4474 Clover Lane CITY OF EAGAN N°_ 1 1219
3830 Pilot Knob Road, P.O. Box 21-199, Eagen, MN 55121
,
` PHONE:4548100 5'?a ?
BUILDIN
G PERMIT ReceiOt # 7
Te b wed fer 1 OF 4 PLEX Est. Volue $60, 000 pate NOVEMBER 7 ?y 85
SiteAddrett 4474B CLOVER LN Erect EK OccuPencv R
Lot 6 Block Z Sec/Sub. EDEN ADDITION Remodel ? zoning PD
Parcel No Repair ? Type af Canst. V
. Add'rtion ? No. Stories
GOOD VALUE HOMES INC Move ? Lengtn 44
Name ?
? 1460 RD Demoliah
N NE Depth 24
; Address int Im
c ?
F
b BLAINE p
780-5510 ?`".
`.
City Phone Install ?
o N SA-ME ADOrorols Fees
F ame _
Vi /\?f089
? City _
Phone
FW Name
x? Address
?W City Phone
1 hereby ocknowledge ihut I hove read fhis apDlication and stote tFwf
fhe inlormation is correct qnd ogree to wmpiy with all opplicable
StoM of Minnesoto Stotut},6 and Ciry of Eag9p.-Qrdinonces.
Sipnoture of Pe ' e
A Bullding Pe i issued to: GOOD VALUE HOME°
oll work sFwll done in acwrdance wlth oll avv?? le State of
Buildinp Officiol
Asussment Permi ?3 • 00
Wacer85ew. Surcherge 30.00
Police PlanRevlew 156.50
Fira SAC 525.00
Erq. weterconn. 500.00
Plonner waterMeter 63.00
Council Roed Unit 280.00
BIdg.Off. 11 /4/F;5 Tr.PI. 132.00
APC Parks
INC
Dera Copies
1,999.50
rotal
on the axpresa tonditlon that
Statutes and Ciry of Eaqon Ordinances.
CITY OF EAGAN N0 17603
3830 Pilot Knab Road, P.O. Box 21-199, Eagan, MN 55721
-7
'
E PHONE: 454-8100
' !? r „
l
`
'
/ r
7
BUILDING PERMIT Receipt p ?
?
Tobeusedfor FIRE REPAIR Est.Value $30,000 Date MAR 14 , 793D
Site Address 4476 CLOVER LN
Lot $ Block 2 Sec/Sub. EDEN OFFICE USE ONLY
PBfCBI r10. Ocwpancy - FEFS
Zonmg _
w Name ANN POZZINI (ACNaI) Consf - Bldg. Permit 285.00
a Address 4476 CLOVER LN (Allowable) - h
S 15.00
urc
arge
City EAGAN Phone x oi Siories -
Plan Rewew
Lenglh _
o Name ADVANCE COMPANIES. INC Depth - SAQCity
ou Address 6400 CENTRAL AVE NE S.F.TOtal
U? City FRIDLEY Phone 572-2000 S.F.FOOlpnnt5 _ SAC,MCWCC
?Nater Conn
On Sde Sewage _
?Q
w W
Nartle
On Si1e Well
-
Wat
r M
te
i?
Addfess
MWCCSystem
_ r
e
e
?i
aw
City Phone
aiywater
_ Aat Deposit
S/VJ P
PRV Requiretl ermtl
I hereby acknowlege thal I have read Ihis application and state Ihal the eooster Pump - SNJ Surcharge
inlormation is correct and agree to Iy th all app able State ot
Mmnesota St City of Ea rdin nc s. Treatment PI
Signalure of Permi APPROVALS Road Unit
A Buildinq Permit is issued to: DV Planner - park Ded.
on ihe expres5 contlition thal all work shall be tlone in accordance with all Council
applicable State of Min
nesota S
tatutes
and
ty
of Eagan Ordinances
C
i Bldg. Off. Copies
n
p
A
,
-
v,.
?
Bwlding OPocial ?kos,u-'] ?1fY. 1 1 f LLI
? vanance - TOTAL 300.00
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21•199, Eagan, MN 55127 N? 15567
1, ' PH ONE: 454-8100
BUILDING PERMIT Receipt#
To be used for FIREPLACE Est. Value $1, 000 Date SEPT 6 ,1988
Site Address 4476 CLOVER LN
Lot g Block z Sec/Sub. EDEN
Parcel No.
a Name ANN POZZININI
W
z Address 4476 CLOVER LN
0
Ciry EAGAN Phone 452-1077
OFFICE USE ONLY
On SRe Sewage _ Occupancy
MWCCSystem _ Zoning
On Sita Well _ (qctuap Const
City Water _ (Allowable)
PRV Required _ # oi Stones
BoosterPump _ Length
Depth
S.F.TOtal
Footpnnt S.F.
a Name D CURTISS & SON
oa address 380 74TH AVE
? City FRIDLEY Phone 786-3330
UW
W ?y
.i
UV
aZ
aw
Name _
Address
Clty-
I hereby acknowledge that 1 have ead t lyapplicatwn and state that the
BuildingONicial m?n_Mmnesota Statutes and Crty a APPROVALS FEES
A euAdmg Permit is issued to D CUR?-QI?]
on the ezpress condition f hat al I work shall be done in accordance wrth ail
apphcable State of Minnesota Slatules and City of Eagan Ordmances.
mSignformatureetion ot is Permd correct tee and a9re _ ?TQ all applicable State o(
Engr/Assess. Permit 24.00
Planner . Surcharge .50
Council Plan Review
BIdg.Off. SAC, City
Variance SAC,MWCC
Water Conn.
Wafer Meter
Road Unit
Treatment Pi
Parks
z4.50
rornL
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55721 N?o 15607
?
BUILDING PERMIT , PH ONE: 454-8100 i Receipt # %144 U
To be used for BASEMENT I Est. Value $1, 500 Date SEPT 16 ,198$_
Site Address 4476 CLOVER LN
Lot 8 Block 2 Sec/Sub. EDEN
Parcel No.
? Name Al'1N POZZINI
3 Address 4476 CLOVER LN
° CitY EAGAN Phone 452-1077
OFPICE USE ONLY
On Site Sewage _ Occupancy
MWCCSystem _ Zoning
On Sde Well _ (ACtual)Cons[
Ciry Water (Allowable)
PRV Required _ n of Stofies
BoosterPump _ Length
Depth
S.F. rotal
Footprint S.F.
,o Name D CURTISS & SON
?a Address 380 74TH AVE NE
m
i- City FRI?LEY Phone 786-3330
W
i
a
z
w
Name_
Address
Clry_
1 herety acknowled9e that I have re thi a? cat?on and state that the
intormaUOn is cortect and a9re e t.?ory? ? ith all apphcable State.nf
Minneso[aStaWtesandCiryof es---1?
Signalure of Permdtee
A Bwlding Permrt is issued to ? RTI3S_6 SO9
oniheexpresscondihonthatallw9 kshallbedoneinacwrdancewithall
applicable State ot Minnesota St?tutes andy?Cdy ot Eagan Ordinances
BuJdingOf6cial_?"_f_fyllc_
I ?
APPROVALS
Engc/ASSess -
Planner _
Council _
Bldg Off. _
Variance _
FEES
Permit
Surcharge
Plan Rewew
SAC, City
SAC, M WCC
Water Conn.
Water Meter
Road Unit
Treatment Pi
MM6 COPy
TOTAL
34.00
1.00
.SO
35.50
(TOWNHOUSE)
CITY OF EAGAN N° 11218
° '§$30 Pilot Knob Road, P.O. Box 21•199, Eagan, MN 55121
BUILDING PERMIT PHONE: 4548100 Receipt jk s ?)- 7 ?-
Te ba and fer 1 OF 4 PLEX Est. Volue $60,000 pote NOVEMBER 7 1985
SiteAddrau 4476B CLOVER LN
Lot 7 BIock 2 sec/Sub. EDEN ADDITIO
Parcel No.
EreCt 6J Occupancy nJ
Remodel ? 2oning PD
Repair ? Type of Conrt. V
Additlon ? No.Stories
Move ? Lengtn 44
Demolish ? Dep[h 24
Int Impr. ? Sq. Ft.
Instell ?
Approvals Faes
W I Name GOOD VALUE HOMES INC
? Address 1460 93RD LN NE
City BLAINE phone 780-5510
,? Name SAME
Address Assessment Permit $ 313.00
? City Phone Wa1er $$ew. Surcharge 30.00
Polica PlenReview 156.50
Fw Neme Flre SAC 525.00
?,-? Address Enp. WaterConn. 500•00
?w City Phone Plonner WeterMeter 63.00
Countll Road Unit 280.00
1 here6y acknowledge tFwf I have reod fhis aODlicotion and state tFwf Bldg. Off. 11 4$rJ Tr. PI. 132.00
the inlormation is wrrect and agree to wmply wrth oll opplicable
Stats of Minnewta Statute n
d Ciry of Eogan Or inonces. AP?
Parks
0 Vaa Date Copies
Siqnafure of Pertnittes 1, 9 9. 50
h Building Dermi lss to: GOOD VALUE AOMES INC on tha ea?
xprcss condieion Ihat
oll work sholl in eccordonee with oll
opDlicqble Stofe o newfu Statutes and City of Eoqon Ordirwnces.
BuildirqOificial ?O.
! X?L c--i
(TOWNHOUSE)
CITY OF EAGAN
` 3830 Pilot Knob Road, P.O. Box 21•199, Eagan, MN 55121
PHONE: 454-8100
BUILDING PERMIT
Te M wad for 1 OF 4
$60,000
SiteAddresc 4476 CLOVER LN
Lot 8 Block Z sec/Sub. EDEN ADDITION
Parcel No.
W Name GOOD VALUE HOMES INC
; Address 1450 93RD LN NE
b City BLAINS phone 780-5510
F Name SAME
Address
City Phone
Gw Name
?W
?? Address
?w City Phone
I hereby acknowledge that I hove read this epplicobon ond slate thaf
fhe inlormation is correcf and ogree to Comply with all opplicoble
State of Minrxwta Sturu and Ciry of Eagan Ordinancez.
Sipnoturo of PermiM '
A Bullding Permit Is GOOD VALUE HOME:
oll work sholl be done in occordcnce with all appl' ble State ot
Buildirp Officiol ?er ? f' ?
N° 11217
C? J
Receipt ;OF J ?°? 7 S
D?tp NOVEMBER 7 ,a 85
Erect 0 Occupancy R3
Remodel ? Zoning pD
R¢pair ? TypeofConst. V
Addition ? No. Stories
Move ? Length 44
Demolish ? Depth 24
Int Impr. ? $q, Ft.
Inetall ?
ADOroreh Faes
Assessment Permlt 0
Water 8 Sew. Surcharge 30.00
Police PlanRevlew 156.50
Fira SAC 525.00
En9• WaterConn 500.00
Plonner WeterMeter 63.00
Council RoadUnit 280•00
BIdg.Off. 11/4/85 Tr.PI 132.00
APC Parks
Var. Date
?-
?
COpie3
INC
Total D
on tMa exprca cordition 1hoi
i)pto_Stotutes ond Ciry of Eoyon Ordinontet.
CITY OF EAGAN N°_ 1 12 2 0
3830 Pilot Krrob Road, P.O. Box 21•199, Eagan, MN 55121
PHONE: 454-8100 j -2?J-,7 S?
BUILDINC PERMIT ?t
Receipt
Te M uwd Mr 1 OF 4 PLEX Est. Volue $60,000 Date NOVEMBER 7 19 85
SiteAddress 4474 CLOVER LANE Erect Ex Occupancy R3
EDEN ADDITION Remodel ?
Lot5-elock 2 SeclSub Zoning PD
.
Parcel No Repair ? Type of Const. V
.
Addidon ?
No. Stories
GOOD VALUE HOMES INC Move ? Length 44
I Name li
?
1460 93Rn LN NE sh
Demo Depth 2¢
; Address Intlmpc ? Sq.Ft.
a City BLAINE phone 780-5510 Install ?
? AvProrals Feas
?
U?
?
Name -c+AMF.
Address
Name _
Addresa
city -
Phone
Asussment _
Water 8 Sew.
Police _
Fire
Enp.
Plonner _
Council _
1 hereby atknowiedge that 1 hove read this epPlication ond stote thof Bldg. Off. IZ 4 85
fhe inlormotion is wrrect nd agree fo comply with all opplicabla APC
State of Minne:ota Stotut and City of Ea Ordmances.
Var. Date
PBf1111I Y J1J?VV
Suroharge 30.00
PlanRevlew 156.50
SAC 525.00
Water Conn. 500.00
water Mete. 63.00
RoadUnit 280.?0
Tr. Pi. 132.00
Parka
Copiea
Sipnoturc of Pe
I Total $L.?Q99-50
A eullding Pe ?t i ued to: GOOD VALUE HOMES INC on fhe exprcss cwditlon Ihm
oll work Sholl done in occordance witly?qli opplicabl State f/ylinnesofa Statutea ond Ciry of Eapcn Ordinancea.
Phone
Buildin0 Official
DATE: 3/6/91
RECEIPT: 100361
SITE ADDRESS 4474 CLOVER LANE Unit # Permit # 12830
L 5 B 2 Sect./Sub. EDEN ADD' N
WENZEL HTG. & AIR 452-2665 INSTALLATIaN OF 2 TnN CEANW.14TR s,
INSPECTION INSPECTOR DATE COMMENTS
y13 e /fl -
?? 14119/jz
- ?nrctsv' ?Uj ' 3?/?/S ? ??`?? °b
?1
, •
3830 Pilot
BUILDING PERMIT
Te M wnd fee C ITY O F EAGAN
Knob Roed, P.O. Box 21•199, Eagan, MN 55121
PHONE: 454-8100
Recelpr #
Est. Vulue ' Date 2 2 0 ?
j
, 19
Site Addrees , Erect 0 Occupa ncy
Remodel ? Zonin
Lot Block Sec/Sub.
g
R
i
? T
Parcel No. r
epa
ype of Conat.
AddRion ? No. Stories
Name ?'O4 ? Move ? Length
li
D
h ? D
h
? emo
s
ept
Address Int Impr. ? Sq. Ft.
City Phone Instell O
Appeora Is Feas
Name
Ou Address Assessment Permit '
?
City Phone Water b Sew. Surcharqe ?
{
Police Plen Revlew
G
c
?uW Neme
Firo ;
SAC !
Address Enq. Water Conn 1
< W City Phone Plonnar Water Meter - J ?
Countil Roed Unit
I hereby acknowladge thct I hove reod this opplicotion and stote that gldg. Oft. Tr. PL
fhe informofion is Corrett ond ogree to comply with oll opplicable A?
StoM of Minr?esota Stotutes ond City o F Ea9an Ordirances. Pe?ks
" r Var. Date Copiea ?
Slynoture of Pertnittee
h Buitding Permit Is euued to: - -
on ? ;
Total
tM express tonditfon thot
oll work shcll be done in occordance wit h all oppliooble Stote of Minnesota Statutes and City o# Eapon Ordinonces.
ak,si.h? nffipi.,i i
i
Pwmit No. Po?mk Holde? Data Tel?phona #
Plu?i? 3 %7 l
H.VA.C. ?O 5 J+ -94,
ENct?iC V C) d
8ofterwr
InWeMion Date Insp. Othar
Footings 1
Footings II
Foundation
Framiny
:
Roofiny ?•;1?
Rougn Pibg.
Rouyh Ht9.
inwl.
Firsplacs
Final Hty. ,z 1.81
Final Plby. %? -
Final
Cort/Occ.
WnK O?sai6e Location:
Ws11
Sewsr
Pr. Disp.
BUILDfNG PERMIT
T. a- ....A 6... 1
Lot
Percei No.
Name
? Address
City
t? Name
u? Addre
cirv
Name
CITY OF EAGAN
Road, P.O. Box 21-199, Eagan, MN 55121
PHON E : 454-8100
p'^ 19217
Raceipt #
ESt. Volue ,? lS Date , 19
Erect ? Occupancy
, Remodel ? Zoning
Repair ? Type of Const.
Addition ? No. Stories
Move ? Len
th
? li
h ? g
Dema
s Depth
Int Impr. ? Sq. Ft.
Install ?
ApKorals Fees
Assessmen t Permit
Woter 3 Sew. Surcharge
Police P1an Review `
Firr SAC
Eny. Water Conn.
Plonner Water Meter
Cauncil Road Unit
his cpplicotion ond state thot gldg. Off. Tr. PI.
o comply with oll applicoble APC
>f Eagan Ordinonus. Parks
Var. Date C?ies
Totel
on the express condition that
?h oll opplicoble State of Minnesoto Stotutes ond Ciry of Eoyon Ordinonces.
i
I hereby acknowled9e that I have reod
fha inforrrwtion is eorrect ond ogree
Stote of Minnesoto Stotutea ond Clty
5ipnature af Permittca
/1 8uildiny Permit Is issued to:
oll work shall be done in accordence w
Bufldinp OffiNal
Prrmit No. Pormit Holda Daft Telephone it
Plumbinq ?( ' ? ( 7
H.VA.C.
EIeetlie r
Softener
Irnpection Date Insp. Othor
FooUnps 1
Footinys 11
Foundatlon
Framing
Roofing
Rouyh Wby. 7;?`? - C-G !Y?-t
Rouyh Htp.
Insut.
Firopisce
Flnal Htg. / O
Final Pibs. _/p- j?
Final
C4rt/Occ.
Water Dowibe Locacion:
WNI
Swwsr
Pr. Disp.
CITY OF EAGAN
. • -,_, ,
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHON E: 454-8100
BUILDING PERMIT Receipt #
To be used for Est. Value ? 1#Sk Date `-L'gT 16
SiteAddress 441" ?1WFIR UN
Lot Block 2 Sec/Sub.
Parcel No.
a Name -?M POZZINI
Z
Address 6v 8 5?°
° City. „A„'A Phone !{ 452" i 077
. o Name - Ct.?'1iT133 d? S1111
o? Address "?n 14? iV? R??
U? City ` `'' f'!..i Phone 756-3330
Name
City
I hereby acknowledge that I have re
information is correct and agree ti
Minnesota Statutes and City of Ea4
Signature of Permittee
A Building Permit is issued to: !-
on the express condition that allwo?
the
a of
Building
On Site Sewage Occupancy
MWCC System Zoning
On Site Well (Actual) Const
City Water (Allowable)
PRV Required * of Stories
Booster Pump Length
Depth
S.F. Total
Footprint S.F.
APPROVALS FEES
Engr./Assess. Permit • ' ?'
Planner Surcharge ? • ? ??
Council _ Plan Review
Bldg. Off. SAC. Ciry
Variance SAC, MWCC
Water Conn.
Water Meter
Road Unit
Treatment Pt
Pgtks ' ?: >
` ?
TOTAL '?•5';
Permit No. Permit Holdar Data TNephone ?
Plumbing
r
H.V.A.C.
Electric
cv
Softener
Inspectlon Date Insp. Comments
Footings I
Footings II
Foundation
Framing
Roofing
Rough Pibg. a,j9• ?.j`
Rough Htg.
Isul.
Fireplace
Final Htg.
Final Pibg.
Bldg. Final
Cert. Occ.
Temp. LP
Deck Ftg.
DeCk Final
Well ? lG - ?. . - A?'
Pr. Disp.
Site Address
Lot Block
? Name _
m Address
c City -
Name _
3 Address
O C'h' -
PERMIT #
' CiTY OF EAGAN . RECEIPT # A
PILOT KNOB ROAD, EAGAN, MN 55122 DATE: ?
S
COMM/IND FEE - 1% OF CONTRACT FEE
APT. BLDGS - COMM RATE APPLIES
TOWNHOUSE 8 CONDO - RES. RATE APPJ
MINIMUM - RESIDENTIAL FEE ?
MINIMUM - COMM/IND FEE -
STATE SURCHARGE PER PERMIT -
(ADD $.50 S/C IF PERMIT PRICE GOES
FOR: CITY OF EAGAN
BLDG. TYPE WORK DESCRIPTION
Res. ''11 New ?
Mult. Add-on
Comm. Repair
Other
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
NO.,- FIXTURES OTII.
? Water Closet - $3.00 ?`'
Bath Tubs - $3.00
t
$3
?L
00
?t;
ava
ory -
.
- •
--"'Shower - $3.00 ? • 4`?
Kitchen Sink - $3.00
UrinallSidet - $3.00
Laundry Tray - $3.00
Floor Drains - $1.50
Water Heater - $1.50
00 Whiripool - $3.00
: Gas Piping Outlets - $1.50
.50 (MINIMUM - 1 PER PERMIn
Softener - $5.00
Weil - $10.00
Private Disp. - S10.00
Rough Openings - $1.50
?
FEE:
STA7E S/C:
GRAND TOTAL 14, :a"
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PH 0 N E: 454-8100
BUILDING PERMIT Receipt
To be used for Est. Value ?l."h) Date ?E ? T 6
Site Address
Lot s" Block ? 5ec/Sub. EDEtt
Parcel No. _
ac Name ,r'.'l'I FO :i:IN 1., I
z Address 4476 k%U3ilEi' Lii
° City EAGA`' Phone 452-1077
o Name
.
o ? Address -???' ? `T `? A•Zr?
U? City F k . ULk1 Phone 786-3330
V¢
y? W
Name I
? W
_ z- Address
a UJ City Phone ? I
I hereby acknowledge that I have n
information is correct and agree t
Minnesota Statutes and City of Eal
Signature of Permittee __ _ _ -
A Building Permit is issued to:__
on the express condition that all wo
applicable State of Minnesota Stat
BuildingOfficial__ ___--
3tion and state that the
all apDlicable State of
o CtRziSs a am
OFFICE USE ONLY
On Site Sewape Oocupancy
MWCC System Zoning
On Site Well (Actuaq Const
City Water (Allowable)
PRV Required # of Stories
Booster Pump Length
Depth
S.F. Total
Footprint S.F.
APPROVALS FEES
Engr./Assess.. Permit 24,0
Planner Surcharge • J'
Council Plan Review
Bldg. Off. SAC, City
Variance _ SAC, MWCC
Water Conn.
Water Meter
Road Unit
Treatment P1
Parks j
TOTAL l?V I
Permit No. Permit Holder Data TeIephone ie
Piumbing
H.V.A.C.
Electric
Softener
Inspection Date Insp. COmmBnts
Footings I
Footings II ,
Foundation
Framing
Roofing
Rough Plbg.
Rough Htg.
Isul.
Fireplace 9 7 ?/ ?l °' •
Final Htg.
Final Pibg.
Bldg. Final
Cert. Occ.
Temp. LP
Deck Ftg.
Deck Final
Well
Pr. Disp.
cm
3830 Pilot
I BUILDING PERMIT
i To be used for F I RE REPAI R
Site Address "76 CIrOVER Lti
' Lot 8 Block 2 Sec/Sub. _
Parcel No.
W Name ANiV P02ZI?JI
; Address 4476 CLOVER LN
0 City EAGAN Phone
a ADVAIQCE COMPAIiI.
o Name
?d Address 6? CSNTRAL AV.
? City ERI D?Y Phone
?a
y? W Name
?? Address
i W City Phone
I hereby acknowlege that I have read this app
information is correct and agree to compty w
Minnesota Statutes and Ciry of Eagan Ordinanc
Signature of Permitee
A Building Permit is issued to: ADVAKE
on the express condition that all work shall be d
applicable State of Minnesota Statutes and City
Building Officiat ?
_ . . :, . ?-. ., . ..
CITY OF EAGAN y?p 17603
b Road, P.O. Box 21-199, Eagan, MN 55121 7
PHONE:454-8100 7 / f
Receipt
value $30+OW Date MAR 14 , 19 90
EUEIi QFFICE USE ONLY
Occupancy - FEFS
2oning
(Actual) Const _
- Bldg. Permit
285.00
(Albwable) - 15.00
* of Stories Surtharge
-
Plan Review
? jNC Lengih
oeRtn _
- sac
ciry
NE S.F.7otal ,
_
$7Z-Zn'? S.F. Footprints _ SAC, MCWCC
Water Conn
On Site Sewage
On Site Well _
- Water Meter
MWCC System _
City Water Acct. Deposit
_
P
tion and state that the
all applicahle State ol PRV Required
6ooster PumP
APPROVALS ermit
_ S/W
- SMI Surcharge
Treatment PI
Road Unit
QMPANI ES , TNC Plenner - park Ded.
! in accordance with all
=agan Ordmances. Council
gld9. pff.
Variance
_ Copies
- TOTAL
300.00
Permit No. Permit Holder Date Telephone #
WATER
SEWER
PLUMBING
H.V.A.C.
ELECTRIC
Inspection Date Insp. Comments
Footings I
Foundation
Framing / ' ?' ^ ?G'?? t?tq9 L
Roofing ??cst
Rough Plbg.
Rough Htg.
Isul.
Fireplace
Fnal Htg.
Finsl Plbg.
COnst. Meter Plbg. Inspector - Notify Plumber
Engr./Plan
Bk1g. Final
Oeck Ftg.
Dedc Final
Well
Pr. Oisp.
' CITY OF EAGAN r i`? c?. 1?
' 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 4548100
BUILDING PERMIT Re«ia #
Te w wad fe. 7
51te Address '
Lot Block Sec/S
Parcei No.
? Name
? Addre
City _
Name
4 Addre
Citv
Name
Erect U Occupancy
Remodel ? Zoninq
Repair ? Type of Const.
Addition ? No. Stwies
Move ? Length '
Demolish ? Depth .
Int Impr. ? Sq. Ft.
wpprwraw req
/lssessment Pertnit
Phone Woter S Sew. Surcharge -?' o?
Police Plan Review 50 i
Fin SAC ? -10
Enp. Water Conn. ?
Phone Plonner Water Meter
Council Road Unit ? 9 Q'
edpe thot I have reod this opplication ond stafe that gldg. Off. Tr. PI. o C)
is correcT ond ogree to tomply with oll opplicoble
,.,, c.......e. ....a r:... ,.s E
h? Sipnoturo of Permittes
A Bulldin9 Pe?nit is {ssued to:
Buildinp Offidol monces.
oll work shali be done in occordance
a9on Ord APC Parks
Var. pate Copies
" - - rotal
I?
- on the exprcss conditlon thot
oll epplicoble Stote of Minnesota Statutes ond Cify of Euqon Ordinances.
. . - - --- -- 7
PormR No. Pormit Holdw Dace Tslephona #
PlumWrq ?- ?
H.VA.C. J
Ebctrle j ??-
Soherw
Iropsetion Dete Insp. Othar
Footlnys I Li
Footings 11
Foundatlon &I?W
Frsming ? Cvrj
Rooling
Rouyh Plby.
Rough Htp.
Inaul.
Flnplece
Finel Htg. -3G -lk
rinei Pleg. -3y-?? ? JiM
SSRS•?
Finsl
COVOCC. %,-'44 Lf/
Water Dfteribe Location:
Well
Sewsr
Pr. Disp.
? .:
• 3830 Pili
dU1LDfNG PERMIT
To M rwd ier
Site A ddreas
Lot Block Sec/Sut
Parcel No.
W Name
; Address '
b Cky Phone
z? Name
?? Addreu
1- City Phone
tat
W
Name
i? Addresa
1 her+eby atknowledga thot I hove read
the inlormotion is correct ond ogree
Stats of Minnesoto Statutes and Ciry
Sipnofure of Permittes
N Building Pe?mit is iuusd to:
all work shall be done in occordonce w
Bufldinq Officiol
CITY OF EAGAN
Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100
Li7
U
$60,000 Dote
Erect ?
j ; Remodel ?
Repe{r ?
AddRion ?
Move ?
Demolish ?
Int Impr. ?
Occupancy
Zoning
Type of Conat.
No. Stories
Length
Depth
Sq. Ft.
/lssessment Pertnit - ?'i Q ;
Woter & Sew. Surcharge )0
?
, Police Plan Review " 0
Firo SAC ' ri I
Enp. J
Water Conn. ' o
Plonner Water Meter 4
Council Roed Unit
plication ond state tfiot Bldg. Off. Tr. PL
ply with all applicable
on Ordinances. '4PC ParkB
Var. Date Copies
Total `
on t he exprcss conditlon thoi {
appliwble Stote of Minnesoto Statutes ond City of Eapon Ordinonces. ?
i" 11218
ReceiPt #
Pwmk No. Pwmit Holder Dats Tslsphone Jk
???ing a g g
H.VA.c. f I- 8 a o
ENctric
Sottarnr
Impsction Date I Other
Footlnps I 1G p 0
Footings II
Foundatlon I
Framinp C!
Roofin9
!,?-
t
ROUQh Plby. '-? LG
Rough Htg.
Insul.
Firoplace
Final Htp.
Flnal Plbg.
Flnal
c.rvocc. s;
Water Dftcribs Location:
Wall
8ewsr
Pr. Dlsp.
CITY OF EAGAN Remarks
Addition F.den Addition Loc S Rik 2 Parcel #10 22750 050 02
owner '`" I I il . -Street 4474 Clover Lane State Eagan MIIV 55122
Improvement Date Amount Annual Years Payment Reoeipt Date
STREET SURF. 504.70 100-94 9,
STREET RESTOR.
GRADING 1 $2 232. 46.6O
SAN SEW TRUNK 1974 3
M SEWER LATERAL (LYL 82 1896.46
WATERMAIN
* WATER LATERAL 1982
WA7ER AREA
* Services 1982
STORM SEW TRK 18 2 26. QQ 1.20
* STORM SEW LAT 19 82 5
CURB & GUTTER
51DEWALK
STREET LIGHT
WATER CbNN.
BUILDING PER.
SAC 52.5.
PARK
CITY OF EAGAN Remarks
Addition Eden Addition Lot 6 Rik 2 Parcel #10 22750 060 02
Owner Street 4474B Clover Lane 5tate Eagan NIN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREETSURF. KO 504.70 4 5 1
STREET RESTOR.
GRADING 4(
SAN SEW TRUNK
+
* SEWER LATERAL ?
WATERMAIN
• WATER LATERAL
WATER AREA /
•
STORM SEW TRK 1982 256.00 51.20 5
?
• STORM SEW LAT 1982
CURB & GUTTER
SIDEWALK
STREET LIGHT
WA R N. n n
BUILDING PER. 11917-11220
SAC 525.00
PARK
CITY OF EAGAN Remarks
Addition-F.den Acidition Lot 9 eik 2 Parcei #10 22750 080 02
Owner h`:-'' Street 4476 Clover Lane State Eagan MN 55122
Improvement Date Amount Annuat Years Payment Receipt Date
STREETSURF. (; 19$2 504.70 100.94 5
STREET RESTOR.
GRADING o 1982 232.99 46.60 '
SAN SEW TRUNK 71
l/I
/ D
* SEWER LATERAL
WATERMAI N
* WATER LATERAL 1982
WATER AREA • d?70 I
* S S 1982
STORM SEW TRK 1982 256.00 I.20
* STORM SEW LAT 1982 5
CtJRB & Gl1TTER
SIDEWALK
STREET LIGHT
Roa Unlt 280.00 57275 11 5 85
WATER CONN. 500.00
BUILDING PER. 11217-11220
SAC 525.00
PARK
CITY OF EAGAN
Addicion E Pn
Owner
Lot 7 elk 2 Parcel #10 22750 070 02
street 44766Clover Lane State Eagan NIN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. 1982 504.7? 100.94 5
STREET RESTOR.
GRADING QqD 9a 2 4
SAN SEW TRUNK
# SEWER LATERAL 1896.46 179.29 5
WATERMAIN
* WATER LATERAL 1982
WATER AREA I
* SP.!'V C 8 1982
STORM 5EW TRK 1982 2 6. o0 1.20
i STORM SEW LAT 1982
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER ONN.
BUILDING PER.
SAC • O
PARK
? -- i - INSPECTION RECORD ?
?
' CITY OF EAGAN PERMIT TYPE:
? 3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued:
(651) 681-4675
SITE ADDRESS:
I i - i i Wt`Et t ANI
f{
I PERMIT SUBTYPE:
? , 1.
6 r? r n 1 V I
Ftll I( iI 1 Nf;
Fl:t4 3rari
leH/l,Li
APPLICANT:
. ii ,
0 Q?Li 1 N4}f-7 ,?140
TYPE OF WORK:
i1N`. 1
NUraIR ?
P Fr•i nr'r-' <,rr, ,N r6
Iir',ftr1Pi10N
l ,`.kF.•, IiNll
F
L
e'N\\A?p
?
?
Permit Holder Date Telephone M
SEWER/
WATER
PLUMBING
HVAC
Inspection Dete inap. Commenta
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
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
MEiER
FLUSH
MAINS
CONDUCTIVITY
TEST
HYDROSTATIC
TEST
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
Recaipt PLUMBING PERMIT Permit No.
CITY OF EAGAN •
Fse
Frll in numbered spaces S/C '
TYpe or Print /egib/y Tot
1. Date 2. Instailation Cost
3. Job Address " Lot Blk. Tract
4. Owner
5. Contractor Phone 6. Address ?
7. City State Zip
S. Building Type: Residential ? Commercial ? Institutional ?
9. Work Description: New 0 Add ? Alter ? Repair 0_
10. Describe
1 11•
No, Fixtures
Water Closet No. Fixtures
Cesspopl/Drainfield
Bath tubs Septic Tank
l..evatory Softner
Shower Well
Kitchen Sink
Urinal/Bidet Other
Laundry Tray
Floor Drains
Drinking Ftn.
Slop Sink
Gas Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed: ' for
Fiough F inal
Inspections: Date Insp. Ddte Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
Reoeipt
MECHANICAL PERMIT
CITY OF EAGAN
Pennit No.
Fee ? -
Fill in numbered speces S/C
Type or Prinr /egibly Tat '
1. Date 2. Installation Cost
3. Job Address Lot Blk. Tract ?
4. Owner
5. Contraccor Phone
8. Address
7. City State Zip
8. Building Type: Residential ?
9. Work Description:
Commercial ? Institutional O
Add ? Alter ? Repair ?
1 10. Describe Fuel TYpe
! 11.
No. Eauinment BTU - M. Ea.
Forced Air No. Equiument CFM
i
Mfg. A
r Handling:
Boiten
Mfg. Mech. Exhaust
Unit Heater
Mfg. Oth
Air Cond. er
AAfg.
Gas, Piping Outlets
12. I hereby certify that the above information is true and correct, and I ayree to
comply with all ordinancea and codes governing this type of work.
Signed :
for
Rough F inal
lnspeCtions: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 464,8100
Receipt PLUMBING PERM17 Psrmit No.
CITY Of EAGAN
Fae
1
• ''% Fi/I in numbered spacea S/C
'J TYPe or Prini /egiblY Tot
/
1. Date. 2. Installation Cost 3. Job Address Lot Blk. Tract
4. Owner S. Contractor Phone
6. Address ?
7. City State Zip `
$. Building Type: Residential Cl Cammercial 0 Institutional ?
9. Work Description: New El Add ? Alter ? Repair ?
M ,o. Des??ibe
I 11.
No. Fixtures
Water Closet No. Fixtures
Cesspool/Drainfield
Bath tubs Septic Tank
Lavatory Softner
' Shower Well
Kitchen Sink
Urinal/Bidet Other
Laundry Tray
Floor Drains
Drinking Ftn.
Slop Sink
Gas Piping Outlets
12. I hereby certify that the above information is true and correct, and 1 agree to
comply with all ordinanCes and codes 9overning this type of work.
Signed: for
Rough Final
Inspections: Date __ Insp. _ Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-5100
INSPECTION RECORD
,
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number. '^;H? I
Eagan, Minnesota 55122-1897 Date Issued:
(651) 681-4675 '
SITE ADDRESS: APPLICANT: ?
4474
( (11= FI
PERMIT SUBTYPE:
uvER tnNF ? ciISrnN r.ONr.FP13 cnr??.r
TYPE OF WORK:
i, iP I ?'IN I ;jl I . I it i n
F- 7
?
?
- -------------------------------------------
ParmR Holder Date Tekphons #
SEWER/
WATER
PLUMBING
HVAC
Inspectfon Date Inap. Comments
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYP BOARD
FIFiEPLACE
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
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued:
(651) 681-4675
TE ADDRESS• , , . .?. : A .. - . ... =?w--..s,.. - ,?
L
' ! tl T' 8 Ej l I 1 l': 14
.. . 1 I 111/Fk ? ?NF
{ 11 I 1'?
PERMIT SUBTYPE:
li11 ! 1 111 146
y Iq iH4
e I /OR rdy
APPLICANT:
l !? 1 : ! tl ° 1 ti - / ,• c} ?
TYPE OF WORK:
IIi=. 1:11'i211, r 1 nW
I F' !i 1 Fk
k=P 1 Arf :, I0 1Ni
' '[, IV A 1
i
IL
i i?N
Pertnit Holder Date Telephone #
EWER/
WATER
PLUMBING
HVAC
inspection Date Insp. Comments
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS 5VC
TEST
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PIBG
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
Receipt
PLUMBING PERMIT Permit No.
CITY OF EAGAN
Fes
fill in numbered spaces S/C
Type ar Prin[ legibJy Tat
1. Date 2. Installation Cost
3. Job Address Lot Blk. Tract
4. Owner '
5. Contractor Phone
6. Address
7. CitY
8. Building Type: Residential ?
9. Work Description: New ?
I 10. Descri6e
1 11.
State Zip
Commercial ? Institutional 0
Add ? Alter ? Repair ?
No, Fixtures
Water Closet No. Fixtures
Cesspool/Drainfield
Bath tubs Septic Tank
Lavatory Softner
Shower We I I
Kitchen Sink
Urinal/Bidet Other
laundry Tray
Floor Drains
Drinking Ftn.
Slop Sink
Gas Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed : for
Rough F i nal
Inspections: Date Insp. Date Insp.
This is Your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
?s------ ! - T- IN?PECTIOl? RECORD
CITY OF EAGAN PERIUIIT TYPE:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued:
(851) 681-4675
! r; SITE ADDRESS:
. , - ; i?VEit t ANI
! PERMIT SUBTYPE:
f
tit+ttti iW,
4'3`;N
L?I /NHi9t)
r'v -1 4' f " W 'f APPLICANT:
r V31 r„C9 :
TYPE OF WORK:
lil':Z;170Ti'1 f.frN
I ;?i?Vt: ; i 1M 1 (
f;s- P A ri,
ftFF'i 14[;I
li)IPJi,
?
Permit Ho{der DBte Telephone #
SEWER/
WATER
PLUMBING
HVAC
Inspection Date Insp. Comments
FOOTINGS
FOUNO
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
FiEATIIVG
GAS SVC
TEST
INSUL
GYP 80ARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
DOMESTIC
METEF
IRRIGATION
METER
FLUSH
MAf NS
coNOUCTivirr
TEST
HYDROSTATIC
TEST
BSMT R.I.
BSMT FINAL
DECK FfG
DECK FINAL
Receipt PLUMBING PERMIT Permit No.
" CITY OF EAGAN FN
FiII in numbered spaces S/C
•' ? Type or Prin[ legibly Tot. .
1. Date 2. Installation Cost
3. Job Address Lot Blk. Tract ,
4. Owner
5. Contractor ' Phone
6. Address '
7. City State 2ip
8. Building Type: Residential ? Commercial ? Institutional El
9. Work Description: New O Add ? Alter ? Repair O
I 10. Describe
1 11.
No. Fixtures
Water Closet No. Fixtures
Cesspool/Drainfield
Bath tubs Septic Tank
l.avatory Softner
Shower Well
Kitchen Sink
Urinal/Bidet Other
Laundry Tray
Floor Drains
Drinking Ftn.
Slop Sink
Gas Piping Outlets
12. 1 hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed : for
Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
SEDGWICK HEATING & AIR CONDITIONING CO. TEST HEATING REC?RD JOB NO. ?.
8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) 881-9000
ADORESS qq? 7 G(-RVN-NC_ L-14+?G
OCCUPANT ??4?!04
SOLDBY "tip?!/'1rv/
MkKE
SERIAL NO. 7:z
THERMOSTAT
LIMIT
VENT SI:
TYPE OF
LINER SI
LIMIT SETTING 60v ?-5e) V FILTERS:
FAN SETTING WIRING
PILOT TYPE TEST TAI
IGNITION MODEL
PILOT TIMING ? "-?f OR
PRESSURE PERCENT COZ
INPUT CFH 7e? PERCENT OZ
STACK TEM - 7 o? PERCENT CO ?
FORM 235 (REY. 11189y
cirv
OWNER 44 /%IN
INSTALLED BY
-7Q
MODEL
INPUT ?D d1,?4
LIGHTING INST. -
? DATETESTED_
CaMPANY TESTING
?-y«-
NAME OF TESTER _
FORM DIS'
YELLOW COPY - CITY
CITY OF EAGAN WATER SERVICE PERMtT
3830 Pilot Knob Rosd
P, O: Box 21198 PERMIT NO.: _
Eagen, MN 551.1 ? DNTE:
? ?' . p
Zanirg: _
,U=, •olU2 No. of Untts:
OwrNr:
Mdnra: ,1µ, ; aver a,?. .., . ._ ,.iLen .tic: ,n.
Slh Mdnss: , .
Plunber.
? p;!
11Aet?r No.: 3 4 ction Charqe: ,
?..,.
Siu: ' ` R Oeposlt: ? : ; . , , i
Itpder No.: a In '?'0 "itlt4eS
?s---?-;T-.-,?----
?rJiw?woM. ? ? ! p•.: r1eter
_ncni iiRrcD
CITY OF EAGAN
3830 Pilot Knob Road
P. A. Box 2ry 199
Eagan, MN 55121
?fo
Zoninp: ,,.....i ?r. ee oe.vh wMb ir. Ckr of lag..
DATE: No. of Units: CITY OF EAGAN WATER SERVICE PERMR
SEWER SERVKE PERMIT
pERMIT NO.: ,
3830 Piloi Knab Rwd `
P. O. Box Z1199 ' PERMIT NO.:
Eagan, MN 551? D/?TE:
Zonirp;. No. of Untts: _
?Mr: O 8 ue
Addr+ess:
, over
ne . n.
Sih Address: Nz e n ..; m.,
nlor
P1
.
u
.
?
fon CFw?ps:
AAe/sr No.
?
- •
y
. .
i S
' •
` pr?IiCS-powt:
?
=
i
RN ?
`?fltjC. -~ x+
?
?
I
, mmply 'W .? fle
u
t?
! °`a""'°"'
EQUIR ED B`T",c?"?°`. I32.00pd TY
R 63.oopa met
g Doto Poid:
Dote of Insp.:
? Insp.:
ft - PI1 wbb !M CRY of aMn
By
Dote of Insp.:
Insp.:
2m
30 Pilot Knob Rosd
0. Box 21199
yan, MN 55721
/ccouM Deposit:
Pennit fw:
Surdhorps: .-
Misc. CF+orpes:
Totol: _
DoM Poid: -
Surcharps:
By Misc. Choros:
Oote of Insp.: Total:
Irop.: Doft Po1d:
i CITY OF EAGAN
383U Pilot Knob Road WATER SERVICE PERMR
P. O. Box 21199
Eegan, MN 651v
? Z°^trp:-
; :a. a ue
Owner,
PERMIT NO.: DATE: - `"- _ -
No. of Units: ti-ptex
Addnsa:
Ske Address: " , over ane 7: : en . ;1T2.
Plumbe?:
CITY OF EAGAN WATER SERYICE PERMIT
3830 Pilot Knob Road
P. Q. Box 21199 PERMIT NO.:
Eagan, MN 55'1,?? R? DATE: '_ P
3'" No. of Unita:
Zoning: -
OwMr, oo a ue
4414 over .d[lE _,_ .:. EIl •!_ic.:`.
/1dd?
Sita Addrcss: .. , , ,
mew ? to u Conrnction Ci?arfle:
Size: ?
`
P
unt Deposit:
v •n
No.:
?? - • ??
?r+ . Fee.
-
I n oo?wvhr ?&i?f?ydll?ii??Caii lo§&kFj Es .?
Onammem YELEPNaNE - EL`CTrA - 2• ` I'4
?y' `op
;
f RED mptEr
By ,
Dote of Insp.:
?- Z-/- Insp.:
?d ?
CITY OF EAGAN SEWER SERVICE PERMIT
3830 Pilot Knob Road
P. O. Box 21199 PERMIT NO.:
Eagan, MN 55121 WATE:
ZoNrp: NO. of Units: + r??
Owrwr.
Address: _
Site Addross:
Plumber. _
i NrM to eow?ly wN` !iw G!p of 4"n
oI'aIMRC!!.
ey
Daft of Irup.:
BZ Fdon Addn
Ga+naction Chorpe:
,
/,CODUf1t DlpoWf:
Prrmit Fw:
Surehorpr
Misc. Charass:
Plumber.
Meftr No..
Sixe: " /tr t
Raodsr No.A10 m
.,n. to .o..h?,.ia R?C??? D
rJt..we.a.
p
'?. O. Pox 21199 --- PERMIT NO.:
F -gan; MN 55121 DATE:
.Zon+ng' No. of Units;
? .• Owrwr:
Address:
Site Add
Plurnber.
I M" M.o.* www ew phr oi Eq?rn
Oraiwsaw
8y
Date of Insp.:
Total:
In4p.:
Dote Pald:
r LLaeposir:
?-
&.s., ? - ?
mwc ?ry.:: , . p mp er
Irop.: I
Connettian (hm"; Aeoount Dsposlt:
Pemat Fae:
Surthorpe:
Misc. Cherpm
Tatol;
Dab P'old:
?/ ?'/
"
9132
?
?
Fequest Dete Frt No Rough-in Inspection
ReqmrBtl ? Ready Now ? Wiil NotAy Inspector
Wpen ReaGyl
tJ ?Ye9
I)(1icensed contractor ? owner hereby request inspection of above electncal work at
Job ROOrBSS Slreet x or R. e No ) ci
?
? ? 0-A,
Ran
$eclmn No Township Name or No 9e No
Coun
OccuPINi)
XtP '
r) t? php. No
Power Supplier AOtlress
Elect I C. vamor [G.any Nam .4 A Cordracror§ icense N ,
Mailinq Atltlres ( onlraCtor or n r Makmg ta Lon)
qwbr,oe0 Sgnatme oMrattor?Ow?nq?hlaking 1 sl Ilalion)
/?M?101??. r LLLf?/?, ?D,1?- Pho e m? ^ ??
II `
L_f.,•,,...?r -
MINNESOTA STRTE 9 D OF ELECTPICITY
Grig9a'1111ICwry BIEg. - oom St]J
tB]t UNVernity Ave., St Poul, MN 55109
PMM (812) 66241600
ni, /9i
nn "anq n n
REOUEST FOR ELECTRICAL INSPECTION
0, See insimcuons for camplevng Ihis brm on back ol yellow copy
THIS INSPECTION FEQUEST WILL NOT
BE nCCEPTED BV THE STATE BOARD
UNLESS PROPER INSPECTION FEE IS
ENCLOSED
,11 I1 RnvPYP(I hV TI115 RBQIIBSt
ff'?-?P, EB-00001-0e I
??
n
ew 4
Adtl Z)1
Rep .7 L .
TypeafBuilding
Home
Duplex
Apt. Building
Comm /Indusirial ..?.,,.. ..,,... _' . _ _ _ ,
ApplianceSWired
Range
Water Heater
Dryer
Furnace pEquipmentWired
Service
ting
ify)
Farm
ana, (:P??yi Air COnditioner
? ?xA"
C
? ?
Compute fnspection Fee Below: p
Fee
q Other Fee M ServiceEnirance Sae Fee # Circuils/Feeders
Swimming Poot 0 to 200 Amps 0 to 100 Amps
Transfofiner5 Above 200 _ AmPS Above 700 _ Am05
Signs Inspeclor5 Use Only. '? TOTAL
?
Irngation Booms ` f
Special Inspection
ication
/C
THIS INSTALLATION MAY BE ORDERED ISCONNECTED IF NOT
ommun
Alarm
Other Fee COMPLETED WITHIN 18 MONTHS .
ihe Electrical Inspector, hereby
I
Rougn-in oate
,
certify that the above inspection has Final oaie _/? O
L
been made.
OFFICE USE ONLY
This requa4t wM 18 monihs fiom
This reques[ vortlC/ /d
19 neviths Imm 7??f d8"
E 1 ?9qR iA p -n
ouun-in insu?:ction ,,,yyy???
9?4/p?/ Re??mretl+ ?ReaEy Now?Will Nou1y Inspec-
0 y ?Yes ?N tor Wh fl dY
? Licensetl Eleclncal ConVador
I here4y re0uest ingpaction of ebova
? Ownra?
electncel work installed at'
Str¢et AAdress, Boa or Route No.
-/ `7G C/o re,e Lw.
??
euinn o TownshiD Name or No. Ranpe No. Count
v
OccuGanllPqINT1
Phone Np,
-/0 7 7
Power $upOlier Atltlress
Eleclncal Cnntractor ICOmpany Name) Confinetor's License No
.
au?.vE? s 5, ? ?-
Mailmq AAdress ICoMrarlm or Owner Mabny Installabon)
nr¢n.tl SiBe»t (Contractor/Owner Makmp InstallaboA Phone Number
'f1"d. /D 77
^^^^ca??p 5iATE BOApD OF ELECTflICITY 1MIS INSPECTION qEQUEST WIIL NOT
Grigps-MiAway Bldg. - floom N-191 BE ACCEPTEO BY THE STqTE BOAND
1821 Universitv Ave.. St Pqud, MN 55104 UNLESS PROPER INSPECTION FEE IS
Phone1612)6C2-O800 ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION ea-ooooi-os
? See insvucbons for complebng this lorm on back ot yellow copy
E 13 9U "X" BeloW Work Oovered by 7his Request
Ad? fleP. TVPe o1 6W 1(lin9 APPImnLe1 WrtaE EqwOmenl Wvee1
Hom¢ Fange Temporary Sorvice
Duplex
Apt Bwiding
Cominercial Bldy. Water Heater
Dryei
Fumace LighUny Fiatuies
Electn? Heatin
Si?0 Unloadi,,
Industnal Bldg. Au Condiboner Bulk Milk Tank
Farm
- oin,., „octi v o?ne? Isnc,?rvI
mm
?ur
a M? su. 1
1 rv
?a..n.... c,.., o_i_... mo, 5?,y? o1n??,
b Fea ceEntrenceS¢a tt Fae FexCers?SoMeetle,s p F.e C?rcmts
200 Am s
fi
ve 200 q?n??y D to 30 Am s
37 to 100 AmpS 0 to 30 Am s
31 to 700 q
s
xning Pool
stormers
s Abve 100_Amps
Ivigaton Boonis
Speciallnspect"n
SD nA
Partial- Othei e
Nem?rks D
`' TOTA?
00
,15 .
Ruveh-in
DTie
1, tne Elec cxl
IfISpBCtOf, M1BrBGy
Final cer4fy that xn¢ a0ove
?BtP insVecUOn has been
' ?ea.
tnra reQUest roitl 18 montia irom
This request void
18 mon(hs (mm
?
08615
?5r3 2
1
`-l>.ov
Request Date Fro No. Rnuehin InsVecunn
R n ?ed?
?Aeatly Nuw
W?II Nouty InsPec-
/ - _ )"'? [or When Reatly
? Lscensed Electncal CnnVaclor I hereby requxst Inspection ot nbova
? Owner eleclrical work installed er
Sveeft?pqq/?J dr x', Box or Roure u.
/ L 2 C'ty
ecUOn o. Township Name or No. Range No. CounlY
Ocr.upnn ( INT) Phone Nn.
Po .r Supolier Adtlress
?
F.lec nral Cnntractor ICOmpanY e1 Coirttaciot's License No.
aJinA Address ICOnLac[nr ot Owne, Makine limstailanonl
r
? ? -5:
Au[honeed 5 ture IConVactor/Owner MakinB InstallaLOnl Phune'Num/ _be'r ye
/
?
26
?} V
1? l.? -
/
MINNESOTA 61t4E 90AH0 Of ELECTHICITV
Gri09s-MiAwaY BItl9. - poom N-191
1821 UniversityAVa., St Peul, MN 55104
Phone 16121 297-2111
IMIS INSYECIIUN REf1Ut51 WILL NOT
eE ACCEPTED BY THE STATE BOAHD
UNLESS PFOPEF INSPECTION FEE IS
ENCLOSED.
REQUEST FOR EIECTRICAL INSPECTION ea-oaooi-oa
y.
6 8 L` ?? See instrucbons tor completm9 This torm on beck ot vellow coOY.
A I
p- E"%" Below Work Covered by 7his Request ?
AJ Rep. Type oi 8mltlmg APOlia in"s Wir Equiumant Wired
Home Range Temporary Service
Duplex Water Heatei Lightuiy Fixtures
Apt Bwldmc7 Dryer Electnc Heatin
Commercial Bldg Furnace Silo Unloadar
Industnal Bldg. Air CondiLOner Bidk Milk Tenk
Farm Iher pemlv Otlie? Itinor.ilyl
t Pf UCIIIy OthC'! O\hY.f
q Fee Service Entranca5,ze H Fee Fentlers/Suhfextlers # Frte Circurts
0 to 200 qm ps 0 to 30 Am s 0 tn 30 Am s
Above 200 qm)s 31 to 100 Ainps 31 to 100 Amps
Swimminy Pool Above 100_P.mps Above 100-Am 5
Transtormers Irrigation Booms Partial: Other Fee
S19f1S SUQLiaI II15pPCIl011
TOTAL FEE-?-
-
Remarks . ,
/?f7'f U)
I - \•' '
You9h-?n the Elec'1nc1
_ ? °? 0 Inspactor, he?eby
wrUty that the above
Final inspecNOn has been
' . C . ?%'?-??Z" /L T? made.
{his reouest void 18 moncln from
This repu¢at void ,1
18 nxonths (mm U U-?' L-'
0 0 8 6 -1 5 2 L
Renuest Date Fire. No. Rou h-in Insuccbon
e ?reA, ,
?RCadY Now
WiII Nolify Insper
?
Yes Nn «or When Re.?tly
U LicenseA Electnwl ConUactor I hereby request mspectwn uf above
? Owner electncal work mstalled ab
Svext AdJress, Box or Foute
.L C , ?/
? Citv )
ecuon o. Township Name or No. Ranc?e No. Counly
Ocr.vpan IN7) ?
(JCJ?•Y ?jC?('?.GGJ?? Phone Ne.
Powe $u I, er Adtlress
Electnc Contracmr IComueny Name C?mhactor's Lu.unse No.
O
a ine a dress (COnVactor or Owner /MJakmg Installau/on)
Authonzed ature Contractor'Owner Mekmy Installavunl
/-l?J Phone Numbcr
? ? - 'G o -
MINNESOT64qTE BOAHD OF ELECTHICITV
Gngps-Midway Bltlg. - Hoom N•191
1621 Univarsity Ave., St. Peu1, MN 55104
Phone 1612) 297-2111
THIS INSPECTION HEQUEST WILL NOT
BE ACCEPTED BY THE STqTE BOARD
UNLESS PROPEft INSPECTION FEE IS
ENCLOSEO.
/ REQUEST FOR ELECTRICAL INSPECTION EB-00001-0'
/i\ L
See in5<rvctions lor completuq this form on betk of Yellow copy. '
Q "X" Below Work Covered by 7his Request
? Ad R.P. Tyoe of BwltlmO Aoc?mnces Wi Enuipment WveA
E
Home Range I II Temporary Service
Duplex Water Heater Lightiny Fizturr;s
Apt. Building Dryer Electnc Heatin
Commeraal Bldg. Fumace Silo Unlonder
Industnal Bldg
a .
Frm
Air ConAiboner
om?,? o«ufv
Bulk Milk Tank
Otntr fsoe..,fvl
t nr ISPCwfY Other Othcr
l,ompu[e inspecu<m ree OCIUW
M F service E trenee5"ze u Fee Feeders/Suhfeednrs N Fee Cvcurts
n0 ta 200 A ps ? 1 ? 0 ro 30 A??s 1/1,0 , 0 to, 30 ,vni
nhnJa 200 omi,l,l I 131 to 7UU qmps r `a I j I to iJV .vmps I
Signs Special Inspection t 70TAL FEf?^
)
Hemarks ? /'?7"• ?
R
h D11
0 tri
I
th
EIl
ai?
-in ?
ouB ?/
/
?~ ,
e
t
c
? Jil Inspector. ho?eby
??? certdy that the above
Final ? ?(^' nspection hes Eeen
? l made.
Thu requesl void 18 montns vom
131Aa1510
lp 74593 g, o.:
Request Date '?e No Fough-inlnspectqn
`? G R mretl?
s ? No ? fleatly Now ? W?II Nohly lirepector
?en Ready?
IP4censed contractor ? owner hereby request inspection of above electrical work at:
Job AOtlress (Streel, Box r Route No ) / ,,-- qN
Seclion N. Townshi0 Name ar No. Rarge No Coun
4l
Occupant(PRINT) Phone No.
Power Supplier
tr 4A-ci?_ tv? t? s S, Atltlress
47 ?,?
ledncal Convactor (COmpeny Name)
?
2 L
Q d Cororactor5 License No
C1
l 0
Mai6ng Address (Conlraclor or irer Makirg Installetion)
AutMnzetl $ig u(CanVectodOwner Mak g Insiallatwn) PhOne N mber
Z <1
MINNESOTA S?pTE BOAqD OF ELEGTRICITY THIS INSPECTION REQUEST WILL NOT
GtlggsMitlw?y Bltlg. - qoom 5773 BE ACCEPTED BV THE STATE BOARD
18t1 UnlversNy qve., SL Veul, MN 5510I UNLESS PROPER INSPECTION FEE IS
Ph^^a (612) M-OSM ENCLOSED
REOUEST FOR ELECTRICAL INSPECTION ea00001-07
/ ? See insWCOOns for compkting ihis krm on back of yelbw copy
I? 7 4 5 9 3 "X" Be/ow Work Covered by This Request
e Add Rep. TypeofBwlding AppliancesWired EquipmenlWrtetl
Home Range 7emporary Service
Duplex Water Heater Eleciric Heating
Apt. Building Dryer Other (Specity)
Comm./Industrial Furnace
Farm Air Conditioner
Olher (specily) ConVacbrS Remarks??.r " ( ' N e v(J ((„V'
??-?y
Compute lnspechon Fee Below:
# Other Fee # ServiceEnirance Size Fee # Circuits/Feetlere Fee
Swimming Pool 0 to 200 Amps ? 0 to 100 Amps
Trensfarmers Above200_Amps A eW0_Amps
Signs InspeaorS Use Onry TOTAL ?
Irngation Booms ?/??
? (y??
Special Inspecaon - - ?
AlarmlCommuniCation
Other Fee .,--,
I, the Electncal Inspector, hereby Rough+n 7_?
certify that ihe above inspection has
been made. Fi?yl Dale
OPFICE USE ONLY L C?
This request wid 18 monihs fmm
rniY ,rauest ?ooa /o//lV eS?"
,a mooms r.om
if ?; dn n 1 c,
&-S// 7 el5l?
991IP,3 ?x/) O'.'
?
Requesf D e
//
F??e o.
Roughin Insuecuon
R¢purteA?
?ReadY Now QW?II NoLiv InsPer
/D?
6 Pf- ??-es ?No ior When Feady
Licensed Electncal ConVactor 1 hereby request ins0ecbon of ebove
Owncr eloctncel work insfalled eY
Street Atldress, Boa or Raute No. City
,W;A6
ectmn o. Township Name or No. Ranye No. C un
OccuuA IPRINT? 7 ?
?ir? Phone Nc.
740j6 -?3'?33Z3
Power uoP er
Adds
?
?V&
a/ %
Electncal Contractor (Company Numel
- ? C""trac1O` SLicense NO•
? 2 6
6T
q! e
Mailmq ress ontra or or Owner akmg ton l J
/ ?
%IrTI
Author¢ed SiPnaIDre n actor?0 er Mak atmnl Ph Nu Ger
MINNESOTA STATE 80AflD OF ELECTHICITV
Gnggs•Midwey BIAg. - Ponm N-191
1821 University Ava., St. Peul, MN 65104
Phane 16121 297-2111
Inia uoiarc, i v. .cu...oT - " ...
BE ACCEPTED eY THE STATE BOANO
UNLESS PflOPEF INSPECTION FEE IS
ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION Ea-oo?
See instmctiens br comolab?g Uin inm on beck of yellow copy. ~
? 5400 X"`800w Work Covered by 7hrs Request ,Sj'Sj // I7
of ewlGmg ? Apobancea Ylirotl Enmpment
ice
lec[nc
ilo Unl
rtioner
N Fee me EntraneeSize p Fee Feaders/Subfeodera p Fee Crrcurts
200 qm s o 0 in 30 Am s
;Above
200 Amps? M 1 to 100 A
vning Pool
mPs s
Above 100_Amps
StormerS Partial. Oth
? .. . . .
This request voitl .-+
?a ,,.,?h8 6153 ? _ ? i ? f?' ? ( ? `? - ? ?' ?
Ryq.es te Pire No. p?ough-,ii,Invue,cUOn ?Ready Now ?I ?otlfy ns0ec
(% ? l ?YOES ?NO ! WhCl1 RUUdy
? Licensed Electriwl Contracmr I hereby request ms0ection of n6ova
? Owner electqcel work installed at.
Sveer AdZ??r qoute No Gity?
ecLOn o. 7ownship Name nr Nn. Hnnge No. Cou IY?
OcwGanl ( T) . Q
-
? U?
? honie No.
C?
sr,
-
-
Power S lier Atldress
EIecV al ConVa(mr ICompanYe) Coctor's L¢ense No.
Mailing Address lCoMracmr or Owner Makinfl InslxltatmN
a?? 72-4-4- 3 ,
Aothonzed Si it e(COntravtor/Owner Makinp bistallation) Phone NumLCr
C - lp?? o n
MINNESOTA STIHE eDAND Of ELECTPICITY
C+ri99s-MiCway Bldg• - Noom N•191
1821 UnivarsilV Ave., St. Paul, MN 55104
Phone (612) 297-2111
THIS INSPECTION HEQUEST WILI NOT
BE ACCEPTED BV THE STqTE BOARD
UNLESS PNOPEN INSPECTION FEE IS
ENCLOSEO.
REQUEST FOR ELECTRICAL INSPECTION Ee-ooooi-o.
See instructions for complating this form on beck of yellow copy. 0 0 n?+ ?n ?6 ,X' Below Work Cverad by Thrs Request o hL /G,--
Ad Rep. Type oi BwltlmB APOliances WireO Equipment Wired
Home Fange Teinp)rary Service
Duplez Watet Heater Lighbny P,xtures
APt. Bulldmq Dryer Electric HeaUn
Commercial Bldy. Fumace Silo Unloader
Industrial Bldg. Air Cnndinoner Butk Milk TaN<
Farm Uihrr prc'fy 77thei ISUanfyl
t rr i5uoci v O:her Othu,
N Fe ServmeEnhancaSize F! Fee feeders/SuMeeders k frta Cucwts
D to 200 Am s' 0 to 30 Am s_ 0 to 30 Am ?s
Above 200 qnnps 31 to 100 Amps 4 5
31 to 100 q y
Swimming Pool Atwve 100__Amp,- Above 100_?mps
Transformers Irngatmn doorcis Parti2l.'Other Fee
Signs Special lnspection
Re marks TOTAL-FEE >
Roueh-in Dote
trye Eleatn
c I
fl
Inspecfq hereby
Final
? ?/' Se?tNY that xhe above
(Bspection has been
Y mede.
This reauesl vold 18 menlRS Irom .
Thre requesl void
18 imnths from
o 096154 L?
Rr.que+t DzW
?? Fre. No. PouP 1?? '??sper,tinn
fie? retl?
Vps E] NO ?
Heatly Nuw Will No?ify Inspec-
lor When ReadY
LJ ucensea tlrctncal ConVactor I I hereby requxsl inspection ot above
? Owner electncal work mstalled at
Street Addr sx, Bon or Roule o. .
L CnY ?p
2
ec Name or No. Range No. County
?-
Or,cupant IP I Phone No.
Fnwer SuppLEr Addre55
Elec
b
iy
I Contractor ICOmpeny Na Con[racmr's
L
icense No.
/
/
,
X' -
7
? / O C
Mailung AdJiess (Convar,tor or Owncr Makmg Instailabonl -
pA) OF/allx_-'
!+uthor¢ed 9A re IContracrodOwner Makmd IntitailaLOnl Phune Number
MIryNESOTA ST{(y( 90ANO OF ELECTRICITY
Griggs-Midwey Bldg. - Raom N-791
1821 University Ave., St. P.W. MN 56104
Phane (812) 297-2111 .
THIS INSPECTION pEpUEST WILL NOT
BE ACCEPTEO 9Y THE STATE BOAHD
UNLESS PROPEH INSPECTION FEE IS
ENCLOSEO
REQUEST FOR ELECTRICAL INSPECTION % ee-oonoi-oa
' Sea mstmctiuns for complebng chis lorm on back of '?
n= (? /1 p? A? p val low coov.
U j j 1 1 I Y ?-X'* Se/ow Work Coveredbv Thi.c RP.,??r.<? iN 1, I t-
j j
Atl ilAmg Appliancea WveO Eqwpmenl I Wi dredl o
H
e
Range
Teinporary Service
), Water Heater Liqhtiny Fixtures
K
m? Dryer
El
ecin
t:
H
ea
m
l Bldg. Fumace Sflo
Unl
o
ad
E:r
ldq. Air Condrtioner Bulk Milk Tank
mrr oe(.i rv
?iy pum,
O?hcr
'Jq lUUt B lnS nacfinn Foa gF# Eiji e tt Fee Fxnders/Suhfaedera N Fee Grcwts
0 to 30 Am s 0
tn 30 Am>s
?y 31 to 700 Antps 31 to 100 pm
Above 100_qm s Amps
Above
100
Irrigavon Booms _
.
Partial-'Other
R¢poarks SUeaal Inspection
rO
TOTAL
R
•
? ? FEE/
1 f"L ?
ough-in DM,e ?
I
thy Elxcvicei?
? iIy/ ,
Inspecbr, hereby
Fnal ce
td
h
? p ?
-
?1eq' ? r
y t
at ihe abova
oris0ecfmn has been
mada. .
My Of EaiaIl
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax:(651)675-5694
2008 RESIDENTIAL BUILDING PeRnnir aPPUCanoN
Dffie: II`I 3-6o Site Address: ?&7? 6 c- [OU2/- 1-1V _
Tenant:
CG
CCc,E?-? 1 I - I ?l
?----------------
i F« on?ce usa
i - 7 1?,f
j Pertnit#: O ?SCJ
? Permit Fee: I JD 'OC5
I ?
? Date Received:
I Stflff:
Sulte ill:
RESIDENT/OWNER Name: e b?Ma45 4 iAVhone:
Address / City / Zip:
Applicant is _ Owner YConVactor
TYPE OF WORK Description of work:
Construction Cost: ?? .?# Multi-Pamily Building: (Yes No
CONTRACTOR Name: 6 & icense #: C.V
Address: 404
m? Zi
r`' ?
'
)
p: _
Sfate:
D(1
City: {?( M i m-I
?
?/ ' ?Z?Contact Person: C /?XY? ?? QV
Phone: 6`J I ?I" ??
ZYY?
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Cateaorv 1 Minnesota Rules 7672
Ene?gy CodB . Residerriial Ventilahon Categary 1 Waksheet • New Energy Cade Worksheet
Cet8901y Submilted SubmiGed
(4 eubmiseion type) • Energy Envelope Calcula6ons Submitted
In the last 12 months, hes the Cfty of Eagan iasued a permit fw a similer plan based on a master p1anR
_Yes _No If yes, date and address of master plan:
Llcensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: PJans and suppatfig documerrts that you submlt are cortsidered to be pubfic inlormation. Port7ons of
the informaflon may be classffi'ed as non-peblic if you pmv(de speclfic reasons that woWd permit fhe C1ty to
conclude ihet the are trade secrets.
I hereby acknowledge that this information is complete and accurate; lliffi the work will be m contormance with ihe ordinances and codes oF the City of
Eagan; that t unders[and this is not a permit, but onty an application fw a permit, and work is not to start wi[hout a pertnR; that the work will 6e in
accordance with the approved plan in the case of work which requires a review and approval o I ns.
x K05c'J r .D J 4be.?S x ?
Applicant°s Prlnted Name Applicant's Signature
Page 1 of 3
DO NOT WRITE BELOW THIS LINE
SUB TYPES
? Foundation ? 05-plex ? 16-plex ? Accessory Building ? Pool
? Single Family ? 06-plex ? Fireplace ? Porch (3-season) ? Ext. Alt. - Multi
? 01 of _ Piex ? 07-plex ? Garage ? Porch (4-season) ? Ext. Alt - SF
? 02-Plex ? 08-plex ;0 Deck ? PorCh (screenlgazebolpergola) ? Multi Mist.
? 03-Plex ? 10-plex ? Lower Level ? Storm Damage
? 04-Plex ? 12-plex ? Miscellaneous
WORK TYPES
? New ? Interior Improvement ? Siding ? Demolish Building'
? Addition ? Move Building ? Reroof ? Demolish Interior
? Alteration ? Fire Repair ? Windows ? Demolish Foundation
? Replacement ? Egress Window ? Water Damage
" Demolition (entve building) - give PCA handout to apphcant
DESCRIPTION:
Valuation ezv• f Occupancy „z2G -f MCES System
Plan Review Code Edition r4n ZGb ? SAC Units
(25°/a_ 100% 1 Zoning City Water
Census Code N?j?7 Stories Booster Pump
# of Units Square Feet PRV
# of Buildings Length Fire Sprinklers
Type of Const. Width ?
REQUIRED INSPECTIONS
Footings (new bldg)
Footings (deck)
Footings (addition)
Foundation
Drein Tile
Roof: _Ice & Water _Final
Framing
Fireplace:_R.I. _AirTest _Final
Insulation
Reviewed By:
Sheetrock Meter Size:
Final/C.O.
FinallNo C.O.
HVAC
Other:
Pool: _Footings _AirlGas Tests _Final
Siding: _Stucco Lath _Stone Lath _Brick
Windows
Retaining Wall
Building Inspector
RESIDENTIAL FEES:
Base Fee
Surcharge
Plan Review
MC1ES SAC
City SAC
Utility Connection Charge
S8W Permit & Surcharge
Treatment Plant
Copies
Total
Page 2 of 3
0
?f?0[?9.E D
or??
Dav
DUdLOUe uwsPEcrIoWS ?? •?? ?? ? y ?
?? ry 6
N r
y
a` ?
00 ?
N
3 ° ?
o ,
I
s8 W
\
I ?
N
V I
` N
II /
B 83??
14 /a
1?
N/
0
15 y
s a
? o
w >4 ` ?
. `
\7
ym
18
\ v v ?
?
, ?,.>,
30
I ,30
47
e.wa
?
44 ty j
I?
I ?
0:07 - J
.5s•„-1w
W
Jzerlace JEx: Si%n9 N
17?° c ? m
OUTLOT
H?
ro
?
B ?
L
L
City of Eap
3830 Pllot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax:(651)675-5694
------------------
? ?o?_om? u5a I
j Pertntt5V`7??
? Pertnit Fee:
I
? Date Received: ? j
I Statf: I
i
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: '`6 Z 1 5ite Address: ?/4 ?? 4 ql 7 6 C bjPf L lJ
Tenent:
5uke 8:
RESIDENT / OWNER Name: ? t43.. jbk*\f 01@?fS 0 .Cv??4hone:
Address / City / Zip:
Applicant is: _ Owner ? Contractor
TYPE OF WORK Description of work: KE r?a T"
Construction Cast:L?f700 ? Multi-Family Building: (Yes ?/ No ?
CONTRACTOR Name: _? )_kboIS 40mP Tani/,2FJpin License#: 2046113'7
Address:11b4 C•y(/ 11r, 5+. Lo.
City: i af I-N,?? State: MN Zip: aS02v
8D,4,1 ??b6Q?3
P
?W-34/23
erson:
Contact
Phone:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Cateaorv t Minnesota Rules 7672
Energy Code . Residential Vendlation Categwy 1 Worksheet • New Enargy Code Worksheet
Category Submitted Submitted
(4 sllbmission typ9) • Energy Envelope Calculations Submitted
In the last 12 months, has the City of Eagan Issued a pertnlt for a similar plan based an a master plan?
Yes _NO If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanlcal Condactor: Phorre:
Sewer 6 Water Contractor: Phone:
NOTE: Plans and supporting documents that you submR are consldered to be yub!!c informaNon. Portions of
the lntormatloo may be classl/led as non-pu61(c N you provlde specltlc reasons thaf woWd permit the CRy to
conclude that the are frade secrets.
I hereby acknowledge Ihat this information is compiete and accurete; that the work vriil be in wnformance with the ordinances and codes of the Ciry o(
Eagan; that I understand ihis is not a permit, but only an application for a permit, and work is not to start without a pertnR; that Ue work mll be in
accordance with the approved plan in the case of work xfiich requires a review and approval of plans.
z KOr??''1T x . ?
Applicant's PriMed Name AppllcanPs Signature
Page 1 of 3
2/84
CITY OF EAGAN
APPLICATION FOR PERMIT
SE:•lER AND/OR WATER CONNECTIODi
(PLEASE PRiHi)
1) P??OP='?t?'?' ACDP.?.SS: g ? ?
(IocBlock/Su:aivisicn or Tax ?arcel I.D. Nur.er)
I i DaT':; 0° C2IGuAL ?.?.'1i ?SJI.l+.Cr:
..':::1.N:/!:.'?oPO-= LS: ? R-1 Si:GL'-. :?%+SLY
? R-2 DU?= ('?':'J II.?I.S7
. ? R-3 'IC7.t1?Hnr„*cg (mcro, + nIITS) ( W. ITS)
? ..-a AP:?2T-7r/c^_?.:.rrir,l ( cr,;zTS)
? CCi^IE.:C='i,/R._.?'".,IL?Ci?'IC:=.'
? ???•s?i
Q L\?ST=_C`:ti../Cw"'v= ?n=T
2) A =Wi=_iP (PLEaSE PR1fiiJ
-Zl,r C•
rLcR=.ss:
sT.= , zIP: ?c n w, r? ? ra Z???N ?d 73
Ph=:
j) F7;`: (PLEAst Pflltii) FOR CSTY (1SE OYLY
PLUH9F S-CIC:YSEc
Active
CIi?, ST?. ?-, ZI°; Q Esp' ed
Pl-.C%Z= M??r.
PLUYBER LICEVSE # ?/,4l?? /y/C? af
Recard
iL
' arC tnlLtdl
g) cX'Z,?PS?/C(•.?:E2 r?cns? rnin??
Esz
ACCRESS: Lo /3?f(E /vCS
cri^r, sr;::::, zIP: ? f Rl NE J? Jv S"SF3 5%
5) IIdDIC:.Tr. ::'[-IICH PEF:•IIT IS SEP:G RFQLiESTLp:
IZI CC..'.IEC:IC:1 ZO CITY SEYER
?[. CC:::,=IGN 'IC) CZTY hTATER
? al-L'.M (PL.ZA-CE D..SC.'RZBE)
6)
• ? PI.: `SE f?OID APPP,OVID PER.mIT Farcle ?-L?i BY C:IE OF AFiCV?
? °T-EiSc :•T'r12L APP?20VE? PFF:•1IT 3, 4 ABOVE
one) '
DATE• !
ll4lo
OR?l c1?lY feJS ? Y? R??a?c:?.? a t P+t rs aFr a+.? _ s I?s i?a :a a?e ra ?tl?ff r-ss? fw f? t?s:?a
F 0 R
P-p"I"' °- ZSSU°D
L E::::=
C 2 T Y U S E O N L Y
rrZS 7 $ /G S U
$ /G-S(i
S
S
$
+S
$
$
5
S
?
/
$
S
S _?S7 1 v
n??'.7T'^
J l: .....: :'.?
LYATCR DER:1TT ?• ? \
(T?..C?;;L..:. SU..C::F,RGL/
hA'=SR i`1ETER/COPFE:?OrZ;;/CUTS=0? RE;,DER
WA:ER TAP (ZNC:.UL`-^. CORPORnT?0N STOP)
S=:IER Ta?
AC.^_Ou?:T D=:POSIT - i•i;i^'?i
WAC
SAC
TBC?iR WAT°R AS2ES...._...
TRi:.i{ SE:]cR
i?....?.,.. :..? ' ?
LAiE:.=.L BLNLC:T/="';K C-'.:-?
LA':?RAL BE\EFIT/'?':;v::K '=?-_?
?JATER TREAT?fENT PIaL`:T SCRCF?aRGE
OTHER:
TC i =.L
A??cU?:T DalD;•R??z:- _ n LS2.t?'S
DCES UTI:,Z:Y CD;7:IEC;ZON REQUZP.E EXCAVATION I,7 PUE:,IC RIGHT OF WAY?
L Y: S IF YES. THE:: H"PER:IIT FOR :•70:.K SQIT??I:I
PUBLIC ROAD:vAY" ,1UST BE ISSGEZ BY TEE
O NO ET7GI:IEERZNG DIVISZON. LZST i,S A CONDI-
TION.
SCBjECT TO THE FOLLOWINIG CONDITIC^:5:
APPROVED SY:
TI':LE: ? .
DAT°_:
? MeW M Wi+w40 VcW Ol?w?.?
• ? '\ , ?
! .,
?. ?
2/84
CITY OF EAGAN
APPLICATIGN FOR PERMZT
SEWER AND/OR WATER CONNECTIODi
(PLEAS£ PRINi)
1) PP.OP= ACD?.ESS:
i Fr=+I. D°SC'??T?CV:
(LOtBlock/S •i.bdivisicn o Tat ?arcei I.D. iJtarner)
, .T'r W'SS='=:G D?.i:. 0?' C2T_GyFiL u`,IL^I.':G -_--S' ZS
? :?_: _•: _??-;
CS: O R-1 S= FPtitrl,y '
Q R-2 C7.TP?.: (T.':O L^?=-S)
? iZ-3 'IC'f.u1i.:rvrcg (m;ic= i [:?TImc) ( UD72^_S)
? r-4 UtiI:: )
p CCi•nIE,?CLaT./RE^^`?SI,/CZ=G:
? ?
?
LS?.Lz
?
?
??/+rR?+..? ?rP
? L\SIT=i
2) Acr?;T (PLEAJE PRltii)
NP1•'F': L LlC1-4 EA CI.,V f---)4
ACCR..sJ:
C; ..,, S:r=- , Zl--":
3) pI z7.?? (PLE?SE PRI4T) FOR CITY USE OBLY
NPJ`F_
PLCwSS:
? PlUN9ER5 LICE45E:
_
?rn? ?
Ac[ive
CIiI, Sn', ZIP: 0 Expired
OV?:
PH Not of Retord
. PLUHBEA LICENSE N_j!!5a/?l.??/yj g
' a$E-"r- :ni;i?i
lru at rxisl)
I3?i '•tE: 600 E d ln ES_
ACDRESS: d 9 3 ? .L,A,X6 1VF
czT^r, sTl=, ziD: 4;1?
PFiaTE= 2b?'D - .SS! d
5) L'NDICMir. ;dI-IICFi PEF.•LIT IS BEIItiG RF7QLJESTI'p:
fo CC:•'.IECrICU M CITI Sai'ER
? CC:Z:,=ZC;1 'IO CITY SJATER
? CI"ii'.f.c'2 (PLE15E DFSCRIBE) 6) II:DIG=IZ C:W:
,i
? PT-= `tSE I?OID APPP,WFD pg3,+^ST FOR PI -L?'r BY CDIE OF
91 °t-= mSE:•AiL APP?1Nm PET'_•LLT 1. 3, 4 AEOVE
, . A / s Lcle one)
7) SIC.:7=,F,:
DATE: Jl
MlDlAiY/s.1si?Yrefl?al?af?Ap ? . .
F 0 R C I T Y U S E O N L Y •
P-'-"•Z'- " ISSU°D
F=_S: $ lG )!i
$ SU
$
?,?L'?•
5
5
$
$
$
c Ga w
$
S
S
5
$
S
S i
?7 1 v
?.'_....:D nrp•.77'^ ?I?:i._....?? ...:??:..?.. \
:vJ w. J
WAT°3 °E3"lIT (I_:C_ ^=' ?„ `
••?•.. =C ::e?Gni
Ttia':ER METER/COPFr::?OrZN/C[:TS=.^,° RPApER
tdATE3 TAP ( I.;CLCIJ : C03?Can7=0?I S^OP )
S :?;c TA?
AC.^_Cu::T DE?^ST_T
w?,C
SAC
T?,:`::( I•:?T?a S?
:, _.._. ..
T3;::1N S?7CE3
Lni ::;.=?L bL.YLt:T/T:,l,N;
LA:: R%eL B%\c.: T-T/'::i?
'^"'?:i
WATER TREA=1T PLA`:T SLRCE:u2GE
OTHER:
T=1L
n
DCES UTT.:,ZTY CON:IEC^.ION REQUIRE EXC.=,VATZON I:7 PU::,T_,^. RIGriT OF SJAy?
7-7 YES IF YES. THE:: h"PE3.IIT e0R :d0=!? WIT1T9
PUBLZC ROAD;daY" MUST BE ISSGE= BY TH?
C NO ENGINEERING DIVISIOid. LIST n5 A CO\DI-
TION. SLGvLCT TO THc FOLL0:9ING CONDITZC`:S:
APPROVED BY:
?
TZ:Lc:
DATr: /?, ?0/??5 J -
-?
? 1.
2/84
CITY OF EAGAN
?1111 APPLICATI^uD7 FOR PERi'4IT
SEWER AND/OR L4aTER CONNECTIODI
(PLEASE PRIHi)
1) PPOP= ACDRiSS: 'Jy 13
?f?,o ?C:etxD
=I. D.°.._TD'T'TCV:
C? ??-
(Lot/Block/Sl;:,auvisicn or Tac Parcei I.D. ivL:.Der)
i: ?•:Z?:=:i, SIM.i::.'^ :v°., Ccli=. 0_° Gc2T_Gi::?w
pm-S?.^_ CC': ? R-1 S-D:GL:. cP-S=Y -
? R-2 CL?L? (?:':O L^?I=)
? R-3 ;C;.Z-:'.:rJS° ('!?-= + L': ?TS) ( W. I"'S)
? c-4
Q CCi.nff'..°.?L??./:2E^'"?L?Cc_??
? 2MCs-171LA:i,
Q L1tSL=C\lAi./GIJ"V=?i?..?'`....T
2) A?=-`T iF?taac Fa1Ir)
f
luv-z:
I.v c.
1Y?r?'?/ A.
ADCR::ss: L3 (3 x
c=, 5=:= , zIP: -5 4 A,g'?i.a 07 .v ? 6S6 73
Ps=: V5 3 - s % 7 /
3) Fu: -=-? (PLEASE P81VI) FOR CITY USE OALY
PL?JH4ERS LIC:SE:
PDCu.55: _ ?p nct' e
CIi_'. ST:+?EE, ZIP: E ired
PNCNZ-= hai u.
PIUNBER LICE:75E #npiBL/L iy/Gj ot of Record
'
• nrSF
inicTai
?t?• ? IPLtASt PRit7f)
4) =-,??py?*i/Lv,';i.TM P
? /?am65_
ADDRESs: ?,016 0 _ ?3 "? .? ,v.w? ?fl, ?'
cr:^r, sraz*, zZD: 61,47ms ??„ Sst/35i -
PFC>IE: 780 - SSi a
5) INpZC1.in ;4HZCH PEF:•lIT IS BEItG R02U:.'STLD:
El CC:::IF.C:ION '1C) CITY SES^iER
? CC:::QEC:IC:I 'IO CITY WATEFt
? C1i'[IM (PLG15E D=RSSE)
6) II:G=G,..: C:.F.: •
. ? Pl---`,SE f?OID APPP,OVID PII2ti+ST FO4 PICi:-L'r SY CNE OF ABM?(?f
.? ol-r--SE MAIL APP?,OVID PER.•ffT 1. 2. 3. 4 AfiOVE
z:c e one)
7) SIC=RE:
I DATE• -
-
OR?! ai?ls.ia i? r???afca a a r? ?ca a??a ? s? rc? ?s.a a?[ ?a t?? a-air ?? ?? yys+?sr
F 0 R C I T Y U S E O N L Y
PE?"IIm u r55UrD
E::::=
rr:S: $
-
/f?• < U
$
S
$
$
J.?- I•G ll
S
$
?
?
$
S
$ ?S J ? u
S :.:E.°, ?3?+r'=
WAT°.^-. DF??1..., ?i`:C? •-.? _ .
??: CH.'vRGc)
WA'=ER METER/COPF£.-^, :On/CGTS_'.] : i2; ADER
TvAT°R TAP ( INC:.'UI.^ CO:2 POrZnT=ON STOP )
5?:•:c:? T??
AC.^_Cu\'T D=:PC'SI-?
j'liC
SAC
T3;,'Ng 67.?1T°_R :yS-SES..--=••-
TR;;2I5 SE:C;rR :.5??- S5::'•iT
LAiE:.yL BL.`jLl:T/T=; 't\ CE. =-,
L:-,:c?',L B2.NE: IT/mcUNY .:AT°_'
?dATER TRE9TMENT PLa= SLRCf?ARGE
OTHER: _
TC ; `,L
DCES UTZ:I.Y CO::::EC:Zpti REQUIP.E E:CC:,VATION I;V PUE:.IC RIGriT OF WAY?
FYES IF YES. THE.; n"PERD]IT FOB :•703? Sd2i??1-I
PUSLIC ROADWAY'• MUST BE ISSliEC gy mvE
F'l NO ET?GZ:]EERING DIVZSIOid. LIST nS el COi:DI-
TION.
SLCJLCT TO TfiE FOLLO:•7I?JG CO\DITZC?:S:
APPROVED BY:
TI:Lc:
DAT° :
? aw ??s w ?.s? .e? ? ? w ?? ?t? ?t ? w ?-r w w R+!? ?i:? w ?w? s? wt? wF ? ri ?i? w+? ?c? ra ?? w ?
i .-
,? ,
-?
I r
2/84
,
`?
p
CI
TY OF EAGaN
imi APPLICATIO.I FOR PE4?tiIIT
SE[dER AND/OR WATER CONNECTZODi
(PLEASE PRINT)
1) PP.OP= ACDR: SS: ArL,2, I
TFf=+L Dy.SG'!'--`'I'ICV: .?? :3,),
(LoLBlock/Su:divisicn or Tax Parcel I.D. Ntsrz2r)
I I"c E'S-z='=:G S?T i:C^.?,Tc° , CAT' O_° ORIG21Ai, `uUI?.DI_':G =.-=_-= ISS?;-?;C?.:
e"
PDyCz:"?" ^T
[?C' . ? 1?-?
JC1
?GL : : rtitSLY "
.
.
? R-? GU?'c :=.'. ('!'•':0
. 0 R-3 1Cr,,,r,T:rr?cg ('I"Lt' + L? ITITS) f (NI_'S) .
D r-4 i;r:,::*'?`:T/CC_?C,drr?1l;,-•1 ( UD+'ITS)
? CCi.n??C=?.L/RF.""'?-.II?C?'Icz-
? ?uus==-,?L
? L1?STI7-Z7, ICNAI./GG'U'"?`:=T
Z) APp=,T IPLEAjE PRf;iTJ
a ,?y A le?,
aDnREss: z -g-
C=. S_'?' ?', ZIP:
P?ONE: 617
1
3) FL?,"=,;..? (PLEASE PR19f) FOR CITY I1SE OYLY
PDC?v.SS:
S?h7 ? PlUM9ERS l , E:
A tiv
CIiI, ST.`.c., 2IP: red
PI:OVE: A
t of Reeord
PLU48ER LICEYSE N
dt' :nl:tdl
,
4] CM?PNT/C,?„?&t ,?r lr?cnst vxir?r?
NP+`IE: ( yrs atv 0 e5+Je4 F -7.,e 6m6S.
AnDRESS: /416 r) - Cj3`0' Z fg.v6 1V$:?:_
ciMI, sT::T"", zzD: .BL',Vi.u>* ^ ,.,..v el
Pf:c::E: 79?o - ss/ a
S) INDIMir. ;vHICH PEFudIT IS SEII`G RFQUESTFD:
9 CC::J]EC:I0,N 'It7 CITY SaiER
CCN-,=CN 'IO CZTY ;qlTEft
? ?'"?'...ft (PLG\SE DFSCRIBE) 6) II:D=G,.. C:W: •
. ? PT'=,SE f'.OID t1PPPWID PEn'ST FO?2 PZCi:-G? BY CDIE OF ABOJE
?
oL :ySc ?r1IL APPRMm PEF: lIT I. ? 3. 4 AfiO?'E
? cle one)
7) ?-
, DATE:
Me w! oqa<aft? r ca ?ca.a?ra a ? rti o s?a a? a? r.c?ara :a a ae r??a.n ??a a? a??a??y
F 0 R C I T Y U S E O N L Y ?
P?-'t'•I'^ °- ISSUrD
E::::=
rr=S: $ AJ• iCi
$ S U
$
S
5
$
$
+S
$
$
S
S
$
$
$
WIT^n D.^7ntrm ?i..C.?....L : ?
SC^C :n?GL?
[tiA T°it METERICOPFE.^-,::OR N/C[:TS:=- iZEhu :3
SvAT?? TAp (INC;,CD- COR?Or??,T?Q?7 S?O?)
S°:•;'c3 TA ?
ACC,^,U\T D;-:P^SIT
W?L
S `_C
mR_`:{ [•.aT°R .a5-t-:._....-...
TR:;2:1 SEP;ER yc._??.?.
.,..? c--c.. _c.__T
L:-,: ° F-?,L SLNL.[ TT/_^.ti-.
m._,;c.
S?...._,
LA?'EtiAi., Bc.Nc.: ?T/mc:.i:tiX :ATr?
WATER TREAT*ENT PLA27T SL'RCEARGE
OTEER: _
$ TC _?_L
$
-J U ?ti'.Ci:•,:: PniDj3°.,r.?c ' - °
• ' " _ S 7 ?S
DC: S UTI:.ITY CO.::IEC:ICti REQUIP,E EYCAVATION ID1 PUE:.IC RIGFiT OF WAY?
L YES Zr ygc, Tgr:: H"PERM2T FOR 1703K SdITHZN
PUBLZC ROAD:4AY" MUST BE ISSliEC BY T???
? NO E*?GZ:IEERING DIVISION, LIST :.S A CO\DI-
TION. •
SCBJECT TO TFic FOLLO:dI.7G CONDITIC::S:
APPROVED BY;
TI': LE: / .
DAT° :
? I b-ID RESIDENTIAL BUILDING 199q_ 7S
Permit ApplicaGon
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5674
New ConsWd'an Reauirements RemodeUi2euair Reauiremen5 Office Use OnN
3 registeied site surveys showing sq. ft of lot sq. k. ol house; and all roofed areas 2 mpies of plan Cert of Survey Recd
(20% mazimum bt coverage albwed) 7 set o( Energy Cakulations (or healed addNOns _ Tree Pres Plan ReW
2 copie.s of plan showing beam 8 window saes; poured found design, etc. 7 site wney for addilions & decks _ Tree Pfas Not Reqd
1 set o( Energy CalaWGons Add'Non - irMicete il on-sile septic system _ On-si0e Septic System
3 copies of Tree Preservatan Plan if lot plaried afler 711193
Rim Joist Defail Options selection shcet (bldgs with 3 or less uniLs
Dete (.S! , ?, ? Coastructioo Cast a, `i s3a?
Site Address yy-}Lk UniUSte #
Description of Work
Multi-Family Bldg _ Y _ N
Fireplace(s) _ 0 _ 1 _ 2
PropertyOwner V*V'n 1_?OA\ Telephone # ?('jl ) (VOT" 61M
Contractor RMA HOME SERVICES INC.
Home Depot Installed Sales
Address 3200 Cobb Galleria Pkwy., Ste. #200
S[ate Atlanta, GA 30339
763-542-8826
BC-20268257
_ City
'elephone # ( ) ' , ? ' •."" i (:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv I _ Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code WoAcsheet
(J submission type) Submitted Submitted
• Energy Envelope Calculations Submitted
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone #(
Telephone #(
Telephone #(
I hereby apply for a Residenrial Building Pemut and aclmowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a
permit; that the work will be in accordance with the approved plan in the case of work which requires a review and
approval of plans.
I??(C-- -,6?5cr,?
Applicant's Printed Name
Apphcant's Stgnature
installed
Siding andW&sPOWER OF ATTORNEY
OF COBB
STATE OF GEORGIA
KNOW ALL PEOPLE BY THESE PRESENTS:
"I'HAT I, David N. Katz, a resident of Montgomery County, Pennsylvania
("Principal"), and a licensed contractor of RMA Home Services, Inc., DBA Home
Depot Installed Sales located at 660 Mendelssohn Avenue North, Golden Valley, MN
55427, having a license number of BC- 20268257, do hereby appoint, name and
constitute Elder-Jones Building Permit Service, Inc. ("Agent") as my true and lawful
attorney-in-fact and do authorize and grant said attomey-in-fact for me and in my
name, place and stead the power to execute, acknowledge, sign and deliver (in such
form as may be required by the municipality) a permit application, or any other
instruinent(s) which may be necessary and appropriate, in order to obtain the proper
permit(s) from the City of Eagan, Minriesota for the installation, maintenance and
repair of windows and siding (the "Work").
The powers conveyed to the Agent by this Limited Power of Attorney are ?
limited solely to the express powers delineated herein and apply solely to the Work.
This Limited Power of Attorney shall expire and automatically be revoked on the 300'
day of May, 2003, which date is one year from the execution hereo£ Further, the
powers conveyed by this Limited Power ofAttorney may be revoked by Principal at
any time by express revocation and shall also be revoked by the Principal's death,
disability, incapacity or incompetence.
IN WITNESS WIEREOF this Limited Power of Attomey is executed this
day of Mh`f , 2002.
David 14. z
SWORN TO AND SUBSCRIBED BEFORE ME by David N. Katz on this
30`h day of May, ?
NotarC? y P?blic in for the Stat of eorgia
My Commission Expires: January 21, 2006
396816 v3
Proudly sold, turnished and installed by RMA Home Services, Inc., a Home Depot authorized contractor.
3200 Cobb Galleria Parkway, Suite 200 • Atlanta, GA 30339 • Phone (770) 779-1300 • Fax (770) 984-0709 • Toll free (800) 79-DEPOT
.
1985 BUILDING PERMIT APPLIC9?ION - CIiY OF EAGAN
NOTE: ALL CONTR9CTORS FN3T BE LICENSED iIITH THE CITY OF EAG9N
COt41ERCiAL
SINGLE FAMILY DHELLINGS
INCLUDE 2 SETS OF ARCHITECTURAL INCLUDE 2 SETS OF PLANS
& STRUCTURAL PLANS, 1 SET OF 3 CERTIFICATES OF SURVEY
SPECIFICATIONS AND 1'SET OF 1 SET OF ENERGY CALCULATIONS
ENERGY CALCULATIONS
$2,000 LANDSCAPE BOND
I oF 4 (,U,n(>o `?' To Be Used For:'D?;III„? Valuation:? Date: _fr???1
?7-
Site Address
Lot $ s Block ?
-r-
Parcel/Sub TIoj
Owner e ?t
Address /&p 934 tjt1 4t.
City/Zip Code N9 ,1 5V3//
Phone 7Ea?02 C)
Contractor cc?
Addres
City/Z
Phone
Arch./
Addres
City/Z
Phone
Erect X
Remodel ?
Repair ?
Addition
Move ,
Demolish ?
Int.Impr. ,
Install ?
APPROV9LS
ONLY
Occupancy
Zoning
Type of Const
# of Stories
Length
Depth
Sq Ft
FEES
Assessments
^ Permit
Water/Sewer Surcharge
Police ? Plan Review
Fire SAC
Engr Water Conn
Planner Water Meter
Council Road Unit
Bldg Off//-gF-- Treatment P1
APC Parks
Variance Copies
TOTAL
(=T? ?0 30 ?S
I I -??zs--
3
. ,, - f?'?
// /
7985 BUILDING PERMIT APPLICATION - CITY OF EAGAN
NOTE: 9LL CONTRACTORS lNST BE LICENSED YITH THE CITY OF EAGAN
C0141ERCIAL
SINGLE FAMILY DiIELLINGS
INCLUDE 2 SETS OF ARCHITECTURAL INCLUDE 2 5ETS OF PLANS
& STRUCTURAL PLANS, 1 SET OF 3 CERTIF'ICATES OF SURVEY
SPECIFICATIONS AND 1 SET OF 1 SET OF ENERGY CALCULATIONS
ENERGY CALCULATIONS
$2,000 LANDSCAPE BOND
1 or- g-
To Be Used For: " Valuation: ?
Site Address 7? 7 y Glo? LJ OFFICE
---r---
Lot ?Z_ Block
Parcel/Sub a.,)
Owner ? d j laj, 0- ?L. eS -k-v C--
Address 1y6 0 93'?"1-rU '? f--
City/Zip Codei?,- e .y/,)
Phone 7fo A32-1O
Contractor C3v6?
Addres
City/Z
Phone
Arch,/
Addres
City/2
Phone # ?
Date• 1(}/3dz0:,pJ
--T-7?--
Erect k Occupancy K,
Remodel Zoning p(
,
Repair
? Type of Const 3Z
Addition $ of Stories
Move ? Length ?
Demolish 1 Depth Z?
Int.Impr. Sq Ft
Install
APPROVALS FEES
Assessments
^ Permit
Water/Sewer Surcharge
Police ^ Plan Review
Fire SAC
Engr Water Conn
Planner Water Meter
Council Road Unit
Bldg Of Treatment Pl
APC Parks
Variance Copies
TOTAL
?
7985 BUILDING PERMIT APPLICAiION - CITY OF EAGAN
NOTE: ALL CONTRACTORS MUST BE LICENSED IiITH THE CITY OF EAGAN
SINGLE FAMILY DHELLINGS
INCLUDE 2 SETS OF ARCHITECTURAL INCLUDE 2 SETS OF PLANS
& STRUCTURAL PLANS, 1 SET OF 3 CERTIF'ICATES OF SURVEY
SPECIFICATIONS AND 1 SET OF 1 SET OF ENERGY CALCULATIONS
ENERGY CALCULATIONS'
$2,000 LANDSCAPE BOND
1 o F 4 (?? `?
To Be Used For; Valuation: ?Zr
Site Address ?y?? G/a???..? e OFFICE
Lot f( Block
Parcel/Sub z?d-e,j Wd.<77?
Oimer J>v `-
Address l V& 0
City/Zip Code )3 lKra ? ?? ? S?7 1`
Phone 7 ' S,?'-?V
Contractor ??' R-
Addres-
City/2
Phone
Arch./
Addres
City/Z
Phone 11
Date: lQ 3e S?
Erect X
Remodel ?
Repair ,
Addition
Move ?
Demolish ?
Int.Impr. ?
Install ?
APPROVAI.S
Y
Occupancy
Zoning
Type of Const
fl of Stories
Length
Depth
Sq Ft
FEES
Assessments Permit
Water/Seuer Surcharge
Police ^ Plan Review
Fire SAC
Engr Water Conn
Planner Water Meter
Council Road Unit
Bldg Offu-4-gy Treatment Pl
APC Parks
Variance Copies
TOTAL
v
?
1985 BUILDING PERHIT APPLICATION - CITY OF EAGAN
NOTE: ALL CONTR6C?ORS MUST BE LICENSED YITH THE CITY OF EAGAN
C0141ERCZAL
SINGLE FAMILY DiiEL[.INGS
INCLUDE 2 SETS OF ARCHITECTURAL INCLUDE 2 SETS OF PLANS
& STRUCTURAL PLANS, 1 SET OF 3 CERTIFICATES OF SURVEY
SPECIFICATIONS AND 1 SET OF 1 SET OF ENERGY CALCULATIONS
ENERGY CALCULATIONS'
$2,000 LANDSCAPE BOND
I vF 4 ?oDpctJ
To Be Used For: N '' Valuation: Afm=
Site Address a?z(?6??
Lot _2 Block
Parcel/Sub ;Lsa++V
Owner >2!4 ?4'L,e
Address lW?r, -r'-?'1?L,j F-
City/Zip Code l2/A.iv x ?+t n> STr?3 54
Phone W-0 sr/o
Contractor
Addres
City/Z
Phone
Arch,/
Addres
City/Z
Phone
Date: ld ?D "
-r
OFFICE USE ONLY
Erect Occupancy V•3
Remodel Zoning
Repair _ Type of Const
Addition U of Stories
Move ? Length q
Demolish Depth 714-
Int.Impr.
? Sq Ft
Install
- - -------- - ---- -
APPROVALS FEES
Assessments Permit
Water/Sewer Surcharge
Police Plan Review
Ffre SAC
Engr Water Conn
Planner Water Meter
Council Road Unit
Bldg Offd.4.gS? Treatment Pl
APC Parks
Variance Copies
TOTAL
C- T(q_ 10 30-?5
I
44q 6
Troy Haskins
Eden Homeowner's Association
PO Box 22195
Eagan, MN 55122
City of Eagan
Building Permits Department
March 21, 1999
To Whom It May Concern:
Ann Ly of 4476B Clover Lane has the approval of the Board of Directors of the Eden
Homeowners Association to extend her deck per the plan submitteci to us.
All decks (including steps), not on the street side of the buildinga, are allowed to be built
out a maximum of twelve feet (12') from the building. All decks (including steps) aze
allowed to be taken to the end of the building (frant of unit), but no part ix allowed to
extend beyond the brick on the front of the unit.
If you have any questions ar concerns, please feel frce to contact me. Thank you for your
help.
Sincerely,
?
Troy Haskins
Maintenance Manager
Home; 651-687-0597
VM: 651-458-7010
LOTS 5,6,7,Ati/D 81 BLUGK 21 EDEN AVDITIOV,
, DAKOTA couNrY, MlNN65oTA /Il?vi.
1?rt 79
(,Qioio). pENOT65 EXISTlN6 66E?A7110N
(Qta.o) DEA/OTE'S PROPaSED ELEVAT/oN
/ND/CATES pIRECTIOti( oF SuRiACE DRA/NA6E
NORTH
sr-ALs : r" a30'
`IT-'?•S = F/NlSHED GARf?66 FloaF ELEVAT/oN
EY •
DATE
Ull I MPS DEPT.
,
920 '-:
a;jt ?l
ZZX"12
c)r.c-w,w=n&3
.?o • v?
s??,a•P?,vT
i ?
<_(J i-
'VF
7 Ter•bvi certify that thie im s true and corract t"epreeentation of a tract? !
? ` 1999 BUILDING
3S3 ?-1
`lew Cons[ructian Requiremen4s
PERMII` APPLICATION (RESIDENTIAL)
CITY'bF EAGAN ,
3830 PII.OT KNOB RD - 55122
(651) 681-4675
RemodeVReoair Reauirements
? 3 registered site surveys
0 2 copies of plans (inGude beam & window sizes; poured tnd. design; etc.)
0 1 energy calculations
? 3 copies ot tree preservation plan ff lot platted after 7N/93
required: _ Yes _ No
DATE: 4-'9"'Iq
DESCRIPTION OF WORK
? 2 Copies of plan
? 1 ske surveys (exterior additions & decks)
? 1 energy calculations for heated additions
CONSTRUCTION COST. kt 4 oO
STREETADDRESS: 406 Cl0?Pir laYIZ
LOT: I BLOCK: SUBD./P.I.D. _??rh
gLfCI i 7] dY1
T'h?c: ho P ?'c bla-7qa8
f
Name: ? ?/ Phone #:
PRC)PERT1' Laz First
OWNER
Sheet Address:?? b f'? ?I ?(er I QV--'
City C?q a Yl State: (n A! Zip: ?-
Company: Phone #:
CONTRACTOR
Street Address: License # Exp.
Ciry State: Zip:
ARCHITECT/ ,
(
5;
ENGINEER Company: ? Phone #:
Name: Registration #:
Street Address:
City State: Zip:
Sewer 8 water licensed plumber (new construction only): Penalty applies when address
change and lot change is requested once permit is issued.
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.
Signature of Applicant:
?
OF'FICE USE ONLY RECEIVED
Certificates of Survey Received _ Yes _ No APR 19 1999
Tree Preservation Plan Received _ Yes _ Nol _ Not Required BY'?
OFFICE USE ONLY
3UILDING PERMIT TYPE
-1 01 Foundation ? 06 Duplex
7 02 SF Dwelling ? 07 4-plex
-1 03 SF Addition ? 08 8-plex
1 04 SF Porch ? 09 12-plex
7 05 SF Misc. ? 10 = plex
NORFf TYPE
0 31 New ? 33 Alterations
? 32 Addition ? 34 Repair
? 11 Apt./Lodging ?
? 12 Multi Repair/Rem. ?
? 13 Garage/Accessory ?
? 14 Fireplace 0
A 15 Deck
? 36 Move
? 37 Demolition
GENERAL INFORfr9A7"ION
Const. (Actual) 5•n? Basement sq. ft.
(Allowable) Main level sq. ft.
UBC Occupancy Sq. fq.
Zoning f7•0 sq.ft.
? of Stories - sq. ft.
'Length - sq. ft.
Nidth - Footprint sq. ft.
4PPhTOVALS
°lanning Building ?? ? _ _l.(,/?
- CT
?
. ; ?.
16 Basement Finish
17 Swim Pool
20 Public Facility
21 Miscellaneous
Census Code 43?
SAC Code v 1
Census Units f
Census Bldg D
MC/ES System
City Water
Booster Pump
PRV
Fire Sprinklered
Engineering Variance
Permit Fee
Surcharge
Plan Review
License
MC/ES SAC
City SAC
iNater Conn.
Water Meter
Acct. Deposit
S/W Permit
5/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
Valuation: $
L.
% SAC
SAC Units
PE'RMIT
CITY OF EAGAN
3830,Pilot-Knob Road
Eagan, Minnesota 55122-1897
(651) 681-4675
SITE ADDRESS:
P.I.N.: LQ-22750-070-02
DESCRIPTION:
44763 CLOVER LRfdE
I.OT: 7 CtLOCK:
F.CiEN
PERMITTYPE: BujLDiNG
Permit Number: 034390
Date Issued: 01 / 0 5 J 9 9
r?. REPLACL SIDINO
BI+ildind'?ermit Type S'(ORM pAMAGE .
Puildinq WO-rk Type ftEPAIR
(t:ensus L'ode 43Q ALT. RES'LpENTIAL
_y
i
/
u
? -. . - . ... ._.
i.._V".< ?A ._ `• ._,
REMARKS:
uNl'r BI.
FEE SUMMARY:
CONTRACTOR: - Hu? ? ? can 1' I I C OWNER:
(:US70M CONCEPTS CONST 18987290 20142417 l_'Y HNPJ
1.654m KENkICK LOOP/STE B 4476B CLOVER LANE
LFlKEV.[LLE MN 65044 EAGFlN MN 55122
(612) 898-7290 L hereby acknowledqe Ltiat .C have head this applic,ai.?on arid st,ite that the
+nlurmation is correct rna aqrac to complv with all appticable StaT.e nh Mn
St,atute?; and C1ty o7 F_at7an Ordineoaes.
?
APPLICANT/PERMITEE SIGNATURE
I
? ??/ z) -
? UED BY: SIGNA RE
1999 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
3830P1 51) 8104?-55122 9?
! I
New Construction Reauirements
? 3 registered srte surveys
? 2 copies of plans (inGude 6eam & window sizes, poured fnd. design; etc.)
? t energy calculations
? 3 copies of hee preservation plan rf lol platted after 7!1193
required: _ Yes _ No
DATE' i- ? Jql
DESCRIPTION OF WORK:
RemodellRepair Requirements
? 2 copies of plan
? 1 site surveys (exterior addi6ons 8 decks)
? 1 energy calculations for heated adddions
CONSTRUCTION COST; ?? 7 S
STREETADDRESS: "Iy-7Lo I7 OO\/2r ?-z,c v
LOT: ? BLOCK: SUBD./PJ.D. #: Az---
vamc:_Lq !1 Vln A Pl?one #:
PROPERTY Fu"st 0'vVNl12
Strcet r\ddress:
City
St?ate:
Zip:
Coliipauy:_ C4-"'1-/VP'1 Phoue
- - ? --------
CO V'PRAC'1'OR
Street Address:??If-O_Z?24[???? _or ? ---- License #Z?L/?' L%?--Erp' -----
City --- ??------------ S[ate: --ET• ?{?------- ???' ?------
ARCHITECT/
ENGINEER Comptuly:-------------- ------------------------ Phone k: -------- - ---------
Regishntiou f#:
SLreet Address:--------- ---------------------
Cily ---------------------- ----- StaLc:,------- ------ 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 compiy with all appiicable
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
No I
_ No _ Not Required? ? ??i ? ?
PERMIT
CITY OF EAGAN
3830 Pilot Knob Road
'Eagan, Nlinnesota 55122-1897
(651)681-4675
PERMITTYPE: aun_ozNG
Permit Number: 0 3 4 3 8 8
Date Issued: 01 /08/ 9 9
SITE ADDRESS:
447413 CLOVFi2 LFlNL"
LOTa 6 QLOCKc 2
EDCN
1'.I.IV.: 10-22750-060-02
DESCRIPTION:
. ? _ ftEPLACE SIDING
Braildinq`,_Perml.t Type STOF2M DAIhA[,t
k3uilding Wo'rk Type NEPAIR
/ctnsus Codc A 434 61L'l. RESTDEiIT1Al
REMARKS:
uivzI, B.
FEE SUMMARY:
CONTRACTOR: - Flppyi.cant - sr. ?ic. OWNER:
CUSTOM CONCEFTS CONST 18987C:9t? 2@142417 KAUFMAN DF1LE
76540 KENRICK LOOPIS7E. B ? 44748 Ct.OWER LANE
LAKEUILL[ MN 55044 EFl(iAN MN 55122
(G12) 89$-7230
?I
I hLreby acknowledqe that I have i-ead thih applioation and state 't.tiaC the
1-ntormaCiori i:. correcC and aqree to comp.Ly with a1l appl5caole State 05' Mn.
Statutes and Citv ut Edqan Ordinances.
APPLICANT/PERMITEE SIGNATURE
>-e,o
I UED BY SIGNAlURE?
?
1999 BUILDING PERMIT APPLICATION (RESIDENTIAL)
7 3830 PILOT I{NOB RD 55122 t- sr' l(
(651) 681-4675
New Cons[ructian Requirements
? 3 registered site surveys
? 2 copies of plans (include 6eam 8 window sizes; poured fnd. design: etc.)
? 1 energy calculations
? 3 copies of tree preservahon plan if iot platted after 7/1193
required: _ Yes No
DATE: I- ? -'qg
RemodellRepair Reqwrements
? 2 copies of plan
? 1 site surveys (extenor additions & decks)
? 1 energy calculations for heated additions
CONSTRUCTION COST; L-13 7 S
; / -
DESCRIPTION OF WORK:
STREET ADDRESS:
LOT: ? BLOCK: --?- SUBD./P.I.D. #: 'E?t,?
1S!_a.?--- -- Phone #:
PROPERTY LLt rusc
l )bVN1.12
SLrcct Address:------------------- ----------
City ------------ ----- --------------- State: ------
Zip:
C0mp:u1V:--C6-1rC.? /1?---- Yhone#: FLL_LLL1?.72??----
--
CO\"1'12ACTOR
StreetAclcl?ess:?y??bLc?j??'1L?-_?t-? _-- Laceiue#?CYtLL?/!(j___E\ p.
Cit}' --
ARCHITECT/
ENGINEER Comp:ui}:
N;uuc:_
Strcet Adc
City ---
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 applicable
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant:
OFFICE USE ONLY
, - -
Certificates of Survey Received _ Yes _ No
State: -,fluLC__------- '_ip: _J?__Oy?---
Phone #:
Registration ii: ____
State: -------- Zlp:
Tree Preservation Plan Received _ Yes _ No - Not Required
PE'RMIT
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(651) 681-4675
PERMITTYPE: FUILDlNc
Permit Number: G 3 4' b 9
Date Issued: o1! 0 3 I 4 9
SITE ADDRESS:
4 4 7 6 cI.uVva LANE
I.Ot"a 8 BLOL'K: 2
ECIF.IV
P.I.N.: 10-22750-080--02
DESCRIPTION:
9:CD:CPdG
STC)f?Ivi DAMAGF.
HEPA7R
43 4 r=rl.I". RESIL7?, PJTIAL
REF'LACL
6ral Ldir3a?, Par n7iC Type
qultd.inq U}ctrk Type
/-ie17sUs C4de
r ,
%
/
r
i REMARKS:
FEE SUMMARY:
CONTRACTOR: -- Applicar:t: -- sT. !_7c. OWNER:
CUSTUM CONLEPTS CONST 18987290 20111241"! hli)VUIc KRI57IiVE
16540 KEM1IR7CK LUOP/S"ft B ? 4476 f.LOVEr7 i_h3NF
LAKEV:CLLf:. MN 5 60 411 i EIaGHiV P4N 65122
( 91.i ) 8 9 8 -7 2 9 0
S hareby aoknawledge t'ftat T have rsad this applicrtion atid staue that the
infiarmati.can is CGYYeCL" and agroe ta comply,uji1:1i all inpcrlieRble SYate of Mno
StaCutes and City aP Eagan Ordinacaces.
L
APPLICANTIPERMITEE SIGNATURE
J
?
I ED BY: SIGNATU E
1999 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
:?) ?-{'_7j 'F? 3830 PILOT KNOB RD - 55122 G
(651) 681-4675
New Construchon Reauirements Remodel/Reoair Requirements
? 3 registered site surveys
? 2 copies of plans (include beam & window sizes; poured fnd design; etc )
? 1 energy calculations
? 3 copies of tree preservahon plan if lot platted after 711193
required: _ Yes _ No
DATE: ? " I '? j
DESCRIPTION OF WORK: S70(vYt I2-fmC1w-
4 ; 2 copies of plan
? 1 site surveys (exterior additions & decks)
?? 1 energy qlculations for heated additions
CONSTRUCTION COST; `-'t,3 7 S
STREET ADDRESS: ql-j/ l.v C 1 DvP r lGv-ie ?
LOT: 'g BLOCK: -,2- SUBD./P.I.D. #:
PROPERTY
OVW ER
Slteet
Ciry
Lvt
S[ate:
"Lip:
CO{??? -- Ylioue #: 62/2--c ff-n fl-!_'2 --- -Q ------
--------
CON1'12:\C"POR ?v,
Street Address:_1FJ?_?,??, fIttOm?,t_7__6 Iscense #2QL4'-2_Lxp.
0 ,/
City - ---??- _ State: _y???! ----- Z1N' -??---J?- ?41 q
ARCHITECT/
ENGIDIEER Compairy:
\.xaie:--
Stree[ Adc
City
Sewer & water licensed plum6er (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 applicable
State of Minnesota Statutes and City of Eagan Ordinances.
Signature oF Applicant:
OFFICE USE ONLY
i
Cerh6cates of Survey Received _ Yes _ No
f+-6 ?VLI? n?
Fvst
Phane #:
--------- Re?pslritioit #: ----
State>--------- ZIp:
Yhone #:
Tree Preservation Plan Received _ Yes _ No - Not Required
" r .1988 BUILDiNG PERMIT APPLICATION - CITY OF EAGAN
SINGLE FAMILY DWELLINGS
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHIC$ ADDRESS
IS DESIAED. NO CAANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED
MULTIPLE DWELLINGS RENTAL QNITS FOR SALE UNITS
# OF UNITS
INCLUDE 2 SETS OF PLANS, CERTIFIC$TE OF SURVEY - CHECK WITH BL?G. DEPT.,
t SET OF ENERGY CALCULATIONS
COMMERCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS Wj,
.P 1 fj 'f998
To He Used For•
Site Address
• ?Loccrr_-?lValuation:
1yEvE'L
c_ 0 uE2 L A) (i
Lot ? Block ?
Parcel/Sub Uom
Owner A y1/l1/ 196 2- 7- 'f'i-/ 7-
Address 146-1-J( C Lnv?-v? LY11
City/Zip Code
Phone L/ S? /? ` 1 U 7 7
Contractor i.')--C t?9TZS3 cFl,*nit) (?.,t
Address 3 g p - y ?/ 7- OA. v,rt yVj,_
City/Zip Code Y- (K ]"/(J / FyyJ A/
Phone -7 k' '- -`?'30 .Ss?/3o
Arch./Engr.
Address
City/Zip Code
).5'ba-
On site sewage
MWCC system
On site well
City water
PAV required
Booster Pump
APPROVALS
Engr/Assess
Planner
Council
Bldg. Off.
Varianee
Date:
CE USE ONLY
Occupancy
_ Zoning
_ Actual Const
Allowa6le
it of stories
_ Length
Depth
S.F. Total
Footprint S.F.
FEES
Permit 3'1,aD
Surcharge ),a a
Plan Review
SAC, City
SAC, MWCC
Water Conn
Water Meter
Aoad Unit
Treatment P1
Parks
Copies
TOTAL
Phone #
1988 BUILDING PERMIT APPLICATION - CITY OF EAGAN
SINGLE FAMILY DWELLINGS
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SUEiVEY, 1 SET OF ENERGY CALCUL.ITIONS
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS
IS DESIRED. NO CHANGES WILL HE ALLOWED ONCE HQILDING PERMIT IS ISSUED
MULTIPLE DWELLINGS RENTAL QNITS FOR SALE UNITS U OF IINITS
INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SURVEY - CHECK WITH HLDG. DEPT,,
1 SET OF ENERGY CALCULATIONS
CONA7ERCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANSt
1 SET OF SPECIFICATIONS AND 7 SET OF ENERGY CALCULATIONS
L) ? ,4 -,te--
,._,??.,
To Be Used For: r ?J??? - Valuation ?'??-? /000
Date: ?
Site Address - L OFFICE USE ONLY
Lot ? Block On site sewage_ Occupancy
? h141CC system Zoning
Parcel/Sub ?,t?.am _
On site well
+ Actual Const
City water Allowable
Owner -Aq/st/ 2? r.vz Nr PRV required _ ll of stories
Booster Pump Length
Address ?y 2 G ? l L vvr° 2 _ Depth
S.F. Total
City/Zip Code !f G??
?, Footprint S.F.
Phone q5 a - APPROVALS FEES
Contractor ,G ?Y1T.T55 SO/v G Engr/Assess Permit
ry Planner Surcharge , So
Address ?X c?-7 y
u ??n?r ? Council Plan Aeview
Bldg. Off. SAC, City
City/21p Code ?/Z.?',(?7`Z Variance SAC, MWCC
Water Conn
Phone Water Meter
Road Unit
Arch./Engr. Treatment P1
Parks
Address Copies
I
TOTAL a y 157-)
City/Zip Code ,
Phone #
1990 BUILDING ERMIT APPLICATION
CZTY OF EAGAN
SINGLE FAMILY DWELLINGS MULTIPLE DWELLINGS COMMERCIAL
2 SETS OF PLANS 2 SETS OF PLANS 2 SETS OF ARCHITECTURAL
3 REGISTERED SITE SURVEYS REGISTERED SITE SURVEYS - & STRUCTURAL PLANS
1 SET OF ENERGY CALCULATIONS (CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFICATIONS
1 SET OF ENERGY CALCULATIONS 1 SET OF ENERGY CALCS
# OF RENTAL UNITS
# OF FOR SALE UNITS
PENALTY APPLIES WHEN: TYPING OF PERMIT IS REQUESTED, SUT NOT PICKED UP BY LAST WORKING DAY
OF MONTH IN WHICH REQUEST IS MADE.
LOT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED.
NOTE: ADDRESSES FOR CORNER LOTS - 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 A PERMIT HAS BEEN COMPLETED.
PERMIT MUST SHOW A LICENSED PLUMBER.
To Be Used For: rzk- A14Z- Valuation: Date: '-' - v
Site Address 7la v0UEe_ LJ
Lot $ Block Z--
Parcel/Sub??
. ..a
Owner
Address d
City/Zip CodeEtqeIa ?
i
Phone
Contractor ? (fA E nr?I.?1N?L?S r Lnir
Address
City/Zip Code 2
PhonC I Z? S7Z ? o0
Arch./Engr.
3
:>
OFFICE USE ONLY
Occupancy
Zoning
Actual Const
Allowable
# of stories
Length
Depth
S.F. Total
Footprint S.F.
On site sewage_
On site well
MWCC System _
City water _
PRV _
Booster Pump _
APPROVALS
Planner
Council
Bldg. Off.
Variance
Address
City/Zip Code
FEES
Bldg. Permit ?2,`5,uc
Surcharge !S<%o
Plan Review
SAC, City
SAC, MWCC
Water Conn
Water Meter
Acct. Deposit
S/W Permit
5/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Copies
SUBTOTAL
Penalty ,
TOTAL ? Phone #
PERMIT
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(651) 681-4675
PERMITTYPE: gulLOiNG
Permit Number: 034 3'rs 1
Date Issued: D 1/ 4l 8/ 9 9
SITE ADDRESS:
447A CI.OVER LAhIE
LUT: 5 CLOCK: w
EDEN
F. I. PI .. : 1 0 -2 2. 760 --0 5 0 - 0 2
DESCRIPTION:
r'•?_ RF.PLACE SIUING
B?aildinq' Permit 'TVpe STORM OAhIAGF
V uildiiia Wot'_k TYPe RC_AATF2
'Crnsus Codo "\. 934 flLl". RF5TDEKITIRL
?
?
i
?
'
.
? . ?.
r -
f
c
?
/.,
REMARKS:
FEE SUMMARY:
CONTRACTOR: - Applicant - st. LTC. OWNER:
CusroM cONctprs cnNsr 18987290 20142417 c;n,1.1. ANN
16540 Kf:l'JRIC:K LOOP/S1"E 6 4474 CLOVER LANE
LAKFV:LLLE MN 5504 4 LliutlN MN 55122
f6121 898-7290
I herebv acknow:.edqe thet 1 he,ve r:?ad tliis 3pplication and sLote [liat i:h2
intprmation is cori•ect and aqroe t:e comply with a11 dpplicablrv Scate ot Mri,
Stetutes and City ot Eec7an Ordirrances.
I
APPLICANT/PERMITEE SIGNATURE
11ED BY: SIGNA'T-URE
?
1999 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
I?
3830 PILOT KNOB RD - 55122 g-q
? (651) 681-4675
,New Construction Requirements Remodel/Reoair Reauirements
? 3 registered site surveys
? 2 copies of plans (include beam 8 window sizes; pouretl fnd. design; etc.)
? 1 energy calculations
? 3 copies of Iree preservation plan if lot plalted after 711l93
required: _ Yes _ No
DATE: I - ?-q ?
? 2 copies of plan
? 1 site surveys (exterior additions & decks)
? 'I energy calculations for heated addiLOns
CONSTRUCTION COST; ? j?-,
DESCRIPTION OF WORK:
STREETADDRESS: 019 OnUQA I&J{?.Q a
LOT: ? BLOCK: a' SUBD./P.I.D. #: o Z.Sk.li?.
\:vue:_ ?_ r ?---- -- Phone #: -------
PROPERTY Fint
i>WVI:12
Strcet Address;
Ci[y ----- ---------- ---- Stalr. ----- -- ---- Zip:
Coiup:w}': ?_1 Plione 9: ?
2 ??--
`F ----- -----
CO\"1'12:\Cl'Olt /' ?r-? /'?, ^ n
S[reet Address: i5? `"'? J [,?! tY License # Z?4! ?1?-L,xp' --
? ?
Cin
ARCHITECT/
E\GINEER CotxiF
\ vnc
Strcct
City
Sewer 8 water licensed plumber (new construction only): _
change and lot change is requested once permit is issued.
Statc: -?dY___----- ZiP' ??L'
Pktone If:
------ Rcbistntion ---
Statr. ------------ ZiP'
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.
Signature of Applicant:
OFFICE USE ONLY
Certificates of Survey Received _ Yes _ No
--
Tree Preservation Plan Received _ Yes _ No _ Not Required
i: ? ??
L _ BL - -- -------RECEIPT/3.r7??
SUBD. ?, ? ? . LGtP,vt RECEIPT DATE: " "OCd
PERMIT #
2000 PLUNIDING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PI7AT IINOB RD
EAGAN, AIIN 55122
651-681-4675
Please complete for: D single family dweliings
? townhomes and condos when pertnits are required for each unit
? backflow preventer for underground sprinkler system
FDCit1RES
EACH a
Alterations to existing dwelling - minimum fee
Describe: IVIAL
$ 30.00
Bath tub $ 3.00 x =
$
Fioor drain
3.00
x
=
$
Gas i in ouUet • minimum -1 3.00 x = $
Hot tub/spa
Kitchen sink
Laundry Vay 3:00
3.00
3.00 x
x
x =
=
= $
$
g
Lavatory 3.00 x = g
Septic S stem new/refuPoished • requires MPC Iic. 75.00 x = g
Septic System abandonment 30.00 x = $
RPZ new installatioNrepaidre6uild 30.00 X = $
Rou h openin . 1.50 x = g
Shawer 3.00 x = $
Unde round sprinkler 'rfdwelling is underconswMion 3.00 x = $
Underground sprinkier if existing dwelling 30.00 x = .$
Water closet 3.00 x = $
Water heater 3.00 x $
Water softener if dwelling under construodon 5.00 x = g
Water softener ff exlsting dwelling 30.00 x = $
Waterturnaround 30.00 x $
State Surcharge .50 -> -> -> g .50
TOtal _> _, S
Reminder. Call for inspect(ons of alterations, i.e. water heaters, water softeners, etc.
°--------------•----------•------------------ - --- --
- ----------------------•------••---------------------•----------•---------------------
hereby atlcnowledge that ? have read tha application, sfate that the infortnation is corre?t, and agree to compty with all applicable Ciry oT Eagan ordinances.
It is the applicant's responsbllily W notify the property owner that the City of Ea9an assumes no liability for any damages caused 6y the City dunng its
nortnal operetional and maintenance activBies to the faciliGes consWeted under this pertnd within City property/right-of-way/easement.
SITE ADDRESS: Lf `1 /"1 l,e4z/fo
OWNER NP,ME: : AN/V L7?IGL
INSTALLER NAME: / l _G./ '
STREET ADDRESS: ZY, eO ??g9Pc?( S /'/Z
cirr: f Lyirloa Tff ST TE: ziP: S?`z/?Y?
?I/f?l/ 53?/ZZ
TELEPHONE#:
, (AREA CODE)
TELEPHONE #: 76S/ .?-?? U S?
(AREA CODE)
7
?
SIGNATURE OF PE eMITTEE
CITY OF EAGAN FOR CITY USE ONLY
3830 PILOT KNOB ROAD
EAGAN, 21N 55122 PERMZT #
PHONE: (612) 454-8100 RECEIPT # D
Y1?1?S9?Nfx,:z,l'?RMIT '
DATE: ?
w PLEASE COMPLETE UPPER PORTION ONLY
foSD9
0n FOR SINGLE FAMILY DWELLINGS &
.
1
TOWNHOMES/CONDOS WHEN PERMITS ARE REQUZRED FOR EACA IINIT.
--
------------
------------------------ ---------------------------
WORK DESCRIPTION ----------------
COMPLETE THE FOLLOWING:
N0. FIXTURES EA. TOTAL
NEW CONST ADD-ON MINIMUM 15.00
ADD ON SHOWER 3.00
REPAIR _ WATER CLOSET 3.00
BATH TUB 3.00
?.
'??
' #d vb-'-
? LAVATORY 3.00
00
3
"1
OWNER NAME: S
E ? _ KITCHEN SINK .
LAUNDRY TRAY 3.00
0
SITE ADDRESS: HOT TUB/SPA 3.0
WATER HEATER 3.00
LOT: ? BLOCK ? SUBD. _ FLOOR DRAIN 3.00
?2G
M
?
R` GAS PIPING OUT.
3
00
cJi?
?
INSTALLER: (MINIMUM - 1) .
f ROUGH OPENINGS 1.50
?
ADDRESS: I??? ???iiE Af OTHER
WATER SOFTENER
00
5
.
CITY: ZIP: PRNATE DISP. 15.00
U.G. SPRINKLER 3.00
PHONE
SUBTOTAL
$
ST. SURCHARGE .50
1/1 " _- SIGNATUR OF PERMIT E -
TOTAL ?-17
:
'?RIALi; PLEASE COMPLETE THIS PORTION FOR ALL
GD?QI$RGIA7.:?iNDUS COMMERCIAL/INDUSTRIAL BUILDINGS AND
,
MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH
DWELLING UNIT.
--°°--___-___-°
-------____-
-_____________° ___---° ____-----____----___-___-°
CONTRACT PRICE: FEES
OWNER NAME:
SITE ADDRESS:
LOT: BLOCK _ SUBD.
INSTALLER:
ADDRESS:
CITY: ZjP:
PHONE #:
FOR:
CITY OF EAGAN
18 OF CONTRACT FEE.
STATE SURCHARGE - $.50 FOR
EACH $1,000 OF PERMIT FEE.
$25.00 MINIMUM FEE.
CONTRACT PRICE x 18
STATE SURCHARGE
TOTAL:
( S I GNATI7RE )
L V, gL ov n CITY USE ONLY
?p RECEIPT#:
SUBD. Cl/? I RECEIPTDATE: ? Fa
1998 PLUMBING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PIIAT IINOB RD
EAGP.I7, D4I 55122
(612) 681-4675
Please complete for: D single family dwellings
? townhomes and condos when permits are required for each unit
? badcflow preventer for underground sprinkler system
??----------------____-_--------
FIXTURES ---- ----------------
EACH --
# TOTAL
Shower 3.00 x =
bVafer Closet 3.00 x =
Bath Tub 3.00 x =
Lavatory 3.00 x =
Kitchen Sink 3.00 x =
Laundry Tray 3.00 x =
Hot Tub/Spa 3.00 x =
Water Heater 3.00 x Z =
Floor Drain 3.00 x =
Gas Piping Outlet ' minimum - 1 3.00 x =
Rough Openings 1.50 x =
Water Softener ' for dwellings under construction 5.00 X =
Water Softener ' for existing dwelling 20.00 x =
U.G. Sprinkler ' for dwelling under const. 3.00 =
U.G.Sprinkler "forexistingdweiling 20.00 =
Alterations ' to existing residence 20.00 =
Water Tum Around 20.00 =
Private Disposal System • MPC iic. 75.00
=
(new and refurbished systems)
Private Disposal Systems' Abandonment 20.00 =
STATE SURCHARGE .50
TOTAL "20• ?G
I hereby acknovvledge that 1 have read this application, state thst the infomiation is corred, and agree to compy wdh all app151ca6le C@y of Eegsn ordinsnces
It is the applicanYs responaibility to notiTy the property owner that the Ciry of Eagen essumes no liability Tor any damages ceused by the City during its
nortnal operotional and maintenance activities to the facildies construded under lhis pertnk wRhin City propertyJright-of-way/easement.
SITE ADDRESS: YT ?? G?G O//z-'e- 41J
OWNER NAME: 2? AZG cr D .eE'
INSTALLERNAME: /rJa2 ?D07?.? I?Lti?.Q/-d! TELEPHONE#:
STREET ADDRESS: 4'16
CITY:
_1
BLl//77GCiTi?
JS/FORMS BLDGJPLBG PERMIT (RESIDENTIAL) 1998
STATE: -? ZIP: -5-3-`
arr use oNLr go a
L 7 BL ? RECEIPT#:
SUBD. CQ44? RECEIPTDATE: '?007
1997 PLUMBING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
(612) 681-4675
Please complete for: . single family dwellings
. townhomes and condos when permits are required for each unit
• backflow preventer for underground sprinkler system
FIXTURES EACH N.Q TQTAL
Shower 3.00 x =
Water Closei 3.00 x =
Bath Tub 3.00 x =
Lavatory 3.00 x =
Kitchen Sink 3.00 x =
Laundry Tray 3.00 x =
Hot Tub/S a
.
=
a e x
Floor Drain 3.00 x =
Gas Piping Outlet ' minimum-1 • 3.00 x =
Rough Openings 1.50 x =
Water Softener ' for dwellings under consWCtion 5.00 x =
Water Softener ' Por existing dvrelling 20.00 x =
U.G. Sprinkler ' for dwelling under const. 3.00 =
U.G.Sprinkler 'forexistingdwelling 20.00 =
Atterations ' to axisting residence 20.00 =
Water Turn Around 20.00 =
Private Disposal System ' oak cty iic. 75.00 =
(new and returbished systems)
Private Disposal Systems'nbandonment 20.00 =
STATE SURCHARGE .50
?, SO
TOTAL
1 hereby acknowledge thet I heve read this application, atate that the infoimatlon is cortect, and agree to compty with all applicabie City
of Eagan ordinances. It is the applieanYs responsibiliry to notify the propeKy owner thet the Ciry of Eegan assumes no IiabilityJor any
dameges pused by the Cfly during its nortnal operational end maintenanoe activfies to Ne faGlkies consWCted under this p_ermiFwiNin
Ciry propertyMghtof-way/easemeM.
SITEADDRESS: B C-GQU?ie L.? _
OWNER NAME: Ly p
INSTALLER NAME: ?Z A117-g.Q TwMBi.r/lr TELEPHONE #:
STREETADDRESS: 5l0
CITY: je4'0?6+aevz! STATE: 111? ZIP:
SIGNATURE O ERMITTEE
CITY OF EAGAN
3830 PIIAT KNOB ROAD
EAGAN, MN 55122
PHONE: (612) 454-8100
FOR CITY USE ONLY
PERMIT #
RECEIPT # /OD3G
DATE: 3 G 9/
PLEASE COMPLETE IIPPER PORTION ONLY FOR SINGLE FAM]
TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
------------------------ ----------------°-----------°---°----
WORK DESCRIPTION FEES
NEW CONST
ADD ON ?
REPAIR _
OWNER NAME: A^w er?"l
SITE ADDRESS: y11"741 IAT: 5' BIACK ?, SUBD.
INSTALLER: 4?/f-1?ZIz?L .ffW (f7we'
ADDRESS: 19.rY- /1a_
CITY:9:9v? ZIP: rf/ ?-'L
PHONE # : '71 Z ' -X
ADD-ON MINIMUM
HVAC 0-100 M BTU
ADDITIONAL 50 M BTU
GAS OUTLETS - MINIMUM
OF 1 PER PERMIT
SUBTOTAL:
STATE S'JRCHARGE:
TOTAL:
DWELLINGS &
15.00
4.00
6.00
3.00
$ 1ro..
.50
$ /.f?o
VGNATU OF RMITTEE
AIW_? i4c_?x /i?, f6??"1?i.,?r„
!f" ??•? G?.z.?/GS?-r'L
CO?IZ?IAI:??nYTSTRTfsL*? PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS,
APARTMENT BUILDINGS, AND MULTI-FAMILY BUILDZNGS WHEN SEPARATE PERMITS ARE
NOT REQUIRED FOR EACH DWELLING UNIT.
CONTRACT PRICE:
OWNER NAME:
SITE ADDRESS:
IAT: BLOCK _ SUBD.
INSTALLER:
ADDRESS:
CITY:
PHONE #:
FOR: _
(SIGNATURE)
FEES
18 OF CONTRACT FEE.
STATE SURCHARGE - $.50 FOR
EACH $1,000 OF PERMIT FEE.
PROCESSED PIPING = $25.00
$25.00 MINIMUM FEE.
CONTRACT PRICE x 18 $
STATE SURCHARGE
ZIP:
' TOTAL:
CITY OF EAGAN
CLAIPt VOUCHER - REF'OND REQUEST
CITY OF EAGAN
CLAI*fANT MELVIN MC MILLON
ADDRESS 4476 CLOVEB LANE
EAGAN. MN 55122
Location 4476 CLOVER LANE
L8. II2, EDEN ADDN.
Receipt No./Date $7444/9-16-88
Reason for Refund HnMEOWNER HIBED ELECTRIC7AN-HE TOOK OUT HIS OWN PERMIT
Type oF Refund Electrical Permit 01-3211 $ 20.00
Plumbing Permit 01-3212 $
Mechanical Permit 01-3213 $
Surcharge 01-2155 $
Water Connection Permit 20-3713 $
Sewer Connection Permit 20-3743 $
Account Deposi[ 20-2252 $
Utility Account Over-?ayment 20-2250 $
Other: $
S
TOTAL $ 20.00
I declare under the penalties of law that this account, claim or demand is just and
that no part of it has been paid..
a OrTf1RRR Il 19$$
Signa[ure ?ate
" ,, ? O,? 33 PavE 38
AOBE COHSUlTIHO EHOINEEIIS
p NGINEEt?ING PLpNNfAS and IAND 3UflVEY0115
COMPAN4, INC.
N
14 1000 EAST 146111 STREET, BURNSVILIE, MlNHESOTA 85337 PH 4432'3000
?CQ? I.D'CJC7'?p?20TC: LoTS 5,6,7AN0 8? BLUCK 21 EDE,V ADOIT/oN,
? DAKOrA CouNrY, MlNNESoTA
??to_a ) pENOTES EX15T/N6 E1EVAT10AJ
( 9La,o) pEA/OT65 PROP0560 ELEVAT/aN
- /NDICATES O/RECTIOti( oF Su2FACE ORA/NA6E
9Z3•5 = FiNiSHED GARN6E FlaoR E"[.EVATioN
NORTH
SCALe: I"= 30'
3a -
Qqi8
?
?
V
t92o ?-?
51
O /
/(X0 o /
?
O
?( V
i
<? ?? ) r
?? , ' •
/
"-
?
PRQ?S &sI .o0 3,S
/?
C9z3, r?
?
? `
?vG13 3
W
0
o M ?
o??r<
ryh (9:
b? /
ti?s ?>
/ >/O ?ep 6`S3 i
30 • ?
/
Q
GT ??ti
i GC-
'`.
,,?r ? .
?.
,
9z51 ?/ p)
s' (oyo
C?4.
9
Z6 h ?
m
v
tl? .
I N ( '
?J \ ? ` i
?
c9
n? ; ? ra
? •
o
?ti ?
.
\92 s?
?
N
•? ?/6. ? / i ?
I harsby certify that thia ie a true and corract rnpresentation of a tract of
land aa sho+m'and deecribed heraon.. Ae preparad by me on this 3eD day ot
(?'zaBF.P , 19 g5 . ' . laa. Xo.?;
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675-5675
www.ci.eagan.mn.us
PERMIT
City of En
Permit Type:
Permit Number:
Date Issued:
Permit Category:
Mechanical
EA074682
08/10/2006
ePermit
Site Address: 4474 Clover Lane
Lot: 5 Block: 2 Addition: Eden
PID:10-22750-050-02
Use:
Description:
Sub Type: e - Fumace
Work Type: Replacement
Description: Furnace
Comments: Quesetions regarding electrical permit requirements should be directed to Ma rk Anderson, State Electrical Inspector,
952-445-2840Crystal Gemuenden 8910 Wentworth Ave S Bloomington, MN 55420 952-881-9000 Crystal.Gemuenden@Se
viceExperts.com
Fee Summary:
Surcharge -Fixed
ME - Permit Fee (Replacements)
$0.50 9001.2195
$30.00 0801.4088
Total:
$30.50
Contractor:
Sedgwick Heating & Air
8910 Wentworth Ave S
Minneapolis MN 55420
(952) 881-7739
- Applicant -
Owner:
Ann Marie Gall
4474 Clover Lane
Eagan MN 55122
I hereby acknowledge that I have read this application and state that the informa
of Minnesota Statutes and City of Eagan Ordinances.
on is correct and agree to comply
h all applicable State
Applicant/Permitee: Signature
Issued By: Signature
From:ALLSTAR CONSTRUCTION 19529427464 09/17/2013 08:49 #582 P.068/079
Use BLUE or BLACK Ink
For Office Use
j Permit M 1 I l j
City of Eap
Permit Fee:
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received: a 1 L3
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 1 Staff: I
I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Dater Site Address: ~41' 4q_Hb,+'nV, Li q11190, UNeV WVlG Unit M
Name E CIO' NO, CumDOnN Phone:
Resident/
Owner. wner. ( Address / City/ Zip: ULM Utu V1 Sl ~I~~IXV r ~ irie, MN (~53fy
- T
Applicant is: Owner Contractor
Type of Work Description of work: lay Off 1-fi f
Construction Cost: IIlol loci, (N) Multi-Family Building: (Yes X / No-)
~ ontact: C lU~ ~i~~Qt~
ComPanY:c-t► ~ l~IUI~~t~+Yi On ll~l I
Address: 1 iq ~ e (h
Contractor 51 5 f~'-U~rS pI IQ~ UC city: Fw
State: Zip: PJ35 1 Phone:
License VC ,CJ15 Lead Certificate %'I7 2p9 wq --o
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
I COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE. Plans and supporting documents that you submit are considered to be public information. Portions of
L Me information may be classified as non public if you, provide spa lp reasons that would permit the City to..
conclude that they are trade secrets. _
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.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. n
Applicant's Printed Name Ap i nPs Signature
Page 1 of 3
From:ALLSTAR CONSTRUCTION 19529427464 02/10/2016 13:07 #301 P.021/022
City of £aan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 6754694
Use BLUE or BLACK Ink
For Office Use
1300/3
Permit #:
Permit Fee:
Date Received:
Staff:
2016 RESIDENTIAL BUILDING PERMITllAPPLICATION n
Date:.?//d �/!o Site Address: VOW" Wi &JV87 - 4y Unit #: �l
Name: Ae.A 4164 t ifi — e-li&/`f 1 0fl
Resident/
Owner is Address / City / Zip:
Phone: ////,
J
Type of Work
Contractor
Applicant is: Owner ai Contractor
Description of work: /191-- /00 1nyiIs7P�°'t7nf/i8--(j�F.�4, ,vtCi+k�`
cJ
Construction Cost: /O,tOl/ ^ Multi -Family Building: (Yes /�/ No )
Company: All544itn giefi;71teelall cls Contact: J 1 nn A item'?
Address:Sl445 I tcs-tr;A I $?- so r -I t. /03 city: MAO- O- fi t, -;et
State: Zip: p 55359
Phone: '9 ' 6T Email: 4.7 74Gl.f/S- r..6
License #:.56 toCo 3S ® Lead Certificate #: itr. lk'% o2®91,9 V - d�
If the project is exempt from Iead certification, please explain why: 1.3u , r� /9es
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:
jSewer & Water Contractor: Phone:
Fire Suppression Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that they are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.aopherstateonecall.orq
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building pemnit issued in accordance with the Minnesota State Buildin .0 plated within 180
days of permit issuance.
10411
Applicant's Printed Name
Applic nt's Signature
Page 1 of 3