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4455 Clover LaneCity of Ea�afl 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 ►Dj Co Use BLUE or BLACK Ink For Permit #: —( L % 0� Permit Fee: ti Date Received: Staff: 2011 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: / —I -' J v iv w `K r 1 c unn .r: RESIDENT / OWNER Name: j rr4z€i ie. 44.Sort Phone: Address / City / Zip: './L/ SS GI 0 v,e c Lel AP -4, -- Applicant is: Owner Contractor TYPE OF WORK t Description of work: t7i id b1 Gte //tefface c7(d 6�X' Construction Cost: _:,-.2.,...-.- 0 Multi -Family Building: (Yes / No ) CONTRACTOR ,_LQ Company: b--LcKs 'y :.7-46. Contact: 530 -e 5.1 -14F -t<' Address: ) /(, 5 V€'►Cvoi AU' - N- City: OGXV clI e nn 1 �c�, / & p State: ►��• k) Zip: 5 7{ ) vv Phone: 5 i " 7 / 7 34 Z� License #: Z0(4, 30 7 0 2 Lead Certificate #: If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) In the last 12 months, Yes No If COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING has the City of Eagan issued a permit for a similar plan based on a master plan? yes, date and address of master plan: Licensed Plumber: Mechanical Contractor: Sewer & Water Contractor: Phone: Phone: Phone: NOTE: Plans and supporting documents that you submit are considered to be public information. Portiarns of the infonnation may be classified as non-public if you provide specific reasons that wouh�l permit the; Cil y to conclude that they are trade secrets. 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. wwwerstateo call.or I hereby acknowledge that this information is complete and accurate; that the work will be in c Eagan; that I understand this is not a permit, but only an application for a permit, and war accordance with the approved plan in the case of work which requires a review and approval Tc,z, SIl9 Applicant's Printed Name ordinances and codes of the City of out a permit; that the work will be in ant's Signature Page 1 of 3 L] C Io a L`1 DO NOT WRITE BELOW THIS LINE SUB TYPES Foundation Single Family Multi 01 of _ Plex Accessory Building WORK TYPES New Addition Alteration Replace _ Retaining Wall _ Fireplace _ Garage It Deck Lower Level _ Interior Improvement _ Move Building Fire Repair — Repair DESCRIPTION Valuation 3 ooO Plan Review (25%_ 100% Census Code # of Units # of Buildings Type of Construction /134 1 Porch (3 -Season) Porch (4 -Season) Porch (Screen/Gazebo/Pergola) Pool Occupancy Code Edition Zoning Stories Square Feet Length Width REQUIRED INSPECTIONS Footings (New Building) Footings (Deck) Footings (Addition) Foundation Drain Tile Roof: _tce & Water Final Framing Fireplace: Rough In Air Test Final Insulation Sheathing Sheetrock Reviewed By: RESIDENTIAL FEE Base Fee Surcharge Plan Review MCES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant Copies Siding Reroof Windows Egress Window _ Storm Damage _ Exterior Alteration (Single Family) _ Exterior Alteration (Multi) Miscellaneous _ Demolish Building* Demolish Interior Demolish Foundation Water Damage *Demolition of entire building – give PCA handout to applicant Pp /Go MCES System SAC Units City Water Booster Pump PRV Fire Sprinklers Meter Size: Final / CO. Required 44 Final / No C.O. Required HVAC _ Gas Service Test Gas Line Air Test Other: Pool: _Footings Air/Gas Tests Final Siding: Stucco Lath Stone Lath Brick Windows Retaining Wall: ` Footings _ Backfill — Final Radon Control Erosion Control l , Building Inspector TOTAL Page 2 of 3 ROSE CONSULTING ENGINES ENGINEERING PLANNERS and LANDER AND S,URVEYORS COMPANY, INC. 1000 EAST 146111 STREET, BURNSVILLE, MINNESOTA 55337 PH 432-3000 Cer�z 'z ccaxfc/ & -vr-ey lasra1 .tcrtio Torr: NORTH SCALE : I" = 3o' DRAIkIA,E AW() UTILITY EASEMENT LOTS I, 2, 3 AND 4, BLOCK 3, ADEN ADDITION, DAKOTA COUKITY, Mit.IMESOTA ;x/.8 i DEAJOTE5 EXISTING Ea vAT70,U (9/7.o) DENOTES PROP05E0 ELEVATIO/U --�+— IINDI CATES DIRECTION OF 5uR/,4CE DRAIAJAGE BY: /7, oo = SND GARAGE' FLOOR ELEVAT/OAJ RE "7VVED 7E: (9 //a) JU 89° 58'02" E /240.B6 74.86 52,00 I LOT I " a A! LOT I O o m (9/6.7J I co \ 9/4-,5) 44.67 PROP 5ED 4 – UNIT n ks t i l (92o.vj 0 L= 28.10 gr. 236.p°„ A-6°45 50 52.00 79.6(9 5 89° 58'02" W 0 0 I CLOVER LANE 199.997/ ,9/7` .4, 55 I hereby certify that this is a true and correct representation of a tract of land as shown'and described hereon.. As prepared by me on this /._ day of NaveMaeR , 19 es. Minn. Reg. Ko. / — Aug. 22. 2012 7:55AM TONYi APPLIANCE CSI bcc c((C Cit of Ea an �s� -QTY rit21 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 No. 0973 P. 1 U e o�Jt 6� ci4AL:K Ink For Office Use � Permit #: ��`""j 7 Permit Fee: 60, 0 Z Date Received: Staff: 2012 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: Niaa `a Site Address: G1455 C1(ov€( uA%t / M1+ Tenant: , VJ .-)1,(11nso l Suite #: Vlit ff 1 J ;,; RESIDENT / OWNER Phone: l 6' f i;--7 Name:�1 VA ()Oh OU JOSl Address / City / Zip: 0S ((l`ef IsnU, cyi .1/R, CONTRACTOR,. Name: 13x1 ,S (tpIWilt/ License #: Address: Ll oqvl e0,61 -k., 4 y' (A ) City: (AM Y t1 Kite ''&7 State: 6( I V7 phone: q yi' /T3"f ,Zip: Contact: .j Email: II' 41 0 / . JI I / .' f // TYPE OF WORK r New replacement Repair Rebuild _-__ Modify Space Work in R.O.W. — Description of work: Rep I asr virim d i. llJ U" "I / t.�C/kip PERMIT TYPE ; . RESIDENTIAL ZWater Heater Lawn Irrigation ( RPZ I— PVB) Water Softener Add Plumbing Fixtures (.._ Main / Lower Level) Septic System Water Turnaround New Abandonment RESIDENTIAL FEES: $60.00 Minimum Water Heater, Water Softener, or Water Heater (includes $5.00 State Surcharge) Fixtures, Septic System Abandonment Water and Softener (includes $5.00 State Surcharge) $60.00 Lawn Irrigation $60.00 Add Plumbing 'Water Turnaround $105.00 Septic System Turnaround' (includes $5.00 State Surcharge) and $5.00 State Surcharge) /� TOTAL FEES $ v (add $189.00 if a 5/8" meter is required) New ($10.00 per as built) (includes County 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.gooherstateonecall.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 accorc nce with the approved plan in the case of work which requires a review and approval of plans. 1' riez App icant's Pt' ted Name FOR OFFICE USE Required Inspections x AppliC-i't's Signature CITY OF EAGAN 3830 Pilot Knob Road P. C. Box 21199 Eagan, MN 55121 WATER SERVICE PERMIT PERMIT NO • DATE. Zoning: _ No. of Units. Owner: Address. Site Address. Plumber: Meter No.: Connection Charge. Size: Account Deposit. Reader No.: Permit Fee - 1 ogres to comply with the City of Eagan Surcharge. Ordinances. Misc. Charges' � � > Total. By '�` ) k_) {. Date Paid - Date of Insp.: f 1 —a:7 "`' Insp • I CITY OF EAGAN SEWER SERVICE PERMIT 3830 Pilot'Knob Road P. O. Box 21199 PERMIT NO • Eagan, MN 55121 DATE: Zoning: No. of Units• Owner: Address: Site Address• Plumber• I agree to comply with the City of Eagan Connection Charge• Ordinances. Account Deposit• Permit Fee: Surcharge• By Misc. Charges: Date of Insp.: Total• Insp.• Date Paid• From:ALLSTAR CONSTRUCTION 19529427464 09/17/2013 08:31 #582 P.023/079 City of aan 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BLUE or BLACK Ink For Office Use Permit #: 1�'"� Permit Fee: `� Date Received: Staff: 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: q ISI 1013 Site Address: -153,4,-1536,LILISS, %B (AMY (en . Unit SI: Resident/ Owner Name: earl I IVO CjO • l7accon t Y 1 ni Phone: ; Address / City / Zip: (PI AItl/IJrVeStParlovat1J, altvi NiviC, MN c;5344 Applicant is: _ Owner r Contractor Type of Work Description of work: Tear off wind re- roof - Construction Cost: S MI 2.1D • 00 Multi -Family Building: (Yes _ / No ) Contractor a 1 Company: /�IIciU' �,Urletrl£CtIDh MCWVi evV rit, LL t, Contact: Jut 1a1st1 ad Address: 51L15 Inditfrial Street #103 City: Maple Plain �y State: MN Zip: CDS , Phone: CI52—gy2-1494 License #: ZCADNG15 Lead Certificate #: NAT— Lv-t 10y' D If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) In the last 12 months, Yes If COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING has the City of Eagan issued a permit for a similar plan based on a master plan? yes, date and address of master plan: _No Licensed Plumber: Phone: Mechanical Contractor: Sewer & Water Contractor: Phone: Phone: NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of the information maybe classified as non-public if you provide specific reasons that would permit the City to conclude that they are trade secrets.��� 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.aopherstateonecall.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. 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. q clue HRistd x c - Applicant's Printed Name Applicant's Signature Page 1 of 3 From:ALLSTAR CONSTRUCTION 19529427464 02/10/2016 12:53 #301 P.001/022 -'•- City of Eaaall 3830 Pilot Knob Road Eagan MN 55122 Phone: (661) 675-5675 Fax; (651) 675-5694 Use BLUE or BLACK Ink For Office Use Permit#: /51(3321 Permit Fee: Date Received: Staff: a 2016 RESIDENTIAL BUILDING PERMIT APPLICATION Date: 1l //1i Site Address: 7 c.,- yrs Avoe Unit u: Ar". Name:lied/W d,41 ,4la - 4164 /-/O T 7 /4 Address / City / Zip: .5.E yf��s C /Oi/�i( I,4i Applicant is: Owner )< Contractor Description of work: 1 - 74 v'ny/ 5 ;&L V Construction Cost: 4a4P,c IV , Multi -Family Building: (Yes / No Phone: /1//i Company: All9 M. n cst ro C.an ff/Mnienetnee Contact: J A wi A /1Ern et -1-2 Address: Ci415 I nQw$A-rrR 157- .5;44-e- /03 City: infteite ?l r4rr t1 State: /1114 Zip: 566359 Phone4040-7t6t Email: i%4@oLds-{a.r• 4 z - License #:136 eogo 3'S © Lead Certificate #: N,4 T- a0 9(Q V - dt If the project is exempt from lead certification, please explain why: 4.4 LT. ;„ A /983 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? I 1 Yes No If yes, date and address of master plan: 1 Licensed Plumber: Phone: 1 Mechanical Contractor: Phone: Sewer & Water Contractor: Phone: Phone: Fire Suppression Contractor: ,:.E Plans and supporting documents that you submit are.consideredto be public. information.: Portions.. of the information may be classified as non-public Nide provide specific reasons that would permit the City to• conclude that they are trade secrets. 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.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 accordance with the approved plan in the case of work which requires a review and approval of plans. Exterior work authorized by a building permit issued in accordance with the Minnesota State Buildin ,:;us • mpleted within 180 days of permit issuance. x Vi ,m n1ef1lan Applicant's Printed Name x Appli nt's Signature Page 1 of 3 City of Eagan PERMIT 41' City of Eaan Permit Type: Mechanical Permit Number: EA152340 Date Issued: 10/10/2018 Permit Category: ePermit Site Address: 4455 Clover Lane A Lot: 2 Block: 03 Addition: Eden PID: 10-22750-03-020 Use: Description: Sub Type: Residential Work Type: Replace Description: Furnace Comments: Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952) 445-2840. Please call Building Inspections at (651) 675-5675 to schedule a final inspection. Fee Summary: ME - Permit Fee (Replacements) $59.00 Surcharge -Fixed $1.00 0801.4088 9001.2195 Total: $60.00 Contractor: Residential Heating & Air 1815 E 41st St Suite A Minneapolis MN 55407-3425 (612) 724-1899 - Applicant - Owner: Hazel E Johnson Tste 4455 Clover Lane Unit A Eagan MN 55122 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. Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA161050 Date Issued:05/01/2020 Permit Category:ePermit Site Address: 4455 Clover Lane Lot:2 Block: 03 Addition: Eden PID:10-22750-03-020 Use: Description: Sub Type:Residential Work Type:Replace Description:Standard 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. Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener). Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087 Surcharge-Fixed $1.00 9001.2195 $60.00 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Kelly Jacobson 4455 Clover Lane Eagan MN 55122 (651) 454-5811 Homeworks Services Co Dba Homeworks Plumbing Htg 1230 Eagan Industrial Rd, Suite 117 Eagan MN 55121 (612) 400-9020 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA163121 Date Issued:08/17/2020 Permit Category:ePermit Site Address: 4455 Clover Lane A Lot:2 Block: 03 Addition: Eden PID:10-22750-03-020 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: 1,500.00 Fee Summary:BL - Base Fee $1500 $62.50 0801.4085 Surcharge - Based on Valuation $1500 $0.75 9001.2195 $63.25 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 - Kelly Jacobson 4455 Clover Lane Eagan MN 55122 (651) 454-5811 Crew2 Inc 2650 Minnehaha Ave Suite 100 Minneapolis MN 55406 (612) 276-1680 Applicant/Permitee: Signature Issued By: Signature -------------I For Office Use I 1 1 i Building Permit #: 116 7 1 0 0 I ®a I S&W Permit #: I EAGAN I Permit Fee: I I I Date Received: 1 3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 (651) 675-5675 ( FAX: (651) 675-5694 1 Date Issued: I buildinginspections(aicityofeagan.com I---------------------., RESIDENTIAL BUILDING PERMIT APPLICATION Date: _3h Site Address: Applicant is: ❑ Owner Contractor Unit #: I ct-4 i o l/-� Homeowner Address:b L3 IA/I:? L4L-155 A City: o`Cka \t� Wip: 512-2 State:/ ytPhone: Email: P Description of work: P_- Type of Construction Cost i y Work Type of building: ❑ Single Family ❑ Townhome, of units Twin Home Compan -Thy Building Address: Ll� ( . i�.� WeS`�t-y City:�GCPin ��G��1y—�1 Contractor State:Wip: 5531-/T /� Phone6tZ-JY5 Emaili AkeQ �e l 4sCSM`��""�Q°`�i �r 0Z V 3/� ZI Expiration ration License #: D E TiQ� Date: Sewer & Company: Contact: Water Contractor Address: City: Required for State: Zip: Phone: Email: new construction License #: Expiration Date: �I understand that Plumbing, Mechanical, and Fire Suppression work require separate applications. NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that they are trade secrets. CALL BEFORE YOU DIG. Contact Gopher State One Call at (651) 454-0002 or www,gopherstateonecall.org for protection against underground utility damage. Contact Gopher State One Call 48 hours before you intend to dig to receive locates of underground utilities. 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. /f 1 1k 1-1 ( ` Applicant's Printed Name A licant's Signature