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4483 Clover Lane Unit B4 0 1° ' City of Eagan 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675 -5675 Fax: (651) 675 -5694 2012 RESIDENTIAL BUILDING / PERMIT APPLICATION 7 7 Date: l2 -2°t' 2_ Site Address:q�9 3 L O V /Y Unit #: Name: /-.h.14 . /Id / - ek Address / City / Zip: 4 C Applicants Printed Name Applicant is: Owner X Contractor 1l1t Staff: a (--"%L7 -- / Address: MPS , PS 6eneVaiWe /1/ City: Qom' dide- State: Nt Zip: Ja0 Use BLUE or BLACK Ink For Office Use / Permit #: /6 �7 (/ ' 6 Permit Fee: / �r7• 1 � Date Received: — 1 -' 1 ' 1 Z. Phone: Description of work: Re- % ' d- eXi sT I de Construction Cosg: i1 5 d Multi - Family Building: (Yes 4. / No ) Company: j 2 Gkc 3Ot Contact: O>, Ck L ��i Phone: Co 51- 7 7 ' 3t/3 License #: f(0 3 0 orx. Lead Certificate #: If the project is exempt from lead certification, please explain y: (see Page 3 for additional information) e i L f a �' r - t 1 7 �� (.A ! t Gj 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: J 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.00pherstateonecall.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. x Ap y' ants Signature Page 1 of 3 0,Giti&pe- [AA& SUB TYPES Foundation Single Family Multi 01 of Plex Accessory Building WORK TYPES New At 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 Aevo REQUIRED INSPECTIONS Footings (New Building) V Footings (Deck) Footings (Addition) Foundation 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 DO NOT WRITE BELOW THIS LINE /3 y7 11 Porch (3- Season) Storm Damage Porch (4- Season) Exterior Alteration (Single Family) Porch (Screen /Gazebo /Pergola) _ Exterior Alteration (Multi) Pool Miscellaneous Occupancy Code Edition Zoning Stories Square Feet Length Width Siding Reroof Windows _ Egress Window Demolish Building* Demolish Interior Demolish Foundation Water Damage *Demolition of entire building — give PCA handout to applicant 112c --1 PO Sk) S J D MCES System SAC U n its City Water Booster Pump PRV Fire Sprinklers pso 46 0 clt g 6-04 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 _Final Siding: _Stucco Lath _Stone Lath _Brick Windows Retaining Wall: _ Footings _ Backfill _ Final Radon Control Erosion Control , Building Inspector Page 2 of 3 b /Or ■ Z % ` f� 3 411.73 lit. I W,V 710 y4 3v : Z ' /!G L/qg* cloth' CITY r)F EAGAN WA • ERVICE PERMIT 4 3795 Pilot Knob Road PERMIT NO.: Eagan, MN 55122 DATE: Zoning:. No. of Units: Owner: -- — Address: tit q X'3 A Site Address: Plumber: Meter No.: Connection Charge: — Size: _ Account Deposit: Reader No.: Permit Fee: - I agree to comply with the City of Eagan Surcharge: Ordinances. Misc. Charges: - Total: By Date Paid: Date of Insp.• Insp.• . CITY OF EAGAN SEWER SERVICE PERMIT PERMIT NO.: .4795 Pilot Knob Road DATE: Eagan, MN 55122 No. of Units: Zoning: __ — Owner: Address: _ Site Address: - -- __ -- Plumber: — -- agree to comply with the City of Eagan Connection Charge: Account Deposit: Ordinances. Permit Fee: Surcharge: _ Misc. Charges: By _ Total: Date of Insp.: Dote Paid: Insp.: PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA112459 Date Issued:08/14/2013 Permit Category:ePermit Site Address: 4483 Clover Lane B Lot:17 Block: 01 Addition: Eden PID:10-22750-01-170 Use: Description: Sub Type:Residential Work Type:Replace Description:Water Heater Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection. Renae Frienwald 2200 Hwy 13 W Burnsville, MN 55337 Fee Summary:PL - Permit Fee (WS &/or WH)$55.00 0801.4087 Surcharge-Fixed $5.00 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 - Linda J Hollien 4483 Clover Lane B Eagan MN 55122 Genz Ryan Plumbing & Heating 2200 West Highway 13 Burnsville MN 55337 (952) 767-1000 Applicant/Permitee: Signature Issued By: Signature From:ALLSTAR CONSTRUCTION 19529427464 09/17/2013 08:27 #582 P.008/079 Use BLUE or BLACK Ink I For Office Use I City ~ Permit j of Ea Ed~ I Permit Fee: 9 1 o I 3830 Pilot Knob Road I I Eagan MN 55122 j Date Received: 0( Phone: (651) 675-5675 I I Fax: (651) 675-5694 1 Staff: I I 1 2013 RESIDENTIAL iBUILDING PERMIT APPLICATION Date: 2013 Site Address:4gpi3l4:56,Hq(7,L44irOI3 00ya Wou Unit Name: E A 1 ~ CIO, uaSSl~! Lwul ~ 'hone: s i Resident/ U(P Owner Address / City / Zip: V H J~ N kt POI K.VY ItiYl 11>04I YI f., MN i39_-3L1 L_1 Applicant is: _ Owner Contractor l Type Description of work: 201 and Y,-YQD of Work Construction Cost: 202W D Multi-Family Building. (Yes /No___) Company ~~YIS~Y1dC110Y1 Molt~a~P , LL Contact: 60t rr,,~ -},~ee.~ Contractor GI(A ( d y; ~ndM&Q(SIIGGI *05 City: pp iain Address:=1 ~rA 951-991, ~-1r~e ~ P State: MN _ Zip: Cr J Fy 1 Phone: ' 1 7-1 License RCIP3IGJ19 Lead Certificate NM - 2DgWq 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: I Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer & Water Contractor: Phone: _s NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of t 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. 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.aonherstateonecall.ora 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 b completed within 180 days of permit issuance. .t 1 llG 4: X_ dut Applicant's Printed Name Ap -ant's Signature 7 Page 1 of 3 PERMIT City of Eagan Permit Type:Building Permit Number:EA129895 Date Issued:03/23/2015 Permit Category:ePermit Site Address: 4483 Clover Lane B Lot:17 Block: 01 Addition: Eden PID:10-22750-01-170 Use: Description: Sub Type:Windows/Doors Work Type:Replace Description:Two or More Windows/Doors Census Code:434 - 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 by law in ALL single family homes . 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 - Linda J Holien 4483 Clover Lane B Eagan MN 55122 (651) 470-1796 My Exteriors Inc 6957 Hwy 10 NW, Suite 206 Anoka MN 55303 (763) 241-4900 Applicant/Permitee: Signature Issued By: Signature From:ALLSTAR CONSTRUCTION 19529427464 10121 /2015 12:29 #269 P.013/020 Use BLUE or BLACK Ink � For Office Use � �} j Permit�: ✓�� 1 �16y o�� RECEIVED � � Permit Fee: � 3830 Pilot Knob Road � I Eagan MN 55122 QCT 2 1 Z015 � Date Received: � Phone:(651)675-5675 � � Fax:(651)575-5694 1 Staff: � � I `_��__��J 2015 R�S��TiAL �tJ�L�� ERi�tT APP�tCATIOi� Date: Site Address: Unit#: �.w.a.,�..�,,.,w..:��..._M,....•.�,.."�.._�,.��.,..�,,.__�_�...._.�,.m�.,.�,_�� ..�-.o.�.rT.��:,-:�....,.�..�,,.._.�.�,.�.�,�...V._�. _ - � � Name: itn�A✓A, 1 ��31t� '" �.�'� �d/� �.�n_.. ..�//g�.��.��.��,,. ,� Resldentl f Phone: � OW11@P_ � Address/City/Zip: `/��3' L�y�-�' � � �p-� � � � �� ' Applicant is: Owner � Contractor �..�.,...�.��,..,..�.:�,,,.. �....,.�.�.��._��.,M.�,:..,.�...._>...�:.�_.r...�...m...._�.�..�.,...�.,�.�....��..-�.,.�.x�,.,..�._�,..M,..... W.�..�..M.w.,�..,-�_.,.�..,.�.,._4..,.�.t,-_..��,-_._..��..,..�.�.,,�,.� Descri tion of work: ��- ,;� ?�,/� _ .... ..... . ,_ � p �r�r Wi:/� L';,�.f�B` �:�.n(` � Type of Work 'f � � � ` Construction Cost: ��';L1CC%� - �N �..,�_,�....,�._...,c,,,��......�Y_.�..r�,-.,..,.�..�....----._... ._. ... ,.�...._�,....,�.4,�....,.m.._.m..,.,�....�......_-.:,.,,_....,_.�...,�,�,,,�.��y B - �g:{Y.�...�.�...�-.._.4._....�-...-...�,...�,..�,,.,. � u ti am uiidi es o ) p Y J �� Company:��St�� C.t^��S'��2u��.Gr��t�ti an tG�9l��t`�' Contact: c.....��n�+ ��.r,.,e�,� � � � i _ ` � Address:�i�/S /n�u5�,��rt�L-5�' ` �u�kf. lL� Cit � ' v: _!�1 n �� I'E�,.� � � Contractor �' � � State:�2ip: a�s.S�`3 Phone: ��Z-`}�2=75�5��Email: �st•�d�c�.l l�'�z f°'. �s'Z- � , License#: .�C (�9i� �C�c? Lead Certificate#: l��• �Jy(�� Z.- � x _ .�.P�,..�,.�.�-x..,.s,.�..�.�...��,�...��,.�,=,m,.,�,�.m-�. .�.R.�.�.,.�.-V�...,,.,. ....�...�..a.�..._....� .....� � If the project is exempt from lead certification, please explain why: ��L„T �„� `c��3 � .�,�,< _..�.,.�,,.�..�.�.w.�..� .......-�._,._..-...�,.,,.�.�.,.�......s,,�.�.,�..��,....��.�-�.�,�,,..,,s__.��,.�..a................��.,�,.:....,1.,�.,,,....n.�_��.�.�.,�,.,,..,�...._.,�...�...:.....,....N...,.,�.� � CON9PLETE THIS AREA ONLY IF CONSTRUCTING A NEVI! BUILDING � � In the last 12 months,has the City of Eagan issued a permit for a simila�plan based on a master plan? � � Yes No If yes,date and address of master plan: � � Lice�sed Plumber: Phone: � � Mechanical Con4ractor: Phone: � � Sewer&Water Contractor. Phone: � s Fire Suppression Contractor. Phone: } , � � NOTE:Plans and supporting documents that you submif are considered to be public information. Portions of� � the information may be c/assified as non-public if you provide speci�c reasons that would permii the City fo [ conc/ude that the�are trade secre ,.�...��,�.,w.,,��.�.�.,.,.�,�_:.�_.._,....m...��.,...�......:.�,�_o.�,.....�..._...�--�,e„-�.�_r_.��.�,w�.__.�,..R��.,�a.,..�,�.�.�._�:..�-�.a,�fs.,T...�...:��...,,�.,..,.��,�.�...,�,�,.�.__�...�..._�,�,._�,..,�......,,.N.�..�.... m. � CALL BEFORE YOU DIG. Call Gophe�State One Call at(651)454-0002 for protection against underground utility damage, Call A8 hours before you intend to dig to receive locates of underground utilities. www.00aherstateonecall.ora 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, bui only an application for a permit, and work is not to start withnut a permit; that the work wili be in accordance with the approved plan in the case of work which requires a review and approvai of plans. Exterior work authorized by a building permit issued in accordance with the Minnesota State 8uilding Code must be co�pleked within 180 - days of permit issuance. ...-- �- :r..... �• ..—. �-''` 1 ' f x �_,�, �//'m�1 x �� ; /�pplicant's Printed �lame � � � Applic nt s Signature Page 1 of 3 � a 's: -------------I For Office Use i Building Permit #: I i I EAGAN I Permit Fee: 4 3 _ ` I I I Date Received: I 3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 I I (651) 675-5675 �FAX: (651) 675-5694 1 I I Date Issued: I buildinginspections a.cityofeagan.com I----------------------j RESIDENTIAL BUILDING PERMIT APPLICATION Date: zh q Site Address: Applicant is: ❑ Owner Contractor Unit #: Name: �G( �V� i--ib Vv`e- CDtt2.,rS A95c,ei ot`-�i b li,/� Homeowner Address: z/L/P!5 yz�P,3 AJB City: �o Ct a ', `'' y Stater l/�ip: 5122 Phone: 1� Email: Description of work: P, Q t' bh- Type of Construction Cost �, j Work Type of building: ❑ Single Family ❑ Townhome, of units Twin Home Compank3 l/� t'c .Lc_ �s Contact: �JJ�`� �✓ M, Building Address p, 61, Wes* T 4/—\y City:1de—yX Contractor �J '/ State: Zip: 553/T Phone6Iz�7 License #: � D Expiration K- q� � 0 Expiration Date: Sewer & Water Contractor Company: Address: Contact: Required for State: Zip: Phone: Email: new construction i I License #: Expiration Date: City: *I 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. Applicant's Printed Name A licant's Signature