EA186542 - Building - Single Fam - Issued Date 09/15/2023PERMIT
City Of Eagan , , r
Permit Type: Building
3830 Pilot Knob Rd ''' IL E
Eagan, MN 55122 a.r
EAGAINIn
Permit Number: EA186542
(651) 675-5675
www.cityofeagan.com
* E A 1 8 6 S 4 2*
Date Issued: 9/15/2023
Site Address: 4179 Countryside Dr
Lot: 5 Block: 2 Addition: Country Hollow
PID:10-18275-02-050
Use: * 10
18275 02-0S0
Description:
Sub Type: Single Fam Construction Type:
V -B
Work Type: Alteration
Description: Kitchen
Census Code: 434 - Residential Additions, Alterations Occupancy:
IRC -1
Zoning: R- I
Square Feet: 0
Comments: Improvements to the home may require smoke detectors in all bedrooms.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Fee Summary: BL - Base Fee $116.60
0801.4085
Valuation: 4,000.00 BL - Plan Review 65% $75.79
0720.4222
Surcharge - Based on Valuation $2.00
9001 2195
Total: $194.39
Contractor: - Applicant - Owner:
Titus Contracting Richard & Karen Collins
12154 Nicol let Avenue 4179 Countryside Dr
Burnsville MN 55337 Eagan MN 55123
(952) 746-7817
This permit shall be null and void if work does not start within 180 days of issuance, or if work is suspended for 180 days or more after
started.
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
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EAGAN II I
Permit Fee: �` ✓ `
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E C E 1 V E I Date Received:
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 � I
(651) 675-5675 1 FAX: (651) 675-5694
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buildinginspectionsCc�citvofeagan com Date Issued:
SEP 0 b 21-3 I---------------------�
RESIDENTIAL BUI�Y"'"'G'- cccnnlT APPLICATION
Date: 9/6/2023 site Address: 4179 Countryside Dr Unit #:
Applicant is: ❑ Owner 14 Contractor R• (� cov_ > 44moW
Name: Karen Collins
Homeowner Address: City: 4179 Countryside Dr Eagan
State: MN ZiR: 55123 Phone: 651-270-9742 Email: karen2882@gmail.COm
Description of work: Kitchen Remodel
Type.of
Work Construction Cost:
Type of building: 0 Single Family ❑ Townhome, of units ❑ Twin Home
Company:
Titus Contracting Inc Contact: Zee Pep miller
Building Address:
12154 Nicollet Ave City: Burnsville
_ ',
Contractor MN 55337 952-444-230'ezee@tituscontracting.com
State: Zip: Phone: Email:
BC752914 3/31 /25
License #: Expiration Date:
Sewer & Company: Contact:
Water
Contractor Address: City:
Required'for State: Zip: Phone: Email:
new construction
License #: Expiration Date:
V] I understand that Plumbing, Mechanical, and Fire Suppression work require separate applications.
NOTE: Pians and supporting documents that you submit afre considered to be public information. Portions of the
Information�may be cia tsifed as no if you provide specific reasons that would permit the City to conclude that they
are'trade secrets.
CALL BEFORE YOU DIG. Contact Gopher State One Call at (651) 454-0002 or www.gopherstateonecall.org for protection against underground utility
damage. Contact Gopher State One Call 48 hours before you intend to dig to receive locates of underground utilities.
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.
X Zee Pepmiller as &r
Applicant's Printed Name Applicant's S gnature