4154 Lantern LaneCITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number.
Eagan, Minnesota 55122-1897 Date Issued:
(612) 681-4675 ,
SITE ADDRESS:
4 1 `14 I.AMTfRN 1ANE i'tJIN CI'1Y Rt1f?f'JriFfa
11111NikY W(il{I111 (61?) 636-9640
{. ?
PERMIT SUBTYPE: TYPE OF WORK: f}: RqrXCEN
Permit Holder Date Telephone #
PLUMBING
HVAC
Inspection Date Inap. Comments
FOOTINGS
FOUND
FRAMING
ROOFING
df'?0
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
IRRI6ATION
METER
FLUSH
MAINS
CONDUCTIVITY
TEST
HvDROSTATIC
TEST
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
..
(gprttfirxtr uf (IDrrupttnry
titp of eagan
EP}iarbtPllf iTf Blttlbtlt-9 ltf9pPttlDtt
7his Certificate issued pursuant to the requirements of Section 306 of !he Uniform Building
Code cenifying that at the dme of issuance this structure was in compliance with the various
ordinances ojthe City regutadng building coxstruction or use. For the following:
Uet CLsifinCOn -:?`i•%i :???.`. Bldg. A'rmit No. .
Occuptncy Type R-{ To1ring UiatnU ' Type Coost. ..
o? &euildiiig <v".?.P:v/:•U:,°'" Aildnmis
ud.-::KBwWing Addrta [,oniiry `*51a!
Dek: !`'.?.C??Y ??• ??'l??'
BuiWing 016ciel
POST IN A CONSPICUOUS PLACE
CITY OF EAGAN ?A372 :
' 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 ?
PHON E: 454-8100
BUILDING PERMIT Receipt #
To be used for Est. Value ' Date ,19
Site Address
,. t . t
Lot Block Sec/Sub. ii'ikY j
' -
Parcel No.
a Name
= Address
Ciry _ Phone
? ?s? 79.7
°C
.o Name
? Q Address
11!` City Phone
U?
y? W Name
F W
_z. Address
u
= City Phone
e W
I hereby acknowledge that I have read this application and state that the
information is correct and agree to comply with all applicable State of
Minnesota Statutes and City of Eagan Ordinances.
Signature of Permittee
A 0uilding Permit is issued to:
on the express condition that all work shall be done in accordance with all
applicable State of Minnesota Statutes and City of Ea9an Ordinances.
Building Official
OFFICE USE ONLY
On Site Sewage _ Occupancy
MWCC System _ 2oning
On Site Well (Actual) Const
Ciry Water ,
_ (Allowable)
PRV Required of Stories
Booster Pump Length
Depth
S.F. Total
Footprint S.F.
APPROVALS FEES
EngrJASSess. Permit " " -
Planner Surcharge -
Council Plan Review
Bldg. Off. SAC, City
Variance SAC, MWCC
Water Conn.
Water Meter
Road Unit
' qj
7reatment Pt ?
Parks
TOTAL ' ' 'j
- Psrmit No. Psrmlt Holdar Date TelspAone *
Plumbing :
H.v.aC. Oaly,71
Electric L"r;^?yC' -/ a? ']` y. ?? ???? ?y" y, <-z•,
Softener
Inspsctlon Dste Insp. COmments
Footings I
Footings II
Foundation
Framing
Roofing
Rough Plbg.
Rough Htg.
Isul.
Fireplace k
Final Htg.
Final Plbg.
Bidg. Final llr"
Cert. Occ.
Temp. LP
Deck Ftg.
Deok Final
Well
Pr. Disp.
PLUMBING PERMIT
CITY OF EAGAN
3930 PILOT KNOB ROAD, EAGAN, MN 55122
PRICE:
Site Address «I t, 4 1 A11t-
Lot Block SeciSub
/ . ? l
y Name 41 0
m Address S p??7 i--4' -?' h:1 i E ?
c City ,41P1 ? Phone j?
Name "?4?I l, t.,"' ^I 1 i I
3 Address
O City Phone
FEES
COMM/IND FEE - 1% OF CONTRACT FEE
APT. BLDGS - COMM RATE APPLIES
TOWNHOUSE 8 CONDO - RES. RATE APPLIES
MINIMUM - RESIDENTIAL FEE - $12.00
MINIMUM - COMM/IND FEE - $20.00
STATE SURCHARGE PER PERMIT - 50
(ADD $.50 S/C IF PERMIT PRICE GOES „
BEYOND $1,000.00)
1 /.
SIGNATURE OF PEFMITTEE
FOR CITY OF EAGAN
PERMIT #
RECEIPT q / J/ S lc
o,arE: /' _
BLDG. TYPE WORK DESCRIPTION
Res. New
Mult. Add-on
Comm. Repair
Other
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
NO. FIXTURES TOTAL
_Water Closet - $3 00 $
_Bath Tubs - $3.00
_Lavatory - $3.00
-Shower - $3.00
_Ki!chen Sink - $3.00
_Urinal/Bidet - $3.00
_Laundry Tray - $3.00
_Floor Orains - $1.50
-Water Heater - $t 50
_Whirlpoot - $3.00
_Gas Piping Outlets - $1.50
(MINIMUM - 1 PER PERMIT)
-Softener - $5.00
-Well - $10.00
_Private Disp. - $10.00
_Rough Openings - $1.50
FEE:
STATE S/C: -?_
GRAND TOTAL: - ,
CONTRACT PRICE:
Site Address
Lot Block _
CITY
3830 PILOT KNOB I
(D
m
c .,
Name 71?
Addfess
- ?.._
City Phonec
Name
c Address
p City Phone _
TYPE OF WORK
Forced Air M BTU
Boiler M BTU
Unit Heater M BTU
Air Cond. M BTU
Vent. CFM
Gas Piping Outlets #
FEE
S/C:
TOTAL•
PERMIT #
PERMIT
EAGAN RECEIPT q
D, EAGAN, MN 55122 DATE:
54-8100
BLDG. TYPE WORK DESCRIPTION
Res. ? New
Mult Add-on
Comm. Repair
FEES
HVAC 0-100 M BTU
RES -$24
00
.
ADDITIONAL 50 M BTU .
- 6.00
(RES
HVAC INCLUDES A/C ON NEW
. '
CONSTRUCTION)
GAS OUTLETS (MINIMUM - 1 PER PEFMIn - 1
50 EA
. . ;
COMM/IND FEE - 1% OF CONTRACT FEE j
APL BLDGS. - COMM. RATE APPLIES ?
TOWNHOUSE 8 CONDOS - RES. RATE APPLIES l
MINIMUM RESIDENTIAL FEE - ALL ADD-ON &
REMODELS - 12.00 i
$ MINIMUM COMMERCIAL FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
$ (ADD $
50 S/C iF PERMIT PRICE GOES
S ?
- .
BEYOND $1,000) j
J , I
?.. ??7U.i ..J.
SI NATURE OF PERMITTEE
? ? .
?i
?
?
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHON E: 454-8100
BUILDING PERMIT
To be used for "Aa
Site Address k
Lot I ' Block
Parcel No.
4 Sec/Sub. ''-'XNTRY dOLLOW
W Name .`4VLLEN f:':0SELLE
= Address 4 30 INDt'5T!ilAL $LVD
o citv M1'LS Phone 376-3'.}::,i
o Name ?A,'.P'
?Q Address
P City Phone
?Q
V W Name_
_ z. Address
u
<w CitY-
1 heieby acknowledge that I have read this application and state that the
information is correct and agree to compty wlth all applicable State of
Minnesota,Statutes and Cttyof Eagan Ordinances.
SignaturA of Permittee
A Building Permit is issued to: ?! Ji
on the express condition that all work shall be done in accordancewith all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building Official
.
Est. Value ' Y l0, IX0O
Ly
Receipt #
Date
f ,??2
t9 . i
OFFICE USE ONLY ?
On Ske Sewage _ Occupancy
MWCC System _ Zoning ? t
On Site Well (Actuap Const vi1
Ciry Water ? (Allowable) VIi
PRV Required of Stories :
Booster Pump _ Length Sl
?r? • 3 ?
Depth
S.F. Total j
Footprint S.F. ?
APPROVALS FEES
Engc/Assess. Permit " 533.50
Planner _ Surcharge 55.00
Council PlanReview 266.75
BIdg.OB. SAC,City tM•00
Variance SAC,MWCC 515.00
WaterConn. 525.00
WaterMeter 67•11DO
Road Unit _10,0(o
Treatment P1 i?Q•?
Parks
TOTAL %'.557.?:
• CASH RECEIPT
CITY OF EAGAN
3830 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE 19
RLC EI V ED
F110M
AMOUNT Q 7
R OOLLAR6
1 oo
F? CASH ??-OCHECK
t
FOR
Y ^? ? Y-z/ w t /, -y+-,j.•"7ti CA
FUND CODE AMOUNT
I •)
Thank You
BY h-
1 96;3 t
Whita-PaVera Copy
Yellow-Posting CoPY
Pink-File Copy
rPtLDG. PERMIT N0. I?
01-3210 ? Bldg. Permit
01-3422 Plan Check
01-3445 Surch./Adm.
01-3446 SAC/Adm.
01-2155 Surcharge
17-3860 Road Unit
20-2275 SAC
20-3865 Water Conn.
20-3868 Water Trmt. _
20-3716 Water Meter
20-2252 Acct. Dep. _
20-3713 Water Permit
20-3743 Sewer Permit
79-3866 Sewer Conn.
11-3855 Park Ded.
TOTAL
"11U1")
_ 1,-
,??, f--j `, 7
???
CASH RECEIPT
.
CITY OF EAGAN
3830 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
?
, DATE 19?
ncceIveo FROM L r
AMOUNT $
& DOLLARS
I oo
E] CASH ? CMECK
FOR
ll
BY . <_-!
. 7 White-PaYers CoPY
Yellow-Posting Copy
Pink-file Copy
Thank You
CITY OF EAGAN Permft No: Date:
3830 Pllot Knob Road B/P No:
Date:
!
P.O. Box 2ulog "
Eagan, MN;5127
Owner. 1' •? ?' i i?
-
SiteAddress:
Plumber. ._`3 1 z c<
MWCC: .
, City Chg:
' Acct Dec
Permit Fee: ` . •` <
Surcharge:
' Misc.:
i
Zoning•
No. of Units:
I agrse to comply with the CRy of Eayan
Ordinances.
ey
SEWER SERVICE PERMIT ?
1
n?
CITY OF EAGAN Permit No: Date: 7
3630 Pilot Knob'Road Meter No: Size:
P.O. Box 27199 ? Reader No: Date: ,
Eagan, MN.6.,121
Owner. '-c':ul leiil;'nselle
Sifn AiiAreo.• G 1 i4 Tantt? T nnn T 1/. 41. r......?«.. 7..1 7....
Conn. Chg: 5. 00Pd Zoning:
Acct. Dep: ` 7-S.OOpci No. of Units: 1
Permit Fee: 10. C'Jpe
Surcharge: •50p4d I agree to comply wlth the City ot Eagan
Tr. Plant i `0 • fl aPi: Ordinances.
By
WATER SERVICE PERMIT
`i
CITY OF EAGAN Permit No: ? Date: ??
3830 Plbt Knob Road Meter No: D , ? Size: ?
P.O. Box 27199 Reader No: GDate: a-?-
Eagan, MN 55127
Owner. `?cr:nllen/ *tna -11 P
Site Address: 4154 1 nn Prn T asa Lfi4 T4 (' ttn y T'ol low
Plumber.
Conn. Chg:
• 1
t'
?
?
?
Acct. Dep: iS.l;U;ac , .. ,
1
1
?
•? ?ijr(?I?g C2l
?}?
??
PermitFee: _it,i;i?l? ,.
.
?;LQ„i-EL C
Surcharge: • S'?'?? I y with ths Clry ol Eagan
Tr. Plant_ lP()• O Or in` nces.
Meter. F Z c)11pd
Misc.: p&V ^7r ? r gy
WATER SERVICE PERMIT
This requesl void
1 B nwn ths ifom //a d ?/t-j?-/
D 7 6 8 3 0 t_ i4 r? ?(il':!A
Request Uate
s Fir No. Rough-i nspeclion
Requirec??/
?eaAy Now Q Wil I Notify InsDec-
_
? ves? ?No [or When Ready
10?Licensed Electrical ConVactor I hereby request inspaction of above
? Owner elec<rical work installed at:
Street Address, Box or Route No. City
? Al
ec ion o. T wnship Name or No. Range o. County-?
?
OccuVant (PflINT) ? Phone No.
Sf
I
? ?
CL
. ? rj
-
s
?
Po Supplier AddresS
JC ???C
P
Elect I Contractor (Compan NameI
I
? Co tractor's License No.
ag??
v r/cc
MailinB Address (Contrac[or r Owner Making Installati n)
f
'
? C
o?,?
f
l,
.41
Authorize ignature ( ontra tor?Ow er Making Installatii?n) hone Number
d ' /
MINNESOTA E BOARD OP ELECTRICITY // THIS INSPECTION REQUEST WILL NOT
Griggs-Midw Bldg. - Noom N.197 v BE ACCEP7ED BV THE STqTE BOAND
1821 Universitv Ave., St. Paul. MN 55104 UNLESS PROPER INSPECTION FEE IS
Phone(672)642-0800 ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTlON es-oooot-os
I, See iastructions for compleiing this lorm on back of yeilDw Copy. ?G5 ,?
?" ? 6830 "x" Below Work Covered by This Request
AAd flett. Type al Building Appl{flnCa! Wifed Equiplnenl Wi/ed
Home Range Temporary Service
Duplex Water Heater Llghtiny Fixtures
Apt. Buildfng Dryer Electrie Heatin
Commercial Bldg. Fumace Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tank
Faffl'1 Oiher peci y Other (Speri(yl
t ni uecify Other Oihcr
Comoute lnsoeciron Fee Below
p Fee ServiceEntranceSize H Fea Fanders/Su6feedere # Fee Circuits
0 to 200 Am s 0 to 30 Am s 0 to 30 Am s
A6ove 200 Amps 31 to 100 Amps " 31 to 100 A s
Swimming Pool Above 100_Amps Above 100_Am s
TransPormerg Irrigation Booms Partial-"Other Fee
Signs Specfal tnspection. S _^^?
TOTAL E
l
qertmrks
a
? tA_0
1
w s w I ir
?
•in
RouBh
?^ Date I, the E tric
-
q
_
?
«?
/' /??.y
Ins ector, herebY
P
certifY that the above
Fina?
?
??f ?'J!? '° ?''?e c.
3i?? inspec6on hes 6een
?de
:?
_ . p
,.
.
This reQUest void 18 montns trom
CITY OF EAGAN N°_ 14 3 7 2
3830 Pilot Knob Road, P.O. Box 21 •199, Eagan, MN 55121 . ' PHONE:454-8100 --1 3--j14?/
BUILDING PERMIT Receipt # /
To be used for 3F nWG/GAR Est. Value $110, 000 Date NOVEMBER 2 19 87
Site
LANTERN LN
Lot 14 Block 4 Sec/Sub
Parcel No.
COUNTRY HOLLOW
¢ Name MCM[iLLEN/MOSELLE
z Address 430 INDUSTRIAL BLVD
o City MPLS phone 378-3981
¢IName SAME
0
0 Q Address
P City Phone
? W Name
?W
_ z. Address
Q W City Phone
I hereby acknowledge that I ave read this application and state that the
informaYion is correct a gree to cp mply wJit?.all ap e State of
Minnesota Statutes an Ci of EagaOr na ?
ci,, .,.f...o..roe.?.?r?ao A_- l???n
on [ne express conamon tnat au worK snan be aone in accoraanCe wrtn ail
applicable Staie of Min so tatutes and Ci f Eag n Ordinances.
Building Official /
-- 15?
OFFICE USE ONLY
On Site Sewage _ Occupancy R3
MWCC System X Zoning R1
On Site Well (Actual) Const Vn
City Water X (Allowable) Vn
PRV Required X # of Stbries
Booster Pump _ Length 52
36.3
Depth
S.F. Total
Footprint S.F.
APPROVALS FEES
? 533.50
Engr./Assess. Permit
Planner Surcharge 55.00
Council Plan Review 266.75
Bldg. Off. SAC, City 100.00
variance SAC, MWCC 525.00
water Conn. 525.00
waterMeter 67.00
Road Unit _-3-Q5s00
Treatment P1 180.00
Parks
TOTAL $2,557.25
-----------------,
96!'-?k*
Permit
I
Permit Fee: ?L - v I
Date Received:
Staff:
__ _J
2008 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: 5/3p Site Address: -l I S"A L" +trn L4rli, •
Tenant:
Suite #:
RESIDENT/OWNER Name: ? fNijind Phone: -ls?) 10 COI I
'
'
S)d
&
Address / City / Zip: ?
t
C.f
l
A
CONTRACTOR Name: . 1 License #: (-?.Q ? sa25
?
V
k
&
?
A
Address• a5
c.?i1,
-P
y
City: 3tcAa,V\ State: fflIV Zip:s??Ssq
Phone: ID IQ 9L00""1 I (_)9 Contact Person: QS
TYPE OF WORK ? New _ Replacement _ Repair _ Rebuild _ Modify Space _ Work in R.O.W.
Descri tion of work:
PERMIT TYPE RESIDENTIAL
Water Heater _ Water Softener
V Lawn Irrigation _ Add Plumbing Fixtures
(_ RPZ /?[ PVB) Main _ Lower Levei)
/-
Septic System _ Water Turnaround
New
Abandonment
RESlDENT/AL FEES:
$50.50 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $.50 State Surcharge)
$30.50 Lawn Irrigation (includes $.50 State Surcharge)
$50.50 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround` (includes $.50 State Surcharge)
'Water Turnaround (add $136.00 if a 5/8" meter is required) D[E r ?
?J
$100.50 Septic System P ew ($10.00 per as built) (includes County fee and $.50 State Surcharge)
?
JIJN Q 5 2008
$90.50 Fire Repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge)
TOTAL FEES $
F6R OFFICE USE
S
Hequired Inspections ?
??? Untler Ground ?Rough in ?h??- Test ? Gas?Test?4
v a ?
r ?..,il? ' ? c3T? tP?:dli. I?P R ..?i -e.
I hereby acknowletlge that this infarmation is complete and accurate; that the work will be in conformance with the oralnances ana coaes or me ary or
Eagan; that I understand this is not a permit, but only an application for a permit, and work i t to start ithout a permit; ihat lhe work will be in
accordance with ihe approved plan in ihe case of work which requires a review and approval o I s.
x J X
AppiicanYs Printed Name A ca ' Signature
2004 RESIDENTIAL BUILDING PERMIT APPLICATION
? City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
?- 1 a-? .L;?b
C o?cfl I ?' ??" c5?
New Construdion Reouiremenis Remodel/Repair Reouirements Offr6g Ae?fil?
Y N
3 registered site suroeys showing sq. ft. of lot, sq. K. oF house; and all roofed areas 2 copies of plan '
(20% mauimum lot coverage allowed) 1 set of Energy Calculations for heated additions
k ?t0e Pces Plan Reod „
Treet?res?uit?i 1
1?
2 copies of plan showing beam &window sizes; poured found design, ete. s
t site survey for a?tions & dec
t
i stem
M $epfie?
Da- 13
Y
1 set of Energy Calculations em
c sys
AddAion - indicate if on-sfle sept y
s ,:.
3 copies of Tree Preseroation Plan if loi plaKed aHer 711193
Rim Joist Detail Options selecfion sheet (bldgs with 3 or less units
Date lb
Site Address
y
/ 5y 441J Construction Cost z/ UUC) _ Oc9
Le4etJ /J Ua,t/ste #
Description of Work ??R C&
Multi-Family Sldg _ Y ? Fireplace(s) 2
Property Owner / U M A, tl CX Telephone #( 6 5)
Contractor ?[f+ c,(e CcsKJf??4e{-r.,y? ?n/c_ 2,T?.1 Q. t<A Lc0?/
Address 5
State rn 57.5- Z Z f44
?V AwC. J N12? City Lt N cvvrre-? ,
Zip SS Oo S Telephone #(6?T/) <-/ 6 2- gc?i I.J
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Mumesota Rules 7670 CateQOrv 1 _ Minnesota Rules 7672
Energy Code Category • Residential Ventllation Category 1 Worksheet • New Energy Code Worksheet
(,I submission type) Submitted Submitted
• Energy Envelope Calculations Submitted
Have you previously constructed a building in Eagan v
fee applies. ?} T "
Licensed Plumber R ? 1,
Mechanical Contractor 1
a similar plan? _ Y _ N If so, 2517o plan review
Telephone # (
Telephone #(
Sewer/Water Contractor
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 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.
! 10 ? ? - w ? ?- ?o yG - ZA?
Applicant's Printed Name Applicant's Si ature
OFFICE USE ONLY
Sub Types
a
? 01 Foundation ? 07 05-plex O 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? OB 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck X 23 Porch (screenlgazebo) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex 0 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex plbg_Y or_ N? 25 Miscellaneous
Work Types
? 31 New ? 35 int Improvement ? 38 Demolish Interior ? 44 Siding
y 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteration ? 37 Demolish Building' ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement •Demolition (Entire Bldg) - G ive PCA handout to applicant
Valuation C.9 0 Occupancy MCES System
Census Code Zoning Cfty Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const Width
_ Footings (new bldg)
Footings (deck)
? Footings(addition)
Foundation
Drain Tile
Roof Ice & Water Final
? Frazning -
_ Fireplace _ R.I. _ Air Test _ Final
Insulation
REQUIRED INSPECTION5
FinaUC.O.
? FinallNo C.O.
_ Plumbing
HVAC
Other
_ Pool _ Ftgs _ Air/Gas Tests Final
_ Siding _ Stucco _ Stone _ Brick
_ Windows
_ Retaining Wall
Approved By: 17 i , Buiiding inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies ?.?
Other
Total
l ??-
= s???
:.F- CERTIFICATE OF SURVEY
KURTH SURVEYING INC.
/ TMA7 TMIS SURVEY, PLAN, OR REPORT WAS PREPANEO 4002 JEFFERSOH STREET N.E. -
MYOIHECT SUPERV141OlL HorHnr i AM A ouLr COLUMBIA MEIGHTS MINNESOTA 55421
iD SU V OR ND R TME L S OF T STATE OF MINNESOTp, 612-780-9769
- oare
REGI TION N0. )?t13 ' PROPOSEO SCaLE I
QRAOES ???RON MONUMENT FD,
BEARING$ ARE ON AN
ASSUMED DA7UM
GARAGE SLAB • 8a?, •C) •a"60 D SPIKE SET
TOP OF BLOCK¦ $POT ELEVATION
BASEMEMTFLOOR• 8??•?'?' ? )'PROPOSEp ELEV.
--! • DRAINAfiE ARROW
\
ao,
?/ \R?? ?> . ?o •.
cp / \`47
? } .O.
., za p
\Y.
\ ?/
Oy ? 22 s ? 4,?
kO
?8 8 ^?
<
,
`°
X? o ? •y ? ,/, 2g.
\
?
'?2
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,?J
k--0 ?-% 14) ?C?K 1 A) C001-LT?C ?J?L:aW , bAKo`rA C.OVt1T?l.Miratur_<-.r,-rx
4 .
1
?
E /C/3 ?401WAW4
1987 BIIILDING PERMIT APPLICATION - CITY OF EAGAN
SINGLE FAMILY DWELLINGS ,
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEYt 1 SET OF ENERGY CALCQI.ATIONS
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MQST DESIGNATE WHICH ADDRESS
IS DESIRED. NO CHANGES WILL BE 9LLOWED ONCS BIIILDING PERMIT IS ISSDED.
M[1LTIPLE DWELLINGS - RESIDENTIAL RENTAL IINITS FOR SALE i7NITS
INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SQRVEY - CHECK FiITH BLDG. DEPT.p
1 SET OF ENERGY CALCULATIONS
COMMERCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTi7RAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF
ENERGY CALCULATIONS,
$29000 LANDSCAPE BOND
To Be Used For: Valuation: .? Date: ib' iGj -q-7
Site Address I OFF]
Lot _4_ Block Ld On Site Sewage_
MWCC System pl,
Parcel/Sub _ Llab/-./ ?b`jav,/ On Site Well
?- ` (? r City tiAater ?
Owner ? IJ(?U.'6'1 & IJ 1
Address
City/Zip Code
Phone
Contractor C,liwl,l MNWL
Address ui
City/Zip Code
Phone
Areh./Engr.
Address
City/Zip Code
Phone #
APPROVALS
Assessments
Water/Sewer
Police
Fire
Engr
Planner
Council
Bldg Off ?0 20
APC
Variance
Occupancy R'3
Zoning R -,
Type of Const
(Actual) V- M
(Allowable) V-N
dk of Stories
Length S Z•a01
Depth 3C. 33'
S.F. Total
Footprint S.F.
FEES
Permit 533. SO
Surcharge SS,oo
Plan Review 2 6(0,
SAC, City / 00 , pb
SAC, MWCC 52 r OU
Water Conn 2 1C?O
Water Meter
p
67,0
Road Unit 0 0 O
Treatment P1 ?Oq
Parks
Copies
TOT9L ??Z<
\1
..---?-----
ZZK 22= ?1 FsyXiZ. = 5`ad6
i35mt ? FtkST°rLoojk
14X22 = 35z
3v K 780
1t32
ZND FLoaPQ.
?..
x SS ?- 65 65CO
30 x zq = e?o xyy ? 36
2.so--..
la? ?u?1
,
,
' CERTIFICATE OF SURVEY
FOR -RCMULLEM - MOSGI_1._C KURTH SURVEYING INC.
IM6REBY CERTIPY TNAT TM19 SUqVEY,PLAN,OR REPORT WAS PNEPAREO 4002 JEFFERSON STREET N.E. BYME OH UNDER MYDIRECT SUPERVI3101L NorHnT i AM A ouLv COLUMBIA MEIGMTS MINNESOTA 33421
p D LAND S V OR , ND p THE L S OFT q STATE OF MINNESOTA. 612-788-9789 OATE ?-1T-?,
.J
' PROPOSEO SCALE 1'??
MINNESOTA REGI TION NO. )(n173 ' O-IRONMONUMENT F:D,
ORAOES 6EARINai ARE ON AN
ASSUMED DATUM
GARAGE SLAB ¦ 8??'O •• 60 D 8PIKE SET
TOP OF BIOCK• 8??•`?' (-)' $POT ELEVATION
BASEMENTF600R• PROPOSEp ELEV..
-!¦ GRAINA6E ARROW
\
S
cp
ot
o
\? ? ? .
o,. /
b
(p ? s J
o
\ \rA,? •o ?? ^l? `?;Z?
`J,( . 3° • `? ?
?8•?,, (\i? ?,? ? _ z?y? p vI
es v ?
?9•6,
,
(V ?
?,_O'T ?LI? PJLQGK 'L?? COUt?I ???`C ?"?rJ?L:?W ? bA?kO`S'A? ?t?1?lT?! ?N`?NMCSO'CA
0
• ?1"Sl -5?8
. CITY OF BUILDING DEPARTC-IENT
E}CTERIOR ENVII,OPE AVERAGE "U ll C0I4PUTATION
(To be submitted ivlth building perrait application)
Il
One or Two Family Dwelling Owner f 1?ZntiC?
All Other
Contractor -::5-1_ C-v\w-l ES VVnroE=5
Site Address
Date Phone
LINEAL FEET OF it
EXPOSED PJALL a11 pV f--?T f t. above $rade cn(n
TOTAL EX1'OSED 1VALL AREA SQ. FT.
OPAQUE WALL CONSTRUCTION: "Ull Value x Area
netaii - FQ.a"I,uII .(:)-1?:3 x sq.
reference IIUII °x SR•
from "" O x SQ.
attached flUit x SQ.
sheets "U" x SQ.
nUn x SQ.
WINDOWS: "Ull Value x Area
FT. 7__ .IC • `aj.IZ (U)(A)
FT. IiZ ?C9= IS.-)(o(U)(A)
FT. I-?9-4Z4 - i,69,(U)(A)
FT. _ (U) (4)
b'T. - (U) (A)
FT. _ (U)(A)
Make & TYPe I?MT nUn x SQ. „--
n a ??Uu - UCo FT._21?- . ; _ .Co-1 (U) ?A)
n u nUn x 3Q. FT. - ?U)?A)
n u x SQ. FT. _ (U)(A)
nUn x SQ. FT. - M(A)
DOORS: "U" Value x Area
idalce & Type n
Un - I4 x SQ. FT. 9u-C? _'S. ??U)?A)
u u 1?AT1(-) nUli •?-I
u n x SR. (U)(A)
nUn X SQ• FT. = (U)(A)
n n
_ IiUII x SQ. FT. _ M(A)
ToTALS Z?orn?i-(o(n SQ. r'T._ ZSI12-49 (U) (A)
AVERA(3E "U"
TOTAL (U)(A) VALUES
DIVIDED BY TOTAL tiVALL
= .lo
AREA z(J4A-CsCp.
AVERA(3E 'lUll ,?t5 r less for 1&2 family dwellings
ROOF/CEILIN(i :
TOTAL AREA: I
Detail reference 'iUll - cz-1 x SQ. FT. 1-7?;5 = Zy -?q (U) (A)
from
attached sheeta. nUII
iiUil x SQ. FT. _ (U) (A)
Describe openings
IlUll x SQ.
x SQ. FT. - (U)(A)
FT. - (U)(A)
in roof. '?U?? x SQ. FT. _ (p)(p)
TOTAL (U) (A) VALUES DIVIDED BY zc{ -?? Tort?LS JJU2L- 54,? Z.4- -4 CUfA>
?
'
TOTAL ROOF/CEILIN4 AREA I ???1 _UZI
At/ERA(3E 'lUll .025?f r ventilated roofs.
• • •
?.?--
.. •
?
--=------__ -
? A?A?? ----
-------
-
-- --- - ---
. ?--,
` -
= ZCoCsA- CQcp -?
-
-
------- ----- - .
- - - __..._ -
-
?-__?_?-.?
---- -_ - .- ---=----------- ------------ --_.?o?s cr...?.-ArrF-,%..
------- M-------------------- =--------- -------?SS_...CorJ? _ _ IIZ-5Cv___
---
" -
. - --=-----.__..---- ,
---__--------
-------- --- C.?a..a > ZI'?=5 _.. --- --
-?-?_-
. .
-
?
-
..
-.
_-
-----
--?-=-- -wx 4-8. _-- ? `?? Q ?? !--? _ __IS.o---- - ---- -----_--- ------ . _-
T
._-
I
--------
7N
Zl x?_12)
__._.._
-- ____ _ -- ?--- - ---- ----- ___..------T?_ Zi?! -5-= -------___ _----------------- ---- -
-- -- _?__-----
?-.----
---
-- -- ----- -_??I-O._?'..--- --- -- ------------------------------------.
. .. .
---- - OF .
-------
--
---- ---- ----------------
.. so? t ??C? = I I?PS O
' - . • --Y7ALL SECTION-- •
,
Determining "Ull values at Roofi Wall, Rim, and Conc. Block
R00
1.)
2.)
3.)
4.)
5.)
F/CEILIN4
Interior Air Film
5/811 ayP. Bd.
Insulation
Exterior Air Film
(STILL)
R VALUE
0.61
.56
qq.oo
.61
uUu = i/R= .07.1 'POTAL (R)=
N»L (R VALUE
6.) Interidr Air Film 0.68
7.) 1" GYp. Bd. .45
8.) Insulation 0_00
9.) 'KnL7w-1YC
?
10.) [?lasonite Siding z67
11.) Exterior Air Film 017
IIpn n 1/R= .(A3 TOTAL (R)_ 73LA
?--
RIM R VALUE
12.) Interior Air Film 0.68
130 Insulatiott 14.00
14.) 211 Fir Rim.Joist 1,$$
150 13ott;r1z,Tc- Z.M
16.) Masonite Siding .67
170 Exterior Air Film o7
uUll _ 1/R= OqU TOTAL (R)= l11.fjtI
FOUPJDATION ' R VALUE
18.) Interior'Air Film 0.68
19.) '
20.) Q%C,iD I&1SVL
21.) 12" Concrete Block . 1.28
22.) .
23.) Exterior Air Film .17
iIUn
TOTAL (R)= 7 13
-? `'CfTY OF EAGAN FERMIT
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
PERMIT TYPE: B U T L D T N G
Permit Number: 0 3 2 2 3 8
Date Issued: 8 6/ 12 / 9$
SITE ADDRESS:
P.I.N.: 10--18275-140-04
4154 LANTERN LANE
LOT: 14 BLQCKs 4
COUNTRY HOLLOW
DESCRIPTION:
STORM DAMAGE
AL7ERATION
434 AL7. RESIDENTIAL
r
a' 0
1
3 € t
REMARKS:
FEE SUMMARY:
CONTRACTOR: -
TWIN CITY ROOFING
2301 WOODBRTDGE
ROSEVILLE MN
(612) 636-9640
Applicant - ST. LIC
16369640 2002094
ST
55113
OWNER:
BLRND TDM
4154 LANTERN LANE
EAGAN MN
(612)683-9614
SZI* 1998 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
3830 PII.OT KNOB RD - 66122
681-4676
New Construction Reauirements RemodeVReoair Requirements
? 3 registered site surveys
? 2 wpies of plans (inGude beam & window s¢es; poured fid. design; etc.)
? 1 energy calwlations
? 3 copies of tree preservation plan if lot platted after 7/7/93
required: _ Yes _ No
DATE: JAP
DESCRIPTION OF WORK: ?
STREET ADDRESS: 7??7
(,CO7: ("I BLOCK: 0 SUBD./P.I.D.
? 2 copies of plan
? 2 sfte surveys (eMerior additions 8 dedcs)
? t energy calculations for heated addkions
CONSTRUCTION COST; ?
,
.
Name: Phone #: 6 8 3 ^
PROPERTY Last First
oWNER
Street Address:
City ?itq??? State: Zip:
Company: W Phone #: ?D 36 -Z6 ?16
CONTRACTOR
Street Address: a30/ GJWbQ e-jbo-& S' License # aoZ)a o9 y 3
City ?US? ?i??? State: Zip: 5 Sy ??
ARCHITECT/
ENGINEER Company: Phone #:
Name: Registration #:
Street Address:
City State: Zip:
Sewer 8 water licensed plumber (new construction only): . Penalty applies when address chang
and iot change is requested once permit is issued.
I hereby acknowledge that I have read this application and state that the infortnation is coRect and agree to comply with all applicabl
State of Minnesota Statutes and City of Eagan Ordinances.
5ignature of
N/ OFFICE USE ONLY
Certificates of Survey Received Yes _ No
Tree Preservation Plan Received _ Yes _ No - Not Required
OFFICE USE ONLY
IBUILDING PERMIT TYPE
? 01 Foundation ? 06 Duplex
? 02 SF Dwelling ? 07 4-plex
? 03 SF Addition O 08 8-plex
0 04 SF Porch ? 09 12-plex
? 05 SF Misc. ? 10 = plex
? 11 Apt./Lodging ?
? 12 Multi Repair/Rem. 0
? 13 Garage/Accessory ?
? 14 Fireplace ?
? 15 Deck
+? ° ..
?
. ,,?,?i , •
16 Basement Finish
17 Swim Pool
20 Public Facility
21 Miscellaneous
WORK TYPE
? 31 New ? 33 Alterations
? 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
Surcharge
Plan Review
License
MCNVS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
SNV Permit
SlVV Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies _
Total:
Valuation: $
% SAC
SAC Units
r
r? RESIDENTIAL
BUILDING PERMIT APPLICATION ! aa'
CITY OF EAGAN '
3830 PILOT KNOB RD, EACAN MN 55122
651-681-4675
NewConstruction Requirements
• 3 registered site surveys showing sq. R. of lot, sq. ft. oi house; and all roofed areas
(20% maximum lot coverage atlowed)
• 2 copies of plan showing beam & window sizes; poured found design, etc.)
. 1 set oi Energy Calculations
• 3 copies of Tree Preservation Plan'rf lot platted after 711193
• Rim Joisf Detail Options selection sheet (bldgs with 3 or less units)
DATE IS•'n?J-0a
RemodellReuair Reauirements
• 2 copies of plan
• 1 set of Energy Calculations for heated additlons
• 1 site survey (or exterior additions & decks
. Indicate if home served by septic system for additions
1?
VALUATION (4, 03 O?
SITE ADDRESS MULTI-FAMILY BLDG _ Y _ N
r.. . ., - ?- •
TYPE OF
APPLICANT
STREET ADDRESS
TEIEPHONE #
? -- ----
FIREPLACE(S) _ 0 _ 1 _ 2
f-i) .
STATE ZIP
IFAX #
- Renewal By Andersen, Inc.
I 1920 Counry Rd. "C" West
i Roseville, MN 55113
CEI 651-264-4777
License # 20130983
PROPERTY OWNER 71;m n CsA TELEPHONE # COSI •I65- I(Will
COMPLETE FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNESO'1'A RULF,S 7670 CATI;GORY 1 MINNESOTA RULE:S 7672
(q submission [ype) • Residential Ventilation Category 1 Worksheet Submitted • New Energy Code Worksheet Submitted
• Energy Envelope Calculations Submitted
?.._.,__... .
_, .,.. ?
?
("i Plumbing Contractor: Plione
Plumbing systern includes: Water Sofiener Lawn Sprinl6er ??'V ? 2?Fee: 1$90.00
a
Water Heater No. of R.I. tr
ths No. of Badis
?r I
Mechanical Contractor: Phone #
Mechanical systcm includcs: Air Conditioning Fee: $70.00
Heat Recovery System
Sewer/Water Contractor: Phone #
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply
with all applicable State of Minnesota Statutes and City of Eagan dinance .
Slgnature of Applicant
--------------------------------------------------------------------------------
OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4/02
vvi ? 1 i ivvi L1LV • •Y
?<. ov rnn r ov1 al l'44a0 1WL71f11AL B?` htVUlSK?lSPI rC al .. ..?,,. . ." „ .
. .;,
_ runo ?AOy " CuY of Eagan .
3836 Pilot gaob Roed -
Eagpw 1Vn+t 5s122 To Whom It Maq conoern: ,
Etder Jones is Iorized to ptlI buiIftg pmnitsfbrg=ewal
Bldcr )ones to pmyidc this servicc for ns in bY Andaisan. picase s&,w
EaW
. datc bcyond 616101; until a?'oaawal by AndGrsen ??is multociza6on i4 valid For any
Lo the City_ mmium eqnusly cevokes it fn wrlcfng
I rcqueat this authozxzation be acceptea-axpedidously. av to not detay in the protmft g of
ovr buildinS P=nita auy fuzdtcr. Elcaac call mc lf thc.tG at+a emy qnearlona.. I caa be
? vontacte?l at 763-507: 4746. .
. ,.
< ., .
Your icnmpdiaAo attcntion to ffiis mattcx is
sirx&*.Iy,
vnd R Rau
eistallation M.anagor
Ronawal by A,ndascn CarPoration
4 U .,k
?
G - 7--,-tov/
"'Ak n,zoos
,
.
em uw
.,
Received Time Jun. 7. I10IPN
APFLICATION FOR PERMIT
SEWER AND/OR WATER CONNECTIQN
? NM: PASMdf OF FFy AT TIME OF y*,
; ArrLIcazz0N noEs rxrr cM- *
* STI1[71E APPAOVAL oF PERNUT.
* IIZSPDCPIOPI CP SEWPR AW/M M'lIIt *.
; irsrnttMONs waa. rnr aE scEXi.Fn ?
; cmnzi. rERruT xAS Bmv r,ePaovm. ;
-dtV •et:+ei**txtf:y*?**w?+tt+x*,e:f?xi#+tf+.
oF eagan
(PLEASE PRINT
i) PROPERTY ADDRESS: L A/:
T.FYGA7. DESC'I2IPTION;.
I,ot B oc S vision or Tax Parcel ID
IF EXISTING STRC?CRq)RE, DATE OF ORIGINAL BUILDING PERMIT ISSLANCE:
Nbnt Year -
PRESENT ZONING/PROPOSID LSE:
Q _COMMERCIAL/RETAIL/OFFICE
Q INDT-ISTRIAL
Q, INSTITUTIONAL/G0VERNMENT
? R-1 SINGLE FAMILY
[=] R-2 DL?PLEX (3tao Units)
? R-3 TOWNHOUSE (Three.+;Uraits)
Q R-4 APARTMETPP/CONIDOMINIUM
( Lnits)
( C?nits )
2) NANIE= PE7'?S Li J4TE2 ,? Sf;z:,ln /r-p- I Il ?
ADoxEss: Z Ip7 VA/ r-- A. 1/- kl,
CITY. STATE. 2IP: M 0=;jS- MO
PHONE: '7FL ? - k?2 ?S4-1
3) :?• rrArE:
ADDRESS:
-2
CITY, STATE, ZIP: ?? OJ`? ? llI ?S? ??
PHONE: r52,,-? :" JS MASTER LICENSE #??
4) • 01 t M976M•
ADDRESS:
CITY, STATE, ZIP:
PHONE:
5)
ff;;jCONNDCTION TO CITY SEWER P;j CONNECTION TO CITY WATEFt DOTfER
? _...
6)
For City Lse
?1 ers I,icense:
( Active
Expired
Not recorded
St Initia
***********************************?**************************************************************?
*
* TfE GOID COPY OF THE PII2NIIT WILL BE SENlP DIRDLTLY TO PUBLIC WORKS TO FACILITATE METER PIQC-UP. *
* PLEASE ALLAW 4W0 WORKIM DAYS FOR PROCFSSING. SOMONE FROM TfIS CITY WILL CANPACT Y(xJ IF TEIERE *
* ARE ANY PROBT.,F.MS. x
?**************************************************************************************************?
FOR CITY USE ONLY
PERMIT # ISSUED
Pd w/Bldg. Permit
$ $
$ $
FEES:
ro - s?
:
$ ? /e Grv $
$ $
$ $
$ $
$ $
s $
$ $
S $
$ $
$ $
$ $
S ? I'0 O- ? S
$ $
SEWER PERMIT (INCLUDE SURCHARGE)
WATER PERMIT (INCLUDE SL'RCHARGE)
WATER METER/COPPERHORN/OC'TSIDE READER
WATER TAP (INCLLDE CORPORATION STOP)
SEWER TAP
ACCOUNT DEPOSIT - SEWER
ACCOC'NT DEPOSIT - WATER
WAC
SAC
TRUNK WATER ASSESSMENT
TRLNK SEWER ASSESSMENT
LATERAL BENEFIT/TRLIVK SEWER
LATERAL BENEFIT/TRONK WATER
WATER TREATMENT PLANT SURCHARGE
OTHER:
$ ?.`? fc 7 ?d U TOTAL
?2e-7 q7 7
RECEIPT RECEIPT
DOES UTILITY CONNECTION REQLIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
F--j YES `IF YES, THEN A"PERMIT FOR WORK bVITH2N PUBLIC
Q
ROADWAY" MqST BE ISSUED BY THE E[VGINEERING
NO DIVISION. LIST AS A CONDITION.
SUBJECT TO THE FOLLOWING CONDITIONS:
APPROVED BY:
TITLE:
DATE:
li ? . ? i{
*kcSk1K*X(A?*?k?ak wsKW?7??K:{'?Y,t?;NG?K??t?C?k?*%R?C:K- At??k?'??;;?+? .
?I CI7'Y OF' E6tGAk T H
CF??FiLE'Ft: .lS Tl•";F:MINAl, NOs 032
'
bATEe iQl06l93 T:CMk:; 12
i ,45:04 '
.
.
hipryOF? AI-l_IFV t"7:Rf..S:iTsE7 :LNCe . ?
4 .
9001 4154 LPiTERiV L:N EU>ap
YL1U 4•1.54 LAP2`CE!";N Li'!,
.
J
.
7b. ?Fa1 tENqr:.>j( a$,Amounte
,
'£FKii.7807 -
?
n
PE!?.?:4;Ta- lAP!
i}
. : ?
?
„- ?y?y.y yr?{ryy?y?yJI?y?ya1?ayyy?jr?yJ?ryWy?y?y?y?t..ya??y
?!h?TTT?'ii?T T?.T+T+T /?%I?TR?? F. TTT-1? TT MT•P?CTT?TT ?? ?kkA.
I, . .. . . . , ? .
?
1999 F?REPLACE PERMIT APPLtCATION
CITY OF EAGAN
3830 PILOT KNOB ROAD - 55122
651 681-4675
Date:?r
Description of Work: _ Construct new fireplace _Gas _Masonry _ Alterations to existing
? Install gas insert anlv _ Install gas line on/y
_ Other
Job address: 1-(i( yl te. (/' yi
Lot: Biock: ? Subdivision/P.LD. #: ? b
Applicant (circle one only): Owner Contractor Pern:it Fee: $60.50
-117 ?, 3 -- 9?j?/
IvTame: ? LG ri (L ( U ? Phone #: '"' ?
PROPERTY Last First
OWNER C_ I?
Street Address: a im ?
City ru V? U h State: !' v, Zip: SS 12 3
?/? ,?j?,-v ?J
Company: ? i / ? C p ( i1 )??Phone #: ??_L(L j'
? (area code)
FIREPLACE ?-?
INSTALLER Street Address:
City e (it ? 0 5 State: M, Zip:
Company: Phone #:
(\n ?/1/'?
GAS LINE (azea code)
vL ? ( ?
INSTALLER Street Address:
' City State: Zip:
?
I hereby acknowledge that I have read this application and state that the information is correct and agree to
comply with all applicable State of Minnesota Statutes City of Eagan Ordinances. ?
c
ozz?xj 4. tX-;;
Signahxre
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 16 Fireplace
WORK TYPE
? 31 New ? 33 Alterations ? 39 Gas Line ? 41 Wood Stove
? 32 Addition ? 34 Repair ? 40 Gas Insert
GENERAI, INFORMATION
Census Code 434
SAC Code 01
REMARKS
Chimney/flue must be inspected before concealing.
I
CITY USE ONLY
LOT I l'I BL RECEIPT #:
SUBD. RECEIPT DATE:
?
MECHANICAL PERMIT #
1999 MEciiAncAr. ?ERMrr (REsinENrtAI)
C1TY OF f.Afi}4N
S$SO PIL01' KNOB itD
EAHAN MN 55122
(651) 6$1-4678
Date: *
-=.
Complete this section onlv if you are installing HVAC in a single family dwelling, townhome or condo under
construction and not owner /occupied.
• 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
.50
$
Complete this section onlv if you are remodeling, adding to, or repairing an existing single family dwelling,
townhome, or condo. Please indicate if it is a new item, alteration, or repair.
u New Alteration Repair _ Other
Reminder: Ca11681-4675 for inspections.
Furnace
X Air exchanger
_ Air conditioning
Other
$ 30.00
State Surchazge .50
Minimum Total Due $ 30.50
SITE ADDRESS: 415%A J-lfQ+Fen/ L..rv
OWNER NAME: 1Z17 R4.4,vn PHONE #: - (D 83 - (?31y
(AREA CODE)
INSTALLERNAME: E}pollo jAf,4Tm1C. PHONE #: 6 51 - 770 -OCc03
?- (AREA CODE)
sTREETADnxESS: tp5ia 3? [3z+?a A/
--'\j - -
CITY: ('Auq-L STATE: IYI/1J ZIP: SS/Ze
SIGNATCTRE OF PERMITTEE
MEMO
L iti ay
TO: THOMAS L. HEDGES, CITY ADMINISTRATOR
FROM: THOMAS A. COLBERT, DIRECTOR OF PUBLIC WORKS
DATE: MAY 3, 1996
SUBJECT: SANITARY SEWER BACK-UP - COUNTRY HOLLOW ADDITION
INCIDENT
At approximately 8:15 A.M. on Monday, April 30, 1996, the maintenance division of the
Public Works Department was contacted by various residents within the Country Hollow
Addition reporting sanitary sewer back-up into their homes. Maintenance employees
dispatched to the area discovered that the Country Hollow sanitary sewer lift station
experienced a power failure and the pumps were not working. Dakota Electric was
contacted and City dispatched a portable generator to the site with one pump being
reactivated at approximately 9:23 A.M.. Full power was ultimately restored at 10:13 A.M..
8y Tuesday morning, the City had indications that approximately seven home owners
experienced a sanitary sewer baclc-up irrto their homes to some degree. See attached map
for location of impacted properties.
CAUSE
Preliminary invesstigations indicate that some type of power spike or surge created a"flash
burrY' at one of the connection points of the control fuse for the electrical motors. Such a
power or mechanical failure should not result in a sewer back-up into residential homes as
the City has portable generators and/or auxiliary pumps that can be commissioned to
maintain continuous sawer service. Unfortunately, the sewer back-up resulted from a failure
in the alarm system to notify the City's maintenance of a lift station malfunction allowing it
to respond with corrective action prior to any homes being impacted.
HISTORY
Unfortunately, a similar situation occurred on June 14, 1994. At that time, five homes were
impacted. Similarly, the 1994 sewer baclc-up resulted from an electrical power outage and
the failure of the alarm system to notify City maintenance.
Due to that previous occurrence, the Public Works Department proceeded in 1995 to
repiacs all such unreliable alarm systems with current technology of radio telemetry SCADA
System Ciry wide. Unfortunately, we were approximately 4- 5 weeks away from completing
the conversion of the alarm system at this location when the second power outage/alarm
failure occurred.
CORRECTIVE ACTION
The Public Works Department has contracted with an Electrical Engineer to review the
electrical controls and alarm system to identify any interim measures that can be taken to
increase reliability. The Public Works Department will aiso be accelerating its efforts to
complete the conversion to the new fail-safe alarm system. During the interim, the City will
be inspecting the faciiity three times per week testing all controls and alarm systems helping
to insure reliability.
The City's insurance agent, League of Minnesota City's Insurance Trust "LMCIT" has
already been in contact with all of the known affected home owners helping to process any
claims they may have. Of the seven homes owners, two of them have indicated the back-up
did not result in any damage requiring on-site inspection by the insurance agent.
COMMUNICATIONS
In addition to numerous phone calls and personal visits with affected property owners,
attached is a letter being sent to affected property owners.
As significant additional information becomes available, I will forward it to your attention.
Please let me know if you would like any further action.
Respectfully submitted.
?
Director of Public WarkS ?
TAC/cb
cc: Eugene VanOverbeke, Director of Finance/Risk Manager
Wayne Schwanz, Superintendent of Utilities
Attachment: Letter dated May 2, 1996
List of Affected Properry Owners
Location map
hl.:' b,31 -I-, Nb
95%9?, ?5 13: 08 EAr,Ahi MT;_= ?;al. - C I r'r HALL-Dr,STp5
4 city oF eagan
N0. 995 P901 QC.
TNOMASE6AN
MoyD!
MAY 2, 1996
NtitviL
ADD12E5S
CITY, STATE ZIP
PAiRtGA AWADA
SHAWN NUNTER
SANOf7A A. MASIN
THEOOORE WACMTER
CouncY Mombars
TMOMAS HECGES
CiIV AOrrnnisrrrnor
E. J. VAN OVERBEKE
GIN Gert
RE: FAILURE OF THE COUIvTRY HOLLOW SANITARY LIFT STATIOIV
ON TIJESDAY, APRIL 309 19%
Dear Name:
It is my understanding that your house was involved in flooding from the backup of the city
sanirary sewer system on Apn130, 1996. The cause of the bacicup was a failure of the Ciry of
Eagan's sanitary lift station which 'tncurred a power failure thus preventing the sewage pumps to
function properly. In itseif, such a power failure would not cause a sewer backup as the ciry has
portaUle generators and pumps to mainiain continuous sewer service. Unfortunately, the backup
resu(ted from a Pailure in the alazm system which notifies the City's maintenance division of a
problem al2owing it to respond with corrective action orior to any of the homes being impacted.
Unon receiving the alarm at 3:1 ? a.m., on Apri1 30th, 1996 the Utiliry Division dispatched two
employees to the scene and they arrived on sixe within 10 tninutes of being notified of a flooding
problem of one oi the homes in the area. They immediately requested a backup generacor to be
brought in which was done within an aclditional 15 minutes. At the same time Dakota Eiecuic
was notified chat a possible power failure may be resulting in the transformer which controls the
sanitary lift stanon. Dakota Electric dispa[chcd a auck which arrived within 40 minutes of the
initial call. The emergency crew connected the generator ta the eleca'ical bypass of the sanitary
lift station and the pumps were operating within minutes_ It took approximately 20 minutes to
pump the system down to concrol any flooding that may have been taken place. Un2brtunately
approximately seven homes in the area had experienced a sewer back up to some degree. The
entire situation was corrected and the station was back on line aperating proQerly by 10:13 a.m.
On May 1, 1946 the Utiliry Division contracted with Jensen Eiectric Company to inspect and test
the control panei at the sanitary lifr stauon. As a result of their inspection, no problem was
discovered within the control panel, suggesting possibly what may have happened was a power
spike being created within the power lines which may have damaged a fuse. Although a fuse
was located which showed that ic may have been exposed to exetssive pawer, it was still
operable. The Uqiity Division also traced and verified the operation oF che current alarm system
which has existed at the sratioa. Further invesugation wiil continue to determine what caused the
MIINICIPAI CEkTER
3890 PILOf KNOB ROAO
EAGAN. MWNESOTA 55122 1897
PNONE. (612) 691 4600
FA]C. (61 2) e81.40 i 2
100 (6121 ?Sd•95J5
• THE tOriE Oo.K TREE
TNE $YMBQI OF STRENGiH AND GROWTH iN OUR COMMUNRY
EGuaI UOP0rturnry/A1Brmat1ve i.Ctlon Employer
MAINTENANCF iACIIITY
3501 CC.4CHMAN POINf
EAGAN .N,NNESOTR 55122
iNQNE: ;J1Z) 6911900
:,aX: r0 12) 68 1 4350
'00 ;012! a5d-d5]S
617 ??1 ?1?@0
05,0-?- 95 !a: gg EqGqN raTf=E F=,C - _tT'r" tiaLL-DhiSTRS NO. 995 P902.-CN'.
On June 20, 1994 this lift station experienced a similar problem due to loss of power from
Dakota Elecoric. After revieuring rhis incident the Division investigated alternatives in systern
control and monitoring failure aJarms which lead co the deveiopment of our current SCADA
(5upervisory Control and Data Acquisition) sysiem wkiich is utilized at our Water Treatment
Plants.
In 1995, [he city initiated an aggressive program of replacing controls and alarms in our entit+e
system with the most current technology availabte which has built in redundaace of a failsafe
mechanism. Unfortunately we were approximateiy five weelcs away from complering the
conversion to the new a]arm system wheu the recent pump and alarm failure and sewer backup
occurred. The ciry will make every effort to further accelerate the campleti'on of this alarm
canversion and hape to comQlete the installation and testing within twa to three weeks. We feel
confident that once this new alazm system is activated there should be no further concerns of
similar situatioas occurring in the funue.
In the meantime, the Utility Division has taken further steps to monitor the operaaon af the lift
station. The current alarm system will be tested tluee times weekly and verified as to the sratus
of iu operation. Also, we wiil be adding a light to be ipstalled at the station which will activate
during a high sewage level situa[ion. This light will provide a visible alarm that a problem with
ihe statian is occurring and therefore allowing the city ta be noufied by residents whenever the
light is observed to be on.
We sincerely apologize fQr the inconvenience you have experienced and want to assure you that
the City of Eagan is committed to praviding a safe, dependable and uouble free sanitary sewer
system to meet all of your expectarions. As the work progresses with the new aiarm system, [
will notify yau as to the progress and completion date oi that project.
Tf you have incurred any darnages the Ciry's insurance company will work with your
homeawners insurance company to process any etaims and reimbursement payments. [f yau
have any quesuons regarding processing your claim, please cantact the city's insurance agent,
Nis. Dariene Boise at 215-4077.
Sincerely,
Wayne Schwanz
Superintendent of Utiliries
WSlnab
t•L? ? h??o??w. ? zo
,
COUNTRY HOLLOW SEINER BACK-UP
Residents Affected (Known as of 5-1-96 3:00 P.M.)
PROPERTY OWNEA APRIL 1996
1. Jess Stacy ?
4179 Prairie Ridge Road
686-0770
2. Joe & Kitty Robertson
4179 Countryside Drive
683-0930
3. Ted Peters
4175 Countryside Drive
687-9267
4. Roger Dean Nelson
4177 Countryside Drive
686-0049
5. Don Dickerson
4175 Prairie Ridge Road
456-0744
6. Tom Bland
4154 Lantern Lane
683-9614
7. Mike Smith
4181 Couniryside Drive
452-6357
8. John Willems
611 Autumn Oaks Court
454-0037
9. Joe Giacomini
4180 Prairie Ridge Road
683-0787
?
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JUNE 1994
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¦ _ ,4PR1L96' SEWER ISACKUP
- - ? •- - •,,._I
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 4154 Lantern Lane
Lot: 14 Block: 4 Addition: Country Hollow
PID:10- 18275- 140 -04
Use:
Description:
Sub Type:
Work Type:
Description:
Census Code:
Zoning:
Square Feet: 0
Comments:
Fee Summary:
Valuation: 3,000.00
Contractor:
Renewal Andersen
1920 County Road C West
Roseville MN 55113
(651) 264 -4777
e- Windows/Doors
Windows/Doors-New/Replacement
House
434-
Applicant/Permitee: Signature
PERMIT
City of Eaan
Improvements to the home require smoke detectors in all bedrooms. If altering window openings, call for framing
inspection. Call for final inspection after installation.
Carbon monoxide detectors are required by law in ALL single family homes.
BL - Base Fee $3K
Surcharge - Based on Valuation $3K
Construction Type:
Occupancy:
$88.50
$1.50
Total: $90.00
- Applicant -
Owner:
Thomas M Bland
4154 Lantern Lane
Eagan MN 55123
Permit Type:
Permit Number:
Date Issued:
Permit Category:
0801
9001
I hereby acknowledge that I have read this application and state that the informa
of Minnesota Statutes and City of Eagan Ordinances.
on is correct and agree to comply
h all applicable State
Issued By: Signature
Building
EA090369
07/28/2009
ePermit
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PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA107818
Date Issued:10/29/2012
Permit Category:ePermit
Site Address: 4154 Lantern Lane
Lot:14 Block: 4 Addition: Country Hollow
PID:10-18275-04-140
Use:
Description:
Sub Type:e - Water Heater
Work Type:Replace
Description:Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Kris Oien
3670 Dodd Rd
Eagan, mn 55123
651-365-1340
Valuation: 848.00
Fee Summary:PL - Permit Fee (WS &/or WH)$55.00 0801.4087
Surcharge-Fixed $5.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Thomas M Bland
4154 Lantern Lane
Eagan MN 55123
Champion Plumbing
3670 Dodd Rd., #100
Eagan MN 55123
(651) 365-1340
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA165240
Date Issued:10/23/2020
Permit Category:ePermit
Site Address: 4154 Lantern Lane
Lot:14 Block: 4 Addition: Country Hollow
PID:10-18275-04-140
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:Does not include skylight(s)
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and leave on site.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Valuation: 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 -
Scott B G Hersk
4154 Lantern Ln
Eagan MN 55123
Snap Construction
8200 Humboldt Ave S, Suite 120
Bloomington MN 55431
(612) 333-7627
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA169142
Date Issued:05/17/2021
Permit Category:ePermit
Site Address: 4154 Lantern Lane
Lot:14 Block: 4 Addition: Country Hollow
PID:10-18275-04-140
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 -
Scott B G Hersk
4154 Lantern Ln
Eagan MN 55123
Renewal Andersen
1920 County Road C West
Roseville MN 55113
(641) 264-4088
Applicant/Permitee: Signature Issued By: Signature