4836 Sky View Ct
~sp.::::xaf: fi`$`.,#.?: ;-v ; . _.y.,.~~.u-..',c s _x.: '"_>F~,"yr,~'°ue~'*_ , . :4 ,,;""rN .°.',~~''~i'.._'~,'~',~,'.`.; . .ri•..
~A. CITY OF EAGAN ' 6Q~9 ~
3630 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 ~
PHONE: 454-8100 ~ ~3~ ~ ~
BUILDING PERMIT Receipt ~ ~
To be used for ~~IDING Est. Value Date J~ Z~ , ~9 ~
Site Ad~ress ~ ~ ~ ~
Lot Btock Sec/Sub. OFFICE USE ONLY
PB~CBI NO. Occupancy - FEES ~
zoning 63.00
W Name (Actualj Caut - Bidg. Permit
_ ~ (Alloweble) '
o Addres5 ~ ~,~9 - Surcharge ~
City Phone t! ol stories -
length _ Plan Review
, p Name ~ 8IDING Depth - SAC, City
Address 1 2 23AD AIB !i S.F.Tocal - ~
U~ City Phone SS7-i~ S.F. Footprints _ SAC, Mcwcc ~
On Site Sewage _ Water Conn
~ ~
W W Name On Site Well - Water Meter ,
~ Z Mwcc s st~ ~
Address y - Aca. oePos~~ ~
<W City Phone ~~'Wa~a'' -
PRV Required _ S/1N Permit ~
I hereby acknowlege that I have read this appliCation and state that the Booster Pump - SNV Surcharge ~
information is correct and agree to comply with all applicable State of
Minnesota StaWtes and City of Eagan Ordinanc~s. Treatment PI
Signature of Pertnitee ' ~r" f r APPROVALS Road Unit ~
A Building Permft is issued to: ~T~ S~Di~i Plannar - park Ded.
on the express condition that all work shall be done in accordance with all
applicable State of Minnesota Statutes and City of Eagan Ordinances. g~~, pN. _ Copies -ay~~
~
8uilding Official ' Variance - TOTAL
.
Pe?mit No. Permit Holder Dats Telephone !F
WAtER
SEYVER
PLUMBING
H.VA.C.
ELECTRIC
h~apection Date Insp. Comments
Footirgs I
Foundatan .
Fr~ming
Rooting .
Rou9h PIb9•
Fid+9h N19.
Isul.
FireplaCe
Final Htg.
Fnal Plbg.
Const. Meter Plbg. Inspector - Notify Plumber
ErgrJPtan
e
Bldg. Final ~ ~ z ,Z ~ ~ /~B /vi9 . N
DeCk Ftg. u C' ~ [
Deck Final
WeM
Pr. Disp.
CITY OF EAGAN Remarks ~ U~~ f~
G
Addition~ g8~a~~ ~~~}~~g~ Lot Q Blk ~ Parcel ~~o~~ -
Owner Street 4R~h S~~Nie*~ CoL~I't State
Improvement Date Amount Annual Years Payment Receipt Date
STREETSURF, o v ~
STREET RESTOR. ' '
- _ a c.
GRADING
SAN SEW TRUNK
SEWER LATERAL
WATERMAIN
WATER LATERAL
WATER AREA
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER.
SAC
PARK
, CITY OF EAGAN ~ ~,q S.~,Z
, ~ 3830 Pllot Knob Road, P.O. Box 21-199, Eagan, MN 55121 1
PHONE: 454-8100
BUILDING PERMIT Receipt#
Tobeusedfor 5~ ~WV~G~ EstValue ~~4,U00 Date 25 ,19 ~6
Site Address 3 G 5KY V I F.i~~ CT Erect C~ Occupancy k3
Lot y Block 1 Sec/Su6. St1FAR1 ZNb Remodel ? Zonino 1~1
Parcel No. Repair ? Type of Const y
Addition ? No. Stories
W tiame ~~ic2ITAGE ce~~~zGY HOMES Move O ~ength 75
3 Address - 4 6 5 5 N I COLS RD Demolish ? Depth '2 ~
o Int Impr. ? Sq. Ft.
City i=~ y~T~ phone 452-5950 ~nsta~~ ?
Z o Name APP?ovals Fees
~ Address Assessment Permit ~ s a~. U ~
~ Ciry Phone Water & Sew. Surcharge 4 2. UO
Police Plan Review 19 2. SU
F W Name Fire SAC 575.00
=d Address Eng. WaterConn. 500.OU
c,,
i W ciry Phone Planner Water Meter 63 . 50
Council RoadUnit 29G.U0
I hereby acknowledge that I have read this application and state that the gldg. Off. 3/ 14 / fi T~. p~. 15 b. U U
information is correct and agree to comply with all applicable State of
Minnesota Statutes and City oi Eagan Ordinances. APC Parks
Signature of Permittee . , ~ Var. Date Copies d•
. • Total S2, 20 . Uu
A Building Permit is issued to: HERITAGE EN~RGY }inME5 on the express condition that
alt work shall be done in accordance with all applicable State of Minnesota Statutes and City oi Eagan Ordinances.
Building Official ~
.
" P~rmlt No. PwmH Nold~~ D~b T~Nphon~ A
P~~~~,~ da 1 3 a~ ~
H.V.A.L'. tp O ? ~
ei.~aic p 7~l~ 'ir7 ~ 5 -~2 -h ;
sona+.~
Inspacfbn Def~ In~p. Comme~b
Foolinys 1 a
Footlnps 11
Foundatloe ~r _ - ~
Frominy -
RooNny ~~t •~t
Rouyh Plby. 7~J' ~ ~`3~ . ~ `ij _
Rouqh Htq. ~ nf~(/ 3` 07 y3~~ l
Imul.
Flr~plac~
FMaI Nly.
Final Plby. ~6,~
81dy. Finel ~ G ~ Q~~ li~
Grl.Oce. r
Oeek Ftp. G- ~ `
Deck Frmq. !
WNI
Pr. Disp.
.
`
~ PERMIT # CITY OF EAGAN FEE
~ i ~ c' MECHANICAL PERMIT S~~ f~-~
RECEIPT # ~ ~ ~ d ~ 454-8100 ~
_ MINIMUM RESIDENTIAL FEE - 510.00 + =.50 TOTAL ~''7 ~
DATE ~ MINIMUM COMMERCIAL FEE - 520.00 + 5.50
1. Bidg. Type: Res ~ Comm Inst 2. New ~ Add Alter Repair
c-~ 'I z ~ k
3. Total Bid Price ~-A 4a Job Address 7, l.~~ L~' ~ l ~'t~`f
1 ~ ~
Lot ~ Block Sec 5. Owner _
~~K1t~L~ f~7l:~ f~1K yl~ ) i~~:~''~~' ~l i~G~1! '~/1'~v..,~~,,~ y.,,~.~;~ r
6. Contra~ctor ~ ~ ~ , s ~ ; '
(Name) ~ ~(j ,r~ (Str~ m+) ~Z~P)
7. Contractor Phone # l~~ S r
RESIDENTIAL HEATING - 01-100,000 BTU's -$24.00. Each additional 50,000 BTU's or fraction -$6.00
RESIDENTIAL COOLING - 01-24,000 BTU's -$12.00. Each additional 6,000 BTU's or fraction -$6.U0
MODIFICATIONS/ALTERATIONS -$10.00 minimum fee
~ HEATING VENTiLATING HOT WATER STEAM AIR COND.
~IR PIPING PROCESSED PIPING AIR HAND. EQUIP. REFRIG.
RES. GAS PIPING OUTIETS -$1.50 TANKS: L.P. UNDERGROUND OTHER
COMM./IND. RATE - 1% OF TOTAL BID PRICE PLUS 5.50 STATE SURCHARGE FOR EACH 51,000 ~F FEE.
Signed: fo~
Approved Inspections: Date Rough Insp. Date Final Insp.
~
, ~
, . ' _ . . PERMIT # ~"i ~ .
• PLUMBING PERMIT RECEIPT # ~ J ~SS
CITY OF EAGAN ,
3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE ?'j~ G'~' (o
CONTRACT PRICE PHONE: 454-8100
Site Address f~W u~- BLDG. TYPE WORK DESCRIPTION
Lot ~ Block Sec/Sub
Res. x New ~
~ Name ~CNC Lcr?. ~n Mult Add-on
~ Address ~t Comm. Repair
c City -Sy r~~-t.o I.~ Phone 7- 3 ~ Other
u / l ~e /le-,.,,t~ • ~O. FIXTURES 6 T~AL
Name Water Closet - $3.00 S
c Addr@SS ~ b SS , iJ /c'~~r /r' . ~~m Tubs - $3.00
p City Phone ` %y- yS5"I ~ Lavatory - $3.00
-~Shower - $3.00 3 .
FEES ~Kitchen Sink - $3.00 •~v
COMM/IND FEE - 146 OF CONTRACT FEE ~ Urinal/Bidet -$3.00 .ev
Laundry Tray - $3.00
MINIMJM - RESIDENTIAL FEE - $10.00 ~Floor Drains - $1.50 • So
MINIMUM - COMM/IND FEE Water Heater -$1.50 SO
STATE SURCHARGE PER PERMIT - .50 Vlfhirlpool -$3.00
(ADD $.50 S/C IF PERMIT PRICE GOES ~Gas Piping Outlets -$1.50
BEYOND $1,000.00) co
~Softener - $5.00
Well - $10.00
~ Private Disp. - $10.00
' ~ ~Rough Openings - $1.50 ~
S NATURE` PERMITTEE FEE O
STATE S/C: ~ ' ~
FOR: C(TY OF EAGAN GRAND TOTAL: ~~3, GU
CITY OF EAGAN s~~ P~R
3830 Pilo~c Knob Rosd
P. O. Box 21199 PERMIT NO.:
Eagan, MN 55121 pA~:
No. of Units:
Owr~r:
Add?ess:
Stte Address: .
Plumber. '
~ Me•. w.~y, wil~ Ii. dlp.i ~.~e¦ Cor+n~ction O,orp.;
~~Mllp/.
AtO01f1! ~~h -
Pr~mif FN:
ey Surciwr~:
Misc. Chorye~
Dab of Irop.: Totol:
DoN Pold:
CITY OF EAGAN
3830 Pilot Knob Road w~4TER SERV~CE pE~
P. 0. Box 21199
E~. MN 55121 PE~IT NO.:
Zonirg; _ DATE: ~ ~ c=:
~M'M~: _ i:? ~ i, • NO. Of UnitS: ~
~~1b35: -
stt. Add.e~ 3 f s k~-v 1ew r.o,; r- p, ,
Plumb~r. •ct~ct ~i;~^_~:;:,
Met~r No.:
5ize: ~nnection pM,Qe;
R~r No.: ^co°u^t DePCS(t: :
Pennit Fee;
~ Mn~ to ao~n~lf wilh Iy Surzho '
~+~w~. . ~Ij-:i
Miic. Ctwrpes: _ 1 _ ~ . nt
~d ; ^
BY Total: o ~ . ~ - ,
DoM Poid:
~ate of Insp.:
~rnP.:
EAGAN Wq~R ~aVICE pERMR
„ •dot Knob Road
P. ~ 3ox 21199 PERMIT NO.:
E~N~.1GiN 55121 DATE: ' ~ ~
Zonirg; .
, t No. of Units: i
OwrNr: r~ :;i s'.. c~~, r~ r,-.
/lddress:
ro '~r
5~ /lddress: • i e~ ~ ~ ~
~<^~r:ltl
P}IM~F, ~ ` .'iil~i~ ~
Mfl~~ ~Vo.;I f ~l ll1 , !Z,~
. K ~?~p~:
t. 1 5 • ^c
M~M !o eM~pl~r Mrp1~ • • ~ J.: t~gd
~ ~D Sr~~;,
UlR
EQ _ ~ 55 . ~
BY Totci: ~3.5~'~p:i trtc+
Dot~ Poid:
Dote of Ir~sp.:
-zi~-8!7
~~~~~~~m~~~~~~~~~~~~~~m~~~~~~~~~~~~~~~~
CI7Y UF EA.r..,A~
r.,qs;FC[GR~ S TE::fiMI~JAL. N0: 874
L1A7.F..;; 03/?S/39 7IMC:: 1U:39~i.2
IT.~ ~
NAME~ WES7l.1FPa C;EL~AR ,UF~FLY
?155 9001 4836 5Y,YVIl:.W CT L.JD
3~?10 9C1!Ji. 4H36 SKYVTFW C;C' f.f.1.E?5
,w
t
Tot;a7, fier..e:i.pt Artio~~r;t; ~.i.3.i5
CF.1Q43 i 4
LI61::fi l:Li: NANC`,'
~k %c m X~ ~%XC m ~ X~ Xc X~ ~X ~X X~ X~ ~k ~X X~ ~%~X ~%Y~ # X~ i k X~ k~ #
Thi , re.quest void S~~_~ 3 G 5 3
18 mon[hs irom
~~7263 ~-~1 ~ - ~ 7,,_.~ ~~r _
Rcquest ate Fire No. RnuUh-in In4poctinn ~
'7/~~ ~jJ Re~~uiredl ~ReadY Nuw ~Will Notify, Insuec-
`d QV ~es ?NO ~or When Ready
? Lice~s ElecVicnl ConVactor I hereb re
y ques~ inspection uf abovB
? Owner elecdical work installed aY.
Stree[ Ad e js
eaz or Route No. ' City
,J ~p `3' !~/Etf/ rP
ur,von o. 7awnship me or Na. nnge No. Coun
/7(.'4Y/ ry
Occupan~IP TI Phonu No.
f ~9P~' CS ~~l`Z-STj~(ZS
Power Su lier p/
J Atldress~_ ` ~
I~ G /~i C /C /~!~'~1'3" //L~ V "'I ~
Elecvir.al [r tor ICOmpanY Nam onVar.tor"s Licen>e No.
~i-~-~~-/ f~. r~~ c yd z i Z
Mnilin Addr ss (C ntractor or wner Ma Installa N
° ~o -7j'~
A~ ~rize ignature (CO cto O er Makiny Installationl Phone n r
u.~. ~.3~s_
MINNESOTA STATE BOAND OF ELECTRICITV THIS INSPECTION REQUEST WILL NOT
Griggs•Midway Bldg. - Naam N-197 gE ACCEPTED BV THE STqTE eOAND
1821 Univeraity Ave.. St. Paul, MN 55104 UNLESS PNOPEN INSPECTION FEE IS
Phone (8121297-21t1 ~ ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION ~ E6-00001.04
u;
' See inst~ru
tiions for comoleting this form on beck of yellow copy.
'o; , ~ S'~'~~'""X"" Below Work Cove~ed by This Request (G 3 ~ S 3
'.4Atl Rep. Type oi Building Appliancas Wired EquinmentWiretl
~ e Range Tem{x~rary Service
Duplez Wa[er Heater Llghtiny Fixtures
Apt. Buildinc~ Dryer ~ Electric Heatin
Commercial Bidg. Furnar,e Silu Unluader
industrial BIAg. Air Conditioner Bulk Milk Tank
Ferm Other peci v Other ISner.~fyl
t er pocify Othe~ Oihor
ompute lnspection Fee Belaw
p Fee ServiceEnVanceSiie R ~Fee Faxdars~SWteetlers # fen Circuils
0 to 200 Am s- 0 to 30 Am ~s .S ~ to 30 M~ ~
Above 200 Amps 31 to 100 Amps 31 to 700 qm s
Swimming Pool Above 100_Amps Above 100-F+mPy
Transiormers Irrigation Boon-~s ,SC> Pdrtial,'Other Fee
Signs Speciallnspection 5 ~
Remarks r TOT VU
7
Roueh-in Date ~
G ihB BC IICAI
~ ~i~ nspectoq hnreby
cerUfy that the above
Final - insVection has been
matla.
l~le requesl volO 1B mont~a irom
CITY OF EAGAN p ~$O69
• 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55721
PHONE:454-8100 N G~'
BUILDING PERMIT Receipt # 0
7o be used for ~-SIDING Est. Va~ue ~4, 000 Date JUNE 28 , 1g2~_
Sile Address 4836 SKY VIEW CT
Lol 9 Block 1 Sec/Sub. SAFARI 2ND OFFICE USE oNLY
PefCBI NO. Oaupancy - FEES
Zoning _
w Name DUANE HAUSER (Actual) Const - 81tlg. Permit 63.00
~ Address 4836 SKY VIEW CT (aiiowabie) - Surcharge 2.00
~ City EAGAN Phone 456-0279 xo~s~odes -
Lenglh _ Plan Review
, o Name METRO SIDING Deplh - SAQ City
~a Address 14240 23RD AVE N S.F.TOtal - SAC,MCWCC
~ City PLYMOOTH Phone 557-1 R08 S.F, Footprints -
On Site Sewage _ ~Nater Conn
r
W W Name On Sila Well - Water Meter
z
MWCCS s[em
Address Y - Accl. Deposil
aw City Phone arywacer -
PRV Required _ ~ Permil
I hereby acknowlege ihat I have read this applicalion and state ihat the eoostar Pump - SM! Surcharga
inlormation is wrrect and agree to comply with all applicable St of
Minnesola Statutes and City of Eagan Ordinance~, Treatmenl PI
C/
Signature ol Permilee ~T APPHOVALS Road Unit
A Building Permit is issued to: METRO SIDING Planner - park DBd.
on the express condilion that all work shall be done in accordance with all Cauncil
applicable State oi Minnesota StaWtes and Cit~yI of Eagan Ordinances. gitlA, pry, _ Copies
p-+yh (1 Variance - TOTAL 65.00
Buildin9011icial ~~~~~TQ~LI I-1tJ~
CITY OF EAGAN
. ' 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 N-° 116 7 2
PHONE:454-8100 ~G~~/G
BUILDING PERMIT Receiptp 7
iobeusedtor SF DWG/GAR Est.va~ue $84~OOD Date ~'RCH 25 1986
SiteAddress 4836 SKY VIEW CT Erect ~ Occupancy R3
Lot 9 Block 1 Sec/Sub. SAFARI ZND Remodel ? Zoning R
Parcel No. Repair ? Type of Const V
Atlditlon ? No. Stories
~ Name HERITAGE ENERGY HOMES Move ? Length 75
3 Address 4655 NICOLS RD ~emolish ? Depth
° EAGAN phone 452-5950 Intlmpr. ? Sq.Ft
~~h Insfell ?
o Name SAME APProvala Fees
$ 385.00
$ i Address Assessment Permit
'p' Ciry Phone Water & Sew. Surcharge 42 . 00
~Q Police PlanReview 192.50
~ W Name Fire SAC 575.00
~ Address 500.00
c~i ~ Eng. Water Conn.
a W Ciry Phone Planner Water Meter 63. 50
Council Road Unit 290.00
Iherebyacknowledgethatlhavereatlthisapplicationandstatethatthe g~dg.Off. 3/14/86 Tf.PI. 156.~~
information is correct and agree to comply with all ap licable State of
Minnesofa StaWtes and City of gan Ordinanc . APC Pafks
Var. Date Copies
Signature of Permittee Total ~2 ~ Z04 . 0~
A Building Permit is issued to: HERITAGE EN RGY HOMES on the express condition that
all work shall be done in accordance wifh a~ll
a li/cab~ State of nneso Statutes and Ciry ot Eagan Ordinances.
Building Official 1 ~c ~q.~i
~ ~
SEDGWICK HEATING & AIR CONDITIONING CO. HEAriNG J08N0
8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) 881-9D00 TEST RECORD
ADDRESS L' " ' ~ ~~L ~ " CITV " ~ ~ ~
OCCUPANT ~ ^u ~ OWNER ~ ~ ~f
SOL~ BY INSTALLED BV
MAKE ~ MODEL ~"v U~~ J ~/v O~
SERIAL NO. INPUT ~r J~
THEFMOSTA7 VENTSIZE / ~r y. -
VALVE ` ' TYPE OF LINER
LIMIT ~~`r~~ LWERSIZE (~~l~
LIMIT SETTING~__~ ~S FILTERS: SIZE i~^`~`"" NUMBER
FANSE7TING ~ WIRING v~~
PILOT TYPE TEST TAG
IGNITION MODEL ~~C'~ U~ ~ LIGHTING INST. ~
PILOTTIMWG ~ K'-S~ ~-~/~Olp
DATETESTED
PRESSURE ~•S ` pERCENT COz
~ ~ COMPANV TESTING ~ ~
INPUT CFH G" PERCENT Oz
a
STACK TEMP. PERCENT CO NAPAE OF TES
FORM235(REV.11/89) FORMDISTRI . WHR COPV- OBFIL VEILOWGOPV-CITY
~ PERMIT
City of Eagan Permit Type: Building
3830 PILOT KNOB RD Permit Number: EA034799
EAGAN, MN 55122 Date Issued: 03/24/1999
(651)681-4675
Site Address:
4836 Sky View Ct
Lot: 9 Block: 1 Addition: THE SAFARI 2ND
~~~~ti ~T_
Description ~
Sub Type: Single Family UBC Occupancy: '"~y~
Work Type: Reroof ; Construction Type:
F%~'
Description: ~ Zomng. ~
t ~
Census Code: pddition/Bsmt fin/Decks/Porch Squ~are Feet:.~~ ~ }-''s"'
~ .~~s~= ~
-•'-"''~'~l~'~ d%~ t'
-s' !~`4 ~ . ~.~,,mm~.~~
~'.:~am_
~ ~
~ ~
~
~7 t,<
~
"~..R' ~
~~`h~.
Remarks: _
Fee Summary: State Surcharge 2.50
Valuation: $5,000.00 Base Fee 11125
$113.75
Contractor: - Applicant - OWner:
WEST'[JRN CEDAR SUPPLY St. Lic.: Peggy Hauser
705 N I~WY 169 4836 Sky View Ct
PLYMOUTH, MN 554410000
+ 6125414207 Eagan, MN 55123 651-456-0279
t
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.
c~-~.A
ApplicanUPermitee: Signature ssued By: Signazure
CITY U E ONLY -yp
L ~ B I I RECEIPT#: I~ N~/~F2
n~
SUBD. ' ~ RECEIPTDATE: ~-7J"~~D
PERMIT# J 7Y5
2000 PLUI~ING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAx, rSt 55122
651-681-4675
Please complete for: ? single family dwellings
D townhomes and condos when permits are required for each unit
? backflow preventerforunderground sprinklersystem •
FIXTURES EACH p TOTAL
Alterations to existing dwelling - minimum fee $ 30.00
Describe:
Bath tub $ 3.00 x = $
Floor drain T i 3.00 x = $
Gas piping outlet ` minimum - 7 3.00 x = $
Hot tub/spa 3.00 x = $
Kitchen sink 3.00 x = $
Laundry Vay 3.00 x = $
Lavato 3.00 x = $
SBptIC S stem newlrefurbished • requires MPC Iie. 75.00 X = $
SeptiC System abandonment 30.00 x = $
RPZ new installation/repaldrebuild 30.00 X = $
Rough opening 1.50 x = $
Shower 3.00 x = $
Under round sprinkler if dwelling is under wnstrudion 3.00 x = $
Under roundsprinkler rfexistingdwelling 30.00 x = $
Water closet 3.00 x = $
Water heater 3.00 x = $
Water softener If dwelling under constructlon 5.00 x = $
Water softener if existing dwelling 30.00 x = $
Water turnaround 30.00 x - _ $
State Surcharge 50 $ .50
TOtal _a ~
Reminder. Call for inspections of alterations, i.e. water heaters, water softeners, etc.
-
I hereby acknowledge that I have read this appliption, state that the iMortnation is coned, and agree to camply with all appliceble City of Eagan ordinances.
It Is the applicanPs responsibility to notify the property owner that the Ciry of Eegan assumes no liability for any damages caused by the City during its
normal operetional and maintenance activities to the NaalRies constructed under this pertnit wRhin Ciry property/rightof-way/easement.
SITE ADDRESS: ~~.i~ S/CY ttiu? ~/~/U ~.f-?? ~S,Zy
OWNER NAME : J/l{Ay1/'E ~h`'q[tt'~I~ TELEPHONE#: ~B-~~, S~-~~'DZ7~1"
(AREA CODE)
INSTALLER NAME: ~ I~`/%- IGOt~~2 TELEPHONE#: ~/Z ~~'~J~
~y ~ (AREA CODE)
STREETADDRESS: 7-SOC7 (i~7s7~°l^-S ~/1~`G~/"~
CITY: P °/rf'10~ STATE: ZIP: ~Y~
. ~
SIGNATURE OF MITTEE
p• .
385 • ,70 +
42~~0+
i4~=:e+
:7s~oo+
5_., .'0+
G3•~~~+
29C^":0+
~56=_C+
.~~-ti>~-J~:
~7~ ~ ~
1985 BUILDING PERMIT APPLICATION - CITY OF EAGAN
NOTE: ALL CONYHACTORS MUST BE LICENSED NITH THE CITY OF EACAN
INCLUDE 2 SETS OF PLANS
3 CERTIFICATES OF SURVEY
t SET OF ENERGY CALCULATIONS
To Be Used For;~7~f,~LC^ ~AYN ILf~Valuation: g~,~0 Date: 3'~.
Site Address: ~g~7~ J~~'a OFFICE USE ONLY
Lot: ~ Block ~ Sect/Sub ~A'~L a~ect x Occupancy ~ 3
f l~ -~7 S}~J C~ ~ 0_ p ~ Remodel Zoning R I
Parcel # Repair Type of Const ~
Enlarge of Stories
Owner Move _ Length ~
5
Demalish Depth 30
Address Grade Sq Ft
City/Zip Code
Phone APPROYALS
Contractor ~ ~7~~~i~ V ~ ~~~`^C~ ,~Assessments Permit 3g~,
1~/~~ r Water/Sewer Surcharge
Address 6S~ ~~~US f(.~A~ Police Plan Review ~ 12.9'
; 'a~ Fire SAC S"15
City/Zip Code ~ Engr Water Conn 5 00-
~ Planner Water Meter (o3.5D
Phone Council Road Unit q p.
Bldg Off3~q8v`aaParks
Arch./Engr. APC Treatment P1 (5(0.
Variance
Address TOTAL ~
i
City/Zip Code
Phone If
95~~~
~ ZJ ~ ~~L 2~'~~Z
~~~b -
~z~~~ ~ ~ x - z~ ~ ~ I
_ ~a,~ ~ g~ ~ ~ ~a 2 x ~
: - ~ ~b b L b -
f x yp
~ ~ ' ~ Q~~. o~ ~S' x ~ b bZ x ~bZ
• ~
, ,
TRI-LAND C0. SITE PLAN FOR~
~ SURVEYING HERITAGE ENERGY
SERVICES HOMES
4655 NICOLS ROAD
EAGAN, MINNESOTA 55~22
-~~KY VIEW COURT -
~s N T6•57' 43" E ~ ~
• 100.00
nr w.
a ~ a
s _ - - --~s
( - ~ ~ ~ ~
r~ ' ~o ~ "
I ~
N I ~
o"'~ , ~ I , v,
~'o N I n., -
~ ~ ` 'n-0 ~ I O 0
o I .J N
~1 ~ `..a I O ~I
~ Iwa~ 1~1
. ~ ~'`5 ~ ~
I LOT 9 ~ sca~: i°=ao'
I ~
`L---------~~
R ~
O[7 _ Nosl
, N T6°S7'43"E
, y8 3 C s~v,
PROPERTY DESCRIPTION
~ar e~.xKJ_,
Sl1FpRl SEC[fNe enn~TION
eee na to th~ heordsd piot tMnof
T CaaMfr, Minnsaoto
O OENOr~ES IRON MaIUMENT PROPOSED CsARAGE FLOOR ELEVATION = l0~1_O~
e pppTES INOOp FN~ SET PROPOSED FIRST FLOOR ELEVATION =
inurrDENOTE3 EXISTINB SPOT PR~POSE09ASEMENT fLOOR =
• ELEVATION ELEVATION
~b~ pENOTE8 PROPOSED SPOT
EIEYATION
~ pENOTES DRAIN~KiE D1R~CTION NOTE ~ VER~IFYH~EF~NSHEtGHTS WITH
~ hr~jr wAItI? tAot this arwy.P~~ o? f~.,,J~_ A~,,,,,~,,.
r~pat wa pre~and br aie or und~r m~r ~i~
dir~cf wp~rvl~fon mid 1ho1 1 am a duly Bradley w Swenson, Mn. R~q. No. I:f233
~ La~~rs
o~t nie sia of~ u~ rM oma : 3~/~ac
w
~
~1 l~+0~l1! ~ ~t~~=. ~
.~i~ect~al cor~uh°~ inc. .
e~..e.~.o» ~?.,..r.,,.
;XTERIOd4 ENV A " '
_ Plon"v.~4-t~co Octe z. .
OwMr
ContractoR 'F'~ ~ a`~,r 1-~+--t'cs ~'"l `
31h Addr~ss: PNONE -
~)TOTAL EXPOSEO WALL AREA Z~~~ s4ft s"u". = Z''I • I I
2) TOTAL EXP09ED ROOF/EElLIN6 AREA ~~'~O s4 tt• j"U~~' •
WALL AREA CALCULATfONB~
TOTAL WINDOW AREA sQ.h.~i~U~~~~
GLAZED
TOTAL OOOR AREA ~ sq.ft.x U°~-_ Z•7
70TAL GLASS DOOR AREA sa/Ri~U"~'L=
I~FSI~ GLAZED . .
T07A~ fiREPLACE WALL AREA ~ s4•~~x~~~
T4TAL WALI FRAMtNG AREA I~~' sC,ft,x tJ~' • I o= ?(o .8
NET INSULATED WALL AREA ~ S~ ~ a4•ft•x~V~~'~- G~~z
TQTAL RIM JOIST AREA '4•TM•x S~
TOTAL FOUNDATION AREA (EXPOSED) N~` sq•H.i
U" /
TOTAI. FOUNDATION WINDOW AREA ~qAt.x~U~~ y~.=
3) TOTAL ~~3•y
, If ilem 3 1t Ms some as,a Isss then item l,rou hove m~f fAe inf~nt o~
2 MCAR l.16009 A ond O. ~
ROOF/CEILINO CALCULATIONS~ '
TOTAL SKYLIGHT AREA { NA aq.it~i~U"~=~
T07AL ROOF~CEILING FRAMING AREA IZ~ ~a.R,a'u"•`~°= 3.3
NET INSULATED ROOF CEILING AREA s4•h-x~U° ~
~ TOTAL
1/ ihm 4 Js the tome oa,a lsss fhon ifsm 2, you Aore m~? the irtfenf of
2 MCAR 7.16008 A an0 0.
ALTERNATE 9UILGIN9 ENVELOPE DESIAN ~
To utiliz~ fM lolal ~nv~bpe.syarem m~Mwd,fh~ wm of irems I ond 2 drolf not
b~ qr~otK tAan rM sum of ir~ma 3 and 4. .
42? = _
31 +j1 ~
~.r,ey o~rnry na+ rn. a?nm~o n.r. d.,atb.a .w.n a.xc..a, +n. s~an or ~wx?ao?o .
eiM?; cons.rvaMon ae+. ~ ~
. • ~ ~r---s~-- ~'7- ,
~ uuw~ i rcin. ~ r~ .
. . rEUM a~ctaM c~.~TEO)
4 . (s
~ ~4 ia rf m aHU „ .
TOTAL R
Y• 1/R•~.L
~ CEILINO FRAMINB :ECTION ' 0.61
( 1 elr /Ilm
~ 2 12~3~ e
t~.ow ~3.Q
' VENTED cs a-~ ri
T~ .
{4 a d.3C
' 15' TOTAL R .1
' ~ y • 1/R ,d7t~
CEIUNO ~CTI~a r ttUnSULATEDl Otl
~ _ t!
' ~ 0.61
(4 alr fflm (sMlf) • -
. • TOTAL R
_ ' V s 1 /R
CEILINO fRANIN6 SECTION . A.sl
' I 1.~le~ ak fiUn
~ 3 4 5 Is
' 2 Is ~2y.ra ei. H~~n o 6t
VENTED ~6 er .eH .eed
~ . ' ' .TOTAL R~-
y s I h
~
. .
4 ExPOED ~EAM CEILINA tECT10M .
~ ~ -a~.~ O .
u ~
~ ts
• ts o,r~ .
~s~e:~ .a ~:~a
. ~K .
^ . , • y, ~ 1/R__.~
' ~ , . • .
, _
_ ~`e . . . •
' , . .
, .
• ,
. • ,~I/ !~t Gac ~~+a • .
[o ~ ~rl'~iv5 .
CONSTRUCTION
~ wK~ ~~Na secrioN
• -~1 ~hrfa afr NMn
3' en~s of solt rooe la87
. ~ . 1/L'cKev_ •(c~o
s 1~v~.w ~
8 ut~ria oir li~m 0.17
. TOTAL R "q•~
U ~ 1/R '
1MALl SECTION (iNBU~ATEO) ,
~ infvlo~ oir tihn 0.68
2 1~°z'~~''~ _ ~9~
; ti~b 1?M~ 19.0
- 4 u=+c.~ dp . •!o/o
. a ,s,r,~~„r .fSl
. - 6 ~afniu nlr film O.ly
~ TOTAL R Z~ • 7
. U • VR
RIM JCIST 9ECTION
~ ' t ri ir I Im 0.68
' 2 ' Ca+~ i.+S I`'l .o
I. ~l
~ . ~'tt ~.l~r~v
` ~ . rorro
~ ~v~.~c. •8~1
6 i~Kfa otr film O.t7
TOTAL R Z'~'y~ •
- - u = ~/R ' °`~'3
fOUNDATION lECTION .
jp~iAor sir /ilm O.~
' • . 1 '.yt~tRt~
• • ; !Z c. 6~x~ ~
. ' ~ , . 4 ut~rio? tir tilm -
• ' ~ • 1'3 G.17
. TOTAI R~i~
' ~ • ' OMOE ' y • 1/11 • V
, • ~ . • ' .
'
• ~ ~ ~ i a• ~ • u r a.
• •a • • ~ ~ ~ a+ • •
. ~
CITY OF EAGAN
APPLICATION FL~R PERMiT SEWERR P.DID/OR WATEEt CONNECTION
(Please Print)
1) PROPERTY ADDRFSS: L~.~.s' H r/~v~ ia ww~
T•FY:AT• D~SQ2IPTION: ~ 4~ N~/r~c. / .~cLFGhi Z~ ticQcK
(Lot Block Subdivision or Tax Parcel I.D. Nimiber)
IF EXISTING STRC'C'IURE, DATE OF ORIGINAL &!ILDING PERNffT ISSC'ANCE:
(Nbn ear)
PRESENP ZONING/PROPOSED LSE: -1 SINGLE FAMILY
R-2 DL'PLEX (7tt,oo L'nits)
R-3 TOWNEIaC'SE (Three + C'nits) ( L'nits)
R-4 APARTMENT/CODIDOMINIL'M ( Onits)
CONA'IERCIAL/RETAIL/OFFICE
INDL'STRIAL
INSTITt
~TIONAL/GOVEE2I~NT
2) ~ Nar~: Ta ~i a,r ~ x ~~.,-~-Ti n 5
ADDRESS: /J~c~~ ~:~~i ~t .a ~Iv<4~
CITY~ STATE. ZIP: Tn ve r ~r-c~~¢ j/'~,f 41'T~ ,i
S O 7S`
PHONE: /,!S / - 4' 9 S~a
3) • r. a~• (/r/ ~ For City L'se
N~% u~"'-l~4,L.! ~ ~ Pltmtbers Licens~
AD'DRESS: ~
_,~7 Y /Ul o n rc ~ f~l Active
CITY, STATE, ZIP: ,f T ~,7n b
S'/ 02 ~T Expired
' Q Not Recor
PHONE: ~~2 - Z z l- 36 7S M~T~ LICENSE # 33 ~lo... M- 5~
Staff
Initial
4) s • NAME: /YL~~,J- ~ ti~., 6~°m.4~ ~~'7~'~-~
'--a
ADDRESS: ~C.T~ N i~ ~ f~'~O (S ~ b~-
CITY. STATE. ZIP: r c~c~a '7)%~xn SS/„2 /
a
PHONE: ~S~ ~ S .$~v
5) o . . a~
~;ONI~CTION TO CITY SEWER ~CONNECTION TO CITY WATER
dt'~III2 (Please Describe)
6) i~ ~ •
~ PLEASE HOLD APPROVID PERMIT F'~R PICK-L'P BY ONE OF AHpVE
~ PLEASE MAIL APPROVID PERMIT ~ 1, 2. 3~ 4, ABOVE
(Circle one)
7) ~ ~~L~-~-+~-~I~f..+~,ms----- ~
~ :i . .
F 0 R C I T Y U S E O N L Y •
PER^1IT ° ISSUED
7.~3 8 ~~2 C: G:
F~~S: S ~~-J~ S~ivc.°, nD~~SIT II`ICLi;D~ SURC:i?RGE)
S S
U W~TE~ PERN1ST (ZNCL'uDE Sli~CHARGE)
$ ~i",~ SJd ~ WATER METER/COPPERHORN/OUTSIDE READER
$ WATER TAP {INCLUDE CORPORATIOV STOP}
5 S~:vEF T~P
$ ~j~ !Yd =C^Oi;:i'= ....?GSI= - __..?3
$ f~' L-7/ ACrOUNT DFPOSIT - p1AT°4
$ ~~`G'-7 ` C/' ~ WAC
$ 7 S Z) SP_C
$ TRlNK [VATER ASSESS;4E:IT
$ TRli:~K Sc:~lER ASSESS;lE.iT
$ LATERIL BE~IEFZT/TRU:1K S::~iFR
$ LATcRAL BENEFIT/TRU:IK I4AT°R
$ ~ v WATER TREATMENT PLANT SURCHARGE
S OTHER:
$ TOTAL
$ zi Ah10UD;T PAID jRECEI2T i_ 1; C~ ~
~ ~~j (
f~ G, 5' o S,.
DO£S UTZLITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGi-IT OF WAY?
~ YES IF YES, THEN n"PERMZT FOR 4+)ORK WITHZN
PUBLIC ROADWAY" MUST BE ISSUED BY THE
Q NO ENGINEEF2ING DIVISION. LIST AS A CONDI-
TION.
SL'BSECT TO THE FOI•LOWING CONDITIONS:
' ~ -
APPROVE~ BY: ,~f~ -
6
TITLE:
DAT° : ~/2 ~ .
~ 1~~~9'
1490 BUILDING PERMIT APPLICATION
CITY OF EAGAN •
SINGLE FAMILY DWELLINGS MULTIPLE DWELLINGS COMMERCIAL
2 SETS OF PLANS 2 SETS OF PLANS 2 SETS OF ARCHITECTURAL
3 REGISTERED SITE SURVEYS REGISTERED SITE SURVEYS - & STRUCTURAL PLANS
1 SET OF ENERGY CALCULATIONS (CHECK WITH BLDG. DEPT.) 1 SET DF SPECIFICATIONS
1 SET OF ENERGY CALCULATIONS 1 SET OF ENERGY CALCS
# OF RENTAL UNITS
OF FOR SALE UNITS
PENALTY APPLIES WHEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY LAST WORKING DAY
OF MONTH IN WHICH REQUEST IS MADE.
LOT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED.
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS
DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
PROCESSING TIME FOR SEWER & WATER PERMITS IS TWD DAYS ONCE A PERMIT HAS BEEN COMPLETED.
PERMIT MUST SHOW A LICENSED PLUMBER.
~ ~~~~,p ° ~-~~-9a
To Be Used For~~. Valuation: ~~~JV Date:
Site Address ~~.3~Sc~~/rui~- Ccc- OFFICE USE ONLY
Lot Block J_ FEES
Occupancy
) Zoning
Parcel/Sub ~ z1U~, Actual Const Bldg. Permit :no
Allowable Surcharge 2,cc
Owner ~ Uc.~..,e I.'~Qt.~.S r. P # of stories P1an Review
~p~ Length SAC, City
Address ~/$<3~ ~~i'[~Ucc~a.~r (~l Depth SAC, MWCC
S.F. Total Water Conn
City/Zip Code ~~CC~Qp/ SS/o2~t- Footprint S.F. Water Meter
Acct. Deposit
Phone 'l',s 6-Oa2-~/~ On site sewage_ 5/W Permit
On site well 5/W Surcharge
Contractor ~~fi^O Si~ s~ d MWCC System _ Treatment P1.
/ City water Road Unit"
Address ~yv2y0 ,~3i^UCjuc /U PRV _ Park Ded.
Booster Pump Copies
City/Zip Code ~~!/yrtB~ .S`S%y~ SUBTOTAL
APPROVALS Penalty
Phone S.S lFd S- Planner _ TOTAL
Council
Arch./Engr. Bldg. Off.
Variance
Address
City/Zip Code
Phone #
1999 BUILDING PERMIT APPLICATION (RESIDENTIAL)
7~-4-~ ~~J 3830 PILOT KNOB RD 55122
J ~ 651-681-4675 ~ ~ ~ ~
New Construction Reouirements RemodeVRe~air Reouirements 7_~. y_~~ '
~
? 3 registered site surveys showing sq. R. of fof, sq. h. ofhouse ? 2 copies ot plan
and a71 roofed areas 120% maximum lot covarege altowed) ? 1 sef of energy calculations for heated additions
? 2 copies ot plens (show beam & wintlow sizes; poured fnd. design; etc.) ? 1 site survey Por exterior additions 8 decks
i t set of energy celculaGons
? 3 copies of tree preservation plan 'rf lot platted after 7/1l93
DATE: J-Z-`t l/ CONSTRUCTION COST: ~`rt,Z g~,
DESCRIPTION OF WORK: - DB~- 1<~~~ ~
STREET AQDRESS: '-f ~ ~ k U v e<,J'. e. ~
LOT: ` BLOCK: SUBD./P.I.D. ~ ~-ckllC' ~ ~
IVame: ~ I"Yf~C~~~ ~ ~ C11~j~_ Phone C9~ ~-~I SC - G~~Z1~
PROPERTY sl ?
O~'I~'ER ' r ~g
StreeL Address U~J~_5 ~~~F U'~i i.~-1 L- ~ _`^~Y
Ci[> - - - - State: w~~ Z'P' -
Compan}':_~~~ l L.J F~-D v Phone N: Z - S 4( ~ C'~ ..S Q Ll
CONTRACTOR 2A~S55"' Ex
StreetAddress:__~~__~CJ-~~ l(n.~i___N~ License# ro p.
City~ ~_~Ay1/tWTJ~ State: w~aJ Zip: --S~-y~-~--
l
ARCHITECT/
ENGINEER Compaziy: Phane _
Name: Regisuation k:
Street Address:
Cip• S~ate: Zip:
5ewer 8 water licensed plumber (required for new construction onlv):
Penalty applies when address change and lot change is requested once permit is issued.
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant: ~-6 /
OFFICE USE ONLY
Certificates of Survey Received _ Yes ~ No
Tree Preservation Plan Received _ Yes _ No _ Not Required
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 4-plex ? 11 10-plex ? 16 Fireplace 0 21 Porch (3-sea.)
? 02 SF Dwelling ? 07 5-plex ? 12 12-plex ? 17 Garage ? 22 Porch/Addn. {4-sea)
? 03 1 of _ plex ? OS 6-plex ? 13 16-plex ? 18 Deck ? 23 Porch (screened)
? 04 2-plex ? Q9 7-plex ? 14 Apartments ? 19 Lower Level ? 24 5torm Damage
? 05 3-plex ? 10 8-plex ? 15 Lodging ? 20 Pool ? 25 Miscellaneous
WORK TYPE
? 31 New ? 35 Tenant Impr ? 39 Gas Line Only ? 43 Siding/Soffits/Fascia
? 32 Addition ? 36 Move Bldg. ? 40 Gas Insert ? 44 Windows/Doors
? 33 Alteration ? 37 Demolish Bldg. ? 41 Wood 5tove ? 45 Fire Repair
? 34 Repair ? 38 Demolish (Interior) ? 42 Reroof
GENERAL INFORMATION
Const. (Actual) Basement sq. ft. Census Code
(Allowable) Main level sq. ft. 5AC Code
UBC Occupancy sq. ft. No. of Units
Zoning sq. ft. No. of Bldgs
# of Stories sq. ft. MC/ES System
Length sq. ft. City Water
~dth Footprint sq. ft. Booster Pump
PRV
Fire Sprinklered
APPROVALS
Pfanning Bui(ding Engineering Variance
Permit Fee Valuation: $
Surcharge
Plan Review
License
MC/ES SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S!W Permit
S/W Surcharge
Treatmenf PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
SAC Units
• CASH RECEIPT ~
~ ~ ~ CITY OF EAGAN
P. 0. BOX 21-199
EAGAN, MINNESOTA 55121
DATE 19
~~cs~veo
RROM
aMOUNT $ I
A DOLLARS
~oo
? CASH ? CHECK
/OR
r ?f/.V • ' ~~T~-
FUND CODE A~~OUNT
Thank You
BY
White-Payera CovY
Yellow-Posting Copy
Pink-File Copy
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 4836 Sky View Ct
Lot: 09 Block: 01 Addition: The Safari 2nd
PID:10- 75851- 090 -01
Use:
Description:
Sub Type: e - Furnace & Air Conditioner
Work Type: Replacement
Description: Fumace & Air Conditioner
Comments: Questions regarding electrical permit requirements should be directed to Mar k Anderson, State Electrical Inspector,
952- 445 -2840. Crystal Gemuenden 8910 Wentworth Ave S Bloomington, MN 55420 952- 881 -9000 Crystal.Gemuenden
@ServiceExperts.com
Fee Summary:
Contractor:
Sedgwick Heating & Air
8910 Wentworth Ave S
Minneapolis MN 55420
(952) 881 -7739
Surcharge -Fixed
ME - Permit Fee (Replacements)
Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply
of Minnesota Statutes and City of Eagan Ordinances.
h all applicable State
Applicant/Permitee: Signature
PERMIT
City of Eaan
- Applicant -
$0.50
$30.00
$30.50
Owner:
Duane A Hauser
4836 Sky View Ct
Eagan MN 55122
Permit Type:
Permit Number:
Date Issued:
Permit Category:
9001
0801
Issued By: Signature
Mechanical
EA074529
07/28/2006
ePermit
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 4836 Sky View Ct
Lot: 9 Block: 1 Addition: The Safari 2nd
PID:10- 75851- 090 -01
Use:
Description:
Sub Type:
Work Type:
Description:
e - Water Heater
New
Water Heater
Meter Size Meter Type
Comments:
Fee Summary:
Contractor:
Champion Plumbing
3670 Dodd Rd., #100
Eagan MN 55123
(651) 365 -1340
Kris Oien
3670 Dodd Rd
Eagan, mn 55123
Manufacturer
PL - Permit Fee (WS & /or WH)
Surcharge -Fixed
Total:
I hereby acknowledge that I have read this application and state that the informa
of Minnesota Statutes and City of Eagan Ordinances.
on is correct and agree to comply
h all applicable State
Applicant/Permitee: Signature
PERMIT
City of Eaan
- Applicant -
Permit Type:
Permit Number:
Date Issued:
Permit Category:
Serial Number Remote Number
Owner:
Duane A Hauser
4836 Sky View Ct
Eagan MN 55122
$50.00 0801.4087
$0.50 9001.2195
$50.50
Issued By: Signature
Plumbing
EA092167
11/27/2009
ePermit
Line Size
Oct 12 2011 1:17PM HP LASERJET FAXBRUCKMUELL 6516882160
44111' fty Of Ba
3830 Pilot Knob Road
Eagan MN 55122
Phone: (851) 675-5675
Fax: (651) 6754694
page 2
Use BLUE or BLACK Ink
1
Permit #:
Permit Fee:
Date Re
Staff:
INFLOW & INFILTRATION PERMIT APPLICATION
Plumbing / Sewer & Water
Date: l0-12- i 1 Site Address: -/g?Ski i 'eaj CCX Gr -
Tenant: Suite #:
RESIDENT /OWNER
Name: dt ca.n 2 d✓ Pegg, HatkceAt^ Phone: 651– 1-151.1- 6,Q 77
Address / City/ Zip: 1- CO i : i
CONTRACTOR
Name: L3r,uC.krhu el/Cr" P/a f0h/;19i.W9C. License #: 0 6, 1 S /-Pm
Address: 39a 9/JenaYid Lanic%t ii,e . City: b—ageiri
State: ilii Zip: 557c93 Phone: 661- (P >(, - £i G. 9 Co
Contact: t'l`/6 or -ffiL/r e. Email: bruckinaed`C.t`,1(.a/riling g g, corn
TYPE OF WORK
PLUMBING (Within the building envelope) SEWER 8 WATER (Outside the building envelope)
✓ Sump Pump Repair Repair
Other: Other:
DESCRIPTION
Description of work: B('fis9 01,rtn diSek r e line.
p ,PL2nlp
AI Code
_____c.p
FEES
$55.00 / Each (includes
$5.00 State Surcharge) TOTAL FEE $ 55.0 a
*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.cityofeactan.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.000herstateonecall.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 ire&-aciernt4e, /e/'
Applicants Printed Name