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
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-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