4365 Medary AveCITY OF EAGAN Remarks
Addition Rioer Hills 9 Loc Q sik 3 Parcei - *0000M 090 03 Owner ?Street 4365 Medary Ave. State EacTan,MN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF,
STREET RESTOR.
GRADING
SAN SEW TRUNK -
* SEWER LATERAL ' -
WATERMAIN
* WATER LATERAL
WATER AREA
STORM SEW TRK
t ITPW SEW LAT 1976
CURB & GUTTER
SIDEWALK
STREET LIGHT E -19
WATER CONN.
BUILDING PER.
SAC
PARK
RESIDENTIAL
t ? ? ' BUILDING PERMIT APPLICATION ?
CITY OF EAGAN t:?40, O ?o
14? 3830 PILOT KNOB RD • 55122
651-681-4675
New Construction Reauirements
• 3 registered site surveys showing sq. ft. of lot, sq. ft of house; an?ll roofed areas
(20°k maximum lot coverege albwed)
. 2 copies of plan showing beam & window sizes; poured found design, etc.)
• 1 set of Energy CalculaUOns
• 3 copies ot 7ree Preservatlon Plan if lot platted afler 711l93
• Rim Joist Detail Options selection sheet (bldgs with 3 or less units)
DATE K I CX) &,..?v lo, ?0 a)
JOB SITE ADDRESS ? ? ? 5 (?t
IF MULTI-FAMILY BUILDIN,G, HOW MA
PROPERTY OWNER nW ?'. LI c"e, ,
TYPE OF WORK
APPLICANT w i L
ADDRESS 'i,7? Co
PAGER #
c'4 i n I-. -
G .--
NITS?1
?}?- 2
l Ser,- soL_.
e a ?-
G? ? AQ. Sr
l PHONE # 7 1-13-
RemodellReaairRequlreinents
• 2 copies oi plan
• 1 set of Energy Calculations for heated additions
• 1 site survey for exterior additions & decks
. Indicale'rf home served by septic system for additions
?
VALUXION ? Z 1 0 o?
?• ?GCG ._ I?LI 1
OCD _*
ISS( Z-1
oYc-L"'`"J`FI EPS) '`? Y vl?,
PHONE#CaS 1 `gy q
ZIPCODE SJ t ?-?
7??i 2 FAX #
NEW RESIDENTIAL BUILDING ONLY- FILL OUT COMPLETELY
Energy Code Category _ MINNESOTA RULES 7670 CA'1'EGORY 1
(check one) - Residential Ventilation Category 1 Worksheet Submitted
- Energy Envelope Calculations Submitted
_ MINNESOTA RULES 7672
- New Energy Code Worksheet Submitted
Plumbing Contractor: Phone #:
Plumbing Systcm Includes: _ Water Softener _ Lawn Spc•inUer
Water Heater No. of R.I. Baths
?
No. of Baths
Mechanical Contractor: Phone #
Mechanical System Includes: _ Air Conditioning
Heat Recovery System
Sewer/Water Contractor: Phone #
All above information must be submitted prior to processing of application.
Fee: $90.00
d:HFI--'-
nl N o \j
I hereby acknowledge that i have read this application, state that the information is or ct, and agree to comply
with all applicable State of Minnesota Statutes and City of Eagar. OrdLces. ?
Signature of Applicant
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 1101
OFFICE USE ONLY
? 01 Foundation
? 02 SF Dwelling
? 03 01 of _ plex
13 04 02-plex
? 05 03-plex
? 06 04-plex
? 07 05-plex ? 13 16-plex
? OS 06-plex ? 16 Fireplace
? 09 07-plex ? 17 Garage
? 10 08-plex ? 18 Deck
? 11 10-plex ? 19 Lower Level
? 12 12-plex Plbg_Y or _ N
? 20 Pool
? 21 Porch (3-sea.)
? 22 Porch/Addn. (4-sea.)
? 23 Porch (screened)
? 24 Storm Damage
? 25 Miscellaneous
..
? 30 Accessory Bidg
? 31 Ext. Alt - Multi
? 33 Ext. Alt - SF
? 36 Multi
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) 0 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)* ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement •Demolition (Entire Bldg only) - Give PCA handout to applicant
Valuation
.411
? 47C>v3
Occupancy
MC/ES System
Census Code ? Zoning City Water
SAC Units ? Stories ? Booster Pump
Nbr. of Units /
---y- Sq. Ft. PRV
Nbr. of Bldgs ? Length Fire Sprinklered
Type of Const ? Width
REQUIRED INSPECTIONS
_ Footings (new bldg)
_ FinaUC.O.
Footings (deck) FinaUNo C.O.
Footings (addition) Y Plumbing
Foundation ?
Drain Tile
Roof Ice & Water Final Other
? Fraxning
Fireplace _ R.I. _ Air Test _ Final
?( Insulation
-r?
Base Fee
Surcharge
Plan Review
MC/ES SAC
city sa,c
Water Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
_ Pool _ Ftgs _ Air/Gas Tests _ Final
_ Siding Stucco Stone
_ Windows (new/replacement)
----------------------------------------------------------- -------------------------------------------- -----------
Approved By ?? , Building Inspector
?a
1 0 , cs 0 ,? s o
?? •g ?
? U-
HVAC
RESIDENTIAL
BUILDING PERMIT APPLICATION ? ?0 0 ,--1
lirl 1) I ? CITY OF EACAN
3830 PILOT KNOB RD - 55122
651-681-4675
NewConstruct(on Reauirements RemodellRepairReauirements
• 3 registered site surveys showing sq. ft. of lot, sq. ft of house; an?ll roofed areas • 2 copies of ptan
(20°k maximum lot coverage albwed) . 1 set o( Energy Calculalions (or heated addi6ons
• 2 copies of plan showing beam & window sizes; poured found design, etc.) . 1 site survey for exterior additions & decks
• lsetofEnergyCalculations . Indicate'rfhomeservedbysepGcsystemforadditions
. 3 copies ot 7ree Preservation Plan if lot platted after 711l93
. Rim Joist Detail OpUons seleclion sheet (bldgs with 3 or less uniLs)
DATE I Ol ,7_--z,I_?1^ VALUAI'ION ?I ?v ^
JOB SITE ADDRESS `t??9 ? 11\?4 CVU?.x.v l?
IF MULTI-FAMILY BUILDING, HOW MANY UNITS?
PROPERTY OWNER \?? ?TY f??
7YPE CF :R'O!t!: AQ \,1lX&aA1 V?Q'Q?1M9A?' FlP,EPLACE(S) _?? _ 1_ 2
APPLICANT PHONE#
ADDRESS BUIIDERS & REMODELERS, INC
..?.,.,??.A,K en ZIPCODE
PAGER # CELL PHONE # MPLS, MN. 554D8 (612-627-5481) FAX #
NE1V RESIDENTIAL BUILDING ONLY- FILL OUT COMPLETELY
?,-----__
Energy Code Category MINNESOTA RULES 7670 CATEGORY 1 ' i)
l
(check one) - Residential Ventilation Category 1 Worksheet Submitted'
- Energy Envelope Calculations Submitted
MINNESOTA RULES 7672
- New Energy Code Worksheet Submitted
Plumbing Contractor: _
Plumbing System Includes:
Mechanical Contractor.
Mechanical Systcm Includcs:
Sewer/Water Contractor:
_ Water Softener ?
_ Water Heater _
No. of Baths
Air Conditioning
Heat Recovery System
Phone #
Phone #
Fee: $90.00
Fee: $70.00
All above information must be submitted prior to processing of application.
I hereby acknowledge that I have read this application, state tha e informati
with all applicable State of Minnesota Statutes and City of Eag n dinances.
Signature of Applicant
Certificates of Survey Received _ Tree Preservation Plan Re eived _
_ Phone
Lawn Sprinklcr
No. of R.I. Baths
is cjorrell:?4, and agree to comply
Not Required
Updated 1/01
OFFICE USE ONLY
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? OS 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 PorchlAddn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screened) ? 36 Multi
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addition ? 36 Move Bidg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)* ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement *Demolition (Entire Bldg only) - Give PCA handout to applicant
Valuation Occupancy MC/ES System
Census Code Zoning City Water
S.°.C 'vn;s Sioriss Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bidgs Length Fire Sprinklered
Type of Const Width REQUIRED INSPECTIONS
Footings (new bldg)
Footings (deck) FinallNo C.O.
(addition) Plumbing
Foundation
Drain Tile
Roof Ice & Water Final Other
Framing _ Pool _ Ftgs _ Air/Gas Tests _ Final
Fireplace _ R.I. _ Air Test _ Final _ Siding Stucco Stone
Insulation _ Windows (new/replacement)
Approved By
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
FinaUC.O.
_ .O.
HVAC
Building Inspector
VIL!AGE._OF EAfiAN WATER SERVICE PERMIT
3795 Pilot Knob Rood PERMIT NO.: 1973 '
Eagan, MN 55122 DATE: 5/5/76
Zoning: RI No. of Units: 1
wind80Y D2t1. COI'p
Owner
.
Address:
site ndare55: 4365 Medary Ave. L9 B3 RH 9
Plumber: Thompr-on P1vIIlbfng Co
?
Meter No .: Connection CharSe;205.00 pd
5" e: " Account Deposit:
?
4
1C 10.00 b lled 865
R ader No.:
-
0 Permit Fee:
-S
• 50 billed 86
1 ogree to/ c-o ply with tho Villaga of Eagan Surchazge:
60.00 pd
Ordinoneefc? y-G° Misa Charges:
a Total:
gy Date Paid:
Date of Insp.: Insp.:
VILL!lOE.4F_EAOAN SEWER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.: 2731
Ecgan, MN 55122 DATE: 5/5/76
Zoning: 'RII No. of Units: _ 1
Owner. Windsor Dev C.b2'p
Address:
Site Address: 4365 Nedary
Plumber: Thompson Plumbina Oo.
100. 00 Pa
1 ogroe to comply witA ehe Villoge of Eogan Connection Chazge;50.00 pd
Ordinancas. Account Deposit:
Permit Fee: 10.00 billed 865
s h .50 billed 865
ey:
Date of Insp.:
[nsp.:
urc arge. -
Misc. Chazges:
Total:
Date Paid: -
CITY of EAGAN
BUILDING PERMIT
O wae: .. (r?..nln???r!/'.:c-•. •.??? ei?-....
........
Address (Presen!) JVAP....lN...1-.?...??..?...?X?f:.....................
........
snUaer ...................... . ••---.._.......-?--i...........................................
Address ..........k..?'SnIR....._....y{.?f••?'L.,/ °•••
DESCRIPTION
- ?/
., ,.
N° 3916
3795 Pilot Kaob Road
Eagan, Minnesota 55122
454-8100
D.:. ..G/44!?Jgd/..?1.9..7..-?.......
To Bo Used For Front Depth Heigh! Eel. Cosi Perms! Fae Remarlu
I ?F ?'0C ? - 7 1 1 LOCATION // j I
Sireet, Road or other Deacription af Location ? Lo! I Block ? waatnoa or z'ract
?
This permit does aot auao:ise the use of streets, :oads, alleps or sidewalka nor does it give the owner or hia egea!
the right !o cre83e aay siiuation which is a nuisaace or which presenls a haaard !o the heatth, eafety, conveaieacs and
THIS PERMIT MUST BE ONom:nuniR?EM W ILE THE WORK IS IN PROGRESI:???%1N5e't
9 Ye p the . .. Y•. ...----..haspermission !o erac! a:
This is io eeriify, lhat.?,1..4..1!(.E-w.... _ •-••-•• ••••- •... t . .............••--••...._upoo
the above described pre ' e bject io the provision??of al1 applicable nanc s fo the Ci3 E
^ --`
............ .:. .......... ....... ... -• - Suildinq Inapeetor
-- -°°--...•••.......... Per ..... . °° --- . .__.? ..... ......... ....... ......................................
?
. ' CITY.cY' rLAG1) rT
37c,`5 Pil,ot T?'r.ob Road
E?..n, Mir.::e;:ota 55' 22
Pi.i `/?1' NJ.
Ti;e City of i,a..-an herery gra:its to 837
C.1
"-"' R`a y ' N ? tTeTf e r ?ie ?tr1? - - -----
a Pe:?;nit foi: (Owner)
MinneapoTi?s
pursuant to application da ted
Heating WinBsor v. rp. Fee Pairle dated this day of , 19?. .
4365 Medary Ave.
$20.00
.50 s/c
28 May 76
Euilcing Inspector
MecranicaJ_ Pei•mi_+s :
Bici Total:
.-
, ? .
CITY OF Lp,r,?.?r1
3795 Pi7.o1; F:nob I;c&d
675 ? _ -. .
• ___
Tile City of Ea-lan heret;y grants to'1'homPecn Plim?bing Oo. ?
i I
`-?- - ?? 12201 Minnetonka Blvd. i I
1f?'i so3-r ne- v. ?brp:, -_?--" ?
a PLUMBING Pe=dt for: (Owner) Karren Anderson?. & tierr Horizon ?e
-- -- -
____? :, :rsuan t to apol? cation dated
billed I
Fee jMjCA: _ 160.00 ciated this 5tkay oi MaY
4.00 5 c ?
Statement #865
_ •i _ .
5/5/76
e 19 76 •
I-
EuiiuinZ Inspector
?
r /ob ite AJd ress:
ATEGORY 1" ALTERNATE FOR
NE & TWO FAMILY DWELLINGS ,city oF eegnn
RUCTIOYS: This alternative may be used for one- and twafamlly dwelliags built to meet the Categary 1 requiremeatt o[
Minnesota Rules, Chapter 7670. Complete Parts A, B, and C. Cleazly mark plans with: insulation R-values; window and slrylight U-
values; size and type of equipment; equipment controls; and location of vapor retarder and windwash bazriers. More detailed
informaaon can be found in the Minnesota Energy Code suaunary sheets available from the hlinnesoca Departmeat of Commerco.
Part A. BUILDING ENVELOPE
Check pmposed envelopejoint sealing opdon 4 ? Preuripave (caulldng, gasicees, ete.) ? Pecformance (test per 7670.0470 subp. 7.C.)
•,?
Check therma! eaergy calcula[ion option used 4 O"Cookboolt' (compltte workshee[ below) O b(nCheck method (attach repoct)
- ? Pedormance (attach (!-vatuc calculatioos) 0 Systetat Analysis method (attach analYsis)
"Cookbook" Worksheet
Ixstxucnoxs
5tep 1. Check item(s) that design meet4 on Minimum Requinments list
w the right Mus[ meec all items to use "Coolcbook" opuoa
Step 2. Indicate pmposed wall rype on table below.
Step 3. [ndicate Window U-value and saurce.
Step 4. Varify toral window (iacluding azea of all foundacion windows)
and door azea is equal or less than allowable percentage.
TABLE FOR DET ERMIIVING MAXIIVIUM wuvlww tury inrvx nnar. :-?
Maximum Allowable Total Window and Door A?ea a4
'
4y
26°/.
a Percenha e of Exposed Wall ' 120/6 14% 16°/. 18%: 20% 22% 2
Wall T Standard Framin : A Wmdow L-valua fcxoc pt founda6on windoas :--
R-13 insulation. R-7 sheathin
? 2x4 0.557 0.47 0.41 036 ' 0.33 0.30 0.27 025
,
R-15 insulatioa, R-5 shcathin
0 2x4 0S2 0.45 039 035 . 0.31 0.28 016 0.24 ; :.022c1
*
,
R-19 insulation, <R-5 sheathin
? 2x6 0.48 OAl 036 032 ' 0.29 0.26 024 0.22.= . 02F
-%
,
R-19 insulation, R-5 shwthin
? 2x6 0.56 0.48 0.42 0.37 034 0.31 0.28 . 0.26 = :C0.:24as.'
'
,
O 2x6, R-21 insulatio <R-S sheathing 0.51 ' 0.43 0.38 034 0.30 0.28 0.25 0.23 "r0:22
. Z
M
0 Zx6. R-21 insulatio4 R•5 sheathin _ 0.58 ..: 0.50 . 0.44 0.39 0.35 0.32 .- 029 A.27„; .02
WaU Advaaced.F • : - , .. _ , . ... ....,. .....
Maximum
A
Window L?
value ex .
c'
t founda . .
tion wmdows :. r . . .. ?,c;n_.:
•.:..
. p ....?.
?•
• 2x6 R-19 insulaao <R-5 sheathin 0.52 ?. .-0.45 0.39 0.35 0.31 0.28 . . 0.26 0.24 ?+ .- 0
'
R•19 insulatioa R-5 sheathin
0 2x6 0.58 0.50 0.44 0.39 035 0.32 : 0.29 `027;."'
' [
:?4
.
a R•5 sheathin
R-21 insulaaon
• 2x6
0.55
0.47
0.41
0.36
0.33
030
027 . 1
0.25
," 230
3• 0
,
,
? 2x6, R-21 insuladon, R•5 sheathin 0.60 0.52 0.46 0.41 " 036 0.33 0.30 " 0.28 •' ?'a16?
Window U-value: ?? . Soucce: O NFRC 'O ASHItAE 1993 Handbook s*-?
. .
,
100 X ;• ?,
.,.r .`_._?,_.?.::... :r?t?
.. .<_.,
k
?
' window & door arca gcoss acposed wall area
MINDIUhI REQUIREMENTS
for °Cookbook' o tlon onl
Ceiling Insulatioa I bfinimum R-38 wirh 754" eaergy heel: or
Nfinimum R-44 wid? tow truu heel; or
Minimwn R-38 with R•5 sheathin when no atdc.
? Entry Doors: Max. U-value of 030 or l'/." soGd wood with storm
:K Rim Joist Insularion: biinicnum R-19
? Floors ova uncondirioned s aces: Minimum R-24
Foundadon Insulation: Minimum R-10
O Fouadatioa windows: F" insulated glass, wood or vin I fiame
M/NNESOTA ENERGY CODE - WHICH RULES MAY 1 USE ?
Detached R 3 occupancy 1- and 2-faml]
Examples: single family, twia homes
Attached R-3 occupancy dwelltap
?
Examola: triplex townhousesaad ro
R-1 occupancy bulidings of 3 etoda or
E7fatI1PIH: CORQOQIIRIUIOS O[ 2p314A!
R-1 occupancy bulldlap over 3smrla
Exarnoles: hiah rise condos or aaaRn
or
Catagory l"
or
xith either "I
or
LE RULES
pressurirrtiou and ventiladou requi?emeits?
?ateHOrY 2•• provisiom
-.+{Tt
"ateBorY 2" Drovisions
r .. ?A
?I
? ;?„tP ?r'Pnhnnr. Yvmb_r.
1? F .- ..: , .. -.
MiASTER CARD
IOCATION /f / N_ //JA I" t/ . `f_ SL. S I?7 - e3'
OWNER
STRUCTURE AND ? /?? ??
IAND USED AS
Permit ?
No.
Issued Issued To
Contractor I Owner
BUILDING LYRIZ 4 -10?? ' 0?-
PLUMBING L 7 S
A&M
CESSPOOL - SEPTIC TANK 10
WELL
ELECTRICAL
HEATING ?3") 5-/d?„?G t/?`?. •
GAS INSTALLING
SANITARY SEWER
OTHER
OTHER I
Items Approved
(Initial)
Date
Remarks
Distance From Well
FOOTING SEPTIC
FOUNDATION CESSPOOL
FRAMING 71LE FIELD FT.
FINAL
EI_ECTRICAL
HE,OTING
?- DEPTH
Of WELL
GAS INSTALLATION
SEPTIC TANK
CESSPOOL
DRAINFIELD
PLUMBING
WELL „ N6 ?
SANITARY SEWER
?
..
?? ?
? ViolaTions Noted
on Back
COMMENTS: ?
COMPLIANCE INSPECTION REPORTS
TO BE USED ONLY IN EVENT OF OBSERVED VIOLATIONS
PERMIT NO. DATE OF INSPECTION
CONDITIONS OF CONSTRUCTION AT THIS INSPECTION
? NO EVIDENCE OF NON-COMPLIANCE
OBSERVED.
a ACCEPTABIE SUBSTITUTIONS OR
DEVIATIONS.
? NON-COMPLIANCE. BUILDER WILL COMPLY
WITHOUT DELAY.
ITEMIZED AND DESCRIBED AS FOLLOWS:
NON-COMPLIANCE. BUILDER DOES NOT
INTEND TO COMPLY.
? COMPLETION OF CERTAIN IMPROVEMENTS
WILL BE DELAYED BY CONDITIONS BEYOND
CONTROL.
? REINSPECTION REQUIRED
REINSPECTION REVEALED
DATE OF REINSPECTION
CERTI FICATION - I certify that I have carefully inspected the above in which I have no interest present or prospective, and that I have reported herein
all significant conditions oL•served to be at variance with ordinances of the Town of Eagan, approved plans and specifications, and any specific require-
ments for off-site improvements relating to the property inspected.
F ALL IMPROVEMENTS ACCEPTABLY COMPLETED
COMMENTS:
BUILDING INSPECTOR
DATE
22
DEVELOPMENTCORPORATION
April 27, 1976
Mr. Dale Peterson
City of Eagan
3795 Pi1ot Knob Road
Eagan, MN 55122
Dear Mr. Peterson:
,l
?
RE: Lot 9 B1ock 3 River Hills
4365 Medary Avenue
Enclosed please find a check for building permit application and
fees as allocated on the check stub in the amount of $1,009.50.
This home wi11 be a Model 76-51, elevation B with a tuck under
garage and wi11 contain the following:
- Brick front per plan
- Patio door DR with concrete slab
- 2 fireplaces
- .Appliances
- Basement unfinished
Attached also find a copy of the proposed plot plan.
Sincerely,
WINDSOR DEVELOPMENT CORPORATION
NQ.P/t1L.-" )j atirk';L?
Warren R. Anderson
Vice President
WRA/ks
Attachment
SUITE 192, 4660 WES7 77TH STREET, EDII+[A, MINNESOTA 55435 • PHONE (612) 831-0717
` / ( CTTY U5E ONLY
PERMIT #: RECEIPT DATE:
2008 Rn1D$PTIiRL bIECHAAICAL PERM1T APPLICATION
crrYoF EAteM
3$30 PILOT KAOB IiD
£Afli4A 1MIN 55122
651-6$1-4675
Please complete for: ? single family dwellings
townhomes and condos when permits are required for each unit
Date: _ C;)- a P?-o zl?
SITE ADDRESS: 9 `f) Lc?-? fN?z C?_
OWNER NAME:
INSTALLER NAME
? u
TELEPHONE #:
STREET ADDRESS: ? I J I?S ?e_?"V_Zo
TELEPHONE #: LS1
V'
STATE: ? ? ZIP: ?? ? ?
Place a check mark next to the permit work type
X Add-on, modification or alteration to existina dwelling unit $ 30.00
• furnace replacement
• air exchanger
• air conditioner
• other
Nature of work: ` -t?? ??Ck,? 't) o' C't Lo D(uC ?
?
EB 2 6 2002
State Surchar e ?Y --
Total $
iz?
SibNATURE F PERMITTEE
1102
?
PERMIT #:
APPROVED BY:
CITY USE ONIY
INSPECTOR
RECEIPT DATE:
2002 C0MMEEtCIAI. MECHANICAI. PEibI1T APPLICATION
CITY Of' EAfiAN
3$30 PILOT KAOB iZD
EA6M, MN 551SE
651-6$1-4675
Please complete for: all commerciaVindustrial buildings
multi-family buildings when separate permits are not required for each dwelling unit
DATE:
SITE ADDRESS:
OWNER NAME: PHONE #:
TENANT NAME (IMPROVEMENTS ONLY):
WAS THF,RE A PREVIOUS TENANT IN THIS SPACE? Y N. NAME:
INSTALLER:
STREET ADDRESS:
CITY: STATE: Z1P:
TELEPHONE
WORK TYPE: New construcrion Install U.G. Tank
Interiar Improvement Remove U.G. Tank
Processed Piping
Specify Nahue of Work:
When installing/removing underground tank, call 651-6814675 for inspection by Fire Marshal and
Plumbing inspector.
Fees: 1% of contract price OR $50.00 minimum fee, wtuchever is greater.
Underground tank removaUinstallation = minimum fee
Contract price: $ x 1% _$ (Base Fee)
State surcharge calculate at $.50 for each $1,000 Base Fee
TOTAL $
SIGNATURE OF PERMITTEE
Updated 1/02
CITY OF EAGAN Remarks
Addition Lot 16 Blk 4 Parcel ` 10 64400 160 04 Owner _ ?._,?.Qar.n? -Street 4368 Medary Ave. State Eagan.MN 55122 67
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
I
STREET RESTOR. ?
i
GRADING
SAN SEW TRUNK ' r
+kSEWER LATERAL 3!2 197 2
WATERMA W
*/UATER LATERAL 197 ?
WATER AREA
+STOflM SEW TRK 197 aid r ?
STORM SEW LAT 'I
?
CURB & GUTTER ?
SIDEWALK I
STREET LIGHT 113. 1980 67.80 - 13.56 $
Additional Sewer tr. nsvl 180.00
WATER CONN. 205.00
6UILDING PER.
SAC
PARK -
I
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA112435
Date Issued:08/13/2013
Permit Category:ePermit
Site Address: 4365 Medary Ave
Lot:9 Block: 3 Addition: River Hills 9th
PID:10-64400-03-090
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.
Kris Oien
3670 Dodd Rd
Eagan, MN 55123
Fee Summary:PL - Permit Fee (WS &/or WH)$55.00 0801.4087
Surcharge-Fixed $5.00 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 R Streff
4365 Medary Ave
Eagan MN 55122
Champion Plumbing
3670 Dodd Rd., #100
Eagan MN 55123
(651) 365-1340
Applicant/Permitee: Signature Issued By: Signature
Use BLUE or BLACK Ink
I For Office Use
• ~ Permit in
I
~W of Ealan '
; Permit Fee: 0
3830 Pilot Knob Road l~C~ 13 ~0 Date Received: V P 1~
Eagan MN 55122 I I
Phone: (651) 675-6675 1 Staff: Cj I
Fax: (651) 675-5694------=-------- I
2013 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: Site Address: ' J _
Tenant: W L Suite
a Name: Phone:
Resident/Owner p
1, r1 E 0'~ oDL c~r~
'Address/ City /Zip'
Nam e• License* Address: `D City:
Contractor e- '
I
State: UV Zip: 11 1 Phone: J C>
i Contact: Email:
_ i` New ~ ~
Type of Work - Replacement - Repair :~Rebuild _ Modify Space Work in R.O.W.
Description of work:
RESIDENTIAL
Water Heater
Water Softener
F Lawn Irrigation RPZ PVB}
Permit Type r Add Plumbing Fixtures Main / Lower Level)
Septic System
€ New Water Turnaround
s 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 $200.00 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)
tw
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.aopherstateonecall.ora
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
Fagan; 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
accord with the approved plan in the case of work which requires a review and approval of lans ~6Ad6lle,
x s x Applicant's Printed Name Apply ant's Signature
FOR OFFICE USE Reviewed By: Date:
Required Inspections: Under Ground Rough-In -Air Test Gas Test -Final
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA160284
Date Issued:02/28/2020
Permit Category:ePermit
Site Address: 4365 Medary Ave
Lot:9 Block: 3 Addition: River Hills 9th
PID:10-64400-03-090
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 -
William R Streff
4365 Medary Ave
Eagan MN 55122
(612) 720-8484
Centerpoint Energy
1240 W River Pkwy
Minneapolis MN 55454
(763) 512-2765
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA167421
Date Issued:03/15/2021
Permit Category:ePermit
Site Address: 4365 Medary Ave
Lot:9 Block: 3 Addition: River Hills 9th
PID:10-64400-03-090
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:One Window/Door
Census Code:434 - Residential Additions, Alterations
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: 1,500.00
Fee Summary:BL - Base Fee $1500 $62.50 0801.4085
Surcharge - Based on Valuation $1500 $0.75 9001.2195
$63.25 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 -
William R & Theresa G Tstes Streff
4365 Medary Ave
Eagan MN 55122
Window Outfitters Inc
12605 Creek View Avenue
Savage MN 55378
(952) 746-6661
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA178897
Date Issued:09/08/2022
Permit Category:ePermit
Site Address: 4365 Medary Ave
Lot:9 Block: 3 Addition: River Hills 9th
PID:10-64400-03-090
Use:
Description:
Sub Type:Water Heater & Water Softener
Work Type:Replace
Description:Standard Water Heater & Water Softener
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
This permit shall be null and void if work does not start within 180 days of issuance, or if work is suspended for 180 days or more after
started.
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 R & Theresa G Tstes Streff
4365 Medary Ave
Eagan MN 55122
Haferman Water Conditioning Inc
12142 12th Ave.
Burnsville MN 55337
(952) 894-4040
Applicant/Permitee: Signature Issued By: Signature