4308B Clemson Cir CITY OF EAGAN WATER SERVICE PERMIT
3830 not Knob Road
P.O. Box 21199 PERMIT NO.:
Eagan, MN 55121 DATE:
Zoning: No. of Units:
Owner:
Address:
Site Addess:
Plumber:
Meter No.: Connection Charge:
Size: Account Deposit:
Reader No.: Permit Fee:
I agree to comply with the City of Eagan Surcharge:
Ordinances. //j Misc. Charges:
Total:
By Date Paid:
Date of Insp.: j c • Insp.:
CITY OF EAGAN SEWER SERVICE PERMIT
3830 Pilot Kr.ob Road PERMIT NO.:
P.O. Box 21199
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:
Surcharge:
By Misc. Charges:
Date of Insp.: Total:
Insp.: Date Paid:
Use BLUE or BLACK Ink
rr I -
For Office Use---___--
Permit City of Ea
aii c u~ '
Permit Fee:
3830 Pilot Knob Road
Eagan' MN 55122 Date Received: O j
Phone: (651) 675-5675 1 1
Pax: 651) 675-5694 1 Staff:
I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address:
S(l~ 017 C7 4f ~t) If W 13 C (eAWN tf'l Unit
Name: Wt n1~ L(----- d- dA Phone:
i Resident/
Owner Address / City / Zip: Ql t~~ UL
i
Applicant is: Owner Contractor
Type of Work Description of work: ~J AS C t ep 7 C -IdIlke Construction Cost;__ __..._.__~___Multi_arra.ily_~uild#ng ('fes~f-No-
Com ari : 1 L8 Re, a4^ . h (#r
!E p y ` Contact:
I q3q). A/
K, t 1. + f `k City: I/Mni'"(Lo
Contractor Address:
(4 7 - 75
State: Zip: Phone: NA L-ieense-#~ Bgm_q - et as-Cert ic`f' aTe --77.21-
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 0-
I the information may be classified as non-public if you provide specific reasons that would permit the City to
1.~ ' _ 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.aopherstateonecall.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 to Building Code must be completed within 180
days of permit issuance.
X_ x
Applicant's'Printed Name Appli s Signature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA138809
Date Issued:09/21/2016
Permit Category:ePermit
Site Address: 4308 Clemson Cir B
Lot:31 Block: 02 Addition: The Trails Of Thomas Lake
PID:10-75865-02-310
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
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 -
Peter Brogle
4308 Clemson Cir Unit B
Eagan MN 55122
(952) 838-5257
Appliance Connections Inc
12850 Chestnut Blvd
Shakopee MN 55379
(952) 445-4803
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA139027
Date Issued:10/05/2016
Permit Category:ePermit
Site Address: 4308 Clemson Cir B
Lot:31 Block: 02 Addition: The Trails Of Thomas Lake
PID:10-75865-02-310
Use:
Description:
Sub Type:Fireplace
Work Type:Gas Insert
Description:
Census Code:434 -
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 -
Peter Brogle
4308 Clemson Cir Unit B
Eagan MN 55122
Fireside Hearth & Home
2700 Fairview Ave N
Roseville MN 55113
(952) 985-6675
Applicant/Permitee: Signature Issued By: Signature
• Use BLUE or BLACK Ink
For Office Use I
Permit:e:
{C1ty 0f EaQa1 � �, Permit ����
3830 Pilot Knob Road �tn' 1 ';; } !
Eagan MN 55122 Date Received: t,'
Phone: (651)675-5675
Fax: (651)675-5694 Staff:
�ctj
2016 RESIDENTIAL BUILDING PERMIT APPLICATION ll,D-73- lw
Date: 11/04/2016 Site Address: 4308 Clemson Cr. Unit#: B
i Name: Dana Palbicki Phone: 952-838-5257
Resident/ 4308 Clemson Circle, Unit B - Eagan , MN 55122
Owner Address/City/Zip: g
Applicant is: Owner X Contractor
Description of work: Kitchen Remodel-Remove non-load bearing wall, replace cabinet,countertop,floor
Type of Work No work is being Ve on any shared walks
Construction Cost: 5,500 Multi-Family Building: (Yes A /No )
I Hale Built Homes Chris or Brad (or office)
i (
' , Address: 12550 W. Frontage Road, SUITE #210 City: Burnsville
ContractorHalebuilthomes@gmail.com
Brad:612-715-2645
State: MN Zip: 55337 Phone: Alicia:612-695-2849 Email: Brad@minnesotakitchens.net
License#: BC696902 Lead Certificate#: NAT-F167467-1
If the project is exempt from lead certification, please explain why:
VI
. . 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:
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 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.gopherstateonecall.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 S Building Code ust be completed within 180
days of permit issuance.
xChristopher Hale x
Applicant's Printed Name Ap ant's Signatur
Page 1 of 3
DO NOT WRITE BELOW THIS LINE (410
SUB TYPES Li31c C esC-1 c
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
?IG 01 of K Plex Lower Level Pool Accessory Building
WORK TYPES
New n Interior Improvement Siding Demolish Building*
Addition Move Building Reroof Demolish Interior
Alteration Fire Repair Windows Demolish Foundation
Replace Repair _ Egress Window Water Damage
Retaining Wall *Demolition of entire building—give PCA handout to applicant
DESCRIPTION
Valuation iZ' 2 ° O. Occupancy z C—3 MCES System
Plan Review Code Edition pnrl ZE 13 SAC Units
(25%_ 100%?"' ) Zoning City Water
Census Code Stories Booster Pump
#of Units Square Feet PRV
#of Buildings Length Fire Suppression Required
Type of Construction 03 Width
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
Footings (Deck) Final/C.O. Required
Footings (Addition) Xp Final/ No C.O. Required
Foundation Foundation Before Backfill pp HVAC _Gas Service Test Gas Line Air Test
Roof: _Ice &Water Final Pool: _Footings _Air/Gas Tests _Final
ZO Framing 30 Minutes 1 Hour Drain Tile
Fireplace: _Rough In _Air Test Final Siding: _Stucco Lath _Stone Lath _Brick_EFIS
X) Insulation Windows
Sheathing Retaining Wall: _Footings_ Backfill_ Final
Sheetrock Radon Control
Fire Walls Fire Suppression: Rough In_Final
Braced Walls Erosion Control
Shower Pan Other:
Reviewed By: %vvri /Yf: , Building Inspector
RESIDENTIAL FEES /3 ere• 0
Base Fee
SurchargeZ a
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit& Surcharge
Treatment Plant
Copies
TOTAL
Page 2 of 3
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA140844
Date Issued:01/26/2017
Permit Category:ePermit
Site Address: 4308 Clemson Cir B
Lot:31 Block: 02 Addition: The Trails Of Thomas Lake
PID:10-75865-02-310
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace & 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 -
Dana Palbicki
4308 Clemson Cir B
Eagan MN 55122
St Paul Plumbing & Heating
640 Grand Ave
St. Paul MN 55105
(651) 228-9200
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA141793
Date Issued:03/30/2017
Permit Category:ePermit
Site Address: 4308 Clemson Cir B
Lot:31 Block: 02 Addition: The Trails Of Thomas Lake
PID:10-75865-02-310
Use:
Description:
Sub Type:Residential
Work Type:Alteration
Description:Basement Fixtures
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Fee Summary:PL - Permit Fee (miscellaneous)$59.00 0801.4087
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 -
Dana Palbicki
4308 Clemson Cir B
Eagan MN 55122
(952) 838-5257
St Paul Plumbing & Heating
640 Grand Ave
St. Paul MN 55105
(651) 228-9200
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA142278
Date Issued:04/24/2017
Permit Category:ePermit
Site Address: 4308 Clemson Cir B
Lot:31 Block: 02 Addition: The Trails Of Thomas Lake
PID:10-75865-02-310
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Softener
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
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 -
Dana Palbicki
4308 Clemson Cir B
Eagan MN 55122
(952) 838-5257
Croix Crystal
3440 Yoerg Dr
Hudson WI 54016
(715) 386-8667
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA166001
Date Issued:12/07/2020
Permit Category:ePermit
Site Address: 4308 Clemson Cir B
Lot:31 Block: 02 Addition: The Trails Of Thomas Lake
PID:10-75865-02-310
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 -
Dana Palbicki
4308 Clemson Cir Unit B
Eagan MN 55122
Renewal Andersen
1920 County Road C West
Roseville MN 55113
(651) 264-4777
Applicant/Permitee: Signature Issued By: Signature