4650 Kingsbury DrCASH RECEIPT
CITY OF EAGAN
3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE
RECEIVED
FROM
19
AMOUNT $ I
& DOLLARS
1 oo
? CASH F-I CHECK
FOR
UND COOE AfAOUNT
Thank You ?
B V
- '
White-Payers Copy
Yellow-Poating Copy
Pink-File Copy
? ----- _ ----------------
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
I Eagan, Minnesota 55122-1897 Date Issued:
( (612) 681-4675
? Pt ti? ?',i7E 4 ti ? t7'
SITE ADDRESS: APPLICANT:
,,.
if W ??N ?! ?! 1 t c, t.• , ,' stt ? t c?r,.?
PERMIT SUBTYPE:
th, I
TYPE OF WORK:
i: F t" r1 'f k
F;t)la(`TN
k0M 1 N
.1, .
Parmit No. Parmit Holder Dete Telephone M
ELECTRIC
PLUMBING
HVAC
Inspection Dats Insp. Commenta
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYPBOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
Receipt ? PLUMBING PERMIT Permit No.
CITY OF EAGAN
Fee
fill !n numbered spaces S/C
Type or Print /egibty _
Tot. I
1. Date 2. Installation Cost '
3. Job Address Lotv " Blk. Tract
? I
4. Owner i
I
5. Contractor ' - Phone "
6. Address
7. City State Zip _ I
8. Building Type: Residential 0 Commercial ? Institutional ?
9. Work Description: New ? Add ? Alter ? Repair ?
10. Describe
11.
No. Fixtures
Water Closet No. Fixtures
Ce
l/Dr
i
field
_ Bath tubs n
sspoo
a
Se
tic Tank
Lavatory p
Softner
Shower Well
_ Kitchen Sink
Urinal/Bidet Othe
_
Laundry Tray r
Floor Drains
Drinking Ftn.
Slop Sink
Gas Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed :
for
Rough Final
Inspections: Date Insp. Date _ Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
CITY OF EAGAN Remarks
Addition BEACON HILL ADDITION Lot 8 plk 4 Parcel 10 13500 OSO 04
Owner.0 st,eet 4650 Kingsbury Drive state EaQan, MRd 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREETSURF. 1982 1806.93 200.77 9 1806.93 C007580 10-1-81
STREET RESTOR.
GRADING 95 1982 526.46 58.50 9 526.46 C007580 10-1-81
SAN SEW TRUNK ' Q
* SEWERLATERAL 1982 3116.46 346.27 9 311 .46 C007580 10-1- 1
WATERMAIN
* WATER LATERAL I982 J
WATER AREA 1982 198.01 22.00 9 198.01 C007580 10-1-81
* Stubs 1982 9
STORMSEW TRK (? Z 1982 359.82 39.98 9 359.82 C007580 10-1-81
* STORM SEW LAT 19$2 9
CURB & GUTTER
SIDEWALK
STREET LIGHT
Ro
WATER CONN. 19
BUILDING PER. 6716
sac 1981
PARK
„ ?i'C?aR?d toM 4
.? .
BUILDING PERMIT
Te be used fer ,
(034 Ca+tibm tlWE Ar• LIt BS1 Bfacen 14 Us
CITY OF EAGAN
3795 Pilot Knob Road Eagan, MN 55122 N2 6716
PHONE: 454-8100
Receipt .# 67_0$` -7 _ _
$ite Address tlb Sb tC ( i?e S l l,i p r•
Lot g Block Sec/Sub.
Parcel #
lx Nome
W
; Address ?' "1 ??82'riEl Iid.
o - _ - • ;1 tcm
o Nome _
Erect p Occupancy
Alter ? Zoning
Repnir ? Fire Zone
Enlarge ? Type of Const.
Move ? # Stories
Dertrolish ? Front fr.
Grade ? Depth fr.
Aoorovals Fees
OU Address Assessment Permit
F C. Phone Water 8 Sew. Surchorge
F Police Plan check
WW Name Fire SAC
?
?? Address Eng. Water Conn.
aW Ci Phone Plonner WaterMeter
Council Rood Unit
I hereby eckrrowledge that I have read this application ond state that gldg. Off.
the informotion is correct ond agree to mmply with all applicoble - State of Minnesota Statutes and Ciry of Eagnn Ordinances. APC Total
Signoture of Permittee
A Building Permit is issued to: ` on the express condition thot
all work sholl be done in eccordunce wiTh oll applicable State of Minnesota Statutes and City of Eogan Ordinances.
Building Officicl
P*nsit #
- pab larW PawIIfM
Plumbin9 2q3b a. Y.I\Z - ?2 0. f\,
Mechonical A(p?U -£r? 4j) F ( r
Tq8-7a g' tc- t
INSPECTIONS DATE ibo(.1siVF_ INSP• Rough-In Final
FoOtings - DaTe Ins . Date Irop.
Foundation Plumbing t- 0 ?
Frame / ins. .Qf Mechanica I _
Final - ? ?
Remarks:
Receipt PLUMBING PERMIT Permit No. .? 3 '*X-
CITY OF EAGAN
Fee
Fill in numbered spaces S/C
Type or Print /egib/y
Tot.
1. Date 2. Installation Cost
4(usc, Kcrqsbur.*'b r,
3. Job Address Lot Blk. ?7 Tract
4. Owner
5. Contractor Phone
6. Address - ; ?
7. CitY ? State ?' ::?i: Zip `.
8. Building Type: Residential El, Commercial ? Institutional 0
9. Work Description: New,Q Add ? Alter ? flepair ?
10. Describe
11.
No. Fixtures
Water Closet No. Fixtures
ool/Drainfield
CesS
_ Bath tubs p
Septic Tank
_ Lavatory Softner
_ Shower Well
Kitchen Sink
Urinal/Bidet Other
_ Laundry Tray
Floor Drains
Drinking Ftn.
Slop Sink
Gas Piping Outlets
- ?.
12. I hereby certify that the aboye 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.
ARproved CITY OF EAGAN
454-87 00
Receipt MECHANICAL PERMIT
CITY OF EAGAN
Fill in numbered spaces
Type or Prini/egib/y
1. Date -1l,-$1
2. Insiallation Cost
Permit No.
Fee
S/C
Tot.
3. Job Address Lot Blk. Tract
4. Owner •
5. Contractor -? -?`i ?, . • Phone
6. Address «??37 Ck13C?;?7ci o.
7. City . State :!. Zip jri'
8. Building Type: Residential El
9. Work Description: New ?
Commercial O Institutional ?
Add ? Alter ? Repair ?
10. Describe ?. °ceci aiI' he, :t nLfuelType :Tat g,.:
11.
No.
? Equioment 9TU - M. Ea.
Forced Air No. Equipment CFM
Ai
H
dli
Mfg. r
an
ng:
? Boilers
Mfg, - Mech. Exhaust
Unit Heater
Mfg. Other
_
J_ Air Cond.
Mfg.
1_ Gas, Piping Outlets
12. I hereby certify that the above information is true and correct, and 1 agree to
, comply with ?Il ardinances and codes governing this type of work.
Signed : for
i
f Rough Final
IAspections: Date Insp. Date Insp.
+• This is your permit when numbered and approved.
tApproved CITY OF EAGAN 464-8100
?-
CITY OF EAGAN
9795 PNof Knob Roed Eegan, MN 55142 -.'r . _) e
PHONEs 454-8100
BUILDING PERMIT ReceiPt #
To be w.d hr DECK Ese_voiue $2,000 oatP June 20 1953
Siro Addreu 4650 t:inaabury Drive
Lot 8- Biock _}_ $ea/Sub. Beacon Hill
pa,ui # 10 13500 080 04
W Name -- llarold Htivden
; Add^ess 4650 Kin$sburv Drive
? Name Owtler
Z
o?u Address
Nome _
Addresa
I hereby acknowledge that 1 hove read this opplication and stote that
the informotion is correct ond agree to comply with ull applicnbla
State of Minnesoto Stotutes amd, City of Eagan Ordinonces.
Sipnoture of Permittee P-f ? , ???r '
aro d Hay en
Erect }M Occuponcy
Alter ? Zoniny
Repolr ? FIrc Zone
Enlarpe ? Type of Const.
Move ? ,{k Stories
Demolish ? Length
Grode ? Depth Sq. Ft.-
AvVrorals Faes
Assessment Permit 32.50
Water 8 Sew. Surcherge 1.00
Police Plan check
Fire SAG
Eny. Water Conn.
Planner Woter Meter
Council Road Unit
Bldg
Off
.
.
APC
Total
A Building Permit Is issued to: on tha express cordition thai
all work sholl be done in accordonce with all applicable Srote of Minnesoto Stmutes ond City of Eoqan Ordinances.
Buildinp Official --
.<_
Parmit No. Permit Halder Mise. Psrmit No. Holder
Mesa
Plumbing
H.V.A.C.
Wall
Wrtar
Disp.
Sawer
Eketric
InspeMion Date Insp. Other
Footings -j7 w
Foundetion
Framinp
Rouph Plbp.
Rouph HVAC
Inwlation
Final Plb¢
Final HVAC
Final ?
Watar Deuri6e Location:
Wel I
Sewer
Pr. Dbp.
cirr :F EAGAN SEWER SERVICE PERMIT
3795 Pllat Knob Rood PERMIT NO.:
Eagan, MN 55122 DATE:
ZO^'^g: No. of Units:
Owner:
Address:
Site Address: -
Plumber.
I aarea M ownon, wRh eM Cky of Eagon Connedion Charge:
Ordiaanees. Account Deposit:
Permit Fee: .
Surcharge:
By Misc. Chorges:
Date of Insp.: Total:
I'5p.: D
t
P
id
c
e
a
:
' EAGAN
3: 05 Fsiot Knob Road
Eagan, MN 5512Z -
Zoning:
Owner:
Addtess: ..S'O
Site Address:
Plumber.
Meter No.:
Size:
Reoder No.:
I e9?ee to eomplr wkh !6a Gfy of Eagon
Ordinaneos.
By
Dote of Insp.:
WATER SERVICE PERMIT
PERMIT NO.:
DATE: _
No. of Unirs:
2
?
Connection Chorge:
Account Deposit:
Permit Fee:
Surcharge:
Mlsc. Chorges:
Totol:
Date Paid: ?
?
WATER SERVICE PERMIT
CITY OF EAGAN
3)55 PiIM Knob Road PERMIT NO.:
Eagan, MN 55112 DATE:
Zoning: No. of Units:
Owner
. -
Address:
Site Address: . r I? "l Ylt'aCLrI "111.1-`
Plumber: ---
Meter No.: Connection Charge:
S Acwunt Deposit:
ize:
R
N
d Permit Fee:
o.:
ea
er
n
Cit
f E
l
i
h
h
I Surcharge:
y o
aga
y w
a
agree M eomp
F
!
Charges:
Misc
Ordinanees. .
Total:
Dote Paid:
gy
Date of Insp
: Insp•:
.
CITY OF EAGAN SEVNER SERVICE PERMIT
8713 Pilaf Kno6 Road PERMIT NO.:
Eagan, MN 55122 DATE:
ZO^i^9: No. of Units:
Owner:
Address:
Site Address:
Plumber.
1 ogrea to oomply with iM Cify of Eagon Connection Chorge:
Ordinaneet. Account Deposit:
Permit Fee:
Surcharge:
BY Misc. CFwrges:
Date of Insp.: Total;
Ir15D.: . 1),.ha On:.l•
CITY OF EAGAN Include 2 sets of plans,
. ? ? 1 site plan w/el,evations &
BUILDING PERNILT APPLICATION 1 set of energy calculations.
Zb Be Used For ?le c Valuation `;q(??OO Date c,rl C o7d /Y-9 3
51t2 Addr2SS: !{Gi .5 n K inu S LJdV [/?iJP
Lot $ Block ? Sec./Sub"y\, 4A(
Parcel #: (D d
Owner: ioto r a li /A vW1. N
Address: v
City/Zip Code: ?a s ? Z Z
Pnone #:
Contractor: ,?
?E??
Address: ?
Gity/Zip Code:
Phone #: ?j
Arch./B7ig. :
Address:
City/Zip Code:
Phone #:
OFFIGE USE ONLY
Erect ? Occupancy _
Alter Zoning
Repair Fire Zone
Enlarge 'Iype of Const.
Nbve # Stories
Demolish Front ft.
Grade Depth ft.
APPROVAI,S FEES
Assessments ' PeYnut
Water/Seaer Surcharge /
--
Police Plan Check
T
Fire SAC
Eng, water Conn.
Planner Water Meter
CounCil Road Unit
Bldg. Off.
APC
? -
TarAL
mmnesVaa aia[n noara or uecancIry
Griggs Midway Bldg. - Room N191 E? 00 ? 2_f?
. 582f University Ave., St. Paul, Minn. 55104 - Phone 297-2111 ?_Ee
REQUEST FOR ELECTRICAL INSPECTION
CHECK BELnNLWORK COVERED BY THIS REOUEST T 49728
Type of Building Ne Add. Rep. Check Appliances Wired Foc Check Equipment Wired For
Home ? ? Range poi Temporary Wiring ?
Duplex ? ? Water Heater Lighting Fixtures ?
. Bldg.
?
?
?
Dryer
Electric Heating .
"U
imetcial Bldg. ? ? ? Furnace Silo Unloader ?
ndustrial Bldg. ? ? ? Ait Conditionec Bulk Milk Tank ?
Farm ? ? ? List List
Other ? ? ? o
Heiers? Hehe=S?
COMPUTE INSPECTION FEE BELOW ao 'a0
Service Entrance Size: # Fee Feedera&Subfeeders: # Fee Circuita: # Fee
0 to 100 Am s. 10 0 to 30 Am eres 0 to 30 Am eres
101 to 200 Amps. 1 31 to 100 Amperes 31 to 1
Amperes
Above 200 A Amps. 4
Above 1mps.
Tcansformers 1 RemoteControlCi:c. Partialofee
Signs Special Ins ection Minimum fee $5.00
Remarks
?'
1
TOTALFEE y? 0
1, the E1 Q"" trica7'Inspector, hereby cer ' •at e iqspection has beeg.ma ?
(Rougha'?r Date ?
(Final) Date
This request void
18 months from
This request"void°? LB', 3V, BFc?ai i v q7 c o d
18 months from
?
Date of this Request ? 1 JSC ? Fire No. ?48728
I, a}?Licensed Electrical Contractor ? Owner, do hereby request inspection of the above electri-
cal a•ln?g installed at:
Street Address or Route No, ?tY E?.? ?
*on Township
R?ge County ?
Which is occupied by
(Name of Occupant)
!s a roughin inspection required on this job? No O Ye.0( Ready Now O Will Cal}04
Power 3upplier kh Address W-h io 4 Tzy
Electrical Contractor C- _
Contractor's License NADI-T
` (Company Name)
Mailing Address n [uw- AaAA
< <?a? ncracto or Owner Making This Installatlon)
Authorized Signature ` ° ?q P
Phone Nu. LS j,D` S?vJ
iiacuicar?onvactor or Owner Making This Installatlon) ---'-?
20??O CU" ??Y This inspectian request will not he accepted by the
w fn1L1U State Board unless proper inspection fee is enclosed.
iUr#iftrttt.e? nf wrrupttnrij
Citp, of (Eagan ' " .. :
- . . . , _.
, EP}iMTftltPttt ii# Bltilat2tg lIw#iPl't[11ti . , --
-
. .. _ . ; sjy:? .??
Thir Ce+ti ficate u.rucd ?rrruant to tbt,rcquisrmenu of 3uaon .306 0/ tlx Uniform Building
Codc arti f ying ihat at thc timr o f i.anana tbi.c tlruituri wai in cmnplianci with the variour
ordinanas of thcCity rrgrdating bnilding connruction or ux Foi thr follounng: -'
g ;.
- -SF'DWG/GARtxY4r}5'??g?>???? 6l16
IHe Cymffkayao &de. Permit No
00-warTYoe R3 Tywc?uw v FiroZone NA ' u" n;.mn Rl
a,= of?„. Centes Homes •,;,d,? 8601 Darnel Rd., Eden Prai
B,,,,;,gA,,,m 4650 Kingsbury Dr. ?ty Lot B,Block 4,Beacon Hill
by
_ eWMingofficial Dau September 28, 19$1
, . . , ? . . . . , s; .. 1':
' rosi w w ew?ncuou? wwci .
ooeea ?e, -- --- --
urno?x u.vn.
G?. ?? ?1L l.? Y lP(?
w /? ?.Y 1 Z OF F-AaV'P
? BLTILDING PE:RMIT APPLICATION
To Be Used For
Addres
valuation
n
L3-19?t $F0,c611-
Include 2 sets of plans,
1 site plan w/elevations &
1 set of energy calculations.
_ Date ?? /??
OFFICE USE OAILY
Sl? S. ?r.z?-. y . .... . . -?..
` T n
Ipt ? Block ? Sec.fSub. a_x Erect` X ???1'
Q / ? Q ??r Zoning ??-
1 ? J? s C7 O pair Fire Zone
Parcel #: v
Enlarge `iype of Const.
Owner: Nbve # Stories
Address: Dennlish _ Front ° fft.
t.
Grade Depth _ y?-
City/Zip Code: yf?
Pr,one #: 9y1-106& ' APpFOvALs FEES
Contractor: ?al2n?
Address:
CityJZip Code:
Phone #:
Arch. /?'ig. : _ -_!5z?" C
Adciress:
Assessments peam-t 'Z?? ?
Water/Sewer
Surcharge o?
S
Police Plan Check / 0 7
Fire SAC ?sTJ
Eng. Water Conn. 33s
planner . Water Meter
`
?--
Council _ Road Unit / ?
?
Bldg. Off.
APC
City/Zip Code:
Phone #,.
? - - CITY OF EAGAN
?J /?? k?? 3795 Pilot Knob Rood Eagan, MN 55122
55,6? ?PHONE: 4548100
`7
BUILDING PERMIT APPLICATION Receipt
To 6e uaed f? .Sr' M'r/GAR Est. Volue $100.000 Date _
Site Address
Lot Block Sec/Sub. BeBCOII Hill8
Parcel # l(1 1,3500 Q10 05
s Name .C2Slt?]LflOmr+R
3 Address 8601 Darnel Rd.
? _ _ _ _. Ai t GLT
W. Name ?1nLT -
?
?? Address
f !':+.. DMnnn
Nome
Address
I hereby acknowledge that I hove read this application and state that
the information is correct and ugree to comply with all applicable
Stote of Minnesota Statutes and City of Eagan Ordinances.
N° 6716
# ar5? ? ?
Erect ol Occupancy
Alter ? Zoning RI -
Repair ? Fire Zone NA
Enlarge ? Type of Const. Y
Move ? # Stories -
Demolish ? Front 60 ff.
Grade ? Depth 42 ft.
Aoorovols Fees
Assessment _
Water & Sew
Police
Fire
Eng.
Plonner -
Council -
Bldg. Off. _
APC
Permit 1
Surcharge 50.00
Plan checlc107.7L
5AC 525.00
Water Conn. 335-00
n
WaterMeter 60_0
Road Unit 185 _ 00
Total $1478_25
Signature of Pertnittee I
A Building Permit is issued to: C@At2% HOID@8 on the express condition that
oll work shall be done in occordance with all applicable Stprq of Minnesota St tes and City of Eagon Ordinances.
Building Official ? '
CITY OF EAGAN N• ? $166
3795 Pilof Knob Raod Eogon, MN 53122
" PHONE: 454-8100
BUILDING PERMIT Receipt #
Te bs ased ior DECK Est. Value $2,000 Date June 20 1 q 83
Sire Address 4650 Kingsbury Drive Erect XN OccuPOncy
Lot $ Block 4 Sec/Sub. $eaCOn H711 Alter ? Zoning
porcel # 10 13500 080 04 Repoir ? Fire Zone
W Name Darold Hayden
9 z Addreu 4650 Kingsbury Drive
rl...Eaizan 55122 06..__
p Name Owner
r
?? Address
~ Cit Phone
u?
W Name
FW
?? Address
<'Z" Ciri Phone
I hereby acknowledge that 1 hove read this application and state that
the informotion is correct ond ogree to comply with all opplicoble
State of Minnesota Smtutes City f ogag ?OLrdisonces.
/ fs ?
Signafure of Permittee
A Building Permif is issued t aro ay en
o:
all work sholl be done in accordonce with ell oppliwble
8uilding Offfciol
Enlarge Q Type of Const.
Move p # Stories
Demolish ? Length
Grode ? Depth Sq. Ft.-
Approvals Fees
Assessment _
Water & Sew.
Police
Fire
Eng.
Planner -
Council _
Bldg. Off. _
APC
Permit 'J°'-"v
Surchorge 1.00
Plan check
SAC
Water Conn.
Water Meter
Rood Unit
Total $3-1-5n
Minnewta
on the express condition thn+
and City of Eagan Ordinontea.
jo?Yi?f7?i.'.',i:??:4iCi.•`,:}?Si(?)?O??.?iY.!i?...?n..uGY?Il?:s:?!;1:.?..J`}?`?;f.iU)?C.B???:Fi:?C)i:')?i
C:f.'r4' Of-- EAGF:N
('! a?ne ..a
?"n,i:?_I'i'?::1?`u T
..:-,...:?,..,_.t. .: ?::??1,N.!.IVi1I... ii:J,? ;,1.
T„ti j??:r. ? :'::11:J:ii `7ir, ?T ?i'i:'. _ f .?1: , ; ;t?j
r .. i.
.IP-.V.... ,?..... _?...?.??r.,
\h',i ;iC.. '. `'if? ?' ;::.?•i ?:'??.'I?_?f. ..1\la
F
`:}•.i?j(l :,^(jj'}•i ?.(:.r.:?j.} i;.j.r??..r?.????_? t.. \ea:}AFI.?'... ?f (?. ??•.,(?
. . . ........ .??...._: ..r._...)
jl.ic:?cr 9001 r.i.F??.`7[1 ?'l'\?n? ,?i ??...1?:.?-%Ijt.i?.. `?? i.50
_.i..._..l ... _ r?l';?;1.?. ,..'(:PC?"i
•}cr
_ ?..? .k:? ?: (-?,4;;'i?_''^:'?; ? „ i _ .i..,.c....?
!. ,
C!'t(7@:,''::;'i:ir+ .
U`_;!::.R I.Y.tr, ;'.Ji`t7';i:;Y
.,...../....?s.•dq.;t:?ry:.p4{.p.?fth^.?I`?j.:;.:?.ef.n,,..:.P-?1?`.?.iitii.:;:?rqz ?'.?A}?.M1)(4(?I+
,_ PERIVIIT
-?'CITY OF EAGAN
3830 Pilot Knob Road PERMIT TYPE: B U I L D I N G
Eagan, Minnesota 55122-1897 Perinit Number: 029027
(612) 681-4675 Date Issued: 10/ 10 J 9 6
SITE ADDRESS:
4650 KINGSBURY DR
IQT: 8 BLOCKc 4
BEACON HILL
P.I.N.a 10-13500-080-04
DESCRIPTION:
(RQQFIN6)
Permit Type
0Vqrk Type
eT?? S
5F (MSSC.)
REPATR
434 ALTe RESIDENTTAL
RENlARKS:
FEE SUMMARY:
vaLuaTxoN
$3,000
Base Fee
Surcharge
Total Fee
c
COIVTRACTOR: - Applicant - 5T. LIG OWNER:
SATHER RQOFING 17381062 0005254 WOLTER sILL
457 GROVNER AVE N 4656 KINGSBURY DR
OAKDALE MN 55128 EAGAN MN
(612) 788-1062 (612)452-4157
t ,
APPLICANT/PERMITEE SIGNATURE
$74.75
$1.59
$76.25
-?I nED B Y. SI J TU E?
CITY OF EAGAN
3830 PILOT KNOB RD - 55122
lq-0211996 BUILDING PERMIT APPLICATION (RESIDENTIAL)
681-4675
New Canstrudion Reauirements
? 3 registered site surveys
? 2 copies of plans (include beam R window sizes; poured fid. design; etc.)
? 1 energy calculations
? 3 copies of hee preservation pian iF bt pletled atter 711/93
Y
Remodel/Renair Reauirements
? 2 copies oF plan
? 2 site surveys (exterior additions & decks)
? 7 energy ealculations for healed additions
requved. ss No ?
_ ?
DATE: c l?Z CONSTRUCTION COST: ?? DESCRIPTION OF WORF
STREET ADDRESS:
LOT 91 BLOCK I SUBDJP.I.D. #: I-? ?? ? r4ill,
PROPERTY
OWNER
GONTRACTOR
ARCHITECTf
ENGINEER
Name: R i I Phone #:
ucr , swsr , , A?,
Street Add
V
City: q ti State: Zip:
Company: ??,v' Ph?on #:
Street Address: V? c? ?`/ vE( ?,/ Lice
Cit???,4 ? State: ?. ? ? Zi?•?J ?°?- ?
Company: _
Name:
5treet Address:
City:
Sewer 8 water licensed plumber:
change are requested once permit is issued.
State: Zip:
Penalty applies when address change and lot
I hereby acknowledge that I have read this application and state that the in ation is correct and agree to compiy with all
applicabfe State of Minnesota Statutes and City of Eagan Ordinances.
?1--p
Signature of Applicant:
OFF{CE USE ONLY
Certificates of Survey Received _ Yes _ No
Phone #:
Registration #:
Tree Preservation Plan Received Yes No
OFFICE USE ONLY
. . ft
a
•.? . ;
4,rt3, ... ? .
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Duplex
? 02 SF Dwelling o 07 4-plex
0 03 SF Addition ? 08 8-plex
0 04 SF Porch ? 09 12-plex
n 05 SF Misc. ? 10 = plex
WORK TYPE
? 31 New o 33 Alterations
D 32 Addition ? 34 Repair
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
length
Depth
APPROVALS
Planning
? 11 Apt./Lodging o 16 Basement Finish
? 12 Multi Repair/Rem. ? 17 Swim Pooi
? 13 Garage/Accessory ? 20 Public Facility
? 14 Fireplace ? 21 Miscellaneous
a 15 Deck
0 36 Move
? 37 Demolition
Basement sq. ft.
Main level sq. ft.
sq. ft.
sq. ft.
sq. ft.
sq. ft.
Footprint sq. ft.
Building
Permit Fee
Surcharge
Plan Review
License
MC/WS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/VN 5urcharge
Treatment PI.
Road Unit
Park Ded.
Trails Ded.
Other
Copies
Total:
Engineering
Valuation: $
MCIWS System
City Water
Fire Sprinklered
PRV
Booster Pump
Census Code.
SAC Code
Census Bldg
Census Unit
Variance
% SAC
SAC Units
Ce`rtiPicate for:
Centex Aanss lRidwest Inc.
8601 Darnell Road
Bden Prsirie, Mln. 55344
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Top le,"'8:
?sse0l?t
Mook g,
tioms" , 1
Pebl'u9"
DELMAR H. SCHWANZ
LANDSURVEVOR
RpfstoW UnMr l+wf Of TM State of Mfnmwta
11!? {49TM lTREET W. - BOX M R MINNBSOTA QlOd!
? SURVEY ?h ClRTIftCATE
O N 'I..._ At tl W,
L40.00 _ 5 890 15W *;?`
0
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pMONEr
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4t7,oc)
890,5a\3z" F_
?Danotee proposed elevatian
Garage F1ooT
that tKie ia a true and corre4t
AILL9, according to the reaorded
a.
1981 Benchmsrk s CenRerlins centerliae
Hill Road $levation - 944.00 ft.
ohm prwPcaed house dune 3. 1981
;. , .
Y_
S I a? ? 3D
"1?? :
tr.
smntation of Lot 1, ,
thereof, Dakota
Road and Beaarnn
' Ce??ti ficate for :
., Cetstex Romss MidNest Inc.
$601 Daretell Road
Bden Prairie, Mhs. 55344 AM
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.
?
. ? ?
30
DELMAR H. SCHWANZ
l,ANO SUiiV EVOR
Rpiftered UndM laws of Tht Slott OI MieeMOti
"TM sTNEET W. - BOX M R ? MINN680TA l1Ob!
SURVEY ?? CERTIFICATE
EN T 0 W t-. At f?l
L4/soo S B9° Ist3 sz" er
,es proposed elevation s??? N
o.ov 'S 69° 3E?' lbz" W? '
czo? ?¢Z•33 0 ?
4 0? -? 3
° t m -1°'? _
? 12,3 o
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? 30 13 .?--- ?
Top af B1ock _
Bamemmt n9or
Garage Floor
?'?•+''0?4z3'
0
m
I'`here11y osltlty /that thie is a true and eorreot re 7
Moak i, BMW ,HILL.4, according to the reaorded plao,
ftuvo3, mimwsexa.
i
aabruel* 30 lool Bencheuice Csaterlirte ceaterli"
Hill Roed Blevatioa - 944•00 ft.
/
Asvised to efiow groPoeed house June 3r 1981
j
?. ?. #.: ?' . . " . . ..
sestation oP Iat 1,,
thereof, Dakota
Road aakd Beatson
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MINNE50TA E iSTHATION N0.88Z6 .+
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Certificate Por: ri?S-o ??11C?Sb? L?'t t?EL 3*?n f-?c`(CS
Centex Homes Midwest Inc. `C (\
8601 Darnell Road Eden Prairie, Mn. 55344
??(IN
DELMAR H. SCHWANZ
LANOSURVEVOR
30 RpisterW UndOf Laws O! TM Sbte of Minnesota
8- 146TH STREET W. - BOX M ROBEMOUNT, MINNESOTA 55088 PHONE 813 C?-7769
? Zi-?-, SURVEYOR'S CERTIFICATE
nN_ ii
y ?. r
\9 ?
4arage floor
Top of Block
?
a
\; Qoh?hb
\
, ?--
.•
Hasement floor
0
SCALE: 1 inch = 30 feet
QDenotse proposed elevation
y ?
z?
, ?
Drainage & utility
,, easement
6 `
Benchmark: Centerline centerline C11Pf Rd. and
Heacon Hill Rd. Elevation- 944.00 ft.
?
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,
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I hereby certlfy that this ia a true and correct representation oP
Lot 8, Block 4, BEACON HILL, aceording to the recorde8 plat thereof,-
Dakota County, Minnesota.
Dated: January 28, 1980
Revised to show proposed houa• July 16, 1981
I ^f, ' ?
?i?.C/f I /'? 1 ?IJ /,??1, ?',+/ !.?" _{
i?
MINNESOTA REGISTRATION N0.8625 '
(..
2004 RESIDENTIAL BUII.DING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
? S-? 0 .C) d
New ConsWction Reouiremenfs RemodellReoair Reauirements
3 registered sde surveys showing sq. ft o( lot, sq. ft oi house; and all roofed areas 2 copies of plan '???'
(200/o maximum bt coverage allowed) 1 set of Energy Calculatlons for heated additions Tree Pfes PtanReK?r 7
2 wpies oi plan showing beam & window sizes; poured found design, etc. 1 site survey for additions & decks ""?4:?'
lsetofEnergyCalculaUons Add'rfion-indicateilon-sitesepticsystem Qns?t,¢Setp.tic"System,,,.,? ??Ni
3 copies of Tree Preservation Plan'rf lot platted after 711193
Rim Joist Detail OpBons selection sheet (bldgs with 3 or less units
Date Construction Cost L
Site Address UniUSte #
Description of Work ,
Multi-Family Bldg _ Y_ N Fireplace(s) _ 0_ 1 _ 2
O Telephone # (6SI )
wner
Property
Contractor ?2&?
Address fh
State Cit3'
Zip ? Telephone #('X3 );Wf.s l
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Energy Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Code Category ? .
Residential Ventilation Category 1 Worksheet New Ener9Y Code Worksheet
(4 submission type) Submitted Submitted
. Energy Envelope Calculations Submitted
Have you previously constructed a building in Eagan with a similar plan2 _ Y _ N If so, 25% plan review
fee applies.
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
11_'? elephone # (
? i ij elephone # (
L)
T?elephone # (
I hereby apply for a Residential Building Pernut and.acknowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; I understand this is not a permit, but only an application for a pernut, 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. ?
?Zx ? S
Applicant's Printed Name Ap icant's Signature
OFFICE USE ONLY
5ub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool 0 30 Accessory Bidg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) O 33 Ext. Alt - SF
? 04 02-plex ? 10 OS-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or_ N ? 25 MiscellaneouS
Work Types
? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteration ? 37 Demolish Building* ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement *Demolition (Entire Bldg) - Give PCA handout to applicant
Valuation Occupancy MCES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const Width
_ Footings (new bldg)
_ Footings(deck)
_ Footings (addition)
Foundarion
Drain Tile
Roof Ice & Water Final
_ Framing
_ Fireplace _ R.I. _ Air Test _ Final
_ Insulation
Approved By:
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
REQUIRED INSPECTIONS
FinaUC.O.
Final/No C.O.
_ Plumbing
HVAC
Other
_ Pool _ Ftgs _ Air/Gas Tests Final
_ Siding _ Stucco _ Sione _ Brick
Windows
_ Retaining Wall
Building Inspector
2009 RESIDENTIAL BUILDING PERMIT APPLICATION
v.? ? ?v ???/Z 2
Date: Site Address:
Tenant: Suite #:
Phone: ''7?l Z
RESIDENT / OWNER Name:
Address / City / Zip:
Applicant is: &Owner _ Contractor
TYPE OF WORK Description of work:
Construction Cost: 11117, dVU _ Multi-Family Building: (Yes No ?
CONTRACTOR Name: License #:
Address:
City: State: Zip:
Phone: Contact Person:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 CateqoN 1 Minnesota Rules 7672
Energy Code • Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
Category Submitted Submitted
(4 submission type) • Energy Envelope Calculations Submitted
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
Yes _fJo If yes, date and address of master ptan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
?iY NoTE: ,Plansi and,'supporfing docirmsrtts thaf you s'ubmrt are considered to be pub9c, rnf?rmatlon Portions of ?y
? the information'irrey;[ie c?assiired as`iiori pabl?c rf you??rovrde:,specific rea`soi?s tt`+at woui?pQrm?##he'C?ty
LLconcludethatthe' ?-
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 f lans.
x ?UiCt??c. /?t G?oll?5" X ?
ApplicanYs Printed Name App canYs Signature
Page 1 of 3
- - - - - - - - - - - - - - - - i
I For Office Use
72 3
Permit
City of EaQall _0,
I Permit Fee:
3830 Pilot Knob Road
Eagan MN 55122 Date Received: ~J
Phone: (651) 675-5675 I Staff:
Fax: (651) 675-5694
2009 RESIDENTIAL BUILDING PERMIT APPLICATION
i S)92 2
Date: ~l ~5-J Site Address: Ki~GS J
Suite
Tenant: l l te 4f
! / Z/S 7
RESIDENT / OWNER Name: Phone:
Z 2-
Address / City / Zip:
Applicant is: ,Owner Contractor
TYPE OF WORK Description of work:
Construction Cost: /9 yVU Multi-Family Building: (Yes / No XI)
CONTRACTOR Name: License
Address:
City: State: Zip:
Phone: Contact Person:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Category 1 Minnesota Rules 7672
Energy Code • Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
Category Submitted Submitted
(J submission type) • Energy Envelope Calculations Submitted
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that they are trade secrets.
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 fr plans.
CGi/~ Gfiv/TES X
Applicant's Printed Name App cant's Signature
Page 1 of 3
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 4650 Kingsbury Dr
Lot: 8 Block: 4 Addition: Beacon Hill
PID:10- 13500- 080 -04
Use:
Description:
Sub Type: e - Furnace & Air Conditioner
Work Type: Replacement
Description: Fumace & Air Conditioner
Comments: Questions regarding electrical perm
952- 445 -2840.
Fee Summary:
Contractor:
Standard Heating & Air Conditioning
130 Plymouth Ave. N
Minneapolis MN 55411
(612) 824 -2656
ME - Permit Fee (Replacements)
Surcharge -Fixed
Total:
Applicant/Permitee: Signature
PERMIT
City of Eaan
- Applicant -
equirements should be directed to Mark Anderson, State Electrical Inspector,
$50.00 0801.4088
Owner:
William Wolters
4650 Kingsbury Dr
Eagan MN 55122
$50.50
Permit Type:
Permit Number:
Date Issued:
Permit Category:
$0.50 9001.2195
I hereby acknowledge that I have read this application and state that the informa
of Minnesota Statutes and City of Eagan Ordinances.
on is correct and agree to comply
h all applicable State
Issued By: Signature
Mechanical
EA079619
09/05/2007
ePermit
City of Evan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
RECEIVED
MAR 142016
For Office Use L�j11/
Permit #: 43 /5 I Q
Permit Fee: /25.%q
Date Received: 3- (� Li 1 (-P
Staff:
2016 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit #:
J
Resident/
Owner
Name: zZZ Y, P i) ,Z 5 Phone: �'9- 5 /X9.10
/
Address / City / Zip: O- 0 k dq , �"ji/E-
Applicant is: Owner /'r Contractor
Type of Work
3 1/47/,
_
Description of work: !l /1•, /i, _ ///, ;!� n �//` � . 1.±- itriJ.
�
Construction Cost: .,?:11.‘27)°Multi-Family Building: (Yes / No )
Contractor
Company: j t,12 l 'j1,1L) .e3rie b Contact: itej�,,ed
Address: /595- t'j1 5 .l, City: f
StaterZip: 30, Phone:7J/1' 'I �? Email: _ f�t/QL:M ,cAdzLitsie-4011
License #: 1E6.. 390/6/ Lead Certificate #: -.
If the project is exempt from lead certification, please explain why: ''k)D
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.qopherstateonecall.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 Minnesota State Building Code must be completed within 180
days of permit issuance.
Applicant's Printed Name
x
App
t !_
`'can 's Signature
Page 1 of 3
1
DO NOT WRITE BELOW THIS LINE
SUB TYPES
Foundation Porch (3 -Season)
Single Family _Porch (4 -Season)
Multi _ Porch (Screen/Gazebo/Pergola)
01 of _ Plex Pool
WORK TYPES
_ New Siding
Addition _ Reroof
Alteration Windows
Replace _ Egress Window
Retaining Wall
Move Building
Fire Repair
Fireplace
Garage
Deck
Lower Level
Interior Improvement
Repair
DESCRIPTION
Valuation A map
Plan Review
(25%_ 100%
Census Code 4/311
# of Units
# of Buildings
Type of Construction
Occupancy
Code Edition
Zoning
Stories
Square Feet
Length
Width
REQUIRED INSPECTIONS
Footings (New Building)
Footings (Deck)
Footings (Addition)
Foundation
Roof: _Ice & Water _Final
Framing
Fireplace: _Rough In Air Test _Final
Insulation
Sheathing
Sheetrock
Fire Walls
Braced Walls
Shower Pan - -
Reviewed By:
Exterior Alteration (Single Family)
Exterior Alteration (Multi)
Miscellaneous
Accessory Building
_ Demolish Building*
Demolish Interior
Demolish Foundation
Water Damage
*Demolition of entire building - give PCA handout to applicant
C `" / MCES System
ZD/ j SAC Units
PJB City Water
Booster Pump
PRV
Fire Suppression Required
Meter Size:
Final / C.O. Required
Final / No C.O. Required
HVAC _ Gas Service Test Gas Line Air Test
Pool: _Footings Air/Gas Tests _Final
Drain Tile
Siding: _Stucco Lath _Stone Lath _Brick
Windows
Retaining Wall: _ Footings _ Backfill _ Final
Radon Control
Fire Suppression: _Rough In _Final
Erosion Control
Other:
, Building Inspector
RESIDENTIAL FEES
Base Fee 73 (-
Surcharge
Plan Review 1.17
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies yQ 0.5 /
TOTAL
0/4
Page 2 of 3
City of kali
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
MAR 252015
Use BLUE or BLACK Ink
For Office Use
Permit #:
Permit Fee:
Date Received:
Staff:
I 3<60-
2016 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: 3/22/2016 Site Address: 4650 Kingsbury Drive
Tenant:
1
Name: Bill and Mary Wolters
Phone:
Suite #:
Address / City / Zip:
Name: Steinkraus Plumbing Inc
License #: 058655
Address: 112 E 5th Street Suite 101 City: Chaska
State:
MN Zip: 55318
Phone: 952-361-0128
Contact: Dis McDevitt Email: Dis@steinkrausplumbing.com
New
✓ Replacement _ Repair _ Rebuild _ Modify Space _ Work in R.O.W.
Description of work: (3) bathrooms new fixtures on existing locations
RESIDENTIAL
Water Heater
Lawn Irrigation ( RPZ / _ PVB)
Septic System
New
Abandonment
Water Softener
IAdd Plumbing Fixtures (1 Main / ✓ Lower Level)
Water Turnaround
RESIDENTIAL FEES:
$60.00 Water Heater, Water Softener, or Water Heater and Softener (includes State Surcharge)
$60.00 Lawn Irrigation (includes State Surcharge)
$60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes State Surcharge)
*Water Turnaround (add $280.00 if a 3/4" meter is required)
$115.00 Septic System New (includes County fee and State Surcharge)
TOTAL FEES $ 60.00
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 i t to start without a that the work will be in
accordance with the approved plan in the case of work which requires a review and approval - pL s.
x Dismas McDevitt
Applicant's Printed Name
x
Applicant's Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA146746
Date Issued:11/13/2017
Permit Category:ePermit
Site Address: 4650 Kingsbury Dr
Lot:8 Block: 4 Addition: Beacon Hill
PID:10-13500-04-080
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener).
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
William Wolters
4650 Kingsbury Dr
Eagan MN 55122
Blaylock Plumbing
7731 4th Ave S
Richfield MN 55423
(612) 869-7531
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA157972
Date Issued:09/18/2019
Permit Category:ePermit
Site Address: 4650 Kingsbury Dr
Lot:8 Block: 4 Addition: Beacon Hill
PID:10-13500-04-080
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: 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 -
William Wolters
4650 Kingsbury Dr
Eagan MN 55122
Kaufman Sheet Metal Roofing
2521 24th Ave S
Minneapolis MN 55406
(612) 722-0965
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA166942
Date Issued:02/16/2021
Permit Category:ePermit
Site Address: 4650 Kingsbury Dr
Lot:8 Block: 4 Addition: Beacon Hill
PID:10-13500-04-080
Use:
Description:
Sub Type:Fireplace
Work Type:Gas Insert
Description:
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home may require smoke detectors in all bedrooms. Chimney / flue must be inspected prior to
concealing.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Valuation: 3,000.00
Fee Summary:BL - Base Fee $3K $88.50 0801.4085
Surcharge - Based on Valuation $3K $1.50 9001.2195
$90.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
William & Mary Wolters
4650 Kingsbury Dr
Saint Paul MN 55122--271
Fireside Hearth & Home
2700 Fairview Ave N
Roseville MN 55113
(651) 633-2561
Applicant/Permitee: Signature Issued By: Signature