3903 Worchester Drr
City of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
Permit #: g' !
Permit Fee: 5 C�
Date Received:
Staff:
2011 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: 3 ' ( ` ( ( Site Address: � 903 " 1430 1
es e. r- R
Tenant:
Suite #:
RESIDENT / OWNER
Name: Tr 0 t ) n,+:� 2.a Ckdc'tf` . Phone: 6St -9czs =41-/l
Address / City / Zip: 5 a.--. ar S <1 100
CONTRACTOR
Name: cip 1.0 (1.()1ek_ t 6 car vt c C31,0 C.A.. License #: ..S' q 3b' 3
Address: 10. C) . (3>< \tea I Q Q City: Ce L r-
State: OA- /LI _ Zip: S.J' 0 ?(j Phone: Y63 — 4/ c/& -
Contact: A(.4,C Email:
TYPE OF WORK
_ New )C Repl ement )c -Repair Rebuild Modify Space Work in R.O.W.
_ _
Description of work: `�� �('(Le-) Jc �; h ' '/" Loa 6.
PERMIT TYPE
E S/DENTI L ` /
Water Softener
Water Heater
Add Plumbing Fixtures ( Main / Lower Level)
Lawn Irrigation (_ RPZ / PVB)
_
Water Turnaround
Septic System
New
Abandonment
RESIDENTIAL FEES:
$55.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge)
$35.00 Lawn Irrigation
$55.00 Add Plumbing
*Water Turnaround
$105.00 Septic System
$95.00 Fire Repair (replace
(includes $5.00 State Surcharge)
Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge)
(add $166.00 if a 5/8" meter is required)
New ($10.00 per as built) (includes County fee and $5.00 State Surcharge)
burned out appliances, ductwork, etc.) (includes $5.00 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.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 in the case of work which requires a review and approval of plans.
x /41(10e to4ef4 •c
Applicant's Printed Name
Applicant's Signature
CITY OF EAGAN Permit Na I s~ g~33 Date: I1-19-87 ,
3830 Plpt Knob Rcad Meter Na Sfze:
P.O. Box 21199 Reader No: Date: ,
Eayan. MN :16121 ,
~ Owner. Grana Qnks
~ Site Addresa: 3903 Wraleel:ter i)rive L3 B3 Hills of Si:one- ,
Plumber. Valk" Y ambiag 1>ridge
~ Conn. Chg: 525.00pd Zoning P~-
15.00pd No. of Units: 1
C Acct Dep:
I P Permit Fee: 10.00pd _
' Surcharge: • 50vd I agne to comply with the City of Eagan
' Tr. Plant 180.00pd Ordlnancq.
Meter. F&7.t?npd
Misc.: BY '
I _ WATER SERVICE PERMIT ;
I - -
, cinr oF EacAN Pormrc Na 4 oate: 1 iM 9- F7 _
3850 PHot iCnqb Rosd B/ P No: . 1 ~ 5 Date: 1 ~ 8_8 7 ;
RA. gbx'iit99 ~
Ea9an,l~,ItLSS$2I ;
Owner.
t,^s•=Pr 'riv:~ t,"t
' Site Address:
Plumber• F~'~'rty• "~.n'. '
~ MWCC: 5~5.QC~ c' Zoning•
fp City Ch9. t:0L)c No. of Unita: I ~
f Acct Dep: 13-00pd
1 agreo to comply with iM CRy of Eapan :
~ Permit Fee: Ordlnances.
~ Surcharge:
r
~ Misc-* BY ~
SEWER SERVICE PERMIT x ,_....v_.._,.~.__ . _.:..T .__s. V. _ i
. . - - - - - -
CITY OF EAGiAN Permft Na. ~ 9233 Datx i 1-Z9-87 i
3830 PNpIJ["±b Raad Meter Na324-1 -f Sizec 5'l °C-- ~
P.O: ox 27fl9 Reader No: Date: 2-
e.gan. MN 55121 oa P 7vo o~~a s+ ~ ;
Owner. t~rand Oaks ls •aU 12-2S 17
SiteAddresx 3903 Worchestex t?rive L3 B3 liills of Stane-
Plumber Valley Plumbing bridge '
Conn. Chg: 525. OOpd WAR" R1 Acct Dep: 15.00 d
, PermR Feec 10.00 _ ~ iggiiigCelpl~u
Surcharge • 5Qp "'fQ44 t3'e6,nipwNh Ihe City o1 Eagen
Tr.Plent 180.00 ~~~~W
Meter. 67 ~ p~E
Misc.:
WATER SERVICE PER ~
CASH RECEIPT ~
. ,
. CITY OF rAGAN
3830 PILOT KNOB ROAD
-,EAGAN, MINNESOTA 55122
DATE ~ 19 ~
RtCLIVfD ' r I
w
AMOUNT $
~
e ooLLwRs
~o.
? CASH ~ CNECK
rUND CODE AMOUNT
Thank You
BY
White-PaYers CoPY
J ~ Yellow-Poitiny CoPY
Pink-File CoPY
• . .
~r-
.
. ~
w_
r r
~ ~ ,
Dj
~n
, ~ . .
BLDG. PERMIT N0.
l~ c.:~
01-3210 Bldg. Permit
01-3422 Plan Check -Z-~~ cc01-3445 5urch./Adm. a;3
01-3446 SAC/Adm.
~
01-2155 Surcharge
~
17-3860 Road Unit 0
-
20-2275 SAC
20-3865 Water Conn. ~
20-3868 Water Trmt.
20-3716 kater Meter 20-2252 Acct. Dep.
20-3713 Water Permit
20-3743 Sewer Permit
79-3866 Sewer Conn.
11-3855 Park Ded. ~
~
i
TOTAL
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PH ON E: 454-8100
BUILDING PERMIT fieCeipt#
To be used for $F ~f GAR Est. Value $ 7S'~~ Date ~TOAfiR 8 ,19 b7
Site Address 3903 WOkCHE5TF.[t Ui{ OFFICE USE ONLY
A3
Lot } 81ock 3 Sec/Sub. NILLS OF STOtiB- on ske Sewege Occupancy ~
BR;DGL MWCCSystem x Zoning
PBrCeI N o. On Site Well (Actual) Const v
GKAEiD OAlCS GLVEL CO Ciry Water X (Allowabie) Vn
s Name
W PRV Required ~ ot Stories
z Address 4521 50 8/1Y L.AKE RU ~
~ City = E~i'Ay PhOn2 452--6934 Booster Pump Length
Depth
, o Natne SAHE S.F. Totel
~ i Address Footprint S.F.
~ Ciry Phone APPROVALS FEES
~a • Engr./Assess. Permit ~ 41b.U~?,
yVj W Name a~ ~ Sti'
Planner Su rcharge
_2 Address ~0$~~~
¢ W City PhOne Council Plan Review
t BIdg.Off. SAC.City 100•00'
I her e by a c k n o w l e d g A t h a t I h a v e r e a d t h i s a p p l i c a t i o n a n d s t a t e t h a t t h e Variance SAC, MWCC 525 001
information is Correct and agree to comply with all applicable State of Water Conn. 525 ijol
Minnesota Statutes and City of Eagan Ordinances._.,_.._. Water Meter 67.170
~
Sigqeture of Permittee __.t_-7 t--~_s' - ROad Unit 3~75 -Q~'i
GAAND OAKS llEVEi. CO ~
A BiDiding Permit is issued to: Treatment P1 _iso 001
on the express condition that all work shall be done in accordance with all
applicable State of Minnesota Statutes and City of Eagan Ordinances. Parks
TOTAL
~uildingOtficial a~3
AdaJ alld-'lu!d
hda3 du!isod-MOIIoA
Ado3 tJaAQd-e114M U 4
A9
nok juiyy
7 ~ r
j •Nnowv s~vo~ aNno
,
Mo.
>I0 3H:)"'Fj HSV7 ?
oei
sar~~oa ~a
$ 1Nnowv
, , aan~aoar
;31VU "
~
ZZISS VlOS3NNIW;1J1(4d3'
dtlOd 80N)1 lOlld 0£8£
NnDd3 Ao Al« -
' ~ '
~ ldl333a HSb'O
CITY QF EAGAN 4
~ 3830 Pllot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHON E: 454-8100
BUILDING PERMIT Receipt ~
To be used for Est Value Date L.".i`P,
Site Address ' OFFICE USE ONLY
Block Sec/Sub. ~~F OnSke3ewaqe Occupency
Lot
? i i•,' - MWCC System ZOniny
Parcel No. On Site Well (Actual) Const vn
; • City water (Allovrable)
a Narrie
_ h~PRV Required ~t of Storf~
Address
o BoosterPump Length
Ciry. Phone
~ Depth
, p Name S.F. Totel
~ 0- Address Footprint S.F.
~ City Phone APPROVALS FEES
v~ Engr./Assess. Permit
Name }7,
WW Planner Surcharqe
_z. . Address
Cit PhOn@ Council Plan Review
~ W y Bldg. Off. SAC. City 1~ H. .
I hereby acknowledge that I have iead this application and state that the Variance SAC, MWCC 5s
information is correct and agree to comply with all applicable State of Water Conn. y; yMinnesota Statutes and City of Eagan Ordinances. Water Meter
Signature of Permittee Road Unit
Treatment P1
A Building PermR is issued to: ` ,
on the expreas condition that all work shall be done in accordance with all
applicable State of Minnesota Statutes and City ol Eagan Ordinances. Pa~
TOTAL - '
Bufiding OffiCial_
Prrmlt No. Permit Holder Wte TeNphone ~e
Plumbing ~SL)
~
l
li.G.AC.
Electric
Softener
I^sPectian an lneP• Commanb
Footings 1 ~
Footings II
Foundation
Frarnin9 ~ 7 co~r~c~•%~~ //-6-(~'7 ~A_
Roofing
Rough Plbp,
Rough Htg.
Isul.
ie
Fireplace
Final Htg.
Final Plbg.
Bldg. Final
Cert Occ.
Temp. LP
Deck Fta
dock Final
weu
Pr. Diep.
-,,f~„~.,.,~r~r,,,v.~ o.~.-r..~ ~.~~._z-.,. ..-=1- , q : .~i -n~Er~ y_~~~~:c7,f,
. y ; PERMIT #
PLUMBING PERMIT
o . ` CiTY OF EAGAN RECEIPT #
3630 PILOT KNOB ROAD, EAGAN, MN 55122 DATE:
CONTRACT PRICE ~ PHONE: 454-8100
Site Address + BLDG. TYPE WORK DESCRIPTION
Lot ~ Block 3 es. _X New
Mult. Add-on
? Name Comm. Repair
y Address~ Other
c Ciry Phone RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
NO. FIXTURES TOTAL
Name _.4-Water Closet -$3.00 S-:-:L C~ v
d ---/_Bath Tubs - $3.00 _ ~ o o
3 Address --LLavatory - $3.00
p Ciry Phone Shower - $3.00
___~_Kitchen Sink - $3.00 z. CDV
FEES Urinal/Bidet - $3.00
COMM/IND FEE - 1% OF CONTRACT FEE --/_Laundry Tray -$3.00
APT. BLDGS - COMM RATE APPLIES -A-Floor Drains -$1.50
TOWNHOUSE & CONDO - RES. RATE APPUES -;L_Water Heater -$i.50
MINIMUM - RESIDENTIAL FEE - $12.00 Whirlpool - $3.00
MINIMUM - COMM/IND FEE - $20.00 __,L_Gas Piping Outlets - $1.50 4-L'L3
STATE SURCHARGE PER PERMIT - .50 (MINIMUM - 1 PER PERMIn
(ADD $.50 S/C IF PERMIT PRICE GOES SoRener -$5.00
BEYO $1,000.00) Well - 510.00
Private Disp. - $10.00
_,,~;__Rough Openings - $1.50 `,7/. S
: s
SIGNA RE RMITTEE FEE: O a
STATE S/C: . _S O
FOR: CITY OF EAGAN GRAND TOTAL• - I
~i"~ , • .
PERMIT
•
, MECHANICAI PEpMIT RECEIPT #
CITY OF EAGAN
3890 PILOT KNOB ROAD, EAGAN, MN 55122 DATE i'
CONTRACT PRICE: PHONE: 454-8100
Site Address . BLDG. TYP WORK RIPTION
~ ec/Sub
Lot Block
• ~ Fies. New
Muf[ Add-on
m Name _ Comm. Repair
Address
Other
c City Phone "
Name t. :1j Y , FEES
RES. HVAC 0-100 M BTU -$24.00
r` r' 'i' ADDITIONAL 50 M 6TU - 6.00
~C Address
p City P~hone__'Lff~ r ,El J (RES. HVAC 1NCLUDES AIC ON NEW
CONSTRUCTION)
GAS OUTLETS (MINIMUM -1 PER PERMIT) - 1.50 EA.
TYPE OF WORK COMM/IND FEE - 196 OF CONTRACT FEE
Forced Air ~ M BTU •~y +K - APT. BLDGS. - COMM. RATE APPLIES
TOWNHOUSE & CONDOS - RES. RATE APPUES
Boiler M BTU MINIMUM RESIDENTIAL FEE - ALL ADD-ON 8
Unit Heater M BTU REMODELS - 12.00
Air Cond. M BTU MINIMUM C4MMERCIAL FEE - 20.00
STATE SURCHARGE PER PERMfT - .50
Vent GFM . (}4DD $.50 S/C IF PERMI7 PRICE GO~S _
Gas Piping OuNets # ; ~ •r~~' BEYOND $1,600)
Other
~r . . ;
FEE
S/C: SIGNAtURE OF PERMITTEE
TOTAL•
FOR: CITY OF EAGAN
. 1
7
1
y
(Jltrti#ira#it of (10rrupanr
titp af (Eagan '
a,epartmrW uf luddwg jwPdimt
This Certifrcate issued pursuant to tlie requfrements of Section 306 oJrhe Uniform Brdlding
Code cerrifying tkat at the ttme of rssuance tlus snvcture was in compliance with the various
ordinances of rhe City regulaang building constrvcction or use. For lhe following.•
u,a..fi.e. T, Ml'GAF, eW F~a rb. 14277
O-UPS-r iYvE R3 zowx noW R.1 T~jw COML i'n
owwor eeaan GiPd+ID UAICS MII, 4D Aaa. 4521 9(3 I;A1 Llt-1,11:; ROE1D. EAGSt4
' buldm AM= 3cX-13 wCPQ1F:,SI'F.P~ M-TV,E ,-BUY 13, B3, HIIJ_-, CF SZVVMDGL?
. . a„e: IPt~2 29. !987
s~ao~ o~aa
POST IN A CANSPICUOUS PUCE
ihis rea.est voitl Lf ~~p 5
1Bmonthslrom ~V/5~87
Do 65883,c3
.Le i F~rp No. 3uph-in InsVer,tion
Fequ/Des~ U/,
_ G^) Hequiretl~ ~NeaAy Nu ~Will Nnuly Inspec-
~f O~ I 0Ves ONo ~or When Feady
~ LicenseA Elecv¢al Convacme I hereby request inspoclion ol above
Owner clechical work inatalled oc
Siree[ Address. Bon or Rnute No. n Cny
3~0-3 (.e~a-Y~L~1~s7-e~ lJr. G` av~
ocuon o. Township N:ime or No. flanBe No. Coumy
OccuGAnt (PRINT) Phune No.
C~' r~. .r.~ (~a k s
Power Suuuliei Atltlress
c~ --~a G ! L ~-c3f.- vi-i i
Eloctncal ConVactoi ICmnVanY Nnmel Con ar,~oi's Liccnse No.
ASDP~~ ~ l~ c~i ~~nc G`~fc
Mailing tlJress ICOntrncror or Owner Makinq Instailalionl
~~n 7 S , 1,3- -SaU f
Amho r.etl $iBnqwre IComoactur/Ow r Makiny installationl Phi e Number
e-476-6 3/,
MINNESOTA STqTE BOANO Of ELECTqICITV TMIS INSPECTION HEQUEST WILL NOT
Griges-Midwey Bldg. - Hoom N•191 BE ACCEPTED BY THE STATE BOAHD
1821 Universitv Ave.. 5[. Pxul, MN 55100 UNLE55 PPOPEF INSPECTION FEE IS
PhOne f612) 642-0800 ENCLOSED
REQUEST FOR ELECTRICAL INSPECTION EB-00001-06
111' See instruc1-0-s lor comoletinq tpis form on back o1 yellow copy.
~ 7~5~DS
oD ~ 6 5 8 8 3 "x BeloW Work Covered by 7his Request
Fdtl NeD.1' TYne ol 6uilEmg Apotioncna Wirod Equiunien, Wirerl
Home Ranye iemporary Service
Duplex Water Heater Liryhnny Fixture5
Apt. 8uflding Dry¢r Electric Heatin
Commercial Bldy. Fwnace Silo Unlonder
IntluS[rial BIAg. Air Condmoner Bulk Milk T&nk
Farm oln«i o7,7 v -thcr ISnec,lyl
~ ~nr pculv iher 0 1 h,;r
ompu[e Inspectmn Fee Below
N Fea SarviceEnheneeSize b Feu Fexders/SUbfeetlens b Fen Gr urts
~ LYJ 0 to 200 qm ps 0 to 30 Am s 1 CaGet 0 ta 30 An p
~Abov. 200 qmps 31 to 100 qmps 31 [0 100 qm y
mming Pool Above 100-Am s Above 100_Amps
nstormers Irriyation Booms Qi Partial. Other Fee
Signs Speciallnspecbon
Hem~rks S L~~ TOTA F ~
flough-in ,
I f ~ I..s the Elecvicnl
ina,onv
certil~ thal tne aeovo
Frnal r ~j inspection has baen
maAe.
!Na ropuest volE 18 monttu tmm -tiW
CITY OF EAGAN N° 'I Q 2]]
3830 Pilot Knob Rosli, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454•8700
BUILDING PERMIT Receiptit
Tobeusedtor SF DWG/GAR Est.Value $75,000 Date OCTOBER S y9 87
Site Address 3903 WORCHESTER DR OFFICE USE ONLY
Lot 3 Block 3 Sec/Sub. HILLS OF STONE- OnSiteSewage - Occupancy R3 BRIDGE MWCC System X 2oning R1
ParcelNo. OnSiteWell (Actual)COnst Vn
GRAND OAKS DEVEL CO Ciry Water X (Allowable) Vn
a Name
= Address 4$21 SO HAY LAKE RD PRVRequired -#of5tories
48
o City EAGAN Phone 452-8934 Booster Pump - Length 44
Depth
, o Name SAMR S.F.TOtal
o~ Address FootprintS.F
U~
~ City Phone pppROVALS FEES
Engr./Assess Permrt $ 416. oC
ww Name 37.SC
~i Planner Surcharge
x- Address
a i City Phone Council Plan Remew ZOB.OC
a W Bldg. Off. SAC, City LOO.OC
I herebyacknowledge iha ve reatl this apphcation and state ihat the Variance SAC, MWCC 525.0C
mformahon is correct an o comply with all pplicable State ot Water Conn. 515 . OC
Minnesota Statutes and i f Eagan Ordinan
WaterMeter -7_.OC
Signature of Permitlee - Road LJm[ 9115 - 0C
A Building Permit is issuetl to GRAND OAKS ?E L CO TreatmeN P1 -180.OC
on lhe express condition that all work shal I be done in accordance with al I
apphw6le Sta[e of Mmnesota St utes andGtyof Eagan Ordinances Parks
TOTAL $2,363.5C
Buildmg OHicial
- 7~
dr--
"x C%AP J 0U U6 ~ D~• ~~i 9,9
Ya
~Laxj
i • q~ti 1~~..ti ~G' ,oo ,
Aml of ccounl a / Uy'"" `lL/U ~ •~'~r' / 1~~ Jr
G Utl7~"
Amt Poid ~ t~~ • t L~~ j
. Bolonce Due
n v
. ~ /
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675
New Construction Raauiraments RemodeVRaoair Renuirements
• 3 reg¢terea sile surveys showing sq. tt. of lol, sq 3 of house, and all roofed areas • 2 co0ies of plan
(20°6 maximum lot coverage allewed) . t set of Enefgy Calculaoons for heated atltlrtions
. 2 copies of plan showing beam S wmdow srzes; poured lound design, elc.) . 1 sAe survey lor extenor adtldions 3 decks
• 1 set of Energy Calculations . Inaicate if home served oy septic syslem for addNons
• 3 copies of Tree Preservatbn Plan J lot platted aker 711,93
. Rim Joist Detail Options selecuon sheet (hldgs with 3 or less umts)
DATE VALUATION C~fZg~0 - ~
SITE ADDRESS ~ ID~ ~~{J~-?C~t~iQSp~~ L tV-21 MULTI-FAMILY BLDG Y N
TYPE OF WORK Ta.rr~ dD dcsb-~ (L.if1 J5~ ~ c'Cc/g ee FIREPLACE(S) _ 0_ 1_ 2
SELA ROOFING & REMODELING I
APPLICANT AWn FxCELSIOR BLVD.
STREET ADDRE55 ST. LOUIS PARK, MN 55416
RE)-#9901060 CITY STATE_ZIP
TELEPHONE CELL PHONE # FAX #
PROPERTYOWNER ~ CtoPnPa-f2- TELEPHONE# 90S- (2(0
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Cate9orY _ MINV'1;50TA RULES 7670 CV"!'4:GOR1' I C~
il
submission rype) • Residential Ventilation Category 1 Worksheet Submittetl Lew ergy Co de Works eSubmiCeC
• Energy Envelope Calculations Submitted I 1 ~ 2002 Plumbing Contractor: Phonc Plumbing systcm includes: _ Wa[cr Softencr La~m Sprinl:lcr Pec $90.00
\-Vatcr Hcater No. of R.I. Baths
\o. of Baths
Mechanical Conhactor: Phone #
.`VIcch.mic;dsystcm includes: _ Air CondiUoning Pcr. y70.00
[-Icat Rccoccn' Systrm
Sewer/Water Confractor: Phone #
I hereby acknowledge that I have read this application, stafe that the information is correct, and agree to comply
with all applicable State of Minnesota Statutes and City of Eogan Ordi nc2s.
Signature of Applicanf
OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4102
OFFICE USE ONLY
? 07 Foundation ? 07 OS-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Owelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 37 Ext. Alt - hlulti
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. AI[ - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screened) ? 36 Multi
? OS 03-plex ? 71 10-plex ? 79 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
? 31 New ? 35 Int Improvement ? 38 Demolish (Interiar) ? 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 15 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)' O 43 Reroof ? 46 Windows/Doors
? 34 Replacement 'Demolition (Entire Bidg only) - Give PCA handout to applicant
Valuation Occupancy MC/ES System
Census Code Zoning Ciry Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footin_s (new bldg) _ Final/C.O.
_ Footings(deck) _ FinaWo C.O.
_ Foocings (addicion) _ Plumbing
Foundatia n H V AC
Drain Tile Other
Roof Ice R Water Final Pool f[es AicGas Tests Final
_ Frartting _ Siding Stucco Stone
_ Fireplace _ R.I. _ Air Test _ Final _ 1Vindows (new1replacement)
_ [nsulacion _ Retaining Nall
Approved By , Building Inspector
Base Fee
Surcharge
Plan Review
MGES SAC
City SAC
W ater Supply 8 Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Olher
Total
PhO '~~.10
. . ~
BQILDING PERMIT 9PPLIC TION - CITY OF EAGAN
SINGLE FAMILY DWELLINGS ~i
INCLIIDE 2 SEPS OF PLANS$ 3 CERTIFICASES OF SQROEY, 1 SET OF ENERGY CALCUL6TIOAS
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MIIST DESIGNATE WHICH ADDRESS
IS DFSIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDZNG PERMIT IS ISSQED.
MUL'fIPLE DWELLINGS - RFSIDENTIAL RENTAL UNITS FOR SALE QHITS
INCLUDE 2 SETS OF PLANS, CEATIFICATE OF SIIRVEY - CHECB HITH BLDG. DEPT.!
1 SET OF ENERGY CALCULATIONS
COMMERCIAL . ~
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET 2n:~5,00K2)~ ENERGY CALCULATIONS,
$2,000 LANDSCAPE BOND
~CD OCT e t9di
To Be Used For: ._q? ~ ValuDate: Z i•n" 1
Site Address OFFICE USE ONLY
Lot Block On Site Sewage Occupancy ~-3
f MWCC System Zoning R-1
Parcel/Sub ~~1~ ('i On Site Well _ Type of Const
City Sdater V (Actual) Y- N
Owner (Allowable) Y-H
of Stories
Address ~S~Z 1 S• l~ ,Q•( (.,yl~ (~f/ Length q F3_
Depth /.}L}
City/Zip Code jP'A GA_itJ S.F. Total
/ Footprint S.F.
Phone Z $rq.3 e/ 9PPROVALS FEFS
Contractor 6'ky4'/ii) Assessments Permit
Water/Sewer Surcharge 3 9.50
Address Police " Plan Review 20Q.oo
Fire SAC, City I OD.oo
City/Zip Code _ Engr SAC, MWCC 525•00
Planner Water Conn 575.60
Phone Council Water Meter t'r].oo
Hldg Off Road Unit 3 OS•Do
Arch./Engr. APC Treatment P1 I F~0.00
Variance Parks
Address Copies
City/Zip Code TOTAL
Phone 11
L.n 1 Cft l llll CLIY V GLUf L Fi V CfIHOC Ll t.ilJl'll' U I H 1 l l.)IY
C,FAhID OAICS DFVE.LOF'MENT COMF'ANY
h10DE=1_ *199MMW.Li (1FiEA U VALUE U X AREA
g I N~t }7 \
I'IA:iil`IUI"I AL_LOWED RY CODE •
l'O'1-AL WAL.L AREA 1696 .11 186.56
"fLTAL. Ft00F AFiE.A 1300 . (_>2b ' 33.8
TOTFIL AI_.l_.OWED 220,,36
ACHIEVED
UJAL.L AREA
Id I NDOWS 203 .5 101.5
DfJUf=CS 40 .077 3.09
SL InL= GL.AS:i ;.;b .40 17.20
F I RL.:F'L_AOF .25 7.5
4JALI_ 1=1';AME AFtEA 169.6 .041 6.95'6
FiIi•1 JOIS'T 144 .0436 6.278A
FQUhJD ACjOVE: GFADE 95 .0769 7.3055
N.-:T WHI...L AREA 970.4 .0378 36.99352
TO('AL WALL 1E36.t7810
ROpF AREA
Sk YL.1TE 8 .5 4
f-f00f= FFiF11hF 1=0 .03:' 4.16
NET Ft00F 1170 .0208 74.336
TQTAL R00F 32.496
"fQTAL_ ACFITEVED 219.3770 '
h9Ak6IN IN L7iCL'S:, L"1F CODE .9829i3
% MARGIN IN EXCESS .4460791
S U R V E YO R' S CERT I F I C A T E GRAND OAKS DEVELOPMENT CO.
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PROPOSED ELE'lATIONS SH041PI b1ERE a~D~3~
y62 ~
TAKEid fROh1 THE DEVE! OPMEiNT PLAPi l900)
FOR H I LLS O F STO N E B R? D GE, PRE-
PARED 6Y ?IOPlEER E?lGINE=RING AND
LAST DAT'cD 3-25-37.. / ~ ~
iU
~ DENOTES PROPOSED SURFACE DRAINAGE
O DENOTES IRON MONUMENT SET SCALE: 1 INCH - 30 FEET
• DENOTES IRON MONUMENT FOUND PROPOSED GARAGE FLOOR - 91 S,0 FEET
X000.0 DENOTES EXISTING ELEVATION PROPOSED LOWEST FLOOR= 9i2. 2 FEET
(000.0) DENOTES PROPOSED ELEVATION PROPOSED TOP OF BLOCK 15,4 FEET
WE HEREBY CERTIFY TO GRAND OAKS DEVELOPMENT CO. THAT THIS IS A TRUE AND CORRECT
REPRESENTATION OF A SURVEY OF THE BOUNDARIES OF:
Lot 3, Block 3, HILLS OF STONEBPoDGE, according to ihe recorded plai thereof, Dakota
County,Minnesota. (THE LEGAL OESCRIPTION USED FOR THIS SURVEY WILL BECOME
VALID UPON FILING OF THE PLAT HILLS OF STONEBRIDGE.)
IT DOES NOT PUFPORT TO SHOW IMPROVEMENTS OR ENCROACHMENTS, EXCFPT AS SHOWN. AS
SURVEYEO BY ME OR UNDER MY DIRECT SUPERVISION THIS 25T11 DAY OF SE97 , 1987.
SIGNED: JA S. I, INC.
BY: ~
HAROLD C. PETEFiSON, LAND SURVEYOR
MINNESOTA LICENSE NUMBER 12294
-i ,
~
m co ~ James R. Hill, inc.
o~~° o <o~ >
_ rm~m T ,rv aN ~
° Z A~ ~ o N m=. Z PLANNERS / ENGINEERS / SURVEYORS
O N Z ~ ~ pp ~ co
- O m J 9401 JAMES AVE. S. • BLOOMINGTON, MN. 55431 • 612-884-3029
a
0
N
APFLICATION FOR PERMIT iM= PAYMENf OF FFF:E AT TIME OF ;
~
• neetlcaxIoN ooES rxyr car ~
STITSTIE APPR(YAL OF PIIUKT. ~
+ SEW ER AND/OR WATER CONNECTIQN I'NsPDma' oF mn/°R w"Ex
; icisrn[uTioKS wna, r,ar se scmunEn ;
r
~ . . . ~ [!NPIL PEIt141T H7S BEEIJ APPRCNID. ~
t ' .
sity oF eagcsn
IPL&ASE PRINT
1) PROPERTY ADDRFSS: -3/(1.3
T•F7f;AT• DESCRIPTION: . L 83 L~s S~a u e 1~r~ i~R -z._
~LOt B ock Sucivision or Tax Parcel ID r'
IF EXISTING STRCC'I[)RE, DATE OF ORIGINAL BLILDING PERMZT ISSOANCE:
[Vbnt Year
PRESENT ZONING/PROPOSID USE:
Q CONIIMEf2CIAL/RE"PAIL/OFFICE , R-1 SINGLE FAMILY
Q INIDLSTRIAL R-2 DOPLEX ('fwa Units)
Q INSTIZVTIONAL/GOVII2PIIMENT Q R-3 TOWNtIOC~SE (Three + Units) ( Units)
Q R-4 APARTMENT/COAIDOMINIUM ( Dnits)
z) ~NAME: ~ t 1 D~r KS ~?e L4 A,A e. A2 l
rDDxESS: ,GRKc •~a~-
crTY, STATE, ZIP:
PHONE:
For City Use
3) • , ; NAME: zzP -7 DI ~t .'4 Pl rs License:
Active
ADDRESS: r1D C~ Pe K 4tc.U P I~ Expired
_ o~; 1~ SJr 3 JY.Z. _ Not recorded
CITY, STATE, ZIP: ~
PHONE: MASTER LICENSE #
~ • .
4)
LtLa A (!2«KS - 7eu7 COuSTRu CtiG 0
ADDRESS: ~ M~ Q S C 2~
CITY, STATE, ZIP:
PHONE:
5)
a CONNEC.TZON TO CITY SES4ER a CONNECTION TO CITY WATER O OTHER
6)
* 12IE GOLD COPY OF 1HE PERNIIT WILL BE SENP DIRECPLY TO PUBI,IC WORKS 7U FACILITATE METER PICK-LP. :
* PLE715E ALIAW '1W0 WORKING DAYS FOR PROCFSSING. SON~'ANE FROM TfIS CITY WILL CONPALT YOU IF 741ERRE *
s
* ARE ANY PROBLEMS. ~
~**************+******~*~*+***r++~+~++,t**~**«*~***,t**~***+~+,t+*~s***w+*,t*******~**,t*+r********~**+**y
TOR -CITY USE ONLY ~ PERMIT # ISSUED ~
Pd w/Bldg. Permit FEES:
$ $ SEWER PERMIT ( ZNCLUDE SURCHARGE)
$ $ WATER PERMIT (INCLUDE SC'RCHARGE)
$ Lr G9O $ WATER METER/COPPERHORN/O[,'TSIDE READER
$ $ WATER TAP (INCLUDE CORPORATION STOP)
$ $ SEWER TAP
$ IS'~ O $ ACCOUNT DEPOSIT - SEWER
S ACCOC'NT DEPOSIT - WATER
s S" 7 s- U`o $ wAc
z sc o o $ sAc
$ $ TRUNK WATER ASSESSMENT
$ $ TRC)NK SEWER ASSESSMENT
$ $ LATERAL BENEFIT/TRUNK SEWER
$ $ LATERAL BENEFIT/TRUNK WATER
$ $ WATER TREATMENT PLANT SURCHARGE
$ $ OTHER:
$ A' Z 7 - $ TOTAL
. 7k~s-s a z0
RE EIPT RE E PT
DOES UTILITY CONNECTION REQUIRE. EXCAVATION IN PUBLIC RIGHT OF WAY?
~ YES IF YES, THEN A"PERMIT FOR WORK WITHIN PUBLIC
Q . ROADWAY" MUST BE ISSUED BY THE EIVGINEERING
NO DIVISION. LIST AS A CONDZTION.
SUBJECT TO THE FOLLOWING CONDITIONS:
APPROVED BY:
TZTLE:
DATE:
/
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PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA112641
Date Issued:08/20/2013
Permit Category:ePermit
Site Address: 3903 Worchester Dr
Lot:3 Block: 3 Addition: Hills Of Stonebridge
PID:10-32990-03-030
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.
Holly Flood
1408 Northland Dr #310
Fee Summary:ME - Permit Fee (Replacements)$55.00 0801.4088
Surcharge-Fixed $5.00 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 -
Troy L Raddatz
3903 Worchester Dr
Eagan MN 55123
Sedgwick Heating & Air Conditioning
1408 Northland Drive, Suite 310
Mendota Heights MN 55120
(952) 881-9000
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA112977
Date Issued:08/27/2013
Permit Category:ePermit
Site Address: 3903 Worchester Dr
Lot:3 Block: 3 Addition: Hills Of Stonebridge
PID:10-32990-03-030
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Holly Flood
1408 Northland Dr #310
Mendota Heights, MN 55340
Fee Summary:PL - Permit Fee (WS &/or WH)$55.00 0801.4087
Surcharge-Fixed $5.00 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 -
Troy L Raddatz
3903 Worchester Dr
Eagan MN 55123
Sedgwick Heating & Air Conditioning
1408 Northland Drive, Suite 310
Mendota Heights MN 55120
(952) 881-9000
Applicant/Permitee: Signature Issued By: Signature
SEDGWICK HEATING & AIR CONDITIONING CO
8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55426 • (952) 881-7739
ADDRESS
OCCUPANT
SOLD BY P& ' " -l
173 Vbikr-laTICZ. 13&
MAKE CV ;A king.1/ l �S
SERIAL NO
THERMOSTAT
VALVE
LIMIT
PikeSTJ 6-E
LIMIT SETTING
FAN SE i i ING
PILOT TYPE
IGNITION MODEL
PILOT TIMING
PRESSURE
INPUT CFH
5 "
STACK TEMP. 3 1. Li (3
FORM 235 (REV. 6/08)
PERCENT CO2
bgla
PERCENT 02 t 7 a 10
CO Q
PERCENT CO
CITY
HEATINO1
TEST RECORD
JOB NO
4 zYoO 7`j
OWNER Q0
INSTALLED BY
MODEL FD lot Or y M o M 1-
INPUT D
VENT SIZE n
F�
TYPE OF LINER Cite -55
LINER SIZE
FILTERS SIZE Z_° H NUMBER
WIRING Alf
TEST TAG
Gv_
LIGHTING INST.
DATE TESTED
e -7---i3
COMPANY TESTING
NAME OF TESTER
FORM DISTRIBUTION: WHITE COPY - JOB FILE YELLOW COPY - CITY
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA165773
Date Issued:11/19/2020
Permit Category:ePermit
Site Address: 3903 Worchester Dr
Lot:3 Block: 3 Addition: Hills Of Stonebridge
PID:10-32990-03-030
Use:
Description:
Sub Type:Reroof & Siding
Work Type:Replace
Description:
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and house wrap and leave on site.
When installing ventilated soffit material, remove existing material (i.e. debris that could block vents) and take steps to
ensure maximum ventilation to attic. Call for final inspection after installation.
Valuation: 10,000.00
Fee Summary:BL - Base Fee $10K $191.75 0801.4085
Surcharge - Based on Valuation $10K $5.00 9001.2195
$196.75 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 -
Troy L Raddatz
3903 Worchester Dr
Eagan MN 55123--165
(651) 425-8493
Krech Exteriors Inc
5866 Blackshire Path
Inver Grove Heights MN 55076
(651) 688-6368
Applicant/Permitee: Signature Issued By: Signature