3034 Sibley Memorial Hwy421 111-1 "1 E6.00001-0e
f REQUEST FOR ELECTRICAL INSPECTION
/ Poo See inshmolons for complebng this form on back of yellow copy.
/4/aglis rx' Below Work Covered by This Request er
Ne Add Rep. Type of Building Appliances Wired Equipment Wired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Load Management
Comm./Industrial Furnace Other (Specify)
Farm Air Conditioner
Other (specify) Cont??GtjGJfs Ramer
Compute Inspection Fee Below:
# Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Swimming Pool 0 to 200 Amps 0 to 100 Amps OD
Transformers Above 200-Amps Above 100-Amps
Signs Inspector's Use Only: TOTAL
Irrigation Booms
.D
Special Inspection
Alarm/Communication THIS INSTALLATION MAY BE CONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONTHS.
I, the Electrical Inspector, hereby
if
h Rough-In Data
cert
y t
at the above inspection has
been made.
Final Dat 1
OFFICE USE ONLY
This request vold 18 months from
0 -
o z5
4 9 1- . ?i aU
5 2 0
Reqate
7d
?? Fire No. Rouge-m yECtion Re 0
(You must call inspect. featly) tspeclion Other Than Rough-In
Ready Now ?tiVill Notify Inspector
El Yes No Date Reatl
I licensed contractor ?owner hereby request inspection of above electrical work at:
Job Atltlress (Street. Box or Route No.) ry?
I City
30 /e mwue?
Section No. Township Name or o. Range No. Coumy
Occu ant (PRINT) Phone No.
Gtr?u me_ 2f5 0S
Power S ier Address
Electrical Contractor (Company Name) Contractors License No.
?c G 60G-7a
Mag Address Contractor or Owner Makin stall
l rich)^(? - ?y A.`?JV?},
o
?.?5.
I i n
t, Y i -S
Auncul3etl Sig ure ontra r her Ma ng Inm a0on) Phone Number
!``!
STATE
BOARD
OF ELECTFI
1CRY
THIS INSPECTION REQUEST WILL N
OT
Griggs
S oP
SMN8
ni
v II I II I I II I I I I I I I I I I BE ACCEPTED BY THE
T
F
6
u
e ,
ersity A
55106
1821 U U
ION
EE
N LESS PROPER NSPEC
Phone (612) 642-0800 ENCLOSED.
CITY OF EAGAN
Addition MCCar
Lot 2 Blk 1 Parcel 10 47700 020 00
iibley Hwy. State Eagan,MN 55121
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK 1968 100.00 0 Paid
* SEWER LATERAL 1972 351414 2 Paid
-
WATERMAIN
* WATER LATERAL 1 2 20
WATER AREA
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. 2 9-1-71
BUILDING PER.
SAC 240.00 020 9-1-71
PARK
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued:
(612) 681-4675
SITE ADDRESS: + 1(11. H i LOCI i APPLICANT:
Mt.t A14I14Y kIWill(b4?'? '.H?• >st..'tr
floill
lilt 1 Ili I N$
1 1 fpf 1 !<)F
PERMIT SUBTYPE: TYPE OF WORK:
11 RAI IIIN
+I + I• I + i I ++ii 11111 ti'. W I NUl)415 )
Permit No. Permit Holder Date Telephone s
ELECTRIC
PLUMBING
HVAC
Inspection Date Insp. Comments
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLSG
FINAL HTG
ORSAT
TEST
BLDG FINAL
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
EAGAN TOWNSHIP
BUILDING PERMIT
Owner /.?[.... 1/... ---J---°°?----------------- *--------- -
Address (present) v .........
.... --`- --..-?"?,"_..........---®®®-
Address .ba.7..,/....... 3:?--"c!'.`.. ........ ? Y/ .. -
DESCRIPTION
N° 1370
Eagan Township
Town Hall
Date .."/lB_?:SS.- ..............
Stories
Used For
To
Be
Front
Depth
Height
E
Cos!
st..
Per
m
il Fee
Remarks
p
? ? _
7
/ l
?
/
Street, Road or other Description of Location I L02 I J310Clr I Addition or Tract
Q
This permit does not authorise the use of streets, roads, alleys or sidewalks nor does it give the owner or his agent
the right to create any situation which is a nuisance or which presents a hazard to the health, safety, convenience and
general welfare to anyone in the community.
THIS PERMIT MUST BE_XEPT ON THE PREMI{gE WHILE THE WORK IS IN PROGRESS.p
... ..? ...............has permission to areal-a..s .I.-... ..--upon
This is to certify, that.-A,
the above described premise subjec fY o the x provisions of the Building Ordinance for Eagan Township adopted April 11,
1955. /? ,rrp
..... .................. ....._...... ... ...............
Chairman of Tnwn Board Suildin9 Impactor
4 6
o l gq
2005 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
0-0
o.
C?? s/z?jos -atJ
New Construction Requirements RemodeVReoaif Requirements office Use Only
3 registered site surveys showing sq. ft. of lot. sq. ft. of house; and L roofed areas 2 copies of plan Cad of survey Reod -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 saes; poured found design, etc. 1 she survey for additions & decks Tree Pres Required
- _Y _ N
1 set of Energy Calculations Addition - indicate ff onske septic system On-site Septic System _ Y -N
3 copies of Tree Preservation Plan ff lot platted after 711193
Rim Joist Detail options selection sheet (buildings with 3 or less units)
Date
4 Constru tion Cost 6 Oo f oo
Site Address L
4?, Unit/Ste Of
Description of Work VYL ll
Multi-Family Bldg _ Y 4 N Fireplace(s) _ 0 _ 1/'? 2
Property Owner Telephone # ( ?) 8-L? 6> Z
S OC
Contractor N - Ktl?
Address VI/ City
State Zip Telephone # ( )
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Category 1 _ Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category i Worksheet • New Energy Code Worksheet
(J submission type) Submitted Submitted
. Energy Envelope Calculations Submitted
Have you previously constructed a building in Eagan with a similar plan? -Y _N If so, 25% plan review
fee applies.
Licensed Plumber
Mechanical Contractor
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 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.
(? Dn
Alle
Applicant's Printed Name Applicant's Sig ature
OFFICE USE ONLY
Sub Types
? 01 Foundation 13 07 05-plex ? 13 16-plex 13 20 Pool
?
/
` 02 SF Dwelling
?
08
06-plex
? 16 Fireplace
? 21 Porch (3-sea.)
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.)
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo)
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Yor_N ? 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement ? 3B Demolish Interior ? 44
? Addition ? 36 Move Building ? 42 Demolish Foundation ? 45
33 Alteration ? 37 Demolish Building" ? 43 Reroof 46
34 Replacement *Demolition (Entire Bldg) -Give PCA handout to applicant
Valuation Occupancy X -j MCES System
Census Code 1 131Y - Zoning R -/ City Water _
SAC Units - Stories Booster Pump _
# of Units Sq. Ft. PRV _
# 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 -Final
Insulation
Approved By: _
Base Fee v r
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
? 30 Accessory Bldg
? 31 Ext. Alt - Multi
? 33 Ext. Alt - SF
? 36 Multi Misc.
Siding
Fire Repair
Windows/Doors
REQUIRED INSPECTIONS
Final/C.O.
_ Final/No C.O.
Plumbing
_ HVAC
Other
Pool _ Ftgs _ Air/Gas Tests _ Final
Siding _ Stucco _ Stone _ Brick
Windows
Retaining Wall
Building Inspector
2004 RESIDENTIAL BUILDING PERMIT APPLICATION \
City Of Eagan % c? U
S (e `? 3830 Pilot Knob Road, Eagan MN 55122
Telephone 4 651-675-5675 FAX # 651-675-5694
New Construction Requirements Remodel/Repair Requirements office F3sebw
3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and all roofed areas 2 copies of plan Certaf Survi¢ Recd Y .._ N
(20%,mwimum lot coverage allowed) 1 set of Energy Calculations for heated additions Tree Pres PIBq ReW ,_ Y _ N;
2 copies of plan showing beam &window saes; poured found design, etc. 1 site survey for additions & decks I& Pres REquuad , Y j
l set of Energy Calculations Addition - indicate if on-site septic system OnsrteSeptic System t_Y _.N.
3 copies of Tree Preservation Plan if lot platted after M193
Rim Joist Detail Options selection sheet (bldgs with 3 or less units
Q
Date
Site Address e, 0
L71
3!t S (
b l {./ t'/ pnt
Construction Cost
ah-,g 1 (T Cy./ Unit/Ste #
Description of Work eo, ? O I' -r O.0 -9
Multi-Family Bldg -
Y _ N Fireplace(s) - 0 - 1 - 2
/
T c U
Property Owner S-??i /?
?/ (`
Telephone # ( )
Contractor / an L 1 h C_ Gy f O ?? ?'
Address O
state w-c S4 19 ?? 1r City 1-067--7 (k?!? 47Z,
zip SS 420 Telephone#(9S2) E8/-2015
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
(J submission type) Submitted Submitted
• Energy Envelope Calculations Submitted
Have you previously constructed a building in Eagan with a similar plan?
fee applies.
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Y _ N If so, 25% plan review
Telephone #(
Re rT q
I hereby apply for a Residential Building Permit and acknowl 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.
lcI--e
Applicant's Printed Name Applic s Signatu e
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 Porch/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 Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteration ? 37 Demolish Building' ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement 'Demolition (Entire Bldg) - Give PCA handout to applicant
Valuation Occupancy MCES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# 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 _ Final
Insulation
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
REQUERED INSPECTIONS
Final/C.O.
_ Final/No C.O.
Plumbing
_ HVAC
Other
Pool _ Ftgs _ Air/Gas Tests _ Final
Siding _ Stucco -Stone -Brick
Windows
Retaining Wall
Building Inspector
_3CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
PERMIT
PERMIT TYPE:
Permit Number:
Date Issued:
CCOAl 9*72/
BUILDING
026659
11/01/95
SITE ADDRESS:
P.I.N.: 10-47700-020-00
3034 SIBLEY MEMORIAL 14WY
LOT: 2 BLOCK:
MCCARTHY RIDGE
DESCRIPTION:
WINDOWS)
SF (MISC.)
ALTERATION
j (EGRESS
Btfildinq.Permi.t Type
$uilding tdbrk Type
i
W
REMARKS:
FEE SUMMARY:
VALUATION $3,000
Base Fee $74.75
Surcharge $1.50
Total Fee $76.25
CONTRACTOR: - Applicant - ST. LIC. OWNER:
MON-RAY WINDOW & DOOR 15468625 0005111 STATE ADMIN/BLDG CONST
8224 OLSON MEMORIAL HWY 50 SHERBURNE AVE
GOLDEN VALLEY MN 55427 ST PAUL MN 55155
(612) 546-8625 (612)215-0138
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'Mn.
Statutes and City of Eagan Ordinances.
'n(tton ??.f yh ?-
APPL ANTIPERMITEE SIGNATURE SSUEDBT. SIGNATURE'
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE: B U I L D I N G
3830 Pilot Knob Road Permit Number: 0 2 G 6 5 9
Eagan, Minnesota 55122-1897 Date Issued: 11/01/95
(612) 681-4675
SITE ADDRESS: P.I.N.` 10-47700-020-00 APPLICANT:
LOT: 2 BLOCK:
3034 SIBLEY MEMORIAL HWY MON-RAY WINDOW & DOOR
MCCARTHY RIDGE (612) 546-8625
IF_
L
PERMIT SUBTYPE: TYPE OF WORK:
SF (MISC.) ALTERATION
DESCRIPTION (EGRESS WINDOWS)
CITY OF EAGAN ill ?F'
3830 PILOT KNOB RD - 55122 l•
1409,995 BUILDING PERMIT APPLICATION (RESIDENTIAL)
681.4675
? 3 registered site surveys
? 2 copies of plans (include beam 8 window saes; poured fnd. design; etc.)
? 1 energy calculations
? 3 copies of Use preservation plan if lot platted after 7/1193
required: _ Yes _ No
DATE: 10 / 27 / 95 CONSTRUCTION COST:
DESCRIPTION OF WORK:
? 2 copies of plan
? 2 site surveys (exterior additions 8 decks)
? 1 energy calculations for heated additions
Enlarge three (3) windows to meet
$2,689.00
U.B.C. Egress
STREET ADDRESS: 3034 Sibley Memorial Hwy.
LOT BLOCK _0 SUED./P.I.D.
State of Minnesota Mike Fitzgerald
PROPERTY Name: Admin/Building Construction Phone #: 215-0138
OVMER " T `""
Street Address' GIO Administration Bldg., 50 Sherburne Ave.
City: St. Paul State: MN Zip: 55155
CONTRACTOR Company: Mon-Ray, inc. Phone #: 544-3646
Street Address: 8224 Olson Memorial HwyLiCense #: 0005111
City: Golden Valley State: MN Zip. 55427-4713
ARCHITECT/ Company: Phone #•
ENGINEER
Name: Registration #•
Stri:< t AuLl
City: State: Zip:
Sewer & water licensed plumber:
change are requested once permit is issued.
Penalty applies when address change and lot
I hereby acknowledge that I have read this application and state that the infonnati 6 collect and agree to comply with all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant:
OFFICE USE ONLY
Certificates of Survey Received _ Yes _ No O C T 3 0 1995
Tree Preservation Plan Received Yes No
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Duplex
? 02 SF Dwelling ? 07 4-plex
? 03 SF Addition ? 08 8-plex
? 04 SF Porch ? 09 12-plex
;?-05 SF Misc. ? 10 = plex
WORK TYPE
? 31 New Ge 33 Alterations
? 32 Addition ? 34 Repair
GENERAL INFORMA1 iON
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
? 11 Apt./Lodging ?
? 12 Mufti Repair/Rem. ?
? 13 Garage/Accessory ?
? 14 Fireplace ?
? 15 Deck
? 36 Move
? 37 Demolition
16 Basement Finish
17 Swim Pool
20 Public Facility
21 Miscellaneous
Basement sq. ft.
Main level sq. ft.
sq. ft.
sq. ft.
sq. ft.
sq. ft.
Footprint sq. ft.
Planning Building
Permit Fee
Surcharge
Plan Review
License
MCMS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI.
Road Unit
Park Ded.
Trails Ded.
Other
Copies
Total:
MCNVS System
City Water
Fire Sprinklered
PRV
Booster Pump
Census Code.
SAC Code
Census Bldg
Census Unit O
Engineering Variance
Valuation: $ C o a
% SAC
SAC Units
STATE OF MINNESOTA
Department of
Administration
PLAN REVIEW / BUILDING INSPECTION AGREEMENT
COPY TO BUILDING OFFICIAL:
Reid, Douglas Michael
To imp°orrovve the e the quality City of Eagan
and productivity 3830 Pilot Knob Road
of Minnesota
government. Eagan MN 55122
Project Title: 4 Bed SOCS Home Alterations
Date: 2/9/96
Location: City of Eagan
Description: Install exterior fence/smoke detectors/egress wind
Date Received: 1/22/96
Assigned Project Number: 960045
Dear Building Official:
Attached is a copy of the notice to the Architect / Designer of the project described above
as to the agreement reached between the Minnesota Building Codes and Standards
Division and City of Eagan delegating building code
administration to your office as per our agreement on this project.
Yours truly,
BUILDING CODES STANDARDS
Stephen P. Hernick
Supervisor, Plan Review
SPH:p
Attachment
PaFormR1
Building Codes and Standards Division, Facilities Management Bureau, 408 Metro Square Building,
Seventh and Robert Streets, St. Paul, MN 55101; Voice: 612 296-4639; Fax: 612 297-1973
TTY/TDD: Twin Cities 612 297-5353 or Greater Minnesota 800 627-3529 and ask for voice number
EAGAN TOWNSHIP
3795 Pilot Knob Road
St. Paul, Minnesota 55111
Telephone 454-5242
PERMIT FOR SEWER SERVICE CONNECTION
DATE: September 1, 1971 NUMBER 867
i
OWNER:Kenneth H. Keegan Address 3034 Sibley Mem. Hwy., Eagan 55121
PLUMBER Wiereke Trenching TYPE OF PIPE Heavy Cast Iron
DESCRIPTION OF BUILDING
Industrial+ Commercial Residential ` Multiple Dwelling No. of units
xxxx
Location of Connections:
Connection Charge 240.00 pd 0 9/1/71
Acct. Dep. 15.00 pd 9/1771
Permit Fee 10.00 pd 9/9/71
.50 pd 9/9/71
Street Repairs
Total
inspected by:
Date
Remarks:
sy
Chief Inspector
In consideration of the issue and delivery to me of the above permit, I
hereby agree to do the proposed work in accordance with the rules and
regulations of Eagan Totmship, Dakota County, Minnesota
By,
,
Wier a Trenching d Excavating
Cliff Road. Eagan 55123
Please notify when ready for inspection and connection and before any portion
of the work is covered.
EAGAN TOWNSHIP
3795 Pilot Knob Road
St..Paul,-Minnesota 55111
Telephone 454-5242
PERMIT FOR WATER SERVICE CONNECTION
Date: September 1, 1971
Billing Name: Kenneth H. Keegan
Owner: same
Plumber: Wiereke T enching
Number 706 0l A. lt?l
Site Address: 3034 Sibley Mem. Hwy., Eagan 55121
Billing Address same
.7RO.00 Pd 9/1/71
Is not connecting to water at
this time but is bringing wate
up to the outside of the house
Water will be turned off at
curb. He will be connecting
to the water in a year or so
and has paid for the meter on
this date 9/1/71.
Building is a:
Residence
Multiple No. Units
Commercial
Industrial
Other
Meter No, Permit Fee 10.00 pd 9/9/71
Meter Reading Meter Dep. .50 pd 9/9/71
Meter Sealed: Yes_ jAdd'1 Chg.
NO I Total Chg.
Inspected by
Date
Remarks:
By:
Chief Inspector
In consideration of the issue and delivery to me of the above permit, I
hereby agree to do the proposed work in accordance with the rules and
regulations of Eagan Township, Dakota County Minnesota.
By:
Wiere Trenching d Excavating
Please notify the above office when ready for inspection and connection.
MEMO
MEMO TO: Peggy Reichert, Community Development Director
FROM: Erik Slettedahl, Planning Intern
DATE: November 7, 1995
SUBJECT: ? 3034 Sibley Memorial Highway
On November 7, 1 received a call from Mike Fitzgerald of the State Human Services
Department concerning the property at 3034 Sibley Memorial Highway. Under the Data
Privacy Act, he could not give out any specific information regarding individuals moving
into the group home; however, the home will house two mentally retarded individuals who
are coming from the Faribault and Cambridge Regional Centers. The individuals will have
24 hour supervision from a licensed care provider and will participate in a work day
program during the day hours. Mr. Fitzgerald was very accommodating and said he
would answer questions that residents may have concerning this home. He also
mentioned that their department has information regarding property values near these
types of homes that is available to anyone concerned about this issue. They also will,
on occasion, have a neighborhood open house so that the residents have a chance to
meet the individuals who eventually move into the home. Also, they are under contract
with Anchor fence Co. to build 43 feet of six foot privacy fence. If the fence is over six
feet high he would like to be contacted.
0$ o
2004 RESIDENTIAL MECHANICAL PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please complete for: single family dwellings & townhomes/condos when permits are required for each unit
97-3o ,lo
Date 0, / C/ / A!?O
'
Site Address 3b3 ,
q
cl S?b /i?c_ / m V
Unit #
Property Owner ? 1 J V Telephone # (l(/5? ) t/?OO /3&r;t-
Contractor /
l?
__
j// (U
Street Ad
d
re
ss ?^
/t1??/
w ' City
l / -r ?J -- 5-7-.
?
?/? ?vUn
?
/
y
?
State Zip Telephone # q
Bond #: Expires:
The Applicant is Owner _A;-Contractor Other
Add-on or alteration to existing dwelling unit $ 30.00
1.e?furnace -Additional 2eplacement
air exchanger
air conditioner -New -Replacement
other
State Surcharge $ .50
Total $ C-30 W
I hereby apply for a Residential Mechanical Permit and acknowledge that the i rmation is complete and accurate; that the work will
be in conformance with the ordinances and codes of the City of Eagan Vw Mecha nial Codes; that I understand this is not a
but only an application for a permit, and work is not to start witmit; that work will be in accordance with the
appr ed plan in the cakgf work which requires a review and approv f n f h
Applicant's Printed Name Applicant's Signature
2004 COMMERCIAL MECHANICAL PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please complete for: commercial/industrial buildings
multi-family buildings when separate permits are not required for each dwelling unit
Date /
Site Street Address Unit #
Tenant Name (if applicable) Previous Tenant Name
Property Owner Telephone # ( )
Contractor
Street Address City.
State Zip Telephone # ( )
Bond #: Expires:
The Applicant is Owner Contractor Other
Work Type
- New Construction - Underground Tank Install -Remove **see below
Interior Improvement - Install Piping - Processed -Gas
Nature of Work:
"When installing/removing underground tank, call for inspection by Fire Marshal and Plumbing Inspector
Permit Fees: $70.50 Underground tank installation/removal
$50.50 Minim" (includes State Surcharge)
or
Contract Value $ x 1% _ $ Permit Fee
• If permit fee is $1,000 or less, add $.50 => $ State Surcharge
If uemiit fee is over $1,000, add $.50 for
every $1,000 permit fee $ Total Fee
I hereby apply for a Commercial Mechanical 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 with the Mechanical Codes; 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.
Applicant's Printed Name
Applicant's Signature
Approved By: , Inspector Date:
2005 RESIDENTIAL BUILDING PERMIT APPLICATION
1 + City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
a5
New Construction Requirements
3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and all roofed areas
RemodellReoair Requirements
2 copies of plan .., ........_
Office UseonW
CedoF $nney Recd
'
,,, Y _.N
(20% maximum lot coverage allowed)
2 copies of plan showing beam & window sizes; poured found design, etc. 1 set of Energy Calculations for heated additions
1 site survey for additions & decks Recd
TYee Pres Ptsq
£ree Pres Ret ai red _Y
?.N
1 set of Energy Calculations Addition - indicate if onsile septic system orkile SappcSyslem
3 copies of Tree Preservation Plan if lot platted after 711/93
Rim Joist Detail options selection sheet (buildings with 3 or less units)
Date 7 _ y
Construction Cost 700w
^
Site Address _3e) Pi S ; e`v 14777 z 1- i Y Unit/Ste #
k
Description bf Work J _ v?g -d--
Multi-FamiJJly Bldg - Y - N Fireplace(s) - 0 - 1 - 2
Property Owner 5?
4'?l'.e
.u Y a r o
Telephone # (/ F7 ?) 582- -IDLYJ
Contractor 1gVA VEer-U 1? , .s l E
?
+`
,
Address 1160p
State ?c?.-72Jc?zr? A
erc` f?? .(?
Zip Z s2 city/ V_o&Zmt AA74
Telephone # 7) 4 (- o 75:7
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 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.. A _
,Q I LLt04-sn., C/- q Coif i
Applicant's Printed Marne Applicant's Signature
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 Porch/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 Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteration ? 37 Demolish Building" ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement 'Demolition (Entire Bldg) -Give PCA handout to applicant
Valuation Occupancy MCES System
Plan Review _ 100% or _ 25%
Census Code Zoning City Water
SAC Units Stories Booster Pump
# of Unts Sq. Ft. PRV
# 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
Brick
_ Fireplace _ R.I. _ Air Test _ Final _
-
-
Windows
_ Insulation _
_ Retaining Wall
Approved By: Bu ilding Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
PERMIT
City of EaganPermit Type: Building
3830 Pilot Knob Rd ' '' Permit Number: EA153953
Eagan,MN 55122 E AG N
Date Issued: 02/05/2019
(651)675-5675
www.ci.eagan.mn.us
Site Address: 3034 Sibley Memorial Hwy
Lot: 2 Block: 0 Addition: McCarthy Ridge
PID: 10-47700-00-020
Use:
Description:
Sub Type: Single Fam Construction Type:
Work Type: Day Care Inspection
Description: Adult foster care
Census Code: - Occupancy:
Zoning:
Square Feet:
Comments: Adam Gregg 952-303-1614
Fee Summary:
Total:
Contractor: Owner: - Applicant -
State of Mn
444 Lafayette Road
St Paul MN 55155
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