4671 Kingsbury Dr
Use BLUE or BLACK Ink
r
For Office Use
I / I
Permit C I
City of Eap I Permit Fee: ~ 7'j- - _
F 2 f
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 i Staff:
2011 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit
Name: u,-rd,( P-Q Phone:V Lnzz
RESIDENT ~
OWNER Address / City / Zip: 6A 2 Applicant is: Owner 1/Contractor
TYPE OF WORK Description of work: -.57at. uDly%d. VDc 5
Construction Cost: l Multi-Family Building: (Yes / No )
Company: ?Z 2,~lOr_S Contact: r-1)t~ ~kLx l-1M
CONTRACTOR Address: 22,23162 LL city: G`r('yyltV\.G+-0 /l-)
%
State: r Zip: S~"n Phone: lOi!~ Z9 00-16
License 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: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
I 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.gor)herstateonecall.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 o plans.
x 5cf 1J Cy2_~' Yv-N x
Applicant's Printed Name Applicant's Signature
Page 1 of 3
Use BLUE or BLACK Ink
For Office Use I
' t ~ - 7G,
I Permit
City of Eapfl
I Permit Fee:
3830 Pilot Knob Road I
Eagan MN 55122 I Date Received:
I
Phone: (651) 675-5675 Staff:
Fax: (651) 675-5694 L---------------
INFLOW & INFILTRATION PERMIT APPLICATION
- _4zi5lumbing I Sewer & Water
Date: / 3 / M t Site Address: +J
Z
C~
Tenant: ~ f b e Suite
Name: b~ 6:XV- 0 Phone:
RESIDENT /OWNER
Address /City /Zip:
Name: License MG 3 5-
Address ~-..~r~~ - ity: G
CONTRACTOR
State: \-1 iJ Zip: Phone: b 3 b 3
Contact: G-J \ Email: Le-?a
PLUMBING (Within the building envelope) SEWER & WATER (Outside the building envelope)
TYPE OF WORK Sump Pump Repair Repair
Other:
Other:
Description of work:
DESCRIPTION
FEES
$55.00 / Each (includes $5.00 State Surcharge) TOTAL FEE $
*Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submit 1/1 repair costs for
reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors
can be found by visiting www.cityofeagan.com/inflow, or City Hall at 3830 Pilot Knob Rd.
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.aopherstateonecall.org
I hereby acknowledge that this information is complete and accurate; that th 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 a 'cation for a permit, and work is not to start without a
pegml that the work will be in accordance with the approved plan in the case of wor hich requires a review and approval of plans.
Applicant's Printed Name Applicant's Signat
FOR OFFICE USE Reviewed By: Date:
Required Inspections: -Under Ground -Rough-In -Final
CASH RECEIPT
CITY OF EAGAN
3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE
is
RHC6I V ED
FROM
AMOUNT $ I
& DOLLAR$
?oo
0 CASH ? CHECK
FOR . " .. -" " ,. ?_. ? w?±_ - .
??-
AMOUNT
?
n BY
White-Payers Copy
Yellow-Posting Copy
? Pink-File Copy
Thank You ?` .
CITY OP EAGAN Remarks
Addition BEACON HIZL ADDITION Lot 20 Bik 3 Parcel- 10 13500 200 03
Owner f?L-:, +. ?:? [: -nrh r street_ 4671 Kingsbury DTlVe State Eaean. hN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREETSURF. (F? v 1982 1806.93- 200.77 9 1806.93 C007561- 10-1-81
STREET RESTOR.
GRADING y? 1982 526.46 58.50 9 526.46 C007561 10-1-81
SAN SEW TRUNK . d 7 9.06 1$ 90.67 3/18180
* SEWERLATERAL 1982 3116346 346.27 9 3 . C007561 10-1-81
WATERMAIN I
WATER LATERAL I982 9
WATER AREA I982 198.02 22.00 9 8.01 C007561 10-1-81
* Stubs 1982 9
STORMSEW TRK 1982 359.82 39.98 9 359.82 C007561 10-1-81
STORM SEW LAT Z98 2 9
1
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
n
ir
8UILDING PER.
5-466
SAC
PARK
I
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued:
(651) 681-4675
I SITE ADDRESS: ' " ' "• ' V'" "
I InT 100 {al r,i r
II PERMIT SUBTYPE:
APPLICANT:
TYPE OF WORK:
,,, . .. . 11
ht:laiN
I .o. F kr trr)i
PArmit Holder Dete Telephone #
SEWER/
WATER
PLUMBING
HVAC
Inapection Dats Insp. Comments
FOOTINGS
FOUND
FRAMING
ROOFING /?_ Z. /? d / • ???
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GVP BOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
DOMESTIC
METER
IRRIGATION
METER
FLUSH
MAINS
CONDUCTIVITY
TEST
HVDROSTATIC
TEST
BSMT R.I.
BSMT FINAL
DECK FfG
DECK FINAL
CITY OF EAGAN
' 3795 Pibt Knob Road Eagan, MN 55122
PHONE: 154-8100
BUILDING PERMIT Receipt .#
TO ba umd fer i'l;' .' Est. Velue Dnfn
Site Address
Lot Blxk Sec/Sub. -
Porcel #
W Nome _'?c::?e;•
? Address _ : ??1TY iT1Ve
o _ 11.. ,,,,
o Name
f
?< Address
rc
1- r:«. . ok....e
I hereby acknowledge that I have reod this applicotion ond state thot
the information is correct and agree to comply with all applicable
Stote of Minnesota SMtutes and City of Eagon Ordinances.
Signoture of Permittee
N? 5833
Erect ? Occupancy
Alter ? Zoning
Repair ? Fire Zone
Enlarge ? Type of Const.
Move ? # Stories
Demolish ? Front ft.
Grade ? Depth ft.
Approvals Faes
Assessment
Water & Sew.
Police
Fire
Eng.
Planner
Counci I
.?
Bldg.Off. '
APC
Permit
Surchorge
Plan check
SAC
Water Conn.
Water Meter
Rood Unit
Total
A Building Permit is issued to: r on the express condition that
oll work shall be done in occordance with oll appliwble State of Minnesota Statutes ond City of Eagan Ordinonces.
Building Officiol
PannM # DaM hn" iKnMNe
Plumbing
Mechanical
INSPECTIONS DATE IPLSP.
Rouqh-In
Finol
Footings Dote Insp. Date Insp.
Foundation Plumbing
Frome/ins. m Mechanical
Finol a
?
Remarks:
.-
CITY OF EAGAN ?A 18619 :
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHONE:454-8100
BUILDING PERMIT Receipt # 'To be used tor BASEMEFR FIMISH Est. value $1 •500 Date llEC 14 19 90
Site Algress 4671 KING3BUitY DR
Lot Block ._ j Sec'Sub. ` '
Parcel No. _
W Name
o Addre
Name_
Phone
I hereby acknowlege that I have read this application and state that the
information is correct and agree to comply with y applicable Stale ol
MinnesoW Statutes and Ciry of EhanPdinafloes?
Signature o( Permitee
A Building Permit is issued to: JOSEPH R !lILLEB
an the express condition that all work shall be done in accordance with all
applicable State of Minnesota Statutes and City ot Eagan Ordinances.
Buikling Otticial
OFFICE USE ONLY
Octupancy -
Zoning -
(Actuaq Const -
(Albwable) -
M ol Stories -
Lenglh -
Depih -
S.P. Total -
S.F. Foolprinls -
On Site Sewage -
on site wen -
MWCC System -
City Waler -
PRV Required _
Booster Pump -
APPROVALS
Planner
Council
Bldg. Off.
Variance
Bldg. Permit
Surcharge
Plan Review
SAQ Ciry
SAC,MCWCC
Water Conn
Water Meter
Acct. Deposil
S/W Permil
S/W Surcharge
Treatment PI
Road Unit
Park Ded.
T TAL
FEFS
35.00
1.00
1
.50
36.50
Permil No. PermN Holder Date Telephone #
WATEfl
SEWER
PLUMBING
H.V.A.C.
ELECTRIC O CYV ?
Inspaclion Date Insp. Comments
Footirgs I
Foundalion '
Framing 2 Z? p
Roofirg
Rough Plbg, d ?'
Rou9h Htg.
Isul.
Fireplace
Final Htg.
Fnal Plbg. - Q
Consl. Meter Plbg. Inspector- Notify Plumber
Ergr./Plan
Final
Deck Ftg.
Deck Final
Well
Pr. Disp.
. '
. • -BUILDING PERMIT
To be usad for
Site Address
Lot Block
Parcel #
m Name
W ' " ' _ . . . " _ . .. , ?-4-
; Address - ?
0? Name _
,o
?? Address
cirr oF EacaN
3795 Pilot Kno6 Road Eagan, MN 55122
PHONE: 451-8100
Receipt #
Est. Value Dete _ .-
Sec/Sub. ?;_? ,
Name _
Address
I hereby acknowledge thot I have read this opplication and state that
the infortnotion is correct and ogree to comply with all applicable
State of Minne:ota Stotutes and City of Eagan Ordinonces.
N4 5366
Erect ? Occupancy
Alter ? Zoning
Repair ? fire Zone
Enlarge ? Type of Const.
Move ? # Stories
Demolish ? Front ft.
Grade ? Depth ft.
Approvals Feea
Assessment -
Water & Sew.
Police
Fire
Eng.
Planner _
Council _
Bldg. Off. -
APC
Permit
Surcharge
Plan check
SAC
Woter Conn.
Water Meter
.,
Total
Signature of Permittee _ I
A Bullding Permit is issued to: on the express condition that
oll work shall be done in ccrnrdan06 with all cpplicable State of Minnewta Stotutes ond City of Eagnn Ordinonces.
Butlding Official
PennR # pets Iswd PWMIMM
Plumbin9 i "a ?--)9 Q-0
Mechaniwl /V3 - b - 1
S 3q S-o Ir -I - z f_jzv_?
INSPECTIONS DATE INSP. Rough-In Final
Footings EA - 71 Dote Inap. Date Insp.
Foundation _ Plumbing 'd
Frame/ins. 27 Mechanirol
Final .,?
Remarks:
. ,
SEWER SERVICE PERMIT
CITY OF EAGAN
3795 Pilot Knob Road
Frgan, MN 55122
Zoning: -
pwner:
Address: -- --'-
Site Address: ---'~'
Plumber. - ?
1 agree to coMply with the City of Eagan
Ordinonces•
BY -
Date of Insp.:
?-
I nsp.:-?--
PERMIT NO
DATE: -?
No. of Units: ?-
?--
';r
Connection Charge: _
Account DePosit: - ?
Permit Fee:
Surcharge: - ?
Misa Charges:
Total:
Date Paid:
WATER SERVICE PERMIT ?
cirr oF IEAc,AN
PERMIT NO
:
3795 Pilot Knob Road . ?
DATE:
Eagan, MN 55122
f Units:
N
Zoning: -- - o. o ?
Owner:
_ . p
Address: G
Site Address:
Plumber:
e: -
n Char
di
C
Meter No.: - g
o
onne , ,
osit:
t De
A
Size: p
ccoun
it Fee:
P r
Reader No.: erm
:
h
S -
---
I egree to wmply with the City of Eagan arge
urc -
?--
?
Ordinances. Misc. Charges: Z;
l :
T
t
o
o
id:
P
D
t
BY a
e
a
f Ins
:
D
t I^5p•:
p.
e o
a ?
EAcArr
W1?? `?•/? ? BUILDING PERMIT APPLICATION
Zb Be Used For Valuation ? tda
site paaress 97,?/w?
Lot Blorac 3 sec./sut?. 'Erect v
Paroel #:
OVJII2Z': ,Pv-f r L rPGs
,
Address: 11 _
City/Zip Code:
Phone `/'?-Z ?/O Y2
Contractor:
Address: i %
City/Zip Code:
Phone #: -7`7 y
Arch./Eng..
Acldress:
City/Zip Code:
Phone #:
Include 2 sets of plans,
1"site plan w/elevations &
1 set of enerqy calculations.
. Dare
OFFICE USE ONLY
Occupancy
Alter Zoning
Repair Fire Zone ?
?hlarge
hl Type of Const.
Nbve # Stories
Demolish Front j Q ft.
Grade Depth ft.
APPROVALS FEES
Assessments PeYmit °-°
[4ater/Sewer Surcharge / vo
Police Plan Check
Fire SAC
gzq, Water Conn.
Planner Water Meter
Council Road Unit
Bldg. Off.
APC
TOTAL /O ?
?37338 ?7.11119 .v
?D
Request Date Fire No.
^ Rough-in Inspection
Requiretl?
? Reatly Now ?ill Notlty InspecNr
C , ? _, I
Y es ? No When ReadyT
IfgUicensed contractor O owner hereby request inspection of above electrical work at:
Job AdAress (Street, Boc or Rout¢ No.) City
Gsf3URY f3R F r-J
$ection No.
Township Name or No. -
Range No.
Counry
I I Da
OCCUpant (PRINT) Phone No.
Power Supplier Adtlress
Electrical CqnVador (Company Name) Corrtractor5 License No.
C ? C_ I vfan?(??-
ailing Atltlress (COntrattor or Owner Making Inslallalion)
1CIT ? ?
Authorixetl Signa (Conlr ctor r Making Installation) Phorre Number
44a- b3?
MINNESOTA STATE BOARD OF ELEC7RICITY THIS INSPECTION REOUEST WILL NOT
GNgysMWway Bldg. - Room S173 . 8E ACCEP7ED BV THE S7ATE BOARD
1821 Unlvarslty Are., St. Paul, MN 55104 UNLESS PROPER INSPEC710N FEE IS.
P1qno (812) 842-0800 ENCLOSED.
CITY OF EAGAN '
3795 Piiot Knob Road Eagan, MN 55122
PHONE: 454-8100
BUILDING PERMIT APPLICATION
Te 6e nsed for
Site Address 4671 Kingsbury Dz'ive
Lot _-20 _ Block 3_ Sec/Sub. BPa non Hi l l Adt.
Portel .#
w IName Robert 0: Groehler
3 Address /+671 King,Gbury T}ri vP
o ? -..• --_ __ . -- - - • -
o I Name Hellick Construction
?? Address
r- r;?, 5t . Paul , oti,,,,e 774-
Name _
Address
I hereby acknowledge that I have read this application and state that
the information is correct and agree to comply with all applicoble
State of Minnesota Stotutes pnid Citv of Eaqon,Qrdinanopd
N° 5833
Receipt # 19 07?
Erect [I Occuponcy h3_
Rlter ? Zoning Rl
Repair ? Fire Zone III
Enlarge ? Type of Const. V
Move ? # Stories
Demolish ? Front 10 ft.
Grcde p Depth 25 ft.
Aoarovals Fees
Assessment
Woter & Sew.
Pol i ce
Fire
Eng.
Planner
Council
BIdg.Off. 5 20 80
APC
Permit '•"`?
Surcharg?-
Plan check
SAC
Water Conn.
Water Meter
Road Unit
Total 10.00
Signoture of Permittee ?
A Building Permit is issued to: Ro 2I!t 0. Gro leP on the express condition that
all work shcll be done in acrnrdonce a ap ' e of Min utes and City of Eagan Ordinances.
Building Officiol --' ??=
-a
' CITY OF EAGAN
NO;.. 1$61-9
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100
BUILDING PERMIT c Receipt # l? ?(
To be used for BASEMENT FINISH EsL Value $1, 500 Date DEC 14 , 192D-
Site Address 4671 KINGSBURY DR
Lot 20 Block 3 SeGSub. BEACON HILLS OFFICE USE ONLY
PdfCEI r10. Occupancy - FEES
Zoning _
W Name ROBERT GROEHLER (Actuap Const - 81dg. Permit 35.00
3 Address 4671 KINGSBURY DR (Allowable) - e 1_ nn
Surchar
? City EAGAN Phone 452-1042 # of Stories - g
Plan Review
Lengih _
o Name JOSEPH R MILLER Depth - SAC, Cily
,
015 Address 17900 VERGUS AVE S.F. Total - M
WCC
C
_
City JORD Phone
S.F. Footprints - SA
,
C
Water Conn
- On Site Sewage _
?
W W
Name
On Sile Well -
Warer Meter
W
z
?
Address
MWCC S stem -
Y
u qcct. Deposit
a W City PhOne City Water -
S/W Permit
PRV Required _
I hereby acknowlege that I have read this application and state that the eooster Pump - SNJ Surcharge
information is correct and agree to comply with all applicable State of
Minnesota Statutes and i y of E gan rdip?r es Treatment PI
U
Signature of Permitee APPROYALS
Road Unit
JOSEPH R MILLER
A Building Permil is is ed to:
Planner -
Park Ded,
on the express condition that all work shall be done in accordance with all Council -- 50
applicable State of Minnesota Statules and City of Eagan Ordinances. gld9, pl}, _ Copies .
Building Official , ? i\41A'?_? I1kN Variance - TOTAL 36.50
Minnesota State Board of Electricity 'NIIFPP?-
1954 University Ave., St. Paul, Minn. 55104-Phone 645-7703
^'REQUEST FOR ELECTRICAL INSPECTION
CAECK BELOW'WORK COVERED BY THIS REOLJEST
??$aG
Type of Building New Add. Rep. Check Applian ces Wi[ed Fw Check Equipment Wired Fo1
Home
Duplex lipm
?
?
?
?
Range
Water Heater
Temporazy Wiring
Lighting Fixmtes
?
Bldg.
ercial Bldg. ?
? ?
? ?
? Dryer
Fumace ? Electric Heating
Silo Unloader
?
strial Bldg. ? ? ? Air Conditioner ? Bulk Milk Tank ?
Fazm ? 0 ? List
? ;;,= List
Other 0 _a:? : ? ?
ReF ?: p
Hehets 1
COMPUTE INSPECTION;?EE`,Ol???``
rervice Entrance Size: # "`r` [,Feeiie'ts&Subfeeders: # Fee 11 Circuits: # Fee
1101 to 200 Amps. ? ?, to 100 Amperes to 100 Amperes i
? Above 200 Amos. Above 100 Amns. Above 100 Amns.
Remazks
TOTAL
I, the Electrical Inspector, hereby c that ,?6oee inspection has beeq m`ade ??
(Rough-in) ?n) Date
_ ?' '
(Final) Date
This request void 18 months from
This request void 18 months from
. !GS°G
D9te of this Request__ S m5o
I, a'Licensed Electrical Contractor 0 Owner, do hereby request inspection of the above electri-
cal wiring installed at: L-)Z (?j 3 be-O-Con t4a(?
Street Address or Route No.
Son Township_
14671 KqJ'?6sfiai'? Dal; CityQ6
Range County
Which is occupied by HtKU
(Name of Occupant)
Is a roughin inspection required on this job? No ? Yesq<- Ready Now O Will CalK
Power Supplier Address b'oy phg\ 1 Al`i'titf% l N'
Electrical Contractor_ Contractor's License Nd', r 67
(Company Nam?ej)? (?
Mailing Address „c1.-{,I? 1'iJ? Uur,-l4S'141LLe
(E I Contractor ot Owner Makin9 This Installation)
Authorized Signature, ?' Phone No. c?
O lL•S?$?,j ?
(EI trica ntractor or Owner Making Thls Installatlon)
S5?j1IE n0 `'2D C0 ?pU ?n This inspection request will not be accepted by the
?; L State Board unless proper inspection fee is endosed.
. .nnesoia acace noara oT tiectncity
Griggs Midway Bldg. - Room N191 y EB-00001-02
. 1821 Qniversity Ave.. St. Paul, Minn. 55104 = Phone 297-2111 ,7?
R50UEST FOR ELECTRICAL INSPECTION 99337
CHECK BEL?OW WZ7RK COVERRn RY THIS RF.(1iTFST
Type of Building New Add. Rep. Check Appliances Wired For Check Fquipment Wired or
Home ? ? ? Range ? Temporary W'ving liz]
Dup(ex EJ ? ? Water Heatet ? Lighting Fixtuies
Apt. Bldg. ? El ? Dtyet ? Electric Heating ?
Commercial Bldg. ? ? ? Furnace ? Silo Unloader ?
Industrial Bldg. ? ? A'u Conditioner ? Bulk Milk Tank ?
List List
Other ? ? p
Heie75? p
Heiers(
COMPUTE INSPECTION FEE BELOW
Service Entrance Size: # Fee Feedecs8c Subfeeders: # Fee Circuitsc # Fce
0 to 100 Am s. ? y to 30 Am eres 0 to 30 Am eres
101 to 200 Am s. 3 0 100 Amperes 31 to 100 Am eres
Above 200 A e 100 Amps. Above 100 Amps.
Transformers mote Control Circ. Partial or other fee
Signs Special lns ction Minimum fe
Remazks ?
?lJ
I1
TOTALEEg.? C?
K L`
i, the tlectrical lnspector, hereby,,?Wify that the above inspection has been made.
(Rough-in) -'""'-- Date
(Final) - r. Date 16- l=l 4
This request void
18 months from
7'hisrequest void C??? ?j3 ?j ?aCpf? ? I??? ?.?' ? ?
18 months fiom r D
Date o this Request Fire No. S 9 9 13 7
ILicensed Electrical Contractor ? Owner, do hereby request inspection of the above electri-
c w nginstalledat:
Street Address or Route No. nNVSVUe/ C'ty `,?-?
Section Township Range County
Which is occupied by ?CNWpr%l
??u v vwruMU? ??/
Is a roughin inspection required on this job? Yes ? Ready N'qw? Will Call ?
_ ? _ ? ?
Power Supplier ? Address ?'?1??11(? ?v
Electrical Contractor ta4_?``? Contractor's License N#262F
(COmpany Name)
Mailing Address l?i ? ? P-
(E?t f al n r or Owner Mak)ng This i nstallation)
Authorized Signature ' Phone No. Jissvs_
(Elect ical Contractor or Own r Making This Installation)
5?1 aV? 00 U 2;? EOp? This inspection request will not be accepted by the
State Board unless proper inspection fee is enclased.
(IrrfifirtttP nf Orrupanry
Citp of (eagan
lgrpttrtmrnt nf Building lnsprrtimt
Tbif Certificate issutd pustriant to the nqaisemcnu o f Section 306 of tbe Unifo+m Building
Code cMi f ying that at the time of itfuanct tbri strurturc wat in compliance with t{x varioHt
osdinaRUS of the City rrgulating building contt+iution or urc. Fos thc f ollowing:
SF Dwlg./Garage 5366
un chsa8u6m Bldg. Pormrt No.
O=PaM TyPe TYDe comwction Fimzo n ZoninBDisvict
a,,m ,f M,o„ Centex HomesAaa,h. 4615 Beacon Hills Ct.
?.? 4671 ,Ftinasbury_J=.,. Eaqan, MN
? 12/28/79
?Cl? IM ? CGM?FNW? 'L?C[
.LITMOiNU.56.
• CITY OF EAGAN
' 3795 PiIM Knob Roed
Eagan, Minnesota 55122
Phene: 454-8100
'JAt@P Sf1f tC?YieP
PERMIT
22/20/79
Dote:
Site Address:
4,6°3'11 FZ?geFauxjv I)s°o
Lot ?^U BI«k L.? Sub/Sec.?
ZtsbeY'$ (si?,h3c?r
Name
` tS:lr3
; Address
O
City P-fi2 _ Phone:
G?:2PS Sof't r,':+.$2?.'
Nome
.
$ 3£301 Cmlifofnin U
g Address
e
u
City _ Phone: _
This Permit is issued on the express condition that all wark shall be
Minnesota Stotutes and City of Eagan Ordinances.
317
No.
2719`3
Receipt No.:
Single I
Residentiol A
Multi Res., Comm./Ind. I
New /Alter. / Repai r
Cost of Instollction
Permit Fee - -
Surcharge
Tota I 5, r ?
done in accordance with all applicable State of
Building Official
? CITY OF EAGAN
• 3795 Pilof Knab Road
' Eagan, Minnesoto 55122
Phone: 454-8100
? ?4rJ" f J
OpY@:
PERMIT
r"-" r r
Site Address:
-•r 3
Lot Block _ Sub/Sec. _-_-
1.1..3'ii;.?;
Nome - - --?--_---
. ? 4 -13 L:z?G!;2an CLii
e Address - -_-
3
3J}?% City - ---- Phone: -.--
''?;,.
Nome _ ___ ___ _
?
0
„ Address - - -_-_?_
e
j;1!!. ..72.-_.. ..
City Phone:
This Permit is issued on the express condition that oli work shail be
Minnesota Statutes and City of Eagan Ordinances.
7 ?.Fj
No.
Receipt No.:
Single
Residential Sl
Multi Res., Comm./Ind. I
New/Alter./Repair
Cost of Installotion -
1'? r-11
J
Permit Fee
c,q
Surcharge
;i ' ?iil
Tota I
done in accordance with all applicoble State of
Building Offitial
. CITY OF EAGAN
• 3795 Pilot Knob Roud
' Eagan, MinnesoM 55122
Phone: 454-8100
,
Date:
Site Address
PERMIT
11 •-?--' ?r,
3
Lot Block Sub/Sec.
Name - ---------
e Address i?;':^?:`'m" =i1 x.I"? ?tiEK'?
3 -
O
City _ Phone: -
;?vv
Name I__
.
?..r <7
Address
e -
0
V .',? t_- ;c
City Phone: This Permit is issued on the express condition that all work sholl be
Minnesota Statutes and City of Eogan Ordinances.
c i;'=:r? 19-ir; ;}7'R
No. 4 ? 'i Z ,. •;
Receipt Na.:
Single
Residential
Multi Res., Comm./Ind. I
New/Alter./Repair.
Cost of Installation
X)?7n
Permit Fee
e5?
Surcharge
'19 r i.
Total ?
done in occordance with all applicable State of
Building Official
??? ?????? ??TME
DATE:
. .9 .I'1 ?
Address •CJ
?.? J/ .C St0 /° ?
Owner/Agent ? ?'-?
a
Owner/Agent
Ordinance Nos. and Cof,rections - Correct By
Si?e Name
.?/
Telephone 612
/2 , ? `" `- ? c/
r
For reinspection
Eagan Dept. ofInspection
3795 Pilot Knob Rd.
Eagan, Minnesota 55122
454-B 100
Inspector:
Dept.:
r
r
s
s
? - CITY OF EAGAM
` . 3795 Pilot Knob Raad Eugon, MN 55122 N2 5366
PHONE: 454-87 00
BUILDING PERMIT APPLICATION Receipt .#
_ 7-
ro ba u:ed fo. SF I)wlg & Garage Est. Value 48,000. Date $-16 ,19 79
Site Address 4671 Kinasbury Drive Erect >U Occupancy R3
Beac017 Hlll
Lot 20 Block 3 $ec/Sub Alter ? Zoning
.
Repair ? Fire Zone
parcel # V
Enlorge ? Type of Const.
o? Name CP11?2X HOTT?^S ?
Move # Stories
z
? 4615 Beacon Hills Court
Addre
Demolish .p
Front 5
ft.
E
Ci cigan phone 454-5236 Grade ? Depth ft.
p Name SaTne Approrals
, Fees
U?
U Address
1- r:...
Name
Assessment _
Water & Sew.
Police
Fire U? Address Eng.
<W . City Phone Plonner
Councii
I hereby acknowledge that I have read this application and state that gldg. Off.
the information is correct and agree to comply with all applicable
Stote of Minnesota Stotutes and City of Eagan Ordinances. APC
Signature of Permittee
Permit 1`??•-"'
Surcharge 24.00
Plan check 67•7$
sAC 525.00
Water Conn. 270•00
Woter Meter 60.00
Road Unit 75.00
roral 1,157. 25
A Building Permit is issued to: on the express condition that
oll work shall be done in accordance w?applica !e S te of Minnes tatutes ond City of Eagan Ordirwnces.
Building Official ?Z? ?C ?'?4«?
, ????
37-33( )
REQUEST FOR ELECTRICAL INSPECTION
? See instructions br completing Ihis fortn on Gack oi yellow copy.
`X" Below Work Covered by This Request
4"trnl,s , ee-ooooi-oe
99870
ew Add FiEp. TypeofBuilding AppliancesWired EquipmentWired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Other (Specity)
Comm.llndustrial ' FUrnace
Farm Air Conditioner
Other (specify) Contractor's Remarks:
Compute Inspection Fee Below: 3PS1g(ikV_t47
# Other Fee # ServiceEntranceSize Fee Circuils/Feeders Fee
Swimming Pool 0 to 200 Amps 4 100 Amps
4
Transformers Above 200 _ Amps 0?1091
Amps
SIgf15 Inspecror§ Use Ony: TOTAL ?
Irrigation Booms Q
Special Inspection
Alarm/Communication THIS INSTALLATION MAY 8E ORDERED DISCONNECTED IF NOT
Olher Fee COMPLETED WITHIN 18 MONTHS.
I, the Electrical Inspector, hereby Rough-in oate/
o
^
certify that the above inspection has
been made. ?
;4.4
Filai Date
7 .17 -Q(
OFFICE USE ONLV
This request voitl 18 manths from -
.A
R- qa-UD
Clty of EaRan
3830 Pitot Knob Road
Eagan MN 55122
Phone: (651) 675•5675
Fax: (651) 675-5694
a?5Z? 1
^-- --------------
, ?
j Permit #:
? P-ermit Fee:
? Daie Received:
I Staff: ? I
L - - - - - - - - ______- - I
J
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: A Site Address:
l
Tenant:
RESIDENT / OWNER Name: Phone:
Address / City / Zip:
Appiicant is: _ Owner x Contractor
TYPE OF WORK .?^ ?
Description of work: iT ?
Construction Cost: 4il lJ Multi-Family Building: (Yes _! No
CONTRACTOR Name: License#: 909RQL11aq
Address: JroLql fflP(Yi(3C ICxi NVf' N •
City: &G iI Va? State: 1"! ? Zip: '?J ?5`JO0
Phone: G 51 " LI ? I • "1 3;v Contact Person: ?ncen
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Cateaorv 1 Minnesota Rules 7672
Energy Code . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
CBtegOry Submitted Submitted
(4 Submi55ion type) • Energy Envelope Calculations Submitted
In the last 12 months, has ihe 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:
!4./IOTF yPla€rsnatani
F +b
H ¢ F'
Y s?.n? w-
Y
y
?
) ?W4 p
..t t?... ???f
? t}?
h 1,..`;y`-0rt -?'?-
I hereby acknowledge that this information is complele and accurate; that the work will be in conformance with the ordinances and codes of [he 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 wilf be in
accordance with the approved plan in the case ot work which requires a review and approval of plans.
x eG G0.w x WM ` 914L,
Applicant's Printed me ApplicanYs Signatuiji
Page 1 of 3
CITY USE ONLY
PERMIT #: RECEIPT DATE:
SOUY oESIDEPTIAL 1VIECHANICAL PERMIT APPLICATIOft
crrYaFKkam .
sgso Pu.o r xxos ftn
Ek6}IR M1Y 851 E8
631-6$I-4676
Please complete for. D singie family dweliings
townhomes and condos when pertnits are required for each unit
Date: ? 0(-3D?
j, .
SITE ADDRESS: bav? ??•
J ?
OWNER NAME: 5?Gtk 6 1?D C, (el- TELEPHONE #:
INSTALLER NAME: Bumsville Heating & A/C,. Inc. TELEPHONE #:
Savage, MN 55378-1122 - ``
STREET ADDRESS: _ CITY: STATE: , ZIP:
Place a check mark next to the permit work type
_ ------------- . -;
Add-on, modification or aiteration to existin dwefiing unit 1$2002
• fumace replacement y i
• air exchanger
• air canditioner
• other
Nature of work:
G?o u PV- 3b&- ()9C) AA)'I) '4 1(?'
?ISXiS-03c)
State Surchar e $ .50
$ 30, 5o
Total
SI NATUAE OF t9RMITTEE
ilo2
C!'TY USE ONIY
PERMIT #:
APPROVED BY:
INSPECTOR
RECEIPT DATE_
2002 CObIMERCUL MECHANICAL PERMIT APPLICATION
Clz'Y og EAGA1v
3830 PaoT Kvo$ gn
£A6m, mN 551 E8 651-6$1-4675
Please complete for_ ali commercialfindustrial buildings
muiti-family buildings when separate permits are not required for each dwelting unit
DATE: .
STTE ADDRESS:
OWNER NAME: PHONE #: .
TENANT NAME (IMPROVEMENTS ONLI):
WAS THERE A PRE VIOUS TENANT IN THIS SPACE? _ Y_ N. NAME:
INSTALLER . ,
STREET ADDRESS:
CTTY:
TELEPHONE #:
WORK TYPE:
_ New construcrion
_ Interior Impmvement ?
_ Processed Piping
STATE: 23P;
Install U.G. Tank
Remove U.G. Tank
SpecifyNature of Work:
When installing/removing underground tank, call 651-681-4675 for inspection by Fire Marshal and
Plumbing inspector.
Fees: I% of contract price OR $50.00 minimum fee, whichever is greater.
Underground tank removaUinstalIation = minimum fee
Conhact price: $ x 1% _$ (Base Fee)
State surcharge calculate at $.50 for each $1,000 Base Fee
TOTAL $
SIGNATUIZE OF PERMITTEE
Updated 1/02
PERMIT
` CfTY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(651) 681-4675
PERMIT TYPE
Permit Number:
Date Issued:
BUILUING
0;3;3886
11fd32J98
SITE ADDRESS:
4671 KINGSBURY DR
LOTe 200 k3LpCKa 3
BEACON HILL
P.I.N.: 10-13569-200-03
DESCRIPTION:
r , n . & R E R Q Q F
Bu,"Idit,rg V.knrmit Type STORM DAMRGE
??i 1ding Wq?l?It,,, Typp REPAIR
C`aY36US Code 434 AL.T. RESIDEiVTIAL
;k
. ;r
w tt .a :..;.?.
\ "?,'.?'s _ > e_•?
i? t-
'<i 11 r
tc N,?;c,?''" ' '_'`
e, '? a" +
"?'°s?u
4 ?$?x ,?ss "'as mi LssB^..4
Zi` suc.s``
REMARKS:
FEE SUMMARY:
CONTRACTOR: - flpplicant - STa LIC. OWNER:
ADVANCEf] EXTERSORS 18908300 20133214 GF2pEWLEF? F20BERT'
$210 W 125TH ST 4671 KTNGSBIJRY C1R
SRVAGE MN 55378 EAGWN MN 55122
(612) 890-8300 (651)
T hereby acknowledge thaG ;I havp read this apPlicataan and sCate that the
infQrrnation is carrePt arrd' agres to. cvmply with all appiicable State ?f l4n,
Statutes anrt Ci,t,y of Eagan.ordinances. ?
APPLICANT/PERMITEE SIGNATURE SSUED BN SIGNA URE
_ 1998 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
3830 PII.OT KNOB RD - 65122
681-4675 fo'?
?
New Construction Reauirements
? 3 registered site surveys
• 2 copies of plans (inGude beam & window sizes; poured fid. Oesign; etc.)
0 1 energy calculffiions
• 3 copies of tree preservation plan H lot platted after 7/1/93
required: _ Yes _ No
DATE: /D -- 3 G- 9"8
DESCRIPTION OF WORK: ,?oo1r?
STREET ADDRESS: LOT: aC)C BLOCK
7
,
,?
f yv-N
3 SUBD./P.I.D. #: 112 Lx-C Qno. rn ? ?
Name: A'OOeR/- I-.Si5?flj,9' Cn/o 1271flea'' Phone #:
PROPERTY
OWriER
Street Address:
City State: Zip: .S--.S
? ,.
Company: 1?.dlrwivccl' L?:-,T ?'ile3AS Phone #: A
CQNTRACTOR
Street Address: ?, ? /t3 G"l . /. License # ?a ( 3 3 ? ?`?
Ciry 5tate: ,/Z./v Zip: SS 3 -7e
ARCHITECT/
ENGINEER Company:
Name:
Street
City State:
Sewer & water licensed plumber (new construction only):
and lot change is requested once permit is issued.
Zip:
Penalty applies when address chang
I hereby acknowledge that I have read this application and state that the infortnation is correct and agree to comply with all applicabl
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant:
OFFICE USE ONLY
Certificates of Survey Received _ Yes _ No
Remodel/Recair Reauirements
? T copies oi plan
? 2 site surveys (exterior addkions 8 decks)
4 1 energy calculations for heated additions
CONSTRUCTION COST; ? 4,060 `o'D
Phone #:
Registration #:
Tree Pceservation Plan Received _ Yes _ No _ Not Required
OFFICE USE ONLY
BUILDING PERMIT TYPE
0 01 Foundation O 06 Duplex
? 02 SF Dwelling 0 07 4-plex
? 03 SF Addition 0 08 8-plex
? 04 SF Porch 0 09 12-plex
? 05 SF Misc. ? 10 _-plex
WORK TYPE
? 31 New ? 33 Alterations
? 32 Addition ? 34 Repair
GENEI3AL INFORMATION
Const. (Actual)
(A(lowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
Planning
? 11 Apt./Lodging ? 16 Basement Finish
? 12 Multi Repair/Rem. ? 17 Swim Pool
? 13 Garage/Accessory ? 20 Public Facility
O 14 Fireplace ? 21 Miscellaneous
0 15 Deck
? 36 Move
? 37 Demolition
Basement sq. ft.
Main level sq. ft.
sq. ft.
sq. ft.
sq. ft.
sq. ft.
Footprint sq. ft.
MClWS System
City Water
Fire Sprinklered
PRV
Booster Pump
Census Code.
SAC Code
Census Bldg
Census Unit
Building Engineering Variance
Permit Fee
Surcharge
Pfan Review
License MCMlS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
Valuation: $
°h SAC
SAC Units
CITY OF EAGAN FOR CITY USE ONLY
` 3830 PILOT KNOB ROAD
EAGAN MN 55122 PERMIT # .Io20
.> ,
` PHONE: (612) 454-8100 RECEIPT #
DATE :
PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS &
TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
--------°-------------- -------------------------------------
WORK DESCRIPTION COMPLETE THE FOLLOWING•
NEW CONST
ADD ON ?
REPAIR e?'
OWNER NAME:
SITE ADDRESS: 4CP`7 Z Ki hQ SbcsM
LOT : or0 BLOCK
INSTALLER: &L? e/"
ADDRESS: ¢SOV i4l1rr-),oJ
CITY: Dd i(Y ?ltti ZIP:
PHONE #: 44 7"'ea 7.3 4?- /J
N0. FIXTURES EA. TOTAL
ADD-ON MINIMUM 15.00 1S'ac
SHOWER 3.00
WATER CLOSET 3.00
BATH TUB 3.00
LAVATORY 3.00
KITCHEN SINK 3.00
LAUNDRY TRAY 3.00
_ HOT TUB/SPA 3.00
WATER HEATER 3.00
? FLOOR DRAIN 3.00
GAS PIPING OUT.
_ (MINIMUM - 1) 3.00
ROUGH OPENINGS 1.50
OTHER
WATER SOFTENER 5.00
PRIVATE DISP. 15.00
U.G. SPRINKLER 3.00
SUBTOTAL V
ST. SURCHARGE .50
SIPNA'fCTRL OF PERMITTEE
TOTAL: $ t S- -sLS
iALri?2DtTSTkIAL,s; PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRZAL BUILDINGS AND
, ._ .....:...> ;
MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH
DWELLING UNIT,
CONTRACT PRICE:
pwr,TFU ulkMF:
SITE ADDRESS:
LOT: BIACK SUBD.
INSTALLER:
ADDRESS
CITY:
ZIP:
PHONE #:
FEES
1$ OF CONTRACT FEE.
STATE SURCHARGE - $.50 FOR
EACH $1,000 OF PERMIT FEE.
$25.00 MINIMUM FEE.
CONTRACT PRICE x 1% $
STATE SURCHARGE
TOTAL:
( S IGNATURE.)
$
FOR:
CITY OF EAGAN
35•00 +
1•00 +
0•5Q +
36•50 *
i
?
1990 SDILDING PERMIT APPLICATION
? CITY OF EAGAN
SINGLE FAMILY DWELLINGS
LTLTIPLE DitELLINGS
COMMERCIAL
2 SETS OF PLANS 2 SETS OF PIANS 2 SETS OF ARCHITECTURAL
3 REGISTERED SITE SURVEYS REGISTERED SITE SURVEY5 - & STRUCTURAL PLANS
1 SET OF ENERGY CALCULATIONS (CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFICATIONS
1 SET OF ENERGY CALCUTATIONS 1 SET OF ENERGY CALCS
# OF RENTAL UNITS
# OF FOR SALE UNITS
PENALTY APPLIES WHEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UY BY LAST WORKING DAY
aF MONTH IN WHICH REQUEST IS ISADE.
LOT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED.
NOTE: ADDRESSES FOR CORNER IATS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRE55 IS
DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DAYS ONCE A PERMIT HAS BEEN COMPLETED.
PERMIT MUST SHOW A LICENSED PLUMBER.
DE? 1 1 REC'
To Be Used For: Valuation:??? Date
Site Address W7Z b4kJ'7
Lot 2.0 Block
FEES
Occupancy
2oning
Parcel/Sub Actual Const Bldg. Permit 3S D0
jJ ? Allowable Surcharge /,Da
Owner _f?d l7 ?Q # of stories Plan Review
L/
?7
k Length SAC, City
Address
{'y ?T
l6
( j tf?4 Depth SAC, MWCC
S.F. Total Water Conn
City/Zip Code E"M
- Footprint S.F. Water Meter
-
t
L{ (? Acct. Deposit
Phone On site sewage_ S/W Permit
On site well S/W Surcharge
Contractor dfi?_ _
MWCC System _ Treatment Pl.
p/'
'
7?
& City water Road Unit
Address
L
V??
dk5 PRV Park Ded.
rl ?J,
?
ya Booster Pump _ Copies
City/Zip Code
? SUBTOTAL
?7
Phone
? APPROVALS
Pl Penalty
TOTAL
?
_
L anner
Couil ;
nc
Arch./Engr. _ dY 4 Bld
g. Off. 12/(3
.. Variance
Address
City/Zip Code
Phone
Z ti 9?
15-00 OFFICE USE ONLY
It 6• M
N?op E L S 3 4 E ?+?v. ? ,r ?,j?
14 )? `? J PATE V ?J
a}> ?
BUILDING PF.RMIT APPLICATION
Include 2 sete of plans, 1 site plan w/elevations and 1 set of enerqy calculationa.
To be used for AOM E, Valuation 48,jP0 d
Site Arldress: ? ?„ ?<N(i S %V ty DR % Y F
2 0 3 13EAca,A "iLL
Lot Block Sec ub Parcel Number
Owner Rmlephone
Actdress
contractor CEIrlTE,k4 AOMF-S
Addrese
Telephone 4S4' S 2 3(o
Arch./Eng. Address
Tielephone '
OFFZCE USE
$rect
Altei
Repair
Enlarge
Move
nemolish
Grade
Oecupancy __ g
Zonfng iYl
Pire Zone ?
Type of Const. _
q of Stories
Front
Depth
OFFICE USB
Date of Approval 6 Initial
Asaeasmeat
water/Sewer
Police _
Fire
?9 •
Planner
Gbuncil
Rldg. Off. ,
A.P.C.
FEES
Pezmit --
Susctiarqe
rian Check
SAC
Flater Conn.
PJater Meter
To2nL
1 l 7_
. _.. , GQrtificate for:
CentQx Homes
DELMAR H. SCHWANZ
LANOSURVEYOR .
- Reqittatatl Unaer Laws of The Staleaf Mi nnesota ' . .
2978 - 145TH STREET W. - BOX M ROSEMOUNT, MINNE&OTA 55068 PHONE 672 423-1769
SURYEYOR'S CEFlTIfICATE
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m Top oP Bloc:k
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,
< .., _
MINNESOTA REGISTPATION NO. 8625
f
PERMIT
City of Eagan Permit Type: Building
3830 Pilot Knob Rd Permit Number: EA088222
Eagan, MN 55122 . Date Issued: 02/17/2009
(651) 675-5675~~~ EPermit Category: ePermit
www.ci.eagan.mn.us lflflUl tflflLLL
Site Address: 4671 Kingsbury Dr
Lot: 20 Block: 3 Addition: Beacon Hill
PID 10-13500-200-03
Use
Description:
Sub Type: e-Windows/Doors Construction Type:
Work Type: Windows/Doors-New/Replacement
Description: House
Census Code: 434- Occupancy:
Zoning:
Square Feet: 0
Comments: huprovements to the home require smoke detectors in all bedrooms. If altering window openings, call for framing
inspection. Call for final inspection after installation.
Carbon monoxide detectors are required by law in ALL single family homes.
Fee Summary: BL - Base Fee $3K $88.50 0801.4085
Surcharge - Based on Valuation $3K $1.50 9001.2195
Valuation: 3,000.00
Total: $90.00
Contractor: -Applicant - Owner:
Renewal Andersen Robert O Groehler
1920 County Road C West 4671 Kingsbury Dr
Roseville MN 55113 Eagan MN 55122
(651) 264-4777
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.
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type: Building
Eagan. Permit Number: EA096472
Date Issued: 10/14/2010
OR Permit Category: ePermit
41 it~ of E3
E
Site Address: 4671 Kingsbury Dr
Lot: 20 Block: 3 Addition: Beacon Hill
PID:10-13500-200-03
Use:
Description:
Sub Type: e-Windows iDoors Construction Type:
Work Type: Windows Doors-New ; Replacement
Description: House
Census Code: 434- Occupancy :
Zonin,:
Square Feet: 0
Comments: Improvements to the home require smoke detectors in all bedrooms. If altering window openings, call for framing
inspection. Call for final inspection after installation.
Carbon monoxide detectors are required by law in ALL single family homes.
Fee Summary: BL - Base Fee S3K $88.50 0801.4085
Valuation: 3.000.00 Surcharge - Based on Valuation S3K $1.50 9001.2195
Total: $90.00
Contractor: - Applicant - Owner:
Builders Remodelers Robert O Groehler
3517 Hennepin Ave S 4671 Kingsbury Dr
Minneapolis NIN 55408-3830 Eagan MN 55122
(612) 827-481
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 Cite of Eagan Ordinances.
ApplicantiPermitee: Signature Issued Bv: Signature
Use BLUE or BLACK Ink
r - - - - - - - - - - - - - - - -
I For Office Use
I I
1
City of Ea11110H Permit#: I
Q II
b I Permit Fee: -
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received: j
Phone: (651) 675-5675 I 1
Fax: (651) 675-5694 L Staff:
2012 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: Site Address: W Jkj
Tenant: Suite
RESIDENT / OWNER Name: U ~G Phone:
Address / City / Zip: 6 //<J~' h
Name: tLJ~frG'1~~~ ( C~LJQ- License
CONTRACTOR Address: g l s- ~uJ7~ `f] Acity: `~/fi)N~
State: Zip: Phone: yy'e,
Contact: kn O ALl(J'1 Email:
TYPE OF WORK - New _ Replacement 1>4 Repair _Rebuild - Modify Space - Work in R.O.W.
Description of work:
RESIDENTIAL
Water Heater
Water Softener
PERMIT TYPE Lawn Irrigation RPZ PVB)
Add Plumbing Fixtures Main Lower Level)
Septic System
New Water Turnaround
Abandonment
RESIDENTIAL FEES:
$60.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge)
$60.00 Lawn Irrigation (includes $5.00 State Surcharge)
$60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge)
*Water Turnaround (add $189.00 if a 5/8" meter is required)
$105.00 Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge)
TOTAL FEES $
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.-goi)herstateonecall.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 lans.
x x U4 Lk-tk
Applicant's Printed Name Applica 's Si nit re
FOR OFFICE USE ' Reviewed By: Date:
Required Inspections: Under Ground Rough-In _Air Test Gas Test Final
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PERMIT
City of Eagan Permit Type:Building
Permit Number:EA139101
Date Issued:10/10/2016
Permit Category:ePermit
Site Address: 4671 Kingsbury Dr
Lot:20 Block: 3 Addition: Beacon Hill
PID:10-13500-03-200
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:One Window/Door
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow
windows, call for framing inspection. Call for final inspection after installation.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Valuation: 500.00
Fee Summary:BL - Base Fee $500 $40.00 0801.4085
Surcharge - Based on Valuation $500 $0.50 9001.2195
$40.50 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 -
Andrew C Welter
4671 Kingsbury Dr
Eagan MN 55122
(952) 220-3675
Crew2 Inc
2650 Minnehaha Ave
Suite 100
Minneapolis MN 55406
(612) 276-1680
Applicant/Permitee: Signature Issued By: Signature
Use BLUE or BLACK o
' For Office Use` e
cif
Permit#: ! 4V �
Cit of Ea al 7 0
Y Permit Fee: / / " .7
3830 Pilot Knob Road ,- .'-',4�=r
Eagan MN 55122 Date Received: f
Phone: (651)675-5675 RECEIVED P1 '
buildinginspections(a�citvofeagan.com Staff: mom
AUG 092017
2017 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: % '9— ( 7 Site Address: 9 7( &"JS L'vv y 1'w Unit#:
r- i Name: ALd ,4` Phone:
Resident/ 4( -7/ ,6 ��
wwner Address/City/Zip: ftr ,�Yy /�Y'
Applicant is: Owner X Contractor ,
[_________,„„________ _
1 Type of Work Description of work: 1--- ---r--11--
Construction Cost: / -0 Multi-Family Building: (Yes /No \iC )
F Company: Sb'✓tc 6,011cfY't.ic.(YL:4 L./..C_ Contact: .54-- -/-4-
1 -/-4-
Address: /(o 3(p/ /-F vi-I•As'TA �-1,- - City: R--‘0C-et/t.-00k,,,`-
Contractor
I State:/4�J Zip: 5-5-0(„S Phone: (o 57 — 1cs,- (0'Finail: smteo>n.s'trc c.(rouOix o.}vt_Q.l'),c
x
i
I 1 License#: t3C-(o2(p(06, 7 Lead Certificate#:
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:
I
i Licensed Plumber: Phone:
I Mechanical Contractor: Phone:
Sewer&Water Contractor: Phone:
Fire Suppression 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
I are trade secrets.
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.00pherstateonecall.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 no 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 pla -.
x c.o SQ1k\ x 1/'��
4
Applicant's Printed Name App'•ant's Signature
Page 1 of 3
��j 7/ (/1&p tel t /(21)0NOT WRITE BELOW THIS LINE /41/1HO
SUB TYPES ,y,
Foundation Fireplace Porch (3-Season) Exterior Alteration (Single Famillyr
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
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 i 0 6,--0 Occupancy ,LA.. MCES System
Plan Review ...,Code Edition 1,4\1\11 01) SAC Units
(25%_ 100%7( Zoning
,i) City Water
Census Code Stories Booster Pump
#of Units Square Feet PRV __
#of Buildings Length Fire Suppression Required _
Type of Construction \11/3 Width
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
jC Footings (Deck) Final I C.O. Required
Footings (Addition) Final I No C.O. Required
_ Foundation Foundation Before Backfill HVAC_Gas Service Test Gas Line Air Test
__ Roof: _Ice &Water _Final 1 t Pool: _Footings _Air/Gas Tests Final
Framing 30 Minutes 1 Hour Drain Tile
Fireplace: _Rough In _Air Test _Final Siding: _Stucco Lath Stone Lath _Brick_ EFIS
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: , Building Inspector
RESIDENTIAL FEES
Base Fee
Surcharge J,/
0 I ' i,
Plan Review '
PACES SAC - 1
City SAC
Utility Connection Charge 9 / D X / 5-1=
9 / 0 5—
S&W Permit& Surcharge " v
Treatment Plant
Copies
TOTAL
Page 2 of 3
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MINNESOTA REGISTRATION NO.8625 ,....."-''
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA148692
Date Issued:04/16/2018
Permit Category:ePermit
Site Address: 4671 Kingsbury Dr
Lot:20 Block: 3 Addition: Beacon Hill
PID:10-13500-03-200
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
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 -
Andrew C Welter
4671 Kingsbury Dr
Eagan MN 55122
(952) 220-3675
Boys Mechanical Inc
490 Villaume Ave, Suite 300
South St. Paul MN 55075
(651) 340-5956
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA155213
Date Issued:05/03/2019
Permit Category:ePermit
Site Address: 4671 Kingsbury Dr
Lot:20 Block: 3 Addition: Beacon Hill
PID:10-13500-03-200
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Air Conditioner
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
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 -
Andrew C Welter
4671 Kingsbury Dr
Eagan MN 55122
(952) 220-3675
Boys Mechanical Inc
490 Villaume Ave, Suite 300
South St. Paul MN 55075
(651) 340-5956
Applicant/Permitee: Signature Issued By: Signature
p l CZI For Office Use 5-7 syz:
44% ;
AUG 2 2 2019 Permit#:
E AG N
Permit Fee: 77
..�.- Date Received:
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651)675-5675 I TDD: (651)454-8535 I FAX: (651)675-5694 Staff:
buildinginspectionsecityofeagan.comC
,1
2019 RESIDENTIAL BUILDING PERMIT APPLICATION �,1r�
8/21/19 . 4671 Kin sbu Drive r
Date: Site Address. g Unit#:
Name: Andy & Allison Welter Phone: 952-220-3675
Resident) 4671 Kingsbury Drive
Owner Address/City/Zip:
Applicant is: Owner ✓ Contractor
T eDescription of work:
Adding basement wall, remodeling basement and upstairs bathrooms.
YP of Work 11367.18
Construction Cost: Multi-Family Building: (Yes /No ✓ )
f �
Craftmasters Remodeling Hannah
Company: Contact:
Contractor
Address: 2495 Maplewood Dr N #314 City: Maplewood
State: MN Zip: 55109 Phone: 651-757-41% Email: craftmasterpermits@gmail.com
License#: BC627243 Lead Certificate#: NAT-32977-2
If the project is exempt from lead certification, please explain why:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
Yes No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer&Water Contractor: Phone:
Fire Suppression Contractor: Phone:
NOTE;Plans and supporting documents that you submit are considered tobe 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.
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.citvofeacian.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.aopherstateonecall.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.
X Hannah Espesesth XHannah Espeseth OateI2019.0821Y164341-05ooeth
Applicant's Printed Name Applicant's Signature
DO NQT WRITE BELOW THIS LINE ,(0\ f Ic) S-4*-
SUB
TYPES Y--t v-t .!2)Vju 1
Foundation Fireplace Porch(3-Season) Exterior Alteration(Single Family)
—X 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
NAlteration Fire Repair _ Windows Demolish Foundation
Replace Repair _ Egress Window Water Damage
Retaining Wall *Demolition of entire building—give PCA handout to applicant
DESCRIPTION
Valuation 010.t7 Occupancy ;?2C_ -.'� MCES System
Plan Review Code Edition ,/`/ ) at✓/S SAC Units
(25% 100%X) Zoning P 0 City Water
Census Code Stories Booster Pump
#of Units Square Feet PRV
#of Buildings Length Fire Suppression Required
Type of Construction ilz 1g Width
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
Footings (Deck) Final/C.O. Required
Footings(Addition) ' Final/ No C.O. Required
Foundation Foundation Before Backfill HVAC Service Test Gas Line Air Test Hood
Roof: Ice &Water Final Pool: Footings Air/Gas Tests Final
)C Framing X 30 Minutes 1 Hour Drain Tile
Fireplace: Rough In Air Test Final Siding: Stucco Lath Stone Lath Brick EFIS
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: (C1 , Building Inspector
RESIDENTIAL FEES ��
Base Fee V £/0 ,
Surcharge to ice' Pc C0
Plan Review
MCES SAC 6.46-00,,,— isc.
City SAC il
Utility Connection Charge )1/6 S . F - x # q�/"°
S&W Permit&Surcharge
Treatment Plant
Radio Meter Read
Copies
TOTAL
Page 2 of 3
r For Office Use ()
Permit#:
E AG N
Permit Fee:
Date Received:
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651)675-5675 I TDD: (651)454-8535 I FAX: (651)675-5694 Staff:
buildinginspections(a�cityofeagan.com
2019 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: ///I/j Site Address: L/6 7/ };,'A) 4 r ci VP-
Tenant:
PTenant: 4-.Air'" 2 !/9'! l��Sr2/l.� l/1�!I�-C rJ` Suite#:
Resident/OwnerName: 4tir±4 4 4/`i/Svn) W-€C-T-e r' Phone:
Address/City/Zip: L//p r.2/ .571‘A)9:5 6W✓'7 0 W`
Name: ip,1(0,,✓ Pp/ License#: ( r)D 607"l
Contractor Address: /f C'4/ 5 ive,/(ln } b r- City:
State: Zip: \i-6-7[3 Phone: (�' /' �9� 7` 1).. l%
Contact: m/Ite, Email: 1 J 9/9-tc4NJ eod-r-AlcAr
Type of Work —New Replacement Repair _Rebuild _Modify Space _Work in R.O.W.
Description of work:
Tankless Water Heater
Lawn Irrigation(_RPZ/_PVB)
Standard Water Heater
Description a Add Plumbing Fixtures(_Main/ Lower Level)
P Water Softener
Description: eC &t./3 h. vas/ I 61,D
Septic System
New Abandonment Connection to City Water from Well
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 New fixtures, adding or removing piping (includes State Surcharge)
$60.00 Septic System Abandonment
$100.00 New Residential (fee collected with Building Permit)
$115.00 New Septic System (includes County fee and State Surcharge)
$60.00 Connecting to City Water from Well*+$290 for Meter and $190 for Radio Read =$540
*Sewer&Water Permit also required for connection charges
TOTAL FEES$
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
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.citvofeaqan.com/subscribe.
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.
x /
Applicant's Printed Name App is Signature
Page 1 of 2
1
For Office Use
•_ :': 41'#.'°
r .r Permit#: -'
E AGA N Permit Fee: 6, 0
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 Date Received: I/--"/ .--/ .'
(651)675-5675 I TDD:(651)454-8535 I FAX:(651)675-5694 REQ L-+ET .y--
Email: buildinginspections a(�citvofeagan.com _ Staff:
Commercial Plan Submittal:eplans a(�citvofeaoan.com L __ ___
NOV 1 9 2019
2019 RESIDENTIAL MECHANICAL PERMIT APPLICATION
Date: Site Address: 1-4‘7/ /'4 cbu ry 1) ;VC (gleie
Tenant: Suite#:
Resident/Owner Name: Phone:
Address/City/Zip: /
-�^ / ) 4j'V19 0 License#: 3 `t(Q
Name: / L) -�G/l/✓4z,ec TI
Address: 1 if 7d .L 5/C1.nN Dr ' 02_ City: 5"pl-1✓j Pad(
Contractor � ) 4 �r
State: /n/L) Zip: cC Dp 4/ Phone: 61 -3S'47//( / d
?d 7
t'/7 1.7-1 1an7-ec dam'%7 c - z--
Contact: �l�C\/) Email: iQ �j
RESIDENTIAL
Furnace & -L7
Air Conditioner
f
Permit Type / ; Lea)/
Air Exchanger
Heat Pump / /et,Y2
° Other
New IV Replacement V Additional Alteration Demolition
Type of Work
Description of work: Il P kvt 0a/6
RESIDENTIAL FEES
$60.00 Minimum Add or alteration to an existing unit,includes State Surcharge
$100.00 Residential New, includes State Surcharge =$ TOTAL FEE
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.
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.nd approval of plans.
0*J ., wy"-
Applicant's Printed Name Applicant's Signature
FOR OFFICE USE
Required Inspections: Reviewed By: Date:
Underground Rough In Air Test Gas Service Test In-floor Heat Final