4637 Cambridge Dr r
Use BLUE or BLACK Ink
I I-----------------,
For Office Use
City of Eajan I Permit 1
I
Permit Fee: I
3830 Pilot Knob Road I I
Eagan MN 55122 1 Date Received:
Phone: 675-5675 1
(651) I Staff:
Fax: (651) 675-5694 1
INFLOW & INFILTRATION PERMIT APPLICATION
Plumbing / Sewer & Water
Date: Lzl~ /0 Site Address: ZJ/ 7
Tenant: r ) /Suite M
RESIDENT / OWNER Name: Phone:
Address/ City/ Zip: (l~dw/~r~l/Gtc~vts ~~Z3
Name:n~ILr~` License#: U7~Z(e~
Address: ~7 City:
CONTRACTOR
State: Zip: 5-5 ! Phone: EE7~Z '~Zy' ~Z
Contact: Email:
PLU B/NG (Within the building envelope) SEWER & WATER (Outside the building envelope)
TYPE OF WORK Sump Pump Repair Repair
Other: Other:
Description of work: c~ LW
DESCRIPTION
FEES
$55.00 / Each (includes $5.00 State Surcharge) TOTAL FEE $ ~S
*Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submit 1/1 repair costs for
reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors
can be found by visiting www.citvofea-gan.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.aopherstateonecall.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 wo i h requires a review and approval of plans.
x
plica rs Printe ame Applica Sign ure
FOR OFFICE USE Reviewed By:~ Date:
Required Inspections: -Under Ground -Rough-In -Final
CITY OF EAGAN WATER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zonieg: No. of Units:
Owner: ~<7SC.71 (:L112 ~Jf.'.~s:a tction
Address:
Site Address:
r(, rs f,
Plumber:
Meter No.: - Connection Charge: 420-t1"D 12cT
Size: Account Deposit:
Reader No.: Permit Fee:
1 agree to comply with the City of Eagan Surcharge: i
Ordinances. Misc. Charges: "0 -
Total:
By Date Paid:
Date of Insp.: Insp.:
CITY OF EAGAN SEWER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.:
Eogon, MN 55122 DATE: n
Zoning: No. of Units:
Owner-
Address-
Address: 4637 "~3.rbE: 'tie %x s'ze I."?4 r,L l eacu_:. it
Site
Plumber: C!('u,
1 agree to comply with the City of Eagan Connection Charge: 02
Ordinanear. Account Deposit:
Permit Fee-
Surcharge-
By r
Misc. Charges:
Date of Insp.: Total:
Insp.: Date Paid:
CITY OF EAGAN
8795 Pilot Knob Read Eason, MN 55121 t" "?.,1
r PHONE: 434-8100
BUILDING PERMIT Receipt #
To be used for F Est. Value Date 19
Site Address r Erect O Occupancy
Lot Block Set/Sub. Alter ❑ Zoning
Parcel # Repair ❑ Fire Zone
Enlarge ❑ Type of Const.
Name
Move ❑ # Stories
Address =l ` of ifi'i, Demolish ❑ Length
b City Phone % Grade ❑ Depth Sq. Ft.
Name Approvals fees
_4
uU Address Assessment Permit
~ City Phone Water & Sew. Surcharge
F Police Plan check
F W Name Fire SAC
Address Eng. Water Conn.
tW city Phone Planner Water Meter
Council Road Unit
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
f
Permit No. Permit Holder Misc. Permit No. Holder
["H. umbing (Q p~ !^9 lll` I~ g^ {
V.A.C. q U Well
er
Disp.
Sewer t/
Electric tJZ(c~{~0 Att'pley~/~,d S,11 yz_
Inspection Date Insp. Other
Footings Sr
Foundation
Framing
Rough Plbg •
Rough HVAC
Insulation rl C',
Final Plbg.
Final HVAC G
Final yt
- Ew
Water Describe Location:
Well
Sewer
Pr. Disp.
-
CITY OF EAGAN Remarks
Addition BEACON HILL ADDITION Lot 24 Blk 4 Parcel 10 13500 2.40 04
Owner -4 Pit 1 r;v L) Street 4637 Caiob:!,idA ~ Drive state Eagan, NIN 55122
Improvement Date Amount Annual - -Years Payment Receipt Date
STREET SURF. 1982 1848.67. 205.41 .9 1643.27 A011553 10-14-82
STREET RESTOR.
GRADING 1982 537.84 59.76 9 478.08 A011553 10-14-82
SAN SEW TRUNK 1976 135.97 9.06 15 72.55 A011553 10-14-82
* SEWER LATERAL 1982 3182.83 353.65 9 2829.19 tt tt
i
WATERMAIN
* WATER LATERAL 1982 9
WATER AREA 1982 202.00 22.44 9 179.56 A011553 10-14-82
* Stubs 1982 9
STORM SEW TRK 1982 367.77 40.86 9 3 2 6.91 A011553 10-14-82
* STORM SEW LAT 1982 9
CURB & GUTTER
SIDEWALK
STREET LIGHT
ROAD UNIT 240-00 #31037 7-21-92
WATER CONN. 20-00 11 it
BUILDING PER. 7396
SAC ;?5 00 n n
PARK
(Irdifiratt of iOrrupattry
eagatt ~ .
City of
Deparfl iml of luilbing JmWPrfion
\ Tht Certificate issud purI to the requirements of Section 306 of the Uniform Building
> + ' Code arti f ying that at the time of issuance this structure was in compliance Pith the various
ordinances of the City regulating building maruction or use. For the following:
r u. c manum SF DWG/GAR 814 PI Na. 7396 ,
R1
oav~s'rrw R3 trw c~ VII rW~• NA 7miva Dheea
o.wawawe Joseph M. Miller Ad&m 14115 Guthrie Ave. Apple
muwd,wm.. 4637 Cambridge Dr,_L~Ay7pt 24.Block 4.8 a onHJ31
Date: September 28, 1982
r~
LII IN U SA.
CITY OF EAGAN
_ 3795 Pilot Knob Road Eagan, MN 55112
PNONEs 454.8100
BUILDING PERMIT Receipt
To be used for SF DWG/GAR Est. Value $49,000 Date July 21 19.82-
Site Address 4637 Cambridge Drive Erect )a Occupancy R-3
Lot 24 Block 4 _Sec/Sub. Beacon Hill Alter ❑ Zoning R-1
Parcel # °500 240 Repair ❑ Fire Zone NA
Enlarge ❑ Type of Const. Vn
W Nome Joseph M. Miller, Inc. Move ❑ # Stories
Address 14115 Guthrie Ave., Demolish ❑ Length4-l' 4'_'
City &gpj&_yajjMy phone 454-4753 Grade ❑ Depth4 18!1-Sq. Ft.-
Name Owner Approvals feet
ou Address Assessment Permit 278.50
V~ city Phone Water 8 Sew. Surcharge 24.50
Police Plan check 139.25
w Name Fire SAC 525.00
~W
x~ Address Eng. Water Conn. 4.O_ On
<W Cf phone Planner Woter Meter 8000
Council Road Unit 240.00.
I hereby acknowledge that I have mod this application and state that Bldg. Off.
the information is correct and agree to comply with all applicable APC Total $1687.25
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Permittee n
i ~
A Building Permit is issued to: JOseDh M. Miller Con Inc. on the express condition that
all work shall be done in accordance with all appli Is Sto of fiil4n!so tesutes and City of Eagan Ordinances.
Building Official
13(2, SC OF EAGAN Include 2 gets of planer
1 site plan w/elevations 6
o! ener~► enlculat3an4. ;
M DING PE*= AMMATiCK
To Be Used For New Hnmr- CC11~t vacation 38:OOd 171g Data 6/29/9.2' _
Site Address: 4637 Cambridge Cry= USE CULY
Ivt 24 Block 4 Sec./Sub. B-eacon Hill Erect wmvuw
Parcel # : 16 ...1 0_0. Alter tmtilg
r
Enlarge Type of OD~fst. .10
OWner: Joseph M Miller Conot Tnc_ 14" # star"" _
Address: 14115 Guxthri a ave 916
ft. craft - -Depth
City/Zip Code: Ag n ]P Valley MN 551 74
APPPdVAIS Fes'
Phone 454-4753
Cbntracbor: Same AseeseMants Permit
Water/Sewer O=Charw
Address: Police ~ Check s---''
c ity/Zip code: Fire .
Watr Com. 4 2 D
Phone t: Ens
Planner water mew 6-0160,
Council Oniti 6 7607
Arch./Erg.: Bldg. Of - a
Address: APC
i
City/Zip Code: -
arnaw7 a'te` .
Phone U: r';
_ Certificate for: House Location For:-
Centpx Homes Midwest Inc. Joesph Miller Construction
8601 Darnell Road 13015 Cedar Avenue So.
Eden.Prairie, Mn. 55344 Apple Valley, MN 55124
DELMAR H. SCHWANZ PI-Nks 89044
LANOSURVEYOR
Registered Under Laws of The State o/ Minnesota
2978 - 148TH STREET W. - BOX M ROSEMOUNT, MINNESOTA 56988 PHONE 872 4237769
` SURVEYOR'S CERTIFICATE
II -TO? Nve 1 %poll YO GotB
992.8 E9fd1r11 0- 96040411 f. P-9*A1 °N10rM~
3 le4o I 5 8090 38'.fZ" E 130 0
N - 5r-- - - l~ qf9 JI F
10 IN R~ to ~gld{,5 I y 3
0\ V P 1' I °Vo I P~' N
„3 I 1> Q 1 ~uaa a r 4
I. ✓ N f N
~qr all w LL) 0 I
ram At' 1 H w
V) I{ i I
AA _ f
rr\ IN N ~3D•
5 - - - -1- qr-~T WOW /
V 1
e1~3.2 S 84° 39~L` E 131.(e'j TaP Ipo~1
27 ev~iWAT T9PCvR0 I
Top ►ao~ f~~*°xA9b E+--91.01 +I
eL= 9~S uo 30
Z.T UE X1<'li6 PRJf3~6Ep FiaISH G aACE sca\e,~ f inch
°n2,6 DE.aare5 E.XtsT,aG EL.P„~lt,rtoal
I hereby certify that this is a true and correct representation of Lot 24,
Block 4, BEACON HILLS, according to the recorded plat thereof, Dakota
County, Minneebta.
February 3e 1981
House location October 7, 1981. ~f
REJsbF_D +b SI4010 GWuSE PS PLA S N0. 89044 ON JU41E 30f ~~Jgz.
l
i,
MINNESOTA EGISTRATION NO. 8625
Permit # do
City of Eaoa~ ~ I
J 6 ~Q~ I Permit Fee: r I
3830 Pilot Knob Road \V l 1 `
Eagan MN 55122 \Un\U I Date Received:
_ 1~_.
Phone: (651) 675-5675
Fax: (651) 675-5694 Staff: j
i 2008 MECHANICAL PERMIT APPLICATION
Date: Site Address: IlJ J7 1, m bra & POW
Tenant: Manua CTnzaI( Suite
RESIDENT/OWNER Name: cfnocl ~UZ~ l'~ Phone:051- 575-0CJ0
Address / City / Zip: 1 637 Carr bri , Dow
CONTRACTOR Name: RX( 5 (M~eC~Q~ (N Ott I 111G~/ License
Address 2~1 lJ t/ ✓I I~ 1 t Ff ( r `d
✓ J~
City.5 [>/L1~ cam[ r_ State, 41 Zip: ~j~
Phone(( '1"15 i✓ _)5 Contact Person:LjOil
TYPE OF WORK New _✓Replacement -Additional I-Alteration -Demolition
Description of work: - f r Fr YIJ~ him Afg
e
FAW1 z
PERMIT TYPE RESIDENTIAL COMMERCIAL
urnace New Construction - Interior Improvement
Yir Conditioner Install Piping - Processed
Air Exchanger Gas Exterior HVAC Unit
HVAC units must be screened
_ Heat Pump _ Under / Above ground Tank Install / _ Remove)
_ Other " When installing/removing tank(s), call for inspection by Fire
Marshal and Plumbing Inspector
RESIDENTIAL FEES:
$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)
$ TOTALFEE
COMMERCIAL FEES:
$70.50 Underground tank installation/removal OR Contract Value $ x1%
$50.50 Minimum (includes State Surcharge)
Permit Fee
- If fta2it En is leas than $1,000, surcharge is $.50.
- If rmi Fee is > $1,000, surcharge increases by $.50 for each State' Surcharge
$1,000 Permit Fee (i.e. a $1,001-$2,000 Permit Fee requires a $1.00 surcharge).
$ TOTAL FEE
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 Stan 7w~ is permit; that the work will be in accordance with the approved
plan in the case of work which requires a review and aappp~rooval of plans.
x Linda jerncl.Yf~~t x
Applicant's Printed Name A cant's Signa u e
-FOR OFFICE+QSE; ,x ~y~,' tm"'~ °'R drippisf~ ~,a date
%
R s. s - n ,r V x a-dr~Asd 3" .a r 4'% wF`,y^Pf&r"'~ mn a.R^ s, M.'s', ,,°e
UnderGf~ bw ~.`St u£ i , ' n ma m,
Rq[~ f~1na 110 fl
Maur..., n.~U
I
I
City of EajaIl I Permit c~~
Permit Fee: _60
- j
3830 Pilot Knob Road
Eagan MN 55122 I Dale Received:
Phone: (651) 675.5675 I
Fax: (651) 675.5694 ~ Stott:
2008 MECHANICAL PERMIT APPLIIICATIO ~l
Date: ID' H_0` SitIIIeAd7fn /~t-'Idrressp: %3"7 CombrO r h `✓n't/ OCT 1 6 2008
Tenant: ICCT)~1c 5 to
RESIDENT / OWNER Name: V (G I OrI uuo-~ C-DO ZO I C5 + P Phon : J= 7Y Cll.
Address City / Zip: l ! 1 VC I CI~C ~i
CONTRACTOR Name:_ ^VJO Wri norn.t /1h6 License
Address:j/"~~ ~~Jfgl d Uftc Y(Al I"+-'1 j
City: 5r,(~~V~j1 ` Ll1 , Sta { te:l~l~ Zip:
Phon '4 ,r C Contact Person: I~
TYPE OF WORK -New ✓eplacement -Additional -Alteration -Demolition
Description of work:
h ti
IAL
ESIDENTIAL COMMERC
New Construction - Interior Improvement
PERMIT TYPE 7~Furnaoe
tioner _ Install Piping - Processed
Air Exchanger _ Gas _ Exterior HVAC Unit
HVAC units must be screened
Heat Pump _ Under / Above ground Tank Install / _ Remove)
Other " When Installing/removing tank(s), call for inspection by Fire
Marshal and Plumbing Inspector
RESIDENTIAL FEES:
$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)
$ TOTAL FEE
COMMERCIAL FEES:
$70.50 Underground tank installation/removal OR Contract Value $ x1%
$50.50 Minimum (includes State Surcharge)
$ Permit Fee
- If Permit fgg is less than $1,000, surcharge is $.50.
- If Permit fgg is > $1,000, surcharge Increases by $.50 for each = $ State Surcharge
$1,000 Penult Fee (i.e, a $1,001-$2,000 Permh Fee requires a $1.00 surcharge).
$ TOTAL FEE
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 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 L)~da Jernanr~~- x
Applicant's Printed Name Ap cant's Signal
10i02i2006 12:14 - ._-EQGRN_ENG±CpM_D)=.V N0..944 94581865
1/v//1~1I10------------------
/ ` ~ For QShce.us i
I Permit a:
City of EaQa~ o,ad
; Permit Fee:
UI r l
3630 Plbt Knob Road mn LE,-
L Dato Feceivod: Eagan MN 55122
Phone; (651) 675.5675 Faz: (651) 675-569e -
BUILDING PERMIT APPLICATION
2008{pRESIDENTIAL
~r
Date: /0~~j 0°~neAddress: I
Suite 0:
Tenant:
r L
RESIDENT 1 OWNER Name: phone:
d a
b I'
Address/ city /Zip;
Applicant is -Owner Js Contractor
TYPE OF WORK Description otwork: P O n I Q t 0 1 5-~--~5
Construction Cost: TjpC~ Mural-FamiiyBwlding:(Yes._INo CONTRACTOR Name:
S erase a
Addrass:
City: State: ~rl Zip 4)
~~/1S~f•
Phone: Contact Pelson:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
W a to ules 767
_ Minnesota Rules 7670 Cateacn 1
New Energy code worksheet
Energy Code . Res,denlial Vonhiadon Catogory t Workshecl Submatod
Category Submitted
(J submission type) Energy Envelope Calwilillons Submlaed
to the last 12 months, has the City of Eagan Issued a permit for a similar plan based on a master plan?
_Yes _No it yes, date and address of master plan.
Licensed Plumber: Phone:
Phone:
Mechanical Contractor:
Sewer 6 Water Contractor: Phone:
NOTE: plans and supporting documents that you submit are considered to be public MICArnallon. Portions of
the Information may be classified as non-pulit: if you provide specific creasons that would permit the City to
conclude that the are trade
1 hereby acknowledge, that Ih,9 inrormaaon 15 complete and swurals; mat the work wi I us in aonl rmance win the ordinances and codes of me C,ry of
Eagan; that I understand this is not a Pormll, but only an applicaden rot a pen^il, and work I not to scan wit a permit; mat the work will be in
aoc dance w h the apor d plan we case of work welch mounds a re Al w and approval et ^e ! D
V `
AppllOanrs P bled Name Ap t lure Page 1 of 3
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PERMIT
City of Eagan Permit Type:Building
Permit Number:EA139482
Date Issued:10/25/2016
Permit Category:ePermit
Site Address: 4637 Cambridge Dr
Lot:24 Block: 4 Addition: Beacon Hill
PID:10-13500-04-240
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:Does not include skylight(s)
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and leave on site.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Valuation: 4,000.00
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 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 -
Manuel Gonzalez
4637 Cambridge Dr
Eagan MN 55122
(651) 675-0515
Cedar Valley Exteriors Inc
13501 Balsam Lane #120
Dayton MN 55327
(763) 755-2221
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA149306
Date Issued:05/16/2018
Permit Category:ePermit
Site Address: 4637 Cambridge Dr
Lot:24 Block: 4 Addition: Beacon Hill
PID:10-13500-04-240
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: 8,000.00
Fee Summary:BL - Base Fee $8K $162.25 0801.4085
Surcharge - Based on Valuation $8K $4.00 9001.2195
$166.25 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 -
Manuel Gonzalez
4637 Cambridge Dr
Eagan MN 55122
(651) 208-7165
Service Restoration Inc
1480 3rd Ave S, Suite 110
Shakopee MN 55379
(952) 403-1158
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA174602
Date Issued:02/07/2022
Permit Category:ePermit
Site Address: 4637 Cambridge Dr
Lot:24 Block: 4 Addition: Beacon Hill
PID:10-13500-04-240
Use:
Description:
Sub Type:Water Heater
Work Type:Replace
Description:Standard Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
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 -
Manuel Gonzalez
4637 Cambridge Dr
Eagan MN 55122--271
Tony's Appliance Inc.
2090 County Road 42 West
Burnsville MN 55337
(952) 435-2442
Applicant/Permitee: Signature Issued By: Signature