4272 Moonstone Dr
Use BLUE or BLACK Ink
,
I
'
Permit
I~ Of E gm,n 05 1 1
Permit Fee: OC I
3830 Pilot Knob Road (((///0 1 1
C I Date Received: 1
Eagan MN 55122 1
Phone: (651) 675-5675 ffli~ 1 6 I
Staff:
I
Fax: 675-5694
2011 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: I I Site Address: q DjP itilyLckn6 Dr Ca Q a k~:)
Tenant: Suite
: , s -
RESIDENT/OWNER Name. ~ fTti1/ C1~I IrY1 ot'~.S Phone~0~i~ Y ~j
Address/ City/ Zip:
CONTRACTOR Name: License 31-1815874 Address: Appliance Connections nc City:
State: 'r ye: 61 y `I 5 `t
Contact: Shakopee, MN-l"a79
TYPE OF WORK - New Replacement _Repair -Rebuild _ Modify Space - Work in R.O.W.
Description of work:
PERMIT TYPE RESIDENTIAL
X Water Heater Water Softener
Lawn Irrigation RPZ PVB) Add Plumbing Fixtures 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._qopherstateonecall.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
acc dance with the approved plan i t case of work which requires a review and appro al of plans.
~ r
x
C )a mi, alpc~?'( 9 fy) e
x
Applicant's Printed N m App ican'fs Signatur
FOR OFFidE'USE Reviewed By Date:.
Required Inspections: 'Under Ground' ''°ROugh-In ;AlrTest GaSTest "'Final
s
Use BLUE or BLACK Ink
1
n ~c_cc
Cit of Ea I Permit G1~~'~~0 I
Ed 11 I 1
Permit Fee: I
3830 Pilot Knob Road I I
Eagan I VIN 55122 i Date Received:
I
Phone: (651) 675-5675 I
Fax: (651) 675-5694 Staff:
L________________~
INFLOW & INFILTRATION PERMIT APPLICATION
Plumbing I Sewer & Water
Date: Site Address: 117-1 Tenant: Suite
Name: Sa'n" Ca'10®S Phone: tf 2, D~141"99 Y
RESIDENT / OWNER Address/ City /Zip: l n n
I ZZ
Name: License
CONTRACTOR Address: City:
State: Zip: Phone:
Contact: Email:
PLUMBING (Within the building envelope) SEWER & WATER (Outside the building envelope)
TYPE OF WORK Sump Pump Repair Repair
Others D LLM J0 TbAll Other:
101
Description of work: j 5C1 pa n 1) LLM rte A L o in
DESCRIPTION
Ids - (-C)L"q 6 WL L InA
. -01 1 FEES
$55.00 / Each (includes $5.00 State Surcharge) TOTAL FEE $
*Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submit 1/1 repair costs for
reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors
can be found by visiting www.cityofeagan.com/inflow, or City Hall at 3830 Pilot Knob Rd.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call
48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and
codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a
permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans.
x <I.ndro. C M PdE~ x jqdAA2
Applicants Printed Name Applicant's Signature
FOR OFFICE USE Reviewed By: Date.
Required Inspections: -Under Ground -Rough-In !Final
CITY OF EAGAN
9796 Pltat Kwo6 Road Eagos, MN 55122 N! 4992
PHONE: 454-8100
BUILDING PERMIT Rece;pr #
To be wed fer Carage Addition Est. Value 1'400'ni) Date 9-26-7" 19
Site Address '., `" oonstrne I?r. ive Erect i
? OCCUpOnGy
Lot ? Block 2 Sec/Sub. CG2 Alter ? Zoning '
Porcel # Repair ? Fire Zone
Enlorge Type of Const.
.ee ':a s?•n?.
ce Nome Move ? # Stories
3 Address 4='72 "Toonszorie E)r. Demolish ? Front ft.
b Ci '=g31t Phone 454-3528 Grode ? Oepth ft.
. .. _... e...........i. e.e.
°C Nome
Zo
o? Addross
u
? r:«.,
Nome _
Address
I hereby acknowled9e thet I hove read this application and state that
the informatlon is correct ond agree to comply with all npplicable
Stote of Minnesoto Statutes and City of Eagan Ordinences.
$ignCture of Permittee
A Building Permit is issued to:
all work shall be done in occo
Building Officiol
Assessment _
Woter & 5ew.
Police
Flre
Eng.
Planner
Council
Bidg. Off. _
APe
Permit ' . " .
Surchorge '
Plon check
SAC
Water Conn.
Woter Meter
Toral
n `il_)? wlk- ^ on the express condition that
ith oll applicable Stote of Minr?esota Stotutes nnd City of Eogan Ordinances.
PennM # oaM Iswd ?awNtM
Plumbing
Mechaniwl
INSPECTIONS DATE INSP. Rouph-In Final
Footings Dats Irup. Dafe Irnp.
Foundotion plumbing
Frome/ins. Mechonicol
Finol
?
Remorks:
CITY OF EAGAN
Remarks Cedar Grove Acquisition
Lot 19 elk 2 Parcei 10 16701 120 02
Street 4272 Moonstone Dr. State Eagan., MN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREETSURF. 88.5- 1266.95 84.46 15 1266.95 C009944 11-9-84
STREET RESTOR.
GRADING
3f SAN SEW TRUNK
SEWER LATERAL 1972 1304.00 52.1
6?
2
_
WATERMAIN
# WATER LATERAL 1972
WATER AREA
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. '
BUILDING PER.
SAC ?-
PARK
EAGAN TOWNSHIP
BU,ILPING PERMIT
Ownar
Address
Builder ......._ ? . . . . ........... ' - - I.??'?!il :.
Addresc °-- ..................J.;l..`4?:. ?!._!..:?...?:?.I./..4:/.!!?//`
DESCAIPTION
N? 2555
Eagan Toweship
Towa Hall
D ete .J.4--t, / . A?.1.?.1• •-? -..
/
Bfosies To Sa Used For Fron! Depih Heigh! Eet. Cos! Permi! ea Ramarks
/l.L /O ??- ?W S.C 3r0a /n t ..X 4?4eol0 S?-
sireei, xoea or otner llefesipuon os Loca:ion I +.o= I niock I AC6lilOR 0I '129CI
? I ?Z-
This pe:mit does aot authorise !he use of alreele, roads, alleys ox sideaalke nor does it give !he owner or his agee!
!he righ! !o ereale anp situation whieh is a avisance or whieh presents a hsaard !o !he healih, safely, convenfeaee and
general welfare !o anpone in She eommunily. THIS PERMIT MUST BE,jCEPT4? N ?PREMIS/?j WHILE THE WORK IS IN PROG SS
This is 2o eaxlify. !haly?-1L1..?.KY..G{?....__..has permission !o erea! a.... . upoa
........... .................._. _
!he abgv,e dgsoribed premi0e,subjee! 20 !he provisions of the Bui?a?6"?dinanqe far? g? Township adopied April 11.
r
HOUSE HEATING TEST RECORD
ADDRESS 4,;t-7OZ M0 O ,"-S+?„'t' D(l° _ APTFLOOR C TY 6q
OCCUPANT OWNFR l9FNa(tAlhQ. ?alSw
HEATLOSS DATEHTG.INST.
SOLD ev HOME ENERGY CENTER INSTALLED BY HOME ENERGY CENTER
Electrical Work By HARRISON ELECTRIC Gas Line By
TYPE OF HEAT GA FA X HW- STEAM - SPACE HTR. UNIT HTR. OTHER
.13A5Wi9iG1'C ' .. ... . . . ' ...eFO ,. . „ „ .Model
Serial
THERMOST,
Valve W
Limit __j
Limit Setting
Fan Setting .
Pilot Type _
Pilot Make _
Pilot Model _
Pilot Tming.
L.W. Cut Ofl
Pressure
Input CFH
Stack Temp.
Form 235
Heat
MAKE OF BURNER_
Model
Max. BTU Rating _
MAKE OF FURNACE
: Model
C_
Percent C02
Percent 02_
Percent CO .
Vent Size
KIND OF LINER_
Draft Hood
Filters Size _
Chimney Location
Chimney Construction
Smoke Bomb _
Draft
Door Pressure_
Date Tested_
Company Testing
Name of Tester_
Inside
_ SIZE NONE
Regulator
Number
Wiring _
Test Tag
Lighting
EAGAN TO W IeI SHI P
BUILDINC; PERMIT
/??_?...
Ownex ----------------------------
Address (Presen3) ---:t?.7.?"•--- '-----'--'--..--__.__-----.l?l-e
Builder --.--....:(45?rv,?l,e•---Q--'-S..L?-`-------
Address ----------?-`-..-.-'------'---------.._.....__----
u
DESCRIPTION
N° 1478
Eagan Township
Town Hall
na:e.0-4q.._.17.r..?-2_.4.G...._.
4
5tories To He Vsed_ For Fronf Depih Heigh! Es:. Cos! Permi! Feel Remarks _
D 4 - --- -
LOCATION
Sireei, Road or oSher Descnp'.ion oT Locailon I Lot I filock i Addlf3on or TracY
I / 9 1 --?- ? 6 -,-L7 --.2--
This permii does nof aulhorise the use of streefs, roads, alleys or sidewelks nor does if give the owner or his ageaY
the righi !o create any sifuafion which is a nuisance or which presenis a hazard !o the healih, saleYp, convenience and
general welfaze fo anyone in the communify.
THIS PERMIT MUST BE 1{EPT ON THE PREMISE WHILE THE WORK IS IN PROGRESS.
?
This is fo aertify. lhaf.Qz -... WR.I-C.s.Y.t4-.4 - .____._..._.....has permission !o exect a__._.___.........."' """'. .. ' ' "" ...... upon
the above described premise suhjec! !o the provisions of the Building Ordinance tor E an Tow ship adopied April 11,
1955.
. . ...(l ?-?f?r-?.._..... Per - - -- - - '-_'. ... .......
........... "-"_'-""'-.'-
............ '- ---- ---- ' .
Chaixman of Tnwn ?Board ? $uildin Ins eclor
EAGAN TOWNSHIP
BLlILDINC; PERfv11T
Ownex "'-"--'..........
Address (pxesen!) ._.15A.4J......._?:....???. !?/?
?"' --- -- -'-
Buildez
Address
DESCRIPTION
N° . . 763
Eagan Township
Town Hall
Date ....?'?.l.----/?6/....
v
Sfories To Be Used For Froni Depih Heigh: Est. Cosf rmit Fee
P
o Remazks - - -
l5j? ?
?
?14 o
LOCATION
Sireei, xoau or oiner 17escr±piion ax i.ocation Lo! 7.'•lock I Aatliiion or 1raci
? • d..a ? &.d? ?. -A? A?
? M
This permit does noi aufho:iae 36e use of slreels, roads, alleys or sidewalks r.or does i3 give the owner or his ag-nt
the xighi !o creale any sikuation which is a nuisanee or which presenfs a hzzard !o the heal4h, safeSy, convenience and
general we3faze !o anyone in the eommunity.
THIS PERMIT MUST BE?KEPT OCrT?HE PREMISE WHIL£ THE WORI{ IS IN PROGHES3. ?
i
This is fo eertify, iha2.._._..?.??..................... hflspermission fo exeeija_'__. 4__.....___...._..._"""'_____ ------------ "_.upon
the above described prem' subjee-,]o ihg?? vxsions of Ehe Building Ord'anance for Eagan Township adopied April 11,
1955. ..Y..__`.....?T..'?
-----°--'°-??---°-----'-_ Per --------------_....---`----- °
""-.. _.--'- .................."---------_'°----
Chairman-..... -- of Tnwn Board Building Inspeclor
CITY OF EAGAN
3795 Pilof Kno6 Reod Eagae, MN 53122
PHONE: 454-8100
BUILDING PERMIT APPLICATION
r„ " ..,eA f,,. Garage Addition F? v„i,,, 1,400.00
Sire nddress 4G/L moonstone urive
Lot 19 Block Z Sec/Sub. CG2
Parcel #
w Name ?cc rminwicn
; Address 4272 Moonstone Dr.
?
?: Eagan ,,,,,,,_ 454-3528
?.
p J Name _
r
?? Address
f r:...
Name _
Address
I hereby acknowledge that I have read this application and state that
the information is correct and agree to comply with ull applicn6le
State of Minnewta Statutes and Ciry of Eagan Ordirances.
N2 4992
Receipf .fk ????" (;
Erect ? OccupancY ?
Alter ? Zoning R-1
Repair ? Fire Zone 3
Enlarge [$ Type of Const. V
Move ? #Srories
Demolish ? Front 18
Grade ? Depth 10 ft.
Aeeromis Fe¢5
Assessment _
Water & Sew
Police _
Fire
Eng.
Planner -
Council -
Bldg. Off. _
APC -
Permit V• uv
Surcharge 1. 00
Plon check
SAC
Water Conn.
Woter Meter
Totol 10.00
Signature of Permittee I
A Building Permit is issued to: L0e W on the express condition thM
ull work shall be done in acwy?" ?with ol a licable State?of Minnesota Statutes and City of Eagan Ordirancea
Buildinp Officfal ^-` "`"F.i'
??
,
?? Cdafi/v
BUILDING PERMIT APPISCATION
?Y7
Include 2 sets of plans, 1 site plan w/elevationa and 1 set of energy calculations.
7b be used far
Valuation
Site Address: ya-7a maTAsTMe Dz.rvz
L-o, qA-,., Vr, w _
Lot Block See. Sub.
i9 tq- GG ?
Owner J,,ra: IjALS?Jic1?
Address Qa.72 YY)o?w?Stdrie
T,> Am,V_mw .
Parcel Numbar
Telephone qsq -a?ag
Contractor
Addresa
Arch./Eltg.
Address
Erect '
Alter
Repair
Enlarge
Nbve
Tlemolish
Grade
Telephone
Telephone
OFFICE USE
pccupancy
Zoninq
Fire Zone
Type of Const.
# of Stories
Front
DePth ? 0
O£FICE USE
Date of Approval & Initial
Assessment
v7aterlSewer
Police
Fire
Enq.
Planriar
Council
Aldg. Off.
A.P.C.
FEES
Pezmit 9
Surcharge
Blan Check ?
SAC
tqater 4bnn.
S7atox Meter
TOTAT.
ities DiQital
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CITY USE ONLY /^
L BL o2. RECEIPT#: / r?,?(/S7
SUBD. Dr4? n/: Lr_.o±ac, "e,-Z?l RECEIPT OATE: ???P 97
1997 PLUMBING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
(612) 681-4675
Please complete for. . single family dwellings
. townhomes and condos when pertnits are required fbr each unit
? backflow preventer fbr underground sprinkler system
FIXTUREg EAC-H m TOTAL
Shower 3.00 x =
Water Closet 3.00 x =
Bath Tub 3.00 x =
Lavatory 3.00 x =
Kitchen Sink 3.00 x =
Laundry Tray 3.00 x =
3.00 x -
Water Fleatbr 3.00 x z0"2L
3.00 x
Gas Piping Outlet ' minlmum - t • 3.00 x =
Rough Openings 1.50 x =
Water Softener ' for dwellinga under consWCtion 5.00 x =
WaterSoftener 'torexistingdwelling 20.00 x =
U.G.Sprinkler 'tordweningunderconst. 3.00 =
U.G. Sprinkler ' for exisdng dxrelling 20.00 =
AftBf2t10n3 ' to existing rosidence 20.00 =
Water Tum Around 20.00 =
Private Disposal System * Dak Cty lic. 75.00 =
(new end reNrbished aystems)
Private Disposai Systems' anandonmerrc 20.00 =
STATE SURCHARGE
TOTAL
.50
I hereby ackrwvAedge that I have reed this applicaHon, state Nat the iMomietion ia corred, and agree M compry wfth all appliwble Ciry
of Eagan ordinances. ft is the appliraM's responsbility to notly Me property owner thet tha CNy of Eagan essumes no liebility fbr any
damages caused by 1he City during its rrortnal oparationel and meirRenence adN1Nes 'IiL'es corksWCled under this (xrtnit within
City Property/riphtof-way/easement. WpL5W I CK LEE
4272 MOOti51 OtiE DR I VE
SITE ADDRESS: ERGAPI , 55 122
01NNER NAME: H 454-3328 U
- '---
INSTALLER NAME:
STREET ADDRESS
CITY: M-PLS I -
ST
TELEPHQNE#:
ZIP: 5154n8
RE OF PERMITTEE
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g 33 7 a-
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675
New Comtruction Reauirements
• 3 registered site surveys showing sq. tt. of IoC sq. ft. ot house; and all roofed areas
(20% maximum lot coverage allowed)
• 2 copies of plan showing heam 8 window sizes; poured found desgn, etc.)
• 1 se[ of Energy CalculaGons
• 3 copies of Tree Presarva6on Plan if lot platted after 711l93
• Rim Joist Detad ODtions selection sheet (bidgs wiM 3 or less units)
DATE ?I? I ?- () ;L
SITE ADDRES
TYPE OF WO
APPLICANT
STREET ADDRESS
TELEPHONE # ?Q"3ClS-IY?CSCELL PHONE #
Idgas
RemodellReoair Renuirements
. 2 copies of plan
• 1 set of Energy Calculafions for heated additions
. 1 site survey for exterior additions 8 decks
• Indicate if home served by septic system for additions
?b
VALUATION ?? ?r? 0.
- v ? .
UITI-FAMILY BLDG Y N
FIREPLACE(S) _ 0 _ 1 _ 2
I,STATEP)A)ZIP?-?i?3t .?
FAX #
PROPERTYOWNER TELEPHONE#
-------------------------- -----.............. -------------------------------------------------
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MIVN1:50'1':\ RLfL1:5 7670 Gv1'CGORY I M[\\L:SO"1'A RiiL1:S 7672
(J submission type) • Residential Ventilation Category 1 Worksheet Submilled • New Energy Code Worksheet Submitied
• Energy Envelope Calculations Submitted
Plumbing Controctor: ____
PlumUing systcm includcs:
Mechanical Contractor:
V[cch,mic.ll svstcm includc;:
Sewer/Water Contractor:
_ Watcr Softcncr
Watcr Hcater
No. oC 13aths
Air Condilioning
I-Icat Rccox'cry Systcm
PllOl1l' #
Iawii Sprinklcr
No. of R.I. Baths
Phone #
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 Ordinances. I j
Signafure of AppBcant
OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4102
OFFICE USE ONLY
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 AccessoryBldg
? 02 SF Dwelling ? OS 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 ? 23 Porch (screened) ? 36 Multi
? OS 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
? 31 New ? 35 Int Improvement O 38 Demolish (Interior) ? 44 Sitling
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)" ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement 'Demolition (Entire Bldg only) - Give PCA handout to applicant
Valuation Occupancy MC/ES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footings (new bldg) Final/C.Q
_ Footings (deck) FinaWi o C.O.
_ Footings (addition) _ Plumbing
_ Foundation HVAC
_ Drain Tile Other
Roof _ Ice & Water _ F inal Pool
Ftgs
AidGas Tests Final
_ Framing _
_ _
_
Siding Stucco Stone _
_ Fireplace _ R.I. _ Air Tes[ _ Final _ Windows (new/replacement)
_ Insulation _ Retaining Wall
Approved By
Base Fee
Surcharge
Plan Review
MClES SAC
City SAC
Water Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
Building Inspector
MECHANICAL (RESIDENTIAL) -9z,6_-z
Permit Application
City OfEagan
3830 Pilot Knob Road, F,agan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5694
Plcasc complefe 1'or. Single Family Uwellings
'fownhomes and Condos when permits are requircd for each unit
Datc
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Property Owner 6P- .,4 lot t H'e' w&L S W l eK- Telep6one #( ) ?i? s? ' Y S`? ? 3 S`L
Contractor -
HOWIE ENEROY CENTER
StreetAddress 15= WM iPI28 City
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Tele
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The Applicant is _ Owner L-?'Contractor _ Other
Add-on, modification or alteration to existing dwelling unit $ 30AU
furnace replacement
air exchanger
air conditioner rn ?
other
- n
BY - ? g 50
State Surcharge
? 3o s?a
Total
l hereby apply for a Residential Mechanical Permit and acknowledge that the information is compiete and accurate; that the work will
be in conformance with the ordinances and codes of tlie City of Eagan and with the Mechanical Codes; that 1 understand this is noi n
permit, but only an application for a permit, and work is not to start without a permiY, that lhe work will be in accordance wiih ihc
approved plan in the case of work which requires a review and approval of plans.
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Applicaut's Printed Name Applicant's Signatur
MECHANICAL (COMMERCIAL)
Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone 9 651-675-5675 FAX 4 651-675-5694
Please complete for: commerci3l/industrial6uildings
multi-fam;ly buildings when separate permits are no[ required for each dwelling unit
Date
Site Address Unit #
Tenant Name (it applicablet Previous Tenant Name
? Peupeeiy O;vuer - - - --- ------ -- Telephone # ( )
Contractor
Street Address .,?v... ,.
City
State Zip Telephone # ( )
The Applicant is _ Owner Contractor Other
Work Type
_ Newconstruction UndergroundTank _Install _Remove
_ Interior Improvement. Call for inspection during installationfremoval of tank
_ Processed Piping
Nature of Work:
Permit F¢¢ $50.50 Minurtum Fee (includes Slale Surchargc)
Contract Value $ x ;.% = $ pe.rmitFee
• If permit fee is $1,000 or less, add $.50 => $ State Surcharge
If permit fee is over $1,000, add $.50 per
$1,000 Pemut Fee
$ Total Fee
. t___1_. _
_.,v,vuy nyp,y ,vi a wmmerciai rviecnamcat reruut antl acimowledge that the information is complete and accwate; that the work
will be in conformance with tae ordinances and codes of the City of Eagan and with the Mechanical Codes; that I understand this is
not a pemut, but only an application for a perniit, and work is not to start witLout a permit; that the work will be in accordance with
the approved plan in the case of woik which requires a review and approval of plans.
ApplicanYs Printed Name
ApplicanPs Signature
Approved By: , Inspector Date:
-;? ys2"1
Zoos RESIDENTIAL PLUMBING PeRnnir aaPLicartoN
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please complete for modifications to existing residential dwellings.
$'iS. 5 0
Date'D7 23I05
- CAMPOS,SAN?RA
SItB Street AddfeSS _ 4272 MOONSTONE DRIVE U?I? #
EAGAN, MN 55122
(612) 242-9959
PropertyOwner Telephoneq ( )
Contractor. Ndrblum PLL4,m (7f n ? Telephone#
Address 2-qD5 C1ar"FI$L4 f1V. SD. City mTZS Statem k1 Zip(?Gqog
11,
The Applicant is: _ Owner V Contractor _Other
Septic System _ New _ Refurbished Submit 2 sets of plans and MPC license includes County fee
$ 100.00
' Per as-built $ 10.00
Alterations to existing dwelling $ 50.00
_ Add plumhing fixtures. This fee includes instaliation of a water softener andlor water
heater at the same time. If you are installing onlv a water sottener and/or water
heater, do not complete this section; move to the next section and check the
appliance(s) you are instaliing.
_Septic System Abandonment ? - L 8
_Water Turnaround (add $130.00 if a 5/8" meter is required)
Other:
/
Water Softener
Water Heater $ 15.00
/
_ new 1! replacement
Lawn Irrigation _RPZ _PV8 _new _repair _rebuild $ 30.00
State Surcharge $ .50
Total $ i GJ 5n
I hereby apply for a Residential Plumbing 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 plumbing codes; that I
understand this is not a permit, but only an application for a permit, work is not t stait without a permit and work will be in
accordance with the approved plan in the event a plan is required to ZSe`;evje?{u?Ianh[approyed. ,
Jeff-rew L. Nortlorvi, ?i`?
ApplicanYs PrinfL:rd Name
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 4272 Moonstone Dr
Lot: 19 Block: 2 Addition: Cedar Grove 2nd
PID:10- 16701 - 190 -02
Use:
Description:
Sub Type: e- Reroof
Work Type: Replace
Description: House
Census Code: 434 -
Zoning:
Square Feet: 0
Comments: If there is no ice protection inspec
acceptable in lieu of inspections.
Fee Summary:
Valuation: 3,000.00
Contractor:
New Life Contracting Inc.
2478 Hillwood Dr E
Maplewood MN 55119
(651) 274 -6943
steven virkus
PERMIT
City of Eaan
BL - Base Fee $3K
Surcharge - Based on Valuation $3K
Total:
Applicant/Permitee: Signature
- Applicant -
Construction Type:
Occupancy:
Permit Type:
Permit Number:
Date Issued:
Permit Category:
on prior to final, you must meet inspector with ladder and flat bar. Pictures are not
Owner:
Sandra J Campos
4272 Moonstone Dr
Eagan MN 55122- -204
$88.50 0801.4085
$1.50 9001.2195
$90.00
Issued By: Signature
Building
EA086130
09/16/2008
ePermit
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
46.
City of Eapil
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
r
Use BLUE or BLACK Ink
For Office Use
Permit #:
I O (
Permit Fee: L.V" ®
Date Re eived:
Staff:
2011 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: LIZ -72— . .4tiSTrp vf-') DXIy /a4/.4-ri . - -ti 5)71L Unit #:
Name: SOL n8 rC Ca. tn, ip c
Address / City / Zip: 427.2 Dlt _ E/4G .-tom
Applicant is: X Owner
Contractor
Phone:4 1 f
Description ofwork:4j tAE-55 ltb..7t' t _
Construction Cost:
Multi -Family Building: (Yes / No X )
Company: Contact:
Address: City:
State: Zip: Phone:
License #: 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:
Phone:
Sewer & Water Contractor: Phone:
Mechanical Contractor:
NOTE: Plans and supporting documents that you submit are considered to be pu,
the information maybe classrbed as non-public tf you provide specific reasons tl
conclude that they are trade
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 1 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 U (a_Ca pryl poS
Applicant's Printed Name
Applicant's Signature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA116976
Date Issued:10/14/2013
Permit Category:ePermit
Site Address: 4272 Moonstone Dr
Lot:19 Block: 2 Addition: Cedar Grove 2nd
PID:10-16701-02-190
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:
Census Code:434 -
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 by law in ALL single family homes .
Chuck Glum
Valuation: 4,000.00
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 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 -
Sandra J Campos
4272 Moonstone Dr
Eagan MN 55122--204
Highmark Exteriors
11237 Nicollet Ave S
Burnsville MN 55337
(952) 882-8904
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA127900
Date Issued:10/20/2014
Permit Category:ePermit
Site Address: 4272 Moonstone Dr
Lot:19 Block: 2 Addition: Cedar Grove 2nd
PID:10-16701-02-190
Use:
Description:
Sub Type:Fireplace
Work Type:Gas Insert
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home may require smoke detectors in all bedrooms. Chimney / flue must be inspected prior to
concealing.
Carbon monoxide detectors are required by law in ALL single family homes .
Valuation: 3,000.00
Fee Summary:BL - Base Fee $3K $88.50 0801.4085
Surcharge - Based on Valuation $3K $1.50 9001.2195
$90.00 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 -
Sandra J Campos
4272 Moonstone Dr
Eagan MN 55122--204
Hearth And Home Technologies
2700 N. Fairview Ave
Roseville MN 55113
(651) 638-3309
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA163061
Date Issued:08/12/2020
Permit Category:ePermit
Site Address: 4272 Moonstone Dr
Lot:19 Block: 2 Addition: Cedar Grove 2nd
PID:10-16701-02-190
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 -
Steven J Lawrence
4272 Moonstone Dr
Eagan MN 55122
Renewal Andersen
1920 County Road C West
Roseville MN 55113
(651) 264-4777
Applicant/Permitee: Signature Issued By: Signature