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sil mdi 46:'I. Forte; Point. L4 .7i . .d peli
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***ter No.: Connection Charge 305.00 pd 1
Site: Account Deposit: €
Reader No.:, , Permit Fee: 10.00 p cl. r ,`
'- i `iNee es. Efiffiliii, with tie (of norm $ur ge; , 50 pd
tXe fe1. Misc. Charges' 60 ,00 n d mete
Total:
ty Date Patel:
- Dote of Insp.: !" Insp.:
110 10** `
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Plumber '(e ? .13.77,1 ;1. 2,
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Deposit:.
Permit few" 1 n 1)fl no
surcharge: c fl r
Odle , , Mist. ()gorges:
�) Total:
ink.: ,/(/ ` �`° Date Paid:
Use BLUE or BLACK Ink
i r-----------------
I For Office Use J 1
Permit
City of Eq,~ rr11, 01
Permit Fee: ICJ
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I'L
Fax: (651) 675-5694 1 Staff: I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
16,
Date: f Site Address-4/4631- 6f 'osr 70Y vi.64 i0-17i4 Unit
Name: fE"
Phone:
Resident/
i Owner Address / City / Zip:
Applicant is: Owner Contractor
d
_
F _
Description of work: 1h,
Type of Work
Construction Cost: Z)dV Multi-Family Building: (Yes i~ No Company: gdW2_ H4f-A,/47 Contact:
Contractor Address: dJ City: 5La
E State: A Zip: 1S ?7
J 7 Phone:,`
License 3 ~D (coo'"' 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:
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 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.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.
App ant's Printed Nam Applicant's gnature
Page 1 of 3
Use BLUE or BLACK Ink
r________________�
I For Office Use � �
� � Permit#: / ���'�"` ��
Clty of ���a� � / ` -^�
i Permit Fee: `"'�/�� O� �
3830 Pilot Knob Road
Eagan MN 55122 � Date Received: �
Phone: (651)675-5675 I I
Fax: (651)675-5694 � Staff: I
I I
2015 RESIDENTIAL BUILDING PERMIT APPLICATION
�ate: Y ` f�' vl� Site Address:�l S`�,��� �D�Ph�� �.�-%;��f's 7 �-t��•�Gz /�init#:
,.
�` ` � �� n �, n
� � � £ l� ✓J�'e��.��e �Z`'r�� Phone:
�� ���.. ' ;� _� Name:_�
� Resrdent� � �
,� �wne� � Address/City/Zip:
�;, ,� �, � '°:
� { ������ �; Applicant is: Owner �Contractor
�
� `� _: ,p ,�1
��'��� �� , � � C �
�_ �' �° � � Description of work: �' �S ✓�--
�Type of�tVork �
}� ��,�,�� � Construction Cost 27 �v� Multi-Family Building:(Yes� /No )
� �., �. �� .;
����� ��� � Company: F�1� ��YI �'l� ��'l j� Contact:�� ��C��7'U}� �'f
° � �� � ��� — /
�����"�`���` Address: ' S�U� .�'t�%6 � l+el'-� � _City: �/�'�v�Gl� ,
� Contractor
� �
����� � �" �� State�'l�Z�p:S S 33 � Phone: �� `���' /��mail:
���� � �
` ��� � �; /
,,,���� „ µ �' �' • � (7� �
" '# ,� �'.�,a, License#: ��� Lead Certificate#:
If the project is exempt from lead certification, please explain why: (see Pa�ge 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:
�.- � � � e � � �. � �;..
NQTE P/ans and support�ng docume�t�that yousubm�t are cor�scderetl�ta��publ�c�r�f��rmat�a�, Po�fion �
��� .� �,... ,� : � �,� ,. , �, ;; .... �*��"��a- �,s� ra�s a � »� ����'rn,ff� c„� .
.�#he�nformat�oit rr�ay be classrfed as non public�tf yo ro►�r�e spec���c r�ass�n,��tl� f:tnioultl e ��t�Ci ', o
,u.. ;���� .��� �������,�,�, �"�.��..���`,��� �`;s conc%ude„#ha#,��l�e'..:arefradeseci%efs� �. �'��=,"���'�' � � �.v.��,-
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.qoaherstateonecall.orc�
I hereby acknowledge that this information is complete and accurate;that the work will be in G�nformance 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 ildin ode must be completed within 180
days of permit issuance.
� / �..
X � � �� ; %"�i' ,�'/- X �
ApplicanYs Printed Nam ApplicanY ' nature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA176168
Date Issued:05/04/2022
Permit Category:ePermit
Site Address: 4688 Horten Pt
Lot:4 Block: 07 Addition: Ridgecliffe 3rd
PID:10-63982-07-040
Use:
Description:
Sub Type:Fireplace
Work Type:Gas Insert
Description:
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home may require smoke detectors in all bedrooms. Chimney / flue must be inspected prior to
concealing.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Valuation: 3,000.00
Fee Summary:BL - Base Fee $3K $88.50 0801.4085
Surcharge - Based on Valuation $3K $1.50 9001.2195
$90.00 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 -
Justin W Mersereau
4688 Horten Pt
Eagan MN 55122
Fireside Hearth & Home
2700 Fairview Ave N
Roseville MN 55113
(651) 633-2561
Applicant/Permitee: Signature Issued By: Signature