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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_ W FG J J wp 3 r~ ~a ¢ LL 1 010 W Z w N U' Q1Q LL W W > ..i ¢O¢CZ -V O a 5 0 ¢ ¢ 0 Fm f~ co ¢ U W Q ,ZW LU0F2 0/ _ Q Hp 6f/ W W cr W y 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