4103 Blueberry Lane
CITY OF PAGAN 352
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 4548100
BUILDING PERMIT Receipt
♦o be used for SF DWG/GXI Est. Value $ 7 9 , 0 0 0 Date JULY 3 0 " 19 a 4
Site Add 4103' BLUEBERRY L"A Erect 1 Occu R3
rg,s Occupancy
Lot L9 Block Sec/Sub. HILLTOP EST Remodel ❑ Zoning
Parcel No. Repair ❑ Type of Const. V
Enlarge ❑ No. Stories
oe Name MCDONALD CON.ST` INC Move ❑ Length 4
Address A Demolish ❑ Depth
b Grade ❑ Sq. Ft.
City one
Name SA14B Approvals Fees
o° 0
00 Address _ Assessment Permit:
City Phone Water & Sew. Surcharge
Police Pion check 1,8 ,
WW Name Fire SAC 525.0 z
i3 Address Eng. Water Conn. 470 ` 0,
Ww City Phone Planner Water Mete. 63 •Of)
Council Rood Unit 260.00
I hereby acknowledge that, ad this application and state that Bldg. Off. Parks
the information is corroct and to comply with all oppiicabl APC Total ~I' 912. 5-0
t
State of Minnesota 96tyte o Ea anfQ~rdina s.
Var. Date
Signature of Permittes jj7
v aI10N INC
A Building Permit is issued 14s- on the express condition that
'-°all work shall be done in accofdonice *ith all opplitable)tat-q,of_Minnesota Statutes and City of Eagan Ordinances.
Building Official - - -a [ r' ,
r
1
Permit No. Permit Holder Date
Plumbing l & -w 1 LI- O
H.V.A.C. g LA)Le U i 1 l~, 3o S
Electric q _(I -9 V lV. CTZ~
9-(4 66, w
Softener
Inspection Date Insp. Other
Footings ti 9~ c s~ " /-fj y
Foundation
Framing
Rough Plbg.
Rough HV
Insulation
Final Plbg.
Final HVAC
final ~~~-e
COWOco. '
Water Describe Location-
WWII
Sewer ~30 - Q C~• ep ;
(n) 0 1-r( :a tsp. e ! vioL2 Cc C k i
Pr. Digs.
I
i
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.
INSPECTION REcokb
CITY OF EAGAN
3830 Pilot Knob Road PERMIT'Tll: ' .
j_ Permit Number: d l
Eagan, Minnesota 55122-1897 Date Issued: pu;
(612) 681-4675
SITE AbDRESS: i N 3 _ ;
APPLICANT:
~i a ; i i rs 3 1 y : It t" t I.. f-l { r -
fi t r t d r t, 0111 a; ra
PERMIT SUBTYPE; TYPE OF WORK:
fi 11dr r>t elf': ter°{rii
P
r~~?la i { r 1.Nl11
Permit No. Permit Holder Date Telephone #
ELECTRIC
PLUMBING
HVAC
Inspection Date Insp. Comments
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
I INSUL
i
GYP BOARD
I
FIREPLACE
FIREPLACE r f
AIR TEST
FINAL PLBG
r
FINAL HTG
i
ORSA7
TEST
BLDG FINAL -
BSMT R.I.
p BSMT FINAL
' lECK FTG
)FCK FINAL
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 OF EAGAN Remarks
Addition HILLTOP ESTATES Lot 29 Blk 6 Parcel
Owner _ J11~~~'. ld1 Street 4103 Blueberry Lane State Eagan, MN 55123
q
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. <y 1336.72. 133.67 10 935.71 coo7619 1-5-80.
STREET RESTOR.
GRADING
SAN SEW TRUNK ? 1973 172.14 8.61 20 86.04 C00 61 , 1-5-80,
* SEWER LATERAL 1980 312.59 in I 2188.08 C00 61 1-5-d2n
WATERMAIN
* WATER LATERAL
• WATER AREA 1980
• Services 1980
* STORM SEW TRK 1980
* STORM SEW LAT 1980
CURB & GUTTER
SIDEWALK
STREET LIGHT
Road Unit 260.00 X645037 7-30-84
WATER CONN. 470.00
BUILDING PER. X69352 r'
SAC 525.00 PARK
CITY OF EAGAN WATER SERVICE PERMIT
383"ilot Kflob Road 5684
P. 0. Box 21199 _ PERMIT NO.:
Eag*n, MWb5121 DATE: 8-31-84
Zoning: R], No. of Units: 1
Owner: AIc'Danald Const
Tess: r f _
ite Address: 410 ":lti ~ t. 'Liar, 1,2 9 B6 Hilltop Estates
- IF
Plumber:
4Meter No.: u 4 7 'CorOeCtlon Charge: 470.00 pd
Size: Account Deposit: 15.00 pd
Reader o.: Permit°.666: 10.00 pd
agree to eamply with the City of Eagan Surcharge: . 50 pd
OrainanCMRnaj,,#, a if Le, 96 o V3 Misc. Charges: 63.00 pd meter
Total:
By Date Paid:
Date of Insp.: - Insp.:
CITY OF FAGAN SEWER SERVICE PERMIT
-
j 3830 PilotWob Road
$7
P. O. Box 24799 PERMIT NO.:
Eagan, MN 5el 1 DATE:
Zoning: No. of Units:
Owner Oftti ! COt18
Address:
Site Address: ua. erzy Lane L29 B6 op 'a{ a cis
Plumber: ~3ev g
.
7-30--'64
1 agree to comply with the City of (Eagan Connection Charge: 425.00 pd
Ordinances. Account Deposit: 10.00 pil
Permit Fee: DO 071
Surcharge:
BY Misc. Charges:
Date of Insp.: Total:
Insp.: Date Paid:
X58 yg ~s.s o
2004 RESIDENTIAL PLUMBING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please complete for modifications to existing residential dwellings.
Date
Site Street Address Unit #
c~p~? Telephone #
Property Owner
e 141-
Contractor o ele hone #
Address State /-2~34) Zip ~
The Applicant is: _ Owner Contractor -Other
Alterations to existing dwelling $ 50.00
-Add fixtures to rooms, excluding water softener and water heater
-Septic System Abandonment
-Water Turnaround (add $121.00 if a 5/8" meter is required)
-Other:
_ Water Softener Water Heater P $ 15.00
replacement _ additional v6
Lawn Irrigation System RPZ_ new _ repair -rebuild $ 30.00
State Surcharge $ .50
Total
I hereby apply for a Residential Plumbing 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 Plumbing codes, • that l 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.
1-2
App icant's Printed Na e is
r
PERMIT d4W56PI~
CITY OF EAGAN
3830 Pilot Knob Road PERMIT TYPE: B U I L D I N G
r Eagan, Minnesota 55122-1897 Permit Number: 0 2 7 4 8 1
(612) 681-4675 Date Issued: 05/06/96
SITE ADDRESS:
4103 BLUEBERRY LANE
LOT: 29 BLOCK: 6
HILLTOP ESTATES
P.I.N.< 10-33000--290-06
DESCRIPTION:
(GAS)
Building Permit Type FIREPLACE
Building Work Type NEW
Census Code 434 ALT. RESIDENTIAL
REMARKS:
FEE SUMMARY:
Base Fee $25.00
Surcharge .50
i
Total Fee $25.50
CONTRACTOR: OWNER: - Applicant -
BECKWITH STEVEN
4103 BLUEBERRY LN
EAGAN MN 55123
(612)452-3699
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 Mn.
I~ Statutes and City of Eagan Ordinances<
'fiv m k~
ANT/PERMITEE IGNATURE ISSUED-BNJ SIONATUFlt-
CITY OF EAGAN
3830 PILOT KNOB RD - 55122
1996 FIREPLACE PERMIT APPLICATION
681-4675
DATE: J G
DESCRIPTION OF WORK: INSTALL MR FIREPLACE: WOOD BURNING GAS
INSTALL GAS LOG ONLY IN EXISTING FIREPLACE
INSTALL GAS LINE ONLY IN EXISTING FIREPLACE
OTHER:
AREA TO BE INSTALLED IN: fA-MILY ~ocr-,
STREET ADDRESS: 4103 ' Uc 6,mz y / dl,
LOT BLOCK SUBD./P.I.D.
APPLICANT: (circle one only) OWNER CONTRACTOR
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.
PROPERTY Name: E(--K J;'T1 jT&V"J Phone ys "3 `l
OWNER ua
Signature:.
Street Address- 9/03 ELF-196PUL2L Z-4/,
city: State: MV Zip: SS' 12.3
FIREPLACE Company: 0A Phone
INSTALLER
Signature:
Street Address: License
I
City: State: Zip-
GAS LINE Company: Phone #
INSTALLER
Name:
Signature:
Street Address-
City: State: Zip:
a
,yr
r
OFFICE USE ONLY
BUILDING PERMIT TYPE
c 14 Fireplace
WORK TYPE
0 31 New o 33 Alterations
v 32 Addition a 34 Repair
GENERAL INFORMATION
Census Code.
SAC Code
REMARKS: Chimney/flue must be Inspected before concealing.
FEES
Permit Fee
Surcharge
Other
Copies
Total:
CITY OF EAGAN N® 9352
3830 Pilot Knob Road, P.O. Box`21-199, Eagan, MN 55121
BUILDING PERMIT PHONE: 454-8100 Receipt ® 3 7
1-5 To he used for SF DWG/GAR Est. Volue $79,000 Dote JULY 3 0 19 84
Site Address 4103 BLUEBERRY LN Erect Occupancy R3
Lot 29 Block 6 Sec/Sub. HILLTOP EST Remodel ❑ Zoning R
Parcel No. Repair ❑ Type of Const. V
Enlarge ❑ No. Stories
ae MCDONALD CONST INC Move El Length 4
i Name 1212 BLUEBILL BAY Demolish El Depth 4$
Address Grade El Sq. Ft.
City BURNSVIL"ne 431-7566
Approvals Fees
o SAME
Name
Zoe Address Assessment Permit 370.50
U~ City Phone Water & Sew. Surcharge 39.50
~ Police Plan check 185.00
F,°C"'„ Name Fire SAC 525.00
10 Address Eng. Water Conn. 470.00
<W City Phone Planner Water Meter 63.00
Council Road Unit 260.00
1 hereby acknowledge that I hove read this application and state that Bldg. Off. Parks
the information is correct and agree to comply with all applicabl APC Total $1, 912.50
State of Minnesota Stotute ty of Eagan Ordinan s.
Var. Date
Signature of Permittee
A Building Permit is issued to: MCDON D CONSTRUCTION INC on the express condition that
all work shall be_done,in ac with all appli ble tat of Minnesota Statutes and City of Eagan Ordinances.
Building 'Official
r r •L
CITY OF EAGAN Include 2 sets of plans,
- IL
7? S 4-
3 Certificate of Survey
/ BUILDING PERMIT APPLICATION 1 set of energy calculations.
To Be Used For / ValuationCII"+ Date
Site Address I - 4 e tt c e- 6 ' OFFICE. USE ONLY
Lot / Block _ Sec . /Sub - Erect_ Occupancy R
tirw Alter Zoning- 1
Parcel Repair
Owner:G Enlarge Type of Const. r
Move # Stories
Address: Demolish t~LL/~IS/~~ ,h~ ,N ft.
Demolish Front 9-1
City/Zip Code: '~~//~rC<!~ Grade Depth 48 ft.
Phone ~Y:3✓ 7
APPROVALS FEES
Assessments Permit Y1 p. p3
Contractor: Water/Sewer Surcharge
Address: Police Plan Check
City/Zip code: Fire SAC
g1g- Water Conn.
Phone Planner Water Meter l" -3,
Council Road unit 2 ro O .
Arch./Eng.: Bldg. Off.
Address : APC
City/Zip code: _
TOTAL
Phone
CERTIFICATE OF SURVEY
/Y
I
01
11'- LOT 30
DRAtN ACHE '
° r/ 0O E V T\LIT`( /38
EASEMENT
b ~ \6>
\04 Lo. 29 \30
a
BL Y,
SrtvMlNoUS \ /O 6
SURF AGE Z,~\ \b
S /k ~ {
011 A)
O
S `S' £ UT1LlTY O ~7
LO-r 2.S\ /F>,?~ EASEMENT a a N
SG
110
CY s J
I hereby certify that this is a correct representation of a survey of:
Lot 29, Block 6, HILLTOP ESTATES, Dakota County, Minnesota, according to
the recorded plat thereof.
and that I am a duly registered land surveyor under the laws of the State of Minnesota. }
Dated this 6th Day of July, 1984 t~
Gene L. Jacobson, innesota Reg. No. 7734
DR BY GRJ SCALE 30' G DENOTES IRON MON. BEARINGS ARE ASSUMED DATUM.
Prepared for:
Bob McDonald JACOBSON SURVEYORS
McDonald Construction LAKEVILLE, MINN. 55044
1212 Bluebill Bay
Burnsville, MN .55337
PHONE 469 - 4 328
l C> (c~ -1
CITY BUILDING D*TMENT
EXTERIOR ENVELOPE AVERAGE "Ulf COMPUTATION
(To be submitted with building permit application)
One or Two Family Dwelling Owner
All Other Site Address
Contractor /ldvC1A[.~ eo~7~T• Date Phone
LINEAL FEET OF 11 ~~PZ '
EXPOSED 1?JALL (.~oR,K o?l~~ fto above grade =
TOTAL EXPOSED WALL AREA SQ. FT.
O: rQUE .BALL CONSTRU.,TION: 'full Value x Area
Detail 2ipmE fluff 'o4Z x SQ. FT. I(oF&.50- 70.07, (U)(A)
FYPI ~ fiww~ "U" ,a72 x SQ. FT. 103.55,}• = g.57 (U) (A)
reverence
from TES? "U" •o4D x SQ. FT. 134,4fn= 5.37 (U)(A)
attached "U" x SQ. FT. _ (U)(A)
sheets fluff x SQ. FT. _ (U) (A)
"U" x SQ. FT. _ (U)(A)
7INDOWS: "U" Value x Area
Ma''ke & Type )AY-0t, d-WdT "U" , 5L x SQ. FT. 53.50 = 79.,5Z (U) (A)
" fluff x SQ. FT. - (U) (A)
11 it fluff x sq. FT. _ (U) (A)
it If "U" x SQ. FT. _ (U) (A)
DOORS: "U" Value x Area
i:,e & Type fruAvL, fluff, . x SQ. FT. Loo _ 2.9 (U) (A)
ATk1UW • "U" .47 x SQ. FT. 3.0 - ~9•(c (U) (A)
fluff x SQ. FT. _ (U) (A)
fluff x SQ. FT. _ (U) (A)
TOTALS ;V 00 SQ. FT. 1q7 IS (U)(A)
AVER~A.uUl~_,.~,
TOTAL (U) (A) VALUES l q7. ~s
DIVIDED BY TOT IdALL AREA 211P7-Do
AVLRAG "U" C~15)r less for 1&2 family re Tings
FOOF/CEILING
TOTAL AREA: /Zo
Detail reference "U" • b/ q x SQ. FT. Za = $•D$ (U) (A)
from "U" x SQ. FT. _ (U)(A)
attached sheets. "U" x SQ. FT. - (U) (A)
Describe openings "U" x SQ. FT. - (U) (A)
yn roof. "U" x SQ. FT. _ (U)(A)
TOTAL (U) (A) VALUES DIVIDED BY o7" l?'ZD NfT 25,0
r
l Z 4
T'O 2AL ROOF/1-0 .1EA ?j- O 's Ol
AVERAGE "U' .025 or ventilated roofs.
so XCzo+ 14+9-&) = 870.00
~•~X ~Zlo+ Zl+ 14) = _579•sc~
11 • so X ~4)~ 7/ 7!sb
a `
~XPvs~A Aww~"
•&-IX(41t41+~ ~Dg•5~
IA-T~cs-r-
WIJV DowS
Z4 X 36 = x Z - IZ,oo
Zext(v = 3-l X = 3•'10
Zo x 48 = (0.7 X 4 = 7&.$0
24 x48 = 840 X (o = 4g.oo'
ZoXtO = 6.t X 4- = 33.60
Zo X 7 Z= /0-61 X Z eo-02
3° AT. ZI. o0
4-z, oo
6r~1 5X Po F- t, ~1 :
z,I(o7oo 1z x 1~ /bg
L656, puwwl:~ 108,,Sg S x q= 7 Z
WDws !S3•so
o
Dao~.s 84:00 I, (r,~~o.SO / zo
PERMIT
City of Eagan Permit Type: Mechanical
Eaaan. Permit Number: EA101206
Date Issued: 09/27/2011
OR Permit Category: ePermit
40~ it~ of E3
E
Site Address: 4103 Blueberry Lane
Lot: 29 Block: 6 Addition: Hilltop Estates
PID: 10-33000-06-290
Use:
Description:
Sub Type: e - Furnace
Work Type: New
Description: Furnace
Comments: Questions regarding electrical permit requirements should be directed to Mark Anderson. State Electrical Inspector.
952-445-2840
Mark Sullwold
1420 Third Avenue West
Fee Summary: ME - Permit Fee (Replacements) $50.00 0801.4088
Valuation: 2.931.00 Surcharge-Fixed $5.00 9001.2195
Total: $».00
Contractor: - Applicant - Owner:
Minnesota Plumbing & Heating Miguel Gomez
1420 West 3rd Ave 4103 BliebeiTv Lane
Shakopee NIN 55379 Eagan MN 55123
(952) 445-4444
I hereby aeknowledae 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 Cite of Ea-an Ordinances.
ApplicantiPermitee: Signature Issued Bv: Signature
PERMIT
City of Eagan Permit Type: Building
Eagan. Permit Number: EA103575
Date Issued: 04/03/2012
OR Permit Category: ePermit
41~ it~ of E3
E
Site Address: 4103 Blueberry Lane
Lot: 29 Block: 6 Addition: Hilltop Estates
PID: 10-33000-06-290
Use:
Description:
Sub Type: e-Sidina & Windows Doors Construction Type:
Work Type: Sidina & Windows doors
Description: House & Garage
Census Code: 434- Occupancy :
Zoning:
Square Feet: 0
Comments: When installing ventilated soffit material, remove existina material (i.e. debris that could block vents) and take steps to
ensure maximum ventilation to attic. Call for final inspection after installation.
Improvements to the home require smoke detectors in all bedrooms. If altering window openings, call for framing
Fee Summary: BE - Base Fee S8K $162.25 0801.4085
Valuation: 8.000.00 Surcharge - Based on Valuation S8K $4.00 9001.2195
Total: $166.25
Contractor: - Applicant - Owner:
Mike Brockway Construction Miguel Gomez
18386 400th St 4103 BluebeiTv Lane
Le Center NIN 56057 Eagan NIN 55123
(507) 357-4397
I hereby aeknowledae 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 Cite of Eaaan Ordinances.
ApplicantiPermitee: Signature Issued Bv: Signature
Use BLUE or BLACK Ink
r
For Office Use /h~ 1
Permit V Z
City of EaAQ~ Permit Fee: ~e3~ I
%~,E-~~ I I
3830 Pilot Knob Road
I Zy 1 Z I h
Eagan MN 55122 Date Received: y
Phone: (651) 675-5675
Staff:
Fax: (651) 675-5694 i
2012 RESIDENTIAL BUILDING PERMIT APPLICATION 1 S
Date: Site Address: Unit
~l
Name: JQV., ~G Phone:
RESIDENT /
he~rc~ C 4
OWNER Address / City / Zip: L413-S
Applicant is: u Owner " Contractor
TYPE OF WORK Description of work: N Q..1 ✓e'c ~L
Construction Cost: Multi-Family Building: (Yes / No X)
Company: \"VizZy-k- Jc~Cw `,t Contact: S'D-7 2 i o _ O~Gt
CONTRACTOR Address City: b- ICQa E~
State: Mk\) Zip: SlP Phone: 3~ 1 - 3 01
License I Le L» Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
9 U" V
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit 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 & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that the are trade secrets.
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.cioi)herstateonecall.org
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.
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~" x
Applicant's Printed Name Applicant's ignature
Page 1 of 3
DO NOT WRITE BELOW THIS LINE
SUB TYPES LJeCr
Foundation Fireplace _ Porch (3-Season) - Storm Da~ge
Single Family _ Garage _ Porch (4-Season) Exterior Alteration (Single Family)
Multi Deck - Porch (Screen/Gazebo/Pergola) Exterior Alteration (Multi)
01 of Plex Lower Level _ Pool _ Miscellaneous
Accessory Building
WORK TYPES
_ New _ Interior Improvement Siding Demolish Building*
. Addition _ Move Building _ Reroof _ Demolish Interior
Alteration Fire Repair _ Windows _ Demolish Foundation
Replace _ Repair Egress Window _ Water Damage
Retaining Wall *Demolition of entire building - give PCA handout to applicant
DESCRIPTION
ors
Valuation Occupancy G- MCES System
Plan Review Code Edition ,Zap? SAC Units
(25%_ 100%~ Zoning City Water
Census Code Stories Booster Pump
# of Units / Square Feet 11-31 PRV
# of Buildings i Length Fire Sprinklers
Type of Construction Width 14
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
- Footings (Deck) Final / C.O. Required
Footings (Addition) Final / No C.O. Required
Foundation HVAC Gas Service Test Gas Line Air Test
Drain Tile Other:
Roof: -Ice & Water -Final Pool: Footings -Air/Gas Tests -Final
Framing Siding: Stucco Lath -Stone Lath -Brick
Fireplace: -Rough In -Air Test -Final Windows
Insulation Retaining Wall: Footings _ Backfill _ Final
Sheathing Radon Control
Sheetrock Erosion Control
Reviewed By: , Building Inspector
RESIDENTIAL FEES d23i
Base Fee /G3
Surcharge
Plan Review ?
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
Page 2 of 3
i%Jk
-CERTIFICATEv#= OF SURVEY
t
fi
Ns, LOT -30
fir /a 96
EA5EMEKT \ ' St9 7a
'j 17' pmt \
rf~'
v d
~'D LO: 2g \o
f3rruM1NaU5 / 10 Cr
SURPAGE 2 \ \b
\ f
c'a
~ O
V
. ~4 1 \ naatNar~ f o N h6
E t)TttaTY sg a.' _
r.Q Ail,
>3\ EAS MEUT f o~ 01-
FQma k6\ / d~ 4G'
u- V
r) AT E q
F,31JILMN(33 DIVISION
I hereby certify that this is a correct representation of a survey of;
Lot 29, Block 6, HILLTOP ESTATES, Dakota County, Minnesota. accnrding to
the recorded plat thereof,
and that. I am a duly registered land surveyor under the laws of the-State of Minnesota.
Bated this 6th Day of July, 1984
Gene L. Jacobson, innesota Reg. No. 7734
'
Use BLUE or BLACK Ink
r - - - - - - - - - - - - - - - - -
I For Office Use /
Permit LD
ind aI
City of EaE
Permit Fee: 1~J I
3830 Pilot Knob Road
Eagan MN 55122 ; Date Received: (3 I
Phone: (651) 675-5675
I I
Fax: (651) 675-5694 I Staff:1 I
I ~ I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit
Name: 41 Phone:
Resident/
Owner Address / City / Zip: ~1f1 flu r !,~-r-y cK C ` f 14
Applicant is: Owner V' Contractor
Type of Work Description of work:
Construction Cost: Multi-Family Building: (Yes / No
jC' )
Company:_ <<s.ra L-t" %i 5 ~#.~Y-~ Contact:
Address: 217.1Ilye City:
Contractor
State: A~A) Zip: Phone: ~a( 2, Yet' ~
License o`-/ S v cti Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit 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 & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that they are trade secrets.
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.gopherstateoneGall.org
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.
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.
Applicant's Printed Nam Applicant's Signature
Page 1 of 3
Jan. 21.2016 2:55PM
Date:
Genz - Ryan
*WA-- (k [01,l lc.l/13
CityriIh m/of Eagan �,
3830 Pilot Knob Road -rV' a'f� xi. me
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
p(‘v44ECEIVED
IMI 212016
No. 0298 P. 1
Use BLUE or BLACK Ink
For Office Use /�
Permit ii; 1 7-1 P
Permit Fee: / 73-37e,
33a
ILP
Date Received:
Staff:
2016 RESIDENTIAL BUILDING PERMIT APPLICATION
1/21/2016 SifeAddress; 4103 BLUEBERRY LANE
Unit #:
J
Residenf/
Owneir.
Name: SAM & STEPHANIE MORSE Phone: 952-457-1870
Address / City / Zip: 4103 BLUEBERRY LANE
Applicant is: Owner V Contractor
Type of Work
Description of work: (2) BATH REMODELS -NEW TUB/SHOWER SURROUNDS, NEW VALVES/FIXTURES
Construction Cost: 5%000 Multi -Family Building: (Yes / No 1 )
Contractor
Company: INSPIRATION DESIGN CENTER Contact: KELLEY BARKER
Address: 2200 WEST HIGHWAY 13 City: BURNSVILLE
State: MN Zip: 55337 Phone: 952-767-1819 Email: kelleyb@inspirationdesigncenter.com
License #: BC639507Lead Certificate #: NAT -114275-1
If the project is exempt from lead certification, please explain why:
V,...,\
In the last 12 months,
Yes No
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Eagan Issued a permit for a similar plan based on a master plan?
If yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Fire Suppression Contractor:
Phone:
Phone:
Phone:
Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information, Portions; of
the Information may be classified as non; public if you provide specific reasons that would permit the City to
• conclude that they are,trsde secrets. •
CALL BEFORE YOU DIG. Call Gopher State One Call at (661) 464-0002 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 steal 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.
)(KELLEY BARKER
Applicant's Printed Name
App icant's Signature
Page 1 of 3
Jan. 21. 2016 2:55PPM Genz cyan
, cC/`1�c ' DO NOT WRITE BELOW THIS LINE
No. 0298 P. 2
SUB TYPES
Foundation
Single Family
Multi
01 of Plex
WORK TYPES
New
Addition
Alteration
_ Replace
_ Retaining Wall
DESCRIPTION
Valuation
Plan Review
(25%^ 100%1)
Census Code
# of Units
# of Buildings
Type of Construction
Fireplace
Garage
Deck
Lower Level
_ Porch (3 -Season) _
Porch (4 -Season)
_ Porch (Screen/Gazebo/Pergola) _
Pool
Interior Improvement
Move Building
_ Fire Repair
_ Repair
REQUIRED INSPECTIONS
Footings (New Building)
Footings (Deck)
Footings (Addition)
Foundation
Roof: _Ice & Water _Final
Framing
Fireplace: Rough In Air Test
Insulation
Sheathing
Sheetrock
Fire Walls
Braced Walls
Shower Pan
Reviewed By;
Occupancy
Code Edition
Zoning
Stories
Square Feet
Length
Width
Final
Siding
Reroof
Windows
_ Egress Window
Exterior Alteration (Single Family)
Exterior Alteration (Multi)
Miscellaneous
Accessory Building
Demolish Building*
_ Demolish Interior
_ Demolish Foundation
_ Water Damage
'Demolition of entire building — give PCA handout to applicant
MCES System
SAC Units
City Water
Booster Pump
PRV
Fire Suppression Required
Meter Size:
Final / C.O. Required
_6 Final / No C.O. Required
HVAC Gas Service Test Gas Line Air Test
Pool: _Footings Air/Gas Tests _Final
Drain Tile
Siding: `Stucco Lath _Stone Lath _Brick
Windows
Retaining Wall: _ Footings _ Backfill_. Final
Radon Control
Fire Suppression: Rough In Final
Erosion Control
Other:
1 C/ , Building Inspector
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
yo0o
Page 2of3
Jan. 21. 2016 2:58PM Genz — Ryan
CIty of Mtn R,p 11v 1�
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675.5675
Fax: (651) 675-5694
No. bL.UL
BJE or P. Ink
For Office Use '
Permit*: �-' / //90
Permit Fee: '-7/01 00 1/
Date Received:
Staff:
2016 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: 1/21/2016 Site Address: 4103 BLUEBERRY LANE
Tenant
J
ite #:
Resident/Owner
Name: SAM & STEPHANIE MORSE Phone: 952-457-1870
Address / City/Zip: 4103 BLUEBERRY LANE
Contractor
Name: GENZ-RYAN License #: PC643433
Address: 2200 WEST HIGHWAY 13 City: BURNSVILLE
State: MN Zip: 55337 Phone: 952-767'1819
Contact: KELLEY BARKER Email: kelleyb@genzryan.com
Type of Work
— New I Replacement Repair Rebuild L Modify Space Work in R.O.W.
_ _ _
Description of work: (2) BATHS: NEW TUB/SHOWERS, VALVES/FIXTURE, MOVE Il DRAIN, NEW SINK/FAUCET
Permit Type
RESIDENTIAL
Water Heater
Water Softener
Lawn Irrigation PVb)
g (_ RPZ /
✓ Add RU Fixtures (_ Main / Lower Level)
_
Septic System
_
Water Turnaround
New
Abandonment
RESIDENTIAL FEES:
$60.00 Water Heater,
$60.00 Lawn Irrigation
$60.00 Add Plumbing
`Water Turnaround
$115.00 Septic System
Water Softener, or Water Heater and Softener
(includes State Surcharge)
Turnaround* (Includes State Surcharge)
TOTAL FEES $
(includes State Surcharge)
Fixtures, Septic System Abandonment, Water
(add $280.00 if a 3/4" meter is required)
New (includes County fee and State Surcharge)
CALL BEFORE YOU DIG. Call Gopher State One Catl at (651) 4540002 for protection against underground utility damage.
Call 4B 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 KELLEY BARKER
Applicant's Printed Name
x l
ApP Signe a re
FOR OFFICE USE
Reviewed By: Date:
Required Inspections: Under Ground Rough -In Air Test Gas Test Final
Meter Related Items: Meter Size Radio Read Manometer Staff
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA159869
Date Issued:01/24/2020
Permit Category:ePermit
Site Address: 4103 Blueberry Lane
Lot:29 Block: 6 Addition: Hilltop Estates
PID:10-33000-06-290
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Standard 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 -
Samuel Morse
4103 Blueberry Lane
Eagan MN 55123
Applicant/Permitee: Signature Issued By: Signature