3942 Worchester Dr101'.
CityofEaau
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
Permit # 70/6'6/3
Permit Fee: CID
Date Received:
Staff:
2011 MECHANICAL PERMIT��APPLICATION
Date: 1 O) l 1 1 I Site Address: 3c11-401 ( )i -Ch )ski O✓.
Tenant: Lt A JVE( SG(J
Suite #:
J
RESIDENT / OWNER
Name: U, S i9 !V CC(_SGI v Phone:LO ► - 49/-/-7(S)67
Address / City / Zip 3 -/) CA)(k f.'/ Fc�Ci (.t./1 , 35723
CONTRACTOR
Name: BURNSVILLE HEATING & A/C, INC. License #: L/ l r SJ3 ct2_..)7J,3
3451 W. Burnsville Parkway
Address: City:
Suite 120
State:/�^++ Ziurnsville, MN 55337 Phone: CIS 2 -� £1 C-/ �I
Contact: l7 (RC1 Email:
TYPE OF WORK
New X Replacement Additional Alteration Demolition
Description of work: �l00 (ILL-L(1Ar /9i l, i
NO E: Roof utnted and ground tr runted ttt ical et l r } . r bo sic ; by ,
C 1de. hanica I apecto for o Evil t t i cf tut' 1�:
PERMIT TYPE
RESIDENTIAL
Furnace
COMMERCIAL
_ New Construction Interior Improvement
')C Air Conditioner
Install Piping Processed
Air Exchanger
Gas Exterior HVAC Unit
Heat Pump
_
Under / Above ground Tank ( Install / Remove)
L7 ,. -(
)J Other `" a 4 �.
< �
_
- When installing/removing tank(s), call for inspection by Fire
Marshal and Plumbing Inspector
RESIDENTIAL FEES:
$55.00 Minimum Add-on
or alteration to an existing unit (includes
burned out appliances, ductwork, etc.) (includes
$5.00 State Surcharge) �y�
$5.00 State Surcharge) $ MI (. LJ TOTAL FEE
$95.00 Fire repair (replace
COMMERCIAL FEES:
$75.00 Underground tank
$55.00 Minimum (includes
installation/removal OR
State Surcharge)
$10,010, surcharge is $ 5.00
surcharge increases by $.50 for each $1,000 Permit
Fee requires a $ 5.50 surcharge)
Contract Value $ x 1%
_ $ Permit Fee
- If the Permit $ is less than
Fee = $ Surcharge
- If the Permit Et?. is > $10,010,
(Le. a $10,010-$11,010 Permit
= $ TOTAL FEE
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.ciouherstateonecad.orq
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance
with the approved plan in the case of work which requires a review and approval of plans.
X AA aC{ - n0-71L1/l
Applicant's Printed Name
x
Applicant's Signature
ar~ a •
fgtrfi#ira#r of (Orrupartril
titp of Cagan
lorverbrttf of iiudbtttg ittapPrtirnt ~
Tbis Certif?cate lssued pursuant 1o the reoquininenRs ojSecAton 306 of the Uniform Butltlirrg ~
Code cerAifying lTia1 at ilre time ojtssuance ihls struclure xws tn complfance with tlre various
ordinances of the GYty reguJaring building construcpon or use. For the following:
uft cL.:ec.oo. SF =/GAR ewy Rmw rro. 16073 ~
0-wa-r TYve R3/M 1 ~e DWma pfl/R ] 7y,a CoolL pN
o„w aeil&-RSM 5516 180II~ ST. E. . PRIQt I~
~ ~~-3942 WURDWM IIM Lbj10, B I.HUiS OF S1QEMRMM I
~
~
D., Bom -11.614 1.
POST IN A COkSPICU0U8 PLACE
~,:'1 . . . . _ ` "Aiv . CITY OF EAGAN 0 • ~ ; a 16073
+t 3830 Pilot Knob Road, P.O. Box 21-199, Eagari, AAII 55121
PHONE: 454-8100
BUILDING PERMIT Receipt # ' To be used for Est. Value ~9 Z•`~ Date 9
Site Address DR R,*T~--(;F
LOt Block ~ Sec/Sub. ST"DA'F~3?1 Nr:' OFFICE USE ONLY
Occupancy FEES
Parcel Na
. Zoning
~
Bldg. Permit
~ Name 4 cncrua0 const
S T i:. (Allowable) Surcharye
Address -•t=
~ City . Phone 440-ia 46 ~ of Sco,ries , .
~8~~ : 4 :'lan Feview NBfne Deptn "L54. SAC. City 1~~~• ~
Address ~ S.F. rotai - sAC, nncwcc 575•00
~ Clty PhOtl@ S.F. Footprints - 5SU*C10
On Site Sewage _ Water Conn
r
W W Name On Site Well Water Meter 90 * QU
=Z Address Mwcc syscem
o~ x ncct. oePoslt 30. <W City Phone' Cay water
PRV Required _ S/W Perrnit
I hereby acknowlege that i have read this application and state that the Booster Pump - SW Surcharge i•e
infortnation is correct and agree to comply with ail applicable State of 21~~(~
Minnesota Statutes and City of Eagan Ordinances. Treatment PI
Signature of Permitee - APPROVALS Road Unif 325"00
A Building Permit is issued to: ~•~;~}p ~T= . Planner - parlc Ded.
on the express condiiion that all work shall be done in accordance with all Council ~
applicable State of Minnesota Statutes and City of Eagan Ordinances. gkig, pry, _ Copies
Building Official Variance - TOTAL 2' c ~ ~ . C-Q,
Pamk No. ParmH Hower Date Telephone #
%R v 9 ~ ~ - .~~C • //~U ~r
-lNER
?LUMBING
j2 , 3 9 7 ~
rH V. A.C. ECTRIC
Inspsction Date Insp. Comments
Footirgs I
Foundation
Framing
Roofing
Rou9h PIb9• Z v I 1
Rough Htg.
ls,i.
Rreplace
Final Htg.
Final Plbg. -.2f -fr
Consl. Meter Plbg. Inspector - Notify Plumber
Engr./Plan
e~tf
Bldg. Final - S,e. , k l)
Deck Ftg.
Deck Final
wen
Pr. Disp.
. ....r _ , • •
PERMIT M "
' J MECHANICAL PERMIT RECEIPT M
' CITY OF EA(iAN
3630 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: ,l
CONTRACT PRICE: PHONE: 454-3100 For OHice Use Only:
Site Address R qr C~~ 5?st gr 7 r. ' gLpp, npE WORK DESCRiPT10N
Lot Block 1 Sec/Sub . Res. New ~
_-(I..,LS OF STOV IDGE ~
BUR'1Sj'I~,I.E ;i i''.a. Mult Add-o?1
y Name
Address TSLAND '7 Comm. Repair
~ ~ ` ' ' •,T'
c Ciry ~4':AG E Phone 894-000" Other
FEES
~ Name ~ G~• RES. HVAC 0-100 M BTU - $24.00
3 Address ADDITtONAL 50 M BTU - 6.00
p City Phone ONSTRUC'TION) DES A/C ON NEW
449 GAS OUTLETS (MINIMUM -1 PER PERMIT) - 1.50 EA
TYPE OF WORK _ COMM/IND FEE - 1% OF CONTRACT FEE
FOrCed Air ~ M BTU ~'y • APT. BLDGS. - COMM. RATE APPLIES l
TOWNHOUSE 8 CONDOS - RES. RATE APPLIES
Boiler M BTU MINIMUM RESIDENTIAI FEE - ALL ADD-ON &
Unk Heater M BTU REMODELS - 12.00
Air Cond. M BTU MINIMUM COMMERCIAL FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
VenL CFM (ADD $.50 S/C IF PERMIT PRICE GOES
Gas Piping Outlets k 1 ' BEYOND $1,000)
Other t~
FEE:
J SIGNATURE OF PERMITTEE ~
3/C:
'
TOTAL ' rJ FOR CITY OF EAGAN
~ -
• . i~~
PERMIT M
PLUMBING PERMIT
CITY OF EAGAN RECEIPT #
~
3830 PIIOT KNOB ROAD, EAGAN, MN 55122 DATE: "CONTRACT PRICE PHONE: 454-8100
Site Address BLDG. TYPE WORK OESCRIPTION
Lot Block ~ Sec/Sub Res. ~ New
' i ~ • ~ - Mult Add-on
~ Name a , r; • ' = + %G Comm. Repair
Other
Address
fi) City w'~ • Phone RES. PLBG. ONLY - COMPLETE THE FITOTAL
c
WING: NQ. FIXTURES Name a. y?~ •.r Water Closet -$3.00
' Bath Tubs - $3.00
; Address ' Lavatory - $3.00 l. ,
p City Phone Shower - $3.00
~ Kitchen Sink - $3.00
FEES Urinal/Bidet - $3.00
COMM/IND FEE - 1% OF CONTRACT FEE 'Laundry Tray -$3.00 ,
APT. BLDGS - COMM RATE APPUES ' Floor Drains -$1.50 TOWNHOUSE 8 CONDO - RES. RATE APPUES " Water Heater -$t.50
MINIMUM - RESIDENTIAL FEE - $12.00 Whirlpool - $3.00
MINIMUM - COMM/IND FEE -$20.00 Gas Piping Outlets -$1.50
STATE SURCHARGE PER PERMIT - .50 (MINIMUM - 1 PER PERMIT)
(ADD $.50 S/C IF PERMIT PRICE GOES Sottener -$5.00
BEYOND $1,000.00) Well - $10.00
Private Disp. - $10.00
t. ' ! ` 2Rough Openings - $1.50
SIGNATURE OF PERMITTEE ~ 7 FEE:
STATE S/C: -~L
FOR: CITY OF EAGAN GHAND TOTAL•
' SEWER & WATEFi PERMIT , OFFICE USE ONLY
CITY OF EAGAN 1%=':.'
PERMIT DATE
3830 Pilot Knob Rd. WATER PERM i 02~~~ SEWER PERMIT # 11388
P.O. Box 21199 METER # B.P. RECEIPT # 9 0 6 80
Eagan, MN 55121 # a 6 7 - q :L B.P. RECEIPT DATE 112-1- I L, 4
METER SIZE
ISSUE DATE PRV _ BOOSTER PUMP
SITE ADDRESS PERMR REQUESTED
LOT 10 BLCVK ~SEC/SUB 610 L3
APPUCANT: kka -)(SEWER __L~WATER - TAPS
ADDRESS: t E - COMMlIND ~ RESIDEPITIAL
CITY, STATE rnZIP 6~;:r7a• x
PHONE: NEW - EXISTIIVG
PLUMBER: L lr av~ t x_' ~
AQDRESS: 1 AGREE T/COMP X WTT'H CITY OF
CITY, STATE ZIP rS3 EA INAN~S:
PHONE:
_r S
OWNER: sv~S-
ADDRESS: /
SI TURE WHE R ISSUED
CITY, STATE ZIP
! PHONE: _~_Jj~z
PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. FOR STORM SEWER PERMITS, CONTACT
' ENGINEERING DEPT.
SEWER & WATER PERMIT , OFFICE USE ONLY
CITY OF EAGAN l! 2 c,1
3830 PIIOt KftOb Rd. PERMIT DATE
P.06 . Bc 2 1 1 9 9 WATER PERMIT # 10249 SEWER PERMIT # ^
Eagan, MN 55121 METER # B.P. RECEIPT 9<)6<
RE,0.DER #E B.P. RECEIPT DATE 1..L241$"
6 METER SIZE
ISSUE DATE _ PRV _ BOOSTER PUMP
SITE XDDRESS PERMIT REOUESTED
LOT IOBLOQK --A-SEC/SUB S o J tL '
S~ t~o wti ~.S y&SEWER ! 1NATER - TAPS
APPLICANT: ADDRESS: COMMJIND XRESIDENTIAL
CITY, STATE ~ o~- l~~ t M?~ 7tP SS~7 ~
PHONE: 440 -11-( NEW - EXISTING
PLUMBER:
ADDRESS: ` kk I AGREE TO COMIPL WtTH CITY OF
CITY, STAIE t ! ZIp ,rS~S EAGAN ORDINAN~
PHONE: `OWNER: ~nn~__ n` C.~. j' ' S
AODRESS: 31GNATURE WHEN METER ISSUED
CITY, STATE ZIP
PHONE:
PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. FOR STORM SEWER PERMITS, CONTACT
ENGINEERING DEPT.
~
~ CASH RECEIPT
~
CITY OF tAGAN
3830 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE 19
WcenEO ~ ' , '
Fr+oui jL_
AMOUNT
& DOLLARS
lao
? CASH Cl CHECK
1'54 L-(J
/ ( i , •L~C_(.iZ,. ( ~ l: E ,,,~t:~ ~
FUND OBJECT ~ AMpUNT F
Thank You .
sv
r t• ~ /1
y t. Y' t VVhM--Fayers Copy
YeOovr-Paeting CaPy
PM-FAS Copy
BLDG. PERMIT NO.
,
U r ~ !r
, `L ~
01-321 U Bidg. Permit 01-3422 Plan Check
~ 4
01-3445 Surch./Adm. ~
01-3446 SAC/Adm.
01-2155 Surcharge
75-3860 Road Unit
20-2275 SAC
264865 Water Conn.
~ , .
20-3868 Water Trmt
20-3716 Water Meter
20-2252 Acct. Dep. ~i
20-3713 Water Permit ~20-3743 Sewer Permit
79-3866 Sewer Conn.
28-3855 Park Ded.
TOTAL
;
~
CITY OF EAGAN
- 3830 Pilo! Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100
BUIL.DING PERMIT Receipt #
To be used for SF DWG/GAk, Est. Value =93 ,000 Date 19a9
Site Address 394 F RC:iE '?'i. x
Lot - 1C' Block _I Sec/Sub. _$24 d OFFlCE USE ONLY
Pqrcel No. ooa,pancv R-3 -11--l FEES
Z-" PD Br1
W Name,_ R S b H0MLS (AcNaq const V-H eag. Pema 604.00
Address 5516 180Tx sT a (nNowable) V-m 45.00
~
° City PEtI4R L.AfiE Phone 440-6900 # or storieg ~~rge
Le,g,r, 62' Plar, Review 302.00
o Name SAME oeptn ~ snc. city 100.00
U l R tldress S.F. Tolal 57 S~
SAC. MCWCC •
~'ity Phone S.F. Footprirns - SSO.00 a I
On Site Sewage _ Water Conn
~l Name a, sde weli wate, r„otor 90.00
Address Mwcc sysw+, x
~ W City Phone ciri water X Acct. Devosn 30. 00
PRV Required - S/W Permn 20.00
I hereby acknowlege that I have read this application and state that the Booster Pump - 5/yy Surcharge 1•00
iMOrmation is cortect and agree to coRfily with all applicable State of
Minnesota Statutes and Cityoi Eagan Ofdi'nan - Treatrnent PI 228.00
Signature of Permitee ~APPROVALS Pooad Unft 325. QQ
A Building Permft is issiied ro: R St1 ~OME5 Pla""er - Parlc Ded.
on the express condition that all work shall be done in accordance with all Couricil -
applicable State of Minnesota Statutes and City of Eagan Ordinances. gldg, pry, _ CoPieB
Building OffiCial V~~ - TOTAL 2~$~ i~~
I
~.`-ME~HANIrAL PERMIT ' DATE: 6/4/91
RECEIPT: 101653
SITE ADDRESS 3942 WORCHESTER DRIVE Unit # Permit # 13074
L 10 B I Sect./Sub. HILLS OF STONEBRIDGE
BURNSVILLE HTG. 6 A C- 894-0005
INSPECTION INSPECTOR DATE COMMENTS
INSPECTION INSPECTOR DATE COMMENTS
. . INSPECTION RECOR.D C°r'`ro'"°
CITY OF EAGAN PERMIT TYPE: avT l 0I M6
3830 Pilot Knob Road Permit Number. +0a686
Eagan, Minnesota 55123 Date Issued:
(612) 681-4675
SITE ADDRESS: Lo Y s 10 APPLICANT:
3942 MORCHES7ER DR Ntlt4M ~ItAO
~ NYkCS Of StOM!!liiI01lE (612) 466•-S490
~ PERMfT.VUBTYPE: TYPE OF WaRK: Mtu
fav r 1.01e
R"ApKS: REGTTPT t C19933 QA7'L0 SJ?f. /92
,
i
I
P+umlt NP. PMnll! HOIdM DiOt TWphotw i
3AN .
I! .
-RAeiNa
HvAc -
EL.ECTRIC
E'LECl'ii1C
I 1n~p~alfa~ o~dr In~q. Ca~ib
fbotliq~ !
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~
CITY OF EAGAN ND 16073
, 3830 Pilot Knob Rnad, P.O. Box 21-199, Eagan, N{N 55121
'
BUILDING PERMIT PHONE:454-8100 Receipt a D ' O
To be used tor SF DWG/GAR Est Value $92, 000 Date , 1989
Site Address 3942 WORCHESTER DR
LOt BIOCk -_1_- S2C/Sub. STONFRRTDC:F OFFICEUSEONLV
Parcel No. occuoancy R-3 M--1 FEES
Zoning PD R=1
w Name R S M HOMES (nctuap Const v-N aiaq. Perma 604.00
o Address 5516 180TH ST E (nuowabie) V=N surcnarge 46.00
City PRIOR LAKE Phone 440-6900 # of Stories - 302.00
Lengih f)2-1 Plan Review
;io Name SAME Depih 351 snc, ciry 100.00
g¢ Address S.F.Total - SAC,MCWCC 575.00
~ Clfy PhOn@ SF.FOOlprinls -
On Sae Sewage _ Water Conn 550.00
rs
$w Name OnSiteWell - WaterMeter 90.00
Address MWCC System X
aw City Phone arywater X Acct Deposit 30.00
PRV Required _ SiW PermR 20.00
I herehy acknowlege #that gad this pplicati and state tha[ the eooster Pump - gW Surcnarge 1.00
Iniormation is correco co wdh I applicable State oi
MinnesotaStawtesaan ance Treatment Pl 228.00
Signature of PermReAPPROVALS Road Unit 325.00
A Butlding Permtl is iH Planner - park Ded
on ihe express condi rk shall be done in accordance with a ll Council _
applicable State of Minnesota StaNtes and Ciry of Eagan Ordmances eldg. Off. _ Copies
Bwlding 0tlicia~ 0 A} I I'hk A Variaace - TOTAL 2'871.00
~
Address: 3 Z(q,l~ •G~~~:. Lot a Blk Sec/Sub ~O.S' S'~i br' c'
These items were/were not complete at the time of the final inspection.
' 9 - S Yes No ~
Final grade (6" from siding)
Permanent steps - garage
Permanent steps - main entry ~
Permanent driveway
Permanent gas
Sod/seeded grass
Trail/curb damage
Porch ~
Basement finish ~ G1r/'rcc ~r~' L
Deck
Please verify vith the builder the removal of roof test caps from the plumbing
system and the shut-off of vater supply to the outside lavn faucet before
freeze potential exists.
White - City copy Yellow - Resident copy Pink - Contractor copy
DATE: 8/26/89
RE: 3942 C,'DRCS`,LISYIIA DLi., H.flO, DY, (•78LLS OP SFQ;33C.REDGE
~5-Your Sewer & Water Permit for the above property has been completed. It wiil be held at the
Public Works Garage (3501 Coachman Road) until the meter is picked up. BE SURE TO
- CALL PUBLIC WORKS (454-5220) FOR YOUR PERMANENT WATER TURN ON.
~
Your Sewer & Water Permit for the above property cannol be completed for the following
/ reasons:
W
i
- Your6ewer & Water Permit for the above property has been completed, but the meter cannot
be is'sued or occupancy allowed until further notice.
~ .j.d .
- COMMERCIAL PROJECTS ONLY: Piease pay tor meter at City Hall. Meter size must be
contirmed by Bill Adams or Dirk House (Plumbing Inspectors - 454-8100) before issuance.
WARNING: BEFORE DIGGING, CALL LOCAL UTILITIES - TELEPHONE, ELECTRIC, GAS, ETC.
- REQUIRED BY LAW.
CONTACT COMMUNITY DEVELOPMENT DEPARTMENT FOR WATER TURN ON POLICY.
Secretary, Building Inspections Dept.
DATE: 1/26189
RE: 3942 GORCHESYt3R DE2., L10, IIfl. t4ZLLS OF S4'Oi73BRLDGE
~
VYour Sewer & Water Permit for the above property has been completed. It will be held at the
Public Works Garage (3501 Coachman Road) until the meter is picked up. BE SURE TO
CALL PUBLIC WORKS (454-5220) FOR YOUR PERMANENT WATER TURN ON.
_!Your Sewer & Water Permit for the above property cannot be completed for the following
reasons:
.
i
Your,Sewer 8 Water Permit for the above property has been completed, but the meter cannot
be itisued or occupancy allowed until further notice.
COMMERCIAL PROJECTS ONLY: Please pay for meter at City Hall. Meter size must be
confirmed by Bill Adams or Dirk House (Plumbing Inspectors - 454-8700) before issuance.
WARNING: BEfORE DIGGING, CALL LOCAL UTILITIES - TELEPHONE, ELECTRIC, GAS, ETC.
- REDUIRED BY LAW.
CONTACT COMMUNITY DEVELOPMENT DEPARTMENT FOR WATER TURN ON POLICV.
Secretary, Bwlding Inspections Dept. ~
yo 2 i,;Z-
C 85 ~ 30 L 1v ~ r3 ,e l-V ez~
Rey,est Date , Fire No. Rough-in Inspecbon
y2 ~ Reqmretl? ? Ready Now Will NoVty Inspector
Ves ?No Whenfleady?
licensed contractor ? owner hereby request inspecUOn of above electrical work at:
JoblWtlress (S[ eC Box or RoNe N. ) C~y
. ~~'Z
SecBon No Tawnship Name or No Range No Counry I q
~,y p~-~c.~
OcwpaM (P WT) Phona No
, 7 'e5
PowerSup Atltlress
rVl 7~,'I
Eledrical CoMraaor (Company Namej Contra rS ~cense No
l~ .~~I oq rq~s3
Mailing Atltlress (COntrador or Owner Making Installd~ion)
CJ< <v . 3- So c/ 'i m eq,
Authonzedr5ignaWre (COntr ador! ne Making Installa[ion) Phone Nu
90-413
MINNESOTA STATE BOARO OF ELECTRICITV THIS INSPECTION REOUEST WILL NOT
Grig9s-MlEway Bltlg. - Foom S173 BE AGCEPTED BY THE $TATE BOAPO
1821 Univereity Ave., SL Paul, MN 55104 UNLE$$ PflOPER INSPECTION FEE I$
Phone(61f)602-0800 ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION l- ea000(11-07
No See inslmcUOns lar mmpleling ihis form on beck ot yellow copY 90/1o/~
C:'9583 D "JC" Below Work Cavered by This Request
ew Add Rep TypeoiBwlding ApphancesWiretl EquipmenlWiretl
Home Range emporary Service
Duplex Water Heater Electric Heating
r Apt. Building Dryer Other (Specify)
Comm./Industrial Furnace
Farm Air Conditioner
Other jspeuty) Coniraclor§ Remarks:
Compufe Inspechon Fee Below:
# Other Fee # ServiceEntranceSize Fee # Circuits/Feetlers Fee
Swimming Pool 0 f0 200 Amps Z- 0 to 100 Amps
Transtormers Above 200 _ Amps Abov 0_ Amps
SignS Inspecro05 Use Only: TOTAL
Irrigation Booms OL,
Special Inspechon
Alarm/Communication
other Fee D '
I, the Electrical Inspector, hereby Rough-m Dale
certify that the above inspection has F„~ai oa~e
been made.
OFFICE USE ONLY ~
This requesl voitl 18 rtronths trom ~
3 v/a'9
99070,Cro
Request Da[e Fire No Rough-in InspecLan
Requiretl+ ?fleatlyNOw~1 WlhenReatlyP~'~r
es ? No
I~Ihcensed coniractor ? owner hereby request inspection of above elecincal work at
Job Atldress (Slreeq Box or Route NoJ, City
. 39 ~-f z ~~c~,~ SY~r--
Sedion No. Townshlp Name or No Range No Couny G
Occupant(PflINTI Phone No
f<. -es
PowerSUr Atltlress
pp e
'
~C.~.q kcr~ en~
Elecincal CoJilredor (COmpeny Name) ~ Con~r tor5 License No
Mailing Atltlress ConVacirn or Owner Making InstallaLOn)
_ 6,1`1 .u _ / 3
AuNOnzetl S naWre (COntrac~o40wner Makmg InstallaLOn) v Phon4umber
, CLe'~
MINNESOTA STATE BOARO OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT
Griggs-Mltlway BIOg - Noam 5113 BE ACCEPTED BY THE STATE BOARO
1821 Unlversiry Ava., SL Peul, MN 55104 UNLESS PROPER INSPECTION FEE IS
Phone(6/2)6C2-0800 ENCLOSED.
0 ~ /a~0/8' -~'j REQUEST FOR ELECTRICAL INSPECTION ~ ee-00001-07' /
? Sce insvuctioris lor completing Ihis form on back oi yelbw copy
0
F 99070 X" Be/ow Work Covered by This Request
ew Adtl Rep. TypeofBuiltling AppliancesWired EquipmenlWired
Home Range Temporary Service
Duplex Water Heater Electric Heating
ApL Building Dryer Other (Specdy)
Comm./Indusirial Furnace
Farm Air CondM1ioner
Oiher (spocity) ConVaclar5 Remarks
Compute /nspection Fee Below:
# Other Fee # SernceEntranceSrze Fee # Circuns/Feeders Fee
Swimming Pool 0 to 200 Amps 1 0 to 100 Amps ~-li_ Transformers Above 200 _ Amps Above-iBQ _ Amps
SignS Inspec[ar9 Use Only: TOTAL~~ S~
Irngation Booms
Special Inspection
Alarm/Communication ~
Other Fee 621~1
• P oate
I, the Electrical Inspector, hereby R°"9M"n
certify that the above inspection has Fnv oa~e
been made.
OFFlCE USE ONLY
mis rewest ma 18 mwrms o-m
' ,1989 9QILDING PERMIT APPLICATION - CITY OF EAGAN'
SINGLE FAMILY DWELr INGS 14 0 7 3
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENEHGY CALCULATIONS
NOTE: ADDRFSSES FOR CORNER LOTS - CONTR9CTOA/HOMEOWNER MOST DESIGNATE WHICH ADDRfiSS
ZS DFSIRED. NO CHANGES WILL HE ALLOWED ONCE BOZLDZNG PEAMIT IS ISSDED.
MfJLTIPLE DWELLINGS RENT9L QNITS FOR SALE DNITS t OF UNITS
INCLUDE 2 SETS OF PLANS, CERTIFICATE OE SURYEY - CHECB WITH BLDG. DEPT.0 1 SET OF ENERGY
CALCULATIONS
COPAfERCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND t SET OF ENERGY CALCULATIONS
- - .T.A~r,.~C ?98?
To Be Used For: Valuation: Date: I- Lg'8 l
Site Address '"Lq,a- ~QCSnzS~.e~. ~V.. of Z ooo- OFEICE OSE ONLY
Lot lp Biook ~ Occupancy 3 M-I FESs
1 Zoning m Q- I
Parcel/Sub N.i~[S Qt ~'~O1J~V2~C~.gt Actual Const V-rY Bldg. Permit oo
1i_KJ Allowable V-YJ Surcharge 4b.0o
Owner R C
mx_s, # of stories Plan Review 39Z400
Length ~ SAC, City /CD,On
Address 55`~_,} ~ Depth 35' SAC, MWCC 575.00
S.F. Total Water Conn . 55 O•G0
City/ZYp Code Footprint S.F. Water Meter 0.00
66Phone `tq0 '6C(.Qo ~~a On site sewage_ S/W tPermitgit
On site well S1W Sureharge {,oJ
Contractor MWCC System ~Treatment P1. 228.00
City water v Road Unit 395,0-:>
Address PRV required _ Park Ded.
Hooster Pump _ Copies
City/Zip Code TOTAL
APPROVAIS ~T" 7
Phone Planner
Council
Arch./Engr. Bldg. Off. ~~z3
Variance
Address Couneil
City/Zip Code
Phone #
NOTE: Sewer R Water Permit fees and account depoait fees will be ineluded in the building
permit fee. Processing time for sewer and xater permits is txo days onee a licenaed
plumber has applied for a permit at City Aall.
YALUATION
, , ,
GARA6 E
ZZxZZ= y84 X
C3SMT
Z2t 13Z
3vqxss= ii9o
14 X 2 = 28
i s x I3- 117s50
13b4 X 149= (e6q3y
ql ZGo
srrmalorv eert#Wte
SURVEY FOR: R.S.M. Homes Inc.
DESCRIBEO AS: Lot 10, Block 1, HILLS OF STONEBRIDGF., City of EaRan,
Dakota Covnty, P!innesota and reserving easements of record.
v
,
~ r~j
$y
Bate
~
E1kCAIV
OPG~~j .
~ C~~ 89S
.~4: _W . .
b 4' a ,4•is. oe ~
6p~ , ~I ~'e e•ec. o0
\ 4
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P~... ~
. -tprs CP xz. 33
5.3 ~
oAa. g
y m
I N aaa ~ ~ 4tn
I w o 8
f6.00 lOvel Pt ~
ttc g \ °o
~ v ~ I 8 PO~ 1' ~ 1 T'n
L
LEVEI R~ {
ec
g
So ~ ' .
~
~ 36.33
`
w ~g 8 $ .
/ e 8
1
S76s 4,16*f 13g- 1
~
33
y
f8.00 2tl3 i , ! 1 890,s-
- l_ J ~ 7
~ i
37.33
PROPOSED ELEVATIONS I JENC~HMARK,
7op ol FounOaNOn . eq,7 .3 T.M. Flvi, Q, S.E. Go~,
Oorope floor • 8 940•9 ' eF
e01e1lIenr Ffoor ~ eOq''L (Utr~~ )
ADO~ot. 8~w~r 9~rvle~ ENv. ~ e..•~J.~ 11MIM. 9AIACK REOIREMENTS
ProponA ElwoNon• ,
Ea1111109 Ehvallons . Front - ie Mewo 61de -ie
Drolnope Dheerlons . RGor - I S Oeraae elAe - 9
Wnotn OtHN 8toke ~ O BCALE: 1 Inob ¦ SO Net
! Mnqr wrM1Y tMl IIN wr"Il Nftn w ryaf was NoMnd y n» JOS NO.i
IfEDLUND K "Ol.., ffl,.kftt .tipwwbion 40. M.t ,.m ..uty R..,.,.... 199R_,z
leM Swvorw unW Ilie 1ewn N na 11reN or Mieneerrs. P/annbp Enyl~MSrirry 8wrsylrrp woK: i
D.~' }
ar.: aac;
. o , uo.n.. ~ Jr
~12cQ~- L;scL 1~lsa~
E
I? S
~k
~to
Cedat- Dcc~K ie l
x k" ~
5-IePs
,
l~fUUS~
PArlo 190UO
AS
CALHOUN'S COLLECfORS SOCIETY
A tradilion o( inlegrily
Since 1928
• •7401 Cahill Road, Minneapolis. Minnesota 55435
612i941-0110 • Telex.29-0977 Calhoun Edna
-Bs-Cc& -j- L-iis~ NelSon
~-~n M N, 551a.3 ~ .
~
r( 5
~
C2G~G-r I ~o ~
DeGK
GG1 ~~G ~ ~r o Doo~S ~-{o c.~s~
AS
CALHOUN'S COLLECTORS SOCIETY
A Iradilion o(integrily
Smce 1928
• 7401 Cahill Road, Minneapolis. Minnesota 55435
612/941-0110 • Telex. 29-0977 Calhoun Edna
. . . EXTL•'ftLUk F.NVG[.OI'1: /1VIiftAGT "U" CO:iPU7'ATI011 .
~ i
GwNER_:S . M lAo
svrs nooieLSS
" conrancrorc~Q.S /1'J. ,~_~+G• _
DATE
~ Determine uorAiny syuarc footagc oC cach.
1. Total exposed wall arca /~f6o.0 sr;. ft. x •<< = 3~0 '
2. Total roof.cciling arca /33B•O sq. f[. x •025 ~ 33~!
Total exposed wall area above floor =/,"AO.O
• a. Total wall vindow area.................................... /D~•
b. Total door area y~• G
c. Total sliding glass door'area .~2• Z
ci. Total Cireplace wall area O
e. Total vall Eraminq area (averaqe lOt) /qb. D
E. Total net aall area above floor IWo 9, 0 g• Total rim joist area /,>y,s/
Total exposed fousidation arca = f0'•`
h. Total foundation Window arca O
i. Total net foundation area above gradu L0g.6
Determine "U" value of each wall seqment. d . ioj, 91_ x S-s
b. y3. L x..,r.
C. .32~ Z X "U" . S.5 = ~7•7
a. o X'l„ll ~ o = a
. e. ~7G•o X •-U••
c._1L~o~~__ x ..U,. • Oy/ = -~~T~ _
~ n. - °~r. .o. . . ' . O
. . `i .
' J... . ...........Ti~GaI = 7V.2
1
[C item M] is thc samc as, or Lc::. ehan itum Nl, you havu inet r.hc [ntwit
u[ SbC GOOG(c) 2. d1(1(~,n -4 Z rl7S.3)
-r.+..G+~ 9,sl1 c bo.oG ~c) 2
Towl exposed rouf/cciliny arua =./338• p__
j. T9ta1 skylight arca . O
Y,. ToCal roof/ceiling Erarniny arvo (avcrayu to't.) . . . 133•R
1. Total neC insulated roof/cuilinq ac<ea..................... DaWrminc "U" valuc for cach roof/ceiling scymenr.,
j ~ X,.U,. ~ d
k . 13~?•O J( «V•• i a .3• y . .
" 1..,~aa s/ r. x..u„ , o~~ e as. a
4 . ......Tocal =
. Lf total of H4 is the same as, or less than k2, you have met [hc intent of
SBC 6006 (c)1. ~w ~ S/ ~L87> L~"~„r~ 1~~3•r~
iternate Building Envelope Design
To utilize thc total envelope system meth«3, clic values establish•:d by t}ic
sum oE items k3 and 14 shall not bc greater than tlie sum o: items 91 and 02.
+ z. a~7
a. /9s. 2 + a. Z8. - 03• . `Q~.K.O ~ U ? . 9, G a.P~o+,-.~ ~Z'Z 7. . .
c-~ ol
PERMIT C°n 0480
~ CITYbFEAGAN PERMITTYPE: euiLDING
3830 Pilot Knob Road 000606
Eagan, Minnesota 55123 Permit Number:
(612) 681-4675 Date Issued: 0 5/ 21 / 9 2
SITE ADDRESS:
3942 WORCHESTER DR
LOT: 10 BLOCK: 1
HILLS OF 3TONEBRIDGE
DESCRIPTION:
Building Permit Type DECK
Building Work Type NEW
Building Length 16
Building Width 16
~ .
. ~
~ .
REMARKS:
RECEIPT q C18933 OATEO 5/21/92
FEE SUMMARY
Base Fee $25.00 COPIES $1.00
Surcharge $.50 Total Fee ;26.50
Subtotal . . $25.50
CONTRACTOR: OWNER: - APPlicant -
NELSON BRAD
3942 WORCHE3TER DR
EAGAN MN
(612)456-5480
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.
Statutes and City of Eagan Ordinances.
I_ ~ ' n J
~
~ ~
APPLICANT/PERMITEESIGNATURE ISSUED SIGNATURE
INSPECTION RECORD I C°n 0480
CITYOFEAGAN PERMITTYPE: euiLoiNG
3830 Pilot Knob Road Permit Number: 000606
Eagan, Minnesota 55123 Date Issued: 05 /21 /92
(612) 681-4675
SITEADDRESS: Lor: ie eLocK; 1 APPLICANT:
3942 WORCHESTER OR NELSON BRAD
HILLS OF STONEBRIDGE (612) 456-5460
PERMIT SUBTYPE: TYPE OF WORK:
DECK NEW
INSPECTION .
FOOTINO FZNA.L._
REMARKS: RECEIPT N C18933 DATED 5/21/92
F
L
~
PERMIT M CITY OF EAGAN
1992 BUILDING PERMIT APPLICATION
681-4675
SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy
calcs.
COMMERCIAL 2 sets of architectural.6 structural plans, 1 set of
specifications, 1 copy of energy calcs.
Penalty applies when typinq of permit is requested, but not picked up by last working day
of month in which re uest is made or lot chan e is re uested once ermit is issued.
Date Valuation of v?ork
SiteAddres,s: ~9 j-{a ~a2Ches`(-P -ri f-i UE -
STREET SiE M
Tenant Name; (commercial only)
LOT ~ BLOLK 1_ SUBD. 7Li-& G P.I.D. f
Descri tion of work: c')?__JK
The applicant is: Owner ? Contractor ? Other (Deseribe)
Name 4~~Yl e~F?W J- LISP Phone
Property LAST F1R5T
Owner Address DVi '/e _
STREET STE !
City State 1 V`{~ Zip
Company Phnne,
C011tfSCtOr Address License # ' Exp.__
City State Zip
Architect/ Company Phone
Engineer Name Registration #
Address
City State Zip
Sewer & water licensed plumber . Processing time for
sewer 8 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
O 01 Foundation 005 Apt. Bldg ? 09 Basement Finish ? 13 Lomn/1nd New ~
O 02 SF Dwg. ? 06 Garage/Accessory ? 10 Swim Pool ? 14 Comm/Ind Add
? 03 Two family El 07 Fireplace ? 11 Res. Add. ? 15 Comm/Ind Rem
? 04 Multi-fam. T.H. ~ 08 Deck 0 12 Res. Porch 016 Public Fac.
. ? 17 Agricultural
WORK TYPE
Af 31 New ? 33 Alterations ? 35 Move
? 32 Addition ? 34 Tenant Finish 0 36 Demolish
GENERAL INFORMATION
Const. (Actual) Basement sq. ft. MWCC System '
(Allowable) lst F1. sq. ft. City Yater
UBC Occupancy 2nd F1. sq. ft. PRY Required
Zoning Sq. Ft. total Booster Pump
t of Stories Foatprint Sq. ft. fire Sprinkler
Length t~ On-site well Census Coda ti~ Y
Depth ~ On-site sewage SAC Code
APPROVALS
Planning Bailding Assessments
Engineering _ Yariance
REQUIRED INSPECTIONS
O Site 04ooting E] framing Q Insulatiun
? Wallboard PZ Final O Oraintile 0 fireplace
Permit Fee 79. 00 v,iuas;d,: s
Surcharge . so
Plan Review
License
MWCC SAC
City SAC
Water :onn.
Mater Meter
Acct. Oeposit
S/W Permit
5/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Trails Ded.
Copies
Other ~ , o 0
Total : ~ r. . ~
SAC %
SAC Units
. .,.m... . ~ -^~~1
• ~ . .
sur~ve~or~s G'ert~,f '~cate
SURVEY FOR: R.S.M. Homes Inc.
DESCRIBED AS: Lot 10, Block 1, HII.LS OF STONEBRIPGF., City of EaRan,
Dakota County, Ptinnesota attd reserving easements of record.
" i
_ _ . _ _.w..
,L,6a~• ~~p.~o~oo • , a 4•~6.0! ~
\ p. A3 y ,
a6 ~---I ~•4 d a'co. o0
.
~
~ ~ 1 1~' 1 t`" "v I
22.33 6AR. 8
4' m s } ~ i g-_ ~ N
~p ~ SI~ ~
n> + 3204 ~ ed 4tri n-6 O g
16.00 L~vsl ~ 7~y4 x
t?c
N •
P
I D v , 8 PaCT~~ x m
I C I I LEVEL ~ S
~ ~ I g sc
ao o 36.23 l to aFt ..0> g g
~ s \
~ -T } ~
9S. ~ `
576. 4,16. - ~ \
f ~g 33
h
f6.00 2L 33
i L a~`S
L.~-L i~
37.33 iI
PROPOSED ELEVATIONS I BENCHMARK~
Top of FounAatlon ¦ eq-13 ~ T.M. Noi, dL S.E. Go~.
Oaropo flaor 9y.9 oF We.<,tisals. C~, . 914.41-
S01eT/flt fl00r d. 's U<r1~ )
e~q• IN.SE~BACK REOIREMENTB
Approt. Stwor 9errlee ENv. v e.,iJ~
PropoleA Elevallans
Exntlnq EUrellom Front - ie Man* lIAe -te
~
Drolnep* Dlnellons Reor - 1 S Oareoe t10e - S
Denotoo Of/ilet 8toks ~ p gCALE: 11noA • 30 feet
t Mnh arnrr rMI INi rwvw. Nmn « rMal MMaN b nr JOS No.t
/~/EDLUND " `n", .`.°t •yrvbkn wN Met t ~ a duh MNbNnd ,z
UM Brwra rM~r 1~~ MN H IM $tete #f MlnnpNe.
DOOK:
P/snMnp Enp/nssrlny Suntiylny
..,b..,.~.,;.~~«..~~~:x^~---~w- D.J'
pN: MOE:
H • 0 , UaM~~ INNfI~ ~
CITY OF EAGAN FOR CITY USE ONLY
3830 PIIAT KNOB ROAD
EAGAN, ?fN 55122 PERMIT
PHONE: (612) 454-8100 RECEIPT ~
~£GNdNICAS;~`Y~IiPiZT DATE: ~ 9/
RESIDEN2IA2;7; PLEASE COMPLETE IIPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS 6
TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
- °
WORK DESCRIPTION FEES
NEW CONST ADD-ON MINIMUM 15.00
ADD ON ~ HVAC 0-100 M BTU 24.00
REPAIR _ ADDITIONAL 50 M BTU 6.00
GAS OUTLETS - MINIMUM 3.00
OWNER NAME: ~4f~ N6t.-S C) A/ OF 1 PER PERMIT
n SUBTOTAL: $
SITE ADDRESS: ~7,~)= ( _)bR-~$L~el~ ~1(L-. STATE SURCHARGE: .50
LOT:BLOCK ~ SUBD. ~ o_e~ TOTAL: $~~5o
INSTALLER: BUff15Ylng Heatin$ & A(C, i^r, ~
12481 Rhode Island Ave. So. - ~ ~
ADDRESS: SayasprMN 5537H-1122 SIGN'TURE F PE TT 894•0005
CITY: ZIP:
PHONE
QOMMERCIALITNDU5TRTAL:; PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS,
APARTMENT BUILDINGS, AND MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE
NOT REQUIRED FOR EACH DWELLING UNZT.
CONTRACT PRICE: FEES
OWNER NAME: 18 OF CONTRACT FEE.
STATE SURCHARGE _ $.50 FOR
..o.c. cn"H pi n. nvnn
S?T.c. :aDv.~.c.
~vv i:i a:u•iii :Eb.
PROCESSED PIPING - $25.00
LOT: BLOCK _ SUBD. ' $25.00 MINIMUM FEE.
INSTALLER: CONTRACT PRICE x 18 $
ADDRESS: STATE SURCHARGE $
CITY: ZIP; .
TOTAL: $
PHONE
(SIGNATURE)
FOR:
CITY OF EAGAN
,
i,~
2004 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
• 3830 Pilot Knob Road, Eagan MN 55122 ~ ~Telephone # 651-675-5675 FAX # 651-675-5694
New Construction Reauirements RemodeVRewir Reauirements Offce Use Onlv
3 registered site suneys showing sq. fL of bt, sq. ft. of house, and ail roofed areas 2 copies of plan Cert o( Survey Recd _ Y_ N
(20% maximum lot coverage aliowed) 1 set ot Eneyy Calcutations tor heated additions Tree Pres Plan Recd Y N.
2 copies of plan shrnving beam & window sizes; poured lound design, etc 1 site survey for additbns 8 decks Tree Pres Required ' Y N
1 set of Energy Calculations Adddion - indicate if on-site sepfic sysfem Omsite Sepfic System Y N
3 copies of Tree Preservation Plan d lot platted after 711193
Rim Joist Detail Options selection sheet (bldgs with 3 or less unifs
Date ZA / 6q Construction C,o~/st
SiteAddress 39y2 ~~'i~ mPy c-Ma3 UniUSte # -r
Description of Work b
Multi-Family Bldg _ Y_ N Fireplace(s) _ 0 _ 1 _ 2
/ p
PropertyOwner TelephoneH(~(jh / t/Scl~•
Contractor ~l~(,n.~Q~UT(J(~ ~c • • ~
Address ~Mdm~ Ciry
State !?~I` I'~11~ ~ ~ ~ ~Y~ Ir'Il1"Zip Telephone#(g5z)_q3s~91~(a9
u - - - ~
Ili n n I II II
I L 4 I~) P
II
I II
Ll
U
COMPLETE ITHIS-AREA=ONL-YIIF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Ca[eeorv I Minnesota Rules 7672
Energy COde CategOry . ResidenGal Ventilalion Category 1 Worksheet . New Energy Coda Worksheet
(4 submissiontype) Submitted Submitted
• Energy Envelope Calculations Submiried
Have you previously constructed a building in Eagan with a similar plan2 _ Y _ N If so, 25% plan review
fee applies.
Licensed Plumber Telephone # ( )
Mechanical Contractor Telephone J
Sewer/Water Contractor 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 plan in the case of work which requires a review and
approval ofplans.
~
vaKs
Applicant's Printed Name Applicant's Si ature
OFFICE USE ONLY
3ub Types .
7 01 Foundation ? 07 OS-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? OS 06-plex ? 16 Fireplace ? 27 Porch (3-sea.) 0 31 EM. Alt- Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 PorchlAddn. (4-sea.) ? 33 E#. Alt - SF
? 04 02-plex ? 10 OB-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc.
? OS 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-piex ? 12 12-plex Plbg_Yor_N ? 25 Miscellaneous
Work Types
? 31 New ? 35 In[ Improvement ? 38 Demalish Interior ? 44 Siding
? 32 Addition ? 36 Move Building ? 42 Demolish Foundafion ? 45 Fire Repair
? 33 Alteration ? 37 Demolish Building' ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement 'Demolition (Entire Bldg) - Give PCA handout to applicant
Valuation Occupancy MCES System
Census Code Zoning City Waler
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
Footings (new blde) _ FinaVC.O.
Foo[ings (deck) _ FinaUNo C.O.
Footings (addition) _ Plumbing
Foundation _ HVAC
Drain Tile Other
Roof Ice & Water Final _ Pool _ Ftgs _ Air/Gas Tests Final
Framing _ Siding _ SNCCO _ Stone _ Brick
Fireplace R.I. Air Test Final Windows
Insulation _ Retaining Wall
Approved By: , Building Inspector
Base Fee
Surcharge
Plan Review
MGES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA108675
Date Issued:12/31/2012
Permit Category:ePermit
Site Address: 3942 Worchester Dr
Lot:10 Block: 1 Addition: Hills of Stonebridge
PID:10-32990-01-100
Use:
Description:
Sub Type:e - Water Heater
Work Type:Replace
Description:Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Kris Oien
3670 Dodd Rd
Eagan, mn 55123
651-365-1340
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 -
Bradley J Nelson
3942 Worchester Dr
Eagan MN 55123
Champion Plumbing
3670 Dodd Rd., #100
Eagan MN 55123
(651) 365-1340
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA145370
Date Issued:09/07/2017
Permit Category:ePermit
Site Address: 3942 Worchester Dr
Lot:10 Block: 1 Addition: Hills Of Stonebridge
PID:10-32990-01-100
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:One Window/Door
Census Code:434 - Residential Additions, Alterations
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: 500.00
Fee Summary:BL - Base Fee $500 $40.00 0801.4085
Surcharge - Based on Valuation $500 $0.50 9001.2195
$40.50 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 -
Bradley J Nelson
3942 Worchester Dr
Eagan MN 55123
(651) 491-1784
Home Depot Usa Dba The Home Depot
2455 Paces Ferry Rd
Atlanta GA 30339
(952) 345-6057
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA145401
Date Issued:09/08/2017
Permit Category:ePermit
Site Address: 3942 Worchester Dr
Lot:10 Block: 1 Addition: Hills Of Stonebridge
PID:10-32990-01-100
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:One Window/Door
Census Code:434 - Residential Additions, Alterations
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: 500.00
Fee Summary:BL - Base Fee $500 $40.00 0801.4085
Surcharge - Based on Valuation $500 $0.50 9001.2195
$40.50 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 -
Bradley J Nelson
3942 Worchester Dr
Eagan MN 55123
(651) 491-1784
Home Depot Usa Dba The Home Depot
2455 Paces Ferry Rd
Atlanta GA 30339
(952) 345-6057
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA167403
Date Issued:03/12/2021
Permit Category:ePermit
Site Address: 3942 Worchester Dr
Lot:10 Block: 1 Addition: Hills Of Stonebridge
PID:10-32990-01-100
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:Does not include skylight(s)
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and leave on site. We encourage you to retain an electronic copy of
photos until the project passes a final inspection.
*Roof permits issued between December and March will be inspected in the spring or when weather warms up.
Valuation: 5,000.00
Fee Summary:BL - Base Fee $5K $118.00 0801.4085
Surcharge - Based on Valuation $5K $2.50 9001.2195
$120.50 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 -
Bradley J & Lisa A Nelson
3942 Worchester Dr
Saint Paul MN 55123--165
(651) 491-1784
Bormann Brothers
17593 Foxboro Ct
Farmington MN 55024
(952) 891-8586
Applicant/Permitee: Signature Issued By: Signature
