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
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A^5ra'ESS :81T CLERK BUILDING DEPT. POLICE DEPT.-
T.d..TP:R F FtumL R DEPT. FI'_2E DLPT. P?TiK DEPT.
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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