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3814 Country Creek Way Use BLUE or BLACK Ink For Office Use 22 Q 2 1 J [~J City of EaV Permit#: I I I I Permit Fee: 55 • 00 I 3830 Pilot Knob Road Eagan INN 55122 1 Date Received: J 1 Phone: (651) 675-5675 j Staff: I Fax: (651) 675-5694 1 INFLOW INFILTRATION PERMIT APPLICATION Plumbing / Sewer & Water Date:~i -C~l( Site Address: Tenant: Suite RESIDENT OWNER Name: LJ fie,-,Yb~ c_ Phone: 7760 / Address / City / Zip: l~_< I ~J c^•~~,.. ~S< Name: License CONTRACTOR Address: City: State: Zip: Phone: Contact: Email: PLUMBING (Within the building envelope) SEWER & WATER (Outside the building envelope) TYPE OF WORK Sump Pump Repair Repair Other: Other: Description of work: ;,n 1 AA DESCRIPTION # FEES $55.00 / Each (includes $5.00 State Surcharge) TOTAL FEE $ *Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submit 1/1 repair costs for reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors can be found by visiting www.citvofeagan.com/inflow, or City Hall at 3830 Pilot Knob Rd. 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. ~I I X c7 X C✓. Applicant's Printed Name - Applicant's Signature Cl) FOR OFFICE USE Reviewed By: Date: Required Inspections: -Under Ground -Rough-In -Final CITY OF EAGAN 3795 Pilot Knob Rood Eagan, MN 55122 N2 4527 . PHONE: 454-8100 BUILDING PERMIT Receipt # To be wed for Date , 19 Site Address - Erect p Occupancy Lot Block Sec/Sub. -I- Alter ? Zoning - Parcel # Repair ? Fire Zone Enlarge ? Type of Const. W Name Move ? .?# Stories Z Address Demolish p Front it. a .-« _ .,l--- _ 1. , -7z Grade Depth _ ft. s 0 Zu ul r Ncme _ Address Name _ Address I hereby acknowledge that I hove read this opplicotion ond state that the informotion is correct ond agree to comply with oll opplicoble Stnte of Minnesota Statutes ond City of Eagan Ordinances. Signature of Permittee A Building Permit is issued ro: . 771 `' ` ?j`- ?' rir :• , oll work shall be done in accordance with all applicable $tote ot. Mii Building Official - Permit _ Surchorge Plan check SAC Water Conn. Water Meter Totul 9 5 4 • 5i) on the express condition that 5totutes ond City of Eagan Ordinances. Assessment Woter 8, Sew. Police Fire Eng. Planner Council I Bldg. Off. APC Pw"It #t Dot• Imod PaoktM Plumbing Cj eo _3? 7 I Mechanical INSPECTIONS DATE INSP• Rotqh-In Final Footings ? Date Inap. Dote Irap. Foundotion Plumbing a 1/111, •- ) Frame/ins. 42 Mechanical Final I Nki Remarks: ?c' - 77 cirY oF EAw+?N . 3795 Pilo Kwe? Roed Eoyaw, MN 55122 1 • PHONEs 454-8100 BUILDING PERMIT go?- T,.kb .}- Receipt # Te be wmd Fa Est. Volue Dote 19 Site /lddross Erect ? Occuponcy Lot 81ock Sec/Sub. Alter ? Zoning parcel # Repoir ? Fire Zone Enlarps ? Type of Const. W Na^e Move ? # Stories ; Addross Demolish p Length b CiM, _ phono _ 6rode ? Depth Sq. Ft. ? $ Name ?? Address ~ Ci Phone WW i-W Nome ?? Address Z i ' '? Citv _ PF,ene 1 hereby ocknowledge thot I hove reod this opplicotion ond state that the inlormotion is correct and cgree to comply with all opplicable State of Minrxsoto Stotutes ond Ciry of Eagan Ordir?onces. Slynoture of Permittee A Building Pertnit is issued to: all work shall be done in occordonce with all 6uildinp pfficiol ApOrovals Ftes /lssessment Permit . Water & Sew. Surchorqe Polite Plan check Firo SAC Enq. Wcter Conn. Planner Water Meter Counc{I Rood Unit Bldp. Off. APC Totol on tha exprcss candiNon tFav State of Minnesoto Statutes and City of Eopan Ordinances. Parmit No. Permit Holder Misc. Permit No. Holder Plumbing 7q ? Q'W yLET H.V.A.C. 3 l? Q W VlE ? S?"Q ?2 Well Water Disp. S?wer EMctric 71`7I lp QZ,J A t^r Insptetion Date Insp. Other Footina Faundation Framinp _a Rough Plbp. ? Rough HVAC ? Inwlation ? ,.. Final Plbp. Finel HVAC Fieul Waur Doscribe Lowtion: YVell . Sewar Pr. Disp. • PERMIT # Site Address PLUMBING PERMIT RECEIPT ti CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: ? Name ?- ' (`i C c ? Address c Ciry Phone Name ? r 3 Addr?s?`? [sf ?'r c c1C ?-?= p City 4 Phone FEES COMM/IND FEE - 1% OF CONTRACT FEE APT. BLDGS - COMM RATE APPLIES TOWNHOUSE & CONDO - RES. RATE APP-UES MINIMUM - RESIDENTIAL FEE L-_ $12,0,?_> MINIMUM - COMM/IND FEE - $20.00 STATE SURCHARGE PER PERMIT - .50 (ADD $.50 S/C IF PERMIT PRICE GOES BEYOND $1,000.00) OF FOR: CITY OF EAGAN BLDG. T PY E WORK DESCRIPTION Res. New Mult. Add-on Comm. Repair Other ? E' (_ ,r, , ; -- ,X_ RES. PLBG. ONLY - COMPLETE THE FOLLOWING: NO. FIXTURES TOTAL Water Closet - $3.00 ! Bath Tubs - $3.00 Lavatory - $3.00 Shower - $3.00 Kitchen Sink - $3.00 Urinal/Bidet - $3.00 Laundry Tray - $3.00 Floor Drains - $1 50 _ I_Water Heater - S t 50 Whirlpool - $3.00 Gas Piping Outlets - $1.50 (MINIMUM - 1 PER PERMIT) Softener - $5.00 Well - $10.00 Private Disp. - $10.00 Rough Openings - $1.50 FEE: STATE S/C: ' Z-) GRAND TOTAL: j ?? ? ?" CITY OF EAGAN Remarks Addition CEDAR GROVE #11 Lot 5 Blk Owner-STd°_ 3$14 Country Creek Way Improvement Date Amount Annual Years Payment Receipt Date STREETSURF. ,() 261 .6 26.16 10 $2.37 005599 2-2-78 STREET RESTOR. ?: ffL 12 . 1 12.43 ],0 74.59 005599 2-2-78 GRADING • ? 03 931.90 005599 2-2-78 SAN SEW TRUNK O 1968 60.0 2.00 0 38.09 005599 2-2-78 iE SEWERLATERAL 1975 1.493.96 298.79 298.80 005599 2-2-78 * Water lat. & stubs 1975 5 WA7ERMAIN WATER LATERAL $;, ga, 1 2(}0. 13.36 1 120.29 005599 2-2-78 WATER AREA * Storm Sewer Trunk I 6 268.39 .68 107.38 A005599 2-2-78 STORMSEW TRK 1'7 1 33.56 1.67 20 20,20 A005599 1 2-2-78 STORMSEWLAT ?t 1971 22.37 1.11 20 13.29 A005599 2-2-78 CURB & GUTTER SIDEWALK 1978 187.52 18.75 10 168.77 A005599 2-2-78 STREET LIGHT WATER CONN. . 10-18-77 BUILDING PER. 10-18-77 sAC 475.00 7767 - - PARK Receipt MECHANICAL PERMIT Permit No. CITY OF EAGAN . . Fee ' Fill in numbered spaces S/C Type or Print legibly Tot • 1. Date 2. Installation Cost 3. Job Address ' Lot Bik. ' Tract 4, Owner 5. Contractor Phone 6. Address 7. City State Zip 8. Building Type: Residential ? Commercial ? Institutional ? 9. Work Description: New O Add ? Alter O Repair ? I 10. Describe Fuel Type ? 11• No. Equipment BTU - M. Ea. Forced Air No. EQUipment GFM Ai Mfg. r Handling: Boilers Mfg. Mech. Exhaust Unit Heater i • • t ? Mfg. Othe Air Cond. r Mfg, ' - 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 Final Inspections: Date Insp. Date Insp. This is yaur permit when numbered and approved. Approved CITY OF EAGAN 454-8700 Receipt " i PLUMBING PERMIT Permit No. ? . ? CITY OF EAGAN Fee ,y Fill in numbened spaces S/C Type or Print /egibly Tot. 1, Date 2. Installation Cost i , 3. Job Address L ?ot t Blk. Trac?j/, , "- G T 4. Owner th1 . . , 5. Contractor 6. Address Phone 7. City State ` Zip 8. Building Type: Residential ? Commercial ? Institutional ? 9. Work Description: New ? Add O Alter ? Repair ? 10. Describe 11. ? No. Fixtures Water Closet No. Fixtures Cess ool/Drainfield Bath tubs p Septic Tank Lavatory Softner Shower Wel I Kitchen Sink Urinal/Bidet Other Laundry Tray Floor Drains Drinking Ftn. Slop Sink Gas Piping Outlets 12. I hereby certify tfiat the abovg inforMation is true and correct, and I agree to comply wift'all ordinonc@s aiid cocl"es governing.this type of work. Signed: ` for Rough Finel Inspections: Date Insp. Date Insp. This is your permit when numbered and approved. Approved CITY OF EAGAN 454-8100 ??- CITY OF EAGAN 8795 Pilot Knob Road Eogon, nAN 55122 Zoning: Owner: Address: Site Address: ('G'-vi?' F ' - Plumber: ,•.?,r.,t?;- 1 '!i:.J?7 :s077? ? I agree M oomply wifh !he City of Eagan Connection Chorge: Ordinaneea. Account Deposit: _ Permit Fee: Surchorge: BY Misc. Charges: _ Dote of Insp.: Totol: Insp.:- Dote Poid: SEWER SERVICE PERMIT PERMIT NQ.: DATE: No. of Units: No.: to eomplr with the Cify of Eagan WATER SERVICE PERMIT Connection Charge: Account Deposit: Permit Fee: $urcharge: Misc. Charges: Total: Date Poid: CITY OF EAGAN N? 7310 3795 Ptlkt K? RNJ Eoqon, MN 55122 PHONEs I34-8100 ?33c1 BUILDING PERMIT Recelpt # Te be wed fee 3 SEAM PORCH Est. Volue $2.O00 Date Jwla 2 _ . 19 82 Slte Addrcss 3814 OoulltrY Creek Nay Erect (jt Occuponcy R-3 Codar GrOVe 11 k 1 S /S b g Bl Alter ? Zonin9 R-1 x ec u , Lot NA 10 16711 050 Ol Repoir ? Fire Zone parcel # V Enlorge p Type of Const. Nome Steoe V111"piA r Addross 3914 Countsy Ci'eek Nay, ,.. Eaaan 55122 452-2698 ? o fJ°'^° OMlzer ul u Addreu p- r:.,, Pl,,,.u, Ncme 1 hereby acknowledfle that I hove reod this applicotion ond stote thot fhe informotion is cArrect ond agree fo comply with oll opplicoble Stote of Minnesofa Stotutes and City of Eogon Ordinonces. Sipnature of Pennittea /1 Buildinfl Pertnit Is fssucd to: SLi oll work shall be done in eccordence with all Buildirq Officiol Move p # Stories Demolish ? Length 22 Grade p Depth 14 Sq. Ft. Approvals Fees Assessment _ Woter & Sew. Police Firo Er?p. Planner Council Bldy. Off. _ APC Permit J4•0v Surcharpe 1.00 Plan check SAC Water Conn. Water Meter Rood Unit Totol $33_5d on the express condition thcil ond City of Enpnn Ordinances. C) CITY QF EAGAN Include 2 sets of plans, .c.<...-U. 1 site plan w/el.evations & x 4;BUILDING APPLICATIC7N 1 set of energy calculations. Zb Be Used For 4;i?g - Valuation ,? ?12 At$- Date Site Address •' ?i? l?t?? OFFICE USE Y I,ot ? Block sec./sub. /Erect OccuPancY Parcel # : (? ? ? ` (?SC) C) ? Alt:ex' Zoni-nq , R,epair Fire Zone 5- -L) ' Enlarge 'I'ype of Const. Owner' Nbve # Stories Address:3-1 ac G? Dennlish Front ft. Grade D?th ft. ?nD City/Zip Qode: Phane # : ?.g ? APPRfJVALS ?S Coritractor: ?-? Assessments Pexmit Arldress : Water/Sewer Surcharge / Polioe Plan Qeck City/Zip Code: Fire SAC Phcne #: Eq, Water Conn. Planner Water Meter Cauncil Fca1 Unit ?h'?g" Bldg. Off. ' Address: APC City/Zip Oode: Phone # : TOTAL _ 33 PERMIT City of Eagan Permit Type:Building Permit Number:EA114766 Date Issued:09/18/2013 Permit Category:ePermit Site Address: 3814 Country Creek Way Lot:5 Block: 1 Addition: Cedar Grove 11th PID:10-16711-01-050 Use: Description: Sub Type:Reroof & Siding Work Type:Replace Description: Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar. Pictures are not acceptable in lieu of inspections. When installing ventilated soffit material, remove existing material (i.e. debris that could block vents) and take steps to ensure maximum ventilation to attic. Call for final inspection after installation. Valuation: 8,000.00 Fee Summary:BL - Base Fee $8K $162.25 0801.4085 Surcharge - Based on Valuation $8K $4.00 9001.2195 $166.25 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Lee W Sternberg 3814 Country Creek Way Eagan MN 55122 Ralow's Roofing 4351 Parklawn Ave. Suite 108E Edina MN 55432 (952) 210-4988 Applicant/Permitee: Signature Issued By: Signature Use BLUE or BLACK Ink r _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - I For Office Use I Permit#: 1 City of Eat(, 1 S v I Permit Fee: 3830 Pilot Knob Road I I Eagan MN 55122 Date Received: Phone: (651) 675-5675 1 1 Fax: (651) 675-5694 1 Staff: 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: 10 031Site Address: (r'~ ~(~ly low 1~) Unit Name: Phone: 0J Resident/ Owner Address / City i Zip: 3 Applicant is: Owner Contractor Type of Work Description of work: ke-p Construction Cost: Multi-Family Building: (Yes / No ~r ) Company: Contact: Contractor Address: City: State: Zip: Phone: License Lead Certificate If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) s COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING i 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: L Sewer & Water Contractor: Phone: NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of It the information may be classified as non-public if you provide specific reasons that would permit the City to L ~ 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.oro I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 days of permit issuance. x x Applicant's Printed Nam Applicant's Signature Page 1 of 3 PERMIT City of Eagan Permit Type:Building Permit Number:EA147209 Date Issued:12/18/2017 Permit Category:ePermit Site Address: 3814 Country Creek Way Lot:5 Block: 1 Addition: Cedar Grove 11th PID:10-16711-01-050 Use: Description: Sub Type:Windows/Doors Work Type:Replace Description:One Window/Door Census Code:434 - Residential Additions, Alterations Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow windows, call for framing inspection. Call for final inspection after installation. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Valuation: 500.00 Fee Summary:BL - Base Fee $500 $40.00 0801.4085 Surcharge - Based on Valuation $500 $0.50 9001.2195 $40.50 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Lee W Sternberg 3814 Country Creek Way Eagan MN 55122 (612) 508-2326 Custom Remodelers 474 Apollo Dr Lino Lakes MN 55014 (651) 784-2646 Applicant/Permitee: Signature Issued By: Signature