4423 Clover Lane
w
Use BLUE or BLACK Ink
I For Office Use
I I
I 1
City of Satan I Permit # ~ • 9
y,, I Permit Fee: I
3830 Pilot Knob Road I I
I
Eagan MN 55122 I Date Received: YZL&
Phone: (651) 675-5675 i staff:
Fax: (651) 675-5694 I
2011 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: -Z ~ C J 0Ve(' "A 'e Unit
Name: KeVo ix 5e44,dn Phone:
RESIDENT /
OWNER Address/ City/ Zip: C I O V-er 4ccAle-
Applicant is: Owner Contractor
TYPE OF WORK Description of work:` ~~tc'j/t Rzf/Gcic) and L-)e( :
ew
Construction Cost.z2cU Multi-Family Building: (Yes / No!)
Company: i-nc, Contact: Jo-
CONTRACTOR Address: 1 cXo S [rc V~ vG City: 0®11(c4w1e_
State: Mn Zip: 'r? (Z 6 Phone: (D - 7`! `7-34(Z3'
License - zC!~30-702 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:
1
Mechanical Contractor: Phondt
Sewer & Water Contractor: Phone:
NOTE: ii-ens and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that the are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage.
Call 48 hours before you intend to dig to receive locates of underground utilities. www.oopherst eonecall.or
I hereby acknowledge that this information is complete and accurate; that the work will be in conforman h 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 rk is not to to without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and appro of pla
Applicant's Printed Name -iicant's Signature
Page 1 of 3
DO NOT WRITE BELOW THIS LINE
SUB TYPES
_ Foundation Fireplace Porch (3-Season) _ Storrs Damage
_ Single Family Garage r 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 :3000 60 Occupancy MCES System J"
Plan Review Code Edition- SAC Units
(25%_ 100%z Zoning - City Water
Census Code Stories Booster Pump
# of Units Square Feet /(p _ PRV
# of Buildings Length _51-Fire Sprinklers
Type of Construction .__!!Aj Width
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
Footings (Deck) Final / C.O. Required
Footings (Addition) V 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 -Brick
Fireplace: -Rough In Air Test -Final Windows
Insulation Retaining Wall: _ Footings _ Backfiil _ Final
Sheathing Radon Control
Sheetrock Erosion Control
Reviewed By: Building Inspector
e
RESIDENTIAL FEE
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
Page 2 of 3
t K 37 17A&:- 5~.
ROBE
fm NGINEERING CONSULTING ENc31NEEAS
PLANNERS RS and LAND iUAVEYOAS
COMPRNY, INC. X23 CmIel
1000 EAST 1461A STREET, BURNSVILLE, MINNESOTA 55337 PH 432'3000
CErZ Accx
...-C 3.sr4 ?gn. , LOT5 211 22, 23 AND 24, BLOCK 3i EDEN ADDITION,
DAKOTA COUNTY, MINNESOTA
C`I SLO DENOTES EXISTING ELEVATIOm
( 9, S DENOTES PROPosE:U ELEVAT IV
NORTH -••F IIVDICATE'S DIRECTION OF SURFACE' DRAINACvE
5CALE 1" = 30, FINISHED GARAGE FLOOR ELEVATION
EAGAN
REVIEWED
EAGA BY
I E D .';1I
DATE:
BUILDING INS 'E( TIONS DIVISION
By 7
DATE
l I AND
~ Epp
A
69 UTj~I-tY ~M 941 ~1_si
~3o' FR NT BUILDING //1~1 1 ° 5132E 5° ' ~5 t~F+1•S
SETBACK LINE L i Nji 16.2 4~ g~~ I
83 LD
10
x933 S~ s- ~ l I
LOT
3z o z 2 2 ( J oo 1
C1
88. I
o M , X936.3 0.
13.
N 4 -UNIT ors) ~ I o
c~in° 'd'PROP056D I r (93b.3~ m
N 84° 39'41"E 1 Z
Q ~pk tg36I~ BUIL.'
I u r I '3.10, 5
i1 _J _N 18g: DQ~_ 936-ii J I~
O = h I C937.Z~ L7T m Lo-r Z4
23
C~J 0 L' 9 37.0
78./3 v'-
935. o/ ~r-/ 60.00 ...e•----_~ 3%.
EAST C4~3.1~
30' ~9 3 S, 3,~
I hereby certify that this is a true and correct representation of a tract. of
land as shown' and described hereon.. As prepared by me on this day of
4 19 .
~ Binn. Reg. NO.
..,.?-.. _ . .
CITY OF EAGAN ?. r ?,?.»? ?
,, ;v+s 3830 Pibt Knob Road, P.O. Box 21-199, Eagan, MN 55121 ' j
PHONE: 454-8100
BUILDlNG PERMIT Receipt#
To be used for 1 pF 4 PLEX Est. value S48,000 Date MAR&H 20 , tg
SiteAddress 4423 CLGVF.R LN Erect ?Xoccupancy R3
Lot2 3 Block -3 Sec/Sub.- • -? ADDiTi0lWemodel ? zoniny pf)
Repair ? Type of Const. u
Parcel No. Addition ? No. Stories
t=CU1:3 VALfTF 3i0ME5 Move ? length 44
Z Name Demolish ? Depth 24
3 Address 1460 9 3.2?J Lld L?IO ? Int, lmpr. ? S Ft
° BL y I ti 2:' 7??1??' I 9'
icitv- i'hone Install ?
= a Name SAI'F,
? ? Address
F l,:ti, oti,,....
Assessment
Water & Sew.
Police
Permit $ 274.00
Surcharge 24.00
Pian Review 137.00
sac 575.00
Water Conn. 500.00
Water Meter 63 . 5 4
Road Unit 290.00
Tr. PI. 156.00
Park5
Copies
Total $2,019.50
Name Fire
Phone
I hereby acknowledge that I have read this application and statethatthe
information is correct and agree to comply with all applicable State of
Minnesota Statutes and City, g Ordinan s.
Signature of Permittee ?z
?4dD VALU? FIG.'?:ES
A Building Permit is issued to:
all work shall be done in accordance with all applicable State of Minneso
Bldg. Off.
APC
Var. Date
on the express condition that
Statutes and City oi Eagan Ordinances.
Building
+ Psrmft No. Pennfl Holder Dats TNephons #
Plumbing
H.V.AMA. 17
Electric
Soltener
Inspectlon Date Inep. Commenb
Footings 1
Footinys II
FoundaHon
Framing ?
Rooling
RougA PlbSi• A{?. ? -
Rough Htg.
Insul. •?. ?V /rf ? .
Firaplace
Final Mty.
Final PI6y.
Bldg. FinN ?
Cert. Occ.
Deck Fty.
Dsek Frmy.
Well
Pr. Disp.
•` `a PLUMBING PERMIT
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55121
PERMIT # ??d (
NECEIPT #
DATE:
BLDG. TYPE WORK DESCRIPTION
m Name
.S Addre:
c City =
? Name
3 Addre
p City 1
FEES
COMM/1ND FEE - 1% OF CONTRACT FEE
MINIMJM - RESIDENTIAL FEE
i MINIMUM - COMM/IND FEE
' STATE SItRCHARGE PER PERMIT
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND t1,000.00)
Res. New
Mult Add-on
Comm. Repair
OtF1@f
NO FIXTURES TOTAL
?Water Closet - $3
00 $
.
Bath Tubs - $3.00 -,.
-
? 0 - •; ; / TLavatory - $3.00 _
Shower - $3.00
--t-
Kitchen Sink - $3.00 ?
Urinal/Bidet - $3.00
$?p ?
_
_ ?:? ?Laundry Tray - $3.00
Floor Drains - $1.50
ZWater Heater - $1.50
_TWhiripool - $3.00
' Gas Piping OuUets - $1.50
;
!
,
Softener - $5.00 -
Well - $10.00
_____rPnvate Disp. - $10.OQ
= Rough Openings - $1.50 FEE:
FOR: CITY OF EAGAN
STATE S/C: ' `GRAND TOTAL:
' MECHANICAL PERMIT
cmr oF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55121
' PRICE: PHONE: 454-8100
PERMIT # `
RECEIPT #
DATE y ?
Site Address `1 'a -A} < ' r ` I ^ gLpG. TYpE
Lot.? Block ? Sec/Sub S -?-?-
? jRea.
m Name l 14 tMutt %
? Address Z + ?? - • Comm.
c City,; ..L, ,-/y Phone' Other
L
m
c
3
O
City
TYPE OF WORK
Forced Air
Boiler
Unit Heater
Air Cond.
Vent
Gas Piping Outleis #
Other
M BTU
M BTU
M BTU
M BTU
CFM
FEE
S/C:
TOTAL•
FEES
RES. HVAC 0-100 M BTU -$24.00
ADDITIONAL 50 M BTU - 6.00
ADD-ON AIR COND. 0-24 BTU - 12.00
ADDITIONAL 6 M BTU - 6.00
GAS OUTLETS - 1.50 EA.
COMM/IND FEE - 1% OF CONTRACT FEE
MINIMUM - RESIDENTIAL FEE - 10.00
MINIMUM - COMM/IND FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND $1,000.00)
?
SIGNATURE OF PERMITTEE
WORK DESCRIPTION
New
Add-on -
Repair
FOR: CITY OF EAGAN
?R ?Ad.B
BUILDING PERMIT
Eagan, MN 55121 N, 2 11655
Receipt #
To be used 1or 1 OF 4 PLEX Est. value $4 ff ,000 Date r ARCH 20, , i9 86
SiteAddress 44238 CLOVER Z.''.'• Erect ? Occupancy R 3
Lot2 g elock FDI:N A
3 SeciSub UDITION Remodel ? Zoning PD
Parcel No . Repair ? Type of Const V
. Addition ? No. Stories
GOOI7 VALUE HOMF'.S Move ? Length 44
W Name 24
9 RD LCi NO Demolish ? Deptn
o Address r
I
t I ? Ft
S
,
780- n
mp
. q.
.
City B 5510
? one Install ?
Assessment
Water & Sew.
Police
Fire
Eng.
Planner
Permit $ 274.00
Surcharge 24.00
Plan Review132-00
SAC 575.00
Water Conn.5Q4- 00
50
Water M eter 63.50
Road Unit 250.00
I hereby acknowledge that I have read this application and state that the B?dg. Off. 3 1? ? Tr. PI. 15 6. a 0
information is correct and agree to comply with all applicable State oi
Minnesota Statutes and Ci f Ordi nces. APC Parks
? Var. Date Copies
Signature of Permitte 1?- ? /I?o?s????/G?/ - $ 2, 019 . 50
Total
A Building Permit is issued to: vOOD VAI.UE HONiES on the express condition that
all work shall be done in accordance with all applicable State oi Minnesota Statutes and City of Eagan Ordinances.
Building Official
Name SAME
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-19!
PHONE: 454-8100
PermM No. Pormit 11oldK Dats TNephone N
Plumbinq 77? ? Woi,
H.V.A.G. l0 4? r O l?
ElscMc
SOIIMK
InspecNon Dste Inap. Commenb
Footlnys I
FooNnps 11
Foundatlon
41-6
JH19.
Final Ptby.
.? ?
.
Bldy. Ffnal
Cort. Occ.
Deck Ft9.
Doclc Frmy.
Wsll
Pr. Dhp.
- PERMIT # =- > -
MECHANICAL PERMIT RECEIPT #
CITY Of EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE
:ONTRACT PRICE: PHONE: 454-8100
Sec/Sub
BLDG. TYPE
WORK DESCRIPTION
Name J f
m
? Address = 3 ' s
c City
? Name
c Address
O Gih+
TYPE OF WORK
Forced Air
Boiler
Unit Heater
Air Cond.
Vent
Gas Piping Outlets #
Other
M BTU
M BTU
? M BTU
M BTU
CFM
FEE: _
S/C:
TOTAL
c
Mult f
Comm.
Other
New
Add-on
Repair
FEES
RES. HUAC 0-100 M BTU -$24.00
AQDITIONAL 50 M BTU - 6.00
AQD-ON AIR COND. 0-24 BTU - 12.00
ADDITIONAL 6 M BTU - 6.00
GAS OUTLETS - 1.50 EA.
COMM/IND FEE - 1% OF CONTRACT FEE
MINIMUM - RESIDENTIAL FEE - 10.00
MINIMUM - COMM/IND FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $60 S/C IF PERMIT PRICE GOES
BEYOND $1,000.00)
- $IGNATURE aF PERMITTEE
FQR: CITY OF EAGAN
CONTRACTI
Site Address
Lot ?
m Name
? Addres
c Ciiy -
? Name
? Addres
O City
PLUMBINC PERMIT
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55121
FEES
COMM/IND FEE - 1% OF CONTRACT FEE
MINIMi1M - RESIDENTIAL FEE
MINIMUM - COMM/IND FEE
STATE SURCHARGE PER PERMIT
(ADD $.50S/C IF PERMIT PRiCE GOES
BEYONCS $1,000.00)
?
OF
$10.00
20.00
.50
I FOR GTY OF EAGAN
?
PERMIT # ? 0 ?Q
RECEIPT # Z'
DATE:
BLDG. TYPE WORK DESCRIPTION
Res. New
Mult Add-on
Comm. Repair
Other
N(? FIXTURES
t
Cl
t ZOTAL
s
Wa
er
ose
- $3.00
Bath Tubs - $3.00
EE
Lavatory - $3.00
Shower - $3.00
?Kitchen Sink - $3.00
Urinal/Bidet - $3.00
Laundry Tray - $3.00
loor Drains - $1.50
/ Water Heater - $1.50
Whirlpool - $3.00
,,?Gas Piping Outlets - $1.50
., '
Softener - $5.00
Well - $10.00
Private Disp. - $10.00
? Rough Openings - $1.50
FEE:
STATE S/C: ?
GRANDTOTAL•
c_
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 ?:.
PHONE: 454-8100
BUILDING PERMIT
Receipt #
110135 3
..ti
To be used for 1 OF 4 PLEXEst Value $48,000 Date 1"=ARCH 20 19 .5' G
Site Address 4425 CLOVER LIV Erec! ? x Occupancy R3
EDF.N
Lot
"lock 3 Sec/Sub AUDITIONRemodei ? Zoning pI)
.
-----
Parcel No Repair ? Type of Const *T-
. Addition ? No. Stories
¢ Name GOOD VALUE E1014ES Move ? Length dd
Demolish ? Depth
;
o Address 1460 93RD LN NO
i Int. Impr. ? Sq. Ft
city BLAINEphone 780-5510 Install 0
o Name SAME Approvi
=
0 ¢ Address Assessment _
~ city Phone Water & Sew.
? ? Police
Lug Name Fir
i
? Z e
? a Address En
g.
W
i
City Phone
Planner
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 an=CitOrdi
Si
gnature of Permitt
GOOD VALUE IiOA'iES
Council
Bldg. Off. 3/14/£
Permit $ 274.00
Surcharge 24.00
Plan Review 137 . 00
SAC 575.00
Water Conn. 500.00
Water Meter 63.50
Road Unit 290.00
yTr. PI. 156.00
Var. Date Copies
Total $2. 015 . 5G
A Building Permit is issued to: on the express condition that
all work shall be done in accordance with all applicable State of Mlnnesota Statutes and City of Eagan Ordinances.
;
Building Otticial
PwmR No. PwmN NMrNr Date TeIephone k
Plumbiny
H.v.n.c.
Eleehic
BoMener
Impsctlon Dale Irnp. Canmants
Footln9s I 'j _
CL?
FooNnqs II
Foundarion
Framiny
Roofinp
Rouyh Ptby.
Rouyh Mty. - . 6 ? •
lesul.
Fireplsce,
Final Htp.
Final Plby. ff /(???j _ ? . •
&dp. Final
CM. Occ.
Dsck Ftp.
Deck Frn?p.
WNI
Pr. Dfap.
? f
, PERMIT #
.
,
. MECHANICAL PERMIT RECEIPT #
CITY OF EAGAN
3830 PIL OT KNOB ROAD, EAGAN, MN 55121 DATE:
CONTRACT PRICE: PHONE: 454-8100
Site Add ess 1 BLDG. TYPE WORK DESCRIPTION
Lot Block Sec/Sub
T
_
N
m
Name ew
"
M
uR . -
Add-on
? Address i
C
R
r
omm.
epa
c City<" " Phone Other
Name ' FEES
..
c
Address
RES. HVAC 0-100 M BTU -$24.00
p City Phone ADDITIONAL 50 M BTU - 6.00
ADD-ON AIR COND. 0-24 BTU - 12.00
ADDITIONAL 6 M BTU - 6.00
TYPE OF WORK GAS OUTLETS - 1.50 EA.
Forced Air M BTU COMM/IND FEE - 1°rb OF CONTRACT FEE
Boiler M BTU MINIMUM - RESIDENTIAL FEE - 10.00
Unit Heater M BTU MINIMUM = COMM/IND FEE - 20.00
Air Cond. M BTU STATE SURCHARGE PER PERMIT - .50
(+4DD $.50 S/C IF PERMIT PRICE GOES
Vent CFM BEYOND $1,000.00)
Gas Piping Outlets #
Other
:
, ? Ci •/ %
/
FEE: c- -2, -- -
?
s/C; ? SIGNATURE OF PERMITTEE
TOTAL: ? 4 -
FOR: CITY OF EAGAN
PERMIT #
PLUMBING PERMIT RECEIPT #
CITY OF EAGAN
3830 PIlOT KN08 ROAD, EAGAN, MN 55121 DATE:
Site
.ot_; 4 c.
,pL Block ? Sec/Sub
? Name 77 ` 1_4 "ti? • 'f :?
a?
? Add?esg ?'`° ?
c Ci1y .?c? • ? Phone'?" K
Name
c Addre,R;
p City /^ Phone
FEES
COMM/IND FEE - 1% OF CONTRACT FEE
MINIMUM - RESIDENTIAL FEE
MINIMUM - COMM/IND FEE
STATE SURCHARGE PER PERMIT
(ADD $.BO S/C IF PERMIT PRICE GOES
BEYOND $1,000.00)
BLDG. TYPE WORK DESCRIPTION
Res. New -
Mult Add-on
Comm. Repair .
%' Other
NQ. FIXTURES
? Water Closet - $3.00
-
?
-Bath Tubs - $3.00
?Lavatory - $3.00
Shower - $3.00
-
Kitchen Sink - $3.00
7-
Urinal/Bidet - $3.00
?
Laundry Tray - $3.00
$???? ?Floor Drains - $1.50
?.? Water Heater - $1.50
•50 _,TWhirlpool - $3.00
'
Gas Piping Outlets - $1.50
Softener - $5.00
Well - $10.00
Privete Disp. - $10.00
h O
i
'? R
oug
pen
ngs - $1.50
FEE
FOR: CITY OF EAGAN
STATE SIC:
GRAND TOTAL:
TOTAL
.`
$
?
?+ - -
CrtiTS ?,fGR SA :. ?? CITY OF EAGAN c,?
3$30 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 11[? ? Z
PHONE: 454-8100 ?
BUILDING PERMIT Receipt #
To be used 1ar Z OF 4 PLEX Est Value $ 4$,0 0 0 Date t'IA?CH 2 U 19 $6
Site Address 4425B CLOVER Lh Erect ? x Occupancy }i 3
Lot 11 Block 3 Secisub. EDEN ADDITIONRemodel ? Zoning pp
Parcel No. Repair ? Type of Const u
Addition ? No. Stories
a Name VOOL) VALUE LiOtr3ES Move ? Length 44
Z 196U 93RD LN I+lU Demolish ? Depth 4
a Address Int. Impr. ? Sq. Ft.
City 11f,X?tN&one 780-5510 Install ?
o Name SAME Approvals Feec
?¢ Address Assessment Permit $ 274 . O
~ City Phone Water & Sew. Surcharge 24.0(
?
? Potice Plan Review 137. 0C
F W Name Fire SAC t)-L:=
?; Address Eng. Water Conn. 500 .0(
i W city Pnone Planner Water Meter 63.5(
Council Road Unit 290.0(
I hereby acknowledge that I have read this appiication and state that the
i
f Bldg. Off. 3/ 14 / 8 Tr. PI. 156.0(
n
ormation is correct and agree to comply with all applicable State of
Minnesota Statutes and Ci an Ordi nces. APC Parks
Var. Date Copie
Signature of Permitt
41,
Total , , 5
C'?D VALU$ FiGMES
A Building Permit is issued ta: on the express condition that
all work shall be done in accordance with all applicable State of Mjr;tnesota Statutes and City of Eagan Ordinances.
Building Official- - ?-? ? d ? _ , :
. PsrmR No. PNmM MokNr o.n TM.phon. ?
Plumbinq
K:VA,C. ?f ? o G
EIlC111C
SoMensr
Inspectbn Date, Insp• CommenU
Foorings l ?r )
Footings 11
Foundatlon
Framin9 - 0(A
Roollny
Rou9h Plbp. rS-?F l. ? / / G t.t '
Rouyh Hty. ?.
Insul.
Fkeplace
Flnal Hty.
Final Plbq. ?
Bldq. FInN
Cert. Oec.
Dack Fty.
Dsek Frmp.
WeII
Pr. Dbp.
PERMIT #
...i
' MECHANICAL PERMIT RECEIPT # j c) •?"
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE:
Site Address
Lot Block ? Se4
y Name
? Address c City'
?
m
c
3
O
Name _
Address
Cily -
TYPE OF WORK
Forced Air
Boiler
Unit Heater
Air Cond.
Vent
Gas Piping Outlets #
Other
'.1?-4"? MBTU
M BTU
M BTU
M BTU
CFM
.
FEE
sic:
TOTAL• .:,
BLDG.TYPE
M ult
Comm.
Other
WORK DESCRIPTION
New
Add-on -
Repair _
FEES
RES. HVAC 0-100 M BTU -$24.00
ADDITIONAL 50 M BTU - 6.00
ADD-ON AIR COND. 0-24 BTU - 12.00
ADDITIONAL 6 M BTU - 6.00
GAS OUTLETS - 1.50 EA,
COMM/IND FEE - 1°rU OF CONTRACT FEE
MINIMUM - RESIDENTIAL FEE - 10.00
MINIMUM - COMM/IND FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND $1,000.00)
SIGNATURE OF PERMITTEE
FOR: CITY OF EAGAN
1 `.
PERMIT #
PLUMBiNC PERMIT RECEIPT #
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE: _
Site Addr ` `/ " "
Lot ? Block
m Name
? Addre
c City =
Name
? Addre
O City/_
, FEES
COMM/IND FEE - 1% OF CONTRACT FEE
MINIMi1M - RESIQENTIAL FEE
MINIMUM - COMM/IND FEE
STATE SURCHAFGE PER PERMIT
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND $1,000.00)
BLDG. TYPE WORK DESCRIPTION
b
Res. New
Mult Add-on
Comm. Repair
Other
NO. FIXTURES
' W
t
Cl
t
$3
00 TOTAL
$
er
-
a
ose
.
?-Bath Tubs - $3.00
?. _ 7 ," Lavatory - $3.00
5hower - $3.00
T
- $10.00
20.00
-
- .50 Kitchen Sink - $3.00
Urinal/Bidet - $3.00
=Laundry Tray - $3.00
?Floor Drains - $1.50
Water Heater - $1.50
Whirlpool - $3.00
Gas Piping Outlets - $1.50
Softener - $5.00
Well - $10
00
'
-
.
P ' te i D' $1000
FOR: CITY OF EAGAN
rtva sp. - .
-? Rough Openings - $1.50 `-. .
FEE
STATE S/C:
GRAND TOTAL• -
CITY OF EAGAN
Addit?vn Aden Ad[li_tinn Lot 2? Rlk 3 Parcel #10 227Sn 2AQ 03
Owner ' - street 4423 Clover Lane state Eajzan A9N 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. (p-0 19$2 504.70 100.94 5
STREET RESTOR.
[
GRADING O 1982 32.99- 4E. SO
SAN SEW TRUNK
# SEWER LATERAL 1982 1896.46 379.29
WATERMAIN
* WATER LATERAL 19 5
WATER AREA SRH 1977 62.93 -
4.20 15
? Sarvices 1 82
STORM SEW TRK jQ 1482 256• 00 51.20 rj
?F STORM SEW LAT 19? 5
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER.
SAC
PARK
CITY OF EAGAN Remarks
_EdEIl AC?dit10A
I Additi'on Lot 24 Blk 3 Parcel #Z? 2275
-
I owr,er 7,,' :" ' `'- street 44 23B Clover Lane State Eagan I?IIV 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREETSURF. ?!Q 19$ 504.70 100.94 5
STREET RESTOR.
GRAOING Q((p 1982 2 . 46.6o 5
SAN SEW TRUNK 7
* SEWER LATERAL 1982 1896.46 3T9.29 5
WATERMAIN
* WATER LATERAL 1982 5
WATER AREA
* Services 1982 5
STORM SEW TRK (?l 1$2 256.Qo 51.20 rj
* STORM SEW LAT 1982 5
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER.
SAC
PARK
I CITY OF EAGAN
Additdon
Owner_
Lot 22 Blk 3 Parcel #10 22750 220 03
Street 4425 Clover Lane State Eagan MN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREETSURF. (j D$2 504.70 100.94 5
STREET RESTOR.
GRADING d 1982 232.99 46.60
SAN SEW TRUNK a/ 1974 62.93 4.20 15
?F SEWER LATERAL 1982 1896.46 379.29
WATERMAIN
!F WATER LATERAL 1982
WATER AREA .
1977 62.93 4.20 15
# Services 1982
STORM SEW TRK ? 1982 256.00 51.20
? STORM SEW LAT I982
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER.
SAC
PARK
CITY OF EAGAN Remarks
-
Additaon Eden Addition Lot 21 Rik 3 Parcel #10 22750 210 03
Owner?t; street 4425B Clover Lane State Eagan MIlV 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREETSURF. D .70 100.94 S
STREET RESTOR.
GRADING U 1-0,82 232,99 46,66
SAN SEW TRUNK ?
* SEWER LATERAL j i ' 1982 3-896.46 379.29 5
WATERMAIN
* WATER LATERAL 1982
WATER AREA
*
STORM SEW TRK ? L 1982 2 6.00 1.20
iF STORM SEW LAT 1982
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
LIUILDING PER.
SAC
PARK
INSPECTIDI\1 RECORD
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55 1 22-1 897 Date Issued:
(651) 681-4675
i . . ? . ? - . '. ?
SITE ADDRESS: APPLICANT:
? 1 i iivF k 4. aW.
PERMIT SUBTYPE:
TYPE OF WORK:
; t ryAic+
V tnr_1_ ',;ri?J ar,
Permk Ndder Date Telephone M
SEWER/
WATER
PLUMBING
HVAC
Inspection Date Insp. CommeMs
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYP BOAAD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTQ
ORSAT
TEST
BLDG FINAL
DOMESTIC
METER
IRRIGATION
METER
FLUSH
MAINS
CONDUCTIVITY
TEST
HYDROSTATIC
TEST
BSMT R.I.
BSMT FINAL
OECK FfG
DECK FINAL
INSPECTION RECORD
CITY OF EAGAN PERIIAIT TYPE:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued:
(651) 681-4675
, ?
SITE ADDRESS:
; .i, i I li'Ji li 1 1101
PERMIT SUBTYPE:
1, , i'. T ,r ,
I i,Rk'ti: UNi i
? APPLICANT:
? r, ( ,° ) „ rr1 f.•,+43
TYPE OF WORK:
HI1fI11TNfi
034
A t /NR I()4
V ff'AfTz
Rt'f'I Af t
Mqo0
PermR Holder Dste Tekphone #
EWER/
WATE R
PLUMBING
HVAC
Inepsctlan Dete Insp. Comments
FOOTINGS
FOUND
FRAMING
ROOFING
FOUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYP BOAFD
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.
65MT FINAL
DECK FTG
DECK FINAL
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(651) 681-4675
a
SITE ADDRESS:
1 1 „Ut it 1. nr+t
II 17
I PERMIT SUBTYPE:
I , i, r.r , 1. ,
I ApY:..• IIMt I
PERMIT TYPE:
Permit Number:
Date Issued:
21 APPUCANT:
it?l,'? H?Iti r,'•?1
TYPE OF WORK:
,•, .. I I 1; ,.
It V PA 114
ki f'I Af'f `-? t1"1WG
? ?N --1
L sltulcm I
PermR Holder Date Tslephone #
SEWER/
WATER
PLUMBING
HVAC
InspecHon Date Insp. Comments
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PIBG
AIR TEST
ROUGH
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
HVDROSTATIC
TEST
BSMT R.I.
BSMT FINAL
DECK FfG
DECK FINAL
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued:
(651) 681-4675
f . . .. , . 41 i i SITE ADDRESS: APPLICANT:
i I t1vE R I nNt
PERMIT SUBTYPE:
, ;I ,
us'row to"
h I ;' 1 Nk1R--
TYPE OF WORK:
l??"??("?tt4'tIr1N
F'TS (:(7NS
'r A
kt'i'NIH
irFl'1 Ftl'F ',IUiN(i
F+VAI
?
?
?
Permli Holder Date Telephone S
SEWER/
WATER
PLUMBING
HVAC
Inapectlon Date Insp. Comments
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYPBOARD
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
CITY Of EAGAN WATER SERVICE PERNIIT
3830 Pilot Knob Road - •? -
P. O.+Sox 21 1i)9 PERMIT NO.:
Esgan, MN 55121 DATE: `'
Zoniny: I 4- ?' e-<
„
'un, V, i10 No. of Units:
Owner.
Addros:
Sih Addnss: 4 '? • - . ? c? , ? L ? ; E ? i ,.-r1 Addn.
Plumber: - . , ? -
Merf NO.'
R der Na.: N C ? t F?• lf ;
1.on. eo ee.ryr wMh t`. . . S0p;?
o?.ma,, RE ?uIitE,? ?: t s Q. oo ?.:? ?
Total: 53.501-„ •,,??er
By iw Darc. Paid:
Data of Insp.: Irap.:
7 -/7' 86
CITY OF EAGAN
3830 Pilot Knob Road SEWER SERVlCE PERMIT
P. O. Box 21199 PERMIT NO.:
Eagan, MN 55121 DATE:
Z4f'11f10: NO. Of Uflitf: ? r
Ownee
Address: _
Sit* Addross: 442313 C i ??vL?r ? _i:-. :.''. _ ? -:•i . ___;::. _
Plurnber. .r:?.
1 prw M eeopip wIM 1V Cilr oi ates Connection Chorge:
Oemomom /lcoount Deposit:
PormFt FM: .
Surdwrpe:
By Mise. Chorpes:
Dote of Irop.: Torol:
Insp.. Doft Paid:
CiiY OF EAGAN VNATER SERVICE PERMIT
383' Ntai Knob Road
P. ?; Box 21199 PERMIT NO.:
-Eagsn, MN 55121 D/1TE:
Zoninp: , No. of Units:
' a i? e ome s
I Owrer.
Address:
Sita /?ddrcss: 4423 C aver .ane t ?
Plurrber ."ic.ce. son P um:? in •_? '. . '??;c'
. Meftf NO.: ?Of1 Ch0fge: "
Size: '' p C!G 15. (.i'q)d
Reodsr No.. 0 E1C. 1(1 ?!ii,d
?nd
? ? .N.. e. «.rh? Wab Nn . '
? oa?..a.. oC?JI IIRE? 15' •?. r'n`' '?'
Totol:
? 1ia?r pots Paid:
of Insp.: (rup.:
- ?- ?3 -8?
OF EAGAN 3EWER SERVlCE PERMR
Pilot Knob Road
Box 21199 PERMIT NO.:
i, MN 55121 DATE:
N0. Of Un{fS: /lddreu:
te eoty V16 tV Cft oi gow¦
of Ir?sp.:
COIIMCri011 C}IGfge:
?
ACCOIx* DRposit:
Pamdt FN: • r? i , ?. .'
Surdhwrge:
Misc. Chorors:
Tatcl:
Dotr Paid:
? CITY OF EAGAN WATER SERVICE PERMIT
` 383P 'ot Knob Raad %- Qr?
P..iOX 21199 PERMIT NO.: 7_ _?, r,
E(ysn, MN 551 ?1 DA?:
Zoning: No. of Uniri:
:)ec 'ia iie ::oMt:>
r.
s:
9F76dren:
Pfumber. -,
Meter No.: ?
? er' No.:
-. .. P ?
I soN !e sevwplf? wuh 11w CF&r[lWN
onill".a... T?a?: T?etE.L
BY Dote Pofd:
Date af ins,a.: imv.:
'? - Z 3 -c6 ('-
?CITY OF EAGAN
3830 Pilot Kr.ob Roed
P. O. Box 21199
'Eagan, MN 55121
t Zoning:
?
Ow++er:
/lddross:
Site Addresa: -
Plunber. • ;? ;
I Mee ro aom* wNi 1iw qhr ?f y"e,
Orliwewom
By
Date of Irap.:
SEWER SERVlCE PERMIT `
PERMIT NO.: DATE: .. ' F, `
No. of Unlfs: -' f- =
, .-, •
..00., 0?,nc
Connection Owrpe; 47 l .
Aoooumt DiepOo: 1 ';,
Permit FN: - ,
Su?dhar+pe;
Mlsc. Chorop;
Totol:
Dab Paid:
CITY OF EAGAN
3830 Pilot Kr?ob Road
P. O. 3ox--21199
Eqsn, aAN 551?1
Zoning:
Y
?-00t1 0 l19 iETi_i:S
Owrnr•
WATER SERVICE PERMR
7
PERMIT NO.:
DATE: `a -- 21 - c
No, af Units: ` Ai Ex
/lddrom
. ?, , ? ., •? ^ ? .., ?.
. , _ _ , .
Si» Addross: . .
PIUn'1blr•
C"g
Mehr No.: .? 72 5? v2 ?:
S3ze: '` o S ti?. cl
Rooe.r No.- tl.s.v Qy .9_4K _ atgilk _ _,.??C?S??' •? :-?? ?,t;,,,.?
lv oevoplg wilb Su
M?. ?
UIP-
7 /?z Gs. Q Tot01: _
/?
oor. Pbla:
? Insp.: lnsp.:
r
CITY OF EAGAN SEWER SERVECE PERmff
3830 Pilot Knob Road
P. O. 3ox 21799 PERMIT NO.:
Eagan, MN 55121 DATE: ?: --:3 •-S G
Zoning: No. af Units:
Owrnr. ?lt.- llddrcss:
PSl» Nddnss: ?=425 C'ioce
W ? z--
urnber.
??.eow/Ip ?vMi? Ko Clry of y?m
By
Dote of lnsp.:
Imp.:
'04. 40pr?
Conr»ction (hora, r• ? S _ 7i)r, .
AococN+t Depotih e
Prm+it FN:
Surdwrpe:
Mhc. Chorpm
Total:
Det@ PaM:
Thi,q repuest void T--)- ?J(i?
78 monlh5 (mm 6 q
Q18081 63ob?
flepuest Date Fire No. RouPh-in Insuer.[ion
- pwreA> []Ready Now Will Nolify Inspec-
- ? es ?No lor When Reatly
? Licensed Electncal Convector 1 hereby requast insOecUOn of ebove
? Own¢r electncal work installed aC
Street Address, eox or floute No. Ciry
ec ton o.
-1 ToJinshi0 Name or No. Haoee o. Cow'y?
Occuoant (PqINT) Phone No.
n
V X.
Power Su001ier Atldress
Elec ical Convac[or ICOmUanY Name) Contrucloe's Lice se No.
3 -
-
?
7
7 -
Mai ing Address IConvacmr o^r?Own¢r Makmg Inslallationl m )
14090 _ Tu o
.AyMponzed S.enature (Co actoJOwneM king Installation) Phone Number
MINNESOTp STATE BOARD OF ELECTRICITV
Griggs-Mitlwey Bldg. - Noom N•191
1e21 Univei Ave., St Paul, MN 56104
Phone 16121 297-2111
THIS INSPECTION pEQUEST WIIL NOT
eE ACCEPTEO 9Y THE STATE BOAND
UNLESS PNOPEP INSPECTION FEE IS
ENCLOSEO.
REQUEST FOR ELECTRICAL INSPECTION Btft /ee-ooiwi.oa
1 See inslruchons lor comOlatirp thiz iwm on beck oi Vellow coDV.
? 18081 "X" Below Work Covered by This Request
? V % TvP f B IE g APOl ancee Wned Equiumend Wired
IGT u....,e R?nrue Temoorarv Service
Apt Buildmq Dryei Electric Heabn
Commercial Bldy. fumace Silo Unloader
vM , Fee V Service Emrence5ize n Fae Fexders/5ubteadars p Fee Cncults
0 to 30 Am s 0 io 30 Am o
Amps 31 to 700 qmps 31 to 100 qm s
i
ff Ave 100_mps Above 100-AmPs
ns Irrigation Boorris Partial.'Oth
h
aogns ST /,J V TOTAL ?F#J/1 Qy
Nemnrks L-i IA ?•
?
Fif I, the Elec?l
Or Insoactoq hereCy
certdv Ihet ihe above
c?insOaction hes been
r.(!/ made.
This repuest void /
18 months from S ?3/SI/e
Q 18074 tg`/ 7 - --
?
Re?ues'' ? '
? _? v\
?- Fve Na. Rough-in InsvecUOn
NequrteA?
ONeady Nuw?Will Notrty InsOec-
J
LJ?'?l- J ,es ?NO [or When Ready
[] licensetl Electncal ConUactor I hereby request inspecfion ol ebove
? Owner elactrical work instelled at.
Street Atldrass, eox or Route No.
? l C
?
ecuon o. Towns io Name or No. RanBe No. County
O cvunntlPfllNTI Phone No.
1?•
Power Supplier Adtlress
EI tncal Con[ractor ICompany Namel Convactor's License No
? r tSP' ?= 3 -1 `7 t-) -
Mailmg Address ?Contrecto?Owner Makmp Ins[ailavonl
RI"
H
'i ?
C
Au nie $iB^ature Contraclnr/Owner Makrnp Insta11a1mN Phone NumOer
MINNESOTA STATE BOARO OF ELECTPIGITY
Griegs•Midwey elde. - Aoom N•191
1821 Universiry Ave.. St. Paul, MN 56104
Phona (612) 297-2111
TNIS INSPECTION PEnUEST WILI NO-
BE ACCEPTED eY THE STATE BO'
UNLESS PPOPER INSPECTIO"
ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION ??oo?ot/.oa
/d , See inslrucbons lor completino lhis lorm on back ol yellow ropy.
2' 1 H U 7 4 "X" Below Work Covered by 7his Request r
AAd ..o?. Type ol Bmltling AoVliancea Wirod Equiumen[ Wved
Home Range Temporary Service
Duple,x Water Heater Lightiny Fixtures
Apt. BwlAing Dryer Electnc Heaun
Commercial 81dg. Furnace Silo Unloader
Industna113 IAg, Air Condrtmner Bulk Milk Tenk
Farm otnvr oeu v tner (sneciryl
1 nr Succ'fy Oiher Other
..uiuouie nisuecirun ree aeiow
M Foa Service EnVencaSae tr Fea Fexdars?5ubfeeders tt Fee Ciromts
U to 200 Am s 0 ro 30 qm s to 30 Am s
Above 200 qmps 31 to 100 Ainps ?" 31 to 100 q y
Swinuning Pool Above 100_Amps Above 100_Amps
Transmrmers Irrigation Boorr?s Parual, Other Fee
Signs Special InspecUOn
pemnrks
?
• TOTA ?Er'
J
. ? .
Rough-i^ Date
S? 1 , ihe Elec ncxl
soecbr, hereby
Rnal
D
n
e cerbiy Ihat the above
-
j
c
? ?nqPecban has been
? `?d maea.
ThIS reaueet voltl 18 monlha Imm
This request void S?"?
,a n,onms r.om
o 1 S2nS2g
63oa d
Py2 -
Aequest Date Fire No. Fouph-in'InsDer,twn
equired
ec-
Reatly Nuw II Nouty InsP
E]
^
/ -
?"l? es ? No [or When Ready
[]Licensed Eleclncal Conlractor I hereEy request inaDection of aCOVe
m,.._ elechmel work installed ac
Shee[ Address, 9ox ar Roa1e o. CrtvE
a?'-)
r
ecuon o. TownsMP Name or No. RanBe o. Cow,W??/?)
v_.?/`i?_?
Oc Vant IPflINTI Phone No.
Power SupDher AAdress
C,.. `'
Elecmcal Contraceee IComDany Namel Coniractor.s Licens No.
?-2- ? __7 ? -
en r-
Sc
i
.
?
MaiIInne ess 1 nVac?o?or wner MakinO listailauon)
..u'
3
I
CI
i: ?
Au onzea SignaWre ( nVac10110 ner Making Installabon) tPhpoe?N;unetm, MINNESOTA STqTE eOAND OF ELECTflICITY
Gn9Bn-Midwav BItl9. - floom N-191
1821 UniversitV Ave., St. Paul. MN 56104
Phone 1612) 297.2111
BE ACCEPTED BV THE STATE 80ARD
UNLESS PHOPEH INSPECTION FEE IS
ENCLOSED.
.2 I?? REQUEST FOR ELECTRICAL INSPECTION /EB-00001-04
? ' See instruchons lor comole4ng thia farm on beck o1 Yellow copy. (,36 V L
? 18082 "K" Be/ow Wark Covered by lhis Request
ea. - Tvee of euiieioe Aoohoncea wirod Eqmpmant Wired
Home Range Temporary Service _
Duplex Water Heater Lighhny Fixtures
Apt. Bwldinc7 Dryer Electnc HeaLn
Commerual Bldg. Fumace Silo Unloader
Industnal Bldg. Air Conditroner Bulk Milk Tank
Farm O'hrr oeci v Ohi,r ISner.?fyl
t ar peu y Ot or 71hur
p ••".. .,
Fee r..
SarvmeEnbanceSrsa
9
Fae
Fanders/5ubiexdeos
p
F5e
Circwts
/'.Op 0 to 200 qm s 0 to 30 Am s d• 0[0 30 Am
Above 200 Amps 31 to 100 Amps 31 to 100 Amps
Swimming Pool Above 100_Amps Above 100_Am 5
Transformers Irrigation 8oom5 Pdrtial'Other fee
aigns 'N° °"` SC?L'?•? TOTAL
Rem3rks
I Nough-m Ihe EIe2?AGa? I
j (/C?? VV ?J'? Insoectoq hereby
r tertify thnt the above
CFinal ? U?f'i1e ?nspecUOn hes beon
V'?.y a`C meAe.
Thla roQUesl valU 18 monih6 trom
REQUEST FOR ELECTRICAL INSPECTION ^ Ee-oowi.oa
, See instrucbens tor eomplelirg this lorm on 6ack ot vellow copy.
? 1 g O 8 O "X'" 8elow Wak Covered by lhis Request
1 Add Roc. Type of euddmp ApDic..cea Wired. Eqmument Wired
Home Range Temporary Service
Duplex Water Heater Lighhny Fixtures
Apt. Bwlding Dryer Electnc Heaiin
Commercial Bldy. Fumace Silo Unloader
Industrial BIAg. Air Contlivoner Bulk Milk Tank
Fa
rm om
r, oeci v
otne. (sm,?,rv)
1 er ucu v tAer Oih.r
l.U/DOtlIE I/1SOEC[!00 rP.P SP/OW
M Fee ServwaEntreneeSiie fl eaders H Fex Grcurts
0 to 200 qm s •Q 0 tn 30 Anl s
Above 200 qmps ps r 31 to 100 qm s
Swinming Pool Ampy
=100-Amps Above 100_Am s
Transiormer5 ms Partial.Other Fee
Si gns ction
5
-
Memarks
7 TOTALFE
Y-
;7
Houph.in 1e I. the Elect.ical
InsPector. M1ereEy
Rnal Dnte `°""r •ha, .hn +ueve
inspectianhas been
•? ?' 't `,?? mode.
Thb repueel voitl 18 monllre Irom
Th.c request voitl
16 mpnths from
C 18080
??6 al
Renuest Date Fre No. Rouph-i Inspection
r eq uetl? DReady Now ill Nnufy Insoec-
?
' ?- Yes ?NO or When Neadv
U LicensBd Eleclncal ConVaclor 1 hereby repuast tnapection of aCOve
? Ownr.r elecvwal work installed et
Streat AdAress, Box or Foute No. City
4q a ?er Q.n
ection o. Townshi0 Name or No. Range No. Counly
? C.D 6-
O cuuant (PNWT)
? ? Phone No.
Power $upplier Atldress
k-
Elecencal ConVacmr ICompa
Namel Contra ?? c,mr's License No.
?
r 11 ? -
Mailme Address IContracmr or O ner
Llo ?
^
- ekmp InstatlaLonl
"
L n..?
Aut? czed,5ignature l ntractor Owne r Making Ins[allaUOnl Phone Number
MINNESOTA STATE BOARD OF ELECTXICITY ? THIS INSPECTION HEQUESi WILL NOT
Grigps-Midwey Blde. - Muom N-191 eE ACCEPTED 9Y TME STATE BOARD
1921 Univers,IY Ave., Sc Peul, MN 55109 UNLESS PflOPEfl INSPECTION FEE IS
Phone 16121 297.2111 ENCLOSED.
----------------,
? PeonR Fee:.?2?
j Date Recaived: S
1 !
! Statf: f
I 1
2008 RES{DENTlAL BUILDING PERMIT APPLICA710N
Date: 8ite Address: q? 7_?-:?- Y y -Z? C?C''L? L/U
Tenant:
Suita ffi:
RESIOENT I OWNER Name: QxJJ?i?S y`?C <?? Phone:
Address ! Ciry / Zip:
Applicantis: _Ovmer 41-(Cantractor
TYPE OF WORK Descrip6on of wark: - (Onlp
Construction Gost:??? ?o ?0 Muid-FamNy 6uildng: (Yes / No
CONTRACTOR Name: ?? ?6P?5 Nam?P 4'tm,l?Tp?°? s License #: 7
-
I/
Address:
City: rwV"t,rtq ?(y^} Stake: 0j" 2ip: Z
Phone: '3yZ 5' Contact Person:
COMPtETE THtS AREA OL.Y IF CONSTRUC"f7NG A NEW BUILQING
_ Minnesota Rules 7670 Cateaarv 1 Minnesota Rules 7672
Energy Code . aesiderrcial vermiaaon Careq«y i woacsneet • raew Eneray cade wonssneet
Category Submitted suanmed
(4 SuWitlsslon type) • EnergY Errvelope Calculatl4ns Submitted
In the lest 12 montha, Ues the Clty ot Eagan Issued a permlt fw a similar plan based ai a master plan7
_Yes -Na If yes, date arid adclress of master plan: T
Licensed Piumber: i'hona;
Mechanlcal Contrectoe: Phone:
Saarer 8 Water Contractor: PAone:
N
i herehy acknovAedge that ihis inforcnation iis conplete arid accumte; tfiat ihe wfNk will be tn Canfortnance with the ordinences a'M codes of the Gty of
pertnit; Mat tha wotk will be in
Eapan; that I unAerstand this is not a pertnit, bu[ only an application fa a permit, and work is not to a
accoNance with the ap{xoved p4an in 4fie case W which requires a rewaw ariG approval o
x ? 1176
ApPltcanPs Ptinted Name AppllcenPS Slgneture
Page 1 of 3
.
//? s- ?'S"
1986 BUILDING PERMIT APPLICA?ION - CITY OF EAGAN
NOTS: ALL COdTRACTOBS MQST BE LICSDi3ED AITH THE CITY OF EAGA9
COMMERCI9L SIHGLS F9FIILY DWELLINGS
INCLUDE 2 SETS OF ARCHITECTURAL INCLUDE 2 3ETS OF PLANS
& STRUCTURAL PLANS, 1 SET OF 3 CERTIFICATES OF SURVEY
SPECIFICATIONS AND 1 3ET OF 1 SET OF ENERGY CALCULATIONS
ENERGY CALCULATIONS
$2,000 LANDSCAPE BOND
To Be Used For: ??t?,UAvv Valuation:
Date: --?? °
Site Address 14 (4 9, ,3 & Ci?' ZL"_ OFFICB IISB ONLY
Lot ??/ Block 3 Ereet _ Occupancy _
Remodel Zoning
Parcel/Sub Repair _ Type of Conat
Addition li of Stories
Owner Move Length
Demolish Depth
Address ?y6d 93? G? int.impr. - sq Ft
City/Zip Code
Phone
Contractor
?
Address
City/Zip Code
Phone
Arch./Engr. _
9ddress
City/Zip Code
Phone lf
Install
APPxovALs Fses
Assessments Permit
Water/Sewer Surcharge
Police _
Fire
Engr
Planner
Couneil
Bldg OfP
APC
Variance
Plan Review
SAC
Water Conn
Water Meter
Road Unit
314-a?'?6§Treatment Pl
Parks
Copies
SOTAL
NOTS: ADDRBSSES FOR CORPSR LOTS - COATRACTOR/HOMSOi1AER MDST DFSIGHATB WHICH
ADDRESS IS DESISEU. HO CHANGES NILL HB ALLOTiSD ONCE BDILDING PERlSTT
IS ISSiTBD.
FOR -SALE UNITS CITY OF EAGAN
Np
11655
_
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100
/
7
BUILDING PERMIT 6 ??
a
iieceipt#
Tobeusedtor 1 OF 4 PLEX Est.value $48,000 Date MARCH 20. ?g86
SiteAddress 4423B CLOVE.°. LN Erect C7 Occupancy R3
Lot 24 elock 3 Sec/Sub. EDEN ADDITION Remodel ? Zoning
Repair ? 7ype of Const. V
Parcel No. Addition ? No Stories
4
4
GOOD VALUE HOMES Move ? Length
?
24
= Name RD Demolish ? Depth
o Address Int Impr. ? Sq. Ft.
Ciry BLAINFphone _
Install ?
. o Name SAME APProvals Fees
V 4 Address
?
?
Ciry Phone
?Q
u?i W
Name
?i
? 0 Address
a w Ciry Phone
I hereby acknowledge that I have read this application and state that the
information is correct and agree to comply with all applicable State ol
Minnesota Statutes and Crty oa Or?d'^ances.
Sgnature of Permmee?
A 8wlding Permit is issued toGOOD VALUE HOMES
all work shall be done in accordance with altappiicable State o Minn sc
Building Official
Assessment
Water & Sew.
Potice
Fire
Eng.
Planner
Council
eidg. off. 3/14/86
APC
Var. Date
Permit ? zl4 - u v
Surcharge 24.00
Plan Rewew 137 . 00 ,
SnC 575.00
water Con n. 5 0 0. D 0
WaterMeter 63.50?
Road tlnit 290.00
7r. PI. 156.00
Parks
Copies 2 , O 1 . 5 0
,,,,
r,,
on the express candition that
Statutes and Ciry of Eagan Ordinances.
n ?. ,.
1986 HOII.DING PERlIIS 9PPLIC9TIOH - CITY OF E9GAN
HOtE: 9I.[. COH?RACfORS MOST BS LICENSED VITH iHE CI?Y OF SAGAA
INCLUDE 2 SETS OF ARCHZTECTURAL
& STRUCTURAL PLANS, 1 SET OF
SPECIFICATIONS AND 1 SET OF
ENERGY CALCULATIONSJ
$2,000 LANDSCAPE BOND
SINGLE FAMIELY DiiSLLINGS
INCLUDE 2 SETS OF PLANS
3 CERTIFICATES OF SURVEY
1 SET OF ENERGY CALCULATIONS
To Be Used For: Valuation: Date:
Site Address OFFICE IISE OHLY
Lot a'?3 Block 3
Parcel/Sub
Owner
Address
City/Zip Code ? , ??y3 y
Phone ?'ZQl? -??/ ()
Contractor ?S 4w~
Address
City/Zip Code
Phone
Areh./Engr. _
Address
City/Zip Code
Phone #
COl4NnCIAL
Erect
Remodel
Repair
Addition
Move '
Demolish
Int.Impr.
Install
Occupancy
Zoning
Type of Const
# of Stories
Length
Depth
Sq Ft
6PPROVAI.S FS&S
Assessments Permit
Water/Sewer ? Surcharge
Police Plan Review
Fire SAC
Engr Water Conn
Planner Water Meter
Council Road Unit
Bldg Off L14-8G b?Treatment Pl
APC Parks
Varianee Copies
TOT9L
NOTS: ADDSSSSFS F08 COBHSB IARS - CUNTHACTOfi/HOMADi1BE9 MOST DFSIGHATE iiHICH
ADDRESS IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BIIILDIHG PBHMIT
IS ISSIISD.
FOR> SALE UNITS CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121N2
PHONE: 454-8100
BUILDING PERMIT
11654 ;
Fleceipt# /f/G'7')? Z
7obeusedfor 1 OF 4 PLEX Est.Value $48.400 Date M"i ZO ,1986
SiteAddress 4423 CLOVER LN Erect C? Occupancy R3
Lot 23 Block 3 Sec/Sub. EDEN ADDITION Remodel ? Zoning PD
Parcel No Repair ? Type of Const. V
. AddiUOn ? No Slories
GOOD VALUE HOMES Move ? Length 44
? Name d
z 1 RD Demolish ? Depth?
# Address I
t
I ? S
Ft
?
BLAINE
Ci n
.
mpr.
? q.
.
p
ty hone Install
°C SAME APPravals Feea
i
$ ¢ Address
? Ciry Phone
?a
F W
Name
Address
a w o Name
City Phone
I hereby acknowledge that I have read this application and state that [he
information is correct and agree to comply with all applicable State of
Minnesota Statutes and Ci of? Ordina es
• -E?• i C l
Signature of Permittee Z
A euildmg Permit is issued to. GOOD VALUE AOMES
all work shall be done in accordance with,all a&licable State f Min sc
Assessment
Water & Sew.
Police
Fire
Planner
Council
Bldg. Off. 3 1
Var. Date
Permit $ 274.00
Surcharge 24.00
Plan Review 137.00
SAC 575.00
Water Conn. 5 0 0. 0 0,
water nneter 63.50
Road Unit 290.00
rr. PI. 156.00
Copies
7otal $2.019.50
on the express condition that
SWtutes and Ciry of Eagan Ordinances
Building Official
1986 B[?II,D7NG PfiRlIIT APPLICATIOH - CITY OF EAGAH
HOYS: ALL COBYRACTORS MOST SB LICSNSED WITH THE CITY OF EAGAB
COM4MERCIAL SINGLE FAAIILY DiiS[.LINGS
INCLUDE 2 SETS OF ARCHITECTORAL INCLUDE 2 SETS OF PLANS
& STRUCTURAL PLANS, 1 SET OF 3 CERTIFICATES OF SURVEY
SPECIFICATIONS AND 7 SET OF 1 SET OF ENERGY CALCULATIONS
ENERGY CALCULATIONS
$2,000 LANDSCAPE HOND
To Be Used For: flValuation: Date: ,?-
Site Address Y`i"a ?Uo ""^ X- OFFICE IISS ONLY
Lot ? Block ?
Parcel/Sub
Owner 422??
Address
City/Zip Code
Phone ?;?W -??-?/o
Contractor
Address
City/Zip Code
Phone
Arch./Engr. _
Address
City/Zip Code
Phone #
Erect
Remodel
Repair
Addition
Move
Demolish
Int.Impr.
Install
Oecupaney
Zoning
Type of Const
# of Stories
Length
Depth
Sq Ft
9PPROVALS FSES
Assessments Permit
Water/Sewer Sureharge
Police Plan Reniew
Fire SAC
Engr Water Conn
Planner Water Meter
Council Road Unit
Bldg Off 3. e6SibTreatment Pl
APC Parks
Variance Copies
TOTAL
NOTS: ADDEESSES FOR CORASR LOTS - COATRACTOR/HOMEOWNES M[JST DFSIGNATE iiHICH
ADDRESS IS DESIRffi. NO CH9NGES WILL BE 9LLOASD ONCS BDILDING PERMIT
IS ISSIIED.
FOR SALE UNITS CITY OF EAGAN 11653
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 551121N2
PHONE: 454-8100 e? 7.?_ ?
BUILDING PERIVIIT Receipt# 86
?RCH 20
$48?000
1 OF 4 PLEX Est. Value
oate
19_
To be used lor
L? R3
ancY
Occu
4425 CLOVER LN Erect PD
p
SiteAddress EDEN ADDITION Remodel ? Zonin9
?
Lot z 2 Block 3 Sec/Sub. Repair ? --d
Type ai Consi.
Parcel No AddiUOn ?
? No. Stories Q Q
Length
GOOD VALUE HOMES Move
Demolish ? Depih?i"-
= Name
W 1460 93RD LN NO Int.lmpr. ? Sq.Ft-
o Address 750-5$1?
???,BLAINE phone Install ?
Fees
t?Addre
Phone
Phone
I hereby acknowledge that I have read this applicaUOn a cable statethatthe
information is correct and agree to comply with all appI?
Minnesota S[aWtes and City Ja9/a? Ordm?a/qces.
Signature of Permitte '2 ""
GOOD VALUE HOMES?
A Building Permit is issued to:
all work shall be done in accordance with all a lic le Stat? f Min es?
t
8uilding Official
O
Assessment Permit-?p0 ,
Water&Sew. Surcharge 137.00
Police Plan Review 575.00
Fire SAC 500.00
Eng. Water Conn. 63 . 50
Planner Water Meter 29 ?. 00 i
Council Road Unit
00
156
.
3/1-4/8 Tr. P?.
Bldg. Off.-
APC Parks
Var. Date Copies 2 019 , 50 ,
Total $
? - on the express condition thet
?
I?q. awtes and Ciry of Eagan Ordinances.
7? __
1986 HIIII.DING PERlIIT 9PPLICATION - CITY OF EAGAN
60TE: 9LL COA?RACTpRS MOST BE LICEBSSD WITH iHE CITY OF EAGAN
3INGLS FAMIILY DiiSl.LINGS
INCLUDE 2 SETS OF ARCHITECTURAL INCLUDE 2 SETS OF PL9NS
& STRUCTURAL PLANS, 1 SET OF 3 CERTIFICATES OF SURVEY
SPECIFICATIONS AND 1 SET OF 1 SET OF ENERGY CALCULATIONS
ENERGY CALCULATIONSJ
$2,000 LANDSCAPE BOND
To Be Used For: Valuation: ? o?? Date:
Site Address g V?n? X, OFFICS DSE ONLY
Lot ??/ Hlock ,-3_
Pareel/Sub ?'?s??
Owner ?•?..?7????e. i/-?r??
Address
City/Zip Code ,/
Phone _ 171qC:5) - 151T/ D
Contraetor ? '00-0te
Address
City/Zip Code
Phone
Arch./Engr. _
Address
City/Zip Code
Phone #
Erect x Oceupaney - (Z 3
Remodel , Zoning PD
Repair Type of Const 'Q
Addition lF of Stories
Move Length 44
Demolish ` Depth ? q-
Znt.2mpr. Sq Ft
Install
9PPROVAIS FSSS
Assessments Permit 2-74'•
Water/Sewer Surcharge 24-
Police Plan Review l 3
Fire SAC 575-
Engr Water Conn 500.
Planner Water Meter h 3-$O
Council Road Unit
Bldg Off3 14•er- Sa8 Treatment Pl (5(p.
APC Parks
Variance Copies
TOTAL
NOTS: ADDBESSSS F06 CO@9SR IATS - CONTSACTOE/HOMEOWNEE MOST DESIC,NAYE W9ICH
ADDRESS IS DfiSIRED. HO CHANGFS iiILL BS ALLOi1BD ONCE BOILDING PERlfTT
ZS ISSQED.
UNITS FOR SALE CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
. •PHONE:454-8100
BUILDING PERMIT
Receipt #
1 OF 4 PLEX $48,000
te
D MARCH 20 1986
.To be used for Est. Value a
4425B CLOVER LN
Erect ,.y
L]" R3
Occupancy
Site Address
EDEN ADDITION
3
21
Remodel
? p
Zonin9
Sec/Sub.
Block
Lot Repair ? Type of Const. V
r
el No
P ? S
.
a
c Addi4on tones
No.
GOOD VALUE HOMES Move ? Lengih 64
W Name Demolish ? Depth------------ $
; Address 1460 93RD LN NO Int Impr. ? Sq. Ft.
° City BLAINE phone 780-5510 Install ?
o Name SAME
Address
?
Ciry Phone
w W Name
?
Address
c w Ciry Phone
I here6y 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 antl Ciry• gan Ordinances.
/'
Signature of Permittee ?
HOMES
A Building Permit is iss GOOD VALUE
ued to.
all work shall be done in accordance with all applicable State ol yinesc
Assessment_
Water & Sew.
Police -
Fire
Planner
Council
BIdg.Off.3 14 86
APC
N0- 11652 1
?Q 7, -d
2 74. 0 C
Permi
h
S ?' 0 C
arg
urc 137.0(
Plan Review-
SAC 575.00
5 0 0. 0 C
Water Conn.
63.5(
Water Meter 290.0(
RoadUnit
7r. PI. 156.0(
Var. Date I Copies?= 5?
i
- on the express condition that
Ea9an Ordinances.
Building Official
PERMIT
.CITlC OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(651) 681-4675
PERMIT TYPE:
Permit Number:
Date Issued:
8 uzL D 1016
039354
0l!@8/99
SITEADDRESS: 4 42 be rLovFR tANe
LnT: zi aLor,t;: s
EuE ni
P.I. N. : 10--22750--2147-0 3
DESCRIPTION:
REPI,ACE SIDIN6
E?uildiiftcr,Permit Type STOf2M DAMHGE
F)tjildina Worh l"yae RFPAI"R
rCensus Code' 434 ALT. 12ESIDEN7IAL
;
?
1
'
..
REMARI(.S: B
FEE SUMMARY
CONTRACTOR: - aoplicant - sr. L7t:• OWNER:
CUSTOM CONCEpTS CONST 18987290 20142417 I-IAfJSON PATRIC'CN
16540 KENRZCK LQOP/STE B 44258 CLOVER LFlNF
LNKEV1LlE MfV 55049 EAfAN MN 55122
(692) 899-7290
IL
I hei-eby acknow!.edne that I have reud this doplication and stato that the
intormaCian is cprrect and aoYe2 to comolV witH ali anolirable State oY Mn.
Statutes and City of Eaqan t)rdiriances.
APPLICANT/PERMITEE SIGNATURE
_?ti 9ti ?Q A?l?
ISSUJD BV. SIGNAT E
1999 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD - 55122 pq
(651) 681-4675
New Construction Reqwrements
? 3 registered site surveys
? 2 copies of plans (include beam & window sizes; poured fnd. design; etc.)
? 1 energy calculations
? 3 copies of tree preservation plan if lot platted after 7/1l93
required: _ Yes _ No
DATE: 4- 7 -99
RemodellRepair Reauiremenls
? 2 copies of plan
? 1 sile Surveys (exterior additions & decks)
• 1 energy calculations for heated additions
CONSTRUCTION COST; ?? 7S
DESCRIPTION OF WORK:
STREETADDRESS: "f-12-s?? I?IChILr t ct np
LOT: ') I BLOCK: SUBD./P.I.D. #:
Name:- ------- - - ?F"? l C Phonc #: -----------
--------------------
PROPERTY ?"' m
( )?XINFIR
Su'cet Addiess: - ----------------------------------
Cil}' ----- ------------ -------- Stalc: ----- --- --- "/_ip:
? ----
----`--C.? C..C9 ?i( ? - Phone Y: Jc?IC-?? 7? =G'?
C'ompan}': /d ? 6_ ??
COV"11tACL'OR
--
/
City --------? -l?----------- --- State: ----- Lip' `?-----
,?RCHITECT/
ENGINEER Compau}':---------------------- ------ -- Phoue tt: --------------- ------------
N.unc'--- ----------------------------- Registnnon ---
Slrcet Addres's:----------- -- -----------------
Gtv ---------- Slale: -------------- - Zip:
Sewer & water licensed plumber (new construction only): _
change and lot change is requested once permit is issued.
Penalty applies when address
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applica6le
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant:
OFFICE USE ONLY
Certificates of Survey Received _ Yes
Tree Preservation Plan Received _ Yes
,
r-
- No , --- ;I
No Not Reqwired
?
PERMIT
CITI( OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(651) 681-4675
SITE ADDRESS:
10-22750--220-03
/
DESCRIPTION:
RtPLACL"
Ba:i.ldina' Perm.it iype
t3'uildinq Oork Type
,Census Gode
i ,
?
I C
,
?
i'
PERMIT TYPE: B IJ I i, o z N r
Permit Number: 034363
Date Issued: 01 / 08! 9 9
51:UING
.roizm c,nmAGF
REPAIR
43,0. ALT. i2ESTDENTTAL
REMARKS:
FEE SUMMARY:
CONTRACTOR: - NpplicUnt - sr. i..zc. OWNER:
CUSTOM CONCEPTS CONS7 1898%290 20142417 RIDGLWAY ftUUREY
15540 KENRSCK I.OOP/STE B 4425 CIGVEk IANE
LAKFVILIE MN 55044 EAGAN MN 55122
(612) 398- 72yO
Z hereby acknawledqe thaC L have read this aoplicat.ton and staTe that the
intormation is correct anrl auree to comoLy with all applicable 5iat:e oT mn.
Stat.utes and CiT.y of Eaqari drdinanc:es.
?
APPLICANT/PERMITEE SIGNATURE
4425 CLOIrER IFlNE
LOT: 22 EilOi.K: 3
EDI_N
?
I55 D BY: SIGNATURE??
- - 1999 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN q
3830 PILOT KNOB RD - 55122 1
(651) 681-4675
New ConsVUC4on Reqwrements
? 3 registered site surveys
? 2 copies oF plans (inUude beam & window sizes; poured fnd design, etc.)
? i energy calculalions
? 3 copies of tree preservation plan if lot ptatted after 711193
required, _ Yes _ No
DATE: ! ` -7-9 ?I
Remodel/Reoan Requirements
? 2 copies of plan
? i site surveys (exienor addihons & decks)
? 1 energy catcula[ions for heated additions
CONSTRUCTION*COST; /? 7S
DESCRIPTION OF WORK: .1)(A?\?c„! tG i na
1514-
STREET ADDRESS: vr '` ? 5 ?X C?l ju lAn?O
LOT: ? a BLOCK: J SIJBD./P.I.D. #:
Varnc? (A)CLM- _ u?[r _ Yhone #:
PROPERTY < < Fiisr
( )bVNl:lt
SLrcct:lddress:
City
State:
Lip:
(:cunpuiy?:----? _- ??---?y ??p lI one #: ?lLo1?JL-? --------
cov??ii,?crox
Stneet Address: -1,0,/ License N??Zk12_-E?P' ----
CIC6'
ARCHITECT/
ENG[NEER ComF
Nnme
Strcct
City
Sewer & water licensed plumber (new construction only):.
change and lot change is requested once permit is issued.
Penalty applies when address
1 hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable
State of Minnesota Statutes and Ciry of Eagan Ordinances. 1<7„
Signature of Applicant:
OFFICE l1SE ONLY
Certifica[es of Survey Received - Yes _ No
Tree Preservation Plan Received _ Yes _ No
S[ate: ? --- ZiP: --
Phonc #:
----- --- Rcgisiratiou #: ----
------- - ---------- - -
State: ------------ "l.ip:
? .- -j
, n I
;li?ll
i
_ Not Required
PERMIT
CJTY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(651) 681-4675
PERMIT TYPE:
Permit Number:
Date Issued:
BUII_D.CNG
034357_
01!@8195
SITE ADDRESS:
44 23B CLOVER LAPIt=
LOT: 24 BLOCKe 3
EfJf_hl
P,7.N.: 10-22750-240-03
DESCRIPTION:
REPLIICF 5IDINf3
BuiLdinaiPermit ivpe SIORM DAMAGE
8uildinq Wc.rk Typ2 flFPA.T.R
;-CR nsu, Code? ? 434 HLT. RESTDEIYTIAL
?.
!
i ?
i
?
\ \ ... . ? _ _ .
. ??v? I. .. .
REMARKS:
lJNll E.
FEE SUMMARY:
CONTRACTOR: - FlpPlzcar'C - 'r. i_iE:. OWNER:
CUSTOM CONCEPT3 CONST 18987290 20142417 ^TUCJ!-1NSKI TREVOR
16b40 KENRICK LOOPJS7t= B 44238 CLpVER I.ANE
LFlKFVILLE mN 55014 EAGAPI MN 55122
(67.2) 8 9 8 - 7 2 9 0
IL
:[ herebv acl:nuwdedqe that I have read tPiis apnlication iinci s,'tate thaL- the
intormation is correcs: and aqree to cuniUlv wit.,h a11 applicable Stare ot Mn.
;;ratutes ,and Citv ot Eaqar. Grdinances.
APPLICANT/PERMITEE SIGNHTURE
?? eq--?'-pm
ISSU Y: SIGNATURE
1999 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
3830 P(551) 680 4RD - 55122 ? a
l
New Construchan Requirements
? 3 registered site surveys
? 2 copies of plans (inGude beam & window sizes; poured fnd. design; etc.)
? t energy calculations
? 3 copies of tree preservation plan if lot platted after 7/1/93
reqwred: _ Yes _ No
DATE: j -7-q s(
DESCRIPTION OF Wi
STREET ADDRESS:
RemodeURepair Reouirements
? 2 copies ofplan
? 1 site surveys (exterior additions & decks)
? 7 energy calculations for heated additions
CONSTRUCTION COST; q37S
LOT: BLOCK: ? SUBD./P.I.D. #: Z??-
N:une: Sl U P)5U _ Tr eJO r?, Ca ?'In Phone #:
PROPERTY i'"`t
OW:V L:R
S[rect :lddress:
Ci[y.
State:
Zip:
l.? N _(..'_Q_pr? _ Phoue ti: (2a_? 1__L_?f!0!
CaN"1'12AC C012
Street Address:?,u?d ??-Pi?/l? c?_?? ? _ Idcense ?! ?D?rZ_Lap• ___
c«> ---------- --- st:,te: _.a%L? _ z;n: _.?T'o ?/`?------
-?--v------------ ------ - -
ARCHITECT/
E\'GNEER
Strcct
Citv
Sewer & water licensed plumber (new construction only): _
change and lot change is requested once permit is issued.
Penalty applies when address
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applica6le
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant:
OFFICE USE ONLY
Certificates of Survey Received _ Yes _ No
--------- Phone #: ------
--- Registrition ----
------------ ----
State: ---- -- %ip:
Tree Preservation Plan Received _ Yes _ No - Not Required
PERMIT
CLTY OF EAGAN
f 3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(651) 681-4675
PERMITTYPE: BujLD1Nr
Permit Number: 0 343 51
Date Issued: 01 / 0 8/ 9 9
SITE ADDRESS:
4423 CLOVER I..HItlE
I_QT; 23 6LOCK: 3
[IJEN
P.I.N.: 70-22750-230-03
DESCRIPTION:
, REPLACL'- SIOIIVG
8uildina'Permit Tvpe STORM DFlMAUE
9u.ildinq Oark Type REPAIR
jCpnsus Coda 4LR4 AI.'i . tdG.STOENTiAL
?
i"
/
?
? i
J l.
REMARKS:
FEE SUMMARY:
CONTRACTOR: - APPlicant - sT. LIc. OWNER:
CUSTOh CONCEPI"S GONST 18987290 20142411 JQHNSUN LOWELL
16590 KENiRICK LUOW/STE Q 442'3 (:l.,OVFR LFlNF.
lldKEV1LLE MN 55094 EAGAtd MN 55122
(612) 896-7290
I Fi2reby acknowled4e that I have read Y.his applicaTiun and staY.e tha* -,he
ini-ormat3on is correct and aaree to complv wi.t'h all applicabie 5tate ot mn.
Statutes and Citv c+Y Eaqan Or•dinances.
I
APPLICANT/PERMITEE SIGNATURE
IS D BV: SIGNATURE
1999 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
7J l( 3S- l 3830 PILOT KNOB RD - 55122
?? (651) 681-4675 q
1_Q.l
(l
New Construction Requirements
? 3 registered site surveys
? 2 copies of plans (include beam & window sizes; poured fnd, design; etc.)
? t energy calwlations
? 3 copies of Vee preservation plan if lot platted after 7f1/93
reqwred: _ Yes _ No
DATE: / ' 7 -
DESCRIPTION OF WORK:
Remodel/Repair Reauirements
? 2 copies of plan
? 1 site surveys (exterior addinons 8 decks)
? 1 energy calculahons for heated additions
CONSTRUCTION COST; % 3 7S
STREET ADDRESS: L??'I a3 ?? 6\1 Q`V-oR ?
LOT: D- BLOCK: _7?_ SUBD./P.I.D. #:
V:une:__??Y l-=`----°_? 1S? ??LCSGC Yhonc#: ---------
PROPERTY t:u? Fvst
OWNEx
Sveet Address:------------------------------- --------------------
City --- ---------- -- State: ---- ---- "Lip:
CON'1'R:\CPOI2 Compw}':__ ?h/S Plwnc #: ------- --
/?(/('? !?-
'J _ License #2aL6&1___ ExP• __-
S[reet Acldress:li.(2??1?'_ T/ l kq?
c«y ------------ 4-11 - ------------------- st,ce: X-Z V- -------- %'p: ----
ARCHITECT/
ENGTYEER
Phonc #:
Rc?isuatioii #:
tiu-eet Address:--- ---------- ------------ ----- ---
c;Lv ---- scs«: -------- ------- zip:
Sewer & water licensed plumber (new construction only):.
change and Iot change is requested once permit is issued.
Penalty applies when address
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable
State of Minnesota Statutes and City of Eagan Ordinances.
Signafure of Applicant:
OFFICE USE ONLY
Certificates of Survey Received _ Yes
Tree Preservation Plan Received - Yes
--
?
I
No
_ No _ Not Required
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Duplex ? 11 Apt./Lodging ? 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
0 32 Addition ? 34 Repair ? 37 Demolition
GENERAL INFORMATION
Const. (Actual) Basement sq. ft.
(Allowable) Main level sq. ft.
UBC Occupancy sq. ft.
Zoning sq. ft.
# of Stories sq. ft.
Length sq. ft.
Width Footprint sq, ft.
APPROVALS
Planning
Permit Fee
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
Copies
Total:
Census Code
SAC Code
Census Units
Census Bldg ,
MC/WS System
City Water
Booster Pump
PRV
Fire Sprinkiered
Building Engineering Variance
Valuation: $
% SAC
SAC Units
CITY OF EAGAN
APPLICATION FOR PERMIT
SEWER AND/OR WATER CONNECTION
*IOTF: PAYM6Plr OF kEE AT TIME OF
APPI.ICA1"ION WES DIOT 0U3SPINIE
APPROVAL OF PII2NIIT.
INSPECTIorr oF sEWM Arm/ox W)TEa
IM=amrONS WILL N0T BE S(HED-
[II.ID UNi'IL PIItMiT HAS BEEN
APPROVID.
P ease Print
1) PROPERTY ADDRESS: ??-"y?7,?' C?p?'iC-,E' ??j?c/E •°
LEGAL DESCRIPTION:
Lot Block Subdivision or Tax Parcel ID
IF E}ISTING SIRL'C.'IS7RE, DATE OF ORIGINAL WILpING.pM,uT ISSL'ANCE: •. .
i •
PRESEW 7ANING/PROPOSID CSE: (l`bn Year
Q COMMEE2CIAL/REPAIL/OFFICE ? R-1 SINGIE FAMILY
? INIDC'SZRIAL ? R-2 DLPLEX (Ttwo Units)
? INSTIZL7TZpNpI,/Gp?n• ? R-3 ZUWNE3OLISE (Three + Units ) ( Onits)
p R-4 ApARTMENT/CODIDOMINILT7 ( Units)
2)
NANE:
ADDRESS e _ ?,(`,-?-
CITY, STATE. ZIP: d?LLL:C?(?tiL
PxorE: 3
3) •
•
u c?
NAME: or City Use
ADDRESS: Plumbers License:
Active
CITY, STATE, ZIP: . ? Expired
Not recorded
?ONE' MAS1'ER LICENSE#
St II11t1d1
4)
NA"E'
_ aDDREss : c -
cxxY, srazE, zzp:
PxorE;
6
•5) ? u a• ? a: •?• : a • a? • a?
? CONNECTION TO CITY SEWIIt ? CpNMCrION 'N CITY WATER
6) '? `' ?•?• ? PI.EASE HOLD APPROVEEa PERMIT FC)R PICK-UP BY ONE OF ABOVE
PLFdaSE MAIL APPROVID PERMIT ?`0 1, 2, 3. 4? AEOVE
(Circl
??i e one)
7) r.r_ ?u: • ?.R_.?7? ?? ?i? ? _
FOR -CITY USE ONLY
PERMIT # ISSUED
7L2 S L F h
Pd w/Bldg. Permit FEES:
$ $ /D S-0 SEWER PERMIT (INCLUDE SURCHARGE)
$ $ ?U S U WATER PERMIT (INCLUDE SC'RCHARGE)
$ $
WATER METER/COPPERHORN/OCTSIDE READER
$ $ WATER TAP (INCLt!DE CORPORATION STOP)
$ $ SEWER TAP
$ $ ACCOUNT DEPOSIT - SEWER
$ $ S•?rt? ACCOUNT DEPOSIT - WATER
$ $ WAC .
$ S7S , a-z? $ sac
$ $ TRiJNK WATER ASSESSMENT
$ $ TRCNK SEWER ASSESSMENT
$ $ • LATERAL BENEFIT/TRUIVR SEWER
$ $ LATERAL BENEFIT/TRUNK WATER
$ $ WATER TREATMENT PLANT SURCHARGE
$ $ OTHER:
$ A2 $ TOTAL
?G r?O? U I?
RECEIPT RECEIPT
DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
F__j YES IF YES, THEN A"PERMIT FOR WORK SVITHIN PUBLIC
Q ROADWAY" MUST BE ISSUED BY THE ENGINEERZNG
NO DIVISION. LIST AS A CONDITION.
SUBJECT TO THE FOLLOWING Cb[VDITIONS:
APPROVED By;
TITLE:
DATE : ?j?/??
CITY OF EAGAN
APPLICATION FOR PERMIT
SEWER AND/OR WATER CONNECTION
*1r******#*#*********#*t**t**i#***t
,*t DRYPE: PAYMFW OF FEE AT TIME OF
? aPrr.icamoN DoFS Nar oorszi=
: APPR(NAL OF PERMrP.
nvsPDCriorr oF sEWM Arro/ox WNIER
TNR'1•A77ATTON$ S+lILS. [Vdl' $E 5(HgD-
ULID UNM PII2MIT HAS BEM
APPROVID.
?*,r**?*,r**??r*,r*x,r,r**:??*+***? P ease Print
? 1) PROPERTY ADDRESS: ?i?j/???j,/3 C/i U?-1c' ???iE ••
LEGAL DESCRIPTION: •-
_ Lot Block Sub ivision or Tax Parce ID
IF EXISTING STRCGZL?RE, DATE OF ORIGINAL BLILDING PIItMIT ISS[,'ANCE: .
PRESENf 7ANING/pROPOSID USE: Mn Year)
? Ca4MCIALAIETAIL/OFFICE [] R-1 SINGLE FAMILY
? INIDC'S'PRIAI, Cj R-2 DLPLEX (1kv L?nits)
? INSTITUTIONAL/GpVE[tNMENr ? g_3 qpy,lNHpUSE (Three + Units) ( Units)
R-4 APAR'ItIm/COBIDOMINIUM ( Units)
2) 1??
NAME
° /
/C ?/.Sa/s- • _.L
/y
ADDRESS: ? 6 x- j? Ss' .
CITY, STATE. ZIP : ?C /3 h/ G?1 /9 //'? N 5.$?G 7?
PxorE: c/ ? 3 - .> / '7 /
3) • u ?:?•
??- For City Use
Plumbers License:
ADDRESS: Active
CITY, STATE, ZIP:
' . bcpired
PHONE:
MASTEB LI(ENS
E# Not recorded
Staff II11t1d1
4) •.. • ?..i.i?;
NAME: _ ?? C?c? L? .? ?t,t /7?rm??
_ ADDRFSS: / SlG p- -l'13 .? J? lY C
CITY, STATE, ZIPe ?j?{4 /it?C f'yJ ic/
F PHONEs O .
'S) ? '? v ? a• • ?• ; a • a• • ??
CONNECTION RO CITY SEMT2 ? CONNDCfION TO CITY WATER rl M'f?R '. .
6) '? •-'?- C] PLEASE HOLD ApPROVID PERMIT FOR PICK-UP BY ONE OF ABOVE --
PLE,n,SE MASL APPROVID PERMIT Z+0 1,? 3. 4. APOVE
ICirole one? '
r. ?. u• - 2:??? '?' A
7) Z
?
. F'OR CITY USE ONLY -
PERMIT # ISSUED
Pd w/Bldg. Permit FEES:
$ $__ /6 ' SZ1 SEWER PERMIT ( INCLDDE SURCHARGE)
$ $ /D S? WATER PERMIT (INCLUDE SLRCHARGE)
$ $
WATER METER/COPPERHORN/OCTSIDE READER
$ $ WATER TAP (INCLODE CORPORATION STOP)
$ $ SEWER TAP
$ $ ACCOUNT DEPOSIT - SEWER
$ $ ACCOIINT DEPOSIT - WATER
co C' $ WAC
$ vT 75`. ?ra $ SAC
$ $ TRLNK WATER ASSESSMENT
$ $ TRUNK SEWER ASSESSMENT
$ $ • LATERAL BENEFIT/TRUNK SEWER
$ $ LATERAL BENEFIT/TRLNK WATER
$ /s??J j? $ WATER
TREATMENT PLANT SLRCHARGE
$ $ OTHER:
$ 9 $
TOTAL
G E ?? r3 ?// 3
3
RECEIPT -
RECEIPT
DOES LTILITY CONNEC TION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
? YES IF YES, THEN A"PERMIT FOR WORK 6VITHIN PUBLIC
Q ROADWAY" MUST BE ISSOED BY THE ENGINEERING
NO DIVISION. LIST AS A CONDITION.
SUBJECT TO THE FOLLOWING CONDITIONS:
APPROVED By; y?? ??{]7,?a
TITLE:
DATE:
CtTY OF EAGAfV
APPUCATION FOR PERMIT
SEWER AND/OR WATER CONNECTION
****f*#**i##****f*f#?****##**+i#
N02E: PAYM6N.C' OF k'EE AT TIME pF
aPrr.icxTzorr ooES Nar corszz=
APPROVAL OF PERNIIT.
arsrncizoN oF sEWOt r,rro/ox WAIEt
IMMUAMONS WII.L I`]0'I' SE.' $Q-II'D-
ULkD pNPIL PII2[-1IT AAS BFISI
APPROVID.
-****+,r #*,r ?* **** *,r*++*##*#*++* *,r * * P ease Print
1) PROPERTY ADDRESS :
LEGAL DESCRIPTION: -
. Lot B ock Subdivision or Tax Parce ID )
IF FJCISTID7G STRCL'IVRE, DATE OF ORZGINAL BLILDING.PERMIT ISS['ANCE:
pRESETTP 7ANING/pROPOSID USE: Mon Ye?
Q COL+RERCIAL/REi`AiL/OFFICE ? R-1 SINGLE FAMILY
Q IPIDCSTRIFIL R-2 DLPLE}C (1Wo L?nits)
INSTITL*rIONAL/G0Va2Zff= ? R-3 40WDIIi00SE (Three + Units) ( L?nits)
• [? R-4 APARTPENT/CpfIDpMINILTI ( Units)
Z) ff??
NAME:
ADDRESS: 21
CITY, STATE, ZIP:
PHONE: yj 3 - 5 / "7 /
3) u .?•
NAMEc
i
ADDRESS: S /a ?Y1 F
GITY, STATE, 2IPe
PFIONE: MASTER LICIINSE#
r.Lumaers i,icense:
Active
E?cpired
Not recorded
St?tial
4) .•. • • •..iu??
- D]AME:
ADDRESS:
CITY, STATE, ZIP:_/3/f3/NE /S/ .
PHONE: ?.?-0
-5) a: ?OI• : op . oo • a(a
? cocvNEcriorr To crrsc sEwm Ca' coMEcrioN To cixY wATEa ? o=_.
6) ? •? •?• [? PLEASE HOLD APPROVID PERMIT F'OR PICK-C'P BY ONE OF ABOVE
? PLEASE MAIL APPROVID PEE2MIT TO 1, 2? 3, q, pB0?7E
/1 i. r • IC'i rrl c ..ns\
FOR CITY USE ONLY
PERMIT # ISSUED
Pd w/Bldg. Permit
$
$
s ?3- S-6
$ -
$
S
S
$ ea d
S
$
$
$
$
$ /cS7o • U C?
$
,, .
FEES:
$ S---z? SEWER PERMIT (INCLUDE SURCHARGE)
$ /D' SD WATER PERMIT (INCLUDE SURCHARGE)
$ WATER METER/COPPERHORN/OL'TSIDE READER
$ WATER TAP (INCLC'DE CORPORATION STOP)
$ SEWER TAP
$ /SD U ACCOUNT DEPOSIT - SEWER
$_ /r? , e- L ACCOLNT DEPOSIT - WATER
$ wAc
S
$
$
$ •
$
$
$
SAC
TRUNK WATER ASSESSMENT
TRUNK SEWER ASSESSMENT
LATERAL BENEFIT/TRUNK SEWER
LATERAL BENEFIT/TRUNK WATER
WATER TREATMENT PLANT SURCHARGE
OTHER:
$ ?a? 1 y S-U $ Jr?' O-7J TOTAL
(le`6D /33
RECEIPT RECEIPT
DOES LTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
F--j YES IF YES, THEN A"PERMIT FOR WORK iVITHIN PUBLIC
Q ROADWAY" MOST BE ISSUED BY THE ENGINEERING
NO DIVISION. LIST AS A CONDITION.
SDBJECT TO THE FOLLOWING CbNDITIONS:
APPROVED BY:
TITLE:
DATE: ? ;j???
' ..
CITY OF EAGAN
APPLICATION FOR PERMIT
SEWER AND/OR WATER CONNECTION
PTOT;3: PAYMF:Nr OF M AT TIME OF
APPI.ICAIZON DOES IVCYr OONST21[TIE
APPROVFL OF PERDIIT.
itasrncrzorr oF sUM Arm/oa WATM
rntsrar.ramrpN5 Hrrr7• NOT gg SQg1}-
ULFD UNlIL PERMIT FiAS BEFSI
APPRWID.
° xxxxrr:xx.zrryerr?ry.,rxv?».x:?ner:swu:?rax
P ease Print
? 1) PROPERTY ADDRESS: y?j??-r3 C/G L? F.e I.J-V{, °
LEGAL DESCRIPTION: •-
. Lot Block Su division or Tax Parce ID )
IF EXISTING S'TRCCMTE, DATE OF ORIGYNAL BLILDING.PERMIT ISSC'ANCE; . .
PRFSEENP ZONING/pROPC)SID LSEs bn ear
? CaIERCIAL/RETAILJOFFICE
r7 I '?DL'STRIAL
[::] INSTITL?TIONAL/GpVERNMENT
2) ?
NAME:%f
C] R-1 SINGLE FAMILY
0 R-2 DL?PLEX (Ttao C?nits)
? R-3 ZOWNHOUSE (Three + Units) ( C?nits)
? R-4 APARTNENi'/CpAIDOMiNILT1 ( Units)
ADDRESS: 113 6 X % .2 j% -
CITY, STATE, ZYPc yO/i
gHONEe t/5 3 -5% 7/
3D u i: ?•
NAhIE:
ADDRESS: Active
CITY, STATE, ZIP: . u Expired
Q Not recorded
PH0NE: MASTII2 LICENSE#
4) •.• ? i?- ?^ -
?"E^_C?GO'!I'
_ ADDRESS:
CIT1°, STATE, ZIP:
PHONEa2,yt7 - S S/?5 •
>
St=Initial
5) ? n en i ? d: •?• :? -a? OEM
? wrnNEcriorr Tv crrx sEWM [A corsrrx:rioN TO cixY waTER ? onM .
63 PI.EASE HOLD APPROVID PII2DIIT FY)R PICK-OP BY ONE OF ABpVE --- --
? PLEASE MAIL APPROVED PEE2MiT TO 1162 3, 4. ABOVE .. 40- 1? ?.-,/) "??? (Circle one)
'
7) /? /
FOR CITY USE ONLY
PERMIT # ISSOED
Pd w/Bldg. Permit
$
$
FEES:
- •r
$ SEWER PERMIT (INCLODE SURCHARGE)
- $ WATER PERMIT (INCLUDE SLRCHARGE)
$ WATER METER/COPPERHORN/OL'TSIDE READER
$ $ WATER TAP (INCLL'DE CORPORATION STOP)
$ $ SEWER TAP
$ $ ACCOUNT DEPOSIT - SEWER
$ $ ACCOUNT DEPOSIT - WATER
-
$ J D 0 O p $ WAC
$ 6- 7S-• $
SAC
$ $ TRUNK WATER ASSESSMENT
$ $ TRONK SEWER ASSESSMENT
$ $ ' LATERAL BENEFIT/TRUNK SEWER
$ $ LATERAL BENEFIT/TRCNK WATER
$ $ WATER TREATMENT PLANT SURCHA
RGE
$ $ OTHER:
$ e-7J
$ TOTAL
-
,?c ?1133
RECEIPT RECEIPT
DOES LTILITY CO NNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
? YES IF YES, THEN A"PERMIT FOR WORK SVITHIN PUBLIC
Q ROADWAY" MUST BE ISSUED BY THE ENGINEERING
NO DIVISION. LIST AS A CONDITION.
SU BJECT TO THE FOLLOWING CbND2TIONS:
APPROVED BY;
TITLE:
DATE : ??/??
2000 FIREPLACE PERMIT APPLICATION
k?3Jr7 CITY OF EAGAN ?LO` ?O
J 3830 PILOT KNOB ROAD - 55122 U
651 681-4675
Date: ?/ l? /? • ? ?°? Oo
;
Description of Work: ? Construct new fireplace vGas _Masonry _ Alterations to existing
Install pas insert onlv _ Install gas line onlv
Other
Job address: `z`-1,X0 ( `/ ('J (i e }^ L- 0 1/7 rc?,
Lot: ) Z Block: ? Subdivision/P.I.D. #: 1- u e y1
Applicant (circle one only): Owner ontractor Permit Fee: $60.50
Name: ? I f ?D 2 0(1 L(?Z Phone #: r0???'
PROPERTY Last ?J- TiFst
OWNER ?f/I )
Street Address: '7 `t ?. LJ? ? ? ? ?? Q ?` h ('A l/! gi
City Eri{ Q (Y h - State: MP./, Zip: J? •..5? ?
e ?y p?
Company:?a?ij ??SPhone #: /S?-4 ??-?
(azea code)
FIREPLACE
INSTALLER Street Address:
Ciry Ar 1d SU p v State: /WY!/ . zip: Jr-S,3-3'
Company: Phone #:
(azea code)
GAS LINE
INSTALLER Street Address: ?
City State: Zip:
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 d City f agan O dinax?ces.
/•
/ //r r
Signature
COMMERCIAL BUILDING
Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
? o q Telephone # 651-675-5675 FAX # 651-675-5694
Foundation Onl New Buildin Interior Im rovement
• SWdu21 Pians (2) seis • Architectural Plans (2) sefs • Architectural Plans (2) sets
• Civil Plarxs (2) • Structural Plans (2) • Code Malysis (1)
• Certificate of Survey (1) • Civil Plans (2) • Project Specs (7)
• Code Analysis (1) • Landscaping Plans (2) • Key Plan (1)
• ProjectSpecs (t) • CodeAnalysis (1) • MasterExitPlan (1)
• Spec Insp. & TesBng Schedule " • Certifcate of Survey (1) • Energy Calculatlons (1) not always"
• Soils Report (1) . Spec. Insp. & Testing Schedule (1) " • Elec. Power & Lighting Forrn (1) not always"
• Meter size must be esta6lished • Meter size must be established • Meter size must be established-if applicabie
1 . ProJectSpecs (1)
1 • EnergyCalculations (1) " l
1 • Electric Power & Lighting Form (1) *' 1
1 . A9asterExitPlan (1) 1
1 . Emergency Response Site Plan (1) *'* 1
1 . SoilsReport (1) 1
• SAC detertnination - call 651-602-1 000 • SAC determination - rall 651-602-1 000 SAC detercninatlon - call 651-602-1000
Cal] NIN Dept of Health at 651-215-0700 for details regarding food & beverage or lodging facili8es.
** Contact Building Inspections for sample and if required when rt states "not always".
*** Permit for new building or addition will not be processed without Emergency Response Site Plan.
Date ? 1,7 7/ ConstructionCost 7?0[Je?g
Site Address ?
7 ?/ z j /y ,¢ ? ?` ?'/Z S ?' /? C (j?y ?y ??;%r?--?- UniUSte #
n
Tenant Name Former Tenant Name
? i--
Description of Work ,? U?i?
?I' lL
Praperty Owner V-0 E'v/ ()`D/1'.,' 'v_?, / '/? : Telephone #f
Contractor cl C? /?('JG?/
Address City 6(?144?ae 6w ?
State &_12 Zip ? Telephone # (651) 7? 5- ez Z 0
Arch/Engr RegistraGon #
Address City
State Zip Telephone #(
u ?j
I r
Licensed plumber installing new sewerJwater service: Phone #: I(m__) I
-,
I hereby apply for a Commercial 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 pertnit, 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.
Applicant's Printed Name
Applicant's Signature
aose
ENGINEEAING
COMPANY, INC.
? 1000 EAST 1461h 57REET,
CONSULTINO EHdIHEEBS
PIANNEfIS and LAND 3UBVEYOf15
?6? 37 PA6E S(P
BURNSYILLE, ?IINMESOTJI 55337 PH 432'3000
Zeaat .De.scr4 2Zan:
LUTS 21, 22, 23 AND 24, BLocK 3) EDEN ADDIT1oN,
DAKOTA CDUNTY, A/IINNESOTA
CV5zo i DENOTES EX15T1it16 6LEVA71DN
( 93s.o ) DENOI'ES PROf'O,SEU ELEVATIO/U
NoRTH -- INDlCATES UIFZEcTION pF SURFACE DRAlNA6E
scsai.E. :!" = 30' 937,5 .= FIA!ISHED GqRA6E FI-OOR ELEVAT/ON
EAGP+
? V I E(Y+}-, D
30' FRoNT BUILD/Nb
sEraqcK L/NE -
L :,i 1
L_ L?
pNP
.
L Jt'? ?Y
A ?
,
L_.? i
L_ - I i
V41 -5)
I hereby certity thnt thie ie a true and correct representation of a tract of
land aa sho+m' and deacribed hereon.• Ae praparad by me on this 7 v day ot
&.ag.c4 t 19 ? .
1le;. No.
'
, 32
8Y
? c`?jPO _ ? ?? ???
DATE i „ ?? ??
From:ALLSTAR CONSTRUCTION 19529427464 09/1712013 08:37 #582 P.038/079
Use BLUE or BLACK Ink
I For Office Use l n
' j Permit
Clt~ of Eap I Permit Fee: ° 50
3830 Pilot Knob Road I I
Eagan MN 55122 j Date Received. 1 j
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 1 staff: I
I I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 01f5 l 2013 Site Address: y4Z3 442>g T 11 , 4L41CVR CIvex LAW/ Unit
Name: dean VVr'1 CIO' C'JO yl cum Phone:
Resident/
Owner Address /City/ Zip: W-1 J UiN "M Pftmi, Eym rare , M N 5 y
Applicant is: Owner Contractor
Description of work: My and yt Ybof
Type of Work `l
Construction Cost: 411 M''ll
V U Multi-Family Building: (Yes / No
Company: _t1
ILVIA t JjOtsLI VVI l l l ►Y`u ! Contact:
.~-y Ct
Contractor Address: ~Iy~ I~ndU CAI St 1e # city: Wit Nih
State:
Zip: ~1 Phone:
License ~~,/r~ UI.~J~ S Icj 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: 4
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
a a ~mvy~ conclude that thM are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454.0002 for protection against underground utility damage, Call 48 hours
before you intend to dig to receive locates of underground utilities. www.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 must be completed within"180
days of permit issuance.
x 6At S A x `L
°
Applicant's Printed ame Ap li ant's Signature
Page 1 of 3
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651) 675-5675 1 FAX: (651) 675-5694
buildinginspections(@citvofeagan.com
-------------I
r For Office Use
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I Building Permit #:
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SSW Permit #:
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Permit Fee: 22q
1 +
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Date Received: I
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I Date Issued:
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RESIDENTIAL BUILDING PERMIT APPLICATION
Date: hqlSite Address: Unit #:
Applicant is: ❑ Owner Contractor
Name: �G([ b V\- fie_ C) S 4455 C7 C? i 0-4
; Address: qq2_3 Ah2 city: act a
Homeowner
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State: i Phone(:: Email:
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Description of work: t> e:,,
Type of
Construction Cost Li
Work
Type of building: ❑ Single Family ❑ Townhome, of units in Home
Compan _.ThLI�M
g IJljesk l� Building 'Address: � � �1 City: �
Contractor `J '/
State:/ Zip: 5�3 T Phone6tZ�'f 5 Email lmel f \e"
O'Z62(0 *� LCJD� ^-
License #: Expiration Date: J
Sewer & Company: Contact:
Water
Contractor Address: City:
Required for State: Zip: Phone: Email:
new construction
License #: Ex iration Date:
*1 understand that Plumbing, Mechanical, and Fire Suppression work require separate applications.
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of the
information may be classified as non-public if you provide specific reasons that would permit the City to conclude that they
are trade secrets.
CALL BEFORE YOU DIG. Contact Gopher State One Call at (651) 454-0002 or www.gopherstateonecall.org for protection against underground utility
damage. Contact Gopher State One Call 48 hours before you intend to dig to receive locates of underground utilities.
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.
Applicant's Printed Name A licant's Signature