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