4450 Clover LaneRESIDENT /
OWNER
Name: Phone:
p
Address / City / Zip: L) i 50 LG,I/ e/ Lars i--(_--
Applicant is: Owner N Contractor
TYPE OF WORK
Description of work: A/ K Gk / /e -VLa l-e-- 13'- 'a -__
Construction Cost: 1 6'0 v Multi - Family Building: (Yes X / No )
CONTRACTOR
Company: ck S M! \( ' �. _ Contact: � let.
Address: 1 /4; 7 3 ---
e1//� /1-1,---C- City: r tt.%r dales
7& a - ' ..
State: Zip: C /Z- r Phone: 6' 2- 6 9 --•/ 7L
License #: Lead Certificate #:
If the project is exempt
from lead certification, please explain why: (see Page 3 for additional information)
&&,,-f1 c f - e.t f ] i17 C ?Vp
In the last 12 months,
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:
_Yes
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
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 they are trade secrets.
41 City of kap
Date:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
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.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.
2012 RESIDENTIAL BUILDING PERMIT APPLICATION
x
Applicant's Printed Name
Site Address:
r
For Office Use /0C—K3 Permit #:
Permit Fee:
L
Date Received: '7J 'J Z
Staff: 4{7
Use BLUE or BLACK Ink
Unit #:
x
Appl' nt's Signature
Page 1 of 3
SUB TYPES
Foundation
Single Family
Multi
01 of _ Plex
Accessory Building
WORK TYPES
New Interior Improvement
Move Building
Addition
Alteration Fire Repair
Replace Repair
Retaining Wall
DESCRIPTION
Valuation
Plan Review
(25% 100 %_)
Census Code
# of Units
# of Buildings
Type of Construction
REQUIRED INSPECTIONS
Footings (New Building)
Footings (Deck)
Footings (Addition)
Foundation
Drain Tile
Roof: Ice & Water _
Framing
Fireplace: Rough In
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
Fireplace
Garage
Deck
Lower Level
TOTAL
Final
DO NOT WRITE BELOW THIS LINE / 05
S13
Occupancy
Code Edition
Zoning
Stories
Square Feet
Length
Width
Air Test Final
Porch (3- Season)
Porch (4- Season)
Porch (Screen /Gazebo /Pergola)
Pool
Siding
Reroof
Windows
Egress Window
Demolish Building*
Demolish Interior
Demolish Foundation
Water Damage
*Demolition of entire building — give PCA handout to applicant
MCES System
SAC Units
City Water
Booster Pump
PRV
Fire Sprinklers
Storm Damage
Exterior Alteration (Single Family)
Exterior Alteration (Multi)
Miscellaneous
Meter Size:
Final / C.O. Required
Final / No C.O. Required
HVAC Gas Service Test Gas Line Air Test
Other:
Pool: Footings Air/Gas Tests
Siding: _Stucco Lath Stone Lath _
Windows
Retaining Wall: _ Footings Backfill
Radon Control
Erosion Control
, Building Inspector
Final
Brick
Final
Page 2 of 3
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:
/ J Total:
By �_ Date Paid:
Date of Insp.: / /° (���'' 4 V Insp.:
CITY OF EAGAN SEWER SERVICE PERMIT
3830 Pilot Knob Road
P. O. Box 27199 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:
By Surcharge:
Y Misc. Charges:
Date of Insp.: Total:
Insp.: Date Paid:
From:ALLSTAR CONSTRUCTION 19529427464 09/17/2013 08:47 #582 P.062/079
Use BLUE or BLACK Ink
I For Office Use (n I
j Permit (I
City of Eagan I Permit Fee.^ 5 I
1 I
3830 Pilot Knob Road I
Eagan MN 55122 Date Received:
N
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 1 Staff: I
I I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 2 Site Address: ~)~G'1 HIB14~%'1yc_pg C, oyck Lam Unit M
Name:WM Niq COQ. US= Phone:
Resident/
Owner . Address / City / Zip: ~j 3y
Applicant is: Owner Contractor
aY 8 t Ye
Type of Work Description of work: itay Off
Construction Cost: $I1 11`5 8D. Multi-Family Building. (Yes X / No
f Company; oy, ma t Contact:
€ Contractor Address:51% l Yd ftal cam.
a 1 reti 10 -City: MWt Nib
c. State: M_ Zip: ICJZ- I'12" IL4
Phone:
t W License f 031''J)J Lead Certificate Nr1T' ~q~Dy'~
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:
NOTE. Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non: public, f you provide specific reasons that would permit the City to
~v ---conclude thattare 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.oopherstateonecall.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 / ;(Lij ~n
x `t ! C1 '
Applica 's Printed Warne A li ant's Signature
Page 1 of 3
From:ALLSTAR CONSTRUCTION 19529427464 10/21 /2015 12:25 #269 P.007/020
Use BLUE or BLACK ink
� For Office Use i
��� �� R�CEIVED � Permit#: �u_ �
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3830 Pilot Knob Road ��OT � 1 �O� � Permit Fee: �
Eagan MN 55122 � Date Received: �
Phone:(651)675-5675 � �
Fax:(651)675-5694 I Staff; �
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2015 R�SIDEl��`!A� ��tLDl�C� PER[��T APRLlC�►YlON
Date: Site Address: Unit#:
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Resident! � Name: ��,A✓f►: J Frti31t� ���.i �de4 Phone: /►//� �
� OWIt@t Address/City/Zip:°�7��'7`/s� � . � �j¢r°
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If the project is exempt from lead certification, please explain why: ,���L� ;,,,� 6�f�3 �
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� �� COiUIPLETE THIS AREi4 ONLY IF CONSTRUCTIAlGyA NEW BUILDiNG�tt�����M ry�
� In the last 12 months,has the City of Eagan issued a permit for a similar pian based on a master plan? �
s �
� Yes No If yes,date and address of master plan: �
�� Licensed Plumber:
Phone: � ;
� Mechanical Contractor: Phone: � ,
� Sewer 8�Water Contractor. Phone: �
�
�� Fire Suppression Contractor: � ����» ������� M phone: ',
NOTE:P/ans and supporting documenfs that you submit are considered to be public informaGon. Poriions of� '
# the information may be ciassi�ed as non-public if you provide specific reasons that would permit the City to � I�
�� conclude that th�aie trade secrets. �
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CALL BEFORE YOU DIG. Call Gopher State One Cal)al(651)456-0002 for protection against underground utility damage. Ca1148 hours
before you intend to dig to receive locates of underground utilities. www.aooherstateonecall.ory
I hereby acknowledge thaf this information is compiete and accurate;that the work wiit 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 aceordance with the Minnesota State Building Code must be co pleted within t80
days of permit issuance. ,�,�......... �,,,.—'�
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Page 1 of 3
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PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA143244
Date Issued:06/08/2017
Permit Category:ePermit
Site Address: 4450 Clover Lane
Lot:46 Block: 02 Addition: Eden
PID:10-22750-02-460
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Air Exchanger
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
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 -
Jean M Burton
4450 Clover Lane
Eagan MN 55122
Haley Comfort Systems
4320 Hwy 52 N
West Frontage Rd
Rochester MN 55901
(507) 281-0138
Applicant/Permitee: Signature Issued By: Signature
Jeffrey Wheeler
From: Tracy Scheiber <tscheiber@haleycomfort.com>
Sent: Friday,July 07, 2017 9:34 AM RECEIVED
To: Jeffrey Wheeler
Subject: 4450 Clover Lane JUL NV
/G(3AKW
Jeff: it was just brought to my attention that I had selected the wrong equipment when applying for the permit. It
should be an Air Conditioner. Sorry about that.
Thanks!
Tracy Scheiber
Haley Comfort Systems, Inc
507-424-1625
1
For Of--------------1
fice Use
Permit
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i Building #: I
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EAGAN
I S&W Permit#: I
I Permit Fee:
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I Date Received: I
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
I I
1
(651) 675-5675 �FAX:
(651) 675-5694
I
I Date Issued: I
buildinginspections(a)cityofeagan.com
I----------------------j
RESIDENTIAL BUILDING PERMIT APPLICATION
Date:, Df Z % & (J.�Q Site Address:
Applicant is: ❑ Owner aContractor
Unit #:
Name:
Homeowner
Address./ in2ld P1(e,iiIUPA/
L3'1 City: b�Q0.
v-,
Stater V�ip: �1 -?_ Phone:
Email:
P� Q J
Description of work: e C,
Type of
Construction Cost � y
Work
Type of building: ❑ Single Family ❑ Townhome,
of units Twin Home
1,1Compan RQM
Contact:
Building
Address: L/5 ��� lJlle�4-v�y
City:�GLe
t�iG�\1r i2,
Contractor
State:m&LIp: .5_3�T`� Phone611-2�/ -
Email. v�
� z 6p(l
n
License #: Ex iration Date: o�,S
Sewer &
Company:
Contact:
Water
Contractor
4 Address:
City:
Required for
State: Zip: Phone:
Email:
new construction
I License #: Expiration Date:
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.
/( '0. V -�2 L\ <_� � C �/ti �� �- x
Applicant's Printed Name A licant's Signature