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3832 Country Creek Way Use BLUE or BLACK Ink I For Office Use I I 1 l I Permit a I City of Ea tit r I I I Permit Fee: 3830 Pilot Knob Road 1 Eagan MN 55122 I Date Received: j Phone: (651) 675-5675 I I 1 Staff: I Fax: (651) 675-5694 1 I 2011 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: Unit Name: I 2evatWin/ Phone: &07- 4452 RESIDENT / OWNER Address / City / Zip: Applicant is: Owner Contractor TYPE OF WORK Description of work: ! 1~/ 4- 77 0-fl/ 4Flo A-135?_1 -el _ Construction Cost: oZ tea Multi-Family Building: (Yes / No ) Company: 4 (--Z- Contact: \ 3 oe- CONTRACTOR Address: /Sr1L.~ City: State: Zip: 62~4 Phone: f< v ^~a P7 License W gd/4. i4 Lead Certificate If the project is exempt from lead certification, please expl~aiin why: (see Page 3 for additional information) Z!~a / 4- C/ / 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: 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 the are trade secrets. CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 4540002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.Qor)herstateonecall.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 thi ' 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 approv d p n in the case of work which requires a review and approval of plans. Exterior wo authorize by ilding it ssued in accordance with the Minnesota State Building Code must be completed within 180 days tissuanc Applican rinted lillame Applicant's Signature Page 1 of 3 DO NOT WRITE BELOW THIJLINE SUB TYPES Foundation _ Fireplace _ Porch (3-Season) _ Storm Damage _ Single Family _ Garage Porch (4-Season) _ Exterior Alteration (Single Family) Multi _ Deck _ Porch (Screen/Gazebo/Pergola) _ Exterior Alteration (Multi) _ 01 of Plex _ Lower Level _ Pool _ Miscellaneous _ Accessory Building WORK TYPES New _ Interior Improvement _ Siding _ Demolish Building* Addition Move Building Reroof _ Demolish Interior Alteration Fire Repair Windows Demolish Foundation Replace _ Repair _ Egress Window _ Water Damage Retaining Wall *Demolition of entire building - give PCA handout to applicant DESCRIPTION Valuation Occupancy MCES System Plan Review Code Edition j&Afj(Vfj 01r) SAC Units (25%_ 100%Zoning City Water Census Code Stories Booster Pump # of Units Square Feet PRV # of Buildings Length Fire Sprinklers Type of Construction- Width REQUIRED INSPECTIONS Footings (New Building) Meter Size: Footings (Deck) Final / C.O. Required Footings (Addition) Final / No C.O. Required Foundation HVAC _ Gas Service Test Gas Line Air Test Drain Tile Other: Roof: -Ice & Water -Final Pool: -Footings -Air/Gas Tests Final ~c Framing Siding: -Stucco Lath -Stone Lath Brick T Fireplace: -Rough In -Air Test -Final Windows Insulation Retaining Wall: _ Footings _ Backfill _ Final Sheathing Radon Control Sheetrock Erosion Control Reviewed By:Building Inspector RESIDENTIAL FEES Base Fee Surcharge Plan Review 12l 92-2 MCES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant Ole Copies 2 Y 7 TOTALM ' /Page 2 of 3 l/I V I v v i v CONCPFTF FOUNPAfiON P0,95 f3Y 5U55F1- L_,l ~~-FCI ICAL (3Y OWWW SUSSF'~ IS NOT P:F5''ON51P FOP: VAMAGF TO FXI5TWG 120VFWAY LANr)5CA2ING AP.O'UNP FX15fIN6 UAPA,F ANP HOU5F FOP, I:FA50N FINA, GOING, SLACK PII2T, Gt;OUNP COVFp, ANP 1NCLUPIWA THE TOl" 50ii- 15 THE OWNFf?512F5PON51mITY 5U55FL TO IN5U11ATF A5 'iNPICATFP ON CI?055 5FCVON ALL WINDOW ANP 0001; HFAJFP: AF:F (2) 2X!0'5 LINLF55 OTHFV Al HFAP7 F,5 -O" ANC LONGED P,FQUIF? POUPI-~ MIMWPP5 AN 3 f pOVIVE FLA5HING Af ALL- WINDOW ANn POOP, OPFNING 3 I115TAL1 C3LOCKIN6 Ai AL-L WINDOW OPFNING5 FOP: WINDOW TEED 0000,0\ CP~~KWpY MOVIDF ~i OCKING FOV FLOOD 5Y51FM A5 PFD' MANUFACTTP 5 Q CGUN PROVIDE 5MOKF DF1'FCTOP5 AND CAPI30N MONOXIDE DFTFCTOP"_ X0.00 20,00' 39 ,00' III-Oil O 16 ,00' ,O EXISTING 00 ~XI51~NG O O HOUSE GAPAL+F FXIST>NG S N GA" FL~~ _ s O ~ of 1.00' 6''O O O PPOPO% O~ O V121flON Q v Na 16,00` 13.00'/ \ 1-46,00, p~Or p~AN SCA,F i' ~ 20' -a' TNFSF PLAN5 AMP FVNNT5 VZ MAIN THE FXCLU5IVF CONFIDENTIAL PWnI:TY OF 5U55FL, AND HOWOMM/ LANb` MAY 13F 1-15FD 13Y OTHEP5 ONLY FOP? THE PUPWO5E 5PFCIFICALLY AUTHOPZIZFD f3Y SU55EL, TO PP2FVFNT M015TUP.F PI20f3LFM UNAUTHOPZIZFD COPYING 012 P.FPWOUC11ON5 OF ANY POP?TION 15 FOPZ13IDDFN BELOW THE TOP OF THE FOUNDA MURi6 AN 11 l (6876 HaEURINO mnn sttwh tiffCavt 4 Atwricipal Sail Trefw4 a Land gwwy,.i • Lnd Picw a ' 'OI Clrt...~,•. - i sumsW4, Mntnescaa 55337 ( Cortiffcate of Survey for S3 (,9 a6 y.i r o-1 a LOT I I BLvC CEDAIZ GROVE NO, It t L - 00kofa Coud Cl3/~' : ~ ~ ► O ^f~rtOrLy !r'bn r»ortum~T ' , " - - 1~22raoT¢5 c~raing9¢ r ufr~ty eageirle/IF i hereby certify that this is a true and correct representation of a survey of the boundaries of the above described land, and of the location of all buildings, thereon, and all visible encroachments, if any, from w on said land. As Surveyed by me this day of i. A.0. 19~71. _ SUBUR13A w ENGINEERING, INC. . ingineors 1.` J Surveygrs . New Construction Energy Code Compliance Certificate Per N1101.8 Building Certificate. A building certificate shall be posted in a permanently visible location inside th Date Certificate Posted building. The certificate shall be completed by the builder and shall list information and values of components /N7=E.tabitshed iA i9ls MN ic, 1934 listed in Table N1101.8. Mailing Address of the ])welling or Dwelling Unit Cih SUSSEL BUILDERS 3~ icy/1i rT 8S4T:maiezRoad 861.643.0331 Name of Residential Contractor MN [,itesse Number 3t.Pavl, Wmnasota 33114 Fax 831.848.8971 5U 7 5 THERMAL ENVELOPE RAD N SYSTEM Type: Check All That Apply assive (No Fan) w o y atllcr.rystem Active Milh lam and ntonouteter or C T v rnonitnrtnsdevi(e) P o a o V o .o p m a a d Pa Pl d U Insulation Location z ro _U p w o ca ea o N o ~ a ~ ~ c "en iio ~ a z w u w° w° w cZ Other Please Describe Here Below Entire Slab Foundation lVall Type in location interior exterior or integral Perimeter of Slab on Grade Rini Joist (Foundation) Type in location: interior exteno.- or Integral Rim Joist (I" Floor+) Type in location: Interior extenoror integral Wall Ceiling, flat Ceiling, vaulted Q- Rnnn Describe other insulated areas Windows & Doors Heating or Cooling Ducts Outside Conditioned Spaces Average U-Factor (excludes skvlights and one door) U: ♦ Not applicable, all ducts located in conditioned space Solar Heat Gain Coefficient (SHGC): s R-value MECHANICAL SYSTEMS Make-up Air Select a Type Appliances Heating System Domestic Water Heater Cooling System Not required per mech. code Fuel Typed Passive Manufacturer t Powered Interlocked with exhaust device. Model K f/7(/ Describe: input in Capacity in output in Other, describe: _ Rating or Size BTUS:, Gallons: Tons: Heat Loss: Heat Gain. Location of duct or system: Structure's Calculated AFUE or SEER: HSPF% ^ alculated Efficiency a ♦ cooling load: Cfm's " round duct OR Mechanical Ventilation System " metal duct Describe any additional or combined heating or cooling systems if installed: (e.g. two furnaces or air Con 13ustion Air Select a Type source heat pump with gas back-up furnace): Not required per mech. code Select Type Passive Heat Recover Ventilator (HRV) Capacity in cfms: Low: High: Older, describe: Energy Recover Ventilator (ERV) Capacity in cfms: Low: High: Location of duct or system: Continuous exhausting fan(s) rated capacity in cfins: Location of fan(s), describe: Cfin's Capacity continuous ventilation rate in cfms: " round duct OR Total ventilation (intermittent + continuous) rate in cfms: " metal duct Created by BAM version 052009 Use BLUE or BLACK Ink I For Office Use/~ I Permit / City of EaVan ~ Permit Fee. 3830 Pilot Knob Road I I Eagan MN 55122 ; Date Received: ; Phone: (651) 675-5675 Fax: (651) 675-5694 Staff: J 2011 RESIDENTIAL BUILDING PERMIT APPLICATION Date: _ Site Address, 3,6 3~ (oun7i C A5Z: 4 CCORt) Unit Name: F/~7`- ) /fi~U Ill Phone: _1( v~l cf 7Q ` Lq RESIDENT I ,fir OWNER Address / City / Zip: 3W R, awyr V eR.&eK_ Lde F'r4cow .Sl~►-~ Applicant is: Owner V_ Contractor Description of work: CT F n~ TYPE OF WORK Construction Cost: 3- &-0 Multi-Family Bt~iIding: (Yes /No Company: -~l.~i/J &A # 10e:: tri!i04ontact: I!Z It ~'7I'~OF /''Ltl bbl CONTRACTOR Address: 54,6E DQal~E`= twe City: State: AA Zip: J`rJ'~Tp~ Phone: r 095 License Lye) -~~DG oZ Lead Certificate /1/Q 7-- -7,& 73 --1 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 fora 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: 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 the 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.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. x ~~E lO£ 5/Y!{4j/ ~/Z x Applicant's Printed Name Applicant's Signature Page 1 of 3 PERMIT City of Eagan Permit Type: Building Permit Number: EA106614 Date Issued: 08/30/2012 Permit Category: ePermit Site Address: 3832 Country Creek ~Vay Lot: 12 Block: 1 Addition: Cedar Grove 1 lth PID: 10-16711-O1-120 Use: Description: Sub Type: e-Reroof Construction Type: Work Type: Replace Description: House & Garage Census Code: 434 - Occupancy: Zoning: Square Feet: 0 Comments: If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar. Pictures are not acceptable in lieu of inspections. Carbon monoxide detectors are required by law in ALL single family homes. Fee Summary: BL -Base Fee $4K $103.25 0801.4085 Surcharge - Based on Valuation $4K $2.00 9001.2195 Valuation: 4,000.00 Total: $105.25 Contractor: -Applicant - Owner: Gullickson Homes Kent J Pederson Revocable Tst 5131/07 12701 Co. Rd. 9 3832 Country Creek Way Goodhue MN 55027 Eagan MN 55122 (651) 208-2602 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.  ApplicanvFermltee: Nignature issued tiy: NIgnature PERMIT City of Eagan Permit Type:Building Permit Number:EA118385 Date Issued:10/31/2013 Permit Category:ePermit Site Address: 3832 Country Creek Way Lot:12 Block: 1 Addition: Cedar Grove 11th PID:10-16711-01-120 Use: Description: Sub Type:Reroof Work Type:Replace Description: Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Please print pictures of ice and water protection and leave on site. Carbon monoxide detectors are required by law in ALL single family homes . Eric Gullickson Valuation: 4,000.00 Fee Summary:BL - Base Fee $4K $103.25 0801.4085 Surcharge - Based on Valuation $4K $2.00 9001.2195 $105.25 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Kent J Pederson Revocable Tst 5/31/07 3832 Country Creek Way Eagan MN 55122 (651) 470-0322 Gullickson Homes 12701 Co. Rd. 9 Goodhue MN 55027 (651) 208-2602 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA146751 Date Issued:11/13/2017 Permit Category:ePermit Site Address: 3832 Country Creek Way Lot:12 Block: 1 Addition: Cedar Grove 11th PID:10-16711-01-120 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. Please call Building Inspections at (651) 675-5675 to schedule a final inspection. Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088 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 - Kent J Pederson Revocable Tst 5/31/07 3832 Country Creek Way Eagan MN 55122 Robert Boldt Hvac 4310 Trenton Tr Eagan MN 55123 (651) 454-7760 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA168494 Date Issued:04/22/2021 Permit Category:ePermit Site Address: 3832 Country Creek Way Lot:12 Block: 1 Addition: Cedar Grove 11th PID:10-16711-01-120 Use: Description: Sub Type:Windows/Doors Work Type:Overhead Garage Door Description: 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, 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 - Kent J Pederson Revocable Tst 5/31/07 3832 Country Creek Way Eagan MN 55122 (651) 470-0322 Twin City Garage Door Co 5601 Boone Avenue North Minneapolis MN 55428 (763) 533-3838 Applicant/Permitee: Signature Issued By: Signature