4058 Amethyst LaneEAGAN TOWNSHIP
BUILDING PERMIT
. -.-. _ . .
Ownex ? •--- -t` ---- ??`•` ? -----------•------
7............................
.............................
Address (Present)
Builder .............................................. ---------------------------------------------- --
Addrass ............................ --•----••••-•.•----------•-•........__...------•.........--------
DESCRIPTION
N° 1815
Esqan Township
Town Hall
na:e _.'Il.?'..1?--..........................
5tories To Be Used Fos
- - -- Fron!
- Depfh Heigh! Est. Cos! Permi! Fee Remarka
-
----
'2,
,.? l?C c._??
.L,J ??
? -
?[%• ? `
LOCATION
Streei, Road or other Descripiion of Locaiion I Lot Block Addiiion or Tract
This permit does not authoriae the use of streels, zoads, alleys or sidewalks nor does it give the owner or his ageni
the :ight to create any situafion which is a nuisance or which presenls a hazard !o the healYh, safety, convenienee and
general welfare !o anpone in the community.
THiS PERMIT MU5T BE KEPT ON THE PREMISE WHILE THE WORK IS IN PAOGRESS.
This ia fo ceriiiy. !ha!-•??r?-------------------•------••---•-•-••--••.has permission fo e:eet .......... ....._?-..--•--•••..upaa
the above dese:ibed premise subject to ihe provisions of the Building Ordinance far Eagan ownship adopted April 11,
1955
....................... . . -------._ ..................................... Per -------- 1'?.?:??--`••---•--._ ..?..._....'L?.-...._......_........---.------........
Chairm?n of Tnwn Baard Building Inspecfo:
Li ?
EAGEiN TOIJNSHIP
3795 Pilot Knob Road
SC. Paul, Ntitiziesota 55111
Telephone 454-5242
PERMIT FOR SE+TER SERVICE CONNLCTION
DATE: 2?? /?
;
owNEx
PLUMSLR
?Z-G i
NurIsEx 12161 .
Address h''G'3
TYPE OF PIPE -?C//_?
DESCRIPTION OF BUILDING
Industriall Conmiercial( Residential I Multiple Dwelling I No. o£ units
Locaeion of Connectiona:
Conttection Charge e, ' <<,R
-??
Permi[ Fee '2, S° , #:,- , ,
?
Street Repairs
Tota 1
Inspected by:
Datie
Remarks:
sy
Chief Inspectar
In consideratioa of the issue atbd delivery to me of the above pexmit, I
hereby agree to do the proposed worlr in accordance with the rules and
regulations of Eagan Township, DakoCa Coun Minnes?ta
•,t ?C:-?1 ?,GBy ?r.-t..
Please notify when ready for iaspecCion aad connection aad befere any portion
of the work is covered.
CITY OF EAGAN Remarks * Cedar Grove Acuuisition
AdditionS_'EIaAR GR(JVE #5 Lot 21 Blk 10 parcyl 10 16704 210 ZO _
Ownerc??? ? ?l1!Iv I)?'a? k"OdU Street 4058 Amethyst Lat1e State Eag?, MN 55122
Improvement ! Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK Z 1967 100.00 5.00 20 Pdid
SEWERLATERAL 196 525.00 26.20 20 Paid
WATERMAIN
* WATER LATERAL 1972 607.00 24.2$ 25 P$1.d
WATER AREA
STORM SEW TRK 'L 7 1974 70.00 4.66 1r'J Paid
STORM SEW LAT
CURB & GUTTER
SIDEWALK
3TREET LIGHT
WATER CONN.
13UILDING PER.
sac 200.00 835 7-8-68
PAR K
This request void 18 months from
r "
6 7
Date of this Request o---z? -..,,Z _- S 2 (0
I, as 11 Licensed Electrical Contractor IffOwner.' do hereby request inspection of the above electri-
cal wiring installed at:
Street Address or Route No. Azl-?
Section Township Range Count?
?--?"
/ . 7
Which is occupied by ? / q
Is a roughin inspection required on this job? Noo, Yes ? Ready Now 0W ill Call
l?
Power Suppli -r Ad?ese?`d '.
Electrical ContrContractor's License No.
(Company Name)
Mailing Address
' (Electrlca! Contrac o'r?o Wn` akin9 rnisP
Authorized S hone No ? --`?'"
?ature ??
(Electrical Contractor or Owner Making This Installation)
STATE BOARD COPY Th;s,°s"ecfio° req°en """ °"` be ac`epted b" the
State Board unless proper inspection fee is endosed.
Minnesota State Board of Electricity
A 1954,Upiversity Ave., St. Paul, Minn. 55104-Phone 645-7703
REQUEST FOR ELECTRICAL INSPECTION
CHEGtC BELOW WQRK COVERED BY TH1S REQUEST
Type of Building New Add. Rep. 11 Check Auvliancea Wired For
/ G Sp 7 '?.
J ' / P1 / TS /
Wired For
Home ? ? ? Range ? Temporary Wiring ?
Duplex ??? Water Heater ? Lighting Fixtures ?
Apt. Bldg. ??? Dryer ? Electric Heating ?
Commercial Bldg. ??? Fumace ? Silo Unloadet ?
Industrial Bldg. ??? Air Conditioner ? Bulk Milk Tank ?
Farm ? ? ? ?t List
Other C] 0 IVT"' I UPhersI phars?
CUMYUTE INSPEC TIO N FEE BELOW
Seivice Entrance Size: # Fce FeedersdkSubfcedecs: # Fee Circuits: # Fee
0 to 100 Am s. 0 to 30 Am res 0 to 30 Am eres
101 to 200 Amps. 31 to 100 Am res 31 to 100 Am tes
Above 20- Amps. Above 100 Amps. Above 100 Am s.
Transformers Remote Control Circ. Partial or other fee ? 1 d
Signs ? Special In ection Minimum fee $5.00
Remark -,:k
I, th tri
S V Q1r-e6y TOTAL F o ,?,_•!Q
?
c?ertify that the above inspection has been m e.
tKOUMLO" Date
(Final ., Date
This request void 18 months from
?
vp, 10 i G.
I 1->//.?y /5e t)
C -?? (i -i ,
F ? ,.
Request Date
/7 4Q ire No. Rough-in Inspection
Required?
? Yes
?Ready Now ? Will Notity Inspector
When Ready?
i?klicensed contractor ? owner hereby request inspection of above electri I work at:
Job Address (Street, Box Route No.) ?
? Ciry
Section No. Township Name or No. Range No. Counly
Occupant(PRIMn
077'f ? Phone No. r
C.(.S?p?
Power Supplier Address
Electrical Contractor (Company Name)
Harrison Electric Inc. Contractwt License No.
421$67
MaiGn63 (CoMractor or Owner Meking Installatio
0 o a Ave u No M ls 55412
Auth
l?
Sign !u r er g Ins?l tio ,.,?.`
Phone Number 1-0920
52
MINNESOTA STATE BOARD OF ELECTRICI'fY
Grlggs-MWway Bldg. - Room S173
7821 Univereity Ave., St. Peul, MN 55704
Phorre (672) 642-0800
THIS INSPECTION REQUEST WILI NOT
BE ACCEPTED BY THE STATE BOARD
UNLESS PROPER INSPECTION FEE IS
ENCLOSED.
? /G? REQUEST FOR ELECTRICAL INSPECTION ?'• es-oaooi-o?
?/13 /`? 9 ? See instryEtions for completing this farm on badc of yallow copy. ? ?'3?9
F 44,51n' "X" Below Work Covered by This Request
e F{ ep. Typeof6uilding AppliancesWired EquipmentWired
Home Range Temporary Service
Dupiex Water Heater Electric Heating
Apt. Building Dryer Other (Specify)
Comm./lndustrial urnace
Farm Conditioner
Other (specify) Contractor§ Remarks: -A ?_ ?•L]Q??
r ?
Compufe fnspection Fee Below:
# Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Swimming Pool 0 to 200 Amps to 100 Amps
Transformers Above 200 Amps Above i0D Amps
SigllS Inspector'. Use Only: TOTAL
Irrigation Booms ??, ?
Special Inspection
Alarm/Communication
Other Fee
I, the Electrical Inspector, hereby Rough-in oa?e
certify that the above inspection has
been made. Final Dat ?
l
OFFICE USE ONLY
This request void 18 months trom
. . . . 0~ t
)1;
'
. .
tMV /???'fA?1?IW anAL PERMI7
. ? T ' ' -
/??y?
?VCIf' 1 '#
.
,. cmr oF EAianN
3830 PKOT KpaB F?AIN EAGAN, Mk 651,22 -
tDAtP:
au
GQMlTRACT PRICE- P#IONE: 4544100 ?? ?t! OrnY:: .
•'::.?
Si1e Address ` ,t
BLDG.'TYPE Y wowl? r
xiy ? :a
Lot ock 0 Sec ub Ftes. New
? ?
/ ' A
, m
? ?? ??
G
' -
,SJ?
` %R
Comr?.
c
?! ?s- •
City
Phone ` .2 Offier
c Name
-?• - FEES
RES. HVAC 0-100 M BTU
Address AODITIQNAI 50 M BTU
.
0 3 City Phone '" s- 4 G UQES A?C ON IGI@W
NCL
(?
. TRUCTIp
N)
GAS OUTLETS {IYIINMM -1 PER PWMff) ?mti,i
#
'r'YPE OF WORK
COMM/1ND FEE - 14'b OF tAA1TRACt FEE ,
,
Forced Air M BTU APT. BLDGS - CUMM. RATE APPtlES ..
'
'' ',
; IAI
E APPLlES
TOWNHOIJSE & CON 438 - RE$, RA
?Boiiler
Bo
Unit Heater M BTU
v
CAMMERC1At. FEE
MNMU
Air Cond.
? M BTU !?. M
S'FATE SURCHAIdQE PER PERMi'f'
Vent CFM (RGD $.50 S!G !F PERMi1`"ICE flOES
, Gas Piping Outiets #
? 9EYOND $1.000)
- ..? ?
Q4her ?,
FEE:
? ;-x..,s.-? «?.__ t A?
..
81 ,
S/C:
A ' TOTAL, W. ?TY OF MAN
4?
/' -?2 /, 494P , d), Jl?- 0 ,t ,??-- 1 IT,
410 W. LAKE ST. QLC.HEATING 1072 PAYNE AVE.
MINNEAPOLIS, MN 55408-2998 ST. PAUL, MN 55101-3892
612/$24-2656 AND AIR CONDITIONING CO 612/7 72-2449
eServioa The Twin Citiea Sinte 1930"
ORSAT TEST RECORD
ADDRESS CITY
OCCUPANT OWNER
DATE HTG. INST. q -'? •- ??( INSTALLED BY ?-GAS LINE BY
TYPE OF HEAT: GA FA ...AW STEAM SPACE HTR. UNIT HTR. OTHER
GAS OESIGN CONVERSION
MAKE kA-!A c? MAKE OF BURNER
MODEL_ q '-t tAC'LlMODEL
SERIAL MAX. BTU RATING ?.
INPUT RL-}. MAKE OF FURNACE
CONTROLS MODEL
THERMOSTATtnC??a,44,-g- EAT PLUG - tE S VENT SIZE VALVE KIND OF LINER SIZE?TNONE
LIMIT DRAFT HOOD REGt1LATOR ?)L
LIMIT SETTING (S(-- C CHIMNEY CONS RUCTION OCaLLGSC LA;,,?(L L-,CiLt
FAN SETTING DRAFT TEST TAG ?C(,t V-C-
PILOT TYPE ll.k LIGHTING INST.
PILOT MAKE p?XJ', (' (,
P I LOT MODEL?? ?r L
PILOT TIMING k-t
PRESSURE 3 ?j PERCENT C02 7 tz DATE TESTED
INPUT CFH PERCENT 02 -- ? ` ?
STACK TEMP.'? PERCENT CO `i c NAME OF TESTER ? l..L?)
?
jµ''hI, hk
1i
MEMO
city of eagan
TO: DlANE DOWNS, UT[LfTY B{LL1NG CLERK
FROM: EQ KIRSCHT, SR. ENGINEERING 7ECHNlCIAN
DATE: AUGUST 231 1993
SUBJECT: STREETUGHT ENERGY COSTS-CEDAR GROVE NO. 5(208 LOTS)
This memo (s to 'sn#orm your department to begin to invoice the energy costs at the single
family rate effective August 1,1993 to the property awners in Cedar Grove No. 5 Addition.
Block 1, Lots 1-22 22
Block 2, Lots 1-19 19
Block 3, Lots 1-1 1 11
Block 4, Lots 1-16 16
Block 5, Lots 1-25 25
Block fi, Lots 1-22 22
Block ?, Lots 1-25 25
Block 8, Lots 1-5 5
Block 9, Lots 1-2 2
Block 10, LotS 1-23 23
Block 11, Lots 1-14 14
Block 12, Lots 1-9 9
Block 13, Lots 1-15 ,15
?,?'l?+1
The City is current(y being billed by Dakota Electric for streetl,ghting in the above listed
subdivision.
Edward J. itsc t
Sr. Engineering Technician
cc: Mike Foertsch
EJK/je
PERMIT
MY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
PERMIT TYPE: Bu ILDING
Permit Number. @ 2 9 7 2 5
Date Issued: 04/14 } 97
SITE ADDRESS:
4058 FIMETHYST LANE
Lp7e 21 BLOCK: 1
CEDAR GROVE #5
P.x.N< e 10--16704--210-10
DESCRIPTION:
REMARKS:
FEE SUMMARY:
Base fiee
Sur-charge
Tota1 Fee
$5fb.00
$.50
$5 0 . 5 0
D E C K
NEW
434 ALT> RESTDENTIAL
,;,? •,?, a?:, , ? ,?ti e
CONTRACTOR:
OWNER: -.- Applicant -
RUDE KEN
4058 RMETHY5T LANE
EAGRN MN 55122
(512)687--0086
II
INSPEiCTION RE??RIP
CITY OF EAGAN PERMff TYPLc'
3830 Pilot Knob Road , Permit Nurnter: T:>S
Eagan, Minnasota 55122-1697 Date Issued: 04 ,f 14 ! 91
(612) 681-4675
SITE ADDRESS: {? ' . " ' 10 - j 6 x'?'? - `' 10 ? 1°i APPLICkN"1':
LOri a 814?(3,
aV,H AMVrHYti,l t. nNF'
CUPArz f,kr,Vi?#1? PERMIT SUBTYPE: TYPE flF WGRK:
ti r c j:
„x . . . . .
N
PlnMlt NO. ,PWmtt NOMar pepR Telephpm#
ElECTM •
PLUMW40
HVAC
f?rlr _ ?
FOOMIS' .
FOUN'D
FfG1k11NM'a
,fW)OFWG
I?i.t???IM[3
AJirTLST
?
? 8YC .
TE81' _
tN?UL
GYP BOAFID .
FfIEPIJIG`E
RFEPLACE
Alt't'RM
SA1M. PLBG ' .
flHAL HTG -
ORSAT • .
TE8T
BLDCi FINAL
B5M7 R,I.
63AAT FINAL -
DECK FTG
OECK FINAL I?t .. ?.dGt
1997 BUfLDtNG PERMIT APPLICATION (RESIDENT1e4L) $J2?9- 4??
41t;i W45 CITY OF EAGAN C?,?,QQCO?-
3830 PIIOT KNOB RD - 55122
661-4675
New Construction Reauinmerrts
? 3 repisterod site surveys ? 2 oopies of plan
? 2 copks of plans (indude beam b window sizq: pound fid. dssgn; etc.) ? 2 site suneys (exterior additions 8 dedcs)
? 1 energy calculations ? 1 energy qkulation= for Mabd addWons
? 3 copies ef troe preseroadon plan if lot platted after 711193
raquired: _ Yas _ No "
DATE: 7 CONSTRUCTION COST: JV
OESCRIPTION OF WORK:
STREET ADDRESS: = ? /P" ?-?--
14T d2? BLOCK / SUBD.iP.I.D. #:
Ot"
PROPERTY Name: _ 9)"tc IPA) Phone #:
OWNER LW ran
Street Address: 465$ 4r1?k54 A,#J
City: State: /21/0
CONTRACTOR Company:
Zip: SSlo?
,
Phone #:
Street Address: License #:
City: State: Zip:
ARCHiTECT! Company:
ENGINEER
Phone #:
Name: Registration #:
S#reet Addrsss: '
City:
State: Zip:
Sewer & water licensed piumber (new canstruction only): . Penaity appiies when address change
and lot change are requested once permit is issued.
i hereby ac{mowledge that I have read this appiicobon and stabe that the information is ooRect and agree to comply with all appiicabte
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Appficant:
OFFICE USE ONLY RECEIVED
Cerbficat,es of Survey Recsived Yes No A P R 4 1997
Tree Preservation Plan Received Yes No Not Required BY:
OFFICE USE ONLY
BU[LDING PERMIT TYPE
a 01 Foundation o 06 Duplex
n 02 SF DweUing o 07 4-plex
0 03 SF Addition o 08 8-plex
0 44 SF Porch o 09 12-plex
0 05 SF Misc. 0 10 = plex
VIfORK TYPE
A 31 New a 33 Alterations
0 32 Addition o 34 Repair
GENERAL lNFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
??? .. ? ?•,: ? .?. ` oo.
?
: -
0 11 Apt.ILodging o 96 Basement Finish
o 12 Muiti RepaiNRem. 0 17 Swim Pooi
m 13 Garage/Acxessory o 20 Public Facility
o 14 Fireplace n 21 Miscellaneous
X 15 Deck
a 36 Move
0 37 Demalition
Basement sq. ft. MC/WS System
Main level sq. ft. ? City Water
8q• ft• ` Fire Sprinklered
_ sq. ft. PRV
sq. ft.
sq• ft. _ Booster Pump ?
i Census Code.
Footprint sq. ft. SAC Gode t1 ?-
Census Bldg
Census Unit
Planning _ Building
? Engineering ? Variance
Permit Fee Valuation:
Surcharge
Plan Review
license
MC/WS SAC
City SAC ,
Water Conn.
Water Meter
Acct. Deposit
S/VN Permit
S!W Surcharge
Treatment PI.
Road Unit
Park Ded.
Trails Ded.
Other Copies
Total:
$
% SAC
SAC Unns
NORTH
SOUTH
SCALE IS 3132" = 1'
;
,-:
L J?
SUBQ.
io
CITY USE ONLY
; ?'- -9 ?s
RECEtPT #:
RECEIPT DATE: ?
PERMIT # OlAknz
1999 PLU1K$INSt PERMIT (REslDENi'UkL)
CTf Y OF £AfiA1V
S$SO PILOT KNOB RD
'i.!l6AN, MN 55122
(651) 6$1-4675
Please compleke for: ? single family dwellings
? townhomes and condos when permits are required for each unit
? backflow preventer for underground sprinkier system
FIXTURES
EACH #
TOTAt,
'3Sih fU`u - ? $ ;i.00 X = $
Floor drain 3.00 x = $
G8S i in outlet '` minimum -1 3.00 x = $
Hot tub/s a 3.00 x = $
Kitchen sink 3.00 x - $
Laund tra 3.00 x = $
Lavato 3.00 x = $
Minimum fee alterations to existin dwellin 30.00 x = $
Private Dis osal S stem new/refurbished * re uires MPC iic. 75.00 x = $
Private Dis osal S stem abandonment 30.00 x - $
RPZ new installationlre air 30.00 x = $
Rou h o enin 1.50 x = $
Shower 3.00 x = $
Under round s rinkler if dwellin is under construction 3.00 x - $
Under round s rinkler if existin dwellin 30.00 x = $
Water closet 3.00 x = $
Water heater 100 x = $
Water softener if dwelling under construction 5.00 X = $
Water softener if existin dwellin 30.00 x = $
Water turnaround 30.00 x ---- = $
State Surchar e .50 --> ----> ----> $ .50
TOtal --> --? ----> ---a 726-50
Remlnd^l': Cali f;,'' InSpi.'c±It3nS i3f aliArntir:jc, i.£. !'d1t°:" h?aWs, 1N3t;er ?oftel38?'3, e':d'+.
..---•------nowled--------ge--that---I--have-------read---this------------------------------------------------- ------------------------------------------------------•
I hereby ack application, state that the inforrnation is correct, and agree to comply with a!1 applicable City ot Eaoan ordinances.
!t is the appliqnt's responsibility to notify the properly owner that the City of Eagan assumes no liability for any damages caused by the City during its
normal operational and r Ier this permit within City propertylright-of-way/easement.
GROBE,GREG
SITE ADDRESS: 4058 AMETHYST LANE
- EAGAN, MN 55122
OWNER NAME: : (651) 454-8162 TELEPHONE #:
(AREA CODE)
INSTALLER NAME: NORBLOM PIUMBING CO. TELEPHONE #:
LR1 ?0 R7 - . . (AREA CODE)
STREET ADDRESS:
ciTr: MINNEAPOLIS, MN 55406,
STATE: ZIP:
YdWE OF PERMITTEE
L07 ';L ( BL
4ri Y ust urvLY
SUBD. Cled ar (;YoU? ? j -CD
q i
PERMIT #: ? I 7G !
RECEIPT #:
RECEIPT DATE:
2000 MECHANICAL PERMIT (RESIDENTIAL)
Date: 2-zS^ M
Complete this section onlv if you are installing HVAC in a single famiiy dwelling, townhome or condo under
construction and not ownerloccunied.
• HVAC: 0-100 M B T U
ADDITIONAL 50 M BTU
• Gas outlets (minimum of one required @$3.00 ea.)
State Surcharge
Total
_ Repair
Complete this section Mlv if you are remodeling, adding to, or re airin an existing single-family dwelling,
townhome, or condo. Please indicate if it is a new item, altera.tion, or repair.
New X_ Alteration
? Furnace
Air exchanger
-4
$ 30.00
6.00
.SO
$
_ Other
Air conditioning
Other
Fee
State Surchazge
Total
Reminder: Call for inspections
51TE ADDREss: ?.n_r-g A me
$ 30.00
.50
$ 30.54
OWNER NAME: v Y ? bc"' PHONE #: (P5) - -_I - 9f o2-
PHONE #: ((ig) 2- - q_l D (9
INSTALLER NAME: 'e
cf V? ',?l . (AREA CODE)
STREET ADDRESS: (P95 & V V I l' ?? J ?uI IDL D -
CITY
CITY OF EAGAN
3830 PII.OT IQNOH RD
EAGAN l+aT 55122
651-661-4675
STATE: lmt)____ Z1P: ? ? Z
&'-d V. w& &"
SIGNATURE OF PERMITTEE
CITY USE ONLY
LOT ? BL PERMIT #; Y)oclo
SUBD. a rAr RECEIP'T #:
RECEIPT DAT'E:
2000 MECAANICAL PERMIT (RESIDENTIAL)
Date: 9-9 jW
Complete this section onlv if you are installing HVAC in a single family dwelling, townhome or condo under
construction and not owner/occunied.
• HVAC: 0-100 MB T U
ADDITIONAL 50 M BTU
• Gas outlets (minimum of one required @$3.00 ea.)
ciTr oF s.AcArr
3830 PILOT IQNOS RD
EAGAN IrIId 55122
651-681-4675
State Surcharge
Total
$ 30.00
6.00
.SQ
$
Complete this section ontv if you are remodelin¢, addin¢ to, or re airin an existing single-farnity dwelling,
townhome, or condo. Please indicate if it is a new item, alteration, or repair.
New A Alteration
_X Furnace
Air exchanger
Reminder: Call for inspections
S[TE ADDRESS: HO
Fee
State Surcharge
rotal
$ 30.00
30.50
?n .
r '`
I "1b,?gg-
OWNER NAME: I'? PHONE #: ?
CODE)
PHONE #: (ARFA
?JSa _- ? ? " ?v-Iq
INSTALLERNAME: Wphkr-(? ???.?ia!? r',`7 •
???) - I?? sf-- su?e ro? (AREACODE)
STREET ADDRESS:
CI?Y: fivpY STATE: ZIP: J/
_ Repair _ Other
Air conditioning
Other
r
SI ATURE OF PERMITTEE
CITY USE ONLY
L BL PERMIT #: SUBD. RECEIPT#:
APPROVEO BY: , INSPECTOR RECEIPT DATE:
2000 MECHANICAL PLRMIT (COMORCIAL)
CITY OF EAGAN
3830 PILOT RNOB RD
EAGAN, MN 55122
651-6$1-4675
Please compiete for: all commerciaVindustrial buildings
multi-family buildings when separate permits are not required for each dwelling unit
DATE:
WORK TYPE: New constn:ction Instalt U.G. Tank
Interior Improvement Remove U.G. Tank
Processed Piping
When Installing/removing underground tank, call 651-681-4675 for inspection by fire marshal and
plumbing inspector.
Descripdon of work:
Fees: 1% of contract price OR $30.00 minimum fee, whichever is greater.
Underground tank removaVinstallation = minimum fee .
Contract price: $ x 1%= $ (Base Fee)
State surcharge calculate at $.50 for each $1,000 Base Fee
TOTAL a
SITE ADDRESS:
OWNER NAME: PHuivE #: -
(AItEA CODE)
TENANT NAME (IMPROVEMENTS ONL1):
WAS THERE A PREVIOUS TENANT IN THIS SPACE7 Y N. NAME:
INSTALLER:
ADDRESS:
CITY:
PHONE #: -
(AREA CODE)
STATE: ZIP:
SIGNATURE OF PERMITTEE
2000 STORM DAMAGE PERMIT APPLICATIDN (RESIDENTIAL)
CITY QF EAGAN
qn* 3830 PILOT KNOB RD - 55122
651-661-4675
ReauiremeMs
D 2 coplea of plan
f 7 ? CONSTRUCTION COST: X
DATE:
DESCRIPTION OF WORK: If mulN-family bldg., how many untts?
INDIC4ATE THE FOLLOWING EQUI EM TO BE REPLACED AND BY WHOM:
?
*'Note: If somebody other than the homeowner is pertorming piumbing or mechanical work, they mustapplyforappropriate
STREET ADDRESS: YO
LOT: ? I BLOCK: SUBD./P.I.D. #: ltdi3V C
Plumbing Homeowner Q Contractor Nam
? Mechanical omeowner Q Contractor Name
permit. C]nly licensed plumbing contractor or homeowner may complete piumbing work.
PROPERTY
OWNER
CONTRACTOR
Name: Phone #: 4CI^
Lasi Firsi
Strset
s,-- LAJ
CNy 7-7? State: Am-j ZIp: 1rV /? 2-.
Se?k
Company: Phone #:
(area code)
SMeet Address: License # Exp.
Clty
AUG ?. 4 2000
I hereby acknowledge that I have read this applicafion, stats t
of Minnesota Statutes and City of Eagan Ordinances.
Signaiure of
2ip:
ite
OFFICE USE ONLY
BUILDING PERMIT SUBTYPES
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 21 Porch (3-sea.) ? 31 Ext. Aft - Mufti
? 02 SF Dwelling ? 08 06-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) O 33 Ext. Alt - SF
? 03 01 of _ plex ? 09 07-plex ? 18 Deck ? 23 Porch (screened) ? 36 Mutti
? 04 02-plex ? 10 08-plex ? 19 Lower Level ? 24 Storm Damage
? 05 03-plex ? 11 10-plex Pibg _Y or_ N 0 25 Miscellaneous
? 06 04-plex ? 12 12-piex ? 20 Pool ? 30 Accessory Bldg.
WORK TYPE
? 31 New ? 36 Move Bidg. ? 43 Reroof
? 32 Addition ? 37 Demolish (Bidg)* ? 44 Siding
? 33 Aiteration ? 38 Demolish (Interior) ? 45 Fire Repair
? 34 Repair ? 42 Demolish (Foundation) X- 46 Windows/Doors
* Demolition permit - Give PCA handout to applicant
GENERAL INFORMATION
# of Stories sq. ft.
Na. of Units Length sq. ft.
No. of Buildings Width Footprint sq. ft.
Const. (Actual) Basement sq. ft. Census Code
(Allowable) Main level sq. ft. MC/ES System
UBC Occupancy sq. ft. Ciry Water
Zoning sq. ft. Booster Pump
PRV
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2005 RESIDENTIAL BUILDING PERMIT APPLICATI4N
City Qf Eagan
3834 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
-'.i& "-"1 () : " c)
9
c 0j??..? l - s
New Construction RequiremenCs RemodeURepairRepuirements ?#"ice?lse'ONv
3 registered site surveys showirtg sq. ft. of Iflt, sq. ft. of house; and aIl rooted areas 2 copies oi plan Ger?pf $i?r.ey Ftocd _Y _N
(20% maximum lot coverage allowed) 1 set of Energy Calculations for heaked additions 'Clee Pr?S1PUn R40d _Y
2 eopies of plan shawing beam & window sizes; poured found design, etc. 1 site survey for additions & decks Tree Rres RWiretl _Y ?N
1 set oi Energy Galculations Addition - fndicate if on-site septic system (?et-sit& Se*System Y i N
3 copies of Tree Preservation Plan if lot platted affer 711193
Rim Joist Debil Optior?s selection sheet (huikiings with 3 or less units)
Date -1 6?_ / Construetion Cost Uma#u.Lo )
Site Address Unit/5te #
Uescription of Work Jg I grdrux n 1 g [. rm Isl ?
Multi-Family Bldg _ YYN 5l?PA. t
Fireplace(s) x 0 _ l _ 2
Property Owner Telephane #
Contractor
Address ? City
State Zip Telephone # ( )
GOMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Categorv 1 Minnesota Rules 7672
Energy Code Categary . Residential Ventilation Category 1 Worksheet + New Energy Code Worksheet
(d submission type) Submiited Submitted
• Energy Envelope Caleulations Submitted
Have you previously constructed a building in Eagan vaith a similar plan? _ Y _ N If so, 25% p[an review
fee applies. '
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractar
Telephone # (
Telephone #
Telephone #
I hereby apply for a Residentia] Building Permit and acknowledge that the info ',on i?t?? curate;
that the work will be in conformance with the ardinances and cacles of the City o agan and the State of MN
Statutes; 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 Ehe case of work which requires a review and
apprvval of plans.
?el-'' ? ' I crUzcj??
'TQW
App icanI 's Printed Name Applicant's ignature
OFFICE USE QNLY
Suh Types
? 01 Foundation
? 02 SF Dwelling
? 03 01 of _ plex
? 04. 02-plex
0 05 03-plex
? 06 04-plex
Wark 7ypes
0 31 New
13 32 Addition
J4 33 Alteration
0 34 Replacement
? 07 05-plex C] 13 16-plex 0 20 Pool
? 08 06-plex ? 16 Fireplace 0 21 Porch (3-sea.)
? 09 07-plex C] 17 Garage 0 22 PorchlAddn. (4-sea.)
? 10 08-plex 0 18 Deck 0 23 Porch (screen/gazebo)
? 11 10-plex ,PJ. 19 Lower Level 0 24 Starrn Damage
? 12 92-plex Plbg_Y or N ? 25 Miscellaneous
Valuafion -62-,,,?
Census Code /y 3,?/
SAC Units r
# af Units `-
# of Bldgs -
Type of Gonst -
_ Footings (new bldg)
_ Footings (deck)
_ Footings (addition)
_ Foundation
Drain Tila
? 35 Int Improvement O 38 Demolish Interior
0 36 Move Building ? 42 Demolish Foundation
C] 37 Demolish Building" ? 43 Reroof
"Demolitian (Entire Bl dg) - Give PCA handout to applicant
Dccupancy MCES System
ZQning R- ? City Water
Stories --• Booster Purnp
Sq. Ft. ` PRV
Length - Fire Sprinklered
?
Width
? SO Accessory Bldg
17 31 Ext. Alt - Multi
C7 33 Ext. Alt - SF
0 38 Multi Misc.
? 44 Sidin$
? 45 Fire Repair
? 46 WindowslDoors
REQUIRED INSPECTIONS
_ FinaUC.O.
? FinallNo C.O.
Plumbing
? HVAC
Other
_ Pool _ Ftgs _ Air/Gas Tests Final
_ Siding ? Stucco ____ Stone _ Brick
_ Windows
_ Retaining Wall
Roof Ice& Water Final
Framing
Fireplace _ R.I. _ Air Test _ Final
? insulation
Approved By__-
Base Fee
Surcharge
Plan Keview
MClES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treafment Plant
License Search
Copies
C}ther
Total
Building Inspector
'__ ? ? _ ? __"_'
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA122228
Date Issued:04/30/2014
Permit Category:ePermit
Site Address: 4058 Amethyst Lane
Lot:21 Block: 10 Addition: Cedar Grove 5th
PID:10-16704-10-210
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and leave on site.
Carbon monoxide detectors are required by law in ALL single family homes .
Lisa Nyberg
Valuation: 4,000.00
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 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 -
Kelly Free
4058 Amethyst Lane
Eagan MN 55122
Property Claim Solutions LLC
2005 Pin Oak Dr
Eagan MN 55122
(651) 994-2028
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA122957
Date Issued:05/23/2014
Permit Category:ePermit
Site Address: 4058 Amethyst Lane
Lot:21 Block: 10 Addition: Cedar Grove 5th
PID:10-16704-10-210
Use:
Description:
Sub Type:Siding
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please leave printed pictures of house wrap on site for the final inspection.
When installing ventilated soffit material, remove existing material (i.e. debris that could block vents) and take steps to
ensure maximum ventilation to attic. Call for final inspection after installation.
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 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 -
Kelly Free
4058 Amethyst Lane
Eagan MN 55122
Property Claim Solutions Llc
2005 Pin Oak Dr
Eagan MN 55122
(651) 994-2028
Applicant/Permitee: Signature Issued By: Signature