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4104 Meadowlark RdCITY OF EAGAN Permit No: Date. 3830 Pilot Knob Road Meter No: Size. P.O. B6x 21199 Reader No: Date. Eagan, MN 55121 Owner Site Address. Plumber Conn. Chg: Zoning. Acct. Dep: No. of Units. Permit Fee. Surcharge. Tr. Plant Ordinance . Meter Misc • By WATER SERVICE P ` ' MIT I agree to comply with the City of Eagan CITY OF EAGAN SEWER SERVICE PERMIT 3830 Pilot Knott Road P.O. 8°1 21199 PERMIT NO Eagan, MN 55121 DATE. Zoning. No. of Units. Owner Address' Site Address. Plumber K rr I agree to comply with the City of Eagan Connection Charge. Ordinances. Account Deposit• Permit Fee. Surcharge. By Misc. Charges• Date of Insp.: Total'",/ Insp.: Date Paid 41' City of Eaaafl 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BLUE or BLACK Ink For Office Use Permit#: f1 -1d 3QI Permit Fee: Date Received: 61/13113 13/13 Staff: 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: 9-1I - IS Site Address: 'PO- LON - 1-11a- sli0g"- (/10 S. 1'% tek K, Name: G,(J<'FIG° { }L)Y1 11D14i_ &co, Phone: Address I City I Zip: Applicant is: Owner Contractor Description of work: -f12)2 O7 f t2J Construction Cost: r 4r Company: Aka) &4erIfllS E'1 5M1� J1W. Address: E0701 ` 3 . A-)• city: nope_ Gro�� Wikvi S Eoli iq y I�S Multi -Family Building: (Yes / des ) Contact: Shv Are/ State: AIM Zip: 6J 3105 Phone: `1G3 -31,-c- p / �0 0 Lead Certificate #: N41- i, / 1//0 License #: I�� 6-93 7-S 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: IOT :Plans and suPPti►dng documents that you subr it are considered Lo be public it rmation. Pa of ti rr►ati » irtay be classifred as non-publ/c rtyou_ ude that they are .trade seer . 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.gopherstateonecaliorq 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 agan; 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 S uil ing de ust be completed within 180 days of ermit issuance. x C�i%t _ x�r Applicant's Printed Name Applicant' Sig ature 0- 6' ' i It %qK Page 1 of 3 r For Office Use t t, E AGA E 6 ( r :::; -5-7-L ee: , E`: CeiV ' Date Received: l 11 3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 C' (651)675-5675 I TDD: (651)454-8535 FAX: (651)675-5'=•,' APR 03 r Staff: buildinginspections(a�citvofeagan.com l l3 ., BY 2019 RESIDENTIAL BUILD IT APPLICATION/ Date: Site Address: n 'I/v'1 S, rnt.d,,e,/lc x il'�nc`' , Unit#: Name: Phone: Resident/ . Owner Address/City/Zip: ' Applicant is: Owner Contractor T e of Work Description of work: PLL I`` ,Z (,l`,C r:ylc'ill' �� / , 4_ ��e'/►-1�— Yp (;"5- Construction Cost: 11'�i 00 k– Multi-Family Building: (Yes /No ) �c, c1L,if,� Contact: C�. I„,] Y� i11/ Company: C' i r �,nS }' 5i/vi i _ • Contractor ' Address: Z/41 3 /!/vi /I J - City: �e�if•� State:trti• Zip: 5'y�Z Z Phone: S/ 2 ill -/00:Email: ( /�:-, f ��ii ci 1 -, C(r'v+i, el,,,- License#: ((I5-0C I ti9 Lead Certificate#: 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? i Yes No If yes, date and address of master plan: 53ror) ?06 It, /4°pk,i `'`,J T/1 , I 1 Licensed Plumber: Phone: j Mechanical Contractor: Phone: Sewer&Water Contractor: Phone: Fire Suppression 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. You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's website at www.citvofeagan.com/subscribe. 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. 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 Pno o start without a permit; that the work will be in ce actor nwith th approved plan in the case of work which requires a review and approvalof Ola 1. li x I;"./1 . vl�,� x Lil LQ /� Applicant's Printed Name Applicant's Signature DO NOT WRITE BELOW THIS LINE l / O q jIf) o SUB TYPES Foundation _ Fireplace Porch (3-Season) Exterior Alteration (Single Family) Single Family Garage Porch (4-Season) Exterior Alteration (Multi) Multi �"Deck Porch (Screen/Gazebo/Pergola) Miscellaneous 01 of a Plex Lower Level Pool Accessory Building WORK TYPES New Interior Improvement Siding Demolish Building* Addition Move Building Reroof Demolish Interior Alteration Fire Repair Windows Demolish Foundation rReplace Repair Egress Window Water Damage Retaining Wall *Demolition of entire building-give PCA handout to applicant DESCRIPTION 5-51::,=0 Valuation 33P11=1:— Occupancy 7 j2 - MCES System Plan Review Code Edition .74 /1 201,5 SAC Units (25% 100%_) Zoning f," City Water Census Code Stories Booster Pump # of Units Square Feet PRV #of Buildings Length Fire Suppression Required Type of Construction V.0 Width REQUIRED INSPECTIONS Footings (New Building) Meter Size: `v Footings (Deck) Final I C.O. Required Footings (Addition) eu Final I No C.O. Required Foundation Foundation Before Backfill HVAC_Service Test Gas Line Air Test_Hood Roof:_Ice &Water _Final Pool:_Footings _Air/Gas Tests _Final Framing 30 Minutes 1 Hour Drain Tile Fireplace:_Rough In _Air Test _Final Siding:_Stucco Lath _Stone Lath _Brick_EFIS Insulation Windows Sheathing Retaining Wall: p Footings Backfill Final Sheetrock Radon Control Fire Walls Fire Suppression: Rough In_Final Braced Walls Erosion Control Shower Pan Other: Reviewed By: TOP) J7)/2 fiL "9- , Building Inspector RESIDENTIAL FEES Base Fee Surcharge Plan Review MCES SAC City SAC Utility Connection Charge S&W Permit& Surcharge Treatment Plant Radio Meter Read Copies TOTAL Page 2 of 3 PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA155647 Date Issued:05/28/2019 Permit Category:ePermit Site Address: 4104 Meadowlark Rd Lot:2 Block: 7 Addition: Hillandale 3rd PID:10-32952-07-020 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 - Dawn Khalifa 4104 Meadowlark Rd S 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 PERMIT City of Eagan Permit Type:Building Permit Number:EA174532 Date Issued:02/02/2022 Permit Category:ePermit Site Address: 4104 Meadowlark Rd Lot:2 Block: 7 Addition: Hillandale 3rd PID:10-32952-07-020 Use: Description: Sub Type:Windows/Doors Work Type:Replace Description:Two or More Windows/Doors Census Code:434 - Residential Additions, Alterations 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 within 10 feet of all sleeping room openings in residential homes (Minnesota State Valuation: 5,000.00 Fee Summary:BL - Base Fee $5K $118.00 0801.4085 Surcharge - Based on Valuation $5K $2.50 9001.2195 $120.50 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 - Abdusattar S Khalifa 4104 Meadowlark Rd S Eagan MN 55122--176 Property Claim Solutions Llc 2005 Pin Oak Dr Eagan MN 55122 (651) 994-2028 Applicant/Permitee: Signature Issued By: Signature