3053 Pine Ridge DrCASH RECEIPT
CITY OF EAGAN
3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE 19
Raceiven
FROM
AMOUNT $ I
& DOLLARS
1 oo
? CASH ? CHECK
FOR
- l ( e
?- B Y
C?
- r??s%'7
NUMERICAI. FILE COPY
'• WATER SERVICE PERMfT
arr
F EAdAN
5 Pilot Kno6 Road PERMIT NO.:
Eogan, MN 55122 DATE:
Zoning; No. of Units:
Owner: ' ?,••_, e;
Address:
Site Address:
Plum6er.
Meter No.: Connection Charge: - -
Si=e: Account Deposit:
Reader No.: Permit Fee:
1 agree !o eomply wtfh fhe Gfr of Eagan Surcharge:
dinanaes. Misc. Chorges:
? Totai:
y Dote Paid:
ate of Insp.: Insp.:
ciTY ,.,r EAGAN SEWER SERVICE PERMIT
3; ' B Pilat Keob Rood PERMIT NO.:
Eagan, MN 55122 DATE: -'-'
Zoning: No. of Units:
Owner: - E Iri:..
Address: _
Site Address: - -JnF'.
Piumben
1 agree fo eomplp with the City oi Eagan Connection Charge:. .'
Ordinances. Account Deposit:
Permit Fee:
Surchorge:
B
;
Y Misc
Charges:
.
D
.te of Insp.: Total:
?.t Insp
: Date Paid:
.
.
?..
?
BtNLDING PERMIT
T_ L_ _"__. ?__ • Lh.: 1. f_
cirY oF EAGAN
3795 Pi1ot Knob Roed Eegae, MN 55122
PHONE: 454-8100
6. Carg.
38,000.
Receipt # -
??*e ? eb
N4 4650 ?
'I
c, 9 77
3r
Site Address 'Avc Erect 0 Occupancy t
Lot Bl ock Sec/Sub. 'i n e ci clNter ? Zoning
Porcel # Repair ? Fire Zone _
E
l e of Const
T
n
arge p yp
.
W njame GCOYE@ ti Kt3bi if MOVe ? # Stories
? Address Demolish p Front ft.
Ci Phone G?ade ? Depth ft.
Approvob Fees
0
z?
U
cc
?
Name
'_ So. Snel l intz
S
Name _
Address
i hereby acknowledge thot I hove read this application ond stote that
the information is correct and agree to comply with all opplicable
Srate of Minnesota Statutes end City of Eagan Ordinances.
Assessment _
Water & Sew.
Police
Fire
Eng.
Planner
Council
Bldg. Off. _
APC
Permit
Surchorge
Plan check
? rl
SAC
Water Conn.
!J
Water Meter _
Totcl `;ly1 i0
Signcture of Permittee I
A Building Permit is issued to: 'Cilsen on Yhe express condition that
all work shall be done in accordonce with oll applimble State of Minnesoto Stotutes ond City of Eogan Ordinances.
Building Official
PermM # Oah IwraA P?MFM
Plumbing 7 -
Medicnicol -9- ?
INSPECTIONS I DATE INSP. Rouph-In Finol
Footings Date Inap. Dafe Ins .
Foundation Plumbing
Freme/ins. ? Mechanical
Finol i
Remarks:
CITY OF EAGAN
3795 Pilot Knob Rood
Eagan, MlnnasoM 55122
Phone: 494-8100
' PLUMBING
Date:
farch 7, 1978
PERMIT
Site Address: ' -
Lot , I Btock f Sub/Sec. `JS 1U71d Tiraber i_-? r
Nome
. .
? Address ' 2 i S ne ? ?? r:
?
ndu
City : - f" • Phone:
No.
Receipt No.: 0"2 4 n
Single I
Residentiol
N1ult7 Res., Comm./Ind. y
New/Alter./Repair. '1ew
Cost of Installation
ry, nr?
Permit Fee ^
Name '-,Olll. S? l. Pe te rCO . Surchprge ?50
.
g Addre1854 GratTld Av ..,, ;_,
e
0
City 't" . pdul r r?^^ Phone: Total ?
This Permit is issued on the express condition thot pll work shall be done in acwrdance with oll applicable State of ,
Minnesota Statutes and City of Eagan Ordinonces.
Building Official
I
CITY OF EAGAN Remarks
Addition Oslund Timberline Lot 39 eik 4 Parcel 10 55300 390 04
Owner GCU2L t` st,eet 3053 Pine Ridge Dr. State Eagan, Mt1 55121
Improvement Oate Amount Annuai Years Payment Receipt Date
STREET SURF.
JITREET RESTOR. pavin 1971
AM&ffli
88. 60
10
7
--
GRAOING
OPIKAN SEW TRUNK 1968 3.33 30 63.37 -4-24-79
1970 2 $100.25 ZQ 1102 - 75 - 4-24-78
• WATERMAIN 1J]O ZO
WATER LATERAL
WATER AREA
STORM SEW TRK
?k STORM SEW L T 19]O ZO
F0.? t0 ?rnt e rs /9 7 7(? ?S 9 . ?(?
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. 230.00 8977 7_3_77
BUILDING PER.
sac 8977 7-3-77
PARK
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued:
(612) 681-4675
SITEADDRESS:
I 1 Nf. {i ! tl??l f?i.
_ it)NU i fli9[ct:kt 1Nt
? APPLICANT:
I hit
ttl11 f 11 ( W1
g%
i3il?:l??t,
?
. ,.
PERNIIT UBTYPE: TYPE OF WORK:
: ?i : ;1; i'A 10
. : ? , : : ; .; i ; t F i.? t F:
Permit No. Permit Hoider Date Telephone #
ELECTRIC
PLUMBING
HVAC
Inspection Date Insp. Comments
FOOTI NGS
FOUND
FRAMING
ROOFING
ROUGH
PLUM8ING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYPBOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSA7
TEST
BLDG FINAL '
65MT R.I.
BSMT FINAL
DECK FTG
DECK FlNAL
' -requeS
s voi months &om
Date of this Request 2'13-78 P 588 4 5
I, aM Licensed Electrical Contractor ? Owner, do hereby request inspection oC the above electri-
cal wiring installed at:
Street Ad ress or Rout?. 3?? nQ NNio.7o? ??_ J Cityjaan
Sectio???Town ?p y ge Co??, Dakota
Which is occupied by Tiloen Homee
(Name ot OccuOant)
Is a roughin inspection required on this job? No ? Yes EF Ready Now ? Will Call Sx
PowerSupplier Dakota Cty. Address Far.mingtott
Electrical Contractor 0. R_ Thomlaann E'1 wr.+r; r.Cn Contractor's License NoA,33235
(Campany Name)
Mailing Address 12201 Mtka Blvd. 0 L4tka 55343
Authorized
phone No. 933•25?1.
ST?TE BOARD COPY This impection request will not 6e accepted 6y the
1 State Board unless praper inspection fee is endosed.
Minnesota State Board of Electricity
1954 Upiversity Ave., St. Paul, Minn. 55104-Phone 645-7703
RF.QUE$T FOR ELECTRICAL INSPECTION
CHECK BE?,OW,WOAK COVERED BY THIS REQUEST
P 58845
Type oLBuilding New Add. Rep. Check Appliances W'ved For Check Equipment Wired Fm
Home? KX ? ? Range TemporaxyWiring ?
Duplex ? ? ? ? r
Wat LighdngFixtu"es ?
Apt. Bldg. ? ? ? Dry?
; Electric H eating ?
Commercial Bldg. ? ? ? Pu' Silo UNoadet ?
lndustrial Bldg. ? ? ? Ait ti e[
on Bulk Milk Tank ?
Farm
O
O
? List )
pthers} . List
(11hers?
Other Hexe ) Bere
f
COMPUTE INSPECTION FEE BELOW
Service Enhance Size: # Fft Fceders&Subieeders: # Fft cuits: # Fft
0 to 100 Am s. 0 to 30 Am eres Am etes 10
]Ol to 200 Am QQ UG 31 [0 100 Am res 0 Am e[es
Above 200 Amps.
Above 100 Amp
s. Lb.,e
00 Amps.
Transformers Remote Contiol Citc. r other fee
Si ns Special Ins ection m fee
Remarks $all F ?Od 40•5
I, the Electrical InsPector, herebY c tha le A ins ction has beef q may ,./
` •
(Rough-in) Date
(Final) Da[e ?c73-7
This request void 18 months from ' ???
Vhis rcquest void 18 months from Oys-3? o
Date of this Request ._,? - /? - ?./.P 32839
I, as O Licensed Electrical Contractor wner, do hereby request inspection of the above electri-
cal wiring installed at:
Street Address or Route No`?
Section
Which is occupiec
Is a roughin inspection required on this job? No [P?" Yes ? Ready Now ? Will Call Pr
Power Supplier?,??_?o_??Address??- ?¦- ? "
Electrical Contracto? s? Contractor's License No. _
(COm any Name)
Mailing Address / o dS -,7, ?---?? r ??• ? ? 5 ?/J ?
? (Electrlcal Contracto? or Owne? Making Thls Installatlon)
Authorized Signature W. /G--d-..-? Phone No.??a G
(EleetfiCal ConK ctor o/ Ownal Making ThiS Instellatl0n) STATE BOARD COPY
Minnesota State Board of Electricity
195¢ University Ave., St, Paul, Minn. 55104-Phone 645•7703
z '-_ ?REQUEST FOR ELECTRICAL INSPECTION
C?IECK BELOW WORK COVERED BY THIS REQUEST
ags'3?
P 32839
Type of Buiiding New ?Add. Rep. Check Appliances Wired Foi Chak Equipment Wi`ed For
Home ? ? Range ?
? Tempo?ary Witing ?/
Duplex ? ? ? W eate Lighting Fixtuies LQ
Apt. Bldg. ? ? ? D er Electiic Heating ?
Commercia161dg. ? ? ? F Silo Unloader ?
Industrial Bldg. ? ? ? Con Bulk Milk Tank ?
Faim ? ? ? pLis F1
eie?g pList
eie13?
Other ? ? ? H
l H
COMPUTE INSPECTION FEE BELOW
Service Enlrance Size: # Fce FcedersBESubPceders: # Fee Circuits: # ee
0 to 100 Am s. 0 to 30 Am eres 0 to 30 Am res ? /O
101 to 200 Amps. 31 [0 100 Amperes 31 to 100 Am res
Above 200_Amps. A6ove ]00 Amps. Above 100 Amps.
Transfoaners RemoteConVolCuc. Paztialoro[hertee G
Signs S cial Ins ection Minimum fee $5.00
Remarks
TOTAL FEE
I, the Electrical Inspector, hereby cerU' ?ttjet th e i?spection has been made.
(Rough•in) //.? Date
(Final) ? „? ? ) Date .?_ /'?- r 7
This request void 18 months from ?' ?
T"_request void 18 months fro
Date?this Request R 78051
?
I, as Licensed Electrical Co ractor 0 Owner, do hereby request inspection of the above electri-
cal wtnng installed at:
Street Address or Route No. 7053 o e- 12, d6E" Cit?
Section Township Range County g?
Which is occupied by LE(3 j Q?
(Nama af Occupany
Is a roughin inspectio? required on this job? No, Yes ? Ready Now>e Will Call ?
Power Supplier
Electrical Contractor
I.lcense
Mailing AddressJ
_ al Contrac -r or wner a n is instauation)
Authodzed Sig ` hone No. ?
lectittal Contractor or er ak ng TM1IS Instal atloh)
SVA?f? ????? ????,Q Thisinspectionrequestwillnotbeacceptedby"the ?
Gj Y State Board unless proper inspection fee is enclosed.?
Minnesota State Board of Electricity
1954 lJniversity Ave., St. Paul, Minn. 55104-Phone 645-7703
RIQUEST FOR ELECTRICAL INSPECTION 'R 78051
OW WOKK COVERED BY THIS REQUEST
Type of Building New Add. Rep. Check Appliances Wired Foc Check Fquipment W¢ed For
Home ? ? ? Range ? Temporary Wving ?
Duplex ? ? ? WaterNeatet ? LightingFixtures ?
ApL Bldg. ? ? ? Dryer ? Electric Heating ?
Commercial Bldg. ? ? ? Fumace ? Silo Unloadet ?
Industrial Bldg. ? 0 0 A'v Conditioner .? Bulk Milk Tank ?
Farm ? ? ? Lis[ . Lis[
Other ? ? ? Re1ers Oe1ers?
H 1
COMPUTE INSPECTION FEE BELONI AI "
Smice Entrance Size:
0 to 100 Am s. # Fce F s S s iL
0 t 0 A ere LAgee C'¢cuits: 11
0 to 30 Am eres # Fee
101 to 200 Amps. 31 to 100 Amperes ' 31 to 100 Am eres
Above 200 Amps. Above 100 Amps. A6ove 100 Amps.
Transformers RemoleControlCirc. Parlialorother fee
Signs Special Inspection Minimum fee $5.00 U
Remazks
TOTAL FEE
I, the Electrical Inspector, hereby certify that the above inspection has been made.
(Rough-in) Date
(Final) _ 1.,,. nl Date - fS- -2?'
This request void 18 months from
CORRECTION NOTICE ??1 D
° ?
b'4?'?
DATE: U V?
Address
Owner/Agent
Ordinance Nos. and Corrections - Correct By
Site Name
Telephone
t
For reinspection
Eagan Dept. of Inspection InSpBCtof:
3795 Pibt Kno6 Rd.
Ea9an, Minnesota 55722
454-8160 Dept.: _
r
CITY OF EAGAN
3795 Pibt Knob Rwd Ea9an, MN 55121
PHONE: 454-8100 BUILDING PERMIT APPLICATION
To be uaed fw SF Dwlg. & GeTg. Est. Value $38t000.
Receipt .# _
Feb.
N? 4650
8977
3. ,,, 78
Site Address 3053 P1IIE R1dgE Erect f] Occupancy i
Lot31)_ Blxk4Sec/Sub. 0s T{mhorl ine (ujdWter ? Zoning R L
Parcel # Repair ? Fire Zone 3
E
l f C
nst
V
T
n
arge ? .
YPe o
o -
¢ Name George H Kubik Move ? # Srories
z
Address 1067 Bo?rdin St. St. Paul
?
Demolish
?
Front
57 ft.
? Ci Phone Grade ? DePth 46 ft.
? N Tilsen HJmes Apvrorub _ Fees
z? aMe 627 So. Snelling
0g Address _
r r:... St. Paul ok,...e 698-5601
Name
Address
I hereby acknowledge that I have read this application and state that
the infortnation is mrrect and agree ro comply with oll applicable
State of Minnesom Statutes and City of Eagan Ordinances.
SignMure of Permittee -
A Building Permit is issued
oll work shall be done in q
Assessment -
Water & Sew.
Police
-
Fire
Eng.
Planner _
CAUncil _
Bidg. Off. _
APC
Permit aaU..'v
Surcharge 19.00
Plan check
SAC 500,00
Water Conn. 230.00
WaterMeter 60•00
Torol 919.50
HVMES on the express condition that
applimble State of Minnewta Statutes and Ciry of Eogan Ordinance:.
Buiidirg Official
EAGAN TOWNSHIP
BUILDING PERMIT
oWO.= ------??.... ?
Address (Presenf) ......... 4-170....1 ..............-------........--'........-----
Builder
Addzess
..............
DESCAIPTION
N° 2096
Eagan Township
Town Hall
Deta ......._9/. /?1 ..................
Stosies To Be Used Foz Froni Depih Heighf Esl. Cos! Permif Fee Remarks
A I ? J 1Plti',wre - 2 y! I /D I A'L.CL•V'L?
" U LOCATION
Sireef, Road os oiher Deseripfion of Locaf3on I Lo! Slock Aatiiiion or '1'raex
?s?v?----?-
This permit does aot auihorise the use of §2reeis, raads, elleys or sidewalks aos does it give the owner or his agen!
!he righ! !o creale anp sifuafion whicL is a auisance or whiah presenls a hasard fo the healfh, safely, eonvenienae and ,
general welfare 1o enpone in the communify.
THIS PERMIT MUST SE KEPT ON THE PA MISE WHILE THE WORK IS IN PAOGR S?o This is !o eeriifp. !hal..i?G.._........ ..'....?....^'.`.c?:--........has permission !o arect a-- ..._ .:. .........._upon
!he above described psemise subjeei fo !he provisions of !ha Building Osdinance foz Ewnship dopied Apsil 11,
1955.
-?...... ?.-. _ ...............
.............. -- F -..... -
-'----'. .. ^''__-"..."-'-'_.... Per ...-- ......... .. .. "- ? t
.ectos
Chai?an of Tnwn Board Building Inap.
y ` 1
t ? qou
Date : AalmGCvLJ / ' /r/?)q
SIIILUI'stG PERP1Ii P.PPLICA^tION
LoT 3 9 BzOcK Al ADDr:Io., 12&
PARCEL & SECTIOPI 17[Ji9IIER IF Ui1PIATTEll
.ADURESS OF
40idT:dG h =
ESTLry1li'ED COS^1
O?'?i]Ei2 TSLEPHOP7E iVO.
,?u?
HDDktESS 10/p / i&WGLL1/J'(! .ClN ZCP t Jt ' YG(,C? 15?5-1 COP:iTPACTOR 1?.?,?//'L? ?(/D?,Q?v? p{?"Y1i(',J• TELEPHONE M. P.oUaZESS kj
4a-L17"lKJ.E'i O?C•I/32P ?Q(',?lm?
Note. Include site plan, building plans, and energy calculations u7ith this
application
Sianed
OFFTCE USB
VALUI1TIOi3
SAC
iIA,Ez coMEcTro:r;
t311TEsR AMTER
BUIF.DIfJG PERI4ST FEIi
SURCHARGE FER
PL)i3i Ce'T^.CK F-LE
PARK DEDICATIOta FEE
OTF.s.R
TOTfiL"'
?
30 -
. ?
!U °
APPROVALS? n ?
ASSESSitilE'.?.'T CLERK 1/?1 • BUILDIiIG DE POLICS DEPT
.?
'']AiER & SFi6aER DEPT. FISL-DEPT. PARK DEPT.
Cities Dijzital
itv Control
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CON9TRUGTION 9URVEV9
<?- tr.-T? ";r ROBERT A. BUSCH
, 1i'U71 1, 1 t?; WUt10' 11 uii CandSarveyor
R6016TENCO pNOGq LAWB OF 9TATE OF MINNESOTA
PHONE 824-8489
1907 W. 31sr ST. MINNEAPOLIS. MINN. 55408
? Soueyan d &4*cette
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SiGNED
, ? . . , MINNESOTA RFGI5TRA710N No. 70?09
wu
? `- - ` -
i ?
DAKOTA COUNTY ABSTRACT CO.
1250 Highway 55
HASTINGS, MINNESOTA 55035
437-5600
Please send me a Pending Assessment Search on the Yollowing tract
°r of land:
` Lot 39, Block 4, Osluad Timberline Addition
? 3053 Pine Aidge Drive, Eagan, Minnesota
Enclosed please find check For $5.00 to cover costs.
Thank you,
Rosie
City of Eagan
3795 Pilot Knob Road
Eagan, MN 55122
Data: March 27, 1978
DakOta County Abstract Co. SPECiAL ASSESSP7ENT SEARCFi
1250 West Highway #55 EM` 3053 Pine Ridge Drfve, Eagan .
Hastings, NW 55033 Lot 39, Block 4, Oslund Timberline
Enclosed hetein' is the searclY which yesu Yeqiseeted made ori the above 8escriHed
ProPertY :
Ki.nd of Impmvement Runs Beginning Oriqinal Amt. Salanoe Due
Street Restor. 10 yrs. 1971 886.00 177.20
?
San Sew Trunk 30 yrs. 1968 100.00 63.37
Sewar Lateral 20 yrs. 1970 2005.00 1102.75
Water Area %97Frs. 1977n 160.00 138.68
I further certify that according to the records of esid office, the following
impmvements are contemplated or pending after having been appmved, and are now
in the procees of planning or oompleti.on.
Kind of Improvement Approx. date of crompletion Approximate cost
none
F']AItEt:
Neither the City of Eaqan nor its employees guarantees the accuracy of the sbove
information which was requested by the pereon or persons 3ndicated. Nor does
the Gity oE its employees assume any liability for the correctness thereof.
In cans3deration for the supplyi.ng of the indicated information in the above .
#orm, and for all other consideration of any nature whatsoever, any claim
against the City of its employees risi.ng there from is hereby expressly waived.
Levied assessments to be paid to the County Auditor at Hastings, Minnesota 55033.
Very truly yours,
SPECIAL ASSESSMENT DEPARTMEN'f
?
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
3053 PINE RIDGE OR
LOT: 39 BLOCK: 4
OSLUND T9IMBERLINE
PERMIT
SITE ADDRESS:
P.I.N.: 10-55300-390-04
DESCRIPTION:
REROOF
f -?
"ilding Permit Type
Bu.ilding'Work Type
Census Code'"\
?
??m \
;t
+
SF (MISC.)
REPAIR
434 ALT. RESIDEN7IAL
.`L??.
.-.? 7 y .. . . . < _ ...., e
f
REMARKS:
FEE SUMMARY:
Base Fee
Surcharge
Total Fee
VALUATION
$87.25
$2.00
$89.25
PERMITTYPE: BuiLnzNe
PermitNumber: e28246
Date Issued: 0 7/ 12 / 9 6
$4.0@0
- nppticanc - ai. L1U . ?/NFp
A rLS?iA?T?cir'sT INC 15935325 0003247 ?KUt3rk" 6EORGE
3315 N HWY 100 3053 PINE RIDGE DR
MINNEAPOLIS MN 55422 EAGAN MN
(612) 593-5325 (612)452-3887
I ?
I hereby acknvwledge tMat-T ha=ve read this appli,catian and state that the
infiormation is correct and agree ta comply with all applzcable State of Mn.
StaCutes and City of Eagen Ordinances.
L ?
APPLICANT/PERMITEE SIGNATURE
ISSUE : SIGNATURE
I CITY OF EAGAN
a$?? ?p 3830 PILOT KNOB RD - 55122
1996 BUILDING PERMIT APPLICATION (RESIDENTIAL)
/
681-4675
n
? 3 regbterod aite surveys ? 2 wpies of plan
? 2 copbs of plans (inGude beam 3 window sizes; poured fid. design; etc.) ? 2 sNe surveys (exterior aOdRfons 3 decks)
?/ enerpy ealculettons ? 7 energy eelculeGons for heated additiona
? 9 copiea W hee presetvaNOn plan N lot Qlatled after 7l1/93
mquired: _ Yea _ No
DATE: It 17, ??. CONSTRUCTION COST:
DESCRIPTION OF WORK: STREET ADDRESS: ?b5 3 4?NE" (t-? o?E i??z
LOT 39 BLOCK ? SUBD./P.I.D. #: T-,
PROPERTY
OWNER
CONTRACTOR
ARCHITECTJ
ENGINEER
Name: Phone #:
u?r raer
Street Address? hrl?> 1??LAOw6- 21`"""F
City:
?--AIQPKIJ
State: AAkK
Zip• .`
P
ne #: 3 2?
l? r13111
License #: 32 `??7
Company:
Street Address: 3316- AI- L?= l c7:)
City: State: M-/ Zip ;?'-QZZ
Company: Phone #:
Name: Registration #Street Address-
City:
Sewer & water licensed piumber:
change are requested once permit is issued.
State: Zip:
Penalty appiies when address change and lot
I hereby acknowledge that 1 have read this application and state that the infortnation is correct and agree to comply with all
appticable State of Minnesota Statutes and City of Eagan Ordinances.
Signature oi Applicant:
OFFICE USE ONLY
Certificates oi 5urvey Received _ Yes No
Tree Preservation Plan Received Yes No
OFFICE USE ONLY
BUILDING PERMIT TYPE
/
r
0 01 Foundation o 06 Duplex ? 11 Apt./Lodging o 16 Basement Finish
0 02 SF Dwelling ? 07 4-plex ? 12 Muiti Repair/Rem. 0 17 Swim Pool
0 03 SF Addition o 08 8-plex ? 13 Garage/Accessory ? 20 Pubiic Facility
0 04 SF Porch o 09 12-plex o 14 Fireplace ? 21 Miscellaneous
n 05 SF Misc. 0 10 = plex ? 15 Deck
WORK TYPE
0 31 New o 33 Akerations ? 36 Move
n 32 Addition /181 34 Repair o 37 Demolition
GENERAL INFORMATION
Consk (Actual) Basement sq. ft. MGWS System
(Allowable) Main leve l sq. ft. City Water
UBC Occupancy sq. ft. Fire Sprinklered
Zoning sq. ft. PRV
# oi Stories sq. ft. Booster Pump
Length sq. fl. Census Code.
Depth Footprint sq. ft. SAC Code
Census Bldg
Census Unit
APPROVALS
Planning Building Engineering Variance
Permit Fee g? Valuation: $
Surcharge o?• D
Plan Review
License
MCMIS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Pertnit
SIW Surcharge
Treatment Pi.
Road Unit
Park Ded.
Treils Ded.
Other
Copies
2J
? ??1
o
Totah
% SAC
SAC UnHs
11?0?0
2005 RESIDENTIAL BUILDING PERNIIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Constmdion Rg4uirements RemodeUReoeir Reauiremenis ?e:l??C7?dY
3 registered site surveys shaxing sq. ft. of IoL sq. N. o( house; and ?II roofed areas 2 copies of plan Ce?i
(20% maximum bt coverage allowedi 1 sN of Energy Calculatiom for heated additions ?tL?Pres PIM`ReCd _.Y "? N.
2 copies of plan showing 6eam & vrindow sizes; poured found design, etc. 1 siie survey for addiYom & decks irCO ArkS R9qii?? Y ,,.N
?
1 set of Energy Calculatiom Addih'on - indicate'rfanaitesepticsysfem ?Y-s?t2?epN0 SysYem .`Y _td
.:
3 copies of Tree Preservation Plan if lot platted after 711/93
Rim Joist Detail Options selection sheet (buildings with 3 or less uniYs)
Date I L l ? L / v?? d
struction Cost 60J
SiteAddress aC7S.5? UniUSte #
Description of Work
Multi-Family Bldg _ Y N Fireplace(s) _ 0 _ 1 _ 2
Property Owner ? Telephone # (o ? / )
Coutractor
Address ,16 13 City
State ? i i Vk_ Zip 5-5-7/f- Telephone # t;S/ ) F3S?
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW SUILDING
- Minnesota Rules 7670 Catecoiv 1 _ Minnasota Rules 7672
Enefgy Code Category . ResidenGal Ventilation Category t Worksheet • New Energy Code Worksheet
(4 submission type) Submitted Submitted
• Energy Envefape Calculations 5ubmitted
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_ Y _ N If yes, date and address of master plan:
Licensed Plumber
Mechanicai Confractor
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 pemut, 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.
?-e,?-
Applicant's Printed Name
Applicant's Signa e
OFFICE USE ONLY
Sub Types
? 01 Foundation ? 07 OS-plex ? 13 16-piex ? 20 Pool ? 30 Accessory Bidg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt-Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea. ) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc.
? OS 03-plex p 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or_ N ? 25 Miscellaneous
Work Types
? 31 New O 35 Int (mprovement 0 38 Oemalish Interior ? 44 Siding
? 32 Addition O 36 Move Building O 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteration ? 37 Demolish Building• O 43 Reroof ? 46 Windows/Doors
? 34 Replacement `Demolition (Entire Bldg) -Give PCA handout to applieant
Valuation Occupancy MCES System
Plan Review 100% or 25°k
Census Code Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIItED INSPECTIONS
_ Footings (new bldg) _ FinallC.O.
_ Footings (deck) _ FinaUNo C.O.
_ Footings (addition) _ Plumbing
Foundalion HVAC
Drain 'I51e Other
Roof
Ice & Water Final _ Pool _ Ftgs _ Air/Gas Tests Final
_
_ Framuig _
_ Siding _ Stucco _ Stone _ Brick
_ Fireplace _ R.I. _ Air Test _ Final _ Windows
_ Insulation _ Retaining Wall
Approved By:
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Sarcharge
Treatment Plant
License Search
Copies
Other
Total
Building Inspector
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA147513
Date Issued:01/16/2018
Permit Category:ePermit
Site Address: 3053 Pine Ridge Dr
Lot:39 Block: 4 Addition: Oslund Timberline
PID:10-55300-04-390
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace & Air Conditioner
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
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 -
George H Kubik
3053 Pine Ridge Dr
Eagan MN 55121
Binder Heating & Air Conditioning
222 Hardman Ave N
South St Paul MN 55075
(651) 457-8781
Applicant/Permitee: Signature Issued By: Signature