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4381 Nybro Cir1% CASH RECEIPT CITY OF EAGAN 3795 PILOT KNOB ROAD EAGAN, MINNESOTA 55122 DATE 19 REGQIVIED FRpM AMOUrur $ I DOLLARS foo ? CASH ? CHECK FOR BY 05136 NUMERICAL FILE COPY 5ite Address !: ! 7 Nvh Lot ' Block ? Parcel # W Name _ 3 Address 0 o Name 9i13P.21 ti 627 $O. oQ Address Uce r:.., , i. }'au Z Name _ Address I hereby ocknowledge that I hove read this the informotion is correct and cgree to c Stote of Minnesoto Stotutes and City of Signature of Permittee A Building Permit is issued to: oll work shull be done in accordance with Building Official Erect 1?'] Occupancy SS PtUT1 4 tAlter ? Zoning Repair ? Fire Zone ? Enlarge ? Type of Const. 5 - Move ? # Stories Demolish ? Front ft. 6rode ? Depth ft. Approvals Fees Assessment Permit %a• 50 Water & Sew. Surcharge 4?+•dc? ? Police Plan check Fire SAC 4 7 5•00 Eng. _ Woter Conn. " 26• 00 Planner WaterMeter 60•o« Council _ ond state that gld9 p{f . oll applicobie APC Total y1`+•5C tonces . ' on the express condition thot Stote of Minnesota Statutes ond City of Easan Ordinonces. CITY OF EAGAN 3795 Pilot Knob Road Eagon, MN 55122 NE 4207 PHONE: 454-81 CO . . BUILDING PERMIT ? `sL`: '°ReceiPt # Pom+it # OaN Iuwd heriMtM Plumbing Mechanical - INSPECTIOh15 DATE INSP. Rouph-in Firal Footings _ ? Date Inap. Dote Irnp. Foundation Plumbing . o. Frame/ins. MechoniCal k -.0e . Finol " I it - 0v . Remarks: 3830 Pllot Knob BUILDING PERMIT Tobeusedfor f'? !_P;'L,,.."... Lot ' Block Parcel No. : Name •++v 5 t:? W 3 Address a City Phone o Name '?-i• ?CONS'i' 0 ? Address P City Phone City that I have read this application and state xrectand agree to complywith all applicable State of Mfnnesota Signature of Perm A Buildfng Permit Is i: all work shall be dono CITY OF EAGAN iad, P.O. Box 21-199, Eagen, MN 55121 PH ON E: 454-8100 ao?otnr * 14029 ,19 Value 58,500 OFFI CE USE ONLY On Site Sewage _ OccupanCy MWCC System _ Zoning On Site Well _ Type of Const City Water _ (Actuaq (Allowable) # of Storles Length Depth S.F. Total Footprlnt S.F. APPROVALS FEES Assessments _ Permit :-? • SV Water/Sewer _ Surcharge 5i % Police _ Plan Review Fire _ SAC, Cfty Engc _ SAC, MWCC Planner _ Water Conn. Council _ Water Meter Bidg. Off. _ Road Unit APC _ Treatment P1 Variance _ Parks Copies TOTAL - on the express conditfon that nnesota Statutes and City of Eagan Ordinances BUN k Permit No. Permit Holder Date Tslephons 7t Plumbing H.V.AC. Electric Softener Inspection Date Insp. Comments Footings I Footings II Foundation Framing Roofing Rough Plbg. Rough Htg. Isul. Fireplace Final Htg. Final Plbg. Bldg. Final Cert. Occ. Temp. LP Deck Ftg. Deck Frmg. _7,r7 Well Pr. Disp. CITY OF EAGAN Remarks Addition Wilderness Run 4th Addition Lot 8 Rik 3 Parcel 10 84353 080 03 owner =d.?? ?•? ?iU??.?(DLit ttilf,J, Sveet 4381 Nvbro Circle State Eagan, MN 55123 Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. STREET RESTOR. GRADING SAN SEW TFiUNK 1973 $163.26 $8.16 20 SEWER LATERAL WATERMAIN WATER LATERAL WATER AREA STORM SEW TRK STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATERCONN. 220.00 05136 1-21-77 BUILDING PER. SAC 475-00 05136 1-2j-']7 PARK CITY OF EAGAN 3795 Pilof Knob Road Eagon, MN 55122 Zoning; _ Owner. ' Address: Site Address: Plumber: Meter No.: Size: Reader No.: I agree to eomply with 4he City of Eogon Ordinances. By _ Qote of I nsp.: - CITY OF EAGAN 379:o' Pilot Knob Road Eogan, MN $5122 f3nmeS IriC. WATER SERVICE PERMIT PERMIT NO.: DATE: - No. of Units: - Connection Chorge: _ AcCOUnt Deposit: - Permit Fee: Surchurge: Misc. Charges: Tota I: - Dpte Paid: - Insp.: SEWER SERVICE PERMIT PERMIT NO.: DATE: No. of Units: Address: `f3:;I ':]Vti•.r0 r'tr'cle T,, n.3 tl?; . ogree to aomply with fhe City oF Eagan e of Insp.: Connection Charge: Acwunt Deposit: _ Permit Fee: Surcharge: Misc. Charges: - Tota I: I , anr oF eacaN t 3795 Piloe Knob Rood Eegan, MN 53124 . i PHONE: 454-6700 BUILDING PERMIT APPLICATION $ 48,000. Receipt To ne uma fo. Sing. Fam L1wlg. & Garg. Dote N2 4207 # Jan. 21? iq 77 $ite Address3$1 UT LA rT---- Erect 7F] Occupanry_ Lor $ ai«k 3 sec/s,b. Wilderness Run 4th Aire. ? zonin9 Porcel # Repoir ? Fire Zone _ 5 Enlarge ? Type of Canst. z Name RLLSSeIl HBnsen Move ? # Stories 3 Address Demolish ? Front 64 ft. ? Cit Phone Grade ? Depth 38 _ ft. p Name Tilsen H Inc. omes Aovrovals Fees 0 o" Address 627 So. , Sne113IIg AVe. Assessment Permit 135,50 _ P8U1 St u? Water&Sew. Surcharge 24.00 , Cit phone Police Plan check Uw Name Fw ? Fire 475,00 SAC ?? Address Eng. Water Conn.220.00 Cit Phone Plunner WoferMeter 60,00 Council I hereby acknowledge that I have read this opplicotion and state that gldg. Off. the information is carrect and agree to comply with oll applicable Stote of Minnesoto Sta!ute?s and? City of Eogon Ordinonces. Signature ot Permittee/_1.L-L?7` ?4"°S1P • ? APC roral 914.50 A Building Permit is issued to: on the express condition that all work sholl a 'n occordanc ? all opplicable State of Minnewta Statutes and City of Eagan Ordinonces. Building Offiuo CITY OF EAGAN o 3830 Pilot Knob Road, P.O. Box 21 •199, Eagan, MN 55121 N PHONE: 454-8100 Receipt ---? ? BUILDING PERMIT # To be used for PORCH/DECK Est Value $8, 500 Date AUGUST 7 14029 1987 SiteAddress 4381 NYSRO CIRCLE OFFICE USE ONLY Lot 8 Block 3 Sec/Sub. WILDERNESS RUN 4 On Site Sewege _ Occupancy MWCCSystem _ Zoning Parcel No. On Site well _ 7ype of Const City Water _ (ACtufll) a Name RUSS HANSEN (Allowable) w Address SAME # of Stories ; Length ° Ciry Phone 454-3461 oepm S.F. Total , o Name VALLEY INVESTMENTS CONST FootorintSF. ?? i Address 3770 S LEXINGTON APPROVALS FEES CityEAGAN phone 454-5191 Assessments Permit $86.50 WaterySewer Surcharge 4_ Sn W w Name Police _ Plan Review ? i x- Address Fire SAC, Ciry - ai Engc _ SAC,MWCC aW City Phone Planner _ WaterConn. Council _ WaterMeter I hereby acknowledge that I have reAd this application end state Bldg. OFf. _ Roed Unit thattheinformationisc tandagreetocomplywithallapplicable APC _ TreatmentPl State oi Minnesota 5 tutes nd City of Eeg n rdinance6. Variance _ Parks 4 Copiea SlgnatUfe Of Pefmit B_ ? TOTAL $91 • 00 A Building Permit is issued o VALLEY INVESTMENTS CONST on the expresa condition that all work shall be done in a rdance with all applicaDYMate of Mi nne0[a ?tautes and City of Eagan Ordinances Building Official 16 CITY tiF S'?G1dD7 3795 Piiot Mab Road - Eagan, i+Iinnesota 55122 PERtiffT N0. : R 31 TY,e City o£ Eagan hereby grants to A. sinAer s Son, Inc. of 120 L•. Rutler Tilsen g HEATID`G permit for:- Constrssetion Co. 4424 Wildernesa Run Ct., f Trail, and at4236 N. carlson .are hnpursuant to application dated 12/2/76 . Pee Paid: S60.00 dated this g day of necember 9 19 7e ? 1.50 s/c Building Inspector N,echanical Permits: Bid Tota.l: o), 0Va-D/g"7 REQUEST FOR ELECTRICAL WSPECTION es/-oooo 1 Sea instructions for completing this torm on back of vellow copy. 7?sp?0 731 2 "X" Be/ow Work Covered by 7his Request Adc1 Peu? qpa ol Building Applian<na WireE Equiument WireA Home Range Temporary Service Duplax Water Heater Liyhtiny Fixtures Apt. Building Dryer ' Etectric Healin Commercial Bldy. Fumace Sllo Unlonder lndustrial Bldg. Air Conditioner Bulk Milk Tenk Farm otnr, aec, v p oiner Isnec?tvi t er Suecify Other pth¢r Compu[e Inspection fee Be/ow " p Fee Service EnVanceSiza p Fae Fanders/5ubleeders N Fee Circuits 0 to200qm s 0 to30Am s 0 to30Am s Above 200 qmoy.. 31 to 100 Amps 31 to 100 Amps L 1 41 Swimming Pool Above 100-Am s Above 100-Amps Transformers Irrigation Booms Partial.-0ther Fee- Signs Special Inspection M `' T N ertarks 3„2, .5 OTAL FE ? tha ElecnieaJ/ I^spectoq hereby •?Y•-10[!' certilV that the above Final . ///? ( UIIale / inspaction has baen _ f / f i _ r .. ./1" MI",fll?? mede. rnie reyuast .oia This request voitl 18 nwnths from p D 7 3 3 ?6.0r8' ;'11-? ---) 1-0 Rxqoes[,JJ?{e ,.? G-7 jJ O Fire No. qnuph-in InsVection RequireA? vv, E]fleatly Now ll No?ify Insue r l Wh lp, yes or en ReaAy oLicensed Elec[rical Conlnetnr 1 hereby request inspection af ebove ? Owner eiectncel work installe0 ar. Sveet Address, Boz or floute No. City 3(39/ 4 ypoA / (_/BCL6 AAl ovntv I OccuDnnt ier I ElecVical Con[rac[or z -- ??,??r ?Bn?T,eeC I Yo Z Y9 -! ? MaJm9 Address IConvaclor or Owner Makinp Instailation) ? Y.rs =ts7? MINNESOTA STATE BOANO OF-ELECTNICITV THIS INSPECTION flEQUEST WILL NOT Grigga•Mitlway Bidg. - Reom N-191 BE ACCEPTED BY THE STATE BOAND 1821 University Ave.. St. Paul, MN 65104 UNLESS PflOPEH INSPECTION FEE IS Phone (612) 662-0800 ENCLOSED. REQUEST FOR ELECTRICAL INSPECTION ee-oucoi.oo I, See instructions far complatirq this form on back of yellow copy. ?d'4 3 5 5 `r"WtW Work Covered by 7his Request Ne. Hdd Rep. Type ol Building Apolinncee Wired Equiument Wired Home Range Temporary Service Duplez Water Heater Lighting Fixtures Apt. Building Dryer Eiectric Heattn Commercial Bldg. Furnace Silo Unlonder Industrial Bidg. Air Conditioner Bulk Milk Tdnk Farm Oahur Specrtv 51her Isi?ecit?l t er SuecifY i er Othir i Compute lnspectron Fee Below .. p Feo ServiceEntrencaSize t! Fee FeederelSubieede+s # Fee Gircuns 0 to200qms 0 to30Ams Oto30Ams Above 200 qmps 31 to 100 Amps 31 to 100 A s Swinvning Pool A6ove 100- Am s Above 100_P,mps Trensiormers lrngation l3oorr?s Pdrtial/ ee . Signs Special Inspection S ? 1 TOT L FE Remarks r? . E p 1 IM. / Final I, tha EreCTri-ca InsDector, herel ciatity ihat the IOSpBCliOl1 h85 madB. H0 ? `? ?. 12, This reQUest void 18 rmnths 7mm . / C 44355 / 5'%Q ;?- ??J-?f?X 'GYtY.!?/L ]?Loi.'?7',!`1 r'S/O cr•? Rquast Date " a Fire No. Foupn-in Insoer,tion Requ ?reA? Ready Nuw?(Jill Notity Inspec- ? 7 g '?- ' N ? Y ?or When Ready U es o ? Licensed Electrical Conlractor I hareby repuest ins0action at above ? Owner eleclrical work inslalled at: Street Address, Boa Or Poute No. CitY / ec ion o. Town ip Name or No. Range o. County u/ / C Occupent (PRINT) Phone No. `,2 - Power Supplier Adtlress - PAkdrA Electricel ConUacmr (COmpany Nnme) Contractor's License No. Mailinq Address (Contractor or Owner Making Instatlation) Author' Sipnature ICo actodOwner Making Installation) Phone Number ? MINNESOTA STqTE BOAPD OF ELECTRICITY THIS INSGECTION REQU[ST WILL NOT Griges-Mitlway Bldg. - Room N•197 BE ACCEPTED BY THE STATE BOARD 1821 UniversitY Ave., St Paul, MN 55104 UNLESS PROPEA INSPECTION FEE IS ph- 16121 297.2111 ENCLOSED. ? '.?j ??-- ? REQUEST FOR ELECTRICAL INSPECTION °'" ?"`'?, ee-ooom-oe See inslmctions for mmpleting this form on Oack ol yellow wpy. ? °?zl 5 3 6?^ Covered by This Request ew Atld Rep. TypeofBUiltling AppliancesWired EquipmeniWired Home Range Temporary Service Duplex Water Heater Electric Heating ApL Building Dryer Other_(Specify) Comm./lntlustrial Furnace Farm Air Conditioner Other (speciry) Comractor5 flemarks: 6?'J Compute Inspection Fee Below: IT?, # Othar Fee # ServiceEntranceSize Fee M Cirwi45iFeeders Fee Swimming Pool 0 to 200 Amps o to 100 Amps Transformers Above 200 _ Amps Above 100 _ Amps Si905 Inspector's U. Only: TOTAL Irrigalion Booms A5; S-0 Special Inspection ? Alarm/Communication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT Other Fee COMPLETED WITHIN 18 MONTHS. I, the Electrical Inspector, hereby Rough-in oera certify that the above inspection has been made. Final ? -9 OFFICE USE ONLY Tiiis request witl 18 monfis imm K 5 3 2 ?o tr ?y ? fteque t Oate ? 0-9 ? Fire No. Rough-in Inspection Re uired? ?Reatly Now ? Will NMity InBpettor n F 9 Wh d i ? Yes a e ea Y 1 9 licensed coniractor p owner hereby request inspection of above electrical work at: Jab AOtlress IStreeL Box or Rou[e ?t3 Fr) ,.t y? eo efz . c? Seclion No. Towns?ip Name or No. Range No. G\ouny w • ?? ( ? Occu an1 fPRINTi ? k5 S ?l ?}rt 5?l Phone No. ?lSZ-- 3?-16 ( Po er SupPl^rer ?? Y'S Atltlress Elea cal Convacmr IGompany Name) i.i`f Ct?c-T?kc' ConVaCtorS License No. G+4 pORS(o Mailing Atlaress Iconttacto?r /o.Owner Making Installationl Z? rC?F V?. r W? 1„"fV. ,,• ` U/ Y'??1 ?bZ 1 Aut ignatur9? rac nOwner Making Installation) PM1One NumDer (oC?"6z ? Z -. HICITY THIS INSPECTION REOUEST WILL NOT MINNESOTA ST -46B RD OF ELE 411 Griggs-Mltlway BICg. - Roam S113 9E ACCEPTED BV TME STATE BOARO 1821 University Rve., 5t. Paul, MN 55100 UNLESS PROPER INSPECTION FEE IS PIwM(61Y) 661-0800 ENGLOSED. 2005 RESIDENTIAL MECHANICAL PERMIT APPLICATION City Of Eagan 3830 Pilot Kno6 Road, Eagan MN 55122 Telephone # 651-675-5675 Please complete for, single family dwellings & townhomeslcondos when permits are required for each unit 3?_1?0 Date 09 / 02 / 05 Site Address 4381 Nvbro Ci r. Unst # Property Owner DiPk & LOrI Holmen Telephone#( 651 ) 405-8548 Contractor Boehm Heati ng Company StreetAddress 1598 Selbv Avenue City St.Pdul State MN Zip 55104 Telep6ane #( 651 ) 644-1410 Bond #: 55-186409 Expires: 8/17/06 The Applicant is _ Owner X Contractor _ Other Add-on or alteration to existing dwelling unit $ 30.D0 X furnace -Additional _Replacement ' air exchanger X airconditioner _New X Replacement other State Surcharge s .50 Total $ 30.50 I hereby apply for a Residential Mechanical Permit and acknowledge that the information is complete and accurate; that the work will 6e in conformance with the ordinances and codes of the City of Eagan and with the Mechanical Codes; 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 cequires a review and approval of plans. Applicant's Printed Name ` - -- - ---- ?? Apphcac t's Signatu ° 2005 COMMERCIAL MECHANICAL PERMIT APPLICATION City Of Eagan 3830 Pilot Knob Road, Eagau MN 55122 ? Telephone # 651-675-5675 Please complete for: commerciaUindustrial buildings . multi-family buildings when separate pertnits are not required for each dwelling unit Date Site Street Address Unit # Tenant Name (if applicable) Previous Tenant Name Property Owner Telep6one # ( ) Contractor Street Address City a State Zip Telephone # ( ') Bond #: Expires: . : The Applicant is Owner Contractor i Other Work Type New Construction _ Underground Tank _ Install _Remove **see below fnterior Improvement _ Install Piping _ Processed _Gas Nature of Work: *'When installing/removing underground tank, ca!l for inspection by Fire Marshal and Plumbing /nspector Permit Fees: S70.50 Underground tank installation/removal $50.50 Minimum(includes State Surcharge) I or „ Contract Value $ x 1% _ $ Permit Fee • If en rmit fee is $1,000 or less, add $.50 => $ State Surcharge If pe rmit Fee is over $1,000, add $.50 for every $1,000 ermit fee $ Total Fee I hereby apply for a Commercial Mechanical 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 with the Mechanical Codes; that I understand this is ?ot 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. ApplicznYs Printed Name Applicant's Signature Approved By: , Inspector RESIDENTIAL BUILDING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB RD, EAGAN MN 55122 651-681-4675 New Construction Reauirements • 3 registered site surveys showing sq. ft. of lot. sq, N. of house; and all roofed areas (20% maximum lot coverage allowed) • 2 copies otplan showing 6eam & window sizes; poured (ound design, elc.) • 1 set of Energy Calculations • 3 copies of Tree Preservation Plan if lol platted afler 711193 . Rim Joist Delail Options selection sheet (61dgs with 3 orless uniGs) DATE l5 - ?J1? ? Oa. SITE ADDRESS TYPE OF MULTI-FAMILY BLDG _ Y ?,,r N _ 0 _ i _ 2 APPLICANTJM•E1orw.n'Lle?{' Tx?.1?'fbS0.FCS , STREETADDRESS?COC?bC-?ltA+o,.??xx? CITY'R??"tiAVYEe` STATE Ci ZIP30537 TELEPHONE # 4(4354Q-S$dlo CELL PHONE # FAX # PROPERTY OWN ER'Vt CYC. MIrN-CI,(NZ?i TELEPHONE# I05I•409' S$-'qg -------------------------------------------°-------------------------------------------------- COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category _ _N41NNl':SO'I'.11tULE5 7670 CATEGORY t YIINNE50"I'A ROLES 7672 (J submission type) . Residential Ventilation Category 7 Worksheet Submitted • New Energy Code Worksheet Submitted • Energy Envelope Calculations Su6mitted Plumbing Contractor: _ Phonc Plutnbing systein includes: _ Water Sof[encr Lawn e: ? Sp *1. 77 Water Heater No. oF R? No. oF Baths Mechanical Contractor: Mcchartical svstem includcs: Sewer/Water Contractor: Phone # Fcc: $70.00 ---°----°---°--------------------------------------------------°-----------°----------------------------------------- I hereby acknowiedge that I have read this appiication, state that the i formation is correct, and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Or nances. SlgnaTure of Applican? ?- -------- ------------------ -------------------------------------------------------------------- ------- --------------------------------------------- -------- ---- OFFICF. USE ONLY Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _ Upda[ed 4/02 _ Air Conditioiiing _ I-(cat Rccovcry Systcm RemodellReoair Reauirements . 2 copies of plan • 1 set of Energy Calculatlons for heated addi[ions • 1 site survey for extenor adCitions & decks . Indica[e if home served hy sep[ic system for additions v VALUATION ? 1(09 7 bFFIbE USE ONLY I ? 01 Foundation ? 02 SF Dwelling ? 03 01 of _ plex ? 04 02-plex ? OS 03-plex ? 06 D4-plex ? 31 New ? 32 Addition ? 33 Alteration ? 34 Replacement u ? zo Pooi il ? 21 Porch (3-sea.) ? 22 Porch/Addn. (4-sea.) ? 23 Porch (screened) I? ? 24 Storm Damage !I ? 25 Miscellaneous ?I ? 30 Accessory Bidg ? 31 Ext. Alt,- Multi ? 33 Eut. Alt'- SF ? 36 Multi ? 35 Int Improvement ? 38 Demolish (Interior) O 44 Siding ? 36 Move Bldg. ? 42 Demolish (FOUndation) O 45 Fire Repair ? 37 Demolish (Bidg)' ? 43 Reroof .0 46 Windows/Dnors . `Demolition (Entire Bldg only) - Give PCA handout to ap;'plicant Valuation Occupancy • MC/ES S?ystem ' Census Code Zoning - City Watelr SAC Units ' Stories Booster P,ump Nbr. of Units Sq. Ft. PRV - i% ' Nbr. of Bldgs ' Length Fire.Sprinklered Type of Const Width REQUIRED INSPECTIONS Footirigs (new bldg) FinaUC.O. Il _ FooCings (deck) FinaUNo C.O. i _ Footings (addirion) Plumbing i _ Founda[ion HVAC II Drain Tile Other Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests _ Final _ Framing _ Sidm Stucco S[oneq _ Ficeplace _ R.I. Air Test Final Windows (new/replacement) I? _ Insulation _ Retaininn, Wall I Approved By Base Fee Surcharge Plan Review MC/ES SAC City SAC Water Supply & Storage S&W Permit & Surcharge Treatment Plant Plumbing Permit Mechanical Permit License Search Copies Other Total 0 07 OS-plex ? 13 16-plex ? OS 06-plex ? 16 Fireplace ? 09 07-plex ? 77 Garage ? 10 08-plex ? 18 Deck ? 11 10-plex ? 19 Lower Level ? 12 12-plex Plbg_Y ar _ N Building Inspector installed ' Siding'andIMW&RspOWER OF ATTORNEY - ' OF COBB STATE OF GEORGIA KNOW ALL PEOPLE BY THESE PRESENTS: THAT I, David N. Katz, a resident of Montgomery County, Pennsylvania ("Principal"), and a licensed contractor of RMA Home Services, Inc., DSA Home Depot Installed Sales located at 660 Mendelssohn Avenue North, Golden Valley, MN 55427, having a license number of BG 20268257, do hereby appoint, name and constitute Elder-Jones Building Permit Service, Inc. ("AgenY') 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, aclrnow(edge, 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 installation, maintenance and repair of windows and siding (the "Work"). The powers conveyed to the Agent by this Limited Power of Attorney are'•: ' limited solely to the express powers delineated herein and apply solely to the Work: This Limited Power of Attorney shall expire and automatically be revoked on the 300' day of May, 2003, which date is one year from the execution hereo£ 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 WIT'NES3 WIEREOF this Limited Power of Attorney is executed this 30rA day of t'+/i/h`F , 2002. a kiz?? David . z SWORN TO AND SUBSCRIBED BEFORE ME by David N. Katz on this 30`h day of May, Notazy blic in for the Stat of eorgia My Commission Expires: 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 ? SINGLE FAMILY DWELLINGS IPCLDDE 2 SETS OF PLAPS, 3 CERTIFICAT&S OF SIIRVEY, 1 SST OF ENERGY C9LCI(LATIOAS NOTE: ADDRESSES FOB COHNER LOTS - CONTR9CTOR/HOMEOSiNER MDST DESIGHATE WHICH ADDRESS IS DESIRfiD. NO CHANGfiS WILL BE ALLOWED ONCE BIIILDING PERMIT IS ISSQED. MOLTZPLE DWELLINGS - RFSIDENTI9L RENT9L 0IFITS FOR SALE ANITS INCLUDE 2 SETS OF PLANS, CERTIFIC9TS OF SITRYSY - CBECB GITH BLPG. DEPT., 1 SET OF ENERGY CALCULATIONS COiMMERCI9L INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS, 1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS! $2,000 LANDSCAPE BOND ?,SE/5-S0nl POP-c.FE To Be Used For: Valuation: Site Address 14381 Lot ? Block 3 Parcel/Sub Owner 77q'1uta/J r /r p Address `73a ( N 46P-0 City/Zip Code )?&60-rj Phone `f.5 Y - c7 S0c ? Date: On Site Sewage MWCC System On Site Well _ City Water _ APPRODALS Contractor (/(-?-(.(?? 1Nd? STMFN'?3 IOpK' Assessments ? Water/Sewer Address 377d S Police Fire City/Zip Code j5a¢?'j4-11) Engr q Planner Phone Couneil Bldg Off Arch./Engr. APC Variance Address City/Zip Code Phone # Occupancy Zoning Type of Const (Actual) (Allowable) # of Stories Length Depth S.F. Total Footprint S.F. FEES Permit R6.so Sureharge q r° Plan Review SAC, City SAC, MWCC Water Conn Water Meter Road Unit Treatment P1 Parks Copies TOTAL 91. 00 („?1bz? f ? J - ? I? I MI J ? ,P_Elg,?- Ako.0'eeTY LvvE ? 6v, ?i -A?,?.ry UN?`? n Q ? D .? ? ?AE?P7"?/ LiN? I ? 0 ? M =i W S L 'i ? r ) ? 1=? ? I 0. a a . U-=? ?`lu?J L?rru-ePP ?Sa"°?'e. - I SSiZ3 Lor ? -bLack Q y ? ? . ?2ar.fT_pROpF_rouTYLIPIE L-? 1- LC]T -PL AN ? , ?... ?;r ?tn t?i"" r .?K?"?•;• ? k l ....? .';:# ii ..[i_..:._ . ? . ? '. . _ ?,,,_ ....: q.<? , . . ,......, ., ? .. 2000 BIJILDING PERMIT APPLICATION (RESIDENTIAL) CITY OF EAGAN 3907Y7 3830 PILOT KNOB RD - 55122 ? 851-881-4675 > s"derea sire a„ryaya OwMng sq. n. a ia, sa. a. a?wuse and gIrooled aroOE C2O% maximum bf eovemae allowedf D 4 coPies of Pkms (ahow Deam S window sizes; Poured Ind. desipn; etc.) > ? ?t of .orgy «d«kft,. a s capies a hee presenanon plCin n la akfta aner 7nro3 DA,E: 3-- f 6- Cb DESCRIPTION OF WORK: _3t?AV\?c, - STREET ADDRESS: q 3 ? LOT: W BLOCK: 3 SUBD./P.I.D. i: PROPERN OWNER COPRRACTOR ARCHITECT/ ENGINEER ? t{ P,,? ?- w c 0d6? Name: /4 c L Phone <6-S '42" Laaf Flra1 Sheet ls? ( J Cly State: ???? Zip: SS-( z Company: Phone #: g0 c((o (area code) SELA ROOFING & REMODELING, INC. Sheet Address: City ST. LOUIS PARK, MINNESOTA 55416 State: Company: Name: Telephone Y: ( ) SheeY Address: Regisfinifon #: citY ?- ? cl . --1 `:?; 3 - 13 oo 2 copiea W plan 1 iet d energy cdcWallons fa heateC adc9HOna 1 qfe atavey ta exiador addllons R decka 4 ( 2,z 6a r 6-0 CONSiRUCTION COST: l +(' C Sfate: Sewer/water Ifcensed plumber (ff Insfaltlrw sewerhvaterf: Phone #: Zip: LP: 1 hareby acknowledye Mal I have read ihis applicatbn, sbte that the InfwmaNon ic eortect, and agree b comply wilh aQ appBCable Stale of Minnesota Statufes and City of Eagan Ordinances. Signalure of AppGcanh ? , OFFICE USE ONLY Certificates of Survey Received _ Yes No ' NiP,R ? 3 Tree Preservation Plan Received _ Yes _ No ? Not Required ucerue # l o Sd Exp.S`3(-0Tl OFFICE USE ONLY BUILDING PERMIT SUBTYPES ? 01 Foundation O 07 OS-plex ? 13 16-plex O 21 Poroh (3-sea.) , O 31 Ext Alt - Multi ? 02 SF Dwelling ? pg pg.plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) 0 33 Ext Alt- SF ? 03 01 of_ plex O 09 07-plex ? 18 Deck O 23 PorCh (screened) ? 36 MuRi. ? 04 02-plex ? 10 08-plex ? 19 Lower Level O 24 Storm Damage ? ? 05 03plex ? 11 10-plex P[tB Yor_N ? 25 Miscellaneous i; ? 06 04-plex ? 12 12-plex p 20 Pool ? 30 Accessory Bldg.; WORK TYPE ? 31 New ? 36 Move Bldg. ? 43 Reroof ? 32 Addition O 37 Demolish (Bldg)" O 44 Siding , . O 33 Alteration O 38 Demolish (Inter(or) ? 45 Fire Repair s, ? 34 Repair ? 42 Demolish (Foundation) ? 46 Windows/Door's • Give PCA handout to applicant for demolition permit GENERAL INFORMATION ? SAC Code # of Stories sq.1ft. No. of Units Length sq.lft. No. of Buildings Width Footprint sq.;ft. Const. (Actual) Basement sq. ft. Census Code;; (Allowable) Main level sq. ft. MC/ES Syste "M UBC Occupancy sq. ft. City Water II Zoning sq. ft. Booster Pump ? PRV Fire Sprinklered MISCELLANEOUS INSPECTtONS ? StuccolStone APPROVALS ' Planning Building Engineering Variance j Permit Fee Valuation: $ I' Surcharge Plan Review i License MC/ES SAC City SAC I Water Conn. Water Meter Acct. Deposit ? 5/W Permit ' S/W Suroharge Treatment PI. ; Park Ded. ? Traiis Ded. Other Copies ' r , Total: SAC Units ' % SAC ? p• L BL y, 2 CITY USE ONLY RECEIPT#: O L SUBD. isdC14yl? ? l REGEIPT DATE: ? 9I?7 1997 PLUMBING PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD - EAGAN, MN 55122 (612) 681-4678 Please complete for. . single family dwellings . townhomes and condos when permits are required for each unit ? backflow preventerfor underground sprinkler sysfem FIXTURES EACH NQ, TOTAL Shower 3.00 x = Water Closet 3.00 x = Bath Tub 3.00 z = Lavatory 3:00 x = Kitchen Sink 3.00 x = Laundry Tray 3:00 x = HnLT_ub/Spa 3.00 x - Water H eater 3.00 x ? - ? ? Floor raib n 3:00 x = Gas Piping Outlet ` minimum - 1 • 3.00 x = Rough Openings 1.50 x Water Softener ' for dwallings under wnstruction 5.00 x =. Water Softener ` for existing dwelling 20.00 x = U.G.Sprinkler `rordweuingunderconst. 3.00 U.G. Sprinkler ' Porexisting dwelling 20.00 = Alterations ' to existlng resiaence 20.00 = Water Tum Around 20.00 = Private Disposal System ` oak Cry lic. 75:00 =- (new and refurbished systems) . Private Disposal Systems' anandonment 20.00 = STATE SURCHARGE .50 ?o TOTAL a? I hereby acknowledge that I haveread this applicatlon, state thatthe: infortnatiodis coired, and:agree to oompy wiN all,applioable Ciry of Eaganordinences. It's the.applican4s responsibilily to notify the property owner that the-Cily ofEagan assumes no liebility for any demages caused by the City duringits nortnaloperatianal.and maintenance ectFrities lo ihe faalities ccnsWCtedunder this pertnk wfthin City property/rigM-of-way/easement. _ SITE ADDRESS: `? ? e f /V`9 OWNER NAME: T{ p INSTALLER NAME: STREETADDy,R,ESS: ?/ 7 ? CITY: ? ? `` LG"( iS Y/)'X' ?vy TELEPWONE STY ' ?/ 61 -f STATE: ?w' .. ZIP; SIGNATURE dF I Use BLUE or BLACK Ink r - - - - - - - - - - - - - - - - I For Office Use Permit City of Ea; as I Permit Fee. y I 3830 Pilot Knob Road I I Eagan MN 55122 Date Received: -7 Phone: (651) 675-5675 Fax: (651) 675-5694 I Staff: I I 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: ID- 3 Site Address: 3X 54r~ Ci rv 6_ Unit Name: 111 k__J44i , ~1 Phone: 4P 51 7- Owy7' Resident/ Owner Address / City / Zip: Applicant is: Owner Contractor Type of Work Description of work: ~pX e."I p+G Construction Cost: lee, Multi-Family Building: (Yes / No ) Company: r C~-E a~ w~Q Contact: (L Contractor Address: MA-14" A) 6t A City: ll~Ct,® 9y,3✓ State: Zip: 5753 Phone: --;k0K yr/? 'A-oZy License 43C- 5'1-(; V L(57 Lead Certificate AM-l-, S Q f38 ° l 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 they are trade secrets. CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 days of permit issuance. x r c, L Gc/d , 7 x Applicant's Printed Na a Applicant's Signature Page 1 of 3 PERMIT City of Eagan Permit Type:Building Permit Number:EA140210 Date Issued:12/01/2016 Permit Category:ePermit Site Address: 4381 Nybro Cir Lot:008 Block: 003 Addition: Wilderness Run 4th PID:10-84353-03-080 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 within 10 feet of all sleeping room openings in residential homes (Minnesota State 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 - Dirk W Holman 4381 Nybro Cir Eagan MN 55123 Twin City Fireplace & Stone Company 6521 Cecilia Cir Minneapolis MN 55439 (952) 232-1840 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA146846 Date Issued:11/16/2017 Permit Category:ePermit Site Address: 4381 Nybro Cir Lot:008 Block: 003 Addition: Wilderness Run 4th PID:10-84353-03-080 Use: Description: Sub Type:Residential Work Type:Replace Description:Furnace Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952) 445-2840. Please call Building Inspections at (651) 675-5675 to schedule a final inspection. Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088 Surcharge-Fixed $1.00 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 - Dirk W Holman 4381 Nybro Cir Eagan MN 55123 Robert Boldt Hvac 4310 Trenton Tr Eagan MN 55123 (651) 454-7760 Applicant/Permitee: Signature Issued By: Signature