3865 Dolomite DrCity of Eaaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
fririgE
Permit #: L� C
Permit Fee:
Date ReceivtiG 24 2n09
Staff:
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: A ). 0 ° 9 Site Address: 4121 q /2 /I/ r L 'c. „s /,10 L S
Tenant: c L' Sr NoL, Al Suite #:
RESIDENT/OWNER
Name: tie As See„}r.d../ Fi..)wa3C.4L "9 A.),t a Lps e-' Phone: 74, -Y9 /- 37x'2
Address / City / Zip: O. 0 ='K A S' S S /Z PIS 5 Y 1/ e
Applicant is: Owner i< Contractor
TYPE OF WORK
Description of work: R e - (o , L d t L G
Construction Cost: gi C'Gc- Multi -Family Building: (Yes X / No )
CONTRACTOR
Name: q £ E x ,- LrZ,0 i2 /1l.•4 /”) 77". L'02 P. License #: XO 2 4'), 3 1
Address: `/L s'" (,. m 6c,' --c 57;
City: /yl PLS , State: MAI Zip: 5S L// `%
Phone: (>R- 8.6/- 6 217/ 3 Contact Person: b 44 N L 4 u Q 2,.3
COMPLETE
Energy Code
Category
(4 submission type)
In the last 12 months, has
Yes 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:
_No
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 out a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approv. of ans.
x 1egc.'j b Y3iizai1 .
Applicant's Printed Name
x
Applicant's Signature
Page 1 of 3
r:
SUB TYPES
❑ Foundation ❑ 05-piex
❑ Single Family ❑ 06-plex
❑ 01 of _ Plex ❑ 07-piex
❑ 02-Plex ❑ 08-piex
O 03-Plex 0 10-piex
❑ 04-Plex 0 12-plex
WORK TYPES
❑ New
O Addition
❑ Alteration
1Q... Replacement
DESCRIPTION: '/
Valuation 17( 0 0
Plan Review
(25% 100%
Census Code
# of Units
# of Buildings
Type of Const.
DO NOT WRITE BELOW THIS LINE
❑ 16-plex
O Fireplace
O Garage
i* Deck
O Lower Level
❑ Interior Improvement
❑ Move Building
O Fire Repair
)
Occupancy
Code Edition
Zoning
Stories
Square Feet
Length
Width
O Accessory Building
O Porch (3 -season)
O Porch (4 -season)
O Porch (screen/gazebo/pergola)
O Storm Damage
❑ Miscellaneous
❑ Pool
O Ext. Alt. — Multi
❑ Ext. Alt. — SF
❑ Multi Misc.
O Siding ❑ Demolish Building*
O Reroof 0 Demolish Interior
❑ Windows 0 Demolish Foundation
❑ Egress Window 0 Water Damage
* Demolition (entire building) — give PCA handout to applicant
Olio 200 7
REQUIRED INSPECTIONS
Footings (new bldg) Sheetrock
.7( Footings (deck) Final/C.O.
Footings (addition) _ Final/No C.O.
Foundation HVAC
Drain Tile Other:
MCES System
SAC Units
City Water
Booster Pump
PRV
Fire Sprinklers
Roof: _Ice & Water Final Pool: _Footings Air/Gas Tests _Final
Framing Siding: _Stucco Lath _Stone Lath _Brick
Fireplace:_ R.I. _Air Test _Final Windows
Insulation Retaining Wall
Reviewed By: , 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
30
(
Page 2 of 3
.T lo.-dson Buiidera Inc.
♦= I. r- r1
5 /1 31K6 3e6ot
�oloni i i --i
F. C. 'JACKSON
LAND SURVEYOR
l%
REGISTERED UNDER LAWS OF STATE OF MINNESOTA
LICENSED IVY ORDINANCE OF CITY OF MINNEAPOLIS \`
721-3434
L�
3616 EAST 55TH STREET55417
c. .�:. /..c'T r ki y /e Y.
(:).14-q. F-, r �t
itiurbepor'g Certificate
1,(
1-1
Or.11270
183-71
/0
(D /
1 HEREBY CERTIFY THAT THE ABOVE IB A TRUE AND CORRECT' PLAT OF A SURVEY QF
Lots 19,20,21 and 22,Block 1,
Briar Hill 3rd. Addition,
Dakota County,Minnesota.
AS SURVEYED HY ME THIS 17th.
Proposed Garage Floor Elev. 103.0
Proposed Basement Floor, Elev.103.37
Proposed First Floor Elev. 110.37'
DAY OF August A D. 1981
SIGNED
CITY Or EAGAN
3795 Pilot Knob Road PERMIT NO •
Eagan, MN 55122 DATE.
Zoning: No. of Units:
Owner:
Address.
Site Address.
Plumber.
Meter No • Connection Charge•
Size: Account Deposit•
Reader No.: Permit Fee:
I agree to comply with the City of Eagan Surcharge•
Ordinances. Misc. Charges.
Total
By � �/< Date Paid•
Date of Insp.: 3 " Q 5 - r - Insp •
WATER SERVICE PERMIT
SEWER SERVICE PERMIT
CITY OF EAGAN
1795 Pilot Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning: No. of Units:
Owner:
Address:
Site Address:
Plumber:
1
1 agree to comply with the City of Eagan Connection Charge:
Ordinances. Account Deposit:
Permit Fee:
Surcharge:
By
Misc. Charges:
Date of Insp.: Total:
I nsp.: 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
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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