4404 Clover LaneCity of Evan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
Applicant's Printed Name
2012 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 7 —( Z Site Address: C(0 (CA/ Z-V
Name: .(o(o,t, Phone:
Address / City / Zip: —1(4 - C.4 O V LIR
Applicant is: Owner Contractor
x
Ap, ca't's r: nature
Use BLUE or BLACK Ink
For Office Use
Permit #: /.S
d
Date Received: — 11 "( 2
Permit Fee:
Staff:
Description of work: Reba I J d /�I 1 I Clei
Construction Cos r : C Multi- Family Building: (Yes / No
J
Unit #:
State: bitty Zip: / a0 Phone:
City:
6 - 7-3
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
/99c
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.000herstateonecall.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.
°
Page 1 of 3
/ C(o- 1/1)(1I O NOT A
WRITE BELOW THIS LINE
SUB TYPES
Foundation
Single Family
Multi
01 of Plex
Accessory Building
WORK TYPES
New
Addition
Alteration
Replace
Retaining Wall
DESCRIPTION
Valuation
Plan Review
(25 %_ 100% i )
Census Code
# of Units
# of Buildings
Type of Construction
Fireplace
_ Garage
Deck
Lower Level
Interior Improvement
— Move Building
Fire Repair
Repair
QZv6
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
r
73
y 9'1
G 2
TOTAL
— Porch (3-Season)
Porch (4- Season)
Porch (Screen /Gazebo /Pergola)
Pool
Occupancy
Code Edition
Zoning
Stories
Square Feet
Length
Width
_ Siding
Reroof
Windows
_ Egress Window
PD
8a
fo
/d 7a—
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
MCES System
SAC Units
City Water
Booster Pump
PRV
Fire Sprinklers
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
()ROBE
ENGINEERING
COMPANY, INC.
1000 EAST 1.461:s STREET,
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4
L DRA:N A,E A i\JD
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D AKcTA C:0LIN Y MINNESOTA
EAGAN n
cK {r iV E�EJAT /C EVIEWED
PROPOSED ELEVATIOA1
DIRECTION B SURFACE ORAWA/AGE %� y
SARA OE ELE= V 77CAI
V BUILDING INSPECTIONS DIVISION
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Ow, oi)
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141.33 FINrSHEi
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CONSULTING ENGINEERS
PLANNERS and LARD SURVEVORS
DgIvo
DENOTES
3co <
BURN5VtLLE. MINNESOTA 51337 PH 4!2
S ~ 7 l C_ {� //
Alb ,i43,,w
I hereby certify that this is a true
land as shown' and described hereon..
, 19 SL.
and ccrrsct
As prepared
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representation of a tract of
by me on this , T'7' day of
9r
leg. No. /448:
CITY OF EAGAN WATER SERVICE PERMIT
3830 Pilot Knob Road PERMIT NO.:
P. O. Box 21199
Eagan, MN 55121 DATE:
Zoning: No. of Units:
Owner: - — —
Address:
Site Address:
Plumber:
Meter No.: Connection Charge:
Size: Account Deposit:
Reader No.• Permit Fee:
agree to comply with the City of Eagan Surcharge:
Ordinances. Misc. Charges:
Total:
By Date Paid:
Date of Insp.: Insp.•
OF EAGAN SEWER SERVICE PERMIT
3830 Pilot Knob Road
P. O. Boat 21199 PERMIT NO.:
Eagan, MN 55121 DATE:
Zoning: No. of Units:
Owner:
Address:
Site Address:
Plumber:
agree to comply with the City of Eagan Connection Charge:
Ordinances. Account Deposit:
Permit Fee:
Surcharge:
B Misc. Charges:
Dote of Insp.: _ Total:
Insp.• Date Paid:
From:ALLSTAR CONSTRUCTION 19529427464 09117/2013 08:42 #582 P.050/079
Use BLUE or BLACK Ink
For Office Use I
j Permit j
City of Eagan I 33
Permit Fee: I
3830 Pilot Knob Road
Eagan MN 55122 Date Received: _Ot
Phone: (651) 675-5675
I I
Fax: (651) 675-5694 1 Staff., I
I I
2013 RESIDE\I
f'Tf(IAL' BUILDING PERMIT APPLICATION
Date: I I ZU~3 Site Address: 4LAIL7LH 1409, 44CH E ChO ~,Cllrhi Unit
to Cf~ ~m~
Name: Phone:
Resident
E Owner Address / City / Zip: ~n WU?) Uhl St PULNOi\V' f& 646 MN %NY ~
Applicant is _ Owner K Contractor
Type of Work Description of work: TO off and Ye-troc~
Construction Cost: Multi-Family Building: (Yes / No
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Company:Abgi t Uh l I LLL Contact ~)Ut I
Address:514Gj Ir1d"IUI S11 d *10 City: MQLDV_ P
t Contractor
State: MN Zip: %Fo 1 Phone: "t b1_g41_ _IHSLA
License* _-r,~l,~2JICJIS Lead Certificate NIT' W~tv-1-O
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-in-formation. ~Pariions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that the 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.cioi)herstateonecall.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 be completed within 180
days of permit issuance.
X_ (It H~ Iwad x 1 .i"Z
Applicant's Print d Name Applicant's Signature
f Page 1 of 3
From:ALLSTAR CONSTRUCTION 19529427464 10/21/2015 12:20 #269 P.001 /020
Use BLUE or BLACK Ink
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3830 Pilot Knob Road �� Z � ��
Eagan MN 55122 � Date Received: �
Phone:(651)675-5675 I I
Fax:(651�675-5694 I Staff: I �
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2015 RESIDENTIAL BUILDING PERMIT APPLICATION � ��
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Date: Site Address: Unit#:
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If the project is exempt from lead certification, please explain why: ��;L, �„� �c�8�
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:
Fire Suppression Contractor: Phone:
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�ID�E Plans�nd suppQr{t�Rg alocuments that y�u subrr►it�re consldece,d:•#o„�ie.publlc r��or�►�t�ar�..�For��o,ns of �
the�,niormation maybe ciassifietl as non pkblic rf you�rov�ple s,pecifi��ie��Qn,s�ha#y�►ou�d p"ern�at th��ity',,#o �
.:�or►clu.�le that.:fhe ;�re.trade;:secrets.: ��
CALL BEFORE YOU DIG. Call Gopher State One Call at(659)454-0002 for protaction against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.aoaherstateonecall.org
I hereby acknowledge that this informaqon is complete and accurate;that the work will be in conformance with the ordinances and codes ofi the City of
Eagan; that I understand this is �ot a permit, but oniy 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. #
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be co. pleted within 780 `'
days of permit issuance. ,_ -. ,..✓� 7:
x ��•�+ �/�fm�hJ X �� �
ApplicanPs Printed Name Applic nt's Signature `
�
Page 1 of 3 S
�
t
�
City of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
MAR 2 6 2016
r
Use BLUE or BLACK Ink
For Office Use
Permit#:
Permit Fee: ,3(46 411
1
Date Received:
IV
Staff:
2016 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: L0 C'\ o,J Le-- l. -N
ro+ l t frifik-
Resident/
Owner
Name:
Address / City / Zip:
Applicant is: Owner Contractor
Phone:
Unit #:
Description of work: arm.... (AA MC/ 1,/,4,1
Construction Cost: lc -00. 00 Multi -Family Building: (Yes / No
1
Company: r 't
(Milk -MV: ,A,. /ppe /uii (C6ontact: ✓(-1 e P� v1,�1-',�,'1
Address: ) l'$ - - )-3rtilIV)/ J
I� City:(' 1
State: r Zip: “7/L1 7 Phone: j 3-1418 -'' _ E ..ail e!' yC y ,g"' 9,3`%`t't r /l sv t.� QL
License # (09 �. 5 `V A �" r--1136, 3 9' 1
�� � Lead Certificate #: t i
NA
,e-0/.1
If the project is exempt from lead certification, please explain why:
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:
I Phone:
Sewer & Water Contractor:
i Phone:
Fire Suppression Contractor:
Phone:
NOTE: Plans and supporting documents that you submit are considered to be public inforticition. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that the are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Cali 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.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 St B ding Code t be completed within 180
days of permit issuance.
x
I
r P/1 -.k.. Ne y
Applicant's Printed Name
x
Appl'c., is igri
Page 1 of 3
'7'4"C . C.; /O f- 2
SUB TYPES
Foundation
Single Family
Multi
01 of _ Plex
WORK TYPES
New
Addition
Alteration
Replace
Retaining Wall
DESCRIPTION
Valuation
Plan Review
(25% 100% y
Census Code
# of Units
# of Buildings
Type of Construction
DO NOT WRITE BELOW THIS LINE
Fireplace
Garage
Deck
Lower Level
Porch (3 -Season)
Porch (4 -Season)
Porch (Screen/Gazebo/Pergola)
Pool
Interior Improvement
_ Move Building
Fire Repair
Repair
REQUIRED INSPECTIONS
Footings (New Building)
Footings (Deck)
Footings (Addition)
Foundation
Roof: Ice & Water _Final
)(' Framing
Fireplace: Rough In Air Test
Insulation
Sheathing
Sheetrock
Fire Walls
Braced Walls
Shower Pan
Reviewed By:
Occupancy
Code Edition
Zoning
Stories
Square Feet
Length
Width
Final
Siding
Reroof
Windows
Exterior Alteration (Single Fa
Exterior Alteration (Multi)
Miscellaneous
Accessory Building
Demolish Building*
Demolish Interior
Demolish Foundation
Egress Window Water Damage
*Demolition of entire building — give PCA handout to applicant
MCES System
SAC Units
City Water
Booster Pump
PRV
Fire Suppression Required
Iy)
Meter Size:
Final / C.O. Required
Final / No C.O. Required
HVAC Gas Service Test Gas Line Air Test
Pool: _ Footings Air/Gas Tests Final
Drain Tile
Siding: _Stucco Lath Stone Lath Brick
Windows
Retaining Wall: Footings Backfill Final
Radon Control
Fire Suppression: Rough In _Final
Erosion Control
Other:
, Building Inspector
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies a X
2---( r
TOTAL
‘49 90-- Ib
Page 2 of
-------------I
r For Office Use
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651) 675-5675 1 FAX: (651) 675-5694
buildinginspectionspcityofeagan.com
1 �ZlL��b✓
I Building Permit #:
1
i
I
1
S&W Permit #:
I Permit Fee:
I
I
I v I
I
I
Date Received:
I
I
I
I
1
I Date Issued:
I
I
I— — — — — — — — — — — — — — — — — — — — — j
RESIDENTIAL BUILDING PERMIT APPLICATION
Date: �h Site Address: _
Applicant is: ❑ Owner aContractor
Homeowner
Name: G(�t/� b V\/�� C'� V. �� U�y'/�� _/fi- CAS e, C' ct-4 6 In
Address:' !A A10 16/04/ �,� r%?�buzy LEI City: �aQOL \P,
Phone:
Description of work: P, 2 Q Cs t�—
Type of Q
Work Construction Cost l `/
Type of building:
❑ Single Family ❑ Townhome, of units Twin Home
Compan 3CM �t/t t't,LC_ C�\/� Contact: �u �✓
Building Address :�� � ��1'� WEST T 1�— y City:z66py-
Contractor fJ / ,/ /? aJ�C ^ >✓L ,
State:��Zip: .SU�T Phone:cotZ�7� Email.{a/Vle.�f �eyr
License #: D 0 Z Expiration Date:
Sewer &
Water
Contractor
Company:
Address:
Contact:
Required for State: Zip: Phone: Email:
new construction
i License #: Expiration Date:
City:
S: I l understand that Plumbing, Mechanical, and Fire Suppression work require separate applications. R
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.y eA x
Applicant's Printed Name A licant's Signature