3861 Dolomite DrCity of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
'
noir rk.,
Permit #: l.O
Permit Fee: 13c.°.°
Date Received:AUG 2 4 2009
Staff:
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Auto 10 0f Site Address: 4a, •1 A. `IirLi c% ..3 Nosh e S
Tenant:
3 t f boL b ,i1)
Suite #:
RESIDENT/OWNER
Name: t/e f1ssoe,47-,..1 F,.,,,,�e,.gL /44.os4£3,4,4..o7- Phone: -7c,1-959- 37 9-7
Address / City / Zip: p. 0 , (k). g /s- & P2 Pi- S, 5 -.5 -LTA e
Applicant is: Owner i< Contractor
TYPE OF WORK
Description of work: k e- A v i L. iS b £ 4./.
Construction Cost: g. boe, Multi -Family Building: (Yes X. / No )
CONTRACTOR
Name: CI g / ex ,- zia, 0,2 )7219 i..t :. Z.4, Q License #: 2-C1 I1 // 3 1
Address: 1/6 s' 1, m 6 o Fc 57—:
City: /71 Pi_ S , State: MAI Zip: -S15-1-//
Phone: 6,Z- $/- Ls Z V3 Contact Person: b :9 v L 4 u ie n i S
COMPLETE
Energy Code
Category
('1 submission type)
In the last 12 months, has
Yes _No If yes,
THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Category 1 Minnesota Rules 7672
_
• Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
Submitted Submitted
• Energy Envelope Calculations Submitted
the City of Eagan issued a permit for a similar plan based on a master plan?
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
conclude that they are trade secrets
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 wor is not to sta ^'" lout a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approvof ans.
x I D w✓Z.u2/g
Applicant's Printed Name
-
Applicant's Signature
Page 1 of 3
DO NOT WRITE BELOW THIS LINE
90qiD4
SUB TYPES
❑ Foundation
❑ Single Family
❑ 01 of _ Plex
❑ 02-Plex
❑ 03-Plex
❑ 04-Plex
WORK TYPES
❑ New
❑ Addition
❑ Alteration
Replacement
DESCRIPTION:
Valuation
05-plex
06-plex
07-plex
08-plex
10-plex
12-plex
❑ 16-plex
❑ Fireplace
O Garage
1+` Deck
O Lower Level
❑ Interior Improvement
❑ Move Building
O Fire Repair
Plan Review
(25% 100%
Census Code
# of Units
# of Buildings
Type of Const.
Occupancy
Code Edition
Zoning
Stories
Square Feet
Length
Width
REQUIRED INSPECTIONS
Footings (new bldg)
Footings (deck)
Footings (addition)
Foundation
Drain Tile
Roof: _Ice & Water _Final
Framing
Fireplace: R.I. Air Test _Final
Insulation
Reviewed By:
O Accessory Building
O Porch (3 -season)
O Porch (4 -season)
❑ Porch (screen/gazebo/pergola)
O Storm Damage
❑ Miscellaneous
O Siding
O Reroof
O Windows
O Egress Window
❑ Pool
O Ext. Alt. - Multi
O Ext. Alt. - SF
❑ Multi Misc.
O Demolish Building*
O Demolish Interior
❑ Demolish Foundation
❑ Water Damage
"Demolition (entire building) - give PCA handout to applicant
Sheetrock
Final/C.O.
• Final/No C.O.
• HVAC
MCES System
SAC Units
City Water
Booster Pump
PRV
Fire Sprinklers
Other:
Pool: _Footings Air/Gas Tests Final
Siding: _Stucco Lath _Stone Lath _Brick
Windows
Retaining Wall
, Building Inspector
RESIDENTIAL FEES:
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
Total
Page 2 of 3
T,ic fs,n Builders Inc.
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F. C. JACKSON
•((// LAND ``((SSURjV�EYYO jR/ �//7
REGIB�RE ��
NDER WGB O1 iT[ OF MINNESOTA
Or.11270
183-71
LICENSED BY ORDINANCE OF CITY OF MINNEAFOLIS\
721-3434 ,\„„
3616 EAST 55TH STREET55417
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P.i�r�fy
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iiurbepor'g Certificate
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I HEREBY CERTIFY THAT THE ABOVE 18 A TRUE AND CORRECT PLAT OFA SURVEY
Lots 19,20,21 and 22,Block 1,
Briar Hill 3rd. Addition,
Dakota County,Minnesota.
Proposed Garage. Floor Elev. 103.0,'
Proposed Basement Floor, E1ev.103.37..`;:`
Proposed first Floor Elev. 110.37`
AS SURVEYED BY ME THIS 17th'
DAY OF August A D 1981
SIGNED
F. C. JACKSON. MINNES9II ' EGISTRATION. No. 3600
City of Eagan
Eagan,
PERMIT
City of Eaan
Permit Type: Mechanical
Permit Number: EA100638
Date Issued: 08/18/2011
Permit Category: ePermit
Site Address: 3861 Dolomite Dr
Lot: 22 Block: 01 Addition: Briar Hill 3rd
PID: 10-14992-01-220
Use:
Description:
Sub Type: e - Furnace
Work Type: New
Description: Furnace
Comments:
Questions regarding electrical permit requirements should be directed to Mark Anderson, State Electrical Inspector,
952-445-2840
Diane Trinka
1770 Gervais Ave.
Fee Summary:
Valuation: 1,900.00
ME - Permit Fee (Replacements) $50.00
Surcharge -Fixed $5.00
0801.4088
9001.2195
Total: $55.00
Contractor:
Perfection Heating & A/C
1770 Gervais Ave
Maplewood MN 55109
(651) 777-7620
- Applicant -
Owner:
Theo D Dupree
3861 Dolomite Dr
Eagan MN 55122
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Applicant/Permitee: Signature
Issued By: Signature
CITY O' EAGAN
3795 Pilot Knob Road PERMIT NO •
Eagan, MN 55122 DATE.
Zoning: No. of Units:
Owner:
Address:
WATER SERVICE PERMIT
Site Address.
Plumber:
Meter No.: Connection Charge -
Size: Account Deposit.
Reader No.: Permit Fee.
1 agree to comply with the City of Eagan Surcharge•
Ordinances. Misc. Charges.
L� J Totals i e
By
•" Date Paid.
Insp • e)r
Date of Insp.: `�� j
CITY OF EAGAN
5795 Pilot Knob Road
Eagan, MN 55122
Zoning:
Owner:
Address:
Site Address:
Plumber:
SEWER SERVICE PERMIT
PERMIT NO.:
DATE:
No. of Units:
1 agree to comply with the City of Eagan
Ordinances.
By ---_
Dote of Insp.:
Insp.:
Connection Charge;
Account Deposit: _
Permit Fee:
Surcharge:
Misc. Charges:
Total:
Date Paid:
411/' City of Etat
3830 Pilot Knob Road
Eagan MN 86122
Phone: (651) 675-5676
Fax: (651) 676.5694
• /i-•2- /
Use BLUE or BLACK Ink
1
For °Moe Uae
Permit*: I
Permit Fee: (Q 00
Date Received: I a-1 a 113
Staff: Lie
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
• 3859, 3Sl(at1 ,3$G3, 1 Lr.,mrrL 62- Unita:
a
Residenti
Dimer
Name: c/o 4e i "1%44 6Z rt Z 47" ,.7.7a c_. Phone: 76 3 - S -I3 — 97 7
0
Address City / Zp: $So 6r corn) n) 2 4v, R) , 1 A Got. D E:1 1414.1 Y JFI
SS' 4/.t7
Applicant is: Owner 2fContraCtor
Typle.orvi rk
'
Descrlpibn of work: Rs, -.-d 0 E. a. RE Pt. ott-f ' J• d / .•) b a F -ase..! 4 /h 8 rid L•
Construction Cost: / y Y da • CIO Multi -Family Building: (Yes / No ___.)
ConiratitorState:
Company: 0 £) E,c r Cie, 02 19141 )'T - ev AA Contact b,4411 0 av/2-2L S
Address: tip -r I•43 (ooh -!"- City: /21 PL 5
/490 Zip: 5"S'4// 9 Phone. (r,/ A- "0/-&21/3
Licensee: (- 2 Y/ / T / Lead Certlflcate #:
If the project is exempt
i)L4/0S.
from Lead certification, please explain why: (see Page 3 for additional information)
Q,,re.,.- Poe:' / S? r
In the last 12 months,
Yes _No If
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW VUILDING
has the City of Eagan leeward a permit for a similar plan based on a master plan?
yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
-
Phone:
Phone:
NOTE: Tir
�(
�•
CALL BEFORE YQU DIG, can Gopher state One Call at (651) 464.0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive Locates of underground utilities. ww•mroherstateonecadorn
1 hereby edmowledge that alis information is complete and accurate; that the work will be in conformance with the ordinances and codas of the Cir of
Eagan:
t t I u the 8ppdp Ws
Is p t anpermit, but e case twit wan pp1Lon far a permit, and work is not to start without a with: that the work wilt be in
requires a review and approval of piens.
Extortor work authorized by a building permit Issued in aocadsnee with the Minnesota State Sultding Code must be completed within 190
days of permit iesuence.
x_§4.4 av,Q.,$
Applicant's Printed Name
ZO/Z0 39tid INIvW 1X3 Iia
Applicants Signature
-779 Page 1d3
L9Z9I98ZI9 £6 :OT ETOZ/ZO/ZT
4111°
C!tyofEaQaa
3830 Pilot Knob Road
Eagan MN 56122
Phone: (661) 875-5875
Fax: (661) 675-5694
Use BLUE or BLACK Ink
I. For Office Use
Permit*: 16)(1 g5
asoma res: a� 7.
Dale Res,eived: �7s l i c
StafF
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: • F- c` site Address: 3VSq, 3g.J, 3 S1,3,3t6S IZSooLOo'TF 13IL. Unit 0:
Name: d o ACT /4 i4. ) 4 6 L r►1 E N; �'a C Phone: 743 --s-f 3- 7 a
Address / City / Zip: 'Sb 6 E G i4 r I i Q Av N / (.' KLF'
Applicant is: Owner 2C, Contractor
Description of woilc ..."7-£.14,2 OI a- a E -
Construction Cost / / 9 CO 0!) Multi -Family Building: (Yes. / No _)
Company: (iE 1 4. rc2ioR A'%iN • 6+214 Contact •knett,r d yv ft - r $
Ars SSYt 7
Address: 90 S cJ 6
City PL?
state: ANZip: 3 9/ 9 phone: 'z - '6 J- G z ¥3
License #: Q C Pi)/ 3 / Laud Certificate #:
lithe project is exempt from lead certification, please explain why: (see Page 3 for additional information)
VS4 eaS 1.3 LI t.. RuIL: Posr J97 S'
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit fora similar plan based on a master plan?
Yes _No If yes, date and address of master plan:
Licensed Plumber Phone:
Mllechanical Contractor. Phone:
•
Sewer & Water Contractor:
Phone;
"`1W it• .ty jk -:�1^Sf
•Yµ.F.,�, 'ri ,�• t.. _ y, �C
ALL
Was you Intend to digto • Call Gopher State One Call at (651) 456.0002 for protection against utility dam
receive locates of underground utilidea. ,www ooeheratateenepaa.orq 9 ui rtlaBround ub age. cat 48 taus
I hereby admowledge mat this Information is complete and accurate; that the wed will be In conformance with the ordinances and codes of the City of
Eagan: that I understand this is not 0 tarter, but only an application for a permit. and work is not to start without a permit: that the wait will be in
accordance with the approved Wan In the ogee of wort welch requires a meow and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minneaota State Whin Code mget be completed within 180
daysofpermit immurca
gQRR'$
Applicant's Printed Name
D3 /-60 39tid
1NIVW 1X3 I38
x
Applicant's Signature
Pagel of s
L9Z9T98ZT9 LO:t bTOZ/80/TO
Date:
City of Eaau
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
r
Use BLUE or BLACK Ink
For Office Us Use
Permit #:
Permit Fee:
Date Received:
Staff:
2014 RESIDENTIAL PLUMBING PERMIT APPLICATION
n. i q Site Address: 3Z 1 Toni4rbr.
Tenant: b \)J Suite #:
Name: UV iijVtPhone: 1-"q03-10(4 95
Address / City / Zip:1 �bC`tll . D
Name: r
C.���c :C... .. _._........ P .._ ,,...._ _
IS License #: '/qq 7 WC
br > City: HUASOn
Phone: t- v L/1/9
g
Contact: fro { )
1 na-
Address: 3 I L'16
State: LO 1 Zip: 5140
New ' \ Replacement _ Repair _ Rebuild _ Modify Space _ Work in R.O.W.
Description of work:
RESIDENTIAL
Water Heater
Lawn Irrigation (_ RPZ / PVB)
Septic System
New
Abandonment
Water Softener
Add Plumbing Fixtures ( Main / _ Lower Level)
Water Turnaround
RESIDENTIAL FEES:
$60.00 Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge)
1 $60.00 Lawn Irrigation (includes $5.00 minimum State Surcharge)
$60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge)
*Water Turnaround (add $200.00 if a 5/8" meter is required)
$115.00 Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge)
TOTAL FEES $ O .
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.gooherstateonecall.ora
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
actor nce with the approved plan in the case of work which requires a review and apprplans.
irnS o b
Applicant's Printed Name Applican s Signature
Gity of hp
Use BLUE or BLACK Ink
For Office Use
Permit #:
V64//.2-
Permit Fee:Ct-S. CO
3830 Pilot Knob Road
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 mus
Fax: (651) 675-5694 Staff:
`
2014 SEWER AND WATER REPAIR / DISCONNECT PERMIT
Date: i ' ) / j q Fee: $65.00
City Sewer City
Iiile_
City Water X Repair Disconnect
Description Of Work: lt)Gl^ re i..r
Street Address for Proposed Work ) k7�
Name t r khLI I 6eE%"V Phone: 7i3 W3) 7
Address / City / Zip: .7o -da.. r 51 �c� "/ - Ul / ec
Applicant is: Owner
Contractor
Licensed Pipelayer
Master Plumber (�
Property Owner
Name: '6)atkCi, Phone:
Address/City/Zip: 773) (16e)�
Pipelayer Training Certification Card #: or Master Plumber License #: C '3::?Co TN)
I acknowledge that the information is complete and accurate and 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 nota permit, but only an application for a permit, and work is
not to art without permit.
1,1
Applicant (Print Name) ( Applicant's Signature
CALL BEFORE YOU DIG. Call Gopher State One CaII 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