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