4126 Lantern LanePERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA112415
Date Issued:08/12/2013
Permit Category:ePermit
Site Address: 4126 Lantern Lane
Lot:12 Block: 4 Addition: Coventry Pass 2nd
PID:10-18401-04-120
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.
Phil Holmin
900 Park Knoll Drive
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 -
Daryle L Petersen
4126 Lantern Lane
Eagan MN 55123
Holmin Heating & Cooling Llc
900 Park Knoll Drive
Eagan MN 55123
(651) 405-3853
Applicant/Permitee: Signature Issued By: Signature
?^ ^ INSPECTION RECORD
I CITY OF EACAN PERMIT TYPE: ':"'
3830 Pilot Knob Road Permit Number: 0•' ?/•"=
i Eagan, Minnesota 55123 Date Issued: 0 N/-' 0!'-I (612) 681-4675
' SITE ADDRESS:
. , . •. . ? r?r.i I ? ? r.; i 6Nt
? PERMIT SUBTYPE:
114 1 f I r r APPLICANT:
+1 I . Yr ! ! ( " I 1 '..' i !?!
i,. j , •i i, ii yii,
TYPE OF WORK:
rqi ii
INSPECTION ., . .•
?
?
PermR No. Permtt Holder Date Telephone A
S/W
PLUMBING
HVAC
ELECTRIC
ELECTRIC
Inspection Date Insp. CommeMs
Footings I
Foundation
Freming
Rooting
Rough Pibg.
Rough Htg.
Isul.
Fireplace
Final Htg.
Orsat Test
Final Plbg. Plbg. Inspector - Notity Plumber
Const. Meter
Engr./Plan
&dg. Final
Deck Ftg. a12Y?3 '
Deck Final O !O ?3
.? ?
Well
Pr. Disp.
? CfTY OF EAGAN
3830 Piiot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
INSPECTION RECORD
PERMIT T1(PE:
Permit Number:
Date Issued:
Control No. 0092
kt?? ? i F?,xwr?
ec+ew{?.?
03J2A/42
SITE ADDRESS: i Ofi = 12
i 4 176 LANit.itN IANE'
CUVENTkY FA ; ; :'W17
PERMIT SUBTYPE:
'.I fi4lt1
TYPE OF WORK:
N F_ lJ
INSPECTION ., •
Fb£?1 IN6 .A
?.
fRAM3NO
Itfv;llLA1"TUN
13R1 t.NCtAkt1 FIPfAL
F EkEPI-AI:F-
l ?.??`
? a??a.
APPLICANT:
MIfTR:LtiTAF.Dt 14RG111ER5
(612) A 5!i -912 fi
J
Permlt No. Permit Hofder Date Telephone #
S/W •f-: -
PLUMBING
HVAC
ELECTRIC c°
ELECTRIC
Inspoction Dete Insp. Comments
Foonnys 1
Foundation
<
Framing t! } gZ DS
Rooflng
Rough Plbg.
Rough Htg. 20
Isul.
Firepiece Z f/r?° J'41DC r 1?! ?y?7?9?-?
Flnal Htg. IF-
1
,
?
orsat resc =2 ??TL ? S-/%-q7 ti?w .•? .Tls?a
Final Plbg. 57,:,77-ft Plbg. Inspector - Notify Plumber ?
Const. Meter
Engr./Plen
Bldg. Pinal
Deck Ftg.
Deck Final
Well
Pr. Disp.
3x
sx
CASH RECEIPT a
CITY OF EAGAN
r
3830 PILOT KNOB ROAD
?
EAGAN, MINNESOTA 55122
DA7E
vnw
AMOUNT S = .-- :?
8 DOLLARS
?m
? CASH ? CHECK
FUND OB.IECT AMOUNT
Thank You BY
C 017948 wnite--PaYm CWv
v4w.-aosag copy ?
Pink--File Copy
SEWER & WATER PERMIT
CITY OF EAtAN
3830 Pilot Knob Rd.
Eagan, MN 551?2-1897
DATE +MAR 24s 1992
METER #
CHIP #
OFFICE USE ONLY
Pzhnnirna,re 03/25/92
PE'-.MiT # 12633
B.P. RECEIPT # C 017948
B.P. RECEIPT DATE 03/24/92
X PRV - BOOSTER PUMP
METER SIZE
ISSUE DATE
SITEADDRESS 4126 LARI'ER:; 1.^;
LOT 12 BLOCK 4 SEC/SUB ?%?VEf< t'' , ',S 2ND
APPLICANT:
ADDRESS:_
CITY, STATE
PHONE: _
PLUMBER: MCDONALD PLBG
ADDRESS: 18271 KENHOOD TR
CITY, STATE LAKEVILLE MN Zlp 55044
PHONE: 435-3334
OWNER: MITTELSTAEDT BROS
ADDRESS: 785 SUNSET DR
CITY, STATE EAGAN !1N Zip 55123
PHONE: 456-9125
ZIP
PERMIT REQUESTED
X SEWER x WATER - TAPS
- COMM/IND
x NEW
X RESIDENTIAL !
EXISTING
Lawn Sprinkler Meters are to be Installed
Ahead of Domestic Meters on Water Line.
Credit WILL NOT be given for Deduct Meters.
I AGREE TO COMPLY WITH CITY OF
EAGAN ORDINANCES
SIGNATURE WHEN METER ISSUED
PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. CALL 454-5220 FOR INSPECTIONS. FOR STORM
SEWER PERMITS, CONTACT ENGINEERING DEPT.
SEWER & WATER PERMIT
GTY OF EAGAN ,
3830 Pilot Knob Rd. ?
Eagan, MN 55122-1897
DATE 4MAR 24. 1992
OFFICE USE ONLY
METER #q-"9 '7 7Z T PERMIT DATE 03/25/92
CHIP # n? 9/ ? 3? 6 pERMIT # 12633
METER SIZE *fr PA B.P. RECEIPT # C 017945
ISSUEDATE B.P.RECEIPTDATE 03/24/92
X PRV _ BOOSTER PUMP
SITE ADDRESS 4126 LANTERN LN
LOT 12 BLOCK 4 SEC/SUB COVENTRY PASS 2ND
APPLICANT:
ADDRESS:_
CITY, STATE
PHONE: -
PLUMBER: MCDONALD PLBG
ADDRESS: 18271 KENWOOD TR
CITY, STATE LAKSVILLE MN Zlp 55044
PHONE: 435-3334
PERMIT REQUESTED
X SEWER X WATER - TAPS '
• i
_ COMM/INQ X RESIDENTIAL i
X NEW - EXISTING
Lawn Sprinkler Meters are to be Installed ?
Ahead of Domestic Meters on Water Line. i
Credit WILL NOT be given for Deduct Meters.
I AGREE TO COMPLY OF
OWNER: MITTELSTAEDT BROS EAGA RDIN NCE?
ADDRESS: 785 SUNSET DR
CITY, STATE EAGAN MN Zlp 55123 ?
PHONE: 456-9125 31G TURE WH N METER ISSUE
?
,? ` --- J fFF'?.n;s:.. f- :lc:iu?1..
PLEA3E ALLO??O ?ORIZING ?AYS?OR PROCESSING.?CALL 454-5220 FOR INSPECTIONS. FOR STORM
SEWER PERMITS, CONTACT ENGINEERING DEPT.
ZIP
Z
3
7 A95 3d,y
06
8 9
),u,
Req?ue%' t Date Fire No-
?'/
? jugh-in Inspection
uired? ...,,,(((''''''
0 Reatly Now ill Notity Inspeclor
W
R
? Yes GNo hen
eady?
I licensed contractor O owner hereby request inspection of above electrical work at:
J b Address (Street. Box or Route Na.)
?/a E Zf1N4E Ciry
Section No- Township Name or No. Range No. County
Occupa (PRINT) Phone No
.
.
' 4S?'A? 4?5-'6 --
Power Supplier Atltlress ?
A k x EG c_ ? ,Ci9?2?? pJ
Elacincal Contmctor (Company Name)
1A15 Connactor's License nlo.
I'z y901
Mailing Adoress (Caniranor or Owner Making Installation)
#* ? /
Authonz¢ Signature (Contractor/Owner Making Insta lation) Phon Number
?yo -y g b a
MINNESOTA STATE BOARD OF ELECTRICITY THIS INSPECTION REQUES7 WILL NOT
Griggs-Mitlway Bldg. - Foom S173 ? BE ACCEPTED BYTHE STATE BOARD
1877 UniversiTy Are., St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS
Phone(812)6a2-0B00 ` 'e ENCLOSED.
p ? nGV?q?11rVn CLG1,IIlIVML ur.?rvn . ? •- 'VQ, co•vv?vi-oo ?
P/Y
'/ ? Sea inshuclinns Mr comoletino ihis form on baCk of Vellow CoOV. /? C 7
J 0
X" Below Work Covered by This Request N ? j?
638S
ew 'Add R?io TypeofBuilding AppliancesWired EquipmeMWired
Home Range Temporary Service
Duplex Water Heater Eleciric Heating
Apt. Building Dryer Other (Specify)
CommJlndustrial Furnace
Farm Air Conditioner
Olher Ispecifyj Coniractor's Remarks:
Compute Inspection Fee Below:
# ', Other Fee # ServiceEntrenceSize Fee # Circuits/Feeders Fee
Swimming Pool 0 to 2D0 Amps 0 to 100 Amps
Transtormers Above 200 _ Amps Above 100 _ Amps
Signs Inspecror's use Only: TOThk
Irrigation Booms ?
Special Inspection
Alarm/COmmunication THIS INSTALLATION MAY BE ORDERE DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN MTRNTH
f
I, the Electrical Inspector, hereby Rough-in oete
certify that the above inspection has
been made. F?„ai r Date
OFFICE USE ONLY .
This request void 18 months Irom
Addr(jis: 4126 LAN= T•ANE Lot 12 Blk 4 Sec/Sub rpVENTRy pASg M
These items were/were not complete at the time of the final inspection.
Date: 5/26/92 Yes No
Final grade (6" from siding)
Permanent steps - garage
Permanent steps - main entry
Permanent driveway
Permanent gas
Sod/seeded grass tr
Trail/curb damage ?
Porch
Basement finish
Deck
PLease verify vith the builder the removal of roof test caps from the plumbing
system and the shut-off of vater supply to the outside lawn faucet before
freeze potential exists. ?
xcrciEOwven
White - City copy Yellow - Resident copy Pink - Contractor copy
DATE: MAR 25, 1992
RE: 4126 LANTERN LN (MITTELSTAEDT BROS)
It Your Sewer & Water Permit for the above property has been completed. It will be held at the
Public Works Garage (3501 Coachman Road) until the meter is picked up. BE SURE TO
CALL PUBLIC WORKS (454-5220) FOR YOUR PERMANENT WATER TURN ON.
Your Sewer & Water Permit for the above property cannot be completed for the following
reasons:
_ Your Sewer & Water Permit tor the above property has been completed, but the meter cannot
be issued or occupancy allowed until further notice.
_ COMMERCIAL PROJECTS ONLY: Please pay for meter at City Hail. Meter size must be
confirmed by Bill Adams or Dirk House (Plumbing Inspectors - 454-8100) before issuance.
WARNING: BEFORE DIGGING, CALL LOCAL UTILITIES - TELEPHONE, ELECTRIC, GAS, ETC.
- REQUIRED BY LAW.
CONTACT COMMUNITY DEVELOPMENT DEPARTMENT FOR WATER TURN ON POLICY.
Secretary, Building Inspections Dept.
2006 RESIDENTIAL MECHANICAL rERMiT aPPLicATioN
CiTy Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please complete for: single family dwellings & townhomes/condos when pernuts aze required for each unit
3(?,,,5z)
'vsi`Sai
Date 6
Site Address Unit #
Property Owner Telephone # ( )
,
_J? (Z
Contractor
-
Street Address ?'2 I c LYL City
?
State Zip SS?7Z Telephone#
Bond #• ires: x; 3/ 6,
Ex
p
The Applicant is _ Owner Contractor Other
Add-on or alteration to eaisting dwelling unit $ 30.00
furnace _Additional _ Replacement _ New
air excha nger
air conditioner
heat pump
other
State Surcharge $ .50
Total $
I hereby apply for a Residenrial Mechanical Permit and aclrnowledge that the information is complete and accurate; that the work will
be in conformance 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 application far a perxnit, and work is not to start without a pernut; that the work will be in accordance with the
appr ed pl?y in the case of work which requires a review and approval of plans. ?
,?4C At4?r?401-1 Applicant's Printed Name Applicant's Signature
2004 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
?o 00
New Construction Requirements RemodeVReoair Reauiremenls
3 registered sife surveys showing sq. ft. of lot, sq. ft. of house; and all roofed areas 2 copies of plan GertoFSeaueyRecd
(20% maximum lot coverage allowed) 1 set of Energy Calculations for heated additions T[eePres A01h Recd Y ?. N
2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey for addflions & decks 3reePres,#, qqired N N
1 sel of Energy Calculations Addition - indicate itoo-site septic system 9?st18 Sepitc8?s?em :?: _?' _ N
3 copies of Tree Preservation Plan if lot platled after 711193
Rim Joisi Detail Options selection sheet (bldgs with 3 or less units
Date 6l I L2- / 0 ? Construction Cost #??,OzpoT
Site Address Unit/5te #
?
Description of Work /,j5/ //ct (3r75
Multi-Family Sldg _ Y kN Fireplace(s) _ 0 2
Property Owner Telephone #(?`?O?
?
r =
Contractor l ?
?J/L
Address city ? A
State Zip 7??3 7 Telephone 07a ?a2
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy Code Category 0 Residential Ventilation Category 1 Worksheet • New Energy Code Worksheef
(dsubmissiontype) Submitted Submitted
. Energy Envelope Calculations Submitted
Have you previously constructed a building in Eagan with a similar plan? _ Y _ N If so, 25% plan review
fee applies.
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone #( ) _
Telephone #( ?_
Telephone #(
I hereby apply for a Residential Building Permit and acknowledge that the information is 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 wark is not to start without a
permit; that the work will be in accordance with the approved plan i the se f which requires a review and
approval of plans. j C ?
%
Applicant's Printed Name Applica t's Signature
???
RESIDENTIAL
29 Z9
BUILDING PERMIT APPLICATION 1-
CITY OF EAGAN
3830 PILOT KNOB RD, EACAN MN 55122
651-681-4675
New Canstruction Reauirements Remodel/Reoair ReQUirements
• 3 registered site surveys showing sq. rt or lot, sq. ft. of house; and all mofea areas • 2 copies of plan
(209'o mazimum lot coverage allowed) • 1 set ot Energy Calculations for heated additions
• 2 copies of plan showing heam & window ;izes; poured found design, etc.) • 1 sile survey for exlenor additions & decks
• 1 set of Energy Calculations • Indicate if home served by septic system /or addi6ons
• 3 copies of Tree Preservatfon Plan if lot plaRed after 711193
• Rim Joist Detail Options selection sheet (bicgs with J or less units)
_S
DATE 11 I S/ 0Z VALUATION ? 2._76, o O
SITE ADDRESS ?I2(e L-An'teer% Ln MULTI-FAMILY BLDG _ Y _ N
TYPE OF WORK FIREPLACE(S) _ 0_ 1_ 2
APPIICANT Wea.,^?
STREET ADDRESS S(647 ?k&?,a?e,J /'tl&. ?. CITY STATE lI ZIP 550k'Z-
TELEPHONE # (a51-y39-?{32D CEII PHONE # FAX # (v51-35)-20?_
I?IO
PROPFRTYOWNER D0.!'VLiL j- C4ora.. t'e.I-e,rSQ-v? TELEPHONE# (05HAI-0
COMPLETE FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ %[[N\ES0"1'.\ RI;I.t:S 7670 C:\"I'I;GORY 1 MIVNF.SO'I':1 RliLI:S 7672
(4submission type) • Residential Ventilation Category 1 Worksheet SuCmitted • New Energy Code Worksheet Submitted
• Energy Envelope Calculations Submitted
Plumbing Contractor: _____
Plumbing systein includes:
Mechanical Contractor: _
N[cch.uiicA svslcm includr;:
Air Conditioning
Fee: $90.00
r•ee:
Hcat Rccovcr}' Systcnt
Sewer/Water Contractor. Phone # r g ?c^? ? il
?i ., F. . . Li'
t
MLi
I hereby acknowledge that I have read this application, state that the information is cqrrect, and OnfPeY#o?-?mp?Y
with all applicabte State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant
OFFICE USE OvLY
Water Soltcncr
Watcr Heater
No. oF Baths
Phonc #
I,acm Sprin(:ler
ti' o. oE' R.I. Baths
Phone #
CertiFicates of Survey Received Tree Preservation Plan Received _ Not Required _
- Updated 4/02
RESIDENTIAL
r BUILDINC PERMIT APPLICATION
J ? CITY OF EACAN
3830 PILOT KNOB RD, EACAN MN 55922
651-687-4675
NewConetruction Reauirementa RemodellReoair Reauirements
• 3 registered sde surveys showing sq. ft. oi lot sq, fl. af house; and all roofed areas • 2 copies of plan
(20°k maximum bt coverage allowed) . 1 set of Energy Calculations for heated additions
• 2 copies of plan shaxing beam & window s¢es; poured Found design, etc.) . 1 site survey for exlenor additions & decks
• 1 sel of Energy CalculaGons . Indicate if home seNed by septic system for additions
• 3 copies of Tree Preservation Plan i( IM plaUed after 711193
• Rim Joist Detad Options selection sheet (bldgs with 3 or less unifs)
DATF 9 VALUATION ??OO
SITEADDRESS y P-0 "n-6.rn L.n. MULTI-FAMILYBLDG Y N
TYPE OF WORK 3 Season iROoW1 FIREPLACE(S) X 0_ 1_ 2
APPUCANT
STREET ADDRESS
TELEPHONE #9s2-qNl -?73-
?, CELL PHONE #
PROPERTY OWNER _I?Arki I&_ PC44rSPn TELEPHONE #651 -6451-pi 710
COMPLETE FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNESOTA RULES 7670 CATEGORY 1 A
(q submission type) • Residential Ventilation Category 1 Worksheet Submitted •
• Energy Envelope Calculations Submitted
Plumbing Contractor:
Plumbing system includes:
Mechanical Contractor:
Mechanical system includes:
Sewer/Water Contractor:
? Water Softener _
_ Water Heater ?
No. of Baths
Air Conditioning
Heat Recovery System
Phone #
TA RULES 7672
gy Code Worksheet,Siu`ff
,
sr. ..? D
? ,?? ?nn?
•?? i
FPP' ,U90.00
_
Fee: $70.00
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply
with ail applicable State of Minnesota Statutes and City of Eagan Ordina ces.
Signature of Applicant
OFFICE USE ONLY
0 r(Y
_ Phone #
Iawn Sprinkler
No. of R.I. Baths
Phone #
' -A(-i° r STATE Mr1-ZIP `S 3:7,2
ov?
FAX #
Certificates of 5urvey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4/02
OFFICE USE ONLY
? 20 Pool
1" 21 Porch (3-sea.)
/
? 22 Porch(Addn. (4-sea.)
? 23 Porch (screened)
? 24 Storm Damage
? 25 Miscellaneous
.
? Ot Foundation
? 02 SF Dwelling
? 03 01 of _ plex
? 04 02-plex
? OS 03-plex
? 06 04-plex
? 31 New
? 32 Addition
• ? 33 Alteration
? 34 Repiacement
?
? 30 Accessory Bldg
0 31 Ext. Alt - Multi
? 33 Ext. Alt - SF
? 36 Multi
? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 37 Demolish (Bldg)' ? 43 Reroof ? 46 Windows/Doors
*Demolition (Entire Bldg only) - Give PCA handout to applicant
Valuation at? ? Occupancy MC/ES System _
Census Code Il 3 471- Zoning City Water _
5AC Units Stories Booster Pump _
Nbr. of Units Sq. Ft. PRV _
Nbr. of 81dgs Length ? Fire Sprinklered _
Type of Const V10 Width ?
REQUIRED INSPECTIONS
_ Footings (new bldg) FinaUC.O.
Footings (deck) $! FinaUNo C.O.
Footings (addition) _ Plumbing
Foundation HVAC
Drain Tile Other
Roof _ Ice & Water _ Final Pool _ Ftgs _ Air/Gas Tests _ Fina]
_y Framing _ Siding Stucco Stone
Fireplace _ R.I. _ Air Test _ Final _ W indows (newlreplacement)
? Insulation _ Retaining Wall
P,pproved By D Z. , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
Ci1y SAC
Water Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanicat Permit
License Search
Copies
Other
Total
? 07 05-plex ? 13 16-plex
? 08 06-plex ? 16 Fireplace
? 09 07-plex 13 17 Garage
? 10 08-plex ? 18 Deck
0 11 10-plex ? 19 Lower Level
? 12 12-plex Plbg_Y or _ N
Q : 7! ? 1/o
?
.
4MVEYOR'S CERYIFICATE
J,_„-?~?9 2 0.6
azs
9: d
?N
azs e .
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2
35 • ?d_..?"'
,
BEMCM NARK ?,.
roa oF PIPE
i Lev.. 029.4> --?-r _
M1TT[LS7AEDT BROS. CONST"RUCTION
R?DGE
`_---,? OAO,
? , '---?-.. ? 29.4
eee.a ?.
94,01 L =40°1p??1??RxJ?
824,5
4. p7 ` S?
,
? e
f 8R9? J
5 a 6 q ?
' I sti
23.00 •' 34.33 -- -- -=- --- - --
1 M5. M 20,'S3 - 31 13
?N ?
tOi PROFGSED ; GAR. :v
ci H O U$E
A2Za ? O i
6.0
' N 8'J
? S. S Q"?
' t`
? B:s.
= 34.0
wi
?.- 25.33
?
?-c-829.9 ----?830.8 •
(-
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c??
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? ? s 4?f
? l
O I
B[Zt / Q
0
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C7 ? fi
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BE N qRK
TOP Opt pIPE
FIFV_rab1.1S
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L OT I? I b'
, ?------,---?-
'k" b / tr onrE_ e2
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1p? ?
.
!
?LO???g?p l I INCH = 30 hEET
? -
?
V?
James R. Hill, I f 1C.
PLANNERS i ENGINEERS / SUAVEYORS
2
500 W. CTY. RD, 42 0 BURNSVILCE, MN. 55337 • 612-$90-5044
NOMENOMMOUN?
` 12- BL T cirr use oNLY
suso. C eh S S :4RECEIPT #:
RECEIPT DATE: 11- ltv? _
PERMIT # 7 7
2000 PLUMING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122 ?t
651-661-4675
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: "L?^ Lcvd $ 30.00
Bath tub $ 3.00 x = $
Floor drain 3.00 x = $
Ges piping outlet ' minimum -1 3.00 X = $
Hot tub/spa 3.00 x = $
Kitchen sink 3.00 x = $
Laundry tray 3.00 x = $
Lavatory 3.00 x = $
Septic System new/refurbished ' requires MPC Ile. 75.00 X = $
Septic System abandonment 30.00 x = $
RPZ new installation/repairlrebuild 30.00 x = $
Rough opening 1.50 x = $
Shower 3.00 x = $
Underground sprinkler if dwelling is under construction 3.00 X = $
Under round sprinkler if existing dweiling 30.00 x = $
Water closet 3.00 x = $
Water heater 3.00 x = $
Water softener If dwelling under construction 5.00 x = $
Water softener if existing dwelling 30.00 X = $
Water turnaround 30.00 x $
State Surcharge .50 --> -> -> $ .50
Total --> --> ----> ---> $
Reminder: Calt for inspections of alterations, i.e. water heaters, water softeners, etc.
------------------------------------------------------------------- --------------------------------------------------------------------
I hereby adcnowledge that I have read this applicaGon, state that the infortnation is conect, and agree to wmpiy with all applicable City of Eagan ardinances.
It is the applicanYs responsibility to notify the property owner that the City of Eagan assumes no liability for any damages ceused by the City during its
normal operational and maintenance activities to the facilities constructed under this pertnit within City propeRy/right-of-wayJeasement.
SITEADDRESS: G ZC(.h-:(-tri-i GdrM -
OWNER NAME: :?l r V?! ?rit'Gv'.S u't TELEPHONE #: / s l ltfl` bI 29
(AREA CODE)
INSTALLER NAME: TELEPHONE #:
(AREA CODE)
STREET ADDRESS:
CITY:
STATE: ZIP:
SIGNATUR OF PERMITTEE
2000 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD - 55122
651-681-4675 'r C1U
? 3 reglatered site wneys ahowlnp sq, fL of loi, aq. R. of house
and go rooled areas (2096 ma)dmum lot coveraae ailowed)
D 2 coplea of plans (ahow beam & wh?dow sizes; poured fnd. design; etcJ
n 1 set of energy calculaflons
? 3 coptes of tree preaeroation plan if Iot platted after 7/1/93
DATE: LIZLIOO
RemodeVReoalrReaulremenh l,ralIcj 1I`19-0
?ppies Ot plan ?
't'SoPOtstsergy cSlculaNons for heated addlfions fl-fy)
i alte wney for extedor addiHons & decks
CONSTRUCTION COST:
DESCRIPTION OF WORK: Idwcr L?vt? ?; v?.iS
STREET ADDRESS: YI.,2 4 LQ,rt-?u^N Ll.L
LOT: ? BLOCK: SUBD./P.I.D. #: -L l.?
yc L
OVPI??f's 2hcl
Name: /'64-Gv`Se-A IL Phone
Po?? Lasf Fi?? ??ti
? ? y g 5S'?
Sheet Address: yiaL laxfcy
. ?in e-
City ?6ui6Cvt state: ztp:
• Company: one #:
(area code)
CONTRAGTOR
Sheet Address: License Y Exp.
C11y _State: Zip:
ARCHITECT/
ENGINEER
Company:_
Telephone #:
Sheet Addre:
Cify
Name;
Regisha8on 0:
Sewedwater licensed plumber (if installina sawerMraterl: Phone #:
Zip:
I hereby acknowledge that I huve read this application, stafe thaF 1he Infortnafion is cortect, ond agree to comply with all appncable StaFe
of Minnesoto Staiutes and CiFy of Eagan Ordinances.
Signature of Applicanh -
OFFICE USE ONLY
Certificates of Survey Received _ Yes
_ No
Tree Preservation Plan Received _ Yes _ No _ Not Required
AtQ(/
n
2Q0o
_?,/?
OFFICE USE ONLY
BUILDING PERMIT SUBTYPES
? 01 Foundation O 07 05-piex ? 13 16-plex ? 21 Porch (3-sea.) ? 31 Ext. Alt - Muw
? 02 SF Dweliing ? OS 06-plex 0 17 Garage 0 22 Porch/Addn. (4-sea.) ? 33 Ext. Ait - SF
? 03 01 of_ plex ? 09 07-plex ?,8 Deck ? 23 Porch (screened) 0 36 MuRi
? 04 02-plex ? 10 OS-plex ? 19 Lower vel
o ? 24 Storm Damage
? 05 03-plex ? 11 r _ N
10-plex Plbg v ? 25 Miscellaneous
? 06 04-piex ? 12 12-plex ? 20 Pool ? 30 Accessory Bidg.
WORK TYPE
? 31 New O 36 Move Bidg. ? 43 Reroof
?2 Addition ? 37 Demolish (Bldg)' ? 44 Siding
? 33 Alteration 0 38 Demolish (Interior) ? 45 Fire Repair
? 34 Repair O 42 Demolish (Foundation) ? 46 Windows/Doors
" Give PCA handout to applicant for demolition permlt
GENERAL INFORMATI ON
SAC Code # of Stories Sq• n.
No. of Units
0 Length sq. ft.
_
No. of Buildings ? Width Footprint sq. ft.
Const. (Actual) vAv Basement sq. ft. Census Code t/3y
(Allowable) vn/ Main level sq. ft. MC/ES System
UBC Occupancy &- I sq. ft. City Water
Zoning sq. ft. Booster Pump
PRV
Fire Sprinklered
MISCELLANEOUS INSPECTIONS
? Stucco/Stone
APPROVALS
Planning Building IS& Engineering Variance
Permit Fee Valuation: $ I)2ov
Surcharge
Plan Review
License
MC/ES SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
SNV Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
SAC Units
% SAC
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE:
3630 Pilot Knob Road Permit Number:
Eagan, Minnesota 55123 Date Issued:
(612) 681-4675
SITEADDRESS: LOT: 12 BLOCK: 4 APPLICANT:
4126 LANTERN LANE ARNETT STEVEN
COVENTRY PASS 2ND (612) 973-0906
PERMIT SUBTYPE:
DECK
TYPE OF WORK:
NEW
BUILDING
021725
08/20/93
INSPECTION D. . .A
FOOTING FINAL
? cITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
PERMIT ? C4"°
PERMIT TYPE:
Permit Numlier:
Date Issued:
BUZLDIMG
021725
08/20/93
SITE ADDRESS:
P.I.N.: 10-18401-120-04
4126 LANTERN LANE
LOTs 12 BLOCK: 4
GQVENTRY PASS 2ND
DESCRIPTION:
ermit Type DECK
@,rk Type NEW
13
14
R"-, ?
i ??
y ??'?
? '"x
REMARKS:
FEE SUMMARY
Base Fee
5urchargs
Subtotal
CONTRACTOR:
$25.@0
1.50
$25.50
r
I horeby soknaw3ed-ge: that I ?hav
Informativn is :ccsrrect.an 1 4 ag.we
stottate.? ?h4I C,i'ty of Eagari Ordi
APPLICANT/PERMITEE SIGNATURE
CQPY $.50
Total Fee $26.00
OWNER: - Applicant -
ARNE7T 57EVEN
4126 LANTERN LANE
EAGAN MN
(612)973-0306
ISSUED BSIRNATUR' ?
,n.
?
?
?
?
x
REACTIVATE
PERK?V# ? .
') 172)" r)
CITY OF EAGAN
1993 BUILDING PERMtT
681-4675
APPLICATIO? o-o
C;? -
SINGLE & 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: 1) when permit is typed, but not picked up by last working day of month.
in which request is made, 2) address is changed or 3) lot change is requested once permit
F
is issued.
Date /?/19 Yal uati on of work '`?9M /A¢tA!1?W
Site Address: ??? `?f2?""?? ?-
STREET SU1TE y ?
Tenant Name: (commercial only)
LOT ? BIACK ? SUBD. ?..I D. *
Descri tion of work: ?-2 6
The applicant is: X Owner [3 Contractor ? Other (Descri6e)
3-03010
Name , P,vT) Phone ptda E(nE??roF_?33
Property LAST FIRST
Owner Address nter'1)
G'1
STREET STE 0
City State l?(1J Zip 5?12-3
Company Su h,.P. Phone
Contractor Address License # Exp.
City State Zip
Company Phone
Architect/
Engtneer Name Registration #
Address
City State Zip
Sewer & water licensed plumber . Processing time for
sewer & water permits is two days once area has been approved.
I hereby acknowledge that I have read this application and state that the information is
correct and agree to comply wit 11 applic ble Stat of Minnesota Statutes and City of
Eagan Ordinances.
Signature of Applicant:
J
OFFICE USE ONLY
BUILDING PERMIT TYPE
O 01 Foundation
? 02 SF Dwg.
O 03 SF Addition
? 04 SF Porch
? 05 SF Misc.
? 06 Duplex
? 07 4-Plex
? 08 8-Plex
? 09 12-Plex
? 10 Multi. Add'1.
WORK TYPE
? 31 New
32 Addition
O 33 Alterations
O 34 Repair
0 11 Apt./Lodging
O 12 Multi. Misc.
? 13 Garage /Acce s sory
? 14 Fireplace
pl? 15 Deck
? 35 Tenant Finish
0 36 Move
, .__. ..
? 16 Basement Finish
? 17 Swim Pool
O 18 Comn./Ind.
O 19 Comm./Ind. Misc.
O 20 Public Facility
O 21 Miscellaneous
? 37 Demolish
GENERAL INFORMATION
Const. (Actual) 'i Basement sq. ft. MWCC System
(Allowable) lst F1. sq. ft. City Mater
UBC Occupancy R. 3 2nd F1. sq. ft. PRV Required
Zoning Sq. Ft. total Booster Pump
# of Stories Footprint Sq. ft. Fire Sprinkler
Length On-site well Census Code L/.;?!?
Depth On-site sewage SAC Code
?-
APPRO\'ALS o
Planning Building Assessments
Engineering Variance
REOUIRED INSPECTION S '
? Site Footing ? Framing O Insulation
[3 Wallboard ? Final O Draintile ? Fireplace
Permi t Fee ZS . v J 1 veLuae;a,: $
Surcharge
Plan Review
License
MWCC SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
5/W Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Trails Ded.
Copies .?
Other
Total:
SAC %
SAC Units
INSPECTION RECORD Control No. 0092
CITYOFEAGAN PERMITTYPE: BUILDING
3830 Pilot Knob Road Permit Number: 000093
Eagan, Minnesota 55123 -- Date Issued: 03 /24 /92
(612) 681-4675
SITE ADDRESS: Lo T: 12
4126 LpN7ERN LpNE
?`GOV,ENTRY PAS5 2ND
PERMIT SUBTYPE:
sF owG
s Loc K: a APPLICANT:
MITTEL5TAEDT BROTHER3
(612) 456-9125
TYPE OF WORK:
NEW
INSPECTION
SITE DA .
FOOTING D•
FRAMING INSULATION
WALLBOARD FINAL
FIREPLACE
F
L
PERMIT `
-CITY OF EAGAN
3830 Pilof Knob Road
Eagan, Minnesota 55123
(612) 681-4675
SITE ADDRESS:
PERMIT TYPE:
Permit Number:
Date Issued:
4126 LANTERN LANE'
LOT: 12 BLOCK: 4
COVENTRY PASS 2ND
DESCRIPTION:
Buildfng Permit Type
Building Work Type
UBC Occupan?cy,,
Constructa,on Ty'pe
Zoning -
Building Lengttt
Building Width ?
? .. ..
3F DWG
NEW
R-3 M-1
VN
R-1
60
26
, -
`
X
BUILDING
000093
03/24/92
REMARKS: ?0) ??4 ?
?^ V
FEE SUMMARY:
Base Fee
Plan Review
Surcharge
SAC
SAC %
SAC Units
Subtotal
VALUATION
$716.50
$465.73
$61.00
$700.00
100
1
$1.943.23
$122,00@
MI3C FEE3 $1,610.50
7ota1 Fee $3,553.73
CONTRACTOR: - applicent - sT. LIWNER:
MITTELSTAEDT BROTHERS 14569125 0003 43 MITTELSTAEDT BROS CONST
785 SUN5ET DR 785 3UNSET DR
EAGAN MN 55123 EAGAN MN 55123
(612) 456-9125 (612)456-9125
I hereby acknawlsdge that I have read this ap,plzcati.an and state that the
information is correct and agree to comply with all applicable State of Mn.
Statutes and City af Eagan Ordinance,s.
? APPLICANTlPER EE SIGNATURE ISSUED BY IGNATURE
Control No. 0092
OFFICE USE ONLY
BUILDING PERMIT TYPE
O 01 foundation
p 02 Single Family
D 03 Two-family
? 04 Multi-fam. T.N.
? 05 Apt. Bldg.
? 06 Garage/Accessory
0 07 Fireplace
? OS Deck
D 09 Basement Finish
? 10 Swim Pool
O 11 Res. Add./Porch
? 12 Cortnn._/Ind. New
? 13 Comm./Ind. Add
O 14 Gomm./Ind. Rem.
? 15 Public Fac.
WORK TYPE
19 90 New
? 91 Addition
O 92 Alterations
? 93 Remodel
O 94 Repair
? 95 Tenant Finish
GENERAL INFORMATION
? 96 Move
? 97 Demolish
O 99 Undefined
? 16 Agricultural
? 17 Biiilding Move
? 18 Demolition
? 20 Miscellaneous
Occupancy V3 / Basement sq. ft. /00 y MWCC System
Zoning
(Actual)
Const lst F1. sq. ft.
d F1
2
ft GG City Water
uired
PRV Re
. n
. sq.
. B q
(Allowable) Sq. Ft. total Booster Pump
# of Stories 2 Footprint Sq. ft. Fire Sprinkler
Length 7_6 On-site well Census Code
Depth 2 61, 3 On-site sewage SAC Code
APPROVALS
Planning Building Assessments
Engineering Variance
AEQUIRED INSPECTIONS
Ig Site 13 Footing
L1 Nallboard 0 final
[,YI Framing
? Draintile
?
?
oL
,0 lnsutation
L7 Fireplace
Permit Fee So v?tuae;«,: : I Z?
Surcharge
Plan Review
73
license -2 Q,? yb ? 800
CWty SAC 200 3,- 3 y =/D ?
Water Conn. !n 25-
' 3,t 3 y =?_
Water Meter qs
Acct. Deposit 30 9 v (o?Z?,p
S/W Permit 30
?
S W Surcharge
Treatment Pl
??
.
- Z h ?
Road Unit 390
Park Ded.
Trails Ded. _ ?/?$5"Z
Copies y - ?
Other
Total:
?QV zzz.r/G ?
`V?
SAC 96
SAC Units
.. l CITY OF EAGAN
1992 BUILDING PERMIT APPLICATION
681 -4675 ,
A i? 'e q RECD
SINGLE & 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 ar lot chan e is re uested once ermit is issued.
Date 3/ Val uat i on of work
Site location: 41a4o 1gAx7e,z.?J Ll?vs
STREET STE #
Tenant Name:
LOT ? BLOCK ?f SECT/SUBD. Czv
ywg.Wj?
P.I.D. #
Descri tion of work: G , t `
Fevw,
The appl i cant i s: ? Owner Contractor ? Other (Oescri6e)
Name Phone
Property LAST FIRST
Owner
Address
STREET STE N
City State Zip
Company X, 2-I"56-6 /gzeft 4ey.L?- Phone
Contractor Address `79'-5 Sr?s?? ,dr??.d? " License # CV,034,? 3
City State Zip 55??14;
Company _ Phone
Architect/
Engineer Name Registration #
Address
City State Zip
Sewer & water licensed plumber AIG {r?.&az.z,4A6&i ? } . Processing time for
sewer & water permits is two days once 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.
5ignature of Applicant:
_ _, r • ?
BUILDING PERMIT TYPE
0 01 Residential
? 02 R. Garages
0 03 Two-family
0 04 Townhouses
0 05 Multi. Dwellings
WORK TYPE
OFFICE USE ONLY
0 06 Commercial
0 07 Industrial
0 08 Public Works
0 09 Utility
0 10 School
0 90 New 0 93 Remodel
0 91 Addition 0 94 Repair
0 92 Alterations 0 95 Tenant Finish
TYPE OF STRUCTURE
0 101-01/20 1 Family Res.
0 102-03/22 1 Family attached
? 103-02/21 2 Family (duplex)
? 104-10/23 3 & 4 Family
0 105-10/23 5 or more Family
0 213-30 Hotel/Motel
0 214-30 Other Shelter/Board
0 318-30 Amusement/Rec.
0 319-30 Place of Worship
0 320-40 Industrial
0 321-30 Non-Res. Pk. fiar.
0 322-30 Service Station
0 323-30 Hosp./Institution
GENERAL INFORMATION
Length
Occupancy Depth
Zoning Sq. Ft.
Const. (Actual) On-site sewage
(Allowable) On-site well
# of Stories
APPROVALS
Planning Building _
Engineering Variance _
REQUIRED INSPECTIONS
? Site ? Footing
O Wallboard ? Final
[
. ,_
0 11 Other Structure
0 12 Demolish
0 13 Fireplace
0 99 Undefined
0 96 Move
0 99 Undefined
0 324-30 Office/8ank
0 325-30 Utilities
? 326-30 Schools/Ed.
0 327-30 Retail/Rest./Whse.
0 328-30 Other Nonres./Sheds
0 329 Non bldg. Structure
0 434 Alt./Add. Residential
0 437 Alt./Add. Non res.
0 438 Alt./Add. Res. 6arage
0 645-50 Deno 1-Fam.
0 646-50 Demo 2-Fam.
13 647-50 0emo 3& 4 Fam.
0 648-50 Dana 5 or more
0 649-50 Demo Other
MWCC System
City Water
PRV Required
Booster Pump
Sprinklers
Assessments
? Framing ? Insulation
? Draintile ? Fireplace
sac catcutas;«,s:
Description
SAC X ,
%
SAC Units
:.. . z _
i?'ri? ?? ?.? .i??? ?_• __L..fIIiL?? ?• IIILL l?t? iL?_ I_?_1.:. L? L 11 r1iJl i-I_?
i
.titJRVE,YOR'S CERTlFICATE MITTELSTAEQT sROS coNsTRucTIorv
f,l'`?8Y 0 6 __?
NSd6V o? ?35, _..?
f-R-I D--G E -?_----R o?
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r 6?
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cr 5? 1 a o % S N
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ro a of 54.33 „15 • M 2033 3"
P?ve -, ?.00 . , . :
f LEV.. OY6.17 (0
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? ? PROF'GSEiJ ; GAR.
N HousE ' a eas.s o?
zzs to G 6.0 ? ¦ .t
340' ---------'---25.33__
at7. ? 7 .? R ?SO.Y 832.6
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eeNCH MaRK
TCP OF PIPE
ELEV•6E1.73
f L,? ?
m ? 1 EAGAN
LOT !2 I I
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---?°-
LA_ mG BY___....?.5
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1 y
i INCH?30 1=EET
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James R. Hill, inc.
PLANNERS / ENGINEERS / SURVEY4R5
2500 W. CTY. RD. 42 • BURNSVILLE, MN. 55337 • 612-880-5044
CITY OF EAGAN
11k
?
L 12.1 bq, N46ry
CITY OF LAKEVILLE
BUILDZNG INSPECTION DEPARTMENT
20195 HOLYOKE AVENUE, P.O. BOX 957
LAKEVILLE, MINNESOTA 55044
612-469-4431
U.1 E SGaf'r
This form is only applicable to detached one-and-two family dwellinqs. The
requirements herein are based on amended Section 502.2.1.7 in lieu of the
criteria specified in Sections 502.2.1.1, .2 and .3.
Building Address: 412, (,,_ (_/470-1E2U) Lnr-
Contractor or owner:
emeIIt "R" Values Area (sq ft) % of Ext.Walls
Ceilings Design?Required 38
Walls* (exterior) Design 2LRequired 21 2 37&
(without foundation)
Floors* Design_34 Required 20
(overheated spaces)
Windows** Design_!L?lRequired 2
Foundation Walls Design13i,Required 5
(when insulating full depth of foundation wall)
Design_Required 10
(when insulating only to frost depth & footings
extend below)
Slab-on-grade Design`?=? Required 8.83
floors
-Doors Design ry Required 3
Footnotes•
* For the insulated cavity of opaque walls, floors, and rim joists.
** Maximum window area must not exceed 12 percent of the area of
exterior walls, not including foundation walls.
CERTIFICATION
I hereby certify that I have completed the above information and that it
complies with le Minnesota State Energy Code.
Signature Date:
. ? - CITY OF EAGAN
3830 PILOT KNOB ROAD
EAGAN, MN 55122
PHONE: (612) 454-8100
FOR CITY USE ONLY
PERMIT #
RECEIPT #
DATE :
It,?S;???';f`;?3> PLEASE COMPLETE
>:.:: ?,...::<:. .:.....::
.......? UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS 5
.
TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FO& EACH UNIT.
------------------------
WORK DESCRIPTION ----- --------------------- ---- ---------------------
COMPLETE THE FOLLOWING; ------
N0. FIXTURES EA. TOTAL
NEW CONST ADD-ON MINIMUM 15.00
ADD ON / SHOWER 3.00
REPAIR ? WATER CLOSET 3.00 ?
/ BATH TUB 3.00 3 '
LAVATORY 3.00
OWNER NAME: l KITCHEN SINK 3.00 3'
LAUNDRY TRAY 3.00 ?r
SITE ADDRESS: HOT TUB/SPA 3.00
,,_,,s,f?
n
?`
?
'
?' / WATER HEATER 3.00 ?
LOT: BLOCK
SUBD.
`-'?-
"
? FLOOR DRAIN 3.00 T=
GAS PIPING DUT.
INSTALLER: (MINIMUM - 1) 3.00 ?
?
O '`??' ? ROUGH OPENINGS 1.50
ADDRESS: OTHER
? r WATER SOFTENER 5.00
? ZIP:
CITY: z- PRIVATE DISP. 15.00
U.G. SPRINKLER 3.00
SUBTOTAL $ q???o
ST. SURCHP.RGE .50
TOTAL: $ ?7_(X,
PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS AND
MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH
DWELLING UNIT.
__- -----°-------------------------°-----°_
CONTRACT PRICE:
dWNER NAME:
SITE ADDRESS:
LOT: BLOCK SUBD.
INSTALLER:
ADDRESS:
CITY: ZIP:
PHONE #:
FEES
18 OF CONTRACT FEE.
STATE SURCHARGE _ $.50 FOR
EACH $1,000 OF PERMIT FEE.
$25.00 MINIMUM FEE.
CONTRACT PRICE x 18 $
STATE SURCHARGE
TOTAL:
$
( S IGNAT[JRE)
FOR:
CITY OF EAGAN
?
CITY OF EAGAN
3830 PILOT KNOB ROAD
EAGAN, MN 55122
PHONE: (612) 454-8100
FOR CITY USE ONLY
PERMIT #
RECEIPT # D
DATE:
PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS &
_.:. . . _. . ....,:::::.
TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
------------------------ ---------------------------------- -----------------°----
WORK DESCRIPTION FEES
NEW CONST v ADD-ON MINIMUM $15 00
ADD ON
REPAIR
OWNER NAME :& 1 fe ( S T-GL'2-??
SITE ADDRESS: 4/eI1-nG
LOT: W, BLOCK __!?4 SUBD. ?DIIe-,1 ?QSS a?d
INSTALLER: RiirncVlllp Heatin$ S4-A?C, Inc
12481 Rhode Island Ave. So.
ADDRESS: SaVage, MN 5-5-,,'?7$ 4-1-2-2
894-0005
CITY: ZIP: -___---
PHONE #
HVAC 0-100 M BTU 4.Z
ADDITIONAL 50 M BTU 6.00
GAS OUTLETS - MINIMUM
OF 1 PER PERMIT
SUBTOTAL:
STATE SURCHARGE:
TOTAL: $??U
Ft'?GNA E OF PERMITTEE/?
^V-S
uP-'Vl ? `? i
-Ce-4-1 , ra-,-j,e..
?01+II?EItC?AT,f?tb'EJST?L?AT.;; PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS,
APARTMENT SUILDINGS, AND MULTI-FAMILY BUILDINGS WEIEN SEPARATE PERMITS ARE
NOT REQUIRED FOR EACH DWELLING IINZT.
-------------------------------------------- _^..___ _----------____?_____-------
CONTRACT PRICE:
OWNER NAME:
SITE ADDRESS:
LOT: SLOCK SUBD.
INSTALLER;
ADDRESS:
CITY: ZIP:
PHONE #:
FOR:
FEES
18 OF CONTRACT FEE.
STATE SURCHARGE _ $.50 FOR
EACH $1,000 OF PERMIT FEE.
PROCESSED PIPING = $25.00
$25.00 MINIMUM FEE.
CONTRACT PRICE x 18 $
STATE SURCHARGE $
TOTAL: $
(SIGNATURE)
CZTY 4F EAGAN
PERMIT
City of Eagan Permit Type: Building
Permit Number: EA105263
Date Issued: 0710512012
itj of 0n Permit Category: ePermit
R
Site Address: 4126 Lantern Lane
Lot: 12 Block: 4 Addition: Coventry Pass 2nd
PID: 10-18401-04-120
Use:
Description:
Sub Type: e-Fireplace Construction Type:
Work Type: Gas Fireplace (new)
Description:
Census Code: 434- Occupancy:
Zoning:
Square Feet: 0
Comments: Improvements to the home may require smoke detectors in all bedrooms. Chimney /flue must be inspected prior to concealing.
Carbon monoxide detectors are required by law in ALL single family homes.
Fee Summary: BL - Base Fee $3K $88.50 0801.4085
Valuation: Surcharge - Based on Valuation $3K $1.50 9001.2195
3,000.00
Total: $90.00
Contractor: - Applicant - Owner:
Hearth and Home Technologies Daryle L Petersen
2700 N. Fairview Ave 4126 Lantern Lane
Roseville MN 55113 Eagan MN 55123
(651) 638-3309
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of
Minnesota Statutes and City of Eagan Ordinances.
Applicant/Permitee: Signature Issued By: Signature
Use BLUE or BLACK Ink
r
For Office Use I
Permit 7 r I
(Ion
City of Ea I I
Permit Fee. zz- 7 I
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received:
I
Fax: (651) 675-5694 I I Staff:
Phone: (651) 675-5675
2012 RESIDENTIAL BUILDING PERMIT APPLICATION C ~t,,c. 1ti
Date: Site Address: Unit
Name: LasW c& Phone: Q 470
RESIDENT/
OWNER Address / City / Zip:
Applicant is: Owner Contractor
TYPE OF WORK Description of work:
Construction Cost: id 1 pp
1$00 ' Multi-Family Building: (Yes / No )
Company: A4.vrif /cv►idR+~nw`~••aC yliC Contact: F."' (LT- f~it2.~C„~Cct
CONTRACTOR Address: Yk -7 G n me~S J e City: -CA
y~I~~1sG
State: MPQ Zip: $7S$%47.A{ Phone: 112 to IL License Lead Certificate (02,6(®3
If the project is exempt from lead certification, lease explain why: (see Page 3 for additional informa
I
f-4,, wig. ur c~ s t ~ 4 ke LC-4t- c S
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.gopherstateonecall.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 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 J4XA R.T' 00 EQr~.t-lam #Wr x
Applicant's Printed Name Applicant% Signature
Page 1 of 3
DO NOT WRITE BELOW THIS LINE 1 1d7U;
SUBTYPES I-llz4o L.;-~
_ 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 xe Windows _ Demolish Foundation
_ Replace _ Repair _ Egress Window _ Water Damage
Retaining Wall *Demolition of entire building - give PCA handout to applicant
DESCRIPTION
Valuation QZI Occupancy MCES System
Plan Review , Code Edition 477 SAC Units
(25% . 100% ~ Zoning - City Water
Census Code lyN Stories Booster Pump
# of Units Square Feet PRV
# of Buildings l 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
Fireplace: -Rough In Air Test -Final Windows
Insulation Retaining Wall: _ Footings _ Backfill _ Final
Sheathing Radon Control
Sheetrock Erosion Control
Reviewed By: , Building Inspector
RESIDENTIAL FEES
Base Fee 3
Surcharge
Plan Review IV 7
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
Page 2 of 3
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA160085
Date Issued:02/12/2020
Permit Category:ePermit
Site Address: 4126 Lantern Lane
Lot:12 Block: 4 Addition: Coventry Pass 2nd
PID:10-18401-04-120
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:Two or More Windows/Doors
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: 5,000.00
Fee Summary:BL - Base Fee $5K $118.00 0801.4085
Surcharge - Based on Valuation $5K $2.50 9001.2195
$120.50 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Daryle L Petersen
4126 Lantern Lane
Eagan MN 55123
(612) 670-1029
Apex Energy Solutions
9655 Newton Ave S
Bloomington MN 55431
(651) 688-2739
Applicant/Permitee: Signature Issued By: Signature