4052 Amethyst Lane
Use BLUE or BLACK Ink
r------ -
1 For Office Use
i i
Permit l 1
Eap at o I Permit Fee:
3830 Pilot Knob Road
Eagan MN 55122 ~j j Date R * ad: t
Phone: (651) 675-5675 6 1 Staff: i
Fax: (651) 875-5694 C 1C L--- _ t
INFLOW NFILTRATION PERMIT APPLICATION
Plumbing / Sewer & Water
Date: Site Address: S ]W
Tenant: e\AV\ S' 1 0~J6-cA. Suite M
RESIDENT / OWNER Name: ngd- Phone:
Address / City t Zip: D e
Name: H t% ju n C~ j4 g !y a -'v jGe~ Tjt License#: QS 3 S i S Q i2
CONTRACTOR Address: T'. LO -A. ! ? City: ter. n
State: M N Zip:.S_C J D- Phone: b %i- 9 25 2
Contact: lyi yic :c 11 1 t-r Email: 1^111Ky j he tj r~4 j-+ D1, r+~t:~~
PLUMBING (Within the building envelope) SEWER $ WATER (Outside the building envelope)
TYPE OF WORK Sump Pump Repair Repair
Other. Other.
DESCRIPTION Description of work: Jr i#t w^ i n w v f
FEES
$55.00 / Each (includes $5.00 State Surcharge) TOTAL FEE $ SS- 00
*Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submlt.Ul repair costs for
reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors
can be found by visiting www.citvgfeastan.comiinftow, 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.Qocftenstateonecall.og
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.
AppiicanCs Printed Name Applicant's Signature
FOR OFFICE USE Reviewed By: Date:
Required Inspections: -Under Ground -Rough-In ____Final
twit 7
PERMIT #
MECHANICAL PERMIT RECEIPT #
rCONTRACT CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE:
PRICE: Y PHONE: 454-8100
Site Address C BLDG. TYPE WORK DESCRIPTION
Lot + Block Sec/Sub Res. New
Mult Add-on
Name Comm. Repair
Address Z !4~'~+' cl~~-o S
c City .%~✓~Ec` Phone Other
.7 if
FEES
Name
RES. HVAC 0-100 M BTU -$24.00
c Address ADDITIONAL 50 M BTU - 6.00
.F I (RES. HVAC INCLUDES A/C-ON NEW
p City Phone CONSTRUCTION)
GAS OUTLETS (MINIMUM - 1 PER PERMIT) - 1.50 EA.
TYPE OF WORK COMM/IND FEE - 1% OF CONTRACT FEE
Forced Air M BTU APT. BLDGS. - COMM. RATE APPLIES
TOWNHOUSE & CONDOS - RES. RATE APPLIES
Boiler M BTU MINIMUM RESIDENTIAL FEE - ALL ADD-ON &
Unit Heater M BTU REMODELS - 12.00
Air Cond. Z+ M BTU MINIMUM COMMERCIAL FEE - 20.00
Vent CFM STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
Gas Piping Outlets # BEYOND $1,000)
Other
FEE:
S/C: S N E E w
TOTAL
y, FO ITY OF EAGAN
CITY OF EAGAN Remarks- * Cedar Grove Acquisition
Addition CEDAR GROVE #5 Lot 20 Blk 10 Parcel 10 16704 200 10
Owner n ~i~ 3 ' rJ2~/ t Street 4052 Amethyst Dane State_ Eaain. MN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SUR F.
STREET RESTOR.
GRADING
SAN SEW TRUNK Z 1967 100.00 5.00 20 Paid
SEWER LATERAL 10 196 540.00 27.00 20 Paid
WATERMAIN
* WATER LATERAL 1972 607.00 24.28. 25 412.76
WATER AREA
STORM SEW TRK ~j 1974 70.00 4.66 15 42.04 C006560 6-4-79
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER.
SAC 200.00 761 5-17-68
PARK
This request void 6,
/„/~~SL,y~(~ V
18 months from Request Uat '1 Q~T Fire. No. Rough-in Inspection
Ys1s 0 Q R❑Ves ' n feadV Now ❑ War lWhrn (Ready ev
ffLicensed Electrical Contractor I hereby request inspection of above
Owner electrical work installed at
Street Address, Box or Route No. Crtv~ ^
Llcy 2- 4Mt,TM-/5 T` c6ii i /t
ecv on o. Township Name or No. Range No. Counttly/~
1/U-0 pQ
Occupant (PRINT) Phone No.
IQ06rueT Shi6_L i', S 625
Power Supplier Address
Electrical Contractor (Company Name) Convector's Lreense No.
(QFh RxFF_ fzLECP~~C~i I)CI o(/a;-(0
MaiOng Address (Contractor or Own Making Instailavgnl
Y ~'LOI~~L ijp.)o ~!}G/fiw ~ti
A uthonze ig ture]Co ra O n r Making Installab on) Phone. Numbers
MINNESOTA STATE BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT
Grlgo,fi wey Bldg. - Room N-191 BE ACCEPTED BY THE STATE BOARD
UNLESS PROPER INSPECTION FEE IS
1021 sHV Ave.. St. Paul. MN 55100
Phone (612) 642-0800 ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION EB-00001-06
,See instrucbans for completing this loan on back of yellow copy. r'
E-; 206,37 - "'X'" Below Work Covered by This Request
Add Rep. Type of Building Appliances Wired Equipment Wired
Home Range Temporary Service
Duplex Water Heater Lighting Futures
Apt. Building Dryer Electric Heating
Commercial Bldg. Furnace Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tank
Farm other Spei.r V ihrrl Spei.i lyl
t er sped v other Oihe.
ompute Inspection Fee Below
d Fee Service Entrance Size it Fee Feeders/SVbfeeders H Fee Circuits
0 to 200 Amps 0 to 30 Ares 0 to 30 Amos
Above 200 Amps 31 to 100 Amps 31 to 100 Amps
Swinvning Pool Above 100-Amps Above 100-Amps
Transtormers Irrigation Booms rS Partial/O
Signs Special Inspection
VV TOT FE?
Reiterrks $ /(q}7y
v
Rough-in Oat. 1. the trio
Inspector. ereby
cartily that the above
Final ' ♦ 't%J inspection has been
made.
This request void 18 months from -
C R
g I ~ryqp.
MEMO
_ city 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
ssub~divisionn.n l/
Edward J. Kiirscht
Sr. Engineering Technician
cc: Mike Foertsch
EJK/je
CASHIER1 JS TERMINAL N04 709
VITE; 0/0/91 TWO 0:3210B
41F SEI?L. GI,I^:IzD SYST'
?117 ":JO:I 4052 'AVE`+VYS ' 1 237.25
2155 900 4052 AM _THYAT 7.C1
k
171 0; jA'r.
1999 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGA
OT KNOB RDN 55122 Of
9 J~ 3830 PIL
0 651-681.4675
New Construction Requirements Remodel/Reogh Requirements
➢ 3 registered site surveys showing sq. It. of lot, sq. ff. of house 2 copies of plan
and all roofed areas (20% maximum lot coverage allowed) 1 set of energy calculations for heated additions
➢ 2 copies of plans (show beam a window sizes; poured fnd. design; etc.) 1 site survey for exterfor additions a decks
D 1 set of energy calculations
D 3 copies of tree preservation plan ti lot platted after 7/l/93
DATE: I _CONSTRUCTION COST: (7D [ 1 J
DESCRIPTION OF WORK:
Ott / ~ 7'/ [oil /~JCJ
STREET ADDRESS: v~ lgfjy7 1 Chji5-- r- CJ
LOT: ~O BLOCK: 1_ SUED./P.I.D. Vli~I F.~
Name: F16 I kLV I Phone (66/ " ZJ T /CJ
PROPERTY Last Fast
OWNER L ILA r~
Street Address: '~/l,1' ~'7~
City 4f"-f) State:_ Zip:
Company:,~ ea-1 C-lu l P.Y U /\JU~ Phone bra '
(area code)
CONTRACTOR r yi ! i j
Street Address: (lam / 1/ Ucense P.
City P ! State: Zip:
ARCHITECT/
ENGINEER Company: Name:
Telephone area code ( )
Street Address: Registration
City State: Zip:
Sewer & water licensed plumber (required for new construction only
Peltaity applies when address change and lot change Is requested once permit Is Issued.
I hereby acknowledge that 1 have read this application, state that the information is correc, an agree to com wit h all opplicabl
Stole of Minnesota Statutes and City of Eagan Ordinances. r
Signature of Applicant:
OFFICE USE ONLY
Certificates of Survey Received Yes No
Tree Preservation Plan Received Yes No Not Required \D
OFFICE USE ONLY
BUILDING PERMIT TYPE
❑ 01 Foundation ❑ 06 4-plex ❑ 11 10-plex ❑ 16 Fireplace ❑ 21 Porch (3-sea.)
❑ 02 SF Dwelling ❑ 07 5-plex ❑ 12 12-plex ❑ 17 Garage ❑ 22 Porch/Addn. (4-sea.
❑ 03 1 of _ plex ❑ 08 6-plex ❑ 13 16-plex ❑ 18 Deck ❑ 23 Porch (screened)
❑ 04 2-plex ❑ 09 7-plex ❑ 14 Apartments ❑ 19 Lower Level ❑ 24 Storm Damage
❑ 05 3-plex ❑ 10 8-plex ❑ 15 Lodging ❑ 20 Pool ❑ 25 Miscellaneous
WORK TYPE
❑ 31 New ❑ 35 Tenant Impr ❑ 39 Gas Line Onlyl 43 Siding/Soffits/Fascia
❑ 32 Addition ❑ 36 Move Bldg. ❑ 40 Gas Insert ❑ 44 Windows/Doors
❑ 33 Alteration ❑ 37 Demolish Bldg.* ❑ 41 Wood Stove ❑ 45 Fire Repair
34 Repair ❑ 38 Demolish (Interior) ~K, 42 Reroof
* Give PGA handout to applicant for demolition permit
GENERAL INFORMATION
Const. (Actual) Basement sq. ft. Census Code
(Allowable) Main level sq. ft. SAC Code
UBC Occupancy sq. ft. No. of Units
Zoning sq. ft. No. of Bldgs
# of Stories sq. ft. MC/ES System
Length sq. ft. City Water
Width Footprint sq. ft. Booster Pump
PRV
Fire Sprinklered
APPROVALS
Planning n!! IIBuilding Engineering Variance
Permit Fee Valuation: $
Surcharge
Plan Review
License
MC/ES SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI. f
Park Ded.
Trails Ded.
Other
Copies
Total:
SAC Units
% SAC
GAS WORK ORDER'
1072 Payne Ave. STANDARD 410 W. Lake St.
St. Paul, MN 55101 Minneapolis, MN 55408
651/772-2449 b HEATING 612/824-2656
& AIR CONDITIONING
A Blue Dof. Service Co. EQUIPMENT INFORMATION
LAST ~snr/At FIRST f+el<i TYPE Q£
ADDRESS 4/0Ta a~ ri/5/si GfA.":C MAKE yq
CITY Z,44114,c/ ZIP Ss a MODELS a oa n
HM PH64 ALTS/- 39;P-(. WK PH SERIAL
TECH ^~iFuR s DATE 8 io INPUT yp e>n-n
ORSAT TEST RECORD
C02 % METEREDINPUT Q Cfh CHIMNEY TYPE (-7
02 / % LIMIT SETTING ° FLUE SIZE In.
CO % PILOT OUTAGE ,,v sec CONNECTOR SIZE C~7 in.
NET STACK TEMP 0 TOTAL CHIMNEY INPUT i,'a O~ btuh
CITY OF EAGAN
CASHIER: JS TERMINAL NO: 786
DATE: 08/23/00 TIME: 09:55:04
ID:
NAME: STANDARD HEATING & AIR
3213 9001 1915 JADE LANE 30.00
2155 9001 1915 JADE LANE 0.50
3213 9001 2079 GARNET LAN 30.00
2155 9001 2079 GARNET LAN 0.50
3213 9001 4052 AMETHYST L 30.00
2155 9001 4052 AMETHYST L 0.50
3213 9001 4024 CINNABAR D 30.00
2155 9001 4024 CINNABAR D 0.50
Total Receipt Amount: 122.00
CR136299
USER ID: JAN
CITY USE ONLY I~ ~f
LOT 20 BL / 10 PERMIT#: u _ 11/~
SUBD. ,e__ 40Y Gn ie #5 RECEIPT I
RECEIPT DATE:
2000 MECHANICAL PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN MN 55122
651-681-4675
Date:
Complete this section only if you are installing HVAC in a single family dwelling, townhome or condo under
construction and not owner/occupied.
• HVAC: 0-100 M B T U $ 30.00
ADDITIONAL 50 M BTU 6.00
• Gas outlets (minimum of one required @ $3.00 ea.)
State Surcharge .50
Total $
Complete this section only if you are remodeling, adding to or reairin an existing single-family dwelling,
townhome, or condo. Please indicate if it is a new item, alteration, or repair.
- New _ Alteration Repair _ Other
Furnace \ ! \ Air conditioning
Air exchanger Other
Fee $ 30.00
State Surcharge
Total $ 30.50
Reminder: Call for ' spections
SITE ADDRESS:~52~
OWNER NAME: C~ (n APHONE S L( S d (AREA CODE)
INSTALLERNAME: ~1NWAt01e F.;fffNA4EO ,,Y y„ ^3~• PHONE
(AREA CODE)
STREET ADDRESS: MBA
CITY: TE: IP:
F ECEIVED -
AUG 2 2 2000 SIGNATU A D
AUG I U 2000
:
BY:__
CITY USE ONLY
L BL PERMIT#:
SUBD. RECEIPT#:
APPROVED BY: INSPECTOR RECEIPT DATE:
2000 MECHANICAL PERMIT (COMMERCIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
651-681-4675
Please complete for. all commercial/industrial buildings
multi-family buildings when separate permits are not required for each dwelling unit
DATE:
WORK TYPE: New construction Install U.G. Tank
Interior Improvement J Remove U.G. Tank
Processed Piping
When installing/removing underground tank, call 651-681-4675 for inspection by frre marshal and
plumbing inspector.
Description of work:
Fees: 1% of contract price OR $30.00 minimum fee, whichever is greater.
Underground tank removaUinstallation = minimum fee
Contract price: $ x 1% = $ (Base Fee)
State surcharge calculate at $.50 for each $1,000 Base Fee
TOTAL $
- - - - - - - - -
SITE ADDRESS: _
OWNER NAME: PHONE
(ARF,A CODE)
TENANT NAME (IMPROVEMENTS ONLY):
WAS THERE A PREVIOUS TENANT IN THIS SPACE? Y N. NAME:
INSTALLER:
ADDRESS: PHONE'#:~' -
(AxEA CODE)
CITY: STATE: ZIP:
SIGNATURE OF PERMITTEE
2000 STORM DAMAGE PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD - 55122
Ivy' ,J 651-681-4675
Reaulremenls ~ / ~ `a(
➢ 2 copies of plan
DATE: -3r k" J ! 0 CONSTRUCTION COST: 76 Z/MSG. O6
$Ast-~.+r WµopwS - ~tlzr;tAr'~ GM~Ci6
DESCRIPTION OF WORK: S M2fttL t y1 NG ° bRywntt If multi-family bldg., how many units?
INDICATE THE FOLLOWING EQUIPMENT TO BE REPLACED AND BY WHOM:
Plumbing Homeowner Qr Contractor Name
Mechanical Homeowner 2E 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: 4v5z AMEtN-TST' LA-uE
LOT: BLOCK: SUBD./P.I.D.
Name: JgSH&'Y:1 ' Dsi-i>LIIS JAGKi~- Phone
PROPERTY Last F *5t
OWNER
Street Address: qo~Z At1om9 sr LANE
City WiK,1F4 State: At1 - zip: t;r5r12z
at0f: l ;?ye-
0072-Company: PLtn -to'v\ wSI61?4 , La PhoneC (,sl q/ -GEZZ
(area code)
CONTRACTOR
Street Address: 304CAY4L2`( !!!A4 License #&Z)=A~9/ Exp. 3/31/00
city AGA1J State: MP- zip: ~1z3 2222
DC«I~[1CJ~
APR 0 3 2001
~ y 1i1r~
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.
1~
Signature of Applicant:
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. baum@se monsheldon.c
TO: John QDFd r, Assistant City Engineer
FROM: Robert B. Bauer, City Attorney /i?/
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); L001
B. e
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); ya o '1 terr
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); Vo,~57 ri
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 Offic on June 20, 2003 as Document
No. 503748 (Easement No. 936); yb~q Van',(,( ems
E. Drainage and Utility Easement between Robert L. Saalbom 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. 503746 (Easement No. 938); cf 0 (v1 ,Am n y s % tia
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); qC) 5a ~a 'o
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); yp; / Aw'od'yS~ d
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 (Easement No. 941); Ion
I. 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.
4 r,,E 2M c
503750 (Easement No. 943); and 470
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). NUyo Pme+tIS F ~w.rc
es r'
~~rucZ ~)e_oiofrd L mds
~~arca^
2
503144
y_
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LL 1
010 W Z w N U' Q1Q LL W W > ..i
¢O¢CZ -V O a 5 0 ¢ ¢ 0
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,ZW LU0F2 0/ _
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LLF pQ_~ I3~~ O
wauw-~ o v W Q W= w o o U 0P..T'RECEIVED o o 0 o LL a °z u v I kIEASUREFi-AUDITOR
DRAINAGE AND UTILITY EASEMENT
THIS EASEMENT, made this j I day of ' 2001, between
DENNIS FISCHBACH and JACQUELIN FISCHBACH / lid R W i fired 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 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
20, 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.
RECEIVED
JAN " i 2523
TREASURER-AL"TOR
IN TESTIMONY WHEREOF, the Landowner has caused athiseasement t be executed
as of the day and year first above written. DENNIS FISC CH
J Q IN FISCHBAC14
STATE OF MINNESOTA)
)ss.
COUNTY OF)
The foregoing instrument was acknowledged before me this -j~ day of
.0 2001, by DENNIS FISCHBACH and JACQUEL FISCHBACH, husband
and wife.
Not Public
APPROVED AS TO FORM: JMIESE.FRUECHTL
noWPr "-4DOODIA
W COMMISSION EXPIRES
K_ ,IAm"kw 31, 2005
City Attorney's Office
Dated: ?(e-d/°/
APPROVED AS TO CONTENT-
P is Worlk,s~ ent
Dated: / C 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
(Easement #939)
(206-19117)
2
2005 RESIDENTIAL PLUMBING PERMIT APPLICATION
( CITY OF EAGAN
} T 3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please complete for modifications to existing residential dwellings.
Date P l_! d
Site Street Address 05_ v 1 -C lL Unit # /
Property Owner a -g-1 v1, '5 f t S Telephone # (b~~) tfS 3L b
Contractor 1_{'- 7-~ /rl/(rrri S Telephone# (~/Z) S~~" d
Address City 11k--, 14 Q State-41A/ Zip
The Applicant is: _ Owner Contractor -Other
Alterations to existing dwelling $ 50.00
Add plumbing fixtures (excludes water softener and/or water heater--complete next
section if installing these appliances).
-Septic System Abandonment
-Water Turnaround (add $125.00 if a 5/8" meter is required)
Other: ojv, vY,,a VJ -%I
Water Softener _ Water Heater $ 15.00
- new _ replacement
Lawn Irrigation _RPZ _PVB new _repair -rebuild $ 30.00
State Surcharge 11 $ .50
Total JAN 1 2 2005 $ 7~ C tiZ~
I hereby apply for a Residential Plumbing Permit and a y formation is complete
and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan and the plumbing codes; that I understand this is not a permit, but only an application for a
permit, work is not to start without a permit and work will be in accordance with the approved plan in
the event a plan is required to be reviewed and approved.
Applicant's Printed Name Applicant's Signature
70, 0-71)
2005 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Construction Requirements RemodebReoair Requirements i]ffx;e use Only
3 registered site surveys showing sq ft of lot, sq ft of house; and all roofed areas 2 copies of plan Cert of Survey Real _Y _N
(20% maximum lot coverage allowed) 1 set of Energy Calculations for heated additions Tree Pres Plan Reod -Y _N
2 copies of plan showing beam & window saes, poured found design, etc. 1 site survey for additions & decks Tree Pres Required _Y _ N
I set of Energy Calculations Addition- indicate ifons#e septic system Onsits Septic Syshm_ _Y.R N~
3 copies of Tree Preservation Plan d lot platted after 711193
Rim Joist Detail Options selection sheet ~(buildings with 3 or less units) Q In n
Date 17 1 Construction Costg I (V OV
Site Address g5 f s t- W Unit/Ste #
Description of Work mI I tS I l1 C d l i l l Q J~ l l l~~ jr
Multi-Family Bldg _ Y _ N Fireplace(s) _ 0 - 1 = 2
Property Owner D nn(S Ficfrjjkocin Y•Telephone #(651) L15 Y- 32
Contractor "Lek
Address AP~N1hMr!►RhR17A City
State Lln, a ~ppb~gry Telephone # ( )
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Category 1 _ Minnesota Rules 7672
Energy Code Category • Residential Ventilation Category 1 Worksheet New Energy Code Worksheet
(J submission type) Submitted Submitted
• Energy Envelope Calculations Submitted
Have you previously constructed a building in Eagan with a similar plan? _ Y _ N If so, 25% plan review
fee applies.
Licensed Plumber Telephone )
Mechanical Contractor Telephone )
Sewer/Woter Contractor Telephone #f
I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; I understand this is not a permit, but only an application for a permit, and w?rk is not to start without a
permit; that the work will be in accordance with the approved'plan in the case of work which require arrevie'w an
d
approval of plans. ,
SneI~~ Pr"'Ir
Applicant's Printed Name Applicant's Signa a`
L
OFFICE USE ONLY
Sub Types
❑ 01 Foundation ❑ 07 05-plex ❑ 13 16-plex ❑ 20 Pool ❑ 30 AccessoryBldg
❑ 02 SF Dwelling ❑ 08 06-plex ❑ 16 Fireplace ❑ 21 Porch (3-sea.) ❑ 31 EM. 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 (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 orfx N ❑ 25 Miscellaneous
Work Types pt) 91/ 4
P,rwml-t
❑ 31 New ❑ 35 Int Improvement ❑ 38 Demolish interior ❑ 44 Siding
❑ 32 Addition ❑ 36 Move Building ❑ 42 Demolish Foundation ❑ 45 Fire Repair
A 33 Alteration ❑ 37 Demolish Building' ❑ 43 Reroof ❑ 46 Windows/Doors
❑ 34 Replacement •Demolfflon (Entire Bldg) - Give PCA handout to applicant
Valuation Occupancy 9_3 MCES System
Census Code //3rd Zoning 12-/ City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. J PRV
C.a d'+ YriilY;iA"vrr :~L j5t+2 3
# of Bldgs engtalr~~( ~bteSA: Fire Sprinklered
Type ofConst Wic~fPtf~~t vall1
REQUIRED INSPECTIONS
Footings (new bldg) Final/C.O.
Footings (deck) Final/No C.O.
Footings (addition) _ Plumbing
_ Foundation _ HVAC "GY~ Y~~f rM~
_ Drain Tile Other
Roof _ Ice & Water _ Final = Pool = Ftgs =Air/Gas Tests _ Final
Framing Siding Stucco Stone Brick
_ Fireplace - R.I. -Air Test -Final Windows
Insulation _ Retaining Wall
Approved By Building Inspector
Base Fee - -
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA148313
Date Issued:03/20/2018
Permit Category:ePermit
Site Address: 4052 Amethyst Lane
Lot:20 Block: 10 Addition: Cedar Grove 5th
PID:10-16704-10-200
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
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 -
Dennis Fischbach
4052 Amethyst Lane
Eagan MN 55122
(651) 454-3276
Standard Heating & Air Conditioning
130 Plymouth Ave. N
Minneapolis MN 55411
(612) 824-2656
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA175156
Date Issued:03/16/2022
Permit Category:ePermit
Site Address: 4052 Amethyst Lane
Lot:20 Block: 10 Addition: Cedar Grove 5th
PID:10-16704-10-200
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:Does not include skylight(s)
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and leave on site.
If water damage is encountered, please call (651) 675-5675 to schedule a site visit to verify the extent of the damage. Any
repairs must be inspected prior to covering. The inspector will determine if an additional permit will be required to repair the
water damage.
Valuation: 5,000.00
Fee Summary:BL - Base Fee $5K $118.00 0801.4085
Surcharge - Based on Valuation $5K $2.50 9001.2195
$120.50 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 -
Dennis & Jacquelin Fischbach
4052 Amethyst Ln
Saint Paul MN 55122--290
(651) 214-2757
Budget Exteriors
8017 Nicollet Avenue South
Bloomington MN 55420
(952) 887-1613
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA177899
Date Issued:07/25/2022
Permit Category:ePermit
Site Address: 4052 Amethyst Lane
Lot:20 Block: 10 Addition: Cedar Grove 5th
PID:10-16704-10-200
Use:
Description:
Sub Type:Water Softener
Work Type:Replace
Description:
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 -
Dennis & Jacquelin Fischbach
4052 Amethyst Ln
Saint Paul MN 55122--290
(651) 214-2757
Tri County Water Conditioning Inc
325 Third Ave NW
P O Box 65
Huchinson MN 55350
(320) 587-2950
Applicant/Permitee: Signature Issued By: Signature