3760 South Hills Dr_ __....-
PERMIT
SEWER SERVICE
GAN
VILLAGE OF 36
PERMIT NO.:
3795 Pilot Knob Road 75
DATE: 10 29
Eagan, MN 55122 i
RII No. Of Units:
Zoning:
R Reikwoski
-B
a re
Owner: _-?•-ate--
5132 So Hills
1
Address:
3760 ,
R111S Dr.
So.
Site Address:
ion
Kleven Pl
Plumber: a 4
Charge
:
lY with the village of Eagan Connection
it:
n
it;
p
1 agree to ca Accounccount Depos
Depos
10.00 Pd
Ordinances. Permit Fee: 50 pd
Surcharge:
Misc. Charges:
BY: Total:
Date of Insp.: Date Paid:
Insp.:
VILLAGE OF EAGAN WATER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.: 1878
Eagan, MN 55122 DATE: 10/29/75
Zoning: .RII No. of Units: 1
Owner: A11.39e FteiklNOS)E1
Address:
Site Address 3760 Sa,-Ri11 8-Ds R2
Plumber:
Meter No.:a""??5 Connection Charge: 160 160 00 pd
size: 4_' 'k u e- IC Account Deposit:
Reader No.: / 7 7 6 --3 o Permit Fee: 10.00 pd
I allrIpp? o imply with Tha Village of Eagan
L Surcharge: .50 pd
OrdiAdn
. - Misc. Charees: CA AA _I
I Total:
By Date Paid:
Date of Insp.: Insp.:
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„ 1
, 0 ???17H 11I 1 1 S OR
l;fiIIIII N1tEs
APPLICANT:
14111 1 1? 1Nil
01)13 1 •1*4
H I I .". I S) F;
PERMIT SUBTYPE: TYPE OF WORK: 1; F H A r R
Permit No. Permit Holder Date Telephone k
ELECTRIC I
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 PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
BSMT R.I.
BSMT FINAL
DECK FTC 9
DECK FINAL Q
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
SITE ADDRESS:
M111 11 1 1 1
INSPECTION RECORD
PERMIT TYPE:
Permit Number:
Date Issued:
lot
MI TIf OIL 1 I
n t, fit 01'.0. APPLICANT:
fIR I l i : I• ?' 1' 1 0
¦
ill I I If I N11
n.. "fw"
1011"/ti1'?
PERMIT SUBTYPE: / TYPE OF WORK:
I:1 PAIR
Iii •,? >. 1 ? i 1 i?r? 1 kr1111 f N1i
Permit No. Permit Holder Date Telephone #
S/W
PLUMBING
HVAC
ELECTRIC
ELECTRIC
Inspection Date Insp. Comments
Footings I
Foundation
Framing
Roofing
Rough Plbg.
Rough Htg.
Isul. 0 G?i7/ n. S
Fireplace _
Final Hig.
Orsat Test
Final Plbg. Plbg. Inspector - Notify Plumber
Const. Meter
Engr./Plan
Bldg. Final
Deck Fig.
Deck Final
Well
Pr. Disp.
w
Reosipt MECHANICAL PERMIT Permit No.
CITY OF EAGAN
Fee
Fill in numbered spaces S/C
Type or Print legibly
Tot.
1. Date 2. Installation Cost
3. Job Address Lot Blk. Tract
4. Owner ?ra
5. Contractor Phone
6. Address i
7. City
State
Zip
8. Building Type: Residential ?
Commercial ? Institutional ?
9. Work Description: New ? Add ? Alter ? Repair ?
10. Describe Fuel Type
11.
No, Equipment BTU - M. Ea.
Forced Air No. Equipment CFM
dli
:
Ai
Ha
Mfg. r
n
ng
Boilers
Mfg. Mech. Exhaust
Unit Heater
Mfg. Other
Air Cond.
Mfg.
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. Date2-Y-,8 Insp. &6d
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454.8100
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE: 'I t I I+114r,
3830 Pilot Knob Road Permit Number: 'rt r ,a t
Eagan, Minnesota 55122-1897 Date Issued: "'' '0l) /,it,
(612) 681-4675
SITE ADDRESS: APPLICANT:
Irll . Ft1?,l+
, 6, ;,+li II I t l ; tlk , ,r+, ?
PERMIT SUBTYPE: TYPE OF WORK:
•. .r.' i?+ Ili .II ,I +i ? .,I I.,N
F 7
J
Permit No. Permit Holder Date Telephone N
ELECTRIC
PLUMBING /?P (o0?`CJbf:/
HVAC
Inspection Date Insp. Comments
FOOTINGS
FOUND
FRAMING d Z .Q
! rsA
ROOFING
ROUGH
PLUMBING
94?
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL Q Z yp?
7
GYPBOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL /Q J
BSMT R.I
BSMT FINAL
DECK FTG
DECK FINAL
I J - 1
CITY OF EAGAN Remarks
Addition SOUTH HILLS lst Lot 5 Blk
Owner Il?u. f E Street 3760 So. Hills Drive
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING 7
SAN SEW TRUNK ( J;5' 1971 1 AA - 4A 7-32 ?n
* SEWER LATERAL 3011? 1975 2
295-31 -
153- 02 15 -,V, -2 As
,
WATERMAIN
* WATER LATERAL
WATER AREA
21g-92
11 .9f;
go
/fit
s -
STORM SEW TRK
* STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. 160.00 951 R-5-79;
BUILDING PER.
SAC 475
00 851 8-5-75
PARK .11
120-00 851 8-5-79
CITY of EAGAN
BUILDING PERMIT
Owner .....A.A„. .`..-..... !!..`^- '..`?'' ........................
.................................... .........................
Address (present) y? ...... &-l . Z-zn .... .4". 1
Builder ..... .: .... J
Address ..... L4?wGt ' . .
a ,.
N2 3740
3785 Pilot Knob Road
Eagan, Minnesota 55122
454.8100
J- • 7, . .
Date .................. .................._...
Biorias To Be Used For I _Fron! Depih Heigh! Est. Coat permit Fea Remarks
-?
-r,U7r. ??c? 1 Sb ?3 G I 'Y61 7ra I =: . f a '-
i v u
-76/0
l i-
,Ot Block Addition Or Tract
This permit does not authorise the use of streets, roads, alloys 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, safely. convenience and
general welfare to anyone in the community.
THIS PERMIT MUST BE KEPT OpN" THE PREMISE WHILE THE WORK IS IN PROCi ESS. ? K
This is to certify, thai..61....91-."?::°- :"..,...`..` ..:....................has permission to erect a............ ........... .........................upon
the above described premise subject to the provisions of all applicable Ordinances for the Ci2 of Eaga
l? : Y..°.` :?.: ``?...-...----............ Per ?.? ..---i...-..?.......,.-...?
....-°..... ............................... .'. Building
Mayor Building Inspector
-143
'3-- Z S. N///S
CITY OF EAGIW
3795 Pilot Knob Road
Eagan, Minnesota 55122
PERMIT NO.:- ?98_
The City of Eagan hereby grants to Ragen !!&;a & Heating
of rzam4a"ea, ;IN 56924
a HF.ATTWr Permit for: (Owner) M W Johnson Contractor
at 17eo 140_ Hills Dr. , pursuant to application dated 11/7/75 _
Fee Paid: s20.00 dated this day of Nov. , 19 75
.50 s/c
Building Inspector
Mechanical Permits:
Bid Total:
CITY OF EAGAN
3795 Pilot Knob Road
Eagan, Minnesota 55122
PERMIT NO.: 628
The City of Eagan hereby grants to m son- 1ev n P he in
of Atr2 Ninniiei Ave. so.. Mols. 55404
a pUAWTUO Permit for: (Owner) JOHNSON - (Bruce Reikwoski)
at 3760 so. Hills Drive , pursuant to application dated 10/28/75
Fee Paid: 120.00 dated this 29 day of October , 19 75
.50 a/c
Building Inspector
Mechanical Permits:
Bid Total:
346-901 OFFlCE SE OJNL_Y The nearest void 18 months ham validation date printed is this box,
PLEASE PRINT OR TYPE
Request Dote Raugh.In inspection required2 Yes [3 Na
?YQ'Jill Call
Inspection Ocher Than Roogh.ln: [] Ready Now
/
?' 0 (You must call d? inspHOr whe ready( t
Dak Ready:
I, licensed contractor ? owner hereby request inspection of the above electrical work at:
Jo Address (Street, Box, or Route No.)
-37G O 564TW HikkS QGIAi City
CA(34Q Zip Code
S-5-10\3
Section No. Township Name or No. Range No. Fire No. Counety??(? ?p
Occupant
MuliZo1;., 444e(Q Phone No.
alb ? -(o Y3
Power Supplier Address
Eleddml Conimcror (Company Name)
,4r?a??? ?N Contractor limma i,
cgoo7r 5- Maxter uc. No. (Plant Elea. Only)
Ath0j(0
Mailing Address (Contmdor or Owner Pedorming Ins lotion)
Li 33 (ZWC,, . Wk," 7YM't`t
E14VTJ rn,v n_0-
Au1ho Sigs?Nre on r a tier arming Insmllabon) Phone No.
EB-000( 1I -W 6/95 STATE BOARD COPY- SEE INSTRUCTIONS ON BACKOF YELLOW COPY
IpI REQUEST FOR ELECTRICAL INSPECTION
IIII II III II I II I I I IIII I II I II III I IIII Minnesota 21 Un ersity AvearRm. Electricity
8 St. Paul, MN 55104
s 0 3 4 6 9 0 1 2 x Phone (612) 642-0800 40
Home Duplex Apt. Bldg. Other: IJew Addn
Commercial Industrial Farm Remod Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
D er Range Elec. Heat Tem .Service
"X" above the work covered by this request. Enter remarks in this space and on the back of the white copy only.
6jj,56 n6vr (ItNiCh
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Cir 7/Feeders Fee
Mobile Home Park Stoll 0 to 200 Amps 0 to 100 Amps
Street Lfg./Traffic Sig. Above 200 Amps ps
Transformer/Generator INSPECTORS USE ONLY
l
T/ T L.
Sign/Outline Ug. Xfmr. r Q•'3 O
Alarm/Remote Control
Swimming Pool I here cent that I ins ed the el-
Irrigation Boom Rough-In Dare
ection
S
i
l Ins -
TH pec
p
a
Investigative Fee
IS INSTALLATION MAY Fbwl Do
BE ORDERED DIS N ECTED IF NOT COMPLETED WITHIN 18 MONTHS.
CITY Of EACAN
CASWLER,, S TERMINAi... NO, 74
DATE. 09/09/96 TIME: 15;09-01
ID a
NAMI :: R 0 CONSTRUCTION
3210 9001 3760 £i0 FILL. S DR 50.00
2155 9001 0760 SO FILLS DR 0.50
Total. Receipt Amount: 5050
CRO6Fi 0'i 1
USER 1% NANCY
kcY?'g9Fikk(Y?i?7K%s7KX(k(iXk<; %?iXikiXk'k:X?3';1k??iYik>RXC?yF>RiXikk?k<k?
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
PERMIT
PERMIT TYPE:
Permit Number:
Date Issued:
BUILDING
028791
09/09/96
SITE ADDRESS:
3760 SOUTH HILLS DR
LOT: 5 BLOCK: 2
SOUTH HILLS 1ST
P.I.N.: 10-70790-050-02
DESCRIPTION:
puilding,,,Permit Type
Building Work Type
Census Code
y'
BASEMENT FINISH
ALTERATION
434 ALT. RESIDENTIAL
1. "_ .?» ..
REMARKS:
FEE SUMMARY:
Base Fee $50.00
Surcharge $.50
Total Fee $50.50
CONTRACTOR: - Applicant - ST. LIC.OWNER:
R 0 CONST 14523575 0004988 HURD MURVIL
980 STONY POINT RD 3760 SOUTH HILLS DR
EAGAN MN 55123 EAGAN MN 55123
(612) 452-3575 (612)452-6143
I hereby acknowledge that I have read this application and state that the'
information is correct and agree to comply with all applicable State of Mn.
L Statutes and City of Eagan Ordinances,
c.
i
APPLICANT/PERMITEE SIGNATURE ISSUED BY. SIGNATURE
CITY OF EAGAN
3830 ' PILOT KNOB RD - 55122
1996 BUILDING NG PERMIT APPLICATION (RESIDENTIAL)
681-4675
New Construction Reauirements
lff6•J
MW M
? 3 registered site surveys ? 2 copies of plan
? 2 copies of plans (include beam & window sizes; poured fnd. design; etc.) ? 2 site surveys (exterior additions & decks)
? 1 energy calculations ? 1 energy calculations for heated additions
? 3 copies of tree preservation plan if lot platted after 7/1/93
required: _Yes _ No t -
? 30 nn ,,c / f -W CS> C.')
DATE: CONSTRUCTION COST:
DESCRIPTION OF WORK: f w? 4 t?2>: e.•„ ,e ?"/?`
STREET ADDRESS: 3 7 G O `7m e 7 ?t (?' l ?s
LOT BLOCK SUBD./P.I.D. #: /JNILTL /V k In
Nr'' y f,2 - 61 y 3?
PROPERTY Name: Phone #:
OWNER `""
3760
r7mwr!? r'°"
N•
Street Address:
City: t -. State: Zip: S? z 3
CONTRACTOR Company: - C s k Phone #:? 2-3
Street Address: 0
5m ky ?? ?d -/
License #: g$
City: t a m •. _ State: •? Zip:/ z ;
ARCHITECT/ Company: Phone #:
ENGINEER
Name: Registration #:
Street Address-
City: State: Zip:
Sewer & water licensed plumber:
change are requested once permit is issued.
I hereby acknowledge that I have read this application and state that
applicable State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant:
Penalty applies when address change and lot
the information is correct and agree to comply with all
OFFICE USE ONLY
t?€
Certificates of Survey Received _ Yes _ No J EJ
Tree Preservation Plan Received Yes No _ _ _ .. _ _ _ _ _ _ _ - -
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Duplex ? 11 Apt./Lodging e'?'16 Basement Finish
? 02 SF Dwelling ? 07 4-plex ? 12 Multi Repair/Rem. ? 17 Swim Pool
? 03 SF Addition ? 08 8-plex ? 13 Garage/Accessory ? 20 Public Facility
? 04 SF Porch ? 09 12-plex ? 14 Fireplace ? 21 Miscellaneous
? 05 SF Misc. ? 10 _-plex ? 15 Deck
WORK TYPE
? 31 New 0-133 Alterations ? 36 Move .
? 32 Addition ? 34 Repair ? 37 Demolition
GENERAL INFORMATION
Const. (Actual) Basement sq. ft. MCNNS System i
(Allowable) Main leve l sq. ft. City Water
UBC Occupancy sq. ft. Fire Sprinklered
Zoning sq. ft. PRV
# of Stories sq. ft. Booster Pump
Length sq. ft. Census Code. J4 S_
Depth Footprint sq. ft. SAC Code 0/
Census Bldg i
Census Unit o
APPROVALS
Planning _ Building A49 E ngineering Variance
Permit Fee Valuation: $
Surcharge
Plan Review
License
MCM/S 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:
% SAC
SAC Units
CITY' OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
VALUATION
PERMIT
C, jy//_ s-s-
BUILDING`
022262
10/19/93
SITE ADDRESS:
P.I.N.: 10-70790-050-02
DESCRIPTION:
3760 SOUTH
LOT: 5 BLOCK:
SOUTH HILLS
(ROOFING)
Bld`ir"g Permit Type
Building Work Type
}
$63.00
$2.00
$65.00
REMARKS:
FEE SUMMARY:
Base Fee
Surcharge
Total Fee
CONTRACTOR: -
OVERHEAD CONST
17259 N CREEK DR
FARMINGTON MN
(612) 463-4592
HILLS DR
2
PERMIT TYPE:
Permit Number:
Date Issued:
SF (MISC.)
REPAIR
$4,000
Applicant - ST. LIC OWNER:
14634592 0004706 HURD MURVIL
3760 SOUTH HILLS OR
55024 EAGAN MN 55123
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 Mr.
Statutes andCity of Eagan Ordinances.
J
rt'ePPLICA T/PERMITEE SIGNATURE ISSUED BY% SIGNATURE
INSPECTION RECORD
CITY OFEAGAN PERMIT TYPE: BUILDING
3830 Pilot Knob Road Permit Number: 022262
Eagan, Minnesota 55123 Date Issued: 10/19/93
(612) 681-4675
SITE ADDRESS: LOT: 5 BLOCK: 2 APPLICANT:
3760 SOUTH HILLS DR OVERHEAD CONST
SOUTH HILLS (612) 463-4592
PERMIT SUBTYPE: TYPE OF WORK:
SF (MISC.) REPAIR
DESCRIPTION (ROOFING)
INSPECTION TYPE „ INSPECTION TYPE DA TE INSPTR.
FINAL
REACTIVATE _
PERMIT #
2A Vol.
CITY OF EAGAN
1993 BUILDING PERMIT APPLICATION $4.6•00
681-4675
SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy
calcs.
COMMERCIAL 2 sets of architectural & structural plans, I set of
specifications, 1 copy of energy calcs.
Penalty applies: 1) when permit is typed, but not picked up by last working day of month.
in which request is made, 2) address is changed or 3) lot change is requested once permit
is issued.
Valuation of work 3 a
Date / 2-257-7_
L
7d e?:> STh°?
s ?
-
/
?
Site Address:
STREET SUITE /
Tenant Name: (commercial only)
LOT BLOCK
I I SOBD JU0&f? fjj
P.I.D. M
Description of work:
'
ractor ? Other 0*.«1be1.
The applicant is: ? Owner IZ?Cont
Name 74? //ler d A4-1, C Phone
Property -
LAST FIRST
Owner ,/
Address 37 e e-K ?h-
STREET STE Y
City L State ? _; Zip
Phonel 3 ASP Z
Company
Contractor /?
Address ?elez? - ) -?- License IF Exp.
City on State Zip 55?
Company Phone
Architect/
Engineer Name Registration Y
Address
City State Zip
Sewer & water licensed plumber Processing time for
sewer & water permits is two days once area has been approved'.
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.
?
..
Signature of Applicant
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation
? 02 SF Dwg.
? 03 SF Addition
? 04 SF Porch
? 05 SF Misc.
? 06 Duplex
? 07 4-Plex
? 08 8-Plex
? 09 12-Plex
? 10 Multi. Add11.
WORK TYPE
? 31 New
? 32 Addition
? 33 Alterations
? 34 Repair
GENERAL INFORMATION
Ilk
? 11 Apt./Lodging... -%-- 3,,,1f,Basen14inish
? 12 Multi. Misc. 0 17 Swim Pool'
? 13 Garage/Accessory ? 18 Comm./Ind.
? 14 Fireplace ? 19 Comm./Ind. Misc.
? 15 Deck ? 20 Public Facility
? 21 Miscellaneous
? 35 Tenant Finish ? 37 Demolish
? 36 Move
Const. (Actual) Basement sq. ft. MWCC System
Allowable) 1st F1. sq. ft. City Water
UBC ccupancy 2nd Fl. sq. ft. PRY Required
Zoning Sq. Ft. total Booster Pump
# of Stories Footprint Sq. ft. Fire Sprinkler
Length On-site well Census Code
Depth On-site sewage SAC Code
APPROVALS
Planning Building Assessments
Engineering Variance
REQUIRED INSPECTIONS
? Site
? Wallboard
? Footing
? Final
? Framing
? Draintile
? Insulation
? Fireplace
Permit Fee
Surcharge
Plan Review
License
MWCC SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total:
SAC %
SAC Units
VaLLation: $
MASTER CARD
STRUCTURE AND
LAND USED AS
Permit
No.
Issued Issued To
Contractor Owner
BUILDING
PLUMBING
CESSPOOL - SEPTIC TANK X90 ,r_ 44- 01Y' In1 1 on
WELL
ELECTRICAL _
HEATING
GAS INSTALLING
SANITARY SEWER -
OTHER
OTHER
Items Approved
(Initial)
Date
S Remarks
Distance From Well
FOOTING SEPTIC
FOUNDATION _ 0, 7f CESSPOOL
FRAMING TILE FIELD FT.
FINAL
ELECTRICAL
HEATING DEPTH
OF WELL
GAS INSTALLATION /ODD' ?S
SEPTIC TANK
CESSPOOL
DRAINFIELD
PLUMBING /n_-?_ _.,
WELL
SANITARY SEWER
Violations Noted
on Back
COMMENTS:
COMPLIANCE INSPECTION REPORTS
TO BE USED ONLY IN EVENT OF OBSERVED VIOLATIONS
PERMIT NO-
DATE OF INSPECTION
CONDITIONS OF CONSTRUCTION AT THIS INSPECTION
? NO EVIDENCE OF NON-COMPLIANCE
OBSERVED.
? ACCEPTABLE SUBSTITUTIONS OR
DEVIATIONS.
? NON-COMPLIANCE. BUILDER WILL COMPLY
WITHOUT DELAY.
ITEMIZED AND DESCRIBED AS FOLLOWS:
NON-COMPLIANCE. BUILDER DOES NOT
INTEND TO COMPLY.
? COMPLETION OF CERTAIN IMPROVEMENTS
WILL BE DELAYED BY CONDITIONS BEYOND
CONTROL.
? REINSPECTION REQUIRED
DATE OF REINSPECTION
CERTt FI CATION -1 certify that I have carefully inspected the above in which I have no interest present or prospective, and that 1 have reported herein
atI significant conditions observed to beat variance with ordinances of the Town of Eagan, approved plans and specifications, and any specific require.
ments for off-site improvements relating to the property inspected.
? ALL IMPROVEMENTS ACCEPTABLY COMPLETED
BUILDING INSPECTOR
DATE
as
CITY USE ONLY / oZ
L r L ?// RECEIPT #:?2rn
SUBD. .l( I DATE: 4'
1996 PLUMBING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
(612) 681-4675
Please complete for: ? single family dwellings
? townhomes and condos when permits are required for each unit
Shower
Water Closet
Bath Tub
Lavatory
Kitchen Sink
Laundry Tray
Hot Tub/Spa
Water Heater
Floor Drain
Gas Piping Outlet " minimum - t
Rough Openings
Water Softener
Private Disposal * Dakota Cty. license
(new and refurbished systems)
U.G. Sprinkler * home under const.
Alterations * to existing
Water Turn Around
EA-CH ?Q.
3.00 x
3.00 x _
3.00 x
3.00 x a
3.00 x
3.00 x
3.00 x
3.00 x
3.00 x
3.00 x
1.50 x
5.00 :Y
65.00
20:0
0
STATE SURCHARGE
TOTAL
TOTAL
Co
-P
= O. GG
.50
0, 'S U
SITE ADDRESS: 3 --? 6,o S u v a 2? P / ) )J Q,.
OWNER
INSTALLI
STREET ADDRESS:
CITY: STATE: ZIP:
PHONE #: ( ) l A-5??
OFFICE USE ONLY
L BL RECEIPT #:
SUBD.
1996 PLUMBING PERMIT (COMMERCIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
(612) 681-4675
Please complete for: b all commerciallindustrial buildings.
multi-family buildings when separate permits are Wj required for each dwelling
unit.
DATE: CONTRACT PRICE:
WORK TYPE: NEW CONSTRUCTION i<DD ON REPAIR
DESCRIPTION OF WORK:
IS WATER METER REQUIRED? - YES _ NO. IF SO, PLEASE PROVIDE THE FOLLOWING:
WATER FLOW: GPM. ARE FLUSHOMETERS TO BE INSTALLED? _ YES ` NO.
FAILURE TO PROVIDE THIS INFORMATION WILL RESULT IN A DELAY OF METER ISSUANCE.
WILL YOU BE INSTALLING A METER FOR A FUTURE U.G. SPRINKLER SYSTEM? _ YES ^ NO.
IF SO, YOU MUST APPLY FOR A SEPARATE U.G. SPRINKLER PERMIT.
FEE: $25.00 minimum fee or 1% of contract price, whichever is greater. State surcharge of $.50 per
$1,000 of FStmd fee due on all permits.
CONTRACT PRICE x 1%
STATE SURCHARGE
TOTAL
SITE ADDRESS:.
TENANT NAME:
OWNER NAME:
INSTALLER: .
ADDRESS: _
CITY:
STE. #
STATE: ZIP:
PHONE #: SIGNATURE:
OFFICE USE ONLY
APPLICANT
METER SIZE: DATE: INSPECTOR:
.t
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
PERMIT
PERMIT TYPE:
Permit Number:
Date Issued:
BUILDING
028199
07/25/96
SITE ADDRESS:
P.I.N.: 10-70790-050-02
3760 SOUTH HILLS DR
LOT: 5 BLOCK: 2
SOUTH HILLS
DESCRIPTION:
REPLACE EXISTING
Permit Type DECK
Iork Type REPAIR
de;"E 434 ALT. RESIDENTIAL
w?
a,
'mo,3 + .un .. ., a
SQ f k
REMARKS:
FEE SUMMARY.,
Base Fee
Surcharge
Total Fee
$45.00
$.50
$45.50
CONTRACTOR: - Applicant - ST. LIC.OWNER:
R 0 CONST 14523575 0004988 HURD MURIEL
980 STONY POINT RD 3760 SOUTH HILLS DR
EAGAN MN 55123 EAGAN MN
(612) 452-3575
hereby"
Infor" i
(612)452-6143
CITY OF EAGAN ?S S
3830 PILOT KNOB RD - 55122
f 1996 BUILDING PERMIT APPLICATION (RESIDENTIAL)
681-4675
Reouiremen
? 3 registered site surveys ? 2 copies of plan
? 2 copies of plans (include beam & window sizes; poured fnd. design; etc.) ? 2 site surveys (exterior additions & decks)
? 1 energy calculations ? 1 energy calculations for healed additions
? 3 copies of tree preservation plan if lot platted after 7/1193
required: _ Yes _ No r B o
DATE: .l",w'- Z ?" p 6 CONSTRUCTION COST:
DESCRIPTION OF WORK: 0,,--?L
STREET ADDRESS:
LOT S BLOCK
PROPERTY
OWNER
3760 ??r.-r4u;//s 2,, I ?I
SUBD./P.I.D. 561.-?
Name: 14w,1d HrA Lp;
Phone* KSi"6r y 3
Wf MIT
Street Address, 176 o 4200-'4 4' "s 12"
City: Fa e/?y -? -State: h't Zip: Z39
CONTRACTOR Company: Phone #: `f 1-1 - 3 f
Street Address: 4S•c> `71rpob 6?: ?C-f License #: N 1' Sit'
City: z State: Zip: 47t-1 L 3
ARCHITECT/ Company: Phone M
ENGINEER
Name: Registration #•
Street Address-
City:
Sewer & water licensed plumber:
change are requested once permit is issued.
State:
Zip:
Penalty applies when address change and lot
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.
Signature of Applicant: ?d
OFFICE USE ONLY
Certificates of Survey Received _ Yes - No JUIN 2 6 19SE
Tree Preservation Plan Received Yes No
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Duplex ? 11 Apt./Lodging ?
? 02 SF Dwelling ? 07 4-plex ? 12 Multi Repair/Rem- ?
? 03 SF Addition ? 08 8-plex o 13 Garage/Accessory ?
? 04 SF Porch ? 09 12-plex ? 14 Fireplace ?
? 05 SF Misc. ? 10 --plex 15 Deck
WORK TYPE
? 31 New ? 33 Alterations ? 36 Move
? 32 Addition X34 Repair ? 37 Demolition
je£ Pc a ?L
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
Planning
Basement sq. ft.
Main level sq. ft.
sq. ft.
sq. ft.
sq. ft.
sq. ft.
Footprint sq. ft.
Building
Engineering
Variance
D
Permit Fee
Surcharge
Plan Review
License
MCNVS 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:
Valuation: $
r,
16 Basement Finish
17 Swim Pool
20 Public Facility
21 Miscellaneous
MCNVS System
City Water
Fire Sprinklered
PRV
Booster Pump
Census Code.
SAC Code
Census Bldg
Census Unit
% SAC
SAC Units
? aao oc?" 3?' :'?
JtJt,t• ]? ?
•
•
? o
o •
•
'
--? ---
? `ticc= -- -- -- - - - -•
- - •
-Aj
•
y
2005 RESIDENTIAL BUILDING PERMIT APPLICATION Qo
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Construction Requirements Remodel/Repair Requirements Office Use Onlr
3 registered site surveys showing sq. ft. of lot, sq. R of house; and all roofed areas 2 copies of plan Cad of Survey Recd _Y _N
(20% maximum lot coverage allowed) t set of Energy Calculations for heated additions Tree Pres Plan Recd _Y _N.
2 copies of plan shoving beam 8 window saes; poured found design, etc. 1 site survey for additions 8 decks Tree Pros Required _Y _N
I set of Energy Calculations Addition - indicate Bon-site septic system Ooslte Septic System _Y _N
3 copies of Tree Preservation Plan if lot platted after 711193
Rim Joist Detail options selection sheet (buildings with 3 or less units)
Date ) / Construction Cost ! 7s
Site Address ?i7ityn,, 1CCAVN LWI-? DC'V Unit/Ste If
l
or\
Description of Work ?(1lnV2, PXi coq PkY+k\ A3C,r a in6JF1 I gel) a j o Clpo/ //)r) ckr
lti
M
Famil
Bld
Y
N 2 I? nln?
1
Fi
l
0
-
u
y
g -
- -
rep
ace(s) -
-
Property Owner m c V N-k.KA Telephone # (&61) q 5g • &q j
Contractor ?1? pU1S OS
ry! .
_
Address `JCL E Trr.VF.?PCt TC7,;( S?P_ ?CX) City _ FX mw],J
State ?1f1nCSO Zip J?_53'j 7 Telephone#( cj a?/ ?, 5cs
1o
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeory I _ Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(J 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 pl in the case of work which requires a review and
approval of plans.
??rE R Z
Applicant's Printed Name 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 D 09 07-piex ? 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
? 32 Addition ? 36
? 33 Alteration ? 37
K 34 Replacement
?
Valuation .
Plan Review 100% or 25%
Census Code
SAC Units
# of Units
# of Bldgs
Type of Const
Int Improvement ? 38 Demolish Interior ? 44 Siding
Move Building ? 42 Demolish Foundation ? 45 Fire Repair
Demolish Building` ? 43 Reroof ? 46 Windows/Doors
`Demolition (Entire Bldg) - Give PCA handout to applicant
Occupancy MCES System
Zoning City Water
Stories Booster Pump
Sq. Ft. PRV
Length Fire Sprinklered
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
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
-? 1,/? I/? -I
2007 RESIDENTIAL PLUMBING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please complete for modifications to existing residential dwellings. 09f7
/S 11 JD
Date L 1 11 1 O l
Site Street Address -i,'11400 ?T&0- wNlkS 0r Unit #
Property Owner IxNuCU1\ VW(A Telephone# ((I5\ )L51.401tO
,( aNa Telephone # ( (pSS)12f
k
?k
ag A
Contractor ? t
, ?LVV t ?
y,"
`
Address ?it?l' Q OiyVQtX?QV\ y?? City Sm)A State M1'\ ZIP
The Applicant is: _ Owner Contractor -Other
Refurbished Submit 2 sets of plans and MPC license
New
Septic System County fee
Includes
_
_ g
Per as-built $ 10.00
Fire Repair (replace burned out fixtures, etc.) $ 90.00
Alterations to existing dwelling $ 50.00
Add plumbing fixtures. This fee includes installation of a water softener and/or water
_
heater at the same time. If you are installing onlv a water softener and/or water
heater, do not complete this section; move to the next section and check the
appliance(s) you are installing.
-Septic System Abandonment
Water Turnaround (add $136.00 if a 5/8" meter is required)
Other:
_ Water Softener Water Heater $ 15.00
new replacement
Lawn Irrigation _RPZ _PVB new -repair -rebuild $ 30.00
$ .50
State Surcharge
$ 16
Total
I hereby apply for a Residential Plumbing 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 plumbing codes; that I
understand this is not a permit, but only an application for a permit, work is not to start without a permit and work will be in
accordance with the approved plan in the event a plan is required to be reviewed and approved. ,
?k je- n?4 1y? ? Y _
Applicant's Printed Name Applican s Signature
(C2? o 7&
2007 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone If 651-675-5675 FAX # 651-675-5694
New Construction Requirements
3 registered site surveys showing sq. ft, of lol, sq. ft. of house; and all roofed areas
(20% maximum lot coverage allowed)
1 Soils Report if proposed building is to be placed on disturbed soil
2 copies of plan showing beam & window sizes; poured found design, etc.
1 set of Energy Calculations
3 copies of Tree Preservation Plan if lot platted after 711/93
Rim Joist Detail Options selection sheet (buildings with 3 or less units)
Minnegasco mechanical ventilation form
0,b(D
Remodel/Repair Requirements Office Use Onlv
2 copies of plan showing footings, beams, joists Cart of Survey Recd -Y _ N
1 set of Energy Calculations for heated additions Soils Report _ Y _ N
I site survey for additions & decks Tree Pres Plan Recd _Y _ N
Addition - indicate if on-site septic system Tree Pros Required y N
On-site Septic System _Y _14
Date CU
Construction Cost 9 0i , `i D
7
Site Address _ 1 /?
,
b o 7P-7-?-t7 / * //,s //? -/ l? Unit/Ste #
Description of Work W I MI)W f q lC-t ( rl'Yl -)I t ( 141
Multi-Family Bldg _ YN Fireplace(s) ? 0 _ 1 _ 2
n '
Property Owner / / "
(/ V y fh,(.;-/ 1
Telephone # (0 1) Q 3
Contractor Lln m 019V-4 f'?IfE1 6r?
'Address
112
4 R ifra if II
-
J p
;late A
`?`` kli
zip ?
j
Telephone if(?zs/j (1lyl' JCP,...
. S i
.
COMPLETE THIS AREA ONLY IF CONSTIi
Energy Code Category - Minnesota Rules 7670 Cateeorv I
Residential Ventilation Category 1 Worksheet
(J submission type) Submitted
Energy Envelope Calculations Submitted
A NEW BUILDING
_ Minnesota Rules 7672
• New Energy Code Worksheet
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 (c
Sewer/Water Contractor 7
Telephone # (
Telephone # (
Telephone #( 1
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.
IDGmLu?z Uexl7??l??gi?Y ?ICIZI °ll>°
Applicant's Printed Name Applicant's Signature
RESIDENT OWNER
Name: /It,J` )If) Phone: CS i.— 9 (cf3
Address City Zip: 3 760 Sct' L t i c t F...-
Applicant is: Owner Y Contractor
TYPE OF WORK
Description of work: F t i rkInl L, l re: \cir vet
Construction Cost: Multi- Family Building: (Yes No lc)
CONTRACTOR
Name: er ('k,,, k• )Sc,c License
Address: Ir;) o 30cJT''1 a ic„
City: `r v State:M/ Zip: X 6)4 Y
Phone: 6 1 2 -3 63 -.3 C;SS Contact Person: .0.0-t.
COMPLETE
In the last 12 months, has
No 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
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.
Tenant: Mix 1
Date:
icant's Printed Name
City of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
Site Address: 326o 14, I IS
o
cant's Signature
For Office Use
Permit
OCT V S 2009
Permit Fee:
Date Received:
Staff:
2009 RESIDENTIAL BUILDING PERMIT APPLICATION
Use BLUE or BLACK Ink
Suite
CALL BEFORE YOU DIG. Call Gopher State One Cali 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.org
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 ip the case of work which requires a review and approval of plans.
Page 1 of 3
SUB TYPES
Foundation Fireplace
Single Family Garage
Multi Deck
01 of Plex Lower Level
Accessory Building
WORK TYPES
New
Addition
Alteration
Replace
Retaining Wall
DESCRIPTION
Valuation
Plan Review
(25 100
Census Code
of Units
of Buildings
Type of Construction
REQUIRED INSPECTIONS
Footings (New Building)
Footings (Deck)
Footings (Addition)
Foundation
C'
Drain Tile
Roof: _Ice Water _Final
Framing
Fireplace: _Rough In _Air Test _Final
Insulation
Meter Size:
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S &W Permit Surcharge
Treatment Plant
Copies
Interior Improvement
Move Building
Fire Repair
Repair
TOTAL
DO NOT WRITE BELOW THIS LINE
Porch (3- Season)
Porch (4- Season)
Porch (Screen /Gazebo /Pergola)
Pool
Occupancy
Code Edition
Zoning
Stories
Square Feet
Length
Width
Siding
Reroof
Windows
Egress Window
PAL
Reviewed By: L- Building Inspector
MCES System
SAC Units
City Water
Booster Pump
PRV
Fire Sprinklers
r)i- '04
Storm Damage
Exterior Alteration (Single Family)
Exterior Alteration (Multi)
Miscellaneous
Demolish Building*
Demolish Interior
Demolish Foundation
Water Damage
*Demolition of entire building give PCA handout to applicant
Sheetrock
Final C.O. Required
Final No C.O. Required
HVAC
Other:
Pool: _Footings _Air /Gas Tests _Final
Siding: _Stucco Lath _Stone Lath _Brick
Windows
l` Retaining Wall: X., Footings Backfill X Final
Radon Control
Erosion Control
Page 2 of 3
LOT SURVEY CHECKLIST FOR RETAINING WALL
BUILDING PERMIT APPLICATION
Address: f r2 s':� ;e,fl'j (-11
/I5
DATE OF SURVEY: Pf f0
Applicant Name:
LATEST REVISION:
*Permits required for Retaining Walls 4 feet high or greater.
Y
0 z a, DOCUMENT STANDARDS
7 Registered Engineer signature and company
pr Building Permit Applicant
,12 Address
p- Legal description
Lot lines /Bearings dimensions
..F' North arrow and scale
2' Street name
,T Show all easements of record and any City utilities within those easements
,Z` Setbacks of proposed structure and side yard setback of adjacent existing structures
ELEVATIONS
.O Property corners
7 Top of curb at the driveway and property line extensions (only if wall is within 30 ft. of curb)
��7 Elevations of any existing adjacent homes
Adequate footing depth of structures due to adjacent utility trenches
,p' Waterways (pond, stream, etc.)
At the foundation of the building and /or nearest structure
PONDING AREA (if applicable)
p' Easement line
p' NWL
,0" HWL
V" Pond designation
p' Emergency Overflow Elevation
1 C� Pond/Wetland buffer delineation
Shoreland Zoning Overlay District
Y i Conservation Easements
RETAINING WALL INFORMATION
Location of Retaining Wall on property
Top bottom elevation at each end of wall and any change in elevation in between
Type of material (i.e. modular block, boulder, etc.)
Directional drainage arrows with slope /gradient
G:FORMS /Building Permit Application- Retaining Walls Rev. 5-4 -09
Reviewed By:/
Date /4/e7/A..)
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PERMIT
City of Eagan Permit Type:Building
Permit Number:EA133099
Date Issued:09/22/2015
Permit Category:ePermit
Site Address: 3760 South Hills Dr
Lot:5 Block: 2 Addition: South Hills 1st
PID:10-70790-02-050
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:
Census Code:434 -
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: 4,000.00
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 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 -
Murvil R Hurd
3760 South Hills Dr
Eagan MN 55123
(651) 452-6143
Craftsmen Home Improvements Inc
7455 France Avenue, #194
Edina MN 55435
(651) 430-1388
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA140530
Date Issued:12/28/2016
Permit Category:ePermit
Site Address: 3760 South Hills Dr
Lot:5 Block: 2 Addition: South Hills 1st
PID:10-70790-02-050
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.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
Surcharge-Fixed $1.00 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 -
Murvil R Hurd
3760 South Hills Dr
Eagan MN 55123
Angell Aire
12253 Nicollet Ave S
Burnsville MN 55337
(952) 746-5200
Applicant/Permitee: Signature Issued By: Signature
1
For Office Use
til/Li
,a ; � rrr :::::
,0 E AG N
,�/_
Date Received:
3830 PILOT KNOB ROAD ( EAGAN, MN 55122-1810
(651)675-5675 I TDD: (651)454-8535 I FAX:(651)675-5694 Staff:
buildinginspections(a�cityofeagan.com L
2018 RESIDENTIAL PLUMBING PERMIT APPLICATION
/
Date: 1 G Site Address: -3 ? 141/4-2-
Tenant:
4/camTenant: Suite#:
/
Name: fY IJ/�. Phone: 657- �5• —�i cef"7
l e11tiOwner
Address/City/Zip: 3760 2k
Name: /4,)(24 Ph Cf N 4S SLI o K License#: /2<, 6 4/4/G 11
} 9 / City: `�
Address:
P'1 State: /L(4) Zip:_ 7.5— Phone: 6.5/ Ly/-3S ?
Contact, Email:
NewReplacement —Repair —Rebuild —Modify Space Work in R.O.W.
Type 4f-lurk — —
Description of work: /2K-174- il.S/Z / 7
RESIDENTIAL
N eve*
X Water Heater
Water Softener
Lawn Irrigation(—RPZ/—PVB)
Permit Type Add PlumbingMain/ Lower Level)
Septic System Fixtures( —
New Water Turnaround
t Y Abandonment
RESIDENTIAL FEES:
$60.00 Water Heater, Water Softener, or Water Heater and Softener(includes State Surcharge)
$60.00 Lawn Irrigation(includes State Surcharge)
$60.00 Add Plumbing Fixtures, Septic System Abandonment,Water Turnaround*(includes State Surcharge)
*Water Turnaround(add$280.00 if a 3/4"meter is required)
$115.00 Septic System New(includes County fee and State Surcharge) TOTAL FEES$
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
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's
website at www.citvofeaqan.com/subscribe.
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. , I
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Applicant's Printed Name Applicant's Signature
FOR OFFICE USE
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PERMIT
City of Eagan Permit Type:Building
Permit Number:EA169688
Date Issued:06/04/2021
Permit Category:ePermit
Site Address: 3760 South Hills Dr
Lot:5 Block: 2 Addition: South Hills 1st
PID:10-70790-02-050
Use:
Description:
Sub Type:Fireplace
Work Type:Gas Insert
Description:
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home may require smoke detectors in all bedrooms. Chimney / flue must be inspected prior to
concealing.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Valuation: 3,000.00
Fee Summary:BL - Base Fee $3K $88.50 0801.4085
Surcharge - Based on Valuation $3K $1.50 9001.2195
$90.00 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 -
Joseph J & Nicole S Cornale
3760 South Hills Dr
Eagan MN 55123
Fireside Hearth & Home
2700 Fairview Ave N
Roseville MN 55113
(651) 633-2561
Applicant/Permitee: Signature Issued By: Signature