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4391 Bent Tree Lane Use BLUE or BLACK Ink --F or- O-ffi-c e-Us- e I • I 977~~9 Cit of EaEdn RECEIVE I Permit#: I Y I Permit Fee: - 371. 069 3830 Pilot Knob Road JAN 2 .2011 I l Eagan MN 55122 j Date Received: j Phone: (651) 675-5675 I I Fax: (651) 675-5694 1 staff: 1 2011 RESIDENTIAL BUILDING PERMIT APPLICATION ~4 c- Date: Site Address: -3 13 -P it w e ei,, Tenant: - Suite RESIDENT / OWNER Name: ',L,D ti a- ~e / .~h-_v~ I Phone: 651- y52 Address / City / Zip: 413 q Applicant is: Owner Contractor TYPE OF WORK Description of work: C (A'e Y) Construction Co : ^ A 4'Al ( 'WA Multi-Family Building: (Yes / Nw_'<~ CONTRACTOR Name: Erd►o$cd eon S //J _ License 2f o?',5- E<cT Address: -Sq- ® 6 City: ~~d~ to P State: Zip: Phone: ~5 J / 2 c i~ Contact: "t Email: 11-3 be_ rf ~4'nS rir-j C /l r!" COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? Yes _No If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer $ Water Contractor: Phone: NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that the are trade secrets. CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.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; th the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. X X Applicant's Printed Name Applic nt's Signature Page 1 of 3 DO NOT WRITE BELOW THIS LINE q7? SUB TYPES _ Foundation _ Fireplace _ Porch (3-Season) _ Storm Damage Single Family _ Garage _ Porch (4-Season) _ Exterior Alteration (Single Family) Multi _ Deck _ Porch (ScreerdGazebo/Pergola) _ Exterior Alteration (Multi) 01 of Plex _ Lower Level _ Pool _ Miscellaneous _ Accessory Building WORK TYPES New 41interior Improvement _ Siding _ Demolish Building* Addition _ Move Building _ Reroof _ Demolish Interior Alteration _ Fire Repair _ Windows Demolish Foundation Replace _ Repair _ Egress Window _ Water Damage Retaining Wall Memolition of entire building - give PCA handout to applicant DESCRIPTION Valuation Occupancy MCES System Plan Review Code Edition SAC Units (25%_ 100% Zoning City Water Census Code Stories Booster Pump # of Units Square Feet PRV # of Buildings Length Fire Sprinklers Type of Construction Width REQUIRED INSPECTIONS Footings (New Building) Meter Size: Footings (Deck) Final / C.O. Required Footings (Addition) Final / No C.O. Required Foundations HVAC Drain Tile Other: Roof: -Ice & Water Final Pool: -Footings Air/Gas Tests -Final Framing Siding: -Stucco Lath -Stone Lath 'Brick Fireplace: -Rough In Air Test -Final Windows 4 Insulation Retaining Wall: _ Footings _ Backfill _ Final Sheathing Radon Control Sheetrock Erosion Control Reviewed By:~ , Building Inspector RESIDENTIAL FEES 1Vf Base Fee Surcharge 600 Plan Review / MCES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant Copies TOTAL Page 2 of 3 Requ {)8t - Fire No. Rough-in Inspecti n 4 a r f Req ' d? ❑ Ready Now 21115TINotity, Inspector (p G No When Ready? 1 Icensed contractor ❑ owner hereby request inspection of above electrical work at: Job Addres (Street. Box or Route ) City ~ t Section No, Township Name or No. Range No. County " Occu (PRINT) - Phone o. Po er pplier Address Electr 1 Contractor !Company Na ) Contractor's Lice No. Mailing Address (C ntractor or Owner Making installation) - - P3 Authorized Sig ture (Contractor caner Making Instat at ) _ Phone Number - 14 g MINNESOTA STATE BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT Griggs-Midway Bldg. - Room S-173 BE ACCEPTED BY THE STATE BOARD 1621 University Ave., St. Paul. MN 55104 UNLESS PROPER INSPECTION FEE IS Phone (612)642-0800 ENCLOSED. REQUEST FOR ELECTRICAL INSPECTION EB-00001 -08 / ► See instructions for completing this form on back of yellow copy. L .x't- 582 X" Below Work Covered by This Request New Ad Type of Building AppliancesWired Equipment Wired Home Range Temporary Service Duplex Water Heater Electric Heating Apt. Building Dryer Other-jSpecify) Comm./industrial Furnace Farm Air Conditioner Other (specify) Contractor's Remarks: Compute Inspection Fee Below: # Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee Swimming Pool 0 to 200 Amps to 100 Amps Transformers Above 200 - Amps Above too Amps TAL Signs Inspector's Use Only: /CON Irrigation Boomsd ;1Spec ial Inspection Alarm/CommunicationTHIS INSTALLATION MAY BE OR TED IF NOT Other Fee COMPLETED WITHIN 18 MO ; 1, the Electrical inspector, hereby Rough-in Date certify that the above inspection has Final n o been made. OFFICE USE ONLY -request void 18 months from - - s s This Cerra; imiie issued pursuant to the requiraem+ertts of i'1 rillo t 1 ariltl`tr tide certifying that at the time of issuance this structure was in compliance with the various ordinances of the City regulating building constrtctim or use. For the, ftrUowing. . SF 14143 IIWG B M& pemlat Nix use chwmc at m R37MI RV cow 0-par TYM OW= Of BuH&g x AA&m .Jay Die. Bm7treg Official I POST IN A CONSPICUOUS PLACE Address 4391 BENT TREE I -AM Zip 5512 3 Lot, 4 Blk 1 Sub ATILM RIDGE 2ND THESE ITEMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECTION. Date: Yes No Inspector: Final grade (6" from siding) Permanent steps (garage) Permanent steps (main entry) Permanent driveway Permanent gas Sod/Seeded grass Trail/curb damage Porch Basement finish Deck 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. Contact engineering division at 6814645 before working in right-of-way or installing underground sprinkler system. White - City Copy Yellow - Resident Copy Pink - Contractor Copy ~ -w !NSPEM C ` M . PER "C YPE ti. 3M P*X Knob Rid t Numb w. EaW, Mitw* .55'123 Data lukx ! (612) 881-#675 tof a ` stoop 'Pt~.1+ A h,. T ",E. Of WC#Wlb ~ Ga r, f tf xx.. P'A ~l~PtrJtrC~ Y3. F ' 7- RK044m,11#1 P i l+e~rmltUo. ~NIrr pw ~ . foc f f 1 mat, ELECT 1 } 1~,. sr. 2 d 93 G Z~ f,. _ c'. I - -PQ 5 IV d i,. Too ac t• I P"ftg. - - P" las~ W" PW" I twit Ftnod L- q W 2005 RESIDENTIAL BUILDING PERMIT APPLICATION 7 70- City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 New Construction Requirements Remodel/Repair Requirements Office Use On]y 3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and all roofed areas 2 copies of plan Cert of Survey Recd _ Y _ N (20% maximum lot coverage allowed) 1 set of Energy Calculations for heated additions Tree Pres Plan Recd _ Y _ N. 2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey for additions & decks Tree Pres Required _ Y _ N 1 set of Energy Calculations Addition - indicate if on-site septic system On-site Septic System - Y _ N 3 copies of Tree Preservation Plan if lot platted after 7/1/93 Rim Joist Detail Options selection sheet (buildings with 3 or less units) Date- 10 / ~ / 0 5 Construction Cost 1~ 1 - y 4 S ~ Site Address 3 q 16 Ix fit„ Unit/Ste # Description of Work jp la t:.Q l ; f 0 c,~ S W i Lki ` SAN fxa. ,rte Multi-Family Bldg Y N Fireplace(s) - 0 _ 1 - 2 Property Owner 'bp\, J( r\,d_t ( SOYI Telephone # ((a 51 ) Lt Sa - 9 5cl Renewal By Andersen Contractor 1920 County Rd. "C" West Address Roseville, MN 55113 City State 651-264-4777 Telephone # ( ) License #20130983 COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING - Minnesota Rules 7670 Category 1 _ Minnesota Rules 7672 Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet (4 submission type) Submitted Submitted • Energy Envelope Calculations Submitted Have you previously constructed a building in Eagan with a similar plan? _ Y _ N If so, 25% plan review fee applies. 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 whicl requires arwew end I appro al of plans. J C 3 ,tn lrj j /2A 00~ Q t f Applicant's Printed Name Applicant's Signature r / t O 2005 RESIDENTIAL BUILDING PERMIT APPLICATION 2 > City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone 9 651-675-5675 FAX # 651-675-5694 New Construction Requirements Remodel/Repair Requirements office use Oni 3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and all roofed areas 2 copies of plan Cert of Survey Reod Y_ _N , (20% maximum lot coverage allowed) 1 set of Energy Calculations for heated additions Tree Pres Plan Recd _Y _N 2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey for additions & decks Tree Pres Required . Y -4 1 set of Energy Calculations Addition - indicate if on-site septic system On-site Septic System _Y N 3 copies of Tree Preservation Plan if lot platted after 7/1/93 Rim Joist Detail Options selection sheet (buildings with 3 or less units) Date Construction Cost ODD Site Address LrtG x4W, Unit/Ste # Description of Work a-E ® C,-,1'j/,>7j Multi-Family Bldg - Y -,-N Fireplace(s) / 0 - 1 - 2 Property Owner Telephone # aSei Contractor XGmt 4~5- P10, C/r ~i rrs ¢ ~~~t SS Address 16r9 Z/ f' Cl s;oe !jI✓d• City .mffihs _ State IN Zip ~S3 S~3 Telephone # (kf/-) 10040 . j-r~ 6 ; a I COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING - Minnesota Rules 7670 Category 1 _ Minnesota Rules 7672 Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet (4 submission type) Submitted Submitted • Energy Envelope Calculations Submitted Have you previously constructed a building in Eagan with a similar plan? _ Y _ N If so, 25% plan review fee applies. 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 an application for a permit, and work is not to start without a permit; that the work will b "f ccor I eTilk approved plan in the case of work which requires a review and approval of plans. 8 Z005 Applicant's P nted Name *ca AVsignature 4' OFFICE USE ONLY Sub Types ❑ 01 Foundation ❑ 07 05-plex ❑ 13 16-plex ❑ 20 Pool ❑ 30 Accessory Bldg ❑ 02 SF Dwelling ❑ 08 06-plex ❑ 16 Fireplace ❑ 21 Porch (3-sea.) ❑ 31 Ext. Alt - Multi ❑ 03 01 of_ plex ❑ 09 07-plex ❑ 17 Garage ❑ 22 Porch/Addn. (4-sea.) ❑ 33 Ext. Alt - SF ❑ 04 02-plex ❑ 10 08-plex ❑ 18 Deck ❑ 23 Porch (screen/gazebo) ❑ 36 Multi Misc. ❑ 05 03-plex ❑ 11 10-plex .p 19 Lower Level ❑ 24 Storm Damage ❑ 06 04-plex ❑ 12 12-plex Plbg_Y or _ N ❑ 25 Miscellaneous Work Types ❑ 31 New 35 Int Improvement ❑ 38 Demolish Interior ❑ 44 Siding ❑ 32 Addition ❑ 36 Move Building ❑ 42 Demolish Foundation ❑ 45 Fire Repair ❑ 33 Alteration ❑ 37 Demolish Building* ❑ 43 Reroof ❑ 46 Windows/Doors ❑ 34 Replacement *Demolition (Entire Bldg) - Give PCA handout to applicant Valuation L' , o0 0 r Occupancy R-' MCES System Census Code L,13 q Zoning City Water SAC Units Stories Booster Pump # of Units Sq. Ft. PRV # of Bldgs Length Fire Sprinklered Type of Const Width REQUIRED INSPECTIONS Footings (new bldg) _ Final/C.O. Footings (deck) A Final/No C.O. Footings (addition) Veil j )7y oR- (30I T - Plumbing _ Foundation L a.,+ D _ HVAC _ Drain Tile Other Roof _ Ice & Water - Final _ Pool _ Ftgs _ Air/Gas Tests -Final Q~ Framing _ Siding _ Stucco -Stone -Brick _ Fireplace _ R.I. -Air Test -Final X1 Windows Insulation _ Retaining Wall Approved By: , Building Inspector Base Fee Surcharge Plan Review MC/ES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant License Search Copies Other Total PERMIT --~-CFTY OF EAGAN Y'. 4k I ~C/ 3830 Pilot Knob Road PERMIT TYPE: B U I L D I N G Eagan, Minnesota 55123 Permit Number: 0 2 3 3 5 8 (612) 681-4675 Date Issued: 04/21/94 SITE ADDRESS: 4391 BENT TREE LANE LOT: 4 BLOCK: 1 AUTUMN RIDGE 2ND P.I.N.: 10-12301-040-01 DESCRIPTION: (INCLUDES DECK) Building Permit Type SF PORCH Building Work Type NEW REMARKS: A SEPARATE PERMIT IS REQUIRED FOR ANY ELECTRICAL WORK FEE SUMMARY VALUATION $8,000 Base Fee $99.00 COPY .50 Surcharge 4.00 Total Fee $103.50 Subtotal $103.00 CONTRACTOR: OWNER: - A p p l i c a n t - RIEDINGER DAN 4391 BENT TREE LN EAGAN MN 55123 (612)687-9643 I hereby a,knowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Mn. Statutes and City of Eagan Ordinances. APPLICANT/PENN: rE SI NATURE ISS07 BY: S ATURE CITY OF EAGAN ~ a 7,77 1884 BUILDING PERMIT APPLICATION 681-4675 APR 12 1994 SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, I copy of energy talcs. COMMERCIAL 2 sets of architectural & structural plans, I set of specifications, I copy of energy talcs. Penalty applies: 1) when permit is typed, but not pinked up by last working day of month in which request is made, 2) address is changed or 3) lot change is requested once permit is issued. .Step t90 Date I . I Yal uati on of wor 19 Site Address: y3~ `!"fle-1 ~F"i E STREET SUITE' Tenant Name: (commercial only) TAT BLOCK SUED.. P . I D . v?w~w. i Z~eP eseri tion of work: 4 The applicant is: Owner 13 Contractor ❑ Other coescrite) Name P"honek6,= Property LAST FIRST Owner Address 4 91 Be t~ !r► STREET STR City Eq~a 0. is~ State zip 7. Company Phone 14 Contractor Address tat uJ• 'Ie ~ e # Exp. . 000 City State. A)_ P Company Phone Architect/ Engineer Name Registration # Address City State zip Sewer & water licensed plumber Processing time for sewer & water permits is two days once area has been approved. I hereby acknowledge that I have read this app~pplication and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances, Signature of Applicant: O FM ONLY "-VOL SUILDING PERMIT Tyf~ # 01 Foundation Q 05 Ouplox Q 11 Apt-YLOW09 0 16-Basement finish 002 SF flog. Q 07 +4-P1 nit 0 12 HUI ti. `Misc. 0 17 swim Pool " 0 03 .SF- Addition a 08 "8-Pl x 03.11 -Garage/Accessory 0 18 Comm./Ind. 04 `SF Porch 09 12-P1 ex 0 14 Fireplace 0 19 Comm./Ind. Mi sc . 0,05 SF M11 sc. 10 Multi. Add-l, Q iS . C 20 Public Facility 0 21 Miscalla s ,WORK TYPE New NrA 4 &eck JO, 31 New f 33 Alterations 0'35 Tenant F'itt tit 0 37 Deal ish 0 32 Addition 0 34 Repair 0 36 Move ' RAL I MATIOW Coast. Actual Basement sq. ft. MCC System AlowIe 1st Fl. sq.;ft. City Mater ABC ccup;ncy 2nd Fl. sq. ft. PRV Required Zonin , Ft. total Booster Pump # of tories ootprint Sq. ft. Fire Sprinkler Length Oh-site well Census Code Depth tan-site s+a SAC Code _ Census Old MPROVALS -asps °"If Planning Building Assessments neeing Variance REQUIRED ROPECTI 13-.Site Or Footing ~ Framing gsulati~n 0 Wallboard 1 Final Q Oraietile Q Fireplace Permit Fee recta Surcharge - tt Plan Revi+art (2.~ / y 26 L icense r2 MCC SAC o City SAC Water Conn Water Motor Acct. Deposit S/W Permit S/1i Surchar 9 Treatment . PP Road Unit Pare Dot, Trail s Den. Copies Other 'total SAC % SAC Units m tb~ Ob 1 v y., 'DEC-14-'92 MON 13:46 ID:JAMES P HILL INC TEL NO:612 890-6244 #1194 P01 41" 414 SURVEYOR'S CERTIFICATE PARISH MARKETING AL1 T U"v 114\1. 951.0 95.00 N 0° 18' 32 W 953 a x In q % I 1 IO EASEMEN a UTILITY g EASEMENT PER PLAT LOT 3 ,00 1 L~_ a 4 N 14 114 1.3 9g 5 x 526 OD 30.00 x ;952.8 46.0 V1 J / n, ~ ~ I •-1-1- M PROPOSED m 1 Z L~= M Ip HOUSE N h YI o p M ~r 00 a ` j OD h 1 a` - - - k14 0 IFi ow/ BENCH MARK N j 0 GARAGE 8 M H 8, TOP OF PIPE oo, ELEV:951.50 c'f - 3_0.00- 952.5 22.0 0 M W= r 1_ ' _ ~p5 Zppgg~~ffi 1 '1 BENCH MAW D101vwY 1 p ` o 10 5 o E E V a IPP11E V, J p M 1.4 0 p fg52 3) 85.00 N 00 18' 32" W 951.9 D y~~ N N 9509 B • BENT TREE t ENGINEERING DEPT NOTE: BUILDING DIMENSIONS SHOWN ARE FOR FOR HORIZONTAL S VERTICAL LOC- ATION OF STRUCTURE ONLY. SEE NOTE- NO SPECIFIC SOILS INVESTIGATION HAS BEEN COMPLETED ARCHITECrUAL PLANS FOR BUILDING ON THIS LOT BY THE SURVEYOR. THE RY Of 9 FOONDATION DIMENSIONS. SOILS TO SUPPORT THE SPECIFIC HOUSE 1 IS DENOTES PROPOSED SURFACE DRAINAGE NOT THE RESPONSIBILITY Of THE SURVEY0jjt O DENOTES IRON MONUMENT SET SCALE: 1 INCH - 30 FEET • DENOTES IRON MONUMENT FOUND PROPOSED GARAGE FLOOR - 954,5 FEET X000.0 DENOTES EXISTING ELEVATION PROPOSED LOWEST FLOOR - yeb,,Z FEET (000.0) DENOTES PROPOSED ELEVATION PROPOSED TOP OF BLOCK - FEET P.R.V. REUIP,6 T WE HEREBY!'ERTIFYT0 PARISH "AAVCT"wlC- THAT T~!..Vr !InVt"I Y A 4I7.VV L'"\,}t- AI►4V VV!f~ C101 n `_rri/i I\L .i r+Idt~, -t~~1 II IJ"dt tIiYr 1 REPRESEN IY TATION OF A SURVEY OF THE BOUNDARIES OF: Lot 4, Block ( , AUTUMN RIDGE 2ND ADDITION, according to the recorded plot thereof, Dakota County, Minne0a. IT DOES NOT PURPORT TO SHOW IMPROVEMENTS OR ENCROACHMENTS, EXCEPT AS SHOWN. AS SURVEYED BY ME OR UNDER MY DIRECT SUPERVISION THIS to TH DAY OF DECEMBER , 1992. PROPOSED GRADES SHOWN WERE SIGN D; J M S R. HILL, INC. TAKEN FROM THE DEVEIDPMENT PLAN FOR AUTUMN RIDGE 2ND ADDITION PREPARED BY PIONEER ENG. LAST DATED 5-11-92. JOHN C. LARSON, LAND SURVEYOR MINNESOTA LICENSE NUMBER 19828 _ V 0 r to C_ rn O ~ N D ~ James R. Hill, inc. _ (p o z to M U1 D o m Z 11 Pt ANNFR4 / FN(~INF P!q I _q1 IPVI=Vnl UTY OF EAGAN PERMIT Control No. 1 3 t " 99 3830 Pilot Knob Road PERMIT TYPE: Eagan, Minnesota 55123 Permit Number: (612) 681-4675 Date Issued: SITE ADDRESS: DESCRIPTION: REMARKS: FEE SUMMARY: CONTRACTOR: OWNER: { i . . .1 "A ;'d PPLICANT/PERMITEE SIGNATURE ISSUED B : SI NATUR PERMIT # CITY OF EAGAN s ,I-, . , IN REACTIVATE _ 1992 BUILDING PERMIT APPLICATION 681-4675 T E r i REq 9 SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, I copy of energy calcs. COMMERCIAL 2 sets of architectural & structural plans, I set of specifications, I 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 chan a is re uested once permit is issued. Date 12-14-92 / i Valuation of work Site Address: 4391 Bent Tree Lane STREET SUITE 0 Tenant Name: (commercial only) LOT 4 BLACK 1 SUBD. Autumn Ridge 2nd p.I.D. Description of work: Single family home The applicant is: ❑ Owner ® Contractor ❑ Other (Describe) Name Parish Marketing & DEvelopment Corp. Photie 452-6644 Property LAST FIRST Owner Address 3799 Briarwood Lane STREET STE ~ City Eagan State Minn. Zip 55123 Company same Phone Contractor Address License # Exp. City State Zip Company Phone Architect/ Engineer Name Registration # Address City State Zip Sewer & water licensed plumber Tom Hessiah~,xiumbing 432-6898 Processing time for sewer & water permits is two days once area has been approved. I hereby acknowledge that I have read this lication and state that the information is correct and agree to comply with all applicable to of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant:, OFFICE USE ONLY ,r BUILDING PERMIT TYPE dr ❑ 01 Foundation ❑ 06 Duplex ❑ 11 Apt./Lodging ❑ 16.6 eme-nt4inish kf 02 SF Dwg. ❑ 07 4-Plex ❑ 12 Multi. Misc. ❑ 17 Swim Pool ❑ 03 SF Addition ❑ 08 8-Plex ❑ 13 Garage/Accessory ❑ 18 Comm./Ind. ❑ 04 SF Porch ❑ 09 12-Plex ❑ 14 Fireplace ❑ 19 Conin./Ind. Misc. ❑ 05 SF Misc. ❑ 10 Multi. Add11. ❑ 15 Deck ❑ 20 Public Facility ❑ 21 Miscellaneous WORK TYPE ~31 New ❑ 33 Alterations ❑ 35 Tenant Finish ❑ 37 Demolish ❑ 32 Addition ❑ 34 Repair ❑ 36 Move GENERAL INFORMATION Const. (Actual) 1l N Basement sq. ft. MWCC System/ (Allowable) 1st F1. sq. ft. City Water YES UBC Occupancy M-I 2nd F1. sq. ft. PRV Required_ Zoning Sq. Ft. total Booster Pump # of Stories Footprint Sq. ft. Fire Sprinkler Length On-site well Census Code la! Depth_ On-site sewage SAC Code ~L APPROVALS Buildin g , Planning 9 Assessments Engineering Variance REQUIRED INSPECTIONS ❑ Site ❑ Footing ❑ Framing ❑ Insulation ❑ Wallboard ❑ Final ❑ Draintile ❑ Fireplace Permit Fee valuation: $ 12y, 000 Surcharge Plan Review GA~AG~ Z }c 2~ 4q o License a ►Ss MWCC p City SAC ' City SAC Water Conn. ' h 4 9 X l6 = /b~ 5 G 9 Water Meter Z 2 X 30 ~ Acct. Deposit S/W Permit 0) 0 C 2" S/W Surcharge 9 Ll YO Treatment Pl. Zwr~ Road Unit Park Ded. 316'j /60 Trails Ded. Copses Other ~s7 Total: SAC % t X f = 100 -30) SAC Units I a 7= 2 119 14 (27 , :ic~_ C C.;,D 17UM14F P)WiZ ARt4 jy X2.0°` 3 I50 3 I~ ~ DEC-14-'92 h90N 13:46 I L7: JA1~1ES P HILL I NC TEL 110:612 e9O-6244 4194 P01 58,4414 SURVEYOR'S CERTIFICATE PARISH MARKETING 951.0 95.00 N 0° 18' 32" W _%x9538 i Ln 1 10 DRAINAGE a UTILITY 5 EASEMENT PER PLAT 3 00 LOT I 3 N w ~ 4 N 0 951.3 952.5 x 526 x 982.8 00 _ 30.00 - 46.0 00 0~ 0 t° 0 Z M PROPOSE ,r> M OUSE N I M p O 8 0 M 140 ®r) z UJ/ BENCH MARK N ° GARAGE O g o_ TOP OF PIPE N ~ O W ELEV'951.50 30.00 952.5 X 22O N gno, DRONEWAY \ ---BENCH MAW 1n 10 8 g EL TOP OF E 14 EV 53.11 L 1.4 0 7- " 85.00 N 00 18' 32" W 951.9 CU DZ~~ N N r' 9509 a.... BENT TREE ~GINEE T `1 DEPT NOTE: BUILDING DIMENSIONS SHOWN ARE FOR HORIZONTAL 9 V01ITCAL LOC- ATION OF STRUCTURE ONLY. SEE NOTE: NO SPECIFIC SOILS INVESTIGATION HAS BEEN COMPLETED ARCHITECTUAL PLANS FOR BUILDING ON THIS LOT BY THE SURVEYOR. THE S rT OF 9 FOUNDATION DIMENSIONS. SOILS TO SUPPORT THE SPECIFIC NOUN IS + DENOTES PROPOSED SURFACE DRAINAGE NOT THE RESPONSIBILITY OF THE SURVEYOR. O DENOTES IRON MONUMENT SET SCALE: 1 INCH - 30 FEET • DENOTES IRON MONUMENT FOUND PROPOSED GARAGE FLOOR - 854,5 FEET X000.0 DENOTES EXISTING ELEVATION PROPOSED LOWEST FLOOR - 94.6.A FEET (000.0) DENOTES PROPOSED ELEVATION PROPOSED TOP OF BLOCK- yam, FEET z • R ■a WE HEREBY CERTIFY TO PARISH MARKETING THAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY OF THE BOUNDARIES OF: Lot 4, Block I , AUTUMN RIDGE 2ND ADDITION, according to the recorded plot thereof, Dakota County, Minnesota. IT DOES NOT PURPORT TO SHOW IMPROVEMENTS OR ENCROACHMENTS, EXCEPT AS SHOWN. AS SURVEYED BY ME OR UNDER MY DIRECT SUPERVISION THIS 10 TH DAY OF DECEMBER 1992. SIGN D: J M S R. HILL, INC. PROPOSED GRADES SHOWN WERE TAKEN FROM THE DEVEU)PWNT PLAN FOR AUTUMN RIDGE SNO ADDITION PREPARED BY PIONEER ENS. LAST DATED 5-1I-912. JOHN C. LARSON, LAND SURVEYOR MINNESOTA LICENSE NUMBER 19828 ~70(v ~~o James R. Hill, i D 0 A-5 z n Z a) > W PLANNERS /ENGINEERS /SURVEYORS nc. 53,17 812_ O m N < 2500 W. CTY. RD. 42 * E3URNSViI I E. MN. 5 • i LOT SURVEY CHECKLIST FOR RESIDENTIAL BUILDING PERMIT APPLICATIO PROPERTY LEGA._~ Date of Survey: ~QCIIMENT BT ARDB GM A GA 0 Registered Land Surveyor signature and company Building Permit Applicant 0 Legal description 1 ❑ Address ❑ North arrow and bar scale 0 0 House type (rambler, walkout, split w/o, split entry,, - lookout, etc.) ' ❑ ❑ Directional drainage arrows with slope/gradient t. 0 Proposed/existing sewer and water services ❑ 0 Street name 0' 0 0 Driveway ELEVATIONS 0 0% Sewer service 0 0 Lot corners 13 00 ; Top of curb at the driveway a a Elevations of any existing adjacent homes rogosed 0""13 0 Garage floor 0 First floor 0~ 0 0 Lowest exposed elevation (walkout/window) 0 0 Property corners 0~0 0 Front and rear of home at the foundation PONDING AREAS (it applicab~~~ 0 Q' 0 Easement line 1) El' , 13 0 0 ; NWL P _ on HWL Cif/~ Pond # designation t0 l 0 Emergency Overflow Elevation DI NSIONS Q 0 Lot lines ❑ Right-of-way and street [3' 0 0 width home dimensions ncludin aback of orb) g any proposed decks, overhangs greater than 210 porches, etc. (i.e. all structures requiring permanent footings) ~0 0 Show all easements of record and any City utilities within 00 13 those easements Setbacks of proposed structure and setback of adjacent existing homes 0 0' 0 Retaining requir ents, if any Reviewed: Na e / ate October 1992 ~ri• el?alx Z2 t - . EXTERIOR ENVELOVE AVERAGE "U" C0.14PUTAT1011 C~4JIJGR _ _ SITE ADD1t1S s L O -T L--c°. C-iK _1 . A wT u M N R 1 D&-- -2,,-,o A ZED I T! p N CONTRAcTori Pea DATE PHONE ONE Determine working square footage of each. 1. Total exposed wall area . • 4g-40a sq. ft. x' • 11 _ ~~3 2. Total roof.ceiling area /~yli.CJ sq. ft. x •025 Total exposed wall area above floor = s~~ y ° J a. Total wall window area b. Total door area y2.8 C. Total sliding glass door' area . $ d. Total fireplace wall area O -C,"d e. Total wall framing area (average 10%) 23c,. V f. Total net wall area above floor / W. g. Total rim joist area •3 Total exposed foundation area = ~Oli•ls h. Total foundation window area O i. Total net foundation area above grade.... /bG~li Determine "U" value of each wall segment. a. X ..U.. -43 b. X U.. , p7G, 3 .3~ c. .J$.Q X "U" S a~/• 3 d. O X .a,.. O d r X U.4 133.3__ _ f ..U.. /o G. G. v~3 8 • e? S7;" G Rol r A7 y 3 Total Lf item 03 is the same as, or le!;!; than item 111, you have et t:)1.' l.lltent of SBC 6006(c)2. e -l fQ~.p~ SAC To tal exposed roof/ceilin4aarea j. Total skylight are . 6 k. Total roof/ceiling framing area (average 1(7'+) 1. Total net insulate roof/ceiling area Determine " value for each roof/ceiling segment. d X ..U.. O _ p k. 6 X ..U.. 1. / X ..U.. O Z/ = o2G. 3 4 ......Total a9'-y f If total of #4 is the same as, or less than #2, you have met t)le intent of SBC 6006 (01. 4V Z r3. ?J•~, t VAr:- 5/3 L Con ©!o(~,"J; d+ Alte nate Building Envelope Design To utilize the total envelope system method, the values establish•A by the sum of items #3 and #4 shall not be greater than the sum of items #1 and 02. 1. Zs3.l~ + 2 3. +4. VIAX 8 7 / 1999 BUILDING ERMIT APPLICATION (RESIDENTIAL) CITY OF MGM I tJ (4 30 PILOT KNOB RD $5122 651-681 f5 _ j C~ -1 Ct - Now conshuction eattironaents Rernad2ILROMA 111 3 registered site surveys stowing sq. ft. of lot, sq. fit. house 2 copies of pion and gl roofed areas (20% maxim ) 1 set of energy calculations for heated addiflons 2 copies of plans (show beam & window sizes: d find. design; etc.) 1 sae survey for wderlor additions & decks A 1 set of energy calcukattons ➢ 3 copies of hoe preservation plan 3 k* plaited off 7/1/93 DATE: to- is- 16 CONSTRUCTION COST: ~O • DESCRIPTION OF WORK: A n yte 4 jean 04~ STREET ADDRESS: 4391 -en 4 ~re e I-ah e LOT. BLOCK:. SUBD./P..Q. vv~ a-41),A) Name. d'~ v ~o Phone PROPERTY . Lost first OWNER street address: L4391 0 f1 ee t aj- e City State: / Zips ti~ S~ l2` Company: (r~~ss! /~da~~ Phone `j'3f=mss'? (area code) CONTRACTOR Street Address- -13O S- k 4. oak rd License # ~~%0 • City ih~t e,a d State: zip: ~S3 ARCHITECT/ ENGINEER Company: Name: Telephone area code ( j Street Address: RegWhatton B: City state: Zip: Sewer & water licensed plumber r a Penalty appEes when address change and lot change Is requested once permit is Issued. I he weby acknowledge that I have read this application, state that the information is correct, and agree to comply with all oppBrabi State of Minnesota Statutes and City of Eagan Ordinances. S gnature of Applicant: r , lap, OFFICE USE ONLY Certificates of Survey Received Yes No Tree Preservation Plan Received Yes No Not Required OFFICE USE ONLY BUILDING PERMIT TYPE ❑ 01 Foundation ❑ 06 4-plex ❑ 11 10-plex ❑ 16 Fireplace ❑ 21 Porch (3-sea.) ❑ 02 SF Dwelling ❑ 07 5-plex ❑ 12 12-plex ❑ 17 Garage ❑ 22 PordUA dn. ( ❑ 03 1 of _ plex ❑ 08 6-plex ❑ 13 16-plex ❑ 18 Deck ❑ 23 Porch (screened) ❑ 04 2-plex ❑ 09 7-plea ❑ 14 Apartments ❑ 19 Lower Level ❑ 24 Storm Damage ❑ 05 3-p ❑ 10 8-plex ❑ 15 Lodging ❑ 20 Pool ❑ 25 Miscellaneous lex WORK TYPE ❑ 31 New ` ❑ 35 Tenant lmpr ❑ 39 'Gas Line Only ❑ 43 Siding/Soffits/Fascia ❑ 32- Addition Q 36 Move Bldg. ❑ 40 Gas Insert ❑ 44 Windows/Doors ❑ 33 Alteration ❑ 37 Demolish Bldg.* ❑ 41 Wood Stove D 45 Fire Repair ❑ 34 Repair ❑ 38 Demolish (interior) ❑ 42 Reroof * Give PCA handout to applicant for demolition permit GENERAL INFORMATION Const. (Actual) Basement sq. ft. Census Cate (Allowable) Main level sq. ft. SAC Cade UBC Occupancy sq. ft. No. of Units Zoning sq. ft. No. of Bktgs # of Stories sq. ft. MCIES System Length sq. ft. City water Width Footprint sq. ft. Booster Pump PRV Fire Sprinidered APPROVALS Planning Building Engineering Variance Permit Fee Valuation: $ Surcharge Plan Review License MC/ES SAC City SAC Water Conn. Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment P}. Paris Ded. Trails Ded. Other Copies Total: SAC Units % SAC BL CITY OF EAGAN CITY USE ONLY 4 PLUMBING PERMIT SURD. ' (612) 681-4675 RECEIPT # 6 ~1 _ DATE /T/ RESIDENTIAL PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMES AND CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT. WORK DESCRIPTION COMPLETE THE FOLLOWING: NO. FIXTURES EA. TOTAL NEW CONST REPAIR/ADD ON 15.00 ADD ON SHOWER 3.00 _I-- REPAIR WATER CLOSET 3.00 BATH TUB 3.00 LAVATORY 3.00 OWNER NAME: Z/~L"~ ? A•~Z / KITCHEN SINK 3.00 LAUNDRY TRAY 3.00 SITE ADDRESS Jl1',y~ HOT TUB/SPA 3.00 WATER HEATER 3.00 rl. OR DRAIN 3,00 ~ GAS PIPING OUT. INSTALLER: TOM HESSIAN paimoiNG, Ime. (MINIMUM - 1) 3.00 121 REDWOOD DRIVE ROUGH OPENINGS 1.50 ADDRESS: eRRi P MAILV, OTHER WATER SOFTENER 5.00 CITY: ZIP- PRIVATE DISP. 15.00 A -7 U.G. SPRINKLER 3,00 PHONE W. TURNAROUND 15.00 STATE SURCHARGE .50 SIGNATURE " F PERMITTEE TOTAL: _a1 COMMERCIAL PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS. ALSO FOR MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT. WORK DESCRIPTION: OWNER NAME: CONTRACT PRICE: SITE ADDRESS: 1% OF CONTRACT FEE. STATE SURCHARGE - $.50 FOR TENANT NAME: EACH $1,000 OF PERMIT FEE. SUITE $25.00 MINIMUM FEE. INSTALLER: CONTRACT PRICE x 1% $ ADDRESS: STATE SURCHARGE $ CITY: ZIP: TOTAL: $ PHONE FOR: (SIGNATURE) CITY OF EAGAN CITY OF EAGAN L B f MECHANICAL PERMIT RECEIPT # c, (612) 681467S DATE / SUBD..n~ ,z~a;. L~41 RESIDENTIAL PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS. ALSO, COMPLETE FOR TOWNHOMES/CONDOS WHEN SEPARATE PERMITS ARE REQUIRED FOR EACH DWELLING UNIT. OWNER: ~C Y" { LS'}°i - tADD-ON A/C ADD-ON FURNACE ❑ SITE ADDRESS: i ADD ON/REMODEL (EXISTING $ 15.00 71 F CONSTRUCTION ONLY) INSTALLER: Burnsville Heating & A/C, Inc. HVAC: 0-100 M BTU 24.00 I t240t Rhode Island Ave. So 5 3 1 8-1122 ADDITIONAL 50 M BTU .00 PHONE Savage, MN 55378-1122" ADDRESS: AS OUTLETS - MINIMUM 1 @ $3 EA l~ D CITY: ZIP: SURCHARGE: $ .50 SIGNATURE: TOTAL: -T 771-k 77 77-77 7 1-7 7- 7- NO PERMIT REQUIRED FOR DUCTWORK ONLY COMMERCIAL PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAUINDUSTRIAL BUILDINGS. ALSO COMPLETE FOR APARTMENT BUILDINGS OR OTHER MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT. WORK DESCRIPTION: r CONTRACT PRICE: FEES 1% OF CONTRACT FEE. STATE SURCHARGE IS $.50 FOR EACH $1,000 OF PERMIT FEE. $ PROCESSED PIPING - $25.00 $ MINIMUM FEE - $25.00 OWNER: TOTAL: $ SITE ADDRESS: TENANT: SUITE INSTALLER: ADDRESS: CITY: ZIP: PHONE CITY SIGNATURE: SIGNATURE: f INSPECTION RECORD CITY OF EAGAN PEIRMIT TYPE: 61.11 C 01 ni r► 3830 Pilot Knob Road Permit dumber: Eagan, Minnesota 55123 Date issued: . (612) 681-4675 SITE ADDRESS: # € APPLICANT: 434J HFN1 IREE. UA : trl.C"DIN€.1ER €JAN . PERMIT SUBTYPE: TYPE OF WORK: ft INAL IAARK':: R 'f-I ARA14 PERM 1 f 10 011:1"let, a I- (W ANY 1. 1.1:t: 1k I At WORI PLC I ELECTRIC Dade hmp. cconmmft Fora %W 1 FOUIfdo*m Framing Iri PAc6v P4 Ugh Plbg. w RAuyh Htg. Ind. f Rnal Htg. Ono Test FkW Plbg. Plbg. lrmpedor - Nom Plumber Conte. Mew E~ lam. FkW Dock P' 2 Lt+ Deck FlW d d d1LW a VftN Pr. Disp. t7 S +K1 _ PERMIT City of Eagan Permit Type: Building Permit Number: EA105768 Date Issued: 0712712012 itj of 0n Permit Category: ePermit R Site Address: 4391 Bent Tree Lane Lot: 4 Block: I Addition: Autumn Ridge 02nd PID: 10-12301-01-040 Use: Description: Sub Type: e-Reroof Construction Type: Work Type: Replace Description: House & Garage Census Code: 434- Occupancy: Zoning: Square Feet: 0 Comments: If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar. Pictures are not acceptable in lieu of inspections. Carbon monoxide detectors are required by law in ALL single family homes. Fee Summary: BL - Base Fee $4K $103.25 0801.4085 Valuation: 4,000.00 Surcharge - Based on Valuation $4K $2.00 9001.2195 Total: $105.25 Contractor: - Applicant - Owner: Gates General Contractors, Inc Robert Anderson 3500 Vicksburg Lane North, Suite 400-351 4391 Bent Tree Lane Plymouth MN 55447 St Paul MN 55123 (763) 550-0043 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 RECEIVED Use BLUE or BLACK Ink For Office Use 441,01` CityOl En nT Permit#: titil(q/Permit Fee: /ill'SJ 3830 Pilot Knob Road 1-401.0Eagan MN 55122 Date Received: 1'11)-1'1 Phone:(651)675-5675 Dr( Fax:(651)675-5694 Staff: 2017 RESIDENTIAL BUILDING PERMIT APPLICATION Date: T l IQj I I Site Address: c:11 $ `4 7-zee L A Q.. Unit#: Name: "1 a�a¢. rk Q.tSa0 Phone: ( SI- Z7)- ILi?Z. Resident/ Owner Address/City/Zip: 4g9 7�a 1,42,.4 o Applicant is: Owner leffontractor /in/i sre'iz )3 d Roi;vs.. Type of Work Description of work: E teral 1 CLbSc± DQ1, N0.1.0 5aintkaei Construction Cost: 111 608. Multi-Family Building: (Yes /No 'VI.-- Company: V )Company: i ao..,ttAs r►11 14Aist M.O 1e.L4 +204AttContact: 41:14,1 G,t i f f Contractor Address:Z .IG,SP cff s'r City: PiAb cit.. State: 104,144, Zip: 5Q1Z3 Phone:V.1-4Z3-?76i Email: .w Palk r,,,o,an_e(ro,fw,S7-.v t. License#: p t5iictQS s Lead Certificate#: ixrri L 1478 If the project is exempt from lead certification, please explain why: 1(4-'' I 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: Fire Suppression Contractor: Phone: NOTE:Plans and supporting documents that you submit are considered to be public information. Portions of T 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.ciopherstateonecall.orq I hereby acknowledge that this information is complete and accurate;that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 days of permit issuance. x _(1114+60.0 Applicant's Printed Name Applic is Signature Page 1 of 3 DO NOT WRITE BELOW THIS LINE dJ 7VV99/. SUB TYPES `73 9 .6 el'? iL TrQ.e L `-Q 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 Id 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 1 2,640, .-_,;=-_ Occupancy j-:P6 - MCES System Plan Review Code Edition iyi y7 ',jc SAC Units (25%_100%N) Zoning J2 --( City Water Census Code Stories Booster Pump #of Units Square Feet PRV #of Buildings Length Fire Suppression Required Type of Construction VB----- Width REQUIRED INSPECTIONS Footings(New Building) Meter Size: Footings(Deck) Final/C.O. Required Footings(Addition) ' Final/No C.O. Required Foundation Foundation Before Backfill )O HVAC_Gas Service Test Gas Line Air Test Roof:_Ice&Water _Final Pool:_Footings Air/Gas Tests _Final "7() Framing 30 Minutes 1 Hour Drain Tile Fireplace:_Rough In Air Test _Final Siding: Stucco Lath _Stone Lath Brick_EFIS )o Insulation Windows Sheathing Retaining Wall:_Footings_Backfill_Final Sheetrock Radon Control Fire Walls Fire Suppression:_Rough In_Final Braced Walls Erosion Control Shower Pan Other: Reviewed By: TO Oil 1 1`t `I, ft , Building Inspector RESIDENTIAL FEES t ,D 5, r, (D -D c-, S Base Fee �' Surcharge Plan Review MCES SAC City SAC Utility Connection Charge S&W Permit&Surcharge Treatment Plant Copies TOTAL Page 2 of 3 PERMIT City of Eagan Permit Type:Building Permit Number:EA166468 Date Issued:01/12/2021 Permit Category:ePermit Site Address: 4391 Bent Tree Lane Lot:4 Block: 1 Addition: Autumn Ridge 2nd PID:10-12301-01-040 Use: Description: Sub Type:Fireplace Work Type:Gas Fireplace (new) Description: Census Code:434 - Residential Additions, Alterations 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 - Robert & Stephanie Anderson 4391 Bent Tree Ln Saint Paul MN 55123--305 Fireside Hearth & Home 2700 Fairview Ave N Roseville MN 55113 (651) 633-2561 Applicant/Permitee: Signature Issued By: Signature