4160 Countryview DrCITY OF EAGAN « t ?
3430 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
? • PHON E: 454-6100
BUILDING PERMIT ? Receipt #
? Site Address ?? ? ?KIMy{?igy DR
I Lot _AL Block 3_- SeclSutCnufrrQt? NnHs1xa "
W Name 5MUM ElQSS 2lIC
? Address ISOQ V COURIY ROAD 42 STE 165
° City SOMYILt.L Phone 890-471i4
Phone
Name
Phone
I hereby acknowlege that I have
information is correct and agree
Minnesota Statutes and Ciry ol E.
Signature of Permitee ?
i and state Ihat the
applicable State of
A Building Permit istisstied to:
on the express condition Ihat all work shall be done in accordance with all
applicable State of Minnesota Statutes and City ot Eagan Ordinances.
Building Otficial I I
TV! 7
OFFICE USE aNLY
Occupancy R-3 FEES
Zoning
(Actual) Const -Y--wX BIdg.Permit "5-00
(Allowable) Surcharge x1. SO
N of Stories
Length ?t Pian Review L19.00
Depth SAG, City lm.M
S.F. Total - SAC, MCWCC 630-00
S.F. Footprints -
On Site sewage _ Water Conn 660-?
On Site well water Meter 95.00
MWCC System x-
?
Water
City ?_ Acct. Deposil
•?
PRVRequired X S1W Permit 20.00
Booster Pump - SNV 5urcharge • ?
Treatment PI 276•?
APPROVALS Raad Unit 370•00
Planner
Council - Park Ded.
BIdg.Off. -
_
C°p'es
Variance -
?Q
TOTAL 3,323.
' PermR No. Permit Holder Date T•lephone #
WATER 33 ?0?? ?'r
SEw_RFi
PLuMBInG
H.VAC. JNo-
ELECTRIC 358&?
l,qmdw ? lnep. Co,,me,ts
Footings I s
Foundation
Framing _/Z •??
Roofing
Rough Plbg.
Rough Htg.
Isul. - ?
Fireplace
Final Hig.
orscat Test 3•. 9 Z `?? ` J ?
Fnal Plbg. /Plbg. Inspecl Notify Plumber
Const. Meter
EngrJPlan
Bldg. Final 31114? d2f'.
oeck Ft9.
Dedc Final
Weli
Pr. Disp.
,a
3830 Pilot Knob Rd.
Eagan, MN 55122-189
DATE aCT' .1C, 1991
METER #
CHIP # __6
>E ONLY '
PERMIT DATE 10/ 11 /91
PERMIT # 12339
B.P. RECEIPT # C 15772
B.P. RECEIPT DATE lb% 10/91
PRV -
SITE ADDRESS
LOT BLOCK -' SECiSUB
ADDRESS:_
CITY, STATE
PHONE: _
PLUMBER: S TAR PLUN:BT 23G
ADDRESS: 101$ MOUND SPRINGS TERK
CITY, STATE
PHONE: _ BLOOMTNG'rGN H.a
884-4149 ZIp
OWNER: SEVERSON tI041ES I14C
ADDRESS: 2500 W CQiTNTY RUAD 42 STE 165
CITY, STATE BUIRNSYILLE MN.
? ZIp 55337
PERMIT RE(.UESTED
X SEWER y WATER _ TAPS
- COMMlIND X RESlDENTIAL
- X NEW _ EXISTING.
Lawn Spri fer Mefers are to be Installed
Ahead of,omest4 Meters on Water Line.
Credit W,dtL NOT: be given for Deduct Meters.
CITY OF
PHONE: S)GIJATUFiE'WHEN METER ISSUED
?
PLEASE ALLaW TWO WORKING DAYS FOR PROCESSING. CALL 454-5220 FOR INSPECTIONS. FOR STORM
SEWER PERMITS, CONTACT ENGINEERING QEPT. -
Address : Lot 4 Blk 3 Sec/SubcouNTRY HoLLow 2ND
These items were/were not complete at the time of the final inspection.
Date: 03/11/42 Yes No
Final grade (6" from siding) ?
Permanent steps - garage
Permanent steps - main entry VII"
Permanent driveway
Permanent gas ?
Sod/seeded grass
Trail/curb damage
Porch
Basernent 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.
N[CKlEO MVER
White - City copy Yellow - Resident copy Pink - Contractor copy
;
ZIP
CITY OF EAGAN
3830 PILOT KNOB RaAD
EAGAN, MN 55122
PHONE: (612) 454-8100
F.?$??? .... . ...C?
;;; ;; ;;;;;,;;>;:.
FOR CITY USE ONLY
PERMIT #
RECEIPT # h9
DATE :
PLEASE COMPLETE IIPPER PQRTION ONLY FOR SINGLE FAMILY DWELLINGS &
TOWNHOMES/CONDOS WKEN PERMITS ARE REQIIIRED FOR EACH UNIT.
WORK DESCRIPTION
NEW CONST
ADD ON
REPAIR
OWNER NAME: ?e?fJSo-? Pgc),nPS
SITE ADDRESS: 4-I u Co&r.,ti?ir eA.J
LOT:? BLOCK -f- SUBD
INSTALLER: 5c-11ele! pjN( ncjc
ADDRES S: 4$0o 4dv oq-? C c-
COMPLETE THE FOLLOWING:
N0. FIXTURES EA. TOTAL
ADD-ON MINIMUM 15.00
SHOWER 3.00
1 WATER CLOSET 3.00 3
? BATH TUB 3.00 ?
I LAVATORY 3.00 .?
! KITCHEN SINK 3.00 -3
? LAUNDRY TRAY 3.00 .3
HOT TUB/SPA 3.00
/
WATER HEATER
3.00 ?
/ FLOOR DRAIN 3.00 -3
GAS PIPING OUT.
1 (MINIMUM - 1) 3.00 -3
? ROUGH OPENINGS 1.50 4:5c
OTHER
WATER SOFTENER 5.00
_ PRIVATE DISP. 15.00
U.G. SPRINKLER 3.00
SUBTOTAL s a8 ?v
ST. SURCHARGE .50
TOTAL : S ? 9 d d
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:
^47NER NAME :
SITE ADDRESS:
IAT: BLOCK SUBD.
INSTALLER:
ADDRESS:_
CITY:
PHONE #:
FEES
1g OF rONTRACT FEE.
STATE SURCHARGE _ $.50 FOR
EACH $1,000 OF PERMIT FEE.
$25.00 MINIMUM FEE.
CONTRACT PRICE x 1$
STATE SURCHARGE
TOTAL:
$
( S IGNATi3RE)
2IP:
FOR:
CITY OF EAGAN
CITY: t''fi U.' bqr°?< ZIP:
`' - ?
1991 BIIILDI1?'P I APP ICATION
CITY OF EAGAN
SINGLE FAMILY DWELLINGS M[TLTIPLE DWELLINGS COMMERCIAL
2 SETS OF PIANS 2 SETS OF PIANS 2 SETS OF ARCHITECT[7RAL
3 REGISTERED SITE SURVEYS REGISTERED SITE SURVEYS - 6 STRUCTURAL PLANS
1 SET OF ENERGY CALCUTATIONS (CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFICATIONS
1 SET OF ENERGY CALCUIATIONS 1,SET OF ENERGY CALCS
_# OF RENTAL UNITS
# OF FOR SALE UNITS
YENALTY APPLIES WHEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY LAST WORKING DAY
OF MONTH IN WHICH REQUEST IS HADE.
IAT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED.
NOTE: ADDRESSES FOR CORNER IATS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS
DESIRED. NO CHANGES WILL BE ALIAWED ONCE BUILDING PERMIT IS ISSUED.
PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DAYS ONCE
PERMIT MUST SHOW A LICENSED PLUMBER. i ?
NGw Nomc? OC7' ?
To Be Used For. (°,J6\ZTlZA)Q7 j 10K? Valuation:? ?? -
Site Address 'N'0 WJnYyyi)/c- W L72, OFFICE
Lot ? Block FEE
Occupancy R 3 M-1 Bldg. Permit 643,00
-
?7
G
w Zoning R_I Surcharge 33
-450
Parcel/Sub
?i
JKMy ILLptJ -
'/aDfJ_ Actual Const v-N Plan Review
p
411810
l
' Allowable V-N SAC, City 0O,O O
1
Owner
N(j;l'»
'rN C. # of stories SAC, MWCC .
50.00
i
Add
?
'Q? W
3
4
) Length ?
' Water Conn.
n
(0601
95
v
ress
,
p? . Depth 30 Water Meter , p
SL)ITL 1?Ds S.F. Total Acct. Deposit 30,00
City/Zip Code IL1 [??-o Footprint S.F. S/w Permit 30,0?0
S/W Surcharge ,S"b
Phone G/ Z' Rem '`fl? YV On site sewage_ Treatment Pl. 2?4,00
On sit
ell Road Unit 37arco
`??x?,
Contractor y w
MWCC S stem ? Park Ded.
City water ? Trail Ded.
Address PRV _ Copies
Booster Pump
City/Zip Code _
SIIBTOTAL
APPROVALS Penalty
Phone Planner I.ot Change
C?' ?
A
h
E
C-
?}
-
]? Gouncil
(
g TOTAL
rc
./
ngr. ?/
Z,
?yy?LS
,w _VC,
t: Bldg. Off.
91 QS
O?
Variance
Address
City/Zip Code
Phone #
Sewer/W.ater Lice Contr. S rZ, ?L0 /V1 23) (°L->( CAVATI N(=s
d ,
agrees that all wo[k shall be done in accordance with
Contractor)
all applicable State of Minnesota Statutes and City of Eagan Ordinances.
CITY OF EAGAN NO 19787
3830 Pilot Knob Road, P.O. Box 21-799, Eagan, MN 55127
! '61-7a
BUILDING PERMIT PHONE:454-8100 Receipt # ??
,
Tobeusedfor SF DWG/GAR Est.value $101,000
Site Address 4160 COUNTRYVIEW DR
Lot 4 Block _3 Sec/SutCOi)NTRY HOL•L.OW 2N
Parcel No.
w IName SEVERSON HOMES INC
? Address 2500 W COUNTY ROAD 42 STE 165
° City BURNSVILLE phone $90-4744
,a Name SAME
0¢ Address
? City Phone
Name _
Address
City -
Phone
I hereby acknowlege that I have re Ihisp plic [ion and state that the
iniormation is correct antl agree comGf d all applicable State of
Minnesota Statules antl Cily of E an 0 di ? n s.
e
Signature of Permit ?
A Building Permil is issued to: jISV.K' EN' INE'
on Ihe express condition that I work shall be done in accordance with all
applicable State of M(i?nnesotaQStatutes and City of Eagan Ordinances.
BuildingOHicial ," ?? "k, ??-
OFFICE USE ONLY
Occupancy R-3 14-1 FEES
R-1
Zoning
(ACtual) Cons1 V-N Bldg. Permit 643.00
(Nlowable) V-N
Surcharge 50.50
# o( Stories -
68 '
Plan Review 418.00
Lenglh
Depth 30' SAC. Ciry 100.00
S.F.TOtal - SAC,MCWCC 6$0.00
S.F. Footprints -
On Site Sewage
_
?^later Conn 660.00
On Site Well Water Meter 95.00
MWCC System X
Acct. Deposit 30.00
Cily Water X
X
SNJ Permit 30.0
PRV Requiretl
BaosterPump - SlWSurcharge •50
TreatmeM PI 276.00
APVHOVALS RoadUnit 370.00
Planner - park Ded.
Council --
BIdg.0t1. _ Copies
Variance - TO7AL 3,323.0?
. A
?er#i#ir?#e vf (?rr?t??rtr?
of eagan
Br{arhnettt of iui(diag imvrctiimt
This Ce?pfca[e issued pursuaru fo the requirementr ojSecdon 306 ojlhe Urdforni Building
Code cerlilY+nB that at rhe 6me oJissuance thissuucrare war tn compliance with the various
J' ord'uwncer of 1he City regulafin8 bulldinS rn"slructi°n or use Far the fo!lowing:
i 5(+ IWG/GAR ' 19787
` um a.mrcimo aus.Permarb VN
?''rya - oia"a z5W W L1'rRB ,
?I iwd,? ?b
/ "?. •?- ? _ ./_ (:? .._._ 03/I1/42
POSY Ml ACONSPICUOUS PLACE
,
SBTSRIOR ENVSLOPB AVERAGE "U" COMPUTATION
OWNER: ?GI/E2SOtJ I-IOMC-S , yNC,
SITE ADDRESS: 4ICoQ GQ0Aff2Y'W6%"W (JPlV(=. ?[?1"-`iJ
CONTRACTOR : ??AfJ F?nnES, IwC.DATE :' '34 ' / PHONE : 510' 4144
Determine working square footaqe of each.
1. Total exposed wall area: 111? 7101 sq.ft.x .11 =[ 21'?, (rGj ?
2. Total roof/ceiling area: /2v8 sq.ft.x.026 =[ 31,4-0 ]
Total exposed wall area above floor = fP>II1
a. Total wall window area ......................
b. Total door area .............. ............. ^,3,7.7 7
c. Total slidinq glass door area ................
d. Total fireplace wall area....................
e. Total wall framing area (average 10$).......
.
f. Total net wall area above floor .............. ?O .
g. Total rim joist area ........................
Total exposed foundation area = )L 2
h. Total foundation window area ................. -
i. Total net foundation area above grade........ IL071
Determine ''U" value of each wall segment.
a. l?i-2-,25 x?,U-, . 4-6 = c?3,4$
b. ??•?7 x - U" , pLo = Z,Zco
c. ?l •?? x ?.o,l , 4& - (S, o0
d. x "U" -
e. 3? x"u" . = g.'7 2
f. 13oB.776, X ?-U,, ,42 = 52,33
g. av X- v" i a4- = c. , 4-g
h. x "U" _
i. I c.z,6%,,7 X 1, u" ,oL. _ ?-? ,')-L
3 ..................................TOtal - IS'J,Gi?'!
If item #3 is the same as , or less than #1 ,
you have met the intent of SBC 6006(c)2.
MINNESOTA STATE BOAFO OF ELECTRICITV
Griggs-Mitlway Bltlg. - Aoom 5413
1821 Univer5ity Ave_ SL VeuL MN 55104
Phane (612) 642-0800
THIS INSPECTION aWUEST WiLL NOT
BE ACGEPTEO 9Y THE STATE 80ARD
UNLESS PROPER INSPEGTION FEE IS
ENCLOSED.
REQUEST FOF ELECTRICAL INSPECTION
? ji, Sae msiruciinis lor oompaling this form oa back oi yellow copy.
Th R est
m'? EB-OOOOi-OB I
u "X" Below Work Covered by +s equ
ew.
Wd
ReO.
Type of Building
AppliancesWired E ui mentWired
q P
,
Home Range Temporary Service
Duplea Water Heater Electric Heating
I ApL Building Dryer Other (Specity)
Comm.ilndusirial ',Fumace
Farm Air Conditioner
Qeer Isyeciyl Comrzcjoi Pemarks.
?j
Inspection Fee Below:
Gom
rt I Other Fee # ServiceEniranceSize ? Fee # CircuitsiFeetlers Fee
minq Pool j
pute 0 to 200 Amps ? S;OO )L 0 to 100 Amps
iormers Above 200 - Amps Above WO _ Amps
- Inspectar's Use Only. TOTAL
??. ?1
? Irriqation Booms
Special Inspection
AlarmiCommunication
THIS INSTALLATION MAY BE O ERED DI f NECTED IF
NOT
Other Fee COMPLETED WITHIN 18 MQWPS.
Rau9h-in ?
e
I, the Electrical Inspector, here6y '
cenify that the above inspection has F,,,,i ( Date
been made.
OFFICE USE DNLY
Tms req?.iesl voitl 1B ironihs ??om
r
Total exposed roof/ceiling area = 1'Z oa
j. Total skylight area..........................
-^
, k. Total roof/ceiling framing area (average 30$) J Z O, 80
1. Total net insulated roof/ceiling area........ ? o F:' "j, Zo
Determine "U" value for each roof/ceiling segment.
j , X flUff _
k. I 2D, 8n x"Ult 4',
1. jOP?']?2b 21,74-
4 ...................................TOta1 57 ]
If total of #4 is the same as, or less than #2, you have met the
intent of SSC 6006(c)1.
Alternate Building Envelope Design
To utilize the total envelope system method, the values established by
the sum of items #3 and #4 shall not be greater than the sum of items
#1 and #2.
+z . 3 I.¢o =
3. --- --?---?- - ---- - --
+4. -- -- - -
CITY OF EAGAN
3830 PIIAT KNOB ROAD
EAGAN, MN 55122
PHONE (612) 454 8100
fEGom,s'iom?,'?'
FOR CITY USE ONLY
PERMIT #
RECEIPT # OO 5
DATE: ?&' 3° /
PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE ]
.::. . .:.::.... ._... ..::.,..
TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
FEES
------------------------ -----------------------------------------
WORK D:7PTION
NEW CONST _
ADD ON _
REPAIR _
OWNER NAME:
SITE ADDRESS: y?kc?O
LAT:__Z_ BLOCK ---I SUBD, u ?e
INSTALLER: ?-
ADDRESS: `A
CITY: ? c+._.r sz_ ZIP: li7i;3"7 lp
PHONE gSQ) y3 O I.
ADD-ON MINIMUM
HVAC 0-100 M BTU
ADDITIONAL 50 M STU
GAS OUTLETS - MINIMUM
OF 1 PEB PERMIT
SUBTOTAL:
STATE SURCHARGE:
TOTAL:
DWELLINGS 5
$15.00
4.0
6.00
3.00
.50
$?. a O
? .? . ?'G? Qn.s....a.... J
SIGNATURE OF PERMfl`TkEE
?`QMMER?TAL/;?L+IDUST?TAI?:. PLEASE COMPLETE TAIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS,
APARTMENT BUILDINGS, AND MULTI-FAMILY BUILDINGS WNEN SEPARATE PERMITS ARE
NOT REQUIRED FOR EACH DWELLING UNIT. CONTRACT PRICE:
OWNER NAME:
SITE ADDRESS:
LOT: BIACK _ SUED.
INSTALLER:
ADDRESS:
CITY; ZIP:
PHONE #:
FOR:
FEES
1% 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)
CITY OF EAGAN
?o-F- y, 6C . 3 ,
L"Jry Naflo.wl ZUj1
Or
3830 PILOT KNOB ROAD THOrMS E6nN
hbyor
EAGAN, MINNESOTA 55122-1897
PHONE: (612) 4548100 DnvID K. GUSTnF50N
FAX: (612) 454-8363 PAMELA MCCREA
TIM PAWLENiY
THEODORE WACHTER
Council Mem6ers
THOMAS HEWES
Ciry Administraror
October 29, 1990 Euc,ENEVnNOVFReEkE
Ciry Clerk
WARREN ISRAELSON
PROGRESS COMPANIES INC
14300 NICOLLET
SUITE 235
BURNSVILLE MN 55337
Re: Hold on Building Permits
Dear Warren:
The City of Eagan has put a temporary hold on building permits for
Lot 4, Block 5, Country Hollow Addition and also Lots 1-10, Block
3, Country Hollow 2nd Addition.
The pond lying east of Lot 4& 5, Block 5, needs excavation work
at the pipe outlet area where sand has accumulated due to upstream
erosion. This work can best be accomplished by access of Lot 4,
Block 5.
Lots 1-10, Block 3, Country Hollow 2nd Addition, are on hold
because of the lack of final restoration work in conjunction with
the retaining wall construction. These lots will remain on hold
till this work gets completed to the satisfaction of the City of
Eagan Engineering Department.
We hope this work will get completed as soon as possible.
If you have any questions pertaining to these items, please call
me at 454-8100. Thank you.
Sincerely, cc: Mike Foertsch, Assistant City
Engineer
yi??? "_ " Craig Knudsen, Engineering Tech
Steve Hanson, Assistant Building
Official
Stan Lexvold
Senior Engineering Tech/Construction
SL/jj
THE LONE OAK TREE...THE SYMBOL OF STRENGTH AND GROlNfH IN OUR COMMUNIN
Equal Opportuniry/Affirmative Action Employer
954870
COIINTRY HOLLOW BSCOND ADDITION
PRE88IIRE REDIICINO VALVB ACiASSMENT
i
This agreement, made and entered into the day
of ?-!-ZL- , 1990, by and between the CITY OF EAGAN, a
municipa/,ity of the State of Minnesota, (hereinafter called the
City), and the Owner and Developer identified,herein.
:he terss "Developer" and "Owner" as used herein refer to:
PROGRESS LAND COMPANY, INC. whose address is 14300 Nicollet Court,
Suite 235, Burnsville, Minnesota 55337.
WHEREAS, the Developer has applied to the city for approval of
the plat or subdivision known as COUNTRY HOLLOW SECOND ADDITION,
located within the City; and
.
WHEREAS, the Owner and Developer aqree to notify the proposed
potential buyers of all lots within COUNTRY HOLLOW SECOND ADDITZON
that Lots 1-4, Block 1, Lots 1-17, Block 2 and Lots 1-10, Block 3 are
in a high water pressure zone and a pressure reducing valve shall be
installed in each home below the elevation of 875 feet. All costs
shall be the responsibility of the Buyer and shall be installed to
prevent damage due to high water pressure.
NOW, THEREFORE, the City, Owner and Developer agree as follows:
1. Recordinv. This agreement shall be recorded with the Dakota
County Recorder so as to provide notice to the owners of Lots 1-4,
Block 1, Lots 1-17, Block 2, and Lots 1-10, Block 3. The Owner shall
provide and execute any and all documents necessary to implement the
recordinq of this agreement.
2. Notice. The recording of this document shall constitute notice
to all owners and future owners of property in the COUNTRY HOLLOW
SECOND ADDITION subdivision that Lots 1-4, Block 1, Lots 1-17,. Block
2, and Lots 1-10, Block 3 are in a high water pressure zone and thafi
?
a pressure reducing valve shall be installed in each home below the
elevatioh of 875 feet. All costs shall be the responsibility of the
Buyer. and shaZl be installed to prevent the damage due to high water
pressure.
3. Validitv. If any portion, section, subsection, sentence,
clause, paraqraph or phrase of this aqreement is for any reason held
to be invalid, such decision sha21 not affect the validity of the
remaining portion of this Contract.
4. Bindina Aareement. The parties mutually recognize and agree
that a21 terms and canditions of this recordable agreement shall run
with the land herein described and shall be binding upon the heirs,
successors, .administrators and assigns of the owners and developers
referenced in this Contract.
IAI WITNESS WHEREOF, we have hereunto set our hands.
CITY OF. OWNER AND DEVELOPi:R:
(Date: ' PROGRESS LAND COMPANY, INC.
Th mas A. By: u i.w ? S?
Its : Mayor 1? tVw r
- I A \?7AAnjalj?
Attest: . J. VanOverbeke
Its: erk
Bv:
Its?
STATE OF MINNESOTA
COUNTY OF DAKOTA
ss
On this v2/ .S% day of
Public within and for said
and E. J. VanOVERBEKE to
duly sworn, each did say
Clerk of the City of Eaga
instrument, and that the s
by authority of its C
acknowledged said instrume
municipality.
?ZL x?? , 1990, before me a Notary
County personally appeared THOMAS A. EGAN
me personally known, who being each by me
that they are respectively the Mayor and
n, the municipality named in the foregoing
eal affixad on behalf of said municipality
ity Council and said Mayor and Clerk
nt to be the free act and deed of said
y •NI!ltf•DC!flIINI/IIMf:H
7 F ' . L Y;
? . . _ _ !.1 . .5.7 A
' . ? _ . 1 .. •.i ? ?
?
E ?
. .. ....... ...t
STATE OF MINNESOTA )
) ss.
COUNTY OF I
?
On this day of 1990, before me a Notary
Public within and for said County, personally
appeared i . ?, ; : , .i-: ,?7+C !`_J r' ttnd- to me
persona? 1y own, Iwho being aacb-by me duly sWorn, eac#} did say that
thc?j*es?eet4?.? the f I (`.I Ll ? i i t
and- of the corporation named in the
foregoing instrument, ____ ________ __ __-_ ________..____ __
tite y , and that said instrument was
signed aiid setrI%eri on behalf of said corpora ion.2?y authority of its
Board of Directors and said rrS ,'"L I1'
-ma"d- acknowledged said instrument to be the
free act and deed of the corporation.
?'^'_ ?,. .,. ..:.,s.:F:w.,......•,n„ryi,ra ? C 1?' ?L?71
Notary Pub? ic
?
APPROVED AS TO FORM:
n ,
?..?,c^a'rl' Q ??l,cir
Public Woxks Department
Dated:
THIS INSTRUMENT WAS DRAFTED BY:
SEVERSON, WILCOX & SHELDON, P.A.
600 Midway National Bank Bldg.
7300 West 147th Street
Apple Valley, MN 55124
(612) 432-3136
MGD
030 L -S95'l
APPROVED A5 TO CONTENT:
?" R3IA:Y?,T,!.::
CITY OF EAGAN
3830 PILOT KNOB ROAD
EAGAN MN 55122
PHONE: (612) 454 8100
"mPCa-0YER'h1"
FOR CITY USE ONLY yULp
PERMIT #
RECEIPT # ? (5e,19
DATE; 1111CY1910-
PLEASE COMPLETE IIPPER PORTZON ONLY FOR SINGLE FAMILY
TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRLD FOR EACH IINIT.
--------------
WORK DESCRIPTION
NEW CONST
ADD ON
REPAIR ?
OWNER NAME: ??1 CY? G{^G??/i
SITE ADDRESS:
IAT:? BLOCK 4' SUBD.
INSTALLER: Burnsville Haating ,R 6` Inc,
12481 Rhode island Ave. 50.
ADDRESS: Gavqggr ?AN rti537$-1122
894-0005
CITY: ZIP:
PHONE #
FEES
DWELLINGS &
ADD-ON MINIMUM P550 HV
AC 0-100 M BTU ADDITIONAL 50 M BTU 6.00
GAS OUTLETS - MINIMIIM 3.00
OF 1 PER PERMIT
SUBTOTAL : $?v O
STATE SURCHARGE: .SD
TOTAL : $? O
Aa7'9?
NAT OF PERMITTEE
? Q r V' ie r sg-? c- 3 fl7`K? o3C
AS7MMER?IAT.frN??USTEtrAI,F PLEASE COMPLETE THIS YORTZON FOR ALL COMMERCIAL/INDUSTRIAL SUILDINGS,
APARTMENT BUZLDZNGS, AND MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE
NOT REQUIRED FOR EACH DWELLING UNIT.
CONTRACT PRICE:
OWNER NAME:
SITE ADDRESS:
LOT: BLOCK SUBD.
INSTALLER:
ADDRESS:
CITY:
PHONE #:
ZIP:
FEES
18 OF CONTRACT FEE.
STATE SURCHARGE - $.SD FDR
EACH $1,000 OF PERMIT FEE.
PROCESSED PIPING - $25.00
$25.00 MINIMUM FEE.
CONTRACT PRICE x 18
STATE SURCHARGE
TOTAL:
$
?
(SIGNATURE)
FOR:
CITY OF EAGAN
%?e?
2006 RESIDENTIAL BUILDING rERMiT arrLicaTioN
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New ConstruMion Requiremenis
3 registe2d site surveys showing sq. fL oi lot, sq. R. of house; and all roofed areas
(20 % maximum lot coverage allowed)
1 Soils Report if proposed building is to be placed on disturbed soil
2 copies of plan showing beam & window sizes; poured found design, etc.
1 set of Energy Calculalions
3 copies of T2e Preservation Plan if lot platted aher 711193
Rim Joist Detail Options selec6on sheet (buildings wilh 3 or less units)
Minnegasw mechanipl ventilation form
RemodellReoair ReauiremenGs
2 copies of plan showing tooGngs, beams, joists
1 set ot Energy Calculations for heatetl additions
1 site survey for additions & decks
Add'Rion - indicate iI on-site sepfic system
???
Offce Use-0nlv
Cert ofSurveyRecd ... _Y _N
SoilsRepoR _Y _N
Tree PresPlan Reoi - _Y _N.
Tree Pres Required - _Y . _N
On-siteSeplic System _ Y _ N
Date I r? / 3b /_PC Construction Cost ? 1?Z`?• ?
Site Address ? l(Pb C CI?tJZ?! ?i?? ? ? Unit/Ste #
d
Description of Work Jt /1
o(, ?S
Multi-Family Bldg _ Y_ N Fireplace(s) _ 0 _ 1 _ 2
Property Owner ??.?LI \0??1b \SI ??C?I Telephone # (GV 16 2 - i1?1Z
Contractor V?? WCl-F
Address
r?-Q f, ? C i t y
A
State 1?1LetiG1,P ?? Zip _ Telephone# ((,,14)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 _ Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(J submission type) Submitted Submitted
• Energy Envelope Calculations Submitted
in the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_ Y _ N If yes, date and address of master plan:
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone #(
Telephone # (
Telephone #(
I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a
rproval that the work will be in accordance with the approved plan in the case of work which requires a review and
o p
lans. . ?T
?
--
Applicant's Printed Name ApplicanYs Signature
SURVEYOR'S CERTIFICATE
` BaL1
/
1.V
? 83
?
w
?
?
Z?
O 830.8
U .
I ?\ al
I l?)
.'
?? - 30.00 -?
32.5 ? 'r-
/810 ? B34D
` _C\-, '
BENCM MARK
/ TOPOF PIPE
ELEV.•03S.99
142.00
- 30.00 j4e34.o
?
?
?
o
I oI?y
Kw ?n 1
02: Co ?
a ?
? a
N Q
p
Z 2.33
j - ?
w
fn W
a?
03 . • .O
00
0 v
/¢x
a
0 I 1 T
cp
?
BSO anexl zs.c
?
I\` ?V.VV
I (93i,2?
_ 30.?001,
142.00
\BENCX M4NK
TOPOF PIPE
EIEV.• 833.74
I ?? ?
SEVERSON HOMES, INC.
c?
<f
_ J
L'I
634.0
[. I
/ c 861,0) I
S89°231 4111 E
8542
?
? 10
It
y M M Jd
U ? %3
7
I
J 2
Ma
Q WZ
aw
?J
a
I
w
834.1
p
?OIR C 0.iA F •,
HOTE: NO SPECFIC SOILS INVESTIGATION HAS BEEN COMPLETE
. ON THIS LOT BY THE SURVEYOR. T/£ SUI7ABILITY OF
501L5 TO SUPPoRT THE SPECIFIC HOUSE' PROPOSED IS
' NOT THE RESPONSIBILITY OF THE SURVEYOR
?- DENOTES PROPOSED SURFACE DRAINAGE
O DENOTES IRON MONUMENT SET
• DENOTES IRON MONUMENT FOUND
X000.0 DENOTES EXISTING ELEVATION
(000.0) DENOTES PROPOSED ELEVATION
M
O
Z
O
?
? cf
I
i
?
L?
S89°2341°E - ? i ?8(04.0)
4 r§.Cz.f'?.lu
D?.'.sPT
D NOTE: BUILDING pMFNS10NS SHOWN ARE
FOR /iORIZONTAL B VERTCAL LOC-
- ATION OF STRUC'fURE ONLY. SEE
ARCHITECTUAL PLANS FCR BUILDING
6 FOUNDATION DIMENSIONS.
SCALE: 1 INCH - 30 FEET
PROPOSED GARAGE FLOOR - 93S.3 FEET
PROPOSED LOWEST FLOOR = 00•6 FEET
__eROP_QSED_TOP-OF BLOCKFEET
?AVm REGlUIRED
WE HEREBY CERTIFY TO SEVERSON HOMES, INC. THAT THIS IS A TRUE AND CORRECT
REPRESENTATION OF A SURVEY OF THE BOUNDARIES OF:
Lot 4, Biock 3, COUNTRY HOLLOW SECAND ADDITION,acoording to 1hR recorded plat thereof,
Dakota' County, Minnesota.
iT DOES iJGT PURPGRT Tv SHOW IMPROVEMENTS OR ENCROACHMENTS, EXCEPT AS SHOWN. AS
SURVEYED BY ME OR UNDER MY DIRECT SUPF6Y?SION THIS 30TH DAY OF SEPT. , 1991.
S
PROPOSED GRADES SHOWN VIERE -
TANEN FROM THE GRAONJG, ORAIN-
AGE 6 EROSION CANTROL PIAN fOF
COUNTRY NOLLOW SECOND ADO.PREPARED BY
PROGRESS ENGINEERING, INC., LAST
DATED 7-30-90
?
00
m O 0 O < N D
- f" m U n 7 ? I o
W > $ E
O O Z
o N?
? v p O m ? Z
m m ? ? ?
O
HILL,INC.
JOHN C. IARSON, LA D SURVEYOR
MINNESOTA LICENSE NUMBER 19828
James R. Hill, inc.
PLANNERS / ENGINEERS / SURVEYORS
2500 W. CTY. RD. 42 9 BURNSVILLE, MN. 55337 9 612-890-6044
7' I
} Use BLUE or BLACK Ink
I For OfficeUse--_-_---_ I
l [i`b' i
Permit
City of EaEd~
I ~ I
I Permit Fee: I
3830 Pilot Knob Roads 1 I
Eagan MN 55122 l Date Received:
Phone: (651) 675-5675 MQ~ o Z~~1 i staff:
Fax: (651) 675-5694 I
2012 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: w a'Jw Ye C_J Unit
Name: y ~ yr ~ Phone: 4Y2--t4S42-
R€$IDENT /
OWNER Address /city /zip: 4((ao Coc;+~-~y y c e~ "Dc-;'terms Min S"Q23
Applicant is: _K Owner Contractor
TYPE OF WORK Description of work: e 17. ec.
Construction Cost: Multi-Family Building: (Yes J No
Company: Contact:
CONTRACTOR Address: City:
i
State: Zip: Phone:
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 ANEW 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:
NdTE; Plans and supporting documents that yott submit are considered.trr-be.poblic information. Portions of
the information may be cfaii if as ran-public if yogi provfde specific masons fit wbufcf perm* the City to
conclude that they are age se'cretg
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.aoaherstateonecall.ora
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
x O~/~~ L7ySlG~-- X.
Applicant's Printed Name Appl' s Signature
Page 1 of 3
DO NOT MITE BELOW THIS LINE l ~ I `--SUB TYPES
Foundation _ Fireplace _ Porch (3-Season) _ Stone Damage
Single Family _ Garage _ Porch (4-Season) _ Exterior Alteration (Single Family)
- Multi Deck _ Porch (Screen/Gazebo/Pergola) _ Exterior Alteration (Multi)
_ 01 of Plex _ Lower Level _ Pool _ Miscellaneous
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 aQ Occupancy I'P,!5, - MCES System
Plan Review Code Edition lag,? SAC Units
(25%_ 100%_Z Zoning. - City Water -
Census Code ~f 3!~ Stories Booster Pump
# of Units Square Feet PRV
# of Buildings Length Fire Sprinklers
Type of Construction Width
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
Footings (Deck) Final / C.O. Required
Footings (Addition) Final / No C.O. Required
Foundation HVAC _ Gas Service Test Gas Line, Air Test
Drain Tile Other:
Roof: -Ice & Water -Final Pool; -Footings -Air/Gas Tests Final
- Framing Siding: -Stucco Lath -Stone Lath yBrick
Fireplace: -Rough In -Air Test -Final Windows
Insulation Retaining Wall: _ footings ` Backfill I Final
Sheathing Radon Control
Sheetrock Erosion Control
Reviewed By: , Building Inspector
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review 7G 120- a G'~ ~r
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
i
Page 2 of 3
SURVEYOR'S CERTIFICATE SEVERSON HOMES, INC.
NOISIAR3 SNO1_L:
NVEN3 i
I A(~ /BENCH MAW TOP F PIPE
ELEV.
~d~ry1 LEV2933.99 (gtjpl,0~ I
30 142.00 S8902314111E - t
831.1 1a 30.00 - O O x834.0 8342 Gf
> 832.3 1t) r _ =-Z00-'
10 804Ax
22.33 _a 18 34.0 10 1 L
A I
~Q O! in w m I W
9 31.3 Qpp~ W M I tD Q Cd 1 I
I t~ Oz I a a h v t0
p 2.33 n o
Z Z
a 1{~ W ~ W 1
1 -1 1
M Q, t~' .~a J d7 a _
03 .0 IL M doe w ~ 00
x ~ p
4 IL ! o _ j5
F_ p I t>;~ a rn ( 00)
I It) I I _ ea ICI if
,
z CD IO 833&1` 26.0 x834.1 /f I !D U-
1 ~..J 1
88 .9 832. r ~ 10-_~- x933.9 834.6 p < • a
U 30.00 - 30.00 If~`~
3 I b"' -14200ARK S89'2341°E ~g~o4.oj
TOPOF PIPE I
I ELE\ts 833.74
+r T
' ~
NOTE' NO SPECIFIC SOILS INVESTIGATION HAS BEEN COMPLETED NOTE: BUILDING DIMENSIONS SHOWN ARE
ON THIS LOT BY THE SURVEYOR. THE SUITABILITY OF FOR HORIZONTAL 9 VERTICAL LDC-
SOILS TO SUPPORT THE SPECIFIC HOUSE' PROPOSED IS ATION OF STRUCTURE ONLY. SEE
NOT THE RESPONSIBILITY OF THE SURVEYOR ARCHITECTUAL PLANS FOR BUILDING
-0---- DENOTES PROPOSED SURFACE DRAINAGE IS FOUNDATION DIMENSIONS-
0 ' DENOTES IRON MONUMENT SET SCALE: 1 INCH - 30 • FEET
0 DENOTES IRON MONUMENT FOUND PROPOSED GARAGE FLOOR - 93S.3 FEET
X000.0 DENOTES EXISTING ELEVATION PROPOSED LOWEST FLOOR - 27.16 FEET
(000.0) DENOTES PROPOSED ELEVATION __RROP_OSED_T-OP-OF- BLOCK FEET
P",mv. 1! llEQUMED
WE HEREBY CERTIFY TO SEVERSON HOMES, INC. HAT THIS IS A TRUE AND CORRECT
REPRESENTATION OF A SURVEY OF THE BOUNDARIES OF:
Lot 4 , Block 3, COUNTRY HOLLOW SECOND ADDITION, according to thB recorded plat thereof,
Dakota' County, Minnesota.
1T DOES NOT PURPORT TO SHOW IMPROVEMENTS OR ENCROACHMENTS, EXCEPT AS SHOWN. AS
SURVEYED BY ME OR UNDER MY DIRECT SUP SION THIS 30TH DAY OF SEPT. ,1991.
SIGNS : JA E R. HILL, INC.
PROPOSED GRADES SHOWN- WERE
TAKEN FROM THE GRADING, DRAIN-
AGE a EROSION CONTROL PLAN FOR r.
COUNTRY HOLLOW SECOND ADD.PREAARED BY BY:
PROGRESS ENGINEERING, INC., LAST JOHN C. LARSON, LA KID SURVEYOR
DATED 7-30.90
MINNESOTA LICENSE NUMBER 19828
T o o m 0 CA James R. Hill, inc.
Q Z M (7 w Al
° ° m A PLANNERS ! ENGINEERS / SURVEYORS
y O m 2500 W. TY
• RD. 42 • BURNSVILLE, MN. 55337 • 612-890-6044
ry
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA170025
Date Issued:06/17/2021
Permit Category:ePermit
Site Address: 4160 Countryview Dr
Lot:4 Block: 3 Addition: Country Hollow 2nd
PID:10-18276-03-040
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 -
John J & Deborah Burke
4160 Countryview Dr
Saint Paul MN 55123--394
(612) 280-7955
Premier Roofing Llc
7835 Telegraph Rd
Minneapolis MN 55438
(612) 445-7663
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA176572
Date Issued:05/23/2022
Permit Category:ePermit
Site Address: 4160 Countryview Dr
Lot:4 Block: 3 Addition: Country Hollow 2nd
PID:10-18276-03-040
Use:
Description:
Sub Type:Furnace & Air Conditioner
Work Type:Replace
Description:
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Pete DeGrood at (507)
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
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 -
John J & Deborah Burke
4160 Countryview Dr
Saint Paul MN 55123--394
Bob Boldt Hvac
4310 Trenton Tr
Eagan MN 55123
(651) 454-7760
Applicant/Permitee: Signature Issued By: Signature