4540 Greenleaf Dr E3830 Pilot Knob Rd.
Eagan, MN 55122-1897
. , DATE
PERMIT# 1''-)872
B.P. RECEIPT # C 372
B.P. RECEIPT DATE
PRV _ BOOSTER PUMP
OFFICE USE ONLY
METER # PERMIT DATE 9 / ? ? ?9
CHIP #
METER SIZE
SfTE ARDRESS
LOT.CABLOCK I-SEC/SUB _-
APPUCANT: ADDRESS: ? F • ? CITY, STATE ZIp
PHONE: '
PLUMBER: ?--
ADDRL'SS: _
CITY, STATE
PHONE: _
ZIP
OWNER:
ADDRESS: ?CITY, STATE ZIP
PHONE:
PERMIT REQUESTED
v.
- SEWER x- WATER - TAPS
- COMM/IND RESIDENTIAL
_ NEW u EXISTING ]
Lawn Sprinkler Meters are to be Installed
Ahead of Domestic Meters on Water Line.
Credit WILL NOT be given for Deduct Meters.
I AGREE TO COMPLY WITH CITY OF
EAGAN ORDINANCES
SIGNATURE WHEN METER ISSUED
PLEASE ALLOW TWO WORKING DAYS FaR PROCESSING. CALL 454-5220 FOR INSPECTIONS. FOR STORM
SEWER PERNIITS, CONTACT ENGINEERING DEPT.
crnr oF E+GAN
8795 Pibt Knob Road Eagan, MN 55122 N! 5998
PHONE: 454-81 QO
BUILDING PERMIT
Receipt #
5ite Address .'? ,?=- ,, ? ? "r•l ?'£?.f ih" .
Erect
Q:
Occuponcy
Lot Block - Sec/5ub.
Alter
Zonin
g
Pcrcel # Repair ? Fire Zone
Enlarge ? Type of Const.
? Nome ` ?: ,, , _ ,.?,.•i:::_:;. Move
?
# Stories
Z
Address
"540 'E• Dr,
Demolish
? ,
Front ft.
3
O
r:...
:':;3g8R7, !?7. 45+-3003
Grade
fl
deDth ft.
` Nome
0
u? Addre:
f- r:...
Name Contractor
I hereby ocknowledge that I have read this application ond state thot
the information is correct nnd agree to comply with all applicable
State of Minnesota $tatutes and City of Eagan Ordinances.
Assessment _
Water & Sew.
Police
Fi re
Eng.
Planner
Council
Bldg. Off. _
APC
Permit
$urcFarge -
Plon check _
SAC
Woter Conn.
Water Meter
Rood Unit -
Total
Signoture of Permittee I
17 ?l_,zr 7'-,,;15.
A Building Permit is issued to: '' ? - on tha expreu condition thot
all work sholl be done in accordonce with all applicable State of Minnesotc Stctvtes and City of Eagan Ordinances.
Buildirq Offitiol '
Deh lau" ?We1Moe
Plumbing
Mechonical
iNSPECTIONS DATE INSP.
Rough-I n
Finof
Footings Dote Insp. Oate Irup.
Foundation Plumbing
Frcme/Ins. Mecfwnicnl
Finol
?
Remarks:
/08'7.P PERMIT #
"Ix, PLUMBINC PERMIT ? jrJ4
CITY OF EAGAN RECEIPT #i ?-
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE:
! Site Address _
lot z2
T Name _
R Address
i
, c Ciiy _
? Name i
3 Address
o C4 -?
FEES
COMM/IND FEE - 196 OF CONTRACT FEE
APT. BLDGS - COMM RATE APPUES
TOWNHOUSE & CONDO - RES. RATE APPLIES
MINIMUM - RESIDENTIAL FEE - $12.00
MINIMUM - COMMIIND FEE - $20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 SJC IF PERMIT PRICE GOES
CITY OF EAGAN
,
r{" -, BLDG. TYPE wORK DESCRIPTION
Block ?- Sec/Sub ? Res. New
Mult. Add-on
Comm. Repair
Other
RES. PIBG. ONLY - COMPLETE THE FOLLOWING
NO. FIXTURES TOTAL
Water Closet - $3.00 t
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
Gas Piping Outiets - $1.50
(MINIMUM - 1 PER PERMM
Softener - $5.00
Well - $10.00
Private Disp. - $10.00
Rough Openings f,$1.50
?EE ? .?
STATE S/C:
GRAND TOTAL:
73MPilot & WATER PERMIT
EAGAN
Knob Rd.
agan, MN 55122-1897
I OATE C;
PRV _ BOOSTER PUMP
?
, SITEAQDRESS ' ?'?' `- • ' ??? ,
LOT __1_BLOCK _?_SEC/SUB--?'% CA
APPLICANT:
ADDRESS: `?4- r - • ' - l.' )
CITY, STATE ZIP '-
PHONE:
PLUMBER: I11 `=--
ADORESS:
CITY, STATE ZIP
PHONE:
PERMfT REQUESTED
X SEWER X WATER _ TAPS
- COMM/IND X RESIDENTIAL
- NEW _Y_ EXISTING
Lawn Sprinkler Meters are to be Installed
Ahead of Domestic Meters on Water Line.
Credit WILL NOT be.given for Deduct Meters.
. ;.
I AGREE TO COMPLY WITH CITY OF
OWNER: . ?? ?'?:? • ?? ` X.-i-/ r? EAGAN ORDINANCES
ADDRESS:, I r r? ? ; _ C?JI?J
CITY, STATE 21P
PHONE: - -' '??-' - SIG ATURE WNEN METER ISSUED
? rM, ?,..5F
PLEASE ALLOW TWO WORKlNG DAYS FOR PROCE5SING. CALL 454-5220 F R INS CTIO S. FOR STORM I
SEWER PERMITS, CONTACT ENCINEERING DEPT.
OFFICE USE ONLY
METER # y?Z35'?ZDI PERMIT DATE 9/7/89
CHIP # 6697L tvO 4 PERMiT # 10872
METER SIZE B.P. RECEIPT # C 3724
o+
ISSUE DATE 9-7- g?T B.P. RECEIPT DATE
CITY OF EAGAN Remarks
Addition SOuth Oakc Lot ? Blk
Owner i ' Street - 4540 Greenleaf flr_ i
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK 198,(r 370.00 24.67 15
SEWER LATERAL
WATERMAIN
WATER LATERAL
WATER AREA
STORM SEW TRK -61 19$l* 617.00 41•13 15
STORM SEW LAT i
CURB & GUTTER
SIDEWALK
STREET LIGHT
3 3 27.50 2886 5-11-76
WATER CONN.
BUILDING PER.
SAC
PARK
Receipt MECNANICAL PERMIT Permit No. 'I
CITY OF EAGAN I
Fee I
Fi/l in numbered spacea S/C
Type or Prini /egib/y Tot.
1. Date 2. Installation Cost 'UD q91
3. Job Address Lot Blk. Tract C)CC??
4. Owner
5. Contractor Phone
6. Address
7. City State Zip
8. Building Type: Residential 0 Commercial ? Institutional ?
9. Work Description: New ? Add 11 Alter ? Repair ?
10. Describe ? Fuel Type
11.
No. Eqlipment STU - M. Ea.
Forced Air No. Equiament CFM
Ai
H
ndli
Mfg. r
a
ng:
Boilers
Mfg. Mech. Exhaust
Unit Heater
Mfg. Other
Air Cond.
Mfg.
Gas, Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
comply with all ordinanoes and codes governing this type of work.
Signed: for
Rough Fln ?
fnspections: Date Insp. Date /a Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
RESIDENTIAL A44K
BUILDING PERMIT APPLICATION "4??43%?b
y? CITK OF EAGAN ?j
fl#W- 9 3830 PILOT KNOB RD - 55122 71^??"? (
651-681-4675 ?
NewConstruction ReauiremaMS RemodeUReoafrReaufrements
• 3 registeted site surveys showing sq. h of b( sq. iL M house; anli ioofed areas • 2 copies of plan
(20% maximum bt cave2ge albwed) . t set of Energy Caladatiore for heated addiBons
• 2 copies of plan showing beam 8 windaw sizes; poured found design, etc.) . t site wrvey (or exteMr additlons & dedcs
• t set of Energy CakuWtions . Indicate it home servad by septic system for addiGons
• 3 copies of Tree Preservation PWn if IM platted afler 71153
• Rim Jdst Detail OpGOns seleCtion sheet (bldgs wilh 3 or kss unNS)
DATE VALURION ?G?
JOB SITE ADDRESS
IF MULTI-FAMILY BUILDING, HOW, M/?ANY UNITS?
PROPERTYOWNER U?"rta?- /?Ct-"/
TYPE OF
APPLICA
REPLACE(S) _ 0 _ 1 _ 2
PHONE# gsz-??y ?.oc,
ADDRESS Y6"9g s? 13('? ZIPCODE SSe{ZO
PAGER # CELL PHONE #
FAX #
NEW RESIDENTIAL BUILDING ONLY- Fill OUT COMPLETELY
Energy Code Category _ MINNESOTA RULES 7670 CATEGORY 1
(check one) - Residential Ventilation Category 1 Workshee
- Energy Envelope Calculations Submitted
114
?
_ MINNESOTA RULES 7672
- New Energy Code Worksheet Submitted ?
Plumbing Confractor. Phone
Plumbing System Includes: _ Water Softener _ Lawn Sprinkler Fee:
Water Heater No. of R.I. Baths
No. of Baths
Mechanical Confractor:
Mechanical System Includes:
3ewer/W ater Controctor.
_ Air Conditioning
_ Heat Recovery System
$90.00
Phone #
Fee: $70.00
Phone #
All above information must be submitted prior to processing af appl'icaNon.
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply
with all applicable State of Minnesota Statutes and City of Eagan rdinanpes.i
Signature of Applknnt
.
Certificates of Survey Received Tree Preservation Plan Received _ Not Required _
Updated 1101
OFFICE USE ONLY
? 01 Foundation
D 02 SF Dwelling
? 03 01 of _ plex
? 04 02-plex
O 05 0&plex
O 06 04-plex
? 07 OSplex ? 13 16plex
? OS 06-plex ? 16 Fireptace
? 09 07-plex ? 17 Garage
? 10 08-plex ? 18 Deck
? 17 70-plex ? 19 Lower Level
? 12 72-plex Plbg_Y or _ N
? 20 Pool
? 21 Porch (3-sea.)
? 22 PorchlAddn. (4sea.)
? 23 Porch (screened)
O 24 Stortn Damage
)K 25 Miscellaneous
? 30 Accessory 81dg
O 31 Ext. Nt - Multi
? 33 Ext Alt - SF
? 36 Multi
? 31 New ? 35 Int Improvement O 38 Qemolish (Interior) ? 44 Siding
? 32 Additlon ? 36 , Move Bldg. 0 42 Demolish (Foundation) ? 45 Fire Repair
X 33 Alteration ? 37 Demolish (Bldg)• O 43 Reroof ? 46 Windows/Doors
? 34 Replacement •Demolitlon (Entire Bldg only) • Give PCA handout to appiicant
01"76 L
4
Valuation Occupancy IC
. MC/ES System
4
Census Code ?J Zoning City W ater
SAC Units Stories Booster Pump
Nbr. ot Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const Width
_x
X
Other .
_ Pool _ Ftgs _ Air/Gas Tests _ Final
_ Siding Stucco Stone
_ Windows (new/replacement)
APProved BYT Z?
REQUIRED INSPECTIONS
Foorings (new bldg)
Footings (deck) FinallNo C.O.
Footings (addifion) Plumbing
Foundation
Drain Tile
Roof Ice & Water Final
Framing
Fireplace _ R.I. _ Air Test _ Final
Insularion
Base Fee
Surcharge
Pian Review
MC/ES SAC
City SAC
Water Supply 8 Storage
S&W Permit & Surcharge
Treatment Piant
Plumbing Permit
MeChanical Permit
License Search
Copies
` Other
Total
<.
FinallC.O.
HVAC
Building Inspector
CITY of EAGAN
BUILDING PERMIT
Owaee ..........
Address (vrasent)
Bulldes ......... .???.................................. ............._'..._..........-'
Addrau ............. ........................ -- - -
DE3CAiDTif1N
. ;,
N° 3933
3795 Pilo1 Knob Road
Eagan, MinaesoYa 55121
454-8100
Dele :...................
Sioriea To Be Uced For Froni DapSh HelghS Eel. Coo! Pesmi! Fsa Asmesln
/J ?
/?i?. /rc'=''2 iT?
A0 ' Sto'
/'d ' (Q?OOd ??-
-? 70 ,
or
P, I 1
or
Thia permit doea not at(thorife the use of slreele, roads, alleys or sidewalks aor does it gtve the owaer or h[s agea!
the righ! !o cseate anp siluation which is a nuisanee or which precenls a hesard !o the healih, safelp, aoaveniencs and
genaral welfare to anyone in the communifp.
THIS PERMIT MUST BE KEPT ON THE PR£MISE WHILE TFSE WORK IS IN PROGAESS.
Thfs is !o eertifp. !hal................................................................ has permfsaion !o erect a........................................................... _upon
the above descrihed premise subject fo the provisions of all applicable Osdinanees for the Ciip of Eagea.
......................... ---.............._.......... Per ._. ..?. . 8,.??s?d.Y..1..-°°°........._..............._... ?
? MBYo= Suildinq Inapeelos? ,
.
Eagan Township
Dekola Covniy, Minnesola
ApgGcation Eor Bnilding Permit
Tppe of building or work eonfemplaied. Cirele correei descripiions.
esidenti Commercial Indusiziel
Euild nlarg Alier Repair
Dimansions j&I-A.(i--- -y-- -.?.
Defails or
LocaSion
Ofher..........................
Inslall Move Wreck Oiher ...............
Cos!_??,. P OO
PERMIT NO.JW3 ......
Dafe ... 4?? ------"
Number 51ree! Beiween whaf cross s2reefs Siae Esf. Valuaiion
Tst{"D f . ??Q.<.?1??-4'C D/'.
Lot Block AddiY:on Reaxrangement or Txaei
a44. aJ1- oa,?
n? ? (? 1? •{' +i f??,
Owner i T?? ??? C? r.... ?__Y?.?!.1?3^..?L?..P 1`:1..0 ?i t2.
" ...... -'= .................
? a
Conlracior .....
."---'."--`•""---'
Address ._.- S./.......... r.:"-_G.VP_C_}?_.I g.te_7...... Dr.-"----'
Address
The undersigned herebp makes apnlicalion for a permi! !o
a do work as herein spacified, agreeiag !o do all work in sSrief
Tolal fee eolleeied. accoxdance wiih !he huildiag ordinanee adopled April 11. 1955
by Ihe Eagaa Township Boexd of Supervisors.
Permif fees are nof , 1 '
refundable. ? ??.,? ?
"--' ----'-"---'--...."-'------------------_
5igned
(
EAGAN TOWNSHtP
BUILDING PERMIT N° 2014
`i
Owner _?2h?r..._ ............. ...t._................... Eegan Township
Address (Present) -------------------------------------- -....................................... Town Hall
Builder .../"J-- . / /
-----'--'--'---- -----------
' S l....?.31...?.,1` ......................
Address .....y?'.rf....???-".^..,w.:C.-.>.....?..._...... Dafe
DESCAIPTION
Siories To Be Used For Front DepYh Heighf Esi. Cosf Permit Fee Aemasks
?
? I
4A- L
r/ LOCATION
screex, noaa or o:ner ueseripxian ox i.ocanon I Lo= aiocx ++aauion or irac:
"7!S' 410 og-` • I --2- / .de , L9??
This pesmit does not aulhoriae the use oi -slreels, raads, elleps or sidewalks nos does i2 giva !he owner or his egenS
the xight to create any sifuation which is a nuisance or whieh presants a hazard So the health, safety, convenience and
genezal welfare !o anpone in the eommunilp.
THIS PERMIT MUST SE KEPT^ -ON THE PREMISE WHILE THE WORK IS IN PROG S5.
This is !o cexlify. 3haf?v?.j :-- cL-!-:??:-:"--_---'---_--.has permission !o aree! a--' -"_.? . .............. . ?!:..`.': ?. ? ' upon
the above described premise subjec! 2o the provisions of the Building Ordinance for Eagffn Top adop epril 11,
1955.
..............'- '-'-'- ----- :' - /45-!rar?----------------'------- Per --....__....x.u...---- --°----_"-------
- - - -- - - - g-- --- --- --"?'-?
C? tsman of Tnwn Board Buil?n Inspeclor
!t . ?,
. ?
? Eagan Township pERMIT NO.
' Dakofa Counly, Minneso2a Dgtw-s=..-._i-"__-??......
Application Eor Buelding Peimit
Tppe of building or work eontemplaled. Circle correcf descripliono,
esi eniial Commereial Indusfrial Olher....----°--------------------------------------- ---------.°°------....-•--°---------°°------...---------
Evild Enlarge Aller Aepair Insiall Move Wreck Ofher...... ....----------------------------------------- ......_......---.-.
............... l?.?
%
Delails or remarks.................................. ........_.......------'--'------....?.._-------__-"-----?-----------"'-----"--.............................--_`._....-"'°-----"--'.'
Localioa
Number Slreef Balween whai cross sfreeis Size Esi. Valuation
Lof Addik?on Rearrangemeni or Trae!
...."'-'--."""_""_'-'----'_"'_-"-'-•"'----.-"'---....'_----""_-".._.. Addxass
Owner --- ------ --°-'°
CG! ?'---"-"-'-' - -... -'----- '
-'- --- ---
----"---°--- '
Conireci°x °'---°------"""'-_....................................................... Address .... ..°............................ ........."'-"----....:_5`...""
?
......................
Tofal fee collec2ed.
Permit fees are not
tefundable.
The undersigned hereby makes applicafion for a permit !o
do work as herein speeif•_ed, agreaing !o do all work in siriet
aceordanee wifh She building ordinaace adopled April 11, 1955
bp !he Eagan Township Baard of Suparvieors.
?
??-?----'-G-?`---"--- --....---"----....-- -------------------- ........
? 1 ?
5igned
?
CITY OF EAGAN
BUILDING PERMIT APPLICATION
'Ib Be Used For ?` 0 L-Y V uation -?So L)
Site Pddress: 4 Sfo fnsT(a@e-u,u'*4?? a) 2 .
Lot ? slock seo./sub. _1??r.ttsr ?-
Parcel #:
....r..._
Owner: (Oqtk d YYlke? CAyam n eQ lp w? Nbve ge
Pddress: ,zw? l_e.rkf De , Demolish
City/Zip Code: ?AG A,l SSi Z.{ Grade
Phone #: ?}S ?4 -31
Contractor: ?
?1 A.?Ll.?,? ,oLS I.fiC AddYess: 12(7 u C: 12 ? iT`°`c' . S ?
City/Zip Code:3NQ„s44\-? i1'1;j - <55337
Phone #: PCj L-k - I 4s C7
Arch./Ehg.: CuVI?°-?To2
P,cldress:
City/Zip Code:
Prone #:
Include 2 sets of plans,
1 site plan w/elevations &
1 set of energy calculations.
Date ??' 1)
OFFICE USE ONLY
OccuPancY
Zoning
Fire Zone 3
Type of Const.
# Stories
Front 3b ft.
pepth /Y ft.
APPROVALS FEES
Assessments
Water/Sewer
Police
Fire
Panner
Council
Bldg. Off.
APC
00
Pesmit o'C? J
Surcharge 3 ?
Plan Check-
SAC
Water Conn.
Water Meter
Road Unit
0
TOTAL ?' 3 y
CITY OF EAGAN
,
° 3795 Pilot Knob Road Eagan, MN 55122 N2 5998
iHONE: 4548100
BUILDING PERMIT APPLICATION Receipt # .? ".>
To be usad for $W= N= PDOL & MC
KEue 5 Dote
500 7_3(1 19-8ja--
. .
. ,
Site Address 4540 F CrPPnl f Dr. Erect Q{ Occupancy - 33-
Loi z Block 1 Sec/Sub. SOUth OflkS . qlter E] Zoning Rl
Repoir ? Fire Zone 3
Pertel # _
E
l T
f C
t
n
arge ? ans
ype o
.
w Name Mack & M ary Chamb2rland Move ? # Stories
Z
? Address 4540 E. Green7.eaf Dr. " oemoiish ? Front 36 ft.
EBgan, M21.
454-3003 Grade ? Depth lg ff.
Ci phone
? Na Valley Pools, Inc, Aovrovals Fees
o me
u? Address 7-2000 12th Ave. S.
F- r:- RilrnSVi l l P. 1bHn___ 891.-1480
Nome Cnntrar.t-or
Address
I hereby acknowledge thot I have read this application ond state thot
the informotion is mrrect and ogree to compiy with all opplicable
State of Minnewta Statufes nnd City of Eogan Ordinonces.
Assessment Permit 21.00
Water & Sew. Surclwrge 3.00
Police Plan cMeck 10.50
Fire SAC
Eng. Water Conn.
Pionner Woter Meter
Council Road Unit
Bldg
Off
.
.
APC
Tosol 34.50
Signoture of Permittee I
A Building Permit is issued to: Vfl118y POOZS, 7riC. on the express condirion that
all work sholl be done in ogqordon all` licable StMe of Minrresota Statutes ond Ciry of Eogan Ordinonces.
Buildi? Otficlol ?? ???E? /'/!.?-.f' J
S-Ss-11
New Construction Rac-'--"-' "- `
• 5 reqislerea srte sui 73?l5 fe uest void
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651•681-4675
? 3qo
.1
.._. 4s4-3 0?S
No.•
(20%maximumloq q ?
• ? copfes of plan shG 18 months from S 66531
• 1 set of Energy Cal1 ? Fire No.
• 3 copies of Tree Pre, Date of this Request
. Rim Joist Detail O pf I, a s O Licensed Electrical Contractor Owner, do he? r e?requeection of the above electn-
cal wiring installed at:
DATE 71) O r.?-0•? ?? +- Cit? a
Street Address ar Route No. y F-??j-
I
SITE ADDRESS j
i
TYPE OF WORK
I
APPLICANT-k,L
STREET ADDRES
Section Township_
Which is occupied by Aa'
(nama oi ......v-••••
Is a roughin inspection required on this job? Nox Yes ? Ready Now ? W? Call 11
Power Suppliec E/e` ' Address
?Gv H e Y Contractor's License No. -
Electrical Contractor
TELEPHONE # ? Mailing Address 45
?
Range County
aud -
o,
?
_2
r
P
Authorized Signatura?
(Eixtrlcal Gontracto por Owner Making This Insta latlon)
PROPERiYOWM D ?a qlp/ Thisinspeetionrequestwillnotbe'aaeptedbytfie
I State Board unless proper inspection fae ia enslosed. )0
COAAPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MIN\fSU1'r1 RULES 7670 C:A"CI:GORY I _ MIVN
(q submission type) . Residential Ventilation Category 1 Worksheet Submitted • New
. Ener9y Envelope Calculations Submitted
Plumbing Conhactor: _
Plumbing system includes:
Mechanicol Contractor:
ti[cckiimic:il scstcm includes
Sewer/Water Contractor:
Air Condiliouing
I-Ieat Rccoccra Svstcm
Phone #
Phone #
-75
?3 .5 a
;*'?'-?%CU'' ?
Code Workshee[ Su
JUl 2 4 2002
Fee: $90.00
Pcc: 570.00
---...------°-------------------------------------------------------------°°------......-----------...._._..----°--•°
I hereby acknowledge that I have read this application, state fhat the information is correct, and agree to comply
with all applicable Sfate of Minnesota Statutes and City of Eagan Ordinances.
Slgnature otApplicanf ?d26?
OFF[CE USE ONLY
_ Water SoFtener
Water Hea[er
\o. of Baths
Phone #
_ Iawn Sprinkler
No. of R.I. Baths
Certificates of Survey Received Tree Preservation Plan Received _ Not Required _
' Updated 4102
RESIDENTIAL
BUILDING PERMIT APPLICATION
cinr oF EAcaN
3830 PILOT KNOB RD, EAGAN MN 55122
851•881-4875
NewConaVUCtion Beaulramenb
• 3 repistered ske wrveys stwwing sy. tt. of bL sq. tt. of house; and pll rooted areas
(20°/ ma)timum bt coverage albwed)
• 2 capies of plan showing beem & window sizes; Doured tound design, etc.)
. 1 sBt of Enargy C2lcu12ti0ns
• 3 coples of Tree Preservalbn Pmn tl bl platled ailer 7/1/93
• Rim ,bist Detall Options selectbn sheet (bldgs wM 3 or less units)
DATE 7 1 'Z- 10+-
pemotleUNeoalr RegS IreLmeMS
• 2 copies of plan ?
• 1 set of Energy Cakulations for heated adtlitions
• 1 s8esurveyfareAerioraddttbns&decks
. Indicate n home served hy septlc system for atltlAbns
VALUAiION 1387 S. ,0o
SITE ADDRESS q 6q4O E. CT?te r.I.eQ -12- hr. MULTI-FAMILY BLDG _ Y ?
TYPE OF WORK 2¢. Qbo?-' FIREPLACE(S) _ 0 _ 1_ 2
APPLICANT ( ¢a-4lwa.s?.rl (' „SE
STREETADDRESS h617 Moxn.on'a.l /A-„e-. N CITY S?Lr STATEi?[ ZIP o Z
TELEPHONE # (o51-q3`1-'I320CELL PHONE #
FAX# (n5)-351-7,696
PROPERTYOWNER?lq?lL TELEPHONE# 1?51-44y-e2R0
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNFSOTA RULES 7670 CATEGORY 1 MINNE50TA RULES 7672
(d submission rype) . Residential Ventilation Category 1 Worksheat Submitted • New Energy Code Worksheet Su6mitted
• Errergy Envelope Calculations Su6miried
Plumbing Conhactor: --_
Plumbing system includes:
Mechanical Conhactor:
Mechanical system includes:
Sewer/Water Conhactor:
Phone #
? ?. II I I 1 u ZQQZ
I hereby acknowledge that I have read this application, state that the Information is correct and agree to comply
with all applicable State of Minnesota Statutes and City of Eagan Ordinances. ^
Signalure ofApplicant 4/,oa,
......... --°--°•°°-----......... ---°...... -........... -?..?.?._...._.?...._ ?.
OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4/02
Phone #
_ Water Softener _ L.awn Sprinkler
? Water Heater _ No. of R.I. Bath:
No. of Baths
Phone #
Air Conditioning
Heat Recovery System
?
Tlils request void 0o
] 8 months from ?T
Date of this Request Fire No. S 66531
I, as ? Licensed Electrical Contractor Owner, do hereby request inspection of the above electri-
cal wiring installed at:
Street Address or Route No. 45??d
Section Township
1Yhich is occupied 6y
Range County
Is a roughin inspection required on this job? Nox Yes ? Ready Now ? Will Call O
PowerSupplierpaola. ZFe<. , Address
Electrical Contractor ?LvN e r Contractor's License No. _
?r.........? m?..vi
Mailing Address -15
a
B!// C (??a`? ?6ry ?.t [[or or o r M nqTFlis I nstallatlon?? 3 `jDV
Authorized Signatur ?+2 a o-j ? Phone No.
(Electrlcal Contracto /?or Ownar Makln9 Thls Insta latlon)
STAT(? ?(???? f' ??? This innpection requett wili not be'aceepted by the
kS ?YJ Cr?l ?S State Boerd unless proper inspectian he is enclased.
mInne50141 01eie ooaro or uecvtcIay
? Griggs Midway Bldg. - Hoom N791 E13-00001-02
7821 Universiry Ave., St. Paul, Minn. 55104 - Phone 297-271
REQUEST FOR ELECTRICAL INSPECTION
CIICK B£LOW WOAK COVERED BY THIS REQUEST 6 6 5 31
Type of Building New Add. Rep. Check Appliances W'ved For Check Equipment Wired For
Home ? ? ? Rangc ? Tempoiary Wiring ?
Duplex ? ? ? Wa[er Heate[ ? Ligh[ing Pixtures ?
Apt. Bldg. ? ? ? Dryer ? Electric Heating ?
Commercial Bldg. ? ? ? Fumace ? Silo UNoader ?
Industria] Bidg. ? ? ? Air Conditioner ? BWk Milk Tank ?
Fatm ? [] ? Lis[ List
Othex ? ? ? p
Heicrs( Hehe?sI COMPUTE INSPECTION FEE BELOW
Service Enhance Size: it Fce Feeders&Subfeedecs: # Fee Ciccuits: # Fee
0 to 100 Am s. 0 to 30 Am eres 0 to 30 Am eres
101 to 200 Amps. 31 to 100 Amperes 31 to 100 Am eres
Above 200_Amps. Above 100 Amps. Above 100 Am s.
Transformers Remote Control Circ. Partiaf or other fee
Si ns T"N S ecial Ins ection Minimum fee $5.00
Remazkss` ? .._.. • yi1-iI¢.h.,,
ie?/ TOTALFEE
I,.the Electti s'' o fy t a e above inspection has been made. 73-??
(Rough-in) ? ?'+?? Date l/- !7 - ?'
(Final) _ / . Date t -17 - C 0
This request void
18 months from
?
535? RESiDENTIAL
? BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55722
651-681•4675
New CanstruCtion Reauirements
. J registerea si[e surveys snowmg sq. ft. of:ol. sq. R. of house; and all roofeC areas
120% maximum lot coverage allowed)
• 2 copies of plan showing beam 5 window ;lzes: poured found design, etc.)
• 1 set of Energy Calculations
• 3 copies of Tree Preservation Plan i( lof pla@ed after 7!1/93
• Rim Joist Oetail Options selec[ion shee[ (6ldgs with 3 or less units)
DATE 7 I l9 I D Z
1 ? } -7s
RemadeNteoair Reauirements
• 2 topies of plan
• 1 set of Energy CaICWalions for heated addilions
. 1 site survey for aztenor additions & decks
. Indicate if home served 6y septic sys[em Por additions
VALUATION -01111117 1f 7 50' (210
SI7E ADDRESS 1 I5LI C) E. GM ehI aY ?.?.C. MULTI-FAMILY BLDG Y oooN
TYPE Of WORK 17eSk82, FIREPLACE(S) _ 0_ 1 _ 2
APPLICANT li1 Cong?. CjD -
STREETADDRESS 5(0q7 M4ntor)a.I Av/L !V, CITY S?:?Iww?Cr STATE44A/ZIP 65097-.
TELEPHONE # 651- y39-(4320 CELL PHONE # FAX #& 51- 35)- ZD54
PROPERTYOWNER_Tal ICe1I.1 TELEPHONE#6SI-2gl- W00
------------------------------------°---------------------------------------------------------
COMPLETE THIS SECTlON FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category M[NyF.50TA 12UI.ES 7670 CATF:('.ORY f MIN N V!*Ik =
?
submissiontype) • Residential Ventilation Category 1 Worksheet Suhmitted ode Wnorksheet
- Energy Envelope Calculatlons Submitted Ul 4 4 201
Plumbing Conhacfor:
Plumbing system include •s:
Mechanical Conhactor.
Mcckimical svstcm includes:
Sewer/Water Contraetor:
_ Water SoFtener
Water Heater _
No. of Baths
Air CondiUOiiiiig
Heal Recoven' Svstem
Phone #
---------------------°-----. _.....----- -----------------------------° ° °----° ----------------------- • --------------- • -
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply
wiih all applicable State of Minnesota Statutes and City of Eagan Ordinances.
Slgnature of Applicani ?0?
OFFICE USE ONLY
P}lORC # .
Larm Spnnkler
No. of R.I. Baths
Phone #
Fee: $90.00
Fec 570.00
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
llpdated 4102
? ?? a I RESIDENTIAL
BUILDING PERMIT APPLICATION
GTY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651-881-4875
New Conatruction ReouiremeMs
• 3 regislered stle sunreys ahowing sq. il, of bt sq. R of house; antl all rooted areas
(2D°/ maximum lot coverage albwed)
• 2 copies of plen showing beam & wlndow sizes; poured fountl design, etc.)
• 1 setofEneyyCakulations
• 3 coples of Tree Preservatbn Pian If bt platled atter 7/1193
• Rim Joist Detail Optbns seledbn sheet (bidgs w0h 3 ar less unAS)
RemodeUReoalrReaufremeMS ?'??l f , 1,S
• 2 ?pies of plan I
• 1 9et of Energy Calculations lor heated addttbns
• 1 silesurveyroraxterloradditions8decks
• Indk;ate 8 hane serred by sepNc system for addBbns
DATE 7 12- VALUATION 6 8 7 S. ,oo
SITEADDRESS YSNO E. C?r ,IPQ-r- ??. MULTI-FAMILYBLDG _ Y ?
TYPE OF WORK 12z oo,C- FIREPLACE(S) _ 0 _ 1_ 2
APPLICANT W eo. ya., C' ,,c}
STREETADDRESS h(ab Mznt.o,no,.l ;4-„m- . N CIN SIvllLj-erSTATE&a ZIP S5o6Z
TELEPHONE# (a5I-439-,4320CEL1. PHONE# FAX# ?a5)-35?-7,n9{?
PROPERTY
TELEPHONE # lo5)-9y14 - e250
° ----- ° --------------------- ----------------- ---------°-----------------------------------°
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNESOTA RULFS 7670 CA1'EGORY 1 MINNESOTA RULES 7672
(4 submission type) • Residential VeMilation Category 1 Worksheet Su6milted • New Energy Code Worksheet Submitted
• Enargy Envelope Calculations Submitted
Plumbing Conhactor: ___
Plumbing system includes:
Mechanlcal Contractor:
Mechanical system includes:
Sewer/Water Contractor:
_ Air Conditioning
_ Heat Recovery System
Phone #
Phone #
? ?122oa2 ?
I hereby acknowledge that I have read this application, state that the Information (s correct, and agree to comply
with all applicable State of Minnesota Statutes and City of Eagan Ordinances. ^
SignalureofApplicant Z.--
_ Water Softener
? Water Heater
? No. of Baths
Phone #
_ Iawn Spruikler
_ No. of R.I. Batt
------°-----------......... _............ ........ ...... -------.?°.?._............._..?..--
OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Ptan Received _ Not Required _
Updated 4/02
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CITY OF EAGAN
SEWER & i1ATEH CONNECTION CFiARGES - 1989
EXISTING PROPERTIES
SEFIER CONNECTION C89RGES
SAC
Previously Pd.
Receipt #
ACCOUNT DEPOSIT
SEWER PERMIT
TOTAL:
TOTAL FOR SEWER & WATER HOOK-UP:
$ 675.00
15.00
10.50
$ 700.50
W9TE8 CONNECTION CHAAGES
WATEB CONNECTION $
Previously Pd.
Receipt II
WATER METER 90.00
TREATMENT SURCHARGE 228.00
ACCOUNT DEP0.SIT 15.00
WATER PERMIT 10.50
PLUMBING PERMIT 12.50
TOTAL: $ 936.00
#t,636.50
OFFICE USE ONLY
PHOPERTY OWNER:
ADDAESS s "A S
Ls B:-L ADDt t?a? - ??+Y-.`?
?H? ?? ?, ?? -???o g
mu- k
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580.00
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CITY OF EAGAN Remarks
Addit(on SOUth Oaka Lot 2 Blk ] Parcel ],QT1,300..g2.ge}
Owner I'' . -,` . gt,mt 4540 Gt'eenleaf nr V& 11?L3'-Siate Eagaa,6ID7 $51$11
Improvement Date Amount Annual Years Paymant Peceipt Date
STREETSURF.
STREET RESTOR.
GRAOING
SAN SEW TRUNK 198 'JQ.QQ 24•(j''/ 15
SEWER LATERAL
WATEflMAIN
WATER LATERAL
WATER AREA
STORM SEW TRK -61 19$4 617.00 41.13 15
STOflM SEW LAT
CURB & GUTTER
SIOEWAIK
STREET LIGHT
27.50 2886 5-11-76
WATEq CONN,
BUILDING PEp,
SAC
PARK
1
70"
• ?? { o iJ
l..f?0 W 0 W 0?
, 0941
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AAZVER OF HEARING OF SPECIAL ASSIGNMENT
City Project No. 536
I/We herehy request and authorize the City of Eagan, MN (Dakota Co.) to
assess the following described property owned by me/us:
Lot 2 Block 1 South Oaks Addition
for the benefit received from the following improvements, constructed under City
Yroject No. 536, Said assessments have been preliminarily computed as follows:
ITEM OIIANTITY RATE AMOIINT PROJEC
Sanitary Sewer
I.ateral 1 ea/lot 3,943.00 $3,943.00 536
Water main Trunk
Atea 1 ea/lot 655.00 655.00 536
Water main Lateral 1 ea/lot 3,252.00 3,252.00 536
Services 1 ea/lot 929.00 929.00 536
Storm Sewer 1 ea/lot 934.00 934.00 536
Street 1 ea/lot 7,361.00 7,361.00 536
TOTAL S 17.074.00
to be spread over 15 years at an annual interest rate of 98 against any remaining
unpaid balance.
The undersigned, for themselves, their heirs, executors, administrators,
successors and assigns, hereby waive notice of any and all hearings necessary,
and waive objections to any technical defects in any proceedings related to these
assessments, and further waive the right to object to or appeal from these
assessments made pursuant to this agree ent./??
Dated: ° ,??
Mark F. Chamberland
Mary . Chamberland
STATE OF-rU % I7 )
)SS
COIINTY OF ?)RX o rl? )
On this lo' day of 's before me a
N,yotary Public within and for said Co ty, personally appeared
G??Fff1'??Y?P[,Rl?17and ? .e?/ i?.f]O to me
pers&ially to be the personS described in and who executed the foregoing
instrument and acknowledged that executed the same as
free act and deed
/7W / i/J ?
------------------------ ----------
MAAItYN L WUCHERPfENNIG AP ROV#
NO'AHV PUBLLExp INNES(ifiA '
??? Public Works Direc
(I? DAKOTA UNTY Eagan
V?:lr My Commi:sion Feb 8. 1 99?
CITY OF EAGAN Remarks
Addition SOUth Daka Lot 2 Blk 1 Parcel 19 73200 829-0I
- aa
Owner !' ,.. , ?e123
? Street 4540 GrP _nl a Tl_r. State E8rj?1AsA?1
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRAOING
SANSEWTRUNK 1984 70.00 24•67 15
SEWER LATERAL
WATERMAIN
WATER LATERAL
WATER AREA
STORM SEW TRK K 1984 617.00 41.13 15
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
27.50 2886 5-11-76
WATEfl CONN.
BUILOING PER.
SAC
PARK
I
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- PHONE: 225•5696 904 CHRISTENSEN LANE
WEST ST. PAUL, MINN. 55118
GENERAL BUILDING CONTRACTOR
WALTER GRETSFELD
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MASTER CARD
LOCATION ycs`yo a / -d??cae,?.
oW????-,?-(',??.???
STRUCTURE AND
LAND USED AS OEIC? A, -AL-
Permi} No. '
I Issued Issued To
Contractor Owner
BUILDING j 93 3 j
PLUMBING
CESSPOOL - SEPTIC TANK
WELL
ELECTRICAL
HEATING
GAS INSTALLING
SANITARY SEWER
OTHER I
i
OTHER I
Items Approved
(Initial)
Date
Remarks
Distance From Well
FOOTING SEPTIC
FOUNDATION CESSPOOL
FFiAMING - TILE FIELD FT.
fINAL
ELECTRICAL
HE.4TING DEPTH
OF WELI
GAS INSTALIATION
SEPTIC TANK
GFSSPOOL I
DRAINFIELD
PLUMBING
WELL
SANITARY SEWER
Violafions Noted
on Back
COMMENTS:
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 4540 Greenleaf Dr E
Lot: 2 Block: 1 Addition: South Oaks
PID:10- 71200 - 020 -01
Use:
Description:
Sub Type: e- Windows/Doors
Work Type: Windows/Doors - New/Replacement
Description: House
Census Code: 434 -
Zoning:
Square Feet: 0
Comments:
Fee Summary:
Valuation: 2,000.00
Contractor:
Windows Plus
6850 Kane Ave
Prior Lake MN 55372
(952) 224 -8358
Applicant/Permitee: Signature
PERMIT
City of Eaan
If altering the opening size, a framing inspection is required. Smoke detec tors are required in all sleeping rooms prior to
final inspection. When wall studs or ceiling joists are exposed, hard -wired detectors are required Bat tery operated types
are acceptable if the wall/ceiling finish (i.e. sheetroc k) has to be removed to install a smoke detector. Peter Lucca 6850 K
ne Ave Prior Lake, MN 55372 952- 440 -6370 windowsplusl @integraonline.com
Surcharge - Based on Valuation $2K
BL - Base Fee $2K
Total:
- Applicant -
Construction Type:
Occupancy:
$1.00
$69.00
$70.00
Owner:
John D Kelley
4540 Greenleaf Dr E
Eagan MN 55123
Permit Type:
Permit Number:
Date Issued:
Permit Category:
9001
0801
Building
EA076262
12/26/2006
ePermit
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.
Issued By: Signature
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Use BLUE or BLACK Ink
For Office Use
j Permit
City of Evan 1
Permit Fee: o
3830 Pilot Knob Road
Eagan MN 55122 Date Received:
Phone: (651)675-5675
Fax: (651) 675-5694 1 Staff. I
I
- - - - - - - -
2013 RESIDENTIAL rBUILDING PERMIT APPLICATION
Date: Site Address: L4~_l,r Unit Name: fir- - Phone: Loci - q I _ ~ bqn
Resident/
Owner Address / City / Zip:
i
F Applicant is: Owner Contractor
l Type of Work Description of work,
Fm~ _ Construction Cost: Multi-Family Building: (Yes / No
Company: CfCYST Co Tnr Contact I,CC~
3 i Address:
i ~ "1 1 t'i ~l Ve .1~ City: ST7 I lldlxL'
Contractor
State:
L4
(hN Zip: S5 Oa Phone: (2)5 L4 _?e1 - -r 'j g(')
I License Lead Certificate #:NPT- j
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: _ _ Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of 't
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 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.
P Lip ~n.o 1 ' x
Applicant's Printed Name Applic Signi
Page 1 of 3
- s 063-0(4
Use BLUE or BLACK Ink
For Office Use I
' r
j Permit City ofEa a '
I
3830 Pilot Knob Road Permit Fee:
Eagan MN 55122 I
Date Received: ay l
Phone: (651) 675-5675
I I
Fax: (651)675-5694 I
1 Staff: I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: l X3 1 r ~ Site Address: ~
•
44015
_ _ 0_ fl ~Pq-t -t fit Unit #
rN
Resident) ame: Phone:...,. Gil
-l~
Owner i Address / City ! Zip:
f ~
_ Applicant is: Owner Contractor
i
i
4 Type of Work ;Description of work: `-3
Construction Cost: Multi-Family Building: (Yes ! No
i
Company: Contact: Ir
Address: city:
7 I luu.+er
Contractor I State: Zip:- S2,13 QL- Phone:
License I XU
Lead Certificate Mir -
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:
E 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
i 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.Qo:)herstate2Qgg@ll.or
o
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 Minnesota State Building Code must be completed.within 180
days of permit Issuance.
~ xL-~l A A
XL
cant s Pnnted Name Applicant's Signature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA145936
Date Issued:09/29/2017
Permit Category:ePermit
Site Address: 4540 Greenleaf Dr E
Lot:2 Block: 1 Addition: South Oaks
PID:10-71200-01-020
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.
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 -
John D Kelley
4540 Greenleaf Dr E
Eagan MN 55123
Weatherguard Construction
10860 60th St N
Stillwater MN 55082
(651) 439-4320
Applicant/Permitee: Signature Issued By: Signature
For Office Use
+ ire
Permit#:
Permit Fee: 1 ti,ar6
4.r'•",„ r)Ei E \I g f } Date Received: •
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 Off
(651)675-5675 TDD:(651)454-8535 I FAX: (651)675-5694 JUN 2 8 2018 Staff: ago
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2018 RESIDENTIAL BUILDING PERMIT APPLICATION ��-"'' 1,IS*
Date: Site Address: Unit#:
Name: k..1la e_i< C� 3.1� ti h 1 k Y'►2 K 1 1 e T Phone: L j or 1(Q—I' 1 0
ii',:;11::::"'0,1411,043 Address/City/Zip: V/O .4 -el v Le 0* 0 ,r)5 14=3
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Applicant is: Owner // Contractor
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Description of work: L j 1 el A.4%C. *►�� w�. 1<C, t A- S it 14 C syn 5%% 11
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Construction Cost: , D Multi-Family Building:(Yes /No )
Company: P,t) VI 510 C..(-3 let,let,`71 Contact: Wit I
Address: l 3 7 1<V4ii_ -vv,t4 v.''S wA-j City: Ir- Or 111",
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State:'1�.^ Zip: 57 i a-7 Phone: zl'3 -:. $7o Email:WI ��-e0 ca.-54d Ne -
License#: 4,0a% . Lead Certificate#: f 14 :5-60 J(o —a
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:
NOTA ** ,. m�irng�Mrten F-' ' $* 4 ,�-c b ...,
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.citvofeagan.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 plans.
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Applicant's Printed Name Applicant's Signature
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DO NOT WRITE BELOW THIS LINE t I C3
SUB TYPES
Foundation _ Fireplace —
Porch(3-Season) _ Exterior Alteration(Single Family)
iX Single Family _ Garage _ Porch(4-Season) _ Exterior Alteration(Multi)
Multi _ Deck _ Porch(Screen/Gazebo/Pergola) _ Miscellaneous
01 of_Plex — Lower Level _ Pool _ Accessory Building
WORK TYPES
New _ Interior Improvement _ Siding _ Demolish Building*
_ Addition _ Move Building _ Reroof _ Demolish Interior
__X,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 641CLO Occupancy ,; , . MCES System
Plan Review Code Edition leneur4011 SAC Units
(25%_100% ) Zoning City Water
Census Code Stories Booster Pump
#of Units Square Feet PRV
#of Buildings Length Fire Suppression Required
Type of Construction tf3
— Width
REQUIRED INSPECTIONS
Footings(New Building) Meter Size:
Footings(Deck) Final/C.O. Required
Footings (Addition) X Final/No C.O. Required
Foundation HVAC_Gas Service Test Gas Line Air Test
Roof:_Ice&Water _Final Pool:_Footings _Air/Gas Tests _Final
Framing 30 Minutes 1 Hour Drain Tile
X, Fireplace: )(Rough In )(Air Test rinal Siding:_Stucco Lath _Stone Lath _Brick
x; Insulation Windows
Sheathing Retaining Wall:_Footings_Backfill Final
Sheetrock Radon Control
Fire Walls Fire Suppression:_Rough In_Final
Braced Walls Erosion Control
Shower Pan .+ Other:
—
Reviewed By: I ,Building Inspector
RESIDENTIAL FEES
Base Fee Of C in
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Surcharge kAt
Plan Review 0417-1Y
(,
MCES SAC
City SAC 1)
Utility Connection Charge r 7.„0„.....!:: `
SSW Permit&Surcharge
Treatment Plant
Copies
TOTAL
Page 2 of 3
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA176356
Date Issued:05/12/2022
Permit Category:ePermit
Site Address: 4540 Greenleaf Dr E
Lot:2 Block: 1 Addition: South Oaks
PID:10-71200-01-020
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.
If water damage is encountered, please call (651) 675-5675 to schedule a site visit to verify the extent of the damage. Any
repairs must be inspected prior to covering. The inspector will determine if an additional permit will be required to repair the
water damage.
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 -
John D & Jennifer M Kelley
4540 Greenleaf Dr
Eagan MN 55123
Evergreen Construction Company Inc
1200 Centre Pointe Curve, #175
St Paul MN 55120
(651) 209-3130
Applicant/Permitee: Signature Issued By: Signature