4357 Beaver Dam Rd�-los.ds
city of
Eaan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Use//�
Permit #: / 7)"'
Permit Fee: IG S S
Date Received:
Staff:
L
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 10// Site Address: "/ 2S �- �
�P_Lt ide j- 1 �`'�r''1 Unit #:
Description of work: I eco -' f 4-(--oQ- %- , (, ? 3) 1
Construction Cost: 23 , . S
Multi -Family Building: (Yes / N
Company:c 4,1E(9j 0('L( CoOg; . Co .i tle., . Contact: I r 0—,
Address: I 0 R(40 (,,%t1k c-5-1-. N .f i , -cr
City:
State: MN Zip: SO2SPhone: Gc 1 — LI3 ("13 0
License #: 3C :;&91-131-1 Lead Certificate #: NAT- - 1 QS6G,2 —
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:
Phone:
Sewer & Water Contractor:
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.gooherstateonecali.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.
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 Name
x
Applicant's Signature
Page 1 of 3
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-. ' Swr A+lclress 4357 Beaver Dam Rd.
f.at 2] IMak 3 SeclSub. Meadowlands ,? p . 2?? '•' ?
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10 48050 210 03 F?ep?ir : p ,
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?7760 MitcheZ B?oad
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Eden Prairie 454-5276-937-9520?? p
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Addreas .?
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Assesunent ? ? .,?,?!?
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Water & Sew. 5
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?'?7y OCk??I?@ th41' I hOVg reGd thiS opplitAtlOn and stElte lhnt BIdgi Of.
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?
ity af Eapan Ordirarices.
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116lah" of Rarmiftee
- NOW* IS kM14d ,, Zachman Homes, Iac.
Stela ofi/AinrmaRo $toi?ul?es ? , h_.
? -°?qlik at $1 bir done in oeootdenm wkh dt,tvlimsblp
.
777
IS
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Plumbing 1590 / /? 6
AAechanicol p
INSPF.CTIONS DATE INSp. Raqh-In Finol
Footings Dote Imp. Oots hap.
Foundation Plut+bi
Frome/ins. . ? Mechcnical
Final
Remarks:
?
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M
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. ' CITY OF EAGAN
3795 Pilot Knob Road
. ? ' Eagan, Minnesoto 55122
Phona: 454-8100
?
PL6mItv. PERMIT No. 1.590
Date: 1l15/80 Receipt No.: 17522
Single I
Site Address• 1+35 t' BeS'P('•~ La441 Pjfld Residential 7C
Lat 21 Block ? Sub/Set. _Meadcnvlancis Multi Res., Comm./Ind. I
Nnme ?'?gGr.3?ISn ii0me9 TriC. New/Alter./Repcir
3 Address '7760 ?'titC';e3 Rd. Cost of Installation
O
City Edeii 7''!`8f2'ie Phone• Permit Fee ?r' •!;?
Name 1`u3'= Pt Flb`y, 5urcharge
.
? Address t ;"'-` vlti-i71k !'ZOt2d i`Y'i?P
0
v Cih, Phone: Total
This Permit is issued on the express condition that all work shnll be done in accordonce with all opplicable 5tate of
Minnesotn Stotutes and City of Eagan Ordinances.
Building Officiai
AIP'AT-Q[; TT3; ;i `
.
PERMIT
Date: 'P?
Sife Address: i'• %5 ?' T3ea'vCZ' Dflm r^,Da.'_
LM Block Sub/Sec. -
Name liOI:lF'S z:1C .
I? Address yrJ, "i ICrt?lli?.A_.
?
City
cirY oF EAGAN
3795 Pilot Kwob Road
Eagan, MienesoM 55122
Phona: 454-8100
`!e;:Qkw? a71d£+'
Phone:
No. 161?()
Receipt No
: '?.77
1 ? `• '
.
Single I
Residentiai
Multi Res., Comm./Ind. I
New/ Alter./ Repair
*IP??
Cost of Installation
Permit Fee
Name ?`3`r '•f .'-,'e l ?er l t?' . 5urcharge
.
? f.', .2,, ralCBfm AvF, ?7n.
? Address
CQ :r:
V _
City Phone: Totnl
This Permit is issued on the express condition thot oll work shall be done in acoordance with all applicnble 5tote of
hAinnesoto Stotutes and City of Eegan Ordinances.
Building Official
n?o. 403
qTY OP EIGAN
37l3 rqat Keob RoW
m"m. Mina..ol. ssIn
Ploes 4,111i-t100
Water. Cond PtttMIT
paft; _ 11- 3-f30
site Add.eas: 4357 Beaver Dem
Lot Biock Sub/5ec.
Nome Peter Klein
.
? Address same
City Phone: .,1OL-521 6
Nome ('.nrmnPt'u .'Af+. WA'tP2`
Adamn ; 8m rAlirn,..,{ a uV
Cih? ?.IpL-.-I-f', Pho„e: 7$1_?
l'hia Permit ia issued on the oxpress condition thot oll work sholl be
Mirnvesoto Stetutes ond City of Eagon Ordinonces.
INSPECTOR NOTIFICATtM
REQUIRED BY LAW ?
FOR ALL iNSPECTIONS
Reeeipt hb.:
Single
Resider?tiof
Multi Res., Comm.llnd.
New/Alter./Repoir
Cost of Instcliotion .
Permit Fee 5.00. .
Surchoe9e - - - -- - ti.?.
A?
TOYdl
done in occardersae wiih aN ??4111P0
ti
Buiidinp G?11t1#? ?
? =?j.: ?? '?, ? -,....? - , ... .. - ----- . ..-d.`.?..af+s+e?•.?
CITY 4F EAGAN SEWER •SERVICE''PERMIT ?
3795 Pilot Knob Rond .. . ` '
PERMIT NO.:
Eo9an, MN 55122 DATE: ' l rZ??$6
Zoning: ":II No. of Units: ? • ? ?n? ' ``?
Owner: . acr:r,,,
Addr`ess:
Site Address: .`f• 37 z' _.ot'! Lt' 121 '? 3^aF't?ti;-C?t?; l?11Gf '
Plumber:r
?i79?j ??•-
' 1 egree'Meoinply with`.the City of Eagun Cannection CMorge
' ?Ordinonees
? Accounf Deposit
? Permrt Fee
?
. 5 ? . ..J ? K t
-do
re:?dBV?g.:..?.Y.?"?4'._?.?t ?y, d 1? t..?.r ?' fi. , a 7???ii' _;?k?.? 7w
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cirvoF EA.;eaN" !
WATER SERVICE PERMIT
379V-Pilot' Knob Rood z?? $
PERMIT NO.: _
ag'ogan; ?+MN 55122 :. DATE: ' T/ 16/89, ;
Zoning: No. of Units: i
Owner. _ ZSChIItAII ItoSieSx IAC
Address:
Site Address: 1+357 BeSVpl7C T?ADt Rd L71 $3 MBAdcW'18a-d
Plumber: };udc Rt PItumbxng '
Meter No.: ?]'0.0(? ? ?
Connection Charge:
Size: Account Deposit: ,
Reqder No.: Permit Fee: 10•00P
i egree to eomply wit6 the City of Eagon Surcharge: •5Q pd '
Ordinonces. Misc. Charges• 60•? p'd
By:
Dote of Insp::
Total:
Date Paid: °
I nsp.: t ?
... , . ,
? CASH?RECEIPT
CITY OF EAGAN
3795 PtL07 KNQB ROAD
EAGAN, MINNESOTA 55122
?
bATE ' 19 '
RaCEEY6D ' PROM
AMOUNT
J?
? aa OOLLARS
f Pa
? CASH
FUNp GODE AMOUM ( -
•: r' ?J 7
r'
7
;
Thank You
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This request void 18 months from
'R 97457
Date of fhis Request ? W,0A[/n
I, as O Licensed Electrical Contractor El bwner, do hereby request ipspection of the above electti-
cal wiring installed at: Street Address or Route ?CC%L-. City
Section Township . Range Coun loCh4z?u
_ ,
Which is occupied by
ls a roughin ins ection required on this job? No O YesTd Ready Now O Will Call Ud'
Power Suppli Address ,?3w- 622-0 -Ay'i
El ' al C ? ? ?d? / ? {' - •?d'?? ?
ectnc ontractor C tractor sce.
(Company Name) ?--L
7_/ ?? •
a_ ?
Mailing Address/ ? '? S?
_(Elecirical Contractor or Ownsr Makf This Installation)
_
Authorized
Making This
Phone
tueccr?ca? contrac[? or
STATE BOARD C
This inspection request will not be accepted by the
State Board unlesa proper inspection fee is endosed.
Minnesota 5tate Board of Electricity
1954 University Ave., St. Paul, Minn. 55104-Phone 645-7703
.REQi6EST?-FOR ELECTRICRL INSPECTION
CHECK $ELOW WQRK COVEREB BY THIS REOUEST .?//f
/74FAs
R 97457
Type of Building New dd. Rcp. Check Appliances W'ved For Check Equipment Wired For*
Homc ? ? Range ? Temporary Wiring ?
Duplex ? ? ? Water Heater ? Lighting Fixtures ?
Apt. Bldg. ? ? ? Dryer ? Electric Heating ?
Commercial Bldg. ? ? ? Furnace ? Silo Unloader ?
Industrial Bldg. ? ? ? Air Conditioner ? Bulk Milk Tank ?
Farm ? ? ? List List
Othei
?
?
? 2e
iels( p
Heie S?
COMPUTE INSPECTIO N FEE B ELOW
Seivice Entrance Size: # ee Feeders& Subfeeders: # Fee Circuits: # Fee
0 to 100 Am s. 0 to 30 Am eres 0 to 30 Am eres
101 to 200 Amps. 31 to 100 Amperes 31 to 100 Am eres
Above 200 Amps. Above s. Above 100 Amps.
Transformers Remo tr Pa?e :f? Tc
; Signs 5peci nspe ` Minimwm fee $5.00
Remazks TOTAL FEE ?
I, the Electrical Inspector, hereby certi?fy?t?t the, `spection has been ade.
(Rough-in) Date ? "2
(Final) • Date
This request void 18 months from
• CITY OF EAGAN
3795 nlat Knob Rood FAgee, MN 55122 N2 5S71
• PHONE: 4548100
BUILDING PERMIT APPLICATION Receipt # / 1c
To 6e nsed for SF Dwlg. Est. Vclue 40, 000. 00 pate 12/14 , 19 79
Site Address 4357 Beaver Dam Rd. Erect Oocupancy R3
Lot 21- Block 3 See/Sub. M@3dOW1811d8 Alter ? Zoning Rl
Parcel # ] 0 48050 210 03 Repcir ? Ftre Zone 3
Enlcrge ? Type of Const. v
oWc Nome KM Zachman Hrnnes, Inc. Move ? # Stories
3 Address 7760 M3.tClle?. ROSd Demolish ? Front ?+8 ft.
o Ci Eden PrairiePhone 454-5276-937-9520Grode ? Depth 36 ft.
ApProvols Fees
z?
°u9
Address
Ctt_L' _
Name _
Address
Assessment 12110/
Water & Sew.
Police
Fire
Eng.
Planner
Council
I hereby ccknowledge thct 1 have recd this application ond stote that gldg. Off. _
the information is correct and agree to comply with all opplicable APC
State of Minnesota Statutes and City of Eagan Ordinances.
Signoture of Permittee
A Building Permit is issued *o: ZBChIDBII Ubm@8, IriC,?% -
all woric shali be done in accordance with all,6auti'oa? Stcte%t/Minnesota Statutes
Permit
Surchcrge 20 00
Plcn check S_?T
SAC c2c nn
Water Co" B.,00.._
Wuter Meter 60=po
Rd. Unit 75.00
Toro1 1123.25
_ on the express condition thot
City of Eagan Ordinancea
50
Building Official 4 -?U, _?"' Ln-7 = "'= e
CITY OF EAGAN Remarks
Addition Meadowland lst lsiddition Loc 21 aik 3 Parcel 10 48050 210 03
OwnerPEA? i' L , 'l)bLn%Fr, U?0 Street 4357 Beivel aAllt ROad State Ea9?,MN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR, jm , 19 •• 1589.99
GRADING
SAN SEW TRUNK 25
• SEWER LATERAL 3156.58 C005430 6 80
WATERMAIN
* WATER LATERAL 1981 lO
WATER AREA 973 95.27 6.35 15
STORM SEW TRK ? r1 1971 282.92 14.15 20
• 570RM SEW LAT 1981 10
* services 9 10
CURB & GUTTER
SIDEWALK
STREET LIGHT
ad U i 75.00 17031 12 11 79
WATER CONN. 270.00 it it
BUILDING PER. ii ri
SAC
PARK
CITY CF FACAN
? gUIId7ING PERMIT APPLICATIQN
Zb Be Used Far :'S' e,;
Site Address: /-/..
Lat .'? ) Block _
Parcel # : /,r /,
Owner: ?
Acidress :
City/zip Code:
Plione #:
?Ccantractor:
Address:
Ctty/Zip Code:
Phone #:
Arch. /Eng. . ?----
Ar3dress:
City/Zip Code:
Phone #:
ValuatiAn I
? ? h
Ir?Iude 2 sets of plans,
1 site plan w/elevatiom &
1 set of eresgy cal ations.
Dabe
OFFICE LTSE OIZLY
. ,?
soec. /Stb7-4 tIc? < Erect ?_? E?PazicY ? '??
Alter Zaning ?
? Repair Fira Zorte -?
-Enlarge 'IyPe of Const.
i'rbve # Stories
Dernolish Front .?g ft.
Grade L)epth 3& ft-
PPPROVALS FEE5
r Asses?ents e?m?.t Water/S?z 'a C)
Polioe Flan Check
Fire SAC
gng , Water CQnn. 2 V
Planre.r Watex Meter (Q o AAW
Counea.l Road Unit ?-AW-
Bldg. Off . ? --
AFC
TCI'AL
,... . _ _ --? _....
ti
t
?i`'?' •? ..???? l ,
?
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s I
Form FFfA 422-3 t a.,,. a. 17.70) _ M I1P O F P R/__ : RTY ..........................................
.,o.? ?o•? ? t • . , ---
?
See ached For legal eullder Zachman Homes Inc.
Loc 2i etk.3 Addttion ME9DDUJLI9Nl1
fA6AN HILcs House Name 'DAK WODD
Address:
,g3 5?7 BEAUE/t DHM ROHi7 House Style 5 PLIT FDYER
\ • I Sq.Ft.House $ 6v -f ? sq.ft.Gar.f
•%c,;c : FHGHN' M/NN - M
FTELD NOTES GAJ Powex ples P Low Areas
Show location of ineters X Telepone poles T Highest Point NORTH
Private well NP Larger TreesCD -
Private septic ?systemlJD ss;o
Public water !(ES
Public sewer YES
Natual gas YES
L.P. GasNO
Culvert requiredNO I ?
Curb cut requiredh/D ?
Sewer $ Water stubbed in Yt$ . I i
Driveway surface fG' @IT ASPtlALT
Front yard setback 3 0; ? I
Sideyard setbacl: 5'? 1 D MlNN I . ?
Att. Gara YES I
Garage le right I ? I
Local Inspector I
City of EHGEN c?
Name p P1CE PE7ERSON ? D DUG RE! D ")
Phone * 54 - 810 D
LOT DETAI LS ? d1?,
"size width g0.00 - 55435•00
Size depth 14 S JY ' t 4743, 17'
Approx. S. F. of lot `oo
High point ? ? • ,I (
Power Poles NonE - ' ?
Telephone poles uohe
Underground yF,,.,?
Larger trees fJ
Street _ Elev. $ 8D . S ' - _ 893' $$ . o ?
?
?
Lot corners 41.9` T?a ?
High point g%3. o . ???4•o a
Low point ?
Gutter or Ditch . ? ?
? - - - - ?
Local Electric Co.
Name NS P 1SfiRHI(YtT0I1- .
Pbvne 507 ' 3'g7 5.621 .
'Local Gas Co.
Nairie -PEOPLES - NfiT GAS fAnvaTon
Phone SF Cs 3` 7 1Z1riser ?
a) Stoops ( ) _, ?
Decks
b) Sidewalk s.f - ?
Driveway s.f. $
Parking Paa S•f•$ '
Curb Cut & Permits $-
lawn steps #_ $
c) Finish Grade $
d) Black Dirt & landscaping
Sod s.f $
e) Underground lltil Ej $
TOTAL
.
fgB1,2
-- -? - -
?+3 5? ti EfVER 0ft H
. AC CH??RGE $ _
_ tater charge ' $__ _
-Park charge $ .
DIRECTTONS TO SITE:
u
DCW 1..?-•. •3a?-
.,•O 919?1•
?
RDA?
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4 , .. ....... +• . .............. s.................. _.?C........ 10........ L ?.. ........
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70,737
2005 RESTDENTIAL BUILDING PERMIT APPLICATION
City Uf Eagan
3830 Pilot Knob Road, Eagan MN 55122
Tefephone # 651-675-5675 FAX # 651-675-5694
?
New Conslrvction RequiremenLc RemadellReoair Reaufrements Oifice Use Onlv
3 registered site surveys sh(ywing sq. tL of lot, sq. 8. of hnuse; and ali roofed afeas 2 oopies of plan CeR of Sunrey Recd ,. ? Y_ N
(2096 ma)imum lot coverage allawed) 9 set of Energy Calculations for heated additions Tree Pros Plan Real _ Y_ N.
2 copies of plan showing beam &windaw sizes; paured faund design, eEc. 1 site survey for additions & decks Tree Pres Requlred ' _ Y_ N
1 set of Energy Calculations Addition - indicaFe if on-slfe septic system On-site Sep6c 5ystem _Y. ,V N
3 capies af Tree Preservatian Plan ff lot platted after 711193
Rim Joist Detaii Optians selection sheet (buiWings witM 3 or less units)
i.2- Df 05
Date
Sit
Add
canstructioo cost
#
2
-Y U
itlSt
e
ress _ n
e
Z
description of Work !:?IdZL?1d -?' %k(.2
Mulfi-Family Bldg _ Y? N
/? 0
Fireplace(s)
_ 1 _ 2
Property Owner Al/ ?Ole Telephone # tl?
s-elf
Contraztor '
Address d?o CJ City A
State /1_{ Zip Telephone # ?? 3 1_;11;? ` 1?2?96
COMPLETE THIS AREA QNLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Category l Minnesota Rules 7672
Energy Code Category , Residential Venti3ation Category 1 Worlcsheet • New Energy Code Warksheet
(d submission type) Submitted 5ubmitted
• Energy Enve4ope Calculations Submitted
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master pian?
_ Y _ N If yes, date and address of master plan:
Licensed Plumber
Mechanical Contractor
Sewer/Water Gontractor
Telephone # (
Telephane # (
Telephone # (
I hereby apply for a Residential Building Permit and acknowledge that the infarmation is complete and accurate;
that the wark will be in conformance with the ordinances and cades af the City of Eagan and the State of MN
5tatutES; I understand this is not a permit, but anly an application far a permit, and work is not ta start without a
permit; that the work will be in accordance with the appraved plan in the case of work which requires a review and
approval of plans. _
13ob 6511t1,h
Applicant's Printed Name Applicant's Signa.ture
OFFICE USE f)NLY
sub ryPes
? 01 Foundation
? 02 SF Dwelling
? 03 01 of _ plex
? 04 02-plex
? 05 03-plex
? OB 04-plex
Work Types
? 31 New
? 32 Addition
? 33 Alteration
? 34 Replaeement
Valuation
Plan Review
Census Code
SAC Units
# of Units
# af Bldgs
Type of Const
_ Footings (new bldg)
_ Foatings (deck)
_ Footings (addition)
Foundation
Drain Tile
Roof Ice & VVater Final
_ Framing
_ Fireplace _ R.I. _ Air Test _ Fin
Insulat[on
Approved By:
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
tltility Connectian Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Capies
4ther
Tatal
? 07 05-plex ? 13 16-plex ? 20 Pool
? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.)
? 09 07-plex ? 17 Garage ? 22 PorchlAddn. (4-sea.)
C] 10 08-plex ? 18 Deck ? 23 Porch (screen/gazeba)
? 11 10-plex 0 19 Lower Level ? 24 Skorm Damage
? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
0 30 Accessory Bldg
0 31 Ext. Alt - Multi
0 33 Ext. Alt - SF
? 36 MuEti Misc.
? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 36 Move Building 0 42 Demofish Foundation ? 45 Fire Repair
? 37 Demolish Suilding" ? 43 Reroaf ? 46 WindowslDoors
"13emoli4ion (Endre Bldg) - Give PGA handout to applicant
Occupancy MCES System
900% or 25%
Zoning City Water
Stories Booster Pump
Sq. Ft. PRV
Length Fire Sprinklered
Width
REQUIRED INSPECTIONS
_ Final/C.O.
_ FinalNo C.O.
_ Plumbing
HVAC
Other
_ Pool _ Ftgs _ AirJGas Tests Final
_ Siding _ Stucco _ Stone ____ Brick
_ Windows
_ Retaining Wall
Suilding Inspector
` 2006RESIDENTIAL BUILDING pERMIT ApPLICATIoN r?
-??? ?
?5'? ? city of Eagan
122
3830 Pilot Knob Road, Eagan MN 55
Telephone # 651-675-5675 FAX # 651-675-5694
New Canstruction Reauirements RemodeUReoair Reduirements
3 regisiered site sunreys showing sq. ft. of lot, sq. ft, of hause; and all roofed areas 2 copies of plan showing footings, beams, jauts Certbf??
1 set of Energy Calculations for heated additions Sails?eport bn
0q1 ? N
?
(2096 maximum fot coverage alfowed)
1 Soils Report rf proposed building is to be placed on disturbed soi( 1 site survey for additions & decks Ttm p? P.1161i
ies af plan showing baam 8 window sizes; poured found design, etc. Addifion - indicate if on-site septic system Tree Pre& ?Ot
2 co
p
4 set of Enertjy Calculafions
3 copies ot Tree Preservation Pian iF lot platted afler 711193
Rim Jaist aelail Options selection sheet (buildings wiih 3 or less units)
Minnegasco mechanipl venlilaGon form
pate ZO ? /2- ? 6 i?g Construction Cost
Sife Address el1.Ua b61./)7 UnitlSte # _
Description of Work /-ea-ir 6?J?V a/? elll YOp T '
Multi-F'amily Bldg _ Y- N Fireplaee(s) _ 4 2
Property Owner Teleghone # ( ?5? ) ?? • ?D
42 GCa4:?'G?'
?6-1
Contractor
-
? . .
Address ,V c,ty SA- Ir&-a-?.??
State P)AI? Zig _t?z5 ?87,P Telephone # (j?57) 1;3•
COMPLETE THIS AREA ONLY IF CONSTRUC"TING A NEW BUILDI aIG
--- Minnesota RuIes 7670 Category 1 Mi.nnesota Rules 76
Energy Code Category Residentfal Ventilation Category 1 Worksheet ? • New Energy Code
(q submission type) 5ubmifted 5ubmitted
. Energy Enve4ope Calculations 5ubmitted
In #he iast 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_ Y _ N If yes, date and address of master plan:
Licensed Plumber Telephone # J ?
Mechanical Cantractor
5ewerlWater Contractor
Telephane # (
Telephone # ( ?
I hereby apply for a Residential Building Permit and acknowledge that the informativn is comi
that the work will be in conformance with the ordinances and codes of the City of Eagan an(
Statutes; I understand this is not a permit, but oa3.ly an application for a permit, and work is na
permit; that the work will be in accordance with the approvad plan in the case of work which rec
approval of plans.
plicant's rinte Name Applicant's Signature
ete and accurate;
the State of MN
to start Without a
ires a review and
Use BLUE or SLACK Ink
---------,
� For Office Use 1
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� Permit Fee: lY� . �� I
3830 Pilot Knob Road ► ' �
Eagan MN 35122 , , _�., i Date Received:�,�� �
Phone: 651 675-5675 �'r`� �' �j`-.'� � � I
t ) �� � � � sta i
Fax: (659)67�-5694 {
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2015 RESIDENTIAL PLUMBING PERMlT APPLICATtON
Date:��Site Address: �` ��� `��.�1�-�. ��Y x .��'�, � �1
Tenant: � � �---= Suite#:
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� Name: � �C� Phone: �
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; Address/City/Zip: ���� ���-�- � � �� � � _ �a
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� Name: � �- 1�- ��� �y ��l� License#.�Q ����� ���- �
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� Address:. � �t � � ,e L- City: �''� &
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� � � Contact: t�� Email: � �tA.�- l��� � �C-� �
� � _New �Re�acement _Repair Rebuild _Madify Space _Work in R.O.W. §
� ������ � �
� Description of work: �
� RESlDEN71AL � �
� -� Water Heater � �
� �Water Softener
� Lawn Irrigation(_RPZ 1_PV8) � i
������ } �
Septic System Add Plumbing Fiutures(_Main J_Lower Level)
� �
� � _�eN, � Water Turnaround
� � �
. _, —
Abandonment
RESIDENTIAL FEES: �
� $60.00 Water Heater,Water Softener,or Water Heater and Softener(includes State Surcharge) �
� $60.00 Lawn Irrigation (includes State Surcharge) �
� $60.00 Add Plumbing Fixtures, Septic Svstem Abandonment,Water Turnaround*(includes State Surcharge)
4 "Water Turnaround(add$21d.00 if a 5!8"meter is required) �
� $115A0 SeRtic SYstem New(includes County fee and State Surcharge} (�
��ry � TOTAL FEES� ��.-� �
CALL BEFORE YOU DIG. Call Gopher State One Cal!at(651)454-�02 for protection against underground utility damage.
Call 48 hours before you intend to dig to receive locates of underground utifities. ��n+vw.qoph�rsfiateoneeall,orq
I hereby acknowledge that this information is complete and acc,�arate;that the w+ork wilt be in confortnance with the ordinances and�des of the City of
Eagan; that f understand this is not a permit, but on�r an application for a petmit, a�wrork is not to start vrithout a permit;that the work wiVV be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
X.._\` \ G.� " ��/1��� 1� �� ✓�`_
Applicant's Printed Name Appli 's Signature
f4���F�#���, ; �+�V�;��; : ��'.
����l�t����� � ���+��v�t� ' �u��n , ; ���'�� �„�a�°�"� _ ��a# ;
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA157401
Date Issued:08/19/2019
Permit Category:ePermit
Site Address: 4357 Beaver Dam Rd
Lot:21 Block: 3 Addition: Meadowlands 1st
PID:10-48050-03-210
Use:
Description:
Sub Type:Siding & Windows/Doors
Work Type:Replace
Description:
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of house wrap and leave on site for final inspection.
When installing ventilated soffit material, remove existing material (i.e. debris that could block vents) and take steps to
ensure maximum ventilation to attic. Call for final inspection after installation.
Valuation: 10,000.00
Fee Summary:BL - Base Fee $10K $191.75 0801.4085
Surcharge - Based on Valuation $10K $5.00 9001.2195
$196.75 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 -
Robert M Delich
12850 Dory Ave
Apple Valley MN 55124
Bell Remodeling & Roofing
7675 W Highway 13
Savage MN 55378
(612) 760-0949
Applicant/Permitee: Signature Issued By: Signature
Ole 71/a
Commercial&Residential
Remodeling/Roofing
September 18, 2019
Re: EAI57401
4357 Beaver Dam Road
Eagan, MN 55122
Derick,
I mistakenly pulled a siding/window permit for the above referenced property. This letter shall serve as our
guarantee we are not replacing any windows. We just replaced the siding.
If you should need any further information, please feel free to contact me.
Sincerely,
Stacey Forst
Stacey Forst
Bella Remodeling and Roofing
7675 Hwy 13 W
Savage, MN 55378
952-454-4549
7675 W Hwy 13 Savage, MN 55378/Phone: 612.760.0949 - Fax 877.253.6955 Page 1