4715 Beacon Hill Rd
Use BLUE or BLACK Ink
For Office Use
q,
City of nam P6A ~ Permit ~
7nj j Permit Fee f ij 1
3830 Pilot Knob Road I I
an MN 55122 S I Date Received:
Eag
Phone: (651) 675-5675 1 Staff: j
Fax: (651) 675-5694o !
- - - - - - - - - - - - - - - - J
I
INFLOW & I ILTRATION PERMIT APPLICATION
Plumbing I Sewer & Water
.1
Date: Site Address:
Tenant:
1AQ
Name: 4114 1 Phone:
RESIDENT / OWNER
Address/ City/ Zip:
Name: T3, License
CONTRACTOR Address: City:
State: Zip: Phone:
Contact: Email
PLUMBING Within the building envelope) SEWER & WATER (Outside the building envelope)
TYPE OF WORK /Sump Pump Repair Repair
V Other: Other:
u,
A J1 a cnpVon o `
DESCRIPTIOt i
V
0714 1 -
)I-rj ) Wi it ar
v
$55.00 /Each (includes $5.00 State Surcharge) (Rev. 6-30-10) y l TOTAL FEE $
."Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submit 1/1 repair costs for MCA V
reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors
can be found by visiting www.citvofeagan.com/inflow, or City Hall at 3830 Pilot Knob Rd.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call
48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org
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 f 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 wh' equires a Z r w and approval of plans.
A4 A. /1
x x
Applicant's Printed Name Appli eat's Signature
FOR OFFICE USE Reviewed By: Date:
Required Inspections: Under Ground -Rough-In Final
PERMIT
City of Eagan Permit Type: Mechanical
3830 Pilot Knob Rd Permit Number: EA076882
Eagan, MN 55122 . Date Issued: 03/06/2007
(651) 675-5675~~~ EPermit Category: ePermit
www.ci.eagan.mn.us lflflUl tflflLLL
Site Address: 4715 Beacon Hill Rd
Lot: 3 Block: 7 Addition: Beacon Hill
PID 10-13500-030-07
Use
Description:
Sub Type: e - Furnace
Work Type: Replacement
Description: Furnace
Comments: Quesetions regarding electrical permit requirements should be directed to Ma rk Anderson, State Electrical Inspector,
952-445-2840Ashley Orman 410 W Lak e St Minneapolis, MN 55408 612-824-2656 ashley@standardheating.com
Fee Summary: Surcharge-Fixed $0.50 9001.2195
ME - Permit Fee (Replacements) $50.00 0801.4088
Total: $50.50
Contractor: -Applicant - Owner:
Standard Heating & Air Conditioning Joann I Simser
130 Plymouth Ave. N 4715 Beacon Hill Rd
Minneapolis MN 55411 Eagan MN 55122-2707
(612) 824-2656
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.
Applicant/Permitee: Signature Issued By: Signature
CITY OF EAGAN WATER SERVICE PERMIT
3745 Pilot Knob Road PERMIT NO.:
Eagan, 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 FAGAN SEWER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.:
Eagan, MN 55123 DATE:
Zoning: No. of Units:
Owner:
Address:
Site Address:
Plumber:
1 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:
CITY OF UGAN
3795 Pilot Knob Road Eagan, MN 66122 N~ 5 614
PHONE: 454-8100
BUILDING PERMIT Receipt #
To be used for Est. Value Date 19
Site Address Erect ❑ Occupancy
Lot Block Sec/Sub. Alter ❑ Zoning
Parcel # Repair ❑ Fire Zone
Enlarge ❑ Type of Const.
W Name Move ❑ # Stories
3 Address Demolish ❑ Front ft.
Grade ❑ Depth ft.
city ~ 'Phone
Name Approvals Fees
o
of Address Assessment Permit
city Phone Water & Sew. Surcharge
Police Plan check
F Nome Fire SAC
Z
u~ Address Eng. Water Conn.
aW City Phone Planner Water Meter
Council -
I hereby acknowledge that I have read this application and state that Bldg. Off.
the information is correct and agree to comply with all applicable APC Total
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Permittee
A Building Permit is issued to: 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
Permit # Date lased Paalttes
Plumbing.
Mechonical Z (j .3 f7p
162
INSPECTIONS DATE INSP. Rough-In Final
Footings Date Insp. Date Insp.
Foundation Plumbing a%-s'r
Frame/ins. Mechonicol`q_ ga
Final -
Remorks:
r
J
f `
CITY OF EAGAN
3795 Pilot Knob Rood
Eagan, Minnesota 55122
Phone: 454-8100
Plumbing PERMIT No. .1
Date: x!21/Stl TIM- Receipt No.:
Single
711 , Peacon `lilt
Site Address: Residential
Lot Block r Sub/Sec. _ ?emcon Lill! _ Multi Res., Comm./Ind. 'e, tlex Name New/Alter./Repair
V
Address Cost of Installation
11
O
City Phone: Permit Fee
Nome ^~?i;^.
` Surcharge
4-
2 Address b
e
0
V
City 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
CITY OF EAGAN
CJNUSTION AIR RFQi a,L, , 3795 Pilot Knob Road
Bogen, Minnesota 55122
Phone: 454-8100
HUTINC, PERMIT No. 17 20 Z 9
313180,
Dote: Receipt No.: 1.'F
0"1 `J 1'8CC'i Hi Single
Site Address: Residential
Lot Block Sub/Sec. _ Multi Res., Comm./Ind.
Cnntey :?asps r%,
Nome New/Alter./Repair
• 86,oi Da-neil -'d.
Address Cost of Installation
O City Phone: Permit Fee
Nome Surcharge
46"V 3.enrro Ave.
g Address
c
City Phone: Total
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
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE: '
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued:
(612) 681-4675
SITE ADDRESS• APPLICANT:
' i 1 ~ tfi ttr
PERMIT SUBTYPE: TYPE OF WORK:
INSPECTION TYPE DDATE INSPTR. INSPECTION TYPE DATE INSPTR.
I~
Permit No. Permit Holder Data Telephone M
ELECTRIC
PLUMBING
HVAC
Inspection Date Insp. Comments
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
i
Eagan, Minnesota 55122-1897 Date Issued:
(651) 681-4675
SITE ADDRESS: APPLICANT:
tV I11' f l (It I
PERMIT SUBTYPE: TYPE OF WORK:
INSPECTION TYPE DATE INSPTR. INSPECTION TYPE DATE INSPTR.
i
i
1
I ~
~I
Permit Holder Date Telephone #
SEWER/
WATER
PLUMBING
HVAC
Inspection Date Insp. ' Camments
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
DOMESTIC
METER
IRRIGATION
METER
FLUSH
MAINS
CONDUCTIVITY
TEST
HYDROSTATIC
TEST
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
All
H
ra Tft ifiratf of (lorruvaury
Citp of pagan ~
ErVartment of Builbing Ini pprtion
This Certificate issued pursuant to the ruquirtmentt of Section W of trUni firm Bxt :ng
Code certifying that at the time of issuance this structure was in compliance with the variout
ordinances of the City regulating building construction or use. For the following:
$ v.. Cidfil SF Dwlg/Garage 8iee- Permit No. 5614 r
0--p y TyP. R3 Type Cmmalon Fin Zone ITT Zaun* wtrict RI Ir
Owmall'badmiq Centex Hgn)I ,x,,.4715 Beacon Hill Ct. LE an,
Y. ~ 71 Beacon . ~ •tr--I+3 B7 Beacon Hill
a Dale S Peterson
By:
VDate. June 16, 1980
1 SAWI
MST N 4 [ GMCUUIIa ► C. =r~ ,
4qr
!~~"gtrwl'.r"~1~'Mwdl~y.~'~►rr.►l+LY~~►al~~~`~1~'+~__1"~.L~ ~ ~ ~'.+J11'N~
CITY OF EAGAN Remarks
Addition BFACON HILL ADDITION Lot 3 Blk 7 ParJel 10 13500 030 07
Owner LV i-v ~LneVi 't, Street 4715 Beacon Hill Road State Fagan, MN SS122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. 10 1982 1806.93 1806.93 0007602 10-1-81
STREET RESTOR.
GRADING 771-
1982 526.46 58.50 g 526.46 0007602 10-1-81
SAN SEW TRUNK 1976 7 9.06 is 99-73 008107 9127179
* SEWER LATERAL 3 1982 3116.46 346.27 3116.46 0007602 10-1-81
WATERMAIN
* WATER LATERAL 1982 9
WATER AREA 5 1982 198.01 22.00 9 198.01 0007602 10-1-81
* Stubs 1982 9
STORM SEW TRK &7q-i 1982 359.82 39.98 9 359.82 0007602 10-1-81
* STORM SEW LAT 1982 9
CURB & GUTTER
SIDEWALK
STREET LIGHT
Rnnij finit- 17893 2/14/80
WATER CONN. ii It
r
13UILDING PER. 5614
SAC 525.00
PARK
Owst void 18 months from 0 g, _-3
1 1
Date of is Request C { i ' 17938
I, Licensed Electrical Contractor D Owner, do reby request inspection of the above electri-
cal wirin 'stalled at:'~~
Street Address or Route No. ~ U City M o
Section. Township Range County WA
Which is occupied by COV
(Name of occupant)
Is a roughin inspection required on this job? NOD { Ready Nqpl~ Will Call 11
Power Supplier. 1Address I1C1k'IZt j
Electrical Contractor ~ Contractor's License NOW
r (Company e)
Mailing Address I~ E' CLNam r ~ iVwviw
WIMIrical tetra or or owner Making This Installation) _
Authorized Signature Phone No.
(Electrical contractor or owner Making This Installation)
O !O1 D D 00H This inspection request will not accepted cl ffie
C/ ll L' LS V L~ State Board unless pro raper inspection fee is is a lrcJosed.
r Minnesota State Board of Electricity
University Ave., St. Paul, Minn. 55104-Phone 645.7703
REQUEST FOR ELECTRICAL INSPECTION C
CHECK BELOW WORK COVERED BY THIS REQUEST J 17938
Type of Budding New Add. Rep. Check Appliances Wired For Check Equipment Wired For
Home ❑ ❑ ❑ Range ❑ Temporary Wiring t
Duplex ❑ ❑ ❑ Water Heater ❑ Lighting Fixtures ❑
Apt. Bldg. ❑ ❑ ❑ Dryer ❑ Electric Heating ❑
Commercial Bldg. ❑ ❑ ❑ Furnace ❑ Silo Unloader ❑
Industrial Bldg. ❑ ❑ ❑ Air Conditioner ❑ Bulk Milk Tank ❑
List List )
Othe p 0 Others Others}
F1ere 111111 _ Here 1
.5
COMPUTE INSPECTION FEE BELOW VAL
S o:, Entrance Size: # Fee Faders bP R:. Fee Circuits: # Fee
0 to 100 Amps. 0 30 - es ; 0 to 30 Amperes
101 to 200 Amps. to- OW ' s 31 to 100 Amperes
Above 200 Amps. A 10 Amps. Above 100 Amps,
Transformers Re eControl Circ. Partial or other fee
Signs Special Ins lion Minimum fe
Remarks IE P (-Z, TOTAL EX- ~.S+0
I, the Electrical Inspector, hereby certify that the above inspection has been Wrade'.
(Rough-in) Date
(Final) bte _
This request void 18 months from '
WZ from Ile Datrt I~ !'3 4 9 7 0
4
1, ast94icensed Electrical Contractor ❑ Owner, do hereby request inspection of the above electri-
cal wiring installed at: °7 Illl may) i/]
St Address or Route No. -5 Bo" iz}li, aw it, Q6AH
Se on Township Range County
Which is occupied by C_JDC J*tt1
(Name of Occupant)
Is a roughin inspection required on this job? No ❑ Yel;K_ Ready Now ❑ will Ca49
Power Supplier N'S p Address W114 A
Electrical Contractor Ems' ELFG _e\C Contractor's License Nt?,7.51q
(company Name)
Mailing Address [ F D. W 51~~~C
~(El trl Contra or or owner making This Installation) ¢q
Authorized Signature Phone No. J l -SSZ~S
(Electricai contractor or owner Making This Installation)
ss will not accepted the
NAVE BOARD C®~ This inspection request
~j ~D} State Board unless proper inspection fee is enclosed.
State Board of Electricity
St. Paul, Minn. 55104-Phone 645.7703 7
1' FOR ELECTRICAL INSPECTION s 349 ~1 0
CHE( _O WORK COVERED BY THIS REQUEST
Type of Budding New Add. Rep. Check Appliances Wired For Check Equipment Wired For
Home ❑ ❑ Range Temporary Wiring ❑
flex ❑ ❑ Water Heater Lighting Fixtures
Bldg. ❑ ❑ ❑ Dryer ❑ Electric Heating
mercial Bldg. ❑ ❑ ❑ Furnace Silo Unloader ❑
Industrial Bldg. ❑ ❑ ❑ Air Conditioner Bulk Milk Tank ❑
Farm E] List 1 List
❑ pO } p
Other ❑ ❑ ❑ Herersl Here s~
COMPUTE INSPECTION FEE BELOW
Service Entrance Size: # Fee Feeders&Subfeeders: # Fee Circuits: # Fee
0 to 100 Amps. 0 to 30 Amperes 0 to 30 Amperes
1 1 to 200 Amps. 31 to 100 Amperes 31 to 100 Amperes 1 2- 9,00
Above 200 Amps. Above 100 Amps. Above 100Am s.
Transformers 11 Remote Control Circ. Partial or other fee
Signs Special Ins ection Minimum f
Remarks TOTAL EQ?~ J a
I, the Electrical Inspector, hereby c that ~insp lion has been ma .
(Rough-in) ill Date
(Final) Date ,/f -'k
This request void 18 months from
CITY OF EAGAN
3794 Pilot Knob Read Eagan, MN 55122 NO 5614
PHONE: 4544100
BUILDING PERMIT APPLICATION Receipt
To be used for 5F Dovlg/Garage Est value 40,000 Dote 2/14/ , 198
Site Address 4715 Beacon Hill Rd. Erect gl Occupancy R3
Lot 3 Block 7 Sec/Sub. Beacon Hill Alter ❑ Zoning Rl
Parcel # Repair ❑ Fire Zone III
Centex Homes Enlarge ❑ Type of Const V
B Nome Move ❑ # Stories
4715 Beacon Hill Ct.
Address Demolish ❑ Front 44 ff.
Ci one 454-5236 Grade ❑ Depth 48 fr.
Name ame Approvals Fees
0
o~ Address Assessment Permit115.57-
8 City Phone Water & Sew. Surcharge 20.00
Police Plan check 57.75
Z Name Fire SAC 525.00
05.00
Address Eng. Water Con
<w CI Phone Planner Water Mete,150.00
Council Rd.Unitl85.00
I hereby acknowledge that 1 have read this application and state that Bldg. Off. 2/5/40
the information is correct and agree to comply with all applicable APC Total 1268.25
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Permittee
A Building Permit is issued to: Centex Homs Midwest on the express condition that
all work shall be done in accord a with-all-applicable State of /Minnesota Statutes and City of Eagan Ordinances.
Building Official i'~"` ~•*uC~S_`--'C
My Ea p I For OfficeSl --y~-------- ~
~4y of f ~jU(~(]n I Permit#: L"~T`f`1'~ j
3830 Pilot Knob Road Permit Fee: /
Eagan MN 55122 j Date Received:
Phone: (651) 675-5675 I /J I
Fax: (651) 675-5694 t Stan: L I
I I
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 7 i 1 D Site Address: 4- 15 ~Regco-A Wit 90
Tenant: 7D0.r1r1 S+rYlSe✓r Suite
RESIDENT / OWNER Name: "J00-r1Vl S i M 5p- Phone: (Ds-1- 170- 3 *26~
Address/ City/Zip: 47 1 S I ectcovt ii-fi I ~ le r7
Applicant is: Owner /Y Contractor
TYPE OF WORK Description of work: ear OPF 1=e - 4"
Construction CostA ~53-8(. r -0 Multi-Family Building: (Yes / No X
CONTRACTOR Name:-Az-4f c K GkC~ruc~ License ),L) X10
Address: N)OS ?)V*' AVE t3
City: _P31_0_0LIAA Pa.o1L State: 0111 IIZip: SSLf'f 3
Phone: 716 3-31 S`-C~`3 30 Contact Person: G.n`S P) I
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
_ Minnesota Rules 7670 Cateaorv 1 _ Minnesota Rules 7672
Energy Code • Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
Category Submitted Submitted
(J submission type) • Energy Envelope Calculations Submitted
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.
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 t 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 I of p
x -k 0.2 ro l ~t 1 ~C t rtQS x
Applican s Printed Name Applicant's ignature
Page 1 of 3
PERMIT# y RECEIPT DATE:
8008 RESIDENTIAL PLUMBING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
651-681-4675
Please complete for: single family dwellings, townhomes and condos when permits are required for each unit,
backflow preveenteer for irrigation system p
SITE ADDRESS: 47 / &-46-&6 8, RD
1 r
OWNER NAME:: ~ ~yy1l~'l a Sy r vG TELEPHONE #:V-> 994
f 852
(AREA CODE)
INSTALLER NAME: H, P. P_) /P-Y wn r" TELEPHONE#. L34 In
STREETP.DDRESS: J~ (o,-70 DDbr) (AR CODE)
CITY: 6000 n STATE: YVt ZIP:
_ SEPTIC SYSTEM, new/refurbished (requires two sets of plans and MPC license) $ 100.00
includes $40.00 County fee
Note: Additional consultant fees may apply
• MODIFICATION/ALTERATION TO EXISTING DWELLING UNIT, INCLUDING:
- Adding fixtures to lower levels or room additions, excluding water softeners and water heaters. $ 50.00
Abandonment of septic system.
Water turnaround - existing dwelling unit 5/8" meter if needed - $118)
Other:
- RPZ: new installation/repair/rebuild $ 30.00
- lawn irrigation system
Replacementladditional: _ water softener water heater $ 15.00
State Surcharge $ .50
Total $n_
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable Cityof Eagan ordinances. It
is the applicants responsibility to notify the property owner that the City of Eagan assumes. noI'ility for any d mages caused by the City during its normal
operational and maintenance activities to the facilities constructed under this permit wifhi Ci opertylrighl- f- ay/ ement.
SI UR OF PERMITTEE 1/02
-
CITY OF EAGAN PERMIT
3830 Pilot Knob Road PERMIT TYPE: BUILDING
Eagan, Minnesota 55122-1897 Permit Number: 0 3 0 5 8 4
(612) 681-4675 Date Issued: 08/08/97
SITE ADDRESS:
4715 BEACON HILL RD
LOT: 3 BLOCK: 7
BEACON HILL
P.I.N.: 10-13500-030-07
DESCRIPTION:
i'ldznc hermit Type SF (MISC. )
Lt#ld~x~glr~~ Type REPAIR
GensUs Cbd 434 A`LT. RESIDENTIAL
5 a t6~cr
re t k _ q a ,x r6~
m
LL
V Lr '~y A- ' C& g P - E 9
' k' x ° ~ rs - is ~,pa s rram».
ems" r ~
k
U IL BW M1 _
4t?z sv-~ ry ~ iflbu
wpm ~wk~r~
Fp t5x Ca Ya ~ mi ,"&4" a#'+9~r Aa
° R
mt;
Arm. Vim; =5 Sw ~ffi,a
REMARKS:
SIDING SOFFIT FASCIA WINDOWS
FEE SUMMARY.
VALUATION $.13,000
Base Fee $199.75
Surcharge $6.50
Total Fee $206.25
CONTRACTOR: - Applicant - ST. LIC OWNER:
MINNESOTA EXTERIORS INC 13915514 0002877 BENNER WERNER
8600 JEFFERSON HWY 4715 BEACON HILL RD
6SSEO MN 55369 EAGAN MN 55122
(612) 391-5514 (612)452-7737
r t~e ac e a g ~ np'p Er ~ ~ e5 ss x~` ~ a, ~ ~ + ~ &
ndKnhPn x<s'ctse,rct5aM11 ~r~ ska~ ors =~rplr,PPb5 Ir
~ p N~ E ~ A.y ti ,y ~~S, ek n. ~ :r i i st rei veb w ie p +naP s t ~ r'
tat ar[d '_(r1L Af YdGICLi.W"C S.9 4't LC 3 G t & urz :atAi^itk '4 i'M1~
" 8 1O ~ 6tf Y 5 id i tj R✓I ~ l %C 2 155 11f ~~~b M ll s~`ya 3E Rrs @LA@
`ni - iY ~ 4"2 1 I ~ L y !dt to i I9 & ~'IA L9 k, 4 S R "tT9 I R'Ifl t 6'`~i
APPLICANT/PERMITEE SIGNATURE ISSUED B : SIGNATURE
~
CITY OF EAGAN
5066f1995 3830 PILOT KNOB RD - 55122
BUILDING PERMIT APPLICATION (RESIDENTIAL)
681-4675
New Construction Requirements Remodel/Repair Requirements
♦ 3 registered site surveys ♦ 2 copies of plan
♦ 2 copies of plans (Include beam & window sizes; poured fnd. design; etc.) ♦ 2 site surveys (exterior additions & docks)
♦ 1 energy calculations ♦ 1 energy calculations for heated additions
♦ 3 copies of tree preserve on plan if IM platted after 711/93
required: ss
DATE: CONSTRUCTION COST:
DESCRIPTION OF ORK:
STREET ADDRESS:
LOT BLOCK SUBD./P.I.D. I Mn la
PROPERTY Name: Phone ZZI 7
OWNER VST FRET
Street Address-
City: State: Zip: CONTRACTOR Company: Phone
Street Address: Lk se # ILI'
City: _l r~ State: Zip:
ARCHITECT/ Company: Phone
ENGINEER
Name: Registration #
Street Address-
City: State: Zip:
Sewer & water licensed plumber. Penalty applies when address change and lot
change are requested once permit is issued.
I hereby acknowledge that I have read this application and state that the information ' . correct and agree to comply with all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant:
OFFICE USE ONLY
Certificates of Survey Received Yes No
Tree Preservation Plan Received Yes No
OFFICE USE ONLY
BUILDING PERMIT TYPE
❑ 01 Foundation ❑ 06 Duplex ❑ 11 Apt./Lodging ❑ 16 Basement Finish
❑ 02 SF Dwelling ❑ 07 4-plex ❑ 12 Multi Repair/Rem. ❑ 17 Swim Pool
❑ 03 SF Addition ❑ 08 8-plex ❑ 13 Garage/Accessory ❑ 20 Public Facility
❑ 04 SF Porch ❑ 09 12-plex ❑ 14 Fireplace ❑ 21 Miscellaneous
❑ 05 SF Misc. ❑ 10 = plex ❑ 15 Deck
WORK TYPE
❑ 31 New ❑ 33 Alterations ❑ 36 Move
❑ 32 Addition ❑ 34 Repair ❑ 37 Demolition
GENERAL INFORMATION
Const. (Actual) Basement sq. ft. MCNVS System
(Allowable) Main level sq. ft. City Water
UBC Occupancy sq. ft. Fire Sprinklered
Zoning sq, ft. PRV
# of Stories sq, ft. Booster Pump
Length sq. ft. Census Code.
Depth Footprint sq. ft. SAC Code
Census Bldg
Census Unit
APPROVALS
Planning Building Engineering Variance
Permit Fee Valuation: $
Surcharge
Plan Review
License
MCNVS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
SNV Permit
SNV Surcharge
Treatment PI.
Road Unit
Park Ded.
Trails Ded.
Other
Copies
Total:
% SAC
SAC Units
PERMIT
CITY OF EAGAN
3830 Pilot Knob Road PERMIT TYPE: BU I L D I N G
Eagan, Minnesota 55122-1897 Permit Number: 0 3 3 7 8 5
(651) 681-4675 Date Issued: 10/26/98
SITE ADDRESS:
4715 BEACON HILL. RD
LOT- 3 BLOCK: 7
BEACON HILL
P.I.N.- 10-13500-030-07
DESCRIPTION:
REROOF
Bu'Idin'-",,permit Type STORM DAMAGE
Building 4J6'nk Type REPAIR
;Census Code` 434 ALT. RESIDENTIAL
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REMARKS:
FEE SUMMARY-
CONTRACTOR: - Applicant - ST. LIC. OWNER:
AZTEC ROOFING 18950040 20139140 BENNER WERNER
11583 RUPP RD 4715 BEACON HILL RD
BURNSVILLE MN 55337 EAGAN MN 55122
(612) 895-0040 (651)452-7737
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. J
APPLICANT/PERMITEE SIGNATURE 149SUED eY: SIGNATURE
1998 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
3830 PELOT KNOB RD - 55122 7
681-4675 1 L
New Construction Requirements Remodel/Repair Requirements
• 3 registered site surveys • 2 copies of plan
2 copies of plans (include beam & window saes; poured fnd. design; etc.) ♦ 2 site surveys (exterior additions, & decks)
• 1 energy calculations ♦ 1 energy calculations for heated additions
• 3 copies of tree preservation plan if lot platted after 711193
required: _Yes _ No
DATE: q - 2Z~; - Q CONSTRUCTION COST;
DESCRIPTION OF WORK:
STREET ADDRESS. - 1) ~ N L(iaL 1ji / &L
LOT: BLOCK: SUBD./P.I.D. C t C ) y m ( 1
Name: O p' n l Lp~y u Phone 7 7 ,31
PROPERTY Last First A-11 OWNER Street Addr I F R~a D/ 1 l"'•
//eyss://~~,,
City lA t ~1Q 14 State: Zip: y~a/ 2
Company: Phone
CONTRACTOR Obn P= License# 2n I /1
Street Address: J f
^ ,5,?0 7
City L State: MtV Zip:
ARCHITECT/
ENGINEER Company: Phone
Name: Registration
Street Address:
City State: Zip:
Sewer & water licensed plumber (new construction only): Penalty applies when address chan
and lot change is requested once permit is issued.
I hereby acknowledge that I have read this application and state that the information correct and agree to mpl~ with all applicat
State of Minnesota Statutes and City of Eagan Ordinances. Uri'c`
Signature of Applicant:
Gil
OFFICE USE ONLY
Certificates of Survey Received Yes No
I U
Tree Preservation Plan Received Yes - No Not Requ
MOM; /0
DATE
BUILDING PERMIT APPLICATION '
Include 2 sets of plans, 1 site plan a/elevations and 1 set of energy calculations.
To be used for~W ~LC>i ~u Valuation A-COic3d O
Site Address:
3 -7 C~jEACON~~L
Lot Block See./Sub,
Parcel Number
Owner Telephone
Address ((~'p ~e^
ContractoJCL4TE X t 1pP•{ f S 1-11~Ky~51 Telephone 54 - d5 a 3 C"o
Address vw-Asn
Arch./Eng. Telephone
Address
v OFFICE USE
Erect ^ Occupancy
Alter Zoning
Repair Fire Zone 3
Enlarge Type of Const. Y
Move I of Stories
Demolish Front
Grade Depth y~
OFFICE USE
Date of Approval 6 Initial FEES + C
Assessment Permit ~~LS2,rJ~
!Pater/Sever Surcharge-- f .2Q,OC)
Police t14n Check SZ_3
Fire SAC X15. DO
Eng. Vater Conn.
Planner Plater Meter ~iO Oa
council ROAD L~.LT /
Bldg. Of 1.
A.P.C. TOTAL.
Cortiiicate for:
Centex Homes Mid:)est Inc. Plan X31
8601 Darnell Road
Eden Prairie, Mn. 55344,
DELMAR H. SCHWANZ
LANOSURVEYOR
R"isteref, Unoer Laws of The State of Minnesota
2978- 145TH STREET W. - 80X M ROSEMOUNT, MINNESOTA 55888 PHONE 812 4231785
SURVEYOR'S CERTIFICATE
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SCALE: 1 inch 30 feet
933 Denotes proposed finished grade
BENCHMARK: Top of hydrant between lot: 4 and 5, Block 1,
939.72 ft.
Top of Block Garage floor 93`f P _
Basement Floor
I hereby certify that this is a true and correct roprc3(2n::at',)n of
Lot 3, Block 7, BEACON HILL, acccrding to the rccoracu plat to r.~f,
Dakota County, Minnesotti.
Dated: may 37, 1974
Revised to 3hr,,'r7 proposer) ht:use anc? st~:k,,d J:n.
f ;
MINNESOTA NEGISTRATION NO. 8625
CITY ~0F-EAGAN Include 2 sets of plans,
/4" 1 site plan w/elevations &
BUILDING PERMIT APPLICATION I set of energy calculations.
To Be Used For ozao~ Valuation Date C6// /'Po
Site Address: -11 7M' C/fC'ci✓ N//,/, lfQ OFFICE USE ONLY
Lot ~3 Block Sec./Sub.E/~Cc✓///{{Erect Occupancy A132
Alter, Zoning
/ Repair Fire Zone
Owner: W'LxwC/i F aElyllt / Enlarge _ Type of Const.
Move # Stories
Address: ~~/_j %3C/J['G ✓ f//~j 7Y~A~' Demolish _ Front ft.
City/Zip Code: /jCA~, /17/✓ huh ~i Grade Depth _ft.
Phone "74, ~2 - 77,' ~7 APPROVALS FEES
Contractor: Sf//U/c '4.5 /~~G✓v' Assessments Permit
Address: Water/Sewer Surcharge
Police Plan Check
City/Zip Code: Fire SAC
Phone Eng. Water Conn.
Planner Water Meter
Arch./Eng.: Council Road Unit
Bldg. Off.
Address: APC
City/Zip Code:
Phone TOTAL
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/ CITY USE ONLY
PERMIT I RECEIPT DATE:
2002 RESIDENTIAL MECHANICAL PERMIT APPLICATION
CITY OF EAGAN
3630 PILOT KNOB RD
EAGAN MN 55122
651-6$1-4695
Please complete for: D single family dwellings
townhomes and condos when permits are required for each unit
Date: 4 r, /
SITE ADDRESS:
OWNER NAME: ~~I Q►7 ] Y,;, TELEPHON44
INSTALLER NAME!!{{{ , ,,r.z e prrnnT051ti;C0. TELEPHONE
{~IKSYVNI'i
410 WEST LAKE -TREET
MINNEAPOLIS: NIN 5WB-2996
STREET ADDRESS: 612.6242656
CITY: STATE: ZIP:
Place a check mark next to the permit work type
Add-on, modification or alteration to existing dwelling unit $ 30.00
• furnace replacement
• air exchanger
• air conditioner D M
• other U
Nature of work: I,° Pte/ GI J UN 2002
ey
State Surcharge $ .50
Total $ •S~
SIGNA OF PERMITTEE
v0z
• -7060 2007 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX 0 651-675-5694
New Construction Requirements Remodel/Repair Requirements Office Use Only
3 registered site surveys showing sq. ft of lot, sq. fl. of house; and all roofed areas 2 copies of plan showing footings, beams, joists Can of Survey Recd _ Y _ N
(20% maximum lot coverage allowed) 1 set of Energy Calculations for heated additions Soils Report _Y _ N
1 Soils Report if proposed building is to be placed on disturbed soil 1 site survey for additions & decks Tree Pres Plan Recd _ Y _ N.
2 copies of plan showing beam & window sizes; poured found design, etc. Addition -indicate if on-site septic system Tree Pros Required, . _Y _ N
1 set of Energy Calculations On-site Septic System _Y _ N
3 copies of Tree Preservation Plan if lot platted after 711193
Rim Joist Detail Options selection sheet (buildings with 3 or less units)
Minnegasco mechanical ventilation form
Date Construction Cost 3 O 6 v
Site Address &acot\, 'F-'ls- Urit/Ste #
Description of Work aAt,1`o-e\,4t(;P_vv~G-fi
Multi-Family Bldg _ Y ~N Fireplace(s) - 0 - 1 _ 2
Property Owner J t` Slh'Y.S~ c Telephone#( 6S1) ci~ (_1 - 3-7 K
Contractor ww //csl~ AT
Address ~lNJ e(Azi l r C__~_ City F
State Zip 5%1 R_ Telephone # ((-,S t) CA - ~d 6
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Cateeory 1 _ Minnesota Rules 7672
Energy Code Category Residential Ventilation Category 1 Worksheet New Energy Code Worksheet
(J submission type) Submitted Submitted
• Energy Envelope Calculations Submitted
In the last 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 # ( )
Mechanical Contractor Telephone )
Sewer/Water Contractor Telephone
I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; I understand this is not a permit, but only an application for a permit, and 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 5d
approval of plans. E ~ v
D
Our
Applicant's Printed Name Applicant's Ignature
7 2007 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Construction Requirements Remodel/Repair Reguirements Office Use OnN
3 registered site surveys showing sq. IL of lot; sq. R of house; and all roofed areas 2 copies of plan showing footings, beams, pats Cert of Survey Reed ' _Y N
(20% maximum lot coverage allowed) 1 set of Energy Calculations for heated additions Soils Report _Y N
1 Soils Report d proposed building is to be placed on disturbed soil 1 site survey for additions & decks Tree Pres Plan Reod _~Y _ N.
2 copies of plan showing beam & window sizes; poured found design, etc. Addition - indicate if on-site septic system Tree Pros Required _Y _ N
1 set of Energy Calculations Onsnte Septic System _Y. _ N
3 copies of Tree Preservation Plan if lot platted after 711193
Rim Joist Detail options selection sheet (buildings with 3 or less units)
Minnegasco mechanical ventilation form
Plans are considered public information unless you state the are trade secret and the reason.
Date r~ / ~ / G Construction Cost /-/566-
Site Address -7 5 0e (D ^ 7 J' Y UnitlSte #
Description or Work Ke /;,le /✓1 N S0 ✓I Y T `^C~ ~A t e, c ~ 4h h e u Multi-Family Bldg _ Y ✓ N Fireplace(s) _ 0 - 1 f-~2
Property Owner -5-D 6f 11 N 'e? Telephone # S t) y 1 7 3 7 (y)-
Contractor ra 01 V SA S-fo Ye / A,t"in f
Address SS a S~- City Zinc L4 k2°s
State Zip S50 / Telephone # ( 6 5 1) 78 S 7 -7
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Mumesota Rules 7670 Category 1 _ Minnesota Rules 7672
Energy Code Category • Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(J submission type) Submitted Submitted
• Energy Envelope Calculations Submitted
In the last 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 )
Mechanical Contractor Telephone )
Sewer/Water Contractor Telephone
I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; I understand this is not a permit, but only an application for a permit, and 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.
/~Aou 1 44141 erS
Applicant's Printed Name . Applicant's Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA138738
Date Issued:09/19/2016
Permit Category:ePermit
Site Address: 4715 Beacon Hill Rd
Lot:3 Block: 7 Addition: Beacon Hill
PID:10-13500-07-030
Use:
Description:
Sub Type:Fireplace
Work Type:Gas Insert
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home may require smoke detectors in all bedrooms. Chimney / flue must be inspected prior to
concealing.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Valuation: 3,000.00
Fee Summary:BL - Base Fee $3K $88.50 0801.4085
Surcharge - Based on Valuation $3K $1.50 9001.2195
$90.00 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 -
Joann I Simser
4715 Beacon Hill Rd
Eagan MN 55122--270
(952) 388-4496
Glowing Hearth and Home LLC
100 Eldorado Dr.
Jordan MN 55352
(952) 492-9276
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA149879
Date Issued:06/13/2018
Permit Category:ePermit
Site Address: 4715 Beacon Hill Rd
Lot:3 Block: 7 Addition: Beacon Hill
PID:10-13500-07-030
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Softener
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 -
Joann I Simser
4715 Beacon Hill Rd
Eagan MN 55122--270
Dean's Professional Plumbing
7400 Kirkwood Court N
Maple Grove MN 55369
(763) 428-1321
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA160442
Date Issued:03/10/2020
Permit Category:ePermit
Site Address: 4715 Beacon Hill Rd
Lot:3 Block: 7 Addition: Beacon Hill
PID:10-13500-07-030
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 -
Joann I Simser
4715 Beacon Hill Rd
Eagan MN 55122--270
(952) 388-4496
Dean's Professional Plumbing
7400 Kirkwood Court N
Maple Grove MN 55369
(763) 428-1321
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA160443
Date Issued:03/10/2020
Permit Category:ePermit
Site Address: 4715 Beacon Hill Rd
Lot:3 Block: 7 Addition: Beacon Hill
PID:10-13500-07-030
Use:
Description:
Sub Type:Residential
Work Type:Alteration
Description:Fixtures
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.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Fee Summary:PL - Permit Fee (miscellaneous)$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 -
Joann I Simser
4715 Beacon Hill Rd
Eagan MN 55122--270
(952) 388-4496
Dean's Professional Plumbing
7400 Kirkwood Court N
Maple Grove MN 55369
(763) 428-1321
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA177102
Date Issued:06/15/2022
Permit Category:ePermit
Site Address: 4715 Beacon Hill Rd
Lot:3 Block: 7 Addition: Beacon Hill
PID:10-13500-07-030
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:Does not include skylight(s)
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and leave on site.
If water damage is encountered, please call (651) 675-5675 to schedule a site visit to verify the extent of the damage. Any
repairs must be inspected prior to covering. The inspector will determine if an additional permit will be required to repair the
water damage.
Valuation: 5,000.00
Fee Summary:BL - Base Fee $5K $118.00 0801.4085
Surcharge - Based on Valuation $5K $2.50 9001.2195
$120.50 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Joann I Simser
4715 Beacon Hill Rd
Eagan MN 55122--270
(952) 388-3197
All Sons Exteriors Inc
P.O. Box 146
Lakeville MN 55044
(952) 469-5221
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA177942
Date Issued:07/26/2022
Permit Category:ePermit
Site Address: 4715 Beacon Hill Rd
Lot:3 Block: 7 Addition: Beacon Hill
PID:10-13500-07-030
Use:
Description:
Sub Type:Air Conditioner
Work Type:Replace
Description:
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Pete DeGrood at (507)
210-0754.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Joann I Simser
4715 Beacon Hill Rd
Eagan MN 55122--270
Standard Heating & Air Conditioning
130 Plymouth Ave. N
Minneapolis MN 55411
(612) 824-2656
Applicant/Permitee: Signature Issued By: Signature