: Phone: Resident/ Owner Address / City / Zip: T 10")( 3, w, Applicant is: Owner Contractor 2- Type of Work Description of work: / L - /&r Construction Cost: Multi-Family Building: (Yes / No Company: ~Jdt 5 1 vvc 7 r/?~ Contact: D " .1- Contractor Address: lZ 7 (,7 /nom 1.w. v~ ,~cL City:l t ~2t~ State:} Zip: 33-3 D0 Phone: 3 S Zb t o 1 License L 1~ Lead Certificate U - y / G If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) I 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: 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.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. 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. ~n X 4(.00)-- x Applicant's Printed Name Applicant's Signature Page 1 of 3