4508 Hay Lake Rd SBI.DG'. 'PERMIT ti0.
01-3210
01-3422
01-3445
01-3446
01-2155
w
17-3860
20-2275
20-3865
20-3868
20-3716
2Q-2252
20-3713
20-3743
79-3866
11-3855
_,.s" ? ?" r
Bldg. Permit
Plan Check
Surch. /Adn:.
SAC/Adm.
Surcharge
Road Unit
SAC
Water Conn.
Water Trmt.
Water Meter
Acct. Dep.
Water Permi
Sewer Permi
Sewer Conn.
Park Ded.
TOTAL
CASH RECEIPT ,
CITY OF EAGAN
3830 PILO"T KNOB ROAD
EAGAN, MINNESOTA 55122
.
DATE % - 19 L.
r
- {` - i
AMOUNT I$
& DOLLARf
?oo
C] CASH [] CNECK
POR
?__r_'. . - .
i'
FUND COOH AMOUNT
Thank You
r n
BY
l
J '
White-Payers Copy
Yellow-Posting C.apy
Pink-File Copy
CITY OF EAGAN
ad, P.O. Box 21-198, Eagan, MN 55121 N 2 12900
PHONE: 454-8104
Receipt #
SF" DWG/c;Art
To ba used 1or Est. Value
$66,000 Date
yOVF;i?:EER 20 .19 ci?
Site Address 4508 SO HAY LAKE RD Erect 41 Occupancy R3
Lot 1 Block 3 Sec/Sub. UVERHIL L FARM 210fiodel ? Zoning H..i_ _
Parcel No. Repair ? Type oi Const A; _
Additian ? No. Stories -
W Name "IRANn dA'•{ S DcvL'L CO Move ? Length
_
Addr :;iJNR I SE CT o??ish ? Depth g r
o e
City ss
Phone 452-8934 Int. Impr.
Instau ?
? Sq. Ft.
o Name SAr'k^ Approvab
=
ou
-K
Address
AS6eSSment
~ City Phone Water & Sew.
Police
W W Name Fi
re
? = Address Eng.
< W City Phone Planner
I hereby acknowledge that I have read this application and state that the
i
f
i
i Council
1 j Z 0?8 I
gldg. Off
n
ormat
on
s correct and agree to comply with all applicable State of .
Minnesota Statutes and City of Eagan Ordinances.
Signature of Permittee - ' / I , ? I .'• . < < APC
Var. Date
Permit ? 331.001
Surcharge 33 . 001
Plan Review G`• 50 ?
SaC 575.00?
Water Conn. 500 • 00
Water Meter- 63,5U
Road Unit 290 . 00
Tr.PI. 156.00
Parks
Copies
Total $2,114.00
A Building Permit is issued to: "icrvv v vlttal? ttr, v:_, u ?-v on the express condition that
aIl work shall be done in accordance with all applicable State of Minnesota Stafutes and City of Eagan Ordinances. ,
Building O}ficial -
_ permit No. PnrmN Holder Oats Tdsphons M
Plumbirq
H.V.A.C.
Elfttft ' I/
214-18 Y f- a,, ?3
SolNner
Impectbn Dab Insp. Comments
Footfnys I
Footlnys II
Foundetlon
Framing
3
RoONny
Rouyh PIDq.
RouQh Htq. ?! } P
Inwl. 1 ?
Finplacs
Final Hty.
Final Pibp.
Bldp. FMaI
c.d. ou. 1-3o-d7 . ?
Deck Ftg.
Dack Frm9• ' L0,44 If',V ' 77 L-
ry•
w.a r c--, 1- 2 --f 7-1;"'
Pr. Dlsp.
CONTRACT PRICE
Site Address ?
Lot Block
- m Name
? Address
c Clty
? Name
3 Addra
O ?ity ?
Res.
Mult
Comm.
Other
PLUMBING PERMIT RECEIPT #
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE
_JI BLDG. T1fPE
r
FEES
COMM/IND FEE - 1% OF CONTRACT FEE
MINIMUM - RESIDENTIAL FEE - $10.00
MINIMUM - COMM/IND FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND $1,000.00)
PERMITTEE
FOR CITY OF EAGAN
PERMIT #
WORK DESCRIPTION
New A
Add-on
Repair
O. FIXTURES
Water Closet - $3.00
i 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
Water Heater - $1.50
Whirlpool - $3.00
1 Gas Piping Outlets - $1.50
Softener - $5.00
Well - $10.00
Private Disp. - $10.Ob
Rough Openings - $1.50
FEE
`TOTAL
?
L
STATE S/C:
GRAND TOTAL•
Cities Dljzltal
itv Control
The following image represents the best
available image from the original page.
Every effort was made to capture the content
from the original page.
I CONTRACT PRICE:
Site Address
Lot Block
PERMIT #
MECHANICAL PERMIT RECEIPT #
CITY OF EAGAN
3830 PILOT KNOB ROAD, EACAN, MN 55121 DATE: 19
ounuc. ece_aInn
m Name
? Address
c City Phone.
BLDG. TYPE WORK DESCRIPTION
? ?
Res. New
Mult Add-on
Comm. . Repair
Other
? Name
c Address
O Ciry Phone
;
TYPE OF WORK
Forced Air M BTU -
Boiler M BTU ?
Air Cond.
Vent
Gas Piping Outleb #
Other
M BTU
M BTU
CFM
FEE
S/C:
TOTAL:
FEES
RES. HVAC 0-100 M BTU - $24.00
ADDITIONAL 50 M BTU - 6.00
ADD-ON AIR COND. 0-24 BTU - 12.00
ADDITIONAL 6 M BTU - 6.00
GAS OUTLETS - 1.50 EA.
COMM/IND FEE - 195 OF CONTRACT FEE
MINIMUM - RESIDENTIAL FEE - 10.00
MINIMUM - COMM/IND FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $50 S/C IF PERMIT PRICE GOES
BEYOND $1,000.00)
?_- / • I- . ?. ! .
U SIGNATURE OF PERMITTEE
FOR: CITY OF EAGAN
?? .
; CITY OF EAGAN WATER SERVICE PERMIT
3830 Pilot Knob Road
' P.O. Box 21189 PERMIT NO.:
? Eagan, MN 55121 DATE: 1 1- 24 •? b
Zoning: r I No. of Units: ?
Owner. C'rand C}siCs
Address:
SiteAddess: -308 So. Tl89 I.aiC@ ROar! 3.1 ,^. R3 (lvnr?4 7 T rT :
Plumber: _
Meter No.: _
Size:
Reader No.:
I 89ree to comply wNh the City oi Eagan
Ordinancea
Connection Chan
Account Deposit:
Permit Fee:
Surcharge:
Misc. Charges: _
Total
By Date Paid: ?
Date ot Insp.: fngp : i
7
?
CITY OF EAGAN
3830 Pilot Knob Raad SRM SERNICE PERMIT
P. O. Box 21199 PERMIT NO.:
Eagan, MN 55121 p,,TE.
ZOring' No of Untts•
Owrnr. ?zt?tld ia's,?. • .
ilddross: ..._-
Site Addreat; i•. . - _ -,.. , -
'.. yr'Ci'i1? F` -
PlUR1bef: --
100.
1 NeN M eaaA* wla ti0 Cihr of bpn Connwctlon C}+arpa: ", C:!]
OeJlrnew Acoount Deposih
hm* FN:
B Surohorpa:
y Misc. Cho?y?s;
Dote of Inap.: Totol:
DcM Piofd:
'
cin? oF E?G?N
?5830 P" Knob Road WATER SERVICE PERMIT
P.O. Box 21199
' PERMIT NO.:
Eayan, MN 55121 DATE: 11-2 -P 6
Zoning: '' 1 No. of Units: 1 ,
Owner. ' rand Oaks
Addreas:
SiteAddess: 4508 So. ?tay La?ce :Zoad F1°
Plumber. Val1ey i 7-umb irt?
Meter No.: on
Size: '-A ,...__......,•
Reader No.:
II
Charge: 500. OOpd
-; ::ft*: 15. (lOnO
I agrrM to comply wlth the tL i tciu - un? L+w .50pd
urcharge:
Ordlnances. /L REQUIREt)1i4yh".W I5E.00P4 'IT
? TOtel: fs`i _ 5[ inA m Y r
BY'- ? Qete Paid:
Date of Insp.: inan .
a- z(0 -$6
CITY OF EAGAN
- 12900
• 3830 Pilot Knob Road, P.O. Box 21-799, Eagan, MN 55121N0
BUILDING'PERMIT PHONE: 454-8100 Receipt #
7obeusedfor SF DWG/GAR Est.value $66.000 Date NOVEMBER 20 19 86
SiteAddress 4508 SO HAY LAKE RD Erect )U Occupancy R3
Lot 18 elock 3 Sec/Sub. OVERHILL FARM ZNIDnodel ? Zaning R1
Parcel No. Repair ? Type of Const..V
Addition ? No. Stories
e GRAND OAKS DEVEL CO Move ? Lengtn 50
z Name Demolish ? Depth ?
3 /+ddress 1881 SUNRISE CT IntlmPr? 5 Ft.
° ciry EAGAN phone 452-8934 Install ? Q
a
0
0 0
u?
?
Name SAME
Address
Ciry Phone
c
W Name
_
? Z
a
Address
z
a W Ciry Phone
I hereby acknowledge that I have read this application and state that the
iniormation is correct and agree to comply with all applica6le State ot
Minnesota Statutes and Qity oi Eaqaa,Ordinances. .
Signature o/
A Building Permit is issued to: (/ VxANI
all work shall be done in accordance with all
Building Official ?
Approvale Fees
Assessment Permit $ . 331.0(
water 8 Sew. Surcharge 33 . 0(
Police Plan Review 165.5(
Fire SAC 575.0(
Eng. Water Conn.50Q. 0(
Planner Water Meter6L3? 5(
Council Road Unit 29 0- 0(
Bldg. Off.11/20/8 Tr. PI. 156 _ 0(
APC Parks
Var. Date Copies
Total $ Z .114 . 0 C
on the express condition that
Statutes and Ciry of Eagan Ordinances.
/$gl' REQUEST FOR ELECTRICAL INSPECTION . ee-ooooi.-/o6
' See instrucLOns 1or rompletirg this lorm an back of Yellow copy. }?'//? /
? 616 7- --"?" Be/ow Work Covered by 7his Request ?
NwAFtldl pep.I TYOe ai 0uiltling I Aoolia.cee Wned I Equiument Wired I
I I I I Duplea I I'Nater Heater I I Liyhtiny Fixnnes J
Milk T
# Fee ServiceEmrancesize n Fae Fexders/5ubfeeders N Fne Circoles
U to 200 Am s 0 to 30 qm s 0 tn 30 An s
Above 200 qmpS 37 to 100 qmps 31 to 100 Am s
Swimming Pool Above 700_Amps
_AmPs
Above 100
Transformers Irrigation Booms Partial.Other Fee
I- L____ISigns ?Special Inspection 1??SLI ?
TOTAL FEE
flerrNrks ?
I, the ElecVical
oa?,or. ha.abY
?s
cerlifV that the above
Final rD?0
11ction has baen
mede
mie repuest volO 18
This request void h /C?C)P
18 rrwn[hs from
? 6 61 72
S3//S?11
*?-) CC>
Request Date
p ire No, pouph-i I InsUec[ion
Ae?Wired7
?Ready Now ?W,II Notify, Insocc-
?Yes ?No tor When ReaAy
? LioenseA Electrical Contractor 1 hareby request insvection of ebove
?Owner elec?rical work installed at:
5[reet Address, Box or Route No.
?sog S # ? P/ CitY
c- AC4?
ecLOn o. Towns ip Name or No. Ran9e No. County
v-
OccuOant (PNINT) Phone No.
0R!'17V+J
Power Suoulier Aad.ess
gLTJ C/
Electrical Con[ractor (Comyany Name) Cnnnacmr"s I.icense Nn.
Mailing AdJress ICumraclor or Owner MakinN trislailationl
li`?6 k oS,
AuMOrized SiBnaiwe ICon aclodOwner Making Installa[ionl Phone Numbnr
MINNESOTA STATE 80ARD OF ELECTFICITY THIS INSPECTIDN PEQUEST WILL NOT
Griges•Midway Bldg. - Room N•191 BE ACCEPTEO BV THE STpTE BOAND
7821 Univarsi<v Ava.. St. Peul. MN 56100 UNLESS PROPER INSPECTION FEE IS
PhOne (611) 842-0800 ENCLOSED.
ntt]UEST FOR ELECTRICAL INSPECTION Ee-ooooi-os
' "' l0 9C? C..z
10 Sse inatructions for comoletinB this 1wm on beek af yellow copy.
"X?? 8elow Work Covered by 7his Request
C_'`r(.585 ?
kAd ReO. Typa o( Beiltlinp ApPlinncea Wirad Equiumenl Wirea '
oner
M Fee ServicaEntmnca5ize p Fee Feeders/Sub/eedere ? Fae Circuits
q
0 to 200 m s 0 to 30 Am s 0 m 30 Am s
Above 2
_qmps 37 to 100 qmps 31 to 700 A s
Swimmin Pool qbove 700_Am s Above 100_Am s
Transformers Irrigation Boorns •5? Partial•"Other Fee
Signs SVeciallnspection
ertNrks TOTAL F
_ . / r
..__... ... ^ _..._ 1. tne
? E?a«.?esr
? Inspeebr, hereby
certify that ihe nbove
Final D'nte inqpeetian hes been
, . -?-J- iv made.
., monm: o-om'"
C 7 7 5 8 5 /1g- Q.3
Cc p6O .-z
Nequest Dal?
'' Fire No. Roiiph-in InsVec[ion
Nequiretl?
?ReaCy Now ?W,11 Nocify
InsVec-
/
?'? ?7 - ic ?' Yes ?NO .
?or When Ready
O'Licansed Elec(rical Contracror I harebY reQUeat inspection ol ebove
? Owner eleetrical work insialled at:
lreei Atltlress. Box or Route No. City
ection o. Township Name or No. Hange o. Cmnty
Oc nt(PflINT) Phon No.
Power Supplier Atldress
??"
Eiec a1 Contractor (CO y Namel
?_?r??c ,G??? - C.ntractor's License No.
T?'/ ?? ?_
Mailin Address ICOnvactor or Owner Making InslallatioN /9 "
AuMorized S?g e ICOn[ ctor Owner ing Installation) Phon N mbet
I ? '
?
? .
f
MINNESOTA STATE BOAND.OF ELECTRICITY THIS INSPECTION pEQUEST YY1'CL NOT
Griypa-Midway BIdB• - poom N-791 BE ACCEPTEU BY THE STATE 90ARD
1827 Univeraity Ava.. St. Peul. MN 65104 UNlESS PflOVEN INSPECTION FEE IS
Phone16121642-0800 ENCLOSED.
ii, o5? :?-Jafy!
.
HAY LAKE ROAD o
? R= 487. 69
o=f0°14105" 8712 -- ?9s?.s)
?
LqsZ' i
w ap' ?5
i
?o F? I? N
? ' --}---- IG-C 2_0 n, ? ? ?
?ro
• OD ?I ?N n w`J`?t ? o 0
o ? ?!95a?'u? ?? o A\a.
2s W 'm
v
PROPOSEO u? I A Cti
(V ?. O H\ E v
46,0
? ` g?•g?, ? ? -?--
?.s_;,?? ca?a,?; ,ti H
OD
?
?
?
?
ORAlNAGE d UTILITY
5 EASEMENT PER \
I PD y
87.26 -'?
? `N 5o19'2311 w ?
--
L_c
?, I .
? -,
?-
I
-?_
- ?
- cN
_ - I N
? 1 I
1
1
1? - -
. . N-
--VT-?
?
; -?
• ? -
S
0 . *
331•OU+
33•00+
165•5U+
575•00+
500•UU+
63•50+
290•00+
150•00+
2, i14•00*
. 6' j7/ "'
?
` 7986 BOILDING PEAlSIT APPLZCATIOH - CITY OF EAG9N
HOYS: ALL CONTRACTOHS MfJST BS LICENSSD ilITH THE CITY OF E6GAN
3IHGLE FANIILY L1AFd.LIAG3
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SIIRVEY, 1 SET OF ENERGY CALCIILATIONS
MOLTIPLS DiiELLINGS - RffiIDENTIAL RENTAL DHITS FOR SALB DNITS
INCLUDE 2 SETS OF PLANS, CERTIFICATB OF SIIR9SY - CHECB WITH BLDG. DEPT.r
1 SET OF ENERGY CALCQLATIONS
COMIliERC2AL
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECZFICATIONS AND 1 SET OF
ENERGY CALCULATIONS,
$2,000 LANDSCAPE HOND
To Be Used For: SX
l? Co? 00?5
i
Valuation:
. 1 .
Site Address
Lot Bloek
Parcel/Sub
Owner 1:?E
Address
City/Zip Code
Phone
Contractor
Address f??l lLc„?Mde C/--
City/Zip Code tti.C -,
Phone
Areh./Engr.
Address
City/Zip Code
Phone S
Erect ?
Remodel
Addition
Move _
Demolish _
Int.Impr.
Install
APPROVAI.4
:
Date: ?ib
Occupancy
Zoning ?•I
Type of Const SG
# of Stories
Length ?O
Depth ?
Sq Ft
Assessments Permit -?31.
Water/Sewer Surcharge 33.
Police Plan Review (0 51?
Fire SAC 575.
Engr Water Conn ?o•
Planner Water Meter (03.SO
Council Road Unit _ 2q O,
Bldg Off Treatment Pl Sro,
APC Parks
Varianee Copies
YOTAL
r
f
NOTS: ADDHESSES FOR CORNER LOT3 - CONTRACTOR/HOMEOiiAER lfQST DESIGNATE NHICH ADDRESS
IS DESIRfiD. NO CHANGES WILL BE ALLOHSD ONCE BIIILDING PERMIT I3 ISSQED.
'
. ;,, • ? , ?; .
EXi'VE RIOR ENVELOPE AVERADE 'U' COMpU7 ATTON
,
GRAND tlA'R.5 pEVELOPME NT COMPANY
MODEL G! AREA U. U X AREA
?
'
REOUI FED .
'
1. TOTFlL WALL AREA 1806 % .11 199
2. TD7AL ROOF AREA 1196 X. 026 31.096
RCHIE VED
AREA U U X AREA
A. WINDOW AREA 186.66 .5 9,'-'•=• ?
D. DGOR AREA 39.0 • 077 --• U6`lb
C. SLIllE 6LASS AREA 13.44 .4£3
.
6.451.2
D. FIREPLACE AREA O V
F. WALL FRAME AREA lfl6 .041 7.39
F. NET WALL AREA 1164.1 .049 57- 0`3'_-)"
G. RIM JOIST AREA 119.52 .0436 5.211072
H. FOUND WIIVDOW AREA U 0
1. FOUND AEOVE GRADE 46.48 .135 13.024E3
3. T07AL• WALL AREA 1800 105.5026
J. SKYLITE d 0 C)
K. ROOF FRAME 119.6 .032 3.e272
L. NET ROOF AREA 1076.4 .025 26.91
4. TOTAL ROOF AREA 1196 ?0.7372
SUM 1.+2. 229.096
6L1M 3.+4. F16.2348
SU.F3VEYOR'S
E R T I F ICA T E GRANU OAKS UEVELOPMEfd f CU,
? ?i-1 - I -P
L-i?/ f r i
30
C)
cc
LLJ
I?
,--,
?
N
87045'28" E 161.51
f - -
? ro I 1 ?? re.3o.<? i
? z2? f
? OPOSfp 0/j 5.67
' DRlVEWAY N GAR/
22.0 -
?
?? LOT
?
?
?
a?
v
` 30 ?
? N
Q ?
s
v
30---
I I ?
' fh
,o
n '
v?
,? ,
? k. _
4ti.00 -- Ji
'-'- S 87°47'42" E
r ?) -7-
L_lI I
r
•
164.75
?'?'?C95t??s:l
I$ t
?
J
Q
zW
`?
3
o W ?
^ I N
?I 0)
0
U-)
00
lV
1
?
\J1
----7 (9ss?S')
DENOTES PROPOSED SURFACE DRAINAGE 30 FEET
O UENOTES 1RON MONUMENT SET SCALE: 1 INCH =
• UENOTES IRON MONUMENT FOUND PROPOSED GARAGE fL00R = q S4?3 FEET
(000.0) DENOTES PROPOSEU ELE1lATION PROPOSED TOPEOF BLOCK = 9cS 4-,? FEET
I HEREBY CERTIFY TO GRAND OAKS DEVELOPMENT C0. TIIAT 1HIS IS A TRUE AND CORRECT
REPRESENTATION OF A SURVEY OF THE f30UNUARIES OF:
Lot 18, Block 3, OVERHILL FARM SECOfJD ADDITION, according to the recorded
plat thereof, Dakota County, tlinnesota. (THTS LEGAL CESCRIPTION 41ILL BECOP"E
VALID UPON FILING THE PL{IT OF OVERHILL FARP1 SECOND ADDITION)
AfID OF TFIE LOCATION OF Fl PROPOSED 6UILDING. IT DOES NOT PURPORT TO SIIOW IMPROVEMENTS.
OR E14CROACIIMENTS, IF ANY, 7HEREON. AS SURVEYED BY ME, OR UNUER h1Y bIRECT SUPERVISION,
1HIS 15TH DAY OF JULY , 1986.
• ' i
NOTE: GRADES SHOWN WERE TAICEN FROM
THE GRADING PLAN FOR OVERHILL FARh1
SECOND ADDITION, PREPARED 8Y MINNESOTA
VALLEY SURVEYORS INC., LAST DATED
MARCH 28, 1986. '
PROJECT N0.
86812
BOOK / PAGE
JAMES R. HILL, INC.
Planners / Engineers / Surveyors
FILE N0.
FOLDER
8200 Humboldt Avanue South
Bloatnington, Mn. 56431 812-884-3029
SIGNED: JAMES R.`NILL, INC.
/
UY :
HlIROLD C. PETERSUN, LANU SURUEYOR
PIINNESOTA LICENSE NU: 12294
-)
lL
CITY OF EAGAiV
APPLICATION FOR PERMIT
ggff? SEWER AND/OR WATER CONNECTION
P ease Print)
1) PROPERTY ADDRESS:
LEGAL DESCRIPTION: •-
IF E:ffSTING STRCCILRE. DATE OF ORIGINAL BC'ILDZNG PEF2MIT ISSCANCE: - -
i
PR£SEtlf ZANING/PROPOSID C'SE: (Dbn Year)
? COD'AfERCIAL/RF,`PI1IL/OFFICE ? R-1 SINGLE FAMILY
f-I IDIDC'STRZAi, Q R-2 DC'PLEX (TF,o C?nits)
n INSTITi'TIONAL/GOVERtzjENr ? R-3 Zt7WNHOC?SE (Three + Units ) ( L?nits )
. ? R-4 ApARTNNEN'p/COAIDOMINIIIM ( Units)
2) ?
ADDRESS:
C.ITSt, STATE. 2IP:
PHONE: /f L-? 3 Y
3) c c a•
- NAME:
ADDRESS:
? CITY, STATE, ZIP:
PHONE:
LICIINSE# C;P/Q''- /f7
4)
••w • • • ia•
NAME:
ADDRESS:
CITY. $TATE, ZIP:
PHONE:
Active
bcpired
Not recorded
Sta In1t1a1
'SJ 1:? Y• ' 1 YC • 71' ? C 91 • 7\ •
? CONNfS..TION 10 CITY SEWII2 NI-?CI`ION M CITY WATER --Ea-pT(IER • .
6) M?r M PLEASE HOLD APPROVED PII2MIT FOR PICK-UP BY ONE ._-
_E"=E MAIL APPROVID PERMIT TO 1, 2, Q 4. ABOVE
' (Circle one) O-
f C k (a
*A7P3: PA)9*39 OF k'FE AT TIME OF
APPLICATION DOES NOT CONSTITM
APPROVAL OF PERMIIT.
nasrncizoN oF sEWM Arm/ox VPMM
IPST1LLamrONS WIIS. NOT BE SCHED-
tn m orrrIL PERMIT.HAs sEEN
APPROIPIID.
FOR CITY USE ONLY
PERMIT # ISSL'ED
?z Z 3 ?-- .
Pd w/Bldg. Permit FEES:
$ jU -?;ZJ $ SEWER PERMIT (INCLDDE SURCHARGE)
$ /O '' 22 $ WATER YERMIT (INCLUDE SPRCHARGE ) ..
$ 4, S7) $ WATER METER/COPPERHORN/OC'TSIDE READER
$ $ WATER TAP (INCLODE CORPORATION STOP)
$ $ SEWER TAP
$ o $ ACCOUNT DEPOSIT - SEWER
$ $ ACCOC'NT DEPOSIT - WATER
S $ WAC
$ ? 7S•o c? $ sAc
$ $ TRUNK WATER ASSESSMENT
$ $ TRLNK SEWER ASSESSMENT
$ $ ` LATERAL BENEFZT/TRUNK SEWER
$ $ LATERAL BENEFIT/TRONK WATER
$ / SI? •L'?U $ WATER TREATMENT PLANT SORCHARGE
$ $ OTHER:
$ $ TOTAL
REC IPT ?- RECEIPT
DOES LTILITY CONNEC TION REQLIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
Q YES IF YES, THELV A" PERMIT FOR WORK WITHIN PLBLIC
ROADWAY" M[7ST BE ISSUED BY THE ENGINEERING
Q
NO DIVISION. LIST AS A COIVDITION.
SUBJE CT TO THE FOLL OWING CONDITIONS:
APPROVED BY:
TITLE:
DATE: // /Zy// (p
RESIDENTIALBTJII,DING as ?
Permit Application
? City OfEagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New ConsWCtion Reouirements RemodeVReoair Reauirements Otfice Use Onlv
3 registe2d site surveys shrnving sq. fl. pf l04 sq, ft. of house; and all roofetl areas 2 copies of plan _ Cert M Survey Recd
(20% mazimum lot coverage allaved) i set of Energy Cakulations for heated additlons Tree Pres Plan Racd
2 copies of plan showing beam 8 windox• sizes; poured fouM design, etc. 1 sile survey for additions & decks Tree Pres Not Reqd
1 set of Eneyy Calculations . Addition - indicate i(on-sita sepfk system _ On-stte Septic System
3 copies ot Tree Preserva6on Plan K lol platted after 711/93
Rim Joist Detail Options selection sheet '(bldgs wBh 3 or less unifs
Date ?/
SiteAddress 1,-2, / 0-,5 ons[ruc n st "???
Unit/Ste #
Description of Work rn. ?
Multi-Family Bldg _ Y_ N Fireplace(s) _ 0 _ 1 _ 2
Property Owner ?!C Q ' ?i/• (T .,?/C" Telephone #
Contractor _ J ?l/l'O jLf.`?CJS n ,.7
Address
State ?3t5-?
X
Zip City
Telephone # (65_? 7 35
COMPLETIE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy COde Category . Residential VentilaUon Category t Worksheet • New Energy Code Worksheet
(J submission type) Submitted Submitted
. • Energy Envelope Calculations Submitted
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
i'e"# (
ie # (
I hereby apply for a Residential Building Permit and acknowledge 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 th.is is not a permit, but only an application for a pernut, and work is not to start without a
pemut; that the wor wi be in accordance with the approved pl ? the case ork which requires a review and
app of plans.
( a ?' !?1
Applicant's Printed Name Applican s Signature
OFFICE USE ONLY
Sub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 EM. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screenlgazebo) ? 36 Multi Misc.
? OS 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or_ N? 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)" ? 43 Reroof ? 46 WindowslDoors
? 34 Replacement •Demolition (Entlre Bldg) - Give PCA handout to applicant
Valuation _ Occupancy MC(ES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footings (new bldg) _ FinaUC.O.
_ Footings (deck) FinaUNo C.O.
_ Footings (addirion) _ Plumbing
Foundarion HVAC
Drain Tile Other
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests _ Final
_ Framing _ Siding Stucco Stone
_ Fireplace _ R.I. Air Test _ Final Windows (new/replacement)
_ Insulation _
_ Retaining Wall
Approved By
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit 8 Surcharge
Treatment Plant
License Search
Copies
Other
Total
Building Inspector
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 WfIICH ADDRESS
IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
MULTIPLE DWELLINGS RENTAL UNITS FOR SALE UNITS # OF UNITS
INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SURVEY - CHECK WITH BLDG. DEPT.,
1 SET OF ENERGY CALCULATIONS
COMMERCIAL
?CAc?ida? 7
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATION jq F7
To Be Used For:4qSr,rP„-?' 1/1i5'Vlluation: O00 Date:
Site Address `fSU8' S.4(y/ 4,ge OFFICE USE ONLY
7
Lot ? Block j
Parcel/Sub
Owner /?/Cf7a? ??Cl f' f/Pi7-Ta1J
Address /41
City/Zip Code !5aZan /YJ`/ SS /a 3
-1
Phone </5 Z - Z v8 ?
Contractor
On site sewage_
M47CC system _
On site well _
City water _
PRV required _
Booster Pump _
APPROVALS
Occupancy
Zoning
Actual Const
Allowable
ll of stories
Length
Depth
S.F. Total
Footprint S.F.
Address - 5q,1'k7? -
City/Zip Code
Phone -?-?
Arch./Engr. 1el C6"2,TT"r>'1
Address -- S R" i", c- -
City/Zip Code
FEES
Engr/Assess Permit
Planner Surcharge
Council Plan Review
Bldg. Off. ?M?/,q SAC, City
Variance SAC, MWCC
Water Conn
Water Meter
Road Unit
Treatment P1
Parks
Copies
TOTAL
Phone ll
63, 4verh:ll f'q?,ra..r?
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RESIDENTIAL BUILDING
Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
t / S'?, z.S
New ConsWCtion Reauirements RemodeUReoair Reauirements Office Use Onlv
3 registered site surveys showing sq. ft of lot sq. ft. ot house; and all roofed areas 2 cnpies of plan Cert of Survey Recd Y N
(29% maximum lot coverage allowed) 1 set of Energy Calculations for heated additions Tree Pres Plan Reoi Y N
2 copies of plan showing beam $ window sizes; poured (ound design, etc. 1 site survey for additions & decks Trce Pres Reqd Y N
1setafEnergyCalwqtions qddifion - indicate'rfomsitesepG'csystem On•siteSeplicSystem _Y _N
3 wpies of Tree Preservation Plan'rf lot platted afler 717193
Rim Joist Oefail Options selection sheet (bldgs wiN 3 or less untls
Date 0 3
SiteAddress '?bouY4 Construction Cost ?i300. crp
1..e,.ti,o kp [-&j?,qrsl Unit/Ste #
Description of Work 7, {
Multi-Family Bldg _ Y? N Fireplace(s) ? 0 _ 1 _ 2
Property Owner M. -, ??oN
) 45 Z? ZY 8 3
Telephone #( 6S)
Contractor {?(e-ck ?1G}t??orS
Address _??3 5 43 rle P" ?
State Mr?
Zip SS'p I L City u.
Telephone #(b S I ) 6 8q - 6 3 6$
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Mianesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(dsubmissiontype) Submitted Submitted
• Energy Envelope Calculations 5ubmitted
Have you previously constructed a building in Eagan with a similar plan? _ Y
fee applies.
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone # (
T hereby apply for a Residential Building Pernut and acknowledge that the i
that the work will be in conformance with the ardinances and codes of the
Statutes; I understand this is not a permit, but only an application for a pern
permit; that the work will be in accordance with the approved plani case
approval of plans.
N If so, 25% plan review
5c 1I 1 , .T.
LV
rmation`N-'?Wplete and accurate;
ly of Eagan`arid?the-State of MN
and work is not to start without a
wrk which requires a review and
w i I hAYV? 16-Y G?- ?
Applicant's Printed Name Applicant's Signature
OFFICE USE ONLY
Sub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? OS 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 07 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Oeck ? 23 Porch (screenlgazebo) ? 36 Multi Misc.
? OS 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addition ? 36 Move Bidg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)* ? 43 Reroof ? 46 Windows/Doors
? 34 ReplaCement •Oemolition (Entire Bldg) - Give PCA handout to applicant
Valuation Occupancy MC/ES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footmgs (new bldg) FinallC.O.
_ Footings (deck) FinallNo C.O.
_ Footings (addition) _ Plumbing
_ Foundation HVAC
_ Drain Tile Other
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tesu _ Final
_ FranllnB Siding Stucco Stone
_ Fireplace _ R.I. _ Au Test _
_ Final _ Windows (new/replacement)
_ Insula6on _ Retaining Wall
Approved By
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
Building Inspector
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 4508 Hay Lake Rd S
Lot: 18 Block: 3 Addition: Overhill Farm 2nd
PID:10- 56151- 180 -03
Use:
Description:
Sub Type: e - Underground Sprinklers
Work Type: New
Description: New
Meter Size Meter Type Manufacturer
Fee Summary:
Contractor:
John Bukraba
4508 S Hay Lake Rd
PERMIT
City of Eaan
PL - Permit Fee (Res Modifications)
Surcharge -Fixed
Total:
Applicant/Permitee: Signature
Permit Type:
Permit Number:
Date Issued:
Permit Category:
Serial Number Remote Number
Comments: Permit closed without required inspection(s). Letter sent to applicant on 12/11/09. (pf)
Owner:
Barbara T Bukraba
4508 Hay Lake Rd S
Eagan MN 55123- -301
$30.00 0801.4087
$0.50 9001.2195
$30.50
Plumbing
EA089519
06/04/2009
ePermit
Line Size
- Applicant -
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
Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA143155
Date Issued:06/05/2017
Permit Category:ePermit
Site Address: 4508 Hay Lake Rd S
Lot:18 Block: 3 Addition: Overhill Farm 2nd
PID:10-56151-03-180
Use:
Description:
Sub Type:Residential
Work Type:Alteration
Description:Fixtures
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Fee Summary:PL - Permit Fee (miscellaneous)$59.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
$60.00 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 -
Barbara T Bukraba
4508 Hay Lake Rd S
Eagan MN 55123--301
(952) 657-4269
Window Concepts Mn
291 Eva St
St Paul MN 55107
(651) 905-0105
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA144702
Date Issued:08/04/2017
Permit Category:ePermit
Site Address: 4508 Hay Lake Rd S
Lot:18 Block: 3 Addition: Overhill Farm 2nd
PID:10-56151-03-180
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:Includes Skylight
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and leave on site.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
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 -
Barbara T Bukraba
4508 Hay Lake Rd S
Eagan MN 55123--301
(612) 518-1320
Signature Select Contracting
332 Minnesota Street - W3171
St Paul MN 55101
(651) 248-4994
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA148427
Date Issued:03/28/2018
Permit Category:ePermit
Site Address: 4508 Hay Lake Rd S
Lot:18 Block: 3 Addition: Overhill Farm 2nd
PID:10-56151-03-180
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
$105.25 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Barbara T Bukraba
4508 Hay Lake Rd S
Eagan MN 55123--301
(612) 518-1320
Signature Select Contracting
332 Minnesota Street - W3171
St Paul MN 55101
(651) 248-4994
Applicant/Permitee: Signature Issued By: Signature
r
For Office Use
i Permit#:
1. 60)
EAGANPerot Fee: 10)---4S
Date Received:
3830 PILOT KNOB ROAD EAGAN, MN 55122-1810
(651)675-5675 I TDD:(651)454-8535 I FAX:(651)675-5694 Staff:
buildinoinsoections@cityofeagan.com
2018 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit#:
s Name: J oil aft - t? t3 J 1C RARA Phone: G/Z 57 /3Z)
Res
Address/City/Zip: 1 5I-06l7• 1497' Me !2
Applicant is: Owner Contractor
Description of work: Lt)1"-s5L) 2Rt- fwtCt
Qg
Construction Cost: /G 'l7
SMulti-Family Building:(Yes /No
Company: `J 4.101 it'l SfcLodi" CGS'rg- Contact:'QoG1ii`".D&J J`io4-0£LtVTj14/J ,Go
y f
ContractorAddress: 332 M y4315P3Y1.5� City: 57 ®1J
State:(MO Zip: /9/ Phone: 9,2 yp,'I//95' Email: IA(m) &5Acsaf�'%rt�rnl•corn
License#: Lead Certificate#: AM]:M]'C/2 Z 51/
If the project is exempt from lead certification, please explain why:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months,has the City of Eagan issued a permit for a similar plan based on a master plan?
Yes No If yes,date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer&Water Contractor: Phone:
Fire Suppression Contractor: Phone:
NOTE:11-4#$� �m f o.:
t
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's
website at www.citvofeanan.com/subscribe.
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.
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.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 lans.
x J ?L4VC velem x1410, 44-`5 11_
Applicant's Printed Name Applicant's - e nature