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627 Atlantic Hill Dr 01/0612011 11:15 6514577116 BINDER PAGE 02102 Use BLUE or BLACK Ink - - - - - - - - - - - - - - - - - I lj ll/ ~S 1 Permit ~ Permit Fee:. City lI 3830 Pilot Knob Road I I Eagan MN 55122 I Data Received: i I I Phone: (651) 675-5675 i Fax: (651) 675-5694 t staff_- - 2011 MECHANICAL PERMIT rPPLICATIO►N 16 ( Slte Address: Date: -4 I f Suite _ Tenant: RESIDENT I OWNER ame: ~Phon~e Address I City I Zip: CONTRACTOR Name: License Address:1 Halldman Ave. N. city: Paid, N 55075 State: zip hone: w Confect: Email: \Ij TYPE OF WORK New Replacement -Z Additional Additional Alteration _ osmolition 1. L Description of work:' r NOTE: Roof mounted and ground mounted mechanical a ipmant is relred to be, screened by City Cade. Please contaet the Mechanical Inspector for Information on permitted st:reening methods. RESIDENTIAL COMMERCIAL PERMIT TYPE _ Furnace _ New Construction _ Interior Improvement _ Air Conditioner _ install Piping Proces,aed _ Air Exchanger _ Gas _ Exterior HVAC Unit _ at Pump _ Under I Above ground Tank Install i _ Remove) When instslling/ramoving tank(s), cult for inspectlon by Fire Other Marshal and Plumbing Ins for RESIDENTIAL FEES: 5. fl inimum Add-on or alteration to an existing unit (includes $5.00 State Surcharge) $95.00 Fire repair (replace homed out appliances, ductwork, etc.) (includes $5,00 State Surcharge) $ . TOTAL FEE COMMERCIAL FEES: $75.00 Underground tank installationlremoval OR Contract Value $ X1% $55.00 Minimum (includes State Surcharge) Permit Fee - If the Permit Fee is less than $10,010, surcharge is $ 5.00 - If the Permit Fee is a $70,010, surcharge increases by $50 for each $1,000 Permit Fee Surcharge (i.e. a $10,010-511.010 Permit Fee requires a $ 5.50 surcharge) TOTAL FEE T$ CALL BEFORE YOU DIG. Call Gopher State One Call at (6511464.0002 for protection against underground utility damaga. Call 4g hours before you intend to dig to receive locates of underground utilities, www.aonhorstakMtR ~t ° I1 I hereby soknowledge that this Information is complete and accurate; that the work will be in conformance with the ordinance and codes of the City of Eagan; that I understand this is not a permit, but only an application fora permit, and work Is not to art without a permit; that the work will be in socordance with th pprovad plan In the case of work which requires a review and approval of pla Applicant's Printed Name Ap ca s Signature FOR OFFICE USE Reviewed By: _ Date: Required Inspections: -Under Ground _ Rough in _Air Test „r Gas Service Test '-In-floor Heat' Final Exterior HVAC Screening Inspecction Use BLUE or BLACK Ink j For Office Use 1 I 1 Permit# X15 I City of Ea ~Il 1 I E Permit Fee: - 1 3830 Pilot Knob Road I I I Date Received. Eagan MN 55122 Phone: (651) 675-5675 i staff: Fax: (651) 675-5694 2011 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: - - ( Site Address: apivp Tenant: Suite RESIDENT/OWNER Name: / c Wa I h Phone: Address / City / Zip: Sa A P CONTRACTOR Name: l u A U I -q License Address: JU ~p,~'~tot, Ti Ve / City: State: Zip: ~J✓1p~~ Phone: `~1 7 ✓ Contact: U Q SVYI r 1 Email- TYPE OF WORK _ New Replacement _ Repair _ Rebuild _ Modify Space _ Work in R.O.W. .f Description of work:(!) v ''0 0 S ' l -S ` f S oS E' ` a p 1 y ~►'7j PERMIT TYPE RESIDENTIAL - Water Heater Water Softener .!'(Add Plumbing Fixtures ( Main / Lower Level) Lawn Imgation ~ RPZ PVB) Septic System Water Turnaround New Abandonment RESIDENTIAL FEES: $55.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge) $35.00 Lawn Irrigation (includes $5.00 State Surcharge) $55.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround" (includes $5.00 State Surcharge) *Water Turnaround (add $166.00 if a 5/8" meter is required) $105.00 Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge) $95.00 Fire Repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge) \ V d 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.ord 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 plans. Q x~d~lj &rh i x a-~/ Applicant's Printed Name Applicant's Signature FOR OFFICE USE Reviewed By: Date: Required Inspections: Under Ground Rough-In Air Test Gas Test Final Use BLUE or BLACK Ink F----------------- I For Office Use I CPermit lU of Eajan - / 1 I I I Permit Fee: 7' 3830 Pilot Knob Road RECEIVED Eagan MN 55122 I Date Receiv Ad Phone: (651) 675-5675 DEC 9 ZQ,~ I staff: Fax: (651) 675-5694 Q ~U I I - - - J ~ESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: 697 ion rtnc K/u aj DqW F Tenant: Suite RESIDENT / OWNER Name: JEsm Paz WkwIN.h Phone: '162-410- 61#4q Address / City / Zip: 42ftfo L AI-LS _ChZ1yG E&W old 56123 Applicant is: Owner Contractor 14`/L T TYPE OF WORK Description of work: INSMU. ?t ' koy\-T 1*CP. od M 41A Construction Cost: 3 GLt7'`' Multi-Family Building: (Yes / No CONTRACTOR Name: 610mA LD 10t m bsutkkrt License 2=6632 Address: &bE C PtA%L . AVG E City: /AluffIL 6RovE Hew**T5 State: MAI Zip: 55716 Phone: IP51- 5614-1234)` Contact Person: d 0Qls jA2 VU E- 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.aogherstateonecall.org I hereby acknowledge t ooghis information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; I under n 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 actor nc ith t a ro ed plan in t case of work which requires a review and appro plans. X l Applicant's Printed Na Applicant's Signature Page 1 of 3 DO NOT WRITE BELOW THIS LINE SUB TYPES _ Foundation _ Fireplace _ Porch (3-Season) _ Storm Damage 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 Valuation 304® Occupancy ~G J. MCES System Plan Review Code Edition ,Z 4.9 -2 SAC Units (25%_ 100% Zoning City Water Census Code ki 34( Stories Booster Pump # of Units Square Feet - PRV - # of Buildings Length - Fire Sprinklers Type of Construction Width REQUIRED INSPECTIONS Footings (New Building) Sheetrock Footings (Deck) Final / C.O. Required Footings (Addition) Final / No C.O. Required Foundation HVAC 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 Meter Size: Radon Control Erosion Control Reviewed By: , Building Inspector 1!; A RESIDENTIAL ES Base Fee 66 Surcharge Plan Review 7 MCES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant Copies TOTAL Page 2 of 3 CITY OF EAGAN WATER SERVICE PERMIT r 3795 Pilot Knob Road PERMIT NO.: , .agan, MN 55122 DATE: Zoning: No. of Units: Owner: Address: Site Address: Plumber: Meter No.: Connection Charge: Size: Account Deposit: Reader No.: Permit Fee: 1 agree to comply with the City of Eagan Surcharge: Ordinances. Misc. Charges: Total: By Date Paid: Date of Insp.: _ Insp.: - CITY OF EAGAN SEWER SERVICE PERMIT r 3745 Pilot Knob Road PERMIT NO.: Ragan, MN 55122 DATE; Zoning: No. of Units: Owner: Address: Site Address: Plumber: I agree to comply with the City of Eagan Connection Charge: Ordinances. Account Deposit: Permit Fee: Surcharge: By Misc. Charges: Date of Insp.: Total: Insp.: Date Paid: NUMERICAL FILE CITY OF EAGAN 3795 PILOT KNOB ROAD EAGAN, MINNESOTA 55122 CASH RECEIPT DATE 19 RECEIVED FROM AMOUNT $ &DOLLARS 100 ❑ CASH ❑ CHECK FOR FUND CODE AMOUNT ti BY 47 4 CASH RECEIPT CITY OF EAGAN 3795 PILOT KNOB ROAD EAGAN, MINNESOTA 55122 DATE 19 RECEIVED FROM AMOUNT 271' G` L DOLLARS loo ❑ CASH ❑ CHECK FOR FUND CODE AMOUNT I Thank You BY White-Payers Copy Yellow-Posting Copy Pink-File Copy CITY OF EAGAN 3795 Pilot Knob Road Eagan, Minnesota 55122 Phone: 454-8100 PERMIT No. 286 Date: Augu 1977 Receipt No.: Single 7 ;1<i :tic ? i. i 1s Site Address: nrive Residential Lot Block 1 Sub/Sec. Lak~sine r'states Multi Res., Comm./Ind. I Name rc` e, ro;)str.tictiort New/Alter./Repair a Address Cost of Installation C City Phone: Permit Fee 1,-)' r me zdaling Exca. (Wenzel i'1W 1-,incr) Surcharge Address 735 So. RobertTrail 0 City ' o75 Phone: Total r This Permit is issued on the express condition that all work sholl be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Building Official i CITY OF EAGAN 3795 Pilot Knob Road Eagan, Minnesota 55122 Phone: 454.8100 PERMIT No. Date: July 13 , Receipt No.: Single Site Address; Residential I Lot Block Sub/Sec. Multi Res., Comm./Ind. Name or ,1e.~ New/Alter./Repair 3 Address Cost of Installation O City ~qan Phone: Permit Fee • Q `Name +:omhlete Heating & Ccoi.irG Surcharge g 1 2nd Address - e City Phone: Total fn Permit is issued on the express condition that all work shall be done in accordance with all applicable State of nesota Statutes and City of Eagan Ordinances. Building Official • CITY OF EAGAN * 3795 Pilot Knob Rood Eagan, Minnesota 55122 Phone: 454-8100 PERMIT No. 7 r ` Date: March 22, 1977 Receipt No.: Single <<nt i i.l', s C':'lv^ Residential ? Site Address: `-."7 L Lot t: Block I Sub/Sec. 7=3? `:-+'e T?>c is i.c= Multi Res., Comm./Ind. Name _ -'vey Yarchner New/Alter. /Repair $ Address Cost of Installation _ City ~qan _ Phone: Permit Fee & 'xing Inc. :enzel Plumbing ,a ` Nome Surcharge Address 3600 Ken neP:c-c 7rive c 0 City I':ac'an Phone: Total This Permit is issued on the express condition that oil work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Building Official _ CITY OF EAGAN 3795 Pilot Knob Road Eagan, Minnesota 55122 Phone: 454-8100 xa: - PERMIT No. f Date: 1077 Receipt No.: F%77 Single Site Address: Residential Lot Block Sub/Sec. LL" Multi Res., Comm./Ind. Nome CC sr,_' New/Alter./Repair. 0 Address Cost of Installation C an Phone: Permit Fee Name Surcharge 5 Address 43 City 1 Phone: Total This Permit is issued 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 T INSPECTION RECORD 7Control No. 0293 "r►1t.a:1rNQ CITY OF EAGAN PERMIT TYPE: ` 3830 Pilot Knob Road Permit Number: 0063 h Eagan, Minnesota 55123 Date Issued: 0 g 2 (612) 681-4675 SITE ADDRESS: R v T; 07,? 81.,)u n; 1 APPLICANT: 627 ATLANTIC HILL DR f REVROL '2 LOWELL 1AXES10E E57ATES (612) 452..3242 PERMIT SUP PE: TYPE OF WORK: ITY t': f All I t: H NEW INSPECTION TYPE DATE INSPTR. INSPECTION TYPE DATE INSPTR. C t 110 1 ) 146 FINAL i I R Of HAkA.`i - INC LUD€. S 17' X 12 Of CiC - El 40, ~4 ~I f Permit No. Permit Holder Data Telephone # SNV PLUMBING HVAC ELECTRIC ELECTRIC i Inapacttan Date Insp. Crnnmerns Footings I Foundation Framing Roofing Rough Plbg. Rough Htg. Isul. Fireplace Final Mg. Orsat Test Final Pibg, Plbg. Inspector- Notify Plumber Const. Meter EngrJPlan 81dg_ Final s " 2 Deck Fig. Deck Final . Zg 92 DS Well Pr. Disp. e3L !3~ ' ,%8d CITY OF EAGAN Remarks 2, Addition LAKESIDE ESTATES Lot- 7 ._Blk 1 Parcel 10 44300 07A 01 OwnerA' l.' )L) Street 627 Atlantic Hills drive State Eagan, h~1 55123 Improvement Date Amount Annual Years Payment Receipt Date STREETSURF. Imp. 198 1690.16 84.51 20 1 STREET RESTOR. S ; s3 -7. or IS' 1981 1409.71 20 70-49 GRADING SAN SEW TRUNK St-An 1981 280-00 14-00 * SEWER LATERAL 19R1 42R1-24 214 - 06 WATERMAIN * WATER LATERAL 1981 WATER AREA ARK- 1991 290-00 14-00 STORMS W TRK 202 1985 657.0 43.8 STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. 250.00 19584 6/25/80 BUILDING PER. 174136 12-7-76 4745 SAC 450.00 4745 12-7-76 PARK CITY of EAGAN N2 _4156 BUILDING PERMIT Harve Kirchner 3795 Pilo! Knob Road Owns: .....................X..................................................................----- Eagan, Minnesota 55122 ftS.t.j„Usr Minn 454.9100 Address (present) 16440 G,ggdw},{t__A~?g,.~,,,, Builder Riscbner...Cons.traction Same as above Dale ..._Dgcemlder,,,,•,r,,,l,•,_,§,,,, Address DESCRIPTION Stories To Be Used For Front Depth Heigh! Est. Cos! Permit Fee Remarks Sin Fain Dwlg 6, 50~ 24' 361000. 118:0 Tuck Under G r e LOCATION Street, Road or other Description of Location I Lo! B10 6W Addition or Tract 627 Atlantic Hills Dr. Eli I6 G 7 1 I Lakeside Estates This permit does not authorise the use of streets, roads, alleys or sidewalks nor does it give the owner or his agent the right to create any situation which is a nuisance or which presents a hazard to the health, safety, convenience and general welfare to anyone in the community. THIS PERMIT MUST BE KEPT ON THE PREMISE WHILE THE WORK IS IN PROGRESS. This is to certify, that...... Kirchner._ConstructioA......haspermission to erect a.... Sing,.,,,Fam,Dwlg,,•_d„T(U Gang the. above described premise subject to the provisions of all applicabl ces for the i of Eagan. C.cG..:~c P~ a l. T~ry..~ Ior BuilBing Inspector RESIDENTIAL a5 BUILDING PERMIT APPLICATION 1 CITY OF EAGAN 3830 PILOT KNOB RD, EAGAN MN 55122 651-681.4675 New Construction Reauirements RemodelfReoair Reaulrements 3 registered site surveys showing sq. A. of lot, sq. ft. of house; and L11 roofed areas • 2 copies of plan (20% maximum lot coverage allowed) • 1 set of Energy calculations for heated additions 2 copies of plan slowing beam & window saes; poured found design, etc.) • 1 site survey for exterior additions & decks 1 set of Energy calculations • Indicate if home served by septic system for additions • 3 copies of Tree Preservation Plan if lot platted after 711/93 Rim Joist Detag Options selection sheet (bldgs with 3 or less units) DATE ~ ra- VALUATION S-J 9'0 SITE ADDRESS C_a2l,7 A4) a 0 j: C 1+L L i S 0,- -MULTI-FAMILY BLDG _Y _N TYPE OF WORKTa5 ,L~ Irrccr-E I)r nSp~ AfF~icl~e~ Q4ra9~_ FIREPLACE(S) -0-1 -2 APPLICANT SELA ROOFING & REMODELING, INC. STREET ADDRESS ST. LOWS PAIARpS~ MN 65416 CITY STATE_ZIP TELEPHONE # G U -Q3- ULfjpT CELI PHONE # FAX # PROPERTYOWNERf 1/ln leY V f In a TELEPHONE# COMPLETE FOR "NEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category _ MINNESOTA RULES 7670 CATEGORY 1 _MJN " r, I FS~672 (J submission type) • Residential Ventilation Category 1 Worksheet Submitted ~n New Energy Code Worksheet Submitted • Energy Envelope Calculations Submitted I 1 ' I Plumbing Contractor: Phone # Plumbing system includes: _ Water Softener _ Lawn Sprinkler---- Fee: $90.00 Water Heater _ No. of R.I. Baths No. of Baths Mechanical Contractor. Phone # Mechanical system includes: _ Air Conditioning Fee: $70.00 Heat Recovery System Sewer/Water Contractor: Phone # 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. Signature of Applicant _ ..r...r.____-- OFnCE - USE ONLY Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _ Updated 4/02 CITY OF EAGAN CITIZEN COMPLAINT NO, COUNC I LMEMBER ~Z~u~ fr CITIZEN NAME____c~_ T ADDRESS ~ a ~<ECo rto1 PHQN E---- DATE _j n - a y - COMPLAINT l~a s_ /1 6.. %4 -aePE iccp& - ~„~l.ra.e-~^, , ~3y .C~/ _ U. ~~,.,ra v~iS.G`~ ✓-as,A' i4i e-~.G ~ !~W ly. K-~ -1.0~;-°-t~. STAFF REPLY DATE BY CITY 01F EAGAN PERMIT Control No. 0293 3830 Pilot Knob Road PERMIT TYPE: BUILDING Eagan, Minnesota 55123 Permit Number: 000325 (612) 681-4675 Date Issued: 04 /24 /92 SITE ADDRESS: 627 ATLANTIC HILL OR LOT: 072 BLOCK: 1 LAKESIDE ESTATES DESCRIPTION: Building-Permit Type RES. ADD/PORCH Building Work Type NEW UBC Occupancy., R-3 Building Length 12 Building Width 12 ILI REMARKS: _ INCLUDES 12' X 12' DECK I ~L~1 FEE SUMMARY- VALUATION $5.000 Base Fee $72.00 COPIES $1.00 Surcharge $2.50 Total Fee $75.50 Subtotal $74.50 CONTRACTOR: OWNER: - Applicant - FREYHOLTZ LOWELL 627 ATLANTIC HILL OR EAGAN NN 55123 (612)452-3242 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. Statutes and City of Eagan Ordinances. APPLICANT/PERMITCE7S U E \ ISSUED BY. SIGNATURE INSPECTION RECORD Control No. 0293 CITY OFEAGAN PERMIT TYPE: BUILDING . 3830 Pilot Knob Road Permit Number: 000325 Eagan, Minnesota 55123 Date Issued: 04/24/92 (612) 681-4675 SITE ADDRESS: LOT: 072 BLOCK: 1 APPLICANT: 627 ATLANTIC HILL DR FREYHOLTZ LOWELL LAKESIDE ESTATES (612) 452-3242 PERMIT SUBTYPE: TYPE OF WORK: RES. ADD/PORCH NEW INSPECTION TYPE DATE INSPTR. INSPECTION TYPE ,DATE INSPTR. FOOTING FINAL .REMARKS: INCLUDES 12' X 12' DECK F- L PERMIT # CITY OF EAGAN 1992 BUILDING PERMIT APPLICATION APR 1 3 -RECu 681-4675 SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, I copy of energy calcs. COMMERCIAL 2 sets of architectural & structural plans, 1 set of specifications, 1 copy of energy calcs. Penalty applies when typing of permit is requested, but not picked up by last working day of month in which request is made or lot change is m guested once permit is issued. Date Valuation of work Site Location: STREET STE # Tenant Name: ~uwt-L~ C. F¢r~Ifio~T~ LOT 022 BLOCK I SUBD. LwLiFs g FS ~p•I•D• # Description of work: CLK- f 5caer ?o Po2ou- The applicant is: Owner ❑ Contractor ❑ Other (Describe) Name t-RE `?R0L T",Z L-0LAELL- Phone 452•-32 12 Property LAST FIRST Owner Address (027 ATLCFNTIC. (L.(.S D2. STREET STE # City I✓ gc,S* P-j State M &3 Zip 55 4 'V3 Company Phone Contractor Address License # Exp. City State Zip Company Phone Architect/ Engineer Name Registration # Address City State Zip Sewer & water licensed plumber % Processing time for sewer & water permits is two days once area has been approved. I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant: L_U~'Go'- 1 OFFICE USE ONLY BUILDING PERMIT TYPE ❑ 01 Foundation ❑ 06 Garage/Accessory 11 Res. A /Parch ❑ 16 Agricultural El 02 SF Dwg. ❑ 07 Fireplace ❑ 12 Comm. . ew ❑ 17 Building Move ❑ 03 Two family ❑ 08 Deck ❑ 13 Comm./Ind. Add ❑ 18 Demolition ❑ 04 Multi-fam. T.H. ❑ 09 Basement Finish ❑ 14 Comm./Ind. Rem. ❑ 20 Miscellaneous ❑ 05 Apt. Bldg. ❑ 10 Swim Pool ❑ 15 Public Fac. WORK TYPE O31 New ❑ 34 Remodel ❑ 37 Move ❑ 32 Addition ❑ 35 Repair ❑ 38 Demolish ❑ 33 Alterations ❑ 36 Tenant Finish ❑ 99 Undefined GENERAL INFORMATION Occupancy Basement sq. ft. MWCC System Zoning 1st F1. sq. ft. City Water Const. (Actual) 2nd F1. sq. ft. PRV Required (Allowable) Sq..Ft. total Booster Pump # of Stories Footprint Sq. ft. Fire Sprinkler Length (Z On-site well Census Code Depth 'On-site sewage SAC Code .31 APPROVALS Planning Building Assessments Engineering Variance REQUIRED INSPECTIONS &L.So 1 LA12 ~~=Z1C ❑ Site q Footing ❑ Framing ❑ Insulation ❑ Wallboard Final ❑ Draintile ❑ Fireplace Permit Fee `7Z, c ra valuation: s _>fi'o Surcharge Ai5t, Plan Review License 5-l2n-J P5rzef~ 12 x l~ = 19 (l MWCC SAC City SAC Water Conn. ) y q x_ 3 6 D 3 Water Meter Acct. Deposit S/W Permit S/W Surchargge Treatment P1. Road Unit Park Ded. 6 Trails Ded. Copies I-~o Other Total: SAC % SAC Units 150' , ExrSTING De,oewAt 85' Q rLAkir/L E ws T, }IrLLs mouse o D.2.. o ' ~ sCa¢eu • ,I ---~Dece C 12'x 2y 1 Pano EKIsTbJd. N B9fx STbPS S rrE PL Ad Nor ~ S~qw' 1 31✓ TsUl'")I IG PEMIT P.PPLICATIO 7 LOT mmcn --Z ADDIT'00 /I PS/ cP P / t" . PAItCrIl E SE!"PIOrN 1:U1MEa 1",•7 776T-T-ATI'ED/ TELEF;r..~er. ~0. ZL sTn7'~-s_Lj_c 6) TELEPHOI4n NO. I:OI^^ IuClPr . ire _.lan, huil.di,lg plans, and energy calculZl-t5.u-,S With this a, :pzi.c-ion Signed /UI ~UI V OFFICE USE VALUATIOi?_ SAC UATu'R C02di ^C I1 S art n d A LZ-----. VULTER !MTER O EUILDING FliRf,17.1' P'74 PI,:+1Y3 CF:X-i: F;E PRIl.C D"-D,.c..7vaG.d FEE O'.C,,,R 6-6 TO[!,i?L* ADPPO•rMB.: A^5ra'ESS :81T CLERK BUILDING DEPT. POLICE DEPT.- T.d..TP:R F FtumL R DEPT. FI'_2E DLPT. P?TiK DEPT. G0 Li 1501 l x ke s,4,e Fs3AI-es of o rt` p A S..Q ° 1b St - - e l We P/ tZ,,i A/ tic' MASTER CARD LOCATION 627 Atlantic Hills Dr/ 7 OWNER Harvey Kirchner STRUCTURE AND LAND USED AS Sing Fam Mg & Tuck Under Garage Issued To Permit No. Issued Contractor Owner BUILDING 4156 1216/76 - Kirchner Construction PLUMBING CESSPOOL - SEPTIC TANK Z ~J WELL -7 5 G _S2 77 ELECTRICAL ~y HEATING 9a-7 7 /.3-J7 C°_X~GCL~Clz-iJ D GAS INSTALLING SANITARY SEWER OTHER OTHER Approved Items (Initial) Date Remarks Distance From Well FOOTING SEPTIC FOUNDATION CESSPOOL ib FRAMING _Io TILE FIELD s'o FT. FINAL ELECTRICAL DEPTH HEATING OF WELL GAS INSTALLATION SEPTIC TANK CESSPOOL DRAINFIELD PLUMBING WELL SANITARY SEWER -I-X9 Violations Noted on Back COMMENTS: III. NEW BUSINESS 1. Leonard Chickett - Project 241 (Lakeside Estates) - Ordinance #66 Deferment FACTS On September 24, 1980, the.City Council adopted the final assessment role for the installation of streets and utilities in the Lakeside Estates Addition. The total amount of assessments against Lot 7, Block 1, Lakeside Estates amounted to $7,941.11. It was determined by Council to spread these assessments over 20 years at 8% interest, which provides an average annual payment of $738.57. The total amount of this assessment exceeds the $300.00 maxim n stipulated under Ordinance #66. The application submitted by Mr. Chickett indicates that he does meet the age requirement in addition to meeting the financial hardship of the average annual payment exceeding 18 of his adjusted gross income by his most recent tax return form. STAFF'S RECO4MOATIONS Based on the amount of the assessments levied under Project 241 and the applica- tion submitted meeting all criteria under ordinance #66, it is the staff's ream endation that deferment of this assessment be granted under this Ordinance #66. Because this is a request pertaining to an existing levied assessment, retroactivity will have to specifically be addressed pertaining to the first year's installment which has already been certified on the 1981 tax statement. aJNY~ITS 42 y® Coos rtment of tie Treasury-Int•.r~aI neuanve 5^. ^.ice 4 , I - l ' U.Se Irdiv.'dual Income Tax Return For Privacy Act I'll". sae pa ve 3 of Instructions ro' m• ,n. Impen pNem err ±I. a, or etner Lf rear bei inning 1919, eMing i9 I tour runt name and init.al 0 jpmt realm, sled [ire apouvb name and iniUSll Last name your social security number RS 1 las Leo..arc L. c Phvllis ,i. _ Chicken l~71, 031 `.5 - Spouse s social security no. IdblL Pnaant ham" add,", (Number and street, including spartment number, or lurat 'lull' Dther- wise, 027 ltlantiC i;ills Drive 2 ' l+ ' please City. te+n or post pni,,. State and ZIP cod" Your occupation ► F e tiro d print ar tyce. -ar ; Ti nn. 5;12 Spous^,'s occupaton ► 5 ql liar will PreSit!Cntial ®Do you want $1 to go to this fund.. Note:increase Checking " your Yes" tax or es X No not Eiection Yes il' No reduce your refund. Campaign Fund I If joint return, does your spouse want $1 to go to this fund? . -IY ,~q. Xf e1 Filing Status 1 _ Single 2 ~ Married filing joint return (even if only one had income) Check only 3 Married filing separate return. Enter spouse's social security number above and full name here 10 ono hot - Head of household. (See page 7 of Instructions.) If qualifying person is your unmarried child, enter child's _ name 6 Qualifying widow(er) with dependent child (Year spouse died ► 19 (See page 1 of Instructions.) 65 or over Blind Enter number of 6+ Yourself I~ I- j boxes checked 3 Exemptions le L I Spouse LJ 65 or over u Blind ) on 6a and b ► Always check - Enter number C First names of your dependent children who lived with you ► of children 6 the box labeled ❑ Yourself. listed lop Check other (3) Number of [4) Did degndent 151 Did you proud. boxes if they It Other de(P)enNamedent5: I (2) Relationship I months fired hers income of me,, than one hell of Enter number ❑ apply in your horns 51.000 or morel dependent's support? of other dependents so, Add numbers entered In ~ 7 Total number of exemptions claimed . - . . • . . . . • ' . . boxes above ► Income 8 Wages, salaries, tips, etc. . 71 s ____4.r 3 1 9 Interest income (attach Schedule 8 if over $400) - Please attach " ' - Copy 0 of ycur IOa Dividends (attach Schedule B if over $400)--_----______L----- 10b Exclusion______________ 10c , Forms W-2 here. c Subtract line 10b from line 10a . . . . If you do not have 11 State and local income tax refunds (does not apply unless refund it a W-2, see is for year you itemized deductions -sea page 10 of Instructions). . page 5 of 12 Instructions. 12 Alimony received . . . _ 13 Business income or (lass) (attach Schedule C) 13 G T d~ 14 Capital gain or (loss) (attach Schedule D) . . . 14 15 Taxable part of capital gain distributions not - .t reported on Schedule D (see page 10 of Instructions) . 15 16 Supplemental gains or (losses) (attach Form 4797) , 16 17 Fully taxable pensions and annuities not reported on Schedule E - 17 18 Pensions, annuities, rents, royalties, partnerships, estates or trusts, etc. (attach Schedule E) . 18 . . . . . . . . . . - . . . jj Please check 19 Farm income or (loss) (attach Schedule F) . . . 19 attach or money 20a Unemployment compensation. Total amount received,. 20b order here. If Taxable part, if any, from worksheet an page 10 of Instructions . 21 Other income (state nature and source-see page 10 of Instructions) to 21 p . 22 Total income. Add amounts in column for lines 8 through 21 . . ► 22 O 3 3^? 23 23 Moving expense (attach Form 3903 or 3903F) . Adjustments 24 Employee business expenses (a n to Income ttach Form 2106) 25 Payments to an IRA (see page 11 01 Instructions) 25 / ' 26 Payments to a Keogh (H.R. 10) retirement plan [27 7/1 7~ ~ / 27 Interest penalty on early withdrawal of savings 28 Alimony paid (see page I1 of Instructions) 29 Disability income exclusion (attachForm 2440) j/ 30 Total adjustments. Add lines 23 through 29 . . . - ► 30 Adjusted 31 Adjusted gross income. Subtract line 30 from line 22. If this line is less than C $10.000, see page 2 of Instructions. If you want IRS to figure your tax, see page 4 131 I i A -3 3o2 Gross IDCDme of instructions rs ark form 1 44 Cities Digital Quality Control The following image represents the best available image from the original page. Every effort was made to capture the content from the original page. e P A I D 11 N P U L L CONTROL DATE RECEIPT NO. NU~BER RECORD OF SPECIAL ASSESSMENTS CITY OF EAGAN COUNTY COPY a9 PROJECT TOTAL ANNUAL TOTAL PAYMENT EXTRA NUMBER PRINCIPAL PRINCIPAL INTEREST REDUCTION IN TER E51 YEAR PAYMENT 1 PAYMENT 2 PAYMENT 3 PAYMENT 4 P4 YMENT 0 AT YEAR Il 397°G G35.a9 /,7~ 158.g~- /~d/ /aoo.59 9csyj 937.,97 9°s,31 ~ 9, _ ~orrS Py/.79 g/o.0-3 77S. .17 7ye.s/ to I_EVlE9 - PRaT A41 .1 /s!7~ 44,9.1717 454 -11 6i9. 47 587 71 G7 / r55.95 j„ PURPOSE FOR WHICH SPECIAL ASSESSMENT IS LEVIED 711 NAME AND ADDRESS DATE DUE NO. F YEARS ASSESSMENT DATE I EON4k~o 0-#-(cK6Tr (2) (3) 141 4,17 R Af//G 11/4L$ bk, AD T AGE P R FOOT AMOUNT I ` LOr 7 /JK I 4Aktr-'496- 4GS7- LOT NO. BLOCK NO. PARCEL NO. PROJECT NO. 11 PLEASE PAY ABOVE AMOUNT APPLICATION AND AUTHORIZATION FOR DELAYED PAYMENT OF T"u: 031 SPECIAL ASSESSMENTS rOR SENIOR CITIZENS' HOMESTEAD LATIS 1974, CEAPTER 206 STATE OF 14INNESOTA ) a 19 COUNTY OF DA10TA ) DATE To: County Auditor, Dakota County, Minnesota I, the undersigned, declare under penalties of perjury: That I reside at~ r71 ✓fTi d~9T." /1/I L 5 w V'r 61 fVa/ M ~~1. 3 o That I am ax.-it less than 65 years of age and that the date of my birth is Ot t o a 'T'hat I ara the owner of the property legally described as: Property Identification No. /d y~/ 9 va D 7,0, 0 That my interest in the ownership of the above property was aquired on_4~4eL- 19~ and is as follows: 1. Sole ownership (Enter yes, if applicable) 2. Joint tenancy, h®l.d with (F ^ arz p d PNy [I s Cite c n rT 3. Other undivided interest (Specify) That on January 2, 19 9 ,1 or June 1, 19 9.) I owned and occupied the above property as :ay homestead and such occupancy began on 19~ Viet the installments for improvements on the special assessments duly adopted in ordinance by the C T of /-.g z I as of 195 which have been allocated against the subject property would create undue personal hardship on my behalf and I respectfully request that payment be delayed and that euch instcilmnnts be ao deferred for the years 19 to 19 Signed j>t an(6.l { 1 t1/ lf~i il~f Owner Clerk of the of in County, State of Minnesota, do hereby certify that the applicatinn of above named, has been duly reviewed and that in accordance with the minutes of official record in said chambers was duly APPROVED or DENIED as of 19 That in accordance with approval granted, the special assessments listed below on the affiants subject property levied for annual collection in the amounts and for the years shown be so deferred with interest at the annual rate shown until such ticoe a.[ it is deemed the applicant no longer qualifies or the property loses its eligibility Years of Name of Auditors D/P Total Colllertion Intrrest Assassment Number No. Amount (Inrlasive) Rate Dated 19 (Clerk or Authorized Deputy) 43 (over) PERMIT City of Eagan Permit Type: Building Eagan. Permit Number: EA101920 Date Issued: 11/01/2011 OR Permit Category: ePermit 41~ it~ of E3 E Site Address: 627 Atlantic Hill Dr Lot: 072 Block: I Addition: Lakeside Estates PID: 10-44300-01-072 Use: Description: Sub Type: e-Windows iDoors Construction Type: Work Type: Windows Doors-New ; Replacement Description: House Census Code: 434- Occupancy : Zonin,: Square Feet: 0 Comments: Improvements to the home require smoke detectors in all bedrooms. If altering window openin,s, call for framing inspection. Call for final inspection after installation. Carbon monoxide detectors are required by law in ALL single family homes. Fee Summary: BE - Base Fee S3K $88.50 0801.4085 Valuation: 3.000.00 Surcharge - Based on Valuation S3K $1.50 9001.2195 Total: $90.00 Contractor: - Applicant - Owner: hrech Exteriors Inc Jennifer 1\1 Walding 5866 Blackshire Path 627 Atlantic Hill Dr Inver Grove Heights NIN 55076 Eagan NIN 55123 (61)688-6368 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 Cite of Eagan Ordinances. ApplicantiPermitee: Signature Issued Bv: Signature