4623 Halden Cir
Use BLUE or BLACK Ink
For Office U%se/
n 1 I(1 I
Pemmit j V
My of Eaed )
, C 0~' I 06 Q 1
~ Permit Fee: / / 1
3830 Pilot Knob Road
RECEIVED 1 Date Received: - Z O
-71
Eagan MN 55122 c" psECE 1
I ~
Phone: (651) 675-5675
1 44-
Fax: (651) 675-5694 I U I 18 2011 Staff:
2011 RESIDENTIAL BUILDING PERMIT APPLICATION t m
o il-k-P
Date: o V Site Address: V& ',3 14o j den C;,, f e Unit
Name: CV f4t q- I/aG ri 4 ! "1`'_J'L. Phone:
RESIDENT / 4A, 3 14 c j. j,
OWNER Address / City / Zip:
Applicant is: Owner Contractor r
TYPE OF WORK Description of work: d e ct \
Construction Cost: Multi-Family Building: (Yes / No x)
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)
/Vo a; T e~ --_5U 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
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.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 riot 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 plans.
( / e
/ ' /~ejeel e_k x
X_
- L:~Q -
Applicant's Printed Name Applicant's Signature
Page 1 of 3
v6ds 4/40 cir
DO NOT WRITE BELOW THIS LINE ~Y) 26
SUB TYPES
_ Foundation _ Fireplace _ Porch (3-Season) _ Storm Damage
Single Family _ Garage _ Porch (4-Season) _ Exterior Alteration (Single Family)
Multi Deck _ Porch (Screen/Gazebo/Pergola) _ Exterior Alteration (Multi)
_ 01 of Plex _ Lower Level Pool _ Miscellaneous
_ Accessory Building"
WORK TYPES C
- New _ Interior Improvement _ Siding _ Demolish Building*
1~ Addition _ Move Building _ Reroof _ Demolish Interior
Alteration _ Fire Repair _ Windows _ Demolish Foundation
_ Replace _ Repair _ Egress Window _ Water Damage
Retaining Wall *Demolition of entire building - give PCA handout to applicant
DESCRIPTION
Valuation Occupancy MCES System
Plan Review Code Edition '.SAC Units
3A.4 A
(25% 100% ) Zoning City Water
Census Code t Stories Booster Pump
# of Units Square Feet PRV
# of Buildings Length Fire Sprinklers
Type of Construction Width
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
Footings (Deck) Final / C.O. Required
Footings (Addition) Final / No C.O. Required
Foundation HVAC _ Gas Service Test Gas Line Air Test
Drain Tile Other:
Roof: ^Ice & Water -Final Pool: -Footings -Air/Gas Tests -Final
Framing Siding: -Stucco Lath ^Stone Lath -Brick
Fireplace: -Rough In -Air Test -Final Windows
Insulation Retaining Wall: _ Footings _ Backfill Final
Sheathing Radon Control
Sheetrock Erosion Control
Reviewed By: Building Inspector
RESIDENTIAL FEES
Base Fee
Surcharge Lam`
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant rr . r
Copies
TOTAL
Page 2 of 3
LANIr-w 114
D SURVEYORS tit
Foi: 1381 EUSTIS ST., ST. PAUL, MINK, ss,oa
u. S. HOME CORPORATION V) c'rc u
too
SCALE 1'*= 30'
C? DENOTC5 1 RON
~C.a SSE`
O
xr ~~O tv , c~ ''`J
\
S a 7 3!
\ ,14 V
c ti '
37
,\o
U) ~
~U
Lot 4, Block 1, Ridgecliffe Fi 'St A ~jjonr
Dakota County, Minnesota.
WE HERESY CERTIFY THAT THIS IS A TRUE -,AND CORRECT REPRESENTATION OF A SURVEY OF THE
BOUNDARIES OF THE LAND ABOVE DESCRIBED AND OF THE LOCATION OF ALL BUILDINGS, IF ANY,
THEREON, AND ALL VISIBLE ENCROACHMENTS, IF ANY, FROM OR ON SAID LAND.
Dated thi,Z41), day ofJs1d~4 -A.D. 198/ G. R. WINDEN & ASSOCIATES, INC.
by
Surveyor, Minnesota Registration No 77.6
N7,1SlV
Use BLUE or BLACK Ink
- - - - - - - - - - - - - - - - -
Eajan Fof Office Else
Cit Uf j Permit D 9~~02 ~
1 Permit Fee: 1-5- 0 U 1
3830 Pilot Knob Road 1 I
I
Eagan MN 55122 ( Date Received:
Phone: (651) 675-5675 I 1
Fax: (651) 675-5694 Staff: /1'1 L j
- - - - - - - - - - - - - - - - - J.
yy rr,, 2010 MECHANICAL PERMIT APPLICATION
Datek0_0Site Address:~A( op,
Tenant: T -f
RESIDENT / OWNER Name: C_L~ . Q` / Phone: (Q_ 1' w5p - USS9
Address / City / Zip: l-' 0
CONTRACTOR Name: BURNSVIL LE HEATING & A/C, INC. License 4 ~ 3451 W. Burnsville away
Address: Suits-. 120 City:
State: If-1p: Vllle, MN 55337 phone:
Contact: ~r Email:
TYPE OF WORK New ~c Replacement Additional Alteration Demolition
Description of work:
NOTE: Roof mounted _an ground mouriW# mechanical equipment is required to be screened by City
Code. Please contact the Mechanical Inspector for;information on permitted screening methods.
RESIDENTIAL COMMERCIAL
PERMIT TYPE Furnace _ New Construction _ Interior Improvement
Air Conditioner Install Piping _ Processed
Air Exchanger Gas _ Exterior HVAC Unit
Heat Pump _ Under / Above ground Tank C__ Install Remove)
y f;}~ When installing/removing tank(s), call for inspection by Fire
Other iX Marshal and Plumbing Inspector
RESIDENTIAL FEES:
$50.50 Minimum Add-on or alteration to an existing unit (includes $.50 State Surcharge)
$90.50 Fire repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) Y _Aj TOTAL FEE
COMMERCIAL FEES:
$70.50 Underground tank installation/removal OR Contract Value $ x1%
$50.50 Minimum (includes State Surcharge)
Permit Fee
- if Permit Fee is less than $1,000, surcharge is $.50.
- If Permit Fee is > $1,000, surcharge increases by $.50 for each = $ Surcharge
$1,000 Permit Fee (i.e. a $1,001-$2,000 Permit Fee requires a $1.00 surcharge).
TOTAL FEE
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.gooherstateonecall.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 approved plan in the case of work which requires a review and approval of plans.
x pr
d I LMIILa4-~ x C---~
Applicant's Printed Name Applican s Signature
FOR OFFICE USE Reviewed By: Date:
Required Inspections: -Under Ground Rough In Air Test "Gas Service Test In-floor Heat Final . "
l=xterior HVAC Screening Inspection
i CASH RECEIPT •
CITY OF EAGAN
3795 PILOT KNQB ROAD
EAGAN. MINNESOTA 55122
DATE
RECEIVED
19
AMOUNT $ I
Q DOLLARS
too
0 CASH ? CHECK
FOR
FUwO GOOE AMOUNT
Thank You
?? . BY f /
White-Payers Copy
Yellow-Postinp Copy
Pink-File Copy
CITY OF EAGAN
, 3795 Pilot Knob Road Eagan, MN $5122
, PHONE: 454-8100
BUILDING PERMIT Receipt #
Tn Ir w?d iar
F.+ V.,I..o . . 1'7..*e
Site OMdress ;? ? `l?': • ? ?? 1
, ? •. ?
Lot Block Sec/Sub.
Porcel #
oe Name „; n ?,,?,?): ?:7SOII }?U1IIPs
-- -
W _
3 Address T -' i(.'I'OSSI08C1
lx Name
?F
?u Address
? Cit
uW
WW Name
FW
=Z Address
I hereby acknowledge thut I hove reod this application and state tFwt
the infortnotion is correct ond agree to comply with ail opplicabie
Stote of Minnesoto Statutes and City of Eogan Ordinonces.
N2 6773
Erect ? Occupancy
Alter Q Zoning
Repcir ? Fire Zone ?
Enlorge ? Type of Const.
Move ? # Stories
Demolish ? Front
Grade (1 Deptfi ft.
Assessment -
Water & Sew.
Police
Fire
E?W
Plunner
Council
Bidg. Off. _
APC
Permit '
Surcharge
Plan check
SAC
Water Conn.
Water Meter
Rood Unit
Total
Signoture of Permittee I
A Building Permit is issued to: ' on the express condition that
oll work sholl be done in occordance with all appliwble State of Minnesota Siatutes and City of Eagan Ordinances.
Building Officiol
•-
rM1*M # 0017 I?NA rM=rMM
Plumbing 2.s 3 Q-t -$ Z?E t4-,-v C ?
Mechoniwl (Q s -.1- -
ElFC, 75??S' Q-I(?-t( ?r F<<
INSPECTIONS DATE INSP. Rouph-In Ffn
Footings Date Inap. Dafe Irup.
Foundation Plumbing
V
Frome/ins. Mechanical ? ?
Final .
Remarks:
)• 2
/?
?-
CITY OF EAGAN
3795 Pilof Knob Road Eagen, MN $5122
tHONE: 454-8100
BUILDING PERMIT
Recelpt #
Te M rad fw W. Volue Date--- _ , 19
Site Addrcu Erect [] Occupanq
Lot Block Sec/Sub. Alter p Zoning
Porcel Repoir ? Firo Zone
Enta?pe Q Type of Const.
W Name Move
p # Stories
= Addross Demolish ? Length
? rir,, o&- r Grode ? Depth Sp. Ft.
A Name
?? ^ddre:
r- r?...
Owner
I hereby acknowledge thot I have read this opplicotion ond stote thot
the informotion is correct cnd ogree to comply with oll opplicable
Stote of Minnesoro Stotutes ond City of Eagan Ordinonces
Asseument _
Water 8 Sew.
Police
Fire
ErW
Plonner
Council
Bidy. Off. _
APG
Sipnoture of Permittee ?-
A Building Pe?mit is issued to:
oll work sholt be done in occordor?ce with
Bu{Idinp Officfal
Permit
5urcharge '
Plon check
SAC
Water Conn.
Water Meter
Road Unit
Totol '
on the express conditfon thal
Is State of Mlnnesoto Statutes ond City of Eoyon Ordinonces.
Psrmit No. Permit Holder Misc. Permit No. Holder
Plumbinp
H.V.A.C.
ater Well
W
Disp.
Sswer
Ekctrie
Inapection data Insp. Other
Footings
Foundation
Fnming
RouqF+ Plbp.
Rouqh HVAC
Insulstion
Fioal Plbg.
Final HVAC
Final ? .
WoUr Dsseril» Loeation:
YVell
Sawer
Pr. Disp.
Receipt
?
AECHANICAL PERMIT Permit No. a
CITY OF EAGAN ?
Fee '
fill rn numbered speces S/C ?
Type or Print legib/ y Tot •
1. Date - ?-- ? 2. Installation Cost 13l)L.. •
3. Job Address `? -` - Lat Blk. / Tract
4. Owner
5. Contractor • • =?J • Phone
6. Address ? -'• y'
. , ,
7. City ? State • Zip •' ?' +•
8. Building Type: Residential O Commercial O Institutional ?
9. Work Description: New 0 Add ? Alter ? Repair ?
10. Describe - - - ' Fuel TYpe
1 11,
No. s7ui ent 8TU - M. Ea.
Forced Air No. Enuiament CFM
Air Handlin
:
Mfg. g
Boilers
Mfg. Mech. Exhaust
Unit Heater
Mfg. Other
Air Cond.
Mfg.
Gas, Piping Outlets
12. I hereby oertify 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 Inal
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 464-8100
Receipt ?(0 PLUMBING PERMIT Permit No. ??? ? ::5
CITY OF EAGAN
9? • F«
Fill in numbered spaces S/C '
Type or Print /egibly Tot. \
,
1. Date 2. Installation Cost •
3. Job Address r? Lot `t Blk. ? Tract j4. Owner
5. Contractor ?(' I a 11 .? A ?Phone
•,
6. Address
7. City State 2ip ?
8. Building Type: Residential E7 Commercial ? Institutional ?
9. Work Description: New P Add O Alier ? Repair ?
10. Describe
11.
No, Fixtures
Water Closet No. Fixtures
Cess
ool/Dr
i
field
Bath tubs p
a
n
Septic Tank
Lavatory 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
OF EAGAN
SEVIIER SERVICE PERMIT
Cildt Kno6 Road PERMI7 NO.:
MN 55122 DATE:
?? - No. of Units:
Site Address: 1 1 t, -' - • i 1. ';.c ? i?' ?
Plumber: -
I agree to wmplp wkb flie Ciryr of Fagen Connedion Chorge: . ;
Ordinontes. Account Deposit:
Permit Fee:
5urcharge:
g1' Miu. Charges:
Dote of Insp.: Totol:
Insp.: Date Poid:
CITY OF EAGAN
3795 171ot Knob Roed
Eagon, MN 55122
Zoning:
Owner: 7 t3c
Address:
Site Address:
Plumber:
Meter No..
Size! ---
Reader IVo.:
1 ageeo to eomply wilb 11w City of F.agon
Ordinonees.
By
Dote of I nsp.:
Connection Charge: ? - ,
Account Deposlt:
Permit Fee:
Surcharge:
Misc. Chnrges: C r
Total: -
Dofe Poid:
Insp.:
CITY OF EAGAN
Addition Ri tiggc-ll AfE'- pirst Addn, l.ot 4 Bik I Paroel #10 63980 040 Ol
oWne, L.wsll ?A' n! : - U( .t (+-screet 4623 Halden Circle 5tate Eagan, hQT 55122"
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK 46-3 980 184.49 12.30 15 14.62 C00 b32 2-18-82
SEWER LATERAL nc:- 7,
- 23 n
WATERMAIN
WATER LATERAL ln, 71i( 39 •?? 2 T r
WATER AREA ? 980 184.49 12.30 iS 147.62 CQo 6 2 2-1842
Storm sewer trunk ln:;? 370-93 24-71 r
STORM SEW TRK 1982 638.24 5 638.24 C007616 12-23-81
STORM SEW LAT 1`:, .,)u 7., ?.
ervices 1982 637.75 5 637.75 C007616 12-23-81
CURB & GUTTER
SIDEWALK
STREET LIGHT
Road Unit 185.00 25889 7-22-81
WATER COIVN. 335.00 it
BUILDING PER. 6773
sac 525.00
PARK
CITY OF EAGAN
3795 Pilot Knob Road Eagen, MN 55122
PHONE: 454-8700
BUILDING PERMIT APPLICATION
T. i. .a sa. SF DNFG/GAR F?. v„i„P Sh6.00(S
Site Address 4043 I181Q@II Lircie ImOQf?l iuu)_
Lot 4- Block 1 Sec/S.b. RidgQC13Pfe lst
Porcel # 10 63980 (14(1 (11
w I Name Orr3n Thomoson Homes
3 Address 1712 Hopkins Crossroad
O .... ,.?..... -.. ........
o Name _
?
?u Addrew
Name _
Address
i hereby acknowiedge that I hove read this application and stote that
the information is correct and agree to comply with all applicable
Smte of Minnewta Statutes ond Ciy of Eagon Ordinances.
Signature of Permittee
A Bullding Pertnit is issued ro: Orrin T Ol 80T1 $1
oll work shall be done in accorda e'with a1L ?Jia le 5}ate of
Buildin9 Officlal <.! :_ .? I.<: ?.ce zC
N2 6773
Receipt .# ? -
Rl
Erect [Z Occupancy R.3
Alter ? Zoning PD
Repair ? Fire Zone NA _
Enlcrge ? Type of Const. y
Move ? # Stories
Demolish ? front 471711 ft.
Grade ? Depth 37 . 4t.
Aoo•ovals Feea
Assessment _
Woter & $ew.
Police -
Flre
Eng.
Planner -
Council -
Bldg. Off. -
APC
Pertnit `"?•""
Surcharge 23•00
Plan check 132..50
_ ,
Sp,c 525.00
Woter Conn. 335 • 00
Water Meter 60,00
Road Unit 185_00
Taal $1525 50
on the express mndition that
Statutes and City of Eogan Ordinances.
CITY OF EAGAN
9795 Hlot Knob Road Eegan, MN SS712
PHONFs 434-8100
BUILDING PERMIT '
N° 7311
Receipt # I i i 7
To M wad 1orpATI0 WI Volue $1
000
NDOW & DEM Dare dun.a 3 19A2
.
. ,
_
Site Addrcss 4623 Hald en C3SCle Erect ,g Occupancy R-3
i.or 4 Biock 1 Sec/s.b. Ri8gecliffe lst Aiter ? zoning R-1 (PD)
10 63980 040 Ol Repuir ? Fire Zone NA
parcel #
Enlarge ? Type of Consi. V
W Namg DSVid L. D6?7t8Ch µove O # Stories
? Addresa 4623 Flalden Circle pe,,,oiis, ? Lenych 14
Ci SagBn 55122 pho. 652-8479 Grade ? Depth 1`~ Sq. Ft.-
N CjwnP1„ _ Approvak Fees
? ome _
?
Addreu
f nw,
Nome _
Address
Assessment _
Woter 8 Sew.
Police _
Fire
Enp.
Plonner -
Council _
1 hereby acknowledge that I hove read this opplicotion and stote that Bidg. Off. -
Ihe informotion is cortect and ogree to comply with oll applitoble APC -
$tate of Minnewta Statut sy a?'n???/ C,ityof Eagan Ord/irwl"nus..,L
$iflnoture of PermiMee?r
A Building Permit is issued ro:
uli work sholl bo done in accordanee with all ppliwble i-AA7'neso
Buildirg Offieiol
Permit 17.$0
SurcFrorye .50
Plan check
SAC
Wuter Conn.
Water Meter
Rood Unif
Toml $lA-nn -
on the express conditlon thn+
Statutes and City of Eopan Ordirwnces.
-?pIt7311
-PQ?V1`0 (A) i rLL oi
Th se Used For ? b LOk
CITy CF EAGAN Include 2 sets of plans,
1 site plan w/elevations &
BC7ILDING PERmPP APPLICATION 1 set of energy calculations.
valuation 4 I D D O°= Date (p 1.3 ZS Z
site Paaress ys,,p Z3 NpL-o Eni C, F-ct-?
Lot y BlOCk I Sec./Sub. ZOl.ECLiFFE
Parcel #: jo u3cgU DqO O) ?sr
Owner: `,AviCl. L. 't---?EUTSCH
Address: yco7-3 HP,%-DEN CiQc}.E
City/Zip Code: LCAv A?.I SS /2Z
Ptaone #: 457- - g4?01
Contractor: SELF
P,ddress:
City/Zip Code:
Phone # :
Arch./Ehq.: S6LF
P,ddress:
OFFICE USE ONLY
Erect pC Occvgancy 3
Alter ? Zoning
Repair Fire Zone ALzO
Ehl.arge _ Zype of Const.
Nbve # Stories
Dgnolish Front / ft-
Grade Depth ft.
APPROVALS FEES
Assessments Pexmit 7
ix-
iqater/Sewer Surchatige ?-
Police Plan Check
Fire SAC
g1q, Water Conn.
Planner Water Meter
cpiuicil Road Unit
Bldg. Off.
AFC
City/Zip Code:
Phane #:
REQUEST FOR ELECTRICAL INSPECTION ?-„ EB-00001-03
? 5? 9 5 4? Sea instrvcLOns tur completing this form on back ot yellow copY. J"
X'" Beld}v Woik Covered by Thls Request --;1(p Fj'3 n
N w Ad p. Type Of BuiltlinA ApPli ..ces Wiretl Equipment Wired
Home Range Tempor2ry Service
Duplex Water Heater Liyhtiny Fixtures
Apt. BwlAiny Dryer Electnc Heatin
Commeraal Bldy.
Industnal Bldg.
farm Furnace
An' Condrtioner
Other pecJV Siio Unloader
Bulk Milk Tank
nthor (SUerify)
tu,r SyecifY Oiher pihur
Compute Inspectlon Fee Below
d Fee ServweEntrance5ixe R Per Feetlers/SUhtaeders # Fee Crtcuits
0.0 0 to 100 qm !-? 0 to 30 qm is 0 to 30 Am s
101 to 20 -A S 1 T 31 to 100 Amps 5,Q7 37 to 100 Am s
Abovy.200 qf)rps Above 100_Am s Above 100_Amps
Transt Ynli,rs Remote Control Circ. Partial.'O ee
n ?qns /J Special Inspection
S
T
Remarks 30 5t) OTAL FEE jo, OCJ
/
?N
Roogh-in °
?`
n I, xhe Electncal
Inspector, hereby
c
bf
tl
t th
b
Final er
y
ia
e x
ovx
pection hes been
This re4uest void
18 months hom
Th,s re9uest void q/l 6f
oths f or,
7'Bm56954?
L-Y BI , 7? ,c, j
v _30, o co
-2CoFS3 O
Requesyyy Uate
??
? V Fire No. flough-in Inspecban
R qwretl? -
C-] fleaAY NowA Will Nobty InsOec-
[
Wh
fl
' Yev ? No or
en
eatlY
.Licensed F.leclncal Contractor I hareb e - y r qiiest inspnct?on nf above
Owner . . electncal work mslelled at
Street Adtlrxss. Box or Route Nn. City .
z3 qhLpc-N MAP
bon o. .TOwnshin Namo or No. Ranqe o.? . Cnunly '
Dihr-ia
Occ?upant?I?Pp_WITI ?• •-•
?f-/"Ily ?`1?'l1 ^"' ?rV Fhune No.
Powe(r? S
uppiie' Atldress
'
` '"'_ mI'1 \Iwg
EI ctncal Cnn[ dctor IComoany Namel' • Cnnhar.ror's-Licnnse No.
u- u- LE- w ?3°i52s
Madfng AdJress' ICon[
ra
c
tor or Owner Making InstailaLOnl .. '
,
.
?
V411 ? • r ?Ii NP-
Authonzed 5 nawr (ConttacmdOwner Mabng Inetallatmn) . Pho
n
e Num
b
rt
r -
` p
p
?/
?
O?j
ID .J>"?
MINNESOTA SiATE BOARO, Oi.ELEC7/11C1TY . . THIS INSPECTION HEQUEST WILL MOT':'
GrigOS-MiEway Bldg. - 1loorn Nd91 ' - QE ACCEVTED BY THE, STATE SOMO
.7827'Universrtv Ave., St Paal, MN' 55104 ' ' ?VNLESS PROPER INSPECTION FEE IS Gn....e f61212972111 ENCLOSED. .
4
1 - .
CI'e-": 0F.,EAGAN . Include 2 sets of plans,
1 site plan w/elevations b
(JC BUIIDING PERhQ.T APPLICATION 1 set of enengy calculations•
S ? ?l y? Date 7' 16"..&l
7b Se Used For Valuatiana?
Site Addzess: '6 2_-k J{ALD E tJ Ck-. 0h oP 6L I,D b) OFFZCE USE C7DII,Y -
Lot _,5_ slocx ?sec./sub. R?oaEC1.tFFt E? ? ??7'
rarcei #: ?b f23 oc(n o/ F1R?' Alter Zonins ?
Repair Fire zone
Owner: Enlarc7e _ 4ype of Const.
Move # Stories
pddrp$g; a Division of U. S. Home C? DFniDlish FzDnt ft.
nrafin?
KINS CROSSROAD GTadE Depth .i^ 7 ft.
Clty/Zip COdP: MINNETONKA.MINN 55,aq'j
Phone #: 544- 133 3 APPROVAIs FEES
contractor: gRRIN T!-4Ah4PS9lV I 18MES
P,dC1LP.55: a Division ot U, S. Home Corporation
.
City/Zip Code: MINNETONKA, MINN. 55343
Phone #:
Arch. /Fng. .
Address:
City/Zip Code:
Phone #:
Assessments Permit
Water/Sc;aer SurchazcJe
Poliee Plan Chec.lc
Fire SAC So"tJ ?
gng, water Conn. 3 6
Plaruier Water *ieter / n -
Council RDad Unit l 5?'6_
Bldg. Off.
APC
?C)'IAL
w
C?erttfirtttr nf (Orrupttnrg
Citp of eAgan
13epttrfmrnf nf i?uilDtng Ansperfimt
Tbir Gertr fitatc irrued purcuant ta the requirementr o f Seuian 306 of tbe Ur:ifarm Building
Gode crrEifying that at tbe timc ot ittuance tbit ttructure wat in tompliance wltb thc vanout
ordinrtnrtt of the City regulating bzeilding ton.ttrwtion or ute. For the following:
UYclaifiu6. SF DWG/GAR e1gPCT11LNO 6773
ouUw rTrwR3 ivRC.w??. V F.rczo. NA zoN? u.stn« PD
o,A.,Maaft Orrin Thompson A,,,g 1712 Hopkins Crsrd., Mtka,
da/2-
o,,,: October 26. 1981
4623 . .
C. R. WINDEN 6 ASSOCIATES, INC.
IAND SURVEYORS Ttl. 645•3646
FOR: 1381 EUSTIS ST., ST, PAULI MINN. 65108
U. S. HOME CORPORATION
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140. 15
Lot 4, Block 1, Ridgecliffe First Addition,
Dakota County, Minnesota.
WE HEREBY CERTIFY THAT THIS IS A TRUE',,AND CORRECT REPRESENTATION OP A SURVEY OF THE
60UNDARIES Of iNE IAND ABOvE DFSCRiBED AND OF THE IOCATION Of ALL 6UILDINGS, IF ANY,
TMEREON, AND All V15181E ENCROACNMENTS, IF ANY, fROM OR ON SAID IAND.
Dotod thisI411Ldoy of1L1 A,D. IV,R? C. R. WINDEN d ASSOCIATES, INC.
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Surwyor, Minn*wfo Ropistrolien No.77Z6
NT.f519
City of Eatan
3830 pilot Knob Road
Eagan MN 55122
Phone: (661) 675-5675
Fax: (651) 675-5694
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2008 RESIDENTIAL BUILDING PERMIT APPLICATION
Date:_71Zqj..Ltg SlteAddress: ti 6 ? H?«•ta-t C-'c--UC-
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SUite
RESIDENT/OWNER Name: :F?a virF c 4- -d-
e Phone: (- V- YSa- ?e.SS 4
Address ! Cily / Zip: A z ? H4-k dN
Applicant is: _ Owner ? Contractor
TYPE OF WORK Description of work: j?'o
Construction Cost: ? lLJf ASO p° Mutti-Family Building: (Yes No e__ I
COMRACTOR Name: V_,,r x g )4.Crs oC witi) T License#:
Address: 2 Sa73 P? LJ' a? L a- n[
Ciry:. A ^ C,,Vn?f State: r'k Zip: .?536 9
Phone: 76 ?- 3+ I- 75-Y7 Contact Person: {3 r?4 R f'Fz
COMPIETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Cateaorv 1 Minnesota Rules 7672
Energy Code . Residantial Ventilation Category 1 Waksheet • New Energy Code Worksheet
Categpry Submitted Submitted
(4 su611113S1Of1 type) • Energy Envelope Calculations SLibmitted
In the last 12 moMhs, has the City of Eagan fssued a pertnlt tor a simllar plan based on s master plan?
_Yes _No If yes, date and address of master plan:
Licensad Plumber: Phone:
YechaNcal Contractor: Phone:
Sewer & Water Contractor: Phone:
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I here6y acknovAetlge ihaf this irrformation is complete and axurate; that ihe work rrill 6e in conformance with Me orclinances and r.odes of the City of
Eagan; that 1 understand this is not a permit, but only an application for a permil, and work is not to start wRhout a pertnR; Mat the work will ba in
accordance with the approved plan in the case of work which requires a review and approval ot plans.
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Appli-canYs?rinted Name Appllcant's gnaturo
Page 1 of 3
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?.• FORe
U. S. HOME CORPORATZON
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C. R. W ? n
IAND SURVEYORS T?L
1381 EUSTIS ST., ST. PAULS MINN. 15510
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scs?LE: i"=30'
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140. 15 I
Lot 4, Block 1, Ridgecliffe First Addition,
Dakota County, Minnesota.
WE MERE6Y CERTIFT THAT TMIS IS A TRUE',AND CORRECT REPRESENTATION OF A SURVEY OF TME
60UNDARIES OF THE IAND A60VE DFSCRI6ED AND Of THE IOCATiON OF All EUIIDINGS, IF ANY,
TMEREON, AND All VI516LE ENCROACFIMENTS, If ANY, iROM OR ON SAID IAND.
Darod Ihia dor oFJJSL44 A.D. 19$/ C. R. WINDEN d ASSOCIATES, INC.
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by
Surwyor. Minnewlo iapislrofion No 77z 6
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PERMIT
City of Eagan Permit Type: Building
Eagan. Permit Number: EA101406
Date Issued: 10/07/2011
OR Permit Category: ePermit
41 it~ of E3
E
Site Address: 4623 Halden Cir
Lot: 4 Block: I Addition: Ridaecliffe 1st
PID: 10-63980-01-040
Use:
Description:
Sub Type: e-Windows iDoors Construction Type:
Work Type: Replace
Description:
Census Code: 434- Occupancy :
Zonin,:
Square Feet: 0
Comments: Mary Derosier
10596 83rd St N
Stillwater, MN 55082
651-770-9315
Fee Summary: BL - Base Fee $500 $40.00 0801.4085
Valuation: 500.00 Surcharge - Based on Valuation $500 $0.50 9001.2195
Total: $40.50
Contractor: - Applicant - Owner:
Window World AKA Probuilt America Curtis E Frederick
2211 11th Ave E, =130 4623 Halden Cir
N St. Paul NIN 55109 Eagan NIN 55122
(61)770-5570
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 Cite of Eagan Ordinances.
ApplicantiPermitee: Signature Issued Bv: Signature
PERMIT
City of Eagan Permit Type: Plumbing
Eaaan, Permit Number: EA103029
Date Issued: 02/16/2012
OR Permit Category: ePermit
41~ it~ of E3
E
Site Address: 4623 Halden Cir
Lot: 4 Block: I Addition: Ridaecliffe 1st
PID: 10-63980-01-040
Use:
Description:
Sub Type: e - Water Heater
Work Type: New
Description: Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments: Kris Oien
3670 Dodd Rd
Eagan, mn 55123
651-365-1340
Fee Summary: PL - Permit Fee (WS &or WH) $55.00 0801.4087
Surcharge-Fixed $5.00 9001.2195
Total: $60.00
Contractor: - Applicant - Owner:
Champion Plumbing Curtis E Frederick
3670 Dodd Rd., =100 4623 Halden Cir
Eagan NIN 55123 Eagan MN 55122
(651) 365-1340
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 Cite of Eaaan Ordinances.
ApplicantiPermitee: Signature Issued Bv: Signature
PERMIT
City of Eagan Permit Type: Building
Eagan, Permit Number: EA104568
Date Issued: 05/30/2012
OR Permit Category: ePermit
41 it~ of E3
E
Site Address: 4623 Halden Cir
Lot: 4 Block: I Addition: Ridaecliffe 1st
PID: 10-63980-01-040
Use:
Description:
Sub Type: e-Windows iDoors Construction Type:
Work Type: Windows Doors-New ; Replacement
Description: House
Census Code: 434- Occupancy :
Zonin,:
Square Feet: 0
Comments: Improvements to the home require smoke detectors in all bedrooms. If altering window openin,s, call for framing
inspection. Call for final inspection after installation.
Carbon monoxide detectors are required by law in ALL single family homes.
Fee Summary: BL - Base Fee S4K $103.25 0801.4085
Valuation: 4,000.00 Surcharge - Based on Valuation S4K $2.00 9001.2195
Total: $105.25
Contractor: - Applicant - Owner:
Window World AKA Probuilt America Curtis E Frederick
2211 11th Ave E, =130 4623 Halden Cir
N St. Paul NIN 55109 Eagan NIN 55122
(61)770-5570
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 Cite of Eagan Ordinances.
ApplicantiPermitee: Signature Issued Bv: Signature