4368 Medary Ave. .
DEVELOPMENT CORPORATION
April 16, 1976
Mr. Dale Peterson
City of Eagan
3795 Pilot Knob Road
Eagan, MN
Dear Mr. Peterson:
RE: Lot 16 Block 4
River Hills 9th
4368 Medary
Eagan, Minnesota
J
Enclosed please find a check for building permit application and
fees as allocated on the check stub in the amount of $1,027.50.
This home will be a Model 76-52, Elevation A, and will contain
the following:
- Rear walkout with patio door and sundeck
- Appliances
- Patio door - dining room - No deck
Attached also find a copy of the proposed plot p1an.
Sincerely,
WINDSOR DEVELOPMENT CORPORATION
Warren R. Anderson
Vice President
WRA/ks
Enclosures
3 *#c°
r
SUITE 192, 4660 WEST 777H STREET, EDINA. MINNESOTA 55435 • PHONE (612) 881-0717
' CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Mmnesota 55122-1897
(612) 681-4675
SITE ADDRESS
`` 'v ' `4 `.
: ?,sr
it it/tH Ftlf_t'? qild
PERMIT SUBTYPE:
PERMIT TYPE: {ill r I l+ i NCj
Permit Number: v? ;% k y:'
Date Issued: ?; 10 / i'if;
400-16e-04 APPLICANT:
16 8i r?Cr; : ?
ivvV i.
, .. , • .. . ? :t , q .
TYPE OF WORK:
Rr f>aie
fiEk0(1F
INSPECTION ., • DA
I
i
i 77
3
i
--
-----------
Permit Holder Date Telephone #
PLUMBING
HVAC
Inspection Date Insp. Comments
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYPBOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
DOMESTIC
METER
IRPoGATION
METER
FLUSH
MAINS
CONDUCTIVIN
?EST
HVDROSTATIC
TEST
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
CITY OF EAGAN
3795 Pilet Knob Rood Eagae, MN 55122 NO
PHONE: 451-8100
BOILDING PERMIT RecetPt #
To be ufed fee Est. Value bate
Site Address Erect ?' Occuponcy -
Lot Block Sec/Sub. -Alter ? Zoning
Porcel .fk Repair ? Fire Zone -
Enlarge ? Type of Const._
W Name Move ? # Stories -
3 Address Demolish ? Front
Ci Phone Grade ? Depth
? Nome Approvals
0
OU Address Assessment Pertnit
~ Ci Phone Water & Sew. Surcha
?
Pollca
Plan c
FW Name Fire SAC _
Address Eng. Water
<W Ci Phone Planner Water
Council Road
I hereby acknowledge that I have read this opplication and state that Bldg
Off ?
the information is correct ond a ree to mm I with cll aPP licoble .
. -
9 P Y
Stote of Minnesota Statutes ond City of Eagan Ordinonces. APC Total
Signoture of Permittee
A Building Permit is issued to: ' on the exp
oll work shall be done in accordance with all appliwble State of Minnesota Statutes and City of Eagon
Building Officiol
787
?2 3
r?
T_TJ
ft.
ft.
ess condition that
Ordinances.
Pwmif # DaN laoad /orniMr
Plumbing
Mechanical
INSPECTIONS DATE INSP. Rough-In Finol
Footings Dde Inap. Date Irxp.
Foundation Plumbing
Frcme/ins. Mechanical
Finai '
Remorks:
YILLAGE OF EAGAN WATER SERVICE PERMIT
304.Pilot Knob Rood PERMIT 1V0.: 1959
Eogan, MN 55122 DATE: 4/20/76
Zoning: RI No. of Units: 1
Owner: W3ndsor Dev. Qprp.
Address:
S;te Address: 4368 Medary Ave. Ll6 B4 R89 ,
Plumber. __,Th9MMP9on Plbg. Oo. Meter Nm,7-4(
S?/) --J Connection Charge• 205.00 Pd
Reader No.: ? 4?-2 AP4 '' I ogree?f?? with fhe Villaga of Eagan
Ordinan a.
By
Date of Insp.:
Account Deposit:
Permit Fee: 10.00 billed #697
Sur¢harge: .50 bill'ed #697
Misc. Charges: .
Total:
Date Paid:
Insp.: -
YILLAGE OF EAIi4N SEWER SERVICE PERMIT
37#5 PiH,t?fnob Rood PERMIT NO.: _ 2716
Eogan, MN 55122 DATE: 4/20/76
Zoning: RI No. of Units: 1
owner: Windsor Dev. Corp.
Address:
Site Address: 4368 Medary Ave. L16 B4 RH4
Plumber: Thompson Plwnbing Co.
4/20/76 #2730 100.00 pd
1 agrea ro eomply with tha Villoye of Eagon Connection Charge: 350.00 pd
Ordinaneas. Account Deposit:
By:
Date of Insp.:
[nsp.:
Permit Fee: 10.00 e
--50 -5illed-M-
Surcharge:
Misc. Chazges:
Total:
Date Paid:
' CITY of EAGAN
BUILDING PERMIT
O wne: .......... . . .................................
Add:ess IPreaenil ....712.1aD.. w . ? 2-P&Iith..dd•`•!?-...-....
Suilder ...... -??--.............................................. .............
Address ..........................
DESCRIPTION
?
oiiw
N°_ 3903
3795 Pilot Knob Road
Eagaa, Minaesota 55122
954-8100
Dals ....... _.
-T-• - -
This permii does aot thori:e the use of sireels, roads, alleys or sidewalks aos does it give the owner or his agea!
the right to create aay situa3ion whieh is a nutsanee or which presenls a hasard !o the healYh, safely, convea[ence and
gane:al welfate io anpone in the communily.
THIS PEAMIT'MVST BE I{EPT ON THE PREMISE WHILE THE WORK IS IN PAOGRESS.
This is lo,certify, lhat.&"saacry,---.?.¢? .. .................... .haspermission 3o erect a...4$? 1?& . . ........... _upon
the above described ptemise subject to the provisions of all applicable Ordinances for the Citp of Eagan.
......._......?.......--••...
_....?..._?. , _ - . .............................................. Pez ?..J??LE-?a?.- °--------
Huflding Iaspeaior?
17
Mayor
x. ?,Pj^ /?? %%S Cj ??7i?
CIT`.' C^ F,:>GAN
3?y5 Pi.7.ot YLnoo P.oad
Ea,,?;=,ti j T.viinneso ta 55 i 22
PEF'1vIIT NO. : 634
The City oi Ea.gan hereby gra.n ts to
Ray Y.We2ter Heati.ng Oo.
of 4637 fJhicago Ane.
a FIEATING Permit for: (Owner) Windsor Dev. Corp•
- _ -- . &
?4368 Medary Ave. , pursuant to app.lication daied _5/18/76
Pee PL-i.d? $40.00 de:ted this
1.00 s c
202' clay oP AfiAy 76?
rJU1i.i1.i1g Tl]C;i':C"?J1
Meo: :-nical Ferm,its:
Uid To tai :
l?II<?
,
C17L Q^ PAG".Pd
Pi.lot Knou f'oa_d
E3gaT1, Tf1T1?'1Fjs0 ta 5711,22
PEP,M`.tT NO a : 673
Thotapson Plwnbing Co.
TI:e City oi Eaga_n hereby grants to
of 12201 Minnetonka Blvd.
_, _______ pLWMIN6 A Permit foro (Owner)
Windsor Dev..Corp.
a'u a368 L?L'x3ary Ave.___, Pursuant to a.pp7--icution dated
billed:
P'ce I)LVX,k 20.00 dE,ted this 20 day of Apr12 ? 19 ?76 .50 s/c
Duiiding I_,Sper: tOi
Ferm_:i.tso
Lid TO 'Q;;,i 8
CITY OF EAGAN
,. 3795 Pilot Knob Raod Eogan, MN 55122 N2 5787
PHONE: 454-8100 J 4??
Bl71LDING PERMIT APPLICATION Receipt ?# / To be uced foe Deck & Remode ]E.atn`coiue 2,000 . 00ate 417-1 , 19_ $?
Site Address 4368 Medary Avenue
Erect ?
Occupancy R3
Lot 16 Block 4 Sec/Sub. R].VEZ' H1l15 9tkter ? Zoning Rl
parcel # Repair ? Fire Zone III _
l
E f C
t
T V
n
ar9e ? ons
.
ype o
z Nome Denni s Raval Move ? # Srories
3 Address same Demolish ? Front 24 ft.
° Ci Eaqan,M N bb-LZZ Phone 894-4254 Grode p Depth 18 ft.
?
o Nome Same Approvals
. Fees
?Q Address Assessment
F Water & Sew. _
Ci Phone
?
Same Police
u
F W Name Fire
?? Address Eng.
<W Gitv Phone Planner
Council
I hereby acknowledge that I have reod this opplication ond state thct gldg. Off.4/18/80
the information is rnrrect and cgree to comply with alI opplicable APC
State of Minnesota Statutes ond City of Eagcn Ordinances.
Signature of Permittee
A Building Permit is issued to: Mrg. D. J.
cll work sholl be done in accordance with oll/gaii
Permit ? • vv
Surcharge 1.00
Plan check
SAC
Water Conn.
Water Meter
Road Unit
Total 10.00
on the express condition thct
and City of Eogan Ordinances.
Building Official
CITY OF EAGAN Include 2 sets of plans,
„ p? .. 1 site plan w/elevations &
BUILDIIWG PERMIT APPLICATION 1 set of energy calculations.
To Be Used For J'ce?. Valuation Date 9/-1 UO
Site Pddress -43tpS 'nsJe,cj A JR- ? OFFIGE USE ONLY
Lot /(P sloclc 1 sec./sub. ,Lwn "-'? grect ?,. occupancy 1<3
Parcel #:
Owner:
Addres:
city/z:
Phone i
Contractor:
Address:
City/Zip Code:
Phone #:
Arch./Eng..
Address:
City/Zip Code:
Phone #:
Alter _
Repair
Enlarge
INove
Derolish
Grade _
Zoning
Fire Zone
7.ype of Const. ?
# Stories
Front ? y ft.
Depth - ? ? ft.
P,PPFtOVALS FEES
Assessments Permit 9•`?
[4ater/Sewer Surcharge
Police Plan Check
Fire SAC
IIzg. Water Conn.
PlannPr Watex' Meter _-
Council . Road Unit
Bldg. Off. ?- -
APC _---
Zl7PAL OrA0
MASTER CARD
LOCATION
? 9
OW N E- R-vAj 40!)e OC/O Q't/
STRUCTURE AND
LAND USED AS
Permit
No.
Issued Issued To
Contractor Owner
BUILDING 39a 3 ,.. o_?/_
'Y?- `
PLUMBING do 73 y-
CESSPOOL - SEPTIC TANK
WELL
ELECTRICAL
HEATING , .
GAS INSTALLING
SANITARY SEWER I
OTHER I
OTHER I
I
Items Approved
(Initial)
Date
Remarks
Distance From Well
FOOTING ? ?? J_? ?,.}/?/._ ,?_ ?a? A
i7d.«? 06?-
rea9z••?
?f SEPTIC
FOUNDATION •
_
i
00 CESSPOOL
FRAMING ' TILE FIELD FT.
FINAL
ELECTRICAL
HE,4TING DEPTH
OF WELL
GAS INSTALLATION
SEPTIC TANK
CESSPOOL
DRAINFIELD
PLUMBING
?
WELL
SANITARY SEWER
494
'
Violations Noted
on Back
COMMENTS:
COMPLIANCE INSPECTION REPORTS
TO BE USED ONLY IN EVENT OF OBSERVED VIOLATIONS
PERMIT NO.
DATE OF INSPECTIQN
CONDITIONS OF CONSTRUCTION AT THIS INSPECTION
? NO EVIDENCE OF NON•COMPLIANCE
OBSERVED.
? 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
ION REVEALED
DATE OF REINSPECTION
CERTI FICATION - I certify that I have carefully inspected the above in which I have no interest present or praspective, 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.
7 ALL IMPROVEMENTS ACCEPTABLY COMPIETED
BUILDING INSPECTOR
COMMENTS:
DATE
$.
O RE- ---
QRoPEV-zY
E D AIzY A\j E.IAu r-
?-? -?
?-' -._.._._._..
l% RAVPI? S
PRopFtzz
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?-- t---?_ _-- -- ? ?1
I ? I 24-0 .. _._..-- - -----------?.
? ? ? ? ? ? ..? ? 12y1t? r?G?IL(?J ??c_? •E?o115?
:
-- - ? _ IL-- L ?-- ? - - - ' --_--? -- ?--- --- :-- ?----?.: _-----_ _.--?
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--_...-- - _.. _.__.._ ? I -------- - -.-_--___--- I
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nntNN. - -- -
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69 °-z. ze-1? CITY OF EAGAN ? CITY USE ONLY
C PLUMBING PERMIT
SUAD. (612) 681- I.675 RECEIPT
DATE S dZ
RESIDENTI?AL
PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWEI.LINGS. ALSO, FOR TOWNHOMES AND CONDOS
'HEN PLRMITS ARE REQUIRED FOR EACH UNIT.
WORK DESCRIPTION
NEW CONST
ADD ON
REPAIR
??- - - -?
OWNER NAME: I.FEUFit- d i ?
4368 FEGfIRY AVEhILE SITE ADDRESS: _ I ? ? ? . ?j? '
INSTALLER:
ADDRESS:
..'?:... ??,... ..
CITY: ZIP:
PHONE
SIGNATURE OF PERMITTEE
CONTRACT PRICE:
1% OF CONTRACT FEE. .
JlAlli .`?ii,`.^.?iiiaiwr', - ,$. r3v i OR
EACH $1,000 OF PERMIT FEE.
COMMERCIAL
PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL SUILDINGS. ALSO FOR MULTI-FAMILY
BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT.
WORK DESCRIPTION:
OWNER NAME:
SITE ADDRESS:
TENANT NAME:
SUITE #:
INSTALLER:
ADDRESS:
CITY: ZIP:
PHONE #:
.
FOR:
$25.00 MINIMUM FEE.
CONTRACT PRICE x 1% $
STATE SURCHARGE
TOTAL:
COMPLETE THE FOLIAWING:
N0. FIXTURES EA. TOTAL
REPAIR/ADD ON 15.00
_ SHOWER 3.00
WATER CLOSET 3.00
BATH T[JB 3.00
_ LAVATORY 3.00
_ KITCHEN SINK 3.00
IAUNDRY TRAY 3.00
HOT TUB/SPA 3.00
j- WATER HEATER 3.00
_ FLOOR DRAIN 3.00
CAS PIPING OUT.
_ (MINIMUM - 1) 3.00
_ ROUGH OPENINGS 1.50
OTHER
WATER SOFTENER 5.00
_ PRIVATE DISP. 1.5.00
_ U.G. SPRINKLER 3.00
W. T[JRNAROLJND 15.00
STATE SURCHARGE .50
TOTAL:
$
(SIGNATURE)
CITY OF EAGAN
%%D.W
PERMIT
CITY-OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS:
P.T.N.a 10-64400-160-OA
DESCRIPTION:
PERMIT TYPE: e u ILoING
Permit Number: @ 3 2 8 4 2
Date Issued: 0 8 J 0 7/ 9 8
4368 MEpARY AVE
LQT: 16 BLiIGK: 4
RIVER HILLS 5TH
RERaoF
ermit Type 570RM DAMAGE
tark 7ype REPAIR
434 AL7. RE5IDENTIAL
3E FI 4E T? .Ha'
REMARKS:
REROOF C1UE TO STORM bAMAGE.
FEE SUMMARY:
CONTRACTOR:
APPLICANT/PERMITEE SIGNATUFiE
????? ?? #R 4y ;HWk
?S.rAtry? -?
? 'p4 21£? ^CV.A' t21Y?:nu
?Sf ¢NT^" g?r iei 64 3'K t?f hi `..d?
2 ffit Yit V, n? ?s xs ,Mt g:,L
?# t'atM 9 hyfewa'?'Fai s? iw .?
OWNER: - Applicant -
RAVAL JYdTL
4368 MEpARY AVE
EAGAN MN 55122
(651)894-4254
46 / '-?4)
CISSUED BY: SIGNATURE
- ' 1998 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
3830 PII.OT I{NOB RD - 55122
681-4675 ,
New Construdion Reouirements RemodeURecair Reauirements
? 3 registered site surveys
? 2 copies of plans (inGude beam 8 window sizes; poured fid. design; etc.)
? 1 energy calalations
? 3 copies ot tree preservation plan if lot platted after 7/7193
required: _ Yes _ No
DATE:
OF
STIEET ADDRESS: /
( ?o
LOT: ? BLOCK:
? 2 copies of plan
? 2 sRe surveys (exterior add'Rions & decks)
? 1 energy calwlations for heated add'Rions
CONSTRUCTION COST;?4,S'00 - oO
? SUBD.IP.I.D. #: Q ? v? r' I--i ? LS ??'?
-5,A 64- 1
Name: oxcj L Phone #: OC7* -
PROPERTY Last Fi t
OWNER ,. ,
Street Address: /-{-5 -o >< ' 1v ?LdZ? ,
City State: I ? ?-f )• Zip:
Company: ?_ • Phone #: 224- l 42,ST,
CONTRACTOR
Street Address: License #
Ciry State: l-qf' J Zip: S ARCHITECT/
ENGINEER Company: Phone #:
Name: Registration #:
Street Address:
Ciry State: Zip:
Sewer & water licensed piumber (new construction onty): . Penalty applies when address chang
and lot change is requested once permit is issued.
I hereby acknowledge that I have read this application and state that the iniortnation is carrect and agree to comply with all appiicabl
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant: OFFICE USE ONLY RECEIVED
Certificates of Survey Received _ Yes _ No
Tree Preservation Plan Received _ Yes _ No _ Not Required BY:
4
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Duplex
0 02 SF Dwelling ? 07 4-plex
O 03 SF Addition ? 08 8-plex
? 04 SF Porch ? 09 12-plex
D 05 SF Misc. ? 10 = plex
OFFICE USE ONLY
? 11 Apt./Lodging ?
? 12 Multi Repair/Rem. ?
? 13 Garage/Accessory ?
13 14 Fireplace ?
? 15 Deck
16 Basement Finish
17 Swim Pool
20 Public Facility
21 Miscellaneous
WORK TYPE
? 31 New ? 33 Alterations
O 32 Addition ? 34 Repair
GENERAL INFORMATION
? 36 Move
? 37 Demolition
Const. (Actual) Basement sq. ft. MC/WS System
(Allowable) Main level sq. ft. City Water
UBC Occupancy sq. ft. Fire Sprinklered
Zoning sq. ft. PRV
# of Stories sq. ft. Booster Pump
Length sq. ft. Census Code.
Depth Footprint sq. ft. SAC Code
Census Bldg
Census Unit
APPROVALS
Planning Building Engineering Variance
Permit Fee Valuation: $
Surcharge
Plan Review
License MCNVS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S1W Permit
S/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
°k SAC
SAC Units
lD?,? ?P RESIDENTIAL MECHAIVICAL
Permit Application
City Of Eagan
3836 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675
Please complete for: Single Family Dwellings & Tovmhomes and Condos when permits aze required for each unit
Date L-2- / ? / 3>
Site Address Unit #
a
Property Owner Telephone # (&6 ? ) ?`t • Z-)
Contractor -
Street Address Gity ??? ?C?` -I lXM
State ? zip lephone # RS5)- )
Bond 931I J lD(y Expires: ?
The Applicant is _ owner Contr tor Other
Add-on, m dification or alteration to existing dwelling unit $ 30.00
furnace replacement
air exchanger
_ air conditioner _ New _ Replac ment
l
othes --
State Surcharge $ .50
Total
?L ? ?
I hereby apply for a Residential Mechanica] Permit and ac
be in conformance with the ordmances and codes of the C
pernut, but only an application for a pernut, and work is
approv an m the case k whi h requires a review
( l ) ?? _
ApplicanYs Friiiied Ivrarr,.,
IBY j
?wledge that the information is complete and accurate; that the work will
of Eagan and with the Mechanical Codes; that I understand this is not a
to start without a permit; that the ork will be in accordance with the
I approval of plans. ?
?pTi ' t's Signature
l
COMMERCIAL MECHANICAL
Permit Application
City Of Eagan
3834 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675
Please complete for: commerciaUindustrial buildings
multi-family buildings when sepazate pemuts aze not required for cach dwelling unit
Date
Site Street Address Unit #
Tenant Name (if applicable) Previous Tenant Name
Property Owner Telephone # ( }
Contractor
Street Address City
State Zip Telephone # ( )
Bond Expires:
The Applicant is _ Owner Contractor Other
Work Type
New construction _ Install _ Remove Underground Tank
Interior Improvement Schedule inspection during installation or removal of tank
Processed Piping
Nature of Work:
Permit Fee $50.50 Minimum Fee (includes State Surcharge)
Contract Value $_ x 1% _$ Pernut Fee
• If pernut fee is $1,000 or less, add $.50 => $ State Surcharge
If permit fee is over $1,000, add $.50 per
$1,000 Permit Fee
$ Total Fee
I hereby apply for a Commercial Mechanical Pemtit and aclmowledge that the information is complete and accurate; that the work
will be in conforxnance with the ordinances and codes of the City of Eagan and with the Mechanical Codes; that I understand this is
not a pernut, but only an applicarion for a permit, and work is not to start without a pernut; that the work will be in accordance with
the approved plan in the case of work which requires a review and approval of plans.
Appiica:.t's Pr.nted i?ame
Applicant's Signahue
Approved By: , Inspector Date:
W, vL:7%.r\ I11K
For Office Use I
City of EPermit#:
I
I
I Permit Fee:
3830 Pilot Knob Road I l
Eagan MN 55122 Date Received: { O 31 ~3 I
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff: j
L--------- -------I
2013 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: Site Address: V3 ~ a 1~,e 4r-
Tenant:
Suite
ResidentlOwner Name: 4- 4h ~Ir s~c N Tk Phone: -7G3,
Address / City/ Zip: L13(~ 1'~.e A,14~ C% r\ 1f I
Name: IL ~P/✓ l(~e~ License #:Q
Contractor Address:./// U C "nl~r/1c3•~ City:
State: i Zip: JJ V`E Phone: jo3 71
Contact: r\,
Email:
Type of Work -New 2 Replacement -Repair _Rebuild - Mod' Space - Work in R.O.W.
Description of work: W a~-(lU/- S04,,-6, A-
RESIDENTIAL
Water Heater y'
Water Softener
Permit Type Lawn Irrigation L- RPZ / PVB)
-
Septic System Add Plumbing Fixtures L- Main / - Lower Level)
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
accord nc with ~r ved plan in the case of work which requires a review and approval of plans.
X.S
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Applicant's Printed Name Applicants Signature
FOR OFFICE USE Reviewed By: Date:
Required Inspections: -Under Ground --.-Rough-In ___Air_Test__ -Gas Test----- Final -
Use BLUE or BLACK Ink
r________________�
I For Office Use I
I I
C�+ O� nn n n j Permit#: � UCa�(�'���� j
e� i�Q�iiii � �i a,5� i
� Permit Fee: ��J� ' I
3830 Pilot Knob Road � �
Eagan MN 55122 � Date Received: ��r�� �
Phone: (651)675-5675 � �
Fax: (651)675-5694 I Staff: /�'2� �
I I
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: ���'���4� Site Address: �b� ����►' ����k� Unit#:
. Name: YV Q1'e� Jrtir��h Phone:7b� / "/ � " ����
Residentl �f� (�g ���qr .��y u�
OVNner ' Address/City/Zip:
Applicant is: Owner �Contractor
Description of work: G�d✓ �j 1�er�a�"F (,,; �✓c+��feziv�'�� S�;h ��S
Type of Work
Construction Cosfi� b��D � LO Multi-Family Building: (Yes /No_�
Company:__�S /„�I eS� L�i�i Contact: ��OMAr,J �5�
Contractor Address: I � ��� 1�1 Z�1 /�t�fi�,� vj� City: �-a k�-✓����
State:/"��Zip: J ��7'� Phone: ��'�-7�-' l��� Email: U���`�—l:� v�W��L��i�C0i"`
License#:�� ���-�"! � Lead Certificate#: fvJ�1 `�1 b� �� �
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
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that the 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.qoqherstateonecall.orq
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance. -. �
x v1SQt �S� x /�/
ApplicanYs Printed Name ppli anYs Signature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA172948
Date Issued:10/22/2021
Permit Category:ePermit
Site Address: 4368 Medary Ave
Lot:16 Block: 4 Addition: River Hills 9th
PID:10-64400-04-160
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Standard Water Heater
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:
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 -
Balmore Alex Artola
4368 Medary Ave
Eagan MN 55122
(320) 251-2505
Bettin, Inc
3208 1st Street South
Waite Park MN 56387
(320) 251-2505
Applicant/Permitee: Signature Issued By: Signature