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4250 Stirrup St ~iTi .AaN WATER SERVICE PERMIT 3795 Filat Knov Road PERMIT NO.: Eogan, MN 55122 DATE: Zoning: No. of Units: Owner: Address: Site Address: ' C) T- Plumber: ~ Meter No.: Connection Chcrye: ' Size: Account Deposft: Reader No.: Permit Fee: I agree Po eweply wMh 1ha Citp of Eaqan Surthorge: Ordinanas. Misc. CFarpes: Total: , By Dote Pcid: Date of Insp.: Insp.: CIT16 OF EAGAN SEVVER SERVICE PERMIT 879'3 /'lloe Kud'# Ros/ PERMIT NO.: Eagen, MN 55122 DATE: Zoning; t No. of Units: Owner: . 1 Address: Site Address: Plumber: 1 pree M oomoy wiN tw Gry of Eagan Connectlon Charpe: Ordinanqs. Acwunt Deposit: ' PermR Fee: Surchorpe: ey Misc. Charyes: Dote of Insp.: Total: I nsp.: Dote Pa1d: vILuAQE QF EaaM SEWER SERVICE PERMIT 3795 Pil..! Kndb kood PERMIT NO.: ' Eague, MN 55122 DATE: ZOning' ~ No. of Units: 1 Owner: . - . v Address: Site Address: 1,771 _r,adc3le'ioz'ri - 4250 Stirn:o ~ Plumber: , I agroe to eomplr with tbe Villoge of Eegan Connection Chazge 375, f)) j)~' ~99/6/3 Ordinoncea. Account Deposit: i Permit Fee: Surcharge: , gy' Misc. Chazges: Date of Insp.: Totat: Insp.: Date Paid: PERMIT # ~ MECHANICAL PEqMIT RECEIPT # CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE CaNTRACT PRICE: PHONE: 454-8100 For Office Use Only: Sfte Address BLDG. TYPE WORK DESCRIPTION Lot Block Sec/Sub Res. New Mult Add-on Name a`? ~ _ Comm. Repair Address Other c Ciry • Phone FEE3- ~ Name RES. HVAC 0-100 M BTU -$24,00 c Address _ ADDITIONAL 50 M BTU - 6.00 p Ciry Phone (R~. HVAC INCLUDES A/C ON NEW CONSTRUCTION) GAS OUTLETS (MINIMUM - 1 PER PERMIT) - 1,50 EA. TYPE OF WORK COMM/IND FEE - 146 OF CONTRACT FEE Forced Air M BTU APT. BLDGS. - COMM. FiATE APPUES TOWNHOUSE & CONDOS - RES. RATE APPUES Boiler M BTU MINIMUM RESIDENTIAL FEE - ALL ADD-ON & Unit Heater M 8TU REMODELS - 12.00 Air Cond. M BTU MINIMUM COMMERCIAL FEE - 20.00 STATE SURCHAFiGE PER PERMIT - .50 Vent CFM $ (ADD $.50 S/C IF PERMIT PRICE GOES Gas Piping OuUets # BEYOND $1,000) Other FEE S/C: SIGN~ E~n~~YEE / 4 .~/l~~{ ' TOTAL ` FOR: CITY OF EAGAN - - r _ ' ~ ~ ~ ~ ~F • HO"U5E 4EATING TEST RECOR'D d `q,~ ADDRESS ~ APT. FLOOR' -CITY A SUB R . QCCUPANT OWNER ~ - HEAT LOSS DA E, ~ . ~~'G. INST. 2/0 - SOLD BY INSTALLED BY 04 Eleetrical Work By Gos Line 8y TYPE OF HEAT GA FA L HW STEAM SPACE HTR. UNIT HTR. OTHER GAS DE51GN CONVERSION MAKE ~ MAKE OF BURNER ' Mod.l µodel S-ial Max. BTU Ratinq INPUT ~ MAKE OF FURNACE Model CONTROLS THERMOSTAT Hwt Plup Vent Siz• Valv KIND OF LINER SIZE NONE Limit Draft Hood _ Reyulawr Limit Settiny Filtws Si:e um"r ~ Fan Sottiny Chimney Loeotion Insidr ~d• PiloT Trps Chimney Consfruction T /.js"5 /~7 Pilot Make f ~ Pilot Mode) ~ Smolce Bomb Wiriny Pilot Timinq- ~ D?aft T•st Tay L.W. Cut Off Door Pressuro Li9htinp Inst. Pnssuro Percent CO2 Date Tested Input CFH Pereent OZ ~ Company Testiny 51aek Tsmp. Porunt CO Name oF Tester Fwm 235 CASH RECEIPT CITY 4F EAGAN . \ 3795 PILOT KNOB ROAD ~ EAGAN, MINNESOTA 55122 ~ ~ ~ DATE 19 'p apsceIVco ~ FROM AMOUNT $ I Q & DOLLAR4 1oo CASH ? CHECK L `I~l lxw&rn 9o~ rOR FUND CODE AMOUNT Thank You BY White-Payers Copy ~ Yellow-Posting Copy Pink-File Copy CITY OF EAGAN Remarks Addition Saddlehorn Lot 7 sik 1 Percei~ owner street 4250 Stirrup state Eagan, ~ 55123 Improvement Date Amount Annual Years 4~• Payment Receipt Date STREET SURF. 1 S 1981 1944.00 0 ",•'X~ STREET RESTOR. 0 • ~ GRADING SAN SEW TRUNK JT`~ 1991 280-00 14-00 20 ,;(/O • UU * SEWER LATERAL ~ r WATERMAIN * WATER LATERAL 1981 WATER AREA STORM SEW TRK STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. 450. 00 34371 2-11-83 BUILDING PER. 135 87 252 5-75 sAC 375.00 8931 9- -73 PAR K DETACH AND RETAIN THIS STATEMENT THE AITACHCO GHECK IB IN PAYMENT OP' ITEMS DEBCRlBEO BELAW. IF NOT CORRECT PLEA6E NOTFY US PROMPfLY. NO RECEIPT OESIRlO. DELLIXE - FORM DVO-2 V-943 DEPT/ACCT 0718/BBO1 ? JUDGMENT SEARCHES r' 071H/BBO1 El ASSE88MENT SEARCHE9 0718/9409 D RECORDINO & CERTIFIED COPIES ~ I 0718/9409 EJ MORTOA[3E REGI8TRATION TAX 0716/9409 ? STATE DEED TAX 071B/9835 ? ABSTRACTiNO ~ ? ~ e ? . ~ ~ • . . . - ' _ r~-" , ^ ~ - _ . ' . . _ _ ?~~.~F' ~ ~ ,_4 a. .r~~,,. ~ - . " r'-~~ ~ r "-s " ~_`ys.`"~'ir~'?`'`r./";.~"i =ti. . ,r~'r ~ ~ \G ~ ~ o~ //c)ZSS'~ V ~ ~ S p~~ 7~ czzY oF F-AGara 3795 Pilot Knob Road Eagan, Minnesota 55122 PERMIT NO.: 611 The City of Eaga-n hereby grants to CoaaplQte i:uatinq ola Hii90, a HF.A T I Nt; 1 e r;ill t f or : ( Owner ) I:1.rchnar 765? 655,L83Sd - at.~2Sd i 4259 Stirzup ~ pursuant to application dated. 9/I3/74 P'es Paid: 680.00 da'ted this 9 day of DOc. 74 2.00 Su-ilding Inspector !'"ac: anical Per. mits: E."d 7.'otal: 3 r- ~38548 ,~,G1 ~ Reques~ Da~e Fire Na. Rough-in Inspection 7/ 28 / 89 Ro ~gd7 ~ 7p ReaEy Now ? WII Notity Inspeclor Wnen ReaM? I[a licensed contractor ? owner heraby request inspection of above electrical work at: Jo0 Aitlress (SVeel, Boa or Route No.) Ciry '4250 Stirrup St. Eagan Section No. I Township Name a No. Rarge No. CouMy Dakota OccupaM(PRINr) Phone No. Marjorie Maroride 681-1908 Power Supplier Atltlress 'Dakota Electric Co. 4300 220th St. Farmington, MN 55024 No. Eleclrical Contrecta (Cpnparry Nama) CoM173Z74 Total Electric, Inc. Maling Adtlre9e (COnVactor w Owner Melting Inslallalbn) 1537 92nd Lane N.E. Blaine, MN 55434 AWIroriEetl SiBnature (CoMrflcirn/Owner Makiny In9i911ation) PMna NumOer - ~ 786-8484 MINNESOTA STA7E BOARD OP ELECTRICRY THIS INSPECTION REQUEST WILL NOT 6rlggaMitlway Bldg. - Room S173 BE ACCEPrED BV THE STATE BOARD 1821 Onlvwally Ave., 51. Poul, MN 55104 UNLESS PROPER INSPECTION FEE IS Phono (812) 642-0BUO ENCLOSEU. /by9 REQUEST Fi LECTRICAL INSPECTION eaaaam-07 ( ? See insUUClions for completing this (orm on back ol yellow copy. P 38548 "X" Below Work Covered 6y This Request ew Add Rep. TypeofBUilding AppliancasWiretl EquipmentWired ' X H3me Range Temporary Service Duplex Water Heater Electric Heating Apt. Building Dryer Olher (Specify) Comm.Andustrial X Furnace Farm Air Condkioner Oiher (specity) CorOraclor's Rematks: CSmpute Inspection Fee Below: # OUier Fea # ServiceEnvanceSize Fee # Circuits/Feetlers Fae Swimming Pool 0 l0 200 Amps o to 100 Amps ~ TrensFormers Above 200 _ Amps Above 100 - Amps SignS Inapecmr§ Use Onty: ITOTAI Inigation eooms 15. 50 Special Inspection ! Alarm/Communication Olher Fee I, the Electrical Inspector, hereby RWgh-in oata certify that the above inspection has F„al oa been made. OFFlCE USE ONLY Tliia reQUeat vaid 18 moniRS hom s~/~"9 2420~,~~ Request Date R. No. Rough-in Inspection Requlred? ? Ready Now NWill NaHry Inspeclor 7 18 s 9 ? Ves No When Reatly? I~I licensed contractor ? owner hereby requeffi inspection of above electrical work at: Job qOtlress (SMeel, Box or floute Na.) City 4250 Stirru St Eacian Section No. I I Townehip Nem¢ or No. Range No. Couny Dakota Occupanl(PRINT) Phone No. Mar'orie Maronde 681-1908 PowarSupplier Adarass Electncal Conitactor (Company Nama) Contrector4 ticansa No. .Hilite Electric, Inc 040445 Mailing Address (COntrenor ar Owner Makiiy Installalion) 1953 Shawnee Rd E n Au~honz ig Nre (COn or 'n InsWlalio~) PMne Numbn 492-8886 NINf1E& 9~ -13""9LECTRICRV THIS INSPECTION REQUEST WILL NOT GM89e-0.1IOwey BItlB. - poom 5113 BE ACCEPTED BV TNE ST.4TE BOARO 7827 Unlvenity Ave., St Paul, MN 55109 UNLESS PROPER INSPECTION FEE IS Plrone (812) 842-0800 ENCLOSEO. - +'f~~t~//~cy REQUEST FOR ELECTRICAL INSPECTION ///ee 00001-07 * See inst`ruc[ions for completing this form on back of yelbw copy. y~a~3 P 24207 "7C" Below Woric Covered by Thrs Request ~ ew Atltl Reg. , Typeoi6uilding AppliancesWired EquipmeniWired Home Range Temporary Service Duplex X water Heater Electric Heating Apt. Building Dryer O[her (Speciy) Comm./Industriai Furnace Farm Air Conditioner Olher (specity) Contractor5 Remarks: Campute Inspection Fee Belaw: Job 20789 fF Other Fee # ServiceEntranceSize Fee # Circuds/Feedere Fee Swimming Pool 0 to 200 Amps 0 t0 100 Amps ~ Transfortners Above 200 _ Amps Above 100 _ Amps ' Signs Inspecror's Use only: ~ TOTAI trrigation Booms /J „UG 15 . 50 Special Inspection Alarm/Communication Other Fee .50 I, the ElecVical Inspector, hereby AO°9n-'" oare certify that the above inspection has Fmai o been made. 1112 0 431 OFFlCE lISE ONLY • This reques[ wid 18 months fmm EAGAN TOWNSHIP BUILDING PERMIT N° 3125 Owne: _"""'-.'_._J.__~i.v'...`- Ea9an Township Address (presen!) ......L~' l'c...~ Towa Hall ~ . Builder ........--......_......pre:",.r.`.............................__.....-"_--'........ ~y Date "ti..-_7a3 Address DESCRIPTION Sfories To Be Used For Fron! Depth Heighl Esi. Cosi Permi! Fee Remarks ,57. o a . ` T 7, LOCATION G G ~ e-e Slreel, Road ot oiher Descripfion of Locafion I Lo! Bloek Addifion or Trae! :~,~a-Sa ,~-~-t-•;p ,~r. '7 / ~~.,r~~-~,..J This pesmit does aot sulhoxise the use of alree2s, roads, slleps or sidewalks nor does it give !he owaer or his ageat the xigh!!o ereaie any situation which is a nuisanee os whieh presen}s a dasard fo the healfh, safelp, aonveaieaee aad general welfaze !o anpone in the eommunilp. THIS PERMIT MUST BE KEPT ON THE PREMISE WHILE THE WOAK IS IN PAOGRESS. Tbis is !o eertifp, ilfa!..... /6.~----- has permiasion !o ereet a..... ........_upoo the above descri6ed premise subf eM fo the provisions ot the Suilding Ordinanae for Ea~Township adopted April 11, 1955. U'-.°-=e.' n Pei .............._............"I`Q_~:e~"'..........:""'._...___ ' Chairm of Tnwn Board ~ . Sullding Inapeclor ~/3 PERMIT NO. Eagan Township q ~ . . . ~ . . Dakofa Counly. Minnesola . . . ~ Dale ! - . . . . . Applicatian for Bailding Permit Tppe of 6uilding os work conlemplaied. Circle eorrec2 ~deseriplions. esidenfi Commercial Indusfrial Other................................. " ~ - uild Enlarge ~ Alfer Aepair, Im2e11 Move Wreck... 01tiex....... . Dimensions........ ~..l..--.2-------- _ Cosi Defails~or remarks._..._...._~::!ct'.....`° ~ . . . ~ ' . ~ . ' .'v _ Localion Number Sireef $elween whet crose sireeis Siso Esf. Valualion ~ ~7 d-u-~ f- ~ Loi Bloclc Addition Reurrangemeat or Trac! ~ j°(2 ~ 74 S ~ 7 Q..'-c- ~ Owner ./.~..~.'~..."~'~---<:4~.......... Addsess .l'..4._4lcFa /c .~r..... -r'1 Coniracior --rv.------------`-....... Address - - . i~ ~ _ ~ •i ' L6-e,, " 4 7 r'v . ~ ' . . The uaderaigaed hereby makes apnlieation for a permi! !o y y./.3 ao Wo:k ea herain 'specffIed, agreeing !o do all work in slrie! Tofal !ee oolleefed. aeeordanee with !he building ordinanee adopled April 11, 1855 bp !he Eagan Township Board of Su ervisors. . . • ~ - ; Permit~ fees aze no4 ' refundable. . - ~ . ~.-1.../- ~ ' , . . : - _ - Si4ned - . ' VILLAGE ON EAGAN 3745 Pilot Knob Road Eagan, Minnesota 55122 PERMT NO.: 4o9 The Village of Eagan hereby grants to w,.;.eI ni,,,,,hi„e r. pantine ine, of gGnn rpmNpnxr nrIva, paoan, MN 55122 8-•FbwlB3liG-.-- Permit for: (Owner) H_ Kirahn~r at -A26e 64ivmW , pursuant to application dated 1L5/73 Fee Paid: _00_ dated this 1?th day. of mnv , 19 73 . .50 s/o Building Inspector Mechanical Permits: Bid Total: ' . 7- / CITY OF EAGAN 3795 Pilot Knob Road Eaga.n, D2innesota 55122 PERNffT NO,: 189 The City of Eagan hereby grants to Bisson Well Drillinq Oo. of 3600 Kennebec Drive, Eaqetn 55122 a WELL Permit for: (Owner) ICirchner Construction at 4250 StirruP St. ~ pursuant to application dated 2/26/74 Fee Paid: $10.00 dated this26th day of February ~ 19 74 , .50 s/c Building Inspeetor Mechanical Permits: Bid Total: 7_ / VILLAGE OF EAGAN 3795 Pilot Knob Road Eagan, Minnesota 55122 PERMIT ND.: 174 The Village of Eagan hereby grants to Roa Icisling o£ 9735 So. RobertTRail, IGS 55075 aSep±ie 2anti 6 ceae. Permit £or: (Owner) Kircbner at Wp gtirrap , pursuant to application dated 11/30/73 , Feo Paid: 510.00 dated this 3rd day.of Dec. , 79 73 . .50 a/a Building Inepector Nechanical Permits: Bid Total. NOc~1. ~.F7_!... ? Eagan Township PERMIT Dakofa Counfp. Minneso3a Daie AppGcation Eor Bnilding Permit ; Tppe of 6uilding or work conYemplated. Cixcle correci descriptiona. - deniia> Commereial Iaduslrial OSher....-------'---- E_~ vild Enlazge AIYer Aapair Inslell Move Wseck Oing~_-I - ~ Dimensions---.'.....-.----. Cosi:A-F Defails os remarks............................. Locafion Number Siree2 Baiween what cross sireefs Siae Esl. Valuation Lo! Bloclc Addit?on Reaxrangement or Tsaef -I 1 sa~a~.~ A :',n Owner-L\160._."_S~~~__.'..... ' - Address o Confraolori Se,\ v....... Address 5_ctvr-2_ The undersigned hereby makes apnliaafion for a permif !o do work as herein specified, agreeiag Yo do all worlc in siziei aeeordence wiih !he building ordinanee adopted April 11, 1955 To ee collecled. by !he Eagan Township Soard of Supervisors. Permif fees are aoY xefundable. . . Signed / RESIDENTIAL BUILDING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB RD, EAGAN MN 55122 851-881-4875 New Constructlon ReaulremeMS RemodeVHeo91r Reauiremems • 3 registered sile sunreys shaving sq. lt. of bt, sq. 8. ot nouse; and gll roofed areas • 2 copies ot plan (200% maximum 1ot cuverage ailowetl) • 1 set of Energy Cakulatbns tor heate0 addXlons . 2 copies of plan showing Oeem & window sizes; poured found design, etc.) • 7 sile sunrey for exlerbr adtlabns & decks • 1 set W Energy Cakulatbns - • IndMxte il Fwme Servetl 6y septic system lor addltions • 3 coples ot Tree Preserrdtbn Plan il lot platted aflar 7/1/99 • Rim,blstDetailOptlonsSelectlonsheet(bltlgswXh3orlessuni[3) DATE VALUATION $'5,70`00 ~ SITE ADDRESS MULTI-FAMILY BLDG _ Y _ N NPE OF WORK ljt~QIIA(b ~ FIREPLACE(S) _ 0_ 1_ 2 APPLICANT ~ l i r'1 /~n[,~ ~l4-(~ W 61~. STREETADDRESS B400- $q~ ~-().2 o Pi-K STATE/ ZIP TELEPHONE # 13- 40LZ~LL PHONE # FAX # '~j TELEPHONE # PROPERTY OWNER i~ 1~17J 0 COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category _ MINNFSOTA RULES 7670 CATEGORY 1 MINNESOTA RLR,F.S 7672 (4 submisaion type) • Residential Venlilation Category 1 Warksheet Submitted • New Energy Code Worksheet Submitted • Energy Envelope Calculations Submk[ad Plumbing Conhqctor: Phone # Plumbing system includes: ~ Water Softener _ I.awn Sprinkler Fee: $90.00 ~ Water Heater _ No. of RI. Baths _ No. of Baths Mechanical Contractor: Phone # Mechanical system includes: _ Air Conditioning Heat Recovery System FN~MAY Sewer/water Conhactor: Pt~one # 2 1 2002 - - - ~ ~ I hereby acknowledge that I hove read this application, state th nformation is corr c#Y, an ~gree to compry with qll appllcable State of Minnesota Statutes and Clty of Ea n Ordlnances. r Signature of Appll aM _._~...r .~...r.~_s_..... OFFICE USE ONLY Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _ Updated 4l02 OFFICE USE ONLY O 01 Foundation ? 07 OSplex O 13 16plex ? 20 Pool ? 30 Accessory Bldg O 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (&sea.) ? 31 Ext. Alt - Mufti 0 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Poroh/Addn. (4-sea.) ? 33 Ext. Aft - SF ? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Poroh (screened) ? 36 Multi ? OS 03plex ? 11 10.plex ? 19 Lower Level ? 24 Storm Damage ? 06 04-plax ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous ? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding ? 32 Additlon ? 36 Move Bldg. O 42 Demolish (FOUndation) ? 45 Fire Repair ? 33 Alteration ? 37 Demolish (Btdg)" ? 43 Reroof ? 46 WindowslDoors ? 34 Replacement *Demolition (Entire Bldg only) - Give PCA handout to applicaM Valuation Occupancy MC/ES System Census Code Zoning City Water SAC Units Stories Booster Pump Nbr. of Units Sq. Ft. PRV Nbr. of Bldgs Length Fire Sprfnklered Type of Const Width REQUIRED INSPECTIONS _ Footings (new bldg) FinaUC.O. _ Footings (deck) FinaUNo C.O. _ Footings (addition) _ Plumbing _ Foundation HVAC _ Drain Tile Other Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests _ Final _ Framing _ Siding Stucco Stone _ Fireplace _ R.I. _ Air Teat _ Final _ Windows (new/replacement) _ Insalarion _ Retaining Wall Approved By , Building InspeCtor Base Fee . Surcharge Plan Review MC/ES SAC City SAC Water Supply & Storage S&W Permit & Surcharge Treatment Plant Plumbing Permit ' Mechanical Permit License Search Copies Other Total 3 i ~ ..sf ~ A-) ~ ~ , ~ 30' o._ pA Vty c ti l 'Goo 1w,4v/9c !s - CITY of EAGAN N4 3587 BUILDING PERMIT Owno: y/J,r 3795 Pilo1 Knob Road '••••-•-:•n.l~~s .J~.~`'~e.l........ Eagan, Minnesofa 55122 Addsess (prasens) .....~7..~.5..~....nrrA..C..'r.elo 459-8100 Butlder rel~ J..9...~,.~" D e:. Addxeea DESCRIPTION Aemarka Sioriec To Be Used Fos Fron! Depih Heigh! Eel. Cos3 M7"71~06' ara~ P 29 z.9 pO ~ int ~ ~D lf ed? . LOCA TION Sireef, Road or oiher Deacriplioa of Loealion I Lo! Block Addilion or Traet 4~50 ,~'~rv~D ^7 / T6is pesmii does not eulhorise the use of slraeic, roads, alleps or sidewelks no: does it give !he owner or his agea! !6e sighi to areate anp situazion whiah is a nuisanee or whieh presenls a hazard fo the healffi, safety, eoavanienes and general melfare !o anpone in the eommunilp. THIS PERMIT MUST BE M~n~ON S TH~ A~I~RE WHIh~ Pe ~~O nR=I~Se N PaOGRESSQ. ~ _ uP~ This fe !o cerliip, !hal..,,~. . ~/y~ the above deseribed premise su6jeei !o the provisions of al1 applicable Or ' ances for !be Cily o a an . Per .........n . --~.........~.(..~_~.~..Y........_°-°-° ° Ma or Buildinp Iaspector , . . MASTER CARD LOCATION . -I OWNER ~ f STRUCTLIRE AND ^ , f IAND USED AS ( JC Issued To Permit No. Issued Coniractor Owner BUILDING PLUMBING CESSPOOL - SEPTIC TANK WELL ELKTRICAL HEATING GAS INSTALLING SANITARY SEWER OTHER OTHER Approved Items (Initial) Date Remarks Distance From Well FOOTING FOUNDATION CESSPOOL FRAMWG 6 TILE FIELD FT. FINAL E I_ECTR I CA L DEPTH HEATING OF WELL GAS INSTALLATION SEPTIC TANK CESSPOOL DRAINFIELD PLUMBING WELL SANITARY SEWER - Violations Noted on 8ack COMMENTS: ~ . COMPLIANCE INSPECTION REPORTS TO BE USED ONIY IN EVENT OF OBSERVED VIOLATIONS PERMIT NO. DATE OF INSPECTION CONDITIONS OF CONSTRUGTION AT THIS INSPECTION NO EVIDENCE OF NON•COMPLIANCE NON-COMPLIANCE. BUILDER DOES NOT ~ OBSERVED. ~ INTEND TO COMPLY. ACCEPTABLE SUBSTITUTIONS OR DEVIATIONS. ? COMPLETION OF CERTAIN IMPROVEMENTS WILL 8E DELAYED BY CONDITIONS BEYOND CONTROL. ? NON-COMPLIANCE. BUILDER WILL COMPLY WITHOUT DELAY. ITEMIZED AND DESCRIBED AS FOLLOWS: ? REINSPECTION REQUIRED DATE OF REINSPECTION REINSPECTION REVEALED CE RTI FICATION - I cenify that I have carefully inspacted the above in which I have no interest present or prospective, and that I have reported herein all significant coPditions observed to be at variance with ordinances of the Town of Eagan, approved plans and specifications, and any specific require- ments for *site improvements relating to the property inspected. r-I ALL IMPROVEMENTS ACCEPTABLY COMPLETED BIJILDING INSPECTOR DATE COMMENTS: MASTEft CARD LOCATION 42 5D vYL OWNER STRUCTURE LAND U ED ASD *A Issued To Permit No. Issued Conirac}or Owner BUILDING 3125 9~5~13 PLUMBING t~o L~ CESSPOOL - SEPTIC TANK VJELL ELECTRICAL H EATI NG GAS INSTALLING SANITARY SEWER OTHER OTHER I Approved Items (Initial) Date Remarks Distance From Well FOOTING /-,J-74 $EPTIC FOUNDATION _ ~ d CESSPOOI --=-~-z FRAMING TILE FIELD FT. FINAL ELECTRICAL DEPTH HEATING ~ OF WELL GAS INSTALLATION SEPTIC TANK CFSSPOOL DRAINFIELD PLUMBING ' WELL SANITARY SEWER - Violations Noted on Batk 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 ~ NON-COMPLIANCE. BUILDER DOES NOT OBSERVED. INTEND TO COMPLY. ? AGCEPTABLE SUBSTITUTIONS OR DEVIATIONS. ? COMPLETION OF CERTAIN IMPROVEMENTS WILL BE DELAYED BY CONDITIONS BEYOND CONTROL. ? NON-COMPLIANCE. BUILDER WILL COMPLY WITHOUT DELAY. ITEMIZED AND DESCRIBED AS FOLLOWS: ? REINSPECTION REQUIRED DATE OF REINSPECTION REINSPECTION REVEALED CERTIFICATION - I certify that I have carefully inspected the above in which I have no interest prasent or prospective, and that I have reported herein all significant conditions observed to be at 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 Bl11LOING INSPEGTOR pATE COMMENTS: ~ • ORDINANCE No. 114: Permi[ No. .'?F:.T.'., CONSTRUCI'ION AND ABANDONMENT WELL PERMTT 91-9042 DAROTA COtTNTY POBLIC HEALTH DEPARTMENT ENVIRONMENTAL HEALTH SERVICEB SECTION WATER QIIALITY MANAGEMENT IINIT ~ 14955 Galaxie Avenue, Apple Valley, MN 55124 Telephone: (612) 891-7556 WHEREAS, the NON-TRANSFERAHLE PERMITTEE/DBAs Kimmes-Bauer, Inc. ISSOED TO #19521 ADDRESB: 21830 Lillehei Ave. REVIEWED BY Worku Hastings, MN 55033 has submitted a permit application, has paid the sum of one hundred ($100.00) dollars to the County of Dakota as required by Ordinance Number 114 and has complied with all of the requirements of said Ordinance necessary for obtaininq this permit to permanently seal the well(s) described herein: An abandoned well(s) with a casing diameter of 4 inches and depth(s) of 180 feet will be permanently sealed. The well(s) shall be cleaned of equipment and debris, disinfected, neat cement pressure grouted and terminated at least two feet below grade. The well is located in the municipality of Eagan as follows: - Well Location: Property Owner and Well Owner and I Address (if 8ifferent) Address (if different) 4250 Stirrup Str. Kim & Honey Maronde Eaqan; MN- 55121 NOW, THEREFORE, Kimmes-Bauer, Inc. is hereby permitted and authorized to permanently seal the well(s) described and located above for the period )April 1991 to April 1992 subject to all provisions of said Ordinance; the Minnesota Water Well Construction Code and any conditions attached on the reverse side of this permit form. Given under my hand this 18th day of April, 1991. ATTEST ENVIRONMENTAL HEALT14 RVISOR E NM TAL HEALTH DIRECTOR M (~'SBoo o7o o / 04i15/91 09:43 DFfdDTR COLMTY-WESIERN SERV. CTR. 002 ! ~ DAKOTA COUNT Y p~LI~CHEALTAMNDI E~ ~N ' (612)450•2814 PUBLIC NHALTTI DEPARTMENT COMMUNITY SEFtYICES DIVISiON Puuuc t7eailh Nutslnp l F~g@Ij[t EmergenCy MEdiCdl ~ • ~j.^r:• Bervices 6ervices ~ ' ru~.ro: • 1 CNmlha6n.w.G~4~N7aemwrvc~Gnb ' ~ S1E~MVM1nlwwlhAK~w 1~¢~pU0NF1lIWMIU! . ~ . , YMI GL hul. MN:r611! 11pp1o VoNY• Mry Ds I26 ro12) m.teoo . r::16lnf+sacwe , ~..ceioMw4n ! . { • ' • DAKOTA COiRiTY PUSLIC HEAI,TH DEPAATMEPT - WATBR QUALI7'Y MANAGFMENT WESiBRN $SRVICC CENTEti. 14955 Galdxie, Ave. WeBt, Appla Vwllay, HN 55124; (612)891-7556 . . . PAC$YMILx (612) 891-7473 i . I2t1NICI1'AL NOTICF OF WELL P,6R14IT APPLICATYUN, BEND xo: 'roloi. 4616trj /•/aAn G~ " nsisv_ MUt1tCIPAZ,zTx: jt;~ 45qn ~ OFFICIIS 7EI,EPHOIiE:~ ~ BAt;SI:MILE: (JIL) S4' : ~ . . . ~ FROM:_$arFrofnL lliotlOVk.w IPSYECTOR A~TBL$PNDNEs. (Q2-) VI1-7C4-f'] . ! DATE/TINE FORWARDEA:~lIS COHtENTSt . RMR TO WELL PERMIT N0. Q DAKOTA COUNTY VJAYER QUALITY NpNAGIIMLNT HAS RECSIVED Z'HE WELL YL+RMIT APPLICATION(S) DS- ~ 6CRI9Ep BfiLOW. PLEASE ttOTE: IF YOU RBQUIRE FSIaTt1ER 1tLVTL~IJ UF TNIS AYYLICATION(S) OR ~ - ' IF YOU llAVB ANY QULfiTLONS OR CONCHRNS ASDUT IT, GON'1'ACT VUR OFPICE AT 891-7536 OR T.HE I j ENVIRONMENTAI, HEpL71i SPECIALIS7 LI5TED ABOVG. IP 'fRBRS 15 NO 1tS5YDN5L+ FftOM YOUR OFFICB 1 NITHIV 24 HOURS (EXCLUDING WEGKENDS pNU HOL2UAXS), STAFF WILL A3SUME T[iAT YOU NAVE NQ OHJECTIONS TO 1`HE ISSUANCE OF SSB PBRMIT. ALSO PI:kAS1i Nt7L'L' 'flfAT PERMIT ISSUANCE IS ALWAYS CONDITIONSD ON THII 085ERVANCE OF ANU COMPI.7.ANCB WITH ALL APPLIGASLE LOCAL RE- QUIRE?]ENTS ANll ORDINANCES. A COPY OF TkiII WELL PP.RMIT WILL SL FORIdA1tDED WEiEN COMPLETBp. f PROPSRIY OIQNER: M+Qr' µ~wM Mi6roAof. WELL ONNER: LOCAIlON OF W}tLL(S): ADDRESS 421%p S~j~rru~ Ala,TwItnp?n. PAOPERTY ID W0. CbO1tUINATLG: OF OF__~ON#WON SLCTIUN ZS YDS~*,1SHIP~1'Z71f/ NORTH, AANGi%LWTSST. MONICIPALITY: ff'/l ryI!' h WELL DRILLERS ~~M1yM6S'r DATE ECORDEAs _ 11Cr ~ ~ ANTICIPATHD DRILLING/SEALYNG DATE (IF HNOWN): ' • WELL(6) DESCRIPTION: P1tIMARY USE NEW CUNSTRUtITION REtiONSTitUCTION • i ~ ~ TE`fPORARY CA1'PZNG_ PHRMANENT SEALING.X ANNOAL MAINTBNANCB: RECLAIPILU REGISTEESD_ ~ WELL DIAMSTL*R.+ INCHES. WELL DEPTA~,F~ET. AQUIFER S!~4ru( 4' a`~wfE. • I ; NOT65 - i . . AN BWAL OPFOk1UFlITY EMi'LOYER . - • OUTSIDE WORiC ORDER FRO:-1: Kathy of Chicago Title Insurance Company 60 F.Ast 4th Street ' St. Paul, Minnesota 55101 Telephone: (612) 227-7226 TO: city o aaan 3795 Pilot Knob Road St. Paul, Minnesota D=Yi'E: 7-5-77 RT': FILE NO. 78955 Legal Description: Lot 7, Block 1 Saddlehorn Addition, Dakota 10 65800 070 01 Ad ress: 4250 Stirrun St. Please Search the records of: ( ) Dakota County ( ) City of bag7n an3 furnish the following information in connection with the above: (NOTE: Furnish only that information indicated by "X") ()[-Iake new abstract covering above legal description r:ake new RPC coverinq above legal description Continue abstract covering above legal description (Abstract enclosed) ( ) tlake no searches ( } Delinquent Tax Taxes for the year 19 Total Amount Homestead Base Tax Non-Homestead Not Paid District First Half Paid Plat Paid in Full Parcel (X) The unpaid amount of levied assessments, including any interest due. NONE (X) The amount or approximate amount of pending assessments for local improvements. NONE ( ) Suater Tax Easenents as shown on the recorded plat. ( ) :tudgments ( ) Bankruptcies ( ) Federal Tar. Liens on the following: Such search discloses the following: Judgm°nts Bankruptcies Federal Tax I,iens Chec}: for $ 5.00 _ is enclosed.PAID O Send statement to pay if there is a charge for the above requested information. rrOTE: If more room is needed than provided on form, use reverse of the this form and indicate that reverse is used. SEE REVERSE. T hereby state that the above is, to my knowledge, a true and correct L; tateme-!t. IIY Ann Goers Assessment CLPrk _DATE1"1),T1977 CTI i-111 (6-72) :II31:::: YCL'. 7i LEO MURPHV TMOMAS MEOGES MAYOA CITY AOMINISTNATOw \l %fl.RJL ~~/C•/V ALYCE BOIKE THOMh3 EGAN CI7Y ~LEpK MARK PARRANTO JAME$ A. sM,rH CITY OF EAGAN TMEODOHE WACHTEP COUNCIL MEMBlN$ . 3786 PILOT KNOB ROAD . EAGAN. MINNESOTA 55122 PMONE I54-8100 f ~ YmLE~IFebruaxy 9, 1979 Mr. GYaig Dahl 4250 St'mup Eagan, M 55123 Dear Mr. Dahl: While driving through your area on FYiday, Decanber 9, 1979, we noticed . what could kie an extrenely hazardous chiamey installation that crould cause a bad fire. I would like to be of assistance. Please oontact me at the Eagan City Hall, 454-8100. Sincerely, CITY CE FIK'~AN ~ ~ Doug Reid L. Fagan Fire Marchal DR:tp THE LONE OAK TREE TME SYMBOL OF STRENGTH AND GROWTM IN Ol1R COMMUNITV. Add-re ss, 4250 Stirrup St., Eaganfj-~~ Date 3-29-77 Owner: ' Order No. TD 22360 Buyer: Bartel ~ GENTLEMEN: PLEASE COMPLETE T$IS PENDING AND/OR SPECIAL ASSESSMENT SEARCH AND KINDLY RETURN IT TO US ALONG WITH YOUR STATEMENT OF CHARGES T0: NORTH STAR AQSTRACT & TITLE GUARANTY,In NORTH STAR ABSTRACT & TITLE GUARANTY, INC. 204 Skyway North American National Dank Complex ST. PAUL,tdINNESOTA 55101 SPECIAL IMPROVEMENTS On all that tract or parcel of land lying and being in Dakota County, Minnesota, described as follows to-wit: Lot 7, Block 1, Saddle Horn Addition 10 65800 070 01 Dakota County l --SPECIAL ASSESSMENT This is to certify that have examined the records in the office of the Clerk, Village/City/TOwnship of Eagan , Dakota County, Minnesota, and from such searc certi y t at t e ol owing specia assessments appear unpaid with respect to the above described tract or parcel of land: (If none, write "NONE".) Total Amount Unpaid Original Subsequent to Kind of Improvement Term Seginning Amount Interest Current Year NONE PENDING ASSESSMENTS I further certify tha ecords of said office, the following improvements are contemplated•or pending in council, and.are now im the.process of planning or completion: (If none, write "NONE".) • Approximate Date of Approx'imatre Cost Kind of Improvement Confirmation or Completion., of Improvement NONE.. . . . , • Dated thia ~ day of April , 19 77 . Ann Goers, Assessment Clerk C er Charge of $5.00 paid Village4nvTownship of EAGAN *Note: The above total amounts unpaid subsequent to current year may be paid between: January 2nd and May 31st with no interest June lst and September 30th with 1/2 year interest October lst and December 31st with full year interest NS-TI 116 City of Eagan 3830 Pilot Knob Rd Eagan, MN 55122 (651) 675 -5675 www.ci.eagan.mn.us Site Address: 4250 Stirrup St Lot: 7 Block: 1 Addition: Saddle Hom PID:10- 65800- 070 -01 Use: Description: Sub Type: e- Reroof Work Type: Replace Description: House & Garage Census Code: 434 - Zoning: Square Feet: 0 Comments: If there is no ice protection inspec acceptable in lieu of inspections. Fee Summary: Valuation: 3,000.00 Contractor: New Life Contracting Inc. 2478 Hillwood Dr E Maplewood MN 55119 (651) 274 -6943 PERMIT City of Eaan BL - Base Fee $3K Surcharge - Based on Valuation $3K Total: Applicant/Permitee: Signature - Applicant - Construction Type: Occupancy: Permit Type: Permit Number: Date Issued: Permit Category: Building EA086777 10/10/2008 ePermit on prior to final, you must meet inspector with ladder and flat bar. Pictures are not $88.50 0801.4085 $1.50 9001.2195 $90.00 Owner: Michael W Dahl 4250 Stirrup St Eagan MN 55123 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 Issued By: Signature City of Eagan 3830 Pilot Knob Rd Eagan, MN 55122 (651) 675 -5675 www.ci.eagan.mn.us Site Address: 4250 Stirrup St Lot: 7 Block: 1 Addition: Saddle Hom PID:10- 65800- 070 -01 Use: Description: Sub Type: e- Reroof Work Type: Replace Description: SEE COMMENTS Census Code: 434 - Zoning: Square Feet: 0 Fee Summary: Valuation: 3,000.00 Contractor: New Life Contracting Inc. 2478 Hillwood Dr E Maplewood MN 55119 (651) 274 -6943 PERMIT City of Eaan BL - Base Fee $3K Surcharge - Based on Valuation $3K Total: Applicant/Permitee: Signature - Applicant - Construction Type: Occupancy: $88.50 0801.4085 $1.50 9001.2195 $90.00 Owner: Michael W Dahl 4250 Stirrup St Eagan MN 55123 Permit Type: Permit Number: Date Issued: Permit Category: Issued By: Signature Building EA087028 10/22/2008 ePermit Comments: 10/27/08 New Life pulled 2 E- permits for roofing for this address. We will put a cancel date on this permit after month end They said they would call and exchange this permit for another address. If there is no ice protection inspection prior to final, you must meet inspector with ladder and flat bar. Pictures are not 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 PERMIT City of Eagan Permit Type:Building Permit Number:EA136534 Date Issued:05/18/2016 Permit Category:ePermit Site Address: 4250 Stirrup St Lot:7 Block: 1 Addition: Saddle Horn PID:10-65800-01-070 Use: Description: Sub Type:Windows/Doors Work Type:Replace Description:Two or More Windows/Doors Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow windows, call for framing inspection. Call for final inspection after installation. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State 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 - Michael W Dahl 4250 Stirrup St Eagan MN 55123 Great Lakes Window & Siding 14690 Galaxie Ave Apple Valley MN 55124 (952) 891-3400 Applicant/Permitee: Signature Issued By: Signature For Office Use : Permit#: kg,- * # 0* t * ,,,,,# i I 7 . ,A, ... z.,a ...... -..„-, Permit Fee: Date Received: 1 3830 PILOT KNOB ROAD I.EAGAN, MN 55122-1810I'S „.„,i . 44 1 7 (651)675-5675 I TDD:(651)454-8535 I FAX:(651)675-5694 Staff: 'filii- I I nu I idinqinspectionsCacitvofeagan corn L. _ _ ._, APR 25 7018 2018 RESIDENTIAL BUILDING PERMIT APPLICATION Date: 04/25/2018 4250 Stirrup St Site Address: Unit#: 1I Name: $ 4' •ft AV:A 47.'1 , Michael & Linda Dahl 612-919-7418 Phone: , Address/city/zip: Eagan, MN 55123 1,,,„A,A,,,,,N.4,,.'4,:ii• , .,-$., r „,,,„, ,tifill 4. 10 .. ,,4 .FFE. ..:-...---, ... . . i,414, tit 1,.,,,,,,,i,:j ih,,„ Applicant is: Owner Contractor , r,4IIII;I:.1111114. its-It:44 0:4%.40/4'4•114,kt. . .firtArqf at Description of work: Bathroom Remodel See Drawing For Details li,„,,A):1°31.40.1•11119-,-,.11; 4000 :T ,i Construction Cost: Multi-FaffillY Building:(Yes /No Company: Great Lakes Window & Siding Contact: Derek ,-.. . Address: 14690 Galaxie Ave Apple Valley . City- .i,lizomi,4440041 i-, sz-4-% mN Zip: State: 55124 Phone: 952-891-3400 Email: derek.gjvvsco@gmaii,00m A 0. kkk , , kkkIk4117'S 1 License#: Lead Certificate BC060427 NAT-23297-2 #: If the project is exempt from lead certification, please explain why: - - COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months,has the City of Eagan issued a permit for a similar plan based on a master plan? _Yes No If yes,date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer&Water Contractor: Phone: Fire Suppression Contractor: Phone: st---..-4.p-,?,4,4',04,1,4304,03'A.14-4744.04',4,R 4 0444W^i",AK.A:...,,,,,***els*"4 .,.t*N.R.',4•94004.074.041%,-OW,.:, ••.!•• .*,.:R.•.s.•;;.,,.........x....A.I.vtz 7;4,...,4,,A.A.....4......,.t.....,7,...,...„:-.! .-,- '-'.,-.4..,,,L44.4,,':,,•.. ia:.,4';:„:,....'.1.,..E.I.'Z.,-', ...4 4.'„,,,,,4,;..: - ...AI,,...;444,..A.f.:f,;,,„.;.:.„4:.,.4....,<444 I.:4...2"tt '.. ': ...........-...., ...t..---A-.. :VA..'....A--,*...A-;`=.`Al 014',`--1:. .'.•,.-.,‘:',...z.A.;.4,e 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.citvofeapan.comfsubscribe. Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 days of permit issuance. CALL BEFORE YOU DIG. Cali Gopher State One Can 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.gooherstateonecall 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 accord ce with the approved plan in the case of work which requires a review and approval of' x i ir't k, /13.- 4,..Ile( ag.„:„)€ x Applicant's Printed Name Applice ....:,., attire ?S) (5frr(3 io 3i- /Y<f). 9r6 DO NOT WRITE BELOW THIS LINE SUB TYPES _ Foundation — Fireplace _ Porch(3-Season) _ Exterior Alteration(Single Family) V Single Family _ Garage _ Porch(4-Season) _ Exterior Alteration(Multi) Multi _ Deck _ Porch(Screen/Gazebo/Pergola) _ Miscellaneous 01 of_Plex _ Lower Level _ Pool _ Accessory Building WORK TYPES New _ Interior Improvement _ Siding _ Demolish Building* Addition _ Move Building _ Reroof _ Demolish Interior Alteration _ Fire Repair _ Windows _ Demolish Foundation Replace _ Repair _ Egress Window _ Water Damage Retaining Wall *Demolition of entire building-give PCA handout to applicant DESCRIPTION ValuationOccupancy V MCES System Plan Review Code Edition 15� SAC Units (25%_100% , ) Zoning City Water Census Code Stories Booster Pump #of Units Square Feet PRV #of Buildings Length Fire Suppression Required Type of Construction y 0 Width REQUIRED INSPECTIONS Footings(New Building) Meter Size: Footings(Deck) Final/C.O. Required Footings (Addition) �L Final/No C.O. Required Foundation / HVAC_Gas Service Test Gas Line Air Test Roof:_Ice&Water _Final Pool:_Footings Air/Gas Tests _Final Framing 30 Minutes 1 Hour Drain Tile Fireplace:_Rough In Air Test Final Siding:_Stucco Lath _Stone Lath _Brick 7( Insulation Windows Sheathing Retaining Wall:_Footings Backfill Final — Sheetrock Radon Control — Fire Walls Fire Suppression:_Rough In_Final — Braced Walls Erosion Control — Shower Pan Other: Reviewed By: 11V , Building Inspector RESIDENTIAL FEES Base Fee Surcharge Plan Reviewpo oti MCES SAC City SAC fOr Utility Connection Charge 1 ` S&W Permit&Surcharge Treatment Plant CopiesAI 0'4 9/ir v TOTAL '` 4 Page 2 of 3 1 For Office Use • E AGA N Permit#: / eg/ Permit Fee: �// ( c) Date Received: 3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 (651)675-5675 (TDD: (651)454-8535 I FAX: (651)675-5694 Staff: buildinqinspectionscityofeaqan.com L 2018 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: "/5' Site Address: LID-S f, ((up Tenant: Suite#: Name: OA L Phone: Resident/Owner Address/City/Zip: 0-50 ......Jt,7(1) ' J/ Name: Jot I' I vvt License#: pc 7 ) is 7) Contractor Address: L 04 4 r''‘,1-e..4 -Z.J1C,Lt PJfl City: P/r-SLv'I LtJ� State: j Zip: s�Ud Phone: 7) (. I Contact: Email: • Re lacement _Re air _Rebuild ModifySpace -Work in R.O.W.Type of Work' —New — p p Description of work: 1-11- RESIDENTIAL wl 1 4' RESIDENTIAL Water Heater Water Softener Lawn Irrigation L_RPZ/ PVB) Permit Type Add Plumbing Fixtures( Main/_Lower Level) Septic System New Water Turnaround 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.citvofeagan.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 o Eagan; that I understand this is not a permit, but only an application for a permit, and work is not t sta ithout 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. / ce Applicant's Printed Name Applicant's gn ure FOR OFFICE USE Reviewed By: Date: Required Inspections: Under Ground Rough-in Air Test Gas Test Final Meter Related Items: Meter Size Radio Read Manometer Staff: