4430 Clover Lane - Unit BRESIDENT !
OWNER
Nam: -C\ `, -c J v t ✓\:5 en Phone:
ry y
Address / City tZip: `143C) C L_Ct11 e E , fiid1
Applicant is: Owner .)( Contractor
TYPE OF WORK
-/ ��,,®
Description of work: > pri c_e - PC.3 10 L)'-
Construction Cost: / ) ' C' ' cLd Multi- Family Building: (Yes / No )
CONTRACTOR
Company: t .c i: Contact: ,1C: t' � fZ. /Jce S
t'
Address: 19� 5 v e:`�:e ? 1,-)c. Ni ° cit ( ,ct xe J
n (� x -I { - Le Phone: (.0 5 ( 7) v5 2 �
State: 1 " t 1 Zip: � S \ `
~ a
License #: / C c)Q l L' 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 consid red to be public information. Portion of
the information may be classified as on ityorr ptovid a spy marts that w oul perrrrit City to
concl a that #1 r a re t secrets.
Cily of Eagan
Date: Site Address:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
x c3ut' 54-01(}6
Applicant's Printed Name
MAY # 1 20i1
2011 RESIDENTIAL BUILDING PERMIT APPLICATION
I hereby acknowledge that this information is complete and accurate; that the work will be in conforms
Eagan; that I understand this is not a permit, but only an application for a permit, and is not
accordance with the approved plan in the case of work which requires a review and appro = + f plans.
nt's Signature
Ste
Use BLUE or BLACK Ink
Fi �_ y
Permit*: ! () a
- G r
Permit Fee: 10 / C
Date R ceived: CL6
Unit
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_copherstateanecaULorq
Parse 1 of 3
with the ordinances and codes of the City of
tart "+ a permit; that the work will be in
IB
TYPES
Foundation Fireplace
Single Family
Multi
01 of Plex
_ Accessory Building
WORK TYPES
_ New _ Interior Improvement
_ Addition _ Move Building
_ Alteration _ Fire Repair
N Replace _ Repair
Retaining Wall
DESCRIPTION
Valuation
Plan Review
(25 %_ 100% )
Census Code
# of Units
# of Buildings
Type of Construction
V
REQUIRED INSPECTIONS
Footings (New Building)
_ Footings(Deck)
_ Footings (Addition)
Foundation
_ Garage
Deck
_- Lower Level
CO o
Drain Tile
_ Roof: _Ice & Water Final
Framing
Fireplace: _Rough In Air Test _Final
Insulation
Sheathing
Sheetrock
Reviewed By:
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S &W Permit & Surcharge
Treatment Plant
Copies
TOTAL
1 4 ( 130 3 C r (a he-
DO NOT WRITE BELOW THIS LINE
Porch (3- Season) _
Porch (4- Season) _
Porch (Screen /Gazebo/Pergola) _
Pool
Occupancy
Code Edition
Zoning
Stories
Square Feet
Length
Width
_ Siding _ Demolish Building*
_ Reroof _ Demolish Interior
Windows Demolish Foundation
_ Egress Window _ Water Damage
`Demolition of entire building give PCA handout to applicant
MCES System
SAC Units
City Water
Booster Pump
PRV
Fire Sprinklers
Meter Size:
Final / C.O. Required
Final / No C.O. Required
HVAC Gas Service Test
Other:
Pool: _Footings
Siding: _Stucco
Windows
Retaining Wall: _
Radon Control
Erosion Control
, Building Inspector
Ow
06/Av
wg
P
ts4)
q9log)
Storm Damage
Exterior Alteration (Single Family)
Exterior Alteration (Multi)
Miscellaneous
Gas Line Air Test
Air/Gas Tests Final
Lath Stone Lath Brick
Footings _ Backfill _ Final
cPO
Page 2 of 3
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LOT 40
40 1
/54.92
EAST
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(9
30 FRO BuILDit4 6
SETBACK LINE
r
ROBE
CONSULTING ENGINEERS,
ENGINEERING PLANNERS and LAND SURVEYORS
COMPANY, INC.
1000 EAST 1461A STREET, BURNSVILLE, MINNESOTA 55337 PH 432
tie
2 _DeAlc7'p2ion: LOTS 40,41,42 AND 43, BLOCK. 2 EDEN ADDITI0KI,
DAKOTA COULJTY, MIKINESOTA
NORTH
SUNLE I" 3o'
(922.3)
63
DRAIM P.GE 4/.11)
UTILITY EASEMENT
( I
L.- I
-5: 91
(93-o)
I
I I , .1. " ,
L_ • t • -'
DELIOTES E X / 577A/6 ELgvA7/0A41
93 DENOTES PROPOSED ELEVATI0M
—I- INDICATES D1REC710AJ OF 5uRFA cE DRAINAG'
93346) F 1 &PSI GARAGE P EL.& vA °Ai
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 / sr day of
Nov6/45E 9 13.
.....L=...4;&?—...rinn• Rig. Kos /43:'•
CITY OF EAGAN WATER 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:
Meter No.: Connection Charge:
Size: Account Deposit:
Reader No.: Permit Fee:
1 agree to comply with the City of Eagan Surcharge:
Ordinances. Misc. Charges:
Total:
By el Dote Paid:
Date of Insp.: Insp••
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:
1 agree to comply with the City of Eagan Connection Charge:
Ordinances. Account Deposit:
Permit Fee:
Surcharge:
Misc. Charges:
•
Total:
Date Paid:
From:ALLSTAR CONSTRUCTION 19529427464 09/17/2043 08:46 #582 P.059/079
Use BLUE or BLACK Ink
Afth- for Office Use 1
non I ` I
I Permit#:__i'`[~~~ l
City of EaEd
Permit Fee: D r
3830 Pilot Knob Road
= 1(i3
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 i I
Fax: (651) 675-5694 1 Staff- I
I I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: q I V 12012) Site Address: 44A yy2kP22, 4430, LIKE C10YU LUX, Unit
i Name: eft c/D• basil m W[riW4 Phone:
Resident °
Owner Address / City / Zip: ~Dy38 G1'N V1 PRY10VAUT M~ i>faIYif, M N 55"
Applicant is: Owner Contractor
Type of Work Description of work: Tea of ~ Ye-Voo
Construction Cost: h t Dad • DO Multi-Family Building: (Yes No )
Company: 4-IIft G)Y"VA INQPlaladmenfj L Contact:
.SJI)t• t fl1~i~~tU
Address: 5145 IndtA Q1 SlTfM * IID3 City: WtiP,f N in
'
I Contractor r'~ OI u rI'
State: MN _ Zip: '~J35 1 Phone: ~GJL~ IZ' 1~ J-i
License %r.IP,2J19 S Lead Certificate WT- 2bq 1pL4 --Q
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
:Plans and supporting documents that you submit are considered to be public information. Portions of
the information maybe c/assfrted as non-public. if you provide specilfc 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.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.
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. 4
Applicant's Printed Name A icanrs Signature
Page 1 of 3
Vi1ii FI~.VO. Vt AfL.IRW ~f i!\
i For Office Use ,Q I
I U
~ Permit I
My of Ea jan
3830 Pilot Knock Road Pernik Feel LI6~ I
Fagan MN 55122 i I
I
Date Received:
Phone: t651j 676-6675 I
Fax: (651) 675-5684 l
i Staff: I
2014 MECHANICAL PERMIT APPLICATION
Please ,su tnit two (2) sets of plans with all commercial applications.
Date., C> 144 Site Address: C 1 Lam'
Tenant: Suite
Name: I Phone: _cC t` - P
RosidentlOwner !
Address I City I ZIp: _ ~.Ja)izr~ o,. z
Name: License tt:
Contractor Address: City:
State: Zip: Phone:
Contact: Email:
New Replacement Additional Alteration Demolition
Type of Work Description of work:
f NOTE: Roof mounted and mound mounted mechanical equipment is
9 required to be screened by City
Code. Please contact the Mechanical Inspector for infonnation on permitted screening metes.
RESIDENTIAL COMMERCIAL
Furnace New Construction inter Improvement
Permit Type -Air Conditioner Install Piping Processed
- Air Exchanger Gas Exterior HVAC Unit
----fit Pump Under/Above ground Tank _ Install t _ Remove)
Other RESIDENTIAL FEES
$60.00 Minim _M Add or alteration to an existing unit (includes $5.00 State Surcharge)
$100.00 Residential New {includes $5.00 State Surcharge} $ TOTAL FEE
COMMERCIAL FEES
Contract Value $ x .01
$55.00 Pe, it Fee Minimum
$70.00 Underground tank irtstallationlremova = $ Permit Fee
*If contract value is LESS than $10,010, Surcharge = $5.00 Surcharge*
**if contract values is GREATER than $10,010, Surcharge Contract Value x $0,0005
*"If the project valuation is over $1 million, please call for Surcharge = $ TOTAL FEE
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
that I understand this i5 not a permit, but only an application for a permit, and work is rioter start without a . t at the work will be in accordance
th approved plan in the case of worts which requires,a review and approval of plans
s Pr inted NaApplicanfignatui"i#
UnZV FOR OFFICE USE
Required Inspections: Reviewed By: _ !:fate:
Underground Rough In Air Test Gas Service Test In-floor Heat Final FIVAG Screening
q
- V
r
i
(Top 3 Inches reserved for recording data)
STATUTORY SHORT FORM POWER OF ATTORNEY Minnesota Uniform Conveyancing Blanks
MINNESOTA STATUTES, SECTION 523.23 Form 100.1.1 (2011)
IMPORTANT NOTICE: The powers granted by this document are broad and sweeping. They are defined to Minnesota Statutes,
Section 523.24. If you have any questions about these powers, obtain competent advice. This power of attorney may be revoked by
you K you wish to do so. This power of attorney Is automatically terminated H It is to your spouse and proceedings are commenced
for dissolution, legal separation, or annulment of your marriage. This power of attorney authorizes, but does not require, the
attorney-in-fact to act for you.
PRINCIPAL (Name and Address of Person Granting the Power) '
Angelia M. Johennsen
4430 8 Clover Lane
Eagan MN 55122
ATTORNEY(S)4N-FACT SUCCESSOR ATTORNEY(8)4N-FACT (Optional)
(Name and Address) To act 9 any named attorney-In-tact dies, realgns, or Is otherwise
unable to serve
(Name and Address)
Rebecca Anderson First Successor
12511 Summerwood Drive
Fort Myers FL 33908
Kathy Dowdy Second Successor
12595 Summerwood Drive
Fort Myers FL 33908
NOTICE: If more than one attomey-hi-fact is designated. make a
check or `x' on the One in front of one of the following statements:
X Each,attomey4n-fact may independently exercise the E)IRATIONDATE (Optlonat)
powers granted.
AG attomeyS-in-fact must Jointly exercise the powers
granted, ussspecae "Wa - aw y- a*
Papa 1 of 3
~Z3
Page 2 of 3 Minnesota Uniform Conveyancing Blanks Form 110411
I (the above named Pdndpan appoint the above named Attomey(s}In-Fact to ad as my attomey(s}tn-fact
FIRST: To act for me in any way that 1 could act with respect to the following matters, as each of them is defined In Minnesota:Statutea,
section 523.24:
(To grant to the attomey-in-fact any of the following powers, make a check or 5c" on the line In front of each power being granted. You
may, but need not, cross out each poorer not granted. Failure to make a check or Y on the line In front of the power will have the effect of '
deleting the power unless the line in front of the power of (N) is i hecked or Y-ed.)
Check or IV
(A) real property transactions;
I choose to runit this power to real property In County, Minnesota, described as
follows: (Use legal description. Do not use street address.)
(If more space is needed, continue on an attachment.)
(B) tangible personal property transactions;
(C) bond, share, and commodity transactions;
(D) banking transactions;
(E) business operating.transadons;
(F) insurance transactions;
(G) beneficiary transactions;
(H) gift transactions;
(1) fiduciary transactions;
(J) claims and litigation;
(i) family maintanance;
(L) benefits from military service; i
(M) records, reports, and statements;
X (N) all of the powers listed In (A) through (M) above and all other matters.
SECOND: (You must Indicate below whether or not this Power of Attorney will be effective if you become Incapacitated or incompetent
Make a check or Y on the line in front of the statement that expresses your intent.)
X This power of attorney shall continue to be efectve f I became incapacitated or incompetent.
This power of attorney shag not be effective If I become Incapacitated or incompetent
THIRD: (You must indicate below whether or not this power of attorney authorizes the attomey4n-fact to transfer your property to the
attomey-In-fact Make a check or `x° on the line In front of the statement that expresses your intent.)
X This power of allomey authorizes the attomey4n-factto transfermypropody to fie attomey4n-fact
This power, of attorney does not authorize the attomey-in-tact to transfer my property to the atromey-In-fact.
atln@3C'a El~W,s Far? 1001.1
F{)U,I TN ~'P nt r n~ ;act ar h. th r 0r rrg t~! is ~eJ, "cd to msa'lc u, a cr -k 0, ' x` on thfj':ne
trt (rant G? i(1" ~ c~tcR2$i t it~t F't,i ~ V;~CS} I 1 f r~' 1
nct re ndeI as accous? r,S CE..5ess 'CyJeSt tj, ortle ac~cuntng ES otrsr1iise bv
i~ Or
j n ,pl gent
O ; IT C."` x al accv c
~ ~nu,=~ C~~i Lfl1L o';t?y ,tc#'} .5 ~3ppq;,-rjc4t, after my (;,<7,h_
In Witness WhereatIhave herat .or: n, dre,this d,3,fof i
ACKNOWLEDGEMENT OF PRINCIPAL
Stew of tknneYota 7,)unri of xj J ~
}
,i ,t c . f ~a r, r
This tns ~m , e, ^t~t~~ietla d befJre n _ f` a - - F Ey,
Angelia M. John- , n
` kFTED SYv' <:u:nfu
fiche -teAi
Fort Myers , t
f
J
F i'!
Nathy '_)away ,
From:ALLSTAR CONSTRUCTION 19529427464 10/21/2015 12:23 #269 P.005/020 .
Use BLUE or BLACK Ink
� For Office Use ' �
� RECEIVED j Permit#: ������ i
Clty of�a�aIl ; . "'�L-� � �
� Permit Fee: V t d �
3880 Pilot Knob Road OCT 11 20�
Eagan MN 55122 � Date Received: �
Phone:(651)675-5675 � �
Fax:(651)675-5694 I Staff: I
I �
���_�.�`_���.����_�J
2075 �E�tC3E�!'T�A� ��IL���� PER�oT �PP�ec�Tion�
Date: Site Address: Unit#:
� �arne:�r,=�., �n�A✓A. 1 jkj31�-m.,..�.,�...:��+�s �'�0����.��-_. Phone: N/�,�_,�.�.,.,M..n.�,.,�...,�...��
� Residen�/ �
Ow�lef Address/City/Zip: ��l��"yy30 �/,� � �'p-� �
� � ��
� �
Applicant is: Owner � Contractor
�-�.._..,� ..�._.n�.,.:�..,..,.. .�....��.F,.�.,T.�..,.�_,�,'..,.��...z-,,t...�__.�.,,,.^.��.�.<..�,.�. . .,,..�.�.r_�.�...�._....�,,�. ,.,�-.os...,....._,.,_r,,.�_.�,...-u..._..�.�
� Descriptionofwork: ��'°' ���c in/ii/� /+�;,�r�'�✓` .��Cf°,�(" �
YP@.O INOr{c
�
Construction Cost: �Z�'i�`'� Muiti-Family Building:(Yes �No �
� n�..,.,�...�..,�,..s-...,�..,.,..x.,z,�_�...,,..�..,,... r......��,....�.„..�.�����..,.��,,,..�....A..,.�,..^._....��_,.�:...,_..�..,.,..�a.....�.m.,.,.,,,,._,..,.�......�T_,..a.
� �---- � A _ + � ..�
.. �Company: ����As�. C..:r�SY��uG�.�a-ti t/1�fh�►���f71� GG'. Contact: .' � /y»��
� � _ ' � �. � 9'I rr+e�}-.� �
k
i ) r
� Address:��� /n[�uS���rrL s� ` Si.:�k�. I C°� City: �A �� ��l ftl�,.�
CO.t1t�1Ct0� .. .� ' � �
� State.�Zip: ����`i Phone: �52-`��2�7��'�Email: �'►•�d c� S /". 17 2.
�
� r� � �
� ,. . .. ..... License#: .�� (r'94'! 3��c� ;
�,,,.. � . _.A�.�,� __. �. Lead Certificate#:���►� ��l y(1� Z_._. .�.� -
If the project is exempt from lead certificatfon, please explain why: �
�+��c-, ;..d r�83
._�....._..�.,�.,..,,, _�.,�....�._,�,�_..��.,�.�.__�..�.., r�.......�T...a...�.,�,.,�....h�-..�n...��.���...�.._.--,.F..,.�.�.�.,�,��.�._.�.r��. .
W�.�
�� COMPLEI'E TH1S AREA ONLY IF CONSTRUCTING A NEW BUILDING �
In fhe last 12 months, has the City of Eagan issued a permit for a similar pian based on a master plan?
� �
Yes No If yes,date and address of master plan: �
� Licensed Plumber: Phone: �
� Mechanical Contractor: �
Phone: �
� c-"--_ o u•_a_..n_—`---`--- r:._.._. �
a
.............._ ; �:
� ?.
i
Fire Suppression Contractor.
�..��.�..,.,�.�:n..,.II..�.�,..—.,.T,..._._:,_�,.��.n.,:-,�:,._�..:3_.��.w:�....�.�_.,�_:.,�.�,,�...�,..�,,.��...A.,�.�..�..��.,..,.,�,�...,.�.,.�..Pho�e
• �&
� NOTE:Plans and supporting documents that you submit are considered to be public information. Portfons of
� the information may be classified as non-public if you provide specific reasons that would permit the City to �
�.,.�:U._,�.��..a,..�,..�.�....:_�.��„�,R,�.r...�..:.�.��._�..�, conc/ude that t,�Y.�'are trade sec�ets��...,..,�.,.�,��..�..�.m.�.��„�.�.�.�.-�A..�..�..�...�
CALL BEFORE YOU DIG. Call Gopher State One Call at f851)454-0002 for proteclion against underground utility damage. Ca�l 48 hours
before you intend to dig to receive locates of underground utilities, www.gooherstateonecall.ora '
I hereby acknowledge thaf 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 !or a permit, and work is not to start without a permit; that ihe work will be in
accorda�ce with ii�e aNpiuv�d pia��;r�ii�e caa��c�i w�rii i�vnitin requires a review ano approvai oi pfans.
Exterior work autho�ized by a building permit issued in accordance with the Minnesota State Building Code must be co pleted within 180
days of permit issuance. _ -.--��
�_ y�...._... yw
X /
x �;:� �//'.�� �". . f "
Applicant's Printed Name �„ Applic nt's Signeture " `
�
Page 1 of 3
�
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651) 675-5675 1 FAX: (651) 675-5694
buildinginspections(cD.cityofeagan.com
-------------I
For Office Use I
I Building Permit #:
I I
S&W Permit #:
I
I. I Permit Fee: I
1 I
I I
Date Received: I
I I
I I
I Date Issued:
t- - - - - - - - - - - - - - - - - - - - - J
RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Shqz6Q23Site Address:
Applicant is: ❑ Owner Contractor
Unit #:
I
Name: �G(� t/� b VV`� C� �_,�� 11�.�.1' S lasers e, C I Ot_4 l C> In
Homeowner 7
Address:
Me ( 1 f7"LAZ /AA City: �aQ OL \/1-,
Phone: Email:
Description of work: P, Q b t7Z
Type of
Work Construction Cost l
Building
Contractor
Type of building: ❑ Single Family ❑ Townhome, of units 19,Twin Home
Compan I7L,qj (� �t`t't.� C_ C� \lam Contact:
��
Address: � r t & W Q�T City: GCS' VG��11' l
StateAwip: 5�3_ Phone6tZ-'f 5 Email(Vtk .k[ �e,� CUk-- �
b 71*-/- / _ —
License #:� 7 4.3 ,i l � Expiration Date: J/ 3
Sewer $ Company: Contact:
Water
Contractor Address: City:
Required for State: Zip: Phone: Email:
new construction i
I License #: Expiration Date:
` 1 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.
x
Applicant's Printed Name A licant's Signature