4040 Camberwell Dr N4 , ,;;-.
? ??..
?;.
I
ir?#?
titp of (tagan
aFparbtPltf of itIaiY[ J iripPltitilt
This Certificate issued pursuant to tlse requrrements of Section 306 of the Unifarm Buildrng
Code certifying that at the time of issuunce this siructure was in cornpliance with the varrous
ordinances of the City regulating building constructian or use. For 1he fallowing.•
144547
Use G7assifica6on SF M7C'AR+ Bldg. PCrmit No.
?P-Y ?'Pe `'`-1 Zomng Disuid PD/R1 'Iy'? Coast. VN
ownff or euamROTTIIJNO 00 IlW- Address 5201 E RIVM i?, FR-]Mff
?.8 aaa. 4040 GMEMU. MVE NT&W Ik, B3, HLLTS OF SlaUMIDGE #3
n.te: ? ???/c)l
Buildin8 Offi • ,
POST IN A CONSPICUdUS PI.ACE
?
CITY OF EAG
. ? ,
i
38a3Q Pilot Knob Road, P.O. Box 21-
• PHONE: 454-81(
,BUILOING PERMIT i
To be used for [ W(y/'(,iAR Est. Val ue sl"ioU0
Site Address ' ._
? ??MRWRI-I• DR N
Lot -A_ Bfock,-Sec/Sub. U71,11J R- nF
Parcel No. _ - ` ST? EBRIDGE 3RID
W Nar?'e THB gOT?f1.1JN? .n ?i
I Adci65s _ 5201 E RIVRR It[?
o ' •
City _ 1??2t1 I,,y_ Phone 5 71..D304
'a Name 8!M
? Address
cc
? City Phone
? W Name
Address
aw Ci#y Phone
ape that I have read this
of
Signature of Permitee
A Building Permit is,issued to:' THE ROTTLUNA CQ INC
on the express condition ihaf all work shall be done in accordance with all
applicable State of Minnesota.Statutes antl Ciry of Eagan Ordinances.
?
Building Official
N
)9
Eagan
MN 55121 ???
,
,
?
Receipt # 1f ? j
Date At1G
12
, 1 g 91 ,
?'
i
OFFICE USE ONLY ?
.?
Occupancy R-3 H--i FEES
Zoning PD SeA
(ActuaQ Const .V-14 Bldg. Permit ?TS._0 I
(Allowable) -I&A Surcharge 74+00 ?
# of 5tories _ ?
lenglh ? Plan Review ??
DePih Me SAC, City 100*?
%
S.F. Toial - SAC, MCWCC 650,00. ?
S.F. Fooiprinis - ?
On Site Sewage _ Water Conn fi?+? 3
On 5ite Well Waler Meter ??
?
MWCC System .?
City Water x Acct. Deposit 300QQ
PRV Required _ S!W Permit 30:00 ;
Boosier Pump - S/W Surcharge ¦ 50 ?i
Treatment PI 276*00
APPROVALS
Hoad Unit ?7p?? j
Planner - park Ded. "
Council
BIdg.Ofl. _ Copies
Variance - TOTAL 3,618.30
. Permk No. Permit Holder Date Telephone #
WATER
SEWER
PLUMBING
H.VJ1.C. ?-
ELECTRIC /,-?e)
Inspection Date Insp. Comments
Footings I a
Foundation 11-41ge
Framing
Roofing
Rough Plbg.
Rough Htg.
Isul.
Fireplace `
Fnal Htg.
Orsta
t Test v
,?
Final Plbg. Plqg. InspeCtor - Notity Plumber
ConsL Meter
EngrJPlan
Bldg. Final
Oeck Ftg. .
Deck Final
Well
Pr_ Disp.
?
/?i`
SEWER & WATER,•PERMIT UFPICE USE ONLY
CITY OF EAGAN MErER # " -?7VS1 PERMIT QATE ?` l 1 5 f y 1
3830 Pilot Knob Rd. cHiP # PERMtT # 1211:
Eagan, M N 5 5 1 2 2- 1 8 97
METER SIZ A B.P. RECEIPT # -
? 15SUE DATE lp ' ?' B.P. RECEIPT DA7E o,91
DATE ?:?.
_ PRV _ BOOSTER PUMP
SITE ADDRESS
LOT BLOCK SEC/SUB }` - ' < c J 7 S
APPLICANT: -- ?- F,: . ; 11,., r: ;-? f. ? n
ADDRESS: F i r? I F; i, ;
,
CITY, STATE ZIP ': 5 ,? j-
PHONE:
PERMIT REGIUESTED
SEWER - WATER _ TAPS
COMM/IND = RESIDENTtAL
x NEW - EXiSTING
? Lawn Sprinkler Meters are to be Installed
PLUMBER: ? ? Ahead of Domestic Meters on Water Line.
ADDRESS: r?Credit WILL NOT be given for Deduct Meters.
CITY, STATE, ; ZIP = . _
PHONE: Za -_ ? , 2 t r?`
4WNER: T:te C:o. Inc
ADDRESS: 5 ? 0 ±
CITY, STATE d 1 ZIP
PHONE: ? --C3
' ^!?";•,, ; :? %'; . r.,_
PLEdSE ALLaW TWO WORKING DAY$ FOR PR'OCESSING. CAII,
SEWER PERMlTS, CONTACT EMGINEERING DEPT.
I AGREE T4COMPLY WITH CITY OF
SEWER & VWATER PERMIT , OFFICE USE ONLY
CITY OF EAGAN METER # PERMIT DATE
3$30 PIIOt Kf10b FCCI.
" CMIP # PERMIT # 12217
Eagan, MN 55122-1837
METER 51ZE B.P. REGEIPT #
G€,
1+4i
E:
- 15SUE DATE ,
B.P. RECEIPT DATE
DATE •-
_ PRV - BOOSTER PUMP
SITE ADDRESS PERMIT REQUESTED
? LOT "?BLOCK SEC/SUB r ?.. f
-5f SEWER ''- WATER - TAPS
APPLIGAN7: --.?.. k_ rt•• i_???'; ir? _. ?'r;:•:.
ADDRESS: 5 -7 C?
?h -COMM/1ND X RESIDENTIAL
.
,
CITY, STATE ZIP r r: ;.:J. =i NEW
EXISTING
- ?
PHONE: - - ` 0 0 ('.t 4 -
. Lawn Sprinkler Meters are to be Installed
PLUMBER: fa I??;z ri 3'=yr:-', r•,<, Ahead of Domestic Meters on Water Line.
ADDRESS: ??? ?`''?- w 3? ?•r'? r; Credit WILL NOT be given for Deduct Meters.
CITY,STATE '0 r??ti Mn. zip 1r:;2
=2- 2'' '
PHONE
:
I AGREE T4£OMPLY WITH CITY OF
OWNER: `v1;`:' EAGAN ORDINANCES
ADDRESS:
? ?..4.'. .y
: r 1'i.?.
: CITY, STATE .L
.9 rr:t??.?
_ ZIP
PHONE: SIGNATURE WHEN METER ISSUED
PLEASE ALLaW TWO WORKING DAYS FOR PROCESSING. CALL 454-5220 FOR INSPECTIONS. FOR STORM
SEWER PERMITS, CONTACT ENGINEERWG DEPT.
. _ . : _. _.: . e;.?... __4._._ . _..f._:..?._.?....__?...?. ,,.?...??
- CITY OF EAGAN N0- 19547
383b Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 A?
PHONE: 454-8100 ? /
BUILDING PERMIT , Receipt # -^ ??/ 5 '?i
Tobeusedfor SF DWG/GAR Est.Value $148,000
Site Address 4040 CAMBERWELL DR N
Lot 4 Block 3 Sec/Sub. HILLS OF
Parcel No. _ STONEBRIDGE 3R
I=. IName THE ROTTLUND CO INC
o Address 5201 E RIVER RD
City FRIDLEY Phone 571-0304
o Name 5AME
}
g; Address
? City Phone
W ? Name
3a Address
g W City Phone
I hereby acknowlege ihat I
have ihis tio n and state Ihat the
g
informaLOn is correct and mp ith all licable State of
Minnesota Statutes and City rfU ances.
SignaWre of Permitee -
A Bundin9 Permit is issued to: THE ROTTLUND CO INC
on the ezpress condition ihat all vrork shall be done in accordance with all
applicable State of Minnesota Statutes antl Ciry out Eagan Ordinances.
Building plficial
OFFICE USE ONLY
Occupancy R-3 -M--1 FEES
Zoning PD R=1
(Actuap Const v=N Bldg. Permn 808.00
(Allowable) V-N Surcharge 74.0?
# ol stories -
Lengih 581 PlanRewew $2$.00
DePth 36' SAC, Ciry 100. 00
S.F.Totel - SAC,MCWCC 650.00
S.F. Foolprinis _
On Sile Sewege _ Water Conn 660_ nn
On Site Well Water Meter 95.00
MWCC System X
cirywater X ncc.Deposa 3o_nn
PRVReqwred _ 5/VJParmil 10-00
Booster Pump - SIW Surcharge .50
7reatmentPl 276.00
APPHOVALS RoadUnit 370.00
%w"t - Park Ded.
CouuA
BIdg.OH, _ Copies
Vanance - 7oTAL 3,618.50
Address:4040 r,AMg&M,L DRIVE NORAot 4 Blk 3 Sec/SubHE[j,g OF S1aCBRTDGE 3RD
These items were/were not completa at the time of the final inspection.
11 7 91 Yes No ?f
Final grade (6" from siding) e/
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 tha removal of roof test caps from the plumbing
system and the shut-o£f of water supply to the outside lawn faucet before
freeza potential exists. ,qk
lbt5'
RCttE?qMR
White - City copy Yellow - Resident copy Pink - Contractor copy
0 :a ?
-? .
V'- AUG 159 1991
DATE:
RE: 4040 GAMBERWELL DR ii (T88 &OTTLUND CO INC)
X "
_ Your Sewer &'Water Permit for the above property has been completed. It will be held at ihe
Public W00s Garage (3501 Coachman Road) until the meter is picked up. BE SURE TO
CALL PUBLIC WORKS (454-5220) FOR YOUR PERMANENT WATER TURN ON.
0
- Your Sewer & Water Permit for the above property cannot be completed for ihe following
reasons:
_ Your Sewer 8 Water Permit for the above property has been completed, but the meter cannot
be issued or occupancy all'17d until further notice. ,
- COMMERCIAL PROJECTS O LY: Please pay for meter at City Hall. Meter size must be
confirmed by Bill Adams or Dirk HoiY?e (Plumbing Inspectors- 454-8100) before issuance.
WARNING: BEFORE DIGGING, CALL LOCAL UTILITIES - TELEPHONE, ELECTRIC, GAS, ETC.
- REQUIRED BY LAW.
CONTACT COMMUNITY DEVELOPMENT DEPARTMENT FOR WpTER TURN ON POLICY.
Secretary, Building Inspections Dept. ' ?
glG191 - 1Oe2881K
1 1204 y o a''
Reques? Oate Fire No
g a ouqh-sn InSpacfion
py???g?o
[l Reatly Now f?Jill NoUty Inspector
?es G N. When ReaCY,
IXhcensed comracror ? owner hereby request inspection of above electncal work aC
Ja0 Atltlress l$treet Bo/ or Route No 1 ,s ,(f?? Ciry
040 l/?W N?
Secuon No I TOwnship Name or No Range No Coyµy?
Occu i ? Phane No
Power Sp
p
pher Atltlress
C?-
?
\
V?. (?(,
Electnca ConvacrorOompany Name1 ConVatlor's Lrtense No.
mc . ¢a9iI 3
Matlmg Ap ress ICOnlraclor or Owner Makmg Installatron}
nulnorrzetl Signamre ICOmract Owne aing Instau ionj Phone NvmOer
+ -- b -3 gl a
.
MINNESOTR STATE BOPPD OP EIECTRICITY THIS INSPECTION REQUEST WILL NOT
Griggs-Mltlway Blag. - Room 5413 BE ACGEPTED 0Y TNE STATE BOARD
1821 UnlveraHy Ave. S[ Paul. MN 55104 UNLESS PROPER INSPECTION FEE IS
Phone(613) 643-0800 ENCIOSED.
REQUEST FCM ELECTRICAL INSPECTION
? See msYructions far complating this lorm on back of yellow copy
i ^ "X" Below Work Covered by This Request
°??•?? EB-00001-0jtL
ew 'Add F'?ep'? TypeofBmlding ApphancesWired EqwpmeniWired
Home 7 R
1 anqe Temporary Service
Duplex Wa[er Heater EIecVic Heating
Apt. euilding Dryer Other (Specify)
Comm./Intlustrial Furnace
Farm Air Conditioner
Otber?syecdy7 ConVactor5 Remarks
Compute Inspechon Fee Below
k Other Fee # Service EnlranceSize Fee # Circutls/Feetlers Fee
Swimming Pool 0 ta 200 Amps ? 0 to 100 Amps
Transformers Above 200 _ Amps 0_ Amps
S19f15 Inspxtor's Use Onty / TOTAL
Irngation 8ooms (OpZ'? ?'rO
Special Inspec6on
AlarmlCommunicahon THIS INSTALLATION MAY BE ORD ED OISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONTHS.
I, ihe Electncal Inspecror, hereby AO°9i -- oare
certify thal the above inspection has
been made.
Ci. 6 v ''Q
OFFICE USE ONLV
Tbis reQUest wid 18 monlns imm
Ns7s33
ReQueslOeta rt9 No . ? Vi bili g?dn Inpsetlian Repwr
au musl wll insp w when reaEy) 1 Ina ecbon Other Than RougM1-ln
30 qeatly Now ? W dI Nallly lnspector
? Yes Na DateReatly
Ilkicensed contractor 0 owner hereby request mspection of above eleancal work at:
JoE Atltlress ?SVeet Box o me No i Qty
?
Secoon No Town5hi0 Name or No Renge No CouMy
OccuOantIPRINTI
-771-AZ Amel CC Ph/o?ne N.
Powar
su
POh r Aatlrass
r
?
N
Eleclncal onhaclor ICOm any Name, ConVacior5 L¢ense No
X11 ???'?f
Mailing AEtlress IGonirdctor, or r M/g?1 nq In tallauon)
?J?i??
AutM1or iqn re IConbacbr:Owner Ins? IlaUOn) PhOpe NumDer
?
7y (?
MINNESOTA STATE BOARD OF ELECTRICITY THIS INSPECTION REQEION LL NOT
Grlggs-Mltlway BIUg. - P.Q. 5-173 ?j BE ACCEPTED BV THE OARD
1821 Univenity pve., SL Paul. MN 55100 UNLESS PROPER FEE I $
Phom (612) 11,12-08,00 ENCLOSEO
/p? ? REQUEST FOR ELECTRICAL INSPECTION
,
? See ingvunions far complevng IDns lorm on back oi yeilow copy
"X° Belokv Work Covered by This Request
`?TME?A EB-00001-08
???• a9,;ri5
e Adtl Rep TypeofBuilding ApphancesWVetl EqwpmeniWVed
Home Range Temporary Service
Duplex Water Heater EleChiC Heating
Apt. Build?ng Dryer Load Management
Comm /Intluslnal Furnace Other (Specify)
Farm Air CondRioner
aher(specity) Comractor5 Remarks: .
Compute Inspection Fee Below: .
a Other Fee # ServweEmrence Srze Fee # Ciromts/Feeders Fee
i Swimming Pool 0 to 200 Amps 0 to 100 Amps
Transbrmers Above 200 _ Amps ov 700 Amps
Sigt15. mapemor3 Use Only:
l -dQ
i Irriganon Booms ? rC;-
Special Inspection ?J
AlarmlCommunicatwn THIS INSTALLATION MAY BE ORD ISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONTHS.
I, ihe Electrical Inspector, hereby
certify that the above inspection has
been made. R°uyn-,n
p,nai oa?a
oa?e
OFFICE USE JNLV
ihs reQUest witl 18 monIDS from
CERTIFICATION OF PURPOSE OF SECONDARY
YCITCHEN FACILITIES WITHIN SINGLE FAMiLY DWELLING
:S?5 W a`? fy?z)j?ec_, , duly swom and under oath, certify that:
I,
(Property Owner's Name)
1. I am the Owner of the one-family detached dwelling as defined in Section 11.03 of the Eagan City Code
locatedat qb?i(?, C a.rnb.e.-Y'w,e_1/\ -0Y'%qe M• ,E3?aYa YY1?
? (Strd Address)
? to-3a99a-eyA.
Ly,?3 E1r,lls '?' 5? ?.?n r ?d qe, 3 r`
and legally described as a
(Legal Description of Property
2. A building permit application has been submiried on my behalf to the City to enlarge, alter, improve,
remodel, and/or finish the above-referenced dwelling, or a portion thereof, to include the installation of
facilities for a secondary kitchen within the dwelling.
3. The secondary kitchen facilities to be installed under the building peanit aze for the sole purpose of
providing cooking and food service facilities for private entertainment of guests by the property owner
at the dwelling.
4. I acknowledge that the Eagan Zoning Code prohibits the existence of a second kitchen facility within a
dweUing unit to serve a complete, independent and secondary living or housekeeping use within the
dwelling. I certify that the installation of the secondary kitchen facilities under the huilding permit is
not for the purpose of providing a second complete, independent and sepazate living and/or
housekeeping unit within the dwelling.
Dated: A,;9` 2003 ?
Owner's Signature
Subscribed and sworn to before me this 13?day of , 20?3.
? '- II?I?F801
y Public ?g
I hereby verify that the above said Certification of Purpose of econ ary c en aci i ies rthin Sing(e
Family Dwelling was recorded at the County Recorder's Office on , 2003.
By:
Its:
THIS 1NSTRUMENT WAS DRAF'TED BY:
Ciry af Eagan
Communily IXvelopment Departmcnt
3830 Pilot Kno6 Road
Eegaf MN 55122
Planming/Fmms/Certiflcation of IGmhen Pacilidea
03
PLUMBING (RESIDENTIAL)
Permit Application
c?r City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5674
Please complete for: Single Family Dwellings
Townhomes and Condos when permits aze required for each unit
Date?/ d 3
r W 4L?- CC Q? IF"< ? U
Sit
Add
it #
e
ress
n
Property Owner Telephone # ( )
?- n
C 15?
Contractor
Address pc? `TCA. L City A§f/(.L+o ? (-f77
State Zip Telephone #(?J ?. ?lo ?? r3 4?d
The Appticant is _ Owner X- Contractor _ Other
Septic System New RefUfbished Submit 2 sets of plans and MPC license $ 100.00
Includes County fee. Addltional consultant fees may apply.
Alteratlons To Ezisting Dwelling Unit, Including $ SD.00
? Adding fxtures to lower levels or room additions, excluding water softener and water heater
_ Abandonment of septic system
_ Water turnaround (+ 518" meter if needed -$1-2?^1.00?)
??
?
?
Other:
-
'u
C? 1/L z
_ RPZ _ new installation _ repair _ rebuild $ 30.00
_ Lawn irrigation system
_ Water softener _ Water heater $ 15.00
_ replacement _ addidonal _
StateSurc6arge 1, ??? 21 ^^?-, i $ .50
Total $
By.__- ?
I hereby apply for a Residenrial Plumbing Permit and ac}mowledge that the informarion is complete and accurate; that the work will
be in conformance with the ordinances and codes of the Ciry of Eagan and with the Plumbing Codes; that I understand this is not a
permit, but only an applica6on for a pernut, and work is not to start without a permit; that the work will be in accordauce with the
approved plan in the case of work which requires a review and approval of plans.
Ckrif rJ J14 il
Applicant's Printed Name Applicant's Si
RESIDENTIAL
°C BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MIY 55122
651-687-4675
New ConstrucUon ReauircmeMa
• 3 rngistered site surveys shrnnng sq. R. of l04 sV. ft of house, and all roofed areas
(20% marimum lat coverage albwed)
. 2 copies of plan slawirg beam & window sizes; poured fouM design, etc.)
• 1 sM of Energy Calculatiom
• 3 coqes M Tree Presenation Plan'rf lot platted atter 711/93
• Rim Joist DeWil Optlons sNeGion sheet (bldgs with 3 ar less uni6s)
DATE IL ' S ' C'Z
SITE ADDRESS LI
TYPE OF
RemodellReoair ReauiremeMS ?
• 2 copies af plan ;
• 1 set of Energy Calculations Por heated additioris ,'a \
7 s0a survey for eztedor additions & decks v y
• Indicate'rf hane served by septlc system for additions r?,
?i
VALUATION ^!0??o
MULTI-FAMILY BIDG Y /N
FIREPLACE(S) ZO _ 1 _ 2
APPLICANT r'P?LAe-L
STREET ADDRESS ?LQ
TELEPHONE #U -qL0q_1_W CELL PHONE #LdZ 9Cafi'? /IL12,3 FAX # OSZ '-IC? ?4 _,-?9
PROPERTY OWNER Tm `? V07nL4 C'(?l1AL2G TELEPHONE#t6k `fSq (¢3J
COMPLETE FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNESOT:1 RULES 7670 CA'1'EGORY 1 MINNESOTA RUL.FS 7672
(d submission type) . ResidenUal VentilaUOn Category 1 Worksheet Submitted • New Energy Code Worksheet Submitted
• Energy Envelope CalculaUOns Submitted '
Plumbing Contraetor: Phone #
Plumbing system includes: _ Water Softener Iawn Sp ' fler" ee:--$90.00
Water Heater No. of R.I. afhs
No. of Baths Mechanicai Contractor. P ne #
Nlechanical sys[em includcs: _ Air Conditioning ?y Fce: 70.00
Hcat Recovery Sys[em
Sewer/Water Contractor: Phone #
I hereby acknowledge that I have read this appiication, state ihat the information is correct, and agree to comply
with all applicable State of Minnesota Statutes and City of Eagan rdinan e
Signoture of Applicar
_....._.._.....__.------°°'----------------__ -- -------------------°----_------- .------------------
OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updaled 4/02
OFFICE USE ONLY
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 OB-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 0 23 Porch (screened) ? 36 Multl
O 05 03-plex ? 11 10-plex ?9 19 LowerLevel ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
? 31 New 'p 35 Int Improvement 0 38 Demolish (Interior) ? 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alteratlon ? 37 Demolish (Bldg)` ? 43 Reroof ? 46 WindowslDoors
0 34 Replacement •Demolition (Entire Bldg only) - Give PCA handout to applicant
Valuation Occupancy MClES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bidgs Length Fire Sprinklered
Type of Const ?l Y1 Width
REQUIRED INSPECTIONS
_ Footings (new bldg) FuiaUC.O.
_ Footings (deck) FinaUNo C.O.
_ Footings (addition) Plumbing
_ Foundation ? HVAC
_ Drain Tile Other
Roof Ice & Water Final Pool Ftgs Air/Gas Tests Final
jV FraminB Siding Stucco Stone
Fireplace _ R.I. _ Air Test _ _
Final Windows (new/replacement)
? Insulation _
_ Retaining Wall
Approved By 2v 1 , Building Inspector
Base Fee
Surcharge
Plan Review
MGES SAC
City SAC
Water Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
Le,) c l -1?'??
Zc,N7f iz
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651-881-4875 "
xew Construct
• 3 regiffiered sile surveys showinp sq. fl. of bt, sq. R of house; and II roofed areas • 2 copies of plan
(20% mar'vnum bt everage albwed) • 1 set of Energy Cakuletbns for neatetl addltiona
• 2 coples of plen showug beam & window sizas; poured tountl design, etc.) • 1 afte survey for exierbr aGdllWns & decks
• 1 set of Energy Cakulations • Nkate tl nome serveG by septk system for addNOrls
• 3 copies of Tree PreServeNOn Plan tt bt pletled after 7/1/93 ,
• Rim Jolst Detall OptWns selection sheet (DkJgs wflh 3 or less untts)
DATE VALUATION (- (0 s-?b &-"-?
SITE ?ADpD?R?E y4 yv Gff/?9l3FRtJ?LL +/"/ mULTI-FAMILY BLDG _Y 1?N
oof FIREPLACE(S) 2? 0_ 1_ 2
NPE? WO *
APPLICANT 4&er'leal &,Io6i r,9 (°.?{?-AC?ars
STREET ADDRESS l 2 z y7 Ni rn //e it- Av r, S'o. CITY efir-i5vAe STATEd#-ZIP 55337
TELEPHONE M 952•7o7- 055 CELL PHONE #612• 9/%-/6 fl FAX # 9s'a-' 767 - 9479
PROPERTYOWNER lu-,xts /yJqlee- TELEPHONE# / S/-NS'/- G3o3
COMPLETE THIS SECTION FOR "MW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNFSOTA RULES 7670 CATEGORY 1 MINNFSOTA RULES 7672
(4 submission type) • RasideMial Ventila6on Category 1 Worksheet Submitted . New Energy Code Worksheet Submitte0
• Energy Envelope Cakailafions Submitted Plumbing ConfraCtor:
Plumbing system includes:
Mechanical Contraclor:
Mechanical system includes:
Sewer/Wafer Conhactor:
_ Air Conditioning
Heat Recovery System
Phone #
Phone #
Fee: $90.00
Fee: $70.00
I hereby acknowledge That I have read this appilcaTlon, state that ihe information is correcT, and agree to comply
with all applicable State of MinnesoTa Statutes and CiTy of Eagan Ordin ces.
SignafureofApplicanf ??
OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updaled 4I02
Phone #
_ Water Softener _ Iawn Spruikler
_ Water Heater ? No. of R.I. Baths
_ No. of Baths
??? RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EACAN
3830 PILOT KNOB RD, EAGAN MN 55722
851-881-4875
H9w Conatruction ReauiremeMs
• 3 teglslBred stte suneys showing sq. N. of bt, sq. tl. of Iwuse; and II roofea ereas
(20%ma)imum bt coverage albwed)
• 2 wples of plan showap beam 8 wintlow s¢es; poured fowA desgn, etc.)
• lsetotEnergyCalculatbne
• 3 coples af Tree Preservatbn Man il bt platted afler 7/7/93
• Rin ,bM DetaD Options selectbn sheet (bldgs wilh 9 or less wds)
DATE S?3o?6z
? ?? < ?Y_
RemodeVHeoatr HeauhemeMs
• 2caplesMplan
• lsetofEnergyCakulstionsforheatedaAAAlons
• tsitesurveyforexlerioraddilbns&Oecks
• IneN;ete tl home serveC by septic system for addMOns
VALUATION
SITE ADDRESS "/0 HD CAM(kRGUE[a )JR, I" MULTI-FAMILY BLDG _Y xN
TYPE OF WORK Sidt 7)gl 22;pIA r-rrzrn f' 4p4A.SF . FIREPLACE(S) Z 0_ 1_ 2
APPLICANT 02?jeri ca ? g?? 16pna C? n ?Yt9GTd YS
J?
STREET ADDRESS _/a1a N y/i/ico/%t Av e• cmr ]jvr„srillr STATE H/%/ ZIP SS 3377
TELEPHONE # 9SZ-7a7-lvYs9 CELL PHONE # FAX # 9 S? -"- 69416
PROPERTYOWNER Zzi'/rs I"IqlPe- TELEPHONE#k5/-4'1-4303
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNFSOTA RULES 7670 CATEGORY 1 MINNFSOTA RUL,ES 7672
(4 aubmission rype) • Residential Ventilation Category 1 WoAcsheet Submitted • New Energy Code Worksheet Submitted
• Energy Envebpe Calculations Submitted
Plumbing Conhactor. _
Plumbing system includes:
Mechanical Confracfor.
Mechanical system includes:
Sewer/Wafer Conhactor:
Water Softener _
_ Water Heater _
No. of Baths
Air Conditioning
Heat Recovery System
_ Phone #
Iawn Sprinkler
No. of R.I. Baths
Phone #
Fee: $90.00
Fee: $70.00
P,onekr ?
I hereby acknowledge that I have read ihis application, state that ihe informationlls correct, and agree To
wNh all applicable State of Minnesota Statutes and City of Eagan Ordinances. 113y -----
Signature of Appllcard ?G/h
...---...... -.... -...... _......... _._......... ..__._..r_r...??...
OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
- Updated M02
?o3?
CITY OF EAGAN
3830 PILOT RNOB ROAD
EAGAN, MN 55122
PHONE: (612) 454-8100
pG'wYIS`sAgg"
FOR CITY IISE ONLY
PERMIT
RECEIPT #
#
DATE:
PLEASE COMPLETE IIPPER PORTION ONLY FOR SINGLE ]
.>...,....._.. ?.< . ::..............
TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH IINIT.
WORK DESCRIPTION
NEW CONST _
ADD ON
REPAIR
OWNER NAME: 'I?j-IS%rIrA
SITE ADDRESS:L46-io l_I7(Ylbaf t a)o i .l Jf: n
? BLOCK o+ SUSD. /JjXV ? 3rcj
LOT:
INSTALLERC ADDRESS: FLARE HTG. St M/C, INC.
czzY: Goiden Valley, MN2§p27
PHONE #:_
FEES
Y DWELLINGS &
ADD-ON MINIMUM $15.00
fiVAC 0-100 M BTU 24.00
ADDITIONAL 50 M BTU 6.00
GAS OUTLETS - MINIMUM 3.00
OF 1 PER PERMIT
fl% SUBTOTAL: $gL?
STATE SURCHARGE: .50
TOTAL: $1 2 Z, 2-iO
S GNATURE D PE ITTE
?`',$ItC?t}Y.j?7?IISTKTA`!::' PLEASE COMPLETE THIS PORTION FOR ALL COMMEERCIAL/INDUSTRIAL BUILDINGS,
?..r?7MM?T,APARTMENT BUILDINGS, AND MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE
NOT REQUIRED FOR EACH DWELLING UNIT.
CONTRACT PRICE: FEES
OWNER NAME: _
SITE ADDRESS:
IAT: BLOCK _ SUBD.
INSTALLER:
ADDRESS:
CITY: ZIP:
PHONE #:
18 OF CONTRACT FEE.
STATE SURCHARGE - $.50 FOR
EACH $1,000 OF PERMIT FEE.
PROCESSED PIPING - $25.00
$25.00 MINIMUM FEE.
CONTRACT PRICE x 1%
STATE SURCHARGE
TOTAL:
$
$
(SIGNATURE)
FOR:
CITY OF EAGAN
,
PLEASE COMI'LETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMES AND
CONDOS WHEN PERMITS AAE AEQUIRED FOR EACH UNTf.
NEW CONSTRUCfIaN
? ADD-ON A/C
ADD-ON FURNACE
FIREPLACE INSERT
DATE ?s -"*;; ?, --- C \,? ?
FEE
HVAC: 0.100 M BTU $ 24.00
ADDITIONAL 50 M BTU 6.00
GAS OUTLETS (MINIMUM 1 @ $3.00 EACH)
ADD-ON/REMODEL (ExISTIlVG CoNSTRUGTioN) $ 20.00
STATE SURCHARGE .50
TOTAL '_SQ?
SITE ADDRESS•?"_-:?r-\` "?L
OWNER NAME: ?----• TELEPHONE #:y`y-?
TELEPHONE #: f?'?cs-'`?,
-?-y-?Y
1994 MECHANICAL PERMIT (RE$IDENTTAI.)
CITY OF EAGAN
3830' PILOT KNOB RD
EAGAN MN 55122
(612) 681-4675
CTTY: STATE: ZIP CODE:
CITY OF EAGAN
3830 PILOT KNOB ROAD
EAGAN, MN 55122
PHONE: (612) 454-8100
?w
w-ga
FOR CITY USE ONLY
PERMIT #
RECEIPT # ?C7 S
DATE:
PLEASE COMPLETE UPPER PORTION DNLY FOR SINGLE FAMILY DWELLINGS &
TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
WORK DESCRIPTION
NEW CONST
ADD ON _
REPAIR _
OWNER NAME:
SITE ADDRESS: yo`411 ?8,/1_ ti
?r?
LOT:? BLOCK ? SUBD. d
INSTALLER: y
ADDRESS:
CITY: 30Jn ? 2IP: SS 3 S>
PHONE #
S
---------- --------------------
COMPLETE THE FOLLOWING:
N0. FIXTURES EA. TOTAL
ADD-ON MINIMUM 15.00
? SHOWER 3.00 :
3 WATER CIASET 3.00 1_
BATH TUB 3.00 C?
LAVATORY 3.00 ? KITCHEN SINK 3.00 3_
I LAUNDRY TRAY 3.00 3
HOT TUB/SPA 3.00
? WATER HEATER 3.00 :1
t FIAOR DRAIN 3.00 3
GAS PIPING DUT.
? (MINIMUM - 1) 3.00 ;
? ROUGH OPENINGS 1.50 `1.Cj
_ OTHER
WATER SOFTENER 5.00
_ PRIVATE DISP. 15.00
U.G. SPRINKLER 3.00
SIIBTOTAL S LA 6D S ?
ST. SURCHARGE .50
TOTAL: s ?l?
it?L: PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS AND
?t?lSMEI?CS4?LF?T??ST? .
MULTI-FAMILY BUILDINGS WHEN SEPARATE PE1tMITS ARE NOT REQUIRED FOR EACN
DWELLING UNIT.
CONTRACT PRICE:
OWNER NAME:
SITE ADDRESS:
LOT: BLOCK _ SUBD.
INSTALLER:
ADDRESS:
CITY:
PHONE
FOR:
CITY OF EAGAN
ZIP:
FEES
1% OF CONTRACT FEE.
STATE SURCHARGE -.$.50 FOR
EACH $1,000 OF PERMIT FEE.
$25.00 MINIMUM FEE.
CONTRACT PRICE x 1$ $_
STATE SURCHARGE $_
TOTAL:
(SIGNATURE)
1991 BIII LDIN-?G PERMIT APPLICATION
CITY OF EAGAN
SINGLE FAMILY DWELLINGS
M[JLTIPLE DWELLINGS
c 9L
COMMERCIAL
2 SETS OF PIANS 2 SETS OF PIANS 2 SETS OF ARCHITECTURAL
3 REGISTERED SITE SURVEYS REGISTERED SITE SURVEYS - & STRUCTURAL PIANS
1 SET OF ENERGY CALCULATIONS (CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFICATIONS
1 SET OF ENERGY CALCULATIONS 1 SET OF ENERGY CALCS
_# OF RENTAL UNITS
# OF FOR SALE UNITS
PENALTY APPLIES WHEN: TYPING OF FERMIT IS REQUESTED, BUT NOT PICKED UP BY IAST WORKING DAY
OF MONTH IN WHICH REQUEST IS MADE.
• IAT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED.
NOTE: ADDRESSES FOR CORNER IATS - CONTRACTOR/HOMEOWNER MUST DESI
DESIRED. NO CHANGES WILL BE ALLOWED ONCE_$UILDING PERMIT
PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DAYS ONCE
PERMIT MUST SHOW A LICENSED PLUMBER.
To Be Used For:-5,61rjF ?/z.y Valuation:-JjNjEjZ: Date: --
Site Address tb4{p 4pyl2Er- ? q::p.,(1 OFFICE USE ONLY
?
Lot 4 Block -2-
Parcel/Sub f{iu-,
?, cf= -? ?
Owner -THE ?g2T-rc_.c? Ls. Il-1G.
Address c?c9/ E. 12?u? Esagp
City/Zip Code _?:-y-yzcey. SrcJ2)
Phone
Contractor
Address
City/Z
Phone
Arch./
Addres
City/Z
Yhone #
occupancy -3 M-)
2oning pD ft-I
Actual Const V-N
Allowable V-N
# of stories
Length 58,
-
Depth 3T
S.F. Total
Footprint S.F.
On site sewage_
On site well
MWCC System ?
City water
PRV
Booster Pump _
APPROVALS
Planner _
Council
Bldg. Off. -9-91 DS,
Variance
FEES
Bldg. Permit 809,00
Surcharge 74,oo
Plan Review 525,0.
SAC, City /bD,DO
SAC, MWCC ,Oo
Water Conn. 660,0?
Water Meter S,oo
Acct. Deposit 3D.00
S/w Permit o,oo
S/W Surcharge .SD
Treatment P1. Q ,0 0
Road Unit 99D. Do
Park Ded.
Trail Ded.
Copies
SUBTOTAL
Penalty
Lot Change
TOTAL -3177.
???? c ?? agrees that all work shall be done in accordance with
(Signare of Contractor)
all applicable State of Minnesota Statutes and City of Eagan Ordinances.
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Pioneer En9lneerin9 6819488 r.a?
2422 EntorMise O'ive
* PtO1VEER ..wnow"Crows.CIvnv?ur??o Mefldota Nvi¢irts, MN 5512p
englncarin ?nu?or?uucns.?nrvoacwrcw?tw?er?s
* * s? (612) 681.1914
Certifcate ol5urvey for: l 171. P V 7 i G tlAl/ 0•
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f gae.on Denofa Fxrstinl flevatiars PIXTPCSFD /ibGeSE ELfYATlONS
• o?o? Derades Anpased Fletratrnns Cowrst Akvr E/evatiorr 8235. -7?p
- ----- -- t?rnrr}es !7? e€'(Jtdilg Eosenzenf l??a a?"BloeJr E/pvnfr'arr 593. Sto
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LDT 4 , BL4C41 3 ,Hil Lic 4F ST4NEBR1 DGf 3PD ADD.
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I hmbr esrNTy MmQ ehh survey, pbn w rmort w9s prepa?di bv nvr et f"y dkftt w0ervfsfOn and thnt I am duly RpyzW@d Land Suevey0r
unQer dtv lorvt o[ Shs Strta ot Min?ate. DJ1Ed dyis-214 AbY of A.Q. ---79 ?.
pcxAV_hl B.S+KIC?+l.S.REC•, 17.1?e9]
p?Or?7 S?Gf?1I. 11?: /!7 fiU
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tx7'F.RTOIi F:NVF.iAi•t: nvi:t;ncr: "u" cOtitru•rnT10:1
. ?.
owr+ER
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SITE ADD;;ESS ?..oT ?4 awaK 3 Hlc.c.5 0?= ?1GaaiR7QlDbt >.!°,/
CONTRACTOR P-0 rTL (hN0 GL?. DATF. Pi{ONE
NOjEM f}NDY
Detenain vorkinf; squnre Yootv;e o!' ench.
1. Total exposed vail area .. 25 1-'; - 1? sR. ft. x 0.11 _
2. Total roof/ceiling area .. I )7 q•:57 sq. tt. x 6.026 _ TO -.6 4?0
Total exposed vail area nbovc floor = Z 5-4 ? ' Z
c
a. Total wall window area . ........................ /rD4, 2 .
t. Total door area .... ......... ............ .......... lo.?'r2
c. Total sliding glnss door area ........... .......... -?
d. Total fireplece vall area ... ............
2 G
..........
e. Total vall frzming area (average lOP) ... .......... ?.I0• -77
f. Total net wall area above floor ......... .......... /$ ° 7,0/
?
. g. Total rim joist area ........ ........ . ..........
•2 2a,A,
Total exposed frn:ndation araa
h. Total foundetion windou area .............. .......... 7 5
i. Total net fouzdation area hbove grade ... .......... ,!i•i
. Determine "U" value o; each vall :,e Fment.
8 154.2 x„?„ p,Er2 _ 77,34
.
b ?Co, ¢Z z 0.138 - 7.78
.
' • C. -- x --
d. X„u„
.e,U,, O.?Sq = l$.?'15
e. X
r 6?97,at X „U,. a43 = . 8-1.57 ?
. .
2 2? , p ,.i,,, o, 04 ! ?_ `f.o 5
. g. X
h ???' ,, 7,y' .OU,. Dr=r!0 7. Zt
. X
6 5-
„
„
; U
X
3. ...... .............. ......... .. . Cor.a] - 2?7?'I'
t
'
IP ite m d3 i s the same as, or less Lti:,n itcci Ml xr met the inten
,
or sac 6006(c)2
f,
. . ?p ?
Total exposed roof/ceilina ++=e1
*A . ? . .. . . --
Total gross roof/ceilinp, are:i =
. . ' J. Total skylight area .......................... _ ?+ 5
k. Total roof/ceiling framing area.•••••••••••• "
1. Total net insulated roof/ceiling area ........ C?/ G/? S_ •
Determine "U" value for cach ruof/ccilini: seEment.
?
X 'lUii ?_--L----
?•
k; X „U„ ---
?. z„U„
u . ............ , ................:. Total
• ? r?
If total oP N4 is the same as, or less than N2, you have met ttke intent of
sac 6oo6(c)i. . .
To utilize the total envelope system method, the values establi_hed by the
sum of iteos M3 e.ad #L shall not be greater. thxn the sum ot iten,s Nl ead N2.
1. ± 2.
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- -o,co2
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? ?= 24;35.-- I
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RESIDENTIAL BUILDING
;7D _C0
Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5674
New Construction Reauirements RemadeUReoeir Reauirements Office Use OnN
3 regateied site surveys showirg sq. fl. of lot, sq. ft. of house; and all roofed areas 2 copies of plan _ Cert of Survey Recd
(20°h maximum lot coverage allowed) 1 sei of Energy CalculaUOns (or heated addifions Tree Pres Plan Recd
2 copies of plan showiig beam & window sizes; poured (ound design, etc. 1 site survey for additions & decks Tree Pres Nol Reqd
1 set of Energy Calalations AddPo'on - mdicefe Monade sepGc system _ Onsite Sepfic System
3 copies of Tree P2senation Plan if lot pladed afler 711193
Rim Joisl Defail Options selection sheet (bldgs wBh 3 or less units
Date /e7-a_ /0&
site address _VDzfD G'4m.ho rt,e Construction Cost SQ D
!/ AV /) un• teAU6 2 4 2006
? ?
Description of Work .?l?Y1$
/Q ! O-
Multi=Family Bldg _ Y_X N Fireplace(s) _ 0 V?'2
Property Owner __?hq'65 Aa l`ee- Telephone # ys?{ '"6303
Contractor C-76,0^0 ap-
Address ?()D El(6ranolp
State rVI N
Zip 3?- City YC?Q
Telephone#(95?-)
COMPLETE THIS AREA ONLY IF
Energy Code Category - Minnesota Rules 7670 Cateeorv 1
• Residential Ventllation Category 7 Worksheet
(dsubmissiontype) Submitted
• Energy Envelope Calalations Submitted
Licensed Piumber
Mechanical Contractor
Sewer/Water Contractor
A NEW BUILDING
Minnesota Rules 7672
• New Energy Code Worksheet
Submitted
Telephone #(
Telephone # ( J
Telephone # (
I hereby apply for a Residential Building Pernut 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 pernut, but only an application for a permit, and work is not to start without a
pernut; that the work will be in accordance with the approved plan in the case/ work which requires a review and
approval ofplans.
`T?-Yr SG?i ?r?lC ?-
Applicant's Printed Name pplican t's ignature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA136148
Date Issued:04/27/2016
Permit Category:ePermit
Site Address: 4040 Camberwell Dr N
Lot:4 Block: 3 Addition: Hills Of Stonebridge 3rd
PID:10-32992-03-040
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:Two or More Windows/Doors
Census Code:434 -
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: 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 -
James W Malec
4040 Camberwell Dr N
Eagan MN 55122
(612) 605-4627
Snap Construction
8200 Humboldt Ave S, Suite 120
Bloomington MN 55431
(612) 333-7627
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA142370
Date Issued:04/28/2017
Permit Category:ePermit
Site Address: 4040 Camberwell Dr N
Lot:4 Block: 3 Addition: Hills Of Stonebridge 3rd
PID:10-32992-03-040
Use:
Description:
Sub Type:Residential
Work Type:Alteration
Description:Fixtures
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Fee Summary:PL - Permit Fee (miscellaneous)$59.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
James W Malec
4040 Camberwell Dr N
Eagan MN 55122
(612) 605-4627
Jake The Plumber
255 Roselawn Ave E, #43
St Paul MN 55117
(651) 212-5253
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA144716
Date Issued:08/07/2017
Permit Category:ePermit
Site Address: 4040 Camberwell Dr N
Lot:4 Block: 3 Addition: Hills Of Stonebridge 3rd
PID:10-32992-03-040
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener).
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
James W Malec
4040 Camberwell Dr N
Eagan MN 55122
Tony's Appliance
2090 County Road 42 West
Burnsville MN 55337
(952) 435-2442
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA168726
Date Issued:04/30/2021
Permit Category:ePermit
Site Address: 4040 Camberwell Dr N
Lot:4 Block: 3 Addition: Hills Of Stonebridge 3rd
PID:10-32992-03-040
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 -
James W & Catherine Malec
4040 Camberwell Dr
Saint Paul MN 55123--391
Pella Northland
15300 25th Ave N #100
Plymouth MN 55447
(763) 745-1400
Applicant/Permitee: Signature Issued By: Signature