3956 Peridot Path
Use BLUE or BLACK Ink
For Office Use
city of Ea~~~ Permit
1
Permit Fee: O
3830 Pilot Knob Road
Eagan MN 55122 1 Date Received:
Phone: (651) 675-5675 j
Fax: (651) 675-5694 1 Staff-
INFLOW ~JINFILTRATION PERMIT APPLICATION
Plumbing / Sewer & Water
Date: Site Address:
Tenant: Suite
RESIDENT /OWNER Name:_.,,L)_- ~ Phone: ~ s 2s - or?
Address / City / Zip: Sel s(, Ct T I H E N rf N CAS 11 Name: 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
-P sump
Other:
Description of work: ~C
DESCRIPTION d
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.cityofea_qan.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 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 requir s review and approval of plans.
xo5t~' H KL LU `N
x c
Applicant's Printed Name Applicant's Signatu
FOR OFFICE USE Reviewed By: Date:
Required Inspections: -Under Ground -Rough-In -Final
CITY OF EAGAN
Addition Cedar Grove #6
flew &
Lot v Blk v Parcel 'v I vI v> wv w
Peridot Path State Eagan+M 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF,
STREET RESTOR.
GRADING
SAN SEW TRUNK
3#- SEWEF LATERAL 1970 1472.00 20 Pald
WATERMAIN
*WATER LATERAL 1970 ZO
WATER AREA
# STORM SEW TRK 1970 ZO
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATERCONN. 200.00 11 i 1-2 -6
8UILOING PER.
sAC 200.00 11 1 1-27
PARK
` CITY of EAGAN
BUILDING PERMIT
Owne: ...... ...:.. . ne?Lc;?.°------•--..
l?
Addreea (Breaen!) .............................................................................
sutia.: ......_
Addrese .....
DESCRIPTTON
w im
N4 3340
3795 PiloS Knob Road
Eagan, Minnesata $5122
454-8300
Dals ..... 9 .. - .. /?:.-.??° ..._.......
......
Sioriea To Be Used Fos Froa! Daplh HaSgh! Esi. Cos! Pesmi! Fea Aamuke
?
/ LOGATiO14 .d e3 0
8fieel. ROad OT Olhe! DBECLipliOn Of L.OC6flOn I LO! I SIOCIC I AO61I10E OL Tl9Cf
I S I <Z I C.6.-;m 1-3
This pesmit does aot auihorise the use of streeffi, roads, alleys or sidewalka nor does it give the owaer or hk agea!
the righ!!o create any sifuafion which ia a nuisanee or whieh presenfs a hasard !o the healfh, asfefy. Convanieaea and
general welfare fo anpone in the communify.
THIS PERMIT MUST BE,?{ EPT N T8E PREMISE WHILE THE WORK IS IN PAOGAES .
This is !o earlifY. !hal--....`?,.°+ . . ?::a'.r..?:s----------------- has parmksion !o ereet a........ ................_._.ti......................._.._upoa the above described premi€e subjeat io the provisions of all applicable Ordinances for !6e .ip of Eaga.
.. .. ... .... ...
.............-.. ?-J=._....Q....-?---y- - ..... -.........-.-----.._.. pa= ......................... ...,?t-? poclos Y
...... ... . Huildinq ...... I.m ... . .
Ma r ? _ ?
EAGAN TOWNSHIP
BUILDING PERMIT
OWRB! ""'"'L{....w--?..:?:.._?:r.!:.......?•..ry.t`_
._... ....................
Addresc (Presenl) -- -'- ?-
Builder ........
Addsess ......
N° 1939
Eagan Township
Town Ftall
Da1e '-'--- ---.... =Q-_""""-"'_'.
Starieo To Be Used For Fron! Depih Heighf Esl. Cos! I Permit Fee Remarks
?lq,?;-., , t?.&?-?n /,3, ?? `""l
e?a ? ? ?? ? ??; ! ?,,(ti .??'7•-??-v-t.
or
LOCATION
or
(f , _a &
This permii does not auihoxise the use of sfreeis, roads, alleps or sidewalics nos does it give the owner or his agen!
the righ! So creale any siSUation whieh is a nuisance or which preseais a hazard !0 the heelSh, safeip, convenienee and
general welfare !o anpone in the communily.
THIS PERMIT MUST SE KEPT ON THE PREMISE WHILE THE WORK IS IN PROGRESS.,
This is !o cerlify, ihaf-..LSc?:2-^r---__.?..?'__.-?.?'.... Cr.':z?......has permission io erect a_ :?:.°.--__`.:... ? upon
------- -..._ _
the abova described premise subjee! !o !he p:ovisions of the Building Ordinance for Eaga Township a opied April 11,
1955.
--------- - --.. .--°.- f- ?---- -----.._........... pe: . .. . ......_ .?1 _-`" -:^.._el??J ..................---
? C}rLirman afl. Tn n Board Suilding IespecSar
C?
-edy of eagan
MEnno
TO: DIANE DOIAfNS, llTILIl'Y BILLING CLERK
FROM: ED KIRSCHT, SR. ENGINEERING TECH
DATE: AUGUST 25, 1993
SUBJECT: STREETLIGHT ENERGY COSTS
CEDAR GROVE NO. 6(141 LOTS)
This memo is to infiorm your department to begin to invoice the energy costs at the single
family rate effective August 1, 1993 to the property owners in Cedar Grove No. 6 Addition
as listed below:
Block 1, Lots 1 1
Biock 2, Lots 1-8 8
Block 3, Lots 1-18 18
BloCk 4, Lots 1-71 11
Block 5, Lots 1-9 9
Block 6, Lots 1-53 53
(Lots 54 through 61, BioCk 6, should not
be bitled at this time)
Block 7, Lots 1-12 12
Block 8, Lots 1-18 18
Block 9, Lots 1-11 11
TOTAL 141
The City is current(y being billed by Dakota Electric for streetlighting in the above listed
subdivision.
?-
Ed Kirscht Sr. Engineering Tech
cc: Mike Foertsch, Asst. Gity Eng.
EK/je
MASTER CARD
LOCATION 3956 Peridot Path EA'' &
OWNER Ji
STRUCTURE AN9 ?
LAND USED-AS Q?
Permit ('-" ?
. .,J No.
Issued Issued To
Contracfor Owner
s
BUILDING
3340
PLUMBING
CESSPOOL - SEPTIC TANK
WELL
ELECTRICAL
HEATING
GAS INSTALIING
SANITARY SEWER
OTHER
OTHER
Items Approved
(Initial)
Daie
Remarks
Distance From Well
FOOT I NG SEPTI C
FOUNDATION CESSPOOL
FaannlNG TILE FIELD FT.
FINAL
ELECTRICAL
HEATING DEPTH
OF WELL
GAS INSTALLATION
SEPTIC TANK
CESSPOOL
DRAINFIELD
PLUMBING
WELL
SANITARY SEWER
Fence ?
Violations Noted
on Back
COMMENTS:
COMPLIANCE INSPECTION REPORTS
TO BE USED ONIY IN EVENT Of OBSERVED VIOLATIONS
PERMIT NO. DATE OF
CONDITIONS OF CONSTRUCTION AT THIS INSPECTION
? NO EVIDENCE OF NON-COMPLIANCE
OBSERVED.
? ACCEPTABLE SUBSTITl1TIONS OR
DEVIATIONS.
? NON-COMPLIANCE. BUILDER WILL COMPLY
WITHOUT DELAV.
NON-COMPLIANCE. BUILDER DOES NOT
INTEND TO COMPLY.
? COMPLETION OF CERTAIN IMPROVEMENTS
WILL BE DELAYED BY CONDITIONS BEYOND
CONTROL.
ITEMIZED AND DESCRIBED AS FOLLOWS:
? REINSPECTION REQUIRED
DATE OF REINSPECTION
REINSPECTION REVEALED
CERTI FICATION -I certify that I have carefully inspected the above in which I have no interest present or prospective, and that I have reported herein
all significant conditions observed to be at variance with ordinances of the Town of Eagan, approved plans and specifications, and any specific require-
ments for off-site improvements relatin9 to the property inspected.
? ALL IMPROVEMENTS ACCEPTABIY COMPLETED
BUII-DING INSPECTOR
COMMENTS:
OATE
'Qp.' :3
!
ft
EAGF.N TOWNSHIP
3795 Pilot Knob Road
SC. Paul, MinnesoCa 55111
Telephone 454-5242
PERtIIT FOR WATER STsRVICE CONNECTION
Date
B111
Owae
Pltild
Number• 214
5ite Address• ALL s3.5lo 4011
Billing Address
Meter Size ICoanection Chg. 200.00
Meter No, Pexmit Fee 7•50
Meter Reading ( Meter Dep.
Meter Sealed: Yea_ lAdd'1 Chg.
IQO ITotal Ch$.
Inspected by
Buildiag is a:
Reaidence /
Multiple Ho,
Commercia 1
Iadustrial
Other
Date
Remarks:
By:
Chief Inspector
In conaideration of the isaue and delivery to me of the above permit, I
hereby agree to do tUe proposed work in accordaace with the rules and
regulations of 8agan Towaship, Dakota County Minnesota.
gy;
Please notify the above office when ready for inspection and connecCion.
f `
EAGEM TOWRTM.iHIP
3795 Pilot Knob P.oad
St. Paul, Minnesota 55111
Telephone 454-5242
PSRMIT_ PbR SEWER SERVICE CONNECTION
DATE •
OWNEP.•
PLUMBER
N[MffiER 332 _
P.ddress f-'F--6 S7-5-6 //-tiyi??.Y"
TYPE OF PIPE (?C`P,d?i ?UGO?LJ
DFSCRIPTION OF BUILDING
Industriall Commerciall Residential I Multiple Dwelling I No. of unita
Locatiou of Connectiona:
Inspected by:
Connection Charge 200.00
Permit Fee 7•50
Street Repairs
Total
DaCe
Remarks•
By.
Chief InspecCOr
In consideration of the issue aad delivery to me of the above permit, T
hereby agree to do the proposed woxk in accordaace with the rules and
regulatione of Eagan Tormship, Dakota County, Minnesota
By ?
Please notify when ready for inspectioa and connection and before any portion
of the work is covered.
ibbk-
Clty of Eap
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
0
C?'?
??
??4_72_
i----------------i
j Pertnit #:
? PermitFee: ???? ?
? Date Received: j
i i
I Staff: ?
I -----------------?
ESIDENTIAL BUI
oete: siea
RESIDENT / OWNER I Name:
TYPE OF WORK
CONTRACTOR
Energy Code
Category
(J su6mission type)
In the last 12 months, 1
_Yes _No Ify?
Licensed Plumber:
Mechanical Contrec4or
Suite #:
Phone:
Address /_C`rty / Zip: Y'x v
Applicant is: _ 04er Contractor r
?
Descnption of work/
/
Construction Cost: Mufti-Family Building: (Yes NoX]
Name: License#:
?
Address: ;Gl.i
Ciry: 2r State: fY?IY zp:
Phonek%.-1,?1-"I&StO ContactPerson:
: THIS AREA ONLY IF CONSTRUCTING A EW BUILDING
Minnesota Rules 7670 Cateaorv 1 Min sota Rules 7672
• ResideMial Ventilation Category 1 Worksheet • New nergy Code WoAcsheet
Submitted Submi
• Energy Envelope Calculations Submitted
the City of Eagan issued a permit for a simllar plen 6ased on a master
date and address of master plan:
Phone:
Phone:
Sewer 3 water Contractor.
Phone:
I hereby acknovAedge that this information is camplete and accurete; that the worK vnll be in confortnanee with the ordinances arM codes of tha City of
Eagan; thai I untlers[and this is not a permit, but only an application for a permit, antl work is not to start without a permR; that the work will be in
accordance with ihe approved plan in the case of work which requires a review and approval of plans.
X I o c ??. Xw I
Appiicant's Printed ame ApplicanYs Signa e
Page 1 of 3
PERMIT APPLICATION
>S 9 o.co
CitY of Eap
3830 Piiot Knob Road
Eagan MN 55122
Phone: (651) 675'`.+b75
Fax:(651)675-5694
A si8$
^----------- ,
j Peemrt N: 7b 47 w j
?
; oate aeoelvea: ,
I Stetf: ?
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-----------------?
2008 RESIDENTIAL BUILDING PERMIT APPLtCATION
Date,
s,ng III:
7en8nt:
j eESiDeNrI owNeR ra„e: ?G kcr'tuoo pr,,,:
Aaaress / cay i zp:
Applrcant is: _ Owner ? CarrtraGOl
TYPE OF WORK Description of work: -?Ea12 i2 e _
consiruction Cost: oe
CpNTRACTOR
Multl•Fampy BuiMing: (Yes-/ NoX.)
License M.
rwaress:
??: _ s?: _s-?_
Phone: G61 - NA9-q= ?ntsotPemon: ICnce'1
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
_?din? fs Rules 7670?tgqorv 1 _ Minnegota Rules 7fi72
Energy Code • pesidenW veimlenon c,sftgory i waksnea . New E+ergpr Code wodsrceet
?;yory suaniaea . su6miae0
(4 submission type) ' E0819Y Emviope Cahilati0^s Submitted .
in the last 12 moMhs, has tho City of EaBan 1834Jed 8 PWMh for a 9M1i18r plan b89Cd on a R185ter Plart?
_Yes _NO If }res, date and address of inester plan:
Uaensed Plumber:
Moehanlcal Contractor:
Sewer 8 Water ConKactor.
Phorre:
Phone:
Phone'
i tmrcDy acWroxledge Mal tNc iMormffikn Cs canpkte a? aau? tt?at 1M work Hd9 be in corrtonn8nC8 wkh tlfe mdinerces atd ooCee of Uie Qty ot
Eayan, mas 1 umerstand this iS not a peemtt, we onN an aMUcaft+ ior a pe^"iC arw wak is noe mspn witlwt,e a vgr"t tliea me wuk wlo ue m
axorda= vriUi me ap{xoved Pim in Me eeae of v`o'K whrch reqmes a review 00 appoval of DIM
x M. cKM MLk(A
ApplicaM's Printed Name aPPiicanYs SignOWra pag 1 of 3
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA112830
Date Issued:08/23/2013
Permit Category:ePermit
Site Address: 3956 Peridot Path
Lot:8 Block: 8 Addition: Cedar Grove 6th
PID:10-16705-08-080
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar.
Pictures are not acceptable in lieu of inspections.
Carbon monoxide detectors are required by law in ALL single family homes .
Cory Zenger
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 -
Joseph S Skoglund
3956 Peridot Path
Eagan MN 55122
Trinity Exteriors Inc
4204 Park Glen Rd
Minneapolis MN 55416
(952) 920-9520
Applicant/Permitee: Signature Issued By: Signature
