1635 Sherwood WayCity of Eaan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
L
Use BLUE or BLACK Ink
Permit Fee:
Date Received:
Staff:
INFLOW & INFILTRATION PERMIT APPLICATION
Plumbing / Sewer & Water
Date: Site Address:
Tenant: Suite #:
RESIDENT / OWNER
Name: _ SG_ E rE'`-k
Phone: 0.5 vS — 9a
Address / City / Zip: /67 3S sA , (-IA) oo(L &,Ao� �l t /II 5 S /a
U
CONTRACTOR
Name:
License #:
C__/"
Address:
City:
State: Zip:
Phone:
Contact: Email:
TYPE OF WORK
PLUMBING (Within the building
Sump Pump Repair
envelope)
SEWER
Repair
& WATER (Outside the building envelope)
Other:
Other:
DESCRIPTION
Description of work:12r- lqu`
u,� �t�� W 14—
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 Ill repair costs for
reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors
can be found by visiting www.citvofeagan.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.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.
x LISA
>rfipUcant's Printed Name
Applicant's Signature
City of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
Permit #:
Permit Fee:
Date Received:
Staff:
966215
2010 RESIDENTIAL BUILDING / PERMIT APPLICATION
Date: /(,' �` 'S -/ v Site Address: ;(035- 6 I eirt"J °� £)y
1
Tenant: Lia Bra -kc(
Suite #:
RESIDENT / OWNER
Name: � / S� B ra-el Phone: 0 S/ - % U 5- - lIO.S
Address / City / Zip: / 3 5 Ir-tr,,�u� a LO
Applicant is: ✓ Owner Contractor
TYPE OF WORK
Description of work: (1er L) $1 el (4) 011 i 0 Lx -s <_
/
Construction Cost a a 0 U Multi -Family Building: (Yes / No r/ )
CONTRACTOR
Name: 5 e / License #:
Address: City:
State: Zip: Phone:
Contact: Email:
COMPLETE
In the last 12 months, has
If yes,
THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
the City of Eagan issued a permit for a similar plan based on a master plan?
date and address of master plan:
_Yes _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.
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.
L b B c -&I<.,2_!
Applicant's Printed Name
x
Ap i icant's Signature
Page 1 of 3
CITY OF EAGAN
3830 Pilot Knob Road
P. O. Box 21199
Eagan, MN 55121
Zoning: R1
Owner: Toll
Address:
Site Address: . 1635
Plum
I agree to eam* with the City of Eagan
Ordinances.
By
Date of I nsp.:
CITY OF EAGAN
3830 Pilot Knob Road
P. O. Box 21199
Eagan, MN 55121
Zoning: Tollef-on !ldrs
Owner:
Address. 1635 OL1ervroou
Site Address:
Plumber:
Meter No..
Size:
Reader No.: C? of Eagan
1 age to 4000y Wj* the
Ordinances.
By
Date of insp.:
SEWER SERVICE PERMIT
PERMIT NO.:
DATE;
No. of Units:
Connection Charge: 425.00 yd
Account Deposit:
Permit Fee: 10 09 pd
Surcharge: 0
Misc. Charges:
Total:
Date Paid:
Connection Charge:
Account Deposit In , (10 n d
permit Fee: .50 7+r1
Surcharge: me-tkr
Misc. Charges:
Total:
Dote paid-
Insp.:
CITY OF EAGAN Remarks
Addition Brittany 2nd Addition Lot 8 Blk 2
Owner_ 1. / Street 1635 Sherwood Way
22
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. 1982 2013.03 402.61 5 805.23 A013537 2-9-84
STREET RESTOR.
GRADING 1982 596.22 119.24 5 238.50 A013537 2-9-84
SAN SEW TRUNK p 1976 143.11 9.54 15 57.25 A013537 2-9-84
*SEWER LATERAL 1982 '3830.14 66.02 5 1532.04
WATERMAIN
*WATER LATERAL 5
WATER AREA 296.92 59.38 5 118.78 A013537 2-9-84
* Services F 5
STORM SEW TRK 628.22 125.64 5 251.30 A013537 2-9-84
*STORM SEW LAT 1982 5
CURB & GUTTER
SIDEWALK
STREET LIGHT
ROAD IT 250.00 39706 11-383
WATER CONN. 450.00 91
BUILDING PER. 8629
SAC
5-25-00
PARK
CASH RECEIPT
CITY OF EAGAN
3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE
RECEIVED
19
AMOUNT
ac DOLLARS
100
? CASH n CHECK
FOR
?,?? You
TIM
BY
IV/ White-Payers Copy
Yellow-Posting Copy
Pink-File Copy
BUILDING PERMIT
Tw Ir w.A S.. SF DWG/GAR
CITY OF EAGAN
3795 Pilot Knob Road logo", MN 55122
PHONE: 454-8100
Receipt #
Fgt. VaIuC - DdtB ''?
Site Address -- - ----- ' ' '" "'
Lot S Block 2 Sec/Sub. Brittany 2nd
Parcel # 10-15001-080-02
a Name Tollefson Builders, inc.
z Address 1655 Norwood Drive
Eagan 55122 4S4-6973
0' Name
,o
d Addre.
?- ru..
Name _
Address
1 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.
Signature of Permittee Totlefson Builders
A Building Permit Is issued to:
all work shall be done in accordance with all applicable State of Mir
Building Official
0;6919
Erect •Vf Occupancy K-3
Alter O Zoning R-1
Repair ? Fire Zone `
Enlarge ? Type of Cont.
Move ? # Storied
U
Demolish ? Length /
-25-7"
D
Grode ? epth Sq. Ft.
Approvals Fees
Assessment Permit svo.uu
XXM 5.50
Water d Sew. Surcharge X
Police Plan check
S
Fire SAC
Eng. Water Conn. 450 00 60
ju
Planner .
Water Meter
Council Road Unit
Bldg. Off.
APC Total b
on t he express condition thnr
solo Statutes and City of Eagan Ordinances.
Permit No. rmit Holder Misc. Permit No. Holder
Plumbing
T
H.V.A.C.
Well
Water
Disp.
Sewwr
Electric 19A 10910 £ 'Ag 6 `. ELI
L- jQ
Inspection Date Insp. Other
Footings ?. e
Foundation
Framing
Rough Plbg. G . ' ?L!
Rough HVA
Insul
Final WV
HVAC ..N
t 1
Final
e
_
Wat
er
Describe Location
Well
Sewer 1
Pr. DisP.
Receipt PLUMBING PERMIT Permit No.
?; ? CITY OF EAGAN Fee
Fill in numbered spaces S/C
Type or Print legibly Tot
.
1. Date -.47 2. Installation Cost _?; . l? s D G7
3. Job Address ,S 1? 3S Lot _BIk. -2- Tract ?; •
4. Owner / G??fr?? /,,tom S
5. Contractor ?ZPhone
6. Address
0-1
r - _
7. City 0'?C "4 (State 11V Zip
8. Building Type: Residential ommercial ? Institutional ?
9. Work Description: New fd? Add ? Alter ? Repair ?
10. Describe
11.
No. Fixtures
Water Closet No. Fixtures
Cesspool /Drainfield
Bath tubs Septic Tank
_ Lavatory Softner
Shower Well
Kitchen Sink
Urinal/Bidet /
Other
% Laundry Tray
Floor Drains Y
Drinking Ftn.
Slop Sink
Gas Piping Outlets
12. 1 hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed : for
Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
Receipt MECHANICAL PERMIT Permit No.
CITY OF EAGAN
Fee
Fill in humbered spaces S/C
Type or Print legibly Tot.
1. Date 2. Installation Cost
3. Job Address Lot Blk. Tract
4. Owner
5. Contractor Phone
6. Address
7. City _ - l State Zip
8. Building Type. Residential ? Commercial ? Institutional ?
9. Work Description: New ? Add ? Alter ? Repair ?
10. Describe
I 11.
Fuel Type
No. Eauioment BTU - M. Ea.
Forced Air No. Equipment CFM
Air Handlin
:
Mfg. g
Boilers
Mfg. Mech. Exhaust
Unit Heater
Mfg. Other
Air Cond.
Mfg.
Gas, Piping Outlets
-
F_ I
12. 1 hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed : for
Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
BUILDING PERMIT
To be used for SF D
CITY OF EAGAN
3795 Pilaf Knob Rood Eagan, MN 55111
PHONE: 454-8100
71.000
Site Address ar
Lot 8 Block 2 Sec/Sub. Brittany 2nd
Parcel # 10-15001-080-02
a Name Tollefson Builders, Inc.
1655 Norwood Drive
Address
Eaean 55122 454-6873
o Name Owner
uu Address
FS r:.,,
Name _
Address
I hereby acknowledge that 1 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.
Signature of Permittee
To le son Builder
A Building Permit Is issued to: i
all work shall be done in accordance with all applicable S11I1 of
Building Official l/A
N° 8629
Receipt # J -2
Erect $$ Occupancy n-3
Alter ? Zoning R-1
Repair ? Fire Zone NA
Enlarge ? Type of Const. V
Move ? # Stories
Demolish ? Length 70
Grade ? Depth -L K-4" 4" Sq. Ft.-
Approvals Foal
Assessment Permit '' W f .w
Water 8 Sew. Surcharge XY" 35.5C
Police Plan check 173.00
Fire SAC 525.00
Eng. Water Conn.
Planner Water Meter 0.00
Council Road Unit 250.00
Bldg. Off.
APC Total 1839.50
on t he express condition thm
atutes miry of Eagan Ordinances.
This request void Z + 3 l?4
18 months from r I 8 Z Sjel / / 6N u 7 o ?r
Request pale .,?
?
` Fire No. Rough- in Insoection
Rough- ?
Ready Now(Will Insper,-
/
'? ! ?? ?`?
.,? yes ?NO / for When n Ready
?(J Licensed Electrical Contractor 1 hereby request inspection of above
Owner electrical work installed at:
Street Address, Be.
or Route No. City
I
ecU On o. Township Name or No. Range No. County
..O-/c--cup//an//t ``IPRINT) /
lj
sr Phone No.
- 1
I
) I
Power Sup
li
e Address
y
{
Etc r cal Contractor (Company Name) Contractor's License No.
06
Mailing..Address (Contractor or Owner Making Instailation)
?A /J
Authorized Signature (7ntractor/Owner Making Ipstallati9yl Phone jNumberr"`?
MINNESOTA STATE BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT
Griggs-Midway Bldg. - Room N-191 BE ACCEPTED BY THE STATE BOARD
1821 University Ave., St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS
Ph... 16121297-2111 ENCLOSED.
rUR ELECTRICAL INSPECTION ES-00001-04
' See instructions for completing this form on back of yellow copy. 10
• /
3-X' Below Work Covered by This Request b `
Nev4 Addj Rep., . Type of Building Appliances Wired Equipment Wired
Home Range Temporary Service
Duplex Water Heater Lighting Fixtures
Apt. Building Dryer Electric Heating
Commercial Bldg. Furnace Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tank
Farm Other Pecs y Other lSper,ifyl
t er $pnClry Ot her
Compute Inspection Fee Below '
fl Fee Service Entrance Size Subteeders k Fee Cucuits
0 to 200 Amps Amps 10 to 30 An,
s
Above 200 Amps Amps f S?. r)0 31 to 100 A s
Swimmin Pool [ _Amps
MO Above 100_Amps
Transrormers Booms SC) Partial.'Othei Fee
Signs nspection 9
7? TOT
Remarks ??r U
U
L V
Rough-in Oate th e ncal
speetor. hereby
certify that the above
final y ,p
d d inspection has been
made.
This request Vold 1B months from
CITY OF CAGAN Include 2 sets of plans.
1 site plan w/elevatiana i
BUILDING PERMIT APPLICATION 1 set of energy calculations.
to be Used For G ?GUVI f1 ?" valuatiou 71f n n Date l xAbte 72, IW23
"to Address
OFFICE USE ONLY
I" Z. Slack Sec./Sub. -7 PId
X- Oom*ancy
??-
parcol 1: l0 l Sr?c?1 - pgd 0 Alter Zoning
I
mepaix Fire Zone
QR1Br: max'' nraarge _ Rype of Cbnst. _
Addeo": Mare _ N Stories
Demnlllsh Front O ft.
City/Up code: Grade - Depth mss- ft.
Phase M:
Oontracto
Addeo"g
city/Zip
Phone 4:
Addnass: _ +
CitY/ZiP Code:
Pharra {:
Water/Sawar surcharge
police Plan Lick /?
Fire SAC a _
3 • Water Corn.
N5
Planner dc%l
Water Meter
CoLincil
'i
- 11oad Unit V$ ?s-
Blr1g. Off.
? aTj
AIaC
TOTAL t ? T a9 &70
Toliefson Builders loc.
N
JACKSON - BURVEYORB
09aIATERED UNMM LAWS OF STATE OF MIMM ADTA
9816 EAST 55th STREET, MINNEAPOLIS, MN 55477 7773491
„mac $yarhrw*% 6trfi talt
- B
der i
i J
Scale: V 30'
a Denotes Iron (J . I 1b 1
? + Drainage
- --Drainage 6 Utility E t. a: = - -
000.0=Existing Elev. \a' ?I
' ?',?cw,Elcr h? Gd? ?N ?i?, ? ? I N / ? 1 D
9C --
__ --
Q
I
Or. 11478
183-78
??NG ? I
J l?
rl?
r
i
I HERBY CEIITIFY THAT THE ASOVE IS A TRUE AND CORRECT PLAT OF A SURVEY OF .. - O -
-------------
Proposed Garage Floor Elev. 102.5
Proposed First Floor Elev. 103.2
Proposed Basement Floor Elev,95.0
Lot S,Block 2,Brittany 2nd,. Addition,
Dakota County,Minnesota.
As 8uev8YED By ME THIs?Ith_DAY orOtt. A.D. 1983
F. C. JACKSON. MINN1116A baNT1MTION. NO. SOON
Cities Digi
ity Contro
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RESIDENTIAL
Permit pli cation ING LA >,/
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Construction Reauiremenis RemodellReoair Reauirements Office Use Only
3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and all roofed areas 2 copies of plan Ced of Survey Recd _Y _N
(20% maximum lot coverage allowed) 1 set of Energy Calculations for heated additions Tree Pres Plan Recd _Y _N
2 copies of plan showing beam & window sizes; poured found design, etc. 1 she survey for additions & decks Trae Pres Reqd _Y _N
1 set of Energy Calculations Addition - indicate if onsife septic system On-site Septic System _Y _N
3 copies of Tree Preservation Plan A lot platted after 7/1193
Rim Joist Delail Options selection sheet (bldgs with 3 or less units
Date
_L0l2?
/ p7 Construction Cost
mm'
Site Address ! 0 3 5 , `ho1c wo o d WG t Unit/Ste #
Description of Work r/ V r (I? (N1 VV ( D Gd?tJ V
Multi-Family Bldg _ Y _ N Fireplace(s) _ 0 _ 1 - 2
Property Owner Li-r
q 8gciA-c,1 ffarnda / /\/e/, r,-7 cy
Telephone #(1051) 9O5 - / I0-5
Contractor 0(ceg-f L a l(e h
Address If q (c,, 5 U e n& q be, City IC Q
State 14IN Zip rJ- JI j_I Telephone # (615 2)
COMPLETE THIS AREA ONLY IF
Energy Code Category - Minnesota Rules 7670 Cateaorv 1
• Residential ventilation Category 1 Worksheet
(J submission type) Submitted
• Energy Envelope Calculations Submitted
Have you previously constructed a building in Eagan w#b-c
tee applies.
Fn R9 ToT
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
A NEW BUILDING
Minnesota Rules 7672
• New Energy Code Worksheet
Submitted
plan? _ Y
N If so, 25% plan review
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 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.
E 1?y?ON5 C,\-
Applicant's Printed Name Applicant's S ature
OFFICE USE ONLY
Sub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 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 Parch/Addn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc.
? 05 03-plex ? 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 ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)' ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement "Demolition (Entire Bldg) - 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
REQUIRED INSPECTIONS
Footings (new bldg) _ Final/C.O.
_ Footings (deck) _ Final/No C.O.
Footings (addition) _ Plumbing
_ Foundation _ HVAC
_ Drain Tile Other
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests -Final
- Framing _ Siding _ Stucco _ Stone
- Fireplace - R.I. _ Air Test -Final _ Windows (new/replacement)
- Insulation _ Retaining Wall
Approved By
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
Building Inspector
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA119933
Date Issued:01/03/2014
Permit Category:ePermit
Site Address: 1635 Sherwood Way
Lot:8 Block: 2 Addition: Brittany 2nd
PID:10-15001-02-080
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.
Craig Angell
12253 Nicollet Ave. S.
Fee Summary:ME - Permit Fee (Replacements)$55.00 0801.4088
Surcharge-Fixed $5.00 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 -
Lisa D Nelsen
1635 Sherwood Way
Eagan MN 55122
Angell Aire
12253 Nicollet Ave S
Burnsville MN 55337
(952) 746-5200
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA164218
Date Issued:09/22/2020
Permit Category:ePermit
Site Address: 1635 Sherwood Way
Lot:8 Block: 2 Addition: Brittany 2nd
PID:10-15001-02-080
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:Does not include skylight(s)
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and leave on site.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Valuation: 5,000.00
Fee Summary:BL - Base Fee $5K $118.00 0801.4085
Surcharge - Based on Valuation $5K $2.50 9001.2195
$120.50 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 -
Lisa D Nelsen
1635 Sherwood Way
Eagan MN 55122
(952) 210-4988
Ralow's Roofing & Remodeling Inc
8609 Lyndale Ave S
Bloomington MN 55420
(952) 210-4988
Applicant/Permitee: Signature Issued By: Signature