3259 Random RdsdiP.
City of Earn
Date:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
AUG —8
ttg el)
t scovTesQ 3s- tt .g. v1 5
r
Use BLUE or BLACK Ink
For Office Use
Permit #: / 5�r`�,
Permit Fee: ` ,-35
Date Received:
Staff:
2011 RESIDENTIAL BUILDING PERMIT APPLICATION Le -R-11/4"6
/0— it
Site Address:
?� 4.e.,./
Unit #:
RESIDENT
OWNER
Name: / ..0 / 7 -r / /e / ( tom^ Phone:
Address I City I Zip: 72 -5-, f -t -r , JCvs/ ieeel cl /2 1
Applicant is: Owner f/ Contractor
Description of work: IA/1-r' amo l lam( /°.r ., /`
TYPE OF WORK
Construction Cos 0 ...C? 5, 4-6, Multi -Family Building: (Yes I No r/ )
CONTRACTOR
//)4.--' Company: /'trr cx /(!.� �' /�'!'!�� _ Contact: • S C � ✓ //) v
Address: X32 v 0 rd 5 City: f/ l_ Le -a f / "' ( .
���
State: /(1/1/ Zip: 5-5-4a I( Phone: 6 /1- c7 / q - 2
(�piA
License #:.2U 6 / 1> 7 Lead Certificate #: 24 ','-. 6/ 2 Ltth
If the project is exempt
#c -�c 4-----5-4-----5-
U,V1dE4--1!ULCC-- / A/10 irit4A,Mij
from lead certification,7please explain why: (see Page 3 for additional information)
Z- r./41 /n 72 /� , CI.<c�?*1 v»y6'
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 maybe classified as non-public if you provide specific reasons that would permit the City to
. .r_ 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.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.
if
Applicant's Printed Name
X
App -nt's Signature
Page 1 of 3
fiik1
DO NOT W T,E BELOW THIS LINE
/005.
SUB TYPES
Foundation
Single Family
Multi
01 of Plex
Accessory Building
WORK TYPES
New
Addition
Alteration
Replace
Retaining Wall
DESCRIPTION
Valuation
Plan Review
(25% 100%
Census Code
# of Units
# of Buildings
Type of Construction
Fireplace
Garage
Deck
Lower Level
Porch (3 -Season)
Porch (4 -Season)
Porch (Screen/Gazebo/Pergola)
Pool
Interior Improvement
Move Building
Fire Repair
Repair
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
Framing
Fireplace: Rough In _Air Test _Final
Insulation
Sheathing
Sheetrock
Reviewed By:
9c
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
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
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:
Pool: Footings Air/Gas Tests _Final
Siding: Stucco Lath Stone Lath Brick
Windows
Retaining Wall: _ Footings _ Backfill Final
Radon Control
Erosion Control
, Building Inspector
TOTAL
3
�(V
Page 2 of 3
íü
ðôø
þýýü ûúÿú ÿ
ùüüýý ð ô ü
ü
õ
áã
þý
ÿþýüû ù ÷à ú ÿ ýüû
ù ýüû ù ÷à ø÷àêûõ
û ÿ
úÿú îî äÿûü
Þ
ôÿë
õû æõ óó õôÿõ þ õè
å ÷ ÷ ûå åõ
ý
û èúå åû å è
úþ õ ç ôÿþü÷ åõüó õè
ëéâéííè
í
èî
í
öù
ÿó Ýÿ éâéè
ð
èð
Ýÿ
è
õó
òñ
ûû
ê÷òóø
ð
ðê õê
ê æòøòø
ñáïáî îããã
óþü ÷ ó
óæ óûû ó óå õ õûü÷ óûûþ
åò ÿ ú ü åäè
ûû à
õ ÿ
ÿü ÿ
CITY OF EAGAN Remarks
Addition EIMRK ADDITION Lot 5 Blk 1 Parcel 10 67100 050 Ol
ownerMarr? /WnC lrf'ea Street 3259 Random Road State Eagan, M 55122
Tarn25 D Z);BleL)
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK 1970 53,..00 2•12 2 Paid
• SEWER LATERAL 1973 1,700,00 113-33 1 Faid
WATERMAIN
• WATER LATERAL 1973 ].
WATER AREA
STORM SEW TRK 1984 435.00 29.00 15
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. 220.00 6674 10-2 - 2
BUILDING PER.
SAC 24O OO 6674 - 10--27-72
PARK
? REQUEST FOR ELECTRICAL INSPECTION Ea-00001-04
...:
? y _ _y ? See instructions for co mpleting this form on back of yellow copy. ?c5 3
C 3 8$.6 X' Be/ow Work Covered by 7his Request
Nev4 Addl Rep. Tne o1,,8uilding
?' Applionces Wired Equipment Wired
' Range Temporary Service
? b iplex Water Neater Lightin,y Fixtures
Apt. Building Dryer Electric Heatin
Commercial Bidy. Furnace Silo Unloader,
Industrial Bidg. Air Conditioner Bulk Milk Tank
Farm ocner Speci v Other (SPerffy)
t er SUecify Other Cliher
m mniif a lnc nprtinn Faa Rv/nw
p: fee Service Entrance Size tt Fee Feeders/Subfeeders # Fee Circuits
0 to200Am s 0 to30Am s 0 to 30Am s
Above 200 qmp5? 31 to 100 Amps 31 to 100 Am s
Swimming Pool Above 100_A Above 1Q0_AmpS
Transformers Irrigation Booms Partial-'Other Fee
aigns
Rerrxarks ?
Rough-in . ?
Final
Special Inspection ? S
te ,-
FEE
/A .-G v
I, the E rical
Inspector, hereby
certify that the above
inspection has been
made.
This request vold 18 months from
This h?e,? void
18 mos t?m,
( 3?86 L- ?, ` ?. ? .?• ?iv -
Request Dat
f Fire No. Rouph- inI nspection
Required?
Ready Now [DWill Notify, Inspec-
? El Yes No tor When Ready
Licensed Electrical Contractor 1 hereby request inspection of above
Owner electrical work installed at:
Street Address, Box or ute No.
3 ? City
?
e Uon o. 7ow ship p Name or No. Range No. Cn;&
,774-
Occupant (PRINT) Phone No.
Power Supplier Address
Elec cal Contractor 1 mpany Namel
? Contractor's License N
.
`?
? l L // Cs ? L ?
Mailing Address ont actor or Owne Making Inst lationl
?,.
?`
Q
? /
,
AJ'?_ / V v?. 1 %
?
Author ig tur (Con to Ma ing I tallation) Phone Nu ber
?? ;?-? 0
r THIS INSPECTION REQUEST WIIL NOT
MINNESOTA STATE BOARD ELE ICITY
Griggs-Midway Bldg. - Room N-19 BE ACCEPTED BY THE STATE BOARD
UNLESS PROPER INSPECTION FEE IS
1821 University Ave., St. Paul, MN 55104
Phone (612) 297.2111 ENCLOSED.
This request void ?!•??f ? J~?7?? ?
18 months from . '
e _4 25 3 5L.Y. 61. zLI q/.?
?? ?/_,? ft' 7 S? C' 'f
IoZW' .? io.
Request Date Fire No, Rough-in InspectionG?
Required?
?Rea ow ll Notify. InsPec-
?
K
?Yes ?No or j
en Ready
'?
e-censed Electrical Contractor 1 hereby request i specti ? lieve
? Owner electrical work i tail 7
Steeet Address, Box or Rout . Citv
ection o. Township Name or No. Range No. Count
l /`T
Occupant (PRINT) Phone No.
L '
Power Supplier Address
EI c Cont actor 1 ompany Name) y Contractor's License No.
/?0 [ ?? 16 ? r/- D l I 1
M iling Address (Contractor or Owner Making Instail ion)
Authori S nature ( ontr ct ? wner Making Installation) Phone Number
. -s' - 0 s-'6 a?
r THIS INSPECTION REQUEST WILL NOT
MINNESOTA STATE UO?A OF E LECTRICITY
GriggMidway Bld om N-191 BE ACCEPTED BY THE STATE BOARD
1821 University Ave., St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS
Phone (612) 297.2111 ENCLOSED.
,4Lf??,? f E
REQUEST FOR ELECTRICAL INSPECTION B-o?oo?-oa
1 See instructions for completing this form on back Ot yellow copy.
OC ?4 3 5 ??X'" Below Work Covered by Thrs Request', T
kdd Rep. Type of Building - Applitfnces Wi.red . Equipment Wired
Home Range Temporary Service
Duplex Water Heater Lightiny Fixtures
Apt. Building Dryer Electrie Heatin
Commercial Bldg. Fumace Sil;o Unloader
Industrial Blcig. Air Conditioner Buik Milk Tank
Farm Other peci v oinFr lsneritv1
t er SVecify Other OTher ompute lnspection Fee Below '
# Fee ServiceEntrBnceSize # Subfeeders it Fee Circuits
Uto200Am s m s 0 to 30Am s
Above 200 Amps Amps 31 to 100 A s
Swiniming Pool 0_Amps
MA Above 100_Amps
Transformers t3ooms Partiaf-'Other Fee
s nspection $ OT L FEE
Rerrarks _:74' ? n 14 1 pq ?,)
Rough-in D I,the Electrical
Inspector, hereby '
. . . ?? certify that theabove
Final ?YA-& inspection has been
made.
This request void 18 months from ? C-V
?' ? ..
.
EAGAN TOWNSHIP
BUILDING PERMIT N? 2823
Owner ._._... . -••--•- -.._.. .__..?.?'J • Eagan Township
Address (Preseni) .1..._??I.Q:.-- ••-- •--•---•- ..... 4
-------- Town Hall
Builder ......... .....:r`e..._.2(14t:2e.`? ..-•-...•---•-••-•--•--•--••-
. •----.--- Z
Date --•-•• -
--••--•---•--••--••--• ....................
Address ......-----•-----•••-•-•------•--•--••-•---•----••-••--•-------------------------•--•-•--•----
DESCRIPTION
53o:ies To Be Used For Front Depth Heigh! Est. Cosi ' Permit Fee Remarks
-r, to -7, i 0-1
LOCATION cl° l '
Stree2, Road or oiher Description of Locaiion I Lo! Block Addition or Traci
3??q Gee,
This permit does not sulhorise the use of streefs, :oads, alleys or sidewalks nor does it give the owner or his agent
the righi to create any situation which is a nuisance or which presents a haaard to the health, safety, convenience ard
general welfare to anyone in the communiiy.
THIS PERMIT MUST BE KEPT ON THE PREMISE WHILE THE WORK IS IN PAOGR S.
This is io certify, fha!_.__?...... ?'?^-?? .............has permissioa to erect _.._.._ _ . upon
---•-•-.._........ . .....----•---
!he above described premise subject to the provisions of the Building Ordinance for Eagan Township adopted April 11.
1955.
-----•• .........................zv.:t . ....- -..?'. .,............
Chairman of Tnwn Board
6
Per -••-•-•-•-••••••---••-..._..?-'"Q?c. .
Building Inspector
13
TO:;"N OF E.AGAN
3795 Piiot Kiiob I:oad
Eagan, Minnesota 55121
PERMIT NO. 266
The Board df Supervisors hereby grants eo '1'h.cmpsoxi Pltunia3ng Co.
of 12201 iNfinnetonka B1vd. Mimetonlca
a PT:z?ATNG Permit f-or: (Owner) Sall:,? Co,.;
aL Rar_dom Ro"i , pursuant to application dated
19119122
.
Fee Paid: ,2_O,00 Dated this 21 st . day of Septembex ,? 932 .
+54 -9Ia
Building Inspector
TOt ?N OF EAGAN
3795 Pilot Knob r?oad
Eagan, Minnesota 55121
PERNIIT N0. P56
The Board of Supervisors hereby grants to Emr.. N, Wglt,er lIeati?_y r.o.
of 4637 CYu?c?a Ave,,a VimeaPvlis 55407
a 17-NTI1VG Permit ior: (Owner) ?ally Lo.
at 9259 1?mdom Roar3, Eagaati 55122 , pursuant to application dated
9/ 191192 ,
Fee Paid: $2d+00 Dated th3s al day of September , 19 72.
.,, s c
Building Inspector
-7
RESIDENTIAL
55BUILDINC PERMIT APPLICATION ?'----
/
o'?
CITY OF EAGAN
3$30 PILOT KNOB ,?RD, EACAN MN 55122
651-681-4675
New Construction Reauirements RemodellRenair Reauirements
• 3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and aii roofed areas I?il • 2 copies of plan
(20% maximum lot coverage allowed) h • t set of Energy Calculations for heated additions
• 2 copies of plan sMowing beam & window sizes; poured found design, etc.) V • 1 site survey for exterior additions & decks
• 1 set of Energy Calculations ?II • Indicate if home served by septic system for additions
• 3 copies of Tree Preserva6on Plan if lot platted after 711l93 ;i
• Rim Joist Detail Options selection sheet (bldgs with 3 or less units)
DATE VALUATION
G r? ? ?'?I
SITE ADDRESS MULTI-FAMILY BLDG _ Y _ N
TYFE OF 10VC)RK F!lREPLACE(S) _ 0_ 1_ 2
APPLICANT ??oMM? (Z MEM99 ?M&
STREET ADDRESS ? 49 Soatb Owasso Bivd. ? CITy STATE ZIP
TELEPHONE # iLftile Canada, Mri 55117
(c??? Ii fAX #
? 5 ;?? 9-4 - ? 1-4 ?,-
PROPERTY OWNER ? II TELEPHONE #
V,
--..----.-----------.m --.------------- .---.-----------------.----------------.-------
COMPLETE THIS SECTION FOR KNEWi" RESIDENTIAL BUILDINGS ONLY
I;
Energy Code Category
_ MINNESOTA RULES 7670 CATEGORY 1 MINNESOTA RULES 7672
(4 submission type) • Residential Ventilation Category 1 Woiicsheet Submitted • New Energy Code Worksheet Submitted
• Energy Envelope Calculations Submitt?ed
u
Piumbing Contractar Pho ?
Plumbing sYstem includes: Water Softener ?
? Water Heater ??? ,. o?' R.?
No. of Baths
Fee: $90.00
Mechanical Contractor:
Mechanical system includes: Air Conditioning ,--------------- ? I'ee: $70.00
Heat Recovery System
Sewer/Water Contractor: Phone #
--------------------------------------------------------------- I'I ----------------------------- - ------------------------
I hereby acknowledge that I have read this application, state that the infor ation is coRe 3, a?i agree to comply
with all applicable State of Minnesota Statutes and City of Eagan?A` nces.
Si9nature of APP ........................
_7-_/_---
I
USE ONLY
Certificates of Survey Received ` Tree Preservation I,I!an Received _ Not Required _
Updated 4/02
OFFICE USE ONLY
? 01 Foundation 0 07 05-plex ? 13 16-plex 0 20 Pooi ? 30 AccessoryBldg'I
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Mutti ,
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF '
? 04 02-plex ? 10 OS-plex ? 18 Deck 0 23 Porch (screened) 0 36 Muiti
0 05 03-plex ? 91 10-plex ? 19 Lower Leve! 0 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or _ N 0 25 Miscellaneous
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
0 33 Alteration ? 37 Demolish (Bldg)" ? 43 Reroof ? 46 Windows/Doors
0 34 Replacement *Demolition (Entire Bldg 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
_ Footings (new bldg)
_ Footings (deck)
_ Footings (addition)
Foundation
Drain Tile
Roof Ice & Water Final
_ Framing
_ Fireplace _ R.I. _ Air Test _ Fin
Insulation
REQUIRED INSPECTIONS
_ FinallC.O.
FinaUNo C.O.
_ Plumbing
HVAC
Other
_ Poot _ Ftgs Air/Gas Tests
_ Siding Siucco Stone
Ll _ Windows (new/replacement)
_ Retaining 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
Final
;
Building Inspector
1
MINNESOTA VALLEY ??epTq•Vq?
SURVEYORS $c ENGiNEERS CORP.
}. k ' N
N
17000 E-17TN AVENUE SOUTN BURNSVILLE, MINNESOTA 55778 G ?
?`-Pti- evanso ?F,yO? ENG??`v
Certificate of Survey ffor : A°EN A LecLeAL/M
,
. ??
1 bcrabrcertily tAo? Ibis is n fruo and corroct reprosanrooioe MinpeSOta d8.11ey SurYeyOTB &
of a snrver of-thc boundaries oi 1he-abeve dessribod iond, EnQ? @@Pg, COPQ??
?
ond of iho locction of all buildings, thereon, aed all visibla by •R L S
eocroocNinonts, if any, from or on soid land.? µ
As srrverod by me this_.-dur of ? A.O. 192Z' MiAiD. R1g. NO. 929-3
k,?±
MASTER CARD
LOCATION 19?DO? VA ?S?L
OWNER ??PFLL_yR&, &
STRUCTURE AND ? ??
LAND USED AS
Permit
No.
Issued • Issued To
Contractor Owner
BUILDING
PLUMBING
6 ?
. .
CESSPOOL - SEPTIC TANK
WELL
ELECTRICAL
HEATING
GAS INSTALLING
SANITARY SEWER Asz
OTHER
07HER
FOOTING
Items
FOUNDATION
FRAMING
FINAL
ELECTRICAL
HEATING
GAS INSTALLATION
SEPTIC TANK
CESSPOOL
DRAINFIELD
PLUMBING
WELL
SANITARY SEWER q
Approved
(Initial) Date Remarks
-lo? -Iy-
?
.
w `
i? • `
?-
. '?• "? Z
s 1` _
COMMENTS:
Distance From Well
SEPTIC
CESSPOOL- .
TILE FIELD
DEPTH
OF WELL
FT.
Violations Noted
on Back
COMPLIANCE INSPECTION REPORTS -
TO BE USED ONLY IN EVENT OF OBSERVED VIOLATIONS
PERMIT NO. DATE OF INSPECTION
CONDITIONS OF CONSTRUCTION AT THIS INSPECTION
? NO EVIDENCE OF NON-COMPLIANCE
OBSERVED.
? ACCEPTABLF SUBS71TtJTlONS OR
DEVIATIONS.
? NON-COMPLIANCE. BUILDER WILL COMPLY
WITHOUT DELAY.
ITEMIZED AND DESCRIBED AS FOLLOWS:
NON-COMPLIANCE. BUILDER DOES NOT
INTEND TO COMPLY.
? COMPLETION OF CERTAIN IMPROVEMENTS
WILL BE DELAYED BY CONDITIONS BEYOND
CONTROL.
? REINSPECTION REQUIRED
REINSPECTION REVEALED
DATE OF REINSPECTION
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 oL-served 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.
? ALL IMPROVEMENTS ACCEPTABtY COMPLETED
COMMENTS:
BUILDING INSPECTOR
DATE
23
3E3 • 5 X
2b• _
100 0 1 • 0 *
1000 1 • x
1?•05 =
17r067•05 ??
EAGAN TOWNSHTP
3795 Pilot Knab Road
St. Paul, Minnesata 55111
Telephone 454•5242
FERMIT FOR SEWER SERVICE CONNECTION
nATE; September 21, 1972
OWNER: Sa71y Co.
PLUM$ER Thampson Plumbing Co.
NtMBER 1150
Address 3259 Random Road
TYPE QF PSPE Heavy Cast Iron
DESCRxPTION OF BUILDING
Industrial{ Commercial( Residential
xx
Locatian of Connections:
Connection Charge 240.00 pd 10/27/72.
Permit Fee 10.00 d 9421472
.50 pd 9 21/72
SCreet Repairs
Tota l
Iaspected by:
Date
Remarks•
Multiple Dwelling I No. of units
By
Chief Inspector
In consideration of the issue and delivery to me of the above perm3.t, I
hereby agree eo do the proposed work in accordance with the rules and
regulations of Eagan Township, Dakota-County, Minnesota
By
Thompson Plumbing Co.
Please notify when ready for,inspection and cozunection and before any portion
of the work is covered.
/
.
y
EAGAN TOWNSHIP
3795 Pilot Knob Rosd
St. Paul, Minnesota 55111
Te2ephone 454-5242
PERt4IT FOR WATER SERVICE CONNECTION
Date: September 2?1, 1972
Number: .993--????
Billing Name: Sa11y (Co. Site Address: 3259 Random Road
Owner: same
Plumber• Thompson Plumbing Go.
Location of Connection
Billing Address
Meter Size
tioa Chg.220.
0/27/72
Meter Permit Fee 10•00 pd 9/21/72
Meter Reading Meter Dep. •50 pd 9/21/72
Meter Sealed: Yes Add' 1 Chg. ?--
NO Total Chg.
Inspected by
Date
Suilding is a:
Resi.dence xx
Multiple R'o. Units
Commercial
Industrial
Other ?
In consideration of the issue and delivery to me of the above pexmit, I
hereby agree ta do tlm proposed work in accordance with the rules and
regulations of Eagan Township, DakoCa Count , M esoCa.
rThompson Plumbing Co.
Remarks:
?235.0? RLE-IKsPECTIQN FEE FOR
flMPROPERLY iNSi'ALtED METERS.
By:
Chief inspecCor
Plea3e notify the above office when ready for inspection and connection.
L J` BL l CITY OF EAGAN
PLUM33ING PERMIT
711L" (612) 681-4675
ItE8ID8NTIAL
PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS,
WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
WORK DESCRIPTION
N0.
NEW CONST
ADD ON _
REPAIR
-_-
----r _T----
DILLEY
OWNER NAME : _ 3259 PANoc)n RM
EFAM ?1??
SITE ADDRES S:_
H 45?4-?,249 W
?
?--- -- - -- ---.._-?`-
INSTALLER: _
ADDRESS :
. f e,°? i..9 . f IL Vt: Q1t J°-..
clTY: )A1NNEAP0LIS, M{NNffx0TA 5,5?'31
827,4033 • 827-4311 -
PHONE #: _
PERMITTEE
CONTRACT PRICE:
1% OF CONTRACT FEE. .
STATE SURCHARGE _ $.50 FOR
EACH $1,000 OF PERMIT FEE.
COMMERCIAL
PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS. ALSO FOR MULTI-FAMILY
BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT.
WORK DESCRIPTION:
OWNER NAME:
SITE ADDRESS:
TENANT NAME:
SUITE #: _
INSTALLER:
ADARESS:
CITY: ZIP:
PHONE #:
FOR:
CITY OF EAGAN
$25.00 MINIMUM FEE.
CONTRACT PRICE x 1% $
STATE SURCHARGE $
TOTAL:
CITY USE ONLY
RECEIPT
DATE4
ALSO, FOR TOWNHOMES AND CONDOS
--------------------------
COMPLETE THE FOLLOWING:
FIXTURES EA. TOTAL
REPAIR/ADD ON 15.00
SHOWER 3.00
WATER CIASET 3.00
BATH TUB 3,00
IAVATORY 3.00
KITCHEN SINK 3.00 ?
LAUNDRY TRAY 3.00
HOT TUB/SPA 3.00
WATER HEATER 3.00
FIAOR DRAIN 3.00
GAS PIPINV OuT.
(MINIMUM - 1) 3.00
ROUGH OPENINGS 1.50
OTHER
WATER SOFTENER 5.00
PRIVATE DISP. 15.00
U.G. SPRINKLER 3.00
W. TURNAROUND 15.00
STATE SURCHARGE .50
TOTAL: S .
$
(SIGNATURE)
?
2007 RESIDENTIAL BUILDING rExMiT ArrLlcaTioN
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Construction Reauirements
3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and ail roofed areas
(20% maximum lot coverage allowed)
1 Soifs Report if proposed buiiding is to be placed on disturbed soil
2 copies of plan showing beam & window sizes; poured found design, etc.
1 set of Energy Calculations
3 copies of Tree Preservation Plan if lot platted after 7/1193
Rim Joist Detail Options selection sheet (buiidings with 3 or less units)
Minnegasco mechanical ventilation form
RemodellRepair Reauirements
2 copies of plan showing footings, beams, joists
1 set of Energy Calculations for heated additions
1 site survey fot additions & decks
Addition - indicate if on-site septic system
?; q O.C?q,
Office lise Oniv
Ced of SuNey Recd` _ Y _ N
Soils Repod _'Y _ N
Tree PresPlan Recd Y _ N,
Tree Pres;Required _ Y _ N
On-site Septic System _Y _'N
Plans are considered nublic infarmation unless vou state they are firade secret and fihe reason.
Date Construction Cost
Site Address Unit/Ste #
Description of Work
Multi-Family Bldg _ Y ?. N Fireplace(s) 2L 0 _ 1 _ 2
Property Owner / Telephone #(???
Contractor L
Address /? ? l`? City ?j'C</"?'J 5' ll /`11e
State ?/?, Zip ?5`?,3 ? Telephone #
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Category 1 _ Minnesota Rules 7672
Energy Code Category • Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(4 submission type) Submitted Submitted
. Energy Envelope Calculations Submitted
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
Mechanical Contractor
Sewer/Water Contractor
Telephone # (
Telephone # (
Telephone # (
I hereby apply for a Residential Building Permit and acknowledge that the intormation is compiete ana 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
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.
<s
Applicant's Printed Name
r ?
Ap licant's Signature
DO NOT WRITE BELOW THIS LINE
Sub Types
? 01 Foundation
? 02 SF Dwelling
? 03 01 of _ plex
? 04 02-plex
? 05 03-plex
? 06 04-plex
Work Types
? 31 New
? 32 Addition
? 33 Alteration
? 34 Replacement
? 07 05-plex ? 13 16-plex 0 20 Pool ? 30 AccessoryBldg
? 08 06-piex ? 16 Fireplace ? 21 Porch (3-sea.) ? 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 (screen/gazebo/pergola) ? 36 Multi Misc.
? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 12 12-plex ? 25 Miscellaneous _
? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 37 Demolish Building* ? 43 Reroof ? 46 Windows/Doors
*Demolition (Entire Bldg) - G ive PCA handout to applicant
D@SCI'Iptloll: Water Damage Yes
Valuation Occupancy
Plan Review 100% or 25°/a Code Edition
Census Code Zoning
SAC Units Stories
# of Units Sq. Ft
# of Bldgs Length
Type of Const Width
_ Footings (new bldg)
_ Footings (deck)
_ Footings (addition)
Foundarion
Drain Tile
Roof Ice & Water Final
_ Framing
_ Fireplace _ R.I. _ Air Test _ Final
Insulation
MCES System
City Water
Booster Pump
PRV
Fire Sprinklered
REQUIRED INSPECTION5
_ Sheetrock
_ FinaUC.O.
FinaUNo C.O.
HVAC
Other
Pool Ftgs
_ Siding _ Stucco Lath
Windows
_ Retaining Wall
Approved By: , Building Inspector
Base Fee
Surcharge
Pfan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
Air/Gas Tests Final
Stone Lath Brick
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA169942
Date Issued:06/15/2021
Permit Category:ePermit
Site Address: 3259 Random Rd
Lot:5 Block: 1 Addition: Selmark
PID:10-67100-01-050
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace & Air Conditioner
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Pete DeGrood at (507)
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 -
Michael & Tammy Nistler
3259 Random Rd
Saint Paul MN 55121--232
Genz Ryan Plumbing & Heating
2200 West Highway 13
Burnsville MN 55337
(952) 767-1000
Applicant/Permitee: Signature Issued By: Signature