4538 Mallard Tr S SEWER & WATER PERMIT OFFICE USE ONLY
CITY Oh EAGAM piETER'# PERMIT DATE 07
Pl 551 �d. CHIP #E ; WA6 PER # 1 511
Eagart;=MN 55122 - 1897
METER SIZE B.P. RECEIPT # ., C * 723
ISSUE DATE B.P. RECEIPT DATE 0710619D
PRV BOOSTER P.
z
SITE ADORES$ 4534 South a11ard Trail .PERiETREQUE _
LoT ocK E uS ,T pmas Lake Woods
SEWER WATER . _. _ TAPS
APPUGANT: Thomas L e Devel ogme t , . Ltd,
ROSS: 6645 Rt Road TS E
r • t i . . c fIND X RESIDENTIAL
CCI'Y,STATE P'r3..r Lake, MR �. - ZIP 55372
PHONE: 4 :, X NEW . easTING
PLUMBER: 4z n P1 umbi g & ' Heating
14745 South Robert . Trail _
'ADDRESS: I AGREE T
Y wITt+criroP
CItY STATE Ro s emd t , , ,MST z#P 55068 AN it
423 - 1144
PHONE: .., W.f f . 11;
OWNER: Thomas Lake Development, Ltd.'
ADDRESS: 6648 Rustic Road S siENATHHE WHEN44ETERISIEIV=
CIrY, STATE Prior 'Lake : MN zip 55372
P .I NE: .
1( ' # � '+ � • 5 1G STOORM SEWER PE� MITE,,`," # m
DEPT. s ANOixLUMBER WILL ,BE ttolwitrt WHEN m P . r D
(4..#
r----_-__-_.___ v• -
I For Office Use
I I
Permit#:! Z11
City of Ea~a~ -
I Permit Fee:
3830 Pilot Knob Road l 1
Eagan MN 55122 Date Received:
-9 1
Phone: (651) 675-5675
1
Fax: (651) 675-5694 j Staff:
I 1
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Ad/dress: l Unit
Name: '7 3 At 3 q, rr, IWPhone:
Resident/
Owner Address / City / Zip:
r1iL
Applicant is: Owner Contractor
Type of Work Description of work: roo
Construction Cost: Multi-Family Building: (Yes No )
Zvi J
Company: / 11 ~Contact: ~a ~~d
? ~~a1
Contractor Address: v~ 4` ity: Lc~j~Lf
State: Zip: 3 Phone: al / 6 3 oe
License SC 6 J 6 3'~;- Lead Certificate
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: i
Sewer & Water Contractor:___ Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of M
1 the information may be classified as non-public if you provide specific reasons that would permit the City to I
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 di to receive locates of underground utilities.
~ 9 wvsN.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.
x nce.
l~ d C k60
x~
Applicant's Printed Name Applicant's Signature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA146967
Date Issued:11/28/2017
Permit Category:ePermit
Site Address: 4538 Mallard Tr S
Lot:17 Block: 03 Addition: Thomas Lake Woods
PID:10-76100-03-170
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
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: 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 -
Karen R Roth Tste
4538 Mallard Tr S
Eagan MN 55122
(651) 338-7174
Bn Builders Inc
PO Box 202
Rosemount MN 55068
(612) 644-8274
Applicant/Permitee: Signature Issued By: Signature