4242 Moonstone Dr
Use BLUE or BLACK Ink
r
For Office Use
I f I
Permit#:City of f Ea I Permit Fee: Ina
3830 Pilot Knob Road _a I
Eagan MN 55122 I Date Received: I
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 L Staff: - - - -
----_I
2010 RESIDENT(I)AL PLUMBING PERMIT APPLICATION
Date: SO i ~3' Site Address: "i Z U Z~ f ~f (1U3~ 5~ 0
Tenant: Suite M
RESIDENT / OWNER Name: (-~hr L c t Phone:
Address / City / Zip:
CONTRACTOR Name: lb-d- YA h /1 fa t License
j -cam
Address: ) 7 S l ~l C~K1'y! City: ;.i.t ecy-ee_
State: /00 Zip: 65179 Phone: 70'6 92-7-,5-
(V t t
Contact: jT^ on Email: %K•C ~y 60
G() ~U!»
TYPE OF WORK _ New T Replacement _ Repair - Rebuild Modify Space - Work in R.O.W.
Description of work:
PERMIT TYPE RESIDENTIAL
Water Heater Water Softener VA e ev,
Lawn Irrigation RPZ PVB) T Add Plumbing Fixtures Main Lower Level)
Septic System Water Turnaround
_ New
Abandonment
RESIDENTIAL 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 $166.00 if a 5/8" meter is required)
$100.50 Septic System New ($10.00 per as built) (includes County fee and $.50 State Surcharge)
$90.50 Fire Repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge)
TOTAL FEES $
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage.
Call 48 hours before you intend to dig to receive locates of underground utilities. www.clopherstateonecall.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.
x 8r( VV p x
Applicant's Printed Na a Applicant's Signat r
FOR OFFICE USE Reviewed By: Date:
Required Inspections: Under Ground Rough-In Air Test Gas Test Final
Use BLUE or BLACK Ink
r
For Office Use
Permit#: r~~ LAY/ .2 7, j
City of Ea~dI
I Permit Fee: /X ° &9
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I Q~Q I
Fax: (651) 675-5694 I Staff:
I I
2010 RESIDENTIAL BUILDING PERMIT APPLICATION'
Date: ! do< d Site Address: /I
Tenant: Act s/GV /71 C Suite M
RESIDENT / OWNER Name: A`Cn 177ci t` y- I ac-'ZA ~ Phone:
Address / City / Zip:
Applicant is: Owner Contractor
TYPE OF WORK Description of work: 60~h ro6w1 fSe/i'e dam`
Construction Cost: Multi-Family Building: (Yes No °Q )
CONTRACTOR Name: t%vi2S uG~~~i `License #:O to`~
Address: 73-0z A~uACCrLi'I ClWe-C- city:
State: 214,~ Zip: 553 ~f Phone: - 557 - oO g [
Contact: Email;~ L'6y1-1
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that the are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage.
Call 48 hours before you intend to dig to receive locates of underground utilities. www.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 ans.
Applicant's Printed Name ( p i a ature
D ~ Page 1 of 2
JUN 1 2110 D
0
DO NOT WRITE BELOW THIS LINE 7
SUB TYPES
_ Foundation _ Fireplace _ Porch (3-Season) _ Storm Damage
Single Family _ Garage _ Porch (4-Season) _ Exterior Alteration (Single Family)
Multi _ Deck Porch (Screen/Gazebo/Pergola) Exterior Alteration (Multi)
_ 01 of Plex _ Lower Level _ Pool _ Miscellaneous
_ Accessory Building
WORK TYPES
New _ Interior Improvement _ Siding _ Demolish Building*
Addition _ Move Building _ Reroof _ Demolish Interior
Alteratio _ Fire Repair _ Windows _ Demolish Foundation
Replace _ Repair _ Egress Window _ Water Damage
Retaining Wall *Demolition of entire building - give PCA handout to applicant
DESCRIPTION
Valuation Occupancy MCES System
Plan Review Code Edition ' . SAC Units
(25%100% ) Zoning City Water
Census Code Stories Booster Pump
# of Units Square Feet PRV
# of Buildings Length Fire Sprinklers
Type of Construction Width
REQUIRED INSPECTIONS
Footings (New Building) Sheetrock
Footings (Deck) Final / C.O. Required
Footings (Addition) Final / No C.O. Required
Foundation HVAC
Drain Tile Other:
Roof: -Ice & Water -Final Pool: -Footings -Air/Gas Tests -Final
~C Framing Siding: -Stucco Lath -Stone Lath -Brick
Fireplace: -Rough In -Air Test -Final Windows
Insulation Retaining Wall: Footings _ Backfill Final
Meter Size: Radon Control
Erosion Control
Reviewed By: Building Inspector
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC C,9,(-2 tJ
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
Page 2 of 2
I
CITY OF EAGAN Remarks Cedar Grove Aequisition
Add;t;o„ Cedar Grove #2 Lot 24 B,k 2 Parcel 10 16701 240 02
Ownerlz iLa-ic? Street 4242 jAoonstme Dr. State Eagan,,MN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. `5 1985 1266.95 84.46 15
STREET RESTOR.
GRADING
SAN SEW TRUNK
3t- SEWER LATERAL ((f(p 1272 1304,00 216 2 Paid
WATERMAIN
# WATER LATERAL 1972
WATER AREA
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. i . ,
BUILDING PER.
5AC ?
PARK
EAGAN 'YOV1/N SH I P
BLlILDIlVG PERMIT
Ownex -----L?-?--?Y'?!!-?....L..d.--34?OG -----'------------
Addsess
Buildex
Address .._...
---------------- ---
------------- ------
DESCRIPTIOI3
N° 763
Eagan Township
Town Hall
Dafe ?u? /fi?6/
?---- ---... .? -------------
Stories To Se Used, For -' Fron! Depth Heighi Esf. Cosi Permit Fee Aemarks
or
LOCATION
?aaulon o: '1 rac2.
3 j C.;LE?/ ?'Y • -?+ a`L+
This permif, does not auihorize fhe- use of streefs, soads, alleys or- sidewallcs r.or docs i1 ?give the owner or nis a.?;sni
!he' righi !o create any sifuaYfon which is a nuisance or which preseats a haaard fo !he healih, safely, convenience aad
general welfare !o anyone in the communify. .. .
THIS PEAMIT MUST BEQKEPON THE PREMISE WHILn THE WORI{ IS IN PAOGRESS: . ? ..
This is !o ceriify, fha! _
??:'__.__._______,___has permission io ereei? _ upon
? .....?.___...
the above deseribed prem" subjec o!h v5sions of the Suilding O*d"ananc.= for Eeoas 9'ownship adopled APzil 11.
1955.
"'_........ C--?'------ -"F?.- _-.-?----. Pez -------------- .----_.--????--------`°""?--?..---------
-
. Chairman of Tnwn Board Bnilding Inspecior -
E RESIDENTIAL 4 a
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD - 55122
651-681-4675
NewConahuctlon ReoufremeMe RemadeVReoeir Reaulremenh
. 3 registered site surveys showing sq. R ot U. sq. tt. W house; aM all mofed am,m • 2 coples of plan
(200% maximum lot coverege allawed) . 1 set af Eneigy Calculatiam fur heated addttbns
. 2 copies of plan showing 6eam & window 5¢es; poured tound desgn, elc.) • 7 site survey for odedor addiions 8 decks
• 1 sel W Ereqy Calculetbns • Indicale if home served by septic system for additbns
• 3 copies M Tree Preservatlon Plen if lot platted afte17/7193
. Rim Joist Oefeil Option.a selection sheet (bldgs wilh 3 or lese unfts)
DATE la-c9-0 a VALUATION I IFIo07a?
JOB SITE ADDRESSLI?44a -1'?1?QQ 4I-Dnn (Jt2
IF MULTI-FAMILY BUILDING, HOW MANY UNITS?
PROPERTY OWNER lZon `4" Li 2. E1/ 1 .
TYPE OF
APPLICA
REPLACE(S) _ 0 _ 1 _ 2
PHONE# 7&3-12S • Az,?7
?
ADDRESS 8q0Q- 'k9]* A)e .14 ScAtF 4 n[1- RlWtlue-vrr ZIPCODE SSY-'/S
PAGER # CELL PHONE # 7423-39/-93i3 Fax # 743 • 39/-/,3&0
rrEw RESIDENTIAL BUILDING ONLY - FILL OUT COMPLETELY
Energy Code Category _ MINNESOTA RULES 7670 CATEGORY 1
(check one) - Residential VeMilation Category 1 Worksheet Submitted
- Energy Envelope Calculations Submitted
_ MINNESOTA RULES 7672
New Energy Code Worksheet Submitted
Plumhing Contractor. Phone #:
Plumbing System Includes: _ Water Softener _ Lawn Sprinkler Fee: $90.00
Water Heater No. of R.I. Baths
_ No. ofBaths
Mechanical Confractor. _
Mechanical System Includes:
Sewer/Water Contraetor.
_ Air Conditioning
_ Heat Recovery System
Phone #
Fee: $70.00
Phone #
All above information must be submitted prior to processing of application.
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comph/
with all applicable State of Minnesota Statutes and Ciiy of Eagan inances. -- ---_-----
?-
?
Signafure of Applican ?
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _ -`
" - Updated 20021
fiLED D:? ; .. ; 2002
OFFICE USE ONLY
? Ot Foundation ? 07 05-plex ? 13 76-piex ? 20 Pool ? 30 Accessory Bldg
0 02 SF Dwelling O 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 PorchlAddn. (4sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screened) . ? 36 Multi
C] 05 03-plex ? 11 10.piex ? 19 Lower Level ? 24 Storm Damage
? 06 04plex ? 12 12-plex PI6g_Y or _ N ? 25 Miscellaneous
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (FOUndation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)" ? 43 Reroof ? 46 WindowslDoors
? 34 Replacement "Demolition (Entire Bldg only) - Give PCA handaut to appliwnt
Valuation Occupancy MC/ES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bidgs Length Fire Sprinklered
Type of Const Width
. REQUIRED IN5PECTIONS
Footings (new bldg) :
Footings (deck) FinaVNo C.O.
Footings (addition)
Foundation
Drain Tile
Roof Ice & Water Final Other
Framing _ Pool _ Ftgs _ AidGas Tests _ Final
Fireplace , R.I. _ Air Test _ Final _ Siding Stucca Stone
Insula[ion _ Windows (new/replacement)
Approved By . Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S&W Permit 8 Surcharge
Treatment Plant
Plumbing Permit
Mechanical Pertnit
License Search
Copies
Other
Total
FinaUC.O.
_ Plumbing
HVAC
6 9 ?3?
2005 RESIDENTIAL BUILDING PII2MTC APPLICATION
City OfEagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX 111651-675-5694
Telephone # (
New Construdion Reouiremenis RemodeUReoair Reauirements Office Use Onlv
3 registered site surveys showing sq. k. of lot, sq. ft. of house; and all roofed areas 2 copies of plan Cert of Survey Recd _ Y_ N
(20% maximum lot wverege allowed) 1 set of Energy Calculalbns for heated additbns Tree Pres Plan Recd _ Y_ N,
2 capies of plan showing beam &window saes; poured found design, etc. 1 site survey foradditions & decks Tree Pres Required _Y _ N
i set of Eneqy Celculadons AddRion - indicate Hon-sffe sep&c system On-sde Sep6c System _ Y_ N
3 copies of Tree Preservation Plan rf lot platted after 7/7193
Rim Joist Detail Optlons uledian sheet (6uildings with 3 or less units)
Date-(? 4,061/05 ConstructionCast LQ,3@ 10/
Site Address y a y a M00Yl,<' n:P _,r)fi l, L.l _ UniUSte #
Description of Work 11?a- zlrxli- ?
Multi-Family Bldg _ Y_ N Fireplace(s) _ 0_ l _ 2
-1 C4,b-<
4A'l G V
t
O
P
'e hone # (L'S 1) q
Tele
_
roper
y
wner
?
-_ p
Contractor RMA I IOME SERVICES, INC.
Home Depot Installed Sales
Address 3200 Co6b Galleria Pkwy., Ste. #200 City
Atlanta, GA 30339
State 763-542-8826 Telephone # ( )
BC-20268257
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 _ Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(Jsubmissiontype) Submitted Su6mitled
. Energy Envelope Calculations Submitted
Nave 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
4;?
,?-
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 work is not to start without a
permit; that the work will be in accordance with the approved p an in the case of work which requires a review and
appr al of plan r?l I p i? ? T L;
c o? ' ?R??'? ' k o5
ApplicanYs Printed Name Ap canYs ignature f ??1
OFFTCE USE ONLY
Sub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? OB 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) O 31 Ext. Alt- Multi
? 03 Ot of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. AR - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex ? 19 LowerLevel ? 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
? 32 Addition ? 38 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteration ? 37 Demolish Building' ? 43 Reroof ? 46 WindowslDoors
? 34 Replacement •Demolition (Entire Bldg) - Give PCA handout to applicant
Valuation Occupancy MCES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footings(new bldg) _ FinaVC.O.
_ Footings (deck) _ Final/No C.O.
_ Footings (addition) _ Plumbing
Foundation HVAC
Drain Tile Other
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests Final
_ Framing _ Siding _ Stucco _ Stone _ Brick
_ Fireplace _ R.I. _ AirTest _ Final _ Windows
_ Insulation _ Retaining Wall
Approved By: , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Pertnit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
,.,-.
Installed
Siding and Windows
LIMITED POWER.OF
COiJNTY OF COBB
STATE OF GEORGIA
KNOW ALL PEOPLE BY THESE PRESENTS:
ATTORNEY
THAT I, David N. Katz, a resident of Montgomery County, Pennsylvania
("Principal"), and a licensed contractor of RMA Home Services, Inc., DBA Home
Depot Installed Sales located at 660 Mendelssohn Avenue North, Go?den V211ey, MN
55427, having a license number of BC- 20268257, do hereby appoint, name and
constitute Elder-Jones Building Permit Service, Inc. ("Agent") as my true and lawful
attorney-in-fact and do authorize and grant said attorney-in-fact for me and in my
name, place and stead the power to execute, acknowledge, sign and deliver (in such
form as may be required by the municipality) a permit application, or any other
instrument(s) which may be necessary and appropriate, in order to obtain the proper
permit(s) from the City of Eagan, Minnesota for the instaliation, maintenance and
repair of windows and siding (the "Work").
The powers conveyed to the Agent by this Limited Power of Atterriey are
limited solely to the express powerS delineated herein and apply solely to the Work.
This Limi*,ed Power of Attorney shall expire and automaticalIy be revoked on the 21st
day of May, 2004, which date is one year from the execution hereof. Further, the
powers conveyed by this Limited Power of Attorney may be revoked by Principal at
any time by express revocation and shall also be revoked by the Principal's death,
disability, incapacity or incompetence.
IN WI"1'NESS WHEREOF this Limited Power ef Atterney is e:cectrted tfiis
21st day of May, 2003
David . Katz
S WORN TO AND 3UBSCRIBED BEFORE ME by David N. Katz on this
21 st day of May, 200?
Notary PWic in for the State o eorgia
My Commission Espires: January 21, 2006
396816.v3 Proudly sold, furnished and installed by RMA Home Services, Inc., a Home Depot authorized contractor.
3200 Cobb Galleria Parkway, Suite 200 • Atlanta, GA 30339 • Phone (770) 779-1300 • Fax (770) 984-0709 • Toll free (800) 79-DEPOT
1 _7J
2006 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX 9 651-675-5694
New ConsWc6on Reouirements
3 registered site surveys showing sq. R of IM, sq. ft. of house; and all rooted areas
(20 % maximum lot coverage allowed)
2 copies of plan showing beam & vrindow s¢es; poured fand design, elc.
1 set of Energy Calculations
3 copies of Tree Preservation Plan if lot platted after 7l153
Rim Jd5[ Delail Options selec6on shed (buildings wiM 3 or less uni6)
Minnegasco mechanical ven[ilation form
RemodeN2eoair ReouiremenLs
2 wpies of plan shaving footings, beams, joists
1 set oi Energy Calculatlons for heated addifions
1 sile survey fa addifions & decks
AddiNon - indkafe il on-sife sepfic system
4 -I(D OU
Office Use Onlv
Cert of$urveyRecd --Y"_N
7ree Pres.PoadRecd Y .,. N
TrcePresRequired'-Y _N
On-sileSeptic $ystem ?. .. _ Y: _N
QfI? - u' _ .?R
Date 09 66 Construction Cost 000
Site Address ? Z-7 Z Hoon 5'lon r Lri v e UniUSte #
Nqn 551 Lz
Description of Work LaWer Leioe,I Fin;SL
Multi-Family Bldg _ Y4N Fireplace(s) ? 0 _ 1 _ 2
+ 612
PropertyOwner ?6?J'0t? an,l Na1? (
?/ ?IGl.4... q
t it! Telephone#('"a)
Contrac[or
Address City
State Zip Telephone # ( )
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category 1 Worksheel • New Energy Code Worksheet
(V submission type) Su6mitted . Submitted
• Energy Emelope Calculations Submitted
In the last 12 monihs, has ihe City of Eagan issved a permit for a similar plan based on a master plan?
_ Y _ N If yes, date and address of master plan:
Licensed Plumber T?,p?r?#(
\) 111?
Mechanical Contractor v Telephon?(
Sewer/WaterContractor Q 1T1eph*one#(
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.
AGco,n " (e), ? /Yc."
Applicant's Printed Nam Applicant's Signature
DO NOT WRITE BELOW THIS LINE
Sub Tvoes
? 01 Foundation
? 02 SF Dwelling
? 03 01 of _ plex
? 04 02-plex
? 05 03-plex
? 06 04-plex
Work Tvoes
? 31 New
? 32 Addition
^133 Alteration
? 34 Repiacement
? 13 16-plex
? 16 Fireplace
? 17 Garage
? 18 Deck
19( 19 Lower Level
? 20 Pool
? 21 Porch (3-sea.)
? 22 Porch/Addn.(4-sea.)
? 23 Porch (screen/gazebo)
? 24 Storm Damage
? 25 Miscellaneous
? 30 Accessory Bldg
? 31 Ext. Alt- Multi
? 33 EM. Alt - SF
? 36 Multi Misc.
? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 37 Demolish Building` ? 43 Reroof ? 46 Windows/Doors
•Demolition (Entlre BIAg) - Give PCA handout to applicant
DBSCIiptiOfl: WaterDamage_Yes
Valuation -3" b U 0
Plan Review 100% or 25%
Census Code ?
SAC Units ?
# of Units ?
# of Bldgs 1
Type of Const .S - 8
Occupancy & ' 5
Zoning
Stories
Sq. Ft.
Length
Width
_ Footings (new bldg)
_ Footings (deck)
_ Foo[ings (addiCion)
Foundation
Drain Tile
Roof Ice & Water Final
? Framing
Fireplace R.I. Air Test Final
Y Insulation
MCES System
City Water
Booster Pump
PRV
Fire Sprinklered
REQUIRED INSPECTIONS
_ Sheetrock
_ Final/C.O.
? Final/No C.O.
? HVAC
Other
Pool Ftgs Air/Gas Tests Final
_ Siding _ Stucco Lath _ Stone La[h _Brick
_ Windows
Retaining Wall
Approved By: Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S8W Permit 8 Surcharge
Treatment Plant
License Search
Copies
Other
Total
? 07 05-plex
? 08 06-plex
? 09 07-plex
? 10 OS-plex
? 11 10-plex
? 12 12-plex
?D?a?
x?, zooo RESIDENTIAL MECHANICAI, PraMrr Al'rLzcATIoN
Ciry orragan
38311 Pilnk Knob Road, 1'sngRn NTN 55,122
Tclephone # 651-675-5675
I l;i
ti
?
i?
t'he
Adt
?
-C
Aoi
19?a,v; cnniplclc liir: siu!,Ir, Iautily dwellin;,s k' Iomihoine.0cmidns when perinilx :u'c rcyufreJ Ibr c;ac6 unit
??50
c VV
? ?
pen)' O?rner jl'i?l`f?
? dL (??Y 6???rFt?- - ?
----------- ----------- I'elep6one # _
,/ ----
rtrarfnr - ----
?,ed Add,e,s
_
(:i,Y
'
!:ilc
?/?---- -------- . - -- ';,, /
??le,,ho,le ft ,9b3 , 5?v-_1L6
fouut:
eai,ii•e,:
------- ------- -----
11 -?
- ---- '
_ .-------------- -------- ------ ------ -
..
:\ppiir:mtis Oxi?ner rnuimctor (nhcr
????? I
-on or alfcratinn fo cxisfiu? d?yelling miif
/ ;p.pp ?
rumace -? Additional _Replacement New
Fiir exr,hanger
sjircanditioner
?
heat pump
`4-o 1
IQ'Y-r- U Q0-01_ 1 WPA
-? ? ---
-
?•.tin???n:???e?,
- - ? ;o
------ - -
? i - --- -- ,h . . ?O S? ,
I hri,.h, opply liir 9 Reeideminl Machanicid Permit ,md ncknowledgr. that ihc infnrma[inn is compiete and accurate; that the work will
6c, iu confinniancc xvillt llia ordiuances amd codss nf Ihe ('.ity nf F:agau ind wiih the Mechanical Codes that I unders[and this is nol a
iwimit_ hut only an npplici[ion foi i pumiL and wak is not to starl utthnui a peimrt; that tLill be in accordance with tho
i i?veJ ??I in in ihe c;tse. ol wnrk ??hich iequites i ifview nnd approval ul l?- - -
\ pp! icanl :s I'rinted Name pplicanl's Si!?natmre
?S3o?
? so. so
Qd v t-SA
2006 RESIDENTIAL PLUMBING PERMIT APPLICATION
CITY OF EAGAN
3830 PiLOT KNOB ROAQ, EAGAN MN 55122
651-67:f-587S ?.px GSs1, 6-?
4
Plcacc completg for rtwdifications to wxisting r?es ??ti ellings.
Date??-? Z.D4 (P
Site Street Address, A(2, q 2
PropeAy Own.w
contruMor V\ ¢. JilP?
Address l l02 S "-""4, \D N E-
The App?icant is: „ Owner
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7elephone # ( )
i. Telephone# (7?? ?$3- 90?0
_C???AYL ?at1C gtate riLr? r'P ?ry3z
?ortractor _UMer
In
sfurbished SuDmit 2 sets 01 plans and MPC tfcense GudE 0County 0.00
plteratians to enistlntl dwelling
? Add plumbing fxture5- This fee includes installation of a water softaner andlor water
heatsr at the same tlme. H you are fnsta8?n9 onlv e?vater softener and/or waier
h82tC?, d0 not CAmpl8t0 (hls secliun; mo`ie tc the ncM soction and cheCk tha
appllance(s) you are installing.
Septic System Abandonmerrt
+Water Turnaround (add $130.00 if a 518" meter is required)
Other:
Water 5oftener
? naw
1Plater Neater
_, reptacement
rP? lnQW ^repair ,rebuild
Lavvn Irrlgdtlon _RP2 B?+T?_
?
State Surcharga
? ?A *400
$ 30.00
$ .so
ToWl ?and accurate; tnac uie
?
t hereby aPP Y
?j for s RaeidenUal Plumning Nermn and acknovaledgg that tne mformanon ?s v' ` the work will be In ?ntormance with the ordinal es?n ?r ?p ?' W? slt?o` t s? ?W?th ut a pg?m alnd work vnll betin codes; understand this Vs not a pem'ut, but only an app' ?
accordance `?'??? ttte approv?ed plan in ehc ovent a plan is rwqu;icant's bs reYiewed and a roved. ?
OZ. M<<Gn?L?l.d' ? ?m
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Signature
ApplicanYs Printed Name O -?
$ 50.00
29
. . ? $ 15.00
T0 39C7d NI SMI112135 9NIHWfI-id 180608LE9L TS :Z0 900ZI8ZJ60
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Use BLUE or BLACK Ink
For Office Use 1
I Permit
City of Eaon(an
Yt ' W
Permit Fee: 1
3830 Pilot Knob Road
Eagan MN 55122 I Date Recei e
1
Phone: (651) 675-5675 I
Staff:
Fax: (651) 675-5694 I -
2011 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: Site Address:
Tenant: Suite
RESIDENT OWNER Name: Phone:
Address / City / Zip:
CONTRACTOR Name: `A--e1►,4-aV i P1 Vr-161 ~ License 0677 16S3_~5_
Address: Q, 1F V ~ 51" e ~ L I D ~ City:
State:, A) Zip: $y ZJV Phone: 5 5-A-2161-®12-$
,t,t
Contact / I i Email:
TYPE OF WORK _ New _ Replacement Repair - Rebuild V_ Modify Space - Work in R.O.W.
Description of work:
PERMIT TYPE RESIDENTIAL
Water Softener
Water Heater
X Add Plumbing Fixtures Main Lower Level)
Lawn Irrigation RPZ PVB)
Septic System Water Turnaround
_ New
_ Abandonment
RESIDENTIAL FEES:
$55.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge)
$35.00 Lawn Irrigation (includes $5.00 State Surcharge)
$5&WAdd Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge)
*Water Turnaround (add $166.00 if a 5/8" meter is required) T0xiol
$105.00 Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge)
$95.00 Fire Repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge)
TOTAL FEES $
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage.
Call 48 hours before you intend to dig to receive locates of underground utilities. www.aopherstateonecall.ora
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work i t to start without a permit; that the work will be in
accordance with approved plan in the case of work which requires a review and approval pla .
x U~~ . /`1 nfi1 x
Applicant's Printed Name Applicant's Signature
FOR OFFICE USE Reviewed By: Date:
Required Inspections: Under Ground Rough-In Air Test Gas Test Final
Use BLUE or BLACK Ink
For Office Use I
j Permit CA/ 5
City of Eap I Permit Fee: V I
I I
3830 Pilot Knob Road 1 I
Eagan MN 55122 - i Date Received: l
Phone: (651) 675-5675 1 staff: 1
Fax: (651) 675-5694 i -
2011 RESIDENTIAL BUILDING PERMIT APPLICATION
1 rn /
Date: ZZ 61 - Site Address: 4ay.2 Dawg Unit#:
SI - 6 $(o ' S~ g
Name: H ftgO N + 1~1 0"J e&4 Lky Phone: 10
RESIDENT / ~
OWNER Address / City / Zip: Z 4t Z dilly g~OA) E Q r2\ U~ L► V9 Crt9 N
APplicant is: Owner Y Contractor
TYPE OF WORK Description of work: K I = tj'sti nG YYto Wr' L._
)
Construction Cost: 3S ~ Multi-Family Building: (Yes No-)(
Company: L-LtJ J AC 1~ S Contact: S tq R~ Lill p-&-Nr
rd
Address: 02 f C1 S ~-CJ . ( 3 - sr City: E
CONTRACTOR
State: AAA Zip: 5 53 ° Phone: - '~&q 0 - '!57 800
4o3-!
License / -s- -:3 6 Lead Certificate N 4T
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes -No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
I
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that the are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www oopherstateonecall.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 1 understand this is riot 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.
Exteriorwork authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
se
days of permit issuance. 1l ~ 6
x N Iw S,ple~s 6y S~w* )-otac)-ir x / L., S
Applicant's Printed Name Applicant's Sig tore
Page 1 of 3
' r v! ~ooo DO NOT WRITE BELOW THIS LINE
SUB TYPES
_ Foundation _ Fireplace _ Porch (3-Season) _ Storm Damage
Single Family _ Garage _ Porch (4-Season) _ Exterior Alteration (Single Family)
_ Multi _ Deck _ Porch (Screen/Gazebo/Pergola) _ Exterior Alteration (Multi)
_ 01 of Plex _ Lower Level Pool _ Miscellaneous
_ Accessory Building
WORK TYPES
_ New _ Interior Improvement _ Siding _ Demolish Building"
_ Addition _ Move Building _ Reroof Demolish Interior
Alteration Fire Repair _ Windows _ Demolish Foundation
Replace _ Repair _ Egress Window _ Water Damage
Retaining Wall "Demolition of entire building -give PCA handout to applicant
DESCRIPTION Valuation Occupancy n%/ 4- MCES System
Plan Review Code Edition od j6~ 2a? V-7) SAC Units
(25% 100%)C) Zoning city water
Census Code Stories Booster Pump
# of Units Square Feet PRV
# of Buildings Length Fire Sprinklers
Type of Construction Width
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
Footings (Deck) Final I 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 iAir/Gas Tests -Final
Framing Siding: -Stucco Lath -Stone Lath -Brick
Fireplace: -Rough in -Air Test JFinal Windows
Insulation Retaining Wall: _ Footings _ Backfill _ Final
Sheathing Radon Control
Sheetrock Erosion Control
Reviewed By: , Building Inspector
RESIDENTIAL FEES
Base Fee
Surcharge jVwfi~N)
Plan Review
Ze`
MCES SAC tip Al
City SAC
Utility Connection Charge
S&W Permit 8 Surcharge ~
Treatment Plantf C~
Copies
TOTAL
Page 2 of 3
PERMIT
City of Eagan Permit Type: Mechanical
Eagan. Permit Number: EA101579
Date Issued: 10/14/2011
OR Permit Category: ePermit
40~ it~ of E3
E
Site Address: 4242 Moonstone Dr
Lot: 24 Block: 2 Addition: Cedar Grove 2nd
PID: 10-16701-02-240
Use:
Description:
Sub Type: e - Gas Line
Work Type: New
Description: Stove
Comments: Questions regarding electrical permit requirements should be directed to Mark Anderson. State Electrical Inspector. (952)
445-2840
Mike Lutz
15021 Manitou Rd NE
Fee Summary: ME - Permit Fee (Replacements) $50.00 0801.4088
Surcharge-Fixed $5.00 9001.2195
Total: $55.00
Contractor: - Applicant - Owner:
Genesis Heating & A C Aaron McCauley
1021 lolanitou Rd 4242 loloonstone Dr
Prior Lake NIN 55372 Eagan NIN 55122--204
(92)447-3762
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 Cite of Eagan Ordinances.
ApplicantiPermitee: Signature Issued Bv: Signature
PERMIT
City of Eagan Permit Type: Mechanical
Permit Number: EA105563
Date Issued: 0711912012
itj of 0n Permit Category: ePermit
R
Site Address: 4242 Moonstone Dr
Lot: 24 Block: 2 Addition: Cedar Grove 2nd
PID: 10-16701-02-240
Use:
Description:
Sub Type: e - Furnace & Air Conditioner
Work Type: New
Description: Furnace & Air Conditioner
Comments: Questions regarding electrical permit requirements should be directed to Mark Anderson, State Electrical Inspector, (952)
445-2840
Fee Summary: ME - Permit Fee (Replacements) $55.00 0801.4088
Surcharge-Fixed $5.00 9001.2195
Total: $60.00
Contractor: - Applicant - Owner:
Apple Lake Heating & Air Conditioning Aaron McCauley
207 150th Street West 4242 Moonstone Dr
Apple Valley MN 55124 Eagan MN 55122--204
(952) 431-4328
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
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA115697
Date Issued:09/30/2013
Permit Category:ePermit
Site Address: 4242 Moonstone Dr
Lot:24 Block: 2 Addition: Cedar Grove 2nd
PID:10-16701-02-240
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Softener
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Jolene Mehle
17484 Goodland Path
Lakeville, MN 55044
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 -
Aaron Mccauley
4242 Moonstone Dr
Eagan MN 55122--204
Dakota Water Treatment
17484 Goodland Path
Lakeville MN 55044
(952) 953-4643
Applicant/Permitee: Signature Issued By: Signature