1138 Tiffany Pt
CITY OF EAGAN WATER SERVICE PERM
3830 Pilot Knob Road
P: O. Box 21199 PERMIT NO.:
Eagan, MN 55121 DATE: _
Zoning: _ No* of Units:
Owner 3. '.''tex son worm t . Inc.
/Address:
1 Tiffs
Add?e:s 1 , ` a 4
Site
Plumber:
' Li;lil I S
Meter No.: ?.pne1 [`merge:
Size: -
t: i J {
?t?=
Reader No.: 11
i 17. d
p
I some h "=ply with the City of Eeyen Surcharge: . 5 , d
Orinenwe, Misc. Changes: 32.C`0 x :'F
T I .00',X.7 rrkt
By
Dote of Insp..
(a y s
i
CITY OF EAGAN
3830 Pilot Knob Road
P. O, Box 21199
Eagan, MN 55121
Zoning:
Owner: !t.arson Conr.
Address:
Site Address: I i 3r? Tiffany
Plumber: -?'??822 Ml
Meter No..
Reader No..
1 some to eernPiy mph on Qtr of Esoen
{
Orineneee.
By
Dote of Insp.:
TY OF EAGAN
30 Pilot Knob Road
0. Box 21199
San, MN 55121
to eem* wpb tee C*y of sepn
ota .
Date Paid:
WATER SERVICE PERM
PERMIT NO.:
DATE: ?- T
_ No. of Units: i
Connection Charge:
L
Account Deposit:
Permit Fee:
Surcharge:
Misc. Charges: r
t J _
.: : u
Total: ,
Dote Paid:
Insp.:
SEWER SERVICE PERMIT
CCD?I{T kr .
Connection Charge; 1_ .OrycX
Account Deposit: 15.006
Permit Fee: 1 ^ . t71
Surcharge:
Misc. Charges:
Total:
Dote Paid:
CITY OF EAGAN 1 0 5 5 9
3830 Pilot Knob Road, P.O. Box 21.199, Eagan, MN 55121
PHONE: 4548100
BUILDING FERMI' Receipt #
A
To be used for Est. Value 3 1-. Dote
14 `
Site Address pT Erect 0 Occupancy
Lot - Blo "EiI]F? 1' Remodel ?
ck Sec/Sub Zoning
.
Repair ?
Type of Const.
Parcel No. Addition ? No. Stories
W Name Move ?
m
li
h ?
t D length
h ,
o
-
e
s Dept
Address Int Impr. ? Sq. Ft.
City Phone Install ?
Name _
Address
City _
Assessment Permit i - 5C
Water & Sew. Surcharge 5C
Police Plan Review -' . 7 5
Fire SAC • O C
Eng. Water Conn. '0.0c
Planner Water Meter _ vas 013
Council Road Unit 260.0c
Bldg. Off. 7/25/b5 Tr. PL 132.0(
APC Parke
Ver. Deft Copies
Total
on ft express condition that
rota Statutes and City o? Eagan Ordinances.
Phone
Name
Address
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 Ordinonces.
Signature of Permittee
A Building Permit is issued to:
all work shall be done in accordance with all applicable State of Mir
Building Official
a n
Permit No. Permit Holder Oats Telephone
Plumbing C 3 Z l' j
H.VA.C. IZ.c 'Y43)9
Electric
Softener
InWection Date Insp. Other
Footings I (Z to
Footings II
Foundation f
Framing
Roofing
Rough Pibg.
Rough Htg.
Insul. s?` S
Fireplace
Final Htg.
Final Plbg. p ,? s
Final
Cert/Occ.
Water Describe Location:
Well
Sewer
Pr. Disp.
CITY OF EAGAN.? i?d
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
BUILDING PERMIT PHONE: 454-8100 Receipt # (,-,.4
,+ To be used for BASEMENT FINISH Est. Value It - 50[? Date WAY 3 1o Q1
Site Address 31138 TIFFANY PT
Lot II Block 7 Sec/Sub.CANTIVIRIMY '
Parcel No.
W Name 7 IrK 1101M
3 Address 1138 TIFFANY P7
0 City EAGAN Phone 652_371 A
o Name MERRILL CIMTMICAlION
uQ Address 2SSR+n XP-RUES AVIL
'- City IFIXG Phone 461_3109
Address
Phone
that I have read this application and state that the
and agree to comply with all applicable State of
id Cit*vfr agan Ordinances.
Occupancy
Zoning
(Actual) Const
(Allowable)
# of Stories
Length
Depth
S.F. Total
S.F. Footprints
On Site Sewage
On Site Well
MWCC System
City Water
PRV Required
Booster Pump
OFFICE USE ONLY
FEES
Bldg. Permit _ 5-0_
- Surcharge LO0
Plan Review
SAC, City
SAC, MCWCC
Water Conn
Water Meter
Acct. Deposit
SIW Permit
S/W Surcharge
Treatment PI
Road Unit
Park Ded.
Copies
TOTAL 36:CO
APPROVALS
A Building Permit is issued to: MEAM " CMSTRMION Planner
on the express condition that all work shall be done in accordance with all Council
applicable State of Minnesota Statutes and City of Eagan Ordinances. Bldg. Off.
Building Official Variance
t ,.
Permit No. Permit Holder Date Telephone #
WATER
SEWER
PLUMBING 7 -
H.VAC.
ELECTRIC L
Inspection Date Insp. Comments
Footings I
Foundation
Framing ?? f y Z4)
Roofing
Rough Pibg.
Rough Htg.
Isul. ?!7v'
%l9 AI
14)
Fireplace
Final Htg_
Orstat Test
Final PIbg. PIbg. Inspector - Notify Plumber
Const. Meter
Engr./Plan
Bldg. Final 7k W
Deck Ftg.
Deck Final
Well
Pr. Disp.
Reoelipt:1 ? 1 r_ PLUMBING PERMIT
CITY OF EAGAN
Fill in numbered spaces
Type or Print legibly
1. Date 2. Installation Cost
3. Job Address Lot - Blk.
4. Owner
5. Contractor
x
6. Address
7. City ? - _ >._ - State
8. Building Type: Residential
9. Work Description: Neyv .?
10. Describe
11.
1?a4 .c:-_--
Zip
Commercial ? Institutional ?
Add ? Alter ? Repair ?
No Fixtures
Water Closet No. Fixtures
Cesspool /Drainfield
_ Bath tubs Se
tic Tank
r Lavatory p
Softner
Shower Wei l
Kitchen Sink
Urinal/Bidet Other
l Laundry Tray
?
Floor Drains
Drinking Ftn.
Slop Sink
Gas Piping Outlets
12. 1 hereby certify that the above information is true and correct, and I agree to
comply with all ordinance; and codes governing this type of work.
Signed :
for
Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454.8100
Permit No.
Fee
S/C
Tot.
Tract
Phone '`,
Receipt MECHANICAL PERMIT Permit No.
CITY OF EAGAN
Fea.
! fill in numbered spaces S/C
Type or Print legibly Tot.
1. Date 2. Installation Cost .
3. Job Address Lot Blk. Tract
4. Owner r
5. Contractor Phone
6. Address
7. City State Zip
Building Type: Residential 4 Commercial ?
Work Description: New ID Add ? Alter ?
Describe
11
Institutional ?
Repair ?
Type ' )"
No. Equgjment BTU - M. Ea.
Forced Air No. Equipment CFM
Air Handlin
:
Mfg 4- -- ,ti J), g
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. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 4648100
CITY OF EAGAN Remarks hi 0 1l1 z e Ij
Additio CANTERBURY FOREST Lot 11
Own Street 1138 TIFFANY DRIVE
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. 1979 Paid unde original rcel
STREET RESTOR.
GRADING 1981 106.78 5.34 20 85.46 A013446 1-12-84
SAN SEW TRUNK Z 1573 Paid unde original p4l Lrcel
SEWER LATERAL 1981 439.42 21.97 20 3S1,54 A013W 1-12-84
WATERMAIN
* WATER LATERAL 1981 20
WATER AREA Q 1979 Paid unde original rcel
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
Road Unit ?280,00 54040 7/26 185
WATER CONN. 500.00
BUILDING PER. 10659
SAC 525.00
PARK
J' 55157
Request Date Flre No, Rough-in coon
4_26-
2 Ready Now El Will Notify Inspector
Requir
n Read
Wh
?
-
9 e
y
ENO
r
Yes
I? licensed contractor 0 owner hereby request inspection of above electrical work at:
Job Address (Street, S. or Route No.)
' ? City
1138 Tiffany eve
a n? Fagan
Section No. Township Name or No. Range No. Coun1Y k
t
o
.
Occupant (PRINT) Phone No.
Torben Holm
Power S?upplieota Electric
? Add Farmington
Electric G
ontrador Company Name)
Faber Ellect is A ConVacto,S License No.
A-40591
Ma,lntggrrr acenira ctor rTwraMaking In Northfield
L
O
l
f
S
gn
PUre Co
n
tr
actorlOwno ak' g Installation?
Authorized S Phone Number
507-645-9760
MINNESOTA STATE BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT
Griggs-Midway edg. - Room S-173 BE ACCEPTED BY THE STATE BOARD
1821 University Ave., SL Paul. MN 55106 UNLESS PROPER INSPECTION FEE IS
Phone (612) 642 0800 ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION xx ? EB-OW01-08
515 See instructions for completing this form on back of yellow copy?1
d`
J ` "X" Below Work Covered by This Request
ew Ayld Rep. - Type of Building Appliances Wired Equipment Wired
X Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Other (Specify)
Comm./Industrial Furnace
Farm Air Conditioner
Other Ispecifyf contractors Remarks-
DEA - AC Controls
Compute Inspection Fee Below:
# .. Other Fee # Service Entrance Size Fee # Circults/Feeders
Swimming Pool 0 to 200 Amps 0 to 100 Amps
Transformers Above 200 _ Amps Above 100 Amps V
Signs inspectors Use omy:C}73 L
Irrigation BOOms 15:0
Special Inspection
Alarm/Communication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONTHS.
I, the Electrical inspector. hereby Rough-in Date
certify that the above inspection has
been made. Final Da1?
? v
OFFICE USE ONLY
This reouest wcd 18 months from
N37313 &75
Request Dare - - Fire No. Roughin Ins
Required?
? Ready Now Will Notify Inspector
s 0 Wren Ready?
licensed contractor D owner hereby request inspection of above electrical work at:
Job Address (Street. Box or Route No.) city
NCI EAGAN
Section No. 1m miliip Name or No. Range No. County
Owupant(PRINT) Phone No.
Power Supplier Adtlress
Electrical Contractor company Name) ComraciorB License No.
R -
Mailing Address tContractor or Owner Making. Installation)
l SC AUJE S
AJAG? SS37
Authorized Signature Corned IQ ing Installation) Phone Number
v
MINNESOTA STATE BOARD OF ELECTRIC" THIS INSPECTION REQUEST WILL NOT
Grlgga-Midway Bldg. - Room S-173 BE ACCEPTED BY THE STATE BOARD
1321 University Ave., St. Paul. MN SS106 UNLESS PROPER INSPECTION FEE IS
FIIOM (612) 36240800 ENCLOSED.
S? ??91
REQUEST FOR ELECTRICAL INSPECTION
? See instructions for completing this form on back of yellow copy.
X" Below Work Covered by This Request
9 16= %, EB-00001-08
New Add Re . Typeof Building Appliances Wired EqulpmerrWired
J( Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Other (Specify)
Comm./Industrial ' Furnace
Farm Air Conditioner
Other (si ecify) Contractors Remarks:
Compute Inspection Fee Below: }p -mew'
# Other Fee # Service Entrance Size Fee # Circuds/Feeders Fee
Swimming Pool 0 to 200 Amps 0 to 100 Amps
Transformers Above 200 _ Amps Above 100 _ Amps
Signs Inspectors use Only: ^ \ TOTAL SQ
Irrigation Booms
Special Inspection
Alarm/Communication THIS INSTALLATION MAY BE ORDERED ISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 HS.
I, the Electrical Inspector, hereby Rough-in to i?/?,p
l``'am 66
certify that the above inspection has
been made. Final
a
OFFICE USE ONLY
This request void 18 months from
. CASH RECEIPT •
CITY OF EAGAN
P. O. BOX 21-199
EAGAN, MINNESOTA 55121 J(((
DATE - ? I x+
i
c'ROM
FROM
AMOUNT ?ll sU
Fu ID LODE AMOIIHT
42 Z-i ego 6&fj
U rte.
Thank You
BY /
N_ 54999
White-Payers Copy
Yellow-Posting Copy
Pink-File COPY
DOLLARS
goo
? CASH CHECK
I ?? .? yr
BUILDING PERMIT
To be used for BASEMENT FINISH Ft values
500
Site Address 1138 TIFFANY PT
Lot 11 Block 2 Sec/Sub. CANTERBURY FORES OFFICE USE ONLY
Parcel No. Occupancy FEES
Zoning
w Name TOBIN HOLM (Actual) Const 5 _ n0
Bldg
Permit 3
Address 1138 TIFFANY PT (Allowable) .
.
-
1
00
.
Surcharge
City EAGAN Phone 452-3718 ao1Stories
Plan Review
Length
o Name MERRILL CONSTRUCTION Depth SAO Cit
}
H
Address 25580 XERXES AVE
S.F. Total y
City ELKO Phone 461-3109 S.F. Footprints SAC, MCWCC
W
t
C
On Site Sewage a
er
onn
ti
oW
Name
On SrteWell
?w Water meter
13i Address MWCC System
Acct Deposit
a City Phone City Water
PRV Required S/W Permit
I hereby acknowlege that I have read this application and state that the Booster Pump SAW Surcharge
information is correct and a ree to comply with all applicable State of
Minnesota Statutes and Ci agan ordinances. Treatment PI
`
Signature of Permilee APPROVALS Road Unit
A Building Permit is issued to: MER LL CONST UCTION Planner Park Dad.
on the express condition that all work shall be done in aocorclance with all Council
applicable State of Minnesota Statutes and City of Eagan Ordinances. Bldg. Ott. Copies
Building Official IRRAi11 1?u Variance TOTAL 36.00
CITY OF EAGAN N2 19004
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 4544100 l2'Ze
Receipt # J _ l
Date MAY 3 , 19 91
CITY OF EAGAN N°- 10 6 5 9
3830 Pilot Knob Road P.O. Box 21-198 Eagan MN 55121
PHONE: 4548100
BUI?DINd PERMIT Receipt # Cl 7
To be wed for SF DWG/GAR Est Value $113,000 Date JULY 26 19 85
Site Address 1138 TIFFANY PT Erect El Occupancy R
Lot 11 Block 2 CANTERBURY
Sec/Sub Remodel ? Zoning R1
Parcel No .
FOREST Repair ? Type of Const. V
. Addition ? No. Stories
PETERSEN CONST INC
S Move ? Length 68
.
Name
4701
W 110TH ST
Demolish ?
38
Depth
Address Int. ImPr. 11 Sq Sq. . Ft Ft.
City MPLS Phone 884-5144 Install ?
SAME
Name
Approvals
Fees
=u
8 Address
M,
Name _
Address
City _
Phone
Phone
I hereby acknowledge fiat 1 have re a i plication and state that
the information is correct and ag compl II icabia
State of Minnesota Statutes a of a n
Signature of Permiffee
A Building Permit is issued to: S. PETERSEN CONS
all work shall be done in accordance with state of t
Building Official I o Ie .C1?--
Assessment -
Water 8 Sew.
Police
Fire
Eng.
Planner -
Council
5
Bldg. off. 7/25/8
APC
Var. Date
Permit ? Y u J. J V
Surcharge 56.50
Plan Review 232.75
SAC 525.00
Water Conn. 5 0 0 .0 0
Water Meter 63.00
Road Unit 280-00
Tr. Pt 132.00
Parks
Copies
Total +S2r254.75
an the express condition than
and City 0 Eagan Ordinonees.
104
r?79T 6 r', 0 7 //4// %//=F y <>ier• ?/
1985 BUILDING PERMIT APPLICATION - CITY OF EAGAN
NOTE: ALL CONTRACTORS MUST BE LICENSED WITH THE CITY OF EAGAN
To Be Used For: Valuation:
/?3 g. 7 Pi
Site Address: ? C'rUvT[31? (3 b0K y
»!-
INCLUDE 2 SETS OF PLANS
3 CERTIFICATES OF SURVEY
1 SET OF ENERGY CALCULATIONS
Date: ?2 -? S~
Fo OFFICE USE ONLY
Lot: Block Sect/Sub Erect X
Remodel _
Parcel p Repair
Addition
Owner 21F 7 Q s EPt/ nN s' i 2 o Move
Demolish _
Address 1-1701 G/J // '; ? S-C- Int.Impr. _
Install
City/Zip Code /Lj??3 SS?37 __________
Phone APPROVALS
Contractor 51?i /-
Address
City/Zip Code
Phone
Arch./Engr.
Address
City/Zip Code
Phone.0
Occupancy
Zoning
Type of Const
11 of Stories
Length
Depth
Sq Ft
FEES
Assessments Permit
Water/Sewer Surcharge
Police Plan Review
Fire SAC
Engr Water Conn
Planner Water Meter
Council Road Unit
Bldg Off tJ atment Pl
APC Parks
Variance Copies
TOTAL
R-3
RBI
(08
3g
5b. so
23-.75
525. °°
500.
=m
-
2aa.
X32 =
oZ? 5) (/, )? 3?
(008 K s 4432 /
4
? ? ISC? K Sq ?'
32x 24- ~ 'Ic?B >c- f1 - 8 98
2v r, 3G - Iooe, ?-- 4c - q 132
12 3o 5
Certificate for:
Svend Peterson
1 /
L?
\DELMAR H. SCHWANZ
LAND RURVEYOW INC
? RPOi51PPo UPOPL.iwi [II T11P RInP AI MnnPSnIH
I4750 SOUIN ROBERT TRAIL ROSEMOUNT, MINNESOTA 55888 PHONE 612 427.17M
otiQSCALE: 1 inch - 30 Peet
SURVE 'S CERTIFICATE Elevations shown are
existhng and based on
assumed datum
9ti y '?Ny
9
Z
Drainage & mss g8'°?p4
utility
easement
o ? ? 0 3
M <a \ 9 j'9r pf dab to a
/o.4.
M"
\ 7 \ / jr /02.0
? ? T? CuRB
IpkP O N ?
Proposed garage floor
elevation
I hereby certify that this is a true and correct representation of
Lot 11, Block 2, CANTERBURY FOREST, according to the recorded plat
thereof, Dakota County, Minnesota.
Also showing the location of a proposed house as staked thereon.
Dated: July 10, 1985 n
MINNESOTA RE STRATION NO. 8625
14004
1991 BUILDING PERMIT APPLICATION
CITY OF KAGAN
SINGLE FAMILY DWELLINGS
2 SETS OF PLANS
3 REGISTERED SITE SURVEYS
1 SET OF ENERGY CALCULATIONS
MULTIPLE DWELLINGS
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 TWO DAYS ONCE A PERMIT HAS BEEN COMPLETED.
PERMIT MUST SHOW A LICENSED PLUMBER.
P rim( v r-
To Be Used For: M I Valuation
Site Address ?l7Jg ?l ?. r
Lot 1L Block
Parcel/Sub ( ,fn a , -rixod-
Owner 10 14p,"
Address 1135 -T) jTA'!j I),-,
City/Zip Code L-ftC4ir
Phone
a'3?1? n/J
Contractor UP2R.1L.(„ ( _wusi.
Address ??SXV K5rWO Fk1E
City/Zip Code EUl-o 'titrf 55b27
Phone X1-3109
Arch./Engr.
Address
City/Zip Code
OFFICE USE ONLY
Occupancy
Zoning
Actual Const
Allowable
# of stories
Length
Depth
S.F. Total
Footprint S.F.
On site sewage_
On site well _
MWCC System
City water
PRV
Booster Pump _
COMMERCIAL
FEES
Bldg. Permit .35,00
Surcharge JA 00
Plan Review
SAC, City
SAC, MWCC
Water Conn.
Water Meter
Acct. Deposit
S/w Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Trail Ded.
Copies
SUBTOTAL
Penalty
Lot Change
TOTAL
APPROVALS
Planner
Council
Bldg. Off.S=S
Variance
Phone #
Z agrees that all work shall be done in accordance with
(Signatur of Contractor)
all applicable State of Minnesota Statutes and City of Eagan Ordinances.
? _ Date: T'SJ I?
2 SETS OF PLANS 2 SETS OF ARCHITECTURAL
REGISTERED SITE SURVEYS - & STRUCTURAL PLANS
(CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFICATIONS
1 SET OF ENERGY CALCULATIONS 1 SET OF ENERGY CALCS
OF RENTAL UNITS
# OF FOR SALE UNITS
CITY OF EAGAN
3830 PILOT KNOB ROAD
EAGAN, MN 55122
PHONE: (612) 454-8100
"
FOR CITY USE ONLY
PERMIT # /5 & _
RECEIPT # C
DATE: 5
PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS &
TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
WORK DESCRIPTION
NEW CONST
ADD ON d?
REPAIR
OWNER NAME: o6inolm
SITE ADDRESS: 113,? LOT: 1L BLOCK SUBD.
INSTALLER: ?Gc k(:at PJ L Y
ADDRESS: 49cx-?
CITY: ,f , or/ /L-? is c ZIP?: -5 5 ?7
PHONE #: t 7" 7 3 /
SIGNATURE )OF-PERMITTEE
---------- --------------------
COMPLETE THE FOLLOWING:
NO. FIXTURES EA. TOTAL
ADD-ON MINIMUM 15.00
SHOWER 3.00
WATER CLOSET 3.00
BATH TUB 3.00
LAVATORY 3.00
KITCHEN SINK 3.00
LAUNDRY TRAY 3.00
HOT TUB/SPA 3.00
WATER HEATER 3.00
FLOOR DRAIN 3.00
GAS PIPING OUT.
(MINIMUM - 1) 3.00
ROUGH OPENINGS 1.50
OTHER _
_ WATER SOFTENER 5.00
PRIVATE DISP. 15.00
U.G. SPRINKLER 3.00
SUBTOTAL 5
ST. SURCHARGE .50
TOTAL: S 5 5C7
PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS AND
MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH
DWELLING UNIT.
CONTRACT PRICE:
OWNER NAME:
SITE ADDRESS:
LOT: BLOCK - SUBD.
INSTALLER:
ADDRESS:
CITY: ZIP:
PHONE
FOR:
FEES
18 OF CONTRACT FEE.
STATE SURCHARGE - $.50 FOR
EACH $1,000 OF PERMIT FEE.
$25.00 MINIMUM FEE.
CONTRACT PRICE x 1%
STATE SURCHARGE $
TOTAL:
(SIGNATURE)
CITY OF EAGAN
I
1 ?:r
CITY OF EAGAN
2/84
L?-*-?•
i, AP
PLICATION FOR PERMIT
SEWER AND/OR WATER CONNECTION
(PLEASE PRINT) _
1) PRCP=- ADDRESS: 1139 F
j?j?(J?
(JE p
l.
7?1
r
?
,v
p
LEG L DESCRIPT?C I:T// f??OG `?JC?i? Y
(L0t/310cx/Sun0-visicn or Tax Parcei I.D. .Luger) T
is °'•SS_= :G SMUCTL., DA - OF ORIG-IAL EUIL.DL`G __-:-?IT ISSN: tiC
°? -
? -?- r r
1 SINGLE Fa.-. I Y - -' -= ,
_
0 R-2 DUPr,1Ii (9-4•;0 -NITS)
? R-3 TCSoNI-ICUSE (T;^22c:c, + L?7ITS) ( UNITS)
? R-4 PPART ° I/CC_ uCiL IL:I ( UNITSi
? CcL%PHAEPCL- iL/RETAIL/OFFIC.
? imusiRL;-L
? I:iSTITLTIC%IAL/GC?//?nIEV'T
2) APPLICANT (PLEASE PRIYi)
NAB -F,: eo 4? L?O.r<r
ADDRESS:
CITY, STATE, ZIP:
GOlj y?/7, G-7?/?/ . /j7 ?3Z/? 7
C2
PHONE: lJ???Cf /S?
3) PLL L9E??:
ADDRESS: 14/4
ROS
CITY, STATE, ZIP: pppp
GLN4:R 7717?I? ''
5 SO. ROBERT
? J
MOUNTP MN
FOR CITY USE ONLY
PLUMBERS LIC&' E:
? ive
Ezpi d
- PHONE: e?lcs
PLUMBER LICENSE # Rec d
arr ini[ia
4) OCCITA-NT/Ci47NNAME: (PLEASE PRINT)
ADDRESS:
CITY, STATE, ZIP:
PHO`,E:
5) INDImTE WHIM P
IS BEING REQUESTM:
T
OZ,u1ECTION TO CITY SO.IER
ONNECTION TO CITY MATER
? OTHER (PLEASE DESCRIBE)
6) 2:'DICA = =: :
? LEASE HOLD APPRCVED PEIRMT FOR PICT;-UP BY ONE OF ABMT
LEN.SE MAIL APPROVED PER:-LIT TO 1, 3, 4 ABOVE
(Girt one)
7) SIG!,?M7-?E: DATE: c?
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F O R
PERMIT °- ISSUED
T Y U S E O N L Y
FEES: $ /U.cU
$ /O 1-y
$
$
S
$ /? l U
$
$ i?lZ7 U
$
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$
SE-'ER nrVMTI I`i or A ro
WATER PERMIT (INCLUDE SURCHARGE)
WATER METER/COPPERHORN/OUTSIDE READER
WATER TAP (INCLUDE CORPORATION STOP)
SEWER TA
ACCOUNT DEPOSIT - SEWER
ACCOUNT DEPOSIT - WATER
WAC
SAC
TRUNK WATER ASSESSMENT
TRUNK SEWER ASSESSMENT
LATERAL BENEFIT/TP.UNK SEWER
LATERAL BENEFIT/TRUNK WATER
OTHER
TOTAL
AMOUNT PAID/RECEIPT rc J rgj J
DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
YES IF YES, THEN A "PERMIT FOR WORK WITHIN
PUBLIC ROADWAY" MUST BE ISSUED BY THE
NO ENGINEERING DIVISION. LIST AS A CONDI-
TION.
SUBJECT TO THE FOLLOWING CONDITIONS:
APPROVED BY:
TITLE:
DATE:
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2006 RESIDENTIAL MECHANICAL PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please complete for single family dwellings & townhotnes/condos when permits are required for each unit
Date ---
l
Site Address ( Q
yJ Unit #
Property Owner('` Q m Telephone #
Contractor STANDARD HEATING & AIR CONDITIONING
4t6-1?E?TL?ICE ?'fIIEET -
Street Address MINNEAPOLIS, MN 55408
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City
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State Zip _ Telephone tt
(
)
Bond#: ?L I SS?181
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xp
res:
The Applicant is Owner Contractor Other -
Add-on or alteration to existing dwelling unit $ 30.00
?[
X furnace -Additional XReplacement _ New
_ air exchanger
_X air conditioner
?a??
0
heat pump r
other
State Surcharge $ .50
Total g _?Q
I hereby apply for a Residential Mechanical Permit and acknowledge that the information is complete and accurate; that the work will
be in conformance with the ordinances and codes of the City of Eagan and with the Mechanical Codes; that I understand this is not a
permit but only an application for a permit, and work is not to start without a permit; that the r will i ccordance with the
appr d plan in the case of?yhich requires a review and approval of s.
Applicant's Printed Name Applicant's Signatu
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PERMIT
City of Eagan Permit Type:Building
Permit Number:EA117000
Date Issued:10/14/2013
Permit Category:ePermit
Site Address: 1138 Tiffany Pt
Lot:11 Block: 2 Addition: Canterbury Forest
PID:10-16350-02-110
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 by law in ALL single family homes .
Eva Lewis
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 -
Torben E Holm Tste
1138 Tiffany Pt
Eagan MN 55123--187
Purpose Driven Restoration Llc
325 Main St NW
Elk River MN 55330
(763) 633-4737
Applicant/Permitee: Signature Issued By: Signature