4102 Johnny Cake Ridge Rd
Use BLUE or BLACK Ink
I For Office Use
Permit# a / d t
h ~ City of Evan I Permit Fee:
I - 1
3830 Pilot Knob Road
Eagan MN 55122 ' Date Received: 1
Phone: (651) 675575 ' Staff:
Fax: (651) 67"694 / .
2011 RESIDENTIAL PLUMB/IN ERMIT AP, C TION ~j
Date: Site Address: C
Tenant Suite M.
RESIDENT / OWNER Name: Phone:
Address / City/-Zip:
CONTRACTOR Name: ,~440- K/ G~ License:
Address: City: I- rF5.~'"~
State: /CLs2. Zip: Phone: % 5p -
Contact 0G' kz 4.1 e°C Email:
TYPE OF WORK New _ Replacement _ Repair , Rebuild _ Modify Space _ Worts in R.O.W.
ripthm of work
PERMIT TYPE RESIDENTIAL
Water Softener
Water Heater
Lawn Irrigation RPZ I - PVB) Add Plumbing Fixtures Main l _ 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 Turnaround" (includes $5.00 State Surcharge)
"Water Turnaround (add $166.00 if a 5/8" meter is required)
$105.00 Septic System New ($1 o.oo per as built) (includes County fee and $5.00 State Surcharge)
$95.00 Fire Repair (replace burred out appliances, ductwork, etc.) (includes $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. e .go herstateonecail.orr~
I hereby acknowledge that rius 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 ties 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
s~a~
x S41111K x
Appli nt's Prin d Name Applican s ignature
FOR OFFICE USE Reviewed By. Date:
Required Inspections: Under Ground -Rough-In -Air Test Gas Test Final
f
Use BLUE or BLACK Ink
r
I For Office Use 1
I I
City of Ea an Permit#: I LJ 5•
I Permit Fee: 1
3830 Pilot Knob Road I I
Date Received;
Eagan MN 55122 JUL Phone: (651) 675-5675 7 2011
I Staff: I
Fax: (651) 675-5694 1 _ I
2011 RESIDENTIAL BUILDING PERMIT APPLICATION ~1,
,~'rp
Date: Site Address: Unit
Name: y A*_ 151_111Q Phone:
RESIDENT /
OWNER Address / City / Zip: z<,& kdoo
Applicant is: Owner Contractor
TYPE OF WORK Description of work:
Construction Cost: #30, OoD Multi-Family Building: (Yes / No )
I Company: 7rcS7% e- elo's c, Contact:
Address: C/~-0/ _s11r. City:
CONTRACTOR
tate: / //4/ Zip: S^S0 7 Phone: to l~ 3 2~'O Z
State:/4//4/
License M -:~t&06 3/ /p 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:
i
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of d
the information may be classified as non-Public if you provide specific reasons that would permit the City to i
~
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.aopherstateonecall.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 of ans.
x ~S'fe~e ~5f z4fic,:2
Applicant's Printed Name Applicant's e:r/
Page 1 of 3
D 4004 WRITE T "1S ~I rQOQ~
SUB TYPES
- Foundation _ Fireplace _ Porch (3-Season) _ Storm Damage
- Single Family _ Garage _ Porch (4-Season) - Exterior Alteration (Single Family)
- Multi Deck _ Porch (Screen/Gazebo/Pergola) - Exterior Alteration (Multi)
01 of _ Plex Lower Level _ Pool - Miscellaneous
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 G 010 Occupancy MCES System
Plan Review Code Edition 04SAC Units
(25% 100%4-) Zoning City Water
Census Code Stories Booster Pump
# of Units Square Feet PRV
# of Buildings Length Fire Sprinklers
Type of Construction Width
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
Footings (Deck) Final / C.O. Required
Footings (Addition) Final / No C.O. Required
Foundation HVAC _ Gas Service Test Gas Line Air Test
Drain Tile Other:
Roof: -Ice & Water -Final Pool: -Footings -Air/Gas Tests -Final
Framing Siding: -Stucco Lath -Stone Lath -Brick
__~C Fireplace: Rough In Air Test Final Windows
Insulation Retaining Wall: Footings _ Backfill Final
Sheathing Radon Control
Sheetrock Erosion Control
Reviewed By: :!no* , Building Inspector
RESIDENTIAL FEES
Base Fee ~/~>rJ
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge 0AJ Y )-0 S-0
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
Page 2 of 3
Address 4109 .T o h n n v Pa k a u; a g P u a Zip 5512_2
L.ot 3 Blk 5 Sub
THESE TI'EMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECTION.
Date: Yes No Inspector.
Final grade (6" from siding)
Permanent steps (garage)
Permanent steps (main enhy)
Permanent driveway
Permanent gas
Sod/Seeded grass
Trail/curb damage
Porch
Basement finish
Deck
Please ve ?'ywith the builder ttie removal of roof 4est caps from the plumbing system and the shuhoff of water supply to
the outside Iawn faucet before &eeze potential exists.
Contact engineering division at 681-4645 before working in rightof-way or installing underground sprinklet system. ?
Whitc - City Copy Yellow - Resident Copy Pink - Contractor Copy
?;-
t. . ,,_ ' ... •. _. _ _ . VEMTq10 FlREPLAC S LOCATION GAS WOOD MANUFA RER °MQpEI. = BTU'S wnEcr nrwos
.. ,. . ..
b x `
Site address:
tiID2 _J41k.
On April 15, 2000 the MlnneSOtd Er
tightness, and ventilotipn, iaas adppto
submitted prior to issoncd qf a.Cerqry
v ,
_ rnis saucsure: Iiiiimnslnucled ic meet
i?This etruqure WIM W' 41"d GD i
-- -- ?
6? .
t;
/ £.-
? ?
iUon protection, air
nring information be
MAKE•UPAIB MODEL , TYPE CFM's
-?
I hereby acknowledge that the 8bova InfortnaUon l& wrrgct and agree to coinply with iha Minnesota Energy Code and City ot Eagan
requirements.
DO
?..
Company Name
1 3 3 ;
` Thisiormisthe re
spon bililY ? Gf Rr
sl tl?gQe??alCanlraCd4?. ? ,??? ?'. T
?
* * * * * * *
CITY OF EAGAN
? l,J -"4" q () `? 1 (d
CA IER: JS TERMINAL NO: 775
DATE: 04/20/00 TIME: 09:25:48
ID:
NAME: PULTE MASTER BUILDER
2252 9220
3210 9001
3866 9379
3422 9001
2275 9220
3446 9001
2.155 9001
3743 9220
2155 9001
38'68 9220
4102
4102
4102
4102
4102
4102
4102
4102
4102
4102
JHNNY CK R
JHNNY CK R
JHNNY CK R
JHNNY CK R
JHNNY CK R
JHNNY CK R
JHNNY CK R
JHNNY CK R
JHNNY CK R
JHNNY CK R
30.00
1,296.15
100.00
842.50
1,089.00
11.00
0.50
50.00
77.00
492.00
CR127037
USER ID: JAN
** CONTINUEL
** CONTINUEE
*?,c***?*?*:*+*+x**t,r??****?**********?*
**x****,t+******rr.x**,t,r**,r,r*?*** CONTINUED
CITY OF EAGAN
CASHIER: JS TERMINAL NO: 775
DATE: 04/20/00 TIME: 09:25:50
ID:
NAME: PULTE MASTER BUILDER
3716 9220 4102 JHNNY CK R 114.00
3713 9220 4102 JHNNY CK R 50.00
3865 9220 4102 JHNNY CK R 840.00
Total Receipt Amount: 4,992.15
CR127037
USER ID: JAN
2000 BUILDING PE[tMIT APPLICATION (RESIDENTIAL)
crTr or FAcwr
? 3630 PILOT IQN06 RD • 55122
. " 851-681-4675 ??1
Naw ConafnicNOn Reaulrsjnanfs RamOAel/Reoalr Raadrert?enb
D 3 reylefered tlie wrvaYs ahowinfl sc41L of W. t9. K of houw Z copiet d Plan
and gR rooled arew (20% maximum lof coveraae albwedf 1 tbt d enerpy ealcWaHau fa haalad addiXaq
D Z coPies ot Wau (ftw beam b window yx9a: Pared hW. dedyn: atc.) 1st19 suneY for exfeAa IX1dIMaq 3 deCb
D 1!ef Of aferyy ctlcWaMOtu .
D J coPieIsI d hee Prewrvalbn Plan H loi Wo4ad dlw 7/1/93
DATE: T I l I/?? CONSTRUCTION COST:
DESCRIPi10N OF WORK: /( Ls 1 R"17"1 01I
51REET ADDRESS: ?IOa ?S U 71 Y!n ?7 C?l ?? ?1W
LOT: ?3 BLOCK: SUBD./P.I.D. #: DA K&R13K1=
Name: Phone
PROPERTY ?ast qrst
OWNER
Sheef Addresa:
citY
State:
ZiP:
Company:AU I( R- fpNrl?,b Phone #: 4?-l /?2 -SZo"a
CONTRACTOR (area code)
sfroet ndar? l3s r?x r?,r?vd u?? r???.`?'???2??J
cny /Yt.uidoic, l?s srare: MiL/ zip:
?S`l2 b
EWGIN ER / Company: sZM ?? i7s A 8OVF- Name:
Telephone s: (
Sheet Address: Registralbn 11:
CRY
State:
3eweMNater Iicenaed plumber (If Insfallino seweAwater): M Il??/ 1Q11/v1fiac^ Phone #:
MP.
(0)????12)
I hereby acknowled9e 1haF 1 have read this opplicafion, alale ttwf 1he fMonrwlbn B correcf, and apree b comply wilh a1 app6cable SFala
of Minnesofa Slahifea and Cily of Eapan Ordinances. ?
. Sipnature of AppOcant
Certiflcates of Survey Received _:?_S"es
Tree Preservatlon Plan Received ._ Yes
OFFICE USE ONLY q06. O'( IS
_ No
_ No -]"ot Required
?
OFFICE U3E ONLY
BUILDING PERMIT SUBTYPES
0 01 Foundation p 07 05-plex
X 02 SF DweAing O OB O6-plex
O 03 01 of _ plex O 09 07-plax
0 04 02-plex p 10 08-plex
0 05 U&plex E3 .11 10-plex
O 06 04-plex O 12 12-plex
ORK TYPE
?
31 New
O 32 Addition
0 33 Alteration
O 34 Repair
0 13 16-piex O 27 Porch (3-sea.) 'L]• 3.1 Ext. Alt - Multi
O 17 Garage ? 22 Porch/Addn. (4sea.) ? 33 Ext Alt - SF
O 18 Ueck ? 23 Porch (screened) p 38 Muw
O 19 Lower Level O 24 Storm Damage
aibp _vor_N O 25 Miscelianeous
O 20 Pool O 30 Accessory Bldg. O 36 Move Bidg. O 43 Reroof
O 37 Demolish (Bldg)' p 44 Siding
O 38 Demolish (Interior) O 45 Fire Repair
13 42 Demolish (Foundation) O 46 Windows/Doors
* Give PCA handout to applicant for demotition psrtnit
GENERAL INFORMATION
SAC Code
No. of Units
No. of Buildings a
Const (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Width
Basement sq. ft.
Main level sq. ft.
G?AJO sq. ft.
sq.ft.
MISCELLANEOUS INSPECTIONS
X StuccofStone 6 (Lg;r,L
APPROVALS
Pianning _
Permit Fee
Surcharge
Plan Review
License
MClES SAC
city sac
Water Conn.
Water Meter
Acct. Deposit
siw aem,it
S!W Surcharge
Treatment Pi.
Park Ded.
Trails Ded.
Other
Copies
Total:
Building
?
?--
a-.
sq.ft.
sq. ft.
Footprint sq. ft.
Census Code
MCIES System
City Water
Booster Pump
PRV
Fire Sprinklered
Engineering Variance
?
ValuaUon: $ ? ??i? (?l?l?
eff5rc
A A 45?
C.-k3 dZ 6?-dr?
/aOK
e ? q'-` k"
?-
I Iwo
0(
7 kX
SAC Units
% SAC
Surveyor's Certificate
SURVEY FQR :PULTE
DESCRIBED AS : Lat 3, Black s, oaK
reserving easements
BA13n?1r EnTGIMERnvG
_ ? 2, 225.
= 1,819-
15%
uT°
?--- ,
?
? --
?
Exiome
TO6t= 935.2
i
?
?
?
? -
IL _?? ` y
Jk
LOT
H SE.
LOT
SQ. FOOTAGE
SQ. FOOTAGE
COVERAGE _
Plon # 18052
PROP05ED ELEVATIONS
Top of foundation = 934•7
Garage Floor - 93,y.3
Basement Floor -qu,o
Aprox. Sewer Service = Gzl.o
Proposed Elev. - (Z=)
Existing Elev. - -
Drainage Directions = -
Denotes Offset Stoke = .
of Eogon, Dokoto County, Minnsoto ?nd
?
SCALE: 1 inch = 30 ieet
4Y
BtNCHMARK,
771Vy @ (-o+7 6IKS
a4_ Sa-5.94/
MIN. SETBACK REQUIREMENTS
Front-25 House Side -
Rear -i5 Goroge Slde-
JOB N0:
HEDL!'!/VD I HEREBY CERTIFY THAT TMI$ IS A TRUE AND CORRECT REPRESENTATION OOR-OBS
OF Th7E BOUNDARIES OF TfiE ABOVE OESCRBEO PROPEltTY AS SURVEYED
BV IAE OR UNCER MY OIRECT SUPERVISION AND OOES NOT PURPORT TO BOOK: PAGE:
PLANN/NC 8NC/N66RlNC SURV6YlNC SHOW IMPROVEMENTS OR ENCROACHMENTS, EXCEPT A$ SHOWN.
2005 Pin Oak Orive _3_ Z? CO •
Eagon, MN 55122 DATE Cn0 FiLE:
Phone: (657) 405-6600 FF 0. IINDGREN, LANp URVEYOR
Fax: (651) 405-6606 MIN OTA LICENSE NUMBE 14376 OAKBROOKE
PECEIVED APR 1 4 2009
LOT SURVEY CHECKLIST FOR RESIDENTIAL
BUILDING PERMIT APPLICATION
? W PROPERTY LEGAL: Lo> 3?GOeK 3 65WRA1-c2{'='
? DATE OF SURVEY: 3- 21 -GO
'
H
w ..
LATEST REVISION: ?
0K
o DOCUMENTSTANDARDS
? Q
O
? Q
Y ?
? ? • Registered Land Surveyar signature and company
i
a ? • Bu
ldingPermitApplicant
a--'o ? • Legal description
v'o o • Address
W? ? • North arrow and scale
o
? ?
? • House type (rambler, walkout, split w/o, split entry, lookout, etc.)
Di
l d
ti
i
Rh
l
¢ ona
nage arrows w
•
rec
re
s
ope/gradient %
ar' ?
Z/ ? • Proposed/ebsting sewer and water services & invert elevaBon
? ? • Street name
6?0 ? • Driveway
Er, ? ? • Lot Square Footage
ly? ? ? • Lot Coverege
ELEVATIONS
Existinq
d?/ ? o • Sewer service (or Proposed)
q ?
, o • Properry corners
V
a ? • Top of curb at the driveway
a' ?/o • Elevations of any ebsting adjacent homes
? Ef ? Adequate footing depth of structures due to adjacent uElity trenches
Prooosed
/
9" ? ? • Garage floor
;/ ? ? • Firstfloor
W/ ? ? • Lowest exposed elevalion (walkouUwindow)
e o
V ? • Properry corners
? ? • Front and rear of home at the foundaGon
PONDING AREA (if aodicaMe)
/
? u
?
?
? ? • Easement Gne
NWL
4
a d o •
• riwL
? ? ?
? • Pond # designation
0
? • Emergency Overflow Elevation
d ? ?
?? ?
W? ?
a y?
a m? ?
DIMENSIONS
• Lot lineslBearings & dimensions
• Right-oi way and street widtli (to back of curb)
• Proposed. home dimensions induQng any proposed decks, overhangs greater than 2', parches, etc.
(i.e. all structures requiring permanentfoodngs)
• Show all easements of record and any Ciry utllitles within those easemenis
• Setbacks of proposed structure and sideyard setback of adjacent epsting structures
• Retaining wall reauiremenis, if anv
Reviewed:
March 7998
CRAIOIBIDGPRMf.FM
Jr'S INITIATION ORr ER
Pulte Homes of
Minnesota Corporation
1355 Mendota Heights Road, Suite 300
Mendota Heighi3, MN 55720-7112
Phone: (651) 452-5200 Fax: (651) 452-5727
DO
CONTRACTOWSUPPUER:
JOBNO.D Z__2_0 /?O
GALDESCRIPTION: IAT? BLOCK UNR
LE
COMuIl1N1TY: ???{)?,7?.?C /:?S??"l-?,?' ? /i'? ADDITION: .
eUILDING ADOqESS?7?, n C`_,( U U U 1M UA{:? ? Q . ?
MOUEL NAME: ?"I L? h1pDEL NUMBE ? q7y; ELEVATION• STATE: L
OARAGE: LEFT RIG
(?/ t/6 ?
BWER'SNAME(3DER:4
C?
CURRENTADDRESS: L - ?y;S7ATE:?ZIP:
2p ?j '?
7BUSINESS c. .
HOME PFIONE: S• J O PHONE: c2? d-tl5'? 'BUSINESS OATEPMONE:OFO
SALES REPRESENTATIVELJ 9yY-1"
;,6tTY:N? 0.O1PT1 ON 4??s ?r,?? ????:OI:?t?i'.??r.? DES.CRtPE7lOhk?i?'Z ¢i, °??; ? .? `'sPIiICE?'?a;
0000 BASE PRICE L ?
---- LOTPREMIUM
ELEVATION # ? o(D
,
ao ??
? 5 ? C?C ZD
r ,
7_,S
Q;'Z5 146 2 ?
cx"t S6
? OoC ?; ALQ- 75
1410OU
(5?
( Z(? (Yl.i nn,k ? Cc/LQ?
I ! n? 0?5
?
ac Cc,ba ? ?5
?
fECt! 7
a5o z0
EE
BuildeYS License 90001371
TOTAL
APPROVED BY BUYER (S)-? --_-J
APPROVED BY SALES: I ?
RELEASED TO START CONST.: eouaL l{ousinc
oPVanrurnri
This constitutes a contract between the Seller and the Purchaser(s) for lhe above items.
MAR-16-2020 10:28 P.02i02
MdT4heck COMPLIANCE RE80RT I
MirWnsota Snergy Cods ? Perm t k
Wcheck Software veraion 3.0
C acke y DaCe
COIID7TY: Dakota --
9TATSt Minsseeptp
20NE; 2
CONBTRUCTSON TYpE: Siagle Family
DATE: 3-16-2000
DAT'Z OF PLJW3: 3/16/00
TITLE: FALKIRR W/D EL. #2
COMPLIANCE: PA9$ES
Required UA . 508
Your HomE = 407
19.9} Bettar Than Code
Arsa or Cavity Cont_ clazing/Door
__Perimeter R-Value R-va:.ue U-Value
--^---------------------------- _ ----^ --------------------------
CEILING3 1444 44.0 0.0
WALLS: Wood Frame, 161, O.C. 2327 19.0 2.0
ViALIS: Yiaod Frame, 16° O.C. 283 10.0 2.0
BSMT: ConC. 9.0' ht/8.3' bg/9.0, insul 402 11.0 0.0
CT?n?ING: WindoWe or poore, Above arade 485 0_350 1
?ORS 38 0.350
F'I+aoRS: Over Unconditioned space 352 38.0 0.0
HVAC BQCTIpidENT, Furaace, 92.0 AP'[TE
-'-----------'------`--------------
COMPLIANCE gTATEMENT; The propoeed building deeign deacribod here is -
consistant with the building p1ane, epacificationa, and other calculatione
suhmitted with the.pextqit application. The propo0ed building h>s been
de8igned to me ?11 e M?ota Energy Code.
Huilder/De
Dace 4/??-??
-
TOTRL P.02
CITY USE ONLY
L _ BL _1; RECEIPT Ii:
SUBO. RECEIPTDATE:/
PERMIT#
8000 PLUM$INfi PERMiT (RESID£NTIlkL) U
C17y0FE*fiM
3830 PI.OT KNOB ftD
SAtHlkN, SIN S51 EE
861-681-4675
//// ,G/l- '
Please complete for: ? single family dwellings
? townhomes and condos when permits are required for each unit
? backflow preventer for underground sprinkler system
FIXTURES
EACH
TOTAL
Alterations to existing dwelling - minimum fee
Describe:
$ 3C.00
Bath tub $ 3.00 x - $
Floor drain 3.00 x = $
GeS i in ODUOt ' minimum -1 3.00 x = $
Hot tub/s a 3.00 x = $
Kitchert sirtk 3.00 x = $
Laund tra 3.00 x = $
Lavato 3.00 x = $
Se tic S stem newtrefurmsned • reqUGes MPC Ifc. 75.00 x = $
Se tiC S Stem abandomment 30.00 x = $ ?
RPZ new installatioN2pairlrebuild 30.00 X = $ ?
Rou h o enin 1.50 x - $ b, 50
Shower 3.00 x = $
Under rounds rinklet ifdwellin isunderconsWction 3.00 x = $
Under round s rinkler if existing dwellin 30.00 x = $
Watercloset 3.00 x = $
Water heater 3.00 x = $ 73
Water softener If dwelling under eonaVuction 5.00 x = $
W ater softener tf exunn dwewn 30.00 x = $
Waterturnaround 30.00 x $
State Surchar e .50 --> ---> ---> $ .50
Total -> -> ----> .---> $
Reminder: Call for inspections of alterations, i.e. water heaters, water softeners, etc.
I -h--er---eb-y --------•••--•-----have ---•--read••-this----appli-----wtl-on--,- stat---e--that---.the_.. information......•---is-- co--r--rect---, ---and-• •agree-----tq-----comply-••with----all-ap
pli----ca-b--leCiry -...--of--Eagan------ord•-----•-inances--
acknowledge Mat I .
It is the applicanCs responsibilily to notl(y Me properry owner that the City of Eagan assumes no liabiliry for any damages raused by the Ciryduring iGS nortnal
operatlonal and maintenance activities to Ne faciliqes constructed untler Ihis Oermit within City properrylrighl-of-way/easement.
SITE ADDRESS:
OWNER NAME: :
INSTALLER NAME:
TELEPHONE #: -
(AREA CODE)
TELEPHONE #:
(aRea. cooe)
STREET ADDRESS:
CITY: STATE: ZIP:
SIGNATURE OF PERMITTEE
L 3) BL CITY USE ONLY
'J
__,sua:. ???i?roon-e?
8000 PLUMSIN6 P£fiM1T (USIDENTIAL)
CflY OF EAGM
sgsoPI.OT KNOB RD
EAeAv, Mx ssi sg
651-681-4675
RECEIPT#: I J G ?7-3
RECEIPT DATE ? ?".}/7 /' (70 _
PERMIT# ?( ? / 5
51,24100
Please complete for: ? single family dwellings
? townhomes and condos when permits are required for each unit
? backflow preventer for underground sprinkler system
FIXTURES
EACH
# TOTAL
Alterations to existing dwelling - minimum fee
Describe:
5 30.00
Bath tub $ 3.00 x
Floor drain 3.00 x = $ --
G85 i in outlet ' minimum -1 3.00 X = $ ?
Hot tub/s a 3.00 x = $
Kitchen sink 3.00 x = $
Laund tra 3.00 x $ r'
Lavato 3.00 x = $ ?
Se tic S stem newlrefurbished 'requlres MPC Ifc. 75.00 x = $
S@ tIC $ stem abandonment 30.00 X = $
RPZ new instaliaUONrepaldrebuild 30.00 x = $
Rou h o enin 1.50 x = $
Shower 3.00 x = $ --
l
Undef rOUnd S finklef ifdwelling is underconsiruction 3.00 x = $
Under rounds rinkler ifexistin dweuin 30.00 x = $
Watercloset 3.00 x = $
Water heater 3.00 x = $- ?
Watef SoftenEf if dwelling underconstruction 5.00 x = $
Watersoftener ifexistin dweilin 30.00 x = $
Waterturnaround 30.00 x ---- _ $
State Surchar e 50 --> ----> ----> $ .50
Total --? _> ----> ----> $ 50"
Reminder: Call for inspections of alterations, i.e. water heaters, water softeners, etc.
--- ?---------------------------------------------------------•---------------?--------------------•---------------
I hereby acknowledge--Nal I have read--this applicatlon, state tha[ the informatlon is covect, and agree to comply with all applipble City of Eagan ordinances.
It is the appliCan['s responsibilily to notl(y the properly owner that the Cily of Eagan assumes no liability for any damages caused by the Ciry during its normal
operational and maintenance activities to the facilities constructed under lhis permit within Ciry propertylright-of-way/easement.
, , , - , r'i ,1 11 n ; n I
SITE
OW NER NAME: :
INSTALLER NAME:
STREET ADDRESS:
CITY:
TELEPHONE #:
(AREA COOE)
TELEPHONE #: ??,
(AREA COdE)
C17'Y USE ONLY
LOT ? BL 6 PERMIT #: / II (f b
SUBD. ?Yl C/ 1' O o RECEIPT #: I-;i 15 & ?
RECEIPTDAI'E: (' '?' UG?
2000 MECHANIC,AL PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PIIAT KNOH RD
EAGAN IIId 55122
651-681-4675
Date:
Complete this section onlv if you are installing HVAC in a single family dwelling, townhome or condo under
construction and not ownedoccupied.
• HVAC: 0-100 M B T U
ADDITIONAL 50 M BTU
• Gas outlets (minimum of one required @$3.00 ea.)
State Surchazge
Total
$ 30.00
6.00
3r.0D
.50
$ 3R. 15e
Complete this section onlv if you are remodelin¢, addine to, or revairine an existing single-famify dweliing,
townhome, or condo. Please indicate if it is a new item, alteration, or repair.
_ New _ Alteration _ Repair _ Other
_ Fumace _ Air conditioning
_ Airexchanger _ Other
?
Fee $ 30.00
State Surchazge .50
Total $ 30.50
Reminder: Call for inspections
SITE ADDRESS: lil C7 a -Z?bv\Yl nl.A cc1.???W-_J_Q&
OWNER NAME: y v 40- q40 fYIQSv v PHONE #: (DSI -Sap p
r (AREA CODE)
INSTALLERNAME:?$'L1 ?M
L(Q. ;t ok? ?'I(' PHONE#: (o/'?-
, _ _ (AREA CODE)
STREET ADDRESS:
CITY:
5
_ ST E: :_SL??CL
GNA OF P ITTEE
f? -9aw
C4 of Ealan
3830 Pifa Knob Roed
Eagsn AfN 55122
Phone:(657)675-b675
FeX:(651) 67"694
as140q
?----------------;
; Pairit Fm-?=?- ,
I
I Date Recened' ?
i smrr: i
----------------
r ?
zoos REStDEN?IA! BUILDING PeRMIT nPPUCAnON
oate: 1 l 00 sIM ,aadress: ? I b i a41 r1 n C'aks? ?-? D?- Q??
TenaM: Suil! P.
RFSIDENTIOWNER Nmdh(o,e
Aea?/ CRY fzW.
npprcau is: _ owner Z,C cmMor
rrreoFwoRK o?a?TEDr? oFr ?2q SQ
Canstr?6on Cost: `?? ??,CO MulG&FamdY Bidlding: (Yes _.1 No ZC J
CONTRACTOR INeme: (.Z?_.L?'li'IFT7kZ'1P[`? L.4g?SPt)Ctf?"1_Ckseraet.
c?: ? 1Ic?`r?es' _ sta, _ mtY -_?.-
Phone: Co51 • yAq-y3X Con= Pawn: KctCPn
COMPLETE THIS AREA ONLY IF CONSTRUCTING ANEW BUII.DING
_ Minrreaoffi Rules 7870 temrv 1 _ AA'u,.estn Ru(es 7672
F.nBlgj( COd2 . pesiclanyv Vwddedon.Camgcry 7 Wwbhw • New 6mWCode Waksheet
: SubldRfld
Category (4 submbslm lYPe) ' Enew Fnvabpefaj? &&m'bd .
in the mst ts monqhs, hm uio Q+lr oe Eaga, iaswd a pexnn ter a oanlbr plan eaeea on a rtmOmr alan?
_Yes No If yes, dafe erd address af inester plan: .
Lieensed Piumb9f• PhWIB'
L?:_'^1'?^T •,
9efror de Waror COnh2ctD[r.
R- qD°-° assoq
; ---------------- ;
j Pertnit #:
City of EaaaIl '
40'
I
3830 Pllot Kt1ob Roed ? Permit Fee: I
Eagan MN 55722 ? Date Received:
Phone: (651) 675-5675 ?
i
Fax: (651) 675-5694 I StaH: ? j
L J
2009 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 5 (? Site Address: "? ? 0 c oh n n.., l_R k,F IeiOC E rCd(
Tenent•
Suite #:
RESIDENT/OWNER Name:3bS4 Phone:6'a'SIoS'q?9x
.
Address ! City / Zip:
Applicant is: _ Owner ? Contractor
TYPE OF WORK Descriptian of work: TFA2 OFF 5Qle200iF
Construc[ion Cost: ?OUnLjCO- Multi-Family Building: (Yes NoN-Ij
CONTRACTOR Name: WEl`l1{U_(?oA0 l.Gn S[1,2u Gi'? t?{'1 License #: ? ?qz?q 1??
Address: 5tDq, f IF-H(jj? ( w- A-ve
CitY: ul1 ?' WQAec State: n?Zip: 512)211?
Phone:(E-43?) ' `tl?(? ContactPerson: t'l
COMPLETE THIS AREA ONLY IF CONST_ RUCTIWC, A NEW BUILDING
_ Minnesota Rul s 7670 ateaorv 7 Minnesota Rules 7672
EnBfgy COdC • Residential Ventilation Calagory 1 Worksheet • New Energy Coda Worksheet
CBtByOty Submltled Submitted
(4 Su6miSSiOn type) • Energy Envelope Calculations Submitted
in the 1as112 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 Piumber:
Phone•
Mechanical Contractor: Phane:
Sewer & Water Contractor: Phone•
.
, .__.:. ._...
?"°.YT.., K tF
?
I hereby acknowiedge that this informafion is complete antl accurate; that the wnrk wili be in contormanca with theorUinances anA codee uf the City of
Eagan; that I understand this is not a pertnit, but only an application for a permit, and work is not to start without a permit; ihat the work will be in
accordance with the approved plan in the case ot work which requires a revlew and approval of plans.
x k . C.°Rmrnu cn X yYl 011.,-Y,
Applicant s Pnnted Name
Applicant's S(gnature
Page 1 of 3
Use BLUE or BLACK Ink
r----------------�
I For Office Use I
C� � Permit#: I ����� �
��el O� �^�^� I Permit Fee: � �c�-°�� I
3830 Pilot Knob Road I =+'-- �'–T— I
Eagan MN 55122 Date Received:
Phone: (651)675-5675 I I
Fax: (651)675-5694 i Staff:_� i
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: � �" �~ l � Site Address: -/ 1�� �1���1��"� G`"''�� ����- �� Unit#:
Name: �o��� �t~L �`�`" Phone: �l� ��� ` ��
�RO ner� `� Address I City I Zip: ��� � ������I ��`-{�'2 �' �'� � L�"G't���
` Applicant is: Owner Contractor
Type of Work
Description of work: 1�� t" � S�I ���x 6'1�'r�.+�-�t ��'" �`��'`� �N�-�ir(
Construction Cost: Multi-Family Building: (Yes /No�
�� �� �y� �� �
Company: �� ��'�� �ZSL�, h�E Contact: � ( �
Contractor Address: (�j�a W� Cc�� ��L�`�9 City: ��idr �"�
' State:�Zip: J J��.� Phone: �����"✓�°�`gmail:
' License#: �� 4 � ���� Lead Certificate#:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
��-�� `-�' �.�-� �r 1 `� ? g'
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 they are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.qopherstateonecall.orq
I hereby acknowledge that this information is complete and accurate;that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
X ���'��'1 ��e.v2��� X , �m.,
ApplicanYs Pririted Name Applica s$ig ture
Page 1 of 3
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA129385
Date Issued:02/05/2015
Permit Category:ePermit
Site Address: 4102 Johnny Cake Ridge Rd
Lot:3 Block: 5 Addition: Oakbrooke
PID:10-53760-05-030
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace & Air Conditioner
Comments:2/5/15 Per Diane at Home Energy Center the customer canceled the job today. I suggested she call with a replacement
address for this permit and she agreed to do that. pf 763-782-7432
Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
Fee Summary:ME - Permit Fee (Replacements)$55.00 0801.4088
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 -
Jorge S Rodriguez
4102 Johnny Cake Ridge Rd
Eagan MN 55122
(651) 994-3988
Home Energy Center
2415 Annapolis Lane N #170
Plymouth MN 55441
(651) 766-6763
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA142124
Date Issued:04/14/2017
Permit Category:ePermit
Site Address: 4102 Johnny Cake Ridge Rd
Lot:3 Block: 5 Addition: Oakbrooke
PID:10-53760-05-030
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Softener
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.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
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 -
Jorge S Rodriguez
4102 Johnny Cake Ridge Rd
Eagan MN 55122
(651) 994-3988
Genz Ryan Plumbing & Heating
2200 West Highway 13
Burnsville MN 55337
(952) 767-1000
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA157478
Date Issued:08/21/2019
Permit Category:ePermit
Site Address: 4102 Johnny Cake Ridge Rd
Lot:3 Block: 5 Addition: Oakbrooke
PID:10-53760-05-030
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace & Air Conditioner
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 -
Jorge S Rodriguez
4102 Johnny Cake Ridge Rd
Eagan MN 55122
(612) 865-4898
Burnsville Heating & Air Conditioning
3451 West Burnsville Parkway, Ste. 120
Burnsville MN 55337
(952) 894-0005
Applicant/Permitee: Signature Issued By: Signature