4260 Moonstone Dr
Use BLUE or BLACK Ink
For Office Use I
I Permit /on9yq
~
City of Eanpim
I
~ Permit Fee: I
3830 Pilot Knob Road I
Eagan (N 5j 122 i Date Rece' ed: l
Phone: (651) 675-5675 a Staff: i
Fax: (651) 675-5694
/ 2011 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: (ZZ 2^bt Site Address: 210 od`1~ S~-V-,~L
Tenant: Suite
RESIDENT/OWNER Name: Phone: f(~ O~ be 91?`
Address / City / Zip: -42&0 ~---Q av,, S / 2Z
CONTRACTOR Name: d ~1°~S ~ Lr- r Inc{ License (c,3 2 q-S
Address: 3 g53 l SSA` S~ W , City:
State: " ~J Zip: S S }C) Phone: ~l2 2f a 4t)eV
Contact: MgAov~ ~ tax Email: C"1vvkC4\ °
TYPE OF WORK -New ~ Replacement -Repair _Rebuild - Modify Space _ Work in R.O.W.
Description of work: ?,ovS-- K-
RESIDENTIAL `r L" "C'-"
PERMIT TYPE
Water Heater Water Softener
Lawn Irrigation RPZ PVB) ?C," Add Plumbing Fixtures C-),,^ Main Lower Level)
Septic System Water Turnaround
_ New
Abandonment
RESIDENTIAL FEES:
$55.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge)
$35.00 Lawn Irrigation (includes $5.00 State Surcharge)
$55.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge)
*Water Turnaround (add $166.00 if a 5/8" meter is required)
$105.00 Septic System New ($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.gopherstateonecall.orci
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 mckrto,, ~~;~s 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
-
~ -------------o----
For Office Use/j Permit Cnon 1 _5
City of Eaed Permit Fee: ~ / C Q 1
3830 Pilot Knob Road i
Date Received: 1
Eagan MN 55122
~ ~ q f ~ sw 1 I
Phone: (651) 675-5675
Fax: (651) 675-5694 1 Staff: 1
Ir„ I I
2011 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: / 3 Z.s Site Address:_( Unit
Name: L--EF- G'$ VLli Phone: (.0 2 3 0_4 -04 31
RESIDENT /
OWNER Address/ City /Zip: 4L&O A,0" J2kC paj vC
Applicant is: Owner _,Z Contractor
TYPE OF WORK Description of work: FF_&V_r P-A*-P RXA^-OQ MQ JR-eDAI /RC..,_UP gap,"Al
Construction Cost: ab )I d-O Multi-Family Building: (Yes / No _Do!~J
Company: Vie- Cd&fOW &-T)W Contact: Cafe 7 174 V9-
CONTRACTOR Address: 11435" f 4 LT) J;A AA) P City: ~L✓1/~$ l/ILL
State: ► A _ Zip: &Y310-4- Phone: 95 Z ` -Lm W1
License Z 04) (93 Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
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
1 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- /"In x c4R7 of Lt t_
Applican s P me Applicant's Signature
Page 1 of 3
DO NOT WRITE BELOW THIS LINE
SUB TYPES
_ Foundation _ Fireplace _ Porch (3-Season) _ Storm Damage
~C Single Family _ Garage T Porch (4-Season) _ Exterior Alteration (Single Family)
Multi Deck Porch (ScreenlGazelw/Pergola) Exterior Alteration (Multi)
_ 01 of - Plex _ Lower Level T Pool _ Miscellaneous
Accessory Building
WORK TYPES ffN~6'-
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 Wail *Demolition of entire building - give PCA handout to applicant
DESCRIPTION
Valuation( Occupancy 4LnsL MCES System
Plan Review Code Edition SAC Units
(25%-100%4 Zoning City Water
Census Code Stories Booster Pump
# of Units Square Feet PRV
# of Buildings Length Fire Sprinklers
Type of Construction Vo_ 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
Surcharge
-.Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge S~ 1('
Treatment Plant 000
Copies
TOTAL l
Page 2 of 3
NMM* 06- L ,i&
l~
~r
rQ 13
f
?d
??/? PERMIT #
MECHANICAL PERMIT RECEIPT # ?
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE:
CONTRACT PRICE: PHONE: 454•8100 For Office Use Only:
m Name _
.S Address
c City _
L Name
c Address
O CitY
; `y `. `," ` ' BLDG. TYPE
Sec/Sub Res
I"1G 77 Muit.
- '3'_ A?VD A=T "' Comm. -
0 eN A m., -, Other
TYPE OF WORK
Forced Air M BTU
Boiler M BTU
Unit Heater M BTU
Air Cond. M BTU
Vent CFM
Gas Piping OuUets # ?
Other
OUTLETS
APT.
r. ii
FEE _
1 S/C:
TOTAL: _
WORK DESCRIPTION
New
Add-on
Repair `
FEES
M BTU - $24.00
ITU - 6.00
r ,(-)
v- ncQ. nn I r_ nr r "n
FEE - ALL ADD-ON &
1.50 EA.
REMODEI.S - 12.00
MINIMUM COMMERCIAL FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C iF PERMIT PRICE GOES
6EYOND $1,000)
SIGNATURE OF PERMITTEE
JI FOR: CITY OF EAGAN
?/?????i.v x<? ,?..?.? s???? .
?/? y /? ? ?-P
??
,.
s
f
I ? .
?f
4'.
, ?.
iN SYLC'1'ION
CITY OF EAGAN
?tagoan, Pilot Knob Road
Minnesota 55122-1897
(651) 681-4675
KIE(:UKll
PERMIT TYPE:
Permit Number:
Date Issued:
SITE ADDRESS: '
PERMIT SUBTYPE:
TYPE OF WORK:
[Ir .c r, 11, t- I i I ts
?
?
' to ` APPLICANT:
1 . , ? Nl n? ?
-1
I
Permit Holder Data Telsphom #
SEWER/
WATER .
PLUMBING
HVAC
Inspection Dato Insp. Commenta
FOOTINGS
FOUND
FRAMINC3
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
DOMESTIC
METER
IRRIGATION
MEfER
FLUSH
MAINS
CONDUCTIVITY
TEST
HYDROSTATIC
TEST
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
CITY OF EAGAN Remarks Cedar Grove Acquisition
Addition Cedar Grove #2 Lot 21 sik 2 Parcel 10 16701 210 02
Owner Street 4260 Moonstone Dr. State Eagan,M1V 55122
Improvement Date Amount Annual Years Payment Receipt Date
STFEET SURF. ? 1985 766.95 51.13 15
STREET RESTOR. SOQ. 00 ,. SQO. 00 C009292 8-29-84
GRADING
SAN 5EW TRUNK
# SEWER LATERAL ! 1
WATERMAIN
* WATER LATERAL 1972
WATER AREA
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. ?
9UILDING PER.
5AC ? ?• '•
PARK
m 6 8 3 2 2 4P
Request Dffie Fire No. Rough-in InspWion
Requiretl? , ?
? Ready Now ?j Will Notity Inspector
?Yes VNO WhenReaUy?
0.licensed contractor ? owner hereby request inspedion of above electrical work at:
Job Atltlress (SVeei, Box or Rate NoJ
1
Ob Ciry
-a cai;
F
I
o -
Section No. Tawnship Name or No. Range No. Cou
nry
y
1?? C-IRA
Occupant (PRINT)
L¢(f C"?5-, vQ% Phona No.
Power Supplier ,
Mdress
Electrical Coniractor (Compeiry Name) CoMraciWs Lkense No.
+1 i '1Zde M2- 3
Mailing Adtlress (Conlraclor ar Uv r Meking
I
n
stallation)
/
?
,
.. F lc.t ?.
lwlhorized Signa CoM alQrrner Ma ' stallaH PMna Number
i?t 5a5?
?
MINNESOTA STA B q0 OF ELECTflICRV ? V THIS INSPECTION REpUEST WILL NOT
Grlgge-Mltlway 81Eg. - Raom 5-173 BE ACCEPrED eYTHE STAiE BOFRD
1821 Univeraky Ave., SL Paul, MN 55106 UNLESS PROPER INSPECTION FEE IS
Phmre (812) 602-0800 ENCLASED.
REQUEST FOR ELECTRICAL INSPECTION es000mo7
! ? See,instructions for compleiing ihis form an back of yelbw copy. J^ ??
9 6V22 "X' Below Work Covered by This Request
e Adtl Rap. TypeofBuiltling AppliancesWired EquipmemWiretl
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. 8uilding Dryer Other (Specity)
Comm./Industrial Furnace
Farm Air Conditioner
Other (apecily) Conlractoh Remarks:
Compute Inspection Fee Below:
# Other Fee # ServiCeEniranceSize Fee # Circuits/Feeders Fee
Swimming Pool 0 to 200 Amps ? p? 0 to 100 Amps
Transformers Above 200 _ Amps A6ove 100 _ Amps
Signs Inspedor5 Use On1y: 1 TO7AL
Irrigation Booms 5cs
Special Inspection l
Alartn/Communication
Other Fee
I, the Electrical Inspector, hereby Rough-in oale
certiythat the above inspection has
been made. Finei oa?e
OFFICE USE ONLY
This requesl voitl 18 rtwnUis irom
//4 9
6 5
5
, 9(a3? 9
%
1
l?
?.
FeC"' ete Fl No. Rough-in Inspeclion
Required?
Ready Now ? WII Natily Inepeclor
?
M
R
tl
? Yes o .
ea
y
I licensed contractor ? owner hereby request inspection of above electrical work at:
Adtlress (Streel, Boz a Rwle Na.)
_ `f.sbIp /",0oN SiQ
rvlt Ciry
Sedion No. Township Name or No. Range No. Cauntyfn',
L!,'7?o rA
Ocwpam (PRINTI
P,4u(- Phone No.
(? 8 a'°-
Power Supplier Address
Electrical Contrador (Companry Nertre) CoMractork License No.
G?/f'LA).Ffi 6La_C, l & C. /NC. O Y?7-?.? (
Mailing Atltlress (COMrector or Oxner Meking Insl
(1 3910i E Aiiii tion)
116411. 6RGfhv
i'YyN ?'?'1 el ?Z
Autnorized ' netu '(COnt r/ n allation) Phone Numbet
,ti.
V7 cjS1-°-Yr3
• Y
MINNESOTA STATE BOAR OF ELECTNICRY THIS INSPECTION REQUEST WILL NOT
Grigps-Mldway BWg. - Room &173 BE ACCEPTED BV THE STATE BOARD
1827 University Ave., St. Paul, MN 55104 UNLESS PfiOPER INSPECTION FEE IS
Phone (812) 642-0Bro ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION AI'M ee-ooom-07
y5ee inslructlons br wmpletingthis form orv back of yellow copy. CJJi?,%, 5?
17515 X" Below Work Covered by Thrs Request
e Add Rep. Type of Building AppliancesWired EquipmentWired
Home Range Temporary Service
Duplex Water Heater Electnc Heating
Apt. Building Oryer Other (Specity)
Comm./Indusirial Furnace
Farm ' Air Conditioner
Olher (speciy) Contreclor5 RemeM1S:
t'ompute Inspection Fee Below:
# Other Fee # ServiceEntrenceSize Fee # Cimuits/Feeders Fee
Swimming Po01 0 to 200 Amps 0 to 100 Amps
TransfOrmers Above 200 _ Amps Above 100 _ Amps
SIg05 InsVector§ U. OnN: TOTAL
InigationBooms iQ'.SID
Special Inspeclion Y
Alarm/Communication
Other Fee b'
I, the Electrical InspecWy hereby Rough-in
Certifythet[heaboveinSpectionhBS
been made. Fnal oete
OFFICE USE ONLY
This request wid 18 moniha imm
/08133
IO /Jr 7 ?- ? ? d- ??9C J7/?. ? p100
?J
FeQUe?L,Date
(/ ?Q
`._
•_•? d re No. Houg?-inlnspection
Requiretl'1 1 /
Y? Reetly Now ?Will Nofirylnspector
d
?
Wn
P
? U = ves o en
y
ea
I? licgnsed contractor O owner hereby request inspection of above electrical work at:
Job AOOress IStreeL Box or Ro J
o )o
h
,? Dv-
?
c CI
"?a ?
tr
?ns
0
-
Sedion No. Township Neme a No. Range No. Cou
? l
lY
(]Gcepen RINt,(p T? ?
?1 h '\
l.lJ--'?, ll Phone No.
Power Supplier AtlEress
Electrt ft Conhapor Ia? ? I
/ CqMratlor$? n? No.
/'1 !\
Mailing?AtldrsIConlra0oror ner MakinA g ns^talla'on) ?
?
?
O'
AuM2J 5i
? aW?¢ IC ntr c10?/OwnBr Makin Ins?allali n?
9 P umbBr
?o-35ss
MINNESOTA STATE 8 RO F LE PICITY THIS INSPECTION REOUEST WILL NOT
Gtlgge-MlAwey BWg. Ro ]3 9E ACCEPTED BV THE STAiE BOARD
1821 Ilniversity Ave.. St. ul. MN Od UNLESS PPOPER INSPECTION FEE I$
Phone (612) 642-0BOD ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION
K 29385 , See instmclions !or compleling4his jorm on back oi yellow wpy
"X" 8elow Work Covered by Thrs Request
?p8`%a a
ew Aotl Rep,; _ TypeolBuilding AppliencesWired EquipmentWirad
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt.Building Dryer Other-(Specity)
Comm./Industrial Furnace
Farm Air Conditioner
Omer (sueciry) Comraclor's emarks:
-5a L?-e-w cSLo;+e.h o n A ll
Compute Inspection Fee Below:
# Other Fee # ServiceEntranceSize Fee # Cireuits/Feeders Fee
Swimming Pool 0 to 200 Amps 0 ta 100 Amps
Transformers Above 200 _ Amps A4oye1(!q,_ Amps
$I(Jf15 Inspector5 Use Only. ' OTAL -??
Irrigation Booms r J • U(J ?,5 ?
Special inspection ?
Alarm/Communication THIS INSTALLATION MAY BE OR DISCONNECTED IF NOT
Other Fee COMPLETE? WITHIN 18 MONTHS.
I, the Electrical Inspector, hereby Rougn-m
? oare
certify that the above inspection has
heen made. F;,,,i
? _ oa
l6' ?'yY
OFi1CE USE ONLY
Tnis request voitl 18 monfis imm
` EAGAN TOWIVSHIP
A^ BUILDING PERMIT
Ownex ...4b.?F.VS/..1°?'.... ..?.. ?..,._.._----__
Address (Presenf) Builder ............. ............................. ....................... --....--........_
Address .......---...--.' -........... .....
DESCRIPTION
x? 1013
Eagan Township
Town Hall
Date ??/G. ...?:s3'.--
5iosies
- To Sa Used For
- Frbn!
--- DepYh
I Fieighf Est. Cosi P mit Fee Remazks
??
? ? _
I ?
f S r-c-i
al ? _
la D . dr-I ---
LOCATION
52reei, Roaa or other DesCripilon of Loca3ion Lo! Block I Addiiion or Traci
. ?O / , CcLw.?.? ? 1
- cfi i f I n i
This permit does noi aulhorise !he use of sireels, roads, elleys or sidewalks noz does if give the owner or his sgeni
the Figh3 fo creafe any situaiion which ic a nuisflnce or which presenfs a haaard !o the healih, safety, tonvenienee and
genexal welfare fo anponein the eommunitp. THIS PERMIT MUST B£ KEPT ON T E PREMISE WHILE THE WORK IS IN PAOGRESS. ,• .
Thic is !o cerfifp. Shaf..&4o-4,? ..f..Af-_t.4?__...has permicsian So eret! ?._?. !"?........._...... ._. ..upon
the above desc*ibed premise subjecf to the provisions of the Building Ordinanee for Eagan 7ownship adopted 11.
1955.
:.................. ...1(.?G.f/CJ..??............ . Per ................. --!?G•?--../. ....F???.._..?.- ^L
._. _ ......................
..
. Chairman of Tnwn .Board Building I _ nspector .
.caM++V & 1 4
EAGAN TO\IVN S H I P
IDILDING
1 11
Ownex l?.M
Address (presenS)
Buitder
Addxess
PERMiT
??140
------'---
DESCRIPTION
N° 667
Eagan Townshfip
Town Hall
Dale ??:.:./P...._?.....-'--.....
SYOries To Be Used For Fron! Depih Height L;; sS Permii Fee Remarks
/ - QP
Thispermii does noi authorise the use of sireeis, roads, alleys or sidewalks aor does it give the owner os his ageni
the righifo creaie any sifuafion which is a nuisance or which presenPs a haaard io the healSh, safeiy, eonvenience and
general welfase !o anyone in the communi3y.
THIS PERMIT MUST 8 PT THE RE I?WHILE THE WORK IS IN PROGFjFSS.
This is fo cerlify. !ha ?t` -- - - - --?. ..?-----_---has permission 3o erect a_tCC.li..?..-- -_ ' - 1--- i_---------------------------
the above descxi ed premise sub'eei fo e provisions of the Building qxd4"nce f a-p adopied April 11,
1955.
.._._._.... ,., . _. _...:.:!?..-`? C------------------- ...._ P
. ...._ _ ..'. ..
Ch ..._......._._.......
airman of Town Board ° nsaecfor
?o
CITY OF EAGAN
3830 Pilgt Knob Road
Eagan, Minnesota 55122-1897
(651) 681-4675
PERMIT
PERMITTYPE:
BuzLozNr
Permit Number: 033919
Date Issued: 11 / 0 3! 9 8
SITE ADDRESS:
4260 MOONSTONE DR
LQTs 21 131-OCK: 2
CEOAR GROVE #2
P.I.N.: 10-16701-210-02
DESCRIPTION:
?T.O. & RERDOF
B ilding?Permit Type
uilding g Wo`r-k Type
/ (?Cer?sus Code ??
\ -.
?
SF (MISC.)
REPATR
434 ALT. RESTDENTIAL
? ?!`i? ??? ? • _
REMARKS:
FEE SUMMARY:
VALUATTON
Base Fee
Surcharge
Total Fee
$2,000
$62.25
$63.25
CONTRACTOR:
4
I
I
OWNER: - p,pplicant -
GFlVLL PAUL
4260 MOONSTONE DR
EHGAN MN 55122
(651)688- 8806
I hereby acknowledqe that I hsve read this application and state that the
information is cprrect and a4ree to comply wiT.h all applicable 5tate of Mn.
Statutes and City oP Eagan Ordinances.
??\
APPLICAM/PERMITEE SIGNATURE
- I ED BY: SIGNATURE ?
?
?
-- _ ?
_r, r T4' t:iF I_:AWN
CASH?i.i::.R,". ?..
? .., TERM.i.i.,i.? ziny 787,
?"?:... ?., ? n.. D?.f...., 1.:}./03.'98 `i:i:h;E;; 0141m1"i;:
xr?.
_.. „
,.,.?..,, i.,?t.?
..l(..
321::' 9001 4260 iii.ifJNCTON:. r,+'',.'?.`
?1..? i `?3f)f?:l 4260 rf!.)t7?1 ; rn?..'ir , . .
. . J. ..:::1
q?I, ? .. ?,
.:..:. I'ie["L•i.l:i'i; AO':ci:_!'r5`;; _
CR'-19`aLi!'..?, (-•:i;.,c _
U':i!!:.',; ,:fi,: NANf'Y
5
1
1998 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
9 l n 3830 PII.OT KN ?O 7 RD - 55122
New Construction Reauirements
? 3 registered site surveys
• 2 copies of plans (inGuda beam & window saes; poured fnd. Cesign; etc.)
• 1 energy wlwlations
? 3 wpies of tree preservation plan ii lot platted after 711/93
required: _Yes No
DATE: /t' 3 .? ?
RemodeVReoair Reauirements
ai?
11-3-9e
? 2 coPbs ot plan
? 2 ske suneys (exterior add'Rions & decks)
? 1 energy calculaUons for heated addRions
CONSTRUCTION COST;
DESCRIPTION OF WORK:
STREET ADDRESS: D Y1,100"\ s S"??` e 13'iz-
LOT: ? BLOCK: -,)-- SUBD.lP.I.D. #: CQ o? C, V
PROPERTY
OWNER
Name: yav le ?\ Phone#: (o S? gC)(0
l.ast First
Street Address: q.Z (?p W00 ri.5 ?o''LC
City ? n ?i 4 h State: Zip:
Company:
CONTRACTOR
Street Adc
City _
ARCHITECT/
ENGiNEER Company:
Street
City
Sewer & water licensed plumber (new conshuctlon only):
and lot change is requested onCe pertnit is issued.
;?, oov
Zip:
Penalty applies when address diarg
I hereby_ acknowledge that I have read this application and state that the infortnation is cortect and agree to comply with all applica6!
State of Minnesota Statutes and Ciry of Eagan Ordinances. p
Signature of Applicant:
OFFICE USE ONLY
Certificates of Survey Received _ Yes _ No
Tree Preservation Pian Received _ Yes _ No
Phone #
License #
State: Zip:
Phone !Y:
Registration
State:
Not Required
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Dupiex
? 02 SF Dwelling ? 07 4-plex
O 03 SF Addition ? 08 8-piex
? 04 SF Porch ? 09 12-plex
? 05 SF Misc. ? 10 = piex
WORK TYPE
? 31 New ? 33 Afterations
? 32 Addition 0 34 Repair
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
Planning
? 11 Apt./Lodging ?
? 12 Muiti RepaiNRem. ?
? 13 Garage/Accessory O
? 14 Fireplace ?
? 15 Deck
? 36 Move
? 37 Demolition
Basement sq. ft.
_ Main level sq. ft.
_ sq. ft.
_ sq. ft.
_ sq.ft.
_ sq. ft.
_ Footprint sq. ft.
Building
Engineering
Variance
Permit Fee Co a- a5
Surcharge - O C
Plan Review
License
MCNVS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Pertnit
S!W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total: 3. a?S-
Valuation: $
16 Basement Finish
17 Swim Pool
20 Public Facility
21 Miscellaneous
MC/WS System
City Water
Fire Sprinklered
PRV
Booster Pump
Census Code.
SAC Code
Census Bldg
Census Unit
% SAC
SAC Units
PERMIT
City of Eagan Permit Type: Building
3830 Pilot Knob Rd Permit Number: EA084442
Eagan, MN 55122 . Date Issued: 07/17/2008
(651) 675-5675~~~ EPermit Category: ePermit
www.ci.eagan.mn.us lflflUl tflflLLL
Site Address: 4260 Moonstone Dr
Lot: 21 Block: 2 Addition: Cedar Grove 2nd
PID 10-16701-210-02
Use
Description:
Sub Type: e-Reroof Construction Type:
Work Type: Replace
Description: House & Garage
Census Code: 434- Occupancy:
Zoning:
Square Feet: 0
Comments: If there is no ice protection inspection prior to final, you must meet inspector with ladder and flat bar. Pictures are not
acceptable in lieu of inspections.
Fee Summary: BL - Base Fee $3K $88.50 0801.4085
Surcharge - Based on Valuation $3K $1.50 9001.2195
Valuation: 3,000.00
Total: $90.00
Contractor: -Applicant - Owner:
Ludzack Construction Inc Kyoung H Lee
13485 Skyline Circle 4260 Moonstone Dr
Shakopee MN 55379 Eagan MN 55122
(952) 445-9067
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
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PERMIT
City of Eagan Permit Type:Building
Permit Number:EA179694
Date Issued:10/18/2022
Permit Category:ePermit
Site Address: 4260 Moonstone Dr
Lot:21 Block: 2 Addition: Cedar Grove 2nd
PID:10-16701-02-210
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.
If water damage is encountered, please call (651) 675-5675 to schedule a site visit to verify the extent of the damage. Any
repairs must be inspected prior to covering. The inspector will determine if an additional permit will be required to repair the
water damage.
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:
This permit shall be null and void if work does not start within 180 days of issuance, or if work is suspended for 180 days or more after
started.
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 -
Kyoung Hwa Lee
4260 Moonstone Dr
Saint Paul MN 55122--204
Ashco Exteriors Inc
11164 Zealand Ave N
Champlin MN 55316
(763) 225-8333
Applicant/Permitee: Signature Issued By: Signature