1363 Cosmos Lane
Use BLUE or BLACK Ink
r
For Office Use
City of Ea~d~ 1 Permit#: 1
I I
I Permit Fee: /~~w
3830 Pilot Knob Road 1
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 1 Staff: I
10 RESIDENTIAL BUILDING PERMIT APPLICATION
r r
Date: Z1 Site Address: LO'~ V
Tenant: Suite
RESIDENT/ OWNER Name: Cap /~Z, Phone:/
Address / City / Zip: ! ~LLd~~ d2~~ t `tT_~ ~l Jam( J
Applicant is: Owner Contractor
1
TYPE OF WORK Description of work: P1~6 L_
Construction Cost: Multi-Family Building: (Yes / No
l}
)
CONTRACTOR Name: License #:,?o / z I
~j /12
Address: City:
State: Zip: Phone:
We7
Contact: / Email:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued -a perm); 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
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that the are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage.
Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the 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; th a work ' e in
accordance with the approved plan in the case of rk which requires a review and approval of plans.
X
r.
Applicant's Printed Name Applicant's Signature
Page 1 of 2
CITY OF EAGAN Remarks
Addition _f' '-derness Run 4th Addition Lot 4 Bik 1 Percei 10 84353 040 Ol
Owner f I Street 1363 Cosmos Lane State Eagan, MN 55123
Improvement Date Amount Annual Years Payment Receipt Date
STREET SUR F.
STREET RESTOR.
GRADING
SAN SEW TRUNK Aal 1973 $163. 26 $8.16 20 PAID
SEWERLATERAL
WATERMAIN
WATER LATERAL
WATER AREA
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. $280,00 10877 6-18-74
BUILDING PER.
sAC $400.00 1C877 6-18-74
PAR K
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued:
(612) 681-4675
SITE ADDRESS: ?
. ? ??•;?f? : E F?hii.
? t f?F kNF'?:? Fr11N rt! tl
? PERMIT SUBTYPE:
11 tol-1 I IV
APPLICANT:
4i
TYPE OF WORK:
!it ';i:f; i F I 1014
t ti
AS fN-,EPT jGA-1 i rmr
t rri A I
Permlt No. Permit Holder Date Telephone A
ELECTRIC
PLUMBING
HVAC
Inapectlon Date Insp. Comments
FOOTINGS
FOUND
FRAMING
RDOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGN
HEATING
GAS SVC
TEST
INSUL
GYPBOARD
FIREPLACE ,7 47;gl
? l
r
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
BSMT R_I.
BSMT FlNAL
DECK FTG
DECK FlNAL
CITY GF Et:GAPd
3795 Pilot Knob Road
Eagan, Nlinnesota 55122
PE:iP?'fIT NO.: 550
The City of Eagan hereby grants i,o vie,.e uenri„g yA4r rnr_
of 13075 Pieneer Traii. FAnn Praarip Saa4'4
a irA22xG Permit for: (Cwr:er) wen=an„ (:onetniction r!e_
at i363 [bamos tane , pursuant to application dated 7/30/74
Fee Paid: SZO.on dated this 8th day of Alim,st ,.I 9 7a•
.so e/c
Bu.ildino Inspector
N:achw-iical Permits:
Bid Totala
y-1
CITY OF EeiGAN
3795 Pilot Knob Road
Eagan, Minnesota 55122
PrRPCT NO.: 497
The City of Eagar. hereby grants to Wenzel Plwnbing & Aeating INC.
o; 3600 Kennebec Dzive, Eagan 55122
aPLUHBING Permit for: (Owr.er)
Wensmann Construction
at _ 1363 Cosmoa Lane ? pursuant to application dated 7/30/74 `
Fee Paid: $20.00 dated this 8th day of Auguet ? 1 9 74
.50 s/c
Building Inspeetor
Machanical Permits:
Bid 7'otals
CITY OF EAG?N
3795 1'ilot Knob Road
Eaga_7, blinnesota 55122
PEFsNLLT NO.: 644
The City of Eagan hereby grants to Kleve xeating & A/C
of Eden Prairie
a AIR COND. Permit £or: (Owner) Rimz el
at 1363 Cosmos Lane , pursuant to application dated 3/3/75
Fee Paid: $5.00 dated this 13 day of Mar. , 19 75
.50 s/c
Suilding Inspector
Mechanical Permits:
Bic To'ual:
tl-?
• " CITY of EAGAN
BUILDING PERMIT
OWO6! .. x.e-- - ..... •'•-t?.:.. ................:....','.:.:....r.............._.
Address (Presenf) ......?`.`-?"'?e'.c?Z??f=t ...........................
Builder ........
Addresa ......
DESCAIPTION
N? 3323
3785 Pilo! Knob Road
Eagaa MinnesoYa 55122
454•8100
Date ....?.?... ..??..?._?.??...... _.......
ories To Be Uaed For Fsonf Depth Hetgh! Est. Coe! ermlt Fee Remarks
7 /Gt? ? • 2Z 9-2-- ?gi0°? Q
?i/S
" LOCATION /.t?:-:SU
Slrael, Aoed or olhar Deceription of Localion I Lo! Bloek Addilioa or Tzaet
A.,..i 4t '2E
This permi2 does aot au2hoxize the use of slreeffi, roads. alleys or sidewalks nor doee it give the ownas or Lia egent
the xigh! !o oreale enq silualion whiah is a nuisenca or which presents a hasard !o the beallh, safatp, eonvaetenee aad
general weliare !o anpone in the eommunilp.
THIS PERMIT MUST BE KEPT ON THE PREMISE WHILE THE WORK IS IN PAOG ESS.
4...._upen
Thia ia !o eertifp. !hal..'??!`?"!?.°..?C"? ................hea permisslon !o ereM a.. ?:`. :?.. ................
the above described pxemise subjeci !o the pzovisions of all applicable Ordinanees for the C of Eagaa.
...................... ?:..:....-'-.Y...a.`.?`.1""'i.................... ._.. Per _ ...................... ..I`°?`:._""??...?.`:'......................
Ma or?/ 12j, Bullding Insyeclor
?
VILLAGE OF EAGAN WATER SERVICE PERMIT
3795 rilor ii.c6 Road 1'ERMIT NO.: 1559
Eagan, MN 55124 llATE: __ 8 8 74
Zoning: No. of Units: 1 .
owner: _-Wensmdnn Construction.
Address:
Sice Address: _1363_-Cosmos Lane
- - - ----
Pluinbec _.._WePZel__P_lumbinq_ & Heating INC.
Mete?,a.?3p7,3?."j? Connection Charge:340.00 pd
Size: _ _?i]._ed C_+? • a Account Deposia
Reader Pennit Fee: 10.00 pd
I n9fea To complr with the Villoga of Eagan Surcharge: •$0 pd
Ordinonee:. Misc Charges:
Total: _
t-' ''J _ llate Paid:
Date of Insp.: Insp.:
YILLAGE OF EAGAN
3795 : ilot !;nab Rood
Eogan, MN 55122
`Loning: P.3
Owner:
Address:
SEWER SERVICE PERMIT
YERMCI' NO.: 2319
DATE: £181 74
No. of Units: I5ite Address; 1363 Cosmos Iane
Plumber: venzel P1uml;ing & Heating IP;c.
I °9'°° to ComDlr wi}6 fhe Villoge oi Eogon Connection Charge: 249yiog p(;
OrdinanC06' Accoun[ Ueposih
Permit Fee: 1-0.00 pd
Surcharqe: • SO j?d
BY' Misa Charges:
Uare of Insp.: Total:
Insp.: Da[e Paid:
PERMIT CITY OF EAGAN
3830`Piiot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS:
1363 COSMOS LANE
LOT: 4 BLOCK: 1
WILDERNESS RUN 4TH
P.I.N.: 10-84353-040-01
DESCRIPTION:
" `- C,AS INSERT/GAS
BuiJ;dinq-Permiti Type
;9uilding Wt?r-k Type
'E Census Code
-,
,
1x? ,
434
PERMIT TYPE:
Permit Number:
Date Issued:
LINE
FIREPLACE
NEW
ALT. RESIpENTIAL
? a, f-L
rFj?t''Ety'.'`r ??`?{j ( tt
*?? ?-''?..:.," `....?,,,3
c2B 1L 4
BUILDING
031159
11/21/97
REMARKS:
FEE SUMMARY:
Base Fee $50.00
Surcharge $.50
To[al Fee $50.50
CONTRACTOR: - ppplicant - OWNER:
GAS LINE PLUS INC 12266220 FRANKLIN MITCHELL
4806 RUTLEDGE ST 1363 COSMOS LANE
PRIOR LAKE MN 55372 EAGAN MN
(612) 226-6220 (612)405-1458
I hereby acknouledge that, T have?-1 reasf this a pp-I 3,a?atiq» ?r d,5ta?e t?i-at.?t he,.
' ic?formation is correct artd agreeto'comply'uith a.tl applitrable 5taie of Pfn. Statutes and City ezf Eaga?? Ord1n°anc4,s.,' , • ._,, , ,; r_
° . . ? _: . . ?
? .01,PM1 I I' I?
APPLICANT/PERMITEE SIGNA7URE -ISSUEb BYI SIG ATU EJ
?
CITY OF EAGAN
3830 PILOT KNOB RD - 55122
1997 FIREPLACE PERNIIT APPLICATION
A51,-1?6q 681-4675
DATE: I I1,19 I 97 PERMIT FEE: $50.50
DESCRIPTION OF WORK; _ CONSTRUCT NM FIREPLACE _ ALTERATIONS TO EXISTING
_ INSTALL GAS INSERT ONLY
INSTALL GAS LINE ONLY
? OTHER: ?
STREETADDRESS: - I 3Ln3 l,oSYVio 5 rt (1
LOT ? BLOCK SUBD./P.I.D. #: t0APll a,IJ IVAAI, 4&
APPLICANT: (circle one only) OWNER ONTRACTO
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.
PROPERTY
OWNER
FIREPLACE
INSTALLER
Nazne: Frav\ot I\ Phone #: 405 -
Signature:
Street Address:
City:
State:
Zip:
Company: G? ?e Plne, Iac. Phone
Signahue: Prlor Lake, MN 66878
a ,
Sueet Address:
City:
GAS LWE Company:
INSTALLER
Phone #:
Name:
Signature:
WV " ;; III III Street Address:
License #:
State: Zip:
City: State: Zip:
MASTER CARD
OWNER ftleph f fj/[ ot_A
STRUCTURE AND
LAND USED AS ?
z
Permit
No.
Issued Issued To
ContractOr Owner
BUILDING o33 .?3
PLUMBING ,[? g 'f
t?? ('?_ ? 7FJ
CESSPOOL - SEPTIC TANK
WELL
ELECTRICAL
HEATING
GAS INSTALLING
SANITARY SEWER
OTHER I
(DTHER I
Items Approved
(Initial)
Date
Remarks
Distance From Well
FOOTING ;L ' 7? SEPTIC
FOUNDATION S?- R' 7q CESSPOOL
FRAMING ?• Z''J ' ?- )? TILE FIELD FT.
FINAL
ELECTRICAL
HEATING
? ?J.•
7 -2 DEPTH
OP WELL
GAS INSTALIATION
SEPTIC TANK
CESSPOOL
DRAINFIELD
PLUMBING
WELL
SANITARY SEWER
Violations Noted
on Back
COMMENTS:
PERMIT # RECEIPT DATE: II `I ?"U I
/a 19G?-?-}9
?? .
RESIDENTL4LL PLUM$1NG PERMIT Af'PI1CATION .:".
? C1N OF EAHAN
S$SO PILOT KPOB RD ?
EA&AN, A1N S51 EE
651-6$1-4675
Please complete for: i single family dwellings
? townhomes and condos when permifs are required for each unit
> backflow preventer for ircigation systerrm
SITEADDRESS: _ V?(n-?j C OS`MCfj \
OWNERNAME:: tY\;ic Vrnr1\4.l TELEPHONE#:[?C,;k_E-10S- ' 145%
(AREA CODE)
INSTALLER NAME: rR,,, TELEPHONE #: g,c-;. q31-q('? ? ?
-T-
STREETADDRESS: 605 12th A40f1Ue 5uu? (??cooE)
„
Lnn 1wiii gvw
CIn:
STATE:
ZIP:
Place a check mark next to the ermit work t e
New residential dwelling unit under construction and not ownerJoccupied $ 90.00
? Add-on, modification or alteration to existin dwelling unit, including: $ 50.00
• abandonment of septic system
• new installation/repair/rebuild of RPZ
• lawn irrigation system
• waterturnaround
Natureofwork:_RPplnnar WC&A" V\2sLl2.Y ?U VOU j 4LUU)
Septic System, new/refurbished - -$ - 225.00- -?
• includes County 8 Consulting Inspector fees
• requires NIrC license
State Surcharge $ .50
Tota l O
$4
7)
?
- _
-
Reminder: Be sure to schedule inspections of alterations, i.e. water heaters, water softeners, etc.
I hereby acknowledge that I have reatl this application, sUte that lhe information is cor fithin nd agree to comply with all appliwble Ciryof Eagan ordinances. It
is Ihe applicanPs responsibility [o noli(y the property owner that the Ciry of Eagan ass no liabili wag0_s caused by the City during its normal
operetional and maintenance activities to the facilities constructed under this permit City p aperty/riglhLod-waq/easement.
Updated t/01
�City afEapli
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
1
For Office Use
Permit #: iC /
Permit Fee: �k^
Date Received: —1
J
INFLOW & INFILTRATION PERMIT APPLICATION
x Plumbing / Sewer & Water
Date: 2-/ Z- 17 Site Address: 1 b 3 C o s o S n g
Tenant: Suite #:
esi
en
Name: 2
Address / City / Zip: l 3 li 3
C w-0
Phone: ( (- `-LO 5 - f 47.57
Mti ss 123
!n1
rac1
Name: License #:
Address: City:
State: Zip: _ Phone:
Contact: Email:
Hype
scription
PLUMBING (Within the building envelope)
Sump Pump Repair
Other:
SEWER & WATER (Outside the building envelope)
Repair
Other:
Description of work:
FEES
$60.00 / 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.qopherstateonecall.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.
s /1
x TecK M. _
Applicant's Printed Name
Applic s ignat re
Use BLUE or BLACK Ink
r - - - - - - - - - - - - - - - - -
I For Office Use
I~ I
Cit of EanoEdn Permit#:
14/'J I Permit Fee: V
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received:
Phone: (651) 675-5675
I I
Fax: (651) 675-5694 I Staff: I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit
c
Name: Phone: (oSJf L/6 5•
Resident/
Owner Address / City / Zip: ~J
Applicant is: Owner ✓ Contractor
Type of Work Description of work: ~ lit- Y DID 1
Construction Cost: Multi-Family Building: (Yes /No )
(0 5
Company:- f ~,e,& 6u~ ~ K ~Contact:
Contractor Address: 1VC City: ~t.l l
State: Zip: ~53 6 Phone:
i
License e 42 ?2, $ Lead Certificate M, 76
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE; Plans and supporting documents that you submit are considered to be public information. Portions of
i 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.oopherstateonecall.org
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a b ilding permit issued in accordance with the Minnesota State Buildin Cod ust b pleted within 180
days ermit issuance.
X x
pplic t 's Printe N7 aphe App ' s g ature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA153178
Date Issued:11/28/2018
Permit Category:ePermit
Site Address: 1363 Cosmos Lane
Lot:004 Block: 001 Addition: Wilderness Run 4th
PID:10-84353-01-040
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:Two or More Windows/Doors
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: 4,000.00
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 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 -
Jean M Erickson
1363 Cosmos Lane
Eagan MN 55123
(651) 247-7309
Homestead Remodeling & Consulting Llc
6053 Hudson Rd, Suite 340
Woodbury MN 55125
(952) 994-6102
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA154697
Date Issued:04/05/2019
Permit Category:ePermit
Site Address: 1363 Cosmos Lane
Lot:004 Block: 001 Addition: Wilderness Run 4th
PID:10-84353-01-040
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:Two or More Windows/Doors
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: 5,000.00
Fee Summary:BL - Base Fee $5K $118.00 0801.4085
Surcharge - Based on Valuation $5K $2.50 9001.2195
$120.50 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Jean M Erickson
1363 Cosmos Lane
Eagan MN 55123
(651) 247-7309
Homestead Remodeling & Consulting Llc
6053 Hudson Rd, Suite 340
Woodbury MN 55125
(952) 994-6102
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA156752
Date Issued:07/17/2019
Permit Category:ePermit
Site Address: 1363 Cosmos Lane
Lot:004 Block: 001 Addition: Wilderness Run 4th
PID:10-84353-01-040
Use:
Description:
Sub Type:Siding
Work Type:Replace
Description:
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please leave printed pictures of house wrap on site for the final inspection.
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: 5,000.00
Fee Summary:BL - Base Fee $5K $118.00 0801.4085
Surcharge - Based on Valuation $5K $2.50 9001.2195
$120.50 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Jean M Erickson
1363 Cosmos Lane
Eagan MN 55123
(651) 247-7309
Krech Exteriors Inc
5866 Blackshire Path
Inver Grove Heights MN 55076
(651) 688-6368
Applicant/Permitee: Signature Issued By: Signature