4512 Hay Lake Rd SCITY OF EAGAN Ni n
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 ??? Jn?
RHONE: 454-8100
BUILDING PERMIT Receipt #
Tobeusedfor 'Ef dwg/qar Escvaiue S66,000 Date AUGUST 25 19 86
Site Address 4 512 SO HAY LAKE RD Erect CT- Occupancy R3 -
Lot 1 Block 3 SeciSub. OVERHILL FARM Remodel ? 2oning PD
Parcel No. 2A1D ADD Repair ? Type of Const. 39-n-
Addition ? No. Stories
? Name GRAND OAKS DEVEL Ca Move ? Length
= 188]. SUNRISE CT Demolish ? Depm 48
o Address Int. Impr. ? Sq. Ft
Phone S - 93 Install ?
o Name SAME
? ? Address
~ Ciry Phone
a
F W Name
_z
? 0 Address
z
? W City Phone
Assessment
Water 8 Sew.
Police
Fire
Planner
Permit $ 331.00
Surcharge 33.00
Plan Review 165.50
SAC 575.00
Water Conn. 500.00
Water Meter 63.50
Road Unit 290.00
Tr. PI. 156.00
I hereby acknowledge that I have read this appiication and state thatthe gldg. Off?1
information is correct and agree to comply with all applicable State of
Minnesota Statutes and City of Eagan Qrdinances. APC
Signature of
A Building Permit is issued to: L'niul
all work shall be done in accordance with all
Building Official
Var. Date Copies / 000
Total
- on the express condition thet
Eagan Ordinances.
PermR No. Pomdt Ho1dK Dats Talophone N
Plumbiny
H.V.A.C. ? locr? % .?? / 6 O ?C
el.etrie
i
Softenw '
Inspeetbn Dafe Inap. Commenb
Footinya I
Footlnqsll
Foundatbn
Framing
RooNny
Rouyh Pibp. - ? ?
Rouyh Mty. Az)
Insul. q/S
Ffreplaee
FMeI Htq.
Finsl Plby. Q-
e?ag. FxM
Cert.Oct. yf A•4
Deck Fly.
Deck Frmy.
Well
Pr. Di?p.
PERMIT #
Site Address y S I
Lot....I_ Block
PLUMBING PERMIT RECEIPT #
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE: ?n2U ?J b
" Name a?
?o Address ' ' -
,-
i '
c City _ .4 ; Phone""
_
Name `-- ? 3 Address
o ciry ?- ' • Phone
FEES
COMM/IND FEE - 1% OF CONTRACT FEE
MINIMiJM - RESIDENTIAL FEE - $10.00
MINIMUM - COMM/IND FEE - 20.00
STA7E SURCHARGE PER PERMIT - .50
(ADD $.50 S/C lF PERMIT PRICE GOES
BEYOND $1,000.00) i
PERMITTEE
FOR CITY OF EAGAN
pL TYPE a? WORK DESCRIPTION
??k X
Res. New
Mult Add-on
Comm. Repair
Other
?Q FIXTURES ,COTt? Water Closet - $3.00 $
-r-Bath Tubs - $3.Ofl ?
TLavatory - $3.00
Shower - $3.00
?-Kitchen Sink - $3.00
Urinal/Bidet - $3.00
-r--Laundry Tray - $3.00
7--Floor Drains - $1.50
? Water Heater - $1.50
Whirlpool - $3.00
Gas Riping Outlets - $1.50 -
Soitener - $5.00
Well - $10.04
Private Disp. - $10.00 Rough O'penings - $1.50
?-'
fEE: 3.
STATE S/C: '
?,
GRAND TOTAL•
? : • , T PERMIT #
» MECHANICAL PERMIT RECEIPT #
cin oF E?c,AN ,
3930 PILOT KNOB ROAD, EAGAN, MN 55121 DATE
CONTRACT PRICE -? < PHONE: 454-8100 Site Address I ' : L ' ti ?LpG..?YP?s -.? WORK DE$CRIPT
41-
Lot Block - ? Sec/Sub v
'
k.
Res. New
? Name Mult Add-on
? Address Comm. Repair
City Phane ` •
Otlier
? Name
c Addre
? o eitv -
TYPE OF WORK
Forced Air
Boiler
Unit Heater
Air Cond.
Vent
Gas Piping Outlets #
Other
IJ ? M BTU
M BTU
M BTU
M BTU
CFM
?FEE:
S/C:
TOTAL:
Li-K
FEE3
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 - 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)
.?r >
SIGNATURE OF PERMITTEE
FOR: CITY OF EAGAN
No.: a sni y5h xc
to empy wkh ti. c.ky ef
TY OF EAGAN SEWER SERVICE PERMIT
L30 Pilot Krwb Road
0. Box 21199 PERMIT NO.:
gan, MN 55121 pATE; • •
^0' ^ No. of Units:
msr, OA XS
Ndd
MM tismPl! wllb !M Clhr d E00001
of tnp.:
ConrwCtlon Chorpa: ' _ - ?.?Q*•,;'„_
/hccount Deposit: -
Prrmit F+s:
Surchorpe:
Misc. Chorpes:
Total:
Dote Pald:
CITY OF EAGAN
3830 Pilot Knob Road WATER SERVICE PERMIT
?
P. Q. Box 21199 PERMIT NO
: ?
Eagsn, MN 55121 .
DATE:
Zon6v: '
' No. of Units: )
Owner. . Zar..' ?
AkB
lldd?em
Slh Add !3 ? i-- ?
res:: .?ak?
,_ , a •:, i ,.._? , .
Plumbar.
Meter No.: Connsction Chorpe; ,
'
Sime: 15 f `) r?
?t.
Reade? No. ? F?
? "M 1o emwqIy wM6 !y ph of `Lmpa Sundwrgr
OrdiMwa?. Misc. Clwrpes:
Tot01:
BY Data Paid:
Dote of ?nsp.: 1.w., . CITY OF EAGAN WpTER SERYICE PERMIT
3830 Pilot Knob Road
: P. O. Bnx 21199 PERMIT NO.:
; Eagan,iAN 55121 D/1TE: '
'lonirg: , Rl No. 1
of Units: _
CITY OF EAGAN
- 12495
3830 Pilot Knob Road, P.O. Box 27-199, Eagan, MN 55121 Np
BUILDING PERMIT PHONE: 454-8100 Receiptx?0 S'-
robeusedfor ' sf dwg/gar Escvawe $66,000 Date AUGUST 25 1986
sitenddress 4512 SO HAY LAKE RD
Lot 1 Biock 3 Sec/Sub. OVERAILL FARM
Parcel No. 2ND ADD
W Name GRAND OAKS DEVEL CO
3 Address 1881 SUNRISE CT
° ciry EAGAN Phone 452-8934
o Name SAME
$ ¢ Address
? City Phone
oi w Name
.
? ? Address
a W City Phone
Erect ? Occupancy x.1
Femodel ? Zoning pn
Repair ? Type of Const. Vn
Addition ? No. Stories
Move ? Length 50
Demolish ? Depth 48
Int Impc ? Sq. Ft
Insfall ?
Aoorovals Fees
Assessment
Water & Sew.
Police
Fire
Planner
Council
Iherebyacknowledgethatlhavereadthisapplicationandst2lethatthe gldg.Off. 8/25/$E
information is correct antl agree to comply with all applica6le State of
Minnesota Statutes and CiN of Eaoan-Ordinances. , APC
of
al/ woipq permit is issued to: GRAN1
By#d`V O111 be done in accordance with all
Var.
Permit $ 331.00
Surcharge 33.OQ
Plan Review 165. SC
SAC 575.OC
Water Conn. 5 0 0. 0 C
WaterMeter 63.5C
Road Unit 290.0C
Tr. PI. 156.0(
Copies
$ 2 ,114 . 0(
on the express condition that
and City of Eagan Ordinances.
_
This requesl void G)9`9L
18 months trom .
,t 43041 ?-
Se r , duPr?? ll rc?u?v.?? ?yg60
Ne est Uate '
/ Fire No. Rouph-in Insuectian
Hepuiretl7
?fteatly Nuw?Will Nntity Insoec-
_ / ? Ves ?Nn ror When Ready
'glicensed Elec[n<al Convactor I hereb
y roqueat inspection ot ebove
?Owner electricel work installed et:
Sneet A dress, Box or R. No. ^ C' v..
11, %%?l
'LL.L
ecvon o. Township Name or No. RanBe No. Count
.pent IPiINT
(Ojvko ,? Phone No.
sa-?
r SupDlier Atldress
le Vicdl Contractor 1 0 0 ?Y Nx ConVar.tor? Li nse No.
ailin AtlJress (COnV mr or Owner Making Instailation)
7s
AuthorizeA SiB? ure (Contr ( i ?Installationl Phone Number
7
?-? 7
-r_?<? ?90-
MINNESOTA STATE BOAXD OF ELECTNICITV THIS INSPECTION REQUEST WILL NOT
Griy9s-Midwey Bide. - Aoom N•197 BE ACCEPTED BY THE STATE BOAND
1821 University Ave., St. Paul, MN 55104 UNLESS PNOPEP INSVECTION FEE IS
Phone (612) 297-2111 ENCLOSEO.
REQUEST FOR ELECTRICAL INSPECTION " EB-O000I-04
ol
IlO See inshuc[ions br tompletinq lhis fprm on back of yellow copy.
43041 "X" Below Work Covered by This Request
Add Xeo. TvPe o1 Building Applinnees Wired EquiVment Wired
Home Range Temporary Service
Duplex- " Water Heater Liyhtiny Pixtures
Apt. BuilAing Dryer Electric HeaLn
Commercial Bldg. Fumace Silu Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tdnk
farm lner peci v iner ISnec,Iyl
t er ycci(y Other Oth¢r
Compute lnspection Fee 8efow
M Fee ServiceEnhenceSiza H Fee Fexders/Subteeders k Fee Gircui(s
+00 0 to 200 Am s 0 to 30 qm s 0 to 30 An! s
bove 200 qm??y 31 to 100 qinps 37 to 700 A s
?A
mming Pool Above 100_Am s Above 100_A
nsinrmers Irngation Hooms U Partial'Other Fee
Signs Specialinspection
5A
<2
TOT
xemarks
i ,
? AL FE
/.av •-i
NouBh-in {??a 1. the Ele .
Inspectoq he,aby
i
cer?i?y that tha above
Final ? Unte insoection has Deen
C ? ??? mede.
U1n reauesl voia 18 montlm trom
/rv *zxxxxsaxaxxxxxxs:xssxmaxaxxrxrxA??
C I T Y O F E A A i?3 ??? m?°E i,,? ???
AePROVaL oF rrRraT.
• ' APPLICATION FOR PERMIT *
. ,y INSPDCTIOL3 OF SESM AND/OR %,TR
. . * nerar=ONS WILL NUT BE SaIID-
SEWER AND/OR WATER CONNECTION ? ULED M= PEWT HAS BEEN
» appxavm.
.
?
.... k*.**?****?*****x***?*t??***?*?***,?
l) PROPERTY ADDRESS:
LEGAL DESCRIPTION:
2) ?
IF EXISTING STR[:CIS-'RE, DATE OF ORIGINAL B[JILDING PERMIT ISS['ANCE: "
?
(Mon Year)
PRFSENf 7ANING/PROPOSID L'SE:
? C0bYWCIAL/F2EPPSL/OFFICE
? IbIIICSTRIAL
INSTITL"PIONAL/GpVIItNMENT
NAME:
ADDRESS:
CITY, STATE, ZIP:
. PHONE:
- d'9,
Please Pririt
? R-1 SINGLE FAMILY
? R-2 DL'PLEX (Two Units)
? R-3 2bWNHOUSE (Three + Units)
q R-4 APARTMEN'P/CODIDOMIDIILTI
3) u i: a•
NAA'lE:
. ADDRESS:
i CITY. STATE, 2IP:,
PHOE:
MASTII2 LICENSE# o?fQ7 le (45,
4) eU • ?-
NAME:
ADDRESS: Idr
CITY, STATE, ZIP:
PAONE: -
( Cnits)
(. Units}
Active
FScpited
Not recorded
Starf Initial
'5) ? r• ? a; • ?• e : ? • ae -r. a>
? CONNECTION 10 CITSC SEWFT2 CONNELTION 2q CITY WATII2 ? OTHER '
1
6) PI,EASE HOLD APPROVEU PERMT FOR PICK-UP BY ONE OF ABC7VE ---- --
PI.F.ASE MAIL APPROVID PERMIT TO 1, 2,(D4, ABOVE .
• (Circle one) '
7) r? u• ? ? 6? -7• (1 S.
?' ` `1: • Y NI: Y ? • • ?. ? ?. 1: OO • J Id' ? P Y71' ?I' 1 • 71• ? ' 7? !' • ? 1
• I. •?i' ?S. 1 t •tfa? I / 1 - :1' • N ?A' • L P ??. ? .
- - --------- -- ----
t.`,.
FOR CITY USE ONLY
PERMIT # ISSUED
Zy"71e
Pd w/Bldg. Permit FEES:
$
$
$ $
$ $
$ $
$
$ $
S $
_ $ $
S $
$ $
$ $ `
$ $
$ $
$ $
3 7
RECEIPT RECEIPT
A •
SEWER PERMIT (INCLDDE SL'RCHARGE)
WATER PERMIT (INCLUDE SL'RCHARGE)
WATER METER/COPPERHORN/OCTSIDE READER
WATER TAP (INCLC'DE CORPORATION STOP)
SEWER TAP
ACCOUNT DEPOSIT - SEWER
ACCOUNT DEPOSIT - WATER
WAC
SAC
TRt!NK WATER ASSESSMENT
TRL'NK SEWER ASSESSMENT
LATERAL BENEFIT/TRDNK SEWER
LATERAL BENEFIT/TRL'NK WATER
WATER TREATMENT PLANT SL'RCHARGE
OTHER:
TOTAL
DOES UTILITY CONNECTION REQDIRE EXCAVATION IN PDBLIC RIGHT OF WAY?
? YES IF YES, THEN A"PERMIT FOR WORK WITHIN PUBLIC
Q ROADWAY" MUST BE ISSUED BY THE ENGINEERING
NO DIVISION. LIST AS A CONDITION.
SUBJECT TO THE FOLLOWING CONDITIONS:
APPROVED BY:
v'
TITLE:
DATE:
o•*
331•+
33•+
165•5+
575•+
500•+
63•5+
290•+
156•+
008
2, 114•*+
.,
# t?Iqq? n
PBIRIIT
? - ,
, i?----?
lTION - CITY OF &AGAN
NOTE: ALL CONTRACTOAS M[JSY BB LICENSSD iiITH THE CI1R OF EAGAN
SIHGLE FAlIIL.Y DWELLIAGS
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SORVEY, 1 SET OF ENERGY CALCULATIONS
M[TLTIPLS Di16LLIAiGS - RESIDE9TI9L
INCLUDE 2 SETS OF PLANS, CER
1 SET OF BNERGY CALCULATIONS
CommCIAf.
RENTAL DNITS FOR SALE IINITS
OF SIIRVBY - CHECB iiITH BLDG. DEPT.,
INCLUDE 2 SETS OF ARCHITECTURAL
1 SET OF SPECIFICATIONS AND 1
ENERGY CALCULATIONS,
$2,000 LANDSCAPE BOND
To Be Used For:
Site Address
Lot ? Bloc
Parcel/Sub
Owner
Address
& STRUCTURAL PLANS,
SET OF
?
Valuation:
City/Zip Code
Date: ?-x
Erect e,5- Oecupancy ?
Remodel Zoning 'pD
Repair Type of Conat ?
Addition # of Stories
Move ` Length ?
Demolish _ Depth
Int.Impr. Sq Ft
Install
Phone ' 9PPROVALS FEE.S
e r.
"/"
Contraetor -Q
???, ."2 _? 4? j Assessments Permit 331
p??? Water/Sewer Surcharge "
Address Police Plan Review SO
Fire SAC 57!?-_
City/Zip Code -?-e? Engr Water Conn
Phone
Planner
Couneil
Water Meter
Road Unit C?
O
? Bldg Off 40 Treatment P1 ?
Arch./Engr. APC Parks
Variance Copies
Address TOT9L
City/Zip Code
Phone #
NOTE: ADDRESSSS FOR CORNER LOTS - CONTRACYOa/HOliE0i1NE8 MIIST DESIGNATE RHICH ADDRESS
IS DESIRfiD. NO CHANGES HILL BE 9LLOWSD ONCE BOILDING PEFtI+IIT IS ISSIISD.
..
-EXTEkIOR ENVELOPE.AVERAGE U' COMpU7ATTON ?
GRAND pAKS DEVELOPMENT CqMPANY
MODEL 0., ?.A?iEA U. U X AREA
w .
RECIUIRED '
1, TOTAL WALL AREA 3800 X.il `
?. TOTAL RpOF AREA. 1196 X.026 31•4
AC:HIEVED A. WIIVDOW AFE(-1
Li. DGOR AREA
C. SLIDE GLA55 AREA
U. FI REPLACE lat2EA
E. WF.LL FRAME AREA
F. NF_T WALL AREA
G. RTM JOIST AREA
H. FOUND WINDDW AREA
1. FOLfND AEOVE GRADE
:i. TOTAI.-WALL AREA
J. SKYLITE
I:. ROOF FRAME
L. NE"f ROOF AREA
4. 7DTAL k00F AREA
SUM 1.+2.
5UM 3. +4.
AREA U ll X AREA
186.66 .5
39.i3 .077 ?.0 S46
13.44 .40 6.51:
0 0 i>
1F30 .041
1164.1 .049 57.O;10y
119.52 .0436 5.211u72
U ? c?
96.48 .135 13.024E3
ieoa ?''6
p p U
119.6 .032 5•9=72
1076.4 .025 26.91
1196 CJ 72
?129. 096
216. 2.?9S
?
SU!IV E Y O R'S C E R T I F I G* A T E GRANU OAKS DEVELOPMEN f CU.
1
30
?
Q n
Oa
?
u
?
W _
Y `°
?
a M.
?j
30 ?
?
S a
1
4
/
9
e4?42y
ro ? \0
?
/`?
?
?°?CRSS.o
__
22.33 O ---y1--a?
sQ7s
?A&IOPQS@ ?pa1't 25.67
WAY
\
cD
22A
? -l
rt? ? /y5f.?l
q l
? W W Q
Q
5 ?
,
o
?
? °° a LOT M
? N I
j----- 26.0 ?
?
3 0
;
?I o
? "
M
10 519 1 i o 2 ?
1314
O I1A 45.24
-2250 `. -- A=15°5252 118.Oq
I ? R=425.73
0 47 E
2 Z + °
N6
M VERHILL _ ROAD M
--s-- DENOTES PROPOSED SURFACE DRAINAGE
O DENOTES IRON MONUMENT SET SCALE: 1 INC11 = 30 FEET
? DENOTES IRON MONUMENT FOUND PROPOSED GARAGE FLOOR = 955,3 FEET
(000.0) DENOTES PROP05ED ELEVATION PROPOSED TOPEOF BLOCK = 9s5 75 FEET
I FIEREEiY CERTIFY TO GRAND OAKS tiEVELOPMENT C0. TfIAT THIS IS A TRUE AND CORRECT
REPRESENTATION OF A SURVEY OF THE [30UNUARIES OF:
Lot 1, Block 3, OVERHILL FARhi SECOND ADDITION, according to the recorded
plat thereof, Dakota County, Minnesota. (TNIS LEGAL DESCRIPTION WfLL
BECOME VALlD UPON F1LIN6 THE PLAT OF OVERHILL FARM SECOND ADDIT10N.)
AflD OF TFIE LOCATION OF Fl PROPOSED DUILDINf. IT DOES NOT PURPORT TO SHOW IMPROVEMEN7S.
OR EIJCROACIIMfNTS, IF ANY, TIIEREUN. AS SURVEYED BY ME, OR UNDER h9Y DIRECT SUPERVISION,
TIiIS 28TH D!!Y OF JULY , 19E36.
NDTE: GRADES SH04lN WERE TAKEN SIGNED: JAME-,SR{ HILL, INC.?
FROP1 TFIE GRADING PLAN FOR OVERHILL /
nARP1 SECOND ADDITION, PREPARED BY
P?INNESOTA VALLEY SURV.EYORS, INC.
LAST DATED P1ARCH 28, 1986. DY:
HAROLD C. PETERSON, LAPJD SURVEYOR
PIINNESaTA LICENSE N0: 12294
PROJECT NO.
86862
FILE NO,
' FOLDER
BOOK / PAGE
JAMES R. HILL, INC.
Planners / Engineers / Surveyors
8200 Humboldt Avenue South
elootnington, Mn. 56431 812-884-3029
? nm27 ,?CtD , L, / , ? 3 ?
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Use BLUE or BLACK Ink
For Office Use _ - - - _ - I
1
Permit 1
of Eam 1 1,
City
QI
3830 Pilot Knob Road Permit Fee:
Eagan MN 55122 1
Date Received: 1
Phone: (651) 675-5675 1
Fax: (651) 675-5694 1 I
I Staff: I
1 I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: I 1 • Site Address:
Unit
i
i Name: I ` ~1c n'ch
{ Resident/ Phone:
Owner Address / City) Zip:
Applicant is: OwnerContractor
1
of Work Description of work
t1( Type
Cost:,
Multi-Family Building: (Yes / No~
Company: ~~(S. rnr
3 Contact: 1
Contractor Address:
City:
State: " ~L _ Zip: =mod. Phone: 03 " Wcl
Ll 1")
License #:G AT
Lead Certificate #:N j-r I
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:
- - - r Phone:
NOTE: Plans and su g - . _
pportin 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.cioDherstate2alggll.org
1 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,
L---i ~1
Applicant's Prin ted Name x 1-~--c
Applicant's Signature
Page 1 of 3
4,1*
City of Eau
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
' 3 2016
r
Use BLUE or BLACK Ink
For Office Use j _
Permit #: /3 �P Y2
Permit Fee:
Date Received:
Staff:
2016 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: SI2.(D/ IID Site Address: (-ISIa2 \cj Itaxi? 1, Unit#:
Resident/
Owner
Name: �UA.\f.- d- MOM- MCA1( ,Y\ Phone: (nS 1- LtS a- any a
1 vv
Address / City / Zip: LIS Ia R lo,\<0 (.)..-A\,,.60.9 Q11,mY\�sYa3
Applicant is: Owner X Contractor
Type of Work
k St
Description of work: 1;f:' place 3 VJk'(1dOws oil e . ,
Construction Cost:31 ,-, I 0o Multi -Family Building:, (Yes / No )
Contractor
Company: Eikirc\ 0 -P____ WC- Contact:
L
p _ b e, -/l -r- Su -) � 1r1 CSU flt
Address: Il -i 5S�J CEJ • i�[�tf T 1�j1, 1' I D'� City:
State:t(VMY\ Zip: Nog Phone: (plot Q 3 Slc Email: c10. ‘)1r1Sv tC -C Q.
9ma•1 • (o—
License # (,per] S'R' Lead Certificate #:
If the project is exempt from lead certification, please explain why:
In the last 12 months,
Yes No
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Eagan issued a permit for a similar plan based on a master plan?
If yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Fire Suppression Contractor:
Phone:
Phone:
Phone:
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.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 plin the case of work which requires a review and approval of plans.
Exterior w rk author' ed • . uilding permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of mit issu
x
Applicant's Signature
Page 1 of 3
City of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
ti 32016
r
Use BLUE or BLACK Ink
For Office Use
Permit #: 3 l �P
Permit Fee:
Date Received:
Staff:
2016 RESIDENTIAL BUILDING PERMIT APPLICATION
J
Date: S I2( j I (1) Site Address: (-j•E Ia Ia3J.1lO (-, ok. Unit #:
Resident!
Owner
Name: Z6V1,-e.- a- MCL -1- mC \Girl Phone: (DS I - 4S'a- ' ALI a
__ p
Address / City / Zip: �S Ia t- 11� .s j'�'tVV \o _ .?N 6a9 ars ,Te W'aS
Applicant is: Owner X Contractor
Type of Work
Description of work:_134.01.Wkt1Ciou3g:j ��i� e ' k 4-f4 'S( 4-
Construction Cost: 691,£.19-00 Multi -Family Building: (Yes / No )
Contractor
Company: Fi-Nvyn olol--e___ LLC. Contact:
Sv i}'{
Address: I JSS �. Rjbef 1-10:1' i 0-1 City: REkeillOU flt
State:1)( Zip: %' O(tkc Phone: (vIQ a3c1 Slc3Email: le.Ctidl0. •-6:1IkilnSv\G.1-e. C
License #e,K (.o S_W,_a Lead Certificate #: 9m0.. ) • f 0
If the project is exempt from lead certification, please explain why:
In the last 12 months,
Yes
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Eagan issued a permit for a similar plan based on a master plan?
If yes, date and address of master plan:
__No
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Fire Suppression Contractor:
Phone:
Phone:
Phone:
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.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 p1. in the case of work which requires a review and approval of plans.
Exterior rk author' ed . • uiiding permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of ,/ rmit issu
x
Applicant's Signature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA143220
Date Issued:06/07/2017
Permit Category:ePermit
Site Address: 4512 Hay Lake Rd S
Lot:1 Block: 3 Addition: Overhill Farm 2nd
PID:10-56151-03-010
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:Does not include skylight(s)
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 -
Matthew E Mcman
4512 Hay Lake Rd S
Eagan MN 55123
Weatherguard Construction
10860 60th St N
Stillwater MN 55082
(651) 439-4320
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA164556
Date Issued:10/01/2020
Permit Category:ePermit
Site Address: 4512 Hay Lake Rd S
Lot:1 Block: 3 Addition: Overhill Farm 2nd
PID:10-56151-03-010
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: 1,500.00
Fee Summary:BL - Base Fee $1500 $62.50 0801.4085
Surcharge - Based on Valuation $1500 $0.75 9001.2195
$63.25 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 -
Matthew E & Julie A Mcman
4512 Hay Lake Rd S
Eagan MN 55123
Pella Northland
15300 25th Ave N #100
Plymouth MN 55447
(763) 745-1400
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA170460
Date Issued:07/02/2021
Permit Category:ePermit
Site Address: 4512 Hay Lake Rd S
Lot:1 Block: 3 Addition: Overhill Farm 2nd
PID:10-56151-03-010
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 -
Matthew E & Julie A Mcman
4512 Hay Lake Rd S
Eagan MN 55123
Pella Northland
15300 25th Ave N #100
Plymouth MN 55447
(763) 745-1400
Applicant/Permitee: Signature Issued By: Signature