4670 Manor Dr
Use BLUE or BLACK Ink
i
NMI=
d,
city of f Eap v\ 1, Permit#: l
% Permit Fee: V j
3830 Pilot Knob Road J I
Eagan MN 55122 Gi .tE 11 1 Date Received:
Phone: (651) 675-5675
v I 'Staff. 1
Fax: (651) 675 5694 I I
?/Q 2011 RESIDENTIAL PLUMBING PERMIT APPLICAT ON
Date: I I U~~~ I Site Address: H (o -io g n o r t) r i v P,~ECt 61 n (V
5 23
Tenant. Suite
RESIDENT/OWNER Name: CC~ r1S0kj /Phone: .(x512450-V-b0
Address / City / Zip: k ~ 7v m ct n o r 4J Y ( v iel
CONTRACTOR Name: MILBERT COMPANY INC.dba CULLIGAN WATER
Address: 1801 50THST EAST City: INVER GROVE HGTS
'.45.1.-2241
State: MN zip: 55.077 Phone: 651
Contact: BILL.MILBERTr . Email:
TYPE OF WORK _ New _ Repair _ Rebuild _ Modify Space _ Work in.R.O.W.
Descrt tion o Peplacement
: ,
PERMIT TYPE RESIDENTIAL
ter Softener
Water Heater -,c
Lawn Irrigation C_ RPZ PVB) Add Plumbing Fixtures Main Lower Level)
Septic System Water Turnaround
-New
Abandonment
RESIDENTIAL FEES:
$55.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge)
$35.00 Lawn Irrigation (includes $5.00 State Surcharge)
$55.00 Add Plumbing Fixtures, Septic System Abandonment, Water Tumaround* (includes $5.00 State.Surcharge)
*Water Turnaround (add $166.00 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)
$95.00 Fire Repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge)
TOTAL FEES $ ~5-ez
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.oooherstateonecall.oro
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 1 understand this Is not a permit, but only an application for a permit, and work is not to sta w h t a permit; that the work will be in
accordance with the approved plan in t case of work which requires a review and approval of plans.
> t b
xx
Applicant's Printed Name Applicant's Signature
`FOR OFFICE USE ` ;L~ :rc a i z }Et*e~.c "r ~~t Date z? r3Y .
Reviewed By ~
•v,tfi ?y~ru;~` 3 -a t.:t 1 t.. .i-fi~IL~~ ,_c`? .:r i n is r~nat,..,,,. f f: t 1,~ St Kn
Vl~
Required Inspections Under GrouPd ,_•Rough-ln •,_Air, .Test Gas,Test=.F„„final
. 'CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
SITE ADDRESS:
I . hfilMtt?-:
1:.lf .l;1? ?i<J'tI{
PERMIT SUBTYPE:
,. I
[NSPECTION RECORD
REAGTIVATED FUR BSMf FINiSH 10/06/93 pERMIT TYPE:
DAVID BANGASSER 454-1564 Permit Number:
Date Issued:
I ff1 ? 0001 13? APPLICANT:
L)R .,ill
( bD <' ) 4 t+4 •Nh 4 4
TYPE OF WORK:
r, ? w
tctl 1 1 I? F N6i
c>d1 vt?n
o y /R41q3
INSPECTION .. . .A
I r3•.111 r? ??'M tr N ?,i
1 M A H k`, - f? f f; f i l' 1 li
IF
F. WP! Hfr ttAY NAEis PI N(y
?
1
PemR No. Permit Holder DeLe TsleQhone i
SNY
PLUMBING ? ? ?'?(0 - (PQ y'
HVAC /?? 7'?• 95'? •??'??
ELECTRIC
ELECTRI YyS,jl,?
Inspsctlon Date Inap. Comments
Footings I ??ll'.3 ?, o
:Ymr?
Foundation
Framing 2-2- _?3 .
Roofing
Rough Plbg.
/ ,CJ
Rough H19. ? 3 l
Isul.
Fireplace
Fnal Mg.
o?satreM
Final Plbg. Plbg. InspecKOr- NotHy Plumber
Const. Meter
EngrJPlan
eldg. Final
xz
Deck Ftg.
Deck Final
Well
Pr. Disp.
4 ? ??? * •s ?
f?
C?Certificate df CccuPanc4
wit? of Cfagan
Tcoartacat of 13oi(biug 3a60atieu
?
This Certificate issued pursuant to the requirernents of the Uniform Building Code
certifying that at the time of issuance this strc'kIture was in compirance with the various
orrlinances of the Ciry regulating building construction or use. For rhe fo!lowing:
Ux CU--sification• SF DiiG/GAR Bldg. Ptrmit Na 1969
R- !!- -
Occupancy Type iRORSua.HOVE79 niog District ?
•• +
Owner of Building Addres.c
• lBt,
Building tl A I.ocaliry
MAR^,H 16, 1993
, c- nate:
??-
Boumog oWwial
POST IN A CONSPICUOUS PLACE
.
?• CITY OF EAGAN PERMIT TYPE: ?.Ip I EIt I NG
' 3830 Pilot Knob Road '? . • `? ` i .?
Permit Number.
Eagan, Minnesota 55122-1897 Date Issued:
(612) 681-4675
SITE ADDRESS: f APPLICANT:
Y1AM1I i ; Ili?
? } iif ` .• ? 1 IJ ? f'Jf ? ? { ?. 4 . ! '?',i.• '?r?ti{j i
PERMIT SUBTYPE:
F (14 t 1' ( NII•.
r-
TYPE OF WORK:
I 1 N f! i
?
PermH No. Permit Hoider Date Telephone N
ELECTRIC
PLUMBING
HVAC
inspectfon Date Inep. Commenta
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS 5VC
TEST
INSUL
GYP BOAAQ
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBO
FINAL HTG
ORSAT
TEST
BLDG FINAL
BSMT R.I.
BSMT FiNAL
DECK FfG =Z? ? _
DECK FWAL
---
? _
Addt¢S? 4610 MANOR DR ZlP 5512_
Lot. .1• . Blk
Sub
LAKEVIEW TRAIL
THESE ITEMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECT70N.
Date: 3/ 17 / 93 Yes No Inspector: M
Final grade (6" from siding)
Petmanent steps (garage)
Permanent steps (main enhy)
Permanent driveway ?
Petmanent gas
Sod/Seeded grass ?
TraiVcurb damage
Porch r/
Basement finish
Deck
Please verify with lhe builder the removal of roof test caps from the plumbing system and the shut-off of water supply to
[he outside lawn faucet before freeze potential exists.
Contact engineering division at 681-4645 before working in rightof-way or installing underground sprinkler system.
While - City Copy Yellow - Resident Copy Pink - Contractor Copy 9
d 3 848 . ?yos?
Reque t Dete /O Fne NO Poug?-in Inspeclwn
Reqwretl?
? Ves C No
? Raedy Now WAI NouN Inspedor
hen Reatly?
I; hcensed contractor (JS,ownei hereby request mspec[ion of above alectrical work at:
Job A ress ISVeet Box ar q ute No ?
;1D City
Sedion No Township Name or No. Renge No Covnry
ent(PRINT)
C1. 4,11
Cl. S SCA Phone No
Power Suppiier Atltlress
Electncal on acror iGOmpany Name)
rn £o ujnw Conttacror§ 4cense No
Madm9 Atlare fCOnrcaaor or Owner Making I ns:anefrom
?honzeq ig Nre ICO ra ??Ownar Mekmg Installatwn) P,one u r
/?
ESOTA STRTE? BOA OP LECTPIGTY {_•n? S4 ?,y?, THIS INSPECTION FEQUEST WILL OT
Grlggs-Mitlwey Bldg. - Poom 573 ?n BE ACCEPTEO BV THE $TATE BOARD
1821 Unlversiry Ave., SI. Vaul. M SS10i UNLESS PROPER INSPEGTION FEE IS
Vhorre (812) 642-0800 ENCLOSED
? 39848
REOUEST FOR ELECTRICAL INSPECTION
? Sea mstmcbons for compleung ihis lorm on back of yellow ro0Y
+'X" Below Work Covered by This Request
6M•?'4 E8-00001-08
?,?,;??,'
ew Add Rep. TypeolBmiding ApphancesWired EqwpmentWiretl
Home Range Temporary Service
Duplex Water Heater - Electric Heating
Apt. BuAding Dryer Othec(Specify)
Comm /Industrial Furnace
Farm Air Condiiioner
Other(specity) Contractor§ Remarks / m ? r l? v
,???1?/I ?
Compute Inspecfion Fee Below:
# Other Fea # Service EnirenceSrze Fee # Cimuns/Feeders Fee
Swimming Pool 0 to 200 Amps o to 100 Amps
Transformers Above 200 _ Amps bove 100 _ Amps
Siyns Inapecmr's Use Onry TOTAL
IrngaGOn Booms 3 Q ?,?
Speaal Inspecuon
Alarm/Communicauon THIS INSTALLATION MA DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 NTH ?
I, the Electncal Inspecior, hereby Rough-in Date G?/?
?g
certif that the above ins ection has
y P
been made. finel Date -7 p3
?4
OFFICE USE ONLV
This reqvest vatl 18 montM1S irom
d 8467
? ??-
Raqu t,a t I'L Fire N. Roug n Inspectlon
q?tl?
? No
es
? Reatly Nom
tll Notrty Inepeclor
Vdhen Reatly'+
Im licensed contractor ? owner hereby request inspection of above electrical work at :
Jo tlr ss IStr a or P t N01
w Qry
SecOOn No Township Neme or No Renga No. Co
O ant(PRINT) Phon
V?
PowerSUppl AtlOress
E c rcal Contra im ?GQm a Nam Co c S' n
illn AO s I nvact r Owner Making In?tali tionl
L •
A onze SignaWrel o ac1or?OwnerMekin In a1190on) P n b
MINNESOTA STATE BOAflD OF ELECTNICITV THIS INSPECTION REOUEST WILL NOT
GHgga-MlOway Bldg - Room &173 BE ACCEPTED BYTHE STATE eOARD
1621 University Ave.. SI. Paul. MN 55106 UNLESS PROPER INSPECTION FEE IS
Phone(61Y)6C2-0B00 ENClO$ED
REQUEST FOR ELECTRICAL INSPECTION
d 0 8 4 6 7 See insrmctmns Mr compietin9 ihis form on back of yellow copy
"X" Below Work Covered by Thrs Request
?^M$? EB-00001-08
?4 n K
ew dti Rep. TypeoBwlding AppliencesWired EqmpmentWired
Home Range Temporary Service
Duplex Water Heater Electric Heallng
Apt Bwldmg yer OtheF(Specify)
Comm lindustnal Fumace
Farm Air Conditioner
plnerlsyecdy) ConVacrorS Remarks
Compute Inspechon Fee Belaw
# Other Fee # ServiceEniranceSize Fee # Circuits/Feeders Fee
Swimming Pool 0 to 200 Amps 0 io 100 Amps
Transformers Above 200 _ Amps Ahove 100 _ Amps
SignS lnspecror5 Use Only,
Irrigatwn 8ooms
N
Special InSpection «
AlarmlCommunwation THIS INSTALLATION MAY BE O DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MON
I, the Electrical Inspector, hereby Rough-in oete j-/?_?
(
certity that the above inspection has
been made. F,rei oate ?.
OFFICE USE JNLY
This repuest voitl 18 monNS irom
6554q
2004 RESIDENTIAL MECHANICAL PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please complete for. single family dwellings & townhomes/condos when pennits are required for each unit
3o-S?
Date 2 2 / 04
Site Address 4 C D'7 O M an Or D01 r vc, unst a
PropertyOwner A ndre.w ?C31' I.'SDt'l Telephone # (() °Jj 5 10 - 92(oQ
Contractor
/' j-eVi? H'?Q- 6 ? ?CJ
StreetAddress 13 ?- E ien
d7Gj l?ioneer {I'QI i City Z:ft? +rcltrte.
State MM Zip 553 Telephone# (Q"5Z)
Bond #: /" 1 LI - 5 ? ? ? LV5 Ex
ires: elj5 04-
p
The Applicant is _ Owner X_ Contractor _ Other
Add-on or alteration to eidsting dwelling unit $ 30.00
? furnace _Additional ?Replacement
air exchanger
? air conditioner _New ? Replacement
other
1 50
$
State Surcharge D .
? JUL 2 3 LO04
u
$ W
?
Total •
By
I hereby apply for a Residential Mechanical Permit and acknowledge tttat
be in conformance with the ordinances and codes of the City of Eagan d with
permit, but only an application for a pemvt, and work is not to start thout a
approved plan in the case of work which requires a review and approva of .
JP,?-e?nu ?'1`1vr?h ? l 1
Applicant's Pfinted Name Appli
ation is complete and accurate; that the work will
Mechanical Pri?es; that I understand this is not a
nit that [h wor ll be pn 46cqfknce wi[h the
?b LE uu11?D
JUL 2 3 2004
?G SS RESIDENI'IAL BUILDING
? I Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5694
Naw Construction Reauirements RemodeVFteoair Reaui2menLS Off?ce Use OnN
3 registered site surveys showing sq fi. of lot, sq il of house; and all roofed areas 2 copies of plan Cert of Survey Recd
(20% maximum lotcoverage allowed) 1 setaf Eneigy Calculations for healed additbns Tree Pres Plan Recd
2 copies oi plan showing beam & wirWow sizes; poured found design, etc. 1 site survey for addNOns & decks Tree Pres Nat Reqd
i set of Energy Calculations AddiNon - Mdkate 'rf orrstte septic system _ Onsite 5eptic System
3 copies of Tree Preserva6on Plan if lot plai[ed afier 111/93
Rim Joist Deqil Options selectian sheet (bldgs with 3 arless unils '
Date ? / ? / 'K Construction Cost W?a -
SiteAddress Unit/S[e #
r f
?
/
-'
-
?
Descriplon of Work (
0 12 /' (X
h S 7 ?
Q
????'k
1, o "
PU?J
11
S I)p H
4
Multi-Family Bldg _ Y_ N Fireplace(s) _ 01 _
Property Owner An6'J( V` P G L?` rfZ)h Telephone #( ) 4?? ? ?
r ' d
N ?
d
Contractor
?
o oo
Address ?-s-U . ? City
State Zip 43'33J Telephone #(9So2) C1 ??r2?
cg-7 0 -(Z
COMPLETE TNIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy Code CategOry . Residentlal Ventilation Category 1 Worksheet • New Energy Code Worksheet
(J submission rype) Submitted Submitted
• Energy Envelope Calalations Submitted
Licensed Plumber
i ?
Mechanical Contractor
Telephone #(
Sewer/Water Contractor
Telephone # (qS? eW-
Telephone #(
I herebY aPP1Y for a Residential Buildin8 Permit and acknowledg' e'thatitheJinformatioriJ's 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 permit, and work is not to start without a
permit; that the work will be in accordance with the approved plari in the case of work-which requires a review and
approval of plans. ?
!?CtU(,l'Q ?/. ?0)5?1 `
Applicant's Printed Name ApplicanYs Signature
RESIDENTIAL
BUILDING PERMIT APPLICATION
2 3830 PILOT KNOB RDEAGAN MN 55'122 1?-{ a
S V U 651-681-4675
New Construcdon Reauiremenb
. 3 registered sile surveys showirg sq. fl. oF lol, sq. fl. of house; and all raofed a2as
(20%maximum lot wverage allowed)
. 2 copies of plan showing beam 8 window s¢es; poured found design, elc.)
• 1 set of Energy Calculalions
• 3 copies o( Tree Preservatian Plan if lol plalted afler 711193
. Rim Joist Detail Optloro selection sheet (bldgs wdh 3 or less units)
DATE c '/ ? - O
RemadeVReoair Reauiremenb
. 2 wpies of plan
. 7 sel of Energy Calculatmns for heated additions
. 1 site survey for ezleriar addi6ons & decks
• Indicate if home served by septic system for additions
VALUATION o Oq6o , 80
SITE ADDRESS '5IZIfi6 "UNdlj MULTI-FAMILY BLDG _ Y _ N
TYPE OF WORK ? ? - 1Q6 a-? FIREPLACE(S) _ 0_ 1 _ 2
APPLICANT
r e
STREET ADDRESS b58.? EAEW t/Als Riv/? su?%s /3o CITY LcD6N lR4.joS STATET' LV ZIP ?Z4/1,
TELEPHONE # CElI PHONE #
FAX#2s'a?-97`/- !d'Ry
PROPERTYOWNER? vNN (1',4 )SoA/ TELEPHONE# &S/-'yS(o`Fo?G?
--------------------------------------------------------- ---------'--------°------"--'-------
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ ;bIINNESO"G\ RULL'S 7670 CA'17:GORY 1 _ MINYLSO'CA Ri1L1:S 7672
(Jsubmission type) • Residential Ventilation Category i Worksheet SubmRted • New Energy Code Worksheet Submitted
• Energy Envelope Calculations Submitted
Plumbtng Contractor: ___
Pluinbing systcm includcs:
Mechaniccl Contraetor:
Mcchanical system includes:
_ Air Conditioning
_ Hcat Recovery System
Phone #
Sewer/Water Contractor: Phone #
Pce: $70•00
S JUN 2 0 200Z Ill h
------------------------------------------------------------------------------------------- - -- -- - ---------U;----
I hereby acknowledge ihat I have read this application, state that the information is ¢ ect, and agree to corhply
with all applicable State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant
orricr, usi: oNLY
_ Water 5oftcner
_ Wa1cr Heatcr
No. of Baths
_ Phone #
I,awn Sprinklcr
No. of R.I. Baths
Fce: $90•00
Certificates of Survey Received - Tree Preservation Plan Received _ Not Required _
Updated 4102
? CITY OF EAGAN PERMIT
3830 Pilot Knob Road PERMIT TYPE: B u z ? o r N c
Eagan, Minnesota 55122-1897 Permit Number: 028334
(612) 681-4675 Date Issued: 0 7/ 2 2/ 9 6
SITE ADDRESS:
P.T.N.: 10-44330-010-01
4670 MANOR OR
LOT: 1 BLOCK: 1
LAKEVIEW TRAIL
DESCRIPTION:
^,, _?
ildi`% Permit Type
T`Buildzng?Giork Type
-=.Csnsusq Cade.
`
r%
E
(
. ,A
"J u
DECK
NEW
434 ALT. RESIDEN7IAL
,-Yr'"w
r- j ES ?
REMARKS:
FEE SUMMARY:
Base Fee $45.00
5urcharge. $.50
Total Fee $45.50
CONTRACTOR:
OWNER: - "PP
CARLSON
4670 MANOR
EAGAN
(612)456-9268
icanc -
ANDREW
DR
MN
I herehy acknowledge that I have read this
information is correct and`egree`CocompSy
Statutes apd Citly af Eagan -Ordinances
I APPLICANT/PERMITEE SIGNATURE
application and state that the
with ell appliceble State of Mn.
('ISSUED BY: SIG? TURE ?
.. . CITY OF EAGAN
3830 PILOT YCNOB RD - 55122
1996 BUILDING PERMIT APPLICATION (RESIDENTIAL)
6814675
RemodellReoair Reauirements
- "I's. E o
? ?
??o
? 3 registered elle surveys
? 2 copies of plans (Include Deam 8 window sizes; poured fnd. design; etc.) ? 2 copies ot plan
? 2 sile surveys (exterivr addRions & decks)
? 7 energy calwlalions ? 1 energy ealculetions (or heated additions
? 3 coDies oi tree preserveHon plan H lot plaHed efter 711193
required: _ Yes No
DATE: Z?, F3I9 c2 CONSTRUCTION COST: 2sc)o
DESCRIPTION OF WORK: T)ECrC
4(070
STREETADDRESS:
LOT ? BLOCK ? SUBD./P.I.D. #: LAK?`?'E"`? T2A?? AvD , Ti O?
Name: A^?OREYJ Phone#:
PROPERTY
OWNER ?* FINBl 4,Ipat< T3(o -359"1
Street Address MaaoR, D2
City: EAG A f1J State: Mtj Zip: 5517-2)
CONTRACTOR Company: Phone #:
Street Address: License #:
City: State: Zip:
ARCHITECTf Company: Phone #:
ENGINEER
Name: Registration #:
Street Address•
City. State: Zip:
Sewer & water licensed plumber:
change are requested once permit is issued.
Penalty applies when address change and lot
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.
Signature of Applicant:
OFFICE USE ONLY
Certificates of Survey Received
Yes _ No
Tree Preservation Plan Received - Yes - No
RECEMEDD
J U L i99s
?_
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Duplex ? 11 Apt./Lodging ? 16 Basement Finish
? 02 SF Dwelling o 07 4-plex ? 12 Muiti Repair/Rem. 0 17 Swim Pool
? 03 SF Addition o 08 8-plex ? 13 Garage/Accessory ? 20 Public Facility
0 04 SF Porch ? 09 12-piex ?
?4 Fireplace o 21 Miscellaneous
? 05 SF Misc. ? 10 = plex e
V' 15 Deck
WORK TYPE
r?' 31 New
?o • 32 Addition
0 33 Alterations ? 36 Move
0 34 Repair o 37 Demolition
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
0N Basement sq. ft.
VAI_ Main level sq. ft.
? sq. ft.
sq. ft.
sq. ft
sq. ft
Footprint sq. ft
APPROVALS
Planning
Building _k4i
Engineering
MClWS System
City Water
Fire Sprinklered
PRV
Booster Pump
Census Code.
SAC Code
Census Bldg
Census Unit
Variance
1
O
Permit Fee
Surcharge
Plan Review
License
MCNVS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
SN11 Surcharge
Treatment PI.
Road Unit
Park Ded.
Trails Ded.
Other
Copies
Total:
Valuation: $
% SAC
SAC Units
.
. •- , .
,
?
,-?--
?
?
I
?
i
I
?
?
?
° -
I ?
, (
w I
;
,
? i
? I
? I
? ?
N
_. ?
`
A?4? LARLSO ?
467 V4rAo2 s5iz3
ip?G MN
.--?-? 1?onnt PH 456 -4Z&8
l?A/_C ? OF-'In V.L-np1? pla 7 Mn-"+r]QI
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
SITE ADDRESS:
4670 MANOR
l r11.L-VTEW TRflXL
PERMIT SUBTYPE:
sr owc
INSPECTION RECORD
PERMIT TYPE:
Permit Number:
Date Issued:
i.nr: 0001. BLocK: 000 ?PPLICANT:
pR TH01?SON HOMES BF2iAN L
(612) 0.54-0644
TYPE OF WORK:
NEW
Bur.Lor_Ne
001969
01/04/93
INSPECTION
FOOTTNG .. .
FftAMSNG .A
ZNSUI_HTIpN 1=T,NAL
(=1Rl=FLflCF
REMAI?KS: RECEIF"T #
S& W f'LEsR -RAY HE1EG PLB(i
?
PERMIT
? CITY OF EAGAN
3830 Pilot Knob Road PERMIT TYPE: e u z L 01 h! r:,
Eagan, Minnesota 55123 Permit Number. 001969
(612) 681-4675 Date Issued: 01/04/ s 3
SITE ADDRESS:
P..I. hJ. : 10-214330-0 10-0 l
4670 MflNUR DR
l_OT; 0001 BLOCk;: 0001,
LAKEVIL"-W TRAII.
DESCRIPTION:
i
8ui1d3ng Permit Typc
Building'WorY l"ype
UBC Occupancy
Constructa.an Type
Zoning ?
Suildirig Length
Bu.ildl.ng WicJth
;;F owc
NFW
F2--3 hi-1
V- N
4-1
46
48
REMARKS:
12[CF,IPT tF S. F bJ PLESR - Rf1Y M7>GG f-'LBG
FEE SUMMARY:
VR1 UF,T70N
B ase Fec
I'lan fe vie w
Surch?+rqe
SAC
SAC Uni.tis
SubtoCa1
$576.5O
y:"374„73
$43.00
$%So e00
1@F)
$ 1 , 7 4 4 .2 a
$86 000
MLS-CELLAIVEf)US $1=7q4.5P.
'1"nt?al Fe? °'3.,488.73
CONTRACTOR: - Applicant -. sTe L.[cOWNER:
THORSON HOMES 6RIAN L 14540644 0001317 THOR50N HOMES INC
4456 WEUGEWOOi7 Oi2 4 46 6 WEDGWCIOD UR
FFlGAPI P4N 55123 EAGf1N MN 55123
(612) 454-0644 (612)4511-0644
I
I I hereby acl:nowledge that I have read Lhis application and staYe Y.hat the
i.nforniation is correct and agz-ica to comply wLTh all appli.cflbl.e State of hin.
Starutes and City ofi Eaqan Ordinances.
? -
a RaLt .??11?
LNI
APPL CANT/PERMITEE SIGNATURE SSUED V IGNATURE
PERMIT N
REACT::ATE _
IqLQ
CITY OF EAGAN -1:.1?
1992 BUILDING PERMIT APPLICATION 434
,??
681-4675 .4. REGO
SINGLE 8 MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy
calcs.
COMMERCIAL 2 sets of architectural $ structural plans, 1 set of
specifications, 1 copy of energy calcs.
Penalty applies when typing of permit is requested, but not picked up by last working day
of month in which re uest is made or lot chan e is re uested once ermit is issued.
Date a" . /-43 /5;.2? Valuation of work
Site Address:_ -k 7Z? D.< +?
STREET SUITE /
Tenant Name: (commercial only)
LOT _L
1
BIACB L_
SUBD. ?
P.I.D. M
Descri tion of work: e 1?? s.,eue ?ie.?'
The applicant is: ? Owner LTContractor ? Other (Deseribe)
Name Phot?e
Property LA51 FIRST
Owner
pddress
STREET STE X
City State Zip
Company 7-zolosoo iJv,r,PS Phone ?5 ? 6Gy'S?
Contractor Address Z0e ve License Exp.3 y
City e 42 n State mL) 2ip
Company Phone
Architect/
Engineer Name Registration #
Address
City State Zip
Sewer 6 water licensed plumber Kd:-4 e.63 ?r?-6int. Processing time for
sewer & water permits is two ofice area has been approved.
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.
f A
li
Si
gnature o
pp
cant:
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation
19 02 SF Dwg.
? 03 SF Addition
E3 04 SF Porch
? 05 SF Misc.
? 06 Duplex
? 07 4-Plex
11 08 8-Plex
? 09 12-Plex
? 10 Multi. Add'1.
? 11 Apt./Lodging
0 12 Multi. Misc.
? 13 Garage/Accessory
El 14 Fireplace
0 15 Deck
WORK TYPE
.tgr 31 New
? 32 Addition
? 33 Al.terations
? 34 Repair
O 35 Tenant Finish
13 36 Move
GENERAL INFORMATION
Const. (Actual) V- N Basement sq. ft.
(Allowable) V_ N lst fl. sq. ft.
UBC Occupancy 9,-3 M_1 2nd F1. sq. ft.
Zoning Sq. Ft. total
f of Stories Footprint Sq. ft.
h On-site well
DepLh 14 On-site sewage
APPROVALS
Planning Building 17?-z -9z DS
Engineering Variance
REGIUIRED INSPECTIONS
? 5ite
D Wallboard
? footing
? Final
? Framing
? Draintile
? Insulation
O Fireplace
Permit Fee
Surcharge
Plan Review
License
MWCC SAC
City SAC
Water Conn.
Mater Meter
Acct. Deposit
S/N Permit
S/W 5urcharge
Treatment P1.
Road Unit
Park Ded.
Trails Ded.
Cop ies
Other
Total:
I veiLanon: $ a 61 oao ~
GnaaaE! ;2492Z= 52gX
BsMT; 26Xy2= lOq2 41 xg= 12
-•----
f sr F?oR; . 1I oy x15=
Bsr?T= 1104 tyaXlS%z= 23
2 K ?'/2 = I 5
IX? = 7
l(1 , sb b
(,D1 8c17
8? 9os
'O 37 Demolish
O 16?flas en?E Fi'tish
? 17 Swim Pool
O 18 Comm./Ind.
? 19 Comm./Ind. Misc.
O 20 Public Facility
? ZI Miscellaneous
MWCC System ES
City Water ?IHS
PRV Required
Booster Pump
Fire Sprinkler
Census Code p/
SAC Code _0L
Assessments
SAC % lpp
SAC Units I
WAYEYOR'S
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iJ
L?
?J
4T
CERTIFICAT'E
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- DRAINAGE 8 UTILITV ?/
' EASTIEHf PER pLAT
j LOT`,,, I /'
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THORSON HOMES
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W302,62
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NOTE: lNLRIN3 DIMlyVSI0N5 5HOhVN ARE fDR Nt7qQOHTAL
d VEqTICAL I.OCATION Of STRUCTURE ONLY SEL" NO7E: NO SPECVIC 50145 INVESTIGATION HA3 BEEN COMPLETp
AI"ITfCI'UAL RANS i0R BVILDING 9 FOUk0ATI0N ON THIS WT 6Y TNE BURVEYOR, T}E $WTA9ILITY OF
aMEN9pNS. SoILS TO BUMMT THE SrWf1C Hp1J/E pftpOftO IS
do DENO7E5 PRpPOSED SURFACE DFIAINAGE NOT TME pE!/pN81B1LITY oF TNE SuRVEYOfi.
O DENOTES IRON MONUMEN7 SET SCALE: t INCH = 30 FEEf
• DENOTES IRON MONUMENT FOUNO PROPOSED QARAGE FLOOR - 9 343 FEET
X000.0 DENQTES EXISTING ELEVATION PROPOSED LOWEST FLOOR - 9244 FEET
(000.0) QENOTES PROPOSED ELEVATION PROPOSED TOP OF BLOCK - 34,7 FEET
WE HEREBY CERTIFY TO TNORSON HOMES THAT THIS IS A TRUE ANO CpRRECT
REPRESENTATION OF A SURVEY OF THE BOUNDAAIES OF:
Lof I, el ock I LAK@VIEW 7RAIL AODITI ON, acCOrding ta the rocorded
plat iMreof , Dokota County, Minnesotn.
IT DOES NOT PURPORT TO SHOW lMPROVEMENTS 4R ENCROACHMENTS, EXCEPT AS SHOWN. AS
SURVEYED BY ME OR UNDER MY DIRECT SUPERVISION THIS 22ND DAY OF DEC. , 1992.
PROPOW dMpss 1?0MM MA11R TAKeN
FM THO rMMn a aswgLeNrw.
NLAN IOV10t4 @if PIONEER ENO.
ev?/?< <
JOHN C. LARSON, LANQ SURVEYOR
MINNESOTA LICENSE NUMBER 19828
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10
James R. Hill, inc.
PLANNERS / ENGINEERS / SURVEY4RS
2500 W. CTY. RD. 42 *BURNSVILLE. MN. 65337 • 612-890-6044
R. HILL, ING.
- LOT BIIRVEY C8ECICLIBT 80R RESIDBNTIAL
BIIILDIN3 p8RId2T ]1PPI+ICATSON
? PROPERTY L13GAL:
Ae?f._,7,_._
aate o! surveys A/T4?2 2
CIIMENT 3TANDARDB
O'? 0 • Registered Land Surveyor signature and company
[9'?0 ? • Building Permit Applicant
0 • Legal description
13 0 • Address
13 • North arrow and bar scale
0 0 • House type (rambler, walkout, eplit w/o, split entry,
-/ lookout, etc.)
H" D? • Directional drainaqe arrows with slope/qradient =.
0[7/?0 • Proposed/existinq sewer and water services
V,fl 0 • Street name
0 0 • Driveway
ELEVATIONS
Exiatinc
D 6? ? • Sewer service
• Lot corners
? Cd? 0 • Top of curb at the driveway
??? • Elevations of any existing adjacent homes
8rocoaeQ
" 0 0 • Garage floor
V0 ? • First floor
fl ?? • Lowest exposed elevation (walkout/win8ow)
C??/C1 0 • Property corners
Q" ? 0 • Front and rear of home at the foundation
PONDING AREAS (1t aDv13Cable)
? B'.? • Easement line
NWL
0 Q? ? • xwL
0 0j ? • Pond # designation
? 0 0 • Emergency Overflow Elevation
Q 0 ?
H 0 0
Q D ?
ta? o ?
0 0" p
DIM8NS20NB
• Lot lfnes
• Right-of-way and street width (to back of curb)
• Proposed home dimensions including any proposed decks,
overhangs greater than 21, porches, etc. (i.e. all
structures requiring permanent footings)
• Show all easements of record and any City utilities within
those easements
• Setbacks of proposed structure and setback of adjacent
October 1992
612-474-06 -1'; L'rl-1RN EXCELS I rR YARD 422 F01
-,? • ,
, • y . h(IIflG?U1A lr a..?+.-v. +r.. rn?4v.?•
?eti?? 9e5E ON r, n T4N. OF T
Hp EAGY COD DLiIO
Adap:lon 6ftaetiv? 1!114
JUIJ 18' 92 17: 4^,•
_ r._ 1. j '
w ' r
)wner THE TUCSOM f Phqne
;1te AddreSS Lor 1, aLzx-K I LAKC.v)s.j-T12,4)LS
:ontraeior
:uilding Classiflcation: Type A1 ($1n9]e Family 6 OuDlex) ?; Type A2 (tiesidenttal
(3 stortps ar ess
(Other) (Over ] stories)
;ENERAL tNFOHHATION
I. 8u11dtng Perlmeter? 144ft.
S4k ?t .. 509
Wail hei ht
9 (9rovnd to eave) ft.
S. 1, x 2. (abovs) gross watl aplp \(?O ft,
.?
1. Building dimensions (L) ..?? x(N)?'?,???+ \O ft.2 raof 3 floor area
i. Square tcot arca of rim jotst - F]oar joist stxe (2 x lo:? ? Z
1,,? x Perlmeter - Rim ?fst__area * ?..\. 4.Zft
5. Doors - Area ?'1 , ? • Thic Tc ess`" n. actor
Type of ConsLruct pn Perimeter??, ft•
ManufacWrer-?
'. 7ota1 door's perimeter _ ft
I. Htndows: Nanufacturer ? r.r L\,t h SCate approvM
U fgctor „ .4 "Z
TrPE SIZE AREn (F, z} !nJMBER OF tOTAL FEE7 z
EAGH UNI?5
zia
v_s? `??go ck 94??0
_
tc?•aA a?
-? - _ b-Q -tt C!\O?
Tote] fC.2 Glass ?\ . \-%\ --
? Fireplace area: Wfdth x heiaht .??x??
. Exposed foundaNon: Nalght x Perimeter,-,--?x p Fl.Z
PLET101f oF TiIIS FORH IS REqUIREO FOR ALL NEU COtiSTaUCT10"r. 1vtJOR REMDELIK At10 IIUIlOi'{c5 BEII
ED utIERE EkERGY, O7NER TIIAN TNE MINIHAI CODE ALLOH.INCE. .I5 USED.
?,.
612-4 ; 4-0677 L`r'P1Ah! ES:CELS I OP. Y'ARD 422 F02 JUtJ 18192 1 i: 48
' Framin? area ? lU% of gross wal] area. ?
Gross wall area Cv O _ f'.,z
z
'W1ndrn+ area A -Z?-?,\. ft. U ++tndows a_ . 4-0 x A ? `1(0
Rim)oist area A \"Z..\ U rim joist •. C7-q- U x A
poor area A__ ?
ft.
'J doar area *• K Ca(,-,A U x•
An _?.C10
Fireplace area A -??f-.Z Ufireplace = $ U x A a -F3-
, ,
Exposed foundation A "I -.94 .c7 Pt.'
Framing area A _ "Z,_? ? _ft.L
het wall area A
U foundation - .\ U Y. Aa `FD.03
J franlnq area •.O U x A¦
'J wall = 'MpAz_ U x
(13s; -:,;AL . '. . . . . . . . . U
Gross xall area x Q?.iT(A-1 singie famtTy 7, ju;,;=x = alloaable U.c A/Codp
(13, above) .
x 0.23 (A-Z other resieentte'„ .
x .27 (Other bufldfng:;
x Z$ (Over 3 stories)
Must be iarger than
x l' ?p?e. ..._ ..?\? • ? ? 138 sbave
(2tiing framing area (Af) aquals 1D.". nf cs;ilnv area or the same as)
C 16? 2
Gross ceiling area +(L)___.c'?-4 z(??,9____ ¦ 1-a,ft.
Joist area (Af) • 10; ceiling araa =?__ ft.2
Net cetling area (.4C) (15A - 158) ¦ft.z
U te111 n9 z A c* ?. O7r,\
U framing x A f* x_?? ,
reTAL u x a . . .. . . .. ..... .. . .. . ... .... .. . . ... .. . . . .
Ceiltng area (15A) x 0.026 {A-1 sing?e `amily S duple
x 0.033 (A-2 other resid2^tial)
x O.C6 (other)
Bo H?"ivst 6e larger than 1E0 (abave)
A U5a) \??.0 _ x ?{G4de1:_.O F (or the sdme as)
?-
PIOTE: Use U an9 ,l vaives obtained r"om nps 1, 3 and 4.
CTTY OF EAGAN cirx vse orn. v
L/ B • ? // MECHANICAL PERMIT RECIIPT #
SUB (612) 681-4675 DATE ?-
RESIDENTIAL
PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELI,INGS. AISO, COMPLEfE FOR
TOR'NHOMES/CONDOS R'HEN SEPARATE PERMITS ARE REQUIRID FOR EACH DWELIdNG UNTI'.
OWNER: Brian Thorson Homes ADD-ON A/C 11 ADD-ON FURNACE ?
SITE ADDRFSS: q670 Manor Drive ?D ON/REMODEL (EDIISTING
CONSTRUCI'ION ONM $ I5.00
INSTALLER: Kleve Heating & Air Conditionin HVAC: 0.100 M BTU -7'Jr,600 -8TL{'5 24•00
PHONE #: 941-421 1 ADD1TlONAL 50 M BTU 6.00
Ai'iDRFS3: 13075 Pioneer Trail GAS `vU-1-1L,E°iS -M2vTiviU=
CI11': Eden Pr ''e, M ZIP. 55347 SURCAARG& $ so ?
SIGNAT[JRE TOTAL: $ 27.50
NO PE?tMIT REQUIRED FOR DUCTWORK ONLY!
CObII4IIERCIAL
PLEASE COMPLETE TKIS POR7'fON FOR ALL COMMERCWJINDUSTRIAL BUILDINGS. ALSO COMPLETE FOR
APARTMENT BUILDINGS OR OTHER MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR
EACH DWELLING UNTT.
R'ORK DESCRIPTTON:
CONTRACf PRICE I FEES
196 OF CONTRACT FEE.
STATE SURCAARGE IS $SO FOR EACH
$1,000 OF PERMTI' FEE.
PROCFS3ED PIPING - $25•00
MirnrnrM rEE . $is.oo
REAC7IVATE -L""
PERMIT
l IOLO)
CITY OF EAGAN
1893 BUILDING PERMIT APPLICATION
681-4675
SINGLE d MULTI-FAMILY 2 sets of plans, 3 registered site surveys. 1 copy of energy
calcs. ,
COMMERCIAL 2 sets of architectural 3 structural plans, 1 set of
specifications, 1 copy of energy calcs.
Penalty applies: 1) when permit is typed, but not picked up by last working day of month•
uested once permit
s re
e i
h
t
l
q
ang
,
o
c
in which request is made, 2) address is changed or 3)
is issued.
/b / __?' - / q 5 Yaluation of work -7 Od'?
Date
Site Address: ?&_/o Mfl"??e JDK1
ataeet were r
Tenant Name: (commercial only)
IAT ? 81ACK ? SUBD.??? i S Y.I.D. M
Descri tion of work:
The applicant is: 14 Owner ? Contractor ? Other coe.«iee>
S,?,'f° lj (r) Phone Z-/ e?U
Nr
i
Name
Property LA51 flRST
.
Owner
c
?6670 MA-1"OK-
Address
STREET STE /
!&S /Z 3
? Zi
p
City 5tate
Company Phone
?
Contra ctor Address ` License # Exp.
City State Zjp
Company Phone
A?ChitBCt/
?-------Re`g s ration #
Engineer Name __
Address
City State ZiP
Sewer & water licensed plumber . Processing time for
sewer & water permits is two days onc a e has been approved.
I hereby acknowledge that I have read this application And state that the information is
te of Minnesota Statutes and City of
bl
St
44
a
e
cA
correct and agree to mply with 11 app
Eagan Ordinances.
'
-
5ignature of Applicant: ?
V
OFFICE USE ONLY
BUILDING PERMIT TYPE
? OI Foundation
El 02 SF Dwg.
O 03 SF Addition
? 04 SF Porch
/045 SF Misc.
WORK TYPE
? 31 New
p 32 Addition
? 06 Duplex
? 07 4-Plex
? 08 8-Plex
? 09 12-Plex
? 10 Multi. Add'1.
F33 Atterations
O 34 Repair
GENERAL INFORMATION
,:. .,
0 11 Apt./Lodging
? 12 Multi. Misc. '
? 13 6arage/Accessory
? 14 Fireplace
? 15 Deck
? 35 Tenant Finish
0 36 Move
O 16 $asement Finish
? lr'Swim Pool
? IB Comn./Ind.
? 19 Loiom./ind. Misc.
? 20 Publlc Facility
? 21 Miscellaneous
O 37 Demolish
Const. (Actual) Basement sq. ft. NWCL System
(Allowable) lst F1. sq. ft. City Mater
UBC Occupancy 2nd F1. sq. ft. PRY Required
2oning Sq. Ft. total Booster Pump
# of Stories Footprint Sq. ft. Fire Sprinkler
-
-
length On-site well Census Code
ZT3
111
Oepth On-site sewage SAC Code
APPROVALS
Planning Building Assessments
Engineeriog Variance
REQUIRED INSPECTIONS
? _._..w.._ ?.._.. _,?.w_..?
O 4ite ? Footing )CFraming ? Insulation
? Wallboard ?k Final ? Draintile ? Fireplace
(
Permit Fee
Surcharge
Plan Review
License
MWCL SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment Pl.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total:
wlustcan: g 4?7•' ..2
SAC %
SAC Units
L ? sL ? CITY OF EAGAN
/^ PLUMBING PERMIT
SUBD. c0?,,,, (612) 681-4675
RSSIDBNTIAL
PLEP.SE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS
WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
CITY USE ONLY
RECEIPT #
DATE ?
ALSO, FOR TOWNHOMES AND CONDOS
WORK DESCRIPTION
NEW CONST ,4-
ADD ON _
REPAIR _
OWNER NAME: fYI.Zlt?] `r'UL61N.L(^J'? 4.LCYYW+J
SITE ADDRESS:^1?1D
INSTALLER: /1/l! . ? ? ( G ?C • ?'
ADDRESS: .?dL ;?3? ?I . 'U •
CITY: Uru ZIP:
PHONE IDDo,
I
COMPLETE THE FOLIAWING:
N0. FIXTURES EA. TOTAL
REPAIR/ADD ON 15.00
? SHOWER 3.00
? WATER CIASET 3.00 3-
? BATH TUB 3.00 3, ?
IAVATORY 3.00 ?-
1 KITCHEN SINK 3.00
I IAUNDRY TRAY 3.00 3•=
HOT TUB/SPA 3.00
? WATER HEATER 3.00 3,-
? FIAOR DRAIN 3.00 3, ?
GA3 PIFING 3UT.
? (MINIMUM - 1) 3.00
ROUGH OPENINGS 1.50 4,S
_ OTHER
WATER SOFfENER 5.00
PRIVATE DISP. 15.00
U.G. SPRINKLER 3.00
_ W. TURNAROUND 15.00
S,TATE SURCHARGE .50
'?
TOTAL: ?, _
COMMERCIAL
PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS. ALSO FOR MITLTI-FAMILY
BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT.
WORK DESCRIPTION:
OWNER NAME:
SITE ADDRESS:
TENANT NAME:
SUITE #: _
INSTALLER:_
ADDRESS:_
CITY:
PHONE
FOR:
CITY OF EAGAN
ZIP:
CONTRACT PRICE:
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:
(SIGNATURE)
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA113452
Date Issued:09/04/2013
Permit Category:ePermit
Site Address: 4670 Manor Dr
Lot:1 Block: 1 Addition: Lakeview Trail
PID:10-44330-01-010
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar.
Pictures are not acceptable in lieu of inspections.
Carbon monoxide detectors are required by law in ALL single family homes .
David Stejskal
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Andrew Carlson
4670 Manor Dr
Eagan MN 55123
(651) 788-0632
Aboveboard Roofing & Siding Inc
22909 Meadowbrook Avenue North
Scandia MN 55073
(651) 238-0601
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA143284
Date Issued:06/09/2017
Permit Category:ePermit
Site Address: 4670 Manor Dr
Lot:1 Block: 1 Addition: Lakeview Trail
PID:10-44330-01-010
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:Does not include skylight(s)
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and leave on site.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Valuation: 4,000.00
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Andrew Carlson
4670 Manor Dr
Eagan MN 55123
Clear Choice Restoration
2722 Hwy. 694, Suite 100
St. Paul MN 55112
(612) 259-7177
Applicant/Permitee: Signature Issued By: Signature