4257 Nybro Lane N
Use BLUE or BLACK Ink
s~ I -
Fir Office Use
z t
I I
Clay of Eakan Permit
I Permit Fee: ~ I
3830 Pilot Knob Road I I
Eagan MN 55122
j Date Received:
Phone: (651) 675-5675 I
Fax: (651) 675-5694 Staff: I
I
2010 MECHANICAL PERMIT APPLICATION
Date: Site Address:
Tenant: cbbbil~_ ~ t- Suite M
RESIDENT / OWNER Name: (CIA b)[0t.) y t Phone:
Address / City / Zip: L f N L.
Name: BURNSVILLE HEATING & A/C, INC. license
CONTRACTOR 3451 W. am vl e a way
Address: Suite 120 City:
EUmsville, MN 55337
State: ZiP:
Phone.
Contact: o~ Email:
TYPE OF WORK New Replacement Additional Alteration Demolition
Description of work: '6041n. 14(-0
NOTE: Roof mounted and ground mounted mechanical equipmlen# is required to be screen edf bytity
Code. Please contac, the Mechanical (nspe~tor for information on permitted screening method;
PERMIT TYPE RESIDENTIAL COMMERCIAL
Furnace _ New Construction = Interior Improvement
Air Conditioner Install Piping Processed
Air Exchanger Gas _ Exterior HVAC Unit
_ Heat Pump _ Under / Above ground Tank L_ Install / Remove)
When installing/removing tank(s), call for inspection by Fire
Other Marshal and Plumbing Inspector
RESIDENTIAL FEES:
$50.50 Minimum Add-on or alteration to an existing unit (includes $.50 State Surcharge)
$90.50 Fire repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) $TOTAL FEE
COMMERCIAL FEES:
$70.50 Underground tank installation/removal OR Contract Value $ x1%
$50.50 Minimum (includes State Surcharge)
Permit Fee
- If Permit Fee is less than $1,000, surcharge is $.50.
- If Permit Fee is > $1,000, surcharge increases by $.50 for each Surcharge
$1,000 Permit Fee (i.e. a $1,001-$2,000 Permit Fee requires a $1.00 surcharge).
TOTAL FEE
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.orq
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 t approved plan in the case of work which requires a review and approval of plans. ~y
Applicant's Printed Name Applicant's Signature
FOR OFFICE USE Reviewed By. Dater
Required Inspections: -Under Ground Rough In -Air Test Gas Service Test In-floor Heat Final
Exterior HVAC Screening Inspection
CASH RECEIPT
• CITY. Q,F EAGAN ? P. O. BOX 21-199
EAGAN, MINNESOTA 55121
DATE
R¢CEIVBD
19
DOLLARS
1 oo
FUNO GODfi qMOUNT
l
Thank You
/
,
BY
White-Payers CopY
Yellow-Posting Copy
Pink-File Copy
,
CASH RECEIPT
~ CITY OF EAGAN
P. O. BOX 21•199
EAGAN, MINNESOTA 55121
DATE 19
wecE?vr,o , , i
FROM
AMOUNT $ I
8k DOLLARS
?oo
? CASH [3CHECK
F O R "" 1
7
FUNO CODE AMOUMT
Thank You
c'X?_D B Y
White-Payers Copy
Yellow-Posting Copy
Pink-File CoRY
CITY OF EAGAN 9362
. ' 3830 Pilct K nob Aoad, P.O. Box 21•199, Eagan, MN 55121
BUILDING PERMIT PHONE: 454-8100
i
t
R
ec p
e #
Ye be tmd fw SF UWG/Gr1R Est. Value $62,000 pat e AUGUST 1 , 19 84
Site Addresa 4 257 Nd NYBRO LN Erect a Occupency R3
Lot 6 Block 3 SeclSub. Tq ILD RUN 6TH Remadel ? Zoniny R
Parcel No. Repair ? Type of Const. V
Enlarge ? No. Stories
W Narne TTLSEN HOMES INC Move ? Length
? Address
S T.
..:... SO SI`IELLI
PAUL 6
e?--- G Demolish
98-5501 Grade ?
? Depth 26
Sq. Ft.
? i131`iE AVP?ovals
Name
0? Address Assessment
? City Phone Water & $ew.
? „r . ,-- Y .............-r Polite
Firo
En0•
Plonner
Countil
Permit
plon check _
SAC
Water Conn.
Woter AAeter
Rood Unit _
I hereby ocknowledge thot I have reud this opplicetion ond stote tFwt gldg, pf{, parks
the iniormotion is correct and ogree to comply with oli appliccble APC 7otal $Jt,827.
Stnte of Minnesoto Statutes and City of Eo9nn Ordinonces.
Var. Date
Sipnature of Permittee
n "., .,,, 1. . ,.
A Buildinq Permit is issued to: on tha txpress condition thal
oll work shotl be done in acoordqnqe with all opplicabla State of IWnnesoto Statutes ond Gty of Eapan Ordinances.
,?
9uildinq pfficial ` ? ?-
?s
Sohener
' Inspection Date I Insp. 11 Other I
Rough
inwlaeion
Firra! Plbg,
Final
l.ocatian:
VYell
Sewer
PERMIT Permit No.
CITY
q- l 3 ? V ;? „
1. Date 2. Insta
3. Joh Address
GAN
Fee '
d spaces S/C =
egibly Tot
.
Cost -f % --
'
?
Blk. Tract
! .?
' Phone > -s / - -`' " )
6. Address G / 1 C ? ? ? ? ?,???• -
7. City? State ?. Zip
8. Building Type: Residential Q? Commercial ? Institutional 0
9. Work Description: New 0 Add ? Alter O
10. Descri be
11.
Repair ?
Ty? -,- j?7 J.
No.
? E,quioment BTU - M. Ea.
Forced Air No. Equiament CFM
Air Handling:
Mfg.
Boilers E
Mfg. Mech.
xhaust
Unit Heater
Mfg, Other
Air Cond.
Mfg.
Gas, Piping Outlets
12. 1 hereby certify that the above information is true and correct, and I agree to
comply,iwith all ordinanceran odes governing his type of work.
- - - ?
Signed?,,-?? 'for
Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
Receipt PLUMBING PERMIT Permit No.
' CITY OF EAGAN
Fee
Fill in numbered spaces S/C
Type or Print legibly Tot.
?
1. Date Installation Cost ? ' -
t t ? J ?? wJ
3. Job Address - Lot Blk. _ Tract
4. Owner i `7'''
5. Contractor ?. ' f' ? 1?.?..c•?L?.fi Phone -6L`4'/
T
?,lyL Y ...
6, Address _
7. City State ' j ?,•-' Zip _%?=?
8. Building Type: Residential ? Commercial O Institutional O
9. Work Description: New ? Add ? Alter ? Repair ?
10. Describe
11,
No. Fixtures
Water Closet No. Fixtures
Cesspool/Drainfield
' Bath tubs Septic Tank
Lavatory Softner
Shower Well
' Kitchen Sink
Urinal/Bidet Other
' Laundry Tray
Floor Drains
Drinking Ftn.
Slop Sink
Gas Piping Outlets
12. 1 hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed . ? ? - -?•I ?? _ =lor
Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454$100
CITY OF EAGAN Remarks
Addition WILDERNESS RUN 6TH ADDITION Lot 6 Rlk 3 Parcel 10 84355 060 03
Owner? f -??- Street 4257 North Nvbro Lane State Eagan, Minnesota 55123
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK M.21 • 56.43 A014836 11-13-84
SEWER LATERAL
WATERMAIN
WATER LATERAL
WATER AREA 341 1977 162.14 .91' 0 -a6- 15 64.94 A014836 -$4
STORM SEW TRK • 7? 9? -? 125 . 58 A014836 11-13-84
S70RM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
Road Unit 260.00 4E45130 8-1-84
WATER CONN. 470.00 "
BUILDING PER. #9362 n
sAC 525.00 " "
PAR K a &
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE: {'" r4 `'
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55123 Date Issued:
(612) 681-4675
SITE ADDRESS: APPLICANT:
? ' ? i:; !? i ?±F,! t? ??: . :i ?•{ ? ? itr?r i
r ? f i . , , f!i , . ? flPJ t? ? i? i t. ) ? ..<? , . •.i[5
PERMIT SUBTYPE: TYPE OF WORK:
I Nr 1 10101 i)VI:kIIAMQ
)
Permlt No. Permit Holder Date Telephone #
S/W
PLUMBING
HVAC
ELECTRIC
ELECTRIC
Inspection nete Insp. Camments
Footings I
Foundation
Framing
Roofing
Rough Plbg.
Rough Htg.
Isui.
Fireplace
Final Htg.
OrsatTest
Final Plbg. Plbg. Inspector - Notily Plumber
Const. Meter
Engr./Plan
Bldg. Final
Deck Ftg.
L-
Deck Final
?
?
Well
Pr. Disp.
CITY OF EAGAN
3830 Pilot Knob Road SEWER SERVICE PERMR
P. O
Box 21199 PERMIT NO.:
.
Eagan, MN 55121 DATE:
' :j
Zoning: r.? No. of Units: ?
Owner; Tilsen Homea Inc
Addresst
Site Address: 4257 No raybro IA =,6 B3 1,:I7. ±`:t:
tllj?h's Plb?
R
Plumber: ?
f
.., 1,1 ?Izi
' ,. .
425.00 rd
1 agrea te werob with tha Ciry of Eagon Connection Charpe:
Ordinanees. Accour?t Deposit: 1J.00 PC.
Permlt Fee:
.J i!'?
Surcharge: ? p
BY Misc. Chorges:
Dute of Insp.: Totnl:
I nsp.: Dota Poid:
?
CITY OF EAGAN WATER SERVICE PERMI T
3830 Pilot Krtob Road
P. 0. Box 21199 PERMIT NO.: 13 U-2-1bi gA
Eagan, MN 55127 DATE: ?- '2 9 `;; 4
Zoning: ' No. of Units: ?
Owner, - Gt;e'.?
/lddress:
51te l4ddress• 4257 tio t'vbro Ln lf, •,' :,''
PI umber: _7'n I}? h. c p T,?
Meter No.: Connection Charge:
Si
zt:
AcGnunt Deposif: Z?'•??
?''
?
Reoder No.: Permit Fee: I.. Ca
1syroe to cawply whh !he Cify af Eaya¦ Surcharge: .50
I;`--
Ordiwasas. Mist. Chorges: G'• 0? ?c!
Toto1:
BY Dote Paid:
Date of Insp.: InsD.:
CITY OF EAGAN
3$30 Pi:ot Kneb Road
P. 0. Box 21199
Eagan, MN 55121
ZUmer: T '
?ddress: ?
?St-te Addr?A.r.e,.?{1
`?Nrnber. zr i_? r ? "=
;----
WATER SERVICE PERlIA1T
PERMIT NQ.: - - -' ?
DATE:
- No. of Units:
R ?
'#
`
0?r N `."Connection Chorge:
F?
Size• ? Acwunt Deposlt: G70.00 pd
- ?l`? ' '` ?'' "P; ? 15.00 Fc?
Rend No.: Permit Fee: 1'1.00 Pd
Isom fo ooniplp wilh 11r Ciry of Eegon Surcharge: • 5r)
Ordinanon. Miac. Chorges:
Total:
BY ate Paid:
Dote of I nsp.: ?Ig I nsp.:
RESIDENTIAL
BUILDINC PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD - 55122
851 •681-4675
NewConstruction Reauirements
• 3 registered sile surveys showing sq. it of b4 sq. fl o( Muse; an(kfl mofed areas
(20% maximum bt coverage albwed)
• 2 copies of pWn showing beam & window shes; poured found design, etc.)
• 1 set of Energy Calculations
• 3 copies of Tree Preservation Plan'rf kt platled after 7/7r83
. Rim Joisl DefaO Optlons selection sheel (bldgs wiM 3 or less uniLs)
DATE
JOB:
IF MULTI-FAMILY BUILDING, HOW MANY UNITS?
PROPERTY (
TYPE Of WC
APPLICANT
ADDRESS A
PAGER # _
CELL PHONE #
FIREPLACE(S) _ 0 _ 1 _ 2
_ PHONE#
ZIPCODE
FAX #
NEW RESIDENTIAL BUILDING ONLY- FILL OUT COMPLETELY
Energy Code cate9ory _ MINNFSOTA RULES 7670 CATEGORY 1
(check one) - Residential Ventilatlon Category 1 Woricsheet Submitted
- Energy Envelope Calculations Submitted
_ MINNESOTA RULES 7672
- New Energy Code Worksheet Submitted
Plumbing Contractor: _
Plumbing System Includes:
Mechanical Conhacior. _
Mechanical System Includes:
Sewer/Water Confractor.
_ Air Conditioning
_ Heat Recovery System
Fee: $90.00
Phone #
Fee: $70.00
Phone #
Ail above infortnation must be subrnitted prior to processing of application.
I hereby acknowledge that I have read this application, state that the informafion is corre t, and ree to comply
with all applicable State of Minnesota Statutes and Ci1y of Eagan O' ances.
Signalure oi Applicant
. <<
Certificates of Survey Received _ Tree Preservation Plan ived _ Not Required _
. . . . '. Updated 1/01
vnwaioN VO?? • ??
_ Water Softener _
_ Water Heater _
_ No. of Baths
RemodallReoairReauirements
. 2 copies o( plan
• 1 set ol Errergy Calalations Mr heated addi0ons
• 7 site wrvay (or aderbr addilbns 8 decks
. Indcate d home served Dy septic syslem for additions
Phone #:
Iawn Sprinkler
No. of R.I. Baths
OFFICE USE ONLY
O 01 Foundation
? 02 SF Dwelling
? 03 01 af _ plex
0 04 02-plex
? OS 03-plex
? 06 04-plex
O 07 OSplex ? 13 16-plex
? 08 06-plex ? 16 Fireplace
? 09 07-piex ? 17 Garage
? 10 08-plex ? 18 Deck
O 11 10.plex ? 19 Lower Level
O 12 12-plex Plbg_Y or_ N
? 20 Paol
O 21 Porch (3-sea.)
O 22 Porch/Addn. (4-sea.)
? 23 Poroh (screened)
? 24 Stortn Damage
? 25 Miscellaneous
? 30 Accessory Bldg
? 31 Ext. Alt - Multi
? 33 EM. Alt - SF
0 36 Multi
13 31 New O 35 Int Improvement 0 38 Oemolish (Interior) ? 44 Siding
? 32 Additlon ? 38 , Move Bldg. O 42 Demoiish (FOUndation) O 45 Fire Repair
0 33 Alteration ? 37 Demolish (Bldg)` 13 43 Reroof 0 46 Windows/Doors
O 34 Replacement •Demolitlon (Entire Bldg only) - Give PCA handout to applicant
Valuation
Census Code
SAC Units
Nbr. of Units
Nbr. of Bldgs
Type of Const
Occupancy MC/ES System
Zoning Cily Water
Stories Booster Pump
Sq. Ft. PRV
Length Fire Sprinklered
W idth
REQUIRED INSPECTIONS
Footings (new bldg)
Footings(deck)
Footings(addition)
Foundarion
Drain Tile
RooF _ Ice & Water _ Final _ Other
Framing _ Pool _ Ftgs _ Air/Gas Tests _ Final
Fireplace _ R.I. _ Air Test _ Final _ Siding Stucco Stone
Insulation _ Windows (new/replacement)
Approved By , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
Cily SAC
YVater Suppiy & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other '
Total
Fina]/C.O.
_ FinallNo C.O.
_ Pl?bing
HVAC
;?r: ' '
93 I,I,yt oF ?? Include 2 sets of plans,
1 site plan w/elevations &
`- BUILDING PEWTT AF'PLICATION 1 set of energy calcvlations•
, O ? Date
' 'ib He Useci.For: Valuation 2, C)O
Site Address d2S'7 Nlor}N UQ rO LII'^C OFE'ICE USE dNLY
.
"ltsect.
Block sec./sub. 4? ? M r3 OccuPancY
.
AIt2Y ZOT11IK3
Parcel
gepaiz
Fire Zone
Enlarge TYL? o£ Const. S?
Owner.
'
Nbve
# Stories
Coo ft.
pddress. Demolish Fmnt
ft.
Grade Depth
GitY/Zip Code:
Phone #:
APP FEES
CAntsactAr: -rl LS'ES Assessments
) "O?rnea a)nr-- raater/Sewer Pernu.t
Surcharge 3(.-
2-7 •?
Pddress
f ,
?.,-Eh Sv?e?1 r?l
police Plan Check
°
'
:.
-
City/ziP. Oode: ,
F?e
?iS1 \ 4? 525..
-
SAC
Water Conn.
Phone
#:• Rlanner WaterMeter 6o3. o?
`
.
° Council Z1cl?
Road vnit
:??•Y.el
Arch./Ei1s ? ?a?r ? • v?'ii'- Bldg. Off.
'Addzess:
City/2ip Code:.
?
7?'
?? SSii`3
"AL GD- 7 S-d
/ [l
Phone # :' ? 3 ??---
? .i
2??. x 4U - IG4C;? 54
G l (QC'n0
159a50•
527=OC+
4; 0 a G C r
63? (iC+
260=OCi
1827•°0t
.
CITY OF EAGAN N? 9362
+ 3830 Pilot Knob Road, P.O. Box 21•199, Eagan, MN 55121
`
PHON E:4548100
BUILDING PERMIT Receipt *
To 6a ussd for SF DWG/GAR Est. Value $62,000 Dore AUGUST 1 1984
,
SiteAtldress 42$7 NQ NYBRO LN Erect IN Occupancy• R3
Lot 6 Block 3 Sec/Suh. WILD RUN 6TH Remodel ? Zoning Rl
Parcel No. Repair ? Type of Const. V
Enlarge ? No. Stories
Neme TILSEN HOMES INC Move ? Length 60
? Address 627 SO SNELLING Demolish ? Depth 26
City ST. PAUL Phong 698-5501 Grade ? Sq.pt.
Aoororals Fees
0
=u
VS
F
Name SAME
Address
Phone
?w I Name CLAIR J. SCHUSTER
x? . Addrass 3632 GERSHWIN LN
?W City OAKDALE phone 735-2455
I hereby ackrrowledge ihat I have read this opplicotion and stote thot
the informafion is-correct and agree to Gomply with oll opplicobie
Stote ot Minnewta Starutes ond City of Engan Ordirwrxes.
Sipnature, of Permittee
A Building;Permit li'issued t? HO?S INC
otl work'shall be Eonein ac r ?th ol oppl' able aro o Mii
Buildirp Official - . ?
i
Assessment
Worer 8 Sew.
Police
Fire
Erp.
Plonner
Countil
Bldg. Off.
APC
Vaa Date _
permir '? o t ? . w
surcna.ge 31.00
Plan cfieck 159.50
SqC 525.00
Water Conn. 470.00
WoterMeter 60.00
Road Unit 260.00
Parks
Total
on the express condition lhot
$totutes und City of Eoqon Ordirwnces.
/ REQUEST FOR ELECTRICAL IN$PECTION „ ee-ooooQt.tu
See instrvc[ions for comoletmg this form m back ot Yellow capy.
A 7 ?21 X" Be/ow Work Covered by This Request -?
Add Rep. Tvoe of Buiidinu Aootiancea Wiretl Equioment Wiree ?
ex
Elec[ric
# Fea SBrvieaEntrance5ize q iee Faeders?Subfeatlers i? Fae Circuite
M UG]_ 200 qm s 0 to 30 Am s 20 . 00 0 to 30 Am s
Above 200 qm - 31 to 100 Amps 31 to 100 A s
Swimming Pool Abave 100_Am s Above 700_Amµs
Transiormers Irrigation Booms Partial•'Olher Fee
I I I Signs ?Special Inspection !5
Remarks 43.00 TOTR L? FEE
L11C1C ri311 ? y ,A/. • JV
Elacvical
:bq heraby
r thet the abpva
:tion has been
TMe reVuest rola
18 1 'd
mon hs from ??, 9 y •'/? /? ?
A 077221 ?L'!, R3 cJ;°u Ru,.?
Nequest Date Fire No. FWugh-1n Inspection
BeQU red? Insoec-
?Ready Nuw i5`Notify,
9-5-1984 X?Yes ?NO ?rwnPnAeaav
g}O-icensetl Electrical ConVactor I hereby request insoection oi ebove
? Owner electrical work installed at:
Street Address. Box or Fioute No. Ci1V
4257 NY101M&$M Nybro Lane Eagan
ecuon o. Township Name or No. anee No. Coonty
Dakota
Occuoam (PflINT) Phone No.
Tilsen Homes
Power Supplier ' Adtlress
FdSH Dakota Ct . Farmington
ElecVical Contractor (Company Name) Convactor's License No.
O.B. Thom son Rlectric Co., Inc. A40602
Mailing Address (ConVactor or Owirer Making Instailation)
12201 Mtk lvd. Mtka 55343.-.
Auffiorizetl Signature 1 o fractor Owner Making?tallat?? PM1One N`y'?b?-GnC?1
V Je?
n ?-
e1'.f"?'?1F _? .. 8
MINNESOTA STATE BOARD OF ELECTflICITY Of THIS INSPECTION REQUEST WIIL NOT
Griggs-Midwey 01de• -Room N•191 BE ACGEPTEO BY THE STATE BOANU
UNLESS PROPEP INSPECTION FEE IS
1821 University Ava., St Paul, MN 55104
o?.....e 19111 >97_911t E NC IOSED.
? ?? 0 ? I
CITY OF EAGAN PERMIT `A 'P"? '?' 0
3830 Pilot Knob Road PERMIT TYPE: B U I L D I N G
Eagan, Minnesota 55123 Permit Number: 0 2 3 4 5 5
(612) 681-4675 Date Issued: 0 4/ 2 9/ 9 4
SITE ADDRESS:
4257 NYBRO LANE N
LOT: 6 BLOCK: 3
WILDERNESS RUN 6TH
P.I.N.: 10-84355-060-03
DESCRIPTION:
(INCL ROOF OVERHANG)
B,uilding'-_Permit Type DECK
Buildirig Wark Type NEW
-?
i
i
! ?.
: -..
REMARKS
FEE SUMMARY:
Base Fee $30.00
Surcharge $.50
Total Fee $30.50
CONTRACTOR:
EAGFlN MN 55123
(612)683-2986
OWNER: - Applicant -
pEV05 MTCHAEL
4257 NYBRO LN N
I hereby acknowledge that I hsve read this
information is correct and agree to comply
Statutes and City of Eagan Ordznances.
?
T/P RMITEE SIGNATURE
application and state that the
with all applicable State of Mn.
J
Jr? 1 c( I rr,:,rf
ISSUED B : SIGI TURE
?
CITY OF EAGAN
1994 BUILDING PERMIT APPLICATION
681-4675
Pa r! 41_, - _630 •?5 0
? .; (i I.. L .....
SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy
calcs.
COMMERCIAL 2 sets of architectural & structural plans, 1 set of
specifications, 1 copy of energy calcs.
Penalty applies: 1) when permit is typed, but not picked up by last working day af month
in which request is made, 2) address is changed or 3) lot change is requested once permit
is issued.
Date 3 Valuation of work Apap. 00
Site Address: 4.1571 A-7.Rbro ..Q
STREET SUITE #
Tenant Name: (commercial only)
IAT SLOCK '7 SUBD. P.I.D. #
V? • ??-?.T 11LOD
Descri tion of work: b2c4-
The applicant is: X Owner ? Contractor ? Other (Describe)
Name Qe91eg M.-?L.? ( Phone (_ $L.-715{S
Property LAST FIRST pR3 -228c- '"b^q
Owner '
Address __`f..9-5 7 N. IVw1s?...
STREET STE #
City ? State (AN Zip 55`"
Company Phone
Co ntractor Address License # Exp.
City State Zio
Company Phone
Architect/
Engineer Name Registration #
Address '
City State Zip
Sewer & water licensed plumber Processing time for
sewer & water permits is two days once area has been approved.
I hereby acknowledge that I have read this applicatio,A? and state that the information is
correct and agree to comply with al applicabl Statk 'of Minnesota Statutes and City of
Eagan Ordinances. ?
Signature of Applicant:
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation
? 02 SF Dwg.
? 03 SF Addition
0 04 SF Porch
? 05 SF Misc.
? 06 Duplex
O 07 4-Plex
? 08 8-Plex
? 09 12-Plex
? 10 Multi. Add'1
I
?
+i"?
rw? Y:
,.,I . ,....? Mn 9,e.•?M^">?
? 16 Basement Finish
? 17 Swim Pool
? 18 Comm./Ind.
? 19 Comm./Ind. Misc.
? 20 Public Facility
? 21 Miscellaneous
? 11 Apt./Lodging
? 12 Multi. Misc.
? 13 Garage/Accessory
? 14 Fireplace
0 15 Deck
WORK TYPE ?e,k o-,J fi ,,f' of-v-r1,a»>
0 31 New ? 33 Alterations ? 35 Tenant Finish
? 32 Addition ? 34 Repair ? 36 Move
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
Planning
Engineering
REGIUIRED INSPECTIONS
?.S;te
? Wallboard
Basement sq. ft.
lst F1. sq. ft.
2nd F1. sq. ft.
Sq. Ft. total
Footprint Sq. ft.
On-site well
On-site sewage
Building
Variance
JM Footing
j7 Final
O 37 Demalish
MWCC System
City Water
PRY Required
Booster Pump
Fire Sprinkler
Census Code y?
SAC Code oi
Census Bldg /
Census Unit ?-
Assessments
0 Framing ? Insulation
? Draintile ? Fireplace
Permit Fee
Surcharge
Pla!1 Rgyjp_w
License
MWCC SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total:
vetmcta,: g I Z Od
5AC %
SAC Units
1 ?
??jy- (p , St_oclC 3
?_i,? r-?G,? n?c-AF-? R??.1 SIXTN Abh?-11o?•1
?
• ??.3,
Aft?-
'iI _ ZO1_d9
..
•1
`??
? CITY USE ONLY
L BL d- o, ?97? RECEIPT#: 9-79IS /
SUBD. RECEIPT DATE: 91499 O
1998 PLtJMBING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3630 PiLOT IQdOB RD
EAGAN, MN 55122
(612) 681-4675
Please complete for: ? single family dwellings ,
D townhomes and condos when permits are required for each unit
? backflow preventer for underground sprinkler system
FIXTURES EACH # TOTAL
Shower 3.00 x =
Water Closet 3.00 x =
Eath Tuu 3.00 x =
Lavatory 3.00 x =
Kitchen Sink 3.00 x =
Laundry Tray 3.00 x =
Hot Tub/5pa 3.00 x =
VNater Heate 3.00 x =
F oor rain 3.00 x =
Gas Piping Outlet * minimum - i 3.00 x =
Rough Openings 1.50 x =
Water Softener ' for dwellings under construction 5.00 X =
Water Softener " for existing dwelling 20.00 x =
U.G. Spfinkler ' Por tlwelling under const 3.00 =
U.G. Sprinkler "forexistingdwelling 20.00 =
Alterations ' to existing residence 20.00 =
Water Turn Around 20.00 =
Private Disposal System * MPC iic. 75.00 =
(new and refur6ished systems)
Private Disposal SyStems " Abandonment 20.00 =
RPZ (new installation only) 20.00 =
STATE SURCHARGE 50
S°
TOTAL ? ?
-- ----------by adcn-------- ---at - ---- - - - ------------ --- - --- ---- - ------ --- ----- •------------ --------- ------------
-
- . -
- City oi - Eagan -
- ordinances -
• is corteU, - and - agree - to - comply - wRh - all - applicable -
I he2owledge th I -
have read - this - application - , - state - that the infortnation -
It is the applicant's responsibility to natify the property owner that the City of Eagan assumes no liabilily for any damages caused hy the City during its
normal operetional and maintenance activities to the facilhies eonstrudetl under this pertnit wRhin Ciry propertylright-of-way/easement.
51TE ADDRESS:
OWNER NAME:
INSTALLER NAME: ?Jw ??3iCy? /<u?Q/.??? TELEPHONE #:
STREETADDRESS: ayd0
CITY: STATE: ZIP: -Ovw
?
RE
CO/PERMIT FORMSIRPLBG PERMIT (RES) - 1998
L6t.: (o ; Bt_ocK 3
y,l, LpE?2 hl?.:i R-O-?:S sl
?A Cs A N ? bA 1CQifl cOvn
.,
$(Q71K i
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?.to2r H ?
ScA Le.
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?ir iP1tF?c?yj 1 1, I Fttt «
'1'0'1'AL, ANF:A :
,Detail reference
from
'in
:10:for all othe'r
CLING:
bq. tt.
,QZ5_X sq, ft. 1040i-e& E
X sq. ft.
X sq.
s.
ft.,
X sq. ft..
_ g 'sq., . tt.
t
QZ? TOTALS ' J[?QO 0 aq? ft.Z
,
n
„ R-value
?
Mi.Ot7
;
W
(
5, ?
,
6
.
39
3t
`
'"NOTE* . If average "U" values as calculated above do not ?
.
meet the Energy.Codi
the'"Alternate Envelope Design" as outlined in SBC 6006 (g) may.be.ua
sheets may be used to show`calculations.
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w.
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ef n
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1
? I 2/84
? CITY OF EAGAN
APPLICATION FOR PERMIT
SEWER AND/OR WATER CONNECTIODI
(PIEASE PRINT)
1) PROPEf2TY ADDRESS c L X '-) --
r.Frar. DESCRZPTI .' ?-
(L ot/Slock/Subdivisi n or Tax Parcel I.D. Nunber)
iF F"{I::'--:G STRliCPUT;E , DATr, OF ORZGINAI, nliIi:L`7G P=•ffT ISSJPNC:
? l =':or.?.i ?eari
PR.Sr-._;T --•.^.`IZ-T;/PROPOS"D USr.: ?R-1 S.i dQ,E FP?,rrL`v
? R-2 DUP= (7w,'0 UNITS;
p R-3 Z9r7NEI0LJSE (TI-IE2EE + I7NIT5) ( UNITS)
? R-4 t-PARTT=/CONIX'.M1:NI[.LM ( UNITS)
? COMTKERCIAL/RETAIZ4/OFFICE
Q LML'STRTAL
? INSTITUTIONAL/GOVERU,?
2) APPLICANr
NAN1E: (PLEASE PRINT)
Y!)&E
4
CY/DRESS: s' ??• .. j? a^/ V?'--^-'"?Y??
crT^r, sraTE
zIP:
,
PHONE:
3) PLUMBER PLEASE PRINT) FOR CITY USE ONLY
NAME_ ? L.L -???i-tr, -... •
PLUMQERS LICENSE:
ADDRESS: ?' f'i? •,,?,' ? [? Active
CITY, STATE,
?n Expired
PHO?- ?-?IXSTE1i
PLUMBER LICENSE 1/ Q Hot of Record
a ni ia
4) OCCUPIN`I•/a17NER (PLEASt PNINTJ
?:
ADDRESS:
PIIONE:
5)
6) INDICATE OrE:
7) SIGIA7LJRE:
CITY, STATE, ZIP:
INDICATE WHICH PERMIT IS BEING REQUESTED:
? CONNECrION 'IC) CITY SEF7ER
CONNECPION 'IO CITY WATEFL
C] dPHQ2 (PLEASE DESCRIBE)
?
?
PLE,ASE HOLI] APPROVID PIIiMIT FOR PICK-UP BY ONE OF AB(RJE
PLE'A,S'E MAIL APPROVED PERMIT TO 1, 2, r3',-'4 AHC7VE
(c;,-,.io ,....,.)
DATE: ? '
4R?l.??i?l/?P?ll!l:?1l:atl?flll?R?j?rq?ilAII?FFI?s,'a:t?IF? , 114. . .. 'f?t?ill:i?fl#ti47?L?",;aca?w
. .. . . . . ? ?? .. . . .
F Cl R f' T T V n c? .? ,., r.. . . ..
PERMIT °- ISSUED
I I
F°ES: $
$ $
$
$
$
$
$
$
S
$
$
S
S SEWE.°. PERMIT (I:JCLUDE SUP.CHARGE)
WATER PERP4IT (INCLUDE SURCHARGE)
WATER METER/COPPERHORN/OUTSIDE READER
WATER TAP (INCLUDE CORPORATION STOP)
SEi4ER TAP
ACCOUNT DEPOSZT - SE;dER
ACCOUNT DEPOSIT - WATER
wAC
SAC
TRUNK WATER ASSESSMENT
TRUNK SEWER ASSESSMENT
LATERAL BENEFIT/TRUNK SEAlER
LATERAL BENEFIT/TRUNK WATER
OTHER
$
$ -?,lJ . ? o
TOTAL
AMOUNT PAID/RECEIPT #
DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGcIT OF WAY?
4 YES IF YES, TAEN A"PERMIT FOR WORK WITHIN
/ PUBLIC ROADWAY" MUST BE ISSUED BY THE
NO ENGINEERING DIVZSION, LIST AS A CONDI-
TION.
SUBJECT TO THE FOLLOWING CONDITIONS:
APPROVED BY; C?e_l G*j
TITLE:
DATE:
??•r?esw??ia?r??se??rE????w? ??f??i7?R?a.E?sea?Ra?c??w?w?
.. .. .. . . ?_.. ..
411? Clty of Eaian
3830 Pilot Kno6 Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
MAY ti 8 2009 ?
-----------,
Permit fk:
Permil Fee:
I,
Da[e Received:
II
I '
Stafl:
-----------------
I
2009 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: 5"=9 Site Address: "-1 25( ? M Vko i-+' `
Suite #:
RESIDENT 1 OWNER I Name:
Address / City / Zip:
CONTRACTOR I Name:
TYPE OF WORK
PERMIT TYPE
RESlOENTIAL FEES:
Address:
Phone:
License #: V! f .o:p? ,
city: 3870 00dd Rd 0140
Phone: Contact Person: ,
_ New (/{?eplapc!?
Descriotion of work: R
Fepair _ Rebuild ?
?
RESIDENT7AL
_ Water Heater
Lawn Irrigation
L_ RPZ / _ PVB)
_ Septic System
New
Abandonment
l Water Softener
Add Plumbing Fixtures
C- Main _ Lower Level)
_ Water Turnaround
Zip:
Foace Work in F.O.W.
$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 SystemAbandonment, Water Turnaround' (includes $.50 State Surcharge)
"Water Tumaround (add $165.00 ii a 5/8" me[er is required)
$100.50 Septic System New ($10.00 per as built) (includes County (ee and $.50 State Surcharge)
$90.50 Fire Repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge)
TOTAL FEES $?
I hereby acknowledge that this information is complefe and accurate; that the work will be in conformance with the ordinances and wdes of Ihe Cily of ', -
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to slart without a permit; thal the work wifl be in :?-
accordance with the approved plan in the case of work which requires a review and approval ot plans . '
X?RX ?/??? ?-°-?-_ . .," r .
App ant's Printed Name ApplicanC$ 3' ature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA115922
Date Issued:10/01/2013
Permit Category:ePermit
Site Address: 4257 Nybro Lane N
Lot:006 Block: 003 Addition: Wilderness Run 6th
PID:10-84355-03-060
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar.
Pictures are not acceptable in lieu of inspections.
Carbon monoxide detectors are required by law in ALL single family homes .
Jayme Meyers
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 -
Scott R Colbert
4257 Nybro Lane N
Eagan MN 55123
Bayport Roofing And Siding Llc
10 South 5th St, Suite 700
Minnepolis MN 55402
(612) 235-7663
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA126941
Date Issued:09/16/2014
Permit Category:ePermit
Site Address: 4257 Nybro Lane N
Lot:006 Block: 003 Addition: Wilderness Run 6th
PID:10-84355-03-060
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Heater
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.
Eric Bruckmueller
3992 Pennsylvania Avenue
Eagan, MN 55123
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 -
Scott R Colbert
4257 Nybro Lane N
Eagan MN 55123
Bruckmueller Plumbing Inc
3992 Pennsylvania Ave
Eagan MN 55123
(651) 686-6696
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA129827
Date Issued:03/17/2015
Permit Category:ePermit
Site Address: 4257 Nybro Lane N
Lot:006 Block: 003 Addition: Wilderness Run 6th
PID:10-84355-03-060
Use:
Description:
Sub Type:Siding & Windows/Doors
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of house wrap and leave on site for final inspection.
When installing ventilated soffit material, remove existing material (i.e. debris that could block vents) and take steps to
ensure maximum ventilation to attic. Call for final inspection after installation.
Valuation: 8,000.00
Fee Summary:BL - Base Fee $8K $162.25 0801.4085
Surcharge - Based on Valuation $8K $4.00 9001.2195
$166.25 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 -
Scott R Colbert
4257 Nybro Lane N
Eagan MN 55123
Spotless & Seamless Exteriors
8715 Jefferson Highway North
Osseo MN 55369
(763) 428-1111
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA139344
Date Issued:10/19/2016
Permit Category:ePermit
Site Address: 4257 Nybro Lane N
Lot:006 Block: 003 Addition: Wilderness Run 6th
PID:10-84355-03-060
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.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
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 -
Scott R Colbert
4257 Nybro Lane N
Eagan MN 55123
(763) 391-4263
Champion Plumbing
3670 Dodd Rd., #100
Eagan MN 55123
(651) 365-1340
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA164495
Date Issued:09/30/2020
Permit Category:ePermit
Site Address: 4257 Nybro Lane N
Lot:006 Block: 003 Addition: Wilderness Run 6th
PID:10-84355-03-060
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Softener
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
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 -
Scott R & Julie L Colbert
4257 Nybro Ln N
Saint Paul MN 55123--174
(651) 235-2718
Bruckmueller Plumbing Inc
3992 Pennsylvania Ave
Eagan MN 55123
(651) 686-6696
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA166741
Date Issued:02/01/2021
Permit Category:ePermit
Site Address: 4257 Nybro Lane N
Lot:006 Block: 003 Addition: Wilderness Run 6th
PID:10-84355-03-060
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Pete DeGrood at (507)
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 -
Scott R & Julie L Colbert
4257 Nybro Ln N
Saint Paul MN 55123--174
(651) 235-2718
Burnsville Heating & Air Conditioning
3451 West Burnsville Parkway, Ste. 120
Burnsville MN 55337
(952) 894-0005
Applicant/Permitee: Signature Issued By: Signature