4555 Lake Park Dr
BUILDtrG PERMIT
Ye 106 w"d fer
Lot
Parcel No.
? Name _
? Address
City -
Erect (;,J Occupsncy ,
Remodel ? Zoning
Repa+r ? Type of Consf.
Additian ? No. Stories
Move ? Length
Demolish ? Qepth 4 ;
Int. Impr. ? Sq, Ft. ?
Install El
? Name ? ? ? f :.? ?) ?µ •v --r?......... ??.. -
OU A??E i7 i:??'S jY r .: ASSlSSfMflt Pertnit
u
? I-' z?. "?1
CitY Phone
Woter ?, $ew.
Surcharge
Police Plan Review
?
d Nsme Fin SAC
?? Address Eny, Water Conn. ?•?
?W City Phone Planner Water Meter
Countil Road Unit 00
I hercby acknowiedga that 1 have rcad this oppliwtion ond state thaf Bldq. Off. Tr. PL 1' ii
the inforrnation is Carred and agree to Comply with oll applitnble A?
P
k
State of Minnesoto $tatutes ond City af Eoqan Ordinoncas.
V
D ar
s
Siqnaturc of Permitfes ar.
ate Copies
7'IB4,.'i( ''.1 i.i''iC
A Bullding Permit is issued ta:
on Total
the txprest conditfan thal
all work sholl be dona in occordnnce with oll opplicable $tote of Minn esoto Statutes and City o} Ecpan Ordinoncas.
9uiWinq Officiol
CITY OF EAGAN
3830 Pilot Knotr Road, P.O. Box 21-198, Eagan, MN 55127
PHONE: 454-8100
Receipt
40l?0
Permit No. Permk Holder psts Taf9phons
Plumbing (,J
H.VA.C. L ? Y / 5 7
Elect.ic i ?ig Y ' al?? l 7d 15-n
Soitemr
Inapaction Date inap. Other
Footings I 8' ? g S
Footinga 11
Foundatlon (k
Framing
Roofinp F•?
Rough Plhg. ?
Rough Mtg.
Insul. ?
Fireplace
Finsl Htg.
Final Plbg. . ?
Flnat
Cert/occ.
Water a?ibe Laeatian:
Wsll
Sswer
Pr. Dlsp.
,
?t
Reaipt - ' MECHANICAL PERMIT
CITY OF EAGAN
- ' Fill in numbered spaces
Type or Print /egib/y
1 Date SLt " 2 Installation Cost
Psrnnit No. 1
Fee
S/C
ToL , JS:? ?:3.._EF 1 1rn . j ;
3. Job Addreu Lot ' Blk. Tract
4. OWner 'zo?L':s 13Y '.'1izLvu1i'o
Phone 62-2775
6. Contractor FREDRJXZ'?j'+ " • & A.C. ``
8. Address 4030 _Beau O'Ruc, _ _ .
7. City State ''-? 2ip ti5122
8. Building Type: Residential U Commercial O Institutional O
9. Work DesaiPtion: New 0 Add O Alter ? Repair ?
10. Describe 3?.r :s?3at Fue1TYPe `-'as
! 11.
No. Fqljioment BTU • M. Ea.
Forced Air ?'- /~ ' ` / ` ' No. EQUipment CFM
Air Handlin
:
Mfg. g
Boilers
Mfg, Mech. Exhaust
Unit Heater
Mfg. Other
Air Cond.
Mfg.
Gat, 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 464-8100
Receipt PLUMBING PERMIT Permit No.
CITY OF EAGAN Fee ,i"1 ;
FAl in numbered spaces S/C Type or Print legibly Tot.
-=?-?-
1. Date '?x_? -.;:•?__2. Instatlation Cost
3. Job Address _/X:"? rLot Blk. Tract
4. Owner 4
,
5. Contractor 111; Phone
6. Address -?-, ` -
7. City - State A??,/ Zip
8. Building Type: Residential Q
9. Work Description: New
10. Describe
11.
Commercial ? Institutional ?
Add O Alter ? Repair ?
No. Fixtures
Water Closet No. Fixtures
Cesspool/Drainfield
-:J Bath tubs Septic Tank
Lavatory Softner
Shower Well
? Kitchen Sink
Urinal/Bidet Other
l.aundry Tray
Floor Drains ,
'
-
Orinking Ftn. r
-?
- '
SIoP Sink
Gas Piping Outlets -
12. I hereby certify that the abave irtformai+on is true and correct, and I agree to
comply with all ordinances and codes governing this tYpe of work.
Signed : ; , _ „-? l!,• ir'p for
, 1 Rough Final
Inspections:. Date ' Insp. _ Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
CITY 4F EAGAN
38XI Pilot Knob Road
P. O. Box 21199
Eapn, MN 55121
Zoninp: .
Owner,
Addross:
Sih Addrea:
Plumber. ?' . -.
AMUr No.:3 s2q?'.
SJze: _# ,
Reodar No.-'&iMqd° ?
1 ym te es?lr ?ri? N
O.rl.snow.
of EMON
By
Dote of Insp.:
WATEt SERVICE PERMR
PERMIT NO.:
DATE: q-8 -; 9-:_; ;
,
No. of Units: 1
Pennit Fee: ``•.
Surcharge:
Misc. Gwrpss: ? ` .
Tofol: 3.
Dote Paid:
?
?
CITY OF EAGAN
3830 Pilot Knob Rosd SEVVER SERVICE PERMIT
P. O. Box 21199 PERMIT NO.:
Eegan, MN 55121 DATE: '
Zonino: ' No. of Unfts:
Ownwr.
Address: -
Site llddress: ' )•? " Taxa , Z',;
Plun+ber. - t - -'?.-
._.._. •. ` i? ---", .
, I NrM te ?s-plq wN6 1M Cleq of fMon CorrNCtion C}+onpe: `_ • u;.,. '-
OrJirwaN. /lcsourn Deposit: - '
Permk FN:
Surtlwroe:
By Misc
Chorgm
.
Date of Irop.: Total:
Insp.: Doft Paid:
CITY OF EAGAN WATM SERVICE PERMIT
3830 Pilot Knob Rosd
P. O. Box 21199 PERMIT NO.:
Eagen
MN 55121 D/1TE:
,
Zoninp: Na of Units:
Owrwr
.
Addrosx
Sih /1ddr.¦.•
Plumber.
AMftr No.: Connection CFwrye:
Size: Acoount Deposit:
Rsoder No.: Perrr+it Fee:
1 Mm !o omph nNA W Ci1q oi lapw Surct?orgs:
0namenew Misc. Choryes: -
TotoL•
Bv Doft Poid:
Dota of I r?sp.:
?CITY OF EAGAN Remarks
A,ddition i.AKE PARK lAT1??N) ST±oreG Lot 6 BIk 1 Parcel #10 44200 060 01
Owner Street 4555 Lake Park Drive State Eagan, MIIN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREETSURF. 1$2 2529.52 505.90 o?b333
STREET RESTOR,
GRADING ,51 0 /?33.j /(o
SAN SEW TRUNK 1976 a sessed und r Rasmussen Addi ion
R)EWER LATERAL ? .2 D IIp 3 3-3
WATERMAIN
+WATER LATERAL iggi
WATER AREA D .O O /
?S
10116
STORM SEW TRK Jl?? , ? fl/(p 33,3
*STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
500.00
a
n
BUILDING PER. 10720
5AC
PARK
. CASH RECEIPT •
•CITY OF EAGAN
' P. 0. BOX 21-199
EAGAN, MINNESOTA 55121
S?
^,
neeeIveo /,f? ? ATE
LL-
AMOUNT I$ .<?7 I Uc-I v/f'
I
&oOOLLAR$
?o
[]CASN []CHECK
POR
l/??Yl?-
?
PIIND COOE FMOVNT
Q V?
0 U
?
r
Thank You
N_ 54920
White-Payers Copy
Vellow-Postin9 CoPY
Pink-File Copy
CITY OF EAGAN N ° 1072 O
3830 Pilot Knob Road, P.O. Box 21-799, Eagan, MN 55121
BUILDIiQG PERMIT PHONE: 454-8100 Rece+ot ;0! ? J
?•2 2U
T. eQ d..e fm SF DWG/GAR Fo V.h?. $121, 000 n,,,. AUGUST 6 ,0 85
SiteAddren 4555 LAKE PARK DR Erect IN Ocwpancv R3
6 1 LAKE PARK
Lot Block Sec/Sub SHOREBemodel ? Zoning Rl
. Repelr ? Type of Const. V
Parcel No.
Addition El No. Stories
STEVEN PARRANTO Move ? Lenqth bb
W Name Demolieh ? Depth 44
; Address 4573 LAKE PARK DR Int Impc ? Sq. Ft.
b City EAGAN pnone 454-6463 Instell ?
? Aovrovalf Fws
o Name TIBERON INC
?? Addrese 3908 SIB MEM HWY
1- c;ty EAGAN phone 454-1600
Gw Name
?W
i-? , Address
v?._. City Phone
I hercby ackrawledps tFat I haw reod thia application ond state that
fha inlorrtwtion IS wrrect and agree to Comply oll ap0lfcoble
Stata o4 Minnemto $tatute d'fy of E ga r nanus.
$iqnoturo of PermiMM
A 8uliding Permie Is issued B RON INC
oll woric sholl be doro in rdonce with all aonliooble State of Mii
Asxssment Permit 49 .50
worer a Sew. surcharee 60 . 50
Police Plan Rev{ew 242 . 75
Firo SAC 525.00
Enp. WaterConn. 500.00
Plonner WaterMeter 63:00
Council Road Unit 280 _ 00
BIdg.Off. $ 5 $S ?r.Pl. 1 '42-00
APC Parks
Var. Date Copiea
Total $2,288.75
a+ the exprea corditlm that
tota tatutes ard City of Eopan Ordirancea
Buildirq Offidal
? REQUEST FOR ELECTRiCJ?L INSPECTION EB'°°°m-04
? See irm[ruct:ons iorAtomplatiig lhis fum m baek of yell- aap?. rD' ? b?
A`n ? ""X"" Below Work Covered by Tbis Request
Atld R.P. Type oT Buildin9 Applia.xea oirad Eq.yeeeot tired
Home Range Tmyorary Service
Duplex Water Heater Ligh6`g FizWres
Apt. 8uilding Dryer Electric Heaif
Commercial Bldg. Furnace Silo Unloader
Indusxrial Bldg. Air Corditioner 8ulk Milk Tank
Farm t e. oecl ohe.lsnec:ry!
T . oec,ty Ot Othv
ompute lnspectron Fee Below
k Fee ServiceEntromeSize p Fea Feeders?5ubfeeders G:rceies
? Oto200 Oto30A Om30
Above 200 A 31 to 100 A?s 31 to 100
Swimmirg Pool Above 100-Anqx!
n Ahove lOD_A
Transfortners IRigation Boortts Partial•'Other Fee
Si?s Special inspection TO
T/
-?
Remarks 1L-FEE
iT?? A 1 C ' 1 //A 17V /
floueh.in e l
?
"? Iecbica
Imoeemr: hxeW
fi? ?[ fir ahova
Final
Q pa? ? ?ms besn
aelft-
mareo?fl vobe1emonuermrn -
Tl,,s repuest vaid ???L
18 months fmm a
A'z 0,9;@2 4 3 L Lk- Pe Sh o),e, 72.50
Nequest?^Daryte ? ?( l Fire No. I Roupl?-in Iqcpectian
rlNO ?I?aMd'?ow???WMnNHeaJy ?_
.Lr? `I?
-[],Licenaed Elec[rical Confmcto? I barapy reyuest ot ebove
? Owner alacinoa1 wark iostalled ar
Sueet AdJres3, Box o No. Citr
???5 ,771 ?/VG.
ection Township ame or No. npe o. Coix
Occupant IPPI
NTI Fhose Mu. '
?
Pow?j¢r S?uoOl.er // / Add?ecs 1
?HKc,? 7+ ?l?C,
Electnw/l Co tr/a9lor (C?O,mpan)y Name) Cmux[or s Li? No.
Mai1inB Atldress IConhactor or OwMr Maki IristaiWtionl
3'?
?
? -_, r.?.
6 cG/- 7
? _
uthOrrze/tl.?,iBnatare (Contra or O r I? Irttaliatiml
.fe.?-?. Mrme Niu?be ?>
A-S d" ?--
NINNESOTA STATE BOAflD OF EIEGTRIC1iY TM? IMPECTION BMUF3TWILL NOT
GriBes-Nidwey Bldg. - Room NA91 13E ACCEPIED 6117NE STA7E BOAIW
UMIFSS PRDPEA INSPEC710N FEE IS
1827 University Ave., St. Paul, MN 55704
oe....n 1612) 297_2111 ENGL06FD'
?gv)
2007 RESIDENTIAL PLUMBING PeRmiTaPPUCaTioN c
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please complete for modifications to existing residential dwellings. Do not combine inside and outside
nlumhinn nn ihe same annlication senarate aoolications and oermits are reauired.
j 0 I 107
r?
oate
Site Street Address u J S S r? ?r- Unit #
t- Q'I c P__ fy
Telephone # ( )
Property Owner
? S6 ?-d G
Contractor Telephone # ( ?)a
Address 2uS ?-?-4 101 Pn q?_c- City StateMN Zip 5S3SG
The Applicant is: _ Owner & Occupant ? Licensed Plumbing Contractor
Septic System _ New _ Refurbished Submit 2 sets of plans and MPC license Includes County fee
$ 100.00
Per as-built $ 10.00
Fire Repair (repiace burned out flxtures, etc.) $ 90.00
This fee a lies when extensive lumbin re airs are made to a buildin .
Alterations to existing dwelling $ 50.00
_ Add plumbing fixtures to main level lower level. This fee includes
installation of a water softener and/or water heater at the same time. !f you are
insfaqing onlv a water softener and/or water heater, do not complete this sedion;
move to the next section and place a checkmark next to the appliance(s) you are
installing.
_Septic System Abandonment
Water Turnaround (add $136.00 if a 5/8" meter is required)
!)k,Other. RJ Yi .Y? ru
Water Softener Water Heater $ 15.00
_ new _ replacement
Lawn Irrigation _RPZ _PVB _new _repair _rebuild $ 30.00
State Surcharge $ 50
Total $
I hereby apply for a Residential Plumbing Permit and acknowledge that the informanon is compiete ana accurate; mac me woric wm oe
in conformance with the ordinances and codes of the City of Eagan and the plumbing codes; that I understand this is not a pertnit, 6ut
only an application for a permit, work is not to start without a pertnit and work will be in accordance w8h the approved plan in the event
a plan is required to be reviewed and approved.
,, ? L ??
Applicant's Printed Name ApplicanYs Signatu
?
1985 BUILDING PERlIIT APPLICA?ION - CITY OF EAG6N
NOiE: ALL CONTRACTORS MUS? BE LICENSED WITH THE CITY OF EAGAN
INCLUDE 2 SETS OF PLANS
3 CERTIFICATES OF SURVEY
1 SET OF ENERGY CALCULATIONS
121,ooc. =
To Be Used For; &5eMv7tdL Valuation: ? Date:
Site Address: 7,5"S'S /,fa/s/= ORY, Q,,, OFFICE USE ONLY
?-
Lot: ? Block ? Sect/Suh 5` k Erect x Occupaney
Remodel ? Zoning Q-?
Parcel II Repair _ Type of Const ?
Addition I! of Stories
Owner S??U?f ,(?¢Q?1XW• Move Length (p(D
Demolish Depth ?
Address Q?1?1t ,(?. Int.impr. _ Sq Ft
Install
City/Zip Code bW6t4hJ /r'/i7/ .S.S122 ---------- -------------------------
Phone APPROVALS FEES
Contractor iA,p Assessments Permit
Water/Sewer Surcharge
Address tq?F? 5/(???r'/ ?y y1? Police Plan Review
Fire SAC
City/Zip Code ? ?l G(4Yl/ /1? yJ S 1122' Engr Water Conn
Planner Water Meter
Phone ??K- l60 U Council Road-Unit
Bldg Off Treatment P1
Arch./Engr. APC Parks
Variance Copies
Address TOTAL
City/Zip Code
Phone !I
485. 5°
c?o . So
2.75
?23 2' w
=S-J?, 12S-
3q zx5¢= z?«8
2Z ? Z3 ` S?co n s4 - Z7?24
(2 x Z7 - 32q-x << ?sc??
`
4?4 x ?t =
s?z4
22- ?c 22
I ?x 30
4 26 x ?( °
1?1220
rv - ?b '+ r, ? I -
I ?j t? 28 __--
n9
? ZO 53G
HINttE50TA STATE EilERGY CODE CALCULATIONS I.?1
BASED OV CHAPTER ? GF THE ?vQ?'?lv
MOULL gNEar,Y CODE - LI)83 EDtTiON
AdupCiun Etfr.ctlve 171/84
p " 7-Z 3-65
)wner i??V9, r ?{l.?'r0 Phone r.atP
;ite Address
:ontractor
Phone
f I
Suilding Classificatian: Type A1 (Single Fa:nily S 0lplex)--,X_Type A2 (Residential
(3 stories ar ess
(Other)
3"cNERAI INFORMflTION
(Over 3 stories)
l. Building Perimeterz;pal U.be.JC.5#Tft.
?. Wall height (ground to eave) ga /?' ft.
2
3. 1. x 2. (above) gross wall ar94, f.t.
I . Building dimensions (N) _/L 1 ft.Z roof S floar area
S. Square fcot area of rim joist - Flaor joist size (2 x/ b? )
/?? x Perimeter = Rim joist area s zS ? ft2
7Z
6 . Daors - Area , ,? ? ,, .? .
' Thickness n. Uctor?
7ype of Construction Perimeter ft.
Manufacturer
7. Total door's perimeter
ft
8. WindoHS: Manufa turer ?gt?,)Z?/ezState approve3
U factor?,
TYPE
SIZE
? W?iLK- -T
A4EA (FL.Z) NUPIEER OF 70TAL fEET Z
EACH UNITS
.
g. TotaT ft.2 Glass `?jG`1"
Fireplace area: Width x heiaht = ;c = ?- Ft.2
11 . Exposed faundation: Height x Perimeter ? 7/ x-Zj(? lZS Ft•2
;)hfPLETION OF THIS FORM IS R:QUIRED fOR ALL tlEW COPISTRUCTION, MAJOR REt400ELING Ah0 9UIlDiNGS BEINt
1)V:0 'AHERE ENERGY, OTHER 7HAN THE t4INIMAI CODE ALLOWAHCE, IS USED.
,1'2, IF.'.:mi'ng area • 10% of gross Frall are k 0;5 -z i D
13. Gross wall area 3 ft.Z
Wfndow area A ??'Ti?} ft.2 U windows ? .4 U x A ¦ Z•Jr&
Aim joist area A 7 ft.2 U rim joist =U x A = 0.3
Door area A ?j ft. Z
U ?
door area a ? U x
A a
7,
?ixaceU ar0e5 A ft.Z U fireplace =U x A '?9, 35
Exposed foundation A lz,?1j ft.2 U foundation = ? d 7? U x A = 44
Framing area A E75 77 L'a ft.2 U framing area U x A = 7,2,5
Net wall area A 2? 7 ft. U wall = ?b??s U x A - B,0
(138) TOTAL . . . . . . . . . . U x A =3Z .g
14. Gross wall area x 0.11 (A-1 single family S Quplex = ailowable U x A/Cade
(13. above) .
x 0.23 (A-2 other residential)
x .23 (Other buildings)
x .28 (Over 3 stories)
? STUH Must be larger tha
A 3? 3 3 x L Code, _?/j ° •?.? 07. 138 above
15. Ceiling framing area (Af) equais lOS of ceiling area (or the same as)
ISA. Gross ceiTing area ?(l)00ir-/,(,??t,?',t/r x(M) _ `F'??' ft.2
158 Joist area (Af) = 10% ceiling area = ft.2
ISC. Net ceiling area (Ac) (15A - T56) - ft•Z
U ceiling x A c? .?ZZ x 7 _ -
U framing x A f= .dz3 x a Z2
150. TOTAL U x A ........................................ CO Z
16. Ceiling area (15A) x 0.026 (A-1 single family 5 duplex - code allowable U x A •
x 0.033 (A-2 other residentiat)
x 0.06 (other)
BaUN Must be larger than 150 (above)
A(15A) x n(codn)= ?J7.Zfl F (ar the same as)
, OL(O
NOTE: Use U and A values obtained Prom nps 1, 3 and 4.
, _..,_
T
e
?
.
O N?x,INIot FwW 67800 oRe[w 7506 BwF evease covReLies rwot iN U.S.A.
.'?kCo wAL(.:
. . . SH??TI?I NU
WALL
SECTZCN
STL'D
SECTION
u +ALue w?L?-uLHilun-?i
VALUE
INSVL. S. ao U VALUE
Inside air film .68
Iaterior ra11 04K (uall) U . ? .
Insulacion 1614)
Sheathing 'L.di(o ?
Siding ,67 ?-
ducaCde air film .17
R rorar. 7gNEM 49 03
mia 5,0
Insida 3ir film .68
Inter:ot wa1L ?4E-
.1e scud (6") R° 150(Framing) U. a .
Sheathing 141o ,b(p?
siatng .lo7 ?
Outafde air f1Ls .17
$ i'OTAL ? /,75 5
ZND VALL
SECTION
Inatde air film R= .68
Iateriar rall
Cion
Exeerior rall riag
Facterior air film R .
(Wall ? U ? R .
R ?OTAL
• Inierior air film R= .62
SIP! InsulaCion
JOIST ?`-? Ty 1 1h ineh soEt uood R=1.88 (RIm U=??
JO15t)
? Shea[hing Z1O4O Dti
Exterior val l covering .467
Exterior air film R- ,17
a rarat, j?4.9-(a
Interiar ai: film R= .68
2nsulatfor. (0.oc>
, Foundatian
1.Zr$
(Fdn.) 1
U ? R ¦
Exterior air film A= .17
R ?OTAL ?2, ('
?
9Luck
? ?: ?
i . . .
CE.Li71G 'dI-H '!E;`lTcD rMC SPRCE AHOVE
R ':AlL'c `/ LUE
? Fr7At4I"G CEILING
' O.cl Air Film 0.61
.
Insuiation ?.?
- ,38 ,lo;st -
Ceiling I C_zo
/r
? ; ? j? t •
? • Q.6T Air Fitm 0.51
?2C(D Total R
1
dZ?i U = T • 02`LL
FL.4T RCOF OA C,3T'rIEORAL C.ILING
R va ue R YALUE
FR;,riirys CEILING
0.51
0.17
inside air film 0.61
Ceiiing -
Jaist (stud
Insuiation
Air space
Rocf decking
Insulation
Built-up roof
Outside air film 0.17
Totdl R
? U
R?
Jindow infiltratian .5 cfm/Tineal foat af crack
tesidential door infiitratien 0.5 cfmisqusre foot or door and minimum code requirement
!cn-residzntial door infiltration 11.0 cfT/lineal 'aot af crack
1b 12" concrete block na 9nsulatfon =.47 R 2.1 -
!y 12" concrete black insulated cores =.26 R 3.8
Jb 12" ligfitweiaht black =.32 R 3.1
;b 12" ligntwei3ht hlock insulated cores =.12 R S.3
1 single glass = 1.13; with storm tivindoH .54
1 double glass = .55
1 tripte glass = .41
M exLerior wa11s and cetlings must have a vapor barrier (0.10 perm r..ax.).
;aoor barrier must 6e on the inside (heatzd side) af toa'1.
iapor barriers of the polye*_helene thin film have no R value. .
CITX USE ONLY
PERMIT #: RECEIPT DATE:
2002 ftESIDENTIAL MECHA1VICAL PEfiMIT APPLICATION
crrY oF ensna
3$30 PILOT KNOB iiD
EAfiAN MN 5512E
651-6$1-4675
Please complete for: ? single family dwellings
townhomes and condos when permits are required for each unit
Date: 12-9-02
SITEADDRESS: 4555 Lake Park Drive
OWNER NAME: Mark Colburn TELEPHONE #:
INSTALLER NAME: Master Mechanical, Inc. TELEPHONE#: 651-905-1600
STREETADDRE5S: 1027 Gem
CITY: Eagan STATE: MN
Place a check mark next to the perntit woric type
Zlp: 551 21
X Add-on, modification or alteration to existin dwelling unit $ 30.00
. furnace replacement
• air exchanger
• airconditioner
• other
Nature of work: Furnace Replacement F ?i
State Surchar e 50
E Tot01 $ 30.50
S NATURE OF PERMITTEE
Gordon Peters, President
voz
RESIDENTIAL
? BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4875
New Construction Raouirements
• 3 registered site surveys showing sq. ft of lot, sq. ft of house; and ell roofed areas
(20%maximum lot wverage allowed) '
. 2 cop+es of plan showiig heam 8 wirnlcw sizes, poured tound design, etc.)
• 1 set of Energy Calculatbns ? "'
• 3 copies o(Tree Preservation Plan if lot platted after7/1/93
• Rim JaislOetail Op6ons selec6on sheet (Wdgs vnfh 3 or less unita4,.
DATE
26 J?? o-Z
SITE ADDRESS
?fSS? Ll.? p=..x.lt_ d r-.
TYPE OF WORK F ev- FIREPLACE(S) _ 0_ 1_ 2,
APPLICANT ?F-a`? <23?? (-c?o Fr ?S V- S•
STREET ADDRESS °F(° `f C:> Xt'`` e"'T R e'-'`' `--' CI7Y ? 1 tiL '"t STATE '`"`' ZIP 5?4` Y Z
TELEPHONE #(z-3 ) 5 Sb'O°`f3 CELL PHONE # 61,, 76` y FAX #
PROPERTYOWNER
4 5'3 SSO.Oo
MULTI-FAMILY BLDG _ Y _ N
TELEPHONE #
---------------------------------------------------------------------------°------------------
GQMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDlNGS ONLY
Energy Code Category _ y[INNESOTA RULES 7670 CATEGORY 1 MINNESOTA RUL,ES 7672
(J su6mission type) . Residantial Ventilation Category 1 Worksheet Submitted • New Energy Code Worksheet Su6mitted
• Energy Envelope Calculahons Submitted
Plumbing Contractor: ____
Plumbing system includes:
Mechanical Contractor.
Mechuiical system includes:
Sewer/Water Contractor.
Air Conditioning
Heat Recovery Syslem
Phone #
Pfione #
Pee: $70.00
._..__...--•-----------------------------------°-----------...------•---------__-- -------°------------.....-----------
I hereby acknowledge that I have read this application, state ihat the information is correct, and agree to comply
with all appiicable State of Minnesota Statutes and City of Eagan Ordinances.
Signature ofApplicant ?c-e
OFFICE USE ONLY
_ Water Softener _
_ Water Heater
No. of Battis
RemodellReoair Renuirements
. 2 copies of plan
. 1 sel of Energy Caiculations far healed addiGons
• 1 site survey far exterior addihons & decks
. Irkicate d home served by sep6c system for addifions
_ Phone #
Lawn Sprinkler
No. of R.I. Battis
VALUATION
t ? Z-1 . -D-<-
ree: $90.00
Certificates of Survey Received - Tree Preservation Plan Received _ Not Required _
Updaled 4/02
i
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II? i
2/84
j CITY OF EAGAN
? APPLICATION FOR PERI?IIT
i 11
SEWER AND/OR WATER CONNECTIODT
(PLEASE P4IHT)
1} PROPEc2TY ADDRESS:
rFr:%i, DES(:RZ°TICN:
(Lat/Block/Subdivision or Tax Parcel I.D. Ntanber)
li EtIS:'=`:G STRL'Ci'=, Da'I:: 0F ORSGii1AL rUILL'Z`iG P----,ST ISSu.aL?:G:
I F?,°_S:=,- ?.^•71 :,'=/?:?'??CS? i5:: m r2-1 SINC?'LE iP`nSLY
Q R-2 GUPLEX ('IWO Wi ITS)
? R-3 ZC;X??'?C{;SE (THP.EM + U^TITS) ( Ln?ITS)
? R-4 ApAR'IP"I'/CJDIDa=I[P4 ( Wi IZ'S)
? COMMEE2CIAL/RETAIT/OFFICE
? =USTRIIIL
Q INSTITUTIOIVP.L/GOVERDZ=
2) APPLIG??+'P (PLEASE PRINL)
NPrIE: ,S'TEVE /,p1{:i'1?Ai(i7z
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aDnREss:
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PHONE:
3} pjUM@ER PLEASE PRlNT) FOR CITY-U5E"aNLY
NA1?fE _
P RS LICEHSE:
AD?RESS: 2600KENNFpECDR1YE. EAGAN,MINN.5512Y Q Active
CITY, STATE, ZIP: 452-1565 Q Expir
MAS[Lq of Record
PHONE: PLUMBER LICENSE # - 001_445M2 ?
ir lnltld
9) OC=11N•P/aqCIER (PLEASE PRINT) '
N11ME: . STEUcr ? x'i:'sl.c?lz
ADDRESS: •.SCrc iJ2k_ ?z.Q-• f` ?--
CITY, STATE, ZIP:
51
PE30NE:
ZNDICP,'I'E SJI-IICH PEPh1iT IS BEI[v'G RD2UESTED:
? Cb:VNECPION TO CITY SETi9ER
Q CONNECTION TO CITY WATER
? 0'i'I'ER (PLE715E DESCRIBE)
6) D:DI= C`:r :
? PLF15E F?OLD APPROVID PERMIT FOR PICiC-UP BY OP1E OF AHC7VE
-? PIEASE bTATL APPROVID PER?IIT 2C) 1, 2.?, 4 AEOVE
(Circle one)
7) DATE:
. . .. . .r..r?.,.....y.:,?. r ...r...,??sa.? ..
F O R C Z T Y U S E O N L Y
PER^SIT °- ISSUED
1- 1
FEES: $ C,SU
$ Jo yo
$ b U
$
$
$
$
$
$
$
$
$ /
$
SEPiER °ER.`?T_T (I`_ICL::D= SUP.CHr?RG7_)
WATER PERf1IT (INCLUDE SURCHARGE)
WATER METER/COPPERHORN/OUTSIDE READER
WATiR TAP (IVCiUDE CORPORATZCN STOP)
SEWER TA°
ACCOUNT DEPOSIT - SEWER
ACCOUNT DEPOSIT - WATER
WAC
SAC
TRUNK WATE.°. ASSFSSMENT
TRUNK SEWER ASSESSMENT
LATEI2AL BENEFIT/TRUNK SEWER
LATERAL BENEFIT/ UNK WATER
OTHER t ,(?-?;e2 ?
TOTAL
AMOUNT PAID/RECEIPT #
DOES UTTLITY CONNECTION REQUIRE EXCAVATION IN PUBLZC RIGHT OF WAY?
F__7 YES IF YES, THEN A PERMIT FOR WORK WITHIN
PUBLIC ROADWAY" MUST BE ISSUED BY THE
==0 ENGINEERING DIVISZON. LIST AS A CONDI-
TION.
SUIIJECT TO TEiE FOLLOWING CONDITIONS:
APPROVED BY:
TZTLE:
DATE:
4WHr OW-00 Wa ="? Mc =s aWWL.W ia w ia W?ft wM w_a w*?Wie qpi"Wiw W.a pc = se W="w.a rcMBa w" wM
51 GIVIA
SURVEYINC
SERVICES
3908 Sibley Memorial Nighway
Eagan, Minnesota 55122
Phone. 1612) 452-3077
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Certificate of Survey For:
Mr, a IMrs. STENE
PARRANTO
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0 Denotes lran .Ncnunrent
° Denotes N'ad Hub Sef
009.6 Denotes E.xisiirg Spnl flevatic.a,
wioY
(„ srwa.y Denotes Proposed Spot E leva i i un
_.----Opnoles Drainage Dirxtrm
-Pi7EKTI' OESC7tlPf1GW-
Loi 6_ , BLarc
accnrQrrg to the recorded plat thereof
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WAYNE D.
CORDES
- 14675 -
?„nn'uin1o,o°,• - 9 Zl . I
PROPOSED GARAGE FLOOR ELEVATlON -
PROPOSED lop ct B lock fLEVAT ION=
PROPOSED BASEaENT rLODR ELEVAlION= YI3, _
NOrE Verify a11 floor heights w+th Final Hwse Plans.
-$Ui2VEYGRS CEKI' iF fCAT f (V - ,
! hereby certify thet fhis survey, plan or report
was Frepered by me or crtler my aI rec r SU(JEfV15/Pn
arri thai I am a duly Reyisterad Larti Surveyor
urder the laws of the Sta!e of Mrnnesota.
?G41-._Date: , Z`i l85
Wayre D CorJes, binn. Reg. N'o. 14675
Alkik. IWco(
City of Eaan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Date: ' V 2L4 t Site Address: Unit #:
Use BLUE or BLACK Ink
For Office Use
Permit #:
Permit Fee:
c). -p'
Date Received:
Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Resident)
Owner
Type of Work
Contractor
Name:
Phone: 65/ -
Address / City / Zip:
Applicant is:
Owner P, Contractor
Description of work L e42 t0 cez
Construction CA 5"cam Multi -Family Building: (Yes / No )
Company:? -RS P(
Address: Lk bb LAc4c Or. e �'
State: Zip: 51-(29 Phone:
License #: CJS (QS9 CA 2
contact?...D
City: PCO n`!�2Ac
-(Qs-SSS-00GD I
Lead Certificate #:
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:
Mechanical Contractor:
Sewer & Water Contractor:
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 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 Minnes
days of permit issuance.
x
Applicant s Printed Name
X
Ap
• • - .te Bui • Code must be completed within 180
iLdiim
..'W'.. nt's Signature
Page 1 of 3
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PERMIT
City of Eagan Permit Type:Building
Permit Number:EA170073
Date Issued:06/18/2021
Permit Category:ePermit
Site Address: 4555 Lake Park Dr
Lot:6 Block: 1 Addition: Lake Park Shores
PID:10-44200-01-060
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:Does not include skylight(s)
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and leave on site. We encourage you to retain an electronic copy of
photos until the project passes a final inspection.
If water damage is encountered, please call (651) 675-5675 to schedule a site visit to verify the extent of the damage. Any
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 -
Alvin M & Carol C Stafford
4555 Lake Park Dr
Eagan MN 55122
Minnesota Restoration Contractors Inc
12252 Nicollet Ave
Burnsville MN 55337
(612) 280-4807
Applicant/Permitee: Signature Issued By: Signature