4055 Beaver Dam Rd41‘111 City of Eaau
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
r
PIA 0 14 1011
Use BLUE or BLACK Ink
For Office Use
Permit #: J Q LPL/4i
Permit Fee: 171���
Date Received:
// 2012 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: (,(4f2o(Z
Site Address: 4055 &mac '
Name: VSe-3A1A.
Phone:
Address/City/Zip: 465 geklecik. R7( MA 55112
Applicant is: Owner Contractor
Description of work: 'Kt
Construction Cost: 142C20
Multi -Family Building: (Yes / No )
Company:O44M )=, OI i l rt C Contact: 46,14
� —
Address: 1 `Z jL1ru� City:
State: W1 Zip: S54 Phone:
License #: 1,C)52
Cad ( —274—3(((,�
Lead Certificate #: Nkt " {O 1 3 I
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:
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.aooherstateonecall.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.
iL((kik( Siwe
Applicants Printed Name
x
Applicar}R's Signa re
Page 1 of 3
DO NOT WRITE BELOW THIS LINE
SUB TYPES
Foundation
W. Single Family
Multi
01 of Plex
Accessory Building
WORK TYPES
New
Addition
Alteration
Replace
_ Retaining Wall
DESCRIPTION
Valuation
Plan Review
(25%_ 100%
Census Code
# of Units
# of Buildings
Type of Construction
_ Fireplace
Garage
Deck
Lower Level
Interior Improvement
Move Building
Fire Repair
Repair
REQUIRED INSPECTIONS
Footings (New Building)
Footings (Deck)
Footings (Addition)
Foundation
Drain Tile
Roof: _Ice & Water Final
4r Framing
Fireplace: Rough In Air Test
Insulation
Sheathing
Sheetrock
Reviewed By:
Porch (3 -Season)
Porch (4 -Season)
Porch (Screen/Gazebo/Pergola)
Pool
_ Siding
Reroof
Windows
_ Egress Window
I 0 thq/
110 c 642ft✓et Oct.-% F
_ 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
Occupancy LA, MCES System
Code Editiontr %0, 5) SAC Units
Zoning City Water
Stories Booster Pump
Square Feet PRV
Length Fire Sprinklers
Width
Final
TL
Meter Size:
Final / C.O. Required
Final / No C.O. Required
HVAC Gas Service Test
Other:
Pool: _Footings Air/Gas Tests -
Siding: _Stucco Lath _Stone Lath
Windows
Retaining Wall: _ Footings — Backfill _ Final
Radon Control
Erosion Control
, Building inspector
Gas Line Air Test
Final
Brick
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
letfolq l
Page 2 of 3
City of Eagan
PERMIT
41'
C!tyofEaa
Permit Type:
Permit Number:
Date Issued:
II Permit Category:
Plumbing
EA105013
06/20/2012
ePermit
Site Address: 4055 Beaver Dam Rd
Lot: 37 Block: 01
PID: 10-20450-01-370
Use:
Addition: Diffley Commons
Description:
Sub Type:
Work Type:
Description:
e - Fixtures
New
Main Floor
Meter Size Meter Type
Manufacturer
Serial Number
Remote Number
Line Size
Comments:
Courtney Monson
15535 Medina Rd
Plymouth, MN 55447
763-473-2267
Fee Summary:
Valuation: 1,946.00
PL - Permit Fee (miscellaneous)
Surcharge -Fixed
$55.00
$5.00
0801.4087
9001.2195
Total:
$60.00
Contractor:
Sabre Plumbing Heating & A/C Inc
15535 Medina Road
Plymouth MN 55447
(763) 473-2267
- Applicant -
Owner:
Barbara A Kromrey Thomas
1421 Appaloosa Tr
Eagan MN 55122
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of
Minnesota Statutes and City of Eagan Ordinances.
Applicant/Permitee: Signature
Issued By: Signature
07/11/2012 10:42 Les Jones Roofing, Inc.
*2110
City of Eaftau
Date:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 6754694
TAX)9528817009
P.004/004
Use BLUE or BLACK Ink
For Office Use /, / }
Permit #: v- __
Permit Fee: ! 4( 7
Date Received: 7'1( /(Z
Staff: 1l `7
2012 RESIDENTIAL BUIWMG PERMIT APPLICATION
7/ft f /. Site Address: *WS- `}OSx !3P.VEQ, DAM ROAD Unit#:
J
:RESIDENT/
OWNER
Name: yo PQOP(a72rf Coi-a$ /N4 Phone: (ACP -13-2i" 99Y9
Address / City / Zip: PO. 80l( 2125 1N vEn. Gr124/0 fielt.otrs, its/ JYio 7 4'
Applicant Is: Owner Contractor
TYPE OF WORK
Description of work: Remo V E 4AIo 1R PL -A -CE l7EcoP44r1 tIE 13,4-N P
Construction Cost: 1-000,62-5-'--Multi-Family Building: (Yes / No
CONTRACT•
OR
�It
Company: L65 JONrS PoDPfNGi /me- Contact 04114S,04114S,
Address: �1 ii( W. gel City:: &DOM <Nb ID"
Phone: f5 - a.2/- 22
State: MAI 5Zip: 5920 4"
/
License #: (PC4 e VII / / 111 Lead Certificate #: A//¢7~- yo37a'-/ 52:8'11 s"
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 fora similar plan based on a master plan?
yes, date and address of master plan:
^No
Llceneed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
Phone:
. NOTE: Plans andsupporting;docum;ents that you:submit are considered to i,e:pybl/c Information: Portions.of
the information maybe claaslfled as nonpublic. if you provide specific.readonslhat:woUrld penrrltathe Cltyto
cone/ude,ti ntthey. areitradesecrets.
CALL BEFORE YOUQJG. CeII Gopher State Ona CaII at (661) 464-0002 for protection against underground utility damage. Cali 48 hours
before you Intend to 019 to receive locates of underground uUllties. www.000herstateonecall.orq
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. end work le 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 piens.
Exterior work authorized by a building permit Issued In accordance with the Minnesota State Building Code must be completed within 180
days of permit leauance.
GttAts A1-NDERSorJ
Applicant's Printed Name
x
Applicant's Signature
Pagel of 3
SEWER & WATER PERMIT
CITY OF EAGAN
3830 Pilot Knob Rd.
Eagan, MN 55122-1897
DATE 9-18-91
OFFICE USE ONLY
METER # PERMIT DATE 12/04/91
CHIP # PERMIT # 12411
METER SIZE B.P. RECEIPT # C 15423
ISSUE DATE B.P. RECEIPT DATE 09 /17/91
PRV BOOSTER PUMP
SITE ADDRESS 4055 Beaver Dam Road
LOT 37 BLOCK 1 SEC/SUB DIFFLEY COMMONS
APPLICANT: The Rottlund Co.
ADDRESS: 5201 East River Rd.
CITY, STATE Fridley, MN zip 55421
PHONE. (612) 571-0304
PLUMBER.
ADDRESS:
CITY, STATE
PHONE:
OWNER:
Valley Plumbing
610 Creek Lane
Jordan, MN
(612) 492-2121
ZIP
55352
PERMIT REQUESTED
X SEWER X WATER TAPS
COMM/IND _X_ RESIDENTIAL
_X_ NEW
EXISTING
Lawn Sprinkler Meters are to be Installed
d of Domestic Meters on Water Line.
WILL NOT be giv; foc,Deduct Meters.
%j,`,d, g:.,
I AGRE TO C DM • WITH CITY OF
The Rottlund Co. EAGANORDI ANCES
ADDRESS:
CITY, STATE
PHO E-
PL TW'OO/RZINrDA S kin4OCESSING. CALL 454-5220 FOR INSPECTIONS. FOR STORM
SEWER PERMITS, CONTACT ENGINEERING DEPT. -
5201 East River Rd.
Fridley, MN ZIP 55421
(612) 571-0304
SIGNATURE WHEN METER ISSUED
05/0612014 09:39 Les Jones Roofing, Inc.
41,Ib6City otBap
3830 Pilot Knob Road
Eagan MN 65122
Phone: (661) 675-5676
Fax: (651) 676-5694
Date: Z19
(FAX)9528817009 P.0021011
Use BLUE or BLACK Ink
For Office Use
Permit ft; s: 'ti
Permit Fee:
Date Received:
Staff
91;
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
T Site Address: 1404cy047 '10671 `ioSS- BE.44/04. AM ki)AD Unit 0:
Name: yo P2oP42TY 4eE tAle-. Phone: 657 -_,6 -,s -z/ ?9'i
Address / City / Zip: Ro., Bo )4 212 rc / jji r v1r 44" 6S57 ?4
Applicant Is: Owner x Contractor
Description of work: gbili3OPS. %Wet 711.4e --S / 0C -"P
Construction Coat: $ Tr, 2‘0. 3
Multi -Family Building: (Yes X / No J
Company: I5- /11E3 ROOffst/,6 Ave.. Contact Char. �Q-ruDazro�
Address: girl W. $O r SrR'r. City: ,Br.Ogad-auefrrea/t/
State: _Nin! Zip: J,412D — Phone: 952 - 76 7 - ,28/9
License #: '57p Lead Certificate 0: 4'4-i `eo 9'J,? -/
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 end address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
• r%57i�V`: _ ,e_ ._e .. 11•i r 9�, rr
e°(lo �/,(1.411:/,1;74:1',
( , ii°i ,7 ' iJ�,:14/1"4";;;/.:1i-14%.: % I 1;wr y iy�
Flr°{6,-/r yo'rc,77 f
Y' M�.fi--
j�7T1iy e R�/ir rA4yam''"7-er '
e,,4y ,,— ,
CALL BEFORE YOU DIG. Call Gopher Stat. Ono Call at (661) 484.0002 for protection against underground utility damage. Call 48 hours
before you Intend to dig to receive locates of underground utIllUes. ywnrw.noaheretateonecall.orq
I hereby acknowledge that thle 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 thie le not a permit. but only an application for a permit. end work Is not to start without a permit; that the work will be In
accordance with the approved plan to the case of work which requires a review and approval of plane.
Exterior work authorized by e building permit leeu.d In accordance with the Minnesota State Building Code must be completed within 180
days of permit Issuance.
x c/i-eAS 4A10672s O/
Applicant's Printed Name
xm .,.
Applicant's Signature
Page 1 of 3
05/21/2014 10:19 Les Jones Roofing, Inc. (fAX)9528817009 P.0111011
1111016City otBaaQa�n
3830 Pilot Knob Road
Eagan MN 55122
Phone: (661) 676-5676
Fax: (651) 675-5694
Use BLUE or BLACK Iflk
For Office Use
Permit #:
Permit Fee:
Date Received;
Staff.
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 0, 9 / Site Address: 4042 1-1041 '4o5j, Y05S & 4VEIL DIM RAD Unit #:
i''';'!".1',�` �0•iw „
,M; a,�. � /�?,; :',
• i�' :. ;; .1g''',
,,.,4, • ;. �v°'
o 667- Yrz/ f9.4/11
Name: yp PeoPa2ry C�.& 6 /VG. Phone:
,
Address / City / Zip: p o• 6o k 212 5 /NvEgt Ciz-ov4oh 44' 63-2479
Applicant Is: Owner _X__ Contractor
r '•Y 4'�f' - , `j
(', IiRh 4' � �I:
'l .•�� +
Description of work: REMo Vt •• 41V0 4 1 OM E c ► I,& V £2M'4-
Construction Cost: *-2°j /34' r Multi -Family Building: (Yes A /No. )
I,. -2 " "n:2' v _''r,
,,til1 ;.�
% .Q RC'•
• ,aC^rdf j � ,4, m
.; . a:,k_,':;1i.rya ti :,
,;��i'' ' y' , ` ,,-;:":_
Company: 1 5 7'A/ R 2AAlE- /NC. Contact: cw s �Q-ivD472sod
i
Address: 91/ IN. ') 771 sib City: "Goa?c 'A6-T0A/
MAIzip: ,r 4'2D Phone: 975 1- 76 7 - a8/7
State: }c�i p
License #: k_91, D Lead Certificate #: ,v4r `/o g 7.Q - 1
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 Iesued a permit for a similar plan based on a master plan?
yes, date and address of master plan:
_No
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
Phone:
a
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CALL BEFORE YOU DIG. Call Gopher State One Call at (661) 464.0002 for protection against underground utility damage. CaII 48 hours
before you Intend to dig to receive locates of underground utilities. www.aooheratateonecall,org
1 hereby acknowledge that this Information Is complete and accurate; that the work will be In conformance with the ordinances end 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 Ieeued In accordance with the Minnesota State Building Code must be completed within 180
days of permit Issuance.
x CN-k,S 4AID SCA/
Applicants Printed Name
x
Applicant's Signature
Page 1 of 3
City of Eagan
PERMIT
41' City of Eaan
Permit Type: Building
Permit Number: EA145759
Date Issued: 09/25/2017
Permit Category: ePermit
Site Address: 4055 Beaver Dam Rd
Lot: 37 Block: 01 Addition: Diffley Commons
PID: 10-20450-01-370
Use:
Description:
Sub Type: Windows/Doors
Work Type: Replace
Description: Two or More Windows/Doors
Census Code: 434 - Residential Additions, Alterations
Zoning:
Square Feet: 0
Construction Type:
Occupancy:
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
Fee Summary:
Valuation: 4,000.00
BL - Base Fee $4K
$103.25
Surcharge - Based on Valuation $4K $2.00
0801.4085
9001.2195
Total: $105.25
Contractor:
Renewal Andersen
1920 County Road C West
Roseville MN 55113
(651) 264-4777
- Applicant -
Owner:
John Keprios
4055 Beaver Dam Rd
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