4068 Camberwell Dr N
D Use BLUE or BLACK Ink
r
'54 G I For Office Use
City an ,?Uill Permit#: of Ea
3830 Pilot Knob Road i Permit Fee:S
Eagan MN 55122 I Date Received:
Phone: (651) 675-5675 j I
Fax: (651) 675-5694 1 Staff: 1
L -----------------1
2010 MECHANICAL PERMIT APPLICATION
Date: 11/ 9 Site Address: ~ ~ ~ 1r r u e `7~,~_
Tenant: Q ~v ~?f Z Suite
RESIDENT / OWNER Name: Phone: ~5l !fl$~- 5F
Address / City / Zip: N 55S1
CONTRACTOR Name: a2~iz- / ~ C License
Address: A'o', City: JCtc, i
State: Zip: JAS/off Phone:
Contact: 2 l"> TQ2 az-f lit Email: def~a 6~Gt'1Nl` Z,114 ✓ac , L &-y'
TYPE OF WORK New X Replacement Additional Alteration Demolition
Description of work: s I~ cfu v ra. e-e-
NOTE: Roof mounted and ground mounted mechanical equipment is required to be screened by City
Code. Please contact the Mechanical Inspector for information on permitted screening methods.
RESIDENTIAL COMMERCIAL
PERMIT TYPE Furnace New Construction Interior Improvement
Air Conditioner Install Piping Processed
Air Exchanger Gas Exterior HVAC Unit
Heat Pump Under / Above ground Tank L_ Install / _ Remove)
" When installing/removing tank(s), call for inspection by Fire
Other Marshal and Plumbing Inspector
RESIDENTIAL FEES: S
$50,50 Minimum Add-on or alteration to an existing unit (includes $.50-State Surcharge)
$90.50 Fire repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) $5' c~a TOTAL FEE
COMMERCIAL FEES:
$70.50 Underground tank installation/removal OR Contract Value $ x1%
$50.50 Minimum (includes State Surcharge)
Permit Fee
- If Permit Fee is less than $1,000, surcharge is $.50.
- If Permit Fee is > $1,000, surcharge increases by $.50 for each Surcharge
$1,000 Permit Fee (i.e. a $1,001-$2,000 Permit Fee requires a $1.00 surcharge).
TOTAL FEE
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.oopherstateonecall.ora
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance
with the approved plan in the case of work which requires a review and approval of plans.
x- /C;- Utr C 1 r t x c y r--
Applicant's Printed Name A ylicant's Signature
Reviewed By: Date:
Cctp of (eavlan
E> wwuut of W> htq jmTera m
This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building
Code certifying that at the time of issuance this structure was in compliance with the. various
ordinances of the City regulating building construction or use For the following.
vxa.'sr SF DWG/GAR ~M- 1)108
P Type R3/M Soaicg Diana FD/R] Type 0000 VN
HDW Addms 5)2) RAIL ILIAD, MDWRM
o Gt sai..ENTEX
Aedrcas 4068 'RDRIVE N. L26, B1, HnM OF SIGEMM 2ND Loargy 7
8/23/91
,
POST IN A CONSPICUOUS PLACE
IRM&WrFk ;,4 MFM' EFCK 1 5/29/92 CITY OF EAGAN
s CAYLEN REM 296-- 4r? ,
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 "
PHONE: 454-8100
BUILDING PERMIT Receipt #
To be used for sr UJC/GR Est. Value $122,0W Date MY 23 1s 91
Site Address 4068 CA2ZERWELL DR N a
Lot - 6 Block I Sec/Sub. Hius OFFICE USE ONLY
Parcel No. 5 ZND Occupancy D-3 K-1 FEES
Zoning 1PD R-1 ti
Name- CEN('E ROWS 4
W (Actual) Const V-N Bldg. Permit 717,00
Address X1929 RAILER RD (Allowable) v-N
c City HINNI81'DWA Surcharge 61.M
Phone 936-rT833 # of Stories
Length Plan Review 4".00
=p Name SAM Depth SAC, City -00,00 • 1,j
oOC Address S.F. Total
uF SAC, MCWCC 550.00
City Phone S.F. Footprints
Water Conn i'
~ On Site Sewage ~f~•~
W W Name On Site well 95.00
w Water Meter it
x= Address MWCC System
30.00
a City Phone City Water Acct. Deposit
PRV Required S/W Permit 30.00
I hereby acknowlege that I have read this application and state that the Booster Pump S/W Surcharge -30
information is correct and agree to comply with ;all applicable State of
Minnesota Statutes and,City of Ea on Ordinance
f Treatment PI 276.00
Signature of Permitee r r et i` APPROVALS Road Unit 390.00
A Building Permit is issued to: ~ 1 ows Planner.
gall Park Dad.
on the express condition that all work 'shall bd done in accordance with all Council
applicable State of Minnesota Statutes and City of Eagan Ordinances. Bldg. Off. Copies
Variance - TOTAL 3,435.50
Building Official .
Permit No. Permit Holder Date Telephone #
WATER Q
SEWED
PLUMBING r y rr
ad.
H.V.A_C-
ELECTRIC Q Q CPr3
Inspection Date Insp. Comments
Footings 1 3 S
Foundation
Framing 9. 2' GkS h / USf~'S ~H (~o~f
Roofing
Rough Plbg. 7-1-V
4*1
Rough Htg. Z
Isul.
Fireplace
Final Htg.
Orstat Test - 1
Final Plbg. - Plbg_ Inspector - Notify Plumber
Const. Meter
EngrJPlan
Bldg. Final
Deck Ftg. -
Deck Final _ S Q u f ar~
27-
Well
Pr. Disp.
SEWER & WATER PERMIT ' / ~ OFFICE USE ONLY
CITY OF EAGAN ` METER # YV--7t' 7-6 0 PERMIT DATE 5!
3830 Pilot Knob Rd. 12006
Eagan, MN 5122-1897 CHIP # 4~_- 2-- PERMIT #
METER SIZE B.P. RECEIPT #
i IAY 23, 1991 ISSUE DATE B.P. RECEIPT DATE 05/24-,'-, I
DATE
- PRV - BOOSTER PUMP
SITE ADDRESS 406E GC.I i;P:!~tyS',LL DR 1-4
PERMIT REQUESTED
LOT Z6 BLOCK 1 SEC/SUB =TILLS OF ~TOidEB?iDc;_ 2.dI'
X SEWER X WATER TAPS
APPLICANT:
ADDRESS: COMMlIND RESIDENTIAL
CITY, STATE ZIP NEW - EXISTING
PHONE:
Lawn Sprinkler Meters are to be Installed
PLUMBER: CENZ--RYAN PLUMBTNG Ahead of Domestic Meters on Water Line,
ADDRESS: 14745 S ROBERT TR Credit WILL NYT be givenlor Deduct Meters.
CITY, STATE ROSEMOUNT MN ZIP 55068
PHONE: 423-1144
AGREE TO C ITH CI OF
OWNER: CENTEX HOMES E 7 N ORDI LACES
ADDRESS: 529 BAKER kD~
CITY, STATE MINNE,TONKA L;N ZIP 55,345
PHONE: 936-7b=33 SIG TURE TER ISSUED
PLItAi~ALLbW TWO WORKING DAYSAOR PROCESSING. CALL 454-5220 FOR INSPECTIONS. FOR STORM
SEWER PERMITS, CONTACT ENGINEERING DEPT.
SEWER & WATER PERMIT OFFICE USE ONLY
CITE GE EAGAN METER # PERMIT DATE 4'31 ` "i I
3830 Pilot Kngb'Rd. I ~Cc;6
Eagan, MN 55122-1897 CHIP # PERMIT #
METER SIZE B.P. RECEIPT #
ISSUE DATE B.P. RECEIPT DATE
DATE 4AY 23, 1991
PRV -BOOSTER PUMP
SITE ADDRESS 4068 Ck"O"WELL Dtt 1: PERMIT REQUESTED
LOT ' " BL_ OCK SEC%SUB itILL S OF STONEBRIDGE i n:
SEWER WATER TAPS
APPLICANT:
ADDRESS: COMM/IND RESIDENTIAL
CITY, STATE ZIP NEW EXISTING
PHONE:
Lawn Sprinkler Meters are to be Installed
PLUMBER: CL%'Z-RYAN PLI MEt114 Ahead of Domestic Meters on Water Line.
ADDRESS: 14745 5 ROPERT T." Credit WILL NOT be given for Deduct Meters.
CITY, STATE ROSSE HC?t_ NT P N ZIP 55068
PHONE: 421-11-14
I AGREE TO COMPLY WITH CITY OF
OWNER: CENTER boot; k:S EAGAN ORDINANCES
ADDRESS: 59{9 BAKER RD
CITY, STATE ZIP
PHONE: SIGNATURE WHEN METER ISSUED
PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. CALL 454-5220 FOR INSPECTIONS. FOR STORM
SEWER PERMITS, CONTACT ENGINEERING DEPT.
CITY OF EAGAN Np 19 108
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100
BUILDING PERMIT Receipt a l t0 j/
To be used for SF RC/1321R Est. Value $122,000 Date MAY 23 19 91
Site Address 4068 CAMBERWELL DR N
Lot 26 Block 1 Sec/Sub. HILLS OF OFFICE USE ONLY
Parcel No. Occupancy R-3 M_-1 FEES
Zoning FD R1
w Name CENTER HOMES (Actual) Const V=N Bldg. Permit 717.00
Address 5929 BAKER RD (Allowable) VV=N surcharge 61.00
City MINNETONKA Phone 936-7833 * of stones
Length 461 Plan Review 466.00
ip Name SAME Depth 501 SAC, City 100.00
0~ Address S.F Total SAC, MCWCC 650.00
City Phone S.F. Footprints -
On Site Sewage Water Conn 660.00
~w Name On Site Well Water Meter 95.00
=3 Address MWCC System XX_
Acct. Deposit 30.00
aW City Phone City water XX
PRV Required SAN Permit 30,00
1 hereby acknowlege that I have read this applies on and state that the Booster Pump S/W Surcharge .90
information is correct and comply h II applicable State of
Minnesota Statutes an y of Ea n Ordi ce Treatment Pf 276.00
Signature of Permitee g_f APPROVALS Road Unit 370.00
A Building Permit is issued to: HOMES Planner Park Dad.
on the express condition that all work ithall lodone in accordance with all Council
applicable State of Minnesota Statutes and City of Eagan Ordinances. Bldg, Oa, Copies
Building Official NY10 I &Lsid I rns Variance TOTAL 3. 4»
Address: 4065 CXOEM :LL DRIVE N. Lot 26 Blk 1 Sec/Subp777.S OF SIB 2ND
These it6ms were/were not complete at the time of the final inspection.
8/23/91 Yes No W
Final grade (6" from siding)
Permanent steps - garage
Permanent steps - main entry
Permanent driveway
Permanent gas /rte
Sod/seeded grass
Trail/curb damage V
Porch L/
Basement finish
Deck 17
Please verify with the builder the removal of roof test caps from the plumbing
system and the shut-off of water supply to the outside lawn faucet before
freeze potential exists.
White - City copy Yellow - Resident copy Pink - Contractor copy
r, DATE: MAY 28, 1991
~vyripyt. R
RE: '408 CAMBERWELL DR N (CENTEX HONES)
X
- Your Sewer & Water Permit for the above property has been completed. It will be held at the
Public Works Garage (3501 Coachman Road) until the meter is picked up. BE SURE TO
CALL PUBLIC WORKS (454-5220) FOR YOUR PERMANENT WATER TURN ON.
Your Sewer & Water Permit for the above property cannot be completed for the following
reasons:
- Your Sewer & Water Permit for the above property has been completed, but the meter cannot
be issued or occupancy allowed until further notice.
COMMERCIAL PROJECTS ONLY: Please pay for meter at City Hall. Meter size must be
confirmed by Bill Adams or Dirk House (Plumbing Inspectors - 454-8100) before issuance.
i
WARNING: BEFORE DIGGING, CALL LOCAL UTILITIES-TELEPHONE, ELECTRIC, GAS, ETC.
- REQUIRED BY LAW.
CONTACT COMMUNITY DEVELOPMENT DEPARTMENT FOR WATER TURN ON POLICY.
Secretary, Building Inspections Dept.
- ~o~ 9B'9-
,6/7.7693'1 a~d C~6 ioo
Request Data Fire ~NoRc -in Inspection
R iretl> Q Ready Now n" on Inspector
6-12-91 Yes F No When Ready?
I X licensed contractor D owner hereby request inspection of above electrical work at:
Job Address (Street Box or Route No) City
4068 Camberwell Eagan
Section No Township Name or No Range No County
Occupant (PRINT) Phone No
Centex Homes
Power Supplier Adtlress
Dakota Electric
Electrical Contractor (Compa)ny Namel Contratlor5 Lroense No
Lazer Electric, Inc. 041935-8
Mailing Address (Contractor or Owner Makmg Installation)
8383 Sunset Road N.E., Minneapolis KNI 55432
Authorized Signature ~(C~o~ntra~c~tor 'Acaner Making Installation) Phone Number
lb C~`11 784-3729
MINNESOTA STATE BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT
Griggs-Midway Bldg - Room 5-173 BE ACCEPTED BY THE STATE BOARD
1821 University Ave. St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS
Phone(612)642-0800 ENCLOSED
(~/(3 REQUEST FOR ELECTRICAL INSPECTION _`7! Ea-OW01-08
► See instructions for completing this form on back of yellow copy
1 7035 amY
"X" Below Work Covered by This Request
New Add Rep. Type of Building AppliancesWtred Equipment Wired
X Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt Building Dryer Other (Specify)
Comm /Industrial Furnace
Farm Air Conditioner
Other (specify) Contrail Remarks
Compute Inspection Fee Below:
# Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Swimming Pool O to 200 Amps 0 to 100 Amps
Transformers Above 200 Amps A 0 Amps
Signs Inspectors Use Only TOTAL
Irrigation Booms (2; -Q-i g6, 50
Special Inspection
Alarm/Communication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 S. t _
I, the Electrical Inspector, hereby Rough-In
certify that the above inspection has Finai Date q~
been made.
OFFICE USE ONLY
This request void 18 months from
CA2
Request Date Fie No. ough-m Inspection
equvedo ❑ Ready Now ❑ Will Nobly Inspector
G Yes C No When Ready?
I licensed contractor ED owner hereby request inspection of above electrical work at:
Job Address (Street Box or Route No yy}}~~ City
(/s wf~L
Section No Township Name or No Range No County
Occupant( T) Phone No
Power Supplier Address
Electrical Cony o (Com'ppany Nam Condaclor's License No
ff~ Mail g dress 7tTruactor o r Makrng Inatallaaonl
Aq' .Ls 3Z
.z~S17f
Authorized Sig a ICpnlractor/Owner Making Installation) Phone u bet
IJnU46- INAYIIIPi
MINNESOTA STATE BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT
Griggs-Midway Bldg. - Room 5.173 BE ACCEPTED BY THE STATE BOARD
1821 University Ave, St Paul. MN 55104 - UNLESS PROPER INSPECTION FEE IS '
Phone (612) 642-0800 ENCLOSED
REQUEST FOR ELECTRICAL INSPECTION EB-00001-08
_p See instructions for completing this form on back of yellow copy /O~7~
167027 ) X' Below Work Covered by This Request s I( 3
ew XW- Rep Type of Building Appliances Weed EgmpmentWired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Bull dmg Dryer Other (Specify)
Comm /Industrial Furnace
Farm Air Conditioner
Other (specify) Contractors Remarks
Compute Inspection Fee Below.
# Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Swimming Pool 0 to 200 Amps 0 to 100 Amps
Transformers Above 200 _ Amps Above 100 Amps
Signs Inspectors Use Only TOTAL
Irrigation Booms ur)
Special Inspection P
Alarm/Communication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONTHS.
I, the Electrical Inspector, hereby Rough-in Date
certify that the above inspection has Finel t Date
been made. 10
OFFICE USE ONLY r
This request void 18 months from
RESIDENTIAL
1 0 BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675
New Construction ReauiremeMS Remodel(Reoair Requirements
• 3 registered site surveys showing sq. ft. of lot, sq. 4. of house; and all roofed areas • 2 copies of plan
(20% maximum lot coverage allowed) • 1 set of Energy Calculations for heated additions
• 2 copies of plan showing beam & window sizes; 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 711193
• Rim Joist Detail Options selection sheet (bldgs with 3 or less units)
DATE j C>- - n z VALUATION O "e DD
SITE ADDRESS MULTI-FAMILY BLDG _ Y _ N
TYPE OF WORKS - S I D F_ FIREPLACE(S) _ 0 _ 1 _ 2
APPLICANT I. S N l~ I Ci 'C~
STREET ADDRESS h 7/~ 12-EL i4)e- N CITY ?(1 anc,)a STATE ZIP
TELEPHONE # CELL PHONE # FAX #
PROPERTYOWNER y12,r' ~Q Qa_tZ TELEPHONE#
COMPLETE FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNESOTA RULES 7670 CATEGORY I _ MINNESOTA RULES 7672
(4 submission type) • Residential Ventilation Category 1 Worksheet Submitted • New Energy Code Worksheet Submitted
Energy Envelope Calculations Submitted
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 # 2 f f
u; u , I.
C T 3 1 2C
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. J Y
Signature of Applicant f
OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4102
CITY OF E:AGAN
CASHTER: JS TERMINAL NO: 943
DATE" 07/30/99 TIME: 13:28:49
ID:
NAME: MIDWEST CEDAR TIMBEROOF CO.
321.0 9001 4077 BAFFIN BAY 1.67.25
2155 9001. 4077 BAFFIN BAY 4.50
3210 9001 nnrr
~,,-,~.,~-~•..v 73 125,25
2135 9nn1~_- r• br 3.00
3210 9001. 49P I., '.110.l_Vk4c1.25.25
211=i5 9001 494; irn i i:ie z+iY 3.00
3210 9001 4066 CAMBERWELL 139.25
2155 900:1. 4068 CAMBF'RNE..L_L. 3.50
~ of a1. Receipt Amount- 5'(':L.00
r,R1.i.4674
USER IDs JAN
~#~>K~~>k%K kCSk*>a ffi>K~ ~>k kC~k~k~F>a>kA~>x#4~A~>K:~ X~~%k#~>x>x~
rra_
1999 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN I I t ~1
3830 PILOT KNOB RD - 55122
651-681-4675
New Construction Reauirements Remodel/Repair Reauiremenfs
➢ 3 registered site surveys showing sq. It. of lot, sq. ft. of house 2 copies of plan
and gp roofed areas (20% maximum W coverage allowed) 1 set of energy calculations for heated additions
2 copies of plans (show beam J. window sizes; poured fnd. design; etc.) 1 site survey for exterior additions 6 decks
➢ 1 set of energy calculations
3 copies of tree preservation plan R lot platted after 711/93
DATE: r'T 1o2I I qq CONSTRUCTION COST. (a!9314-5c-
DESCRIPTION OF WORK: 1 ~
hn,A, 0- ) Qr
STREETADDRESS: `ldb CQmber e-u Dr
LOT: 1L BLOCK: SUBD./P.I.D. J + V
Name: ~~~T C~(al~/ ~~(1 Phone ~86 - GT J ~~1
PROPERTY Last First
OWNER Street Address: qQbS
dd~ CQ(nbe rc( }e. o Dr
City _C~ ts-fQn State: Zip: S~a3
Company: MI dw2S r- Tf m b2,IrDUi= Phone 9 b1a 8oF5 " 14 9
(area code)
CONTRACTOR
Street Address: IGY~I CII iE DoI License#c:Z/g73L3bExp..3-2CQ0
City ~L{Y~1SVI ~~e- State: Zip: T
ARCHITECT/
ENGINEER Company: Name:
Telephone area code It
)
Street Address: Registration
City State: Zip:
Sewer 8 water licensed plumber (required for new construction only):
Penalty applies when address change and lot change is requested once permit is Issued.
I hereby acknowledge that I have read this application, state that the Information is correct, and agree to comply with all applicabl
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant -
OFFICE USE ONLY D r"^
Certificates of Survey Received Yes No 2
Tree Preservation Plan Received Yes No Not Required
CITY USE ONLY
LOT BL RECEIPT M OF 915 . /(O y
SUBD.,J(X~A, clAfYtd~i~~,Z. RECEIPT DATE: 1111ylgf/
l/ 1998 MECHANICAL PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT BNOB RD
EAGAN MN 55122
Date: 4-i7-,91 681-0675
Complete this section only if you are installing HVAC in single family, townhomes or condos under
construction and not owner /occupied
• HVAC: 0-100 M B T U $ 24.00
ADDITIONAL 50 M BTU 6.00
• Gas outlets (minimum of one required @ $3.00 ea.)
• State Surcharge: .50
• TOTAL:
Complete this section only if you are remodeling, adding to, or repairing existing single family dwellings,
townhomes, or condos. Note: Mechanical permit is not required for alteration/add-on to ductwork in
existing residential units; but is required for the following:
Install furnace 1L'- Install air conditioning
Install air exchanger, i.e. Vance system, etc. Other
Minimum fee applies to all remodel or add-ons of existing residences $ 20.00
State Surcharge .50
Total: $ 20.50
SITE ADDRESS: L~IC~``~R a.wvhc~, ,•e~ PJ 8911 / d/ OWNERNAME: l /ei( AZ✓\ 11eZ 5 PHONE#: fp010.- 9169
~1` ~ '994-999Z
INSTALLER NAME: Li V Q C 1 M PHONE M ' `STREET ADDRESS: y I c3 l C)J ~ to e j ! ` \ e,v✓I r1 ✓ I M1~ W 1~
CITY: Ci 01 O r STATE: 1 1 V~ - ZIP: -E ~1
N OF PE I E
ISIFORMS BLDIMECH PERMIT (RES) -1998
PERMIT N CITY OF EAGAN
(11101) 1992 BUILDING PERMIT APPLICATION
681-4675 ,SAY 2 'i
R :Cn
SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 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 re guest is made or lot change is re guested once Permit is issued.
Date / / - valuation of work 4f 13 3,5
Site Address:" y0/a~ ( 40s 6t 1 AfAL ly&r~
STREET STE 0
Tenant Name: (commercial only)
LOT BLDCK SUBD.II~slls ~p,~,p+u~v 94~t Z P.I.D. /
Description of work:
The applicant is: 0 Owner ❑ Contractor ❑ Other (Describe)
Name Igmf7_ ~'~~1-tom F Phone (aM'9168 !k
Property LAST -FIRST ai& -03q W
Owner Address 11060 Ca.ru.{Cxwlll '6 ~ /yo-rlk~'
STREET STE 0
City State Zip 4i35-/7_3
Company Phone
Contractor Address License # Exp.
City State Zip
Architect/ Company Phone
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 appplication and state that the information is
correct and agree to comply wi h all applicable State of Minnesota Statutes and City of
Eagan Ordinances.
Signature of Applicant:
* * 2422 Enterprise Drive
* PIONEER EET~ Mendota Heights, MN 55120
engineering.. 1612) 681.1914
CENTU N010ES
Certificate of Survey tor:
NORTH
6S1'
X74 , %t
I h . yT 32'3~„W
- 1
40
~ ~ _ 3I. I kb ~ se.33 1 879 0
W
~ Ia e w e y 1 z
IM)
g.o
y 1 .9
' 1~p ~ L1 0 1° m O ~ 211
C o
m n a' - IS :
1+r 1 N .h
L . 8
ao
~ N - 34.44- W
<s
!51.26 SS4
zz
soo.o Denotes exisfin Elevation PROPOSED HOUSE LEVATION
y900.oDerofes propmed Elevation LowestFoor E eve ion s»•6&
Denotes DrainoJe f Uliiily Easemenf Top o+ Block Elevation sa5y
-v.- Denotes Drainf:YYSe Flow Arrows GarQ e Slab Elevation Bs* e3
Denotes monumenf o Oeno`T'es Ot ff set Nub
Bearin js shown are assumed Sur ed to Easements oi''Record
LOT 261 BLOCk 1 NILLS OF STONEBRIOG PLAT 2
04140TA COUNTY
I hereby certify that this survey, plan or report was prepared by me or under my direct supervision and that I am duly flegistwed land Surveyor
under the taws of the Stale of Minnesota, bated this day of A.D. 19 .
Sca(e: I f" •.¢0'"f
n PERT 9. SIKICK .S. ftEC. ND. 1ae91
q0117-11
1991 BUILDING PERMIT APPLICATION
CITY OF EAGAN
SINGLE FAMILY DWELLINGS MULTIPLE DWELLINGS COMMERCIAL
2 SETS OF PLANS 2 SETS OF PLANS 2 SETS OF ARCHITECTURAL
3 REGISTERED SITE SURVEYS REGISTERED SITE SURVEYS - & STRUCTURAL PLANS
1 SET OF ENERGY CALCULATIONS (CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFICATIONS
1 SET OF ENERGY CALCULATIONS 1 SET OF ENERGY CALCS
OF RENTAL UNITS
# OF FOR SALE UNITS
PENALTY APPLIES WHEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY LAST WORKING DAY
OF MONTH IN WHICH REQUEST IS MADE.
LOT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED.
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS
DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DAYS ONCE A PERMIT HAS BEEN COMPLETED.
PERMIT MUST SHOW A LICENSED PLUMBER.
To Be Used For: s r D/~ 6,, e44 RValuation: V?000 ~ Date:
Site Address la8 6862 r OFFICE USE ONLY
Lot Block FEES
Occupancy R- M-~ Bldg. Permit
Zoning D I Surcharge 1,o
Parcel/Sub E1/LLS or 5'TwvER2~D tRnT Actual Const V- Plan Review 4f(06.00
Owner Allowable V-N SAC, City fo-0,00
00
S # of stories SAC, MWCC 650,00
Length (oT Water Conn. 1
Address Depth $O' Water Meter
Total Acct. Deposit 30,00
City/Zip Code !1 Footprint S.F. S/w Permit 30,00
c, S/W Surcharge 160
Phone - X83 3 On site sewage- Treatment P1. 2 ,On
On site well _ Road Unit 370,oa
Contractor MWCC System 1" Park Ded.
City water t/ Trail Ded.
Address PRV Copies
Booster Pump _
City/Zip Code SUBTOTAL
APPROVALS Penalty
Phone Planner Lot Change
i Council TOTAL
Arch./Engr. Bldg. Off. 3-z3-3/pS
Variance
Address _
City/Zip Code// i 5 '74/S v
Phone #
agrees that all work shall be done in accordance with
(Signatur of ontractor)
all applicable State of Minnesota Statutes and City of Eagan Ordinances.
* * * 2422 Enterprise Drive
* PIONEER Mendota Heights, MN 55120
engineering..
1612) till-1914
CEIVTEK HOMES _
Certificate of Survey for:
I
NoPT"
SS1'
°
~ 32'3k,
I
~ ~p• 5o,w3 ~ ~ ~ 1
d\
_ 303' So.33 .--p I 7? ,o
D „ ~ za.a3 w
J 1 t ~
3 0 ~ w ra 1 Z
. C~C1 ~ \1 ~ 1` z.e a ~ ~ 8 0 0,a 1
s om h W
73
~ 1 : n „ X9.•1 1
~ J
m _1 _ 1
y wzL~
~ o I~ :4 ~ zo o <11
e _ g
S~.ob O
N 34.44
Ir7l 26
rS
, i
VV
Z -
EAGAN EN INEERING DEPT
00010 Denotes exirWin flevation PROPOSED NOOSE LEVATION
y 900.0 Denof¢s propel E/evasion LowesnFoor eva ron_ s~7.~
denotes Drainoie (Uhli y Easemenf Top of Block Elevation 0 .16
Denotes Drain Flow Orrows Gara f e Slab Elevation ss4. e3
Denotes monument o Deno es 0 trsef Nub
gwrin~s shown are assumed Su Jed to Easements oir'Record
LOT 261BLOCkI 1 HILLS OF( TONEBRIDGE PLAT 2
DAKOTA Co t4rV
I hereby certify that this survey, plan or report was prepared by me or under my direct supervision and that I am duly Registered Land Surveyor
Londeof the State of Minnesota. Dated this..-zagday of JL A.D. 19~ .
Scate • I f~f~, aTO RDPERT 9. Sr KICFI .S. REO. NO. 14891
R` 1
.
Plaruiing Design Inc. COMM. NO. 8902S 1
1611 Highway 10 Id.E.
Minneapolis, MM 55432
612-780-190
Minnesota State Energy Code Calculations
Based on Chap4:er 5 of the Model Energy Cude
19,9 Edition Adapted 1/1/84
Owner: MODEL, 4745 Comm. IVO: O
SiLQ Address:
Cnntractor: CENTEX HOMES Phone:
Bldg. Class; Al Al for Single Family/Dup.ler,
A2, residential 3 stories
Over 3 stories
Other
GENERAL INFORMATION!
Note: The section designations ("Section A", "Section B" etc.) are for
convenience in calculations only, and are not related from one set of
calculations below to the next.
1. Bldg. Walls Perimeter x Wall heights, = Area
ground to eave
Section A . 50 10.67 533.5
Srac i ion B . 110 18.58 - 2043.8
Section C : 0 0
Cect;.ni D 0T 0 ii
Gr•uss Wall Area 2577.3
2. Building dimensions Floor or
Ceiling
Length x Width = Area
Sectiun A : 16.5 20.6 = 339.9
Section B : 28 27 = 756
Section C : 0 0 = 0
Section D 0 0 0
Total floor or ceiling area = 1093.9
Rim Joist Perimeter = 160
Floor joist 2 by (8", 10", 12"'or 16")): 10
Rim Joist Area 133.3333
4. Doors
Area: 37.8 Thickness (inches): 0
Perimeter (feet): 0
Type of construction:
Total doer's perimeter: 0
6. hJinUoac,
1 118f1Ufachnrer; ,1rr'1THERSHIELD tl factor; 0.4/
gyai:e <approvud: YES
TYP Might Lfenglh Number Total
(inches) (Inches) of glass f SgFt.
units
BSMT. UNIT 14 27 3 7. 00
DOUBLE HUJGS 16 16 4 7.1.1
20 16 2 4.44
28 16 2 6.22
24 24 6 24
%26 2.1 6 28
16 23 6..,"?
24 28 14 65. Z.."
28 2a 10 54.41
32 28 4 24.89
16 36 2 a 12 36 1 3
SK`fl_ITE.S' 40 ?4 2 16
7. Window glass area (SgFt) _ .255.53
rve Height Length Number - Total
(feet) (feet) units SgF•t
S. Patio Door; 0 0 0 0
9. Atrium: 6.e y 1 20.4
10. Fireplace area
Width- 6 Height; -
Total 3q Ft: = 30
r
11. ENposed Foundation
Height area At 0.67 Perimeter area A; 145
Sq Ft area A = 97.15
Exposed Foundation
Height area B: 0 Perimeter area B: 0
Sq Ft area B = 0
12. SgFt U -factor U v. A
Gross wall area 2577.3
minus
Window area 255.53 0.47 120.1
Patio door area 0 0 0
Atrium area 20.4 0.47 9.59
Rim joist area 133.33333333 0.035 4.67
Door area 37.0 0.14 5.29
Fireplace area 30 0.17 5.1
(-.:::posed Found. 97.15 0.14 13.6
u Framing area 257.73 0.069 17.78
equals
Totals for net wall; 1745.2566667 0.037 64.58
r_L al s for gruNs wall area: 240.7.1
Framing area is 10'/ . of Urns s area
s.s
13. Gross wall area x Factor below = ll & per code
Factor is .11 for A-1 single family & duplex
.23 for A-2 and other residential
.23 for other buildings
.25 •for over :stories
K"Wtor is: (-).l1
OTUH 283.503
I`ll.li=T BE OR = 240./1
(calculated above)
14. i. (L 3 r,_i 1 i ng area = 1093. 1?
13. Coiling framing area (10% Of Ce1.1ing area) 109.59
16. Joist Area (10% of ceiling area)
10?. 517. Net ceiling area (Cross cei1. area - Joist area) 906.1
18. U. ceiling: 0.G21 Net cell. area =20.7125t
IV. U framing: 0.024 r. Joist area = 2.63016
20. Total of item 18 x item 19 = 23 34267
21. Gross ceiling area x factor below = U x A per code
Factor is .026 for A-1 single family &< duplex
033 for A-2 and other residential
.06 for other buildings
Factor i=_: 0.026
£1TUH = 20.4934 MUST BE OR - 23.34267
(calculated above)
r
U VALUE CALCULATIONS
C 6 / HIGH "R° SHEATHING R VALUE U VAL,UF.
Inside air film .68
WALL Interior wall .45 (Wall) U = I =
SwrION Insulation 19.00 R
Sheathing 6.0 .037
Siding .67 -
' Outside air film .17
R TOTAL 26.97
Inside air film .68
STUD Interior wall .45
SECTION
Stud - 6 6.50. (Framing) U = 1 =
Sheathing 6.0 R
Siding .67 _069
Outside air film .17 '
R TOTAL 1447
Interior air film .60
RIM Insulation 19.00
JOISTr 1 : inch soft wood ;.88 (Rim Joist) U = I _
Sheathing • . 6.0 [t
Exterior wall covering .67
' .035
Exterior air film .17
R TOTAL 28.4
1 interior air film .68
t - insulation 5.00 '
FON.
Foundation (12 ° Block) 1.28 (Foundation) U = 1 =
Exterior air film .17 R
R TOTAL 7.13 -14
CEILING WITH VENTED ATTIC SPACE ABOVE
R VALUE R VALUE
FRAMING CEILING
0.61 Air Film 0.61
36.00 Insulation 44.00
4.38 Joist
/ .56 Ceiling .56
i
0.61 Air Film 0.61
41.55 Total R '45.78
.024 U = 1 .021
R
CATHEDRAL CEILING
R VALUE R VALUE
FRAMING CRLING
0.61 Inside air film 0.61
Y 56 Ceiling 56
14.375 * Joist(Spacer) -
Insulation 33.85
- Air Space .50
.67 Roof decking .67
.06 Felt .06
.44 Shingle .44
0.17 Outside air film 0.17
16.88 Total R 36.86
.059 R = U .027
Window infiltration .5 cfm/lineai foot of crack
Residential door infiltration 0_5 cfm/square foot or door and minim code requirement
Non-residential door infiltration 11.0 cfm/lineal foot of crack
Cb 12' concrete block no insulation = .781 R 1.28
double glass = _52
triple glass = .31
All exterior galls and ceilings must have a vapor barrier (0.10) perm max.).
Vapor barrier must be on the inside (heated side) of wall.
Vapor bariers of the polyethelene thin film have no R value.
CITY OF EAGAN FOR CITY USE ONLY
3830 PILOT KNOB ROAD
EAGAN. MN 55122 PERMIT
PHONE: (612) 454-8100 RECEIPT # S
. DATE: 4
PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS 6
TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
WORK DESCRIPTION COMPLETE THE FOLLOWING:
NO. FIXTURES EA. TOTAL
NEW CONST AIJD-ON MINIMUM 15.00
ADD ON SHOWER 3.00
REPAIR WATER CLOSET 3.00
BATH TUB 3.00 le) d
LAVATORY 3.00 as
OWNER NAME: /S~f ynt-~ KITCHEN SINK 3.00 ?QQ
LAUNDRY TRAY 3.00 3
SITE ADDRESS: J HOT TUB/SPA 3.00
/J40Z-v 7- WATER
LOT•~~ BLOCK _L_ SUBD. `-y
R DRAIN 3.00
INSTALLER: GENZ-RYAN PLUMBING & HEATING CO. GAS( PIPING OUT.
(MINIMUM - 1) 3.00'
ADDRESS: 14745 South Robert Trail OTHER OPENINGS 1.50 ~S D
WATER SOFTENER 5.00
CITY: Rosemount, MN ZIP: 55068 r PRIVATE DISP. 15.00
T.O 612 423-1144 U.G. SPRINKLER 3.00
SUBTOTAL s Ito '5'b
ST. SURCHARGE .50
SIGNATURE 0 ERMI EE
TOTAL: S 7 ~~/y
itEltOifSTA: PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS AND
MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH
DWELLING UNIT.
CONTRACT PRICE: FEES
OSPNER NAME: 18 OF CONTRACT FEE.
STATE SURCHARGE - $.50 FOR
SITE ADDRESS: EACH $1,000 OF PERMIT FEE.
LOT: BLOCK SUBD. $25.00 MINIMUM FEE.
INSTALLER: CONTRACT PRICE x 18 $
ADDRESS: STATE SURCHARGE $
CITY: ZIP:
TOTAL: $
PHONE
(SIGNATURE)
FOR:
CITY OF EAGAN
CITY OF EAGAN FOR CITY USE ONLY
3830 PILOT KNOB ROAD
EAGAN, MN 55122 PERMIT #
PHONE: (612) 454-8100 RECEIPT # 0/
11 DATE:
PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS &
TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
WORK DESCRIPTION FEES
NEW CONST ! ADD-ON MINIMUM $15.00
ADD ON HVAC 0-100 M BTU 24.00
REPAIR ADDITIONAL 50 M BTU 6.00'•
GAS OUTLETS - MINIMUM 3.00---'
OWNER NAME: A) I-L-5L OF I PER PERMIT w~
A SUBTOTAL: $b`~
SITE ADDRESS: ~01~0 l: Fin A, U~ZItJL~CC ~t/f1 STATE SURCHARGE: .50
LOT: BIAOK
^'`rM! SUED. /Vo TOTgr, $ -
INSTALLER: K u N, kbLz re ✓r_ j~~(e6
ADDRESS: rr ' SIGNATURE OF PERMITT
CITY: ZIP:
PHONE 7Sd ~~7 T -
C1fIhfE(tCA1NUSTRTAI` PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS,
APARTMENT BUILDINGS, AND MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE
NOT REQUIRED FOR EACH DWELLING UNIT.
CONTRACT PRICE: FEES
OWNER NAME: 18 OF CONTRACT FEE.
STATE SURCHARGE a $.50 FOR
SITE ADDRESS: EACH $1,000 OF PERMIT FEE.
PROCESSED PIPING - $25.00
LOT: BLOCK SUBD. $25.00 MINIMUM FEE.
INSTALLER: CONTRACT PRICE x 18 $
ADDRESS: STATE SURCHARGE $
CITY: ZIP:
TOTAL: $
PHONE
(SIGNATURE)
FOR:
CITY OF EAGAN
Use BLUE or BLACK Ink
r - - - - - - - - - - - - - - - - -
I For Office Use
/
/ (~O
Permit 1 l
City of Ea Da. aq
Permit Fee.
3830 Pilot Knob Road
Eagan MN 55122 `i ? x Date Received:
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff: 1 I
I I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit
Name: / SJ1 f-IV6F-4, Phone: 651-iRGI"1526
Resident/
Owner Address/ City/ Zip: !yoCo g cg GtJLcLL L7Je /~1
Applicant is: Owner _)k'Contractor
N15/-~
Type of Work Description of work:
Construction Cost: a0O Multi-Family Building: (Yes / No X)
Company: aL D 6g ~ 6t4 0()1K..5 Contact: ad
Contractor Address: 3~;SLS W-11 C-IjZ City: gxoOKL-4* P/C~x
State: Ad Al Zip: SS '-N 3 Phone: 6 /R- e-15 -.3e/9'i/0
License Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
ROOM /S C)AIFIM15HE
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that they are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
x Da} J L_/ l SS4 fJ I
Applicant's Printed Name Applicant's Signature
Page 1 of 3
I~~
L n Cawbwwt 0 f3,-. 0 j9 X03
DO NOT WRITE BELOW THIS LINE t I `
SUB TYPES
Foundation _ Fireplace _ Porch (3-Season) _ Exterior Alteration (Single Family)
Single Family _ Garage _ Porch (4-Season) _ Exterior Alteration (Multi)
_ Multi _ Deck _ Porch (Screen/Gazebo/Pergola) _ Miscellaneous
01 of Plex Lower Level Pool 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 Occupancy MCES System
Plan Review Code Edition 1,0V7 SAC Units
(25%_ 100% VIII/ Zoning City Water
Census Code y3V Stories Booster Pump
# of Units / Square Feet PRV
# of Buildings Length Fire Sprinklers
Type of Construction 1J~ Width
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
Footings (Deck) Final / C.O. Required
Footings (Addition) Final / No C.O. Required
Foundation HVAC Gas Service Test Gas Line Air Test
Drain Tile Other:
Roof: -Ice & Water -Final Pool: -Footings -Air/Gas Tests -Final
Framing Siding: -Stucco Lath -Stone Lath -Brick
Fireplace: -Rough In -Air Test -Final Windows
Insulation Retaining Wall: _ Footings _ Backfill _ Final
Sheathing Radon Control
Sheetrock Erosion Control
Reviewed By: , Building Inspector
RESIDENTIAL FEES zpomll.f' S-760 O!
..i
Base Fee / 31
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
Page 2 of 3
!"
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(AA#*$2+ D4,3K* ,, &/*.+2 13,5==1,)&"@ &/*.+2 13,
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA172290
Date Issued:09/23/2021
Permit Category:ePermit
Site Address: 4068 Camberwell Dr N
Lot:26 Block: 1 Addition: Hills Of Stonebridge Plat 2
PID:10-32991-01-260
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.
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 -
Doug & Susan M Blomker
4068 Camberwell Dr N
Eagan MN 55123
Pure Home Restoration Llc
20384 Hampton Ave
Lakeville MN 55044
(952) 955-9011
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA173266
Date Issued:11/05/2021
Permit Category:ePermit
Site Address: 4068 Camberwell Dr N
Lot:26 Block: 1 Addition: Hills Of Stonebridge Plat 2
PID:10-32991-01-260
Use:
Description:
Sub Type:Siding
Work Type:Replace
Description:
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please leave printed pictures of house wrap on site for the 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. When a weather barrier is installed or
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 -
Doug & Susan M Blomker
4068 Camberwell Dr N
Eagan MN 55123
Pure Home Restoration Llc
20384 Hampton Ave
Lakeville MN 55044
(952) 955-9011
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA174063
Date Issued:12/21/2021
Permit Category:ePermit
Site Address: 4068 Camberwell Dr N
Lot:26 Block: 1 Addition: Hills Of Stonebridge Plat 2
PID:10-32991-01-260
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:Two or More Windows/Doors
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow
windows, call for framing inspection. Call for final inspection after installation.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
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 -
Doug & Susan M Blomker
4068 Camberwell Dr N
Eagan MN 55123
Pure Home Restoration Llc
20384 Hampton Ave
Lakeville MN 55044
(952) 955-9011
Applicant/Permitee: Signature Issued By: Signature