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4390 Bent Tree Lane Use BLUE or BLACK Ink -For Office Use I • i Permit City Eakan I Permit Fee: y I 3830 Pilot Knob Road i 1 Eagan MN 65122 Date Received: Phone: (651) 676-5675 ~ staff: j Fax: (651) 675-5694 2011 21311 RESIDENTIAL PLUMBING PERMIT PPUCATION Date: 4,//? Site Address: Tenant: Suite : RESIDENT ! OWNER Name: L° ~t I a M 4'A Phone: Address t C4 Zip` 1,0 4 771 1^~P CQ,hTRACTOR Name: rq License Mfr r Address: 1e~ tt ' r~.:_ city: e, State: r'V Zip: j3 Phone: / Contact:+ Email; .1A'~si, f d TYPE OF WORK New Replacement _Repair _Rebuild _ Modify Space - Work in R.O.W. Descri tion of work: PERMIT TYPE RESIDENTIAL Water Heater f _ Water Softener Lawn Irrigation RPZ / B) Add Plumbing Factures Main) _ Lower Level) _ Septic System Water Turnaround New Abandonment RESIDENTIAL FEES: $55.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge) $35.00 Lawn Irrigation (includes $5.00 State Surcharge) $55.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnarounds (includes $5.00 State Surcharge) *Water Turnaround (add $166.00 if a 5l8" meters required) $905.00 Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge) $35.00 Fire Repair (replace burned out appliances, ductwork; etc.) (includes $5♦00 State Surcharge) I fl rr TOTAL FEES CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection acaf~ ' underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. I hereby acknowledge that this information is complete and ac curate. 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 applicat:m fora permit, and work is not to start witriout a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. x "'n 4Y Appiicant's Printed Name Ap icant's Signature FOR OFFICE USE Reviewed By: Date: Required Inspections: -Under Ground _Rough-In Air Test Gas Test Final PERMIT City of Eagan Permit Type: Mechanical 3830 Pilot Knob Rd Permit Number: EA085404 Eagan, MN 55122 . Date Issued: 08/20/2008 (651) 675-5675~~~ EPermit Category: ePermit www.ci.eagan.mn.us lflflUl tflflLLL Site Address: 4390 Bent Tree Lane Lot: 3 Block: 2 Addition: Autumn Ridge 02nd PID 10-12301-030-02 Use Description: Sub Type: e - Furnace & Air Conditioner Work Type: New Description: Furnace & Air Conditioner Comments: Questions regarding electrical permit requirements should be directed to Mark Anderson, State Electrical Inspector, 952-445-2840. Permit expired without required inspections. 6/10/09 CE Fee Summary: ME - Permit Fee (Replacements) $50.00 0801.4088 Surcharge-Fixed $0.50 9001.2195 Total: $50.50 Contractor: -Applicant - Owner: Boldt, Bob Ghislain Devlaminck 4310 Trenton Tr 4390 Bent Tree Lane Eagan MN 55123 Eagan MN 55123-3053 (651) 454-7760 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 - la J 3 ~o f?equest Date Fite 1146. Rough-in Inspection Required? ❑ Ready Now ill Notify Inspector r es C No When Ready? ~ensed contractor ❑ owner hereby request inspection of above electrical work at: Job Address (Street. Box or Route ) City Section No. Township Name or No. Range No. County Occupant (PRINT) Phone No. Power pplier Address jElectr Contractor (Company N me) Contract s License No. Mailing Address (Contractor or Owner Making Installatio ) Authorized Sign ure (Contractor/Owner Making Installation) Phone Number MINNESOTA STATE BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT Griggs-Midway Bldg. - Room S-173 BE ACCEPTED BY THE STATE BOARD 1821 University Ave., St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS Phone (612) 642-0800 ENCLOSED. REQUEST FOR ELECTRICAL INSPECTION a 'F EB-00001-08 65399 `See instructions for completing this form on back of yellow copy. /J X" $elow Vbdrk Covered by This Request e Add Rep. - Type of Building Appliances Wired Equipment Wired Home Range Temporary Service Duplex Water Heater Electric Heating Apt. Building Dryer Other (Specify) 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 11 0 to 100 Amps Transformers Above 200 Amps Above 100 Amps Signs Inspector's Use Only: TOTAL R~ Irrigation Booms Special Inspection Alarm/Communication THIS INSTALLATION MAY BE OR"111 D DISCONNECTED IF NOT Other Fee A'' COMPLETED WITHIN 18 M0fiWFS. I, the Electrical Inspector, hereby Rough-in Date G. certify that the above inspection has Final Date been made. OFFICE USE ONLY This request void 18 months from / `moo Requ st Date Fir No. Rough-in Inspection G' Req,red? ❑ Ready Now ill Notify Inspector / es No hen Ready? I ❑ licensed contractor owner hereby request inspection of above electrical work at: Job Address (Street oute No.3 City W.g qQ l e ht- l re e kA Section No. Township Name or No. Range No. County Occu nt(PRINT) Phone No. - /`s /q /Yl 1< Power Supplier Address Electrical Contra for (Company Name) Contractor's License No. -A Ile- 4W17eK Mailing A ress (C ntractor or Owner Making Installation) Authorized Si nature (Con ctov0wner Ma g Installation) Phone Number MINNESOTA STATE BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT Griggs-Midway Bldg. - Room S-173 BE ACCEPTED BY THE STATE BOARD 1821 University Ave., St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS Phone (612) 642-0800 ENCLOSED. REQUEST FOR ELECTRICAL INSPECTIONS EB-00001-08 ► See instructions for completing this form on back of yellow copy. ~ V, `X" Below Work Covered by This Request L X9881 New A Rep: Type of Building Appliances Wired Equipment Wired Home Range Temporary Service Duplex Water Heater Electric Heating Apt. Building Dryer Other(Specify) Comm./Industrial Furnace Farm Air Conditioner Other (specify) Contractor's Remarks: T, I Compute Inspection Fee Below: I # Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee Swimming Pool 0 to 200 Amps 0 to 100 Amps Transformers Above 200 Amps Above 100 Amps Signs Inspector's Use Only: TOTAL _ Irrigation Booms trd Special Inspection Alarm/Communication THIS INSTALLATION MAY B 04DERED I~CONNECTED IF NOT Other Fee COMPLETED WITHIN 1 THS 4,. AN I, the Electrical Inspector, hereby Rough-in at certify that the above inspection has Final e been made. OFFICE USE ONLY This request void 18 months from I a o 0 CTION,RECORD, P*m* Nu~ am PRO Knob Awd, #AWwimxft t 56123 Deft Wated* (612) 2!14675 ` :"Aut"o *106 2" ~ felt) *94 WORT r 16 --woo - - i r' KVAC 9#7 1 40- s FWft ftuo . ' f.~+.i x-1'1--~/' p "w S11 / -r r CordL MOW i ► DO& pv. WON Pr. CND. (gerfiftratr of (orrupaur citp of . Cagan Mrpnrbund of Wadb o Jmppntinn This Cer#ficate issued pursuant to the requirements of Section 306 of the Uniform Building Code certifying that at the time of issuance this structure was in compliance with the various ordinances of the City regulating building construction or use. For the following. 11w ck~wfi ation SF DWG Bldg. Hamk No. 904 O-Pa-Y 7hx R- 3 M--1 zooing District R-1 Type C . V-N OW=ofwMing KEYLAND HOMES Am. 14450 BURNSVILLE PKWY - Wilding Add= 4390 BENT TREE LN Locat,L3. B2. AUTUMN RIDGE 2ND AUGUST 28s, 199-2 Buading dffkw POST IN A CONSPICUOUS PLACE ` Address: 4390 BENT TREE LN Lot 3 Blk 2 Sec/Sub AUTUMN RIDGE 2ND These items were/were not complete at the time of the final inspection. Date: AUGUST 28, 1992 Yes No Final grade (6" from siding) ,~rr Permanent steps - garageV Permanent steps - main entry i~ Permanent driveway Permanent gas /r Sod/seeded grass Trail/curb damage 1J~ Porch L~ 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. 4 White - City copy Yellow - Resident copy Pink,- Contractor copy K maw" i PERMIT Control No. 0700 f _ s CITY OF EAGAN 3830 Pilot Knob Road PERMIT TYPE: BUILDING Eagan, Minnesota 55123 Permit Number: 000904 (612) 681-4675 Date Issued: 06/24/92 SITE ADDRESS: 4390 BENT TREE LANE LOT: 3 BLOCK: 2 AUTUMN RIDGE 2ND DESCRIPTION: Building Permit Type SF DWG Building Work Type NEW UBC Occupancy R-3 M-1 Ar Construction Type VN Zoning R-1 Building Length 54 Building Width 39 REMARKS: RECEIPT 0 PRV SSW PLBR - D.C. MECH. FEE SUMMARY VALUATION $133,000 Base Fee $755.00 MISC FEES 1 610.50 Plan Review $490.75 Total Fee $3,622.75 Surcharge $66.50 SAC $700.00 SAC % 100 SAC Units 1 Subtotal $2,012.25 CONTRACTOR: - Applicant - ST. LICOWNER: KEYLAND HOMES 18942636 0001553 KEYLAND HOMES 14450 BURNSVILLE PKWY 14450 BURNSVILLE PKWY BURNSVILLE MN 55337 BURNSVILLE MN 55337 (612) 894-2636 (612)894-2636 I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Mn. Statutes',,~nd City of Eagan Ordinances. 4T/F(ERIA E ITE SIGNATUR ISSUED Y: IGNAT RE PERMIT # CITY OF EAGAN a. w~ S 1992 BUILDING PERMIT APPLICATION 681-4675 JUN I SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy calcs. COMMERCIAL 2 sets of architectural.& structural plans,~l set of specifications, 1 copy of energy calcs. Penalty applies when typing of permit is requested, but not picked up by last working day of month in which request is made or lot change is reg uested once ermit is issued. D to J L)s.1ir_- Valuation of work ~O ~4cx~ b ` Site Address 9Xx eshl:r :rrz L.AQr- STREET STE Tenant Name: (commercial only) I LOT BLOCK SUED. ALrr~1MIa Vi pe-,s P.I .D. it 2''-° Zvi " Description of work: The applicant is: El Owner Contractor O Other (Describe) Name Phone Property LAST FIRST Owner Address STREET STE 9 City State Zip Company Phone z4d%e Contractor Address 1*=_-:x slur F P11, Y License # 155 Exp.,L91 City 5021"',v I4Le State M t--~ Zip G6?i _ Company Phone Architect) Engineer Name Registration # Address City State Zip Sewer & water licensed plumber M &Ikca"W_AL_ Processing time for sewer & water permits is two days once area has been approved. I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all-appli abl State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant: OFFICE USE ONLY } BUILDING PERMIT TYPE i ❑ 01 Foundation ❑ 05 Apt. Bldg ❑ 09 Basement Finish ❑ 13 Comm/Ind New 13~02 SF Dwg. Q 06 Garage/Accessory ❑ 10 Swim Pool ❑ 14 Comm/Ind Add ❑ 03 Two family ❑ 07 Fireplace ❑ 11 Res. Add. ❑ 15 Comm/Ind Rem ❑ 04 Multi-fam. T.H. 0 08 Deck ❑ 12 Res. Porch ❑ 16 Public Fac. ❑ 17 Agricultural WORK TYPE W31 New ❑ 33 Alterations ❑ 35 Move ❑ 32 Addition ❑ 34 Tenant Finish ❑ 36 Demolish GENERAL INFORMATION _ Const. (Actual V- Basement sq. ft. MWCC System Ye S (A owable) v-r~ - 1st F1. sq. ft. City Water T- UBC Occupancy 2nd F1. sq. ft. PRV Required Nes Zoning Sq. Ft. total Booster Pump # of Stories Footprint Sq. ft. Fire Sprinkler Length sy, On-site well Census Code /0 1 Depth 35 , On-site sewage SAC Codel APPROVALS Planning Building Assessments Engineering Variance REQUIRED INSPECTIONS Site D Footing Framing ❑ Insulation ❑ Wallboard 12 Final ❑ Draintile ❑ Fireplace Permit Fee x155, 00 valuation: $S. Surcharge 6,!o CAP-; Plan Review 9- a 75 License <48~ MWCC SAC `7D0, y a City SAC ton, cap 6 Le K 1 e = )'01 014 Water Conn. fo75,ov SPrtT Water Meter 9S) oo X~6 = '?Z8 Acct. Deposit 30,oo S/W Permit 3 0, oo 0~z ~ 12 yo S/W Surcharge Treatment P1. 300,00 Road Unit 390,00 16 t(a ,t /6- 15 Zty© Park Ded. 'trails Ded. 15T ~Looy'Q_ Copies Other ~T f q 7 G. x Total: SAC, % ln(2 X 53 , $ SAC Units _ I Fwtir 4? Y,,) G 77 113 401 U xn~'e ~n .10 Pioneer Engineering 6819488 P-02 2422 EnRerprlse Drive * . Mendota Heights, MN 55124 y P=iyrzER LAND suRVEYORS • CIVIL ENGINEERS (612 681-1914•Fvx 681--9488 er g n43arjr'~g LAND PLANNERS + LANDSCAPE ARCHITECTS 625 HtghWgy 10 NOrthegSt * ~w► Bloin. MN 55434 •k * ~ {612)e 783-1680*Fox 783-1883 C. Certificate of Survey for: K e, l a n d D eyel OD m en t, In Douse Address: Bent Tree Lane, Eagan, MN I I I S 89'41'28" W 25 1 25 I 52.2 125.00 X952. 30.00 39.00 - - - - I I - c- - 1.5 CANT. - - I rv I I W I 1 ~NI I 1 ~ I I I~ ~ I~ I 1 < I 1 pq J J 0.00 2.57 1 ( CSD N o Q p I 1 I O CA J w > L J ! r y > 00 4:1. 1 L>_i J (1 M I i1J ` t s 27.77 0 _ { M J I`~ I 1 15 ( 1 I I J 1 m l .f I ~ I I I 1 i { l_' M L39. I ~ >r=19.25 I ~ ~ 952. °~f ` f' l r- r•'~ r~ 1 .p p 413.Q1 r o I 0 0~s6h n f elm H Al ;KM a.1 . _r x 900.a `-'Derr 4#es Existing Eievdt~on PROPOSED HOUSE ELEVATION x <9079x Denotes Proposed Elevation Lowest Floor Elevation:946.75 Denotes Drainage & Utility Easement Denotes Drainage Flow Direction Top of Block Elevation: 954.86 ---o-- Denotes Monument Garage Slab Elevation: 954.53 --9 Denotes Offset Hub Bearings shown are assumed LOT 3 BLOCK 2 AUTUMN RIDGE DAKOTA COUNTY, MINNESOTA 2ND ' A D D I TI a N 1 hereby certify that this survey, plan or report was prepared by me or under my direct supervision and that 1 am duly Registered Land Surveyor under the laws of the State of Minnesota. Dated this 5ky day of 0 04G, -A.D. 191n~. Scale. 1 inch=30feet R06ER 6, 5 I L,S. REG. NO. 14891 ® 92233.00 EXTERIOR ENVELOPE AVERAGE "U"__COMPIITATION_ ' DnT(: Co -10 - ct2 OWNER: e~T t,a~K ~crt l~ ► J~~7Lp - SITE ADDRESS: tT <1 sr La PHONE: CJ9CONTRACTOR: PLAN # .Determine working square footage of each 1. Total exposed wall, area..... Z~S 15r`(S- sq. -ft. x .11 309,toq 2. Total roof/ceiling area _ 10-1 q sq. ft. x .026 = Z~ ~S Z Total exposed wall area above.floor=,Z`A 3~1 ~y a. Total wall window area 13 b." Total door area 3 % c. Total sliding glass door area 3 Z~ d. Total fireplace wall area 7- 11 e. Total wall framing area (average 10%) f. Total rim joist area 3o ~ g. net wall area above floor Zl~li~c~ h. wall area above floor. i. wall area above floor - j. frame wall area at ion:ndat?on p~ta~o Total exposed foundation area=____]_( k. '.Total foundation window area I.- Total net foundation area above grade "71M Determine "u" value of each wall segment _ (e.g. window, door, each separate wall section) a. 138,`j X llull b. X „u„ 1.3 Z- = ~P d. X 14Ull _ e. X lidll o~ = oL f, o y 31 X U~~ g. Z1q (,b3 X ItU11_ p = h X It U ll i X ll U ll If item r'3 is the k. 6,Z-G X "U" as, or less than i - xl, you have met ty 1. -71 y X 1.1U11 intent of SBC 6006 3. .................................Total = ~.'S"rLlZi Total exposed roof/ceiling area Total skylight area n. Total roo_`/ceiling•framing area (average 10%): ~~~<<} o. Total net insulated roof/ceiling area. Determine "U" value for each roof/ceiling segment n. X "U., 0. 11 COIA tu_ X "lull 13 Total tonal c i s the same as, or less than ##2, you have met the. intent of S:3C 5005 ,C) 1. Alternate Building Envelope Design To L'.ti.li Z.e the total envelope 'system method, the values established by the s:zrt of items ;3 a-nd -4 shall not be greater than the sum 0f items #1 and '2. r~ 1.,0►C9 l + 2. Z7,9 7- -37, Co i ROOF-CEILING CONSTRUCTION R-VAU.F- 1. IN'T'ERIOR AIR FILM 0.61 J 2. 5/ . 3. IMUgTTTN • ~ c TOTAL VENT U = .02 ti FRAME i 1. INTERIOR AIR FILM 0.'61 VD= NEAT FLYO 2. 'Lip i 1 I 3. X - 111---~~1 4. FIG. #5 U = 0.024 CONSTRUCTION INSIDE AIR FILM 0.61 3. ' 4. . - - FRAME 1. INSIDE AIR FILM 0.61 l j ¢ 2 kEAT FLOW UP VENTED 3. 4. • 5 • OUT FIG. #6 U = 1, INSIDE AIR FILM 0.61 3 4 5 2. 3. _ , , . • ; ' f ~ 5. TOTAL NOTE: USE ADDITIONAL SHEETS IF _ MORE SPACE IS NON-VEN'T'ED NEEDED FOR DETAILS AND CAL~tILATIONS- HEAT FLOW UP FIG. #7 WoU- SfC N uL e.1 5% Of opaque wn l 1 arm ft)r A-ame ccx~str~tC~ inn R- VAIITE CONSTRUCTION•=- FRAMING ~ 1. INTERIOR AIR FILM 0.68 2. 2 D .4 3. 5 1/2" SOFT WOOD 6.87 4• ~.~giUtzS.ltATrI~~W► ti*~Su~1 5• 5, SIDING .159 BASIC 6. EXTERIOR AIR FILM 0.17 WA t..L_ TOTAL R= J . c9 U= -FIG. #1 '(UPV EvJ cF PRAII1 WALL NET 1. INTERIOR AIR FILM 0.68 2,. i2 GYPBD .45 ! 3. 4. ?14' ~tvtt~ CwSui,l 5.4 5. S ING .62 ' 6. R AIR FILM 0.17 3 TOTAL d~•-3a ~ U- .ay 1. INTERIOR AIR FILM 0.68 2. 6 INSUL. 19.00 3. x R - JOIST 9 -7\ 4. 4 5. SIDING .62 ® 6. EXTERIOR AIR FI 7 a U- a4 2 O ♦t / BLOCK WALL t • •9~ 1. INTERIOR AIR FILM 0.68 VAT.- / 2• 1.28 3. 0 5.00 t~ 4. PROTECTIVE BARRIER 5. 6. EXTERIOR A FILM 0.17 TOTAL R= 7.13 _ U= .14 SLAB ON GRADE . 43 I it }0 ` NOTE: INDICATE TYPE, "R" VALUE. DEPTH AND PLACEMENT OF INSULATION. PERMIT i CKV OF EAGAN 3830 Pilot Knob Road PERMIT TYPE: B t1I1-C3I NG Eagan, Minnesota 55122-1897 Permit Number: 033892 (651) 681-4675 Date Issued: J,.1 /0 3 ~ 9 S SITE ADDRESS: i OT n 3 BLOCK., A U1UMN 2ND DESCRIPTION: r ra i ld lrtq PerITI1.t: TvDe3 BASEMENT FINISH 8ui.1di_ttci WoTvne AE_°f"E_RZArI0N Ce n< .a Code, 4:34 AL..T. RF' IDENTTAI_ i i i i REMARKS: PLAN RE-VILWED BY BILL AOAi1S,. SEPARUE PEF?,IVEI"F REQUIRE)) FOR AN`r'' P[.IJMBING WORK. GAW. FEE SU MMARY Rase Fee $5orvjo ELECTRTCYAL. FORM $1.00 Surchat-cie 150 C:0p E I..._5.0. Subto twat 3;500 50 T o t a J Fe i~ X5:3 r ~7~) CONTRACTOR: OWNER: - A p p t... ca nt - OEVL_AMTNCK GHISI_A:IN A390 BENI' TREE LANE EAGAN MN 5512 3 265:1.)+ E31--1.19 T her-ebv acknow edoe Lha.'r_': T .t,: thi ,ypu1. c ,t:i_nn r_;r,d i, It tt 2:kIE> L 1o rfn at1on 1-_t covrec.;t:. onG c3Qi o coliJ1,v l:,II aJ_I apta1;Lcai+):' M o ci l:, J_ 'C: v o l E_: c, f a n a r d i r n c c-- I J r APPLICANT/PERMITEE SIGNATURE UED BY: SIGNATURE f REACTIVATE _ CITY OF EAGAN PERMIT # 00 1993 BUILDING PERMIT APPLICATION 681-4675 _FE8 0 A RECO SINGLE MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy calcs. COMMERCIAL 2 sets of architectural & structural plans, 1 set of specifications, 1 copy of energy calcs. Penalty applies: 1) when permit is typed, but not picked 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. Date Valuation of work ,,jJ7J Site Address: G/3 q 815 AT 7'Re~C L A J STREET SUITE #t Tenant Name: (commercial only) LOT BLOCK _ SUBD. P.I.D. # = o Description of w a 13,1 The applicant is: Owner ❑ Contractor ❑ Other (Describe) Name L Z-)1#71A)d HIS~A/,~[ Phone 6~/-13) Property LAST FIRST "I/ - ~j5d 3 JO Owner Address '/3" U /3 c/lj T 11-Z tr z_ 111 STREET STE # City L laState M Zip Company S L Phone Contractor Address License # Exp. City State Zip Architect/ Company S C L j~_: Phone Engineer Name Registration # Address City State Zip Sewer & water licensed plumber Processing time for sewer & water permits is two days once area has been approved. I hereby acknowledge that I have read this application and s to that the information is correct and agree to comply with all applicable State of Mi sota Statutes and City of Eagan Ordinances. Signature of Applicant: OFFICE USE ONLY BUILDING PERMIT TYPE ❑ 01 Foundation ❑ 06 Duplex ❑ 11 Apt./Lodging 8 Finish ❑ 02 SF Dwg. ❑ 07 4-Plex ❑ 12 Multi. Misc. 9117 Swim Pool ❑ 03 SF Addition ❑ 08 8-Plex ❑ 13 Garage/Accessory ❑ 18 Comm./Ind. ❑ 04 SF Porch ❑ 09 12-Plex ❑ 14 Fireplace ❑ 19 Conun./Ind. Misc. ❑ 05 SF Misc. ❑ 10 Multi. Add'l. ❑ 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) Basement sq. ft. MWCC System (Allowable) 1st F1. sq. ft. City Water UBC Occupancy 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 Depth On-site sewage SAC Code APPROVALS S u94 - - Planning Building Assessments Engineering Variance REQUIRED INSPECTIONS ❑ Site ❑ Footing raming ❑ Insulation ❑ Wallboard Final ~raintile ❑ Fireplace Permit Fee t~ U► valuation: S Surcharge Plan Review License MWCC SAC City SAC Water Conn. Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment Pl. Road Unit Park Ded. Trails Ded. Copies Other Total. SAC X SAC Units ` s CITY OF EAGAN FOR CITY USE ONLY - 3830 PILOT KNOB ROAD EAGAN, MN 55122 PERMIT # _ PHONE: (612) 454-8100 RECEIPT # OZ~ DATE : ~ 3;7cs- PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS & TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT. WORK DESCRIPTION COMPLETE THE FOLLOWING: NO. FIXTURES EA. TOTAL NEW CONST ADD-ON MINIMUM 15.00 ADD ON SHOWER 3.00 REPAIR 3 WATER CLOSET 3.00 1 BATH TUB 3.00 3 ff LL LAVATORY 3.00 ta- OWNER NAME: _ C~ KITCHEN SINK 3.00 3-` LAUNDRY 11 Y 3.00 SITE ADDRESS: Lk C) HOTTUB/SPA 3.00 - WATER HEATER 3.00 LOT:_ _ BLOCK SUBD. FLOOR DRAIN 3.00 GAS PIPING OUT. INSTALLER: V Y~L~n~C~ 1 (MINIMUM - 1) 3.00 ROUGH OPENINGS 1.50 ADDRESS:--)LNk OTHER _ WATER SOFTENER 5.00 CITY:-ZIP: PRIVATE DISP. 15.00 U.G. SPRINKLER 3.00 PHONE _ SUBTOTAL ~50 ST. SURCHARGE .50 SIGNATURE RMITTEE~ ~ TOTAL: $ 2~IMER `IITIT TRIAL' PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS AND MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT. CONTRACT PRICE: FEES OWNER NAME: 1% OF CONTRACT FEE. STATE SURCHARGE - $.50 FOR SITE ADDRESS: EACH $1,000 OF PERMIT FEE. LOT: BLOCK SUBD. $25.00 MINIMUM FEE. INSTALLER: CONTRACT PRICE x 1% $ ADDRESS: STATE SURCHARGE $ CITY: ZIP: TOTAL: $ PHONE (SIGNATURE) FOR: CITY OF EAGAN i CITY OF EAGAN FOR CITY USE ONLY 3830 PILOT KNOB ROAD EAGAN, MN 55122 PERMIT # PHONE: (612) 454-8100 RECEIPT # DATE : NTIP,` PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS & TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT. WORK DESCRIPTION FEES NEW CONST ADD-ON MINIMUM $15.00 ADD ON HVAC 0-100 M BTU 24.00 REPAIR ADDITIONAL 50 M BTU 6.00 GAS OUTLETS - MINIMUM 3.00 OF 1 PER PERMIT OWNER NAME: ~ SUBTOTAL: $ 42-0 SITE ADDRESS: STATE SURCHARGE: .50 LOT : _ -3 BLOCK _ A SUBD. TOTAL: -27-50 INSTALLER:n ADDRESS : 14m SIGNATURE OF PERMITTEE CITY: 1/ " ZIP: ~J`vJ~7 PHONE COMMERCIAL/INDIISkPLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/ INDUSTRIAL BUILDINGS, APARTMENT BUILDINGS, AND MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT. CONTRACT PRICE: FEES OWNER NAME: 1% OF CONTRACT FEE. STATE SURCHARGE = $.50 FOR SITE ADDRESS: EACH $1,000 OF PERMIT FEE. PROCESSED PIPING = $25.00 LOT: BLOCK SUBD. $25.00 MINIMUM FEE. INSTALLER: CONTRACT PRICE x 1% $ ADDRESS: STATE SURCHARGE $ CITY: ZIP: , TOTAL: $ PHONE (SIGNATURE) FOR: CITY OF EAGAN i LZ CITY USE ONLY Q Q L ~ BL RECEIPT / / &)~f 3 SUBD. ~ RECEIPT DATE: 1998 PLUMBING PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, HN 55122 (612) 681-4675 Please complete for: ➢ single family dwellings ➢ townhomes and condos when permits are required for each unit ➢ backflow preventer for underground sprinkler system FIXTURES EACH # TOTAL Shower 3.00 x _ '3,00 Water Closet 3.00 x = :3.0w Bath Tub 3.00 x = Lavatory 3.00 x _ 3.00 Kitchen Sink 4 w E ; ZjI R) 3.00 x 3.00 Laundry Tray 3.00 x = Hot Tub/Spa 3.00 x = Water Heater 3.00 x = Floor Drain 3.00 x = Gas Piping Outlet * minimum -1 3.00 x = Rough Openings 1.50 x = Water Softener * for dwellings under construction 5.00 X = Water Softener * for existing dwelling 20.00 x = U.G. Sprinkler * for dwelling under const. 3.00 = U.G. Sprinkler * for existing dwelling 20.00 = Alterations * to existing residence 20.00 = Water Turn Around 20.00 = Private Disposal System * MPC Iic. 75.00 = (new and refurbished systems) Private Disposal Systems * Abandonment 20.00 = RPZ (new installation only) 20.00 STATE SURCHARGE .50 TOTAL 019-5,0 Ihereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable City of Eagan ordinances. It is the applicants responsibility to notify the property owner that the City of Eagan assumes no liability for any damages caused by the City during its normal operational and maintenance activities to the facilities constructed under this permit within City property/right-of-way/easement. A SITE ADDRESS: 4/3'20 13,zrv y 41f& S OWNER NAME: l`N/St ,14i.4/ 0~: V Z-rq IdA / GA' INSTALLER NAME: CgoVI se-1914 J D.5 VI-4 /'till/ G i< TELEPHONE STREET ADDRESS: L/ 4 U Y2,_ yam/ r 7 lz Ly0 A / 6' CITY: El4 G X STATE: I W4-1 ZIP: OCT 11301998 -o- SIGNATURE OF PERMITTEE CD/PERMIT FORMS/RP 998 1998 BUILDING PERMIT APPLICATION (RESIDENTIAL) s CITY OF FAGAN 3830 PILOT KNOB RD - 55122 C 681-4675 New Construction Requirements Remodel/Repair Requirements ♦ 3 registered site surveys ♦ 2 copies of plan ♦ 2 copies of plans (include beam & window sizes; poured fnd. design; etc.) ♦ 2 site surveys (exterior additions & decks) ♦ 1 energy calculations ♦ 1 energy calculations for heated additions ♦ 3 copies of tree preservation plan if lot platted after 7/1/93 required: _ Yes ` No DATE: GC -r6 o R 3o, 1 g q~< CONSTRUCTION COST; 7 S d _ DESCRIPTION OF WORK: } F)PI S+4 /3AiK,; M9jQ-T Roc aoy~~~ 13A7N_ wsr SAL STREET ADDRESS: 1Y 3 0J D .8 G IV -r R 5 l5 L,40 15 LOT: _77~? BLOCK:- SUBD./P.I.D. 3/ ~f Name: D, VLA M j0c:1< 614151.A1N Phone !s PROPERTY Last First OWNER G Street Address: 3 / d ~Y tR L /4 N f7 a City &A 6 AnJ State: m Al Zip: Company: 5C- G Phone CONTRACTOR Street Address: License # City State: Zip: ARCHITECT/ ENGINEER Company: SZ G ~r Phone Name: Registration Street Address: City State: Zip: Sewer & water licensed plumber (new construction only): Penalty applies when address chang and lot change is requested once permit is issued. I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicabl State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant: 1 RECEIVED 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 Duplex ❑ 11 Apt./Lodging At 16 Basement Finish ❑ 02 SF Dwelling ❑ 07 4-plex ❑ 12 Multi Repair/Rem. ❑ 17 Swim Pool ❑ 03 SF Addition ❑ 08 8-plex ❑ 13 Garage/Accessory ❑ 20 Public Facility ❑ 04 SF Porch ❑ 09 12-plex ❑ 14 Fireplace ❑ 21 Miscellaneous ❑ 05 SF Misc. ❑ 10 _-plex ❑ 15 Deck WORK TYPE ❑ 31 New 33 Alterations ❑ 36 Move ❑ 32 Addition ❑ 34 Repair ❑ 37 Demolition GENERAL INFORMATION Const. (Actual) Basement sq. ft. MC/WS System (Allowable) Main level sq. ft. City Water UBC Occupancy sq. ft. Fire Sprinklered Zoning sq. ft. PRV # of Stories sq. ft. Booster Pump Length sq. ft. Census Code. Depth Footprint sq. ft. SAC Code 0 Census Bldg Census Unit C~ APPROVALS Planning Building Engineering Variance Permit Fee Valuation: $ Surcharge Plan Review License MC/WS SAC City SAC Water Conn. Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment PI. Park Ded. Trails Ded. Other L~,~~ rGrl C 1?f/' Copies , ea't` Total: % SAC SAC Units ✓ 1NSL' CT fON-R CORD CITY OF EAGAN PERMIT TYPE: i 3830 Pilot Knob Road Permit Number: a Eagan, Minnesota 55122-1897 Date Issued: r (A (651) 681-4675 SITE ADDRESS: APPLICANT: 4390 sA i _ r 1 13} ',.tt 1b14 1 PERMIT SUBTYPE: TYPE OF WORK: INSPECTION DATE INSPTR. • TYPE DATE INSPI F! I`'' I? A MA rota .1 1 P•1 t O tt 011 t N 1~1 oil [ i~ 0'3 6 f I< i~i1'E I ;:k1 i k t 1..11 1t t;~ 1a { i 1t)k{t€l. i i.ftr(.j 1 L.- Permit Holder Date Telephone # SEWER/ WATER PLUMBING HVAC Inspection Date Insp. Comments FOOTINGS FOUND FRAMING ROOFING ! ROUGH PLUMBING i PLBG AIR TEST ROUGH l HEATING GAS SVC TEST INSUL GYP BOARD FIREPLACE FIREPLACE AIR TEST FINAL PLBG FINAL HTG ORSAT TEST BLDG FINAL DOMESTIC METER IRRIGATION METER FLUSH MAINS CONDUCTIVITY TEST HYDROSTATIC TEST BSMT R.I. BSMT FINAL DECK FTG DECK FINAL PERMIT City of Eagan Permit Type: Building Eagan. Permit Number: EA102857 Date Issued: 01/27/2012 OR Permit Category: ePermit 41~ it~ of E3 E Site Address: 4390 Bent Tree Lane Lot: 3 Block: 2 Addition: Autumn Ridae 02nd PID: 10-12301-02-030 Use: Description: Sub Type: e-Windows iDoors Construction Type: Work Type: Windows Doors-New ; Replacement Description: House Census Code: 434- Occupancy : Zonin,: Square Feet: 0 Comments: Improvements to the home require smoke detectors in all bedrooms. If altering window openin,s, call for framing inspection. Call for final inspection after installation. Carbon monoxide detectors are required by law in ALL single family homes. Fee Summary: BL - Base Fee S4K $103.25 0801.4085 Valuation: 4.000.00 Surcharge - Based on Valuation S4K $2.00 9001.2195 Total: $105.25 Contractor: - Applicant - Owner: Renewal Andersen Ghislain Devla ninck 1920 County Road C West 4390 Bent Tree Lane Roseville NIN 55113 Eagan NIN 55123--305 (61)264-4777 I hereby aeknowledae 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 Cite of Eagan Ordinances. ApplicantiPermitee: Signature Issued Bv: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA108546 Date Issued:12/17/2012 Permit Category:ePermit Site Address: 4390 Bent Tree Lane Lot:3 Block: 2 Addition: Autumn Ridge 02nd PID:10-12301-02-030 Use: Description: Sub Type:e-Siding & Windows/Doors Work Type:Siding & Windows/doors Description:House Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments: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. Improvements to the home require smoke detectors in all bedrooms. If altering window openings, call for framing 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 - Ghislain Devlaminck 4390 Bent Tree Lane Eagan MN 55123--305 Twin Cities Siding Professionals 664 Transfer Road, Suite 22A St. Paul MN 55114 (651) 255-2844 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA108546 Date Issued:12/17/2012 Permit Category:ePermit Site Address: 4390 Bent Tree Lane Lot:3 Block: 2 Addition: Autumn Ridge 02nd PID:10-12301-02-030 Use: Description: Sub Type:e-Siding & Windows/Doors Work Type:Siding & Windows/doors Description:House Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments: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. Improvements to the home require smoke detectors in all bedrooms. If altering window openings, call for framing 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 - Ghislain Devlaminck 4390 Bent Tree Lane Eagan MN 55123--305 Twin Cities Siding Professionals 664 Transfer Road, Suite 22A St. Paul MN 55114 (651) 255-2844 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA114169 Date Issued:09/11/2013 Permit Category:ePermit Site Address: 4390 Bent Tree Lane Lot:3 Block: 2 Addition: Autumn Ridge 2nd PID:10-12301-02-030 Use: Description: Sub Type:Reroof Work Type:Replace Description: Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: 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 . Jonathan Estebo 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 - Ghislain Devlaminck 4390 Bent Tree Lane Eagan MN 55123--305 St Paul Siding Inc 1597 Niles Ave St Paul MN 55116 (651) 698-7777 Applicant/Permitee: Signature Issued By: Signature • City otEagau 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 RECEIVED MM 21 2014 Use BLUE or BLACK Ink For Office Use Permit #: /-33V7 Permit Fee: 9700 Date Received: 6 4/ /LT" Staff: 2014 RESIDENTIAL BUILDING PERMIT APPLICATION Dec 5/21/14 Site Address: 4390 Bent Tree Lane Unit #: Name: Ghislain & Virginia Devlaminck Phone: 651-681-1319 Address / City / Zip: 4390 Bent Tree Ln, Eagan, MN 55123 Applicant is: Owner X Contractor Description of work: Remodel kitchen, new finishes, upgrade electric. Construction Cost: $12,000.00 Multi -Family Building: (Yes / No X ) Company: Remodeling Dimensions Contact: Kevin Shultz Address: 4202 Sumac Point City: Eagan State: Zip: 55122 Phone:952*920-5555 Email: info@remodelingdimensions.com License#: BC084895 Lead certificate it: NAT -102932-1 If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) 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: CALL BEFORE YOU DIG. Call Gopher State One CaII 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.aopherstateonecalioro 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 Build g Code must be completed within 180 days of permit issuance. (k/ Not i! -- Ap licant's Printed Name Page 1 of 3 X390 {ayx( DO NOT WRITE BELOW THIS LINE /D33 Y7 SUB TYPES Foundation ,( Single Family Multi 01 of Plex WORK TYPES New _ Interior Improvement _ Move Building Fire Repair Repair Fireplace _ Garage Deck Lower Level — Porch (3 -Season) _ — Porch (4 Season) _ Porch (Screen/Gazebo/Pergola) Pool Addition Alteration _ Replace Retaining Wall DESCRIPTION Valuation Plan Review (25%_ 100% ) Census Code # of Units # of Buildings Type of Construction REQUIRED INSPECTIONS Footings (New Building) Footings (Deck) Footings (Addition) Foundation Roof: Ice & Water _Final Framing Fireplace: Rough In Air Test _Final Insulation Sheathing Sheetrock Fire Walls Braced Walls Reviewed By: Y Occupancy Code Edition Zoning Stories Square Feet Length Width RESIDENTIAL FEES Base Fee Surcharge Plan Review MCES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant Copies TOTAL _ Siding Reroof Windows Exterior Alteration (Single Family) Exterior Alteration (Multi) Miscellaneous Accessory Building — Demolish Building* _ Demolish Interior Demolish Foundation Egress Window _ Water Damage *Demolition of entire building – give PCA handout to applicant MCES System J SAC Units City Water Booster Pump PRV Fire Sprinklers Meter Size: Final / C.O. Required Final / No C.O. Required HVAC _ Gas Service Test Gas Line Air Test Pool: _Footings Air/Gas Tests Final Drain Tile Siding: _Stucco Lath Stone Lath _Brick Windows Retaining Wall: Footings _ Backfill , Final Radon Control Erosion Control Other: , Building Inspector .,21i0 K2-0 Page2of3 Use BLUE or BLACK Ink r----------------� I For Office Use � I (� ' � Permit#: � � � �a � I �lty Of ����Il ' j�, � � Permit Fee: v1�. u� I 3830 Pilot Knob Road i ��j i Eagan MN 55122 � Date Received: .� � l �� � Phone: (651) 675-5675 � j Fax: (651) 675-5694 L Staff: ____—___ ------� 2014 RESIDENTIAL PLUMBING PERMIT APP ICATION Date: ' Site Address: ��-�l� � Tenant: Suite#: , 7 ReSlderit/(�Wne� ' Name: Phone: � ' Address/City/Zip: �.-/L--�— � � �'���� , � , ; Name: % � �� �w� License#: �f� ,� � � , �° ,�a�„n���y Address�o�L����� �� �.�� City: .��� ��;Ol��l'���0�',,x'. �. .: State:'�Zip: .���.°� Phone: �7�5-- �L57LC Contact: � Email: • � � .��p� �f�Q�,� _New �Replacement _Repair _Rebuild _Modify Space _Work in R.O.V�(. Description of work: l�s��'z-� + ' � 1'�+--��� �� `�. '' RESIDENTIAL Water Heater ` Water Softener Lawn Irrigation�RPZ/_PVB) 1�4CI'Yli#T�(�3� Add Plumbing Fixtures(�Main/_Lower Level) Septic System � - New Water Turnaround Abandonment RESIDENTIAL FEES: $60.00 Water Heater, Water Softener, or Water Heater and Softener(includes$5.00 State Surcharge) $60.00 Lawn Irrigation (includes$5.00 minimum State Surcharge) $60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround*(includes$5.00 State Surcharge) *Water Turnaround (add$200.00 if a 5/8"meter is required) $115.00 SeptiC SVStem New($10.00 per as built)(includes County fee and$5.00 State Surcharge) TOTAL FEES $ CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org I hereby acknowledge that this information is complete and accurate;that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. X -�� . _ L ��L�c� r X --�'�C.. �',� �.. Applicant's Printed Name ApplicanYs Signature : Ft3t�m�?FFIG�USE , Reuiew+�d B�. , ,L'�ate:, � , T Requirsd Inspec#ions: �rider Graund-' �� ' I��u���ln ' Air Test ; ��s fiesf '. . 'Final [ Meter Related[tsms, M�t�:r��i�e � i ...__ R�div`R�aci: <�7lanori�e#er. ` vfiafif. Use BLUE or BLACK Ink r-----------------+ I For Office Use � I Z I ' � Permit#: �� ✓ I Clty of ����� � �C7�� ; � Permit Fee: ( ) 3830 Pilot Knob Road I I Eagan MN 55122 � Date Received: � Phone: (651)675-5675 I I Fax: (651)675-5694 �� I Staff: I I I 2014 RESIDENTIAL BUILDING PERMIT APPLICATION Date: " Site Address: Unit#: Name:�"1-Z-�L 1�1� �Jt:.�L�Ll.�-/�-�t ���-\ Phone: ��"'_ti it�" �P�� Res�dentl Qy���� ' Address/City/Zip: ���� ���/�� ���,,��(1� Applicant is: Owner �Contractor �T�r .6 Of:11�F01'k'���; Description ofwork: (.��'R�'�. �Jt9�R �f����l�il�l' ,��� ��.a Construction Cost: �•�'� Multi-Family Building: (Yes /No� � Company: ��i����(� ������ � Contact: �.��, ^)�iiJ��� �, Address: C���,�����f� ��C• YV. City: T5111��� C(lflfCactQ ��� State: Iv. Zip:����CL� Phone:��;�6�"7p�,�� Email:�'p�„��,�f�`s�-����/�, ' itij ' License#: Lead Certificate#: If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) 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: N4Ti� Plar�s�nd sup�orfin�alv�um,en#s t/i'��yocr submi#are��r�sidered tr�be p�blic�rrfc�rmatior�. Pcrr�tiQn�•af t��►n�orrir�fi�n may�#���a�s�fieal���nart'pu�l�c��f,�Yau^prA►ritle sp��ific rea�vns.fthaf would permit'th�°City#v co�e��rsa�e=tti�f t�e :are trade:secr�t�. 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 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 ust be completed within 180 days of permit issuance. ! �.. x � i�-�i� ��1�1��L�'� X ,i : Applicant's Printed Name Appli nYs Signature Page 1 of 3 . �- t Use BLUE or BLACK Ink --------- � For O�ce Use j « � Permit#: ���) I C�t of �� a� ��EQ � . /� /�� �� ; Y � ���� Permit Fee: vJ '-J` � 3830 Pilot Knob Road � Eagan MN 55122 MAR 21 2Q1� I 3�Z�` f I � Date Received: � Phone: (651) 675-5675 Fax: (651) 675-5694 � Staff: � � -----------------� Q�,��.� � � 2014 COMME��IA�L BUILDING PERMIT APPLICATION �,i�:�'� Date: 3/18/14 Site Address: ,�� Blackhawk Rd. �"� Tenant Name: Eagan Pointe Senior Living (Tenant is: X New/ Existing) Suite#: Former Tenant: '� ' Name: Eagan Pointe Senior Living, LLC phone: ,: � P����������� ,. Address/City/Zip: 1984 Oakdale Ave . / West St . Paul / 55118 � `��� , ��� ;., � % ^ `" Applicant is: Owner X Contractor �._,� � �� ' ' : Description ofwork:__Senior Living 4 story wood framed w/ Precast �YF�� of�lllork ,; � �` ��``� � ; Construction Cost: $13, 0 0 0, 0 0 0 . 0 0 �: ��: �� � : � , ' Name: Stonebridge Construction, Inc .License#: � /^f� � ���antc ��or : Address: 15734 Foliage Ave . City: Apple Valley Cfu.W- 7�3-2bt - 4G2.Z- ` �r� ���� ;` State: M�`� Zi 5 512 4 9 5 2 . 4 31 . 5 7 0 0 f'1cT Z3 O `�,�,� p: Phone: r � � ' � M 4TT CURGE 1'NGVt�"/CQSfont,b��e LoA+muAl'�teS,.cvw�► ,: Contact: Brad Friesz Email: bfriesz@stonebridgecommunities . c m � � Name: Harriss Architects Registration#: 22603 ����r : � �r ` �� ����,������������, Address: �,��� Washington Ave . N City: Minneapolis blZ •44p•Ztb! MI� r.' S5401 612 . 940 . 6427 ; ' State: � Zip: Phone: � �� ��� '. C7t�OR�'1�.�OtFNSO Contact P.,erson: John Harriss Email:Jharriss@harrissarchitects . c m Licensed plumber installing new sewe'r/water service: JBe rd Me chan i ca l phone#: 3 2 0 . 6 5 6 . 0 8 4 7 ' K f'f��rs���d st���t��#�ng, �etr�s#�,a� r�sulamlt�n���at�sialer�d i�a�i��ncrb i� ' �or�i�or�. � '� th��,�#`'�rr»a��n may��,+�las�����'��r�on=':R� ����oct: ` �r3�a1e s����ti�r+����,�s���,�a�ro �a � ���Gr��y;�`� v ��; � � t��fha�##�._ :�r�e frade�°��`��'s` ���� �;� ,., , u v z,...: �_._ ._.,..... � � 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.qopherstateonecall.org I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan;that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit;that the work will be in accordance with the approved plan in the case of work which qui s a review and approval of plans. :.� �l ._ X Brad Friesz ApplicanYs Printed Name Applicant's Signatur Page 1 of 3 �� � . y - - ����- �la��c 1���k- l� � DO NOT WRITE BELOW THIS LINE � (� �� SUB TYPES Foundation Public Facility Exterior Alteration-Apartments �Commercial/Industrial Accessory Building Exterior Alteration-Commerciai Apartments Greenhouse/Tent Exterior Alteration-Public Facility Miscellaneous Antennae WORK TYPES ✓ New Interior Improvement Siding Demolish Building* Addition Exterior Improvement Reroof Demolish Interior Alteration Repair Windows Demolish Foundation _ Replace _ Water Damage _ Fire Repair _ Retaining Wall _ Salon Owner Change *Demolition of entire building-give PCA handout to applicant DESCRIPTION M,r, ✓ Valuation /t� 97d� AUG �Occupancy SZr�Z,�'�/,A3 MCES System Plan Review ✓ Code Edition 'ZDO'j/rISgG SAC Units � (25%_100%� Zoning �D City Water Census Code Stories � Booster Pump #of Units �S3 Square Feet 20���?/ PRV � #of Buildings � Length Fire Sprinklers Type of Construction 1/� • 14 ,1-� Width REQUIRED INSPECTIONS Footings(New Building) � Sheetrock Footings(Deck) � Final/C.O. Required Footings(Addition) Final/No C.O.Required Foundation � Other: F!!-� SlDpp/�V b � Drain Tile � / Pool: Footings _Air/Gas Tests Final Roof: Decking _Insulation Ice&Water �Final � Siding:_Stucco Lath Stone Lath Brick � Framing Windows Fireplace:_Rough In _Air Test Final � Retaining Wall �Insulation � Erosion Control Meter Size: Final C/O Inspection: Schedule Fire Marshal to be present: V Yes No Reviewed By: (��G , Building Inspector Reviewed By: S��' T , Planning COMMERCIAL FEES Base Fee 53,g�G. ?� Water Quality Surcharge l�B1�•S�G Water Sampling Fee Plan Review 3Sj D�{S. 89 Water Supply 8�Storage (WAC) MCES SAC PA�l� Storm Sewer Trunk City SAC �A�t D Sewer Trunk S�W Permit�Surcharge �7F'l A Water Trunk Treatment Plant P/1�/D Street Lateral Treatment Plant(Irrigation) BZg. ao Street Park Dedication Water Lateral Trail Dedication Other:� Water Quality TOTAtf/ �l/, Gq�•/� � Page 2 of 3 07/23/2014 09:09�M 6516338859 TIMBERCRAFT P�GE 12/12 a 4 i I Use BLUE or BLACK Ink � ForOfflcaUae^---- ---� I' I � I � � . �� � I C�ty af E��aIl , Permit�: � i � r I �i R�CE���� � PermRFee: � � 1 3830 Pllot Knob Road I � Eagan MN 55122 � Date Racalvetl: � Phone'(651)6755675 JUL Z 3 ?,(l14 � i Fax:(651)675-5694 � Staff: � �---------------��� 2014 RESIDENTIAL BUILDING PERMIT APPLICATION ,(� �� Date: / � 2'� � � `SibeAddress: ( � ��1 !�! f�� UNt#: � �� Name: �^�� �� � Phone: Address/City/Zip: 7� � � ��1 �1 � �"'� � Applicant is: Owner X Contractor ������ � Z� L � ����~ -� Description of work: � Constn,cti�n Cost:� ZJ��• � Multi-Family Building:(Yes�/No� k.�... �-; p r:�!• �"' '� P Y: I ��'1�� lR. � Contact: ,�, ..�,�"�S" Com an � e �;,'�:�;� � . t��� 3�� C��.u�.L�ii►,r�/�J� _S w ciy: �IV�-�J ���, � �� ��t�� Address: �'1���} � � State��� Zip: w ( � � Phone:(D�� � �jEmail: ��ZO.•�+a � C ''� �� r�;�"�s �%�`��• ��cense�: �Z6�` Lead Certlflcete#: Z.� ! �� � _ IYI�.� :.J.'Hi.':��'-*t If the project is exempt from lead certiflcation, please explain why: (see Page 3 for additional infotmation) � 6 �' � 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: Mechanlcal Contractor: Phone: 3ewer&Water Contracto�: Phone: :�'• `'�; x�:, ":i �rr'� w"e,'`;���^`;�isl�-'�4�i%?,� �. .3� CALL BEFORE YOU DIG. Call Gopher State One Call dt(651�a54-0002 tor protectlon agalnst underground utility damage. Call bB hours befo�e you inte�d to dip to receive�ocates of underground utilities. �ppp�.�opher.stateonecall_ora I horoby acknowledge th�t this tnformatlon Is complete and accu�le;that the work wi�l be��co�fo�mance with the ordlnanaes and codes of lhe City of Eagan;thal I understand this is not a permit, but only an appllcatlon kr a pennit,and wo�C Is not In start withouf a permit Shat tne work wiu be in accordancA witn the approv9d plan in tha caso of work whlch requlres n revlGw and approval of plans. ExtoHOr work autAorlaAd by a bulld�ng pom�l!Issued In�ccorda�ce wlth the Mlnnesota Bullding Codo n►ust Ao ComploWd wlthln 180 days of pertnit ie6uance. . x�'�,� 1'I�-IO'US„! x - ApplicanYs Printed Name Ap icanYs ature . Page 1 oF 3 ' � � ��� � �� �� � � DO NOT W� BELOW THIS LINE Z � � ���� r°�� SUB TYPES � _ Foundation _ Fireplace _ Porch(3-Season) _ Exterior Alteration (Single Family) _ Single Family _ Garage _ Porch(4-Season) _ Exterior Alteration (Multi) _ Multi _ Deck _ Porch(ScreenlGazebo/Pergola) Miscellaneous _ 01 of_Plex _ Lower Level _ Pool � Accessory Building WORK TYPES New _ Interior Improvement _ Siding Demolish Building' _ Addition _ Move Building Reroof Demolish Interior Alteration Fire Repair Windows Demolish Foundation Replace Repair Egress Window Water Damage _ Retaining Wall "Demolition of entire building-give PCA handout to applicant DESCRIPTION � Valuation � C�7"' Occupancy � G•� MCES System -- Plan Review Code Edition ,�Gb'� SAC Units —' (25%_ 100% Y ) Zoning P,a City Water �" Census Code 34 Stories / Booster Pump � #of Units � Square Feet 5?G PRV �' #of Buildings / Length �_ Fire Sprinklers "� Type of Construction _�� Width � REQUIRED INSPECTIONS � Footings (New Building) Meter Size: Footings (Deck) Final/C.O. Required Footings (Addrtion) _ _ _ e� Final I No C.O. Required � Foundation � HVAC Gas Service Test Gas Line Air Test � �� Roof: _Ice &Water Final Pool: Footings _Air/Gas Tests Final � Framing Drain Tile Fireplace: _Rough In _Air Test _Final Siding:_Stucco Lath _Stone Lath _Brick Insulation Windows Sheathing Retaining WaIL• _Footings_ Backfill_Final Sheetrock Radon Control Fire Walls � Erosion Control Braced Walls Other: Reviewed By: , Building Inspector RESIDENTIAL FEES ase ee � �j I Surcharge � 7�i p�r r��ws� ���.s(X 7"'� /7it� J Plan Review °�Ol�_ MCES SAC City SAC '� Utility Connection Charge I S&W Permit& Surcharge Treatment Plant Copies TOTAL Page 2 of 3 r , ,� . � �� �� � � �:�.;� �. �� < ,...... �.: �.� � c_.° � ��.. Q �,° � � � � i ��:9� � � � � ' � � � ; ' � o, � � { �s � a� i � � �. K� '� 1 � Q cv � � x � �i 4 N � � � � � � i ` � � ¥ � � v � � � i ,� v � � � -' -� � � � T �.� � �� � � �� � I / t � � � � � �' ` X � W u I � � i ,,� � j` ; � a0E � _ � �.. � � � � � q� � � � � �— �;� � � �:,, r ,,.� � n � � � et� N a � � ,.� ,- ,M� g � i 1 � Q i � �!! � / 1 � � � � � � � � � �� � ' O ;�S �g ro i � LL <•,w � �, �� ! � � � � � � J � j � T �2 �� 9�9Z �.� � � t.- �, �� � r�- w i � 4 T � � } �� � , Use BLUE or BLACK Ink �----------------- J�� � For Office Use � rV"" I �+ /I� /� �14 �1 L� �� j Permit#. ���£�%,�- y/,J(���� r _� � Permit Fee: /`�� `�" / i� 3830 Pilot Knob Road Ea an MN 55122 � Date Received: ` ���� � g RECEIVED � � Phone:(657)675-5675 I I Fax:(651)675-5694 I Staff: I NOU 0 3 2015 !----------------� 2015 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: Unit#: Name:G�S�'�5�..�� �" V ti��1�1R �EV L�M W�.'KPhone: rov�ti' �s��• `�J�� l�+�sid��� _ ��g� ° Address/City/Zip: � �G � ' Applicant is: Owner x Contractor Descriptionofwork: R.G����L. �13 �1� ���� ���������: ' � ,� � Construction Cost: b�� Multi-Family Building:(Yes /No�) Company: ���—U.N�C7' ��In�N��,�N�S Contact:�R.VCE �,.�0�',.,a ,� a Address:�"���Z ��� �0��� City: F���'N t'tf��kqT '- BRVt°iE�D�:J.N�6�jJl�YtE1�L I State:�Zip: �►-G. Phone: L� v���mail: 1M ;', . �� , �' License#:RCOS���� Lead Ce '�cate#: {��i�"��Z\3�`'�� If the project is exempt from lead certification, please explain why: � t�ous� t3vu.� 1a �9��2 �� �� ��°�_ 7�'i- l 7 �7 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: 11t��' �Pla�����1��, ���at��,��r��`��h�t�rra�r������r���rc�r��Ca„�b��cr�lc F�r���. �r��arr� � tfre fr�fc�rma#rc��r�a,����€s��i�t�s�c��n�tabl���`'y�ru prrr�v�+�f;� � �r��-ea,�o����l��rm1�1�+�� `�� �,.: :. s ��� tl����`t�� 'ar��tr� �� �� �. . ....: ,..:,:': >.�. ' .� , � ,. �... CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utiliry damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.popherstateonecall.ora I hereby acknowledge that this infortnation 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. Exteriorwork authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 days of permit issuance. X r3� LYo�S X ��-.�. ApplicanYs Printed Name ApplicanYs Signature Page 1 of 3 ���7�` ��� ��'��" �� DO NOT WRITE BELOW THIS LINE � � :.� �`�S�� SUB TYPES Foundation _ Fireplace _ Porch(3-Season) _ Exterior Alteration(Single Family) �.Single Family _ Garage _ Porch(4-Season) _ Exterior Alteration(Multi) _ Multi _ Deck _ Porch(Screen/Gazebo/Pergola) _ Miscellaneous 01 of_Plex Lower Level Pool Accessory Building WORK TYPES _ New _ Interior Improvement _ Siding _ Demolish Building* _ Addition _ Move Buiiding _ Reroof _ Demolish Interior � Alteration _ Fire Repair _ Windows _ Demolish Foundation _ Replace _ Repair _ Egress Window _ Water Damage Retaining WaU *Demolition of entire building—give PCA handout to applicant DESCRIPTION , Valuation -��� � Occupancy G � MCES System `�' Plan Review Code�Edition '��/q SAC Units '�'' (25%_100%� Zoning ��1 City Water �--� Census Code �/ 3lr Stories �'"' Booster Pump .-�* #of Units 1 Square Feet � PRV -- #of Buildings l Length — Fire Suppression Required --�'' Type of Construction � Width . �- " - REQUIRED INSPECTIONS • Footings(New Building) Meter_Size: Footings(Deck) Final/C.O. Required ' Footings(Addition) , • � Final/No C.O RequiRed • � Foundation �HVAC_Gas Service Test Gas Line Air Test Roof:_Ice&Water _Final Pool:_Footings Air/Gas Tests _Final Framing , Drain Tile Fireplace:_Rough In Air Test _Final Siding:_Stucco Lath _Stone Lath _Brick Insulation Windows Sheathing Retaining Wall:_Footings_Backfill_Final Sheetrock Radon Control Fire Walls Fire Suppression:_Rough In_Final Braced Walls --'" Erosion Control ��"`��^����~ Other: ,. Reviewed By: , Building Inspector RESIDENTIAL FEES X ?3 � �f,��9'Y'15► �/ 0��l.y °�� 'r Base Fee � `� � Surcharge ��t� � Plan Review � 7 94 MCES SAC City SAC Utility Connection Charge S&W Permit�Surcharge Treatment Plant Copies � TOTAL Page 2 of 3 Use BLUE or BLACK Ink r----------------� I For Office Use / � /'� I � � Permit#: �� "� I Clty of ����� ; . U� � I Permit Fee: � 3830 Pilot Knob Road � Eagan MN 55122 � Date Received: � Phone: (651) 675-5675 � � Fa�c: (651) 675-5694 L Staff:______________� 2015 RESIDEIVTIAL PLUMBING PERMIT APPLICATION Date: �1�1,�Site Address: � Tenant: , Suite#: Residen�0�►�►�1e�' Name: ���� � ! Phone: I Address/City/Zip: I Name: �`sc,G, License#: C'�!�_3m2� �ZI.L . � COntt'aGtOr Address:.,,��,� ��,,�,.2.. . ,� Ciry: S(sf� State:�Zip:��Cj77 Phone: (�' �.��"—��' Contact: EmaiL � Q ' ��,r T�pe of 11a/�rk —New �Replacement _Repair _Rebuild _Modify Space _Work in R.O.W. Description of work: RESIDENTIAL Water Heater Water Softener Lawn I�rigation(_RPZ/_PVB) P�1'�11i1#TjI�B Add Plumbing Fixtures�Main/_Lower Level) Septic System New Water Tumaround Abandonment RESIDENTIAL FEES: $60.00 Water Heater, Water Softener, or Water Heater and Softener(includes State Surcharge) $60.00 Lawn Irrigation(includes State Surcharge) $60.00 Add Plumbing Fixtures, Septic Svstem Abandonment, Water Turnaround''(includes State Surcharge) "Water Turnaround(add$210.00 if a 5/8"meter is required) $115.00 Septic Svstem New(includes County fee and State Surcharge) TOTAL FEES$ 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.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. "��►-�+�--- 1 • T��� �- • X �---�--j� � .� Applicant's Printed Name Applicant's Signature f012 O�FICE USE Rev�ewed By: Date; Required lnspections: Under Ground Rough-ln Air Tss# , Gas Test Final �Vleter Related Items: Meter Size Radio Read Manotneter Staff: PERMIT City of Eagan Permit Type:Building Permit Number:EA160345 Date Issued:03/04/2020 Permit Category:ePermit Site Address: 4390 Bent Tree Lane Lot:3 Block: 2 Addition: Autumn Ridge 2nd PID:10-12301-02-030 Use: Description: Sub Type:Windows/Doors Work Type:Replace Description:One Window/Door 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: 1,500.00 Fee Summary:BL - Base Fee $1500 $62.50 0801.4085 Surcharge - Based on Valuation $1500 $0.75 9001.2195 $63.25 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 - Ghislain Devlaminck 4390 Bent Tree Lane Eagan MN 55123--305 (651) 704-9939 Pella Northland 15300 25th Ave N #100 Plymouth MN 55447 (763) 745-1400 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA169069 Date Issued:05/13/2021 Permit Category:ePermit Site Address: 4390 Bent Tree Lane Lot:3 Block: 2 Addition: Autumn Ridge 2nd PID:10-12301-02-030 Use: Description: Sub Type:Reroof Work Type:Replace Description:Does not include skylight(s) Census Code:434 - Residential Additions, Alterations Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Please print pictures of ice and water protection and leave on site. We encourage you to retain an electronic copy of photos until the project passes a final inspection. If water damage is encountered, please call (651) 675-5675 to schedule a site visit to verify the extent of the damage. Any 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 - Ghislain & Virginia Devlaminck 4390 Bent Tree Ln Eagan MN 55123--305 Ashco Exteriors Inc 11164 Zealand Ave N Champlin MN 55316 (763) 225-8333 Applicant/Permitee: Signature Issued By: Signature