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1581B Clemson DrCITY OF EAGAN 3830 Pitot knob Road P. 0. Box 21199 Eagan, MN 55121 Zoning: No. of Units. Owner: Address. Site Address: WATER SERVICE PERMIT PERMIT NO • DATE. Plumber: Meter No.: Connection Charge. Size: Account Deposit - Reader No.: Permit Fee. 1 agree to comply with the City of Eagan Surcharge. Ordinances. Misc. Charges. Total. By Dote Paid - Dote of Insp.: Insp • CITY OF EAGAN SEWER SERVICE PERMIT 3830 Pilot'Knob Road P. O. Box 21199 PERMIT NO • Eagan, MN 55121 DATE - Zoning: No. of Units. Owner: Address: Site Address. Plumber 1 agree to comply with the City of Eagan Connection Charge. Ordinances. Account Deposit. Permit Fee. Surcharge. By Misc. Charges: Total- Date Paid - Date of Insp.: Insp.: �City 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BLUE or BLACK Ink For Office Use Permit#: I (W 14 0 Permit Fee: 44 . O 0 Date Received:ei20 Staff: O , 2013 RESIDENTIAL BUILDING PERMIT APPLICATION # Date: kb 1 13 15� Lt:Site Ls3fa J Name: -7-64/17h0.1,00,5 __ Phone: ‘(-L 72/- re) el Address / City / Zip: Applicant is: Owner Y_, Contractor Description of work: Re roc P irry aConstruction Cost: _ S '247 i 88 4 Multi -Family Building: (Yes __ / No Company: 4 (' Coosrg UC T.' Contact: 23:e,"(61C'/3 Address: { 7 0 .Z M 'ranehetAek — City: Aiturl g //S State: / r it/ Zip: 5_3-410 4 Phone: ___6/a - '7 Z l - � j j6 License #; S ("- 1' 9z. o‘ 2— Lead Certificate #: f 1 4 r -- 2 7 9' `1l %— f 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: 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.gooherstateonecall.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. x '/(2 Applicant's Printed Name x (7 Applica s Signature Page 1 of 3 City of Eakall 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 r Use BLUE or BLACK Ink For Office Use (� Permit #: L / R-- Permit Fee: 1"11 Date Received: Staff: 2016 RESIDENTIAL BUILDING PERMIT APPLICATION Date: /G� Pi//4 Site Address: cel C s4)v 4444;1.e Unit #: 01n �t hone: Address / City / Zip: TYPe of Work Contractor Applicant is: Owner '°'Contractor Description of work: lei,cre A -N' c? be et /-vi_zivi Construction Cost: 62 O Company: /4r rAter I Address: /th2 City: C57e1i6z Air State: Mow' Zip: SS -6W Phone:19/V ' VP/ Email. 4rc C' fTd y s.rgmer w y Multi -Family Building: (Yes ` / No ) Contact: R e L #r . /Ayr - License #: `? z- _ 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? Yes No If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Phone: Sewer & Water Contractor: I 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 -pubic 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 1 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 to Building Code must be completed within 180 days of permit issuance; x ,ISG - } Applicant's Printed Nae x Ap icant's Signature Page 1 of 3 • DO NOT WRITE BELOW THIS LINE t391/412_ SUB TYPES Foundation Single Family Multi 01 of Plex WORK TYPES New Addition Alteration Replace Retaining Wall DESCRIPTION Valuation Plan Review (25%T 100% XI) Census Code # of Units # of Buildings Type of Construction 1C - Fireplace Garage Deck Lower Level Interior Improvement Move Building Fire Repair Repair REQUIRED INSPECTIONS Footings (New Building) Footings (Deck) Footings (Addition) Porch (3 -Season) Porch (4 -Season) Porch (Screen/Gazebo/Pergola) Pool Occupancy Code Edition Zoning Stories Square Feet Length Width Foundation Foundation Before Backfill Roof: Ice & Water _Final Framing 30 Minutes 1 Hour Fireplace: _Rough In _Air Test Insulation Sheathing Sheetrock Fire Walls Braced Walls Shower Pan Reviewed By: TO on In ; /( /y8 Siding Reroof Windows Egress Window' Exterior Alteration (Single Family) Exterior Alteration (Multi) Miscellaneous Accessory Building Demolish Building* Demolish Interior Demolish Foundation _ Water Damage *Demolition of entire building - give PCA handout to applicant _,s-..17 6 - 3 l//7/?2'/SPP - MCES System SAC Units City Water Booster Pump PRV Fire Suppression Required 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 Final Siding: _Stucco Lath _Stone Lath _Brick _ EFIS 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 TOTAL Page 2 of 3 City of Eagan PERMIT EAGAN Permit Type: Building Permit Number: EA154178 Date Issued: 02/26/2019 Permit Category: ePermit Site Address: 1581 Clemson Dr B Lot: 45 Block: 02 Addition: Thomas Lake Heights 2nd PID: 10-75951-02-450 Use: Description: Sub Type: Fireplace Construction Type: Work Type: Gas Insert Description: Census Code: 434 - Residential Additions, Alterations Occupancy: Zoning: Square Feet: 0 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 Fee Summary: Valuation: 3,000.00 BL - Base Fee $3K $88.50 Surcharge - Based on Valuation $3K $1.50 0801.4085 9001.2195 Total: $90.00 Contractor: Fireside Hearth & Home 2700 Fairview Ave N Roseville MN 55113 (651) 633-2561 - Applicant - Owner: Steven Borowiak 1581 Clemson Dr B Eagan MN 55122 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. Applicant/Permitee: Signature Issued By: Signature