4046 Amethyst Lane
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3830 Pilot Knob Raad, P.O. Box 21-199, Eagan, MN 55121
PHON E: 454-8100 ,
BUILDING PERMIT Receipt #
To be used for Est. Value Date ,19
Site Address
Lot Block Sec/Sub. ''f?'"? GF :?VL• 5'I!i
Parcel No.
oc Name '
W
; Address
° City Phone ?';7r
a Name ` .
O
? i Address
P City Phone
...--
FW Name '
? ? Address
g W City Phone
OFFIC E USE ONLY
On Site Sewage _ Occupancy
MWCC System _ Zoning
On Site Well _ Type of Conet
City Water _ (ActuaD
(Allowable)
* of Stories
L
th
eng
Depth
S.F. Total
Foatprint S.F.
APPROVALS
Assessments _
Water/Sewer _
Police -
Fire _
Engr. _
Planner _
Council _
FEES
Permit
Suroharge
Plan Review
SAC, City
SAC, MWCC
Water Conn.
Water Meter
Road Unit
Treatment P1
Parks
Copies
TOTAL
$7R, ,
I hereby acknowledge that I have read this application and state Bldg. Off. _
that the information is Correct and agree to comply with all applicable I A? -
State of Minnesota Statutes and City of Eagan Ordinances. Variance _
Signature of Permittee
i c:-•.i;, u:,.? .
A Building Permit is issued to: . on the express condition that
all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building Official
Permit No. Permit Holder Date Telephone ?
Plumbing
H.V.A.C.
E lectric
Softener
Inspection Date Insp. Comments
Footings I 9?Y? ? ?-
Footings 11
Foundation
Framing /1GCis 3 - .z?+'! a OJi • /
Roofing O .?
Rough Plbg.
Rough Htg.
Isul.
Fireplace
Final Htg. ?
Finel Plbg.
Bldg. Final
Cert Occ.
Temp. LP
Deck Ftg.
Dock Frmg.
Well
Pr. Disp.
CITY OF EAGAN Remarks * Cedar Gz+ove Acql1isit].on
Addition CEI]AR GI20VE #5 Lot i.9 Blk 10 Parcel 10 16704 190 10
I Ownep-- Street 4046 AmethYSt L3rie State rA9an• I"IN 55122
Z --
Improvement Date Amount Annuai Years Payment Receipt Date
STREET SUR F.
STREET RESTOR.
GRADING
5AN 5EW TRUNK 30 ? 1967 100.00 5.00 20 Pa].d
SEWERLATERAL j?ad 1967 540.00 27.00 20 Pdld
WATERMAIN
* WATERLATERAL f(ol 1972 607.00 24.28 25 Paid
WATER AREA
STORM SEW TRK 21111 1974 70.00 4.66 PSid
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER,
SAC 200.00
PARK
CITY OF EAGAN N° 1413 4
3830 Pllot Knob Road, P.O. Box 21-199, Eagan, MN 55121
' PHONE:454•8100 --] --I ' ::;z I
BUILYIING PERMIT Receipt#
Tobeusedfor GARAGE/DECK EstValue $8>000 Date SEPTEMBER 8 19 87
SiteAddrass 4046 AMETHYST LN
Lot 19 Block 10 Sec/Sub. CEDAR GROVE STH
Parcel No.
a Name TOM BENSON
; Address SAME
0 City Phone 454-2376
o Name M& S HOME IMPROVEMENTS
,
?a Address 946 SD SMITH
: City W ST PAUL phone 457-3052
w W Name
fw
i?
Address
a W City Phone
OFFICE USE ONLY
On Site Sewage _ Occupancy
MWCC System _ Zoning
On Site Wall _ Type of Const
Ciry Water _ (ACtuaq
(qllowable)
n of Srories
Length
Depth
S.F. Total
Footprint S.F.
APPROVALS
Assessments
Water/Sewer
Police
Fire
Engr.
Planner
Council
FEES
- Permit
Surcharge
- Plan Review
_ SAG City
- SAC,MWCC
_ WaterConn.
_ Water Meter
_ Road Unit
- Treatment Pt
_ Parks
Copies
TOTAL
$79.50
4.00
I hereby acknowladge that I have read this application and state 81dg.Off.
thattheinformationiscorrectandagreetocomplywithallapplicable I APC
State of Minnesota Statutes Cijy ag?n Ordi ces. Variance
Signature of Permittee
a?
A Building Permit is issued to: M. & J. HOME IMPROVEMENTS
all work shall be done in accordance with all applicable/9tate of MinnesqMStatL
on the express condition that
and City of Eagan Ordinance&
Building
EAGL.N TOtdNSHIP
3795 Pilot Knob P.oad
5t. Paul? TRinnesota SSill
Telephone 454-5242
PERMIT_ POR SE4dER SERVICE COD!NECTIOTI
DATE• MA,g ?(, 1968 ,w-
06J14ER: _(:cdar_Grova Gonat_ Co_
PLUMBER 4t.oinv? Tn?_
NUMBER 173
P.ddress $O46 Amethvst Lna (12-10-5)
TYPE OF PIPS cast iron
DFSCRIPTION OF BUIIAING
Industriall Commerciall Residential I rYultiple Dwelling I No, of units
x
Location of Connections:
Connection Charge 8200.0o Pd. 5/20/65
PermiC Fee 7.50 "
Street Repairs
Total 207.50 "
Inspected by:
Date
Remarks•
By
Chief InspecYOr
In considaration of the issue and delivery to me of the above pezmiY, I
hereby agree Co do the proposed work in accordance with the rules and
regulations of Eagan Tormship, Dakota County, Minnesota
By Stgj4s. Inc.
Please notify when ready for inspection and connection and before any portion
of the work is covered.
1987 BDILDING PERMIT APPLICATION - CITY OF EAGAN
SINGLE FAMILY DWELLINGS
IRCL[TDE 2 SETS OF PLANS, 3 CERTIFICATfiS OF SIIROEX, 1 SST OF ENERGY C9LCOLATIONS
PIOTE: 6DD&ESSES FOH CORNER LOTS - C06TTRACTOR/HOMEOWNER MIIST DESIGAATE WHICH ADDRESS
IS DFSIRfiD. NO CH9PTGES HILL BE ALLOWED ONCfi BUILDING PERMIT 23 ISSDED.
MOLTIPLE DWELLINGS - RSSIDENTIAL RENTAL 0NITS FOR SALE 0NITS
INCLUDE 2 SETS OF PLANS, CERTIFIC9TE OF SORVEY - CHECS WITH BLDG. DEPT.,
t SET OF ENERGY CALCULATIONS
COPMERCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
7 SET OF SPECIFICATIONS AND 1 SET OF
ENERGY CALCULATIONS,
$2,000 LANDSCAPE BOND
tv °-
To Be UsedhFor:?TFk-kt Oa,Qa?.P 4 10eeKValuation: ?OC'`J Date: 9-3- g
--o
Site Address '/ 0 Y(' '0 A, f,u tf OFFICE USE ONLY 1
Lot / ? Block / o
Parcel/Sub Ce4Q GV'OVe /X ,j
Dwner T5,tj '6 e?so---I
Address 4/6 Yb 4vy`f4 r/S? 44?1
City/Zip Code li cSSra --?
-d`
Phone ?/ -- ou 2 ?
/YI 4
Contractor ?l'I,;(?.? J-?a ??.<<2so-?
Address g yG .5? -/ h
City/Zip Code W. f't 1""'f/ 3f
/Phone ?.S ? - 3 D /S ?
Arch./Engr. /1-/b
Address
On Site Sewage_ Occupancy M_\
MWCC System _ Zoning
On Site Well Type of Const
City Water _ (Actual) V-0
(Allowable) V'N
4l of Stories
Length
Depth
S.F. Total
Footprint S.F.
APPROVALS FEBS
Assessments Permit 97150
Water/Sewer Sureharge y,00
Police Plan Review
Fire SAC, City
ngr SAC, MWCC
?
lanner Water Conn
Council Water Meter
Sldg Off Road Unit
APC Treatment P1
Variance Parks
Copies
TOT9L
City/Zig Gode
Phone #
DecK 14?L1' 196 x8= 1568 `,.. ? '+?
6,Pl? Z2 x z,o - yyowY= 6,160
?/ /? l l 7 1
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ENGINEERIN , INC.
_ •,???•?;?? ?? ?I?????L????ti ( ????? ?????C???? ?'?'_ ? '
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Mortgage Loan Survey foa
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f
LOT BLOCK CEDAR GROVE 'No.? 5
? DAKOTA COUNTY
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?!'qQ tuCld ,nRtC p4t'? ?,? ?:? "i .Oh ?;/ ? U?a.nrfJ /UP,o? T.,
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?y 3
PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOIvES AND
COND05 WHEN PERMITS ARE REQUIRED FOR EACH UNTT•
SITE
NO. FIXTURES EACH
SHOWER 3•00
WA'I EP? CLQSET 3.00 _ .Y..
BATH TUB 3.00
LAVATORY 3•00
KITCHEN SINK 3•00
LAUNDRY TRAY 3•00
HOT TUB/SPA 3•00
= WATER HEATER 3•00
FLOOR DRAIN 3.00
GAS PIPING OUTLET • minimum - t 3.00
ROUGH OPENINGS 1.50
WATER SOFTENER 5.00
PRIVATE DISP. • Dekcty. rc. 15.00
U.G. $PRINKLER • nome undu consL 3.00
ALTERATIONS • w oisting 15•00
WATER TURN AROUND 15.00
STATE SURCHARGE .50
TOTAL: ?
OWNER NAME:
INSTALLER: aGo'('nFlK ? @71rM01`a
190.5 GARPreELD AlJENUE SOUTH
ADDRE3S: . -
CITY
PHONE?
7 70-df3
- d,a1c
R27?9tNTE; ZIP CODE:
6NNNN?AA RE OF PERMITTEE
1993 PLUMBING PERMIT (R,ESIDEIVT7AL)
C1TY OF EAGAN
3830 PIIAT KNOB RD
EAGAN MN 55122
(612) 6814675
???,6h??1L•,•?r •v)?
?4/.'...r..... .?........ ?
1993 PLUMBING PERMIT (COMMERCIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN MN 55122
(612) 6814675
PLEASE COMPLETE FOR ALL COMbERCIAI,RNDUSTRIAL BUILDINGS. ALSO FOR MULTI-
FAMILY BUII.DINGS WHEN SEPARATE PERMTfS ARE NOT REQUIRED FOR EACH
DWELLING UNTT.
_ NEW CONSTRUCI'ION
ADD OAT
REPAdR
WORK DESCRIPTION:
CONTRACT PRICE: $
FEE: 1% OF CONTRACT FEE.
STATE SURCAARGE: $.50 FOR FACH $1,000 OF FEE
MINIMUM FEE: $ 25.00
CONTRACT PRICE X 1%
STATESURCHARGE
TOTAL
SI1'E ADDRESS:
TENANT NAME:
OWNER NAME:
WSTALLER:
ADDRESS:
CITY:
PHONE #:
STATE:
ZIP CODE:
$
$
STE. #
FOR:
CITY OF EAGAN APPLICANT
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- city of eagan
MEMO
T0: DIANE DOWNS, UTILITY BILLING CLERK
FROM: ED KIRSChIT, SR. ENGINEERfidG TECIiNfCIAN
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 ?
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
RESIDENTIAL BUILDING
Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX 4 651-675-5694
New Construction ReouiremenGS RemodellReoair Reuuiremems Office Use Onlv
3 registeretl site surveys showing sq. ft of IoL sq. ft. of house, and all roofed areas 2 copies of plan Cert ot Survey Recd
(20% maximum lot cove2ge allowed) 1 set of Energy Calculahons for healed additlons Tree Pres Plan ReaJ
2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey for addihons & decks Tree Pres Not Reqd
1 set of Energy Calalations Add"rtfon - indica(e Son-site sepht sysfem _ Oo-site Septic System
3 copies of Tree Preservation Plan 'rf bt platted after 7l1193
Rim Joist Detail OpUons selection sheet (hldgs with 3 or less units
Date ConstruMion Cost
Site Address L10 L) (-, 4 S? c. r? UniUSte #
Description of Work _ ?Q.np--k h LPf„ LA, \? ?•J? C ,i (/1 ?r? ?
Multi-Family Bldg _ Y _KN Fyreplace(s) ? 0 _ 1 _ 2
Property Owner ? n i-. Telephone
Contractor
Address City
State M 1/1 Zip Telephone# ((i'? ) q:) D '? 1a?
(? 1 V19. 4S__
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(J submission type) Submitted Submitted
• Energy Envelope CalculaGons Submitted
Licensed Ptumber
7elephone #(
Mechanical Contractor
Sewer/Water Contractor
Telephone #(
Telephone #(
I hereby apply for a Residential Building Permit and acknowledge that the information is compleYe and accurate;
that the wark 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. n n n
C ?N C?/1 R 1'I I (? J rNV, (1/" A"- ? 1
ApplicanYs Printed Name Apphcant's Signatnre?6
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 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 PorchlAddn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex p 10 OS-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 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 Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alteratlon ? 37 Demolish (Bldg)* ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement `Demolition (Entire Bldg) • 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) FinaUC.O.
_ Footings (deck) FinaUNo C.O.
_ Foorings(addition) Plumbing
_ Foundahon HVAC
_ 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)
_ Insulauon _ Retaining Wall
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
Building Inspector
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;NW_l 's '`;OUWTY
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DRAINAGE AND UTILITY EASEMENT
?
TffiS EASEMENT, made this day of ? v 2001, between
THOMAS S. BENSON and CARLA L. BENSON/"AMY - f&Wto as "Landowner"), and
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 perxnanent drainage and
utility easement, over, across and under the following described premises, situated within Dakota
County, Minnesota, to-wif:
A permanent drainage and utility easement over the east 10' of Lot
19, Block 10, Cedar Grove 5.
The grant of the foregoing permanent easement far 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 construcrion, 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, undergowth 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.
F2ECEIVEd - MAIL
N10V 05 2603
osdcorH cour+rr
TREASURER-AUDITOR
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DRAINAGE AND UTILITY EASEMENT
THIS EASEMENT, made this 3 _ day of ??Q v\e, , 2001, between
_
THOMAS S. BENSON and CARLA L. BENSON/?W?ffM ffiff to as "Landowner"), and
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 aclmowledged, 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
19, Block 10, Cedar Grove 5.
The grant of the foregoing permanent easement for drainage and utility purposes includes
the right of fhe 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.
RECEIVED - MAIL
() ;
DAKO7A COUNTY
TREASURER-AUDITOR
IN TESTIMONY WHEREOF, the Landowner has caused this easement to be executed
as of the day and year first above written.
???'1^''? ? ?11?a s?
T MAS S. BEN ON
?
C A L. BENSON
STATE OF MINNESOTA)
)ss.
COUNTY OF b
The foregoing instrument was acknowledged befare me this ?A day of
?-? v.... 12001, by THOMAS S. BENSON and CARLA L. BENSON, husband
and wife. ?
Nota Public
APPROVED AS TO FORM:
,?"? JAMES E. FRUECHPL
?.? raoramaueuc-uir?som
? / / AA1' COMMISSION IXPIRES
l?? ?._??_ JANUARY 31. 200.5
City Attomey's Office ?
Dated: 9//0 ( ,)/
APPROVED AS TO CONTE T:
Dated: ?? ?21
lic Wo s Department
'l
THIS INSTRUMENT WAS DRAFTED BY:
SEVERSON, SHELDON, DOUGHERTY &
MOLENDA, P.A.
? 7300 West 147th Street, Suite 600
Apple Valley MN 55124
(952) 432-3136
( FUsement Aq44 )
(206 - 19117)
i--.,--.-------------,
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? Permit#:
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? PermitFee: ?%U-
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? Date Received: j - ? 7 ?
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?-----------------
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
oace: 3 l?7 n? sieeaaaress:
Tenant• a._. Suite
RESIDENT/OWNER Phone:(nsl
Name:CrIV-a &'1^.5c')
)
Address / City / Zip: -1C7!(O y? f"1Me??l ( l S?
Applicant is: _ Owner ?&ntractor
TYPEOFWORK Descriptionafwork: °}'ehh, C-F o
w 1 w.?
(1,
1C?
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Construction CosL Mul6-Family Building: ( es
CONTRACTOR Name: '?ra U 1 ? 1(i%'1 CnY; ,,4Y,"hnrVLicense #: 00q0oZ 25.V4
K
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Address:
1oZ.
cl')ro`lCi y)1 (&Ic.r,
: S J 1 oZ-
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YI State
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Cit
GC
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p
y:
:
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Phone:?- ? ? Y`5 .? •?? 1 b Contact Person:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Cateoorv 1 Minnesota Rules7672
EnCYgy Code . Residential VeMilation Category 1 Worksheet ? New Energy Code Worksheel
Category sutmmed suarn;ned
(4 submisslOn type) • Energy Envelope Calculations Submiled
In the lest 12 months, has the CRy ot Eagan Issued apertnlt tor a simlNr plan based on a master plan9
_Yes _No If yes, date and address of master plan:
Llcensed Plumber: Phone:
Mechanlcal Contractor: Phone:
Sewer & Watar Contractor: Phone:
:-
t? A
I hereby acknowletlge that this Intormation is comWete and accurate; tliat ihe work will 6e in conformance wilh the oNinances and codes of ihe City of
Eagan: Mm I understand this is not a permit, 4rt only an applicatian for a pertnit, arW work is not to start wiUqul a permi[; that ihe work will he in
accaMance with the approved plan in the case of +wrk which requirea a review and approval of pans.
Tza'elw X r.h,. ??---
canPs PAnted Name Appikant's fgnature
Page 1 of 3
a , 4
Use BLUE or BL/lCK Ink
------------------
� F�Office Use �
�`} �t 1 Permit#: /� l-/((/� I
6� O� �i���Il RECEIVED � ,
� Permit Fee. �� �
3830 Pilot Knob Road 'UL � � ���� I I
Eagan MN 55122 I Date Received: ' ' �
Phone:(651)675-5675 � �
Fax:(651)675-5694 � Staff: _ �
L--------------- �
2014 RESIDENTIAL BUILDING PERMIT APPLICATION � ,j
��i '
Date: Site Address: Unit#:
Name: C, A � `E! �e v� S v l�v Phone: (01?- �?q - J?�o(�
Residerrtl �1 1� �
�W��' Address/City/Zip: b (� I* r+�e"'f �1 +. �
Applicant is: Owner �Contractor
Description of work: �1 t �O �1'�[ C�1 iA�n�..p F�y+u r19 '�'�,�}v � �T"`.S'
7ype af Work
Construction Cost: � l� �� Multi-Family Building:(Yes /No�
Q { 1,„
Company:��k�'! V��✓- �O t�, �-a �-5 fi Contad: �i),P �
C011#P1C#01" Address: y 3�o� I{A cy�✓si�.h i-� � �4 t, Ciiy: ��1-t= ��-�-
F�ff �/�
State:�►.. Zip:,,�'��-,� Phone: �l!�a..-,�j�Email: �1�) �CAtl�trt � �,brtic�5�.�'
' �icense#: �G Yc� af� ,3'� Lead CeN3ficatie#: �la-fi—,s'b a� 6 - �
If the project is exempt from lead certification, please explain why: (see Page 3 for additional informatianj
��� v �J'
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 mor�ths,has the City of Eagan issued a pertnit 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 8 Water Contractor: Phone:
Nt�TE.Plans antl suppartFng dacuments that ycr�submit ar�e+�c�nstdered#c�be artbli+c irrfrrrmatfi4�:Poeti+arns vf
the ir�f�rmatror�may be class�ed a,�rrnn�e�b/ic�f yvu prorr�de spec�c r+sasoa�s#��t wauld p�enrrit#/��City to '
' c�ncluxte tt�at#h are trac�l�s�cr��,s.
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. uvww.gopherstateonecall.orq
I hereby adcnowledge that this informffiion is canplete and accurate;that the work will be in confomiance with the orclinances 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 m� � A-e �C�e►� x_��.� ��
ApplicanYs Printed Name ApplicanYs Signature
Page 1 of 3
. �o�� ��r
DO NOT WRITE BELOW THIS LINE �a r���
SUB TYPES
_ Foundation _ Fireplace _ Porch(3�eason) _ Exterior Alteration(Single Family)
_ Single Family _ Garage _ Porch(4-Season) _ Exterior Alteration(Multi)
_ Muf6 _ Deck _ Porch(ScreeNGazebo/Pergola� _ Miscelfaneous
_ 01 of_Plex _ Lower Level _ Pool T Accessary Building
WORK TYPES
_ New _ Interior Improvemerrt _ Siding _ Demolish Building"'
_ Addition _ Move Building _ Reroof _ Demolish Interior
_ Alteration _ Fire Repair _ Windoars _ Demolish Foundation
_ Replace _ Repair _ Egre,ss�ndow _ Water Damage
_ Retaining Wali "Demolition of entire building-give PCA handout to appiicarrt
DESCRIPTION
Valuation i�"''� Occupancy ��,,, �,� MCES System
Plan Review Code Edition SAC Units
(25%_100%�J Zoning City Water
Census Code Stories Boaster Pump
#of Units Square Feet PRV
#of Buiidings Length Firre Sprinkiers
Type of Construction � Width
REQUIRED INSPECTIONS
Footings(New Building) Meter Size:
Footings(Deck) Final/C.O. Required
Footings(Addition) � Final/Na C.O.Required
Foundation HVAG Gas Service Test Gas Line Air Test
Roof:_Ice&Water _Final Pool:_Footings AidGas Tests _Final
Framing Drain Tile
Fireplace:_Rough In Air Test _Final Siding:_Stucxo Lath _Stone Lath _Brick
'"� Insulation Windows
� Sheathing Retaining Wall:_Footings_Backfill_Final
Sheetrock Radon Control
Fire Walls Erosion Gontrol
Braced Walls f,,. Other.
Reviewed By: �/ Building Inspector
RESIDENTIAL FEES
Base Fee �
Surcharge ��^��
Plan Review �
MCES SAG ��-
City SAC ��``�
Utility Connection Charge � �..'
S8�W Permit 8 Surcharge � � Ci
Treatment Plant + r �
�'� ��
copies
TOTAL
Page 2 of 3
Use BLUE or BLACK Ink
� r————————————————�
I For Office Use �
� r,� I
� � Permit#: �� ���Y' I
Clty of Ea�a� ; . � ;
I Permit Fee: �� �
3830 Pilot Knob Road -� �3 'y i
Eagan MN 55122 � Date Received: I
Phone: (651) 675-5675 � I
Fax: (651 j 675-5694 L Staff: ____ _________i
2014 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: �`—� ����Site Address: �� `i � ��1 �y �
�'�
Tenant: Suite#:
; ;�W�
F�BSId�n�/C�W11�1' "' Name: Phone:
�a
' Address/City/Zip:
Name/�,�/��.e/�S'd�/ 1'D� U��1/1�(� License#: ��4� �D
G011tY1C�Ut' ', Address: 4� ���� � 7`�� City: �,�,/•-u�����L
State: Zip: ��/�Q,� Phone:l�� ��/ � �`f�
Contact �t � Email:
New �Replacement _Repair _Rebuild _Modify Space Work in R.O.W.
Type of:Ull„Qrk — —
Description of work: � ��� �����`�--
RESIDENTIAL
Water Heater
Water Softener
Lawn Irrigation �RPZ/_PVB)
P�t'111�t�T��4 Add Plumbing Fixtures�Main/_Lower Level)
� ��� �
Septic System
� �,,�,�ca�=.=, _NeW Water Turnaround
�
" `���" �� Abandonment
,�
RESIDENTIAL FEES:
$60.00 Water Heater, Water Softener, or Water Heater and Softener(includes$5.0o State Surcharge)
$60.00 Lawn Irrigation (includes$5.00 minimum State Surcharge)
$60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround*(includes$5.00 State Surcharge)
"Water Turnaround (add$200.00 if a 5/8"meter is required)
$115.00 SeptiC System New($10.00 per as built) (includes County fee and$5.00 State Surcharge)
TOTAL FEES $
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 ���/l� ���/%b x '
ApplicanYs Printe Name A cant's Sign e
; - o Cda - � ' -
I°����������� � i � o �� �l�i���I �iR� �.7��'. - �+C�t�rN� ���� '.
h�l li
Req�ired Inspectians: i Clnder�ro�'��f; l�ciu�'� In Air T��t �as T�st !Finaf '
����,:
M�ter Rela#ed l#ems �' �`Meter Siz�� � w ,, Racij���ead M�rt�m�t�r-, �taff.:
, � �a � , .. '��
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA137478
Date Issued:07/06/2016
Permit Category:ePermit
Site Address: 4046 Amethyst Lane
Lot:19 Block: 10 Addition: Cedar Grove 5th
PID:10-16704-10-190
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace & 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 -
Carla L Benson
4046 Amethyst Lane
Eagan MN 55122
(612) 839-3006
Blue Ox Heating & Air Llc
5720 International Pkwy
New Hope MN 55428
(612) 238-9709
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA148955
Date Issued:04/30/2018
Permit Category:ePermit
Site Address: 4046 Amethyst Lane
Lot:19 Block: 10 Addition: Cedar Grove 5th
PID:10-16704-10-190
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:Two or More Windows/Doors
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: 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 -
Carla L Benson
4046 Amethyst Lane
Eagan MN 55122
Renewal Andersen
1920 County Road C West
Roseville MN 55113
(651) 264-4777
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA174866
Date Issued:02/24/2022
Permit Category:ePermit
Site Address: 4046 Amethyst Lane
Lot:19 Block: 10 Addition: Cedar Grove 5th
PID:10-16704-10-190
Use:
Description:
Sub Type:Water Heater
Work Type:Replace
Description:Standard Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
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 -
Stephen M Hilyar
4046 Amethyst Ln
Eagan MN 55122
One Hour Heating & Air
11825 Point Douglas Rd S
Hastings MN 55033
(651) 437-4177
Applicant/Permitee: Signature Issued By: Signature