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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