4253 Amber Dr' CITY OF EAGAN
? 3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS:
t+J,i ,, 1t .
? PERMIT SUBTYPE:
I"rI i1T t i4I -o ':c
F 1 N A !
;CORD
PERMIT TYPE:
Permit Number:
Date Issued:
APPLICANT:
t:d0 .1 :i1
TYPE OF WORK:
.I .,, ll , i-ra
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( [iE"1RrHFfi)
REMIANk '. ;', )(f F'I {iM 1 NOI t'ATk s fNA I I ? ARAAF IN To) Itt; ,1' T EtAf. K'1-FttlN I"Hf- SinE YfttlPt R f Y
1 IFif /MT f"i:AC'TLY 6' Q" Pt pN kE`ViF11fO 13Y MX?F RAkt-'V
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Pertnit No. Permit Holder Oate TNephone M
ELECTRIC
PLUMBINd
HVAC
Inepectlon Data Inap. Comments
FOOTINGS FWA'riNG S4vr/3 O1c.
FOUND
FRAMING
ROOFING
ROUGH
PLUMBiNG
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAI HTG
ORSAT
TEST
BLDG FINAL
BSMT R.I. ?
BSMT FINAL
DECK FTG
DECK FINAL
CITY OF EAGAN Remarks Cedar Grove Acquisition
Addition Cedar Grove #2 Lot 6 Rik 7 Parcel 10 16701 060 07
Owner Street 4253 Amber 4euia46- D lr ` state- Eagan.MN ,-?r'S122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. .1989 1266-95 84-46 15
STREET RESTOR. ,
GRADING
SAN SEW TRUNK
# SEWER LATERAL , 1972 1 2
WATERMAIN
# WATER LATERAL 1972
WATER AREA
STQRM 5EW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN, i ?
BUILOING PER.
SAC I
PARK
I
This request void 18 months from (6- 7
' &A'R39542
Date of this Request ?c _ctFs, \?'1'15
I, as C?Tcensed Electrical Contrao OO eni r, do hereby request inspection of the above electri-
cal wmng mstalled at:
Street Address or Route No. J`?a.53 City
Section Township Range Count
n o
Which is occupied by
Is a roughin inspection required Jthis jo6? 140116? Yes O Ready Now ? Will Call.Jil-
Power Supplier _
Electrical Contractor
Mailing Address _
Authorized Sienature
Name)
Contractor's License No.
or or owner Makln9 Tnmnstallatlol?
L
;?2 ,i/?f. Phone No.
leclricel Contractor or Owner MeKin9 Thls IMtallation)
2V /'? ?j ? 6000 ?0?? This inspection requen will not 6a accepted 6y the
i,a u State Board unless proper inspection fae is endosed.
40 Minnesota State Board of Electricity
.1954 University Ave., St. Paul, Minn. 55104-Phone 645-7703
'?40REQUEST FOR ELECTRICAL INSPECTION
CHECK BELOW WORK COVERED BY THIS REQUEST
/,:;z l0 9 <:?
R39542
Type of Building New Add. Rep. Check Appliances Wired For Check Equipment W¢ed For
Home El ? Rangc ? Tempocazy W'ving ?
Duplex ? ? ? Water Heater ? Lighting Pixtures ?
Apl. Bldg. ? El ? Dryer
q Electric Heating ?
Commexcial Bldg. ? ? ? Furnace i Silo Unloader ?
Industrial Bldg. ? ? ? A'v Conditioner Bulk Milk Tank ?
Faim Lis[ ) List l
Olher
?
?
? }
p
Hehe sf p
}
Heie?s!
COMPUTE INSPECTION FEE BELOW ?:k A
Secvice Entrance Size: # Fee Feed u . ? Fee Circuits: # Fee
0 to 100 Am s. to 3 s 0[0 30 Am etes
101 to 200 Amps. to Am eres 31 to 100 Am eres
Above 200_Amps. bov 00 Amps. Above 100 Amps.
'Iransformers
1
1 emoteControlCirc.
Partialorothwfee
$' ns Special Inspection Minimum f
Remazks
TO'IAL F E S ? (j?
I, the Elec[rical Inspectot, hereby certify that the above inspection has been ma
(Rough-in) Date
(Final) ?ate
This request void 18 months from
.
i'
EAGAN TOWNSHIP No 405
BUILDING PERMIT ? Eagan Township
_ ,
Ownez ? --
Addsess (Preseni c ?? ,?;?.,?;. -`l..r? .,F? /rCl,?•?-`-`-'J
) ..... '----?^---- ?-,J . . ........ Town Hall
Builde: ....----°-------_..........--- ------- ..------- ---°
Date . _---?__.._
Address -----------------....._.. , -
DESCRIPTION
lwoz7ga To Ba Used For Front Depih Heighf Esl. Cos4 IPermif FeeI Remazks
? ?G? rC/'1?lll?? C?`?OCI??`GI 7rr' l:? i?
°!i .
or
LOCATION
This permit does not aulhoriae the use of streels, roads, lleys or sidewalks nor does ii give the o?wner or his ageni
!he righS !o ereaie any siluafion whieh is a nuisance or which presenls a h=zard io the healfh, safefy, convenience and
general welfare !o anyoae ia the community.
THIS PEAMIT MUST B K$PT THE f??MI?$E' "W?HrILE THE WORK IS IN FROG/R£SS.
This is fo cerlify, Shat?1F..?Cf:.O?_haspermission io erecf ------ 4!?%?F?r_,__.upon
the abo e described pre ' e subjec io !he provisions of the Buildang Ordina:?co ior Eagan Townsht?adonied iep:il 11,
1955..
Chairman,?. -
?'- -...??.. Per -"- - --- - -ild_ --in -Q .I.n - p
o ow a3?'d ---- Bus ecior
EAGAN TOWNSHIP
BUILDING PERMIT
oWnO: -
-----`-,`---.
_.... ...._.-"'- ----------- ...----- ...... ...............'--
Address (Pre en!) =?---------??--"'"=?`-=-''"?------=??.----------..
Suilder ---?t-..... ?.......e.°...'_......... '--------------------- __.
.......f ................
Address -----.?.-...1L ??- -_
?
-'- ' z.......---'---......
DESCAIPTION
N° 2169
Eagan Township
Town Hali
DB:e ...................
Siories To Be Used For Fron! Depih Heighf Esi. Cos! Permit £ee Remarks
LOCATION
Slxeei, Aoad or oiher Descripllon of Locaiion Lot rilocK Atlaltion or "1"reet
I 4 g 7 2
This pexmii does not aulhorize the use of slreefs, roads, alleys or sidewalks nor does if give the owner ox his aganf
ffie righ! !o creafe any situation which is a nuisance or which presenls a hazerd fo the heallh, safety, eoaveaience and
general welfare !o anyone in the communify.
THIS PEAMIT MUST BEPT ON THE PREMISE WHILE THE WOAK IS IN PROGRESS. _
This is 1o eerlifp, 1hai.... ...r.+:?...._4%?....___.___.....__...has permission !o erecY a._.-.?_'.Z:°__.?pon
!he above desasibed psemise subjec! !o the provisions of the Building Ordinance for Eagan Township adopfed April 11,
1955.
?l ?? p?
... .?.......(!.?`f.`.T..<. ................
""""""'----"-- r.!c-:c._ .................'----. Per . :c
Cha?man of Tnwn Soard Building inspeofor
4 < 0
LbT (,,,.
`gulz 46
Ce7op2 G2ovs ?2-
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CT7v OF I'ulrAN
C'???:!-ITP ??• c; iPp;M'(Nfa.. N!'c i 79
C'F, 7S.0'S!J`:;/90 'rIPM1f:::? I':??:`?'•i:-';3
t'OI?;G'!1R?;1_f)Id
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LJSE"F .[I!? t?.AN(.4
I
CITY OF EAGAN
' 3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
PERMIT
PERMIT TYPE:
Permit Number:
Date Issued:
BUILDING
032007
@5J14/98
SITE ADDRESS:
P.I.N.: 10-16701-060-07
0.253 AMBER DR
LOT: 6 BLOCK: 7
CEDAR GROVE #2
DESCRIPTION:
(DETACHED)
.=
Buildint'}?;,Permit Type
Building l,rv,rk Type
` Caneus Cod 'e
.. ,'
: n
GARAGE/ACCE550RY
NEW
438 ALT. GARAGE
REMARKS:
5T7E PLAN INDICATES THAT GARAGE TS 70 BE SET 6ACK FROM THE SIDE PROPERTY
LINE AT EXACTLY 5' 0" PLAN REVTEWED BY MIKE BARCK
FEE SUMMARY:
VALUATION $7,000
Base Fee $124.75
Surcharge $3.58
Lic. Search Fee $5.00
Total Fee $133.25
CONTRACTOR: - Applicant - sT. LIC.OWNER:
1SUSSEL CORP 16450331 0001934 MICHAEL JOHN
f852 COMO AVE 4253 AMBER DR
T PAUL MN 55108 EAGAN MN 55122
?(612) 645-0331 (612)454-3525
, I fier6.by acknawled-9e that T h4v'e art:cl statey°tha'C th? p
information is correct an'd ag'ree to aomplywith sll eppli-cable Stete`ofi Mn.
.?,
,:and City;cafEagan Ord,ina-taicev.
? SCatu.t'es '
. _ . .._ m . ' _.
APPLICANT/PERMITE SIGNATURE ISSUED B: SIG ATURE
I ?
008 BUILDING PERMIT APPLICATION (RFSIDENTIAL) -? I? •?.--?
CITY OF EAGAN Sloof 3830 PII.OT I{NOB RD - BS 122 r-
681-4b75
New Consiruction Reauiremants RemodeVReoair Reauirements
? 3 registered site surveys • 2 copies of plan
? 2 copies of plana (inGUde beam 8 window saes; poured fnd. dasign; eta) ? 2 site surveys (ex[erior addRions & decks)
? t enerpy calalatlons ? 7 energy calculedons for heated addRions
? 8 copies oi tiee presenation plan N lot platted eRer 711193
required: _ Yes _ No
?? 7 ff
DATE: 2-), l CONSTRUCTION COST;
4.
DESCRIPTION OF WORK:
STREETADDRESS: 9,,5?3
LOT: t BLOCK: ? SUBD./P.I.D.#: (A&, 111tmEL4L
Name: <6 ?h,eG ,- U Phone #:
PROPERTY 1-ast First
OWNER ,I J?
Street Address: '7 .2- 5LZ ! Y Pq h-2.1 0,P1
City 4-t- Ci?cc VI State: Zip:
-'
Company: ? ? -?; S e Phone #:
CONTRACTOR //J
Street Address: P ?/l ? 7V (J License # ? % T
Ciry ?? CC LIC? State: Zip: --5 ?
ARCHITECT/
ENGINEER Company: Phone #:
Name: Registrarion 1t:
Street
Ciry V State: Zip:
Sewer 8 water licensed plumber (new construction onty): . Penalty applies when address chang
and lot change is requested once pertnR is issued.
I hereby acknowledge that I have read this application and state that the iniormation is correct and agree to comply with all applicabl
State of Minnesota Statutes and City of Eagan Ordinances. 1-11
Signature of Applicant
OFFICE USE ONLY
Certficates of Survey Received _ Yes _ No
Tree Preservation Pian Received - Yes - No -
OFFICE USE ONLY
BUILDING PERMIT TYPE
.?y,
« '?P
' ?.
? 01 Foundation ? 06 Duplex ? 11 Apt./Lodging ? 16 Basement Finish
? 02 SF Dwelling ? 07 4-plex ? 12 Multi RepaidRem. ? 17 Swim Pool
? 03 SF Addition ? 08 8-plex Er-13 Garage/Accessory ? 20 Public Facility
? 04 SF Porch ? 09 12-plex ? 14 Fireplace r ? 21 Miscellaneous
? 05 SF Misc. ? 10 _-plex ? 15 Deck ?
WORK TYPE firc P.1,/v
2?31 N
' 6719"4L 9?S 7b
1
ew ? 33 Aiterations ? 36 Move
? 32 Addition ? 34 Repair ? 37 Demolition ?'K 9c r-z 5? S? 69
GENERAL INFORMATION
Const. (Actual) Basement sq. ft. MC/WS System
(Allowable) Main level sq. ft. City Water
UBC Occupancy sq. ft. Fire Sprinklered
Zoning sq. ft. PRV
# of Stories sq. ft. Booster Pump
Length sq. ft. Census Code. 4K38
Depth Footprint sq. ft. SAC Code o ?
Census Bldg _L
Census Unit d
APPROVALS
Planning Building Engineering Variance
Permit Fee Valuation: $ li
Surcharge '
Plan Review
License
MCNVS SAC ?
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
SNV Surcharge
Treatment PI. ? -?
l/
Park Ded.
Trails Ded. v
Other
Copies -
Total: L ? I
% SAC
SAC Unif's""` .---?-? % 1
_ i
. , , . . ? .,.
, .. - . F. C. JACKSCfN ` ..
, . .. . ,
Mr. John Michaels SUR\'EYOR
4253 Amber Dr.
Eagan, MN 55122 ^???=-=r== '-.°==r -?.?= ?. ?-••? ? VIHH[4DTA
4C[RLLO CY ORDIMANCE OF CITY Or MINH[APJLIL
31716 EAST 55rH STREE-F PA. 4"4GB1
?ff urbrr-,r'?; Ccrtificatt .
S Flo* 7 10? ?
? ? ? pvS
?
oS qv o i
i ?
y, N
? Ok
N
I HEFECY CERTIFY THAT THE AeOVE IB A TFUE ANp WRRECT PtAT OP A SURVEY OF
i.ot 6 Blook 7, Cedar Grove P:o. 2
'na-an Po-;rns,iip,liakota `%ount9, M.inn.
?
i
O
\I
c1
?
?
?
+I
I
Scale: / ? = 30?
PZRAM
1ca n ?'1 f
Af SUPVCYEO 6Y MC THIS
SIGAE0.-?
F. C JACK50`.. KINHrsC? F[¢IilR/.TIOM, h<. 3E0*!
?h?M?yn:k?%kh,?'C9FmYnf;M7'?ik4l•8(??kh'?SCWht?i %R7R:4??i k?`??KWKL;:XCx
CIT'r' 01= F.:Af;iAN
CFl;3Fi.f.El;: lS TEF.'W1:Nt•tl.. N0:: 692
DA713:: 02/1.0/959 T:I?1E: 1.0? 1 f3 ^08
IT.i;;
P!FlME: FiL.COVI_ Rf]f:IFINt:i ix 9111 i:NW :[NC.
;E':lp 13001 211.4 MAIIBI...E I_N L'r?5.25
2155 9001 i?ii i MFlS;BI_F:: LN 3.00
-;c'10 :JOCI'I. 42.`i3 AMBL-::Ci DF( 11. J-c 5
205 9001 425;3 AMf.3EFt UF 2.50
3210 9001 2066 LiZFf L.EY hii 03„25
205 9501 cQE'iE, Tl'1:FF'I._Fi:V FiD 4.00
Tr]'1;1.L IiL-+CF7.pt F;mnuni:. 399.25
Gf':I.1C'iCi68
l.1Sf:i:R TD: 1FlN
1999 BUILDING PERMIT APPLICATION (RESIDENTIAL)
and all roofed areaa (20% maximum lot coveraae allowed) 1 sel ot energy caleulaHons for heated addttions
D 2 coples ot plans (ahow beam 6 wtndow sizes; poured Ind. design; etc.) 1 sRe survey for exlerlor addMlons 3 decks
D 1 sef of energy calculaf(ona
? 3 copies of hee preservation plan M loi platted affer 711 /93
DATE: g-T 6e-) CONSTRUCTION COST:
DESCRIPTION OP WORK: ? ?-?e oef
CITY OF EAGAN
3830 PILOT KNOB RD - 55122
651-681-4675
I IS-
New ? 3 Conregidsfiueredc}ion ske suneys Reauiremenfs ahowing sq. R. of lot, sq. R. of house 2 copies ol plan Remodel/Renalr Reauirements
STREETADDRESS: Lta-53 /`???ee:?c ,/?
LOT: BLOCK: ? SUBD./P.I.D. #: rov
Name: I ??I cAE? J ONN
Phone #: ??[ o
PROPERTY lcs? First
OWNER Street Address:qd4U" /"
p•M3 &A- ?
City 4 State:
CONTRACTOR
ARCHITECT/
ENGINEER
Company: td C CG)l J e /C06AJN"6
Zip: J??
Phone#: cs-l - cl-a ? s?CIO)
(area code)
Sheet Address: 3aO "VN 6-6EC
City E-4 ?4N State:
Company: Name:
Telephone #: area code (
Zip: ?-?--
Street Address: Registration #:
City
Sewer 3 water Ilcensed plumber (reouired for new consirucHon onlv):
State:
Penalty applfes when address change ond lot change Is requested once permN Is izsued.
Zip:
I hereby acknowledge thaf I have read ihis applieatlon, state that fhe informailon Is cortect, and agree to comply with all applicabl
Staie.ot Mlnnesota Statufes and Cify o( Eagan Ordinances.
. Signature of Applicant:
OFFICE USE ONLY
llcense # ao 13 0614p.
Certificates of Survey Received _ Yes _ No
Tree Preservation Plan Received _ Yes _ No _ Not Required
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 4-plex ? 11 10-plex ? 16 Fireplace ? 21 Porch (3-sea.)
? 02 SF Dweiling ? 07 5-plex ? 12 12-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.
? 03 1 of _ plex ? 08 6-plex ? 13 16-plex ? 18 Deck ? 23 Porch (screened)
? 04 2-plex ? 09 7-plex ? 14 Apartments ? 19 Lower Level ? 24 5torm Damage
? 05 3-plex ? 10 8-plex ? 15 Lodging ? 20 Pool O 25 Miscellaneous
WORK TYPE
? 31 New ? 35
? 32 Addition ? 36
? 33 Alteration ? 37
? 34 Repair ? 38
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Width
APPROVALS
Planning
Tenant Impr ? 39 Gas Line Only ? 43 Siding/5offits/Fascia
Move Bldg. ? 40 Gas Insert ? 44 Windows/Doors
Demolish Bldg.* ? 41 Wood Stove 0 45 Fire Repair
Demolish (!riterior) ? 42 F2eroof
• Give PCA handout to applicant for demolition permit
Basement sq. ft.
Main level sq. ft.
sq. ft.
sq. ft.
sq. ft.
sq. ft.
Footprint sq. ft.
Buitding
Engineering
Census Code
SAC Code
No. of Units
No. of Bldgs
MC/ES System
City Water
Booster Pump
PRV
Fire Sprinklered
Variance
Permit Fee
Surcharge
Plan Review
License
MC/ES SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
5/W Permit
SNV Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
Valuation: $
SAC Units
% SAC
2004 RESIDENTIAL BUII.DING PERNIIT APPLICATION
City Of Eagan
? 3830 Pilot I{nob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
-S??o.oo
Nevr ConsW ction Reaui2ments RemodeUReoair Reauiremenis ro?
3 registered site suneys shaving sq. ft of lot, sq. ft of haise; and aU roofed areas 2 coDles of plan C"?ert?,a??rirvey,`?3eotl' 4°^ eY-,''-'?``N
(20% mazimum bt coverage allowed) i set oi Energy Calalatlons for heated additions Tree?P?e`s'Parmecil Y"N,
2 copies of plan showing beem & window sizes; poured found design, etc. 1 ske survey Por additions & decks ? ,'?d N
1 sel of Eneigy CalculaUons Addilion • irMicete if on-stte sepfic system bo- _?0
3 copies of Tree Pieserva0on Plan if lot platted after 7/1193
Rim Joist Detail Options selectlon sheet (bldgs wilh 3 w less unlls
Date (D / LC! l O? ConstrucGon Cost
SiteAddress u2, S U 194AJO,'
C. l
n
? U12. Unit/Ste #
? ,-)
Description ot Work lN $ %??
Multi-FamilyBldg _ Y 4<N Fireplace(s) _ 0 1 _ 2
Property Owner m
/P? ?
Telephone # ( ?? ) ? ??' ??? 2" ?
Contractor ti f d
Address 3?' ? L"?, (7f:j/ '7 / 3 City
State ?J Zip ?9,;3 3 ? Telephone #
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Tviinnesota Rules 7670 Cateeorv 1 Minnesoh Rules 7672
Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(J submission type) Submitted Submitted
• Energy Envelope Calculations Submitted
Have you previously constructed a building in Eagan with a similar plan? _ Y _ N If so, 25% plan review
fee applies.
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone # (
Telephone #(
Telephone # (
I hereby apply for a Residential Building Pemut and acknowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; I understand this is not a pemut, but only an application for a permit, and work is not to start without a
pernut; that the work will be in accordance with the approved pl in the ase of workAv?#h requires a review and
approval of lan
? s. ' o? `,sG?'`? ?
Apphcant s Pnnted Name Apphc t s Signature
OFFICE USE ONLY
Su6 Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - MuIG
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex ? 19 Lower Level O 24 Storm Damage
? OB 04-plex ? 12 72-plex Pibg_Y ar _ N ? 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteration ? 37 Demolish Building• O 43 Reroof ? 46 Windows/Doors
? 34 RepleCement •Demolition (Entire Bldg) - Give PCA handout to applicant
Valuation Occupancy MCES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const Width
_ Footings (new bldg)
_ Footings (deck)
_ Footings (addition)
Foundation
Drain Tile
Roof Ice & Water Final
_ Framing
_ Fireplace _ R.I. _ Air Test _ Final
Insulation
Approved By:
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
REQUIRED INSPECTIONS
FinallC.O.
FinaVNo C.O.
_ Plumbing
HVAC
Other
_ Pool Ftgs _ Air/Gas Tests Final
_ Siding _ Stucco _ Stone _ Brick
_ Windows
_ Retaining Wall
Building Inspector
2004 RESIDENTIAL PLUMBING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please complete for modifications to existing residential dwellings.
Date0!5"_/OS /?
T
Site Street Address Nag2 QmbQC nQ Unit #
Property Owner V44 M•C6LQI Telephone# (bSl) HSH•35a5
Contractor -n K 4rr1e QI,m h:na Telephone #( 95ZI)99y - 7 60e
Address laqbl Z:n raA ailp _ City JCO.Jasey State1],? a_ Zip 4C218
The Applicant is: _ Owner LC Contractor _Other
Alteretions to existing dwelling
_Add fixtures to rooms, excluding water softener and water heater
_Septic System Abandonment
_Water Turnaround (add $121.00 if a 5l8" meter is required)
Other: $ 50.00
Water Softener Water Heater
_ replacement _ additional $ 15.00
/Lawn Irrigation System RPZ_ repair _rebuild $ 30.00
State Surcharge $ •50
Total =30_?
I hereby apply for a Residential Plumbing Permit and acknowledge that the information is complete
and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan and the plumbing codes; that I understand this is not a permit, but only an application for a
permit, work is not to start without a permit and work will be in accordance with the approved plan in
the event a plan is required to be reviewed and approved.
paJe 9".e1l _
ApplicanYs Printed Name
Signature
MAY U 6 2004 1
l
ajI
2005 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Construdion Reauiremenis
3 regislered sile surveys showing sq. R. of lol, sq. ft. of house; and all roofed areas
(20No marzimum lot coverage allawed)
2 copies of plan sfwwing beam & window saes; poured found design, e[c.
1 selaf Energy Calculatlons
3 copies of Tree Preservatlon Plan'rf lot platled aRer 711193
Rim Joist DetaJ Options seledian sheat (6uildings with 3 or less units)
RemodeVReoairReaui2ments Off?ce Use Onlv
2 copies of plan CeR of Survey Recd _ Y_ N
1 set of Eneqy Calculatbns for heated additions Tree Pres Plan Recd _ Y_ N
lsilesurveyforadditbns&decks Tree Pres Required _Y _N
Addition - irMkate'rfon-snesepficsysfem bn-siteSepticSystem '_Y _N
Date
/ & Construction Cost
1J
Site Address ? ir- ? Unit/Ste #
Description of Wo k (. ! I
Muiti-Fumily Bldg _ Y_ N Fireplace(s) _ 0_ 1 _ 2
-3
Property Owner 52 S
Telephone #(il J
Contractor Ao d I IIfM wAnJW _ itix.
Address ??O GkfWla Dfto C<<Y
State ? ( ?1?1.t100at? N1?tL0 Telephone # ( )
m Lie. N Z00l01111V
COMPLETE THIS AREA ONLY IF
A NEW BUILDING
Minnesota Rules 7670 Categorv 1 Minnesota Rules 7672
Energy Code Category , Residential Ventilation Category 1 Worksheei • New Energy Code Worksheel
(J submission type) Submitted Submitted
• Energy Envelope Calculations Su6mitted
Have you previously constructed a building in Eagan with a similar plan2
fee applies.
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Y_ N If so, 25% plan review
Telephone # (
Telephone # (
Telephone # (
I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan 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 the case of work which requires a review and
approval of plans.
Shei iq Patp-
Applicant' Printed Name Applicant's Si e
OFFICE USE ONLY
Sub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Mutti
? 03 01of_plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn.(4sea.) ? 33 EM.AIt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screenlgazebo) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or _ N? 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteretion ? 37 Demolish Building' ? 43 Reroof ? 46 WindowslDoors
? 34 ReplaCement 'Demolition (Entire Bldg) - G ive PCA handout to appiicant
VBlUat1UP1
Census Code
SAC Units
# of Units
# of Bldgs
Type of Const
_ Footings (new bldg)
_ Footings (deck)
_ Footings (addition)
Foundation
Drain Tile
Roof Ice & Water
_ Framing
Final
Occupancy MCES System
Zoning City Water
Stories Booster Pump
Sq. Ft. PRV
Length a : -t,,{rv Lyt...FirAe+Sprinklered
Width arItU cL:YaZ; ?le?'Ar
i?:D.'C8 7iZYI i' ` v3ac? c? ?sz• , is?
xEQuiREMWTiAs
Final/C.O.
Final/No C.O.
_ Plumbing
HVAC
Other
_ Pool _ Ftgs _ Air/Gas Tests Final
_ Siding _ SNCCO _ Stone _ Brick
_ Windows
_ Retaining Wall
_ Fireplace _ R.I. _ Air Test _ Final
Insulation
Approved By:
Easa Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
Building Inspector
41 Dty Of ?ap
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
F-----------------
For Office Use ?
j PermitM:
? Permit Fee:
? Date Received: ' j
I Statt:
?----------------'
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: 4253 1'f h\,bv- DC.
Tenant: -,TO ? ?Cjka-e- ? Suite #:
RESIDENTlOWNER Name: ?O?n (fi iC,ka21 Phone: 4N- 3Jra2$
Address / Ciry / Zip: 4qSJ nYVI bo- D('
Applicant is: _ Owner ? Contractor
TYPE OF WORK Description of work: Op-e ?
Construction Cost: ??3? • w Multi-Family Buitding: (Yes No
CONTRACTOR Name: AZ'TEC 1'1OOp nG l ar sOx License 1t: 20 139 1'F0
Address: 4 I O5 554.1, A/E
Ciry: .4ri Pa.fk state: (Ylh1 zip: 55i1?3
Phone: -7 (Q3- 31 S- 053 O Contact Person: A4_2j C?utK-in0.5
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7672
_ Minnesota Rules 7670 Categorv 1
_
Energy Code • Residemial Venhlation Category 1 Worksheet • New Energy Code Worksheet
CatEgOry Su6mitted Submitted
(4 Submission typC) • Energy Envebpe Calculations Submitted
In the last 12 moMhs, has the City of Eagan issued a permit far a similar pian based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plum6er: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and supporiing documents that you submit are considered to tre public information. Portions o/
the information may be classiiied as non•public if you provide speclfic reasons thaf would pennit the Clty to
conclude that the are trade secaais.
I hereby acknowledge that this information is complete and accurate; that the work will 6e in confortnance with the ordinances and cades of the City of
Eagan; ihat I understarcl this is not a permit, but only an application for a permit, arM work is oot to staA without a permR; that ihe work will be in
accordance xnth ihe approved plan in the case of work which requires a review and approval ol plans.
x -? p. 1 E C?.u-k-t naS x iYkPA.f' ?
ApplicanYs Printed Name ApplicanY Signature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA112023
Date Issued:07/24/2013
Permit Category:ePermit
Site Address: 4253 Amber Dr
Lot:6 Block: 7 Addition: Cedar Grove 2nd
PID:10-16701-07-060
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.
Tony Boerner
2090 County Road 42 W
Burnsville, MN 55337
Fee Summary:PL - Permit Fee (WS &/or WH)$55.00 0801.4087
Surcharge-Fixed $5.00 9001.2195
60.00Total:
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 -
John R Michael
4253 Amber Dr
Eagan MN 55122
Tony's Appliance
2090 County Road 42 West
Burnsville MN 55337
952) 435-2442
Applicant/Permitee: Signature Issued By: Signature
Use BLUE or BLACK Ink
r-----------------
I For Office Use
I i I
Permit
City of Ea
Ed~
I Permit Fee:
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received: 3
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 i Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: "`t ✓YL Unit
Name: Vfl Phone: J/ Resident/ C~
Owner Address / City / Zip: J &C,- Gt 'G'am
Applicant is: Owner .Contractor
clo_~
Type of Work Description of work:
Construction Cost: L` O Multi-Family Building: (Yes / NoD_~
I
rWB~
I. Company: 3-U,7CST 4. ~ "i Contact: ' Pt~
Contractor Address: U o t~ ' 6_ City:
State: ~M4_) Zip: Phone: Yom"
License YJ Lead Certificate y" /U 0~~ `C
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 of i
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.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 State Building Code must be completed within 180
days of ermit isZance.
x )-r x /7~ Z~Lf4,/
Applicant's Printed Nm Ap lic t' gnature
Page 1 of 3
City of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Date:
RECEIVED
AUG 0 8 2016
r
Use BLUE or BLACK Ink
For Office Use
G / f
Permit #: / O b 7 7
Permit Fee: 'It/6"C'
Date Received:
Staff:
2016 RESIDENTIAL BUILDING PERMIT APPLICATION
Site Address: C. A C(A:l2 C- 0 C' v e_
Unit #:
J
esident/
Owner
Name: �c\t1 c c\ \Gere
Address / City / Zip: k --\a S CC\'C
Phone: GS \-�lS�l
�t1 n SS
Applicant is: Owner Contractor
Type of Work
Contractor
2Qe CAV& ce Oatwyc\l tet.)
Description of work: ex\SS c tc..3..c5V) o&'N
Construction Cost:
Company:
U S
CASCD? Multi -Family Building: (Yes
Address: 81_)V
/No�)
Contact: \\ iA_ t`c1c:�C1S(S't'\
City: 'iAeoc"Nc1nU(\
State: \(\ Zip:i<N(.) Phone`tStXS Email:
License #` Pc,LOo (09-0-k 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 25 -No If yes, date and address of master plan:
Licensed Plumber: Phone:
Phone:
Phone:
Fire Suppression Contractor: Phone:
Mechanical Contractor:
Sewer & Water Contractor:
y07Er..Plans-and supporting documents that;you submit are consitit
the information may be classified as non-public if you provide' spec
conclude. that the are:,trade
ad t be public; information:? Portions of
c feaa nerr'that-would permit the Cita to
Sts,
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.aooherstateonecall.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 l 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 Buildin • Co • e must be completed within 180
days of permit issuance.
x \\fin ��1C71C1
Applicant's Printed Name
x
Applic
Page 1 of 3
City of Eaafl
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
a35d,L1, \ DS
Use BLUE or BLACK Ink
RECEIVED
AUG 182016
r
I For Office Use
Permit #:
Permit Fee:
Date Received:
Staff:
2016 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 8 -Ys-\ L Site Address: k a,STS Qm ?c .
Unit #:
J
Resident/
Owner
Type of Work
Contractor
Name: •-\dcyc\ c\�,c-`c e
Address / City / Zip: k -%S3 C‘VN\ c- pc
Phone: bS\-L►S4- 3�s
Eo\ ctc•\ c\ -‘t -N SS \d'
Applicant is: Owner Z5- Contractor
e mcwe o.c‘C ' e ?\ot.ce
Description of work: c
cw?cox \S, S sc _Ac .ce
Construction Cost: \a, 5'3C O o Multi -Family Building: (Yes
Company: 4w �u v cx S
/ No
Contact: c\-, vS\SU Kl
Address:80\1 cm cA\\e\ City: 1:Acc>c\-,, -‘cn\uy
State. Zip: SS`-id0 Phone:`1S4 S1- \2 Email: \ManSUv _be, cc c�‘k . GcAh
License #: (SCCX (OS(. 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 D No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor:
Sewer & Water Contractor:
Fire Suppression Contractor:
Phone:
Phone:
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.qopherstateonecall.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 Builds g Code must be completed within 180
days of permit issuance.
x MX\SUn x
Applicant's Printed Name
Applic
Page 1 of 3
as
k, 5 r /\ \ U S Use BLUE or BLACK Ink
,-
I For Office Use
` � { `(_0
Cll of Ea n j Permit#: 1'"1()t
Permit Fee: I '-i '05
3830 Pilot Knob Road r
Eagan MN 55122 Date Received: 5 -to- i 7
Phone: (651) 675-5675
Fax: (651)675-5694 FEtn. 1 Staff:
2016 RESIDENTIAL BUIMLDING PERMJT APPLICATION
Date: 5-9.-\--\ Site Address:L`c�S-)- k-)CliN c o f
Unit#:
IName: J Q\- �
c\ ,ic.\.ae. (5\ Phone: t-ctSit,-- 53,5S-
Resident! _
Owner Address/City/Zip:L\�S: i ��* 'c �� • • 1 u r1 S
Applicant is: Owner Contractor
.:s
Type of Work
Description of work: ',1c��Raj
.
Construction Cost: I S1CMulti-Family Building: (Yes
Company: (�� t i c ‘c...)(�‘c...)(c S
/No )
Contact G, mvVI.SUi7
Contractor Address:.7,T\. C1.i C� Aker\ 9to e S City: \.cx..)ch cNN -UY1
State:t 1C\ Zip:,,,,5Lid0 Phone: 1-- 1-1613 Email:ki�ilO� .KNA 'c t\ .cuM
License#: 6LtOL,SfoL1 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:
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 State Building Code must be completed within 180
days of permit issuance. _..
x ll- VOA n x
Applicant's Printed Name Appli ,. 's Signate
Page 1 of 3
Use BLUE or BLACK Ink
r
(� Eaaan For Office Use
iof r .D Permit#: 141),`"7°70
3830 Pilot Knob Road
Permit Fee: (Q 0
Eagan MN 55122 MAY 1 8 2017 Date Received: S"-Ig'--11
Phone:(651)675-5675
Fax:(651)675-5694 Staff: /
2017 MECHANICAL PERMIT APPLICATION
❑ Please submit two(2)sets of plans with all commercial applications.
Date: \\O\NI. Site Address: '"� -�s 4x),--.10.51,-- Vi 1 1--(2--
Tenant: Suite#:
-
Resident/Owner Name: i b n ' MAC � Phone: Cod l"ck. U-3S2�t
Address/City/Zip:
Name: P r( ( S \--- --eA- L_C C License#: 11 YO 1 0 2
Contractor Address: `-\Ct(,) �L< [r.1 (- �)
J City: C_UC
State:rnN Zip: 3---1 2" Phone: CD1'N 2 31 S" t00 2
Contact: )--.172.-ii) Email: /J t® at.r;C 1(`-�� cCo V-N
New x Keplacement Additional Alteration Demolition
—
Type ofWork Description of work:
NOTE:Roof mounted and ground mounted mechanical equipment is required to be screened by City
Code. Please contact the Mechanical inspector for infomiation on permitted screening methods.
�� RESIDENTIAL COMMERCIAL
Furnace _New Construction _Interior Improvement
Permit Type —Air Conditioner _Install Piping _Processed
_Air Exchanger _Gas _Exterior HVAC Unit
Heat Pump Under/Above ground Tank ( Install/_Remove)
Other
RESIDENTIAL FEES
$60.00 Minimum Add or alteration to an existing unit, indudes State Surcharge
$100.00 Residential New, includes State Surcharge =$ ZWO
TOTAL FEE
COMMERCIAL FEES Contract Value$ x.01
$60.00 Permit Fee Minimum
$75.00 Underground tank installation/removal, includes State Surcharge =$ Permit Fee
=$ Surcharge
Surcharge=Contract Value x$0.0005 ��
If the project valuation is over$1 million,please call for Surcharge =$ a TOTAL FEE
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 appr ved plan in the case of work which requires a review and approval of plaps:
41119hbl
Xe,
SC Lk) ‘ x
Applicant's ' ted Name Appli ant's i a, re
FOR OFFICE USE �`'
Required Inspections: Reviewed By: fats
Underground Rough In ' Air Test " Gas Service Test" In-floor Heat Final ~: .HVAC Screening. ..
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA148437
Date Issued:03/29/2018
Permit Category:ePermit
Site Address: 4253 Amber Dr
Lot:6 Block: 7 Addition: Cedar Grove 2nd
PID:10-16701-07-060
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:One Window/Door
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: 1,500.00
Fee Summary:BL - Base Fee $1500 $62.50 0801.4085
Surcharge - Based on Valuation $1500 $0.75 9001.2195
$63.25 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 -
John R Michael
4253 Amber Dr
Eagan MN 55122
(651) 454-3525
Budget Exteriors
8017 Nicollet Avenue South
Bloomington MN 55420
(952) 887-1613
Applicant/Permitee: Signature Issued By: Signature