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4473 Clover LaneDate: City of Eaall 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675 -5675 Staff: Fax: (651) 675 -5694 2012 RESIDENTIAL BUILDING PERMIT APPLICATION 0 Site Address: LA q 1 . 1 CA6\J e V Unit #: Name: $ .■-■\ Phone: Address / City / Zip: Lfi L,1 C IOVVI Applicant is: Owner Contractor For Office Use (� Permit #: / C/ -‘ b q Permit Fee: / 73. / q Description of work: Re-klc` c kecK Construction Cosg ` CV ��rr� S Multi - Family Building: (Yes 4._ / No ) Company: NC Icy,t Address: /%S &eneVarf� - bit 1V State: I Zip: sl N,6 License #: 3 0 - ) n fri Lead Certificate #: Date Received: Contact: ,S OL ` G( City: oi / e. Phone: ( O 3 l — 3Ya3 If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) s Signature Use BLUE or BLACK Ink 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.aopherstateonecall.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. J Page 1 of 3 of�73 C touelz- SUB TYPES — Foundation Fireplace Single Family _ Garage _ Multi z e Deck _ 01 of _ Plex _ Lower Level — Accessory Building WORK TYPES _ New Interior Improvement Addition Move Building _ Alteration Fire Repair _ Replace _ Repair Retaining Wall DESCRIPTION Valuation Plan Review (25% !/ ) Census Code 1' #of Units # of Buildings Type of Construction REQUIRED INSPECTIONS Footings (New Building) 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 GL R DO NOT WRITE BELOW THIS LINE 73 4� y QZ- TOTAL /o6te — 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 *Demolition of entire building — give PCA handout to applicant PD / Demolish Building* _ Demolish Interior Demolish Foundation _ Water Damage MCES System SAC Units City Water Booster Pump PRV Fire Sprinklers Meter Size: Final / C.O. Required Final / - 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 e Backfill Final Radon Control Erosion Control , Building Inspector Page 2 of 3 ROBE ENGINEERING COMPRNY INC. I EAST 1461ti STREET, 4,Q NORTH SCALE: 1 30' EAGAN R E r-7. N E D DATE 7 BUILD!N.G + o BY: 84 r i -. 4'4 ' / � ' U T CONSULTING ENGINEERS PLANNSAS and LAND SURVEYORS BURNSVILLE, MINNESOTA 55337 PH 432 - 3000 Cer•Z e c z 1c a ?rG�"'?fP ' JD g q larsts.L.lagszi z n: LOTS 9, lo, ll, AtJD 12, BLOCK !' EDEAJ ADD /T /'A DAKOTA Cot/Airy MIA1AIESOTA C.(1:41 '_�O% DENOTES EX/ 577A16 6'LEV4I (' z DENOThS PROPO5 £LEV,IT/['A/ 1 A DI CATE 5 DiREcT/ON oF SvRFACE PRA /NAME 99o.5 P /A//S1-&'D GARA &E FLOOR ELEVAT ION S DIVI ION o / .‘; Y `..9 '6U / 1 hereby certify that this is a trueland c orrect land as shown' and described hereon.. As prepared Gera, e. , 19 Fly . 33 37 , 1 4q -7 tdifil L a -1-e- 9 representation f a tract of by me on this .34? , day of Hinn. Reg. llo. 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: !'. Total: By Date Paid: Date of Insp.: 4177:5".-."--- i • sp. CITY OF EAGAN SEWER SERVICE PERMIT 383p Pilot Knob Road P. O. Box 21199 PERMIT NO.: Eagan, MN 55121 DATE: Zoning: — No. of Units: Owner: Address: Site Address: Plumber: I agree to comply with the City of Eagan Connection Charge: Ordinances. Account Deposit: Permit Fee: B Surcharge: Y Misc. Charges: Dote of lnsp.• Total: Insp.• Dote Paid: From:ALLSTAR CONSTRUCTION 19529427464 09/17/2013 08:29 #582 P.014/079 Use BLUE or BLACK Ink I For OfficeUse--------- I j Permit M City j of EaflaIl I Permit Fee: J 0 , r7 3830 Pilot Knob Road Eagan MN 55122 I Date Received: i Phone: (651) 675-5675 I I Fax: (651) 675-5694 1 Staff: I 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: q 1,512-013 Site Address: 'Iy1I,4~h1 g,yy13.yy13B CtUve►~ Lahr unit Name: Ean big CIO*, &_Qlal I COMWA Phone: Resident/ i~ ~n~ Owner Address / City / Zip: tt/13t G tm Y ~a1 1 Pa1,m C'CiG') IPM Ae f MN 55391 t(Applicant is: Owner Contractor Type of Work Description of work: T@GY and Ve-=f Construction Cost: 5,1150 • y0 Multi-Family Building: (Yes / No Company: AiMar MwWw Mau , L LC, contact: (hit alftrgd Contractor Address: uy s Indunjoi l M+ *103 City: Mapt , I iai n State:M N Zip: ~J3 Phone: q~JZ" q~1Z" -I~'IS"1 f License Bu.24 G- 1r, Certificate N T" i0y If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) r~ 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: E NOTE. Plans and supporting documents that you submit are considered to be public information. Portions of the information maybe 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. Cali 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.oooherstateonecall.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 pe completed within 180 days of permit issuance. rfl X_ Hai& Applicant's Printed Name Appff/ant's Signature Page 1 of 3 ff Dec 04 2015 02:05PM HP FaxPerfection Heating 6517773252 page 2 Use BLUE or BLACK Ink ---------(' � � For Office Use �/ I Clt 0�� 8I1 j Pertnit#: � �! �� / I PermN Fee: �� I 3$30 Pilot Knob Road � C I Eagan MN 55122 � I Date Received: � Phone:(651)675-5675 I � Fax:(651)675�5694 � I I Staff: � �-----------------� 2015 MECHANICAL PERMIT APPLICATION ❑ Please submit twa (2)sets of plans with all commercial applications. Date: �� Site Address: �"l �� t ��:�' f LC?�.� U%L'�� k- l�� Tenant: Suite�!: �-�` � � C �- ff Name: C'�-;-� `, r;•�. c_ .�n/1�t i � Phone: ` � ' �� G�- > ,:::'::.:...:.:::::�::;:.: ::;`. ..;� � b� �L .I �.�� ..� `�l � ResidentlO:wner• Add ress!City/Zip: �'t��';ti�_.,^ �,. '�. � :�f' Narne: l�� ;'�r .�--`�..ti :� ��-- c:�i�t;�.��;� License�: J�l i.`,��C'�:3 I �� T ' , J d � '`` ' � � A dress: � I `7c_ ,�� - c�t , �� A t -\ �� 1!- .R;�" .1 )i' �` v: .,�...1� v b � `��n :,c" , ::� fta.�:"r;��<�:;. ..�.,. Q. .;;t; State:��1 -•, p; "� (N ;� /�: Zi �� L'i Phone: S f �7'7 ��n.m�.t' �..: ' A � .4 . ' .;'. ' : . 2 ....; ' A ..- " :�.:.0.:.. ...........:��'.;:..::::..t::r ,....:..F.y:...,:Y•y — � Contacr ��t':ti e u'..c'�,-�.. Email: .k �. L .r.��.�.:�� c- , . . . .C. . :�'�.'.;:.::::..^s:''.�:..j:�'::xr::�::.��:...�..;,.�.yJT.f . " New �Replacement Additional Alteration Demolition ::.: :::. .. .::::.. .: ` � ; Type;of::Wo[k::; Description of work: ' � v I.x. ,' l�-��. .. �=�. � 1�. .� ; ��=�_: 4— , ..., :_. .. . .. ,::;-.:. ,:...:, � ,. .. . -::;.;.::,.:....:: :.::: ..::N�T.�:;Roof,mounled.a�nd:. round.:mounted.m.echanical e. ui r,►lertt:i�:r ui:rad:.to:be.s�re��ed ti';�� .'",z 9 q p . � t X�iRtY.. Y C;o+de, Pl.e�se ;contaot#he Mechani�al�Inspectoc:for iRforrm�tiori�n perrn;��tl:scre�ening`,m�t�io�s,�`:,:�..;': s;:` — :>>, :;l= <':��''i''.:�i:�^``;�`';,��.;`>'>:�:�:'2 . RES/DENT/AL COMMERCIAL :':'f;':::..:,�::t'::,��.�.f.:':::,:��'�� ::t.:.:•.r..,':;•'��.^,:..::.:.�.�:.:... ;za:�:=;;:,:.�;,�:,;. : Furnace New n n ,, : ' � � _ Co struction I te�ior Improvement t�� _� } � �+' Air Gonditioner Install Piping Processed Permit'Typ�e, — _Air Exchanger Gas Exterior HVAC U�if Heat Pump UndedAbove ground Tank �Install i_Remove) �Other )-� `,.1;,. •+ RESIDENT/AL FEES $60.00 Minimum Add or alteration to an existing unit,includes State Surcharge t�J �100.00 Residerrtial New, includes State Surcharge = $� G�'• TOTAL FEE COMMERCIAL FEES Contract Value$ x.01 $60.00 PeRnit Fee Minimum $70.00 Underground tank installationlremoval = $ Permit Fee _ $ Surd�arge Surcharge=Contract Value x$0.0005 If the pro)ect valualion is over$1 million,please call tor Surcharge =$ TOTAL FEE I hereby acknowiedge that this informetion is complete and accurate;that the uwnork will be in aonfortnance wi�the ordinances and ooc�ps o1 ihe Cily of Eagan;that I understand this is nol a permit,but only an application for a permit,and work is not to stah without a permit;that the woiic will be in accordance with the approved plan in the case of work which requires a review and approval of plans. " �:� , �' � � r-'�� j � ! x - ' `'_•' - z _.�-' � Ap ant's Printed ame " ApplicanYs gnatuce�' �,,..�' .,,..,......:,,:..:...,::: ... . ..,.. ,. . ...:....... .:::::: :::...:.. .... :.:�,.. . .,, .:: .. . ,. :;.,.. >FORO�.IC : .,, .., ;.: F E US� ,i �..�;� . �Raq�ir8d ltrspec��ot�s R�vlewed By: D � ' ;:`r•:i ; ,, , at � �: M l7nder��uri�"� �� gtiw��` Y t�4ir�a�� ` �a�:Senn+a�T�st 'in=�fiioo�h�e�t ` � , r�s�� ,�.r,_ ,�,,, . . �� .. �inml H�i�G SY�e,� �n�' �:. 'v,..:�<,�. Use BLUE or BLACK Ink r----------------� I For Office Use � � � Permit#: �� C` � j Clt� Of �� Il ' � , �� i Permit Fee: �� 3830 Pilot Knob Road � Eagan MN 55122 � Date Received: � Phone: (651) 675-5675 � � Fa�c: (651) 675-5694 L Staff:______________� 2015 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: Site Address: �� i� �� v�'A�-�. Tenant: Suite#: Residen#��wner ` Name: pnone: Address/City/Zip: n / Name: � � Gth+ � ��b c�.�� License#: �� 4�L�� COt1tt'�Ctol' Address: f ��JC ��n �'""( City: � /�� 8d1, � �'.�� s �� State: Zip: �' Phone: � •� � e._.11 /G �/ � ,�'. � Contact: / EmaiL �0 . New �eplacement _Repair _Rebuild _Modify Space Work in R.O.W. T�Ae o�VUork — — ° Description ofwork: �� U�� ` �� RESIDENTIAL " �Water Heater Water Softener Lawn Irrigation�RPZ/ PVB) Per�it Ty�e — Septic System Add Plumbing Fixtures�Main/_Lower Level) New Water Tumaround Abandonment RESIDENTIAL FEES: $60.00 Water Heater, Water Softener, or Water Heater and Softener(includes State Surcharge) $60.00 Lawn Irrigation(includes State Surcharge) $60.00 Add Plumbing Fixtures, Septic Svstem Abandonment, Water Turnaround"(includes State Surcharge) ''Water Turnaround(add$210.00 if a 5/8"meter is required) $115.00 Septic Svstem New(includes County fee and State Surcharge) TOTAL FEES$ 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.caopherstateonecall.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 apptication 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. x � , ��}/�,� x ApplicanYs f� nted Name .� Ap nt's i ,ture FOR OFFICE USE Reviewed Bq: Date;. Required lnspections: :Under Ground Rough-ln Air Tes# Gas Test Final 'Meter Related ltems: Meter Size Radio Read Manometer Staff: PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA155639 Date Issued:05/28/2019 Permit Category:ePermit Site Address: 4473 Clover Lane A Lot:11 Block: 01 Addition: Eden PID:10-22750-01-110 Use: Description: Sub Type:Residential Work Type:Replace Description:Air Conditioner 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 - Tafesse W Semayate 4473 Clover Lane Eagan MN 55122 (404) 519-0730 Centerpoint Energy 1240 W River Pkwy Minneapolis MN 55454 (612) 321-5597 Applicant/Permitee: Signature Issued By: Signature % z , 0 ® I I e r ® �.•• •®,V® EAGAN 3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 (651) 675-5675 1 FAX: (651) 675-5694 buildinginspections a�cityofeagan.com ------------- For Office Use I I Building Permit #: I I I I I S&W Permit #: I � I I I Permit Fee: I I I I Date Received: I I I I Date Issued: I t---------------------- RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: Applicant is: ❑ Owner Contractor Unit #: I Name: IGt e sA b ul�e— (z:> �_�� y,_ ._- _f4s�5 o C' A Ot_4 k 6 In Homeowner Address: J "i -�, I N—t! � i q "1 —+ D"�/ City: �aaOL State: Wip: S51 ?—Phone: OoQ6-✓ LEmail: I Description of work: �2 C, tD, Type of 2 Work Construction Cost) of building: ❑ Single Family ❑ Townhome, of units 14,Twin Home Compan �ThQ��tl Building Address: �� T KAA/. City:��iLe Contractor � / '/ State:M&6: 5-37 Phone�otZ�7)' Email. _Vlke�C ,\^_e,v� License #: o O Ex Iration Date: Sewer & Company: Water Contractor Address: Required for State: _ new construction Zip: Phone: Contact: Email: 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 v~.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. X Applicant's Printed Name A licant's Signature