4040 Amethyst Lane f
Use BLUE or BLACK Ink
r - - - - - - - - - - - - - - -
Fol Office. USE
City Permit of Ea~a~
I
I Permit Fee: ~
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received: j
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 L Staff:
INFLOW & FILTRATION PERMIT APPLICATION
Plumbing / Sewer & Water
Date: Site Address: 7- IL 2~Mt~-4
Tenant: Suite
Name: D Phone:
RESIDENT / OWNER -
Address / City / Zip:
Name: License
CONTRACTOR Address: City:
State: Zip: Phone:
Contact: Email
PLUMBING (Within the building envelope) SEWER & WATER (Outside the building envelope)
TYPE OF WORK Sump Pump Repair Repair
zwll
'/Other:
Other:
Description of work:
DESCRIPTION
FEES
$55.00 / Each (includes $5.00 State Surcharge) TOTAL FEE $ 6S.~U
*Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submit 1/1 repair costs for
reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors
can be found by visiting www.cityofeaclan.com/inflow, or City Hall at 3830 Pilot Knob Rd.
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.
x~~~~Ct Vl~ x
Applicant's Printed Name Applicant's Signature
FOR OFFICE USE Reviewed By: Date:
Required Inspections: ` -Under Ground -Rough-In -Final
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road 1 41,
Permit Number:
Eagan, Minnesota 55122-1897 Date Issued:
(612) 681-4675
r 4 t„";
SITE ADDRESS: fill Ito 'if r I APPLICANT:
! fi r ' ! I I ! i I I, 1 4 Il~{I
PERMIT SUBTYPE: TYPE OF WORK: t r F' r r ~r1
INSPECTION TYPE DATE INSPTR. INSPECTION TYPE .DATE INSPTR.
I~ ~
Permit No. Permit Holder Date Telephone
ELECTRIC
PLUMBING
HVAC
Inspection Data Insp. Comments
FOOTINGS
FOUND
FRAMING
ROOFING ~~ol
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
CITY OF EAGAN Remarks * Cedar Grove Acquisition
Addition CEDAR GRGVR #5 Lot is Blk 10 Parcel 10 16704 180 10
Owner !/'i ! I' I. /.;:,'f ("r`~)fl Street 4040 Amethya Tang State Fagan. HN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK L 1967 100.00 5-00 paiti
SEWER LATERAL 1967 515.00 25.70 20 paif9l
WATERMAIN
* WATER LATERAL 1972 607.00 24.28 75 paid
WATER AREA
STORM SEW TRK 1974 70.00 4.66 15 Paid
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER.
SAC 200.00 RAS 2-1- 7-68
PARK
EAGAN TOWNSHIP
BUILDING PERMIT N°• 1823
Owner Sti..,6.L4-e-/<•- Eagan Township
Address (Present) '.~Z ......dam--..... Town Hall
Builder Date .~I
Address -
_ DESCRIPTION
Stories To Be Used For Front Depth Height Est. Cost Permit Fee Remarks
/S~-`-c
LOCATION
Street,_ Road or other Description of Location Lot Block Addition or Tract
This permit does not authorize the use of streets, roads, alleys or sidewalks nor does it give the owner or his agent
the right to create any situation which is a nuisance or which presents a hazard to the health, safety, convenience and
general welfare to anyone in the community.
THIS PERMIT MUST BE KEPT ON THE PREMISE WHILE THE WORK IS IN PROGRESS.
This is to cerfify that. J i!.x-.._.c
. c._.... . .
- -..has permission to erect a a'E - = . . upon
the above described premise subject to the provisions of the Building Ordinance for Eagan Td4rnship ado ted April 11.
1955. J
/
Per _......:y. _.._..._....__._......a...___`-
Chaff man of Tnwn Board Building Inspector
EAGAN TOWNSHIP
3795 Pilot Knob Road
St. Paul, Minnesota 55111
Telephone 454-5242
PERMIT FOR SEWER SERVICE CONNECTION
DATE:_ G' ArUP1EtiR ~~j2' ~ -
OWNER:Z ~/f ~Jr(t7_T~__, Address 109-lo-S 7®~([J ~ '*L/ r Kx~
PLUMBER S~~f a~x a TYPE OF PIPE 4;1%1 ~
DESCRIPTION OF BUILDING
Industrial Commercial Residential Multiple Dwelling No. of units
Location of Connections: Connection Charge .~cns " F a ~117 h-'f
✓ff ~.rY45
Permit Fee 7- "
Street Repairs
Total r, -7.
Inspected by:
Date
Remarks:
By
Chief Inspector
In consideration of the issue and delivery to me of the above permit, I
hereby agree to do the proposed work in accordance with the rules and
regulations of Eagan Township, Dakota County, Minnesota
Please notify when ready for inspection and connection and before any portion
of the work is covered.
r
STATE OF MINNESOTA
Department of Public Safety Date:
State Fire Marshal Division '
Time:
0 G n-~ EXIT INTERVIEW
5 s-0 'r~l \
Gi
Name: _ Pfione:
cl- ~G3 tti~ 9 .v1'0 f FAG-G ?S;vQ
Address:
1/01/0 1-7 7 Z-- 'K r~j g
Owner of Premises:
In accordance with the provisions of Minnesota Statute 299F.011, Minnesota Uniform Fire Code, inspection of
the above premises was completed and the following violations and/or deficiencies were noted requiring corrective
action:
Code Violation Summary Deficiency and Corrective Action
r,,- -
-2
p~yvI C-
H/ 1
®~Ocav/ G~7 ~ T tv C--
THERE IS A VARIANCE PROCEDURE
PROVIDED BY STATUTE
• NOTE • Signatures indicate receipt of copies
For further assistance please Owner/Representative
contact the Fire Inspector at r% '
the following number: n C/i/_~` f / Cwt L~-/ \
Fire Chief lRepresentative (•liL~ -{'~,+/L~/'"' Fire Inspector, Fire Marshal Division
Distribution: White - Owner/Representative; Canary - Fire Chief/Representative;
L PS-06057-02 Pink - Division Office; Gold - State Fire Inspector
C AN
L-LL BO MECHANICAL PERMIT RECEIPT # / d O
SUBD. (¢.awa+t J S (612) 6814675 DATE 9
RESIDENTIAL
PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS. ALSO, COMPLETE FOR
TOWNHOMFS/CONDOS WHEN SEPARATE PERMITS ARE REQUIRED FOR EACH DWELLING UNIT.
OWNER: pdI FEES
SITE ADDRESS:qoq49 a4 ~ i,(p~`{LKV - ADD ONMEMODEL (EXISTING $ 15.00
CONSTRUCTION ONLY)
IN STALIM HVAC: 0-100 M BTU 24.00
PHONE 5 p'CJ ADDITIONAL 50 M BTU 6.00
ADDRESS: GAS OUTLETS - MINIM UM 1 @ $3 EA.
CTIY: ZHP:~ ~ SURCHARGE: $ .50
SIGNATURE TOTAL: $ZJ,-56
I
COMMERCIAL
PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAIJINDUSTRIAL BUILDINGS. ALSO COMPLETE FOR
APARTMENT BUILDINGS OR OTHER MULTI-FAMILY `11U LDINGS WHEN SEPARATE PERMITS AaE NOT REQUIRED FOR
EACH DWELLING UNIT.
WORK DESCRIPTION: CONTRACT PRICE: FEES
1% OF CONTRACT FEE.
STATE SURCHARGE IS $.50 FOR EACH i
$1,000 OF PERMIT FEE. $
/ PROCESSED PIPING - $25.00
$
MINIMUM FEE - $25.00
OWNER: TOTAL $
SITE ADDRESS:
TENANT:
SUM
INSTALLER:
ADDRESS:
CITY: ZIP:
PHONE CITY SIGNATURE:
SIGNATURE:
t
a 7523 J°<va54,9
Tao 93- /S b/D ~ 1%115 00
Request Date Fire No Rough-In Inspection
1 Required Ready Now E) WIII Notify Inspector
r GYes No When Ready?
I licensed contractor ❑ owner hereby request inspection of above electrical work at:
Job Address (Street Box or Rod No 1 City
G ,wr f S 4 a n
Section No Township Neme or No Range No. cop
~
OPRINTI Phone No
ccu am(
Aar e,i cl
Power Suppii Address
Elegn ai Corn acla ICOmpany ame) Convador5 Li ense No
Zc3
R i5e C4 -
Mailing Address (Contractor or Own r Making Installation)
Aulhorrz nature ICO ad +Ow r kin PhJone4Nttder
MINNESOTA STATE BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT
Griggs-611Cway Bldg. - Room S-173 BE ACCEPTED BY THE STATE BOARD
1831 University Ave.. St Paul. MN 55106 UNLESS PROPER INSPECTION FEE IS
Phone (612) 602-0800 ENCLOSED
~J~~rJ/QaL REQUEST FOR ELECTRICAL INSPECTION Ee-OOamaa
W See mslrgelions for completing this form on back of yellow copy.
~7 i 6 7T
W 0 7 5 2 3 •X" Below Work Covered by This Request
New Add Rep. Type of Building AppllancesWlred EgmpmentWired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Other (Specify)
Comm./Industrial rnace
Farm Air Conditioner
Other IspKgf connector's Remarks
Compute Inspection Fee Below. °jn`W << ! C Ft;f vv /'u C
# Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Swimming Pool 0 to 200 Amps ` 0 to 100 Amps ('.'a 0
Transformers Above 200 _ Amps 0 Amps
L }
Signs inwonf tr's use Only / '16
TD pLr. J
Irrigation Booms / j J rj
Special Inspection 6 tJ
AlarmiCommunication THIS INSTALLATION MAY BE ORDEREb DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONTHS.
I, the Electrical Inspector, hereby Rough-in oam
certify that the above inspection has Final oats
been made.
OFFICE USE ONLY
This request void to months from
N4Yw
{ 5 'y
MEMO
of of eagan
TO: DIANE DOWNS, UTILITY BILLING CLERK
FROM: ED KIRSCHT, SR. ENGINEERING TECHNICIAN
DATE: AUGUST 23, 1993
SUBJECT: STREETLIGHT ENERGY COSTS-CEDAR GROVE NO. 5 (208 LOTS)
This memo is to inform your department to begin to invoice the energy costs at the single
family rate effective August 1, 1993 to the property owners in Cedar Grove No. 5 Addition.
Block 1, Lots 1-22 22
Block 2, Lots 1-19 19
Block 3, Lots 1-11 11
Block 4, Lots 1-16 16
Block 5, Lots 1-25 25
Block 6, Lots 1-22 22
Block 7, 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
208
The City is currently being billed by Dakota Electric for streetlighting in the above listed
subdivision.
Edward J. irscht
Sr. Engineering Technician
cc: Mike Foertsch
EJK/je
moo( 7 1997 BUILDING PERMIT APPLICATION (RESIDENTIAL) 74- ZS-
CITY OF EAGAN
3830 PILOT KNOB RD - 551220
681-4675
New Construction Requirements Remodel/Repair Requirements l
♦ 3 registered site surveys ♦ 2 copies of plan
• 2 copies of plans (Include beam & window saes; poured frd. design; etc.) ♦ 2 she surveys (exterior additions & decks)
♦ 1 energy calculations ♦ 1 energy calculations for heated additions
♦ 3 copies of tree preservation plan h lot platted after 711/93
required: _ Yes _ No
DATE: 4~c//~~?OTt7 CONSTRUCTION COST: 712
DESCRIPTION OF WORK: /fe/IOPr~
STREETADDRESS: y ~fi L4 y G
1/ n
LOT /R ~ BLOCK SUBD./P.I.D.
PROPERTY Name: Phone `1"i Z ^3e~
OWNER
Street Address:
City: 4 %z State: A n Zip: SS/2 2-
CONTRACTOR Company: P/DS2O Loy Phone
Street Address: License
City: ~7bse~i~k' State: Zip: ARCHITECT/ Company: Phone
ENGINEER
Name: egistration
Street Address:
City: State: Zip:
Sewer & water licensed plumber (new construction only): Penally applies when address change
and lot change are requested once permit is issued.
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.
Signature of Applicant:
OFFICE USE ONLY
Certificates of Survey Received Yes No
Tree Preservation Plan Received Yes No Not Required
OFFICE USE ONLY ^
BUILDING PERMIT TYPE
❑ 01 Foundation ❑ 06 Duplex ❑ 11 Apt./Lodging ❑ 16 Basement Finish
❑ 02 SF Dwelling ❑ 07 4-plex ❑ 12 Multi Repair/Rem. ❑ 17 Swim Pool
❑ 03 SF Addition ❑ 08 8-plex ❑ 13 Garage/Accessory ❑ 20 Public Facility
❑ 04 SF Porch ❑ 09 12-plex ❑ 14 Fireplace ❑ 21 Miscellaneous
❑ 05 SF Misc. ❑ 10 _ plex ❑ 15 Deck
WORK TYPE
❑ 31 New ❑ 33 Alterations ❑ 36 Move
❑ 32 Addition ❑ 34 Repair ❑ 37 Demolition
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.
Depth Footprint sq. ft. SAC Code
Census Bldg
Census Unit
APPROVALS
Planning Building Engineering Variance
Permit Fee 7 75 Valuation: $
Surcharge J . S J
Plan Review
License
MC/WS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI.
Road Unit
Park Ded.
Trails Ded.
Other
Copies
Total:
% SAC
SAC Units
CITY OF EAGAN
CASHIER: S TERMINAL N0: 88
DATE-., 06/02/97 TIME: 15"42:08
III
NAME DOSCO
3210 9001. 4040 AMETHYST L 74.V5
2155 9001 4040 AMETHYST L 1.50
Y
Total Receipt Amount: 0.25
CR0745B4
USER 1% NANCY
~%kYF~k~%~~k~'F~F~k~k~~X«k~kWW#~kM%~:Rt?k~XBnk~klkM~kM%~~KxYYFM7k
11~ . • PERMIT
CITY OF EAGAN
3830 Pilot Knob Road PERMIT TYPE: B U I L D I N G
Eagan, Minnesota 55122-1897 Permit Number: 030146
(612) 681-4675 Date Issued: 06/02/97
SITE ADDRESS:
4040 AMETHYST LANE
LOT: 18 BLOCK: 10
CEDAR GROVE 5TH
P.I.N.: 10-16704--180-10
DESCRIPTION:
r R E R 0 0 F
B;Giildi-g'-,,PermJt Type SF (MISC.)
661ldin9 L~& Type ALTERATION
('Census Code 434 ALT. RESIDENTIAL
`t
REMARKS:
FEE SUMMARY:
VALUATION $30000
Base Fee $74.75
Surcharge 11.50
Total Fee $76.25
CONTRACTOR: - Applicant ST. LIC. OWNER:
DOSCO 14231814 0004144 EFTELAND DAVE
147VIO DELFT AVE A 4040 AMETHYST LANE
ROSEMOUNT MN 55068 EAGAN MN
(612) 423-1814 (612)452-9304
I hereby acknowledge that Z have read this application and state that the
information 4 r rm0t and pgr,9e t0~ 00mp).y it1T X11 ipxi0abl_BtaGE of_ Mn,
Statutes a C'~y of Eagan Ordinances.
-f Ilk
A LICANT/PERMITEE SIGNATURE /ISWEIJtj7 SIGNATURE
CITY USE ONLY p r
L BL ~ RECEIPT 0 J 5
SUBD. /x1171 C_ RECEIPT DATE:
1998 PLUMING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
(612) 681-4675
Please complete for: i single family dwellings
➢ townhomes and condos when permits are required for each unit
➢ backflow preventer for underground sprinkler system
_
FIXTURES EACH # TOTAL
Shower 3.00 x = 3 "
Water Closet 3.00 x =
Bath Tub 3.00 x =
Lavatory 3.00 x =
Kitchen Sink 3.00 x
Laundry Tray 3.00 x
Hot Tub/Spa 3.00 x =
Water Heater 3.00 x =
Floor Drain 3.00 x =
Gas Piping Outlet ' minimum -1 3.00 x =
Rough Openings 1.50 x =
Water Softener ' for dwellings under construction 5.00 X =
Water Softener ' for existing dwelling 20.00 x =
U.G. Sprinkler 'fordwelling under const. 100
U.G Snriaclet-=e r-e 'stin d 20.00 = ~Q
Alterations ' to existing residue 20.00 = 1~
ater Turn Around 20.00 =
Private Disposal System ' MPC tic. L-~~ 75.00 =
(new and refurbished systems)
Private Disposal Systems " Abandonment 20.00 =
STATE SURCHARGE 50
-5 el
TOTAL
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable City of Eagan ordinances.
It is the applicant's responsibility to notify the property owner that the City of Eagan assumes no liability for any damages caused by the City during its
normal operational and maintenance activities to the facilities constructed under this permit within City property/right-of-way/easement-
SITE ADDRESS: fe~Yg
OWNER NAME: {~gjk:'
dS°~s P~9 TELEPHONE#: ~~5-029
INSTALLER NAME: //an kle/91
STREET ADDRESS: /d5 68 Sp}`~/N
CITY: D~~1 y STATE: Ah' ZIP: SS~//a
Ish SIGNATURE 61PERM'ITTEE
JS/FORMS BLDG/PLBG PERMIT (RESIDENTIAL) 1998
CITY OF EAGAN
CASHIER: JS TERMINAL NO: 786
DATE: 08/23/00 TIME: 11:06:59
ID:
NAME: DAVID EFTLAND
3212 9001 4040 AMETHYST L 30.0C
2155 9001 4040 AMETHYST L 0.5(
Total Receipt Amount: 30.5(
CR136309
USER ID: JAN
I CITY USE ONLY
L ~ BL L RECEIPT#:
SUED. CeA Ar (100, 1-F`J RECEIPT DATE:
PERMIT# 41441
2000 PLUMING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
651-681-4675
Please complete for: > single family dwellings
> townhomes and condos when permits are required for each unit
> backflow preventer for underground sprinkler system
FIXTURES EACH # TOTAL
Alterations to sting dwelling - minimum fee $ 30.00
Describe: t1uW1n bump
Bath tub $ 3.00 x = $
Floor drain 3.00 x = $
Gas piping outlet ' minimum - 1 3.00 x = $
Hot tub/spa 3.00 x = $
Kitchen sink 3.00 x = $
Laundry tray 3.00 x = $
Lavatory 3.00 x = $
Septic System new/refurbished ' requires MPC lic. 75.00 x = $
Septic System abandonment 30.00 x = $
RPZ new installation/repair/rebuild 30.00 x = $
Rough opening 1.50 x = $
Shower 3.00 x = $
Underground sprinkler if dwelling is under construction 3.00 x = $
Underground sprinkler if existing dwelling 30.00 x = $
Water closet 3.00 x = $
Water heater 3.00 x = $
Water softener if dwelling under construction 5.00 x = $
Water softener If existing dwelling 30.00 x = $
Water turnaround 30.00 x $
State Surcharge .50 $ .50
Total > $
Reminder. Call for inspections of alterations, i.e. water heaters, water softeners, etc.
hereby acknowledge that I have read this application, state that the information is correct, and agree to comply w@h all applicable City of Eagan ordinances.
It is the applicants responsibility to notify the property owner that the City of Eagan assumes no liability for any damages caused by the City during its
'normal operational and maintenance activities to the facilities constructed under this permit within City property/right-of-way/easement.
SITE ADDRESS: 40tt S 4- L
OWNER NAME:: V1 Grom TELEPHONE#: ~ ~ig
(AREA CODE)
INSTALLER NAME: I~ TELEPHONE#:
(AREA CODE)
STREET ADDRESS:
CITY: T ZIP:
NATURE OF PERM EE
2000 STORM DAMAGE PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD - 55122
I 651-681-4675
Requirements
2 copies of plan /S o0o
DATE: <r°1 ~`~r CONSTRUCTION COST: ~T
units?
DESCRIPTION OF WORK: F0f V5'~r If multi-family bldg., how many/
INDICATE THE FOLLOWING EQUIPMENT TO BE REPLACED AND BY WHOM:
Plumbing X Homeowner ctr Contractor Name /
- Mechanical Homeowner Q Contractor Name
"Note: If somebody other than the homeowner is performing plumbing or mechanical work they must apply for appropriate
permit. Only licensed plumbing contractor or homeowner may complete plumbing work.
STREET ADDRESS:
LOT: U BLOCK: SUBD./P.I.D. Cday V rbyel
Name: Phone
PROPERTY Last Fifst,
OWNER J
Street Address~. //Oz/ tt h~~ f
city -Ik'4N State: /y 1' L"~ Zip:
Company: J~ Phone
(area code)
CONTRACTOR
Street Address: License # Exp.
City State: Zip:
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
~ i
Signature of Applicant: /L
~ ~
2000 BUILDING PERMIT APPLICATION (RESIDENTIAL) `/l~
OF EAGAN
3830 PILIOT KN B RD - 55122 "1 3l 7 o
851-881-4875 Re 1/~ (p111
New Construction Reauiremenh model/Reoair Reauiremen v h O I rl. V 10-9-00
> 3 registered site surveys showing sq. ft. of lot, sq. ft. Of house 2 copies of plan
and gfi roofed areas (20% moximum lot coverage allowed) I set of energy calculations for heated addfllom
> 2 copies of plans (show beam rt window sizes: poured Ind. design; etc.) 1 site survey for exterior additions a decks
> 1 set of energy calculations
> 3 copies of tree preservation plan N lat platted offer 7/1/93
DATE: /0 - k1-0 0 CONSTRUCII ION COST: X I b
DESCRIPTION OF WORK: e~ Y(eS,^S_ MoJoWS Iyqlj&ll h46flif1 ff-/
STREET ADDRESS: u 0 u u hm e hi o~ L n
LOT: A- BLOCK: SUBD./P.I.D. W t (yP/ 46
Name: r C, V, CI P6(VICl Phone#: 1e5~ 'y5Z'~13U
PROPERTY Lost First
OWNER
Street Address:
City State: Zip: 5-5121
Company: Phone
(area code)
CONTRACTOR
Street Address: License # Exp.
City State: Zip:
ARCHITECT/
ENGINEER Company Name:
Telephone ( )
Street Address: Registration
City State: Zip:
Sewer/water licensed plumber (it installing sewerlwaterPlane
I hereby acknowledge that I have read this application, state that the Infonnafion byone and ogres t omp with oil applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant. X L
OFFICE USE ONLY
OCT 0 4 2000
Certificates of Survey Received Yes No I
I' I
_ _
Tree Preservation Plan Received Yes No Not Required
OFFICE USE ONLY
BUILDING PERMIT SUBTYPES
❑ 01 Foundation ❑ 07 05-plex ❑ 13 16-plex ❑ 21 Porch (3-sea.) ❑ 31 Ext. Aft - Multi
❑ 02 SF Dwelling ❑ 08 06-plex ❑ 17 Garage ❑ 22. Porch/Addn. (4-sea.) ❑ 33 Ext. Aft - SF
❑ 03 01 of _ plex ❑ 09 07-plex ❑ 18 Deck ❑ 23 Porch (screened) ❑ 36 Mufti
❑ 04 02-plex ❑ 10 08-plex ❑ 19 Lower Level ❑ 24 Storm Damage
❑ 05 03-plex ❑ 11 10-plex Plbg _Yor_N & 25 Miscellaneous
❑ 06 04-plex ❑ 12 12-plex ❑ 20 Pool ❑ 30 Accessory Bldg.
WORK TYPE
19 31 New ❑ 36 Move Bldg. ❑ 43 Reroof
❑ 32 Addition ❑ 37 Demolish (Bldg)' ❑ 44 Siding
❑ 33 Alteration ❑ 38 Demolish (Interior) ❑ 45 Fire Repair
❑ 34 Repair ❑ 42 Demolish (Foundation) ❑ 46 Windows/Doors
* Give PCA handout to applicant for demolition permit
GENERAL INFORMATION
SAC Code # of Stories sq. ft.
No. of Units Length sq. ft.
No. of Buildings Width Footprint sq. ft.
Const. (Actual) h f/ Basement sq. ft. Census Code
(Allowable) 5--tl Main level sq. ft. MC/ES System
UBC Occupancy sq. ft. City Water
Zoning sq. ft. Booster Pump
PRV
Fire Sprinklered
MISCELLANEOUS INSPECTIONS
❑ Stucco/Stone
APPROVALS
Planning Building Engineering Variance
Permit Fee Valuation: $
Surcharge
Plan Review
License a - F~sS G~ a+d~J S
MC/ES SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment Pl.
Park Ded.
Trails Ded.
Other
Copies
Total:
SAC Units
% SAC
CITY USE ONLY
L 8L ~ V RECEIPT
SUED. -0Q &.a ✓ ~V c) J -C RECEIPT DATE:
PERMIT#
2000 PLUMBING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
651-681-4675
Please complete for: > single family dwellings
> townhomes and condos when permits are required for each unit
> backttow preventer for underground sprinkler system
FIXTURES EACH # TOTAL
Alterations to existing dwelling - minimum fee $ 30.00
Describe: s3sFc~wa e PV/ye-
s a Al Y EG✓ L G IAl Bath tub $ 3.00 x = $
Floor drain 3.00 x = $
Gas piping outlet ' minimum - t 3.00 x = $
Hot tub/spa 3.00 x = $
Kitchen sink 3.00 x = $
Laundry tray 3.00 x = $
Lavatory 3.00 x = $
Septic System new/refurbished `requires MPC lic. 75.00 x = $
Septic System abandonment 30.00 x = $
RPZ new installation/repair/rebuild 30.00 x = $
Rough opening 1.50 x = $
Shower 3.00 x = $
Underground sprinkler if dwelling is under construction 3.00 x = $
Underground sprinkler if existing dwelling 30.00 x = $
Water closet 3.00 x = $
Water heater 3.00 x = $
Water softener if dwelling under construction 5.00 x = $
Water softener If existing dwelling 30.00 x = $
Water turnaround 30.00 x $
State Surcharge .50 $ .50
Total
Reminder. Call for inspections of alterations, i.e. water heaters, water softeners, etc.
I - -hat-1 haver - -a -
hereby acknowledge t ed this application, state that the information is cone d, and agree to comply with- all applicable City of Eagan ordinances.
It is the applicant's responsibility to notify the property owner that the City of Eagan assumes no liability for any damages caused by the City during its
normal operational and maintenance activities to the facilities constructed under this permit within City property/right-of-way/easement.
SITE ADDRESS: Z/N/o Rn'1ET/~YST L n ti
OWNER NAME:: D~~~~I E fT~CAND TELEPHONE
(AREA CODE)
GS/- 7/ yO
INSTALLER NAME: ~6n/rS ~.r~ TELEPHONE*
(AREA CODE)
STREET ADDRESS:
CITY: Sr STAT ~ ZIP:
SIGNATURE OF PERMITTEE
CITY OF EAGAN
CASHIER: JS TERMINAL NO: 769
DATE: 08/24/00 TIME: 13:06:00
ID:
NAME: BONFE'S PLUMBING & HEATING
3212 9001 4040 AMETHYST L 30.00
2155 9001 4040 AMETHYST L 0.50
Total Receipt Amount: 30.50
CR136432
USER ID: JAN
Cities Digital Quality Control
The following image represents the best
available image from the original page.
Every effort was made to capture the content
from the original page.
CITY USE ONLY 3V S~/
L _y BL RECEIPT
SUBD. r1 rr:w RECEIPT DATE:
PERMIT # qZi/^- l/
2000 PLUMBING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
651-681-4675
Please complete for: > single family dwellings
> townhomes and condos when permits are required for each unit
> backflow preventer for underground sprinkler system
FIXTURES EACH # TOTAL
Alterations to existing wpiling - mimum fee $ 30.00
Describe: LL w piling (tl e gr
Bath tub $ 3.00 x = $
Floor drain 3.00 x = $
Gas piping outlet ' minimum -1 3.00 x = $
Hot tub/spa 3.00 x = $
Kitchen sink 3.00 x J = $
Laundry tray 3.00 x = $
Lavatory 3.00 x = $
Septic System new/refurbished • requires MPC lic. 75.00 x = $
Septic System abandonment 30.00 x = $
RPZ new installation/repair/rebuild 30.00 x = $
Rough opening 1.50 x = $
Shower 3.00 x = $
Underground sprinkler if dwelling is under construction 3.00 x = $
Underground sprinkler if existing dwelling 30.00 x = $
Water closet 3.00 x = $
Water heater 3.00 x = $
Water softener if dwelling under construction 5.00 x = $
Water softener if existing dwelling 30.00 x = $
Water turnaround 30.00 x - _ $
State Surcharge 50 $ 50
Total $ 3_0 - 5T_1
Reminder. Call for inspections of alterations, i.e. water heaters, water softeners, etc.
I hereby acknowledge tliai i Have read this application, state that the information is correct, and agree to comply with all appficahte City of Eagan oniinarioea
It is the applicant's responsibility to notify the property owner that the City of Eagan assumes no liability for any damages caused by the City during its
normal operational and maintenance activities to the facilities constructed under this permit within City property/right-of-way/easement.
SITE ADDRESS: (
_h `0qo /~YVIC~hys ~h
OWNER NAME:: DaM E felaild -TELEPHONE
(AREA CODE)
INSTALLER NAME: l\ I TELEPHONE
(AREA CODE)
STREET ADDRESS:
CITY: STATE: _ ZIP:
IGNATURE OF PERMITTEE
,7-5y 10 CITY USE ONLY
L BL RECEIPT#:
SUBD. RECEIPT DATE. -7
PERMIT#
2000 PLUMBING PERMIT (RESIDENTIAL-
CITY OF EAGAN
3830 PILOT KNOB RD "I r
EAGAN, Pod 55122 ~j V O
651-681-4675
l I
Please complete for: > single family dwellings \
> townhomes and condos when permits are required for each unit C~
> backflow preventer for underground sprinkler system /
FIXTURES EACH # TOTAL
Alterations to existing dwelling - minimum fee $ 30.00
Describe:
Bath tub $ 3.00 x = $
Floor drain 3.00 x = $
Gas piping outlet * minimum - 1 3.00 x = $
Hot tub/spa 3.00 x = $
Kitchen sink 3.00 x = $
Laundry tray 3.00 x = $
Lavatory 3.00 x = $
Septic System new/refurbished "requires MPC lic. 75.00 x = $
Septic System abandonment 30.00 x = $
RPZ new installation/repaidrebuild 30.00 x = $
Rough opening 1.50 x = $
Shower 3.00 x = $
Underground sprinkler if dwelling Is under construction 3.00 x = $
Underground sprinkler if existing dwelling 30.00 x = $
Water closet 3.00 x = $
Water heater 3.00 x = $
Water softener if dwelling under construction 5.00 x = $
Water softener If existing dwelling 30.00 x = $
Water turnaround 30.00 x $
State Surcharge .50 $ .50
Total a $
Reminder.- Call for inspections of alterations, i.e. water heaters, water softeners, etc.
- - - - - -
I hereby acknowledge that I have read this appligtion, state that the information is cored, and agree to comply wah all applicable City of Eagan ordinances.
It is the applicant's responsibility to notify the property owner that the City of Eagan assumes no liability for any damages caused by the City during its
normal operational and maintenance activities to the facilities' constructed under' this., permit within City property/right-of-way/easement.
SITE ADDRESS: L
(~J~T -rA
OWNER NAME:: ~Xl Q ~TI ti'C~1 0.1 TELEPHONE* UVN • -I
(AREA CODE)
C~ `
INSTALLER NAME: TELEPHONE ! 1. b51 , O 5~~"
X 1
D
(AREt
STREET ADDRESS:
CITY: ~~1~CYYS~11 STATE: mn ZIP:
~`6IS,~ 1
*SAT'RRE OF RMITTEE
CITY USE ONLY
` PERMIT RECEIPT DATE: 7-L-Q)
RUIDENTL kL M£CHMICAL PERMrr > PPI ICATION
crrYoP iBmm
s8so PD.or KNos $D
EAGM MN 55122
681-681-4675
Please complete for: A single family dwellings
-7 townhomes and condos when permits are required for each unit
Date: - c f 1
SITE ADDRESS: 4/0 'S
/
OWNER NAME: ~QVe „co" 641-1
TELEPHONE #:L- 93oY
/ f~ (AREA CODE)
INSTALLER NAME: pAJb(n11fr0 CQ i/ TELEPHONE Co51'
JJ II (AREA CODE)
STREET ADDRESS:
~lfs AUP
CITY: ~/,.I STATE: ZIP: ~~pay
Place a check mark next to the permit work type
New residential dwelling unit under constructionand not owner/occupied $ 70.00
_ Add-on, modification or alteration to existing dwelling unit $ 50.00
• furnace replacement
• air exchanger
• air conditioner
• other L/
Nature of work: A-_ I qr e / Q G ~YE.'QTS 7`"S
//0
$ 50
State Surcharge
Total $
Reminder: Call for inspections.
zn~ -
SIGNATURE OF ERMITTEE
Updated 1/DI
CITY USE ONLY
PERMIT RECEIPT DATE:
APPROVED BY: INSPECTOR
COMMERCIAL MECHANICAL PU MIT APPLICATION
arYoF $14am
3$30 PILOT KNOB RD
EALffikN, MN 55122
651-681-11675
Please complete for: all commercial/industrial buildings
multi-family buildings when separate permits are not required for each dwelling unit
DATE:
SITE ADDRESS:
OWNER NAME: PHONE
(AREA CODE)
TENANT NAME (IMPROVEMENTS ONLY):
WAS THERE A PREVIOUS TENANT IN THIS SPACE? Y N. NAME:
INSTALLER:
ADDRESS: PHONE#: -
(AREA CODE)
CITY: STATE: ZIP:
WORK TYPE: New construction Install U.G. Tank
Interior Improvement Remove U.G. Tank
Processed Piping
Specify Nature of Work:
When installing/removing underground tank, call 651-681-4675 for inspection by Fire Marshal and
Plumbing Iinspector.
Fees: 1% of contract price OR $50.00 minimum fee, whichever is greater.
Underground tank removal/installation = minimum fee
Contract price: $ x 1%= $ (Base Fee)
State surcharge calculate at $.50 for each $1,000 Base Fee
TOTAL $
SIGNATURE OF PERMITTEE
Updated 1/01
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF E!AGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675
New Construction Requirements Remodel/Repair Requirements
• 3 registered site surveys showing sq. ft. of lot, sq. ft of house; and g_II roofed areas • 2 copies of plan
(20% maximum lot coverage allowed) • 1 set of Energy Calculations for heated additions
• 2 copies of plan showing beam & window sizes; poured found design, etc.) 1 site survey for exterior additions & decks
• 1 set of Energy Calculations Indicate if home served by septic system for additions
• 3 copies of Tree Preservation Plan if lot platted after 71V93
• Rim Joist Detail Options selection sheet (bldgs with 3 or less units)
DATE L VALUATION "~BJ~~ ~v(
SITE ADDRESS / 4 L~O / t YY1 ~~1~/S aYI C MULTI-FAMILY BLDG _Y _ N
TYPE OF WORK ear ofd G(t~, _'5Rf C: ~ 4Z_ FIREPLACE(S) _ 0 _ 1 _ 2
M 9: r•~~t,l
APPLICANT IN )fS* t00
37
STREET ADDRESS _(a~CsCr ',ver ~c ~U~v~• CITY~vnSA1f STATE /16) ZIP-553
TELEPHONE # K?-JQyP_,?(0 r0 CELL PHONES # 6/a'250-LV FAX # 9-2-66- 077 1
PROPERTYOWNER ~ren~a y Slav GT~t 1cA~~ TELEPHONE# 651'252-9-30
COMPLETE FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNESOTA RULES 7670 CATEGORY I _ MINNESOTA RULES 7672
(4 submission type) • Residential ventilation Category 1 Worksheet Submitted New Energy Code Worksheet Submitted
• Energy Envelope Calculations Submitted
Plumbing Contractor: Phone #
Plumbing system includes: Water Softener Lawn Sprinkler Fee: $90.00
Water Heater _ No. of R.I. Baths
No. of Baths
Mechanical Contractor: Phone #
Mechanical system includes: Air Conditioning Fee: $70.00_1
Heat Recovery System
Sewer/Water Contractor: Phone # 1 9'
LI
I hereby acknowledge that I have read this application, state that the information is correct, andQggee- o-comply
with all applicable State of Minnesota Statutes and City of Eagan Ordinances. -
Signature of Applicant
OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4/02
OFFICE USE ONLY
❑ 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 - Multi
❑ 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 (screened) ❑ 36 Multi
❑ 05 03-plex ❑ 11 10-plex ❑ 19 Lower Level ❑ 24 Storm Damage
❑ 06 04-plex ❑ 12 12-plex Plbg_Y or _ N ❑ 25 Miscellaneous
❑ 31 New ❑ 35 Int Improvement ❑ 38 Demolish (Interior) ❑ 44 Siding
❑ 32 Addition ❑ 36 Move Bldg. ❑ 42 Demolish (Foundation) ❑ 45 Fire Repair
❑ 33 Alteration ❑ 37 Demolish (Bldg)' ❑ 43 Reroof ❑ 46 Windows/Doors
❑ 34 Replacement *Demolition (Entire Bldg only) - Give PCA handout to applicant
Valuation Occupancy MC/ES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
- Footings (new bldg) _ Final/C.O.
Footings (deck) _ Final/No C.O.
- Footings (addition) _ Plumbing
_ Foundation I-I
_ VAC
_ Drain Tile Other
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests _ Final
Framing _ Siding _ Stucco _ Stone
Fireplace _ R.I. _ Air Test _ Final _ Windows (new/replacement)
- Insulation _ Retaining Wall
Approved By Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
r '
W I
ra 3 503 (4S
i¢ a
o sz W p w C, 'r W 0
W Z W Ln m 2 LL W LR > _
¢ a
U
11W 0
7 Z W= < cc W yVj n
0 1 z • d Z I U f>f~~"
r0a0 Z W li.
W W
x-00¢ ¢ Z m 1- O
M<mw zLL~F j< a I ¢o
vo w Jo.~+' W y zo
o c o o LL a z ;=~TACcIIT°rTf
DRAINAGE AND UTILITY EASEMENT
THIS EASEMENT, made this a kqa 2' be an wife
erre o as ahdowner an
DAVID EFTELAND and BRENDA EFTEL,AN17 iei'ein er re
"Of
the CITY OF EAGAN, a municipal corporation, organized under the laws of the State of
Minnesota, (hereinafter referred to as the "City"),
WITNESSETH:
That the Landowner, in consideration of the sum of One Dollar ($1.00) and other good
and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, does
hereby grant and convey unto the City, its successors and assigns, a permanent drainage and
utility easement, over, across and under the following described premises, situated within Dakota
County, Minnesota, to-wit:
A permanent drainage and utility easement over the east 10' of Lot
18, Block 10, Cedar Grove 5.
The grant of the foregoing permanent easement for drainage and utility purposes includes
the right of the City, its contractors, agents and servants to enter upon the premises at all
reasonable times to construct, reconstruct, inspect, repair and maintain pipes, conduits and mains;
and the further right to remove trees, brush, undergrowth and other obstructions. After
completion of such construction, maintenance, repair or removal, the City shall restore the
premises to the condition in which it was found prior to the commencement of such actions, save
only for the necessary removal of trees, brush, undergrowth and other obstructions.
And the Landowner, its successors and assigns, does covenant with the City, its
successors and assigns, that it is the Landowner of the premises aforesaid and has good right to
grant and convey the easement herein to the City.
R9P"r- !V ±7
JAN ' I
~N ?13Ci
IIAI I A COuh .
T~ojroa
IN TESTIMONY WHEREOF, the Landowner has caused this easement to be executed
as of the day and year first above written.
DAVID EFTELAND
&44) fsk--i BRENDA EFTELAND i
STATE OF MINNESOTA)
)ss.
COUNTY OF
The foregoing instrument was acknowledged before me this LS day of
y 1 2001, by DAVID EFTELAND and BRENDA EF FELANIR f.k/A--Brenda K.
Dinndorf, husband and wife. J
u
Nota Public
APPROVED AS TO FORM:
` JAWS E. FRUECF{tL
A" MY COMM1SS10N EXPIRES
City Attorney's Office "CRY 31, 2005
Dated:
APPROVED AS TO CONTENT: 6///, "Oz
P; ic Wefks Department
Dated:
THIS INSTRUMENT WAS DRAFTED BY:
SEVERSON, SHELDON, DOUGHERTY &
MOLENDA, P.A.
7300 West 147th Street, Suite 600
Apple Valley MN 55124
(952) 432-3136
(fiWsement #945)
(206 - 19117)
2
SEVERSON,SHELDON,
DOUGHERTY & MOLENDA, P.A.
SUITE 600
7300 WEST 147TH STREET
APPLE VALLEY, MINNESOTA 55124-7580
(952) 432-3136
TELEFAX NUMBER (952) 432-3780
E-MAIL buerrr@se monsheldon.com
TO: John (x r, Assistant City Engineer
FROM: Robert B. Bauer, City Attorney 1-721/
DATE: March 16, 2004
RE: Cedar Grove - July Storm
Project 815
Our File No. 206-19117
John,
Enclosed for the City's records in connection with the above-referenced matter, please find the
following original documents:
A. Drainage and Utility Easement between Lawrence Glerum and Patricia
Glerum and the City of Eagan dated June 25, 2001 and recorded with the
Dakota County Registrar of Titles Office on, June 20, 1003 as Document
No. 503749 (Easement No. 931); upU /
B. Drainage and Utility Easement between Andrew J. Brown and Patricia
Brown and the City of Eagan dated June 20, 2001 and recorded with the
Dakota County Registrar of Titles Office on June 20, 2003 as Document
No. 503751 (Easement No. 934); q0 o I f•;;. ez- 1,%P"=-
C. Drainage and Utility Easement between Charles E. Barney and Delva
Barney and the City of Eagan dated June 15, 2001 and recorded with the
Dakota County Registrar of Titles Office on June 20, 2003 as Document
No. 503742 (Easement No. 935); yo 5 i111 _ _ ;I z I a-
D. Drainage and Utility Easement between George L. Hunnel and Debra K.
Hunnel and the City of Eagan dated June 14, 2001 and recorded with the
Dakota County Registrar of Titles Office on June 20, 2003 as Document
No. 503748 (Easement No. 936); yp lq L r k"(,t ~ 61e.
E. Drainage and Utility Easement between Robert L. Saalborn and Carol
Saalbom and the City of Eagan dated June 13, 2001 and recorded with the
Dakota County Registrar of Titles Office on June 20, 2003 as Document
No. 503 746 (Easement No. 93 8); yp y A,,r,, - '
F. Drainage and Utility Easement between Dennis Fischbach and Jacquelin
Fischbach and the City of Eagan dated June 13, 2001 and recorded with
the Dakota County Registrar of Titles Office on June 20, 2003 as
Document No. 503744 (Easement No. 939); yp a e ~t y s = a
G. Drainage and Utility Easement between Gerald Albright, Jr. and Theresa
Albright and the City of Eagan dated June 13, 2001 and recorded with the
Dakota County Registrar of Titles Office on June 20, 2003 as Document
No. 503747 (Easement No. 940); yb;/ ~lm~r~ysf ~n
H. Drainage and Utility Easement between Brent A. Bartsch and Kristen K.
Bartsch and the City of Eagan dated June 12, 2001 and recorded with the
Dakota County Registrar of Titles Office on June 20, 2003 as Document
No. 503745 (EasementNo. 941); /coo tea
1. Drainage and Utility Easement between Bob J. Stein and Judy A. Stein
and the City of Eagan dated June 13, 2001 and recorded with the Dakota
County Registrar of Titles Office on June 20, 2003 as Document No.
503743 (Easement No. 942);
J. Drainage and Utility Easement between David J. Ryan and Caryl A. Ryan
and the City of Eagan dated June 12, 2001 and recorded with the Dakota
County Registrar of Titles Office on June 20, 2003 as Document No.
503750 (Easement No. 943); and 7p rcr.,e jr~M a.
K. Drainage and Utility Easement between David Efteland and Brenda
Efteland and the City of Eagan dated June 25, 2001 and recorded with the
Dakota County Registrar of Titles Office on June 20, 2003 as Document
No. 503741 (Easement No. 945). L40go FmrfJ~s4
es r
2
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA118606
Date Issued:11/05/2013
Permit Category:ePermit
Site Address: 4040 Amethyst Lane
Lot:18 Block: 10 Addition: Cedar Grove 5th
PID:10-16704-10-180
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 .
Robert Antonsen
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 -
David Efteland
4040 Amethyst Lane
Eagan MN 55122
Antonsen Construction Inc
411 marie Ave Ste B
South St Paul MN 55075
(651) 340-1791
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA152698
Date Issued:10/26/2018
Permit Category:ePermit
Site Address: 4040 Amethyst Lane
Lot:18 Block: 10 Addition: Cedar Grove 5th
PID:10-16704-10-180
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.
Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener).
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
$60.00 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 -
David Efteland
4040 Amethyst Lane
Eagan MN 55122
(651) 452-9304
Champion Plumbing
3670 Dodd Rd., #100
Eagan MN 55123
(651) 365-1340
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA153819
Date Issued:01/24/2019
Permit Category:ePermit
Site Address: 4040 Amethyst Lane
Lot:18 Block: 10 Addition: Cedar Grove 5th
PID:10-16704-10-180
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Air Conditioner
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
Surcharge-Fixed $1.00 9001.2195
$60.00 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 -
David Efteland
4040 Amethyst Lane
Eagan MN 55122
(651) 452-9304
One Hour Heating & Air
11825 Point Douglas Rd S
Hastings MN 55033
(651) 437-4177
Applicant/Permitee: Signature Issued By: Signature